1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. SISA STOK PER 31 DESEMBER 2021 ADALAH SISA STOK PER 31 DESEMBER 2021 DI SATUAN KERJA
3. PREDIKSI PENGADAAN TAHUN 2022 ADALAH PREDIKSI JUMLAH YANG DIRENCANAKAN UNTUK DIADAKAN TAHUN 2022
4. PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 ADALAH PEMAKAIAN RATA-RATA PER BULAN DI SATKER SELAMA TAHUN 2021
5. PREDIKSI SISA STOK 31 DESEMBER 2022 ADALAH SISA STOK PER 31 DESEMBER 2021 DITAMBAH PREDIKSI PENGADAAN TAHUN 2022 DIKURANGI (12 x
6. JUMLAH KEBUTUHAN TAHUN 2023 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : T
7. RENCANA KEBUTUHAN TAHUN 2023 ADALAH JUMLAH KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIK
8. RENCANA PENGADAAN TAHUN 2023 ADALAH RENCANA UNTUK PENGADAAN DI TAHUN 2023 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / K
9. RENCANA PENGADAAN TAHUN 2022 ADALAH OTOMATIS TERISI DARI SISTEM JIKA SATKER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2022
10. REALISASI PENGADAAN TAHUN 2021 ADALAH REALISASI PENGADAAN OBAT JKN BAIK E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2021

RENCANA KEBUTUHAN OBAT PADA (FKTP) TAHUN 2

SATUAN KERJA : PUSKESMAS …...

PEMAKAIAN
PREDIKSI PREDIKSI SISA
NO NAMA OBAT SATUAN SISA STOK PER 31 RATA-RATA PER
PENGADAAN STOK 31
DESEMBER 2021 BULAN SELAMA (d) = (a)+(b)-
(a) TAHUN
(b)2022 (c) DESEMBER 2022
2021 (12x(c))
1 Abacavir 300 mg Tablet/kaplet/kapsul 0 0 00
2 Air untuk injeksi Botol 250 ml 0 0 00
3 Air untuk injeksi ampul/vial/botol 10 mL 0 0 00
4 Air untuk injeksi Botol 100 ml 0 0 00
5 Air untuk injeksi amp 20 ml ampul/vial/botol 0 0 00
6 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 0 0 00
7 Albendazol susp 200 mg/5 ml Botol 0 0 00
8 Albendazol tab 400 mg tablet/kapsul/kaplet 0 0 00
9 Alopurinol tab 100 mg Tab 0 0 00
10 Alopurinol tab 300 mg tablet/kapsul/kaplet 0 0 00
11 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0 0 00
12 Aminofilin tab 150 mg tablet/kapsul/kaplet 0 0 00
13 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0 0 00
14 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 0 0 00
15 Amlodipin tab 10 mg tablet/kapsul/kaplet 0 0 00
16 Amlodipin tab 5 mg tablet/kapsul/kaplet 0 0 00
17 Amoksisilin drops 100 mg/ml Botol @10 ml 0 0 00
18 Amoksisilin drops 100 mg/ml Botol @15 ml 0 0 00
19 Amoksisilin drops 100 mg/ml Botol @20 ml 0 0 00
Amoksisilin sir forte 250 mg/5
20 ml botol 60 ml 0 0 00
Amoksisilin sir kering 125 mg/5
21 ml Botol 0 0 00
22 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0 00
23 Amoksisilin tab 500 mg tablet/kapsul/kaplet 0 0 00
24 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0 00
25 Ampisilin
Anestetik serblokalinj
gigi250 mg/vial : Vial
kombinasi 0 0 00
26 Antasida, kombinasi :
lidokain hcl 2% + epinefrin 1 : ampul/vial 0 0 00
aluminium 2hidroksida
80.000 injkombinasi
Antasida, ml : 200 mg tablet/kapsul/kaplet
27 0 0 00
+aluminium
magnesium hidroksida 200200
hidroksida mg
28 mg
Anti Parkinsonhidroksida
+ magnesium kombinasi200: botol 60 ml 0 0 00
29 benzerasid
mg
Antifungi 25 mg
salep, + levodopa
kombinasi : Kaps 0 0 00
Antihemoroid,
100 mg kombinasi:
30 asam
bismutbenzoat
subgalat6%+
150asam
mg + pot 30 g 0 0 00
31 salisilat 3%
heksaklorofen 2,5 mg + Suppositoria 0 0 00
32 lidokain lidokain 10
Aquadest cairan 500 ml mg+ seng Botol 500 ml 0 0 00
oksida 120serb
Artesunat mg +injsup
60ad 2g
mg/ml
33 ampul/vial 0 0 00
(i.v./i.m.)
Articulating paper kertas Kertas warna penanda
34 0 0 00
warna penanda oklusi oklusi
35 Asam asetat tetes telinga 2% Botol 0 0 00
36 Asam asetilsalisilat (asetosal) tablet/kapsul/kaplet 0 0 00
tab
Asam 80askorbat
mg (vitamin C) tab
37 Tab 0 0 00
250 mg
Asam askorbat (vitamin C) tab tablet/kapsul/kaplet
38 0 0 00
50 mg
39 Asam folat tab 0,4 mg tablet/kapsul/kaplet 0 0 00
40 Asam folat tab 1 mg tablet/kapsul/kaplet 0 0 00
41 Asam folat tab 5 mg Tab 0 0 00
42 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0 00
43 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/ 0 0 00
kaptab
44 Asam retinoat krim 0,05% Tube/pot 0 0 00
45 Asam retinoat krim 0,1% Tube @ 10 gram 0 0 00
46 Asam retinoat krim 0,1% Tube @ 20 gram 0 0 00
47 Asam salisilat lar 0,1% Botol 0 0 00
48 Asam salisilat salep 10% Tube 0 0 00
49 Asam salisilat salep 2% Tube 0 0 00
50 Asam salisilat salep 5% Tube 0 0 00
51 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 0 00
52 Asiklovir tab 400 mg tablet/kapsul/kaplet 0 0 00
53 Atapulgit 600 mg tablet/kapsul/kaplet 0 0 00
54 Atapulgit tab 630 mg tablet/kapsul/kaplet 0 0 00
55 Atapulgit tablet 650 mg tablet/kapsul/kaplet 0 0 00
56 Atapulgit tablet 750 mg Tab 0 0 00
57 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0 00
58 Atenolol tab 50 mg tablet/kapsul/kaplet 0 0 00
Atropin inj 0,25 mg/ml
59 Ampul 0 0 00
(i.m./i.v./s.k)
60 Atropin tab 0,5 mg Tab 0 0 00
61 Bahan tumpatan sementara Botol 0 0 00
lar, serb
62 Bedak salisil serb 2% Dus/Sachet/Plastik 0 0 00
63 Betametason krim 0,1% tube 5 gram 0 0 00
64 Betametason krim 0,5 mg/g Tube 0 0 00
65 Betametason salep 0,1% tube 5 gram 0 0 00
66 Betametason tts mata 1 mg/ml catchcover, botol 0,6 mL 0 0 00
67 Betametason tts mata 1 mg/ml botol @5 ml 0 0 00
68 Bisakodil sup 10 mg Suppositoria 0 0 00
69 Bisakodil sup 5 mg Suppositoria 0 0 00
70 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 0 00
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 0 00
Budesonid cairan ih
72 respoules 0 0 00
0,25mg/ml, respoules 2 ml
73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 0 00
74 Budesonid cairan ih 0,5 mg/ml, respoules 0 0 00
respoules
Budesonid2serbml ih 100
75 Botol 0 0 00
mcg/dosis
Budesonid serb ih 200
76 100 dosis 0 0 00
mcg/dosis
Budesonid serb ih 200
77 mcg/dosis 200 dosis 0 0 00
78 Copper T set/buah 0 0 00
79 Deksametason inj 5 mg/ml ampul/vial 0 0 00
(i.v./i.m.)
80 Deksametason tab 0,5 mg tablet/kapsul/kaplet 0 0 00
81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 0 00
82 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 0 0 00
83 Diazepam inj 5 mg/ml ampul/vial 0 0 00
(i.v./i.m.)
84 Diazepam tab 2 mg tablet/kapsul/kaplet 0 0 00
85 Diazepam tab 5 mg tablet/kapsul/kaplet 0 0 00
86 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0 00
87 Difenhidramin inj 10 mg/ml ampul/vial 0 0 00
(i.v./i.m.)
88 Digoksin tab 0,25 mg tablet/kapsul/kaplet 0 0 00
89 Diltiazem kaps SR 100 mg Kapsul lepas lambat 0 0 00
90 Diltiazem kaps SR 200 mg Kapsul lepas lambat 0 0 00
91 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 0 0 00
92 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 0 0 00
93 Dolutegravir tab 50 mg tablet/kapsul/kaplet 0 0 00
94 Domperidon susp 5 mg/5 ml botol @60 ml 0 0 00
95 Domperidon tab 10 mg tablet/kapsul/kaplet 0 0 00
96 Efavirenz tab 200 mg Tablet
tablet salut 0 0 00
97 Efavirenz tab sal 600 mg selaput/kaplet salut 0 0 00
Epinefrin (adrenalin) inj 1 selaput
98 Ampul 0 0 00
mg/ml
99 Ergotamin tab 1 mg Tab 0 0 00
100 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0 0 00
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0 00
102 Eritromisin tab 500 mg tablet/kapsul/kaplet 0 0 00
103 Estrogen terkonjugasi tab sal tablet salut gula/kaplet 0 0 00
0,625 mg salut gula
104 Etambutol tab 400 mg tablet/kapsul/kaplet 0 0 00
105 Etanol 70% cairan 70% Botol 0 0 00
106 Etil klorida semprot 100 ml Botol 0 0 00
107 Etonogestrel implan 68 mg Set 0 0 00
108 Eugenol Botol 0 0 00
Fenitoin Na inj 50 mg/ml (100
109 mg/ 2 mL) ampul @ 2 ml 0 0 00
110 Fenitoin Na kaps 100 mg Kaps 0 0 00
111 Fenitoin Na kaps 30 mg Kaps 0 0 00
112 Fenobarbital tab 100 mg Tab 0 0 00
113 Fenobarbital tab 30 mg tablet/kapsul/kaplet 0 0 00
Fenoksimetil penisilin (penisilin
114 V) tab 250 mgpenisilin (penisilin Tab 0 0 00
115 Fenoksimetil Tab 0 0 00
V) tab 500 mg (vitamin K 1) inj
Fitomenadion
116 2 mg/ml (i.m.) (vitamin K 1) tab ampul/vial 0 0 00
Fitomenadion
117 sal 10 mg Tab sal 0 0 00
118 Fitomenadion (vitamin K1) inj tablet salut gula/kaplet 0 0 00
10 mg/ml (i.m) salut gula
119 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 0 0 00
120 Fluoksetin kaps 20 mg tablet/kapsul/kaplet 0 0 00
121 Fluor kapl 1 mg Kaplet 0 0 00
122 Fluor sediaan topikal Tube 0 0 00
123 Formokresol Botol 0 0 00
124 Framisetin Sulfat Tulle 1% Patch 0 0 00
125 Furosemid inj 10 mg/ml ampul/vial 0 0 00
(i.v./i.m.)
126 Furosemid tab 40 mg tablet/kapsul/kaplet 0 0 00
Galactose microparticle 200-
127 400 mgFe,micropart/ml Vial 0 0 00
128 Garam setara dengan Fe Botol 0 0 00
elemental
Garam Fe, 15 mg/5
setara mL Fe
dengan
129 Sachet 0 0 00
elemental
Garam Fe, 60
oralit mg dengan: Fe
kombinasi
setara
130 natrium klorida Botol 0 0 00
elemental 60 mg0,52 g + kalium
131 klorida 0,30 g + trinatrium sachet 0 0 00
132 sitrat 0,58 g + glukosa anhidrat
Gentamisin salep mata 0,3% Tube 0 0 00
2,7 g
133 Gentamisin
Glass ionomer tts ART
mata(Atraumatic
0,3% Botol 0 0 00
134 Restorative Treatment) cocoa Sachet 0 0 00
135 Glass
butterionomer
5g ART (Atraumatic Botol 0 0 00
Restorative
Glass ionomer Treatment) lar
ART (Atraumatic
136 Vial 0 0 00
Restorative Treatment) serb
137 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0 0 00
138 Glibenklamid tab 5 mg tablet/kapsul/kaplet 0 0 00
139 Glikuidon tab 30 mg tablet/kapsul/kaplet 0 0 00
140 Glimepirid tab 1 mg tablet/kapsul/kaplet 0 0 00
141 Glimepirid tab 2 mg tablet/kapsul/kaplet 0 0 00
142 Glipizid tab 5 mg tablet/kapsul/kaplet 0 0 00
143 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0 0 00
144 Gliserin tts 100 mg/ml Botol 0 0 00
Glukosa Larutan Infus 10%
145 steril 100Larutan
ml Botol 0 0 00
Glukosa Infus 10%
146 steril 250 ml Botol 0 0 00
147 Glukosa Larutan Infus 10% Botol 0 0 00
steril 500 ml
148 Glukosa Larutan Infus 40% Ampul @25 ml 0 0 00
Glukosa Larutan Infus 5% steril
149 100 ml Larutan Infus 5% steril Botol 0 0 00
150 Glukosa Botol 0 0 00
250 ml Larutan Infus 5% steril
Glukosa
151 Botol 0 0 00
500 ml
Griseofulvin (micronized) tab
152 125 mg tablet/kapsul/kaplet 0 0 00
Griseofulvin (micronized) tab
153 scored 250 mg tablet/kapsul/kaplet 0 0 00
154 Gutta percha dan paper points Roll 0 0 00
15 - 40percha
Gutta mm dan paper points
155 Roll 0 0 00
45 - 80 mm
156 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0 00
157 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0 0 00
158 Haloperidol tab 1,5 mg tablet/kapsul/kaplet 0 0 00
159 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0 00
160 Haloperidol tab 5 mg tablet/kapsul/kaplet 0 0 00
161 Haloperidol tts 2 mg/ml botol 0 0 00
Hepatitis B imunoglobulin
162 Ampul 0 0 00
(human) inj 150 IU/1,5 ml
163 Hidrogen peroksida cairan 3% Botol 0 0 00
164 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 0 0 00
165 Hidrokortison krim 2,5% tube @ 5 g 0 0 00
166 Hidrokortison serb inj 100 mg Vial 0 0 00
167 Hiosina butilbromida tab 10 tablet/kapsul/kaplet 0 0 00
mg
Human tetanus imunoglobulin
168 Ampul 0 0 00
inj 250 UI
Human (i.m.) imunoglobulin
tetanus
169 Ampul 0 0 00
inj 500 UI (i.m.)
170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 0 00
171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 0 00
172 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0 00
173 Ibuprofen tab 400 mg tablet/kapsul/kaplet 0 0 00
 Ipratropium bromida aerosol
174 20 mcg/semprot Botol 0 0 00
175 Ipratropium bromida cairan ih Botol 0 0 00
0,025%
176 Isoniazid tab 100 mg Tab 0 0 00
177 Isoniazid tab 300 mg Tab 0 0 00
178 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 0 0 00
179 IUD Cu T 380 A Set 0 0 00
180 IUD Levonorgestrel Set 0 0 00
181 Kalamin Tube 0 0 00
182 Kalsium glukonat inj 100 ampul/vial 0 0 00
mg/ml
Kalsium hidroksida bubuk,
183 Tube 0 0 00
pasta
184 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0 00
Kalsium laktat (kalk) tab 500
185 mg tablet/kapsul/kaplet 0 0 00
186 Kaptopril tab 12,5 mg tablet/kaplet 0 0 00
187 Kaptopril tab 25 mg tablet/kaplet 0 0 00
188 Kaptopril tab 50 mg tablet/kaplet 0 0 00
189 Karbamazepin sir 100 mg/5 ml Botol 0 0 00
190 Karbamazepin tab 100 mg Tab 0 0 00
191 Karbamazepin Tab 200 mg Tablet 0 0 00
192 Karbogliserin tts telinga 10 % Botol 0 0 00
193 Ketokonazol tab 200 mg tablet/kapsul/kaplet 0 0 00
194 Klindamisin kaps 150 mg Kaps 0 0 00
195 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 0 00
196 Klofazimin, micronized kaps 50 Kapsul 0 0 00
mg
Klofazimin, micronizedkaps
197 kapsul 0 0 00
100 mg
198 Klonidin tab 0,15 mg tablet/kapsul/kaplet 0 0 00
199 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0 00
200 Kloramfenikol salep 2% tube 15g 0 0 00
201 Kloramfenikol salep mata 1% tube @ 5 gram 0 0 00
202 Kloramfenikol serb inj 1.000 vial/ampul 0 0 00
mg/ml
Kloramfenikol susp 125 mg/5
203 botol 60 ml 0 0 00
ml
204 Kloramfenikol tetes telinga 3% Botol 0 0 00
205 Kloramfenikol tts mata 0,5% botol 0 0 00
206 Kloramfenikol tts mata 1% Botol 0 0 00
207 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 0 0 00
208 Klorfenol kamfer mentol Botol 0 0 00
(CHKM)
209 Klorheksidin lar 0,2% Botol 0 0 00
210 Klorheksidin lar 15% Botol 0 0 00
211 Klorpromazin inj 25 mg/ml ampul/vial 0 0 00
(i.m.)
212 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
tablet salut 0 0 00
213 Klorpromazin tab sal 100 mg selaput/kaplet salut 0 0 00
214 Klorpromazin tab sal 25 mg selaput
Tab sal 0 0 00
215 Klortalidon tab 50 mg Tab 0 0 00
216 Klozapin tab 100 mg tablet 0 0 00
217 Klozapin tab 25 mg tablet 0 0 00
218 Kodein tab 10 mg tablet/kapsul/kaplet 0 0 00
Komb:
KombinasiDeksametason
(DHP) : 0,1%
219 Botol
tablet salut 0 0 00
Thymol 5% Paraklorphenol
dihidroartemisin 40 mg + 30
220 Kombinasi
Piperakuin :320(Zidovudin 60 mg + selaput/kaplet salut
mg tab sal 0 0 00
221 Lamivudin 30 mg + Nevirapin selaput
selaput Tab dispersible 0 0 00
Kombinasi
50 mg) Ped: Triple
artemether
FDC 20 mg tablet/kapsul/kaplet
222 0 0 00
+Kombinasi
lumefantrin 120 mg 150
: Desogestrel
223 mcg Etinilestradiol 30 mcg Tab 0 0 00
224 Kombinasi : ergotamin 1 mg+ tablet/kapsul/kaplet 0 0 00
Kombinasi
kafein 50 mg: Ferro fumarat 60
225 mg + asam folat 0,4 mg tab tablet salut gula 0 0 00
Kombinasi : levonorgestrel 150
salut
226 tab salut gula 0 0 00
mcg + etinilestradiol
Kombinasi : Tenofovir30300mcg
mg Tab
227 Kombinasi : Tenofovir 0 0 00
+ Emtrisitabin 200 mg 300 mg
228 + Lamivudin 300 mg + Tab 0 0 00
Kombinasi : zidovudin
Efavirenz 600 mg 300 mg
229 Kombinasi: Tab 0 0 00
+lamivudin Ipratropium
150 mg
230 bromida 0,5 mg + Salbutamol Ampul/vial 0 0 00
231 Kombinasi: kaolin
2,5 mg, cairan ih 550 mg +
Kombinasi:
pektin 20 mg lopinavir 200 mg + Tab 0 0 00
232 ritonavir
Kombinasi:(LVP) 50 mg, 300
Tenofovir tab 250
mg + Tab 0 0 00
233 mg
Komibinasi: lidokain
Lamivudin 300 mg + + Tablet/kapsul/kaplet 0 0 00
234 medisinal creosote
Dolutegravir 50 mg,phenol
tablet + Botol 0 0 00
eugenol + benzil alkohol,
235 Komposit
cairan resin(dewasa)
Kotrimoksazol Set 0 0 00
236 kombinasi : sulfametoksazol
Kotrimoksazol (dewasa) tab/kaptab 0 0 00
237 400 mg+ trimetoprim 80
kombinasi : sulfametoksazol mg tab/kaptab 0 0 00
800 mg+ trimetoprim 160 mg
 Kotrimoksazol kombinasi tiap 5
238 ml suspensi : sulfametoksazol botol 60 mL 0 0 00
239 200
Kuininmginj+ trimetoprim
25% (i.v.) 40 mg Vial 0 0 00
240 Kuinin tab 200 mg tablet/kapsul/kaplet 0 0 00
241 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 0 00
242 Lamivudin
Larutan mengandung elektrolit tablet/kapsul/kaplet
(3TC) tab 150 mg 0 0 00
243 (CaCl2H2O 0,165 gr, KCl 0,15 Botol plastik @500 ml 0 0 00
Larutan
gr, NaCl mengandung
4,3 gr) Elektrolit
244 (Kalium Klorida) Botol 0 0 00
Larutan mengandung Elektrolit
245 (KCl 0,15%, (KN1) Botol
NaCL 0,9%)Elektrolit 0 0 00
246 Larutan mengandung
Larutan mengandung Elektrolit Botol 0 0 00
(KCl
(Na 0,3%,NaCl
130 mEq, K0,9%) 4 mEq, (KN2)
Cl 109 Botol plastik @ 500 ml
247 Larutan mengandung Elektrolit 0 0 00
Larutan
mEq, Ca mengandung
3 mEq, Asetat
(Na 130 mEq, K 4 mEq, Cl 109 Elektrolit
28 mEq)
248 (Tiap
Ringer
(Sodium 1000 ml
Asetat
Lactate mengandung
sol
mEq, Ca 3 mEq, Asetat 28 mEq)(50%) 113 Softbag @ 500 ml 0 0 00
249 electrolit:
gr/L,
Ringer Sodium
Potassium 145
Asetat Chloride 0.3 mmol/l, Botol 0 0 00
250 Potassium
gr/L, Calcium 4.0Chloride
mmol/l, 0.2 Calcium
gr/L, Botol 0 0 00
Larutan
2.5 mengandung
mmol/l,
elektrolit) Magnesium 1.0
251 Larutan
mmol/l, mengandung
Karbohidrat (Fructose
Chloride 120 g, Botol
118 mmol/l, 0 0 00
Karbohidrat
glucose
Acetate 66
24 g,(Fructose 6015
Xylitol Malate
mmol/l, g/mg,
L)5.0 softbag
252 Larutan
glucose mengandung 30 mg,
monohydrate 0 0 00
253 mmol/l)
Karbohidrat
xylitol mg)(Fructose 200 g, Botol
Larutan15mengandung 0 0 00
254 Larutan
glucose mengandung
Karbohidrat g,
110 Xylitol 100
(Fructose 60 g,g/ L) Botol 0 0 00
Karbohidrat
Larutan +
mengandung Elektrolit
glucose 33 g, Xylitol 30 g/ L) (25.00g
255 dextrose anhidrat, 3.00 g Botol 0 0 00
Karbohidrat +(Maltose
Elektrolit10%)
(25.00g
256 sodium chloride,
maltose, 3.00 g sodium0.15 g Botol plastik @500 ml 0 0 00
257 potassium
Larutan
chloride, chloride,
mengandung
0.15 0.10 g
g potassium Botol plastik @500 ml 0 0 00
calcium
Karbohidrat
chloride, chloride
0.10
Larutan mengandung+ dihydrate
Elektrolit
g calcium dan
258 1.55 g sodium lactate) Botol 0 0 00
(Acetate,
chloride
Karbohidrat Na,+K,Elektrolit
dihydrate Cl, dan
Ca, Mg,
1.55 g
259 Larutan
Sorbitol mengandung
505%,
gr/L) Botol 0 0 00
sodium
(Dextrose
Larutan
Karbohidratlactate)
mengandung NaCL 0,45%, KCl)
+ Elektrolit
260 (HSD)
Karbohidrat Botol 0 0 00
120+ g,
(Fructosemengandung
Larutan Elektrolit
glucose 66 g,
261 (Glukosa
Xylitol 6025
Karbohidrat g/ g, NaCl 2,0 g, KCl Botol
+L +Elektrolit
elektrolit) 0 0 00
262 1,3 g,
Larutan Natrium
(Glukosamengandung Laktat
55 g ; Natrium 3,1 g, air Botol 0 0 00
untuk injeksi
Karbohidrat
Chloride 9 g,+air ad untukml)
1000
Elektrolit injeksi botol/softbag
263 Larutan mengandung 0 0 00
(Glukosa:
ad 1000 110.0
ml) (D5-NS)g; NaCl: 1.80 g)
264 Larutan
Karbohidrat
(D10-1/5NS)mengandung
+ Elektrolit Botol 0 0 00
Karbohidrat
Larutan 25,0+ Elektrolit
(Glukosa:mengandung g; NaCl: 4,5 g) botol/softbag @ 500 mL
265 0 0 00
(Glukosa:
Karbohidrat 55.0
Larutan mengandung g; NaCl: 2.25 g)
+ Elektrolit
266 (D5-1/4NS) botol/softbag @ 100 mL 0 0 00
(Glukosa:
Karbohidrat 55.0 g; NaCl: 2.25 g)
+ Elektrolit
267 (D5-1/4NS)
(Larutan nutrisi Botol 0 0 00
(Glukosa: 55.0 g;kombinasi
NaCl: 4.5 g)
268 infus permengandung
(D5-1/2NS)
Larutan L: Na. 100mEQ, K Botol 0 0 00
269 18mEQ, Ca. 4mEQ,
Karbohidrat + Elektrolit Mg 6mEQ, Botol 0 0 00
Cl 90mEQ,
(Larutan Asetat
Ringer & 38mEQ,
Glukosa 5%)
Sorbitol 50g)
 Larutan mengandung
Karbohidrat + Elektrolit (NaCl
Larutan mengandung
270 1.125 gr, Dekstrosa 18.75 gr) Botol 0 0 00
271 Karbohidrat
Larutan + Elektrolit
mengandung (NaCl Botol 0 0 00
(KA
1.75 EN
Larutan 1B)
g, KCL 1.5g,
mengandungGlukosa(NaCl
100
272 Karbohidrat + Elektrolit Botol 0 0 00
gr)
Karbohidrat
1.75 g, KCL
Larutan + Elektrolit
1.5g,
mengandung (Nacl
Na Lactate
273 1.75
2.24 gr, KCl 1.5
g, Glukosa
Karbohidrat gr,
100Na
gr)Lactat
+ Elektrolit (Nacl Botol 0 0 00
274 2.24 gr,
2.34 gr, Na
Dekstrosa 27 gr)
Laktat 2.24 gr,(KA
KCL Botol 0 0 00
EN 3B)
Levonorgestrel
0.75 gr Dekstrosaimplan
27 gr)2 (KA
rods,
EN
275 pack/ sachet/ set 0 0 00
75
3A)mg (3-4 tahun)
276 Lidokain gel 2% syringe/syringe plastik 0 0 00
277 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 0 00
278 Lidokain salep 5% Tube 0 0 00
279 Lidokain spray oral 10% botol 0 0 00
280 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0 0 00
Liquor carbonis detergens lar
281 5% Botol 0 0 00
282 Loperamid tab 2 mg Tab 0 0 00
Lopinavir 100 mg + Ritonavir
283 tab sal selaput 0 0 00
25 mg
284 Loratadin tab 10 mg tablet/kapsul/kaplet 0 0 00
285 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0 0 00
286 Lorazepam tab 1 mg tablet/kapsul/kaplet 0 0 00
287 Lorazepam tab sal 2 mg Tab sal 0 0 00
288 Lugol Botol 0 0 00
289 Magnesium sulfat inj 20% ampul/vial @25 ml 0 0 00
290 Magnesium sulfat inj 20% ampul/vial 0 0 00
291 Magnesium sulfat inj 40% ampul/vial 0 0 00
292 Magnesium sulfat inj 40% ampul/vial @25 ml 0 0 00
Magnesium sulfat serb, ktg 30
293 Sachet 0 0 00
g
294 Manitol lar infus 20% Botol @ 250 ml 0 0 00
295 Manitol lar infus 20% Botol @ 100 ml 0 0 00
296 Manitol lar infus 20% Botol @ 500 ml 0 0 00
297 Mebendazol sir 100 mg/5 ml Botol 0 0 00
298 Mebendazol tab 100 mg Tan 0 0 00
299 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0 00
Medroksi progesteron asetat
300 ampul/vial 0 0 00
inj 150 mg/ml
Medroksi Progesteron Asetat
301 Inj 50 mg/ml ampul/vial 0 0 00
 Metenamin mandelat
302 (heksamin mandelat) tab salut Tab salut 0 0 00
303 enterik 500tab
Metformin mg 500 mg tablet/kapsul/kaplet 0 0 00
304 Metformin tab 850 mg tablet/kapsul/kaplet 0 0 00
305 Metilergometrin inj 0,2 mg/ml ampul/vial 0 0 00
Metilergometrin tab salut tablet/kaplet salut
306 0,125 0 0 00
307 Metilprednisolon inj 125 mg/2 selaput
mg
ampul/vial 0 0 00
ml
308 Metoklopramid inj 5 mg/ml ampul/vial 0 0 00
309 Metoklopramid tab 10 mg tablet/kapsul/kaplet 0 0 00
310 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0 0 00
311 Metronidazol lar inf 5 mg/ml botol 0 0 00
Metronidazol susp 125 mg/5
312 ml Botol @ 60 ml 0 0 00
Metronidazol susp 125 mg/5
313 ml Botol @ 100 ml 0 0 00
314 Metronidazol tab 250 mg tablet/kapsul/kaplet 0 0 00
315 Metronidazol tab 500 mg tablet/kapsul/kaplet 0 0 00
316 Mikonazol krim 2% tube 0 0 00
Mineral Mix (Bismuth
317 Mikonazol serb 2%
Subcitrate Tripotasium, Copper botol / sachet 0 0 00
318 sulfate, Magnesium Chloride Sachet 0 0 00
319 Anhydrous, Potassium
N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 0 0 00
Chloride, Zinc Acetate)
320 NaCl 0,9% Larutan Botol @25 ml 0 0 00
321 NaCl 0,9% Larutan Botol @100 ml 0 0 00
322 NaCl 0,9% Larutan Botol @1.000 mL 0 0 00
323 NaCl 0,9% Larutan Botol @250 ml 0 0 00
324 NaCl 0,9% Larutan Botol @500 ml 0 0 00
325 NaCl 0,9% Larutan Ampul/botol @ 10 mL 0 0 00
326 NaCl 3% Larutan Botol
tabletplastik
salut @500 ml 0 0 00
327 Natrium diklofenak tab 25 mg enterik/kaplet
tablet salut salut 0 0 00
328 enterik
Natrium diklofenak tab 50 mg enterik/kaplet salut 0 0 00
Natrium Diklofenak Tetes Mata enterik
329 botol 5 mL 0 0 00
1 mg/ml hipoklorit cairan
Natrium
330 Botol 0 0 00
konsentrat 5%
331 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0 00
332 Nevirapin tab 200 mg tablet/kapsul/kaplet 0 0 00
333 Nifedipin kaps 10 mg tablet/kapsul/kaplet 0 0 00
334 Nistatin susp 100.000 UI/ml botol/vial 0 0 00
335 Nistatin tab salut 500.000 UI tablet salut gula/kaplet 0 0 00
salut gula
336 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 0 00
337 Nitrofurantoin tab 50 mg Tab 0 0 00
338 Norepinefrin inj 1 mg/ml ampul/vial 0 0 00
339 Obat Anti Tuberculosis FDC paket 0 0 00
Kategori
Obat AntiAnak
Tuberculosis FDC
340 Kategori paket 0 0 00
Obat AntiI Tuberculosis FDC
341 Kategori paket 0 0 00
342 Obat AntiIITuberculosis FDC paket 0 0 00
Kategori
Obat AntiSisipan
Tuberculosis
343 Paket 0 0 00
Kombipak Anak
Obat Anti Tuberculosis
344 Kombipak Dewasa paket 0 0 00
345 Oksigen ih, gas dlm tabung Botol 0 0 00
346 Oksimetazolin tts hidung botol @ 10 mL 0 0 00
0,025%
Oksimetazolin tts hidung
347 botol @ 10 mL 0 0 00
0,050%
348 Oksitetrasiklin 1% Salep Mata tube 0 0 00
349 Oksitosin inj 10 UI/ml ampul/vial 0 0 00
350 Olopatadin tts mata 0,1% Botol 0 0 00
351 Omeprazol inj 40 mg/10 ml ampul/vial 0 0 00
352 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 0 00
353 Paraformaldehid tab 1 g Tab 0 0 00
354 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 0 00
355 Parasetamol tab 500 mg tablet/kapsul/kaplet 0 0 00
356 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 0 00
357 Pasta devitalisasi (non arsen) Tube 0 0 00
358 Pasta pengisi saluran akar Tube 0 0 00
(pasta)
359 Perak nitrat lar 20% Botol 0 0 00
360 Perak sulfadiazin krim 1% Tube 0 0 00
361 Permetrin krim 5 % Tube 30 g 0 0 00
362 Permetrin krim 5 % Tube 15 g 0 0 00
363 Permetrin krim 5 % Tube 10 g 0 0 00
Pirantel pamoat susp 125 mg/5
364 Botol 0 0 00
ml
365 Pirantel pamoat tab 500 mg Tab 0 0 00
 Pirantel pamoat tab scored 125
366 mg tablet/kapsul/kaplet 0 0 00
367 Pirantel pamoat tab scored 250 Tab 0 0 00
mg
Piridoksin (vitamin B6) inj 100 Ampul
368 0 0 00
mg/ml
Piridoksin (vitamin B6) tab 10
369 mg tab/kap/kapl 0 0 00
Piridoksin (vitamin B6) tab 25
370 mg tablet/kapsul/kaplet 0 0 00
371 Povidon iodin lar 100 mg/ml botol 30 mL 0 0 00
372 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0 00
373 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0 00
374 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0 00
375 Prednison tab 5 mg tablet/kapsul/kaplet 0 0 00
376 Primakuin tab 15 mg Tab 0 0 00
377 Probenesid tab 500 mg tablet/kapsul/kaplet 0 0 00
378 Prokain benzilpenisilin serb inj ampul/vial 0 0 00
3 juta UI/vial (i.m.)
379 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0 00
380 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0 00
381 Ranitidin tab 150 mg tablet/kapsul/kaplet 0 0 00
Retinol (vitamin A) kaps lunak
382 kaps lunak 0 0 00
100.000 UI
Retinol (vitamin A) kaps lunak
383 200.000 UI kaps lunak 0 0 00
384 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0 0 00
385 Rifapentin tablet 150 mg Tablet/kapsul/kaplet 0 0 00
386 Ringer Laktat Larutan Botol 0 0 00
387 Risperidon tab sal 1 mg tablet/kapsul/kaplet 0 0 00
388 Risperidon tab sal 2 mg tablet/kapsul/kaplet 0 0 00
389 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0 0 00
390 Salbutamol sir 2 mg/5 ml Botol 0 0 00
391 Salbutamol tab 2 mg tablet/kapsul/kaplet 0 0 00
392 Salbutamol tab 4 mg : asam
Salep 2-4, kombinasi tablet/kapsul/kaplet 0 0 00
393 salisilat
Salep 2-4,2 %+ endap 4 pot 15 gram
belerang: asam
kombinasi 0 0 00
394 %
salisilat 2 %+ belerang endap 4 pot 30 gram 0 0 00
395 %
Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0 0 00
396 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 0 0 00
Sefadroksil sir kering 125 mg/5
397 ml botol @ 60 mL 0 0 00
 Sefadroksil sir kering 250 mg/5
398 Serum anti bisa ular : A.B.U. I botol @ 60 mL
ml 0 0 00
399 (khusus
Serum antiularbisa
dariular
luar:A.B.U.II
Papua) Vial 0 0 00
400 inj (i.m./i.v.)
(khusus ular dari Papua) inj Vial 0 0 00
Serum antidifteri (A.D.S) inj
(i.m./i.v.)
401 (i.m./i.v.) Inj i.m 10.000 UI/ Vial 0 0 00
402 Serum antirabies inj 100 UI/ml Vial 0 0 00
403 Serum antirabies inj 200 UI/ml Vial 0 0 00
Serum antitetanus (A.T.S) (i.m.)
404 Inj 10.000 UI/vial (i.m /i.v.)inj Vial 0 0 00
Serum antitetanus (A.T.S)
405 1500 (i.m.) (A.T.S) inj Ampul 0 0 00
406 SerumUI/amp
antitetanus Vial 0 0 00
20.000 UI/vial (i.m /i.v.)
Serum antitetanus (A.T.S) inj Ampul/vial
407 0 0 00
5.000 IU/mL (i.m)
408 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0 00
Sianokobalamin (vitamin B12)
409 inj 500 mcg/ml (vitamin B12) ampul/vial 0 0 00
410 Sianokobalamin tablet/kapsul/kaplet/
tablet/kapsul/kaplet 0 0 00
tab 50 mcg tablet salut
411 Simvastatin tab sal 10 mg tablet/kapsul/kaplet/ 0 0 00
selaput/kaplet
tablet salut salut
412 Simvastatin tab sal 20 mg selaput 0 0 00
413 Simvastatin tab sal selaput 40 selaput/kaplet
Tab sal
salut
0 0 00
selaput
Siprofloksasin tab scored 500 tablet salut
mg
414 selaput/kaplet salut 0 0 00
mg selaput
415 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0 00
416 Stannous pyrophosphate 27,6 Vial 0 0 00
mg sodium pyrophosphate/vial
Streptomisin serb inj 1.000
417 ampul/vial 0 0 00
mg/vial
418 Surgical ginggival pack Tube
tablet salut 0 0 00
419 Tenofovir tab 300 mg selaput/kaplet salut 0 0 00
420 Terbutalin cairan ih 2,5 mg/ml selaputBotol 0 0 00
421 Terbutalin inj 0,5 mg/ml ampul/vial 0 0 00
422 Tetanus toxoid inj Ampul 0 0 00
423 Tetrakain tts mata 0,5% Botol 0 0 00
424 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0 00
425 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0 0 00
426 Tetrasiklin Salep Mata 1% Tube 0 0 00
427 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 0 0 00
428 Timolol tts mata 0,25% botol @ 5 mL 0 0 00
429 Timolol tts mata 0,5% botol @ 5 mL 0 0 00
430 Urea krim 10 % Tube/pot 0 0 00
431 Urea krim 20 % Tube/pot 0 0 00
432 Vaksin BCG inj (i.k) Vial 0 0 00
Vaksin bivalen OPV (b-OPV)
433 Vaksin
drops 10 Hepatitis
dosis Rekombinan Vial 0 0 00
434 Inj Prefilled Injection Device Vial 0 0 00
435 Vaksin
(Uniject)HPV0,5(Human
ml (i.m)Papilloma Ampul/vial 0 0 00
Virus), vial 0,5 mL
436 Vaksin Influenza Vial 0 0 00
Vaksin Japanese Enchepalitis
437 (J.E) Vial 0 0 00
438 Vaksin jerap difteri tetanus Vial 0 0 00
(DT)
Vaksin jerap difteri tetanus
439 Vial 0 0 00
(Td)
440 Vaksin kombinasi DPT-HB-Hib Vial 0 0 00
Vaksin measless rubella (MR)
441 Inj 0,5 mL (s.k) Vial 0 0 00
442 Vaksin Meningitis Vial 0 0 00
Meningokokus
443 Vaksin polio IPV inj 0,5 ml Vial 0 0 00
Vaksin rabies, untuk manusia
444 serb injrabies,
(s.k./i.k) + booster Vial 0 0 00
445 Vaksin untuk manusia Vial 0 0 00
serb Inj 2,5 IU
446 Vaksin Yellow Fever Vial 0 0 00
447 Valproat sir 250 mg/5 ml botol @ 120 ml 0 0 00
448 Valproat tab sal 250 mg tablet salut enterik/ 0 0 00
kaplet salut enterik
449 Vitamin B kompleks Tablet/kapsul/kaplet/
tablet 0 0 00
Vitamin C 500 mg minimal non tab sal selaput/kaplet
450 0 0 00
acidic 250 mg sal selaput/tab sal
451 Zidovudin kaps 100 mg tablet/kapsul/kaplet
gula/kaplet sal gula 0 0 00
452 Zinc drops 10 mg/ml Botol 0 0 00
453 Zinc serb 10 mg Sachet 0 0 00
454 Zinc sir 20 mg/5 ml botol 0 0 00
455 Zinc tab disp 20 mg tablet dispersible 0 0 00
HUN 2022 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2021)
ATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2022
EPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
AN RKO TAHUN 2022
SELAMA TAHUN 2021

ADA (FKTP) TAHUN 2023

JUMLAH RENCANA RENCANA RENCANA REALISASI

KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN PENGADAAN KETERANGAN
TAHUN
(e) = (c)2023
x 18 TAHUN
(f) = (e)2023
- (d) TAHUN
(g)2023 TAHUN
(h)2022 TAHUN
(i) 2021 (j)
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