1.

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

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP

SATUAN KERJA : Dinas kesehatan pengendalian penduduk dan keluraga berencana

NO NAMA OBAT SATUAN SISA STOK PER 31

DESEMBER 2020

(a)
1 Abacavir 300 mg Tablet/kaplet/kapsul 0
2 Air untuk injeksi Botol 100 ml 0
3 Air untuk injeksi Botol 250 ml 0
4 Air untuk injeksi ampul/vial/botol 10 mL 0
5 Air untuk injeksi amp 20 ml ampul/vial/botol 0
6 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 82
7 Albendazol susp 200 mg/5 ml Botol 0
8 Albendazol tab 400 mg tablet/kapsul/kaplet 690
9 Alopurinol tab 100 mg Tab 850
10 Alopurinol tab 300 mg tablet/kapsul/kaplet 0
11 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0
12 Aminofilin tab 150 mg tablet/kapsul/kaplet 0
13 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0
14 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 0
15 Amlodipin tab 10 mg tablet/kapsul/kaplet 0
16 Amlodipin tab 5 mg tablet/kapsul/kaplet 0
17 Amoksisilin drops 100 mg/ml Botol @20 ml 0
18 Amoksisilin drops 100 mg/ml Botol @10 ml 0
19 Amoksisilin drops 100 mg/ml Botol @15 ml 0
20 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0
21 Amoksisilin sir kering 125 mg/5 ml Botol 98
22 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0
23 Amoksisilin tab 500 mg tablet/kapsul/kaplet 5100
24 Ampisilin serb inj 1000 mg/vial ampul/vial 0
25 Ampisilin serb inj 250 mg/vial Vial 0
26 Anestetik lokal gigi kombinasi : lidokain hcl 2% ampul/vial 0
+ epinefrin 1 : 80.000 inj 2 ml
27 Antasida, kombinasi : aluminium hidroksida tablet/kapsul/kaplet 2900
200 mg + magnesium hidroksida 200 mg
28 Antasida, kombinasi : aluminium hidroksida botol 60 ml 0
200 mg + magnesium hidroksida 200 mg
29 Anti Parkinson kombinasi : benzerasid 25 mg + Kaps 0
levodopa 100 mg
30 Antifungi salep, kombinasi : asam benzoat 6%+ pot 30 g 50
asam salisilat 3%
31 Antihemoroid, kombinasi: bismut subgalat 150 Suppositoria 0
mg + heksaklorofen 2,5 mg + lidokain lidokain
10 mg+ seng oksida 120 mg + sup ad 2 g

32 Aquadest cairan 500 ml Botol 500 ml 0

33 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial 0
34 Articulating paper kertas warna penanda oklusi Kertas warna penanda okl 0

35 Asam asetat tetes telinga 2% Botol 0

36 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet 0
37 Asam askorbat (vitamin C) tab 250 mg Tab 0
38 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet 4800
39 Asam folat tab 0,4 mg tablet/kapsul/kaplet 1000
40 Asam folat tab 1 mg tablet/kapsul/kaplet 0
41 Asam folat tab 5 mg Tab 0
42 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0
43 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/kap 1250
44 Asam retinoat krim 0,05% Tube/pot 0
45 Asam retinoat krim 0,1% Tube @ 20 gram 0
46 Asam retinoat krim 0,1% Tube @ 10 gram 0
47 Asam salisilat lar 0,1% Botol 0
48 Asam salisilat salep 10% Tube 0
49 Asam salisilat salep 2% Tube 0
50 Asam salisilat salep 5% Tube 0
51 Asiklovir tab 200 mg tablet/kapsul/kaplet 0
52 Asiklovir tab 400 mg tablet/kapsul/kaplet 300
53 Atapulgit 600 mg tablet/kapsul/kaplet 0
54 Atapulgit tab 630 mg tablet/kapsul/kaplet 0
55 Atapulgit tablet 650 mg tablet/kapsul/kaplet 656
56 Atapulgit tablet 750 mg Tab 0
57 Atenolol tab 100 mg tablet/kapsul/kaplet 0
58 Atenolol tab 50 mg tablet/kapsul/kaplet 0
59 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0
60 Atropin tab 0,5 mg Tab 0
61 Bahan tumpatan sementara lar, serb Botol 0
62 Bedak salisil serb 2% Dus/Sachet/Plastik 59
63 Betahistin tab 6 mg tablet/kapsul/kaplet 0
 64 Betametason krim 0,1% tube 5 gram 0
65 Betametason krim 0,5 mg/g Tube 5
66 Betametason salep 0,1% tube 5 gram 0
67 Betametason tts mata 1 mg/ml botol @5 ml 0
68 Betametason tts mata 1 mg/ml catchcover, botol 0,6 mL 0
69 Bisakodil sup 10 mg Suppositoria 0
70 Bisakodil sup 5 mg Suppositoria 0
71 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0
72 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0
73 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules 0

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

75 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules 0

76 Budesonid serb ih 100 mcg/dosis Botol 0

77 Budesonid serb ih 200 mcg/dosis 200 dosis 0
78 Budesonid serb ih 200 mcg/dosis 100 dosis 0
79 Copper T set/buah 0
80 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 160
81 Deksametason tab 0,5 mg tablet/kapsul/kaplet 0
82 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0
83 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 0
84 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 0
85 Diazepam tab 2 mg tablet/kapsul/kaplet 100
86 Diazepam tab 5 mg tablet/kapsul/kaplet 0
87 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0
88 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 0
89 Digoksin tab 0,25 mg tablet/kapsul/kaplet 200
90 Diltiazem kaps SR 100 mg Kapsul lepas lambat 0
91 Diltiazem kaps SR 200 mg Kapsul lepas lambat 0
92 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 600
93 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 500
94 Dolutegravir tab 50 mg tablet/kapsul/kaplet 0
95 Domperidon susp 5 mg/5 ml botol @60 ml 0
96 Domperidon tab 10 mg tablet/kapsul/kaplet 700
97 Efavirenz tab 200 mg Tablet 0
98 Efavirenz tab sal 600 mg tablet salut selaput/kaple 0
99 Epinefrin (adrenalin) inj 1 mg/ml Ampul 0
100 Ergotamin tab 1 mg Tab 0
101 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0
102 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0
103 Eritromisin tab 500 mg tablet/kapsul/kaplet 0
104 Estrogen terkonjugasi tab sal 0,625 mg tablet salut gula/kaplet sa 0
105 Etambutol tab 400 mg tablet/kapsul/kaplet 0
106 Etanol 70% cairan 70% Botol 6
107 Etil klorida semprot 100 ml Botol 0
108 Etonogestrel implan 68 mg Set 0
109 Eugenol Botol 0
110 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml 0
111 Fenitoin Na kaps 100 mg Kaps 0
112 Fenitoin Na kaps 30 mg Kaps 0
113 Fenobarbital tab 100 mg Tab 0
114 Fenobarbital tab 30 mg tablet/kapsul/kaplet 300
115 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 0

116 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 0

117 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 0

118 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 1900
119 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/kaplet sa 0
120 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 200
121 Fluoksetin kaps 20 mg tablet/kapsul/kaplet 0
122 Fluor kapl 1 mg Kaplet 0
123 Fluor sediaan topikal Tube 0
124 Formokresol Botol 0
125 Framisetin Sulfat Tulle 1% Patch 0
126 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0
127 Furosemid tab 40 mg tablet/kapsul/kaplet 2150
128 Galactose microparticle 200-400 mg Vial 0
micropart/ml
129 Garam Fe, setara dengan Fe elemental 15 mg/5 Botol 0
mL
130 Garam Fe, setara dengan Fe elemental 60 mg Botol 0
131 Garam Fe, setara dengan Fe elemental 60 mg Sachet 0
132 Garam oralit kombinasi : natrium klorida 0,52 g sachet 0
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g
+ glukosa anhidrat 2,7 g
133 Gentamisin salep mata 0,3% Tube 0
134 Gentamisin tts mata 0,3% Botol 0
135 Glass ionomer ART (Atraumatic Restorative Sachet 0
Treatment) cocoa butter 5 g
136 Glass ionomer ART (Atraumatic Restorative Botol 0
Treatment) lar
137 Glass ionomer ART (Atraumatic Restorative Vial 0
Treatment) serb
138 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0
139 Glibenklamid tab 5 mg tablet/kapsul/kaplet 1100
140 Glikuidon tab 30 mg tablet/kapsul/kaplet 0
141 Glimepirid tab 1 mg tablet/kapsul/kaplet 0
142 Glimepirid tab 2 mg tablet/kapsul/kaplet 100
143 Glipizid tab 5 mg tablet/kapsul/kaplet 0
144 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0
145 Gliserin tts 100 mg/ml Botol 64
146 Glukosa Larutan Infus 10% steril 100 ml Botol 0
147 Glukosa Larutan Infus 10% steril 250 ml Botol 0
148 Glukosa Larutan Infus 10% steril 500 ml Botol 1
149 Glukosa Larutan Infus 40% Ampul @25 ml 0
150 Glukosa Larutan Infus 5% steril 100 ml Botol 0
151 Glukosa Larutan Infus 5% steril 250 ml Botol 0
152 Glukosa Larutan Infus 5% steril 500 ml Botol 0
153 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet 0
154 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet 0
155 Gutta percha dan paper points 15 - 40 mm Roll 0
156 Gutta percha dan paper points 45 - 80 mm Roll 0
157 Haloperidol inj 5 mg/ml (i.m.) Vial 0
158 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0
159 Haloperidol tab 1,5 mg tablet/kapsul/kaplet 395
160 Haloperidol tab 2 mg tablet/kapsul/kaplet 0
161 Haloperidol tab 5 mg tablet/kapsul/kaplet 200
162 Haloperidol tts 2 mg/ml botol 0
163 Hepatitis B imunoglobulin (human) inj 150 Ampul 0
IU/1,5 ml
164 Hidrogen peroksida cairan 3% Botol 0
165 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 2300
166 Hidrokortison krim 2,5% tube @ 5 g 67
167 Hidrokortison serb inj 100 mg Vial 0
168 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet 0
169 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul 0

170 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul 0

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

172 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0
173 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0
174 Ibuprofen tab 400 mg tablet/kapsul/kaplet 0
175 Ipratropium bromida aerosol 20 mcg/semprot Botol 0

176 Ipratropium bromida cairan ih 0,025% Botol 0

177 Isoniazid tab 100 mg Tab 0
178 Isoniazid tab 300 mg Tab 0
179 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 4300
180 IUD Cu T 380 A Set 0
181 IUD Levonorgestrel Set 0
182 Kalamin Tube 0
183 Kalsium glukonat inj 100 mg/ml ampul/vial 20
184 Kalsium hidroksida bubuk, pasta Tube 0
185 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0
186 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet 2600
187 Kaptopril tab 12,5 mg tablet/kaplet 600
188 Kaptopril tab 25 mg tablet/kaplet 0
189 Kaptopril tab 50 mg tablet/kaplet 0
190 Karbamazepin sir 100 mg/5 ml Botol 0
191 Karbamazepin tab 100 mg Tab 0
192 Karbamazepin Tab 200 mg Tablet 0
193 Karbogliserin tts telinga 10 % Botol 0
194 Ketokonazol tab 200 mg tablet/kapsul/kaplet 900
195 Klindamisin kaps 150 mg Kaps 0
196 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0
197 Klofazimin, micronized kaps 50 mg Kapsul 0
198 Klofazimin, micronizedkaps 100 mg kapsul 0
199 Klonidin tab 0,15 mg tablet/kapsul/kaplet 0
200 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0
201 Kloramfenikol salep 2% tube 15g 0
202 Kloramfenikol salep mata 1% tube @ 5 gram 0
203 Kloramfenikol serb inj 1.000 mg/ml vial/ampul 0
204 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0
205 Kloramfenikol tetes telinga 3% Botol 0
206 Kloramfenikol tts mata 0,5% botol 0
207 Kloramfenikol tts mata 1% Botol 0
208 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 6547
209 Klorfenol kamfer mentol (CHKM) Botol 0
210 Klorheksidin lar 0,2% Botol 0
211 Klorheksidin lar 15% Botol 0
212 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 39
213 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0
214 Klorpromazin tab sal 100 mg tablet salut selaput/kaple 0
215 Klorpromazin tab sal 25 mg Tab sal 0
216 Klortalidon tab 50 mg Tab 0
217 Klozapin tab 100 mg tablet 0
218 Klozapin tab 25 mg tablet 0
219 Kodein tab 10 mg tablet/kapsul/kaplet 0
220 Komb: Deksametason 0,1% Thymol 5% Botol 0
Paraklorphenol 30
221 Kombinasi (DHP) : dihidroartemisin 40 mg + tablet salut selaput/kaple 0
Piperakuin 320 mg tab sal selaput
222 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 Tab dispersible 0
mg + Nevirapin 50 mg) Ped Triple FDC
223 Kombinasi : artemether 20 mg + lumefantrin tablet/kapsul/kaplet 0
120 mg
224 Kombinasi : Desogestrel 150 mcg Etinilestradiol Tab 0
30 mcg
225 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0
226 Kombinasi : Ferro fumarat 60 mg + asam folat tablet salut gula 0
0,4 mg tab salut
227 Kombinasi : levonorgestrel 150 mcg + tab salut gula 0
etinilestradiol 30 mcg
228 Kombinasi : Tenofovir 300 mg + Emtrisitabin Tab 0
200 mg
229 Kombinasi : Tenofovir 300 mg + Lamivudin 300 Tab 0
mg + Efavirenz 600 mg
230 Kombinasi : zidovudin 300 mg +lamivudin 150 Tab 0
mg
231 Kombinasi: Ipratropium bromida 0,5 mg + Ampul/vial 35
Salbutamol 2,5 mg, cairan ih
232 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 30
233 Kombinasi: lopinavir 200 mg + ritonavir (LVP) Tab 0
50 mg, tab 250 mg
234 Kombinasi: Tenofovir 300 mg + Lamivudin 300 Tablet/kapsul/kaplet 0
mg + Dolutegravir 50 mg, tablet
235 Komibinasi: lidokain + medisinal creosote Botol 0
phenol + eugenol + benzil alkohol, cairan
236 Komposit resin Set 0
237 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 800
sulfametoksazol 400 mg+ trimetoprim 80 mg
238 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0
sulfametoksazol 800 mg+ trimetoprim 160 mg

239 Kotrimoksazol kombinasi tiap 5 ml suspensi : botol 60 mL 375

sulfametoksazol 200 mg + trimetoprim 40 mg

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

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

246 Larutan mengandung Elektrolit (KCl 0,15%, Botol 0

NaCL 0,9%) (KN1)
247 Larutan mengandung Elektrolit (KCl 0,3%,NaCl Botol 0
0,9%) (KN2)
248 Larutan mengandung Elektrolit (Na 130 mEq, K Softbag @ 500 ml 0
4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
Ringer Asetat
249 Larutan mengandung Elektrolit (Na 130 mEq, K Botol plastik @ 500 ml 0
4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
Ringer Asetat
250 Larutan mengandung Elektrolit (Sodium Botol 0
Lactate sol (50%) 113 gr/L, Potassium Chloride
0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
251 Larutan mengandung Elektrolit (Tiap 1000 ml Botol 0
mengandung electrolit: Sodium 145 mmol/l,
Potassium 4.0 mmol/l, Calcium 2.5 mmol/l,
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)

252 Larutan mengandung Karbohidrat (Fructose Botol 0

120 g, glucose 66 g, Xylitol 60 g/ L)
253 Larutan mengandung Karbohidrat (Fructose 15 softbag 0
mg, glucose monohydrate 30 mg, xylitol 15 mg)

254 Larutan mengandung Karbohidrat (Fructose Botol 0

200 g, glucose 110 g, Xylitol 100 g/ L)
255 Larutan mengandung Karbohidrat (Fructose 60 Botol 0
g, glucose 33 g, Xylitol 30 g/ L)
256 Larutan mengandung Karbohidrat (Maltose Botol 0
10%)
257 Larutan mengandung Karbohidrat + Elektrolit Botol plastik @500 ml 0
(25.00g dextrose anhidrat, 3.00 g sodium
chloride, 0.15 g potassium chloride, 0.10 g
calcium chloride dihydrate dan 1.55 g sodium
lactate)

258 Larutan mengandung Karbohidrat + Elektrolit Botol plastik @500 ml 0

(25.00g maltose, 3.00 g sodium chloride, 0.15 g
potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)

259 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)

260 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Dextrose 5%, NaCL 0,45%, KCl) (HSD)

261 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Fructose 120 g, glucose 66 g, Xylitol 60 g/ L +
elektrolit)
262 Larutan mengandung Karbohidrat + Elektrolit Botol 0
(Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium
Laktat 3,1 g, air untuk injeksi ad 1000 ml)

263 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Glukosa 55 g ; Natrium Chloride 9 g, air untuk
injeksi ad 1000 ml) (D5-NS)
264 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0
(Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS)
265 Larutan mengandung Karbohidrat + Elektrolit Botol 0
(Glukosa: 25,0 g; NaCl: 4,5 g)
266 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 500 mL 0
(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS)

267 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 100 mL 0

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS)

268 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS)

269 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Larutan nutrisi kombinasi infus per L: Na.
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl
90mEQ, Asetat 38mEQ, Sorbitol 50g)

270 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(Larutan Ringer & Glukosa 5%)
271 Larutan mengandung Karbohidrat + Elektrolit Botol 0
(NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)

272 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr)

273 Larutan mengandung Karbohidrat + Elektrolit Botol 0

(NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g,
Glukosa 100 gr)
274 Larutan mengandung Karbohidrat + Elektrolit Botol 34
(Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr,
Dekstrosa 27 gr) (KA EN 3B)
275 Larutan mengandung Karbohidrat + Elektrolit Botol 57
(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr
Dekstrosa 27 gr) (KA EN 3A)
276 Levonorgestrel implan 2 rods, 75 mg (3-4 pack/ sachet/ set 0
tahun)
277 Lidokain gel 2% syringe/syringe plastik 0
278 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0
279 Lidokain salep 5% Tube 0
280 Lidokain spray oral 10% botol 0
281 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0
282 Liquor carbonis detergens lar 5% Botol 0
283 Loperamid tab 2 mg Tab 0
284 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput 0
285 Loratadin tab 10 mg tablet/kapsul/kaplet 0
286 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0
287 Lorazepam tab 1 mg tablet/kapsul/kaplet 0
288 Lorazepam tab sal 2 mg Tab sal 0
289 Lugol Botol 0
290 Magnesium sulfat inj 20% ampul/vial @25 ml 0
291 Magnesium sulfat inj 20% ampul/vial 0
292 Magnesium sulfat inj 40% ampul/vial @25 ml 0
293 Magnesium sulfat inj 40% ampul/vial 0
294 Magnesium sulfat serb, ktg 30 g Sachet 0
295 Manitol lar infus 20% Botol @ 500 ml 0
296 Manitol lar infus 20% Botol @ 100 ml 0
297 Manitol lar infus 20% Botol @ 250 ml 0
298 Mebendazol sir 100 mg/5 ml Botol 0
299 Mebendazol tab 100 mg Tan 0
300 Mebendazol tab 500 mg tablet/kapsul/kaplet 0
301 Medroksi progesteron asetat inj 150 mg/ml ampul/vial 0
302 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial 0
303 Metenamin mandelat (heksamin mandelat) tab Tab salut 0
salut enterik 500 mg
304 Metformin tab 500 mg tablet/kapsul/kaplet 600
305 Metformin tab 850 mg tablet/kapsul/kaplet 0
306 Metilergometrin inj 0,2 mg/ml ampul/vial 0
307 Metilergometrin tab salut 0,125 mg tablet/kaplet salut selapu 500
308 Metilprednisolon inj 125 mg/2 ml ampul/vial 0
309 Metoklopramid inj 5 mg/ml ampul/vial 0
310 Metoklopramid tab 10 mg tablet/kapsul/kaplet 0
311 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0
312 Metronidazol lar inf 5 mg/ml botol 4
313 Metronidazol susp 125 mg/5 ml Botol @ 60 ml 0
314 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0
315 Metronidazol tab 250 mg tablet/kapsul/kaplet 0
316 Metronidazol tab 500 mg tablet/kapsul/kaplet 300
317 Mikonazol krim 2% tube 254
318 Mikonazol serb 2% botol / sachet 0
319 Mineral Mix (Bismuth Subcitrate Tripotasium, Sachet 0
Copper sulfate, Magnesium Chloride
Anhydrous, Potassium Chloride, Zinc Acetate)

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

321 NaCl 0,9% Larutan Botol @25 ml 0
322 NaCl 0,9% Larutan Botol @100 ml 0
323 NaCl 0,9% Larutan Botol @1.000 mL 0
324 NaCl 0,9% Larutan Botol @250 ml 0
325 NaCl 0,9% Larutan Botol @500 ml 72
326 NaCl 0,9% Larutan Ampul/botol @ 10 mL 0
327 NaCl 3% Larutan Botol plastik @500 ml 0
328 Natrium diklofenak tab 25 mg tablet salut enterik/kaple 1800
329 Natrium diklofenak tab 50 mg tablet salut enterik/kaple 0
330 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0
331 Natrium hipoklorit cairan konsentrat 5% Botol 0
332 Natrium tiosulfat inj 25% (i.v.) Ampul 0
333 Nevirapin tab 200 mg tablet/kapsul/kaplet 0
334 Nifedipin kaps 10 mg tablet/kapsul/kaplet 0
335 Nistatin susp 100.000 UI/ml botol/vial 0
336 Nistatin tab salut 500.000 UI tablet salut gula/kaplet sa 0
337 Nistatin tab vaginal 100.000 UI tablet/kaplet 200
338 Nitrofurantoin tab 50 mg Tab 0
339 Norepinefrin inj 1 mg/ml ampul/vial 0
340 Obat Anti Tuberculosis FDC Kategori Anak paket 0
341 Obat Anti Tuberculosis FDC Kategori I paket 0
342 Obat Anti Tuberculosis FDC Kategori II paket 0
343 Obat Anti Tuberculosis FDC Kategori Sisipan paket 0
344 Obat Anti Tuberculosis Kombipak Anak Paket 0
345 Obat Anti Tuberculosis Kombipak Dewasa paket 0
346 Oksigen ih, gas dlm tabung Botol 0
347 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0
348 Oksimetazolin tts hidung 0,050% botol @ 10 mL 0
349 Oksitetrasiklin 1% Salep Mata tube 0
350 Oksitosin inj 10 UI/ml ampul/vial 0
351 Olopatadin tts mata 0,1% Botol 0
352 Omeprazol inj 40 mg/10 ml ampul/vial 0
353 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0
354 Paraformaldehid tab 1 g Tab 0
355 Parasetamol sir 120 mg/5 ml botol @ 60 mL 276
356 Parasetamol tab 500 mg tablet/kapsul/kaplet 5600
357 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 23
358 Pasta devitalisasi (non arsen) Tube 0
359 Pasta pengisi saluran akar (pasta) Tube 0
360 Perak nitrat lar 20% Botol 0
361 Perak sulfadiazin krim 1% Tube 1
362 Permetrin krim 5 % Tube 10 g 15
363 Permetrin krim 5 % Tube 30 g 0
364 Permetrin krim 5 % Tube 15 g 0
365 Pirantel pamoat susp 125 mg/5 ml Botol 0
366 Pirantel pamoat tab 500 mg Tab 0
367 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet 0
368 Pirantel pamoat tab scored 250 mg Tab 0
369 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0
370 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 3000
371 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet 0
372 Povidon iodin lar 100 mg/ml botol 30 mL 30
373 Povidon iodin lar 100 mg/ml botol @ 60 mL 0
374 Povidon iodin lar 100 mg/ml Botol 300 ml 40
375 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0
376 Prednison tab 5 mg tablet/kapsul/kaplet 650
377 Primakuin tab 15 mg Tab 0
378 Probenesid tab 500 mg tablet/kapsul/kaplet 0
379 Prokain benzilpenisilin serb inj 3 juta UI/vial ampul/vial 0
(i.m.)
380 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0
381 Propranolol tab 10 mg tablet/kapsul/kaplet 300
382 Ranitidin tab 150 mg tablet/kapsul/kaplet 0
383 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak 500
384 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak 400
385 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0
386 Rifapentin tablet 150 mg Tablet/kapsul/kaplet 0
387 Ringer Laktat Larutan Botol 0
388 Risperidon tab sal 1 mg tablet/kapsul/kaplet 707
389 Risperidon tab sal 2 mg tablet/kapsul/kaplet 0
390 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0
391 Salbutamol sir 2 mg/5 ml Botol 0
392 Salbutamol tab 2 mg tablet/kapsul/kaplet 2100
393 Salbutamol tab 4 mg tablet/kapsul/kaplet 300
394 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram 63
belerang endap 4 %
395 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 15 gram 0
belerang endap 4 %
396 Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0
397 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 0
398 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL 0
399 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL 0
400 Serum anti bisa ular : A.B.U. I (khusus ular dari Vial 0
luar Papua) inj (i.m./i.v.)
401 Serum anti bisa ular :A.B.U.II (khusus ular dari Vial 0
Papua) inj (i.m./i.v.)
402 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial 0
10.000 UI/
403 Serum antirabies inj 100 UI/ml Vial 0
404 Serum antirabies inj 200 UI/ml Vial 0
405 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 Vial 0
UI/vial (i.m /i.v.)
406 Serum antitetanus (A.T.S) inj 1500 UI/amp Ampul 0
(i.m.)
407 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m Vial 0
/i.v.)
408 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial 0

409 Setirizin sir 5 mg/5 ml. botol @ 60 mL 5

410 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial 0

411 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet 1800

412 Simvastatin tab sal 10 mg tablet/kapsul/kaplet/table 0
413 Simvastatin tab sal 20 mg tablet/kapsul/kaplet/table 780
414 Simvastatin tab sal selaput 40 mg Tab sal 0
415 Siprofloksasin tab scored 500 mg tablet salut selaput/kaple 0
416 Spironolakton tab 25 mg tablet/kapsul/kaplet 0
417 Stannous pyrophosphate 27,6 mg sodium Vial 0
pyrophosphate/vial
418 Streptomisin serb inj 1.000 mg/vial ampul/vial 0
419 Surgical ginggival pack Tube 0
420 Tenofovir tab 300 mg tablet salut selaput/kaple 0
421 Terbutalin cairan ih 2,5 mg/ml Botol 0
422 Terbutalin inj 0,5 mg/ml ampul/vial 0
423 Tetanus toxoid inj Ampul 0
424 Tetrakain tts mata 0,5% Botol 0
425 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0
426 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0
427 Tetrasiklin Salep Mata 1% Tube 0
428 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 1000
429 Timolol tts mata 0,25% botol @ 5 mL 0
430 Timolol tts mata 0,5% botol @ 5 mL 0
431 Urea krim 10 % Tube/pot 0
432 Urea krim 20 % Tube/pot 0
433 Vaksin BCG inj (i.k) Vial 0
434 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0
435 Vaksin Hepatitis Rekombinan Inj Prefilled Vial 0
Injection Device (Uniject) 0,5 ml (i.m)
436 Vaksin HPV (Human Papilloma Virus), vial 0,5 Ampul/vial 0
mL
437 Vaksin Influenza Vial 0
438 Vaksin Japanese Enchepalitis (J.E) Vial 0
439 Vaksin jerap difteri tetanus (DT) Vial 0
440 Vaksin jerap difteri tetanus (Td) Vial 0
441 Vaksin kombinasi DPT-HB-Hib Vial 0
442 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial 0
443 Vaksin Meningitis Meningokokus Vial 0
444 Vaksin polio IPV inj 0,5 ml Vial 0
445 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial 0
booster
446 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0
447 Vaksin Yellow Fever Vial 0
448 Valproat sir 250 mg/5 ml botol @ 120 ml 13
449 Valproat tab sal 250 mg tablet salut enterik/ kaple 0
450 Vitamin B kompleks tablet 2400
451 Vitamin C 500 mg minimal non acidic 250 mg Tablet/kapsul/kaplet/tab s 0
452 Zidovudin kaps 100 mg tablet/kapsul/kaplet 0
453 Zinc drops 10 mg/ml Botol 0
454 Zinc serb 10 mg Sachet 0
455 Zinc sir 20 mg/5 ml botol 0
456 Zinc tab disp 20 mg tablet dispersible 0
ATUAN KERJA
AN UNTUK DIADAKAN TAHUN 2021
A PER BULAN DI SATKER SELAMA TAHUN 2020
DITAMBAH PREDIKSI PENGADAAN TAHUN 2021 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2020)
LAMA 2020 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET /
G BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2021
HUN 2022 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN D
ATKER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2021
AIK E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2022

TINGKAT PERTAMA (FKTP) TAHUN 2022

PREDIKSI PEMAKAIAN PREDIKSI SISA STOK 31 JUMLAH RENCANA

PENGADAAN RATA-RATA PER DESEMBER 2021 KEBUTUHAN KEBUTUHAN
TAHUN 2021 BULAN SELAMA TAHUN 2022 TAHUN 2022
2020

(b) (c) (d) = (a)+(b)-(12x(c)) (e) = (c) x 18 (f) = (e) - (d)

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
450 24 244 432 188
0 0 0 0 0
0 0 690 0 -690
126000 400 122050 7200 -114850
2000 200 0 3600 3600
0 0 0 0 0
0 0 0 0 0
8950 500 2950 9000 6050
5300 300 1700 5400 3700
113700 7830 19740 140940 121200
124200 8490 22320 152820 130500
0 0 0 0 0
10 5 0 90 90
0 0 0 0 0
0 0 0 0 0
9611 32 9325 576 -8749
0 0 0 0 0
191800 5000 136900 90000 -46900
950 33 554 594 40
0 0 0 0 0
 1510 55 850 990 140

168094 10800 41394 194400 153006

21970 32 21586 576 -21010

0 0 0 0 0

1559 32 1225 576 -649

1240 60 520 1080 560

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

200 22 0 396 396

19450 400 14650 7200 -7450
13000 520 6760 9360 2600
98100 4200 52500 75600 23100
36050 1890 14370 34020 19650
27500 1200 13100 21600 8500
0 0 0 0 0
0 0 0 0 0
164650 1455 148440 26190 -122250
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
29250 650 21450 11700 -9750
27250 2890 0 52020 52020
31100 300 27500 5400 -22100
0 0 0 0 0
10000 450 5256 8100 2844
0 0 0 0 0
300 15 120 270 150
300 15 120 270 150
95 7 11 126 115
0 0 0 0 0
51 3 15 54 39
3343 128 1866 2304 438
0 0 0 0 0
 6121 67 5317 1206 -4111
0 0 5 0 -5
0 0 0 0 0
150 6 78 108 30
0 0 0 0 0
310 8 214 144 -70
4285 9 4177 162 -4015
6650 25 6350 450 -5900
500 12 356 216 -140
0 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 1 38 18 -20
0 0 0 0 0
4800 8 4864 144 -4720
158044 7500 68044 135000 66956
135 3 99 54 -45
135 6 63 108 45
219 2 195 36 -159
380 30 120 540 420
5312 170 3272 3060 -212
0 0 0 0 0
2509 15 2329 270 -2059
5460 20 5420 360 -5060
0 0 0 0 0
0 0 0 0 0
0 0 600 0 -600
5320 40 5340 720 -4620
0 0 0 0 0
3769 23 3493 414 -3079
65200 3890 19220 70020 50800
0 0 0 0 0
0 0 0 0 0
264 15 84 270 186
3000 200 600 3600 3000
22400 600 15200 10800 -4400
4602 7 4518 126 -4392
13000 400 8200 7200 -1000
0 0 0 0 0
0 0 0 0 0
559 25 265 450 185
270 4 222 72 -150
0 0 0 0 0
 128 2 104 36 -68
0 0 0 0 0
100 10 0 180 180
0 0 0 0 0
1000 100 0 1800 1800
3590 140 2210 2520 310
0 0 0 0 0

0 0 0 0 0

531 2 507 36 -471

15630 4 17482 72 -17410
1675 30 1315 540 -775
200 20 160 360 200
0 0 0 0 0
0 0 0 0 0
5 1 0 18 18
52 0 52 0 -52
0 0 0 0 0
380 7 296 126 -170
39300 980 29690 17640 -12050
0 0 0 0 0

0 0 0 0 0

51710 0 51710 0 -51710

0 0 0 0 0
0 0 0 0 0

1265 19 1037 342 -695

300 11 168 198 30
51 2 27 36 9

3 2 0 36 36

3 2 0 36 36

0 0 0 0 0
70400 2390 42820 43020 200
0 0 0 0 0
0 0 0 0 0
26000 700 17700 12600 -5100
0 0 0 0 0
0 0 0 0 0
70 2 110 36 -74
0 0 0 0 0
 0 0 0 0 0
740 20 501 360 -141
0 0 0 0 0
10 1 0 18 18
0 0 0 0 0
1184 40 704 720 16
13640 488 7784 8784 1000
500 35 80 630 550
6 2 0 36 36
6 1 0 18 18
126 4 78 72 -6
200 30 0 540 540
7165 100 6360 1800 -4560
0 0 0 0 0
13640 350 9640 6300 -3340
0 0 0 0 0
0 0 0 0 0

220 8 124 144 20

13800 750 7100 13500 6400
0 0 67 0 -67
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
46800 1980 23040 35640 12600
143600 4570 88760 82260 -6500
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10700 580 8040 10440 2400
5 1 0 18 18
0 0 0 0 0
200 27 0 486 486
438 13 302 234 -68
0 0 0 0 0
500 160 0 2880 2880
90694 3200 54894 57600 2706
116295 9800 0 176400 176400
238710 8500 136710 153000 16290
10500 490 4620 8820 4200
 0 0 0 0 0
0 0 0 0 0
16430 789 6962 14202 7240
350 12 206 216 10
37944 200 36444 3600 -32844
17485 320 13645 5760 -7885
17000 566 10208 10188 -20
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3700 46 3148 828 -2320
1049 4 1001 72 -929
1524 2 1500 36 -1464
0 0 0 0 0
140 2 116 36 -80
1570 5 1510 90 -1420
1246 8 1150 144 -1006
130 8 34 144 110
181800 6500 110347 117000 6653
84 3 48 54 6
0 1 0 18 18
0 0 0 0 0
81 6 48 108 60
0 0 0 0 0
13875 550 7275 9900 2625
7400 388 2744 6984 4240
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

620 0 620 0 -620

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

2000 340 0 6120 6120

0 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 39 144 105

1400 56 758 1008 250

0 0 0 0 0

0 0 0 0 0

0 1 0 18 18

3 1 0 18 18
24844 970 14004 17460 3456

6938 320 3098 5760 2662

11181 172 9492 3096 -6396

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

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
 0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 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 0 -34

0 0 57 0 -57

45 2 21 36 15

0 1 0 18 18
3785 38 3329 684 -2645
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12900 285 9480 5130 -4350
0 0 0 0 0
26000 1090 12920 19620 6700
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 0 0 0 0 0
110 6 38 108 70
377 2 353 36 -317
466 2 442 36 -406
70 4 22 72 50
0 0 0 0 0
0 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 10 0 180 180
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

155000 5080 94640 91440 -3200

1000 10 880 180 -700
1377 8 1281 144 -1137
6950 35 7030 630 -6400
0 0 0 0 0
0 0 0 0 0
4750 38 4294 684 -3610
0 0 0 0 0
10 4 0 72 72
0 0 0 0 0
0 0 0 0 0
13700 48 13124 864 -12260
30200 240 27620 4320 -23300
4037 87 3247 1566 -1681
0 0 0 0 0
0 0 0 0 0

6900 256 3828 4608 780

850 3 814 54 -760
100 2 76 36 -40
0 0 0 0 0
0 0 0 0 0
72 17 0 306 306
0 0 0 0 0
0 0 0 0 0
78700 840 70420 15120 -55300
75700 765 66520 13770 -52750
0 0 0 0 0
0 0 0 0 0
 0 0 0 0 0
0 0 0 0 0
16000 23 15724 414 -15310
860 3 824 54 -770
230 20 0 360 360
1910 20 1870 360 -1510
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9410 196 7334 3528 -3806
320200 11230 191040 202140 11100
400 18 207 324 117
2 1 0 18 18
2 1 0 18 18
0 0 0 0 0
173 3 138 54 -84
0 0 15 0 -15
0 0 0 0 0
75 4 27 72 45
150 3 114 54 -60
0 0 0 0 0
2400 70 1560 1260 -300
0 0 0 0 0
0 0 0 0 0
41450 220 41810 3960 -37850
2000 92 896 1656 760
595 12 481 216 -265
20 3 0 54 54
330 8 274 144 -130
0 0 0 0 0
82900 2500 53550 45000 -8550
0 0 0 0 0
0 0 0 0 0
 0 0 0 0 0

1700 240 0 4320 4320

9400 240 6820 4320 -2500
72100 2800 38500 50400 11900
500 0 1000 0 -1000
400 0 800 0 -800
700 200 0 3600 3600
0 0 0 0 0
3080 40 2600 720 -1880
450 90 77 1620 1543
3232 180 1072 3240 2168
25 8 0 144 144
0 0 0 0 0
61900 2130 38440 38340 -100
27800 800 18500 14400 -4100
1369 18 1216 324 -892

100 8 4 144 140

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
21 5 0 90 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 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 1800 0 -1800
0 0 0 0 0
70970 2900 36950 52200 15250
0 0 0 0 0
 30600 90 29520 1620 -27900
3500 90 2420 1620 -800
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
24400 560 18680 10080 -8600
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 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 0 -13
0 0 0 0 0
143900 0 146300 0 -146300
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1005 32 621 576 -45
0 0 0 0 0
AN TAHUN 2020)
OL / AMPUL / VIAL / TUBE / SACCHET / PUFF

TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2021 BERDASARKAN

RENCANA RENCANA REALISASI KETERANGAN

PENGADAAN PENGADAAN PENGADAAN
TAHUN 2022 TAHUN 2021 TAHUN 2020

(g) (h) (i) (j)

0 0 0
0 0 0
0 0 0
0 0 0
0 30 0
300 450 288
0 0 0
0 0 0
5000 126000 4800
2500 2000 2400
0 0 0
0 0 0
6000 8950 6000
4000 5300 3600
94000 113700 93960
102000 124200 101880
0 0 0
100 10 60
0 0 0
0 0 0
400 9611 384
0 7000 0
80000 191800 60000
100 950 396
0 0 0
 700 1510 660

130000 168094 129600

400 21970 384

0 0 0

400 1559 384

800 1240 720

0 0 0
0 0 0
0 1 0

300 200 264

5000 19450 4800
7000 13000 6240
50400 98100 50400
23000 36050 22680
15000 27500 14400
0 0 0
0 0 0
18000 164650 17460
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
8000 29250 7800
35000 27250 34680
4000 31100 3600
0 0 0
6000 10000 5400
0 0 0
200 300 180
200 300 180
150 95 84
0 0 0
36 51 36
2000 3343 1536
0 0 0
 800 6121 804
0 800 0
0 750 0
72 150 72
0 0 0
100 310 96
100 4285 108
800 6650 300
150 500 144
0 0 0

0 0 0
0 0 0

0 0 0
0 0 0
30 50 12
0 0 0
200 4800 96
90000 158044 90000
36 135 36
42 135 72
15 219 24
400 380 360
2000 5312 2040
0 0 0
200 2509 180
500 5460 240
0 0 0
0 0 0
0 12640 0
300 5320 480
0 0 0
500 3769 276
50000 65200 46680
0 0 0
0 0 0
200 264 180
2500 3000 2400
7200 22400 7200
100 4602 84
5000 13000 4800
0 0 0
0 0 0
300 559 300
50 270 48
0 0 0
 24 128 24
0 0 0
120 100 120
0 0 0
1200 1000 1200
1800 3590 1680
0 0 0

0 0 0

50 531 24
200 15630 48
300 1675 360
240 200 240
0 0 0
0 100 0
12 5 12
0 52 0
0 0 0
100 380 84
20000 39300 11760
0 0 0

0 0 0

0 51710 0
0 0 0
0 0 0

300 1265 228

150 300 132
20 51 24

15 3 24

15 3 24

0 0 0
30000 70400 28680
0 0 0
0 0 0
9000 26000 8400
0 0 0
0 60 0
30 70 24
0 10 0
 0 0 0
300 740 240
0 0 0
12 10 12
0 0 0
480 1184 480
6000 13640 5856
500 500 420
24 6 24
12 6 12
50 126 48
500 200 360
1500 7165 1200
0 0 0
5000 13640 4200
0 0 0
0 0 0

100 220 96
10000 13800 9000
0 4007 0
0 0 0
0 1000 0
0 0 0

0 0 0

0 2093 0
0 100 0
25000 46800 23760
55000 143600 54840
0 0 0

0 0 0
0 480 0
0 1420 0
7000 10700 6960
12 5 12
0 0 0
400 200 324
200 438 156
0 0 0
2000 500 1920
40000 90694 38400
120000 116295 117600
102000 238710 102000
6000 10500 5880
 0 0 0
0 0 0
10000 16430 9468
150 350 144
2500 37944 2400
4000 17485 3840
7000 17000 6792
0 0 0
0 0 0
0 0 0
600 3700 552
50 1049 48
50 1524 24
0 0 0
24 140 24
60 1570 60
100 1246 96
100 130 96
80000 181800 78000
36 84 36
18 0 12
0 0 0
72 81 72
0 0 0
7000 13875 6600
5000 7400 4656
0 0 0
0 0 0
0 0 0
0 600 0
0 0 0

0 620 0

0 0 0

0 0 0

0 0 0

5000 2000 4080

0 0 0

0 0 0

0 0 0
 0 0 0

0 0 0

100 100 96

700 1400 672

0 0 0

0 0 0

12 0 12

12 3 12
12000 24844 11640

4000 6938 3840

2000 11181 2064

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 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0
 0 0 0

0 0 0

0 0 0

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 45 24

12 2 12
500 3785 456
0 0 0
0 20 0
0 0 0
0 0 0
4000 12900 3420
0 0 0
13000 26000 13080
0 0 0
0 0 0
0 0 0
 0 0 0
72 110 72
24 377 24
24 466 24
48 70 48
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
120 20 120
0 0 0
0 0 0
0 0 0

100000 155000 60960

5000 1000 120
50 1377 96
500 6950 420
0 0 0
0 0 0
500 4750 456
0 0 0
50 10 48
0 0 0
0 0 0
600 13700 576
3000 30200 2880
2000 4037 1044
0 0 0
0 0 0

4000 6900 3072

40 850 36
24 100 24
0 0 0
0 0 0
350 380 204
0 0 0
0 0 0
11000 78700 10080
9200 75700 9180
0 0 0
0 0 0
 0 0 0
0 0 0
800 16000 276
36 860 36
250 230 240
250 1910 240
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 0
0 0 0
0 1147 0
0 1812 0
0 0 0
0 160 0
120000 112500 0
0 0 0
7000 9410 2352
150000 320200 134760
200 400 216
12 2 12
12 2 12
0 0 0
36 173 36
0 0 0
0 0 0
100 75 48
36 150 36
0 0 0
900 2400 840
0 0 0
0 0 0
2700 41450 2640
1200 2000 1104
150 595 144
40 20 36
100 330 96
0 0 0
60000 82900 30000
0 0 0
0 0 0
 0 0 0

3000 1700 2880

3000 9400 2880
55000 72100 33600
0 0 0
0 0 0
2500 700 2400
0 0 0
700 3080 480
1200 450 1080
2200 3232 2160
100 25 96
0 0 0
26000 61900 25560
10000 27800 9600
220 1369 216

100 100 96

0 0 0
0 0 0
0 0 0
0 0 0
60 21 60

0 5 0

0 0 0

0 5 0
0 2 0
0 0 0

0 36 0

0 0 0

0 0 0

0 5300 0
0 1750 0

0 32400 0
0 83220 0
35000 70970 34800
0 0 0
1100 30600 1080
900 3500 1080
0 0 0

0 76 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 600 0
0 6100 0
0 0 0
7000 24400 6720
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 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
0 143900 0
0 0 0
0 0 0
0 0 0
0 0 0
400 1005 384
0 0 0
NO NAMA OBAT SATUAN SISA STOK PER
31 DESEMBER
2020

a. Obat a
1 Ambroxol Syr Botol/ 60 ml 28
2 Ambroxol Tab Tablet 1300
3 Asam Traneksamat Caps 0
4 Asam Traneksamat Injeksi Ampul 0
5 Bisoprolol 10 mg Tablet 1560
6 Cefadroxil Caps 500 mg Caps 0
7 Cefadroxil Syr 125 mg Botol/ 60 ml 0
8 Cefriaxone Injeksi AMpul
9 Cetirizine Tablet Tablet 0
10 Curviplex Syr Botol/ 60 ml 9
11 Gemfibrozil Caps 150
12 Glimepirid 4 mg Tablet 1500
13 Glukosamin Tablet Tablet 0
14 Grafachlor Tablet 0
15 Guaiefenisine Tablet Tablet 100
16 Klobazam 10 mg Tablet 197
17 Ketorolak Injeksi Ampul
18 Meloxicam 15 mg Tablet 300
19 Meloxicam 7.5 mg Tablet 300
20 Metyl Prednisolon 4 mg Tablet 0
21 Microlax Tube 0
22 Obat Batuk Hitam Syr (OBH) Botol/ 60 ml 39
23 Omeprazole Injeksi Ampul
24 Ondansetron Injeksi Ampul
25 Paraflu Syr ( PCT+PPN+CTM GG) Botol/ 60 ml 25
26 Parasetamol Rektal 5 mg Supp 5
27 Piroxicam 20mg Tablet 100
28 Spasminal Tablet 0
29 Lidocain Gel 2% Tube

b. BMHP
1 Abbocath no. 18 G pcs 100
2 Abbocath No. 20 G pcs 309
3 Abbocath No. 22 G pcs 0
 4 Abbocath No. 24 G pcs 14
5 Alkohol Swab box/ 100 pcs 0
6 APD Coverall pcs 41
7 Blood Lanset Kotak/ 100pcs 6
8 Canula Nasal Anak pcs 0
9 Canula Nasal Bayi pcs 30
10 Canula Nasal Dewasa pcs 0
11 Cut Gut Plan 3/0 pcs 48
12 Cut Gut HR 40 yg segitiga pcs 0
13 HandScoon L (non Steril) box/ 100 pcs 34
14 HandScoon M (non Steril) box/ 100 pcs 31
15 HandScoon S (non steril) box/ 100 pcs 44
16 Handscoon Steril No. 6 box/ 100 pcs 0
17 Handscoon Steril No. 6.5 box/ 100 pcs 0
18 Handscoon Steril No. 7 pcs 395
19 Handscoon Steril No. 7.5 pcs 200
20 Infuset Anak pcs 0
21 Infuset Bayi pcs 0
22 Infuset Dewasa pcs 118
23 Jarum No. 23G pcs 950
24 Jarum No. 24 G pcs 1110
25 Jarum No. 25 G pcs 1985
26 Jarum No. 27 G pcs 0
27 Jelly USG Tube 0
28 Kapas 250 gr roll 6
29 Kapas Berlemak 250 gr roll 0
30 Kasa 2 M x 80 roll 0
31 Kasa steril Kompres 40 x 40 roll 55
32 Kasa 4 m x 5 cm roll 0
33 Kasa 40 x 80 roll 0
34 Kasa 4m x 15 cm roll 0
35 Kasa elastis 4 m x 15 cm roll 55
36 Kasa Steril 16x16 cm box/ 100 pcs 0
37 Masker Ear Loop pcs 40
38 Masker N95 pcs 100
39 Masker Nebulazer Anak pcs 0
40 Masker Nebulazer Dewasa pcs 0
41 Masker Oksigen Anak pcs 0
42 Masker Oksigen Bayi pcs 0
43 Masker Oksigen Dewasa pcs 0
44 Masker Tie on pcs 450
45 NGT. No. 16 pcs 0
46 NGT. No. 18 pcs 0
47 NGT. No. 20 pcs 0
48 Paket Reagen Alat Labor Kimia darah Chemray 120 RayTo paket 0
49 Paket Reagen Midrey BC 20 S-M30 paket 0
50 Plaster 2.5 cm x 4.5 m roll 48
51 Spuit 1 cc pcs 135
52 Spuit 2.5 cc pcs 1475
53 Spuit 20 cc pcs 0
54 Spuit 3 cc pcs 1283
55 Spuit 5 cc pcs 365
56 Spuit 50 CC pcs 0
57 Urin Bag pcs 108
58 Volley Catheter No. 16 FR Two Way pcs 33
59 Volley Catheter No. 18 FR Two Way pcs 22
60 Volley Catheter No. 20 FR Two Way pcs 0
61 Needle cytoject pcs 0
62 cytoject Ampul ampul 0
63 Endo Spray tube 0
64 Komposit A1 tube 0
65 Komposit A2 tube 0
66 Giemsa botol 0
67 Metilen Blue botol 0
68 Karbo Fuchin botol 0
69 Asam Alkohol awk 0
70 Hcl 0.1 N 0
PREDIKSI PEMAKAIAN PREDIKSI SISA JUMLAH RENCANA RENCANA
PENGADAAN RATA-RATA STOK 31 KEBUTUHAN KEBUTUHAN PENGADAAN
TAHUN 2021 PER BULAN DESEMBER TAHUN 2022 TAHUN 2022 TAHUN 2022
SELAMA 2020 2021

b c d e f g
380 37 -36 666 702 800
3400 970 -6940 17460 24400 25000
120 600 -7080 10800 17880 9000
22 12 -122 216 338
2200 288 304 5184 4880 5000
300 500 -5700 9000 14700 1500
10 15 -170 270 440 60
5 90 20
500 200 -1900 3600 5500 6000
50 28 -277 504 781 800
200 12 206 216 10 100
1600 220 460 3960 3500 4000
500 800 -9100 14400 23500 25000
200 500 -5800 9000 14800 15000
2900 670 -5040 12060 17100 18000
280 210 -2043 3780 5823 2300
15 270
2000 120 860 2160 1300 1500
1000 90 220 1620 1400 1500
200 500 -5800 9000 14800 9000
10 20 -230 360 590 80
400 33 43 594 551 600
15 270 15
15 270 15
200 34 -183 612 795 550
30 5 -25 90 115 120
1800 189 -368 3402 3770 3800
1000 1200 -13400 21600 35000 10000
1 18 25

400 18 284 324 40 150

400 22 445 396 -49 150
150 8 54 144 90 100
 220 12 90 216 126 50
200 5 140 90 -50 55
200 12 97 216 119 200
300 12 162 216 54 450
50 2 26 36 10 10
3 1 21 18 -3 3
150 9 42 162 120 3
72 12 -24 216 240 20
72 12 -72 216 288 24
18 12 -92 216 308 400
22 18 -163 324 487 600
15 2 35 36 1 300
1044 58 348 1044 696 700
2000 110 680 1980 1300 1300
4500 255 1835 4590 2755 3000
3000 120 1760 2160 400 400
200 11 68 198 130 100
50 3 14 54 40 20
600 28 382 504 122 580
330 16 1088 288 -800 200
328 18 1222 324 -898 200
228 22 1949 396 -1553 200
55 8 -41 144 185 50
90 5 30 90 60 100
22 4 -20 72 92 100
15 5 -45 90 135 50
80 2 56 36 -20 10
22 1 65 18 -47 20
12 2 -12 36 48 10
20 3 -16 54 70 10
70 2 46 36 -10 10
15 4 22 72 50 10
100 3 64 54 -10 20
80 238 -2736 4284 7020 8000
200 12 156 216 60 50
120 7 36 126 90 20
400 12 256 216 -40 30
40 2 16 36 20 50
50 3 14 54 40 10
200 8 104 144 40 100
155 585 -6415 10530 16945 20000
60 5 0 90 90 20
36 3 0 54 54 20
36 3 0 54 54 20
50 1 38 18 -20 12
50 1 38 18 -20 12
300 12 204 216 12 50
 2000 100 935 1800 865 900
15000 586 9443 10548 1105 1500
150 5 90 90 0 5
20000 670 13243 12060 -1183 500
10000 465 4785 8370 3585 4000
120 4 72 72 0 3
150 7 174 126 -48 25
24 2 33 36 3 10
26 3 12 54 42 10
29 2 5 36 31 10
0 22 -264 396 660 150
0 12 -144 216 360 12
0 1 -12 18 30 12
0 2 -24 36 60 12
0 2 -24 36 60 12
12 1 0 18 18 6
2 1 -10 18 28 6
17 1 5 18 13 6
22 1 10 18 8 6
15 1 3 18 15 6
RENCANA REALISASI KETERANGAN
PENGADAAN PENGADAAN
TAHUN 2021 TAHUN 2020

h i j
380 444
3400 11640
120 7200
22 144
2200 3456
300 6000
10 180
60
500 2400
50 336
200 144
1600 2640
500 9600
200 6000
2900 8040
280 2520
180
2000 1440
1000 1080
200 6000
10 240
400 396
180
180
200 408
30 60
1800 2268
1000 14400
12

400 216
400 264
150 96
 220 144
200 60
200 144
300 144
50 24
3 12
150 108
72 144
72 144
18 144
22 216
15 24
1044 696
2000 1320
4500 3060
3000 1440
200 132
50 36
600 336
330 192
328 216
228 264
55 96
90 60
22 48
15 60
80 24
22 12
12 24
20 36
70 24
15 48
100 36
80 2856
200 144
120 84
400 144
40 24
50 36
200 96
155 7020
60 60
36 36
36 36
50 12
50 12
300 144
 2000 1200
15000 7032
150 60
20000 8040
10000 5580
120 48
150 84
24 24
26 36
29 24
0 264
0 144
0 12
0 24
0 24
12 12
2 12
17 12
22 12
15 12