Kebutuhan Obat Puskesmas S.Parman 2022

DINAS KESEHATAN KOTA BANJARMASIN
RENCANA KEBUTUHAN OBAT TAHUN 2022

PUSKESMAS : S.PARMAN
TOTAL SISA TOTAL

PEMAKAIAN PEMAKAIAN PREDIKSI PREDIKSI SISA RENCANA USULAN
SISA STOK SISA STOK OBAT STOK OBAT PEMAKAIAN
RATA2/BULAN RATA2/BULA PENERIMAAN STOK PER KEBUTUHAN PENGADAAN
NO NAMA OBAT SATUAN OBAT APBD JKN PER 31 RATA2 /
OBAT APBD N OBAT JKN NOV & DES DESEMBER OBAT TAHUN 2022
31 OKT 2021 31 OKT 2021 OKTOBER BULAN
2021 2021 2022 (PEMBULATAN)
2021
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13

A OBAT
1 Albendazol tablet 400 mg* tablet 0 440 440 -880 8,800 5,000
2 Allopurinol tablet 100 mg tablet 420 420 108 108 204 1,740 2,000
3 Aminofilin injeksi 24 mg/ml-10 ml ampul 0 0 0 0 -
4 Aminofilin tablet 200 mg tablet 0 0 0 0 -
5 Amitriptilin Hcl tablet salut 25 mg tablet 0 0 0 0 -
6 Amlodipin 5 mg tablet 2680 2680 300 300 2080 3,320 7,000
7 Amoksisilin 500 mg kaplet tablet 770 770 523 523 -276 9,690 8,000
8 Amoksisilin Sirup kering 125 mg/5 ml botol 50 50 20 20 10 350 350
9 Ampisilin serbuk injeksi i.m.i.v 1000 mg/m vial 0 0 0 0 -
10 Antasida doen tablet kombinasi tablet 2240 2240 400 400 1440 5,760 8,000
11 Antasida sirup botol 0 60 60 -120 1,200 700
12 Antifungi doen kombinasi tube 0 0 0 0 -
13 Artemether injeksi 80 Mg* ampul 0 0 0 0 -
14 Artesunate cairan injeksi 60 mg* ampul 0 0 0 0 -
15 Asam Askorbat(vit C) tablet 50 mg tablet 2840 2840 547 547 1746 8,100 10,000
16 Asam Folat 1 mg tablet tablet 0 130 130 -260 2,600 5,000
17 Asam mefenamat 500 mg kaplet tablet 1655 1655 300 300 1055 4,345 5,000
18 Asiklovir 200 mg tablet tablet 936 936 15 15 906 (636) 3,000
19 Asiklovir 400 mg tablet tablet 800 800 46 46 708 120 3,000
20 Atropin Sulfat tablet 0,5 mg tablet 0 0 0 0 -
21 Benzatin Benzil Penisilin inj 1,2 juta iu/via vial 0 0 0 0 -
22 Benzatin Benzil Penisilin inj 1,4 juta iu/via vial 0 0 0 0 -
23 Betametason krim 0,1 % tube 95 95 15 15 65 205 300
24 Clindamisin kapsul 300 mg kapsul 0 0 0 0 -
25 Deksametason tablet 0,5 mg tablet 0 0 0 0 - 3,000
26 Deksametason inj 5 mg/ml-1 ml ampul 3 3 0 0 3 (3) 20
DHP / Darplex / D-Artepp (Dehidro 0 0 0 0 -
27 artemisin Piperaquin) tab* tablet
28 Diazepam inj 5 mg/ml-2 ml ampul 0 0 0 0 -
29 Diazepam tablet 2 mg tablet 0 0 0 0 - 200
30 Diazepam tablet 5 mg tablet 70 70 3 3 64 (10) 200
31 Dietilkarbamazin sitrat tablet 100 mg* tablet 0 0 0 0 -
Page 1 of 37
TOTAL SISA TOTAL
SISA STOK SISA STOK OBAT STOK OBAT PEMAKAIAN PEMAKAIAN PEMAKAIAN PREDIKSI PREDIKSI SISA RENCANA USULAN
2021 2021 2022 (PEMBULATAN)
2021
32 Difenhidramin Hcl inj 10 mg/ml-1 ml ampul 0 1 1 -2 20 20

33 Digoksin tablet 0,25 mg tablet 0 0 0 0 -
34 Dimenhidrinate tablet tablet 40 40 22 22 -4 400 800
35 Doksisiklin 100 mg kapsul kapsul 0 0 0 0 -
36 Domperidon 10 mg tablet 100 100 0 0 100 (100) 3,000
37 Epinefrin Hcl/Bitartrat(adrenalin)inj 0,1 % ampul 8 8 3 3 2 52 50
38 Erytromisin sirup (trovilon) botol 0 0 0 0 -
39 Erytromisin 500 mg kaplet tablet 200 200 20 20 160 200 500
40 Etambutol 500 mg tablet tablet 0 0 0 0 -
41 Fenitoin kapsul 50 mg kapsul 0 0 0 0 -
42 Fenobarbital inj 50 mg / ml - 2 ml ampul 0 0 0 0 -
43 Fenobarbital tablet 30 mg tablet 0 0 0 0 -
44 Ferrous sulphate tab selaput 300 mg tablet 0 0 0 -
Ferro folat tab sal selaput 200 mg + 0,25 0 0 0 0 -
45 mg (Tablet tambah darah komb.) tablet
46 Fitomenadion ( vit k 1 ) tablet salut 10 mg tablet 215 215 96 96 23 1,705 2,000
47 Fitomenadion ( vit k 1 ) inj 10 mg / ml - 1 ampul 10 10 6 6 -2 110 100
48 Furosemid tablet 40 mg tablet 175 175 41 41 93 645 700
49 Furosemid Cairan Injeksi 10 mg/ml ampul 0 0 0 0 -
50 Garam oralit untuk 200 ml air sachet 50 50 42 42 -34 790 1,000
51 Gentamisin inj 40 mg/2 ml* ampul 0 0 0 0 -
52 Gentamisin inj 80 mg/2 ml* ampul 0 0 0 0 -
53 Glibenklamid tablet 5 mg tablet 275 275 30 30 215 325 500
54 Glimepirid tab 1 mg tablet 295 295 20 20 255 105 500
55 Griseofulvin tablet 125 mg micronized tablet 0 0 0 0 -
56 Haloperidol tablet 0,5 mg tablet 79 79 1 1 77 (59) 200
57 Haloperidol tablet 5 mg tablet 0 0 0 0 -
58 Hidroklortiazid ( Hct ) tablet 25 mg tablet 0 0 0 0 -
59 Hidrokortison krim 2,5 % tube 34 34 20 20 -6 366 400
60 Ibuprofen tablet 200 mg tablet 0 303 303 -606 6,060 6,000
61 Ibuprofen tablet 400 mg tablet 0 300 300 -600 6,000 6,000
62 Isoniazid tablet 100 mg tablet 0 0 0 0 -
63 Isoniazid tablet 300 mg tablet 0 0 0 0 -
64 Isosorbit dinitrat tablet sublingual 5 mg tablet 200 200 11 11 178 20 300
65 Kalsium Gluconas inj* ampul 0 0 0 0 -
66 Kalsium Karbonat tablet 500 mg tablet 0 0 0 0 -
67 Kaptopril 25 mg tablet tablet 100 100 0 0 100 (100)
68 Karbamazepin tablet 200 mg tablet 170 170 0 0 170 (170)
69 Ketokenazol 200 mg tablet tablet 190 190 45 45 100 710
70 Kloramfenikol kapsul 250 mg kapsul 180 180 2 2 176 (140)
71 Kloramfenikol salep 2 % tube 0 0 0 0 -
72 Kloramfenikol salep mata 1 % tube 21 21 1 1 19 (1)
73 Kloramfenikol sirup botol 0 5 5 -10 100
74 Klorfeniramin maleat ( CTM ) tablet 4 mg tablet 685 685 840 840 -995 16,115 20,000
Page 2 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
75 Klorpromazin Hcl inj 5 mg / ml - 2 ml ampul 0 0 0 0 -

76 Klorpromazin Hcl tablet salut 100 mg tablet 0 0 0 0 -
77 Kodein tablet 10 mg tablet 0 0 0 0 -
78 Kotrimoksazol DOEN I (dewasa) tablet tablet 114 114 30 30 54 486 800
79 Kotrimoksazol suspensi botol 35 35 4 4 27 45 150
80 Kuinine tablet salut selaput 200 mg* tablet 0 0 0 0 -
81 Kuinine Dihydrochloride cairan inj 25%-2 ampul 0 0 0 0 -
82 Lidocain injeksi 2 % ampul 0 0 0 0 -
83 Lidokain kompositum injeksi ampul 20 20 2 2 16 20 50
84 Loratadin tablet tablet 1050 1050 65 65 920 250 3,000
85 Magnesium sulfat inj ( 1V ) 20 % - 25 ml* vial 1 1 0 0 1 (1) 2
86 Magnesium sulfat inj ( 1V ) 40 % - 25 ml* vial 2 2 0 0 2 (2) 2
87 Mebendazol tablet 100 mg (vermox) tablet 0 0 0 0 -
88 Metformin tab 500 mg tablet 1220 1220 168 168 884 2,140 4,000
89 Metformin tab 850 mg tablet 300 300 0 0 300 (300) 2,000
90 Metilergometrin maleat tablet salut 0,12 tablet 0 9 9 -18 180 500
91 Metilergometrin maleat inj 0,200 mg - 1 ampul 5 5 0 0 5 (5) 5
92 Metilprednisolon 4 mg tablet tablet 1400 1400 278 278 844 4,160 6,000
93 Metilprednisolon 16 mg tablet tablet 0 0 0 0 -
94 Metoklorpropamid tablet tablet 1780 1780 29 29 1722 (1,200) 2,000
95 Metronidazol tablet 250 mg tablet 0 0 0 0 -
96 Metronidazol tablet 500 mg (Farizol) tablet 473 473 26 26 421 47 50
97 Metronidazol suspension 125 mg/ml botol 0 1 1 -2 20 20
98 Miconazol krim tube 24 24 15 15 -6 276 400
99 Mineral mix serbuk 8 gr* sachet 0 0 0 0 -
100 Natrium Bikarbonat tablet 500 mg tablet 0 0 0 0 -
101 Natrium Diklofenak tablet 25 mg tablet 1010 1010 103 103 804 1,050 3,000
102 Natrium Diklofenak tablet 50 mg tablet 328 328 70 70 188 1,072 3,000
Natrium Tiroksin (Levotiroksin) tablet 0
0 0 0 -
103 100 mg (Euthyrox) tablet
104 Nipedipin 10 mg tablet tablet 170 170 2 2 166 (130) 100
105 Nicotinamida tablet 20 mg tablet 0 0 0 0 -
106 Nistatin 100.000 iu /g tablet vagina tablet 0 0 0 0 -
107 Obat antituberkolusis katagori 1* paket 9 9 1 1 7 11 35
108 Obat antituberkolusis katagori 2* paket 0 1 1 -2 20 3
109 Obat antituberkulosis anak* paket 0 1 1 -2 20
110 Obat FDC Kategori 1* paket 0 0 0 0 -
111 obat FDC KATEGORI 2* paket 0 0 0 0 -
112 Oksitetrasiklin Hcl salep mata 1 % tube 0 1 1 -2 20 50
113 Oksitosin injeksi 10 iu / ml ampul 4 4 0 0 4 (4)
114 Omeprazol inj 40 mg/10 ml ampul 0 0 0 0 -
115 Omeprazole 20 mg capsul kapsul 2000 2000 99 99 1802 (20) 4,000
116 Parasetamol sirup 120 mg / 5 ml botol 316 316 20 20 276 84 400
117 Parasetamol tablet 500 mg tablet 5285 5285 2500 2500 285 44,715 50,000
Page 3 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
118 Pirantel pamoat 125 mg tablet tablet 79 79 1 1 77 (59)

119 Pirantel suspensi 5 mg/ml botol 0 0 0 0 -
120 Piridoksin Hcl tablet 10 mg tablet 910 910 328 328 254 5,650 6,000
121 Piridoksin Hcl tablet 25 mg tablet 0 0 0 0 -
122 Prednison tablet 5 mg tablet 0 0 0 0 -
123 Primakuin tablet 15 mg* tablet 0 0 0 0 -
124 Prokain benzil penisilin 3 juta iu / vial inje vial 0 0 0 0 -
125 Propanolol Hcl tablet 40 mg tablet 0 4 4 -8 80 300
126 Propiltiourasil tablet 100 mg tablet 70 70 23 23 24 390 500
127 Ranitidin tablet tablet 500 500 0 0 500 (500) 2,000
128 Retinol ( Vit A ) 100.000 IU kapsul* kapsul 0 125 125 -250 2,500 3,000
129 Retinol ( Vit A ) 200.000 IU kapsul* kapsul 0 50 50 -100 1,000 1,000
130 Salbutamol tablet 2 mg tablet 937 937 1 1 935 (917) 1,000
131 Salbutamol tablet 4 mg tablet 0 79 79 -158 1,580 4,000
132 Salep 2 - 4 kombinasi tablet 35 35 3 3 29 25 50
133 Sefadroxil kapsul 500 mg tablet 120 120 117 117 -114 2,220 4,000
134 Sefadroxil syp kering 125 ml / 5 ml botol 50 50 1 1 48 (30) 50
135 Sianokobalamin ( Vit.B.12 ) inj 500 mcg / ampul 0 0 0 0 -
136 Simpastatin 10 mg tablet tablet 500 500 239 239 22 4,280 5,000
137 Siprofloksasin 500 mg tablet tablet 650 650 30 30 590 (50) 2,000
138 Tetrasiklin Hcl kapsul 250 mg kapsul 0 0 0 0 -
139 Tetrasiklin Hcl kapsul 500 mg kapsul 0 0 0 0 -
140 Thiamin Hcl monohidrat ( Vit B1 ) 50 mg tablet 2035 2035 331 331 1373 4,585 5,000
141 Triheksilfenidil hidroklorida tablet 2 mg tablet 100 100 0 0 100 (100) 100
142 Vitamin B komplek tablet tablet 945 945 744 744 -543 13,935 15,000
143 Zink 20 mg tablet (generik) tablet 80 80 142 142 -204 2,760 5,000
144 Vaksin BCG* vial 20 20 15 15 -10 280 300
145 Vaksin Jerap D T* vial 14 14 0 0 14 (14) 50
146 Vaksin CAMPAK 10 Dosis* vial 0 2 2 -4 40 300
147 Vaksin POLIO 10 Dosis* vial 3 3 11 11 -19 217 200
148 Vaksin HEPATITIS B 0,5 ml ADS* vial 32 32 16 16 0 288 300
149 Pentabio Vaksin DTP-HB-HIB inj* vial 12 12 14 14 -16 268 300
150 Vaksin Td* vial 13 13 10 10 -7 187 200
4 1
Vaksin IPV (Poliomyelitis Vaccine inj 4 1 2 16
151 (ShanIPV)* vial 20
152 Vaksin MR* vial 15 15 10 10 -5 185 200
153 Acdat salep tube 0 0 0 -
154 Air untuk irigasi lar infus 1000 ml botol 0 0 0 0 -
155 Akarbose tablet 100 mg tablet 0 0 0 0 -
156 Albendazol suspensi 200mg/5 ml botol 0 0 0 0 -
157 Alprazolam 0,5 mg tablet 0 0 0 0 -
158 Alprazolam 1 mg tablet 0 0 0 0 -
159 Alvit drops botol 0 0 0 0 -
160 Ambroxol sirup botol 71 71 1 1 69 (51) 200
Page 4 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
161 Ambroxol tablet tablet 660 660 145 145 370 2,240 3,000
162 Amlodipin 10 mg tablet 1625 1625 522 522 581 8,815 9,000
163 Amoksisilin 250 mg tablet 0 0 0 0 -
164 Anemolat 1 mg tablet tablet 0 0 0 -
165 Antalgin (Metampiron) tablet 500 mg tablet 0 0 0 0 -
166 Antalgin injeksi 250 mg/5 ml ampul 0 0 0 0 -
167 Anti bakteri doen salep kombinasi tube 82 82 2 2 78 (42) 100
168 Antihemaroid doen kombinasi supp 149 149 11 11 127 71 300
169 Antimigrain doen kombinasi tablet 0 0 0 0 - 50
170 Antiparkinson doen tablet kombinasi tablet 0 0 0 0 -
171 Antrain inj ampul 0 0 0 0 -
172 Apialis Drops botol 0 0 0 0 -
173 Apialys sirup botol 0 0 0 0 - 100
174 Aqua proinjeksi steril,bebas pirogen vial 0 0 0 0 -
175 Arkavit tablet 820 820 18 18 784 (460) 5,000
176 Asam Asetilsalisilat tablet 100 mg (Asetos tablet 150 150 1 1 148 (130) 200
177 Asam Asetilsalisilat tablet 500 mg (Asetos tablet 0 0 0 0 -
178 Asam askorbat(vit C) tablet 250 mg tablet 0 0 0 0 - 1,000
179 Asam Folat 5 mg tablet tablet 0 0 0 0 -
180 Asam Traneksamat 500 mg kapsul kapsul 90 90 18 18 54 270 500
181 Asam Traneksamat injeksi 5 % 250 mg/ 5 ampul 0 0 0 0 -
182 Asiklovir salep kulit tube 72 72 1 1 70 (52) 100
183 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ampul 0 0 0 0 -
184 Atropin Sulfat tetes mata 0,5 % botol 0 0 0 0 -
185 Atrovent HFA kotak 0 0 0 0 -
186 Azitromisin 500 mg tablet tablet 0 0 0 0 -
187 Baby Cough sirup botol 200 200 0 0 200 (200) 500
188 Betahistin mesilat tablet 6 mg tablet 40 40 43 43 -46 820 2,000
189 Bioplacenton Cream tube 0 0 0 0 - 20
190 Bisoprolol tablet 5 mg tablet 300 300 14 14 272 (20)
191 Buscopan tablet tablet 0 1 1 -2 20 500
192 Cendo Augentonic tetes mata botol 0 0 0 0 -
193 Cendo Catarlent tetes mata botol 0 1 1 -2 20 30
194 Cendo Edta tetes mata botol 0 0 0 0 -
195 Cendo Floxa tetes mata botol 0 0 0 0 -
196 Cendo fungicide tetes mata botol 0 0 0 0 -
197 Cendo Homatrol tetes mata botol 0 0 0 0 -
198 Cendo Lyteers tetes mata botol 13 13 1 1 11 7 30
199 Cendo mydriatil tetes mata botol 0 0 0 0 -
200 Cendo Tobroson tetes mata botol 0 0 0 0 -
201 Cendo tropin tetes mata botol 0 0 0 0 -
202 Cendo Xytrol tetes mata botol 9 9 1 1 7 11 30
203 Cetop-zink kaplet tablet 0 0 0 0 -
204 Clopidogrel 75 mg tablet tablet 0 0 0 0 - 300
Page 5 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
205 Curcuma tablet tablet 570 570 104 104 362 1,510 2,000
206 Dekstran 70 larutan infus 6 % steril botol 0 0 0 0 -
207 Depakene sirup botol 0 0 0 0 0 -
208 Depakote tablet tablet 0 0 0 0 -
209 Desoksimetason 0,25 mg (Denomix) tube 29 29 2 2 25 11 100
210 Dextamine tablet tablet 0 0 0 0 0 -
211 DEXTAMIN SYR botol 0 0 0 0 - 50
212 Dextrofen sirup botol 0 0 0 0 - 100
213 Diamicron MR 30 mg tablet tablet 0 0 0 0 0 -
214 Diltiazem tablet tablet 0 0 0 0 -
215 Domperidon Suspensi 5 mg/5 ml botol 0 0 0 0 -
216 Dopamet (metildopa) tablet 0 0 0 0 -
217 Dulcolax 10 mg supp supp 0 0 0 0 -
218 Dulcolax 5 mg tablet tablet 195 195 1 1 193 (175) 300
219 Efedrin Hcl tablet 25 mg tablet 0 0 0 0 -
220 Erytromisin 250 mg kapsul kapsul 0 16 16 -32 320 300
221 Etakridin ( Rivanol ) larutan 0,1 % botol 0 1 1 -2 20 10
222 Etambutol Hcl tablet 250 mg tablet 0 0 0 0 -
223 Famotidin 40 mg tablet tablet 0 0 0 0 -
224 Fenitoin natrium inj 50 mg / ml ampul 0 0 0 0 -
225 Fenitoin natrium kapsul 100 mg kapsul 0 0 0 0 -
226 Fenobarbital tablet 100 mg tablet 0 0 0 0 -
227 Fenofibrat kaps 100 mg tablet 0 0 0 0 - 300
228 Fenol gliserol tetes telinga 10 % botol 42 42 2 2 38 (2) 50
229 Flukonazol tab 150 mg tablet 0 0 0 -
230 Fluor tablet 0,5 mg tablet 0 0 0 0 -
231 Fucilex ointment (natrium fusidat) tube 0 0 0 -
232 Fungasol 2 % botol 0 0 0 -
233 Fuson ointment tube 0 0 0 0 -
234 Gemfibrozil 300 mg tablet 830 830 38 38 754 (70) 1,000
235 Gentamisin salep kulit tube 43 43 10 10 23 157 200
236 Gentamisin salep mata tube 55 55 4 4 47 25 50
237 Gentamisin Tetes mata botol 88 88 6 6 76 32 150
238 Gentian violet larutan 1 % pot 45 45 8 8 29 115 100
239 Glimepirid tab 2 mg tablet 0 0 0 0 -
240 Gliseril guayakolat tablet 100 mg tablet 556 556 269 269 18 4,824 6,000
241 Gliserin larutan 50% botol 0 0 0 0 -
242 Glukosa larutan infus 10 % steril botol 0 0 0 0 -
245 Glukosamin 250 mg tablet (osmin) tablet 331 331 52 52 227 709 800
246 H.Booster sirup botol 0 0 0 0 - 50
247 Haloperidol tablet 1,5 mg tablet 0 0 0 0 -
248 Hemafort tablet tablet 0 1000 1000 -2000 20,000 20,000
Page 6 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
249 HEXADOL (Larutan Hexetidine) botol 0 3 3 -6 60 100

250 Hidrokortison krim 1% tube 0 0 0 -
251 Hyorex 10 mg tablet tablet 0 0 0 -
252 Hyoscine N Butilbromida 10 mg tablet tablet 0 0 0 0 -
253 Ibuprofen syr 100 mg/5ml botol 0 0 0 0 -
254 Ichtyol salep tube 0 0 0 -
255 Inhitril 10 mg tablet 0 0 0 -
256 Inhitril 5 mg tablet 0 0 0 0 -
257 Interhistin tablet tablet 0 0 0 0 -
258 Irbesartan tab 150 mg tablet 0 0 0 0 -
259 Kalsium laktat ( Kalk ) tablet 500 mg tablet 510 510 307 307 -104 5,630 7,000
260 Kandesartan 8 mg tablet tablet 0 0 0 0 - 1,500
261 Kandesartan 16 mg tablet tablet 0 0 0 0 - 3,000
262 Kandistatin drops (nistatin 100.000IU) botol 2 2 1 1 0 18 50
263 Kaptopril 12,5 mg tablet tablet 0 0 0 0 -
264 Kaptopril 50 mg tablet tablet 0 0 0 0 -
265 Ketokonazol Krim tube 120 120 5 5 110 (20) 100
266 Ketoprofen 100 mg tablet tablet 0 0 0 0 -
267 Klindamisin 150 mg tablet tablet 0 0 0 0 -
268 Klobazam 10 mg tablet tablet 0 3 3 -6 60 200
269 Klonidin 0,15 mg tablet tablet 0 0 0 0 -
270 Kloramfenikol tetes telinga 3 % botol 11 11 12 12 -13 229 200
271 Klorpromazin Hcl inj 25 mg / ml - 12 ml ampul 0 0 0 0 -
272 Klorpromazin Hcl tablet salut 25 mg tablet 0 0 0 0 -
273 Klozapin 25 mg tablet tablet 0 0 0 0 -
276 Kombinasi pirimetamin 25 mg / sulfadoks tablet 0 0 0 0 -
277 Kombipak Azitromycin-Cefixim paket 0 0 0 0 -
278 Kotrimoksazol DOEN II (pedriatik) tablet tablet 0 0 0 0 -
279 Lanzoprazol tablet 1135 1135 444 444 247 7,745 8,000
280 Lapalos Cream tube 0 0 0 0 - 50
281 Laxadine emulsi botol 4 4 1 1 2 16
282 L-Bio sachet sachet 0 0 0 0 - 200
283 Lanzoprazol tablet 0 0 0 0 -
284 Lapalos Cream tube 0 0 0 0 -
285 Levofloksasin tab 500 mg tablet 0 0 0 0 -
286 Lexapram sirup botol 0 0 0 0 -
287 Lidocain jeli 2 % (Xylocaine Jelly 2%) syringe 0 0 0 0 -
288 Lincomisin 500 mg tablet 0 0 0 0 -
289 Lisinopril 10 mg tablet tablet 0 0 0 0 -
290 Lisinopril 5 mg tablet tablet 0 0 0 0 -
291 Lisol botol 0 0 0 0 -
292 Livertran salep tube 0 0 0 0 - 30
Page 7 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
293 Longatin 25 mg tablet 0 54 54 -108 1,080 1,000

294 Loperamida tablet tablet 340 340 46 46 248 580 800
295 Lorazepam (Merlopam) 2 mg tablet tablet 0 0 0 0 -
296 Lytacur botol 60ml botol 0 0 0 0 -
297 MDT Combi* paket 0 0 0 0 -
298 Mebendazol sirup 100 mg / 5 ml botol 0 0 0 0 -
299 Meloxikam 15 mg tablet tablet 933 933 256 256 421 4,187 5,000
300 Meloxikam 7,5 mg tablet tablet 795 795 245 245 305 4,105 5,000
301 Mersibion injeksi ampul 0 0 0 0 -
302 Metoklorpropamid sirup botol 22 22 1 1 20 (2)
303 Metronidazol infus 500 mg/100 ml botol 0 0 0 0 -
304 Metronidazol supp 500 mg (Flagyl supp) supp 0 0 0 0 -
305 Metronidazol sirup botol 0 0 0 0 -
306 Miniaspi 80 mg tablet 0 0 0 0 - 100
307 Misoprostol 200 mg (gastrul) tablet 0 0 0 0 -
308 Mixaria sachet 0 0 0 0 -
309 Moksifloksasin tetes mata 0,5% (Vigamox botol 0 0 0 0 -
310 Mometason furoat krim 0,1 % tube 0 0 0 0 -
311 Natrium klorida larutan infus 0,9 % steril botol 15 15 1 1 13 5 30
312 Neo Diaform tablet 375 375 74 74 227 1,105 2,000
313 Neurodex tablet tablet 0 0 0 0 - 500
314 New Diatabs tablet 0 0 0 0 -
315 Nistatin 500.000 iu /g tablet salut tablet 0 0 0 0 -
316 Nitral (gliseril trinitras sublingual 0.5 mg) tablet 0 0 0 0 -
317 Nopres 20 mg tablet tablet 0 0 0 0 -
318 Norages Injeksi ampul 0 0 0 0 -
319 novadium tablet 0 0 0 0 -
320 Novastan sirup botol 0 0 0 0 -
321 Noza tablet tablet 0 0 0 0 - 300
322 Obat antituberkulosis kat.3* paket 0 0 0 0 -
0
0 0 0 -
323 Obat antituberkulosis kat.sisipan* paket
324 Obat Batuk Hitam ( OBH ) cairan botol 98 98 24 24 50 382 400
325 Obat suntik KB I (3 bulan) ampul 80 80 2 2 76 (40)
326 Obat suntik KB II (1 bulan) ampul 0 0 0 0 -
327 Ofloksasin tab 400 mg tablet 0 0 0 0 - 500
328 Oksimetazolin tts hidung 0,025% (Iliadin botol 0 0 0 0 -
329 Oksitetrasiklin Hcl salep kulit 3 % tube 56 56 5 5 46 44 150
330 Ondansetron inj 4 mg/2ml ampul 0 0 0 0 -
331 Ondansetron tab 4 mg tablet 0 0 0 0 - 200
332 Optiflox tetes mata botol 0 0 0 0 -
333 Pamol supp supp 27 27 0 0 27 (27)
334 Pantocain 0,5 % TM botol 0 0 0 0 -
335 Papaverin 40 mg tablet tablet 0 50 50 -100 1,000 1,000
Page 8 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
336 Parasetamol Drop 100 mg/ml botol 49 49 17 17 15 291 300

337 Pedialyte botol 0 0 0 0 -
338 Pehacain injeksi ampul 0 0 0 0 -
339 Pil KB I tablet 0 0 0 0 -
340 Pil KB II / Laktasi tablet 0 0 0 0 -
341 Pim-Tra-Kol sirup botol 57 57 10 10 37 143 300
342 Pirazinamid tab 500 mg tablet 0 0 0 0 -
343 Piroksikam 10 mg tablet tablet 690 690 21 21 648 (270)
344 Piroksikam 20 mg tablet tablet 0 0 0 0 -
345 Polikresulen botol 0 0 0 0 -
346 Povidon Iodida larutan 10 % 30 ml botol 0 0 0 0 -
347 Povidon Iodida larutan 10 % 300 ml botol 0 0 0 0 -
348 Povidon Iodida Larutan 1000 ml botol 0 0 0 0 -
349 Povidon Iodida Larutan 60 ml botol 0 1 1 -2 20 20
350 PP Isoniazide 100 mg* tablet 0 0 0 -
351 Prazikuantel tablet 600 mg tablet 0 0 0 0 -
352 Prenatin DF tablet tablet 0 0 0 0 -
353 Primolut N tablet 0 0 0 0 -
354 Protofen supp supp 0 0 0 -
355 Protofen tablet tablet 0 0 0 0 -
356 Pularex tablet tablet 0 0 0 0 -
357 Pulmicort respules ampul 0 0 0 -
358 Pulmicort turbuhaler kotak 0 0 0 0 -
359 Ramabion tab tablet 0 0 0 0 -
360 Ranitidin inj 25mg/2ml ampul 0 0 0 0 -
361 Recovit sirup botol 0 0 0 0 -
362 Reserpin tablet 0,25 mg tablet 0 0 0 0 -
363 Rifampisin kaplet 600 mg tablet 0 0 0 0 -
364 Rifampisin kapsul 300 mg tablet 0 0 0 0 -
365 Rifampisin kapsul 450 mg tablet 0 0 0 0 -
366 Ringer laktat larutan infus steril botol 0 0 0 0 -
367 Risperidon 2 mg tab tablet 0 0 0 0 -
368 Salisil bedak 2 % kotak 54 54 10 10 34 146 300
369 Sandepril 50 mg tablet 0 0 0 -
370 Sangobion kids drop botol 0 0 0 0 -
371 Sangobion Kids Sirup botol 5 5 2 2 1 35 40
372 Scabicid cream 10 gram tube 0 0 0 0 -
373 Scabimite cream 10 gram tube 0 4 4 -8 80 200
374 Scopma tablet tablet 105 105 10 10 85 95 1,000
375 Sefaleksin kapsul 500 mg kapsul 0 0 0 0 -
376 Sefiksim kapsul 100 mg kapsul 0 0 0 0 -
377 Sefiksim syr kering 100mg/5ml botol 0 0 0 0 -
378 Seretide Inhaler 50 mcg kotak 0 0 0 0 -
379 Serum anti bisa ular polivalen inj 5 ml ( AB vial 0 0 0 0 -
Page 9 of 37
TOTAL SISA TOTAL
2021 2021 2022 (PEMBULATAN)
2021
380 Serum anti bisa ular polivalen inj 50 ml ( A vial 0 0 0 0 -

381 Serum anti defteri inj 1000 mg / vial vial 0 0 0 0 -
382 Serum anti tetanus inj 1.500 IU / ampul ( ampul 0 0 0 0 -
383 Serum anti tetanus inj 20.000 IU / ampul ( ampul 0 0 0 0 -
384 Setirizin sirup 5 mg/ml botol 79 79 21 21 37 341 400
385 Setirizine tablet 10 mg tablet 450 450 610 610 -770 11,750 15,000
386 Simetidin tablet tablet 0 0 0 0 -
387 Simpastatin 20 mg tablet tablet 20 20 26 26 -32 500 1,000
388 Sohobion tablet tablet 0 28 28 -56 560 3,000
389 Spiramisin 500 mg tablet tablet 0 0 0 0 -
390 Spironolakton tab 25 mg tablet 0 0 0 0 - 100
401 Tanapress 5 mg (imidapril ) tablet 0 0 0 0 -
402 Tensigard tablet tablet 0 0 0 0 -
403 Terra Flu tablet tablet 795 795 20 20 755 (395) 1000
404 Tetagam ampul 0 0 0 0 -
405 Thiamfenicol 500 mg kapsul kapsul 0 0 0 0 - 300
406 Thiamin Hcl ( Vit B1 ) inj.100 mg / ml - 1 m ampul 0 0 0 0 -
407 Thrombophob gel tube 2 2 0 0 2 (2) 20
408 Timolol tetes mata 0,5% botol 0 0 0 0 -
409 Tramadol 50 mg kapsul kapsul 0 0 0 -
410 Tramadol inj 50 mg/ml ampul 0 0 0 0 -
411 Triflouperazin 5mg tablet tablet 0 0 0 0 -
412 Truvit drops botol 0 0 0 0 -
413 Truvit sirup botol 26 26 2 2 22 14 50
414 Ulsafate sirup botol 0 0 0 - 500
415 Ulsidex tablet tablet 0 0 0 0 -
416 Urea krim (Soft U derm) botol 0 0 0 0 -
417 Urotractin (asam pipemidat) 400 mg tablet 0 0 0 0 -
418 Vagizol ovula (metronidazol ovula) ovula 47 47 0 0 47 (47)
419 valisanbe 2 mg tablet 0 0 0 0 -
420 Valsartan tab 80 mg (Diovan 80mg) tablet 0 0 0 0 -
421 Vastral tablet 0 14 14 -28 280 1,000
422 Ventolin inhaler kotak 0 0 0 0 -
423 Ventolin Nebulizer ampul 5 5 1 1 3 15 20
424 Vitamin A6000IU tablet 0 0 0 0 -
425 Vitamin B 12 tablet tablet 10 10 213 213 -416 4,250 5,000
426 Vitonorm tablet tablet 0 0 0 0 -
427 Xylocain spray kotak 0 0 0 0 -
428 Yodium Test botol 0 0 0 0 -
Page 10 of 37

USULAN PENGADAAN TOTAL

NO NAMA OBAT SATUAN HARGA OBAT PROYEKSI PENGADAAN TOTAL RUPIAH
2022 PENGADAAN
APBD total Rp APBD JKN total Rp JKN
1 2 3 4 5 6 7=5*6 8 9= 5*8 10 = 7 + 9 11 = 5 * 10
A OBAT
1 Albendazol tablet 400 mg* tablet 5,000 463 5,000 2,315,000 - 5,000 2,315,000
2 Allopurinol tablet 100 mg tablet 2,000 105 2,000 210,000 - 2,000 210,000
3 Aminofilin injeksi 24 mg/ml-10 ml ampul - 3,071 - - - -
4 Aminofilin tablet 200 mg tablet - 101 - - - -
5 Amitriptilin Hcl tablet salut 25 mg tablet - 237 - - - -
6 Amlodipin 5 mg tablet 7,000 81 7,000 567,000 - 7,000 567,000
7 Amoksisilin 500 mg kaplet tablet 8,000 265 8,000 2,120,000 - 8,000 2,120,000
8 Amoksisilin Sirup kering 125 mg/5 m botol 350 3,665 350 1,282,820 - 350 1,282,820
9 Ampisilin serbuk injeksi i.m.i.v 100 vial - 8,237 - - - -
10 Antasida doen tablet kombinasi tablet 8,000 60 8,000 480,000 - 8,000 480,000
11 Antasida sirup botol 700 2,098 700 1,468,600 - 700 1,468,600
12 Antifungi doen kombinasi tube - 5,517 - - - -
13 Artemether injeksi 80 Mg* ampul - 29,925 - - - -
14 Artesunate cairan injeksi 60 mg* ampul - 52,350 - - - -
15 Asam Askorbat(vit C) tablet 50 mg tablet 10,000 120 10,000 1,200,000 - 10,000 1,200,000
16 Asam Folat 1 mg tablet tablet 5,000 81 5,000 405,000 - 5,000 405,000
17 Asam mefenamat 500 mg kaplet tablet 5,000 250 5,000 1,250,000 - 5,000 1,250,000
18 Asiklovir 200 mg tablet tablet 3,000 706 3,000 2,116,653 - 3,000 2,116,653
19 Asiklovir 400 mg tablet tablet 3,000 454 3,000 1,361,220 - 3,000 1,361,220
20 Atropin Sulfat tablet 0,5 mg tablet - 26 - - - -
21 Benzatin Benzil Penisilin inj 1,2 juta vial - 10,780 - - - -
22 Benzatin Benzil Penisilin inj 1,4 juta vial - 14,740 - - - -
23 Betametason krim 0,1 % tube 300 1,465 300 439,500 - 300 439,500
24 Clindamisin kapsul 300 mg kapsul - 1,017 - - - -
25 Deksametason tablet 0,5 mg tablet 3,000 143 3,000 429,000 - 3,000 429,000
26 Deksametason inj 5 mg/ml-1 ml ampul 20 1,210 20 24,200 - 20 24,200
DHP / Darplex / D-Artepp (Dehidro - - - - -

27 artemisin Piperaquin) tab* tablet 2,134
28 Diazepam inj 5 mg/ml-2 ml ampul - 1,913 - - - -
29 Diazepam tablet 2 mg tablet 200 86 200 17,200 - 200 17,200
Page 11 of 37
NO NAMA OBAT SATUAN USULAN PENGADAAN HARGA OBAT PROYEKSI PENGADAAN TOTAL TOTAL RUPIAH
2022 PENGADAAN
30 Diazepam tablet 5 mg tablet 200 109 200 21,800 - 200 21,800
31 Dietilkarbamazin sitrat tablet 100 tablet - 180 - - - -
32 Difenhidramin Hcl inj 10 mg/ml-1 m ampul 20 1,347 20 26,940 - 20 26,940
33 Digoksin tablet 0,25 mg tablet - 104 - - - -
34 Dimenhidrinate tablet tablet 800 129 800 103,200 - 800 103,200
35 Doksisiklin 100 mg kapsul kapsul - 299 - - - -
36 Domperidon 10 mg tablet 3,000 522 3,000 1,566,345 - 3,000 1,566,345
37 Epinefrin Hcl/Bitartrat(adrenalin)inj ampul 50 1,518 50 75,900 - 50 75,900
38 Erytromisin sirup (trovilon) botol - 13,176 - - - -
39 Erytromisin 500 mg kaplet tablet 500 730 500 365,002 - 500 365,002
40 Etambutol 500 mg tablet tablet - 4,661 - - - -
41 Fenitoin kapsul 50 mg kapsul - 1 - - - -
42 Fenobarbital inj 50 mg / ml - 2 ml ampul - 2,135 - - - -
43 Fenobarbital tablet 30 mg tablet - 197.00 - - - -
44 Ferrous sulphate tab selaput 300 m tablet - 1 - - - -
Ferro folat tab sal selaput 200 mg
+ 0,25 mg (Tablet tambah darah - - - - -
45 komb.) tablet 409
46 Fitomenadion ( vit k 1 ) tablet salut tablet 2,000 818 2,000 1,636,000 - 2,000 1,636,000
47 Fitomenadion ( vit k 1 ) inj 10 mg / m ampul 100 4,236 100 423,600 - 100 423,600
48 Furosemid tablet 40 mg tablet 700 84 700 58,800 - 700 58,800
49 Furosemid Cairan Injeksi 10 mg/ml ampul - 1,555 - - - -
50 Garam oralit untuk 200 ml air sachet 1,000 281 1,000 281,000 - 1,000 281,000
51 Gentamisin inj 40 mg/2 ml* ampul - 3,509 - - - -
52 Gentamisin inj 80 mg/2 ml* ampul - 2,750 - - - -
53 Glibenklamid tablet 5 mg tablet 500 137 500 68,500 - 500 68,500
54 Glimepirid tab 1 mg tablet 500 174 500 87,000 - 500 87,000
55 Griseofulvin tablet 125 mg microniz tablet - 238 - - - -
56 Haloperidol tablet 0,5 mg tablet 200 55 200 11,000 - 200 11,000
57 Haloperidol tablet 5 mg tablet - 56 - - - -
58 Hidroklortiazid ( Hct ) tablet 25 mg tablet - 163 - - - -
59 Hidrokortison krim 2,5 % tube 400 2,533 400 1,013,200 - 400 1,013,200
60 Ibuprofen tablet 200 mg tablet 6,000 237 6,000 1,422,960 - 6,000 1,422,960
61 Ibuprofen tablet 400 mg tablet 6,000 345 6,000 2,069,760 - 6,000 2,069,760
62 Isoniazid tablet 100 mg tablet - 143 - - - -
63 Isoniazid tablet 300 mg tablet - 173 - - - -
64 Isosorbit dinitrat tablet sublingual tablet 300 178 200 35,574 - 200 35,574
65 Kalsium Gluconas inj* ampul - 10,351 - - - -
66 Kalsium Karbonat tablet 500 mg tablet - 1 - - - -
67 Kaptopril 25 mg tablet tablet - 147 - - - -
68 Karbamazepin tablet 200 mg tablet - 250 - - - -
69 Ketokenazol 200 mg tablet tablet - 681 - - - -
70 Kloramfenikol kapsul 250 mg kapsul - 711 - - - -
Page 12 of 37
2022 PENGADAAN
71 Kloramfenikol salep 2 % tube - 1 - - - -
72 Kloramfenikol salep mata 1 % tube - 10,197 - - - -
73 Kloramfenikol sirup botol - 5,319 - - - -
74 Klorfeniramin maleat ( CTM ) tablet tablet 20,000 60 20,000 1,197,700 - 20,000 1,197,700
75 Klorpromazin Hcl inj 5 mg / ml - 2 m ampul - 376 - - - -
76 Klorpromazin Hcl tablet salut 100 m tablet - 181 - - - -
77 Kodein tablet 10 mg tablet - 600 - - - -
78 Kotrimoksazol DOEN I (dewasa) tabl tablet 800 133 800 106,400 - 800 106,400
79 Kotrimoksazol suspensi botol 150 2,052 150 307,800 - 150 307,800
80 Kuinine tablet salut selaput 200 mg tablet - 311 - - - -
81 Kuinine Dihydrochloride cairan inj ampul - 2,616 - - - -
82 Lidocain injeksi 2 % ampul - 1,408 - - - -
83 Lidokain kompositum injeksi ampul 50 1,405 50 70,250 - 50 70,250
84 Loratadin tablet tablet 3,000 136 3,000 408,000 - 3,000 408,000
85 Magnesium sulfat inj ( 1V ) 20 % - 2 vial 2 3,328 2 6,656 - 2 6,656
86 Magnesium sulfat inj ( 1V ) 40 % - 2 vial 2 3,796 2 7,592 - 2 7,592
87 Mebendazol tablet 100 mg (vermox tablet - 9,150 - - - -
88 Metformin tab 500 mg tablet 4,000 109 4,000 436,000 - 4,000 436,000
89 Metformin tab 850 mg tablet 2,000 178 2,000 356,000 - 2,000 356,000
90 Metilergometrin maleat tablet salu tablet 500 271 500 135,500 - 500 135,500
91 Metilergometrin maleat inj 0,200 mg ampul 5 3,399 5 16,995 - 5 16,995
92 Metilprednisolon 4 mg tablet tablet 6,000 148 6,000 888,000 - 6,000 888,000
93 Metilprednisolon 16 mg tablet tablet - 875 - - - -
94 Metoklorpropamid tablet tablet 2,000 124 2,000 248,000 - 2,000 248,000
95 Metronidazol tablet 250 mg tablet - 94 - - - -
96 Metronidazol tablet 500 mg (Farizol tablet 50 282 50 14,105 - 50 14,105
97 Metronidazol suspension 125 mg/m botol 20 3,800 20 76,000 - 20 76,000
98 Miconazol krim tube 400 3,926 400 1,570,400 - 400 1,570,400
99 Mineral mix serbuk 8 gr* sachet - 2,920 - - - -
100 Natrium Bikarbonat tablet 500 mg tablet - 10 - - - -
101 Natrium Diklofenak tablet 25 mg tablet 3,000 152 3,000 456,000 - 3,000 456,000
102 Natrium Diklofenak tablet 50 mg tablet 3,000 136 3,000 408,000 - 3,000 408,000
Natrium Tiroksin (Levotiroksin) - - - - -
103 tablet 100 mg (Euthyrox) tablet 1,072
104 Nipedipin 10 mg tablet tablet 100 193 100 19,300 - 100 19,300
105 Nicotinamida tablet 20 mg tablet - 1 - - - -
106 Nistatin 100.000 iu /g tablet vagina tablet - 688 - - - -
107 Obat antituberkolusis katagori 1* paket 35 317,018 35 11,095,630 - 35 11,095,630
108 Obat antituberkolusis katagori 2* paket 3 1,379,984 3 4,139,952 - 3 4,139,952
109 Obat antituberkulosis anak* paket - 285,343 - - - -
110 Obat FDC Kategori 1* paket - 477,791 - - - -
111 obat FDC KATEGORI 2* paket - 1,379,984 - - - -
Page 13 of 37
2022 PENGADAAN
112 Oksitetrasiklin Hcl salep mata 1 % tube 50 2,600 - - - -
113 Oksitosin injeksi 10 iu / ml ampul - 1,232 - - - -
114 Omeprazol inj 40 mg/10 ml ampul - 10,002 - - - -
115 Omeprazole 20 mg capsul kapsul 4,000 480 4,000 1,920,892 - 4,000 1,920,892
116 Parasetamol sirup 120 mg / 5 ml botol 400 3,739 400 1,495,600 - 400 1,495,600
117 Parasetamol tablet 500 mg tablet 50,000 178 50,000 8,893,500 - 50,000 8,893,500
118 Pirantel pamoat 125 mg tablet tablet - 353 - - - -
119 Pirantel suspensi 5 mg/ml botol - 9,100 - - - -
120 Piridoksin Hcl tablet 10 mg tablet 6,000 150 6,000 900,000 - 6,000 900,000
121 Piridoksin Hcl tablet 25 mg tablet - 222 - - - -
122 Prednison tablet 5 mg tablet - 79 - - - -
123 Primakuin tablet 15 mg* tablet - 253 - - - -
124 Prokain benzil penisilin 3 juta iu / via vial - 7,910 - - - -
125 Propanolol Hcl tablet 40 mg tablet 300 300 300 90,000 - 300 90,000
126 Propiltiourasil tablet 100 mg tablet 500 500 500 250,000 - 500 250,000
127 Ranitidin tablet tablet 2,000 229 2,000 457,700 - 2,000 457,700
128 Retinol ( Vit A ) 100.000 IU kapsul* kapsul 3,000 356 3,000 1,068,000 - 3,000 1,068,000
129 Retinol ( Vit A ) 200.000 IU kapsul* kapsul 1,000 637 1,000 637,000 - 1,000 637,000
130 Salbutamol tablet 2 mg tablet 1,000 122 2,000 244,222 - 2,000 244,222
131 Salbutamol tablet 4 mg tablet 4,000 128 3,000 383,955 - 3,000 383,955
132 Salep 2 - 4 kombinasi tablet 50 3,219 50 160,950 - 50 160,950
133 Sefadroxil kapsul 500 mg tablet 4,000 809 4,000 3,234,000 - 4,000 3,234,000
134 Sefadroxil syp kering 125 ml / 5 ml botol 50 4,360 50 218,000 - 50 218,000
135 Sianokobalamin ( Vit.B.12 ) inj 500 ampul - 1,067 - - - -
136 Simpastatin 10 mg tablet tablet 5,000 664 5,000 3,318,000 - 5,000 3,318,000
137 Siprofloksasin 500 mg tablet tablet 2,000 306 2,000 611,666 - 2,000 611,666
138 Tetrasiklin Hcl kapsul 250 mg kapsul - 200 - - - -
139 Tetrasiklin Hcl kapsul 500 mg kapsul - 310 - - - -
140 Thiamin Hcl monohidrat ( Vit B1 ) 5 tablet 5,000 94 5,000 470,000 - 5,000 470,000
141 Triheksilfenidil hidroklorida tablet tablet 100 95 100 9,500 - 100 9,500
142 Vitamin B komplek tablet tablet 15,000 135 15,000 2,025,000 - 15,000 2,025,000
143 Zink 20 mg tablet (generik) tablet 5,000 604 5,000 3,020,000 - 5,000 3,020,000
144 Vaksin BCG* vial 300 66,154 300 19,846,200 - 300 19,846,200
145 Vaksin Jerap D T* vial 50 17,450 50 872,500 - 50 872,500
146 Vaksin CAMPAK 10 Dosis* vial 300 28,204 40 1,128,160 - 40 1,128,160
147 Vaksin POLIO 10 Dosis* vial 200 21,285 200 4,257,000 - 200 4,257,000
148 Vaksin HEPATITIS B 0,5 ml ADS* vial 300 23,270 300 6,981,000 - 300 6,981,000
149 Pentabio Vaksin DTP-HB-HIB inj* vial 300 84,282 300 25,284,600 - 300 25,284,600
150 Vaksin Td* vial 200 18,128 200 3,625,600 - 200 3,625,600
Vaksin IPV (Poliomyelitis Vaccine 20 20 2,890,800 - 20 2,890,800
151 inj (ShanIPV)* vial 144,540
152 Vaksin MR* vial 200 166,265 200 33,253,000 - 200 33,253,000
153 Acdat salep tube - 6,241 - - - -
Page 14 of 37
2022 PENGADAAN
154 Air untuk irigasi lar infus 1000 ml botol - 12,100 - - - -
155 Akarbose tablet 100 mg tablet - 960 - - - -
156 Albendazol suspensi 200mg/5 ml botol - 4,146 - - - -
157 Alprazolam 0,5 mg tablet - 94 - - - -
158 Alprazolam 1 mg tablet - 128 - - - -
159 Alvit drops botol - 12,500 - - - -
160 Ambroxol sirup botol 200 4,861 200 972,180 - 200 972,180
161 Ambroxol tablet tablet 3,000 150 3,000 450,000 - 3,000 450,000
162 Amlodipin 10 mg tablet 9,000 94 9,000 846,000 - 9,000 846,000
163 Amoksisilin 250 mg tablet - 377 - - - -
164 Anemolat 1 mg tablet tablet - 81 - - - -
165 Antalgin (Metampiron) tablet 500 tablet - 67 - - - -
166 Antalgin injeksi 250 mg/5 ml ampul - 408 - - - -
167 Anti bakteri doen salep kombinasi tube 100 5,455 100 545,468 - 100 545,468
168 Antihemaroid doen kombinasi supp 300 3,642 200 728,400 - 200 728,400
169 Antimigrain doen kombinasi tablet 50 149 50 7,450 - 50 7,450
170 Antiparkinson doen tablet kombinas tablet - 1,035 - - - -
171 Antrain inj ampul - 12,000 - - - -
172 Apialis Drops botol - 21,175 - - - -
173 Apialys sirup botol 100 33,000 100 3,300,000 - 100 3,300,000
174 Aqua proinjeksi steril,bebas pirogen vial - 2,860 - - - -
175 Arkavit tablet 5,000 244 5,000 1,218,360 - 5,000 1,218,360
176 Asam Asetilsalisilat tablet 100 mg ( tablet 200 356 200 71,148 - 200 71,148
177 Asam Asetilsalisilat tablet 500 mg ( tablet - 100 - - - -
178 Asam askorbat(vit C) tablet 250 mg tablet 1,000 164 1,000 164,040 - 1,000 164,040
179 Asam Folat 5 mg tablet tablet - 64 - - - -
180 Asam Traneksamat 500 mg kapsul kapsul 500 3,202 500 1,600,830 - 500 1,600,830
181 Asam Traneksamat injeksi 5 % 250 ampul - 1,813 - - - -
182 Asiklovir salep kulit tube 100 3,773 100 377,300 - 100 377,300
183 Atropin Sulfat injeksi 0,25 mg/ml-1 ampul - 1,859 - - - -
184 Atropin Sulfat tetes mata 0,5 % botol - 2,801 - - - -
185 Atrovent HFA kotak - 83,500 - - - -
186 Azitromisin 500 mg tablet tablet - 1,778 - - - -
187 Baby Cough sirup botol 500 4,851 300 1,455,300 - 300 1,455,300
188 Betahistin mesilat tablet 6 mg tablet 2,000 119 2,000 238,000 - 2,000 238,000
189 Bioplacenton Cream tube 20 23,716 20 474,320 - 20 474,320
190 Bisoprolol tablet 5 mg tablet - 264 - - - -
191 Buscopan tablet tablet 500 4,346 500 2,173,000 - 500 2,173,000
192 Cendo Augentonic tetes mata botol - 29,792 - - - -
193 Cendo Catarlent tetes mata botol 30 35,200 30 1,056,000 - 30 1,056,000
194 Cendo Edta tetes mata botol - 37,500 - - - -
195 Cendo Floxa tetes mata botol - 30,800 - - - -
196 Cendo fungicide tetes mata botol - 18,500 - - - -
Page 15 of 37
2022 PENGADAAN
197 Cendo Homatrol tetes mata botol - 43,785 - - - -
198 Cendo Lyteers tetes mata botol 30 26,681 30 800,415 - 30 800,415
199 Cendo mydriatil tetes mata botol - 34,100 - - - -
200 Cendo Tobroson tetes mata botol - 54,843 - - - -
201 Cendo tropin tetes mata botol - 13,200 - - - -
202 Cendo Xytrol tetes mata botol 30 32,313 30 969,375 - 30 969,375
203 Cetop-zink kaplet tablet - 4,840 - - - -
204 Clopidogrel 75 mg tablet tablet 300 1,469 300 440,700 - 300 440,700
205 Curcuma tablet tablet 2,000 1,049 2,000 2,098,866 - 2,000 2,098,866
206 Dekstran 70 larutan infus 6 % steril botol - 35,526 - - - -
207 Depakene sirup botol - 17,789 - - - -
208 Depakote tablet tablet - 1,200 - - - -
209 Desoksimetason 0,25 mg (Denomix) tube 100 12,075 100 1,207,500 - 100 1,207,500
210 Dextamine tablet tablet - 1,957 - - - -
211 DEXTAMIN SYR botol 50 30,200 50 1,510,000 - 50 1,510,000
212 Dextrofen sirup botol 100 12,451 100 1,245,090 - 100 1,245,090
213 Diamicron MR 30 mg tablet tablet - 638 - - - -
214 Diltiazem tablet tablet - 143 - - - -
215 Domperidon Suspensi 5 mg/5 ml botol - 4,312 - - - -
216 Dopamet (metildopa) tablet - 1,088 - - - -
217 Dulcolax 10 mg supp supp - 5,900 - - - -
218 Dulcolax 5 mg tablet tablet 300 1,661 300 498,239 - 300 498,239
219 Efedrin Hcl tablet 25 mg tablet - 198 - - - -
220 Erytromisin 250 mg kapsul kapsul 300 636 300 190,800 - 300 190,800
221 Etakridin ( Rivanol ) larutan 0,1 % botol 10 11,103 10 111,034 - 10 111,034
222 Etambutol Hcl tablet 250 mg tablet - 186 - - - -
223 Famotidin 40 mg tablet tablet - 192 - - - -
224 Fenitoin natrium inj 50 mg / ml ampul - 11,856 - - - -
225 Fenitoin natrium kapsul 100 mg kapsul - 158 - - - -
226 Fenobarbital tablet 100 mg tablet - 127 - - - -
227 Fenofibrat kaps 100 mg tablet 300 1,191 300 357,291 - 300 357,291
228 Fenol gliserol tetes telinga 10 % botol 50 2,764 50 138,200 - 50 138,200
229 Flukonazol tab 150 mg tablet - 21,528 - - - -
230 Fluor tablet 0,5 mg tablet - 33 - - - -
231 Fucilex ointment (natrium fusidat) tube - 4,889 - - - -
232 Fungasol 2 % botol - 24,200 - - - -
233 Fuson ointment tube - 7,500 - - - -
234 Gemfibrozil 300 mg tablet 1,000 436 1,000 436,370 - 1,000 436,370
235 Gentamisin salep kulit tube 200 2,572 200 514,360 - 200 514,360
236 Gentamisin salep mata tube 50 3,075 50 153,750 - 50 153,750
237 Gentamisin Tetes mata botol 150 4,885 150 732,750 - 150 732,750
238 Gentian violet larutan 1 % pot 100 3,258 100 325,820 - 100 325,820
239 Glimepirid tab 2 mg tablet - 207 - - - -
Page 16 of 37
2022 PENGADAAN
240 Gliseril guayakolat tablet 100 mg tablet 6,000 167 6,000 999,240 - 6,000 999,240
241 Gliserin larutan 50% botol - 5,867 - - - -
242 Glukosa larutan infus 10 % steril botol - 8,003 - - - -
245 Glukosamin 250 mg tablet (osmin) tablet 800 949 800 758,912 - 800 758,912
246 H.Booster sirup botol 50 14,168 50 708,400 - 50 708,400
247 Haloperidol tablet 1,5 mg tablet - 59 - - - -
248 Hemafort tablet tablet 20,000 920 20,000 18,409,600 - 20,000 18,409,600
249 HEXADOL (Larutan Hexetidine) botol 100 20,752 100 2,075,150 - 100 2,075,150
250 Hidrokortison krim 1% tube - 10,724 - - - -
251 Hyorex 10 mg tablet tablet - 405 - - - -
252 Hyoscine N Butilbromida 10 mg tabl tablet - 1,626 - - - -
253 Ibuprofen syr 100 mg/5ml botol - 4,522 - - - -
254 Ichtyol salep tube - 6,200 - - - -
255 Inhitril 10 mg tablet - 385 - - - -
256 Inhitril 5 mg tablet - 660 - - - -
257 Interhistin tablet tablet - 984 - - - -
258 Irbesartan tab 150 mg tablet - 425 - - - -
259 Kalsium laktat ( Kalk ) tablet 500 mg tablet 7,000 63 7,000 441,000 - 7,000 441,000
260 Kandesartan 8 mg tablet tablet 1,500 629 1,500 943,500 - 1,500 943,500
261 Kandesartan 16 mg tablet tablet 3,000 998 3,000 2,994,000 - 3,000 2,994,000
262 Kandistatin drops (nistatin 100.000I botol 50 36,300 50 1,815,000 - 50 1,815,000
263 Kaptopril 12,5 mg tablet tablet - 69 - - - -
264 Kaptopril 50 mg tablet tablet - 135 - - - -
265 Ketokonazol Krim tube 100 2,577 100 257,700 - 100 257,700
266 Ketoprofen 100 mg tablet tablet - 1,366 - - - -
267 Klindamisin 150 mg tablet tablet - 803 - - - -
268 Klobazam 10 mg tablet tablet 200 916 200 183,200 - 200 183,200
269 Klonidin 0,15 mg tablet tablet - 224 - - - -
270 Kloramfenikol tetes telinga 3 % botol 200 8,894 200 1,778,700 - 200 1,778,700
271 Klorpromazin Hcl inj 25 mg / ml - 12 ampul - 1,243 - - - -
272 Klorpromazin Hcl tablet salut 25 mg tablet - 252 - - - -
273 Klozapin 25 mg tablet tablet - 1,121 - - - -
274 Kodein tablet 15 mg tablet - 728 - - - -
275 Kodein tablet 20 mg tablet - 1,494 - - - -
276 Kombinasi pirimetamin 25 mg / sul tablet - 380 - - - -
277 Kombipak Azitromycin-Cefixim paket - 44,550 - - - -
278 Kotrimoksazol DOEN II (pedriatik) ta tablet - 79 - - - -
279 Lanzoprazol tablet 8,000 352 8,000 2,816,000 - 8,000 2,816,000
280 Lapalos Cream tube 50 14,300 50 715,000 - 50 715,000
281 Laxadine emulsi botol - 41,250 - - - -
282 L-Bio sachet sachet 200 5,775 200 1,155,000 - 200 1,155,000
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2022 PENGADAAN
283 Lanzoprazol tablet - 86,000 - - - - -
284 Lapalos Cream tube - 14,304 - - - -
285 Levofloksasin tab 500 mg tablet - 479 - - - -
286 Lexapram sirup botol - 2,900 - - - -
287 Lidocain jeli 2 % (Xylocaine Jelly 2%) syringe - 40,000 - - - -
288 Lincomisin 500 mg tablet - 1,601 - - - -
289 Lisinopril 10 mg tablet tablet - 341 - - - -
290 Lisinopril 5 mg tablet tablet - 250 - - - -
291 Lisol botol - 45,100 - - - -
292 Livertran salep tube 30 4,600 30 138,000 - 30 138,000
293 Longatin 25 mg tablet 1,000 3,320 1,000 3,320,240 - 1,000 3,320,240
294 Loperamida tablet tablet 800 85 800 68,000 - 800 68,000
295 Lorazepam (Merlopam) 2 mg tablet tablet - 995 - - - -
296 Lytacur botol 60ml botol - 16,500 - - - -
297 MDT Combi* paket - 41,240 - - - -
298 Mebendazol sirup 100 mg / 5 ml botol - 957 - - - -
299 Meloxikam 15 mg tablet tablet 5,000 540 5,000 2,697,695 - 5,000 2,697,695
300 Meloxikam 7,5 mg tablet tablet 5,000 448 5,000 2,241,140 - 5,000 2,241,140
301 Mersibion injeksi ampul - 6,000.0 - - - -
302 Metoklorpropamid sirup botol - 16,500 - - - -
303 Metronidazol infus 500 mg/100 ml botol - 8,250 - - - -
304 Metronidazol supp 500 mg (Flagyl s supp - 3,655 - - - -
305 Metronidazol sirup botol - 3,950 - - - -
306 Miniaspi 80 mg tablet 100 105 100 10,500 - 100 10,500
307 Misoprostol 200 mg (gastrul) tablet - 13,044 - - - -
308 Mixaria sachet - 1,260 - - - -
309 Moksifloksasin tetes mata 0,5% (Vi botol - 81,000 - - - -
310 Mometason furoat krim 0,1 % tube - 8,437 - - - -
311 Natrium klorida larutan infus 0,9 % s botol 30 6,840 30 205,200 - 30 205,200
312 Neo Diaform tablet 2,000 273 2,000 545,468 - 2,000 545,468
313 Neurodex tablet tablet 500 495 500 247,500 - 500 247,500
314 New Diatabs tablet - 557 - - - -
315 Nistatin 500.000 iu /g tablet salut tablet - 910 - - - -
316 Nitral (gliseril trinitras sublingual 0 tablet - 1,400 - - - -
317 Nopres 20 mg tablet tablet - 4,565 - - - -
318 Norages Injeksi ampul - 7,700 - - - -
319 novadium tablet - 200 - - - -
320 Novastan sirup botol - 8,800 - - - -
321 Noza tablet tablet 300 880 300 264,000 - 300 264,000
322 Obat antituberkulosis kat.3* paket - 154,000 - - - -
323 Obat antituberkulosis kat.sisipan* paket - 160,000 - - - -
324 Obat Batuk Hitam ( OBH ) cairan botol 400 4,733 400 1,893,320 - 400 1,893,320
325 Obat suntik KB I (3 bulan) ampul - 7,175 - - - -
Page 18 of 37
2022 PENGADAAN
326 Obat suntik KB II (1 bulan) ampul - 6,342 - - - -
327 Ofloksasin tab 400 mg tablet 500 700 500 350,000 - 500 350,000
Oksimetazolin tts hidung 0,025% - - - - -
328 (Iliadin drops) botol 60,229
329 Oksitetrasiklin Hcl salep kulit 3 % tube 150 2,230 150 334,455 - 150 334,455
330 Ondansetron inj 4 mg/2ml ampul - 1,258 - - - -
331 Ondansetron tab 4 mg tablet 200 429 200 85,800 - 200 85,800
332 Optiflox tetes mata botol - 14,005 - - - -
333 Pamol supp supp - 15,178 - - - -
334 Pantocain 0,5 % TM botol - 17,500 - - - -
335 Papaverin 40 mg tablet tablet 1,000 660 1,000 660,000 - 1,000 660,000
336 Parasetamol Drop 100 mg/ml botol 300 7,646 300 2,293,800 - 300 2,293,800
337 Pedialyte botol - 32,287 - - - -
338 Pehacain injeksi ampul - 3,381 - - - -
339 Pil KB I tablet - 1,350 - - - -
340 Pil KB II / Laktasi tablet - 11,062 - - - -
341 Pim-Tra-Kol sirup botol 300 11,296 200 2,259,180 - 200 2,259,180
342 Pirazinamid tab 500 mg tablet - 238 - - - -
343 Piroksikam 10 mg tablet tablet - 244 - - - -
344 Piroksikam 20 mg tablet tablet - 316 - - - -
345 Polikresulen botol - 43,976 - - - -
346 Povidon Iodida larutan 10 % 30 ml botol - 5,929 - - - -
347 Povidon Iodida larutan 10 % 300 ml botol - 14,350 - - - -
348 Povidon Iodida Larutan 1000 ml botol - 66,000 - - - -
349 Povidon Iodida Larutan 60 ml botol 20 6,772 20 135,432 - 20 135,432
350 PP Isoniazide 100 mg* tablet - 282 - - - -
351 Prazikuantel tablet 600 mg tablet - 2,295 - - - -
352 Prenatin DF tablet tablet - 3,300 - - - -
353 Primolut N tablet - 2,618 - - - -
354 Protofen supp supp - 2,380 - - - -
355 Protofen tablet tablet - 880 - - - -
356 Pularex tablet tablet - 187 - - - -
357 Pulmicort respules ampul - 9,725 - - - -
358 Pulmicort turbuhaler kotak - 101,000 - - - -
359 Ramabion tab tablet - 6,490 - - - -
360 Ranitidin inj 25mg/2ml ampul - 1,188 - - - -
361 Recovit sirup botol - 8,650 - - - -
362 Reserpin tablet 0,25 mg tablet - 114 - - - -
363 Rifampisin kaplet 600 mg tablet - 1,209 - - - -
364 Rifampisin kapsul 300 mg tablet - 670 - - - -
365 Rifampisin kapsul 450 mg tablet - 868 - - - -
366 Ringer laktat larutan infus steril botol - 7,630 - - - -
367 Risperidon 2 mg tab tablet - 287 - - - -
Page 19 of 37
2022 PENGADAAN
368 Salisil bedak 2 % kotak 300 6,927 300 2,078,010 - 300 2,078,010
369 Sandepril 50 mg tablet - 8,250 - - - -
370 Sangobion kids drop botol - 35,000 - - - -
371 Sangobion Kids Sirup botol 40 29,645 40 1,185,800 - 40 1,185,800
372 Scabicid cream 10 gram tube - 11,475 - - - -
373 Scabimite cream 10 gram tube 200 50,397 100 5,039,650 - 100 5,039,650
374 Scopma tablet tablet 1,000 1,418 1,000 1,417,614 - 1,000 1,417,614
375 Sefaleksin kapsul 500 mg kapsul - 717 - - - -
376 Sefiksim kapsul 100 mg kapsul - 2,668 - - - -
377 Sefiksim syr kering 100mg/5ml botol - 32,577 - - - -
378 Seretide Inhaler 50 mcg kotak - 58,000 - - - -
379 Serum anti bisa ular polivalen inj 5 m vial - 512,204 - - - -
380 Serum anti bisa ular polivalen inj 50 vial - 28,468,086 - - - -
381 Serum anti defteri inj 1000 mg / vial vial - 2,200,000 - - - -
382 Serum anti tetanus inj 1.500 IU / am ampul - 130,999 - - - -
383 Serum anti tetanus inj 20.000 IU / a ampul - 604,670 - - - -
384 Setirizin sirup 5 mg/ml botol 400 3,061 400 1,224,400 - 400 1,224,400
385 Setirizine tablet 10 mg tablet 15,000 104 15,000 1,560,000 - 15,000 1,560,000
386 Simetidin tablet tablet - 330 - - - -
387 Simpastatin 20 mg tablet tablet 1,000 225 1,000 225,000 - 1,000 225,000
388 Sohobion tablet tablet 3,000 2,200 3,000 6,600,000 - 3,000 6,600,000
389 Spiramisin 500 mg tablet tablet - 1,223 - - - -
390 Spironolakton tab 25 mg tablet 100 226 100 22,600 - 100 22,600
391 Stesolid rectal 5 mg supp - 14,459 - - - -
392 Stimuno Forte tablet tablet - 2,668 - - - -
393 Stimuno Sirup botol - 27,500 - - - -
394 Sucralfate 500 mg/5 ml suspensi botol - 7,338 - - - -
395 Sulfasetamid natrium tetes mata 15 botol - 8,500 - - - -
396 Susuk KB II set - 213,937 - - - -
397 Symbicort turbuhaler 160/4.5 mg kotak - 134,284 - - - -
398 Symbicort turbuhaler 80/4.5 mg kotak - 121,000 - - - -
399 Synarcus krim tube - 2,534 - - - -
400 Taburia sachet - 888 - - - -
401 Tanapress 5 mg (imidapril ) tablet - 2,530 - - - -
402 Tensigard tablet tablet - 2,293 - - - -
403 Terra Flu tablet tablet 1,000 807 1,000 807,000 - 1,000 807,000
404 Tetagam ampul - 188,663 - - - -
405 Thiamfenicol 500 mg kapsul kapsul 300 2,600 300 780,000 - 300 780,000
406 Thiamin Hcl ( Vit B1 ) inj.100 mg / ml ampul - 730 - - - -
407 Thrombophob gel tube 20 58,697 20 1,173,942 - 20 1,173,942
Page 20 of 37
2022 PENGADAAN
408 Timolol tetes mata 0,5% botol - 10,286 - - - -

409 Tramadol 50 mg kapsul kapsul - 580 - - - -
410 Tramadol inj 50 mg/ml ampul - 1,882 - - - -
411 Triflouperazin 5mg tablet tablet - 330 - - - -
412 Truvit drops botol - 32,253 - - - -
413 Truvit sirup botol 50 18,973 50 948,640 - 50 948,640
414 Ulsafate sirup botol 500 7,338 500 3,669,000 - 500 3,669,000
415 Ulsidex tablet tablet - 296 - - - -
416 Urea krim (Soft U derm) botol - 7,040 - - - -
417 Urotractin (asam pipemidat) 400 m tablet - 3,866 - - - -
418 Vagizol ovula (metronidazol ovula) ovula - 3,590 - - - -
419 valisanbe 2 mg tablet - 236 - - - -
420 Valsartan tab 80 mg (Diovan 80mg) tablet - 3,900 - - - -
421 Vastral tablet 1,000 605 1000 605,000 - 1,000 605,000
422 Ventolin inhaler kotak - 60,000 - - - -
423 Ventolin Nebulizer ampul 20 11,191 20 223,817 - 20 223,817
Page 21 of 37

TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL PREDIKSI PREDIKSI SISA RENCANA USULAN
SISA STOK SISA STOK STOK OBAT RATA2/BULAN RATA2/BULAN PEMAKAIAN PENERIMAAN STOK PER KEBUTUHAN PENGADAAN
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN RATA2 / HARGA OBAT PROYEKSI PENGADAAN
PER 31 OKT OBAT APBD OBAT JKN NOV & DES DESEMBER OBAT GIGI 2022
31 OKT 2021 31 OKT 2021 BULAN
2021 2021 2021 TAHUN 2022 (PEMBULATAN)
APBD
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14 15
B OBAT GIGI
1 Achatit/Fuji II kotak 0 1 1 -2 20 3 Rp 459,910.00 3

2 acid etching kotak 0 1 1 -2 20 3 Rp 231,000.00 3
3 Air raksa dental use botol 0 0 0 - Rp 437,500.00 -
4 Alveogyl kotak 0 0 0 - Rp 951,049.00 -
5 Aplicator kotak 0 0 0 - Rp 82,500.00 -
6 Arsenic Pasta 10 gr/pot 0 0 0 - Rp 942,040.00 -
7 Articulating paper kotak 0 0 0 - Rp 263,538.00 -
8 Bond strenght kotak 0 0 0 - 3 Rp 359,370.00 3
9 Caviton kotak 0 1 1 2 -4 40 6 Rp 207,537.00 6
10 Citodur (Bahan tambalan sementara) kotak 0 0 0 - Rp 200,200.00 -
11 Cotton pelet pack 0 2 2 -4 40 Rp 38,500.00 -
12 Cotton roll pack 0 2 2 -4 40 4 Rp 82,500.00 4
13 Cresofen / endoseptone pack 0 0 0 - Rp 473,000.00 -
14 Dental floss kotak 0 1 1 -2 20 Rp 82,500.00 -
15 Dentin conditioning kotak 0 1 1 -2 20 3 Rp 366,465.00 3
16 Devitalisasi pasta (non arsen) / D.Pulp botol 0 0 0 - Rp 752,400.00 -
17 Devitalisasi pasta (non arsen) / Devitec kotak 0 0 0 - Rp 995,967.50 -
Dysclosing agent / Disclosing gel (GC tri 0 0 0 - -
18 plaque ID Gel) botol Rp 361,570.00
19 Ethyl klorida semprot botol 0 2 1 3 -6 60 6 Rp 143,000.00 6
20 Eugenol cairan botol 0 0 0 - 3 Rp 136,400.00 3
21 Flour sediaan topical botol 0 0 0 - Rp 165,000.00 -
22 Formokresol botol 0 1 1 -2 20 3 Rp 239,580.00 3
23 G aenial bond kotak 0 0 0 - Rp 875,578.00 -
24 Glass Ionomer cemen ( GC IX ) kotak 0 0 0 - 3 Rp 957,000.00 3
25 Glass Ionomer cemen / ketakmolar kotak 0 0 0 - Rp 880,000.00 -
26 Glass Ionomer Light cured Universal restorati kotak 0 0 0 - Rp 363,000.00 -
27 Gutta perchha point 15-40 mm kotak 0 0 0 - Rp 51,700.00 -
28 Gutta perchha point 45-80 mm kotak 0 0 0 - Rp 50,000.00 -
29 Jarum Dental cytoject pcs 0 0 0 - Rp 2,640.00 -
30 Kalsium hidroksida pasta kotak 0 1 1 -2 20 1 Rp 239,580.00 1
TOTAL
TOTAL SISA PEMAKAIAN PEMAKAIAN PREDIKSI PREDIKSI SISA RENCANA USULAN
SISA STOK SISA STOK PEMAKAIAN
STOK OBAT RATA2/BULAN RATA2/BULAN PENERIMAAN STOK PER KEBUTUHAN PENGADAAN
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN PER 31 OKT OBAT APBD OBAT JKN RATA2 / NOV & DES DESEMBER OBAT GIGI 2022 HARGA OBAT PROYEKSI PENGADAAN
31 OKT 2021 31 OKT 2021 2021 BULAN 2021 2021 TAHUN 2022 (PEMBULATAN)
APBD
31 Marbalet/neocones botol 0 0 0 - Rp 750,000.00 -
32 Masker Gigi box 0 0 0 - Rp 34,650.00 -
33 Monoklorkamfer mentol cairan (camphenol) kotak 0 0 0 - Rp 55,000.00 -
34 Monoklorkamfer mentol cairan (CHKM) kotak 0 3 3 -6 60 2 Rp 149,820.00 2
35 Mummifying pasta kotak 0 0 0 - Rp 419,255.10 -
36 Oco Tooth Clensing botol 0 0 0 - Rp 209,627.00 -
37 Paper point 15-40 mm kotak 0 0 0 - Rp 47,300.00 -
38 Paper point 45-80 mm kotak 0 2 2 -4 40 Rp 47,300.00 -
39 Pasta pengisi saluran akar kotak 0 0 0 - Rp 906,125.00 -
40 Rockless kotak 0 0 0 - 3 Rp 1,135,200.00 3
41 Sarung tangan box 0 0 0 - 8 Rp 89,100.00 8
42 Scandonest kotak 0 0 0 - Rp 881,100.00 -
43 selang saliva eyector pack 0 0 0 - Rp 157,300.00 -
44 Semen seng fosfat serbuk dan cairan kotak 0 0 0 - Rp 239,580.00 -
45 Silver amalgam serbuk 65 - 75 % kotak 0 0 0 - Rp 937,500.00 -
46 Surgical ginggival pack (Coe Pak) kotak 0 0 0 - Rp 669,350.00 -
47 Tambalan sinar solare A2 kotak 0 0 0 - 4 Rp 329,450.00 4
48 Tambalan sinar solare A3 kotak 0 0 0 - 3 Rp 329,450.00 3
49 Tambalan sinar solare A3,5 kotak 0 0 0 - Rp 308,900.00 -
50 Tampon pack 0 5 5 -10 100 Rp 300,000.00 -
51 Temporary stopping fletcher serbuk dan cair set 0 6 6 -12 120 Rp 62,150.00 -
52 Topical anastesi pasta kotak 0 0 0 - 3 Rp 302,500.00 3
53 Trikesol Formalin ( TKF ) cairan botol 0 1 1 -2 20 3 Rp 179,685.00 3
54 Varnish box 0 0 0 - Rp 165,440.00 -
TOTAL
MENGETAHUI :
KEPALA PUSKESMAS PENGELOLA OBAT PUSKESMAS

TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL PREDIKSI PREDIKSI SISA RENCANA USULAN
SISA STOK SISA STOK STOK OBAT RATA2/BULAN RATA2/BULAN PEMAKAIAN PENERIMAAN STOK PER KEBUTUHAN PENGADAAN
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN RATA2 / HARGA OBAT PROYEKSI PENGADAAN
PER 31 OKT OBAT APBD OBAT JKN NOV & DES DESEMBER OBAT GIGI 2022
31 OKT 2021 31 OKT 2021 BULAN
2021 2021 2021 TAHUN 2022 (PEMBULATAN)
APBD total Rp APBD
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14 15 16 = 14 * 15
B OBAT GIGI
1 Achatit/Fuji II kotak 0 1 1 -2 20 3 Rp 459,910.00 3 1,379,730

2 acid etching kotak 0 1 1 -2 20 3 Rp 231,000.00 3 693,000
3 Air raksa dental use botol 0 0 0 - Rp 437,500.00 - -
4 Alveogyl kotak 0 0 0 - Rp 951,049.00 - -
5 Aplicator kotak 0 0 0 - Rp 82,500.00 - -
6 Arsenic Pasta 10 gr/pot 0 0 0 - Rp 942,040.00 - -
7 Articulating paper kotak 0 0 0 - Rp 263,538.00 - -
8 Bond strenght kotak 0 0 0 - 3 Rp 359,370.00 3 1,078,110
9 Caviton kotak 0 1 1 2 -4 40 6 Rp 207,537.00 6 1,245,222
10 Citodur (Bahan tambalan sementara) kotak 0 0 0 - Rp 200,200.00 - -
11 Cotton pelet pack 0 2 2 -4 40 Rp 38,500.00 - -
12 Cotton roll pack 0 2 2 -4 40 4 Rp 82,500.00 4 330,000
13 Cresofen / endoseptone pack 0 0 0 - Rp 473,000.00 - -
14 Dental floss kotak 0 1 1 -2 20 Rp 82,500.00 - -
15 Dentin conditioning kotak 0 1 1 -2 20 3 Rp 366,465.00 3 1,099,395
16 Devitalisasi pasta (non arsen) / D.Pulp botol 0 0 0 - Rp 752,400.00 - -
17 Devitalisasi pasta (non arsen) / Devitec kotak 0 0 0 - Rp 995,967.50 - -
Dysclosing agent / Disclosing gel (GC tri 0 0 0 - - -
18 plaque ID Gel) botol Rp 361,570.00
19 Ethyl klorida semprot botol 0 2 1 3 -6 60 6 Rp 143,000.00 6 858,000
20 Eugenol cairan botol 0 0 0 - 3 Rp 136,400.00 3 409,200
21 Flour sediaan topical botol 0 0 0 - Rp 165,000.00 - -
22 Formokresol botol 0 1 1 -2 20 3 Rp 239,580.00 3 718,740
23 G aenial bond kotak 0 0 0 - Rp 875,578.00 - -
24 Glass Ionomer cemen ( GC IX ) kotak 0 0 0 - 3 Rp 957,000.00 3 2,871,000
25 Glass Ionomer cemen / ketakmolar kotak 0 0 0 - Rp 880,000.00 - -
26 Glass Ionomer Light cured Universal restorati kotak 0 0 0 - Rp 363,000.00 - -
27 Gutta perchha point 15-40 mm kotak 0 0 0 - Rp 51,700.00 - -
28 Gutta perchha point 45-80 mm kotak 0 0 0 - Rp 50,000.00 - -
29 Jarum Dental cytoject pcs 0 0 0 - Rp 2,640.00 - -
30 Kalsium hidroksida pasta kotak 0 1 1 -2 20 1 Rp 239,580.00 1 239,580
TOTAL
TOTAL SISA PEMAKAIAN PEMAKAIAN PREDIKSI PREDIKSI SISA RENCANA USULAN
STOK OBAT RATA2/BULAN RATA2/BULAN PENERIMAAN STOK PER KEBUTUHAN PENGADAAN
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN PER 31 OKT OBAT APBD OBAT JKN RATA2 / NOV & DES DESEMBER OBAT GIGI 2022 HARGA OBAT PROYEKSI PENGADAAN
31 OKT 2021 31 OKT 2021 2021 BULAN 2021 2021 TAHUN 2022 (PEMBULATAN)
APBD total Rp APBD

31 Marbalet/neocones botol 0 0 0 - Rp 750,000.00 - -
32 Masker Gigi box 0 0 0 - Rp 34,650.00 - -
33 Monoklorkamfer mentol cairan (camphenol) kotak 0 0 0 - Rp 55,000.00 - -
34 Monoklorkamfer mentol cairan (CHKM) kotak 0 3 3 -6 60 2 Rp 149,820.00 2 299,640
35 Mummifying pasta kotak 0 0 0 - Rp 419,255.10 - -
36 Oco Tooth Clensing botol 0 0 0 - Rp 209,627.00 - -
37 Paper point 15-40 mm kotak 0 0 0 - Rp 47,300.00 - -
38 Paper point 45-80 mm kotak 0 2 2 -4 40 Rp 47,300.00 - -
39 Pasta pengisi saluran akar kotak 0 0 0 - Rp 906,125.00 - -
40 Rockless kotak 0 0 0 - 3 Rp 1,135,200.00 3 3,405,600
41 Sarung tangan box 0 0 0 - 8 Rp 89,100.00 8 712,800
42 Scandonest kotak 0 0 0 - Rp 881,100.00 - -
43 selang saliva eyector pack 0 0 0 - Rp 157,300.00 - -
44 Semen seng fosfat serbuk dan cairan kotak 0 0 0 - Rp 239,580.00 - -
45 Silver amalgam serbuk 65 - 75 % kotak 0 0 0 - Rp 937,500.00 - -
46 Surgical ginggival pack (Coe Pak) kotak 0 0 0 - Rp 669,350.00 - -
47 Tambalan sinar solare A2 kotak 0 0 0 - 4 Rp 329,450.00 4 1,317,800
48 Tambalan sinar solare A3 kotak 0 0 0 - 3 Rp 329,450.00 3 988,350
49 Tambalan sinar solare A3,5 kotak 0 0 0 - Rp 308,900.00 - -
50 Tampon pack 0 5 5 -10 100 Rp 300,000.00 - -
51 Temporary stopping fletcher serbuk dan cair set 0 6 6 -12 120 Rp 62,150.00 - -
52 Topical anastesi pasta kotak 0 0 0 - 3 Rp 302,500.00 3 907,500
53 Trikesol Formalin ( TKF ) cairan botol 0 1 1 -2 20 3 Rp 179,685.00 3 539,055
54 Varnish box 0 0 0 - Rp 165,440.00 - -
TOTAL 19,092,722
MENGETAHUI :
KEPALA PUSKESMAS PENGELOLA OBAT PUSKESMAS
RENCANA KEBUTUHAN BMHP TAHUN 2022

TOTAL
SISA STOK SISA STOK TOTAL SISA PEMAKAIAN PEMAKAIAN PEMAKAIAN 1PREDIKSI PREDIKSI SISA
STOK BMHP RATA2/BULAN RATA2/BULAN PENERIMAAN STOK PER
NO NAMA OBAT SATUAN BMHP APBD BMHP JKN RATA2 /
PER 31 OKT BMHP APBD BMHP JKN NOV & DES DESEMBER
31 OKT 2021 31 OKT 2021 BULAN
2021 2021 2021
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2)

C BMHP
1 Alat suntik sekali pakai 1 ml pcs 400 400 40 40 320
2 Alat suntik sekali pakai 10 ml pcs 0 0 0 0
3 Alat suntik sekali pakai 2,5 ml pcs 0 10 10 -20
6 Albothyl botol 0 0 0
7 Alkohol Swab lembar 0 547 547 -1094
8 Bioplacenton tulle pcs 0 0 0 0
9 Bistruri/scalpel balde No 10 pcs 0 0 0 0
10 Bistruri/scalpel balde No 11 pcs 0 0 0 0
11 Bisturi/scalpel balde No 15 pcs 0 0 0 0
12 Blood Lancet pcs 800 800 30 30 740
13 Blood transfusion set pcs 0 0 0 0
14 Blue Tip pack 7 7 20 20 -33
15 Box slide TB kotak 0 1 1 -2
16 canula dewasa pcs 0 0 0 0
17 Cat Gut chromic No 1 pcs 0 0 0 0
18 Catgut/benang bedah no 2/0 chronic pcs 0 0 0 0
19 Catgut/benang bedah no 2/0 plain pcs 0 0 0 0
20 Catgut/benang bedah no 3/0 chronic pcs 0 0 0 0
21 Catgut/benang bedah no 3/0 plain pcs 0 0 0 0
22 Celulid strip pcs 0 0 0
23 Cetride 5 Liter galon 0 0 0 0
24 Clorheksidin 2,5 % botol 0 0 0 0
25 Coverplast pcs 0 0 0 0
26 Deck glass / objek glass 20 x 20 mm pack 2 2 0 0 2
27 Deck glass / objek glass 22 x 22 mm pack 0 0 0 0
28 Deck gelas / objek glass 24 x 24 mm pack 0 0 0 0
29 Disposibel vagina speculum pcs 0 0 0 0
30 D-Pierce X12 box 0 0 0
31 ECG 112 mm x 30 mm x 16 mm roll 0 0 0 0
32 ECG 58 mm x 25 mm x 16 mm roll 0 0 0 0
33 Film Rontgen 24 x 30 cm lembar 0 0 0 0
36 Fixomull pcs 3 3 0 0 3
37 Foley cateter no 16 pcs 0 0 0 0
38 Foley cateter no 18 pcs 0 1 1 -2
39 Fukuda M.E.ECG Paper pcs 0 0 0 0
40 handiplast pcs 0 0 0 0
41 Holder tube vacutainer pcs 0 0 0 0
42 Hypafix uk. Kecil 5 cm x 5 m pcs 0 1 1 -2
43 IUD set 0 0 0 0
44 Infusiun set anak pcs 5 5 0 0 5
45 Infusiun set dewasa pcs 6 6 0 0 6
46 IV Catheter no 18 G pcs 0 0 0 0
47 IV Catheter no 20 G pcs 0 0 0 0
48 IV Catheter no 22 G pcs 0 1 1 -2
49 IV Catheter no 24 G pcs 4 4 1 1 2
50 Jarum (Needle) no 23 pcs 200 200 0 0 200
51 Jarum (Needle) no 25 pcs 100 100 30 30 40
52 Jarum Jahit kulit no 10 GT pack 0 0 0 0
53 Jarum Jahit Kulit No 11 GT pack 0 0 0 0
54 Jarum Jahit kulit no 12 GT pack 0 0 0 0
57 jarum K-File no 15-40 kotak 0 0 0 0
60 Jelly (Aquagel) botol 0 0 0 0
61 kantongan plastik pack 0 0 0 0
62 Kapas berlemak 500 mg roll 0 0 0 0
63 Kapas pembalut / absorben 250 mg roll 4 4 1 1 2
64 Kasa kompres 40 / 40 steril pcs 0 1 1 -2
65 Kasa pembalut 2 m x80 cm pcs 0 2 2 -4
66 Kasa pembalut hidrofil 4m x 15 cm pcs 9 9 1 1 7
67 Kasa pembalut hidrofil 4m x 3 cm pcs 0 0 0 0
68 Kasa steril 16 cm x 16 cm box 13 13 2 2 9
69 Kertas EKG (uk 80 x 90 x 280) lembar 0 0 0 0
70 Kertas Puyer lembar 49373 49373 0 0 49373
71 Kertas Thermal roll 0 0 0 0
72 kertas thermal 50 mm x 57 mm roll 0 0 0 0
73 Kertas thermal mindray 50mm x 50 mm roll 0 0 0 0
74 Kertas thermal mindray 80 x 50 roll 0 0 0 0
75 Kertas thermal mindray 80 x 80 roll 0 0 0 0
76 Klorin botol 0 0 0 0
77 Kondom pcs 0 0 0 0
78 Larutan antiseptik (Aseptan) botol 0 0 0 0
79 Lidi Kapas/cotton swab pcs 0 10 10 -20
80 Markerpen pcs 0 0 0 0
81 Masker N 95 3M 1860 pcs 4 4 0 0 4
82 Masker N 95 3M 1860S pcs 0 0 0 0
83 Masker N 95 3M 1870 pcs 0 0 0 0
84 masker nebule dewasa pcs 0 0 0 0
85 masker oksigen anak pcs 0 0 0 0
86 masker oksigen dewasa pcs 0 0 0 0
87 Mata Bor high speed pack 0 0 0 0
88 Microtube 1,5 cc pack 0 0 0 0
89 Minyak handpiece 500 ml botol 0 0 0 0
90 Mouthpiece sterilbreath 250s box 0 0 0 0
91 NaOcl 2,5 % untuk sal irigasi botol 0 0 0 0
92 Needle flashback pcs 0 0 0 0
93 Obyek glass* biasa pack 5 5 0 0 5
94 Open akses bur pcs 0 0 0 0
95 Pembalut gips pcs 0 0 0 0
96 Penjepit tali pusat pcs 0 0 0 0
97 Pharmafix pcs 0 0 0 0
98 pipet ESR citotes pcs 0 0 0 0
99 Plastik klip sedang pack/100s 0 1 1 -2
100 Plastik Obat kecil (uk. 8 cm x 5 cm) pack 100 100 0 0 100
101 Plastik Obat pembungkus puyer (uk. Besar) pack 0 1 1 -2
102 Plester (hansaplast 5 cm x 4,5 m) pcs 0 0 0 0
103 Plesterin pcs 0 0 0 0
104 Pot Sputum pcs 0 40 40 -80
105 safety box* pcs 0 1 1 -2
106 sealing wax pcs 0 0 0 0
107 Serum gel tes tube 5 ml / tabung gel & cloat activ pcs 0 80 80 -160
108 Silk ( benang bedah sutra ) no.3/0 pcs 0 0 0 0
109 silk no 2/0 pcs 0 1 1 -2
110 Spon gelatin cubicle 1 x 1 x 1 cm pcs 0 0 0 0
111 Spuit 0,05 ml pcs 158 158 10 10 138
112 Spuit 0,5 ml pcs 500 500 530 530 -560
113 Steril Pouch 9 x 26 cm kotak 0 0 0 0
114 Suction tips pack 0 0 0 0
115 Surflo No 18 pcs 0 0 0 0
116 Surflo No 20 pcs 0 0 0 0
117 Surflo No 22 pcs 5 5 0 0 5
118 Surflo No 24 pcs 0 0 0 0
119 Surgical Glove No 6,5 pcs 0 0 0 0
120 Surgical Glove No 8 pcs 0 0 0 0
121 Surgical Glove obsgyn / gynecolog No 6,5 pcs 0 1 1 -2

122 Surgical Glove obsgyn / gynecolog No 7 pcs 0 0 0 0
123 Surgical Gloves non steril uk L pcs 500 500 20 20 460
SEHATAN KOTA BANJARMASIN
KEBUTUHAN BMHP TAHUN 2022

USKESMAS : S.PARMAN
RENCANA USULAN
KEBUTUHAN PENGADAAN
BMHP TAHUN 2022
2022 (PEMBULATAN)
12 = (9 * 18)- 11 13
400 1,200
- 100
200
(300) 600
98 600
-
10,940
-
-
-
-
(200) 900
-
393 5
20 7
-
-
-
-
-
-
-
-
-
- 1200
(2) 3
-
-
-
-
-
-
-
-
-
(3) 20
-
20
-
- 600
-
20
- 3
(5)
(6)
-
-
20
16
(200) 500
500 500
-
-
-
-
-
-
-
-
-
-
-
16
20
40
11
-
27 100
-
(49,373)
-
-
-
-
-
-
-
- 5
200
-
(4) 120
-
-
-
-
-
-
- 5
-
-
-
-
(5) 5
-
-
-
-
-
20
(100)
20
-
-
800 400
20 15
-
1,600
-
20
-
42
10,100 1000
-
-
-
-
(5)
-
-
-
20
-
(100) 2000
RENCANA KEBUTUHAN BMHP TAHUN 2022

USULAN TOTAL
NO NAMA BMHP SATUAN PENGADAAN HARGA BMHP PROYEKSI PENGADAAN PENGADAAN TOTAL RUPIAH
2022

1 2 3 4 5 6 7=5*6 8 9= 5*8 10 = 6 + 8 11 = 5 * 10
C BMHP
1 Alat suntik sekali pakai 1 ml pcs 1,200 930 1,200 1,116,000 - 1,200 1,116,000
2 Alat suntik sekali pakai 10 ml pcs 100 1,463 100 146,300 - 100 146,300
3 Alat suntik sekali pakai 2,5 ml pcs - 605 - - - - -
4 Alat suntik sekali pakai 3 ml pcs 600 920 600 552,000 - 600 552,000
5 Alat suntik sekali pakai 5 ml pcs 600 1,600 600 960,000 - 600 960,000
6 Albothyl botol - 45,000 - - - - -
7 Alkohol Swab lembar - 126 - - - - -
8 Bioplacenton tulle pcs - 10,920 - - - - -
9 Bistruri/scalpel balde No 10 pcs - 3,069 - - - - -
10 Bistruri/scalpel balde No 11 pcs - 3,069 - - - - -
11 Bisturi/scalpel balde No 15 pcs - 2,790 - - - - -
12 Blood Lancet pcs 900 176 900 158,400 - 900 158,400
13 Blood transfusion set pcs - 3,780 - - - - -
14 Blue Tip pack 5 45,685 5 228,425 - 5 228,425
15 Box slide TB kotak 7 73,340 7 513,380 - 7 513,380
16 canula dewasa pcs - 1 - - - - -
17 Cat Gut chromic No 1 pcs - 1 - - - - -
18 Catgut/benang bedah no 2/0 chronic pcs - 5,863 - - - - -
19 Catgut/benang bedah no 2/0 plain pcs - 5,863 - - - - -
20 Catgut/benang bedah no 3/0 chronic pcs - 5,863 - - - - -
21 Catgut/benang bedah no 3/0 plain pcs - 5,863 - - - - -
22 Celulid strip pcs - 73,700 - - - - -
23 Cetride 5 Liter galon - 774,972 - - - - -
24 Clorheksidin 2,5 % botol - 618,750 - - - - -
25 Coverplast pcs 1,200 825 1,200 990,000 - 1,200 990,000
26 Deck glass / objek glass 20 x 20 mm pack 3 48,000 3 144,000 - 3 144,000
27 Deck glass / objek glass 22 x 22 mm pack - 52,300 - - - - -
28 Deck gelas / objek glass 24 x 24 mm pack - 48,000 - - - - -
29 Disposibel vagina speculum pcs - 7,500 - - - - -
30 D-Pierce X12 box - 817,455 - - - - -
31 ECG 112 mm x 30 mm x 16 mm roll - 92,666 - - - - -
32 ECG 58 mm x 25 mm x 16 mm roll - 55,325 - - - - -
33 Film Rontgen 24 x 30 cm lembar - 4,970 - - - - -
36 Fixomull pcs 20 42,800 20 856,000 - 20 856,000
37 Foley cateter no 16 pcs - 11,890 - - - - -
38 Foley cateter no 18 pcs - 12,520 - - - - -
39 Fukuda M.E.ECG Paper pcs - 56,567 - - - - -
40 handiplast pcs 600 385 600 231,000 - 600 231,000
41 Holder tube vacutainer pcs - 6,940 - - - - -
42 Hypafix uk. Kecil 5 cm x 5 m pcs - 98,900 - - - - -
43 IUD set 3 11,800 3 35,400 - 3 35,400
44 Infusiun set anak pcs - 2,970 - - - - -
45 Infusiun set dewasa pcs - 3,360 - - - - -
46 IV Catheter no 18 G pcs - 3,990 - - - - -
50 Jarum (Needle) no 23 pcs 500 254 500 127,000 - 500 127,000
51 Jarum (Needle) no 25 pcs 500 825 500 412,500 - 500 412,500
52 Jarum Jahit kulit no 10 GT pack - 38,000 - - - - -
53 Jarum Jahit Kulit No 11 GT pack - 32,500 - - - - -
54 Jarum Jahit kulit no 12 GT pack - 38,000 - - - - -
57 jarum K-File no 15-40 kotak - 173,177 - - - - -
60 Jelly (Aquagel) botol - 32,500 - - - - -
61 kantongan plastik pack - 3,100 - - - - -
62 Kapas berlemak 500 mg roll - 21,533 - - - - -
63 Kapas pembalut / absorben 250 mg roll - 25,159 - - - - -
64 Kasa kompres 40 / 40 steril pcs - 3,300 - - - - -
65 Kasa pembalut 2 m x80 cm pcs - 8,085 - - - - -
66 Kasa pembalut hidrofil 4m x 15 cm pcs - 2,200 - - - - -
67 Kasa pembalut hidrofil 4m x 3 cm pcs - 620 - - - - -
68 Kasa steril 16 cm x 16 cm box 100 6,300 100 630,000 - 100 630,000
69 Kertas EKG (uk 80 x 90 x 280) lembar - 106,250 - - - - -
70 Kertas Puyer lembar - 90 - - - - -
71 Kertas Thermal roll - 94,500 - - - - -
72 kertas thermal 50 mm x 57 mm roll - 18,200 - - - - -
73 Kertas thermal mindray 50mm x 50 mm roll - 76,500 - - - - -
74 Kertas thermal mindray 80 x 50 roll - 24,250 - - - - -
75 Kertas thermal mindray 80 x 80 roll - 27,550 - - - - -
76 Klorin botol - 15,970 - - - - -
77 Kondom pcs - 717 - - - - -
78 Larutan antiseptik (Aseptan) botol 5 40,230 5 201,150 - 5 201,150
79 Lidi Kapas/cotton swab pcs - 1,000 - - - - -
80 Markerpen pcs - 1 - - - - -
81 Masker N 95 3M 1860 pcs 120 71,500 120 8,580,000 - 120 8,580,000
82 Masker N 95 3M 1860S pcs - 19,500 - - - - -
83 Masker N 95 3M 1870 pcs - 432,000 - - - - -
84 masker nebule dewasa pcs - 20,429 - - - - -
85 masker oksigen anak pcs - 19,800 - - - - -
86 masker oksigen dewasa pcs - 19,800 - - - - -
87 Mata Bor high speed pack - 154,000 - - - - -
88 Microtube 1,5 cc pack 5 245,000 5 1,225,000 - 5 1,225,000
89 Minyak handpiece 500 ml botol - 561,000 - - - - -
90 Mouthpiece sterilbreath 250s box - 1,131,900 - - - - -
91 NaOcl 2,5 % untuk sal irigasi botol - 123,200 - - - - -
92 Needle flashback pcs - 2,900 - - - - -
93 Obyek glass* biasa pack 5 22,097 5 110,485 - 5 110,485
94 Open akses bur pcs - 135,300 - - - - -
95 Pembalut gips pcs - 55,000 - - - - -
96 Penjepit tali pusat pcs - 2,200 - - - - -
97 Pharmafix pcs - 27,000 - - - - -
98 pipet ESR citotes pcs - 6,600 - - - - -
99 Plastik klip sedang pack/100s - 5,000 - - - - -
100 Plastik Obat kecil (uk. 8 cm x 5 cm) pack - 17,000 - - - - -
101 Plastik Obat pembungkus puyer (uk. Besar) pack - 7,100 - - - - -
102 Plester (hansaplast 5 cm x 4,5 m) pcs - 12,000 0 - - - -
103 Plesterin pcs - 185 0 - - - -
104 Pot Sputum pcs 400 23,790 400 9,516,000 - 400 9,516,000
105 safety box* pcs 15 23,902 15 358,530 - 15 358,530
106 sealing wax pcs - 164,000 0 - - - -
107 Serum gel tes tube 5 ml / tabung gel & cloat pcs - 1,980 0 - - - -
108 Silk ( benang bedah sutra ) no.3/0 pcs - 3,208 0 - - - -
109 silk no 2/0 pcs - 3,208 0 - - - -
110 Spon gelatin cubicle 1 x 1 x 1 cm pcs - 1,850 0 - - - -
111 Spuit 0,05 ml pcs - 1,650 0 - - - -
112 Spuit 0,5 ml pcs 1,000 1,580 1,000 1,580,000 - 1,000 1,580,000
113 Steril Pouch 9 x 26 cm kotak - 88,660 0 - - - -
114 Suction tips pack - 73,700 0 - - - -
115 Surflo No 18 pcs - 8,355 0 - - - -
116 Surflo No 20 pcs - 8,355 0 - - - -
117 Surflo No 22 pcs - 8,355 0 - - - -
118 Surflo No 24 pcs - 8,355 0 - - - -
119 Surgical Glove No 6,5 pcs - 5,125 0 - - - -
120 Surgical Glove No 8 pcs - 4,169 0 - - - -
121 Surgical Glove obsgyn / gynecolog No 6,5 pcs - 20,007 0 - - - -
122 Surgical Glove obsgyn / gynecolog No 7 pcs - 20,010 0 - - - -
123 Surgical Gloves non steril uk L pcs 2,000 1,870 2,000 3,740,000 - 2,000 3,740,000
124 Surgical Gloves non steril uk M pcs 5,000 1,870 5,000 9,350,000 - 5,000 9,350,000
125 Surgical Gloves non steril uk S pcs 5,000 1,870 5,000 9,350,000 - 5,000 9,350,000
126 Surgical mask 3 ply tie on pcs - 551 0 - - - -
127 Surgical mask-plus 3 ply plus earloop (Jilbab pcs 10,000 462 10,000 4,620,000 - 10,000 4,620,000
128 Surgikal Gloves No 7 pcs 500 8,289 500 4,144,250 - 500 4,144,250
129 Surgikal Gloves No 7.5 pcs - 7,260 0 - - - -
130 Tabung EDTA K-3 pcs 1,200 870 1200 1,044,000 - 1,200 1,044,000
131 Tabung EdtA K-3 micro 0,5 cc pcs - 1888 0 - - - -
132 Tabung hematokrit pack - 180500 0 - - - -
133 Tabung reaksi / Test tube 75 x 100 dia 1 c pcs - 5500 0 - - - -
134 Tabung reaksi kaca uk.12 x 75 mm pcs - 8745 0 - - - -
135 Tip ukuran 60 pack - 179200 0 - - - -
136 Tip ukuran 61 pack - 230600 0 - - - -
137 Underpad pcs - 4640 0 - - - -
138 Urine bag pcs - 3150 0 - - - -
RENCANA KEBUTUHAN REAGEN TAHUN 2022

TOTAL
TOTAL SISA PEMAKAIAN PEMAKAIAN PREDIKSI PREDIKSI SISA
NO NAMA OBAT SATUAN REAGEN APBD REAGEN JKN STOK REAGEN RATA2/BULAN RATA2/BULAN RATA2 / PENERIMAAN STOK PER
PER 31 OKT REAGEN APBD REAGEN JKN NOV & DES DESEMBER
31 OKT 2021 31 OKT 2021 BULAN
2021 2021 2021
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2)

D REAGEN
1 Abate/temephos botol 0 0 0
2 ACS level I (control serum) botol 0 0 0 0
3 Aquadest steril botol 7 7 1 1 5
4 Asam klorida 0,1 N botol 0 0 0 0
5 Asam sulfosalisilat 20 % botol 0 0 0 0
6 bactive SL botol 0 0 0
7 Blood Analisir Clianac Detergen (Nihon kohden) botol 0 0 0 0
8 Blood Analisir Hemolinac 3N Lysing (nihon kohden) botol 0 0 0 0
9 Blood Analisir Isotonac 3 Diluent (nihon kohden) botol 0 0 0 0
10 Blood Analisir Clianac Detergen (norma clean NK) botol 0 0 0
11 Blood Analisir Hemolinac 3N Lysing (norma lyse NK) botol 0 0 0
12 Blood Analisir Isotonac 3 Diluent (norma diluent NK) botol 0 0 0

0 0 0 0
13 Carbol gentian violet botol
14 Cynoff 25 UL botol 0 0 0
0 0 0 0
15 Edta kering botol
16 Etanol 70 % 1 Liter botol 0 1 1 -2
17 Etanol 70 % 100 ml botol 0 1 1 -2
18 K-Othrine 20 EW / Cyflutrin botol 0 0 0
19 Kontrol darah botol 0 0 0 0
20 Kontrol norma low botol 0 0 0 0
21 Kontrol norma normal botol 0 0 0 0
22 kontrol norma high botol 0 0 0 0
23 Lab Pro reagen botol 0 0 0 0
24 Larutan Air Fuchsin botol 0 0 0 0
25 Larutan Alkohol 95 % botol 0 0 0 0
26 Larutan Alkohol 96 % botol 0 0 0 0
27 Larutan alkohol aseton botol 0 0 0 0
28 Larutan amonium oksalat botol 0 0 0 0
29 Larutan Anisol botol 0 0 0 0
30 Larutan Asam asetat 5% botol 0 0 0 0
31 Larutan Barium Klorida botol 0 0 0 0
32 Larutan Benedict botol 0 0 0 0
33 Larutan Buffer Fosfat botol 0 0 0 0
34 Larutan Developer botol 0 0 0 0
35 Larutan Edta 10% botol 0 0 0 0
36 Larutan Eosin 2 % botol 0 0 0 0
37 Larutan Etanol Asam botol 0 0 0 0
38 Larutan Eter alkohol botol 0 0 0 0
39 Larutan Fixer botol 0 0 0 0
40 Larutan Foucet botol 0 0 0 0
41 Larutan Giemsa Sain botol 0 0 0 0
42 Larutan hayem botol 0 0 0 0
43 Larutan Hidrogen Peroksida (H2O2) botol 0 0 0 0
44 Larutan Iodium 1 % botol 0 0 0 0
45 Larutan Karbol Fuksin botol 0 0 0 0
46 Larutan KOH 10 % botol 0 0 0 0
47 Larutan KOH 20 % botol 0 0 0 0
48 Larutan Lugol 1 % botol 0 0 0 0
49 Larutan Metilen Biru botol 0 1 1 -2
50 Larutan Natrium Citrat 3,8 % botol 0 0 0 0
51 larutan safranin botol 0 0 0 0
52 Larutan sodium hipoklorid 1 L botol 10 10 1 1 8
53 Larutan sodium hipoklorid 100 ML botol 0 0 0 0
54 Larutan Turk botol 0 0 0 0
55 Larutan Xylol botol 0 0 0 0
56 Lipid Panel cardiocheck PA kotak 0 0 0 0
57 Lipid Pro pcs 0 0 0 0
58 M-30 CFL LYSE 500 ML Mindray botol 0 0 0 0
59 M-30 DILUENT Mindray botol 0 0 0 0
60 M-30 E-Z Cleanser Mindray botol 0 0 0 0
61 M-30 PROBE CLEANSER Mindray botol 0 0 0 0
62 M-30 RINSE Mindray botol 0 0 0 0
63 B30 Control Hematology Analyzer Mindray botol 0 0 0 0
64 Medonic Diluent 20 L botol 0 0 0 0
65 Medonic Lyse 5 L botol 0 0 0 0
66 Metanol botol 0 0 0 0
67 Norma cleaner botol 0 0 0 0
68 Norma diluent diff botol 0 0 0 0
69 Norma lyse diff botol 0 0 0 0
70 Oil Imersi botol 0 0 0 0
71 Pewarnaan Gram 1 % botol 0 0 0 0
72 Rapid 1 SD HIV 1/2 3.0 stik 2 2 0 0 2
73 Rapid 2 Intec HIV stik 0 0 0 0
74 Rapid 3 oncoprobe stik 0 0 0 0
75 Rapid 4 right sign HIV stik 0 0 0 0
76 Rapid 5 CTK Bioteck HIV stik 0 0 0 0

77 Rapid 6 HIV Vikia stik 0 0 0 0
78 Rapid 7 HIV Card Vcare stik 0 0 0 0
79 Rapid 8 Fokus HIV stik 0 0 0 0
80 Reagen Albumin biosystem kit 0 0 0 0
81 Reagen albumin agappe / mindray kit 0 0 0 0
82 Reagen Albumin randox kit 0 0 0 0
83 Reagen Asam Urat biosystem kit 0 0 0 0
84 Reagen Asam Urat agappe / mindray kit 0 0 0 0
85 Reagen Asam Urat randox kit 0 0 0 0
86 Reagen Bilirubin Direct biosystem kit 0 0 0 0
87 Reagen Bilirubin Direct agappe / mindray kit 0 0 0 0
88 Reagen Bilirubin Direct randox kit 0 0 0 0
89 Reagen Bilirubin Total biosystem kit 0 0 0 0
90 Reagen Bilirubin Total agappe / mindray kit 0 0 0 0
91 Reagen Bilirubin Total randox kit 0 0 0 0
92 Reagen Cholesterol biosystem kit 0 1 1 -2
93 Reagen Cholesterol agappe / mindray kit 0 0 0 0
94 Reagen Cholesterol randox kit 0 0 0 0
95 Reagen Cholesterol HDL biosystem kit 0 0 0 0
96 Reagen Cholesterol HDL agappe / mindray kit 0 0 0 0
97 Reagen Cholesterol HDL randox kit 0 0 0 0
98 Reagen Creatinin biosystem kit 0 0 0 0
99 Reagen Creatinin agappe / mindray kit 0 0 0 0
100 Reagen Creatinin randox kit 0 0 0 0
101 Reagen Glucose biosystem kit 0 0 0 0
102 Reagen Glucose agappe / mindray kit 0 0 0 0
103 Reagen Glucose PAP randox kit 0 0 0 0
104 Reagen golongan darah set-2 0 0 0 0
105 Reagen golongan darah set-4 0 0 0 0
106 Reagen HB Cyanida kit 0 0 0 0
107 Reagen HB konsentrat biosystem kit 0 0 0 0
108 Reagen HB konsentrat randox kit 0 0 0 0
109 Reagen Protein Total biosystem kit 0 0 0 0
110 Reagen Protein Total agappe / mindray kit 0 0 0 0
111 Reagen Protein Total randox kit 0 0 0 0
112 Reagen SGOT / AST biosystem kit 0 0 0 0
113 Reagen SGOT / AST Mindray kit 0 0 0 0
114 Reagen SGOT / AST randox kit 0 0 0 0
115 Reagen SGOT / AST Biolabo kit 0 0 0 0
116 Reagen SGPT / ALT biosystem kit 0 0 0 0
117 Reagen SGPT / ALT mindray kit 0 0 0 0
118 Reagen SGPT / ALT randox kit 0 0 0 0
119 Reagen SGPT / ALT biolabo kit 0 0 0 0
120 Reagen Trigliseride biosystem kit 0 0 0 0
121 Reagen Trigliseride mindray kit 0 0 0 0

122 Reagen Trigliseride randox kit 0 0 0 0
123 Reagen Ureum biosystem kit 0 0 0 0
124 Reagen Urea Mindray kit 0 0 0 0
125 Reagen Ureum randox kit 0 0 0 0
126 Reagen Ureum Biolabo kit 0 0 0 0
127 Reagen Wright Stain kit 0 0 0 0
128 reagent cholesterol pap sl (microlab/elitech) kit 0 0 0 0
129 reagent cholesterol standar 200 mg/dl (microlab/elitech) kit 0 0 0 0
130 reagent glucose pap sl (microlab/elitech) kit 0 0 0 0
131 reagent glucose standar 100 mg/dl (microlab/elitech) kit 0 0 0 0
132 reagent trigliserid mono sl (microlab/elitech) kit 0 0 0 0
133 reagent trigliserid standar 200 mg/dl (microlab/elitech) kit 0 0 0 0
134 reagent uric acid mono sl (microlab/elitech) kit 0 0 0 0
135 reagent uric acid standar (microlab/elitech) kit 0 0 0 0
136 Reagen Elitrol 1 Normal 1 x 5 ml (elitech) kit 0 0 0 0
137 Res eker botol 0 0 0 0
138 RPR syfilis randox botol 0 0 0 0
139 RPR syfilis Fokus Diagnostik botol 0 0 0 0
140 RPR syfilis "Human" botol 0 0 0 0
141 Serum kontrol mindray (Qualichek normal mindray) botol 0 0 0 0
142 Spiritus 1 L botol 11 11 0 0 11
143 Stik asam urat easy touch stik 0 0 0 0
144 Stik asam urat Nesco stik 0 0 0 0
145 Stik Cholesterol easy touch stik 0 0 0 0
146 Stik Cholesterol Nesco stik 0 0 0 0
147 Stik gula darah ( gluco dr autosensor) stik 150 150 0 0 150
148 Stik Gula Darah (Gluko DR supersensor) stik 0 0 0 0
149 Stik Gula Darah Accu cek stik 0 10 10 -20

150 Stik HB BeneCheck stik 0 0 0 0
0 2 2 -4
151 Stik HB Easy touch stik
152 Stik HBSAb merek Intec stik 0 0 0 0
153 Stik HBSAg merek SD stik 0 0 0 0
154 Stik HBSAg merek Intec stik 0 0 0 0
155 Stik Kehamilan stik 200 200 10 10 180
156 Stik syphilis 'SD' stik 0 0 0 0
RENCANA
USULAN
KEBUTUHAN PENGADAAN 2022
REAGEN TAHUN
(PEMBULATAN)
2022
12 = (9 * 18)- 11 13
-
- 12
13 10
-
-
-
-
-
-
-
-
-
-
-
-
20 30
20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
-
-
10
-
-
-
-
-
- 6
- 12
- 15
- 2
- 12
- 12
-
-
-
-
-
-
- 2
-
(2) 500
- 200
- 200
-
-
-
-
-
-
-
-
- 26
-
-
-
-
-
-
-
-
20 26
-
-
-
-
-
-
-
-
- 26
-
-
- 3
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- 26
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- 2
-
-
(11)
-
- 300
-
- 400
(150) 600
-
200 100
-
40 500
-
-
-
- 240
- 500
RENCANA KEBUTUHAN REAGEN TAHUN 2022

USULAN TOTAL
NO NAMA REAGEN SATUAN PENGADAAN HARGA REAGEN PROYEKSI PENGADAAN PENGADAA TOTAL RUPIAH
2022 N

1 2 3 5 6 7 8=6*7 9 10 = 6 * 9 11 = 7 + 9 12 = 6 * 11
D REAGEN
1 Abate/temephos botol - 2,197,800 - - - - -
2 ACS level I (control serum) botol 12 4,950,000 12 59,400,000 - 12 59,400,000
3 Aquadest steril botol 10 55,000 10 - 10 -
4 Asam klorida 0,1 N botol - 154,000 - - - - -
5 Asam sulfosalisilat 20 % botol - 531,000 - - - - -
6 bactive SL botol - 30,700 - - - - -
7 Blood Analisir Clianac Detergen (Nihon kohde botol - 8,050,000 - - - - -
8 Blood Analisir Hemolinac 3N Lysing (nihon ko botol - 3,850,000 - - - - -
9 Blood Analisir Isotonac 3 Diluent (nihon kohd botol - 4,290,000 - - - - -
10 Blood Analisir Clianac Detergen (norma clean botol - 2,112,000 - - - - -
11 Blood Analisir Hemolinac 3N Lysing (norma ly botol - 5,240,000 - - - - -
12 Blood Analisir Isotonac 3 Diluent (norma dilu botol - 3,696,000 - - - - -
13 Carbol gentian violet botol - 73,700 - - - - -
14 Cynoff 25 UL botol - 1,320,000 - - - - -
15 Edta kering botol - 100,100 - - - - -
16 Etanol 70 % 1 Liter botol 30 107,800 30 3,234,000 - 30 3,234,000
17 Etanol 70 % 100 ml botol - 11,000 - - - - -
18 K-Othrine 20 EW / Cyflutrin botol - 1,000,000 - - - - -
19 Kontrol darah botol - 1,358,500 - - - - -
20 Kontrol norma low botol - 596,000 - - - - -
21 Kontrol norma normal botol - 596,000 - - - - -
22 kontrol norma high botol - 596,000 - - - - -
23 Lab Pro reagen botol - 203,500 - - - - -
24 Larutan Air Fuchsin botol - 32,500 - - - - -
25 Larutan Alkohol 95 % botol - 335,000 - - - - -
26 Larutan Alkohol 96 % botol - 48,500 - - - - -
27 Larutan alkohol aseton botol - 31,000 - - - - -
28 Larutan amonium oksalat botol - 56,100 - - - - -
29 Larutan Anisol botol - 418,000 - - - - -
30 Larutan Asam asetat 5% botol - 19,500 - - - - -
31 Larutan Barium Klorida botol - 49,500 - - - - -
32 Larutan Benedict botol - 309,100 - - - - -
33 Larutan Buffer Fosfat botol - 52,800 - - - - -
34 Larutan Developer botol - 1,320,000 - - - - -
35 Larutan Edta 10% botol - 62,700 - - - - -
36 Larutan Eosin 2 % botol - 429,000 - - - - -
37 Larutan Etanol Asam botol - 62,700 - - - - -
38 Larutan Eter alkohol botol - 68,200 - - - - -
39 Larutan Fixer botol - 660,000 - - - - -
40 Larutan Foucet botol - 253,000 - - - - -
41 Larutan Giemsa Sain botol - 378,125 - - - - -
42 Larutan hayem botol - 137,500 - - - - -
43 Larutan Hidrogen Peroksida (H2O2) botol - 550,000 - - - - -
44 Larutan Iodium 1 % botol - 27,500 - - - - -
45 Larutan Karbol Fuksin botol - 165,000 - - - - -
46 Larutan KOH 10 % botol - 36,300 - - - - -
47 Larutan KOH 20 % botol - 40,700 - - - - -
48 Larutan Lugol 1 % botol - 193,600 - - - - -
49 Larutan Metilen Biru botol - 93,170 - - - - -
50 Larutan Natrium Citrat 3,8 % botol - 71,500 - - - - -
51 larutan safranin botol - 68,200 - - - - -
52 Larutan sodium hipoklorid 1 L botol - 132,000 - - - - -
53 Larutan sodium hipoklorid 100 ML botol - 18,634 - - - - -
54 Larutan Turk botol - 44,000 - - - - -
55 Larutan Xylol botol - 100,100 - - - - -
56 Lipid Panel cardiocheck PA kotak - 10,930,633 - - - - -
57 Lipid Pro pcs - 836,000 - - - - -
58 M-30 CFL LYSE 500 ML Mindray botol 6 2,332,000 6 13,992,000 - 6 13,992,000
59 M-30 DILUENT Mindray botol 12 2,200,000 12 26,400,000 - 12 26,400,000
60 M-30 E-Z Cleanser Mindray botol 15 1,650,000 15 24,750,000 - 15 24,750,000
61 M-30 PROBE CLEANSER Mindray botol 2 165,000 2 330,000 - 2 330,000
62 M-30 RINSE Mindray botol 12 2,200,000 12 26,400,000 - 12 26,400,000
63 B30 Control Hematology Analyzer Mindray botol 12 2,378,000 12 28,536,000 - 12 28,536,000
64 Medonic Diluent 20 L botol - 6,116,000 - - - - -
65 Medonic Lyse 5 L botol - 8,305,000 - - - - -
66 Metanol botol - 24,645 - - - - -
67 Norma cleaner botol - 2,400,999 - - - - -
68 Norma diluent diff botol - 2,241,000 - - - - -
69 Norma lyse diff botol - 2,992,000 - - - - -
70 Oil Imersi botol 2 991,100 2 1,982,200 - 2 1,982,200
71 Pewarnaan Gram 1 % botol - 518,100 - - - - -
72 Rapid 1 SD HIV 1/2 3.0 stik 500 11,975 500 5,987,500 - 500 5,987,500
73 Rapid 2 Intec HIV stik 200 15,380 200 3,076,000 - 200 3,076,000
74 Rapid 3 oncoprobe stik 200 49,456 200 9,891,200 - 200 9,891,200
75 Rapid 4 right sign HIV stik - 35,120 - - - - -
76 Rapid 5 CTK Bioteck HIV stik - 30,250 - - - - -
77 Rapid 6 HIV Vikia stik - 51,436 - - - - -
78 Rapid 7 HIV Card Vcare stik - 30,250 - - - - -
79 Rapid 8 Fokus HIV stik - 13,896 - - - - -
80 Reagen Albumin biosystem kit - 800,000 - - - - -
81 Reagen albumin agappe / mindray kit - 1,400,000 - - - - -
82 Reagen Albumin randox kit - 962,500 - - - - -
83 Reagen Asam Urat biosystem kit 26 1,100,000 26 28,600,000 - 26 28,600,000
84 Reagen Asam Urat agappe / mindray kit - 1,386,000 - - - - -
85 Reagen Asam Urat randox kit - 1,669,500 - - - - -
86 Reagen Bilirubin Direct biosystem kit - 2,090,000 - - - - -
87 Reagen Bilirubin Direct agappe / mindray kit - 877,800 - - - - -
88 Reagen Bilirubin Direct randox kit - 970,000 - - - - -
89 Reagen Bilirubin Total biosystem kit - 2,090,000 - - - - -
90 Reagen Bilirubin Total agappe / mindray kit - 877,800 - - - - -
91 Reagen Bilirubin Total randox kit - 897,000 - - - - -
92 Reagen Cholesterol biosystem kit 26 935,000 26 24,310,000 - 26 24,310,000
93 Reagen Cholesterol agappe / mindray kit - 2,189,000 - - - - -
94 Reagen Cholesterol randox kit - 2,227,500 - - - - -
95 Reagen Cholesterol HDL biosystem kit - 2,475,000 - - - - -
96 Reagen Cholesterol HDL agappe / mindray kit - 8,690,000 - - - - -
97 Reagen Cholesterol HDL randox kit - 1,991,000 - - - - -
98 Reagen Creatinin biosystem kit - 1,210,000 - - - - -
99 Reagen Creatinin agappe / mindray kit - 930,600 - - - - -
100 Reagen Creatinin randox kit - 937,750 - - - - -
101 Reagen Glucose biosystem kit 26 605,000 26 15,730,000 - 26 15,730,000
102 Reagen Glucose agappe / mindray kit - 1,331,000 - - - - -
103 Reagen Glucose PAP randox kit - 529,290 - - - - -
104 Reagen golongan darah set-2 3 128,000 3 384,000 - 3 384,000
105 Reagen golongan darah set-4 - 142,650 - - - - -
106 Reagen HB Cyanida kit - 275,000 - - - - -
107 Reagen HB konsentrat biosystem kit - 308,000 - - - - -
108 Reagen HB konsentrat randox kit - 533,660 - - - - -
109 Reagen Protein Total biosystem kit - 545,000 - - - - -
110 Reagen Protein Total agappe / mindray kit - 770,000 - - - - -
111 Reagen Protein Total randox kit - 880,000 - - - - -
112 Reagen SGOT / AST biosystem kit - 825,000 - - - - -
113 Reagen SGOT / AST Mindray kit - 1,265,000 - - - - -
114 Reagen SGOT / AST randox kit - 514,110 - - - - -
115 Reagen SGOT / AST Biolabo kit - 1,824,887 - - - - -
116 Reagen SGPT / ALT biosystem kit - 825,000 - - - - -
117 Reagen SGPT / ALT mindray kit - 1,265,000 - - - - -
118 Reagen SGPT / ALT randox kit - 509,946 - - - - -
119 Reagen SGPT / ALT biolabo kit - 1,824,887 - - - - -
120 Reagen Trigliseride biosystem kit 26 1,430,000 26 37,180,000 - 26 37,180,000
121 Reagen Trigliseride mindray kit - 1,804,000 - - - - -
122 Reagen Trigliseride randox kit - 2,629,000 - - - - -
123 Reagen Ureum biosystem kit - 1,870,000 - - - - -
124 Reagen Urea Mindray kit - 1,072,500 - - - - -
125 Reagen Ureum randox kit - 1,430,000 - - - - -
126 Reagen Ureum Biolabo kit - 1,905,773 - - - - -
127 Reagen Wright Stain kit - 308,000 - - - - -
128 reagent cholesterol pap sl (microlab/elitech) kit - 3,300,000 - - - - -
129 reagent cholesterol standar 200 mg/dl (microl kit - 633,600 - - - - -
130 reagent glucose pap sl (microlab/elitech) kit - 1,795,000 - - - - -
131 reagent glucose standar 100 mg/dl (microlab/ kit - 448,800 - - - - -
132 reagent trigliserid mono sl (microlab/elitech) kit - 5,000,000 - - - - -
133 reagent trigliserid standar 200 mg/dl (microla kit - 475,200 - - - - -
134 reagent uric acid mono sl (microlab/elitech) kit - 3,350,000 - - - - -
135 reagent uric acid standar (microlab/elitech) kit - 580,800 - - - - -
136 Reagen Elitrol 1 Normal 1 x 5 ml (elitech) kit - 5,940,000 - - - - -
137 Res eker botol - 154,000 - - - - -
138 RPR syfilis randox botol - 1,555,920 - - - - -
139 RPR syfilis Fokus Diagnostik botol 2 4,260 2 8,520 - 2 8,520
140 RPR syfilis "Human" botol - 5,684 - - - - -
141 Serum kontrol mindray (Qualichek normal mi botol - 968,000 - - - - -
142 Spiritus 1 L botol - 170,500 - - - - -
143 Stik asam urat easy touch stik - 4,796 0 - - - -
144 Stik asam urat Nesco stik 300 5,258 300 1,577,400 - 300 1,577,400
145 Stik Cholesterol easy touch stik - 21,890 0 - - - -
146 Stik Cholesterol Nesco stik 400 24,090 400 9,636,000 - 400 9,636,000
147 Stik gula darah ( gluco dr autosensor) stik 600 7,238 600 4,342,800 - 600 4,342,800
148 Stik Gula Darah (Gluko DR supersensor) stik - 6,800 0 - - - -
149 Stik Gula Darah Accu cek stik 100 7,590 100 759,000 - 100 759,000
150 Stik HB BeneCheck stik - 7,955 0 - - - -
151 Stik HB Easy touch stik 500 7,260 500 3,630,000 - 500 3,630,000
152 Stik HBSAb merek Intec stik - 27,478 0 - - - -
153 Stik HBSAg merek SD stik - 8,233 0 - - - -
154 Stik HBSAg merek Intec stik - 5,060 0 - - - -
155 Stik Kehamilan stik 240 2,156 240 517,440 - 240 517,440
156 Stik syphilis 'SD' stik 500 35,429 500 17,714,500 - 500 17,714,500
157 Stik syphilis 'Monotest' stik - 10,758 0 - - - -
158 Stik syphilis 'Human hexagonal' stik - 26,744 0 - - - -
159 Stik urinalisa 10 parameter (Dirui) stik - 3,600 0 - - - -

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DINAS KESEHATAN KOTA BANJARMASIN

RENCANA KEBUTUHAN OBAT TAHUN 2022

TOTAL SISA TOTAL

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13

32 Difenhidramin Hcl inj 10 mg/ml-1 ml ampul 0 1 1 -2 20 20

75 Klorpromazin Hcl inj 5 mg / ml - 2 ml ampul 0 0 0 0 -

118 Pirantel pamoat 125 mg tablet tablet 79 79 1 1 77 (59)

249 HEXADOL (Larutan Hexetidine) botol 0 3 3 -6 60 100

293 Longatin 25 mg tablet 0 54 54 -108 1,080 1,000

336 Parasetamol Drop 100 mg/ml botol 49 49 17 17 15 291 300

380 Serum anti bisa ular polivalen inj 50 ml ( A vial 0 0 0 0 -

RENCANA KEBUTUHAN OBAT TAHUN 2022

USULAN PENGADAAN TOTAL

DHP / Darplex / D-Artepp (Dehidro - - - - -

408 Timolol tetes mata 0,5% botol - 10,286 - - - -

RENCANA KEBUTUHAN OBAT TAHUN 2022

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14 15

1 Achatit/Fuji II kotak 0 1 1 -2 20 3 Rp 459,910.00 3

RENCANA KEBUTUHAN OBAT TAHUN 2022

APBD total Rp APBD

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14 15 16 = 14 * 15

1 Achatit/Fuji II kotak 0 1 1 -2 20 3 Rp 459,910.00 3 1,379,730

APBD total Rp APBD

RENCANA KEBUTUHAN BMHP TAHUN 2022

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2)

121 Surgical Glove obsgyn / gynecolog No 6,5 pcs 0 1 1 -2

KEBUTUHAN BMHP TAHUN 2022

RENCANA KEBUTUHAN BMHP TAHUN 2022

APBD total Rp APBD JKN total Rp JKN

RENCANA KEBUTUHAN REAGEN TAHUN 2022

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2)

2 ACS level I (control serum) botol 0 0 0 0

3 Aquadest steril botol 7 7 1 1 5

4 Asam klorida 0,1 N botol 0 0 0 0

5 Asam sulfosalisilat 20 % botol 0 0 0 0

7 Blood Analisir Clianac Detergen (Nihon kohden) botol 0 0 0 0

8 Blood Analisir Hemolinac 3N Lysing (nihon kohden) botol 0 0 0 0

9 Blood Analisir Isotonac 3 Diluent (nihon kohden) botol 0 0 0 0

10 Blood Analisir Clianac Detergen (norma clean NK) botol 0 0 0

11 Blood Analisir Hemolinac 3N Lysing (norma lyse NK) botol 0 0 0

12 Blood Analisir Isotonac 3 Diluent (norma diluent NK) botol 0 0 0

17 Etanol 70 % 100 ml botol 0 1 1 -2

18 K-Othrine 20 EW / Cyflutrin botol 0 0 0

19 Kontrol darah botol 0 0 0 0

20 Kontrol norma low botol 0 0 0 0

21 Kontrol norma normal botol 0 0 0 0

22 kontrol norma high botol 0 0 0 0

23 Lab Pro reagen botol 0 0 0 0

24 Larutan Air Fuchsin botol 0 0 0 0

25 Larutan Alkohol 95 % botol 0 0 0 0

26 Larutan Alkohol 96 % botol 0 0 0 0

27 Larutan alkohol aseton botol 0 0 0 0

28 Larutan amonium oksalat botol 0 0 0 0

29 Larutan Anisol botol 0 0 0 0

30 Larutan Asam asetat 5% botol 0 0 0 0

31 Larutan Barium Klorida botol 0 0 0 0

32 Larutan Benedict botol 0 0 0 0

33 Larutan Buffer Fosfat botol 0 0 0 0

34 Larutan Developer botol 0 0 0 0

35 Larutan Edta 10% botol 0 0 0 0

36 Larutan Eosin 2 % botol 0 0 0 0

37 Larutan Etanol Asam botol 0 0 0 0