Stok Opname BMHP 2020

1
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS :
PUSKESMAS : Rawajitu
KECAMATAN : Rawajitu selatan
KABUPATEN : TULANG BAWANG BULAN : Januari
PROPINSI : LAMPUNG TAHUN : 2017
HARGA HARGA PER PENGELU

NO NAMA OBAT SATUAN KMSN PERMINTAAN
SATUAN KEMASAN ARAN
1 2 3 4 5 6 15 19
1 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550 0
2 Alopurinol tablet 100 mg tablet 100 tablet/kotak 86 8,600 0
3 Alopurinol tablet 300 mg tablet 30 tablet/kotak 331 9,923 0
4 Alprazolam tablet 1 mg tablet 100 tablet/kotak 233 23,300 0
5 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml 3,300 3,300 0
6 Ambroxol tab 30 mg tablet 100 tablet/kotak 86 8,593 0
7 Aminofilin tablet 200mg tablet 100 tablet/kotak 80 8,000 0
8 Aminofilina injeksi 24 mg/ml ktk 30 ampul@10
ampul 4,050 121,500 0
ml
9 Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 112 11,200 0
10 Amlodipine Tablet 10 mg tablet 30 tablet/kotak 330 9,900 160
11 Amlodipine Tablet 5 mg tablet 30 tablet/kotak 187 5,610 150
12 Amoksisilin Injeksi serbuk 1000mg vial 10 vial/kotak 10,125 101,250 0
13 Amoksisilin kapsul 250 mg tablet 100 tablet/kotak 388 38,799 0
14 Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 311 31,100 0
15 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 2,445 2,445 40
16 Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak 201 20,115 0
17 Antalgin injeksi 250 mg/ml - 2 ml vial 30 vial/kotak 1,800 54,000 0
18 Antasida DOEN II suspensi komb botol botol 60 ml 2,160 2,160 50
19 Antasida DOEN tablet tablet 100 tablet/kotak 72 7,200 1,000
Anti Bakteri DOEN salep
20 tube 25 tube/kotak 2,581 62,900 0
kombinasi:Bacitracin-polymixin B krim
21 Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 2,000 20,000 0
22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 2,320 55,688 0
Asam Benzoat 6% + Asam Salisilat 3%
23 Antimalaria DOEN kombinasi tablet 100 tablet/kotak 518 51,800 0
24 Antimigren:Ergotamin Tartrat 1mg +Kofein tablet 100 tablet/botol 135 13,500 0
50mg
Antiparkinson DOEN tablet Kombinasi
25 tablet 100 tablet/kotak 1,500 150,000 0
benzerazid 25 mg levodopa 100 mg ( Levopar)
26 Aqua pro Injeksi steril, bebas pirogen vial 10 vial/kotak 7,425 74,250 0
27 Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak 29,925 179,550 0
28 Asam Askorbat (Vit C) tablet 50 mg tablet 100 tablet/kotak 95 9,500 200
29 Asam folat tablet 1 mg tablet 100 tablet/botol 84 8,400 0
30 Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 144 14,400 1,000
31 Asiklovir krim 5% tube 25 tube/kotak 4,253 101,250 0
32 Asiklovir tablet 200 mg tablet 100 tablet/kotak 524 52,404 0
33 Asiklovir tablet 400 mg tablet 100 tablet/kotak 771 77,130 70
34 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial vial 10 vial/kotak 11,070 110,700 0
35 Besi (II ) Sulfat + asam folat 0.25 tab sachet 30 tablet/sachet 2,700 2,700 0
36 Betametason krim 0,1% tube tube 1,520 1,520 30
37 Budesonid inhaler 200 mcg/puff, 100 dosis turbuhaler turbuhaler 93,000 93,000 0
(pulmicort turbuhaler)
38 Budesonid-formoterol ( fixed combination) turbuhaler turbuhaler 117,600 117,600 0
inhaler 160/4,5 mcg (symbicort
Budesonid-formoterol turbuhaler)
( fixed combination)
39 turbuhaler turbuhaler 110,500 110,500 0
inhaler 80/4,5 mcg (symbicort)
40 Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580 158,000 0
41 Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62 6,200 200
42 DHP tablet (Prog : malaria) tablet 9 tablet/kotak 3,567 32,101 0
43 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054 31,620 0
44 Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143 14,300 0
45 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 5
46 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
47 Domperidone tablet 10mg tablet 100 tablet/kotak 167 16,700 100
48 Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38 38,000 0
Epinefrina HCl/Bitartrat ( Epinefrina /
49 Adrenalina ) ampul 30 ampul/kotak 8,100 243,000 0
50 Ergakalsiferol
Injeksi 0,1% - 1(vitamin
ml D3/D2) kapsul 50000
tablet tablet 650 650 0
UI/ml (D-Vit FT)
51 Ergakalsiferol (vitamin D3/D2) suspensi 10000 botol botol 8,000 8,000 0
UI/ml (D-Vit syrup)
52 Eritromisin kapsul 250mg tablet 120 tablet/kotak 494 59,230 0
53 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
54 Etanol 70% cairan botol 100 ml/botol 2,500 2,500 20
55 FDC kategori anak paket kotak 214,990 214,990 0
56 FDC OAT Kategori I paket kotak 359,990 359,990 1
57 FDC OAT Kategori II paket kotak 1,199,900 1,199,900 0
58 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
59 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0
60 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800 54,000 0
61 Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220 22,000 0
62 Fenol Gliserol tetes telinga 10% (Karbogliserin botol 24 botol/kotak 2,042 49,008 0
10%)
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml ampul 10 ampul/kotak 4,698 46,980 0
64 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417 102,510 0
65 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634 63,400 0
66 Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829 45,725 0
67 Furosemid tablet 40 mg tablet 100 tablet/kotak 85 8,500 0
68 Garam oralit untuk 200 ml air (Prog : diare) sachet 100 sachet/kotak 292 29,200 0
69 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0
70 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
71 Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,399 16,995 0
72 Gentian Violet larutan 1 % botol botol 900 900 0
73 Glibenklamid tablet 5 mg tablet 101 tablet/kotak 56 5,600 100
74 Glimepiride tablet 2 mg tablet 50 tablet/kotak 436 21,800 0
75 Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 28 27,900 0
76 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet 1,500 1,500 0
77 Glukonas Kalsikus 10 % kotak kotak 187,200 187,200 0
78 Glukosa larutan infus 10% steril (Produk lokal) botol 500 ml/botol 5,700 5,700 0
79 Glukosa larutan infus 40% steril (Produk lokal) botol botol 1,960 1,960 0
80 Glukosa larutan infus 5% steril (Produk lokal) botol 500 ml/botol 5,200 5,200 10
81 Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 324 32,400 0
82 Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
83 Haloperidol tablet 0,5 mg tablet 100 tablet/kotak 53 5,252 100
84 Haloperidol tablet 1,5 mg tablet 100 tablet/kotak 83 8,258 100
85 Haloperidol tablet 5 mg tablet 100 tablet/kotak 88 8,823 0
86 Hidrokortison krim 2,5% tiube 24 tube/kotak 2,798 67,152 0
87 Ibuprofen sirup 100mg / 5ml botol botol 3,499 3,499 0
88 Ibuprofen suspensi 200mg / 5ml botol botol 4,499 4,499 0
89 Ibuprofen tablet 200 mg tablet 100 tablet/botol 116 11,550 0
90 Ibuprofen tablet 400 mg tablet 100 tablet/kotak 150 15,000 100
91 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 81 8,071 0
92 Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 70 7,000 200
93 Kaptopril tablet 12,5 mg tablet 100 tablet/kotak 62 6,200 0
94 Kaptopril tablet 25 mg tablet 100 tablet/kotak 84 8,400 0
95 Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243 24,300 0
96 Ketokenazol tablet 200mg tablet 50 tablet/kotak 554 27,675 0
97 Ketokonazol krim 2% tube 12 tube/kotak 4,700 56,400 0
98 Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823 182,250 0
99 Ketorolak inj 10 mg ampul 5 ampul/kotak 8,080 40,400 0
100 Natrium Diklofenac 50 mg kotak 8,700 0
101 Nistatin tablet salut 500.000 IU kotak 64,000 0
102 Ketorolak inj 30 mg ampul 6 ampul/kotak 2,300 13,800 0
103 Klindamisin 150 mg tablet 50 tablet/kotak 382 19,100 0
104 Klindamisin 300 mg tablet 50 tablet/kotak 527 26,350 0
105 Kloramfenikol kapsul 250 mg tablet 100 tablet/kotak 578 57,750 0
106 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
107 Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51 5,100 1,000
108 Klorpromasin tablet 100 mg tablet 100 tablet/kotak 149 14,900 0
109 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 ampul/kotak 1,021 30,630 0
(SK.720 : kemasan 2 ml)
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950 28,500 0
111 Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149 14,900 0
112 Kodein 10 mg tablet tablet 100 tablet/kotak 500 50,000 0
113 Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190 40
200mg + Trimetoprim 40 mg
114 Kotrimoksazol tablet komb: Sulfametoksazol tablet 100 tablet/kotak 138 13,800 200
115 Lansoprazol inj 30 mg/ml ampul 1 ampul/kotak 82,042 82,042 0
Larutan mengandung karbohidrat + elektrolit
116 (NaCl 1,75 gr. Na Lactat 2,24 gr. KCl 1.5 botol botol 10,000 10,000 0
gr.Dextrosa
117 (NaCl 27 Na
2,34 gr. gr) Lactat
/ KA EN 3Bgr. KCl 0.75 gr.
2,24 botol botol 10,000 10,000 0
118 Dextrosa
Lidokain 27
Inj gr)
2 %/ KA EN 3A ampul 30 ampul/kotak 1,333 40,000 0
119 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak 2,078 20,780 0
120 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 2,629 26,290 0
121 Mebendazol tablet 100 mg tablet 30 tablet/kotak 228 6,840 0
122 Metilergometrin Maleat (Metilergometrin) tab tablet 100 tablet/kotak 154 15,400 0
salut 0,125 mg
123 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 ampul/kotak 2,175 65,250 0
124 Metilprednisolon tablet 16 mg tablet 30 tablet/kotak 635 19,050 0
125 Metilprednisolon tablet 8 mg tablet 100 tablet/kotak 300 30,000 0
126 Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070 20,700 0
127 Metoklopramid 5 mg tablet 100 tablet/kotak 110 11,000 0
128 Metronidazol Infus 500mg/100ml botol botol 100 ml 39,825 39,825 0
129 Metronidazol supositoria 500 mg ( flagyl) suppositoria suppositoria 3,220 3,220 0
130 Metronidazol tablet 250 mg tablet 100 tablet/kotak 193 19,305 0
131 Metronidazol tablet 500 mg tablet kotak 160 16,000 200
132 Mikonazol krim/ salep 2 % tube tube 3,000 3,000 3
133 Mineral mix (Prog. Gizi) sachet 40 sachet/kotak 2,450 98,000 560
134 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200 0
135 Natrium Diklofenac 50 mg tablet 50 tablet/kotak 200 10,000 100
136 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
137 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0
(Produk lokal)
138 Hidrokortison krim 2,5% tube 24 tube/kotak 2,979 71,500 0
139 Natrium Tiroksin tablet 100 mcg tablet tablet 1,694 1,694 0
140 Nifedipin tablet 10mg tablet kotak 129 12,900 0
141 Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 640 64,000 0
142 Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak 2,618 78,540 0
143 Nystatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 480 47,960 0
144 Obat Batuk Hitam botol botol 5,500 5,500 0
145 Ofloxacin 200 mg Tab Salut Selulose tablet 100 tablet/kotak 207 20,650 0
146 Ofloxacin 400 mg Tab Salut Selulose tablet 100 tablet/kotak 327 32,700 0
147 Oksimetazolin tetes hidung 0,025% (ilaidin botol botol 27,550 27,550 0
drop)
148 Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 1,600 40,000 0
149 Oksitosin injeksi 10IU/ml-1ml ampul 10 ampul/kotak 2,200 22,000 0
150 Omeprazol kapsul 20mg tablet 30 tablet/kotak 211 6,330 0
151 ondansetron tablet 4 mg tablet 30 tablet/kotak 716 21,480 0
152 ondansetron tablet 8 mg tablet 30 tablet/kotak 1,189 35,670 0
153 Ondansetron inj 4 mg/ 2 ml ampul ampul 2,400 2,400 0
154 Papaverin tablet 40mg tablet 100 tablet/kotak 119 11,900 0
155 Paracetamol drop 100 mg/ml botol botol 5,200 5,200 0
156 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,438 1,438 60
157 Parasetamol tablet 500 mg tablet 100 tablet/kotak 79 7,900 3,000
158 Piracetam 400 mg Tablet tablet 100 tablet/kotak 609 60,885 0
159 Piracetam 800 mg kapsul tablet 100 tablet/kotak 1,084 108,405 0
160 Piracetam inj 1 gr/ 5 ml ampul 10 ampul/kotak 7,425 74,250 0
161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
162 Pirantel tablet 125 mg tablet 30 tablet/kotak 420 12,595 0
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 110 11,000 100
164 Piroksikam 20 mg tablet 100 tablet/kotak 105 10,500 0
165 Povidon Iodida larutan 10% botol botol 30 ml 2,163 2,163 3
167 Prednisone tablet 5 mg tablet 100 tablet/kotak 114 11,400 0
168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400 0
169 Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404 40,442 0
170 Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 3,614 86,738 0
171 Ranitidin tablet 150 mg tablet 100 kaplet/kotak 120 12,000 100
172 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 50 kapsul/botol 460 23,000 0
173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 50 kapsul/botol 260 13,000 0
174 Ringer Laktat larutan infus steril botol botol 500 ml 5,200 5,200 0
175 Salbutamol 2 mg tablet 100 tablet/kotak 59 5,900 0
176 Salbutamol 4 mg tablet 100 tablet/kotak 97 9,749 0
Salbutamol inshalasi/ aerosol 100 mcg/dosis
177 Botol Botol 63,750 63,750 0
(ventolin inheler)
178 Salbutamol inshalasi/ aerosol 200 mcg/kaps kapsul kapsul 431 431 0
(ventolin rotacaps)
179 Salbutamol inshalasi/ aerosol 200 mcg/rotahaler rotahaler rotahaler 5,867 5,867 0
(ventolin rotaheler)
180 Salep 2-4 Komb : As Salisilat 2 % + Belerang pot pot 2,000 2,000 0
endap 2 %
181 Salisil Bedak 2% kotak kotak 1,250 1,250 0
182 Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855 25,650 0
183 Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042 52,100 0
184 sefadroksil sirup kering 125mg/5ml botol botol 4,896 4,896 15
185 Sefotaksim inj 1 gr vial 2 vial/kotak 6,050 12,100 0
186 Sefriakson serbuk injeksi 1 g/vial vial vial 11,000 11,000 0
187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial @ 5 ml 47,300 473,000 0
(ABU I)
188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul
Dus, 10 ampul @ 1
12,600 126,000 0
(A.T.S) ml
189 Setrizin tablet 10 mg tablet 100 tablet/kotak 181 18,100 100
190 Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 ampul/kotak 916 91,600 0
191 Simetidin tablet 200 mg tablet 100 tablet/kotak 111 11,100 0
192 Simvastatin tablet 10 mg tablet 50 tablet/kotak 693 34,628 0
193 Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 255 25,500 0
194 Sulfadoxine Pyrimethamine 525 mg tablet tablet 100 tablet/kotak 478 47,800 0
195 Tablet Tambah Darah sachet 30 tablet/sachet 1,260 1,260 0
196 Terbutalin sulfat (Molasma) tablet 2,5 mg tablet 50 tablet/kotak 99 4,950 0
197 Terbutalin turbu (serbuk ih) 0,50 mg (bricasma turbuhaler turbuhaler 71,100 71,100 0
turbuhaler 0,5mg)
198 Tetrasiklin HCl kapsul 250 mg kaplet 100 kaplet/kotak 149 14,900 0
199 Tetrasiklin HCl kapsul 500 mg kaplet 100 kaplet/kotak 257 25,700 0
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak 690 20,700 0
201 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tablet 1000 tablet/botol 38 37,800 0
202 Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400 27,000 0
203 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 40 4,000 0
204 Vaksin Rabies Vero - Rabipur Dus, 1 vial @ 1
vial 78,500 78,500 0
dosis + syringe
205 Vitamin B komplek tablet tablet 100 tablet/kotak 108 10,700 200
206 zinc drop 10 mg/ ml botol botol 12,840 12,840 0
207 Zinc sirup 10 mg/ml botol botol 14,980 14,980 0
208 Zinc Tab 20 mg tablet 100 tablet/kotak 474 47,400 0
0
PERBEKALAN KESEHATAN 0
209 Alat suntik sekali pakai 0,5 ml pcs kotak/ 100 psc 2,140 214,000 0
210 Alat suntik sekali pakai 1 ml pcs kotak/ 100 psc 650 65,000 0
213 Alkohol Swab pcs kotak/ 100 psc 216 21,560 0
214 Aqua bides 20 liter galon galon 174,000 174,000 0
Catgut / benang bedah no 2/0 dengan jarum
215 pcs 24pcs/kotak 26,667 640,000 0
bedah
216 Catgut / beneng bedah no 3/0 dengan jarum pcs 24psc/kotal 23,299 559,176 20
bedah
217 Cut gut chromic 3/0 pcs 24 pcs/kotak 5,583 134,000 0
218 Elastis Perban 75 Fesco roll roll 17,160 17,160 0
219 Exell tulle pcs kotak / psc 14,014 14,014 0
220 Foley cateter pcs pcs 8,495 8,495 0
221 Handscoon uk 7 pcs kotak 5,267 5,267 0
223 Hidrogen Peroksida (H2 O2) 10% botol botol 800 ml 30,238 30,238 0
224 Infus set anak set 50 set/kotak 16,500 82,500 0
225 Infus set dewasa set 50 set/kotak 6,785 339,250 0
226 IV Catheter No. 22 G set 50 set/kotak 7,700 385,000 0
228 IV Chateter No 20 G set 50 set/kotak 7,700 385,000 3
229 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 7,500 7,500 0
230 Kasa Pembalut Elastic 3 inchi pcs psc 7,000 7,000 0
232 Kasa Pembalut Hidrofil 36 x 80 cm Rol Rol 55,200 55,200 0
233 Kasa Pembalut Hidrofil 4 m x 10 roll roll 30,350 30,350 0
234 Kasa Pembalut Hidrofil 4 m x 5 cm roll roll 30,350 30,350 0
235 Kassa Hidrofil steril uk. 16x16 (surya husada) pcs 16 lembar/kotak 363 5,800 5
236 Kassa Hidrofil steril uk. 18x22 (isi 12 lembar) pcs 12 lembar/kotak 396 4,750 0
237 Kassa kompres steril 40 x 40 cm Pcs Pcs 1,600 1,600 0
238 Kertas Puyer pack ball/ 10 pack 6,402 64,020 0
239 Klip Plastik 10 x 7 KP pack ball/ 10 pack 7,682 76,820 5
240 Klip Plastik 13x8,7 KP pack ball/ 10 pack 11,204 114,000 5
241 Lisorin 1liter botol botol 18,865 18,865 1
242 Masker pcs 50 pcs/kotak 1,125 56,250 100
243 Pembalut Gibs 3 inchi rol rol 23,500 23,500 0
244 Plester 5 yard x 2 inch Rol Rol 23,625 23,625 0
245 Silk ( Benang Bedah Sutera ) No. 3/0 dg jarum pcs 36pcs/kotak 14,316 515,376 4
bedah
246 Sterobat nf. 400ml botol botol 78,000 78,000 0
247 Strip gula 50 strip (blonime) box box 464,000 464,000 0
248 Umbilical cord nylon one med (Klem tali pusat) pcs kotak/ 50 psc 1,940 97,020 160
249 Under Pet pcs 10 pcs/kotak 5,390 53,900 0
250 Urine Bag Pcs Pcs 4,000 4,000 0
251 Wing Needle No. 21 G Pcs kotak/ 100 psc 5,770 577,000 0
0
0BAT GIGI 0
255 Devitalisasi Pasta (Non Arsen) kotak kotak 390,000 390,000 0
256 Etil klorida spray botol botol 146,300 146,300 2
257 Glass Ionomer Cement (GC IX) ART botol botol 395,000 395,000 0
258 Kalsium Hidroksida Pasta kotak kotak 242,000 242,000 0
259 Klorfenol Kamfer Mentol (CHKM) botol botol 55,000 55,000 0
260 Mummifying Pasta kotak kotak 176,000 176,000 0
261 Semen Seng Fosfat serbuk dan cairan botol botol 93,500 93,500 0
262 Temporary Stopping Fletcher (Fletcher) serbuk botol botol 34,000 34,000 0
& cairan
0
OBAT DENGAN NAMA DAGANG 0
263 Armovit Kapsul kapsul 30 kapsul/kotak 1,537 46,100 0

264 Asifit kapsul 30 kapsul/kotak 1,818 54,540 0
265 Betason-N krim Tube 24 tube/kotak 9,182 220,368 0
266 Bioneuron Injeksi ampul Kotak 5 Ampul 4,341 21,705 0
267 Bionick botol 60 ml/botol 16,000 16,000 0
268 Bionick drop botol 15 ml/botol 22,500 22,500 0
269 Blonick Plus Syr Botol Botol 18,700 18,700 0
270 Chlorampecort Cr Tube Tube 10 gr 9,085 9,085 0
271 Diapecta Tablet 100 tablet/kotak 384 38,400 0
272 Febrinex Suspensi Botol Botol 15,855 15,855 0
273 Fercee Tablet 100 tablet/kotak 1,044 104,400 0
274 Fituno Tablet 30 kaplet/kotak 3,273 98,190 0
275 Fludane plus syr 60 ml botol botol 60 ml 15,950 15,950 0
276 Flutamol Sirup botol 60 mL/botol 13,500 13,500 0
277 Hustab Tablet 10 tablet/strip 284 2,840 0
278 Lybex sirup botol botol 60 ml 19,800 19,800 0
279 Mersibion inj ampul 10 ampul/kotak 4,400 44,000 0
280 Neorodial kaplet 100 kaplet/kotak 1,091 109,100 0
281 Neurovit-E Tablet 60 tablet/kotak 818 49,080 0
282 Noza Tablet 4 tablet/strip 399 1,596 0
283 Poncobex Tablet kotak 100 tablet 1,353 135,300 0
284 Ponflu Tablet kotak 100 tablet 935 93,500 0
285 Progastric Tablet 10 tablet/strip 303 3,030 0
286 Ramaton Tablet 100 tablet/kotak 698 69,800 0
287 Scabicid Cream Tube Tube 10 gr 28,380 28,380 0
288 Siobio kapsul kotak 100 kapsul 946 94,600 0
289 Kasa Pembalut Hidrofil 36 x 80 cm rol rol 140,337 140,337 0
(AHMADARIS)
290 Master Plast Plastik 1 inc (plester) roll roll 27,088 27,088 0
0
OBAT TAMBAHAN 0
291 0
292 0
293 0
294 0
295 0
296 0
297 0
298 0
299 0
300 0
301 0
0
UMUM
JUMLAH KUNJUNGAN RESEP TIDAK BAYAR
BAYAR
PBI PUSAT PBI DAERAH NON PBI
Mengetahui/Menyetujui :
Kepala puskesmas Rawajitu Petugas Gudang Farmasi
Puskesmas Rawajitu
Baidullah S.siagian Endang Sulastri Amd.Keb

NIP.196901241989021001 NIP.197202191992032001
2
KODE PUSKESMAS :
KABUPATEN : TULANG BAWANG BULAN : Februari
PROPINSI : LAMPUNG TAHUN : 2017
PEMAKAIA
STOK AKHIR
HARGA HARGA PER PENGELUAR STOK N RATA-
NO NAMA OBAT SATUAN KMSN PERSEDIAAN DALAM
SATUAN KEMASAN AN AKHIR RATA S/D
RUPIAH
BULAN INI
1 2 3 4
24 5 6 14 15 16 17 18
1 ACT (Artesunat + Amodiaquin ) tablet tablet tab/Kota 1,856 44,550 0 0 0 0 0
100
2 Alopurinol tablet 100 mg tablet k
tablet/ko 86 8,600 0 0 0 0 0
30
3 Alopurinol tablet 300 mg tak
tablet tablet/ko 331 9,923 0 0 0 0 0
100
4 Alprazolam tablet 1 mg tak
tablet tablet/ko 233 23,300 0 0 0 0 0
5 Ambroxol sirup 15 mg/ 5 ml botol
tak 60
botol 100 3,300 3,300 0 0 0 0 0
ml
6 Ambroxol tab 30 mg tablet tablet/ko 86 8,593 0 0 0 0 0
100
7 Aminofilin tablet 200mg tak
tablet tablet/ko 80 8,000 0 0 0 0 0
ktk 30
8 Aminofilina injeksi 24 mg/ml tak
ampul ampul@ 4,050 121,500 0 0 0 0 0
100
10 ml
9 Amitriptillin tablet salut 25 mg tablet tablet/ko 112 11,200 100 0 100 11,200 0
30
10 Amlodipine Tablet 10 mg tak
tablet tablet/ko 330 9,900 600 100 500 165,000 100
30
tablet tablet/ko 187 5,610 550 100 450 84,150 100
10
12 Amoksisilin Injeksi serbuk 1000mg tak
vial vial/kota 10,125 101,250 0 0 0 0 0
100
k
13 Amoksisilin kapsul 250 mg tablet tablet/ko 388 38,799 0 0 0 0 0
100
tak
14 Amoksisilin kapsul 500 mg tablet tablet/ko 311 31,100 0 0 0 0 0
15 Amoksisilin sirup kering 125 mg/ 5 ml tak 60
botol
botol 2,445 2,445 70 40 30 73,350 40
100
ml
16 Antalgin (Metampiron) tablet 500 mg tablet tablet/ko 201 20,115 0 0 0 0 0
30
17 Antalgin injeksi 250 mg/ml - 2 ml tak
vial vial/kota 1,800 54,000 0 0 0 0 0
18 Antasida DOEN II suspensi komb botol
k 60
botol 100 2,160 2,160 240 50 190 410,400 50
ml
19 Antasida DOEN tablet tablet tablet/ko 72 7,200 2,000 500 1,500 108,000 500
25
Anti Bakteri DOEN salep tak
20 tube tube/kot
10 2,581 62,900 0 0 0 0 0
kombinasi:Bacitracin-polymixin B krim
21 Anti Hemoroid DOEN Kombinasi ak
supp supp/kot 2,000 20,000 0 0 0 0 0
24
22 Antifungi DOEN Kombinasi: pot ak
pot/kota 2,320 55,688 0 0 0 0 0
Asam Benzoat 6% + Asam Salisilat 3% 100
23 Antimalaria DOEN kombinasi k
tablet tablet/ko 518 51,800 0 0 0 0 0
100
tak
24 Antimigren:Ergotamin Tartrat 1mg tablet tablet/bo 135 13,500 0 0 0 0 0
Antiparkinson
+Kofein 50mg DOEN tablet Kombinasi 100
25 benzerazid 25 mg levodopa 100 mg tol
tablet tablet/ko 1,500 150,000 0 0 0 0 0
10
26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen tak
vial vial/kota 7,425 74,250 0 0 0 0 0
6
27 Arthemeter injeksi 1 ml : 80 mg k
ampul ampul/k 29,925 179,550 0 0 0 0 0
100
28 Asam Askorbat (Vit C) tablet 50 mg otak
tablet tablet/ko 95 9,500 100 100 0 0 100
100
29 Asam folat tablet 1 mg tak
tablet tablet/bo 84 8,400 0 0 0 0 0
100
30 Asam Mefenamat tablet 500 mg tol
tablet tablet/ko
25 144 14,400 1,000 500 500 72,000 500
31 Asiklovir krim 5% tak
tube tube/kot 4,253 101,250 0 0 0 0 0
100
32 Asiklovir tablet 200 mg ak
tablet tablet/ko 524 52,404 0 0 0 0 0
100
33 Asiklovir tablet 400 mg tak
tablet tablet/ko 771 77,130 100 70 30 23,130 70
10
34 Benzatin Benzil Penicillin injeksi 1,2 jt tak
vial vial/kota
30 11,070 110,700 0 0 0 0 0
IU/vial
35 Besi (II ) Sulfat + asam folat 0.25 tab k
sachet tablet/sa 2,700 2,700 0 0 0 0 0
36 Betametason krim 0,1% chet
tube tube 1,520 1,520 100 30 70 106,400 30
37 Budesonid inhaler 200 mcg/puff, 100 turbuhale turbuhal 93,000 93,000 0 0 0 0 0
Budesonid-formoterol ( fixed
dosis (pulmicort turbuhaler)
38 combination) inhaler 160/4,5 mcg r
turbuhale er
turbuhal 117,600 117,600 0 0 0 0 0
39 (symbicort turbuhaler)
combination) inhaler 80/4,5 mcg r er
turbuhale turbuhal 110,500 110,500 0 0 0 0 0
100
(symbicort)
40 Deksametason injeksi 5mg.ml-1ml r er
ampul ampul/k
100 1,580 158,000 0 0 0 0 0
41 Deksametason tablet 0,5 mg otak
tablet tablet/ko 62 6,200 100 100 0 0 100
9
42 DHP tablet (Prog : malaria) tak
tablet tablet/ko 3,567 32,101 0 0 0 0 0
30
tak
43 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul ampul/k 1,054 31,620 0 0 0 0 0
100
otak
44 Digoksin tablet 0,25 mg tablet tablet/ko 143 14,300 0 0 0 0 0
45 Domperidon suspensi/sirup 5 mg/5ml tak
botol botol 3,333 3,333 0 0 0 0 0
46 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0 0 0 0 0
100
47 Domperidone tablet 10mg tablet tablet/ko 167 16,700 0 0 0 0 0
1000
tak
48 Ekstrak Belladon tablet 10 mg tablet tablet/bo 38 38,000 0 0 0 0 0
Epinefrina HCl/Bitartrat ( Epinefrina / 30
49 Adrenalina ) tol
ampul ampul/k 8,100 243,000 0 0 0 0 0
50 Ergakalsiferol
ml D3/D2) kapsul
tablet
otak
tablet 650 650 0 0 0 0 0
50000 UI/ml (D-Vit FT)
51 Ergakalsiferol (vitamin D3/D2) suspensi botol botol 8,000 8,000 0 0 0 0 0
10000 UI/ml (D-Vit syrup) 120
52 Eritromisin kapsul 250mg tablet tablet/ko 494 59,230 0 0 0 0 0
53 Eritromisin sirup 200mg/5ml tak
botol botol 7,220 7,220 0 0 0 0 0
54 Etanol 70% cairan 100
botol 2,500 2,500 80 20 60 150,000 20
ml/botol
55 FDC kategori anak paket kotak 214,990 214,990 3 0 3 644,970 0
56 FDC OAT Kategori I paket kotak 359,990 359,990 1 1 0 0 1
57 FDC OAT Kategori II paket kotak 1,199,900 1,199,900 8 0 8 9,599,200 0
58 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0 0 0 0 0
59 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0 0 0 0 0
30
60 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul ampul/k 1,800 54,000 0 0 0 0 0
100
otak
61 Fenobarbital tablet 100 mg tablet tablet/ko 220 22,000 0 0 0 0 0
24
62 Fenol Gliserol tetes telinga 10% botol tak
botol/ko 2,042 49,008 0 0 0 0 0
(Karbogliserin 10%) 10
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul tak
ampul/k 4,698 46,980 0 0 0 0 0
1 ml 30
64 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul otak
ampul/k 3,417 102,510 0 0 0 0 0
100
65 Fitomenadion (Vit.K1)tab salut gula 10 tablet
otak
tablet/bo 634 63,400 0 0 0 0 0
mg 25
66 Furosemid inj 40 mg/ml tol
ampul ampul/k
100 1,829 45,725 0 0 0 0 0
67 Furosemid tablet 40 mg tablet otak
tablet/ko 85 8,500 0 0 0 0 0
100
Garam oralit untuk 200 ml air (Prog : tak
68 sachet sachet/k 292 29,200 0 0 0 0 0
diare)
69 Gentamicin salep mata 0,3 % (genoint ) tube otak
tube 2,600 2,600 0 0 0 0 0
70 Gentamicin tetes mata 0,3 % (genoint ) 5
botol 5 3,194 3,194 0 0 0 0 0
ml/botol
71 Gentamisin injeksi 40 mg/ml ampul ampul/k 3,399 16,995 0 0 0 0 0
72 Gentian Violet larutan 1 % otak
botol botol 900 900 0 0 0 0 0
101
73 Glibenklamid tablet 5 mg tablet tablet/ko 56 5,600 0 0 0 0 0
50
74 Glimepiride tablet 2 mg tak
tablet tablet/ko
1000 436 21,800 0 0 0 0 0
75 Gliseril Guayacolat tablet 100 mg tablet tak
tablet/bo 28 27,900 0 0 0 0 0
76 Gliseril trinitrat tab sublingual 0,5mg tablet tol
tablet 1,500 1,500 0 0 0 0 0
(nitral)
77 Glukonas Kalsikus 10 % kotak kotak 187,200 187,200 0 0 0 0 0
78 Glukosa larutan infus 10% steril (Produk botol
500
5,700 5,700 0 0 0 0 0
lokal) ml/botol
79 Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960 0 0 0 0 0
lokal)
500
5,200 5,200 30 10 20 104,000 10
lokal) 100
ml/botol
81 Griseofulvin tablet 125 mg, micronized tablet tablet/ko 324 32,400 0 0 0 0 0
82 Haloperidol inj 50 mg/ml (haldol tak
ampul ampul 83,333 83,333 0 0 0 0 0
decanoas) 100
83 Haloperidol tablet 0,5 mg tablet tablet/ko 53 5,252 1,400 100 1,300 68,276 100
100
tak
84 Haloperidol tablet 1,5 mg tablet tablet/ko 83 8,258 1,400 100 1,300 107,354 100
100
tak
85 Haloperidol tablet 5 mg tablet tablet/ko 88 8,823 0 0 0 0 0
24
86 Hidrokortison krim 2,5% tak
tiube tube/kot 2,798 67,152 0 0 0 0 0
87 Ibuprofen sirup 100mg / 5ml ak
botol botol 3,499 3,499 0 0 0 0 0
88 Ibuprofen suspensi 200mg / 5ml botol botol 4,499 4,499 0 0 0 0 0
100
89 Ibuprofen tablet 200 mg tablet tablet/bo 116 11,550 0 0 0 0 0
100
90 Ibuprofen tablet 400 mg tol
tablet tablet/ko 150 15,000 0 0 0 0 0
100
tak
91 Isosorbid Dinitrat tablet sublingual 5 mg tablet tablet/ko 81 8,071 0 0 0 0 0
100
92 Kalsium Laktat tab 500 mg tak
tablet tablet/ko 70 7,000 2,800 200 2,600 182,000 200
100
tak
93 Kaptopril tablet 12,5 mg tablet tablet/ko 62 6,200 0 0 0 0 0
100
tak
94 Kaptopril tablet 25 mg tablet tablet/ko 84 8,400 0 0 0 0 0
100
95 Karbamazepin tablet 200 mg tak
tablet tablet/ko
50 243 24,300 0 0 0 0 0
96 Ketokenazol tablet 200mg tak
tablet tablet/ko 554 27,675 0 0 0 0 0
12
tak
97 Ketokonazol krim 2% tube tube/kot 4,700 56,400 0 0 0 0 0
100
ak
98 Ketoprofen tablet 100 mg tablet tablet/ko 1,823 182,250 0 0 0 0 0
5
99 Ketorolak inj 10 mg tak
ampul ampul/k 8,080 40,400 0 0 0 0 0
100 Natrium Diklofenac 50 mg kotak otak 8,700 0 0 0 0 0
101 Nistatin tablet salut 500.000 IU kotak 64,000 0 0 0 0 0
6
102 Ketorolak inj 30 mg ampul ampul/k 2,300 13,800 0 0 0 0 0
50
103 Klindamisin 150 mg otak
tablet tablet/ko 382 19,100 0 0 0 0 0
50
104 Klindamisin 300 mg tak
tablet tablet/ko 527 26,350 0 0 0 0 0
100
105 Kloramfenikol kapsul 250 mg tak
tablet tablet/ko 578 57,750 0 0 0 0 0
106 Kloramfenikol tetes telinga 3% tak
botol botol 1,599 1,599 0 0 0 0 0
100
107 Klorfeniramin Maleat (CTM) tablet tablet tablet/ko 51 5,100 2,800 1,000 1,800 91,800 1,000
100
108 Klorpromasin tablet 100 mg tak
tablet tablet/ko 149 14,900 0 0 0 0 0
30
109 Klorpromazin HCl injeksi 25 mg/ml - 1 tak
ampul ampul/k 1,021 30,630 0 0 0 0 0
ml (SK.720 : kemasan 2 ml)
otak
30
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul ampul/k 950 28,500 0 0 0 0 0
100
111 Klorpromazin HCl tablet salut 100 mg otak
tablet tablet/ko 149 14,900 100 0 100 14,900 0
100
112 Kodein 10 mg tablet tak
Kotrimoksazol Susp komb: tablet tablet/ko 500 50,000 0 0 0 0 0
113 Sulfametoksazol 200mg + Trimetoprim 40 botol botol
tak 60
Kotrimoksazol tablet komb: 100 2,190 2,190 70 40 30 65,700 40
ml
mg
114 Sulfametoksazol 400mg + Trimetoprim 80 tablet tablet/ko 138 13,800 500 200 300 41,400 200
1
115 mg
Lansoprazol inj 30 mg/ml ampul
tak
ampul/k 82,042 82,042 0 0 0 0 0
Larutan mengandung karbohidrat +
116 elektrolit (NaCl 1,75 gr. Na Lactat 2,24 gr. botol otak
botol 10,000 10,000 0 0 0 0 0
KCl 1.5 gr.Dextrosa
117 elektrolit 27 gr)
(NaCl 2,34 gr. Na /Lactat
KA EN 3Bgr. botol
2,24 botol 10,000 10,000 0 0 0 0 0
30
KCl 0.75inj
118 Lidokain gr.2Dextrosa
% 27 gr) / KA EN 3A ampul ampul/k 1,333 40,000 0 0 0 0 0
10
119 Magnesium Sulfat inj (IV) 20% - 25 ml otak
vial vial/kota 2,078 20,780 0 0 0 0 0
10
120 Magnesium Sulfat inj (IV) 40% - 25 ml k
vial vial/kota 2,629 26,290 0 0 0 0 0
30
121 Mebendazol tablet 100 mg k
tablet tablet/ko 228 6,840 0 0 0 0 0
100
122 Metilergometrin Maleat (Metilergometrin) tak
tablet tablet/ko 154 15,400 0 0 0 0 0
tab salut 0,125 mg 30
123 Metilergometrin Maleat inj 0,200 mg-1 tak
ampul ampul/k 2,175 65,250 0 0 0 0 0
ml 30
124 Metilprednisolon tablet 16 mg otak
tablet tablet/ko
100 635 19,050 0 0 0 0 0
125 Metilprednisolon tablet 8 mg tak
tablet tablet/ko 300 30,000 0 0 0 0 0
10
126 Metoklopramid inj 5 mg/ml tak
ampul ampul/k 2,070 20,700 0 0 0 0 0
100
127 Metoklopramid 5 mg otak
tablet tablet/ko 110 11,000 0 0 0 0 0
128 Metronidazol Infus 500mg/100ml botol
tak
botol 39,825 39,825 0 0 0 0 0
100 ml
129 Metronidazol supositoria 500 mg ( flagyl) supposito supposit 3,220 3,220 0 0 0 0 0
100
130 Metronidazol tablet 250 mg ria
tablet oria
tablet/ko 193 19,305 0 0 0 0 0
131 Metronidazol tablet 500 mg tablet tak
kotak 160 16,000 100 100 0 0 100
132 Mikonazol krim/ salep 2 % tube tube
40 3,000 3,000 2 2 0 0 2
133 Mineral mix (Prog. Gizi) sachet sachet/k 2,450 98,000 0 0 0 0 0
134 Natrium Bikarbonat inj i.v 8,4% (meylon) otak
ampul ampul 6,200 6,200 0 0 0 0 0
50
135 Natrium Diklofenac 50 mg tablet tablet/ko 200 10,000 100 100 0 0 100
136 Natrium Diklofenak 25 mg tablet tak
kotak 174 8,700 0 0 0 0 0
137 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0 0 0 0 0
(Produk lokal) 24
138 Hidrokortison krim 2,5% tube tube/kot 2,979 71,500 0 0 0 0 0
139 Natrium Tiroksin tablet 100 mcg tablet ak
tablet 1,694 1,694 0 0 0 0 0
140 Nifedipin tablet 10mg tablet kotak 129 12,900 0 0 0 0 0
100
141 Nistatin tablet salut 500.000 IU tablet tablet/ko 640 64,000 0 0 0 0 0
30
142 Noretisteron tablet 5 mg (Primolut N) tak
tablet tablet/ko 2,618 78,540 0 0 0 0 0
100
143 Nystatin vaginal tablet 100.000 UI tak
tablet tablet/ko 480 47,960 0 0 0 0 0
144 Obat Batuk Hitam botol tak
botol 5,500 5,500 0 0 0 0 0
100
145 Ofloxacin 200 mg Tab Salut Selulose tablet tablet/ko 207 20,650 0 0 0 0 0
100
146 Ofloxacin 400 mg Tab Salut Selulose tak
tablet tablet/ko 327 32,700 0 0 0 0 0
147 Oksimetazolin tetes hidung 0,025% botol tak
botol 27,550 27,550 0 0 0 0 0
(ilaidin drop) 25
148 Oksitetrasiklin HCl salep mata 1 % tube tube/kot 1,600 40,000 0 0 0 0 0
10
149 Oksitosin injeksi 10IU/ml-1ml ampul ak
ampul/k 2,200 22,000 0 0 0 0 0
30
150 Omeprazol kapsul 20mg otak
tablet tablet/ko 211 6,330 0 0 0 0 0
30
151 ondansetron tablet 4 mg tak
tablet tablet/ko 716 21,480 0 0 0 0 0
30
tablet tablet/ko 1,189 35,670 0 0 0 0 0
153 Ondansetron inj 4 mg/ 2 ml tak
ampul ampul 2,400 2,400 0 0 0 0 0
100
154 Papaverin tablet 40mg tablet tablet/ko 119 11,900 0 0 0 0 0
155 Paracetamol drop 100 mg/ml tak
botol botol 5,200 5,200 0 0 0 0 0
156 Parasetamol sirup 120 mg / 5 ml botol 60
60 ml 100 1,438 1,438 58 58 0 0 58
ml
157 Parasetamol tablet 500 mg tablet tablet/ko 79 7,900 12,000 3,000 9,000 711,000 3,000
100
158 Piracetam 400 mg Tablet tablet tak
tablet/ko 609 60,885 0 0 0 0 0
100
159 Piracetam 800 mg kapsul tablet tak
tablet/ko 1,084 108,405 0 0 0 0 0
10
160 Piracetam inj 1 gr/ 5 ml ampul tak
ampul/k 7,425 74,250 0 0 0 0 0
161 Pirantel sirup 125mg/5ml botol otak
botol 8,250 8,250 0 0 0 0 0
30
162 Pirantel tablet 125 mg tablet tablet/ko 420 12,595 0 0 0 0 0
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet tak
tablet/ko 110 11,000 0 0 0 0 0
100
164 Piroksikam 20 mg tablet tak
tablet/ko 105 10,500 0 0 0 0 0
165 Povidon Iodida larutan 10% botol
tak 30
botol 2,163 2,163 0 0 0 0 0
ml
botol
166 Povidon Iodida larutan 10% botol 14,203 14,203 7 2 5 71,015 2
300100ml
167 Prednisone tablet 5 mg tablet tablet/ko 114 11,400 0 0 0 0 0
30
168 Prokain Benzil Penicillin G injeksi 3 jt vial tak
vial/kota 10,780 323,400 0 0 0 0 0
IU/vial 100
169 Propiltiourasil tablet 100 mg tablet k
tablet/bo 404 40,442 0 0 0 0 0
25
170 Ranitidin inj.25mg/2ml ampul tol
ampul/k 3,614 86,738 0 0 0 0 0
100
171 Ranitidin tablet 150 mg tablet otak
kaplet/k 120 12,000 100 100 0 0 100
50
172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul otak
kapsul/b 460 23,000 0 0 0 0 0
Lunak 50
173 Retinol (Vitamin A) 100.000 IU Kapsul kapsul otol
kapsul/b 260 13,000 0 0 0 0 0
Lunak
174 Ringer Laktat larutan infus steril botol
otol
botol 5,200 5,200 0 0 0 0 0
500
100ml
175 Salbutamol 2 mg tablet tablet/ko 59 5,900 0 0 0 0 0
tak
100
176 Salbutamol 4 mg tablet tablet/ko 97 9,749 0 0 0 0 0
Salbutamol inshalasi/ aerosol 100 tak
177 Botol Botol 63,750 63,750 0 0 0 0 0
mcg/dosis (ventolin inheler)
178 Salbutamol inshalasi/ aerosol 200 kapsul kapsul 431 431 0 0 0 0 0
mcg/kaps (ventolin rotacaps)
179 Salbutamol inshalasi/ aerosol 200 rotahaler rotahaler 5,867 5,867 0 0 0 0 0
mcg/rotahaler (ventolin rotaheler)
180 Salep 2-4 Komb : As Salisilat 2 % + pot pot 2,000 2,000 0 0 0 0 0
Belerang endap 2 %
181 Salisil Bedak 2% kotak kotak 1,250 1,250 0 0 0 0 0
30
182 Sefadroksil kapsul 250 mg tablet tablet/ko 855 25,650 0 0 0 0 0
50
183 Sefadroksil kapsul 500 mg tak
tablet tablet/ko 1,042 52,100 0 0 0 0 0
184 sefadroksil sirup kering 125mg/5ml tak
botol botol 4,896 4,896 15 15 0 0 15
2
185 Sefotaksim inj 1 gr vial vial/kota 6,050 12,100 0 0 0 0 0
186 Sefriakson serbuk injeksi 1 g/vial k
vial vial10
Dus, 11,000 11,000 0 0 0 0 0
187 Serum Anti Bisa Ular Polivalen injeksi 5 vial vial
ml (ABU I) Dus,@105 47,300 473,000 0 0 0 0 0
188 Serum Anti Tetanus injeksi 1.500 ampul ml
ampul 12,600 126,000 0 0 0 0 0
IU/ampul (A.T.S) 100
189 Setrizin tablet 10 mg @ 1 ml
tablet tablet/ko 181 18,100 0 0 0 0 0
100
tak
190 Sianokobalamin (vit B12) injeksi 500mcg- ampul ampul/k 916 91,600 0 0 0 0 0
ml 100
191 Simetidin tablet 200 mg tablet otak
tablet/ko 111 11,100 0 0 0 0 0
50
192 Simvastatin tablet 10 mg tablet tak
tablet/ko 693 34,628 0 0 0 0 0
100
193 Siproflaxacin tablet 500 mg tablet tak
tablet/ko 255 25,500 0 0 0 0 0
100
194 Sulfadoxine Pyrimethamine 525 mg tablet tablet tak
tablet/ko 478 47,800 0 0 0 0 0
30
195 Tablet Tambah Darah sachet tak
tablet/sa 1,260 1,260 0 0 0 0 0
50
196 Terbutalin sulfat (Molasma) tablet 2,5 mg tablet chet
tablet/ko 99 4,950 0 0 0 0 0
197 Terbutalin turbu (serbuk ih) 0,50 mg turbuhale tak
turbuhal 71,100 71,100 0 0 0 0 0
(bricasma turbuhaler 0,5mg) 100
198 Tetrasiklin HCl kapsul 250 mg r er
kaplet kaplet/k 149 14,900 0 0 0 0 0
100
199 Tetrasiklin HCl kapsul 500 mg otak
kaplet kaplet/k
30 257 25,700 0 0 0 0 0
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ampul otak
ampul/k 690 20,700 0 0 0 0 0
ml 1000
201 Tiamin HCl / Mononitrat (Vit.B1) tablet tablet otak
tablet/bo 38 37,800 0 0 0 0 0
50 mg 5
202 Tramadol inj 50mg/5ml ampul tol
ampul/k 5,400 27,000 0 0 0 0 0
100
203 Triheksifenidil Hidroklorida tablet 2 mg tablet otak 1
tablet/ko
Dus, 40 4,000 0 0 0 0 0
204 Vaksin Rabies Vero - Rabipur vialtak
@1
vial 78,500 78,500 0 0 0 0 0
dosis
100 +
205 Vitamin B komplek tablet tablet syringe
tablet/ko 108 10,700 500 200 300 32,310 200
206 zinc drop 10 mg/ ml tak
botol botol 12,840 12,840 0 0 0 0 0
207 Zinc sirup 10 mg/ml botol botol 14,980 14,980 0 0 0 0 0
100
208 Zinc Tab 20 mg tablet tablet/ko 474 47,400 0 0 0 0 0
tak
0 0 0 0 0
PERBEKALAN KESEHATAN 0 0 0 0 0
209 Alat suntik sekali pakai 0,5 ml kotak/

pcs 2,140 214,000 0 0 0 0 0
100 psc
210 Alat suntik sekali pakai 1 ml kotak/
pcs 650 65,000 0 0 0 0 0
100 psc
pcs 650 65,000 500 100 400 260,000 100
100 psc
kotak/
212 Alat suntik sekali pakai 5 ml pcs 750 75,000 400 100 300 225,000 100
100 psc
kotak/
213 Alkohol Swab pcs 216 21,560 0 0 0 0 0
100 psc
214 Aqua bides 20 liter galon galon 174,000 174,000 0 0 0 0 0
Catgut / benang bedah no 2/0 dengan 24pcs/k
215 pcs 26,667 640,000 0 0 0 0 0
jarum bedah otak
216 Catgut / beneng bedah no 3/0 dengan pcs
24psc/k
23,299 559,176 20 5 15 349,485 5
jarum bedah 24
otal
217 Cut gut chromic 3/0 pcs pcs/kota 5,583 134,000 0 0 0 0 0
218 Elastis Perban 75 Fesco k
roll roll 17,160 17,160 0 0 0 0 0
219 Exell tulle kotak /
pcs 14,014 14,014 0 0 0 0 0
psc
220 Foley cateter pcs pcs 8,495 8,495 0 0 0 0 0
221 Handscoon uk 7 pcs kotak 5,267 5,267 0 0 0 0 0
222 Handscoon uk 8 pcs kotak 5,270 5,270 0 0 0 0 0
223 Hidrogen Peroksida (H2 O2) 10% botol
botol 30,238 30,238 0 0 0 0 0
80050ml
224 Infus set anak set set/kota 16,500 82,500 0 0 0 0 0
50
225 Infus set dewasa set k
set/kota 6,785 339,250 0 0 0 0 0
50
226 IV Catheter No. 22 G set k
set/kota 7,700 385,000 0 0 0 0 0
50
227 IV Catheter No. 24 G set k
set/kota 7,700 385,000 3 2 1 7,700 2
50
228 IV Chateter No 20 G set k
set/kota 7,700 385,000 7 3 4 30,800 3
229 Kapas Pembalut / Absorben 250 gram k
Bungkus Bungkus 7,500 7,500 0 0 0 0 0
230 Kasa Pembalut Elastic 3 inchi pcs psc 7,000 7,000 0 0 0 0 0
231 Kasa Pembalut Elastic 4 inchi pcs psc 10,000 10,000 0 0 0 0 0
232 Kasa Pembalut Hidrofil 36 x 80 cm Rol Rol 55,200 55,200 1 1 0 0 1
233 Kasa Pembalut Hidrofil 4 m x 10 roll roll 30,350 30,350 0 0 0 0 0
234 Kasa Pembalut Hidrofil 4 m x 5 cm roll roll 30,350 30,350 0 0 0 0 0
16
235 Kassa Hidrofil steril uk. 16x16 (surya pcs lembar/k 363 5,800 0 0 0 0 0
husada) 12
236 Kassa Hidrofil steril uk. 18x22 (isi 12 pcs otak
lembar/k 396 4,750 0 0 0 0 0
lembar)
237 Kassa kompres steril 40 x 40 cm otak
Pcs Pcs 1,600 1,600 0 0 0 0 0
238 Kertas Puyer ball/ 10
pack 6,402 64,020 0 0 0 0 0
pack
239 Klip Plastik 10 x 7 KP ball/ 10
pack 7,682 76,820 5 5 0 0 5
pack
240 Klip Plastik 13x8,7 KP ball/ 10
pack 11,204 114,000 0 0 0 0 0
pack
241 Lisorin 1liter botol botol 18,865 18,865 0 0 0 0 0
50
242 Masker pcs pcs/kota 1,125 56,250 900 100 800 900,000 100
243 Pembalut Gibs 3 inchi rol k
rol 23,500 23,500 0 0 0 0 0
244 Plester 5 yard x 2 inch Rol Rol 23,625 23,625 0 0 0 0 0
245 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/k 14,316 515,376 6 4 2 28,632 4
jarum bedah
246 Sterobat nf. 400ml otak
botol botol 78,000 78,000 0 0 0 0 0
247 Strip gula 50 strip (blonime) box box 464,000 464,000 0 0 0 0 0
248 Umbilical cord nylon one med (Klem tali pcs
kotak/
1,940 97,020 36 0 36 69,854 0
pusat) 50 10
psc
249 Under Pet pcs pcs/kota 5,390 53,900 0 0 0 0 0
250 Urine Bag k
Pcs Pcs 4,000 4,000 0 0 0 0 0
251 Wing Needle No. 21 G kotak/
Pcs 5,770 577,000 0 0 0 0 0
100 psc
Pcs 5,770 577,000 0 0 0 0 0
100 psc
Pcs 5,770 577,000 0 0 0 0 0
100 psc
Pcs 5,770 549,750 0 0 0 0 0
100 psc
0 0 0 0 0
0BAT GIGI 0 0 0 0 0
255 Devitalisasi Pasta (Non Arsen) kotak kotak 390,000 390,000 0 0 0 0 0
256 Etil klorida spray botol botol 146,300 146,300 4 2 2 292,600 2
257 Glass Ionomer Cement (GC IX) ART botol botol 395,000 395,000 0 0 0 0 0
258 Kalsium Hidroksida Pasta kotak kotak 242,000 242,000 0 0 0 0 0
259 Klorfenol Kamfer Mentol (CHKM) botol botol 55,000 55,000 0 0 0 0 0
260 Mummifying Pasta kotak kotak 176,000 176,000 0 0 0 0 0
261 Semen Seng Fosfat serbuk dan cairan botol botol 93,500 93,500 0 0 0 0 0
262 Temporary Stopping Fletcher (Fletcher) botol botol 34,000 34,000 0 0 0 0 0
serbuk & cairan
0 0 0 0 0
OBAT DENGAN NAMA DAGANG 0 0 0 0 0

30
263 Armovit Kapsul kapsul kapsul/k 1,537 46,100 0 0 0 0 0
30
264 Asifit otak
kapsul kapsul/k 1,818 54,540 0 0 0 0 0
24
265 Betason-N krim otak
Tube tube/kot 9,182 220,368 0 0 0 0 0
266 Bioneuron Injeksi Kotak
ak 5
ampul 4,341 21,705 0 0 0 0 0
Ampul
60
267 Bionick botol 16,000 16,000 0 0 0 0 0
ml/botol
15
268 Bionick drop botol 22,500 22,500 0 0 0 0 0
ml/botol
269 Blonick Plus Syr Botol Botol 18,700 18,700 0 0 0 0 0
270 Chlorampecort Cr Tube 10
Tube 100 9,085 9,085 0 0 0 0 0
gr
271 Diapecta Tablet tablet/ko 384 38,400 0 0 0 0 0
272 Febrinex Suspensi Botol tak
Botol 15,855 15,855 0 0 0 0 0
100
273 Fercee Tablet tablet/ko 1,044 104,400 0 0 0 0 0
30
274 Fituno tak
Tablet kaplet/k 3,273 98,190 0 0 0 0 0
275 Fludane plus syr 60 ml botol
otak60
botol 60 15,950 15,950 0 0 0 0 0
ml
276 Flutamol Sirup botol mL/boto
10 13,500 13,500 0 0 0 0 0
277 Hustab l
Tablet tablet/str 284 2,840 0 0 0 0 0
278 Lybex sirup botol
ip 60
botol 10 19,800 19,800 0 0 0 0 0
ml
279 Mersibion inj ampul ampul/k 4,400 44,000 0 0 0 0 0
100
280 Neorodial otak
kaplet kaplet/k 1,091 109,100 0 0 0 0 0
60
281 Neurovit-E otak
Tablet tablet/ko 818 49,080 0 0 0 0 0
4
282 Noza tak
kotak
283 Poncobex Tablet ip
100 1,353 135,300 0 0 0 0 0
kotak
284 Ponflu Tablet tablet
100 935 93,500 0 0 0 0 0
10
285 Progastric tablet
100
286 Ramaton ip
Tablet tablet/ko 698 69,800 0 0 0 0 0
287 Scabicid Cream Tubetak 10
Tube kotak 28,380 28,380 0 0 0 0 0
gr
288 Siobio kapsul 100 946 94,600 0 0 0 0 0
289 Kasa Pembalut Hidrofil 36 x 80 cm kapsul
rol rol 140,337 140,337 0 0 0 0 0
(AHMADARIS)
290 Master Plast Plastik 1 inc (plester) roll roll 27,088 27,088 0 0 0 0 0
0 0 0 0 0
OBAT TAMBAHAN 0 0 0 0 0
291 0 0 0 0 0
292 0 0 0 0 0
293 0 0 0 0 0
294 0 0 0 0 0
295 0 0 0 0 0
296 0 0 0 0 0
297 0 0 0 0 0
298 0 0 0 0 0
299 0 0 0 0 0
300 0 0 0 0 0
301 0 0 0 0 0
0 0 0 0 0
15,101,626
UMUM
BAYAR
PBI PUSATPBI DAERAH NON PBI
Mengetahui/Menyetujui : Yang Menyerahkan

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi Petugas Gudang Farmasi
Dinas Kesehatan Puskesmas Rawajitu
Endang Sulastri Amd.Keb

NIP.197202191992032001
dr. H. Herry Novrizal, MM.Kes.,MM Melina Susan,S.si., Apt
NIP.197211242002121002 NIP. 198105062005012010
PERMINTAA
N
19
300
2,000
2,000
500
200
3
,
KODE PUSKESMAS :
KABUPATEN : TULANG BAWANG
PROPINSI : LAMPUNG
STOK
PENERIMAAN
HARGA HARGA PER
NO NAMA OBAT SATUAN KMSN
SATUAN KEMASAN
AWAL
APBD I PROGRAM DAK DAK DAK
2016 2015 2014 2016
1 2 3 4
24 5 6 7 8 9 10 11 12
1 ACT (Artesunat + Amodiaquin ) tablet tablet tab/Kota 1,856 44,550 0
100
2 Alopurinol tablet 100 mg k
tablet tablet/ko 86 8,600 0 200
30
3 Alopurinol tablet 300 mg tak
tablet tablet/ko 331 9,923 0
100
4 Alprazolam tablet 1 mg tak
5 Ambroxol sirup 15 mg/ 5 ml botol
tak 60
botol 100 3,300 3,300 0
ml
6 Ambroxol tab 30 mg tablet tablet/ko 86 8,593 0
100
7 Aminofilin tablet 200mg tak
ktk 30
8 Aminofilina injeksi 24 mg/ml ampul ampul@tak 4,050 121,500 0
100
10 ml
9 Amitriptillin tablet salut 25 mg tablet tablet/ko 112 11,200 100 100
30
30
10
12 Amoksisilin Injeksi serbuk 1000mg tak
vial vial/kota 10,125 101,250 0
100
k
13 Amoksisilin kapsul 250 mg tablet tablet/ko 388 38,799 0 500
100
tak
14 Amoksisilin kapsul 500 mg tablet tablet/ko 311 31,100 0 500 13,500
15 Amoksisilin sirup kering 125 mg/ 5 ml tak 60
botol
botol 2,445 2,445 30 288
100
ml
16 Antalgin (Metampiron) tablet 500 mg tablet tablet/ko 201 20,115 0
30
17 Antalgin injeksi 250 mg/ml - 2 ml tak
vial vial/kota 1,800 54,000 0
18 Antasida DOEN II suspensi komb botol
k 60
botol 100 2,160 2,160 190 240
ml
19 Antasida DOEN tablet tablet tablet/ko 72 7,200 1,500 3,200 1,500
25
Anti Bakteri DOEN salep kombinasi:Bacitracin- tak
20 tube tube/kot
10 2,581 62,900 0
polymixin B krim
21 Anti Hemoroid DOEN Kombinasi ak
supp supp/kot 2,000 20,000 0 20
24
22 Antifungi DOEN Kombinasi: ak
pot pot/kota 2,320 55,688 0
23 Antimalaria DOEN kombinasi k
100
tak
24 Antimigren:Ergotamin Tartrat 1mg +Kofein
tablet tablet/bo
100 135 13,500 0
50mg
25 Antiparkinson DOEN tablet Kombinasi tol
tablet tablet/ko 1,500 150,000 0
benzerazid 25 mg levodopa 100 mg ( Levopar) 10
26 Aqua pro Injeksi steril, bebas pirogen tak
vial vial/kota 7,425 74,250 0
6
27 Arthemeter injeksi 1 ml : 80 mg ampul ampul/kk 29,925 179,550 0
100
28 Asam Askorbat (Vit C) tablet 50 mg otak
tablet tablet/ko 95 9,500 0 1,500
100
29 Asam folat tablet 1 mg tak
tablet tablet/bo 84 8,400 0
100
30 Asam mefenamat tol
tablet tablet/ko
25 144 14,400 500 3,500
31 Asiklovir krim 5% tak
tube tube/kot 4,253 101,250 0 25
100
32 Asiklovir tablet 200 mg ak
100
33 Asiklovir tablet 400 mg tak
10
34 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial tak
vial vial/kota
30 11,070 110,700 0
35 Besi (II ) Sulfat + asam folat 0.25 tab k
sachet tablet/sa 2,700 2,700 0
36 Betametason krim 0,1% chet
tube tube 1,520 1,520 70 25 50
37 Budesonid inhaler 200 mcg/puff, 100 dosis
turbuhal turbuhal 93,000 93,000 0
38 Budesonid-formoterol ( fixed combination) er
turbuhal er
turbuhal 117,600 117,600 0
inhaler 160/4,5 mcg (symbicort turbuhaler)
39 Budesonid-formoterol ( fixed combination) er er
turbuhal turbuhal 110,500 110,500 0
inhaler 80/4,5 mcg (symbicort) 100
40 Deksametason injeksi 5mg.ml-1ml er er
ampul ampul/k
100 1,580 158,000 0 25
41 Deksametason tablet 0,5 mg otak
9
42 DHP tablet (Prog : malaria) tak
30
tak
43 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul ampul/k 1,054 31,620 0
100
otak
44 Digoksin tablet 0,25 mg tablet tablet/ko 143 14,300 0 100
45 Domperidon suspensi/sirup 5 mg/5ml tak
botol botol 3,333 3,333 0 50
100
47 Domperidone tablet 10mg tablet tablet/ko 167 16,700 0 800
1000
tak
48 Ekstrak Belladon tablet 10 mg tablet tablet/bo 38 38,000 0
Epinefrina HCl/Bitartrat ( Epinefrina / 30
49 Adrenalina ) tol
ampul ampul/k 8,100 243,000 0
50 Ergakalsiferol
tablet
otak
tablet 650 650 0
UI/ml (D-Vit FT)
51 Ergakalsiferol (vitamin D3/D2) suspensi 10000 botol botol 8,000 8,000 0
UI/ml (D-Vit syrup) 120
52 Eritromisin kapsul 250mg tablet tablet/ko 494 59,230 0 600
53 Eritromisin sirup 200mg/5ml tak
botol botol 7,220 7,220 0 15
botol 2,500 2,500 60 100
ml/botol
30
60 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul ampul/k 1,800 54,000 0
100
otak
61 Fenobarbital tablet 100 mg tablet tablet/ko 220 22,000 0
24
62 Fenol Gliserol tetes telinga 10% (Karbogliserin botol tak
botol/kot 2,042 49,008 0
10%) 10
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml ampul ak
ampul/k 4,698 46,980 0
30
64 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul otak
ampul/k 3,417 102,510 0 300
100
65 Fitomenadion (Vit.K1)tab salut gula 10 mg otak
tablet tablet/bo 634 63,400 0
25
66 Furosemid inj 40 mg/ml tol
ampul ampul/k
100 1,829 45,725 0
67 Furosemid tablet 40 mg tablet otak
tablet/ko 85 8,500 0 600
100
68 Garam oralit untuk 200 ml air (Prog : diare) sachet tak
sachet/k 292 29,200 0 1,300
69 Gentamicin salep mata 0,3 % (genoint ) tube otak
tube 2,600 2,600 0 120
70 Gentamicin tetes mata 0,3 % (genoint ) 5
botol 5 3,194 3,194 0 12
ml/botol
71 Gentamisin injeksi 40 mg/ml ampul ampul/k 3,399 16,995 0
72 Gentian Violet larutan 1 % otak
botol botol 900 900 0
101
73 Glibenklamid tablet 5 mg tablet tablet/ko 56 5,600 0 1,400
50
74 Glimepiride tablet 2 mg tak
tablet tablet/ko
1000 436 21,800 0 800
75 Gliseril Guayacolat tablet 100 mg tablet tak
tablet/bo 28 27,900 0 15,000
76 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tol
tablet 1,500 1,500 0
78 Glukosa larutan infus 10% steril (Produk lokal) 500
botol 5,700 5,700 0
ml/botol
79 Glukosa larutan infus 40% steril (Produk lokal) botol botol 1,960 1,960 0
80 Glukosa larutan infus 5% steril (Produk lokal) 500
botol 100 5,200 5,200 20 20
ml/botol
81 Griseofulvin tablet 125 mg, micronized tablet tablet/ko 324 32,400 0
82 Haloperidol inj 50 mg/ml (haldol decanoas) tak
ampul ampul 83,333 83,333 0
100
83 Haloperidol tablet 0,5 mg tablet tablet/ko 53 5,252 1,300
100
tak
84 Haloperidol tablet 1,5 mg tablet tablet/ko 83 8,258 1,300
100
tak
85 Haloperidol tablet 5 mg tablet tablet/ko 88 8,823 0
24
86 Hidrokortison krim 2,5% tak
tiube tube/kot 2,798 67,152 0 96
87 Ibuprofen sirup 100mg / 5ml ak
botol botol 3,499 3,499 0
100
89 Ibuprofen tablet 200 mg tablet tablet/bo 116 11,550 0
100
90 Ibuprofen tablet 400 mg tol
100
tak
91 Isosorbid Dinitrat tablet sublingual 5 mg tablet tablet/ko 81 8,071 0 300
100
92 Kalsium Laktat tab 500 mg tak
tablet tablet/ko 70 7,000 2,600
100
tak
93 Kaptopril tablet 12,5 mg tablet tablet/ko 62 6,200 0 500 100
100
tak
94 Kaptopril tablet 25 mg tablet tablet/ko 84 8,400 0 600
100
95 Karbamazepin tablet 200 mg tak
tablet tablet/ko
50 243 24,300 0 100
96 Ketokenazol tablet 200mg tak
12
tak
97 Ketokonazol krim 2% tube tube/kot 4,700 56,400 0 20
100
ak
98 Ketoprofen tablet 100 mg tablet tablet/ko 1,823 182,250 0
5
99 Ketorolak inj 10 mg tak
ampul ampul/k 8,080 40,400 0
100 Natrium Diklofenac 50 mg kotak otak 8,700 0
6
102 Ketorolak inj 30 mg ampul ampul/k 2,300 13,800 0 80
50
103 Klindamisin 150 mg tablet otak
tablet/ko 382 19,100 0
50
104 Klindamisin 300 mg tablet tak
tablet/ko 527 26,350 0
100
105 Kloramfenikol kapsul 250 mg tablet tak
tablet/ko 578 57,750 0
106 Kloramfenikol tetes telinga 3% tak
100
107 Klorfeniramin Maleat (CTM) tablet tablet tablet/ko 51 5,100 1,800 1,000 5,000
100
108 Klorpromasin tablet 100 mg tak
30
109 Klorpromazin HCl injeksi 25 mg/ml - 1 ml tak
ampul ampul/k 1,021 30,630 0
otak
30
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul ampul/k 950 28,500 0
100
111 Klorpromazin HCl tablet salut 100 mg otak
100
112 Kodein 10 mg tablet tak
113 Kotrimoksazol Susp komb: Sulfametoksazol botol
botol
tak 60
2,190 2,190 30 250
200mg + Trimetoprim 40 mg 100
ml
114 Kotrimoksazol tablet komb: Sulfametoksazol tablet tablet/ko 138 13,800 300 600
400mg + Trimetoprim 80 mg 1
115 Lansoprazol inj 30 mg/ml tak
Larutan mengandung karbohidrat + elektrolit ampul ampul/k 82,042 82,042 0
116 (NaCl 1,75 gr. Na Lactat 2,24 gr. KCl 1.5 botol otak
botol 10,000 10,000 0
gr.Dextrosa
117 (NaCl 27 Na
2,34 gr. gr) Lactat
2,24 botol botol 10,000 10,000 0
30
118 Dextrosa
Lidokaian27
injgr)
2% / KA EN 3A ampul ampul/k 1,333 40,000 0 90 15
10
119 Magnesium Sulfat inj (IV) 20% - 25 ml vial otak
vial/kota 2,078 20,780 0
10
120 Magnesium Sulfat inj (IV) 40% - 25 ml vial k
vial/kota 2,629 26,290 0
30
121 Mebendazol tablet 100 mg tablet k
tablet/ko 228 6,840 0
100
122 Metilergometrin Maleat (Metilergometrin) tab tak
salut 0,125 mg 30
123 Metilergometrin Maleat inj 0,200 mg-1 ml tak
ampul ampul/k 2,175 65,250 0
30
124 Metilprednisolon tablet 16 mg otak
tablet tablet/ko
100 635 19,050 0
125 metilprednisolon tablet 4 mg tablet tak
tablet/ko 300 30,000 0 300
10
126 Metoklopramid inj 5 mg/ml ampul tak
ampul/k 2,070 20,700 0
100
127 Metoklopramid 5 mg otak
128 Metronidazol Infus 500mg/100ml botol
tak
botol 39,825 39,825 0
100 ml
129 Metronidazol supositoria 500 mg ( flagyl) supposit supposit 3,220 3,220 0
100
130 Metronidazol tablet 250 mg oria
tablet oria
tablet/ko 193 19,305 0
131 Metronidazol tablet 500 mg tablet tak
kotak 160 16,000 0 300
132 Mikonazol krim/ salep 2 % tube tube
40 3,000 3,000 0 12
133 Mineral mix (Prog. Gizi) sachet sachet/k 2,450 98,000 0 600
134 Natrium Bikarbonat inj i.v 8,4% (meylon) otak
ampul ampul 6,200 6,200 0
50
135 Natrium Diklofenac 50 mg tablet tablet/ko 200 10,000 0 600
136 Natrium Diklofenak 25 mg tablet tak
kotak 174 8,700 0
137 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0 140
(Produk lokal) 24
138 Hidrokortison krim 2,5% tube tube/kot 2,979 71,500 0
139 Natrium Tiroksin tablet 100 mcg tablet ak
tablet 1,694 1,694 0
140 Nifedipin tablet 10mg tablet kotak 129 12,900 0 600 200
100
141 Nistatin tablet salut 500.000 IU tablet tablet/ko 640 64,000 0 100
30
142 Noretisteron tablet 5 mg (Primolut N) tak
100
143 Nystatin vaginal tablet 100.000 UI tak
144 Obat Batuk Hitam botol tak
botol 5,500 5,500 0 60
100
145 Ofloxacin 200 mg Tab Salut Selulose tablet tablet/ko 207 20,650 0
100
146 Ofloxacin 400 mg Tab Salut Selulose tak
147 Oksimetazolin tetes hidung 0,025% (ilaidin botol tak
botol 27,550 27,550 0
drop) 25
148 Oksitetrasiklin HCl salep mata 1 % tube tube/kot 1,600 40,000 0
10
149 Oksitosin injeksi 10IU/ml-1ml ampul ak
ampul/k 2,200 22,000 0 50
30
150 Omeprazol kapsul 20mg otak
30
30
tablet tablet/ko 1,189 35,670 0 400 288
153 Ondansetron inj 4 mg/ 2 ml tak
ampul ampul 2,400 2,400 0 35
100
154 Papaverin tablet 40mg tablet tablet/ko 119 11,900 0
155 Paracetamol drop 100 mg/ml tak
156 Parasetamol sirup 120 mg / 5 ml botol 60
60 ml 100 1,438 1,438 0 168
ml
157 Parasetamol tablet 500 mg tablet tablet/ko 79 7,900 9,000 3,000 10,000
100
158 Piracetam 400 mg Tablet tablet tak
tablet/ko 609 60,885 0
100
159 Piracetam 800 mg kapsul tablet tak
tablet/ko 1,084 108,405 0
10
160 Piracetam inj 1 gr/ 5 ml ampul tak
ampul/k 7,425 74,250 0
161 Pirantel sirup 125mg/5ml botol otak
botol 8,250 8,250 0
30
162 Pirantel tablet 125 mg tablet tablet/ko 420 12,595 0 300
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet tak
tablet/ko 110 11,000 0 4,500
100
164 Piroksikam 20 mg tablet tak
tablet/ko 105 10,500 0 1,300
165 Povidon Iodida larutan 10% botol
tak 30
botol 2,163 2,163 0
ml
botol
166 Povidon Iodida larutan 10% botol 14,203 14,203 5
300100ml
167 Prednisone tablet 5 mg tablet tablet/ko 114 11,400 0 400
30
168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial tak
vial/kota 10,780 323,400 0
100
169 Propiltiourasil tablet 100 mg tablet k
tablet/bo 404 40,442 0
25
170 Ranitidin inj.25mg/2ml ampul tol
ampul/k 3,614 86,738 0 135
100
171 Ranitidin tablet 150 mg tablet otak
kaplet/k 120 12,000 0 4,200
50
172 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul otak
kapsul/b 460 23,000 0
50
173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul otol
kapsul/b 260 13,000 0
174 Ringer Laktat larutan infus steril botol
otol
botol 5,200 5,200 0 80
500
100ml
175 Salbutamol 2 mg tablet tablet/ko 59 5,900 0 700
tak
100
176 Salbutamol 4 mg tablet tablet/ko 97 9,749 0 1,200
Salbutamol inshalasi/ aerosol 100 mcg/dosis tak
177 Botol Botol 63,750 63,750 0
(ventolin inheler)
(ventolin rotacaps)
179 Salbutamol inshalasi/ aerosol 200 mcg/rotahaler rotahaler 5,867 5,867 0
(ventolin rotaheler) rotahaler
endap 2 %
30
182 Sefadroksil kapsul 250 mg tablet tablet/ko 855 25,650 0
50
183 Sefadroksil kapsul 500 mg tak
tablet tablet/ko 1,042 52,100 0 900
184 sefadroksil sirup kering 125mg/5ml tak
botol botol 4,896 4,896 0 60
2
185 Sefotaksim inj 1 gr vial vial/kota 6,050 12,100 0 10
186 Sefriakson serbuk injeksi 1 g/vial k
vial vial10
Dus, 11,000 11,000 0 16
187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial vial
(ABU I) Dus,@105 47,300 473,000 0
188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul ampul ml 12,600 126,000 0
(A.T.S) 100
189 Setrizin tablet 10 mg @ 1 ml
100
tak
190 Sianokobalamin (vit B12) injeksi 500mcg-ml ampul ampul/k 916 91,600 0
100
191 Simetidin tablet 200 mg otak
50
192 Si mvastatin 10 Mg tak
100
193 Siproflaxacin tablet 500 mg tak
100
194 Sulfadoxine Pyrimethamine 525 mg tablet tak
30
195 Tablet Tambah Darah tak
sachet tablet/sa 1,260 1,260 0 4,300
50
196 Terbutalin sulfat (Molasma) tablet 2,5 mg chet
197 Terbutalin turbu (serbuk ih) 0,50 mg (bricasma turbuhal turbuhal
tak 71,100 71,100 0
turbuhaler 0,5mg) 100
198 Tetrasiklin HCl kapsul 250 mg er er
kaplet kaplet/k 149 14,900 0
100
199 Tetrasiklin HCl kapsul 500 mg otak
kaplet kaplet/k
30 257 25,700 0
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml otak
ampul ampul/k 690 20,700 0
1000
201 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg otak
tablet tablet/bo 38 37,800 0 500
5
202 Tramadol inj 50mg/5ml tol
ampul ampul/k 5,400 27,000 0
100
203 Triheksifenidil Hidroklorida tablet 2 mg otak 1
tablet tablet/ko
Dus, 40 4,000 0
204 Vaksin Rabies Vero - Rabipur vialtak
@1
vial 78,500 78,500 0
dosis
100 +
205 Vitamin B komplek tablet syringe
tablet tablet/ko 108 10,700 300 4,500
206 zinc drop 10 mg/ ml tak
botol botol 12,840 12,840 0
207 Zinc sirup 10 mg/ml botol botol 14,980 14,980 0 25
100
208 Zinc Tab 20 mg tablet tablet/ko 474 47,400 0 600
tak
0
209 Alat suntik sekali pakai 0,5 ml kotak/

pcs 2,140 214,000 0
100 psc
pcs 650 65,000 0
100 psc
pcs 650 65,000 400 500
100 psc
kotak/
212 Alat suntik sekali pakai 5 ml pcs 750 75,000 300
100 psc
kotak/
213 Alkohol Swab pcs 216 21,560 0
100 psc
Catgut / benang bedah no 2/0 dengan jarum 24pcs/ko
215 pcs 26,667 640,000 0
bedah tak
216 Catgut / beneng bedah no 3/0 dengan jarum pcs
24psc/ko
23,299 559,176 15
bedah 24
tal
217 Cut gut chromic 3/0 pcs pcs/kota 5,583 134,000 0
218 Elastis Perban 75 Fesco k
roll roll 17,160 17,160 0
219 Exell tulle kotak /
pcs 14,014 14,014 0
psc
223 Hidrogen Peroksida (H2 O2) 10% botol
botol 30,238 30,238 0
80050ml
224 Infus set anak set 16,500 82,500 0 150
set/kotak
50
225 Infus set dewasa set 6,785 339,250 0
set/kotak
50
226 IV Catheter No. 22 G set 7,700 385,000 0
set/kotak
50
227 IV Catheter No. 24 G set 7,700 385,000 1
set/kotak
50
228 IV Chateter No 20 G set 7,700 385,000 4
set/kotak
229 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 7,500 7,500 0 3
232 Kasa Pembalut Hidrofil 36 x 80 cm Rol Rol 55,200 55,200 0 2
16
235 Kassa Hidrofil steril uk. 16x16 (surya husada) pcs lembar/k 363 5,800 0 20
12
236 Kassa Hidrofil steril uk. 18x22 (isi 12 lembar) pcs otak
lembar/k 396 4,750 0
237 Kassa kompres steril 40 x 40 cm otak
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack
pack 7,682 76,820 0
pack
pack 11,204 114,000 0
pack
50
242 Masker pcs pcs/kota 1,125 56,250 800 240
243 Pembalut Gibs 3 inchi rol k
rol 23,500 23,500 0
245 Silk ( Benang Bedah Sutera ) No. 3/0 dg jarum pcs 36pcs/ko 14,316 515,376 2
bedah
246 Sterobat nf. 400ml tak
botol botol 78,000 78,000 0
248 Umbilical cord nylon one med (Klem tali pusat) kotak/
pcs 1,940 97,020 36
50 10
psc
249 Under Pet pcs pcs/kota 5,390 53,900 0
250 Urine Bag k
Pcs Pcs 4,000 4,000 0 5
Pcs 5,770 577,000 0
100 psc
Pcs 5,770 577,000 0
100 psc
Pcs 5,770 577,000 0
100 psc
Pcs 5,770 549,750 0
100 psc
0
0BAT GIGI 0
256 Etil klorida spray botol botol 146,300 146,300 2 2
262 Temporary Stopping Fletcher (Fletcher) serbuk botol botol 34,000 34,000 0
& cairan
0
OBAT DENGAN NAMA DAGANG

30
263 Armovit Kapsul kapsul kapsul/k 1,537 46,100 0
30
264 Asifit otak
kapsul kapsul/k 1,818 54,540 0
24
265 Betason-N krim otak
Tube tube/kot 9,182 220,368 0
266 Bioneuron Injeksi Kotak
ak 5
ampul 4,341 21,705 0
Ampul
60
267 Bionick botol 16,000 16,000 0
ml/botol
15
268 Bionick drop botol 22,500 22,500 0
ml/botol
270 Chlorampecort Cr Tube 10
Tube 100 9,085 9,085 0
gr
271 Diapecta Tablet tablet/ko 384 38,400 0
272 Febrinex Suspensi Botol tak
Botol 15,855 15,855 0
100
273 Fercee Tablet tablet/ko 1,044 104,400 0
30
274 Fituno tak
Tablet kaplet/k 3,273 98,190 0
275 Fludane plus syr 60 ml botol
otak60
botol 60 15,950 15,950 0
ml
276 Flutamol Sirup botol mL/boto
10 13,500 13,500 0
277 Hustab l
Tablet tablet/str 284 2,840 0
278 Lybex sirup botol
ip 60
botol 10 19,800 19,800 0
ml
279 Mersibion inj ampul ampul/k 4,400 44,000 0
100
280 Neorodial otak
kaplet kaplet/k 1,091 109,100 0
60
281 Neurovit-E otak
Tablet tablet/ko 818 49,080 0
4
282 Noza tak
kotak
283 Poncobex Tablet ip
100 1,353 135,300 0
kotak
284 Ponflu Tablet tablet
100 935 93,500 0
10
285 Progastric tablet
100
286 Ramaton ip
Tablet tablet/ko 698 69,800 0
287 Scabicid Cream Tubetak 10
Tube kotak 28,380 28,380 0
gr
288 Siobio kapsul 100 946 94,600 0
289 Kasa Pembalut Hidrofil 36 x 80 cm kapsul
rol rol 140,337 140,337 0
(AHMADARIS)
300 0
ampul kotak
OBAT TAMBAHAN 0
291 0 30
Trufit sirup Botol Kotak
292 0 1,000
CALCIMEGA Tablet Kotak
293 0 50
Solafluz Sirup Botol Kotak
294 0 1,200
Lodecon Forte Tablet Kotak
295 0 700
Solvitron Kapsul Kapsul Kotak
296 0 200
Doksisiklin Kapsul Kotak
297 0 600
Cloramex 500 MG Kapsul Kotak
298 0 300
Loperamid tab 2 mg Tablet Kotak
299 0 1,000
Metformin HCL 500 mg tablet Kotak
300 0 660
Simvastatin 20 mg Tablet Kotak
301 0 300
Spironolakton 25 mg Tablet Kotak
0
UMUM
BAYAR
Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi Kepala Puskesmas
Dinas Kesehatan
Baidulllah S Siagian
NIP.196901241989021001
NIP.197211242002121002 NIP. 198105062005012010
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : Maret KABUPATEN
TAHUN : 2017 PROPINSI
PEMAKAIAN
PENGELUARA STOK STOK AKHIR RATA-RATA
PERSEDIAAN PERMINTAAN NO NAMA OBAT
N AKHIR DALAM RUPIAH S/D BULAN
INI
TOTAL
13 14 15 16 17 18 19 1 2
0 0 0 0 0 0 300 1 ACT (Artesunat + Amodiaquin ) tablet
200 200 100 100 8,600 100 2,000 2 Alopurinol tablet 100 mg
0 0 0 0 0 0 2,000 3 Alopurinol tablet 300 mg
100 100 50 50 11,650 50 500 4 Alprazolam tablet 1 mg
0 0 0 0 0 0 200 5 Ambroxol sirup 15 mg/ 5 ml
0 0 0 0 0 0 6 Ambroxol tab 30 mg
0 0 0 0 0 0 7 Aminofilin tablet 200mg
0 0 0 0 0 0 8 Aminofilina injeksi 24 mg/ml
100 200 100 100 11,200 100 9 Amitriptillin tablet salut 25 mg
900 1,400 700 700 231,000 700 10 Amlodipine Tablet 10 mg

300 750 400 350 65,450 400 11 Amlodipine Tablet 5 mg
0 0 0 0 0 0 12 Amoksisilin Injeksi serbuk 1000mg
500 500 300 200 77,598 300 13 Amoksisilin kapsul 250 mg
14,000 14,000 7,000 7,000 2,177,000 7,000 14 Amoksisilin kapsul 500 mg
288 318 190 128 312,960 190 15 Amoksisilin sirup kering 125 mg/ 5 ml
0 0 0 0 0 0 16 Antalgin (Metampiron) tablet 500 mg

0 0 0 0 0 0 17 Antalgin injeksi 250 mg/ml - 2 ml
240 430 240 190 410,400 240 18 Antasida DOEN II suspensi komb
4,700 6,200 2,500 3,700 266,400 2,500 19 Antasida DOEN tablet
20
Anti Bakteri DOEN salep kombinasi:Bacitracin-
0 0 0 0 0 0
polymixin B krim
20 20 10 10 20,000 10 21 Anti Hemoroid DOEN Kombinasi
0 0 0 0 0 0 22 Antifungi DOEN Kombinasi:

0 0 0 0 0 0 23 Antimalaria DOEN kombinasi
0 0 0 0 0 0 24 Antimigren:Ergotamin Tartrat 1mg +Kofein

50mg
Antiparkinson DOEN tablet Kombinasi
0 0 0 0 0 0 25
benzerazid 25 mg levodopa 100 mg ( Levopar)
0 0 0 0 0 0 26 Aqua pro Injeksi steril, bebas pirogen
0 0 0 0 0 0 27 Arthemeter injeksi 1 ml : 80 mg
1,500 1,500 900 600 57,000 900 28 Asam Askorbat (Vit C) tablet 50 mg
0 0 0 0 0 0 29 Asam folat tablet 1 mg
3,500 4,000 3,000 1,000 144,000 3,000 30 Asam mefenamat

25 25 10 15 63,795 10 31 Asiklovir krim 5%
200 200 50 150 78,600 50 32 Asiklovir tablet 200 mg
200 230 50 180 138,780 50 33 Asiklovir tablet 400 mg
0 0 0 0 0 0 34 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial

0 0 0 0 0 0 35 Besi (II ) Sulfat + asam folat 0.25 tab
75 175 100 75 114,000 100 36 Betametason krim 0,1%
0 0 0 0 0 0 37 Budesonid inhaler 200 mcg/puff, 100 dosis

0 0 0 0 0 0 38 Budesonid-formoterol ( fixed combination)
0 0 0 0 0 0 39
25 25 10 15 23,700 10 40 Deksametason injeksi 5mg.ml-1ml
2,500 2,500 1,700 800 49,600 1,700 41 Deksametason tablet 0,5 mg

0 0 0 0 0 0 42 DHP tablet (Prog : malaria)
0 0 0 0 0 0 43 Difenhidramin HCl injeksi 10 mg/ml-1ml
100 100 0 100 14,300 0 44 Digoksin tablet 0,25 mg
50 50 5 45 149,985 5 45 Domperidon suspensi/sirup 5 mg/5ml
0 0 0 0 0 46 Domperidon tetes/ 5 mg/ml

800 800 500 300 50,100 500 47 Domperidone tablet 10mg
0 0 0 0 0 0 48 Ekstrak Belladon tablet 10 mg

Epinefrina HCl/Bitartrat ( Epinefrina / Adrenalina
0 0 0 0 0 0 49 )
0 0 0 0 0 0 50 Ergakalsiferol
UI/ml (D-Vit FT)
0 0 0 0 0 0 51 Ergakalsiferol (vitamin D3/D2) suspensi 10000
UI/ml (D-Vit syrup)
600 600 200 400 197,432 200 52 Eritromisin kapsul 250mg
15 15 15 108,300 0 53 Eritromisin sirup 200mg/5ml
100 160 110 50 125,000 110 54 Etanol 70% cairan
0 3 0 3 644,970 0 55 FDC kategori anak
0 2 1 1 359,990 1 56 FDC OAT Kategori I
0 8 0 8 9,599,200 0 57 FDC OAT Kategori II
0 0 0 0 0 0 58 Fenitoin Natrium injeksi 50 mg/ml
0 0 0 0 0 0 59 Fenitoin Natrium Kapsul 100 mg
0 0 0 0 0 0 60 Fenobarbital Injeksi i.m/i.v 50 mg/ml
0 0 0 0 0 0 61 Fenobarbital tablet 100 mg
0 0 0 0 0 0 62 Fenol Gliserol tetes telinga 10% (Karbogliserin

10%)
0 0 0 0 0 0 63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml
300 300 70 230 785,910 70 64 Fitomenadion (Vit.K1) injeksi 2mg/ml
0 0 0 0 0 0 65 Fitomenadion (Vit.K1)tab salut gula 10 mg
0 0 0 0 0 0 66 Furosemid inj 40 mg/ml

600 600 200 400 34,000 200 67 Furosemid tablet 40 mg
1,300 1,300 600 700 204,400 600 68 Garam oralit untuk 200 ml air (Prog : diare)
120 120 87 33 85,800 87 69 Gentamicin salep mata 0,3 % (genoint )
12 12 7 5 15,970 7 70 Gentamicin tetes mata 0,3 % (genoint )
0 0 0 0 0 0 71 Gentamisin injeksi 40 mg/ml
0 0 0 0 0 0 72 Gentian Violet larutan 1 %
1,400 1,400 500 900 50,400 500 73 Glibenklamid tablet 5 mg
800 800 300 500 218,000 300 74 Glimepiride tablet 2 mg

15,000 15,000 6,000 9,000 251,100 6,000 75 Gliseril Guayacolat tablet 100 mg
0 0 0 0 0 0 76 Gliseril trinitrat tab sublingual 0,5mg (nitral)
0 0 0 0 0 0 77 Glukonas Kalsikus 10 %
0 0 0 0 0 0 78 Glukosa larutan infus 10% steril (Produk lokal)
0 0 0 0 0 0 79 Glukosa larutan infus 40% steril (Produk lokal)

20 40 30 10 52,000 30 80 Glukosa larutan infus 5% steril (Produk lokal)
0 0 0 0 0 0 81 Griseofulvin tablet 125 mg, micronized
0 0 0 0 0 0 82 Haloperidol inj 50 mg/ml (haldol decanoas)
0 1,300 500 800 42,016 500 83 Haloperidol tablet 0,5 mg
0 1,300 500 800 66,064 500 84 Haloperidol tablet 1,5 mg
0 0 0 0 0 0 85 Haloperidol tablet 5 mg
96 96 66 30 83,940 66 86 Hidrokortison krim 2,5%
0 0 0 0 0 0 87 Ibuprofen sirup 100mg / 5ml
0 0 0 0 0 0 88 Ibuprofen suspensi 200mg / 5ml

0 0 0 0 0 0 89 Ibuprofen tablet 200 mg
1,200 1,200 600 600 90,000 600 90 Ibuprofen tablet 400 mg
300 300 100 200 16,140 100 91 Isosorbid Dinitrat tablet sublingual 5 mg
0 2,600 1,700 900 63,000 1,700 92 Kalsium Laktat tab 500 mg
600 600 300 300 18,600 300 93 Kaptopril tablet 12,5 mg
600 600 300 300 25,200 300 94 Kaptopril tablet 25 mg
100 100 0 100 24,300 0 95 Karbamazepin tablet 200 mg

0 0 0 0 0 0 96 Ketokenazol tablet 200mg
20 20 10 10 47,000 10 97 Ketokonazol krim 2%
0 0 0 0 0 0 98 Ketoprofen tablet 100 mg

0 0 0 0 0 0 99 Ketorolak inj 10 mg
0 0 0 0 0 0 100 Natrium Diklofenac 50 mg
0 0 0 0 0 0 101 Nistatin tablet salut 500.000 IU
80 80 20 60 138,000 20 102 Ketorolak inj 30 mg
0 0 0 0 0 0 103 Klindamisin 150 mg

0 0 0 0 0 0 104 Klindamisin 300 mg
0 0 0 0 0 0 105 Kloramfenikol kapsul 250 mg
0 0 0 0 0 0 106 Kloramfenikol tetes telinga 3%
6,000 7,800 3,000 4,800 244,800 3,000 107 Klorfeniramin Maleat (CTM) tablet
0 0 0 0 0 0 108 Klorpromasin tablet 100 mg
0 0 0 0 0 0 109 Klorpromazin HCl injeksi 25 mg/ml - 1 ml
0 0 0 0 0 0 110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml
0 100 0 100 14,900 0 111 Klorpromazin HCl tablet salut 100 mg
0 0 0 0 0 0 112 Kodein 10 mg tablet
250 280 165 115 251,850 165 113 Kotrimoksazol Susp komb: Sulfametoksazol
600 900 900 0 0 900 114 Kotrimoksazol tablet komb: Sulfametoksazol
0 0 0 0 0 0 115 Lansoprazol inj 30 mg/ml
0 0 0 0 0 0 116 (NaCl 1,75 gr. Na Lactat 2,24 gr. KCl 1.5
0 0 0 0 0 0 gr.Dextrosa
117 (NaCl 27 Na
2,34 gr. gr) Lactat
2,24
105 105 70 35 46,667 70 118 Dextrosa
Lidokaian27
injgr)
2% / KA EN 3A
0 0 0 0 0 0 119 Magnesium Sulfat inj (IV) 20% - 25 ml
0 0 0 0 0 0 120 Magnesium Sulfat inj (IV) 40% - 25 ml
0 0 0 0 0 0 121 Mebendazol tablet 100 mg
0 0 0 0 0 0 122 Metilergometrin Maleat (Metilergometrin) tab

salut 0,125 mg
0 0 0 0 0 0 123 Metilergometrin Maleat inj 0,200 mg-1 ml
0 0 0 0 0 0 124 Metilprednisolon tablet 16 mg

300 300 0 300 90,000 0 125 metilprednisolon tablet 4 mg
0 0 0 0 0 0 126 Metoklopramid inj 5 mg/ml
300 300 0 300 33,000 0 127 Metoklopramid 5 mg
0 0 0 0 0 0 128 Metronidazol Infus 500mg/100ml
0 0 0 0 0 0 129 Metronidazol supositoria 500 mg ( flagyl)
0 0 0 0 0 0 130 Metronidazol tablet 250 mg

300 300 300 0 0 300 131 Metronidazol tablet 500 mg
12 12 2 10 30,000 2 132 Mikonazol krim/ salep 2 %
600 600 0 600 1,470,000 0 133 Mineral mix (Prog. Gizi)
0 0 0 0 0 0 134 Natrium Bikarbonat inj i.v 8,4% (meylon)
600 600 300 300 60,000 300 135 Natrium Diklofenac 50 mg
0 0 0 0 0 0 136 Natrium Diklofenak 25 mg

140 140 50 90 441,000 50 137 Natrium Klorida larutan infus 0,9 % steril
(Produk lokal)
0 0 0 0 0 0 138 Hidrokortison krim 2,5%
0 0 0 0 0 0 139 Natrium Tiroksin tablet 100 mcg
800 800 500 300 38,700 500 140 Nifedipin tablet 10mg
100 100 0 100 64,000 0 141 Nistatin tablet salut 500.000 IU
0 0 0 0 0 0 142 Noretisteron tablet 5 mg (Primolut N)
0 0 0 0 0 0 143 Nystatin vaginal tablet 100.000 UI
60 60 20 40 220,000 20 144 Obat Batuk Hitam
0 0 0 0 0 0 145 Ofloxacin 200 mg Tab Salut Selulose
200 200 0 200 65,400 0 146 Ofloxacin 400 mg Tab Salut Selulose
0 0 0 0 0 0 147 Oksimetazolin tetes hidung 0,025% (ilaidin drop)
0 0 0 0 0 0 148 Oksitetrasiklin HCl salep mata 1 %
50 50 10 40 88,000 10 149 Oksitosin injeksi 10IU/ml-1ml
420 420 150 270 56,970 150 150 Omeprazol kapsul 20mg
288 288 108 180 128,880 108 151 ondansetron tablet 4 mg
688 688 158 530 630,170 158 152 ondansetron tablet 8 mg
35 35 15 20 48,000 15 153 Ondansetron inj 4 mg/ 2 ml
0 0 0 0 0 0 154 Papaverin tablet 40mg
0 0 0 0 0 0 155 Paracetamol drop 100 mg/ml

168 168 110 58 83,404 110 156 Parasetamol sirup 120 mg / 5 ml
13,000 22,000 11,500 10,500 829,500 11,500 157 Parasetamol tablet 500 mg
0 0 0 0 0 0 158 Piracetam 400 mg Tablet
0 0 0 0 0 0 159 Piracetam 800 mg kapsul
0 0 0 0 0 0 160 Piracetam inj 1 gr/ 5 ml
0 0 0 0 0 0 161 Pirantel sirup 125mg/5ml
300 300 120 180 75,569 120 162 Pirantel tablet 125 mg
4,500 4,500 1,900 2,600 286,000 1,900 163 Piridoksin HCl (Vit.B6) tablet 10 mg
1,300 1,300 600 700 73,500 600 164 Piroksikam 20 mg
0 0 0 0 0 0 165 Povidon Iodida larutan 10%
0 5 4 1 14,203 4 166 Povidon Iodida larutan 10%
400 400 0 400 45,600 0 167 Prednisone tablet 5 mg

0 0 0 0 0 0 168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial
0 0 0 0 0 0 169 Propiltiourasil tablet 100 mg
135 135 70 65 234,910 70 170 Ranitidin inj.25mg/2ml
4,200 4,200 1,500 2,700 324,000 1,500 171 Ranitidin tablet 150 mg
0 0 0 0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul Lunak
0 0 0 0 0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak
80 80 40 40 208,000 40 174 Ringer Laktat larutan infus steril
700 700 300 400 23,600 300 175 Salbutamol 2 mg

1,200 1,200 500 700 68,243 500 176 Salbutamol 4 mg
177
Salbutamol inshalasi/ aerosol 100 mcg/dosis
0 0 0 0 0 0
(ventolin inheler)
0 0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 200 mcg/kaps
(ventolin rotacaps)
0 0 0 0 0 0 179 Salbutamol inshalasi/ aerosol 200 mcg/rotahaler
(ventolin rotaheler)
0 0 0 0 0 0 180 Salep 2-4 Komb : As Salisilat 2 % + Belerang
endap 2 %
0 0 0 0 0 0 181 Salisil Bedak 2%
0 0 0 0 0 0 182 Sefadroksil kapsul 250 mg

900 900 400 500 521,000 400 183 Sefadroksil kapsul 500 mg
60 60 35 25 122,400 35 184 sefadroksil sirup kering 125mg/5ml
10 10 0 10 60,500 0 185 Sefotaksim inj 1 gr
16 16 0 16 176,000 0 186 Sefriakson serbuk injeksi 1 g/vial

0 0 0 0 0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 ml
(ABU I)
0 0 0 0 0 0 188 Serum Anti Tetanus injeksi 1.500 IU/ampul
(A.T.S)
0 0 0 0 0 0 189 Setrizin tablet 10 mg
0 0 0 0 0 0 190 Sianokobalamin (vit B12) injeksi 500mcg-ml

0 0 0 0 0 0 191 Simetidin tablet 200 mg
0 0 0 0 0 0 192 Si mvastatin 10 Mg
700 700 300 400 102,000 300 193 Siproflaxacin tablet 500 mg
0 0 0 0 0 0 194 Sulfadoxine Pyrimethamine 525 mg tablet
4,300 4,300 700 3,600 4,536,000 700 195 Tablet Tambah Darah
200 200 100 100 9,900 100 196 Terbutalin sulfat (Molasma) tablet 2,5 mg
0 0 0 0 0 0 197 Terbutalin turbu (serbuk ih) 0,50 mg (bricasma
turbuhaler 0,5mg)
0 0 0 0 0 0 198 Tetrasiklin HCl kapsul 250 mg
0 0 0 0 0 0 199 Tetrasiklin HCl kapsul 500 mg

0 0 0 0 0 0 200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml
500 500 400 100 3,780 400 201 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg
0 0 0 0 0 0 202 Tramadol inj 50mg/5ml
0 0 0 0 0 0 203 Triheksifenidil Hidroklorida tablet 2 mg
0 0 0 0 0 0 204 Vaksin Rabies Vero - Rabipur
4,500 4,800 2,500 2,300 247,710 2,500 205 Vitamin B komplek tablet
0 0 0 0 0 0 206 zinc drop 10 mg/ ml

25 25 13 12 179,760 13 207 Zinc sirup 10 mg/ml
600 600 500 100 47,400 500 208 Zinc Tab 20 mg
0 0 0 0 0 0
0 0 0 0 0 0 PERBEKALAN KESEHATAN
0 0 0 0 0 0 209 Alat suntik sekali pakai 0,5 ml
0 0 0 0 0 0 210 Alat suntik sekali pakai 1 ml
500 900 500 400 260,000 500 211 Alat suntik sekali pakai 3 ml
0 300 220 80 60,000 220 212 Alat suntik sekali pakai 5 ml

0 0 0 0 0 0 213 Alkohol Swab
0 0 0 0 0 0 214 Aqua bides 20 liter
0 0 0 0 0 0 215
bedah
0 15 14 1 23,299 14 216 Catgut / beneng bedah no 3/0 dengan jarum
bedah
0 0 0 0 0 0 217 Cut gut chromic 3/0
0 0 0 0 0 0 218 Elastis Perban 75 Fesco

0 0 0 0 0 0 219 Exell tulle
0 0 0 0 0 0 220 Foley cateter
0 0 0 0 0 0 221 Handscoon uk 7
0 0 0 0 0 0 222 Handscoon uk 8
0 0 0 0 0 0 223 Hidrogen Peroksida (H2 O2) 10%

150 150 40 110 1,815,000 40 224 Infus set anak
0 0 0 0 0 0 225 Infus set dewasa
0 0 0 0 0 0 226 IV Catheter No. 22 G
0 1 3 -2 -15,400 3 227 IV Catheter No. 24 G
0 4 2 2 15,400 2 228 IV Chateter No 20 G
3 3 0 3 22,500 0 229 Kapas Pembalut / Absorben 250 gram
0 0 0 0 0 0 230 Kasa Pembalut Elastic 3 inchi
0 0 0 0 0 0 231 Kasa Pembalut Elastic 4 inchi
2 2 1 1 55,200 1 232 Kasa Pembalut Hidrofil 36 x 80 cm
0 0 0 0 0 0 233 Kasa Pembalut Hidrofil 4 m x 10
0 0 0 0 0 0 234 Kasa Pembalut Hidrofil 4 m x 5 cm
20 20 8 12 4,350 8 235 Kassa Hidrofil steril uk. 16x16 (surya husada)
0 0 0 0 0 0 236 Kassa Hidrofil steril uk. 18x22 (isi 12 lembar)
0 0 0 0 0 0 237 Kassa kompres steril 40 x 40 cm
0 0 0 0 0 0 238 Kertas Puyer

0 0 5 -5 -38,412 5 239 Klip Plastik 10 x 7 KP
0 0 0 0 0 0 240 Klip Plastik 13x8,7 KP

0 0 0 0 0 0 241 Lisorin 1liter
240 1,040 600 440 495,000 600 242 Masker
0 0 0 0 0 0 243 Pembalut Gibs 3 inchi
0 0 0 0 0 0 244 Plester 5 yard x 2 inch
0 2 2 0 0 2 245 Silk ( Benang Bedah Sutera ) No. 3/0 dg jarum
bedah
0 0 0 0 0 0 246 Sterobat nf. 400ml
0 0 0 0 0 0 247 Strip gula 50 strip (blonime)
0 36 0 36 69,854 0 248 Umbilical cord nylon one med (Klem tali pusat)
0 0 0 0 0 0 249 Under Pet
5 5 0 5 20,000 0 250 Urine Bag
0 0 0 0 0 0 251 Wing Needle No. 21 G
0 0 0 0 0 0 252 Wing Needle No. 23 G
0 0 0 0 0 0 253 Wing Needle No. 25 G
0 0 0 0 0 0 254 Wing Needle No. 27 G
0 0 0 0 0 0
0 0 0 0 0 0 0BAT GIGI
0 0 0 0 0 0 255 Devitalisasi Pasta (Non Arsen)
2 4 2 2 292,600 2 256 Etil klorida spray

0 0 0 0 0 0 257 Glass Ionomer Cement (GC IX) ART
0 0 0 0 0 0 258 Kalsium Hidroksida Pasta
0 0 0 0 0 0 259 Klorfenol Kamfer Mentol (CHKM)
0 0 0 0 0 0 260 Mummifying Pasta
0 0 0 0 0 0 261 Semen Seng Fosfat serbuk dan cairan
0 0 0 0 0 0 262 Temporary Stopping Fletcher (Fletcher) serbuk &
cairan
0 0 0 0 0 0

0 0 0 0 0 0 263 Armovit Kapsul
0 0 0 0 0 0 264 Asifit
0 0 0 0 0 0 265 Betason-N krim
0 0 0 0 0 0 266 Bioneuron Injeksi
0 0 0 0 0 0 267 Bionick
0 0 0 0 0 0 268 Bionick drop
0 0 0 0 0 0 269 Blonick Plus Syr
0 0 0 0 0 0 270 Chlorampecort Cr
0 0 0 0 0 0 271 Diapecta
0 0 0 0 0 0 272 Febrinex Suspensi
0 0 0 0 0 0 273 Fercee
0 0 0 0 0 0 274 Fituno
0 0 0 0 0 0 275 Fludane plus syr 60 ml
0 0 0 0 0 0 276 Flutamol Sirup
0 0 0 0 0 0 277 Hustab
0 0 0 0 0 0 278 Lybex sirup
0 0 0 0 0 0 279 Mersibion inj
0 0 0 0 0 0 280 Neorodial
0 0 0 0 0 0 281 Neurovit-E
0 0 0 0 0 0 282 Noza
0 0 0 0 0 0 283 Poncobex
0 0 0 0 0 0 284 Ponflu
0 0 0 0 0 0 285 Progastric
0 0 0 0 0 0 286 Ramaton
0 0 0 0 0 0 287 Scabicid Cream
0 0 0 0 0 0 288 Siobio
0 0 0 0 0 0 289 Kasa Pembalut Hidrofil 36 x 80 cm

(AHMADARIS)
0 0 0 0 0 0 290 Master Plast Plastik 1 inc (plester)
0 0 0 300
IV Cateter 18 G
0 0 0 0 0 OBAT TAMBAHAN
30 30 18 12 0 18 291
Trufit sirup
1,000 1,000 500 500 0 500 292
CALCIMEGA
50 50 30 20 0 30 293
Solafluz Sirup
1,200 1,200 600 600 0 600 294
Lodecon Forte
700 700 200 500 0 200 295
Solvitron Kapsul
200 200 0 200 0 0 296
Doksisiklin
600 600 300 300 0 300 297
Cloramex 500 MG
300 300 0 300 0 0 298
Loperamid tab 2 mg
1,000 1,000 500 500 0 500 299
Metformin HCL 500 mg
660 660 220 440 0 220 300
Simvastatin 20 mg
300 300 0 300 0 0 301
Spironolakton 25 mg
0 0 0 0 0 0 302
Dletiazepam 5 mg tab
33,197,557
JUMLAH KUNJUNGAN RESEP
Mengetahui/Menyetujui :
Petugas Gudang Farmasi Kepala Dinas Kesehatan
Puskesmas Rawajitu

NIP.197202191992032001
dr. H. Herry Novrizal, MM.Kes.,MM
NIP.197211242002121002
4
:
: Rawajitu
: Rawajitu selatan
: TULANG BAWANG BULAN : April
: LAMPUNG TAHUN : 2017
STOK
PENERIMAAN
HARGA HARGA PER PENGELUAR
SATUAN KMSN PERSEDIAAN STOK AKHIR
SATUAN KEMASAN AN
AWAL
PROGR
APBD I AM DAK DAK Lain lain TOTAL
2015 2014 2017
3 4 5 6 7 8 9 10 11 12 13 14 15 16
tablet 24 tab/Kotak 1,856 44,550 0 0 0 0 0
100
tablet 86 8,600 100 300 300 400 100 300
tablet/kotak
tablet 30 tablet/kotak 331 9,923 0 0 0 0 0
100
tablet 233 23,300 50 0 50 50
tablet/kotak
botol botol 60 ml 3,300 3,300 0 0 0 0 0
100
tablet 86 8,593 0 0 0 0 0
tablet/kotak
100
tablet 80 8,000 0 0 0 0 0
tablet/kotak
ktk 30
ampul 4,050 121,500 0 0 0 0 0
ampul@10 ml
100
tablet 112 11,200 100 0 100 0 100
tablet/kotak
vial 10 vial/kotak 10,125 101,250 0 0 0 0 0
100
tablet 388 38,799 200 0 200 100 100
tablet/kotak
100
tablet 311 31,100 7,000 0 7,000 1,000 6,000
tablet/kotak
botol botol 60 ml 2,445 2,445 128 0 128 30 98
100
tablet 201 20,115 0 0 0 0 0
tablet/kotak
vial 30 vial/kotak 1,800 54,000 0 0 0 0 0
botol botol 60 ml 2,160 2,160 190 0 190 30 160
100
tablet 72 7,200 3,700 0 3,700 500 3,200
tablet/kotak
tube 25 tube/kotak 2,581 62,900 0 0 0 0 0
supp 10 supp/kotak 2,000 20,000 10 0 10 0 10
pot 24 pot/kotak 2,320 55,688 0 0 0 0 0
100
tablet 518 51,800 0 0 0 0 0
tablet/kotak
100
tablet 135 13,500 0 0 0 0 0
tablet/botol
100
tablet 1,500 150,000 0 0 0 0 0
tablet/kotak
vial 10 vial/kotak 7,425 74,250 0 0 0 0 0
ampul 6 ampul/kotak 29,925 179,550 0 0 0 0 0
100
tablet 95 9,500 600 0 600 300 300
tablet/kotak
100
tablet 84 8,400 0 0 0 0 0
tablet/botol
100
tablet 144 14,400 1,000 0 1,000 500 500
tablet/kotak
tube 25 tube/kotak 4,253 101,250 15 0 15 10 5
100
tablet 524 52,404 150 0 150 50 100
tablet/kotak
100
tablet 771 77,130 180 0 180 80 100
tablet/kotak
vial 10 vial/kotak 11,070 110,700 0 0 0 0 0
30
sachet 2,700 2,700 0 0 0 0 0
tablet/sachet
tube tube 1,520 1,520 75 0 75 25 50
turbuhaler turbuhaler 93,000 93,000 0 0 0 0 0
100
ampul 1,580 158,000 15 0 15 10 5
ampul/kotak
100
tablet 62 6,200 800 0 800 400 400
tablet/kotak
tablet 9 tablet/kotak 3,567 32,101 0 0 0 0 0
30
ampul 1,054 31,620 0 0 0 0 0
ampul/kotak
100
tablet 143 14,300 100 0 100 0 100
tablet/kotak
botol botol 3,333 3,333 45 0 45 10 35
botol botol 15,600 15,600 0 0 0 0

100
tablet 167 16,700 300 0 300 100 200
tablet/kotak
1000
tablet 38 38,000 0 0 0 0 0
tablet/botol
30
ampul 8,100 243,000 0 0 0 0 0
ampul/kotak
tablet tablet 650 650 0 0 0 0 0
botol botol 8,000 8,000 0 0 0 0 0
120
tablet 494 59,230 400 0 400 200 200
tablet/kotak
botol botol 7,220 7,220 15 0 15 10 5
botol 100 ml/botol 2,500 2,500 50 0 50 20 30
paket kotak 214,990 214,990 3 0 3 0 3
paket kotak 359,990 359,990 1 0 1 1 0
paket kotak 1,199,900 1,199,900 8 0 8 0 8
ampul ampul 20,250 20,250 0 0 0 0 0
kapsul botol 133 13,300 0 0 0 0 0

30
ampul 1,800 54,000 0 60 60 60 0 60
ampul/kotak
100
tablet 220 22,000 0 0 0 0 0
tablet/kotak
botol 24 botol/kotak 2,042 49,008 0 0 0 0 0
10
ampul 4,698 46,980 0 0 0 0 0
ampul/kotak
30
ampul 3,417 102,510 230 0 230 10 220
ampul/kotak
100
tablet 634 63,400 0 0 0 0 0
tablet/botol
25
ampul 1,829 45,725 0 0 0 0 0
ampul/kotak
100
tablet 85 8,500 400 0 400 100 300
tablet/kotak
100
sachet 292 29,200 700 0 700 200 500
sachet/kotak
tube tube 2,600 2,600 33 0 33 13 20
botol 5 ml/botol 3,194 3,194 5 0 5 5 0
botol botol 900 900 0 0 0 0 0
101
tablet 56 5,600 900 0 900 200 700
tablet/kotak
1000
tablet 28 27,900 9,000 0 9,000 1,000 8,000
tablet/botol
tablet tablet 1,500 1,500 0 0 0 0 0
kotak kotak 187,200 187,200 0 0 0 0 0
botol 500 ml/botol 5,700 5,700 0 0 0 0 0
botol botol 1,960 1,960 0 0 0 0 0
botol 500 ml/botol 5,200 5,200 10 0 10 5 5
100
tablet 324 32,400 0 0 0 0 0
tablet/kotak
ampul ampul 83,333 83,333 0 0 0 0 0
100
tablet 53 5,252 800 0 800 0 800
tablet/kotak
100
tablet 83 8,258 800 0 800 0 800
tablet/kotak
100
tablet 88 8,823 0 0 0 0 0
tablet/kotak
tiube 24 tube/kotak 2,798 67,152 30 0 30 15 15
botol botol 3,499 3,499 0 0 0 0 0
botol botol 4,499 4,499 0 0 0 0 0
100
tablet 116 11,550 0 0 0 0 0
tablet/botol
100
tablet 150 15,000 600 0 600 100 500
tablet/kotak
100
tablet 81 8,071 200 0 200 100 100
tablet/kotak
100
tablet 70 7,000 900 0 900 200 700
tablet/kotak
100
tablet 62 6,200 300 0 300 100 200
tablet/kotak
100
tablet 84 8,400 300 0 300 300 0
tablet/kotak
100
tablet 243 24,300 100 0 100 0 100
tablet/kotak
50
tablet 554 27,675 0 0 0 0 0
tablet/kotak
tube 12 tube/kotak 4,700 56,400 10 0 10 5 5
100
tablet 1,823 182,250 0 0 0 0 0
tablet/kotak
kotak 8,700 0 0 0 0 0
kotak 64,000 0 0 0 0 0
100
tablet 578 57,750 0 0 0 0 0
tablet/kotak
botol botol 1,599 1,599 0 0 0 0 0
100
tablet 51 5,100 4,800 0 4,800 1,000 3,800
tablet/kotak
100
tablet 149 14,900 0 0 0 0 0
tablet/kotak
30
ampul 1,021 30,630 0 0 0 0 0
ampul/kotak
30
ampul 950 28,500 0 0 0 0 0
ampul/kotak
100
tablet 149 14,900 100 0 100 0 100
tablet/kotak
100
tablet 500 50,000 0 200 200 200 0 200
tablet/kotak
botol botol 60 ml 2,190 2,190 115 0 115 30 85
100
tablet 138 13,800 0 0 0 0 0
tablet/kotak
botol botol 10,000 10,000 0 0 0 0 0
botol botol 10,000 10,000 0 0 0 0 0
30
ampul 1,333 40,000 35 0 35 15 20
ampul/kotak
vial 10 vial/kotak 2,078 20,780 0 0 0 0 0
vial 10 vial/kotak 2,629 26,290 0 0 0 0 0
100
tablet 154 15,400 0 0 0 0 0
tablet/kotak
30
ampul 2,175 65,250 0 0 0 0 0
ampul/kotak
30
tablet 635 19,050 0 0 0 0 0
tablet/kotak
100
tablet 300 30,000 300 0 300 100 200
tablet/kotak
10
ampul 2,070 20,700 0 0 0 0 0
ampul/kotak
100
tablet 110 11,000 300 0 300 100 200
tablet/kotak
botol botol 100 ml 39,825 39,825 0 0 0 0 0
suppositori suppositoria 3,220 3,220 0 0 0 0 0
a 100
tablet 193 19,305 0 0 0 0 0
tablet/kotak
tablet kotak 160 16,000 0 0 0 0 0
tube tube 3,000 3,000 10 0 10 5 5
40
sachet 2,450 98,000 600 0 600 0 600
sachet/kotak
ampul ampul 6,200 6,200 0 0 0 0 0
tablet kotak 174 8,700 0 0 0 0 0
botol botol 4,900 4,900 90 0 90 20 70
tube 24 tube/kotak 2,979 71,500 0 0 0 0 0
tablet tablet 1,694 1,694 0 0 0 0 0
tablet kotak 129 12,900 300 0 300 100 200
100
tablet 640 64,000 100 0 100 0 100
tablet/kotak
100
tablet 480 47,960 0 0 0 0 0
tablet/kotak
botol botol 5,500 5,500 40 0 40 20 20
100
tablet 207 20,650 0 0 0 0 0
tablet/kotak
100
tablet 327 32,700 200 0 200 100 100
tablet/kotak
botol botol 27,550 27,550 0 0 0 0 0
tube 25 tube/kotak 1,600 40,000 0 0 0 0 0
10
ampul 2,200 22,000 40 0 40 10 30
ampul/kotak
ampul ampul 2,400 2,400 20 0 20 10 10
100
tablet 119 11,900 0 0 0 0 0
tablet/kotak
botol botol 5,200 5,200 0 0 0 0 0
60 ml botol 60 ml 1,438 1,438 58 0 58 38 20
100
tablet 79 7,900 10,500 0 10,500 2,000 8,500
tablet/kotak
100
tablet 609 60,885 0 0 0 0 0
tablet/kotak
100
tablet 1,084 108,405 0 0 0 0 0
tablet/kotak
10
ampul 7,425 74,250 0 0 0 0 0
ampul/kotak
botol botol 8,250 8,250 0 0 0 0 0
100
tablet 110 11,000 2,600 0 2,600 600 2,000
tablet/kotak
100
tablet 105 10,500 700 0 700 200 500
tablet/kotak
botol botol 30 ml 2,163 2,163 0 0 0 0 0
botol botol 300 ml 14,203 14,203 1 0 1 0 1
100
tablet 114 11,400 400 0 400 100 300
tablet/kotak
vial 30 vial/kotak 10,780 323,400 0 0 0 0 0
100
tablet 404 40,442 0 0 0 0 0
tablet/botol
25
ampul 3,614 86,738 65 0 65 15 50
ampul/kotak
100
tablet 120 12,000 2,700 0 2,700 500 2,200
kaplet/kotak
kapsul 50 kapsul/botol 460 23,000 0 0 0 0 0
kapsul 50 kapsul/botol 260 13,000 0 0 0 0 0
botol botol 500 ml 5,200 5,200 40 0 40 10 30
100
tablet 59 5,900 400 0 400 100 300
tablet/kotak
100
tablet 97 9,749 700 0 700 100 600
tablet/kotak
Botol Botol 63,750 63,750 0 0 0 0 0
kapsul kapsul 431 431 0 0 0 0 0
rotahaler rotahaler 5,867 5,867 0 0 0 0 0
pot pot 2,000 2,000 0 0 0 0 0
kotak kotak 1,250 1,250 0 0 0 0 0

botol botol 4,896 4,896 25 0 25 15 10
vial 2 vial/kotak 6,050 12,100 10 0 10 6 4

vial vial 11,000 11,000 16 0 16 6 10
Dus, 10 vial @
47,300 473,000 0 0 0 0 0
Dus, 510mlampul
ampul 12,600 126,000 0 0 0 0 0
@ 1 ml
100
tablet 181 18,100 0 0 0 0 0
tablet/kotak
100
ampul 916 91,600 0 0 0 0 0
ampul/kotak
100
tablet 111 11,100 0 0 0 0 0
tablet/kotak
100
tablet 255 25,500 400 0 400 100 300
tablet/kotak
100
tablet 478 47,800 0 0 0 0 0
tablet/kotak
30
sachet 1,260 1,260 3,600 0 3,600 600 3,000
tablet/sachet
50
tablet 99 4,950 100 0 100 0 100
tablet/kotak
100
kaplet 149 14,900 0 0 0 0 0
kaplet/kotak
100
kaplet 257 25,700 0 0 0 0 0
kaplet/kotak
30
ampul 690 20,700 0 0 0 0 0
ampul/kotak
1000
tablet 38 37,800 100 0 100 100 0
tablet/botol
100
tablet 40 4,000 0 0 0 0 0
tablet/kotak
Dus, 1 vial @
vial 1 dosis + 78,500 78,500 0 8 8 8 0 8
syringe
100
tablet 108 10,700 2,300 0 2,300 500 1,800
tablet/kotak
botol botol 12,840 12,840 0 0 0 0 0
botol botol 14,980 14,980 12 0 12 6 6
100
tablet 474 47,400 100 0 100 100 0
tablet/kotak
0 0 0 0 0
0 0 0 0 0
pcs kotak/ 100 psc 2,140 214,000 0 0 0 0 0

pcs kotak/ 100 psc 650 65,000 0 0 0 0 0
pcs kotak/ 100 psc 650 65,000 400 0 400 100 300
pcs kotak/ 100 psc 750 75,000 80 0 80 80 0
pcs kotak/ 100 psc 216 21,560 0 0 0 0 0
galon galon 174,000 174,000 0 0 0 0 0
pcs 24pcs/kotak 26,667 640,000 0 0 0 0 0
pcs 24psc/kotal 23,299 559,176 1 0 1 1 0
pcs 24 pcs/kotak 5,583 134,000 0 0 0 0 0
roll roll 17,160 17,160 0 0 0 0 0
pcs kotak / psc 14,014 14,014 0 0 0 0 0
pcs pcs 8,495 8,495 0 0 0 0 0
pcs kotak 5,267 5,267 0 200 200 200 0 200
pcs kotak 5,270 5,270 0 0 0 0 0
botol botol 800 ml 30,238 30,238 0 0 0 0 0
set 50 set/kotak 16,500 82,500 110 0 110 10 100
set 50 set/kotak 6,785 339,250 0 80 80 80 0 80
set 50 set/kotak 7,700 385,000 0 50 50 50 0 50
set 50 set/kotak 7,700 385,000 50 50 50 50
set 50 set/kotak 7,700 385,000 2 50 50 52 2 50
Bungkus Bungkus 7,500 7,500 3 0 3 1 2
pcs psc 7,000 7,000 0 0 0 0 0
pcs psc 10,000 10,000 0 0 0 0 0
Rol Rol 55,200 55,200 1 0 1 1 0
roll roll 30,350 30,350 0 0 0 0 0
roll roll 30,350 30,350 0 0 0 0 0
16
pcs 363 5,800 12 100 100 112 8 104
lembar/kotak
12
pcs 396 4,750 0 0 0 0 0
lembar/kotak
Pcs Pcs 1,600 1,600 0 0 0 0 0
pack ball/ 10 pack 6,402 64,020 0 0 0 0 0
pack ball/ 10 pack 7,682 76,820 -5 0 0 0
pack ball/ 10 pack 11,204 114,000 0 50 50 50 0 50
botol botol 18,865 18,865 0 0 0 0 0
pcs 50 pcs/kotak 1,125 56,250 440 0 440 100 340
rol rol 23,500 23,500 0 0 0 0 0
Rol Rol 23,625 23,625 0 0 0 0 0
pcs 36pcs/kotak 14,316 515,376 0 0 0 0
botol botol 78,000 78,000 0 0 0 0 0
box box 464,000 464,000 0 0 0 0 0
pcs kotak/ 50 psc 1,940 97,020 36 0 36 0 36
pcs 10 pcs/kotak 5,390 53,900 0 0 0 0 0
Pcs Pcs 4,000 4,000 5 0 5 1 4
Pcs kotak/ 100 psc 5,770 577,000 0 0 0 0 0
Pcs kotak/ 100 psc 5,770 577,000 0 0 0 0 0
Pcs kotak/ 100 psc 5,770 577,000 0 0 0 0 0
Pcs kotak/ 100 psc 5,770 549,750 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
kotak kotak 390,000 390,000 0 0 0 0 0

botol botol 146,300 146,300 2 0 2 1 1
botol botol 395,000 395,000 0 0 0 0 0
kotak kotak 242,000 242,000 0 0 0 0 0
botol botol 55,000 55,000 0 0 0 0 0
kotak kotak 176,000 176,000 0 0 0 0 0
botol botol 93,500 93,500 0 0 0 0 0
botol botol 34,000 34,000 0 0 0 0 0
0 0 0 0 0
0 0 0 0
30
kapsul 1,537 46,100 0 0 0 0 0
kapsul/kotak
30
kapsul 1,818 54,540 0 0 0 0 0
kapsul/kotak
Tube 24 tube/kotak 9,182 220,368 0 0 0 0 0
Kotak 5
ampul 4,341 21,705 0 0 0 0 0
Ampul
botol 60 ml/botol 16,000 16,000 0 0 0 0 0
botol 15 ml/botol 22,500 22,500 0 0 0 0 0
Botol Botol 18,700 18,700 0 0 0 0 0
Tube Tube 10 gr 9,085 9,085 0 0 0 0 0
100
Tablet 384 38,400 0 0 0 0 0
tablet/kotak
Botol Botol 15,855 15,855 0 0 0 0 0
100
Tablet 1,044 104,400 0 0 0 0 0
tablet/kotak
Tablet 30 kaplet/kotak 3,273 98,190 0 0 0 0 0
botol botol 60 ml 15,950 15,950 0 0 0 0 0
botol 60 mL/botol 13,500 13,500 0 0 0 0 0
Tablet 10 tablet/strip 284 2,840 0 0 0 0 0
botol botol 60 ml 19,800 19,800 0 0 0 0 0
10
ampul 4,400 44,000 0 0 0 0 0
ampul/kotak
100
kaplet 1,091 109,100 0 0 0 0 0
kaplet/kotak
Tablet 60 tablet/kotak 818 49,080 0 0 0 0 0
kotak 100
Tablet 1,353 135,300 0 0 0 0 0
tablet100
kotak
Tablet 935 93,500 0 0 0 0 0
tablet
100
Tablet 698 69,800 0 0 0 0 0
tablet/kotak
Tube Tube 10 gr 28,380 28,380 0 0 0 0 0
kotak 100
kapsul 946 94,600 0 0 0 0 0
kapsul
rol rol 140,337 140,337 0 0 0 0 0
roll roll 27,088 27,088 0 0 0 0 0
0 50 50 50 50
0 0 0 0 0
Botol Kotak 12 0 12 10 2
Tablet Kotak 500 0 500 300 200
Botol Kotak 20 0 20 10 10
Tablet Kotak 600 0 600 300 300
Kapsul Kotak 500 0 500 200 300

Kapsul Kotak 200 0 200 100 100
Kapsul Kotak 300 0 300 100 200
Tablet Kotak 300 0 300 0 300
tablet Kotak 500 0 500 100 400
Tablet Kotak 440 0 440 220 220
Tablet Kotak 300 0 300 100 200
Tablet Kotak 0 200 200 200 0 200
UMUM
TIDAK BAYAR
BAYAR
Yang Menyerahkan Yang Menerima/Melapor

Kepala UPT Instalasi Farmasi Kepala Puskesmas Petugas Gudang Farmasi
Baidulllah S Siagian Endang Sulastri Amd.Keb

NIP.196901241989021001 NIP.197202191992032001
Melina Susan,S.si., Apt
NIP. 198105062005012010
PEMAKAIAN
STOK AKHIR
RATA-RATA PERMINTAA
DALAM
S/D BULAN N
RUPIAH
INI
17 18 19
0 0 300
25,800 100 2,000
0 0 2,000
11,650 0 500
0 0 200
0 0
0 0
0 0
11,200 0
191,400 120
43,010 120
0 0
38,799 100
1,866,000 1,000
239,610 30
0 0
0 0
345,600 30
230,400 500
0 0
20,000 0
0 0
0 0
0 0
0 0
0 0
0 0
28,500 300
0 0
72,000 500
21,265 10
52,400 50
77,100 80
0 0
0 0
76,000 25
0 0
0 0
0 0
7,900 10
24,800 400
0 0
0 0
14,300 0
116,655 10
0 0
33,400 100
0 0
0 0
0 0
0 0
98,716 200
36,100 10
75,000 20
644,970 0
0 1
9,599,200 0
0 0
0 0
108,000 0
0 0
0 0
0 0
751,740 10
0 0
0 0
25,500 100
146,000 200
52,000 13
0 5
0 0
0 0
39,200 200
174,400 100
223,200 1,000
0 0
0 0
0 0
0 0
26,000 5
0 0
0 0
42,016 0
66,064 0
0 0
41,970 15
0 0
0 0
0 0
75,000 100
8,070 100
49,000 200
12,400 100
0 300
24,300 0
0 0
23,500 5
0 0
0 0
0 0
0 0
115,000 10
0 0
0 0
0 0
0 0
193,800 1,000
0 0
0 0
0 0
14,900 0
100,000 0
186,150 30
0 0
0 0
0 0
0 0
26,667 15
0 0
0 0
0 0
0 0
0 0
0 0
60,000 100
0 0
22,000 100
0 0
0 0
0 0
0 0
15,000 5
1,470,000 0
0 0
40,000 100
0 0
343,000 20
0 0
0 0
25,800 100
64,000 0
0 0
0 0
110,000 20
0 0
32,700 100
0 0
0 0
66,000 10
44,310 60
71,600 80
392,370 200
24,000 10
0 0
0 0
28,760 38
671,500 2,000
0 0
0 0
0 0
0 0
62,975 30
220,000 600
52,500 200
0 0
14,203 0
34,200 100
0 0
0 0
180,700 15
264,000 500
0 0
0 0
156,000 10
17,700 100
58,494 100
0 0
0 0
0 0
0 0
0 0
0 0
312,600 200
48,960 15
24,200 6
110,000 6
0 0
0 0
0 0
0 0
0 0
0 0
76,500 100
0 0
3,780,000 600
9,900 0
0 0
0 0
0 0
0 0
0 100
0 0
0 0
628,000 0
193,860 500
0 0
89,880 6
0 100
0 0
0 0
0 0
0 0
195,000 100
0 80
0 0
0 0
0 0
0 1
0 0
0 0
0 0
0 0
1,053,333 0
0 0
0 0
1,650,000 10
542,764 0
385,000 0
385,000 0
385,000 2
15,000 1
0 0
0 0
0 1
0 0
0 0
37,700 8
0 0
0 0
0 0
0 0
560,175 0
0 0
382,500 100
0 0
0 0
0 0
0 0
0 0
69,854 0
0 0
16,000 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
146,300 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 10
0 300
0 10
0 300
0 200
0 100
0 100
0 0
0 100
0 220
0 100
0 0
32,165,989
5
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK
PENERIMAAN
HARGA HARGA PER
SATUAN KEMASAN
AWAL
APBD I PROGRAM DAK DAK Lain lain
2015 2014 2017
1 2 3 4 5 6 7 8 9 10 11 12
1 ACT (Artesunat + Amodiaquin ) tablet 24
tablet 1,856 44,550 0
tab/Kotak
100
2 Alopurinol tablet 100 mg tablet 86 8,600 300
tablet/kotak
30
tablet/kotak
100
4 Alprazolam tablet 1 mg tablet 233 23,300 50
tablet/kotak
6 Ambroxol tab 30 mg 100
tablet 86 8,593 0
tablet/kotak
100
7 Aminofilin tablet 200mg tablet 80 8,000 0
ktk 30
tablet/kotak
8 Aminofilina injeksi 24 mg/ml ampul ampul@10 4,050 121,500 0
9 Amitriptillin tablet salut 25 mg ml
100
tablet 112 11,200 100
tablet/kotak
30
10 Amlodipine Tablet 10 mg tablet 330 9,900 580
tablet/kotak
30
tablet/kotak
12 Amoksisilin Injeksi serbuk 1000mg 10
vial 10,125 101,250 0
vial/kotak
13 Amoksisilin kapsul 250 mg 100
tablet 388 38,799 100
tablet/kotak
tablet 311 31,100 6,000
tablet/kotak
16 Antalgin (Metampiron) tablet 500 mg 100
tablet 201 20,115 0
tablet/kotak
30
17 Antalgin injeksi 250 mg/ml - 2 ml vial 1,800 54,000 0
vial/kotak
19 Antasida DOEN tablet 100
Anti Bakteri DOEN salep tablet 72 7,200 3,200
tablet/kotak
25
20 kombinasi:Bacitracin-polymixin B tube 2,581 62,900 0
tube/kotak
10
21 krim
Anti Hemoroid DOEN Kombinasi supp 2,000 20,000 10
Antifungi DOEN Kombinasi: supp/kotak
22 Asam Benzoat 6% + Asam Salisilat pot 24 pot/kotak 2,320 55,688 0
23 3% 100
Antimalaria DOEN kombinasi tablet 518 51,800 0
tablet/kotak
24 Antimigren:Ergotamin Tartrat 1mg tablet
100
135 13,500 0
Antiparkinson
+Kofein 50mg DOEN tablet tablet/botol
25 Kombinasi benzerazid 25 mg levodopa 100
tablet 1,500 150,000 0
tablet/kotak
10
26 100
Aquamg
pro( Levopar)
Injeksi steril, bebas pirogen vial 7,425 74,250 0
vial/kotak
6
27 Arthemeter injeksi 1 ml : 80 mg ampul 29,925 179,550 0
ampul/kotak
100
28 Asam Askorbat (Vit C) tablet 50 mg tablet 95 9,500 300
tablet/kotak
100
29 Asam folat tablet 1 mg tablet 84 8,400 0
tablet/botol
30 Asam mefenamat 100
tablet 144 14,400 500
tablet/kotak
25
31 Asiklovir krim 5% tube 4,253 101,250 5
tube/kotak
100
32 Asiklovir tablet 200 mg tablet 524 52,404 100
tablet/kotak
33 Asiklovir tablet 400 mg 100
tablet 771 77,130 100
tablet/kotak
34 Benzatin Benzil Penicillin injeksi 1,2 vial
10
11,070 110,700 0
jt IU/vial vial/kotak
30
35 Besi (II ) Sulfat + asam folat 0.25 tab sachet 2,700 2,700 0
tablet/sachet
37 Budesonid inhaler 200 mcg/puff, 100 turbuhaler turbuhaler 93,000 93,000 0
38 combination) inhaler 160/4,5 mcg turbuhaler turbuhaler 117,600 117,600 0
combination) inhaler 80/4,5 mcg turbuhaler turbuhaler 110,500 110,500 0
(symbicort)
40 Deksametason injeksi 5mg.ml-1ml 100
ampul 1,580 158,000 5
ampul/kotak
100
41 Deksametason tablet 0,5 mg tablet 62 6,200 400
tablet/kotak
9
42 DHP tablet (Prog : malaria) tablet 3,567 32,101 0
tablet/kotak
43 Difenhidramin HCl injeksi 10 mg/mlampul
30
1,054 31,620 0
1ml ampul/kotak
44 Digoksin tablet 0,25 mg 100
tablet 143 14,300 100
tablet/kotak
47 Domperidone tablet 10mg 100
tablet 167 16,700 200
tablet/kotak
48 Ekstrak Belladon tablet 10 mg 1000
tablet 38 38,000 0
Epinefrina HCl/Bitartrat ( Epinefrina / tablet/botol
49 Adrenalina ) 30
ampul 8,100 243,000 0
ampul/kotak
50 Ergakalsiferol
ml D3/D2) kapsul
51 Ergakalsiferol (vitamin D3/D2) botol botol 8,000 8,000 0
suspensi 10000 UI/ml (D-Vit syrup) 120
52 Eritromisin kapsul 250mg tablet 494 59,230 200
tablet/kotak
botol 2,500 2,500 30
ml/botol
60 Fenobarbital Injeksi i.m/i.v 50 mg/ml 30
ampul 1,800 54,000 60
ampul/kotak
61 Fenobarbital tablet 100 mg 100
tablet 220 22,000 0
tablet/kotak
62 Fenol Gliserol tetes telinga 10% botol
24
2,042 49,008 0
(Karbogliserin 10%) botol/kotak
63 Fitomenadion (Vit.K1) injeksi 10 ampul
10
4,698 46,980 0
mg/ml - 1 ml ampul/kotak
64 Fitomenadion (Vit.K1) injeksi ampul
30
3,417 102,510 220
2mg/ml ampul/kotak
65 Fitomenadion (Vit.K1)tab salut gula tablet
100
634 63,400 0
10 mg tablet/botol
66 Furosemid inj 40 mg/ml 25
ampul 1,829 45,725 0
ampul/kotak
100
67 Furosemid tablet 40 mg tablet 85 8,500 300
Garam oralit untuk 200 ml air (Prog : tablet/kotak
100
68 sachet 292 29,200 500
diare)
Gentamicin salep mata 0,3 % sachet/kotak
69 tube tube 2,600 2,600 20
(genoint )
71 Gentamisin injeksi 40 mg/ml 5
ampul 3,399 16,995 0
ampul/kotak
73 Glibenklamid tablet 5 mg 101
tablet 56 5,600 700
tablet/kotak
74 Glimepiride tablet 2 mg 50
tablet 436 21,800 400
tablet/kotak
1000
75 Gliseril Guayacolat tablet 100 mg tablet 28 27,900 8,000
tablet/botol
76 Gliseril trinitrat tab sublingual 0,5mg tablet tablet 1,500 1,500 0
(nitral)
78 Glukosa larutan infus 10% steril botol
500
5,700 5,700 0
(Produk lokal) ml/botol
79 Glukosa larutan infus 40% steril botol botol 1,960 1,960 0
(Produk lokal)
500
5,200 5,200 5
(Produk lokal)tablet 125 mg,
Griseofulvin ml/botol
100
81 tablet 324 32,400 0
micronized tablet/kotak
82 Haloperidol inj 50 mg/ml (haldol ampul ampul 83,333 83,333 0
decanoas)
83 Haloperidol tablet 0,5 mg 100
tablet 53 5,252 800
tablet/kotak
tablet 83 8,258 800
tablet/kotak
85 Haloperidol tablet 5 mg 100
tablet 88 8,823 0
tablet/kotak
86 Hidrokortison krim 2,5% 24
tiube 2,798 67,152 15
tube/kotak
89 Ibuprofen tablet 200 mg 100
tablet 116 11,550 0
tablet/botol
100
90 Ibuprofen tablet 400 mg tablet 150 15,000 500
tablet/kotak
91 Isosorbid Dinitrat tablet sublingual 5 tablet
100
81 8,071 100
mg tablet/kotak
92 Kalsium Laktat tab 500 mg 100
tablet 70 7,000 700
tablet/kotak
93 Kaptopril tablet 12,5 mg 100
tablet 62 6,200 200
tablet/kotak
94 Kaptopril tablet 25 mg 100
tablet 84 8,400 0
tablet/kotak
95 Karbamazepin tablet 200 mg 100
tablet 243 24,300 100
tablet/kotak
50
96 Ketokenazol tablet 200mg tablet 554 27,675 0
tablet/kotak
97 Ketokonazol krim 2% 12
tube 4,700 56,400 5
tube/kotak
98 Ketoprofen tablet 100 mg 100
tablet 1,823 182,250 0
tablet/kotak
5
99 Ketorolak inj 10 mg ampul 8,080 40,400 0
ampul/kotak
102 Ketorolak inj 30 mg 6
ampul 2,300 13,800 50
ampul/kotak
50
103 Klindamisin 150 mg tablet 382 19,100 0
tablet/kotak
50
tablet/kotak
100
105 Kloramfenikol kapsul 250 mg tablet 578 57,750 0
tablet/kotak
107 Klorfeniramin Maleat (CTM) tablet 100
tablet 51 5,100 3,800
tablet/kotak
100
108 Klorpromasin tablet 100 mg tablet 149 14,900 0
tablet/kotak
109 Klorpromazin HCl injeksi 25 mg/ml - ampul
30
1,021 30,630 0
1 ml (SK.720 : kemasan 2 ml) ampul/kotak
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ampul
30
950 28,500 0
ml ampul/kotak
100
111 Klorpromazin HCl tablet salut 100 mg tablet 149 14,900 100
tablet/kotak
112 Kodein 10 mg tablet 100
Kotrimoksazol Susp komb: tablet 500 50,000 200
tablet/kotak
113 Sulfametoksazol 200mg + botol botol 60 ml 2,190 2,190 85
Kotrimoksazol tablet komb:
114 Trimetoprim 40 mg 100
Sulfametoksazol 400mg + tablet 138 13,800 0
tablet/kotak
115 Trimetoprim
Larutan 80 mg karbohidrat +
mengandung 1
Lansoprazol inj 30 mg/ml ampul 82,042 82,042 0
ampul/kotak
116 elektrolit (NaCl 1,75 gr.
Larutan mengandung Na Lactat+
karbohidrat botol botol 10,000 10,000 0
2,24 gr. KCl 1.5 gr.Dextrosa 27 gr) /
117 elektrolit
KA EN 3B
(NaCl 2,34 gr. Na Lactat
botol botol 10,000 10,000 0
2,24 gr. KCl 0.75 gr. Dextrosa 27 gr) / 30
118 Lidokaian
KA EN 3Ainj 2 % ampul 1,333 40,000 20
ampul/kotak
119 Magnesium Sulfat inj (IV) 20% - 25 vial
10
2,078 20,780 0
ml
Magnesium Sulfat inj (IV) 40% - 25 vial/kotak
10
120 vial 2,629 26,290 0
ml vial/kotak
30
121 Mebendazol tablet 100 mg tablet 228 6,840 0
tablet/kotak
122 Metilergometrin Maleat tablet
100
154 15,400 0
(Metilergometrin) tab salut 0,125 mg tablet/kotak
123 Metilergometrin Maleat inj 0,200 mg- ampul
30
2,175 65,250 0
1 ml ampul/kotak
124 Metilprednisolon tablet 16 mg 30
tablet 635 19,050 0
tablet/kotak
100
125 metilprednisolon tablet 4 mg tablet 300 30,000 200
tablet/kotak
10
126 Metoklopramid inj 5 mg/ml ampul 2,070 20,700 0
ampul/kotak
127 Metoklopramid 5 mg 100
tablet 110 11,000 200
tablet/kotak
128 Metronidazol Infus 500mg/100ml botol 100
botol 39,825 39,825 0
ml
129 Metronidazol supositoria 500 mg suppositori 3,220 3,220 0
( flagyl) suppositoria
100
130 Metronidazol tablet 250 mg a
tablet 193 19,305 0
tablet/kotak
133 Mineral mix (Prog. Gizi) 40
sachet 2,450 98,000 600
sachet/kotak
134 Natrium Bikarbonat inj i.v 8,4% ampul ampul 6,200 6,200 0
(meylon)
135 Natrium Diklofenac 50 mg 50
tablet 200 10,000 200
tablet/kotak
137 Natrium Klorida larutan infus 0,9 % botol botol 4,900 4,900 70
steril (Produk lokal) 24
138 Hidrokortison krim 2,5% tube 2,979 71,500 0
tube/kotak
141 Nistatin tablet salut 500.000 IU 100
tablet 640 64,000 100
tablet/kotak
30
142 Noretisteron tablet 5 mg (Primolut N) tablet 2,618 78,540 0
tablet/kotak
100
143 Nystatin vaginal tablet 100.000 UI tablet 480 47,960 0
tablet/kotak
145 Ofloxacin 200 mg Tab Salut Selulose 100
tablet 207 20,650 0
tablet/kotak
100
146 Ofloxacin 400 mg Tab Salut Selulose tablet 327 32,700 100
Oksimetazolin tetes hidung 0,025% tablet/kotak
147 botol botol 27,550 27,550 0
(ilaidin drop) 25
148 Oksitetrasiklin HCl salep mata 1 % tube 1,600 40,000 0
tube/kotak
10
149 Oksitosin injeksi 10IU/ml-1ml ampul 2,200 22,000 30
ampul/kotak
150 Omeprazol kapsul 20mg 30
tablet 211 6,330 210
tablet/kotak
151 ondansetron tablet 4 mg 30
tablet 716 21,480 100
tablet/kotak
tablet 1,189 35,670 330
tablet/kotak
154 Papaverin tablet 40mg 100
tablet 119 11,900 0
tablet/kotak
157 Parasetamol tablet 500 mg 100
tablet 79 7,900 8,500
tablet/kotak
100
158 Piracetam 400 mg Tablet tablet 609 60,885 0
tablet/kotak
100
159 Piracetam 800 mg kapsul tablet 1,084 108,405 0
tablet/kotak
10
160 Piracetam inj 1 gr/ 5 ml ampul 7,425 74,250 0
ampul/kotak
162 Pirantel tablet 125 mg
30
tablet 420 12,595 150
tablet/kotak
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 110 11,000 2,000
tablet/kotak
100
164 Piroksikam 20 mg tablet 105 10,500 500
tablet/kotak
167 Prednisone tablet 5 mg 100
tablet 114 11,400 300
tablet/kotak
168 Prokain Benzil Penicillin G injeksi 3 jt vial
30
10,780 323,400 0
IU/vial vial/kotak
100
169 Propiltiourasil tablet 100 mg tablet 404 40,442 0
tablet/botol
25
170 Ranitidin inj.25mg/2ml ampul 3,614 86,738 50
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 2,200
kaplet/kotak
172 Retinol (Vitamin A) 200.000 IU kapsul
50
460 23,000 0
Kapsul Lunak kapsul/botol
50
260 13,000 0
175 Salbutamol 2 mg 100
tablet 59 5,900 300
tablet/kotak
tablet 97 9,749 600
Salbutamol inshalasi/ aerosol 100 tablet/kotak
177 Botol Botol 63,750 63,750 0
178 Salbutamol inshalasi/ aerosol 200 kapsul kapsul 431 431 0
179 Salbutamol inshalasi/ aerosol 200 rotahaler rotahaler 5,867 5,867 0
180 Salep 2-4 Komb : As Salisilat 2 % + pot pot 2,000 2,000 0
Belerang endap 2 %
182 Sefadroksil kapsul 250 mg 30
tablet 855 25,650 0
tablet/kotak
tablet 1,042 52,100 300
tablet/kotak
187 Serum Anti Bisa Ular Polivalen injeksi Dus, 10 vial
47,300 473,000 0
5 ml (ABU I) Dus,
@ 5 ml10
188 Serum Anti Tetanus injeksi 1.500 ampul ampul @ 1 12,600 126,000 0
IU/ampul (A.T.S)
189 Setrizin tablet 10 mg ml
100
tablet 181 18,100 0
tablet/kotak
190 Sianokobalamin (vit B12) injeksi ampul
100
916 91,600 0
500mcg-ml ampul/kotak
100
191 Simetidin tablet 200 mg tablet 111 11,100 0
tablet/kotak
50
192 Si mvastatin 10 Mg tablet 693 34,628 0
tablet/kotak
100
193 Siproflaxacin tablet 500 mg tablet 255 25,500 300
tablet/kotak
194 Sulfadoxine Pyrimethamine 525 mg tablet
100
478 47,800 0
tablet tablet/kotak
30
195 Tablet Tambah Darah sachet 1,260 1,260 3,000
tablet/sachet
196 Terbutalin sulfat (Molasma) tablet 2,5 tablet
50
99 4,950 100
mg tablet/kotak
197 Terbutalin turbu (serbuk ih) 0,50 mg turbuhaler turbuhaler 71,100 71,100 0
(bricasma turbuhaler 0,5mg)
198 Tetrasiklin HCl kapsul 250 mg 100
kaplet 149 14,900 0
kaplet/kotak
kaplet 257 25,700 0
kaplet/kotak
200 Tiamin HCl (Vit.B1) injeksi 100 ampul
30
690 20,700 0
mg/ml-1 ml ampul/kotak
201 Tiamin HCl / Mononitrat (Vit.B1) tablet
1000
38 37,800 0
tablet 50 mg tablet/botol
5
202 Tramadol inj 50mg/5ml ampul 5,400 27,000 0
ampul/kotak
203 Triheksifenidil Hidroklorida tablet 2 tablet
100
40 4,000 0
mg tablet/kotak
Dus, 1 vial
204 Vaksin Rabies Vero - Rabipur vial @ 1 dosis + 78,500 78,500 8
100
tablet 108 10,700 1,800
tablet/kotak
208 Zinc Tab 20 mg 100
tablet 474 47,400 0
tablet/kotak
0
209 Alat suntik sekali pakai 0,5 ml kotak/ 100

pcs 2,140 214,000 0
psc
210 Alat suntik sekali pakai 1 ml kotak/ 100
pcs 650 65,000 0
psc
pcs 650 65,000 300
psc 100
kotak/
psc 100
kotak/
psc
Catgut / benang bedah no 2/0 dengan
215 pcs 24pcs/kotak 26,667 640,000 0
jarum bedah
216 Catgut / beneng bedah no 3/0 dengan pcs 24psc/kotal 23,299 559,176 0
jarum bedah
223 Hidrogen Peroksida (H2 O2) 10% botol 800
botol 30,238 30,238 0
ml
16
235 Kassa Hidrofil steril uk. 16x16 (surya pcs lembar/kota 363 5,800 104
husada) 12
236 Kassa Hidrofil steril uk. 18x22 (isi 12 pcs k
lembar/kota 396 4,750 0
lembar)
237 Kassa kompres steril 40 x 40 cm k
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack
pack 7,682 76,820 0
pack
pack 11,204 114,000 50
pack
245 Silk ( Benang Bedah Sutera ) No. 3/0 pcs 36pcs/kotak 14,316 515,376 0
dg jarum bedah
248 Umbilical cord nylon one med (Klem pcs
kotak/ 50
1,940 97,020 36
tali pusat) psc
249 Under Pet 10
pcs 5,390 53,900 0
pcs/kotak
251 Wing Needle No. 21 G kotak/ 100
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 549,750 0
psc
0
0BAT GIGI 0
262 Temporary Stopping Fletcher botol botol 34,000 34,000 0
(Fletcher) serbuk & cairan
0
263 Armovit Kapsul 30

kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
265 Betason-N krim Tube 9,182 220,368 0
tube/kotak
Kotak 5
266 Bioneuron Injeksi ampul 4,341 21,705 0
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
274 Fituno 30
Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
279 Mersibion inj 10
ampul 4,400 44,000 0
ampul/kotak
100
280 Neorodial kaplet 1,091 109,100 0
kaplet/kotak
60
281 Neurovit-E Tablet 818 49,080 0
tablet/kotak
283 Poncobex kotak 100
Tablet 1,353 135,300 0
tablet100
kotak
284 Ponflu Tablet 935 93,500 0
tablet
10
285 Progastric Tablet 303 3,030 0
tablet/strip
100
286 Ramaton Tablet 698 69,800 0
tablet/kotak
288 Siobio kotak 100
kapsul 946 94,600 0
kapsul
(AHMADARIS)
300 IV Cateter 18 G 50
OBAT TAMBAHAN 0
291 2
292 200
293 10
294 300
295 300
296 100
297 200
298 300
299 400
300 220
301 200
302 200
Dletiazepam 5 mg tab Tablet Kotak
UMUM
BAYAR

Dinas Kesehatan
NIP.196901241989021001
NIP.197211242002121002 NIP. 198105062005012010
(LPLPO)
BULAN Mei
TAHUN : 2017
PEMAKAIAN
STOK AKHIR
PENGELUAR STOK RATA-RATA PERMINTAA
PERSEDIAAN DALAM
AN AKHIR S/D BULAN N
RUPIAH
INI
TOTAL
13 14 15 16 17 18 19
0 0 0 0 0
0 300 200 100 8,600 200
0 0 0 0 0 0
0 50 0 50 11,650 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 580 180 400 132,000 180
0 230 90 140 26,180 90
0 0 0 0 0 0
0 100 100 0 0 100
0 6,000 1,000 5,000 1,555,000 1,000
0 98 48 50 122,250 48
0 0 0 0 0 0
0 0 0 0 0 0
0 160 40 120 259,200 40
0 3,200 1,200 2,000 144,000 1,200
0 0 0 0 0 0
0 10 0 10 20,000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 300 200 100 9,500 200
0 0 0 0 0 0
0 500 300 200 28,800 300
0 5 5 0 0 5
0 100 50 50 26,200 50
0 100 50 50 38,550 50
0 0 0 0 0 0
0 0 0 0 0 0
0 50 20 30 45,600 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 5 5 0 0 5
0 400 300 100 6,200 300
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 100 14,300 0
0 35 15 20 66,660 15
0 0 0 0 0 0
0 200 100 100 16,700 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 49,358 100
0 5 5 0 0 5
0 30 15 15 37,500 15
0 3 0 3 644,970 0
0 0 0 0 0 0
0 8 0 8 9,599,200 0
0 0 0 0 0 0
0 0 0 0 0 0
0 60 20 40 72,000 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 220 30 190 649,230 30
0 0 0 0 0 0
0 0 0 0 0 0
0 300 100 200 17,000 100
0 500 200 300 87,600 200
0 20 10 10 26,000 10
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 700 100 600 33,600 100
0 400 100 300 130,800 100
0 8,000 1,000 7,000 195,300 1,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 5 5 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 800 100 700 36,764 100
0 800 100 700 57,806 100
0 0 0 0 0 0
0 15 15 0 0 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 500 200 300 45,000 200
0 100 100 0 0 100
0 700 300 400 28,000 300
0 200 100 100 6,200 100
0 0 0 0 0 0
0 100 0 100 24,300 0
0 0 0 0 0 0
0 5 5 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 50 20 30 69,000 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 35 20,213 0
0 0 0 0 0 0
0 3,800 1,800 2,000 102,000 1,800
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 200 100 100 50,000 100
0 85 35 50 109,500 35
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 20 20 0 0 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 30,000 100
0 0 0 0 0 0
0 200 100 100 11,000 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 5 5 0 0 5
0 600 0 600 1,470,000 0
0 0 0 0 0 0
0 200 100 100 20,000 100
0 0 0 0 0 0
0 70 20 50 245,000 20
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 12,900 100
0 100 0 100 64,000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 20 10 10 55,000 10
0 0 0 0 0 0
0 100 0 100 32,700 0
0 0 0 0 0 0
0 0 0 0 0 0
0 30 10 20 44,000 10
0 210 60 150 31,650 60
0 100 50 50 35,800 50
0 330 130 200 237,800 130
0 10 5 5 12,000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 20 20 0 0 20
0 8,500 2,500 6,000 474,000 2,500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 150 20 130 54,578 20
0 2,000 500 1,500 165,000 500
0 500 200 300 31,500 200
0 0 0 0 0 0
0 1 1 0 0 1
0 300 200 100 11,400 200
0 0 0 0 0 0
0 0 0 0 0 0
0 50 25 25 90,350 25
0 2,200 500 1,700 204,000 500
0 0 0 0 0 0
0 0 0 0 0 0
0 30 10 20 104,000 10
0 300 100 200 11,800 100
0 600 200 400 38,996 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 300 200 100 104,200 200
0 10 10 0 0 10
0 4 2 2 12,100 2
0 10 6 4 44,000 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 300 200 100 25,500 200
0 0 0 0 0 0
0 3,000 1,000 2,000 2,520,000 1,000
0 100 0 100 9,900 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 8 8 0 0 8
0 1,800 800 1,000 107,700 800
0 0 0 0 0 0
0 6 6 0 0 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 300 10 290 188,500 10
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 526,667 100
0 0 0 0 0 0
0 0 0 0 0 0
0 100 5 95 1,567,500 5
0 80 10 70 474,918 10
0 50 10 40 308,000 10
0 50 5 45 346,500 5
0 50 5 45 346,500 5
0 2 1 1 7,500 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 104 44 60 21,750 44
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 50 15 35 392,123 15
0 0 0 0 0 0
0 340 100 240 270,000 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 36 0 36 69,854 0
0 0 0 0 0 0
0 4 0 4 16,000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 1 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 50 10 40 0 10
0 0 0 0 0 0
0 2 2 0 0 2
0 200 100 100 0 100
0 10 10 0 0 10
0 300 100 200 0 100
0 300 100 200 0 100
0 100 100 0 0 100
0 200 100 100 0 100
0 300 100 200 0 100
0 400 100 300 0 100
0 220 100 120 0 100
0 200 100 100 0 100
0 200 100 100 0 100
25,469,416
Petugas Gudang Farmasi

Puskesmas Rawajitu

NIP.197202191992032001
6
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK
PENERIMAAN
HARGA HARGA PER
SATUAN KEMASAN
AWAL
Instalasi PROGRAM DAK DAK Lain lain
Farmasi 2015 2014 2017
1 2 3 4 5 6 7 8 9 10 11 12
tablet 1,856 44,550 0
tab/Kotak
100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 86 8,593 0
tablet/kotak
100
ktk 30
tablet/kotak
100
tablet 112 11,200 0
tablet/kotak
30
10 Amlodipine Tablet 10 mg tablet 330 9,900 400 3,000
tablet/kotak
30
tablet/kotak
vial 10,125 101,250 0
vial/kotak
tablet 388 38,799 0
tablet/kotak
tablet 311 31,100 5,000 10,600
tablet/kotak
15 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 2,445 2,445 50 360
tablet 201 20,115 0
tablet/kotak
30
vial/kotak
tablet 72 7,200 2,000 7,200
Anti Bakteri DOEN salep tablet/kotak
25
20 tube 2,581 62,900 0
kombinasi:Bacitracin-polymixin B krim tube/kotak
10
21 Anti Hemoroid DOEN Kombinasi supp 2,000 20,000 10
supp/kotak
23 Antimalaria DOEN kombinasi 100
tablet 518 51,800 0
tablet/kotak
100
135 13,500 0
Antiparkinson
+Kofein 50mg DOEN tablet Kombinasi tablet/botol
25 benzerazid 25 mg levodopa 100 mg 100
tablet 1,500 150,000 0
tablet/kotak
10
26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial 7,425 74,250 0
vial/kotak
6
ampul/kotak
100
28 Asam Askorbat (Vit C) tablet 50 mg tablet 95 9,500 100 2,000
tablet/kotak
100
tablet/botol
tablet 144 14,400 200
tablet/kotak
25
31 Asiklovir krim 5% tube 4,253 101,250 0 100
tube/kotak
100
tablet/kotak
tablet 771 77,130 50
tablet/kotak
34 Benzatin Benzil Penicillin injeksi 1,2 jt vial
10
11,070 110,700 0
IU/vial vial/kotak
30
tablet/sachet
36 Betametason krim 0,1% tube tube 1,520 1,520 30 50
37 Budesonid inhaler 200 mcg/puff, 100 turbuhaler turbuhaler 93,000 93,000 0
(symbicort)
ampul 1,580 158,000 0 100
ampul/kotak
100
41 Deksametason tablet 0,5 mg tablet 62 6,200 100 5,000
tablet/kotak
9
tablet/kotak
43 Difenhidramin HCl injeksi 10 mg/ml-1ml 30
ampul 1,054 31,620 0
ampul/kotak
tablet 143 14,300 100
tablet/kotak
tablet 167 16,700 100
tablet/kotak
tablet 38 38,000 0
49 Adrenalina ) 30
ampul 8,100 243,000 0
ampul/kotak
50 Ergakalsiferol
ml D3/D2) kapsul
51 Ergakalsiferol (vitamin D3/D2) suspensi botol botol 8,000 8,000 0
tablet/kotak
botol 2,500 2,500 15
ml/botol
56 FDC OAT Kategori I paket kotak 359,990 359,990 0 16
ampul 1,800 54,000 40
ampul/kotak
tablet 220 22,000 0
tablet/kotak
24
2,042 49,008 0
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul
10
4,698 46,980 0
1 ml ampul/kotak
30
64 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 3,417 102,510 190
ampul/kotak
100
634 63,400 0
mg tablet/botol
ampul 1,829 45,725 0
ampul/kotak
100
100
68 sachet 292 29,200 300 1,200
diare) sachet/kotak
69 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 10 192
ampul 3,399 16,995 0
ampul/kotak
tablet 56 5,600 600 3,000
tablet/kotak
tablet 436 21,800 300
tablet/kotak
1000
75 Gliseril Guayacolat tablet 100 mg tablet 28 27,900 7,000 10,000
tablet/botol
(nitral)
500
5,700 5,700 0
lokal) ml/botol
79 Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960 0
lokal)
500
5,200 5,200 0
lokal) ml/botol
100
81 Griseofulvin tablet 125 mg, micronized tablet 324 32,400 0
tablet/kotak
decanoas)
tablet 53 5,252 700
tablet/kotak
tablet 83 8,258 700
tablet/kotak
tablet 88 8,823 0
tablet/kotak
tiube 2,798 67,152 0 100
tube/kotak
tablet 116 11,550 0
tablet/botol
100
90 Ibuprofen tablet 400 mg tablet 150 15,000 300 2,000
tablet/kotak
91 Isosorbid Dinitrat tablet sublingual 5 mg 100
tablet 81 8,071 0
tablet/kotak
tablet 70 7,000 400 3,000
tablet/kotak
tablet 62 6,200 100 1,900
tablet/kotak
tablet 84 8,400 0
tablet/kotak
tablet 243 24,300 100
tablet/kotak
50
tablet/kotak
tube 4,700 56,400 0
tube/kotak
tablet 1,823 182,250 0
tablet/kotak
5
ampul/kotak
ampul 2,300 13,800 30
ampul/kotak
50
tablet/kotak
50
tablet/kotak
100
tablet/kotak
tablet 51 5,100 2,000 5,000
tablet/kotak
100
tablet/kotak
30
1,021 30,630 0
ml (SK.720 : kemasan 2 ml) ampul/kotak
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml 30
ampul 950 28,500 0
ampul/kotak
100
tablet/kotak
tablet/kotak
113 Sulfametoksazol 200mg + Trimetoprim 40 botol botol 60 ml 2,190 2,190 50
114 mg 100
Sulfametoksazol 400mg + Trimetoprim 80 tablet 138 13,800 0
tablet/kotak
115 mg 1
Lansoprazol inj 30 mg/ml
Larutan mengandung karbohidrat + ampul 82,042 82,042 0
ampul/kotak
116 elektrolit (NaCl 1,75 gr. Na Lactat 2,24 gr. botol botol 10,000 10,000 0
KCl 1.5 gr.Dextrosa
117 elektrolit 27 gr)
(NaCl 2,34 gr. Na /Lactat
KA EN 3Bgr.
2,24 botol botol 10,000 10,000 0
KCl 0.75 gr. 30
118 Lidokaian inj Dextrosa
2% 27 gr) / KA EN 3A ampul 1,333 40,000 0 150
ampul/kotak
10
119 Magnesium Sulfat inj (IV) 20% - 25 ml vial 2,078 20,780 0
vial/kotak
10
vial/kotak
30
tablet/kotak
122 Metilergometrin Maleat (Metilergometrin) tablet
100
154 15,400 0
tab salut 0,125 mg tablet/kotak
123 Metilergometrin Maleat inj 0,200 mg-1 ampul
30
2,175 65,250 0
ml ampul/kotak
tablet 635 19,050 0
tablet/kotak
100
tablet/kotak
10
ampul/kotak
tablet 110 11,000 100
tablet/kotak
botol 39,825 39,825 0
ml
129 Metronidazol supositoria 500 mg ( flagyl) suppositori 3,220 3,220 0
suppositoria
100
130 Metronidazol tablet 250 mg a
tablet 193 19,305 0
tablet/kotak
sachet 2,450 98,000 600
sachet/kotak
tablet 200 10,000 100 2,000
tablet/kotak
137 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 50 200
(Produk lokal) 24
tube/kotak
tablet 640 64,000 100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
144 Obat Batuk Hitam botol botol 5,500 5,500 10 60
tablet 207 20,650 0
tablet/kotak
100
tablet/kotak
147 Oksimetazolin tetes hidung 0,025% botol botol 27,550 27,550 0
(ilaidin drop) 25
tube/kotak
10
ampul/kotak
tablet 211 6,330 150 2,100
tablet/kotak
tablet 716 21,480 50
tablet/kotak
tablet 1,189 35,670 200
tablet/kotak
tablet 119 11,900 0
tablet/kotak
tablet 79 7,900 6,000 16,800
tablet/kotak
100
tablet/kotak
100
tablet/kotak
10
ampul/kotak
30
tablet 420 12,595 130
tablet/kotak
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 110 11,000 1,500 5,000
tablet/kotak
100
164 Piroksikam 20 mg tablet 105 10,500 300 2,900
tablet/kotak
tablet 114 11,400 100
tablet/kotak
30
10,780 323,400 0
IU/vial vial/kotak
100
tablet/botol
25
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 1,700 3,000
kaplet/kotak
172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul
50
460 23,000 0
Lunak kapsul/botol
50
260 13,000 0
Lunak kapsul/botol
174 Ringer Laktat larutan infus steril botol botol 500 ml 5,200 5,200 20 200
tablet 59 5,900 200 3,000
tablet/kotak
tablet 97 9,749 400 3,000
177 Botol Botol 63,750 63,750 0
Belerang endap 2 %
tablet 855 25,650 0
tablet/kotak
tablet 1,042 52,100 100
tablet/kotak
184 sefadroksil sirup kering 125mg/5ml botol botol 4,896 4,896 0 120
187 Serum Anti Bisa Ular Polivalen injeksi 5 Dus, 10 vial
47,300 473,000 0
ml (ABU I) Dus,
@ 5 ml10
IU/ampul (A.T.S)
100
tablet 181 18,100 0
tablet/kotak
190 Sianokobalamin (vit B12) injeksi 500mcg- ampul
100
916 91,600 0
ml ampul/kotak
100
tablet/kotak
50
192 Si mvastatin 10 Mg tablet 693 34,628 0 3,000
tablet/kotak
100
tablet/kotak
100
194 Sulfadoxine Pyrimethamine 525 mg tablet tablet 478 47,800 0
tablet/kotak
30
tablet/sachet
50
196 Terbutalin sulfat (Molasma) tablet 2,5 mg tablet 99 4,950 100
Terbutalin turbu (serbuk ih) 0,50 mg tablet/kotak
kaplet 149 14,900 0
kaplet/kotak
kaplet 257 25,700 0
kaplet/kotak
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ampul
30
690 20,700 0
ml ampul/kotak
201 Tiamin HCl / Mononitrat (Vit.B1) tablet tablet
1000
38 37,800 0 2,000
50 mg tablet/botol
5
ampul/kotak
100
203 Triheksifenidil Hidroklorida tablet 2 mg tablet 40 4,000 0
tablet/kotak
Dus, 1 vial
100
tablet 108 10,700 1,000
tablet/kotak
tablet 474 47,400 0
tablet/kotak
0

pcs 2,140 214,000 0
psc
pcs 650 65,000 0
psc
pcs 650 65,000 290 2,000
psc 100
kotak/
psc 100
kotak/
psc
215 pcs 24pcs/kotak 26,667 640,000 0
jarum bedah
jarum bedah
botol 30,238 30,238 0
ml
224 Infus set anak set 50 set/kotak 16,500 82,500 95 200
225 Infus set dewasa set 50 set/kotak 6,785 339,250 70 160
16
husada) 12
lembar)
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack
pack 7,682 76,820 0
pack
pack 11,204 114,000 35
pack
245 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 14,316 515,376 0
jarum bedah
kotak/ 50
1,940 97,020 36
pusat) psc
249 Under Pet 10
pcs 5,390 53,900 0
pcs/kotak
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 549,750 0
psc
0
0BAT GIGI 0
262 Temporary Stopping Fletcher (Fletcher) botol botol 34,000 34,000 0
serbuk & cairan
0

kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
tube/kotak
Kotak 5
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
274 Fituno 30
Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
ampul 4,400 44,000 0
ampul/kotak
100
kaplet/kotak
60
tablet/kotak
Tablet 1,353 135,300 0
tablet100
kotak
tablet
10
tablet/strip
100
tablet/kotak
kapsul 946 94,600 0
kapsul
(AHMADARIS)
300 40
IV Cateter 18 G
OBAT TAMBAHAN 0
291 0
292 100
293 0
294 200
295 200
296 0
297 100
298 200
299 300
300 120
301 100
302 100
UMUM
BAYAR

Dinas Kesehatan
NIP.196901241989021001
NIP.197211242002121002 NIP. 198105062005012010
PLPO)
BULAN Juni
TAHUN : 2017
STOK PEMAKAIAN
PENGELUAR STOK AKHIR RATA-RATA PERMINTAA
PERSEDIAAN
AN AKHIR DALAM S/D BULAN N
RUPIAH INI
TOTAL
13 14 15 16 17 18 19
0 0 0 0 0
0 100 100 0 0 0
0 0 0 0
0 50 50 0 0 50
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3,000 3,400 300 3,100 1,023,000 300
0 140 40 100 18,700 40
0 0 0 0 0
0 0 0 0 0
10,600 15,600 2,000 13,600 4,229,600 2,000
360 410 60 350 855,750 60
0 0 0 0 0
0 0 0 0 0
0 120 20 100 216,000 20
7,200 9,200 2,000 7,200 518,400 2,000
0 0 0 0 0
0 10 10 0 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2,000 2,100 500 1,600 152,000 500
0 0 0 0 0
0 200 200 0 0 200
100 100 20 80 340,240 20
0 50 50 0 0 50
0 50 0 50 38,550 0
0 0 0 0 0 0
0 0 0 0 0 0
50 80 15 65 98,800 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 100 10 90 142,200 10
5,000 5,100 500 4,600 285,200 500
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 100 14,300 0
0 20 10 10 33,330 10
0 0 0 0 0 0
0 100 100 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 20 80 39,486 20
0 0 0 0 0 0
0 15 15 0 0 15
0 3 0 3 644,970 0
16 16 0 16 5,759,840 0
0 8 0 8 9,599,200 0
0 0 0 0 0 0
0 0 0 0 0 0
0 40 10 30 54,000 10
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 190 0 190 649,230 0
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 8,500 100
1,200 1,500 200 1,300 379,600 200
192 202 15 187 486,200 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3,000 3,600 300 3,300 184,800 300
0 300 100 200 87,200 100
10,000 17,000 3,000 14,000 390,600 3,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 700 0 700 36,764 0
0 700 100 600 49,548 100
0 0 0 0 0 0
100 100 10 90 251,820 10
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2,000 2,300 300 2,000 300,000 300
0 0 0 0 0 0
3,000 3,400 400 3,000 210,000 400
1,900 2,000 200 1,800 111,600 200
0 0 0 0 0 0
0 100 0 100 24,300 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 30 5 25 57,500 5
0 0 0 0 0 0
0 0 0 0 0 0
0 35 35 0 0 35
0 0 0 0 0 0
5,000 7,000 1,000 6,000 306,000 1,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 50 20 30 65,700 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
150 150 25 125 166,666 25
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 0 0 0 0 0
0 100 0 100 11,000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 600 0 600 1,470,000 0
0 0 0 0 0 0
2,000 2,100 500 1,600 320,000 500
0 0 0 0 0 0
200 250 20 230 1,127,000 20
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 100 12,900 0
0 100 0 100 64,000 0
0 0 0 0 0 0
0 0 0 0 0 0
60 70 20 50 275,000 20
0 0 0 0 0 0
0 100 50 50 16,350 50
0 0 0 0 0 0
0 0 0 0 0 0
0 20 10 10 22,000 10
2,100 2,250 250 2,000 422,000 250
0 50 20 30 21,480 20
0 200 50 150 178,350 50
0 5 5 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
16,800 22,800 3,000 19,800 1,564,200 3,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 130 30 100 41,983 30
5,000 6,500 1,000 5,500 605,000 1,000
2,900 3,200 300 2,900 304,500 300
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 25 5 20 72,280 5
3,000 4,700 700 4,000 480,000 700
0 0 0 0 0 0
0 0 0 0 0 0
200 220 20 200 1,040,000 20
3,000 3,200 200 3,000 177,000 200
3,000 3,400 200 3,200 311,968 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 50 50 52,100 50
120 120 20 100 489,600 20
0 2 2 0 0 2
0 4 2 2 22,000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3,000 3,000 300 2,700 1,869,912 300
0 100 100 0 0 100
0 0 0 0 0 0
0 2,000 500 1,500 1,890,000 500
0 100 0 100 9,900 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2,000 2,000 300 1,700 64,260 300
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1,000 200 800 86,160 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2,000 2,290 290 2,000 1,300,000 290
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 100 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
200 295 20 275 4,537,500 20
160 230 20 210 1,424,754 20
0 40 10 30 231,000 10
0 45 5 40 308,000 5
0 45 15 30 231,000 15
0 1 1 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 60 30 30 10,875 30
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 35 10 25 280,088 10
0 0 0 0 0 0
0 240 100 140 157,500 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 36 0 36 69,854 0
0 0 0 0 0 0
0 4 2 2 8,000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 40 0 40 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 100 0 0
0 0 0 0 0 0
0 200 100 100 0 100
0 200 100 100 0 100
0 0 0 0 0 0
0 100 0 100 0 0
0 200 100 100 0 100
0 300 100 200 0 100
0 120 60 60 0 60
0 100 0 100 0 0
0 100 0 100 0 0
49,409,109
Petugas Gudang Farmasi

Puskesmas Rawajitu

NIP.197202191992032001
7
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK
PENERIMAAN
HARGA HARGA PER
SATUAN KEMASAN
AWAL
2015 2014 2017
1 2 3 4 5 6 7 8 9 10 11 12
tablet 1,856 44,550 0
tab/Kotak
100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 86 8,593 0
tablet/kotak
100
ktk 30
tablet/kotak
100
tablet 112 11,200 0
tablet/kotak
30
10 Amlodipine Tablet 10 mg tablet 330 9,900 3,100
tablet/kotak
30
tablet/kotak
vial 10,125 101,250 0
vial/kotak
tablet 388 38,799 0
tablet/kotak
tablet 311 31,100 13,600
tablet/kotak
tablet 201 20,115 0
tablet/kotak
30
vial/kotak
tablet 72 7,200 7,200
25
20 tube 2,581 62,900 0
10
supp/kotak
23 Antimalaria DOEN kombinasi 100
tablet 518 51,800 0
tablet/kotak
24 Antimigren:Ergotamin Tartrat 1mg +Kofein tablet
100
135 13,500 0
Antiparkinson
50mg DOEN tablet Kombinasi tablet/botol
tablet 1,500 150,000 0
tablet/kotak
10
26 (Aqua
Levopar)
vial/kotak
6
ampul/kotak
100
28 Asam Askorbat (Vit C) tablet 50 mg tablet 95 9,500 1,600
tablet/kotak
100
tablet/botol
tablet 144 14,400 0
tablet/kotak
25
tube/kotak
100
tablet/kotak
tablet 771 77,130 50
tablet/kotak
10
11,070 110,700 0
IU/vial vial/kotak
30
tablet/sachet
ampul 1,580 158,000 90
ampul/kotak
100
41 Deksametason tablet 0,5 mg tablet 62 6,200 4,600
tablet/kotak
9
tablet/kotak
ampul 1,054 31,620 0
ampul/kotak
tablet 143 14,300 100
tablet/kotak
tablet 167 16,700 0
tablet/kotak
tablet 38 38,000 0
49 Adrenalina ) 30
ampul 8,100 243,000 0
ampul/kotak
50 Ergakalsiferol
UI/ml (D-Vit FT)
tablet/kotak
botol 2,500 2,500 0
ml/botol
ampul 1,800 54,000 30
ampul/kotak
tablet 220 22,000 0
tablet/kotak
24
2,042 49,008 0
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul
10
4,698 46,980 0
ml ampul/kotak
30
ampul/kotak
65 Fitomenadion (Vit.K1)tab salut gula 10 mg 100
tablet 634 63,400 0
tablet/botol
ampul 1,829 45,725 0
ampul/kotak
100
tablet/kotak
100
68 Garam oralit untuk 200 ml air (Prog : diare) sachet 292 29,200 1,300
sachet/kotak
ampul 3,399 16,995 0
ampul/kotak
tablet 56 5,600 3,300
tablet/kotak
tablet 436 21,800 200
tablet/kotak
1000
75 Gliseril Guayacolat tablet 100 mg tablet 28 27,900 14,000
tablet/botol
76 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet 1,500 1,500 0
500
5,700 5,700 0
lokal) ml/botol
lokal) 500
80 Glukosa larutan infus 5% steril (Produk lokal) botol 5,200 5,200 0
ml/botol
100
tablet/kotak
82 Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
tablet 53 5,252 700
tablet/kotak
tablet 83 8,258 600
tablet/kotak
tablet 88 8,823 0
tablet/kotak
tiube 2,798 67,152 90
tube/kotak
tablet 116 11,550 0
tablet/botol
100
90 Ibuprofen tablet 400 mg tablet 150 15,000 2,000
tablet/kotak
91 Isosorbid Dinitrat tablet sublingual 5 mg 100
tablet 81 8,071 0
tablet/kotak
tablet 70 7,000 3,000
tablet/kotak
tablet 62 6,200 1,800
tablet/kotak
tablet 84 8,400 0
tablet/kotak
tablet 243 24,300 100
tablet/kotak
50
tablet/kotak
tube 4,700 56,400 0
tube/kotak
tablet 1,823 182,250 0
tablet/kotak
5
ampul/kotak
ampul 2,300 13,800 25
ampul/kotak
50
tablet/kotak
50
tablet/kotak
100
tablet/kotak
tablet 51 5,100 6,000
tablet/kotak
100
tablet/kotak
109 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul
30
1,021 30,630 0
(SK.720 : kemasan 2 ml) ampul/kotak
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml 30
ampul 950 28,500 0
ampul/kotak
100
tablet/kotak
tablet 500 50,000 0
tablet/kotak
113 Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190 30
114 Kotrimoksazol tablet komb: Sulfametoksazol tablet
100
138 13,800 0
400mg + Trimetoprim 80 mg tablet/kotak
115 Lansoprazol inj 30 mg/ml 1
Larutan mengandung karbohidrat + elektrolit ampul 82,042 82,042 0
ampul/kotak
116 (NaCl 1,75 gr. Na Lactat 2,24 gr. KCl 1.5 botol botol 10,000 10,000 0
gr.Dextrosa
117 (NaCl 27 Na
2,34 gr. gr) Lactat
/ KA EN 3Bgr. KCl 0.75
2,24 botol botol 10,000 10,000 0
118 gr. Dextrosa 30
Lidokaian inj27
2%gr) / KA EN 3A ampul 1,333 40,000 125
ampul/kotak
10
vial/kotak
10
vial/kotak
30
tablet/kotak
122 Metilergometrin Maleat (Metilergometrin) tab tablet
100
154 15,400 0
salut 0,125 mg tablet/kotak
123 Metilergometrin Maleat inj 0,200 mg-1 ml 30
ampul 2,175 65,250 0
ampul/kotak
tablet 635 19,050 0
tablet/kotak
100
tablet/kotak
10
ampul/kotak
tablet 110 11,000 100
tablet/kotak
botol 39,825 39,825 0
ml
129 Metronidazol supositoria 500 mg ( flagyl) 3,220 3,220 0
suppositoria suppositoria
100
130 Metronidazol tablet 250 mg tablet 193 19,305 0
tablet/kotak
sachet 2,450 98,000 600
sachet/kotak
tablet 200 10,000 1,600
tablet/kotak
(Produk lokal) 24
tube/kotak
tablet 640 64,000 100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 207 20,650 0
tablet/kotak
100
tablet/kotak
drop) 25
tube/kotak
10
ampul/kotak
tablet 211 6,330 2,000
tablet/kotak
tablet 716 21,480 30
tablet/kotak
tablet 1,189 35,670 150
tablet/kotak
tablet 119 11,900 0
tablet/kotak
tablet 79 7,900 19,800
tablet/kotak
100
tablet/kotak
100
tablet/kotak
10
ampul/kotak
30
tablet 420 12,595 100
tablet/kotak
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 110 11,000 5,500
tablet/kotak
100
164 Piroksikam 20 mg tablet 105 10,500 2,900
tablet/kotak
tablet 114 11,400 0
tablet/kotak
30
168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 10,780 323,400 0
vial/kotak
100
tablet/botol
25
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 4,000
kaplet/kotak
50
460 23,000 0
Lunak kapsul/botol
50
260 13,000 0
Lunak kapsul/botol
tablet 59 5,900 3,000
tablet/kotak
tablet 97 9,749 3,200
Salbutamol inshalasi/ aerosol 100 mcg/dosis tablet/kotak
177 Botol Botol 63,750 63,750 0
(ventolin inheler)
(ventolin rotacaps)
endap 2 %
tablet 855 25,650 0
tablet/kotak
tablet 1,042 52,100 50
tablet/kotak
187 Serum Anti Bisa Ular Polivalen injeksi 5 ml Dus, 10 vial
47,300 473,000 0
(ABU I) Dus,
@ 5 ml10
188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul ampul @ 1 12,600 126,000 0
(A.T.S)
100
tablet 181 18,100 0
tablet/kotak
190 Sianokobalamin (vit B12) injeksi 500mcg-ml 100
ampul 916 91,600 0
ampul/kotak
100
tablet/kotak
50
192 Simvastatin 20 mg tablet 693 34,628 2,700
tablet/kotak
100
tablet/kotak
100
tablet/kotak
30
tablet/sachet
50
tablet/kotak
kaplet 149 14,900 0
kaplet/kotak
kaplet 257 25,700 0
kaplet/kotak
30
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 690 20,700 0
ampul/kotak
201 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet
1000
38 37,800 1,700
mg tablet/botol
5
ampul/kotak
100
tablet/kotak
Dus, 1 vial
100
tablet 108 10,700 800
tablet/kotak
tablet 474 47,400 0
tablet/kotak
0

pcs 2,140 214,000 0
psc
pcs 650 65,000 0
psc
pcs 650 65,000 2,000
psc 100
kotak/
psc 100
kotak/
psc
215 pcs 24pcs/kotak 26,667 640,000 0
bedah
216 Catgut / beneng bedah no 3/0 dengan jarum pcs 24psc/kotal 23,299 559,176 0
bedah
botol 30,238 30,238 0
ml
16
235 Kassa Hidrofil steril uk. 16x16 (surya husada) pcs lembar/kota 363 5,800 30
12
236 Kassa Hidrofil steril uk. 18x22 (isi 12 lembar) pcs k
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack
pack 7,682 76,820 0
pack
pack 11,204 114,000 25
pack
jarum bedah
kotak/ 50
1,940 97,020 36
pusat) psc
249 Under Pet 10
pcs 5,390 53,900 0
pcs/kotak
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 549,750 0
psc
0
0BAT GIGI 0
serbuk & cairan
0

kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
tube/kotak
Kotak 5
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
274 Fituno 30
Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
ampul 4,400 44,000 0
ampul/kotak
100
kaplet/kotak
60
tablet/kotak
Tablet 1,353 135,300 0
tablet100
kotak
tablet
10
tablet/strip
100
tablet/kotak
kapsul 946 94,600 0
kapsul
(AHMADARIS)
300 40
IV Cateter 18 G
OBAT TAMBAHAN 0
291 0
292 100
293 0
294 100
295 100
296 0
297 100
298 100
299 200
300 60
301 100
302 100 200
UMUM
BAYAR

Dinas Kesehatan
NIP.196901241989021001
NIP.197211242002121002 NIP. 198105062005012010
LPLPO)
KODE PUSKESMAS :
BULAN Juli KABUPATEN : TULANG BAWANG
TAHUN : 2017 PROPINSI : LAMPUNG
PEMAKAIAN
STOK AKHIR
PENGELUAR RATA-RATA PERMINTAA
PERSEDIAAN STOK AKHIR DALAM NO NAMA OBAT SATUAN KMSN
AN S/D BULAN N
RUPIAH
INI
TOTAL
13 14 15 16 17 18 19 1 2 3 4
0 0 0 0 0 0 300 1 ACT (Artesunat + Amodiaquin ) tablet
24
tablet tab/Kotak
100
0 0 0 0 0 2,000 2 Alopurinol tablet 100 mg tablet
tablet/kotak
30
0 0 0 0 0 0 2,000 3 Alopurinol tablet 300 mg tablet
tablet/kotak
100
0 0 0 0 0 500 4 Alprazolam tablet 1 mg tablet
tablet/kotak
0 0 0 0 0 0 200 5 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml
0 0 0 0 0 0 tablet
tablet/kotak
100
0 0 0 0 0 0 7 Aminofilin tablet 200mg tablet ktk 30
tablet/kotak
0 0 0 0 0 0 8 Aminofilina injeksi 24 mg/ml ampul ampul@10
100
0 0 0 0 0 0 tablet
tablet/kotak
30
0 3,100 300 2,800 924,000 300 10 Amlodipine Tablet 10 mg tablet
tablet/kotak
30
0 100 100 0 0 100 11 Amlodipine Tablet 5 mg tablet
tablet/kotak
0 0 0 0 0 0 12 Amoksisilin Injeksi serbuk vial
10
1000mg vial/kotak
0 0 0 0 0 tablet
tablet/kotak
0 13,600 2,000 11,600 3,607,600 2,000 tablet
tablet/kotak
0 350 40 310 757,950 40 15 Amoksisilin sirup kering 125 mg/ botol botol 60 ml
5 ml
0 0 0 0 0 0 16 Antalgin (Metampiron) tablet 500 tablet
100
mg tablet/kotak
30
0 0 0 0 0 0 17 Antalgin injeksi 250 mg/ml - 2 ml vial
vial/kotak
0 100 25 75 162,000 25 18 Antasida DOEN II suspensi komb botol botol 60 ml
0 7,200 1,000 6,200 446,400 1,000 Anti Bakteri DOEN salep tablet
tablet/kotak
25
0 0 0 0 0 0 20 kombinasi:Bacitracin-polymixin tube
tube/kotak
0 0 0 0 0 0 21 Anti Hemoroid DOEN
B krim supp
10
Antifungi
KombinasiDOEN Kombinasi: supp/kotak
0 0 0 0 0 0 22 Asam Benzoat 6% + Asam pot 24 pot/kotak
23 Salisilat 3% 100
0 0 0 0 0 0 Antimalaria DOEN kombinasi tablet
tablet/kotak
0 0 0 0 0 0 24 Antimigren:Ergotamin Tartrat tablet
100
Antiparkinson DOEN tablet
1mg +Kofein 50mg tablet/botol
25 Kombinasi benzerazid 25 mg 100
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 26 Aqua pro 100
levodopa Injeksi
mgsteril, bebas
( Levopar) vial
10
pirogen vial/kotak
6
0 0 0 0 0 0 27 Arthemeter injeksi 1 ml : 80 mg ampul
ampul/kotak
0 1,600 500 1,100 104,500 500 28 Asam Askorbat (Vit C) tablet 50 tablet
100
mg tablet/kotak
100
0 0 0 0 0 0 29 Asam folat tablet 1 mg tablet
tablet/botol
0 0 0 0 0 tablet
tablet/kotak
25
0 80 20 60 255,180 20 31 Asiklovir krim 5% tube
tube/kotak
100
0 0 0 0 0 32 Asiklovir tablet 200 mg tablet
tablet/kotak
0 50 50 0 0 50 tablet
tablet/kotak
0 0 0 0 0 0 34 Benzatin Benzil Penicillin injeksi vial
10
1,2 jt IU/vial vial/kotak
0 0 0 0 0 0 35 Besi (II ) Sulfat + asam folat 0.25 sachet
30
tab tablet/sachet
0 65 15 50 76,000 15 36 Betametason krim 0,1% tube tube
0 0 0 0 0 0 37 Budesonid inhaler 200 mcg/puff, turbuhaler turbuhaler
100 dosis (pulmicort turbuhaler)
0 0 0 0 0 0 38 combination) inhaler 160/4,5 mcg turbuhaler turbuhaler
0 0 0 0 0 0 39 (symbicort turbuhaler)
combination) inhaler 80/4,5 mcg turbuhaler turbuhaler
Deksametason injeksi 5mg.ml-
40 (symbicort) 100
0 90 10 80 126,400 10 ampul
1ml ampul/kotak
100
0 4,600 500 4,100 254,200 500 41 Deksametason tablet 0,5 mg tablet
tablet/kotak
9
0 0 0 0 0 0 42 DHP tablet (Prog : malaria) tablet
tablet/kotak
0 0 0 0 0 0 43 Difenhidramin HCl injeksi 10 ampul
30
mg/ml-1ml ampul/kotak
0 100 0 100 14,300 0 tablet
tablet/kotak
0 10 10 0 0 10 45 Domperidon suspensi/sirup 5 botol botol
mg/5ml
0 0 0 0 0 46 Domperidon tetes/ 5 mg/ml botol botol
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 tablet
Epinefrina HCl/Bitartrat tablet/botol
49 ( Epinefrina / Adrenalina ) 30
0 0 0 0 0 0 ampul
ampul/kotak
0 0 0 0 0 0 50 Ergakalsiferol
ml D3/D2)
tablet tablet
Ergakalsiferol (vitamin
kapsul 50000 UI/ml D3/D2)
(D-Vit FT)
0 0 0 0 0 0 51 suspensi 10000 UI/ml (D-Vit botol botol
52 syrup) 120
0 80 80 0 0 80 Eritromisin kapsul 250mg tablet
tablet/kotak
0 0 0 0 0 53 Eritromisin sirup 200mg/5ml botol botol
0 0 0 0 0 botol
ml/botol
0 3 0 3 644,970 0 55 FDC kategori anak paket kotak
0 16 16 5,759,840 0 56 FDC OAT Kategori I paket kotak
0 8 0 8 9,599,200 0 57 FDC OAT Kategori II paket kotak
0 0 0 0 0 0 58 Fenitoin Natrium injeksi 50 ampul ampul
mg/ml
0 0 0 0 0 0 59 Fenitoin Natrium Kapsul 100 mg kapsul botol
0 30 10 20 36,000 10 60 Fenobarbital Injeksi i.m/i.v 50 ampul
30
mg/ml ampul/kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 62 Fenol Gliserol tetes telinga 10% botol
24
0 0 0 0 0 0 63 Fitomenadion (Vit.K1) injeksi 10 ampul
10
0 190 20 170 580,890 20 64 Fitomenadion (Vit.K1) injeksi ampul
30
2mg/ml ampul/kotak
0 0 0 0 0 0 65 Fitomenadion (Vit.K1)tab salut tablet
100
gula 10 mg tablet/botol
0 0 0 0 0 0 ampul
ampul/kotak
100
0 100 100 0 0 100 67 Furosemid tablet 40 mg tablet
Garam oralit untuk 200 ml air tablet/kotak
100
0 1,300 300 1,000 292,000 300 68 sachet
(Prog : diare)salep mata 0,3 %
Gentamicin sachet/kotak
0 187 20 167 434,200 20 69 tube tube
(genoint )
0 0 0 0 0 70 Gentamicin tetes mata 0,3 % botol 5 ml/botol
(genoint ) 5
0 0 0 0 0 0 71 Gentamisin injeksi 40 mg/ml ampul
ampul/kotak
0 0 0 0 0 0 72 Gentian Violet larutan 1 % botol botol
0 3,300 300 3,000 168,000 300 tablet
tablet/kotak
0 200 100 100 43,600 100 tablet
tablet/kotak
1000
0 14,000 2,000 12,000 334,800 2,000 75 Gliseril Guayacolat tablet 100 mg tablet
tablet/botol
0 0 0 0 0 0 76 Gliseril trinitrat tab sublingual tablet tablet
0,5mg (nitral)
0 0 0 0 0 0 77 Glukonas Kalsikus 10 % kotak kotak
0 0 0 0 0 0 78 Glukosa larutan infus 10% steril botol
500
0 0 0 0 0 0 79 Glukosa larutan infus 40% steril botol botol
(Produk lokal)
0 0 0 0 0 80 Glukosa larutan infus 5% steril botol
500
100
0 0 0 0 0 0 81 tablet
0 0 0 0 0 0 82 Haloperidol inj 50 mg/ml (haldol ampul ampul
decanoas)
0 700 200 500 26,260 200 tablet
tablet/kotak
0 600 200 400 33,032 200 tablet
tablet/kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 90 20 70 195,860 20 tiube
tube/kotak
0 0 0 0 0 0 87 Ibuprofen sirup 100mg / 5ml botol botol
0 0 0 0 0 0 88 Ibuprofen suspensi 200mg / 5ml botol botol
0 0 0 0 0 0 tablet
tablet/botol
100
0 2,000 300 1,700 255,000 300 90 Ibuprofen tablet 400 mg tablet
tablet/kotak
0 0 0 0 0 91 Isosorbid Dinitrat tablet tablet
100
sublingual 5 mg tablet/kotak
0 3,000 500 2,500 175,000 500 tablet
tablet/kotak
0 1,800 300 1,500 93,000 300 tablet
tablet/kotak
0 0 0 0 0 tablet
tablet/kotak
0 100 100 0 0 100 tablet
tablet/kotak
50
0 0 0 0 0 0 96 Ketokenazol tablet 200mg tablet
tablet/kotak
0 0 0 0 0 tube
tube/kotak
0 0 0 0 0 0 tablet
tablet/kotak
5
0 0 0 0 0 0 99 Ketorolak inj 10 mg ampul
ampul/kotak
0 0 0 0 0 0 100 Natrium Diklofenac 50 mg kotak
0 0 0 0 0 0 101 Nistatin tablet salut 500.000 IU kotak
0 25 10 15 34,500 10 ampul
ampul/kotak
50
0 0 0 0 0 0 103 Klindamisin 150 mg tablet
tablet/kotak
50
tablet/kotak
100
0 0 0 0 0 0 105 Kloramfenikol kapsul 250 mg tablet
tablet/kotak
0 0 0 0 0 0 106 Kloramfenikol tetes telinga 3% botol botol
0 6,000 1,000 5,000 255,000 1,000 107 Klorfeniramin Maleat (CTM) tablet
100
tablet tablet/kotak
100
0 0 0 0 0 0 108 Klorpromasin tablet 100 mg tablet
Klorpromazin HCl injeksi 25 tablet/kotak
109 mg/ml - 1 ml (SK.720 : kemasan 30
0 0 0 0 0 0 ampul
ampul/kotak
2 ml)
0 0 0 0 0 0 110 Klorpromazin HCl injeksi 5 ampul
30
0 0 0 0 0 0 111 Klorpromazin HCl tablet salut tablet
100
100 mg tablet/kotak
0 0 0 0 0 0
Kotrimoksazol Susp komb: tablet
tablet/kotak
0 30 20 10 21,900 20 113 Sulfametoksazol 200mg + botol botol 60 ml
0 0 0 0 0 0 Sulfametoksazol 400mg + tablet
tablet/kotak
115 Trimetoprim
Larutan 80 mg karbohidrat
mengandung 1
0 0 0 0 0 0 Lansoprazol inj 30 mg/ml ampul
ampul/kotak
0 0 0 0 0 0 116 + elektrolit
Larutan (NaCl 1,75karbohidrat
mengandung gr. Na
botol botol
Lactat 2,24 gr. KCl 1.5
0 0 0 0 0 0 117 + elektrolit (NaCl 2,34 gr. Na
gr.Dextrosa 27 gr) / KA EN 3B botol botol
Lactat 2,24 gr. KCl 0.75 gr. 30
0 125 30 95 126,666 30 118 Lidokaian
Dextrosa 27injgr)
2% / KA EN 3A ampul
ampul/kotak
0 0 0 0 0 0 119 Magnesium Sulfat inj (IV) 20% - vial
10
25 ml
Magnesium Sulfat inj (IV) 40% - vial/kotak
10
0 0 0 0 0 0 120 vial
25 ml vial/kotak
30
0 0 0 0 0 0 121 Mebendazol tablet 100 mg tablet
Metilergometrin Maleat tablet/kotak
122 (Metilergometrin) tab salut 0,125 100
0 0 0 0 0 0 tablet
tablet/kotak
mg
123 Metilergometrin Maleat inj 0,200 30
0 0 0 0 0 0 ampul
mg-1 ml ampul/kotak
0 0 0 0 0 0 tablet
tablet/kotak
100
0 0 0 0 0 125 metilprednisolon tablet 4 mg tablet
tablet/kotak
10
0 0 0 0 0 0 126 Metoklopramid inj 5 mg/ml ampul
ampul/kotak
0 100 100 0 0 100 tablet
tablet/kotak
0 0 0 0 0 0 botol
ml
0 0 0 0 0 0 129 Metronidazol supositoria 500 mg
( flagyl) suppositoria suppositoria
100
0 0 0 0 0 0 130 Metronidazol tablet 250 mg tablet
tablet/kotak
0 0 0 0 0 0 131 Metronidazol tablet 500 mg tablet kotak
0 0 0 0 0 132 Mikonazol krim/ salep 2 % tube tube
0 600 0 600 1,470,000 0 sachet
sachet/kotak
0 0 0 0 0 0 134 Natrium Bikarbonat inj i.v 8,4% ampul ampul
(meylon)
0 1,600 300 1,300 260,000 300 tablet
tablet/kotak
0 0 0 0 0 0 136 Natrium Diklofenak 25 mg tablet kotak
0 230 30 200 980,000 30 137 Natrium Klorida larutan infus 0,9 botol botol
% steril (Produk lokal) 24
0 0 0 0 0 0 138 Hidrokortison krim 2,5% tube
tube/kotak
0 0 0 0 0 0 139 Natrium Tiroksin tablet 100 mcg tablet tablet
0 100 0 100 12,900 0 140 Nifedipin tablet 10mg tablet kotak
0 100 0 100 64,000 0 tablet
Noretisteron tablet 5 mg tablet/kotak
30
0 0 0 0 0 0 142 tablet
(Primolut
Nystatin N)
vaginal tablet 100.000 tablet/kotak
100
0 0 0 0 0 0 143 tablet
UI tablet/kotak
0 50 20 30 165,000 20 144 Obat Batuk Hitam botol botol
0 0 0 0 0 0 145 Ofloxacin 200 mg Tab Salut tablet
100
Selulose
Ofloxacin 400 mg Tab Salut tablet/kotak
100
0 50 50 0 0 50 146 tablet
Selulose
Oksimetazolin tetes hidung tablet/kotak
0 0 0 0 0 0 147 botol botol
0,025% (ilaidin drop)
0 0 0 0 0 0 148 Oksitetrasiklin HCl salep mata 1 tube
25
% tube/kotak
10
0 10 10 0 0 10 149 Oksitosin injeksi 10IU/ml-1ml ampul
ampul/kotak
0 2,000 150 1,850 390,350 150 tablet
tablet/kotak
0 30 30 0 0 30 tablet
tablet/kotak
0 150 150 0 0 150 tablet
tablet/kotak
0 0 0 0 0 153 Ondansetron inj 4 mg/ 2 ml ampul ampul
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 155 Paracetamol drop 100 mg/ml botol botol
0 0 0 0 0 156 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml
0 19,800 3,000 16,800 1,327,200 3,000 tablet
tablet/kotak
100
0 0 0 0 0 0 158 Piracetam 400 mg Tablet tablet
tablet/kotak
100
0 0 0 0 0 0 159 Piracetam 800 mg kapsul tablet
tablet/kotak
10
0 0 0 0 0 0 160 Piracetam inj 1 gr/ 5 ml ampul
ampul/kotak
0 0 0 0 0 0 161 Pirantel sirup 125mg/5ml botol botol
30
0 100 30 70 29,388 30 tablet
tablet/kotak
0 5,500 1,000 4,500 495,000 1,000 163 Piridoksin HCl (Vit.B6) tablet 10 tablet
100
mg tablet/kotak
100
0 2,900 500 2,400 252,000 500 164 Piroksikam 20 mg tablet
tablet/kotak
0 0 0 0 0 0 165 Povidon Iodida larutan 10% botol botol 30 ml
0 0 0 0 0 0 166 Povidon Iodida larutan 10% botol botol 300 ml
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 168 Prokain Benzil Penicillin G vial
30
injeksi 3 jt IU/vial vial/kotak
100
0 0 0 0 0 0 169 Propiltiourasil tablet 100 mg tablet
tablet/botol
25
0 20 15 5 18,070 15 170 Ranitidin inj.25mg/2ml ampul
ampul/kotak
100
0 4,000 500 3,500 420,000 500 171 Ranitidin tablet 150 mg tablet
kaplet/kotak
0 0 0 0 0 0 172 Retinol (Vitamin A) 200.000 IU kapsul
50
0 0 0 0 0 0 173 Retinol (Vitamin A) 100.000 IU kapsul
50
0 200 20 180 936,000 20 174 Ringer Laktat larutan infus steril botol botol 500 ml
0 3,000 300 2,700 159,300 300 tablet
tablet/kotak
0 3,200 400 2,800 272,972 400 tablet
0 0 0 0 0 0 177 Botol Botol
0 0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 200 kapsul kapsul
0 0 0 0 0 0 179 Salbutamol inshalasi/ aerosol 200 rotahaler rotahaler
0 0 0 0 0 0 180 Salep 2-4 Komb : As Salisilat 2 pot pot
% + Belerang endap 2 %
0 0 0 0 0 0 181 Salisil Bedak 2% kotak kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 50 50 0 0 50 tablet
tablet/kotak
0 100 20 80 391,680 20 184 sefadroksil sirup kering botol botol
125mg/5ml
0 0 0 0 0 185 Sefotaksim inj 1 gr vial 2 vial/kotak
0 2 2 0 0 2 186 Sefriakson serbuk injeksi 1 g/vial vial vial
0 0 0 0 0 0 187 Serum Anti Bisa Ular Polivalen Dus, 10 vial
injeksi 5 ml (ABU I) Dus,
@ 5 ml10
0 0 0 0 0 0 188 Serum Anti Tetanus injeksi 1.500 ampul ampul @ 1
IU/ampul (A.T.S)
100
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 190 Sianokobalamin (vit B12) injeksi ampul
100
100
0 0 0 0 0 0 191 Simetidin tablet 200 mg tablet
tablet/kotak
50
0 2,700 700 2,000 1,385,120 700 192 Si mvastatin 10 Mg tablet
tablet/kotak
100
0 0 0 0 0 193 Siproflaxacin tablet 500 mg tablet
tablet/kotak
0 0 0 0 0 0 194 Sulfadoxine Pyrimethamine 525 tablet
100
mg tablet tablet/kotak
30
0 1,500 500 1,000 1,260,000 500 195 Tablet Tambah Darah sachet
tablet/sachet
0 100 0 100 9,900 0 196 Terbutalin sulfat (Molasma) tablet
50
tablet 2,5 mg tablet/kotak
0 0 0 0 0 0 197 Terbutalin turbu (serbuk ih) 0,50 turbuhaler turbuhaler
mg (bricasma turbuhaler 0,5mg)
0 0 0 0 0 0 kaplet
kaplet/kotak
0 0 0 0 0 0 kaplet
kaplet/kotak
0 0 0 0 0 0 200 Tiamin HCl (Vit.B1) injeksi 100 ampul
30
0 1,700 300 1,400 52,920 300 201 Tiamin HCl / Mononitrat tablet
1000
(Vit.B1) tablet 50 mg tablet/botol
5
0 0 0 0 0 0 202 Tramadol inj 50mg/5ml ampul
ampul/kotak
0 0 0 0 0 0 203 Triheksifenidil Hidroklorida tablet
100
tablet 2 mg tablet/kotak
Dus, 1 vial
0 0 0 0 0 0 204 Vaksin Rabies Vero - Rabipur vial @ 1 dosis +
100
0 800 300 500 53,850 300 tablet
tablet/kotak
0 0 0 0 0 0 206 zinc drop 10 mg/ ml botol botol
0 0 0 0 0 207 Zinc sirup 10 mg/ml botol botol
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0
0 0 0 0 0 0 PERBEKALAN KESEHATAN
0 0 0 0 0 0 pcs
psc
0 0 0 0 0 0 pcs
psc
0 2,000 300 1,700 1,105,000 300 pcs
psc 100
kotak/
0 0 0 0 0 212 Alat suntik sekali pakai 5 ml pcs
psc 100
kotak/
0 0 0 0 0 0 213 Alkohol Swab pcs
psc
0 0 0 0 0 0 214 Aqua bides 20 liter galon galon
Catgut / benang bedah no 2/0
0 0 0 0 0 0 215 pcs 24pcs/kotak
dengan jarum bedah
0 0 0 0 0 216 Catgut / beneng bedah no 3/0 pcs 24psc/kotal
dengan jarum bedah
0 0 0 0 0 0 217 Cut gut chromic 3/0 pcs 24 pcs/kotak
0 0 0 0 0 0 218 Elastis Perban 75 Fesco roll roll
0 0 0 0 0 0 219 Exell tulle pcs kotak / psc
0 0 0 0 0 0 220 Foley cateter pcs pcs
0 0 0 0 0 0 221 Handscoon uk 7 pcs kotak
0 0 0 0 0 0 botol
ml
0 275 10 265 4,372,500 10 224 Infus set anak set 50 set/kotak
0 210 10 200 1,356,909 10 225 Infus set dewasa set 50 set/kotak
0 30 5 25 192,500 5 226 IV Catheter No. 22 G set 50 set/kotak
0 30 5 25 192,500 5 228 IV Chateter No 20 G set 50 set/kotak
Kapas Pembalut / Absorben 250
0 0 0 0 0 229 Bungkus Bungkus
gram
0 0 0 0 0 0 230 Kasa Pembalut Elastic 3 inchi pcs psc
0 0 0 0 0 0 231 Kasa Pembalut Elastic 4 inchi pcs psc
0 0 0 0 0 232 Kasa Pembalut Hidrofil 36 x 80 Rol Rol
cm
0 0 0 0 0 0 233 Kasa Pembalut Hidrofil 4 m x 10 roll roll
0 0 0 0 0 0 234 Kasa Pembalut Hidrofil 4 m x 5 roll roll
cm 16
0 30 10 20 7,250 10 235 Kassa Hidrofil steril uk. 16x16 pcs lembar/kota
(surya husada) 12
0 0 0 0 0 0 236 Kassa Hidrofil steril uk. 18x22 pcs k
lembar/kota
(isi 12 lembar)
0 0 0 0 0 0 Pcs Pcs
0 0 0 0 0 0 pack
pack
0 0 0 0 0 pack
pack
0 25 10 15 168,053 10 pack
pack
0 0 0 0 0 0 241 Lisorin 1liter botol botol
0 140 50 90 101,250 50 242 Masker pcs 50 pcs/kotak
0 0 0 0 0 0 243 Pembalut Gibs 3 inchi rol rol
0 0 0 0 0 0 244 Plester 5 yard x 2 inch Rol Rol
0 0 0 0 0 245 Silk ( Benang Bedah Sutera ) No. pcs 36pcs/kotak
3/0 dg jarum bedah
0 0 0 0 0 0 246 Sterobat nf. 400ml botol botol
0 0 0 0 0 0 247 Strip gula 50 strip (blonime) box box
0 36 0 36 69,854 0 248 Umbilical cord nylon one med pcs
kotak/ 50
(Klem tali pusat) psc
249 Under Pet 10
0 0 0 0 0 0 pcs
pcs/kotak
0 2 1 1 4,000 1 250 Urine Bag Pcs Pcs
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0
0 0 0 0 0 0 0BAT GIGI
0 0 0 0 0 0 255 Devitalisasi Pasta (Non Arsen) kotak kotak
0 0 0 0 0 256 Etil klorida spray botol botol
0 0 0 0 0 0 257 Glass Ionomer Cement (GC IX) botol botol
ART
0 0 0 0 0 0 258 Kalsium Hidroksida Pasta kotak kotak
0 0 0 0 0 0 259 Klorfenol Kamfer Mentol botol botol
(CHKM)
0 0 0 0 0 0 260 Mummifying Pasta kotak kotak
0 0 0 0 0 0 261 Semen Seng Fosfat serbuk dan botol botol
cairan
0 0 0 0 0 0 262 Temporary Stopping Fletcher botol botol
0 0 0 0 0 0
OBAT DENGAN NAMA
0 0 0 0
DAGANG
0 0 0 0 0 0 kapsul
kapsul/kotak
30
0 0 0 0 0 0 264 Asifit kapsul
kapsul/kotak
24
0 0 0 0 0 0 265 Betason-N krim Tube
tube/kotak
Kotak 5
0 0 0 0 0 0 266 Bioneuron Injeksi ampul
Ampul
0 0 0 0 0 0 267 Bionick botol 60 ml/botol
0 0 0 0 0 0 268 Bionick drop botol 15 ml/botol
0 0 0 0 0 0 269 Blonick Plus Syr Botol Botol
0 0 0 0 0 0 270 Chlorampecort Cr Tube Tube 10 gr
271 Diapecta 100
0 0 0 0 0 0 Tablet
tablet/kotak
0 0 0 0 0 0 272 Febrinex Suspensi Botol Botol
273 Fercee 100
0 0 0 0 0 0 Tablet
tablet/kotak
274 Fituno 30
0 0 0 0 0 0 Tablet
kaplet/kotak
0 0 0 0 0 0 275 Fludane plus syr 60 ml botol botol 60 ml
0 0 0 0 0 0 276 Flutamol Sirup botol 60 mL/botol
277 Hustab 10
0 0 0 0 0 0 Tablet
tablet/strip
0 0 0 0 0 0 278 Lybex sirup botol botol 60 ml
0 0 0 0 0 0 ampul
ampul/kotak
100
0 0 0 0 0 0 280 Neorodial kaplet
kaplet/kotak
60
0 0 0 0 0 0 281 Neurovit-E Tablet
tablet/kotak
0 0 0 0 0 0 282 Noza Tablet 4 tablet/strip
0 0 0 0 0 0 Tablet
tablet100
kotak
0 0 0 0 0 0 284 Ponflu Tablet
tablet
10
0 0 0 0 0 0 285 Progastric Tablet
tablet/strip
100
0 0 0 0 0 0 286 Ramaton Tablet
tablet/kotak
0 0 0 0 0 0 287 Scabicid Cream Tube Tube 10 gr
0 0 0 0 0 0 kapsul
kapsul
0 0 0 0 0 0 289 Kasa Pembalut Hidrofil 36 x 80 rol rol
cm (AHMADARIS)
0 0 0 0 0 0 290 Master Plast Plastik 1 inc roll roll
(plester)
0 40 40 0 0 40 300
IV Cateter 18 G
0 0 0 0 0 0 OBAT TAMBAHAN
0 0 0 0 0 291
0 100 100 0 0 100 292
0 0 0 0 0 293
0 100 100 0 0 100 294
0 100 100 0 0 100 295
0 0 0 0 0 296
0 100 100 0 0 100 297
0 100 100 0 0 100 298
0 200 100 100 0 100 299
0 60 60 0 0 300
0 100 100 0 0 100 301
200 300 0 300 0 0 302
44,083,214
UMUM
JUMLAH KUNJUNGAN RESEP TIDAK B
BAYAR
PBI PUSAT
Mengetahui/Menyetujui : Yang Men

Petugas Gudang Farmasi Kepala Dinas Kesehatan Kepala UPT Ins
Puskesmas Rawajitu Dinas Ke

NIP.197202191992032001
dr. H. Herry Novrizal, MM.Kes.,MM Melina Susa
NIP.197211242002121002 NIP. 19810506
8
BULAN : Agustus
TAHUN : 2017
STOK
PENERIMAAN PEMAKAIAN
STOK AKHIR
HARGA HARGA PER PENGELUAR RATA-RATA
PERSEDIAAN STOK AKHIR DALAM
SATUAN KEMASAN AN S/D BULAN
AWAL RUPIAH
INI
APBD I PROGRAM DAK DAK Lain lain TOTAL
2015 2014 2017
5 6 7 8 9 10 11 12 13 14 15 16 17 18
1,856 44,550 0 0 0 0 0 0 0
86 8,600 0 0 0 0 0 0
331 9,923 0 0 0 0 0 0 0
233 23,300 0 0 0 0 0 0
3,300 3,300 0 0 0 0 0 0 0
86 8,593 0 0 0 0 0 0 0
80 8,000 0 0 0 0 0 0 0
4,050 121,500 0 0 0 0 0 0 0
112 11,200 0 0 0 0 0 0 0
330 9,900 2,800 0 2,800 300 2,500 825,000 300
187 5,610 0 0 0 0 0 0
10,125 101,250 0 0 0 0 0 0 0
388 38,799 0 0 0 0 0 0
311 31,100 11,600 0 11,600 3,000 8,600 2,674,600 3,000

2,445 2,445 310 0 310 40 270 660,150 40
201 20,115 0 0 0 0 0 0 0
1,800 54,000 0 0 0 0 0 0 0
2,160 2,160 75 0 75 20 55 118,800 20
72 7,200 6,200 0 6,200 1,000 5,200 374,400 1,000
2,581 62,900 0 0 0 0 0 0 0
2,000 20,000 0 0 0 0 0 0 0
2,320 55,688 0 0 0 0 0 0 0
518 51,800 0 0 0 0 0 0 0
135 13,500 0 0 0 0 0 0 0
1,500 150,000 0 0 0 0 0 0 0
7,425 74,250 0 0 0 0 0 0 0
29,925 179,550 0 0 0 0 0 0 0
95 9,500 1,100 0 1,100 400 700 66,500 400
84 8,400 0 0 0 0 0 0 0
144 14,400 0 0 0 0 0 0
4,253 101,250 60 0 60 30 30 127,590 30
524 52,404 0 0 0 0 0 0
771 77,130 0 0 0 0 0 0
11,070 110,700 0 0 0 0 0 0 0
2,700 2,700 0 0 0 0 0 0 0
1,520 1,520 50 0 50 25 25 38,000 25
93,000 93,000 0 0 0 0 0 0 0
117,600 117,600 0 0 0 0 0 0 0
110,500 110,500 0 0 0 0 0 0 0
1,580 158,000 80 0 80 20 60 94,800 20
62 6,200 4,100 0 4,100 1,000 3,100 192,200 1,000
3,567 32,101 0 0 0 0 0 0 0
1,054 31,620 0 0 0 0 0 0 0
143 14,300 100 0 100 0 100 14,300 0
3,333 3,333 0 0 0 0 0 0
15,600 15,600 0 0 0 0 0 0
167 16,700 0 0 0 0 0 0
38 38,000 0 0 0 0 0 0 0
8,100 243,000 0 0 0 0 0 0 0
650 650 0 0 0 0 0 0 0
8,000 8,000 0 0 0 0 0 0 0
494 59,230 0 0 0 0 0 0
7,220 7,220 0 0 0 0 0 0
2,500 2,500 0 0 0 0 0 0
214,990 214,990 3 0 3 0 3 644,970 0
359,990 359,990 16 0 16 1 15 5,399,850 1
1,199,900 1,199,900 8 0 8 0 8 9,599,200 0
20,250 20,250 0 0 0 0 0 0 0
133 13,300 0 0 0 0 0 0 0
1,800 54,000 20 0 20 0 20 36,000 0
220 22,000 0 0 0 0 0 0 0
2,042 49,008 0 0 0 0 0 0 0
4,698 46,980 0 0 0 0 0 0 0
3,417 102,510 170 0 170 30 140 478,380 30
634 63,400 0 0 0 0 0 0 0
1,829 45,725 0 0 0 0 0 0 0
85 8,500 0 0 0 0 0 0
292 29,200 1,000 0 1,000 300 700 204,400 300
2,600 2,600 167 0 167 30 137 356,200 30
3,194 3,194 0 0 0 0 0 0
3,399 16,995 0 0 0 0 0 0 0
900 900 0 0 0 0 0 0 0
56 5,600 3,000 0 3,000 300 2,700 151,200 300
436 21,800 100 0 100 100 0 0 100
28 27,900 12,000 0 12,000 3,000 9,000 251,100 3,000
1,500 1,500 0 0 0 0 0 0 0
187,200 187,200 0 0 0 0 0 0 0
5,700 5,700 0 0 0 0 0 0 0
1,960 1,960 0 0 0 0 0 0 0
5,200 5,200 0 0 0 0 0 0
324 32,400 0 0 0 0 0 0 0
83,333 83,333 0 0 0 0 0 0 0
53 5,252 500 0 500 100 400 21,008 100
83 8,258 400 0 400 100 300 24,774 100
88 8,823 0 0 0 0 0 0 0
2,798 67,152 70 0 70 25 45 125,910 25
3,499 3,499 0 0 0 0 0 0 0
4,499 4,499 0 0 0 0 0 0 0
116 11,550 0 0 0 0 0 0 0
150 15,000 1,700 0 1,700 300 1,400 210,000 300
81 8,071 0 0 0 0 0 0
70 7,000 2,500 0 2,500 500 2,000 140,000 500
62 6,200 1,500 0 1,500 300 1,200 74,400 300
84 8,400 0 0 0 0 0 0
243 24,300 0 0 0 0 0 0 0
554 27,675 0 0 0 0 0 0 0
4,700 56,400 0 0 0 0 0 0
1,823 182,250 0 0 0 0 0 0 0
8,080 40,400 0 0 0 0 0 0 0
8,700 0 0 0 0 0 0 0
64,000 0 0 0 0 0 0 0
2,300 13,800 15 0 15 5 10 23,000 5
382 19,100 0 0 0 0 0 0 0
527 26,350 0 0 0 0 0 0 0
578 57,750 0 0 0 0 0 0 0
1,599 1,599 0 0 0 0 0 0 0
51 5,100 5,000 0 5,000 1,000 4,000 204,000 1,000
149 14,900 0 0 0 0 0 0 0
1,021 30,630 0 0 0 0 0 0 0
950 28,500 0 0 0 0 0 0 0
149 14,900 0 0 0 0 0 0 0
500 50,000 0 0 0 0 0 0 0
2,190 2,190 10 0 10 10 0 0 10
138 13,800 0 0 0 0 0 0 0
82,042 82,042 0 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0 0
1,333 40,000 95 0 95 40 55 73,333 40
2,078 20,780 0 0 0 0 0 0 0
2,629 26,290 0 0 0 0 0 0 0
228 6,840 0 0 0 0 0 0 0
154 15,400 0 0 0 0 0 0 0
2,175 65,250 0 0 0 0 0 0 0
635 19,050 0 0 0 0 0 0 0
300 30,000 0 0 0 0 0 0
2,070 20,700 0 0 0 0 0 0 0
110 11,000 0 0 0 0 0 0
39,825 39,825 0 0 0 0 0 0 0
3,220 3,220 0 0 0 0 0 0 0
193 19,305 0 0 0 0 0 0 0
160 16,000 0 0 0 0 0 0 0
3,000 3,000 0 0 0 0 0 0
2,450 98,000 600 0 600 0 600 1,470,000 0
6,200 6,200 0 0 0 0 0 0 0
200 10,000 1,300 0 1,300 300 1,000 200,000 300
174 8,700 0 0 0 0 0 0 0
4,900 4,900 200 0 200 30 170 833,000 30
2,979 71,500 0 0 0 0 0 0 0
1,694 1,694 0 0 0 0 0 0 0
129 12,900 100 0 100 100 0 0 100
640 64,000 100 0 100 0 100 64,000 0
2,618 78,540 0 0 0 0 0 0 0
480 47,960 0 0 0 0 0 0 0
5,500 5,500 30 0 30 20 10 55,000 20
207 20,650 0 0 0 0 0 0 0
327 32,700 0 0 0 0 0 0
27,550 27,550 0 0 0 0 0 0 0
1,600 40,000 0 0 0 0 0 0 0
2,200 22,000 0 0 0 0 0 0
211 6,330 1,850 0 1,850 180 1,670 352,370 180
716 21,480 0 0 0 0 0 0
1,189 35,670 0 0 0 0 0 0
2,400 2,400 0 0 0 0 0 0
119 11,900 0 0 0 0 0 0 0
5,200 5,200 0 0 0 0 0 0 0
1,438 1,438 0 0 0 0 0 0
79 7,900 16,800 0 16,800 3,000 13,800 1,090,200 3,000
609 60,885 0 0 0 0 0 0 0
1,084 108,405 0 0 0 0 0 0 0
7,425 74,250 0 0 0 0 0 0 0
8,250 8,250 0 0 0 0 0 0 0
420 12,595 70 0 70 30 40 16,793 30
110 11,000 4,500 0 4,500 1,000 3,500 385,000 1,000
105 10,500 2,400 0 2,400 400 2,000 210,000 400
2,163 2,163 0 0 0 0 0 0 0
14,203 14,203 0 0 0 0 0 0 0
114 11,400 0 0 0 0 0 0
10,780 323,400 0 0 0 0 0 0 0
404 40,442 0 0 0 0 0 0 0
3,614 86,738 5 0 5 5 0 0 5
120 12,000 3,500 0 3,500 500 3,000 360,000 500
460 23,000 0 0 0 0 0 0 0
260 13,000 0 0 0 0 0 0 0
5,200 5,200 180 0 180 30 150 780,000 30
59 5,900 2,700 0 2,700 300 2,400 141,600 300
97 9,749 2,800 0 2,800 300 2,500 243,725 300
63,750 63,750 0 0 0 0 0 0 0
431 431 0 0 0 0 0 0 0
5,867 5,867 0 0 0 0 0 0 0
2,000 2,000 0 0 0 0 0 0 0
1,250 1,250 0 0 0 0 0 0 0
855 25,650 0 0 0 0 0 0 0
1,042 52,100 0 0 0 0 0 0
4,896 4,896 80 0 80 30 50 244,800 30
6,050 12,100 0 0 0 0 0 0
11,000 11,000 0 0 0 0 0 0
47,300 473,000 0 0 0 0 0 0 0
12,600 126,000 0 0 0 0 0 0 0
181 18,100 0 0 0 0 0 0 0
916 91,600 0 0 0 0 0 0 0
111 11,100 0 0 0 0 0 0 0
693 34,628 2,000 0 2,000 300 1,700 1,177,352 300
255 25,500 0 0 0 0 0 0
478 47,800 0 0 0 0 0 0 0
1,260 1,260 1,000 0 1,000 400 600 756,000 400
99 4,950 100 0 100 0 100 9,900 0
71,100 71,100 0 0 0 0 0 0 0
149 14,900 0 0 0 0 0 0 0
257 25,700 0 0 0 0 0 0 0
690 20,700 0 0 0 0 0 0 0
38 37,800 1,400 0 1,400 300 1,100 41,580 300
5,400 27,000 0 0 0 0 0 0 0
40 4,000 0 0 0 0 0 0 0
78,500 78,500 0 0 0 0 0 0
108 10,700 500 0 500 200 300 32,310 200
12,840 12,840 0 0 0 0 0 0 0
14,980 14,980 0 0 0 0 0 0
474 47,400 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
2,140 214,000 0 0 0 0 0 0 0
650 65,000 0 0 0 0 0 0 0
650 65,000 1,700 0 1,700 300 1,400 910,000 300
750 75,000 0 0 0 0 0 0
216 21,560 0 0 0 0 0 0 0
174,000 174,000 0 0 0 0 0 0 0
26,667 640,000 0 0 0 0 0 0 0
23,299 559,176 0 0 0 0 0 0
5,583 134,000 0 0 0 0 0 0 0
17,160 17,160 0 0 0 0 0 0 0
14,014 14,014 0 0 0 0 0 0 0
8,495 8,495 0 0 0 0 0 0 0
5,267 5,267 0 0 0 0 0 0 0
5,270 5,270 0 0 0 0 0 0 0
30,238 30,238 0 0 0 0 0 0 0
16,500 82,500 265 0 110 20 90 1,485,000 20
6,785 339,250 200 0 200 20 180 1,221,218 20
7,700 385,000 25 0 25 3 22 169,400 3
7,700 385,000 35 0 35 5 30 231,000 5
7,700 385,000 25 0 25 3 22 169,400 3
7,500 7,500 0 0 0 0 0 0
7,000 7,000 0 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0 0
55,200 55,200 0 0 0 0 0 0
30,350 30,350 0 0 0 0 0 0 0
30,350 30,350 0 0 0 0 0 0 0
363 5,800 20 0 20 12 8 2,900 12
396 4,750 0 0 0 0 0 0 0
1,600 1,600 0 0 0 0 0 0 0
6,402 64,020 0 0 0 0 0 0 0
7,682 76,820 0 0 0 0 0 0
11,204 114,000 15 0 15 15 0 0 15
18,865 18,865 0 0 0 0 0 0 0
1,125 56,250 90 0 90 50 40 45,000 50
23,500 23,500 0 0 0 0 0 0 0
23,625 23,625 0 0 0 0 0 0 0
14,316 515,376 0 0 0 0 0 0
78,000 78,000 0 0 0 0 0 0 0
464,000 464,000 0 0 0 0 0 0 0
1,940 97,020 36 0 36 0 36 69,854 0
5,390 53,900 0 0 0 0 0 0 0
4,000 4,000 1 0 1 1 0 0 1
5,770 577,000 0 0 0 0 0 0 0
5,770 577,000 0 0 0 0 0 0 0
5,770 577,000 0 0 0 0 0 0 0
5,770 549,750 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
390,000 390,000 0 0 0 0 0 0 0
146,300 146,300 0 0 0 0 0 0
395,000 395,000 0 0 0 0 0 0 0
242,000 242,000 0 0 0 0 0 0 0
55,000 55,000 0 0 0 0 0 0 0
176,000 176,000 0 0 0 0 0 0 0
93,500 93,500 0 0 0 0 0 0 0
34,000 34,000 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0
1,537 46,100 0 0 0 0 0 0 0
1,818 54,540 0 0 0 0 0 0 0
9,182 220,368 0 0 0 0 0 0 0
4,341 21,705 0 0 0 0 0 0 0
16,000 16,000 0 0 0 0 0 0 0
22,500 22,500 0 0 0 0 0 0 0
18,700 18,700 0 0 0 0 0 0 0
9,085 9,085 0 0 0 0 0 0 0
384 38,400 0 0 0 0 0 0 0
15,855 15,855 0 0 0 0 0 0 0
1,044 104,400 0 0 0 0 0 0 0
3,273 98,190 0 0 0 0 0 0 0
15,950 15,950 0 0 0 0 0 0 0
13,500 13,500 0 0 0 0 0 0 0
284 2,840 0 0 0 0 0 0 0
19,800 19,800 0 0 0 0 0 0 0
4,400 44,000 0 0 0 0 0 0 0
1,091 109,100 0 0 0 0 0 0 0
818 49,080 0 0 0 0 0 0 0
399 1,596 0 0 0 0 0 0 0
1,353 135,300 0 0 0 0 0 0 0
935 93,500 0 0 0 0 0 0 0
303 3,030 0 0 0 0 0 0 0
698 69,800 0 0 0 0 0 0 0
28,380 28,380 0 0 0 0 0 0 0
946 94,600 0 0 0 0 0 0 0
140,337 140,337 0 0 0 0 0 0 0
27,088 27,088 0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0
100 0 100 100 0 0
60 0 60 60 0 0 60
0 0 0 0 0 0
300 0 300 100 200 0 100
35,971,468
UMUM
TIDAK BAYAR
PBI DAERAH NON PBI

ala UPT Instalasi Farmasi Kepala Puskesmas Petugas Gudang Farmasi

NIP.196901241989021001 NIP.197202191992032001
P. 198105062005012010
9
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMINT
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK
PENERIMAA
PERMINTAA HARGA HARGA PER
NO NAMA OBAT NAMA OBAT KMSN
N SATUAN KEMASAN
AWAL
reguler PROGRAM
19 1 2 3 4 5 6 7 8 9
300 1 ACT (Artesunat + Amodiaquin ) tablet
24
1,856 44,550 0 0
tablet tab/Kotak
100
2,000 2 Alopurinol tablet 100 mg tablet 86 8,600 0 0
tablet/kotak
30
2,000 3 Alopurinol tablet 300 mg tablet 331 9,923 0 0
tablet/kotak
100
500 4 Alprazolam tablet 1 mg tablet 233 23,300 0 0
tablet/kotak
200 5 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml 3,300 3,300 0 0
tablet 86 8,593 0 0
tablet/kotak
100
7 Aminofilin tablet 200mg tablet 80 8,000 0 0
ktk 30
tablet/kotak
8 Aminofilina injeksi 24 mg/ml ampul ampul@10 4,050 121,500 0 0
100
tablet 112 11,200 0 0
tablet/kotak
30
10 Amlodipine Tablet 10 mg tablet 330 9,900 2,500 0
tablet/kotak
30
11 Amlodipine Tablet 5 mg tablet 187 5,610 0 0
tablet/kotak
12 Amoksisilin Injeksi serbuk vial
10
10,125 101,250 0 0
1000mg vial/kotak
tablet 388 38,799 0 2,000
tablet/kotak
tablet 311 31,100 8,600 10,500
tablet/kotak
15 Amoksisilin sirup kering 125 mg/ botol botol 60 ml 2,445 2,445 270 240
5 ml
16 Antalgin (Metampiron) tablet 500 tablet
100
201 20,115 0 0
mg tablet/kotak
30
17 Antalgin injeksi 250 mg/ml - 2 ml vial 1,800 54,000 0 0
vial/kotak
18 Antasida DOEN II suspensi komb botol botol 60 ml 2,160 2,160 55 180
Anti Bakteri DOEN salep tablet 72 7,200 5,200 7,200
tablet/kotak
25
20 kombinasi:Bacitracin-polymixin B tube 2,581 62,900 0 0
tube/kotak
10
krimHemoroid DOEN Kombinasi
21 Anti supp 2,000 20,000 0 20
22 Asam Benzoat 6% + Asam pot 24 pot/kotak 2,320 55,688 0 0
23 Salisilat 3% 100
Antimalaria DOEN kombinasi tablet 518 51,800 0 0
tablet/kotak
24 Antimigren:Ergotamin Tartrat tablet
100
135 13,500 0 0
Antiparkinson DOEN tablet
25 Kombinasi benzerazid 25 mg 100
tablet 1,500 150,000 0 0
tablet/kotak
26 Aqua pro 100
levodopa Injeksi
mgsteril, bebas
( Levopar) vial
10
7,425 74,250 0 0
pirogen vial/kotak
6
27 Arthemeter injeksi 1 ml : 80 mg ampul 29,925 179,550 0 0
ampul/kotak
28 Asam Askorbat (Vit C) tablet 50 tablet
100
95 9,500 700 5,000
mg tablet/kotak
100
29 Asam folat tablet 1 mg tablet 84 8,400 0 0
tablet/botol
tablet 144 14,400 0 5,000
tablet/kotak
25
31 Asiklovir krim 5% tube 4,253 101,250 30 0
tube/kotak
100
32 Asiklovir tablet 200 mg tablet 524 52,404 0 0
tablet/kotak
tablet 771 77,130 0 0
tablet/kotak
34 Benzatin Benzil Penicillin injeksi vial
10
11,070 110,700 0 0
1,2 jt IU/vial vial/kotak
35 Besi (II ) Sulfat + asam folat 0.25 sachet
30
2,700 2,700 0 0
tab tablet/sachet
36 Betametason krim 0,1% tube tube 1,520 1,520 25 0
37 Budesonid inhaler 200 mcg/puff, turbuhaler turbuhaler 93,000 93,000 0 0
100 dosis (pulmicort turbuhaler)
38 combination) inhaler 160/4,5 mcg turbuhaler turbuhaler 117,600 117,600 0 0
combination) inhaler 80/4,5 mcg turbuhaler turbuhaler 110,500 110,500 0 0
40 Deksametason
(symbicort) injeksi 5mg.ml- 100
ampul 1,580 158,000 60 0
1ml ampul/kotak
100
41 Deksametason tablet 0,5 mg tablet 62 6,200 3,100 2,000
tablet/kotak
9
42 DHP tablet (Prog : malaria) tablet 3,567 32,101 0 0
tablet/kotak
43 Difenhidramin HCl injeksi 10 ampul
30
1,054 31,620 0 0
tablet 143 14,300 100 0
tablet/kotak
45 Domperidon suspensi/sirup 5 botol botol 3,333 3,333 0 100
mg/5ml
46 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0 0
tablet 167 16,700 0 0
tablet/kotak
tablet 38 38,000 0 0
ampul 8,100 243,000 0 0
ampul/kotak
50 Ergakalsiferol
ml D3/D2)
tablet tablet 650 650 0 0
kapsul 50000 UI/ml D3/D2)
(D-Vit FT)
51 suspensi 10000 UI/ml (D-Vit botol botol 8,000 8,000 0 0
52 syrup) 120
Eritromisin kapsul 250mg tablet 494 59,230 0 0
tablet/kotak
53 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0 0
botol 2,500 2,500 0 200
ml/botol
55 FDC kategori anak paket kotak 214,990 214,990 3 0
56 FDC OAT Kategori I paket kotak 359,990 359,990 15 0
57 FDC OAT Kategori II paket kotak 1,199,900 1,199,900 8 0
58 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0 0
59 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0 0
60 Fenobarbital Injeksi i.m/i.v 50 ampul
30
1,800 54,000 20 0
mg/ml ampul/kotak
tablet 220 22,000 0 0
tablet/kotak
24
2,042 49,008 0 0
63 Fitomenadion (Vit.K1) injeksi 10 ampul
10
4,698 46,980 0 0
64 Fitomenadion (Vit.K1) injeksi ampul
30
3,417 102,510 140 120
2mg/ml ampul/kotak
65 Fitomenadion (Vit.K1)tab salut tablet
100
634 63,400 0 0
gula 10 mg tablet/botol
ampul 1,829 45,725 0 0
ampul/kotak
100
67 Furosemid tablet 40 mg tablet 85 8,500 0 1,000
100
68 sachet 292 29,200 700 2,400
69 tube tube 2,600 2,600 137 150
(genoint )
70 Gentamicin tetes mata 0,3 % botol 5 ml/botol 3,194 3,194 0 0
(genoint ) 5
71 Gentamisin injeksi 40 mg/ml ampul 3,399 16,995 0 30
ampul/kotak
72 Gentian Violet larutan 1 % botol botol 900 900 0 0
tablet 56 5,600 2,700 2,000
tablet/kotak
tablet 436 21,800 0 0
tablet/kotak
1000
75 Gliseril Guayacolat tablet 100 mg tablet 28 27,900 9,000 10,000
tablet/botol
76 Gliseril trinitrat tab sublingual tablet tablet 1,500 1,500 0 0
0,5mg (nitral)
77 Glukonas Kalsikus 10 % kotak kotak 187,200 187,200 0 0
500
5,700 5,700 0 0
79 Glukosa larutan infus 40% steril botol botol 1,960 1,960 0 0
(Produk lokal)
500
5,200 5,200 0 20
100
81 tablet 324 32,400 0 0
82 Haloperidol inj 50 mg/ml (haldol ampul ampul 83,333 83,333 0 0
decanoas)
tablet 53 5,252 400 0
tablet/kotak
tablet 83 8,258 300 0
tablet/kotak
tablet 88 8,823 0 0
tablet/kotak
tiube 2,798 67,152 45 75
tube/kotak
87 Ibuprofen sirup 100mg / 5ml botol botol 3,499 3,499 0 0
88 Ibuprofen suspensi 200mg / 5ml botol botol 4,499 4,499 0 0
tablet 116 11,550 0 0
tablet/botol
100
90 Ibuprofen tablet 400 mg tablet 150 15,000 1,400 2,000
tablet/kotak
91 Isosorbid Dinitrat tablet tablet
100
81 8,071 0 0
tablet 70 7,000 2,000 2,000
tablet/kotak
tablet 62 6,200 1,200 0
tablet/kotak
tablet 84 8,400 0 0
tablet/kotak
tablet 243 24,300 0 0
tablet/kotak
50
96 Ketokenazol tablet 200mg tablet 554 27,675 0 0
tablet/kotak
tube 4,700 56,400 0 0
tube/kotak
tablet 1,823 182,250 0 0
tablet/kotak
5
99 Ketorolak inj 10 mg ampul 8,080 40,400 0 0
ampul/kotak
100 Natrium Diklofenac 50 mg kotak 8,700 0 0
101 Nistatin tablet salut 500.000 IU kotak 64,000 0 0
ampul 2,300 13,800 10 0
ampul/kotak
50
103 Klindamisin 150 mg tablet 382 19,100 0 0
tablet/kotak
50
104 Klindamisin 300 mg tablet 527 26,350 0 0
tablet/kotak
100
105 Kloramfenikol kapsul 250 mg tablet 578 57,750 0 0
tablet/kotak
106 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0 0
107 Klorfeniramin Maleat (CTM) tablet
100
51 5,100 4,000 3,000
tablet tablet/kotak
100
108 Klorpromasin tablet 100 mg tablet 149 14,900 0 0
109 mg/ml - 1 ml (SK.720 : kemasan 2 30
ampul 1,021 30,630 0 0
ampul/kotak
ml)
110 Klorpromazin HCl injeksi 5 ampul
30
950 28,500 0 0
111 Klorpromazin HCl tablet salut 100 tablet
100
149 14,900 0 0
mg tablet/kotak
Kotrimoksazol Susp komb: tablet 500 50,000 0 0
tablet/kotak
113 Sulfametoksazol 200mg + botol botol 60 ml 2,190 2,190 0 200
Sulfametoksazol 400mg + tablet 138 13,800 0 2,000
tablet/kotak
115 Trimetoprim
Larutan 80 mg karbohidrat
mengandung 1
Lansoprazol inj 30 mg/ml ampul 82,042 82,042 0 0
ampul/kotak
116 + elektrolit
Larutan (NaCl 1,75karbohidrat
mengandung gr. Na
botol botol 10,000 10,000 0 0
Lactat 2,24 gr. KCl 1.5
117 + elektrolit (NaCl 2,34 gr. Na
gr.Dextrosa 27 gr) / KA EN 3B botol botol 10,000 10,000 0 0
Lactat 2,24 gr. KCl 0.75 gr. 30
118 Lidokaian
Dextrosa 27injgr)
2% / KA EN 3A ampul 1,333 40,000 55 30
ampul/kotak
119 Magnesium Sulfat inj (IV) 20% - vial
10
2,078 20,780 0 0
25 ml
Magnesium Sulfat inj (IV) 40% - vial/kotak
10
120 vial 2,629 26,290 0 20
25 ml vial/kotak
30
121 Mebendazol tablet 100 mg tablet 228 6,840 0 0
122 (Metilergometrin) tab salut 0,125 100
tablet 154 15,400 0 0
tablet/kotak
mg
123 Metilergometrin Maleat inj 0,200 30
ampul 2,175 65,250 0 0
mg-1 ml ampul/kotak
tablet 635 19,050 0 0
tablet/kotak
100
125 metilprednisolon tablet 4 mg tablet 300 30,000 0 0
tablet/kotak
10
126 Metoklopramid inj 5 mg/ml ampul 2,070 20,700 0 0
ampul/kotak
tablet 110 11,000 0 0
tablet/kotak
botol 39,825 39,825 0 0
ml
129 Metronidazol supositoria 500 mg ( suppositoria 3,220 3,220 0 0
flagyl) suppositoria
100
130 Metronidazol tablet 250 mg tablet 193 19,305 0 0
tablet/kotak
131 Metronidazol tablet 500 mg tablet kotak 160 16,000 0 0
132 Mikonazol krim/ salep 2 % tube tube 3,000 3,000 0 0
sachet 2,450 98,000 600 1,000
sachet/kotak
134 Natrium Bikarbonat inj i.v 8,4% ampul ampul 6,200 6,200 0 0
(meylon)
tablet 200 10,000 1,000 0
tablet/kotak
136 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0 0
137 Natrium Klorida larutan infus 0,9 botol botol 4,900 4,900 170 40
% steril (Produk lokal) 24
138 Hidrokortison krim 2,5% tube 2,979 71,500 0 0
tube/kotak
139 Natrium Tiroksin tablet 100 mcg tablet tablet 1,694 1,694 0 0
140 Nifedipin tablet 10mg tablet kotak 129 12,900 0 0
tablet 640 64,000 100 0
tablet/kotak
142 Noretisteron tablet 5 mg (Primolut tablet
30
2,618 78,540 0 0
N) tablet/kotak
100
143 Nystatin vaginal tablet 100.000 UI tablet 480 47,960 0 0
tablet/kotak
144 Obat Batuk Hitam botol botol 5,500 5,500 10 0
145 Ofloxacin 200 mg Tab Salut tablet
100
207 20,650 0 0
Selulose tablet/kotak
146 Ofloxacin 400 mg Tab Salut tablet
100
327 32,700 0 0
Selulose tablet/kotak
147 Oksimetazolin tetes hidung botol botol 27,550 27,550 0 0
148 Oksitetrasiklin HCl salep mata 1 tube
25
1,600 40,000 0 0
% tube/kotak
10
149 Oksitosin injeksi 10IU/ml-1ml ampul 2,200 22,000 0 0
ampul/kotak
tablet 211 6,330 1,670 900
tablet/kotak
tablet 716 21,480 0 600
tablet/kotak
tablet 1,189 35,670 0 0
tablet/kotak
153 Ondansetron inj 4 mg/ 2 ml ampul ampul 2,400 2,400 0 0
tablet 119 11,900 0 0
tablet/kotak
155 Paracetamol drop 100 mg/ml botol botol 5,200 5,200 0 0
156 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,438 1,438 0 336
tablet 79 7,900 13,800 17,000
tablet/kotak
100
158 Piracetam 400 mg Tablet tablet 609 60,885 0 0
tablet/kotak
100
159 Piracetam 800 mg kapsul tablet 1,084 108,405 0 0
tablet/kotak
10
160 Piracetam inj 1 gr/ 5 ml ampul 7,425 74,250 0 0
ampul/kotak
161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0 0
30
tablet 420 12,595 40 0
tablet/kotak
163 Piridoksin HCl (Vit.B6) tablet 10 tablet
100
110 11,000 3,500 5,000
mg tablet/kotak
100
164 Piroksikam 20 mg tablet 105 10,500 2,000 0
tablet/kotak
165 Povidon Iodida larutan 10% botol botol 30 ml 2,163 2,163 0 0
166 Povidon Iodida larutan 10% botol botol 300 ml 14,203 14,203 0 0
tablet 114 11,400 0 0
tablet/kotak
168 Prokain Benzil Penicillin G injeksi vial
30
10,780 323,400 0 0
3 jt IU/vial vial/kotak
100
169 Propiltiourasil tablet 100 mg tablet 404 40,442 0 0
tablet/botol
25
170 Ranitidin inj.25mg/2ml ampul 3,614 86,738 0 60
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 3,000 3,500
kaplet/kotak
50
460 23,000 0 0
50
260 13,000 0 0
174 Ringer Laktat larutan infus steril botol botol 500 ml 5,200 5,200 150 60
tablet 59 5,900 2,400 0
tablet/kotak
tablet 97 9,749 2,500 2,000
177 Botol Botol 63,750 63,750 0 0
178 Salbutamol inshalasi/ aerosol 200 kapsul kapsul 431 431 0 0
179 Salbutamol inshalasi/ aerosol 200 rotahaler rotahaler 5,867 5,867 0 0
180 Salep 2-4 Komb : As Salisilat 2 % pot pot 2,000 2,000 0 0
+ Belerang endap 2 %
181 Salisil Bedak 2% kotak kotak 1,250 1,250 0 0
tablet 855 25,650 0 0
tablet/kotak
tablet 1,042 52,100 0 0
tablet/kotak
184 sefadroksil sirup kering botol botol 4,896 4,896 50 0
125mg/5ml
185 Sefotaksim inj 1 gr vial 2 vial/kotak 6,050 12,100 0 0
186 Sefriakson serbuk injeksi 1 g/vial vial vial 11,000 11,000 0 0
187 Serum Anti Bisa Ular Polivalen Dus, 10 vial
47,300 473,000 0 0
injeksi 5 ml (ABU I) Dus,
@ 5 ml10
188 Serum Anti Tetanus injeksi 1.500 ampul ampul @ 1 12,600 126,000 0 0
IU/ampul (A.T.S)
100
tablet 181 18,100 0 0
tablet/kotak
100
916 91,600 0 0
100
191 Simetidin tablet 200 mg tablet 111 11,100 0 0
tablet/kotak
50
192 Si mvastatin 10 Mg tablet 693 34,628 1,700 1,000
tablet/kotak
100
193 Siproflaxacin tablet 500 mg tablet 255 25,500 0 2,500
tablet/kotak
194 Sulfadoxine Pyrimethamine 525 tablet
100
478 47,800 0 0
mg tablet tablet/kotak
30
195 Tablet Tambah Darah sachet 1,260 1,260 600 5,600
tablet/sachet
196 Terbutalin sulfat (Molasma) tablet tablet
50
99 4,950 100 0
2,5 mg tablet/kotak
197 Terbutalin turbu (serbuk ih) 0,50 turbuhaler turbuhaler 71,100 71,100 0 0
mg (bricasma turbuhaler 0,5mg)
kaplet 149 14,900 0 0
kaplet/kotak
kaplet 257 25,700 0 0
kaplet/kotak
200 Tiamin HCl (Vit.B1) injeksi 100 ampul
30
690 20,700 0 0
201 Tiamin HCl / Mononitrat (Vit.B1) tablet
1000
38 37,800 1,100 0
tablet 50 mg tablet/botol
5
202 Tramadol inj 50mg/5ml ampul 5,400 27,000 0 0
ampul/kotak
203 Triheksifenidil Hidroklorida tablet tablet
100
40 4,000 0 0
2 mg tablet/kotak
Dus, 1 vial
204 Vaksin Rabies Vero - Rabipur vial @ 1 dosis + 78,500 78,500 0 0
100
tablet 108 10,700 300 0
tablet/kotak
206 zinc drop 10 mg/ ml botol botol 12,840 12,840 0 0
207 Zinc sirup 10 mg/ml botol botol 14,980 14,980 0 50
tablet 474 47,400 0 3,000
tablet/kotak
primaquin tablet 0 1,000

pcs 2,140 214,000 0
psc
pcs 650 65,000 0
psc
pcs 650 65,000 1,400 1,000
psc 100
kotak/
psc 100
kotak/
psc
215 pcs 24pcs/kotak 26,667 640,000 0
dengan jarum bedah
216 Catgut / beneng bedah no 3/0 pcs 24psc/kotal 23,299 559,176 0
dengan jarum bedah
botol 30,238 30,238 0
ml
224 Infus set anak set 50 set/kotak 16,500 82,500 90 50
225 Infus set dewasa set 50 set/kotak 6,785 339,250 180 0
227 IV Catheter No. 24 G set 50 set/kotak 7,700 385,000
Kapas Pembalut / Absorben 250
229 Bungkus Bungkus 7,500 7,500 0
gram
232 Kasa Pembalut Hidrofil 36 x 80 Rol Rol 55,200 55,200 0
cm
cm 16
235 Kassa Hidrofil steril uk. 16x16 pcs lembar/kota 363 5,800 8
(surya husada) 12
236 Kassa Hidrofil steril uk. 18x22 (isi pcs k
12 lembar)
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack
pack 7,682 76,820 0
pack
pack 11,204 114,000 0 20
pack
242 Masker pcs 50 pcs/kotak 1,125 56,250 40 1,000
245 Silk ( Benang Bedah Sutera ) No. pcs 36pcs/kotak 14,316 515,376 0
3/0 dg jarum bedah
248 Umbilical cord nylon one med pcs
kotak/ 50
1,940 97,020 36
249 Under Pet 10
pcs 5,390 53,900 0
pcs/kotak
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 577,000 0
psc
Pcs 5,770 549,750 0
psc
0
0BAT GIGI 0
257 Glass Ionomer Cement (GC IX) botol botol 395,000 395,000 0
ART
259 Klorfenol Kamfer Mentol botol botol 55,000 55,000 0
(CHKM)
261 Semen Seng Fosfat serbuk dan botol botol 93,500 93,500 0
cairan
262 Temporary Stopping Fletcher botol botol 34,000 34,000 0
0
OBAT DENGAN NAMA
0
DAGANG
kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
tube/kotak
Kotak 5
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
274 Fituno 30
Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
ampul 4,400 44,000 0
ampul/kotak
100
kaplet/kotak
60
tablet/kotak
Tablet 1,353 135,300 0
tablet100
kotak
tablet
10
tablet/strip
100
tablet/kotak
kapsul 946 94,600 0
kapsul
289 Kasa Pembalut Hidrofil 36 x 80 rol rol 140,337 140,337 0
cm (AHMADARIS)
300 0
IV Cateter 18 G
OBAT TAMBAHAN 0
291 0
292 0 2,000
293 0 80
294 0 3,000
295 0
296 0
297 0
298 0
299 100 3,000
300 0
301 0 1,000
302 200
UMUM
BAYAR
Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Mela

Dinas Kesehatan
Baidulllah S Siagia
NIP.196901241989021
NIP.197211242002121002 NIP. 198105062005012010
AR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : September KABUPATEN
TAHUN : 2017 PROPINSI
STOK AKHIR
PENGELUAR STOK RATA-RATA PERMINTA
PERSEDIAAN DALAM NO
AN AKHIR S/D BULAN AN
RUPIAH
INI
DAK DAK Lain lain TOTAL
2015 2014 2017
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 300 1
0 0 0 0 0 0 2,000 2
0 0 0 0 0 0 2,000 3
0 0 0 0 0 0 500 4
0 0 0 0 0 0 200 5
0 0 0 0 0 0 6
0 0 0 0 0 0 7
0 0 0 0 0 0 8
0 0 0 0 0 0 9
0 2,500 400 2,100 693,000 400 10

0 0 0 0 0 11
0 0 0 0 0 0 12
2,000 2,000 300 1,700 659,583 300 13
10,500 19,100 3,000 16,100 5,007,100 3,000 14
240 510 60 450 1,100,250 60 15
0 0 0 0 0 0 16
0 0 0 0 0 0 17
180 235 40 195 421,200 40 18
7,200 12,400 2,000 10,400 748,800 2,000 19
0 0 0 0 0 0 20
20 20 10 10 20,000 10 21
0 0 0 0 0 0 22
0 0 0 0 0 0 23
0 0 0 0 0 0 24
0 0 0 0 0 0 25
0 0 0 0 0 0 26
0 0 0 0 0 0 27
5,000 5,700 700 5,000 475,000 700 28
0 0 0 0 0 0 29
5,000 5,000 1,000 4,000 576,000 1,000 30

0 30 10 20 85,060 10 31
0 0 0 0 0 32
0 0 0 0 0 33
0 0 0 0 0 0 34
0 0 0 0 0 0 35
0 25 10 15 22,800 10 36
0 0 0 0 0 0 37
0 0 0 0 0 0 38
0 0 0 0 0 0 39
0 60 20 40 63,200 20 40
2,000 5,100 1,000 4,100 254,200 1,000 41

0 0 0 0 0 0 42
0 0 0 0 0 0 43
0 100 0 100 14,300 0 44
100 100 20 80 266,640 20 45
0 0 0 0 0 46
0 0 0 0 0 47
0 0 0 0 0 0 48
0 0 0 0 0 0 49
0 0 0 0 0 0 50
0 0 0 0 0 0 51
0 0 0 0 0 52
0 0 0 0 0 53
200 200 20 180 450,000 20 54
0 3 0 3 644,970 0 55
0 15 1 14 5,039,860 1 56
0 8 0 8 9,599,200 0 57
0 0 0 0 0 0 58
0 0 0 0 0 0 59
0 20 10 10 18,000 10 60
0 0 0 0 0 0 61
0 0 0 0 0 0 62
0 0 0 0 0 0 63
120 260 20 240 820,080 20 64
0 0 0 0 0 0 65
0 0 0 0 0 0 66
1,000 1,000 200 800 68,000 200 67
2,400 3,100 200 2,900 846,800 200 68
150 287 30 257 668,200 30 69
0 0 0 0 0 70
30 30 0 30 101,970 0 71
0 0 0 0 0 0 72
2,000 4,700 500 4,200 235,200 500 73
0 0 0 0 0 74
10,000 19,000 2,000 17,000 474,300 2,000 75
0 0 0 0 0 0 76
0 0 0 0 0 0 77
0 0 0 0 0 0 78
0 0 0 0 0 0 79
20 20 5 15 78,000 5 80
0 0 0 0 0 0 81
0 0 0 0 0 0 82
0 400 100 300 15,756 100 83
0 300 100 200 16,516 100 84
0 0 0 0 0 0 85
75 120 25 95 265,810 25 86
0 0 0 0 0 0 87
0 0 0 0 0 0 88
0 0 0 0 0 0 89
2,000 3,400 500 2,900 435,000 500 90
0 0 0 0 0 91
2,000 4,000 500 3,500 245,000 500 92
0 1,200 300 900 55,800 300 93
0 0 0 0 0 94
0 0 0 0 0 0 95
0 0 0 0 0 0 96
0 0 0 0 0 97
0 0 0 0 0 0 98
0 0 0 0 0 0 99
0 0 0 0 0 0 100
0 0 0 0 0 0 101
0 10 5 5 11,500 5 102
0 0 0 0 0 0 103
0 0 0 0 0 0 104
0 0 0 0 0 0 105
0 0 0 0 0 0 106
3,000 7,000 1,500 5,500 280,500 1,500 107

0 0 0 0 0 0 108
0 0 0 0 0 0 109
0 0 0 0 0 0 110
0 0 0 0 0 0 111
0 0 0 0 0 0 112
200 200 40 160 350,400 40 113

2,000 2,000 500 1,500 207,000 500 114
0 0 0 0 0 0 115
0 0 0 0 0 0 116
0 0 0 0 0 0 117
30 85 30 55 73,333 30 118
0 0 0 0 0 0 119
20 20 0 20 52,580 0 120
0 0 0 0 0 0 121
0 0 0 0 0 0 122
0 0 0 0 0 0 123
0 0 0 0 0 0 124
0 0 0 0 0 125
0 0 0 0 0 0 126
0 0 0 0 0 127
0 0 0 0 0 0 128
0 0 0 0 0 0 129
0 0 0 0 0 0 130
0 0 0 0 0 0 131
0 0 0 0 0 132
1,000 1,600 0 1,600 3,920,000 0 133
0 0 0 0 0 0 134
0 1,000 300 700 140,000 300 135
0 0 0 0 0 0 136
40 210 20 190 931,000 20 137
0 0 0 0 0 0 138
0 0 0 0 0 0 139
0 0 0 0 0 140
0 100 0 100 64,000 0 141
0 0 0 0 0 0 142
0 0 0 0 0 0 143
0 10 10 0 0 10 144
0 0 0 0 0 145
0 0 0 0 0 146
0 0 0 0 0 0 147
0 0 0 0 0 0 148
0 0 0 0 0 149
900 2,570 570 2,000 422,000 570 150
600 600 200 400 286,400 200 151
0 0 0 0 0 152
0 0 0 0 0 153
0 0 0 0 0 0 154
0 0 0 0 0 0 155
336 336 60 276 396,888 60 156
17,000 30,800 3,000 27,800 2,196,200 3,000 157
0 0 0 0 0 0 158
0 0 0 0 0 0 159
0 0 0 0 0 0 160
0 0 0 0 0 0 161
0 40 40 16,793 0 162
5,000 8,500 1,000 7,500 825,000 1,000 163
0 2,000 500 1,500 157,500 500 164
0 0 0 0 0 0 165
0 0 0 0 0 0 166
0 0 0 0 0 167
0 0 0 0 0 0 168
0 0 0 0 0 0 169
60 60 20 40 144,560 20 170
3,500 6,500 500 6,000 720,000 500 171
0 0 0 0 0 0 172
0 0 0 0 0 0 173
60 210 20 190 988,000 20 174
0 2,400 400 2,000 118,000 400 175

2,000 4,500 500 4,000 389,960 500 176
0 0 0 0 0 0 177
0 0 0 0 0 0 178
0 0 0 0 0 0 179
0 0 0 0 0 0 180
0 0 0 0 0 0 181
0 0 0 0 0 0 182
0 0 0 0 0 183
0 50 25 25 122,400 25 184
0 0 0 0 0 185
0 0 0 0 0 186
0 0 0 0 0 0 187
0 0 0 0 0 0 188
0 0 0 0 0 0 189
0 0 0 0 0 0 190
0 0 0 0 0 0 191
1,000 2,700 500 2,200 1,523,632 500 192
2,500 2,500 500 2,000 510,000 500 193
0 0 0 0 0 0 194
5,600 6,200 1,500 4,700 5,922,000 1,500 195
0 100 100 9,900 0 196
0 0 0 0 0 0 197
0 0 0 0 0 0 198
0 0 0 0 0 0 199
0 0 0 0 0 0 200
0 1,100 300 800 30,240 300 201
0 0 0 0 0 0 202
0 0 0 0 0 0 203
0 0 0 0 0 0 204
0 300 300 0 0 300 205
0 0 0 0 0 0 206
50 50 10 40 599,200 10 207
3,000 3,000 500 2,500 1,185,000 500 208
1,000 1,000 0 1,000 0 0
0 0 0 0 0 0
0 0 0 0 0 0 209
0 0 0 0 0 0 210
1,000 2,400 200 2,200 1,430,000 200 211
0 0 0 0 0 212
0 0 0 0 0 0 213
0 0 0 0 0 0 214
0 0 0 0 0 0 215
0 0 0 0 0 216
0 0 0 0 0 0 217
0 0 0 0 0 0 218
0 0 0 0 0 0 219
0 0 0 0 0 0 220
0 0 0 0 0 0 221
0 0 0 0 0 0 222
0 0 0 0 0 0 223
50 140 10 130 2,145,000 10 224
180 20 160 1,085,527 20 225
22 0 22 169,400 0 226
0 0 0 0 0 227
0 22 5 17 130,900 5 228
0 0 0 0 0 229
0 0 0 0 0 0 230
0 0 0 0 0 0 231
0 0 0 0 0 232
0 0 0 0 0 0 233
0 0 0 0 0 0 234
0 8 8 0 0 8 235
0 0 0 0 0 0 236
0 0 0 0 0 0 237
0 0 0 0 0 0 238
0 0 0 0 0 239
20 20 5 15 168,053 5 240
0 0 0 0 0 0 241
1,000 1,040 200 840 945,000 200 242
0 0 0 0 0 0 243
0 0 0 0 0 0 244
0 0 0 0 0 245
0 0 0 0 0 0 246
0 0 0 0 0 0 247
0 36 0 36 69,854 0 248
0 0 0 0 0 0 249
0 0 0 0 0 250
0 0 0 0 0 0 251
0 0 0 0 0 0 252
0 0 0 0 0 0 253
0 0 0 0 0 0 254
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 255
0 0 0 0 0 256
0 0 0 0 0 0 257
0 0 0 0 0 0 258
0 0 0 0 0 0 259
0 0 0 0 0 0 260
0 0 0 0 0 0 261
0 0 0 0 0 0 262
0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 263
0 0 0 0 0 0 264
0 0 0 0 0 0 265
0 0 0 0 0 0 266
0 0 0 0 0 0 267
0 0 0 0 0 0 268
0 0 0 0 0 0 269
0 0 0 0 0 0 270
0 0 0 0 0 0 271
0 0 0 0 0 0 272
0 0 0 0 0 0 273
0 0 0 0 0 0 274
0 0 0 0 0 0 275
0 0 0 0 0 0 276
0 0 0 0 0 0 277
0 0 0 0 0 0 278
0 0 0 0 0 0 279
0 0 0 0 0 0 280
0 0 0 0 0 0 281
0 0 0 0 0 0 282
0 0 0 0 0 0 283
0 0 0 0 0 0 284
0 0 0 0 0 0 285
0 0 0 0 0 0 286
0 0 0 0 0 0 287
0 0 0 0 0 0 288
0 0 0 0 0 0 289
0 0 0 0 0 0 290
0 0 0 0 0 300
0 0 0 0 0 0
0 0 0 0 0 291
2,000 2,000 300 1,700 0 300 292
80 80 20 60 0 20 293
3,000 3,000 500 2,500 0 500 294
0 0 0 0 0 295
0 0 0 0 0 296
0 0 0 0 0 297
0 0 0 0 0 298
3,000 3,100 300 2,800 0 300 299
0 0 0 0 0 300
1,000 1,000 300 700 0 300 301
0 200 100 100 0 100 302
59,223,315
Menerima/Melapor
epala Puskesmas Petugas Gudang Farmasi
Puskesmas Rawajitu
dulllah S Siagian Endang Sulastri Amd.Keb

96901241989021001 NIP.197202191992032001
10
E PUSKESMAS :
KESMAS : Rawajitu
AMATAN : Rawajitu selatan
UPATEN : TULANG BAWANG
PINSI : LAMPUNG
STOK
PENERIMAAN
HARGA HARGA PER
NAMA OBAT SATUAN KMSN
SATUAN KEMASAN
AWAL
2015 2014 2017
2 3 4 5 6 7 8 9 10 11 12
24
ACT (Artesunat + Amodiaquin ) tablet tablet 1,856 44,550 0
tab/Kotak
100
Alopurinol tablet 100 mg tablet 86 8,600 0
tablet/kotak
30
Alopurinol tablet 300 mg tablet 331 9,923 0
tablet/kotak
100
Alprazolam tablet 1 mg tablet 233 23,300 0
tablet/kotak
Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml 3,300 3,300 0
100
Ambroxol tab 30 mg tablet 86 8,593 0
tablet/kotak
100
Aminofilin tablet 200mg tablet ktk 30 80 8,000 0
tablet/kotak
Aminofilina injeksi 24 mg/ml ampul ampul@10 4,050 121,500 0
ml
100
Amitriptillin tablet salut 25 mg tablet 112 11,200 0
tablet/kotak
30
Amlodipine Tablet 10 mg tablet 330 9,900 2,100
tablet/kotak
30
Amlodipine Tablet 5 mg tablet 187 5,610 0
tablet/kotak
10
Amoksisilin Injeksi serbuk 1000mg vial 10,125 101,250 0
vial/kotak
100
Amoksisilin kapsul 250 mg tablet 388 38,799 1,700
tablet/kotak
100
Amoksisilin kapsul 500 mg tablet 311 31,100 16,100
tablet/kotak
Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 2,445 2,445 450
100
Antalgin (Metampiron) tablet 500 mg tablet 201 20,115 0
tablet/kotak
30
Antalgin injeksi 250 mg/ml - 2 ml vial 1,800 54,000 0
vial/kotak
Antasida DOEN II suspensi komb botol botol 60 ml 2,160 2,160 195
100
Antasida DOEN
Anti Bakteri DOENtablet
salep tablet 72 7,200 10,400
tablet/kotak
25
kombinasi:Bacitracin-polymixin B tube 2,581 62,900 0
tube/kotak
10
krim
Anti Hemoroid DOEN Kombinasi supp 2,000 20,000 10
pot 24 pot/kotak 2,320 55,688 0
100
Antimalaria DOEN kombinasi tablet 518 51,800 0
tablet/kotak
Antimigren:Ergotamin Tartrat 1mg 100
Antiparkinson tablet 135 13,500 0
100
benzerazid 25 mg levodopa 100 mg tablet 1,500 150,000 0
tablet/kotak
10
(Aqua
Levopar)
vial/kotak
6
Arthemeter injeksi 1 ml : 80 mg ampul 29,925 179,550 0
ampul/kotak
100
Asam Askorbat (Vit C) tablet 50 mg tablet 95 9,500 5,000
tablet/kotak
100
Asam folat tablet 1 mg tablet 84 8,400 0
tablet/botol
100
Asam mefenamat tablet 144 14,400 4,000
tablet/kotak
25
Asiklovir krim 5% tube 4,253 101,250 20
tube/kotak
100
Asiklovir tablet 200 mg tablet 524 52,404 0
tablet/kotak
100
Asiklovir tablet 400 mg tablet 771 77,130 0
tablet/kotak
Benzatin Benzil Penicillin injeksi 1,2 jt 10
vial 11,070 110,700 0
IU/vial vial/kotak
30
Besi (II ) Sulfat + asam folat 0.25 tab sachet 2,700 2,700 0
tablet/sachet
Betametason krim 0,1% tube tube 1,520 1,520 15
Budesonid inhaler 200 mcg/puff, 100
Budesonid-formoterol ( fixed turbuhaler turbuhaler 93,000 93,000 0
combination) inhaler 160/4,5
Budesonid-formoterol ( fixed mcg turbuhaler turbuhaler 117,600 117,600 0
(symbicort turbuhaler)
(symbicort) 100
Deksametason injeksi 5mg.ml-1ml ampul 1,580 158,000 40
ampul/kotak
100
Deksametason tablet 0,5 mg tablet 62 6,200 4,100
tablet/kotak
9
DHP tablet (Prog : malaria) tablet 3,567 32,101 0
tablet/kotak
Difenhidramin HCl injeksi 10 mg/ml- 30
ampul 1,054 31,620 0
1ml ampul/kotak
100
Digoksin tablet 0,25 mg tablet 143 14,300 100
tablet/kotak
Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 80
Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0

100
Domperidone tablet 10mg tablet 167 16,700 0
tablet/kotak
1000
Ekstrak Belladon tablet 10 mg tablet 38 38,000 0
30
Adrenalina ) ampul 8,100 243,000 0
ampul/kotak
Ergakalsiferol
ml D3/D2) kapsul
Ergakalsiferol (vitamin D3/D2)
suspensi 10000 UI/ml (D-Vit syrup) 120
Eritromisin kapsul 250mg tablet 494 59,230 0
tablet/kotak
Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
100
Etanol 70% cairan botol 2,500 2,500 180
ml/botol
FDC kategori anak paket kotak 214,990 214,990 3
FDC OAT Kategori I paket kotak 359,990 359,990 14
FDC OAT Kategori II paket kotak 1,199,900 1,199,900 8
Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0

30
Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 1,800 54,000 10
ampul/kotak
100
Fenobarbital tablet 100 mg tablet 220 22,000 0
Fenol Gliserol tetes telinga 10% tablet/kotak
24
botol 2,042 49,008 0
(Karbogliserin 10%) injeksi 10
Fitomenadion (Vit.K1) botol/kotak
10
ampul 4,698 46,980 0
30
Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 3,417 102,510 240
ampul/kotak
Fitomenadion (Vit.K1)tab salut gula 10 100
tablet 634 63,400 0
mg tablet/botol
25
Furosemid inj 40 mg/ml ampul 1,829 45,725 0
ampul/kotak
100
Furosemid tablet 40 mg tablet 85 8,500 800
100
sachet 292 29,200 2,900
diare) sachet/kotak
Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 257
Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
5
Gentamisin injeksi 40 mg/ml ampul 3,399 16,995 30
ampul/kotak
Gentian Violet larutan 1 % botol botol 900 900 0
101
Glibenklamid tablet 5 mg tablet 56 5,600 4,200
tablet/kotak
50
Glimepiride tablet 2 mg tablet 436 21,800 0
tablet/kotak
1000
Gliseril Guayacolat tablet 100 mg tablet 28 27,900 17,000
Gliseril trinitrat tab sublingual 0,5mg tablet/botol
tablet tablet 1,500 1,500 0
(nitral)
Glukonas Kalsikus 10 % kotak kotak 187,200 187,200 0
Glukosa larutan infus 10% steril 500
botol 5,700 5,700 0
Glukosa larutan infus 40% steril
(Produk
Glukosa lokal)
larutan infus 5% steril (Produk 500
botol 5,200 5,200 15
lokal) ml/botol
100
Griseofulvin tablet 125 mg, micronized tablet 324 32,400 0
tablet/kotak
Haloperidol inj 50 mg/ml (haldol
ampul ampul 83,333 83,333 0
decanoas)
100
Haloperidol tablet 0,5 mg tablet 53 5,252 300
tablet/kotak
100
Haloperidol tablet 1,5 mg tablet 83 8,258 200
tablet/kotak
100
Haloperidol tablet 5 mg tablet 88 8,823 0
tablet/kotak
24
Hidrokortison krim 2,5% tiube 2,798 67,152 95
tube/kotak
Ibuprofen sirup 100mg / 5ml botol botol 3,499 3,499 0
Ibuprofen suspensi 200mg / 5ml botol botol 4,499 4,499 0
100
Ibuprofen tablet 200 mg tablet 116 11,550 0
tablet/botol
100
Ibuprofen tablet 400 mg tablet 150 15,000 2,900
tablet/kotak
Isosorbid Dinitrat tablet sublingual 5 100
tablet 81 8,071 0
mg tablet/kotak
100
Kalsium Laktat tab 500 mg tablet 70 7,000 3,500
tablet/kotak
100
Kaptopril tablet 12,5 mg tablet 62 6,200 900
tablet/kotak
100
Kaptopril tablet 25 mg tablet 84 8,400 0
tablet/kotak
100
Karbamazepin tablet 200 mg tablet 243 24,300 0
tablet/kotak
50
Ketokenazol tablet 200mg tablet 554 27,675 0
tablet/kotak
12
Ketokonazol krim 2% tube 4,700 56,400 0
tube/kotak
100
Ketoprofen tablet 100 mg tablet 1,823 182,250 0
tablet/kotak
5
Ketorolak inj 10 mg ampul 8,080 40,400 0
ampul/kotak
Natrium Diklofenac 50 mg kotak 8,700 0
Nistatin tablet salut 500.000 IU kotak 64,000 0
6
Ketorolak inj 30 mg ampul 2,300 13,800 5
ampul/kotak
50
Klindamisin 150 mg tablet 382 19,100 0
tablet/kotak
50
Klindamisin 300 mg tablet 527 26,350 0
tablet/kotak
100
Kloramfenikol kapsul 250 mg tablet 578 57,750 0
tablet/kotak
Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
100
Klorfeniramin Maleat (CTM) tablet tablet 51 5,100 5,500
tablet/kotak
100
Klorpromasin tablet 100 mg tablet 149 14,900 0
Klorpromazin HCl injeksi 25 mg/ml - 1 tablet/kotak
30
ampul 1,021 30,630 0
Klorpromazin HCl injeksi 5 mg/ml - 2 30
ampul 950 28,500 0
ml ampul/kotak
100
Klorpromazin HCl tablet salut 100 mg tablet 149 14,900 0
tablet/kotak
100
Kodein 10 mg tablet
tablet/kotak
Sulfametoksazol 200mg
Kotrimoksazol tablet + Trimetoprim
komb: botol botol 60 ml 2,190 2,190 160
40 mg 100
Sulfametoksazol 400mg + Trimetoprim tablet 138 13,800 1,500
tablet/kotak
80 mg mengandung karbohidrat +
Larutan 1
elektrolit (NaCl 1,75 gr. Na Lactat+2,24 ampul/kotak
Larutan mengandung karbohidrat botol botol 10,000 10,000 0
gr. KCl 1.5
elektrolit gr.Dextrosa
(NaCl 27 gr)
2,34 gr. Na / KA
Lactat EN
2,24
3B botol botol 10,000 10,000 0
gr. KCl 0.75 gr. Dextrosa 27 gr) / KA 30
Lidokaian
EN 3A inj 2 % ampul 1,333 40,000 55
ampul/kotak
10
Magnesium Sulfat inj (IV) 20% - 25 ml vial 2,078 20,780 0
vial/kotak
10
Magnesium Sulfat inj (IV) 40% - 25 ml vial 2,629 26,290 20
vial/kotak
30
Mebendazol tablet 100 mg tablet 228 6,840 0
tablet/kotak
Metilergometrin Maleat 100
tablet 154 15,400 0
Metilergometrin Maleat inj 0,200 mg-1 30
ampul 2,175 65,250 0
ml ampul/kotak
30
Metilprednisolon tablet 16 mg tablet 635 19,050 0
tablet/kotak
100
metilprednisolon tablet 4 mg tablet 300 30,000 0
tablet/kotak
10
Metoklopramid inj 5 mg/ml ampul 2,070 20,700 0
ampul/kotak
100
Metoklopramid 5 mg tablet 110 11,000 0
tablet/kotak
botol 100
Metronidazol Infus 500mg/100ml botol 39,825 39,825 0
ml
Metronidazol supositoria 500 mg
3,220 3,220 0
100
Metronidazol tablet 250 mg tablet 193 19,305 0
tablet/kotak
Metronidazol tablet 500 mg tablet kotak 160 16,000 0
Mikonazol krim/ salep 2 % tube tube 3,000 3,000 0
40
Mineral mix (Prog. Gizi) sachet 2,450 98,000 1,600
Natrium Bikarbonat inj i.v 8,4% sachet/kotak
ampul ampul 6,200 6,200 0
(meylon)
50
Natrium Diklofenac 50 mg tablet 200 10,000 700
tablet/kotak
Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
Natrium Klorida larutan infus 0,9 %
botol botol 4,900 4,900 190
Hidrokortison krim 2,5% tube 2,979 71,500 0
tube/kotak
Natrium Tiroksin tablet 100 mcg tablet tablet 1,694 1,694 0
Nifedipin tablet 10mg tablet kotak 129 12,900 0
100
Nistatin tablet salut 500.000 IU tablet 640 64,000 100
tablet/kotak
30
Noretisteron tablet 5 mg (Primolut N) tablet 2,618 78,540 0
tablet/kotak
100
Nystatin vaginal tablet 100.000 UI tablet 480 47,960 0
tablet/kotak
Obat Batuk Hitam botol botol 5,500 5,500 0
100
Ofloxacin 200 mg Tab Salut Selulose tablet 207 20,650 0
tablet/kotak
100
Ofloxacin 400 mg Tab Salut Selulose tablet 327 32,700 0
Oksimetazolin tetes hidung 0,025% tablet/kotak
botol botol 27,550 27,550 0
(ilaidin drop) 25
Oksitetrasiklin HCl salep mata 1 % tube 1,600 40,000 0
tube/kotak
10
Oksitosin injeksi 10IU/ml-1ml ampul 2,200 22,000 0
ampul/kotak
30
Omeprazol kapsul 20mg tablet 211 6,330 2,000
tablet/kotak
30
ondansetron tablet 4 mg tablet 716 21,480 400
tablet/kotak
30
ondansetron tablet 8 mg tablet 1,189 35,670 0
tablet/kotak
Ondansetron inj 4 mg/ 2 ml ampul ampul 2,400 2,400 0
100
Papaverin tablet 40mg tablet 119 11,900 0
tablet/kotak
Paracetamol drop 100 mg/ml botol botol 5,200 5,200 0
Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,438 1,438 276
100
Parasetamol tablet 500 mg tablet 79 7,900 27,800
tablet/kotak
100
Piracetam 400 mg Tablet tablet 609 60,885 0
tablet/kotak
100
Piracetam 800 mg kapsul tablet 1,084 108,405 0
tablet/kotak
10
Piracetam inj 1 gr/ 5 ml ampul 7,425 74,250 0
ampul/kotak
Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
30
Pirantel tablet 125 mg tablet 420 12,595 40
tablet/kotak
100
Piridoksin HCl (Vit.B6) tablet 10 mg tablet 110 11,000 7,500
tablet/kotak
100
Piroksikam 20 mg tablet 105 10,500 1,500
tablet/kotak
Povidon Iodida larutan 10% botol botol 30 ml 2,163 2,163 0
Povidon Iodida larutan 10% botol botol 300 ml 14,203 14,203 0
100
Prednisone tablet 5 mg tablet 114 11,400 0
Prokain Benzil Penicillin G injeksi 3 jt tablet/kotak
30
vial 10,780 323,400 0
IU/vial vial/kotak
100
Propiltiourasil tablet 100 mg tablet 404 40,442 0
tablet/botol
25
Ranitidin inj.25mg/2ml ampul 3,614 86,738 40
ampul/kotak
100
Ranitidin tablet 150 mg tablet 120 12,000 6,000
Retinol (Vitamin A) 200.000 IU kaplet/kotak
50
kapsul 460 23,000 0
Kapsul
Retinol Lunak
(Vitamin A) 100.000 IU Kapsul kapsul/botol
50
kapsul 260 13,000 0
Lunak kapsul/botol
Ringer Laktat larutan infus steril botol botol 500 ml 5,200 5,200 190
100
Salbutamol 2 mg tablet 59 5,900 2,000
tablet/kotak
100
Salbutamol 4 mg tablet 97 9,749 4,000
Botol Botol 63,750 63,750 0
mcg/dosis
Salbutamol(ventolin
inshalasi/inheler)
aerosol 200
kapsul kapsul 431 431 0
Salbutamol inshalasi/ aerosol 200
rotahaler rotahaler 5,867 5,867 0
Salep 2-4 Komb : As Salisilat 2 % +
pot pot 2,000 2,000 0
Belerang endap 2 %
Salisil Bedak 2% kotak kotak 1,250 1,250 0
30
Sefadroksil kapsul 250 mg tablet 855 25,650 0
tablet/kotak
50
Sefadroksil kapsul 500 mg tablet 1,042 52,100 0
tablet/kotak
sefadroksil sirup kering 125mg/5ml botol botol 4,896 4,896 25
Sefotaksim inj 1 gr vial 2 vial/kotak 6,050 12,100 0

Sefriakson serbuk injeksi 1 g/vial vial vial 11,000 11,000 0
Serum Anti Bisa Ular Polivalen injeksi Dus, 10 vial
Dus, 10 47,300 473,000 0
5Serum
ml (ABU
Anti I)
Tetanus injeksi 1.500 @ 5 ml
ampul ampul @ 1 12,600 126,000 0
IU/ampul (A.T.S)
ml
100
Setrizin tablet 10 mg tablet 181 18,100 0
tablet/kotak
Sianokobalamin (vit B12) injeksi 100
ampul 916 91,600 0
100
Simetidin tablet 200 mg tablet 111 11,100 0
tablet/kotak
50
Si mvastatin 10 Mg tablet 693 34,628 2,200
tablet/kotak
100
Siproflaxacin tablet 500 mg tablet 255 25,500 2,000
Sulfadoxine Pyrimethamine 525 mg tablet/kotak
100
tablet 478 47,800 0
tablet tablet/kotak
30
Tablet Tambah Darah sachet 1,260 1,260 4,700
Terbutalin sulfat (Molasma) tablet 2,5 tablet/sachet
50
tablet 99 4,950 100
mg
Terbutalin turbu (serbuk ih) 0,50 mg tablet/kotak
turbuhaler turbuhaler 71,100 71,100 0
100
Tetrasiklin HCl kapsul 250 mg kaplet 149 14,900 0
kaplet/kotak
100
Tetrasiklin HCl kapsul 500 mg kaplet 257 25,700 0
Tiamin HCl (Vit.B1) injeksi 100 kaplet/kotak
30
ampul 690 20,700 0
mg/ml-1 ml
Tiamin HCl / Mononitrat (Vit.B1) tablet ampul/kotak
1000
tablet 38 37,800 800
50 mg tablet/botol
5
Tramadol inj 50mg/5ml ampul 5,400 27,000 0
ampul/kotak
100
Triheksifenidil Hidroklorida tablet 2 mg tablet 40 4,000 0
tablet/kotak
Dus, 1 vial
Vaksin Rabies Vero - Rabipur vial @ 1 dosis + 78,500 78,500 0
syringe
100
Vitamin B komplek tablet tablet 108 10,700 0
tablet/kotak
zinc drop 10 mg/ ml botol botol 12,840 12,840 0
Zinc sirup 10 mg/ml botol botol 14,980 14,980 40
100
Zinc Tab 20 mg tablet 474 47,400 2,500
tablet/kotak
Primaquin 1,000
kotak/ 100
Alat suntik sekali pakai 0,5 ml pcs 2,140 214,000 0
psc
kotak/ 100
Alat suntik sekali pakai 1 ml pcs 650 65,000 0
psc
kotak/ 100
Alat suntik sekali pakai 3 ml pcs 650 65,000 2,200
psc 100
kotak/
Alat suntik sekali pakai 5 ml pcs 750 75,000 0
psc 100
kotak/
Alkohol Swab pcs 216 21,560 0
psc
Aqua bides 20 liter galon galon 174,000 174,000 0
pcs 24pcs/kotak 26,667 640,000 0
jarum bedah
Catgut / beneng bedah no 3/0 dengan
pcs 24psc/kotal 23,299 559,176 0
jarum bedah
Cut gut chromic 3/0 pcs 24 pcs/kotak 5,583 134,000 0
Elastis Perban 75 Fesco roll roll 17,160 17,160 0
Exell tulle pcs kotak / psc 14,014 14,014 0
Foley cateter pcs pcs 8,495 8,495 0
Handscoon uk 7 pcs kotak 5,267 5,267 0
Handscoon uk 8 pcs kotak 5,270 5,270 0
botol 800
Hidrogen Peroksida (H2 O2) 10% botol 30,238 30,238 0
ml
Infus set anak set 50 set/kotak 16,500 82,500 130
Infus set dewasa set 50 set/kotak 6,785 339,250 160
IV Catheter No. 22 G set 50 set/kotak 7,700 385,000 22
IV Catheter No. 24 G set 50 set/kotak 7,700 385,000
IV Chateter No 20 G set 50 set/kotak 7,700 385,000 17
Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 7,500 7,500 0
Kasa Pembalut Elastic 3 inchi pcs psc 7,000 7,000 0
Kasa Pembalut Elastic 4 inchi pcs psc 10,000 10,000 0
Kasa Pembalut Hidrofil 36 x 80 cm Rol Rol 55,200 55,200 0
Kasa Pembalut Hidrofil 4 m x 10 roll roll 30,350 30,350 0
Kasa Pembalut Hidrofil 4 m x 5 cm roll roll
16 30,350 30,350 0
Kassa Hidrofil steril uk. 16x16 (surya
pcs lembar/kota
12 363 5,800 0
husada)
Kassa Hidrofil steril uk. 18x22 (isi 12
pcs k
lembar)
k
Kassa kompres steril 40 x 40 cm Pcs Pcs 1,600 1,600 0
ball/ 10
Kertas Puyer pack 6,402 64,020 0
pack
ball/ 10
Klip Plastik 10 x 7 KP pack 7,682 76,820 0
pack
ball/ 10
Klip Plastik 13x8,7 KP pack 11,204 114,000 15
pack
Lisorin 1liter botol botol 18,865 18,865 0
Masker pcs 50 pcs/kotak 1,125 56,250 840
Pembalut Gibs 3 inchi rol rol 23,500 23,500 0
Plester 5 yard x 2 inch Rol Rol 23,625 23,625 0
Silk ( Benang Bedah Sutera ) No. 3/0 dg
pcs 36pcs/kotak 14,316 515,376 0
jarum bedah
Sterobat nf. 400ml botol botol 78,000 78,000 0
Strip gula 50 strip (blonime) box box 464,000 464,000 0
Umbilical cord nylon one med (Klem kotak/ 50
pcs 1,940 97,020 36
tali pusat) psc
10
Under Pet pcs 5,390 53,900 0
pcs/kotak
Urine Bag Pcs Pcs 4,000 4,000 0
kotak/ 100
Wing Needle No. 21 G Pcs 5,770 577,000 0
psc
kotak/ 100
psc
kotak/ 100
psc
kotak/ 100
psc
0
0BAT GIGI 0
Devitalisasi Pasta (Non Arsen) kotak kotak 390,000 390,000 0

Etil klorida spray botol botol 146,300 146,300 0
Glass Ionomer Cement (GC IX) ART botol botol 395,000 395,000 0
Kalsium Hidroksida Pasta kotak kotak 242,000 242,000 0
Klorfenol Kamfer Mentol (CHKM) botol botol 55,000 55,000 0
Mummifying Pasta kotak kotak 176,000 176,000 0
Semen Seng Fosfat serbuk dan cairan botol botol 93,500 93,500 0
Temporary Stopping Fletcher (Fletcher)
botol botol 34,000 34,000 0
serbuk & cairan
0

30
Armovit Kapsul kapsul 1,537 46,100 0
kapsul/kotak
30
Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
Betason-N krim Tube 9,182 220,368 0
tube/kotak
Kotak 5
Bioneuron Injeksi ampul 4,341 21,705 0
Ampul
Bionick botol 60 ml/botol 16,000 16,000 0
Bionick drop botol 15 ml/botol 22,500 22,500 0
Blonick Plus Syr Botol Botol 18,700 18,700 0
Chlorampecort Cr Tube Tube 10 gr 9,085 9,085 0
100
Diapecta Tablet 384 38,400 0
tablet/kotak
Febrinex Suspensi Botol Botol 15,855 15,855 0
100
Fercee Tablet 1,044 104,400 0
tablet/kotak
30
Fituno Tablet 3,273 98,190 0
kaplet/kotak
Fludane plus syr 60 ml botol botol 60 ml 15,950 15,950 0
Flutamol Sirup botol 60 mL/botol 13,500 13,500 0
10
Hustab Tablet 284 2,840 0
tablet/strip
Lybex sirup botol botol 60 ml 19,800 19,800 0
10
Mersibion inj ampul 4,400 44,000 0
ampul/kotak
100
Neorodial kaplet 1,091 109,100 0
kaplet/kotak
60
Neurovit-E Tablet 818 49,080 0
tablet/kotak
Noza Tablet 4 tablet/strip 399 1,596 0
kotak 100
Poncobex Tablet 1,353 135,300 0
tablet100
kotak
Ponflu Tablet 935 93,500 0
tablet
10
Progastric Tablet 303 3,030 0
tablet/strip
100
Ramaton Tablet 698 69,800 0
tablet/kotak
Scabicid Cream Tube Tube 10 gr 28,380 28,380 0
kotak 100
Siobio kapsul 946 94,600 0
kapsul
Kasa Pembalut Hidrofil 36 x 80 cm
rol rol 140,337 140,337 0
(AHMADARIS)
Master Plast Plastik 1 inc (plester) roll roll 27,088 27,088 0
IV Cateter 18 G 0
OBAT TAMBAHAN 0
Trufit sirup Botol Kotak 0
CALCIMEGA Tablet Kotak 1,700
Solafluz Sirup Botol Kotak 60
Lodecon Forte Tablet Kotak 2,500
Solvitron Kapsul Kapsul Kotak 0

Doksisiklin Kapsul Kotak 0
Cloramex 500 MG Kapsul Kotak 0
Loperamid tab 2 mg Tablet Kotak 0
Metformin HCL 500 mg tablet Kotak 2,800
Simvastatin 20 mg Tablet Kotak 0
Spironolakton 25 mg Tablet Kotak 700
Dletiazepam 5 mg tab Tablet Kotak 100
UMUM
BAYAR

Dinas Kesehatan
NIP.196901241989021001
NIP.197211242002121002 NIP. 198105062005012010
LPLPO)
KODE PUSKESMAS :
BULAN : Oktober KABUPATEN : TULANG BAWANG
TAHUN : 2017 PROPINSI : LAMPUNG
PEMAKAIAN
STOK AKHIR
PERSEDIAAN DALAM NO NAMA OBAT SATUAN KMSN
RUPIAH
INI
TOTAL
13 14 15 16 17 18 19 1 2 3 4
0 0 0 0 0 0 300 1 ACT (Artesunat + tablet
24
Amodiaquin ) tablet tab/Kotak
100
0 0 0 0 0 2,000 2 Alopurinol tablet 100 mg tablet
tablet/kotak
30
0 0 0 0 0 0 2,000 3 Alopurinol tablet 300 mg tablet
tablet/kotak
100
0 0 0 0 0 500 4 Alprazolam tablet 1 mg tablet
tablet/kotak
0 0 0 0 0 0 200 5 Ambroxol sirup 15 mg/ 5 botol botol 60 ml
ml 100
0 0 0 0 0 0 6 Ambroxol tab 30 mg tablet
tablet/kotak
100
0 0 0 0 0 0 7 Aminofilin tablet 200mg tablet ktk 30
tablet/kotak
0 0 0 0 0 0 8 Aminofilina injeksi 24 ampul ampul@10
mg/ml
9 Amitriptillin tablet salut 25 ml
100
0 0 0 0 0 0 tablet
mg tablet/kotak
30
0 2,100 500 1,600 528,000 500 10 Amlodipine Tablet 10 mg tablet
tablet/kotak
30
0 0 0 0 0 11 Amlodipine Tablet 5 mg tablet
tablet/kotak
0 0 0 0 0 0 12 Amoksisilin Injeksi serbuk vial
10
1000mg vial/kotak
0 1,700 400 1,300 504,387 400 tablet
tablet/kotak
0 16,100 3,000 13,100 4,074,100 3,000 tablet
tablet/kotak
0 450 80 370 904,650 80 15 Amoksisilin sirup kering botol botol 60 ml
125 mg/ 5 ml
0 0 0 0 0 0 16 Antalgin (Metampiron) tablet
100
0 0 0 0 0 0 17 Antalgin injeksi 250 mg/ml vial
30
- 2 ml vial/kotak
0 195 50 145 313,200 50 18 Antasida DOEN II botol botol 60 ml
suspensi komb 100
0 10,400 2,000 8,400 604,800 2,000 19 Antasida DOEN tablet tablet
20 kombinasi:Bacitracin-
25
0 0 0 0 0 0 tube
tube/kotak
0 10 10 0 0 10 21 Anti Hemoroid
polymixin
Antifungi DOENDOEN
B krim supp
10
Kombinasi
Kombinasi: supp/kotak
0 0 0 0 0 0 22 pot 24 pot/kotak
Asam Benzoat 6% + Asam
0 0 0 0 0 0 23 Antimalaria
Salisilat 3%
DOEN
tablet
100
kombinasi tablet/kotak
Antimigren:Ergotamin
24 Antiparkinson DOEN 100
0 0 0 0 0 0 tablet
Tartrat 1mg +Kofein 50mg
tablet Kombinasi tablet/botol
100
0 0 0 0 0 0 25 tablet
benzerazid 25 mg levodopa tablet/kotak
0 0 0 0 0 0 26 Aqua pro Injeksi steril,
100 mg ( Levopar) vial
10
bebas pirogen vial/kotak
0 0 0 0 0 0 27 Arthemeter injeksi 1 ml : ampul
6
80 mg ampul/kotak
0 5,000 1,000 4,000 380,000 1,000 28 Asam Askorbat (Vit C) tablet
100
100
0 0 0 0 0 0 29 Asam folat tablet 1 mg tablet
tablet/botol
0 4,000 1,000 3,000 432,000 1,000 tablet
tablet/kotak
25
0 20 10 10 42,530 10 31 Asiklovir krim 5% tube
tube/kotak
100
0 0 0 0 0 0 32 Asiklovir tablet 200 mg tablet
tablet/kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 34 Benzatin Benzil Penicillin vial
10
injeksi 1,2 jt IU/vial vial/kotak
0 0 0 0 0 0 35 Besi (II ) Sulfat + asam sachet
30
folat 0.25 tab tablet/sachet
0 15 15 0 0 15 36 Betametason krim 0,1% tube tube
Budesonid inhaler 200
0 0 0 0 0 0 37 Budesonid-formoterol
mcg/puff, 100 dosis turbuhaler turbuhaler
0 0 0 0 0 0 38 (Budesonid-formoterol
fixed combination)
(pulmicort turbuhaler) turbuhaler turbuhaler
inhaler 160/4,5 mcg
0 0 0 0 0 0 39 ((symbicort
fixed combination)
turbuhaler) turbuhaler turbuhaler
inhaler 80/4,5 mcg
0 40 10 30 47,400 10 40 Deksametason
(symbicort)
injeksi
ampul
100
5mg.ml-1ml
Deksametason tablet 0,5 ampul/kotak
100
0 4,100 1,500 2,600 161,200 1,500 41 tablet
mg
DHP tablet (Prog : tablet/kotak
9
0 0 0 0 0 0 42 tablet
malaria) tablet/kotak
0 0 0 0 0 0 43 Difenhidramin HCl injeksi ampul
30
10 mg/ml-1ml ampul/kotak
0 100 0 100 14,300 0 tablet
tablet/kotak
0 80 20 60 199,980 20 45 Domperidon suspensi/sirup botol botol
5 mg/5ml
0 0 0 0 0 46 Domperidon tetes/ 5 mg/ml botol botol
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 48 Ekstrak Belladon tablet 10 tablet
1000
mg
0 0 0 0 0 0 ampul
Ergakalsiferol (vitamin ampul/kotak
0 0 0 0 0 0 50 Injeksi 0,1% - 1 ml
D3/D2) kapsul 50000 tablet tablet
0 0 0 0 0 0 51 UI/ml (D-Vit FT)
D3/D2) suspensi 10000 botol botol
52 UI/ml (D-Vitkapsul
syrup)250mg 120
0 0 0 0 0 Eritromisin tablet
tablet/kotak
0 0 0 0 0 53 Eritromisin sirup botol botol
200mg/5ml
0 180 20 160 400,000 20 botol
ml/botol
0 3 0 3 644,970 0 55 FDC kategori anak paket kotak
0 14 1 13 4,679,870 1 56 FDC OAT Kategori I paket kotak
0 8 0 8 9,599,200 0 57 FDC OAT Kategori II paket kotak
0 0 0 0 0 0 58 Fenitoin Natrium injeksi 50 ampul ampul
mg/ml
0 0 0 0 0 0 59 Fenitoin Natrium Kapsul kapsul botol
100 mg
0 10 10 0 0 10 60 Fenobarbital Injeksi i.m/i.v ampul
30
50 mg/ml ampul/kotak
0 0 0 0 0 0 61 Fenobarbital tablet 100 tablet
100
mg tablet/kotak
0 0 0 0 0 0 62 Fenol Gliserol tetes telinga botol
24
10% (Karbogliserin 10%) botol/kotak
0 0 0 0 0 0 63 Fitomenadion (Vit.K1) ampul
10
injeksi 10 mg/ml - 1 ml ampul/kotak
0 240 30 210 717,570 30 64 Fitomenadion (Vit.K1) ampul
30
injeksi 2mg/ml ampul/kotak
0 0 0 0 0 0 65 Fitomenadion (Vit.K1)tab tablet
100
salut gula 10 mg tablet/botol
0 0 0 0 0 0 ampul
ampul/kotak
100
0 800 200 600 51,000 200 67 Furosemid tablet 40 mg tablet
Garam oralit untuk 200 ml tablet/kotak
100
0 2,900 400 2,500 730,000 400 68 sachet
air (Prog : diare)
Gentamicin salep mata 0,3 sachet/kotak
0 257 30 227 590,200 30 69 tube tube
% (genoint )
0 0 0 0 0 70 Gentamicin tetes mata 0,3 botol 5 ml/botol
% (genoint )injeksi 40
Gentamisin 5
0 30 0 30 101,970 0 71 ampul
mg/ml ampul/kotak
0 0 0 0 0 0 72 Gentian Violet larutan 1 % botol botol
0 4,200 400 3,800 212,800 400 tablet
tablet/kotak
0 0 0 0 0 tablet
tablet/kotak
0 17,000 2,000 15,000 418,500 2,000 75 Gliseril Guayacolat tablet tablet
1000
100 mg tablet/botol
0 0 0 0 0 0 76 Gliseril trinitrat tab tablet tablet
sublingual 0,5mg (nitral)
0 0 0 0 0 0 77 Glukonas Kalsikus 10 % kotak kotak
0 0 0 0 0 0 78 Glukosa larutan infus 10% botol
500
steril (Produk lokal) ml/botol
0 0 0 0 0 0 79 Glukosa larutan infus 40% botol botol
steril (Produk lokal)
0 15 5 10 52,000 5 80 Glukosa larutan infus 5% botol
500
steril (Produktablet
Griseofulvin lokal)125 mg, ml/botol
100
0 0 0 0 0 0 81 tablet
0 0 0 0 0 0 82 Haloperidol inj 50 mg/ml ampul ampul
(haldol decanoas)
0 300 100 200 10,504 100 tablet
tablet/kotak
0 200 100 100 8,258 100 tablet
tablet/kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 95 30 65 181,870 30 tiube
tube/kotak
0 0 0 0 0 0 87 Ibuprofen sirup 100mg / botol botol
5ml
0 0 0 0 0 0 88 Ibuprofen suspensi botol botol
200mg / 5ml 100
0 0 0 0 0 0 89 Ibuprofen tablet 200 mg tablet
tablet/botol
100
0 2,900 500 2,400 360,000 500 90 Ibuprofen tablet 400 mg tablet
tablet/kotak
0 0 0 0 0 91 Isosorbid Dinitrat tablet tablet
100
0 3,500 1,000 2,500 175,000 1,000 tablet
tablet/kotak
0 900 200 700 43,400 200 tablet
tablet/kotak
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 95 Karbamazepin tablet 200 tablet
100
mg tablet/kotak
50
0 0 0 0 0 0 96 Ketokenazol tablet 200mg tablet
tablet/kotak
0 0 0 0 0 tube
tube/kotak
0 0 0 0 0 0 tablet
tablet/kotak
5
0 0 0 0 0 0 99 Ketorolak inj 10 mg ampul
ampul/kotak
0 0 0 0 0 0 100 Natrium Diklofenac 50 mg kotak
0 0 0 0 0 0 101 Nistatin tablet salut kotak
500.000 IU
0 5 5 11,500 0 ampul
ampul/kotak
50
tablet/kotak
50
tablet/kotak
0 0 0 0 0 0 105 Kloramfenikol kapsul 250 tablet
100
mg tablet/kotak
0 0 0 0 0 0 106 Kloramfenikol tetes telinga botol botol
3%
0 5,500 2,000 3,500 178,500 2,000 107 Klorfeniramin Maleat tablet
100
(CTM) tablet tablet/kotak
0 0 0 0 0 0 108 Klorpromasin tablet 100 tablet
100
Klorpromazin HCl injeksi
mg tablet/kotak
109 25 mg/ml - 1 ml (SK.720 : 30
0 0 0 0 0 0 ampul
ampul/kotak
kemasan 2 ml)
0 0 0 0 0 0 110 Klorpromazin HCl injeksi ampul
30
5 mg/ml - 2 ml ampul/kotak
0 0 0 0 0 0 111 Klorpromazin HCl tablet tablet
100
salut 100 mg tablet/kotak
0 0 0 0 0 0
Kotrimoksazol Susp komb: tablet
tablet/kotak
0 160 30 130 284,700 30 Kotrimoksazol tablet
113 Sulfametoksazol 200mg + botol botol 60 ml
0 1,500 300 1,200 165,600 300 114 komb: Sulfametoksazol
Trimetoprim 40 mg tablet
100
Larutan
400mg +mengandung
Trimetoprim 80 tablet/kotak
115 karbohidrat +inj
elektrolit 1
0 0 0 0 0 0 Lansoprazol
mg
Larutan mengandung 30 mg/ml ampul
ampul/kotak
0 0 0 0 0 0 116 (NaCl 1,75 gr.
karbohidrat Na Lactat
+ elektrolit botol botol
2,24 gr.2,34
KClgr.1.5
0 0 0 0 0 0 117 (NaCl
gr.Dextrosa
Na Lactat
botol botol
2,24 gr. KCl270.75gr) gr.
/ KA
30
0 55 30 25 33,333 30 118 EN 3B 27
Lidokaian
Dextrosa injgr)
2% / KA EN ampul
ampul/kotak
0 0 0 0 0 0 119 Magnesium
3A Sulfat inj (IV)
vial
10
20% - 25 mlSulfat inj (IV)
Magnesium vial/kotak
10
0 20 0 20 52,580 0 120 vial
40% - 25 ml vial/kotak
30
0 0 0 0 0 0 121 Mebendazol tablet 100 mg tablet
122 (Metilergometrin) tab salut 100
0 0 0 0 0 0 tablet
tablet/kotak
0,125 mg
123 Metilergometrin Maleat inj 30
0 0 0 0 0 0 ampul
0,200 mg-1 ml ampul/kotak
124 Metilprednisolon tablet 16 30
0 0 0 0 0 0 tablet
mg
metilprednisolon tablet 4 tablet/kotak
100
0 0 0 0 0 125 tablet
mg tablet/kotak
0 0 0 0 0 0 126 Metoklopramid inj 5 ampul
10
mg/ml ampul/kotak
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 128 Metronidazol Infus botol
botol 100
500mg/100ml ml
0 0 0 0 0 0 129 Metronidazol supositoria
500 mg ( flagyl)
Metronidazol tablet 250 suppositoria suppositoria
100
0 0 0 0 0 0 130 tablet
mg tablet/kotak
0 0 0 0 0 0 131 Metronidazol tablet 500 tablet kotak
mg
0 0 0 0 0 132 Mikonazol krim/ salep 2 % tube tube
0 1,600 0 1,600 3,920,000 0 sachet
sachet/kotak
0 0 0 0 0 0 134 Natrium Bikarbonat inj i.v ampul ampul
8,4% (meylon)
0 700 300 400 80,000 300 tablet
tablet/kotak
0 0 0 0 0 0 136 Natrium Diklofenak 25 mg tablet kotak
Natrium Klorida larutan
0 190 40 150 735,000 40 137 infus 0,9 % steril (Produk botol botol
138 lokal) 24
0 0 0 0 0 0 Hidrokortison krim 2,5% tube
tube/kotak
0 0 0 0 0 0 139 Natrium Tiroksin tablet tablet tablet
100 mcg
0 0 0 0 0 0 140 Nifedipin tablet 10mg tablet kotak
0 100 0 100 64,000 0 141 Nistatin tablet salut tablet
100
500.000 IU tablet/kotak
0 0 0 0 0 0 142 Noretisteron tablet 5 mg tablet
30
(Primolut N) tablet/kotak
0 0 0 0 0 0 143 Nystatin vaginal tablet tablet
100
100.000 UI tablet/kotak
0 0 0 0 0 144 Obat Batuk Hitam botol botol
0 0 0 0 0 0 145 Ofloxacin 200 mg Tab tablet
100
Salut Selulose
Ofloxacin 400 mg Tab tablet/kotak
100
0 0 0 0 0 146 tablet
Salut Selulose tablet/kotak
0 0 0 0 0 0 147 Oksimetazolin tetes hidung botol botol
0 0 0 0 0 0 148 Oksitetrasiklin HCl salep tube
25
mata 1 % tube/kotak
0 0 0 0 0 149 Oksitosin injeksi 10IU/mlampul
10
1ml ampul/kotak
0 2,000 300 1,700 358,700 300 tablet
tablet/kotak
0 400 200 200 143,200 200 tablet
tablet/kotak
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 153 Ondansetron inj 4 mg/ 2 ml ampul ampul
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 155 Paracetamol drop 100 botol botol
mg/ml
0 276 80 196 281,848 80 156 Parasetamol sirup 120 mg / 60 ml botol 60 ml
5 ml 100
0 27,800 5,000 22,800 1,801,200 5,000 157 Parasetamol tablet 500 mg tablet
tablet/kotak
100
0 0 0 0 0 0 158 Piracetam 400 mg Tablet tablet
tablet/kotak
100
0 0 0 0 0 0 159 Piracetam 800 mg kapsul tablet
tablet/kotak
10
0 0 0 0 0 0 160 Piracetam inj 1 gr/ 5 ml ampul
ampul/kotak
0 0 0 0 0 0 161 Pirantel sirup 125mg/5ml botol botol
30
0 40 30 10 4,198 30 tablet
tablet/kotak
0 7,500 1,000 6,500 715,000 1,000 163 Piridoksin HCl (Vit.B6) tablet
100
100
0 1,500 300 1,200 126,000 300 164 Piroksikam 20 mg tablet
tablet/kotak
0 0 0 0 0 0 165 Povidon Iodida larutan botol botol 30 ml
10%
0 0 0 0 0 0 166 Povidon Iodida larutan botol botol 300 ml
10% 100
0 0 0 0 0 167 Prednisone tablet 5 mg tablet
tablet/kotak
0 0 0 0 0 0 168 Prokain Benzil Penicillin G vial
30
0 0 0 0 0 0 169 Propiltiourasil tablet 100 tablet
100
mg tablet/botol
25
0 40 15 25 90,350 15 170 Ranitidin inj.25mg/2ml ampul
ampul/kotak
100
0 6,000 1,000 5,000 600,000 1,000 171 Ranitidin tablet 150 mg tablet
kaplet/kotak
0 0 0 0 0 0 172 Retinol (Vitamin A) kapsul
50
200.000 IU Kapsul Lunak kapsul/botol
0 0 0 0 0 0 173 Retinol (Vitamin A) kapsul
50
100.000 IU Kapsul Lunak kapsul/botol
0 190 30 160 832,000 30 174 Ringer Laktat larutan infus botol botol 500 ml
steril
0 2,000 300 1,700 100,300 300 tablet
tablet/kotak
0 4,000 400 3,600 350,964 400 Salbutamol inshalasi/ tablet
tablet/kotak
0 0 0 0 0 0 177 aerosol 100 mcg/dosis Botol Botol
Salbutamol inshalasi/
0 0 0 0 0 0 178 (ventolin inheler)
aerosol 200 mcg/kaps kapsul kapsul
Salbutamol inshalasi/
0 0 0 0 0 0 179 (ventolin rotacaps)
aerosol 200 mcg/rotahaler rotahaler rotahaler
Salep 2-4 Komb : As
0 0 0 0 0 0 180 (ventolin rotaheler)
Salisilat 2 % + Belerang pot pot
0 0 0 0 0 0 181 endap 2%
Salisil Bedak 2% kotak kotak
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 tablet
tablet/kotak
0 25 15 10 48,960 15 184 sefadroksil sirup kering botol botol
125mg/5ml
0 0 0 0 0 185 Sefotaksim inj 1 gr vial 2 vial/kotak
0 0 0 0 0 186 Sefriakson serbuk injeksi 1 vial vial
Serum Anti Bisa Ular
g/vial
187 Polivalen injeksi 5 ml Dus, 10 vial
0 0 0 0 0 0 Dus, 10
@ 5 ml
0 0 0 0 0 0 188 Serum
(ABU I)Anti Tetanus injeksi ampul ampul @ 1
1.500 IU/ampul (A.T.S)
100
0 0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 190 Sianokobalamin (vit B12) ampul
100
injeksi 500mcg-ml ampul/kotak
100
0 0 0 0 0 0 191 Simetidin tablet 200 mg tablet
tablet/kotak
50
0 2,200 500 1,700 1,177,352 500 192 Si mvastatin 10 Mg tablet
tablet/kotak
0 2,000 500 1,500 382,500 500 193 Siproflaxacin tablet 500 tablet
100
Sulfadoxine
mg tablet/kotak
194 Pyrimethamine 525 mg 100
0 0 0 0 0 0 tablet
tablet/kotak
30
0 4,700 2,000 2,700 3,402,000 2,000 195 tablet
Tablet Tambah Darah sachet
tablet/sachet
0 100 0 100 9,900 0 196 Terbutalin sulfat tablet
50
Terbutalin
(Molasma)turbu
tablet(serbuk
2,5 mg tablet/kotak
0 0 0 0 0 0 197 ih) 0,50 mg (bricasma turbuhaler turbuhaler
turbuhaler 0,5mg)
198 Tetrasiklin HCl kapsul 250 100
0 0 0 0 0 0 kaplet
mg kaplet/kotak
0 0 0 0 0 0 kaplet
mg kaplet/kotak
0 0 0 0 0 0 200 Tiamin HCl (Vit.B1) ampul
30
injeksi 100 mg/ml-1 ml ampul/kotak
0 800 300 500 18,900 300 201 Tiamin HCl / Mononitrat tablet
1000
5
0 0 0 0 0 0 202 Tramadol inj 50mg/5ml ampul
Triheksifenidil ampul/kotak
100
0 0 0 0 0 0 203 tablet
Hidroklorida tablet 2 mg tablet/kotak
Dus, 1 vial
0 0 0 0 0 0 204 Vaksin Rabies Vero - vial @ 1 dosis +
Rabipur
100
0 0 0 0 0 tablet
tablet/kotak
0 0 0 0 0 0 206 zinc drop 10 mg/ ml botol botol
0 40 10 30 449,400 10 207 Zinc sirup 10 mg/ml botol botol
0 2,500 500 2,000 948,000 500 tablet
tablet/kotak
0 1,000 500 500 0 500 Primaquin
PERBEKALAN
0 0 0 0 0 0
KESEHATAN
0 0 0 0 0 0 209 Alat suntik sekali pakai 0,5 pcs
kotak/ 100
ml psc
0 0 0 0 0 0 210 Alat suntik sekali pakai 1 pcs
kotak/ 100
ml psc
0 2,200 500 1,700 1,105,000 500 211 Alat suntik sekali pakai 3 pcs
kotak/ 100
ml
Alat suntik sekali pakai 5 psc 100
kotak/
0 0 0 0 0 212 pcs
ml psc 100
kotak/
0 0 0 0 0 0 213 Alkohol Swab pcs
psc
0 0 0 0 0 0 214 Aqua bides 20 liter galon galon
Catgut / benang bedah no
0 0 0 0 0 0 215 pcs 24pcs/kotak
2/0 dengan jarum bedah
0 0 0 0 0 216 Catgut / beneng bedah no pcs 24psc/kotal
3/0 dengan jarum bedah
0 0 0 0 0 0 217 Cut gut chromic 3/0 pcs 24 pcs/kotak
0 0 0 0 0 0 218 Elastis Perban 75 Fesco roll roll
0 0 0 0 0 0 219 Exell tulle pcs kotak / psc
0 0 0 0 0 0 220 Foley cateter pcs pcs
0 0 0 0 0 221 Handscoon uk 7 pcs kotak
0 0 0 0 0 0 223 Hidrogen Peroksida (H2 botol
botol 800
O2) 10% ml
0 130 20 110 1,815,000 20 224 Infus set anak set 50 set/kotak
0 160 25 135 915,913 25 225 Infus set dewasa set 50 set/kotak
0 0 0 0 0 227 IV Catheter No. 24 G set 50 set/kotak
0 17 10 7 53,900 10 228 IV Chateter No 20 G set 50 set/kotak
Kapas Pembalut /
0 0 0 0 0 229 Bungkus Bungkus
Absorben
Kasa 250 gram
Pembalut Elastic 3
0 0 0 0 0 0 230 pcs psc
inchi
Kasa Pembalut Elastic 4
0 0 0 0 0 0 231 pcs psc
inchi
0 0 0 0 0 232 Kasa Pembalut Hidrofil 36 Rol Rol
x 80 cm
0 0 0 0 0 0 233 Kasa Pembalut Hidrofil 4 roll roll
m x 10
0 0 0 0 0 0 234 Kasa Pembalut Hidrofil 4 roll roll
m x 5 cm 16
0 0 0 0 0 235 Kassa Hidrofil steril uk. pcs lembar/kota
16x16 (surya husada) 12
0 0 0 0 0 0 236 Kassa Hidrofil steril uk. pcs k
lembar/kota
18x22 (isi 12 lembar)
0 0 0 0 0 0 237 Kassa kompres steril 40 x Pcs
k
Pcs
40 cm ball/ 10
0 0 0 0 0 0 238 Kertas Puyer pack
pack
0 0 0 0 0 pack
pack
0 15 10 5 56,018 10 pack
pack
0 0 0 0 0 0 241 Lisorin 1liter botol botol
0 840 300 540 607,500 300 242 Masker pcs 50 pcs/kotak
0 0 0 0 0 0 243 Pembalut Gibs 3 inchi rol rol
0 0 0 0 0 0 244 Plester 5 yard x 2 inch Rol Rol
0 0 0 0 0 245 Silk ( Benang Bedah Sutera pcs 36pcs/kotak
) No. 3/0 dg jarum bedah
0 0 0 0 0 0 246 Sterobat nf. 400ml botol botol
0 0 0 0 0 0 247 Strip gula 50 strip box box
(blonime)
0 36 0 36 69,854 0 248 Umbilical cord nylon one pcs
kotak/ 50
med (Klem tali pusat) psc
249 Under Pet 10
0 0 0 0 0 0 pcs
pcs/kotak
0 0 0 0 0 250 Urine Bag Pcs Pcs
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0 Pcs
psc
0 0 0 0 0 0
0 0 0 0 0 0 0BAT GIGI
0 0 0 0 0 0 255 Devitalisasi Pasta (Non kotak kotak
Arsen)
0 0 0 0 0 256 Etil klorida spray botol botol
0 0 0 0 0 0 257 Glass Ionomer Cement botol botol
(GC IX) ART
0 0 0 0 0 0 258 Kalsium Hidroksida Pasta kotak kotak
0 0 0 0 0 0 259 Klorfenol Kamfer Mentol botol botol
(CHKM)
0 0 0 0 0 0 260 Mummifying Pasta kotak kotak
0 0 0 0 0 0 261 Semen Seng Fosfat serbuk botol botol
Temporary
dan cairan Stopping
0 0 0 0 0 0 262 Fletcher (Fletcher) serbuk botol botol
0 0 0 0 0 0
& cairan
OBAT DENGAN NAMA

0 0 0
DAGANG
0 0 0 0 0 0 kapsul
kapsul/kotak
30
0 0 0 0 0 0 264 Asifit kapsul
kapsul/kotak
24
0 0 0 0 0 0 265 Betason-N krim Tube
tube/kotak
Kotak 5
0 0 0 0 0 0 266 Bioneuron Injeksi ampul
Ampul
0 0 0 0 0 0 267 Bionick botol 60 ml/botol
0 0 0 0 0 0 268 Bionick drop botol 15 ml/botol
0 0 0 0 0 0 269 Blonick Plus Syr Botol Botol
0 0 0 0 0 0 270 Chlorampecort Cr Tube Tube 10 gr
271 Diapecta 100
0 0 0 0 0 0 Tablet
tablet/kotak
0 0 0 0 0 0 272 Febrinex Suspensi Botol Botol
273 Fercee 100
0 0 0 0 0 0 Tablet
tablet/kotak
274 Fituno 30
0 0 0 0 0 0 Tablet
kaplet/kotak
0 0 0 0 0 0 275 Fludane plus syr 60 ml botol botol 60 ml
0 0 0 0 0 0 276 Flutamol Sirup botol 60 mL/botol
277 Hustab 10
0 0 0 0 0 0 Tablet
tablet/strip
0 0 0 0 0 0 278 Lybex sirup botol botol 60 ml
0 0 0 0 0 0 ampul
ampul/kotak
100
0 0 0 0 0 0 280 Neorodial kaplet
kaplet/kotak
60
0 0 0 0 0 0 281 Neurovit-E Tablet
tablet/kotak
0 0 0 0 0 0 282 Noza Tablet 4 tablet/strip
0 0 0 0 0 0 Tablet
tablet100
kotak
0 0 0 0 0 0 284 Ponflu Tablet
tablet
10
0 0 0 0 0 0 285 Progastric Tablet
tablet/strip
100
0 0 0 0 0 0 286 Ramaton Tablet
tablet/kotak
0 0 0 0 0 0 287 Scabicid Cream Tube Tube 10 gr
0 0 0 0 0 0 kapsul
kapsul
0 0 0 0 0 0 289 Kasa Pembalut Hidrofil 36 rol rol
x 80 cm (AHMADARIS)
0 0 0 0 0 0 290 Master Plast Plastik 1 inc roll roll
(plester)
0 0 0 0 0 300
IV Cateter 18 G
0 0 0 0 0 0 OBAT TAMBAHAN
0 0 0 0 0 291
0 1,700 500 1,200 0 500 292
0 60 30 30 0 30 293
0 2,500 500 2,000 0 500 294
0 0 0 0 0 295
0 0 0 0 0 296
0 0 0 0 0 297
0 0 0 0 0 0 298
0 2,800 400 2,400 0 400 299
0 0 0 0 0 300
0 700 100 600 0 100 301
0 100 0 100 0 0 302
49,265,230
UMUM
JUMLAH KUNJUNGAN
TIDAK BAYAR
RESEP BAYAR
PBI PUSAT
Mengetahui/Menyetujui : Yang Menyerahka

Petugas Gudang Farmasi Kepala Dinas Kesehatan Kepala UPT Instalasi F
Puskesmas Rawajitu Dinas Kesehatan

NIP.197202191992032001
dr. H. Herry Novrizal, MM.Kes.,MM Melina Susan,S.si.,
NIP.197211242002121002 NIP. 19810506200501
11
BULAN : Nopember
TAHUN : 2017
STOK
PENERIMAAN
STOK AKHIR
HARGA HARGA PER PENGELUAR
PERSEDIAAN STOK AKHIR DALAM
SATUAN KEMASAN AN
AWAL RUPIAH
APBD I PROGRAM DAK DAK Lain lain TOTAL
2015 2014 2017
5 6 7 8 9 10 11 12 13 14 15 16 17
1,856 44,550 0 0 0 0 0 0
86 8,600 0 0 0 0 0
331 9,923 0 0 0 0 0 0
233 23,300 0 0 0 0 0
3,300 3,300 0 0 0 0 0 0
86 8,593 0 0 0 0 0 0
80 8,000 0 0 0 0 0 0
4,050 121,500 0 0 0 0 0 0
112 11,200 0 0 0 0 0 0
330 9,900 1,600 0 1,600 300 1,300 429,000
187 5,610 0 0 0 0 0
10,125 101,250 0 0 0 0 0 0
388 38,799 1,300 0 1,300 300 1,000 387,990
311 31,100 13,100 0 13,100 3,100 10,000 3,110,000

2,445 2,445 370 0 370 70 300 733,500
201 20,115 0 0 0 0 0 0
1,800 54,000 0 0 0 0 0 0
2,160 2,160 145 0 145 45 100 216,000
72 7,200 8,400 0 8,400 1,000 7,400 532,800
2,581 62,900 0 0 0 0 0 0
2,000 20,000 0 0 0 0 0 0
2,320 55,688 0 0 0 0 0 0
518 51,800 0 0 0 0 0 0
135 13,500 0 0 0 0 0 0
1,500 150,000 0 0 0 0 0 0
7,425 74,250 0 0 0 0 0 0
29,925 179,550 0 0 0 0 0 0
95 9,500 4,000 0 4,000 1,500 2,500 237,500
84 8,400 0 0 0 0 0 0
144 14,400 3,000 0 3,000 1,000 2,000 288,000
4,253 101,250 10 0 10 10 0 0
524 52,404 0 0 0 0 0
771 77,130 0 0 0 0 0
11,070 110,700 0 0 0 0 0 0
2,700 2,700 0 0 0 0 0 0
1,520 1,520 0 0 0 0 0
93,000 93,000 0 0 0 0 0 0
117,600 117,600 0 0 0 0 0 0
110,500 110,500 0 0 0 0 0 0
1,580 158,000 30 0 30 10 20 31,600
62 6,200 2,600 0 2,600 1,200 1,400 86,800
3,567 32,101 0 0 0 0 0 0
1,054 31,620 0 0 0 0 0 0
143 14,300 100 0 100 0 100 14,300
3,333 3,333 60 0 60 10 50 166,650
15,600 15,600 0 0 0 0 0
167 16,700 0 0 0 0 0
38 38,000 0 0 0 0 0 0
8,100 243,000 0 0 0 0 0 0
650 650 0 0 0 0 0 0
8,000 8,000 0 0 0 0 0 0
494 59,230 0 0 0 0 0
7,220 7,220 0 0 0 0 0
2,500 2,500 160 0 160 40 120 300,000
214,990 214,990 3 0 3 0 3 644,970
359,990 359,990 13 0 13 2 11 3,959,890
1,199,900 1,199,900 8 0 8 0 8 9,599,200
20,250 20,250 0 0 0 0 0 0
133 13,300 0 0 0 0 0 0
1,800 54,000 0 0 0 0 0
220 22,000 0 0 0 0 0 0
2,042 49,008 0 0 0 0 0 0
4,698 46,980 0 0 0 0 0 0
3,417 102,510 210 0 210 30 180 615,060
634 63,400 0 0 0 0 0 0
1,829 45,725 0 0 0 0 0 0
85 8,500 600 0 600 100 500 42,500
292 29,200 2,500 0 2,500 400 2,100 613,200
2,600 2,600 227 0 227 40 187 486,200
3,194 3,194 0 0 0 0 0
3,399 16,995 30 0 30 0 30 101,970
900 900 0 0 0 0 0 0
56 5,600 3,800 0 3,800 400 3,400 190,400
436 21,800 0 0 0 0 0
28 27,900 15,000 0 15,000 2,000 13,000 362,700
1,500 1,500 0 0 0 0 0 0
187,200 187,200 0 0 0 0 0 0
5,700 5,700 0 0 0 0 0 0
1,960 1,960 0 0 0 0 0 0
5,200 5,200 10 0 10 5 5 26,000
324 32,400 0 0 0 0 0 0
83,333 83,333 0 0 0 0 0 0
53 5,252 200 0 200 0 200 10,504
83 8,258 100 0 100 0 100 8,258
88 8,823 0 0 0 0 0 0
2,798 67,152 65 0 65 25 40 111,920
3,499 3,499 0 0 0 0 0 0
4,499 4,499 0 0 0 0 0 0
116 11,550 0 0 0 0 0 0
150 15,000 2,400 0 2,400 400 2,000 300,000
81 8,071 0 0 0 0 0
70 7,000 2,500 0 2,500 500 2,000 140,000
62 6,200 700 0 700 200 500 31,000
84 8,400 0 0 0 0 0
243 24,300 0 0 0 0 0 0
554 27,675 0 0 0 0 0 0
4,700 56,400 0 0 0 0 0
1,823 182,250 0 0 0 0 0 0
8,080 40,400 0 0 0 0 0 0
8,700 0 0 0 0 0 0
64,000 0 0 0 0 0 0
2,300 13,800 5 0 5 5 0 0
382 19,100 0 0 0 0 0 0
527 26,350 0 0 0 0 0 0
578 57,750 0 0 0 0 0 0
1,599 1,599 0 0 0 0 0 0
51 5,100 3,500 0 3,500 1,500 2,000 102,000
149 14,900 0 0 0 0 0 0
1,021 30,630 0 0 0 0 0 0
950 28,500 0 0 0 0 0 0
149 14,900 0 0 0 0 0 0
500 50,000 0 0 0 0 0 0
2,190 2,190 130 0 130 30 100 219,000
138 13,800 1,200 0 1,200 200 1,000 138,000
82,042 82,042 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0
1,333 40,000 25 0 25 15 10 13,333
2,078 20,780 0 0 0 0 0 0
2,629 26,290 20 0 20 5 15 39,435
228 6,840 0 0 0 0 0 0
154 15,400 0 0 0 0 0 0
2,175 65,250 0 0 0 0 0 0
635 19,050 0 0 0 0 0 0
300 30,000 0 0 0 0 0
2,070 20,700 0 0 0 0 0 0
110 11,000 0 0 0 0 0
39,825 39,825 0 0 0 0 0 0
3,220 3,220 0 0 0 0 0 0
193 19,305 0 0 0 0 0 0
160 16,000 0 0 0 0 0 0
3,000 3,000 0 0 0 0 0
2,450 98,000 1,600 0 1,600 0 1,600 3,920,000
6,200 6,200 0 0 0 0 0 0
200 10,000 400 0 400 400 0 0
174 8,700 0 0 0 0 0 0
4,900 4,900 150 0 150 40 110 539,000
2,979 71,500 0 0 0 0 0 0
1,694 1,694 0 0 0 0 0 0
129 12,900 0 0 0 0 0
640 64,000 100 0 100 0 100 64,000
2,618 78,540 0 0 0 0 0 0
480 47,960 0 0 0 0 0 0
5,500 5,500 0 0 0 0 0
207 20,650 0 0 0 0 0 0
327 32,700 0 0 0 0 0
27,550 27,550 0 0 0 0 0 0
1,600 40,000 0 0 0 0 0 0
2,200 22,000 0 0 0 0 0
211 6,330 1,700 0 1,700 240 1,460 308,060
716 21,480 200 0 200 100 100 71,600
1,189 35,670 0 0 0 0 0
2,400 2,400 0 0 0 0 0
119 11,900 0 0 0 0 0 0
5,200 5,200 0 0 0 0 0 0
1,438 1,438 196 0 196 80 116 166,808
79 7,900 22,800 0 22,800 4,000 18,800 1,485,200
609 60,885 0 0 0 0 0 0
1,084 108,405 0 0 0 0 0 0
7,425 74,250 0 0 0 0 0 0
8,250 8,250 0 0 0 0 0 0
420 12,595 10 0 10 10 4,198
110 11,000 6,500 0 6,500 500 6,000 660,000
105 10,500 1,200 0 1,200 200 1,000 105,000
2,163 2,163 0 0 0 0 0 0
14,203 14,203 0 0 0 0 0 0
114 11,400 0 0 0 0 0
10,780 323,400 0 0 0 0 0 0
404 40,442 0 0 0 0 0 0
3,614 86,738 25 0 25 15 10 36,140
120 12,000 5,000 0 5,000 1,000 4,000 480,000
460 23,000 0 0 0 0 0 0
260 13,000 0 0 0 0 0
5,200 5,200 160 0 160 40 120 624,000
59 5,900 1,700 0 1,700 300 1,400 82,600
97 9,749 3,600 0 3,600 500 3,100 302,219
63,750 63,750 0 0 0 0 0 0
431 431 0 0 0 0 0 0
5,867 5,867 0 0 0 0 0 0
2,000 2,000 0 0 0 0 0 0
1,250 1,250 0 0 0 0 0 0
855 25,650 0 0 0 0 0 0
1,042 52,100 0 0 0 0 0
4,896 4,896 10 0 10 10 0 0
6,050 12,100 0 0 0 0 0
11,000 11,000 0 0 0 0 0
47,300 473,000 0 0 0 0 0 0
12,600 126,000 0 0 0 0 0 0
181 18,100 0 0 0 0 0 0
916 91,600 0 0 0 0 0 0
111 11,100 0 0 0 0 0 0
693 34,628 1,700 0 1,700 400 1,300 900,328
255 25,500 1,500 0 1,500 300 1,200 306,000
478 47,800 0 0 0 0 0 0
1,260 1,260 2,700 0 2,700 700 2,000 2,520,000
99 4,950 100 0 100 0 100 9,900
71,100 71,100 0 0 0 0 0 0
149 14,900 0 0 0 0 0 0
257 25,700 0 0 0 0 0 0
690 20,700 0 0 0 0 0 0
38 37,800 500 0 500 100 400 15,120
5,400 27,000 0 0 0 0 0 0
40 4,000 0 0 0 0 0 0
78,500 78,500 0 0 0 0 0 0
108 10,700 0 0 0 0 0
12,840 12,840 0 0 0 0 0 0
14,980 14,980 30 0 30 15 15 224,700
474 47,400 2,000 0 2,000 500 1,500 711,000
500 0 500 0 500 0
0 0 0 0 0 0
2,140 214,000 0 0 0 0 0 0
650 65,000 0 0 0 0 0 0
650 65,000 1,700 0 1,700 300 1,400 910,000
750 75,000 0 0 0 0 0
216 21,560 0 0 0 0 0 0
174,000 174,000 0 0 0 0 0 0
26,667 640,000 0 0 0 0 0 0
23,299 559,176 0 0 0 0 0
5,583 134,000 0 0 0 0 0 0
17,160 17,160 0 0 0 0 0 0
14,014 14,014 0 0 0 0 0 0
8,495 8,495 0 0 0 0 0 0
5,267 5,267 0 0 0 0 0 0
5,270 5,270 0 0 0 0 0 0
30,238 30,238 0 0 0 0 0 0
16,500 82,500 110 0 110 15 95 1,567,500
6,785 339,250 135 0 135 20 115 780,223
7,700 385,000 12 0 12 5 7 53,900
7,700 385,000 0 0 0 0
7,700 385,000 7 0 7 5 2 15,400
7,500 7,500 0 0 0 0 0
7,000 7,000 0 0 0 0 0 0
10,000 10,000 0 0 0 0 0 0
55,200 55,200 0 0 0 0 0
30,350 30,350 0 0 0 0 0 0
30,350 30,350 0 0 0 0 0 0
363 5,800 0 0 0 0 0
396 4,750 0 0 0 0 0 0
1,600 1,600 0 0 0 0 0 0
6,402 64,020 0 0 0 0 0 0
7,682 76,820 0 0 0 0 0
11,204 114,000 5 0 5 5 0 0
18,865 18,865 0 0 0 0 0 0
1,125 56,250 540 0 540 200 340 382,500
23,500 23,500 0 0 0 0 0 0
23,625 23,625 0 0 0 0 0 0
14,316 515,376 0 0 0 0 0
78,000 78,000 0 0 0 0 0 0
464,000 464,000 0 0 0 0 0 0
1,940 97,020 36 0 36 0 36 69,854
5,390 53,900 0 0 0 0 0 0
4,000 4,000 0 0 0 0 0
5,770 577,000 0 0 0 0 0 0
5,770 577,000 0 0 0 0 0 0
5,770 577,000 0 0 0 0 0 0
5,770 549,750 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
390,000 390,000 0 0 0 0 0 0
146,300 146,300 0 0 0 0 0
395,000 395,000 0 0 0 0 0 0
242,000 242,000 0 0 0 0 0 0
55,000 55,000 0 0 0 0 0 0
176,000 176,000 0 0 0 0 0 0
93,500 93,500 0 0 0 0 0 0
34,000 34,000 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0
1,537 46,100 0 0 0 0 0 0
1,818 54,540 0 0 0 0 0 0
9,182 220,368 0 0 0 0 0 0
4,341 21,705 0 0 0 0 0 0
16,000 16,000 0 0 0 0 0 0
22,500 22,500 0 0 0 0 0 0
18,700 18,700 0 0 0 0 0 0
9,085 9,085 0 0 0 0 0 0
384 38,400 0 0 0 0 0 0
15,855 15,855 0 0 0 0 0 0
1,044 104,400 0 0 0 0 0 0
3,273 98,190 0 0 0 0 0 0
15,950 15,950 0 0 0 0 0 0
13,500 13,500 0 0 0 0 0 0
284 2,840 0 0 0 0 0 0
19,800 19,800 0 0 0 0 0 0
4,400 44,000 0 0 0 0 0 0
1,091 109,100 0 0 0 0 0 0
818 49,080 0 0 0 0 0 0
399 1,596 0 0 0 0 0 0
1,353 135,300 0 0 0 0 0 0
935 93,500 0 0 0 0 0 0
303 3,030 0 0 0 0 0 0
698 69,800 0 0 0 0 0 0
28,380 28,380 0 0 0 0 0 0
946 94,600 0 0 0 0 0 0
140,337 140,337 0 0 0 0 0 0
27,088 27,088 0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
1,200 0 1,200 400 800 0
30 0 30 10 20 0
2,000 0 2,000 500 1,500 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
2,400 0 2,400 500 1,900 0
0 0 0 0 0
600 0 600 200 400 0
100 0 100 50 50 0
41,604,931
UMUM
TIDAK BAYAR
PBI DAERAH NON PBI

ala UPT Instalasi Farmasi Kepala Puskesmas Petugas Gudang Farmasi

NIP.196901241989021001 NIP.197202191992032001
P. 198105062005012010
12
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PER
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK
PEMAKAIAN PENERIMA
RATA-RATA PERMINTAA HARGA HARGA PER
S/D BULAN N SATUAN KEMASAN
AWAL
INI
APBD I PROGRAM
18 19 1 2 3 4 5 6 7 8 9
0 300 1 ACT (Artesunat + tablet
24
1,856 44,550 0
Amodiaquin ) tablet tab/Kotak
100
0 2,000 2 Alopurinol tablet 100 mg tablet 86 8,600 0
tablet/kotak
30
0 2,000 3 Alopurinol tablet 300 mg tablet 331 9,923 0
tablet/kotak
100
0 500 4 Alprazolam tablet 1 mg tablet 233 23,300 0
tablet/kotak
0 200 5 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml 3,300 3,300 0
0 tablet 86 8,593 0
tablet/kotak
100
0 7 Aminofilin tablet 200mg tablet 80 8,000 0
ktk 30
tablet/kotak
0 8 Aminofilina injeksi 24 mg/ml ampul ampul@10 4,050 121,500 0
9 Amitriptillin tablet salut 25 ml
100
0 tablet 112 11,200 0
mg tablet/kotak
30
300 10 Amlodipine Tablet 10 mg tablet 330 9,900 1,300
tablet/kotak
30
0 11 Amlodipine Tablet 5 mg tablet 187 5,610 0
tablet/kotak
0 12 Amoksisilin Injeksi serbuk vial
10
10,125 101,250 0
1000mg vial/kotak
300 tablet 388 38,799 1,000
tablet/kotak
3,100 tablet 311 31,100 10,000
tablet/kotak
70 15 Amoksisilin sirup kering 125 botol botol 60 ml 2,445 2,445 300
mg/ 5 ml
0 16 Antalgin (Metampiron) tablet tablet
100
201 20,115 0
500 mg tablet/kotak
0 17 Antalgin injeksi 250 mg/ml - vial
30
1,800 54,000 0
2 ml vial/kotak
45 18 Antasida DOEN II suspensi botol botol 60 ml 2,160 2,160 100
komb 100
1,000 19 Antasida DOEN tablet tablet 72 7,200 7,400
20 kombinasi:Bacitracin-
25
0 tube 2,581 62,900 0
tube/kotak
0 21 Anti Hemoroid
polymixin DOEN
B krim supp
10
2,000 20,000 0
Antifungi
KombinasiDOEN Kombinasi: supp/kotak
0 22 Asam Benzoat 6% + Asam pot 24 pot/kotak 2,320 55,688 0
23 Salisilat 3% 100
0 Antimalaria DOEN kombinasi tablet 518 51,800 0
tablet/kotak
24 Antimigren:Ergotamin Tartrat 100
0
Antiparkinson DOEN tablet tablet 135 13,500 0
100
0 25 Kombinasi benzerazid 25 mg tablet 1,500 150,000 0
tablet/kotak
0 26 Aqua pro 100
levodopa Injeksi
mg steril, bebas
( Levopar) vial
10
7,425 74,250 0
pirogen
Arthemeter injeksi 1 ml : 80 vial/kotak
6
0 27 ampul 29,925 179,550 0
mg
Asam Askorbat (Vit C) tablet ampul/kotak
100
1,500 28 tablet 95 9,500 2,500
50 mg tablet/kotak
100
0 29 Asam folat tablet 1 mg tablet 84 8,400 0
tablet/botol
1,000 tablet 144 14,400 2,000
tablet/kotak
25
10 31 Asiklovir krim 5% tube 4,253 101,250 0
tube/kotak
100
0 32 Asiklovir tablet 200 mg tablet 524 52,404 0
tablet/kotak
0 tablet 771 77,130 0
tablet/kotak
0 34 Benzatin Benzil Penicillin vial
10
11,070 110,700 0
injeksi 1,2 jt IU/vial vial/kotak
0 35 Besi (II ) Sulfat + asam folat sachet
30
2,700 2,700 0
0.25 tab tablet/sachet
0 36 Betametason krim 0,1% tube tube 1,520 1,520 0
Budesonid inhaler 200
0 37 mcg/puff, 100 dosis turbuhaler turbuhaler 93,000 93,000 0
0 (pulmicort turbuhaler)
38 combination) inhaler 160/4,5 turbuhaler turbuhaler 117,600 117,600 0
0 39 mcg (symbicort turbuhaler)
combination) inhaler 80/4,5 turbuhaler turbuhaler 110,500 110,500 0
10 40 Deksametason injeksi
mcg (symbicort)
ampul
100
1,580 158,000 20
5mg.ml-1ml ampul/kotak
100
1,200 41 Deksametason tablet 0,5 mg tablet 62 6,200 1,400
tablet/kotak
9
0 42 DHP tablet (Prog : malaria) tablet 3,567 32,101 0
tablet/kotak
0 43 Difenhidramin HCl injeksi 10 ampul
30
1,054 31,620 0
0 tablet 143 14,300 100
tablet/kotak
10 45 Domperidon suspensi/sirup 5 botol botol 3,333 3,333 50
mg/5ml
0 46 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
0 tablet 167 16,700 0
tablet/kotak
0 tablet 38 38,000 0
0 ampul 8,100 243,000 0
Ergakalsiferol (vitamin ampul/kotak
0 50 Injeksi 0,1% - 1 ml
D3/D2) kapsul 50000 UI/ml tablet tablet 650 650 0
0 51 (D-Vit FT)
D3/D2) suspensi 10000 UI/ml botol botol 8,000 8,000 0
52 (D-Vit syrup) 120
tablet/kotak
0 53 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
40 botol 2,500 2,500 120
ml/botol
0 55 FDC kategori anak paket kotak 214,990 214,990 3
2 56 FDC OAT Kategori I paket kotak 359,990 359,990 11
0 57 FDC OAT Kategori II paket kotak ### 1,199,900 8
0 58 Fenitoin Natrium injeksi 50 ampul ampul 20,250 20,250 0

mg/ml
0 59 Fenitoin Natrium Kapsul 100 kapsul botol 133 13,300 0
mg
0 60 Fenobarbital Injeksi i.m/i.v 50 ampul
30
1,800 54,000 0
mg/ml ampul/kotak
0 tablet 220 22,000 0
tablet/kotak
0 62 Fenol Gliserol tetes telinga botol
24
2,042 49,008 0
10% (Karbogliserin 10%) botol/kotak
0 63 Fitomenadion (Vit.K1) injeksi ampul
10
4,698 46,980 0
10 mg/ml - 1 ml ampul/kotak
30 64 Fitomenadion (Vit.K1) injeksi ampul
30
3,417 102,510 180
2mg/ml ampul/kotak
0 65 Fitomenadion (Vit.K1)tab tablet
100
634 63,400 0
salut gula 10 mg tablet/botol
0 ampul 1,829 45,725 0
ampul/kotak
100
100 67 Furosemid tablet 40 mg tablet 85 8,500 500
100
400 68 sachet 292 29,200 2,100
40 69 tube tube 2,600 2,600 187
(genoint )
0 70 Gentamicin tetes mata 0,3 % botol 5 ml/botol 3,194 3,194 0
(genoint ) 5
0 71 Gentamisin injeksi 40 mg/ml ampul 3,399 16,995 30
ampul/kotak
0 72 Gentian Violet larutan 1 % botol botol 900 900 0
400 tablet 56 5,600 3,400
tablet/kotak
0 tablet 436 21,800 0
tablet/kotak
2,000 75 Gliseril Guayacolat tablet 100 tablet
1000
28 27,900 13,000
mg tablet/botol
0 76 Gliseril trinitrat tab sublingual tablet tablet 1,500 1,500 0
0,5mg (nitral)
0 77 Glukonas Kalsikus 10 % kotak kotak 187,200 187,200 0
0 78 Glukosa larutan infus 10% botol
500
5,700 5,700 0
steril (Produk lokal) ml/botol
0 79 Glukosa larutan infus 40% botol botol 1,960 1,960 0
steril (Produk lokal)
5 80 Glukosa larutan infus 5% botol
500
5,200 5,200 5
steril (Produktablet
Griseofulvin lokal)125 mg, ml/botol
100
0 81 tablet 324 32,400 0
0 82 Haloperidol inj 50 mg/ml ampul ampul 83,333 83,333 0
(haldol decanoas)
0 tablet 53 5,252 200
tablet/kotak
0 tablet 83 8,258 100
tablet/kotak
0 tablet 88 8,823 0
tablet/kotak
25 tiube 2,798 67,152 40
tube/kotak
0 87 Ibuprofen sirup 100mg / 5ml botol botol 3,499 3,499 0
0 88 Ibuprofen suspensi 200mg / botol botol 4,499 4,499 0
5ml 100
0 89 Ibuprofen tablet 200 mg tablet 116 11,550 0
tablet/botol
100
400 90 Ibuprofen tablet 400 mg tablet 150 15,000 2,000
tablet/kotak
0 91 Isosorbid Dinitrat tablet tablet
100
81 8,071 0
500 tablet 70 7,000 2,000
tablet/kotak
200 tablet 62 6,200 500
tablet/kotak
0 tablet 84 8,400 0
tablet/kotak
0 tablet 243 24,300 0
tablet/kotak
50
0 96 Ketokenazol tablet 200mg tablet 554 27,675 0
tablet/kotak
0 tube 4,700 56,400 0
tube/kotak
0 tablet 1,823 182,250 0
tablet/kotak
5
0 99 Ketorolak inj 10 mg ampul 8,080 40,400 0
ampul/kotak
0 100 Natrium Diklofenac 50 mg kotak 8,700 0
0 101 Nistatin tablet salut 500.000 kotak 64,000 0
IU
5 ampul 2,300 13,800 0
ampul/kotak
50
0 103 Klindamisin 150 mg tablet 382 19,100 0
tablet/kotak
50
0 104 Klindamisin 300 mg tablet 527 26,350 0
tablet/kotak
100
0 105 Kloramfenikol kapsul 250 mg tablet 578 57,750 0
tablet/kotak
0 106 Kloramfenikol tetes telinga botol botol 1,599 1,599 0
3%
1,500 107 Klorfeniramin Maleat (CTM) tablet
100
51 5,100 2,000
tablet tablet/kotak
100
0 108 Klorpromasin tablet 100 mg tablet 149 14,900 0
109 mg/ml - 1 ml (SK.720 : 30
0 ampul 1,021 30,630 0
ampul/kotak
kemasan 2 ml)
0 110 Klorpromazin HCl injeksi 5 ampul
30
950 28,500 0
0 111 Klorpromazin HCl tablet salut tablet
100
149 14,900 0
100 mg tablet/kotak
0
tablet/kotak
30 113 Sulfametoksazol 200mg + botol botol 60 ml 2,190 2,190 100
200 Sulfametoksazol 400mg + tablet 138 13,800 1,000
tablet/kotak
0 115 Larutan mengandung
Trimetoprim 80 mg
Lansoprazol inj 30 mg/ml ampul
1
82,042 82,042 0
karbohidrat + elektrolit (NaCl
Larutan mengandung ampul/kotak
0 116 1,75 gr. Na Lactat 2,24 gr. botol botol 10,000 10,000 0
karbohidrat + elektrolit (NaCl
0 KCl 1.5
117 2,34 gr.Dextrosa
gr. Na 27 gr.
Lactat 2,24 gr) / botol botol 10,000 10,000 0
KA
KCl EN
0.753B
gr. 30
15 118 Lidokaian injDextrosa
2% 27 gr) / ampul 1,333 40,000 10
KA EN 3A ampul/kotak
0 119 Magnesium Sulfat inj (IV) vial
10
2,078 20,780 0
20% - 25 mlSulfat inj (IV)
Magnesium vial/kotak
10
5 120 vial 2,629 26,290 15
40% - 25 ml vial/kotak
30
0 121 Mebendazol tablet 100 mg tablet 228 6,840 0
122 (Metilergometrin) tab salut 100
0 tablet 154 15,400 0
tablet/kotak
0,125 mg
123 Metilergometrin Maleat inj 30
0 ampul 2,175 65,250 0
0,200 mg-1 ml ampul/kotak
0 tablet 635 19,050 0
tablet/kotak
100
0 125 metilprednisolon tablet 4 mg tablet 300 30,000 0
tablet/kotak
10
0 126 Metoklopramid inj 5 mg/ml ampul 2,070 20,700 0
ampul/kotak
0 tablet 110 11,000 0
tablet/kotak
0 128 Metronidazol Infus botol
botol 100
39,825 39,825 0
500mg/100ml ml
0 129 Metronidazol supositoria 500 3,220 3,220 0
mg ( flagyl) suppositoria suppositoria
100
0 130 Metronidazol tablet 250 mg tablet 193 19,305 0
tablet/kotak
0 131 Metronidazol tablet 500 mg tablet kotak 160 16,000 0
0 132 Mikonazol krim/ salep 2 % tube tube 3,000 3,000 0
0 sachet 2,450 98,000 1,600
sachet/kotak
0 134 Natrium Bikarbonat inj i.v ampul ampul 6,200 6,200 0
8,4% (meylon)
400 tablet 200 10,000 0
tablet/kotak
0 136 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
40 137 Natrium Klorida larutan infus botol botol 4,900 4,900 110
0,9 % steril (Produk lokal) 24
0 138 Hidrokortison krim 2,5% tube 2,979 71,500 0
Natrium Tiroksin tablet 100 tube/kotak
0 139 tablet tablet 1,694 1,694 0
mcg
0 140 Nifedipin tablet 10mg tablet kotak 129 12,900 0
0 141 Nistatin tablet salut 500.000 tablet
100
640 64,000 100
IU
Noretisteron tablet 5 mg tablet/kotak
30
0 142 tablet 2,618 78,540 0
(Primolutvaginal
Nystatin N) tablet tablet/kotak
100
0 143 tablet 480 47,960 0
100.000 UI tablet/kotak
0 144 Obat Batuk Hitam botol botol 5,500 5,500 0
0 145 Ofloxacin 200 mg Tab Salut tablet
100
207 20,650 0
Selulose
Ofloxacin 400 mg Tab Salut tablet/kotak
100
0 146 tablet 327 32,700 0
Selulose
Oksimetazolin tetes hidung tablet/kotak
0 147 botol botol 27,550 27,550 0
0 148 Oksitetrasiklin HCl salep tube
25
1,600 40,000 0
mata 1 % tube/kotak
10
0 149 Oksitosin injeksi 10IU/ml-1ml ampul 2,200 22,000 0
ampul/kotak
240 tablet 211 6,330 1,460
tablet/kotak
100 tablet 716 21,480 100
tablet/kotak
0 tablet 1,189 35,670 0
tablet/kotak
0 153 Ondansetron inj 4 mg/ 2 ml ampul ampul 2,400 2,400 0
0 tablet 119 11,900 0
tablet/kotak
0 155 Paracetamol drop 100 mg/ml botol botol 5,200 5,200 0
80 156 Parasetamol sirup 120 mg / 5 60 ml botol 60 ml 1,438 1,438 116
ml 100
4,000 157 Parasetamol tablet 500 mg tablet 79 7,900 18,800
tablet/kotak
100
0 158 Piracetam 400 mg Tablet tablet 609 60,885 0
tablet/kotak
100
0 159 Piracetam 800 mg kapsul tablet 1,084 108,405 0
tablet/kotak
10
0 160 Piracetam inj 1 gr/ 5 ml ampul 7,425 74,250 0
ampul/kotak
0 161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
30
0 tablet 420 12,595 10
Piridoksin HCl (Vit.B6) tablet tablet/kotak
100
500 163 tablet 110 11,000 6,000
10 mg tablet/kotak
100
200 164 Piroksikam 20 mg tablet 105 10,500 1,000
tablet/kotak
0 165 Povidon Iodida larutan 10% botol botol 30 ml 2,163 2,163 0
0 166 Povidon Iodida larutan 10% botol botol 300 ml 14,203 14,203 0
0 tablet 114 11,400 0
tablet/kotak
0 168 Prokain Benzil Penicillin G vial
30
10,780 323,400 0
100
0 169 Propiltiourasil tablet 100 mg tablet 404 40,442 0
tablet/botol
25
15 170 Ranitidin inj.25mg/2ml ampul 3,614 86,738 10
ampul/kotak
100
1,000 171 Ranitidin tablet 150 mg tablet 120 12,000 4,000
kaplet/kotak
0 172 Retinol (Vitamin A) 200.000 kapsul
50
460 23,000 0
IU Kapsul Lunak kapsul/botol
0 173 Retinol (Vitamin A) 100.000 kapsul
50
260 13,000 0
IU Kapsul Lunak kapsul/botol
40 174 Ringer Laktat larutan infus botol botol 500 ml 5,200 5,200 120
steril
300 tablet 59 5,900 1,400
tablet/kotak
500 Salbutamol inshalasi/ aerosol tablet 97 9,749 3,100
tablet/kotak
0 177 100 mcg/dosis (ventolin Botol Botol 63,750 63,750 0
Salbutamol inshalasi/ aerosol
0 178 inheler)
200 mcg/kaps (ventolin kapsul kapsul 431 431 0
Salbutamol inshalasi/ aerosol
0 179 rotacaps)
200 mcg/rotahaler (ventolin rotahaler rotahaler 5,867 5,867 0
Salep 2-4 Komb : As Salisilat
180 rotaheler)
0 pot pot 2,000 2,000 0
2 % + Belerang endap 2 %
0 181 Salisil Bedak 2% kotak kotak 1,250 1,250 0
0 tablet 855 25,650 0
tablet/kotak
0 tablet 1,042 52,100 0
tablet/kotak
10 184 sefadroksil sirup kering botol botol 4,896 4,896 0
125mg/5ml
0 185 Sefotaksim inj 1 gr vial 2 vial/kotak 6,050 12,100 0
0 186 Sefriakson serbuk injeksi 1 vial vial 11,000 11,000 0
Serum Anti Bisa Ular
g/vial
187 Polivalen injeksi 5 ml (ABU Dus, 10 vial
0 Dus, 10 47,300 473,000 0
@ 5 ml
0 188 Serum
I) Anti Tetanus injeksi
ampul ampul @ 1 12,600 126,000 0
1.500 IU/ampul (A.T.S)
100
0 tablet 181 18,100 0
tablet/kotak
0 190 Sianokobalamin (vit B12) ampul
100
916 91,600 0
injeksi 500mcg-ml ampul/kotak
100
0 191 Simetidin tablet 200 mg tablet 111 11,100 0
tablet/kotak
50
400 192 Si mvastatin 10 Mg tablet 693 34,628 1,300
tablet/kotak
100
300 193 Siproflaxacin tablet 500 mg tablet 255 25,500 1,200
tablet/kotak
0 194 Sulfadoxine Pyrimethamine tablet
100
478 47,800 0
525 mg tablet tablet/kotak
30
700 195 Tablet Tambah Darah sachet 1,260 1,260 2,000
tablet/sachet
0 196 Terbutalin sulfat (Molasma) tablet
50
99 4,950 100
Terbutalin turbu (serbuk ih)
tablet 2,5 mg tablet/kotak
0 197 0,50 mg (bricasma turbuhaler turbuhaler turbuhaler 71,100 71,100 0
0 198 0,5mg)
Tetrasiklin HCl kapsul 250
kaplet
100
149 14,900 0
mg kaplet/kotak
0 kaplet 257 25,700 0
mg kaplet/kotak
0 200 Tiamin HCl (Vit.B1) injeksi ampul
30
690 20,700 0
100 mg/ml-1 ml ampul/kotak
100 201 Tiamin HCl / Mononitrat tablet
1000
38 37,800 400
5
0 202 Tramadol inj 50mg/5ml ampul 5,400 27,000 0
Triheksifenidil Hidroklorida ampul/kotak
100
0 203 tablet 40 4,000 0
Dus, 1 vial
0 204 Vaksin Rabies Vero - Rabipur vial @ 1 dosis + 78,500 78,500 0
100
0 tablet 108 10,700 0
tablet/kotak
0 206 zinc drop 10 mg/ ml botol botol 12,840 12,840 0
15 207 Zinc sirup 10 mg/ml botol botol 14,980 14,980 15
500 tablet 474 47,400 1,500
tablet/kotak
0 Primaquin 500
PERBEKALAN
0 0
KESEHATAN
0 pcs 2,140 214,000 0
psc
0 pcs 650 65,000 0
psc
300 pcs 650 65,000 1,400
psc 100
kotak/
0 212 Alat suntik sekali pakai 5 ml pcs 750 75,000 0
psc 100
kotak/
0 213 Alkohol Swab pcs 216 21,560 0
psc
0 214 Aqua bides 20 liter galon galon 174,000 174,000 0
0 215 pcs 24pcs/kotak 26,667 640,000 0
dengan jarum bedah
0 216 Catgut / beneng bedah no 3/0 pcs 24psc/kotal 23,299 559,176 0
dengan jarum bedah
0 217 Cut gut chromic 3/0 pcs 24 pcs/kotak 5,583 134,000 0
0 218 Elastis Perban 75 Fesco roll roll 17,160 17,160 0
0 219 Exell tulle pcs kotak / psc 14,014 14,014 0
0 220 Foley cateter pcs pcs 8,495 8,495 0
0 221 Handscoon uk 7 pcs kotak 5,267 5,267 0
0 222 Handscoon uk 8 pcs kotak 5,270 5,270 0
0 223 Hidrogen Peroksida (H2 O2) botol
botol 800
30,238 30,238 0
10% ml
15 224 Infus set anak set 50 set/kotak 16,500 82,500 95
20 225 Infus set dewasa set 50 set/kotak 6,785 339,250 115
5 226 IV Catheter No. 22 G set 50 set/kotak 7,700 385,000 7
0 227 IV Catheter No. 24 G set 50 set/kotak 7,700 385,000
5 228 IV Chateter No 20 G set 50 set/kotak 7,700 385,000 2
Kapas Pembalut / Absorben
0 229 Bungkus Bungkus 7,500 7,500 0
250 gram
0 230 Kasa Pembalut Elastic 3 inchi pcs psc 7,000 7,000 0
0 231 Kasa Pembalut Elastic 4 inchi pcs psc 10,000 10,000 0
0 232 Kasa Pembalut Hidrofil 36 x Rol Rol 55,200 55,200 0
80 cm
0 233 Kasa Pembalut Hidrofil 4 m x roll roll 30,350 30,350 0
10
0 234 Kasa Pembalut Hidrofil 4 m x roll roll 30,350 30,350 0
5 cm 16
0 235 Kassa Hidrofil steril uk. pcs lembar/kota 363 5,800 0
16x16 (surya husada) 12
0 236 Kassa Hidrofil steril uk. pcs k
18x22 (isi 12 lembar)
0 237 Kassa kompres steril 40 x 40 Pcs
k
Pcs 1,600 1,600 0
cm ball/ 10
0 238 Kertas Puyer pack 6,402 64,020 0
pack
0 pack 7,682 76,820 0
pack
5 pack 11,204 114,000 0
pack
0 241 Lisorin 1liter botol botol 18,865 18,865 0
200 242 Masker pcs 50 pcs/kotak 1,125 56,250 340
0 243 Pembalut Gibs 3 inchi rol rol 23,500 23,500 0
0 244 Plester 5 yard x 2 inch Rol Rol 23,625 23,625 0
0 245 Silk ( Benang Bedah Sutera ) pcs 36pcs/kotak 14,316 515,376 0
No. 3/0 dg jarum bedah
0 246 Sterobat nf. 400ml botol botol 78,000 78,000 0
0 247 Strip gula 50 strip (blonime) box box 464,000 464,000 0
0 248 Umbilical cord nylon one med pcs
kotak/ 50
1,940 97,020 36
249 Under Pet 10
0 pcs 5,390 53,900 0
pcs/kotak
0 250 Urine Bag Pcs Pcs 4,000 4,000 0
0 Pcs 5,770 577,000 0
psc
0 Pcs 5,770 577,000 0
psc
0 Pcs 5,770 577,000 0
psc
0 Pcs 5,770 549,750 0
psc
0 0
0 0BAT GIGI 0
0 255 Devitalisasi Pasta (Non Arsen) kotak kotak 390,000 390,000 0

0 256 Etil klorida spray botol botol 146,300 146,300 0
0 257 Glass Ionomer Cement (GC botol botol 395,000 395,000 0
IX) ART
0 258 Kalsium Hidroksida Pasta kotak kotak 242,000 242,000 0
0 259 Klorfenol Kamfer Mentol botol botol 55,000 55,000 0
(CHKM)
0 260 Mummifying Pasta kotak kotak 176,000 176,000 0
0 261 Semen Seng Fosfat serbuk dan botol botol 93,500 93,500 0
cairan
0 262 Temporary Stopping Fletcher botol botol 34,000 34,000 0
0 0
OBAT DENGAN NAMA
0
DAGANG
0 kapsul 1,537 46,100 0
kapsul/kotak
30
0 264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
0 265 Betason-N krim Tube 9,182 220,368 0
tube/kotak
Kotak 5
0 266 Bioneuron Injeksi ampul 4,341 21,705 0
Ampul
0 267 Bionick botol 60 ml/botol 16,000 16,000 0
0 268 Bionick drop botol 15 ml/botol 22,500 22,500 0
0 269 Blonick Plus Syr Botol Botol 18,700 18,700 0
0 270 Chlorampecort Cr Tube Tube 10 gr 9,085 9,085 0
271 Diapecta 100
0 Tablet 384 38,400 0
tablet/kotak
0 272 Febrinex Suspensi Botol Botol 15,855 15,855 0
273 Fercee 100
0 Tablet 1,044 104,400 0
tablet/kotak
274 Fituno 30
0 Tablet 3,273 98,190 0
kaplet/kotak
0 275 Fludane plus syr 60 ml botol botol 60 ml 15,950 15,950 0
0 276 Flutamol Sirup botol 60 mL/botol 13,500 13,500 0
277 Hustab 10
0 Tablet 284 2,840 0
tablet/strip
0 278 Lybex sirup botol botol 60 ml 19,800 19,800 0
0 ampul 4,400 44,000 0
ampul/kotak
100
0 280 Neorodial kaplet 1,091 109,100 0
kaplet/kotak
60
0 281 Neurovit-E Tablet 818 49,080 0
tablet/kotak
0 282 Noza Tablet 4 tablet/strip 399 1,596 0
0 Tablet 1,353 135,300 0
tablet100
kotak
0 284 Ponflu Tablet 935 93,500 0
tablet
10
0 285 Progastric Tablet 303 3,030 0
tablet/strip
100
0 286 Ramaton Tablet 698 69,800 0
tablet/kotak
0 287 Scabicid Cream Tube Tube 10 gr 28,380 28,380 0
0 kapsul 946 94,600 0
kapsul
0 289 Kasa Pembalut Hidrofil 36 x rol rol 140,337 140,337 0
80 cm (AHMADARIS)
0 290 Master Plast Plastik 1 inc roll roll 27,088 27,088 0
(plester)
0 300 0
IV Cateter 18 G
0 OBAT TAMBAHAN 0
0 291 0
400 292 800
10 293 20
500 294 1,500
0 295 0
0 296 0
0 297 0
0 298 0
500 299 1,900
0 300 0
200 301 400
50 302 50
UMUM
BAYAR
Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Mel

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi Kepala Puskesma
Dinas Kesehatan
Baidulllah S Siagi
NIP.19690124198902
NIP.197211242002121002 NIP. 198105062005012010
2
EMBAR PERMINTAAN OBAT (LPLPO)
BULAN : Desember
TAHUN : 2017
STOK AKHIR
PERSEDIAAN DALAM
RUPIAH
INI
DAK DAK Lain lain TOTAL
2015 2014 2017
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 300
0 0 0 0 0 2,000
0 0 0 0 0 0 2,000
0 0 0 0 0 500
0 0 0 0 0 0 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1,300 400 900 297,000 400
0 0 0 0 0
0 0 0 0 0 0
0 1,000 400 600 232,794 400
0 10,000 3,000 7,000 2,177,000 3,000
0 300 80 220 537,900 80
0 0 0 0 0 0
0 0 0 0 0 0
0 100 35 65 140,400 35
0 7,400 1,000 6,400 460,800 1,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2,500 1,500 1,000 95,000 1,500
0 0 0 0 0 0
0 2,000 1,000 1,000 144,000 1,000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 20 10 10 15,800 10
0 1,400 1,000 400 24,800 1,000
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 100 14,300 0
0 50 20 30 99,990 20
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 120 40 80 200,000 40
0 3 0 3 644,970 0
0 11 3 8 2,879,920 3
0 8 0 8 9,599,200 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 180 20 160 546,720 20
0 0 0 0 0 0
0 0 0 0 0 0
0 500 200 300 25,500 200
0 2,100 400 1,700 496,400 400
0 187 40 147 382,200 40
0 0 0 0 0
0 30 10 20 67,980 10
0 0 0 0 0 0
0 3,400 500 2,900 162,400 500
0 0 0 0 0
0 13,000 3,000 10,000 279,000 3,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 5 5 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 200 100 100 5,252 100
0 100 0 100 8,258 0
0 0 0 0 0 0
0 40 15 25 69,950 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2,000 500 1,500 225,000 500
0 0 0 0 0
0 2,000 500 1,500 105,000 500
0 500 200 300 18,600 200
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2,000 1,500 500 25,500 1,500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 30 70 153,300 30
0 1,000 500 500 69,000 500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 10 10 0 0 10
0 0 0 0 0 0
0 15 0 15 39,435 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 1,600 0 1,600 3,920,000 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 110 20 90 441,000 20
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 100 0 100 64,000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 1,460 360 1,100 232,100 360
0 100 60 40 28,640 60
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 116 40 76 109,288 40
0 18,800 5,000 13,800 1,090,200 5,000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 10 10 4,198 0
0 6,000 1,000 5,000 1,000 1,000
0 1,000 400 600 63,000 400
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 10 10 0 0 10
0 4,000 1,000 3,000 360,000 1,000
0 0 0 0 0 0
0 0 0 0 0 0
0 120 20 100 520,000 20
0 1,400 300 1,100 64,900 300
0 3,100 300 2,800 272,972 300
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1,300 500 800 554,048 500
0 1,200 400 800 204,000 400
0 0 0 0 0 0
0 2,000 500 1,500 1,890,000 500
0 100 100 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 400 400 0 0 400
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 15 15 0 0 15
0 1,500 400 1,100 521,400 400
0 500 0 500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1,400 300 1,100 715,000 300
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 95 10 85 1,402,500 10
0 115 30 85 576,686 30
0 7 0 7 53,900 0
0 0 0 0 0
0 2 2 0 0 2
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 340 100 240 270,000 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 36 0 36 69,854 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 800 300 500 0 300
0 20 20 0 0 20
0 1,500 500 1,000 0 500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 1,900 400 1,500 0 400
0 0 0 0 0
0 400 100 300 0 100
0 50 50 0 0 50
33,672,056
g Menerima/Melapor
Kepala Puskesmas Petugas Gudang Farmasi
Puskesmas Rawajitu
aidulllah S Siagian Endang Sulastri Amd.Keb

196901241989021001 NIP.197202191992032001
2
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMI
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK PENER
HARGA HARGA PER
NO NAMA OBAT SATUAN KMSN AWAL APBD I
SATUAN KEMASAN
1 2 3 4 5 6 7 8
1 ACT (Artesunat + Amodiaquin ) tablet
24
tablet 1,856 44,550 0
tab/Kotak
100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 86 8,593 0
tablet/kotak
100
7 Aminofilin tablet 200mg tablet ktk 30 80 8,000 0
tablet/kotak
9 Amitriptillin tablet salut 25 mg 100
ml
tablet 112 11,200 100
tablet/kotak
30
tablet/kotak
30
tablet/kotak
10
12 Amoksisilin Injeksi serbuk 1000mg vial 10,125 101,250 0
vial/kotak
100
13 Amoksisilin kapsul 250 mg tablet 388 38,799 0
tablet/kotak
100
tablet/kotak
tablet 201 20,115 0
tablet/kotak
30
vial/kotak
tablet 72 7,200 2,000
tablet/kotak
20 Anti Bakteri DOEN salep tube
25
2,581 62,900 0
10
supp/kotak
tablet/kotak
100
135 13,500 0
Antiparkinson
tablet 1,500 150,000 0
tablet/kotak
26 (Aqua
Levopar) 10
vial/kotak
6
ampul/kotak
100
tablet/kotak
100
tablet/botol
100
30 Asam Mefenamat tablet 500 mg tablet 144 14,400 1,000
tablet/kotak
31 Asiklovir krim 5% 25
tube 4,253 101,250 0
tube/kotak
tablet 524 52,404 0
tablet/kotak
tablet 771 77,130 100
tablet/kotak
10
11,070 110,700 0
IU/vial vial/kotak
30
tablet/sachet
inhaler 160/4,5 mcg (symbicort turbuhaler)
inhaler 80/4,5 mcg (symbicort) 100
40 Deksametason injeksi 5mg.ml-1ml ampul 1,580 158,000 0
ampul/kotak
100
tablet/kotak
42 DHP tablet (Prog : malaria) 9
tablet 3,567 32,101 0
tablet/kotak
ampul 1,054 31,620 0
ampul/kotak
tablet 143 14,300 0
tablet/kotak
tablet 167 16,700 0
tablet/kotak
1000
48 Ekstrak Belladon tablet 10 mg tablet 38 38,000 0
49 Adrenalina ) 30
ampul 8,100 243,000 0
ampul/kotak
50 Ergakalsiferol
ml D3/D2) kapsul
tablet/kotak
botol 2,500 2,500 80
ml/botol
ampul 1,800 54,000 0
ampul/kotak
100
61 Fenobarbital tablet 100 mg tablet 220 22,000 0
tablet/kotak
24
2,042 49,008 0
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul
10
4,698 46,980 0
1 ml ampul/kotak
64 Fitomenadion (Vit.K1) injeksi 2mg/ml 30
ampul 3,417 102,510 0
ampul/kotak
65 Fitomenadion (Vit.K1)tab salut gula 10 mg 100
tablet 634 63,400 0
tablet/botol
ampul 1,829 45,725 0
ampul/kotak
67 Furosemid tablet 40 mg 100
tablet 85 8,500 0
tablet/kotak
68 Garam oralit untuk 200 ml air (Prog : sachet
100
292 29,200 0
diare) sachet/kotak
69
Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0

ampul 3,399 16,995 0
ampul/kotak
tablet 56 5,600 0
tablet/kotak
tablet 436 21,800 0
tablet/kotak
75 Gliseril Guayacolat tablet 100 mg 1000
tablet 28 27,900 0
tablet/botol
(nitral)
500
5,700 5,700 0
lokal) ml/botol
lokal)
500
5,200 5,200 30
lokal) ml/botol
100
tablet/kotak
decanoas) 100
83 Haloperidol tablet 0,5 mg tablet 53 5,252 1,400
tablet/kotak
tablet 83 8,258 1,400
tablet/kotak
100
85 Haloperidol tablet 5 mg tablet 88 8,823 0
tablet/kotak
tiube 2,798 67,152 0
tube/kotak
tablet 116 11,550 0
tablet/botol
100
tablet/kotak
100
91 Isosorbid Dinitrat tablet sublingual 5 mg tablet 81 8,071 0
tablet/kotak
tablet 70 7,000 2,800
tablet/kotak
tablet 62 6,200 0
tablet/kotak
tablet 84 8,400 0
tablet/kotak
tablet 243 24,300 0
tablet/kotak
96 Ketokenazol tablet 200mg 50
tablet 554 27,675 0
tablet/kotak
tube 4,700 56,400 0
tube/kotak
tablet 1,823 182,250 0
tablet/kotak
ampul 8,080 40,400 0
ampul/kotak
ampul 2,300 13,800 0
ampul/kotak
50
tablet/kotak
50
tablet/kotak
100
tablet/kotak
tablet 51 5,100 2,800
tablet/kotak
108 Klorpromasin tablet 100 mg 100
tablet 149 14,900 0
tablet/kotak
109 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul
30
1,021 30,630 0
(SK.720 : kemasan 2 ml) ampul/kotak
30
110 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 950 28,500 0
ampul/kotak
111 Klorpromazin HCl tablet salut 100 mg 100
tablet 149 14,900 0
tablet/kotak
100
112 Kodein 10 mg tablet tablet 500 50,000 0
Kotrimoksazol Susp komb: tablet/kotak
113 Sulfametoksazol 200mg + Trimetoprim 40 botol botol 60 ml 2,190 2,190 70
mg
114 Sulfametoksazol 100
400mg + Trimetoprim 80 tablet 138 13,800 500
tablet/kotak
1
115 mg
Larutan mengandung karbohidrat + ampul/kotak
elektrolitmengandung
116 Larutan (NaCl 1,75 gr. Na Lactat+2,24 gr.
KCl 1.5 gr.Dextrosa
117 elektrolit (NaCl 2,34 27
gr.gr)
Na/Lactat
KA EN 3B gr.
2,24 botol botol 10,000 10,000 0
118 KCl 0.75 jeli
gr. Dextrosa 27 gr) jelly
/ KA2EN 30
Lidokain 2 % (xylocaine %)3A ampul 1,333 40,000 0
ampul/kotak
10
vial/kotak
10
vial/kotak
30
tablet/kotak
122 Metilergometrin Maleat (Metilergometrin) tablet
100
154 15,400 0
tab salut 0,125 mg tablet/kotak
30
123 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 2,175 65,250 0
ampul/kotak
30
124 Metilprednisolon tablet 16 mg tablet 635 19,050 0
tablet/kotak
tablet 300 30,000 0
tablet/kotak
10
ampul/kotak
tablet 110 11,000 0
tablet/kotak
botol 39,825 39,825 0
ml
129 Metronidazol supositoria 500 mg ( flagyl) 3,220 3,220 0
suppositoria suppositoria
100
tablet/kotak
sachet 2,450 98,000 560
sachet/kotak
tablet 200 10,000 100
tablet/kotak
(Produk lokal) 24
tube/kotak
tablet 640 64,000 0
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 207 20,650 0
tablet/kotak
100
tablet/kotak
drop) 25
tube/kotak
149 Oksitosin injeksi 10IU/ml-1ml 10
ampul 2,200 22,000 0
ampul/kotak
30
150 Omeprazol kapsul 20mg tablet 211 6,330 0
tablet/kotak
30
151 ondansetron tablet 4 mg tablet 716 21,480 0
tablet/kotak
tablet 1,189 35,670 0
tablet/kotak
tablet 119 11,900 0
tablet/kotak
tablet 79 7,900 13,000
tablet/kotak
100
tablet/kotak
159 Piracetam 800 mg kapsul 100
tablet 1,084 108,405 0
tablet/kotak
10
ampul/kotak
162 Pirantel tablet 125 mg 30
tablet 420 12,595 0
tablet/kotak
163 Piridoksin HCl (Vit.B6) tablet 10 mg 100
tablet 110 11,000 0
tablet/kotak
164 Piroksikam 20 mg 100
tablet 105 10,500 0
tablet/kotak
tablet 114 11,400 0
tablet/kotak
30
10,780 323,400 0
IU/vial vial/kotak
100
tablet/botol
25
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 100
kaplet/kotak
50
460 23,000 0
Lunak kapsul/botol
50
260 13,000 0
Lunak kapsul/botol
tablet 59 5,900 0
tablet/kotak
100
176 Salbutamol 4 mg tablet 97 9,749 0
tablet/kotak
177 Salbutamol inshalasi/ aerosol 100 Botol Botol 63,750 63,750 0
Belerang endap 2 %
tablet 855 25,650 0
tablet/kotak
50
183 Sefadroksil kapsul 500 mg tablet 1,042 52,100 0
tablet/kotak
187
Serum Anti Bisa Ular Polivalen injeksi 5 Dus, 10 vial
vial Dus, 10 47,300 473,000 0
ml (ABU I) @ 5 ml
IU/ampul (A.T.S) 100
189 Setrizin tablet 10 mg tablet ml 181 18,100 0
Sianokobalamin (vit B12) injeksi 500mcg- tablet/kotak
100
190 ampul 916 91,600 0
ml ampul/kotak
100
tablet/kotak
50
192 Simvastatin tablet 10 mg tablet 693 34,628 0
tablet/kotak
100
tablet/kotak
100
tablet/kotak
30
195 Tablet Tambah Darah sachet 1,260 1,260 0
tablet/sachet
50
tablet/kotak
198 Tetrasiklin HCl kapsul 250 mg kaplet 149 14,900 0
kaplet/kotak
100
kaplet/kotak
200 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ampul
30
690 20,700 0
ml
Tiamin HCl / Mononitrat (Vit.B1) tablet 50 ampul/kotak
1000
201 tablet 38 37,800 0
mg tablet/botol
5
ampul/kotak
100
Dus, 1 vial
tablet/kotak
205 Vitamin B komplek tablet 100
syringe
tablet 108 10,700 500
tablet/kotak
tablet 474 47,400 0
tablet/kotak
PERBEKALAN KESEHATAN
pcs 2,140 214,000 0
psc 100
kotak/
psc 100
kotak/
psc 100
kotak/
psc 100
kotak/
psc
215 Catgut / benang bedah no 2/0 dengan pcs 24pcs/kotak 26,667 640,000 0
jarum bedah
jarum bedah
botol 30,238 30,238 0
ml
16
husada) 12
236 Kassa Hidrofil steril uk. 18x22 (isi 12 k
pcs lembar/kota 396 4,750 0
lembar)
Pcs Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack10
ball/
239 Klip Plastik 10 x 7 KP pack 7,682 76,820 5
pack10
ball/
240 Klip Plastik 13x8,7 KP pack 11,204 114,000 0
pack
jarum bedah
kotak/ 50
1,940 97,020 196
pusat) psc
10
249 Under Pet pcs 5,390 53,900 0
pcs/kotak
Pcs 5,770 577,000 0
psc 100
kotak/
252 Wing Needle No. 23 G Pcs 5,770 577,000 0
psc 100
kotak/
psc
Pcs 5,770 549,750 0
psc
0BAT GIGI
serbuk & cairan

kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
tube/kotak
Kotak 5
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
30
274 Fituno Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
ampul 4,400 44,000 0
ampul/kotak
280 Neorodial 100
kaplet 1,091 109,100 0
kaplet/kotak
60
tablet/kotak
Tablet 1,353 135,300 0
tablet100
kotak
tablet
10
tablet/strip
100
tablet/kotak
kapsul 946 94,600 0
kapsul
(AHMADARIS)
0
OBAT TAMBAHAN
291
292
293
294
295
296
297
298
299
300
301
JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

UMUM
BAYAR
Mengetahui/Menyetujui : Yang Menyerahkan

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi
Dinas Kesehatan
NIP.197211242002121002 NIP. 198105062005012010
2
AIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : Februari
TAHUN : 2017
STOK AKHIR
PENGELUAR RATA-RATA
APBD II DAK ASKES LAIN-LAIN TOTAL PERSEDIAAN STOK AKHIR DALAM
AN S/D BULAN
RUPIAH
INI
2015 (………..)
9 10 11 12 13 14 15 16 17 18
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 11,200 #REF!
0 600 600 198,000 #REF!
0 550 550 102,850 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
70 70 171,150 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
240 240 518,400 #REF!
2,000 2,000 144,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 9,500 #REF!
0 0 0 0 #REF!
0 1,000 1,000 144,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 77,100 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 152,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 6,200 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 5 5 16,665 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 80 80 200,000 #REF!
0 3 3 644,970 #REF!
0 7 7 2,519,930 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 30 30 156,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 1,400 1,400 73,528 #REF!
0 1,400 1,400 115,612 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 2,800 2,800 196,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 2,800 2,800 142,800 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 70 70 153,300 #REF!
0 500 500 69,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 16,000 #REF!
0 2 2 6,000 #REF!
0 560 560 1,372,000 #REF!
0 0 0 0 #REF!
0 100 100 20,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 88 88 126,544 #REF!
0 13,000 13,000 1,027,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 3 3 6,489 #REF!
0 9 9 127,827 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 12,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 25 25 122,400 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 500 500 53,850 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 500 500 325,000 #REF!
0 400 400 300,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 20 20 465,980 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 5 5 38,500 #REF!
0 10 10 77,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 1 1 55,200 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 5 5 1,813 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 5 5 38,412 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 900 900 1,012,500 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 10 10 143,160 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 196 196 380,318 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 4 4 585,200 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 #REF!
0 0 0 #REF!
0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
SA STOK BULAN INI (Rp.) 12,135,398
Yang Menerima/Melapor
Puskesmas Rawajitu
NIP.196901241989021001 NIP.197202191992032001
PERMINTAA
N
19
300
2,000
2,000
500
200
3
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMIN
KODE PUSKESMAS :
PROPINSI : LAMPUNG
STOK PENERIM
HARGA HARGA PER
NO NAMA OBAT SATUAN KMSN AWAL APBD I APBD II
SATUAN KEMASAN
1 2 3 4 5 6 7 8 9
tablet 1,856 44,550 0
tab/Kotak
100
tablet/kotak
30
tablet/kotak
100
tablet/kotak
6 Ambroxol tab 30 mg
100
tablet 86 8,593 0
tablet/kotak
100
7 Aminofilin tablet 200mg tablet ktk 30 80 8,000 0
tablet/kotak
9 Amitriptillin tablet salut 25 mg 100
ml
tablet 112 11,200 100
tablet/kotak
30
tablet/kotak
30
tablet/kotak
10
12 Amoksisilin Injeksi serbuk 1000mg vial 10,125 101,250 0
vial/kotak
100
tablet/kotak
100
tablet/kotak
tablet 201 20,115 0
tablet/kotak
30
vial/kotak
tablet 72 7,200 2,000
tablet/kotak
20 Anti Bakteri DOEN salep tube
25
2,581 62,900 0
21 Anti Hemoroid DOEN Kombinasi 10
supp 2,000 20,000 0
supp/kotak
tablet/kotak
100
135 13,500 0
Antiparkinson
tablet 1,500 150,000 0
tablet/kotak
10
26 (Aqua
Levopar)
vial/kotak
6
ampul/kotak
100
tablet/kotak
100
tablet/botol
100
30 Asam Mefenamat tablet 500 mg tablet 144 14,400 1,000
tablet/kotak
25
tube/kotak
100
tablet/kotak
100
tablet/kotak
10
11,070 110,700 0
IU/vial vial/kotak
30
tablet/sachet
37 Budesonid inhaler 200 mcg/puff, 100
Budesonid-formoterol ( fixed turbuhaler turbuhaler 93,000 93,000 0
40 (symbicort) 100
Deksametason injeksi 5mg.ml-1ml ampul 1,580 158,000 0
ampul/kotak
100
tablet/kotak
9
tablet/kotak
43 Difenhidramin HCl injeksi 10 mg/mlampul
30
1,054 31,620 0
1ml ampul/kotak
100
44 Digoksin tablet 0,25 mg tablet 143 14,300 0
tablet/kotak
tablet 167 16,700 0
tablet/kotak
1000
48 Ekstrak Belladon
Epinefrina tablet 10
HCl/Bitartrat mg
( Epinefrina / tablet 38 38,000 0
tablet/botol
30
49 Adrenalina ) ampul 8,100 243,000 0
ampul/kotak
50 Ergakalsiferol
ml D3/D2) kapsul
tablet/kotak
botol 2,500 2,500 80
ml/botol
ampul 1,800 54,000 0
ampul/kotak
100
61 Fenobarbital tablet 100 mg tablet 220 22,000 0
tablet/kotak
24
2,042 49,008 0
63 Fitomenadion (Vit.K1) injeksi 10 mg/ml ampul
10
4,698 46,980 0
- 1 ml ampul/kotak
30
ampul/kotak
100
634 63,400 0
mg tablet/botol
25
66 Furosemid inj 40 mg/ml ampul 1,829 45,725 0
ampul/kotak
100
tablet/kotak
68 Garam oralit untuk 200 ml air (Prog : sachet
100
292 29,200 0
diare) sachet/kotak
ampul 3,399 16,995 0
ampul/kotak
tablet 56 5,600 0
tablet/kotak
50
74 Glimepiride tablet 2 mg tablet 436 21,800 0
tablet/kotak
75 Gliseril Guayacolat tablet 100 mg 1000
tablet 28 27,900 0
tablet/botol
(nitral)
500
5,700 5,700 0
lokal) ml/botol
lokal)
500
5,200 5,200 30
lokal) ml/botol
100
tablet/kotak
decanoas) 100
tablet/kotak
100
tablet/kotak
100
85 Haloperidol tablet 5 mg tablet 88 8,823 0
tablet/kotak
24
86 Hidrokortison krim 2,5% tiube 2,798 67,152 0
tube/kotak
tablet 116 11,550 0
tablet/botol
100
tablet/kotak
100
91 Isosorbid Dinitrat tablet sublingual 5 mg tablet 81 8,071 0
tablet/kotak
100
92 Kalsium Laktat tab 500 mg tablet 70 7,000 2,800
tablet/kotak
tablet 62 6,200 0
tablet/kotak
tablet 84 8,400 0
tablet/kotak
100
95 Karbamazepin tablet 200 mg tablet 243 24,300 0
tablet/kotak
50
tablet/kotak
12
97 Ketokonazol krim 2% tube 4,700 56,400 0
tube/kotak
100
98 Ketoprofen tablet 100 mg tablet 1,823 182,250 0
tablet/kotak
5
ampul/kotak
ampul 2,300 13,800 0
ampul/kotak
50
tablet/kotak
50
tablet/kotak
100
tablet/kotak
tablet 51 5,100 2,800
tablet/kotak
100
tablet/kotak
30
1,021 30,630 0
30
950 28,500 0
ml ampul/kotak
111 Klorpromazin HCl tablet salut 100 mg 100
tablet 149 14,900 0
tablet/kotak
tablet 500 50,000 0
Kotrimoksazol Susp komb: tablet/kotak
113 Sulfametoksazol 200mg + Trimetoprim botol botol 60 ml 2,190 2,190 70
114 40 mg 100
Sulfametoksazol 400mg + Trimetoprim tablet 138 13,800 500
tablet/kotak
1
115 80 mg mengandung
Larutan
Lansoprazol karbohidrat +
inj 30 mg/ml ampul 82,042 82,042 0
ampul/kotak
116 elektrolit (NaCl 1,75 gr.
Larutan mengandung Na Lactat+2,24
gr. KCl 1.5 gr.Dextrosa 27 gr) / KA EN
117 elektrolit
3B
(NaCl 2,34 gr. Na Lactat 2,24
botol botol 10,000 10,000 0
gr. KCl 0.75 gr. Dextrosa 27 gr) / KA 30
118 EN
Lidokain
3A jeli 2 % (xylocaine jelly 2 %) ampul 1,333 40,000 0
ampul/kotak
10
vial/kotak
10
vial/kotak
30
tablet/kotak
122 Metilergometrin Maleat tablet
100
154 15,400 0
123 Metilergometrin Maleat inj 0,200 mg-1 ampul
30
2,175 65,250 0
ml ampul/kotak
30
tablet/kotak
100
tablet/kotak
10
ampul/kotak
100
127 Metoklopramid 5 mg tablet 110 11,000 0
tablet/kotak
botol 100
128 Metronidazol Infus 500mg/100ml botol 39,825 39,825 0
ml
129 Metronidazol supositoria 500 mg 3,220 3,220 0
100
tablet/kotak
sachet 2,450 98,000 560
sachet/kotak
134 Natrium Bikarbonat inj i.v 8,4% ampul ampul 6,200 6,200 0
(meylon) 50
135 Natrium Diklofenac 50 mg tablet 200 10,000 100
tablet/kotak
137 Natrium Klorida larutan infus 0,9 % botol botol 4,900 4,900 0
tube/kotak
tablet 640 64,000 0
tablet/kotak
30
tablet/kotak
100
tablet/kotak
tablet 207 20,650 0
tablet/kotak
tablet 327 32,700 0
tablet/kotak
147 Oksimetazolin tetes hidung 0,025% botol botol 27,550 27,550 0
(ilaidin drop)
148 Oksitetrasiklin HCl salep mata 1 % 25
tube 1,600 40,000 0
tube/kotak
10
ampul/kotak
30
150 Omeprazol kapsul 20mg tablet 211 6,330 0
tablet/kotak
30
151 ondansetron tablet 4 mg tablet 716 21,480 0
tablet/kotak
30
152 ondansetron tablet 8 mg tablet 1,189 35,670 0
tablet/kotak
tablet 119 11,900 0
tablet/kotak
tablet 79 7,900 13,000
tablet/kotak
100
tablet/kotak
100
tablet/kotak
10
ampul/kotak
162 Pirantel tablet 125 mg 30
tablet 420 12,595 0
tablet/kotak
100
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 110 11,000 0
tablet/kotak
100
164 Piroksikam 20 mg tablet 105 10,500 0
tablet/kotak
tablet 114 11,400 0
tablet/kotak
30
10,780 323,400 0
IU/vial vial/kotak
100
tablet/botol
25
ampul/kotak
100
171 Ranitidin tablet 150 mg tablet 120 12,000 100
kaplet/kotak
50
460 23,000 0
Lunak kapsul/botol
50
260 13,000 0
Lunak kapsul/botol
tablet 59 5,900 0
tablet/kotak
100
176 Salbutamol 4 mg tablet 97 9,749 0
tablet/kotak
177 Salbutamol inshalasi/ aerosol 100 Botol Botol 63,750 63,750 0
Belerang endap 2 %
tablet 855 25,650 0
tablet/kotak
50
183 Sefadroksil kapsul 500 mg tablet 1,042 52,100 0
tablet/kotak
187 Serum Anti Bisa Ular Polivalen injeksi 5 vial
Dus, 10 vial
47,300 473,000 0
ml (ABU I) Dus,
@ 5 ml10
IU/ampul (A.T.S)
ml
189 Setrizin tablet 10 mg 100
tablet 181 18,100 0
tablet/kotak
100
916 91,600 0
100
tablet/kotak
50
192 Simvastatin tablet 10 mg tablet 693 34,628 0
tablet/kotak
100
tablet/kotak
194 Sulfadoxine Pyrimethamine 525 mg tablet
100
478 47,800 0
tablet tablet/kotak
30
195 Tablet Tambah Darah sachet 1,260 1,260 0
tablet/sachet
196 Terbutalin sulfat (Molasma) tablet 2,5 tablet
50
99 4,950 0
mg tablet/kotak
kaplet/kotak
100
kaplet/kotak
200 Tiamin HCl (Vit.B1) injeksi 100 mg/mlampul
30
690 20,700 0
1 ml ampul/kotak
201 Tiamin HCl / Mononitrat (Vit.B1) tablet tablet
1000
38 37,800 0
50 mg tablet/botol
5
ampul/kotak
100
Dus, 1 vial
tablet/kotak
205 Vitamin B komplek tablet 100
syringe
tablet 108 10,700 500
tablet/kotak
tablet 474 47,400 0
tablet/kotak
PERBEKALAN KESEHATAN
pcs 2,140 214,000 0
psc 100
kotak/
psc 100
kotak/
psc 100
kotak/
psc 100
kotak/
psc
215 Catgut / benang bedah no 2/0 dengan pcs 24pcs/kotak 26,667 640,000 0
jarum bedah
jarum bedah
botol 30,238 30,238 0
ml
16
husada) 12
lembar)
237 Kassa kompres steril 40 x 40 cm Pcs k
Pcs 1,600 1,600 0
pack 6,402 64,020 0
pack10
ball/
239 Klip Plastik 10 x 7 KP pack 7,682 76,820 5
pack
pack 11,204 114,000 0
pack
jarum bedah
kotak/ 50
1,940 97,020 196
pusat) psc
10
249 Under Pet pcs 5,390 53,900 0
pcs/kotak
Pcs 5,770 577,000 0
psc 100
kotak/
psc 100
kotak/
psc 100
kotak/
psc
0BAT GIGI
serbuk & cairan

kapsul 1,537 46,100 0
kapsul/kotak
30
264 Asifit kapsul 1,818 54,540 0
kapsul/kotak
24
tube/kotak
Kotak 5
Ampul
271 Diapecta 100
Tablet 384 38,400 0
tablet/kotak
273 Fercee 100
Tablet 1,044 104,400 0
tablet/kotak
30
274 Fituno Tablet 3,273 98,190 0
kaplet/kotak
277 Hustab 10
Tablet 284 2,840 0
tablet/strip
ampul 4,400 44,000 0
ampul/kotak
100
kaplet/kotak
60
tablet/kotak
Tablet 1,353 135,300 0
tablet100
kotak
tablet
10
tablet/strip
100
tablet/kotak
kapsul 946 94,600 0
kapsul
(AHMADARIS)
0
OBAT TAMBAHAN
291
292
293
294
295
296
297
298
299
300
301
JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

UMUM
BAYAR
Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Mela

Dinas Kesehatan
Baidulllah S Siagia
NIP.196901241989021
NIP.197211242002121002 NIP. 198105062005012010
3
T DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : Maret
TAHUN : 2017
STOK AKHIR
PENGELUAR RATA-RATA PERMINTAA
DAK ASKES LAIN-LAIN TOTAL PERSEDIAAN STOK AKHIR DALAM
AN S/D BULAN N
RUPIAH
INI
2015 (………..)
10 11 12 13 14 15 16 17 18 19
0 0 0 0 #REF! 300
0 0 0 0 #REF! 2,000
0 0 0 0 #REF! 2,000
0 0 0 0 #REF! 500
0 0 0 0 #REF! 200
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 11,200 #REF!
0 600 600 198,000 #REF!
0 550 550 102,850 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
70 70 171,150 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
240 240 518,400 #REF!
2,000 2,000 144,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 9,500 #REF!
0 0 0 0 #REF!
0 1,000 1,000 144,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 77,100 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 152,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 100 100 6,200 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 5 5 16,665 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 80 80 200,000 #REF!
0 3 3 644,970 #REF!
0 7 7 2,519,930 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 30 30 156,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 1,400 1,400 73,528 #REF!
0 1,400 1,400 115,612 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 2,800 2,800 196,000 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 2,800 2,800 142,800 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 0 0 0 #REF!
0 70 70 153,300 #REF!
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LAN INI (Rp.) 12,135,398
Yang Menerima/Melapor
Puskesmas Rawajitu

NIP.196901241989021001 NIP.197202191992032001
LILI DANA ASTRI NIA wuri HENI
1
BUKU HARIAN ATK & BMHP BULAN JANUARI TAHUN 2020
PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
LILI DANA ASTRI NIA wuri HENI
TANGGAL
NO NAMA Barang JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 2 2 0
2 Block Note 10 10 20 8
3 Bolliner BLLH 20 C Blue/Black 0 1
4 Buku Folio 100lembar kiky 2 2 4 0
5 Cliper Kertas 2 2 4
6 Buku Kwitansi 100ER 0 0
7 Kertas NCR 1 1 2
8 Kertas Bufallo 0 0
9 Kertas Karton 0 0
10 Kertas Origami 0 0
11 Isi Staples kecil 1 1 0
12 Kertas HVS 70gr f4 Sinar Dunia 2 2 4 3
13 Map Kertas 5001 Ichimaru 3 2 5 7
14 Map Odner Gobi 2 2 4 0
15 Map Sbelhecter plastik 10 10 2 10 10 42 30
16 Pembolong kertas type 85 Kenko 1 1 0
17 Pena Biasa 1 2 3 1
18 Pena Gel tizo ink 1 1 2 0
19 Penggaris Besi 40cm Asia 1 1 0
20 Pensil 9000 2B Faber Castel 1 1 2 2
21 Stapler Kangaro HS-45p 1 1 0
22 Stapler 0310 Deli 0 0
23 Spidol Non permanen 0 0
24 Spidol permanen 1 1 0
25 Tinta Printer Hitam Blue Print 1 1 0
26 Tinta Printer Warna Blue Print 0 0
27 Tinta Peinter Epson Black 1 1 0
28 Tinta Peinter Epson Color 0 0
29 Tpe Ex 0 0
30 Binder Klip No. 111 0 0
31 HVS A4 0 0
32 Verpirator 0 0
33 Tinta Stempel 0 0
34 Mouse Votre 1 1 0
35 Catrige Canon 1 1 1
36 Falshdisk 16GB 1 1 0
37 Materai 6000 10 2 12 5
38 Materai 3000 10 10 0
39 Kohort ANC 0 0
40 Persalinan 0 0
41 Bayi 0 0
42 Balita & Apras 0 0
43 KB 0 0
44 Imunisasi 0 0
45 Stikerr KS 0 0
46 Leaflet COVID 19 0 0
40 Banner 17 17 0
0 0
BMHP 0 0
41 Stick GDS 2 2 1
42 Cholesterol 2 2 1
43 Asam Urat 2 2 1
44 Golongan Darah 0 0
45 HandSoap 1 1 2 4 6
46 Tissue 2 1 1 2 2 8 2
47 SOS 0 0
48 Wipol 0 0
49 Widal 0 0
50 PPTS 0 0
51 Protein Urine 0 0
52 HB 1 1 0
53 Lanset 200 1 1 0
54 Kertas Puyer Besar 3 3 3
55 Plastik Klip Besar 0 0
56 Plastik Klip Kecil 0 0
57 Kertas Puyer Besar 0 0
58 Reagen Lab 0 0
0 0
APD dan Alkes 0 0
58 Jas hujan Ponco 0 0
59 Cover All Suit 0 0
60 Face Shield 0 18
61 Masker Bedah 0 0
62 Masker 95 0 0
63 Masker Spunbond 0 0
64 Kacamata google 0 0
65 Sepatu Booth 0 0
66 Sarung Tangan Panjang 0 0
67 Handscoon Steril 0 0
68 Set APD Lengkap 0 0
YETTI LILI HENI ENDANG astri
2
BUKU HARIAN ATK, BMHP BULAN FEBRUARI TAHUN 2020
PUSKESMAS : RAWAJITU
KECAMATAN : RAWAJITU SELATAN
PROPINSI : LAMPUNG
YETTI LILI HENI ENDANG astri
Stok
STOK TANGGAL
NO NAMA ATK, BMHP BOK JKN DINKES Opnam JUMLAH SISA
AWAL
e 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28###
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 0 1 1 0 1
2 Block Note 8 14 22 7 7 14 8
3 Bolliner BLLH 20 C Blue/Black 1 1 0 1
5 Cliper Kertas 4 6 10 1 1 3 5 5
6 Buku Kwitansi 100ER 0 1 1 1 1 0
7 Kertas NCR 2 2 1 1 1
8 Kertas Bufallo 0 0 0 0
9 Kertas Karton 0 0 0 0
10 Kertas Origami 0 0 0 0
11 Isi Staples kecil 0 0 0 0
12 Kertas HVS 70gr f4 Sinar Dunia 3 3 0 3
13 Map Kertas 5001 Ichimaru 7 12 24 43 12 12 12 36 7
14 Map Odner Gobi 0 4 24 28 6 6 6 18 10
15 Map Sbelhecter plastik 30 12 42 5 10 10 5 30 12
16 Pembolong kertas type 85 Kenko 0 0 0 0
17 Pena Biasa 1 5 6 1 1 1 3 3
18 Pena Gel tizo ink 0 2 2 1 1 1
19 Penggaris Besi 40cm Asia 0 0 0 0
20 Pensil 9000 2B Faber Castel 2 1 3 1 1 2
21 Stapler Kangaro HS-45p 0 0 0 0
22 Stapler 0310 Deli 0 0 0 0
23 Spidol Non permanen 0 0 0 0
24 Spidol permanen 0 2 2 0 2
25 Tinta Printer Hitam Blue Print 0 2 2 4 1 1 2 2
26 Tinta Printer Warna Blue Print 0 3 3 1 1 2 1
27 Tinta Peinter Epson Black 0 1 1 1 1 0
28 Tinta Peinter Epson Color 0 3 3 0 3
29 Tpe Ex 0 0 0 0
30 Binder Klip No. 111 0 0 0 0
31 HVS A4 0 0 0 0
32 Verpirator 0 0 0 0
33 Tinta Stempel 0 0 0 0
34 Mouse Votre 0 0 0 0
35 Catrige Canon 1 1 0 1
36 Falshdisk 16GB 0 0 0 0
37 Materai 6000 5 5 4 4 1
38 Materai 3000 0 0 0 0
39 Kohort ANC 0 0 0 0
40 Persalinan 0 0 0 0
41 Bayi 0 0 0 0
42 Balita & Apras 0 0 0 0
43 KB 0 0 0 0
44 Imunisasi 0 0 0 0
45 Stikerr KS 0 0 0 0
46 Leaflet COVID 19 0 0 0 0
40 Banner 0 3 3 3 3 0
0 0 0 0
BMHP 0 0
41 Stick GDS 1 1 2 0 2
42 Cholesterol 1 2 3 0 3
43 Asam Urat 1 1 2 0 2
44 Golongan Darah 0 0 0 0
45 HandSoap 6 6 1 1 5
46 Tissue 2 2 1 1 1
47 SOS 0 0 0 0
48 Wipol 0 0 0 0
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
51 Protein Urine 0 0 0 0
52 HB 0 0 0 0
53 Lanset 200 0 0 0 0
54 Kertas Puyer Besar 3 6 9 3 3 6
55 Plastik Klip Besar 0 0 0 0
56 Plastik Klip Kecil 0 0 0 0
57 Kertas Puyer Kecil 0 1 1 1 1 0
58 Reagen Lab 0 0 0 0
0 0 0 0
APD dan Alkes 0 0 0 0
58 Jas hujan Ponco 0 0 0 0
59 Cover All Suit 0 0 0 0
60 Face Shield 18 18 0 18
61 Masker Bedah 0 0 0 0
62 Masker 95 0 0 0 0
63 Masker Spunbond 0 0 0 0
64 Kacamata google 0 0 0 0
65 Sepatu Booth 0 0 0 0
66 Sarung Tangan Panjang 0 0 0 0
67 Handscoon Steril 0 0 0 0
68 Set APD Lengkap 0 0 0
NIA WIJI LILI WIJI HENI WURI
3
BUKU HARIAN ATK, BMHP BULAN MARET TAHUN 2020
PROPINSI : LAMPUNG
NIA WIJI LILI HENI WURI
STOK STOK TANGGAL
NO NAMA ATK, BMHP AWAL
BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 1 1 2 2 2 0
2 Block Note 8 17 25 7 8 15 10
3 Bolliner BLLH 20 C Blue/Black 1 1 2 1 1 1
4 Buku Folio 100lembar kiky 0 2 2 1 1 2 0
5 Cliper Kertas 5 5 10 2 2 2 2 8 2
9 Kertas Karton 0 20 20 10 10 20 0
10 Kertas Origami 0 3 3 3 3 0
12 Kertas HVS 70gr f4 Sinar Dunia 3 3 5 11 0 11
14 Map Odner Gobi 10 2 12 4 1 5 7
15 Map Sbelhecter plastik 12 12 24 6 6 6 18 6
17 Pena Biasa 3 3 6 1 1 1 3 3
18 Pena Gel tizo ink 1 8 9 2 2 4 5
20 Pensil 9000 2B Faber Castel 2 2 4 0 4
22 Stapler 0310 Deli 0 1 4 5 0 5
23 Spidol Non permanen 0 2 2 1 1 2 0
24 Spidol permanen 2 2 1 1 2 0
25 Tinta Printer Hitam Blue Print 2 2 4 0 4
26 Tinta Printer Warna Blue Print 1 2 3 6 1 2 3 3
27 Tinta Peinter Epson Black 0 0 0 0
29 Tpe Ex 0 3 3 1 1 2
30 Binder Klip No. 111 0 10 10 2 2 2 6 4
31 HVS A4 0 0 0 0
37 Materai 6000 1 28 29 15 10 25 4
38 Materai 3000 0 6 6 1 3 4 2
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 0 2
42 Cholesterol 3 3 0 3
43 Asam Urat 2 2 0 2
45 HandSoap 5 31 36 8 8 16 20
46 Tissue 1 1 0 1
47 SOS 0 31 31 8 8 16 15
48 Wipol 0 0 0 0
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 0 2 2 2 2 0
53 Lanset 200 0 1 1 1 1 0
54 Kertas Puyer Besar 6 6 0 6
57 Kertas Puyer Kecil 0 5 5 0 5
0 0 0 0
59 Jas hujan Ponco 0 60 60 4 4 4 4 4 20 40
60 Cover All Suit 0 0 0 0
61 18 18 4 4 4 12 6
62 Masker Bedah 0 250 250 50 50 50 50 50 250 0
63 Masker 95 0 0 0 0
68 Set APD Lengkap 0 0
HENI WURI LILI TIKA ASTRI
4
BUKU HARIAN ATK, BMHP BULAN APRIL TAHUN 2020
PROPINSI : LAMPUNG
STOK DINKE STOK TANGGAL

BOK JKN
S OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 0 1 2 3 2 2 1
2 Block Note 10 11 21 7 6 13 8
3 Bolliner BLLH 20 C Blue/Black 1 2 3 1 1 1 3 0
5 Cliper Kertas 2 5 7 1 1 1 3 4
7 Kertas NCR 0 3 3 1 1 2
8 Kertas Bufallo 0 2 2 1 1 1
11 Isi Staples kecil 0 1 1 1 1 0
12 Kertas HVS 70gr f4 Sinar Dunia 11 3 14 2 2 1 5 9
13 Map Kertas 5001 Ichimaru 9 10 24 43 12 12 24 19
14 Map Odner Gobi 7 4 12 23 2 4 2 8 15
17 Pena Biasa 3 10 13 2 2 2 6 7
18 Pena Gel tizo ink 5 3 8 1 1 1 3 5
22 Stapler 0310 Deli 5 5 1 1 1 3 2
24 Spidol permanen 0 1 1 0 1
28 Tinta Peinter Epson Color 2 2 0 2
29 Tpe Ex 2 2 1 1 1
30 Binder Klip No. 111 4 4 1 1 3
31 HVS A4 0 5 5 1 1 4
37 Materai 6000 4 4 4 4 0
38 Materai 3000 2 2 2 2 0
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 8 8 8 8 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 1 1 1
43 Asam Urat 2 2 1 1 1
45 HandSoap 20 20 6 6 14
46 Tissue 1 1 1 1 0
47 SOS 15 15 2 2 13
48 Wipol 0 5 5 2 2 3
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 0 0 0 0
53 Lanset 200 0 0 0 0
54 Kertas Puyer Besar 6 6 3 3 3
0 0 0 0
59 Jas hujan Ponco 40 1 41 4 4 4 4 16 25
60 Cover All Suit 0 21 21 0 21
61 Face Shield 6 10 16 4 4 8 8
62 Masker Bedah 0 250 200 727 1,177 150 150 150 150 600 577
63 Masker 95 0 2 2 0 2
65 Kacamata google 0 1 1 0 1
69 Set APD Lengkap 0 1 1 0 1
70 Masker Kain 0 100 100 80
WURI LILI WJI HENI WATI LILI WIJI
5
BUKU HARIAN ATK, BMHP BULAN MEI TAHUN 2020
PROPINSI : LAMPUNG
STOK stok TANGGAL

BOK JKN DINKES
opnam JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
2 Block Note 8 8 2 2 1 1 6 2
4 Buku Folio 100lembar kiky 0 2 4 6 1 1 1 1 4 2
5 Cliper Kertas 4 4 1 1 2 2
6 Buku Kwitansi 100ER 0 0 0 0
8 Kertas Bufallo 1 1 1 1 0
11 Isi Staples kecil 0 1 1 1 1 0
12 Kertas HVS 70gr f4 Sinar Dunia 9 2 5 16 1 3 1 2 7 9
13 Map Kertas 5001 Ichimaru 19 10 29 12 12 24 5
14 Map Odner Gobi 15 4 12 31 5 5 10 21
17 Pena Biasa 7 10 2 19 5 5 5 15 4
18 Pena Gel tizo ink 5 2 7 2 2 2 6 1
20 Pensil 9000 2B Faber Castel 3 1 4 1 1 2 2
22 Stapler 0310 Deli 2 2 0 2
23 Spidol Non permanen 0 2 2 1 1 2 0
24 Spidol permanen 1 2 3 1 1 2 1
27 Tinta Peinter Epson Black 1 1 2 1 1 2 0
29 Tpe Ex 1 1 1 1 0
30 Binder Klip No. 111 3 3 1 1 2 1
31 HVS A4 4 4 1 1 3
32 Verpirator 0 1 1 1 1 0
37 Materai 6000 0 0 0 0
38 Materai 3000 0 0 0 0
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 1 1 1 1 0
43 Asam Urat 1 1 1 1 0
45 HandSoap 14 12 26 6 6 6 18 8
46 Tissue 0 0 0 0
47 SOS 13 12 25 6 6 12 13
48 Wipol 3 3 0 3
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 0 0 0 0
53 Lanset 200 0 0 0 0
0 0 0 0
0 0 0 0
58 Jas hujan Ponco 25 25 4 4 8 17
59 Cover All Suit 21 16 37 4 4 8 29
60 Face Shield 8 18 26 4 4 8 18
61 Masker Bedah 577 500 200 1,277 150 150 150 150 600 677
62 Masker 95 2 2 0 2
68 Set APD Lengkap 1 1 0 1
0 0
LILI wiji ASTRI WURI wiji PENI HENI YETTI
6
BUKU HARIAN ATK, BMHP BULAN JUNI TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 0 1 2 3 1 1 2 1
2 Block Note 2 2 4 1 1 2 2
5 Cliper Kertas 2 2 10 14 2 2 2 2 2 2 12 2
7 Kertas NCR 1 3 4 1 1 2 2
14 Map Odner Gobi 21 4 25 4 2 4 10 15
15 Map Sbelhecter plastik 6 10 120 136 12 12 12 12 12 60 76
18 Pena Gel tizo ink 1 5 6 1 1 1 3 3
20 Pensil 9000 2B Faber Castel 2 5 7 1 2 1 4 3
22 Stapler 0310 Deli 2 2 1 1 1
23 Spidol Non permanen 0 1 1 1 1 0
25 Tinta Printer Hitam Blue Print 4 2 1 7 2 2 5
26 Tinta Printer Warna Blue Print 3 3 1 1 2
28 Tinta Peinter Epson Color 2 3 5 1 1 4
29 Tpe Ex 0 0 0 0
31 HVS A4 3 3 1 1 2
37 Materai 6000 0 0 0 0
38 Materai 3000 0 0 0 0
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 0 2 2 1 1 1
42 Cholesterol 0 2 2 1 1 1
43 Asam Urat 0 2 2 1 1 1
45 HandSoap 8 20 28 8 8 16 12
46 Tissue 0 0 0 0
47 SOS 13 20 33 8 8 16 17
48 Wipol 3 3 0 3
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 0 2 2 1 1 1
53 Lanset 200 0 0 0 0
57 Kertas Puyer Kecil 1 1 0 1
59 Handsanitizer 0 17 17 5 4 9 8
59 Cover All Suit 29 36 65 4 4 4 4 4 20 45
60 Face Shield 18 18 4 4 4 12 6
61 Masker Bedah 677 500 400 1,577 200 200 200 200 200 1,000 577
62 Masker 95 2 63 65 4 4 4 12 53
68 Set APD Lengkap 1 5 6 3 3 3
LILI RDEWI WURI WIJI HENI WIJI
7
BUKU HARIAN ATK, BMHP BULAN JULI TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
2 Block Note 2 2 1 1 2 0
3 Bolliner BLLH 20 C Blue/Black 0 3 3 1 1 2 1
4 Buku Folio 100lembar kiky 2 2 1 1 2 0
5 Cliper Kertas 2 4 6 0 6
12 Kertas HVS 70gr f4 Sinar Dunia 4 5 5 14 3 2 1 2 8 6
14 Map Odner Gobi 15 4 19 6 6 12 7
17 Pena Biasa 4 1 5 2 2 4 1
18 Pena Gel tizo ink 3 3 1 1 2 1
22 Stapler 0310 Deli 1 1 1 1 0
25 Tinta Printer Hitam Blue Print 5 2 7 2 2 5
26 Tinta Printer Warna Blue Print 2 2 1 1 1
29 Tpe Ex 0 0 0 0
31 HVS A4 2 2 1 1 1
37 Materai 6000 0 11 11 5 4 9 2
38 Materai 3000 0 10 10 2 2 4 6
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 1 2 3 1 1 2 1
42 Cholesterol 1 3 4 1 1 2 2
43 Asam Urat 1 2 3 1 1 2 1
45 HandSoap 12 30 42 5 10 10 25 17
46 Tissue 0 0 0 0
47 SOS 17 30 47 5 10 10 25 22
48 Wipol 3 3 0 3
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 1 2 3 1 1 2
53 Lanset 200 0 0 0 0
59 Handsanitizer 8 8 4 4 8 0
59 Cover All Suit 45 45 4 4 4 4 16 29
60 Face Shield 6 6 4 2 6 0
61 Masker Bedah 577 500 1,077 200 200 200 200 800 277
62 Masker 95 53 53 4 4 8 45
WURI LILI HEPMI WIJI HENI YETTI WIJI
8
BUKU HARIAN ATK, BMHP BULAN AGUSTUS TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

NO NAMA ATK, BMHP BOK JKN DINKES JUMLAH SISA
AWAL OPNAM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 0 2 2 4 1 1 2 2
2 Block Note 0 0 0 0
4 Buku Folio 100lembar kiky 0 1 1 1 1 0
5 Cliper Kertas 6 2 8 2 1 1 4 4
8 Kertas Bufallo 0 2 2 1 1 2 0
9 Kertas Karton 0 7 7 2 2 4 3
11 Isi Staples kecil 0 2 2 1 1 2 0
12 Kertas HVS 70gr f4 Sinar Dunia 6 3 9 3 1 1 1 6 3
14 Map Odner Gobi 7 4 12 23 5 5 5 15 8
17 Pena Biasa 1 2 3 1 Q 1 2 1
18 Pena Gel tizo ink 1 1 0 1
22 Stapler 0310 Deli 0 0 0 0
27 Tinta Peinter Epson Black 1 1 2 1 1 2 0
29 Tpe Ex 0 2 2 1 1 2 0
31 HVS A4 1 1 1 1 0
37 Materai 6000 2 2 2 2 0
38 Materai 3000 6 6 0 6
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 1 2 3 1 1 2
43 Asam Urat 1 2 3 1 1 2
44 Golongan Darah 0 1 1 1 1 0
45 HandSoap 17 37 54 5 10 10 25 29
46 Tissue 0 0 0 0
47 SOS 22 37 59 5 10 10 25 34
48 Wipol 3 3 0 3
49 Widal 0 0 0 0
50 PPTS 0 1 1 1 1 0
52 HB 2 2 4 1 1 3
53 Lanset 200 0 0 0 0
58 Reagen Lab 0 10 10 2 2 8
59 Handsanitizer 0 0 0 0
60 Cover All Suit 29 2 31 4 4 4 4 16 15
62 Masker Bedah 277 500 777 200 200 200 150 750 27
63 Masker 95 45 45 4 4 4 4 16 29
WURI HENI LILI WIJI ANDU WIJI
9
BUKU HARIAN ATK, BMHP BULAN SEPTEMBER TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
ATK
5 Cliper Kertas 4 1 5 1 1 2 3
14 Map Odner Gobi 8 2 10 3 4 1 8 2
15 Map Sbelhecter plastik 8 10 18 5 5 13
21 Stapler Kangaro HS-45p 0 1 1 1 1 0
22 Stapler 0310 Deli 0 0 0 0
23 Spidol Non permanen 0 1 2 3 1 1 2 1
24 Spidol permanen 0 0 0 0
26 Tinta Printer Warna Blue Print 5 5 1 1 2 3
29 Tpe Ex 0 1 1 1 1 0
31 HVS A4 0 0 0 0
33 Tinta Stempel 0 1 1 1 1 0
37 Materai 6000 0 30 30 7 7 23
38 Materai 3000 6 7 13 4 4 9
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 4 2 2 2
43 Asam Urat 2 2 4 2 2 2
45 HandSoap 29 37 66 10 5 10 25 41
46 Tissue 0 0 0 0
47 SOS 34 37 71 10 5 10 25 46
48 Wipol 3 3 0 3
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 3 2 5 1 1 4
53 Lanset 200 0 0 0 0
57 Kertas Puyer kecil 1 1 0 1
58 Reagen Lab 8 8 1 1 7
59 handsanitizer 0 30 30 5 2 5 12 18
59 Cover All Suit 15 15 30 4 4 4 4 16 14
61 Masker Bedah 27 500 500 750 1,777 200 200 200 200 800 977
62 Masker 95 29 60 89 4 4 4 4 16 73
LILI WID WURI HENI WIJI WIJI
10
BUKU HARIAN ATK, BMHP BULAN OKTOBER TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 1 1 1 1 0
3 Bolliner BLLH 20 C Blue/Black 2 2 1 1 1
5 Cliper Kertas 3 1 4 1 1 2 2
7 Kertas NCR 3 3 1 1 2 1
13 Map Kertas 5001 Ichimaru 15 13 48 76 12 12 6 12 42 34
14 Map Odner Gobi 2 3 12 17 6 6 12 5
18 Pena Gel tizo ink 4 4 1 1 3
22 Stapler 0310 Deli 0 0 0 0
23 Spidol Non permanen 1 1 1 1 0
28 Tinta Peinter Epson Color 2 3 5 1 1 4
29 Tpe Ex 0 0 0 0
31 HVS A4 0 5 5 1 1 1 3 2
37 Materai 6000 23 23 6 6 12 11
38 Materai 3000 9 9 4 4 5
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 4 2 2 2
43 Asam Urat 2 2 4 1 1 3
45 HandSoap 41 41 5 8 10 23 18
46 Tissue 0 0 0 0
47 SOS 46 46 5 8 10 23 23
48 Wipol 3 3 0 3
49 Widal 0 1 1 1 1 0
50 PPTS 0 0 0 0
52 HB 4 2 6 1 1 5
53 Lanset 200 0 2 2 1 1 1
56 Plastik Klip Kecil 0 10 10 3 3 7
57 Kertas Puyer Kecil 1 10 11 3 3 8
58 Reagen Lab 7 7 1 1 6
59 Handsanitizer 18 9 27 2 5 5 12 15
59 Jas hujan Ponco 17 17 4 4 13
60 Cover All Suit 14 14 4 4 4 12 2
62 Masker Bedah 977 500 1,477 200 200 200 200 800 677
63 Masker 95 73 73 4 4 4 4 16 57
69 Set APD Lengkap 9 9 1 1 1 3 6
LILI WIJI DIAN ASTRI HENI WURI WIJI
11
BUKU HARIAN ATK, BMHP BULAN NOVEMBER TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
ATK
1 Amplop Air Mail 90 80 gr Silic kiky 0 0 0 0
7 Kertas NCR 1 3 4 1 1 2 2
8 Kertas Bufallo 1 3 4 1 1 2 2
9 Kertas Karton 3 3 1 1 1 3 0
14 Map Odner Gobi 5 2 12 19 4 4 4 12 7
17 Pena Biasa 1 5 2 8 1 1 1 3 5
22 Stapler 0310 Deli 0 0 0 0
24 Spidol permanen 0 0 0 0
26 Tinta Printer Warna Blue Print 3 3 1 1 2 1
29 Tpe Ex 0 0 0 0
30 Binder Klip No. 111 1 1 1 1 0
31 HVS A4 2 2 1 1 2 0
37 Materai 6000 11 11 5 5 6
38 Materai 3000 5 5 4 4 1
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 4 2 2 2
43 Asam Urat 3 2 5 2 2 3
45 HandSoap 18 37 55 10 5 10 25 30
46 Tissue 0 0 0 0
47 SOS 23 23 10 5 5 20 3
48 Wipol 3 3 1 1 2 1
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 5 2 7 2 2 5
53 Lanset 200 1 1 1 1 0
56 Plastik Klip Kecil 7 7 2 2 5
58 Reagen Lab 6 6 2 2 4
59 Handsanitizer 15 15 5 2 5 12 3
58 Jas hujan Ponco 13 13 4 4 4 1 13 0
59 Cover All Suit 2 2 2 2 0
61 Masker Bedah 677 500 1,177 200 200 200 200 200 1,000 177
62 Masker 95 57 57 4 4 4 4 4 20 37
LILI ASTRWIJI YETTI HENI TAMA WIJI WURI
12
BUKU HARIAN ATK, BMHP BULAN DESEMBER TAHUN 2020
PROPINSI : LAMPUNG
STOK STOK TANGGAL

BOK JKN DINKES
OPNAM JUMLAH SISA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATK
3 Bolliner BLLH 20 C Blue/Black 1 1 2 0 2
7 Kertas NCR 2 3 5 2 2 1 5 0
13 Map Kertas 5001 Ichimaru 20 15 35 12 6 6 2 6 32 3
14 Map Odner Gobi 7 2 9 6 1 7 2
15 Map Sbelhecter plastik 9 10 12 31 3 6 12 1 6 28 3
17 Pena Biasa 5 5 2 2 4 1
18 Pena Gel tizo ink 3 5 8 1 2 1 4 4
22 Stapler 0310 Deli 0 0 0 0
29 Tpe Ex 0 0 0 0
31 HVS A4 0 0 0 0
35 Catrige Canon 1 1 1 1 0
37 Materai 6000 6 6 2 4 6 0
38 Materai 3000 1 1 1 1 0
41 Bayi 0 0 0 0
43 KB 0 0 0 0
40 Banner 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
41 Stick GDS 2 2 2 2 0
43 Asam Urat 3 3 2 2 1
45 HandSoap 30 37 67 10 10 20 47
46 Tissue 0 0 0 0
47 SOS 3 3 2 1 3 0
48 Wipol 1 1 1 1 0
49 Widal 0 0 0 0
50 PPTS 0 0 0 0
52 HB 5 5 2 2 3
53 Lanset 200 0 0 0 0
56 Plastik Klip Kecil 5 5 2 2 3
58 Reagen Lab 4 4 1 1 3
59 Handsanitizer 3 30 33 5 2 5 5 17 16
61 Cover All Suit 0 70 70 4 4 5 4 4 21 49
62 Face Shield 0 26 26 4 5 4 13 13
63 Masker Bedah 177 500 1,000 1,677 200 200 5 200 200 805 872
64 Masker 95 37 140 177 5 73 78 99
69 Handscoon Steril 0 200 200 5 5 195
71 Clorin 0 2 2 0 2
72 Bayclean 0 15 15
73 Alkohol 90% 0 15 15
74
75
76

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1

LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)

HARGA HARGA PER PENGELU

OBAT DENGAN NAMA DAGANG 0

263 Armovit Kapsul kapsul 30 kapsul/kotak 1,537 46,100 0

Baidullah S.siagian Endang Sulastri Amd.Keb

209 Alat suntik sekali pakai 0,5 ml kotak/

OBAT DENGAN NAMA DAGANG 0 0 0 0 0

Mengetahui/Menyetujui : Yang Menyerahkan

Endang Sulastri Amd.Keb

2016 2015 2014 2016

209 Alat suntik sekali pakai 0,5 ml kotak/

OBAT DENGAN NAMA DAGANG

Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

100 200 100 100 11,200 100 9 Amitriptillin tablet salut 25 mg

900 1,400 700 700 231,000 700 10 Amlodipine Tablet 10 mg

0 0 0 0 0 0 12 Amoksisilin Injeksi serbuk 1000mg

500 500 300 200 77,598 300 13 Amoksisilin kapsul 250 mg

14,000 14,000 7,000 7,000 2,177,000 7,000 14 Amoksisilin kapsul 500 mg

0 0 0 0 0 0 16 Antalgin (Metampiron) tablet 500 mg

0 0 0 0 0 0 22 Antifungi DOEN Kombinasi:

0 0 0 0 0 0 24 Antimigren:Ergotamin Tartrat 1mg +Kofein

3,500 4,000 3,000 1,000 144,000 3,000 30 Asam mefenamat

200 230 50 180 138,780 50 33 Asiklovir tablet 400 mg

0 0 0 0 0 0 34 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial

75 175 100 75 114,000 100 36 Betametason krim 0,1%

0 0 0 0 0 0 37 Budesonid inhaler 200 mcg/puff, 100 dosis

2,500 2,500 1,700 800 49,600 1,700 41 Deksametason tablet 0,5 mg

0 0 0 0 0 0 43 Difenhidramin HCl injeksi 10 mg/ml-1ml

100 100 0 100 14,300 0 44 Digoksin tablet 0,25 mg

50 50 5 45 149,985 5 45 Domperidon suspensi/sirup 5 mg/5ml

0 0 0 0 0 46 Domperidon tetes/ 5 mg/ml

0 0 0 0 0 0 48 Ekstrak Belladon tablet 10 mg

15 15 15 108,300 0 53 Eritromisin sirup 200mg/5ml

100 160 110 50 125,000 110 54 Etanol 70% cairan

0 3 0 3 644,970 0 55 FDC kategori anak

0 2 1 1 359,990 1 56 FDC OAT Kategori I

0 8 0 8 9,599,200 0 57 FDC OAT Kategori II

0 0 0 0 0 0 58 Fenitoin Natrium injeksi 50 mg/ml

0 0 0 0 0 0 59 Fenitoin Natrium Kapsul 100 mg

0 0 0 0 0 0 60 Fenobarbital Injeksi i.m/i.v 50 mg/ml

0 0 0 0 0 0 61 Fenobarbital tablet 100 mg

0 0 0 0 0 0 62 Fenol Gliserol tetes telinga 10% (Karbogliserin

0 0 0 0 0 0 65 Fitomenadion (Vit.K1)tab salut gula 10 mg

0 0 0 0 0 0 66 Furosemid inj 40 mg/ml

0 0 0 0 0 0 72 Gentian Violet larutan 1 %

1,400 1,400 500 900 50,400 500 73 Glibenklamid tablet 5 mg

800 800 300 500 218,000 300 74 Glimepiride tablet 2 mg

0 0 0 0 0 0 78 Glukosa larutan infus 10% steril (Produk lokal)

0 0 0 0 0 0 79 Glukosa larutan infus 40% steril (Produk lokal)

0 0 0 0 0 0 82 Haloperidol inj 50 mg/ml (haldol decanoas)

0 1,300 500 800 42,016 500 83 Haloperidol tablet 0,5 mg

0 1,300 500 800 66,064 500 84 Haloperidol tablet 1,5 mg

96 96 66 30 83,940 66 86 Hidrokortison krim 2,5%

0 0 0 0 0 0 87 Ibuprofen sirup 100mg / 5ml

0 0 0 0 0 0 88 Ibuprofen suspensi 200mg / 5ml

0 2,600 1,700 900 63,000 1,700 92 Kalsium Laktat tab 500 mg

600 600 300 300 18,600 300 93 Kaptopril tablet 12,5 mg

600 600 300 300 25,200 300 94 Kaptopril tablet 25 mg

100 100 0 100 24,300 0 95 Karbamazepin tablet 200 mg

20 20 10 10 47,000 10 97 Ketokonazol krim 2%

0 0 0 0 0 0 98 Ketoprofen tablet 100 mg

80 80 20 60 138,000 20 102 Ketorolak inj 30 mg

0 0 0 0 0 0 103 Klindamisin 150 mg