LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS PAKUE
OBAT DAK

PUSKESMAS : PAKUE
KECAMATAN : PAKUE
KABUPATEN : KOLAKA UTARA
PROVINSI : SULAWESI TENGGARA
P
PE P P P
Tanggal/Bulan/ :SAT E
05 / 05 / 2021 N E E E
N
UAN APBN DAK 2017
G APBN DAKN 2018 N 2019
APBN DAK APBN DAKN 2020 TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
1 Acyclovirkotak
20 10x10 tab- A A A A
0A - - 0 - - 236 - 100 605 - 100 - - - 60,500 300 - -
N N N N
2 Acyclovir kotak
40 50 tab - N
0 - - 440 - 350 440 200 150 - - - - - 66,000 - 500 - 200
3 Acyclovirktk
cr 25 tube 5gr - ### - - 4,500 - 66 4,400 16 50 - - - - - 220,000 - 100 - 16
4 Albendazole
10 sbotol 5 ml - 0 - - 4,800 - - - - 20 4,800 - 20 - - - 96,000 - -
5 Albendazole
kotak 10x10 tab - 0 - - 484 - - 484 - 500 484 - 500 - - - 242,000 - -
6 Allopurinol
kotak
t 10x10 tab - 120 - - 102 - - 108 - 1,200 108 600 600 - - - 64,800 2,000 - 600
Ambroxol
7 HCL Sirup Botol 60 ml - ### - - 3500 - - 5,500 - 60 5,280 35 25 - - - 132,000 100 - 35
Ambroxol
15mg/ml
8 Tablet 30Ktk 10x10 tablet - 204 - - 140 - - 165 - 1,800 209 1,300 500 - - - 104,500 3,000 - 1,300
Aminophylin
mg
9 Injeksi 24Kotak 30 amp - 0 - - 2,878 - 90 2,878 - 90 - - - - - 259,020 - - -
Aminophylin
mg/ml
10 kotak 10x10 tab - 0 - - - - - - - - - - - - - - - -
Tab 100 mg
Amitriptilin
11 kotak 100 tab - 0 - - - - 400 168 - 400 - - - - - 67,200 - - -
tab 25 mg
12 Amlodipinkotak
Besil300 tab - 110 - - 99 - - 99 - 1,200 106 980 220 - - - 23,320 3,000 - 980
13 Amlodipinkotak
Besila300 tab - 93 - - 78 - - 78 - 1,800 83 680 1,120 - - - 92,960 3,000 - 680
14 Amoxicillin
kotakkapsu
10x10 tab - 192 - - 248 - 8,500 265 2,000 6,500 - - - - - 1,722,500 - 10,000 - 2,000
15 AmoxicillinBotol
Si 60 ml - ### - - - - 260 4,400 25 235 - - - - - 1,034,000 - - 25
16 Antalgin Inje Ampul - 0 - - - - - - - - - - - - - - - -
Ktk
17 Antalginkotak
tabl 10 x 10 tab - 256 - - - - - - - - - - - - - - - -
Antasida 10x1
18 DOEN I Tab 0 - 61 - - 57 - - 61 - 1,200 61 500 700 - - - 42,700 3,000 - 500
Antasida
kunyah table
19 Botol 60 ml - ### - - 2,146 - - - - 75 2,290 46 29 - - - 66,410 200 - 46
Suspensi t
20 Anti Ktk25 tube @ 5 g- ###
Anti fungi D
bakter - - 3,642 - - - - 48 6,600 - 48 - - - 316,800 - -
21 DOEN Ktk 24 pot 30 g - ### - 114 5,395 - 114 - - - - - - - 615,030 - - 20 - -
Anti
komb-salep
Anti Migren
22 Hemoroid kotak 10 supp - 0 - - 3,800 - 50 3,800 20 30 - - - - - 114,000 - - 20
Kom;
Kom. Supp
23 Aqua pro ktk 10 x 10 tab - - - - 208 - - - - - - - - - - - 500 - -
Ergotamin +
injeksi (Otsu
24 Asam
Cafaine botol 25 ml - - - - 2,860 - - - - 14 9,026 7 7 - - - 63,182 50 - 7
water for inj
askorbat
25 26 ml Ktk 10x10 tablet- 0 - - - - - - - - - - - - - - - -
( Vit. C ) tab
26 Asammgaskorbat
250 Ktk 10x10 tablet - ### - - 126 - 1,100 126 1,000 100 - - - - - 12,600 - 5,000 - 1,000
27 Asam folat
ktkta10 x 10 tab - 52 - - 84 - - 84 - - - - - - - - 1,000 - -
Asam folat
28 tab 400 mcg
ktk 10 x 10 tab - 64 - - - - - - - - - - - - - - 1,000 - -
(Afolat)
 P
PE P P P
SAT E
N E E E
N
UAN APBN DAK 2017 G APBN DAKN 2018 N 2019
APBN DAK APBN DAKN 2020 TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
Asam 1 N M N
2 3 ga 4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
mefenamat A
29 Ktk 10x10 tablet - ### A A A A A
500 mg - - 106 - 4,500 319 1,600 2,900 2,000 341 2,000 - - 925,100 682,000 10,000 - 1,600
N N N N
30 Besi II sulfat Fer30 tab - 430 N
saset - - 427 - - - - - 427 - - - - - - -
31 Betahistin tablet - - - - - - 2,900 119 - 2,900 - - - - - 345,100 - - -
32 Betametazon
Ktk 25kritube 5 g - 227 - - 1,400 - 90 1,400 - 15 - - - - - 21,000 - 100 - - 75
33 Bisakodil Ktk
tab 3 x 10 tab - - - - 330 - - - - 400 572 - 400 - - - 228,800 - -
34 CalciumKtk
Lact10x10 tablet - 64 - - 60 - 600 64 - 600 - - - - - 38,400 - 1,000 - -
35 CaptoprilKtk
12,10x10 tablet - 72 - - 68 - 600 68 100 500 - - - - - 34,000 - - 100
36 CaptoprilKtk
2510x10 tablet - 89 - - 82 - - 121 - 1,000 165 200 800 - - - 132,000 500 - 200
37 CaptoprilKtk
5010x10 tablet - ### - - 149 - - - - 700 275 100 600 - - - 165,000 - 100
38 Carbamazepi
Ktk 10x10 tablet- 0 - - - - - - - - - - - - - - - -
39 Cefadroksil
kotak500
10x10 tab - ### - - 690 - - 770 - 1,500 924 1,000 500 - - - 462,000 5,000 - 1,000
40 CefadroksilBotol
Sir 60 ml - ### - 153 4,086 42 111 - - - - - - - 453,546 - - 50 - 42
41 Cetrizine
Cefotaksimkotak
In 2 vial - - ### - 7,241 - 30 7,241 - - - - - - - - 50 - - 30
HCL 10 mg
42 kotak 10 x10 tab- ### - - 98 - - - - - - - - - - - 3,000 - -
Cetrizine
43 Botol 60 ml - ### - - 3,035 - - 3,104 - 140 3,104 15 125 - - - 388,000 50 - 15
sirup
44 Chlorampheni
Ktk 10x10 tablet - ### - - 341 - - 715 - 1,200 704 120 1,080 - - - 760,320 - 120
45 Chlorampheni
kotak 24 tube,5g - ### - - 2,013 - 96 2,013 - 96 - - - - - 193,248 - - -
46 Chlorampheni
Botol 60 ml - ### - - 5,175 - - 5,522 - 75 9,900 10 65 - - - 643,500 50 - 10
47 Chlorpheniramtab - 40 - 19,000 25 1,500 17,500 5,000 27 - 5,000 - - - - 437,500 135,000 - - 1,500
48 Chlorpromazi
Ktk 10x10 tablet - - - - 177 - - - - - - - - - - - 500 - -
Ciprofloxaci
49 n 500 mgKtk 10 x 10 tablet - ### - - 292 - 800 550 - 800 1,000 660 - 1,000 - - 440,000 660,000 - -
Clindamicin
tab
50 Kaplet - 786 - - 646 - - 786 - - - - - - - - 1,000 - -
Cap 150 mg
Clindamicin
51 Ktk 5 x 10 tablet- 646 - - - - - - - - - - - - - - 500 - -
Cap 300 mg
52 Cotrimoxazol
Ktk 10x10 tablet- 158 - - 129 - - - - 3,200 138 500 2,700 - - - 372,600 1,000 - 500
53 Cotrimoxazole
Ktk 10x10 tablet - - - - - - - - - - - - - - - - - -
54 Cotrimoxazol
Botol 60 ml - ### - - 2,115 - 113 2,257 8 105 - - - - - 236,985 - 50 - 8
55 Cyanocobalamin
ktk 100 amp - ### - 390 1,187 - - - - - - - - - - - 200 - - 390
56 Cyanocobalamin
Ktk 10x10 tablet - - - - 50 - 1,700 50 - 1,700 - - - - - 85,000 - 1,500 - -
57 Deksametason
Ampul
in - ### - - 1,278 - - 1,278 - 60 1,278 - 60 - - - 76,680 50 - -
58 Deksametason
Ktk 10x10 tablet - 46 - - 35 - - 88 - 1,600 97 1,600 - - - - - 10,000 - 1,600
59 DekstrometorTable - 0 - - - - - - - - - - - - - - - -
60 Dextrosa Lar 0 - - - - - - - - - - - - - - - - 10 - -
61 Diazepamktk
5 mg
10 amp - - - 30 2,010 10 20 40 2,010 - 40 - - - - 40,200 80,400 - - 10
62 Diazepambotol
tab 100 tab - ### - - - - 600 86 100 500 - - - - - 43,000 - 300 - 100
63 Difenhidramin
Ktk 30
Inj amp - - - - 1,316 - - - - - - - - - - - - -
64 Difenhidramin
Ktk 30
Inj amp - ### - 60 1,316 - 60 180 1,316 - 180 - - - - 78,960 236,880 - - -
65 Digoksin TablTable - - - - - - - - - - - - - - - - - -
 P
PE P P P
SAT E
N E E E
UAN APBN DAK 2017N
G APBN DAKN 2018 APBN DAKN 2019 N 2020
APBN DAK TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga 4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
66 Doksisiklin
Ktk K10x10 tablet - A A A A
- A - - - - 600 264 - 600 - - - - - 158,400 - - -
N N N N
67 Domperidon Botol
S 60 ml - N
- - - 2,970 - 196 2,970 10 186 - - - - - 552,420 - - 10
68 Domperidon
Ktk 10x10
t tablet- - - - - - - 90 - 2,100 96 400 1,700 - - - 163,200 1,000 - 400
69 Efineprina
Kotak
HCL100 amp - ### - - 2,068 - - 2,068 - - - - - - - - 50 - -
70 ErytromicinBotol
Si 60 ml - - - - - - - - - 25 14,300 - 25 - - - 357,500 - -
71 Erytromycin
Ktk 10
s x 10 kap - ### - - 677 - - 666 - - - - - - - - - -
72 Erytromycin
Ktk 10
s x 10 kap- ### - - - - - - - 400 781 100 300 - - - 234,300 - 100
73 Etakridin (Riv
Btl 300 ml - ### - - 3,600 - - 3,600 - - - - - - - - 30 - -
74 Etanol 70 botol
% 100 ml - 0 - - - - - - - - - - - - - - - -
75 Etanol 70 botol
% 300 ml - - - - 11,600 - - 9,475 - 24 7,843 4 20 - - - 156,860 10 - 4
76 Etanol 70botol
% 1000 ml - - - - 25,300 - - 26,053 - 5 33,000 - 5 - - - 165,000 - -
77 Fhytomenadion
Ktk 30 amp - ### - - 4,420 - - 4,420 - 60 4,420 - 60 - - - 265,200 - -
78 Fhytomenadion
Ktk 10x10 tablet - ### - - - - 1,300 855 - 1,300 - - - - - 1,111,500 - - -
79 Formalin botol 1 liter - ### - - 63,910 - - - - - - - - - - - 1 - -
80 Furosemid
kotak
ta 10 x 10 tab - - - - 82 - - 82 - 800 88 - 800 - - - 70,400 - -
81 Garam Oralit
kotak 100 sst - ### - - - - 300 293 - 300 - - - - - 87,900 - - -
82 Gemfibrozil
kotak 10 x 10 tab - - - 200 446 - 200 - - - - - - - 89,200 - - - -
83 Gentamisin
ktk 24
te btl@ 5 ml - ### - - 5,098 - - - - - - - - - - - 10 - -
84 Glibenklamid
Ktk 10x10 tablet- 0 - - 143 - 1,000 143 100 900 - - - - - 128,700 - 1,500 - 100
85 Glimipiride
Ktk 210x10 tablet - ### - - - - 800 207 - 800 - - - - - 165,600 - - -
86 Glukosa laruta
botol 500 ml - 0 - - - - - - - - - - - - - - 60 - -
87 Glukosa laruta
botol 500 ml - - - - - - - - - - 7,363 - - - - - 60 - -
88 Griseufulvin
Ktk 10x10 tablet - ### - - 231 - - 247 - - - - - - - - 2,000 - -
89 Guavenisin
kotak
(Gly100 tab - - - - 91 - - 154 - 1,400 143 200 1,200 - - - 171,600 2,000 - 200
90 Haloperidol
Ktk 10x10
0 tablet - - - - - - - - - 800 55 - 800 - - - 44,000 - -
91 Haloperidol
Ktk 10x10
1 tablet - 65 - - - - - - - 800 59 - 800 - - - 47,200 - -
92 Hydroclorotia
ktk 10 x 10 tab - ### - - - - 700 186 - 700 500 186 - 500 - - 130,200 93,000 - -
93 Hydrocortison
ktk 24 tube 5 G - ### - - 2,648 - 119 2,648 - 119 48 2,648 - 48 - - 315,112 127,104 - -
94 Ibuprofen Su
Botol 60 ml - ### - - 2,716 - - - - 120 2,898 20 100 - - - 289,800 100 - 20
95 Ibuprofenktk
tab10 x 10 tab - ### - - 116 - - 264 - 1,300 242 400 900 - - - 217,800 5,000 - 400
96 Ibuprofenktk
tab10 x 10 tab - ### - - 123 - - 308 - 2,000 352 900 1,100 - - - 387,200 5,000 - 900
97 Isosorbit Dini Table - 0 - - - - - - - 100 176 - 100 - - - 17,600 - -
98 Ketoconazole
Ktk 5 x 10 tab - 308 - - 297 - 1,000 317 - - 200 550 - - - - - - 1,000 - - 1200
99 Ketokonazole
Tubekri 10 g - ### - - 2,694 - 100 2,694 25 75 - - - - - 202,050 - 100 - 25
100 Lanzoprasol kap
tab - 370 - - 343 - - 360 - 1,150 360 200 950 - - - 342,000 3,000 - 200
101 Lidocaine
Ktk HCL
100 amp@2ml- - - - 1,375 - - - - - - - - - - - - -
102 Lidocaine HCL
Ktk 30
i amp - ### - 368 1,380 30 338 120 1,380 - 120 - - - - 466,440 165,600 - - 30
 P
PE P P P
SAT E
N E E E
N
UAN APBN DAK 2017 G APBN DAKN 2018 APBN DAKN 2019 N 2020
APBN DAK TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga 4 5 R6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
103 Loperamid ktkHC
10 x 10 tab - 91 A A A A A
- - 210 - 2,100 210 - 2,100 - - - - - 441,000 - - -
N N N N
104 Lysol 1 lt botol 1000 ml - ### N - - 49,200 - 6 49,200 1 5 - - - - - 246,000 - - 1
105 Metamizole
kotak 100 tab - - ### 1,600 189 - - - - - - - - - - - - 1,000 - - 1600
106 Metforminktk5010 x 10 tab - ### - - 110 - - 117 - 1,600 117 300 1,300 - - - 152,100 2,000 - 300
107 Metilpredniso
ktk 10 x 10 tab - 230 - - - - - 143 - 1,800 153 600 1,200 - - - 183,600 3,000 - 600
108 Metoklorprop
Botol 60 ml - - - - - - - - - 70 6,490 - 70 - - - 454,300 50 - -
109 Metoklorprop
Ktk 10x10 tablet - - - - 129 - 1,200 129 - 1,200 - - - - - 154,800 - - -
110 Metronidasol
ktk 10 x 10 tab - ### - - - - - 330 - 1,100 308 700 400 - - - 123,200 3,000 - 700
111 Metronidasol Ampul - 0 - - - - - 8,250 - - - - - - - - 20 - -
112 Metylergometr
ktk 100 amp - ### - - 3,553 - 400 3,553 - - - - - - - - - 200 - - 400
113 Metylergometr
ktk 10 x 10 tab - - - - 254 - 600 254 - 600 - - - - - 152,400 - 800 - -
114 Miconazole
kotakkri
24 tube 10gr
- 170 - - 4,097 - 48 4,097 - 48 - - - - - 196,656 - 72 - -
115 Natrium diklo
Ktk 5 x 10 tab - ### - - 154 - - 154 - 1,700 264 600 1,100 - - - 290,400 2,000 - 600
116 Natrium diklo
Ktk 5 x 10 tab - ### - - 146 - - 146 - 1,000 319 400 600 - - - 191,400 3,000 - 400
117 Natrium klorida
Botol 500 ml - ### - 131 6,410 46 85 - - - - - - - 544,850 - - 300 - 46
118 NifedipinKtk
tabl
10x10 tablet - ### - 2,700 182 - 2,700 1,000 154 - 1,000 - - - - 491,400 154,000 - - -
119 Nystatinktktab
10 x 10 tab vag- ### - - 675 - - - - - - - - - - - 300 - -
120 Nystatin table
ktk 10 x 10 tab - ### - - 950 - 150 950 - 150 - - - - - 142,500 - - -
121 OAT FDC kat.
PAKET - - - - 1,557,474 - - - - - - - - - - - - -
122 Obat BatukBotol
Hitam60 ml - ### - - 7,000 - - - - 40 6,050 11 29 - - - 175,450 100 - 11
123 Ofloxacin TabTablet - - - - - - - - - - - - - - - - - -
124 Oksitetrasikli
kotak 25 tube - - - - - - 57 4,400 - 57 - - - - - 250,800 - - -
125 Omeprasol
kotak
ta 3 x 10 tab - ### - - 143 - - 153 - 1,020 440 420 600 - - - 264,000 3,000 - 420
126 Oxytetracikli
kotak 25 tube - 0 - 150 2,600 - 150 - - - - - - - 390,000 - - - -
127 Oxytocinkotak
Injeks100 amp - ### - - 1,287 - 25 1,287 - 25 - - - - - 32,175 - 100 - -
128 Papaverine
kotak
t 100 tab - - - - 231 - 3,600 264 - 3,600 - - - - - 950,400 - - -
129 Paracetamol
Ktk 10 x 10 tablet - ### - - 63 - 3,500 143 2,200 1,300 - - - - - 185,900 - 10,000 - 2,200
130 Paracetamol
Botol 60 ml - - - - 7,979 - - 7,979 - 8 7,979 8 - - - - - 50 - 8
131 Paracetamol
botol
I 100 cc - - - - 11,990 - - 11,990 - 3 11,990 3 - - - - - 50 - 3
132 Paracetamol
Botol
s 60 ml - - - - 1,190 - - - - 145 4,400 63 82 - - - 360,800 200 - 63
133 Phenobarbital
Kotak 30 amp - ### - - 2,230 - 90 2,230 - 90 - - - - - 200,700 - - -
134 Phenobarbital
kotak tab - - - 1,000 205 - 1,000 1,000 205 - 1,000 - - - - 205,000 205,000 - - -
135 Phenol Glyser
kotak 24 botol - ### - - 2,590 - - 2,590 - - - - - - - - 24 - -
136 Pirantel Pamoat
ktk 25 x 4 tab - ### - - 346 - 200 346 - 200 - - - - - 69,200 - - -
137 Piridoksin
Ktk(Vi
10 x 10 tablet- 142 - - 148 - - 148 - 2,400 158 200 2,200 - - - 347,600 - 200
138 Piroxicam
Ktk10
10 x 10 tablet - ### - - 113.4 - 1,500 176 400 1,100 - - - - - 193,600 - 1,000 - 400
139 Piroxicam
Ktk20
10 x 10 tablet - ### - - 141.12 - 1,500 220 200 1,300 - - - - - 286,000 - 1,000 - 200
 P
PE P P P
SAT E
N E E E
N
UAN APBN DAK 2017G APBN DAKN 2018 APBN DAKN 2019 APBN DAKN 2020 TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga 4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
140 Povidone 10
botol 30 ml - A A A A
0A - - 3,380 - 20 3,000 - 20 - - - - - 60,000 - - -
N N N N
141 Thiamin Hcl (vampul N
- - ### - - - - - - 30 1,596 - - - - - - 60 - - 30
142 Povidone botol
10 300 ml - ### - - 19,600 - 15 17,883 4 11 - - - - - 196,713 - 10 - 4
143 Prednisonktkta10 x 10 tab - 85 - - 74 - - 79 - 900 79 200 700 - - - 55,300 3,000 - 200
144 Propiltiorasil Table - - - - - - - - - 900 660 - 900 - - - 594,000 - -
145 Ranitidinkotak
inje 100 amp - - - - 1,320 - - - - - - - - - - - 100 - -
146 Ranitidin
Ktktab
10 x 10 tablet- ### - - 175 - - 242 - 1,300 220 200 1,100 - - - 242,000 2,000 - 200
147 Retinol (vit.A
botol 50 kaps - - - - - - - - - - - - - - - - - -
148 Retinol (vit.A
botol 50 kaps - - - 300 622 - 300 - - - - - - - 186,600 - - - -
149 Ringer laktat
Botol 500 ml - ### - - 7,150 - - 7,150 - 160 7,630 120 40 - - - 305,200 300 - 120
150 Salbutamol
kotakT 10 x 10 tab - - - - - - - - - 700 110 - 700 - - - 77,000 - -
151 Salbutamol
kotakT 10 x 10 tab - ### - - 81 - - 132 - 1,200 132 200 1,000 - - - 132,000 1,000 - 200
152 Salep 2-4, kombi
pot - ### - 81 3,143 - 81 - - - - - - - 254,583 - - - -
153 Salisil bedak
kotak / botol - ### - - 7,000 - 5 6,600 5 - - - - - - - - 100 - 5
154 Simvastatin
Ktk10
3 xm10 tab - ### - - - - - 110 - 720 117 510 210 - - - 24,570 3,000 - 510
155 Simvastatin
kotak
20 m
500 tab - ### - - 235 - - 235 - 1,250 247 250 1,000 - - - 247,000 500 - 250
156 Sucrolfate Botol
syr 60 ml - - - - 7,789 - - 7,789 - 30 7,789 30 - - - - - 100 - 30
157 Tetracyline
Ktk 10
5 x 10 tablet- ### - - 324 - 1,700 324 100 1,600 - - - - - 518,400 - - 100
158 Thiamfenicol
Ktk 10 x 10 tablet - ### - - 770 - - - - 700 990 200 500 - - - 495,000 500 - 200
159 Tiamin Ktk
HCL10(Vit.
x 10 tablet- 90 - 600 92 200 400 - - - - - - - 36,800 - - 2,000 - 200
160 Trihexifenidil
Ktk 10 x 10 tablet- 0 - - 92 - - 106 - 100 440 100 - - - - - 1,000 - 100
161 Urine bag Pcs - - - - 1,596 - - - - 25 6,653 - 25 - - - 166,325 - -
162 VitaminKtk
B plex
10 x 10 tablet- ### - - 141 - - 141 - 1,200 150 1,050 150 - - - 22,500 10,000 - 1,050
163 Zink Sulfate
Ktk 10 x 10 tablet- - - - 631 - - 631 - 1,200 631 - 1,200 - - - 757,200 - -
PERBEKALAN
0 KESEHATAN
0 - - - - - - - - - - - - - - - - - -
164 Alat suntikotak
sek 100 pcs - ### - - 809 - 350 822 100 250 - - - - - 205,500 - - 100
165 Alat suntikotak
sek 100 pcs - ### - - 816 - 400 829 100 300 - - - - - 248,700 - 500 - 100
166 Alat suntikotak
sek 100 pcs - ### - - 970 - 470 986 - 470 - - - - - 463,420 - - -
167 Cat gut 2/0
kotak 12 pcs - ### - - - - - - - - - - - - - - - -
168 Cat gut 3/0
kotak 12 pcs - ### - - - - - - - - - - - - - - - -
169 Cat gut Cromic
kotak 24 pcs - - - - 8,938 - - - - - - - - - - - - -
170 Cat gut Cromic
kotak 24 pcs - - - - 8,938 - - 0 - - - - - - - - - -
171 Cat gut Plain
kotak 24 pcs - ### - 24 8,938 4 20 - - - - - - - 178,760 - - - 4
172 Cat gut Plain
kotak3 24 pcs - ### - 71 8,938 20 51 - - - - - - - 455,838 - - 60 - 20
173 Foly Cateter
kotak 10 pcs - 0 - - 21,220 - - - - - 20,700 - - - - - 20 - -
174 Foly Cateter
kotak 10 pcs - 0 - - 21,220 - - - - - - - - - - - - -
175 Handscoon pcs - - - - 631 - - 515 - - - - - - - - 500 - -
 P
PE P P P
SAT E
N E E E
N
UAN APBN DAK 2017G APBN DAKN 2018 APBN DAKN 2019 N 2020
APBN DAK TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga 4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
176 Handscoon L 100 pcs - A A A A
kotak 0A - - - - - 515 - - - - - - - - 500 - -
N N N N
177 Handscoon Nopcs N
- 0 - - - - 45 4,680 45 - - - - - - - - 200 - 45
178 Handscoon Nopcs - ### - - 4,680 - - - - 100 6,595 100 - - - - - 200 - 100
179 Handscoon No.7
pcs - ### - - 4,680 - - 4,680 - - - - - - - - 200 - -
180 Handscoon No.pcs - ### - - 4,680 - - 4,680 - 50 6,595 50 - - - - - 200 - 50
181 Infuset Anak
Kotak 50 Pcs - ### - 349 7,250 50 299 - - - - - - - 2,167,750 - - - 50
182 Infuset Dewasa
Kotak 50 Pcs - ### - 600 7,688 50 550 - - - - - - - 4,228,400 - - - 50
183 IV.CateterKotak
no 50 Pcs - - - 100 4,290 - 100 - - - - - - - 429,000 - - - -
184 IV.CateterKotak
no 50 Pcs - - - - - - 240 9,461 50 190 - - - - - 1,797,590 - 100 - 50
185 IV.Cateterkotak
no 50 pcs - ### - - 4,290 - 240 9,459 90 150 - - - - - 1,418,850 - 200 - 90
186 IV.Cateterkotak
no. 2250 pcs - ### - 490 4,290 50 440 - - - - - - - 1,887,600 - - - 50
187 IV.Cateterkotak
no 50 pcs - ### - 440 4,290 50 390 - - - - - - - 1,673,100 - - - 50
188 Kapas Berlem
Bungkus - 0 - - - - - - - - - - - - - - - -
189 kapas pembalut
Roll - ### - - 14,375 - 14 14,375 4 10 - - - - - 143,750 - 5 - 4
190 Kasa Hidrofil
kotak 16 pcs - - - - - - 25 9,200 25 - - - - - - - - 100 - 25
191 Kasa Hidrofil Roll - ### - - - - - - - 55 2,415 15 40 - - - 96,600 50 - 15
192 Kasa Hidrofil Roll - - - - - - - - - - - - - - - - - -
193 Kasa Hidrofil Roll - ### - - 120,750 - 2 120,750 2 - 10 155,250 3 7 - - - 1,086,750 10 - 5
194 Kasa HidrofilBungkus - - - - 3,615 - - - - - - - - - - - - -
195 Masker Hijab/ pcs
ji - ### - - 506 - - 425 - 170 4,598 120 50 - - - 229,900 200 - 120
196 Masker N 95 pcs - - - - - - 20 7,489 - 20 - - - - - 149,780 - - -
197 Plester 5 yards
kotak
x - ### - - - - 15 37,371 10 5 - - - - - 186,855 - 50 - 10
198 Sarung tangaPAKET - - - - - - - 22,264 - - - - - - - - - -
199 Silk Blak 2/0 pcs - 0 - - - - - - - - - - - - - - - -
200 Silk Blak 3/0
kotak 12 pcs - ### - - - - - - - - - - - - - - - -
201 Silk Blak 3/0
kotak 36 pcs - ### - - 4,639 - 72 215 72 - - - - - 15,480 - 72 - -
202 TB Lampu spirpcs - 0 - - - - - 44,000 - - - - - - - - 1 - -
203 TB Spiritus pcs - - - - - - 1 27,500 - 1 - - - - - 27,500 - - -
204 TB. Reagen 1zi paket - ### - - 5,230 - - - - - 274,560 - - - - - - -
OBAT
0 GIGI dan Antiseptik
0 - - - - - - - - - - - - - - - - - -
205 Aceptik gelBotol 500 ml - ### - - 215,600 - - - - 1 31,800 - 1 - - - 31,800 - -
206 Caviton'w (3Mbotol - - (2) 2 215,600 - - - - - - - - - - - - - - 2
207 Aceptan Liqui
Botol 500 ml - - - - 92,400 - - - - 1 43,956 - 1 - - - 43,956 - -
208 Cooling 5 botol - - - - 47,909 - 6 38,500 - 6 - - - - - 231,000 - - -
209 Bracket hand
kotak 300 tab - ### - - 939,400 - - - - - 20,125 - - - - - 5 - -
210 Elitte Semen
set/kotak 2 botol- ### - - 231,000 - 8 209,000 - 8 - - - - - 1,672,000 - - -
211 Etil kloridabotol
s 100 ml - - - - 231,000 - 2 198,000 - 2 - - - - - 396,000 - - -
 P
PE P P P
SAT E
N E E E
UAN APBN DAK 2017 N
G APBN DAKN 2018 APBN DAKN 2019 APBN DAKN 2020 TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga 4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
212 Eugenol Cair botol A A A A
- ### A - - 22,589 - - 22,589 - - - - - - - - - -
N N N N
213 GC Fuji set/kotak
IX ( 2 botol - ### N - - 729,729 - - - - 2 638,000 - 2 - - - 1,276,000 - -
214 One scrubBotol
4% 500 ml - ### - - 223,300 - - - - 1 7,500 - 1 - - - 7,500 - -
215 LydocaineBotol
Jel 100 ml - - - - 41,600 - - 41,600 - - - - - - - - - -
216 LydocaineBotol
spr 100 ml - - - - 177,216 - - 177,216 - - - - - - - - - -
217 Pulp - X DeviBotol - - - 2 364,000 - 2 - - - - - - - 728,000 - - - -
218 Temporary sto set - ### - - 364,000 - - - - - - - - - - - - -
TOTAL HARGA - 16,038,557 20,919,584 17,459,287 54,417,428

Olo-oloho, 25 Mei 2021

Mengetahui, Yang Menerima Yang Melapor Pembuat Laporan
Kepala Dinas Kesehatan Kepala Instalasi Farmasi Kepala Puskesmas Pakue
Kabupaten Kolaka Utara Kabupaten Kolak Utara

Irham, SKM, M.KES Karmila Akri, S.Farm., Apt Nurhana, SKM Nurhasanah, S.Farm
Nip. 19690226 199003 1 003 Nip. 19820303 200604 2 017 Nip. 19690618 198903 2 003 Nip. 19900501 201402 2 008
 P
PE P P P
SAT E
N E E E
N
UAN APBN DAK 2017
G APBN DAKN 2018 N 2019
APBN DAK N 2020
APBN DAK TOTAL
/ E PERMINTAA PEN Expire
NAMA OBAT Sat EL SI E PENGE E PENGE E PENGE HARGA
NO KEM STOK uan R U SA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA STOK Satuan
RI LUARA
SISA N ERI PENGEL Date
ASA AWAL I AWAL Harga STOK AWAL Harga STOK AWAL Harga STOK MAA UARAN
Har A ST M N M N M N
N M N
1 2 3 ga4 5 R 6 OK
7 8 9 10
A 11 12 13 14 15
A 16 17 18 19 20
A 21 22 23 24 25 26 27 28 29 30
A
A A A A
A
N N N N
N

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