DAFTAR PERMINTAAN BARANG COVID - 19 TRIWULAN III

Instansi: Puskesmas Sei Bamban

NO NAMA BARANG SATUAN KEMASAN Volume

1 Desinfektan Liter Botol, 5 Liter 5

2 Hand Sanitizer 5% Liter Botol, 500 ml 20
3 Masker Kotak Kotak, 50 Pieces 50
4 Masker N 95 Pieces Pieces 10
5 Masker Kain Pieces Pieces 20
6 HandsRub 4% Botol Botol, 500 ml 20
7 Multivitamin Kotak Kotak, 100 tab 2000
8 Nurse Cap Pieces Kotak
9 Handscoon non steril Kotak Kotak, 100 Pieces 20
10 Apron Pieces Kotak, 100 Pieces 20
11 Cover All Set Set 5
12 Multivitamin ( Sivit - Zinc) Kaplet Botol, 30 Kaplet 2000
13 Vitamin C 500 mg Kaplet Kotak, 100 Kaplet 2000
14 Selcom C Kaplet Kotak, 100 Kaplet 2000
15 Selviplex Kaplet Kotak, 100 Kaplet 2000
16 Immunance Kaplet Kotak, 30 Kaplet 2000
17 Santa E Kaplet Kotak, 100 Kaplet 2000
18 Bio Starch Kaplet Kotak, 100 tab 2000

Diketahui Oleh :
KUPT Puskesmas Sei Bamban Petugas Pengelola Obat

dr. Endang Toto Kaban Siska Wulansari, S.Farm

NIP.19710805 200502 1 003 NIP. 19941203 201903 2 003
 DAFTAR PERMINTAAN OBAT DAN BMHP TRIWULAN 3

Instansi: Puskesmas Sei Bamban

NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

OBAT DAK 2019

1 Parasetamol sirup Botol Botol, 60 ml

DAK 2020
2 Air untuk injeksi amp 25 ml Vial Vial
3 Alprazolam tablet 1 mg Tab Dus, 10 Strip @ 10 Tablet
4 Alprazolam tablet 0,5 mg Dus, 10 Strip @ 10 Tablet
5 Aminofilin Tab 200 mg Tab Botol @100 Tablet Salut Selaput
6 Aminofilin inj 24 mg/ml Ampul Box, 30 ampul @ 1 ml
7 Amitriptilin tab sal 25 mg Tab sal Dus, 10 Strip @ 10 tablet
8 Amlodipin tab 10 mg Tab Dus, 3 Strip @ 10 Kaptab
9 Amlodipin tab 5 mg Tab Dus, 30 blister @ 10 Kaptab
10 Amoksisilin tab 500 mg Tab Dus, 10 Strip @ 10 Kaptab

Antasida, kombinasi : aluminium hidroksida Dus , 10 blister @ 10 tablet

11 Tab
200 mg + magnesium hidroksida 200 mg kunyah

Antasida, kombinasi : aluminium hidroksida

12 Botol Botol, 60 ml
200 mg + magnesium hidroksida 200 mg

Antihemoroid, kombinasi: bismut subgalat

150 mg + heksaklorofen 2,5 mg + lidokain
13 Supp Dus, 10 suppositoria @ 2g
lidokain 10 mg+ seng oksida 120 mg + sup
ad 2 g

Asam asetilsalisilat (asetosal) tab 80 mg Dus, 10 strip @ 10 tablet salut

14 Tab
(Miniaspi 80 mg) enterik
15 Asam Traneksamat inj 50mg/ 5 ml Ampul Dus, 10 Ampul @ 5 ml
16 Asering infus Botol, 500 ml
17 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
18 Betahistin tab 6 mg Tablet Dus, 10 Strip @ 10 tablet
19 Betametason krim 0,1% Tube Dus, 25 tube @ 5 gram
20 Bisakodil sup 5 mg Supp Box, 3 catch cover @10 tablet
21 Bisoprolol 5 mg Tablet Box, 3 blister @ 10 tab
NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

22 Bisoprolol 2,5 mg/Concor 2,5 mg Tablet Box, 100 film coated tablet
23 Ceftriaxon inj 1000 mg Vial Box, 10 vial
24 Deksametason inj 5 mg/ml (i.v./i.m.) Ampul Box, 10 ampul @ 1 ml
25 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul Box, 10 ampul @ 2 ml
26 Diazepam enema 10 mg/2,5 ml Botol Dus, 5 alubag @ 1 tube @ 2.5 ml
27 Diazepam tab 2 mg Tab Botol, 100 tab
28 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul Box, 30 ampul @ 1 ml
29 Digoksin tab 0,25 mg Tab Dus, 10 strip @ 10 tablet
30 Domperidon tab 10 mg Tab Dus, 10 strip @ 10 tablet
31 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul Box, 100 ampul @ 1 ml
botol plastik @ 100 tablet salut
32 Ergotamin tab 1 mg + Kofein 50 mg Tab
selaput
33 Eritromisin tab 500 mg Tab Dus, 10 strip @ 10 kaplet
34 Fenobarbital tab 30 mg Tab Dus, 10 strip @ 10 tablet
35 Fenobarbital inj 50 mg/mL Box, 30 ampul @ 1 ml

36 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial Dus, 30 ampul @ 1 mL

37 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal Dus, 10 strip @ 10 TSG

38 Gentamisin salep mata 0,3% Tube tube@3,5 gram

39 Gentamisin tts mata 0,3% Botol Botol, 5 ml
40 Glibenklamid tab 5 mg Tab Dus, 10 Strip @ 10 Kaptab
41 Glimepirid tab 1 mg Tab Dus, 10 Strip @ 10 Kap
42 Glimepirid tab 2 mg Tab Dus, 10 Strip @ 10 Kap
43 Glukosa Larutan Infus 5% steril 500 ml Botol Dus, 20 Botol plastik @ 500 ml
44 Haloperidol tablet 0,5 mg Tablet Dus, 10 strip @ 10 tablet
45 Ibuprofen sir 200 mg/5 ml Botol Botol, 60 ml
46 Kalsium laktat (kalk) tab 500 mg Tab Dus, 10 blister @ 10 tablet
47 Kandesartan tablet 8 mg Tab Dus, 3 blister @ 10 tablet
Dus, 10 strip @ 10 kaplet salut
48 Karbamazepin Tab 200 mg Tablet
selaput
49 Ketokonazol krim 2 % Tube Dus,tube 10 gr
50 Ketorolac injeksi 30 mg/ml Ampul Box, 100 ampul @1 ml
51 Klindamisin kaps 150 mg Kaps Dus, 5 Blister @ 10 kapsul
52 Kloramfenikol salep kulit 2% Tube Tube, 15 gram
53 kloramfenicol kapsul 500 mg Kapsul Dus, 10 strip @ 10 kapsul
NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

54 Klobazam 10 mg tablet Tablet Dus, 10 strip @ 10 tablet

55 Klozapin tab 25 mg Tab Dus, 5 Blister @ 10 tablet
56 Kodein tab 10 mg Tab Dus, 10 strip @ 10 tablet

Kotrimoksazol (dewasa) kombinasi :

57 Tab Dus, 10 blister @ 10 tablet
sulfametoksazol 400 mg+ trimetoprim 80 mg

Kotrimoksazol kombinasi tiap 5 ml suspensi :

58 sulfametoksazol 200 mg + trimetoprim 40 Botol Botol, 60 ml
mg
Dus, 10Strip@10 Tablet, Salut
59 Kalium Klorida 200 mg (KSR) Tablet
Selaput Lepas Lambat
60 Lansoprazole tab 30 mg Box, 2 strips @ 10 kapsul
61 Lidokain inj 2% (infiltr/p.v.) Ampul Box 100 ampul @2 ml

62 Lidokain inj 2% + Epinefrin 1 :80.000 inj 2 ml Ampul Box 30 ampul @2 ml

63 Magnesium sulfat inj 40% Vial Dus, 120 Ampul Plastik @25ml
Dus, 10 strip @ 10 tablet salut
64 Metformin tab 500 mg Tab
selaput
65 Metilergometrin inj 0,2 mg/ml Ampul Dus, 100 ampul@1 ml
66 Metilergometrin tab salut 0,125 mg Tab sal Dus, 10 strip @ 10 tablet
67 Metilprednisolon tab 4 mg Tab 10 strip @ 10 tablet
68 Metoklopramid inj 5 mg/ml Ampul Dus, 100 ampul@2 ml
69 Metronidazol sir 125 mg/5 Ml Botol Botol, 60 ml
70 Mikonazol krim 2% Tube Dus, 24 tube @ 10 gr
71 N-asetil sistein kaps 200 mg Kaps Dus, 10 strip @ 10 tablet
72 NaCl 0,9% Larutan Botol Botol plastik, 500 ml
73 Natrium diklofenak tab 50 mg Tab Dus, 5 strip @ 10 TSE
74 Nistatin tab salut 500.000 UI Tab Dus, 10 strip @ 10 TSG
75 Nistatin tab vaginal 100.000 UI Tab Dus, 10 strip @ 10 tablet vaginal
76 Oksimetazolin tts hidung 0,050% Botol Botol, 10 ml
77 Oksitetrasiklin 1% Salep Mata Tube Dus, 25 Tube @ 3,5 gram
78 Parasetamol sir 120 mg/5 ml Botol Botol plastik @ 60 ml
79 Parasetamol tts 60 mg/0,6 ml Botol Botol, 15 ml
80 Piridoksin (vitamin B6) tab 10 mg Tab Dus, 10 strip @ 10 tablet
81 Prednison tab 5 mg Tab Dus, 10 strip @ 10 tablet
82 Propranolol tab 10 mg Tab Box, 10x 10 tablet
83 Ranitidin injeksi 25 mg/ml Ampul Box, 100 ampul @2 ml
 NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

84 Ringer Laktat Larutan Botol Botol, 500 ml

85 Risperidon tab sal 2 mg Tab sal Dus, 10 strip @ 10 tablet
86 Salbutamol lar ih 0,5 % Botol Botol
87 Salbutamol tab 2 mg Tab Dus, 10 strip @ 10 tablet
Salep 2-4, kombinasi : asam salisilat 2 %+
88 Tube Pot @ 30 gram
belerang endap 4 %
89 Sefadroksil sirup kering 250 mg/5mL Botol Dus, botol @ 60 mL

Verorab Vaksin Rabies untuk manusia, serb Dus, 1 vial + 1 syringe @ 0,5 ml
90 Vial
inj 2,5 IU (s.k.) NaCI 0,4%

91 Serum antitetanus (A.T.S) inj 1500 IU/ml (im) Ampul Box 10 ampul @ 1 ml 1500 IU

92 Setirizin tab 10 mg Tablet Box, 5 strip x 10 tab

93 Setirizin sir 5 mg/5 ml. Botol Dus, botol @ 60 mL
Sianokobalamin (vitamin B12) inj 500
94 Vial Box, 100 ampul @ 1 ml
mcg/ml
95 Sianokobalamin (vitamin B12) tab 50 mcg Tab Dus, 10 strip @ 10 tablet
96 Simvastatin tab sal 10 mg Tab sal Box, 3 strip x 10 tab
97 Spironolakton tab 25 mg Tab Dus, 10 strip @ 10 tablet
98 Sukralfat suspensi 500 mg/ml Botol Dus, botol 100 ml
99 Tiamin (vitamin B1) tab 50 mg Tab Dus, 10 strip @ 10 tablet
APBD 2020
100 Alphamol kaplet Dus, 15 strip @10 tablet
101 Ambroxol HCl tab 30 mg Tablet Dus 10 strip @ 10 tablet
102 Ambroxol sirup Botol Botol, 60 ml
103 Amoksisilin sir kering 125 mg/5 ml Botol Botol, 60 ml
104 Asiklovir tab 400 mg Tab Dus 5 strip @ 10 tablet
105 Betafort sirup Botol Botol 60 ml
106 Bioron injeksi Ampul Kotak 5 ampul@3ml
107 Hustab Tab Tab Dus, 30 strip @ 10 tab
108 Cefotaxim inj 1000 mg Vial kotak, 2 vial @ 1 gr
109 Chlorpheniramine Maleate 4 mg tab Tab Dus 10 strip @ 10 tablet
110 Cefadroxil 500 mg kaps Kapsul Dus, 10 strip @10 tablet
111 Ciprofloksasin 500 mg tab Tab Dus, 10 strip @10 tablet
112 Cendo xytrol eye minidose Tube strip, 5 tube x 0,6 ml
113 Cynoff Botol Botol, 1 Liter
114 Dextamin tablet Tablet Dus, 10 x 10 tab
 NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

115 Dextrofen Syrup Botol Botol, 60 ml

116 Domperidon susp 5 mg/5 ml Botol Dus, Botol 60 ml
117 Etil Klorida spray Botol Botol, 100 ml
118 Etadium tab Tab Dus, 10 strip @ 10 tablet
119 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul Dus, 30 ampul @ 1 mL
120 Flucort N krim Tube Tube, 5 mg
121 Hemafort tsg Tab Dus, 10 strip @ 10 tablet
122 Imboost Force Caplet Kaplet Box, 3 stip @ 10 kaplet
123 Klindamisin kaps 300 mg Kaps Dus, 10 Blister @ 10 kapsul
124 Lexatrans 500 Kaplet Salut Selaput Tablet Dus 5 strip @ 10 tablet
125 Molasic kaplet salut film Kaplet Dus 10 strip @ 10 tablet
126 Meloxicam 7,5 mg Tablet Dus, 5 strip @ 10 tablet
127 Meloxicam 15 mg Tablet Dus, 5 strip @ 10 tablet
128 Metaneuron Tablet Dus, 30 x 10's
129 Molagit Tablet Tab Dus 15 strip @ 10 tablet
130 Molazol tablet Tab Dus, 10 strip @ 10 tablet
131 Molexflu sirup Botol Botol, 60 ml
132 Neo Kaominal Suspensi Botol Botol, 60 ml
133 Osteotin Kapsul Box, 6 x 10 kapsul
134 Pritanol 300 mg Tab Dus, 10 Strip @ 10 tablet
135 Ranitidin tab 150 mg Tab Dus, 10 strip @10 tablet
136 Vitamin C FC Kaplet 500 mg Kaplet Dus 10 strip @ 10 tablet
BAHAN MEDIS HABIS PAKAI
137 Infusion set dewasa Y type
138 IV Catheter No. 18 G pcs box, 50 pcs
139 IV Catheter No. 20 G pcs box, 50 pcs
140 IV Catheter No. 22 G pcs box, 50 pcs
141 IV Catheter No. 24 G pcs box, 50 pcs
142 Alat Suntik 1 cc Box 100 pcs/box
143 Alat Suntik 3 cc Box 100 pcs/box
144 Alat Suntik 5 cc Box 100 pcs/box
145 Alkohol 70% btl karton, 20 botol
146 Nonwoven fixation 5cmx10 m Roll 120 Roll / Karton
147 Nonwoven fixation 10cmx10m Roll 60 Roll / Karton
NO NAMA OBAT/KOMPOSISI SATUAN KEMASAN

148 Plaster 1,25 cm x 9.14m Roll 24 Roll / Box

149 Plaster 2,5 cm x 9.14m Roll 12 roll / Box
150 Plaster 5 cm x 9.14m Roll 6 Roll / Box
151 Kasa 16x16 cm Pcs 12 pcs/box
152 Kasa pembalut 3 yard x 5 cm Pack 100 Roll/ Pack
153 Kasa pembalut 3 yard x 10 cm Pack 50 Roll/ Pack
154 Kasa pembalut 3 yard x 15 cm Pack 50 Roll/ Pack
155 Catgut Plain Cutting 3/0 pcs box,12 pcs
156 Catgut Plain Cutting 4/0 pcs box,12 pcs
157 Catgut Chromic round body 2/0 pcs box,12 pcs
158 Silk Black Cutting 2/0 pcs box,12 pcs
159 Silk Black Cutting 3/0 pcs box,12 pcs
160 Silk Black Cutting 4/0 pcs box,12 pcs
161 Kapas pembalut/abs 250 gr Rol karton, 50 roll
162 Kapas pembalut/abs 500 gr Rol karton, 50 roll
163 Povidone iodine 300 ml btl box, 24 botol
164 Povidone iodine 60 ml btl box, 48 botol
BUFEER STOCK PROVINSI
165 Infus Set Dewasa Pieces Box, 50 pcs

Diketahui Oleh :
KUPT Puskesmas Sei Bamban

dr. Endang Toto Kaban

NIP.19710805 200502 1 003
TAAN OBAT DAN BMHP TRIWULAN 3

PERMINTAAN

100

20
100

10

1,000
2,000
10,000

5,000

200

50

1,000

100
50
100
1,000
100
30
500
PERMINTAAN

500
50
20

20
1,000
1,000

5,000

100

500

100
100
500
500
500
50

100
1,000

200

5,000
100
5,000
PERMINTAAN

2,000

10,000
100

100

10

5,000

200

10,000
100
50
150

20
5,000
500
500

50
100
1,000
5,000

200
PERMINTAAN

100
5,000

500

200

200

7,000
100

100

1,000

100

5,000
5,000
150
200
5,000
200
200
2,000
10
5,000
5,000
2,000
500

10,000
PERMINTAAN

200
20
5
200

100
200
2,000
10,000
200
10,000
5,000
5,000
1,000
1,000
5,000
100
200
300

500
2,000

100
2
2
2
2
5,000
5,000
1,000
10
2
2
 PERMINTAAN

2
2
2
10
10
10
10
2
2
2

20
20
10
15

20

Petugas Pengelola Obat

Siska Wulansari, S.Farm

NIP. 19941203 201903 2 003