LAMPIRAN : PERSEDIAAN OBAT-OBATAN DAN BMHP

PUSTU ALUE PEUNAWA

PER 31 DESEMBER 2019
BERSUMBER DARI DINAS KESEHATAN KAB. ACEH BARAT DAYA

SALDO AKHIR PER 31 DESEMBER 2018

NO URAIAN Satuan
Jumlah(Unit) Harga Satuan

1 2 3 12
1 Albendazol tab 400 mg Tab 0.00
Albendazole sirup Botol 4,426.00
Air untuk injeksi Ampul 2,750.00
2 Alopurinol tab 100 mg Tab 95.00
Allopurinol 100 mg Tab 30.00 117.00
3 Ambroxol srup Botol 4,000.00
Ambroxol sirup Botol
4 Aminofiline 200 tab mg Tab
Aminofiline injeksi Ampul 3,349.00
5 Ambroxol tablet 30 mg Tab 150.00
Ambroxol tablet 30 mg Tab 150.00
6 Amitriptilin tab sal 25 mg Tab sal 200.00
7 Amlodipin tab 10 mg Tab 0.00
8 Amlodipin tab 10 mg Tab 95.00
Amlodipin tab 5 mg Tab 90.00
Amlodipin tab 5 mg Tab 74.00
9 Amoksisilin sir kering 125 mg/5 ml Botol 2,200.00
10 Amoksisilin tab 250 mg Tab 0.00
Amoksisilin tab 250 mg Tab 40.00 196.00
11 Amoksisilin tab 500 mg Tab 191.00
Amoksisilin tab 500 mg Tab 191.00
Anestetik lokal gigi kombinasi : lidokain hcl 2% +
12 Vial 2,227.00
epinefrin 1 : 80.000 inj 2 ml
Antasida, kombinasi : aluminium hidroksida 200
13 Tab 64.00
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200
Tab 64.00
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200
14 Botol 0.00
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200
Botol 3,106.00
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200
Botol 2,098.00
mg + magnesium hidroksida 200 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
15 Tube 0.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
16 Tube 4,972.00
asam salisilat 3%
Antifungi salep, kombinasi : asam benzoat 6%+
Tube
asam salisilat 3%
17 Antihemoroid Tab 139.00
Antihemoroid Tab 3,642.00
18 Asam askorbat (vitamin C) tab 50 mg Tab 120.00
 Asam askorbat (vitamin C) tab 50 mg Tab 120.00
19 Asam mefenamat kaps 500 mg Kaps 113.00
Asam mefenamat kaps 500 mg kaps 113.00
20 Asering infus botol 1,800.00
21 Asam Traneksamat injeksi 100 mg/5 ml Ampul 2,536.00
22 Asiklovir krim 5 % - 5 gram Tube 0.00
Asiklofir krim 5%- 5 Gram Tube 2.00 3,500.00
Asiklovir 200 mg Tube 60.00 3,500.00
22 Asiklovir tab 400 mg Tab 415.00
23 Atapulgit 600 mg Tab 166.00
24 Bedak salisil serb 2% Botol 1,066.00
Bedak salisil serb 2% 1,071.00
25 Betametason krim 0,5 mg/g Tube 0.00
Betametason krim 0,5 mg/g Tube 1,373.00
26 Bisakodil tab sal 5 mg (Dulcolax) Tab sal 2,700.00
27 Cetirizine tablet 10 mg Tab 0.00
Cetirizine tablet 10 mg Tab 97.00
28 Cetirizine sir 5 mg/5 ml. Botol 0.00
29 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,805.00
30 Deksametason tab 0,5 mg Tab 48.00
Desametasone tab 0.5 mg Tab 45.00
31 Diazepam tab 2 mg Tab 100.00
32 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 0.00
33 Digoksin tab 0,25 mg Tab 103.00
34 Domperidon susp 5 mg/5 ml Botol 0.00
Domperidon susp 5 mg/5 ml Botol 2,862.00
35 Domperidon tab 10 mg Tab 116.00
Domperidone tab 10 mg Tab 86.00
36 Efedrin HCl tablet 25 mg Tab 15,750.00
Epinefrrin (adrenaline) Ampul 9,800.00
37 Eritromisin kaps 250 mg Kaps 0.00
Erytromicine kap 250 mg Kaps 636.00
38 Eritromisin sir 200 mg/5 ml Botol 6,461.00
39 Eritromisin tab 500 mg Tab 781.00
40 Etakridin ( Rivanol ) larutan 0,1% - 300 ml botol 0.00
41 Etanol 70 % 1000 ml Botol 25,800.00
42 Etanol 70% 100 ml Botol 2,625.00
43 Fitomenadion (vitamin K 1) injeksi Tab sal 0.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 30.00 818.00
44 Fenobarbital tab Tab 1,500.00
Fenobarbital tab Tab 197.00
45 Fenobarbital injeksi Ampul
46 Furosemid tab 40 mg Tab 84.00
Garam oralit kombinasi : natrium klorida 0,52 g +
47 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet 10.00 273.00
glukosa anhidrat 2,7 g
48 Gentamisin salep kulit 3 % - 5 gram Tube 3,000.00
Gentamicine salep kulit 3 % -5 gram tube
49 Gentamisin sulfat tetes mata 0,3 %-5 ml botol 0.00
Gentamisin sulfat tetes mata 0,3 %-5 ml botol 9,500.00
50 Gentian Violet larutan 1 % -10 ml Botol 3.00 2,500.00
51 Glibenklamid tab 5 mg Tab 0.00
Glibenklamid tab 5 mg Tab
 Glimeperide 4 mg Tab 137.00
52 Glimepirid tab 2 mg Tab 296.00
53 Gliseril Guayakolat tablet 100 mg Tab 100.00
54 Gliserin tts 100 mg/ml Botol 6,600.00
55 Glukosa Larutan Infus 5% steril 500 ml Botol 5,720.00
56 Griseofulvin (micronized) tab 125 mg Tab 200.00 263.00
Gliseovulvin (micronized)tab 125 mg Tab 64.00
57 Haloperidol tab 5 mg Tab 76.00
58 Haloperidol tab 1,5 mg Tab 74.00
59 Hidroklortiazid Tab 2,838.00
60 Hidrokortison krim 2,5% Tube 0.00
61 Ibuprofen tab 200 mg Tab 112.00
Ibuprofen 200 mg Tab 112.00
62 Ibuprofen tab 400 mg Tab 0.00
Ibuprofen tab 400 mg Tab 0.00
63 Isosorbid dinitrat tab 5 mg Tab 89.00
Isosorbid dinitrat tab 5 mg Tab 82.00
64 Kalsium laktat (kalk) tab 500 mg Tab 4,000.00
65 Kaolin pektin syrup Botol 0.00
66 Kaptopril tab 12,5 mg Tab 65.00
Kaptopril tab 12,5 mg Tab 0.00
67 Kaptopril tab 25 mg Tab 0.00
Kaptropil tab 25 mg Tab 0.00
68 Karbamazepin Tab 200 mg Tablet 0.00
69 Kenalaog in orabase salep Tube 2,577.00
70 Ketokonazol krim 2 % - 15 grm Tube 320.00
Ketokonazol krim 2 % - 15 grm Tube 358.00
71 Ketokonazol tab 200 mg Tab 1,383.00
Ketokonazol 200 mg Tab 3,327.00
Ketorolak injeksi Ampul 1,760.00
72 Kloramfenikol salep kulit 2% Tube 1,850.00
73 Kloramfenikol salep mata 1% Tube 4,982.00
Kloramfenicol salep mata 1% Tube 0.00
74 Kloramfenikol susp 125 mg/5 ml Botol 9,000.00
75 Kloramfenikol tetes telinga 3% Botol 0.00
Kloramfenikol tetes telinga 3% Botol 9,000.00
76 Kloramfenikol tts mata 0,5% Botol 39.00
Kloramfenikol tts mata 0,5% Botol
77 Klorfeniramin tab 4 mg Tab 0.00
Klorfeniramine maleat tab 4mg Tab 0.00
78 Klorfenicol kamfer mentol (CHKM) Botol 223.00
79 Klorpromazin tab sal 100 mg Tab sal 158.00
80 Klorformazine injeksi Tab 131.00
81 Kodein Tab sal 2,225.00
Kotrimoksazol (dewasa) kombinasi :
82 Tab 1,280.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazole (dewasa) kombinasi:
Tab 3,200.00
sulfametoksazol 400mg
Kotrimoksazol (dewasa) kombinasi tiap 5 ml
83 suspensi : sulfametoksazol 200 mg + trimetoprim Botol 3,328.00
40 mg
84 Lidokain injeksi 2% - 2 ml Ampul 0.00
85 Magnesium sulfat inj 20% Vial 9,765.00
Magnesium sulfat inj 20% Vial 9,500.00
 86 Magnesium sulfat inj 40% Vial 0.00
Metamizol injeksi Vial 150.00
Metamizol injeksi Vial 500.00
87 Metformin tab 500 mg Tab 4.00 3,278.00
Metformin tab 500 mg Tab 139.00
Metilergometrine tablet Tab
88 Metilergometrin inj 0,2 mg/ml Ampul 3,800.00
89 Metilprednisolon 4mg Tablet 60.00 94.00
Metilprednisolon 4mg Tab 115.00
Metro ssirup Botol 108.00
90 Metronidazol tab 250 mg Tab
91 Metronidazol tab 500 mg Tab 3,500.00
92 Metoklopramid tab 10 mg Tab 2,750.00
93 Metoklopramid injeksi Ampul 0.00
Metokloporamid injeksi Ampul 0.00
94 Metokloproramide sirup Botol 249.00
95 Mikonazol krim 2% Tube 0.00
Mikonazol krim 2% Tube 0.00
96 Multivitamin Tab 5,170.00
97 Multivitamin Syrup Botol 6,410.00
Multivitamin Syrup Botol 58.00
98 NaCl 0,9% Larutan Botol 0.00
NaCl 0,9% Larutan Botol 150.00
99 Natrium Bikarbonat tablet 500 mg Tab 142.00
100 Natrium diklofenak tab 25 mg Tab 161.00
Natrium diklofenak tab 25 mg Tab 200.00
Natriumdiklofenak25 mg Tab 136.00
101 Natrium diklofenak tab 50 mg Tab 120.00
Natrium diklofenak tab 50 mg Tab 0.00
Natriumdiklofenak50 mg Tab 910.00
102 Nifedipin kaps 10 mg Kaps 0.00
103 Nistatin tab salut 500.000 UI Tab 0.00
Nistatin tab salut 500.000 UI Tab 0.00
104 Obat Batuk Anak Sirup Botol 0.00
Obat Batuk Anak Sirup Botol 0.00
105 Obat Batuk Hitam ( O.B.H. ) cairan - 100 ml Botol 2,864.00
106 Obat Flu tablet Tablet 3,000.00
107 Obat Flu Syrup Botol 2,600.00
108 Oksitetrasiklin salep kulit 3% (HCl) - 5 gr Tube 1,900.00
109 Oksitetrasikline salep mata Tube 195.00
110 Oksitetrasiklin salep mata 1% (HCl) - 3,5 gr Tube 148.00
111 Oksitoksine injeksi Ampul 141.00
Oksitoksine injeksi Ampul
112 Omeprazol kaps 20 mg Kaps 1,198.00
Omeprazol kaps 20 mg Kaps 542.00
113 Ondansetron injeksi Ampul 1,119.00
Ondansetron injeksi Ampul 2,500.00
114 Ondansetron tablet Tablet 0.00
115 Parasetamol sir 120 mg/5 ml Botol 105.00
Parasetamol sir 120 mg/5 ml Botol 20,700.00
116 Parasetamol tab 500 mg Tab 3,113.00
Parasemol tab 500 mg Tab 0.00
117 Perak sulfadiazin krim 1% Tube 331.00
118 Pehacain injeksi Ampul 136.00
119 Pirantel pamoat tab scored 125 mg Tab 136.00
120 Pirantel pamoat tab scored 125 mg Tab 90.00
121 Piridoksin (vitamin B6) tab 10 mg Tab 100.00
Piridoksin (vitamin B6) tab 10 mg Tab 0.00
122 Piroksikam kapsul 10 mg Tab 0.00
Piroksikam kapsul 10 mg Tab 4,150.00
123 Piroksikam kapsul 20 mg Tab 2,900.00
Piroksikam kapsul 20 mg Tab 35,000.00
124 Povidon iodin lar 100 mg/ml Botol 30 ml 1,800.00
Povidon iodin lar 100 mg/ml Botol 30 ml 80.00

125 Povidon iodin lar 100 mg/ml Botol 300 ml 215.00

Povidon iodin lar 100 mg/ml Botol 300 ml 351.00

126 Propanolol tab 10 mg (HCL) Tab 85.00

127 Propanolol tab 40 mg (HCL) Tab 74.00
128 Propitiourasil tab 100 mg Tab 1,677.00
129 Prednison tab 5 mg Tab 110.00
Prednison tab 5 mg Tab 327.00
130 Ranitidin injeksi 25 mg/ml-2ml Ampul 500.00
131 Ranitidin tab 150 mg Tab 7,150.00
132 Retinol (Vitamin A) kap lunak 100.000 UI Tab 7,150.00
133 Retinol (Vitamin A) kap lunak 200.000 UI Tab 68.00
134 Ringer Laktat Larutan Botol 89.00
Ringer Laktat Larutan Botol 2,797.00
135 Salbutamol tab 2 mg Tab 2,017.00
135 Salbutamol tab 4 mg Tab 455.00
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang
136 Tube 492.00
endap 4 %
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang
Tube 3,900.00
endap 4 %
137 Sefadroksil kapsul 500 mg Tab 4,722.00
Sefadroksilkapsul 500 mg Tab 462,000.00
138 Seftriasone injeksi Vial
Seftriasone injeksi Vial 7,500.00
Serum anti bisa ular Vial 4,133.00
Serum anti tetanus Ampul 1,226.00
139 Sefadroksil sirup kering 125mg/5ml - 60 ml Botol 58.00
Sefadrosil sirup kering 125mg/ml-60 ml Botol 55.00
140 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml Ampul 113.00
141 Sianokobalamin (vitamin B12) tab 50 mcg Tab 252.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 225.00
142 Simvastatin tab sal 10 mg Tab sal 225.00
143 Simvastatin 20 mg Tb sala 254.00
Simvastatin tab sal 20 mg Tab sal
Simvastatin tab sal 20 mg Tab sal 181.00
144 Siprofloksasin tab scored 500 mg Tab 329.00
Stesolid 5 mg rectal Tube 310.00
145 Tetrasiklin kaps 250 mg Kaps 91.00
146 Tetrasiklin kaps 500 mg Kaps 87.00
Tetrasiklin kaps 500 mg Kaps 88.00
147 Tiamin (vitamin B1) tab 50 mg Tab 80.00
Tiamin (vitamin B1) tab 50 mg Tab 0.00
 Tiamin (vitamin B1) tab 50 mg Tab 368.00
148 Triheksifenidil tab 2 mg Tab 650.00
149 Trombopop gel Tube 132.00
150 Ulsidex - Sukralfat tablet 500 mg Tab 89.00
Ulsidex - Sukralfat tablet 500 mg Tab 4,959.00
151 Vitamin B kompleks Tab 591.00
152 Vitamin B kompleks Tab 17,500.00
153 Zinc sir 20 mg/5 ml Botol 151.00
154 Zinc tab disp 20 mg Tab 110.00
155 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul 848.00
156 Betahistin tablet 6 mg Tablet 0.00
Betahistin tablet 6 mg Tablet 714.00
157 Alat Suntik Sekali Pakai 1 ml Pcs 774.40
158 Alat Suntik Sekali Pakai 2,5 ml Pcs 181.00
Alat suntik sekali pakai 2,5 ml Pcs 26,400.00
159 Alat suntik 3 ml Pcs 7,286.25
160 Alat Suntik Sekali Pakai 5 ml Pcs 18,271.00
161 Alkohol Swab Set 18,271.00
162 Aseptic gel 500 ml Botol 0.00

163 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs 473.00

164 Folly catheter No.16 Pcs 30,000.00

165 Folly catheter No.18 Pcs 6,222.00
166 HandScun pcs 5,856.00
HandScun Pcs 6,280.00
167 Hidrogen peroksida lar. Konsentrat 3% Botol 800 ml 4,959.00
168 Infusion Set Anak Set 5,254.37
169 Infusion Set Dewasa Set 5,687.00
170 Infusion Set Y-Connector Pcs 16,312.50
171 IV Catheter No. 20 G Set 120,750.00
172 IV Catheter No. 22 G Set 0.00
173 IV Catheter No. 24 G Set 4.00 1,532.00
174 Kapas Pembalut / Absorben 250 gram Roll 8,855.00
175 Kasa Hydrophil 40 x 80 cm roll 1,130.00
Kasa Hydrophil 40 x 80 cm roll 2,415.00
176 Kasa Kompres 40/40 Steril pcs 2,100.00
177 Kasa Pembalut 2 m x 80 cm roll 334.00
Kasa Pembalut 2 m x 80 cm roll 5,000.00
178 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic Rol 8,000.00
Kasa Pembalut Hidrofil 4 m x 15 cm Elastic Rol 15,000.00
179 Kasa Pembalut Hidrofil 4 m x 5 cm Elastic roll 585.00
180 Kassa steril 16 cm x 16 cm roll 480.00
Kassa steril 16 cm x 16 cm roll 7,323.75
181 Lomatuell H/Lomatul Pcs 0.00

182 Masker pcs 3,150.00

Masker Pcs 3,150.00

183 Masker N 95 pcs 3,150.00

Masker N 95 box 40,000.00

184 Pisau Bisturi No. 10 Buah 3,513.89

185 Pisau Bisturi no. 15 set 90,000.00

186 Pisau Bisturi no. 21 Set 0.00

187 Plester 5 yards x 2 inch roll 0.00

Silk (Benang Bedah Sutera) No 3/0 dengan jarum

188 pcs 165,000.00
bedah

189 Strip tes asam urat (easytouch) Btl 25 pcs 0.00

190 Strip tes gula darah (easytouch) Btl 25 pcs 5,904.80

191 Strip tes gula darah (autocheck) Btl 25 pcs 0.00

192 Strip tes HB (easytouch) Btl 25 pcs 0.00

193 Strip tes kolesterol (easytouch) Btl 10 pcs 18,333.00

194 Urin bag Pcs 0.00

195 Test pek Hamil Pcs 2,000.00

196 Etil klorida semprot 100 ml Botol 500,000.00

197 Eugenol Botol
TOTAL HARGA 443.00

Babhrot, 31 Desember 2019

Yang diperiksa
Pengelola ObatPustu alue peunawa
Kabupaten Aceh Barat Daya

Renti azriani,Amd.keb
Nip. 19870822 201705 2 001
H BARAT DAYA

IR PER 31 DESEMBER 2018 PENERIMAAN PEMAKAIAN

Nilai Persediaan (Rp) Jumlah(Unit) Harga Satuan Nilai Persediaan (Rp) Jumlah(Unit) Harga Satuan

14 6 8 9
- 0.00 0.00 0.00
- 4,426.00 0.00 0.00
- 2,750.00 0.00 0.00
- 100.00 117.00 11,700.00 100.00 117.00
3,510 200.00 105.00 21,000.00 230.00 105.00
- 4,000.00 0.00 0.00
4,000.00 0.00 0.00
0.00 0.00 0.00
- 33,499.00 0.00 0.00
- 150.00 0.00 0.00
150.00 0.00 0.00
- 200.00 0.00 0.00
- 0.00 0.00 0.00
- 95.00 0.00 0.00
- 90.00 0.00 0.00
- 74.00 0.00 0.00
- 170.00 4,395.00 747,150.00 160.00 4,395.00
- 191.00 0.00 0.00
7,840 196.00 0.00 40.00 196.00
- 400.00 350.00 140,000.00 400.00 350.00
- 500.00 260.00 130,000.00 500.00 260.00

- 2,227.00 0.00 0.00

- 78.00 0.00 0.00

- 1,000.00 64.00 64,000.00 1,000.00 64.00

- 2,106.00 0.00 0.00

- 60.00 2,098.00 125,880.00 60.00 2,098.00

- 70.00 2,239.00 156,730.00 60.00 2,239.00

- 3,365.00 0.00 0.00

- 15.00 5,170.00 77,550.00 10.00 5,170.00

4,972.00 0.00

- 3,502.00 0.00 0.00

- 3,642.00 0.00 0.00
- 120.00 0.00 0.00
 - 1,000.00 120.00 120,000.00 1,000.00 120.00
- 1,300.00 103.00 133,900.00 1,300.00 103.00
- 113.00 0.00 0.00
- 0.00 0.00 0.00
- 2,536.00 0.00 0.00
- 10.00 3,500.00 35,000.00 10.00 3,500.00
7,000 10.00 4,048.00 40,480.00 12.00 4,048.00
210,000 100.00 440.00 44,000.00 120.00 440.00
- 415.00 0.00 0.00
- 400.00 149.00 59,600.00 300.00 149.00
- 35.00 4,500.00 157,500.00 35.00 4,500.00
- 23.00 3,850.00 88,550.00 20.00 3,850.00
- 1,373.00 0.00 0.00
- 55.00 1,373.00 75,515.00 53.00 1,373.00
- 0.00 0.00 0.00
- 300.00 104.00 31,200.00 300.00 104.00
- 97.00 0.00 0.00
- 3,300.00 0.00 0.00
- 1,805.00 0.00 0.00
- 48.00 0.00 0.00
- 1,500.00 34.00 51,000.00 1,500.00 34.00
- 100.00 0.00 0.00
- 1,222.00 0.00 0.00
- 103.00 0.00 0.00
- 0.00 0.00 0.00
- 2,862.00 0.00 0.00
- 116.00 0.00 0.00
- 86.00 0.00 0.00
- 15,750.00 0.00 0.00
- 9,800.00 0.00 0.00
- 0.00 0.00 0.00
- 636.00 0.00 0.00
- 10.00 6,461.00 64,610.00 10.00 6,461.00
- 781.00 0.00 0.00
- 3,060.00 0.00 0.00
- 25,800.00 0.00 0.00
- 2,625.00 0.00 0.00
- 0.00 0.00 0.00
24,540 818.00 0.00 30.00 818.00
- 1,500.00 0.00 0.00
- 197.00 0.00 0.00
1,980.00 0.00
- 84.00 0.00 0.00

2,730 80.00 263.00 21,040.00 80.00 263.00

- 3,000.00 0.00 0.00

- 3,513.00 0.00 0.00

- 9,500.00 0.00 0.00
7,500 10.00 2,500.00 25,000.00 13.00 2,500.00
- 135.00 0.00 0.00
137.00 0.00 0.00
 - 330.00 0.00 0.00
- 0.00 0.00 0.00
- 400.00 100.00 40,000.00 400.00 100.00
- 0.00 0.00 0.00
- 5,720.00 0.00 0.00
52,600 600.00 223.00 133,800.00 800.00 223.00
- 400.00 238.00 95,200.00 400.00 238.00
- 0.00 0.00 0.00
- 76.00 0.00 0.00
- 163.00 0.00 0.00
- 65.00 2,533.00 164,645.00 65.00 2,533.00
- 200.00 242.00 48,400.00 200.00 242.00
- 112.00 0.00 0.00
- 133.00 0.00 0.00
- 113.00 0.00 0.00
- 98.00 0.00 0.00
- 89.00 0.00 0.00
- 82.00 0.00 0.00
- 4,000.00 0.00 0.00
- 0.00 0.00 0.00
- 1,200.00 65.00 78,000.00 1,160.00 65.00
- 200.00 86.00 17,200.00 200.00 86.00
- 300.00 123.00 36,900.00 300.00 123.00
- 0.00 0.00 0.00
- 0.00 0.00 0.00
- 0.00 0.00 0.00
- 2,577.00 0.00 0.00
- 320.00 0.00 0.00
- 358.00 0.00 0.00
- 1,383.00 0.00 0.00
- 3,327.00 0.00 0.00
- 1,760.00 0.00 0.00
- 1,850.00 0.00 0.00
- 4,982.00 0.00 0.00
- 7,700.00 0.00 0.00
- 10.00 9,000.00 90,000.00 10.00 9,000.00
- 25.00 9,000.00 225,000.00 25.00 9,000.00
9,000.00 0.00 0.00
- 1,000.00 24.00 24,000.00 1,000.00 24.00
- 500.00 26.00 13,000.00 500.00 26.00
-
- 0.00 0.00 0.00
- 210.00 0.00 0.00
- 550.00 0.00 0.00

- 400.00 125.00 50,000.00 400.00 125.00

- 131.00 0.00 0.00

- 70.00 2,052.00 143,640.00 70.00 2,052.00

- 10.00 1,280.00 12,800.00 6.00 1,280.00

- 3,200.00 0.00 0.00
- 3,328.00 0.00 0.00
 - 3,650.00 0.00 0.00
- 9,765.00 0.00 0.00
- 9,500.00 0.00 0.00
13,112 119.00 0.00 4.00 3,278.00
- 150.00 0.00 0.00
500.00 0.00 0.00
- 10.00 3,399.00 33,990.00 2.00 3,399.00
5,640 165.00 0.00 60.00 94.00
- 300.00 139.00 41,700.00 300.00 139.00
- 3,800.00 0.00 0.00
94.00 0.00 0.00
- 115.00 0.00 0.00
- 108.00 0.00 0.00
- 3,904.00 0.00 0.00
- 3,500.00 0.00 0.00
- 2,750.00 0.00 0.00
- 4,250.00 0.00 0.00
- 55.00 3,926.00 215,930.00 55.00 3,926.00
- 1,500.00 249.00 373,500.00 1,200.00 249.00
- 3,850.00 0.00 0.00
- 4,000.00 0.00 0.00
- 5,170.00 0.00 0.00
- 6,410.00 0.00 0.00
- 900.00 58.00 52,200.00 860.00 58.00
- 167.00 0.00 0.00
- 850.00 142.00 120,700.00 850.00 142.00
- 142.00 0.00 0.00
- 1,200.00 136.00 163,200.00 1,150.00 136.00
- 200.00 0.00 0.00
- 136.00 0.00 0.00
- 120.00 0.00 0.00
- 0.00 0.00 0.00
- 910.00 0.00 0.00
- 4,000.00 0.00 0.00
- 5,000.00 0.00 0.00
- 10.00 3,850.00 38,500.00 10.00 3,850.00
- 0.00 0.00 0.00
- 10,000.00 0.00 0.00
- 25.00 3,300.00 82,500.00 25.00 3,300.00
- 3,000.00 0.00 0.00
- 20.00 2,687.00 53,740.00 20.00 2,687.00
- 1,900.00 0.00 0.00
10.00 1,232.00 12,320.00 4.00 1,232.00
- 148.00 0.00 0.00
- 141.00 0.00 0.00
- 1,254.00 0.00 0.00
- 1,198.00 0.00 0.00
- 542.00 0.00 0.00
- 1,119.00 0.00 0.00
- 100.00 1,238.00 123,800.00 100.00 1,238.00
- 105.00 0.00 0.00
- 800.00 68.00 54,400.00 800.00 68.00
- 20,700.00 0.00 0.00
- 3,113.00 0.00 0.00
- 0.00 0.00 0.00
- 331.00 0.00 0.00
- 1,200.00 136.00 163,200.00 1,200.00 136.00
- 141.00 0.00 0.00
- 90.00 0.00 0.00
- 100.00 0.00 0.00
- 200.00 165.00 33,000.00 200.00 165.00
- 200.00 0.00 0.00
- 4,150.00 0.00 0.00
- 4.00 2,900.00 11,600.00 3.00 2,900.00

- 35,000.00 0.00 0.00

- 1,800.00 0.00 0.00

- 80.00 0.00 0.00

- 215.00 0.00 0.00
- 351.00 0.00 0.00
- 1,500.00 85.00 127,500.00 1,500.00 85.00
- 74.00 0.00 0.00
- 1,677.00 0.00 0.00
- 700.00 114.00 79,800.00 700.00 114.00
- 0.00 0.00
- 0.00
- 7,150.00 0.00 0.00
- 7,150.00 0.00 0.00
- 68.00 0.00 0.00
- 89.00 0.00 0.00

- 2,797.00 0.00 0.00

- 2,907.00 0.00 0.00

- 455.00 0.00 0.00

- 492.00 0.00 0.00
3,900.00 0.00 0.00
- 4,722.00 0.00 0.00
- 462,000.00 0.00 0.00
- 126,500.00 0.00 0.00
- 7,500.00 0.00 0.00
- 4,133.00 0.00 0.00
- 1,226.00 0.00 0.00
- 100.00 49.00 4,900.00 100.00 49.00
- 55.00 0.00 0.00
- 113.00 0.00 0.00
- 252.00 0.00 0.00
225.00 0.00 0.00
- 225.00 0.00 0.00
- 100.00 440.00 44,000.00 100.00 440.00
- 0.00
- 100.00 181.00 18,100.00 100.00 181.00
- 300.00 88.00 26,400.00 300.00 88.00
- 0.00 0.00
- 91.00 0.00 0.00
- 87.00 0.00 0.00
 - 1,600.00 88.00 140,800.00 1,600.00 88.00
- 80.00 0.00 0.00
- 65,000.00 0.00 0.00
- 368.00 0.00 0.00
- 650.00 0.00 0.00
- 700.00 132.00 92,400.00 700.00 132.00
- 500.00 89.00 44,500.00 400.00 89.00
- 4,959.00 0.00 0.00
- 591.00 0.00 0.00
- 17,500.00 0.00 0.00
- 151.00 0.00 0.00
- 110.00 0.00 0.00
- 848.00 0.00 0.00
- 90.00 713.90 64,251.00 90.00 713.90
- 50.00 713.00 35,650.00 50.00 713.00
- 714.00 0.00 0.00
- 774.40 0.00 0.00
- 181.00 0.00 0.00
- 26,400.00 0.00 0.00

- 10.00 4,168.00 41,680.00 6.00 4,168.00

- 18,271.00 0.00 0.00

- 18,271.00 0.00 0.00
- 520.30 0.00 0.00
- 473.00 0.00 0.00
- 30,000.00 0.00 0.00
- 6,222.00 0.00 0.00
- 5,856.00 0.00 0.00
- 6,280.00 0.00 0.00
- 4,959.00 0.00 0.00
- 5,254.37 0.00 0.00
6,128 5,687.00 0.00 4.00 1,532.00
- 16,312.50 0.00 0.00
- 120,750.00 0.00 0.00
- 105,000.00 0.00 0.00
- 10.00 1,792.00 17,920.00 8.00 1,792.00
- 2.00 8,624.00 17,248.00 2.00 8,624.00
- 2.00 10,857.00 21,714.00 0.00 10,857.00
- 2,415.00 0.00 0.00
- 2,100.00 0.00 0.00
- 334.00 0.00 0.00
- 5,000.00 0.00 0.00
- 8,000.00 0.00 0.00
- 15,000.00 0.00 0.00

- 585.60 0.00 0.00

- 480.00 0.00 0.00

- 0.00 0.00 0.00

- 6,512.00 0.00 0.00

- 3,150.00 0.00 0.00

 - 3,150.00 0.00 0.00

- 3,150.00 0.00 0.00

- 1.00 40,000.00 40,000.00 0.00 40,000.00

- 10.00 3,514.00 35,140.00 7.00 3,514.00

- 90,000.00 0.00 0.00

- 90,000.00 0.00 0.00

- 90,000.00 0.00 0.00

- 0.00 0.00 0.00

- 170,000.00 0.00 0.00

- 0.00 0.00 0.00

- 3,000.00 0.00 0.00

- 125,000.00 0.00 0.00

18,333.00 0.00 443.00
340,600.00 25,687.00 6,020,273.00 25,832.00
EMAKAIAN SALDO AKHIR PER 31 DESEMBER 2019 SALDO EXPIRE DATE PER 31 DESEMBER 2019
Nilai Persediaan Nilai Persediaan
Nilai Persediaan (Rp) Jumlah(Unit) Harga Satuan Jumlah(Unit) Harga Satuan
(Rp) (Rp)
11 12 14 15 16 17
- 0.00 - 0.00 359.00 -
- 4,426.00 -
- 2,750.00 -
11,700.00 0.00 117.00 - 0.00 0.00 -
24,150.00 0.00 105.00 -
- 4,000.00 - 0.00 0.00 -
-
- 0.00 97.00 -
- 3,349.00 -
- 150.00 - 0.00 0.00 -
- 150.00
- 200.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 95.00 - 0.00 0.00 -
- 90.00 - 0.00 0.00 -
- 74.00 - 0.00 0.00 -
703,200.00 10.00 4,395.00 43,950 0.00 0.00 -
- 0.00 - 0.00 0.00 -
7,840.00 196.00 - 0.00 0.00 -
140,000.00 0.00 350.00 - 0.00 0.00 -
130,000.00 0.00 260.00 - 0.00 0.00 -

- 2,227.00 - 0.00 0.00 -

- 64.00 - 0.00 0.00 -

64,000.00 0.00 64.00 - 0.00

- 0.00 - 0.00 0.00 -

125,880.00 2,098.00 - 0.00 0.00 -

134,340.00 10.00 2,239.00 22,390 0.00 0.00 -

- 0.00 - 0.00 0.00 -

51,700.00 5.00 5,170.00 25,850 0.00 0.00 -

- 139.00 - 0.00 0.00 -

- 0.00 3,642.00 -
- 120.00 - 0.00 0.00 -
120,000.00 0.00 120.00 - 0.00 0.00 -
133,900.00 0.00 103.00 - 0.00 113.00 -
- 113.00 - 0.00
- 1,800.00 - 0.00 0.00 -
- 2,536.00 - 0.00 0.00 -
35,000.00 0.00 3,500.00 - 0.00 0.00 -
48,576.00 0.00 4,048.00 -
52,800.00 40.00 440.00 17,600 0.00 0.00 -
- 415.00 - 0.00 0.00 -
44,700.00 100.00 149.00 14,900 0.00 0.00 -
157,500.00 0.00 1,066.00 - 0.00 0.00 -
77,000.00 3.00 3,850.00 11,550 0.00
- 1,373.00 - 0.00 0.00 -
72,769.00 2.00 1,373.00 2,746 0.00 0.00 -
- 2,700.00 - 0.00 0.00 -
31,200.00 0.00 104.00 - 0.00 0.00 -
- 97.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 1,805.00 - 0.00 0.00 -
- 48.00 - 0.00 0.00 -
51,000.00 0.00 34.00 - 0.00 0.00 -
- 100.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 103.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 2,862.00 - 0.00 0.00 -
- 116.00 - 0.00 0.00 -
- 86.00 - 0.00 0.00 -
- 15,750.00 - 0.00 200.00 -
9,800.00 -
- 0.00 - 0.00 0.00 -
- 636.00 - 0.00 0.00 -
64,610.00 0.00 6,461.00 - 0.00 0.00 -
- 781.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 25,800.00 - 0.00 0.00 -
- 2,625.00 - 0.00 0.00 -
- 0.00 - 0.00 3,754.00 -
24,540.00 818.00 - 0.00 0.00 -
- 1,500.00 - 0.00 0.00 -
- 197.00 -
0.00 1,980.00 -
- 84.00 - 0.00 0.00 -

21,040.00 10.00 263.00 2,630 0.00 0.00 -

- 3,000.00 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -

- 9,500.00 - 0.00 0.00 -
32,500.00 0.00 2,500.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
-
 - 137.00 - 0.00 330.00 -
- 296.00 - 0.00 296.00 -
40,000.00 0.00 100.00 - 0.00 0.00 -
- 6,600.00 - 0.00 0.00 -
- 5,720.00 - 0.00 0.00 -
178,400.00 0.00 223.00 - 0.00 0.00 -
95,200.00 0.00 238.00 -
- 64.00 - 0.00 0.00 -
- 76.00 - 0.00 0.00 -
- 74.00 - 0.00 0.00 -
164,645.00 0.00 2,533.00 - 0.00 0.00 -
48,400.00 0.00 242.00 - 0.00 0.00 -
- 112.00 -
- 112.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 0.00 - 0.00 98.00 -
- 89.00 -
- 82.00 - 0.00 0.00 -
- 4,000.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
75,400.00 40.00 65.00 2,600 0.00 0.00 -
17,200.00 0.00 86.00 - 0.00 0.00 -
36,900.00 0.00 123.00 -
- 0.00 0.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 0.00 - 0.00 3,135.00 -
- 2,577.00 - 0.00 0.00
- 320.00 - 0.00 0.00 -
- 358.00 - 0.00 0.00 -
- 1,383.00 -
- 3,327.00 - 0.00 0.00 -
- 1,760.00 - 0.00 1,850.00 -
- 1,850.00 - 0.00 1,850.00 -
- 4,982.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
90,000.00 0.00 9,000.00 - 0.00 0.00 -
225,000.00 0.00 9,000.00 - 0.00 7,700.00 -
- 9,000.00 - 0.00 0.00 -
24,000.00 0.00 24.00 - 0.00 0.00 -
13,000.00 0.00 26.00 -

- 0.00 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -
- 223.00 - 0.00 0.00 -

50,000.00 0.00 125.00 - 0.00 0.00 -

- 131.00 - 0.00 0.00 -

143,640.00 0.00 2,052.00 - 0.00 0.00 -

7,680.00 4.00 1,280.00 5,120 0.00 0.00 -

- 3,200.00 - 0.00 0.00 -
- 3,328.00 - 0.00 0.00 -
 - 0.00 - 0.00 0.00 -
- 9,765.00 - 0.00 0.00 -
- 9,500.00 -
13,112.00 0.00 - 0.00 0.00 -
- 150.00 - 0.00 0.00 -
- 500.00 - 0.00 0.00 -
6,798.00 8.00 3,399.00 27,192 0.00 3,278.00 -
5,640.00 139.00 - 0.00 0.00 -
41,700.00 0.00 139.00
- 3,800.00 -
- 94.00 - 0.00 0.00 -
- 115.00 - 0.00 0.00 -
- 108.00 -
-
- 3,500.00 -
- 2,750.00 -
- 0.00 - 0.00 0.00 -
215,930.00 0.00 3,926.00 - 0.00 0.00 -
298,800.00 300.00 249.00 74,700 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 5,170.00 - 0.00 0.00 -
- 6,410.00 - 0.00 0.00 -
49,880.00 40.00 58.00 2,320 0.00 0.00 -
- 0.00 - 0.00 0.00 -
120,700.00 0.00 142.00 - 0.00 0.00 -
- 142.00 -
156,400.00 50.00 136.00 6,800 0.00 0.00 -
- 200.00 - 0.00 0.00 -
- 136.00 -
- 120.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 910.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
38,500.00 0.00 3,850.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
82,500.00 0.00 3,300.00 - 0.00 0.00 -
- 3,000.00 -
53,740.00 0.00 2,687.00 - 0.00 0.00 -
- 1,900.00 - 0.00 0.00 -
4,928.00 6.00 1,232.00 7,392
- 148.00 - 0.00 0.00 -
- 141.00 - 0.00 0.00
-
- 1,198.00 - 0.00 542.00 -
- 542.00 -
- 1,119.00 - 0.00 0.00 -
123,800.00 0.00 1,238.00 - 0.00
- 0.00 - 0.00 0.00 -
54,400.00 0.00 68.00 -
- 20,700.00 - 0.00 0.00 -
 - 3,113.00 - 0.00 0.00
- 0.00 - 0.00 318.00 -
- 331.00 - 0.00 0.00 -
163,200.00 0.00 136.00 -
- 136.00 - 0.00 0.00 -
- 90.00 - 0.00 0.00 -
- 100.00 - 0.00 0.00 -
33,000.00 0.00 165.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 4,150.00 - 0.00 0.00 -
8,700.00 1.00 2,900.00 2,900 0.00 0.00 -

- 35,000.00 - 0.00 0.00 -

- 1,800.00 -

- 80.00 - 0.00 0.00 -

- 215.00 - 0.00
- 351.00 - 0.00
127,500.00 0.00 85.00 - 0.00 0.00 -
- 74.00 - 0.00 0.00 -
- 1,677.00 - 0.00 0.00 -
79,800.00 0.00 114.00 - 0.00 0.00 -
327.00 - 0.00
500.00 - 0.00
- 7,150.00 - 0.00 0.00 -
- 7,150.00 -
- 68.00 - 0.00 0.00 -
- 89.00 - 0.00 0.00 -

- 2,797.00 - 0.00 0.00 -

- 2,017.00 -

- 455.00 - 0.00 0.00 -

- 492.00 -
- 3,900.00 -
- 4,722.00 -
- 462,000.00 -

- 7,500.00 - 0.00 0.00 -

- 4,133.00 - 0.00
- 1,226.00 - 0.00 0.00 -
4,900.00 0.00 49.00 - 0.00 0.00 -
- 55.00 -
- 113.00 - 0.00 113.00 -
- 252.00 -
- 225.00 - 0.00 0.00 -
- 225.00 - 0.00 0.00 -
44,000.00 0.00 440.00 - 0.00 0.00 -

18,100.00 0.00 181.00 - 0.00 0.00 -

26,400.00 0.00 88.00 - 0.00 329.00 -
- 310.00 - 0.00 0.00 -
- 91.00 - 0.00 0.00 -
- 87.00 - 0.00
140,800.00 0.00 88.00 - 0.00 0.00
- 80.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
- 368.00 - 0.00 0.00 -
- 650.00 - 0.00 0.00 -
92,400.00 0.00 132.00 - 0.00 0.00 -
35,600.00 100.00 89.00 8,900 0.00 0.00 -
- 4,959.00 - 0.00 591.00 -
- 591.00 - 0.00 591.00 -
- 17,500.00 - 0.00 0.00 -
- 151.00 - 0.00 0.00 -
- 110.00 - 0.00 0.00 -
- 848.00 - 0.00 0.00 -
64,251.00 0.00 0.00 - 0.00 0.00 -
35,650.00 0.00 713.00 -
- 714.00 -
- 774.40 - 0.00 0.00 -
- 181.00 - 0.00 0.00 -
- 26,400.00 - 0.00 0.00 -

25,008.00 4.00 4,168.00 16,672 0.00 0.00 -

- 18,271.00 - 0.00
- 18,271.00 - 0.00
- 0.00 - 0.00 0.00 -
- 473.00 - 0.00 0.00 -
- 30,000.00 - 0.00 0.00 -
- 6,222.00 - 0.00 0.00 -
- 5,856.00 - 0.00 52,704.00 -
6,280.00 -
- 4,959.00 - 0.00 0.00 -
- 5,254.37 - 0.00 0.00 -
6,128.00 5,687.00 - 0.00 0.00 -
- 16,312.50 - 0.00 0.00 -
- 120,750.00 - 0.00 0.00 -
- 0.00 - 0.00 0.00 -
14,336.00 2.00 1,792.00 3,584 0.00 0.00 -
17,248.00 8,624.00 - 0.00 0.00 -
- 2.00 10,857.00 21,714
- 2,415.00 - 0.00 0.00 -
- 2,100.00 - 0.00 0.00 -
- 334.00 - 0.00 0.00 -
- 5,000.00 - 0.00 0.00 -
- 8,000.00 - 0.00 0.00 -
- 15,000.00 - 0.00 0.00 -

- 585.00 - 0.00 0.00 -

- 480.00 - 0.00 0.00 -

- 7,323.75 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -

- 3,150.00 - 0.00 0.00 -

 - 3,150.00 - 0.00 0.00 -

- 3,150.00 - 0.00 0.00 -

- 1.00 40,000.00 40,000 0.00 0.00 -

24,598.00 3.00 3,514.00 10,542 0.00 0.00 -

- 90,000.00 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -

- 165,000.00 - 0.00 165,000.00 -

- 0.00 - 0.00 0.00 -

- 5,904.80 -

- 0.00 - 0.00 0.00 -

- 0.00 - 0.00 0.00 -

- 18,333.00 - 0.00 18,333.00 -
5,797,857.00 741.00 372,052.00 0.00 0.00

Kepala Puskesmas
Babahrot
Kabupaten Aceh Barat Daya

HJ.Ely afriani,SKM.MKM
Nip. 19
bulan 1-5 harga 2016
Rp330,000
LAMPIRAN : PERSEDIAAN OBAT-OBATAN DAN BMHP
PUSTU ALUE PEUNAWA
PER 31 DESEMBER 2020
BERSUMBER DARI DINAS KESEHATAN KAB. ACEH BARAT DAYA

SALDO AKHIR PER 31 SALDO AKHIR PER 31 SALDO EXPIRE DATE PER
PENERIMAAN PEMAKAIAN
DESEMBER 2019 DESEMBER 2020 31 DESEMBER 2019

URAIAN Satuan Nilai Nilai Nilai

Jumlah Harga Jumlah Harga Nilai Persediaan Jumlah Nilai Persediaan Jumlah Harga Jumlah Harga
Persediaan Harga Satuan Persediaan Persedia
(Unit) Satuan (Unit) Satuan (Rp) (Unit) (Rp) (Unit) Satuan (Unit) Satuan
(Rp) (Rp) an (Rp)
NO
1 2 3 12 14 6 8 9 11 12 14 15 16 17
Albendazol tab 400
1 Tab 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 359.00 -
mg

Albendazole sirup Botol 4,426.00 - 4,426.00 0.00 0.00 - 4,426.00 -

Air untuk injeksi Ampul 2,750.00 - 2,750.00 0.00 0.00 - 2,750.00 -

Alopurinol tab 100
Tab 0.00 117.00 - 400.00 117.00 46,800.00 340.00 117.00 39,780.00 60.00 117.00 7,020 0.00 0.00 -
2 mg
Allopurinol 100 mg Tab 0.00 105.00 - 105.00 0.00 0.00 105.00 - 0.00 105.00 -

3 Ambroxol srup Botol 4,000.00 - Rp100 4,000.00 400,000.00 50.00 4,000.00 200,000.00 50.00 4,000.00 200,000 0.00 0.00 -
Ambroxol sirup Botol - 4,000.00 0.00 0.00 - -
Aminofiline 200
Tab - 0.00 0.00 0.00 - - 0.00 97.00 -
4 tab mg
Aminofiline injeksi Ampul 3,349.00 - 33,499.00 0.00 0.00 - 3,349.00 -

Ambroxol tablet 30
Tab 150.00 - 600.00 152.00 91,200.00 500.00 152.00 76,000.00 150.00 - 0.00 0.00 -
5 mg
Amitriptilin tab sal
Tab sal 200.00 - 200.00 0.00 0.00 - 200.00 - 0.00 0.00 -
6 25 mg
Amlodipin tab 10
Tab 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
7 mg
Amlodipin tab 10
Tab 95.00 - 95.00 0.00 0.00 - 95.00 - 0.00 0.00 -
8 mg
Amlodipin tab 5
Tab 90.00 - 90.00 0.00 0.00 - 90.00 - 0.00 0.00 -
mg
Amlodipin tab 5
Tab 74.00 - 74.00 0.00 0.00 - 74.00 - 0.00 0.00 -
mg
 Amoksisilin sir
Botol 6.00 4,395.00 26,370 40.00 4,395.00 175,800.00 35.00 4,395.00 153,825.00 10.00 4,395.00 43,950 0.00 0.00 -
kering 125 mg/5 ml
9

Amoksisilin sir
Botol - 20.00 4,250.00 85,000.00 10.00 4,250.00 42,500.00 -
kering 125 mg/5 ml

Amoksisilin tab
Tab 0.00 - 100.00 191.00 19,100.00 100.00 191.00 19,100.00 0.00 - 0.00 0.00 -
10 250 mg
Amoksisilin tab
Tab 196.00 - 196.00 0.00 0.00 196.00 - 196.00 - 0.00 0.00 -
250 mg
Amoksisilin tab
Tab 0.00 350.00 - 700.00 260.00 182,000.00 700.00 265.00 185,500.00 0.00 350.00 - 0.00 0.00 -
11 500 mg
Amoksisilin tab
Tab 0.00 260.00 - 200.00 265.00 53,000.00 200.00 265.00 53,000.00 0.00 260.00 - 0.00 0.00 -
500 mg
Anestetik lokal gigi
kombinasi :
lidokain hcl 2% + Vial 2,227.00 - 2,227.00 0.00 0.00 - 2,227.00 - 0.00 0.00 -
epinefrin 1 : 80.000
12 inj 2 ml

Antasida,
kombinasi :
aluminium
Tab 64.00 - 500.00 78.00 39,000.00 500.00 78.00 39,000.00 64.00 - 0.00 0.00 -
hidroksida 200 mg
+ magnesium
hidroksida 200 mg
13

Antasida,
kombinasi :
aluminium
Tab 0.00 64.00 - 300.00 60.00 18,000.00 300.00 60.00 18,000.00 0.00 64.00 - 0.00
hidroksida 200 mg
+ magnesium
hidroksida 200 mg

Antasida,
kombinasi :
aluminium
Botol 0.00 - 24.00 2,106.00 50,544.00 19.00 2,106.00 40,014.00 5.00 2,106.00 10,530 0.00 0.00 -
hidroksida 200 mg
+ magnesium
hidroksida 200 mg
14
 Antasida,
kombinasi :
aluminium
Botol 2,098.00 - 2,098.00 0.00 0.00 2,098.00 - 2,098.00 - 0.00 0.00 -
hidroksida 200 mg
+ magnesium
hidroksida 200 mg

Antasida,
kombinasi :
aluminium
Botol 10.00 2,237.00 22,370 2,239.00 0.00 0.00 2,239.00 - 10.00 2,239.00 22,390 0.00 0.00 -
hidroksida 200 mg
+ magnesium
hidroksida 200 mg

Antibakteri,
kombinasi :
basitrasin 500 Tube 0.00 - 3,365.00 0.00 0.00 - 0.00 - 0.00 0.00 -
UI/g+ Polimiskin B
15 10.000 UI/g
Antifungi salep,
kombinasi : asam
Tube 5.00 5,170.00 25,850 5,170.00 0.00 0.00 5,170.00 - 5.00 5,170.00 25,850 0.00 0.00 -
benzoat 6%+ asam
16 salisilat 3%
Antifungi salep,
kombinasi : asam
Tube - 4,972.00 0.00 0.00 - -
benzoat 6%+ asam
salisilat 3%
17 Antihemoroid Tab 139.00 - 3,502.00 0.00 0.00 - 139.00 - 0.00 0.00 -
Antihemoroid Tab 0.00 3,642.00 - 3,642.00 0.00 0.00 - 0.00 3,642.00 -
Asam askorbat
(vitamin C) tab 50 Tab 120.00 - 1,100.00 120.00 132,000.00 1,100.00 120.00 132,000.00 120.00 - 0.00 0.00 -
18 mg
Asam mefenamat
Kaps 0.00 103.00 - 900.00 103.00 92,700.00 900.00 103.00 92,700.00 0.00 103.00 - 0.00 113.00 -
19 kaps 500 mg
Asam mefenamat
kaps 113.00 - 113.00 0.00 0.00 - 113.00 - 0.00
kaps 500 mg
20 Asering infus botol 1,800.00 - 0.00 0.00 0.00 - 1,800.00 - 0.00 0.00 -

Asam Traneksamat
Ampul 2,536.00 - 2,536.00 0.00 0.00 - 2,536.00 - 0.00 0.00 -
injeksi 100 mg/5 ml
21
Asiklovir krim 5 %
Tube 0.00 3,500.00 - 3,500.00 0.00 0.00 3,500.00 - 0.00 3,500.00 - 0.00 0.00
22 - 5 gram
Asiklofir krim 5%-
Tube 0.00 4,048.00 - 4,048.00 0.00 0.00 4,048.00 - 0.00 4,048.00 -
5 Gram
 Asiklovir 200 mg Tube 40.00 440.00 17,600 440.00 0.00 11.00 440.00 4,840.00 40.00 440.00 17,600 0.00 0.00 -
Asiklovir tab 400
Tab 415.00 - 415.00 0.00 0.00 - 415.00 - 0.00 0.00 -
22 mg
23 Atapulgit 600 mg Tab 100.00 149.00 14,900 100.00 149.00 14,900.00 100.00 149.00 14,900.00 100.00 149.00 14,900 0.00 0.00 -
Bedak salisil serb
Botol 0.00 1,066.00 - 20.00 4,500.00 90,000.00 20.00 4,500.00 90,000.00 0.00 1,066.00 - 0.00 0.00 -
24 2%
Bedak salisil serb
3.00 3,850.00 11,550 3,850.00 0.00 3.00 3,850.00 11,550.00 0.00 3,850.00 - 0.00
2%
Betametason krim
Tube 1,373.00 - 5.00 1,373.00 6,865.00 5.00 1,373.00 6,865.00 1,373.00 - 0.00 0.00 -
25 0,5 mg/g
Betametason krim
Tube 2.00 1,373.00 2,746 10.00 1,465.00 14,650.00 10.00 1,465.00 14,650.00 2.00 1,373.00 2,746 0.00 0.00 -
0,5 mg/g
Bisakodil tab sal 5
Tab sal 2,700.00 - 0.00 0.00 0.00 - 2,700.00 - 0.00 0.00 -
26 mg (Dulcolax)
Cetirizine tablet 10
Tab 0.00 104.00 - 104.00 0.00 0.00 104.00 - 0.00 104.00 - 0.00 0.00 -
27 mg
Cetirizine tablet 10
Tab 97.00 - 97.00 0.00 0.00 - 97.00 - 0.00 0.00 -
mg
Cetirizine sir 5
Botol 0.00 - 3,300.00 0.00 0.00 - 0.00 - 0.00 0.00 -
28 mg/5 ml.
Deksametason inj 5
Vial 1,805.00 - 1,805.00 0.00 0.00 - 1,805.00 - 0.00 0.00 -
29 mg/ml (i.v./i.m.)
Deksametason tab
Tab 48.00 - 200.00 48.00 9,600.00 200.00 48.00 9,600.00 48.00 - 0.00 0.00 -
30 0,5 mg
Desametasone tab
Tab 0.00 34.00 - 200.00 100.00 20,000.00 200.00 100.00 20,000.00 0.00 34.00 - 0.00 0.00 -
0.5 mg

Diazepam tab 2 mg Tab 100.00 - 100.00 0.00 0.00 - 100.00 - 0.00 0.00 -
31

Difenhidramin inj
Ampul 0.00 - 1,222.00 0.00 0.00 - 0.00 - 0.00 0.00 -
10 mg/ml (i.v./i.m.)
32
Digoksin tab 0,25
Tab 103.00 - 103.00 0.00 0.00 - 103.00 - 0.00 0.00 -
33 mg
Domperidon susp 5
Botol 0.00 - 20.00 2,862.00 57,240.00 20.00 2,862.00 57,240.00 0.00 - 0.00 0.00 -
34 mg/5 ml
Domperidon susp 5
Botol 2,862.00 - 2,862.00 0.00 0.00 - 2,862.00 - 0.00 0.00 -
mg/5 ml
Domperidon tab 10
35 mg Tab 116.00 - 116.00 0.00 0.00 - 116.00 - 0.00 0.00 -
Domperidone tab
Tab 86.00 - 86.00 0.00 0.00 - 86.00 - 0.00 0.00 -
10 mg
Efedrin HCl tablet
Tab 15,750.00 - 15,750.00 0.00 0.00 - 15,750.00 - 0.00 200.00 -
36 25 mg
Epinefrrin
Ampul 9,800.00 - 9,800.00 0.00 0.00 - 9,800.00 -
(adrenaline)
 Eritromisin kaps
Kaps 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
37 250 mg
Erytromicine kap
Kaps 636.00 - 636.00 0.00 0.00 - 636.00 - 0.00 0.00 -
250 mg
Eritromisin sir 200
Botol 0.00 6,461.00 - 6,461.00 0.00 0.00 6,461.00 - 0.00 6,461.00 - 0.00 0.00 -
38 mg/5 ml
Eritromisin tab 500
Tab 781.00 - 781.00 0.00 0.00 - 781.00 - 0.00 0.00 -
39 mg
Etakridin
( Rivanol ) larutan botol 0.00 - 3,060.00 0.00 0.00 - 0.00 - 0.00 0.00 -
40 0,1% - 300 ml
Etanol 70 % 1000
Botol 25,800.00 - 25,800.00 0.00 0.00 - 25,800.00 - 0.00 0.00 -
41 ml
Etanol 70% 100 ml Botol 2,625.00 - 2,625.00 0.00 0.00 - 2,625.00 - 0.00 0.00 -
42
Fitomenadion
(vitamin K 1) Tab sal 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 3,754.00 -
43 injeksi
Fitomenadion
(vitamin K 1) tab Tab sal 818.00 - 818.00 0.00 0.00 818.00 - 818.00 - 0.00 0.00 -
sal 10 mg
44 Fenobarbital tab Tab 1,500.00 - 1,500.00 0.00 0.00 - 1,500.00 - 0.00 0.00 -
Fenobarbital tab Tab 197.00 - 197.00 0.00 0.00 - 197.00 -
45 Fenobarbital injeksi Ampul - 1,980.00 0.00 0.00 - - 0.00 1,980.00 -
Furosemid tab 40
Tab 84.00 - 84.00 0.00 0.00 - 84.00 - 0.00 0.00 -
46 mg
Garam oralit
kombinasi :
natrium klorida
0,52 g + kalium
Sachet 10.00 263.00 2,630 70.00 263.00 18,410.00 70.00 263.00 18,410.00 10.00 263.00 2,630 0.00 0.00 -
klorida 0,30 g +
trinatrium sitrat
0,58 g + glukosa
47 anhidrat 2,7 g
Gentamisin salep
Tube 3,000.00 - 3,000.00 0.00 0.00 - 3,000.00 - 0.00 0.00 -
48 kulit 3 % - 5 gram

Gentamicine salep
tube - 0.00 0.00 - -
kulit 3 % -5 gram

Gentamisin sulfat
tetes mata 0,3 %-5 botol 0.00 - 3,513.00 0.00 0.00 - 0.00 - 0.00 0.00 -
49 ml
Gentamisin sulfat
tetes mata 0,3 %-5 botol 9,500.00 - 9,500.00 0.00 0.00 - 9,500.00 - 0.00 0.00 -
ml
 Gentian Violet
Botol 0.00 2,500.00 - 2,500.00 0.00 0.00 2,500.00 - 0.00 2,500.00 - 0.00 0.00 -
larutan 1 % -10 ml
50
Glibenklamid tab 5
Tab 0.00 - 135.00 0.00 0.00 - 0.00 - 0.00 0.00 -
51 mg
Glibenklamid tab 5
Tab - 137.00 0.00 0.00 - -
mg
Glimeperide 4 mg Tab 137.00 - 330.00 0.00 0.00 - 137.00 - 0.00 330.00 -
Glimepirid tab 2
Tab 296.00 - 0.00 0.00 0.00 1.00 10.00 296.00 - 0.00 296.00 -
52 mg

Gliseril Guayakolat
Tab 0.00 100.00 - 200.00 100.00 20,000.00 200.00 100.00 20,000.00 0.00 100.00 - 0.00 0.00 -
tablet 100 mg
53

Gliseril Guayakolat
Tab - 100.00 110.00 11,000.00 100.00 110.00 11,000.00 -
tablet 100 mg

Gliserin tts 100

Botol 6,600.00 - 0.00 0.00 0.00 - 6,600.00 - 0.00 0.00 -
54 mg/ml
Glukosa Larutan
Infus 5% steril 500 Botol 5,720.00 - 5,720.00 0.00 0.00 - 5,720.00 - 0.00 0.00 -
55 ml
Griseofulvin
(micronized) tab Tab 0.00 223.00 - 300.00 223.00 66,900.00 260.00 223.00 57,980.00 40.00 223.00 8,920 0.00 0.00 -
56 125 mg
Gliseovulvin
(micronized)tab Tab 0.00 238.00 - 238.00 0.00 0.00 238.00 - 0.00 238.00 -
125 mg
Haloperidol tab 5
Tab 64.00 - 0.00 0.00 0.00 - 64.00 - 0.00 0.00 -
57 mg
Haloperidol tab 1,5
58 mg Tab 76.00 - 76.00 0.00 0.00 - 76.00 - 0.00 0.00 -
59 Hidroklortiazid Tab 74.00 - 163.00 0.00 0.00 - 74.00 - 0.00 0.00 -
Hidrokortison krim
Tube 0.00 2,533.00 - 25.00 2,533.00 63,325.00 25.00 2,533.00 63,325.00 0.00 2,533.00 - 0.00 0.00 -
60 2,5%
Ibuprofen tab 200
Tab 0.00 242.00 - 200.00 242.00 48,400.00 200.00 242.00 48,400.00 0.00 242.00 - 0.00 0.00 -
61 mg
Ibuprofen 200 mg Tab 112.00 - 500.00 240.00 120,000.00 500.00 240.00 120,000.00 112.00 -
Ibuprofen tab 400
Tab 112.00 - 100.00 133.00 13,300.00 100.00 133.00 13,300.00 112.00 - 0.00 0.00 -
62 mg
Ibuprofen tab 400
Tab 0.00 - 600.00 300.00 180,000.00 600.00 300.00 180,000.00 0.00 - 0.00 0.00 -
mg
Isosorbid dinitrat
Tab 0.00 - 98.00 0.00 0.00 - 0.00 - 0.00 98.00 -
63 tab 5 mg
Isosorbid dinitrat
Tab 89.00 - 89.00 0.00 0.00 - 89.00 -
tab 5 mg
 Kalsium laktat
Tab 82.00 - 100.00 82.00 8,200.00 100.00 82.00 8,200.00 82.00 - 0.00 0.00 -
64 (kalk) tab 500 mg
Kaolin pektin syrup Botol 4,000.00 - 4,000.00 0.00 0.00 - 4,000.00 - 0.00 0.00 -
65
Kaptopril tab 12,5
Tab 0.00 - 200.00 65.00 13,000.00 200.00 65.00 13,000.00 0.00 - 0.00 0.00 -
66 mg
Kaptopril tab 12,5
Tab 40.00 65.00 2,600 65.00 0.00 0.00 65.00 - 40.00 65.00 2,600 0.00 0.00 -
mg
Kaptopril tab 25
Tab 0.00 86.00 - 110.00 123.00 13,530.00 30.00 123.00 3,690.00 80.00 86.00 6,880 0.00 0.00 -
67 mg
Kaptropil tab 25
Tab 0.00 123.00 - 100.00 150.00 15,000.00 100.00 150.00 15,000.00 0.00 123.00 -
mg
Karbamazepin Tab
Tablet 0.00 0.00 - 0.00 0.00 0.00 - 0.00 0.00 - 0.00 0.00 -
68 200 mg
Kenalaog in
Tube 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
69 orabase salep

Ketokonazol krim 2
Tube 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 3,135.00 -
% - 15 grm
70

Ketokonazol krim 2
Tube 2,577.00 - 2,577.00 0.00 0.00 - 2,577.00 - 0.00 0.00
% - 15 grm

Ketokonazol tab
Tab 320.00 - 320.00 0.00 0.00 - 320.00 - 0.00 0.00 -
71 200 mg
Ketokonazol 200
Tab 358.00 - 358.00 0.00 0.00 - 358.00 - 0.00 0.00 -
mg
Ketorolak injeksi Ampul 1,383.00 - 1,383.00 0.00 0.00 - 1,383.00 -
Kloramfenikol
Tube 3,327.00 - 3,327.00 0.00 0.00 - 3,327.00 - 0.00 0.00 -
72 salep kulit 2%
Kloramfenikol
Tube 1,760.00 - 1,760.00 0.00 0.00 - 1,760.00 - 0.00 1,850.00 -
73 salep mata 1%
Kloramfenicol
Tube 1,850.00 - 1,850.00 0.00 0.00 - 1,850.00 - 0.00 1,850.00 -
salep mata 1%
Kloramfenikol susp
Botol 4,982.00 - 20.00 4,982.00 99,640.00 20.00 20.00 400.00 4,982.00 - 0.00 0.00 -
74 125 mg/5 ml
Kloramfenikol tetes
Botol 0.00 - 7,700.00 0.00 0.00 - 0.00 - 0.00 0.00 -
75 telinga 3%
Kloramfenikol tetes
Botol 0.00 9,000.00 - 9,000.00 0.00 0.00 9,000.00 - 0.00 9,000.00 - 0.00 0.00 -
telinga 3%
Kloramfenikol tts
Botol 0.00 9,000.00 - 9,000.00 0.00 0.00 9,000.00 - 0.00 9,000.00 - 0.00 7,700.00 -
76 mata 0,5%
Kloramfenikol tts
Botol 9,000.00 - 9,000.00 0.00 0.00 - 9,000.00 - 0.00 0.00 -
mata 0,5%
Klorfeniramin tab 4
77 mg Tab 0.00 24.00 - 1,000.00 24.00 24,000.00 970.00 24.00 23,280.00 0.00 24.00 - 0.00 0.00 -
 Klorfeniramine
Tab 0.00 26.00 - 100.00 50.00 5,000.00 100.00 50.00 5,000.00 0.00 26.00 -
maleat tab 4mg

Klorfenicol kamfer
Botol - 0.00 0.00 - -
mentol (CHKM)
78
Klorpromazin tab
Tab sal 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
79 sal 100 mg
Klorformazine
Tab 0.00 - 210.00 0.00 0.00 - 0.00 - 0.00 0.00 -
80 injeksi
81 Kodein Tab sal 223.00 - 550.00 0.00 0.00 - 223.00 - 0.00 0.00 -

Kotrimoksazol
(dewasa) kombinasi
: sulfametoksazol Tab 0.00 125.00 - 200.00 125.00 25,000.00 200.00 125.00 25,000.00 0.00 125.00 - 0.00 0.00 -
400 mg+
trimetoprim 80 mg
82
Kotrimoksazole
(dewasa)
kombinasi: Tab 131.00 - 131.00 0.00 0.00 - 131.00 - 0.00 0.00 -
sulfametoksazol
400mg

Kotrimoksazol
(dewasa) kombinasi
tiap 5 ml suspensi :
Botol 0.00 2,052.00 - 80.00 2,052.00 164,160.00 76.00 2,052.00 155,952.00 4.00 2,052.00 8,208 0.00 0.00 -
sulfametoksazol
200 mg +
trimetoprim 40 mg
83
Lidokain injeksi
Ampul 4.00 1,280.00 5,120 1,280.00 0.00 0.00 1,280.00 - 4.00 1,280.00 5,120 0.00 0.00 -
84 2% - 2 ml
Magnesium sulfat
Vial 3,200.00 - 3,200.00 0.00 0.00 - 3,200.00 - 0.00 0.00 -
85 inj 20%
Magnesium sulfat
Vial 3,328.00 - 3,328.00 0.00 0.00 - 3,328.00 - 0.00 0.00 -
inj 20%
Magnesium sulfat
Vial 0.00 - 3,650.00 0.00 0.00 - 0.00 - 0.00 0.00 -
86 inj 40%
Metamizol injeksi Vial 9,765.00 - 9,765.00 0.00 0.00 - 9,765.00 - 0.00 0.00 -

Metamizol injeksi Vial 9,500.00 - 9,500.00 0.00 0.00 - 9,500.00 -

Metformin tab 500

Tab 0.00 - 119.00 0.00 0.00 3,278.00 - 0.00 - 0.00 0.00 -
87 mg
 Metformin tab 500
Tab 150.00 - 150.00 0.00 0.00 - 150.00 - 0.00 0.00 -
mg
Metilergometrine
Tab 500.00 - 500.00 0.00 0.00 - 500.00 - 0.00 0.00 -
tablet
Metilergometrin inj
Ampul 8.00 3,399.00 27,192 3,399.00 0.00 0.00 3,399.00 - 8.00 3,399.00 27,192 0.00 3,278.00 -
88 0,2 mg/ml
Metilprednisolon
Tablet 139.00 - 165.00 0.00 0.00 94.00 - 139.00 - 0.00 0.00 -
89 4mg
Metilprednisolon
Tab 0.00 139.00 - 139.00 0.00 0.00 139.00 - 0.00 139.00 -
4mg
Metro ssirup Botol 3,800.00 - 3,800.00 0.00 0.00 - 3,800.00 -
Metronidazol tab
Tab 94.00 - 94.00 0.00 0.00 - 94.00 - 0.00 0.00 -
90 250 mg
Metronidazol tab
Tab 115.00 - 115.00 0.00 0.00 - 115.00 - 0.00 0.00 -
91 500 mg
Metoklopramid tab
Tab 108.00 - 108.00 0.00 0.00 - 108.00 -
92 10 mg
Metoklopramid
Ampul - 3,904.00 0.00 0.00 - -
93 injeksi
Metokloporamid
Ampul 3,500.00 - 3,500.00 0.00 0.00 - 3,500.00 -
injeksi
Metokloproramide
Botol 2,750.00 - 2,750.00 0.00 0.00 - 2,750.00 -
94 sirup
Mikonazol krim
Tube 0.00 - 34.00 4,250.00 144,500.00 32.00 4,250.00 136,000.00 0.00 - 0.00 0.00 -
95 2%
Mikonazol krim
Tube 0.00 3,926.00 - 3,926.00 0.00 0.00 3,926.00 - 0.00 3,926.00 - 0.00 0.00 -
2%
96 Multivitamin Tab 300.00 249.00 74,700 249.00 0.00 300.00 249.00 74,700.00 0.00 249.00 - 0.00 0.00 -

Multivitamin Syrup Botol 0.00 - 15.00 4,500.00 67,500.00 15.00 4,500.00 67,500.00 0.00 - 0.00 0.00 -
97
NaCl 0,9% Larutan Botol 5,170.00 - 5,170.00 0.00 0.00 - 5,170.00 - 0.00 0.00 -
98
NaCl 0,9% Larutan Botol 6,410.00 - 6,410.00 0.00 0.00 - 6,410.00 - 0.00 0.00 -

Natrium Bikarbonat
Tab 40.00 58.00 2,320 58.00 0.00 40.00 58.00 2,320.00 0.00 58.00 - 0.00 0.00 -
tablet 500 mg
99

Natrium diklofenak
Tab 0.00 - 800.00 167.00 133,600.00 800.00 167.00 133,600.00 0.00 - 0.00 0.00 -
tab 25 mg
100

Natrium diklofenak
Tab 0.00 142.00 - 142.00 0.00 -60.00 142.00 (8,520.00) 60.00 142.00 8,520 0.00 0.00 -
tab 25 mg

Natriumdiklofenak
Tab 142.00 - 142.00 0.00 0.00 - 142.00 -
25 mg
 Natrium diklofenak
Tab 50.00 136.00 6,800 700.00 200.00 140,000.00 690.00 200.00 138,000.00 60.00 136.00 8,160 0.00 0.00 -
tab 50 mg
101

Natrium diklofenak
Tab 200.00 - 200.00 145.00 29,000.00 200.00 145.00 29,000.00 200.00 - 0.00 0.00 -
tab 50 mg

Natriumdiklofenak
Tab 136.00 - 136.00 0.00 0.00 - 136.00 -
50 mg
Nifedipin kaps 10
Kaps 120.00 - 120.00 0.00 0.00 - 120.00 - 0.00 0.00 -
102 mg
Nistatin tab salut
Tab 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
103 500.000 UI
Nistatin tab salut
Tab 910.00 - 910.00 0.00 0.00 - 910.00 - 0.00 0.00 -
500.000 UI
Obat Batuk Anak
Botol 0.00 - 10.00 6,500.00 65,000.00 10.00 6,500.00 65,000.00 0.00 - 0.00 0.00 -
104 Sirup
Obat Batuk Hitam (
O.B.H. ) cairan - Botol 0.00 3,850.00 - 25.00 5,000.00 125,000.00 35.00 5,000.00 175,000.00 0.00 3,850.00 - 0.00 0.00 -
105 100 ml
106 Obat Flu tablet Tablet 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 0.00 -
107 Obat Flu Syrup Botol 0.00 - 10,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
Oksitetrasiklin
salep kulit 3% Tube 1.00 3,300.00 3,300 25.00 3,300.00 82,500.00 26.00 3,300.00 85,800.00 0.00 3,300.00 - 0.00 0.00 -
108 (HCl) - 5 gr
Oksitetrasikline
Tube 3,000.00 - 5.00 3,000.00 15,000.00 5.00 3,000.00 15,000.00 3,000.00 -
109 salep mata
Oksitetrasiklin
salep mata 1% Tube 0.00 2,687.00 - 2,687.00 0.00 0.00 2,687.00 - 0.00 2,687.00 - 0.00 0.00 -
110 (HCl) - 3,5 gr
Oksitoksine injeksi Ampul 1,900.00 - 1,900.00 0.00 0.00 - 1,900.00 - 0.00 0.00 -
111
Oksitoksine injeksi Ampul 6.00 1,232.00 7,392 1,232.00 0.00 6.00 1,232.00 7,392.00 0.00 1,232.00 -
Omeprazol kaps 20
112 mg Kaps 148.00 - 148.00 0.00 0.00 - 148.00 - 0.00 0.00 -
Omeprazol kaps 20
Kaps 141.00 - 141.00 0.00 0.00 - 141.00 - 0.00 0.00
mg
Ondansetron injeksi Ampul - 1,254.00 0.00 0.00 - -
113
Ondansetron injeksi Ampul 1,198.00 - 1,198.00 0.00 0.00 - 1,198.00 - 0.00 542.00 -

Ondansetron tablet Tablet 542.00 - 542.00 0.00 0.00 - 542.00 -

114
Parasetamol sir 120
Botol 1,119.00 - 30.00 3,300.00 99,000.00 30.00 3,300.00 99,000.00 1,119.00 - 0.00 0.00 -
115 mg/5 ml
Parasemol tab 500
Tab 0.00 68.00 - 350.00 68.00 23,800.00 350.00 68.00 23,800.00 0.00 68.00 -
116 mg
 Parasemol tab 500
Tab 0.00 68.00 - 700.00 150.00 105,000.00 700.00 150.00 105,000.00 0.00 68.00 -
mg
Perak sulfadiazin
Tube 20,700.00 - 20,700.00 0.00 0.00 - 20,700.00 - 0.00 0.00 -
117 krim 1%
118 Pehacain injeksi Ampul 3,113.00 - 3,113.00 0.00 0.00 - 3,113.00 - 0.00 0.00

Pirantel pamoat tab

Tab 0.00 - 0.00 0.00 0.00 - 0.00 - 0.00 318.00 -
scored 125 mg
119

Pirantel pamoat tab

Tab 331.00 - 331.00 0.00 0.00 - 331.00 - 0.00 0.00 -
scored 125 mg
120

Piridoksin (vitamin
Tab 0.00 136.00 - 900.00 136.00 122,400.00 900.00 136.00 122,400.00 0.00 136.00 -
B6) tab 10 mg
121

Piridoksin (vitamin
Tab 136.00 - 141.00 0.00 0.00 - 136.00 - 0.00 0.00 -
B6) tab 10 mg

Piroksikam kapsul
Tab 90.00 - 90.00 0.00 0.00 - 90.00 - 0.00 0.00 -
122 10 mg
Piroksikam kapsul
Tab 100.00 - 100.00 0.00 0.00 - 100.00 - 0.00 0.00 -
10 mg
Piroksikam kapsul
Tab 0.00 165.00 - 400.00 200.00 80,000.00 400.00 200.00 80,000.00 0.00 165.00 - 0.00 0.00 -
123 20 mg
Piroksikam kapsul
Tab 0.00 - 500.00 121.00 60,500.00 500.00 121.00 60,500.00 0.00 - 0.00 0.00 -
20 mg
Povidon iodin lar
Botol 30 ml 4,150.00 - 4,150.00 0.00 0.00 - 4,150.00 - 0.00 0.00 -
124 100 mg/ml
Povidon iodin lar
Botol 30 ml 1.00 2,900.00 2,900 2,900.00 0.00 0.00 2,900.00 - 1.00 2,900.00 2,900 0.00 0.00 -
100 mg/ml
Povidon iodin lar Botol 300
35,000.00 - 35,000.00 0.00 0.00 - 35,000.00 - 0.00 0.00 -
125 100 mg/ml ml

Povidon iodin lar Botol 300

1,800.00 - 1,800.00 0.00 0.00 - 1,800.00 -
100 mg/ml ml
Propanolol tab 10
Tab 80.00 - 80.00 0.00 0.00 - 80.00 - 0.00 0.00 -
126 mg (HCL)
Propanolol tab 40
Tab 215.00 - 215.00 0.00 0.00 - 215.00 - 0.00
127 mg (HCL)
Propitiourasil tab
Tab 351.00 - 351.00 0.00 0.00 - 351.00 - 0.00
128 100 mg
Prednison tab 5 mg Tab 0.00 85.00 - 800.00 85.00 68,000.00 689.00 85.00 58,565.00 0.00 85.00 - 0.00 0.00 -
129
Prednison tab 5 mg Tab 74.00 - 74.00 0.00 0.00 - 74.00 - 0.00 0.00 -
 Ranitidin injeksi 25
Ampul 1,677.00 - 1,677.00 0.00 0.00 - 1,677.00 - 0.00 0.00 -
130 mg/ml-2ml
Ranitidin tab 150
Tab 0.00 114.00 - 114.00 0.00 0.00 114.00 - 0.00 114.00 - 0.00 0.00 -
131 mg
Retinol (Vitamin
A) kap lunak Tab 327.00 - 0.00 0.00 - 327.00 - 0.00
132 100.000 UI
Retinol (Vitamin
A) kap lunak Tab 500.00 - 0.00 0.00 - 500.00 - 0.00
133 200.000 UI
Ringer Laktat
Botol 7,150.00 - 7,150.00 0.00 0.00 - 7,150.00 - 0.00 0.00 -
134 Larutan
Ringer Laktat
Botol 7,150.00 - 7,150.00 0.00 0.00 - 7,150.00 -
Larutan
Salbutamol tab 2
Tab 68.00 - 68.00 0.00 0.00 - 68.00 - 0.00 0.00 -
135 mg
Salbutamol tab 4
Tab 89.00 - 89.00 0.00 0.00 - 89.00 - 0.00 0.00 -
135 mg

Salep 2-4,
kombinasi : asam
Tube 2,797.00 - 2,797.00 0.00 0.00 - 2,797.00 - 0.00 0.00 -
salisilat 2 %+
belerang endap 4 %
136

Salep 2-4,
kombinasi : asam
Tube 2,017.00 - 2,907.00 0.00 0.00 - 2,017.00 -
salisilat 2 %+
belerang endap 4 %

Sefadroksil kapsul
Tab 455.00 - 455.00 0.00 0.00 - 455.00 - 0.00 0.00 -
137 500 mg
Sefadroksilkapsul
Tab 492.00 - 492.00 0.00 0.00 - 492.00 -
500 mg

Seftriasone injeksi Vial 3,900.00 - 3,900.00 0.00 0.00 - 3,900.00 -

138
Seftriasone injeksi Vial 4,722.00 - 4,722.00 0.00 0.00 - 4,722.00 -

Serum anti bisa ular Vial 462,000.00 - 462,000.00 0.00 0.00 - 462,000.00 -

Serum anti tetanus Ampul - 126,500.00 0.00 0.00 - -

Sefadroksil sirup
kering 125mg/5ml - Botol 7,500.00 - 7,500.00 0.00 0.00 - 7,500.00 - 0.00 0.00 -
139 60 ml
Sefadrosil sirup
kering 125mg/ml- Botol 4,133.00 - 4,133.00 0.00 0.00 - 4,133.00 - 0.00
60 ml
 Sianokobalamin
(Vit.B12) injeksi Ampul 1,226.00 - 1,390.00 0.00 1.00 1,390.00 1,390.00 1,226.00 - 0.00 0.00 -
140 500 mcg-ml
Sianokobalamin
(vitamin B12) tab Tab 0.00 49.00 - 200.00 49.00 9,800.00 197.00 49.00 9,653.00 0.00 49.00 - 0.00 0.00 -
141 50 mcg
Sianokobalamin
(vitamin B12) tab Tab 55.00 - 55.00 0.00 0.00 - 55.00 -
50 mcg
Simvastatin tab sal
Tab sal 113.00 - 113.00 0.00 0.00 - 113.00 - 0.00 113.00 -
142 10 mg
Simvastatin 20 mg Tb sala 252.00 - 252.00 0.00 0.00 - 252.00 -
143
Simvastatin tab sal
Tab sal 225.00 - 225.00 0.00 0.00 - 225.00 - 0.00 0.00 -
20 mg
Simvastatin tab sal
Tab sal 225.00 - 225.00 0.00 0.00 - 225.00 - 0.00 0.00 -
20 mg

Siprofloksasin tab
Tab 0.00 440.00 - 440.00 0.00 0.00 440.00 - 0.00 440.00 - 0.00 0.00 -
scored 500 mg
144
Stesolid 5 mg rectal Tube - 0.00 0.00 - -

Tetrasiklin kaps
Kaps 0.00 181.00 - 181.00 0.00 0.00 181.00 - 0.00 181.00 - 0.00 0.00 -
145 250 mg
Tetrasiklin kaps
Kaps 0.00 88.00 - 200.00 88.00 17,600.00 124.00 88.00 10,912.00 0.00 88.00 - 0.00 329.00 -
146 500 mg
Tetrasiklin kaps
Kaps 310.00 - 0.00 0.00 - 310.00 - 0.00 0.00 -
500 mg
Tiamin (vitamin
Tab 91.00 - 600.00 91.00 54,600.00 600.00 - 91.00 - 0.00 0.00 -
147 B1) tab 50 mg
Tiamin (vitamin
Tab 87.00 - 500.00 94.00 47,000.00 500.00 - 87.00 - 0.00
B1) tab 50 mg
Triheksifenidil tab
Tab 80.00 - 80.00 0.00 0.00 - 80.00 - 0.00 0.00 -
148 2 mg
149 Trombopop gel Tube 0.00 - 65,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -

Ulsidex - Sukralfat
Tab 368.00 - 368.00 0.00 0.00 - 368.00 - 0.00 0.00 -
tablet 500 mg
150

Ulsidex - Sukralfat
Tab 650.00 - 650.00 0.00 0.00 - 650.00 - 0.00 0.00 -
tablet 500 mg

Vitamin B
Tab 0.00 132.00 - 700.00 132.00 92,400.00 700.00 132.00 92,400.00 0.00 132.00 - 0.00 0.00 -
151 kompleks
Vitamin B
Tab 100.00 89.00 8,900 200.00 95.00 19,000.00 300.00 95.00 28,500.00 0.00 89.00 - 0.00 0.00 -
152 kompleks
 Zinc sir 20 mg/5 ml Botol 4,959.00 - 10.00 4,959.00 49,590.00 0.00 49,590.00 - 4,959.00 - 0.00 591.00 -
153
Zinc sir 20 mg/5 ml Botol - 10.00 3,285.00 32,850.00 10.00 32,850.00 328,500.00 -

Zinc tab disp 20 mg Tab 591.00 - 591.00 0.00 0.00 - 591.00 - 0.00 591.00 -
154
Diazepam inj 5
Ampul 17,500.00 - 17,500.00 0.00 0.00 - 17,500.00 - 0.00 0.00 -
155 mg/ml (i.v./i.m.)
Betahistin tablet 6
Tablet 151.00 - 151.00 0.00 0.00 - 151.00 - 0.00 0.00 -
156 mg
Betahistin tablet 6
Tablet 110.00 - 110.00 0.00 0.00 - 110.00 - 0.00 0.00 -
mg
Alat Suntik Sekali
Pcs 848.00 - 848.00 0.00 0.00 - 848.00 - 0.00 0.00 -
157 Pakai 1 ml
Alat Suntik Sekali
Pcs 0.00 0.00 - 40.00 713.90 28,556.00 40.00 713.90 28,556.00 0.00 0.00 - 0.00 0.00 -
158 Pakai 2,5 ml
Alat suntik sekali
Pcs 0.00 713.00 - 713.00 0.00 0.00 713.00 - 0.00 713.00 -
pakai 2,5 ml
159 Alat suntik 3 ml Pcs 714.00 - 714.00 0.00 0.00 - 714.00 -
Alat Suntik Sekali
Pcs 774.40 - 774.40 0.00 0.00 - 774.40 - 0.00 0.00 -
160 Pakai 5 ml
161 Alkohol Swab Set 181.00 - 181.00 0.00 0.00 - 181.00 - 0.00 0.00 -

Aseptic gel 500 ml Botol 26,400.00 - 26,400.00 0.00 0.00 - 26,400.00 - 0.00 0.00 -
162
Catgut / Benang
Bedah No. 2/0
Pcs 4.00 4,168.00 16,672 4,168.00 0.00 0.00 4,168.00 - 4.00 4,168.00 16,672 0.00 0.00 -
dengan jarum
163 bedah
Folly catheter
Pcs 18,271.00 - 18,271.00 0.00 0.00 - 18,271.00 - 0.00
164 No.16
Folly catheter
Pcs 18,271.00 - 18,271.00 0.00 0.00 - 18,271.00 - 0.00
165 No.18
166 HandScun pcs 0.00 - 30.00 54,395.00 1,631,850.00 29.00 54,395.00 1,577,455.00 0.00 - 0.00 0.00 -
Hidrogen
peroksida lar. Botol 800 ml 30,000.00 - 30,000.00 0.00 0.00 - 30,000.00 - 0.00 0.00 -
167 Konsentrat 3%
Infusion Set Anak Set 6,222.00 - 6,222.00 0.00 0.00 - 6,222.00 - 0.00 0.00 -
168
Infusion Set
Set 5,856.00 - 5,856.00 0.00 0.00 - 5,856.00 - 0.00 52,704.00 -
169 Dewasa
Infusion Set Y-
Pcs 6,280.00 - 6,280.00 0.00 0.00 - 6,280.00 -
170 Connector
IV Catheter No. 20
Set 4,959.00 - 4,959.00 0.00 0.00 - 4,959.00 - 0.00 0.00 -
171 G
 IV Catheter No. 22
Set 5,254.37 - 5,254.37 0.00 0.00 - 5,254.37 - 0.00 0.00 -
172 G
IV Catheter No. 24
Set 5,687.00 - 5,687.00 0.00 0.00 1,532.00 - 5,687.00 - 0.00 0.00 -
173 G

Kapas Pembalut /
Roll 16,312.50 - 16,312.50 0.00 0.00 - 16,312.50 - 0.00 0.00 -
Absorben 250 gram
174
Kasa Hydrophil 40
roll 120,750.00 - 120,750.00 0.00 0.00 - 120,750.00 - 0.00 0.00 -
175 x 80 cm
Kasa Hydrophil 40
roll 1.00 0.00 - 105,000.00 0.00 1.00 - 0.00 - 0.00 0.00 -
x 80 cm
Kasa Kompres
pcs 2.00 1,792.00 3,584 1,792.00 0.00 0.00 1,792.00 - 2.00 1,792.00 3,584 0.00 0.00 -
176 40/40 Steril
Kasa Pembalut 2 m
roll 8,624.00 - 8,624.00 0.00 0.00 8,624.00 - 8,624.00 - 0.00 0.00 -
177 x 80 cm
Kasa Pembalut 2 m
roll 2.00 10,857.00 21,714 10,857.00 0.00 0.00 10,857.00 - 2.00 10,857.00 21,714
x 80 cm
Kasa Pembalut
Hidrofil 4 m x 15 Rol 2,415.00 - 2,415.00 0.00 0.00 - 2,415.00 - 0.00 0.00 -
178 cm Elastic
Kasa Pembalut
Hidrofil 4 m x 15 Rol 2,100.00 - 2,100.00 0.00 0.00 - 2,100.00 - 0.00 0.00 -
cm Elastic
Kasa Pembalut
Hidrofil 4 m x 5 cm roll 334.00 - 334.00 0.00 0.00 - 334.00 - 0.00 0.00 -
179 Elastic
Kassa steril 16 cm
roll 5,000.00 - 5,000.00 0.00 0.00 - 5,000.00 - 0.00 0.00 -
180 x 16 cm
Kassa steril 16 cm
roll 8,000.00 - 8,000.00 0.00 0.00 - 8,000.00 - 0.00 0.00 -
x 16 cm
Lomatuell
Pcs 15,000.00 - 15,000.00 0.00 0.00 - 15,000.00 - 0.00 0.00 -
181 H/Lomatul
182 Masker pcs 585.00 - 585.60 0.00 0.00 - 585.00 - 0.00 0.00 -
Masker Pcs 480.00 - 480.00 0.00 0.00 - 480.00 - 0.00 0.00 -
183 Masker N 95 pcs 7,323.75 - 0.00 0.00 0.00 - 7,323.75 - 0.00 0.00 -
Masker N 95 box 0.00 - 6,512.00 0.00 0.00 - 0.00 - 0.00 0.00 -
Pisau Bisturi No.
184 Buah 3,150.00 - 3,150.00 0.00 0.00 - 3,150.00 - 0.00 0.00 -
10
185 Pisau Bisturi no. 15 set 3,150.00 - 3,150.00 0.00 0.00 - 3,150.00 - 0.00 0.00 -
186 Pisau Bisturi no. 21 Set 3,150.00 - 3,150.00 0.00 0.00 - 3,150.00 - 0.00 0.00 -
Plester 5 yards x 2
roll 1.00 40,000.00 40,000 40,000.00 0.00 1.00 40,000.00 40,000.00 1.00 40,000.00 40,000 0.00 0.00 -
187 inch
Silk (Benang
Bedah Sutera) No
pcs 3.00 3,514.00 10,542 3,514.00 0.00 0.00 3,514.00 - 3.00 3,514.00 10,542 0.00 0.00 -
188 3/0 dengan jarum
bedah
 Strip tes asam urat
Btl 25 pcs 90,000.00 - 90,000.00 0.00 0.00 - 90,000.00 - 0.00 0.00 -
189 (easytouch)
Strip tes gula darah
Btl 25 pcs 0.00 - 90,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
190 (easytouch)
Strip tes gula
Btl 25 pcs 0.00 - 90,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
191 darah (autocheck)
Strip tes HB
Btl 25 pcs 165,000.00 - 0.00 0.00 0.00 - 165,000.00 - 0.00 165,000.00 -
192 (easytouch)
Strip tes kolesterol
Btl 10 pcs 0.00 - 170,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
193 (easytouch)
194 Urin bag Pcs 5,904.80 - 0.00 0.00 0.00 - 5,904.80 -

195 Test pek Hamil Pcs 0.00 - 3,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
Etil klorida semprot
Botol 0.00 - 125,000.00 0.00 0.00 - 0.00 - 0.00 0.00 -
196 100 ml
197 Eugenol Botol 18,333.00 - 18,333.00 0.00 0.00 - 18,333.00 - 0.00 18,333.00 -
TOTAL HARGA 739.00 357,752.00 5,851,310.00 17,345.00 5,690,434.00 601.00 518,628.00 0.00 0.00

Babhrot, 31 Desember 2020 Kepala Puskesmas

Yang diperiksa Babahrot
Pengelola ObatPustu alue peunawa Kabupaten Aceh Barat Daya
Kabupaten Aceh Barat Daya

Renti azriani,Amd.keb FIRDAUS

Nip. 19870822 201705 2 001 Nip. 19720315 199403 1 004
 Rp495,000

###
LAMPIRAN : PERSEDIAAN OBAT-OBATAN DAN BMHP
PUSTU ALUE PEUNAWA
PER 30 JUNI 2021
BERSUMBER DARI DINAS KESEHATAN KAB. ACEH BARAT DAYA

SALDO AKHIR PER 31 SALDO EXPIRE DATE PER

PENERIMAAN PEMAKAIAN SALDO AKHIR PER 30 JUNI 2021
DESEMBER 2020 30 JUNI 2021

URAIAN Satuan Nilai Nilai Nilai

Jumlah Harga Jumlah Harga Nilai Persediaan Jumlah Nilai Persediaan Jumlah Harga Jumlah Harga
Persediaan Harga Satuan Persediaan Persedia
(Unit) Satuan (Unit) Satuan (Rp) (Unit) (Rp) (Unit) Satuan (Unit) Satuan
(Rp) (Rp) an (Rp)
NO
1 2 3 12 14 6 8 9 11 12 14 15 16 17
Alopurinol tab 100
Tab 60.00 117.00 7,020 117.00 0.00 40.00 117.00 4,680.00 20.00 117.00 2,340 117.00 -
1 mg
2 Ambroxol srup Botol 50.00 4,000.00 200,000 Rp100 4,000.00 400,000.00 150.00 4,000.00 600,000.00 4,000.00 - 4,000.00 -

Amlodipin tab 10 mg Tab 95.00 - 120.00 95.00 11,400.00 120.00 95.00 11,400.00 95.00 - 95.00 -
3
Amoksisilin sir
Botol 10.00 4,395.00 43,950 40.00 4,395.00 175,800.00 50.00 4,395.00 219,750.00 4,395.00 - 4,395.00 -
4 kering 125 mg/5 ml

Antasida, kombinasi :
aluminium hidroksida
Tab 0.00 64.00 - 500.00 64.00 32,000.00 500.00 64.00 32,000.00 64.00 - 64.00
200 mg + magnesium
hidroksida 200 mg
5

Antasida, kombinasi :
aluminium hidroksida
Botol 5.00 2,106.00 10,530 2,106.00 0.00 5.00 2,106.00 10,530.00 2,106.00 - 2,106.00 -
200 mg + magnesium
hidroksida 200 mg
6

Antasida, kombinasi :
aluminium hidroksida
Botol 10.00 2,239.00 22,390 80.00 2,239.00 179,120.00 90.00 2,239.00 201,510.00 2,239.00 - 2,239.00 -
200 mg + magnesium
hidroksida 200 mg
7
Antifungi salep,
kombinasi : asam
Tube 5.00 5,170.00 25,850 5,170.00 0.00 -9.00 5,170.00 (46,530.00) 14.00 5,170.00 72,380 5,170.00 -
benzoat 6%+ asam
8 salisilat 3%
9 Antihemoroid Tab 0.00 3,642.00 - 3,642.00 0.00 0.00 3,642.00 - 3,642.00 - 3,642.00
 Asam askorbat
(vitamin C) tab 50 Tab 120.00 - 300.00 120.00 36,000.00 300.00 120.00 36,000.00 120.00 - 120.00 -
10 mg
Asam mefenamat
Kaps 0.00 103.00 - 800.00 103.00 82,400.00 800.00 103.00 82,400.00 103.00 - 103.00 -
11 kaps 500 mg
12 Asiklovir 200 mg Tube 40.00 440.00 17,600 100.00 440.00 44,000.00 140.00 440.00 61,600.00 440.00 - 440.00 -
13 Atapulgit 600 mg Tab 100.00 149.00 14,900 149.00 0.00 100.00 149.00 14,900.00 149.00 - 149.00 -
Betametason krim 0,5
Tube 2.00 1,373.00 2,746 15.00 1,373.00 20,595.00 12.00 1,373.00 16,476.00 5.00 1,373.00 6,865 1,373.00 -
14 mg/g
Desametasone tab 0.5
Tab 0.00 34.00 - 900.00 34.00 30,600.00 900.00 34.00 30,600.00 34.00 - 34.00 -
15 mg

Etakridin ( Rivanol )
botol 0.00 - 2.00 0.00 0.00 2.00 0.00 - 0.00 - 0.00 -
larutan 0,1% - 300 ml
16
17 Etanol 70% 100 ml Botol 2,625.00 - 2.00 2,625.00 5,250.00 2.00 2,625.00 5,250.00 2,625.00 - 2,625.00 -
Garam oralit
kombinasi : natrium
klorida 0,52 g +
kalium klorida 0,30 g Sachet 10.00 263.00 2,630 263.00 0.00 1.00 263.00 263.00 9.00 263.00 2,367 263.00 -
+ trinatrium sitrat
0,58 g + glukosa
18 anhidrat 2,7 g
Glibenklamid tab 5
Tab 0.00 - 100.00 0.00 0.00 100.00 0.00 - 0.00 - 0.00 -
19 mg
Gliseril Guayakolat
Tab 0.00 100.00 - 600.00 100.00 60,000.00 600.00 100.00 60,000.00 100.00 - 100.00 -
20 tablet 100 mg
Griseofulvin
(micronized) tab 125 Tab 40.00 223.00 8,920 500.00 223.00 111,500.00 540.00 223.00 120,420.00 223.00 - 223.00 -
21 mg
Hidrokortison krim
Tube 0.00 2,533.00 - 10.00 2,533.00 25,330.00 5.00 2,533.00 12,665.00 5.00 2,533.00 12,665 2,533.00 -
22 2,5%
Ibuprofen tab 200 mg Tab 0.00 242.00 - 600.00 242.00 145,200.00 600.00 242.00 145,200.00 242.00 - 242.00 -
23
24 Ibuprofen 200 mg Tab 112.00 - 112.00 0.00 0.00 112.00 - 112.00 - 112.00

Ibuprofen tab 400 mg Tab 112.00 - 600.00 112.00 67,200.00 600.00 112.00 67,200.00 112.00 - 112.00 -
25
Kaptopril tab 12,5
Tab 40.00 65.00 2,600 200.00 65.00 13,000.00 240.00 65.00 15,600.00 65.00 - 65.00 -
26 mg
Kaptopril tab 25 mg Tab 80.00 86.00 6,880 86.00 0.00 80.00 86.00 6,880.00 86.00 - 86.00 -
27
Kaptropil tab 25 mg Tab 0.00 123.00 - 300.00 123.00 36,900.00 300.00 123.00 36,900.00 123.00 - 123.00
28
Kloramfenikol tetes
Botol 0.00 - 0.00 0.00 0.00 0.00 - 0.00 - 0.00 -
29 telinga 3%
Kloramfenikol tetes
Botol 0.00 9,000.00 - 10.00 9,000.00 90,000.00 10.00 9,000.00 90,000.00 9,000.00 - 9,000.00 -
30 telinga 3%
Klorfeniramine
Tab 0.00 26.00 - 700.00 26.00 18,200.00 700.00 26.00 18,200.00 26.00 - 26.00
31 maleat tab 4mg
 Kotrimoksazol
(dewasa) kombinasi :
sulfametoksazol 400 Tab 0.00 125.00 - 200.00 125.00 25,000.00 200.00 125.00 25,000.00 125.00 - 125.00 -
mg+ trimetoprim 80
32 mg
Kotrimoksazol
(dewasa) kombinasi
tiap 5 ml suspensi :
Botol 4.00 2,052.00 8,208 20.00 2,052.00 41,040.00 14.00 2,052.00 28,728.00 10.00 2,052.00 20,520 2,052.00 -
sulfametoksazol 200
mg + trimetoprim 40
mg
33
Lidokain injeksi 2% -
Ampul 4.00 1,280.00 5,120 1,280.00 0.00 4.00 1,280.00 5,120.00 1,280.00 - 1,280.00 -
34 2 ml
Metilergometrin inj
Ampul 8.00 3,399.00 27,192 3,399.00 0.00 8.00 3,399.00 27,192.00 3,399.00 - 3,399.00 -
35 0,2 mg/ml
36 Metro ssirup Botol 3,800.00 - 10.00 3,800.00 38,000.00 10.00 3,800.00 38,000.00 3,800.00 - 3,800.00
Metoklopramid tab
Tab 108.00 - 100.00 108.00 10,800.00 100.00 108.00 10,800.00 108.00 - 108.00
37 10 mg
Mikonazol krim 2% Tube 0.00 3,926.00 - 10.00 3,926.00 39,260.00 5.00 3,926.00 19,630.00 5.00 3,926.00 19,630 3,926.00 -
38
39 Multivitamin Tab 0.00 249.00 - 249.00 0.00 0.00 249.00 - 249.00 - 249.00 -

Multivitamin Syrup Botol 4,500.00 - 25.00 4,500.00 112,500.00 25.00 4,500.00 112,500.00 4,500.00 - 0.00 -
40
Natrium diklofenak
Tab 60.00 142.00 8,520 500.00 142.00 71,000.00 560.00 142.00 79,520.00 142.00 - 142.00 -
41 tab 25 mg
Natriumdiklofenak25
Tab 142.00 - 142.00 0.00 0.00 142.00 - 142.00 - 142.00
42 mg
Natrium diklofenak
Tab 60.00 136.00 8,160 136.00 0.00 60.00 136.00 8,160.00 136.00 - 136.00 -
43 tab 50 mg
Natriumdiklofenak50
Tab 136.00 - 550.00 136.00 74,800.00 550.00 136.00 74,800.00 136.00 - 136.00
44 mg
Nistatin tab salut
Tab 0.00 - 10.00 0.00 0.00 10.00 0.00 - 0.00 - 0.00 -
45 500.000 UI
Obat Batuk Anak
Botol 0.00 - 20.00 0.00 0.00 20.00 0.00 - 0.00 - 0.00 -
46 Sirup
Obat Batuk Hitam
( O.B.H. ) cairan - Botol 0.00 3,850.00 - 20.00 3,850.00 77,000.00 20.00 3,850.00 77,000.00 3,850.00 - 3,850.00 -
47 100 ml

Oksitetrasiklin salep
Tube 0.00 3,300.00 - 5.00 3,300.00 16,500.00 5.00 3,300.00 16,500.00 3,300.00 - 3,300.00 -
kulit 3% (HCl) - 5 gr
48
Oksitetrasiklin salep
mata 1% (HCl) - 3,5 Tube 0.00 2,687.00 - 35.00 2,687.00 94,045.00 31.00 2,687.00 83,297.00 4.00 2,687.00 10,748 2,687.00 -
49 gr
50 Oksitoksine injeksi Ampul 1,900.00 - 1,900.00 0.00 0.00 1,900.00 - 1,900.00 - 1,900.00 -
5,152 Oksitoksine injeksi Ampul 0.00 1,232.00 - 5.00 1,232.00 6,160.00 5.00 1,232.00 6,160.00 1,232.00 - 1,232.00
 Parasetamol sir 120
Botol 1,119.00 - 70.00 1,119.00 78,330.00 70.00 1,119.00 78,330.00 1,119.00 - 1,119.00 -
53 mg/5 ml
Parasemol tab 500
Tab 0.00 68.00 - 800.00 68.00 54,400.00 800.00 68.00 54,400.00 68.00 - 68.00
54 mg
Piridoksin (vitamin
Tab 136.00 - 600.00 136.00 81,600.00 600.00 136.00 81,600.00 136.00 - 136.00 -
55 B6) tab 10 mg
Piroksikam kapsul 20
Tab 0.00 165.00 - 400.00 165.00 66,000.00 400.00 165.00 66,000.00 165.00 - 165.00 -
56 mg
Povidon iodin lar 100
Botol 30 ml 1.00 2,900.00 2,900 2,900.00 0.00 1.00 2,900.00 2,900.00 2,900.00 - 2,900.00 -
57 mg/ml
58 Prednison tab 5 mg Tab 74.00 - 100.00 74.00 7,400.00 100.00 74.00 7,400.00 74.00 - 74.00 -
Sefadrosil sirup
kering 125mg/ml-60 Botol 4,133.00 - 20.00 4,133.00 82,660.00 20.00 4,133.00 82,660.00 4,133.00 - 4,133.00
59 ml
Simvastatin tab sal 20
Tab sal 225.00 - 100.00 225.00 22,500.00 100.00 225.00 22,500.00 225.00 - 225.00 -
60 mg
Tetrasiklin kaps 500
Kaps 0.00 88.00 - 200.00 88.00 17,600.00 200.00 88.00 17,600.00 88.00 - 88.00 -
61 mg
Tiamin (vitamin B1)
Tab 91.00 - 500.00 91.00 45,500.00 500.00 91.00 45,500.00 91.00 - 91.00 -
62 tab 50 mg
Vitamin B kompleks Tab 0.00 89.00 - 400.00 89.00 35,600.00 400.00 89.00 35,600.00 89.00 - 89.00 -
63
64 Zinc sir 20 mg/5 ml Botol 4,959.00 - 10.00 4,959.00 49,590.00 10.00 4,959.00 49,590.00 4,959.00 - 4,959.00 -
Catgut / Benang
Bedah No. 2/0 Pcs 4.00 4,168.00 16,672 4,168.00 0.00 4.00 4,168.00 16,672.00 4,168.00 - 4,168.00 -
65 dengan jarum bedah
Infusion Set Dewasa Set 5,856.00 - 2.00 5,856.00 11,712.00 2.00 5,856.00 11,712.00 5,856.00 - 5,856.00 -
66
Kasa Kompres 40/40
pcs 2.00 1,792.00 3,584 5.00 1,792.00 8,960.00 7.00 1,792.00 12,544.00 1,792.00 - 1,792.00 -
67 Steril
Kasa Pembalut 2 m x
roll 2.00 10,857.00 21,714 10,857.00 0.00 2.00 10,857.00 21,714.00 10,857.00 - 10,857.00
68 80 cm
Kasa Pembalut
Hidrofil 4 m x 5 cm roll 334.00 - 1.00 334.00 334.00 1.00 334.00 334.00 334.00 - 334.00 -
69 Elastic
Plester 5 yards x 2
roll 1.00 40,000.00 40,000 40,000.00 0.00 1.00 40,000.00 40,000.00 40,000.00 - 40,000.00 -
70 inch
Silk (Benang Bedah
Sutera) No 3/0 pcs 3.00 3,514.00 10,542 3,514.00 0.00 3.00 3,514.00 10,542.00 3,514.00 - 3,514.00 -
71 dengan jarum bedah
TOTAL HARGA 601.00 518,628.00 2,934,786.00 12,426.00 3,294,599.00 172.00 158,815.00 0.00 0.00

Kepala Puskesmas Babhrot, 30 Juni 2021

Babahrot Yang diperiksa
Kabupaten Aceh Barat Daya Pengelola ObatPustu alue peunawa
 Kabupaten Aceh Barat Daya

FIRDAUS Renti azriani,Amd.keb

Nip. 19720315 199403 1 004 Nip. 19870822 201705 2 001