LPLPO 2021 S Nipah

LAPORAN PEMAKAIAN DAN PENGELUARAN OBAT
( LPLPO )
KODE PUSKESMAS P6302120201 BULAN :……..- ……….

PUSKESMAS : TAHUN : 2021
KECAMATAN :
KAB. / KODYA : Kotabaru
PROPINSI : Kalimantan Selatan
PENGELUARAN
No STOK PEMBERIAN
KODE NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN SISA STOK STOK OPT PERMINTAAN KET
URUT AWAL EXPIRED DATE PEMAKAIAN
DAK APBD II APBD I PROGRAM JML
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
GOLONGAN OBAT GENERIK / ESENSIAL
1 10.01.19.0422.0001 Alopurinol tablet 100 mg Tab 50 0 0 50 0 (50)
2 10.01.18.0520.0002 Alopurinol tablet 300 mg Tab 0 0 0 0
3 30.01.20.0521.0003 Aminofilin tablet 200 mg Tab 0 0 0 0
4 10.01.20.0821.0004 Aminofilin injeksi 24 mg/ml - 10 ml Amp 0 0 0 0
5 10.01.20.0224.0005 Amitriptilin HCl tab. Salut 25 mg Tab 0 0 0 0
6 10.01.19.0821.0193 Ampisilin serbuk injeksi 250 mg (Viccillin ) Amp 0 0 0 0
7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 30 30 0 30 0 (30)
8 10.01.19.0522.0007 Amoksisillin 100mg Drop Amp 0 0 0 0
9 10.01.20.1022.0008 Amoksisilin sirup kering 125 mg / 5 ml Btl 3 3 0 3 0 (3)
10 10.01.20.1022.0009 Amoksisilin sirup kering 250 mg / 5 ml Btl 0 0 0 0
11 10.01.17.0319.0160 Amoxilin Injeksi 1000mg Vial 0 0 0 0
12 10.01.19.0522.0010 Antasida Doen tablet kombinasi Tab 0 0 0 0
13 10.01.20.1121.0011 Antasida suspensi Btl 1 1 0 1 0 (1)
14 10.01.18.0822.0012 Antibakteri doen salep kombinasi (Bacitracin) Tub 0 0 0 0
15 10.01.19.0720.0013 Antihemoroid doen kombinasi Suppo 0 0 0 0
16 10.01.19.1022.0014 Antifungi doen kombinasi Pot 0 0 0 0
17 10.01.20.0323.0015 Antimigran doen kombinasi (Ergotamin) Tab 0 0 0 0
18 20.01.20.1222.0016 Aqua proinjeksi steril, bebas pirogen Btl 0 0 0 0
19 10.01.18.0322.0017 Asam askorbat (vit c) tablet 50 mg Tab 0 0 0 0
20 10.01.20.0322.446 Asam askorbat (vit c) tablet 250 mg 0 0 0 0
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0
22 30.01.20.0624.506 Atropin Tab 0,5 mg Tab 0 0 0 0
23 10.01.18.1019.0021 Atropin sulfat injeksi 0,25 mg/ml - 1 ml Amp 0 0 0 0
24 10.01.20.0522.0022 Acetyl Cystein 200mg Kaps 0 0 0 0
25 20.01.20.0923.0023 Acyclovir Cream Tube 0 0 0 0
26 10.01.18.0322.0024 Acyclovir tablet 200 mg Tab 0 0 0 0
27 10.01.18.0722.0025 Acyclovir tablet 400 mg Tab 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
28 20.01.20.1022.0026 Ambroksol sirup Btl 0 0 0 0
29 30.01.20.1221.0027 Ambroksol tablet 30mg Tab 0 0 0 0
30 10.01.20.1121.0028 Asam Mefenamat tablet 500 mg Tab 0 0 0 0
31 10.01.19.0222.0029 Asam Traneksamat Tablet 500 mg Tab 0 0 0 0
32 10.01.18.0722.0030 Asam Traneksamat 100 mg/5 ml Injeksi Amp 0 0 0 0
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0
37 30.01.20.0624.0510 Asam folat tab 0,4mg Tab 0 0 0 0
38 10.01.19.0521.0035 Asam folat tab 1 mg Tab 0 0 0 0
39 10.01.19.0321.0036 Betametason krim 0,1 % Tub 0 0 0 0
40 10.01.20.0423.0037 Betahistin mesilate tablet 6 mg Tab 0 0 0 0
41 30.01.20.0123.0038 Cefadroxil 500 mg kaps Kaps 0 0 0 0
42 30.01.20.0520.0039 Cefadroxil sirup kering 125 mg/5ml Btl 0 0 0 0
43 10.01.18.0820.0039 Cefadroxil sirup kering 250 mg/5ml Btl 0 0 0 0
44 10.01.19.1223.0040 Captopril tablet 12,5 mg Tab 0 0 0 0
45 30.01.20.0624.0041 Captopril tablet 25 mg Tab 0 0 0 0
46 10.01.18.0921.0042 Captopril tablet 50 mg Tab 0 0 0 0
47 10.01.20.0122.0043 Ciprofloxacin tablet 500 mg Tab 0 0 0 0
48 10.01.19.0521.0044 Cetirizine Tab 10 mg Tab 0 0 0 0
49 10.01.20.0922.0045 Cetirizine Sirup 5mg/5ml Btl 0 0 0 0
50 10.01.20.0822.0046 Ceptriaxon injeksi 1000 mg Vial 0 0 0 0
51 10.01.19.0421.0047 Cefotaxime Sodium Serb.Inj 1000 mg Vial 0 0 0 0
52 10.01.20.0322.0048 Clindamicin 150 mg Tab 0 0 0 0
53 30.01.20.0624.0509 Clindamicin 300 mg Tab 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0
55 10.01.20.0122.0049 Deksametason inj 5 mg/ml - 1 ml Amp 0 0 0 0
56 30.01.20.1022.0050 Deksametason tablet 0,5 mg Tab 0 0 0 0
57 10.01.20.0423.0051 Diazepam inj 5 mg/ml - 2 ml Amp 0 0 0 0
58 10.01.18.0822.0052 Diazepam tablet 5 mg Tab 0 0 0 0
59 10.01.19.0523.0053 Diazepam tablet 2 mg Tab 0 0 0 0
60 30.01.20.0822.0054 Difenhidramin HCl inj 10 mg/ml - 1 ml Amp 0 0 0 0
61 10.01.19.0321.0055 Digoksin tablet 0,25 mg Tab 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0
63 10.01.19.0623.0057 Dimenhidrat Kaplet 50 mg Tab 0 0 0 0
64 10.01.19.0522.0058 Domperidone tablet 10 mg Tab 0 0 0 0
65 10.01.20.0422.0059 Domperidon suspensi 5 mg / 5 ml Btl 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
66 10.01.18.0720.0060 Doxycycline 100 mg Kaps 0 0 0 0
67 10.01.17.0219.0061 Efedrin HCl tablet 25 mg Tab 0 0 0 0
68 10.01.20.0222.0062 Epinefrin 1 mg/ml inj s.c/i.m Amp 0 0 0 0
69 30.01.18.1020.0063 Etakridin (rivanol) larutan 0,1 % Btl 0 0 0 0
70 30.01.18.0722.0064 Erytromicin kaplet 500 mg Kapl 0 0 0 0
71 10.01.20.0322.0448 Erytromicin Syrup 200 mg / 5 ml Botol 0 0 0 0
72 20.01.18.0522.0065 Etambutol tab 500mg ( HCL ) Tab 0 0 0 0
73 10.01.19.1123.0065 Etambutol tab 250mg ( HCL ) Tab 0 0 0 0
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0
75 30.01.19.0421.0067 Fenytoin Sodium 100 mg Kap 0 0 0 0
76 10.01.19.0321.0068 Fenol Gliserol Tetes Telinga 10% Btl 0 0 0 0
77 10.01.20.0523.0069 Fenobarbital injeksi 50 mg/ml - 2 ml Amp 0 0 0 0
78 10.01.20.0324.0070 Fenobarbital tablet 30 mg Tab 0 0 0 0
79 10.01.20.1121.0071 Fitomenadion (Vit K 1) Injeksi 2mg/ml Amp 0 0 0 0
80 30.01.20.0624.0511 Fitomenadion (Vit K 1) Injeksi 10mg/ml Amp 0 0 0 0
81 10.01.19.0821.0072 Fitomenadion (vit K 1) tablet salut 10 mg Tab 0 0 0 0
82 10.01.19.0621.0073 Furosemid tablet 40 mg Tab 0 0 0 0
83 10.01.20.0222.0074 Furosemid inj 10mg/ml amp 0 0 0 0
84 10.01.19.1021.0075 Garam Oralit 200 ml Sachet 0 0 0 0
85 10.01.18.0323.0076 Glibenklamid Tab 0 0 0 0
86 20.01.20.0422.0077 Glimepiride 2 mg Tab 0 0 0 0
87 10.01.19.0921.0078 Glimepiride 1 mg Tab 0 0 0 0
88 10.01.17.0921.0079 Gliseril guayakolat 100 mg Tab 0 0 0 0
89 20.01.20.0423.0080 Guaiafenesin 100 mg Tab 0 0 0 0
90 10.01.17.1121.0081 Gliserin / Gliserol Btl 0 0 0 0
91 10.01.20.0122.0082 Glukosa larutan infus 5 % steril Btl 2 2 0 2 0 (2)
92 10.01.18.0820.0083 Griseofulvin tablet 125 mg, micronized Tab 0 0 0 0
93 30.01.20.0624.0508 Griseofulvin tablet 250 mg Tab 0 0 0 0
94 10.01.18.0620.0084 Griseofulvin tablet 500 mg Tab 0 0 0 0
95 10.01.17.1119.0085 Gentamycin Sulfat Inj 2 ml Amp 0 0 0 0
96 20.01.20.1022.0086 Gentamycin tetes mata 0,3 % Botol 2 2 0 2 0 (2)
97 10.01.19.0622.0087 Gentamycin Salep mata 0,3 % Tube 5 5 0 5 0 (5)
98 10.01.20.0322.453 Gentamycin Cream Kulit Tube 0 0 0 0
99 10.01.19.0422.0088 Gemfibrozil 300 mg Kaps 0 0 0 0
100 10.01.20.0824.0089 Gentian Violet Larutan 1% Btl 0 0 0 0
101 20.01.20.1120.0090 Haloperidol tablet 0,5 mg Tab 0 0 0 0
102 10.01.18.0623.0091 Haloperidol tablet 1,5 mg Tab 0 0 0 0
103 10.01.18.0620.0092 Haloperidol tablet 5 mg Tab 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
104 10.01.19.0123.0093 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0 0 0
105 10.01.17.1022.0094 Hidrokortison krim 2,5 mg Tub 0 0 0 0
106 10.01.17.1022.0512 Hidrogen Peroksida 3 % Botol 0 0 0 0
107 30.01.20.0624.0507 Isoniazid tab 100 mg Tab 0 0 0 0
109 10.01.18.0420.0096 Ibuprofen syr 100mg/ 5 ml Botol 6 6 0 6 0 (6)
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0
112 10.01.18.0722.0098 Isosorbid dinitrat tablet sublingual 5 mg Tab 0 0 0 0
113 10.01.20.0825.0099 Ichtiol salep pot 0 0 0 0
114 10.01.19.0422.0100 Kalsium laktat (kalk) tablet 500 gram Tab 0 0 0 0
115 10.01.20.1122.0101 Karbamazepin tablet 200 gram Tab 0 0 0 0
116 10.01.18.0322.0102 Kloramfenikol kapsul 250 mg Kap 0 0 0 0
117 10.01.19.0122.0103 Kloramfenikol salep mata 1 % Tub 0 0 0 0
118 20.01.20.0221.0104 Kloramfenikol Tetes Mata 0,5 % Btl 0 0 0 0
119 30.01.20.0823.0105 Kloramfenikol Tetes Telinga 1% Btl 0 0 0 0
120 10.01.19.0921.0106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0 0 0
121 10.01.19.0721.0107 Klorfeniramin maleat (CTM) tablet 4 mg Tab 0 0 0 0
122 10.01.19.0422.0108 Kloramfenikol Salep 2% (Bufacetine) Tub 0 0 0 0
123 10.01.20.0322.452 Klorpromazin HCl tablet salut 25 mg Tab 0 0 0 0
124 30.01.20.1022.0109 Klorpromazin HCl tablet salut 100 mg Tab 0 0 0 0
125 10.01.17.0819.0115 Klorpromazine HCL inj 25mg/ml-1 ml injeksi Amp 0 0 0 0
126 10.01.20.0923.0110 Kodein HCl tablet 10 mg Tab 0 0 0 0
127 10.01.19.0522.0111 Kotrimoksazol suspensi 480 mg/5 ml Btl 0 0 0 0
128 10.01.19.0522.0112 Kotrimoxazol Tablet Tab 0 0 0 0
129 10.01.19.0822.0113 Ketokonazole cream Tub 0 0 0 0
130 10.01.20.0423.0114 Ketokonazole 200mg Tab Tab 0 0 0 0
131 10.01.19.1120.0116 Lactulose 3,335 g/5ml Btl 0 0 0 0
132 10.01.19.0821.0117 Lansoprazole Kap 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0
135 10.01.18.0821.0120 Loratadine 5 mg Tab 0 0 0 0
136 10.01.17.0220.0121 Lar anhydrous dextrose,Nacl,Kcl,Na laktat,(KAEN 3A) Btl 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0
138 10.01.20.0823.0123 Metilergometrin maleat inj. 0,2 mg - 1 ml Amp 0 0 0 0
139 10.01.19.0122.0124 Metilergometrin maleat tablet 0,125 mg Tab 0 0 0 0
140 10.01.19.0322.0125 Miconazol 2 % cream Tub 0 0 0 0
141 10.01.19.0323.0126 Metoklopramide tablet 10 mg Tab 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
142 10.01.19.0822.0127 Metoklopramide Syrup Btl 0 0 0 0
143 10.01.19.0621.0128 Metoklopramide injeksi Amp 0 0 0 0
144 10.01.20.0322.450 Metronidazol Tablet 250 mg tablet Tab 0 0 0 0
145 20.01.20.1122.0129 Metronidazol Tablet 500 mg tablet Tab 0 0 0 0
146 10.01.20.1120.0130 Metronidazol larutan Infus 5 mg/ml Btl 0 0 0 0
147 10.01.19.0122.0131 Metronidazol syrup 125 mg / 5 ml Btl 0 0 0 0
148 10.01.20.0522.0132 Metilprednisolon 4 mg Tab 0 0 0 0
149 10.01.19.0123.0133 Metilprednisolon 16 mg Tab 0 0 0 0
150 10.01.10.0922.0134 Metformin 500 mg Tab 50 50 0 50 0 (50)
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0
152 10.01.19.0321.0136 Metamizole Inj 500mg/ml Amp 0 0 0 0
153 10.01.19.1121.0137 Metamizole 500mg kaplet Kaplet 0 0 0 0
154 10.01.20.1021.0138 Magnesium Sulfat 20% (MgSo4) Vial 0 0 0 0
155 10.01.20.1021.0139 Magnesium Sulfat 40% (MgSo4) Vial 0 0 0 0
156 10.01.20.0322.0140 Natrium klorida larutan infus 0,9% steril Btl 2 2 0 2 0 (2)
157 10.01.19.0723.0141 Nistatin 100.000 iu/g tablet vaginal Tab 0 0 0 0
158 10.01.18.0481.0142 Nistatin 500.000 iu tablet salut Tab 0 0 0 0
159 10.01.20.0323.0143 Natrium diclofenak 25 mg Tab 0 0 0 0
160 10.01.20.0822.0144 Natrium diclofenak 50 mg Tab 0 0 0 0
161 20.01.17.1020.0146 Obat batuk hitam (o.b.h) cairan Btl 2 2 0 2 0 (2)
162 20.01.19.1120.0147 Oksitosin injeksi 10 iu/ml - ml Amp 10 10 0 10 0 (10)
163 30.01.20.0721.451 Oksitetrasiklin Salep Kulit Tub 0 0 0 0
164 10.01.19.0222.0148 Oksitetrasiklin Salep Mata Tub 0 0 0 0
165 10.01.19.0921.0149 Omeprazole kapsul/kaplet 20 mg Kap 0 0 0 0
166 10.01.19.0921.0150 Ondansetron Tablet 8 Mg Tab 0 0 0 0
167 10.01.20.0822.0151 Parasetamol tetes 100mg/ 0,6 ml Botol 15 ml 3 3 3 5 5
168 30.01.20.1022.0152 Parasetamol syr 120 mg / 5 ml Btl 2 2 0 2 0 (2)
169 30.01.20.0722.0153 Parasetamol tablet 500 mg Tab 60 60 60 90 90
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0
171 10.01.17.0319.0154 Petidin HCl injeksi 50 mg/ml - 2 ml Amp 0 0 0 0
172 20.01.20.0921.0155 Piridoksin HCl tablet 10 mg Tab 0 0 0 0
173 10.01.20.0322.0156 Prednison tablet 5 mg Tab 0 0 0 0
174 10.01.17.0120.0157 Primakuin tablet 15 mg Tab 0 0 0 0
175 30.01.17.0621.0158 Propiltiourasil tablet 100 mg Tab 0 0 0 0
176 10.01.18.0721.0159 Propranolol HCl tablet 10 mg Tab 0 0 0 0
177 10.01.17.0920.0161 Piracetam Injeksi 1g / 5 ml Vial 0 0 0 0
178 10.01.20.0322.454 Piracetam 800 mg tab Tab 0 0 0 0
179 10.01.18.0220.0162 Pirazinamide 500mg tab tab 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
180 10.01.19.0723.0163 Pirantel Pamoat 125 mg Tab 0 0 0 0
181 30.01.20.0624.505 Pirantel Pamoat 250 mg Tab 0 0 0 0
182 30.01.19.0321.0164 Pirantel Pamoat Susp 125mg/5ml btl 0 0 0 0
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0
184 10.01.20.0723.0178 Permetrin krim (Scabimite 5% ) Tub 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0
186 10.01.17.0220.0167 Ringer laktat larutan infus steril Btl 5 5 2 3 3 0
187 10.01.20.0923.0168 Ranitidin tablet 150 mg Tab 0 0 0 0
188 10.01.19.1220.0169 Ranitidin Injeksi 50mg/2ml amp 5 5 0 5 0 (5)
189 10.01.20.0622.0170 Retinol (vitamin A) kapsul 100.000 iu Kap 0 0 0 0
190 10.01.19.0421.0171 Retinol (vitamin A) kapsul 200.000 iu Kap 0 0 0 0
191 10.01.20.0322.455 Rifampisin kaplet 300 mg Tab 0 0 0 0
192 20.01.18.0422.0172 Rifampisin kaplet 600 mg Tab 0 0 0 0
193 10.01.18.0921.0173 Salbutamol tablet 2 mg Tab 0 0 0 0
194 30.01.17.0721.0174 Salbutamol tablet 4 mg Tab 0 0 0 0
195 10.01.19.0421.0175 Salbutamol 2mg/5ml Syr Btl 0 0 0 0

196 10.01.18.0921.0176 Salep 2-4 kombinasi Pot 0 0 0 0
197 10.01.19.0019.0176 Salep 2-4 kombinasi Pot 0 0 0 0
198 10.01.18.0420.0177 Salisil bedak 2 % Ktk 0 0 0 0
199 10.01.19.0521.0179 Serum anti bisa ular polivalen inj. 5 ml (abu I) Vial 0 0 0 0
200 10.01.19.0820.0180 Serum anti tatanus inj. 1.500 iu/ampul (a.t.s I ) Amp 0 0 0 0
201 10.01.20.1021.0181 Sianokobalamin (Vit. B12) inj. 500 mcg/ml Amp 0 0 0 0
202 10.01.19.0923.0182 Sianokobalamin (Vit. B12) tablet 50 mcg Tab 0 0 0 0
203 10.01.18.0720.0183 Simvastatin tablet 10 mg Tab 50 50 0 50 0 (50)
204 10.01.19.0520.0184 Simvastatin tablet 20 mg Tab 0 0 0 0
205 10.01.19.0820.0516 Spironolactone 100 mg Tab 0 0 0 0
206 10.01.19.0820.0185 Spironolactone 25 mg Tab 0 0 0 0
207 10.01.20.0622.0186 Tablet tambah darah Tab 0 0 0 0
208 10.01.20.0322.456 Tetrasiklin 250 mg Tab 0 0 0 0
209 10.01.19.1021.0187 Tetrasiklin 500 mg Tab 0 0 0 0
210 10.01.17.0420.0188 Tiamin HCl (Vit. B1) inj. 100 mg/ml - 1 ml Amp 0 0 0 0
211 10.01.19.0923.0189 Tiamin HCl monohidrat (Vit. B1) tablet 50 mg Tab 0 0 0 0
212 10.01.18.0920.0190 Triheksifenidil hidroklorida tablet 2 mg Tab 0 0 0 0
213 10.01.18.0821.0191 Thiamfenikol tab 500 mg Amp 0 0 0 0
214 10.01.18.0221.0192 Vitamin B kompleks tablet Tab 0 0 0 0
215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0
216 10.01.18.0221.0195 Yodium povidon larutan 10 % 30 ml Btl 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
219 10.08.19.0320.0197 Zink Tablet 20 mg Tab 0 0 0 0
220 10.01.19.0221.0198 Zinc Sulfate Sirup 20mg/5ml Btl 0 0 0 0
GOLONGAN OBAT GIGI
221 30.01.19.1122.0516 Anastetik Lokal Gigi Kombinasi ( Lidocain kompositum injeksi ) amp 0 0 0 0
222 30.01.19.1122.0199 Cholorophenol camphor menthol (chkm) Set 0 0 0 0
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0
225 30.01.19.1220.0202 Ceivtron( tambalan sementara ) ktk 0 0 0 0
226 30.01.19.0521.0203 Devitalisasi Arsen Kotak 0 0 0 0
227 10.01.20.0322.458 Devitalisasi pasta (non arsen) caustinerf forte kotak 0 0 0 0
228 30.01.19.0921.0204 Etil klorida semprot Kaleng 0 0 0 0
229 30.01.19.0000.0205 Eugenol cairan Btl 0 0 0 0
230 30.01.19.1121.0206 Elite Cement Kotak 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0
232 30.01.19.1121.0513 Formokresol Botol 0 0 0 0
233 10.01.20.0322.459 kalsium hidroksida pasta tube 0 0 0 0
234 30.01.19.0121.0207 Glass Ionomer Cement (GK-Fuji IX) Kotak 0 0 0 0
235 10.01.20.0322.460 Iodoform paste Ktk 0 0 0 0
236 10.01.20.0322.461 Mummifying pasta / tempophore btl 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0
239 30.01.19.0221.0209 Semen Seng Fosfat serbuk dan cairan kotak 0 0 0 0
240 10.01.20.0322.462 Spons gelatin Cubicles 1 x 1 x 1 Cm Ktk 0 0 0 0
241 10.01.20.0322.463 Temporary stopingfletcher serbuk dan cairan Set 0 0 0 0
242 30.01.19.0000.0210 Trikresol formalin (TKF) cairan Btl 0 0 0 0
GOLONGAN OBAT BAHAN HABIS PAKAI
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0
245 10.01.20.0820.0213 Anti septic Poliwash (Chlorhexidine) Botol 0 0 0 0
246 10.01.18.0221.0214 Aseptic Gel Botol 0 0 0 0
247 20.01.20.0521.440 Antiseptic dan Desinfektan (Odex) Botol 0 0 0 0
248 20.01.20.0823.0215 Catgut/benang bedah no.2/0 Plain Sak 0 0 0 0
249 20.01.20.0421.0215 Catgut/benang bedah no.2/0 Chromic Sak 0 0 0 0
250 20.01.20.0524.0215 Catgut/benang bedah no.3/0 Plain Sak 0 0 0 0
251 10.01.17.1119.0216 Catgut/benang bedah no. 3/0 chromic Sak 0 0 0 0
252 10.01.19.1223.0217 Disposable Syringe 1 cc pcs 0 0 0 0
253 10.01.19.0423.0218 Disposable Syringe 2,5 cc pcs 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
254 10.01.17.0521.0219 Disposable Syringe 3 cc Pcs 0 0 0 0
257 10.01.17.0322.0223 Elastic band roll 0 0 0 0
258 10.01.19.0321.0224 Folley catheter no.16 Pcs 0 0 0 0
259 10.01.19.0421.0225 Folley catheter no.18 pcs 0 0 0 0
260 10.01.17.1121.0226 Folley catheter no.20 Pcs 0 0 0 0
261 10.01.19.0823.0227 Infus set anak pcs 0 0 0 0
262 30.01.19.0823.0228 Infus set dewasa pcs 0 0 0 0
263 10.01.20.1022.0254 IV Catheter No. 26 G Pcs 0 0 0 0
266 20.01.20.0424.0257 IV Catheter No 20G Pcs 0 0 0 0
267 10.01.19.1022.0258 IV Catheter No 18 G Pcs 0 0 0 0
268 30.01.17.0922.0229 Kapas berlemak 500 gram Bks 0 0 0 0
269 20.01.18.1021.0230 Kapas pembalut/absorben 250 gram Bks 0 0 0 0
270 20.01.20.0222.0231 Kapas pembalut 250 gram Bks 0 0 0 0
271 10.01.19.0223.0232 Kasa kompres 40/40 steril Rol 0 0 0 0
272 20.01.20.0525.0233 Kasa Steril 16x16 cm kotak 0 0 0 0
273 10.01.19.0523.0234 Kasa pembalut 36 m x 80 cm Rol 0 0 0 0
275 20.01.19.0224.0236 Kasa pembalut 2m x 80 cm Rol 0 0 0 0
276 20.01.19.1020.0237 Kasa Pembalut 40 m x 40 cm Rol 0 0 0 0
277 10.01.18.0422.0238 Kasa pembalut hidrofil 4 m x 10 cm Rol 0 0 0 0

279 10.01.18.0322.0240 Kasa Pembalut hidrofil 4 x 3 pack 0 0 0 0
280 10.01.19.1023.0242 Kasa Pembalut hidrofil 3,6m x 10cm Rol 0 0 0 0
281 10.01.18.0423.0243 Kasa steril Kasa Steril 10 x 10, 8ply, 1x10's Pcs 0 0 0 0
282 10.01.20.0122.0245 Mask Surgical 3 Ply (Earloop/Hijab/Tie On) pcs 0 0 0 0
283 30.01.18.1122.0247 Mask Nasal Oxygen Cannula Infant (anak) Pcs 0 0 0 0
284 30.01.18.1122.0248 Mask Nasal Oxygen Cannula Adult (dewasa) Pcs 0 0 0 0
285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0
286 10.01.19.1022.0250 Nebulizer Masker Infant Pcs 0 0 0 0
287 20.01.19.0583.0251 Nebulizer Masker Adult Pcs 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0
291 10.01.19.1022.0260 Pembalut gips 3 inchi Rol 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
292 20.01.20.0122.0261 Pap Smear kit Steril (L) set 0 0 0 0
293 30.01.18.0323.0262 Pap Smear kit Steril (M) set 0 0 0 0
294 10.01.18.0623.0263 Pap Smear kit Steril (S) set 0 0 0 0
295 10.01.18.0922.0264 Pharmafix 15x 500 cm Rol 0 0 0 0
298 20.01.20.0323.0267 Sarung Tangan Non Steril Ukuran S pcs 0 0 0 0

299 20.01.20.0824.0268 Sarung Tangan Non Steril Ukuran M pcs 0 0 0 0
300 20.01.20.0824.0269 Sarung Tangan Non Steril Ukuran L Pcs 50 50 0 50 0 (50)
301 30.01.19.0823.0270 Sarung Tangan Steril (Surgical gloves) 7,5 Pair 0 0 0 0
302 10.01.19.0923.0271 Sarung Tangan Steril (Surgical gloves) 6.5 Pair 0 0 0 0
303 10.01.19.0723.0272 Sarung Tangan Steril (Surgical gloves) 7 Pair 2 2 0 2 0 (2)
304 10.01.20.0322.444 Sarung Tangan Steril (Surgical gloves) 8 Pair 0 0 0 0
305 20.01.20.0219.0273 Surgical Blade No 15 Pcs 0 0 0 0
308 10.01.17.0821.0275 Silk (benang bedah sutera) no. 3/0 Box 0 0 0 0
309 30.01.20.0621.0276 Stik Kolesterol box 0 0 0 0
310 30.01.20.1221.0277 Stik Asam Urat box 0 0 0 0
311 30.01.20.0721.0278 Stik Gula Darah box 0 0 0 0
312 20.01.20.0422.436 Spekulum Vagina Ukuran S Set 0 0 0 0
313 20.01.20.1122.437 Spekulum Vagina Ukuran M Set 0 0 0 0
314 20.01.20.0422.438 Spekulum Vagina Ukuran L Set 0 0 0 0
315 10.01.20.0322.445 Steril Lubricant Jelly Botol 0 0 0 0
316 10.01.20.0921.0279 Ultrasonic gel Galon 0 0 0 0
317 10.01.18.0722.0280 Umbrical Cord Nylon OM Pcs 5 5 0 5 0 (5)
318 20.01.20.0921.439 Underpad Pcs 0 0 0 0
319 10.01.17.0122.0281 Urine bag Steril Pcs 0 0 0 0
GOLONGAN OBAT PROGRAM MALARIA
320 10.02.19.0621.0314 Artesunate Inj, vial 60 mg / ml vial 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0
325 10.02.18.0000.0318 Kaca Slide (objek glass frosted 7105 one) Pcs 0 0 0 0
326 10.02.19.0621.0319 Kuinin (kina) tab 222 mg tablet 0 0 0 0
327 10.02.19.0621.0320 LABORATORY KID PAKET 0 0 0 0
328 10.02.19.0621.0321 Mikroskop + Box Nikon Eclipse E-100 Unit 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0
330 10.02.20.1021.0323 Obat Anti Malaria DHP (Dihydroartemisinin) Tablet 0 0 0 0
331 10.02.20.0420.0323 Obat Anti Malaria DHP (Dihydroartemisinin) Tablet 0 0 0 0
332 10.02.20.0621.0324 Primakuin tab 15 mg tablet 0 0 0 0
333 10.02.20.1121.0325 Rapid Test Malaria (pf/PAN) combo Test 0 0 0 0
334 10.02.19.0621.0326 RDT DBD Combo TEST 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0

336 10.02.19.0621.0328 Sipermetrin zeta 15 UL Galon 0 0 0 0
GOLONGAN OBAT PROGRAM FILARIASIS
337 10.02.17.0620.0329 Albendazole 400 mg tablet 0 0 0 0
338 10.01.20.0322.442 Albendazole 200 mg / 5 ml sirup Botol 0 0 0 0
339 10.02.18.0820.0330 Dietil karbamazepin Sitrat tab 100 mg tablet 0 0 0 0
GOLONGAN OBAT PROGRAM TB PARU
340 10.01.20.0322.500 Catridge Gene Xpert MTB / RIF Buah 0 0 0 0
343 10.02.19.0824.0333 Masker Surgical pcs 0 0 0 0
344 10.02.20.0320.0334 Obat Anti tuberkulosis FDC I Paket 0 0 0 0
345 10.02.20.0121.0334 Obat Anti tuberkulosis FDC I Paket 0 0 0 0
346 10.02.18.0521.0335 Obat Anti tuberkulosis FDC II Paket 0 0 0 0
347 10.02.20.0521.0336 Obat Anti tuberkulosis Anak Paket 0 0 0 0
348 10.02.19.0722.0337 Obat Anti TBC FDC Kombipak kategori I Paket 0 0 0 0
349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0
GOLONGAN OBAT PROGRAM DIARE
351 10.02.20.0423.0340 Garam Oralit 200 ml Sac 0 0 0 0
352 10.02.20.1022.0341 ZINK Tablet 200 mg tablet 0 0 0 0
GOLONGAN OBAT PROGRAM ISPA
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0
354 10.02.18.0720.0343 Pulse Oxtmetri Portable Unit 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0
GOLONGAN OBAT PROGRAM KUSTA
356 10.02.20.1021.0345 MB.Dewasa blister 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0

358 10.02.20.0723.0346 PB.Dewasa blister 0 0 0 0
359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0
GOLONGAN OBAT PROGRAM IMUNISASI
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0
369 10.02.20.1121.0357 Polio BOVP 10 doses vial 0 0 0 0
370 10.02.18.0422.0358 Spidol Pen Marker Pcs 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0
372 10.02.18.1120.0360 Rabies Immune Globulin (Human) Vial 0 0 0 0
373 10.02.19.0620.0361 Tuberkulin Inj vial 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0
376 10.02.20.0522.0364 Vaksin Measles and Rubella 10 DS vial 0 0 0 0
377 10.02.20.0820.0577 Vaksin Influenza Vial 0 0 0 0
378 10.02.20.0221.0365 Vaksin Meningitis Vial 0 0 0 0
GOLONGAN OBAT PROGRAM GIZI
379 10.02.18.1120.0366 Ampisilin Serbuk injeksi i.m/i.v 1000mg vial 0 0 0 0
380 10.02.20.0522.0367 Besi (II) Sulphate (Tablet tambah darah Ibu Nifas) Tab 0 0 0 0
381 10.02.18.1021.0368 Diazepam injeksi 5 mg/ml Amp 0 0 0 0
382 10.02.18.0520.0369 Fenobarbital 50 mg injeksi Amp 0 0 0 0
383 10.02.18.1021.0370 Gentamisin Sulfat Injeksi 40 mg/ml Amp 0 0 0 0
384 10.02.19.0820.0371 Glukonas Kalsikus 1 gr Amp 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0
387 10.02.19.0820.0373 Magnesium Sulfat 40% (MgSo4) Btl 0 0 0 0
388 10.02.18.1120.0374 Magnesium Sulfat 20% (MgSo4) Btl 0 0 0 0
389 10.01.20.0322.466 MP ASI Biskuit Bks 0 0 0 0

390 10.02.19.0821.0375 Oksitetrasiklin Salep Mata Tub 0 0 0 0
391 10.02.18.0819.0376 Prokain Penisillin 3 juta IU vial 0 0 0 0
392 10.02.18.0420.0377 Phytomenadion 2 mg/ml Amp 0 0 0 0
393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0
GOLONGAN OBAT PROGRAM KIA
395 10.01.20.0322.467 Ampicillin Inj Vial 0 0 0 0
396 10.01.20.0322.468 Calsium Gluconas 100 mg/ml Injeksi Amp 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
397 10.02.19.0820.0380 Deteksi tes kehamilan Paket 0 0 0 0
398 10.01.20.0322.469 Diazepam inj 5 mg/ ml amp 0 0 0 0
399 10.01.20.0322.470 Fitomenadion 10 mg/ vit K inj amp 0 0 0 0
400 10.02.19.0820.0381 Glukonas Kalsikus 1 00 mg Amp 0 0 0 0
401 10.01.20.0322.471 Gentamicin 80 mg inj amp 0 0 0 0
402 10.01.20.0322.472 Implant KB buah 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0

404 20.01.20.0520.441 Masker Ibu Bersalin Pcs 0 0 0 0
405 10.02.19.1120.0382 Methylergometrin Injeksi 0,2 mg/1 ml Amp 0 0 0 0
406 10.01.20.0322.474 Metil ergometrine Maleat 125 mg tablet tab 0 0 0 0
407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0
409 10.01.20.0322.477 Natrium Tiroksin / Tyhrax tab tab 0 0 0 0
410 10.01.20.0322.478 Oksitosin Inj 10 IU 1 ml amp 0 0 0 0
411 10.01.20.0322.479 Prokain Penisiline 3 ml unit inj Vial 0 0 0 0
412 10.01.20.0322.480 Progesteron Depot Inj 1 ml Vial 0 0 0 0
413 10.01.20.0322.481 Pil KB Kombinasi cycles 0 0 0 0
414 10.01.20.0322.482 Urine Strip strip 0 0 0 0
GOLONGAN OBAT PROGRAM JIWA
415 10.01.20.0322.483 Amitripilin HCL 25 mg tablet tablet 0 0 0 0
416 10.01.20.0322.484 Fluoksetin 10 mg tablet tablet 0 0 0 0
417 10.01.20.0322.485 Haloperidol 0,5 mg Tab 0 0 0 0
418 10.01.20.0322.486 Haloperidol 1.5 mg Tab 0 0 0 0
419 10.01.20.0322.487 Haloperidol 5 mg Tab 0 0 0 0
420 10.01.20.0322.488 Haloperidol inj 5 mg/ml ampul 0 0 0 0
421 10.01.20.0322.489 Haloperidol dekanoat inj 50 mg/ml ampul 0 0 0 0
422 10.01.20.0322.490 Imipramin HCL 25 mg tablet tablet 0 0 0 0
423 10.02.19.1120.0383 Karbamazepin 200 mg Tab 0 0 0 0
424 10.01.20.0322.491 Klobazam 10 mg tablet tablet 0 0 0 0
425 10.01.20.0322.492 Klorpromazin 100 mg tablet tablet 0 0 0 0
426 10.01.20.0322.493 Klozapin 25 mg tablet tablet 0 0 0 0
427 10.01.20.0322.494 Metadon HCL 50 mg/5 ml btl 1 L 0 0 0 0
428 10.01.20.0322.495 Risperidon 2 mg Tablet tablet 0 0 0 0
429 10.01.20.0322.496 Triheksifenidil hidroklorida tablet 2 mg Tab 0 0 0 0
430 10.01.20.0322.497 Trifluoperazine HCL 5 mg tablet tablet 0 0 0 0
GOLONGAN OBAT PROGRAM HIV
431 10.01.20.0421.0418 Azithromicyn 1000mg + Cefixime 400mg Paket 0 0 0 0
432 10.01.20.0421.0419 Benzatin Penicillin 2,4 Juta IU vial 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
433 10.01.20.0421.0420 Blue Tipe (Mikropipet) Pcs 0 0 0 0
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0
435 10.01.20.0421.0422 Human Hexagon Sypilis Test 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0
437 10.01.20.0421.0424 Lubricant Sutra Pcs 0 0 0 0
438 10.01.20.0421.0425 Latex Sarung Tangan Pcs 0 0 0 0
439 10.01.20.0621.0426 Rapid I (SD Bioline HIV 1/2.3.0 Multi) Pcs 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0
441 10.01.20.0721.0428 Rapid Test HIV 3 Pcs 0 0 0 0
442 10.01.20.0222.0429 Rapid Test HBSAg Test 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0
444 10.01.20.0421.0431 RPR Sypilis RB Test 0 0 0 0
445 10.01.20.0421.0432 Swab Desinfektan (Descoderm) Pcs 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0
448 10.01.20.0421.0435 Yellow Tipe (mikropipet) Pcs 0 0 0 0
GOLONGAN OBAT TAMBAHAN
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0
450 10.01.18.0821.0283 Atapulgit (New Antides ) Tab 0 0 0 0
451 20.01.18.0523.0284 Bromheksin tablet 8 mg (HUSTAB P) Tab 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0
453 10.01.18.1122.0286 Bisacodyl suppositoria Supp 0 0 0 0
454 20.01.18.0523.0287 Counterpain cream tube 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0
456 20.01.18.0523.0289 Dextamine Tab Tab 0 0 0 0
457 20.01.18.0523.0290 Dextamine syr Btl 0 0 0 0
458 30.01.19.0621.0314 Diazepam Inj (Valisanbe ) Amp 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0
462 20.01.18.0523.0293 Hyperil (Ramipril 5 mg) Tab 0 0 0 0
463 20.01.20.0622.0294 Hyosine N Butil Bromide (SCOPMA) Tab 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0
466 10.01.20.0221.0104 Kloramfenikol Tetes Mata (RECO ) Btl 0 0 0 0
467 10.01.20.1022.0296 Kaolin Pektin (Novadiar syrup ) btl 6 6 6 9 9
468 20.01.20.0924.0297 Loperamid (colidium) tab 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
470 30.01.17.0422.0298 Levetran salep Pot 0 0 0 0
471 20.01.20.0922.0299 Noza Tab 0 0 0 0
472 10.01.19.0521.0145 Nifedipine (Adalat Oros) Tab 0 0 0 0
473 10.01.19.0822.0127 Metoklopramide Syrup (Primpen sirup 5 mg/5ml ) Btl 5 5 5 8 8
474 30.01.20.0523.0136 Metamizol 500 mg / ml Injeksi Amp 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0
476 20.01.18.0523.0301 Obat Flu Batuk Anak (Pimtracol syrup) Botol 0 0 0 0
477 20.01.18.0523.0301 Obat Flu Batuk Anak (Solafluz syrup) Botol 0 0 0 0
478 20.01.18.0523.0302 Obat Flu Batuk Neonatus (baby Cough) Btl 0 0 0 0
479 30.01.20.0624.502 Obat Flu Batuk Anak (HUFAGRIF) Btl 0 0 0 0
480 30.01.20.0425.0173 Salbutamol 2 mg (Lasal) Tab 0 0 0 0
481 30.01.20.0222.0303 Salbutamol Inhalasi (Salbulin) Kotak 0 0 0 0
482 20.01.18.0523.0304 Sakatonik abc tab 0 0 0 0
483 10.01.20.0523.0305 Stesolid Rectal (Diazepam enema 5mg/2,5 ml) tube 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0
485 20.01.18.0523.0307 Thromboflash Tube 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0
487 30.01.20.0623.0190 Triheksifenidil hidroklorida tablet 2 mg (Hexymer) Tab 0 0 0 0
488 20.01.18.0523.0309 Vitamin Neutropik (Bioron) Tab 0 0 0 0
489 20.01.18.0523.0310 Vitamin Tambah Darah Tab 0 0 0 0
490 20.01.18.0523.0311 Vitamin Anak (Tialisin syrup) btl 0 0 0 0
491 20.01.18.0523.0312 Vitamin Dewasa (Becefort tablet ) Tab 0 0 0 0
492 10.01.20.0322.465 Vital Ear Drop Botol 0 0 0 0
493 20.01.18.0523.0313 Ventolin Nebules 2,5 mg Amp 0 0 0 0
494 10.01.20.0322.0517 Ondansetron Injeksi Amp 0 0 0 0
JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH
Mengetahui / Menyetujui
Kepala Dinas Kesehatan Kepala IFK Kepala Puskesmas …………………. , 2021
………………………………… Pengelola Obat Instalasi

Farmasi Puskesmas ……………
………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….
Keterangan Kode : 10/𝐴 , 01/𝐵 , 20/𝐶 , 0820/𝐷 , 0001/𝐸 , /𝐹

A. Dua digit pertama (30 : APBD II, 20 : APBD I, 10 : APBN,00: BANTUAN )
B. Jenis Barang ( 01 = Program , 02 = PKD ,03 BANTUAN)
C. Tahun Masuk
D. Bulan dan Tahun Expired
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 10.01.19.0422.0001 Alopurinol tablet 100 mg Tab 50 50 0 50 0 (50)
2 10.01.18.0520.0002 Alopurinol tablet 300 mg Tab 0 0 0 0 0
3 30.01.20.0521.0003 Aminofilin tablet 200 mg Tab 0 0 0 0 0
4 10.01.20.0821.0004 Aminofilin injeksi 24 mg/ml - 10 ml Amp 0 0 0 0 0
5 10.01.20.0224.0005 Amitriptilin HCl tab. Salut 25 mg Tab 0 0 0 0 0
6 10.01.19.0821.0193 Ampisilin serbuk injeksi 250 mg (Viccillin ) Amp 0 0 0 0 0
7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 30 30 30 30 0 45 45
8 10.01.19.0522.0007 Amoksisillin 100mg Drop Amp 0 0 0 0 0
9 10.01.20.1022.0008 Amoksisilin sirup kering 125 mg / 5 ml Btl 3 3 3 5 5
11 10.01.17.0319.0160 Amoxilin Injeksi 1000mg Vial 0 0 0 0 0
12 10.01.19.0522.0010 Antasida Doen tablet kombinasi Tab 0 0 0 0 0
13 10.01.20.1121.0011 Antasida suspensi Btl 1 1 1 2 2
14 10.01.18.0822.0012 Antibakteri doen salep kombinasi (Bacitracin) Tub 0 0 0 0 0
15 10.01.19.0720.0013 Antihemoroid doen kombinasi Suppo 0 0 0 0 0
16 10.01.19.1022.0014 Antifungi doen kombinasi Pot 0 0 0 0 0
17 10.01.20.0323.0015 Antimigran doen kombinasi (Ergotamin) Tab 0 0 0 0 0
18 20.01.20.1222.0016 Aqua proinjeksi steril, bebas pirogen Btl 0 0 0 0 0
19 10.01.18.0322.0017 Asam askorbat (vit c) tablet 50 mg Tab 0 0 0 0 0
20 10.01.20.0322.446 Asam askorbat (vit c) tablet 250 mg 0 0 0 0 0
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0
22 30.01.20.0624.506 Atropin Tab 0,5 mg Tab 0 0 0 0 0
23 10.01.18.1019.0021 Atropin sulfat injeksi 0,25 mg/ml - 1 ml Amp 0 0 0 0 0
24 10.01.20.0522.0022 Acetyl Cystein 200mg Kaps 0 0 0 0 0
25 20.01.20.0923.0023 Acyclovir Cream Tube 0 0 0 0 0
26 10.01.18.0322.0024 Acyclovir tablet 200 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
28 20.01.20.1022.0026 Ambroksol sirup Btl 0 0 0 0 0
29 30.01.20.1221.0027 Ambroksol tablet 30mg Tab 0 0 0 0 0
30 10.01.20.1121.0028 Asam Mefenamat tablet 500 mg Tab 0 0 0 0 0
31 10.01.19.0222.0029 Asam Traneksamat Tablet 500 mg Tab 0 0 0 0 0
32 10.01.18.0722.0030 Asam Traneksamat 100 mg/5 ml Injeksi Amp 0 0 0 0 0
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
37 30.01.20.0624.0510 Asam folat tab 0,4mg Tab 0 0 0 0 0
38 10.01.19.0521.0035 Asam folat tab 1 mg Tab 0 0 0 0 0
39 10.01.19.0321.0036 Betametason krim 0,1 % Tub 0 0 0 0 0
40 10.01.20.0423.0037 Betahistin mesilate tablet 6 mg Tab 0 0 0 0 0
41 30.01.20.0123.0038 Cefadroxil 500 mg kaps Kaps 0 0 0 0 0
42 30.01.20.0520.0039 Cefadroxil sirup kering 125 mg/5ml Btl 0 0 0 0 0
44 10.01.19.1223.0040 Captopril tablet 12,5 mg Tab 0 0 0 0 0
45 30.01.20.0624.0041 Captopril tablet 25 mg Tab 0 0 0 0 0
47 10.01.20.0122.0043 Ciprofloxacin tablet 500 mg Tab 0 0 0 0 0
48 10.01.19.0521.0044 Cetirizine Tab 10 mg Tab 0 0 0 0 0
49 10.01.20.0922.0045 Cetirizine Sirup 5mg/5ml Btl 0 0 0 0 0
50 10.01.20.0822.0046 Ceptriaxon injeksi 1000 mg Vial 0 0 0 0 0
51 10.01.19.0421.0047 Cefotaxime Sodium Serb.Inj 1000 mg Vial 0 0 0 0 0
52 10.01.20.0322.0048 Clindamicin 150 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
55 10.01.20.0122.0049 Deksametason inj 5 mg/ml - 1 ml Amp 0 0 0 0 0
56 30.01.20.1022.0050 Deksametason tablet 0,5 mg Tab 0 0 0 0 0
57 10.01.20.0423.0051 Diazepam inj 5 mg/ml - 2 ml Amp 0 0 0 0 0
58 10.01.18.0822.0052 Diazepam tablet 5 mg Tab 0 0 0 0 0
60 30.01.20.0822.0054 Difenhidramin HCl inj 10 mg/ml - 1 ml Amp 0 0 0 0 0
61 10.01.19.0321.0055 Digoksin tablet 0,25 mg Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0
63 10.01.19.0623.0057 Dimenhidrat Kaplet 50 mg Tab 0 0 0 0 0
64 10.01.19.0522.0058 Domperidone tablet 10 mg Tab 0 0 0 0 0
65 10.01.20.0422.0059 Domperidon suspensi 5 mg / 5 ml Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
66 10.01.18.0720.0060 Doxycycline 100 mg Kaps 0 0 0 0 0
67 10.01.17.0219.0061 Efedrin HCl tablet 25 mg Tab 0 0 0 0 0
68 10.01.20.0222.0062 Epinefrin 1 mg/ml inj s.c/i.m Amp 0 0 0 0 0
69 30.01.18.1020.0063 Etakridin (rivanol) larutan 0,1 % Btl 0 0 0 0 0
70 30.01.18.0722.0064 Erytromicin kaplet 500 mg Kapl 0 0 0 0 0
71 10.01.20.0322.0448 Erytromicin Syrup 200 mg / 5 ml Botol 0 0 0 0 0
72 20.01.18.0522.0065 Etambutol tab 500mg ( HCL ) Tab 0 0 0 0 0
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0
75 30.01.19.0421.0067 Fenytoin Sodium 100 mg Kap 0 0 0 0 0
76 10.01.19.0321.0068 Fenol Gliserol Tetes Telinga 10% Btl 0 0 0 0 0
77 10.01.20.0523.0069 Fenobarbital injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0
78 10.01.20.0324.0070 Fenobarbital tablet 30 mg Tab 0 0 0 0 0
79 10.01.20.1121.0071 Fitomenadion (Vit K 1) Injeksi 2mg/ml Amp 0 0 0 0 0
81 10.01.19.0821.0072 Fitomenadion (vit K 1) tablet salut 10 mg Tab 0 0 0 0 0
82 10.01.19.0621.0073 Furosemid tablet 40 mg Tab 0 0 0 0 0
83 10.01.20.0222.0074 Furosemid inj 10mg/ml amp 0 0 0 0 0
84 10.01.19.1021.0075 Garam Oralit 200 ml Sachet 0 0 0 0 0
85 10.01.18.0323.0076 Glibenklamid Tab 0 0 0 0 0
86 20.01.20.0422.0077 Glimepiride 2 mg Tab 0 0 0 0 0
88 10.01.17.0921.0079 Gliseril guayakolat 100 mg Tab 0 0 0 0 0
89 20.01.20.0423.0080 Guaiafenesin 100 mg Tab 0 0 0 0 0
90 10.01.17.1121.0081 Gliserin / Gliserol Btl 0 0 0 0 0
91 10.01.20.0122.0082 Glukosa larutan infus 5 % steril Btl 2 2 2 2 3 3
92 10.01.18.0820.0083 Griseofulvin tablet 125 mg, micronized Tab 0 0 0 0 0
93 30.01.20.0624.0508 Griseofulvin tablet 250 mg Tab 0 0 0 0 0
95 10.01.17.1119.0085 Gentamycin Sulfat Inj 2 ml Amp 0 0 0 0 0
96 20.01.20.1022.0086 Gentamycin tetes mata 0,3 % Botol 2 2 1 1 2 1
97 10.01.19.0622.0087 Gentamycin Salep mata 0,3 % Tube 5 5 1 4 2 (3)
98 10.01.20.0322.453 Gentamycin Cream Kulit Tube 0 0 0 0 0
99 10.01.19.0422.0088 Gemfibrozil 300 mg Kaps 0 0 0 0 0
100 10.01.20.0824.0089 Gentian Violet Larutan 1% Btl 0 0 0 0 0
101 20.01.20.1120.0090 Haloperidol tablet 0,5 mg Tab 0 0 0 0 0
103 10.01.18.0620.0092 Haloperidol tablet 5 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
104 10.01.19.0123.0093 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0 0 0 0
105 10.01.17.1022.0094 Hidrokortison krim 2,5 mg Tub 0 0 0 0 0
106 10.01.17.1022.0512 Hidrogen Peroksida 3 % Botol 0 0 0 0 0
107 30.01.20.0624.0507 Isoniazid tab 100 mg Tab 0 0 0 0 0
109 10.01.18.0420.0096 Ibuprofen syr 100mg/ 5 ml Botol 6 6 6 9 9
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 6 6 0 6 0 (6)
112 10.01.18.0722.0098 Isosorbid dinitrat tablet sublingual 5 mg Tab 0 0 0 0 0
113 10.01.20.0825.0099 Ichtiol salep pot 0 0 0 0 0
114 10.01.19.0422.0100 Kalsium laktat (kalk) tablet 500 gram Tab 0 0 0 0 0
115 10.01.20.1122.0101 Karbamazepin tablet 200 gram Tab 0 0 0 0 0
116 10.01.18.0322.0102 Kloramfenikol kapsul 250 mg Kap 0 0 0 0 0
117 10.01.19.0122.0103 Kloramfenikol salep mata 1 % Tub 0 0 0 0 0
118 20.01.20.0221.0104 Kloramfenikol Tetes Mata 0,5 % Btl 0 0 0 0 0
119 30.01.20.0823.0105 Kloramfenikol Tetes Telinga 1% Btl 0 0 0 0 0
120 10.01.19.0921.0106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0 0 0 0
121 10.01.19.0721.0107 Klorfeniramin maleat (CTM) tablet 4 mg Tab 0 0 0 0 0
122 10.01.19.0422.0108 Kloramfenikol Salep 2% (Bufacetine) Tub 0 0 0 0 0
123 10.01.20.0322.452 Klorpromazin HCl tablet salut 25 mg Tab 0 0 0 0 0
125 10.01.17.0819.0115 Klorpromazine HCL inj 25mg/ml-1 ml injeksi Amp 0 0 0 0 0
126 10.01.20.0923.0110 Kodein HCl tablet 10 mg Tab 0 0 0 0 0
127 10.01.19.0522.0111 Kotrimoksazol suspensi 480 mg/5 ml Btl 0 0 0 0 0
128 10.01.19.0522.0112 Kotrimoxazol Tablet Tab 0 0 0 0 0
129 10.01.19.0822.0113 Ketokonazole cream Tub 0 0 0 0 0
130 10.01.20.0423.0114 Ketokonazole 200mg Tab Tab 0 0 0 0 0
131 10.01.19.1120.0116 Lactulose 3,335 g/5ml Btl 0 0 0 0 0
132 10.01.19.0821.0117 Lansoprazole Kap 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
135 10.01.18.0821.0120 Loratadine 5 mg Tab 0 0 0 0 0
136 10.01.17.0220.0121 Lar anhydrous dextrose,Nacl,Kcl,Na laktat,(KAEN 3A) Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0
138 10.01.20.0823.0123 Metilergometrin maleat inj. 0,2 mg - 1 ml Amp 0 0 0 0 0
139 10.01.19.0122.0124 Metilergometrin maleat tablet 0,125 mg Tab 0 0 0 0 0
140 10.01.19.0322.0125 Miconazol 2 % cream Tub 0 0 0 0 0
141 10.01.19.0323.0126 Metoklopramide tablet 10 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
142 10.01.19.0822.0127 Metoklopramide Syrup Btl 0 0 0 0 0
143 10.01.19.0621.0128 Metoklopramide injeksi Amp 0 0 0 0 0
144 10.01.20.0322.450 Metronidazol Tablet 250 mg tablet Tab 0 0 0 0 0
146 10.01.20.1120.0130 Metronidazol larutan Infus 5 mg/ml Btl 0 0 0 0 0
147 10.01.19.0122.0131 Metronidazol syrup 125 mg / 5 ml Btl 0 0 0 0 0
148 10.01.20.0522.0132 Metilprednisolon 4 mg Tab 0 0 0 0 0
150 10.01.10.0922.0134 Metformin 500 mg Tab 50 50 50 50 0 75 75
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
152 10.01.19.0321.0136 Metamizole Inj 500mg/ml Amp 0 0 0 0 0
153 10.01.19.1121.0137 Metamizole 500mg kaplet Kaplet 0 0 0 0 0
154 10.01.20.1021.0138 Magnesium Sulfat 20% (MgSo4) Vial 0 0 0 0 0
156 10.01.20.0322.0140 Natrium klorida larutan infus 0,9% steril Btl 2 2 2 2 0 3 3
157 10.01.19.0723.0141 Nistatin 100.000 iu/g tablet vaginal Tab 0 0 0 0 0
158 10.01.18.0481.0142 Nistatin 500.000 iu tablet salut Tab 0 0 0 0 0
159 10.01.20.0323.0143 Natrium diclofenak 25 mg Tab 0 0 0 0 0
161 20.01.17.1020.0146 Obat batuk hitam (o.b.h) cairan Btl 2 2 2 0 3 3
162 20.01.19.1120.0147 Oksitosin injeksi 10 iu/ml - ml Amp 10 10 1 9 2 (8)
163 30.01.20.0721.451 Oksitetrasiklin Salep Kulit Tub 0 0 0 0 0
164 10.01.19.0222.0148 Oksitetrasiklin Salep Mata Tub 0 0 0 0 0
165 10.01.19.0921.0149 Omeprazole kapsul/kaplet 20 mg Kap 0 0 0 0 0
166 10.01.19.0921.0150 Ondansetron Tablet 8 Mg Tab 0 0 0 0 0
168 30.01.20.1022.0152 Parasetamol syr 120 mg / 5 ml Btl 2 2 2 0 3 3
169 30.01.20.0722.0153 Parasetamol tablet 500 mg Tab 60 60 0 60 0 (60)
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0
171 10.01.17.0319.0154 Petidin HCl injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0
172 20.01.20.0921.0155 Piridoksin HCl tablet 10 mg Tab 0 0 0 0 0
173 10.01.20.0322.0156 Prednison tablet 5 mg Tab 0 0 0 0 0
174 10.01.17.0120.0157 Primakuin tablet 15 mg Tab 0 0 0 0 0
175 30.01.17.0621.0158 Propiltiourasil tablet 100 mg Tab 0 0 0 0 0
176 10.01.18.0721.0159 Propranolol HCl tablet 10 mg Tab 0 0 0 0 0
177 10.01.17.0920.0161 Piracetam Injeksi 1g / 5 ml Vial 0 0 0 0 0
178 10.01.20.0322.454 Piracetam 800 mg tab Tab 0 0 0 0 0
179 10.01.18.0220.0162 Pirazinamide 500mg tab tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
180 10.01.19.0723.0163 Pirantel Pamoat 125 mg Tab 0 0 0 0 0
182 30.01.19.0321.0164 Pirantel Pamoat Susp 125mg/5ml btl 0 0 0 0 0
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
184 10.01.20.0723.0178 Permetrin krim (Scabimite 5% ) Tub 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0
186 10.01.17.0220.0167 Ringer laktat larutan infus steril Btl 3 3 0 3 0 (3)
187 10.01.20.0923.0168 Ranitidin tablet 150 mg Tab 0 0 0 0 0
188 10.01.19.1220.0169 Ranitidin Injeksi 50mg/2ml amp 5 5 0 5 0 (5)
189 10.01.20.0622.0170 Retinol (vitamin A) kapsul 100.000 iu Kap 0 0 0 0 0
191 10.01.20.0322.455 Rifampisin kaplet 300 mg Tab 0 0 0 0 0
193 10.01.18.0921.0173 Salbutamol tablet 2 mg Tab 0 0 0 0 0
195 10.01.19.0421.0175 Salbutamol 2mg/5ml Syr Btl 0 0 0 0 0

196 10.01.18.0921.0176 Salep 2-4 kombinasi Pot 0 0 0 0 0
198 10.01.18.0420.0177 Salisil bedak 2 % Ktk 0 0 0 0 0
199 10.01.19.0521.0179 Serum anti bisa ular polivalen inj. 5 ml (abu I) Vial 0 0 0 0 0
200 10.01.19.0820.0180 Serum anti tatanus inj. 1.500 iu/ampul (a.t.s I ) Amp 0 0 0 0 0
201 10.01.20.1021.0181 Sianokobalamin (Vit. B12) inj. 500 mcg/ml Amp 0 0 0 0 0
202 10.01.19.0923.0182 Sianokobalamin (Vit. B12) tablet 50 mcg Tab 0 0 0 0 0
203 10.01.18.0720.0183 Simvastatin tablet 10 mg Tab 50 50 0 50 0 (50)
204 10.01.19.0520.0184 Simvastatin tablet 20 mg Tab 0 0 0 0 0
205 10.01.19.0820.0516 Spironolactone 100 mg Tab 0 0 0 0 0
207 10.01.20.0622.0186 Tablet tambah darah Tab 0 0 0 0 0
208 10.01.20.0322.456 Tetrasiklin 250 mg Tab 0 0 0 0 0
210 10.01.17.0420.0188 Tiamin HCl (Vit. B1) inj. 100 mg/ml - 1 ml Amp 0 0 0 0 0
211 10.01.19.0923.0189 Tiamin HCl monohidrat (Vit. B1) tablet 50 mg Tab 0 0 0 0 0
212 10.01.18.0920.0190 Triheksifenidil hidroklorida tablet 2 mg Tab 0 0 0 0 0
213 10.01.18.0821.0191 Thiamfenikol tab 500 mg Amp 0 0 0 0 0
214 10.01.18.0221.0192 Vitamin B kompleks tablet Tab 0 0 0 0 0
215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
216 10.01.18.0221.0195 Yodium povidon larutan 10 % 30 ml Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
219 10.08.19.0320.0197 Zink Tablet 20 mg Tab 0 0 0 0 0
220 10.01.19.0221.0198 Zinc Sulfate Sirup 20mg/5ml Btl 0 0 0 0 0
GOLONGAN OBAT GIGI
221 30.01.19.1122.0516 Anastetik Lokal Gigi Kombinasi ( Lidocain kompositum injeksi ) amp 0 0 0 0 0
222 30.01.19.1122.0199 Cholorophenol camphor menthol (chkm) Set 0 0 0 0 0
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
225 30.01.19.1220.0202 Ceivtron( tambalan sementara ) ktk 0 0 0 0 0
226 30.01.19.0521.0203 Devitalisasi Arsen Kotak 0 0 0 0 0
227 10.01.20.0322.458 Devitalisasi pasta (non arsen) caustinerf forte kotak 0 0 0 0 0
228 30.01.19.0921.0204 Etil klorida semprot Kaleng 0 0 0 0 0
229 30.01.19.0000.0205 Eugenol cairan Btl 0 0 0 0 0
230 30.01.19.1121.0206 Elite Cement Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
232 30.01.19.1121.0513 Formokresol Botol 0 0 0 0 0
233 10.01.20.0322.459 kalsium hidroksida pasta tube 0 0 0 0 0
234 30.01.19.0121.0207 Glass Ionomer Cement (GK-Fuji IX) Kotak 0 0 0 0 0
235 10.01.20.0322.460 Iodoform paste Ktk 0 0 0 0 0
236 10.01.20.0322.461 Mummifying pasta / tempophore btl 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
239 30.01.19.0221.0209 Semen Seng Fosfat serbuk dan cairan kotak 0 0 0 0 0
240 10.01.20.0322.462 Spons gelatin Cubicles 1 x 1 x 1 Cm Ktk 0 0 0 0 0
241 10.01.20.0322.463 Temporary stopingfletcher serbuk dan cairan Set 0 0 0 0 0
242 30.01.19.0000.0210 Trikresol formalin (TKF) cairan Btl 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
245 10.01.20.0820.0213 Anti septic Poliwash (Chlorhexidine) Botol 0 0 0 0 0
246 10.01.18.0221.0214 Aseptic Gel Botol 0 0 0 0 0
247 20.01.20.0521.440 Antiseptic dan Desinfektan (Odex) Botol 0 0 0 0 0
248 20.01.20.0823.0215 Catgut/benang bedah no.2/0 Plain Sak 0 0 0 0 0
249 20.01.20.0421.0215 Catgut/benang bedah no.2/0 Chromic Sak 0 0 0 0 0
251 10.01.17.1119.0216 Catgut/benang bedah no. 3/0 chromic Sak 0 0 0 0 0
252 10.01.19.1223.0217 Disposable Syringe 1 cc pcs 0 0 0 0 0
253 10.01.19.0423.0218 Disposable Syringe 2,5 cc pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
254 10.01.17.0521.0219 Disposable Syringe 3 cc Pcs 0 0 0 0 0
257 10.01.17.0322.0223 Elastic band roll 0 0 0 0 0
258 10.01.19.0321.0224 Folley catheter no.16 Pcs 0 0 0 0 0
259 10.01.19.0421.0225 Folley catheter no.18 pcs 0 0 0 0 0
261 10.01.19.0823.0227 Infus set anak pcs 0 0 0 0 0
262 30.01.19.0823.0228 Infus set dewasa pcs 0 0 0 0 0
263 10.01.20.1022.0254 IV Catheter No. 26 G Pcs 0 0 0 0 0
266 20.01.20.0424.0257 IV Catheter No 20G Pcs 0 0 0 0 0
267 10.01.19.1022.0258 IV Catheter No 18 G Pcs 0 0 0 0 0
268 30.01.17.0922.0229 Kapas berlemak 500 gram Bks 0 0 0 0 0
269 20.01.18.1021.0230 Kapas pembalut/absorben 250 gram Bks 0 0 0 0 0
270 20.01.20.0222.0231 Kapas pembalut 250 gram Bks 0 0 0 0 0
271 10.01.19.0223.0232 Kasa kompres 40/40 steril Rol 0 0 0 0 0
272 20.01.20.0525.0233 Kasa Steril 16x16 cm kotak 0 0 0 0 0
273 10.01.19.0523.0234 Kasa pembalut 36 m x 80 cm Rol 0 0 0 0 0
275 20.01.19.0224.0236 Kasa pembalut 2m x 80 cm Rol 0 0 0 0 0
276 20.01.19.1020.0237 Kasa Pembalut 40 m x 40 cm Rol 0 0 0 0 0
277 10.01.18.0422.0238 Kasa pembalut hidrofil 4 m x 10 cm Rol 0 0 0 0 0

279 10.01.18.0322.0240 Kasa Pembalut hidrofil 4 x 3 pack 0 0 0 0 0
280 10.01.19.1023.0242 Kasa Pembalut hidrofil 3,6m x 10cm Rol 0 0 0 0 0
281 10.01.18.0423.0243 Kasa steril Kasa Steril 10 x 10, 8ply, 1x10's Pcs 0 0 0 0 0
282 10.01.20.0122.0245 Mask Surgical 3 Ply (Earloop/Hijab/Tie On) pcs 0 0 0 0 0
283 30.01.18.1122.0247 Mask Nasal Oxygen Cannula Infant (anak) Pcs 0 0 0 0 0
284 30.01.18.1122.0248 Mask Nasal Oxygen Cannula Adult (dewasa) Pcs 0 0 0 0 0
285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
286 10.01.19.1022.0250 Nebulizer Masker Infant Pcs 0 0 0 0 0
287 20.01.19.0583.0251 Nebulizer Masker Adult Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
291 10.01.19.1022.0260 Pembalut gips 3 inchi Rol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
292 20.01.20.0122.0261 Pap Smear kit Steril (L) set 0 0 0 0 0
293 30.01.18.0323.0262 Pap Smear kit Steril (M) set 0 0 0 0 0
294 10.01.18.0623.0263 Pap Smear kit Steril (S) set 0 0 0 0 0
295 10.01.18.0922.0264 Pharmafix 15x 500 cm Rol 0 0 0 0 0
298 20.01.20.0323.0267 Sarung Tangan Non Steril Ukuran S pcs 0 0 0 0 0

299 20.01.20.0824.0268 Sarung Tangan Non Steril Ukuran M pcs 0 0 0 0 0
300 20.01.20.0824.0269 Sarung Tangan Non Steril Ukuran L Pcs 50 50 30 20 45 25
301 30.01.19.0823.0270 Sarung Tangan Steril (Surgical gloves) 7,5 Pair 0 0 0 0 0
302 10.01.19.0923.0271 Sarung Tangan Steril (Surgical gloves) 6.5 Pair 0 0 0 0 0
303 10.01.19.0723.0272 Sarung Tangan Steril (Surgical gloves) 7 Pair 2 2 0 2 0 (2)
304 10.01.20.0322.444 Sarung Tangan Steril (Surgical gloves) 8 Pair 0 0 0 0 0
305 20.01.20.0219.0273 Surgical Blade No 15 Pcs 0 0 0 0 0
308 10.01.17.0821.0275 Silk (benang bedah sutera) no. 3/0 Box 0 0 0 0 0
309 30.01.20.0621.0276 Stik Kolesterol box 0 0 0 0 0
310 30.01.20.1221.0277 Stik Asam Urat box 0 0 0 0 0
311 30.01.20.0721.0278 Stik Gula Darah box 0 0 0 0 0
312 20.01.20.0422.436 Spekulum Vagina Ukuran S Set 0 0 0 0 0
313 20.01.20.1122.437 Spekulum Vagina Ukuran M Set 0 0 0 0 0
314 20.01.20.0422.438 Spekulum Vagina Ukuran L Set 0 0 0 0 0
315 10.01.20.0322.445 Steril Lubricant Jelly Botol 0 0 0 0 0
316 10.01.20.0921.0279 Ultrasonic gel Galon 0 0 0 0 0
317 10.01.18.0722.0280 Umbrical Cord Nylon OM Pcs 5 5 4 1 6 5
318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
319 10.01.17.0122.0281 Urine bag Steril Pcs 0 0 0 0 0
320 10.02.19.0621.0314 Artesunate Inj, vial 60 mg / ml vial 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
325 10.02.18.0000.0318 Kaca Slide (objek glass frosted 7105 one) Pcs 0 0 0 0 0
326 10.02.19.0621.0319 Kuinin (kina) tab 222 mg tablet 0 0 0 0 0
327 10.02.19.0621.0320 LABORATORY KID PAKET 0 0 0 0 0
328 10.02.19.0621.0321 Mikroskop + Box Nikon Eclipse E-100 Unit 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
330 10.02.20.1021.0323 Obat Anti Malaria DHP (Dihydroartemisinin) Tablet 0 0 0 0 0
332 10.02.20.0621.0324 Primakuin tab 15 mg tablet 0 0 0 0 0
333 10.02.20.1121.0325 Rapid Test Malaria (pf/PAN) combo Test 0 0 0 0 0
334 10.02.19.0621.0326 RDT DBD Combo TEST 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

336 10.02.19.0621.0328 Sipermetrin zeta 15 UL Galon 0 0 0 0 0
337 10.02.17.0620.0329 Albendazole 400 mg tablet 0 0 0 0 0
338 10.01.20.0322.442 Albendazole 200 mg / 5 ml sirup Botol 0 0 0 0 0
339 10.02.18.0820.0330 Dietil karbamazepin Sitrat tab 100 mg tablet 0 0 0 0 0
340 10.01.20.0322.500 Catridge Gene Xpert MTB / RIF Buah 0 0 0 0 0
343 10.02.19.0824.0333 Masker Surgical pcs 0 0 0 0 0
344 10.02.20.0320.0334 Obat Anti tuberkulosis FDC I Paket 0 0 0 0 0
346 10.02.18.0521.0335 Obat Anti tuberkulosis FDC II Paket 0 0 0 0 0
347 10.02.20.0521.0336 Obat Anti tuberkulosis Anak Paket 0 0 0 0 0
348 10.02.19.0722.0337 Obat Anti TBC FDC Kombipak kategori I Paket 0 0 0 0 0
349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
351 10.02.20.0423.0340 Garam Oralit 200 ml Sac 0 0 0 0 0
352 10.02.20.1022.0341 ZINK Tablet 200 mg tablet 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
354 10.02.18.0720.0343 Pulse Oxtmetri Portable Unit 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
356 10.02.20.1021.0345 MB.Dewasa blister 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

358 10.02.20.0723.0346 PB.Dewasa blister 0 0 0 0 0
359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
369 10.02.20.1121.0357 Polio BOVP 10 doses vial 0 0 0 0 0
370 10.02.18.0422.0358 Spidol Pen Marker Pcs 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
372 10.02.18.1120.0360 Rabies Immune Globulin (Human) Vial 0 0 0 0 0
373 10.02.19.0620.0361 Tuberkulin Inj vial 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
376 10.02.20.0522.0364 Vaksin Measles and Rubella 10 DS vial 0 0 0 0 0
377 10.02.20.0820.0577 Vaksin Influenza Vial 0 0 0 0 0
378 10.02.20.0221.0365 Vaksin Meningitis Vial 0 0 0 0 0
379 10.02.18.1120.0366 Ampisilin Serbuk injeksi i.m/i.v 1000mg vial 0 0 0 0 0
380 10.02.20.0522.0367 Besi (II) Sulphate (Tablet tambah darah Ibu Nifas) Tab 0 0 0 0 0
381 10.02.18.1021.0368 Diazepam injeksi 5 mg/ml Amp 0 0 0 0 0
382 10.02.18.0520.0369 Fenobarbital 50 mg injeksi Amp 0 0 0 0 0
383 10.02.18.1021.0370 Gentamisin Sulfat Injeksi 40 mg/ml Amp 0 0 0 0 0
384 10.02.19.0820.0371 Glukonas Kalsikus 1 gr Amp 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0
387 10.02.19.0820.0373 Magnesium Sulfat 40% (MgSo4) Btl 0 0 0 0 0
389 10.01.20.0322.466 MP ASI Biskuit Bks 0 0 0 0 0

391 10.02.18.0819.0376 Prokain Penisillin 3 juta IU vial 0 0 0 0 0
392 10.02.18.0420.0377 Phytomenadion 2 mg/ml Amp 0 0 0 0 0
393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
395 10.01.20.0322.467 Ampicillin Inj Vial 0 0 0 0 0
396 10.01.20.0322.468 Calsium Gluconas 100 mg/ml Injeksi Amp 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
397 10.02.19.0820.0380 Deteksi tes kehamilan Paket 0 0 0 0 0
398 10.01.20.0322.469 Diazepam inj 5 mg/ ml amp 0 0 0 0 0
399 10.01.20.0322.470 Fitomenadion 10 mg/ vit K inj amp 0 0 0 0 0
400 10.02.19.0820.0381 Glukonas Kalsikus 1 00 mg Amp 0 0 0 0 0
401 10.01.20.0322.471 Gentamicin 80 mg inj amp 0 0 0 0 0
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

404 20.01.20.0520.441 Masker Ibu Bersalin Pcs 0 0 0 0 0
405 10.02.19.1120.0382 Methylergometrin Injeksi 0,2 mg/1 ml Amp 0 0 0 0 0
406 10.01.20.0322.474 Metil ergometrine Maleat 125 mg tablet tab 0 0 0 0 0
407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
409 10.01.20.0322.477 Natrium Tiroksin / Tyhrax tab tab 0 0 0 0 0
410 10.01.20.0322.478 Oksitosin Inj 10 IU 1 ml amp 0 0 0 0 0
411 10.01.20.0322.479 Prokain Penisiline 3 ml unit inj Vial 0 0 0 0 0
412 10.01.20.0322.480 Progesteron Depot Inj 1 ml Vial 0 0 0 0 0
413 10.01.20.0322.481 Pil KB Kombinasi cycles 0 0 0 0 0
414 10.01.20.0322.482 Urine Strip strip 0 0 0 0 0
415 10.01.20.0322.483 Amitripilin HCL 25 mg tablet tablet 0 0 0 0 0
416 10.01.20.0322.484 Fluoksetin 10 mg tablet tablet 0 0 0 0 0
417 10.01.20.0322.485 Haloperidol 0,5 mg Tab 0 0 0 0 0
418 10.01.20.0322.486 Haloperidol 1.5 mg Tab 0 0 0 0 0
419 10.01.20.0322.487 Haloperidol 5 mg Tab 0 0 0 0 0
420 10.01.20.0322.488 Haloperidol inj 5 mg/ml ampul 0 0 0 0 0
421 10.01.20.0322.489 Haloperidol dekanoat inj 50 mg/ml ampul 0 0 0 0 0
422 10.01.20.0322.490 Imipramin HCL 25 mg tablet tablet 0 0 0 0 0
423 10.02.19.1120.0383 Karbamazepin 200 mg Tab 0 0 0 0 0
424 10.01.20.0322.491 Klobazam 10 mg tablet tablet 0 0 0 0 0
425 10.01.20.0322.492 Klorpromazin 100 mg tablet tablet 0 0 0 0 0
426 10.01.20.0322.493 Klozapin 25 mg tablet tablet 0 0 0 0 0
427 10.01.20.0322.494 Metadon HCL 50 mg/5 ml btl 1 L 0 0 0 0 0
428 10.01.20.0322.495 Risperidon 2 mg Tablet tablet 0 0 0 0 0
430 10.01.20.0322.497 Trifluoperazine HCL 5 mg tablet tablet 0 0 0 0 0
431 10.01.20.0421.0418 Azithromicyn 1000mg + Cefixime 400mg Paket 0 0 0 0 0
432 10.01.20.0421.0419 Benzatin Penicillin 2,4 Juta IU vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
433 10.01.20.0421.0420 Blue Tipe (Mikropipet) Pcs 0 0 0 0 0
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
435 10.01.20.0421.0422 Human Hexagon Sypilis Test 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0
437 10.01.20.0421.0424 Lubricant Sutra Pcs 0 0 0 0 0
438 10.01.20.0421.0425 Latex Sarung Tangan Pcs 0 0 0 0 0
439 10.01.20.0621.0426 Rapid I (SD Bioline HIV 1/2.3.0 Multi) Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
441 10.01.20.0721.0428 Rapid Test HIV 3 Pcs 0 0 0 0 0
442 10.01.20.0222.0429 Rapid Test HBSAg Test 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
444 10.01.20.0421.0431 RPR Sypilis RB Test 0 0 0 0 0
445 10.01.20.0421.0432 Swab Desinfektan (Descoderm) Pcs 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
448 10.01.20.0421.0435 Yellow Tipe (mikropipet) Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
450 10.01.18.0821.0283 Atapulgit (New Antides ) Tab 0 0 0 0 0
451 20.01.18.0523.0284 Bromheksin tablet 8 mg (HUSTAB P) Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
453 10.01.18.1122.0286 Bisacodyl suppositoria Supp 0 0 0 0 0
454 20.01.18.0523.0287 Counterpain cream tube 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
456 20.01.18.0523.0289 Dextamine Tab Tab 0 0 0 0 0
457 20.01.18.0523.0290 Dextamine syr Btl 0 0 0 0 0
458 30.01.19.0621.0314 Diazepam Inj (Valisanbe ) Amp 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
462 20.01.18.0523.0293 Hyperil (Ramipril 5 mg) Tab 0 0 0 0 0
463 20.01.20.0622.0294 Hyosine N Butil Bromide (SCOPMA) Tab 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
466 10.01.20.0221.0104 Kloramfenikol Tetes Mata (RECO ) Btl 0 0 0 0 0
467 10.01.20.1022.0296 Kaolin Pektin (Novadiar syrup ) btl 0 0 6 0 0 0
468 20.01.20.0924.0297 Loperamid (colidium) tab 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
470 30.01.17.0422.0298 Levetran salep Pot 0 0 0 0 0
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
472 10.01.19.0521.0145 Nifedipine (Adalat Oros) Tab 0 0 0 0 0
474 30.01.20.0523.0136 Metamizol 500 mg / ml Injeksi Amp 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
476 20.01.18.0523.0301 Obat Flu Batuk Anak (Pimtracol syrup) Botol 0 0 0 0 0
477 20.01.18.0523.0301 Obat Flu Batuk Anak (Solafluz syrup) Botol 0 0 0 0 0
478 20.01.18.0523.0302 Obat Flu Batuk Neonatus (baby Cough) Btl 0 0 0 0 0
479 30.01.20.0624.502 Obat Flu Batuk Anak (HUFAGRIF) Btl 0 0 0 0 0
480 30.01.20.0425.0173 Salbutamol 2 mg (Lasal) Tab 0 0 0 0 0
481 30.01.20.0222.0303 Salbutamol Inhalasi (Salbulin) Kotak 0 0 0 0 0
482 20.01.18.0523.0304 Sakatonik abc tab 0 0 0 0 0
483 10.01.20.0523.0305 Stesolid Rectal (Diazepam enema 5mg/2,5 ml) tube 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
485 20.01.18.0523.0307 Thromboflash Tube 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0
487 30.01.20.0623.0190 Triheksifenidil hidroklorida tablet 2 mg (Hexymer) Tab 0 0 0 0 0
488 20.01.18.0523.0309 Vitamin Neutropik (Bioron) Tab 0 0 0 0 0
489 20.01.18.0523.0310 Vitamin Tambah Darah Tab 0 0 0 0 0
490 20.01.18.0523.0311 Vitamin Anak (Tialisin syrup) btl 0 0 0 0 0
491 20.01.18.0523.0312 Vitamin Dewasa (Becefort tablet ) Tab 0 0 0 0 0
492 10.01.20.0322.465 Vital Ear Drop Botol 0 0 0 0 0
493 20.01.18.0523.0313 Ventolin Nebules 2,5 mg Amp 0 0 0 0 0
494 10.01.20.0322.0517 Ondansetron Injeksi Amp 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 10.01.19.0422.0001 Alopurinol tablet 100 mg Tab 50 0 50 50 75 75
3 30.01.20.0521.0003 Aminofilin tablet 200 mg Tab 0 0 0 0 0 0
4 10.01.20.0821.0004 Aminofilin injeksi 24 mg/ml - 10 ml Amp 0 0 0 0 0 0
5 10.01.20.0224.0005 Amitriptilin HCl tab. Salut 25 mg Tab 0 0 0 0 0 0
6 10.01.19.0821.0193 Ampisilin serbuk injeksi 250 mg (Viccillin ) Amp 0 0 0 0 0 0
7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 0 0 0 0 0 0
8 10.01.19.0522.0007 Amoksisillin 100mg Drop Amp 0 0 0 0 0 0
9 10.01.20.1022.0008 Amoksisilin sirup kering 125 mg / 5 ml Btl 0 0 0 0 0 0
11 10.01.17.0319.0160 Amoxilin Injeksi 1000mg Vial 0 0 0 0 0 0
12 10.01.19.0522.0010 Antasida Doen tablet kombinasi Tab 0 0 0 0 0 0
13 10.01.20.1121.0011 Antasida suspensi Btl 0 0 0 0 0 0
14 10.01.18.0822.0012 Antibakteri doen salep kombinasi (Bacitracin) Tub 0 0 0 0 0 0
15 10.01.19.0720.0013 Antihemoroid doen kombinasi Suppo 0 0 0 0 0 0
16 10.01.19.1022.0014 Antifungi doen kombinasi Pot 0 0 0 0 0 0
17 10.01.20.0323.0015 Antimigran doen kombinasi (Ergotamin) Tab 0 0 0 0 0 0
18 20.01.20.1222.0016 Aqua proinjeksi steril, bebas pirogen Btl 0 0 0 0 0 0
19 10.01.18.0322.0017 Asam askorbat (vit c) tablet 50 mg Tab 0 0 0 0 0 0
20 10.01.20.0322.446 Asam askorbat (vit c) tablet 250 mg 0 0 0 0 0 0
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0 0
22 30.01.20.0624.506 Atropin Tab 0,5 mg Tab 0 0 0 0 0 0
23 10.01.18.1019.0021 Atropin sulfat injeksi 0,25 mg/ml - 1 ml Amp 0 0 0 0 0 0
24 10.01.20.0522.0022 Acetyl Cystein 200mg Kaps 0 0 0 0 0 0
25 20.01.20.0923.0023 Acyclovir Cream Tube 0 0 0 0 0 0
26 10.01.18.0322.0024 Acyclovir tablet 200 mg Tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
28 20.01.20.1022.0026 Ambroksol sirup Btl 0 5 5 5 8 8 5

29 30.01.20.1221.0027 Ambroksol tablet 30mg Tab 0 0 0 0 0 0
30 10.01.20.1121.0028 Asam Mefenamat tablet 500 mg Tab 0 0 0 0 0 0
31 10.01.19.0222.0029 Asam Traneksamat Tablet 500 mg Tab 0 0 0 0 0 0
32 10.01.18.0722.0030 Asam Traneksamat 100 mg/5 ml Injeksi Amp 0 0 0 0 0 0
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0 0
37 30.01.20.0624.0510 Asam folat tab 0,4mg Tab 0 0 0 0 0 0
38 10.01.19.0521.0035 Asam folat tab 1 mg Tab 0 0 0 0 0 0
39 10.01.19.0321.0036 Betametason krim 0,1 % Tub 0 0 0 0 0 0
40 10.01.20.0423.0037 Betahistin mesilate tablet 6 mg Tab 0 0 0 0 0 0
41 30.01.20.0123.0038 Cefadroxil 500 mg kaps Kaps 0 0 0 0 0 0
42 30.01.20.0520.0039 Cefadroxil sirup kering 125 mg/5ml Btl 0 0 0 0 0 0
44 10.01.19.1223.0040 Captopril tablet 12,5 mg Tab 0 0 0 0 0 0
45 30.01.20.0624.0041 Captopril tablet 25 mg Tab 0 0 0 0 0 0
47 10.01.20.0122.0043 Ciprofloxacin tablet 500 mg Tab 0 0 0 0 0 0
48 10.01.19.0521.0044 Cetirizine Tab 10 mg Tab 0 0 0 0 0 0
49 10.01.20.0922.0045 Cetirizine Sirup 5mg/5ml Btl 0 0 0 0 0 0
50 10.01.20.0822.0046 Ceptriaxon injeksi 1000 mg Vial 0 0 0 0 0 0
51 10.01.19.0421.0047 Cefotaxime Sodium Serb.Inj 1000 mg Vial 0 0 0 0 0 0
52 10.01.20.0322.0048 Clindamicin 150 mg Tab 0 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0 0
55 10.01.20.0122.0049 Deksametason inj 5 mg/ml - 1 ml Amp 0 0 0 0 0 0
56 30.01.20.1022.0050 Deksametason tablet 0,5 mg Tab 0 0 0 0 0 0
57 10.01.20.0423.0051 Diazepam inj 5 mg/ml - 2 ml Amp 0 0 0 0 0 0
58 10.01.18.0822.0052 Diazepam tablet 5 mg Tab 0 0 0 0 0 0
60 30.01.20.0822.0054 Difenhidramin HCl inj 10 mg/ml - 1 ml Amp 0 0 0 0 0 0
61 10.01.19.0321.0055 Digoksin tablet 0,25 mg Tab 0 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0 0
63 10.01.19.0623.0057 Dimenhidrat Kaplet 50 mg Tab 0 0 0 0 0 0
64 10.01.19.0522.0058 Domperidone tablet 10 mg Tab 0 0 0 0 0 0
65 10.01.20.0422.0059 Domperidon suspensi 5 mg / 5 ml Btl 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
66 10.01.18.0720.0060 Doxycycline 100 mg Kaps 0 0 0 0 0 0
67 10.01.17.0219.0061 Efedrin HCl tablet 25 mg Tab 0 0 0 0 0 0
68 10.01.20.0222.0062 Epinefrin 1 mg/ml inj s.c/i.m Amp 0 0 0 0 0 0
69 30.01.18.1020.0063 Etakridin (rivanol) larutan 0,1 % Btl 0 0 0 0 0 0
70 30.01.18.0722.0064 Erytromicin kaplet 500 mg Kapl 0 0 0 0 0 0
71 10.01.20.0322.0448 Erytromicin Syrup 200 mg / 5 ml Botol 0 0 0 0 0 0
72 20.01.18.0522.0065 Etambutol tab 500mg ( HCL ) Tab 0 0 0 0 0 0
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0 0
75 30.01.19.0421.0067 Fenytoin Sodium 100 mg Kap 0 0 0 0 0 0
76 10.01.19.0321.0068 Fenol Gliserol Tetes Telinga 10% Btl 0 0 0 0 0 0
77 10.01.20.0523.0069 Fenobarbital injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0 0
78 10.01.20.0324.0070 Fenobarbital tablet 30 mg Tab 0 0 0 0 0 0
79 10.01.20.1121.0071 Fitomenadion (Vit K 1) Injeksi 2mg/ml Amp 0 0 0 0 0 0
81 10.01.19.0821.0072 Fitomenadion (vit K 1) tablet salut 10 mg Tab 0 0 0 0 0 0
82 10.01.19.0621.0073 Furosemid tablet 40 mg Tab 0 0 0 0 0 0
83 10.01.20.0222.0074 Furosemid inj 10mg/ml amp 0 0 0 0 0 0
84 10.01.19.1021.0075 Garam Oralit 200 ml Sachet 0 0 0 0 0 0
85 10.01.18.0323.0076 Glibenklamid Tab 0 0 0 0 0 0
86 20.01.20.0422.0077 Glimepiride 2 mg Tab 0 0 0 0 0 0
88 10.01.17.0921.0079 Gliseril guayakolat 100 mg Tab 0 0 0 0 0 0
89 20.01.20.0423.0080 Guaiafenesin 100 mg Tab 0 0 0 0 0 0
90 10.01.17.1121.0081 Gliserin / Gliserol Btl 0 0 0 0 0 0
91 10.01.20.0122.0082 Glukosa larutan infus 5 % steril Btl 0 3 3 3 5 5 3

92 10.01.18.0820.0083 Griseofulvin tablet 125 mg, micronized Tab 0 0 0 0 0 0
93 30.01.20.0624.0508 Griseofulvin tablet 250 mg Tab 0 0 0 0 0 0
95 10.01.17.1119.0085 Gentamycin Sulfat Inj 2 ml Amp 0 0 0 0 0 0
96 20.01.20.1022.0086 Gentamycin tetes mata 0,3 % Botol 1 1 2 2 3 3 1

97 10.01.19.0622.0087 Gentamycin Salep mata 0,3 % Tube 4 0 4 4 6 6
98 10.01.20.0322.453 Gentamycin Cream Kulit Tube 0 0 0 0 0 0
99 10.01.19.0422.0088 Gemfibrozil 300 mg Kaps 0 0 0 0 0 0
100 10.01.20.0824.0089 Gentian Violet Larutan 1% Btl 0 0 0 0 0 0
101 20.01.20.1120.0090 Haloperidol tablet 0,5 mg Tab 0 0 0 0 0 0
103 10.01.18.0620.0092 Haloperidol tablet 5 mg Tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
104 10.01.19.0123.0093 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0 0 0 0 0
105 10.01.17.1022.0094 Hidrokortison krim 2,5 mg Tub 0 0 0 0 0 0
106 10.01.17.1022.0512 Hidrogen Peroksida 3 % Botol 0 0 0 0 0 0
107 30.01.20.0624.0507 Isoniazid tab 100 mg Tab 0 0 0 0 0 0
109 10.01.18.0420.0096 Ibuprofen syr 100mg/ 5 ml Botol 0 5 5 5 8 8 5

110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 6 0 6 6 9 9
112 10.01.18.0722.0098 Isosorbid dinitrat tablet sublingual 5 mg Tab 0 0 0 0 0 0
113 10.01.20.0825.0099 Ichtiol salep pot 0 0 0 0 0 0
114 10.01.19.0422.0100 Kalsium laktat (kalk) tablet 500 gram Tab 0 0 0 0 0 0
115 10.01.20.1122.0101 Karbamazepin tablet 200 gram Tab 0 0 0 0 0 0
116 10.01.18.0322.0102 Kloramfenikol kapsul 250 mg Kap 0 0 0 0 0 0
117 10.01.19.0122.0103 Kloramfenikol salep mata 1 % Tub 0 0 0 0 0 0
118 20.01.20.0221.0104 Kloramfenikol Tetes Mata 0,5 % Btl 0 0 0 0 0 0
119 30.01.20.0823.0105 Kloramfenikol Tetes Telinga 1% Btl 0 0 0 0 0 0
120 10.01.19.0921.0106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0 0 0 0 0
121 10.01.19.0721.0107 Klorfeniramin maleat (CTM) tablet 4 mg Tab 0 0 0 0 0 0
122 10.01.19.0422.0108 Kloramfenikol Salep 2% (Bufacetine) Tub 0 0 0 0 0 0
123 10.01.20.0322.452 Klorpromazin HCl tablet salut 25 mg Tab 0 0 0 0 0 0
125 10.01.17.0819.0115 Klorpromazine HCL inj 25mg/ml-1 ml injeksi Amp 0 0 0 0 0 0
126 10.01.20.0923.0110 Kodein HCl tablet 10 mg Tab 0 0 0 0 0 0
127 10.01.19.0522.0111 Kotrimoksazol suspensi 480 mg/5 ml Btl 0 0 0 0 0 0
128 10.01.19.0522.0112 Kotrimoxazol Tablet Tab 0 0 0 0 0 0
129 10.01.19.0822.0113 Ketokonazole cream Tub 0 0 0 0 0 0
130 10.01.20.0423.0114 Ketokonazole 200mg Tab Tab 0 0 0 0 0 0
131 10.01.19.1120.0116 Lactulose 3,335 g/5ml Btl 0 0 0 0 0 0
132 10.01.19.0821.0117 Lansoprazole Kap 0 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0 0
135 10.01.18.0821.0120 Loratadine 5 mg Tab 0 0 0 0 0 0
136 10.01.17.0220.0121 Lar anhydrous dextrose,Nacl,Kcl,Na laktat,(KAEN 3A) Btl 0 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0 0
138 10.01.20.0823.0123 Metilergometrin maleat inj. 0,2 mg - 1 ml Amp 0 0 0 0 0 0
139 10.01.19.0122.0124 Metilergometrin maleat tablet 0,125 mg Tab 0 0 0 0 0 0
140 10.01.19.0322.0125 Miconazol 2 % cream Tub 0 0 0 0 0 0
141 10.01.19.0323.0126 Metoklopramide tablet 10 mg Tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
142 10.01.19.0822.0127 Metoklopramide Syrup Btl 0 0 0 0 0 0
143 10.01.19.0621.0128 Metoklopramide injeksi Amp 0 0 0 0 0 0
144 10.01.20.0322.450 Metronidazol Tablet 250 mg tablet Tab 0 0 0 0 0 0
146 10.01.20.1120.0130 Metronidazol larutan Infus 5 mg/ml Btl 0 0 0 0 0 0
147 10.01.19.0122.0131 Metronidazol syrup 125 mg / 5 ml Btl 0 0 0 0 0 0
148 10.01.20.0522.0132 Metilprednisolon 4 mg Tab 0 0 0 0 0 0
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 80 80 80 120 120 80

151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0 0
152 10.01.19.0321.0136 Metamizole Inj 500mg/ml Amp 0 0 0 0 0 0
153 10.01.19.1121.0137 Metamizole 500mg kaplet Kaplet 0 0 0 0 0 0
154 10.01.20.1021.0138 Magnesium Sulfat 20% (MgSo4) Vial 0 0 0 0 0 0
156 10.01.20.0322.0140 Natrium klorida larutan infus 0,9% steril Btl 0 3 3 3 5 5 3

157 10.01.19.0723.0141 Nistatin 100.000 iu/g tablet vaginal Tab 0 0 0 0 0 0
158 10.01.18.0481.0142 Nistatin 500.000 iu tablet salut Tab 0 0 0 0 0 0
159 10.01.20.0323.0143 Natrium diclofenak 25 mg Tab 0 0 0 0 0 0
162 20.01.19.1120.0147 Oksitosin injeksi 10 iu/ml - ml Amp 9 0 9 9 14 14
163 30.01.20.0721.451 Oksitetrasiklin Salep Kulit Tub 0 0 0 0 0 0
164 10.01.19.0222.0148 Oksitetrasiklin Salep Mata Tub 0 0 0 0 0 0
165 10.01.19.0921.0149 Omeprazole kapsul/kaplet 20 mg Kap 0 0 0 0 0 0
166 10.01.19.0921.0150 Ondansetron Tablet 8 Mg Tab 0 0 0 0 0 0
167 10.01.20.0822.0151 Parasetamol tetes 100mg/ 0,6 ml Botol 15 ml 0 5 5 5 8 8 5

168 30.01.20.1022.0152 Parasetamol syr 120 mg / 5 ml Btl 0 3 3 3 5 5 3
169 30.01.20.0722.0153 Parasetamol tablet 500 mg Tab 60 0 60 60 90 90
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0 0
171 10.01.17.0319.0154 Petidin HCl injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0 0
172 20.01.20.0921.0155 Piridoksin HCl tablet 10 mg Tab 0 0 0 0 0 0
173 10.01.20.0322.0156 Prednison tablet 5 mg Tab 0 0 0 0 0 0
174 10.01.17.0120.0157 Primakuin tablet 15 mg Tab 0 0 0 0 0 0
175 30.01.17.0621.0158 Propiltiourasil tablet 100 mg Tab 0 0 0 0 0 0
176 10.01.18.0721.0159 Propranolol HCl tablet 10 mg Tab 0 0 0 0 0 0
177 10.01.17.0920.0161 Piracetam Injeksi 1g / 5 ml Vial 0 0 0 0 0 0
178 10.01.20.0322.454 Piracetam 800 mg tab Tab 0 0 0 0 0 0
179 10.01.18.0220.0162 Pirazinamide 500mg tab tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
180 10.01.19.0723.0163 Pirantel Pamoat 125 mg Tab 0 0 0 0 0 0
182 30.01.19.0321.0164 Pirantel Pamoat Susp 125mg/5ml btl 0 0 0 0 0 0
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0 0
184 10.01.20.0723.0178 Permetrin krim (Scabimite 5% ) Tub 0 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0 0
186 10.01.17.0220.0167 Ringer laktat larutan infus steril Btl 3 0 3 3 5 5
187 10.01.20.0923.0168 Ranitidin tablet 150 mg Tab 0 0 0 0 0 0
188 10.01.19.1220.0169 Ranitidin Injeksi 50mg/2ml amp 5 0 5 5 8 8
189 10.01.20.0622.0170 Retinol (vitamin A) kapsul 100.000 iu Kap 0 0 0 0 0 0
191 10.01.20.0322.455 Rifampisin kaplet 300 mg Tab 0 0 0 0 0 0
193 10.01.18.0921.0173 Salbutamol tablet 2 mg Tab 0 0 0 0 0 0
195 10.01.19.0421.0175 Salbutamol 2mg/5ml Syr Btl 0 0 0 0 0 0

196 10.01.18.0921.0176 Salep 2-4 kombinasi Pot 0 0 0 0 0 0
198 10.01.18.0420.0177 Salisil bedak 2 % Ktk 0 0 0 0 0 0
199 10.01.19.0521.0179 Serum anti bisa ular polivalen inj. 5 ml (abu I) Vial 0 0 0 0 0 0
200 10.01.19.0820.0180 Serum anti tatanus inj. 1.500 iu/ampul (a.t.s I ) Amp 0 0 0 0 0 0
201 10.01.20.1021.0181 Sianokobalamin (Vit. B12) inj. 500 mcg/ml Amp 0 0 0 0 0 0
202 10.01.19.0923.0182 Sianokobalamin (Vit. B12) tablet 50 mcg Tab 0 0 0 0 0 0
203 10.01.18.0720.0183 Simvastatin tablet 10 mg Tab 50 0 50 50 75 75
205 10.01.19.0820.0516 Spironolactone 100 mg Tab 0 0 0 0 0 0
207 10.01.20.0622.0186 Tablet tambah darah Tab 0 0 0 0 0 0
208 10.01.20.0322.456 Tetrasiklin 250 mg Tab 0 0 0 0 0 0
210 10.01.17.0420.0188 Tiamin HCl (Vit. B1) inj. 100 mg/ml - 1 ml Amp 0 0 0 0 0 0
211 10.01.19.0923.0189 Tiamin HCl monohidrat (Vit. B1) tablet 50 mg Tab 0 0 0 0 0 0
212 10.01.18.0920.0190 Triheksifenidil hidroklorida tablet 2 mg Tab 0 0 0 0 0 0
213 10.01.18.0821.0191 Thiamfenikol tab 500 mg Amp 0 0 0 0 0 0
214 10.01.18.0221.0192 Vitamin B kompleks tablet Tab 0 0 0 0 0 0
215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0 0
216 10.01.18.0221.0195 Yodium povidon larutan 10 % 30 ml Btl 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
219 10.08.19.0320.0197 Zink Tablet 20 mg Tab 0 0 0 0 0 0
220 10.01.19.0221.0198 Zinc Sulfate Sirup 20mg/5ml Btl 0 0 0 0 0 0
GOLONGAN OBAT GIGI 0
221 30.01.19.1122.0516 Anastetik Lokal Gigi Kombinasi ( Lidocain kompositum injeksi ) amp 0 0 0 0 0 0
222 30.01.19.1122.0199 Cholorophenol camphor menthol (chkm) Set 0 0 0 0 0 0
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0 0
225 30.01.19.1220.0202 Ceivtron( tambalan sementara ) ktk 0 0 0 0 0 0
226 30.01.19.0521.0203 Devitalisasi Arsen Kotak 0 0 0 0 0 0
227 10.01.20.0322.458 Devitalisasi pasta (non arsen) caustinerf forte kotak 0 0 0 0 0 0
228 30.01.19.0921.0204 Etil klorida semprot Kaleng 0 0 0 0 0 0
229 30.01.19.0000.0205 Eugenol cairan Btl 0 0 0 0 0 0
230 30.01.19.1121.0206 Elite Cement Kotak 0 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0 0
232 30.01.19.1121.0513 Formokresol Botol 0 0 0 0 0 0
233 10.01.20.0322.459 kalsium hidroksida pasta tube 0 0 0 0 0 0
234 30.01.19.0121.0207 Glass Ionomer Cement (GK-Fuji IX) Kotak 0 0 0 0 0 0
235 10.01.20.0322.460 Iodoform paste Ktk 0 0 0 0 0 0
236 10.01.20.0322.461 Mummifying pasta / tempophore btl 0 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0 0
239 30.01.19.0221.0209 Semen Seng Fosfat serbuk dan cairan kotak 0 0 0 0 0 0
240 10.01.20.0322.462 Spons gelatin Cubicles 1 x 1 x 1 Cm Ktk 0 0 0 0 0 0
241 10.01.20.0322.463 Temporary stopingfletcher serbuk dan cairan Set 0 0 0 0 0 0
242 30.01.19.0000.0210 Trikresol formalin (TKF) cairan Btl 0 0 0 0 0 0
GOLONGAN OBAT BAHAN HABIS PAKAI 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0 0
245 10.01.20.0820.0213 Anti septic Poliwash (Chlorhexidine) Botol 0 0 0 0 0 0
246 10.01.18.0221.0214 Aseptic Gel Botol 0 0 0 0 0 0
247 20.01.20.0521.440 Antiseptic dan Desinfektan (Odex) Botol 0 0 0 0 0 0
248 20.01.20.0823.0215 Catgut/benang bedah no.2/0 Plain Sak 0 0 0 0 0 0
249 20.01.20.0421.0215 Catgut/benang bedah no.2/0 Chromic Sak 0 0 0 0 0 0
251 10.01.17.1119.0216 Catgut/benang bedah no. 3/0 chromic Sak 0 0 0 0 0 0
252 10.01.19.1223.0217 Disposable Syringe 1 cc pcs 0 0 0 0 0 0
253 10.01.19.0423.0218 Disposable Syringe 2,5 cc pcs 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
254 10.01.17.0521.0219 Disposable Syringe 3 cc Pcs 0 0 0 0 0 0
257 10.01.17.0322.0223 Elastic band roll 0 0 0 0 0 0
258 10.01.19.0321.0224 Folley catheter no.16 Pcs 0 0 0 0 0 0
259 10.01.19.0421.0225 Folley catheter no.18 pcs 0 0 0 0 0 0
261 10.01.19.0823.0227 Infus set anak pcs 0 0 0 0 0 0
262 30.01.19.0823.0228 Infus set dewasa pcs 0 0 0 0 0 0
263 10.01.20.1022.0254 IV Catheter No. 26 G Pcs 0 0 0 0 0 0
266 20.01.20.0424.0257 IV Catheter No 20G Pcs 0 0 0 0 0 0
267 10.01.19.1022.0258 IV Catheter No 18 G Pcs 0 0 0 0 0 0
268 30.01.17.0922.0229 Kapas berlemak 500 gram Bks 0 0 0 0 0 0
269 20.01.18.1021.0230 Kapas pembalut/absorben 250 gram Bks 0 0 0 0 0 0
270 20.01.20.0222.0231 Kapas pembalut 250 gram Bks 0 0 0 0 0 0
271 10.01.19.0223.0232 Kasa kompres 40/40 steril Rol 0 0 0 0 0 0
272 20.01.20.0525.0233 Kasa Steril 16x16 cm kotak 0 0 0 0 0 0
273 10.01.19.0523.0234 Kasa pembalut 36 m x 80 cm Rol 0 0 0 0 0 0
275 20.01.19.0224.0236 Kasa pembalut 2m x 80 cm Rol 0 0 0 0 0 0
276 20.01.19.1020.0237 Kasa Pembalut 40 m x 40 cm Rol 0 0 0 0 0 0
277 10.01.18.0422.0238 Kasa pembalut hidrofil 4 m x 10 cm Rol 0 0 0 0 0 0

279 10.01.18.0322.0240 Kasa Pembalut hidrofil 4 x 3 pack 0 0 0 0 0 0
280 10.01.19.1023.0242 Kasa Pembalut hidrofil 3,6m x 10cm Rol 0 0 0 0 0 0
281 10.01.18.0423.0243 Kasa steril Kasa Steril 10 x 10, 8ply, 1x10's Pcs 0 0 0 0 0 0
282 10.01.20.0122.0245 Mask Surgical 3 Ply (Earloop/Hijab/Tie On) pcs 0 0 0 0 0 0
283 30.01.18.1122.0247 Mask Nasal Oxygen Cannula Infant (anak) Pcs 0 0 0 0 0 0
284 30.01.18.1122.0248 Mask Nasal Oxygen Cannula Adult (dewasa) Pcs 0 0 0 0 0 0
285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0 0
286 10.01.19.1022.0250 Nebulizer Masker Infant Pcs 0 0 0 0 0 0
287 20.01.19.0583.0251 Nebulizer Masker Adult Pcs 0 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0 0
291 10.01.19.1022.0260 Pembalut gips 3 inchi Rol 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
292 20.01.20.0122.0261 Pap Smear kit Steril (L) set 0 0 0 0 0 0
293 30.01.18.0323.0262 Pap Smear kit Steril (M) set 0 0 0 0 0 0
294 10.01.18.0623.0263 Pap Smear kit Steril (S) set 0 0 0 0 0 0
295 10.01.18.0922.0264 Pharmafix 15x 500 cm Rol 0 0 0 0 0 0
298 20.01.20.0323.0267 Sarung Tangan Non Steril Ukuran S pcs 0 0 0 0 0 0

299 20.01.20.0824.0268 Sarung Tangan Non Steril Ukuran M pcs 0 0 0 0 0 0
301 30.01.19.0823.0270 Sarung Tangan Steril (Surgical gloves) 7,5 Pair 0 0 0 0 0 0
302 10.01.19.0923.0271 Sarung Tangan Steril (Surgical gloves) 6.5 Pair 0 0 0 0 0 0
303 10.01.19.0723.0272 Sarung Tangan Steril (Surgical gloves) 7 Pair 2 0 2 2 3 3
305 20.01.20.0219.0273 Surgical Blade No 15 Pcs 0 0 0 0 0 0
308 10.01.17.0821.0275 Silk (benang bedah sutera) no. 3/0 Box 0 0 0 0 0 0
309 30.01.20.0621.0276 Stik Kolesterol box 0 0 0 0 0 0
310 30.01.20.1221.0277 Stik Asam Urat box 0 0 0 0 0 0
311 30.01.20.0721.0278 Stik Gula Darah box 0 0 0 0 0 0
312 20.01.20.0422.436 Spekulum Vagina Ukuran S Set 0 0 0 0 0 0
313 20.01.20.1122.437 Spekulum Vagina Ukuran M Set 0 0 0 0 0 0
314 20.01.20.0422.438 Spekulum Vagina Ukuran L Set 0 0 0 0 0 0
315 10.01.20.0322.445 Steril Lubricant Jelly Botol 0 0 0 0 0 0
316 10.01.20.0921.0279 Ultrasonic gel Galon 0 0 0 0 0 0
318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0 0
319 10.01.17.0122.0281 Urine bag Steril Pcs 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM MALARIA 0
320 10.02.19.0621.0314 Artesunate Inj, vial 60 mg / ml vial 0 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0 0
325 10.02.18.0000.0318 Kaca Slide (objek glass frosted 7105 one) Pcs 0 0 0 0 0 0
326 10.02.19.0621.0319 Kuinin (kina) tab 222 mg tablet 0 0 0 0 0 0
327 10.02.19.0621.0320 LABORATORY KID PAKET 0 0 0 0 0 0
328 10.02.19.0621.0321 Mikroskop + Box Nikon Eclipse E-100 Unit 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0 0
330 10.02.20.1021.0323 Obat Anti Malaria DHP (Dihydroartemisinin) Tablet 0 0 0 0 0 0
332 10.02.20.0621.0324 Primakuin tab 15 mg tablet 0 0 0 0 0 0
333 10.02.20.1121.0325 Rapid Test Malaria (pf/PAN) combo Test 0 0 0 0 0 0
334 10.02.19.0621.0326 RDT DBD Combo TEST 0 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0 0

336 10.02.19.0621.0328 Sipermetrin zeta 15 UL Galon 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM FILARIASIS 0
337 10.02.17.0620.0329 Albendazole 400 mg tablet 0 0 0 0 0 0
338 10.01.20.0322.442 Albendazole 200 mg / 5 ml sirup Botol 0 0 0 0 0 0
339 10.02.18.0820.0330 Dietil karbamazepin Sitrat tab 100 mg tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM TB PARU 0
340 10.01.20.0322.500 Catridge Gene Xpert MTB / RIF Buah 0 0 0 0 0 0
343 10.02.19.0824.0333 Masker Surgical pcs 0 0 0 0 0 0
344 10.02.20.0320.0334 Obat Anti tuberkulosis FDC I Paket 0 0 0 0 0 0
346 10.02.18.0521.0335 Obat Anti tuberkulosis FDC II Paket 0 0 0 0 0 0
347 10.02.20.0521.0336 Obat Anti tuberkulosis Anak Paket 0 0 0 0 0 0
348 10.02.19.0722.0337 Obat Anti TBC FDC Kombipak kategori I Paket 0 0 0 0 0 0
349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM DIARE 0
351 10.02.20.0423.0340 Garam Oralit 200 ml Sac 0 0 0 0 0 0

352 10.02.20.1022.0341 ZINK Tablet 200 mg tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM ISPA 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0 0

354 10.02.18.0720.0343 Pulse Oxtmetri Portable Unit 0 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM KUSTA 0
356 10.02.20.1021.0345 MB.Dewasa blister 0 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0 0

358 10.02.20.0723.0346 PB.Dewasa blister 0 0 0 0 0 0
359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM IMUNISASI 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0 0
369 10.02.20.1121.0357 Polio BOVP 10 doses vial 0 0 0 0 0 0
370 10.02.18.0422.0358 Spidol Pen Marker Pcs 0 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0 0
372 10.02.18.1120.0360 Rabies Immune Globulin (Human) Vial 0 0 0 0 0 0
373 10.02.19.0620.0361 Tuberkulin Inj vial 0 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0 0
376 10.02.20.0522.0364 Vaksin Measles and Rubella 10 DS vial 0 0 0 0 0 0
377 10.02.20.0820.0577 Vaksin Influenza Vial 0 0 0 0 0 0
378 10.02.20.0221.0365 Vaksin Meningitis Vial 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM GIZI 0
379 10.02.18.1120.0366 Ampisilin Serbuk injeksi i.m/i.v 1000mg vial 0 0 0 0 0 0
380 10.02.20.0522.0367 Besi (II) Sulphate (Tablet tambah darah Ibu Nifas) Tab 0 0 0 0 0 0
381 10.02.18.1021.0368 Diazepam injeksi 5 mg/ml Amp 0 0 0 0 0 0
382 10.02.18.0520.0369 Fenobarbital 50 mg injeksi Amp 0 0 0 0 0 0
383 10.02.18.1021.0370 Gentamisin Sulfat Injeksi 40 mg/ml Amp 0 0 0 0 0 0
384 10.02.19.0820.0371 Glukonas Kalsikus 1 gr Amp 0 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0 0
387 10.02.19.0820.0373 Magnesium Sulfat 40% (MgSo4) Btl 0 0 0 0 0 0
389 10.01.20.0322.466 MP ASI Biskuit Bks 0 0 0 0 0 0

391 10.02.18.0819.0376 Prokain Penisillin 3 juta IU vial 0 0 0 0 0 0
392 10.02.18.0420.0377 Phytomenadion 2 mg/ml Amp 0 0 0 0 0 0
393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM KIA 0
395 10.01.20.0322.467 Ampicillin Inj Vial 0 0 0 0 0 0
396 10.01.20.0322.468 Calsium Gluconas 100 mg/ml Injeksi Amp 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
397 10.02.19.0820.0380 Deteksi tes kehamilan Paket 0 0 0 0 0 0
398 10.01.20.0322.469 Diazepam inj 5 mg/ ml amp 0 0 0 0 0 0
399 10.01.20.0322.470 Fitomenadion 10 mg/ vit K inj amp 0 0 0 0 0 0
400 10.02.19.0820.0381 Glukonas Kalsikus 1 00 mg Amp 0 0 0 0 0 0
401 10.01.20.0322.471 Gentamicin 80 mg inj amp 0 0 0 0 0 0
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0 0

404 20.01.20.0520.441 Masker Ibu Bersalin Pcs 0 0 0 0 0 0
405 10.02.19.1120.0382 Methylergometrin Injeksi 0,2 mg/1 ml Amp 0 0 0 0 0 0
406 10.01.20.0322.474 Metil ergometrine Maleat 125 mg tablet tab 0 0 0 0 0 0
407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0 0
409 10.01.20.0322.477 Natrium Tiroksin / Tyhrax tab tab 0 0 0 0 0 0
410 10.01.20.0322.478 Oksitosin Inj 10 IU 1 ml amp 0 0 0 0 0 0
411 10.01.20.0322.479 Prokain Penisiline 3 ml unit inj Vial 0 0 0 0 0 0
412 10.01.20.0322.480 Progesteron Depot Inj 1 ml Vial 0 0 0 0 0 0
413 10.01.20.0322.481 Pil KB Kombinasi cycles 0 0 0 0 0 0
414 10.01.20.0322.482 Urine Strip strip 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM JIWA 0
415 10.01.20.0322.483 Amitripilin HCL 25 mg tablet tablet 0 0 0 0 0 0
416 10.01.20.0322.484 Fluoksetin 10 mg tablet tablet 0 0 0 0 0 0
417 10.01.20.0322.485 Haloperidol 0,5 mg Tab 0 0 0 0 0 0
418 10.01.20.0322.486 Haloperidol 1.5 mg Tab 0 0 0 0 0 0
419 10.01.20.0322.487 Haloperidol 5 mg Tab 0 0 0 0 0 0
420 10.01.20.0322.488 Haloperidol inj 5 mg/ml ampul 0 0 0 0 0 0
421 10.01.20.0322.489 Haloperidol dekanoat inj 50 mg/ml ampul 0 0 0 0 0 0
422 10.01.20.0322.490 Imipramin HCL 25 mg tablet tablet 0 0 0 0 0 0
423 10.02.19.1120.0383 Karbamazepin 200 mg Tab 0 0 0 0 0 0
424 10.01.20.0322.491 Klobazam 10 mg tablet tablet 0 0 0 0 0 0
425 10.01.20.0322.492 Klorpromazin 100 mg tablet tablet 0 0 0 0 0 0
426 10.01.20.0322.493 Klozapin 25 mg tablet tablet 0 0 0 0 0 0
427 10.01.20.0322.494 Metadon HCL 50 mg/5 ml btl 1 L 0 0 0 0 0 0
428 10.01.20.0322.495 Risperidon 2 mg Tablet tablet 0 0 0 0 0 0
430 10.01.20.0322.497 Trifluoperazine HCL 5 mg tablet tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM HIV 0
431 10.01.20.0421.0418 Azithromicyn 1000mg + Cefixime 400mg Paket 0 0 0 0 0 0
432 10.01.20.0421.0419 Benzatin Penicillin 2,4 Juta IU vial 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
433 10.01.20.0421.0420 Blue Tipe (Mikropipet) Pcs 0 0 0 0 0 0
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0 0
435 10.01.20.0421.0422 Human Hexagon Sypilis Test 0 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0 0
437 10.01.20.0421.0424 Lubricant Sutra Pcs 0 0 0 0 0 0
438 10.01.20.0421.0425 Latex Sarung Tangan Pcs 0 0 0 0 0 0
439 10.01.20.0621.0426 Rapid I (SD Bioline HIV 1/2.3.0 Multi) Pcs 0 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0 0
441 10.01.20.0721.0428 Rapid Test HIV 3 Pcs 0 0 0 0 0 0
442 10.01.20.0222.0429 Rapid Test HBSAg Test 0 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0 0
444 10.01.20.0421.0431 RPR Sypilis RB Test 0 0 0 0 0 0
445 10.01.20.0421.0432 Swab Desinfektan (Descoderm) Pcs 0 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0 0
448 10.01.20.0421.0435 Yellow Tipe (mikropipet) Pcs 0 0 0 0 0 0
GOLONGAN OBAT TAMBAHAN 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0 0
450 10.01.18.0821.0283 Atapulgit (New Antides ) Tab 0 0 0 0 0 0
451 20.01.18.0523.0284 Bromheksin tablet 8 mg (HUSTAB P) Tab 0 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0 0
453 10.01.18.1122.0286 Bisacodyl suppositoria Supp 0 0 0 0 0 0
454 20.01.18.0523.0287 Counterpain cream tube 0 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0 0
456 20.01.18.0523.0289 Dextamine Tab Tab 0 0 0 0 0 0
457 20.01.18.0523.0290 Dextamine syr Btl 0 0 0 0 0 0
458 30.01.19.0621.0314 Diazepam Inj (Valisanbe ) Amp 0 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0 0
462 20.01.18.0523.0293 Hyperil (Ramipril 5 mg) Tab 0 0 0 0 0 0
463 20.01.20.0622.0294 Hyosine N Butil Bromide (SCOPMA) Tab 0 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0 0
466 10.01.20.0221.0104 Kloramfenikol Tetes Mata (RECO ) Btl 0 0 0 0 0 0
468 20.01.20.0924.0297 Loperamid (colidium) tab 0 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
470 30.01.17.0422.0298 Levetran salep Pot 0 0 0 0 0 0
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0 0
472 10.01.19.0521.0145 Nifedipine (Adalat Oros) Tab 0 0 0 0 0 0
473 10.01.19.0822.0127 Metoklopramide Syrup (Primpen sirup 5 mg/5ml ) Btl 0 0 0 0 0 0
474 30.01.20.0523.0136 Metamizol 500 mg / ml Injeksi Amp 0 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0 0
476 20.01.18.0523.0301 Obat Flu Batuk Anak (Pimtracol syrup) Botol 0 0 0 0 0 0
477 20.01.18.0523.0301 Obat Flu Batuk Anak (Solafluz syrup) Botol 0 0 0 0 0 0
478 20.01.18.0523.0302 Obat Flu Batuk Neonatus (baby Cough) Btl 0 0 0 0 0 0
479 30.01.20.0624.502 Obat Flu Batuk Anak (HUFAGRIF) Btl 0 0 0 0 0 0
480 30.01.20.0425.0173 Salbutamol 2 mg (Lasal) Tab 0 0 0 0 0 0
481 30.01.20.0222.0303 Salbutamol Inhalasi (Salbulin) Kotak 0 0 0 0 0 0
482 20.01.18.0523.0304 Sakatonik abc tab 0 0 0 0 0 0
483 10.01.20.0523.0305 Stesolid Rectal (Diazepam enema 5mg/2,5 ml) tube 0 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0 0
485 20.01.18.0523.0307 Thromboflash Tube 0 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0 0
487 30.01.20.0623.0190 Triheksifenidil hidroklorida tablet 2 mg (Hexymer) Tab 0 0 0 0 0 0
488 20.01.18.0523.0309 Vitamin Neutropik (Bioron) Tab 0 0 0 0 0 0
489 20.01.18.0523.0310 Vitamin Tambah Darah Tab 0 0 0 0 0 0
490 20.01.18.0523.0311 Vitamin Anak (Tialisin syrup) btl 0 0 0 0 0 0
491 20.01.18.0523.0312 Vitamin Dewasa (Becefort tablet ) Tab 0 0 0 0 0 0
492 10.01.20.0322.465 Vital Ear Drop Botol 0 0 0 0 0 0
493 20.01.18.0523.0313 Ventolin Nebules 2,5 mg Amp 0 0 0 0 0 0
494 10.01.20.0322.0517 Ondansetron Injeksi Amp 0 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
3 30.01.20.0521.0003 Aminofilin tablet 200 mg Tab 0 0 0 0 0 0
4 10.01.20.0821.0004 Aminofilin injeksi 24 mg/ml - 10 ml Amp 0 0 0 0 0 0
5 10.01.20.0224.0005 Amitriptilin HCl tab. Salut 25 mg Tab 0 0 0 0 0 0
6 10.01.19.0821.0193 Ampisilin serbuk injeksi 250 mg (Viccillin ) Amp 0 0 0 0 0 0
7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 0 0 0 0 0 0
8 10.01.19.0522.0007 Amoksisillin 100mg Drop Amp 0 0 0 0 0 0
11 10.01.17.0319.0160 Amoxilin Injeksi 1000mg Vial 0 0 0 0 0 0
12 10.01.19.0522.0010 Antasida Doen tablet kombinasi Tab 0 0 0 0 0 0
13 10.01.20.1121.0011 Antasida suspensi Btl 0 0 0 0 0 0
14 10.01.18.0822.0012 Antibakteri doen salep kombinasi (Bacitracin) Tub 0 0 0 0 0 0
15 10.01.19.0720.0013 Antihemoroid doen kombinasi Suppo 0 0 0 0 0 0
16 10.01.19.1022.0014 Antifungi doen kombinasi Pot 0 0 0 0 0 0
17 10.01.20.0323.0015 Antimigran doen kombinasi (Ergotamin) Tab 0 0 0 0 0 0
18 20.01.20.1222.0016 Aqua proinjeksi steril, bebas pirogen Btl 0 0 0 0 0 0
19 10.01.18.0322.0017 Asam askorbat (vit c) tablet 50 mg Tab 0 0 0 0 0 0
20 10.01.20.0322.446 Asam askorbat (vit c) tablet 250 mg 0 0 0 0 0 0
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0 0
22 30.01.20.0624.506 Atropin Tab 0,5 mg Tab 0 0 0 0 0 0
23 10.01.18.1019.0021 Atropin sulfat injeksi 0,25 mg/ml - 1 ml Amp 0 0 0 0 0 0
24 10.01.20.0522.0022 Acetyl Cystein 200mg Kaps 0 0 0 0 0 0
25 20.01.20.0923.0023 Acyclovir Cream Tube 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
28 20.01.20.1022.0026 Ambroksol sirup Btl 0 0 0 0 0 0
29 30.01.20.1221.0027 Ambroksol tablet 30mg Tab 0 0 0 0 0 0
30 10.01.20.1121.0028 Asam Mefenamat tablet 500 mg Tab 0 0 0 0 0 0
31 10.01.19.0222.0029 Asam Traneksamat Tablet 500 mg Tab 0 0 0 0 0 0
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0 0
37 30.01.20.0624.0510 Asam folat tab 0,4mg Tab 0 0 0 0 0 0
38 10.01.19.0521.0035 Asam folat tab 1 mg Tab 0 0 0 0 0 0
39 10.01.19.0321.0036 Betametason krim 0,1 % Tub 0 3 3 3 5 5 3

40 10.01.20.0423.0037 Betahistin mesilate tablet 6 mg Tab 0 0 0 0 0 0
41 30.01.20.0123.0038 Cefadroxil 500 mg kaps Kaps 0 0 0 0 0 0
44 10.01.19.1223.0040 Captopril tablet 12,5 mg Tab 0 0 0 0 0 0
47 10.01.20.0122.0043 Ciprofloxacin tablet 500 mg Tab 0 0 0 0 0 0
48 10.01.19.0521.0044 Cetirizine Tab 10 mg Tab 0 0 0 0 0 0
49 10.01.20.0922.0045 Cetirizine Sirup 5mg/5ml Btl 0 0 0 0 0 0
50 10.01.20.0822.0046 Ceptriaxon injeksi 1000 mg Vial 0 0 0 0 0 0
51 10.01.19.0421.0047 Cefotaxime Sodium Serb.Inj 1000 mg Vial 0 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0 0
55 10.01.20.0122.0049 Deksametason inj 5 mg/ml - 1 ml Amp 0 5 5 5 8 8 5

56 30.01.20.1022.0050 Deksametason tablet 0,5 mg Tab 0 50 50 50 75 75 50
57 10.01.20.0423.0051 Diazepam inj 5 mg/ml - 2 ml Amp 0 0 0 0 0 0
60 30.01.20.0822.0054 Difenhidramin HCl inj 10 mg/ml - 1 ml Amp 0 0 0 0 0 0
61 10.01.19.0321.0055 Digoksin tablet 0,25 mg Tab 0 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0 0
63 10.01.19.0623.0057 Dimenhidrat Kaplet 50 mg Tab 0 0 0 0 0 0
64 10.01.19.0522.0058 Domperidone tablet 10 mg Tab 0 0 0 0 0 0
65 10.01.20.0422.0059 Domperidon suspensi 5 mg / 5 ml Btl 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
66 10.01.18.0720.0060 Doxycycline 100 mg Kaps 0 0 0 0 0 0
67 10.01.17.0219.0061 Efedrin HCl tablet 25 mg Tab 0 0 0 0 0 0
68 10.01.20.0222.0062 Epinefrin 1 mg/ml inj s.c/i.m Amp 0 0 0 0 0 0
69 30.01.18.1020.0063 Etakridin (rivanol) larutan 0,1 % Btl 0 0 0 0 0 0
70 30.01.18.0722.0064 Erytromicin kaplet 500 mg Kapl 0 0 0 0 0 0
71 10.01.20.0322.0448 Erytromicin Syrup 200 mg / 5 ml Botol 0 0 0 0 0 0
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0 0
75 30.01.19.0421.0067 Fenytoin Sodium 100 mg Kap 0 0 0 0 0 0
76 10.01.19.0321.0068 Fenol Gliserol Tetes Telinga 10% Btl 0 0 0 0 0 0
77 10.01.20.0523.0069 Fenobarbital injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0 0
78 10.01.20.0324.0070 Fenobarbital tablet 30 mg Tab 0 0 0 0 0 0
81 10.01.19.0821.0072 Fitomenadion (vit K 1) tablet salut 10 mg Tab 0 0 0 0 0 0
82 10.01.19.0621.0073 Furosemid tablet 40 mg Tab 0 0 0 0 0 0
83 10.01.20.0222.0074 Furosemid inj 10mg/ml amp 0 0 0 0 0 0
84 10.01.19.1021.0075 Garam Oralit 200 ml Sachet 0 0 0 0 0 0
85 10.01.18.0323.0076 Glibenklamid Tab 0 0 0 0 0 0
88 10.01.17.0921.0079 Gliseril guayakolat 100 mg Tab 0 0 0 0 0 0
89 20.01.20.0423.0080 Guaiafenesin 100 mg Tab 0 0 0 0 0 0
90 10.01.17.1121.0081 Gliserin / Gliserol Btl 0 0 0 0 0 0
91 10.01.20.0122.0082 Glukosa larutan infus 5 % steril Btl 0 0 0 0 0 0
92 10.01.18.0820.0083 Griseofulvin tablet 125 mg, micronized Tab 0 0 0 0 0 0
95 10.01.17.1119.0085 Gentamycin Sulfat Inj 2 ml Amp 0 0 0 0 0 0
96 20.01.20.1022.0086 Gentamycin tetes mata 0,3 % Botol 0 0 0 0 0 0
97 10.01.19.0622.0087 Gentamycin Salep mata 0,3 % Tube 0 0 0 0 0 0
98 10.01.20.0322.453 Gentamycin Cream Kulit Tube 0 0 0 0 0 0
99 10.01.19.0422.0088 Gemfibrozil 300 mg Kaps 0 0 0 0 0 0
100 10.01.20.0824.0089 Gentian Violet Larutan 1% Btl 0 0 0 0 0 0
103 10.01.18.0620.0092 Haloperidol tablet 5 mg Tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
104 10.01.19.0123.0093 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0 0 0 0 0
105 10.01.17.1022.0094 Hidrokortison krim 2,5 mg Tub 0 0 0 0 0 0
106 10.01.17.1022.0512 Hidrogen Peroksida 3 % Botol 0 0 0 0 0 0
109 10.01.18.0420.0096 Ibuprofen syr 100mg/ 5 ml Botol 0 0 0 0 0 0
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0 0
112 10.01.18.0722.0098 Isosorbid dinitrat tablet sublingual 5 mg Tab 0 0 0 0 0 0
113 10.01.20.0825.0099 Ichtiol salep pot 0 0 0 0 0 0
114 10.01.19.0422.0100 Kalsium laktat (kalk) tablet 500 gram Tab 0 100 100 100 150 150 100
115 10.01.20.1122.0101 Karbamazepin tablet 200 gram Tab 0 0 0 0 0 0
116 10.01.18.0322.0102 Kloramfenikol kapsul 250 mg Kap 0 0 0 0 0 0
117 10.01.19.0122.0103 Kloramfenikol salep mata 1 % Tub 0 0 0 0 0 0
118 20.01.20.0221.0104 Kloramfenikol Tetes Mata 0,5 % Btl 0 0 0 0 0 0
119 30.01.20.0823.0105 Kloramfenikol Tetes Telinga 1% Btl 0 0 0 0 0 0
120 10.01.19.0921.0106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0 0 0 0 0
121 10.01.19.0721.0107 Klorfeniramin maleat (CTM) tablet 4 mg Tab 0 100 100 100 150 150 100
122 10.01.19.0422.0108 Kloramfenikol Salep 2% (Bufacetine) Tub 0 0 0 0 0 0
125 10.01.17.0819.0115 Klorpromazine HCL inj 25mg/ml-1 ml injeksi Amp 0 0 0 0 0 0
126 10.01.20.0923.0110 Kodein HCl tablet 10 mg Tab 0 0 0 0 0 0
127 10.01.19.0522.0111 Kotrimoksazol suspensi 480 mg/5 ml Btl 0 0 0 0 0 0
128 10.01.19.0522.0112 Kotrimoxazol Tablet Tab 0 0 0 0 0 0
129 10.01.19.0822.0113 Ketokonazole cream Tub 0 0 0 0 0 0
130 10.01.20.0423.0114 Ketokonazole 200mg Tab Tab 0 0 0 0 0 0
131 10.01.19.1120.0116 Lactulose 3,335 g/5ml Btl 0 0 0 0 0 0
132 10.01.19.0821.0117 Lansoprazole Kap 0 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 5 5 5 8 8 5

134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0 0
135 10.01.18.0821.0120 Loratadine 5 mg Tab 0 0 0 0 0 0
136 10.01.17.0220.0121 Lar anhydrous dextrose,Nacl,Kcl,Na laktat,(KAEN 3A) Btl 0 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0 0
138 10.01.20.0823.0123 Metilergometrin maleat inj. 0,2 mg - 1 ml Amp 0 0 0 0 0 0
139 10.01.19.0122.0124 Metilergometrin maleat tablet 0,125 mg Tab 0 0 0 0 0 0
140 10.01.19.0322.0125 Miconazol 2 % cream Tub 0 0 0 0 0 0
141 10.01.19.0323.0126 Metoklopramide tablet 10 mg Tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
142 10.01.19.0822.0127 Metoklopramide Syrup Btl 0 0 0 0 0 0
143 10.01.19.0621.0128 Metoklopramide injeksi Amp 0 0 0 0 0 0
146 10.01.20.1120.0130 Metronidazol larutan Infus 5 mg/ml Btl 0 0 0 0 0 0
147 10.01.19.0122.0131 Metronidazol syrup 125 mg / 5 ml Btl 0 0 0 0 0 0
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0 0
152 10.01.19.0321.0136 Metamizole Inj 500mg/ml Amp 0 0 0 0 0 0
153 10.01.19.1121.0137 Metamizole 500mg kaplet Kaplet 0 0 0 0 0 0
156 10.01.20.0322.0140 Natrium klorida larutan infus 0,9% steril Btl 0 0 0 0 0 0
157 10.01.19.0723.0141 Nistatin 100.000 iu/g tablet vaginal Tab 0 0 0 0 0 0
158 10.01.18.0481.0142 Nistatin 500.000 iu tablet salut Tab 0 0 0 0 0 0
160 10.01.20.0822.0144 Natrium diclofenak 50 mg Tab 0 100 100 100 150 150 100
162 20.01.19.1120.0147 Oksitosin injeksi 10 iu/ml - ml Amp 0 0 0 0 0 0
163 30.01.20.0721.451 Oksitetrasiklin Salep Kulit Tub 0 3 3 3 5 5 3

165 10.01.19.0921.0149 Omeprazole kapsul/kaplet 20 mg Kap 0 0 0 0 0 0
166 10.01.19.0921.0150 Ondansetron Tablet 8 Mg Tab 0 0 0 0 0 0
167 10.01.20.0822.0151 Parasetamol tetes 100mg/ 0,6 ml Botol 15 ml 0 0 0 0 0 0
168 30.01.20.1022.0152 Parasetamol syr 120 mg / 5 ml Btl 0 0 0 0 0 0
169 30.01.20.0722.0153 Parasetamol tablet 500 mg Tab 0 100 100 100 150 150 100
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0 0
171 10.01.17.0319.0154 Petidin HCl injeksi 50 mg/ml - 2 ml Amp 0 0 0 0 0 0
172 20.01.20.0921.0155 Piridoksin HCl tablet 10 mg Tab 0 0 0 0 0 0
173 10.01.20.0322.0156 Prednison tablet 5 mg Tab 0 0 0 0 0 0
174 10.01.17.0120.0157 Primakuin tablet 15 mg Tab 0 0 0 0 0 0
175 30.01.17.0621.0158 Propiltiourasil tablet 100 mg Tab 0 0 0 0 0 0
176 10.01.18.0721.0159 Propranolol HCl tablet 10 mg Tab 0 0 0 0 0 0
177 10.01.17.0920.0161 Piracetam Injeksi 1g / 5 ml Vial 0 0 0 0 0 0
178 10.01.20.0322.454 Piracetam 800 mg tab Tab 0 0 0 0 0 0
179 10.01.18.0220.0162 Pirazinamide 500mg tab tab 0 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
182 30.01.19.0321.0164 Pirantel Pamoat Susp 125mg/5ml btl 0 0 0 0 0 0
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0 0
184 10.01.20.0723.0178 Permetrin krim (Scabimite 5% ) Tub 0 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0 0
186 10.01.17.0220.0167 Ringer laktat larutan infus steril Btl 0 5 5 5 8 8 5

187 10.01.20.0923.0168 Ranitidin tablet 150 mg Tab 0 0 0 0 0 0
188 10.01.19.1220.0169 Ranitidin Injeksi 50mg/2ml amp 0 10 10 10 15 15 10

195 10.01.19.0421.0175 Salbutamol 2mg/5ml Syr Btl 0 0 0 0 0 0

198 10.01.18.0420.0177 Salisil bedak 2 % Ktk 0 0 0 0 0 0
199 10.01.19.0521.0179 Serum anti bisa ular polivalen inj. 5 ml (abu I) Vial 0 0 0 0 0 0
200 10.01.19.0820.0180 Serum anti tatanus inj. 1.500 iu/ampul (a.t.s I ) Amp 0 0 0 0 0 0
201 10.01.20.1021.0181 Sianokobalamin (Vit. B12) inj. 500 mcg/ml Amp 0 0 0 0 0 0
202 10.01.19.0923.0182 Sianokobalamin (Vit. B12) tablet 50 mcg Tab 0 0 0 0 0 0
207 10.01.20.0622.0186 Tablet tambah darah Tab 0 300 300 300 450 450 300
210 10.01.17.0420.0188 Tiamin HCl (Vit. B1) inj. 100 mg/ml - 1 ml Amp 0 0 0 0 0 0
211 10.01.19.0923.0189 Tiamin HCl monohidrat (Vit. B1) tablet 50 mg Tab 0 0 0 0 0 0
213 10.01.18.0821.0191 Thiamfenikol tab 500 mg Amp 0 0 0 0 0 0
214 10.01.18.0221.0192 Vitamin B kompleks tablet Tab 0 0 0 0 0 0
215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
219 10.08.19.0320.0197 Zink Tablet 20 mg Tab 0 0 0 0 0 0
220 10.01.19.0221.0198 Zinc Sulfate Sirup 20mg/5ml Btl 0 0 0 0 0 0
GOLONGAN OBAT GIGI 0
221 30.01.19.1122.0516 Anastetik Lokal Gigi Kombinasi ( Lidocain kompositum injeksi ) amp 0 0 0 0 0 0
222 30.01.19.1122.0199 Cholorophenol camphor menthol (chkm) Set 0 0 0 0 0 0
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0 0
225 30.01.19.1220.0202 Ceivtron( tambalan sementara ) ktk 0 0 0 0 0 0
226 30.01.19.0521.0203 Devitalisasi Arsen Kotak 0 0 0 0 0 0
227 10.01.20.0322.458 Devitalisasi pasta (non arsen) caustinerf forte kotak 0 0 0 0 0 0
228 30.01.19.0921.0204 Etil klorida semprot Kaleng 0 0 0 0 0 0
229 30.01.19.0000.0205 Eugenol cairan Btl 0 0 0 0 0 0
230 30.01.19.1121.0206 Elite Cement Kotak 0 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0 0
232 30.01.19.1121.0513 Formokresol Botol 0 0 0 0 0 0
233 10.01.20.0322.459 kalsium hidroksida pasta tube 0 0 0 0 0 0
234 30.01.19.0121.0207 Glass Ionomer Cement (GK-Fuji IX) Kotak 0 0 0 0 0 0
235 10.01.20.0322.460 Iodoform paste Ktk 0 0 0 0 0 0
236 10.01.20.0322.461 Mummifying pasta / tempophore btl 0 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0 0
239 30.01.19.0221.0209 Semen Seng Fosfat serbuk dan cairan kotak 0 0 0 0 0 0
240 10.01.20.0322.462 Spons gelatin Cubicles 1 x 1 x 1 Cm Ktk 0 0 0 0 0 0
241 10.01.20.0322.463 Temporary stopingfletcher serbuk dan cairan Set 0 0 0 0 0 0
242 30.01.19.0000.0210 Trikresol formalin (TKF) cairan Btl 0 0 0 0 0 0
GOLONGAN OBAT BAHAN HABIS PAKAI 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0 0
245 10.01.20.0820.0213 Anti septic Poliwash (Chlorhexidine) Botol 0 0 0 0 0 0
246 10.01.18.0221.0214 Aseptic Gel Botol 0 0 0 0 0 0
247 20.01.20.0521.440 Antiseptic dan Desinfektan (Odex) Botol 0 0 0 0 0 0
249 20.01.20.0421.0215 Catgut/benang bedah no.2/0 Chromic Sak 0 0 0 0 0 0
251 10.01.17.1119.0216 Catgut/benang bedah no. 3/0 chromic Sak 0 0 0 0 0 0
253 10.01.19.0423.0218 Disposable Syringe 2,5 cc pcs 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
254 10.01.17.0521.0219 Disposable Syringe 3 cc Pcs 0 0 0 0 0 0
257 10.01.17.0322.0223 Elastic band roll 0 0 0 0 0 0
259 10.01.19.0421.0225 Folley catheter no.18 pcs 0 0 0 0 0 0
261 10.01.19.0823.0227 Infus set anak pcs 0 0 0 0 0 0
262 30.01.19.0823.0228 Infus set dewasa pcs 0 0 0 0 0 0
266 20.01.20.0424.0257 IV Catheter No 20G Pcs 0 0 0 0 0 0
267 10.01.19.1022.0258 IV Catheter No 18 G Pcs 0 0 0 0 0 0
268 30.01.17.0922.0229 Kapas berlemak 500 gram Bks 0 0 0 0 0 0
269 20.01.18.1021.0230 Kapas pembalut/absorben 250 gram Bks 0 0 0 0 0 0
270 20.01.20.0222.0231 Kapas pembalut 250 gram Bks 0 0 0 0 0 0
271 10.01.19.0223.0232 Kasa kompres 40/40 steril Rol 0 0 0 0 0 0
272 20.01.20.0525.0233 Kasa Steril 16x16 cm kotak 0 5 5 5 8 8 5
275 20.01.19.0224.0236 Kasa pembalut 2m x 80 cm Rol 0 0 0 0 0 0
276 20.01.19.1020.0237 Kasa Pembalut 40 m x 40 cm Rol 0 0 0 0 0 0
277 10.01.18.0422.0238 Kasa pembalut hidrofil 4 m x 10 cm Rol 0 0 0 0 0 0

279 10.01.18.0322.0240 Kasa Pembalut hidrofil 4 x 3 pack 0 0 0 0 0 0
280 10.01.19.1023.0242 Kasa Pembalut hidrofil 3,6m x 10cm Rol 0 0 0 0 0 0
281 10.01.18.0423.0243 Kasa steril Kasa Steril 10 x 10, 8ply, 1x10's Pcs 0 0 0 0 0 0
282 10.01.20.0122.0245 Mask Surgical 3 Ply (Earloop/Hijab/Tie On) pcs 0 0 0 0 0 0
283 30.01.18.1122.0247 Mask Nasal Oxygen Cannula Infant (anak) Pcs 0 0 0 0 0 0
284 30.01.18.1122.0248 Mask Nasal Oxygen Cannula Adult (dewasa) Pcs 0 0 0 0 0 0
285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0 0
286 10.01.19.1022.0250 Nebulizer Masker Infant Pcs 0 0 0 0 0 0
287 20.01.19.0583.0251 Nebulizer Masker Adult Pcs 0 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0 0
291 10.01.19.1022.0260 Pembalut gips 3 inchi Rol 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
292 20.01.20.0122.0261 Pap Smear kit Steril (L) set 0 0 0 0 0 0
293 30.01.18.0323.0262 Pap Smear kit Steril (M) set 0 0 0 0 0 0
294 10.01.18.0623.0263 Pap Smear kit Steril (S) set 0 0 0 0 0 0
298 20.01.20.0323.0267 Sarung Tangan Non Steril Ukuran S pcs 0 0 0 0 0 0

299 20.01.20.0824.0268 Sarung Tangan Non Steril Ukuran M pcs 0 0 0 0 0 0
301 30.01.19.0823.0270 Sarung Tangan Steril (Surgical gloves) 7,5 Pair 0 0 0 0 0 0
302 10.01.19.0923.0271 Sarung Tangan Steril (Surgical gloves) 6.5 Pair 0 20 20 20 30 30 20
306 20.01.20.0224.0274 Surgical Blade No 11 Pcs 0 3 3 3 5 5 3
308 10.01.17.0821.0275 Silk (benang bedah sutera) no. 3/0 Box 0 0 0 0 0 0
309 30.01.20.0621.0276 Stik Kolesterol box 0 0 0 0 0 0
310 30.01.20.1221.0277 Stik Asam Urat box 0 0 0 0 0 0
311 30.01.20.0721.0278 Stik Gula Darah box 0 0 0 0 0 0
312 20.01.20.0422.436 Spekulum Vagina Ukuran S Set 0 0 0 0 0 0
313 20.01.20.1122.437 Spekulum Vagina Ukuran M Set 0 0 0 0 0 0
314 20.01.20.0422.438 Spekulum Vagina Ukuran L Set 0 0 0 0 0 0
315 10.01.20.0322.445 Steril Lubricant Jelly Botol 0 0 0 0 0 0
316 10.01.20.0921.0279 Ultrasonic gel Galon 0 0 0 0 0 0
318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0 0
319 10.01.17.0122.0281 Urine bag Steril Pcs 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM MALARIA 0
320 10.02.19.0621.0314 Artesunate Inj, vial 60 mg / ml vial 0 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0 0
325 10.02.18.0000.0318 Kaca Slide (objek glass frosted 7105 one) Pcs 0 0 0 0 0 0
326 10.02.19.0621.0319 Kuinin (kina) tab 222 mg tablet 0 0 0 0 0 0
327 10.02.19.0621.0320 LABORATORY KID PAKET 0 0 0 0 0 0
328 10.02.19.0621.0321 Mikroskop + Box Nikon Eclipse E-100 Unit 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0 0
332 10.02.20.0621.0324 Primakuin tab 15 mg tablet 0 0 0 0 0 0
333 10.02.20.1121.0325 Rapid Test Malaria (pf/PAN) combo Test 0 0 0 0 0 0
334 10.02.19.0621.0326 RDT DBD Combo TEST 0 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0 0

336 10.02.19.0621.0328 Sipermetrin zeta 15 UL Galon 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM FILARIASIS 0
337 10.02.17.0620.0329 Albendazole 400 mg tablet 0 0 0 0 0 0
338 10.01.20.0322.442 Albendazole 200 mg / 5 ml sirup Botol 0 0 0 0 0 0
339 10.02.18.0820.0330 Dietil karbamazepin Sitrat tab 100 mg tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM TB PARU 0
340 10.01.20.0322.500 Catridge Gene Xpert MTB / RIF Buah 0 0 0 0 0 0
343 10.02.19.0824.0333 Masker Surgical pcs 0 0 0 0 0 0
346 10.02.18.0521.0335 Obat Anti tuberkulosis FDC II Paket 0 0 0 0 0 0
347 10.02.20.0521.0336 Obat Anti tuberkulosis Anak Paket 0 0 0 0 0 0
348 10.02.19.0722.0337 Obat Anti TBC FDC Kombipak kategori I Paket 0 0 0 0 0 0
349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM DIARE 0
351 10.02.20.0423.0340 Garam Oralit 200 ml Sac 0 0 0 0 0 0

352 10.02.20.1022.0341 ZINK Tablet 200 mg tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM ISPA 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0 0

354 10.02.18.0720.0343 Pulse Oxtmetri Portable Unit 0 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM KUSTA 0
356 10.02.20.1021.0345 MB.Dewasa blister 0 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0 0

358 10.02.20.0723.0346 PB.Dewasa blister 0 0 0 0 0 0
359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM IMUNISASI 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0 0
369 10.02.20.1121.0357 Polio BOVP 10 doses vial 0 0 0 0 0 0
370 10.02.18.0422.0358 Spidol Pen Marker Pcs 0 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0 0
372 10.02.18.1120.0360 Rabies Immune Globulin (Human) Vial 0 0 0 0 0 0
373 10.02.19.0620.0361 Tuberkulin Inj vial 0 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0 0
376 10.02.20.0522.0364 Vaksin Measles and Rubella 10 DS vial 0 0 0 0 0 0
377 10.02.20.0820.0577 Vaksin Influenza Vial 0 0 0 0 0 0
378 10.02.20.0221.0365 Vaksin Meningitis Vial 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM GIZI 0
379 10.02.18.1120.0366 Ampisilin Serbuk injeksi i.m/i.v 1000mg vial 0 0 0 0 0 0
380 10.02.20.0522.0367 Besi (II) Sulphate (Tablet tambah darah Ibu Nifas) Tab 0 0 0 0 0 0
381 10.02.18.1021.0368 Diazepam injeksi 5 mg/ml Amp 0 0 0 0 0 0
382 10.02.18.0520.0369 Fenobarbital 50 mg injeksi Amp 0 0 0 0 0 0
383 10.02.18.1021.0370 Gentamisin Sulfat Injeksi 40 mg/ml Amp 0 0 0 0 0 0
384 10.02.19.0820.0371 Glukonas Kalsikus 1 gr Amp 0 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0 0
389 10.01.20.0322.466 MP ASI Biskuit Bks 0 0 0 0 0 0

391 10.02.18.0819.0376 Prokain Penisillin 3 juta IU vial 0 0 0 0 0 0
392 10.02.18.0420.0377 Phytomenadion 2 mg/ml Amp 0 0 0 0 0 0
393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM KIA 0
395 10.01.20.0322.467 Ampicillin Inj Vial 0 0 0 0 0 0
396 10.01.20.0322.468 Calsium Gluconas 100 mg/ml Injeksi Amp 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
397 10.02.19.0820.0380 Deteksi tes kehamilan Paket 0 0 0 0 0 0
398 10.01.20.0322.469 Diazepam inj 5 mg/ ml amp 0 0 0 0 0 0
399 10.01.20.0322.470 Fitomenadion 10 mg/ vit K inj amp 0 0 0 0 0 0
400 10.02.19.0820.0381 Glukonas Kalsikus 1 00 mg Amp 0 0 0 0 0 0
401 10.01.20.0322.471 Gentamicin 80 mg inj amp 0 0 0 0 0 0
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0 0

404 20.01.20.0520.441 Masker Ibu Bersalin Pcs 0 0 0 0 0 0
405 10.02.19.1120.0382 Methylergometrin Injeksi 0,2 mg/1 ml Amp 0 0 0 0 0 0
406 10.01.20.0322.474 Metil ergometrine Maleat 125 mg tablet tab 0 0 0 0 0 0
407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0 0
409 10.01.20.0322.477 Natrium Tiroksin / Tyhrax tab tab 0 0 0 0 0 0
410 10.01.20.0322.478 Oksitosin Inj 10 IU 1 ml amp 0 0 0 0 0 0
411 10.01.20.0322.479 Prokain Penisiline 3 ml unit inj Vial 0 0 0 0 0 0
412 10.01.20.0322.480 Progesteron Depot Inj 1 ml Vial 0 0 0 0 0 0
413 10.01.20.0322.481 Pil KB Kombinasi cycles 0 0 0 0 0 0
414 10.01.20.0322.482 Urine Strip strip 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM JIWA 0
415 10.01.20.0322.483 Amitripilin HCL 25 mg tablet tablet 0 0 0 0 0 0
416 10.01.20.0322.484 Fluoksetin 10 mg tablet tablet 0 0 0 0 0 0
417 10.01.20.0322.485 Haloperidol 0,5 mg Tab 0 0 0 0 0 0
418 10.01.20.0322.486 Haloperidol 1.5 mg Tab 0 0 0 0 0 0
419 10.01.20.0322.487 Haloperidol 5 mg Tab 0 0 0 0 0 0
420 10.01.20.0322.488 Haloperidol inj 5 mg/ml ampul 0 0 0 0 0 0
421 10.01.20.0322.489 Haloperidol dekanoat inj 50 mg/ml ampul 0 0 0 0 0 0
422 10.01.20.0322.490 Imipramin HCL 25 mg tablet tablet 0 0 0 0 0 0
423 10.02.19.1120.0383 Karbamazepin 200 mg Tab 0 0 0 0 0 0
424 10.01.20.0322.491 Klobazam 10 mg tablet tablet 0 0 0 0 0 0
425 10.01.20.0322.492 Klorpromazin 100 mg tablet tablet 0 0 0 0 0 0
426 10.01.20.0322.493 Klozapin 25 mg tablet tablet 0 0 0 0 0 0
427 10.01.20.0322.494 Metadon HCL 50 mg/5 ml btl 1 L 0 0 0 0 0 0
428 10.01.20.0322.495 Risperidon 2 mg Tablet tablet 0 0 0 0 0 0
430 10.01.20.0322.497 Trifluoperazine HCL 5 mg tablet tablet 0 0 0 0 0 0
GOLONGAN OBAT PROGRAM HIV 0
431 10.01.20.0421.0418 Azithromicyn 1000mg + Cefixime 400mg Paket 0 0 0 0 0 0
432 10.01.20.0421.0419 Benzatin Penicillin 2,4 Juta IU vial 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
433 10.01.20.0421.0420 Blue Tipe (Mikropipet) Pcs 0 0 0 0 0 0
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0 0
435 10.01.20.0421.0422 Human Hexagon Sypilis Test 0 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0 0
437 10.01.20.0421.0424 Lubricant Sutra Pcs 0 0 0 0 0 0
438 10.01.20.0421.0425 Latex Sarung Tangan Pcs 0 0 0 0 0 0
439 10.01.20.0621.0426 Rapid I (SD Bioline HIV 1/2.3.0 Multi) Pcs 0 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0 0
441 10.01.20.0721.0428 Rapid Test HIV 3 Pcs 0 0 0 0 0 0
442 10.01.20.0222.0429 Rapid Test HBSAg Test 0 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0 0
444 10.01.20.0421.0431 RPR Sypilis RB Test 0 0 0 0 0 0
445 10.01.20.0421.0432 Swab Desinfektan (Descoderm) Pcs 0 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0 0
448 10.01.20.0421.0435 Yellow Tipe (mikropipet) Pcs 0 0 0 0 0 0
GOLONGAN OBAT TAMBAHAN 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0 0
450 10.01.18.0821.0283 Atapulgit (New Antides ) Tab 0 0 0 0 0 0
451 20.01.18.0523.0284 Bromheksin tablet 8 mg (HUSTAB P) Tab 0 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0 0
453 10.01.18.1122.0286 Bisacodyl suppositoria Supp 0 0 0 0 0 0
454 20.01.18.0523.0287 Counterpain cream tube 0 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0 0
456 20.01.18.0523.0289 Dextamine Tab Tab 0 0 0 0 0 0
457 20.01.18.0523.0290 Dextamine syr Btl 0 0 0 0 0 0
458 30.01.19.0621.0314 Diazepam Inj (Valisanbe ) Amp 0 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0 0
462 20.01.18.0523.0293 Hyperil (Ramipril 5 mg) Tab 0 0 0 0 0 0
463 20.01.20.0622.0294 Hyosine N Butil Bromide (SCOPMA) Tab 0 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0 0
466 10.01.20.0221.0104 Kloramfenikol Tetes Mata (RECO ) Btl 0 0 0 0 0 0
468 20.01.20.0924.0297 Loperamid (colidium) tab 0 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
470 30.01.17.0422.0298 Levetran salep Pot 0 0 0 0 0 0
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0 0
472 10.01.19.0521.0145 Nifedipine (Adalat Oros) Tab 0 0 0 0 0 0
473 10.01.19.0822.0127 Metoklopramide Syrup (Primpen sirup 5 mg/5ml ) Btl 0 0 0 0 0 0
474 30.01.20.0523.0136 Metamizol 500 mg / ml Injeksi Amp 0 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0 0
476 20.01.18.0523.0301 Obat Flu Batuk Anak (Pimtracol syrup) Botol 0 0 0 0 0 0
477 20.01.18.0523.0301 Obat Flu Batuk Anak (Solafluz syrup) Botol 0 0 0 0 0 0
478 20.01.18.0523.0302 Obat Flu Batuk Neonatus (baby Cough) Btl 0 0 0 0 0 0
479 30.01.20.0624.502 Obat Flu Batuk Anak (HUFAGRIF) Btl 0 0 0 0 0 0
480 30.01.20.0425.0173 Salbutamol 2 mg (Lasal) Tab 0 0 0 0 0 0
481 30.01.20.0222.0303 Salbutamol Inhalasi (Salbulin) Kotak 0 0 0 0 0 0
482 20.01.18.0523.0304 Sakatonik abc tab 0 0 0 0 0 0
483 10.01.20.0523.0305 Stesolid Rectal (Diazepam enema 5mg/2,5 ml) tube 0 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0 0
485 20.01.18.0523.0307 Thromboflash Tube 0 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0 0
487 30.01.20.0623.0190 Triheksifenidil hidroklorida tablet 2 mg (Hexymer) Tab 0 0 0 0 0 0
488 20.01.18.0523.0309 Vitamin Neutropik (Bioron) Tab 0 0 0 0 0 0
489 20.01.18.0523.0310 Vitamin Tambah Darah Tab 0 0 0 0 0 0
490 20.01.18.0523.0311 Vitamin Anak (Tialisin syrup) btl 0 0 0 0 0 0
491 20.01.18.0523.0312 Vitamin Dewasa (Becefort tablet ) Tab 0 0 0 0 0 0
492 10.01.20.0322.465 Vital Ear Drop Botol 0 0 0 0 0 0
493 20.01.18.0523.0313 Ventolin Nebules 2,5 mg Amp 0 0 0 0 0 0
494 10.01.20.0322.0517 Ondansetron Injeksi Amp 0 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 0 0 0 0 0
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0
91 10.01.20.0122.0082 Glukosa larutan infus 5 % steril Btl 0 0 0 0 0
96 20.01.20.1022.0086 Gentamycin tetes mata 0,3 % Botol 0 0 0 0 0
97 10.01.19.0622.0087 Gentamycin Salep mata 0,3 % Tube 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
156 10.01.20.0322.0140 Natrium klorida larutan infus 0,9% steril Btl 0 0 0 0 0
161 20.01.17.1020.0146 Obat batuk hitam (o.b.h) cairan Btl 0 0 0 0 0
162 20.01.19.1120.0147 Oksitosin injeksi 10 iu/ml - ml Amp 0 0 0 0 0
168 30.01.20.1022.0152 Parasetamol syr 120 mg / 5 ml Btl 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0
186 10.01.17.0220.0167 Ringer laktat larutan infus steril Btl 0 0 0 0 0
188 10.01.19.1220.0169 Ranitidin Injeksi 50mg/2ml amp 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

300 20.01.20.0824.0269 Sarung Tangan Non Steril Ukuran L Pcs 0 0 0 0 0
317 10.01.18.0722.0280 Umbrical Cord Nylon OM Pcs 0 0 0 0 0
318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch
( LPLPO )

KECAMATAN :
PENGELUARAN
No STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0 0
36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0 0
54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0 0
62 10.01.19.0124.0056 Diltiazem 30 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
74 20.01.20.1123.0066 Etanol 70 % ( 1000 ML ) Btl 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
110 10.01.20.0322.443 Ibuprofen 200 mg Tab 0 0 0 0 0
111 20.01.20.1022.0097 Ibuprofen 400 mg Tab 0 0 0 0 0
133 10.01.18.0521.0118 Lidokain Amp 0 0 0 0 0
134 30.01.17.0000.0119 Lisol Btl 0 0 0 0 0
137 10.01.19.0921.0122 Mineral Mix Sach 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
150 10.01.10.0922.0134 Metformin 500 mg Tab 0 0 0 0 0
151 30.01.18.0920.0135 Metformin 850 mg Tab 0 0 0 0 0
170 30.01.20.0624.503 Papeverin 40 mg Tab 0 0 0 0 0

PENGELUARAN
No STOK PEMBERIAN
183 20.01.20.0922.0165 Piroksikam Tab 0 0 0 0 0
185 10.01.18.0523.0166 Quinine 222 mg Tab 0 0 0 0 0

215 10.01.18.1219.0194 Wida Bes Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
GOLONGAN OBAT GIGI
223 30.01.19.1020.0200 Cal Excel Kotak 0 0 0 0 0
224 30.01.19.0422.0201 Calform - RC Kotak 0 0 0 0 0
231 30.01.19.1121.0514 Flour Kaplet 0 0 0 0 0
237 30.01.19.0921.0208 Oco ktk 0 0 0 0 0
238 30.01.19.0921.0515 Resin Set 0 0 0 0 0
243 10.01.18.1120.0211 Alkohol Swab Pcs 0 0 0 0 0
244 20.01.20.0921.0212 Asam Asetat 6% Btl 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

285 10.01.19.0125.0249 Masker N95 Pcs 0 0 0 0 0
288 10.01.19.0622.0252 Optime 2/0 Pcs 0 0 0 0 0
289 10.01.19.1122.0253 Optime 3/0 Pcs 0 0 0 0 0
290 10.01.19.1022.0259 Polid Aid Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN

318 20.01.20.0921.439 Underpad Pcs 0 0 0 0 0
321 10.02.19.0621.0315 Abate Botol 0 0 0 0 0
322 10.02.19.0621.0316 Bactivec Botol 0 0 0 0 0
323 10.02.20.0000.0317 Cynoff 25 UL Botol 0 0 0 0 0
324 10.01.20.0322.499 Giemsa Botol 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
329 10.02.19.0000.0322 Malation Liter 0 0 0 0 0
335 10.02.17.0000.0327 Kotak Slide BUAH 0 0 0 0 0

349 10.02.19.0120.0338 Pot Sputum pot 0 0 0 0 0
350 10.02.20.0721.0339 Reagen Zn kit 0 0 0 0 0
353 10.02.18.0720.0342 Masker N95 Pcs 0 0 0 0 0
355 10.02.17.0000.0344 Sound Timer Unit 0 0 0 0 0
357 10.02.17.0000.0345 MB. Anak blister 0 0 0 0 0

359 10.02.19.0820.0347 PB.Anak blister 0 0 0 0 0
360 10.02.20.0222.0348 ADS .0,05 ml pcs 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
361 10.02.20.0224.0349 ADS.0,5 ml pcs 0 0 0 0 0
362 10.02.20.0724.0350 ADS 5 ml pcs 0 0 0 0 0
363 10.02.20.0921.0351 BCG (10 doses) vial 0 0 0 0 0
364 10.02.20.0523.0352 DT vial 0 0 0 0 0
365 10.02.20.0521.0353 DPT-HB-HIB vial 0 0 0 0 0
366 10.02.20.0522.0354 HB-PID vial 0 0 0 0 0
367 10.02.20.1022.0355 HBIG Amp 0 0 0 0 0
368 10.02.20.1121.0356 IPV Polio vial 0 0 0 0 0
371 10.02.20.0000.0359 Safety box Pcs 0 0 0 0 0
374 10.02.20.0821.0362 TD vial 0 0 0 0 0
375 10.02.20.0621.0363 VAR Vial 0 0 0 0 0
385 10.01.20.0322.465 Iodine Test Btl 0 0 0 0 0
386 10.02.18.0820.0372 Mineral Mix Sach 0 0 0 0 0

393 10.02.18.0220.0378 Vitamin A 200.000 IU Kap 0 0 0 0 0
394 10.02.19.0820.0379 Vitamin A 100.000 IU Kap 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
402 10.01.20.0322.472 Implant KB buah 0 0 0 0 0
403 10.01.20.0322.473 IV catheter 18 pcs 0 0 0 0 0

407 10.01.20.0322.475 Mg Sulfat 20% 25 ml Vial 0 0 0 0 0
408 10.01.20.0322.476 Mg Sulfat 40% 25 ml Vial 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
434 10.01.20.0421.0421 Efavirenz 600 mg Tab 0 0 0 0 0
436 10.01.20.0421.0423 Kondom Sutra Pcs 0 0 0 0 0

440 10.01.20.0521.0427 Rapid 2 HIV Pcs 0 0 0 0 0
443 10.01.20.0421.0430 RPR Sypilis Test 0 0 0 0 0
446 10.01.20.0421.0433 Tipe Ukuran 61 Pcs 0 0 0 0 0
447 10.01.20.0421.0434 Tipe Ukuran 60 Pcs 0 0 0 0 0
449 20.01.18.0523.0282 Asifit Tab 0 0 0 0 0
452 10.01.18.0720.0285 Bisacodyl 5 mg Tab 0 0 0 0 0
455 30.01.20.0723.0288 Curcuma FTC Tab 0 0 0 0 0
459 30.01.20.0624.0504 Ester C Tab 0 0 0 0 0
460 20.01.18.0523.0291 FG Troches tab 0 0 0 0 0
461 20.01.19.0421.0292 Hefagard Kap 0 0 0 0 0
464 20.01.18.0523.0295 Imunos Kap 0 0 0 0 0
465 30.01.20.0322.501 Imboost Kap 0 0 0 0 0
469 30.01.20.1022.0297 Loperamid tab 0 0 0 0 0
PENGELUARAN
No STOK PEMBERIAN
471 20.01.20.0922.0299 Noza Tab 0 0 0 0 0
475 20.01.18.0523.0300 Osteotin Tab 0 0 0 0 0
484 20.01.19.0422.0306 Tensigard Tab 0 0 0 0 0
486 20.01.18.0523.0308 Thrombopob tube 0 0 0 0 0

………………………………………………. ………………………………………………. ………………………………………………. ……………………………………………….

PENGELUARAN
No STOK PEMBERIAN
NIP……………………………………. NIP……………………………………. NIP……………………………………. NIP…………………………………….

C. Tahun Masuk
E. Kode Barang
F. Batch

LPLPO 2021 S Nipah

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LPLPO 2021 S Nipah

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LAPORAN PEMAKAIAN DAN PENGELUARAN OBAT

KODE PUSKESMAS P6302120201 BULAN :……..- ……….

1 10.01.19.0422.0001 Alopurinol tablet 100 mg Tab 50 0 0 50 0 (50)

2 10.01.18.0520.0002 Alopurinol tablet 300 mg Tab 0 0 0 0

3 30.01.20.0521.0003 Aminofilin tablet 200 mg Tab 0 0 0 0

4 10.01.20.0821.0004 Aminofilin injeksi 24 mg/ml - 10 ml Amp 0 0 0 0

5 10.01.20.0224.0005 Amitriptilin HCl tab. Salut 25 mg Tab 0 0 0 0

6 10.01.19.0821.0193 Ampisilin serbuk injeksi 250 mg (Viccillin ) Amp 0 0 0 0

7 10.01.19.0221.0006 Amoksisilin Kaptab 500 mg Kapt 30 30 0 30 0 (30)

8 10.01.19.0522.0007 Amoksisillin 100mg Drop Amp 0 0 0 0

9 10.01.20.1022.0008 Amoksisilin sirup kering 125 mg / 5 ml Btl 3 3 0 3 0 (3)

10 10.01.20.1022.0009 Amoksisilin sirup kering 250 mg / 5 ml Btl 0 0 0 0

11 10.01.17.0319.0160 Amoxilin Injeksi 1000mg Vial 0 0 0 0

12 10.01.19.0522.0010 Antasida Doen tablet kombinasi Tab 0 0 0 0

13 10.01.20.1121.0011 Antasida suspensi Btl 1 1 0 1 0 (1)

14 10.01.18.0822.0012 Antibakteri doen salep kombinasi (Bacitracin) Tub 0 0 0 0

15 10.01.19.0720.0013 Antihemoroid doen kombinasi Suppo 0 0 0 0

16 10.01.19.1022.0014 Antifungi doen kombinasi Pot 0 0 0 0

17 10.01.20.0323.0015 Antimigran doen kombinasi (Ergotamin) Tab 0 0 0 0

18 20.01.20.1222.0016 Aqua proinjeksi steril, bebas pirogen Btl 0 0 0 0

19 10.01.18.0322.0017 Asam askorbat (vit c) tablet 50 mg Tab 0 0 0 0

20 10.01.20.0322.446 Asam askorbat (vit c) tablet 250 mg 0 0 0 0

21 10.01.20.0122.0020 Asetosal 80 mg Tab 0 0 0 0

22 30.01.20.0624.506 Atropin Tab 0,5 mg Tab 0 0 0 0

23 10.01.18.1019.0021 Atropin sulfat injeksi 0,25 mg/ml - 1 ml Amp 0 0 0 0

24 10.01.20.0522.0022 Acetyl Cystein 200mg Kaps 0 0 0 0

25 20.01.20.0923.0023 Acyclovir Cream Tube 0 0 0 0

26 10.01.18.0322.0024 Acyclovir tablet 200 mg Tab 0 0 0 0

27 10.01.18.0722.0025 Acyclovir tablet 400 mg Tab 0 0 0 0

28 20.01.20.1022.0026 Ambroksol sirup Btl 0 0 0 0

29 30.01.20.1221.0027 Ambroksol tablet 30mg Tab 0 0 0 0

30 10.01.20.1121.0028 Asam Mefenamat tablet 500 mg Tab 0 0 0 0

31 10.01.19.0222.0029 Asam Traneksamat Tablet 500 mg Tab 0 0 0 0

32 10.01.18.0722.0030 Asam Traneksamat 100 mg/5 ml Injeksi Amp 0 0 0 0

33 10.01.19.0621.0031 Asam Traneksamat 250 mg/5 ml Injeksi Amp 0 0 0 0

34 10.01.20.0523.0032 Asam Traneksamat 500 mg/5 ml Injeksi Amp 0 0 0 0

35 10.01.18.0920.0033 Amlodipin 5mg Tab 0 0 0 0

36 10.01.18.0821.0034 Amlodipin 10 mg Tab 0 0 0 0

37 30.01.20.0624.0510 Asam folat tab 0,4mg Tab 0 0 0 0

38 10.01.19.0521.0035 Asam folat tab 1 mg Tab 0 0 0 0

39 10.01.19.0321.0036 Betametason krim 0,1 % Tub 0 0 0 0

40 10.01.20.0423.0037 Betahistin mesilate tablet 6 mg Tab 0 0 0 0

41 30.01.20.0123.0038 Cefadroxil 500 mg kaps Kaps 0 0 0 0

42 30.01.20.0520.0039 Cefadroxil sirup kering 125 mg/5ml Btl 0 0 0 0

43 10.01.18.0820.0039 Cefadroxil sirup kering 250 mg/5ml Btl 0 0 0 0

44 10.01.19.1223.0040 Captopril tablet 12,5 mg Tab 0 0 0 0

45 30.01.20.0624.0041 Captopril tablet 25 mg Tab 0 0 0 0

46 10.01.18.0921.0042 Captopril tablet 50 mg Tab 0 0 0 0

47 10.01.20.0122.0043 Ciprofloxacin tablet 500 mg Tab 0 0 0 0

48 10.01.19.0521.0044 Cetirizine Tab 10 mg Tab 0 0 0 0

49 10.01.20.0922.0045 Cetirizine Sirup 5mg/5ml Btl 0 0 0 0

50 10.01.20.0822.0046 Ceptriaxon injeksi 1000 mg Vial 0 0 0 0

51 10.01.19.0421.0047 Cefotaxime Sodium Serb.Inj 1000 mg Vial 0 0 0 0

52 10.01.20.0322.0048 Clindamicin 150 mg Tab 0 0 0 0

53 30.01.20.0624.0509 Clindamicin 300 mg Tab 0 0 0 0

54 10.01.20.0322.0447 Cimetidin Tab 0 0 0 0

55 10.01.20.0122.0049 Deksametason inj 5 mg/ml - 1 ml Amp 0 0 0 0

56 30.01.20.1022.0050 Deksametason tablet 0,5 mg Tab 0 0 0 0

57 10.01.20.0423.0051 Diazepam inj 5 mg/ml - 2 ml Amp 0 0 0 0

58 10.01.18.0822.0052 Diazepam tablet 5 mg Tab 0 0 0 0

59 10.01.19.0523.0053 Diazepam tablet 2 mg Tab 0 0 0 0

60 30.01.20.0822.0054 Difenhidramin HCl inj 10 mg/ml - 1 ml Amp 0 0 0 0

61 10.01.19.0321.0055 Digoksin tablet 0,25 mg Tab 0 0 0 0