Lplpo P.senjaya 21 Oke

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS : P6201062202

PUSKESMAS : PANDU SENJAYA BULAN
KECAMATAN : PANGKALAN LADA TAHUN
KABUPATEN : KOTAWARINGIN BARAT
PROVINSI : KALIMANTAN TENGAH
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH STOK AWAL PENERIMA PERSEDIAA PENGELUAR GUDANG OPTIMUM WAKTU
NO OBAT DAN PERBEKKES SATUAN AWAL AN N N AN N AN PUSKESMA KOSONG
KEBUTUHA
AN (40 %) N
S
GUDANG GUDANG GUDANG GUDANG
TABLET
1 Albendazol 400 mg Tab 30 90 120 - 120 - 120 - 90 90 - 90 - 90 - - - 120
2 Alopurinol 100 mg Tab 1,000 1,000 20 1,100 - 120 980 1,000 1,000 - 1,000 - 1,000 28 580 - 372
3 Ambroksol 30 mg Tab 1,112 1,000 2,112 92 2,072 - 52 2,020 100 1,000 1,100 - 1,100 - 1,100 129 - - 1,891
4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - -

5 Amitriptilin 25 mg Tab 100 - 100 6 214 - 120 94 100 - 100 - 100 - 100 8 - - 86
6 Amlodipin 5 mg Tab 1,105 300 1,405 100 1,305 - 1,305 700 300 1,000 - 1,000 - 1,000 140 - - 1,165
7 Amlodipin 10 mg Tab 770 300 1,070 150 950 - 30 920 550 300 850 50 800 - 800 210 - - 710
8 Amoksisilin 250 mg Tab 140 - 140 - 140 - 140 100 - 100 - 100 - 100 - - - 140
9 Amoksisilin 500 mg Tab 1,366 1,000 2,366 245 2,206 - 85 2,121 600 1,000 1,600 200 1,400 - 1,400 343 - - 1,778
10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - -

11 Antasida kombinasi Tab 88 - 88 88 - - - - - - - - - - 123 2,640 2,763
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - -
13 Asam asetilsalisilat (asetosal) 80 mg Tab 430 - 430 150 470 - 190 280 200 - 200 - 200 - 200 210 - - 70
14 Asam mefenamat 500 mg Tab 680 2,000 2,680 280 2,580 - 180 2,400 100 2,000 2,100 100 2,000 - 2,000 392 420 - 1,588
15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
16 Asiklovir 200 mg Tab 60 - 60 40 60 - 40 20 - - - - - - - 56 1,200 1,236
17 Asiklovir 400 mg Tab 206 300 506 14 492 - 492 50 300 350 50 300 - 300 20 - - 472
18 Atapulgit 630 mg Tab 937 - 937 30 1,052 - 145 907 800 - 800 - 900 - 100 800 42 - - 865
19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - -
20 Azitromisin 500 mg Tab 510 510 160 - 350 350 510 510 - - 510 510 224 4,800 4,674
21 Asam folat 1 mg Tab - - - 10 - 10 - - - - - - - - - -
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - -
23 Betahistin 6 mg Tab 390 500 890 465 425 - 425 100 500 600 500 100 - 100 651 - 226
24 Deksametason 0,5 mg Tab 1,011 1,500 2,511 154 2,773 - 416 2,357 400 1,500 1,900 100 1,800 - 1,800 216 - - 2,141
25 Digoksin 0,25 mg Tab 200 200 - 200 - 200 200 200 - 200 - 200 - - - 200
26 Dimenhidrinat 50 mg Tab 545 - 545 15 791 - 261 530 500 - 500 - 700 - 200 500 21 - - 509
27 Domperidon 10 mg Tab 439 300 739 140 990 - 391 599 300 300 600 300 300 - 300 196 - - 403
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - -

30 Eritromisin 500 mg Tab 322 200 522 78 538 - 94 444 - 200 200 - 200 - 200 109 2,262 1,927
31 Fenitoin 30 mg Kaps 100 - 100 - 100 - 100 - - - - - - - - - - 100
32 Fenitoin 100 mg Kaps 100 - 100 - 100 - 100 - - - - - - - - - - 100
33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - -
34 Furosemid 40 mg Tab 557 200 757 130 837 - 210 627 200 200 400 - 400 - 400 182 - - 445
35 Garam oralit kombinasi Sak 394 - 394 54 340 - 340 212 - 212 - 212 - 212 76 - - 264
36 Gemfibrozil 300 mg Kaps 8 - 8 8 120 - 120 - - - - - 120 - 120 - 11 240 251
37 Glibenklamid 5 mg Tab 1,310 1,500 2,810 330 2,630 - 150 2,480 300 1,500 1,800 300 1,500 - 1,500 462 - - 2,018
38 Glimepirid 2 mg Tab 625 200 825 130 695 - 695 200 200 400 - 400 - 400 182 - - 513
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 701 500 1,201 78 2,245 - 1,122 1,123 500 500 1,000 - 1,500 - 500 1,000 109 - - 1,014
40 Griseofulvin (micronized) 125 mg Tab 330 200 530 70 491 - 31 460 50 200 250 50 200 - 200 98 - - 362
41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - -
42 Haloperidol 2 mg Tab - - - - - - - - - - - - - - -
43 Haloperidol 5 mg Tab - - - - - - - - - - - - - - - - -
44 Hiosina butilbromida 10 mg Tab 150 200 350 40 310 - 310 - 200 200 - 200 - 200 56 1,160 906
45 Ibuprofen 200 mg Tab - - - 80 - 80 - - - - - - - - - -
46 Ibuprofen 400 mg Tab 758 1,000 1,758 158 1,684 - 84 1,600 200 1,000 1,200 100 1,100 - 1,100 221 - - 1,379
47 Isosorbid dinitrat 5 mg Tab 53 100 153 - 163 - 10 153 - 100 100 - 100 - 100 - - - 153
48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - -
50 Kalsium laktat (kalk) 500 mg Tab 335 - 335 180 735 - 580 155 100 - 100 100 - - - 252 - 97
51 Kandesartan 8 mg - - - - - - - - - - - - - - -
52 Kandesartan 16 mg Tab 310 - 310 120 190 - 190 150 - 150 150 - - - 168 44 22
53 Kaptopril 12,5 mg Tab 3,413 1,500 4,913 100 4,813 - 4,813 2,700 1,500 4,200 500 3,700 - 3,700 140 - - 4,673
54 Kaptopril 25 mg Tab 3,167 1,000 4,167 171 5,496 - 1,500 3,996 2,200 1,000 3,200 100 4,500 - 1,400 3,100 239 - - 3,757
55 Karbamazepin 200 mg Tab 200 - 200 - 200 - 200 - - - - - - - - - - 200
56 Ketokonazol 200 mg Tab 438 200 638 20 768 - 150 618 150 200 350 - 350 - 350 28 - - 590
57 Ketoprofen 100 mg Tab 313 200 513 5 508 - 508 - 200 200 - 200 - 200 7 145 - 356
58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - -

59 Klindamisin 300 mg Kaps - - - - - - - - - - - - - - -
60 Kloramfenikol 500 mg Kaps 54 200 254 - 380 - 126 254 - 200 200 - 200 - 200 - - - 254
61 Klorfeniramin maleat (ctm) 4 mg Tab 1,571 2,000 3,571 75 3,991 - 495 3,496 700 2,000 2,700 - 2,700 - 2,700 105 - - 3,391
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 100 100 87 13 - 13 100 100 100 - - - 122 2,610 2,719
64 Klozapin 25 mg Tab 98 - 98 - 98 - 98 - - - - - - - - - - 98
65 Klozapin 100 mg Tab 70 - 70 1 69 - 69 - - - - - - - 1 30 - 38
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - - - - - - - -
67 Kotrimoksazol (dewasa) 480 mg Tab 580 - 580 10 870 - 300 570 300 - 300 - 300 - 300 14 - - 556
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 812 - 812 32 1,033 - 253 780 100 - 100 - 100 - 100 45 - - 735
69 Kuinin 222 mg Tab - - - - - - - - - - - - - - -
70 Lanzoprazol 30 mg Kaps 44 550 594 230 14 350 364 - 550 550 200 - 350 350 322 6,900 6,858
71 Levotiroksin 50 mµ Tab - - - - - - - - - - - - - - -
72 Levofloksasin 500 mg Tab 204 100 304 50 254 - 254 50 100 150 100 50 - 50 70 - - 184
73 Loratadin 10 mg Tab 676 500 1,176 66 1,320 - 210 1,110 500 500 1,000 - 1,000 - 1,000 92 - - 1,018
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -
78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - -
79 Meloksikam 7,5 mg Tab 30 - 30 30 - - - - - - - - - - 42 900 942
80 Meloksikam 15 mg Tab 250 - 250 30 220 - 220 100 - 100 - 100 - 100 42 - - 178
81 Metamizol (antalgin) 500 mg Tab 240 400 640 6 640 - 6 634 100 400 500 - 500 - 500 8 - - 626
82 Metformin 500 mg Tab 1,880 1,000 2,880 310 2,680 - 110 2,570 1,500 1,000 2,500 100 2,400 - 2,400 434 - - 2,136
83 Metilergometrin 0,125 mg Tab 160 - 160 - 380 - 220 160 100 - 100 - 100 - 100 - - - 160
84 Metilprednisolon 4 mg Tab 1,450 500 1,950 164 1,798 - 12 1,786 1,200 500 1,700 300 1,400 - 1,400 230 - - 1,556
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
85 Metilprednisolon 8 mg Tab - - - - - - - - - - - - - - -
86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - -
87 Metronidazol 500 mg Tab 467 500 967 98 1,168 - 299 869 - 500 500 - 500 - 500 137 2,842 2,110
88 Mineral Mix Sak 40 - 40 - 40 - 40 40 - 40 - 40 - 40 - - - 40
89 Multivitamin ibu hamil (Gestiamin) Tab 140 2,020 2,160 10 1,150 1,000 2,150 - 2,020 2,020 - 1,020 1,000 2,020 14 290 - 1,846
90 Multivitamin ibu hamil (hemafort) Tab - - - 60 - 60 - - - - - - - - - -
91 Multivitamin lansia (pehavral) Tab 570 1,000 1,570 270 1,485 - 185 1,300 300 1,000 1,300 200 1,100 - 1,100 378 - - 922
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - -
93 Natrium diklofenak 25 mg Tab 582 1,500 2,082 317 2,011 - 246 1,765 400 1,500 1,900 100 1,800 - 1,800 444 - - 1,321
94 Natrium diklofenak 50 mg Tab - - - - - - - - - - - - - - - - -
95 Nifedipin 10 mg Tab 120 - 120 - 170 - 50 120 - - - - - - - - - - 120
96 Nifedipin 20 mg Tab 290 - 290 30 500 - 240 260 240 - 240 - 240 - 240 42 - - 218
97 Nistatin 500.000 IU Tab 82 - 82 82 - - - 100 - 100 100 - - - 115 - 115
98 N-asetil sistein 200 mg kaps 270 530 800 380 70 350 420 - 530 530 180 - 350 350 532 11,400 11,512
99 OAT Kategori Anak Pkt - - - - - - - - - - - - - - -
100 OAT Kategori I Pkt 2 2 - - 2 2 2 2 - - 2 2 - - - 2
101 OAT Kategori II Pkt - - - - - - - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - -
103 Ofloksasin 200 mg Tab 200 200 20 300 - 120 180 200 200 - 300 - 100 200 28 600 448
104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - -

105 Omeprazol 20 mg Kaps 350 2,010 2,360 1,250 1,110 - 1,110 60 2,010 2,070 1,060 1,010 - 1,010 1,750 833 1,473
106 Ondansetron 4 mg Tab 57 600 657 10 699 - 52 647 - 600 600 25 600 - 25 575 14 290 - 343
107 Parasetamol 500 mg Tab 4,276 500 4,776 596 4,768 - 588 4,180 2,200 500 2,700 200 2,500 - 2,500 834 - - 3,346
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
108 Pirantel pamoat 125 mg Tab 7 100 107 - 107 - 107 - 100 100 - 100 - 100 - - - 107
109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - -
110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - -
111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - -
112 Piroksikam 20 mg Tab 215 1,000 1,215 50 1,280 - 115 1,165 100 1,000 1,100 100 1,000 - 1,000 70 - - 1,095
113 Prednison 5 mg Tab 1,500 1,500 - 1,720 - 220 1,500 1,500 1,500 - 1,500 - 1,500 - - - 1,500
114 Primakuin 15 mg Tab - - - - - - - - - - - - - - -
115 Propiltiourasil 100 mg Tab - - - - - - - - - - - - - - -
116 Propranolol 10 mg Tab 737 - 737 80 1,300 - 643 657 700 - 700 - 1,200 - 500 700 112 - - 545
117 Propranolol 40 mg Tab 370 - 370 - 430 - 60 370 200 - 200 - 200 - 200 - - - 370
118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - -
119 Risperidon 1 mg Tab - - - - - - - - - - - - - - -
121 Salbutamol 2 mg Tab 1,018 500 1,518 76 1,510 - 68 1,442 500 500 1,000 200 800 - 800 106 - - 1,336
122 Salbutamol 4 mg Tab 272 500 772 40 732 - 732 100 500 600 - 600 - 600 56 - - 676
123 Sefadroksil 500 mg Kaps 469 1,000 1,469 270 1,647 - 448 1,199 200 1,000 1,200 200 1,000 - 1,000 378 7,830 7,009
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - -
125 Setirizin 10 mg Tab 1,477 500 1,977 184 1,940 - 147 1,793 1,200 500 1,700 100 1,700 - 100 1,600 258 - - 1,535
126 Simetidin 200 mg Tab - - - - - - - - - - - - - - -
127 Simvastatin 10 mg Tab 310 - 310 30 380 - 100 280 150 - 150 - 150 - 150 42 - - 238
128 Simvastatin 20 mg Tab 1,165 500 1,665 133 1,612 - 80 1,532 500 500 1,000 - 1,000 - 1,000 186 - - 1,346
129 Siprofloksasin 500 mg Tab 545 - 545 70 685 - 210 475 350 - 350 - 350 - 350 98 - - 377
130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
131 Tambah darah kombinasi (fe dan asam folat) Tab 80 900 980 60 1,300 - 380 920 - 900 900 - 900 - 900 84 1,740 904
132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - -
133 Triheksifenidil 2 mg Tab - - - - - - - - - - - - - - -
135 Vitamin A 100.000 IU (retinol) Biru Kaps 97 350 447 36 61 350 411 - 350 350 - 50 300 350 50 1,080 719
136 Vitamin A 200.000 IU (retinol) Merah kaps 1,405 750 2,155 654 751 750 1,501 1,400 750 2,150 650 750 750 1,500 916 - - 585
137 Vitamin B 1 (tiamin) 50 mg Tab 867 1,000 1,867 20 1,917 - 70 1,847 200 1,000 1,200 - 1,200 - 1,200 28 - - 1,819
138 Vitamin B 6 (piridoksin) 10 mg Tab 770 500 1,270 150 1,120 - 1,120 300 500 800 500 300 - 300 210 - - 910
139 Vitamin B kompleks Tab 1,103 1,500 2,603 254 2,349 - 2,349 100 1,500 1,600 100 1,500 - 1,500 356 7,366 5,373
140 Vitamin C (asam askorbat) 50 mg Tab 847 - 847 240 607 - 607 300 - 300 300 - - - 336 240 - 31
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 310 - 310 41 469 - 200 269 200 - 200 100 200 - 100 100 57 - - 212
142 Vitamin Hepagard Tab 165 - 165 40 155 - 30 125 150 - 150 - 150 - 150 56 - - 69
143 Zinc tablet dispersibel 20 mg Tab 335 200 535 290 445 - 200 245 100 200 300 200 300 - 200 100 406 - 161
TAMBAHAN - - - - - - - - - - - - - - -
1 Becefort 800 800 - - 800 800 800 800 - - - - - - - 800
2 Imbos forte 630 630 - - 630 630 630 630 - - - - - - - 630
3 Livron B Plex - - - - - - - - - - - - - - -
4 Multivitamin (Sivit - Zink) - - - - - - - - - - - - - - -
5 Oseltamivir 75 mg 570 570 - - 570 570 570 570 - - - - - - - 570

INJEKSI - - - - - - - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 13 - 13 9 6 - 2 4 - - - - - - - 13 270 279
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 20 20 - 20 - 20 20 20 - 20 - 20 - - - 20
3 Aminofilin 24 mg/ml Amp 27 - 27 5 22 - 22 15 - 15 6 15 - 6 9 7 - - 15

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 15 - 15 - 25 - 10 15 7 - 7 - 7 - 7 - - - 15
5 Antrain Inj Amp - - - - - - - - - - - - - - -
6 Artemether 80 mg/ml Amp - - - - - - - - - - - - - - -
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - - - - - - -
8 Asam traneksamat 50 mg/ml Amp - - - 40 - 40 - - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp 10 20 30 30 - - - 10 20 30 20 10 - 10 42 - 42
10 Atropin 0,25 mg/ml Amp 3 - 3 - 3 - 3 - - - - - - - - - - 3
11 Deksametason 5 mg/ml Amp 28 50 78 2 122 - 46 76 10 50 60 - 60 - 60 3 - - 73

Pangkalan Bun, 30 September 2011
12 Difenhidramin hcl 10 mg/ml Amp Subsie Evaluasi
35 dan 30
Perencanaan
65 - 65 - 65 - 30 30 - 30 - 30 - - - 65
13 Epinefrin (adrenalin) 0,1% Amp 51 - 51 41 20 - 10 10 30 - 30 30 - - - 57 41 88
14 Furosemid 10 mg/ml Amp 16 10 26 1 36 - 11 25 10 10 20 - 20 - 20 1 - - 24

MARIYANI
15 Flufenazin 25 mg/ml (Sikzonoate) Amp NIP: 19750812 200003
- 2 003 - - - - - - - - - - - - - -
16 Gentamisin 40 mg/ml Amp 10 - 10 10 - - - - - - - - - - 14 300 314
17 Haloperidol 5 mg/ml Amp - - - - - - - - - - - - - - -

18 Haloperidol 50 mg/ml Amp - - - - - - - - - - - - - - -
19 Kalsium glukonat 10 % Amp 20 - 20 10 10 - 10 10 - 10 - 10 - 10 14 - 4
20 Ketorolak 30 mg/ml Amp 20 15 35 15 20 - 20 - 15 15 - 15 - 15 21 450 451
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - - - - - - -
22 Lidokain 2 % Amp 135 100 235 18 225 - 8 217 87 100 187 - 187 - 187 25 - - 192
23 Lidokain kompositum Amp 60 - 60 32 82 - 54 28 60 - 60 - 60 - 60 45 - 17

24 Magnesium sulfat 20 % (i.v.) Btl 7 20 27 - 29 - 2 27 2 20 22 - 22 - 22 - - - 27
25 Magnesium sulfat 40 % (i.v.) Btl 11 2 13 - 18 - 5 13 6 2 8 - 8 - 8 - - - 13
26 Metamizol (antalgin) 500 mg/2 ml Amp 120 - 120 6 120 - 6 114 100 - 100 10 100 - 10 90 8 - - 106
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
27 Metilergometrin 0.2 mg/ml Amp 50 50 50 - - - 50 50 50 - - - 70 1,500 1,570
28 Oksitosin 10 iu/ml Amp 6 30 36 20 17 - 1 16 - 30 30 30 - - - 28 600 612
29 Omeprazole 40 mg/ml Amp 15 50 65 7 58 - 58 - 50 50 30 20 - 20 10 210 162
30 Ondansetron 4 mg/2 ml Amp 68 100 168 19 157 - 8 149 - 100 100 - 100 - 100 27 570 448
31 Piracetam 1 gr Amp 14 20 MENGETAHU

MENGETA
34 1 44 - 11 33 ,MENGETAHUI
,MENGETAHUI
10 20 30 - 30 - 30 1 - - 32
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
32 MENGETA
Prokain benzil penisillin 3 juta iu/ml Amp - Kepala
Kepala
- Dinas - - - -KabupatenKotawaringin
Kabupaten Kotawaringin- - - - - - - - -
,HUI Dinas
Kesehatan Barat
Barat
33 Kepala 25 ml/ml
Ranitidin Amp - -
Kesehatan
Kabupaten - 27 - 27 - - - - - - - - - -
Dinas Kotawaringin
Kabupaten
34 Sefotaksim serb. inj 1000 mg
Kesehatan Vial 1 15 16
Kotawaring
Barat 1 15 - 15 - 15 15 - 15 - 15 1 30 16
Kabupate in Barat
35 Seftriakson
n serb. inj 1.000 mg Vial 15 15 - 15 - 15 15 15 - 15 - 15 - - - 15
Kotawarin drg.INDRAWAN
drg.INDRAWAN
36 Vitamin
gin BaratK 1 (fitomenadion) 2 mg/ml Amp 33 60 93 24 98 - 29 69 -
SAKTI,MKes
SAKTI,MKes 60 60 - 60 - 60 34 720 685
NIP:
NIP:19610521
19610521199303
19930311
37 Vitamin K 1 (fitomenadion) 10 mg/ml (i.m.) Amp - -
drg.INDRAW - - - - 004
004 - - - - - - - - -
drg.INDRA
AN
38 Vitamin B 1 (tiamin) 100 mg /ml Amp - -
SAKTI,MKes
WAN - - - - - - - - - - - - -
SAKTI,MKe
NIP:
39 drg.INDRA
Vitamin B 12 (sianokobalamin) 500 mcg Amp 65 50 115
19610521
s 15 118 - 18 100 12 50 62 - 62 - 62 21 - - 79
WAN 199303
NIP: 1
SAKTI,MK
TAMBAHAN - 19610521
004
- - - - - - - - - - - - - -
es 199303 1
1 AirNIP:
untuk injeksi (aqua pro injeksi) 10 ml - - 004
- - - - - - - - - - - - - -
19610521
199303
NARKOTIKA
1 & PSIKOTROPIKA - - - - - - - - - - - - - - -
004
1 Diazepam (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - - - - - - - -
3 Diazepam 2 mg Tab - - - - - - - - - - - - - - - -
4 Diazepam 5 mg Tab 37 - 37 - - 37 37 - - - - - - - - - - 37
5 Diazepam 5 mg/ml (i.v.) Amp 80 - 80 10 - 70 70 - - - - - - - 14 - - 56
6 Fenobarbital 50 mg/ml Amp 30 - 30 - - 30 30 - - - - - - - - - - 30
7 Fenobarbital 30 mg Tab 100 - 100 - - 100 100 - - - - - - - - - - 100

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
8 Kodein 10 mg Tab 200 - 200 - - 200 200 - - - - - - - - - - 200
9 Klobazam 10 mg Tab - - - - - - - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - - - - - - - -
1 Antifungi kombinasi Tube 10 10 20 - 20 - 20 - 10 10 - 10 - 10 - - - 20
2 Antihemoroid kombinasi Supp 21 - 21 - 30 - 9 21 20 - 20 3 17 - 17 - - - 21
3 Asiklovir 5% Krim Tube 12 50 62 6 59 - 3 56 - 50 50 - 50 - 50 8 174 126
4 Basitrasin - polimiksin B Tube - - - 36 - 36 - - - - 4 - 4 - - - -
5 Bedak salisil 2% Ktk 2 - 2 2 2 - 2 - - - - - - - - 3 60 63
6 Betametason 0,1% krim Tube 32 50 82 16 87 - 21 66 - 50 50 - 50 - 50 22 464 420
7 Bioplacenton krim Tube - - - - - - - - - - - - - - -
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 58 - 58 23 35 - 35 - - - - - - - 32 690 687
10 Desoksimetason 0,25 % krim Tube 31 - 31 2 29 - 29 20 - 20 - 20 - 20 3 - - 26
11 Gentamisin salep kulit Tube 41 - 41 4 37 - 37 23 - 23 - 23 - 23 6 - - 31

12 Gentamisin salep mata Tube 32 24 56 - 59 - 3 56 15 24 39 - 39 - 39 - - - 56
13 Hidrokortison 2,5% krim Tube 30 - 30 2 64 - 36 28 25 - 25 - 25 - 25 3 - - 25
14 Ketokonazol 2 % krim Tube 36 - 36 6 39 - 9 30 33 - 33 - 33 - 33 8 - - 22
15 Ketoprofen 100 mg Supp 10 10 - 10 - 10 10 10 - 10 - 10 - - - 10
16 Kloramfenikol 1% salep mata Tube 40 - 40 - 60 - 20 40 24 - 24 - 24 - 24 - - - 40
17 kloramfenikol 3% salep kulit Tube 24 - 24 3 33 - 12 21 2 - 2 - 19 - 17 2 4 - - 17

18 Mikonazol 2 % krim Tube 42 24 66 5 91 - 30 61 32 24 56 - 56 - 56 7 - - 54
19 metronidazol ovula 500 mg ovul 40 - 40 - 40 - 40 - - - - - - - - - - 40
20 Nistatin 100.000 IU Supp 42 - 42 - 102 - 60 42 42 - 42 - 42 - 42 - - - 42

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
21 Oksitetrasiklin salep kulit Tube 20 - 20 5 18 - 3 15 - - - - - - - 7 150 142

22 Oksitetrasiklin salep mata Tube 28 25 53 - 58 - 5 53 5 25 30 30 - - - - - - 53
23 povidon iodin / betadine salep Tube 12 5 17 7 10 - 10 11 5 16 16 - - - 10 - - 0
24 Salep 2-4 kombinasi krim Tube 48 48 - 64 - 16 48 48 48 - 48 - 48 - - - 48
25 Sulfadiazine 10 Mg Salep Tube 7 5 12 2 - 10 10 5 5 10 10 - - - 3 - - 7
SIRUP - - - - - - - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 59 50 109 1 136 - 28 108 44 50 94 - 94 - 94 1 - - 107
3 ambroxol sirup 30 mg/5 ml Btl 117 - 117 2 118 - 3 115 100 - 100 - 100 - 100 3 - - 112
4 Amoksisilin sirup kering 125 mg/5 ml Btl 47 - 47 11 103 - 67 36 2 - 2 - 2 - 2 15 - - 21
5 Amoksisilin sirup kering 250 mg/5 ml Btl 112 - 112 1 116 - 5 111 90 - 90 - 95 - 5 90 1 - - 110
6 Antasida susp Btl 33 200 233 17 216 - 216 - 200 200 - 200 - 200 24 493 301
7 Caviflex sirup Btl - - - - - - - - - - - - - - -
8 Dextrofen sirup Btl 34 100 134 6 169 - 41 128 4 100 104 - 104 - 104 8 - - 120
9 Domperidon sirup 5 mg/5 ml Btl 85 - 85 4 89 - 8 81 42 - 42 - 42 - 42 6 - - 75
10 Ibuprofen sups 100 mg / 5 ml Btl - 50 50 - 50 - 50 - 50 50 - 50 - 50 - - - 50
11 Ibuprofen sups 200 mg / 5 ml Btl 9 - 9 8 1 - 1 - - - - - - - 11 240 250
12 Kloramfenikol susp 125 mg/5 ml Btl 34 - 34 2 54 - 22 32 15 - 15 - 15 - 15 3 - - 29
13 Kotrimoksazol susp 240 mg/5 ml Btl 15 100 115 - 115 - 115 - 100 100 - 100 - 100 - - - 115
14 Laktulosa 3,335 g/5 ml Btl 18 - 18 - 18 - 18 17 - 17 - 17 - 17 - - - 18
15 Metronidazol susp 125 mg/5 mL Btl 24 - 24 - 25 - 1 24 18 - 18 - 19 - 1 18 - - - 24
16 Nistatin drop 100.000 IU/ml Btl 16 - 16 - 17 - 1 16 10 - 10 - 10 - 10 - - - 16
17 Obat batuk hitam (OBH) sirup Btl 46 - 46 14 54 - 22 32 - - - - - - - 20 420 408
18 Parasetamol drops 100 mg/ml Btl 40 120 160 - 204 - 44 160 10 120 130 - 136 - 6 130 - - - 160
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
19 Parasetamol sirup 120 mg/5 ml Btl 63 100 163 16 187 - 40 147 25 100 125 - 125 - 125 22 - - 125
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - - - - - - - -
21 Procuma sirup Btl 73 50 123 8 120 - 5 115 54 50 104 - 104 - 104 11 - - 104
22 Sefadroksil sirup kering 125 mg/5 ml Btl 63 50 113 8 158 - 53 105 - 50 50 - 84 - 34 50 11 240 146
23 sefadroxil sirup kering 250 mg /forte Btl 92 - 92 1 124 - 33 91 71 - 71 - 71 - 71 1 - - 90
24 setirizin 5mg / 5 ml Btl 88 100 188 10 180 - 2 178 37 100 137 - 137 - 137 14 - - 164
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - - - - - - -
26 Zink sirup 20mg/ 5ml Btl 44 - 44 4 40 - 40 20 - 20 - 20 - 20 6 - - 34
TAMBAHAN - - - - - - - - - - - - - - -
1 Becefort syrup Btl - - - - - - - - - - - - - - - -
2 Imbos Syrup Btl - 6 6 - - 6 6 6 6 - - 6 6 - - - 6
LARUTAN - - - - - - - - - - - - - - -
1 Alkazyme Bks - - - - - - - - - - - - - - - -
2 Alkacide btl - - - - - - - - - - - - - - - -
3 Bromhexin (Bisolvon) Btl 1 - 1 - 1 - 1 1 - 1 - 1 - 1 - - - 1
4 Etanol 70 % 1000 ml Btl 75 75 150 77 73 - 73 75 75 150 77 73 - 73 108 - 35

5 Etakridinn laktat 0,1% (rivanol) Btl 6 - 6 1 5 - 5 5 - 5 - 5 - 5 1 - - 4
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - - - - - - -
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - - - - - - -
8 Gentamisin 0,3 % tetes mata Btl 22 - 22 5 17 - 17 17 - 17 5 12 - 12 7 - - 10
9 Gentian violet 1 % Btl 62 - 62 - 82 - 20 62 49 - 49 10 39 - 39 - - - 62
10 Glukosa 10 % (D.10) 500 ml Btl 13 10 23 - 29 - 6 23 1 10 11 - 29 - 18 11 - - - 23
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 15 - 15 - 39 - 24 15 - - - - 29 - 29 - - - - 15

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
13 KA-EN 1 B 500 ml Btl 16 - 16 - 28 - 12 16 16 - 16 - 26 - 10 16 - - - 16
14 KA-EN 3 B 500 ml Btl 10 20 30 - 48 - 18 30 10 20 30 - 38 - 8 30 - - - 30
15 kloramfenikol Tetes mata Btl - - - - - - - - - - - - - - -
16 Kloramfenikol 3% tetes telinga Btl 8 - 8 - 9 - 1 8 8 - 8 8 - - - - - - 8
17 Lysol 1 liter Btl 6 - 6 2 4 - 4 6 - 6 2 4 - 4 3 - - 1
18 Metronidazol infus 5 mg/ml Btl 1 - 1 - 1 - 1 1 - 1 - 1 - 1 - - - 1
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 51 60 111 11 100 - 100 24 60 84 10 74 - 74 15 - - 85
20 Povidon iodin 10 % 30 ml Btl 8 10 18 - 21 - 3 18 5 10 15 1 14 - 14 - - - 18
21 Povidon iodin 10 % 300 ml Btl 13 - 13 1 19 - 7 12 10 - 10 - 10 - 10 1 - - 11
22 Parasetamol infus 10 mg/ml Btl - - - 2 - 2 - - - - - - - - - -
23 Ringer laktat (RL) 500 ml Btl 71 100 171 9 169 - 7 162 53 100 153 20 133 - 133 13 - - 149
TAMBAHAN - - - - - - - - - - - - - - - -
1 Bayclin - - - - - - - - - - - - - - - -
2 larutan disenfektan karbol Btl 48 - 48 - 48 - 48 - - - 48 - 48 - - - - 48

3 Sabun cuci tangan Btl 23 11 34 - 34 - 34 11 11 - 34 - 23 11 - - - 34
4 Alkohol 1 liter - - - - - - - - - - - - - - - -
5 antiseptic gel - - - - - - - - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial - - - - - - - - - - - - - - -
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 6 - 6 - - 6 6 - - - - - - - - - - 6
4 Vaksin BCG Vial 14 10 24 - - 24 24 - 10 10 - - 10 10 - - - 24
5 Vaksin campak Vial - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
6 Vaksin hepatitis (HBO) Bayi Pouches 36 - 36 - - 36 36 - - - - - - - - - - 36
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 - 10 - - 10 10 - - - - - - - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 13 - 13 - - 13 13 - - - - - - - - - - 13
11 Vaksin kombinasi DPT-HB-Hib Vial 93 20 113 - - 113 113 - 20 20 - - 20 20 - - - 113
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 10 10 - - 10 10 10 10 - - 10 10 - - - 10
13 Vaksin polio t-opv drops 10 dosis Vial 30 20 50 - - 50 50 - 20 20 - - 20 20 - - - 50
14 vaksin MR Vial 3 20 23 - - 23 23 - 20 20 - - 20 20 - - - 23
TAMBAHAN -
ADS 0,05 ML - - - - - - - - - - - - - - - -
ADS 0,5 ML - 300 300 - - 300 300 300 300 - - 300 300 - - - 300
ADS 5 ML - - - - - - - - - - - - - - - -
Safety box 5 L - - - - - - - - - - - - - - - -
VAKSIN SINOVAC - - - - - - - - - - - - - - - -
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set - - - - - - - - - - - - - - -
2 Alat suntik sekali pakai 0,5 ml Set 10,000 10,000 - - 10,000 10,000 10,000 10,000 - - 10,000 10,000 - - - 10,000
3 Alat suntik sekali pakai 1 ml Set 354 - 354 - 340 14 354 300 - 300 - 300 - 300 - - - 354
4 Alat suntik sekali pakai 3 ml Set 464 - 464 10 512 - 58 454 440 - 440 100 340 - 340 14 - - 440
5 Alat suntik sekali pakai 5 ml Set 487 - 487 5 516 - 34 482 430 - 430 5 430 - 5 425 7 - - 475
6 Alat suntik sekali pakai 10 ml Set 5 50 55 19 36 - 36 - 50 50 20 30 - 30 27 570 561
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
8 Alkohol swabs Pcs 10,000 10,000 - 11,700 - 1,700 10,000 100 10,000 10,100 100 11,700 - 1,700 10,000 - - - 10,000
9 Antiseptik gel 500 ml Btl 62 62 124 80 44 - 44 59 62 121 77 44 - 44 112 - 68
10 Bisturi uk.20 Pcs 21 - 21 - 29 - 8 21 20 - 20 9 20 - 9 11 - - - 21
11 Bisturi uk.21 Pcs 9 - 9 4 5 - 5 8 - 8 8 - - - 6 - 1
12 Blood transfusi set Set 10 - 10 5 5 - 5 5 - 5 5 - - - 7 - 2
13 Cat gut chromic 2/0 Pcs 12 - 12 - 22 - 10 12 5 - 5 5 - - - - - - 12
14 Cat gut chromic 3/0 Pcs 34 24 58 28 30 - 30 - 24 24 - 24 - 24 39 840 849
15 Cat gut plain 2/0 Sak 75 - 75 2 85 - 12 73 72 - 72 - 72 - 72 3 - - 70

16 Cat gut plain 3/0 Sak 56 - 56 - 57 - 1 56 56 - 56 - 56 - 56 - - - 56
17 Folly catheter No.16 pcs 8 10 18 - 21 - 3 18 5 10 15 - 15 - 15 - - - 18
18 Folly catheter No.18 pcs 10 10 20 - 24 - 4 20 6 10 16 - 16 - 16 - - - 20
19 I.V. catheter No.18 pcs 77 50 127 - 136 - 9 127 59 50 109 10 99 - 99 - - - 127
20 I.V. catheter No.20 pcs 35 50 85 2 84 - 1 83 35 50 85 22 63 - 63 3 - - 80
21 I.V. catheter No.22 pcs 70 50 120 10 110 - 110 65 50 115 20 95 - 95 14 - - 96

22 I.V. Catheter No.24 pcs 19 50 69 4 65 - 65 - 50 50 - 50 - 50 6 120 61
23 I.V. Catheter No.26 pcs 9 - 9 - 10 - 1 9 5 - 5 - 5 - 5 - - - 9
24 Infus set anak pcs 20 20 40 23 17 - 17 - 20 20 5 15 - 15 32 667 682
25 Infus set dewasa pcs 100 100 - 139 - 39 100 - 100 100 5 110 - 15 95 - - - 100
26 Jarum (needle) 23 Pcs 18 - 18 5 13 - 13 18 - 18 5 13 - 13 7 - - 6
27 Jarum (needle) 27 Pcs 79 - 79 9 70 - 70 75 - 75 5 70 - 70 13 - - 57

28 K.y jelly 82 gram Tube 2 10 12 - 16 - 4 12 4 10 14 - 14 - 14 - - - 12
29 Kapas pembalut/absorben 250 gram Bks 7 - 7 - 16 - 9 7 6 - 6 - 14 - 8 6 - - - 7
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 75 - 75 - 80 - 5 75 75 - 75 - 75 - 75 - - - 75

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 - 20 - 20 20 - 20 - 20 - 20 - - - 20
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 76 - 76 - 80 - 4 76 76 - 76 - 76 - 76 - - - 76
34 Kasa kompres 40/40 steril Roll 95 50 145 - 146 - 1 145 111 50 161 31 130 - 130 - - - 145
35 Kasa 40 m x 80 cm Roll - - - - - - - - - - - - - - -
36 Kasa pembalut 2 m x 80 cm Roll ,Pangkalan38

Bun,31 Desember
- 201238 14 24 - 24 30 - 30 15 15 - 15 20 - - 4
Kepala Instalasi Farmasi Kabupaten
37 Kasa steril 16x16 cm ktk Kotawaringin
9 Barat
50 59 - 59 - 59 3 50 53 - 57 - 4 53 - - - 59
38 Kertas puyer biasa Pack 2 - 2 1 1 - 1 2 - 2 1 1 - 1 1 - 0
39 Kertas puyer press Pack 900 - 900 - 1,100 - 200 900 900 - 900 - 1,100 - 200 900 - - - 900
40 Kondom Sutra pcs SONNY SAPUTRA,SKM

- - - - - - - - - - - - - - -
NIP: 19750508 199903 1 002
41 Masker Pcs 8,550 - 8,550 - 8,550 - 8,550 8,550 - 8,550 - 8,550 - 8,550 - - - 8,550
42 Masker N 95 pcs 260 - 260 148 112 - 112 312 - 312 200 112 - 112 207 - 95
43 Penjepit tali pusat Pcs 4 30 34 4 30 - 30 - 30 30 - 30 - 30 6 116 92
44 penghisap lendir pcs 24 20 44 - 49 - 5 44 - 20 20 - 40 - 20 20 - - - 44

45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr - - - - - - - - - - - - - - -
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr - - - - - - - - - - - - - - -

,MENGETAHUI
47 Plester 1,25 X 4,5 m Roll Kepala Dinas Kesehatan
- - - - - - - - - - - - - - -
Kabupaten Kotawaringin Barat
48 Plester 5cm x 4,5 cm Roll - - - - - - - - - - - - - - -
49 Plester bulat/ plesterin pcs 200 - 200 - 563 - 363 200 200 - 200 - 563 - 363 200 - - - 200
50 Plester cannofix pcs drg.INDRAWAN

20 SAKTI,M.Kes
20 40 - 6 34 40 20 20 40 - 6 34 40 - - - 40
NIP: 19610521 199303 1 004
51 Plester dermafix Pcs - - - - - - - - - - - - - - -
52 Plester hypafix Roll 10 10 - 16 - 6 10 - 10 10 1 15 - 6 9 - - - 10
53 Safety box Bh 10 20 30 - 26 4 30 4 20 24 - 20 4 24 - - - 30
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
54 Sarung tangan non steril Uk. S Psg 3,150 3,150 6,300 3,350 2,950 - 2,950 3,150 3,150 6,300 3,350 2,950 - 2,950 4,690 - 1,740
55 Sarung tangan non steril Uk. M Psg 3,600 3,600 7,200 7,064 136 - 136 3,600 3,600 7,200 7,064 136 - 136 9,890 - 9,754
56 Sarung tangan non steril Uk. L Psg 1,750 7,800 9,550 - 9,550 - 9,550 1,750 7,800 9,550 - 9,550 - 9,550 - - - 9,550
57 Sarung tangan steril ginekologi Psg 3 - 3 - 3 - 3 3 - 3 - 3 - 3 - - - 3
58 Sarung tangan steril No.6 Psg - - - - - - - - - - - - - - -
59 Sarung tangan steril No.6,5 Psg 72 - 72 11 61 - 61 63 - 63 3 60 - 60 15 - - 46
60 Sarung tangan steril No.7 Psg 17 - 17 13 4 - 4 20 - 20 20 - - - 18 - 14
61 Sarung tangan steril No.7,5 Psg 42 - 42 3 56 - 17 39 17 - 17 - 17 - 17 4 - - 35
62 Sarung Tangan steril no.8 Psg 96 - 96 - 184 - 88 96 96 - 96 - 167 - 71 96 - - - 96
63 Selang oksigen anak Pcs 17 - 17 - 19 - 2 17 16 - 16 9 10 - 3 7 - - - 17
64 Selang oksigen bayi Pcs 26 - 26 - 32 - 6 26 20 - 20 - 26 - 6 20 - - - 26

65 Selang oksigen dewasa Pcs 8 20 28 7 21 - 21 3 20 23 8 15 - 15 10 - - 11
66 Sendok kertas puyer Pcs - - - - - - - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 1 72 73 2 82 - 11 71 - 72 72 1 72 - 1 71 3 58 - 10
68 Silk (benang bedah sutra) No. 3/0 Sak 6 36 42 4 38 - 38 8 36 44 8 36 - 36 6 116 84
69 Speculum Uk S pcs - - - - - - - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - - - - - - - -
71 Speculum Uk L pcs - - - 18 - 18 - - - - 18 - 18 - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - - - - - - - -
73 Underpads Pcs 10 50 60 10 50 - 50 - 50 50 - 50 - 50 14 290 254
74 Urin bag Pcs 11 20 31 5 26 - 26 - 20 20 - 20 - 20 7 150 131
75 Wing needle no 27 G Pcs 71 - 71 - 71 - 71 71 - 71 - 71 - 71 - - - 71
TAMBAHAN - - - - - - - - - - - - - - -
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
1 Back pack sprayer Pcs - - - - 2 - 2 - 2 - 2 - 2 - 2 - - - -
2 Rapid test covid-19 antibody Pcs - 75 75 - 3 72 75 3 75 78 - 3 - 3 - - - - 75
3 Rapid test antigen Pcs - 25 25 - 2 23 25 4 25 29 - 2 - 2 - - - - 25
4 Masker KN 95 - - - - 40 - 40 - 5 - 5 - 40 - 40 - - - -
5 Masker N95 - - - - 30 - 30 - 6 - 6 - 30 - 30 - - - -
6 Masker Bedah - - - - 47 - 47 - 7 - 7 - 47 - 47 - - - -
7 Kacamata google - - - - 24 - 24 - 8 - 8 - 24 - 24 - - - -
8 Face shield Nagita - 35 35 - 460 - 425 35 9 35 44 - 460 - 460 - - - - 35
9 Face shield naik turun - - - - 5,256 - 5,256 - 10 - 10 - 5,256 - 5,256 - - - -
10 Face shield - - - - 1,262 - 1,262 - 11 - 11 - 1,262 - 1,262 - - - -
11 Sepatu boot - - - - 231 - 231 - 12 - 12 - 231 - 231 - - - -
12 Baju Hazmat kain - - - - 6 - 6 - 13 - 13 - 6 - 6 - - - -
13 Baju Hazmat cuci ulang - - - - - - - 14 - 14 - - - - - - -
14 Hand schoon M - - - - 300 - 300 - 15 - 15 - 300 - 300 - - - -

15 Hand schoon L - - - - 35 - 35 - 16 - 16 - 35 - 35 - - - -
16 Hand schoon s - - - - 5 - 5 - 17 - 17 - 5 - 5 - - - -
17 Hand schoon steril no 7,5 - - - - 50 - 50 - 18 - 18 - 50 - 50 - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - 19 - 19 - - - - - - -
19 APD - - - - - - - 20 - 20 - - - - - - -
20 APD SET HIJAU - - - - - - - 21 - 21 - - - - - - -

21 APD BOHO - - - - - - - 22 - 22 - - - - - - -
22 APD LEVEL 2 - - - - - - - 23 - 23 - - - - - - -
23 APD LEVEL 3 - - - - - - - 24 - 24 - - - - - - -
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
24 APD PEMDA/DONASI - - - - - - - 25 - 25 - - - - - - -
25 APD 1 SET - - - - - - - 26 - 26 - - - - - - -
26 GOWN - - - - - - - 27 - 27 - - - - - - -
27 COOL BOK 6 LITER - - - - - - - 28 - 28 - - - - - - -
28 COOL BOK 12,5 LITER - - - - - - - 29 - 29 - - - - - - -
29 ANAFILATIK KIT - 5 5 - - 5 5 30 5 35 - - 1 1 - - - 5
BAHAN & ALAT LABORATORIUM - - - - - - - - - - - - - - -
1 Asam asetat (Cuka) Btl - - - - - - - - - - - - - - -
2 Alat pulmo (peak flow) set - - - - - - - - - - - - - - -
3 Bilik hitung Pcs 2 - 2 - 2 - 2 - - - - 2 - 2 - - - - 2
4 Blood lancet Pcs 242 1,000 1,242 - - 1,242 1,242 - 1,000 1,000 - - 1,000 1,000 - - - 1,242
5 Bulb pipet Bh - - - - - - - - - - - - - - -
6 Cartrialge genexpert KIT set - - - - - - - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - - - - - - - -

8 Compresson nebulizer pcs - - - - - - - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - - - - - - - -
13 Kaca slide/ Kaca objek Set 222 - 222 - - 222 222 - - - - - - - - - - 222
14 KIT diagnostic untuk HIV Pcs - - - - - - - - - - - - - - - -
15 KIT RPR pcs - - - - - - - - - - - - - - -
16 Kotak slide Pcs 5 - 5 - - 5 5 - - - - - - - - - - 5

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
17 Lampu spiritus 150 ml Pcs 2 - 2 - - 2 2 - - - - - - - - - - 2
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - - - - - - - -
20 Medline Pcs - - - - - - - - - - - - - - -
21 Microhematokrit tube wax Pcs - - - - - - - - - - - - - - -
22 Mikro tube (Vol 1,5 ml) Pcs - - - - - - - - - - - - - - -
23 Mikroskope cover glasses 18x18 mm Pcs 25 - 25 - - 25 25 - - - - - - - - - - 25
24 Mikroskope cover glasses 20x20 mm Pcs - - - - - - - - - - - - - - - -
25 Mikroskope cover glasses 22x22 mm Pcs - - - - - - - - - - - - - - -
27 Nebulizer Bh - - - - - - - - - - - - - - -
28 Peak flow meter Pcs - - - - - - - - - - - - - - -
29 Pen lancet Pcs 5 - 5 - - 5 5 - - - - - - - - - - 5
30 Pengukur tinggi badan Pcs - - - - - - - - - - - - - - - -

31 Pipet eritrosit Pcs 2 - 2 - - 2 2 - - - - - - - - - - 2
32 Pipet HB Pcs 2 - 2 - - 2 2 - - - - - - - - - - 2
33 Pipet leukosit Pcs 2 - 2 - - 2 2 - - - - - - - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - - - - - - - - -
35 Pipet westergren Bh - - - - - - - - - - - - - - -
36 Pot dahak Pcs 85 - 85 - - 85 85 - - - - - - - - - - 85

37 Pot urine Pcs - - - - - - - - - - - - - - -
38 Rak staenles tes tube Test - - - - - - - - - - - - - - -
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test - - - - - - - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - - - - - - - - - - -
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 86 100 186 - - 186 186 50 100 150 - - 150 150 - - - 186
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test - - - - - - - - - - - - - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test 49 - 49 - - 49 49 50 - 50 - - 50 50 - - - 49
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 50 50 - - 50 50 50 50 - - 50 50 - - - 50
49 Rapid test pemeriksaan malaria Test 25 - 25 - - 25 25 25 - 25 - - 25 25 - - - 25
50 Reagen Cell clean Btl - - - - - - - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 50 50 - - 50 50 50 50 - - 50 50 - - - 50
52 Reagen Giemsa Btl 1 - 1 - - 1 1 - - - - - - - - - - 1
53 Reagen Gol Darah Btl 4 - 4 - - 4 4 - - - - - - - - - - 4

54 Reagen Gol darah anti D Btl - - - - - - - - - - - - - - -
55 Reagen Immersion Btl 1 - 1 - - 1 1 - - - - - - - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 3 - 3 - - 3 3 - - - - - - - - - - 3
58 RPR Sipilis fokus Pcs - - - - - - - - - - - - - - -
59 Spritus Btl 1 - 1 - - 1 1 - - - - - - - - - - 1
60 Tabung hematokrit heparin Pcs 125 - 125 - - 125 125 - - - - - - - - - - 125
61 Tabung hematokrit non heparin Pcs 25 - 25 - - 25 25 - - - - - - - - - - 25
62 Tabung vacutainer edta warna ungu Pcs - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
63 Test asam urat Pcs 200 200 400 400 - - - - 200 200 - - 200 200 560 - 560
64 Test gluco protein urine Pcs 30 - 30 30 - - - - - - - - - - 42 900 942
65 Test iodium Pcs 8 - 8 - - 8 8 - - - - - - - - - - 8
66 Test kehamilan / PP test Test 4 - 4 - - 4 4 - - - - - - - - - - 4
67 Test kolestrol Tube 250 250 500 500 - - - - 250 250 - - 250 250 700 - 700
68 Test pemeriksaan gula darah Pcs 200 1,200 1,400 248 1,152 - 1,152 - 1,200 1,200 - - 1,200 1,200 347 - - 805
69 Test pemeriksaan HB Test - - - - - - - - - - - - - - -
70 Test Pemeriksaan Urine 10 Parameter Test 150 - 150 - - 150 150 - - - - - - - - - - 150
71 Tipe mikro pipet warna biru Test 250 - 250 - - 250 250 - - - - - - - - - - 250
72 Tipe mikro pipet warna kuning Test 157 - 157 - - 157 157 - - - - - - - - - - 157
73 Tipe mikro pipet warna putih Test - - - - - - - - - - - - - - -
74 Tisue mikroskop Pcs - - - - - - - - - - - - - - -
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs - - - - - - - - - - - - - - -

77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - - - - - - - -
TAMBAHAN - - - - - - - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 40 50 90 - - 90 90 40 50 90 - - 90 90 - - - 90
BAHAN GIGI - - - - - - - - - - - - - - -
1 Bahan tambahan light curing 2 - 2 - - 2 2 - - - - - - - - - - 2
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - - - - - - - - -

3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - - - - - - - - -
4 Bonding resine Btl 2 - 2 - - 2 2 - - - - - - - - - - 2
5 Caviton Btl 2 - 2 - - 2 2 - - - - - - - - - - 2
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
6 Cellopand strip swenska Pack 2 - 2 - - 2 2 - - - - - - - - - - 2
7 Devitalisasi pasta Btl 2 - 2 - - 2 2 - - - - - - - - - - 2
8 Etil klorida semprot 100 ml Btl 3 - 3 - - 3 3 - - - - - - - - - - 3
9 Etching SDI liquid / Acid ethan liquid Btl 3 - 3 - - 3 3 - - - - - - - - - - 3
10 Eugenol cairan Btl 2 - 2 - - 2 2 - - - - - - - - - - 2
11 Endometason Pcs - - - - - - - - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 2 - 2 - - 2 2 - - - - - - - - - - 2
13 Fraser / Bentuk silinder Bh 2 - 2 - - 2 2 - - - - - - - - - - 2
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - - - - - - - - -
15 Gutta percha poins Ktk 2 - 2 - - 2 2 - - - - - - - - - - 2
16 H-file Pcs - - - - - - - - - - - - - - -
17 K-file Pcs - - - - - - - - - - - - - - -
18 Kalsium hidroksida pasta Ktk 2 - 2 - - 2 2 - - - - - - - - - - 2
19 Kertas artikulasi (articulating paper) Pack 2 - 2 - - 2 2 - - - - - - - - - - 2

20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - - - - - - - - -
24 Mata bor mikromotor (RA) Pack 1 - 1 - - 1 1 - - - - - - - - - - 1
25 Mata bor white stone Set 1 - 1 - - 1 1 - - - - - - - - - - 1

26 Mata bor hand place (FG diamond) Set - - - - - - - - - - - - - - - -
27 Mata bor tulang / Oral surgery (meisenger) Pcs 11 - 11 - - 11 11 - - - - - - - - - - 11
28 Needle olyco / Jarum carpule Pcs - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
29 Needle Septoject Pcs - - - - - - - - - - - - - - -
30 Oil spray Btl - - - - - - - - - - - - - - -
31 Paper points Ktk 2 - 2 - - 2 2 - - - - - - - - - - 2
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - - - - - - - -
33 Komposit resin (solare x) Tube - - - - - - - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - - - - - - - -
36 Siver amalgam (serbuk) Btl - - - - - - - - - - - - - - - -
37 Solare X A2 Bh 1 - 1 - - 1 1 - - - - - - - - - - 1
38 Solare X A3 Bh - - - - - - - - - - - - - - -
39 ,MENGETAHUI/MENYETUJUI
Silver amalgram (cair) Btl ,Yang- Menyerahkan
- - - - Yang
- Menerima/Melapor- - - - - -
Yang - -
Menerima/Melapor -
Kepala Dinas Kesehatan Kepala UPTD Instalasi Pimpinan Puskesmas Petugas Puskesmas
40 Spon Hemostatis
Kabupaten Kotawaringin Barat pcs - - Farmasi - - - - - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - - - - - - - -
Achmad Rois, SKM. M.Kes SOUFIA ARDIANI, S.Si.Apt dr.Yordan Pradiksa Rahmat Wildan, A.Md., Farm
NIP: 19691104 199203 1 002 NIP: 19800211 200312 2 011 .NIP: 19820121 201001 1 011 ..NIP: 19870406 201101 1 004
UMUM
ASKES JUMLAH
TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR BAYAR
78 158 326 562
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S

LAPORAN
: JANUARI
: 2021
PERMINTAAN PEMBERIAN
PERMINTAAN
PUSKESMAS ALASAN SUMBER ALASAN
APBN HIBAH ED
2,000
500
PERMINTAAN
APBN HIBAH ED
100
1,000
200
500
100
600
PERMINTAAN
APBN HIBAH ED
1,000
1,000
300
300
PERMINTAAN
APBN HIBAH ED
100
100
2,000
200
500
500
500
PERMINTAAN
APBN HIBAH ED
1,000
100
300
300
500
PERMINTAAN
APBN HIBAH ED
500
500
500
100
500
500
500
500
500
PERMINTAAN
APBN HIBAH ED
500
1,000
-
PERMINTAAN
APBN HIBAH ED
50
30
30
20
30
10
30
10
10
10
PERMINTAAN
APBN HIBAH ED
50
50
PERMINTAAN
APBN HIBAH ED
25
20
20
PERMINTAAN
APBN HIBAH ED
25
25
10
20
100
30
100
PERMINTAAN
APBN HIBAH ED
10
30
2
30
20
PERMINTAAN
APBN HIBAH ED
25
25
2
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
30
30
30
PERMINTAAN
APBN HIBAH ED
3
PERMINTAAN
APBN HIBAH ED
50
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
NO OBAT DAN PERBEKKES SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
1 Albendazol 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alopurinol 100 mg Tab 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0
3 Ambroksol 30 mg Tab 0 0 0 30 0 0 0 0 0 0 6 0 0 0 10 10 0 10 0 0 0 0 0 0 3 13 0 0
4 Aminofilin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Amitriptilin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 13 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 0 0 20 10 0 0 20 30 0 0 0 0 10 40 0 0 0 0 0 0 0 0 0
8 Amoksisilin 250 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Antasida kombinasi Tab 0 0 0 20 0 0 0 20 15 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0
12 Asam asetilsalisilat (asetosal) 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Asam mefenamat 500 mg Tab 0 10 0 10 40 10 20 10 0 0 0 20 0 0 0 0 0 10 10 0 10 10 10 0 0 10 0 0
15 Asam traneksamat 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Asiklovir 200 mg Tab 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Azitromisin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Bisakodil (dulkolax) 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Betahistin 6 mg Tab 0 0 0 0 0 0 10 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0
24 Deksametason 0,5 mg Tab 0 0 0 14 0 0 3 10 0 0 16 10 0 0 0 0 0 0 2 0 4 12 0 0 0 3 20 10
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Dimenhidrinat 50 mg Tab 0 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Domperidon 10 mg Tab 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 10 20 10 10 0 20 10 0 20
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
28 Dietilkarbamazepin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Ergotamin kafein kombinasi (antimigren) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Eritromisin 500 mg Tab 0 0 0 4 0 0 3 15 0 0 0 0 0 15 0 20 0 0 0 0 10 0 0 0 3 8 0 0
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Flukonazol 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 10 0 0 0
35 Garam oralit kombinasi Sak 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0

36 Gemfibrozil 300 mg Kaps 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Glibenklamid 5 mg Tab 0 0 0 0 0 0 0 0 0 0 30 0 30 0 0 30 0 20 30 0 30 0 0 0 0 30 0 0
38 Glimepirid 2 mg Tab 0 0 0 0 90 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0
40 Griseofulvin (micronized) 125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0
41 Haloperidol 1,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Haloperidol 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Hiosina butilbromida 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 10 0 0 0 0 0 0 10 0 20 10 0 0 0 0 0 42 2 0 0 0 20 0 0 0 0 4

47 Isosorbid dinitrat 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Isoniazid oral 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Kalium diklofenak 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50 Kalsium laktat (kalk) 500 mg Tab 0 0 0 0 80 0 30 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 20 0 0
51 Kandesartan 8 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0
55 Karbamazepin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Ketokonazol 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 10 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
57 Ketoprofen 100 mg Tab 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Klindamisin 150 mg kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Klindamisin 300 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Kloramfenikol 500 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

61 Klorfeniramin maleat (ctm) 4 mg Tab 0 0 0 4 5 8 0 0 0 0 12 0 0 0 0 0 0 0 2 0 4 0 0 0 0 0 0 0
62 Klorpromazin hcl 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Kotrimoksazol (dewasa) 480 mg Tab 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Lanzoprazol 30 mg Kaps 0 0 0 10 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Levotiroksin 50 mµ Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Levofloksasin 500 mg Tab 0 0 0 0 10 0 0 0 10 0 0 0 0 0 0 0 0 0 10 0 10 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 16 0 0 10 10 10 0
74 MDT FB anak (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 MDT FB dewasa (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

76 MDT MB anak (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 MDT MB dewasa (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Mebendazol 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

79 Meloksikam 7,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Meloksikam 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Metamizol (antalgin) 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 Metformin 500 mg Tab 0 0 0 10 120 0 0 20 0 0 0 20 30 0 0 0 0 0 30 0 0 0 0 0 0 0 30 0

83 Metilergometrin 0,125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Metilprednisolon 4 mg Tab 0 0 0 0 20 10 0 0 10 0 10 0 0 0 10 10 0 30 0 12 0 0 0 0 13 13 6 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
86 Metronidazol 250 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Multivitamin ibu hamil (Gestiamin) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

90 Multivitamin ibu hamil (hemafort) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Multivitamin lansia (pehavral) Tab 0 10 0 50 0 0 0 10 0 0 10 70 0 0 0 0 0 0 0 10 0 0 0 0 0 0 50 0
92 Natrium bikarbonat 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Natrium diklofenak 25 mg Tab 0 0 0 20 46 10 0 10 20 0 106 0 0 0 0 0 0 15 0 20 20 0 0 0 30 10 10 0

95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 N-asetil sistein 200 mg kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 OAT Kategori Anak Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 OAT Kategori I Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

101 OAT Kategori II Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 OAT Kategori I Kombipak Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Ofloksasin 200 mg Tab 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0

105 Omeprazol 20 mg Kaps 0 0 0 0 30 0 30 0 0 0 50 30 0 10 0 10 0 30 10 0 0 0 0 0 0 0 0 0
106 Ondansetron 4 mg Tab 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Parasetamol 500 mg Tab 0 10 0 30 20 10 20 30 30 20 0 20 10 10 0 40 0 10 10 10 0 10 20 0 0 25 0 10

108 Pirantel pamoat 125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Piroksikam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
115 Propiltiourasil 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Propranolol 10 mg Tab 0 0 0 0 20 0 30 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

119 Risperidon 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Salbutamol 2 mg Tab 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 20 0 4 0 10 0 3 13 0 20

123 Sefadroksil 500 mg Kaps 0 10 0 0 10 0 10 0 0 0 10 40 0 0 10 0 0 20 0 0 0 0 20 0 0 0 10 0
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Setirizin 10 mg Tab 0 0 0 40 0 0 0 6 0 0 0 0 10 0 0 15 0 20 0 0 10 0 4 0 3 36 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Simvastatin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Siprofloksasin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0

130 Spironolakton 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Tambah darah kombinasi (fe dan asam folat) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Trifluoperazin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Triheksifenidil 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Vitamin A 100.000 IU (retinol) Biru Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Vitamin A 200.000 IU (retinol) Merah kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Vitamin B 1 (tiamin) 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Vitamin B 6 (piridoksin) 10 mg Tab 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 10 0 0 10 10 0 0 30 0 0 0 0 0
139 Vitamin B kompleks Tab 0 10 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 10 0 16 10 0 0 0 0 0
140 Vitamin C (asam askorbat) 50 mg Tab 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 6 0 0 25 0 0 0 0 0 0 0 0 0
142 Vitamin Hepagard Tab 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

143 Zinc tablet dispersibel 20 mg Tab 0 0 0 0 10 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Multivitamin (Sivit - Zink) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9

2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Aminofilin 24 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Artemether 80 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Artesunat 60 mg/ml (i.v./i.m.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Asam traneksamat 50 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Deksametason 5 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Difenhidramin hcl 10 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Epinefrin (adrenalin) 0,1% Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41
14 Furosemid 10 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
15 Flufenazin 25 mg/ml (Sikzonoate) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Gentamisin 40 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10
17 Haloperidol 5 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Kalsium glukonat 10 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10

20 Ketorolak 30 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Klorpromazin 25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
23 Lidokain kompositum Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32
24 Magnesium sulfat 20 % (i.v.) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Metamizol (antalgin) 500 mg/2 ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6

27 Metilergometrin 0.2 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50
28 Oksitosin 10 iu/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20
29 Omeprazole 40 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7
30 Ondansetron 4 mg/2 ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18

31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
32 Prokain benzil penisillin 3 juta iu/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MENGETA
33 Ranitidin 25 ml/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
,HUI
Kepala serb. inj 1000 mg
34 Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Dinas
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kabupate
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15
Kotawarin
37 Vitamin K 1 (fitomenadion) 10 mg/ml (i.m.)
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Vitamin B 1 (tiamin) 100 mg /ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
1 Air untuk injeksi (aqua pro injeksi) 10 ml
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
NIP: & PSIKOTROPIKA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Diazepam 5 mg/ml (i.v.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Fenobarbital 50 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 Fenobarbital 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
SALEP DAN SUPPOSITORIA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Antifungi kombinasi Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Antihemoroid kombinasi Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Asiklovir 5% Krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Basitrasin - polimiksin B Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bedak salisil 2% Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Betametason 0,1% krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0
7 Bioplacenton krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 bisakodil ( dulcolax ) 5mg supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Bisakodil (dulcolax) 10 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Desoksimetason 0,25 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Gentamisin salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Gentamisin salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hidrokortison 2,5% krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0
14 Ketokonazol 2 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Ketoprofen 100 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kloramfenikol 1% salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 kloramfenikol 3% salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Mikonazol 2 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 metronidazol ovula 500 mg ovul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Oksitetrasiklin salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Oksitetrasiklin salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 povidon iodin / betadine salep Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Salep 2-4 kombinasi krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Sulfadiazine 10 Mg Salep Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Ambroxol drop 15 mg/ ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Ambroxol sirup 15 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ambroxol sirup 30 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Amoksisilin sirup kering 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Antasida susp Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Caviflex sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Dextrofen sirup Btl 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Domperidon sirup 5 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Ibuprofen sups 100 mg / 5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Kloramfenikol susp 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Kotrimoksazol susp 240 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Laktulosa 3,335 g/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Metronidazol susp 125 mg/5 mL Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Nistatin drop 100.000 IU/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Obat batuk hitam (OBH) sirup Btl 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Parasetamol drops 100 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Parasetamol sirup 120 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Procuma sirup Btl 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Sefadroksil sirup kering 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 sefadroxil sirup kering 250 mg /forte Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 setirizin 5mg / 5 ml Btl 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Sukralfat susp 500 mg/ 5ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Zink sirup 20mg/ 5ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
3 Bromhexin (Bisolvon) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Etakridinn laktat 0,1% (rivanol) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Fenoterol HBR 0,1 % (Berotec) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Fenol gliserol 10 % tetes telinga Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Gentamisin 0,3 % tetes mata Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Gentian violet 1 % Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 kloramfenikol Tetes mata Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Kloramfenikol 3% tetes telinga Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Metronidazol infus 5 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Povidon iodin 10 % 30 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Parasetamol infus 10 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Ringer laktat (RL) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 larutan disenfektan karbol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Sabun cuci tangan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Serum anti bisa ular (A.B.U l) Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Vaksin anti rabies/ VAR/ Verorab Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Vaksin campak Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Vaksin hepatitis (HBO) Bayi Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Vaksin hepatitis Bayi (HBIG) Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Vaksin hepatitis B dewasa Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Vaksin kombinasi DPT-HB-Hib Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Vaksin polio t-opv drops 10 dosis Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN HABIS PAKAI (BHP)/PERBEKKES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alat suntik sekali pakai 0,05 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Alat suntik sekali pakai 1 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Alkohol swabs Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Antiseptik gel 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Blood transfusi set Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Cat gut chromic 2/0 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Folly catheter No.16 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 I.V. catheter No.18 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 I.V. Catheter No.24 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Infus set anak pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Infus set dewasa pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 K.y jelly 82 gram Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Kapas pembalut/absorben 250 gram Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

34 Kasa kompres 40/40 steril Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Kasa pembalut 2 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Kasa steril 16x16 cm ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

38 Kertas puyer biasa Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
39 Kertas puyer press Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Penjepit tali pusat Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 penghisap lendir pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Plester 5cm x 4,5 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Plester bulat/ plesterin pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Plester cannofix pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Plester dermafix Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Plester hypafix Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Sarung tangan non steril Uk. S Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Sarung tangan non steril Uk. M Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Sarung tangan non steril Uk. L Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Sarung tangan steril ginekologi Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

58 Sarung tangan steril No.6 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Sarung tangan steril No.6,5 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

62 Sarung Tangan steril no.8 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Selang oksigen anak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Selang oksigen bayi Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Selang oksigen dewasa Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Sendok kertas puyer Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

67 Silk (benang bedah sutra ) No. 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
68 Silk (benang bedah sutra) No. 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Speculum logam (Marwa) pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Wing needle no 27 G Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Back pack sprayer 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Rapid test antigen 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Face shield Nagita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Face shield naik turun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Baju Hazmat cuci ulang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Hand schoon steril no 7,5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Helm kuning ( Face shild kaca mika 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN & ALAT LABORATORIUM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Asam asetat (Cuka) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alat pulmo (peak flow) set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Cartrialge genexpert KIT set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Compresson nebulizer pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Disposible pipet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Dropper besar Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Jarum Vacutainer Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Kaca slide/ Kaca objek Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KIT diagnostic untuk HIV Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lampu spiritus 150 ml Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lancet aktiv BD 1,8 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Microhematokrit tube wax Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Mikro tube (Vol 1,5 ml) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Mikroskope cover glasses 18x18 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Peak flow meter Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Pengukur tinggi badan Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Pipet eritrosit Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Pipet leukosit Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Pipet tips universal 10 ui Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Pipet westergren Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Rak staenles tes tube Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

39 Rapid test pemeriksaan DBD/ NS-1 Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Rapid Test pemeriksaan Hepatitis HCV Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

46 Rapid test pemeriksaan HIV (SD BIO) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Rapid test pemeriksaan HIV (VIKIA) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Rapid test pemeriksaan HIV (FOKUS) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
49 Rapid test pemeriksaan malaria Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Reagen Cell clean Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Rapid Test pemeriksaan sipilis Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Reagen Giemsa Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

53 Reagen Gol Darah Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Reagen Gol darah anti D Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Reagen Immersion Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Reagen Stromatolyer Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

57 Reagen Ziehl Neelson Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 RPR Sipilis fokus Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Tabung hematokrit heparin Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Tabung hematokrit non heparin Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Tabung vacutainer edta warna ungu Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Test asam urat Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

64 Test gluco protein urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Test kehamilan / PP test Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Test kolestrol Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

68 Test pemeriksaan gula darah Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Test pemeriksaan HB Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Test Pemeriksaan Urine 10 Parameter Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

71 Tipe mikro pipet warna biru Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Tipe mikro pipet warna kuning Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Tipe mikro pipet warna putih Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Tisue mikroskop Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

75 Tube microtainer/ mierogard EDTA Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Tube mikro (Vol 1,5 ml) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Tube mikro (Vol 2 ml) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bahan tambahan light curing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bor Diamond RA Student Kit (Edenta) Kit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Bonding resine Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Cellopand strip swenska Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Devitalisasi pasta Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Etil klorida semprot 100 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Etching SDI liquid / Acid ethan liquid Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Eugenol cairan Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Jarum ekterpasi (exterpatie swenska) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Fraser / Bentuk silinder Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Gutta percha poins Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Kalsium hidroksida pasta Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Kertas artikulasi (articulating paper) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Klorfenol kamfer mentol (CHKM) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Lentulo merk VDW Germany (ANTAEOS) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Lidokain Spray (xylocain) btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

24 Mata bor mikromotor (RA) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Mata bor white stone Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Mata bor hand place (FG diamond) Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
27 Mata bor tulang / Oral surgery (meisenger) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Needle olyco / Jarum carpule Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Needle Septoject Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Penghisap ludah (tips suetion) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Komposit resin (solare x) Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Semen seng fosfat Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Silver amalgam (serbuk + cair) Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Siver amalgam (serbuk) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Silver amalgram (cair) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Spon Hemostatis pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 TKF (tri kesol formalin) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 30 31 TOTAL
0 0 0 0
0 0 0 20
0 0 0 82
0 0 0 0
0 0 0 6
0 0 37 60
0 0 0 130
0 0 0 0
0 0 0 155
0 0 0 0
0 0 5 70
0 0 0 0
0 0 0 150
0 0 0 180
0 0 0 0
0 0 0 40
0 0 4 14
0 0 0 30
0 0 0 0
0 0 160 160
0 0 0 0
0 0 0 0
0 0 395 425
0 0 0 104
0 0 0 0
0 0 0 15
0 10 0 120
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 78
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 40
0 0 28 54
0 0 0 8
0 30 0 230
0 0 10 130
0 0 0 8
0 0 0 20
0 0 0 0
0 0 0 0
0 0 0 0
0 0 30 40
0 0 0 0
0 10 0 128
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 150
0 0 0 0
0 0 0 110
0 0 30 40
0 0 0 40
0 0 0 0
0 0 0 20
29 30 31 TOTAL
0 0 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 35
0 0 0 0
0 0 87 87
0 0 0 0
0 0 1 1
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 0
0 0 210 230
0 0 0 0
0 0 10 50
0 0 0 56
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 30 30
0 0 0 0
0 6 0 6
0 30 0 290
0 0 0 0
0 10 0 154
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 98
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 210
0 0 0 0
0 0 0 317
0 0 0 0
0 0 0 0
0 0 0 30
0 0 82 82
0 0 380 380
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 0
0 0 1,050 1,250
0 0 0 10
60 0 0 405
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 80
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 76
0 0 10 40
20 0 0 160
0 0 0 0
0 0 0 144
0 0 0 0
0 0 0 0
0 0 0 113
0 0 0 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 36 36
0 0 654 654
0 0 0 0
0 0 70 140
0 0 158 224
0 0 140 160
0 0 0 41
0 30 0 40
0 0 250 290
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 9
0 0 0 0
0 0 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 30 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 41 Subsie Evaluasi dan Perencanaan
0 0 0 1
0 0 0 0
MARIYANI
0 0 0 10 NIP: 19750812 200003 2 003
0 0 0 0
0 0 0 0
0 0 0 10
0 0 15 15
0 0 0 0
0 0 0 16
29 30 31 TOTAL
0 0 0 32
0 0 0 0
0 0 0 0
0 0 0 6
0 0 0 50
0 0 0 20
0 0 0 7
0 0 0 18
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 15
0 0 0 0
0 0 0 0
0 0 0 13
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 6
0 0 0 0
1 0 0 1
6 0 0 11
0 0 0 0
0 0 0 0
0 0 23 23
2 0 0 2
0 0 4 4
0 0 0 0
1 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
3 0 0 3
4 0 0 4
0 0 0 0
0 0 0 0
5 0 0 5
0 0 0 0
0 0 7 7
0 0 0 0
2 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
1 0 0 1
3 0 5 8
0 0 0 0
4 0 0 5
3 0 0 3
0 0 0 0
7 0 1 8
2 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 8
0 0 0 0
5 0 0 6
0 0 0 0
2 0 0 3
4 0 0 4
1 0 0 1
4 1 0 7
0 0 0 0
4 0 0 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 77 77
0 0 1 1
0 0 0 0
0 0 0 0
0 0 5 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 2 2
0 0 0 0
0 0 7 7
0 0 0 0
0 0 0 0
0 0 0 0
0 5 0 9
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 19 19
0 0 0 0
0 0 0 0
0 0 80 80
29 30 31 TOTAL
0 0 0 0
0 0 4 4
0 0 5 5
0 0 0 0
0 0 28 28
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 10 10
0 0 4 4
0 0 0 0
0 0 23 23
0 0 0 0
0 0 5 5
0 0 9 9
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 13 13
0 0 0 0 ,Pangkalan Bun,31 Desember 2012

0 0 1 1 Kotawaringin Barat
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
29 30 31 TOTAL ,Pangkalan Bun,31 Desember 2012
Kotawaringin Barat
0 0 0 0
0 0 0 0
0 0 0 0 SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
0 0 148 148
0 0 4 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
,MENGETAHUI
0 0 0 0 Kepala Dinas Kesehatan
0 0 0 0
0 0 0 0
0 0 0 0 drg.INDRAWAN SAKTI,M.Kes
NIP: 19610521 199303 1 004
0 0 0 0
0 0 0 0
0 0 3,350 3,350
0 0 7,064 7,064
0 0 0 0
0 0 0 0
0 0 0 0
0 0 11 11
0 0 13 13
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 7 7
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 4 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 10 10
0 0 5 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 400 400
0 0 30 30
0 0 0 0
0 0 0 0
0 0 500 500
0 0 248 248
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
1 Albendazol 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alopurinol 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Aminofilin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Amitriptilin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Amoksisilin 250 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Antasida kombinasi Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Asam asetilsalisilat (asetosal) 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Asam mefenamat 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Asam traneksamat 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Azitromisin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Bisakodil (dulkolax) 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Betahistin 6 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Deksametason 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Dimenhidrinat 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Domperidon 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 200 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
28 Dietilkarbamazepin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Ergotamin kafein kombinasi (antimigren) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Eritromisin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Flukonazol 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Garam oralit kombinasi Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Gemfibrozil 300 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Glibenklamid 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Glimepirid 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Griseofulvin (micronized) 125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Haloperidol 1,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Haloperidol 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Hiosina butilbromida 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Isosorbid dinitrat 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Isoniazid oral 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Kalium diklofenak 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50 Kalsium laktat (kalk) 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0
51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Kandesartan 16 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0
55 Karbamazepin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Ketokonazol 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
57 Ketoprofen 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Klindamisin 150 mg kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Klindamisin 300 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Kloramfenikol 500 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

61 Klorfeniramin maleat (ctm) 4 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Klorpromazin hcl 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Kotrimoksazol (dewasa) 480 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Lanzoprazol 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Levotiroksin 50 mµ Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Levofloksasin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 MDT FB anak (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 MDT FB dewasa (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

76 MDT MB anak (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 MDT MB dewasa (obat kusta) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Mebendazol 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

79 Meloksikam 7,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Meloksikam 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Metamizol (antalgin) 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 Metformin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0

83 Metilergometrin 0,125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Metilprednisolon 4 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
86 Metronidazol 250 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Multivitamin ibu hamil (Gestiamin) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

90 Multivitamin ibu hamil (hemafort) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Multivitamin lansia (pehavral) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0 0 0
92 Natrium bikarbonat 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Natrium diklofenak 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 50 0 0 0 0 0

95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 N-asetil sistein 200 mg kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 OAT Kategori Anak Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 OAT Kategori I Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

101 OAT Kategori II Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 OAT Kategori I Kombipak Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Ofloksasin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

105 Omeprazol 20 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0
106 Ondansetron 4 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25 0
107 Parasetamol 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0

108 Pirantel pamoat 125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Piroksikam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
115 Propiltiourasil 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Propranolol 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

119 Risperidon 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Salbutamol 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0

123 Sefadroksil 500 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 100 0 0 0 0 0
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Setirizin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Simvastatin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Siprofloksasin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

130 Spironolakton 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Tambah darah kombinasi (fe dan asam folat) Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Trifluoperazin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Triheksifenidil 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Vitamin A 100.000 IU (retinol) Biru Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Vitamin A 200.000 IU (retinol) Merah kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Vitamin B 1 (tiamin) 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Vitamin B 6 (piridoksin) 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0
139 Vitamin B kompleks Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0
140 Vitamin C (asam askorbat) 50 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0 0 0 0 0 0 0 0
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0
142 Vitamin Hepagard Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

143 Zinc tablet dispersibel 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Multivitamin (Sivit - Zink) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Aminofilin 24 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Artemether 80 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Artesunat 60 mg/ml (i.v./i.m.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Asam traneksamat 50 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Deksametason 5 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Difenhidramin hcl 10 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Epinefrin (adrenalin) 0,1% Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Furosemid 10 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Flufenazin 25 mg/ml (Sikzonoate) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Gentamisin 40 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Haloperidol 5 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Kalsium glukonat 10 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Ketorolak 30 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Klorpromazin 25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
23 Lidokain kompositum Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Magnesium sulfat 20 % (i.v.) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Metamizol (antalgin) 500 mg/2 ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0

27 Metilergometrin 0.2 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Oksitosin 10 iu/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Omeprazole 40 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Ondansetron 4 mg/2 ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Prokain benzil penisillin 3 juta iu/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 MENGETA
Ranitidin 25 ml/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
,HUI
34 Kepala serb. inj 1000 mg
Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kabupate
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Vitamin B 1 (tiamin) 100 mg /ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
NIP: & PSIKOTROPIKA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Diazepam 5 mg/ml (i.v.) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Fenobarbital 50 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 Fenobarbital 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
SALEP DAN SUPPOSITORIA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Antifungi kombinasi Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Antihemoroid kombinasi Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Asiklovir 5% Krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Basitrasin - polimiksin B Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bedak salisil 2% Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Betametason 0,1% krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Bioplacenton krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 bisakodil ( dulcolax ) 5mg supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Bisakodil (dulcolax) 10 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Desoksimetason 0,25 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Gentamisin salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Gentamisin salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hidrokortison 2,5% krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Ketokonazol 2 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Ketoprofen 100 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kloramfenikol 1% salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 kloramfenikol 3% salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Mikonazol 2 % krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 metronidazol ovula 500 mg ovul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Oksitetrasiklin salep kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Oksitetrasiklin salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 povidon iodin / betadine salep Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Salep 2-4 kombinasi krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Sulfadiazine 10 Mg Salep Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Ambroxol drop 15 mg/ ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Ambroxol sirup 15 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ambroxol sirup 30 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Amoksisilin sirup kering 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Antasida susp Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Caviflex sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Dextrofen sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Domperidon sirup 5 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Ibuprofen sups 100 mg / 5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Kloramfenikol susp 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Kotrimoksazol susp 240 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Laktulosa 3,335 g/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Metronidazol susp 125 mg/5 mL Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Nistatin drop 100.000 IU/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Obat batuk hitam (OBH) sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Parasetamol drops 100 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Parasetamol sirup 120 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Procuma sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Sefadroksil sirup kering 125 mg/5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 sefadroxil sirup kering 250 mg /forte Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 setirizin 5mg / 5 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Sukralfat susp 500 mg/ 5ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Zink sirup 20mg/ 5ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
3 Bromhexin (Bisolvon) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Etakridinn laktat 0,1% (rivanol) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Fenoterol HBR 0,1 % (Berotec) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Fenol gliserol 10 % tetes telinga Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Gentamisin 0,3 % tetes mata Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Gentian violet 1 % Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 kloramfenikol Tetes mata Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Kloramfenikol 3% tetes telinga Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0
17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Metronidazol infus 5 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0

20 Povidon iodin 10 % 30 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Parasetamol infus 10 mg/ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Ringer laktat (RL) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 10 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 larutan disenfektan karbol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Sabun cuci tangan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Serum anti bisa ular (A.B.U l) Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Vaksin anti rabies/ VAR/ Verorab Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Vaksin campak Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Vaksin hepatitis (HBO) Bayi Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Vaksin hepatitis Bayi (HBIG) Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Vaksin hepatitis B dewasa Pouches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Vaksin kombinasi DPT-HB-Hib Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Vaksin polio t-opv drops 10 dosis Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN HABIS PAKAI (BHP)/PERBEKKES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alat suntik sekali pakai 0,05 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Alat suntik sekali pakai 1 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Alkohol swabs Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Antiseptik gel 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0
12 Blood transfusi set Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0
13 Cat gut chromic 2/0 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Folly catheter No.16 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 I.V. catheter No.18 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 I.V. Catheter No.24 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Infus set anak pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Infus set dewasa pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0
26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 K.y jelly 82 gram Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Kapas pembalut/absorben 250 gram Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

34 Kasa kompres 40/40 steril Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Kasa pembalut 2 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Kasa steril 16x16 cm ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

38 Kertas puyer biasa Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
39 Kertas puyer press Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Penjepit tali pusat Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 penghisap lendir pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Plester 5cm x 4,5 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Plester bulat/ plesterin pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Plester cannofix pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Plester dermafix Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Plester hypafix Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Sarung tangan non steril Uk. S Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Sarung tangan non steril Uk. M Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18
56 Sarung tangan non steril Uk. L Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Sarung tangan steril ginekologi Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

58 Sarung tangan steril No.6 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Sarung tangan steril No.6,5 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

62 Sarung Tangan steril no.8 Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Selang oksigen anak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0
64 Selang oksigen bayi Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Selang oksigen dewasa Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
66 Sendok kertas puyer Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

67 Silk (benang bedah sutra ) No. 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
68 Silk (benang bedah sutra) No. 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Speculum logam (Marwa) pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Wing needle no 27 G Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Back pack sprayer 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Rapid test antigen 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Face shield Nagita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Face shield naik turun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Baju Hazmat cuci ulang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Hand schoon steril no 7,5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Helm kuning ( Face shild kaca mika 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN & ALAT LABORATORIUM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Asam asetat (Cuka) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alat pulmo (peak flow) set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Cartrialge genexpert KIT set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Compresson nebulizer pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Disposible pipet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Dropper besar Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Jarum Vacutainer Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Kaca slide/ Kaca objek Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KIT diagnostic untuk HIV Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lampu spiritus 150 ml Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lancet aktiv BD 1,8 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Microhematokrit tube wax Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Mikro tube (Vol 1,5 ml) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Mikroskope cover glasses 18x18 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Peak flow meter Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Pengukur tinggi badan Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Pipet eritrosit Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Pipet leukosit Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Pipet tips universal 10 ui Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Pipet westergren Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Rak staenles tes tube Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

39 Rapid test pemeriksaan DBD/ NS-1 Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Rapid Test pemeriksaan Hepatitis HCV Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

46 Rapid test pemeriksaan HIV (SD BIO) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Rapid test pemeriksaan HIV (VIKIA) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Rapid test pemeriksaan HIV (FOKUS) Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
49 Rapid test pemeriksaan malaria Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Reagen Cell clean Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Rapid Test pemeriksaan sipilis Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Reagen Giemsa Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

53 Reagen Gol Darah Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Reagen Gol darah anti D Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Reagen Immersion Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Reagen Stromatolyer Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

57 Reagen Ziehl Neelson Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 RPR Sipilis fokus Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Tabung hematokrit heparin Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Tabung hematokrit non heparin Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Tabung vacutainer edta warna ungu Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Test asam urat Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

64 Test gluco protein urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Test kehamilan / PP test Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Test kolestrol Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

68 Test pemeriksaan gula darah Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Test pemeriksaan HB Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Test Pemeriksaan Urine 10 Parameter Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

71 Tipe mikro pipet warna biru Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Tipe mikro pipet warna kuning Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Tipe mikro pipet warna putih Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Tisue mikroskop Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

75 Tube microtainer/ mierogard EDTA Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Tube mikro (Vol 1,5 ml) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Tube mikro (Vol 2 ml) Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bahan tambahan light curing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bor Diamond RA Student Kit (Edenta) Kit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Bonding resine Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Cellopand strip swenska Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Devitalisasi pasta Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Etil klorida semprot 100 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Etching SDI liquid / Acid ethan liquid Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Eugenol cairan Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Jarum ekterpasi (exterpatie swenska) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Fraser / Bentuk silinder Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Gutta percha poins Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Kalsium hidroksida pasta Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Kertas artikulasi (articulating paper) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Klorfenol kamfer mentol (CHKM) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Lentulo merk VDW Germany (ANTAEOS) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Lidokain Spray (xylocain) btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

24 Mata bor mikromotor (RA) Pack 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Mata bor white stone Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Mata bor hand place (FG diamond) Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
27 Mata bor tulang / Oral surgery (meisenger) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Needle olyco / Jarum carpule Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Needle Septoject Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Penghisap ludah (tips suetion) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Komposit resin (solare x) Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Semen seng fosfat Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

35 Silver amalgam (serbuk + cair) Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Siver amalgam (serbuk) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Silver amalgram (cair) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Spon Hemostatis pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 TKF (tri kesol formalin) Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 200
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 50
0 0
0 0
0 0
0 0
0 0
500 500
100 100
0 0
0 0
0 300
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
300 300
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 100
0 0
0 150
500 500
0 100
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
200 300
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 200
0 0
0 100
0 0
0 0
0 0
100 100
180 180
0 0
0 0
0 0
0 0
0 0
0 0
1,030 1,060
0 25
0 200
0 0
0 0
0 0
0 0
0 100
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
100 200
0 0
0 200
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
650 650
0 0
400 500
0 100
100 300
0 100
0 0
200 200
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 6
0 0
0 0
0 0
0 0
0 0
20 20
0 0
0 0
0 0
30 30 Subsie Evaluasi dan Perencanaan
0 0
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 10
50 50
30 30
30 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
3 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 30
16 16
0 0
10 10
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
77 77
0 0
0 0
0 0
5 5
10 10
0 0
0 0
0 0
0 0
0 0
0 0
0 8
2 2
0 0
0 10
1 1
0 0
0 0
7 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
95 100
0 5
20 20
0 0
100 100
77 77
31 TOTAL
0 9
0 8
0 5
0 5
0 0
0 0
0 0
0 0
0 0
10 10
22 22
10 20
0 0
0 0
5 5
0 5
5 5
5 5
0 0
0 0
0 0
0 0
0 0
0 0
31 31
0 0
15 15
0 0 ,Pangkalan Bun,31 Desember 2012
1 1 Kotawaringin Barat
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
31 TOTAL ,Pangkalan Bun,31 Desember 2012
Kotawaringin Barat
0 0
0 0
0 0 SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
200 200
0 0
0 0
0 0
0 0
0 0
,MENGETAHUI
0 0 Kepala Dinas Kesehatan
0 0
0 0
0 0 drg.INDRAWAN SAKTI,M.Kes
NIP: 19610521 199303 1 004
0 1
0 0
3,350 3,350
7,046 7,064
0 0
0 0
0 0
3 3
20 20
0 0
0 0
0 9
0 0
7 8
0 0
1 1
31 TOTAL
5 8
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
TABLET
1 Albendazol 400 mg Tab 120 - 120 38 82 - 82 90 - 90 30 60 - 60 53 - - 29
2 Alopurinol 100 mg Tab 980 - 980 295 685 - 685 1,000 - 1,000 1,000 - - - 413 1,180 908
3 Ambroksol 30 mg Tab 2,020 - 2,020 847 1,173 - 1,173 1,100 - 1,100 800 300 - 300 1,186 - 13
4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - - - -

5 Amitriptilin 25 mg Tab 94 - 94 - 100 - 6 94 100 - 100 100 - - - - - - 94
6 Amlodipin 5 mg Tab 1,305 - 1,305 385 920 - 920 1,000 - 1,000 700 300 - 300 539 - - 381
7 Amlodipin 10 mg Tab 920 - 920 194 726 - 726 800 - 800 390 410 - 410 272 - - 454
8 Amoksisilin 250 mg Tab 140 - 140 40 100 - 100 100 - 100 100 - - - 56 200 156
9 Amoksisilin 500 mg Tab 2,121 - 2,121 777 1,344 - 1,344 1,400 - 1,400 600 800 - 800 1,088 - - 256
10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - - - -

11 Antasida kombinasi Tab - - - - - - - - - - - - - - - - -
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - - - -
13 Asam asetilsalisilat (asetosal) 80 mg Tab 280 - 280 170 110 - 110 200 - 200 200 - - - 238 850 978
14 Asam mefenamat 500 mg Tab 2,400 - 2,400 371 2,029 - 2,029 2,000 - 2,000 700 1,300 - 1,300 519 - - 1,510
15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
16 Asiklovir 200 mg Tab 20 - 20 20 - - - - - - - - - - 28 600 628
17 Asiklovir 400 mg Tab 492 - 492 105 387 - 387 300 - 300 250 50 - 50 147 - - 240
18 Atapulgit 630 mg Tab 907 - 907 - 980 - 73 907 800 - 800 100 700 - 700 - - - 907
19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - - - -
20 Azitromisin 500 mg Tab 350 120 470 120 - 350 350 510 120 630 280 - 350 350 168 3,600 3,418
21 Asam folat 1 mg Tab - - - - - - - - - - - - - - - - -
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - - - -
23 Betahistin 6 mg Tab 425 - 425 181 244 - 244 100 - 100 100 - - - 253 5,430 5,439
24 Deksametason 0,5 mg Tab 2,357 - 2,357 237 2,120 - 2,120 1,800 - 1,800 600 1,200 - 1,200 332 - - 1,788
25 Digoksin 0,25 mg Tab 200 - 200 - 200 - 200 200 - 200 200 - - - - - - 200
26 Dimenhidrinat 50 mg Tab 530 - 530 - 692 - 162 530 500 - 500 100 400 - 400 - - - 530
27 Domperidon 10 mg Tab 599 - 599 69 530 - 530 300 - 300 200 100 - 100 97 - - 433
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - - - -

30 Eritromisin 500 mg Tab 444 - 444 71 373 - 373 200 - 200 - 200 - 200 99 - - 274
31 Fenitoin 30 mg Kaps 100 - 100 29 71 - 71 - - - - - - - 41 870 840
32 Fenitoin 100 mg Kaps 100 - 100 100 - - - - - - - - - - 140 3,000 3,140
33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - - - -
34 Furosemid 40 mg Tab 627 - 627 200 427 - 427 400 - 400 50 350 - 350 280 - - 147
35 Garam oralit kombinasi Sak 340 - 340 24 316 - 316 212 - 212 30 182 - 182 34 - - 282
36 Gemfibrozil 300 mg Kaps - - - - - - - - - - - - - - - - -
37 Glibenklamid 5 mg Tab 2,480 - 2,480 1,390 1,090 - 1,090 1,500 - 1,500 1,000 500 - 500 1,946 - 856
38 Glimepirid 2 mg Tab 695 - 695 442 253 - 253 400 - 400 400 - - - 619 578 944
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 1,123 - 1,123 - 1,328 - 205 1,123 1,000 - 1,000 300 700 - 700 - - - 1,123
40 Griseofulvin (micronized) 125 mg Tab 460 - 460 - 450 10 460 200 - 200 200 - - - - - - 460
41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - - - -
44 Hiosina butilbromida 10 mg Tab 310 - 310 20 290 - 290 200 - 200 - 200 - 200 28 - - 262
45 Ibuprofen 200 mg Tab - - - - - - - - - - - - - - - - -
46 Ibuprofen 400 mg Tab 1,600 - 1,600 963 637 - 637 1,100 - 1,100 900 200 - 200 1,348 - 711
47 Isosorbid dinitrat 5 mg Tab 153 - 153 - 153 - 153 100 - 100 - 100 - 100 - - - 153
48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - - - -
50 Kalsium laktat (kalk) 500 mg Tab 155 - 155 - 865 - 710 155 - - - - - - - - - - 155
51 Kandesartan 8 mg - - - - - - - - - - - - - - - - -
52 Kandesartan 16 mg Tab 190 - 190 190 - - - - - - - - - - 266 5,700 5,966

53 Kaptopril 12,5 mg Tab 4,813 - 4,813 1,195 3,618 - 3,618 3,700 - 3,700 600 3,100 - 3,100 1,673 - - 1,945
54 Kaptopril 25 mg Tab 3,996 - 3,996 - 4,672 - 676 3,996 3,100 - 3,100 200 4,300 - 1,400 2,900 - - - 3,996
56 Ketokonazol 200 mg Tab 618 - 618 10 608 - 608 350 - 350 100 250 - 250 14 - - 594
57 Ketoprofen 100 mg Tab 508 - 508 98 410 - 410 200 - 200 - 200 - 200 137 - - 273
58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - - - -

59 Klindamisin 300 mg Kaps - - - - - - - - - - - - - - - - -
60 Kloramfenikol 500 mg Kaps 254 - 254 - 380 - 126 254 200 - 200 - 200 - 200 - - - 254
61 Klorfeniramin maleat (ctm) 4 mg Tab 3,496 - 3,496 321 3,175 - 3,175 2,700 - 2,700 300 2,400 - 2,400 449 - - 2,726
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 13 - 13 - 13 - 13 - - - - - - - - - - 13
64 Klozapin 25 mg Tab 98 - 98 - 98 - 98 - - - - - - - - - - 98
65 Klozapin 100 mg Tab 69 - 69 - 69 - 69 - - - - - - - - - - 69
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - - - - - - - - - -
67 Kotrimoksazol (dewasa) 480 mg Tab 570 - 570 - 840 - 270 570 300 - 300 - 300 - 300 - - - 570
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 780 - 780 - 1,013 - 233 780 100 - 100 - 100 - 100 - - - 780
69 Kuinin 222 mg Tab - - - - - - - - - - - - - - - - -
70 Lanzoprazol 30 mg Kaps 364 - 364 14 - 350 350 350 - 350 - - 350 350 20 420 90
71 Levotiroksin 50 mµ Tab - - - - - - - - - - - - - - - - -
72 Levofloksasin 500 mg Tab 254 - 254 100 154 - 154 50 - 50 50 - - - 140 500 486
73 Loratadin 10 mg Tab 1,110 - 1,110 58 1,052 - 1,052 1,000 - 1,000 300 700 - 700 81 - - 971
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - - - -

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - 3 3 3 - - - - 3 3 3 - - - 4 90 94
78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - - - -
79 Meloksikam 7,5 mg Tab - - - - - - - - - - - - - - - - -
80 Meloksikam 15 mg Tab 220 - 220 160 60 - 60 100 - 100 100 - - - 224 18 182
81 Metamizol (antalgin) 500 mg Tab 634 - 634 84 550 - 550 500 - 500 100 400 - 400 118 - - 432
82 Metformin 500 mg Tab 2,570 - 2,570 580 1,990 - 1,990 2,400 - 2,400 600 1,800 - 1,800 812 - - 1,178
83 Metilergometrin 0,125 mg Tab 160 - 160 50 110 - 110 100 - 100 100 - - - 70 250 210
84 Metilprednisolon 4 mg Tab 1,786 - 1,786 491 1,295 - 1,295 1,400 - 1,400 400 1,000 - 1,000 687 - - 608
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
85 Metilprednisolon 8 mg Tab - - - - - - - - - - - - - - - - -
86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - - - -
87 Metronidazol 500 mg Tab 869 - 869 76 793 - 793 500 - 500 300 200 - 200 106 - - 687
88 Mineral Mix Sak 40 - 40 - 40 - 40 40 - 40 - 40 - 40 - - - 40
89 Multivitamin ibu hamil (Gestiamin) Tab 2,150 - 2,150 1,460 690 - 690 2,020 - 2,020 1,750 270 - 270 2,044 - 1,354
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - - - - - - - - - - -
91 Multivitamin lansia (pehavral) Tab 1,300 - 1,300 607 693 - 693 1,100 - 1,100 800 300 - 300 850 - 157
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - - - -
93 Natrium diklofenak 25 mg Tab 1,765 - 1,765 175 1,590 - 1,590 1,800 - 1,800 400 1,400 - 1,400 245 - - 1,345
95 Nifedipin 10 mg Tab 120 - 120 30 90 - 90 - - - - - - - 42 900 852
96 Nifedipin 20 mg Tab 260 - 260 - 390 - 130 260 240 - 240 - 240 - 240 - - - 260
97 Nistatin 500.000 IU Tab - 80 80 - 80 - 80 - 80 80 80 - - - - - - 80
98 N-asetil sistein 200 mg kaps 420 30 450 70 - 380 380 350 30 380 - - 380 380 98 2,100 1,818
99 OAT Kategori Anak Pkt - - - - - - - - - - - - - - - - -
100 OAT Kategori I Pkt 2 - 2 - - 2 2 2 - 2 - - 2 2 - - - 2
101 OAT Kategori II Pkt - - - - - - - - - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - - - -
103 Ofloksasin 200 mg Tab 180 - 180 - 300 - 120 180 200 - 200 100 100 - 100 - - - 180
104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - - - -

105 Omeprazol 20 mg Kaps 1,110 120 1,230 - 1,525 - 295 1,230 1,010 120 1,130 - 1,350 - 220 1,130 - - - 1,230
106 Ondansetron 4 mg Tab 647 - 647 68 579 - 579 575 - 575 95 480 - 480 95 - - 484
107 Parasetamol 500 mg Tab 4,180 - 4,180 2,549 1,631 - 1,631 2,500 - 2,500 2,000 500 - 500 3,569 - 1,938
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
108 Pirantel pamoat 125 mg Tab 107 - 107 - 107 - 107 100 - 100 - 100 - 100 - - - 107
109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - - - -
110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - - - -
111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - - - -
112 Piroksikam 20 mg Tab 1,165 - 1,165 75 1,090 - 1,090 1,000 - 1,000 300 700 - 700 105 - - 985
113 Prednison 5 mg Tab 1,500 - 1,500 20 1,480 - 1,480 1,500 - 1,500 200 1,300 - 1,300 28 - - 1,452
114 Primakuin 15 mg Tab - - - - - - - - - - - - - - - - -
115 Propiltiourasil 100 mg Tab - - - - - - - - - - - - - - - - -
116 Propranolol 10 mg Tab 657 - 657 657 - - - 700 - 700 700 - - - 920 3,285 4,205
117 Propranolol 40 mg Tab 370 - 370 260 110 - 110 200 - 200 200 - - - 364 1,300 1,554
118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - - - -
119 Risperidon 1 mg Tab - - - - - - - - - - - - - - - - -
121 Salbutamol 2 mg Tab 1,442 - 1,442 247 1,195 - 1,195 800 - 800 200 600 - 600 346 - - 849
122 Salbutamol 4 mg Tab 732 - 732 - 862 - 130 732 600 - 600 200 400 - 400 - - - 732
123 Sefadroksil 500 mg Kaps 1,199 - 1,199 8 1,191 - 1,191 1,000 - 1,000 500 500 - 500 11 - - 1,180
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - - - -
125 Setirizin 10 mg Tab 1,793 - 1,793 526 1,267 - 1,267 1,600 - 1,600 900 700 - 700 736 - - 531
126 Simetidin 200 mg Tab - - - - - - - - - - - - - - - - -
127 Simvastatin 10 mg Tab 280 - 280 130 150 - 150 150 - 150 - 150 - 150 182 - 32
128 Simvastatin 20 mg Tab 1,532 - 1,532 650 882 - 882 1,000 - 1,000 700 300 - 300 910 - 28
129 Siprofloksasin 500 mg Tab 475 - 475 95 380 - 380 350 - 350 250 100 - 100 133 - - 247
130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
131 Tambah darah kombinasi (fe dan asam folat) Tab 920 - 920 390 530 - 530 900 - 900 540 360 - 360 546 - 16
132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - - - -
133 Triheksifenidil 2 mg Tab - - - - - - - - - - - - - - - - -
135 Vitamin A 100.000 IU (retinol) Biru Kaps 411 - 411 50 11 350 361 350 - 350 - - 350 350 70 86 - 205
136 Vitamin A 200.000 IU (retinol) Merah kaps 1,501 - 1,501 468 283 750 1,033 1,500 - 1,500 550 200 750 950 655 - - 378
137 Vitamin B 1 (tiamin) 50 mg Tab 1,847 - 1,847 910 937 - 937 1,200 - 1,200 600 600 - 600 1,274 - 337
138 Vitamin B 6 (piridoksin) 10 mg Tab 1,120 - 1,120 484 636 - 636 300 - 300 - 400 - 100 300 678 - 42
139 Vitamin B kompleks Tab 2,349 - 2,349 2,014 335 - 335 1,500 - 1,500 1,400 100 - 100 2,820 - 2,485
140 Vitamin C (asam askorbat) 50 mg Tab 607 - 607 519 88 - 88 - - - - - - - 727 15,570 16,209
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 269 - 269 221 48 - 48 100 - 100 100 - - - 309 1,105 1,366
142 Vitamin Hepagard Tab 125 - 125 - 125 - 125 150 - 150 120 30 - 30 - - - 125
143 Zinc tablet dispersibel 20 mg Tab 245 - 245 95 350 - 200 150 100 - 100 100 - - - 133 380 363
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Becefort 800 200 1,000 - - 1,000 1,000 - 200 200 - - - - - - - 1,000
2 Imbos forte 630 120 750 - - 750 750 - 120 120 - - - - - - - 750
3 Livron B Plex - - - - - - - - - - - - - - - - -
4 Multivitamin (Sivit - Zink) Bh - 120 120 - - 120 120 - 120 120 - - - - - - - 120
5 Oseltamivir 75 mg Bh 570 - 570 - - 570 570 - - - - - - - - - - 570

INJEKSI - - - - - - - - - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 4 - 4 2 2 - 2 - - - - - - - 3 60 61
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 20 - 20 8 12 - 12 20 - 20 10 10 - 10 11 - - 1
3 Aminofilin 24 mg/ml Amp 22 - 22 17 5 - 5 9 - 9 9 - - - 24 340 359

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 15 - 15 12 3 - 3 7 - 7 7 - - - 17 360 374
5 Antrain Inj Amp - - - - - - - - - - - - - - - - -
6 Artemether 80 mg/ml Amp - - - - - - - - - - - - - - - - -
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - - - - - - - - -
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp - - - - 10 - 10 - 10 - 10 - 10 - 10 - - -
10 Atropin 0,25 mg/ml Amp 3 - 3 3 - - - - - - - - - - 4 90 94
11 Deksametason 5 mg/ml Amp 76 - 76 24 52 - 52 60 - 60 40 20 - 20 34 - - 18
12 Difenhidramin hcl 10 mg/ml Amp 65 - 65 52 13 - 13 30 - 30 30 - - - 73 1,560 1,620

13 Epinefrin (adrenalin) 0,1% Amp Subsie
10 Evaluasi
- dan Perencanaan
10 - - 10 10 - - - - - - - - - - 10
14 Furosemid 10 mg/ml Amp 25 - 25 25 - - - 20 - 20 20 - - - 35 750 785
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - - - - - - - - - -

MARIYANI
16 Gentamisin 40 mg/ml Amp NIP:
- 19750812
- 200003 2- 003 - - - - - - - - - - - - - -
17 Haloperidol 5 mg/ml Amp - - - - - - - - - - - - - - - - -

19 Kalsium glukonat 10 % Amp 10 - 10 - - 10 10 10 - 10 10 - - - - - - 10
20 Ketorolak 30 mg/ml Amp 20 - 20 - - 20 20 15 - 15 15 - - - - - - 20
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - - - - - - - - -
22 Lidokain 2 % Amp 217 - 217 24 193 - 193 187 - 187 29 158 - 158 34 - - 159
23 Lidokain kompositum Amp 28 - 28 - 60 - 32 28 60 - 60 32 30 - 2 28 - - - 28

24 Magnesium sulfat 20 % (i.v.) Btl 27 - 27 6 21 - 21 22 - 22 2 20 - 20 8 - - 13
25 Magnesium sulfat 40 % (i.v.) Btl 13 - 13 - 14 - 1 13 8 - 8 - 8 - 8 - - - 13
26 Metamizol (antalgin) 500 mg/2 ml Amp 114 - 114 29 85 - 85 90 - 90 20 70 - 70 41 - - 44

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
27 Metilergometrin 0.2 mg/ml Amp - - - - 190 - 190 - - - - - - - - - - -
28 Oksitosin 10 iu/ml Amp 16 - 16 13 3 - 3 - - - - - - - 18 390 405
29 Omeprazole 40 mg/ml Amp 58 - 58 34 24 - 24 20 - 20 1 19 - 19 48 - 24
30 Ondansetron 4 mg/2 ml Amp 149 - 149 74 75 - 75 100 - 100 40 60 - 60 104 - 29
31 Piracetam 1 gr Amp 33 - 33 23 10 - 10 30 - 30 20 10 - 10 32 - 22
32 Prokain benzil penisillin 3 juta iu/ml Amp - - - - MENGETAHU

MENGETA- - - - - - ,MENGETAHUI
,MENGETAHUI
- - - - - - -
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
Ranitidin Amp - - - - Kepala
Kepala Dinas
- - - - - - Kabupaten- Kotawaringin
Kabupaten -
Kotawaringin - - - - -
,HUI Dinas
Kesehatan Barat
Barat
Sefotaksim Vial 15 - 15 - Kesehatan
Kabupaten - 15 15 15 - 15 15 - - - - - - 15
Dinas Kotawaringin
Kabupaten
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 15 - 15 6 Barat -
Kotawaring 9 9 15 - 15 15 - - - 8 180 179
Kabupate in Barat
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 69 - 69 39 30 - 30 60 - 60 30 30 - 30 55 1 26
drg.INDRAWAN
gin Barat Amp - - - - - - - - - - -
SAKTI,MKes
SAKTI,MKes - - - - - -
NIP:
NIP:19610521
19610521199303
19930311
38 Vitamin B 1 (tiamin) 100 mg /ml Amp - - - - drg.INDRAW
- - - - - - - 004
004 - - - - - -
drg.INDRA
AN
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 100 - 100 85 SAKTI,MKes
WAN15 - 15 62 - 62 62 - - - 119 2,550 2,654
SAKTI,MKe
NIP:
TAMBAHAN
drg.INDRA - - - - 19610521
s - - - - - - - - - - - - -
WAN 199303
NIP: 1
SAKTI,MK - - - - 19610521
004 - - - - - - - - - - - - -
es 199303 1
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 004 - - - - - - - - - - - - -
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - - - - - - - - -
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube - - - - - - - - - - - - - - - - -
3 Diazepam 2 mg Tab - - - - - - - - - - - - - - - - -
4 Diazepam 5 mg Tab 37 - 37 18 - 19 19 - - - - - - - 25 540 546

5 Diazepam 5 mg/ml (i.v.) Amp 70 - 70 11 - 59 59 - - - - - - - 15 330 286

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
8 Kodein 10 mg Tab 200 - 200 200 - - - - - - - - - - 280 6,000 6,280
9 Klobazam 10 mg Tab - - - - - - - - - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - - - - - - - - - -
1 Antifungi kombinasi Tube 20 - 20 2 18 - 18 10 - 10 10 - - - 3 3 - 13
2 Antihemoroid kombinasi Supp 21 - 21 6 - 15 15 17 - 17 7 - 10 10 8 - - 7
3 Asiklovir 5% Krim Tube 56 - 56 21 35 - 35 50 - 50 20 30 - 30 29 - - 6
4 Basitrasin - polimiksin B Tube - 29 29 - 29 - 29 - 29 29 29 29 - 29 - - - - 29
5 Bedak salisil 2% Ktk - 10 10 - 10 - 10 - 10 10 10 - - - - - - 10
6 Betametason 0,1% krim Tube 66 - 66 9 57 - 57 50 - 50 35 15 - 15 13 - - 44
7 Bioplacenton krim Tube - - - - - - - - - - - - - - - - -
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 35 - 35 - - 35 35 - - - - 35 - 35 - - - - 35
10 Desoksimetason 0,25 % krim Tube 29 - 29 12 17 - 17 20 - 20 20 - - - 17 16 15
11 Gentamisin salep kulit Tube 37 - 37 - 38 - 1 37 23 - 23 4 19 - 19 - - - 37

12 Gentamisin salep mata Tube 56 - 56 13 43 - 43 39 - 39 39 - - - 18 17 - 8
13 Hidrokortison 2,5% krim Tube 28 - 28 - 46 - 18 28 25 - 25 25 - - - - - - 28
14 Ketokonazol 2 % krim Tube 30 - 30 - 37 - 7 30 33 - 33 8 25 - 25 - - - 30
15 Ketoprofen 100 mg Supp 10 - 10 - - 10 10 10 - 10 10 - - - - - - 10
16 Kloramfenikol 1% salep mata Tube 40 - 40 - 59 - 19 40 24 - 24 24 - - - - - - 40
17 kloramfenikol 3% salep kulit Tube 21 - 21 10 11 - 11 2 - 2 2 - - - 14 300 303

18 Mikonazol 2 % krim Tube 61 - 61 - 172 - 111 61 56 - 56 8 48 - 48 - - - 61
19 metronidazol ovula 500 mg ovul 40 - 40 - - 40 40 - - - - - - - - - - 40
20 Nistatin 100.000 IU Supp 42 - 42 - 56 - 14 42 42 - 42 - 42 - 42 - - - 42

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
21 Oksitetrasiklin salep kulit Tube 15 - 15 - 43 - 28 15 - - - - 25 - 25 - - - - 15

22 Oksitetrasiklin salep mata Tube 53 - 53 2 61 - 10 51 - - - - - - - 3 60 12
23 povidon iodin / betadine salep Tube 10 - 10 - 26 - 16 10 - - - - - - - - - - 10
24 Salep 2-4 kombinasi krim Tube 48 - 48 - 36 12 48 48 - 48 24 24 - 24 - - - 48
25 Sulfadiazine 10 Mg Salep Tube 10 - 10 - 10 - 10 - - - - - - - - - - 10
SIRUP - - - - - - - - - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 108 - 108 14 94 - 94 94 - 94 25 69 - 69 20 - - 74
3 ambroxol sirup 30 mg/5 ml Btl 115 - 115 31 84 - 84 100 - 100 20 80 - 80 43 - - 41
4 Amoksisilin sirup kering 125 mg/5 ml Btl 36 - 36 - 79 - 43 36 2 - 2 - 2 - 2 - - - 36
5 Amoksisilin sirup kering 250 mg/5 ml Btl 111 - 111 - - 111 111 90 - 90 10 80 - 80 - - - 111
6 Antasida susp Btl 216 - 216 24 192 - 192 200 - 200 34 166 - 166 34 - - 158
7 Caviflex sirup Btl - - - - - - - - - - - - - - - - -
8 Dextrofen sirup Btl 128 - 128 8 41 79 120 104 - 104 - 104 - 104 11 - - 109
9 Domperidon sirup 5 mg/5 ml Btl 81 - 81 28 53 - 53 42 - 42 15 27 - 27 39 - - 14
10 Ibuprofen sups 100 mg / 5 ml Btl 50 - 50 - - 50 50 50 - 50 - 50 - 50 - - - 50
11 Ibuprofen sups 200 mg / 5 ml Btl 1 - 1 1 - - - - - - - - - - 1 30 31
12 Kloramfenikol susp 125 mg/5 ml Btl 32 - 32 - 52 - 20 32 15 - 15 - 15 - 15 - - - 32
13 Kotrimoksazol susp 240 mg/5 ml Btl 115 - 115 25 90 - 90 100 - 100 10 90 - 90 35 - - 55
14 Laktulosa 3,335 g/5 ml Btl 18 - 18 1 17 - 17 17 - 17 - 17 - 17 1 - - 16
15 Metronidazol susp 125 mg/5 mL Btl 24 - 24 - 24 - 24 18 - 18 - 19 - 1 18 - - - 24
16 Nistatin drop 100.000 IU/ml Btl 16 - 16 1 - 15 15 10 - 10 10 - - - 1 30 16
17 Obat batuk hitam (OBH) sirup Btl 32 - 32 - 42 - 10 32 - - - - - - - - - - 32
18 Parasetamol drops 100 mg/ml Btl 160 - 160 - 169 - 9 160 130 - 130 4 126 - 126 - - - 160
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
19 Parasetamol sirup 120 mg/5 ml Btl 147 - 147 1 146 - 146 125 - 125 20 105 - 105 1 - - 145
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - - - - - - - - -
21 Procuma sirup Btl 115 - 115 20 95 - 95 104 - 104 39 65 - 65 28 - - 67
22 Sefadroksil sirup kering 125 mg/5 ml Btl 105 - 105 - 121 - 16 105 50 - 50 - 60 - 10 50 - - - 105
23 sefadroxil sirup kering 250 mg /forte Btl 91 - 91 1 11 79 90 71 - 71 - 71 - 71 1 - - 89
24 setirizin 5mg / 5 ml Btl 178 - 178 4 - 174 174 137 - 137 10 127 - 127 6 - - 168
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - - - - - - - - -
26 Zink sirup 20mg/ 5ml Btl 40 - 40 10 30 - 30 20 - 20 - 20 - 20 14 - - 16
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Becefort syrup - - - - - - - - - - - - - - - - -
2 Imbos Syrup 6 - 6 - - 6 6 6 - 6 - - 6 6 - - - 6
LARUTAN - - - - - - - - - - - - - - - - -
1 Alkazyme Bks - - - - - - - - - - - - - - - - -
2 Alkacide btl - - - - - - - - - - - - - - - - -
3 Bromhexin (Bisolvon) Btl 1 - 1 - 1 - 1 1 - 1 - 1 - 1 - - - 1
4 Etanol 70 % 1000 ml Btl 73 - 73 7 73 - 7 66 73 - 73 73 - - - 10 210 154

5 Etakridinn laktat 0,1% (rivanol) Btl 5 - 5 - - 5 5 5 - 5 - 5 - 5 - - - 5
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - - - - - - - - -
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - - - - - - - - -
8 Gentamisin 0,3 % tetes mata Btl 17 - 17 - 12 5 17 12 - 12 - 12 - 12 - - - 17
9 Gentian violet 1 % Btl 62 - 62 5 62 - 5 57 39 - 39 15 24 - 24 7 - - 50
10 Glukosa 10 % (D.10) 500 ml Btl 23 - 23 14 9 - 9 11 - 11 2 9 - 9 20 0 11
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 15 - 15 10 5 - 5 - - - - - - - 14 300 309

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
13 KA-EN 1 B 500 ml Btl 16 - 16 - - 16 16 16 - 16 - 16 - 16 - - - 16
14 KA-EN 3 B 500 ml Btl 30 - 30 - - 30 30 30 - 30 - 30 - 30 - - - 30
15 kloramfenikol Tetes mata Btl - - - - 5 - 5 - - - - - - - - - - -
16 Kloramfenikol 3% tetes telinga Btl 8 - 8 8 - - - - - - - - - - 11 240 251
17 Lysol 1 liter Btl 4 - 4 - 1 3 4 4 - 4 1 3 - 3 - - - 4
18 Metronidazol infus 5 mg/ml Btl 1 - 1 - - 1 1 1 - 1 - 1 - 1 - - - 1
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 100 - 100 33 67 - 67 74 - 74 14 60 - 60 46 - - 21
20 Povidon iodin 10 % 30 ml Btl 18 - 18 1 6 11 17 14 - 14 - 14 - 14 1 - - 16
21 Povidon iodin 10 % 300 ml Btl 12 - 12 - 3 9 12 10 - 10 1 9 - 9 - - - 12
22 Parasetamol infus 10 mg/ml Btl - - - - - - - - - - - - - - - - -
23 Ringer laktat (RL) 500 ml Btl 162 - 162 18 144 - 144 133 - 133 11 122 - 122 25 - - 119
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Bayclin Btl - - - - - - - - - - - 48 - 48 - - - -
2 larutan disenfektan karbol Btl 48 - 48 - - 48 48 11 - 11 - 34 - 23 11 - - - 48

3 Sabun cuci tangan 34 - 34 - - 34 34 - - - - - - - - - - 34
4 Alkohol 1 liter - - - - - - - - - - - - - - - - -
5 antiseptic gel - - - - - - - Err:509 - Err:509 - - - - - - -
SERUM DAN VAKSIN - - - - - - - - - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial - - - - - - - - - - - - - - - - -
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 6 4 10 - 10 - 10 - 4 4 4 - - - - - - 10
4 Vaksin BCG Vial 24 9 33 7 16 10 26 10 9 19 9 - 10 10 10 210 194
5 Vaksin campak Vial - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
6 Vaksin hepatitis (HBO) Bayi Pouches 36 6 42 10 32 - 32 - 6 6 6 - - - 14 300 282
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 7 10 - 17 - 7 10 - 7 7 7 - - - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 13 5 18 - 18 - 18 - 5 5 5 - - - - - - 18
11 Vaksin kombinasi DPT-HB-Hib Vial 113 - 113 60 33 20 53 20 - 20 - - 20 20 84 1,800 1,831
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 10 20 30 8 12 10 22 10 20 30 20 - 10 10 11 240 229
13 Vaksin polio t-opv drops 10 dosis Vial 50 - 50 11 19 20 39 20 - 20 - - 20 20 15 330 306
14 vaksin MR Vial 23 29 52 8 24 20 44 20 29 49 29 - 20 20 11 240 207
TAMBAHAN - - - - - - - - - - - - - - - - -
ADS 0,05 ML - - - - - - - - - - - - - - - - -
ADS 0,5 ML 300 - 300 - - 300 300 300 - 300 - - 300 300 - - - 300
ADS 5 ML - - - - - - - - - - - - - - - - -
Safety box 5 L - - - - - - - - - - - - - - - - -
VAKSIN SINOVAC - 116 116 116 - - - - 116 116 116 - - - 162 3,480 3,642
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set - 404 404 14 390 - 390 - 404 404 404 - - - 20 420 50
2 Alat suntik sekali pakai 0,5 ml Set 10,000 10,600 20,600 226 496 19,878 20,374 10,000 10,600 20,600 10,600 - 10,000 10,000 316 6,780 - 13,278
3 Alat suntik sekali pakai 1 ml Set 354 - 354 122 232 - 232 300 - 300 100 200 - 200 171 - - 61
4 Alat suntik sekali pakai 3 ml Set 454 - 454 23 167 264 431 340 - 340 150 190 - 190 32 - - 399
5 Alat suntik sekali pakai 5 ml Set 482 - 482 32 620 - 170 450 425 - 425 225 200 - 200 45 - - 405
6 Alat suntik sekali pakai 10 ml Set 36 - 36 30 6 - 6 30 - 30 30 - - - 42 900 936
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
8 Alkohol swabs Pcs 10,000 - 10,000 93 11,700 - 1,793 9,907 10,000 - 10,000 10,000 - - - 130 2,790 - 6,987
9 Antiseptik gel 500 ml Btl 44 - 44 - 44 - 44 44 - 44 - 44 - 44 - - - 44
10 Bisturi uk.20 Pcs 21 - 21 7 14 - 14 11 - 11 11 - - - 10 210 206
11 Bisturi uk.21 Pcs 5 - 5 - 8 - 3 5 - - - - - - - - - - 5
12 Blood transfusi set Set 5 - 5 - 5 - 5 - - - - - - - - - - 5
13 Cat gut chromic 2/0 Pcs 12 - 12 - 20 - 8 12 - - - - - - - - - - 12
14 Cat gut chromic 3/0 Pcs 30 - 30 - 7 23 30 24 - 24 - 24 - 24 - - - 30
15 Cat gut plain 2/0 Sak 73 - 73 - 74 - 1 73 72 - 72 22 50 - 50 - - - 73

16 Cat gut plain 3/0 Sak 56 - 56 - 10 46 56 56 - 56 - 56 - 56 - - - 56
17 Folly catheter No.16 pcs 18 - 18 - 18 - 18 15 - 15 3 12 - 12 - - - 18
18 Folly catheter No.18 pcs 20 - 20 - 20 - 20 16 - 16 1 15 - 15 - - - 20
19 I.V. catheter No.18 pcs 127 - 127 1 219 - 93 126 99 - 99 - 186 - 87 99 1 - - 125
20 I.V. catheter No.20 pcs 83 - 83 16 67 - 67 63 - 63 13 50 - 50 22 - - 45
21 I.V. catheter No.22 pcs 110 - 110 20 90 - 90 95 - 95 20 75 - 75 28 - - 62

22 I.V. Catheter No.24 pcs 65 - 65 - 69 - 4 65 50 - 50 5 45 - 45 - - - 65
23 I.V. Catheter No.26 pcs 9 - 9 - 10 - 1 9 5 - 5 - 5 - 5 - - - 9
24 Infus set anak pcs 17 - 17 4 20 - 7 13 15 - 15 - 20 - 5 15 6 - - 7
25 Infus set dewasa pcs 100 - 100 3 118 - 21 97 95 - 95 - 97 - 2 95 4 - - 93
26 Jarum (needle) 23 Pcs 13 - 13 - 18 - 5 13 13 - 13 - 13 - 13 - - - 13
27 Jarum (needle) 27 Pcs 70 - 70 50 20 - 20 70 - 70 55 15 - 15 70 - 50

28 K.y jelly 82 gram Tube 12 - 12 8 2 2 4 14 - 14 10 4 - 4 11 - 7
29 Kapas pembalut/absorben 250 gram Bks 7 - 7 - 19 - 12 7 6 - 6 - 14 - 8 6 - - - 7
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 75 - 75 - 5 70 75 75 - 75 - 75 - 75 - - - 75

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 76 - 76 - 4 72 76 76 - 76 - 76 - 76 - - - 76
34 Kasa kompres 40/40 steril Roll 145 - 145 8 148 - 11 137 130 - 130 - 130 - 130 11 - - 126
35 Kasa 40 m x 80 cm Roll - - - - - - - - - - - - - - - - -
36 Kasa pembalut 2 m x 80 cm Roll 24 - 24 2 27 - 5 22 15 - 15 - 15 - 15 3 - - 19
37 Kasa steril 16x16 cm ktk ,Pangkalan

59 Bun,31 - Desember
59 2012 22 37 - 37 53 - 53 19 34 - 34 31 - - 6
38 Kertas puyer biasa Pack 1 Kotawaringin- Barat 1 - 2 - 1 1 1 - 1 - 1 - 1 - - - 1
40 Kondom Sutra pcs - - - - - - - - - - - - - - - - -
41 Masker Pcs 8,550 SONNY SAPUTRA,SKM

- 8,550 872 8,550 - 872 7,678 8,550 - 8,550 8,550 - - - 1,221 26,160 19,703
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 112 - 112 - 112 - 112 112 - 112 - 112 - 112 - - - 112
43 Penjepit tali pusat Pcs 30 - 30 - 30 - 30 30 - 30 30 - - - - - - 30
44 penghisap lendir pcs 44 - 44 - 29 15 44 20 - 20 - 20 - 20 - - - 44

45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr - - - - - - - - - - - - - - - - -
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr - - - - - - - - - - - - - - - - -
47 Plester 1,25 X 4,5 m Roll - - - - - - - - - - - - - - - - -

,MENGETAHUI
48 Plester 5cm x 4,5 cm Roll - Kepala Dinas
- Kesehatan
- - - - - - - - - - - - - - -
49 Plester bulat/ plesterin pcs 200 - 200 - 563 - 363 200 200 - 200 - 563 - 363 200 - - - 200
50 Plester cannofix pcs 40 - 40 - - 40 40 40 - 40 - 40 - 40 - - - 40

51 Plester dermafix Pcs -drg.INDRAWAN
- SAKTI,M.Kes
- - - - - - - - - - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll 10 - 10 - 1 9 10 9 - 9 1 8 - 8 - - - 10
53 Safety box Bh 30 - 30 6 17 7 24 24 - 24 6 8 10 18 8 - - 16
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
54 Sarung tangan non steril Uk. S Psg 2,950 - 2,950 317 2,950 - 317 2,633 2,950 - 2,950 2,950 - - - 444 9,510 7,321
55 Sarung tangan non steril Uk. M Psg 136 - 136 100 136 - 100 36 136 - 136 136 - - - 140 3,000 3,104
56 Sarung tangan non steril Uk. L Psg 9,550 - 9,550 756 9,550 - 756 8,794 9,550 - 9,550 9,550 - - - 1,058 22,680 14,944
57 Sarung tangan steril ginekologi Psg 3 - 3 - - 3 3 3 - 3 - 3 - 3 - - - 3
58 Sarung tangan steril No.6 Psg - - - - - - - - - - - - - - - - -
59 Sarung tangan steril No.6,5 Psg 61 - 61 4 57 - 57 60 - 60 5 55 - 55 6 - - 51
60 Sarung tangan steril No.7 Psg 4 - 4 1 3 - 3 - - - - - - - 1 30 28
61 Sarung tangan steril No.7,5 Psg 39 - 39 4 43 - 8 35 17 - 17 - 17 - 17 6 - - 29
62 Sarung Tangan steril no.8 Psg 96 - 96 - 17 79 96 96 - 96 - 167 - 71 96 - - - 96
63 Selang oksigen anak Pcs 17 - 17 - 18 - 1 17 7 - 7 2 9 - 4 5 - - - 17
64 Selang oksigen bayi Pcs 26 - 26 - 6 20 26 20 - 20 - - 20 20 - - - 26

65 Selang oksigen dewasa Pcs 21 - 21 6 15 - 15 15 - 15 6 9 - 9 8 - - 7
66 Sendok kertas puyer Pcs - - - - - - - - - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 71 - 71 4 67 - 67 71 - 71 4 67 - 67 6 - - 61
68 Silk (benang bedah sutra) No. 3/0 Sak 38 - 38 12 26 - 26 36 - 36 11 25 - 25 17 - - 9
69 Speculum Uk S pcs - - - - - - - - - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - - - - - - - - - -
71 Speculum Uk L pcs - - - - - - - - - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - - - - - - - - - -
73 Underpads Pcs 50 - 50 5 49 - 4 45 50 - 50 5 45 - 45 7 - - 38
74 Urin bag Pcs 26 - 26 - 22 4 26 20 - 20 3 17 - 17 - - - 26
75 Wing needle no 27 G Pcs 71 - 71 - - 71 71 71 - 71 - 71 - 71 - - - 71
TAMBAHAN - - - - - - - - - - - - - - - - -
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
1 Back pack sprayer Pcs - - - - 2 - 2 - - - - - 2 - 2 - - - -
2 Rapid test covid-19 Pcs 75 - 75 - 3 72 75 - - - - 3 - 3 - - - - 75
3 Rapid test antigen Pcs 25 - 25 - 2 23 25 - - - - 2 - 2 - - - - 25
4 Masker KN 95 - - - - 40 - 40 - - - - - - - - - - -
5 Masker N95 - - - - 30 - 30 - - - - - - - - - - -
6 Masker Bedah - - - - 47 - 47 - - - - - - - - - - -
7 Kacamata google - - - - 24 - 24 - - - - - - - - - - -
8 Face shield Nagita 35 - 35 - - 35 35 - - - - - - - - - - 35
9 Face shield naik turun - - - - - - - - - - - - - - - - -
10 Face shield - - - - - - - - - - - - - - - - -
11 Sepatu boot - - - - - - - - - - - - - - - - -
12 Baju Hazmat kain - - - - - - - - - - - - - - - - -
13 Baju Hazmat cuci ulang - - - - - - - - - - - - - - - - -
14 Hand schoon M - - - - - - - - - - - - - - - - -
15 Hand schoon L - - - - - - - - - - - - - - - - -
16 Hand schoon s - - - - - - - - - - - - - - - - -
17 Hand schoon steril no 7,5 - - - - - - - - - - - - - - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - - - - - - - - - - -
19 APD - - - - 460 - 460 - - - - - - - - - - -
20 APD SET HIJAU - - - - 5,256 - 5,256 - - - - - - - - - - -

21 APD BOHO - - - - 1,262 - 1,262 - - - - - - - - - - -
22 APD LEVEL 2 - - - - 231 - 231 - - - - - - - - - - -
23 APD LEVEL 3 - - - - 6 - 6 - - - - - - - - - - -
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
24 APD PEMDA/DONASI - - - - - - - - - - - - - - - - -
25 APD 1 SET - - - - 300 - 300 - - - - - - - - - - -
26 GOWN - - - - 35 - 35 - - - - - - - - - - -
27 COOL BOK 6 LITER - - - - 5 - 5 - - - - - - - - - - -
28 COOL BOK 12,5 LITER - - - - 50 - 50 - - - - - - - - - - -
29 ANAFILATIK KIT 5 - 5 5 - - - - - - - - - - 7 150 157
BAHAN & ALAT LABORATORIUM - - - - - - - - - - - - - - - - -
1 Asam asetat (Cuka) Btl - - - - - - - - - - - - - - - - -
2 Alat pulmo (peak flow) set - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
3 Bilik hitung Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
4 Blood lancet Pcs 1,242 200 1,442 - 1,156 286 1,442 1,000 200 1,200 - - 1,200 1,200 - - - 1,442
5 Bulb pipet Bh - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
6 Cartrialge genexpert KIT set - - - - - - - - - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - - - - - - - - - -

8 Compresson nebulizer pcs - - - - - - - - - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - - - - - - - - - -
13 Kaca slide/ Kaca objek Set 222 - 222 222 1 - 1 - - - - - - - - 311 6,660 6,971
14 KIT diagnostic untuk HIV Pcs - - - - - - - - - - - - - - - - -
15 KIT RPR pcs - - - - - - - - - - - - - - - - -
16 Kotak slide Pcs 5 - 5 3 2 - 2 - - - - - - - 4 90 92

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
17 Lampu spiritus 150 ml Pcs 2 - 2 1 1 - 1 - - - - - - - 1 30 30
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - - - - - - - - - -
20 Medline Pcs - - - - - - - - - - - - - - - - -
21 Microhematokrit tube wax Pcs - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
22 Mikro tube (Vol 1,5 ml) Pcs - 50 50 - 50 - 50 - 50 50 50 - - - - - - 50
23 Mikroskope cover glasses 18x18 mm Pcs 25 35 60 - 60 - 60 - 35 35 35 - - - - - - 60
24 Mikroskope cover glasses 20x20 mm Pcs - - - - - - - - - - - - - - - - -
27 Nebulizer Bh - - - - - - - - - - - - - - - - -
28 Peak flow meter Pcs - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
29 Pen lancet Pcs 5 2 7 - 7 - 7 - 2 2 2 - - - - - - 7
30 Pengukur tinggi badan Pcs - - - - - - - - - - - - - - - - -

31 Pipet eritrosit Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
32 Pipet HB Pcs 2 - 2 1 1 - 1 - - - - - - - 1 30 30
33 Pipet leukosit Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - - - - - - - - - -
35 Pipet westergren Bh - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
36 Pot dahak Pcs 85 - 85 5 80 - 80 - - - - - - - 7 150 77

37 Pot urine Pcs - - - - - - - - - - - - - - - - -
38 Rak staenles tes tube Test - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test - - - - - - - - - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - - - - - - - - - - - - -
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 186 200 386 12 105 269 374 150 200 350 81 - 269 269 17 360 3
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test - - - - - - - - - - - - - - - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test 49 - 49 - - 49 49 50 - 50 - - 50 50 - - - 49
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 50 127 177 20 107 50 157 50 127 177 127 - 50 50 28 600 471
50 Reagen Cell clean Btl - - - - - - - - - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 50 89 139 18 71 50 121 50 89 139 89 - 50 50 25 540 444
52 Reagen Giemsa Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
53 Reagen Gol Darah Btl 4 - 4 3 1 - 1 - - - - - - - 4 90 93

54 Reagen Gol darah anti D Btl - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
55 Reagen Immersion Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 3 1 4 2 1 1 2 - 1 1 - - 1 1 3 60 61
58 RPR Sipilis fokus Pcs - - - - - - - - - - - - - - - - -
59 Spritus Btl 1 - 1 1 - - - - - - - - - - 1 30 31
60 Tabung hematokrit heparin Pcs 125 - 125 125 - - - - - - - - - - 175 3,750 3,925
61 Tabung hematokrit non heparin Pcs 25 - 25 25 - - - - - - - - - - 35 750 785
62 Tabung vacutainer edta warna ungu Pcs - 143 143 - 143 - 143 - 143 143 143 - - - - - - 143
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
63 Test asam urat Pcs - 248 248 12 236 - 236 200 248 448 248 - 200 200 17 360 141
64 Test gluco protein urine Pcs - 59 59 - 59 - 59 - 59 59 56 - 3 3 - - - 59
65 Test iodium Pcs 8 - 8 8 - - - - - - - - - - 11 240 251
66 Test kehamilan / PP test Test 4 64 68 4 64 - 64 - 64 64 64 - - - 6 120 62
67 Test kolestrol Tube - 306 306 8 298 - 298 250 306 556 556 - - - 11 - - 287
68 Test pemeriksaan gula darah Pcs 1,152 150 1,302 55 1,247 - 1,247 1,200 150 1,350 150 - 1,200 1,200 77 - - 1,170
69 Test pemeriksaan HB Test - 75 75 10 73 - 8 65 - 75 75 75 - - - 14 300 249
70 Test Pemeriksaan Urine 10 Parameter Test 150 - 150 72 78 - 78 - - - - - - - 101 2,160 2,183
71 Tipe mikro pipet warna biru Test 250 175 425 - 425 - 425 - 175 175 175 - - - - - - 425
72 Tipe mikro pipet warna kuning Test 157 398 555 - 555 - 555 - 398 398 398 - - - - - - 555
73 Tipe mikro pipet warna putih Test - - - - - - - - - - - - - - - - -
74 Tisue mikroskop Pcs - 1 1 - 1 - 1 - 1 1 1 - - - - - - 1
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs - 50 50 - 50 - 50 - 50 50 50 - - - - - - 50

77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - - - - - - - - - -
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 90 - 90 - - 90 90 90 - 90 - - 90 90 - - - 90
BAHAN GIGI - - - - - - - - - - - - - - - - -
1 Bahan tambahan light curing 2 - 2 2 - - - - - - - - - - 3 60 63
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - - - - - - - - - -

3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - - - - - - - - - -
4 Bonding resine Btl 2 - 2 2 - - - - - - - - - - 3 60 63
5 Caviton Btl 2 - 2 2 - - - - - - - - - - 3 60 63
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
6 Cellopand strip swenska Pack 2 - 2 1 - 1 1 - - - - - - - 1 30 30
7 Devitalisasi pasta Btl 2 - 2 2 - - - - - - - - - - 3 60 63
8 Etil klorida semprot 100 ml Btl 3 - 3 3 - - - - - - - - - - 4 90 94
9 Etching SDI liquid / Acid ethan liquid Btl 3 - 3 3 - - - - - - - - - - 4 90 94
10 Eugenol cairan Btl 2 - 2 2 - - - - - - - - - - 3 60 63
11 Endometason Pcs - - - - - - - - - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 2 - 2 1 - 1 1 - - - - - - - 1 30 30
13 Fraser / Bentuk silinder Bh 2 - 2 1 - 1 1 - - - - - - - 1 30 30
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - - - - - - - - - -
15 Gutta percha poins Ktk 2 - 2 2 - - - - - - - - - - 3 60 63
16 H-file Pcs - - - - - - - - - - - - - - - - -
17 K-file Pcs - - - - - - - - - - - - - - - - -
18 Kalsium hidroksida pasta Ktk 2 - 2 2 - - - - - - - - - - 3 60 63
19 Kertas artikulasi (articulating paper) Pack 2 - 2 1 - 1 1 - - - - - - - 1 30 30

20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - - - - - - - - - -
24 Mata bor mikromotor (RA) Pack 1 - 1 1 - - - - - - - - - - 1 30 31
25 Mata bor white stone Set 1 - 1 1 - - - - - - - - - - 1 30 31

26 Mata bor hand place (FG diamond) Set - - - - - - - - - - - - - - - - -
27 Mata bor tulang / Oral surgery (meisenger) Pcs 11 - 11 6 - 5 5 - - - - - - - 8 180 183
28 Needle olyco / Jarum carpule Pcs - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
29 Needle Septoject Pcs - 200 200 - - 200 200 - 200 200 200 - - - - - - 200
30 Oil spray Btl - - - - - - - - - - - - - - - - -
31 Paper points Ktk 2 - 2 1 - 1 1 - - - - - - - 1 30 30
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - - - - - - - - - -
33 Komposit resin (solare x) Tube - - - - - - - - - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - - - - - - - - - -
36 Siver amalgam (serbuk) Btl - - - - - - - - - - - - - - - - -
37 Solare X A2 Bh 1 - 1 1 - - - - - - - - - - 1 30 31
38 Solare X A3 Bh - - - - - - - - - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - - - - - - - - - -
UMUM
ASKES JUMLAH
TIDAK
82 159 339 580
,MENGETAHUI/MENYETUJUI ,Yang Menyerahkan Yang Menerima/Melapor

Kepala Dinas Kesehatan Kepala UPTD Instalasi Farmasi Pimpinan Puskesmas
Kabupaten Kotawaringin Barat Kabupaten Kotawaringin Barat
Achmad Rois, SKM. M.Kes SOUFIA ARDIANI, S.Si.Apt dr.Yordan Pradiksa

NIP: 19691104 199203 1 002 NIP: 19800211 200312 2 011 .NIP: 19820121 201001 1 011
,Yang Menyerahkan Yang Menerima/Melapor
Kepala UPTD Instalasi Farmasi Pimpinan Puskesmas
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH STOK AWAL PENERIMA PERSEDIAA PENGELUAR
dr.Yordan Pradiksa GUDANG OPTIMUM WAKTU
NO OBAT DAN PERBEKKES SATUAN AWAL ANSOUFIA NARDIANI,NS.Si.Apt AN N AN PUSKESMA KOSONG
KEBUTUHA
AN .NIP: 19820121 201001 1 011 (40 %) N
NIP: 19800211 200312 2 011 S

LAPORAN
: FEBRUARI
: 2021
PERMINTAAN
APBN HIBAH ED
1,000
500
300
300
100
2,000
500
1,000
500
PERMINTAAN
APBN HIBAH ED
500
100
1,000
200
1,000
500
500
100
600
1,000
1,000
PERMINTAAN
APBN HIBAH ED
1,000
1,000
1,000
1,000
300
300
PERMINTAAN
APBN HIBAH ED
100
100
1,000
200
500
500
500
500
300
PERMINTAAN
APBN HIBAH ED
500
1,000
1,000
500
100
500
100
1,000
500
2,000
PERMINTAAN
APBN HIBAH ED
500
500
500
100
500
1,000
1,500
500
500
500
200
300
500
PERMINTAAN
APBN HIBAH ED
500
500
1,000
500
2,000
2,000
1,000
500
-
PERMINTAAN
APBN HIBAH ED
30
30
30
20
30
10
30
10
10
10
PERMINTAAN
APBN HIBAH ED
50
10
10
50
PERMINTAAN
APBN HIBAH ED
25
20
20
PERMINTAAN
APBN HIBAH ED
25
25
10
20
100
30
100
PERMINTAAN
APBN HIBAH ED
10
30
2
30
20
PERMINTAAN
APBN HIBAH ED
25
25
2
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
30
30
30
PERMINTAAN
APBN HIBAH ED
3
PERMINTAAN
APBN HIBAH ED
50
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
PERMINTAAN
APBN HIBAH ED
Yang Menerima/Melapor
Petugas Puskesmas
Rahmat Wildan, A.Md., Farm

..NIP: 19870406 201101 1 004
Petugas Puskesmas
PERMINTAAN Rahmat Wildan, A.Md., Farm

ALASAN SUMBER ALASAN
PUSKESMAS ..NIP: 19870406 201101 1 004
APBN HIBAH ED
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
1 Albendazol 400 mg Tab 0 0 0 q 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 3 32 0
3 Ambroksol 30 mg Tab 0 0 0 55 0 43 0 50 0 0 0 0 0 0 0 20 0 10 20 0 0 10 0 0 20 514 0 0
6 Amlodipin 5 mg Tab 0 0 0 30 0 50 0 0 0 0 0 0 0 0 20 0 20 10 0 0 0 0 0 0 0 205 0 0
7 Amlodipin 10 mg Tab 6 0 0 0 0 0 0 30 0 0 30 0 0 0 0 0 30 0 0 0 0 12 6 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 4 0 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 5 0 0 0 0 0 0 20 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29 0 0
32 Fenitoin 100 mg Kaps 0 0 0 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 71 0 0
34 Furosemid 40 mg Tab 0 10 0 60 0 0 0 0 0 0 0 0 0 0 10 10 0 0 10 0 0 0 0 0 0 100 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 124 0 0 0 0 10 0 0 0 0 0 0 10 20 0 10 0 0 10 10 0 10 579 0 0


53 Kaptopril 12,5 mg Tab 0 0 0 345 0 20 0 0 0 0 0 0 0 0 0 0 80 0 0 150 0 0 0 0 0 530 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


82 Metformin 500 mg Tab 0 0 0 170 0 30 0 0 30 0 0 0 0 0 0 0 0 20 0 30 0 0 40 0 0 230 30 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Multivitamin ibu hamil (Gestiamin) Tab 0 0 0 0 0 0 0 0 1,000 0 0 80 0 0 0 0 0 70 0 0 0 0 70 0 150 30 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


107 Parasetamol 500 mg Tab 70 20 23 1,478 0 116 0 70 10 0 0 0 10 0 30 0 95 0 40 5 0 32 0 0 0 70 0 0

109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 10 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 4 0 0 111 0 20 0 16 32 0 0 0 0 0 0 10 0 10 20 0 0 40 40 0 14 94 10 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 2 0 0 0 15 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 22 0 0

MENGETA
,HUI
34 Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 6 0 6 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 116 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 822 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL
38
225
742
335
114
40
603
0
170
230
20
55
120
0
171
87
69
TOTAL
71
29
100
200
23
0
1,220
392
0
0
20
783
0
0
0
190
1,125
0
0
TOTAL
98
0
203
0
0
14
0
100
0
0
0
0
110
64
580
0
391
0
TOTAL
56
1,400
0
541
165
0
30
70
0
0
0
0
34
2,069
0
0
0
20
0
TOTAL
657
260
0
0
237
0
8
421
10
610
95
0
380
50
460
780
434
1,864
519
221
0
50
TOTAL
0
0
2
8
17
12
0
0
18
50
0 Subsie Evaluasi dan Perencanaan
25
0
MARIYANI
0 NIP: 19750812 200003 2 003
0
0
18
TOTAL
29
0
10
34
72
23
39
0
0
79
0
0
0
0
18
11
0
0
200
0
TOTAL
20
0
0
0
12
12
0
0
0
0
0
0
0
0
0
0
0
3
27
TOTAL
14
0
0
23
1
0
25
0
1
11
0
0
0
10
0
0
0
TOTAL
6
0
0
0
0
0
14
10
0
0
8
33
0
14
0
0
0
0
0
TOTAL
0
10
0
0
60
11
0
0
116
0
14
226
121
28
30
0
93
0
TOTAL
0
0
0
16
18
0
50
0
0
8
0
19 ,Pangkalan Bun,31 Desember 2012

0 Kotawaringin Barat
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
TOTAL ,Pangkalan Bun,31 Desember 2012
Kotawaringin Barat
0
822 SONNY SAPUTRA,SKM

NIP: 19750508 199903 1 002
0
0
15
0
0
,MENGETAHUI
0 Kepala Dinas Kesehatan
0
0 drg.INDRAWAN SAKTI,M.Kes
NIP: 19610521 199303 1 004
0
4
317
100
756
0
0
1
0
0
1
TOTAL
11
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
5
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Kepala UPTD Puskesmas
Instalasi Farmasi
...............................................
...............................................
SOUFIA ARDIANI, S.Si.Apt
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300 0 0 0 0 100 0 200 200 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 300 100 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 60 0 0 0 0 0 150 0 0 0 0 80 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

25 Digoksin 0,25 mg Tab 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 200 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0 100 200 0 0 0


51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 0 200 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 100 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0


82 Metformin 500 mg Tab 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 300 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Multivitamin ibu hamil (Gestiamin) Tab 0 0 0 0 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 0 0 0 90 0 360 0 1,000 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 80 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 200 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400 0 0 0 200 0 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Multivitamin (Sivit - Zink) Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 5 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 MENGETA
,HUI
Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 116 0 0 0

2 Alat suntik sekali pakai 0,5 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0


8 Alkohol swabs Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,550 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0
54 Sarung tangan non steril Uk. S Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,950 0 0 0
56 Sarung tangan non steril Uk. L Psg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,550 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 30
0 1,000
0 800
0 0
0 100
0 700
0 390
0 100
0 600
0 0
0 0
0 0
0 200
0 700
0 0
0 0
0 250
0 100
0 0
0 280
0 0
0 0
0 100
0 600
0 200
0 100
0 200
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 50
0 30
0 0
0 1,000
0 400
0 300
0 200
0 0
0 0
0 0
0 0
0 0
0 900
0 0
0 0
0 0
0 0
0 0
0 0
0 600
0 200
0 0
0 100
31 TOTAL
0 0
0 0
0 0
0 0
0 300
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 50
0 300
0 0
0 0
0 0
0 3
0 0
0 0
0 100
0 100
0 600
0 100
0 400
0 0
31 TOTAL
0 0
0 300
0 0
0 1,750
0 0
0 800
0 0
0 400
0 0
0 0
0 0
0 80
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 0
0 95
0 2,000
0 0
0 0
0 0
0 0
0 300
0 200
0 0
31 TOTAL
0 0
0 700
0 200
0 0
0 0
0 0
0 200
0 200
0 500
0 0
0 900
0 0
0 0
0 700
0 250
0 0
0 540
0 0
0 0
0 0
0 0
0 550
0 600
0 0
0 1,400
0 0
0 100
0 120
0 100
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 10
0 9
0 7
0 0
0 0
0 0
0 0
0 0
0 0
0 40
0 30
0 20
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 10
0 15
0 0
0 29
31 TOTAL
0 32
0 2
0 0
0 20
0 0
0 0
0 1
0 40
0 20
0 0
0 0
0 15
0 15
0 30
0 0
0 0
0 62
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 10
0 7
0 20
0 29
0 10
0 35
0 0
0 0
0 0
0 20
0 4
0 39
0 25
0 8
0 10
0 24
0 2
0 8
0 0
0 0
0 0
0 0
0 0
0 24
0 0
0 0
0 0
0 25
0 20
31 TOTAL
0 0
0 10
0 34
0 0
0 0
0 15
0 0
0 0
0 0
0 10
0 0
0 0
0 10
0 0
0 4
0 20
0 0
0 39
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 73
0 0
0 0
0 0
0 0
0 15
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 1
0 0
0 14
0 0
0 1
0 0
0 11
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 4
0 9
0 0
0 6
0 0
0 0
0 7
0 5
0 0
0 20
0 0
0 29
0 0
0 0
0 0
0 0
0 0
0 116
0 0
0 404
0 10,600
0 100
0 150
0 225
0 30
0 0
0 10,000
0 0
31 TOTAL
0 11
0 0
0 0
0 0
0 0
0 22
0 0
0 3
0 1
0 0
0 13
0 20
0 5
0 0
0 0
0 0
0 0
0 55
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0
0 0
0 8,550 SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
0 0
0 30
0 0
0 0
0 0
0 0
,MENGETAHUI
0 0
0 0
NIP: 19610521 199303 1 004
0 1
0 6
0 2,950
0 136
0 9,550
0 0
0 0
0 5
0 0
0 0
0 0
0 2
0 0
0 6
0 0
0 4
31 TOTAL
0 11
0 0
0 0
0 0
0 0
0 5
0 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
0 0
0 0
0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 1
0 50
0 35
0 0
0 0
0 0
0 0
0 1
0 2
0 0
0 0
0 0
0 0
0 0
0 1
0 0
0 0
0 1
0 0
0 0
0 0
0 0
0 81
0 0
0 0
0 0
0 0
0 127
31 TOTAL
0 0
0 0
0 89
0 0
0 0
0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 143
0 248
0 56
0 0
0 64
0 556
0 150
0 75
0 0
0 175
0 398
0 0
0 1
0 0
0 50
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
KODE PUSKESMAS : P6201062202 LAPORAN
PUSKESMAS : PANDU SENJAYA BULAN :
KECAMATAN : PANGKALAN LADA TAHUN :
KABUPATEN : KOTAWARINGIN BARA
JUMLAH JUMLAH PERMINTAAN
STOCK
STOCK STOCK
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH PENERIMA PERSEDIAA PENGELUAR GUDANG OPTIMUM WAKTU JUMLAH PERMINTAAN
NO OBAT DAN PERBEKKES SATUAN AWAL AN N N STOK AWAL AN N AN PUSKESMA KOSONG KEBUTUHAN PUSKESMAS ALASAN
AN (40 %)
S
TABLET
1 Albendazol 400 mg Tab 82 - 82 9 73 60 - 60 60 - - - 13 - - 60
2 Alopurinol 100 mg Tab 685 - 685 320 365 - - - - - - - 448 1,280 1,363 1,000
3 Ambroksol 30 mg Tab 1,173 500 1,673 166 1,507 300 500 800 400 400 - 400 232 - - 1,275 500
4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - - 300

5 Amitriptilin 25 mg Tab 94 - 94 22 72 - - - - - - - 31 660 619 300
6 Amlodipin 5 mg Tab 920 300 1,220 145 1,075 300 300 600 600 - - - 203 - - 872
7 Amlodipin 10 mg Tab 726 - 726 465 261 410 - 410 410 - - - 651 - 390
8 Amoksisilin 250 mg Tab 100 - 100 80 20 - - - - - - - 112 400 492 100
9 Amoksisilin 500 mg Tab 1,344 - 1,344 212 1,132 800 - 800 500 300 - 300 297 - - 835
10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - -

11 Antasida kombinasi Tab - - - - - - - - - - - - - - - 2,000
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - - 500
13 Asam asetilsalisilat (asetosal) 80 mg Tab 110 - 110 10 100 - - - - - - - 14 50 - 36 1,000
14 Asam mefenamat 500 mg Tab 2,029 - 2,029 515 1,514 1,300 - 1,300 500 800 - 800 721 - - 793
15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - - 500

STOCK
STOCK STOCK
AN (40 %)
S
16 Asiklovir 200 mg Tab - - - - - - - - - - - - - - - 500
17 Asiklovir 400 mg Tab 387 - 387 26 361 50 - 50 50 - - - 36 - - 325
18 Atapulgit 630 mg Tab 907 - 907 30 877 700 - 700 400 300 - 300 42 - - 835
19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - - 100
20 Azitromisin 500 mg Tab 350 - 350 - 350 350 - 350 - - 350 350 - - - 350
21 Asam folat 1 mg Tab - - - - - - - - - - - - - - - 1,000
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - - 200
23 Betahistin 6 mg Tab 244 200 444 40 404 - 200 200 - 200 - 200 56 1,200 852 1,000
24 Deksametason 0,5 mg Tab 2,120 - 2,120 387 1,733 1,200 - 1,200 700 500 - 500 542 - - 1,191
25 Digoksin 0,25 mg Tab 200 200 400 10 390 - 200 200 200 - - - 14 50 - 326
26 Dimenhidrinat 50 mg Tab 530 - 530 2 528 400 - 400 400 - - - 3 - - 525
27 Domperidon 10 mg Tab 530 500 1,030 750 280 100 500 600 600 - - - 1,050 - 770 500
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - - 500

30 Eritromisin 500 mg Tab 373 - 373 73 300 200 - 200 200 - - - 102 - - 198
31 Fenitoin 30 mg Kaps 71 - 71 6 65 - - - - - - - 8 180 123
32 Fenitoin 100 mg Kaps - - - - - - - - - - - - - - -
33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - - 100
34 Furosemid 40 mg Tab 427 - 427 100 327 350 - 350 350 - - - 140 - - 187
35 Garam oralit kombinasi Sak 316 - 316 54 262 182 - 182 182 - - - 76 - - 186
36 Gemfibrozil 300 mg Kaps - 480 480 - 480 - 480 480 480 - - - - - - 480 600
37 Glibenklamid 5 mg Tab 1,090 1,000 2,090 645 1,445 500 1,000 1,500 800 700 - 700 903 - - 542 1,000
38 Glimepirid 2 mg Tab 253 - 253 120 133 - - - - - - - 168 157 192 1,000
STOCK
STOCK STOCK
AN (40 %)
S
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 1,123 - 1,123 54 1,069 700 - 700 400 300 - 300 76 - - 993
40 Griseofulvin (micronized) 125 mg Tab 460 200 660 60 600 - 200 200 200 - - - 84 300 - 216
41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - -
42 Haloperidol 2 mg Tab - - - - - - - - - - - - - - -
43 Haloperidol 5 mg Tab - 400 400 40 360 - 400 400 400 - - - 56 1,200 896
44 Hiosina butilbromida 10 mg Tab 290 - 290 200 90 200 - 200 200 - - - 280 - 190
45 Ibuprofen 200 mg Tab - - - - - - - - - - - - - - - 1,000
46 Ibuprofen 400 mg Tab 637 1,000 1,637 142 1,495 200 1,000 1,200 400 800 - 800 199 - - 1,296 1,000
47 Isosorbid dinitrat 5 mg Tab 153 - 153 136 17 100 - 100 100 - - - 190 - 173
48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - - 1,000
50 Kalsium laktat (kalk) 500 mg Tab 155 - 155 130 25 - - - - - - - 182 3,900 4,057
51 Kandesartan 8 mg - - - - - - - - - - - - - - -
52 Kandesartan 16 mg Tab - - - - - - - - - - - - - - - 1,000

53 Kaptopril 12,5 mg Tab 3,618 - 3,618 535 3,083 3,100 - 3,100 600 2,500 - 2,500 749 - - 2,334
54 Kaptopril 25 mg Tab 3,996 - 3,996 345 3,651 2,900 - 2,900 800 3,500 - 1,400 2,100 483 - - 3,168
55 Karbamazepin 200 mg Tab 200 - 200 - 200 - - - - - - - - - - 200
56 Ketokonazol 200 mg Tab 608 - 608 30 578 250 - 250 250 - - - 42 - - 536
57 Ketoprofen 100 mg Tab 410 - 410 - 410 200 - 200 200 - - - - - - 410
58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - - 300

59 Klindamisin 300 mg Kaps - - - - - - - - - - - - - - - 300
60 Kloramfenikol 500 mg Kaps 254 - 254 - 254 200 - 200 200 - - - - - - 254
61 Klorfeniramin maleat (ctm) 4 mg Tab 3,175 - 3,175 235 2,940 2,400 - 2,400 700 1,700 - 1,700 329 - - 2,611
STOCK
STOCK STOCK
AN (40 %)
S
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 13 - 13 - 13 - - - - - - - - - - 13
64 Klozapin 25 mg Tab 98 - 98 20 78 - - - - - - - 28 600 550
65 Klozapin 100 mg Tab 69 100 169 - 169 - 100 100 100 - - - - - - 169
66 Kombinasi dihidro artemisin piperakuin (act/dhp Tab - - - - - - - - - - - - - - - 100
67 Kotrimoksazol (dewasa) 480 mg Tab 570 - 570 - 570 300 - 300 300 - - - - - - 570
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 780 - 780 10 770 100 - 100 100 - - - 14 - - 756
69 Kuinin 222 mg Tab - - - - - - - - - - - - - - - 100
70 Lanzoprazol 30 mg Kaps 350 - 350 - 350 350 - 350 - - 350 350 - - - 350 1,000
71 Levotiroksin 50 mµ Tab - - - - - - - - - - - - - - - 200
72 Levofloksasin 500 mg Tab 154 300 454 20 434 - 300 300 150 150 - 150 28 100 - 306 500
73 Loratadin 10 mg Tab 1,052 - 1,052 150 902 700 - 700 500 200 - 200 210 - - 692
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -
78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - - 500
79 Meloksikam 7,5 mg Tab - - - - - - - - - - - - - - - 500
80 Meloksikam 15 mg Tab 60 - 60 36 24 - - - - - - - 50 4 30 500
81 Metamizol (antalgin) 500 mg Tab 550 - 550 20 530 400 - 400 400 - - - 28 - - 502
82 Metformin 500 mg Tab 1,990 - 1,990 750 1,240 1,800 - 1,800 900 1,000 - 100 900 1,050 - - 190
83 Metilergometrin 0,125 mg Tab 110 300 410 - 410 - 300 300 - 300 - 300 - - - 410 300
84 Metilprednisolon 4 mg Tab 1,295 - 1,295 348 947 1,000 - 1,000 700 300 - 300 487 - - 460
STOCK
STOCK STOCK
AN (40 %)
S
85 Metilprednisolon 8 mg Tab - - - - - - - - - - - - - - - 500
86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - -
87 Metronidazol 500 mg Tab 793 - 793 110 683 200 - 200 200 - - - 154 - - 529
88 Mineral Mix Sak 40 - 40 40 - 40 - 40 40 - - - 56 - 56
89 Multivitamin ibu hamil (Gestiamin) Tab 690 - 690 550 140 270 - 270 270 - - - 770 - 630 1,000
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - - - - - - - 2,850 2,850 1,000
91 Multivitamin lansia (pehavral) Tab 693 500 1,193 440 753 300 500 800 800 - - - 616 - - 137 500
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - - 100
93 Natrium diklofenak 25 mg Tab 1,590 - 1,590 501 1,089 1,400 - 1,400 700 700 - 700 701 - - 388
94 Natrium diklofenak 50 mg Tab - - - - - - - - - - - - - - -
95 Nifedipin 10 mg Tab 90 - 90 35 55 - - - - - - - 49 1,050 1,044 500
96 Nifedipin 20 mg Tab 260 - 260 20 240 240 - 240 240 - - - 28 - - 212
97 Nistatin 500.000 IU Tab 80 300 380 - 380 - 300 300 - 300 - 300 - - - 380 100
98 N-asetil sistein 200 mg kaps 380 - 380 - 380 380 - 380 - - 380 380 - - - 380 1,000
99 OAT Kategori Anak Pkt - - - - - - - - - - - - - - -
100 OAT Kategori I Pkt 2 - 2 - 2 2 - 2 - - 2 2 - - - 2
101 OAT Kategori II Pkt - - - - - - - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - -
103 Ofloksasin 200 mg Tab 180 - 180 - 180 100 - 100 100 - - - - - - 180
104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - - 500

105 Omeprazol 20 mg Kaps 1,230 - 1,230 695 535 1,130 - 1,130 1,010 180 - 60 120 973 - 438
106 Ondansetron 4 mg Tab 579 - 579 198 381 480 - 480 360 120 - 120 277 - - 104
107 Parasetamol 500 mg Tab 1,631 2,000 3,631 781 2,850 500 2,000 2,500 900 1,600 - 1,600 1,093 - - 1,757 2,000
STOCK
STOCK STOCK
AN (40 %)
S
108 Pirantel pamoat 125 mg Tab 107 - 107 107 - 100 - 100 100 - - - 150 - 150
109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - - 500
110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - - 500
111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - - 500
112 Piroksikam 20 mg Tab 1,090 - 1,090 259 831 700 - 700 700 - - - 363 - - 468
113 Prednison 5 mg Tab 1,480 - 1,480 125 1,355 1,300 - 1,300 600 700 - 700 175 - - 1,180
114 Primakuin 15 mg Tab - - - - - - - - - - - - - - - 100
115 Propiltiourasil 100 mg Tab - 200 200 - 200 - 200 200 200 - - - - - - 200 500
116 Propranolol 10 mg Tab - 500 500 40 460 - 500 500 500 - - - 56 200 - 204 1,000
117 Propranolol 40 mg Tab 110 - 110 70 40 - - - - - - - 98 350 408 1,500
118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - - 500
120 Risperidon 2 mg Tab - 400 400 30 370 - 400 400 400 - - - 42 900 572
121 Salbutamol 2 mg Tab 1,195 - 1,195 187 1,008 600 - 600 600 - - - 262 - - 746
122 Salbutamol 4 mg Tab 732 - 732 - 732 400 - 400 400 - - - - - - 732
123 Sefadroksil 500 mg Kaps 1,191 - 1,191 426 765 500 - 500 500 - - - 596 - - 169
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - - 500
125 Setirizin 10 mg Tab 1,267 - 1,267 629 638 700 - 700 700 - - - 881 - 243
126 Simetidin 200 mg Tab - - - - - - - - - - - - - - - 500
127 Simvastatin 10 mg Tab 150 - 150 150 - 150 - 150 150 - - - 210 - 210 200
128 Simvastatin 20 mg Tab 882 500 1,382 237 1,145 300 500 800 800 - - - 332 - - 813 300
129 Siprofloksasin 500 mg Tab 380 500 880 50 830 100 500 600 300 300 - 300 70 - - 760
130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - 500

STOCK
STOCK STOCK
AN (40 %)
S
131 Tambah darah kombinasi (fe dan asam folat) Tab 530 600 1,130 340 790 360 600 960 810 150 - 150 476 - - 314 500
132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - - 500
133 Triheksifenidil 2 mg Tab - 400 400 33 367 - 400 400 400 - - - 46 990 669
135 Vitamin A 100.000 IU (retinol) Biru Kaps 361 - 361 2 359 350 - 350 - - 350 350 3 3 - 353
136 Vitamin A 200.000 IU (retinol) Merah kaps 1,033 - 1,033 5 1,028 950 - 950 50 150 750 900 7 - - 1,021
137 Vitamin B 1 (tiamin) 50 mg Tab 937 1,000 1,937 630 1,307 600 1,000 1,600 900 700 - 700 882 - - 425 1,000
138 Vitamin B 6 (piridoksin) 10 mg Tab 636 500 1,136 373 763 300 500 800 800 - - - 522 - - 241 500
139 Vitamin B kompleks Tab 335 2,000 2,335 638 1,697 100 2,000 2,100 1,100 1,000 - 1,000 893 - - 804 2,000
140 Vitamin C (asam askorbat) 50 mg Tab 88 - 88 - 88 - - - - - - - - - - 88 2,000
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 48 1,000 1,048 38 1,010 - 1,000 1,000 200 1,000 - 200 800 53 190 - 767 1,000
142 Vitamin Hepagard Tab 125 - 125 - 125 30 - 30 30 - - - - - - 125
143 Zinc tablet dispersibel 20 mg Tab 150 - 150 70 80 - - - - - - - 98 280 298 500
TAMBAHAN - - - - - - - - - - - - - - -
1 Becefort 1,000 - 1,000 - 1,000 - - - - - - - - - - 1,000
2 Imbos forte 750 - 750 - 750 - - - - - - - - - - 750
3 Livron B Plex - - - - - - - - - - - - - - -
4 Multivitamin (Sivit - Zink) Bh 120 - 120 - 120 - - - - - - - - - - 120
5 Oseltamivir 75 mg Bh 570 - 570 - 570 - - - - - - - - - - 570

INJEKSI - - - - - - - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 2 - 2 1 1 - - - - - - - 1 30 30 -
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 12 - 12 - 12 10 - 10 10 - - - - - - 12
3 Aminofilin 24 mg/ml Amp 5 - 5 - 5 - - - - - - - - - - 5

STOCK
STOCK STOCK
AN (40 %)
S
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 3 - 3 - 3 - - - - - - - - - - 3
5 Antrain Inj Amp - - - - - - - - - - - - - - - 30
6 Artemether 80 mg/ml Amp - - - - - - - - - - - - - - - 30
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - - - - - - - 30
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp - - - - - 10 - 10 - 10 - 10 - - -
10 Atropin 0,25 mg/ml Amp - 20 20 - 20 - 20 20 - 20 - 20 - - - 20 20
11 Deksametason 5 mg/ml Amp 52 - 52 - 52 20 - 20 - 20 - 20 - - - 52
12 Difenhidramin hcl 10 mg/ml Amp 13 - 13 1 12 - - - - - - - 1 30 19

10 Evaluasi
15 dan Perencanaan
25 - 25 - 15 15 15 - - - - - - 25 30
14 Furosemid 10 mg/ml Amp - - - - - - - - - - - - - - -
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - - - - - - - - 10

MARIYANI
- 19750812
- 200003 2- 003 - - - - - - - - - - - - 30
17 Haloperidol 5 mg/ml Amp - - - - - - - - - - - - - - - 10

18 Haloperidol 50 mg/ml Amp - - - - - - - - - - - - - - - 10
19 Kalsium glukonat 10 % Amp 10 - 10 - 10 - - - - - - - - - - 10
20 Ketorolak 30 mg/ml Amp 20 - 20 - 20 - - - - - - - - - - 20
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - - - - - - - 10
22 Lidokain 2 % Amp 193 - 193 2 191 158 - 158 58 100 - 100 3 - - 188
23 Lidokain kompositum Amp 28 - 28 9 19 28 - 28 28 - - - 13 - - 6

24 Magnesium sulfat 20 % (i.v.) Btl 21 - 21 1 20 20 - 20 20 10 - 10 - 1 - - 19
25 Magnesium sulfat 40 % (i.v.) Btl 13 - 13 3 10 8 - 8 8 - - - 4 - - 6
26 Metamizol (antalgin) 500 mg/2 ml Amp 85 - 85 4 81 70 - 70 70 - - - 6 - - 75

STOCK
STOCK STOCK
AN (40 %)
S
27 Metilergometrin 0.2 mg/ml Amp - - - - - - - - - - - - - - -
28 Oksitosin 10 iu/ml Amp 3 - 3 3 - - - - - - - - 4 90 94
29 Omeprazole 40 mg/ml Amp 24 - 24 3 21 19 - 19 19 - - - 4 - - 17
30 Ondansetron 4 mg/2 ml Amp 75 - 75 3 72 60 - 60 - 60 - 60 4 - - 68
31 Piracetam 1 gr Amp 10 - 10 1 9 10 - 10 - 10 - 10 1 - - 8

MENGETA- - - - ,MENGETAHUI
,MENGETAHUI
- - - - - - -
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
Kepala Dinas
- - - - Kabupaten- Kotawaringin
Kabupaten -
Kotawaringin - - - - - 50
,HUI Dinas
Kesehatan Barat
Barat
Sefotaksim Vial 15 10 25 6 Kesehatan
Kabupaten19 - 10 10 - 10 - 10 8 180 169 10
Dinas Kotawaringin
Kabupaten
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 9 10 19 1 Kotawaring
Barat18 - 10 10 - 10 - 10 1 30 13 10
Kabupate in Barat
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 30 - 30 1 29 30 - 30 10 20 - 20 1 0 - 28
drg.INDRAWAN
gin Barat Amp - - - - - - - - -
SAKTI,MKes
SAKTI,MKes - - - - - -
NIP:
NIP:19610521
19610521199303
19930311
- - - - - 004
004 - - - - - - 50
drg.INDRA
AN
WAN11 - - - - - - - 6 120 115
SAKTI,MKe
NIP:
TAMBAHAN
drg.INDRA - - - - 19610521
s - - - - - - - - - - -
WAN 199303
NIP: 1
SAKTI,MK - - - - 19610521
004 - - - - - - - - - - -
es 199303 1
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 004 - - - - - - - - - - -
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - - - - - - -
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube - - - - - - - - - - - - - - -
3 Diazepam 2 mg Tab - - - - - - - - - - - - - - -
4 Diazepam 5 mg Tab 19 200 219 - 219 - 200 200 100 - 100 100 - - - 219
5 Diazepam 5 mg/ml (i.v.) Amp 59 10 69 15 54 - 10 10 10 - - - 21 450 417
6 Fenobarbital 50 mg/ml Amp 30 - 30 - 30 - - - - - - - - - - 30
7 Fenobarbital 30 mg Tab 100 - 100 - 100 - - - - - - - - - - 100

STOCK
STOCK STOCK
AN (40 %)
S
8 Kodein 10 mg Tab - - - - - - - - - - - - - - -
9 Klobazam 10 mg Tab - - - - - - - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - - - - - - - -
1 Antifungi kombinasi Tube 18 - 18 8 10 - - - - - - - 11 10 12
2 Antihemoroid kombinasi Supp 15 - 15 5 10 10 - 10 10 - - - 7 - - 3
3 Asiklovir 5% Krim Tube 35 - 35 2 33 30 - 30 30 - - - 3 - - 30
4 Basitrasin - polimiksin B Tube 29 - 29 8 21 - - - - - - - 11 10 1 25
5 Bedak salisil 2% Ktk 10 - 10 10 - - - - - - - - 14 300 314 20
6 Betametason 0,1% krim Tube 57 - 57 7 50 15 - 15 - 15 - 15 10 - - 40
7 Bioplacenton krim Tube - - - - - - - - - - - - - - - 20
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 35 - 35 10 25 - - - - - - - 14 300 289
10 Desoksimetason 0,25 % krim Tube 17 - 17 3 14 - - - - - - - 4 4 - 6
11 Gentamisin salep kulit Tube 37 - 37 21 16 19 - 19 19 - - - 29 - 13

12 Gentamisin salep mata Tube 43 - 43 - 43 - - - - 19 - 19 - - - - 43
13 Hidrokortison 2,5% krim Tube 28 - 28 - 28 - - - - - - - - - - 28
14 Ketokonazol 2 % krim Tube 30 - 30 1 29 25 - 25 - 25 - 25 1 - - 28
15 Ketoprofen 100 mg Supp 10 - 10 - 10 - - - - - - - - - - 10
16 Kloramfenikol 1% salep mata Tube 40 - 40 1 39 - - - - - - - 1 1 - 36
17 kloramfenikol 3% salep kulit Tube 11 - 11 - 11 - - - - 10 - 10 - - - - 11

18 Mikonazol 2 % krim Tube 61 - 61 1 60 48 - 48 24 24 - 24 1 - - 59
19 metronidazol ovula 500 mg ovul 40 - 40 - 40 - - - - - - - - - - 40
20 Nistatin 100.000 IU Supp 42 - 42 - 42 42 - 42 - 42 - 42 - - - 42

STOCK
STOCK STOCK
AN (40 %)
S
21 Oksitetrasiklin salep kulit Tube 15 - 15 - 15 - - - - - - - - - - 15 25

22 Oksitetrasiklin salep mata Tube 51 50 101 - 101 - 50 50 - 75 - 25 50 - - - 101 25
23 povidon iodin / betadine salep Tube 10 - 10 - 10 - - - - - - - - - - 10 10
24 Salep 2-4 kombinasi krim Tube 48 - 48 16 32 24 - 24 - 24 - 24 22 - - 10
25 Sulfadiazine 10 Mg Salep Tube 10 15 25 - 25 - 15 15 - 15 - 15 - - - 25 20
SIRUP - - - - - - - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 94 - 94 2 92 69 - 69 19 50 - 50 3 - - 89
3 ambroxol sirup 30 mg/5 ml Btl 84 - 84 2 82 80 - 80 20 60 - 60 3 - - 79
4 Amoksisilin sirup kering 125 mg/5 ml Btl 36 - 36 7 29 2 - 2 2 - - - 10 - - 19
5 Amoksisilin sirup kering 250 mg/5 ml Btl 111 - 111 21 90 80 - 80 - 85 - 5 80 29 - - 61
6 Antasida susp Btl 192 - 192 51 141 166 - 166 85 81 - 81 71 - - 70
7 Caviflex sirup Btl - - - - - - - - - - - - - - - 100
8 Dextrofen sirup Btl 120 - 120 54 66 104 - 104 94 10 - 10 76 - 10
9 Domperidon sirup 5 mg/5 ml Btl 53 - 53 3 50 27 - 27 27 - - - 4 - - 46
10 Ibuprofen sups 100 mg / 5 ml Btl 50 50 100 1 99 50 50 100 30 70 - 70 1 - - 98
11 Ibuprofen sups 200 mg / 5 ml Btl - - - - - - - - - - - - - - - 30
12 Kloramfenikol susp 125 mg/5 ml Btl 32 - 32 - 32 15 - 15 15 - - - - - - 32
13 Kotrimoksazol susp 240 mg/5 ml Btl 90 - 90 - 90 90 - 90 30 70 - 10 60 - - - 90
14 Laktulosa 3,335 g/5 ml Btl 17 - 17 2 15 17 - 17 17 - - - 3 - - 12
15 Metronidazol susp 125 mg/5 mL Btl 24 - 24 1 23 18 - 18 18 - - - 1 - - 22
16 Nistatin drop 100.000 IU/ml Btl 15 - 15 - 15 - - - - 10 - 10 - - - - 15
17 Obat batuk hitam (OBH) sirup Btl 32 - 32 5 27 - - - - - - - 7 150 130 100
18 Parasetamol drops 100 mg/ml Btl 160 - 160 5 155 126 - 126 26 100 - 100 7 - - 148
STOCK
STOCK STOCK
AN (40 %)
S
19 Parasetamol sirup 120 mg/5 ml Btl 146 - 146 11 135 105 - 105 30 75 - 75 15 - - 120
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - - - - - - - 10
21 Procuma sirup Btl 95 - 95 8 87 65 - 65 - 65 - 65 11 - - 76
22 Sefadroksil sirup kering 125 mg/5 ml Btl 105 - 105 6 99 50 - 50 - 60 - 10 50 8 - - 91
23 sefadroxil sirup kering 250 mg /forte Btl 90 - 90 3 87 71 - 71 21 50 - 50 4 - - 83
24 setirizin 5mg / 5 ml Btl 174 - 174 20 154 127 - 127 27 100 - 100 28 - - 126
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - - - - - - - 30
26 Zink sirup 20mg/ 5ml Btl 30 - 30 2 28 20 - 20 20 - - - 3 - - 25
TAMBAHAN - - - - - - - - - - - - - - -
1 Becefort syrup - - - - - - - - - - - - - - -
2 Imbos Syrup 6 - 6 - 6 6 - 6 - - 6 6 - - - 6
LARUTAN - - - - - - - - - - - - - - -
1 Alkazyme Bks - - - - - - - - - - - - - - -
2 Alkacide btl - - - - - - - - - - - - - - -
3 Bromhexin (Bisolvon) Btl 1 - 1 - 1 1 - 1 1 - - - - - - 1
4 Etanol 70 % 1000 ml Btl 66 - 66 2 64 - - - - - - - 3 60 - 1

5 Etakridinn laktat 0,1% (rivanol) Btl 5 - 5 - 5 5 - 5 - 5 - 5 - - - 5
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - - - - - - - 2
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - - - - - - - 30
8 Gentamisin 0,3 % tetes mata Btl 17 - 17 1 16 12 - 12 - 12 - 12 1 - - 15
9 Gentian violet 1 % Btl 57 - 57 2 55 24 - 24 - 24 - 24 3 - - 52
10 Glukosa 10 % (D.10) 500 ml Btl 9 - 9 - 9 9 - 9 9 - - - - - - 9
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 5 15 20 - 20 - 15 15 10 5 - 5 - - - 20 20

STOCK
STOCK STOCK
AN (40 %)
S
13 KA-EN 1 B 500 ml Btl 16 - 16 - 16 16 - 16 - 26 - 10 16 - - - 16
14 KA-EN 3 B 500 ml Btl 30 - 30 - 30 30 - 30 - 38 - 8 30 - - - 30
15 kloramfenikol Tetes mata Btl - - - - - - - - - - - - - - - 25
16 Kloramfenikol 3% tetes telinga Btl - - - - - - - - - - - - - - - 25
17 Lysol 1 liter Btl 4 - 4 3 1 3 - 3 3 - - - 4 - 3
18 Metronidazol infus 5 mg/ml Btl 1 - 1 - 1 1 - 1 1 - - - - - - 1
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 67 - 67 3 64 60 - 60 30 30 - 30 4 - - 60
20 Povidon iodin 10 % 30 ml Btl 17 - 17 - 17 14 - 14 - 75 - 61 14 - - - 17
21 Povidon iodin 10 % 300 ml Btl 12 - 12 - 12 9 - 9 5 5 - 1 4 - - - 12
22 Parasetamol infus 10 mg/ml Btl - 4 4 - 4 - 4 4 - 4 - 4 - - - 4 2
23 Ringer laktat (RL) 500 ml Btl 144 - 144 44 100 122 - 122 64 58 - 58 62 - - 38
TAMBAHAN - - - - - - - - - - - - - - -
1 Bayclin Btl - - - - - - - - - 48 - 48 - - - -
2 larutan disenfektan karbol Btl 48 - 48 10 38 11 - 11 - 34 - 23 11 14 - - 24

3 Sabun cuci tangan 34 - 34 - 34 - - - - - - - - - - 34
4 Alkohol 1 liter - - - - - - - - - - - - - - -
5 antiseptic gel - - - - - - - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial - - - - - - - - - - - - - - -
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 10 - 10 - 10 - - - - - - - - - - 10
4 Vaksin BCG Vial 26 10 36 - 36 10 10 20 - - 20 20 - - - 36
5 Vaksin campak Vial - - - - - - - - - - - - - - -

STOCK
STOCK STOCK
AN (40 %)
S
6 Vaksin hepatitis (HBO) Bayi Pouches 32 24 56 19 37 - 24 24 - - 24 24 27 570 560
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 - 10 - 10 - - - - - - - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 18 - 18 6 12 - - - - - - - 8 180 176
11 Vaksin kombinasi DPT-HB-Hib Vial 53 50 103 5 98 20 50 70 - - 70 70 7 150 59
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 22 - 22 - 22 10 - 10 - - 10 10 - - - 22
13 Vaksin polio t-opv drops 10 dosis Vial 39 20 59 - 59 20 20 40 - - 40 40 - - - 59
14 vaksin MR Vial 44 20 64 4 60 20 20 40 - - 40 40 6 120 66
TAMBAHAN - -
ADS 0,05 ML - - - - - - - - - - - - - - -
ADS 0,5 ML 300 - 300 - 300 300 - 300 - - 300 300 - - - 300
ADS 5 ML - - - - - - - - - - - - - - -
Safety box 5 L - - - - - - - - - - - - - - -
VAKSIN SINOVAC - - - - - - - - - - - - - - -
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set 390 - 390 - 390 - - - - - - - - - - 390
2 Alat suntik sekali pakai 0,5 ml Set 20,374 - 20,374 16 20,358 10,000 - 10,000 - - 10,000 10,000 22 480 - 19,856
3 Alat suntik sekali pakai 1 ml Set 232 - 232 4 228 200 - 200 - 200 - 200 6 - - 222
4 Alat suntik sekali pakai 3 ml Set 431 - 431 103 328 190 - 190 90 100 - 100 144 - - 184
5 Alat suntik sekali pakai 5 ml Set 450 - 450 10 440 200 - 200 - 200 - 200 14 - - 426
6 Alat suntik sekali pakai 10 ml Set 6 - 6 2 4 - - - - 50 - 50 - 3 60 59
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - - - - - - - -

STOCK
STOCK STOCK
AN (40 %)
S
8 Alkohol swabs Pcs 9,907 - 9,907 - 9,907 - - - - - - - - - - 9,907
9 Antiseptik gel 500 ml Btl 44 - 44 12 32 44 - 44 - - 44 44 17 - - 15
10 Bisturi uk.20 Pcs 14 - 14 - 14 - - - - 10 - 10 - - - - 14
11 Bisturi uk.21 Pcs 5 - 5 - 5 - - - - - - - - - - 5 30
12 Blood transfusi set Set 5 20 25 - 25 - 20 20 - 20 - 20 - - - 25 30
13 Cat gut chromic 2/0 Pcs 12 48 60 2 58 - 48 48 6 48 - 6 42 3 60 5 30
14 Cat gut chromic 3/0 Pcs 30 - 30 27 3 24 - 24 24 - - - 38 - 35
15 Cat gut plain 2/0 Sak 73 - 73 5 68 50 - 50 24 20 6 26 7 - - 61

16 Cat gut plain 3/0 Sak 56 - 56 30 26 56 - 56 24 - 32 32 42 - 16
17 Folly catheter No.16 pcs 18 - 18 4 14 12 - 12 - 2 10 12 6 - - 8
18 Folly catheter No.18 pcs 20 - 20 1 19 15 - 15 12 3 - 3 1 - - 18
19 I.V. catheter No.18 pcs 126 - 126 16 110 99 - 99 49 50 - 50 22 - - 88
20 I.V. catheter No.20 pcs 67 - 67 5 62 50 - 50 30 20 - 20 7 - - 55
21 I.V. catheter No.22 pcs 90 - 90 39 51 75 - 75 70 15 - 10 5 55 - 4

22 I.V. Catheter No.24 pcs 65 - 65 12 53 45 - 45 25 20 - 20 17 - - 36
23 I.V. Catheter No.26 pcs 9 - 9 - 9 5 - 5 5 - - - - - - 9
24 Infus set anak pcs 13 - 13 - 13 15 - 15 15 - - - - - - 13
25 Infus set dewasa pcs 97 - 97 8 89 95 - 95 85 17 - 7 10 11 - - 78
26 Jarum (needle) 23 Pcs 13 - 13 - 13 13 - 13 13 - - - - - - 13
27 Jarum (needle) 27 Pcs 20 - 20 5 15 15 - 15 15 15 - 15 - 7 - - 8

28 K.y jelly 82 gram Tube 4 - 4 - 4 4 - 4 4 4 - 4 - - - - 4
29 Kapas pembalut/absorben 250 gram Bks 7 - 7 - 7 6 - 6 6 - - - - - - 7
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 75 - 75 45 30 75 - 75 50 25 - 25 63 - 33

STOCK
STOCK STOCK
AN (40 %)
S
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 - 20 20 - 20 20 - - - - - - 20
32 Kasa pembalut hidrofil 4 m x 10 cm Roll 15 - 15 - 15 15 - 15 15 - - - - - - 15
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 76 - 76 1 75 76 - 76 56 20 - 20 1 - - 74
34 Kasa kompres 40/40 steril Roll 137 - 137 6 131 130 - 130 90 50 - 10 40 8 - - 123
35 Kasa 40 m x 80 cm Roll - 4 4 2 2 - 4 4 - - 4 4 3 60 61 3
36 Kasa pembalut 2 m x 80 cm Roll 22 - 22 11 11 15 - 15 11 4 - 4 15 - 4

37 2012 - 37 34 - 34 24 10 - 10 - - - 37
38 Kertas puyer biasa Pack 1 Kotawaringin
5 Barat 6 2 4 1 5 6 - 2 4 6 3 - - 1
39 Kertas puyer press Pack 900 - 900 - 900 900 - 900 - 1,100 - 200 900 - - - 900
40 Kondom Sutra pcs - - - - - - - - - - - - - - -

- 7,678 2,810 4,868 - - - - - - - 3,934 84,300 83,366
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 112 - 112 72 40 112 - 112 72 40 - 40 101 - 61
43 Penjepit tali pusat Pcs 30 - 30 3 27 - - - - - - - 4 90 67
44 penghisap lendir pcs 44 - 44 - 44 20 - 20 - 20 - 20 - - - 44

45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr - 1,000 1,000 - 1,000 - 1,000 1,000 - - 1,000 1,000 - - - 1,000
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr - 500 500 - 500 - 500 500 - - 500 500 - - - 500
47 Plester 1,25 X 4,5 m Roll - - - - - - - - - - - - - - -

,MENGETAHUI
- Kesehatan
- - - - - - - - - - - - -
49 Plester bulat/ plesterin pcs 200 - 200 - 200 200 - 200 200 - - - - - - 200
50 Plester cannofix pcs 40 - 40 - 40 40 - 40 - - 40 40 - - - 40

- SAKTI,M.Kes
- - - - - - - - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll 10 - 10 - 10 8 - 8 5 - 3 3 - - - 10
53 Safety box Bh 24 5 29 3 26 18 5 23 - - 23 23 4 - - 22
STOCK
STOCK STOCK
AN (40 %)
S
54 Sarung tangan non steril Uk. S Psg 2,633 - 2,633 500 2,133 - - - - - - - 700 15,000 13,567
55 Sarung tangan non steril Uk. M Psg 36 - 36 2 34 - - - - - - - 3 60 29
56 Sarung tangan non steril Uk. L Psg 8,794 - 8,794 2,000 6,794 - - - - - - - 2,800 60,000 56,006
57 Sarung tangan steril ginekologi Psg 3 - 3 3 - 3 - 3 - - 3 3 4 - 4
58 Sarung tangan steril No.6 Psg - - - - - - - - - - - - - - -
59 Sarung tangan steril No.6,5 Psg 57 - 57 4 53 55 - 55 55 - - - 6 - - 47
60 Sarung tangan steril No.7 Psg 3 - 3 - 3 - - - - - - - - - - 3 50
61 Sarung tangan steril No.7,5 Psg 35 - 35 21 14 17 - 17 17 - - - 29 - 15
62 Sarung Tangan steril no.8 Psg 96 - 96 15 81 96 - 96 67 - 29 29 21 - - 60
63 Selang oksigen anak Pcs 17 - 17 - 17 5 - 5 - 9 - 4 5 - - - 17
64 Selang oksigen bayi Pcs 26 - 26 - 26 20 - 20 - 26 - 6 20 - - - 26

65 Selang oksigen dewasa Pcs 15 - 15 8 7 9 - 9 - - 9 9 11 - 4
66 Sendok kertas puyer Pcs - - - - - - - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 67 - 67 27 40 67 - 67 21 35 11 46 38 - - 2
68 Silk (benang bedah sutra) No. 3/0 Sak 26 - 26 - 26 25 - 25 25 - - - - - - 26
69 Speculum Uk S pcs - - - - - - - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - - 18 - 18 - - - -
71 Speculum Uk L pcs - - - - - - - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - - - - - - - -
73 Underpads Pcs 45 - 45 1 44 45 - 45 10 35 - 35 1 - - 43
74 Urin bag Pcs 26 - 26 19 7 17 - 17 - - 17 17 27 - 20
75 Wing needle no 27 G Pcs 71 - 71 37 34 71 - 71 - 34 37 71 52 - 18
TAMBAHAN - - - - - - - - - - - - - - -
STOCK
STOCK STOCK
AN (40 %)
S
1 Back pack sprayer Pcs - - - - - - - - - 1 - 1 - - - -
2 Rapid test covid-19 Pcs 75 50 125 - 125 - 50 50 - 3 47 50 - - - 125
3 Rapid test antigen Pcs 25 - 25 - 25 - - - - 2 - 2 - - - - 25
4 Masker KN 95 - - - - - - - - - - - - - - -
5 Masker N95 - - - - - - - - - - - - - - -
6 Masker Bedah - - - - - - - - - - - - - - -
7 Kacamata google - - - - - - - - - - - - - - -
8 Face shield Nagita 35 - 35 - 35 - - - - - - - - - - 35
9 Face shield naik turun - - - - - - - - - - - - - - -
10 Face shield - - - - - - - - - - - - - - -
11 Sepatu boot - - - - - - - - - - - - - - -
12 Baju Hazmat kain - - - - - - - - - - - - - - -
13 Baju Hazmat cuci ulang - - - - - - - - - - - - - - -
14 Hand schoon M - - - - - - - - - - - - - - -
15 Hand schoon L - - - - - - - - - - - - - - -
16 Hand schoon s - - - - - - - - - - - - - - -
17 Hand schoon steril no 7,5 - - - - - - - - - - - - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - - - - - - - - -
19 APD - - - - - - - - - - - - - - -
20 APD SET HIJAU - - - - - - - - - - - - - - -

21 APD BOHO - - - - - - - - - - - - - - -
22 APD LEVEL 2 - - - - - - - - - - - - - - -
23 APD LEVEL 3 - - - - - - - - - - - - - - -
STOCK
STOCK STOCK
AN (40 %)
S
24 APD PEMDA/DONASI - - - - - - - - - - - - - - -
25 APD 1 SET - - - - - - - - - - - - - - -
26 GOWN - - - - - - - - - - - - - - -
27 COOL BOK 6 LITER - - - - - - - - - - - - - - -
28 COOL BOK 12,5 LITER - - - - - - - - - - - - - - -
29 ANAFILATIK KIT - - - - - - - - - - - - - - -
BAHAN & ALAT LABORATORIUM - - - - - - - - - - - - - - -
1 Asam asetat (Cuka) Btl - - - - - - - - - - - - - - -
2 Alat pulmo (peak flow) set 1 - 1 - 1 - - - - - - - - - - 1
3 Bilik hitung Pcs 2 - 2 - 2 - - - - - - - - - - 2
4 Blood lancet Pcs 1,442 - 1,442 - 1,442 1,200 - 1,200 - - 1,200 1,200 - - - 1,442
5 Bulb pipet Bh 1 - 1 - 1 - - - - - - - - - - 1
6 Cartrialge genexpert KIT set - - - - - - - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - - - - - - - -

8 Compresson nebulizer pcs - - - - - - - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - - - - - - - -
13 Kaca slide/ Kaca objek Set - - - - - - - - - - - - - - -

14 KIT diagnostic untuk HIV Pcs - - - - - - - - - - - - - - -
15 KIT RPR pcs - - - - - - - - - - - - - - -
16 Kotak slide Pcs 2 - 2 - 2 - - - - - - - - - - 2

STOCK
STOCK STOCK
AN (40 %)
S
17 Lampu spiritus 150 ml Pcs 1 - 1 - 1 - - - - - - - - - - 1
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - - - - - - - -
20 Medline Pcs - - - - - - - - - - - - - - -
21 Microhematokrit tube wax Pcs 1 - 1 - 1 - - - - - - - - - - 1
22 Mikro tube (Vol 1,5 ml) Pcs 50 - 50 - 50 - - - - - - - - - - 50
23 Mikroskope cover glasses 18x18 mm Pcs 60 - 60 - 60 - - - - - - - - - - 60
27 Nebulizer Bh - - - - - - - - - - - - - - -
28 Peak flow meter Pcs 1 - 1 - 1 - - - - - - - - - - 1
29 Pen lancet Pcs 7 - 7 - 7 - - - - - - - - - - 7
30 Pengukur tinggi badan Pcs - - - - - - - - - - - - - - -

31 Pipet eritrosit Pcs 2 - 2 - 2 - - - - - - - - - - 2
32 Pipet HB Pcs 1 - 1 - 1 - - - - - - - - - - 1
33 Pipet leukosit Pcs 2 - 2 - 2 - - - - - - - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - - - - - - - -
35 Pipet westergren Bh 1 - 1 - 1 - - - - - - - - - - 1
36 Pot dahak Pcs 80 - 80 2 78 - - - - - - - 3 60 - 15

37 Pot urine Pcs - - - - - - - - - - - - - - -
38 Rak staenles tes tube Test 1 - 1 - 1 - - - - - - - - - - 1
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - - - - - - - -

STOCK
STOCK STOCK
AN (40 %)
S
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - - - - - - - - - - -
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 374 200 574 207 367 269 200 469 - - 469 469 290 6,210 6,133
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnosta Test - - - - - - - - - - - - - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test 49 - 49 - 49 50 - 50 - - 50 50 - - - 49
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 157 - 157 11 146 50 - 50 - - 50 50 15 330 199
49 Rapid test pemeriksaan malaria Test 25 - 25 - 25 25 - 25 - - 25 25 - - - 25
50 Reagen Cell clean Btl - - - - - - - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 121 - 121 11 110 50 - 50 - - 50 50 15 330 235
52 Reagen Giemsa Btl 1 - 1 - 1 - - - - - - - - - - 1
53 Reagen Gol Darah Btl 1 - 1 - 1 - - - - - - - - - - 1

54 Reagen Gol darah anti D Btl 1 - 1 - 1 - - - - - - - - - - 1
55 Reagen Immersion Btl 1 - 1 - 1 - - - - - - - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 2 - 2 - 2 1 - 1 - - 1 1 - - - 2
58 RPR Sipilis fokus Pcs - - - - - - - - - - - - - - -
59 Spritus Btl - - - - - - - - - - - - - - -
60 Tabung hematokrit heparin Pcs - - - - - - - - - - - - - - -
61 Tabung hematokrit non heparin Pcs - - - - - - - - - - - - - - -
62 Tabung vacutainer edta warna ungu Pcs 143 - 143 8 135 - - - - - - - 11 240 116
STOCK
STOCK STOCK
AN (40 %)
S
63 Test asam urat Pcs 236 - 236 12 224 200 - 200 - - 200 200 17 360 153
64 Test gluco protein urine Pcs 59 - 59 1 58 3 - 3 - - 3 3 1 - - 57
65 Test iodium Pcs - - - - - - - - - - - - - - -
66 Test kehamilan / PP test Test 64 - 64 3 61 - - - - - - - 4 90 33
67 Test kolestrol Tube 298 - 298 16 282 - - - - - - - 22 - - 260
68 Test pemeriksaan gula darah Pcs 1,247 - 1,247 - 1,247 1,200 - 1,200 - - 1,200 1,200 - - - 1,247
69 Test pemeriksaan HB Test 65 - 65 16 49 - - - - - - - 22 480 453
70 Test Pemeriksaan Urine 10 Parameter Test 78 - 78 6 72 - - - - - - - 8 180 116
71 Tipe mikro pipet warna biru Test 425 - 425 - 425 - - - - - - - - - - 425
72 Tipe mikro pipet warna kuning Test 555 - 555 - 555 - - - - - - - - - - 555
73 Tipe mikro pipet warna putih Test - - - - - - - - - - - - - - -
74 Tisue mikroskop Pcs 1 - 1 - 1 - - - - - - - - - - 1
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs 50 - 50 - 50 - - - - - - - - - - 50

77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - - - - - - - -
TAMBAHAN - - - - - - - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 90 - 90 - 90 90 - 90 - - 90 90 - - - 90
BAHAN GIGI - - - - - - - - - - - - - - -
1 Bahan tambahan light curing - - - - - - - - - - - - - - -
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - - - - - - - -

3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - - - - - - - -
4 Bonding resine Btl - - - - - - - - - - - - - - -
5 Caviton Btl - - - - - - - - - - - - - - -
STOCK
STOCK STOCK
AN (40 %)
S
6 Cellopand strip swenska Pack 1 - 1 - 1 - - - - - - - - - - 1
7 Devitalisasi pasta Btl - - - - - - - - - - - - - - -
8 Etil klorida semprot 100 ml Btl - - - - - - - - - - - - - - -
9 Etching SDI liquid / Acid ethan liquid Btl - - - - - - - - - - - - - - -
10 Eugenol cairan Btl - - - - - - - - - - - - - - -
11 Endometason Pcs - - - - - - - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 1 - 1 - 1 - - - - - - - - - - 1
13 Fraser / Bentuk silinder Bh 1 - 1 - 1 - - - - - - - - - - 1
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - - - - - - - -
15 Gutta percha poins Ktk - - - - - - - - - - - - - - -
16 H-file Pcs - - - - - - - - - - - - - - -
17 K-file Pcs - - - - - - - - - - - - - - -
18 Kalsium hidroksida pasta Ktk - - - - - - - - - - - - - - -
19 Kertas artikulasi (articulating paper) Pack 1 - 1 - 1 - - - - - - - - - - 1

20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - - - - - - - -
24 Mata bor mikromotor (RA) Pack - - - - - - - - - - - - - - -
25 Mata bor white stone Set - - - - - - - - - - - - - - -

26 Mata bor hand place (FG diamond) Set - - - - - - - - - - - - - - -
27 Mata bor tulang / Oral surgery (meisenger) Pcs 5 - 5 - 5 - - - - - - - - - - 5
28 Needle olyco / Jarum carpule Pcs - - - - - - - - - - - - - - -

STOCK
STOCK STOCK
AN (40 %)
S
29 Needle Septoject Pcs 200 - 200 - 200 - - - - - - - - - - 200
30 Oil spray Btl - - - - - - - - - - - - - - -
31 Paper points Ktk 1 - 1 - 1 - - - - - - - - - - 1
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - - - - - - - -
33 Komposit resin (solare x) Tube - - - - - - - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - - - - - - - -
36 Siver amalgam (serbuk) Btl - - - - - - - - - - - - - - -
37 Solare X A2 Bh - - - - - - - - - - - - - - -
38 Solare X A3 Bh - - - - - - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - - - - - - - -
UMUM
ASKES JUMLAH
TIDAK
82 159 339 580
Yang Menerima/M
Petugas Puskesm
dr.Yordan Pradiksa Rahmat Wildan, A.M

Achmad Rois, SKM. M.Kes Nunik Aulia, S.Si.Apt.M.Si
NIP: 19691104 199203 1 002 .NIP: 19820121 201001 1 011 ..NIP: 19870406 2011
NIP: 19810223 200604 2 006
Yang Menerima/M
Pimpinan Puskesmas Petugas Puskesm
Kepala Dinas Kesehatan Kepala UPTD Instalasi Farmasi
STOCK
STOCK STOCK Rahmat Wildan, A.M
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH PENERIMA PERSEDIAA PENGELUAR
dr.Yordan Pradiksa GUDANG OPTIMUM WAKTU JUMLAH PERMINTAAN
NO Achmad
OBAT DANRois, SKM. M.Kes
PERBEKKES SATUAN AN Nunik Aulia, S.Si.Apt.M.Si STOK AWAL ALASAN
NIP: 19691104 199203 1 002
AWAL N N AN AN N AN
.NIP: 19820121 201001 1 011
PUSKESMA (40 %) KOSONG KEBUTUHAN PUSKESMAS ..NIP: 19870406 2011
NIP: 19810223 200604 2 006 S

RAN
MARET
2021
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
PEMBERIAN
SUMBER ALASAN
APBN HIBAH ED
Petugas Puskesmas
hmat Wildan, A.Md., Farm

NIP: 19870406 201101 1 004
Petugas Puskesmas
PEMBERIAN
hmat Wildan, A.Md., Farm

SUMBER ALASAN
NIP: 19870406 201101 1 004
APBN HIBAH ED
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
3 Ambroksol 30 mg Tab 10 5 0 20 0 0 0 0 5 10 0 0 2 0 0 10 40 0 4 0 0 0 10 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 30 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 10 0 0 0 0 0 20 0 285 0 0 40 0 10 30 40 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 4 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 20 0 0 0 0 0 0 0 0 0 20 0 0 0 0 10 0 0 0 0 0 10 20 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 20 0 0 0 0 0 0 0 0 10 0 0 0 0 10 20 0 0 0 0 0 0 0 0 0 0 10 0


53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 240 110 0 0 20 30 20 0 0 0 0 30 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 60 25 0 120 0 0 20 0 0 30 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 10 10 0 0 0 0 0 0 0 10 0 0 0 0 10 0 0 10 0 0 0


82 Metformin 500 mg Tab 0 0 0 0 50 0 0 60 40 0 0 140 70 0 30 0 0 20 0 20 0 0 10 0 10 50 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
88 Mineral Mix Sak 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 10 0 0 10 10 20 0 0 2 0 36 0 28 0 20 0 0 37 40 0 10 0 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MENGETA
,HUI
34 Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 30 31 TOTAL
0 0 0 3
10 0 0 230
10 0 0 126
0 0 0 0
0 0 12 22
0 10 65 115
0 0 0 435
0 0 0 10
0 0 0 150
0 0 0 0
0 0 0 0
0 0 0 0
0 0 10 10
10 0 10 345
0 0 0 0
0 0 0 0
0 0 2 16
0 0 10 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 30
0 14 203 347
0 0 0 10
0 0 0 2
10 10 560 670
29 30 31 TOTAL
0 0 0 0
0 0 0 0
10 4 6 73
0 0 0 6
0 0 0 0
0 0 0 0
10 0 10 100
0 0 0 24
0 0 0 0
30 30 0 595
0 0 60 120
0 0 0 16
0 0 10 10
0 0 0 0
0 0 0 0
40 0 0 40
0 0 190 200
0 0 0 0
0 0 0 70
0 0 0 136
0 0 0 0
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 450
0 0 0 255
0 0 0 0
0 0 10 20
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 4 0 125
0 0 0 0
0 0 0 0
0 0 20 20
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 10 20
10 0 10 70
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 26
0 0 0 20
60 0 0 560
0 0 0 0
30 0 10 248
0 0 0 0
29 30 31 TOTAL
0 0 0 0
30 0 0 100
0 0 10 40
0 0 0 540
0 0 0 95
60 0 0 320
0 0 0 0
30 10 120 491
0 0 0 0
0 0 35 35
0 0 0 20
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 10 30 695
0 0 44 192
0 0 40 668
60 0 0 107
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 154
0 0 105 125
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 40 40
20 0 0 70
0 0 0 0
0 0 0 0
30 0 0 30
20 0 0 157
0 0 0 0
20 216 10 356
0 0 0 0
10 266 10 509
0 0 0 0
0 0 0 150
0 0 57 197
0 0 4 24
0 0 0 0
0 0 130 330
0 0 0 0
30 0 0 33
0 0 0 0
0 0 0 0
0 0 0 3
0 0 234 564
50 0 20 370
20 40 30 455
0 0 0 0
0 0 15 38
0 0 0 0
0 0 10 40
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
MARIYANI
0 0 0 0 NIP: 19750812 200003 2 003
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
29 30 31 TOTAL
0 0 0 9
0 0 0 1
0 0 0 1
0 0 0 3
0 0 0 0
0 0 0 3
0 0 0 3
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 6 6
0 0 0 1
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2 0 0 15
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 8 8
0 0 0 5
0 0 0 0
0 0 7 7
0 0 10 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 2
0 0 21 21
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 15 16
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 1
29 30 31 TOTAL
0 1 0 1
0 0 16 16
0 1 35 45
0 0 0 0
0 0 53 53
0 0 0 1
0 1 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 1 0 1
0 0 0 0
0 0 0 0
0 2 0 2
0 0 0 6
0 0 0 0
0 1 0 3
0 0 6 6
0 0 0 2
0 0 12 17
0 0 0 0
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 36 44
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 16 16
0 0 1 4
0 0 80 94
0 0 0 8
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 2 2
0 0 24 27
0 0 4 5
0 0 30 30
0 0 4 4
0 0 0 1
0 0 13 16
0 0 0 5
0 0 36 39
0 0 9 12
0 0 0 0
0 0 0 0
0 0 0 8
0 0 0 0
0 0 5 5
0 0 0 0
0 0 0 0
0 0 45 45
0 0 0 0
0 0 0 0
0 0 1 1
0 0 0 6
0 0 2 2
0 0 11 11

SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0 0 0
0 0 0 0
NIP: 19750508 199903 1 002
0 0 66 66
0 0 0 3
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
,MENGETAHUI
0 0 0 0
0 0 0 0
NIP: 19610521 199303 1 004
0 0 0 0
0 0 3 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 3 3
0 0 0 0
0 0 0 4
0 0 0 0
0 0 21 21
0 0 15 15
0 0 0 0
0 0 0 0
0 0 7 8
0 0 0 0
0 0 27 27
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 17 19
0 0 37 37
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50
18 Atapulgit 630 mg Tab 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 0 150 0 0 0 0 0 0 0 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0


51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 200 0 0 0 0 0 0 100 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 300 0 0 0 400 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300


82 Metformin 500 mg Tab 0 300 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 100 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
88 Mineral Mix Sak 0 0 0 0 0 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 150 0 0 0 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 500 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 58 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 MENGETA
,HUI
Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 72 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 60
0 0
0 400
0 0
0 0
0 600
0 410
0 0
0 500
0 0
0 0
0 0
0 0
0 500
0 0
0 0
0 50
0 400
0 0
0 0
0 0
0 0
0 0
100 700
0 200
0 400
500 600
31 TOTAL
0 0
0 0
0 200
0 0
0 0
0 0
0 350
0 182
0 480
0 800
0 0
0 400
0 200
0 0
0 0
0 400
0 200
0 0
0 400
0 100
0 0
0 0
0 0
0 0
0 0
0 600
0 800
0 0
0 250
31 TOTAL
0 200
0 0
0 0
0 200
0 700
0 0
0 0
0 0
0 100
0 0
0 300
0 100
0 0
0 0
0 0
0 150
0 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 400
0 900
0 0
0 700
0 0
31 TOTAL
0 0
0 200
0 40
0 270
0 0
0 800
0 0
0 700
0 0
0 0
0 240
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 1,010
0 360
0 900
0 100
0 0
0 0
0 0
0 700
0 600
0 0
31 TOTAL
0 200
0 500
0 0
0 0
0 0
0 400
0 600
0 400
0 500
0 0
0 700
0 0
0 150
0 800
0 300
0 0
0 810
0 0
0 400
0 0
0 0
0 50
0 900
0 800
0 1,100
0 0
0 200
0 30
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 0
0 0
0 0
0 58
31 TOTAL
0 28
0 20
0 8
0 70
0 0
0 0
0 19
0 0
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 10
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 10
0 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 19
0 0
0 0
0 0
0 0
0 0
0 0
0 24
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 19
0 20
31 TOTAL
0 2
0 0
0 85
0 0
0 94
0 27
0 30
0 0
0 15
0 30
0 17
0 18
0 0
0 0
0 26
0 30
0 0
0 0
0 0
0 21
0 27
0 0
0 20
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 9
0 0
0 10
0 0
0 0
0 0
0 0
0 3
0 1
0 30
0 0
0 5
0 0
0 64
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 90
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 6
0 24
0 24
0 24
0 0
0 12
0 49
0 30
0 70
0 25
0 5
0 15
0 85
0 13
0 15
0 4
0 6
0 50
0 20
0 15
0 56
0 90
0 0
0 11
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0
0 0
NIP: 19750508 199903 1 002
0 72
0 0
0 0
0 0
0 0
0 0
,MENGETAHUI
0 200
0 0
NIP: 19610521 199303 1 004
0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 55
0 0
0 17
0 67
0 0
0 0
0 0
0 0
0 21
31 TOTAL
0 25
0 0
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) AMPRAHAN I
PUSKESMAS : PANDU SENJAYA BULAN : MARET
KECAMATAN : PANGKALAN LADA TAHUN : 2021
STOCK
STOCK STOCK JUMLAH
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH GUDANG OPTIMUM WAKTU KEBUTUHA PERMINTAAN
NO OBAT DAN PERBEKKES SATUAN AWAL AN N N PUSKESMA KOSONG PUSKESMAS ALASAN SUMBER ALASAN
AN (40 %) N
S
APBN HIBAH ED
TABLET
1 Albendazol 400 mg Tab 30 90 120 47 73 - 66 - - 7 100
2 Alopurinol 100 mg Tab - 1,000 1,000 635 365 - 889 1,362 1,886 2,000
3 Ambroksol 30 mg Tab 1,112 1,500 2,612 1,105 1,507 400 1,547 - 40 500
4 Aminofilin 200 mg Tab - - - - - - - - - 300

5 Amitriptilin 25 mg Tab 100 - 100 28 72 - 39 41 8 300
6 Amlodipin 5 mg Tab 1,105 600 1,705 630 1,075 - 882 - - 193 1,000
7 Amlodipin 10 mg Tab 770 300 1,070 809 261 - 1,133 - 872 1,000
8 Amoksisilin 250 mg Tab 140 - 140 120 20 - 168 13 161 100
9 Amoksisilin 500 mg Tab 1,366 1,000 2,366 1,234 1,132 300 1,728 - 596 1,000
10 Ampicilin 500 mg Tab - - - - - - - - -

11 Antasida kombinasi Tab 88 - 88 88 - - 123 - 123 2,000
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - 500
13 Asam asetilsalisilat (asetosal) 80 mg Tab 430 - 430 330 100 - 462 13 375 1,000
14 Asam mefenamat 500 mg Tab 680 2,000 2,680 1,166 1,514 800 1,632 86 205 1,000
15 Asam traneksamat 500 mg Tab - - - - - - - - - 500

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
16 Asiklovir 200 mg Tab 60 - 60 60 - - 84 - 84 500
17 Asiklovir 400 mg Tab 206 300 506 145 361 - 203 - - 158 500
18 Atapulgit 630 mg Tab 937 - 937 60 877 300 84 - - 793 500
19 Atropin 0,5 mg Tab - - - - - - - - - 500
20 Azitromisin 500 mg Tab - 630 630 280 350 350 392 - 42 500
21 Asam folat 1 mg Tab - - - - - - - - - 2,000
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - 200
23 Betahistin 6 mg Tab 390 700 1,090 686 404 200 960 56 613 1,500
24 Deksametason 0,5 mg Tab 1,011 1,500 2,511 778 1,733 500 1,089 - - 644 1,500
25 Digoksin 0,25 mg Tab - 400 400 10 390 - 14 73 - 303 300
26 Dimenhidrinat 50 mg Tab 545 - 545 17 528 - 24 - - 504 300
27 Domperidon 10 mg Tab 439 800 1,239 959 280 - 1,343 - 1,063 1,000
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - 500
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - 500

30 Eritromisin 500 mg Tab 322 200 522 222 300 - 311 35 46 1,000
31 Fenitoin 30 mg Kaps 100 - 100 35 65 - 49 180 164 200
32 Fenitoin 100 mg Kaps 100 - 100 100 - - 140 - 140 100
33 Flukonazol 150 mg Tab - - - - - - - - - 100
34 Furosemid 40 mg Tab 557 200 757 430 327 - 602 - 275 500
35 Garam oralit kombinasi Sak 394 - 394 132 262 - 185 - - 77 500
36 Gemfibrozil 300 mg Kaps 8 480 488 8 480 - 11 - - 469 600
37 Glibenklamid 5 mg Tab 1,310 2,500 3,810 2,365 1,445 700 3,311 - 1,866 2,000
38 Glimepirid 2 mg Tab 625 200 825 692 133 - 969 73 909 1,000
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 701 500 1,201 132 1,069 300 185 - - 884 1,000
40 Griseofulvin (micronized) 125 mg Tab 330 400 730 130 600 - 182 13 - 406 1,000
41 Haloperidol 1,5 mg Tab - - - - - - - - -
42 Haloperidol 2 mg Tab - - - - - - - - - 300
43 Haloperidol 5 mg Tab - 400 400 40 360 - 56 1,200 896 500
44 Hiosina butilbromida 10 mg Tab 150 200 350 260 90 - 364 95 369 500
45 Ibuprofen 200 mg Tab - - - - - - - - - 1,000
46 Ibuprofen 400 mg Tab 758 2,000 2,758 1,263 1,495 800 1,768 - 273 1,000
47 Isosorbid dinitrat 5 mg Tab 53 100 153 136 17 - 190 65 238 300
48 Isoniazid oral 100 mg Tab - - - - - - - - - 300
49 Kalium diklofenak 50 mg Tab - - - - - - - - - 1,000
50 Kalsium laktat (kalk) 500 mg Tab 335 - 335 310 25 - 434 19 428 1,500
51 Kandesartan 8 mg - - - - - - - - - 500
52 Kandesartan 16 mg Tab 310 - 310 310 - - 434 - 434 1,000

53 Kaptopril 12,5 mg Tab 3,413 1,500 4,913 1,830 3,083 2,500 2,562 - - 521 1,500
54 Kaptopril 25 mg Tab 3,167 1,000 4,167 516 3,651 2,100 722 - - 2,929 2,000
55 Karbamazepin 200 mg Tab 200 - 200 - 200 - - - - 200
56 Ketokonazol 200 mg Tab 438 200 638 60 578 - 84 - - 494 500
57 Ketoprofen 100 mg Tab 313 200 513 103 410 - 144 - - 266 500
58 Klindamisin 150 mg kaps - - - - - - - - - 300

59 Klindamisin 300 mg Kaps - - - - - - - - - 300
60 Kloramfenikol 500 mg Kaps 54 200 254 - 254 - - - - 254 500
61 Klorfeniramin maleat (ctm) 4 mg Tab 1,571 2,000 3,571 631 2,940 1,700 883 - - 2,057 1,000
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - 500
63 Klorpromazin hcl 100 mg Tab - 100 100 87 13 - 122 - 109 500
64 Klozapin 25 mg Tab 98 - 98 20 78 - 28 600 550 500
65 Klozapin 100 mg Tab 70 100 170 1 169 - 1 - - 168 500
66 Kombinasi dihidro artemisin piperakuin (act/dhp Tab - - - - - - - - - 100
67 Kotrimoksazol (dewasa) 480 mg Tab 580 - 580 10 570 - 14 - - 556 500
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 812 - 812 42 770 - 59 - - 711 200
69 Kuinin 222 mg Tab - - - - - - - - - 100
70 Lanzoprazol 30 mg Kaps 44 550 594 244 350 350 342 - - 8 1,000
71 Levotiroksin 50 mµ Tab - - - - - - - - - 200
72 Levofloksasin 500 mg Tab 204 400 604 170 434 150 238 25 - 171 500
73 Loratadin 10 mg Tab 676 500 1,176 274 902 200 384 - - 518 1,000
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - 1
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - - 1

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - 1
77 MDT MB dewasa (obat kusta) Pkt - 3 3 3 - - 4 - 4 2
78 Mebendazol 100 mg Tab - - - - - - - - - 500
79 Meloksikam 7,5 mg Tab 30 - 30 30 - - 42 - 42 500
80 Meloksikam 15 mg Tab 250 - 250 226 24 - 316 2 294 500
81 Metamizol (antalgin) 500 mg Tab 240 400 640 110 530 - 154 - - 376 500
82 Metformin 500 mg Tab 1,880 1,000 2,880 1,640 1,240 900 2,296 - 1,056 1,500
83 Metilergometrin 0,125 mg Tab 160 300 460 50 410 300 70 - - 340 300
84 Metilprednisolon 4 mg Tab 1,450 500 1,950 1,003 947 300 1,404 - 457 1,000
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
85 Metilprednisolon 8 mg Tab - - - - - - - - - 500
86 Metronidazol 250 mg Tab - - - - - - - - - 300
87 Metronidazol 500 mg Tab 467 500 967 284 683 - 398 48 - 238 500
88 Mineral Mix Sak 40 - 40 40 - - 56 - 56 100
89 Multivitamin ibu hamil (Gestiamin) Tab 140 2,020 2,160 2,020 140 - 2,828 257 2,945 1,000
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - 2,850 2,850 1,000
91 Multivitamin lansia (pehavral) Tab 570 1,500 2,070 1,317 753 - 1,844 - 1,091 500
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - 100
93 Natrium diklofenak 25 mg Tab 582 1,500 2,082 993 1,089 700 1,390 - 301 1,500
94 Natrium diklofenak 50 mg Tab - - - - - - - - - 500
95 Nifedipin 10 mg Tab 120 - 120 65 55 - 91 1,050 1,086 500
96 Nifedipin 20 mg Tab 290 - 290 50 240 - 70 - - 170 300
97 Nistatin 500.000 IU Tab 82 380 462 82 380 300 115 - - 265 100
98 N-asetil sistein 200 mg kaps 270 560 830 450 380 380 630 - 250 1,000
99 OAT Kategori Anak Pkt - - - - - - - - -
100 OAT Kategori I Pkt - 2 2 - 2 2 - - - 2
101 OAT Kategori II Pkt - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - -
103 Ofloksasin 200 mg Tab - 200 200 20 180 - 28 - - 152 500
104 Ofloksasin 400 mg Tab - - - - - - - - - 500

105 Omeprazol 20 mg Kaps 350 2,130 2,480 1,945 535 120 2,723 154 2,342 2,500
106 Ondansetron 4 mg Tab 57 600 657 276 381 120 386 91 97 900
107 Parasetamol 500 mg Tab 4,276 2,500 6,776 3,926 2,850 1,600 5,496 - 2,646 2,000
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
108 Pirantel pamoat 125 mg Tab 7 100 107 107 - - 150 51 201 200
109 Pirasetam 400 mg Tab - - - - - - - - - 500
110 Pirasetam 1200 mg Tab - - - - - - - - - 500
111 Piroksikam 10 mg Tab - - - - - - - - - 500
112 Piroksikam 20 mg Tab 215 1,000 1,215 384 831 - 538 - - 293 1,000
113 Prednison 5 mg Tab - 1,500 1,500 145 1,355 700 203 61 - 1,091 1,000
114 Primakuin 15 mg Tab - - - - - - - - - 100
115 Propiltiourasil 100 mg Tab - 200 200 - 200 - - - - 200 500
116 Propranolol 10 mg Tab 737 500 1,237 777 460 - 1,088 50 678 1,000
117 Propranolol 40 mg Tab 370 - 370 330 40 - 462 88 510 1,500
118 Ranitidin 150 mg Tab - - - - - - - - - 500
119 Risperidon 1 mg Tab - - - - - - - - - 200
120 Risperidon 2 mg Tab - 400 400 30 370 - 42 900 572 200
121 Salbutamol 2 mg Tab 1,018 500 1,518 510 1,008 - 714 - - 294 1,000
122 Salbutamol 4 mg Tab 272 500 772 40 732 - 56 - - 676 500
123 Sefadroksil 500 mg Kaps 469 1,000 1,469 704 765 - 986 169 390 1,500
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - 500
125 Setirizin 10 mg Tab 1,477 500 1,977 1,339 638 - 1,875 - 1,237 1,500
126 Simetidin 200 mg Tab - - - - - - - - - 500
127 Simvastatin 10 mg Tab 310 - 310 310 - - 434 - 434 200

128 Simvastatin 20 mg Tab 1,165 1,000 2,165 1,020 1,145 - 1,428 - 283 300
129 Siprofloksasin 500 mg Tab 545 500 1,045 215 830 300 301 - - 529 1,000
130 Spironolakton 25 mg Tab - - - - - - - - - 500

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
131 Tambah darah kombinasi (fe dan asam folat) Tab 80 1,500 1,580 790 790 150 1,106 157 473 500
132 Trifluoperazin 5 mg Tab - - - - - - - - - 500
133 Triheksifenidil 2 mg Tab - 400 400 33 367 - 46 990 669 500
134 Triheksifenidil 5 mg Tab - - - - - - - - - 200
135 Vitamin A 100.000 IU (retinol) Biru Kaps 97 350 447 88 359 350 123 - - 236
136 Vitamin A 200.000 IU (retinol) Merah kaps 1,405 750 2,155 1,127 1,028 900 1,578 - 550
137 Vitamin B 1 (tiamin) 50 mg Tab 867 2,000 2,867 1,560 1,307 700 2,184 - 877 1,000
138 Vitamin B 6 (piridoksin) 10 mg Tab 770 1,000 1,770 1,007 763 - 1,410 - 647 500
139 Vitamin B kompleks Tab 1,103 3,500 4,603 2,906 1,697 1,000 4,068 216 2,588 2,000
140 Vitamin C (asam askorbat) 50 mg Tab 847 - 847 759 88 - 1,063 - 975 2,000
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 310 1,000 1,310 300 1,010 800 420 48 - 543 1,000
142 Vitamin Hepagard Tab 165 - 165 40 125 - 56 - - 69 200
143 Zinc tablet dispersibel 20 mg Tab 335 200 535 455 80 - 637 46 603 500
TAMBAHAN - - - - - - - - -
1 Becefort - 1,000 1,000 - 1,000 1,000 - - - 1,000
2 Imbos forte - - - - - - - - -
3 Livron B Plex - 630 630 - 630 630 - - - 630
4 Multivitamin (Sivit - Zink) Bh - 120 120 - 120 120 - - - 120
5 Oseltamivir 75 mg Bh - - - - - - - - -
INJEKSI - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 13 - 13 12 1 - 17 30 46 30
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl - 20 20 8 12 - 11 - - 1 10
3 Aminofilin 24 mg/ml Amp 27 - 27 22 5 - 31 - 26 30

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 15 - 15 12 3 - 17 - 14
5 Antrain Inj Amp - - - - - - - - - 30
6 Artemether 80 mg/ml Amp - - - - - - - - - 30
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - 30
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - - 30
9 Asam traneksamat 100 mg/ml Amp 10 20 30 30 - 10 42 - 42 60
10 Atropin 0,25 mg/ml Amp 3 20 23 3 20 20 4 - - 16 20
11 Deksametason 5 mg/ml Amp 28 50 78 26 52 20 36 - - 16 50
12 Difenhidramin hcl 10 mg/ml Amp 35 30 65 53 12 - 74 30 92 60

51 Evaluasi
15 dan Perencanaan
66 41 25 - 57 - 32 30
14 Furosemid 10 mg/ml Amp 16 10 26 26 - - 36 - 36 30
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - - 10

MARIYANI
16 Gentamisin 40 mg/ml Amp 10NIP: 19750812
- 20000310
2 003 10 - - 14 - 14 30
17 Haloperidol 5 mg/ml Amp - - - - - - - - - 10

18 Haloperidol 50 mg/ml Amp - - - - - - - - - 10
19 Kalsium glukonat 10 % Amp 20 - 20 10 10 - 14 - 4 20
20 Ketorolak 30 mg/ml Amp 20 15 35 15 20 - 21 - 1 30
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - 10
22 Lidokain 2 % Amp 135 100 235 44 191 100 62 - - 129 100
23 Lidokain kompositum Amp 60 - 60 41 19 - 57 - 38 60

24 Magnesium sulfat 20 % (i.v.) Btl 7 20 27 7 20 - 10 - - 10 20
25 Magnesium sulfat 40 % (i.v.) Btl 11 2 13 3 10 - 4 - - 6 20
26 Metamizol (antalgin) 500 mg/2 ml Amp 120 - 120 39 81 - 55 - - 26 100

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
27 Metilergometrin 0.2 mg/ml Amp - 50 50 50 - - 70 - 70 30
28 Oksitosin 10 iu/ml Amp 6 30 36 36 - - 50 90 140 30
29 Omeprazole 40 mg/ml Amp 15 50 65 44 21 - 62 1 42 50
30 Ondansetron 4 mg/2 ml Amp 68 100 168 96 72 60 134 - 62 100
31 Piracetam 1 gr Amp 14 20 34 25 9 10 35 - 26 30

MENGETA- ,MENGETAHUI
,MENGETAHUI
- - - -
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
Kepala Dinas
- Kabupaten - Kotawaringin
Kabupaten -
Kotawaringin - - 60
,HUI Dinas
Kesehatan Barat
Barat
Kabupaten19 10 10 180 171 60
Dinas Kotawaringin
Kabupaten
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial - 25 25 7 Kotawaring
Barat18 10 10 30 22 60
Kabupate in Barat
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 33 60 93 64 29 20 90 1 61 100
drg.INDRAWAN
gin Barat Amp - - - - - -
SAKTI,MKes
SAKTI,MKes - - - 50
NIP:
NIP:19610521
19610521199303
19930311
38 Vitamin B 1 (tiamin) 100 mg /ml Amp - - - - drg.INDRAW - - 004
004 - - - 50
drg.INDRA
AN
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 65 50 115 104 WAN11
SAKTI,MKes - 146 - 135 150
SAKTI,MKe
NIP:
TAMBAHAN
drg.INDRA - - - - s -
19610521 - - - -
WAN 199303
NIP: 1
SAKTI,MK - - - - 004 -
19610521 - - - -
es 199303 1
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 004 - - - - -
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - 10
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube - - - - - - - - - 10
3 Diazepam 2 mg Tab - - - - - - - - - 100
4 Diazepam 5 mg Tab 37 200 237 18 219 100 25 - - 194 100

5 Diazepam 5 mg/ml (i.v.) Amp 80 10 90 36 54 - 50 28 25 30
6 Fenobarbital 50 mg/ml Amp 30 - 30 - 30 - - - - 30 30
7 Fenobarbital 30 mg Tab 100 - 100 - 100 - - - - 100

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
8 Kodein 10 mg Tab 200 - 200 200 - - 280 - 280 100
9 Klobazam 10 mg Tab - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - -
1 Antifungi kombinasi Tube 10 10 20 10 10 - 14 19 23 20
2 Antihemoroid kombinasi Supp 21 - 21 11 10 - 15 - 5
3 Asiklovir 5% Krim Tube 12 50 62 29 33 - 41 - 8 25
4 Basitrasin - polimiksin B Tube - 29 29 8 21 - 11 17 7 25
5 Bedak salisil 2% Ktk 2 10 12 12 - - 17 300 317 20
6 Betametason 0,1% krim Tube 32 50 82 32 50 15 45 - - 5 25
7 Bioplacenton krim Tube - - - - - - - - - 20
8 Bisakodil ( dulcolax ) 5mg supp - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 58 - 58 33 25 - 46 - 21
10 Desoksimetason 0,25 % krim Tube 31 - 31 17 14 - 24 1 11 30
11 Gentamisin salep kulit Tube 41 - 41 25 16 - 35 - 19

12 Gentamisin salep mata Tube 32 24 56 13 43 - 18 - - 25 25
13 Hidrokortison 2,5% krim Tube 30 - 30 2 28 - 3 - - 25 25
14 Ketokonazol 2 % krim Tube 36 - 36 7 29 25 10 - - 19
15 Ketoprofen 100 mg Supp - 10 10 - 10 - - - - 10 25
16 Kloramfenikol 1% salep mata Tube 40 - 40 1 39 - 1 - - 38 25
17 kloramfenikol 3% salep kulit Tube 24 - 24 13 11 - 18 - 7 25

18 Mikonazol 2 % krim Tube 42 24 66 6 60 24 8 - - 52
19 metronidazol ovula 500 mg ovul 40 - 40 - 40 - - - - 40
20 Nistatin 100.000 IU Supp 42 - 42 - 42 42 - - - 42

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
21 Oksitetrasiklin salep kulit Tube 20 - 20 5 15 - 7 - - 8 25

22 Oksitetrasiklin salep mata Tube 28 75 103 2 101 50 3 - - 98 25
23 povidon iodin / betadine salep Tube 12 5 17 7 10 - 10 - - 0 25
24 Salep 2-4 kombinasi krim Tube - 48 48 16 32 24 22 8 - 2
25 Sulfadiazine 10 Mg Salep Tube 7 20 27 2 25 15 3 - - 22 20
SIRUP - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - 50
2 Ambroxol sirup 15 mg/5 ml Btl 59 50 109 17 92 50 24 - - 68
3 ambroxol sirup 30 mg/5 ml Btl 117 - 117 35 82 60 49 - - 33
4 Amoksisilin sirup kering 125 mg/5 ml Btl 47 - 47 18 29 - 25 - - 4 100
5 Amoksisilin sirup kering 250 mg/5 ml Btl 112 - 112 22 90 80 31 - - 59
6 Antasida susp Btl 33 200 233 92 141 81 129 21 9
7 Caviflex sirup Btl - - - - - - - - - 100
8 Dextrofen sirup Btl 34 100 134 68 66 10 95 - 29
9 Domperidon sirup 5 mg/5 ml Btl 85 - 85 35 50 - 49 - - 1 100
10 Ibuprofen sups 100 mg / 5 ml Btl - 100 100 1 99 70 1 0 - 97
11 Ibuprofen sups 200 mg / 5 ml Btl 9 - 9 9 - - 13 - 13 100
12 Kloramfenikol susp 125 mg/5 ml Btl 34 - 34 2 32 - 3 - - 29 100
13 Kotrimoksazol susp 240 mg/5 ml Btl 15 100 115 25 90 60 35 - - 55 50
14 Laktulosa 3,335 g/5 ml Btl 18 - 18 3 15 - 4 - - 11 100
15 Metronidazol susp 125 mg/5 mL Btl 24 - 24 1 23 - 1 - - 22 100
16 Nistatin drop 100.000 IU/ml Btl 16 - 16 1 15 - 1 - - 14 20
17 Obat batuk hitam (OBH) sirup Btl 46 - 46 19 27 - 27 - - 0 100
18 Parasetamol drops 100 mg/ml Btl 40 120 160 5 155 100 7 - - 148
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
19 Parasetamol sirup 120 mg/5 ml Btl 63 100 163 28 135 75 39 - - 96
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - 10
21 Procuma sirup Btl 73 50 123 36 87 65 50 - - 37 100
22 Sefadroksil sirup kering 125 mg/5 ml Btl 63 50 113 14 99 50 20 3 - 76
23 sefadroxil sirup kering 250 mg /forte Btl 92 - 92 5 87 50 7 - - 80
24 setirizin 5mg / 5 ml Btl 88 100 188 34 154 100 48 - - 106
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - 100
26 Zink sirup 20mg/ 5ml Btl 44 - 44 16 28 - 22 - - 6 100
TAMBAHAN - - - - - - - - -
1 Becefort syrup - - - - - - - - -
2 Imbos Syrup - 6 6 - 6 6 - - - 6
LARUTAN - - - - - - - - -
1 Alkazyme Bks - - - - - - - - - 1
2 Alkacide btl - - - - - - - - - 1
3 Bromhexin (Bisolvon) Btl 1 - 1 - 1 - - - - 1
4 Etanol 70 % 1000 ml Btl 75 75 150 86 64 - 120 - 56

5 Etakridinn laktat 0,1% (rivanol) Btl 6 - 6 1 5 5 1 - - 4
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - 2
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - 30
8 Gentamisin 0,3 % tetes mata Btl 22 - 22 6 16 12 8 - - 8 24
9 Gentian violet 1 % Btl 62 - 62 7 55 24 10 - - 45 24
10 Glukosa 10 % (D.10) 500 ml Btl 13 10 23 14 9 - 20 - 11 20
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 15 15 30 10 20 5 14 - - 6 60

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
13 KA-EN 1 B 500 ml Btl 16 - 16 - 16 16 - - - 16
14 KA-EN 3 B 500 ml Btl 10 20 30 - 30 30 - - - 30
15 kloramfenikol Tetes mata Btl - - - - - - - - - 25
16 Kloramfenikol 3% tetes telinga Btl 8 - 8 8 - - 11 - 11 25
17 Lysol 1 liter Btl 6 - 6 5 1 - 7 - 6
18 Metronidazol infus 5 mg/ml Btl 1 - 1 - 1 - - - - 1 2
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 51 60 111 47 64 30 66 - 2
20 Povidon iodin 10 % 30 ml Btl 8 10 18 1 17 14 1 - - 16
21 Povidon iodin 10 % 300 ml Btl 13 - 13 1 12 4 1 - - 11
22 Parasetamol infus 10 mg/ml Btl - 4 4 - 4 4 - - - 4 2
23 Ringer laktat (RL) 500 ml Btl 71 100 171 71 100 58 99 - - 1 60
TAMBAHAN - - - - - - - - -
1 Bayclin Btl 48 - 48 - 48 - - - - 48
2 larutan disenfektan karbol Btl 23 11 34 10 24 11 14 - - 10

3 Sabun cuci tangan - - - - - - - - -
4 Alkohol 1 liter - - - - - - - - -
5 antiseptic gel - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial - - - - - - - - - 2
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - 5

3 Vaksin anti rabies/ VAR/ Verorab Vial 6 4 10 - 10 - - - - 10
4 Vaksin BCG Vial 14 29 43 7 36 20 10 - - 26
5 Vaksin campak Vial - - - - - - - - -

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
6 Vaksin hepatitis (HBO) Bayi Pouches 36 30 66 29 37 24 41 - 4
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 7 10 - 10 - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 13 5 18 6 12 - 8 - - 4
11 Vaksin kombinasi DPT-HB-Hib Vial 93 70 163 65 98 70 91 - - 7
12 Vaksin polio ipv 0,5 ml (i.m.) Vial - 30 30 8 22 10 11 - - 11
13 Vaksin polio t-opv drops 10 dosis Vial 30 40 70 11 59 40 15 - - 44
14 vaksin MR Vial 3 69 72 12 60 40 17 - - 43
TAMBAHAN
1 ADS 0,05 ML - - - - - - - - -
2 ADS 0,5 ML - 300 300 - 300 300 - - - 300
3 ADS 5 ML - - - - - - - - -
4 Safety box 5 L - - - - - - - - -
5 VAKSIN SINOVAC - 116 116 116 - - 162 - 162
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set - 404 404 14 390 - 20 - - 370 500
2 Alat suntik sekali pakai 0,5 ml Set - 20,600 20,600 242 20,358 10,000 339 480 - 19,539
3 Alat suntik sekali pakai 1 ml Set 354 - 354 126 228 200 176 - - 52
4 Alat suntik sekali pakai 3 ml Set 464 - 464 136 328 100 190 - - 138 300
5 Alat suntik sekali pakai 5 ml Set 487 - 487 47 440 200 66 - - 374 200
6 Alat suntik sekali pakai 10 ml Set 5 50 55 51 4 - 71 60 127 20
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - -

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
8 Alkohol swabs Pcs - 10,000 10,000 93 9,907 - 130 - - 9,777
9 Antiseptik gel 500 ml Btl 62 62 124 92 32 44 129 - 97
10 Bisturi uk.20 Pcs 21 - 21 7 14 - 10 - - 4
11 Bisturi uk.21 Pcs 9 - 9 4 5 - 6 - 1 30
12 Blood transfusi set Set 10 20 30 5 25 20 7 - - 18 30
13 Cat gut chromic 2/0 Pcs 12 48 60 2 58 42 3 4 - 51 30
14 Cat gut chromic 3/0 Pcs 34 24 58 55 3 - 77 13 87
15 Cat gut plain 2/0 Sak 75 - 75 7 68 26 10 - - 58

16 Cat gut plain 3/0 Sak 56 - 56 30 26 32 42 - 16
17 Folly catheter No.16 pcs 8 10 18 4 14 12 6 - - 8
18 Folly catheter No.18 pcs 10 10 20 1 19 3 1 - - 18
19 I.V. catheter No.18 pcs 77 50 127 17 110 50 24 - - 86
20 I.V. catheter No.20 pcs 35 50 85 23 62 20 32 - - 30
21 I.V. catheter No.22 pcs 70 50 120 69 51 5 97 - 46

22 I.V. Catheter No.24 pcs 19 50 69 16 53 20 22 6 - 25
23 I.V. Catheter No.26 pcs 9 - 9 - 9 - - - - 9
24 Infus set anak pcs 20 20 40 27 13 - 38 - 25
25 Infus set dewasa pcs - 100 100 11 89 10 15 - - 74
26 Jarum (needle) 23 Pcs 18 - 18 5 13 - 7 - - 6
27 Jarum (needle) 27 Pcs 79 - 79 64 15 - 90 - 75

28 K.y jelly 82 gram Tube 2 10 12 8 4 - 11 - 7
29 Kapas pembalut/absorben 250 gram Bks 7 - 7 - 7 - - - - 7
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 75 - 75 45 30 25 63 - 33

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 - 20 - - - - 20
32 Kasa pembalut hidrofil 4 m x 10 cm Roll 15 - 15 - 15 - - - - 15
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 76 - 76 1 75 20 1 - - 74
34 Kasa kompres 40/40 steril Roll 95 50 145 14 131 40 20 - - 111
35 Kasa 40 m x 80 cm Roll - 4 4 2 2 4 3 60 61 3
36 Kasa pembalut 2 m x 80 cm Roll 38 - 38 27 11 4 38 - 27

9 Bun,31
50 Desember 59 2012 22 37 10 31 - - 6
38 Kertas puyer biasa Pack 2 Kotawaringin
5 Barat 7 3 4 6 4 - 0
39 Kertas puyer press Pack 900 - 900 - 900 900 - - - 900
40 Kondom Sutra pcs - - - - - - - - -

- 8,550 3,682 4,868 - 5,155 - 287
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 260 - 260 220 40 40 308 - 268
43 Penjepit tali pusat Pcs 4 30 34 7 27 - 10 89 72
44 penghisap lendir pcs 24 20 44 - 44 20 - - - 44

45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr - 1,000 1,000 - 1,000 1,000 - - - 1,000
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr - 500 500 - 500 500 - - - 500
47 Plester 1,25 X 4,5 m Roll - - - - - - - - -

,MENGETAHUI
- Kesehatan
- - - - - - -
49 Plester bulat/ plesterin pcs 200 - 200 - 200 - - - - 200
50 Plester cannofix pcs 20 20 40 - 40 40 - - - 40

- SAKTI,M.Kes
- - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll - 10 10 - 10 3 - - - 10
53 Safety box Bh 10 25 35 9 26 23 13 - - 13
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
54 Sarung tangan non steril Uk. S Psg 3,150 3,150 6,300 4,167 2,133 - 5,834 - 3,701
55 Sarung tangan non steril Uk. M Psg 3,600 3,600 7,200 7,166 34 - 10,032 - 9,998
56 Sarung tangan non steril Uk. L Psg 1,750 7,800 9,550 2,756 6,794 - 3,858 - - 2,936
57 Sarung tangan steril ginekologi Psg 3 - 3 3 - 3 4 - 4
58 Sarung tangan steril No.6 Psg - - - - - - - - -
59 Sarung tangan steril No.6,5 Psg 72 - 72 19 53 - 27 - - 26
60 Sarung tangan steril No.7 Psg 17 - 17 14 3 - 20 - 17 50
61 Sarung tangan steril No.7,5 Psg 42 - 42 28 14 - 39 - 25
62 Sarung Tangan steril no.8 Psg 96 - 96 15 81 29 21 - - 60
63 Selang oksigen anak Pcs 17 - 17 - 17 5 - - - 17
64 Selang oksigen bayi Pcs 26 - 26 - 26 20 - - - 26

65 Selang oksigen dewasa Pcs 8 20 28 21 7 9 29 - 22
66 Sendok kertas puyer Pcs - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 1 72 73 33 40 46 46 13 19
68 Silk (benang bedah sutra) No. 3/0 Sak 6 36 42 16 26 - 22 - - 4
69 Speculum Uk S pcs - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - -
71 Speculum Uk L pcs - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - -
73 Underpads Pcs 10 50 60 16 44 35 22 0 - 21
74 Urin bag Pcs 11 20 31 24 7 17 34 9 36
75 Wing needle no 27 G Pcs 71 - 71 37 34 71 52 - 18
TAMBAHAN - - - - - - - - -
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
1 Back pack sprayer Pcs - - - - - 2 - - -
2 Rapid test covid-19 Pcs - 125 125 - 125 128 - - - 125
3 Rapid test antigen Pcs - 25 25 - 25 29 - - - 25
4 Masker KN 95 - - - - - 5 - - -
5 Masker N95 - - - - - 6 - - -
6 Masker Bedah - - - - - 7 - - -
7 Kacamata google - - - - - 8 - - -
8 Face shield Nagita - 35 35 - 35 44 - - - 35
9 Face shield naik turun - - - - - 10 - - -
10 Face shield - - - - - 11 - - -
11 Sepatu boot - - - - - 12 - - -
12 Baju Hazmat kain - - - - - 13 - - -
13 Baju Hazmat cuci ulang - - - - - 14 - - -
14 Hand schoon M - - - - - 15 - - -
15 Hand schoon L - - - - - 16 - - -
16 Hand schoon s - - - - - 17 - - -
17 Hand schoon steril no 7,5 - - - - - 18 - - -
18 Helm kuning ( Face shild kaca mika - - - - - 19 - - -
19 APD - 35 35 - 35 44 - - - 35
20 APD SET HIJAU - - - - - 10 - - -

21 APD BOHO - - - - - 11 - - -
22 APD LEVEL 2 - - - - - - - - -
23 APD LEVEL 3 - - - - - 13 - - -
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
24 APD PEMDA/DONASI - - - - - 14 - - -
25 APD 1 SET - - - - - 15 - - -
26 GOWN - - - - - 16 - - -
27 COOL BOK 6 LITER - - - - - 17 - - -
28 COOL BOK 12,5 LITER - - - - - 18 - - -
29 ANAFILATIK KIT - - - 5 - 5 19 7 - 12
BAHAN & ALAT LABORATORIUM - - - - - - - - -
1 Asam asetat (Cuka) Btl - - - - - - - - -
2 Alat pulmo (peak flow) set - 1 1 - 1 - - - - 1
3 Bilik hitung Pcs 2 - 2 - 2 1,000 - - - 2
4 Blood lancet Pcs 242 1,200 1,442 - 1,442 200 - - - 1,442
5 Bulb pipet Bh - 1 1 - 1 - - - - 1
6 Cartrialge genexpert KIT set - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - -

8 Compresson nebulizer pcs - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - -
13 Kaca slide/ Kaca objek Set 222 - 222 - 222 - - - - 222

14 KIT diagnostic untuk HIV Pcs - - - - - - - - -
15 KIT RPR pcs - - - - - - - - -
16 Kotak slide Pcs 5 - 5 3 2 - 4 - 2

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
17 Lampu spiritus 150 ml Pcs 2 - 2 1 1 - 1 - 0
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - -
20 Medline Pcs - - - - - - - - -
21 Microhematokrit tube wax Pcs - 1 1 - 1 - - - - 1
22 Mikro tube (Vol 1,5 ml) Pcs - 50 50 - 50 - - - - 50
23 Mikroskope cover glasses 18x18 mm Pcs 25 35 60 - 60 - - - - 60
24 Mikroskope cover glasses 20x20 mm Pcs - - - - - - - - -
27 Nebulizer Bh - - - - - - - - -
28 Peak flow meter Pcs - 1 1 - 1 - - - - 1
29 Pen lancet Pcs 5 2 7 - 7 - - - - 7
30 Pengukur tinggi badan Pcs - - - - - - - - -

31 Pipet eritrosit Pcs 2 - 2 - 2 - - - - 2
32 Pipet HB Pcs 2 - 2 1 1 - 1 - 0
33 Pipet leukosit Pcs 2 - 2 - 2 - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - -
35 Pipet westergren Bh - 1 1 - 1 - - - - 1
36 Pot dahak Pcs 85 - 85 7 78 - 10 - - 68

37 Pot urine Pcs - - - - - - - - -
38 Rak staenles tes tube Test - 1 1 - 1 - - - - 1
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - -

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - 150 - - -
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 86 500 586 219 367 319 307 - - 60
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnosta Test - - - - - 50 - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test 49 - 49 - 49 - - - - 49
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - 50 - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test - 177 177 31 146 25 43 - - 103
49 Rapid test pemeriksaan malaria Test 25 - 25 - 25 - - - - 25
50 Reagen Cell clean Btl - - - - - 50 - - -
51 Rapid Test pemeriksaan sipilis Btl - 139 139 29 110 - 41 - - 69
52 Reagen Giemsa Btl 1 - 1 - 1 - - - - 1
53 Reagen Gol Darah Btl 4 - 4 3 1 - 4 - 3

54 Reagen Gol darah anti D Btl - 1 1 - 1 - - - - 1
55 Reagen Immersion Btl 1 - 1 - 1 - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 3 1 4 2 2 1 3 - 1
58 RPR Sipilis fokus Pcs - - - - - - - - -
59 Spritus Btl 1 - 1 1 - - 1 - 1
60 Tabung hematokrit heparin Pcs 125 - 125 125 - - 175 - 175
61 Tabung hematokrit non heparin Pcs 25 - 25 25 - - 35 - 35
62 Tabung vacutainer edta warna ungu Pcs - 143 143 408 - 265 200 571 - 836
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
63 Test asam urat Pcs 200 448 648 54 594 - 76 - - 518
64 Test gluco protein urine Pcs 30 59 89 1 88 3 1 - - 87
65 Test iodium Pcs 8 - 8 8 - - 11 - 11
66 Test kehamilan / PP test Test 4 64 68 507 - 439 250 710 - 1,149
67 Test kolestrol Tube 250 556 806 272 534 950 381 - - 153
68 Test pemeriksaan gula darah Pcs 200 1,350 1,550 55 1,495 - 77 - - 1,418
69 Test pemeriksaan HB Test - 75 75 26 49 - 36 - - 13
70 Test Pemeriksaan Urine 10 Parameter Test 150 - 150 78 72 - 109 - 37
71 Tipe mikro pipet warna biru Test 250 175 425 - 425 - - - - 425
72 Tipe mikro pipet warna kuning Test 157 398 555 - 555 398 - - - 555
73 Tipe mikro pipet warna putih Test - - - - - - - - -
74 Tisue mikroskop Pcs - 1 1 - 1 1 - - - 1
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs - 50 50 - 50 50 - - - 50

77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - -
TAMBAHAN - - - - - 90 - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 40 50 90 - 90 - - - - 90
BAHAN GIGI - - - - - - - - -
1 Bahan tambahan light curing 2 - 2 2 - - 3 - 3
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - -

3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - -
4 Bonding resine Btl 2 - 2 2 - - 3 - 3
5 Caviton Btl 2 - 2 2 - - 3 - 3
STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
6 Cellopand strip swenska Pack 2 - 2 1 1 - 1 - 0
7 Devitalisasi pasta Btl 2 - 2 2 - - 3 - 3
8 Etil klorida semprot 100 ml Btl 3 - 3 3 - - 4 - 4
9 Etching SDI liquid / Acid ethan liquid Btl 3 - 3 3 - - 4 - 4
10 Eugenol cairan Btl 2 - 2 2 - - 3 - 3
11 Endometason Pcs - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 2 - 2 1 1 - 1 - 0
13 Fraser / Bentuk silinder Bh 2 - 2 1 1 - 1 - 0
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - -
15 Gutta percha poins Ktk 2 - 2 2 - - 3 - 3
16 H-file Pcs - - - - - - - - -
17 K-file Pcs - - - - - - - - -
18 Kalsium hidroksida pasta Ktk 2 - 2 2 - - 3 - 3
19 Kertas artikulasi (articulating paper) Pack 2 - 2 1 1 - 1 - 0

20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - -
24 Mata bor mikromotor (RA) Pack 1 - 1 1 - - 1 - 1
25 Mata bor white stone Set 1 - 1 1 - - 1 - 1

26 Mata bor hand place (FG diamond) Set - - - - - - - - -
27 Mata bor tulang / Oral surgery (meisenger) Pcs 11 - 11 6 5 - 8 - 3
28 Needle olyco / Jarum carpule Pcs - - - - - - - - -

STOCK
STOCK STOCK JUMLAH
AN (40 %) N
S
APBN HIBAH ED
29 Needle Septoject Pcs - 200 200 - 200 - - - - 200
30 Oil spray Btl - - - - - - - - -
31 Paper points Ktk 2 - 2 1 1 - 1 - 0
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - -
33 Komposit resin (solare x) Tube - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - -
36 Siver amalgam (serbuk) Btl - - - - - - - - -
37 Solare X A2 Bh 1 - 1 - 1 - - - - 1
38 Solare X A3 Bh - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - -
UMUM
ASKES JUMLAH
TIDAK
82 159 339 580
Petugas Puskesmas
dr.Yordan Pradiksa Rahmat Wildan, A.Md., Farm

NIP: 19691104 199203 1 002 .NIP: 19820121 201001 1 011 ..NIP: 19870406 201101 1 004
NIP: 19810223 200604 2 006
Pimpinan Puskesmas Petugas Puskesmas
STOCK
STOCK STOCK JUMLAH Rahmat Wildan, A.Md., Farm
STOCK PENERIMA PERSEDIAA PEMAKAIA KESELURUH GUDANG OPTIMUMdr.YordanWAKTU KEBUTUHA PERMINTAAN
Pradiksa
NO Achmad
OBAT DANRois, SKM. M.Kes
PERBEKKES SATUAN AN Nunik Aulia, S.Si.Apt.M.Si ALASAN SUMBER ALASAN
NIP: 19691104 199203 1 002
AWAL N N AN PUSKESMA KOSONG
(40 19820121
.NIP: %) N
201001 1 011
PUSKESMAS ..NIP: 19870406 201101 1 004
NIP: 19810223 200604 2 006 S
APBN HIBAH ED
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
TABLET
1 Albendazol 400 mg Tab 73 120 193 13 220 - 40 180 - 120 120 - 120 - 120 18 - - 162
2 Alopurinol 100 mg Tab 365 - 365 70 435 - 140 295 - - - - - - - 98 2,100 1,903
3 Ambroksol 30 mg Tab 1,507 300 1,807 309 1,742 - 244 1,498 400 300 700 50 650 - 650 433 - - 1,065
4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - - - -

5 Amitriptilin 25 mg Tab 72 - 72 11 61 - 61 - - - - - - - 15 330 284
6 Amlodipin 5 mg Tab 1,075 300 1,375 531 844 - 844 - 300 300 100 200 - 200 743 - - 101
7 Amlodipin 10 mg Tab 261 1,000 1,261 402 874 - 15 859 - 1,000 1,000 400 600 - 600 563 - - 296
8 Amoksisilin 250 mg Tab 20 - 20 20 30 - 30 - - - - - - - - 28 600 628
9 Amoksisilin 500 mg Tab 1,132 1,000 2,132 244 2,016 - 128 1,888 300 1,000 1,300 150 1,150 - 1,150 342 - - 1,546
10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - - - -

11 Antasida kombinasi Tab - - - - - - - - - - - - - - - - -
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - - - -
13 Asam asetilsalisilat (asetosal) 80 mg Tab 100 - 100 - 110 - 10 100 - - - - - - - - - - 100
14 Asam mefenamat 500 mg Tab 1,514 500 2,014 352 1,662 - 1,662 800 500 1,300 700 600 - 600 493 - - 1,169
15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
16 Asiklovir 200 mg Tab - - - - - - - - - - - - - - - - -
17 Asiklovir 400 mg Tab 361 200 561 70 491 - 491 - 200 200 - 200 - 200 98 - - 393
18 Atapulgit 630 mg Tab 877 - 877 23 887 - 33 854 300 - 300 50 250 - 250 32 - - 822
19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - - - -
20 Azitromisin 500 mg Tab 350 - 350 350 - - - 350 - 350 350 - - - 490 10,500 10,990
21 Asam folat 1 mg Tab - - - - - - - - - - - - - - - - -
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - - - -
23 Betahistin 6 mg Tab 404 - 404 70 890 - 556 334 200 - 200 - 200 - 200 98 - - 236
24 Deksametason 0,5 mg Tab 1,733 500 2,233 325 1,908 - 1,908 500 500 1,000 100 900 - 900 455 - - 1,453
25 Digoksin 0,25 mg Tab 390 100 490 - 490 - 490 - 100 100 - 100 - 100 - - - 490
26 Dimenhidrinat 50 mg Tab 528 300 828 - 992 - 164 828 - 300 300 - 300 - 300 - - - 828
27 Domperidon 10 mg Tab 280 500 780 285 535 - 40 495 - 500 500 100 400 - 400 399 - - 96
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - - - -

30 Eritromisin 500 mg Tab 300 100 400 173 227 - 227 - 100 100 100 - - - 242 - 15
31 Fenitoin 30 mg Kaps 65 200 265 65 200 - 200 - 200 200 200 - - - 91 - - 109
32 Fenitoin 100 mg Kaps - 100 100 - 100 - 100 - 100 100 100 - - - - - - 100
33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - - - -
34 Furosemid 40 mg Tab 327 200 527 41 486 - 486 - 200 200 - 200 - 200 57 - - 429
35 Garam oralit kombinasi Sak 262 200 462 16 545 - 99 446 - 200 200 - 200 - 200 22 - - 424
36 Gemfibrozil 300 mg Kaps 480 120 600 56 614 - 70 544 - 120 120 - 120 - 120 78 - - 466
37 Glibenklamid 5 mg Tab 1,445 2,000 3,445 670 2,775 - 2,775 700 2,000 2,700 550 2,150 - 2,150 938 - - 1,837
38 Glimepirid 2 mg Tab 133 - 133 50 83 - 83 - - - - - - - 70 1,500 1,487

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab 1,069 - 1,069 1,069 1,376 - 1,376 - 300 - 300 - 300 - 300 1,497 - 1,497
40 Griseofulvin (micronized) 125 mg Tab 600 100 700 70 630 - 630 - 100 100 100 - - - 98 - - 532
41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - - - -
43 Haloperidol 5 mg Tab 360 - 360 30 - 330 330 - - - - - - - 42 900 612
44 Hiosina butilbromida 10 mg Tab 90 400 490 10 480 - 480 - 400 400 - 400 - 400 14 - - 466
45 Ibuprofen 200 mg Tab - - - - - - - - - - - - - - - - -
46 Ibuprofen 400 mg Tab 1,495 1,000 2,495 253 2,242 - 2,242 800 1,000 1,800 300 1,500 - 1,500 354 - - 1,888
47 Isosorbid dinitrat 5 mg Tab 17 300 317 10 337 - 30 307 - 300 300 100 200 - 200 14 - - 293
48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - - - -
50 Kalsium laktat (kalk) 500 mg Tab 25 - 25 25 510 - 510 - - - - - - - - 35 750 785
51 Kandesartan 8 mg - - - - - - - - - - - - - - - - -
52 Kandesartan 16 mg Tab - - - - - - - - - - - - - - - - -
53 Kaptopril 12,5 mg Tab 3,083 500 3,583 500 3,145 - 62 3,083 2,500 500 3,000 200 2,800 - 2,800 700 - - 2,383
54 Kaptopril 25 mg Tab 3,651 500 4,151 300 4,497 - 646 3,851 2,100 500 2,600 - 3,450 - 850 2,600 420 - - 3,431
56 Ketokonazol 200 mg Tab 578 100 678 120 558 - 558 - 100 100 50 50 - 50 168 - - 390
57 Ketoprofen 100 mg Tab 410 100 510 10 510 - 10 500 - 100 100 - 100 - 100 14 - - 486
58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - - - -

59 Klindamisin 300 mg Kaps - - - - - - - - - - - - - - - - -
60 Kloramfenikol 500 mg Kaps 254 200 454 - 580 - 126 454 - 200 200 - 200 - 200 - - - 454
61 Klorfeniramin maleat (ctm) 4 mg Tab 2,940 - 2,940 900 2,040 - 2,040 1,700 - 1,700 50 1,650 - 1,650 1,260 - - 780
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 13 - 13 - 100 - 87 13 - - - - - - - - - - 13
64 Klozapin 25 mg Tab 78 - 78 - 78 - 78 - - - - - - - - - - 78
65 Klozapin 100 mg Tab 169 - 169 100 69 - 69 - - - - - - - 140 3,000 3,071
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - - - - - - - - - -
67 Kotrimoksazol (dewasa) 480 mg Tab 570 100 670 30 640 - 640 - 100 100 - 100 - 100 42 - - 598
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 770 100 870 20 1,361 - 511 850 - 100 100 - 100 - 100 28 - - 822
69 Kuinin 222 mg Tab - - - - - - - - - - - - - - - - -
70 Lanzoprazol 30 mg Kaps 350 - 350 350 - - - 350 - 350 350 - - - 490 10,500 10,990
71 Levotiroksin 50 mµ Tab - - - - - - - - - - - - - - - - -
72 Levofloksasin 500 mg Tab 434 - 434 36 402 - 4 398 150 - 150 - 150 - 150 50 180 - 168
73 Loratadin 10 mg Tab 902 200 1,102 175 931 - 4 927 200 200 400 50 350 - 350 245 - - 682
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - 2 2 2 - - - - 2 2 - - 2 2 3 60 63

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - - - -
78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - - - -
79 Meloksikam 7,5 mg Tab - - - - - - - - - - - - - - - - -
80 Meloksikam 15 mg Tab 24 - 24 10 114 - 100 14 - - - - - - - 14 300 300
81 Metamizol (antalgin) 500 mg Tab 530 - 530 80 530 - 80 450 - - - - - - - 112 2,400 2,062
82 Metformin 500 mg Tab 1,240 1,400 2,640 680 1,960 - 1,960 900 1,400 2,300 500 1,800 - 1,800 952 - - 1,008
83 Metilergometrin 0,125 mg Tab 410 - 410 50 360 - 360 300 - 300 50 250 - 250 70 250 - 40
84 Metilprednisolon 4 mg Tab 947 1,000 1,947 320 1,762 - 135 1,627 300 1,000 1,300 400 900 - 900 448 - - 1,179
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
85 Metilprednisolon 8 mg Tab - - - - - - - - - - - - - - - - -
86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - - - -
87 Metronidazol 500 mg Tab 683 500 1,183 90 1,133 - 40 1,093 - 500 500 50 450 - 450 126 - - 967
88 Mineral Mix Sak - - - - - - - - - - - - - - - - -
89 Multivitamin ibu hamil (Gestiamin) Tab 140 - 140 20 130 - 10 120 - - - - - - - 28 600 508
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - - - - - - - - - - -
91 Multivitamin lansia (pehavral) Tab 753 500 1,253 1,053 200 - 200 - 500 500 500 - - - 1,474 - 1,274
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - - - -
93 Natrium diklofenak 25 mg Tab 1,089 1,500 2,589 616 2,003 - 30 1,973 700 1,500 2,200 550 1,650 - 1,650 862 - - 1,111
95 Nifedipin 10 mg Tab 55 - 55 20 185 - 150 35 - - - - - - - 28 600 593
96 Nifedipin 20 mg Tab 240 - 240 - 460 - 220 240 - - - - - - - - - - 240
97 Nistatin 500.000 IU Tab 380 - 380 50 330 - 330 300 - 300 50 250 - 250 70 - - 260
98 N-asetil sistein 200 mg kaps 380 - 380 380 - - - 380 - 380 380 - - - 532 11,400 11,932
99 OAT Kategori Anak Pkt - - - - - - - - - - - - - - - - -
100 OAT Kategori I Pkt 2 1 3 2 - 1 1 2 1 3 3 - - - 3 60 62
101 OAT Kategori II Pkt - - - - - - - - - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - - - -
103 Ofloksasin 200 mg Tab 180 100 280 - 382 - 102 280 - 100 100 - 100 - 100 - - - 280
104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - - - -

105 Omeprazol 20 mg Kaps 535 720 1,255 955 300 - 300 120 720 840 540 300 - 300 1,337 - 1,037
106 Ondansetron 4 mg Tab 381 - 381 13 381 - 13 368 120 - 120 48 72 - 72 18 - - 350
107 Parasetamol 500 mg Tab 2,850 2,000 4,850 966 4,072 - 188 3,884 1,600 2,000 3,600 1,500 2,100 - 2,100 1,352 - - 2,532
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
108 Pirantel pamoat 125 mg Tab - 100 100 1 207 - 108 99 - 100 100 - 100 - 100 1 - - 98
109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - - - -
110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - - - -
111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - - - -
112 Piroksikam 20 mg Tab 831 500 1,331 300 1,031 - 1,031 - 500 500 150 350 - 350 420 - - 611
113 Prednison 5 mg Tab 1,355 200 1,555 45 1,510 - 1,510 700 200 900 - 900 - 900 63 - - 1,447
114 Primakuin 15 mg Tab - 10 10 - 10 - 10 - 10 10 - 10 - 10 - - - 10
115 Propiltiourasil 100 mg Tab 200 - 200 - 200 - 200 - - - - - - - - - - 200
116 Propranolol 10 mg Tab 460 500 960 460 500 - 500 - 500 500 200 300 - 300 644 15 159
117 Propranolol 40 mg Tab 40 - 40 30 80 - 70 10 - - - - - - - 42 900 932
118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - - - -
120 Risperidon 2 mg Tab 370 - 370 370 - - - - - - - - - - 518 11,100 11,618
121 Salbutamol 2 mg Tab 1,008 500 1,508 127 1,381 - 1,381 - 500 500 - 500 - 500 178 - - 1,203
122 Salbutamol 4 mg Tab 732 500 1,232 33 1,375 - 176 1,199 - 500 500 - 500 - 500 46 - - 1,153
123 Sefadroksil 500 mg Kaps 765 - 765 395 370 - 370 - - - - - - - 553 11,850 12,033
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - - - -
125 Setirizin 10 mg Tab 638 1,500 2,138 571 1,567 - 1,567 - 1,500 1,500 400 1,100 - 1,100 799 - - 768
126 Simetidin 200 mg Tab - - - - - - - - - - - - - - - - -
127 Simvastatin 10 mg Tab - - - - 90 - 90 - - - - - - - - - - -

128 Simvastatin 20 mg Tab 1,145 500 1,645 806 919 - 80 839 - 500 500 200 300 - 300 1,128 - 289
129 Siprofloksasin 500 mg Tab 830 500 1,330 180 1,150 - 1,150 300 500 800 150 650 - 650 252 - - 898
130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
131 Tambah darah kombinasi (fe dan asam folat) Tab 790 510 1,300 430 940 - 70 870 150 510 660 150 510 - 510 602 - - 268
132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - - - -
133 Triheksifenidil 2 mg Tab 367 - 367 90 - 277 277 - - - - - - - 126 2,700 2,549
135 Vitamin A 100.000 IU (retinol) Biru Kaps 359 - 359 309 50 - 50 350 - 350 350 - - - 433 9,270 9,653
136 Vitamin A 200.000 IU (retinol) Merah kaps 1,028 - 1,028 757 271 - 271 900 - 900 750 150 - 150 1,060 - 789
137 Vitamin B 1 (tiamin) 50 mg Tab 1,307 1,000 2,307 405 1,902 - 1,902 700 1,000 1,700 100 1,600 - 1,600 567 - - 1,335
138 Vitamin B 6 (piridoksin) 10 mg Tab 763 500 1,263 217 1,373 - 327 1,046 - 500 500 - 500 - 500 304 - - 742
139 Vitamin B kompleks Tab 1,697 - 1,697 476 1,470 - 249 1,221 1,000 - 1,000 200 800 - 800 666 - - 555
140 Vitamin C (asam askorbat) 50 mg Tab 88 - 88 10 78 - 78 - - - - - - - 14 300 236
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 1,010 - 1,010 360 650 - 650 800 - 800 150 650 - 650 504 1,800 1,654
142 Vitamin Hepagard Tab 125 210 335 - 335 - 335 - 210 210 - 210 - 210 - - - 335
143 Zinc tablet dispersibel 20 mg Tab 80 - 80 - 310 - 230 80 - - - - - - - - - - 80

TAMBAHAN - - - - - - - - - - - - - - - - -
1 Becefort 1,000 - 1,000 1,000 - - - - - - - - - - 1,400 30,000 31,400
2 Imbos forte 750 - 750 750 - - - - - - - - - - 1,050 22,500 23,550
3 Livron B Plex - - - - - - - - - - - - - - - - -
4 Multivitamin (Sivit - Zink) Bh 120 - 120 120 - - - - - - - - - - 168 3,600 3,768
5 Oseltamivir 75 mg Bh 570 - 570 570 - - - - - - - - - - 798 17,100 17,898

INJEKSI - - - - - - - - - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial 1 - 1 1 6 - 6 - - - - - - - - 1 30 31
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 12 - 12 2 15 - 5 10 - - - - - - - 3 60 53
3 Aminofilin 24 mg/ml Amp 5 30 35 - 44 - 9 35 - 30 30 - 30 - 30 - - - 35

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 3 - 3 - 25 - 22 3 - - - - - - - - - - 3
5 Antrain Inj Amp - - - - - - - - - - - - - - - - -
6 Artemether 80 mg/ml Amp - - - - - - - - - - - - - - - - -
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - - - - - - - - -
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp - 10 10 7 3 - 3 10 10 20 20 - - - 10 - 7
10 Atropin 0,25 mg/ml Amp 20 20 40 - 43 - 3 40 20 20 40 - 40 - 40 - - - 40
11 Deksametason 5 mg/ml Amp 52 50 102 5 151 - 54 97 20 50 70 10 60 - 60 7 - - 90
12 Difenhidramin hcl 10 mg/ml Amp 12 60 72 1 126 - 55 71 - 60 60 - 60 - 60 1 - - 70

25 Evaluasi
- dan Perencanaan
25 15 10 - 10 - - - - - - - 21 450 461
14 Furosemid 10 mg/ml Amp - 25 25 - 42 - 17 25 - 25 25 - 25 - 25 - - - 25
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - - - - - - - - - -

MARIYANI
- 19750812
- 200003 2- 003 - - - - - - - - - - - - - -

19 Kalsium glukonat 10 % Amp 10 20 30 - 30 - 30 - 20 20 - 20 - 20 - - - 30
20 Ketorolak 30 mg/ml Amp 20 30 50 - 64 - 14 50 - 30 30 - 30 - 30 - - - 50
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - - - - - - - - -
22 Lidokain 2 % Amp 191 100 291 54 237 - 237 100 100 200 102 98 - 98 76 - - 161
23 Lidokain kompositum Amp 19 30 49 15 119 - 85 34 - 30 30 - 30 - 30 21 - - 13

24 Magnesium sulfat 20 % (i.v.) Btl 20 10 30 - 40 - 10 30 - 10 10 - 10 - 10 - - - 30
25 Magnesium sulfat 40 % (i.v.) Btl 10 - 10 - 18 - 8 10 - - - - - - - - - - 10
26 Metamizol (antalgin) 500 mg/2 ml Amp 81 100 181 88 93 - 93 - 100 100 100 - - - 123 - 30
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
27 Metilergometrin 0.2 mg/ml Amp - 30 30 - - 30 30 - 30 30 30 - - - - - - 30
28 Oksitosin 10 iu/ml Amp - 30 30 - 10 20 30 - 30 30 30 - - - - - - 30
29 Omeprazole 40 mg/ml Amp 21 - 21 10 43 - 32 11 - - - - - - - 14 300 303
30 Ondansetron 4 mg/2 ml Amp 72 100 172 12 160 - 160 60 100 160 60 100 - 100 17 - - 143
31 Piracetam 1 gr Amp 9 30 39 6 56 - 23 33 10 30 40 10 30 - 30 8 - - 25

MENGETA- - - - - - ,MENGETAHUI
,MENGETAHUI
- - - - - - -
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
Kepala Dinas
- - - - - - Kabupaten- Kotawaringin
Kabupaten -
Kotawaringin - - - - -
,HUI Dinas
Kesehatan Barat
Barat
Kabupaten22 - 22 10 10 20 10 10 - 10 10 - - 12
Dinas Kotawaringin
Kabupaten
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 18 10 28 5 Kotawaring
Barat23 - 23 10 10 20 10 10 - 10 7 - - 16
Kabupate in Barat
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 29 90 119 1 366 - 248 118 20 90 110 - 110 - 110 1 - - 117
drg.INDRAWAN
gin Barat Amp - 100 100 - - 100 100 - 100 100 100
SAKTI,MKes -
SAKTI,MKes - - - - - 100
NIP:
NIP:19610521
19610521199303
19930311
- - - - - - - 004
004 - - - - - -
drg.INDRA
AN
WAN186 - 176 10 - - - - 80 - 80 - 1 30 21
SAKTI,MKe
NIP:
TAMBAHAN
drg.INDRA - - - - 19610521
s - - - - - - - - - - - - -
WAN 199303
NIP: 1
SAKTI,MK - 100 100 - 19610521
100
004 - 100 - 100 100 - 100 - 100 - - - 100
es 199303 1
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 004 - - - - - - - - - - - - -
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - - - - - - - - -
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube - - - - - - - - - - - - - - - - -
3 Diazepam 2 mg Tab - 100 100 - - 100 100 - 100 100 100 - - - - - - 100
4 Diazepam 5 mg Tab 219 - 219 - - 219 219 100 - 100 - - 100 100 - - - 219
5 Diazepam 5 mg/ml (i.v.) Amp 54 30 84 44 - 40 40 - 30 30 30 - - - 62 1 23

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
8 Kodein 10 mg Tab - 100 100 - - 100 100 - 100 100 100 - - - - - - 100
9 Klobazam 10 mg Tab - - - - - - - - - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - - - - - - - - - -
1 Antifungi kombinasi Tube 10 - 10 - 10 - 10 - - - - - - - - - - 10
2 Antihemoroid kombinasi Supp 10 - 10 - 21 - 11 10 - - - - - - - - - - 10
3 Asiklovir 5% Krim Tube 33 25 58 - 78 - 20 58 - 25 25 - 25 - 25 - - - 58
4 Basitrasin - polimiksin B Tube 21 - 21 2 19 - 19 - - - - - - - 3 60 44
5 Bedak salisil 2% Ktk - - - - - - - - - - - - - - - - -
6 Betametason 0,1% krim Tube 50 25 75 8 67 - 67 15 25 40 5 35 - 35 11 - - 56
7 Bioplacenton krim Tube - - - - - - - - - - - - - - - - -
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 25 - 25 - - 25 25 - - - - - - - - - - 25
10 Desoksimetason 0,25 % krim Tube 14 12 26 6 20 - 20 - 12 12 5 7 - 7 8 - - 12
11 Gentamisin salep kulit Tube 16 - 16 5 12 - 1 11 - - - - - - - 7 150 146

12 Gentamisin salep mata Tube 43 24 67 2 71 - 6 65 - 24 24 - 38 - 14 24 3 - - 62
13 Hidrokortison 2,5% krim Tube 28 24 52 2 52 - 2 50 - 24 24 10 14 - 14 3 - - 47
14 Ketokonazol 2 % krim Tube 29 - 29 15 14 - 14 25 - 25 16 9 - 9 21 - 7
15 Ketoprofen 100 mg Supp 10 10 20 10 10 - 10 - 10 10 - 10 - 10 14 - 4
16 Kloramfenikol 1% salep mata Tube 39 24 63 5 58 - 58 - 24 24 5 19 - 19 7 - - 51
17 kloramfenikol 3% salep kulit Tube 11 - 11 - 18 - 7 11 - - - - 10 - 10 - - - - 11

18 Mikonazol 2 % krim Tube 60 - 60 1 64 - 5 59 24 - 24 10 14 - 14 1 - - 58
19 metronidazol ovula 500 mg ovul 40 - 40 - 40 - 40 - - - - - - - - - - 40
20 Nistatin 100.000 IU Supp 42 - 42 5 99 - 62 37 42 - 42 - 42 - 42 7 - - 30

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
21 Oksitetrasiklin salep kulit Tube 15 - 15 - 18 - 3 15 - - - - - - - - - - 15

22 Oksitetrasiklin salep mata Tube 101 - 101 - 139 - 38 101 50 - 50 - 70 - 20 50 - - - 101
23 povidon iodin / betadine salep Tube 10 - 10 - 23 - 13 10 - - - - - - - - - - 10
24 Salep 2-4 kombinasi krim Tube 32 - 32 14 18 - 18 24 - 24 10 14 - 14 20 - 2
25 Sulfadiazine 10 Mg Salep Tube 25 - 25 - 25 - 25 15 - 15 - 15 - 15 - - - 25
SIRUP - - - - - - - - - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 92 - 92 10 115 - 33 82 50 - 50 - 50 - 50 14 - - 68
3 ambroxol sirup 30 mg/5 ml Btl 82 - 82 9 111 - 38 73 60 - 60 - 60 - 60 13 - - 60
4 Amoksisilin sirup kering 125 mg/5 ml Btl 29 - 29 10 40 - 21 19 - - - - - - - 14 300 295
5 Amoksisilin sirup kering 250 mg/5 ml Btl 90 - 90 13 77 - 77 80 - 80 10 70 - 70 18 - - 59
6 Antasida susp Btl 141 - 141 87 54 - 54 81 - 81 81 - - - 122 - 68
7 Caviflex sirup Btl - - - - - - - - - - - - - - - - -
8 Dextrofen sirup Btl 66 - 66 14 52 - 52 10 - 10 - - 10 10 20 - - 32
9 Domperidon sirup 5 mg/5 ml Btl 50 90 140 10 143 - 13 130 - 90 90 - 78 12 90 14 - - 116
10 Ibuprofen sups 100 mg / 5 ml Btl 99 - 99 45 55 - 1 54 70 - 70 - 55 15 70 63 - 9
11 Ibuprofen sups 200 mg / 5 ml Btl - - - - 19 - 19 - - - - - - - - - - -
12 Kloramfenikol susp 125 mg/5 ml Btl 32 - 32 - 41 - 9 32 - - - - - - - - - - 32
13 Kotrimoksazol susp 240 mg/5 ml Btl 90 20 110 23 87 - 87 60 20 80 - 60 20 80 32 - - 55
14 Laktulosa 3,335 g/5 ml Btl 15 - 15 4 11 - 11 - - - - - - - 6 120 115
15 Metronidazol susp 125 mg/5 mL Btl 23 - 23 3 22 - 2 20 - - - - - - - 4 90 74
16 Nistatin drop 100.000 IU/ml Btl 15 - 15 3 27 - 15 12 - - - - 8 - 8 - 4 90 82
17 Obat batuk hitam (OBH) sirup Btl 27 - 27 4 31 - 8 23 - - - - - - - 6 120 103
18 Parasetamol drops 100 mg/ml Btl 155 - 155 6 149 - 149 100 - 100 - 95 5 100 8 - - 141
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
19 Parasetamol sirup 120 mg/5 ml Btl 135 - 135 20 123 - 8 115 75 - 75 - 60 15 75 28 - - 87
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - - - - - - - - -
21 Procuma sirup Btl 87 100 187 54 133 - 133 65 100 165 - 92 73 165 76 - - 57
22 Sefadroksil sirup kering 125 mg/5 ml Btl 99 - 99 27 72 - 72 50 - 50 - 50 - 50 38 - - 34
23 sefadroxil sirup kering 250 mg /forte Btl 87 - 87 46 41 - 41 50 - 50 - - 50 50 64 - 23
24 setirizin 5mg / 5 ml Btl 154 - 154 30 124 - 124 100 - 100 - 84 16 100 42 - - 82
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - - - - - - - - -
26 Zink sirup 20mg/ 5ml Btl 28 20 48 - 48 - 48 - 20 20 - 14 6 20 - - - 48
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Becefort syrup - - - - - - - - - - - - - - - - -
2 Imbos Syrup 6 - 6 6 - - - 6 - 6 - - 6 6 8 180 188
LARUTAN - - - - - - - - - - - - - - - - -
1 Alkazyme Bks - 25 25 - 25 - 25 - 25 25 - 25 - 25 - - - 25
2 Alkacide btl - 1 1 - 1 - 1 - 1 1 - 1 - 1 - - - 1
3 Bromhexin (Bisolvon) Btl 1 - 1 - - 1 1 - - - - - - - - - - 1
4 Etanol 70 % 1000 ml Btl 64 - 64 - - 64 64 - - - - - - - - - - 64

5 Etakridinn laktat 0,1% (rivanol) Btl 5 - 5 - 5 - 5 5 - 5 - 5 - 5 - - - 5
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - - - - - - - - -
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - - - - - - - - -
8 Gentamisin 0,3 % tetes mata Btl 16 24 40 - 45 - 5 40 12 24 36 - 36 - 36 - - - 40
9 Gentian violet 1 % Btl 55 - 55 2 53 - 53 24 - 24 - 13 11 24 3 - - 50
10 Glukosa 10 % (D.10) 500 ml Btl 9 - 9 - 9 - 9 - - - - - - - - - - 9
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 20 5 25 - 25 - 25 5 5 10 - 10 - 10 - - - 25

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
13 KA-EN 1 B 500 ml Btl 16 - 16 - 19 - 3 16 16 - 16 - 18 - 2 16 - - - 16
14 KA-EN 3 B 500 ml Btl 30 - 30 - 47 - 17 30 30 - 30 - 38 - 8 30 - - - 30
15 kloramfenikol Tetes mata Btl - - - - - - - - - - - - - - - - -
16 Kloramfenikol 3% tetes telinga Btl - - - - 5 - 5 - - - - - - - - - - -
17 Lysol 1 liter Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
18 Metronidazol infus 5 mg/ml Btl 1 2 3 - 3 - 3 - 2 2 - 3 - 1 2 - - - 3
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 64 - 64 45 19 - 19 30 - 30 - - 30 30 63 - 44
20 Povidon iodin 10 % 30 ml Btl 17 - 17 5 12 - 12 14 - 14 - 12 2 14 7 - - 5
21 Povidon iodin 10 % 300 ml Btl 12 - 12 - 14 - 2 12 4 - 4 - 4 - 4 - - - 12
22 Parasetamol infus 10 mg/ml Btl 4 2 6 - 8 - 2 6 4 2 6 - 6 - 6 - - - 6
23 Ringer laktat (RL) 500 ml Btl 100 60 160 48 112 - 112 58 60 118 - 53 65 118 67 - - 45
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Bayclin Btl - - - - - - - - - - - - - - - - -
2 larutan disenfektan karbol Btl 38 - 38 - - 38 38 11 - 11 - - 11 11 - - - 38

3 Sabun cuci tangan 34 - 34 - - 34 34 - - - - - - - - - - 34
4 Alkohol 1 liter - - - - - - - - - - - - - - - - -
5 antiseptic gel - - - - - - - - - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial - 2 2 - - 2 2 - 2 2 - - 2 2 - - - 2
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 10 - 10 4 6 - 6 - - - - - - - 6 120 120
4 Vaksin BCG Vial 36 - 36 28 8 - 8 20 - 20 - - 20 20 39 840 871
5 Vaksin campak Vial - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
6 Vaksin hepatitis (HBO) Bayi Pouches 37 - 37 32 5 - 5 24 - 24 - - 24 24 45 960 1,000
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 - 10 - 17 - 7 10 - - - - - - - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 12 - 12 1 11 - 11 - - - - - - - 1 30 20
11 Vaksin kombinasi DPT-HB-Hib Vial 98 - 98 66 32 - 32 70 - 70 - - 70 70 92 1,980 2,040
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 22 - 22 16 6 - 6 10 - 10 - - 10 10 22 480 496
13 Vaksin polio t-opv drops 10 dosis Vial 59 - 59 52 7 - 7 40 - 40 - - 40 40 73 1,560 1,626
14 vaksin MR Vial 60 - 60 52 8 - 8 40 - 40 - - 40 40 73 1,560 1,625
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set 390 100 490 390 100 - 100 - 100 100 - 100 - 100 546 - 446
2 Alat suntik sekali pakai 0,5 ml Set 20,358 300 20,658 - - 20,658 20,658 10,000 300 10,300 - - 10,300 10,300 - - - 20,658
3 Alat suntik sekali pakai 1 ml Set 228 - 228 22 210 - 4 206 200 - 200 - 200 - 200 31 - - 175
4 Alat suntik sekali pakai 3 ml Set 328 300 628 207 421 - 421 100 300 400 - 290 110 400 290 - - 131
5 Alat suntik sekali pakai 5 ml Set 440 200 640 264 376 - 376 200 200 400 - 200 200 400 370 - - 6
6 Alat suntik sekali pakai 10 ml Set 4 20 24 2 72 - 50 22 - 20 20 - 70 - 50 20 3 - - 19
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - - - - - - - - - -
8 Alkohol swabs Pcs 9,907 400 10,307 - - 10,307 10,307 - 400 400 - - 400 400 - - - 10,307
9 Antiseptik gel 500 ml Btl 32 10 42 - 1 41 42 44 10 54 - - 54 54 - - - 42
10 Bisturi uk.20 Pcs 14 - 14 1 23 - 10 13 - - - - 10 - 10 - 1 30 18
11 Bisturi uk.21 Pcs 5 - 5 - 7 - 2 5 - - - - - - - - - - 5
12 Blood transfusi set Set 25 10 35 5 30 - 30 20 10 30 - 30 - 30 7 - - 23
13 Cat gut chromic 2/0 Pcs 58 - 58 10 48 - 48 42 - 42 - 38 4 42 14 - - 34

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
14 Cat gut chromic 3/0 Pcs 3 - 3 3 - - - - - - - - - - 4 90 94
15 Cat gut plain 2/0 Sak 68 - 68 38 30 - 30 26 - 26 - 24 2 26 53 - 23
16 Cat gut plain 3/0 Sak 26 - 26 - 59 - 33 26 32 - 32 - 25 7 32 - - - 26
17 Folly catheter No.16 pcs 14 - 14 8 6 - 6 12 - 12 - 2 10 12 11 - 5
18 Folly catheter No.18 pcs 19 - 19 11 8 - 8 3 - 3 - 3 - 3 15 - 7
19 I.V. catheter No.18 pcs 110 - 110 42 68 - 68 50 - 50 - 50 - 50 59 - - 9
20 I.V. catheter No.20 pcs 62 - 62 34 28 - 28 20 - 20 - 20 - 20 48 - 20
21 I.V. catheter No.22 pcs 51 - 51 26 25 - 25 5 - 5 - 15 - 10 5 36 - 11
22 I.V. Catheter No.24 pcs 53 - 53 24 29 - 29 20 - 20 - 20 - 20 34 - 5
23 I.V. Catheter No.26 pcs 9 - 9 9 - - - - - - - - - - 13 270 283
24 Infus set anak pcs 13 - 13 7 6 - 6 - - - - - - - 10 210 214
25 Infus set dewasa pcs 89 - 89 62 27 - 27 10 - 10 - 12 - 2 10 87 - 60
26 Jarum (needle) 23 Pcs 13 - 13 - 15 - 2 13 - - - - 15 - 15 - - - - 13
27 Jarum (needle) 27 Pcs 15 - 15 - 71 - 56 15 - - - - 71 - 71 - - - - 15

28 K.y jelly 82 gram Tube 4 - 4 - 4 - 4 - - - - 4 - 4 - - - - 4
29 Kapas pembalut/absorben 250 gram Bks 7 - 7 4 3 - 3 - - - - - - - 6 120 123
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 - - 20 20 - - - - - - - - - - 20
32 Kasa pembalut hidrofil 4 m x 10 cm Roll 15 - 15 - - 15 15 - - - - - - - - - - 15
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 75 - 75 55 20 - 20 20 - 20 - 20 - 20 77 - 57

34 Kasa kompres 40/40 steril Roll 131 - 131 70 61 - 61 40 - 40 - 50 - 10 40 98 - 37
35 Kasa 40 m x 80 cm Roll 2 - 2 2 - - - 4 - 4 - - 4 4 3 - 3
36 Kasa pembalut 2 m x 80 cm Roll 11 - 11 3 9 - 1 8 4 - 4 - - 4 4 4 - - 4

,Pangkalan Bun,31 Desember 2012
Kotawaringin Barat
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S

37 2012 10 27 - 27 10 - 10 - 10 - 10 14 - - 13
38 Kertas puyer biasa Pack 4 Kotawaringin- Barat 4 - 5 - 1 4 6 - 6 - 2 4 6 - - - 4
40 Kondom Sutra pcs - - - - - - - - - - - - - - - - -

50 4,918 30 26 4,862 4,888 - 50 50 - - 50 50 42 900 - 3,946
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 40 - 40 - 40 - 40 40 - 40 - 40 - 40 - - - 40
43 Penjepit tali pusat Pcs 27 - 27 27 - - - - - - - - - - 38 810 848
44 penghisap lendir pcs 44 - 44 - 18 26 44 20 - 20 - 18 2 20 - - - 44
45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr 1,000 - 1,000 - - 1,000 1,000 1,000 - 1,000 - - 1,000 1,000 - - - 1,000
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr 500 - 500 - - 500 500 500 - 500 - - 500 500 - - - 500
47 Plester 1,25 X 4,5 m Roll - - - - - - - - - - - - - - - - -

,MENGETAHUI
- Kesehatan
- - - - - - - - - - - - - - -
49 Plester bulat/ plesterin pcs 200 400 600 - - 600 600 - 400 400 - - 400 400 - - - 600
50 Plester cannofix pcs 40 - 40 - 60 - 20 40 40 - 40 - 60 - 20 40 - - - 40

- SAKTI,M.Kes
- - - - - - - - - - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll 10 - 10 6 4 - 4 3 - 3 - 3 - 3 8 - 4
53 Safety box Bh 26 10 36 27 9 - 9 23 10 33 - - 33 33 38 - 29
54 Sarung tangan non steril Uk. S Psg 2,133 100 2,233 - - 2,233 2,233 - 100 100 - - 100 100 - - - 2,233
55 Sarung tangan non steril Uk. M Psg 34 - 34 1 - 33 33 - - - - - - - 1 30 - 2
56 Sarung tangan non steril Uk. L Psg 6,794 100 6,894 - - 6,894 6,894 - 100 100 - - 100 100 - - - 6,894
57 Sarung tangan steril ginekologi Psg - - - - - - - 3 - 3 - - 3 3 - - -
58 Sarung tangan steril No.6 Psg - - - - - - - - - - - - - - - - -
59 Sarung tangan steril No.6,5 Psg 53 - 53 - 8 45 53 - - - - - - - - - - 53

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
60 Sarung tangan steril No.7 Psg 3 - 3 - 6 - 3 3 - - - - - - - - - - 3
61 Sarung tangan steril No.7,5 Psg 14 - 14 10 4 - 4 - - - - - - - 14 - 10
62 Sarung Tangan steril no.8 Psg 81 - 81 - 100 - 19 81 29 - 29 - 100 - 71 29 - - - 81
63 Selang oksigen anak Pcs 17 - 17 7 10 - 10 5 - 5 - 9 - 4 5 10 - - 0
64 Selang oksigen bayi Pcs 26 - 26 2 24 - 24 20 - 20 - 24 - 4 20 3 - - 21

65 Selang oksigen dewasa Pcs 7 - 7 6 1 - 1 9 - 9 - - 9 9 8 - 7
66 Sendok kertas puyer Pcs - - - - - - - - - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 40 - 40 - 41 - 1 40 46 - 46 - 36 10 46 - - - 40
68 Silk (benang bedah sutra) No. 3/0 Sak 26 - 26 17 9 - 9 - - - - - - - 24 - 15
69 Speculum Uk S pcs - - - - - - - - - - - - - - - - -
70 Speculum Uk M pcs - - - - 20 - 20 - - - - - 18 - 18 - - - -
71 Speculum Uk L pcs - - - - - - - - - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - - - - - - - - - -
73 Underpads Pcs 44 - 44 15 29 - 29 35 - 35 - 20 15 35 21 - - 8
74 Urin bag Pcs 7 - 7 3 4 - 4 17 - 17 - - 17 17 4 - 0
75 Wing needle no 27 G Pcs 34 - 34 - - 34 34 71 - 71 - - 71 71 - - - 34
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Back pack sprayer Pcs - - - - - - - - - - - - - - - - -
2 Rapid test covid-19 Pcs 125 80 205 - - 205 205 50 80 130 - - 130 130 - - - 205
3 Rapid test antigen Pcs 25 - 25 - - 25 25 - - - - - - - - - - 25
4 Masker KN 95 - - - - - - - - - - - - - - - - -
5 Masker N95 - - - - - - - - - - - - - - - - -
6 Masker Bedah - - - - - - - - - - - - - - - - -
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
7 Kacamata google - - - - - - - - - - - - - - - - -
8 Face shield Nagita 35 - 35 - - 35 35 - - - - - - - - - - 35
9 Face shield naik turun - - - - - - - - - - - - - - - - -
10 Face shield - - - - - - - - - - - - - - - - -
11 Sepatu boot - - - - - - - - - - - - - - - - -
12 Baju Hazmat kain - - - - - - - - - - - - - - - - -
13 Baju Hazmat cuci ulang - - - - - - - - - - - - - - - - -
14 Hand schoon M - - - - - - - - - - - - - - - - -
15 Hand schoon L - - - - - - - - - - - - - - - - -
16 Hand schoon s - - - - - - - - - - - - - - - - -
17 Hand schoon steril no 7,5 - - - - - - - - - - - - - - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - - - - - - - - - - -
19 APD - - - - - - - - - - - - - - - - -
20 APD SET HIJAU - - - - - - - - - - - - - - - - -

21 APD BOHO - - - - - - - - - - - - - - - - -
22 APD LEVEL 2 - - - - - - - - - - - - - - - - -
23 APD LEVEL 3 - - - - - - - - - - - - - - - - -
24 APD PEMDA/DONASI - - - - - - - - - - - - - - - - -
25 APD 1 SET - - - - - - - - - - - - - - - - -
26 GOWN - 20 20 - - 20 20 - 20 20 - - 20 20 - - - 20
27 COOL BOK 6 LITER - - - - - - - - - - - - - - - - -
28 COOL BOK 12,5 LITER - - - - - - - - - - - - - - - - -
BAHAN & ALAT LABORATORIUM - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
1 Asam asetat (Cuka) Btl - - - - - - - - - - - - - - - - -
2 Alat pulmo (peak flow) set 1 - 1 - 1 - 1 - - - - - - - - - - 1
3 Bilik hitung Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
4 Blood lancet Pcs 1,442 - 1,442 462 980 - 980 1,200 - 1,200 - - 1,200 1,200 647 13,860 13,527
5 Bulb pipet Bh 1 - 1 - 1 - 1 - - - - - - - - - - 1
6 Cartrialge genexpert KIT set - - - - - - - - - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - - - - - - - - - -
8 Compresson nebulizer pcs - - - - - - - - - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - - - - - - - - - -
13 Kaca slide/ Kaca objek Set - 216 216 - 4 212 216 - 216 216 - - 216 216 - - - 216
14 KIT diagnostic untuk HIV Pcs - - - - - - - - - - - - - - - - -

15 KIT RPR pcs - - - - - - - - - - - - - - - - -
16 Kotak slide Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
17 Lampu spiritus 150 ml Pcs 1 - 1 - 1 - 1 - - - - - - - - - - 1
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - - - - - - - - - -
20 Medline Pcs - - - - - - - - - - - - - - - - -
21 Microhematokrit tube wax Pcs 1 - 1 - 1 - 1 - - - - - - - - - - 1
22 Mikro tube (Vol 1,5 ml) Pcs 50 - 50 - 50 - 50 - - - - - - - - - - 50
23 Mikroskope cover glasses 18x18 mm Pcs 60 100 160 22 138 - 138 - 100 100 - - 100 100 31 660 553
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
27 Nebulizer Bh - - - - - - - - - - - - - - - - -
28 Peak flow meter Pcs 1 - 1 - 1 - 1 - - - - - - - - - - 1
29 Pen lancet Pcs 7 - 7 - 7 - 7 - - - - - - - - - - 7
30 Pengukur tinggi badan Pcs - - - - - - - - - - - - - - - - -
31 Pipet eritrosit Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
32 Pipet HB Pcs 1 - 1 - 1 - 1 - - - - - - - - - - 1
33 Pipet leukosit Pcs 2 - 2 - 2 - 2 - - - - - - - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - - - - - - - - - -
35 Pipet westergren Bh 1 - 1 - 1 - 1 - - - - - - - - - - 1
36 Pot dahak Pcs 78 60 138 12 126 - 126 - 60 60 - - 60 60 17 360 251
37 Pot urine Pcs - - - - - - - - - - - - - - - - -

38 Rak staenles tes tube Test 1 - 1 - 1 - 1 - - - - - - - - - - 1
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - - - - - - - - - - - - -
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 367 - 367 285 82 - 82 469 - 469 - - 469 469 399 8,550 8,867
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test - - - - - - - - - - - - - - - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test 49 - 49 49 - - - 50 - 50 - - 50 50 69 1,470 1,539

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 146 100 246 72 174 - 174 50 100 150 - - 150 150 101 2,160 2,087
50 Reagen Cell clean Btl - - - - - - - - - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 110 - 110 - 138 - 28 110 50 - 50 - - 50 50 - - - 110
52 Reagen Giemsa Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
53 Reagen Gol Darah Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
54 Reagen Gol darah anti D Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
55 Reagen Immersion Btl 1 - 1 - 1 - 1 - - - - - - - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 2 1 3 1 2 - 2 1 1 2 - - 2 2 1 30 29
58 RPR Sipilis fokus Pcs - 100 100 - - 100 100 - 100 100 - - 100 100 - - - 100
59 Spritus Btl - - - - - - - - - - - - - - - - -
60 Tabung hematokrit heparin Pcs - - - - - - - - - - - - - - - - -

61 Tabung hematokrit non heparin Pcs - - - - - - - - - - - - - - - - -
62 Tabung vacutainer edta warna ungu Pcs 135 - 135 7 128 - 128 - - - - - - - 10 210 92
63 Test asam urat Pcs 224 - 224 25 199 - 199 200 - 200 - - 200 200 35 750 586
64 Test gluco protein urine Pcs 58 - 58 3 55 - 55 3 - 3 - - 3 3 4 - - 51
65 Test iodium Pcs - - - - - - - - - - - - - - - - -
66 Test kehamilan / PP test Test 61 - 61 9 52 - 52 - - - - - - - 13 270 231

67 Test kolestrol Tube 282 - 282 22 260 - 260 - - - - - - - 31 - - 229
68 Test pemeriksaan gula darah Pcs 1,247 200 1,447 - 238 1,209 1,447 1,200 200 1,400 - - 1,400 1,400 - - - 1,447
69 Test pemeriksaan HB Test 49 100 149 20 129 - 129 - 100 100 - - 100 100 28 600 499
JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
70 Test Pemeriksaan Urine 10 Parameter Test 72 - 72 9 63 - 63 - - - - - - - 13 270 220
71 Tipe mikro pipet warna biru Test 425 - 425 2 423 - 423 - - - - - - - 3 60 - 360
72 Tipe mikro pipet warna kuning Test 555 - 555 - 555 - 555 - - - - - - - - - - 555
73 Tipe mikro pipet warna putih Test - - - - - - - - - - - - - - - - -
74 Tisue mikroskop Pcs 1 - 1 - 1 - 1 - - - - - - - - - - 1
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs 50 - 50 - 50 - 50 - - - - - - - - - - 50
77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - - - - - - - - - -
TAMBAHAN - - - - - - - - - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 90 - 90 - - 90 90 90 - 90 - - - - - - - 90
BAHAN GIGI - - - - - - - - - - - - - - - - -
1 Bahan tambahan light curing - - - - - - - - - - - - - - - - -
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - - - - - - - - - -
3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - - - - - - - - - -

4 Bonding resine Btl - - - - - - - - - - - - - - - - -
5 Caviton Btl - - - - - - - - - - - - - - - - -
6 Cellopand strip swenska Pack 1 - 1 - 2 - 1 1 - - - - - - - - - - 1
7 Devitalisasi pasta Btl - - - - - - - - - - - - - - - - -
8 Etil klorida semprot 100 ml Btl - - - - - - - - - - - - - - - - -
9 Etching SDI liquid / Acid ethan liquid Btl - - - - - - - - - - - - - - - - -

10 Eugenol cairan Btl - - - - - - - - - - - - - - - - -
11 Endometason Pcs - - - - - - - - - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 1 - 1 - 1 - 1 - - - - - - - - - - 1

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
13 Fraser / Bentuk silinder Bh 1 - 1 - 1 - 1 - - - - - - - - - - 1
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - - - - - - - - - -
15 Gutta percha poins Ktk - - - - 2 - 2 - - - - - - - - - - -
16 H-file Pcs - - - - - - - - - - - - - - - - -
17 K-file Pcs - - - - - - - - - - - - - - - - -
18 Kalsium hidroksida pasta Ktk - - - - - - - - - - - - - - - - -
19 Kertas artikulasi (articulating paper) Pack 1 - 1 - 2 - 1 1 - - - - - - - - - - 1
20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - - - - - - - - - -
24 Mata bor mikromotor (RA) Pack - - - - - - - - - - - - - - - - -
25 Mata bor white stone Set - - - - 1 - 1 - - - - - - - - - - -
26 Mata bor hand place (FG diamond) Set - - - - - - - - - - - - - - - - -

27 Mata bor tulang / Oral surgery (meisenger) Pcs 5 - 5 - 5 - 5 - - - - - - - - - - 5
28 Needle olyco / Jarum carpule Pcs - - - - - - - - - - - - - - - - -
29 Needle Septoject Pcs 200 - 200 - 200 - 200 - - - - - - - - - - 200
30 Oil spray Btl - - - - - - - - - - - - - - - - -
31 Paper points Ktk 1 - 1 - 2 - 1 1 - - - - - - - - - - 1
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - - - - - - - - - -

33 Komposit resin (solare x) Tube - - - - - - - - - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK
STOCK STOCK JUMLAH
KEBUTUHA
AN (40 %) N
S
36 Siver amalgam (serbuk) Btl - - - - - - - - - - - - - - - - -
37 Solare X A2 Bh - - - - - - - - - - - - - - - - -
38 Solare X A3 Bh - - - - - - - - - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - - - - - - - - - -
UMUM
ASKES JUMLAH
TIDAK
92 167 356 615

Achmad Rois, SKM. M.Kes Nunik Aulia, S.Si.Apt.M.Si dr.Yordan Pradiksa

NIP: 19691104 199203 1 002 NIP: 19810223 200604 2 006 .NIP: 19820121 201001 1 011
JUMLAH JUMLAH
,MENGETAHUI/MENYETUJUI Yang Menerima/Melapor STOCK

PENERIMA ,PERSEDIAA
Yang Menyerahkan STOCK STOCK JUMLAH
STOCK PEMAKAIA KESELURUH STOK AWAL PENERIMA PERSEDIAA PENGELUAR GUDANG OPTIMUM WAKTU
NO OBATDinas
Kepala DAN PERBEKKES
Kesehatan SATUAN ANKepala UPTD Pimpinan Puskesmas KEBUTUHA
AWAL N Instalasi
N Farmasi AN AN N AN PUSKESMA (40 %) KOSONG N
S

NIP: 19691104 199203 1 002 NIP: 19810223 200604 2 006 .NIP: 19820121 201001 1 011
LAPORAN
: APRIL
: 2021
PERMINTAA
N ALASAN SUMBER ALASAN
PUSKESMAS
APBN HIBAH ED
Sep-2021
Jan-2022
Jan-2022
Nov-2023
Feb-2022
1,000
Jul-2022
300
PERMINTAA
PUSKESMAS
APBN HIBAH ED
Nov-2023
Aug-2021
1,000
Dec-2021
Jul-2022
Jul-2022
Feb-2023
Jan-2023
100
May-2023
Jul-2022
Mar-2022
500
PERMINTAA
PUSKESMAS
APBN HIBAH ED
1,000 May-2021
Feb-2023
Sep-2021
Jul-2021
800
Jun-2023
Sep-2023
Dec-2021
Mar-2022
PERMINTAA
PUSKESMAS
APBN HIBAH ED
May-2022
Apr-2022
1,000
Feb-2022
Aug-2024
300
1,000
Apr-2023
Oct-2022
PERMINTAA
PUSKESMAS
APBN HIBAH ED
Sep-2024
500
1,200
Feb-2023
500
1,000
PERMINTAA
PUSKESMAS
APBN HIBAH ED
100
500
2,000
300
PERMINTAA
PUSKESMAS
APBN HIBAH ED
300
PERMINTAA
PUSKESMAS
APBN HIBAH ED
10
30
PERMINTAA
PUSKESMAS
APBN HIBAH ED
50
20
PERMINTAA
PUSKESMAS
APBN HIBAH ED
25
25
25
5
PERMINTAA
PUSKESMAS
APBN HIBAH ED
200
100
60
50
100
PERMINTAA
PUSKESMAS
APBN HIBAH ED
50
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
50
25
10
10
20
10
25
50
50
30
30
4
PERMINTAA
PUSKESMAS
APBN HIBAH ED
50
15
PERMINTAA
PUSKESMAS
APBN HIBAH ED
50
10
25
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
PERMINTAA
PUSKESMAS
APBN HIBAH ED
Petugas Puskesmas

..NIP: 19870406 201101 1 004
PERMINTAA
N ALASAN Petugas Puskesmas
SUMBER ALASAN
PUSKESMAS
APBN HIBAH ED

..NIP: 19870406 201101 1 004
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
3 Ambroksol 30 mg Tab 0 0 10 0 10 0 10 0 21 0 0 40 30 0 10 0 0 0 0 3 11 10 10 0 0 10 10 10
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 10 0 0 0 20 0 0 20 0 0 0 0 0 30 40 30 0 0 10 0 0
7 Amlodipin 10 mg Tab 10 0 30 0 0 0 0 0 0 0 0 0 40 0 0 0 0 0 10 0 0 10 10 30 0 0 10 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 10 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 20 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 5 0 0 0 10 0 0 0 0 20 0 10 0 0 20 10 0 0 0 10 20 0 0 0 0 10 10 0


53 Kaptopril 12,5 mg Tab 0 0 300 0 0 40 0 0 30 0 0 40 60 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 60 20 0 0 10 20 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 10 0 20 0 0 0 3 10 0 20 20 0 10 0 0 0 0 10 0 12 20 0 0 0 0 0


82 Metformin 500 mg Tab 0 0 60 0 30 40 0 0 0 0 0 0 30 0 0 0 0 0 0 20 70 0 20 0 0 300 30 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 20 0 0 10 0 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 10 10 0 10 0 12 0 20 0 6 0 0 0 0 0 25 23 0 0 20 0 0 0 10
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 12 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 5 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MENGETA
,HUI
34 Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 30 31 TOTAL
0 0 0 11
0 0 0 20
10 20 0 225
0 0 0 0
0 0 9 11
0 90 231 481
70 110 0 330
0 0 0 20
0 30 0 70
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 0 17 227
0 0 0 0
0 0 0 0
0 10 40 70
0 10 0 23
0 0 0 0
0 0 350 350
0 0 0 0
0 0 0 0
0 0 0 40
0 0 65 295
0 0 0 0
0 0 0 0
0 30 0 250
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 5 173
0 0 65 65
0 0 0 0
0 0 0 0
0 10 1 41
0 6 0 16
0 0 0 56
30 0 115 540
0 0 0 50
0 0 510 522
0 0 40 50
0 0 0 0
0 0 0 0
0 0 0 30
0 0 0 10
0 0 0 0
0 30 48 203
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 0
0 0 0 0
0 0 0 470
10 30 0 170
0 0 0 0
6 0 44 80
29 30 31 TOTAL
0 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 669 802
0 0 0 0
0 0 0 0
0 0 0 0
0 0 100 100
0 0 0 0
10 10 10 30
0 0 0 0
0 0 0 0
0 0 350 350
0 0 0 0
0 6 0 36
0 0 0 135
0 0 0 0
0 0 2 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 10
0 0 0 30
0 0 40 640
0 0 50 50
20 10 0 310
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 80
0 0 0 0
0 0 0 0
0 0 0 0
0 60 213 973
0 0 0 0
20 0 150 536
0 0 0 0
0 0 0 10
0 0 0 0
0 0 50 50
0 0 380 380
0 0 0 0
0 0 2 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 40 350 955
0 0 0 13
20 0 0 693
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 70 160
0 0 0 45
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 10 210 460
0 0 0 30
0 0 0 0
0 0 0 0
20 0 320 370
0 0 30 107
0 0 0 33
30 20 82 315
0 0 0 0
20 10 345 521
0 0 0 0
0 0 0 0
10 0 485 756
0 0 30 80
0 0 0 0
0 0 0 370
0 0 0 0
30 0 0 90
0 0 0 0
0 0 309 309
0 0 757 757
0 0 110 315
0 0 0 155
10 0 0 436
0 0 0 10
0 0 360 360
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 1,000 1,000
0 0 750 750
0 0 0 0
0 0 120 120
0 0 570 570
0 0 0 0
0 0 0 1
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 7
0 0 0 0
0 0 0 3
0 0 0 1
0 0 0 0
0 0 0 0
MARIYANI
0 0 0 0 NIP: 19750812 200003 2 003
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 38 51
29 30 31 TOTAL
0 0 0 15
0 0 0 0
0 0 0 0
0 0 79 88
0 0 0 0
0 0 0 0
0 0 0 10
0 0 4 7
0 0 0 6
0 0 0 0
0 0 0 0
0 0 5 7
0 0 3 5
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 44
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 4 4
0 0 0 0
0 0 0 0
0 0 0 0
1 0 5 6
0 0 0 0
0 0 0 1
0 0 0 0
0 0 13 13
0 0 10 10
0 0 5 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 14 14
0 0 0 0
0 0 0 0
0 0 0 0
0 2 0 3
0 0 0 5
29 30 31 TOTAL
0 0 0 0
0 0 9 11
0 5 62 80
0 0 0 0
0 0 14 14
0 0 0 8
0 1 39 45
0 0 0 0
0 0 0 0
0 0 22 23
0 0 2 4
1 0 0 3
0 0 0 0
0 0 0 0
0 0 2 3
0 0 0 7
0 0 0 0
1 0 48 51
0 0 19 24
0 2 39 44
0 3 19 25
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 6 6
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 41 45
0 0 5 5
0 0 0 0
0 0 0 0
0 0 44 48
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 4 4
0 0 28 28
0 0 0 0
0 0 32 32
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 1
0 0 66 66
0 0 16 16
0 0 52 52
0 0 52 52
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 23
0 0 0 0
0 0 390 390
0 0 0 0
0 0 0 19
0 0 172 197
0 0 257 262
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 5 5
0 0 10 10
0 0 1 1
0 0 38 38
0 0 0 0
0 0 8 8
0 0 11 11
0 0 41 42
0 0 31 32
0 0 18 24
0 0 15 23
0 0 3 9
0 0 6 7
0 0 54 59
0 0 0 0
0 0 0 0
0 0 0 0
0 0 4 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 55 55
0 0 70 70
0 0 0 2
0 0 0 0

SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0 0 0
0 0 0 0
NIP: 19750508 199903 1 002
0 0 0 0
0 0 27 27
0 0 26 26
0 0 0 0
0 0 0 0
0 0 0 0
,MENGETAHUI
0 0 0 0
0 0 0 0
NIP: 19610521 199303 1 004
0 0 5 5
0 0 27 27
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 5 5
0 0 0 0
0 0 7 7
0 0 2 2
0 0 6 6
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 12 17
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 15 15
0 0 3 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 462 462
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 22 22
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 12 12
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 285 285
0 0 0 0
0 0 0 0
0 0 49 49
0 0 0 0
0 0 72 72
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 7 7
0 0 25 25
0 0 3 3
0 0 0 0
0 0 9 9
0 0 22 22
0 0 0 0
0 0 20 20
0 0 9 9
0 0 2 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
7 Amlodipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200

32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
34 Furosemid 40 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300


51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50


82 Metformin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50


107 Parasetamol 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,500

109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10
33 MENGETA
,HUI
Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 0
0 0
0 50
0 0
0 0
0 100
0 400
0 0
0 150
0 0
0 0
0 0
0 0
0 700
0 0
0 0
0 0
0 50
0 0
0 350
0 0
0 0
0 0
0 100
0 0
0 0
0 100
31 TOTAL
0 0
0 0
0 100
0 200
0 100
0 0
0 0
0 0
0 0
0 550
0 0
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 300
0 100
0 0
0 0
0 0
0 0
0 0
0 200
0 0
0 0
0 50
31 TOTAL
0 0
0 0
0 0
0 0
0 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 350
0 0
0 0
0 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 500
0 50
0 400
0 0
31 TOTAL
0 0
0 50
0 0
0 0
0 0
0 500
0 0
0 550
0 0
0 0
0 0
0 50
0 380
0 0
0 3
0 0
0 0
0 0
0 0
0 540
0 48
0 1,500
0 0
0 0
0 0
0 0
0 150
0 0
0 0
31 TOTAL
0 0
0 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 400
0 0
0 0
0 200
0 150
0 0
0 150
0 0
0 0
0 0
0 350
0 750
0 100
0 0
0 200
0 0
0 150
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 20
0 0
0 10
0 0
0 0
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 0
0 0
0 0
0 102
31 TOTAL
0 0
0 0
0 0
0 100
0 30
0 30
0 0
0 60
0 10
0 0
0 0
0 10
0 10
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 30
0 0
0 0
0 100
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 5
0 0
0 0
0 0
0 5
0 0
0 0
0 10
0 16
0 0
0 5
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 10
0 81
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0
0 0
NIP: 19750508 199903 1 002
0 0
0 0
0 0
0 0
0 0
0 0
,MENGETAHUI
0 0
0 0
NIP: 19610521 199303 1 004
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
PUSKESMAS : PANDU SENJAYA BULAN MEI
KECAMATAN : PANGKALAN LADA TAHUN 2021
STOCK STOCK STOCK

WAKTU JUMLAH PERMINTAAN
NO OBAT DAN PERBEKKES SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN KESELURUHA GUDANG OPTIMUM KOSONG KEBUTUHAN PUSKESMAS ALASAN SUMBER ALASAN
N PUSKESMAS (40 %)
APBN HIBAH ED
TABLET
1 Albendazol 400 mg Tab 180 - 180 82 98 - 115 6 23 Sep-2021
2 Alopurinol 100 mg Tab 295 - 295 30 265 - 42 900 677
3 Ambroksol 30 mg Tab 1,498 - 1,498 475 1,023 650 665 - - 358 Jan-2022
4 Aminofilin 200 mg Tab - - - - - - - - -

5 Amitriptilin 25 mg Tab 61 - 61 61 - - 85 1,830 1,915 -
6 Amlodipin 5 mg Tab 844 - 844 80 764 200 112 - - 652 Jan-2022
7 Amlodipin 10 mg Tab 859 - 859 265 594 200 371 - - 223 Nov-2023
8 Amoksisilin 250 mg Tab - - - - - - - - -
9 Amoksisilin 500 mg Tab 1,888 - 1,888 337 1,551 1,100 472 - - 1,079 Feb-2022
10 Ampicilin 500 mg Tab - - - - - - - - -

11 Antasida kombinasi Tab - - - - - - - - - 2,000
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - -
13 Asam asetilsalisilat (asetosal) 80 mg Tab 100 - 100 - 100 - - - - 100
14 Asam mefenamat 500 mg Tab 1,662 - 1,662 260 1,402 400 364 - - 1,038 Jul-2022
15 Asam traneksamat 500 mg Tab - - - - - - - - - 300

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
16 Asiklovir 200 mg Tab - - - - - - - - -
17 Asiklovir 400 mg Tab 491 - 491 136 355 100 190 - - 165 Nov-2023
18 Atapulgit 630 mg Tab 854 - 854 47 807 - 66 3 - 738 Aug-2021
19 Atropin 0,5 mg Tab - - - - - - - - -
20 Azitromisin 500 mg Tab - 200 200 200 - - 280 6,000 6,280
21 Asam folat 1 mg Tab - - - - - - - - - 1,000
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - -
23 Betahistin 6 mg Tab 334 - 334 20 314 - 28 1 - 285 Dec-2021
24 Deksametason 0,5 mg Tab 1,908 - 1,908 280 1,628 900 392 - - 1,236 Jul-2022
25 Digoksin 0,25 mg Tab 490 - 490 10 480 100 14 50 - 416 Jul-2022
26 Dimenhidrinat 50 mg Tab 828 - 828 20 808 300 28 - - 780 Feb-2023
27 Domperidon 10 mg Tab 495 - 495 293 202 - 410 8,790 8,998 2,000 Jan-2023
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - -

30 Eritromisin 500 mg Tab 227 - 227 104 123 - 146 3,120 3,143 100
31 Fenitoin 30 mg Kaps 200 - 200 100 100 - 140 3,000 3,040
32 Fenitoin 100 mg Kaps 100 - 100 - 100 - - - - 100
33 Flukonazol 150 mg Tab - - - - - - - - -
34 Furosemid 40 mg Tab 486 - 486 77 409 100 108 - - 301 May-2023
35 Garam oralit kombinasi Sak 446 - 446 26 420 200 36 - - 384 Jul-2022
36 Gemfibrozil 300 mg Kaps 544 - 544 - 544 120 - - - 544 Mar-2022
37 Glibenklamid 5 mg Tab 2,775 - 2,775 600 2,175 1,450 840 - - 1,335
38 Glimepirid 2 mg Tab 83 - 83 50 33 - 70 1,500 1,537 1,000

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab - - - - - - - - - 1,000 May-2021
40 Griseofulvin (micronized) 125 mg Tab 630 - 630 - 630 - - - - 630
41 Haloperidol 1,5 mg Tab - - - - - - - - -
42 Haloperidol 2 mg Tab - - - - - - - - -
43 Haloperidol 5 mg Tab 330 - 330 330 - - 462 9,900 10,362
44 Hiosina butilbromida 10 mg Tab 480 - 480 200 280 200 280 - - Feb-2023
45 Ibuprofen 200 mg Tab - - - - - - - - -
46 Ibuprofen 400 mg Tab 2,242 - 2,242 260 1,982 1,500 364 - - 1,618 Sep-2021
47 Isosorbid dinitrat 5 mg Tab 307 - 307 30 277 - 42 2 - 233 Jul-2021
48 Isoniazid oral 100 mg Tab - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - -
50 Kalsium laktat (kalk) 500 mg Tab - - - - - - - - - 1,000
51 Kandesartan 8 mg - - - - - - - - - 1,000
52 Kandesartan 16 mg Tab - - - - - - - - - 2,000

53 Kaptopril 12,5 mg Tab 3,083 - 3,083 183 2,900 2,800 256 - - 2,644
54 Kaptopril 25 mg Tab 3,851 - 3,851 220 3,631 2,600 308 - - 3,323
55 Karbamazepin 200 mg Tab 200 - 200 - 200 - - - - 200
56 Ketokonazol 200 mg Tab 558 - 558 86 472 50 120 - - 352 Jun-2023
57 Ketoprofen 100 mg Tab 500 - 500 - 500 - - - - 500 Sep-2023
58 Klindamisin 150 mg kaps - - - - - - - - -

59 Klindamisin 300 mg Kaps - - - - - - - - -
60 Kloramfenikol 500 mg Kaps 454 - 454 - 454 100 - - - 454 Dec-2021
61 Klorfeniramin maleat (ctm) 4 mg Tab 2,040 - 2,040 152 1,888 1,650 213 - - 1,675 Mar-2022
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
62 Klorpromazin hcl 25 mg Tab - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 13 - 13 10 3 - 14 300 311
64 Klozapin 25 mg Tab 78 - 78 10 68 - 14 300 246
65 Klozapin 100 mg Tab 69 - 69 - 69 - - - - 69
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - -
67 Kotrimoksazol (dewasa) 480 mg Tab 640 - 640 10 630 100 14 - - 616 May-2022
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 850 - 850 20 830 100 28 - - 802 Apr-2022
69 Kuinin 222 mg Tab - - - - - - - - -
70 Lanzoprazol 30 mg Kaps - - - - - - - - - -
71 Levotiroksin 50 mµ Tab - - - - - - - - -
72 Levofloksasin 500 mg Tab 398 - 398 124 274 100 174 620 520 Feb-2022
73 Loratadin 10 mg Tab 927 - 927 110 817 350 154 - - 663 Aug-2024
74 MDT FB anak (obat kusta) Pkt - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - -

76 MDT MB anak (obat kusta) Pkt - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - -
78 Mebendazol 100 mg Tab - - - - - - - - -
79 Meloksikam 7,5 mg Tab - - - - - - - - - 1,000
80 Meloksikam 15 mg Tab 14 - 14 - 14 - - - - 14 1,000
81 Metamizol (antalgin) 500 mg Tab 450 - 450 10 440 - 14 300 - 126 1,000
82 Metformin 500 mg Tab 1,960 - 1,960 230 1,730 1,700 322 - - 1,408
83 Metilergometrin 0,125 mg Tab 360 - 360 - 360 250 - - - 360 Apr-2023
84 Metilprednisolon 4 mg Tab 1,627 - 1,627 282 1,345 600 395 - - 950 Oct-2022
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
85 Metilprednisolon 8 mg Tab - - - - - - - - -
86 Metronidazol 250 mg Tab - - - - - - - - -
87 Metronidazol 500 mg Tab 1,093 - 1,093 75 1,018 450 105 - - 913 Sep-2024
88 Mineral Mix Sak - - - - - - - - -
89 Multivitamin ibu hamil (Gestiamin) Tab 120 - 120 40 80 - 56 1,200 1,176 1,000
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - - -
91 Multivitamin lansia (pehavral) Tab 200 1,200 1,400 330 1,070 1,000 462 - - 608
92 Natrium bikarbonat 500 mg Tab - - - - - - - - -
93 Natrium diklofenak 25 mg Tab 1,973 - 1,973 241 1,732 1,650 337 - - 1,395 Feb-2023
94 Natrium diklofenak 50 mg Tab - - - - - - - - -
95 Nifedipin 10 mg Tab 35 - 35 - 35 - - - - 35
96 Nifedipin 20 mg Tab 240 - 240 - 240 - - - - 240
97 Nistatin 500.000 IU Tab 330 - 330 216 114 - 302 6,480 6,668
98 N-asetil sistein 200 mg kaps - 300 300 300 - - 420 9,000 9,420 500
99 OAT Kategori Anak Pkt - - - - - - - - -
100 OAT Kategori I Pkt 1 - 1 - 1 - - - - 1
101 OAT Kategori II Pkt - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - -
103 Ofloksasin 200 mg Tab 280 - 280 - 280 - - - - 280
104 Ofloksasin 400 mg Tab - - - - - - - - -

105 Omeprazol 20 mg Kaps 300 - 300 300 - - 420 9,000 9,420 2,000
106 Ondansetron 4 mg Tab 368 - 368 65 303 72 91 - - 212
107 Parasetamol 500 mg Tab 3,884 - 3,884 842 3,042 1,200 1,179 - - 1,863
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
108 Pirantel pamoat 125 mg Tab 99 - 99 4 95 100 6 - - 89
109 Pirasetam 400 mg Tab - - - - - - - - -
110 Pirasetam 1200 mg Tab - - - - - - - - -
111 Piroksikam 10 mg Tab - - - - - - - - -
112 Piroksikam 20 mg Tab 1,031 - 1,031 90 941 350 126 - - 815
113 Prednison 5 mg Tab 1,510 - 1,510 20 1,490 900 28 - - 1,462
114 Primakuin 15 mg Tab 10 - 10 - 10 10 - - - 10
115 Propiltiourasil 100 mg Tab 200 - 200 30 170 - 42 900 772
116 Propranolol 10 mg Tab 500 100 600 80 520 400 112 3 - 405
117 Propranolol 40 mg Tab 10 - 10 10 - - 14 300 314 300
118 Ranitidin 150 mg Tab - - - - - - - - -
119 Risperidon 1 mg Tab - - - - - - - - -
120 Risperidon 2 mg Tab - - - - - - - - -
121 Salbutamol 2 mg Tab 1,381 - 1,381 231 1,150 500 323 - - 827
122 Salbutamol 4 mg Tab 1,199 - 1,199 10 1,189 500 14 - - 1,175
123 Sefadroksil 500 mg Kaps 370 - 370 132 238 - 185 3,960 3,907 2,000
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - -
125 Setirizin 10 mg Tab 1,567 - 1,567 601 966 500 841 - - 125
126 Simetidin 200 mg Tab - - - - - - - - -
127 Simvastatin 10 mg Tab - - - - - - - - - 1,000

128 Simvastatin 20 mg Tab 839 500 1,339 554 785 200 776 - - 9 300
129 Siprofloksasin 500 mg Tab 1,150 - 1,150 120 1,030 650 168 - - 862
130 Spironolakton 25 mg Tab - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
131 Tambah darah kombinasi (fe dan asam folat) Tab 870 - 870 265 605 210 371 - - 234
132 Trifluoperazin 5 mg Tab - - - - - - - - -
133 Triheksifenidil 2 mg Tab 277 - 277 277 - - 388 8,310 8,698
134 Triheksifenidil 5 mg Tab - - - - - - - - -
135 Vitamin A 100.000 IU (retinol) Biru Kaps 50 - 50 - 50 - - - - 50
136 Vitamin A 200.000 IU (retinol) Merah kaps 271 - 271 156 115 - 218 4,680 4,783
137 Vitamin B 1 (tiamin) 50 mg Tab 1,902 - 1,902 145 1,757 1,600 203 - - 1,554
138 Vitamin B 6 (piridoksin) 10 mg Tab 1,046 - 1,046 160 886 500 224 - - 662
139 Vitamin B kompleks Tab 1,221 - 1,221 240 981 600 336 - - 645
140 Vitamin C (asam askorbat) 50 mg Tab 78 - 78 78 - - 109 2,340 2,449 2,000
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 650 - 650 100 550 500 140 500 90
142 Vitamin Hepagard Tab 335 - 335 61 274 210 85 - - 189
143 Zinc tablet dispersibel 20 mg Tab 80 360 440 360 80 - 504 10,800 11,224 2,000
TAMBAHAN - - - - - - - - -
1 Becefort - 200 200 200 - - 280 6,000 6,280
2 Imbos forte - 360 360 360 - - 504 10,800 11,304
3 Livron B Plex - - - - - - - - -
4 Multivitamin (Sivit - Zink) Bh - - - - - - - - -
5 Oseltamivir 75 mg Bh - 40 40 40 - - 56 1,200 1,256

INJEKSI - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial - - - - - - - - -
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 10 - 10 - 10 - - - - 10
3 Aminofilin 24 mg/ml Amp 35 - 35 1 34 20 1 - - 33

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 3 - 3 - 3 - - - - 3
5 Antrain Inj Amp - - - - - - - - -
6 Artemether 80 mg/ml Amp - - - - - - - - -
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - -
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp 3 10 13 - 13 - - - - 13
10 Atropin 0,25 mg/ml Amp 40 - 40 - 40 40 - - - 40
11 Deksametason 5 mg/ml Amp 97 - 97 17 80 50 24 - - 56
12 Difenhidramin hcl 10 mg/ml Amp 71 - 71 12 59 - 17 4 - 39

10 Evaluasi dan
- Perencanaan
10 - 10 - - - - 10
14 Furosemid 10 mg/ml Amp 25 - 25 3 22 - 4 10 - 8
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - -

MARIYANI
- 19750812 200003
- 2 003- - - - - - -
17 Haloperidol 5 mg/ml Amp - - - - - - - - -

18 Haloperidol 50 mg/ml Amp - - - - - - - - -
19 Kalsium glukonat 10 % Amp 30 - 30 - 30 20 - - - 30
20 Ketorolak 30 mg/ml Amp 50 - 50 18 32 - 25 540 533
21 Klorpromazin 25 mg/ml Amp - - - - - - - - -
22 Lidokain 2 % Amp 237 - 237 25 212 98 35 - - 177
23 Lidokain kompositum Amp 34 - 34 4 30 30 6 - - 24

24 Magnesium sulfat 20 % (i.v.) Btl 30 - 30 - 30 10 - - - 30
25 Magnesium sulfat 40 % (i.v.) Btl 10 - 10 - 10 - - - - 10
26 Metamizol (antalgin) 500 mg/2 ml Amp 93 - 93 79 14 - 111 16 112 100

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
27 Metilergometrin 0.2 mg/ml Amp 30 - 30 - 30 - - - - 30
28 Oksitosin 10 iu/ml Amp 30 - 30 20 10 - 28 600 618 200
29 Omeprazole 40 mg/ml Amp 11 - 11 2 9 - 3 60 54 50
30 Ondansetron 4 mg/2 ml Amp 160 - 160 147 13 - 206 16 209 200
31 Piracetam 1 gr Amp 33 - 33 5 28 - 7 1 - 20

MENGETA - ,MENGETAHUI
,MENGETAHUI
- - - -
,HUI,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
KepalaDinas
- Kabupaten
Kabupaten - Kotawaringin
-
Kotawaringin - -
,HUI Dinas
Kesehatan Barat
Barat
Sefotaksim Vial 22 - 22 22 Kabupaten-
Kesehatan - 31 72 103 50
Dinas Kotawaringin
Kabupate
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 23 - 23 23 Barat
n - - 32 76 108 50
Kabupate Kotawarin
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 118 - 118 - gin Barat118 - - - - 118
drg.INDRAWAN
gin Barat Amp 100 - 100 - 100 -
SAKTI,MKes
SAKTI,MKes - - - 100
NIP:
NIP:19610521
19610521199303
19930311
38 Vitamin B 1 (tiamin) 100 mg /ml Amp - - - - drg.INDRAW - -004
004 - - -
AN
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 10 - 10 1 drg.INDRA
SAKTI,MKes 9 - 1 30 22 20
WAN
NIP:
TAMBAHAN
drg.INDRA - - - - 19610521-
SAKTI,MK - - - -
WAN 199303
es 1
SAKTI,MK 100 - 100 50 004 50
NIP: 50 70 - 20 20
es 19610521
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 199303 1 - - - - -
19610521 004
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - 10
004
2 Diazepam (Stesolid) enema 10 mg/2,5 ml Tube - - - - - - - - - 10
3 Diazepam 2 mg Tab 100 - 100 2 98 - 3 60 - 35
4 Diazepam 5 mg Tab 219 - 219 - 219 - - - - 219

5 Diazepam 5 mg/ml (i.v.) Amp 40 - 40 - 40 - - - - 40
6 Fenobarbital 50 mg/ml Amp 30 - 30 - 30 - - - - 30
7 Fenobarbital 30 mg Tab 100 - 100 - 100 - - - - 100

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
8 Kodein 10 mg Tab 100 - 100 - 100 - - - - 100
9 Klobazam 10 mg Tab - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - -
1 Antifungi kombinasi Tube 10 - 10 - 10 - - - - 10
2 Antihemoroid kombinasi Supp 10 - 10 10 - - 14 300 314
3 Asiklovir 5% Krim Tube 58 - 58 4 54 - 6 0 - 48
4 Basitrasin - polimiksin B Tube 19 - 19 - 19 - - - - 19 25
5 Bedak salisil 2% Ktk - - - - - - - - -
6 Betametason 0,1% krim Tube 67 - 67 9 58 35 13 - - 45
7 Bioplacenton krim Tube - - - - - - - - -
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 25 - 25 - 25 - - - - 25
10 Desoksimetason 0,25 % krim Tube 20 - 20 2 18 - 3 0 - 15
11 Gentamisin salep kulit Tube 11 30 41 12 29 20 17 - - 12 25

12 Gentamisin salep mata Tube 65 - 65 - 65 24 - - - 65
13 Hidrokortison 2,5% krim Tube 50 - 50 5 45 14 7 - - 38
14 Ketokonazol 2 % krim Tube 14 - 14 1 13 - 1 30 18 25
15 Ketoprofen 100 mg Supp 10 - 10 - 10 10 - - - 10
16 Kloramfenikol 1% salep mata Tube 58 - 58 1 57 19 1 - - 56
17 kloramfenikol 3% salep kulit Tube 11 - 11 5 6 - 7 150 151 50

18 Mikonazol 2 % krim Tube 59 - 59 2 57 14 3 - - 54
19 metronidazol ovula 500 mg ovul 40 - 40 - 40 - - - - 40
20 Nistatin 100.000 IU Supp 37 - 37 - 37 42 - - - 37

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
21 Oksitetrasiklin salep kulit Tube 15 - 15 - 15 - - - - 15

22 Oksitetrasiklin salep mata Tube 101 - 101 29 72 - 41 2 - 29
23 povidon iodin / betadine salep Tube 10 - 10 - 10 - - - - 10
24 Salep 2-4 kombinasi krim Tube 18 - 18 1 17 14 1 - - 16
25 Sulfadiazine 10 Mg Salep Tube 25 - 25 2 23 13 3 - - 20
SIRUP - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 82 - 82 4 78 50 6 - - 72
3 ambroxol sirup 30 mg/5 ml Btl 73 - 73 3 70 60 4 - - 66
4 Amoksisilin sirup kering 125 mg/5 ml Btl 19 - 19 4 15 - 6 120 111 100
5 Amoksisilin sirup kering 250 mg/5 ml Btl 77 - 77 7 70 67 10 - - 60
6 Antasida susp Btl 54 - 54 29 25 - 41 870 886 300
7 Caviflex sirup Btl - - - - - - - - -
8 Dextrofen sirup Btl 52 - 52 1 51 10 1 - - 50
9 Domperidon sirup 5 mg/5 ml Btl 130 - 130 2 128 78 3 - - 125
10 Ibuprofen sups 100 mg / 5 ml Btl 54 - 54 1 53 55 1 - - 52
11 Ibuprofen sups 200 mg / 5 ml Btl - - - - - - - - -
12 Kloramfenikol susp 125 mg/5 ml Btl 32 - 32 - 32 - - - - 32
13 Kotrimoksazol susp 240 mg/5 ml Btl 87 - 87 - 87 60 - - - 87
14 Laktulosa 3,335 g/5 ml Btl 11 - 11 2 9 - 3 60 54 50
15 Metronidazol susp 125 mg/5 mL Btl 20 - 20 1 19 - 1 30 12 12
16 Nistatin drop 100.000 IU/ml Btl 12 - 12 - 12 - - - - 12
17 Obat batuk hitam (OBH) sirup Btl 23 - 23 2 21 - 3 60 42 50
18 Parasetamol drops 100 mg/ml Btl 149 - 149 9 140 95 13 - - 127

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
19 Parasetamol sirup 120 mg/5 ml Btl 115 - 115 14 101 13 20 - - 81
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - -
21 Procuma sirup Btl 133 - 133 13 120 - 18 1 - 101
22 Sefadroksil sirup kering 125 mg/5 ml Btl 72 - 72 50 22 25 70 - 48 50
23 sefadroxil sirup kering 250 mg /forte Btl 41 50 91 4 87 35 6 - - 81 50
24 setirizin 5mg / 5 ml Btl 124 - 124 9 115 84 13 - - 102
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - -
26 Zink sirup 20mg/ 5ml Btl 48 - 48 5 43 14 7 - - 36
TAMBAHAN - - - - - - - - -
1 Becefort syrup - - - - - - - - -
2 Imbos Syrup - 2 2 2 - - 3 60 63
LARUTAN - - - - - - - - -
1 Alkazyme Bks 25 - 25 - 25 25 - - - 25
2 Alkacide btl 1 - 1 - 1 1 - - - 1
3 Bromhexin (Bisolvon) Btl 1 - 1 1 - - 1 30 31
4 Etanol 70 % 1000 ml Btl 64 - 64 10 54 - 14 300 260

5 Etakridinn laktat 0,1% (rivanol) Btl 5 - 5 - 5 - - - - 5
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - -
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - -
8 Gentamisin 0,3 % tetes mata Btl 40 - 40 31 9 - 43 124 158 50
9 Gentian violet 1 % Btl 53 - 53 1 52 13 1 - - 51
10 Glukosa 10 % (D.10) 500 ml Btl 9 - 9 - 9 - - - - 9
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 25 - 25 1 24 10 1 - - 23

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
13 KA-EN 1 B 500 ml Btl 16 - 16 - 16 - - - - 16
14 KA-EN 3 B 500 ml Btl 30 - 30 10 20 8 14 - - 6
15 kloramfenikol Tetes mata Btl - - - - - - - - -
16 Kloramfenikol 3% tetes telinga Btl - - - - - - - - -
17 Lysol 1 liter Btl 1 - 1 - 1 - - - - 1
18 Metronidazol infus 5 mg/ml Btl 3 - 3 - 3 2 - - - 3
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 19 - 19 9 10 - 13 270 273 200
20 Povidon iodin 10 % 30 ml Btl 12 - 12 - 12 6 - - - 12
21 Povidon iodin 10 % 300 ml Btl 12 - 12 - 12 4 - - - 12
22 Parasetamol infus 10 mg/ml Btl 6 - 6 - 6 6 - - - 6
23 Ringer laktat (RL) 500 ml Btl 112 - 112 84 28 15 118 - 90 90
TAMBAHAN - - - - - - - - -
1 Bayclin Btl - - - - - - - - -
2 larutan disenfektan karbol Btl 38 - 38 10 28 - 14 300 286

3 Sabun cuci tangan 34 - 34 27 7 - 38 810 841
4 Alkohol 1 liter - - - - - - - - -
5 antiseptic gel - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial 2 - 2 - 2 - - - - 2
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 6 - 6 - 6 - - - - 6
4 Vaksin BCG Vial 8 7 15 11 4 - 15 330 341
5 Vaksin campak Vial - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
6 Vaksin hepatitis (HBO) Bayi Pouches 5 10 15 10 5 - 14 300 309
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 - 10 - 10 - - - - 10
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 11 - 11 - 11 - - - - 11
11 Vaksin kombinasi DPT-HB-Hib Vial 32 10 42 15 27 - 21 450 444
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 6 - 6 5 1 - 7 150 156
13 Vaksin polio t-opv drops 10 dosis Vial 7 10 17 11 6 - 15 330 339
14 vaksin MR Vial 8 - 8 10 - 2 - 14 300 316
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set 100 - 100 9 91 100 13 - - 78
2 Alat suntik sekali pakai 0,5 ml Set 20,658 200 20,858 11,094 9,764 - 15,532 332,820 338,588
6 Alat suntik sekali pakai 10 ml Set 22 - 22 6 16 - 8 - - 8
7 Alat suntik sekali pakai 15 ml Set - - - - - - - - -
8 Alkohol swabs Pcs 10,307 - 10,307 409 9,898 - 573 12,270 2,945
9 Antiseptik gel 500 ml Btl 42 - 42 41 1 - 57 1,230 1,286
10 Bisturi uk.20 Pcs 13 - 13 1 12 - 1 30 19 20
11 Bisturi uk.21 Pcs 5 - 5 - 5 - - - - 5
12 Blood transfusi set Set 30 - 30 8 22 10 11 - - 11

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
13 Cat gut chromic 2/0 Pcs 48 - 48 9 39 24 13 - - 26
14 Cat gut chromic 3/0 Pcs - 24 24 8 16 - 11 240 235 100
15 Cat gut plain 2/0 Sak 30 24 54 - 54 48 - - - 54 25
16 Cat gut plain 3/0 Sak 26 - 26 - 26 25 - - - 26
17 Folly catheter No.16 pcs 6 10 16 - 16 10 - - - 16 10
18 Folly catheter No.18 pcs 8 10 18 1 17 13 1 - - 16 10
19 I.V. catheter No.18 pcs 68 - 68 2 66 50 3 - - 63
20 I.V. catheter No.20 pcs 28 20 48 19 29 - 27 1 - 1 20
21 I.V. catheter No.22 pcs 25 10 35 63 - 28 - 88 2 118 100
22 I.V. Catheter No.24 pcs 29 5 34 32 2 - 45 - 43 50
23 I.V. Catheter No.26 pcs - 10 10 - 10 10 - - - 10
24 Infus set anak pcs 6 50 56 - 56 50 - - - 56
25 Infus set dewasa pcs 27 50 77 23 54 20 32 - - 22
26 Jarum (needle) 23 Pcs 13 - 13 - 13 - - - - 13

27 Jarum (needle) 27 Pcs 15 - 15 - 15 - - - - 15
28 K.y jelly 82 gram Tube 4 - 4 - 4 - - - - 4
29 Kapas pembalut/absorben 250 gram Bks 3 - 3 - 3 - - - - 3
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 30 - 30 - 30 25 - - - 30
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 20 - - 28 600 628
32 Kasa pembalut hidrofil 4 m x 10 cm Roll 15 - 15 1 14 - 1 30 17 10

33 Kasa pembalut hidrofil 4 m x 15 cm Roll 20 30 50 - 50 50 - - - 50
34 Kasa kompres 40/40 steril Roll 61 30 91 6 85 70 8 - - 77
35 Kasa 40 m x 80 cm Roll - - - - - - - - -
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
36 Kasa pembalut 2 m x 80 cm Roll 8 - 8 - 8 - - - - 8

27 Bun,31 Desember
- 2012
27 - 27 10 - - - 27
38 Kertas puyer biasa Pack 4 Kotawaringin - Barat 4 - 4 2 - - - 4
39 Kertas puyer press Pack 900 - 900 - 900 900 - - - 900
40 Kondom Sutra pcs - - - - - - - - -
41 Masker Pcs 4,888SONNY SAPUTRA,SKM

- 4,888 4,872 16 - 6,821 146,160 152,965
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 40 - 40 - 40 40 - - - 40
43 Penjepit tali pusat Pcs - 50 50 - 50 50 - - - 50 50
44 penghisap lendir pcs 44 - 44 - 44 18 - - - 44
45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr 1,000 - 1,000 - 1,000 1,000 - - - 1,000
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr 500 - 500 - 500 500 - - - 500
47 Plester 1,25 X 4,5 m Roll - - - - - - - - -

,MENGETAHUI
48 Plester 5cm x 4,5 cm Roll - Kepala Dinas- Kesehatan - - - - - - -
49 Plester bulat/ plesterin pcs 600 - 600 200 400 400 280 6,000 5,880
50 Plester cannofix pcs 40 - 40 - 40 40 - - - 40
51 Plester dermafix Pcs drg.INDRAWAN

- - SAKTI,M.Kes
- - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll 4 5 9 1 8 8 1 - - 7 5
53 Safety box Bh 9 15 24 6 18 48 8 - - 10 15
54 Sarung tangan non steril Uk. S Psg 2,233 - 2,233 - 2,233 - - - - 2,233
55 Sarung tangan non steril Uk. M Psg 33 - 33 33 - - 46 990 1,036

56 Sarung tangan non steril Uk. L Psg 6,894 - 6,894 - 6,894 - - - - 6,894
57 Sarung tangan steril ginekologi Psg - - - - - 3 - - -
58 Sarung tangan steril No.6 Psg - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
59 Sarung tangan steril No.6,5 Psg 53 - 53 - 53 - - - - 53
60 Sarung tangan steril No.7 Psg 3 - 3 - 3 - - - - 3
61 Sarung tangan steril No.7,5 Psg 4 50 54 5 49 50 7 - - 42
62 Sarung Tangan steril no.8 Psg 81 - 81 - 81 29 - - - 81
63 Selang oksigen anak Pcs 10 - 10 6 4 2 8 - 4
64 Selang oksigen bayi Pcs 24 - 24 3 21 15 4 - - 17
65 Selang oksigen dewasa Pcs 1 10 11 5 6 19 7 0 1
66 Sendok kertas puyer Pcs - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 40 - 40 3 37 36 4 - - 33
68 Silk (benang bedah sutra) No. 3/0 Sak 9 36 45 1 44 36 1 - - 43 25
69 Speculum Uk S pcs - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - -
71 Speculum Uk L pcs - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - - - - - - -
73 Underpads Pcs 29 - 29 10 19 35 14 - - 5
74 Urin bag Pcs 4 - 4 1 3 17 1 - - 2
75 Wing needle no 27 G Pcs 34 - 34 - 34 71 - - - 34

TAMBAHAN - - - - - - - - -
1 Back pack sprayer Pcs - - - - - - - - -
2 Rapid test covid-19 Pcs 205 - 205 204 1 - 286 - 285
3 Rapid test antigen Pcs 25 - 25 79 - 54 - 111 - 165
4 Masker KN 95 - - - - - - - - -
5 Masker N95 - - - - - - - - -
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
6 Masker Bedah - - - - - - - - -
7 Kacamata google - - - - - - - - -
8 Face shield Nagita 35 - 35 35 - - 49 1,050 1,099
9 Face shield naik turun - - - - - - - - -
10 Face shield - - - - - - - - -
11 Sepatu boot - - - - - - - - -
12 Baju Hazmat kain - - - - - - - - -
13 Baju Hazmat cuci ulang - - - - - - - - -
14 Hand schoon M - - - - - - - - -
15 Hand schoon L - - - - - - - - -
16 Hand schoon s - - - - - - - - -
17 Hand schoon steril no 7,5 - - - - - - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - - -
19 APD - - - - - - - - -
20 APD SET HIJAU - - - - - - - - -
21 APD BOHO - - - - - - - - -
22 APD LEVEL 2 - - - - - - - - -
23 APD LEVEL 3 - - - - - - - - -
24 APD PEMDA/DONASI - - - - - - - - -
25 APD 1 SET - - - - - - - - -
26 GOWN 20 - 20 - 20 - - - - 20
27 COOL BOK 6 LITER - - - - - - - - -
28 COOL BOK 12,5 LITER - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
BAHAN & ALAT LABORATORIUM - - - - - - - - -
1 Asam asetat (Cuka) Btl - - - - - - - - -
2 Alat pulmo (peak flow) set 1 - 1 - 1 - - - - 1
3 Bilik hitung Pcs 2 - 2 - 2 - - - - 2
4 Blood lancet Pcs 980 - 980 115 865 - 161 3,450 2,746
5 Bulb pipet Bh 1 - 1 - 1 - - - - 1
6 Cartrialge genexpert KIT set - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - -
8 Compresson nebulizer pcs - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - -
13 Kaca slide/ Kaca objek Set 216 - 216 - 216 - - - - 216

14 KIT diagnostic untuk HIV Pcs - - - - - - - - -
15 KIT RPR pcs - - - - - - - - -
16 Kotak slide Pcs 2 - 2 - 2 - - - - 2
17 Lampu spiritus 150 ml Pcs 1 - 1 - 1 - - - - 1
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - -

20 Medline Pcs - - - - - - - - -
21 Microhematokrit tube wax Pcs 1 - 1 - 1 - - - - 1
22 Mikro tube (Vol 1,5 ml) Pcs 50 - 50 - 50 - - - - 50

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
23 Mikroskope cover glasses 18x18 mm Pcs 138 - 138 - 138 - - - - 138
27 Nebulizer Bh - - - - - - - - -
28 Peak flow meter Pcs 1 - 1 - 1 - - - - 1
29 Pen lancet Pcs 7 - 7 - 7 - - - - 7
30 Pengukur tinggi badan Pcs - - - - - - - - -
31 Pipet eritrosit Pcs 2 - 2 - 2 - - - - 2
32 Pipet HB Pcs 1 - 1 - 1 - - - - 1
33 Pipet leukosit Pcs 2 - 2 - 2 - - - - 2
34 Pipet tips universal 10 ui Pcs - - - - - - - - -
35 Pipet westergren Bh 1 - 1 - 1 - - - - 1
36 Pot dahak Pcs 126 - 126 2 124 - 3 60 - 61

37 Pot urine Pcs - - - - - - - - -
38 Rak staenles tes tube Test 1 - 1 - 1 - - - - 1
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - - - - - - -

43 Rapid Test pemeriksaan Hepatitis HBSAG Test 82 - 82 12 70 - 17 360 307
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
46 Rapid test pemeriksaan HIV (SD BIO) Test - - - - - - - - -
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 174 - 174 28 146 - 39 840 733
49 Rapid test pemeriksaan malaria Test 25 - 25 - 25 - - - - 25
50 Reagen Cell clean Btl - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 110 - 110 - 110 - - - - 110
52 Reagen Giemsa Btl 1 - 1 - 1 - - - - 1
53 Reagen Gol Darah Btl 1 - 1 - 1 - - - - 1
54 Reagen Gol darah anti D Btl 1 - 1 - 1 - - - - 1
55 Reagen Immersion Btl 1 - 1 - 1 - - - - 1
56 Reagen Stromatolyer Btl - - - - - - - - -
57 Reagen Ziehl Neelson Pcs 2 - 2 - 2 - - - - 2
58 RPR Sipilis fokus Pcs 100 - 100 - 100 - - - - 100
59 Spritus Btl - - - - - - - - -
60 Tabung hematokrit heparin Pcs - - - - - - - - -
61 Tabung hematokrit non heparin Pcs - - - - - - - - -
62 Tabung vacutainer edta warna ungu Pcs 128 - 128 5 123 - 7 150 34
63 Test asam urat Pcs 199 - 199 18 181 - 25 540 384
64 Test gluco protein urine Pcs 55 - 55 - 55 - - - - 55
65 Test iodium Pcs - - - - - - - - -

66 Test kehamilan / PP test Test 52 - 52 10 42 - 14 300 272
67 Test kolestrol Tube 260 - 260 33 227 - 46 - - 181
68 Test pemeriksaan gula darah Pcs 1,447 - 1,447 1,265 182 - 1,771 - 1,589
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
69 Test pemeriksaan HB Test 129 - 129 18 111 - 25 540 454
70 Test Pemeriksaan Urine 10 Parameter Test 63 - 63 4 59 - 6 120 67
71 Tipe mikro pipet warna biru Test 423 - 423 - 423 - - - - 423
72 Tipe mikro pipet warna kuning Test 555 - 555 - 555 - - - - 555
73 Tipe mikro pipet warna putih Test - - - - - - - - -
74 Tisue mikroskop Pcs 1 - 1 - 1 - - - - 1
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs 50 - 50 - 50 - - - - 50
77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - -
TAMBAHAN - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 90 - 90 - 90 - - - - 90
BAHAN GIGI - - - - - - - - -
1 Bahan tambahan light curing - - - - - - - - -
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - -

3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - -
4 Bonding resine Btl - - - - - - - - -
5 Caviton Btl - - - - - - - - -
6 Cellopand strip swenska Pack 1 - 1 - 1 - - - - 1
7 Devitalisasi pasta Btl - - - - - - - - -
8 Etil klorida semprot 100 ml Btl - - - - - - - - -

9 Etching SDI liquid / Acid ethan liquid Btl - - - - - - - - -
10 Eugenol cairan Btl - - - - - - - - -
11 Endometason Pcs - - - - - - - - -
STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
12 Jarum ekterpasi (exterpatie swenska) Pack 1 - 1 - 1 - - - - 1
13 Fraser / Bentuk silinder Bh 1 - 1 - 1 - - - - 1
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - -
15 Gutta percha poins Ktk - - - - - - - - -
16 H-file Pcs - - - - - - - - -
17 K-file Pcs - - - - - - - - -
18 Kalsium hidroksida pasta Ktk - - - - - - - - -
19 Kertas artikulasi (articulating paper) Pack 1 - 1 - 1 - - - - 1
20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - -
24 Mata bor mikromotor (RA) Pack - - - - - - - - -
25 Mata bor white stone Set - - - - - - - - -

26 Mata bor hand place (FG diamond) Set - - - - - - - - -
27 Mata bor tulang / Oral surgery (meisenger) Pcs 5 - 5 - 5 - - - - 5
28 Needle olyco / Jarum carpule Pcs - - - - - - - - -
29 Needle Septoject Pcs 200 - 200 - 200 - - - - 200
30 Oil spray Btl - - - - - - - - -
31 Paper points Ktk 1 - 1 - 1 - - - - 1

32 Penghisap ludah (tips suetion) Pcs - - - - - - - - -
33 Komposit resin (solare x) Tube - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - -

STOCK STOCK STOCK

N PUSKESMAS (40 %)
APBN HIBAH ED
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - -
36 Siver amalgam (serbuk) Btl - - - - - - - - -
37 Solare X A2 Bh - - - - - - - - -
38 Solare X A3 Bh - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - -
UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
85 179 372 636

Pimpinan Puskesmas Petugas Puskesmas
dr.Yordan Pradiksa Rahmat Wildan, A.Md., Farm

NIP: 19691104 199203 1 002 .NIP: 19820121 201001 1 011 ..NIP: 19870406 201101 1 004
NIP: 19810223 200604 2 006
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
3 Ambroksol 30 mg Tab 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 20 0 0 0 0 4 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 0 30 10 0 0 30 0 0 0 0 0 0 0 20 0 0 40 10 0 0 0 0 15 0 0 60 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 20 3 0 10 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 20

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 30 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0


53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63 30

54 Kaptopril 25 mg Tab 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 50 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

64 Klozapin 25 mg Tab 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 10 0 0 0


82 Metformin 500 mg Tab 0 0 30 0 0 30 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 10 0 0 30 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 22 0 10 0 6 0 0 10 26 0 0 0 0 0 6 16 12 0 56 8 0 0 20 0 10 20
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 5 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0

MENGETA
,HUI
34 Sefotaksim Vial 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 0 0 0 2 0 3 1 0 0 0 3` 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0





1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 386 10 455
0 0 0 0
0 0 0 61
0 0 0 30
0 0 10 225
0 0 0 0
0 0 20 140
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 20 165
0 0 0 0
0 0 0 0
0 110 0 136
0 27 0 37
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 135
0 0 0 10
0 0 0 20
10 0 10 209
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 20 20 104
0 100 0 100
0 0 0 0
0 0 0 0
0 4 0 77
0 0 0 12
0 0 0 0
30 0 0 560
0 0 0 50
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 270 30 330
0 200 0 200
0 0 0 0
0 0 0 60
0 0 0 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 103
0 0 0 180
0 0 0 0
0 56 0 86
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 92
0 0 0 0
0 0 0 10
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 72 0 124
0 0 10 60
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 10
30 0 30 200
0 0 0 0
10 0 10 232
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 10 75
0 0 0 0
0 10 0 10
0 0 0 0
0 0 20 200
0 0 0 0
0 0 30 191
0 0 0 0
0 0 0 0
0 0 0 0
0 200 0 200
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 240
10 0 0 41
10 0 30 525
0 0 0 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 35
0 0 0 20
0 0 0 0
29 30 31 TOTAL
0 0 0 30
0 0 0 80
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 10 121
0 0 0 10
0 0 0 72
0 0 0 0
0 279 30 531
0 0 0 0
0 0 0 0
10 200 60 464
10 0 0 30
0 0 0 0
0 0 10 260
0 0 0 0
0 127 30 277
0 0 0 0
0 0 0 0
0 150 0 156
10 0 0 105
20 0 0 140
0 0 0 120
0 78 0 78
0 0 10 100
0 11 30 61
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 0 0 12
1 0 0 3
0 0 0 0
MARIYANI
0 0 0 0 NIP: 19750812 200003 2 003
0 0 0 0
0 0 0 0
0 0 0 0
0 16 0 18
0 0 0 0
1 10 0 23
29 30 31 TOTAL
1 1 0 4
0 0 0 0
0 0 0 0
9 56 0 79
0 0 0 0
0 20 0 20
0 0 0 2
11 128 0 146
3 0 0 5
0 0 0 0
0 0 0 0
0 20 0 22
0 23 0 23
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 49 0 50
0 0 0 0
0 0 0 0
0 0 0 0
0 2 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 10 0 10
0 1 0 3
0 0 0 0
0 0 0 0
0 3 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 11 0 12
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 5 0 5
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 27 0 27
0 0 0 0
0 0 0 0
0 2 0 2
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 1
29 30 31 TOTAL
0 0 0 0
0 0 0 2
0 0 0 17
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 3
0 0 0 7
0 0 0 0
0 0 0 2
0 45 0 45
0 0 0 1
0 0 0 5
0 0 0 0
0 4 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 1 0 1
0 1 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 31 0 31
0 0 0 0
0 0 0 0
0 0 0 0
0 1 0 1
0 0 0 0
0 9 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 8
0 0 0 0
0 0 0 0
0 0 0 0
1 71 0 82
0 0 0 0
0 0 0 0
0 0 0 0
0 17 0 17
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2 0 0 5
4 0 0 12
2 0 0 15
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 3 0 5
0 4 0 4
0 0 0 6
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
1 0 0 1
0 0 0 1
13 0 0 16
4 25 0 37
0 15 0 16
0 0 0 0
0 0 0 0
12 0 0 21
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 20 0 20
0 1 0 1
0 0 0 0
0 0 0 6
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 4,862 0 4,862 SONNY SAPUTRA,SKM

NIP: 19750508 199903 1 002
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
,MENGETAHUI
0 200 0 200
0 0 0 0
NIP: 19610521 199303 1 004
0 0 0 0
0 0 0 0
0 0 0 0
0 32 0 32
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 4 0 6
0 2 0 3
0 0 0 5
0 0 0 0
1 0 0 2
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 10 0 10
29 30 31 TOTAL
1 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 164 0 164
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 35 0 35
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 35 0 35
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 5 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 8 0 8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 3 0 3
0 9 0 9
0 0 0 0
0 0 0 0
0 3 0 3
0 13 0 13
0 1,224 0 1,224
0 6 0 6
0 1 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Yang
,Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 250 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


82 Metformin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 250 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 600
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 360
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


31 Piracetam 1 gr Amp 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0
33 MENGETA
,HUI
Sefotaksim Vial 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alat suntik sekali pakai 0,5 ml Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ###



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 900
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

68 Test pemeriksaan gula darah Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,400



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 120
0 0
0 0
0 0
0 0
0 0
0 400
0 0
0 50
0 0
0 0
0 0
0 0
0 200
0 0
0 0
0 100
0 250
0 0
0 200
0 0
0 0
0 200
0 0
0 0
0 0
0 400
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 0
0 700
0 0
0 300
0 0
0 0
0 0
0 0
0 200
0 0
0 0
0 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 100
0 0
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 50
0 0
0 0
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 300
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 200
0 0
0 0
0 0
0 0
0 0
0 250
0 300
0 0
0 0
0 0
0 0
0 100
0 0
0 300
0 0
0 900
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 600
0 0
0 0
0 600
0 0
0 0
0 300
0 0
0 0
0 0
0 0
0 150
0 0
0 0
0 200
0 0
0 150
0 0
0 360
31 TOTAL
0 0
0 200
0 360
0 0
0 0
0 40
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 10
0 60
0 25
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 0
0 30
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 30
0 0
0 0
0 10
0 10
0 110
0 0
0 0
0 0
0 0
0 50
0 0
0 0
0 0
0 0
0 100
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 25
0 0
0 0
0 0
0 0
0 0
0 0
0 7
0 10
0 0
0 0
0 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 50
0 0
0 0
0 2
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 3
0 0
0 0
0 0
0 12
0 15
0 0
0 0
0 20
0 0
0 0
0 0
0 0
0 5
0 62
0 0
0 165
0 25
0 65
0 16
0 0
0 6
0 0
0 0
0 8
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 5
0 0
0 0
0 36
0 11
0 0
0 0
0 0
0 16
0 22
0 0
0 0
0 0
0 0
0 30
0 8
0 0
0 0
0 103
0 0
0 0
0 11
0 0
0 0
0 0
0 0
0 2
31 TOTAL
0 0
0 0
0 27
0 0
0 34
0 0
0 0
0 0
0 0
0 80
0 0
0 50
0 40
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 10,500
0 0
0 110
0 200
0 20
0 0
0 400
0 54
31 TOTAL
0 0
0 0
0 20
0 18
0 24
0 2
0 7
0 12
0 0
0 0
0 40
0 15
0 25
0 0
0 0
0 40
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 4
0 4
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0
0 0
NIP: 19750508 199903 1 002
0 0
0 0
0 2
0 0
0 0
0 0
,MENGETAHUI
0 0
0 0
NIP: 19610521 199303 1 004
0 0
0 0
0 100
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 3
0 5
0 0
0 0
0 10
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 130
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 900
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 216
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 60
0 0
0 0
0 0
0 0
0 0
0 0
0 82
0 0
0 0
0 50
0 0
0 150
31 TOTAL
0 25
0 0
0 50
0 0
0 0
0 0
0 0
0 0
0 2
0 100
0 0
0 0
0 0
0 0
0 199
0 3
0 0
0 0
0 0
0 1,400
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP
PUSKESMAS : PANDU SENJAYA
KECAMATAN : PANGKALAN LADA
JUMLAH JUMLAH
STOCK STOCK STOCK

STOCK PENERIMA PERSEDIAA KESELURUH STOK AWAL PENERIMAA PERSEDIAA PENGELUAR WAKTU
NO OBAT DAN PERBEKKES SATUAN AWAL AN N PEMAKAIAN N N AN
GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
TABLET
1 Albendazol 400 mg Tab 180 - 180 - - 180 180 120 - 120 120 - - - - -
2 Alopurinol 100 mg Tab 295 - 295 - - 295 295 - - - - - - - - -
3 Ambroksol 30 mg Tab 1,498 - 1,498 455 - 1,043 1,043 650 - 650 - - 650 650 637 -
4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - - -

5 Amitriptilin 25 mg Tab 61 - 61 61 - - - - - - - - - - 85 1,830
6 Amlodipin 5 mg Tab 844 - 844 30 - 814 814 200 - 200 - - 200 200 42 -
7 Amlodipin 10 mg Tab 859 - 859 225 - 634 634 600 - 600 400 - 200 200 315 -
8 Amoksisilin 250 mg Tab - - - - - - - - - - - - - - - -
9 Amoksisilin 500 mg Tab 1,888 - 1,888 140 - 1,748 1,748 1,150 - 1,150 50 - 1,100 1,100 196 -
10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - - -

11 Antasida kombinasi Tab - - - - - - - - - - - - - - - -
12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - - -
13 Asam asetilsalisilat (asetosal) 80 mg Tab 100 - 100 - - 100 100 - - - - - - - - -
14 Asam mefenamat 500 mg Tab 1,662 - 1,662 165 - 1,497 1,497 600 - 600 200 - 400 400 231 -
15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
16 Asiklovir 200 mg Tab - - - - - - - - - - - - - - - -
17 Asiklovir 400 mg Tab 491 - 491 136 - 355 355 200 - 200 100 - 100 100 190 -
18 Atapulgit 630 mg Tab 854 - 854 37 - 817 817 250 - 250 250 - - - 52 -
19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - - -
20 Azitromisin 500 mg Tab - - - - - - - - - - 200 - - 200 - 200 - -
21 Asam folat 1 mg Tab - - - - - - - - - - - - - - - -
22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - - -
23 Betahistin 6 mg Tab 334 - 334 20 - 314 314 200 - 200 200 - - - 28 -
24 Deksametason 0,5 mg Tab 1,908 - 1,908 135 - 1,773 1,773 900 - 900 - - 900 900 189 -
25 Digoksin 0,25 mg Tab 490 - 490 10 - 480 480 100 - 100 - - 100 100 14 50
26 Dimenhidrinat 50 mg Tab 828 - 828 20 - 808 808 300 - 300 - - 300 300 28 -
27 Domperidon 10 mg Tab 495 - 495 209 - 286 286 400 - 400 400 - - - 293 -
28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - - -
29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - - -

30 Eritromisin 500 mg Tab 227 - 227 104 - 123 123 - - - - - - - 146 -
31 Fenitoin 30 mg Kaps 200 - 200 100 - 100 100 - - - - - - - 140 -
32 Fenitoin 100 mg Kaps 100 - 100 - - 100 100 - - - - - - - - -
33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - - -
34 Furosemid 40 mg Tab 486 - 486 77 - 409 409 200 - 200 100 - 100 100 108 -
35 Garam oralit kombinasi Sak 446 - 446 12 - 434 434 200 - 200 - - 200 200 17 -
36 Gemfibrozil 300 mg Kaps 544 - 544 - - 544 544 120 - 120 - - 120 120 - -
37 Glibenklamid 5 mg Tab 2,775 - 2,775 560 - 2,215 2,215 2,150 - 2,150 700 - 1,450 1,450 784 -
38 Glimepirid 2 mg Tab 83 - 83 50 - 33 33 - - - - - - - 70 1,500

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
39 Gliseril guaiakolat 100 mg (guaifenesin) Tab - - - - - - - 300 - 300 300 - - - - -
40 Griseofulvin (micronized) 125 mg Tab 630 - 630 - - 630 630 - - - - - - - - -
41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - - -
42 Haloperidol 2 mg Tab - - - - - - - - - - - - - - - -
43 Haloperidol 5 mg Tab 330 - 330 330 - - - - - - - - - - 462 9,900
44 Hiosina butilbromida 10 mg Tab 480 - 480 200 - 280 280 400 - 400 200 - 200 200 280 -
45 Ibuprofen 200 mg Tab - - - - - - - - - - - - - - - -
46 Ibuprofen 400 mg Tab 2,242 - 2,242 60 - 2,182 2,182 1,500 - 1,500 - - 1,500 1,500 84 -
47 Isosorbid dinitrat 5 mg Tab 307 - 307 30 - 277 277 200 - 200 200 - - - 42 -
48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - - -
49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - - -
50 Kalsium laktat (kalk) 500 mg Tab - - - - - - - - - - - - - - - -
51 Kandesartan 8 mg - - - - - - - - - - - - - - - -
52 Kandesartan 16 mg Tab - - - - - - - - - - - - - - - -
53 Kaptopril 12,5 mg Tab 3,083 - 3,083 103 - 2,980 2,980 2,800 - 2,800 - - 2,800 2,800 144 -
54 Kaptopril 25 mg Tab 3,851 - 3,851 180 - 3,671 3,671 2,600 - 2,600 - - 2,600 2,600 252 -
55 Karbamazepin 200 mg Tab 200 - 200 - - 200 200 - - - - - - - - -
56 Ketokonazol 200 mg Tab 558 - 558 86 - 472 472 50 - 50 - - 50 50 120 -
57 Ketoprofen 100 mg Tab 500 - 500 - - 500 500 100 - 100 100 - - - - -
58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - - -

59 Klindamisin 300 mg Kaps - - - - - - - - - - - - - - - -
60 Kloramfenikol 500 mg Kaps 454 - 454 - - 454 454 200 - 200 100 - 100 100 - -
61 Klorfeniramin maleat (ctm) 4 mg Tab 2,040 - 2,040 92 - 1,948 1,948 1,650 - 1,650 - - 1,650 1,650 129 -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - - -
63 Klorpromazin hcl 100 mg Tab 13 - 13 10 - 3 3 - - - - - - - 14 300
64 Klozapin 25 mg Tab 78 - 78 10 - 68 68 - - - - - - - 14 300
65 Klozapin 100 mg Tab 69 - 69 - - 69 69 - - - - - - - - -
66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - - - - - - - - -
67 Kotrimoksazol (dewasa) 480 mg Tab 640 - 640 10 - 630 630 100 - 100 - - 100 100 14 -
68 Kotrimoksazol Forte (dewasa) 960 mg Tab 850 - 850 - - 850 850 100 - 100 - - 100 100 - -
69 Kuinin 222 mg Tab - - - - - - - - - - - - - - - -
70 Lanzoprazol 30 mg Kaps - - - - - - - - - - - - - - - -
71 Levotiroksin 50 mµ Tab - - - - - - - - - - - - - - - -
72 Levofloksasin 500 mg Tab 398 - 398 124 - 274 274 150 - 150 50 - 100 100 174 620
73 Loratadin 10 mg Tab 927 - 927 60 - 867 867 350 - 350 - - 350 350 84 -
74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - - -
75 MDT FB dewasa (obat kusta) Pkt - - - - - - - 2 - 2 2 - - - - -

76 MDT MB anak (obat kusta) Pkt - - - - - - - - - - - - - - - -
77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - - -
78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - - -
79 Meloksikam 7,5 mg Tab - - - - - - - - - - - - - - - -
80 Meloksikam 15 mg Tab 14 - 14 - - 14 14 - - - - - - - - -
81 Metamizol (antalgin) 500 mg Tab 450 - 450 10 - 440 440 - - - - - - - 14 300

82 Metformin 500 mg Tab 1,960 - 1,960 200 - 1,760 1,760 1,800 - 1,800 100 - 1,700 1,700 280 -
83 Metilergometrin 0,125 mg Tab 360 - 360 - - 360 360 250 - 250 - - 250 250 - -
84 Metilprednisolon 4 mg Tab 1,627 - 1,627 232 - 1,395 1,395 900 - 900 300 - 600 600 325 -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
85 Metilprednisolon 8 mg Tab - - - - - - - - - - - - - - - -
86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - - -
87 Metronidazol 500 mg Tab 1,093 - 1,093 75 - 1,018 1,018 450 - 450 - - 450 450 105 -
88 Mineral Mix Sak - - - - - - - - - - - - - - - -
89 Multivitamin ibu hamil (Gestiamin) Tab 120 - 120 10 - 110 110 - - - - - - - 14 300
90 Multivitamin ibu hamil (hemafort) Tab - - - - - - - - - - - - - - - -
91 Multivitamin lansia (pehavral) Tab 200 - 200 200 - - - - - - 200 - - 200 - 200 280 -
92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - - -
93 Natrium diklofenak 25 mg Tab 1,973 - 1,973 191 - 1,782 1,782 1,650 - 1,650 - - 1,650 1,650 267 -
94 Natrium diklofenak 50 mg Tab - - - - - - - - - - - - - - - -
95 Nifedipin 10 mg Tab 35 - 35 - - 35 35 - - - - - - - - -
96 Nifedipin 20 mg Tab 240 - 240 - - 240 240 - - - - - - - - -
97 Nistatin 500.000 IU Tab 330 - 330 200 - 130 130 250 - 250 250 - - - 280 -
98 N-asetil sistein 200 mg kaps - - - - - - - - - - 300 - - 300 - 300 - -

99 OAT Kategori Anak Pkt - - - - - - - - - - - - - - - -
100 OAT Kategori I Pkt 1 - 1 - - 1 1 - - - - - - - - -
101 OAT Kategori II Pkt - - - - - - - - - - - - - - - -
102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - - -
103 Ofloksasin 200 mg Tab 280 - 280 - - 280 280 100 - 100 100 - - - - -
104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - - -

105 Omeprazol 20 mg Kaps 300 - 300 240 - 60 60 300 - 300 300 - - - 336 -
106 Ondansetron 4 mg Tab 368 - 368 41 - 327 327 72 - 72 - - 72 72 57 -
107 Parasetamol 500 mg Tab 3,884 - 3,884 525 - 3,359 3,359 2,100 - 2,100 900 - 1,200 1,200 735 -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
108 Pirantel pamoat 125 mg Tab 99 - 99 4 - 95 95 100 - 100 - - 100 100 6 -
109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - - -
110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - - -
111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - - -
112 Piroksikam 20 mg Tab 1,031 - 1,031 35 - 996 996 350 - 350 - - 350 350 49 -
113 Prednison 5 mg Tab 1,510 - 1,510 20 - 1,490 1,490 900 - 900 - - 900 900 28 -
114 Primakuin 15 mg Tab 10 - 10 - - 10 10 10 - 10 - - 10 10 - -
115 Propiltiourasil 100 mg Tab 200 - 200 30 - 170 170 - - - - - - - 42 900
116 Propranolol 10 mg Tab 500 - 500 80 - 420 420 300 - 300 - - 300 300 112 3
117 Propranolol 40 mg Tab 10 - 10 10 - - - - - - - - - - 14 300
118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - - -
119 Risperidon 1 mg Tab - - - - - - - - - - - - - - - -
120 Risperidon 2 mg Tab - - - - - - - - - - - - - - - -
121 Salbutamol 2 mg Tab 1,381 - 1,381 121 - 1,260 1,260 500 - 500 - - 500 500 169 -
122 Salbutamol 4 mg Tab 1,199 - 1,199 10 - 1,189 1,189 500 - 500 - - 500 500 14 -
123 Sefadroksil 500 mg Kaps 370 - 370 72 - 298 298 - - - - - - - 101 2,160
124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - - -
125 Setirizin 10 mg Tab 1,567 - 1,567 531 - 1,036 1,036 1,100 - 1,100 600 - 500 500 743 -
126 Simetidin 200 mg Tab - - - - - - - - - - - - - - - -
127 Simvastatin 10 mg Tab - - - - - - - - - - - - - - - -

128 Simvastatin 20 mg Tab 839 - 839 464 - 375 375 300 - 300 600 - - 300 - 300 650 -
129 Siprofloksasin 500 mg Tab 1,150 - 1,150 30 - 1,120 1,120 650 - 650 - - 650 650 42 -
130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
131 Tambah darah kombinasi (fe dan asam folat) Tab 870 - 870 260 - 610 610 510 - 510 300 - 210 210 364 -
132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - - -
133 Triheksifenidil 2 mg Tab 277 - 277 277 - - - - - - - - - - 388 8,310
134 Triheksifenidil 5 mg Tab - - - - - - - - - - - - - - - -
135 Vitamin A 100.000 IU (retinol) Biru Kaps 50 - 50 - - 50 50 - - - - - - - - -
136 Vitamin A 200.000 IU (retinol) Merah kaps 271 - 271 156 - 115 115 150 - 150 150 - - - 218 -
137 Vitamin B 1 (tiamin) 50 mg Tab 1,902 - 1,902 105 - 1,797 1,797 1,600 - 1,600 - - 1,600 1,600 147 -
138 Vitamin B 6 (piridoksin) 10 mg Tab 1,046 - 1,046 140 - 906 906 500 - 500 - - 500 500 196 -
139 Vitamin B kompleks Tab 1,221 - 1,221 120 - 1,101 1,101 800 - 800 200 - 600 600 168 -
140 Vitamin C (asam askorbat) 50 mg Tab 78 - 78 78 - - - - - - - - - - 109 2,340
141 Vitamin K 1 (Fitomenadion) 10 mg Tab 650 - 650 100 - 550 550 650 - 650 150 - 500 500 140 500
142 Vitamin Hepagard Tab 335 - 335 61 - 274 274 210 - 210 - - 210 210 85 -
143 Zinc tablet dispersibel 20 mg Tab 80 - 80 - - 80 80 - - - 360 - - 360 - 360 - -

TAMBAHAN - - - - - - - - - - - - - - - -
1 Becefort - - - - - - - - - - 200 - - 200 - 200 - -
2 Imbos forte - - - - - - - - - - 360 - - 360 - 360 - -
3 Livron B Plex - - - - - - - - - - - - - - - -
4 Multivitamin (Sivit - Zink) Bh - - - - - - - - - - - - - - - -
5 Oseltamivir 75 mg Bh - - - - - - - - - - 40 - - 40 - 40 - -
INJEKSI - - - - - - - - - - - - - - - -
1 Air untuk injeksi (aqua pro injeksi) 20 ml Vial - - - - - - - - - - - - - - - -
2 Air untuk injeksi (aqua pro injeksi) 25 ml Btl 10 - 10 - - 10 10 - - - - - - - - -
3 Aminofilin 24 mg/ml Amp 35 - 35 1 - 34 34 30 - 30 10 - 20 20 1 -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
4 Ampisillin serb. inj 1000 mg (i.v.) Amp 3 - 3 - - 3 3 - - - - - - - - -
5 Antrain Inj Amp - - - - - - - - - - - - - - - -
6 Artemether 80 mg/ml Amp - - - - - - - - - - - - - - - -
7 Artesunat 60 mg/ml (i.v./i.m.) Amp - - - - - - - - - - - - - - - -
8 Asam traneksamat 50 mg/ml Amp - - - - - - - - - - - - - - - -
9 Asam traneksamat 100 mg/ml Amp 3 - 3 - - 3 3 - - - 10 - - 10 - 10 - -
10 Atropin 0,25 mg/ml Amp 40 - 40 - - 40 40 40 - 40 - - 40 40 - -
11 Deksametason 5 mg/ml Amp 97 - 97 - - 97 97 60 - 60 10 - 50 50 - -
12 Difenhidramin hcl 10 mg/ml Amp 71 - 71 12 - 59 59 60 - 60 60 - - - 17 -

10 Evaluasi
- dan Perencanaan
10 - - 10 10 - - - - - - - - -
14 Furosemid 10 mg/ml Amp 25 - 25 3 - 22 22 25 - 25 25 - - - 4 -
15 Flufenazin 25 mg/ml (Sikzonoate) Amp - - - - - - - - - - - - - - - -

MARIYANI
- 19750812
- 200003 2- 003 - - - - - - - - - - - - -
17 Haloperidol 5 mg/ml Amp - - - - - - - - - - - - - - - -

18 Haloperidol 50 mg/ml Amp - - - - - - - - - - - - - - - -
19 Kalsium glukonat 10 % Amp 30 - 30 - - 30 30 20 - 20 - - 20 20 - -
20 Ketorolak 30 mg/ml Amp 50 - 50 18 - 32 32 30 - 30 30 - - - 25 -
21 Klorpromazin 25 mg/ml Amp - - - - - - - - - - - - - - - -
22 Lidokain 2 % Amp 237 - 237 23 - 214 214 98 - 98 - - 98 98 32 -
23 Lidokain kompositum Amp 34 - 34 4 - 30 30 30 - 30 - - 30 30 6 -

24 Magnesium sulfat 20 % (i.v.) Btl 30 - 30 - - 30 30 10 - 10 - - 10 10 - -
25 Magnesium sulfat 40 % (i.v.) Btl 10 - 10 - - 10 10 - - - - - - - - -
26 Metamizol (antalgin) 500 mg/2 ml Amp 93 - 93 79 - 14 14 - - - - - - - 111 -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
27 Metilergometrin 0.2 mg/ml Amp 30 - 30 - - 30 30 - - - - - - - - -
28 Oksitosin 10 iu/ml Amp 30 - 30 20 - 10 10 - - - - - - - 28 -
29 Omeprazole 40 mg/ml Amp 11 - 11 2 - 9 9 - - - - - - - 3 60
30 Ondansetron 4 mg/2 ml Amp 160 - 160 146 - 14 14 100 - 100 100 - - - 204 -
31 Piracetam 1 gr Amp 33 - 33 5 - 28 28 30 - 30 30 - - - 7 -

MENGETA - - - - - - ,MENGETAHUI
,MENGETAHUI
- - - - - -
,HUI
,I Kepala
KepalaDinas
DinasKesehatan
Kesehatan
33 MENGETA25 ml/ml
KepalaDinas- - - - - - Kabupaten- Kotawaringin
Kabupaten -
Kotawaringin - - - -
,HUI Dinas
Kesehatan Barat
Barat
Sefotaksim Vial 22 - 22 22 Kabupaten -
Kesehatan - - 10 - 10 10 - - - 31 -
Dinas Kabupaten
Kotawaringin
35 Seftriakson
Kesehatan serb. inj 1.000 mg Vial 23 - 23 23 Barat -
Kotawarin - - 10 - 10 10 - - - 32 -
Kabupate gin Barat
36 Vitamin
n K 1 (fitomenadion) 2 mg/ml Amp 118 - 118 - - 118 118 110 - 110 110 - - - - -
drg.INDRAWAN
gin Barat Amp 100 - 100 - - 100 100 - - - -
SAKTI,MKes
SAKTI,MKes - - - - -
NIP:
NIP:19610521
19610521199303
19930311
38 Vitamin B 1 (tiamin) 100 mg /ml Amp - - - - drg.INDRAW- - - - - - - 004
004 - - - - -
drg.INDRA
AN
39 Vitamin B 12 (sianokobalamin) 500 mcg Amp 10 - 10 - SAKTI,MKes
WAN - 10 10 - - - - - - - - -
SAKTI,MK
NIP:
TAMBAHAN
drg.INDRA - - - - 19610521
es - - - - - - - - - - - -
WAN 199303
NIP: 1
SAKTI,MK 100 - 100 50 19610521
004 - 50 50 100 - 100 50 - 50 50 70 -
es 199303 1
NARKOTIKA
NIP: & PSIKOTROPIKA - - - - 004 - - - - - - - - - - - -
19610521
1 Diazepam
199303 1 (Stesolid) enema 5 mg/2,5 ml Tube - - - - - - - - - - - - - - - -
004
3 Diazepam 2 mg Tab 100 - 100 2 - 98 98 - - - - - - - 3 -
4 Diazepam 5 mg Tab 219 - 219 - - 219 219 100 - 100 100 - - - - -

5 Diazepam 5 mg/ml (i.v.) Amp 40 - 40 - - 40 40 - - - - - - - - -
6 Fenobarbital 50 mg/ml Amp 30 - 30 - - 30 30 - - - - - - - - -
7 Fenobarbital 30 mg Tab 100 - 100 - - 100 100 - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
8 Kodein 10 mg Tab 100 - 100 - - 100 100 - - - - - - - - -
9 Klobazam 10 mg Tab - - - - - - - - - - - - - - - -
SALEP DAN SUPPOSITORIA - - - - - - - - - - - - - - - -
1 Antifungi kombinasi Tube 10 - 10 - - 10 10 - - - - - - - - -
2 Antihemoroid kombinasi Supp 10 - 10 10 - - - - - - - - - - 14 300
3 Asiklovir 5% Krim Tube 58 - 58 3 - 55 55 25 - 25 25 - - - 4 -
4 Basitrasin - polimiksin B Tube 19 - 19 - - 19 19 - - - - - - - - -
5 Bedak salisil 2% Ktk - - - - - - - - - - - - - - - -
6 Betametason 0,1% krim Tube 67 - 67 5 - 62 62 35 - 35 - - 35 35 7 -
7 Bioplacenton krim Tube - - - - - - - - - - - - - - - -
8 bisakodil ( dulcolax ) 5mg supp - - - - - - - - - - - - - - - -
9 Bisakodil (dulcolax) 10 mg Supp 25 - 25 - - 25 25 - - - - - - - - -
10 Desoksimetason 0,25 % krim Tube 20 - 20 2 - 18 18 7 - 7 7 - - - 3 -
11 Gentamisin salep kulit Tube 11 - 11 12 - - 1 - 1 - - - 10 - - 10 - 10 17 360

12 Gentamisin salep mata Tube 65 - 65 - - 65 65 24 - 24 - - 24 24 - -
13 Hidrokortison 2,5% krim Tube 50 - 50 - - 50 50 14 - 14 - - 14 14 - -
14 Ketokonazol 2 % krim Tube 14 - 14 - - 14 14 9 - 9 9 - - - - -
15 Ketoprofen 100 mg Supp 10 - 10 - - 10 10 10 - 10 - - 10 10 - -
16 Kloramfenikol 1% salep mata Tube 58 - 58 1 - 57 57 19 - 19 - - 19 19 1 -
17 kloramfenikol 3% salep kulit Tube 11 - 11 5 - 6 6 - - - - - - - 7 150

18 Mikonazol 2 % krim Tube 59 - 59 1 - 58 58 14 - 14 - - 14 14 1 -
19 metronidazol ovula 500 mg ovul 40 - 40 - - 40 40 - - - - - - - - -
20 Nistatin 100.000 IU Supp 37 - 37 - - 37 37 42 - 42 - - 42 42 - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
21 Oksitetrasiklin salep kulit Tube 15 - 15 - - 15 15 - - - - - - - - -

22 Oksitetrasiklin salep mata Tube 101 - 101 27 - 74 74 50 - 50 50 - - - 38 1
23 povidon iodin / betadine salep Tube 10 - 10 - - 10 10 - - - - - - - - -
24 Salep 2-4 kombinasi krim Tube 18 - 18 - - 18 18 14 - 14 - - 14 14 - -
25 Sulfadiazine 10 Mg Salep Tube 25 - 25 2 - 23 23 15 - 15 2 - 13 13 3 -
SIRUP - - - - - - - - - - - - - - - -
1 Ambroxol drop 15 mg/ ml Btl - - - - - - - - - - - - - - - -
2 Ambroxol sirup 15 mg/5 ml Btl 82 - 82 2 - 80 80 50 - 50 - - 50 50 3 -
3 ambroxol sirup 30 mg/5 ml Btl 73 - 73 1 - 72 72 60 - 60 - - 60 60 1 -
4 Amoksisilin sirup kering 125 mg/5 ml Btl 19 - 19 - - 19 19 - - - - - - - - -
5 Amoksisilin sirup kering 250 mg/5 ml Btl 77 - 77 2 - 75 75 70 - 70 3 - 67 67 3 -
6 Antasida susp Btl 54 - 54 17 - 37 37 - - - - - - - 24 -
7 Caviflex sirup Btl - - - - - - - - - - - - - - - -
8 Dextrofen sirup Btl 52 - 52 - - 52 52 10 - 10 - - 10 10 - -
9 Domperidon sirup 5 mg/5 ml Btl 130 - 130 - - 130 130 90 - 90 12 - 78 78 - -
10 Ibuprofen sups 100 mg / 5 ml Btl 54 - 54 - - 54 54 70 - 70 15 - 55 55 - -
11 Ibuprofen sups 200 mg / 5 ml Btl - - - - - - - - - - - - - - - -
12 Kloramfenikol susp 125 mg/5 ml Btl 32 - 32 - - 32 32 - - - - - - - - -
13 Kotrimoksazol susp 240 mg/5 ml Btl 87 - 87 - - 87 87 80 - 80 20 - 60 60 - -
14 Laktulosa 3,335 g/5 ml Btl 11 - 11 2 - 9 9 - - - - - - - 3 60
15 Metronidazol susp 125 mg/5 mL Btl 20 - 20 1 - 19 19 - - - - - - - 1 30
16 Nistatin drop 100.000 IU/ml Btl 12 - 12 - - 12 12 - - - - - - - - -
17 Obat batuk hitam (OBH) sirup Btl 23 - 23 - - 23 23 - - - - - - - - -
18 Parasetamol drops 100 mg/ml Btl 149 - 149 3 - 146 146 100 - 100 5 - 95 95 4 -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
19 Parasetamol sirup 120 mg/5 ml Btl 115 - 115 7 - 108 108 75 - 75 62 - 13 13 10 -
20 Pirantel pamoat susp sirup 125 mg/5 ml Btl - - - - - - - - - - - - - - - -
21 Procuma sirup Btl 133 - 133 2 - 131 131 165 - 165 165 - - - 3 -
22 Sefadroksil sirup kering 125 mg/5 ml Btl 72 - 72 45 - 27 27 50 - 50 25 - 25 25 63 -
23 sefadroxil sirup kering 250 mg /forte Btl 41 - 41 1 - 40 40 50 - 50 65 - - 15 - 15 1 -
24 setirizin 5mg / 5 ml Btl 124 - 124 5 - 119 119 100 - 100 16 - 84 84 7 -
25 Sukralfat susp 500 mg/ 5ml Btl - - - - - - - - - - - - - - - -
26 Zink sirup 20mg/ 5ml Btl 48 - 48 5 - 43 43 20 - 20 6 - 14 14 7 -
TAMBAHAN - - - - - - - - - - - - - - - -
1 Becefort syrup - - - - - - - - - - - - - - - -
2 Imbos Syrup - - - - - - - 6 - 6 8 - - 2 - 2 - -
LARUTAN - - - - - - - - - - - - - - - -
1 Alkazyme Bks 25 - 25 - - 25 25 25 - 25 - - 25 25 - -
2 Alkacide btl 1 - 1 - - 1 1 1 - 1 - - 1 1 - -
3 Bromhexin (Bisolvon) Btl 1 - 1 1 - - - - - - - - - - 1 30
4 Etanol 70 % 1000 ml Btl 64 - 64 1 - 63 63 - - - - - - - 1 30

5 Etakridinn laktat 0,1% (rivanol) Btl 5 - 5 - - 5 5 5 - 5 5 - - - - -
6 Fenoterol HBR 0,1 % (Berotec) Btl - - - - - - - - - - - - - - - -
7 Fenol gliserol 10 % tetes telinga Btl - - - - - - - - - - - - - - - -
8 Gentamisin 0,3 % tetes mata Btl 40 - 40 31 - 9 9 36 - 36 36 - - - 43 -
9 Gentian violet 1 % Btl 53 - 53 - - 53 53 24 - 24 11 - 13 13 - -
10 Glukosa 10 % (D.10) 500 ml Btl 9 - 9 - - 9 9 - - - - - - - - -
11 Glukosa 40 % (D.40) 25 ml Btl - - - - - - - - - - - - - - - -
12 Glukosa 5 % (D.5) 500 ml Btl 25 - 25 1 - 24 24 10 - 10 - - 10 10 1 -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
13 KA-EN 1 B 500 ml Btl 16 - 16 - - 16 16 16 - 16 16 - - - - -
14 KA-EN 3 B 500 ml Btl 30 - 30 10 - 20 20 30 - 30 22 - 8 8 14 -
15 kloramfenikol Tetes mata Btl - - - - - - - - - - - - - - - -
16 Kloramfenikol 3% tetes telinga Btl - - - - - - - - - - - - - - - -
17 Lysol 1 liter Btl 1 - 1 - - 1 1 - - - - - - - - -
18 Metronidazol infus 5 mg/ml Btl 3 - 3 - - 3 3 2 - 2 - - 2 2 - -
19 Natrium klorida 0,9 % (NACL) 500 ml Btl 19 - 19 8 - 11 11 30 - 30 30 - - - 11 -
20 Povidon iodin 10 % 30 ml Btl 12 - 12 - - 12 12 14 - 14 8 - 6 6 - -
21 Povidon iodin 10 % 300 ml Btl 12 - 12 - - 12 12 4 - 4 - - 4 4 - -
22 Parasetamol infus 10 mg/ml Btl 6 - 6 - - 6 6 6 - 6 - - 6 6 - -
23 Ringer laktat (RL) 500 ml Btl 112 - 112 82 - 30 30 118 - 118 103 - 15 15 115 -
TAMBAHAN - - - - - - - - - - - - - - - -
1 Bayclin Btl - - - - - - - - - - - - - - - -
2 larutan disenfektan karbol Btl 38 - 38 - - 38 38 11 - 11 11 - - - - -

3 Sabun cuci tangan 34 - 34 17 - 17 17 - - - - - - - 24 510
4 Alkohol 1 liter - - - - - - - - - - - - - - - -
5 antiseptic gel - - - - - - - - - - - - - - - -
SERUM DAN VAKSIN - - - - - - - - - - - - - - - -
1 Serum anti bisa ular (A.B.U l) Vial 2 - 2 - - 2 2 2 - 2 2 - - - - -
2 Serum anti tetanus inj.1.500 iu / ( a.t.s ) Amp - - - - - - - - - - - - - - - -

3 Vaksin anti rabies/ VAR/ Verorab Vial 6 - 6 - - 6 6 - - - - - - - - -
4 Vaksin BCG Vial 8 - 8 - - 8 8 20 - 20 27 - - 7 - 7 - -
5 Vaksin campak Vial - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
6 Vaksin hepatitis (HBO) Bayi Pouches 5 - 5 - - 5 5 24 - 24 34 - - 10 - 10 - -
7 Vaksin hepatitis Bayi (HBIG) Pouches - - - - - - - - - - - - - - - -
8 Vaksin hepatitis B dewasa Pouches - - - - - - - - - - - - - - - -
9 Vaksin jerap difteri tetanus (DT) < 7 th Vial 10 - 10 - - 10 10 - - - - - - - - -
10 Vaksin jerap difteri tetanus (TD) ≥ 7 th Vial 11 - 11 - - 11 11 - - - - - - - - -
11 Vaksin kombinasi DPT-HB-Hib Vial 32 - 32 - - 32 32 70 - 70 80 - - 10 - 10 - -
12 Vaksin polio ipv 0,5 ml (i.m.) Vial 6 - 6 - - 6 6 10 - 10 - - 10 10 - -
13 Vaksin polio t-opv drops 10 dosis Vial 7 - 7 - - 7 7 40 - 40 50 - - 10 - 10 - -
14 vaksin MR Vial 8 - 8 - - 8 8 40 - 40 40 - - - - -
BAHAN HABIS PAKAI (BHP)/PERBEKKES - - - - - - - - - - - - - - - -
1 Alat suntik sekali pakai 0,05 ml Set 100 - 100 - - 100 100 100 - 100 - - 100 100 - -
2 Alat suntik sekali pakai 0,5 ml Set 20,658 - 20,658 - - 20,658 20,658 10,300 - 10,300 10,500 - - 200 - 200 - -
3 Alat suntik sekali pakai 1 ml Set 206 - 206 - - 206 206 200 - 200 - - 200 200 - -
4 Alat suntik sekali pakai 3 ml Set 421 - 421 - - 421 421 400 - 400 110 - 290 290 - -
5 Alat suntik sekali pakai 5 ml Set 376 - 376 - - 376 376 400 - 400 200 - 200 200 - -
6 Alat suntik sekali pakai 10 ml Set 22 - 22 5 - 17 17 20 - 20 20 - - - 7 -
7 Alat suntik sekali pakai 15 ml Set - - - 4 - - 4 - 4 - - - - - - - 6 120
8 Alkohol swabs Pcs 10,307 - 10,307 6 - 10,301 10,301 400 - 400 400 - - - 8 180
9 Antiseptik gel 500 ml Btl 42 - 42 - - 42 42 54 - 54 54 - - - - -
10 Bisturi uk.20 Pcs 13 - 13 - - 13 13 - - - - - - - - -
11 Bisturi uk.21 Pcs 5 - 5 - - 5 5 - - - - - - - - -
12 Blood transfusi set Set 30 - 30 1 - 29 29 30 - 30 20 - 10 10 1 -
13 Cat gut chromic 2/0 Pcs 48 - 48 1 - 47 47 42 - 42 18 - 24 24 1 -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
14 Cat gut chromic 3/0 Pcs - - - 16 - - 16 - 16 - - - 24 - - 24 - 24 22 480
15 Cat gut plain 2/0 Sak 30 - 30 37 - - 7 - 7 26 - 26 2 - 24 24 52 -
16 Cat gut plain 3/0 Sak 26 - 26 16 - 10 10 32 - 32 7 - 25 25 22 -
17 Folly catheter No.16 pcs 6 - 6 - - 6 6 12 - 12 12 - - - - -
18 Folly catheter No.18 pcs 8 - 8 - - 8 8 3 - 3 - - 3 3 - -
19 I.V. catheter No.18 pcs 68 - 68 21 - 47 47 50 - 50 - - 50 50 29 -
20 I.V. catheter No.20 pcs 28 - 28 - - 28 28 20 - 20 40 - - 20 - 20 - -
21 I.V. catheter No.22 pcs 25 - 25 - - 25 25 5 - 5 15 - - 10 - 10 - -
22 I.V. Catheter No.24 pcs 29 - 29 - - 29 29 20 - 20 25 - - 5 - 5 - -
23 I.V. Catheter No.26 pcs - - - - - - - - - - - - - - - -
24 Infus set anak pcs 6 - 6 - - 6 6 - - - - - - - - -
25 Infus set dewasa pcs 27 - 27 20 - 7 7 10 - 10 40 - - 30 - 30 28 -
26 Jarum (needle) 23 Pcs 13 - 13 1 - 12 12 - - - - - - - 1 30
27 Jarum (needle) 27 Pcs 15 - 15 - - 15 15 - - - - - - - - -

28 K.y jelly 82 gram Tube 4 - 4 6 - - 2 - 2 - - - - - - - 8 180
29 Kapas pembalut/absorben 250 gram Bks 3 - 3 - - 3 3 - - - - - - - - -
30 Kasa pembalut hidrofil 4 m x 3 cm Roll 30 - 30 - - 30 30 25 - 25 - - 25 25 - -
31 Kasa pembalut hidrofil 4 m x 5 cm Roll 20 - 20 - - 20 20 - - - - - - - - -
32 Kasa pembalut hidrofil 4 m x 10 cm Roll 15 - 15 - - 15 15 - - - - - - - - -
33 Kasa pembalut hidrofil 4 m x 15 cm Roll 20 - 20 - - 20 20 20 - 20 - - 20 20 - -

34 Kasa kompres 40/40 steril Roll 61 - 61 - - 61 61 40 - 40 - - 40 40 - -
35 Kasa 40 m x 80 cm Roll - - - 4,862 - - 4,862 - 4,862 4 - 4 4 - - - 6,807 -
36 Kasa pembalut 2 m x 80 cm Roll 8 - 8 - - 8 8 4 - 4 4 - - - - -

,Pangkalan Bun,31 Desember 2012
Kotawaringin Barat
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)

27 2012 - - 27 27 10 - 10 - - 10 10 - -
38 Kertas puyer biasa Pack 4 Kotawaringin- Barat 4 - - 4 4 6 - 6 4 - 2 2 - -
39 Kertas puyer press Pack 900 - 900 - - 900 900 900 - 900 - - 900 900 - -
40 Kondom Sutra pcs - - - - - - - - - - - - - - - -

- 4,888 - - 4,888 4,888 50 - 50 50 - - - - -
NIP: 19750508 199903 1 002
42 Masker N 95 pcs 40 - 40 - - 40 40 40 - 40 - - 40 40 - -
43 Penjepit tali pusat Pcs - - - 200 - - 200 - 200 - - - - - - - 280 6,000
44 penghisap lendir pcs 44 - 44 - - 44 44 20 - 20 2 - 18 18 - -
45 Plastik klip pembungkus obat 8,7 x 13 cm Lbr 1,000 - 1,000 - - 1,000 1,000 1,000 - 1,000 - - 1,000 1,000 - -
46 Plastik klip pembungkus obat 8,7 x 5 cm Lbr 500 - 500 - - 500 500 500 - 500 - - 500 500 - -
47 Plester 1,25 X 4,5 m Roll - - - - - - - - - - - - - - - -

,MENGETAHUI
- Kesehatan
- - - - - - - - - - - - - -
49 Plester bulat/ plesterin pcs 600 - 600 32 - 568 568 400 - 400 - - 400 400 45 960
50 Plester cannofix pcs 40 - 40 - - 40 40 40 - 40 - - 40 40 - -

- SAKTI,M.Kes
- - - - - - - - - - - - - -
NIP: 19610521 199303 1 004
52 Plester hypafix Roll 4 - 4 - - 4 4 3 - 3 - - 3 3 - -
53 Safety box Bh 9 - 9 - - 9 9 33 - 33 - - 33 33 - -
54 Sarung tangan non steril Uk. S Psg 2,233 - 2,233 - - 2,233 2,233 100 - 100 100 - - - - -
55 Sarung tangan non steril Uk. M Psg 33 - 33 - - 33 33 - - - - - - - - -
56 Sarung tangan non steril Uk. L Psg 6,894 - 6,894 - - 6,894 6,894 100 - 100 100 - - - - -
57 Sarung tangan steril ginekologi Psg - - - 6 - - 6 - 6 3 - 3 - - 3 3 8 -
58 Sarung tangan steril No.6 Psg - - - 3 - - 3 - 3 - - - - - - - 4 90
59 Sarung tangan steril No.6,5 Psg 53 - 53 5 - 48 48 - - - - - - - 7 -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
60 Sarung tangan steril No.7 Psg 3 - 3 - - 3 3 - - - - - - - - -
61 Sarung tangan steril No.7,5 Psg 4 - 4 2 - 2 2 - - - - - - - 3 -
62 Sarung Tangan steril no.8 Psg 81 - 81 1 - 80 80 29 - 29 - - 29 29 1 -
63 Selang oksigen anak Pcs 10 - 10 - - 10 10 5 - 5 3 - 2 2 - -
64 Selang oksigen bayi Pcs 24 - 24 - - 24 24 20 - 20 5 - 15 15 - -

65 Selang oksigen dewasa Pcs 1 - 1 - - 1 1 9 - 9 - - 9 9 - -
66 Sendok kertas puyer Pcs - - - - - - - - - - - - - - - -
67 Silk (benang bedah sutra ) No. 2/0 Sak 40 - 40 10 - 30 30 46 - 46 10 - 36 36 14 -
68 Silk (benang bedah sutra) No. 3/0 Sak 9 - 9 1 - 8 8 - - - - - - - 1 -
69 Speculum Uk S pcs - - - - - - - - - - - - - - - -
70 Speculum Uk M pcs - - - - - - - - - - - - - - - -
71 Speculum Uk L pcs - - - - - - - - - - - - - - - -
72 Speculum logam (Marwa) pcs - - - 164 - - 164 - 164 - - - - - - - 230 4,920
73 Underpads Pcs 29 - 29 - - 29 29 35 - 35 - - 35 35 - -
74 Urin bag Pcs 4 - 4 - - 4 4 17 - 17 - - 17 17 - -
75 Wing needle no 27 G Pcs 34 - 34 - - 34 34 71 - 71 - - 71 71 - -
TAMBAHAN - - - - - - - - - - - - - - - -
1 Back pack sprayer Pcs - - - - - - - - - - - - - - - -
2 Rapid test covid-19 Pcs 205 - 205 35 - 170 170 130 - 130 130 - - - 49 -
3 Rapid test antigen Pcs 25 - 25 - - 25 25 - - - - - - - - -
4 Masker KN 95 - - - - - - - - - - - - - - - -
5 Masker N95 - - - - - - - - - - - - - - - -
6 Masker Bedah - - - - - - - - - - - - - - - -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
7 Kacamata google - - - - - - - - - - - - - - - -
8 Face shield Nagita 35 - 35 - - 35 35 - - - - - - - - -
9 Face shield naik turun - - - - - - - - - - - - - - - -
10 Face shield - - - - - - - - - - - - - - - -
11 Sepatu boot - - - - - - - - - - - - - - - -
12 Baju Hazmat kain - - - - - - - - - - - - - - - -
13 Baju Hazmat cuci ulang - - - - - - - - - - - - - - - -
14 Hand schoon M - - - - - - - - - - - - - - - -
15 Hand schoon L - - - - - - - - - - - - - - - -
16 Hand schoon s - - - - - - - - - - - - - - - -
17 Hand schoon steril no 7,5 - - - - - - - - - - - - - - - -
18 Helm kuning ( Face shild kaca mika - - - - - - - - - - - - - - - -
19 APD - - - - - - - - - - - - - - - -
20 APD SET HIJAU - - - - - - - - - - - - - - - -

21 APD BOHO - - - - - - - - - - - - - - - -
22 APD LEVEL 2 - - - - - - - - - - - - - - - -
23 APD LEVEL 3 - - - - - - - - - - - - - - - -
24 APD PEMDA/DONASI - - - - - - - - - - - - - - - -
25 APD 1 SET - - - - - - - - - - - - - - - -
26 GOWN 20 - 20 - - 20 20 20 - 20 20 - - - - -
27 COOL BOK 6 LITER - - - - - - - - - - - - - - - -
28 COOL BOK 12,5 LITER - - - 35 - - 35 - 35 - - - - - - - 49 1,050
BAHAN & ALAT LABORATORIUM - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
1 Asam asetat (Cuka) Btl - - - - - - - - - - - - - - - -
2 Alat pulmo (peak flow) set 1 - 1 - - 1 1 - - - - - - - - -
3 Bilik hitung Pcs 2 - 2 - - 2 2 - - - - - - - - -
4 Blood lancet Pcs 980 - 980 - - 980 980 1,200 - 1,200 900 - 300 300 - -
5 Bulb pipet Bh 1 - 1 - - 1 1 - - - - - - - - -
6 Cartrialge genexpert KIT set - - - - - - - - - - - - - - - -
7 CD-4 Pima Pcs - - - - - - - - - - - - - - - -
8 Compresson nebulizer pcs - - - - - - - - - - - - - - - -
9 Disposible pipet Pcs - - - - - - - - - - - - - - - -
10 Dropper 80 mm Pcs - - - - - - - - - - - - - - - -
11 Dropper besar Pcs - - - - - - - - - - - - - - - -
12 Jarum Vacutainer Pcs - - - - - - - - - - - - - - - -
13 Kaca slide/ Kaca objek Set 216 - 216 - - 216 216 216 - 216 216 - - - - -
14 KIT diagnostic untuk HIV Pcs - - - - - - - - - - - - - - - -

15 KIT RPR pcs - - - - - - - - - - - - - - - -
16 Kotak slide Pcs 2 - 2 - - 2 2 - - - - - - - - -
17 Lampu spiritus 150 ml Pcs 1 - 1 - - 1 1 - - - - - - - - -
18 Lancet aktiv BD 1,8 Pcs - - - - - - - - - - - - - - - -
19 Lancet blue 1,5 Pcs - - - - - - - - - - - - - - - -
20 Medline Pcs - - - - - - - - - - - - - - - -
21 Microhematokrit tube wax Pcs 1 - 1 - - 1 1 - - - - - - - - -
22 Mikro tube (Vol 1,5 ml) Pcs 50 - 50 - - 50 50 - - - - - - - - -
23 Mikroskope cover glasses 18x18 mm Pcs 138 - 138 - - 138 138 100 - 100 100 - - - - -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
27 Nebulizer Bh - - - - - - - - - - - - - - - -
28 Peak flow meter Pcs 1 - 1 - - 1 1 - - - - - - - - -
29 Pen lancet Pcs 7 - 7 - - 7 7 - - - - - - - - -
30 Pengukur tinggi badan Pcs - - - - - - - - - - - - - - - -
31 Pipet eritrosit Pcs 2 - 2 - - 2 2 - - - - - - - - -
32 Pipet HB Pcs 1 - 1 - - 1 1 - - - - - - - - -
33 Pipet leukosit Pcs 2 - 2 - - 2 2 - - - - - - - - -
34 Pipet tips universal 10 ui Pcs - - - - - - - - - - - - - - - -
35 Pipet westergren Bh 1 - 1 - - 1 1 - - - - - - - - -
36 Pot dahak Pcs 126 - 126 - - 126 126 60 - 60 60 - - - - -
37 Pot urine Pcs - - - 5 - - 5 - 5 - - - - - - - 7 150

38 Rak staenles tes tube Test 1 - 1 - - 1 1 - - - - - - - - -
39 Rapid test pemeriksaan DBD/ NS-1 Test - - - - - - - - - - - - - - - -
40 Rapid Test pemeriksaan Hepatitis Anti - HBS Test - - - - - - - - - - - - - - - -
41 Rapid Test pemeriksaan Hepatitis Anti - HBS Test - - - - - - - - - - - - - - - -
42 Rapid Test pemeriksaan Hepatitis Anti - HCV Test - - - 8 - - 8 - 8 - - - - - - - 11 240
43 Rapid Test pemeriksaan Hepatitis HBSAG Test 82 - 82 - - 82 82 469 - 469 82 - 387 387 - -
44 Rapid Test pemeriksaan Hepatitis HCV Test - - - - - - - - - - - - - - - -
45 Rapid Test pemeriksaan Hepatitis HIV Diagnostar Test - - - - - - - - - - - - - - - -
46 Rapid test pemeriksaan HIV (SD BIO) Test - - - - - - - 50 - 50 50 - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
47 Rapid test pemeriksaan HIV (VIKIA) Test - - - - - - - - - - - - - - - -
48 Rapid test pemeriksaan HIV (FOKUS) Test 174 - 174 - - 174 174 150 - 150 150 - - - - -
49 Rapid test pemeriksaan malaria Test 25 - 25 - - 25 25 25 - 25 25 - - - - -
50 Reagen Cell clean Btl - - - - - - - - - - - - - - - -
51 Rapid Test pemeriksaan sipilis Btl 110 - 110 - - 110 110 50 - 50 50 - - - - -
52 Reagen Giemsa Btl 1 - 1 - - 1 1 - - - - - - - - -
53 Reagen Gol Darah Btl 1 - 1 - - 1 1 - - - - - - - - -
54 Reagen Gol darah anti D Btl 1 - 1 - - 1 1 - - - - - - - - -
55 Reagen Immersion Btl 1 - 1 - - 1 1 - - - - - - - - -
56 Reagen Stromatolyer Btl - - - 3 - - 3 - 3 - - - - - - - 4 90
57 Reagen Ziehl Neelson Pcs 2 - 2 9 - - 7 - 7 2 - 2 2 - - - 13 270
58 RPR Sipilis fokus Pcs 100 - 100 - - 100 100 100 - 100 100 - - - - -
59 Spritus Btl - - - - - - - - - - - - - - - -
60 Tabung hematokrit heparin Pcs - - - 3 - - 3 - 3 - - - - - - - 4 90

61 Tabung hematokrit non heparin Pcs - - - 13 - - 13 - 13 - - - - - - - 18 390
62 Tabung vacutainer edta warna ungu Pcs 128 - 128 1,224 - - 1,096 - 1,096 - - - - - - - 1,714 36,720
63 Test asam urat Pcs 199 - 199 6 - 193 193 200 - 200 199 - 1 1 8 180
64 Test gluco protein urine Pcs 55 - 55 1 - 54 54 3 - 3 3 - - - 1 -
65 Test iodium Pcs - - - - - - - - - - - - - - - -
66 Test kehamilan / PP test Test 52 - 52 - - 52 52 - - - - - - - - -

67 Test kolestrol Tube 260 - 260 - - 260 260 - - - - - - - - -
68 Test pemeriksaan gula darah Pcs 1,447 - 1,447 - - 1,447 1,447 1,400 - 1,400 1,400 - - - - -
69 Test pemeriksaan HB Test 129 - 129 - - 129 129 100 - 100 100 - - - - -
JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
70 Test Pemeriksaan Urine 10 Parameter Test 63 - 63 - - 63 63 - - - - - - - - -
71 Tipe mikro pipet warna biru Test 423 - 423 - - 423 423 - - - - - - - - -
72 Tipe mikro pipet warna kuning Test 555 - 555 - - 555 555 - - - - - - - - -
73 Tipe mikro pipet warna putih Test - - - - - - - - - - - - - - - -
74 Tisue mikroskop Pcs 1 - 1 - - 1 1 - - - - - - - - -
75 Tube microtainer/ mierogard EDTA Pcs - - - - - - - - - - - - - - - -
76 Tube mikro (Vol 1,5 ml) Pcs 50 - 50 - - 50 50 - - - - - - - - -
77 Tube mikro (Vol 2 ml) Pkt - - - - - - - - - - - - - - - -
TAMBAHAN - - - - - - - - - - - - - - - -
1 Rapid Test pemeriksaan Hepatitis HIV Diagnostar 3 90 - 90 - - 90 90 - - - - - - - - -
BAHAN GIGI - - - - - - - - - - - - - - - -
1 Bahan tambahan light curing - - - - - - - - - - - - - - - -
2 Bahan tumpatan (fuji GC 1-1 Ekstra) Pack - - - - - - - - - - - - - - - -
3 Bor Diamond RA Student Kit (Edenta) Kit - - - - - - - - - - - - - - - -

4 Bonding resine Btl - - - - - - - - - - - - - - - -
5 Caviton Btl - - - - - - - - - - - - - - - -
6 Cellopand strip swenska Pack 1 - 1 - - 1 1 - - - - - - - - -
7 Devitalisasi pasta Btl - - - - - - - - - - - - - - - -
8 Etil klorida semprot 100 ml Btl - - - - - - - - - - - - - - - -
9 Etching SDI liquid / Acid ethan liquid Btl - - - - - - - - - - - - - - - -

10 Eugenol cairan Btl - - - - - - - - - - - - - - - -
11 Endometason Pcs - - - - - - - - - - - - - - - -
12 Jarum ekterpasi (exterpatie swenska) Pack 1 - 1 - - 1 1 - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
13 Fraser / Bentuk silinder Bh 1 - 1 - - 1 1 - - - - - - - - -
14 Glass ionomer FUJI GC ekstra 1-1 (hijau) Ktk - - - - - - - - - - - - - - - -
15 Gutta percha poins Ktk - - - - - - - - - - - - - - - -
16 H-file Pcs - - - - - - - - - - - - - - - -
17 K-file Pcs - - - - - - - - - - - - - - - -
18 Kalsium hidroksida pasta Ktk - - - - - - - - - - - - - - - -
19 Kertas artikulasi (articulating paper) Pack 1 - 1 - - 1 1 - - - - - - - - -
20 Klorfenol kamfer mentol (CHKM) Btl - - - - - - - - - - - - - - - -
21 Lentulo merk VDW Germany (ANTAEOS) Pcs - - - - - - - - - - - - - - - -
22 Lidokain gel 2 % btl - - - - - - - - - - - - - - - -
23 Lidokain Spray (xylocain) btl - - - - - - - - - - - - - - - -
24 Mata bor mikromotor (RA) Pack - - - - - - - - - - - - - - - -
25 Mata bor white stone Set - - - - - - - - - - - - - - - -
26 Mata bor hand place (FG diamond) Set - - - - - - - - - - - - - - - -

27 Mata bor tulang / Oral surgery (meisenger) Pcs 5 - 5 - - 5 5 - - - - - - - - -
28 Needle olyco / Jarum carpule Pcs - - - - - - - - - - - - - - - -
29 Needle Septoject Pcs 200 - 200 - - 200 200 - - - - - - - - -
30 Oil spray Btl - - - - - - - - - - - - - - - -
31 Paper points Ktk 1 - 1 - - 1 1 - - - - - - - - -
32 Penghisap ludah (tips suetion) Pcs - - - - - - - - - - - - - - - -

33 Komposit resin (solare x) Tube - - - - - - - - - - - - - - - -
34 Semen seng fosfat Ktk - - - - - - - - - - - - - - - -
35 Silver amalgam (serbuk + cair) Sak - - - - - - - - - - - - - - - -

JUMLAH JUMLAH
STOCK STOCK STOCK

GUDANG OPTIMUM
KOSONG
AN PUSKESMAS (40 %)
36 Siver amalgam (serbuk) Btl - - - - - - - - - - - - - - - -
37 Solare X A2 Bh - - - - - - - - - - - - - - - -
38 Solare X A3 Bh - - - - - - - - - - - - - - - -
39 Silver amalgram (cair) Btl - - - - - - - - - - - - - - - -
40 Spon Hemostatis pcs - - - - - - - - - - - - - - - -
41 TKF (tri kesol formalin) Btl - - - - - - - - - - - - - - - -
UMUM
ASKES JUMLAH
TIDAK
92 167 356 615


NIP: 19691104 199203 1 002 NIP: 19810223 200604 2 006 .NIP: 19820121 201001 1 011
LAPORAN
BULAN : MEI
TAHUN : 2021
JUMLAH PERMINTAA
KEBUTUHA N ALASAN SUMBER ALASAN
N PUSKESMAS
APBN HIBAH ED
- 180 Sep-2021
- 295
- 406 Jan-2022
-
1,915 -
- 772 Jan-2022
- 319 Nov-2023
- 1,552 Feb-2022
-
- 1,000
- 100
- 1,266 Jul-2022
- 300
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 165 Nov-2023
- 765 Aug-2021
- 1,000
- 286 Dec-2021
- 1,584 Jul-2022
- 416 Jul-2022
- 780 Feb-2023
7 Jan-2023
-
23 100
40
- 100
- 301 May-2023
- 417 Jul-2022
- 544 Mar-2022
- 1,431
1,537 500
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 1,000 May-2021
- 630
10,362
- Feb-2023
- 2,098 Sep-2021
- 235 Jul-2021
- 800
-
- 2,836
- 3,419
- 200
- 352 Jun-2023
- 500 Sep-2023
-
-
- 454 Dec-2021
- 1,819 Mar-2022
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
311
246
- 69
- 616 May-2022
- 850 Apr-2022
- 1,000
520 Feb-2022
- 783 Aug-2024
-
-
- 14 300
- 126 1,000
- 1,480
- 360 Apr-2023
- 1,070 Oct-2022
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 913 Sep-2024
204 500
280 1,200
- 1,515 Feb-2023
- 35
- 240
150
- 500
-
- 1
- 280
-
276 1,000
- 270
- 2,624
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 89
- 947
- 1,462
- 10
772
- 305 100
314 500
- 1,091
- 1,175
1,963 2,000
- 293
-
275 300
- 1,078
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 246
8,698
- 50
103
- 1,650
- 710
- 933
2,449 300
90
- 189
- 80
-
-
-
- 10
- 33
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 3
- 3 10
- 40
- 97
- 42
- 10 30
- 18
-
-
- 30
- 7
- 182
- 24
- 30
- 10
97
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 30
18
54 50
190
- 21
31
32
- 118
- 100
- 10 20
-
20
- 95
- 219
- 40
- 30
- 100
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 100
- 10
314
- 51
- 19 25
- 55
- 25
- 15
378 25
- 65
- 50
- 14 25
- 10 5
- 56
151
- 57
- 40
- 37
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 15
- 35
- 10
- 18
- 20
-
-
- 77
- 71
- 19 200
- 72
- 13 100
- 52
- 130
- 54
- 32
- 87
54 60
12 50
- 12
- 23 100
- 142
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 98
- 128
36
- 39 50
- 112
- 36
- 25
- 1
31
- 32
- 5
-
-
34
- 53
- 9
- 23
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 16
- 6
- 1
- 3
- 12
- 12
- 6
85
- 38
517
- 2
-
- 6
- 8
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 5
- 10
- 11
- 32
- 6
- 7
- 8
- 100
- 20,658
- 206
- 421
- 376
- 10
130
- 10,113
- 42
- 13
- 5
- 28
- 46
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
518 50
59 25
12
- 6 10
- 8 10
- 18
- 28 20
- 25 10
- 29 5
- 25
- 6 50
21 50
19
- 15
190
- 3
- 30
- 20
- 15
- 20 30
- 61 30
11,669 4
- 8
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 27
- 4
- 900
- 4,888
- 40
6,480 50
- 44
- 1,000
- 500
437
- 40
-
- 4 5
- 9 15
- 2,233
- 33
- 6,894
14
97
- 41
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 3
1 50
- 79
- 10
- 24
- 1 10
- 16
- 7 25
-
-
5,314
- 29
- 4
- 34
-
-
- 121
- 25
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 35
-
-
- 20
-
1,134
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 1
- 2
- 980
- 1
- 216
-
-
- 2
- 1
-
- 1
- 50
- 138
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 1
- 7
- 2
- 1
- 2
- 1
- 126
162
- 1
259
- 82
-
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 174
- 25
- 110
- 1
- 1
- 1
- 1
97
290
- 100
97
421
39,530
- 5
- 53
- 52
- 260
- 1,447
- 129
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 63
- 423
- 555
- 1
- 50
- 90
-
-
- 1
-
-
- 1
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
- 1
- 1
-
- 5
- 200
- 1
-
-
-
JUMLAH PERMINTAA
N PUSKESMAS
APBN HIBAH ED
Petugas Puskesmas

..NIP: 19870406 201101 1 004
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TABLET
3 Ambroksol 30 mg Tab 0 10 20 0 0 0 10 100 0 20 10 0 0 0 5 43 10 10 20 0 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 10 10 10 10 0 10 90 0 0 10 20 0 40 30 100 0 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 10 0 0 15 10 0 0 0 10 0 10 0 10 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 10 0 0 30 20 0 6 10 10 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 10 0 0 0 0 10 0 0 0 50 0 0 10 0 0 0 10 10 0 0 0 0 0 0 0 0 0


53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 30 0 0 100 0 0 60 0 0 20 0 20 0 10 30 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 10 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 10 0 0 0 0 0 0 0 0 0


82 Metformin 500 mg Tab 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 16 60 13 12 0 30 42 0 20 0 0 0 10 25 23 6 20 28 0 0 0 0 0 0 0 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28


31 Piracetam 1 gr Amp 0 0 2 2 0 1 3 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MENGETA
,HUI
34 Sefotaksim
Kepala serb. inj 1000 mg Vial 0 0 0 0 0 0 0 0 0 0 2 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 1 2 1 2 1 3 1 0 0 4 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28




20 Nistatin 100.000 IU Supp 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0





1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 30 31 TOTAL
0 0 0 4
0 0 0 0
0 0 0 258
0 0 0 0
0 0 0 16
0 0 0 10
0 0 0 340
0 0 0 0
0 0 0 132
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 100
0 0 0 0
0 0 0 0
0 0 0 30
0 0 0 20
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 30
0 0 0 87
0 0 0 65
0 0 0 30
0 0 0 200
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 30
0 0 0 0
0 0 0 96
0 0 0 10
0 0 0 22
0 0 0 360
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 30
0 0 0 20
0 0 0 0
0 0 0 100
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 270
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 73
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 40
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 20
0 0 0 212
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 20
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 50
0 0 0 0
0 0 0 140
0 0 0 0
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 24
0 0 0 600
0 0 0 12
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 50
0 0 0 10
0 0 0 0
29 30 31 TOTAL
0 0 0 10
0 0 0 50
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 44
0 0 0 40
0 0 0 0
0 0 0 0
0 0 0 305
0 0 0 0
0 0 0 0
0 0 0 276
0 0 0 60
0 0 0 0
0 0 0 250
0 0 0 0
0 0 0 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 20
0 0 0 20
0 0 0 440
0 0 0 0
0 0 0 30
0 0 0 10
0 0 0 40
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 15
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 0
0 0 0 3
29 30 31 TOTAL
0 0 0 3
0 0 0 0
0 0 0 0
0 0 0 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 63
0 0 0 9
0 0 0 0
0 0 0 0
0 0 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 32
0 0 0 0
0 0 0 18
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 3
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 3
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 1
0 0 0 1
0 0 0 0
0 0 0 5
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 1
29 30 31 TOTAL
0 0 0 1
0 0 0 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 7
0 0 0 0
0 0 0 40
0 0 0 0
0 0 0 7
0 0 0 4
0 0 0 0
0 0 0 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 22
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 16
0 0 0 0
0 0 0 21
0 0 0 6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 4
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 4
0 0 0 6
0 0 0 11
0 0 0 9
0 0 0 1
0 0 0 0
0 0 0 16
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 5
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 2
0 0 0 0
0 0 0 4
0 0 0 0
0 0 0 0
0 0 0 6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
29 30 31 TOTAL
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TABLET
3 Ambroksol 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Ampicilin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Asiklovir 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Asiklovir 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Atapulgit 630 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Atropin 0,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Asam folat 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Digoksin 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 Fenitoin 30 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Fenitoin 100 mg Kaps 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Furosemid 40 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

45 Ibuprofen 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Ibuprofen 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


51 Kandesartan 8 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Kaptopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Kaptopril 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

64 Klozapin 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klozapin 100 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kuinin 222 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loratadin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


82 Metformin 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
88 Mineral Mix Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


95 Nifedipin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Nifedipin 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Nistatin 500.000 IU Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



109 Pirasetam 400 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Pirasetam 1200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

113 Prednison 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Primakuin 15 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
118 Ranitidin 150 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


125 Setirizin 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
126 Simetidin 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Livron B Plex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Oseltamivir 75 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
INJEKSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Antrain Inj Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Atropin 0,25 mg/ml Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



22 Lidokain 2 % Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


31 Piracetam 1 gr Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 MENGETA
,HUI
Sefotaksim Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dinas
35 Seftriakson
Kabupate
36 Vitamin
Kotawarin
gin Barat Amp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN
drg.INDRA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WAN
SAKTI,MK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
es
NARKOTIKA
19610521
1 Diazepam
004
3 Diazepam 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Diazepam 5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Kodein 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Klobazam 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30




20 Nistatin 100.000 IU Supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30





TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Becefort syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Imbos Syrup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LARUTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkazyme Bks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alkacide btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Etanol 70 % 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


10 Glukosa 10 % (D.10) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Glukosa 40 % (D.40) 25 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Glukosa 5 % (D.5) 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 KA-EN 1 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 KA-EN 3 B 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Lysol 1 liter Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bayclin BTL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Alkohol 1 liter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 antiseptic gel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SERUM DAN VAKSIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
4 Vaksin BCG Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


14 vaksin MR Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 ADS 0,05 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0,5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 ADS 5 ML 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Safety box 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VAKSIN SINOVAC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 Bisturi uk.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisturi uk.21 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cat gut plain 2/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Cat gut plain 3/0 Sak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Jarum (needle) 23 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Jarum (needle) 27 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


35 Kasa 40 m x 80 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
40 Kondom Sutra pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Masker N 95 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

47 Plester 1,25 X 4,5 m Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Safety box Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
69 Speculum Uk S pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Speculum Uk M pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Speculum Uk L pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Underpads Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Urin bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rapid test covid-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Masker KN 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Masker N95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Masker Bedah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kacamata google 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Face shield 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Sepatu boot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Baju Hazmat kain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand schoon M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Hand schoon L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Hand schoon s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 APD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 APD SET HIJAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 APD BOHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 APD LEVEL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 APD LEVEL 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 APD PEMDA/DONASI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 APD 1 SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 GOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 COOL BOK 6 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 COOL BOK 12,5 LITER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 ANAFILATIK KIT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bilik hitung Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Blood lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Bulb pipet Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 CD-4 Pima Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Dropper 80 mm Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 KIT RPR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kotak slide Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Lancet blue 1,5 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
20 Medline Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Nebulizer Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Pen lancet Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Pipet HB Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Pot dahak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Pot urine Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


59 Spritus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

65 Test iodium Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
TAMBAHAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAHAN GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Caviton Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Endometason Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 H-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 K-file Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lidokain gel 2 % btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 Oil spray Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Paper points Ktk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37 Solare X A2 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Solare X A3 Bh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
MARIYANI
0 0 NIP: 19750812 200003 2 003
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
SONNY SAPUTRA,SKM
NIP: 19750508 199903 1 002
Kotawaringin Barat
0 0
0 0
NIP: 19750508 199903 1 002
0 0
0 0
0 0
0 0
0 0
0 0
,MENGETAHUI
0 0
0 0
NIP: 19610521 199303 1 004
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
31 TOTAL
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
,Yang
Yang
Menerima/Melapor
Menyerahkan
Pimpinan
Petugas
Instalasi Farmasi
...............................................
...............................................
.......................................
.......................................
NIP: 19800211 200312 2 011 ::NIP
NIP

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KODE PUSKESMAS : P6201062202

GUDANG GUDANG GUDANG GUDANG

4 Aminofilin 200 mg Tab - - - - - - - - - - - - - - -

10 Ampicilin 500 mg Tab - - - - - - - - - - - - - - -

12 Asam asetilsalisilat (asetosal) 100 mg Tab - - - - - - - - - - - - - - -

15 Asam traneksamat 500 mg Tab - - - - - - - - - - - - - - -

GUDANG GUDANG GUDANG GUDANG

16 Asiklovir 200 mg Tab 60 - 60 40 60 - 40 20 - - - - - - - 56 1,200 1,236

19 Atropin 0,5 mg Tab - - - - - - - - - - - - - - -

21 Asam folat 1 mg Tab - - - 10 - 10 - - - - - - - - - -

22 Bisakodil (dulkolax) 5 mg Tab - - - - - - - - - - - - - - -

28 Dietilkarbamazepin 100 mg Tab - - - - - - - - - - - - - - -

29 Ergotamin kafein kombinasi (antimigren) Tab - - - - - - - - - - - - - - -

31 Fenitoin 30 mg Kaps 100 - 100 - 100 - 100 - - - - - - - - - - 100

32 Fenitoin 100 mg Kaps 100 - 100 - 100 - 100 - - - - - - - - - - 100

33 Flukonazol 150 mg Tab - - - - - - - - - - - - - - -

GUDANG GUDANG GUDANG GUDANG

41 Haloperidol 1,5 mg Tab - - - - - - - - - - - - - - -

45 Ibuprofen 200 mg Tab - - - 80 - 80 - - - - - - - - - -

48 Isoniazid oral 100 mg Tab - - - - - - - - - - - - - - -

49 Kalium diklofenak 50 mg Tab - - - - - - - - - - - - - - -

55 Karbamazepin 200 mg Tab 200 - 200 - 200 - 200 - - - - - - - - - - 200

58 Klindamisin 150 mg kaps - - - - - - - - - - - - - - -

GUDANG GUDANG GUDANG GUDANG

62 Klorpromazin hcl 25 mg Tab - - - - - - - - - - - - - - -

65 Klozapin 100 mg Tab 70 - 70 1 69 - 69 - - - - - - - 1 30 - 38

66 Kombinasi dihidro artemisin piperakuin (act/dhp) Tab - - - - - - - - - - - - - - -

69 Kuinin 222 mg Tab - - - - - - - - - - - - - - -

74 MDT FB anak (obat kusta) Pkt - - - - - - - - - - - - - - -

75 MDT FB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -

77 MDT MB dewasa (obat kusta) Pkt - - - - - - - - - - - - - - -

78 Mebendazol 100 mg Tab - - - - - - - - - - - - - - -

79 Meloksikam 7,5 mg Tab 30 - 30 30 - - - - - - - - - - 42 900 942

GUDANG GUDANG GUDANG GUDANG

86 Metronidazol 250 mg Tab - - - - - - - - - - - - - - -

88 Mineral Mix Sak 40 - 40 - 40 - 40 40 - 40 - 40 - 40 - - - 40

90 Multivitamin ibu hamil (hemafort) Tab - - - 60 - 60 - - - - - - - - - -

92 Natrium bikarbonat 500 mg Tab - - - - - - - - - - - - - - -

94 Natrium diklofenak 50 mg Tab - - - - - - - - - - - - - - - - -

95 Nifedipin 10 mg Tab 120 - 120 - 170 - 50 120 - - - - - - - - - - 120

97 Nistatin 500.000 IU Tab 82 - 82 82 - - - 100 - 100 100 - - - 115 - 115

100 OAT Kategori I Pkt 2 2 - - 2 2 2 2 - - 2 2 - - - 2

101 OAT Kategori II Pkt - - - - - - - - - - - - - - -

102 OAT Kategori I Kombipak Pkt - - - - - - - - - - - - - - -

104 Ofloksasin 400 mg Tab - - - - - - - - - - - - - - -

GUDANG GUDANG GUDANG GUDANG

109 Pirasetam 400 mg Tab - - - - - - - - - - - - - - -

110 Pirasetam 1200 mg Tab - - - - - - - - - - - - - - -

111 Piroksikam 10 mg Tab - - - - - - - - - - - - - - -

114 Primakuin 15 mg Tab - - - - - - - - - - - - - - -

115 Propiltiourasil 100 mg Tab - - - - - - - - - - - - - - -

118 Ranitidin 150 mg Tab - - - - - - - - - - - - - - -

119 Risperidon 1 mg Tab - - - - - - - - - - - - - - -

120 Risperidon 2 mg Tab - - - - - - - - - - - - - - -

124 Sefiksim 400 mg + Azitromisin 1000 mg Tab - - - - - - - - - - - - - - -

126 Simetidin 200 mg Tab - - - - - - - - - - - - - - -

130 Spironolakton 25 mg Tab - - - - - - - - - - - - - - - -

GUDANG GUDANG GUDANG GUDANG

132 Trifluoperazin 5 mg Tab - - - - - - - - - - - - - - -

133 Triheksifenidil 2 mg Tab - - - - - - - - - - - - - - -

134 Triheksifenidil 5 mg Tab - - - - - - - - - - - - - - -

1 Becefort 800 800 - - 800 800 800 800 - - - - - - - 800