PEMERINTAH KABUPATEN BANDUNG

DINAS KESEHATAN
PUSKESMAS SOREANG
Jln. Raya Soreang – Banjaran KM 3 Kode Pos 40971 Telepon (022) – 589 7420
Email : pusksoreang_bandungkab@yahoo.com

BERITA ACARA STOCK OPNAME PERSEDIAAN PUSKESMAS SOREANG

PER 31 JANUARI 2020
NOMOR : 027 / / II / 2020

Pada Hari ini Senin Tanggal 3 Februari 2020, telah melaksanakan stock opname Persediaan
Pada Puskesmas Soreang

1.    Nama : dr. Dewi Syafitri

Nip : 19711003 200904 2 001
Jabatan : Kepala Puskesmas Soreang
2.    Nama : Fitri Kasari
Nip : 19810220 200604 2 009
Jabatan : Pembantu Pengurus Barang

No Uraian Jumlah (Rp)

Persediaan Obat BLUD Rp 80,140,526.52

1. Persediaan Obat APBD Rp 29,292,294.00

Persediaan Obat APBN Rp 39,796,386.00

Total Obat-Obatan Rp 149,229,206.52

Persediaan BMHP BLUD Rp 23,254,994.00

2. Persediaan BMHP APBD Rp 9,369,459.00

Persediaan BMHP APBN Rp 2,171,940.00

Total BMHP Rp 34,796,393.00

3. Persediaan Cetakan BLUD Rp 52,938,600.00

Persediaan Cetakan APBD Rp 574,316.82

Persediaan Cetakan APBN Rp -

Total Cetakan Rp 53,512,916.82

4. Persediaan Alat Tulis Kantor (ATK) Rp 24,617,890.00

Total Persediaan Rp 262,156,406.34

Demikian berita acara stock opname persediaan ini di buat dengan sebenarnya untuk dapat
dipergunakan sebagaimana mestinya.
 Soreang, 3 Februari 2020

Kepala Puskesmas Soreang Pembantu Pengurus Barang

dr. Dewi Syafitri Fitri Kasari

Nip 19711003 200904 2 001 Nip 19810220 200604 2 009
20
LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : OBAT
SUMBER : BLUD

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
Tahun Satuan TA. 2019)
NO Nama Barang/Jenis Barang Merk/Type
Pengadaan Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang
1 2 3 4 5 6 7 8 9 10 11 12(6+9) 13(8+11) 14 15 16 17(12-14)
1 Ambroxol Syr 2019 Botol 433 2,999.70 1,298,870.10 2,999.70 - 433 1,298,870.10 58 2,999.70 173,982.60 375
2 Amlodipin 5 2019 Tablet 15,000 144.06 2,160,900.00 144.06 - 15,000 2,160,900.00 144.06 - 15,000
3 Amoxicillin syr 125mg/5ml 2018 Botol 397 2,700.50 1,072,098.50 2,700.50 - 397 1,072,098.50 35 2,700.50 94,517.50 362
4 Asam Asetil salisilat Gramasal 2019 Tablet 5,000 232.89 1,164,450.00 232.89 - 5,000 1,164,450.00 232.89 - 5,000
5 Asam Folat 2017 Tablet 100 67.00 6,700.00 67.00 - 100 6,700.00 67.00 - 100
6 Asam Mefenamat 2019 Tablet 9,402 303.60 2,854,447.20 303.60 - 9,402 2,854,447.20 1,168 303.60 354,604.80 8,234
7 Asiklovir SK 2017 Tube 287 3,055.00 876,785.00 3,055.00 - 287 876,785.00 15 3,055.00 45,825.00 272
8 Dexametason 2020 Teblet - - - 7,500 66.00 495,000.00 7,500 495,000.00 1,012 66.00 66,792.00 6,488
9 Digoxin Fargoxin 2019 Tablet 96 221.78 21,290.88 221.78 - 96 21,290.88 221.78 - 96
10 Fenol Gliserol 2019 Botol 100 4,440.70 444,070.00 4,440.70 - 100 444,070.00 4,440.70 - 100
11 Gentamisin Salep Kulit Genalten 2019 Tube 770 3,378.50 2,601,445.00 3,378.50 - 770 2,601,445.00 45 3,378.50 152,032.50 725
12 Glibenclamide 2016 Tablet 4,145 92.40 382,998.00 92.40 - 4,145 382,998.00 324 92.40 29,937.60 3,821
13 Gliseril Guaikolat 2016 Tablet 24,286 108.00 2,622,839.43 108.00 - 24,286 2,622,839.43 1,996 108.00 215,564.01 22,290
14 Ibuprofen 2019 Tablet 2,242 226.99 508,911.58 226.99 - 2,242 508,911.58 980 226.99 222,450.20 1,262
15 Isoniazide 2019 Tablet 4,000 142.56 570,240.00 142.56 - 4,000 570,240.00 142.56 - 4,000
16 Isosorbid Dinitrat 2019 Tablet 1,926 107.45 206,948.70 107.45 - 1,926 206,948.70 66 107.45 7,091.70 1,860
17 Ketokonazole 2019 Tablet 975 468.07 456,368.25 468.07 - 975 456,368.25 48 468.07 22,467.36 927
18 Kloramfenicol Tetes Telinga Erlamicetin 2019 Botol 213 6,871.70 1,463,672.10 6,871.70 - 213 1,463,672.10 19 6,871.70 130,562.30 194
19 Metronidazole Erbifin 2019 Tablet 9,464 300.96 2,848,285.44 300.96 - 9,464 2,848,285.44 860 300.96 258,825.60 8,604
20 Nifedipine Farmalat 2019 Tablet 816 318.32 259,749.12 318.32 - 816 259,749.12 32 318.32 10,186.24 784
21 Obat Antidiare non spesifik Kaotin 2019 Botol 30 1,119.07 33,572.10 1,119.07 - 30 33,572.10 3 1,119.07 3,357.21 27
22 Obat Batuk Hitam 2019 Botol 929 4,349.40 4,040,592.60 4,349.40 - 929 4,040,592.60 91 4,349.40 395,795.40 838
23 Obat Flu Syrup Pramolta 2019 Botol 790 3,818.00 3,016,220.00 3,818.00 - 790 3,016,220.00 146 3,818.00 557,428.00 644
24 Obat Flu Tablet Flutamol 2019 Kaplet 29,978 330.00 9,892,740.00 330.00 - 29,978 9,892,740.00 2,118 330.00 698,940.00 27,860
25 Paracetamol 2019 Tablet 50,000 132.00 6,600,000.00 132.00 - 50,000 6,600,000.00 132.00 - 50,000
26 Piroxicam 2019 Tablet 10,852 95.04 1,031,374.08 95.04 - 10,852 1,031,374.08 95.04 - 10,852
27 Prednison 2019 Tablet 3,164 155.41 491,717.24 155.41 - 3,164 491,717.24 155.41 - 3,164
28 Salbutamol Nebulizer Ventolin 2019 Ampul 60 10,381.14 622,868.40 10,381.14 - 60 622,868.40 10,381.14 - 60
29 Salep Luka Bakar Neosenta 2017 Tube 5 10,692.00 53,460.00 10,692.00 - 5 53,460.00 1 10,692.00 10,692.00 4
30 Permentin Medscab 2018 Tube 70 58,905.00 4,123,350.00 58,905.00 - 70 4,123,350.00 18 58,905.00 1,060,290.00 52
31 Kalium Diklofenak Erphaflam 2019 Tablet 1,592 283.58 451,459.36 283.58 - 1,592 451,459.36 92 283.58 26,089.36 1,500
32 Lidocain Injeksi 2017 Ampul 80 1,111.00 88,880.00 1,111.00 - 80 88,880.00 1,111.00 - 80
33 Obat Batuk Kering Dexyl 2019 Botol 236 4,087.60 964,673.60 4,087.60 - 236 964,673.60 3 4,087.60 12,262.80 233
34 Ambroxol Tab 2017 Tablet 3,128 143.68 449,437.30 143.68 - 3,128 449,437.30 362 143.68 52,012.88 2,766
35 Cefixime 2019 Kapsul 440 995.00 437,800.00 995.00 - 440 437,800.00 52 995.00 51,740.00 388
36 Ciprofloxasin 2017 Tablet 3,604 300.00 1,081,200.00 300.00 - 3,604 1,081,200.00 640 300.00 192,000.00 2,964
37 Vitamin syrup Etacurvita 2019 Botol 184 184.00 33,856.00 184.00 - 184 33,856.00 34 184.00 6,256.00 150
38 Kloramfenicol syrup Hufamicetin 2019 Botol 100 7,551.50 755,150.00 7,551.50 - 100 755,150.00 7,551.50 - 100
39 Gemfibrozile 2018 Kapsul 2,222 367.54 816,673.88 367.54 - 2,222 816,673.88 258 367.54 94,825.32 1,964
40 Glimepirid 2019 Tablet 10,000 264.00 2,640,000.00 264.00 - 10,000 2,640,000.00 264.00 - 10,000
41 Betahistin Histigen 2019 Tablet 1,795 572.00 1,026,740.00 572.00 - 1,795 1,026,740.00 397 572.00 227,084.00 1,398
42 Metronidazole syr Farizol 2019 Botol 33 5,100.70 168,323.10 5,100.70 - 33 168,323.10 8 5,100.70 40,805.60 25
43 Klindamicin 300 Dacin 2017 Kapsul 445 1,467.00 652,815.00 1,467.00 - 445 652,815.00 1,467.00 - 445
44 Bisacodil Laxana 2017 Tablet 141 266.00 37,506.00 266.00 - 141 37,506.00 24 266.00 6,384.00 117
45 Klindamisin 150 2017 Kapsul 1,200 702.24 842,688.00 702.24 - 1,200 842,688.00 400 702.24 280,896.00 800
46 Genta-Beta Salep Kulit Skillone 2019 Tube 879 9,001.30 7,912,142.70 9,001.30 - 879 7,912,142.70 76 9,001.30 684,098.80 803
47 Multivitamin syaraf Corsaneuron 2019 Tablet 3,484 590.37 2,056,849.08 590.37 - 3,484 2,056,849.08 1,092 590.37 644,684.04 2,392
48 Parasetamol drop Turpan 2019 Botol 711 8,280.80 5,887,648.80 8,280.80 - 711 5,887,648.80 28 8,280.80 231,862.40 683
49 Parasetamol 100 2017 Tablet 3,497 68.88 240,873.36 68.88 - 3,497 240,873.36 400 68.88 27,552.00 3,097
50 Gentian Violet 2017 Botol 256 5,662.00 1,449,472.00 5,662.00 - 256 1,449,472.00 4 5,662.00 22,648.00 252
51 Tambalan Sementara Ceivitron 2019 Botol 7 74,250.00 519,750.00 74,250.00 - 7 519,750.00 3 74,250.00 222,750.00 4
52 Tambalan Tetap Shofu 2019 Botol 9 594,000.00 5,346,000.00 594,000.00 - 9 5,346,000.00 7 594,000.00 4,158,000.00 2
53 Doksisiklin 2018 Tablet 113 370.00 41,810.00 370.00 - 113 41,810.00 370.00 - 113
54 Cetrizine Syr 2019 Botol 161 358.36 57,695.96 358.36 - 161 57,695.96 8 358.36 2,866.88 153
55 Domperidon Syr 2018 Botol 216 3,400.00 734,400.00 3,400.00 - 216 734,400.00 16 3,400.00 54,400.00 200
56 Acarbose 100 2019 Tablet 1,849 779.00 1,440,371.00 779.00 - 1,849 1,440,371.00 1,809 779.00 1,409,211.00 40
57 Tiamfenicol 500 2019 Tablet 4,450 867.91 3,862,199.50 867.91 - 4,450 3,862,199.50 223 867.91 193,543.93 4,227
58 Eritromisin 500 2019 Tablet 6 770.00 4,620.00 770.00 - 6 4,620.00 770.00 - 6
59 Loratadin 2020 Tablet - - - 4,000 290.99 1,163,960.00 4,000 1,163,960.00 320 290.99 93,116.80 3,680

TOTAL OBAT BLUD 91,727,998.35 1,658,960.00 93,386,958.35 13,246,431.83

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001
 Sisa Barang

Harga Satuan Jumlah Harga

17 18
2,999.70 1,124,887.50 -
144.06 2,160,900.00 -
2,700.50 977,581.00 -
232.89 1,164,450.00 -
67.00 6,700.00 -
303.60 2,499,842.40 -
3,055.00 830,960.00 -
66.00 428,208.00 -
221.78 21,290.88 -
4,440.70 444,070.00 -
3,378.50 2,449,412.50 -
92.40 353,060.40 -
108.00 2,407,275.42 -
226.99 286,461.38 -
142.56 570,240.00 -
107.45 199,857.00 -
468.07 433,900.89 -
6,871.70 1,333,109.80 -
300.96 2,589,459.84 -
318.32 249,562.88 -
1,119.07 30,214.89 -
4,349.40 3,644,797.20 -
3,818.00 2,458,792.00 -
330.00 9,193,800.00 -
132.00 6,600,000.00 -
95.04 1,031,374.08 -
155.41 491,717.24 -
10,381.14 622,868.40 -
10,692.00 42,768.00 -
58,905.00 3,063,060.00 -
283.58 425,370.00 -
1,111.00 88,880.00 -
4,087.60 952,410.80 -
143.68 397,424.41 -
995.00 386,060.00 -
300.00 889,200.00 -
184.00 27,600.00 -
7,551.50 755,150.00 -
367.54 721,848.56 -
264.00 2,640,000.00 -
572.00 799,656.00 -
5,100.70 127,517.50 -
1,467.00 652,815.00 -
266.00 31,122.00 -
 702.24 561,792.00 -
9,001.30 7,228,043.90 -
590.37 1,412,165.04 -
8,280.80 5,655,786.40 -
68.88 213,321.36 -
5,662.00 1,426,824.00 -
74,250.00 297,000.00 -
594,000.00 1,188,000.00 -
370.00 41,810.00 -
358.36 54,829.08 -
3,400.00 680,000.00 -
779.00 31,160.00 -
867.91 3,668,655.57 -
770.00 4,620.00 -
290.99 1,070,843.20 -
-
-
80,140,526.52 -
LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : OBAT
SUMBER : APBD

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan
Merk/T Satuan TA. 2019)
NO Nama Barang/Jenis Barang Tahun Pengadaan
ype Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang

1 2 3 4 5 6 7 8 9 10 11 12(6+9)
1 Alopurinol tablet 100 mg APBD (DAK) 2019 tablet 2,135 99.00 211,365.00 99.00 - 2,135
2 Amitriptilin tablet 25 mg APBD (DAK) 2018 tablet - 167.00 - 167.00 - -
3 Amlodipine Tab 10 mg APBD 2019 tablet 8,528 93.00 793,104.00 93.00 - 8,528
4 Amlodipine Tab 5 mg APBD 2019 tablet 14,400 70.00 1,008,000.00 70.00 - 14,400
5 Amoksisilin kaplet 500 mg APBD 2019 tablet 6,569 233.00 1,530,577.00 233.00 - 6,569
6 Amoksisilin kapsul 250 mg APBD (DAK) 2019 kapsul 2,392 196.00 468,832.00 196.00 - 2,392
Amoksisilin Sirup Forte 250 mg
7 APBD (DAK) 2019 botol 397 3,628.00 1,440,316.00 3,628.00 - 397
/ 5 ml
8 Antasida DOEN suspensi APBD (DAK) 2019 botol 281 1,995.00 560,595.00 1,995.00 - 281
9 Antasida DOEN tablet APBD (DAK) 2019 tablet 6,318 54.00 341,172.00 54.00 - 6,318
10 Antifungi Doen APBD (DAK) 2019 pot 19 4,496.00 85,424.00 4,496.00 - 19
11 Antihemoroid Supp APBD (DAK) 2019 supp 25 3,167.00 79,175.00 3,167.00 - 25
Aquabidest (Aqua Pro Inject) 20
12 APBD (DAK) 2019 vial 20 2,449.00 48,980.00 2,449.00 - 20
ml
Asam Asetil Salisilat (Asetosal)
13 APBD (DAK) 2019 tablet 6,200 105.00 651,000.00 105.00 - 6,200
Tablet 80 mg (Vit. C) tablet
Asam Askorbat
14 APBD (DAK) 2019 tablet 8,573 105.00 900,165.00 105.00 - 8,573
50 mg
15 Asiklovir tablet 400 mg ABPD (DAK) 2019 tablet 1,552 380.00 589,760.00 380.00 - 1,552
16 Azitromisin tablet 500 mg APBD 2019 tablet 45 1,778.00 80,010.00 1,778.00 - 45
17 Bedak Salisil APBD 2019 kotak 11 4,510.00 49,610.00 4,510.00 - 11
18 Betametason krim 0.1 % APBD (DAK) 2019 tube 221 1,340.00 296,140.00 1,340.00 - 221
19 Diazepam Injeksi 5 mg/ml APBD (DAK) 2019 ampul 5 1,735.00 8,675.00 1,735.00 - 5
20 Diazepam Rectal 5 mg APBD (DAK) 2019 Supp 5 12,573.00 62,865.00 12,573.00 - 5
21 Diazepam tablet 2 mg APBD 2019 tablet - 86.00 - 86.00 - -
22 Domperidon 10 mg APBD 2019 tablet 1,321 91.00 120,211.00 91.00 - 1,321
Domperidon suspensi 5 mg / 5
23 APBD (DAK) 2019 btl 100 2,700.00 270,000.00 2,700.00 - 100
ml
Epinefrin HCl injeksi 0,1% - 1
24 APBD 2017 ampul 30 1,749.00 52,470.00 1,749.00 - 30
ml
25 Ergotamin Kofein tab APBD 2018 tablet 812 173.00 140,476.00 173.00 - 812
26 Etanol larutan 70 % - 1000 ml APBD 2019 botol 7 18,700.00 130,900.00 18,700.00 - 7
27 Etanol larutan 70 % - 300 ml APBD 2019 botol 7 6,820.00 47,740.00 6,820.00 - 7
28 Etakridin APBD 2019 Botol - 0.00 - 23 3,000.00 69,000.00 23
29 Eugenol 10 ml APBD (DAK) 2019 btl - 20,087.00 - 20,087.00 - -
30 Fenobarbital tablet 30 mg APBD (DAK) 2019 tablet - 171.00 - 171.00 - -
31 Fenoksimeil Penicillin 500 APBD 2019 - - - -
Fenol Gliserol 10% Tetes
32 APBD 2019 botol 120 2,764.00 331,680.00 2,764.00 - 120
Telinga
Fitomenadion ( Vit K) injeksi 2
33 APBD 2019 ampul 14 3,682.00 51,548.00 3,682.00 - 14
mg/ml
Fitomenadion (Vit. K) tablet 10
34 APBD (DAK) 2019 tablet 136 710.00 96,560.00 200 710.00 142,000.00 336
mg
35 Furosemid 40 mg APBD (DAK) 2019 tablet 74 77.00 5,698.00 1,000 77.00 77,000.00 1,074
36 Garam Oralit APBD 2019 sase 1,046 257.00 268,822.00 257.00 - 1,046
37 Gentamisin salep mata APBD (DAK) 2019 tube 231 2,675.00 617,925.00 2,675.00 - 231
38 Gentamisin tetes mata APBD 2018 tube 136 4,232.00 575,552.00 240 4,232.00 1,015,680.00 376
39 Glibenclamide 5 mg tablet APBD (DAK) 2019 tablet 3,000 119.00 357,000.00 119.00 - 3,000
40 Glimepirid 2 mg APBD 2019 tablet 1,000 207.00 207,000.00 207.00 - 1,000
41 Haloperidol tablet 1.5 mg APBD (DAK) 2019 tablet 260 59.00 15,340.00 500 59.00 29,500.00 760
42 Haloperidol tablet 5 mg APBD (DAK) 2019 tablet 321 56.00 17,976.00 56.00 - 321
43 Hidroklortiazid tablet 25 mg APBD (DAK) 2019 tablet 42 155.00 6,510.00 1,000 155.00 155,000.00 1,042
44 Hidrokortison krim 2,5% APBD (DAK) 2019 tube - 2,475.00 - 120 2,475.00 297,000.00 120
Ibuprofen Suspensi 200 mg/ 5
45 APBD 2018 botol 433 4,465.00 1,933,345.00 4,465.00 - 433
ml 60 ml
46 Kalsium lactat 500 mg APBD (DAK) 2019 tablet 2,722 59.00 160,598.00 59.00 - 2,722
47 Kaptopril tablet 12.5 mg APBD (DAK) 2019 tablet 1,895 66.00 125,070.00 66.00 - 1,895
Kaptopril tablet 12.5 mg APBD (DAK) 2019 tablet 6,200 62.00 384,400.00 6,200
48 Kaptopril tablet 25 mg APBD 2018 tablet - 75.00 - 75.00 - -
49 Karbamazepin 200 mg tablet APBD (DAK) 2019 tablet 310 230.00 71,300.00 230.00 - 310
50 Klindamisin kapsul 150 mg APBD (DAK) 2019 kapsul 800 759.00 607,200.00 759.00 - 800
51 Kloramfenikol 1% Salep Mata APBD (DAK) 2019 tube 96 1,881.00 180,576.00 1,881.00 - 96
Kloramfenikol 2% Salep Kulit
52 APBD 2019 tube 237 3,038.00 720,006.00 3,038.00 - 237
(Bufacetin)
 Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan
Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan
Merk/T Satuan TA. 2019)
NO Nama Barang/Jenis Barang Tahun Pengadaan
ype Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang

1 2 3 4 5 6 7 8 9 10 11 12(6+9)
Klorfeniramin maleat (CTM)
53 APBD (DAK) 2019 tablet 5,880 23.00 135,240.00 23.00 - 5,880
tablet 4 mg
54 Klorpromazin 100 mg APBD (DAK) 2019 tablet 623 157.00 97,811.00 157.00 - 623
Kotrimoksazol susp. 120 mg/5
55 APBD (DAK) 2019 botol - 2,052.00 - 2,052.00 - -
ml - 60ml
56 Kotrimosazol tablet 480 mg APBD (DAK) 2019 tablet 3,770 125.00 471,250.00 125.00 - 3,770
57 Lidocain komp. injeksi 2 % - ml APBD 2019 ampul - 1,229.00 - 90 1,229.00 110,610.00 90
Magnesium sulfat injeksi 40% -
58 APBD (DAK) 2019 vial - 3,796.00 - 3,796.00 - -
25 ml
59 Metformin tablet 500 mg APBD 2019 tablet 8,756 96.00 840,576.00 96.00 - 8,756
Metformin tablet 500 mg APBD 2019 10,000 102.00 1,020,000.00 10,000
Metilergometrin maleat
60 APBD (DAK) 2019 tablet 294 210.00 61,740.00 210.00 - 294
(Metergin) tabletmaleat
Metilergometrin salut 0,125 mg
injeksi
61 APBD 2019 ampul 100 2,959.00 295,900.00 2,959.00 - 100
0,2 mg/ml
62 Metoklorpramid 10 mg tablet APBD (DAK) 2019 tablet - 85.00 - 85.00 - -
63 Mikonazol krim 2% APBD (DAK) 2019 tube 139 3,414.00 474,546.00 72 3,414.00 245,808.00 211
64 Multivitamin Tablet (Vit Ever) APBD 2019 tablet - 990.00 - 990.00 - -
65 Natrium Diklofenak 50 mg APBD 2019 Tablet 6,918 123.00 850,914.00 123.00 - 6,918
Natrium Klorida larutan infus
66 APBD 2017 botol 1 4,700.00 4,700.00 20 4,700.00 94,000.00 21
0,9% - 500 ml (Attapulgite 600
New Antidest
67 APBD (DAK) 2019 tablet 2,940 145.00 426,300.00 145.00 - 2,940
mg)
68 Nistatin tablet 500.000 IU APBD 2019 tablet
tablet 162 843.00 136,566.00 843.00 - 162
Nistatin tablet vaginal 100.000
69 APBD (DAK) 2019 vaginal 49 560.00 27,440.00 100 560.00 56,000.00 149
IU
70 Oksitosin injeksi 10 IU/ml APBD 2019 ampul 100 1,199.00 119,900.00 1,199.00 - 100
71 Omeprazol 20 mg tab APBD (DAK) 2019 kapsul 2,902 139.00 403,378.00 139.00 - 2,902
72 Parasetamol sirup 120 mg/ 5 ml APBD (DAK) 2019 botol 410 1,107.00 453,870.00 1,107.00 - 410
73 Parasetamol tablet 500 mg APBD (DAK) 2019 tablet 20,000 113.30 2,266,000.00 113.30 - 20,000
74 Phenobarbital (Luminal) 30 mg APBD (DAK) 2019 tablet - 171.00 - 500 171.00 85,500.00 500
75 Piridoksin 10 mg tablet APBD (DAK) 2019 tablet 6,846 123.00 842,058.00 123.00 - 6,846
Povidon iodida 10% larutan - 30
76 APBD 2019 botol 10 2,900.00 29,000.00 2,900.00 - 10
ml
Povidon iodida 10% larutan -
77 APBD 2019 botol 4 18,000.00 72,000.00 18,000.00 - 4
300 ml
78 Prednison 5mg APBD (DAK) 2019 tablet 2,000 73.00 146,000.00 73.00 - 2,000
79 Propanolol tablet 10 mg APBD (DAK) 2018 tablet 100 54.00 5,400.00 54.00 - 100
80 Ranitidine tablet 150 mg APBD (DAK) 2019 tablet - 112.00 - 112.00 - -
81 Retinol kapsul lunak 100.000 IU APBD (DAK) 2019 kapsul 288.00 - 288.00 - -
82 Retinol kapsul lunak 200.000 IU APBD (DAK) 2019 kapsul 517.00 - 517.00 - -
Ringer Laktat larutan infus -
83 APBD (DAK) 2019 botol 20 7,150.00 143,000.00 7,150.00 - 20
500 ml
84 Rivanol 0,1% 300 ml APBD 2019 botol 23 3,000.00 69,000.00 3,000.00 - 23
85 Salbutamol 2 mg tablet APBD 2019 tablet - 67.00 - 500 67.00 33,500.00 500
86 Salbutamol 4 mg tablet APBD (DAK) 2018 tablet 700 70.00 49,000.00 1,000 70.00 70,000.00 1,700
Salbutamol Nebules 2,5mg
87 Salep 2-4 kombinasi : Asam APBD (DAK) 2019 ampul 60 4,550.00 273,000.00 4,550.00 - 60
(Combivent)
88 Salisilat 2% + Belerang endap APBD (DAK) 2019 pot 286 2,621.00 749,606.00 2,621.00 - 286
Scabimite Cream (Premetrin 5%
4%
89 APBD 2018 tube 60 11,825.00 709,500.00 11,825.00 - 60
krim)
Sianokobalamin (Vit. B12) 50
90 APBD (DAK) 2019 tablet 472 1,104.00 521,088.00 1,104.00 - 472
mcg
91 Simvastatin tablet 10 mg APBD (DAK) 2019 tablet 7,646 110.00 841,060.00 110.00 - 7,646
92 Softanol 5 Liter APBD 2019 botol 2 550,000.00 1,100,000.00 550,000.00 - 2
93 Softanol 500 ML APBD 2019 botol 55,000.00 - 55,000.00 - -
94 Tetrasiklin 500 mg kapsul APBD (DAK) 2019 kapsul 10 303.00 3,030.00 303.00 - 10
95 Thiamin Hcl (Vit B1) APBD (DAK) 2019 tablet 7,366 91.00 670,306.00 91.00 - 7,366
Trihexifenidril Hidroksida tablet
96 APBD (DAK) 2019 tablet 460 91.00 41,860.00 500 91.00 45,500.00 960
2 mg
97 Viorex 2% 5 Liter APBD 2019 botol 2 554,400.00 1,108,800.00 554,400.00 - 2
98 Viorex 2% 500 Ml APBD 2019 botol 67,650.00 - 67,650.00 - -
99 Vitamin B Kompleks tablet APBD (DAK) 2019 tablet 8,103 89.00 721,167.00 89.00 - 8,103
 Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan
Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan
Merk/T Satuan TA. 2019)
NO Nama Barang/Jenis Barang Tahun Pengadaan
ype Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang

1 2 3 4 5 6 7 8 9 10 11 12(6+9)
100 Zink Syr 60ml APBD (DAK) 2019 botol - 3,171.00 - 3,171.00 - -
101 Zink tablet 200 mg dispersible APBD 2019 tablet 2,009 524.00 1,052,716.00 524.00 - 2,009

TOTAL OBAT APBD 32,530,990.00 3,930,498.00

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001
ah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang

Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga

13(8+11) 14 15 16 17(12-14) 17 18
211,365.00 498 99.00 49,302.00 1,637 99.00 162,063.00
- 167.00 - - 167.00 -
793,104.00 2,736 93.00 254,448.00 5,792 93.00 538,656.00
1,008,000.00 2,768 70.00 193,760.00 11,632 70.00 814,240.00
1,530,577.00 451 233.00 105,083.00 6,118 233.00 1,425,494.00
468,832.00 380 196.00 74,480.00 2,012 196.00 394,352.00
1,440,316.00 55 3,628.00 199,540.00 342 3,628.00 1,240,776.00
560,595.00 123 1,995.00 245,385.00 158 1,995.00 315,210.00
341,172.00 1,996 54.00 107,784.00 4,322 54.00 233,388.00
85,424.00 4,496.00 - 19 4,496.00 85,424.00
79,175.00 25 3,167.00 79,175.00 - 3,167.00 -
48,980.00 2,449.00 - 20 2,449.00 48,980.00
651,000.00 184 105.00 19,320.00 6,016 105.00 631,680.00
900,165.00 1,027 105.00 107,835.00 7,546 105.00 792,330.00
589,760.00 380.00 - 1,552 380.00 589,760.00
80,010.00 4 1,778.00 7,112.00 41 1,778.00 72,898.00
49,610.00 11 4,510.00 49,610.00 - 4,510.00 -
296,140.00 72 1,340.00 96,480.00 149 1,340.00 199,660.00
8,675.00 1,735.00 - 5 1,735.00 8,675.00
62,865.00 12,573.00 - 5 12,573.00 62,865.00
- 86.00 - - 86.00 -
120,211.00 100 91.00 9,100.00 1,221 91.00 111,111.00
270,000.00 2,700.00 - 100 2,700.00 270,000.00
52,470.00 30 1,749.00 52,470.00 - 1,749.00 -
140,476.00 114 173.00 19,722.00 698 173.00 120,754.00
130,900.00 18,700.00 - 7 18,700.00 130,900.00
47,740.00 1 6,820.00 6,820.00 6 6,820.00 40,920.00
69,000.00 - 3,000.00 - 23 3,000.00 69,000.00
- 20,087.00 - - 20,087.00 -
- 171.00 - - 171.00 -
- - -
331,680.00 2,764.00 - 120 2,764.00 331,680.00
51,548.00 3,682.00 - 14 3,682.00 51,548.00
238,560.00 38 710.00 26,980.00 298 710.00 211,580.00
82,698.00 63 77.00 4,851.00 1,011 77.00 77,847.00
268,822.00 451 257.00 115,907.00 595 257.00 152,915.00
617,925.00 19 2,675.00 50,825.00 212 2,675.00 567,100.00
1,591,232.00 54 4,232.00 228,528.00 322 4,232.00 1,362,704.00
357,000.00 119.00 - 3,000 119.00 357,000.00
207,000.00 170 207.00 35,190.00 830 207.00 171,810.00
44,840.00 166 59.00 9,794.00 594 59.00 35,046.00
17,976.00 230 56.00 12,880.00 91 56.00 5,096.00
161,510.00 306 155.00 47,430.00 736 155.00 114,080.00
297,000.00 2,475.00 - 120 2,475.00 297,000.00
1,933,345.00 433 4,465.00 1,933,345.00 - 4,465.00 -
160,598.00 620 59.00 36,580.00 2,102 59.00 124,018.00
125,070.00 1,895 66.00 125,070.00 - 66.00 -
384,400.00 294 62.00 18,228.00 5,906 62.00 366,172.00
- 75.00 - - 75.00 -
71,300.00 170 230.00 39,100.00 140 230.00 32,200.00
607,200.00 759.00 - 800 759.00 607,200.00
180,576.00 1,881.00 - 96 1,881.00 180,576.00
720,006.00 3,038.00 - 237 3,038.00 720,006.00
ah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang

Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga

13(8+11) 14 15 16 17(12-14) 17 18
135,240.00 874 23.00 20,102.00 5,006 23.00 115,138.00
97,811.00 145 157.00 22,765.00 478 157.00 75,046.00
- 2,052.00 - - 2,052.00 -
471,250.00 1,200 125.00 150,000.00 2,570 125.00 321,250.00
110,610.00 20 1,229.00 24,580.00 70 1,229.00 86,030.00
- 3,796.00 - - 3,796.00 -
840,576.00 5,760 96.00 552,960.00 2,996 96.00 287,616.00
1,020,000.00 102.00 - 10,000 102.00 1,020,000.00
61,740.00 210.00 - 294 210.00 61,740.00
295,900.00 100 2,959.00 295,900.00 - 2,959.00 -
- 85.00 - - 85.00 -
720,354.00 13 3,414.00 44,382.00 198 3,414.00 675,972.00
- 990.00 - - 990.00 -
850,914.00 2,052 123.00 252,396.00 4,866 123.00 598,518.00
98,700.00 4,700.00 - 21 4,700.00 98,700.00
426,300.00 254 145.00 36,830.00 2,686 145.00 389,470.00
136,566.00 162 843.00 136,566.00 - 843.00 -
83,440.00 72 560.00 40,320.00 77 560.00 43,120.00
119,900.00 1,199.00 - 100 1,199.00 119,900.00
403,378.00 1,692 139.00 235,188.00 1,210 139.00 168,190.00
453,870.00 130 1,107.00 143,910.00 280 1,107.00 309,960.00
2,266,000.00 113.30 - 20,000 113.30 2,266,000.00
85,500.00 121 171.00 20,691.00 379 171.00 64,809.00
842,058.00 1,445 123.00 177,735.00 5,401 123.00 664,323.00
29,000.00 2,900.00 - 10 2,900.00 29,000.00
72,000.00 18,000.00 - 4 18,000.00 72,000.00
146,000.00 558 73.00 40,734.00 1,442 73.00 105,266.00
5,400.00 54.00 - 100 54.00 5,400.00
- 112.00 - - 112.00 -
- 288.00 - - 288.00 -
- 517.00 - - 517.00 -
143,000.00 7,150.00 - 20 7,150.00 143,000.00
69,000.00 3,000.00 - 23 3,000.00 69,000.00
33,500.00 92 67.00 6,164.00 408 67.00 27,336.00
119,000.00 202 70.00 14,140.00 1,498 70.00 104,860.00
273,000.00 4,550.00 - 60 4,550.00 273,000.00
749,606.00 32 2,621.00 83,872.00 254 2,621.00 665,734.00
709,500.00 11,825.00 - 60 11,825.00 709,500.00
521,088.00 116 1,104.00 128,064.00 356 1,104.00 393,024.00
841,060.00 1,910 110.00 210,100.00 5,736 110.00 630,960.00
1,100,000.00 550,000.00 - 2 550,000.00 1,100,000.00
- 55,000.00 - - 55,000.00 -
3,030.00 10 303.00 3,030.00 - 303.00 -
670,306.00 848 91.00 77,168.00 6,518 91.00 593,138.00
87,360.00 410 91.00 37,310.00 550 91.00 50,050.00
1,108,800.00 554,400.00 - 2 554,400.00 1,108,800.00
- 67,650.00 - - 67,650.00 -
721,167.00 533 89.00 47,437.00 7,570 89.00 673,730.00
ah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang

Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga

13(8+11) 14 15 16 17(12-14) 17 18
- 3,171.00 - - 3,171.00 -
1,052,716.00 9 524.00 4,716.00 2,000 524.00 1,048,000.00

36,461,488.00 7,169,194.00 29,292,294.00

LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : OBAT
SUMBER : APBN

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
Tahun Satuan TA. 2019)
NO Nama Barang/Jenis Barang Merk/Type
Pengadaan Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan
1 2 3 4 5 6 7 8 9 10 11 12(6+9) 13(8+11) 14 15 16 17(12-14) 17
1 Albendazol 400 mg tablet APBN 2019 tablet 84 430.00 36,120.00 430.00 - 84 36,120.00 430.00 - 84 430.00
Besi kombinasi asam folat tablet tablet
2 APBN 2019 113,180 350.00 39,613,000.00 350.00 - 113,180 39,613,000.00 16,448 350.00 5,756,800.00 96,732 350.00

Obat antituberkulosa FDC Anak

3 APBN 2019 paket 10 232,518.00 2,325,180.00 232,518.00 - 10 2,325,180.00 10 232,518.00 2,325,180.00 - 232,518.00

Obat antituberkulosa FDC kat. 1

4 APBN 2019 paket - 389,344.00 - 16 389,344.00 6,229,504.00 16 6,229,504.00 7 389,344.00 2,725,408.00 9 389,344.00

Obat antituberkulosa FDC kat. 2 paket 1,199,985.00 1,199,985.00 1,199,985.00 1,199,985.00

5 APBN 2018 3 3,599,955.00 - 3 3,599,955.00 1 1,199,985.00 2

Retinol kapsul lunak 100.000 IU kapsul 288.00 288.00 288.00 288.00

6 APBN 2018 - - 1,600 460,800.00 1,600 460,800.00 1,600 460,800.00 -

Retinol kapsul lunak 200.000 IU kapsul 517.00 517.00 517.00 517.00

7 APBN 2018 - - 16,350 8,452,950.00 16,350 8,452,950.00 16,350 8,452,950.00 -

8 Vaksin DTP HB/HIB APBN 2019 vial - 84,282.00 - 100 84,282.00 8,428,200.00 100 8,428,200.00 100 84,282.00 8,428,200.00 - 84,282.00
Vaksin Hepatitis B saset 25,597.00 25,597.00 25,597.00 25,597.00
9 Recombinant Injeksi 0,5 ml APBN 2019 - - 80 2,047,760.00 80 2,047,760.00 80 2,047,760.00 -

10 Vaksin BCG APBN 2020 vial - 66,154.00 - 66,154.00 - - - 66,154.00 - - 66,154.00

11 Pelarut BCG APBN 2021 ampul - 0.00 - 0.00 - - - 0.00 - - 0.00
12 Vaksin Polio (BOPV) APBN 2022 vial - 19,954.00 - 19,954.00 - - - 19,954.00 - - 19,954.00
13 Vaksin MR APBN 2023 vial - 166,265.00 - 166,265.00 - - - 166,265.00 - - 166,265.00
14 Pelarut MR APBN 2019 vial - 0.00 - 200 0.00 - 200 - 200 0.00 - - 0.00

TOTAL OBAT APBN 45,574,255.00 25,619,214.00 71,193,469.00 31,397,083.00

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001

Nip. 19711003 200904 2 001

Barang

Jumlah Harga
18
36,120.00 -

33,856,200.00 -

- -

3,504,096.00 -

2,399,970.00 -

- -

- -
- -

- -
- -
- -
- -
- -
- -
-
-
39,796,386.00 -
LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : BMHP
SUMBER : BLUD

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
Tahun Satuan TA. 2019)
NO Nama Barang/Jenis Barang Merk/Type
Pengadaan Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan
1 2 3 4 5 6 7 8 9 10 11 12(6+9) 13(8+11) 14 15 16 17(12-14) 17
1 Masker 2018 Lembar 6,300 440.00 2,772,000.00 440.00 - 6,300 2,772,000.00 750 440.00 330,000.00 5,550 440.00
2 Sarung tangan non steril 2019 Pasang 4,500 760.00 3,420,000.00 760.00 - 4,500 3,420,000.00 2,000 760.00 1,520,000.00 2,500 760.00
3 Plastik Uk 5x8 2018 Pak 20 49,500.00 990,000.00 49,500.00 - 20 990,000.00 49,500.00 - 20 49,500.00
4 Plastik Uk 7x10 2019 Pak 74 80,882.00 5,985,268.00 80,882.00 - 74 5,985,268.00 80,882.00 - 74 80,882.00
5 Plastik Uk 8,7x13 2019 Pak 44 125,000.00 5,500,000.00 125,000.00 - 44 5,500,000.00 125,000.00 - 44 125,000.00
6 Plastik 10x15 2019 Pak 34 161,764.00 5,499,976.00 161,764.00 - 34 5,499,976.00 161,764.00 - 34 161,764.00
7 Sendok Obat 2018 Buah 800 500.00 400,000.00 500.00 - 800 400,000.00 500.00 - 800 500.00
8 Alkohol swab 2018 Lembar 4,800 90.00 432,000.00 90.00 - 4,800 432,000.00 2,400 90.00 216,000.00 2,400 90.00
9 Aqubidest 20 L 2018 Galon 3 107,250.00 321,750.00 107,250.00 - 3 321,750.00 107,250.00 - 3 107,250.00

TOTAL BMHP BLUD 25,320,994.00 - 25,320,994.00 2,066,000.00

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001

Nip. 19711003 200904 2 001

Barang

Jumlah Harga
18
2,442,000.00 -
1,900,000.00 -
990,000.00 -
5,985,268.00 -
5,500,000.00 -
5,499,976.00 -
400,000.00 -
216,000.00 -
321,750.00 -
-
-
23,254,994.00 -
LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : BMHP
SUMBER : APBD

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
Tahun Satuan TA. 2019)
NO Nama Barang/Jenis Barang Merk/Type
Pengadaan Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan
1 2 3 4 5 6 7 8 9 10 11 12(6+9) 13(8+11) 14 15 16 17(12-14) 17
1 Alat Suntik sekali pakai 1 ml APBD 2019 pcs 800 1,023.00 818,400.00 1,023.00 - 800 818,400.00 1,023.00 - 800 1,023.00
2 Alat Suntik sekali pakai 3 ml APBD 2019 pcs 900 950.00 855,000.00 950.00 - 900 855,000.00 400 950.00 380,000.00 500 950.00
3 Infus Set Adult 20 drops/mL APBD 2017 Set 10 6,380.00 63,800.00 6,380.00 - 10 63,800.00 6,380.00 - 10 6,380.00

4 Infus Set Pedriatic 60 drops/mL APBD 2019 10 5,415.00 54,150.00 5,415.00 - 10 54,150.00 5,415.00 - 10 5,415.00
set
Kapas Pembalut/Absorben 250
5 APBD 2019 8 12,500.00 100,000.00 12,500.00 - 8 100,000.00 12,500.00 - 8 12,500.00
gram bks
6 Kasa 16 x 16 cm APBD 2019 kotak 150 8,000.00 1,200,000.00 8,000.00 - 150 1,200,000.00 8,000.00 - 150 8,000.00
7 Kasa 40 x 80 APBD 2019 roll 2 105,000.00 210,000.00 105,000.00 - 2 210,000.00 105,000.00 - 2 105,000.00
Kasa Pembalut Hidrofil 4 m x
8 APBD 2013 90 1,100.00 99,000.00 1,100.00 - 90 99,000.00 1,100.00 - 90 1,100.00
10 cm bks
Kasa Pembalut Hidrofil 4 m x 5
9 APBD 2013 119 550.00 65,450.00 550.00 - 119 65,450.00 550.00 - 119 550.00
cm bks
10 Lisol APBD 2019 botol - 41,000.00 - 41,000.00 - - - 41,000.00 - - 41,000.00
11 Masker 3 ply APBD 2018 pcs 1,500 438.90 658,350.00 438.90 - 1,500 658,350.00 438.90 - 1,500 438.90
12 Masker N 95 APBD 2019 pcs 300 6,512.00 1,953,600.00 6,512.00 - 300 1,953,600.00 6,512.00 - 300 6,512.00

13 Plester 2,5 cm x 4,5 cm (kecil) APBD 2019 3 12,675.00 38,025.00 12,675.00 - 3 38,025.00 12,675.00 - 3 12,675.00
roll

14 Plester 7,5 cm x 5 cm (besar) APBD 2019 4 37,371.00 149,484.00 37,371.00 - 4 149,484.00 37,371.00 - 4 37,371.00
roll
15 Sarung tangan non steril uk.M APBD 2019 1,000 572.00 572,000.00 572.00 - 1,000 572,000.00 572.00 - 1,000 572.00
psg
16 Sarung tangan steril 6,5 G APBD 2019 psg 600 3,938.00 2,362,800.00 3,938.00 - 600 2,362,800.00 3,938.00 - 600 3,938.00

17 Sarung tangan non steril uk. S APBD 2019 1,000 549.40 549,400.00 549.40 - 1,000 549,400.00 549.40 - 1,000 549.40
psg

TOTAL BMHP APBD 9,749,459.00 - 9,749,459.00 380,000.00

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001
Nip. 19711003 200904 2 001
Barang

Jumlah Harga
18
818,400.00 -
475,000.00 -
63,800.00 -

54,150.00 -

100,000.00 -
1,200,000.00 -
210,000.00 -

99,000.00 -

65,450.00 -
- -
658,350.00 -
1,953,600.00 -

38,025.00 -

149,484.00 -

572,000.00 -
2,362,800.00 -

549,400.00 -
-
-
9,369,459.00 -
LAMPIRAN BERITA ACARA STOK OPNAME PER 31 JANUARI 2020

PUSKESMAS : SOREANG
NAMA PERSEDIAAN : BMHP
SUMBER : APBN

Saldo Awal Tahun 2020 (Sisa Hasil Pengadaan

Pengadaan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
Tahun Satuan TA. 2019)
NO Nama Barang/Jenis Barang Merk/Type
Pengadaan Barang
Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Barang Harga Satuan Jumlah Harga Jumlah Barang Harga Satuan
1 2 3 4 5 6 7 8.00 9 10 11.00 12(6+9) 13(8+11) 14 15 16.00 17(12-14) 17
Alat suntik sekali pakai 0,5 ml vial 1,185.00 1,185.00 1,185.00 1,185.00
1 APBN 2019 - - - - - - -

2 Alat Suntik sekali pakai 5 ml APBN 2019 pcs 100 1,640.00 164,000.00 1,640.00 - 100 164,000.00 1,640.00 - 100 1,640.00
Penetes Vaksin Polio (BPOV) pcs
3 APBN 2019 - - - - - - -
0.00 0.00 0.00 0.00
4 Safety Box APBN 2020 Kotak - 22,433.00 - 22,433.00 - - - 22,433.00 - - 22,433.00
5 HIV Test 1 (SD) APBN 2019 strip - 11,975.00 - 400 11,975.00 4,790,000.00 400 4,790,000.00 400 11,975.00 4,790,000.00 - 11,975.00
6 Rapid Test Sypilis APBN 2019 strip - 20,400.00 - 400 20,400.00 8,160,000.00 400 8,160,000.00 400 20,400.00 8,160,000.00 - 20,400.00
7 Rapid Test HBsAg APBN 2019 test - 9,878.00 - 400 9,878.00 3,951,200.00 400 3,951,200.00 400 9,878.00 3,951,200.00 - 9,878.00
8 Reagen Ziehl Neelsen APBN 2019 Botol - 256,735.00 - 10 256,735.00 2,567,350.00 10 2,567,350.00 6 256,735.00 1,540,410.00 4 256,735.00
9 Pot Dahak APBN 2019 Pot - 4,905.00 - 200 4,905.00 981,000.00 200 981,000.00 4,905.00 - 200 4,905.00

TOTAL BMHP APBN 164,000.00 20,449,550.00 20,613,550.00 18,441,610.00

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti Fitri Kasari

S.KM
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001

Nip. 19711003 200904 2 001

Barang

Jumlah Harga
18.00

- -
164,000.00 -

- -
- -
- -
- -
- -
1,026,940.00 -
981,000.00 -
-
-
2,171,940.00 -
Lampiran Berita Acara Stock Opname Barang
Per 31 Januari 2020
Puskesmas : Soreang
Nama Persediaan : CETAK BLUD

SUMBER : BLUD

Saldo Awal Bulan Januari 2020 Pengadaan Bulan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
No Jenis Barang Satuan
Jumlah Harga Jumlah Jumlah Jumlah
Jumlah Harga Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Harga Harga Satuan
Barang Satuan Barang Barang Barang
1 2 3 4 5 6 7 8 9 10= (4+7) 11 = (6+9) 12 13 14= (10-12) 15
1 Kartu berobat lbr 11,500 275.00 3,162,500.00 - 275 - 11,500 3,162,500.00 - 11,500 275
2 Agenda Surat Keluar buku 1 79,200.00 79,200.00 - 79,200 - 1 79,200.00 - 1 79,200
3 Agenda Surat Masuk buku 1 79,200.00 79,200.00 - 79,200 - 1 79,200.00 - 1 79,200
4 Buku Bagan MTBS buku 2 49,940.00 99,880.00 - 49,940 - 2 99,880.00 - 2 49,940
5 Buku Bukti Barang Keluar (BBK) buku 6 29,920.00 179,520.00 - 29,920 - 6 179,520.00 6 179,520.00 - 29,920
6 Buku Formulir MTBM buku 10 19,910.00 199,100.00 - 19,910 - 10 199,100.00 - 10 19,910
7 Buku Formulir MTBS buku 50 19,800.00 990,000.00 - 19,800 - 50 990,000.00 2 39,600.00 48 19,800
8 Buku Kunjungan Pasien buku 8 29,920.00 239,360.00 - 29,920 - 8 239,360.00 - 8 29,920
9 Buku Kwitansi Lunas Bayar buku 200 9,900.00 1,980,000.00 - 9,900 - 200 1,980,000.00 - 200 9,900
10 Buku Pedoman MTBS buku 2 29,920.00 59,840.00 - 29,920 - 2 59,840.00 - 2 29,920
11 Buku Register Gelatik buku 2 19,910.00 39,820.00 - 19,910 - 2 39,820.00 - 2 19,910
12 Buku Register KIA Buku 14 29,920.00 418,880.00 - 29,920 - 14 418,880.00 - 14 29,920
13 Buku Resep buku 20 7,040.00 140,800.00 - 7,040 - 20 140,800.00 - 20 7,040
14 Buku SOAP buku 6 29,920.00 179,520.00 - 29,920 - 6 179,520.00 - 6 29,920
15 Buku Tamu buku 1 79,750.00 79,750.00 - 79,750 - 1 79,750.00 - 1 79,750
16 Form Iva Test lbr 2,000 715.00 1,430,000.00 - 715 - 2,000 1,430,000.00 - 2,000 715
17 K4 kartu KB lbr 1,500 2,970.00 4,455,000.00 - 2,970 - 1,500 4,455,000.00 - 1,500 2,970
18 Kartu Bayi lbr 2,000 495.00 990,000.00 - 495 - 2,000 990,000.00 - 2,000 495
19 Kartu Ibu lbr 2,000 990.00 1,980,000.00 - 990 - 2,000 1,980,000.00 - 2,000 990
20 Kartu K1 lbr 2,000 990.00 1,980,000.00 - 990 - 2,000 1,980,000.00 - 2,000 990
21 Kartu K4 lbr 2,000 990.00 1,980,000.00 - 990 - 2,000 1,980,000.00 - 2,000 990
22 Kartu medrek lbr 12,000 990.00 11,880,000.00 - 990 - 12,000 11,880,000.00 - 12,000 990
23 Kartu Stock obat lbr 800 990.00 792,000.00 - 990 - 800 792,000.00 - 800 990
24 Kartu stok barang lbr 50 990.00 49,500.00 - 990 - 50 49,500.00 - 50 990
25 Kohort Buku 42 49,940.00 2,097,480.00 - 49,940 - 42 2,097,480.00 17 848,980.00 25 49,940
26 Leaflet lbr 5,000 2,970.00 14,850,000.00 - 2,970 - 5,000 14,850,000.00 - 5,000 2,970
27 Map Family Folder Buah 1,000 1,980.00 1,980,000.00 - 1,980 - 1,000 1,980,000.00 - 1,000 1,980
28 Outgaide Buah 250 1,485.00 371,250.00 - 1,485 - 250 371,250.00 - 250 1,485
29 Poster bh 15 49,940.00 749,100.00 - 49,940 - 15 749,100.00 - 15 49,940
30 Surat Keterangan Sakit buku 20 9,900.00 198,000.00 - 9,900 - 20 198,000.00 - 20 9,900
31 Surat Keterangan Sehat buku 20 9,900.00 198,000.00 - 9,900 - 20 198,000.00 - 20 9,900
32 TB 01 lbr 300 990.00 297,000.00 - 990 - 300 297,000.00 300 297,000.00 - 990
33 TB 01 Pencegahan lbr 100 990.00 99,000.00 - 990 - 100 99,000.00 - 100 990
34 TB 02 lbr 300 990.00 297,000.00 - 990 - 300 297,000.00 300 297,000.00 - 990
35 TB 03 Buku 2 39,930.00 79,860.00 - 39,930 - 2 79,860.00 2 79,860.00 - 39,930
36 TB 05 lbr 300 1,430.00 429,000.00 - 1,430 - 300 429,000.00 300 429,000.00 - 1,430
TOTAL 55,109,560.00 - 55,109,560.00 2,170,960.00

Pengurus Barang Pengguna Pengurus Barang Pembantu Tim Pemeriksa :

Patryawan Rivai, SP.,MM ……………………

NIP. 19700329 200212 1 005

Ina Agustina Eka Suswanti S.KM Fitri Kasari Arief 19840720

Nurachman H, SKM.,MH ……………………
NIP. 201101 1 001
NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Hj.Wahju Wiandari, S.Sos ……………………

NIP. 19710927 200501 2 004
Menyetujui,
Kepala Puskesmas Soreang Rini Marini, S.IP ……………………
NIP. 19770907 200901 2 002

dr. Dewi Syafitri

NIP. 19711003 200904 2 001
 Saldo Awal Bulan Januari 2020 Pengadaan Bulan Januari 2020 Jumlah Saldo awal + Pengadaan Penggunaan Barang Sisa Barang
No Jenis Barang Satuan
Jumlah Harga Jumlah Jumlah Jumlah
Jumlah Harga Harga Satuan Jumlah Harga Barang Jumlah Harga Jumlah Harga Harga Satuan
Barang Satuan Barang Barang Barang
1 2 3 4 5 6 7 8 9 10= (4+7) 11 = (6+9) 12 13 14= (10-12) 15

Catatan :
Seluruh barang-barang hasil pengadaan Tahun Anggaran 2019 yang disajikan oleh Perangkat Daerah telah diserahkan
serta telah diperiksa seluruhnya oleh Inspektorat Kabupaten Bandung pada tanggal tersebut diatas
Sisa Barang
Keterangan
Jumlah Harga

16
3,162,500.00
79,200.00
79,200.00
99,880.00
-
199,100.00
950,400.00
239,360.00
1,980,000.00
59,840.00
39,820.00
418,880.00
140,800.00
179,520.00
79,750.00
1,430,000.00
4,455,000.00
990,000.00
1,980,000.00
1,980,000.00
1,980,000.00
11,880,000.00
792,000.00
49,500.00
1,248,500.00
14,850,000.00
1,980,000.00
371,250.00
749,100.00
198,000.00
198,000.00
-
99,000.00
-
-
-
52,938,600.00
Lampiran Berita Acara Stock Opname Barang
Per 31 Januari 2020
Puskesmas : Soreang
Nama Persediaan : CETAK APBD

SUMBER : APBD
Jumlah Saldo awal
Saldo Awal Bulan Januari 2020 Pengadaan/Penerimaan Bulan Januari 2020
Pengadaan/Penerima
No Jenis Barang Satuan
Jumlah Harga Jumlah
Jumlah Harga Harga Satuan Jumlah Harga Barang
Barang Satuan Barang
1 2 3 4 5 6 7 8 9 10= (4+7)
1 Karcis Tarif 10.000 lbr 85 76.23 6,479.55 - 76.23 - 85
2 Karcis Tarif 20.000 lbr 477 76.23 36,361.71 - 76.23 - 477
3 Karcis Tarif 4.000 lbr 1,330 76.23 101,385.90 - 76.23 - 1,330
4 Karcis Tarif 7.000 lbr 4,110 76.23 313,305.30 2,000 76.23 152,460.00 6,110
5 Karcis Putih lbr - - - 3,412 76.23 260,096.76 3,412
TOTAL 457,532.46 412,556.76

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti S.KM Fitri Kasari

NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001
 Jumlah Saldo awal +
Penggunaan Barang Sisa Barang
Pengadaan/Penerimaan
Keterangan
Jumlah Jumlah
Jumlah Harga Jumlah Harga Harga Satuan Jumlah Harga
Barang Barang
11 = (6+9) 12 13 14= (10-12) 15 16
6,479.55 85 6,479.55 - 76.23 -
36,361.71 4 304.92 473 76.23 36,056.79
101,385.90 - - 1,330 76.23 101,385.90
465,765.30 1,409 107,408.07 4,701 76.23 358,357.23
260,096.76 2,382 181,579.86 1,030 76.23 78,516.90
870,089.22 295,772.40 574,316.82
Lampiran Berita Acara Stock Opname Persediaan ATK
Per 31 Januari 2020
Puskesmas : Soreang
Nama Persediaan : ATK BLUD

SUMBER : BLUD
Jumlah Saldo awa
Saldo Awal Bulan Januari 2020 Pengadaan Bulan Januari 2020
Pengadaan
No Jenis Barang Satuan
Jumlah Jumlah
Harga Satuan Jumlah Harga Harga Satuan Jumlah Harga Barang
Barang Barang
1 2 3 4 5 6 7 8 9 10= (4+7)
1 Amplop Putih Besar pak 10 16,720.00 167,200.00 - 16,720.00 - 10
2 Amplop Putih Kecil pak 8 27,500.00 220,000.00 - 27,500.00 - 8
3 Ballpoint Hitam lsn 33 24,200.00 798,600.00 - 24,200.00 - 33
4 Bantalan Stempel buah 3 16,500.00 49,500.00 - 16,500.00 - 3
5 Bindek/Ordner buah 127 22,000.00 2,794,000.00 - 22,000.00 - 127
6 Binder Clip Besar pak 14 15,400.00 215,600.00 - 15,400.00 - 14
7 Binder Clip Kecil pak 28 7,700.00 215,600.00 - 7,700.00 - 28
8 Binder Clip Sedang pak 18 12,100.00 217,800.00 - 12,100.00 - 18
9 Box File buah 58 24,200.00 1,403,600.00 - 24,200.00 - 58
10 Buku Ekspedisi buah 2 19,800.00 39,600.00 - 19,800.00 - 2
11 Buku Kwitansi Besar buku 40 8,800.00 352,000.00 - 8,800.00 - 40
12 Buku Kwitansi Kecil buku 10 6,600.00 66,000.00 - 6,600.00 - 10
13 Business File buah 140 5,500.00 770,000.00 - 5,500.00 - 140
14 Catridge Canon 745 (hitam) buah 4 286,000.00 1,144,000.00 - 286,000.00 - 4
15 Catridge Canon 746 (color) buah 7 330,000.00 2,310,000.00 - 330,000.00 - 7
16 Catridge Canon 810 buah 3 247,500.00 742,500.00 - 247,500.00 - 3
17 Catridge Canon 811 buah 3 275,000.00 825,000.00 - 275,000.00 - 3
18 Cutter Besar buah 2 13,200.00 26,400.00 - 13,200.00 - 2
19 Gunting Besar buah 4 19,800.00 79,200.00 - 19,800.00 - 4
20 Gunting Kecil buah 1 16,500.00 16,500.00 - 16,500.00 - 1
21 Hekter Besar buah 3 27,500.00 82,500.00 - 27,500.00 - 3
22 Hekter Kecil buah 20 16,500.00 330,000.00 - 16,500.00 - 20
23 Isi Cutter Besar pack 1 13,200.00 13,200.00 - 13,200.00 - 1
24 Isi Staples Besar dus 6 33,000.00 198,000.00 - 33,000.00 - 6
25 Isi Staples Kecil box 24 4,400.00 105,600.00 - 4,400.00 - 24
26 Kertas Buram rim 2 44,000.00 88,000.00 - 44,000.00 - 2
27 Kertas Hvs F4 70gr rim 5 45,870.00 229,350.00 - 45,870.00 - 5
28 Kertas Hvs F4 80gr rim 15 52,800.00 792,000.00 - 52,800.00 - 15
29 Kertas HVS F4 warna biru rim 2 50,600.00 101,200.00 - 50,600.00 - 2
30 Kertas HVS F4 warna kuning rim 1 50,600.00 50,600.00 - 50,600.00 - 1
31 Kertas HVS F4 warna pink rim 2 50,600.00 101,200.00 - 50,600.00 - 2
32 Kertas Hvs Warna Hijau rim 1 56,100.00 56,100.00 - 56,100.00 - 1
33 Kertas Lipat pak 7 14,850.00 103,950.00 - 14,850.00 - 7
34 Kertas Stiker pak 5 49,500.00 247,500.00 - 49,500.00 - 5
35 Lakban Double Tape Besar roll 12 11,000.00 132,000.00 - 11,000.00 - 12
36 Lakban Double Tape Kecil roll 6 6,600.00 39,600.00 - 6,600.00 - 6
37 Lem Kertas pcs 5 13,200.00 66,000.00 - 13,200.00 - 5
38 Map Kertas pak 40 28,600.00 1,144,000.00 - 28,600.00 - 40
39 Map plastik buah 12 5,170.00 62,040.00 - 5,170.00 - 12
40 Pembatas Kertas/ Post it buah 10 22,000.00 220,000.00 - 22,000.00 - 10
41 Penggaris Besi pcs 3 13,200.00 39,600.00 - 13,200.00 - 3
42 Penggaris Plastik pcs 8 4,400.00 35,200.00 - 4,400.00 - 8
43 Pensil dus 2 28,600.00 57,200.00 - 28,600.00 - 2
44 Pensil Kaca warna merah buah 2 9,955.00 19,910.00 - 9,955.00 - 2
45 Pulpen Dudukan (Pulpen Tali) buah 20 9,570.00 191,400.00 - 9,570.00 - 20
46 Pulpen Tinta Biru dus 2 23,100.00 46,200.00 - 23,100.00 - 2
47 Pulpen Tinta Merah dus 2 23,100.00 46,200.00 - 23,100.00 - 2
48 Rautan Pensil mekanik buah 1 64,900.00 64,900.00 - 64,900.00 - 1
49 Selotip Besar (Lakban) buah 1 9,900.00 9,900.00 - 9,900.00 - 1
50 Spidol Marker Merah buah 6 10,450.00 62,700.00 - 10,450.00 - 6
51 Spidol warna pack 6 12,100.00 72,600.00 - 12,100.00 - 6
52 Stabilo buah 12 4,400.00 52,800.00 - 4,400.00 - 12
53 Stiker Plastik buah 2 29,700.00 59,400.00 - 29,700.00 - 2
54 Termal Paper (Roll Kertas Struk) Roll 127 4,950.00 628,650.00 - 4,950.00 - 127
55 Tinta printer canon hitam botol 14 149,600.00 2,094,400.00 - 149,600.00 - 14
56 Tinta printer canon biru botol 8 149,600.00 1,196,800.00 - 149,600.00 - 8
57 Tinta printer canon kuning botol 8 149,600.00 1,196,800.00 - 149,600.00 - 8
58 Tinta Printer canon merah botol 8 149,600.00 1,196,800.00 - 149,600.00 - 8
59 Tinta Printer Canon Warna Biru botol 16 38,500.00 616,000.00 - 38,500.00 - 16
60 Tinta Printer Canon Warna Hitam botol 30 38,500.00 1,155,000.00 - 38,500.00 - 30
61 Tinta Printer Canon Warna Kuning botol 16 38,500.00 616,000.00 - 38,500.00 - 16
62 Tinta Printer Canon Warna Merah botol 16 38,500.00 616,000.00 - 38,500.00 - 16
63 Tinta Printer Epson Warna Biru botol 15 44,000.00 660,000.00 - 44,000.00 - 15
 Jumlah Saldo awa
Saldo Awal Bulan Januari 2020 Pengadaan Bulan Januari 2020
Pengadaan
No Jenis Barang Satuan
Jumlah Jumlah
Harga Satuan Jumlah Harga Harga Satuan Jumlah Harga Barang
Barang Barang
1 2 3 4 5 6 7 8 9 10= (4+7)
64 Tinta Printer Epson Warna Hitam botol 26 44,000.00 1,144,000.00 - 44,000.00 - 26
65 Tinta Printer Epson Warna Merah botol 15 44,000.00 660,000.00 - 44,000.00 - 15
66 Tinta Printer EpsonWarna Kuning botol 15 44,000.00 660,000.00 - 44,000.00 - 15
67 Tipe X tape buah 20 16,500.00 330,000.00 - 16,500.00 - 20
TOTAL 30,144,400.00 -

Pengurus Barang Pengguna Pengurus Barang Pembantu

Ina Agustina Eka Suswanti S.KM Fitri Kasari

NIP. 19800821 201001 2 008 NIP. 19810220 200604 2 009

Menyetujui,
Kepala Puskesmas Soreang

dr. Dewi Syafitri

NIP. 19711003 200904 2 001

Catatan :
Seluruh barang-barang hasil pengadaan Tahun Anggaran 2019 yang disajikan oleh Perangkat Daerah telah diserahkan
serta telah diperiksa seluruhnya oleh Inspektorat Kabupaten Bandung pada tanggal tersebut diatas
Jumlah Saldo awal +
Penggunaan Barang Sisa Barang
Pengadaan
Keterangan
Jumlah Jumlah
Jumlah Harga Jumlah Harga Harga Satuan Jumlah Harga
Barang Barang
11 = (6+9) 12 13 14= (10-12) 15 16
167,200.00 1 16,720.00 9 16,720.00 150,480.00
220,000.00 - - 8 27,500.00 220,000.00
798,600.00 4 96,800.00 29 24,200.00 701,800.00
49,500.00 - - 3 16,500.00 49,500.00
2,794,000.00 8 176,000.00 119 22,000.00 2,618,000.00
215,600.00 - - 14 15,400.00 215,600.00
215,600.00 1 7,700.00 27 7,700.00 207,900.00
217,800.00 1 12,100.00 17 12,100.00 205,700.00
1,403,600.00 7 169,400.00 51 24,200.00 1,234,200.00
39,600.00 1 19,800.00 1 19,800.00 19,800.00
352,000.00 - - 40 8,800.00 352,000.00
66,000.00 - - 10 6,600.00 66,000.00
770,000.00 1 5,500.00 139 5,500.00 764,500.00
1,144,000.00 1 286,000.00 3 286,000.00 858,000.00
2,310,000.00 1 330,000.00 6 330,000.00 1,980,000.00
742,500.00 - - 3 247,500.00 742,500.00
825,000.00 - - 3 275,000.00 825,000.00
26,400.00 1 13,200.00 1 13,200.00 13,200.00
79,200.00 1 19,800.00 3 19,800.00 59,400.00
16,500.00 - - 1 16,500.00 16,500.00
82,500.00 - - 3 27,500.00 82,500.00
330,000.00 1 16,500.00 19 16,500.00 313,500.00
13,200.00 - - 1 13,200.00 13,200.00
198,000.00 2 66,000.00 4 33,000.00 132,000.00
105,600.00 2 8,800.00 22 4,400.00 96,800.00
88,000.00 - - 2 44,000.00 88,000.00
229,350.00 5 229,350.00 - 45,870.00 -
792,000.00 5 264,000.00 10 52,800.00 528,000.00
101,200.00 - - 2 50,600.00 101,200.00
50,600.00 - - 1 50,600.00 50,600.00
101,200.00 1 50,600.00 1 50,600.00 50,600.00
56,100.00 - - 1 56,100.00 56,100.00
103,950.00 - - 7 14,850.00 103,950.00
247,500.00 - - 5 49,500.00 247,500.00
132,000.00 2 22,000.00 10 11,000.00 110,000.00
39,600.00 - - 6 6,600.00 39,600.00
66,000.00 - - 5 13,200.00 66,000.00
1,144,000.00 4 114,400.00 36 28,600.00 1,029,600.00
62,040.00 - - 12 5,170.00 62,040.00
220,000.00 3 66,000.00 7 22,000.00 154,000.00
39,600.00 1 13,200.00 2 13,200.00 26,400.00
35,200.00 1 4,400.00 7 4,400.00 30,800.00
57,200.00 - - 2 28,600.00 57,200.00
19,910.00 - - 2 9,955.00 19,910.00
191,400.00 2 19,140.00 18 9,570.00 172,260.00
46,200.00 1 23,100.00 1 23,100.00 23,100.00
46,200.00 - - 2 23,100.00 46,200.00
64,900.00 - - 1 64,900.00 64,900.00
9,900.00 - - 1 9,900.00 9,900.00
62,700.00 - - 6 10,450.00 62,700.00
72,600.00 - - 6 12,100.00 72,600.00
52,800.00 - - 12 4,400.00 52,800.00
59,400.00 1 29,700.00 1 29,700.00 29,700.00
628,650.00 - - 127 4,950.00 628,650.00
2,094,400.00 2 299,200.00 12 149,600.00 1,795,200.00
1,196,800.00 2 299,200.00 6 149,600.00 897,600.00
1,196,800.00 2 299,200.00 6 149,600.00 897,600.00
1,196,800.00 2 299,200.00 6 149,600.00 897,600.00
616,000.00 11 423,500.00 5 38,500.00 192,500.00
1,155,000.00 13 500,500.00 17 38,500.00 654,500.00
616,000.00 11 423,500.00 5 38,500.00 192,500.00
616,000.00 13 500,500.00 3 38,500.00 115,500.00
660,000.00 3 132,000.00 12 44,000.00 528,000.00
Jumlah Saldo awal +
Penggunaan Barang Sisa Barang
Pengadaan
Keterangan
Jumlah Jumlah
Jumlah Harga Jumlah Harga Harga Satuan Jumlah Harga
Barang Barang
11 = (6+9) 12 13 14= (10-12) 15 16
1,144,000.00 - - 26 44,000.00 1,144,000.00
660,000.00 1 44,000.00 14 44,000.00 616,000.00
660,000.00 4 176,000.00 11 44,000.00 484,000.00
330,000.00 3 49,500.00 17 16,500.00 280,500.00
30,144,400.00 5,526,510.00 24,617,890.00

Tim Pemeriksa :

Patryawan Rivai, SP.,MM ……………………

NIP. 19700329 200212 1 005

Arief Nurachman H, SKM.,MH ……………………

NIP. 19840720 201101 1 001

Hj.Wahju Wiandari, S.Sos ……………………

NIP. 19710927 200501 2 004

Rini Marini, S.IP ……………………

NIP. 19770907 200901 2 002