DATA BELANJA MODAL DANA KAPITASI SEMESTER II TAHUN 2020

SKPD : PUSKSMAS NGALUPOLO

KOTA : ENDE
PROPINSI : NUSA TENGGARA TIMUR

No Kode Rekening Nama Rekening Nama Barang Merk/Type/Bahan Banyaknya

1 5.2.16.13.3.29.02 PENGADAAN PERSONAL COMPUTER PC Computer Lenovo / Plastik 1

2 5.2.16.13.3.29.02 PENGADAAN PERSONAL COMPUTER PC Computer Lenovo / Plastik 2

3 5.2.16.13.3.29.05 PERALATAN PERSONAL COMPUTER Printer Canon Pixma iP 2770 Canon Pixma / Plastik 5

4 5.2.16.13.3.29.05 PERALATAN PERSONAL COMPUTER Printer Epson L3110 Epson / Plastik 1

5 5.2.16.13.3.29.05 PERALATAN PERSONAL COMPUTER Hardisk 1 Tera Toshiba / Plastik 2

6 5.2.16.13.3.29.03 PERALATAN KOMPUTER MAINFRAME Hardisk 1 Tera Plastik 2

7 5.2.16.13.3.29.03 PERALATAN KOMPUTER MAINFRAME Hardisk 500Gb Plastik 1

8 5.2.16.13.3.28.01 MEUBELAIR Lemari 2 Pintu Kayu 1

9 5.2.16.13.3.28.01 MEUBELAIR Lemari 1 Pintu Kayu 1

10 5.2.16.13.3.28.01 MEUBELAIR Lemari Kayu Ukuran Besar 2 Pintu Kayu 1

11 5.2.16.13.3.28.01 MEUBELAIR Lemari Ukurang Sedang 1 Pintu Kayu 1

12 5.2.16.13.3.28.01 MEUBELAIR Meja Ukuran Kecil 60cm x 1m Kayu 2

13 5.2.16.13.3.28.01 MEUBELAIR Spon Giovani/Kain 4

14 5.2.16.13.3.28.01 MEUBELAIR Sprei 90x200 cm Fata/Kain 4

15 5.2.16.13.3.28.01 MEUBELAIR Bantal Royal/Kain/Busa 8

16 5.2.16.13.3.28.04 PENGADAAN ALAT PENDINGIN Kipas Angin Plastik 3

17 5.2.6.13.3.27.05 PENGADAAN ALAT KANTOR LAINNYA Generator 10 PK Besi 1

18 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Stetoscope Dewasa Deluxe/Plastik/Stainles 8

s

19 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Ultrasonic Fetal Doppler OneMed/Plastik 2

20 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Aneroid Sphygmomanometer Serenitiy/Plastik 8

21 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Digital Personal Scale SRB-9332 Serenitiy/Plastik 5

22 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Thermometer OneMed/Plastik 15

23 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Tensi Digital OneMed/Plastik 2

24 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Hecting Set Marwa/Stainless 2

25 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Partus Set Marwa/Stainless 2

26 5.2.16.03.3.34.01 ALAT KEDOKTERAN UMUM Stetoscope Dewasa Serenitiy/Plastik 2

TOTAL BELANJA MODAL SEMESTER II 2020

R II TAHUN 2020

Jangka Waktu No/Tgl Nota Pesan/SPK

Harga Satuan Jumlah Harga Tgl/Pembeliha Pesan/Barang
n Terima Nomor Tanggal

Rp 9,477,000 Rp 9,477,000 10-Oct-20 1 HARI 149.b/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 9,477,000 Rp 18,954,000 5-Dec-20 1 HARI 158.a/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 28,431,000

Rp 800,000 Rp 4,000,000 10-Oct-20 1 HARI 149.c/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 3,048,000 Rp 3,048,000 10-Oct-20 1 HARI 149.c/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 1,580,000 Rp 3,160,000 10-Oct-20 1 HARI 149.c/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 10,208,000

Rp 1,250,000 Rp 2,500,000 5-Dec-20 1 HARI 158.b/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 660,000 Rp 660,000 5-Dec-20 1 HARI 158.b/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 3,160,000

Rp 3,300,000 Rp 3,300,000 10-Oct-20 1 HARI 149.d/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 1,700,000 Rp 1,700,000 10-Oct-20 1 HARI 149.d/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 2,500,000 Rp 2,500,000 5-Dec-20 1 HARI 158.c/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 2,000,000 Rp 2,000,000 5-Dec-20 1 HARI 158.c/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 750,000 Rp 1,500,000 5-Dec-20 1 HARI 158.c/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 1,500,000 Rp 6,000,000 23-Oct-20 1 HARI 153/TU.01/PUSK.NPL/NP/X/2020 22-Oct-20

Rp 165,000 Rp 660,000 10-Oct-20 1 HARI 149.e/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 82,500 Rp 660,000 10-Oct-20 1 HARI 149.f/TU.01/PUSK.NPL/NP/X/2020 9-Oct-20

Rp 18,320,000

Rp 847,733 Rp 2,543,199 5-Dec-20 60 HARI 158.d/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 2,543,199

Rp 20,000,000 Rp 20,000,000 5-Dec-20 60 HARI 158.e/TU.01/PUSK.NPL/NP/XII/2020 4-Dec-20

Rp 20,000,000

Rp 49,455 Rp 395,640 5-Dec-20 79 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 1,309,440 Rp 2,618,880 5-Dec-20 79 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 950,000 Rp 7,600,000 5-Dec-20 80 HARI 03/SP/ALKES/KAPITASI/IX/2020 24-Sep-20

Rp 250,000 Rp 1,250,000 5-Dec-20 80 HARI 03/SP/ALKES/KAPITASI/IX/2020 24-Sep-20

Rp 40,000 Rp 600,000 24-Dec-20 90 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 825,000 Rp 1,650,000 24-Dec-20 90 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 500,000 Rp 1,000,000 24-Dec-20 90 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 500,000 Rp 1,000,000 24-Dec-20 90 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 49,455 Rp 98,910 24-Dec-20 90 HARI 05/SP/ALKES/KAPITASI/X/2020 23-Sep-20

Rp 16,213,430

Rp 98,875,629
 No/Tgl BA Pemeriksaan No/Tgl BAST
Dari Toko/CV
Nomor Tanggal Nomor Tanggal

150.b/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.b/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Delta Com

159.a/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.a/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mitra Abadi

150.c/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.c/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Delta Com

150.c/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.c/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Delta Com

150.c/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.c/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Delta Com

159.b/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.b/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mitra Abadi

159.b/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.b/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mitra Abadi

150.d/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.d/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Mamo Djawa

150.d/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.d/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Mamo Djawa

159.c/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.c/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mamo Djawa

159.c/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.c/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mamo Djawa

159.c/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.c/TU.01/PUSK.NPL/BASTB/X/2020 5-Dec-20 CV. Mamo Djawa

154/TU.01/PUSK.NPL/BAPB/X/2020 23-Oct-20 155/TU.01/PUSK.NPL/BASTB/X/2020 23-Oct-20 CV. Dewangga

150.e/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.e/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Dewangga

150.f/TU.01/PUSK.NPL/BAPB/X/2020 10-Oct-20 151.f/TU.01/PUSK.NPL/BASTB/X/2020 10-Oct-20 CV. Dewangga

159.d/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.d/TU.01/PUSK.NPL/BASTB/XII/2020 5-Dec-20 CV. Mitra Abadi

159.e/TU.01/PUSK.NPL/BAPB/XII/2020 5-Dec-20 160.e/TU.01/PUSK.NPL/BASTB/XII/2020 5-Dec-20 CV. Mitra Abadi

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

02/PAN/KAPITASI/X/2020 27-Oct-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Adi Barata

Asti
 PT. Adi Barata
02/PAN/KAPITASI/X/2020 27-Oct-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 Asti
PT. Mahkota
05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 Anugrah Karya

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

05/PAN/KAPITASI/XI/2020 1-Dec-20 05/BAST.ALKED/KAPITASI/XII/2020 14-Dec-20 PT. Mahkota

Anugrah Karya

Plt.Kepala Puskesmas Ngalupolo

Yohanes Sako, A.Md.Kep

NIP. 19800313 200212 1 005
 Alamat Toko/CV Pimpinan Toko/CV NPWP Bank

Jl. Sudirman Ende Boby 02.703.423.0.923.000 BRI Cabang Ende

Jln. Anggrek Dra. Theresia Lake 95.792.089.5-923.000 BANK NTT CABANG ENDE

Jl. Sudirman Ende Boby 02.703.423.0.923.000 BRI Cabang Ende

Jl. Sudirman Ende Boby 02.703.423.0.923.000 BRI Cabang Ende

Jl. Sudirman Ende Boby 02.703.423.0.923.000 BRI Cabang Ende

Jln. Anggrek Dra. Theresia Lake 95.792.089.5-923.000 BANK NTT CABANG ENDE

Jln. Anggrek Dra. Theresia Lake 95.792.089.5-923.000 BANK NTT CABANG ENDE

Jl. Sultan Hasanudin Damianus Lagu 02.925.201.2.923.000 BANK BRI UNIT MARILONGA
Ende

Jl. Sultan Hasanudin

Ende Damianus Lagu 02.925.201.2.923.000 BANK BRI UNIT MARILONGA

Jl. Sultan Hasanudin Damianus Lagu 02.925.201.2.923.000 BANK BRI UNIT MARILONGA
Ende
Jl. Sultan Hasanudin
Damianus Lagu 02.925.201.2.923.000 BANK BRI UNIT MARILONGA
Ende

Jl. Sultan Hasanudin

Ende Damianus Lagu 02.925.201.2.923.000 BANK BRI UNIT MARILONGA

Jln. Pabean Haslinda 74.952.199.3.923.000 BANK NTT CABANG ENDE

Mbongawani
Jln. Pabean Haslinda 74.952.199.3.923.000 TUNAI
Mbongawani

Jln. Pabean Haslinda 74.952.199.3.923.000 TUNAI

Mbongawani

Jln. Anggrek Dra. Theresia Lake 95.792.089.5-923.000 BANK NTT CABANG ENDE

Jln. Anggrek Dra. Theresia Lake 95.792.089.5-923.000 BANK NTT CABANG ENDE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Denpasar PT. Adi Barata Asti BCA DENPASAR CABANG HASANUDIN DENPASAR
 Denpasar PT. Adi Barata Asti BCA DENPASAR CABANG HASANUDIN DENPASAR

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Maumere PT. Mahkota Anugrah Karya BANK NTT CABANG MAUMERE

Mengetahui
Plt.Kepala Puskesmas Ngalupolo

Yohanes Sako, A.Md.Kep

NIP. 19800313 200212 1 005
 No Rekening Ket

0024.01.000443.56-5

004.02.01.00465.4

0024.01.000443.56-5

0024.01.000443.56-5

0024.01.000443.56-5

004.02.01.00465.4

004.02.01.00465.4

4648.01.011944.53-6

4648.01.011944.53-6

4648.01.011944.53-6

4648.01.011944.53-6

4648.01.011944.53-6

2500382719

TUNAI

TUNAI

004.02.01.00465.4

004.02.01.00465.4

002.01.13.000390-4

002.01.13.000390-4

040.182.003-4
 040.182.003-4

002.01.13.000390-4

002.01.13.000390-4

002.01.13.000390-4

002.01.13.000390-4

002.01.13.000390-4

Ngalupolo, 31 Desember 2020

Pengurus Barang Pembantu

Ernestin A. S. D. Salo, S.Kep.Ns

NIP. 19880402 201101 2 014