Data Untuk Stock Opname

BUKTI PENGAMBILAN BARANG
Dikeluarkan dari : GUDANG FARMASI KAB BELITUNG

Berdasarkan Perintah : Kepala Dinas Kesehatan Kab.Belitung
Surat Nomor : 442/ 223 /GFK/2020
Diserahkan Kepada : PUSKESMAS SIJUK
Tanggal : 28 AGUSTUS 2020
No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH
ED PROG APBD+DAK BUFFER BERIAN SATUAN (Rp)

1 Acarbose 100 mg Tab 5OE0047/Maret 21 0 Rp 821 Rp -
2 Acetyl Sistein Kap 18AS1063/Agst 20 0 Rp 376 Rp -
3 Allopurinol 100 mg (2019) Tab A90746/April 22 0 Rp 99 Rp -
4 Ambroksol Sirup Btl 190718184/Juli 21 0 Rp 3,860 Rp -
5 Ambroksol Tab 1907146/Juli 21 300 300 Rp 137 Rp 41,100
6 Aminopillin 200 mg Tab BN9C019123/Mar 21 0 Rp 142 Rp -
Aminopillin 200 mg (buffer) Tab 17CK043/Okto 20 0 Rp 92 Rp -
7 Aminopillin injeksi Amp 19I6034B/Juli 21 0 Rp 2,789 Rp -
8 Amitriptillin 25 mg Tab A1409CW/Maret 23 0 Rp 168 Rp -
9 Amlodipin 10 mg (2019) Tab AE09H018/Mei 21 0 Rp 94 Rp -
Amlodipin 10 mg Tab 0 Rp 213 Rp -
10 Amlodipin 5 mg (2018+2019) Tab 12519/Januari 21 1800 1800 Rp 76 Rp 136,800
11 Amoksisillin 500 mg (2019) Kap CAMXA90969/Mei 21 0 Rp 245 Rp -
Amoksisillin 500 mg (2018) Kap HE018092/Mei 21 0 Rp 375 Rp -
Amoksisillin 500 mg (2017) Kap 0 Rp 330 Rp -
12 Amoksisillin 250 mg Kap 0 Rp 190 Rp -
Amoksisillin 250 mg (Buffer) Kap 17094751/Sept 20 0 Rp 190 Rp -
13 Amoksisillin sirup (2019) Btl 19071196/Juli 21 0 Rp 3,180 Rp -
Amoksisillin sirup Btl 1810796/Nopem 20 0 Rp 4,666 Rp -
14 Antasida doen 500mg Tab A91498/Juni 22 0 Rp 56 Rp -
15 Antasida Suspensi Btl K701258/Juni 21 200 200 Rp 2,051 Rp 410,200
16 Antibakteri doen salep, kombinasi Tube 1898069/Agust 22 0 Rp 3,187 Rp -
17 Antihemoroid doen kombinasi Supp 681975W/Juli 2022 0 Rp 3,325 Rp -
18 Antimigrain doen kombinasi (2018) Tab J82079B/Sept 2021 0 Rp 182 Rp -
Antimigrain doen kombinasi Tab H92066B/Juli 22 0 Rp 203.5 Rp -
19 Antifungi salep kombinasi Pot 185J11C/Sept 2022 0 Rp 4,721 Rp -
20 Aqua pro injeksi steril bebas pirogen Vial 86A48A/Januari 21 0 Rp 2,860 Rp -
21 Asam Askorbat (Vit. C) 250 mg Tab H91996B/Juli 22 0 Rp 132 Rp -
22 Asam Askorbat (Vit. C) 50 mg Tab K78125B/Sept 20 200 200 Rp 110 Rp 22,000
23 Asam Mefenamat Tablet 500mg (2019) Tab A91072/Juli 22 500 500 Rp 103 Rp 51,500
Asam Mefenamat Tablet 500mg Tab A81652/Agustus 20 0 Rp 132 Rp -
24 Asam Asetilsalisilat 80 mg Tab A91211/Mei 21 0 Rp 99 Rp -
25 Asam Pipemidat 400 mg Tab 0 Rp 1,485 Rp -
26 Asam Traneksamat Tab Tab TS61094B/Feb 22 0 Rp 1,684 Rp -
27 Asam Traneksamat injeksi Vial BN2490461/Mar 22 0 Rp 1,813 Rp -
28 Asedas sirup Btl DB092/April 21 0 Rp 38,500 Rp -
29 Asiklovir tab 400 mg (2018) Tab 081129J/April 23 0 Rp 743 Rp -
Asiklovir tab 400mg (Buffer) Tab 06303014/Mei 21 0 Rp 380 Rp -
30 Asiklovir tab 200 mg Tab A1307CW/Maret 21 0 Rp 236 Rp -
31 Asiklovir Salep Tube F91585/Juni 21 0 Rp 4,343 Rp -
1
JUMLAH Rp 661,600

32 Atapulgit 600 Tab S10341921/Sep 21 200 200 Rp 145 Rp 29,000
33 Albendazol 400 mg (Program) Tab 1905076/Mei 21 0 Rp 404 Rp -
34 Artemeter injeksi (Program) Amp 0 Rp 25,490 Rp -
35 Betahistin 6 mg Tab 50E0501/Oktober 21 0 Rp 110 Rp -
36 Besi sirup Btl 0998YO/Juni 21 0 Rp 35,200 Rp -
37 Betametason krim 0,1 % Tube E81035TJ/Mei 21 0 Rp 1,373 Rp -
38 Betametason krim 0,5 mg / g Tube 0 Rp 3,350 Rp -
39 Bioplacenton salap Tube 0 Rp 15,950 Rp -
40 Bisakodil kapsul 5 mg Kap 6B6066/Juli 20 0 Rp 306 Rp -
41 Bisakodil Supp 5 mg (2019) Supp 18070947/Juni 22 0 Rp 6,000 Rp -
Bisakodil Supp 5 mg (2018) Supp 0 Rp 5,670 Rp -
42 Bisakodil Supp 10 mg Supp 17101282/Sept 21 0 Rp 5,900 Rp -
43 Bisoprolol Fumarat 5 mg Tab Tab BN2590649/April 22 0 Rp 237 Rp -
44 Calcii Glukonas Vial 97LB0070/Feb 21 0 Rp 10,351 Rp -
45 Cefadroksil 500 mg Kap 0 Rp 581 Rp -
46 Cefadroksil Sirup (2019) Btl 6908006/Agust 22 0 Rp 4,339 Rp -
Cefadroksil Sirup Btl 0 Rp 6,395 Rp -
47 Cefotaxim inj 1 g (2019) Vial 107014AJ/Juli 21 0 Rp 4,571 Rp -
Cefotaxim inj 1 g (2018) Vial 0 Rp 10,511 Rp -
48 Cetirizin tablet 10 mg Tab T07020AJ/Juli 21 0 Rp 101 Rp -
49 Cetirizin sirup Btl S07024/Juli 21 0 Rp 2,973 Rp -
50 Cefixime Kapsul Kap 0 Rp 626 Rp -
51 Ciprofloksasin tab 500mg Tab 0 Rp 272 Rp -
Ciprofloksasin tab 500mg (Buffer) Tab 0 Rp 257 Rp -
52 Clindamycin 300 mg Kap KPC07847/Feb 21 0 Rp 1,300 Rp -
53 Chlorfeniramin Maleat (CTM) 4 mg (2019 Tab 1811-05-0512/Nop22 0 Rp 25 Rp -
Chlorfeniramin Maleat (CTM) 4 mg Tab 16326001/Mei 21 1000 1000 Rp 23 Rp 23,000
Chlorfeniramin Maleat (CTM) 4 mg Tab 0 Rp 163 Rp -
54 Clozapin 100 mg Tablet Tab BN50C0339/Mar 21 0 Rp 3,622 Rp -
55 Deksametason tablet 0,5 mg (2019) Tab 691876/Juni 24 500 500 Rp 118 Rp 59,000
Deksametason tablet 0,5 mg Tab 0 Rp 33 Rp -
56 Deksametason inj. 5mg/ml-1 ml (2018) Amp 0 Rp 1,152 Rp -
57 Diazepam tablet 2 mg Tab A3107DW/Apr 23 0 Rp 86 Rp -
58 Diazepam tablet 5 mg Tab 0 Rp 122 Rp -
59 Diazepam injeksi (2019) Amp F9B711/Feb 22 0 Rp 1,822 Rp -
60 Difenhidramin hcl inj. 10mg/ml-1 ml (201 Amp 16342003-2/Feb 22 30 30 Rp 1,152 Rp 34,560
Difenhidramin hcl inj. 10mg/ml-1 ml Amp 0 Rp 1,235 Rp -
61 Digoksin tablet 0,25 mg (2019) Tab A8603AW/Jan 21 0 Rp 104 Rp -
Digoksin tablet 0,25 mg Tab A7806DU/April 21 0 Rp 106 Rp -
62 Domperidon 10mg tablet Tab A9A0792/Des 21 200 200 Rp 86 Rp 17,200
63 Domperidon syrup Btl 1910-52-186/Okto21 0 Rp 2,781 Rp -
64 Domperidon Tetes 5 mg/ml Btl SCE13648/April 21 0 Rp 24,948 Rp -
65 Efedrin inj 50 mg / ml Amp 97LL0098/Nop 21 0 Rp 8,569 Rp -
66 Epinefrin hcl bitartratinj 0,1 % 1ml (201 Amp 97LA0017/Nop 20 0 Rp 1,408 Rp -
Epinefrin hcl bitartratinj 0,1 % 1ml Amp 0 Rp 2,354 Rp -
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67 Eritromisin Tab 500mg Tab 0 Rp 765 Rp -
68 Eritromisin Sirup Btl E91511J/Mei 24 0 Rp 13,721 Rp -
JUMLAH Rp 162,760

69 Etakridin (rivanol) larutan 0,1 % Btl 0 Rp 2,275 Rp -
70 Etanol 70% 100 ml Btl 0 Rp 2,575 Rp -
72 Etil klorida semprot Btl 184076/Agusts 23 0 Rp 415,000 Rp -
73 Eugenol cairan Btl F81646/Juni 22 0 Rp 19,765 Rp -
74 Fenobarbital tablet 30 mg Tab K72809B/Okto22 0 Rp 180 Rp -
Fenobarbital tablet 30 mg (2019) amp 681346B/Juni 23 0 Rp 2,068 Rp -
75 Fenobarbital inj amp 0 Rp 2,079 Rp -
76 Fenol gliserol tetes telinga 10 % Btl 0 Rp 2,590 Rp -
77 Fitomenadion (vit k 1) inj 10mg/ml-1 ml Amp 0 Rp 3,728 Rp -
78 Fitomenadion tab 10 mg (2018) Tab 16381005/April 21 0 Rp 747 Rp -
Fitomenadion tab 10 mg Tab 6381005/Agstus 20 0 Rp 726 Rp -
79 Furosemid tablet 40 mg Tab K727168B/Okto 20 0 Rp 79 Rp -
Furosemid tablet 40 mg Tab L82673B/Desem 21 0 Rp 79 Rp -
80 FDC Kategori I (Program) Paket 692523J/Juni 21 0 Rp 408,812 Rp -
81 FDC Kategori II (Program) Paket 36471002-3/Juni 22 0 Rp 1,362,789 Rp -
82 FDC Kategori Anak (Program) Paket 26493014/Mei 21 0 Rp 260,526 Rp -
83 Gabapentin 100 mg tab Tab W2237102/Jan 21 0 Rp 1,095 Rp -
84 Gentamisin Salep Kulit 0,1% Tub 0 Rp 2,126 Rp -
85 Glas Ionomer ART (Serbuk) Btl 1901291/Jan 22 0 Rp 534,600 Rp -
86 Glibenclamid tablet 5 mg Tab 0 Rp 105 Rp -
87 Glimepiride 1 mg Tab 50D0180/Maret 22 0 Rp 174 Rp -
88 Glimepiride 2 mg Tab 50E0215/April 22 0 Rp 207 Rp -
Glimepiride 2 mg (Buffer) Tab 0 Rp 231 Rp -
89 Glukosa larutan infus 10 % steril Btl 290521/Juni 21 0 Rp 7,500 Rp -
91 Grisoefulvin tablet 125 mg (2019) Tab 1908-02-176/Agst 21 0 Rp 232 Rp -
Grisoefulvin tablet 125 mg (2018) Tab 0 Rp 217 Rp -
92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23 1000 1000 Rp 96 Rp 96,000
93 Garam Oralit 200 mg (Program) Bks H81524/Maret 20 0 Rp 263 Rp -
Garam Oralit 200 mg (Program) Bks D91123/Maret 20 0 Rp 263 Rp -
94 Haloperidol tablet 0,5 mg (2019) Tab A1807FV/Juli 23 0 Rp 55 Rp -
95 Haloperidol tablet 1,5 mg Tab A1910EW/Mei 24 0 Rp 59 Rp -
96 Haloperidol tablet 5 mg Tab A92471/Septm 22 0 Rp 56 Rp -
97 Hidrokortison krim 2,5 % Tub K82339T/Nopem 22 0 Rp 2,533 Rp -
98 Hidroklorotiazid (hct) tablet 25 mg Tab 172010B/Agst 22 0 Rp 163 Rp -
Hidroklorotiazid (hct) tablet 25 mg (2019 Tab B80167B/Jan 23 0 Rp 163 Rp -
99 Ibuprofen tablet 200 mg (2019) Tab E91181B/Agst 21 0 Rp 181 Rp -
Ibuprofen tablet 200 mg Tab 0 Rp 108 Rp -
100 Ibuprofen tablet 400 mg (2019) Tab 1907-11-134/Jul 21 0 Rp 306.36 Rp -
Ibuprofen tablet 400 mg Tab 0 Rp 215.29 Rp -
101 Ibuprofen Suspensi (2019) Btl 16357025/Juni 21 0 Rp 2,420 Rp -
Ibuprofen Suspensi Btl 0 Rp 4,755 Rp -
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102 Isoniazid 100 mg (2019) Tab K72734B/Okto 22 0 Rp 142.56 Rp -
Isoniazid Tab AL91202/Des 20 0 Rp 75 Rp -
Isoniazid (Program) Tab 0 Rp 125 Rp -
103 Isoniazid 300 mg Tab F91589B/Mei 21 0 Rp 190.3 Rp -
JUMLAH Rp 96,000

104 Isosorbid dinitrat tablet sublingual 5 mg Tab A23190V/April 22 0 Rp 89 Rp -
105 Kalium Diklofenak 50 mg Tab Tab HTDPSA94056/Jul 21 0 Rp 644 Rp -
106 Kalsium Glukonas inj Amp 0 Rp 9,955 Rp -
107 Kalsium laktat tab 500 mg (2019) Tab 491011/April 22 800 800 Rp 59 Rp 47,200
Kalsium laktat (kalk) tablet 500 mg (2018 Tab 16322005/Jul 22 0 Rp 178.95 Rp -
108 Kandesartan 16 mg tablet Tab 50D4224/Mar 21 0 Rp 943 Rp -
109 Kaptopril 12.5 mg (2019) Tab B90321B/Feb 24 0 Rp 65 Rp -
Kaptopril 12.5 mg Tab 1380281B/Jan 23 0 Rp 65 Rp -
110 Kaptopril 25 mg (2019) Tab E91181B/April 24 0 Rp 145 Rp -
111 Karbamazepin tablet 200 mg (2019)) Tab A91055/Mei 23 0 Rp 231 Rp -
112 Kasa pembalut hidrofil 4 m x 10 cm Rol 100 100 Rp 607 Rp 60,700
113 Ketokonazole Krim Tub E90645T/Mei 23 25 25 Rp 2,577 Rp 64,425
114 Ketokonazole Tab 200mg (2019) Tab 190810103/Agst 21 200 200 Rp 297 Rp 59,400
Ketokonazole Tab 200mg Tab 0 Rp 278 Rp -
115 Ketoprofen Suppo Supp 0 Rp 10,436 Rp -
116 Ketorolac inj Amp 9619C0065A/Feb 21 0 Rp 1,089 Rp -
117 Klobazam Tab 50D0402/Mar 22 0 Rp 900 Rp -
118 Kloramfenikol kapsul 250 mg (2019) Kap 1804-10-251/Apr 22 0 Rp 682 Rp -
Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21 100 100 Rp 320 Rp 32,000
119 Kloramfenikol salep mata 1 % Tub A90069W/Jan 22 24 24 Rp 1,925 Rp 46,200
120 Kloramfenikol Suspensi Btl HI61433B/Agst 20 0 Rp 8,949 Rp -
121 Klorpromazin hcl inj. 5mg/ml-2 ml Amp 0 Rp 1,310 Rp -

122 Klorpromazin hcl tab salut 100 mg (2019 Tab 0 Rp 153 Rp -
Klorpromazin hcl tab salut 100 mg (buffe Tab 0 Rp 165 Rp -
123 Kodein hcl tablet 10 mg (2018) Tab L73947/Des 21 0 Rp 600 Rp -
124 Kotrimoksazole dewasa Forte Tab A90576/Mar 22 0 Rp 299 Rp -
125 Kotrimoksazole dewasa tablet 480 mg Tab A91844/Jul 22 0 Rp 125 Rp -
126 Kotrimoksazole suspensi Btl A91425/Jul 22 0 Rp 2,052 Rp -
127 Kolkisin Tab OUN031/Jun 22 0 Rp 2,414 Rp -
128 Kaca Slide Kotak/72 0 Rp 20,000 Rp -
129 Levopar Tablet Tab 0 Rp 1,289 Rp -
130 Lidokain kompositum injeksi (2018) Amp 16815010/Feb 21 0 Rp 1,205 Rp -
Lidokain Kompositum injeksi Amp 0 Rp 1,937 Rp -
131 Loratadin tablet 10 mg Tab 6010218100/Sep 21 0 Rp 125 Rp -
132 Loperamid tablet 2 mg (Buffer) Tab 0 Rp 92 Rp -
133 Magnesium sulfat inj.(iv) 20%-25 ml Vial 0 Rp 3,328 Rp -
134 Magnesium sulfat inj.(iv)40%-25 ml Vial 76148B/Septem 20 0 Rp 3,796 Rp -
135 Metformin tab 500mg (2019) Tab HTMNA91781/Jan 21 0 Rp 99 Rp -
136 Metilergometrin maleat 0,125 mg (2018) Tab C70296J/Mar 22 0 Rp 221 Rp -
Metilergometrin maleat 0,125 mg (2019) Tab B90250J/Feb 24 0 Rp 221 Rp -
137 Metilergometrin maleat injeksi (2019) Ampul 97KL0050/Mar 22 0 Rp 2,684 Rp -
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138 Metilprednisoon 16 mg tablet Tablet 5000192/Feb 23 0 Rp 558 Rp -
139 Metoklorpramide Tab 10 mg (2018) Tab WK3775/Nop 20 0 Rp 80 Rp -
Metoklorpramide Tab 10 mg (2019) Tab YK2306/Nop 22 0 Rp 80 Rp -
140 Metronidazol tablet 250 mg (Buffer) Tab 0 Rp 96 Rp -
141 Metronidazol tablet 500 mg Tab D90855B 0 Rp 286.0 Rp -
142 Metronidazol infus Botol 0 Rp 8,250 Rp -
JUMLAH Rp 309,925

143 Metronidazol Ovula 500 mg Ovul B80459W/Feb 22 0 Rp 3,590 Rp -
144 Meloksikam 15 mg Tab TMXLB90237/Jun21 0 Rp 527 Rp -
145 Mikonazole Krim 2% Tub F81391W/Jun 22 48 48 Rp 3,585 Rp 172,080
146 Natrium Diklofenak Tab 25mg Tab 16364088/Okto 21 500 500 Rp 132 Rp 66,000
147 Natrium Diklofenak Tab 50mg Tab 1636518/Nop 20 0 Rp 127 Rp -
148 Natrium klorida larutan infus 0,9 % steril Btl 480401/Mar 22 20 20 Rp 6,410 Rp 128,200
149 Nipedipin Tab 10 (2019) Tab D90976B/Mar 23 0 Rp 193.49 Rp -
Nipedipin Tab 10 (2018) Tab HJ15883/Agust 21 0 Rp 194 Rp -
150 Nistatin Vaginal Tablet 100.000IU Tab 16372022/Jul 22 0 Rp 590 Rp -
151 Nistatin 500.000 iu/g tab salut Tab 16371004/April 21 0 Rp 830 Rp -
152 OBH Btl 001B6018/Agst 21 0 Rp 5,500 Rp -
153 Oksitetrasiklin hcl salep 3 % Tub 782823W/Okto 21 50 50 Rp 2,412.3 Rp 120,615
154 Oksitetrasiklin hcl 1% salep mata Tub B90193W/Feb 22 0 Rp 2,774 Rp -
155 Omeprazole Kapsul 20mg (2019) caps 19090653/Sep 21 600 600 Rp 143 Rp 85,800
Omeprazole Kapsul 20mg caps 0 Rp 134 Rp -
156 Oxytocin injeksi Amp 97K10062/Okto 20 0 Rp 1,199 Rp -
157 Parasetamol tab 500 mg (2019) Tab A90786/April 22 7000 7000 Rp 56.00 Rp 392,000
Parasetamol tab 500 mg Tab A81600/Agut 20 0 Rp 170.00 Rp -
158 Parasetamol sirup 120 mg/5 ml ) Btl A90836/April 22 0 Rp 1,110 Rp -
159 Phenytoin 100 mg Kap 390606/Juni 21 0 Rp 158 Rp -
160 Piracetam 800 mg Tab 0 Rp 579 Rp -
161 Pirantel Pamoat 125 mg (2019) Tab 1908089/Agustus 21 0 Rp 328 Rp -
162 Pirantel pamoad sirup250mg/ml Btl 2906009/Juni 21 0 Rp 10,100 Rp -
Pirantel pamoad sirup250mg/ml Btl 2908008/Agustus 21 0 Rp 10,100 Rp -
163 Piridoxin hcl tablet 10 mg Tab B90266B/Jan 22 1000 1000 Rp 129 Rp 129,000
164 Piroksikam Tab 10mg Tab 190402143/April 23 0 Rp 201 Rp -
166 Povidon Iodin larutan 10 % 30 ml Btl 471779W/Agust 20 0 Rp 4,950 Rp -
167 Prednison tablet 5 mg (2019) Tab 1907197/Juli 21 700 700 Rp 77 Rp 53,900
168 Primaquin tablet 15 mg (Program) Tab 16386002/Mei 21 0 Rp 224 Rp -
169 Propanolol 40 mg tab Tab 1905156/Mei 22 0 Rp 61 Rp -
Propanolol 10 mg tab Tab 1909004/Sep 22 0 Rp 61 Rp -
170 Ranitidin Tab 150 mg Tab TRNTB93063/Mei 22 0 Rp 216 Rp -
171 Ranitidin injeksi Amp BNPIB09847/Jan 21 0 Rp 1,188 Rp -
Ranitidin injeksi (2019) Amp 9619A00094/Feb 21 0 Rp 2,816 Rp -
172 Retinol (vitamin a) kap 200.000 iu Kap D90421W/April 22 0 Rp 579 Rp -
Retinol (vitamin a) kap 200.000 iu(Prog Kap 0 Rp 534 Rp -
173 Retinol (vitamin a) kap 100.000 iu Kap 482353W/Agst 21 0 Rp 323 Rp -
Retinol (vitamin a) kapsul 100.000 iu Kap 0 Rp 298 Rp -
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174 Ringer Asetat Btl 0 Rp 9,275 Rp -
175 Ringer Laktat Btl 48060G/Mei 22 0 Rp 7,150 Rp -
176 Risperidon 2 mg Kap BN 50E0491/April 22 0 Rp 287 Rp -
177 Salbutamol 2 mg Tab YJ073G/Okto 22 300 300 Rp 64 Rp 19,200
178 Salbutamol 4 mg Tab YK347G/Nop 22 0 Rp 74 Rp -
179 Salisil bedak 2 % Bks K718945/Nop 22 0 Rp 6,006 Rp -
180 Salep 2 - 4 kombinasi Pot 4904015/April 23 0 Rp 2,750 Rp -
181 Serum ABU polivalen inj. 5ml Amp 4700219/Agst 21 0 Rp 479,996 Rp -
JUMLAH Rp 1,166,795

182 Serum anti dipteri inj. 20.000 iu/vial (a. d Vial 0 Rp - Rp -
183 Serum anti tetanus inj. 1.500 iu/ampul (a. Amp 4200319/Jul 21 0 Rp 130,999 Rp -
Serum Anti Tetanus inj (Tetagam) Amp 0 Rp 170,000 Rp -
184 Sianokobalamin (vit b 12) Tab (2018+20 Tab 19TB024/Feb 24 0 Rp 47 Rp -
185 Sianokobalamin (vit b 12) inj. 500 mcg/m Amp 19IG020/Juli 23 0 Rp 1,136 Rp -
186 Simvastatin 10 mg Tab A8716DW/April 21 0 Rp 110 Rp -
187 Simvastatin 20 mg (2019) Tab 111348/Okto 20 1000 1000 Rp 214 Rp 214,000
Simvastatin 20 mg Tab 0 Rp 976 Rp -
188 Spironolakton 10 mg Tab 50C4235/Jul 21 0 Rp 195 Rp -
189 Stesolid 5 mg/2,5 ml Supp W23681710/April 22 0 Rp 13,202 Rp -
190 Stesolid 10 mg/2,5 ml Supp W2369174/Mei 22 0 Rp 19,193 Rp -
191 Sukralfat suspensi 500 mg Btl E9G32G/Juli 21 50 50 Rp 6,989 Rp 349,450
192 Tablet tambah darah kombinasi Tab E90121BB/Apr 21 0 Rp 372 Rp -
Tablet tambah darah kombinasi(Program Tab 0 Rp 367 Rp -
193 Tetrasiklin hcl kapsul 250 mg (2018) Kap 1803061/Mar 22 0 Rp 183 Rp -
194 Teofilin 300 mg tab Tab E91192B/April 24 0 Rp 1,179 Rp -
195 Thiamin hcl (vit b 1) tablet (2019) Tab 1864221158/April 22 0 Rp 91 Rp -
Thiamin hcl (vit b 1) tablet Tab 190801158/Agust 23 0 Rp 85 Rp -
196 Triheksifenidil hidroklorida tablet 2 mg Tab A92248/Agst 22 0 Rp 87 Rp -
197 Ventolin Inhaler Btl NBNNT5S/Peb 21 4 4 Rp 60,000 Rp 240,000
198 Ventolin Nebule Amp FV0638/Peb 22 0 Rp 4,000 Rp -
199 Vitamin B complek tablet (2019) Tab 19TB008/Peb 22 0 Rp 123 Rp -

Vitamin B complek tablet Tab E80908T/Mei 21 2000 2000 Rp 144 Rp 288,000
200 Xylocain jelly 2 % Syringe 0 Rp 41,600 Rp -
201 Zink sirup Btl 052039/Mei 21 0 Rp 3,122 Rp -
202 Zink Tab (Program) Tab 264960/Maret 22 0 Rp 555 Rp -
203 Obat anti Malaria Kotak/9 0 Rp 31,482 Rp -
204 MDT MB Combi blister B.KCC163/Juli 23 6 6 Rp 20,908 Rp 125,448
205 MDT MB Combi Anak blister 0 Rp - Rp -
206 MDT PB Combi blister 0 Rp - Rp -
207 Kloramfenikol salep kulit 2 % Tube 0 Rp 3,140 Rp -
208 SD HIV Test 0 Rp 14,344 Rp -
209 Kina Tab (Program) Tab 0 Rp 704 Rp -
210 Flukonazol (Program) Paket 0 Rp 18,000 Rp -
211 Oseltamivir Kap 0 Rp 12,969 Rp -
212 Pot Sputum Buah 0 Rp 2,950 Rp -
213 RDT Malaria Test 190326 Mar 21 0 Rp 17,894 Rp -
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214 Gentamisin Salep Mata Tub 0 Rp 2,830 Rp -
215 SD Biosensor Syphilis Test 0 Rp 20,400 Rp -
216 SD Syphilis Test 0 Rp 7,250 Rp -
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
218 Masker Surgical (TIE ON) e-Care Pcs 0 Rp 479.90 Rp -
220 DHP Primal Tb 190326 Mar 21 0 Rp 164.00 Rp -
JUMLAH Rp 1,216,898.00
Rp 661,600 Rp 162,760 Rp 96,000 Rp 309,925 Rp 1,166,795 Rp 1,216,898 Rp 3,613,978
Yang menyerahkan
Yang Menerima Pembantu Penyimpan Barang
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
Kuasa Pengguna Barang
(Satum Sumantri)
NIP. 196412121998031003
1. Petugas Gudang Farmasi (…………….………..)
2.Petugas Puskesmas (..………..………..…..)
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Diserahkan Kepada : PUSKESMAS BADAU

3 Allopurinol 100 mg (2019) Tab A90746/April 22 200 200 Rp 99 Rp 19,800
5 Ambroksol Tab 1907146/Juli 21 0 Rp 137 Rp -
10 Amlodipin 5 mg (2018+2019) Tab 12519/Januari 21 0 Rp 76 Rp -
11 Amoksisillin 500 mg (2019) Kap CAMXA90969/Mei 21 27400 27400 Rp 245 Rp 6,713,000
17 Antihemoroid doen kombinasi Supp 681975W/Juli 2022 10 10 Rp 3,325 Rp 33,250
21 Asam Askorbat (Vit. C) 250 mg Tab H91996B/Juli 22 1300 1300 Rp 132 Rp 171,600
14
JUMLAH Rp 7,557,350

35 Betahistin 6 mg Tab 50E0501/Oktober 21 200 200 Rp 110 Rp 22,000
37 Betametason krim 0,1 % Tube E81035TJ/Mei 21 25 25 Rp 1,373 Rp 34,325
48 Cetirizin tablet 10 mg Tab T07020AJ/Juli 21 100 100 Rp 101 Rp 10,100
54 Clozapin 100 mg Tablet Tab BN50C0339/Mar 21 100 100 Rp 3,622 Rp 362,200
59 Diazepam injeksi (2019) Amp F9B711/Feb 22 10 10 Rp 1,822 Rp 18,220
60 Difenhidramin hcl inj. 10mg/ml-1 ml (201 Amp 16342003-2/Feb 22 0 Rp 1,152 Rp -
15
JUMLAH Rp 587,845

88 Glimepiride 2 mg Tab 50E0215/April 22 300 300 Rp 207 Rp 62,100
91 Grisoefulvin tablet 125 mg (2019) Tab 1908-02-176/Agst 21 100 100 Rp 232 Rp 23,200
92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23 0 Rp 96 Rp -
95 Haloperidol tablet 1,5 mg Tab A1910EW/Mei 24 200 200 Rp 59 Rp 11,800
100 Ibuprofen tablet 400 mg (2019) Tab 1907-11-134/Jul 21 900 900 Rp 306.36 Rp 275,724
16
JUMLAH Rp 372,824

Kaptopril 12.5 mg Tab 1380281B/Jan 23 200 200 Rp 65 Rp 13,000
110 Kaptopril 25 mg (2019) Tab E91181B/April 24 1100 1100 Rp 145 Rp 159,500
112 Kasa pembalut hidrofil 4 m x 10 cm Rol 50 50 Rp 607 Rp 30,350
114 Ketokonazole Tab 200mg (2019) Tab 190810103/Agst 21 0 Rp 297 Rp -
Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21 0 Rp 320 Rp -
119 Kloramfenikol salep mata 1 % Tub A90069W/Jan 22 0 Rp 1,925 Rp -

126 Kotrimoksazole suspensi Btl A91425/Jul 22 0 Rp 2,052 Rp -
134 Magnesium sulfat inj.(iv)40%-25 ml Vial 76148B/Septem 20 6 6 Rp 3,796 Rp 22,776
135 Metformin tab 500mg (2019) Tab HTMNA91781/Jan 21 1800 1800 Rp 99 Rp 178,200
136 Metilergometrin maleat 0,125 mg (2018) Tab C70296J/Mar 22 100 100 Rp 221 Rp 22,100
137 Metilergometrin maleat injeksi (2019) Ampul 97KL0050/Mar 22 5 5 Rp 2,684 Rp 13,420
17
JUMLAH Rp 562,771

145 Mikonazole Krim 2% Tub F81391W/Jun 22 0 Rp 3,585 Rp -
146 Natrium Diklofenak Tab 25mg Tab 16364088/Okto 21 0 Rp 132 Rp -
147 Natrium Diklofenak Tab 50mg Tab 1636518/Nop 20 500 500 Rp 127 Rp 63,500
148 Natrium klorida larutan infus 0,9 % steril Btl 480401/Mar 22 0 Rp 6,410 Rp -
Nipedipin Tab 10 (2018) Tab HJ15883/Agust 21 100 100 Rp 194 Rp 19,400
153 Oksitetrasiklin hcl salep 3 % Tub 782823W/Okto 21 0 Rp 2,412.3 Rp -
154 Oksitetrasiklin hcl 1% salep mata Tub B90193W/Feb 22 25 25 Rp 2,774 Rp 69,350
156 Oxytocin injeksi Amp 97K10062/Okto 20 20 20 Rp 1,199 Rp 23,980
158 Parasetamol sirup 120 mg/5 ml ) Btl A90836/April 22 100 100 Rp 1,110 Rp 111,000
163 Piridoxin hcl tablet 10 mg Tab B90266B/Jan 22 0 Rp 129 Rp -
167 Prednison tablet 5 mg (2019) Tab 1907197/Juli 21 0 Rp 77 Rp -
170 Ranitidin Tab 150 mg Tab TRNTB93063/Mei 22 1200 1200 Rp 216 Rp 259,200
18
175 Ringer Laktat Btl 48060G/Mei 22 20 20 Rp 7,150 Rp 143,000
177 Salbutamol 2 mg Tab YJ073G/Okto 22 0 Rp 64 Rp -
178 Salbutamol 4 mg Tab YK347G/Nop 22 1000 1000 Rp 74 Rp 74,000
179 Salisil bedak 2 % Bks K718945/Nop 22 12 12 Rp 6,006 Rp 72,072
JUMLAH Rp 1,300,202

184 Sianokobalamin (vit b 12) Tab (2018+20 Tab 19TB024/Feb 24 1500 1500 Rp 47 Rp 70,500
189 Stesolid 5 mg/2,5 ml Supp W23681710/April 22 3 3 Rp 13,202 Rp 39,606
191 Sukralfat suspensi 500 mg Btl E9G32G/Juli 21 0 Rp 6,989 Rp -
197 Ventolin Inhaler Btl NBNNT5S/Peb 21 0 Rp 60,000 Rp -

202 Zink Tab (Program) Tab 264960/Maret 22 200 200 Rp 555 Rp 111,000
204 MDT MB Combi blister B.KCC163/Juli 23 0 Rp 20,908 Rp -
19
217 Masker N 95 1860 Pcs 20 20 Rp 19,500 Rp 390,000
JUMLAH Rp 948,506.00
Rp 7,557,350 Rp 587,845 Rp 372,824 Rp 562,771 Rp 1,300,202 Rp 948,506 Rp 11,329,498
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
20
21
1
22
2
23
3
24
4
25
6
26
Diserahkan Kepada : PUSKESMAS TANJUNG PANDAN

Amoksisillin sirup Btl 1810796/Nopem 20 60 60 Rp 4,666 Rp 279,960
28 Asedas sirup Btl DB092/April 21 24 24 Rp 38,500 Rp 924,000
27
JUMLAH Rp 16,743,910

32 Atapulgit 600 Tab S10341921/Sep 21 0 Rp 145 Rp -
36 Besi sirup Btl 0998YO/Juni 21 24 24 Rp 35,200 Rp 844,800
42 Bisakodil Supp 10 mg Supp 17101282/Sept 21 20 20 Rp 5,900 Rp 118,000
Chlorfeniramin Maleat (CTM) 4 mg Tab 16326001/Mei 21 0 Rp 23 Rp -
57 Diazepam tablet 2 mg Tab A3107DW/Apr 23 100 100 Rp 86 Rp 8,600
62 Domperidon 10mg tablet Tab A9A0792/Des 21 0 Rp 86 Rp -
28
JUMLAH Rp 1,119,725

74 Fenobarbital tablet 30 mg Tab K72809B/Okto22 700 700 Rp 180 Rp 126,000
80 FDC Kategori I (Program) Paket 692523J/Juni 21 5 5 Rp 408,812 Rp 2,044,060
90 Glukosa larutan infus 5 % steril Btl 290708/Juni 22 20 20 Rp 6,900 Rp 138,000
93 Garam Oralit 200 mg (Program) Bks H81524/Maret 20 300 300 Rp 263 Rp 78,900
97 Hidrokortison krim 2,5 % Tub K82339T/Nopem 22 48 48 Rp 2,533 Rp 121,584
29
JUMLAH Rp 2,862,132

Kaptopril 12.5 mg Tab 1380281B/Jan 23 500 500 Rp 65 Rp 32,500
111 Karbamazepin tablet 200 mg (2019)) Tab A91055/Mei 23 300 300 Rp 231 Rp 69,300
112 Kasa pembalut hidrofil 4 m x 10 cm Rol 0 Rp 607 Rp -
117 Klobazam Tab 50D0402/Mar 22 100 100 Rp 900 Rp 90,000

124 Kotrimoksazole dewasa Forte Tab A90576/Mar 22 300 300 Rp 299 Rp 89,700
126 Kotrimoksazole suspensi Btl A91425/Jul 22 100 100 Rp 2,052 Rp 205,200
130 Lidokain kompositum injeksi (2018) Amp 16815010/Feb 21 60 60 Rp 1,205 Rp 72,300
30
139 Metoklorpramide Tab 10 mg (2018) Tab WK3775/Nop 20 100 100 Rp 80 Rp 8,000
JUMLAH Rp 1,417,550

144 Meloksikam 15 mg Tab TMXLB90237/Jun21 800 800 Rp 527 Rp 421,600
154 Oksitetrasiklin hcl 1% salep mata Tub B90193W/Feb 22 25 25 Rp 2,774 Rp 69,350
164 Piroksikam Tab 10mg Tab 190402143/April 23 600 600 Rp 201 Rp 120,600
31
176 Risperidon 2 mg Kap BN 50E0491/April 22 100 100 Rp 287 Rp 28,700
180 Salep 2 - 4 kombinasi Pot 4904015/April 23 48 48 Rp 2,750 Rp 132,000
JUMLAH Rp 1,872,765

199 Vitamin B complek tablet (2019) Tab 19TB008/Peb 22 5500 5500 Rp 123 Rp 676,500
Vitamin B complek tablet Tab E80908T/Mei 21 0 Rp 144 Rp -
32
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
JUMLAH Rp 1,468,050.00
Rp 16,743,910 Rp 1,119,725 Rp 2,862,132 Rp1,417,550 Rp 1,872,765 Rp 1,468,050 Rp 25,484,132
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
33
34
1
35
2
36
3
37
4
38
6
39
Diserahkan Kepada : PUSKESMAS TANJUNG BINGA

Amoksisillin 250 mg (Buffer) Kap 17094751/Sept 20 200 200 Rp 190 Rp 38,000
40
JUMLAH Rp 2,559,000

40 Bisakodil kapsul 5 mg Kap 6B6066/Juli 20 6 6 Rp 306 Rp 1,836
41 Bisakodil Supp 5 mg (2019) Supp 18070947/Juni 22 5 5 Rp 6,000 Rp 30,000
53 Chlorfeniramin Maleat (CTM) 4 mg (2019 Tab 1811-05-0512/Nop22 1000 1000 Rp 25 Rp 25,000
60 Difenhidramin hcl inj. 10mg/ml-1 ml (201 Amp 16342003-2/Feb 22 30 30 Rp 1,152 Rp 34,560
65 Efedrin inj 50 mg / ml Amp 97LL0098/Nop 21 10 10 Rp 8,569 Rp 85,690
66 Epinefrin hcl bitartratinj 0,1 % 1ml (201 Amp 97LA0017/Nop 20 10 10 Rp 1,408 Rp 14,080
41
JUMLAH Rp 403,386

Fitomenadion tab 10 mg Tab 6381005/Agstus 20 500 500 Rp 726 Rp 363,000
42
JUMLAH Rp 772,860

107 Kalsium laktat tab 500 mg (2019) Tab 491011/April 22 0 Rp 59 Rp -
Kalsium laktat (kalk) tablet 500 mg (2018 Tab 16322005/Jul 22 300 300 Rp 178.95 Rp 53,685
113 Ketokonazole Krim Tub E90645T/Mei 23 0 Rp 2,577 Rp -

126 Kotrimoksazole suspensi Btl 0 Rp 2,052 Rp -
43
JUMLAH Rp 676,325

158 Parasetamol sirup 120 mg/5 ml ) Btl A90836/April 22 100 100 Rp 1,110 Rp 111,000
44
JUMLAH Rp 745,494

195 Thiamin hcl (vit b 1) tablet (2019) Tab 1864221158/April 22 1000 1000 Rp 91 Rp 91,000

45
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
JUMLAH Rp 701,450.00
Rp 2,559,000 Rp 403,386 Rp 772,860 Rp 676,325 Rp 745,494 Rp 701,450 Rp 5,858,515
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
46
47
1
48
2
49
3
50
4
51
6
52
Diserahkan Kepada : PUSKESMAS MEMBALONG

Amoksisillin sirup Btl 1810796/Nopem 20 60 60 Rp 4,666 Rp 279,960
22 Asam Askorbat (Vit. C) 50 mg Tab K78125B/Sept 20 0 Rp 110 Rp -
53
JUMLAH Rp 4,603,860

33 Albendazol 400 mg (Program) Tab 1905076/Mei 21 30 30 Rp 404 Rp 12,120
54
JUMLAH Rp 374,345

79 Furosemid tablet 40 mg Tab K727168B/Okto 20 200 200 Rp 79 Rp 15,800
92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23 2700 2700 Rp 96 Rp 259,200
55
JUMLAH Rp 550,292

116 Ketorolac inj Amp 9619C0065A/Feb 21 10 10 Rp 1,089 Rp 10,890

56
JUMLAH Rp 1,552,590

57
175 Ringer Laktat Btl 48060G/Mei 22 180 180 Rp 7,150 Rp 1,287,000
JUMLAH Rp 3,906,892

184 Sianokobalamin (vit b 12) Tab (2019) Tab 19TB024/Feb 24 3200 3200 Rp 47 Rp 150,400
192 Tablet tambah darah kombinasi Tab E90121BB/Apr 21 16800 16800 Rp 372 Rp 6,249,600
195 Thiamin hcl (vit b 1) tablet (2019) Tab 1864221158/April 22 100 100 Rp 91 Rp 9,100
199 Vitamin B complek tablet (2019) Tab 19TB008/Peb 22 1400 1400 Rp 123 Rp 172,200
58
217 Masker N 95 1860 Pcs 20 20 Rp 19,500 Rp 390,000
JUMLAH Rp 7,498,300.00
Rp 4,603,860 Rp 374,345 Rp 550,292 Rp1,552,590 Rp 3,906,892 Rp 7,498,300 Rp 18,486,279
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
59
60
1
61
2
62
3
63
4
64
6
65
Diserahkan Kepada : PUSKESMAS SIMPANG RUSA

23 Asam Mefenamat Tablet 500mg (2019) Tab A91072/Juli 22 0 Rp 103 Rp -
66
JUMLAH Rp 5,720,350

67
JUMLAH Rp 186,660

99 Ibuprofen tablet 200 mg (2019) Tab E91181B/Agst 21 200 200 Rp 181 Rp 36,200
68
JUMLAH Rp 158,264


124 Kotrimoksazole dewasa Forte Tab A90576/Mar 22 200 200 Rp 299 Rp 59,800
130 Lidokain kompositum injeksi (2018) Amp 16815010/Feb 21 30 30 Rp 1,205 Rp 36,150
135 Metformin tab 500mg (2019) Tab HTMNA91781/Jan 21 0 Rp 99 Rp -
69
JUMLAH Rp 214,650

70
JUMLAH Rp 316,700

Serum Anti Tetanus inj (Tetagam) Amp 2 2 Rp 170,000 Rp 340,000
187 Simvastatin 20 mg (2019) Tab 111348/Okto 20 0 Rp 214 Rp -

202 Zink Tab (Program) Tab 264960/Maret 22 200 200 Rp 555 Rp 111,000
208 SD HIV Test 25 25 Rp 14,344 Rp 358,600
71
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
JUMLAH Rp 1,109,600.00
Rp 5,720,350 Rp 186,660 Rp 158,264 Rp 214,650 Rp 316,700 Rp 1,109,600 Rp 7,706,224
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
72
73
1
74
2
75
3
76
4
77
6
78
STOCK OPNAME UNIT FARMASI PUSKESMAS PERAWAS
BULAN :
No NAMA OBAT SATUAN No.Batch +

GUDANG OBAT APOTEK JUMLAH
ED
1 Acarbose 100 mg Tab 5OE0047/Maret 21
2 Acetyl Sistein Kap 18AS1063/Agst 20
3 Allopurinol 100 mg (2019) Tab A90746/April 22
4 Ambroksol Sirup Btl 190718184/Juli 21
5 Ambroksol Tab 1907146/Juli 21
6 Aminopillin 200 mg Tab BN9C019123/Mar 21
Aminopillin 200 mg (buffer) Tab 17CK043/Okto 20
7 Aminopillin injeksi Amp 19I6034B/Juli 21
8 Amitriptillin 25 mg Tab A1409CW/Maret 23
9 Amlodipin 10 mg (2019) Tab AE09H018/Mei 21
Amlodipin 10 mg Tab
10 Amlodipin 5 mg (2018+2019) Tab 12519/Januari 21

11 Amoksisillin 500 mg (2019) Kap CAMXA90969/Mei 21
Amoksisillin 500 mg (2018) Kap HE018092/Mei 21
Amoksisillin 500 mg (2017) Kap
12 Amoksisillin 250 mg Kap
Amoksisillin 250 mg (Buffer) Kap 17094751/Sept 20

13 Amoksisillin sirup (2019) Btl 19071196/Juli 21
Amoksisillin sirup Btl 1810796/Nopem 20
14 Antasida doen 500mg Tab A91498/Juni 22
15 Antasida Suspensi Btl K701258/Juni 21
16 Antibakteri doen salep, kombinasi Tube 1898069/Agust 22
17 Antihemoroid doen kombinasi Supp 681975W/Juli 2022
18 Antimigrain doen kombinasi (2018) Tab J82079B/Sept 2021
Antimigrain doen kombinasi Tab H92066B/Juli 22
19 Antifungi salep kombinasi Pot 185J11C/Sept 2022
20 Aqua pro injeksi steril bebas pirogen Vial 86A48A/Januari 21
21 Asam Askorbat (Vit. C) 250 mg Tab H91996B/Juli 22
22 Asam Askorbat (Vit. C) 50 mg Tab K78125B/Sept 20
23 Asam Mefenamat Tablet 500mg (2019) Tab A91072/Juli 22
Asam Mefenamat Tablet 500mg Tab A81652/Agustus 20
24 Asam Asetilsalisilat 80 mg Tab A91211/Mei 21
25 Asam Pipemidat 400 mg Tab
26 Asam Traneksamat Tab Tab TS61094B/Feb 22

27 Asam Traneksamat injeksi Vial BN2490461/Mar 22
28 Asedas sirup Btl DB092/April 21
29 Asiklovir tab 400 mg (2018) Tab 081129J/April 23
Asiklovir tab 400mg (Buffer) Tab 06303014/Mei 21
30 Asiklovir tab 200 mg Tab A1307CW/Maret 21
31 Asiklovir Salep Tube F91585/Juni 21
JUMLAH Rp - 1
79
ED
32 Atapulgit 600 Tab S10341921/Sep 21
33 Albendazol 400 mg (Program) Tab 1905076/Mei 21
34 Artemeter injeksi (Program) Amp
35 Betahistin 6 mg Tab 50E0501/Oktober 21

36 Besi sirup Btl 0998YO/Juni 21
37 Betametason krim 0,1 % Tube E81035TJ/Mei 21
38 Betametason krim 0,5 mg / g Tube
39 Bioplacenton salap Tube
40 Bisakodil kapsul 5 mg Kap 6B6066/Juli 20
41 Bisakodil Supp 5 mg (2019) Supp 18070947/Juni 22
Bisakodil Supp 5 mg (2018) Supp
42 Bisakodil Supp 10 mg Supp 17101282/Sept 21
43 Bisoprolol Fumarat 5 mg Tab Tab BN2590649/April 22
44 Calcii Glukonas Vial 97LB0070/Feb 21
45 Cefadroksil 500 mg Kap
46 Cefadroksil Sirup (2019) Btl 6908006/Agust 22

Cefadroksil Sirup Btl
47 Cefotaxim inj 1 g (2019) Vial 107014AJ/Juli 21

Cefotaxim inj 1 g (2018) Vial
48 Cetirizin tablet 10 mg Tab T07020AJ/Juli 21
49 Cetirizin sirup Btl S07024/Juli 21
50 Cefixime Kapsul Kap
51 Ciprofloksasin tab 500mg Tab
Ciprofloksasin tab 500mg (Buffer) Tab
52 Clindamycin 300 mg Kap KPC07847/Feb 21

53 Chlorfeniramin Maleat (CTM) 4 mg (2019 Tab 1811-05-0512/Nop22
Chlorfeniramin Maleat (CTM) 4 mg Tab 16326001/Mei 21
Chlorfeniramin Maleat (CTM) 4 mg Tab
54 Clozapin 100 mg Tablet Tab BN50C0339/Mar 21

55 Deksametason tablet 0,5 mg (2019) Tab 691876/Juni 24
Deksametason tablet 0,5 mg Tab
56 Deksametason inj. 5mg/ml-1 ml (2018) Amp
57 Diazepam tablet 2 mg Tab A3107DW/Apr 23

58 Diazepam tablet 5 mg Tab
59 Diazepam injeksi (2019) Amp F9B711/Feb 22
60 Difenhidramin hcl inj. 10mg/ml-1 ml (201 Amp 16342003-2/Feb 22
Difenhidramin hcl inj. 10mg/ml-1 ml Amp
61 Digoksin tablet 0,25 mg (2019) Tab A8603AW/Jan 21

Digoksin tablet 0,25 mg Tab A7806DU/April 21
62 Domperidon 10mg tablet Tab A9A0792/Des 21
63 Domperidon syrup Btl 1910-52-186/Okto21
64 Domperidon Tetes 5 mg/ml Btl SCE13648/April 21
65 Efedrin inj 50 mg / ml Amp 97LL0098/Nop 21
66 Epinefrin hcl bitartratinj 0,1 % 1ml (201 Amp 97LA0017/Nop 20
80
Epinefrin hcl bitartratinj 0,1 % 1ml Amp
67 Eritromisin Tab 500mg Tab
68 Eritromisin Sirup Btl E91511J/Mei 24

JUMLAH Rp -

ED
69 Etakridin (rivanol) larutan 0,1 % Btl
70 Etanol 70% 100 ml Btl
72 Etil klorida semprot Btl 184076/Agusts 23

73 Eugenol cairan Btl F81646/Juni 22
74 Fenobarbital tablet 30 mg Tab K72809B/Okto22
Fenobarbital tablet 30 mg (2019) amp 681346B/Juni 23
75 Fenobarbital inj amp
76 Fenol gliserol tetes telinga 10 % Btl
77 Fitomenadion (vit k 1) inj 10mg/ml-1 ml Amp
78 Fitomenadion tab 10 mg (2018) Tab 16381005/April 21

Fitomenadion tab 10 mg Tab 6381005/Agstus 20
79 Furosemid tablet 40 mg Tab K727168B/Okto 20
Furosemid tablet 40 mg Tab L82673B/Desem 21
80 FDC Kategori I (Program) Paket 692523J/Juni 21
81 FDC Kategori II (Program) Paket 36471002-3/Juni 22
82 FDC Kategori Anak (Program) Paket 26493014/Mei 21
83 Gabapentin 100 mg tab Tab W2237102/Jan 21
84 Gentamisin Salep Kulit 0,1% Tub
85 Glas Ionomer ART (Serbuk) Btl 1901291/Jan 22

86 Glibenclamid tablet 5 mg Tab
87 Glimepiride 1 mg Tab 50D0180/Maret 22

88 Glimepiride 2 mg Tab 50E0215/April 22
Glimepiride 2 mg (Buffer) Tab
89 Glukosa larutan infus 10 % steril Btl 290521/Juni 21
91 Grisoefulvin tablet 125 mg (2019) Tab 1908-02-176/Agst 21
Grisoefulvin tablet 125 mg (2018) Tab
92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23

93 Garam Oralit 200 mg (Program) Bks H81524/Maret 20
Garam Oralit 200 mg (Program) Bks D91123/Maret 20
94 Haloperidol tablet 0,5 mg (2019) Tab A1807FV/Juli 23
95 Haloperidol tablet 1,5 mg Tab A1910EW/Mei 24
96 Haloperidol tablet 5 mg Tab A92471/Septm 22
97 Hidrokortison krim 2,5 % Tub K82339T/Nopem 22
98 Hidroklorotiazid (hct) tablet 25 mg Tab 172010B/Agst 22
Hidroklorotiazid (hct) tablet 25 mg (2019 Tab B80167B/Jan 23
99 Ibuprofen tablet 200 mg (2019) Tab E91181B/Agst 21
Ibuprofen tablet 200 mg Tab
100 Ibuprofen tablet 400 mg (2019) Tab 1907-11-134/Jul 21
81
101 Ibuprofen Suspensi (2019) Btl 16357025/Juni 21

Ibuprofen Suspensi Btl
102 Isoniazid 100 mg (2019) Tab K72734B/Okto 22

Isoniazid Tab AL91202/Des 20
Isoniazid (Program) Tab
103 Isoniazid 300 mg Tab F91589B/Mei 21

JUMLAH Rp - 3
ED
104 Isosorbid dinitrat tablet sublingual 5 mg Tab A23190V/April 22
105 Kalium Diklofenak 50 mg Tab Tab HTDPSA94056/Jul 21
106 Kalsium Glukonas inj Amp
107 Kalsium laktat tab 500 mg (2019) Tab 491011/April 22

Kalsium laktat (kalk) tablet 500 mg (2018 Tab 16322005/Jul 22
108 Kandesartan 16 mg tablet Tab 50D4224/Mar 21
109 Kaptopril 12.5 mg (2019) Tab B90321B/Feb 24
Kaptopril 12.5 mg Tab 1380281B/Jan 23
110 Kaptopril 25 mg (2019) Tab E91181B/April 24
111 Karbamazepin tablet 200 mg (2019)) Tab A91055/Mei 23
112 Kasa pembalut hidrofil 4 m x 10 cm Rol
113 Ketokonazole Krim Tub E90645T/Mei 23

114 Ketokonazole Tab 200mg (2019) Tab 190810103/Agst 21
Ketokonazole Tab 200mg Tab
115 Ketoprofen Suppo Supp
116 Ketorolac inj Amp 9619C0065A/Feb 21

117 Klobazam Tab 50D0402/Mar 22
118 Kloramfenikol kapsul 250 mg (2019) Kap 1804-10-251/Apr 22
Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21
119 Kloramfenikol salep mata 1 % Tub A90069W/Jan 22
120 Kloramfenikol Suspensi Btl HI61433B/Agst 20
121 Klorpromazin hcl inj. 5mg/ml-2 ml Amp
122 Klorpromazin hcl tab salut 100 mg (2019 Tab
Klorpromazin hcl tab salut 100 mg (buffe Tab
123 Kodein hcl tablet 10 mg (2018) Tab L73947/Des 21

124 Kotrimoksazole dewasa Forte Tab A90576/Mar 22
125 Kotrimoksazole dewasa tablet 480 mg Tab A91844/Jul 22
126 Kotrimoksazole suspensi Btl
127 Kolkisin Tab OUN031/Jun 22

128 Kaca Slide Kotak/72
129 Levopar Tablet Tab
130 Lidokain kompositum injeksi (2018) Amp 16815010/Feb 21

Lidokain Kompositum injeksi Amp
131 Loratadin tablet 10 mg Tab 6010218100/Sep 21

132 Loperamid tablet 2 mg (Buffer) Tab
133 Magnesium sulfat inj.(iv) 20%-25 ml Vial
82
134 Magnesium sulfat inj.(iv)40%-25 ml Vial 76148B/Septem 20
135 Metformin tab 500mg (2019) Tab HTMNA91781/Jan 21
136 Metilergometrin maleat 0,125 mg (2018) Tab C70296J/Mar 22
Metilergometrin maleat 0,125 mg (2019) Tab B90250J/Feb 24
137 Metilergometrin maleat injeksi (2019) Ampul 97KL0050/Mar 22
138 Metilprednisoon 16 mg tablet Tablet 5000192/Feb 23
139 Metoklorpramide Tab 10 mg (2018) Tab WK3775/Nop 20
Metoklorpramide Tab 10 mg (2019) Tab YK2306/Nop 22
140 Metronidazol tablet 250 mg (Buffer) Tab
141 Metronidazol tablet 500 mg Tab D90855B

142 Metronidazol infus Botol
JUMLAH Rp - 4
ED
143 Metronidazol Ovula 500 mg Ovul B80459W/Feb 22
144 Meloksikam 15 mg Tab TMXLB90237/Jun21
145 Mikonazole Krim 2% Tub F81391W/Jun 22
146 Natrium Diklofenak Tab 25mg Tab 16364088/Okto 21
147 Natrium Diklofenak Tab 50mg Tab 1636518/Nop 20
148 Natrium klorida larutan infus 0,9 % steril Btl 480401/Mar 22
149 Nipedipin Tab 10 (2019) Tab D90976B/Mar 23
Nipedipin Tab 10 (2018) Tab HJ15883/Agust 21
150 Nistatin Vaginal Tablet 100.000IU Tab 16372022/Jul 22
151 Nistatin 500.000 iu/g tab salut Tab 16371004/April 21
152 OBH Btl 001B6018/Agst 21
153 Oksitetrasiklin hcl salep 3 % Tub 782823W/Okto 21
154 Oksitetrasiklin hcl 1% salep mata Tub B90193W/Feb 22
155 Omeprazole Kapsul 20mg (2019) caps 19090653/Sep 21
Omeprazole Kapsul 20mg caps
156 Oxytocin injeksi Amp 97K10062/Okto 20

157 Parasetamol tab 500 mg (2019) Tab A90786/April 22
Parasetamol tab 500 mg Tab A81600/Agut 20
158 Parasetamol sirup 120 mg/5 ml ) Btl A90836/April 22
159 Phenytoin 100 mg Kap 390606/Juni 21
160 Piracetam 800 mg Tab
161 Pirantel Pamoat 125 mg (2019) Tab 1908089/Agustus 21

162 Pirantel pamoad sirup250mg/ml Btl 2906009/Juni 21
Pirantel pamoad sirup250mg/ml Btl 2908008/Agustus 21
163 Piridoxin hcl tablet 10 mg Tab B90266B/Jan 22
164 Piroksikam Tab 10mg Tab 190402143/April 23
166 Povidon Iodin larutan 10 % 30 ml Btl 471779W/Agust 20
167 Prednison tablet 5 mg (2019) Tab 1907197/Juli 21
168 Primaquin tablet 15 mg (Program) Tab 16386002/Mei 21
169 Propanolol 40 mg tab Tab 1905156/Mei 22
Propanolol 10 mg tab Tab 1909004/Sep 22
83
170 Ranitidin Tab 150 mg Tab TRNTB93063/Mei 22
171 Ranitidin injeksi Amp BNPIB09847/Jan 21
Ranitidin injeksi (2019) Amp 9619A00094/Feb 21
172 Retinol (vitamin a) kap 200.000 iu Kap D90421W/April 22
Retinol (vitamin a) kap 200.000 iu(Prog Kap
173 Retinol (vitamin a) kap 100.000 iu Kap 482353W/Agst 21

Retinol (vitamin a) kapsul 100.000 iu Kap
174 Ringer Asetat Btl
175 Ringer Laktat Btl 48060G/Mei 22

176 Risperidon 2 mg Kap BN 50E0491/April 22
177 Salbutamol 2 mg Tab YJ073G/Okto 22
178 Salbutamol 4 mg Tab YK347G/Nop 22
179 Salisil bedak 2 % Bks K718945/Nop 22
180 Salep 2 - 4 kombinasi Pot 4904015/April 23
181 Serum ABU polivalen inj. 5ml Amp 4700219/Agst 21
JUMLAH Rp -

ED
182 Serum anti dipteri inj. 20.000 iu/vial (a. d Vial
183 Serum anti tetanus inj. 1.500 iu/ampul (a. Amp 4200319/Jul 21
Serum Anti Tetanus inj (Tetagam) Amp
184 Sianokobalamin (vit b 12) Tab (2018+20 Tab 19TB024/Feb 24

185 Sianokobalamin (vit b 12) inj. 500 mcg/m Amp 19IG020/Juli 23
186 Simvastatin 10 mg Tab A8716DW/April 21
187 Simvastatin 20 mg (2019) Tab 111348/Okto 20
Simvastatin 20 mg Tab
188 Spironolakton 10 mg Tab 50C4235/Jul 21

189 Stesolid 5 mg/2,5 ml Supp W23681710/April 22
190 Stesolid 10 mg/2,5 ml Supp W2369174/Mei 22
191 Sukralfat suspensi 500 mg Btl E9G32G/Juli 21
192 Tablet tambah darah kombinasi Tab E90121BB/Apr 21
Tablet tambah darah kombinasi(Program Tab
193 Tetrasiklin hcl kapsul 250 mg (2018) Kap 1803061/Mar 22

194 Teofilin 300 mg tab Tab E91192B/April 24
195 Thiamin hcl (vit b 1) tablet (2019) Tab 1864221158/April 22
Thiamin hcl (vit b 1) tablet Tab 190801158/Agust 23
196 Triheksifenidil hidroklorida tablet 2 mg Tab A92248/Agst 22
197 Ventolin Inhaler Btl NBNNT5S/Peb 21
198 Ventolin Nebule Amp FV0638/Peb 22
199 Vitamin B complek tablet (2019) Tab 19TB008/Peb 22
Vitamin B complek tablet Tab E80908T/Mei 21
200 Xylocain jelly 2 % Syringe
201 Zink sirup Btl 052039/Mei 21

202 Zink Tab (Program) Tab 264960/Maret 22
203 Obat anti Malaria Kotak/9
204 MDT MB Combi blister B.KCC163/Juli 23
84
205 MDT MB Combi Anak blister
206 MDT PB Combi blister
207 Kloramfenikol salep kulit 2 % Tube
208 SD HIV Test

209 Kina Tab (Program) Tab
210 Flukonazol (Program) Paket
211 Oseltamivir Kap
212 Pot Sputum Buah
213 RDT Malaria Test 190326 Mar 21

214 Gentamisin Salep Mata Tub
215 SD Biosensor Syphilis Test
216 SD Syphilis Test
217 Masker N 95 1860 Pcs
218 Masker Surgical (TIE ON) e-Care Pcs

220 DHP Primal Tb 190326 Mar 21
JUMLAH Rp - 6
Rp - Rp - Rp -
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri) 85
NIP.
196412121998031003
Mengetahui
(Satum Sumantri)
NIP.
196412121998031003
86
Diserahkan Kepada : PUSKESMAS SELAT NASIK

10 Amlodipin 5 mg (2018+2019) Tab 12519/Januari 21 0 Rp 76 Rp -
11 Amoksisillin 500 mg (2019) Kap CAMXA90969/Mei 21 0 Rp 245 Rp -
14 Antasida doen 500mg Tab A91498/Juni 22 3000 3000 Rp 56 Rp 168,000
23 Asam Mefenamat Tablet 500mg (2019) Tab A91072/Juli 22 0 Rp 103 Rp -
87
JUMLAH Rp 419,050

65 Efedrin inj 50 mg / ml Amp 97LL0098/Nop 21 5 5 Rp 8,569 Rp 42,845
88
68 Eritromisin Sirup Btl E91511J/Mei 24 24 24 Rp 13,721 Rp 329,304
JUMLAH Rp 684,689

79 Furosemid tablet 40 mg Tab K727168B/Okto 20 600 600 Rp 79 Rp 47,400
80 FDC Kategori I (Program) Paket 692523J/Juni 21 1 1 Rp 408,812 Rp 408,812
101 Ibuprofen Suspensi (2019) Btl 16357025/Juni 21 50 50 Rp 2,420 Rp 121,000
89
JUMLAH Rp 665,012


125 Kotrimoksazole dewasa tablet 480 mg Tab A91844/Jul 22 200 200 Rp 125 Rp 25,000
126 Kotrimoksazole suspensi Btl 100 100 Rp 2,052 Rp 205,200
90
141 Metronidazol tablet 500 mg Tab D90855B 500 500 Rp 286.0 Rp 143,000
JUMLAH Rp 1,657,625

91
JUMLAH Rp 1,053,196

183 Serum anti tetanus inj. 1.500 iu/ampul (a. Amp 4200319/Jul 21 2 2 Rp 130,999 Rp 261,998
187 Simvastatin 20 mg (2019) Tab 111348/Okto 20 0 Rp 214 Rp -
191 Sukralfat suspensi 500 mg Btl E9G32G/Juli 21 200 200 Rp 6,989 Rp 1,397,800

208 SD HIV Test 25 25 Rp 14,344 Rp 358,600
213 RDT Malaria Test 190326 Mar 21 25 25 Rp 17,894 Rp 447,350
92
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
220 DHP Primal Tb 190326 Mar 21 9 9 Rp 164.00 Rp 1,476.00
JUMLAH Rp 2,755,224.00
Rp 419,050 Rp 684,689 Rp 665,012 Rp1,657,625 Rp 1,053,196 Rp 2,755,224 Rp 7,234,796
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
93
94
1
95
2
96
3
97
4
98
6
99
Diserahkan Kepada : PUSKESMAS AIR SAGA

3 Allopurinol 100 mg (2019) Tab A90746/April 22 0 Rp 99 Rp -
26 Asam Traneksamat Tab Tab TS61094B/Feb 22 400 400 Rp 1,684 Rp 673,600
28 Asedas sirup Btl DB092/April 21 24 24 Rp 38,500 Rp 924,000
30 Asiklovir tab 200 mg Tab A1307CW/Maret 21 500 500 Rp 236 Rp 118,000
31 Asiklovir Salep Tube F91585/Juni 21 50 50 Rp 4,343 Rp 217,150
100
JUMLAH Rp 11,339,300

41 Bisakodil Supp 5 mg (2019) Supp 18070947/Juni 22 12 12 Rp 6,000 Rp 72,000
42 Bisakodil Supp 10 mg Supp 17101282/Sept 21 12 12 Rp 5,900 Rp 70,800
48 Cetirizin tablet 10 mg Tab T07020AJ/Juli 21 2000 2000 Rp 101 Rp 202,000
63 Domperidon syrup Btl 1910-52-186/Okto21 50 50 Rp 2,781 Rp 139,050
101
JUMLAH Rp 738,070

78 Fitomenadion tab 10 mg (2018) Tab 16381005/April 21 200 200 Rp 747 Rp 149,400
83 Gabapentin 100 mg tab Tab W2237102/Jan 21 200 200 Rp 1,095 Rp 219,000
90 Glukosa larutan infus 5 % steril Btl 290708/Juni 22 20 20 Rp 6,900 Rp 138,000
102
JUMLAH Rp 690,216

105 Kalium Diklofenak 50 mg Tab Tab HTDPSA94056/Jul 21 1000 1000 Rp 644 Rp 644,000
108 Kandesartan 16 mg tablet Tab 50D4224/Mar 21 2100 2100 Rp 943 Rp 1,980,300
110 Kaptopril 25 mg (2019) Tab E91181B/April 24 0 Rp 145 Rp -
117 Klobazam Tab 50D0402/Mar 22 100 100 Rp 900 Rp 90,000
Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21 100 100 Rp 320 Rp 32,000

131 Loratadin tablet 10 mg Tab 6010218100/Sep 21 200 200 Rp 125 Rp 25,000
103
139 Metoklorpramide Tab 10 mg (2018) Tab WK3775/Nop 20 400 400 Rp 80 Rp 32,000
JUMLAH Rp 3,613,092

104
180 Salep 2 - 4 kombinasi Pot 4904015/April 23 48 48 Rp 2,750 Rp 132,000
JUMLAH Rp 1,391,600

183 Serum anti tetanus inj. 1.500 iu/ampul (a. Amp 4200319/Jul 21 4 4 Rp 130,999 Rp 523,996
196 Triheksifenidil hidroklorida tablet 2 mg Tab A92248/Agst 22 500 500 Rp 87 Rp 43,500

105
217 Masker N 95 1860 Pcs 0 Rp 19,500 Rp -
JUMLAH Rp 2,841,946.00
Rp 11,339,300 Rp 738,070 Rp 690,216 Rp3,613,092 Rp 1,391,600 Rp 2,841,946 Rp 20,614,224
Yang menyerahkan
Petugas Puskesmas
( Yunita )
(.......................................) NIP. 198706302006042005
NIP.
Mengetahui
(Satum Sumantri)
NIP. 196412121998031003
106
107
1
108
2
109
3
110
4
111
6
112
STOCK OPNAME UNIT FARMASI PUSKESMAS PERAWAS
BULAN : JUNI 2022
No.Batch + GUDANG
No NAMA OBAT SATUAN APOTEK JUMLAH
OBAT
ED
1 Acarbose 100 mg Tab 5OE0047/Maret 21
2 Acetyl Sistein Kap 18AS1063/Agst 20
3 Allopurinol 100 mg (2019) Tab A90746/April 22
4 Ambroksol Sirup Btl 190718184/Juli 21
5 Ambroksol Tab 1907146/Juli 21
6 Aminopillin 200 mg Tab BN9C019123/Mar 21
Aminopillin 200 mg (buffer) Tab 17CK043/Okto 20
7 Aminopillin injeksi Amp 19I6034B/Juli 21
8 Amitriptillin 25 mg Tab A1409CW/Maret 23
9 Amlodipin 10 mg (2019) Tab AE09H018/Mei 21
Amlodipin 10 mg Tab
10 Amlodipin 5 mg (2018+2019) Tab 12519/Januari 21
11 Amoksisillin 500 mg (2019) Kap CAMXA90969/Mei 21
Amoksisillin 500 mg (2018) Kap HE018092/Mei 21
Amoksisillin 500 mg (2017) Kap
12 Amoksisillin 250 mg Kap
Amoksisillin 250 mg (Buffer) Kap 17094751/Sept 20
13 Amoksisillin sirup (2019) Btl 19071196/Juli 21
Amoksisillin sirup Btl 1810796/Nopem 20
14 Antasida doen 500mg Tab A91498/Juni 22
15 Antasida Suspensi Btl K701258/Juni 21
16 Antibakteri doen salep, kombinasi Tube 1898069/Agust 22
17 Antihemoroid doen kombinasi Supp 681975W/Juli 2022
18 Antimigrain doen kombinasi (2018) Tab J82079B/Sept 2021
Antimigrain doen kombinasi Tab H92066B/Juli 22
19 Antifungi salep kombinasi Pot 185J11C/Sept 2022
20 Aqua pro injeksi steril bebas pirogen Vial 86A48A/Januari 21

21 Asam Askorbat (Vit. C) 250 mg Tab H91996B/Juli 22
22 Asam Askorbat (Vit. C) 50 mg Tab K78125B/Sept 20
23 Asam Mefenamat Tablet 500mg (201 Tab A91072/Juli 22
Asam Mefenamat Tablet 500mg Tab A81652/Agustus 20
24 Asam Asetilsalisilat 80 mg Tab A91211/Mei 21
25 Asam Pipemidat 400 mg Tab
26 Asam Traneksamat Tab Tab TS61094B/Feb 22
27 Asam Traneksamat injeksi Vial BN2490461/Mar 22
28 Asedas sirup Btl DB092/April 21
29 Asiklovir tab 400 mg (2018) Tab 081129J/April 23
Asiklovir tab 400mg (Buffer) Tab 06303014/Mei 21
30 Asiklovir tab 200 mg Tab A1307CW/Maret 21
31 Asiklovir Salep Tube F91585/Juni 21
32 Atapulgit 600 Tab S10341921/Sep 21
33 Albendazol 400 mg (Program) Tab 1905076/Mei 21
34 Artemeter injeksi (Program) Amp
35 Betahistin 6 mg Tab 50E0501/Oktober 21
36 Besi sirup Btl 0998YO/Juni 21
37 Betametason krim 0,1 % Tube E81035TJ/Mei 21
38 Betametason krim 0,5 mg / g Tube
39 Bioplacenton salap Tube
40 Bisakodil kapsul 5 mg Kap 6B6066/Juli 20
41 Bisakodil Supp 5 mg (2019) Supp 18070947/Juni 22
Bisakodil Supp 5 mg (2018) Supp
42 Bisakodil Supp 10 mg Supp 17101282/Sept 21
43 Bisoprolol Fumarat 5 mg Tab Tab BN2590649/April 22
44 Calcii Glukonas Vial 97LB0070/Feb 21
45 Cefadroksil 500 mg Kap
46 Cefadroksil Sirup (2019) Btl 6908006/Agust 22
Cefadroksil Sirup Btl
47 Cefotaxim inj 1 g (2019) Vial 107014AJ/Juli 21

Cefotaxim inj 1 g (2018) Vial
48 Cetirizin tablet 10 mg Tab T07020AJ/Juli 21
49 Cetirizin sirup Btl S07024/Juli 21
50 Cefixime Kapsul Kap
51 Ciprofloksasin tab 500mg Tab
Ciprofloksasin tab 500mg (Buffer) Tab
52 Clindamycin 300 mg Kap KPC07847/Feb 21
53 Chlorfeniramin Maleat (CTM) 4 mg ( Tab 1811-05-0512/Nop22
Chlorfeniramin Maleat (CTM) 4 mg Tab 16326001/Mei 21
Chlorfeniramin Maleat (CTM) 4 mg Tab
54 Clozapin 100 mg Tablet Tab BN50C0339/Mar 21
55 Deksametason tablet 0,5 mg (2019) Tab 691876/Juni 24
Deksametason tablet 0,5 mg Tab
56 Deksametason inj. 5mg/ml-1 ml (201 Amp
57 Diazepam tablet 2 mg Tab A3107DW/Apr 23
58 Diazepam tablet 5 mg Tab
59 Diazepam injeksi (2019) Amp F9B711/Feb 22
60 Difenhidramin hcl inj. 10mg/ml-1 ml Amp 16342003-2/Feb 22
Difenhidramin hcl inj. 10mg/ml-1 ml Amp
61 Digoksin tablet 0,25 mg (2019) Tab A8603AW/Jan 21
Digoksin tablet 0,25 mg Tab A7806DU/April 21
62 Domperidon 10mg tablet Tab A9A0792/Des 21
63 Domperidon syrup Btl 1910-52-186/Okto21
64 Domperidon Tetes 5 mg/ml Btl SCE13648/April 21
65 Efedrin inj 50 mg / ml Amp 97LL0098/Nop 21
66 Epinefrin hcl bitartratinj 0,1 % 1ml Amp 97LA0017/Nop 20
Epinefrin hcl bitartratinj 0,1 % 1ml Amp
67 Eritromisin Tab 500mg Tab
68 Eritromisin Sirup Btl E91511J/Mei 24
69 Etakridin (rivanol) larutan 0,1 % Btl

72 Etil klorida semprot Btl 184076/Agusts 23
73 Eugenol cairan Btl F81646/Juni 22
74 Fenobarbital tablet 30 mg Tab K72809B/Okto22
Fenobarbital tablet 30 mg (2019) amp 681346B/Juni 23
75 Fenobarbital inj amp
76 Fenol gliserol tetes telinga 10 % Btl
77 Fitomenadion (vit k 1) inj 10mg/ml-1 Amp
78 Fitomenadion tab 10 mg (2018) Tab 16381005/April 21
Fitomenadion tab 10 mg Tab 6381005/Agstus 20
79 Furosemid tablet 40 mg Tab K727168B/Okto 20
Furosemid tablet 40 mg Tab L82673B/Desem 21
80 FDC Kategori I (Program) Paket 692523J/Juni 21
81 FDC Kategori II (Program) Paket 36471002-3/Juni 22
82 FDC Kategori Anak (Program) Paket 26493014/Mei 21
83 Gabapentin 100 mg tab Tab W2237102/Jan 21
84 Gentamisin Salep Kulit 0,1% Tub
85 Glas Ionomer ART (Serbuk) Btl 1901291/Jan 22
86 Glibenclamid tablet 5 mg Tab
87 Glimepiride 1 mg Tab 50D0180/Maret 22
88 Glimepiride 2 mg Tab 50E0215/April 22
Glimepiride 2 mg (Buffer) Tab
91 Grisoefulvin tablet 125 mg (2019) Tab 1908-02-176/Agst 21
Grisoefulvin tablet 125 mg (2018) Tab
92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23
93 Garam Oralit 200 mg (Program) Bks H81524/Maret 20
Garam Oralit 200 mg (Program) Bks D91123/Maret 20
94 Haloperidol tablet 0,5 mg (2019) Tab A1807FV/Juli 23
95 Haloperidol tablet 1,5 mg Tab A1910EW/Mei 24

96 Haloperidol tablet 5 mg Tab A92471/Septm 22
97 Hidrokortison krim 2,5 % Tub K82339T/Nopem 22
98 Hidroklorotiazid (hct) tablet 25 mg Tab 172010B/Agst 22
Hidroklorotiazid (hct) tablet 25 mg (2 Tab B80167B/Jan 23
99 Ibuprofen tablet 200 mg (2019) Tab E91181B/Agst 21
100 Ibuprofen tablet 400 mg (2019) Tab 1907-11-134/Jul 21
101 Ibuprofen Suspensi (2019) Btl 16357025/Juni 21
Ibuprofen Suspensi Btl
102 Isoniazid 100 mg (2019) Tab K72734B/Okto 22
Isoniazid Tab AL91202/Des 20
Isoniazid (Program) Tab
103 Isoniazid 300 mg Tab F91589B/Mei 21
104 Isosorbid dinitrat tablet sublingual 5 Tab A23190V/April 22
105 Kalium Diklofenak 50 mg Tab Tab HTDPSA94056/Jul 21
106 Kalsium Glukonas inj Amp
107 Kalsium laktat tab 500 mg (2019) Tab 491011/April 22
Kalsium laktat (kalk) tablet 500 mg ( Tab 16322005/Jul 22
108 Kandesartan 16 mg tablet Tab 50D4224/Mar 21
109 Kaptopril 12.5 mg (2019) Tab B90321B/Feb 24
Kaptopril 12.5 mg Tab 1380281B/Jan 23
110 Kaptopril 25 mg (2019) Tab E91181B/April 24
111 Karbamazepin tablet 200 mg (2019)) Tab A91055/Mei 23
112 Kasa pembalut hidrofil 4 m x 10 cm Rol
113 Ketokonazole Krim Tub E90645T/Mei 23
114 Ketokonazole Tab 200mg (2019) Tab 190810103/Agst 21
Ketokonazole Tab 200mg Tab
115 Ketoprofen Suppo Supp
116 Ketorolac inj Amp 9619C0065A/Feb 21
117 Klobazam Tab 50D0402/Mar 22

118 Kloramfenikol kapsul 250 mg (2019) Kap 1804-10-251/Apr 22
Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21
119 Kloramfenikol salep mata 1 % Tub A90069W/Jan 22
120 Kloramfenikol Suspensi Btl HI61433B/Agst 20
121 Klorpromazin hcl inj. 5mg/ml-2 ml Amp
122 Klorpromazin hcl tab salut 100 mg (2 Tab
Klorpromazin hcl tab salut 100 mg (bu Tab
123 Kodein hcl tablet 10 mg (2018) Tab L73947/Des 21
124 Kotrimoksazole dewasa Forte Tab A90576/Mar 22
125 Kotrimoksazole dewasa tablet 480 m Tab A91844/Jul 22
126 Kotrimoksazole suspensi Btl
127 Kolkisin Tab OUN031/Jun 22
128 Kaca Slide Kotak/72
129 Levopar Tablet Tab
130 Lidokain kompositum injeksi (2018) Amp 16815010/Feb 21
Lidokain Kompositum injeksi Amp
131 Loratadin tablet 10 mg Tab 6010218100/Sep 21
132 Loperamid tablet 2 mg (Buffer) Tab
133 Magnesium sulfat inj.(iv) 20%-25 ml Vial
134 Magnesium sulfat inj.(iv)40%-25 ml Vial 76148B/Septem 20
135 Metformin tab 500mg (2019) Tab HTMNA91781/Jan 21
136 Metilergometrin maleat 0,125 mg (2 Tab C70296J/Mar 22
Metilergometrin maleat 0,125 mg (2 Tab B90250J/Feb 24
137 Metilergometrin maleat injeksi (2019) Ampul 97KL0050/Mar 22
138 Metilprednisoon 16 mg tablet Tablet 5000192/Feb 23
139 Metoklorpramide Tab 10 mg (2018) Tab WK3775/Nop 20
Metoklorpramide Tab 10 mg (2019) Tab YK2306/Nop 22
140 Metronidazol tablet 250 mg (Buffer) Tab
141 Metronidazol tablet 500 mg Tab D90855B
142 Metronidazol infus Botol
143 Metronidazol Ovula 500 mg Ovul B80459W/Feb 22

144 Meloksikam 15 mg Tab TMXLB90237/Jun21
145 Mikonazole Krim 2% Tub F81391W/Jun 22
146 Natrium Diklofenak Tab 25mg Tab 16364088/Okto 21
147 Natrium Diklofenak Tab 50mg Tab 1636518/Nop 20
148 Natrium klorida larutan infus 0,9 % ste Btl 480401/Mar 22
149 Nipedipin Tab 10 (2019) Tab D90976B/Mar 23
Nipedipin Tab 10 (2018) Tab HJ15883/Agust 21
150 Nistatin Vaginal Tablet 100.000IU Tab 16372022/Jul 22
151 Nistatin 500.000 iu/g tab salut Tab 16371004/April 21
152 OBH Btl 001B6018/Agst 21
153 Oksitetrasiklin hcl salep 3 % Tub 782823W/Okto 21
154 Oksitetrasiklin hcl 1% salep mata Tub B90193W/Feb 22
155 Omeprazole Kapsul 20mg (2019) caps 19090653/Sep 21
Omeprazole Kapsul 20mg caps
156 Oxytocin injeksi Amp 97K10062/Okto 20
157 Parasetamol tab 500 mg (2019) Tab A90786/April 22
Parasetamol tab 500 mg Tab A81600/Agut 20
158 Parasetamol sirup 120 mg/5 ml ) Btl A90836/April 22
159 Phenytoin 100 mg Kap 390606/Juni 21
160 Piracetam 800 mg Tab
161 Pirantel Pamoat 125 mg (2019) Tab 1908089/Agustus 21
162 Pirantel pamoad sirup250mg/ml Btl 2906009/Juni 21
Pirantel pamoad sirup250mg/ml Btl 2908008/Agustus 21
163 Piridoxin hcl tablet 10 mg Tab B90266B/Jan 22
166 Povidon Iodin larutan 10 % 30 ml Btl 471779W/Agust 20
167 Prednison tablet 5 mg (2019) Tab 1907197/Juli 21
168 Primaquin tablet 15 mg (Program) Tab 16386002/Mei 21
169 Propanolol 40 mg tab Tab 1905156/Mei 22
Propanolol 10 mg tab Tab 1909004/Sep 22

170 Ranitidin Tab 150 mg Tab TRNTB93063/Mei 22
171 Ranitidin injeksi Amp BNPIB09847/Jan 21
Ranitidin injeksi (2019) Amp 9619A00094/Feb 21
172 Retinol (vitamin a) kap 200.000 iu Kap D90421W/April 22
Retinol (vitamin a) kap 200.000 iu(P Kap
173 Retinol (vitamin a) kap 100.000 iu Kap 482353W/Agst 21
Retinol (vitamin a) kapsul 100.000 iu Kap
174 Ringer Asetat Btl
175 Ringer Laktat Btl 48060G/Mei 22
176 Risperidon 2 mg Kap BN 50E0491/April 22
177 Salbutamol 2 mg Tab YJ073G/Okto 22
178 Salbutamol 4 mg Tab YK347G/Nop 22
179 Salisil bedak 2 % Bks K718945/Nop 22
180 Salep 2 - 4 kombinasi Pot 4904015/April 23
181 Serum ABU polivalen inj. 5ml Amp 4700219/Agst 21
182 Serum anti dipteri inj. 20.000 iu/vial ( Vial
183 Serum anti tetanus inj. 1.500 iu/ampul Amp 4200319/Jul 21
Serum Anti Tetanus inj (Tetagam) Amp
184 Sianokobalamin (vit b 12) Tab (2018 Tab 19TB024/Feb 24
185 Sianokobalamin (vit b 12) inj. 500 m Amp 19IG020/Juli 23
186 Simvastatin 10 mg Tab A8716DW/April 21
187 Simvastatin 20 mg (2019) Tab 111348/Okto 20
Simvastatin 20 mg Tab
188 Spironolakton 10 mg Tab 50C4235/Jul 21
189 Stesolid 5 mg/2,5 ml Supp W23681710/April 22
190 Stesolid 10 mg/2,5 ml Supp W2369174/Mei 22
191 Sukralfat suspensi 500 mg Btl E9G32G/Juli 21
192 Tablet tambah darah kombinasi Tab E90121BB/Apr 21
Tablet tambah darah kombinasi(Prog Tab
193 Tetrasiklin hcl kapsul 250 mg (2018) Kap 1803061/Mar 22
194 Teofilin 300 mg tab Tab E91192B/April 24

195 Thiamin hcl (vit b 1) tablet (2019) Tab 1864221158/April 22
Thiamin hcl (vit b 1) tablet Tab 190801158/Agust 23
196 Triheksifenidil hidroklorida tablet 2 m Tab A92248/Agst 22
197 Ventolin Inhaler Btl NBNNT5S/Peb 21
198 Ventolin Nebule Amp FV0638/Peb 22
199 Vitamin B complek tablet (2019) Tab 19TB008/Peb 22
Vitamin B complek tablet Tab E80908T/Mei 21
200 Xylocain jelly 2 % Syringe
201 Zink sirup Btl 052039/Mei 21
202 Zink Tab (Program) Tab 264960/Maret 22
203 Obat anti Malaria Kotak/9
204 MDT MB Combi blister B.KCC163/Juli 23
205 MDT MB Combi Anak blister
206 MDT PB Combi blister
207 Kloramfenikol salep kulit 2 % Tube
208 SD HIV Test
209 Kina Tab (Program) Tab
210 Flukonazol (Program) Paket
211 Oseltamivir Kap
212 Pot Sputum Buah
213 RDT Malaria Test 190326 Mar 21
214 Gentamisin Salep Mata Tub
215 SD Biosensor Syphilis Test
216 SD Syphilis Test
217 Masker N 95 1860 Pcs
220 DHP Primal Tb 190326 Mar 21

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BUKTI PENGAMBILAN BARANG

Dikeluarkan dari : GUDANG FARMASI KAB BELITUNG

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH

ED PROG APBD+DAK BUFFER BERIAN SATUAN (Rp)

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH

ED PROG APBD+DAK BUFFER BERIAN SATUAN (Rp)

Furosemid tablet 40 mg Tab L82673B/Desem 21 0 Rp 79 Rp -

80 FDC Kategori I (Program) Paket 692523J/Juni 21 0 Rp 408,812 Rp -

81 FDC Kategori II (Program) Paket 36471002-3/Juni 22 0 Rp 1,362,789 Rp -

82 FDC Kategori Anak (Program) Paket 26493014/Mei 21 0 Rp 260,526 Rp -

83 Gabapentin 100 mg tab Tab W2237102/Jan 21 0 Rp 1,095 Rp -

84 Gentamisin Salep Kulit 0,1% Tub 0 Rp 2,126 Rp -

85 Glas Ionomer ART (Serbuk) Btl 1901291/Jan 22 0 Rp 534,600 Rp -

86 Glibenclamid tablet 5 mg Tab 0 Rp 105 Rp -

87 Glimepiride 1 mg Tab 50D0180/Maret 22 0 Rp 174 Rp -

88 Glimepiride 2 mg Tab 50E0215/April 22 0 Rp 207 Rp -

Glimepiride 2 mg (Buffer) Tab 0 Rp 231 Rp -

89 Glukosa larutan infus 10 % steril Btl 290521/Juni 21 0 Rp 7,500 Rp -

90 Glukosa larutan infus 5 % steril Btl 290708/Juni 22 0 Rp 6,900 Rp -

91 Grisoefulvin tablet 125 mg (2019) Tab 1908-02-176/Agst 21 0 Rp 232 Rp -

Grisoefulvin tablet 125 mg (2018) Tab 0 Rp 217 Rp -

92 Guayafenesin 100 mg (2019) Tab 190707155/Juli 23 1000 1000 Rp 96 Rp 96,000

93 Garam Oralit 200 mg (Program) Bks H81524/Maret 20 0 Rp 263 Rp -

Garam Oralit 200 mg (Program) Bks D91123/Maret 20 0 Rp 263 Rp -

94 Haloperidol tablet 0,5 mg (2019) Tab A1807FV/Juli 23 0 Rp 55 Rp -

95 Haloperidol tablet 1,5 mg Tab A1910EW/Mei 24 0 Rp 59 Rp -

96 Haloperidol tablet 5 mg Tab A92471/Septm 22 0 Rp 56 Rp -

97 Hidrokortison krim 2,5 % Tub K82339T/Nopem 22 0 Rp 2,533 Rp -

98 Hidroklorotiazid (hct) tablet 25 mg Tab 172010B/Agst 22 0 Rp 163 Rp -

Hidroklorotiazid (hct) tablet 25 mg (2019 Tab B80167B/Jan 23 0 Rp 163 Rp -

99 Ibuprofen tablet 200 mg (2019) Tab E91181B/Agst 21 0 Rp 181 Rp -

Ibuprofen tablet 200 mg Tab 0 Rp 108 Rp -

100 Ibuprofen tablet 400 mg (2019) Tab 1907-11-134/Jul 21 0 Rp 306.36 Rp -

Ibuprofen tablet 400 mg Tab 0 Rp 215.29 Rp -

101 Ibuprofen Suspensi (2019) Btl 16357025/Juni 21 0 Rp 2,420 Rp -

Ibuprofen Suspensi Btl 0 Rp 4,755 Rp -

Isoniazid Tab AL91202/Des 20 0 Rp 75 Rp -

Isoniazid (Program) Tab 0 Rp 125 Rp -

103 Isoniazid 300 mg Tab F91589B/Mei 21 0 Rp 190.3 Rp -

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH

ED PROG APBD+DAK BUFFER BERIAN SATUAN (Rp)

105 Kalium Diklofenak 50 mg Tab Tab HTDPSA94056/Jul 21 0 Rp 644 Rp -

106 Kalsium Glukonas inj Amp 0 Rp 9,955 Rp -

Kalsium laktat (kalk) tablet 500 mg (2018 Tab 16322005/Jul 22 0 Rp 178.95 Rp -

108 Kandesartan 16 mg tablet Tab 50D4224/Mar 21 0 Rp 943 Rp -

109 Kaptopril 12.5 mg (2019) Tab B90321B/Feb 24 0 Rp 65 Rp -

Kaptopril 12.5 mg Tab 1380281B/Jan 23 0 Rp 65 Rp -

110 Kaptopril 25 mg (2019) Tab E91181B/April 24 0 Rp 145 Rp -

111 Karbamazepin tablet 200 mg (2019)) Tab A91055/Mei 23 0 Rp 231 Rp -

112 Kasa pembalut hidrofil 4 m x 10 cm Rol 100 100 Rp 607 Rp 60,700

113 Ketokonazole Krim Tub E90645T/Mei 23 25 25 Rp 2,577 Rp 64,425

Ketokonazole Tab 200mg Tab 0 Rp 278 Rp -

115 Ketoprofen Suppo Supp 0 Rp 10,436 Rp -

116 Ketorolac inj Amp 9619C0065A/Feb 21 0 Rp 1,089 Rp -

117 Klobazam Tab 50D0402/Mar 22 0 Rp 900 Rp -

118 Kloramfenikol kapsul 250 mg (2019) Kap 1804-10-251/Apr 22 0 Rp 682 Rp -

Kloramfenikol kapsul 250 mg Kap H91467T/Agst 21 100 100 Rp 320 Rp 32,000

119 Kloramfenikol salep mata 1 % Tub A90069W/Jan 22 24 24 Rp 1,925 Rp 46,200

120 Kloramfenikol Suspensi Btl HI61433B/Agst 20 0 Rp 8,949 Rp -

121 Klorpromazin hcl inj. 5mg/ml-2 ml Amp 0 Rp 1,310 Rp -

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH

No NAMA OBAT SATUAN No.Batch + PEMBERIAN JML.PEM HARGA JUMLAH