PEMERINTAH KABUPATEN PARIGI MOUTONG

DINAS KESEHATAN
Jl. Matalemo Desa Bambalemo Parigi Telp./Fax. (0450) 22243

SURAT BUKTI BARANG KELUAR (SBBK)

NOMOR : 442/ /Diskes

TANGGAL : 22 Januari 2016
UNTUK : RS. Pratama Moutong

Telah dikeluarkan dari Instalasi Farmasi Kabupaten Parigi Moutong, Stock Obat-obatan untuk pelayanan RS. Pratama Moutong, sebagai berikut :

Harga Satuan Jumlah Harga

No. Nama Obat Satuan Volume Ket.
(Rp) (Rp)
OBAT-OBATAN
1 Alopurinol tablet 300 mg Box, 10 strips @10 tablet 4 - BUFFER
2 Alprazolam tablet/kapsul/kaplet 0,5 mg Box, 10 strips @10 tablet 3 18,500 55,500 PKD 2014
3 Ambroxol tablet 30 mg Box, 10 strips @10 tablet 1 19,490 19,490 PKD 2015
4 Amlodipin 5 mg tablet Box @ 30 tab 10 - BUFFER
5 Aminofilin injeksi 24 mg/ml Dus, 30 amp @ 10 ml 2 126,120 252,240 PKD 2015
6 Aminofilin tablet scored 200 mg Btl @ 100 tablet 2 8,600 17,200 PKD 2015
7 Amoksisilin kaplet 500 mg Box, 10 strips @10 tablet 10 27,900 279,000 PKD 2015
8 Amoksisilin sirup kering 125 mg/ 5 mg Botol @ 60 ml 120 2,560 307,200 PKD 2016
Antasida Doen I tablet kunyah, kombinasi :
9 Aluminium Hidroksida 200 mg + Magnesium Dus, 10 strips@10 tablet 10 - BUFFER
Hidroksida 200 mg

Antasida Doen II Suspensi, kombinasi :

10 Aluminium Hidroksida 200 mg/5 ml + Magnesium Botol 60 ml 100 2,300 230,000 PKD 2015
Hidroksida 200 mg/5 ml

JAMKESDA
11 Asam Traneksamat 500 mg tablet Box, 10 strips @10 tablet 2 156,000 312,000
2015
JAMKESDA
12 Asam Traneksamat 100 mg/ml Injeksi Box @ 10 ampul 10 110,000 1,100,000
2016
13 Asam mefenamat kaplet 500 mg Box, 10 strips @10 tablet 10 12,700 127,000 PKD 2015
14 Asiklovir tablet 400 mg Box, 10 strips @10 tablet 5 - BUFFER
15 Asiklovir cream 5 % tube 5 gram 25 3,140 78,500 PKD 2015
16 Betametason krim 0,1% (sebagai Valerat) tube 5 gram 100 1,596 159,600 PKD 2015
17 Bisoprolol tablet 5 mg Box @ 30 tab 5 20,850 104,250 PKD 2015
18 Sefotaksim serbuk inj 1.000 mg Ktk/2 vial @ 1 g 50 12,080 604,000 PKD 2015
19 Seftriakson serbuk injeksi 1 g/vial Vial @ 1 g 25 3,900 97,500 PKD 2015
20 Cetirizine 10 mg tablet Box, 5 strips @10 tablet 3 15,640 46,920 PKD 2015
21 Ciprofloxacine 500 mg tablet (sebagai HCl) Dus, 10 blister @ 10 tablet 5 44,280 221,400 PKD 2015
22 Cefadroksil sirup kering 250 mg / 5 ml btl @ 60 ml 100 5,286 528,600 PKD 2015
23 Cefadroksil Kapsul 500 mg Dus, 10 strip @ 10 kaps 10 54,800 548,000 PKD 2015
24 Glukosa larutan infus 5 % steril Botol @ 500 ml 20 5,720 114,400 PKD 2015
25 Deksametason tablet 0,5 mg Dus, 10 strips@10 tablet 5 - BUFFER
 Harga Satuan Jumlah Harga
No. Nama Obat Satuan Volume Ket.
(Rp) (Rp)
26 Deksametason injeksi i.v./i.m. 5 mg/ml Dus, 100 ampul @ 1 ml 5 - BUFFER
27 Digoksin tablet 0,25 mg Box 10 x 10 tablet 10 10,300 103,000 PKD 2015
28 Doksisiklin tablet/kapsul 100 mg Box 10 strips x 10 kapsul 10 29,800 298,000 PKD 2015
29 Domperidon tab 10 mg Dus 10 strip x 10 tab 5 17,400 87,000 PKD 2015
30 Epinefrin (Adrenalin) injeksi iv/sk./im 0,1% Dus, 100 ampul @ 1 ml 5 - BUFFER
Antimigren: Ergotamin Tartrat 1 mg + Kofein 50
31 Btl @ 100 tablet 2 - BUFFER
mg
32 Fitomenadion (Vit.K1) injeksi i.m. 2 mg/ml Dus @ 30 ampul 3 112,620 337,860 PKD 2015
33 Fitomenadion (Vit.K1) tablet salut gula 10 mg Btl @ 100 tablet salut gula 2 69,700 139,400 PKD 2015
34 Furosemid 40 mg tablet Dus, 10 strip @ 10 tablet 5 - PKD 2015
35 Gliseril Guaiakolat tablet 100 mg Btl/1000 tab 1 - ASKES SOS
36 Hidrokortison krim 2,5 % tube 5 gram 48 2,938 141,024 PKD 2015
37 Ibuprofen tablet 400 mg Dus, 10 strips@10 tablet 10 - BUFFER
38 Povidon Iodida 10 % Btl @ 300 ml 10 15,386 153,860 PKD 2015
39 Isosorbid Dinitrat 5 mg tablet Dus, 10 Strip@10 tablet 1 9,800 9,800 PKD 2015
40 Ketokonazol 2 % cream tube 10 gram 50 2,697 134,850 PKD 2015
41 Ketokonazol tablet 200 mg Dus, 5 strips@10 tab 5 31,999 159,995 JKN 2014
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 -
42 Dus, 30 ampul @ 2 ml 3 - BUFFER
2ml

Kotrimoksazol DOEN I (dewasa) kombinasi :

43 Dus, 10 Strip@10 Tablet 10 15,200 152,000 PKD 2015
Sulfametoksazol 400 mg Trimetoprim 80 mg

Kotrimoksazol Suspensi komb: Sulfametoksazol

44 btl @ 60 ml 100 2,298 229,800 PKD 2015
200 mg + Trimetoprim 40 mg / 5 ml

45 Metilergometrin Maleat injeksi 0,200 mg-1 ml Box/100 Ampul @ 1 ml 1 350,000 350,000 PKD 2015
46 Metilprednisolon tablet 4 mg Dus, 10 blister @ 10 tab 5 - BUFFER
47 Metronidazol tablet 500 mg Ktk 10 x 10 tablet 5 16,900 84,500 PKD 2015
48 Mikonazol krim/salep 2 % (Nitrat) tube 10 gram 120 3,150 378,000 PKD 2015
49 Metformin 500 mg tablet Dus, 10 blister @ 10 tablet 5 12,450 62,250 PKD 2015
50 Metildopa tablet salut 250 mg Dus, 10 Strip @ 10 tablet 2 88,000 176,000 PKD 2015
51 Natrium Klorida 0,9% Botol @ 500 ml 50 9,120 456,000 PKD 2015
52 Natrium Diklofenak tablet 50 mg Dus, 5 x 10 tablet 5 9,650 48,250 PKD 2015
53 Omeprazole kapsul 20 mg Dus, 3 x 10 strip 5 6,630 33,150 PKD 2015
54 Oksitosin injeksi 10 IU/ml ampul @ 1 ml 100 1,900 190,000 BUFFER
55 Paracetamol 500 mg Dus, 10 Strip@10 Kaplet 10 8,800 88,000 PKD 2015
56 Paracetamol sirup 120 mg / 5 ml Botol @ 60 ml 100 1,535 153,500 PKD 2015
57 Ranitidin injeksi 25 mg/ml Dus, 10 Ampul @ 2 ml 2 13,400 26,800 PKD 2015
58 Ranitidine tablet 150 mg Dus, 10 Strip @ 10 tab 5 - BUFFER
59 Ringer Laktat Cairan Infus Botol @ 500 ml 100 5,720 572,000 PKD 2015
JAMKESDA
60 Simvastatin scored tablet 10 mg Dus, 3 strip @ 10 tablet 10 12,650 126,500
2015
61 Vitamin B Kompleks tablet Dus 10 strip x 10 tab 10 - BUFFER
62 Air untuk injeksi (Aqua pro injeksi) 20 ml Ampul @ 25 ml 240 - BUFFER
63 Alkohol 70 % Btl @ 100 ml 50 - BUFFER
BAHAN MEDIS HABIS PAKAI
 Harga Satuan Jumlah Harga
No. Nama Obat Satuan Volume Ket.
(Rp) (Rp)
1 Abbocath No. 18 Pcs 50 4,959 247,950 PKD 2015
2 Abbocath No. 20 Pcs 50 4,959 247,950 PKD 2015
3 Abbocath No. 22 Pcs 50 4,959 247,950 PKD 2015
4 Abbocath No. 24 Pcs 50 4,959 247,950 PKD 2015
JAMKESDA
5 Bisturi No. 15 Box/100 pcs 1 150,010 150,010
2015
JAMKESDA
6 Bisturi No. 23 Box/100 pcs 1 150,010 150,010
2015
7 Blood Lancet Box/100 pcs 1 159,900 159,900 PKD 2014
8 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Box/24 pcs 1 703,000 703,000 PKD 2014
9 Catgut Chromic 3/0 + jarum 1/2 GT 35 mm Box/24 pcs 1 648,000 648,000 PKD 2014
10 Catgut Plain 2/0 + jarum 1/2 GT 35 mm Box/24 pcs 1 703,000 703,000 PKD 2014
11 Catgut Plain 3/0 + jarum 1/2 GT 35 mm Box/24 pcs 1 648,000 648,000 PKD 2014
12 Silk 3/0 + jarum 1/2 GT 35 mm Box/36 pcs 1 681,000 681,000 PKD 2014
13 Foley Catheter no. 18 Ktk/10 Pcs 2 83,520 167,040 PKD 2015
14 Etil Chlorida Semprot Vial / Can / 100 ml 5 115,200 576,000 PKD 2014
15 Gloves surgical no. 6,5 steril Ktk/50 psg 1 -
16 Gloves surgical no. 7,0 steril Ktk/50 psg 1 -
17 Plester 5 yards x 2 inch Roll 10 32,426 324,260 PKD 2015
18 Infus set Anak Pcs 100 -
19 Infus set Dewasa Pcs 100 4,176 417,600 BUFFER
20 Kapas Pembalut / Absorben 250 gram Roll 10 16,313 163,130 PKD 2015
21 Kasa Pembalut Hydrophil 3,6 m x 15 cm Roll 10 - BUFFER
22 Kasa Hydrophil 40 x 80 cm Roll 5 137,025 685,125 PKD 2015
23 Kasa Hydrophil Steril 16 x 16 cm Box/16 lbr 5 - BUFFER
24 Lysol Btl 1000 ml 5 53,505 267,525 PKD 2015
25 Handscrub 500 cc Btl 500 ml 5 81,563 407,815 PKD 2015
Pembalut Elastis Perban ukuran 10 cmx4,55 m
26 Roll 1 33,000 33,000 PKD 2015
terlentang
27 Alat Suntik Sekali Pakai 1 cc Ktk/100 pcs 2 84,825 169,650 PKD 2015
28 Alat Suntik Sekali Pakai 3 cc Ktk/100 pcs 5 84,825 424,125 PKD 2015
29 Alat Suntik Sekali Pakai 5 cc Ktk/100 pcs 2 97,875 195,750 PKD 2015
30 Surgical Mask 3 ply earloop Ktk/50 pcs 3 - JKN 2014

Mengetahui Parigi, 22 Januari 2016

a.n. Kepala Dinas Kesehatan Penanggung Jawab
Kabupaten Parigi Moutong Kepala Seksi Kefarmasian
Kabid. Jamsarkes

I Wayan Budiantara, SKM Asmarafia, S.Si, Apt

NIP. 19781203 199803 1 002 NIP. 19750209 200604 2 016

Yang Menerima
Nama :

NIP :
 Harga Satuan Jumlah Harga
No. Nama Obat Satuan Volume Ket.
(Rp) (Rp)
Jabatan :

Tanda Tangan :