LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN LOGISTIK COVID 19

UPT PUSKESMAS KINTAMANI IV

BULAN JANUARI 2022

STOK AWAL
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
HARGA JUMLAH TOTAL
Propinsi Bali dan Kemenkes
1 APD (Kemenkes) - - - -
2 Kaca Mata Google pcs 125,950 - - -
- - - -
Dana Tidak Terduga Dinkes Bangli (DTT I) - - - -
1 Masker N95-NIOSH Standard/ Vflex pcs 175,000 - - -
Sarung tangan M (Protos exam powder glove) pcs 640 - - -
Sarung tangan L (Protos exam powder glove) pcs 640 - - -

1 Rapid test Biozek tes

383,125 179 68,579,375 179
Medika Antiseptik Handrub 500 ml botol 59,956 - - -
APD set set 850,000 - - -
APD set 3 Protevtive Coverall pcs
- - - -
2 APD Sepatu Boots Panjang All Size (1) pcs - - - -
Tuth APD Face Shield pcs - - - -
QTR APD Latex Hand Gloves 5 pcs - - - -
3 Tuth SLO APD Gown Coverall Spunbond pcs - - - -
4 Onemed APD Nurse Cap pcs - - - -
5 Tuth APD Shoes Cover pcs - - - -
6 Kardus/Tas pcs - - - -
7 3M Masker KN95-9501V+ pcs - - - -
Tissue Livi Evo pcs 22,000 42 924,000 42
Curcuma FCT 120's tablet 876 - - -
1 Imbost Force kaplet 5,808 - - -
2 Onecare Thermometer Non Contact DT-8809C unit 2,337,500 - - -
3 Handwash 500 ml Hclean botol 33,000 17 561,000 17
4 Desinfektan 5 L btl 165,000 - - -
5 Becefort tablet 1,533 - - -
6 Dana Tidak Terduga Dinkes Bangli (DTT II)
- - - -
7 Baju Operasi hijau set 220,000 - - -
Rapid test Biozek test 383,125 - - -
Caviplex tablet 1,230 - - -
Latex safeglove exam (M) pcs 1,045 - - -
Maxter surg gloved steril 6 pcs 8,744 - - -
Maxter surg gloved steril 6,5 pcs 8,744 - - -
Maxter surg gloved steril 7 pcs 8,744 - - -
Maxter surg gloved steril 7,5 pcs 8,744 - - -
Latex safeglove exam (S) pcs 1,045 - - -
Latex safeglove exam (L) pcs 1,045 - - -
8 Propinsi Bali - - - -
9 APD (APBD BTT 2020) pcs 165,000 - - -
10 VTM Cito Swab set 53,000 - - -
11 Kemenkes - - -
12 Masker Kain Logo Earloop pcs 5,500 - - -
13 Masker Kain Logo Headloop pcs 5,500 - - -
14 Propinsi Bali - - - -
15 Masker Bedah Sensi (APBD BTT 2020) pcs 2,156 - - -
16
Coverall Protective Disposable (Hibah BPBD 2020) pcs - - - -
Masker KN95 Tainuoer (Hibah Kemenkes RI) pcs - 15 - 15
1 - - - -
2 DTT II tahap II - - - -
3 Masker N 95 1860 pcs 77,000 - - -
4 Latex Examination golden gloves M pcs 1,595 - - -
5 Face Shield pcs 30,000 - - -
6 - - -
7 Hibah Kemenkes RI - - -
8 Coverall Maxifirst pcs - - -
9 Masker N95 Dreamcare pcs 20 - 20
10 - - -
11 Propinsi Bali - - -
 Sarung tangan Nitrile Golden Gloves Size S
12 (Sumbangan Temasek Foundation) pcs - - -
13 Rapid Test Antigen (Panbio) BNPB 2020 set 97000 - - -
14 VTM Poctman BNPB 2020 set - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED Nov
15 2021 set - - -
16 Rapid Test Antigen Genbody Hibah BNPB 2021 test 99000 - - -
17 VTM Zybio BNPB 2020 test - - -
18 VTM +Dacron Swab (KH Medical) Test 42000 - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED okt
19 2022 set 69978 21 1,469,538 21
TAMBAHAN - - -
1 Rapid Test (APBD DTT 2020) pcs 135,000 - - -
Vikacheck Infrared Non Contact thermometer VK 300 unit
2 2,475,000 - - -
3 Masker Kain Polos Earloop pcs - - -
4 Masker Kain Polos Headloop pcs - - -
5 Mesin Semprot Hama Charge unit 1,250,000 - - -
6 Masker Disposible facemask 3 ply pcs 7,700 - - -
7 Face Shield pcs 40,000 - - -
8 Masker Bedah (BNPB) box - 100 - 100
9 Face Shield (BNPB) pcs - - - -
10 Arkan VTM 129,800 - - -
Baju Coverall DHG pcs 15 - 15
Baju Coverall DHG pcs 168000 - -
Rapid Test Antigen SD Biosensor ED Desember 2023
(APBN 2021) test 82856 25 2,071,400 25
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2023 test 82855 - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2024 test - -
Masker Bedah Anak Merk Vio (Hibah Pusat Krisis
kemenkes RI) pcs 1,100 - 1,100
Masker N95 Eexi inherent (Hibah Kemenke RI) pcs - - -
Masker KN95 Utamma (BPBD Prop. Bali) pcs 12000 - - -
Masker Bedah BYD (Sumbangan Temasek Foundation
2021) pcs 28.516 102 2,909 102
VTM Yahoabio test 13300 -
73,608,222

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta

Kepala Dinas Kesehatan Kab. Bangli Ka. Tu UPT Gudang Farmasi Kepala UPT Puskesmas Kintamani IV

dr. I Nyoman Arsana, M.Kes I Dewa Gede Raka Sutresna, S.KM dr. Ida Bagus Putra Suryadi
NIP.196708031999031004 NIP.196604211988031012 NIP. 19841105 201409 1 001
RMINTAAN LOGISTIK COVID 19
TAMANI IV
2022

OBAT ED/ STOK

PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
RUSAK OPTIMUM

-
-
-
-
-
-
-

179
-
-

-
-
-
-
-
-
-
-
-
22 20 48
-
-
-
1 16 18
-
- 800

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
15 20
-
-
-
-
-
-
-
-
20 20
-
-
 -
-
-

-
-
-
- 50

21
-
-

-
-
-
-
-
-
100
-
-
15 30
-

25 50

1,100
-
-

102 -
-

ang Meminta Yang Menerima

Puskesmas Kintamani IV Pengelola Obat Puskesmas

Bagus Putra Suryadi Ni Wayan Sri Yulistiawati, A.Md.Keb

41105 201409 1 001 NIP. 199207072015032007
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN LOGISTIK COVID 19
UPT PUSKESMAS KINTAMANI IV
BULAN FEBRUARI 2022

STOK AWAL
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN OBAT ED/ STOK AKHIR STOK PERMINTAAN PEMBERIAN KET
RUSAK OPTIMUM
HARGA JUMLAH TOTAL
Propinsi Bali dan Kemenkes
1 APD (Kemenkes) - - - - -
2 Kaca Mata Google pcs 125,950 - - - -
- - - - -
Dana Tidak Terduga Dinkes Bangli (DTT I) - - - - -
1 Masker N95-NIOSH Standard/ Vflex pcs 175,000 - - - -
Sarung tangan M (Protos exam powder glove) pcs 640 - - - -
Sarung tangan L (Protos exam powder glove) pcs 640 - - - -

1 Rapid test Biozek tes

383,125 179 68,579,375 179 179
Medika Antiseptik Handrub 500 ml botol 59,956 - - - -
APD set set 850,000 - - - -
APD set 3 Protevtive Coverall pcs
- - - - -
2 APD Sepatu Boots Panjang All Size (1) pcs - - - - -
Tuth APD Face Shield pcs - - - - -
QTR APD Latex Hand Gloves 5 pcs - - - - -
3 Tuth SLO APD Gown Coverall Spunbond pcs - - - - -
4 Onemed APD Nurse Cap pcs - - - - -
5 Tuth APD Shoes Cover pcs - - - - -
6 Kardus/Tas pcs - - - - -
7 3M Masker KN95-9501V+ pcs - - - - -
Tissue Livi Evo pcs 22,000 20 440,000 20 8 12
Curcuma FCT 120's tablet 876 - - - -
1 Imbost Force kaplet 5,808 - - - -
2 Onecare Thermometer Non Contact DT-8809C unit 2,337,500 - - - -
3 Handwash 500 ml Hclean botol 33,000 16 528,000 18 34 4 30
4 Desinfektan 5 L btl 165,000 - - - -
5 Becefort tablet 1,533 - - 800 800 400 400
6 Dana Tidak Terduga Dinkes Bangli (DTT II)
- - - - -
7 Baju Operasi hijau set 220,000 - - - -
Rapid test Biozek test 383,125 - - - -
Caviplex tablet 1,230 - - 500 500 100 400
Latex safeglove exam (M) pcs 1,045 - - - -
Maxter surg gloved steril 6 pcs 8,744 - - - -
Maxter surg gloved steril 6,5 pcs 8,744 - - - -
Maxter surg gloved steril 7 pcs 8,744 - - - -
Maxter surg gloved steril 7,5 pcs 8,744 - - - -
Latex safeglove exam (S) pcs 1,045 - - - -
Latex safeglove exam (L) pcs 1,045 - - - -
8 Propinsi Bali - - - - -
9 APD (APBD BTT 2020) pcs 165,000 - - - -
10 VTM Cito Swab set 53,000 - - - -
11 Kemenkes - - - -
12 Masker Kain Logo Earloop pcs 5,500 - - - -
13 Masker Kain Logo Headloop pcs 5,500 - - - -
14 Propinsi Bali - - - - -
15 Masker Bedah Sensi (APBD BTT 2020) pcs 2,156 - - - -
16
Coverall Protective Disposable (Hibah BPBD 2020) pcs - - - - -
Masker KN95 Tainuoer (Hibah Kemenkes RI) pcs - 15 - 15 15
1 - - - - -
2 DTT II tahap II - - - - -
3 Masker N 95 1860 pcs 77,000 - - - -
4 Latex Examination golden gloves M pcs 1,595 - - - -
5 Face Shield pcs 30,000 - - - -
6 - - - -
7 Hibah Kemenkes RI - - - -
8 Coverall Maxifirst pcs - - - -
9 Masker N95 Dreamcare pcs 20 - 20 20
10 - - - -
11 Propinsi Bali - - - -
Sarung tangan Nitrile Golden Gloves Size S
12 (Sumbangan Temasek Foundation) pcs - - - -
13 Rapid Test Antigen (Panbio) BNPB 2020 set 97000 - - - -
14 VTM Poctman BNPB 2020 set - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED Nov
15 2021 set - - - -
16 Rapid Test Antigen Genbody Hibah BNPB 2021 test 99000 - - - -
17 VTM Zybio BNPB 2020 test - - - -
18 VTM +Dacron Swab (KH Medical) Test 42000 - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED okt
19 2022 set 69978 21 1,469,538 21 21 -
TAMBAHAN - - - -
1 Rapid Test (APBD DTT 2020) pcs 135,000 - - - -
Vikacheck Infrared Non Contact thermometer VK 300 unit
2 2,475,000 - - - -
3 Masker Kain Polos Earloop pcs - - - -
4 Masker Kain Polos Headloop pcs - - - -
5 Mesin Semprot Hama Charge unit 1,250,000 - - - -
6 Masker Disposible facemask 3 ply pcs 7,700 - - - -
7 Face Shield pcs 40,000 - - - -
8 Masker Bedah (BNPB) box - 100 - 100 100
9 Face Shield (BNPB) pcs - - - - -
10 Arkan VTM 129,800 - - - -
11 Baju Coverall DHG pcs 15 - 15 10 5
Baju Coverall DHG pcs 168000 - 20 20 20
Rapid Test Antigen SD Biosensor ED Desember 2023
12 (APBN 2021) test 82856 25 2,071,400 25 18 7
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
13 DJanuari 2023 test 82855 - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2024 test - 50 50 50
Masker Bedah Anak Merk Vio (Hibah Pusat Krisis
14 kemenkes RI) pcs 1,100 - 1,100 1,100
15 Masker N95 Eexi inherent (Hibah Kemenke RI) pcs - - - -
16 Masker KN95 Utamma (BPBD Prop. Bali) pcs 12000 - - - -
Masker Bedah BYD (Sumbangan Temasek Foundation
17 2021) pcs 28.516 - - - -
18 VTM Yahoabio test 13300 - 100 100 33 67
73,088,313

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. Bangli Ka. Tu UPT Gudang Farmasi Kepala UPT Puskesmas Kintamani IV Pengelola Obat Puskesmas
dr. I Nyoman Arsana, M.Kes I Dewa Gede Raka Sutresna, S.KM dr. Ida Bagus Putra Suryadi Ni Wayan Sri Yulistiawati, A.Md.Keb
NIP.196708031999031004 NIP.196604211988031012 NIP. 19841105 201409 1 001 NIP. 199207072015032007
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN LOGISTIK COVID 19
UPT PUSKESMAS KINTAMANI IV
BULAN MARET 2022

STOK AWAL
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN OBAT ED/ STOK AKHIR STOK PERMINTAAN PEMBERIAN KET
RUSAK OPTIMUM
HARGA JUMLAH TOTAL
Propinsi Bali dan Kemenkes
1 APD (Kemenkes) - - - - -
2 Kaca Mata Google pcs 125,950 - - - -
- - - - -
Dana Tidak Terduga Dinkes Bangli (DTT I) - - - - -
1 Masker N95-NIOSH Standard/ Vflex pcs 175,000 - - - -
Sarung tangan M (Protos exam powder glove) pcs 640 - - - -
Sarung tangan L (Protos exam powder glove) pcs 640 - - - -

1 Rapid test Biozek tes

383,125 179 68,579,375 179 179 -
Medika Antiseptik Handrub 500 ml botol 59,956 - - - -
APD set set 850,000 - - - -
APD set 3 Protevtive Coverall pcs
- - - - -
2 APD Sepatu Boots Panjang All Size (1) pcs - - - - -
Tuth APD Face Shield pcs - - - - -
QTR APD Latex Hand Gloves 5 pcs - - - - -
3 Tuth SLO APD Gown Coverall Spunbond pcs - - - - -
4 Onemed APD Nurse Cap pcs - - - - -
5 Tuth APD Shoes Cover pcs - - - - -
6 Kardus/Tas pcs - - - - -
7 3M Masker KN95-9501V+ pcs - - - - -
Tissue Livi Evo pcs 22,000 12 264,000 12 8 4
Curcuma FCT 120's tablet 876 - - - -
1 Imbost Force kaplet 5,808 - - - -
2 Onecare Thermometer Non Contact DT-8809C unit 2,337,500 - - - -
3 Handwash 500 ml Hclean botol 33,000 30 990,000 54 84 26 58
4 Desinfektan 5 L btl 165,000 - - 4 4 1 3
5 Becefort tablet 1,533 400 613,200 400 400
6 Dana Tidak Terduga Dinkes Bangli (DTT II)
- - - - -
7 Baju Operasi hijau set 220,000 - - - -
Rapid test Biozek test 383,125 - - - -
Caviplex tablet 1,230 400 491,920 400 400
Latex safeglove exam (M) pcs 1,045 - - - -
Maxter surg gloved steril 6 pcs 8,744 - - - -
Maxter surg gloved steril 6,5 pcs 8,744 - - - -
Maxter surg gloved steril 7 pcs 8,744 - - - -
Maxter surg gloved steril 7,5 pcs 8,744 - - - -
Latex safeglove exam (S) pcs 1,045 - - - -
Latex safeglove exam (L) pcs 1,045 - - - -
8 Propinsi Bali - - - - -
9 APD (APBD BTT 2020) pcs 165,000 - - - -
10 VTM Cito Swab set 53,000 - - - -
11 Kemenkes - - - -
12 Masker Kain Logo Earloop pcs 5,500 - - - -
13 Masker Kain Logo Headloop pcs 5,500 - - - -
14 Propinsi Bali - - - - -
15 Masker Bedah Sensi (APBD BTT 2020) pcs 2,156 - - - -
16
Coverall Protective Disposable (Hibah BPBD 2020) pcs - - - - -
Masker KN95 Tainuoer (Hibah Kemenkes RI) pcs - 15 - 15 15
1 - - - - -
2 DTT II tahap II - - - - -
3 Masker N 95 1860 pcs 77,000 - - - -
4 Latex Examination golden gloves M pcs 1,595 - - - -
5 Face Shield pcs 30,000 - - - -
6 - - - -
7 Hibah Kemenkes RI - - - -
8 Coverall Maxifirst pcs - - - -
9 Masker N95 Dreamcare pcs 20 - 20 20
10 - - - -
11 Propinsi Bali - - - -
Sarung tangan Nitrile Golden Gloves Size S
12 (Sumbangan Temasek Foundation) pcs - - - -
13 Rapid Test Antigen (Panbio) BNPB 2020 set 97000 - - - -
14 VTM Poctman BNPB 2020 set - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED Nov
15 2021 set - - - -
16 Rapid Test Antigen Genbody Hibah BNPB 2021 test 99000 - - - -
17 VTM Zybio BNPB 2020 test - - - -
18 VTM +Dacron Swab (KH Medical) Test 42000 - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED okt
19 2022 set 69978 - - - -
TAMBAHAN - - - -
1 Rapid Test (APBD DTT 2020) pcs 135,000 - - - -
Vikacheck Infrared Non Contact thermometer VK 300 unit
2 2,475,000 - - - -
3 Masker Kain Polos Earloop pcs - - - -
4 Masker Kain Polos Headloop pcs - - - -
5 Mesin Semprot Hama Charge unit 1,250,000 - - - -
6 Masker Disposible facemask 3 ply pcs 7,700 - - - -
7 Face Shield pcs 40,000 - - - -
8 Masker Bedah (BNPB) box - 100 - 100 100
9 Face Shield (BNPB) pcs - - - - -
10 Arkan VTM 129,800 - - - -
11 Baju Coverall DHG pcs 5 - 5 5
Baju Coverall DHG pcs 168000 20 3,360,000 20 20
Rapid Test Antigen SD Biosensor ED Desember 2023
12 (APBN 2021) test 82856 7 579,992 7 7 -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
13 DJanuari 2023 test 82855 - - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2024 test 50 - 50 25 25
Masker Bedah Anak Merk Vio (Hibah Pusat Krisis
14 kemenkes RI) pcs 1,100 - 1,100 100 1,000
15 Masker N95 Eexi inherent (Hibah Kemenke RI) pcs - - - -
16 Masker KN95 Utamma (BPBD Prop. Bali) pcs 12000 - - - -
Masker Bedah BYD (Sumbangan Temasek Foundation
17 2021) pcs 28.516 - - - -
18 VTM Yahoabio test 13300 67 891,100 67 67
74,878,487

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. Bangli Ka. Tu UPT Gudang Farmasi Kepala UPT Puskesmas Kintamani IV Pengelola Obat Puskesmas
dr. I Nyoman Arsana, M.Kes I Dewa Gede Raka Sutresna, S.KM dr. Ida Bagus Putra Suryadi Ni Wayan Sri Yulistiawati, A.Md.Keb
NIP.196708031999031004 NIP.196604211988031012 NIP. 19841105 201409 1 001 NIP. 199207072015032007
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN LOGISTIK COVID 19
UPT PUSKESMAS KINTAMANI IV
BULAN APRIL 2022

STOK AWAL
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN OBAT ED/ STOK AKHIR STOK PERMINTAAN PEMBERIAN KET
RUSAK OPTIMUM
HARGA JUMLAH TOTAL
Propinsi Bali dan Kemenkes
1 APD (Kemenkes) - - - - -
2 Kaca Mata Google pcs 125,950 - - - -
- - - - -
Dana Tidak Terduga Dinkes Bangli (DTT I) - - - - -
1 Masker N95-NIOSH Standard/ Vflex pcs 175,000 - - - -
Sarung tangan M (Protos exam powder glove) pcs 640 - - - -
Sarung tangan L (Protos exam powder glove) pcs 640 - - - -

1 Rapid test Biozek tes

383,125 - - - -
Medika Antiseptik Handrub 500 ml botol 59,956 - - - -
APD set set 850,000 - - - -
APD set 3 Protevtive Coverall pcs
- - - - -
2 APD Sepatu Boots Panjang All Size (1) pcs - - - - -
Tuth APD Face Shield pcs - - - - -
QTR APD Latex Hand Gloves 5 pcs - - - - -
3 Tuth SLO APD Gown Coverall Spunbond pcs - - - - -
4 Onemed APD Nurse Cap pcs - - - - -
5 Tuth APD Shoes Cover pcs - - - - -
6 Kardus/Tas pcs - - - - -
7 3M Masker KN95-9501V+ pcs - - - - -
Tissue Livi Evo pcs 22,000 4 88,000 4 4 -
Curcuma FCT 120's tablet 876 - - - -
1 Imbost Force kaplet 5,808 - - - -
2 Onecare Thermometer Non Contact DT-8809C unit 2,337,500 - - - -
3 Handwash 500 ml Hclean botol 33,000 58 1,914,000 58 28 30
4 Desinfektan 5 L btl 165,000 3 495,000 3 1 2
5 Becefort tablet 1,533 400 613,200 300 700 700
6 Dana Tidak Terduga Dinkes Bangli (DTT II)
- - - - -
7 Baju Operasi hijau set 220,000 - - - -
Rapid test Biozek test 383,125 - - - -
Caviplex tablet 1,230 400 491,920 400 400
Latex safeglove exam (M) pcs 1,045 - - - -
Maxter surg gloved steril 6 pcs 8,744 - - - -
Maxter surg gloved steril 6,5 pcs 8,744 - - - -
Maxter surg gloved steril 7 pcs 8,744 - - - -
Maxter surg gloved steril 7,5 pcs 8,744 - - - -
Latex safeglove exam (S) pcs 1,045 - - - -
Latex safeglove exam (L) pcs 1,045 - - - -
8 Propinsi Bali - - - - -
9 APD (APBD BTT 2020) pcs 165,000 - - - -
10 VTM Cito Swab set 53,000 - - - -
11 Kemenkes - - - -
12 Masker Kain Logo Earloop pcs 5,500 - - - -
13 Masker Kain Logo Headloop pcs 5,500 - - - -
14 Propinsi Bali - - - - -
15 Masker Bedah Sensi (APBD BTT 2020) pcs 2,156 - - - -
16
Coverall Protective Disposable (Hibah BPBD 2020) pcs - - - - -
Masker KN95 Tainuoer (Hibah Kemenkes RI) pcs - 15 - 15 15
1 - - - - -
2 DTT II tahap II - - - - -
3 Masker N 95 1860 pcs 77,000 - - - -
4 Latex Examination golden gloves M pcs 1,595 - - - -
5 Face Shield pcs 30,000 - - - -
6 - - - -
7 Hibah Kemenkes RI - - - -
8 Coverall Maxifirst pcs - - - -
9 Masker N95 Dreamcare pcs 20 - 20 20
10 - - - -
11 Propinsi Bali - - - -
Sarung tangan Nitrile Golden Gloves Size S
12 (Sumbangan Temasek Foundation) pcs - - - -
13 Rapid Test Antigen (Panbio) BNPB 2020 set 97000 - - - -
14 VTM Poctman BNPB 2020 set - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED Nov
15 2021 set - - - -
16 Rapid Test Antigen Genbody Hibah BNPB 2021 test 99000 - - - -
17 VTM Zybio BNPB 2020 test - - - -
18 VTM +Dacron Swab (KH Medical) Test 42000 - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED okt
19 2022 set 69978 - - - -
TAMBAHAN - - - -
1 Rapid Test (APBD DTT 2020) pcs 135,000 - - - -
Vikacheck Infrared Non Contact thermometer VK 300 unit
2 2,475,000 - - - -
3 Masker Kain Polos Earloop pcs - - - -
4 Masker Kain Polos Headloop pcs - - - -
5 Mesin Semprot Hama Charge unit 1,250,000 - - - -
6 Masker Disposible facemask 3 ply pcs 7,700 - - - -
7 Face Shield pcs 40,000 - - - -
8 Masker Bedah (BNPB) box - 100 - 100 100
9 Face Shield (BNPB) pcs - - - - -
10 Arkan VTM 129,800 - - - -
11 Baju Coverall DHG pcs 5 - 5 5
Baju Coverall DHG pcs 168000 20 3,360,000 20 20
Rapid Test Antigen SD Biosensor ED Desember 2023
12 (APBN 2021) test 82856 - - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
13 DJanuari 2023 test 82855 - - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2024 test 25 - 25 4 21
Masker Bedah Anak Merk Vio (Hibah Pusat Krisis
14 kemenkes RI) pcs 1,000 - 1,000 1000 -
15 Masker N95 Eexi inherent (Hibah Kemenke RI) pcs - - - -
16 Masker KN95 Utamma (BPBD Prop. Bali) pcs 12000 - - - -
Masker Bedah BYD (Sumbangan Temasek Foundation
17 2021) pcs 28.516 - - - -
18 VTM Yahoabio test 13300 67 891,100 67 67
6,962,120

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. Bangli Ka. Tu UPT Gudang Farmasi Kepala UPT Puskesmas Kintamani IV Pengelola Obat Puskesmas
dr. I Nyoman Arsana, M.Kes I Dewa Gede Raka Sutresna, S.KM dr. Ida Bagus Putra Suryadi Ni Wayan Sri Yulistiawati, A.Md.Keb
NIP.196708031999031004 NIP.196604211988031012 NIP. 19841105 201409 1 001 NIP. 199207072015032007
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN LOGISTIK COVID 19
UPT PUSKESMAS KINTAMANI IV
BULAN MEI 2022

STOK AWAL
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN OBAT ED/ STOK AKHIR STOK PERMINTAAN PEMBERIAN KET
RUSAK OPTIMUM
HARGA JUMLAH TOTAL
Propinsi Bali dan Kemenkes
1 APD (Kemenkes) - - - - -
2 Kaca Mata Google pcs 125,950 - - - -
- - - - -
Dana Tidak Terduga Dinkes Bangli (DTT I) - - - - -
1 Masker N95-NIOSH Standard/ Vflex pcs 175,000 - - - -
Sarung tangan M (Protos exam powder glove) pcs 640 - - - -
Sarung tangan L (Protos exam powder glove) pcs 640 - - - -

1 Rapid test Biozek tes

383,125 - - - -
Medika Antiseptik Handrub 500 ml botol 59,956 - - - -
APD set set 850,000 - - - -
APD set 3 Protevtive Coverall pcs
- - - - -
2 APD Sepatu Boots Panjang All Size (1) pcs - - - - -
Tuth APD Face Shield pcs - - - - -
QTR APD Latex Hand Gloves 5 pcs - - - - -
3 Tuth SLO APD Gown Coverall Spunbond pcs - - - - -
4 Onemed APD Nurse Cap pcs - - - - -
5 Tuth APD Shoes Cover pcs - - - - -
6 Kardus/Tas pcs - - - - -
7 3M Masker KN95-9501V+ pcs - - - - -
Tissue Livi Evo pcs 22,000 - - - -
Curcuma FCT 120's tablet 876 - - - -
1 Imbost Force kaplet 5,808 - - - -
2 Onecare Thermometer Non Contact DT-8809C unit 2,337,500 - - - -
3 Handwash 500 ml Hclean botol 33,000 30 990,000 30 16 14
4 Desinfektan 5 L btl 165,000 2 330,000 2 1 1
5 Becefort tablet 1,533 700 1,073,100 700 400 300
6 Dana Tidak Terduga Dinkes Bangli (DTT II)
- - - - -
7 Baju Operasi hijau set 220,000 - - - -
Rapid test Biozek test 383,125 - - - -
Caviplex tablet 1,230 400 491,920 400 400
Latex safeglove exam (M) pcs 1,045 - - - -
Maxter surg gloved steril 6 pcs 8,744 - - - -
Maxter surg gloved steril 6,5 pcs 8,744 - - - -
Maxter surg gloved steril 7 pcs 8,744 - - - -
Maxter surg gloved steril 7,5 pcs 8,744 - - - -
Latex safeglove exam (S) pcs 1,045 - - - -
Latex safeglove exam (L) pcs 1,045 - - - -
8 Propinsi Bali - - - - -
9 APD (APBD BTT 2020) pcs 165,000 - - - -
10 VTM Cito Swab set 53,000 - - - -
11 Kemenkes - - - -
12 Masker Kain Logo Earloop pcs 5,500 - - - -
13 Masker Kain Logo Headloop pcs 5,500 - - - -
14 Propinsi Bali - - - - -
15 Masker Bedah Sensi (APBD BTT 2020) pcs 2,156 - - - -
16
Coverall Protective Disposable (Hibah BPBD 2020) pcs - - - - -
Masker KN95 Tainuoer (Hibah Kemenkes RI) pcs - 15 - 15 15
1 - - - - -
2 DTT II tahap II - - - - -
3 Masker N 95 1860 pcs 77,000 - - - -
4 Latex Examination golden gloves M pcs 1,595 - - - -
5 Face Shield pcs 30,000 - - - -
6 - - - -
7 Hibah Kemenkes RI - - - -
8 Coverall Maxifirst pcs - - - -
9 Masker N95 Dreamcare pcs 20 - 20 20
10 - - - -
11 Propinsi Bali - - - -
Sarung tangan Nitrile Golden Gloves Size S
12 (Sumbangan Temasek Foundation) pcs - - - -
13 Rapid Test Antigen (Panbio) BNPB 2020 set 97000 - - - -
14 VTM Poctman BNPB 2020 set - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED Nov
15 2021 set - - - -
16 Rapid Test Antigen Genbody Hibah BNPB 2021 test 99000 - - - -
17 VTM Zybio BNPB 2020 test - - - -
18 VTM +Dacron Swab (KH Medical) Test 42000 - - - -
Rapid Test Antigen (SD Biosensor) BNPB 2021) ED okt
19 2022 set 69978 - - - -
TAMBAHAN - - - -
1 Rapid Test (APBD DTT 2020) pcs 135,000 - - - -
Vikacheck Infrared Non Contact thermometer VK 300 unit
2 2,475,000 - - - -
3 Masker Kain Polos Earloop pcs - - - -
4 Masker Kain Polos Headloop pcs - - - -
5 Mesin Semprot Hama Charge unit 1,250,000 - - - -
6 Masker Disposible facemask 3 ply pcs 7,700 - - - -
7 Face Shield pcs 40,000 - - - -
8 Masker Bedah (BNPB) box - 100 - 100 100
9 Face Shield (BNPB) pcs - - - - -
10 Arkan VTM 129,800 - - - -
11 Baju Coverall DHG pcs 5 - 5 5
Baju Coverall DHG pcs 168000 20 3,360,000 20 20
Rapid Test Antigen SD Biosensor ED Desember 2023
12 (APBN 2021) test 82856 - - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
13 DJanuari 2023 test 82855 - - - -
Rapid Test Antigen (SD Biosensor) APBN 2021) ED
DJanuari 2024 test 21 - 21 21
Masker Bedah Anak Merk Vio (Hibah Pusat Krisis
14 kemenkes RI) pcs - - - -
15 Masker N95 Eexi inherent (Hibah Kemenke RI) pcs - - - -
16 Masker KN95 Utamma (BPBD Prop. Bali) pcs 12000 - - - -
Masker Bedah BYD (Sumbangan Temasek Foundation
17 2021) pcs 28.516 - - - -
18 VTM Yahoabio test 13300 67 891,100 67 67
6,245,020

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. Bangli Ka. Tu UPT Gudang Farmasi Kepala UPT Puskesmas Kintamani IV Pengelola Obat Puskesmas
dr. I Nyoman Arsana, M.Kes I Dewa Gede Raka Sutresna, S.KM dr. Ida Bagus Putra Suryadi Ni Wayan Sri Yulistiawati, A.Md.Keb
NIP.196708031999031004 NIP.196604211988031012 NIP. 19841105 201409 1 001 NIP. 199207072015032007