1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. SISA STOK PER 31 DESEMBER 2020 ADALAH SISA STOK PER 31 DESEMBER 2020 DI SATUAN KERJA
3. PREDIKSI PENGADAAN TAHUN 2021 ADALAH PREDIKSI JUMLAH YANG DIRENCANAKAN UNTUK DIADAKAN TAHUN
4. PEMAKAIAN RATA-RATA PER BULAN SELAMA 2020 ADALAH PEMAKAIAN RATA-RATA PER BULAN DI SATKER SELAM
5. PREDIKSI SISA STOK 31 DESEMBER 2021 ADALAH SISA STOK PER 31 DESEMBER 2020 DITAMBAH PREDIKSI PENGAD
6. JUMLAH KEBUTUHAN TAHUN 2022 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2020 DIKALI 18 BULAN
7. RENCANA KEBUTUHAN TAHUN 2022 ADALAH JUMLAH KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KO
8. RENCANA PENGADAAN TAHUN 2022 ADALAH RENCANA UNTUK PENGADAAN DI TAHUN 2022 DALAM SATUAN TE
9. RENCANA PENGADAAN TAHUN 2021 ADALAH OTOMATIS TERISI DARI SISTEM JIKA SATKER TELAH MENGIRIMKAN
10. REALISASI PENGADAAN TAHUN 2020 ADALAH REALISASI PENGADAAN OBAT JKN BAIK E-PURCHASING MAUPUN

RENCANA KEBUTUHAN O

SATUAN KERJA : PUSKESMAS MALEI

SISA STOK PER 31 PREDIKSI

NO NAMA OBAT SATUAN DESEMBER 2020 PENGADAAN
TAHUN 2021

1 Abacavir 300 mg
2 Air untuk injeksi
3 Air untuk injeksi
4 Air untuk injeksi
5 Air untuk injeksi amp 20 ml
6 Air untuk injeksi amp 25 ml
7 Albendazol susp 200 mg/5 ml
8 Albendazol tab 400 mg
9 Alopurinol tab 100 mg
10 Alopurinol tab 300 mg
11 Aminofilin inj 24 mg/ml
12 Aminofilin tab 150 mg
13 Aminofilin Tab 200 mg
14 Amitriptilin tab sal 25 mg
15 Amlodipin tab 10 mg
16 Amlodipin tab 5 mg
17 Amoksisilin drops 100 mg/ml
18 Amoksisilin drops 100 mg/ml
19 Amoksisilin drops 100 mg/ml
(a) (b)
Tablet/kaplet/kapsul 0 0
Botol 250 ml 0 0
ampul/vial/botol 10 mL 0 0
Botol 100 ml 0 0
ampul/vial/botol 0 0
ampul/vial/botol 25 mL 18 40
Botol 0 0
tablet/kapsul/kaplet 0 0
Tab 0 15000
tablet/kapsul/kaplet 0 0
ampul/vial 10 ml 0 0
tablet/kapsul/kaplet 0 0
tablet/kapsul/kaplet 0 0
tablet/kapsul/kaplet 0 0
tablet/kapsul/kaplet 2640 18640
tablet/kapsul/kaplet 0 0
Botol @10 ml 0 0
Botol @15 ml 0 0
Botol @20 ml 0 0
 Amoksisilin sir forte 250 mg/5
20 ml botol 60 ml 0 0

Amoksisilin sir kering 125 mg/5

21 Botol 119 959
ml
22 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0
23 Amoksisilin tab 500 mg tablet/kapsul/kaplet 4400 30400

24 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0

25 Ampisilin serb inj 250 mg/vial Vial 0 0
Anestetik lokal gigi kombinasi :
26 lidokain hcl 2% + epinefrin 1 : ampul/vial 0 0
80.000 inj 2 ml

Antasida, kombinasi :
aluminium hidroksida 200 mg
27 tablet/kapsul/kaplet 0 0
+ magnesium hidroksida 200
mg

Antasida, kombinasi :
28 aluminium hidroksida 200 mg botol 60 ml 0 0
+ magnesium hidroksida 200
mg

Anti Parkinson kombinasi :

29 benzerasid 25 mg + levodopa Kaps 0 0
100 mg
Antifungi salep, kombinasi :
30 asam benzoat 6%+ asam pot 30 g 0 0
salisilat 3%

Antihemoroid, kombinasi:
bismut subgalat 150 mg +
31 heksaklorofen 2,5 mg + Suppositoria 0 0
lidokain lidokain 10 mg+ seng
oksida 120 mg + sup ad 2 g
32 Aquadest cairan 500 ml Botol 500 ml 0 0
Artesunat serb inj 60 mg/ml
33 ampul/vial 0 0
(i.v./i.m.)

34 Articulating paper kertas Kertas warna penanda 0 0

warna penanda oklusi oklusi
35 Asam asetat tetes telinga 2% Botol 0 0
36 Asam asetilsalisilat (asetosal) tablet/kapsul/kaplet 0 0
tab 80 mg
Asam askorbat (vitamin C) tab
37 250 mg Tab 0 0
 Asam askorbat (vitamin C) tab
38 50 mg tablet/kapsul/kaplet 0 0
39 Asam folat tab 0,4 mg tablet/kapsul/kaplet 0 0
40 Asam folat tab 1 mg tablet/kapsul/kaplet 0 0
41 Asam folat tab 5 mg Tab 0 0
42 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0

43 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/ka 0 0

ptab
44 Asam retinoat krim 0,05% Tube/pot 0 0
45 Asam retinoat krim 0,1% Tube @ 10 gram 0 0
46 Asam retinoat krim 0,1% Tube @ 20 gram 0 0
47 Asam salisilat lar 0,1% Botol 0 0
48 Asam salisilat salep 10% Tube 0 0
49 Asam salisilat salep 2% Tube 0 0
50 Asam salisilat salep 5% Tube 0 0
51 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 0
52 Asiklovir tab 400 mg tablet/kapsul/kaplet 0 0
53 Atapulgit 600 mg tablet/kapsul/kaplet 0 0
54 Atapulgit tab 630 mg tablet/kapsul/kaplet 0 0
55 Atapulgit tablet 650 mg tablet/kapsul/kaplet 0 0
56 Atapulgit tablet 750 mg Tab 0 0
57 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0
58 Atenolol tab 50 mg tablet/kapsul/kaplet 0 0
Atropin inj 0,25 mg/ml
59 Ampul 0 0
(i.m./i.v./s.k)
60 Atropin tab 0,5 mg Tab 0 0
61 Bahan tumpatan sementara Botol 0 0
lar, serb
62 Bedak salisil serb 2% Dus/Sachet/Plastik 0 0
63 Betametason krim 0,1% tube 5 gram 0 0
64 Betametason krim 0,5 mg/g Tube 0 0
65 Betametason salep 0,1% tube 5 gram 0 0
66 Betametason tts mata 1 mg/ml catchcover, botol 0,6 mL 0 0

67 Betametason tts mata 1 mg/ml botol @5 ml 0 0

68 Bisakodil sup 10 mg Suppositoria 0 0
69 Bisakodil sup 5 mg Suppositoria 0 0
70 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 0
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 0
 Budesonid cairan ih
72 0,25mg/ml, respoules 2 ml respoules 0 0

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 0

74 Budesonid cairan ih 0,5 mg/ml, respoules 0 0

respoules 2 ml

75 Budesonid serb ih 100 Botol 0 0

mcg/dosis
Budesonid serb ih 200
76 mcg/dosis 100 dosis 0 0

Budesonid serb ih 200

77 200 dosis 0 0
mcg/dosis
78 Copper T set/buah 0 0
Deksametason inj 5 mg/ml
79 ampul/vial 0 0
(i.v./i.m.)
80 Deksametason tab 0,5 mg tablet/kapsul/kaplet 0 0
81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 0

82 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 0 0

Diazepam inj 5 mg/ml

83 (i.v./i.m.) ampul/vial 0 0
84 Diazepam tab 2 mg tablet/kapsul/kaplet 0 0
85 Diazepam tab 5 mg tablet/kapsul/kaplet 0 0
86 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0
Difenhidramin inj 10 mg/ml
87 ampul/vial 0 0
(i.v./i.m.)
88 Digoksin tab 0,25 mg tablet/kapsul/kaplet 0 0
89 Diltiazem kaps SR 100 mg Kapsul lepas lambat 0 0
90 Diltiazem kaps SR 200 mg Kapsul lepas lambat 0 0
91 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 0 0
92 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 0 0
93 Dolutegravir tab 50 mg tablet/kapsul/kaplet 0 0
94 Domperidon susp 5 mg/5 ml botol @60 ml 0 0
95 Domperidon tab 10 mg tablet/kapsul/kaplet 0 0
96 Efavirenz tab 200 mg Tablet 0 0
tablet salut
97 Efavirenz tab sal 600 mg selaput/kaplet salut 0 0
selaput
Epinefrin (adrenalin) inj 1
98 mg/ml Ampul 0 0
99 Ergotamin tab 1 mg Tab 0 0
100 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0 0
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0
102 Eritromisin tab 500 mg tablet/kapsul/kaplet 0 0
Estrogen terkonjugasi tab sal tablet salut gula/kaplet
103 0 0
0,625 mg salut gula
104 Etambutol tab 400 mg tablet/kapsul/kaplet 0 0
105 Etanol 70% cairan 70% Botol 0 0
106 Etil klorida semprot 100 ml Botol 0 0
107 Etonogestrel implan 68 mg Set 0 0
108 Eugenol Botol 0 0
Fenitoin Na inj 50 mg/ml (100
109 mg/ 2 mL) ampul @ 2 ml 0 0
110 Fenitoin Na kaps 100 mg Kaps 0 0
111 Fenitoin Na kaps 30 mg Kaps 0 0
112 Fenobarbital tab 100 mg Tab 0 0
113 Fenobarbital tab 30 mg tablet/kapsul/kaplet 0 0
Fenoksimetil penisilin (penisilin
114 V) tab 250 mg Tab 0 0

Fenoksimetil penisilin (penisilin

115 Tab 0 0
V) tab 500 mg

116 Fitomenadion (vitamin K 1) inj ampul/vial 0 0

2 mg/ml (i.m.)
Fitomenadion (vitamin K 1) tab
117 sal 10 mg Tab sal 0 0

118 Fitomenadion (vitamin K1) inj tablet salut gula/kaplet 0 0

10 mg/ml (i.m) salut gula
119 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 0 0
120 Fluoksetin kaps 20 mg tablet/kapsul/kaplet 0 0
121 Fluor kapl 1 mg Kaplet 0 0
122 Fluor sediaan topikal Tube 0 0
123 Formokresol Botol 0 0
124 Framisetin Sulfat Tulle 1% Patch 0 0
Furosemid inj 10 mg/ml
125 (i.v./i.m.) ampul/vial 0 0
126 Furosemid tab 40 mg tablet/kapsul/kaplet 0 0
127 Galactose microparticle 200- Vial 0 0
400 mg micropart/ml
Garam Fe, setara dengan Fe
128 elemental 15 mg/5 mL Botol 0 0

129 Garam Fe, setara dengan Fe Sachet 0 0

elemental 60 mg
Garam Fe, setara dengan Fe
130 elemental 60 mg Botol 0 0
 Garam oralit kombinasi :
natrium klorida 0,52 g + kalium
131 klorida 0,30 g + trinatrium sachet 0 0
sitrat 0,58 g + glukosa anhidrat
2,7 g
132 Gentamisin salep mata 0,3% Tube 0 0
133 Gentamisin tts mata 0,3% Botol 0 0
Glass ionomer ART (Atraumatic
134 Restorative Treatment) cocoa Sachet 0 0
butter 5 g

Glass ionomer ART (Atraumatic

135 Restorative Treatment) lar Botol 0 0

Glass ionomer ART (Atraumatic

136 Restorative Treatment) serb Vial 0 0

137 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0 0

138 Glibenklamid tab 5 mg tablet/kapsul/kaplet 0 0
139 Glikuidon tab 30 mg tablet/kapsul/kaplet 0 0
140 Glimepirid tab 1 mg tablet/kapsul/kaplet 0 0
141 Glimepirid tab 2 mg tablet/kapsul/kaplet 0 0
142 Glipizid tab 5 mg tablet/kapsul/kaplet 0 0
143 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0 0
144 Gliserin tts 100 mg/ml Botol 0 0
Glukosa Larutan Infus 10%
145 steril 100 ml Botol 0 0

Glukosa Larutan Infus 10%

146 Botol 0 0
steril 250 ml
Glukosa Larutan Infus 10%
147 Botol 0 0
steril 500 ml
148 Glukosa Larutan Infus 40% Ampul @25 ml 0 0
149 Glukosa Larutan Infus 5% steril Botol 0 0
100 ml
Glukosa Larutan Infus 5% steril
150 250 ml Botol 0 0

Glukosa Larutan Infus 5% steril

151 500 ml Botol 0 0

Griseofulvin (micronized) tab

152 tablet/kapsul/kaplet 0 0
125 mg

153 Griseofulvin (micronized) tab tablet/kapsul/kaplet 0 0

scored 250 mg
Gutta percha dan paper points
154 15 - 40 mm Roll 0 0
 Gutta percha dan paper points
155 45 - 80 mm Roll 0 0
156 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0
157 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0 0
158 Haloperidol tab 1,5 mg tablet/kapsul/kaplet 0 0
159 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0
160 Haloperidol tab 5 mg tablet/kapsul/kaplet 0 0
161 Haloperidol tts 2 mg/ml botol 0 0
162 Hepatitis B imunoglobulin Ampul 0 0
(human) inj 150 IU/1,5 ml
163 Hidrogen peroksida cairan 3% Botol 0 0
164 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 0 0
165 Hidrokortison krim 2,5% tube @ 5 g 0 0
166 Hidrokortison serb inj 100 mg Vial 0 0
167 Hiosina butilbromida tab 10 tablet/kapsul/kaplet 0 0
mg

168 Human tetanus imunoglobulin Ampul 0 0

inj 250 UI (i.m.)

169 Human tetanus imunoglobulin Ampul 0 0

inj 500 UI (i.m.)

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 0

171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 0
172 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0
173 Ibuprofen tab 400 mg tablet/kapsul/kaplet 0 0
174 Ipratropium bromida aerosol Botol 0 0
20 mcg/semprot
Ipratropium bromida cairan ih
175 0,025% Botol 0 0
176 Isoniazid tab 100 mg Tab 0 0
177 Isoniazid tab 300 mg Tab 0 0
178 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 0 0
179 IUD Cu T 380 A Set 0 0
180 IUD Levonorgestrel Set 0 0
181 Kalamin Tube 0 0
Kalsium glukonat inj 100
182 ampul/vial 0 0
mg/ml

183 Kalsium hidroksida bubuk, Tube 0 0

pasta
184 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0
185 Kalsium laktat (kalk) tab 500 tablet/kapsul/kaplet 0 0
mg
186 Kaptopril tab 12,5 mg tablet/kaplet 0 0
187 Kaptopril tab 25 mg tablet/kaplet 0 0
188 Kaptopril tab 50 mg tablet/kaplet 0 0
189 Karbamazepin sir 100 mg/5 ml Botol 0 0
190 Karbamazepin tab 100 mg Tab 0 0
191 Karbamazepin Tab 200 mg Tablet 0 0
192 Karbogliserin tts telinga 10 % Botol 0 0
193 Ketokonazol tab 200 mg tablet/kapsul/kaplet 0 0
194 Klindamisin kaps 150 mg Kaps 0 0
195 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 0
196 Klofazimin, micronized kaps 50 Kapsul 0 0
mg
Klofazimin, micronizedkaps
197 100 mg kapsul 0 0
198 Klonidin tab 0,15 mg tablet/kapsul/kaplet 0 0
199 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0
200 Kloramfenikol salep 2% tube 15g 0 0
201 Kloramfenikol salep mata 1% tube @ 5 gram 0 0
Kloramfenikol serb inj 1.000
202 mg/ml vial/ampul 0 0

Kloramfenikol susp 125 mg/5

203 botol 60 ml 0 0
ml

204 Kloramfenikol tetes telinga 3% Botol 0 0

205 Kloramfenikol tts mata 0,5% botol 0 0
206 Kloramfenikol tts mata 1% Botol 0 0
207 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 0 0
Klorfenol kamfer mentol
208 (CHKM) Botol 0 0
209 Klorheksidin lar 0,2% Botol 0 0
210 Klorheksidin lar 15% Botol 0 0
Klorpromazin inj 25 mg/ml
211 ampul/vial 0 0
(i.m.)

212 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0 0

tablet salut
213 Klorpromazin tab sal 100 mg selaput/kaplet salut 0 0
selaput
214 Klorpromazin tab sal 25 mg Tab sal 0 0
215 Klortalidon tab 50 mg Tab 0 0
216 Klozapin tab 100 mg tablet 0 0
217 Klozapin tab 25 mg tablet 0 0
218 Kodein tab 10 mg tablet/kapsul/kaplet 0 0
Komb: Deksametason 0,1%
219 Botol 0 0
Thymol 5% Paraklorphenol 30
Kombinasi (DHP) :
tablet salut
220 dihidroartemisin 40 mg + selaput/kaplet salut 0 0
Piperakuin 320 mg tab sal
selaput
selaput

Kombinasi : (Zidovudin 60 mg +
221 Lamivudin 30 mg + Nevirapin Tab dispersible 0 0
50 mg) Ped Triple FDC

Kombinasi : artemether 20 mg
222 + lumefantrin 120 mg tablet/kapsul/kaplet 0 0

Kombinasi : Desogestrel 150

223 Tab 0 0
mcg Etinilestradiol 30 mcg

224 Kombinasi : ergotamin 1 mg+ tablet/kapsul/kaplet 0 0

kafein 50 mg
Kombinasi : Ferro fumarat 60
225 mg + asam folat 0,4 mg tab tablet salut gula 0 0
salut

226 Kombinasi : levonorgestrel 150 tab salut gula 0 0

mcg + etinilestradiol 30 mcg

227 Kombinasi : Tenofovir 300 mg Tab 0 0

+ Emtrisitabin 200 mg
Kombinasi : Tenofovir 300 mg
228 + Lamivudin 300 mg + Tab 0 0
Efavirenz 600 mg
Kombinasi : zidovudin 300 mg
229 +lamivudin 150 mg Tab 0 0

Kombinasi: Ipratropium
230 bromida 0,5 mg + Salbutamol Ampul/vial 0 0
2,5 mg, cairan ih
Kombinasi: kaolin 550 mg +
231 Tab 0 0
pektin 20 mg
Kombinasi: lopinavir 200 mg +
232 ritonavir (LVP) 50 mg, tab 250 Tab 0 0
mg
Kombinasi: Tenofovir 300 mg +
233 Lamivudin 300 mg + Tablet/kapsul/kaplet 0 0
Dolutegravir 50 mg, tablet
 Komibinasi: lidokain +
medisinal creosote phenol +
234 Botol 0 0
eugenol + benzil alkohol,
cairan
235 Komposit resin Set 0 0
Kotrimoksazol (dewasa)
236 kombinasi : sulfametoksazol tab/kaptab 0 0
400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa)
237 kombinasi : sulfametoksazol tab/kaptab 0 0
800 mg+ trimetoprim 160 mg

Kotrimoksazol kombinasi tiap 5

238 ml suspensi : sulfametoksazol botol 60 mL 0 0
200 mg + trimetoprim 40 mg

239 Kuinin inj 25% (i.v.) Vial 0 0

240 Kuinin tab 200 mg tablet/kapsul/kaplet 0 0
241 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 0
242 Lamivudin (3TC) tab 150 mg tablet/kapsul/kaplet 0 0
Larutan mengandung elektrolit
243 (CaCl2H2O 0,165 gr, KCl 0,15 Botol plastik @500 ml 0 0
gr, NaCl 4,3 gr)

244 Larutan mengandung Elektrolit Botol 0 0

(Kalium Klorida)

245 Larutan mengandung Elektrolit Botol 0 0

(KCl 0,15%, NaCL 0,9%) (KN1)

246 Larutan mengandung Elektrolit Botol 0 0

(KCl 0,3%,NaCl 0,9%) (KN2)

Larutan mengandung Elektrolit

247 (Na 130 mEq, K 4 mEq, Cl 109 Botol plastik @ 500 ml 0 0
mEq, Ca 3 mEq, Asetat 28 mEq)
Ringer Asetat

Larutan mengandung Elektrolit

(Na 130 mEq, K 4 mEq, Cl 109
248 mEq, Ca 3 mEq, Asetat 28 mEq) Softbag @ 500 ml 0 0
Ringer Asetat

Larutan mengandung Elektrolit

(Sodium Lactate sol (50%) 113
249 gr/L, Potassium Chloride 0.3 Botol 0 0
gr/L, Calcium Chloride 0.2 gr/L,
elektrolit)
 Larutan mengandung Elektrolit
(Tiap 1000 ml mengandung
electrolit: Sodium 145 mmol/l,
Potassium 4.0 mmol/l, Calcium
250 2.5 mmol/l, Magnesium 1.0 Botol 0 0
mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0
mmol/l)

Larutan mengandung
251 Karbohidrat (Fructose 120 g, Botol 0 0
glucose 66 g, Xylitol 60 g/ L)

Larutan mengandung
252 Karbohidrat (Fructose 15 mg, softbag 0 0
glucose monohydrate 30 mg,
xylitol 15 mg)

Larutan mengandung
253 Karbohidrat (Fructose 200 g, Botol 0 0
glucose 110 g, Xylitol 100 g/ L)

Larutan mengandung
254 Karbohidrat (Fructose 60 g, Botol 0 0
glucose 33 g, Xylitol 30 g/ L)
Larutan mengandung
255 Karbohidrat (Maltose 10%) Botol 0 0

Larutan mengandung
Karbohidrat + Elektrolit (25.00g
dextrose anhidrat, 3.00 g
256 sodium chloride, 0.15 g Botol plastik @500 ml 0 0
potassium chloride, 0.10 g
calcium chloride dihydrate dan
1.55 g sodium lactate)

Larutan mengandung
Karbohidrat + Elektrolit (25.00g
maltose, 3.00 g sodium
257 chloride, 0.15 g potassium Botol plastik @500 ml 0 0
chloride, 0.10 g calcium
chloride dihydrate dan 1.55 g
sodium lactate)
 Larutan mengandung
Karbohidrat + Elektrolit
258 Botol 0 0
(Acetate, Na, K, Cl, Ca, Mg,
Sorbitol 50 gr/L)

Larutan mengandung
Karbohidrat + Elektrolit
259 (Dextrose 5%, NaCL 0,45%, KCl) Botol 0 0
(HSD)

Larutan mengandung
Karbohidrat + Elektrolit
260 Botol 0 0
(Fructose 120 g, glucose 66 g,
Xylitol 60 g/ L + elektrolit)

Larutan mengandung
Karbohidrat + Elektrolit
261 (Glukosa 25 g, NaCl 2,0 g, KCl Botol 0 0
1,3 g, Natrium Laktat 3,1 g, air
untuk injeksi ad 1000 ml)

Larutan mengandung
Karbohidrat + Elektrolit
262 (Glukosa 55 g ; Natrium Botol 0 0
Chloride 9 g, air untuk injeksi
ad 1000 ml) (D5-NS)

Larutan mengandung
263 Karbohidrat + Elektrolit botol/softbag 0 0
(Glukosa: 110.0 g; NaCl: 1.80 g)
(D10-1/5NS)

Larutan mengandung
264 Karbohidrat + Elektrolit Botol 0 0
(Glukosa: 25,0 g; NaCl: 4,5 g)

Larutan mengandung
Karbohidrat + Elektrolit
265 botol/softbag @ 500 mL 0 0
(Glukosa: 55.0 g; NaCl: 2.25 g)
(D5-1/4NS)

Larutan mengandung
266 Karbohidrat + Elektrolit botol/softbag @ 100 mL 0 0
(Glukosa: 55.0 g; NaCl: 2.25 g)
(D5-1/4NS)

Larutan mengandung
Karbohidrat + Elektrolit
267 Botol 0 0
(Glukosa: 55.0 g; NaCl: 4.5 g)
(D5-1/2NS)
 Larutan mengandung
Karbohidrat + Elektrolit
(Larutan nutrisi kombinasi
268 infus per L: Na. 100mEQ, K Botol 0 0
18mEQ, Ca. 4mEQ, Mg 6mEQ,
Cl 90mEQ, Asetat 38mEQ,
Sorbitol 50g)

Larutan mengandung
269 Karbohidrat + Elektrolit Botol 0 0
(Larutan Ringer & Glukosa 5%)

Larutan mengandung
270 Karbohidrat + Elektrolit (NaCl Botol 0 0
1.125 gr, Dekstrosa 18.75 gr)
(KA EN 1B)

Larutan mengandung
Karbohidrat + Elektrolit (NaCl
271 1.75 g, KCL 1.5g, Glukosa 100 Botol 0 0
gr)

Larutan mengandung
272 Karbohidrat + Elektrolit (NaCl Botol 0 0
1.75 g, KCL 1.5g, Na Lactate
2.24 g, Glukosa 100 gr)

Larutan mengandung
Karbohidrat + Elektrolit (Nacl
273 1.75 gr, KCl 1.5 gr, Na Lactat Botol 0 0
2.24 gr, Dekstrosa 27 gr) (KA
EN 3B)

Larutan mengandung
Karbohidrat + Elektrolit (Nacl
274 2.34 gr, Na Laktat 2.24 gr, KCL Botol 0 0
0.75 gr Dekstrosa 27 gr) (KA EN
3A)

Levonorgestrel implan 2 rods,

275 75 mg (3-4 tahun) pack/ sachet/ set 0 0
276 Lidokain gel 2% syringe/syringe plastik 0 0
277 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 0
278 Lidokain salep 5% Tube 0 0
279 Lidokain spray oral 10% botol 0 0
280 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0 0
281 Liquor carbonis detergens lar Botol 0 0
5%
282 Loperamid tab 2 mg Tab 0 0
 Lopinavir 100 mg + Ritonavir
283 25 mg tab sal selaput 0 0
284 Loratadin tab 10 mg tablet/kapsul/kaplet 0 0
285 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0 0
286 Lorazepam tab 1 mg tablet/kapsul/kaplet 0 0
287 Lorazepam tab sal 2 mg Tab sal 0 0
288 Lugol Botol 0 0
289 Magnesium sulfat inj 20% ampul/vial @25 ml 0 0
290 Magnesium sulfat inj 20% ampul/vial 0 0
291 Magnesium sulfat inj 40% ampul/vial 0 0
292 Magnesium sulfat inj 40% ampul/vial @25 ml 0 0
293 Magnesium sulfat serb, ktg 30 Sachet 0 0
g
294 Manitol lar infus 20% Botol @ 250 ml 0 0
295 Manitol lar infus 20% Botol @ 100 ml 0 0
296 Manitol lar infus 20% Botol @ 500 ml 0 0
297 Mebendazol sir 100 mg/5 ml Botol 0 0
298 Mebendazol tab 100 mg Tan 0 0
299 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0
Medroksi progesteron asetat
300 inj 150 mg/ml ampul/vial 0 0

Medroksi Progesteron Asetat

301 ampul/vial 0 0
Inj 50 mg/ml
Metenamin mandelat
302 (heksamin mandelat) tab salut Tab salut 0 0
enterik 500 mg
303 Metformin tab 500 mg tablet/kapsul/kaplet 0 0
304 Metformin tab 850 mg tablet/kapsul/kaplet 0 0
305 Metilergometrin inj 0,2 mg/ml ampul/vial 0 0

Metilergometrin tab salut tablet/kaplet salut

306 0 0
0,125 mg selaput
Metilprednisolon inj 125 mg/2
307 ampul/vial 0 0
ml
308 Metoklopramid inj 5 mg/ml ampul/vial 0 0
309 Metoklopramid tab 10 mg tablet/kapsul/kaplet 0 0
310 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0 0
311 Metronidazol lar inf 5 mg/ml botol 0 0
312 Metronidazol susp 125 mg/5 Botol @ 60 ml 0 0
ml
Metronidazol susp 125 mg/5
313 ml Botol @ 100 ml 0 0
314 Metronidazol tab 250 mg tablet/kapsul/kaplet 0 0
315 Metronidazol tab 500 mg tablet/kapsul/kaplet 0 0
316 Mikonazol krim 2% tube 0 0
317 Mikonazol serb 2% botol / sachet 0 0

Mineral Mix (Bismuth

Subcitrate Tripotasium, Copper
318 sulfate, Magnesium Chloride Sachet 0 0
Anhydrous, Potassium
Chloride, Zinc Acetate)

319 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 0 0

320 NaCl 0,9% Larutan Botol @25 ml 0 0
321 NaCl 0,9% Larutan Botol @100 ml 0 0
322 NaCl 0,9% Larutan Botol @1.000 mL 0 0
323 NaCl 0,9% Larutan Botol @250 ml 0 0
324 NaCl 0,9% Larutan Botol @500 ml 0 0
325 NaCl 0,9% Larutan Ampul/botol @ 10 mL 0 0
326 NaCl 3% Larutan Botol plastik @500 ml 0 0
tablet salut
327 Natrium diklofenak tab 25 mg enterik/kaplet salut 0 0
enterik
tablet salut
328 Natrium diklofenak tab 50 mg enterik/kaplet salut 0 0
enterik

329 Natrium Diklofenak Tetes Mata botol 5 mL 0 0

1 mg/ml
Natrium hipoklorit cairan
330 konsentrat 5% Botol 0 0

331 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0

332 Nevirapin tab 200 mg tablet/kapsul/kaplet 0 0
333 Nifedipin kaps 10 mg tablet/kapsul/kaplet 0 0
334 Nistatin susp 100.000 UI/ml botol/vial 0 0
tablet salut gula/kaplet
335 Nistatin tab salut 500.000 UI 0 0
salut gula

336 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 0

337 Nitrofurantoin tab 50 mg Tab 0 0
338 Norepinefrin inj 1 mg/ml ampul/vial 0 0
339 Obat Anti Tuberculosis FDC paket 0 0
Kategori Anak
Obat Anti Tuberculosis FDC
340 Kategori I paket 0 0
 Obat Anti Tuberculosis FDC
341 Kategori II paket 0 0

Obat Anti Tuberculosis FDC

342 paket 0 0
Kategori Sisipan

343 Obat Anti Tuberculosis Paket 0 0

Kombipak Anak

344 Obat Anti Tuberculosis paket 0 0

Kombipak Dewasa
345 Oksigen ih, gas dlm tabung Botol 0 0
Oksimetazolin tts hidung
346 botol @ 10 mL 0 0
0,025%
Oksimetazolin tts hidung
347 0,050% botol @ 10 mL 0 0

348 Oksitetrasiklin 1% Salep Mata tube 0 0

349 Oksitosin inj 10 UI/ml ampul/vial 0 0
350 Olopatadin tts mata 0,1% Botol 0 0
351 Omeprazol inj 40 mg/10 ml ampul/vial 0 0
352 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 0
353 Paraformaldehid tab 1 g Tab 0 0
354 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 0
355 Parasetamol tab 500 mg tablet/kapsul/kaplet 0 0
356 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 0
357 Pasta devitalisasi (non arsen) Tube 0 0
Pasta pengisi saluran akar
358 (pasta) Tube 0 0
359 Perak nitrat lar 20% Botol 0 0
360 Perak sulfadiazin krim 1% Tube 0 0
361 Permetrin krim 5 % Tube 30 g 0 0
362 Permetrin krim 5 % Tube 15 g 0 0
363 Permetrin krim 5 % Tube 10 g 0 0
364 Pirantel pamoat susp 125 mg/5 Botol 0 0
ml
365 Pirantel pamoat tab 500 mg Tab 0 0
366 Pirantel pamoat tab scored 125 tablet/kapsul/kaplet 0 0
mg
Pirantel pamoat tab scored 250
367 mg Tab 0 0

Piridoksin (vitamin B6) inj 100

368 Ampul 0 0
mg/ml
Piridoksin (vitamin B6) tab 10
369 tab/kap/kapl 0 0
mg
 Piridoksin (vitamin B6) tab 25
370 mg tablet/kapsul/kaplet 0 0
371 Povidon iodin lar 100 mg/ml botol 30 mL 0 0
372 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0
373 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0
374 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0
375 Prednison tab 5 mg tablet/kapsul/kaplet 0 0
376 Primakuin tab 15 mg Tab 0 0
377 Probenesid tab 500 mg tablet/kapsul/kaplet 0 0
Prokain benzilpenisilin serb inj
378 3 juta UI/vial (i.m.) ampul/vial 0 0
379 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0
380 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0
381 Ranitidin tab 150 mg tablet/kapsul/kaplet 0 0
382 Retinol (vitamin A) kaps lunak kaps lunak 0 0
100.000 UI
Retinol (vitamin A) kaps lunak
383 200.000 UI kaps lunak 0 0
384 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0 0
385 Rifapentin tablet 150 mg Tablet/kapsul/kaplet 0 0
386 Ringer Laktat Larutan Botol 0 0
387 Risperidon tab sal 1 mg tablet/kapsul/kaplet 0 0
388 Risperidon tab sal 2 mg tablet/kapsul/kaplet 0 0
389 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0 0
390 Salbutamol sir 2 mg/5 ml Botol 0 0
391 Salbutamol tab 2 mg tablet/kapsul/kaplet 0 0
392 Salbutamol tab 4 mg tablet/kapsul/kaplet 0 0
Salep 2-4, kombinasi : asam
393 salisilat 2 %+ belerang endap 4 pot 15 gram 0 0
%
Salep 2-4, kombinasi : asam
394 salisilat 2 %+ belerang endap 4 pot 30 gram 0 0
%
395 Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0 0
396 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 0 0
Sefadroksil sir kering 125 mg/5
397 ml botol @ 60 mL 0 0

Sefadroksil sir kering 250 mg/5

398 botol @ 60 mL 0 0
ml
Serum anti bisa ular : A.B.U. I
399 (khusus ular dari luar Papua) Vial 0 0
inj (i.m./i.v.)
 Serum anti bisa ular :A.B.U.II
400 (khusus ular dari Papua) inj Vial 0 0
(i.m./i.v.)

401 Serum antidifteri (A.D.S) inj Vial 0 0

(i.m./i.v.) Inj i.m 10.000 UI/

402 Serum antirabies inj 100 UI/ml Vial 0 0

403 Serum antirabies inj 200 UI/ml Vial 0 0

404 Serum antitetanus (A.T.S) (i.m.) Vial 0 0

Inj 10.000 UI/vial (i.m /i.v.)

405 Serum antitetanus (A.T.S) inj Ampul 0 0

1500 UI/amp (i.m.)
Serum antitetanus (A.T.S) inj
406 Vial 0 0
20.000 UI/vial (i.m /i.v.)
Serum antitetanus (A.T.S) inj
407 5.000 IU/mL (i.m) Ampul/vial 0 0
408 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0
Sianokobalamin (vitamin B12)
409 inj 500 mcg/ml ampul/vial 0 0

Sianokobalamin (vitamin B12)

410 tablet/kapsul/kaplet 0 0
tab 50 mcg

tablet/kapsul/kaplet/tab
411 Simvastatin tab sal 10 mg let salut selaput/kaplet 0 0
salut selaput

tablet/kapsul/kaplet/tab
412 Simvastatin tab sal 20 mg let salut selaput/kaplet 0 0
salut selaput

Simvastatin tab sal selaput 40

413 mg Tab sal 0 0

tablet salut
Siprofloksasin tab scored 500
414 mg selaput/kaplet salut 0 0
selaput
415 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0

416 Stannous pyrophosphate 27,6 Vial 0 0

mg sodium pyrophosphate/vial

Streptomisin serb inj 1.000

417 mg/vial ampul/vial 0 0
418 Surgical ginggival pack Tube 0 0
 tablet salut
419 Tenofovir tab 300 mg selaput/kaplet salut 0 0
selaput

420 Terbutalin cairan ih 2,5 mg/ml Botol 0 0

421 Terbutalin inj 0,5 mg/ml ampul/vial 0 0
422 Tetanus toxoid inj Ampul 0 0
423 Tetrakain tts mata 0,5% Botol 0 0
424 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0
425 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0 0
426 Tetrasiklin Salep Mata 1% Tube 0 0
427 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 0 0
428 Timolol tts mata 0,25% botol @ 5 mL 0 0
429 Timolol tts mata 0,5% botol @ 5 mL 0 0
430 Urea krim 10 % Tube/pot 0 0
431 Urea krim 20 % Tube/pot 0 0
432 Vaksin BCG inj (i.k) Vial 0 0
Vaksin bivalen OPV (b-OPV)
433 Vial 0 0
drops 10 dosis
Vaksin Hepatitis Rekombinan
434 Inj Prefilled Injection Device Vial 0 0
(Uniject) 0,5 ml (i.m)

435 Vaksin HPV (Human Papilloma Ampul/vial 0 0

Virus), vial 0,5 mL
436 Vaksin Influenza Vial 0 0
437 Vaksin Japanese Enchepalitis Vial 0 0
(J.E)
Vaksin jerap difteri tetanus
438 (DT) Vial 0 0

Vaksin jerap difteri tetanus

439 Vial 0 0
(Td)

440 Vaksin kombinasi DPT-HB-Hib Vial 0 0

441 Vaksin measless rubella (MR) Vial 0 0

Inj 0,5 mL (s.k)
Vaksin Meningitis
442 Meningokokus Vial 0 0
443 Vaksin polio IPV inj 0,5 ml Vial 0 0
Vaksin rabies, untuk manusia
444 serb inj (s.k./i.k) + booster Vial 0 0

Vaksin rabies, untuk manusia

445 Vial 0 0
serb Inj 2,5 IU
446 Vaksin Yellow Fever Vial 0 0
447 Valproat sir 250 mg/5 ml botol @ 120 ml 0 0
tablet salut enterik/
448 Valproat tab sal 250 mg 0 0
kaplet salut enterik
449 Vitamin B kompleks tablet 0 0
Tablet/kapsul/kaplet/ta
450 Vitamin C 500 mg minimal non b sal selaput/kaplet sal 0 0
acidic 250 mg selaput/tab sal
gula/kaplet sal gula
451 Zidovudin kaps 100 mg tablet/kapsul/kaplet 0 0
452 Zinc drops 10 mg/ml Botol 0 0
453 Zinc serb 10 mg Sachet 0 0
454 Zinc sir 20 mg/5 ml botol 0 0
455 Zinc tab disp 20 mg tablet dispersible 0 0
 UNTUK DIADAKAN TAHUN 2021
ER BULAN DI SATKER SELAMA TAHUN 2020
TAMBAH PREDIKSI PENGADAAN TAHUN 2021 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2020)
MA 2020 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SA
ERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2021
N 2022 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG
KER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2021
E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2022

ANA KEBUTUHAN OBAT PADA (FKTP) TAHUN 2022

PEMAKAIAN
RATA-RATA PER PREDIKSI SISA JUMLAH RENCANA RENCANA RENCANA
BULAN SELAMA STOK 31 KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN
2020 DESEMBER 2021 TAHUN 2022 TAHUN 2022 TAHUN 2022 TAHUN 2021

(d) = (a)+(b)-
(c) (e) = (c) x 18
(12x(c))
0 0
0 0
0 0
0 0
0 0
4 10
0 0
0 0
733 6204
0 0
0 0
0 0
0 0
0 0
1553 2644
0 0
0 0
0 0
0 0
(f) = (e) - (d) (g)
0 0
0 0
0 0
0 0
0 0
72 62
0 0
0 0
13194 6990 7000
0 0
0 0
0 0
0 0
0 0
27954 25310 25400
0 0
0 0
0 0
0 0
(h)
0 0
0 0
0 0
0 0
0 0
62 0
0 0
0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0
0 0
0 0
0 0
 0 0 0 0 0 0

80 118 1440 1322 1380 0

0 0 0 0 0 0
2025 10500 36450 25950 26000 0

0 0 0 0 0 0
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0 0 0 0 0 0

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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
TAHUN 2020)
AMPUL / VIAL / TUBE / SACCHET / PUFF

BE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2021 BERDASARKAN

REALISASI
PENGADAAN KETERANGAN
TAHUN 2020

(i) (j)
0
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