Lplpo Manual 2021

547 Siprofloksasin tablet 500 mg DAK 0 0 0 0 0
548 Siprofloksasin tablet 500 mg DAK 551 0 551 210 0 341

549 Stabimed sol 1 ltr - DAK 2 0 2 0 2
550 Steril Pouch 9 x 26 cm DAK 0 0 0 0 0
551 Stik Glucose (BENECHECK) DAK 5 0 5 0 5
552 Stik HB - DAK 6 0 6 0 6
553 STOMACH TUBE 14 - DAK 0 0 0 0 0
554 Stomach Tube 16 - DAK 0 0 0 0 0
556 Suction Cathether - FR.18 (8) DAK 0 0 0 0 0
557 Tablet Tambah Darah DAK 7920 7920 1200 0 6720
558 Tabung Venoject (P3M) DAK- DAK 0 0 0 0 0
HIV
559 Tetagam 250UI/mL 1mL DAK 0 0 0 0 0

Injeksi (Serum Anti Tetanus)
560 Tetrasiklin HCl kapsul 250 mg DAK 0 0 0 0 0

-
Tiamin Hcl ( Vit B1 ) Tablet 50
561 mg DAK 0 0 0 0 0
562 Trihexypenidhil 2 mg DAK 0 0 0 0 0
563 Urine bag DAK 0 0 0 0 0
564 Vit B12 - DAK 0 0 0 0 0
565 Vitamin B Kompleks tab - DAK 0 0 0 0 0
566 Vitamin B Kompleks tab - DAK 5000 0 5000 500 0 4500
567 Xylocain Spray DAK 0 0 0 0 0
568 Zinc Dispersible tab DAK 0 0 0 0 0
Mengetahui/Menyetujui Yang
menyerahkan Yang meminta/melapor Yang menerima
Kepala Seksi Perbekalan Petugas Gudang Kepala UPTD Puskesmas Pesanggaran
Kesehatan dan Farmasi Farmasi Petugas Puskesmas
WAWAN PURNAWAN,SKM AGUS EFENDI dr. H. EDI NURCAHYO SAFI'I LINDA DWI RAHAYU;
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
Lokasi : Puskesmas Pesanggaran
Periode Feb-21
NO NAMA SUMBER HARGA AWAL TERIMA SEDIA PAKAI RUSAK SISA MINTA
1 Alat Suntik sekali pakai - 1 ml APBD 0 0 0 0 0
2 Alat Suntik sekali pakai - 1 ml APBD 0 0 0 0 0 0

3 Alat ukur tinggi badan - APBD 0 0 0 0 0
4 Alat Ukur Tinggi Badan - APBD 0 0 0 0 0
5 Aminofilin injeksi 24 mg/ml APBD 0 0 0 0 0
6 Aminofilin injeksi 24 mg/ml APBD 0 0 0 0 0 0
7 Amitriptillin 25 mg APBD 0 0 0 0 0
8 Amoksisilin kap APBD 0 0 0 0 0
Amoksisilin sirup kering 125
9 APBD 65 0 65 21 0 44
mg/ 5 ml
Ampisillin Injeksi 1000 mg /
10 APBD 0 0 0 0 0 0
ml
11 Antalgin inj. 250 mg/ml APBD 0 0 0 0 0
12 Antimigren Doen kombinasi / APBD 0 0 0 0 0
Ergotamin kofein
13 Asam Askorbat (Vitamin C) APBD 0 0 0 0 0

tablet 50 mg
14 Asam Folat tablet 1 mg APBD 0 0 0 0 0
15 Asam Traneksamat injeksi APBD 0 0 0 0 0
16 Asiklovir krim 5% - tube 5 APBD 0 0 0 4 0 -4
gram
Asiklovir krim 5% - tube 5
17 gram APBD 17 0 17 0 17
Blood Glucose Test Strip 50' -

18 APBD 0 0 0 0 0
Laboratorium -
19 Cholesterol Stick APBD 0 0 0 0 0
20 Citicholin injeksi APBD 0 0 0 0 0
21 Dextrofen APBD 0 0 0 0 0
22 Doksisiklin kapsul 100 mg APBD 0 0 0 0 0 50
23 Efedrin Hcl tablet 25 ml APBD 0 0 0 0 0
24 Eritromisin kaplet 500 mg APBD 75 0 75 10 0 65
25 Etil Klorida semprot APBD 8 0 8 2 0 6
26 Fenobarbital tablet 30 mg APBD 121 0 121 30 0 91
27 Fitomenadion Inj APBD 0 0 0 0 0
28 Gentamisin Salep Kulit APBD 0 0 0 0 0
Gliseril Guayakolat tab 100
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 0 0 0 0 0 20
31 HALDOL DECANOAS AMP - APBD 0 0 0 0 0
32 Haloperidol 5 mg tab APBD 0 0 0 0 0
33 I.V. Catheter 22 APBD 0 0 0 0 0
34 Ibuprofen tablet 400 mg APBD 0 0 0 0 0
35 Infusion set anak APBD 48 0 48 3 0 45
36 Iodina Test APBD 0 0 0 0 0
37 Kaca mulut + handle - KESGA APBD 0 0 0 0 0
38 Kapas Pembalut 250 g APBD 0 0 0 0 0
39 Karbamazepin tablet 200 mg APBD 0 0 0 0 0
40 Kasa pembalut Hidrofil 4 M x APBD 0 0 0 0 0

5 Cm
41 Ketoprofen Injeksi APBD 0 0 0 0 0 10
42 Klorpromazin 100 mg tab APBD 0 0 0 0 0
43 Lysol APBD 0 0 0 0 0
Metilergometrin Maleat
44 inj.0.200 mg-1ml APBD 0 0 0 0 0
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0 50
46 Metoklopramide Injeksi 5 APBD 20 0 20 5 0 15
mg / ml
47 Multivitamin sirup APBD 0 0 0 0 0 50
48 Obyek Glass - APBD 0 0 0 0 0
50 ONDANSETRON 4 INJ APBD 0 0 0 0 0 200
51 Pelilit Kapas/Cotton APBD 0 0 0 0 0
Aplicator/Lidi Watten -
52 Pen light (senter) APBD 0 0 0 0 0
53 Pengukur lingkar perut - APBD 0 0 0 0 0
54 Pengukur Lingkar Perut - APBD 0 0 0 0 0
KESGA
Pengukur Tinggi Badan - One
55 Med APBD 0 0 0 0 0
Pinset Anatomis 14 cm -
56 APBD 0 0 0 0 0
KESGA
57 PinSet Bengkok - APBD 0 0 0 0 0
58 Pirasetam tab 400 mg APBD 0 0 0 0 0
59 Piroksikam 20 mg tablet APBD 3060 0 3060 430 0 2630
60 Ranitidin Injeksi 25 mg/ml APBD 0 0 0 0 0
61 Santagesix Injeksi APBD 0 0 0 0 0
62 Snellen Chart - APBD 0 0 0 0 0
63 stik glukosa (LANSIA KIT) APBD 0 0 0 0 0
64 Tabung Venoject (BOK) APBD 0 0 0 0 0
65 Tabung Venoject (tutup ungu) APBD 0 0 0 0 0
66 Tabung Venoject - APBD 0 0 0 0 0
67 Termometer Digital - KESGA APBD 0 0 0 0 0
68 THIAMPHENICOL 500 TAB APBD 0 0 0 0 0
69 THIAMPHENICOL 500 TAB APBD 200 0 200 200 0 0
70 Timbangan Dewasa - KESGA APBD 0 0 0 0 0
71 Uric Acid Stick (LANSIA KIT) APBD 0 0 0 0 0
72 Urine bag APBD 7 0 7 0 7
73 Vit B12 Tablet APBD 0 0 0 0 0
74 Acetylcystein 200 mg - JKN 0 0 0 0 0
76 Acetylcystein 200 mg - JKN 249 0 249 249 0 0
77 Alat Suntik sekali pakai - 10 ml JKN 0 0 0 0 0
78 Alat Suntik sekali pakai - 3 ml JKN 522 0 522 370 0 152
79 Alat Suntik sekali pakai - 5 ml JKN 142 0 142 219 -77

80 Alkohol Swab - JKN 0 0 0 0 0 10
81 Alkohol Swab - JKN 0 0 0 0 0
Alopurinol tablet 100 mg - ktk
82 JKN 590 0 590 90 0 500
10 x 10 tablet
83 Aminofilin tablet 200 mg - btl JKN 0 0 0 0 0 200

100 tablet
Amlodipin tablet 10 mg - ktk 3
84 x 10 tablet JKN 43 0 43 43 0 0

85 JKN 17 0 17 17 0 0
x 10 tablet
86 Amoksisilin kaplet 500 mg JKN 2282 0 2282 760 0 1522
87 JKN 0 0 0 0 0
mg/ 5 ml - btl 60 ml
88 amoksisilin tab 500 mg JKN 0 0 0 0 0
Antasida DOEN I tablet
kunyah,kombinasi :
89 Aluminium Hidroksida 200 mg JKN 6630 0 6630 4600 0 2030
dan Magnesium Hidroksida
200 m - ktk 10 x 10 tablet
kunyah
90 antihemoroid, kombinasi : JKN 0 0 0 0 0

suppositoria
91 Aqua PI 25 cc - Otsuka JKN 0 0 0 0 0
92 Aqua Pro Injeksi 25 cc JKN 0 0 0 0 0
asam askorbat (vitamin C) tab
93 JKN 0 0 0 0 0 3000
250 mg
Asam Folat tablet 1 mg - btl
94 JKN 0 0 0 0 0
100 tablet
95 Asam Mefenamat 500mg JKN 11049 0 11049 980 0 10069

Tablet
96 asam mefenamat kapl 500 mg JKN 0 0 0 0 0
Asam traneksamat injeksi 50

97 JKN 0 0 0 0 0
mg/ml
98 ATS 1500UI - Bio Farma JKN 0 0 0 0 0
99 BATANG PENGADUK - JKN 0 0 0 0 0
100 Beaker Glass 500 ml - JKN 0 0 0 0 0
101 blood lancet - JKN 0 0 0 0 0
102 blood lancet - JKN 6 0 6 4 0 2
103 Captopril 25mg Tablet JKN 1045 0 1045 390 0 655
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
107 Cawan Porselen JKN 0 0 0 0 0
108 Corong JKN 0 0 0 0 0
109 Deksametason tablet 0,5 mg JKN 3199 3199 560 0 2639
110 Dental pinset JKN 0 0 0 0 0
111 Dexamethasone 0,5mg Tablet JKN 14210 0 14210 210 0 14000
Difenhidramin injeksi i.m. 10

112 mg/ml (HCl) JKN 132 0 132 19 0 113
113 Erlenmeyer JKN 0 0 0 0 0
114 Erythromycin 250mg Tablet - JKN 100 0 100 20 0 80
115 Etil Chorida JKN 1 0 1 0 1
116 Etil Klorida Semprot JKN 8 0 8 2 0 6
117 Excavator JKN 0 0 0 0 0
118 Face masker 2 ply - JKN 0 0 0 0 0
119 FOLEY 18 - JKN 26 0 26 6 0 20
120 Folley catheter 18 JKN 10 0 10 0 10
121 Folley Catheter 20 JKN 4 0 4 0 4
122 Folley Chateter 16 JKN 15 0 15 3 0 12
123 Gelas Piala 100 mL JKN 0 0 0 0 0
124 Gentamisin salep kulit 0,1% JKN 60 0 60 3 0 57
125 Gentamisin Tetes Mata - JKN 38 0 38 4 0 34
126 Glibenklamide tablet 5 mg JKN 1630 0 1630 450 0 1180
127 Glibenklamide tablet 5 mg JKN 710 0 710 0 710
Glimepiride tablet 2 mg - ktk 5
128 x 10 tablet JKN 0 0 0 0 0
129 Glove/Handscun JKN 11400 0 11400 2100 0 9300
130 Glove/Handscun JKN 6000 0 6000 0 6000
Glyceryl Guaiacolate 100mg
131 JKN 10000 0 10000 700 0 9300
Tablet
132 H2O2 3% JKN 0 0 0 2 0 -2
133 H2O2 3% 100mL JKN 0 0 0 0 0
134 HANDSCOEN SAFEGLOVE 7,5 - JKN 0 0 0 0 0
135 Handscoon Steril JKN 91 0 91 20 0 71
136 hidroklorotiazid tab 25 mg JKN 3560 0 3560 90 0 3470
Hidrokortison krim 2,5 % -
137 JKN 96 0 96 12 0 84
tube 5 gram
138 Hidrokortison krim 2,5 % - JKN 94 0 94 0 94

tube 5 gram
Hyosin N Butilbromide injeksi
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN 7 0 7 3 0 4
141 I.V. Catheter 22 - Venocath JKN 3 0 3 0 3
142 I.V. Catheter 24 - Surflo JKN 58 0 58 0 58
143 Ibuprofen 400 mg Tablet JKN 0 0 0 0 0
Ibuprofen suspensi 100 mg/5
144 JKN 0 0 0 0 0
ml - btl 60 ml
145 ibuprofen tab 400 mg JKN 0 0 0 0 0 0
isosorbid dinitrat tab
146 sublingual 5 mg JKN 860 0 860 20 0 840
147 Kaca mulut tanpa tangkai JKN 0 0 0 0 0
148 Kapas berlemak 500 g JKN 4 0 4 2 0 2
149 Kaptopril tab 25 mg JKN 0 0 0 0 0
150 Kasa hidrofil 16 / 16 Steril JKN 0 0 0 0 0
152 Kasa pembalut 36 M x 80 Cm JKN 0 0 0 0 0 0
153 Kertas Puyer/Kertas roti JKN 0 0 0 0 0
Klindamisin kapsul 150 mg -
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0
Kloramfenikol kapsul 250 mg -

155 JKN 3750 0 3750 80 0 3670
ktk 10 X 10 kapsul
156 Kloramfenikol suspensi 125 JKN 90 0 90 9 0 81
157 Kloramfenikol tetes mata 0,5 JKN 25 0 25 6 0 19 30

%
Klorfeniramin Maleat tab 4
158 mg JKN 0 0 0 0 0
159 Klorfeniramin Maleat tab 4 JKN 0 0 0 0 0

mg
160 Kotrimoksasol susp. - JKN 0 0 0 0 0 0
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
162 lidokain cairan inj 2% JKN 0 0 0 0 0
Lidokain injeksi 2% (HCl) +
163 Epinefrin 1 : 80.000 - 2ml - ktk JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0
165 Metformin HCL Tablet 500 mg JKN 0 0 0 0 0
Metformin HCl tablet 500 mg

166 - ktk 10 x 10 tablet JKN 340 0 340 160 0 180
metilergometrin cairan inj 0,2

167 mg/mL JKN 36 0 36 5 0 31
(Metilergometrin) tablet salut
168 JKN 0 0 0 0 0
0,125 mg - ktk 10 x 10 tablet
salut
169 (Metilergometrin) tablet salut JKN 720 0 720 80 0 640
salut
170 Metilprednisolon tablet 4 mg - JKN 0 0 0 0 0

ktk 10 x 10 tablet
171 metoklopramid tab 10 mg JKN 0 0 0 0 0
172 Metronidazol tab 500 mg JKN 745 0 745 210 0 535
173 Metronidazole 500mg Tablet JKN 4680 0 4680 0 4680
174 Miconazole krim 2 % JKN 0 0 0 0 0
175 Miconazole krim 2 % JKN 39 0 39 6 0 33
176 mikonazol krim 2% JKN 0 0 0 0 0
177 MY JELLY 82 G - JKN 6 0 6 2 0 4
178 JKN 0 0 0 0 0
179 Natrium Diklofenak tab 25 mg JKN 950 0 950 490 0 460
180 Natrium Diklofenak tab 50 mg JKN 0 0 0 0 0
natrium diklofenak tab sal

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg
183 nistatin tab vaginal 100.000 IU JKN 0 0 0 0 0
184 Nistatin tablet salut 500.000 JKN 0 0 0 0 0 200

IU
Nistatin tablet salut 500.000
185 IU JKN 0 0 0 0 0
Nistatin vaginal tablet 100.000

186 JKN 90 0 90 30 0 60
IU/ g
187 Oksitosin inj. 10 IU/ml JKN 0 0 0 0 0 0 50
188 Oksitosin inj. 10 IU/ml - JKN 0 0 0 0 0
189 omeprazol 20 mg JKN 6 0 6 0 6
190 Omeprazole 20mg Kapsul JKN 7900 0 7900 560 0 7340
Omeprazole 40mg/10mL
191 JKN 66 0 66 12 0 54
10mL
192 Paracetamol 500mg Tablet JKN 1300 0 1300 3400 0 1300 10000
193 Parasetamol sirup 120 JKN 276 0 276 24 0 252
mg/5ml -
194 parasetamol tab 500 mg JKN 0 0 0 0 0
195 Perak Sulfadiazin Cream - JKN 2 0 2 2 0 0 10
196 Permetrin Krim - JKN 0 0 0 0 0
197 PHYOTMENADION INJ BAYI - JKN 0 0 0 0 0
198 Piridoksina HCl tab 10 mg - JKN 0 0 0 4 0 -4
199 Plesterin Bulat JKN 0 0 0 0 0
Povidon Iodida larutan 10% -
200 btl 300 ml JKN 0 0 0 1 0 -1
Povidon Iodida larutan 10%

201 300 ml JKN 6 0 6 0 6
202 Prednison 5 mg JKN 0 0 0 0 0
203 Prednison 5 mg JKN 0 0 0 0 0 0
204 PULAREX ACTIVATED JKN 253 0 253 0 253
ATTAPULGITE 630MG
Salbutamol tablet 2 mg
205 (sebagai Sulfat) - ktk 10 x 10 JKN 0 0 0 0 0
tablet
206 (sebagai Sulfat) - ktk 10 x 10 JKN 0 0 0 11 0 -11
tablet
Salep 2-4 , Kombinasi: Asam

207 Salisilat 2% + Belerang endap JKN 0 0 0 0 0
4% - ktk 24 pot @ 30 gram
208 Salisil Bedak 2 % - ktk 50 gram JKN 0 0 0 0 0
209 Simvastatin tab sal selaput 10 JKN 1220 0 1220 90 0 1130

mg
Siprofloksasin tablet 500 mg
210 ( sebagai HCI) - ktk 5 x 10 JKN 0 0 0 0 0
tablet
211 Sonde lengkung JKN 0 0 0 0 0
212 Sonde Lurus JKN 0 0 0 0 0
213 Sonde Paradontal JKN 0 0 0 0 0
214 Spasmolit Tablet 10mg JKN 0 0 0 0 0
215 Spuit 10 cc - Terumo JKN 111 0 111 12 0 99
216 stesolid lar rektal 5 mg/2,5 mL JKN 0 0 0 0 0
217 Surgical Blade JKN 88 0 88 12 0 76
Tang pencabut akar gigi
218 bawah anak JKN 0 0 0 0 0
Tang Pencabut Gigi Geraham

219 JKN 0 0 0 0 0
Bawah Anak
220 Tang pencabut gigi seri dan JKN 0 0 0 0 0

taring atas anak
221 Tangkai kaca mulut JKN 0 0 0 0 0
222 Test kehamilan JKN 50 0 50 50 0 0
223 Tetrasiklin kapsul 500 mg JKN 71 0 71 0 71
224 Tetrasiklin kapsul 500 mg JKN 4105 0 4105 120 0 3985
225 Tiamin HCl tab 50 mg - JKN 11030 0 11030 760 0 10270
227 Tourniquet JKN 0 0 0 0 0
228 Tourniquet JKN 0 0 0 1 0 -1
229 Urine bag JKN 0 0 0 0 0
230 vitamin b kompleks JKN 0 0 0 0 0
231 Zinc Dispersible tab - JKN 0 0 0 0 0
232 Alat Suntik sekali pakai - 1 ml PROGRAM 0 0 0 0 0
Albendazol tablet/tablet
233 kunyah 400 mg - ktk 5 x 6 PROGRAM 0 0 0 0 0
tablet
234 Antimalaria DOEN kombinasi PROGRAM 0 0 0 0 0

235 Autoclik Lancet - PROGRAM 0 0 0 0 0
237 Blood lancet - PROGRAM 200 0 200 0 200
238 Calcii Glukonas Inj PROGRAM 0 0 0 0 0
239 Efavirenz (EFV) 600mg Tablet PROGRAM 640 0 640 0 640
FDC (Tenofovir
240 300+Lamivudin300+Efavirenz PROGRAM 150 0 150 0 150
600) Tablet
241 Garam Oralit 200 ml PROGRAM 0 0 0 0 0
245 Glucose Protein - PROGRAM 0 0 0 0 0
246 HALDOL DECANOAS injeksi PROGRAM 9 0 9 0 9
50mg/ml
247 Kaca mulut - SS/Lokal PROGRAM 0 0 0 0 0
248 Kondom - PROGRAM 1440 0 1440 0 1440
249 Lamivudin 3TC 150mg Tablet PROGRAM 600 0 600 0 600
250 Lamivudine tablet 150 mg PROGRAM 0 0 0 0 0
252 Masker N95 - One med PROGRAM 0 0 0 0 0
253 MDT-MB Dewasa Tablet PROGRAM 0 0 0 0 0
254 Mineral Mix PROGRAM 0 0 0 0 0
Nevirapin tablet 200 mg - btl
255 60 tablet PROGRAM 0 0 0 0 0
256 Nevirapin tablet 200 mg - btl PROGRAM 380 0 380 440 0 -60
60 tablet
257 Obat Anti Tuberculosis FDC PROGRAM 3 0 3 0 3

Paket Kat I
Obat Antituberkulosis FDC
258 Kategori 1 - paket PROGRAM 0 0 0 0 0
259 Pen Light - PROGRAM 0 0 0 0 0
260 Pinset anatomis 18 cm PROGRAM 0 0 0 0 0
261 Pot Sputum PROGRAM 0 0 0 0 0
262 Pot Sputum - PROGRAM 0 0 0 0 0
263 PRIMAQUIN - 15 mg tablet PROGRAM 0 0 0 0 0
264 Retinol (Vitamin A) 200.000 IU PROGRAM 0 0 0 0 0
265 Safety Box PROGRAM 0 0 0 0 0
266 Safety Box - 5 Liter PROGRAM 61 0 61 0 61
267 Sikzonate Inj - PROGRAM 0 0 0 0 0 20
268 Slides Mikroskop PROGRAM 11 0 11 0 11
269 Tablet Tambah Darah - PROGRAM 0 0 0 0 0
270 Tenofovir (TDF) 300mg Tablet PROGRAM 450 0 450 0 450
272 Tenofovir + Lamivudin + PROGRAM 30 0 30 0 30

Efaviren -
Tenofovir 300 + Lamivudin
273 300 + Efaviren 600 PROGRAM 0 0 0 0 0
274 Tenofovir 300 mg PROGRAM 0 0 0 0 0
275 Test kehamilan - PROGRAM 100 0 100 0 100
Zidovudin 300 mg +
276 Lamivudine 150 mg - btl 60 PROGRAM 0 0 0 0 0
tablet
Zidovudin 300 mg +
tablet
278 Zinc Dispersible tab PROGRAM 0 0 0 0 0
280 Zinc Dispersible tab PROGRAM 1356 0 1356 190 0 1166
281 Buscopan injeksi RAWAT INAP 64 0 64 0 64
282 Citicholin injeksi RAWAT INAP 44 0 44 0 44
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
286 Karbozokrom injeksi 10mg/ml RAWAT INAP 0 0 0 0 0
Metoklopramide injeksi 5
288 mg/ml RAWAT INAP 100 0 100 0 100
289 Piracetam injeksi 3 g/15 ml RAWAT INAP 0 0 0 0 0
290 Seftriakson injeksi 1 g - RAWAT INAP 0 0 0 0 0
PERSALINAN
JKN
292 Alat Suntik sekali pakai - 3 ml PERSALINAN 0 0 0 0 0
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN
295 Gelang Identitas Pasien JKN 131 0 131 0 131

PERSALINAN
296 HANDSCOEN SAFEGLOVE 7,5 JKN 199 0 199 0 199
PERSALINAN
297 Handscoon Panjang siku - JKN 99 0 99 0 99

PERSALINAN
JKN
298 I.V. Catheter 18 PERSALINAN 2 0 2 0 2
299 Mucus Extractor - JKN 131 0 131 0 131

PERSALINAN
JKN
300 MY JELLY 82 G - PERSALINAN 32 0 32 0 32
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN
303 Underpad steril - JKN 82 0 82 0 82

PERSALINAN
JKN
304 Urine bag PERSALINAN 0 0 0 0 0
305 Alat Suntik sekali pakai - 3 ml ALOKON 46 0 46 0 46

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
310 Dermafix - ALOKON 0 0 0 0 0
Desinfektan (klorin 5,25%) -1
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
313 Handscoen Steril - ALOKON 0 0 0 0 0
315 IUD Coper T ALOKON 80 0 80 0 80
316 IUD Coper T - ALOKON 25 0 25 0 25
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
319 Kondom Aroma ALOKON 0 0 0 0 0
321 Kondom Aroma ALOKON #VALUE! 0 #VALUE! 0 #VALUE!
322 Lidocaine Hcl ALOKON 24 0 24 0 24
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
326 Pil KB ALOKON 0 0 0 0 0
328 btl 1000 ml ALOKON 1 0 1 0 1
329 Povidon Iodida larutan 10% - ALOKON 5 0 5 0 5

btl 30 ml
330 Suntik KB ALOKON 40 0 40 0 40
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
335 Susuk KB ALOKON 0 0 0 0 0
336 Susuk KB - ALOKON 9 0 9 0 9
337 Susuk KB - ALOKON 58 0 58 0 58
339 Susuk KB II ALOKON 20 0 20 0 20
340 Ampisillin Injeksi 1000 mg / JKN RAWAT 5 0 5 0 5
ml INAP
341 Buscopan Injeksi JKN RAWAT 0 0 0 0 0
INAP
342 Citicholin inj JKN RAWAT 0 0 0 0 0

INAP
JKN RAWAT
343 Citicholin inj. INAP 0 0 0 0 0
344 Furamin Injeksi JKN RAWAT 0 0 0 0 0

INAP
JKN RAWAT
345 Furamin Injeksi INAP 0 0 0 0 0
JKN RAWAT
346 Furosemid injeksi 10 mg/ml 0 0 0 0 0
INAP
JKN RAWAT
347 Furosemide injeksi 10 mg / ml 40 0 40 0 40
INAP
348 Glibenklamide tablet 5mg JKN RAWAT 1220 0 1220 0 1220

INAP
Ketorolac injeksi 10 mg - ktk JKN RAWAT
349 12 ampul @ 1 ml INAP 5 0 5 0 5
Loperamid tablet 2 mg - ktk JKN RAWAT

350 0 0 0 0 0 500
10 x 10 tablet INAP
JKN RAWAT
351 Mersibion Inj - 0 0 0 0 0
INAP
352 Metamizol Inj - JKN RAWAT 0 0 0 0 0

INAP
Norages 500mg/mL 2mL JKN RAWAT
353 Injeksi INAP 431 431 90 0 341
Piracetam 1 gr/5 mL 5 mL JKN RAWAT

354 98 0 98 0 98 50
Injeksi INAP
Ranitidine 25mg/2mL 2mL JKN RAWAT
355 600 0 600 26 0 574
Injeksi - INAP
356 Seftriakson injeksi 1 g JKN RAWAT 0 0 0 0 0

INAP
357 Seftriaksone serbuk Injeksi 1 g JKN RAWAT 0 0 0 0 0
INAP
358 Thiamfilex Kapsul 500mg JKN RAWAT 241 0 241 0 241

INAP
JKN RAWAT
359 Ventolin Nebulizer - Glaxco INAP 208 0 208 5 5 203
360 Acetylcystein 200 mg - DAK 2000 0 2000 450 450 1550
361 Alat Suntik sekali pakai - 3 ml DAK 2677 0 2677 0 2677
365 Alat suntik sekali pakai 0.05 DAK 0 0 0 0 0

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
368 Alkohol Swab (P3M) DAK-HIV DAK 0 0 0 0 0
369 Alkohol Swab - DAK 0 0 0 0 0
370 Alopurinol tablet 100 mg DAK 0 0 0 0 0
371 Aminofilin injeksi 24 mg/ml DAK 0 0 0 0 0 50
372 Aminofilin tablet 200 mg DAK 0 0 0 0 0
373 Amitriptillin 25 mg - HCl DAK 80 0 90 10 80
374 Amlodipin tablet 10 mg - ktk 3 DAK 0 0 0 0 0
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
x 10 tablet
378 Amoksisilin kaplet 500 mg DAK 3131 0 3131 0 3131
379 Amoksisilin sirup kering 125 DAK 0 0 0 0 0
mg/ 5 ml

kunyah,kombinasi :
380 Aluminium Hidroksida 200 mg DAK 1123 0 1123 760 0 363
200 mg
381 Antasida DOEN II suspensi DAK 64 0 64 24 0 40
Anti Bakteri DOEN salep

382 kombinasi: Basitrasin 500 IU/g DAK 0 0 0 0 0
+ Polimiksin 10.000 dan IU/g
383 Antihemoroid DOEN DAK 0 0 0 0 0

kombinasi
384 Aqua Pro Injeksi 25 cc DAK 0 0 0 0 0
385 Aqua Pro Injeksi 25 cc DAK 0 0 0 0
386 AQUADEST 25 LITER - DAK 0 0 0 0 0
Asam Askorbat (Vitamin C)
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
389 Asam cuka DAK 8 0 8 0 8
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
392 Asam mefenamat 500 mg DAK 0 0 0 0 0
Asam Mefenamat 500mg
393 DAK 0 0 0 0 0
Tablet -
394 ASEPTAN + DISPS 500ML - E- DAK 0 0 0 0 0
care
395 Asering Lart infus DAK 88 0 88 88 88 40
396 Asiklovir 400 mg DAK 13 0 13 0 13
397 Asiklovir krim 5% DAK 24 24 0 24
398 Atropin sulfat injeksi DAK 15 0 15 0 15
399 Betahistin Mesilat tablet 6 mg DAK 422 0 422 0 422
Betametason krim 0,1 %

400 (sebagai Valerat) - tube 5 DAK 16 16 0 16
gram
401 Blood Lancet DAK 30 0 30 0 30
402 Blood set DAK 0 0 0 0 0
Catgut - CHROMIC 3/0
403 DAK 166 0 166 0 166
75C+JARUM 1/2 22 M R
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500
409 Cuticell Classic 10 x 10 cm DAK 0 0 0 0 0
411 D-piece Smokerlizer DAK 0 0 0 0 0
Decacetin Tetes Mata /
412 Kloramfenikol TM DAK 25 0 25 7 0 18
413 Deksametason tablet 0,5 mg DAK 686 0 686 0 686

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
415 Desinfektan (klorin 5,25%) DAK 0 0 0 0 0
416 Desinfektan (klorin 5,25%) - DAK 0 0 0 0 0
417 Devitalisasi Pasta DAK 1 0 1 0 1
419 Diazepam injeksi 5 mg/ml DAK 5 0 5 20 5
420 Diazepam tablet 2 mg DAK 0 0 0 100 0
421 Digoksin tablet 0,25 mg DAK 100 0 100 0 100
422 Domperidon Tablet 10 mg DAK 774 0 774 60 0 714
423 ELEKTRODA SKINTACT - DAK 6 0 6 0 6
424 Epinefrin (Adrenalin) injeksi DAK 0 0 0 0 0
0,1 % (sebagai HCl)
425 Eritromisin kaplet 500 mg DAK 170 0 170 0 170
Etakridin / Rivanol 300mL -
426 Onemed DAK 4 0 4 0 4
427 Face masker 2 ply - DAK 0 0 0 0 0
428 Fenobarbital tablet 30 mg DAK 140 0 140 0 140
429 Fitomenadion (Vit.K1) tablet DAK 0 0 0 0 0
salut gula 10 mg
430 Fitomenadion Inj DAK 100 0 100 0 100
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
433 Folley catheter 18 DAK 28 0 28 0 28
434 Folley Chateter 16 DAK 56 0 56 7 0 49
435 Furosemid tablet 40 mg DAK 260 0 260 60 0 200
436 Glass Ionomer DAK 6 0 6 0 6
437 Glimepiride tablet 2 mg DAK 530 0 530 90 0 440
438 Gliseril Guayakolat tab 100 DAK 0 0 0 0 0
mg -
439 Glukosa larutan infus 5 % DAK 112 0 112 20 0 92 100

steril -
Glukosa larutan infus 5 %
440 steril - btl 500 ml DAK 1 0 1 0 1
441 Handscoen Steril - DAK 70 0 70 30 0 40
442 Hansaplast Standart BDF DAK 0 0 0 46 0 -46
443 I.V. Catheter 18 DAK 125 0 125 9 0 116
444 I.V. Catheter 18 - Venocath DAK 0 0 0 0 0
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 323 0 323 18 0 305
448 I.V. Catheter 24 DAK 157 0 157 12 0 145
449 IBUPROFEN 200 - DAK 0 0 0 0
450 Ibuprofen suspensi 100 mg/5 DAK 0 0 0 0 0
ml
451 Ibuprofen tablet 400 mg DAK 0 0 0 0 0 0
453 Infuset Dewasa DAK 347 0 347 34 0 313
454 Infuset Dewasa - DAK 0 0 0 0 0
456 Infusion - set anak DAK 85 0 85 0 85
457 Isosorbid Dinitrat tablet DAK 0 0 0 0 0
sublingual 5 mg
458 Kalsium Laktat tab 500 mg DAK 0 0 0 0 0
Kapas adsorben/pembalut
459 DAK 14 0 14 0 14
250 g
460 Kapas adsorben/pembalut DAK 10 0 10 0 10

250 g
461 Kaptopril tablet 25 mg DAK 2750 0 2750 549 0 2201 3000
462 KASA HYDROFIL 40X80 DAK 4 0 4 2 0 2
463 Kasa Pembalut - 2m x 80cm DAK 46 0 46 4 0 42
464 Kasa pembalut 36 M x 80 Cm - DAK 19 0 19 0 19
465 Kasa pembalut Hidrofil 4 M x DAK 0 0 0 0 0

10 Cm
Kasa Steril 16x16 - Kasa
466 DAK 0 0 0 16 0 -16
Husada
467 Kertas Puyer Sealing DAK 0 0 0 0 0
468 Kertas Puyer/Kertas roti - DAK 0 0 0 0 0
lokal
469 Ketokonazol krim 2% DAK 31 31 9 0 22
470 Kloramfenikol kapsul 250 mg DAK 200 0 200 60 0 140
Kloramfenikol tetes mata 0,5

471 % DAK 0 0 0 0 0
Kloramfenikol tetes telinga 3

472 % DAK 22 0 22 6 0 16

473 DAK 0 0 0 0 0 0
mg
474 Klorfeniramin Maleat tab 4 DAK 48 0 48 0 48 5000

mg
Klorfenol kamfer Menthol
475 (CHKM) - DAK 3 0 3 0 3
476 Klorpromazin 100 mg tab - DAK 0 0 0 0 0 1000
477 Kotrimoksasol susp DAK 0 0 0 0 0 100
Kotrimoksazol DOEN I
(dewasa) kombinasi :
478 DAK 718 0 718 190 0 528
Sulfametoksazol 400 mg
Trimetoprim 80 mg
479 (dewasa) kombinasi : DAK 0 0 0 0 0
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
481 lidokain cairan inj 2% DAK 0 0 0 0 0
482 lidokain cairan inj 2% DAK 35 35 0 35
483 Lidokain Injeksi - DAK 0 0 0 0 0
484 Lidokain injeksi 2% (HCl) + DAK 0 0 0 0 0
Epinefrin 1 : 80.000 - 2ml
485 Loratadin tablet 10 mg DAK 3115 0 3115 120 0 2995
486 Lysol DAK 1 0 1 0 1
Magnesium Sulfat Injeksi 20 %
487 DAK 0 0 0 0 0 20
- 25 ml
488 Magnesium Sulfat Injeksi 40 % DAK 0 0 0 0 0 20

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0
Metilergometrin tablet salut

491 DAK 508 508 0 508
0,125 mg
492 Metilprednisolon tablet 4 mg - DAK 327 0 327 0 327

ktk 10 x 10 tablet
Metoklopramide tablet 10 mg
493 - ktk 10 x 10 tablet DAK 1801 0 1801 60 0 1741
494 Metronidazol tablet 500 mg DAK 0 0 0 97 0 -97
495 Metronidazol tablet 500 mg DAK 32 0 32 0 32
Mikonazol krim/salep 2 %
496 (Nitrat) - tube 10 gram DAK 17 17 0 17
497 Mouthpiece Smokerlizer DAK 0 0 0 0 0
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19
500 Natrium Diklofenak tab 25 mg DAK 6 0 6 0 6
501 Natrium Diklofenak tab 25 mg DAK 8100 0 8100 790 0 7310
502 Natrium Diklofenak tablet 50 DAK 0 0 470 0 -470

mg
Natrium Klorida larutan infus
503 0,9 % - DAK 21 0 21 0 21

504 DAK 69 0 69 34 0 35
0,9 % -
505 Natrium Klorida larutan infus DAK 25 0 25 0 25
0,9 % - btl 500 ml
506 Nifedipin tablet DAK 5 0 5 0 5
507 Nifedipin tablet 10 mg DAK 0 0 0 0 0 3000
508 DAK 20 0 20 9 0 11
IU/ g
509 Oksitetrasiklin HCl salep mata DAK 8 0 8 0 8 30

1%
510 Oksitosin inj. 10 IU/ml DAK 183 0 183 9 0 174 EXP
511 PAPSMEAR KIT - DAK 0 0 0 0 0 0
Parasetamol sirup 120
512 DAK 12 0 12 54 0 -42
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
514 Parasetamol tablet 500 mg DAK 0 0 0 0 0
515 Parasetamol tablet 500 mg - DAK 3400 0 3400 2000 0 1400
ktk 10 x 10 tablet
516 Perak Sulfadiazin Cream - DAK 0 0 0 0 0
517 Permetrin Krim - DAK 6 0 6 0 6
Piridoksin (vitamin B6) tab 10
518 mg DAK 0 0 0 0 0
519 Plesterin Anti Air - DAK 30 0 30 0 30
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml
523 Povidon Iodida larutan 10% - DAK 4 0 4 0 4

btl 60 ml
524 Prednison - 5 mg DAK 0 0 0 0 0
526 PROPANOLOL 10 TAB - DAK 220 0 220 0 220
527 Propiltiourasil tablet 100 mg DAK 210 0 210 0 210
528 PULAREX ACTIVATED DAK 44 0 44 0 44

ATTAPULGITE 630MG
529 RANITIDIN INJ - DAK 0 0 0 0 0
530 Ranitidin tablet 150 mg DAK 4 0 4 0 4
531 Ranitidin tablet 150 mg DAK 2298 2298 620 0 1678 2000
532 Retinol (Vitamin A) 100.000 IU DAK 0 0 0 0 0
kapsul lunak
Retinol (Vitamin A) 200.000 IU
533 DAK 0 0 0 0 0
kapsul lunak
534 Ringer laktat inf - DAK 11 0 11 0 11 100
535 Ringer laktat inf - DAK 0 0 0 0
536 Risperidon 2 mg DAK 0 0 0 0 0
537 Salbutamol tablet 2 mg DAK 0 0 0 0 0

538 Salisilat 2% + Belerang endap DAK 0 0 0 6 0 -6
539 Salisil Bedak 2 % DAK 17 0 17 3 0 14

540 Semen Seng DAK 0 0 0 0 0
541 Serum Anti Bisa ular polivalen DAK 0 0 0 0 0
I-
Serum Anti Bisa ular polivalen
542 I- DAK 0 0 0 0 0
543 Serum antitetanus (A.T.S) DAK 0 0 0 0 0
544 silk 3/0 - DEMETECH DAK 3 0 3 0 3
545 SIMVASTATIN 10MG DAK 0 0 0 0 0

552 Stik HB - DAK 6 0 6 0 6
Tabung Venoject (P3M) DAK-
558 HIV DAK 0 0 0 0 0
Tetagam 250UI/mL 1mL

559 Injeksi (Serum Anti Tetanus) DAK 0 0 0 0 0
Tetrasiklin HCl kapsul 250 mg

560 DAK 0 0 0 0 0
-
561 Tiamin Hcl ( Vit B1 ) Tablet 50 DAK 0 0 0 0 0

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
Mengetahui/Menyetujui Yang meminta/melapor Yang menerima
menyerahkan
Kepala Seksi Perbekalan Petugas Gudang
Kesehatan dan Farmasi Farmasi Kepala UPTD Puskesmas Pesanggaran Petugas Puskesmas
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode Mar-21

9 APBD 44 0 44 21 0 23
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein

tablet 50 mg
16 Asiklovir krim 5% - tube 5 APBD -4 0 -4 4 0 -8
gram
17 gram APBD 17 0 17 0 17

18 APBD 0 0 0 0 0
Laboratorium -
22 Doksisiklin kapsul 100 mg APBD 0 0 0 0 0
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 0 20 20 4 0 16

5 Cm
41 Ketoprofen Injeksi APBD 0 0 0 0 0
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 0 50 50 0 50
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0
mg / ml
47 Multivitamin sirup APBD 0 0 0 0 0
50 ONDANSETRON 4 INJ APBD 0 0 0 0 0
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA
69 THIAMPHENICOL 500 TAB APBD 0 0 0 200 0 -200
76 Acetylcystein 200 mg - JKN 0 0 0 249 0 -249
78 Alat Suntik sekali pakai - 3 ml JKN 152 0 152 370 0 -218
79 Alat Suntik sekali pakai - 5 ml JKN -77 0 -77 219 -296

82 JKN 500 0 500 50 0 450
10 x 10 tablet

100 tablet
84 x 10 tablet JKN 0 0 0 43 0 -43

85 JKN 0 0 0 17 0 -17
x 10 tablet
87 JKN 0 0 0 0 0
kunyah,kombinasi :
89 Aluminium Hidroksida 200 mg JKN 2030 0 2030 4600 0 -2570
kunyah

suppositoria
93 JKN 0 3000 3000 0 3000 3000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN 2 0 2 4 0 -2
103 Captopril 25mg Tablet JKN 655 0 655 390 0 265
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0

112 mg/ml (HCl) JKN 113 0 113 19 0 94
119 FOLEY 18 - JKN 20 0 20 6 0 14
128 x 10 tablet JKN 0 0 0 0 0
131 JKN 9300 0 9300 700 0 8600
Tablet
132 H2O2 3% JKN -2 0 -2 2 0 -4
133 H2O2 3% 100mL JKN 0 0 0 0 0
137 JKN 84 0 84 12 0 72
tube 5 gram

tube 5 gram
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN 4 0 4 3 0 1
144 JKN 0 0 0 0 0
ml - btl 60 ml
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0

155 JKN 3670 0 3670 80 0 3590
ktk 10 X 10 kapsul

%
158 mg JKN 0 0 0 0 0

mg
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0

166 - ktk 10 x 10 tablet JKN 180 0 180 160 0 20

167 mg/mL JKN 31 0 31 5 0 26
168 JKN 0 0 0 0 0
salut
salut

ktk 10 x 10 tablet
177 MY JELLY 82 G - JKN 4 0 4 2 0 2
178 JKN 0 0 0 0 0
179 Natrium Diklofenak tab 25 mg JKN 460 0 460 490 0 -30

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg

IU
185 IU JKN 0 0 0 0 0

186 JKN 60 0 60 30 0 30
IU/ g
191 JKN 54 0 54 12 0 42
10mL
mg/5ml -
198 Piridoksina HCl tab 10 mg - JKN -4 0 -4 4 0 -8
200 btl 300 ml JKN -1 0 -1 1 0 -2

201 300 ml JKN 6 0 6 0 6
ATTAPULGITE 630MG
tablet
206 (sebagai Sulfat) - ktk 10 x 10 JKN -11 0 -11 11 0 -22
tablet


mg
tablet

219 JKN 0 0 0 0 0
Bawah Anak

taring atas anak
222 Test kehamilan JKN 0 0 0 50 0 -50
226 Tiamin HCl tab 50 mg - JKN 90 0 90 670 0 -580
228 Tourniquet JKN -1 0 -1 1 0 -2
tablet

FDC (Tenofovir
600) Tablet
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
256 Nevirapin tablet 200 mg - btl PROGRAM -60 0 -60 440 0 -500
60 tablet

Paket Kat I

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
288 mg/ml RAWAT INAP 100 0 100 0 100
PERSALINAN
JKN
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN

PERSALINAN
PERSALINAN

PERSALINAN
JKN

PERSALINAN
JKN
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

btl 30 ml
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
INAP

INAP
JKN RAWAT

INAP
JKN RAWAT
JKN RAWAT
INAP
JKN RAWAT
INAP
348 Glibenklamide tablet 5mg JKN RAWAT 1220 0 1220 610 0 610
INAP
349 12 ampul @ 1 ml INAP 5 0 5 0 5

350 0 0 0 0 0 500
10 x 10 tablet INAP
JKN RAWAT
INAP

INAP
353 Injeksi INAP 341 341 90 0 251

354 98 0 98 0 98 50
Injeksi INAP
355 574 0 574 26 0 548
Injeksi - INAP

INAP
INAP

INAP
JKN RAWAT

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
372 Aminofilin tablet 200 mg DAK 0 200 200 50 0 150
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
377 Amlodipin tablet 5 mg - ktk 3 DAK 3375 0 3375 350 0 3025
x 10 tablet
378 Amoksisilin kaplet 500 mg DAK 3131 0 3131 660 0 2471
mg/ 5 ml

kunyah,kombinasi :
380 Aluminium Hidroksida 200 mg DAK 363 0 363 760 0 -397
200 mg
381 Antasida DOEN II suspensi DAK 40 0 40 24 0 16


kombinasi
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
393 DAK 0 0 0 0 0
Tablet -
care
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 DAK 166 0 166 0 166
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
0,1 % (sebagai HCl)
426 Onemed DAK 4 0 4 0 4
salut gula 10 mg
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
mg -

steril -
440 steril - btl 500 ml DAK 1 0 1 0 1
441 Handscoen Steril - DAK 40 0 40 30 0 10
442 Hansaplast Standart BDF DAK -46 0 -46 46 0 -92
443 I.V. Catheter 18 DAK 116 0 116 9 0 107
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 305 0 305 18 0 287
448 I.V. Catheter 24 DAK 145 0 145 12 0 133
449 IBUPROFEN 200 - DAK 0 0 0 0
ml
sublingual 5 mg
459 DAK 14 0 14 0 14
250 g

250 g
462 KASA HYDROFIL 40X80 DAK 2 0 2 2 0 0

10 Cm
466 DAK -16 0 -16 16 0 -32
Husada
lokal

471 % DAK 0 0 0 0 0

472 % DAK 16 0 16 6 0 10

473 DAK 0 0 0 0 0 0
mg

mg
475 (CHKM) - DAK 3 0 3 0 3
478 DAK 528 0 528 190 0 338
Trimetoprim 80 mg
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
486 Lysol DAK 1 0 1 0 1
487 DAK 0 21 21 0 21 20
- 25 ml

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0

491 DAK 508 508 0 508
0,125 mg

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1741 0 1741 60 0 1681
494 Metronidazol tablet 500 mg DAK -97 0 -97 97 0 -194
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19
502 Natrium Diklofenak tablet 50 DAK -470 -470 470 0 -940

mg
503 0,9 % - DAK 21 0 21 0 21

504 DAK 35 100 135 34 0 101
0,9 % -
0,9 % - btl 500 ml
508 DAK 11 0 11 9 0 2
IU/ g

1%
512 DAK -42 0 -42 54 0 -96
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
515 Parasetamol tablet 500 mg - DAK 1400 0 1400 2000 0 -600
ktk 10 x 10 tablet
518 mg DAK 0 0 0 0 0
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml

btl 60 ml

ATTAPULGITE 630MG
kapsul lunak
533 DAK 0 0 0 0 0
kapsul lunak

538 Salisilat 2% + Belerang endap DAK -6 0 -6 6 0 -12

I-
542 I- DAK 0 0 0 0 0

548 Siprofloksasin tablet 500 mg DAK 131 0 131 210 0 -79
552 Stik HB - DAK 6 0 6 0 6
557 Tablet Tambah Darah DAK 5520 5600 11120 1200 0 9920
558 HIV DAK 0 0 0 0 0


560 DAK 0 0 0 0 0
-

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode Apr-21

9 APBD 23 0 23 21 0 2
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein

tablet 50 mg
gram
17 gram APBD 17 0 17 0 17

18 APBD 0 0 0 0 0
Laboratorium -
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 16 0 16 2 0 14

5 Cm
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 50 0 50 0 50
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0
mg / ml
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA
69 THIAMPHENICOL 500 TAB APBD -200 0 -200 200 0 -400
76 Acetylcystein 200 mg - JKN -249 0 -249 249 0 -498
78 Alat Suntik sekali pakai - 3 ml JKN -218 0 -218 370 0 -588

82 JKN 450 0 450 90 0 360
10 x 10 tablet

100 tablet
84 x 10 tablet JKN -43 0 -43 43 0 -86

85 JKN -17 0 -17 17 0 -34
x 10 tablet
87 JKN 0 0 0 0 0
kunyah,kombinasi :
89 Aluminium Hidroksida 200 mg JKN -2570 0 -2570 4600 0 -7170
kunyah

suppositoria
93 JKN 3000 0 3000 0 3000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN -2 0 -2 4 0 -6
103 Captopril 25mg Tablet JKN 265 0 265 390 0 -125
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0

112 mg/ml (HCl) JKN 94 0 94 19 0 75
119 FOLEY 18 - JKN 14 0 14 6 0 8
128 x 10 tablet JKN 0 0 0 0 0
131 JKN 8600 0 8600 700 0 7900
Tablet
132 H2O2 3% JKN -4 0 -4 2 0 -6
133 H2O2 3% 100mL JKN 0 0 0 0 0
137 JKN 72 0 72 12 0 60
tube 5 gram

tube 5 gram
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN 1 0 1 3 0 -2
144 JKN 0 0 0 0 0
ml - btl 60 ml
148 Kapas berlemak 500 g JKN 0 0 0 2 0 -2
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0

155 JKN 3590 0 3590 80 0 3510
ktk 10 X 10 kapsul

%
158 mg JKN 0 0 0 0 0

mg
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0

166 - ktk 10 x 10 tablet JKN 20 0 20 160 0 -140

167 mg/mL JKN 26 0 26 5 0 21
168 JKN 0 0 0 0 0
salut
salut

ktk 10 x 10 tablet
177 MY JELLY 82 G - JKN 2 0 2 2 0 0
178 JKN 0 0 0 0 0
179 Natrium Diklofenak tab 25 mg JKN -30 0 -30 490 0 -520

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg

IU
185 IU JKN 0 0 0 0 0

186 JKN 30 0 30 30 0 0
IU/ g
191 JKN 42 0 42 12 0 30
10mL
192 Paracetamol 500mg Tablet JKN 1300 200 1500 3980 1120 1300
mg/5ml -
195 Perak Sulfadiazin Cream - JKN 8 0 8 2 0 6
198 Piridoksina HCl tab 10 mg - JKN 0 0 0 0 0 0
200 btl 300 ml JKN 0 0 0 0 0 0

201 300 ml JKN 6 0 6 0 6
ATTAPULGITE 630MG
tablet
206 (sebagai Sulfat) - ktk 10 x 10 JKN 0 0 0 0 0 0
tablet


mg
tablet

219 JKN 0 0 0 0 0
Bawah Anak

taring atas anak
222 Test kehamilan JKN -50 0 -50 50 0 -100
226 Tiamin HCl tab 50 mg - JKN -580 0 -580 670 0 -1250
228 Tourniquet JKN -2 0 -2 1 0 -3
tablet

FDC (Tenofovir
600) Tablet
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
60 tablet

Paket Kat I
267 Sikzonate Inj - PROGRAM 10 0 10 0 10

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
288 mg/ml RAWAT INAP 100 0 100 0 100
PERSALINAN
JKN
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN

PERSALINAN
PERSALINAN

PERSALINAN
JKN

PERSALINAN
JKN
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

btl 30 ml
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
INAP

INAP
JKN RAWAT

INAP
JKN RAWAT
JKN RAWAT
INAP
JKN RAWAT
INAP

INAP
349 12 ampul @ 1 ml INAP 5 0 5 0 5

350 0 0 0 0 0
10 x 10 tablet INAP
JKN RAWAT
INAP

INAP
353 Injeksi INAP 251 251 90 0 161

354 98 0 98 0 98
Injeksi INAP
355 548 0 548 26 0 522
Injeksi - INAP

INAP
INAP

INAP
JKN RAWAT

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
371 Aminofilin injeksi 24 mg/ml DAK 0 0 0 0 0
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
x 10 tablet
mg/ 5 ml

kunyah,kombinasi :
380 Aluminium Hidroksida 200 mg DAK -397 0 -397 760 0 -1157
200 mg
381 Antasida DOEN II suspensi DAK 16 0 16 24 0 -8


kombinasi
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
393 DAK 0 0 0 0 0
Tablet -
care
395 Asering Lart infus DAK 88 0 88 88 88
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 DAK 166 0 166 0 166
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
0,1 % (sebagai HCl)
426 Onemed DAK 4 0 4 0 4
salut gula 10 mg
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
mg -
439 Glukosa larutan infus 5 % DAK 172 0 172 20 0 152

steril -
440 steril - btl 500 ml DAK 1 0 1 0 1
441 Handscoen Steril - DAK 10 0 10 30 0 -20
443 I.V. Catheter 18 DAK 107 0 107 9 0 98
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 287 0 287 18 0 269
448 I.V. Catheter 24 DAK 133 0 133 12 0 121
449 IBUPROFEN 200 - DAK 0 0 0 0
ml
452 Ibuprofen tablet 400 mg DAK 3000 0 3000 0 3000
sublingual 5 mg
459 DAK 14 0 14 0 14
250 g

250 g
461 Kaptopril tablet 25 mg DAK 1652 0 1652 549 0 1103
462 KASA HYDROFIL 40X80 DAK 0 0 0 2 0 -2

10 Cm
466 DAK -32 0 -32 16 0 -48
Husada
lokal

471 % DAK 0 0 0 0 0

472 % DAK 10 0 10 6 0 4

473 DAK 0 0 0 0 0 0
mg
474 Klorfeniramin Maleat tab 4 DAK 5048 0 5048 0 5048

mg
475 (CHKM) - DAK 3 0 3 0 3
476 Klorpromazin 100 mg tab - DAK 0 0 0 0 0
477 Kotrimoksasol susp DAK 0 0 0 0 0
478 DAK 338 0 338 190 0 148
Trimetoprim 80 mg
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
486 Lysol DAK 1 0 1 0 1
487 DAK 21 0 21 0 21
- 25 ml
488 Magnesium Sulfat Injeksi 40 % DAK 21 0 21 0 21

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0

491 DAK 508 508 0 508
0,125 mg

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1681 0 1681 60 0 1621
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19
502 Natrium Diklofenak tablet 50 DAK 0 0 0 0 0

mg
503 0,9 % - DAK 21 0 21 0 21

504 DAK 101 0 101 34 0 67
0,9 % -
0,9 % - btl 500 ml
507 Nifedipin tablet 10 mg DAK 0 0 0 0 0
508 DAK 2 0 2 9 0 -7
IU/ g
509 Oksitetrasiklin HCl salep mata DAK 8 0 8 0 8

1%
510 Oksitosin inj. 10 IU/ml DAK 0 0 0 0 0 0
512 DAK 0 0 0 0 0 0
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
515 Parasetamol tablet 500 mg - DAK 0 0 0 0 0 0
ktk 10 x 10 tablet
518 mg DAK 0 0 0 0 0
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml

btl 60 ml

ATTAPULGITE 630MG
kapsul lunak
533 DAK 0 0 0 0 0
kapsul lunak
534 Ringer laktat inf - DAK 111 0 111 0 111


I-
542 I- DAK 0 0 0 0 0

548 Siprofloksasin tablet 500 mg DAK -79 0 -79 210 0 -289
552 Stik HB - DAK 6 0 6 0 6
558 HIV DAK 0 0 0 0 0


560 DAK 0 0 0 0 0
-

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode May-21

9 APBD 2 0 2 21 0 -19
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein

tablet 50 mg
gram
17 gram APBD 17 0 17 0 17

18 APBD 0 0 0 0 0
Laboratorium -
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 14 0 14 5 0 9

5 Cm
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 50 0 50 0 50
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0
mg / ml
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA

82 JKN 360 0 360 90 0 270
10 x 10 tablet
83 Aminofilin tablet 200 mg - btl JKN 200 0 200 0 200

100 tablet
84 x 10 tablet JKN -86 0 -86 43 0 -129

85 JKN -34 0 -34 17 0 -51
x 10 tablet
86 Amoksisilin kaplet 500 mg JKN 2 0 2 760 0 -758
87 JKN 0 0 0 0 0
kunyah,kombinasi :
kunyah

suppositoria
93 JKN 3000 0 3000 0 3000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN -6 0 -6 4 0 -10
103 Captopril 25mg Tablet JKN -125 0 -125 390 0 -515
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0

112 mg/ml (HCl) JKN 75 0 75 19 0 56
119 FOLEY 18 - JKN 8 0 8 6 0 2
126 Glibenklamide tablet 5 mg JKN 280 0 280 450 0 -170
128 x 10 tablet JKN 0 0 0 0 0
131 JKN 7900 0 7900 700 0 7200
Tablet
132 H2O2 3% JKN -6 0 -6 2 0 -8
133 H2O2 3% 100mL JKN 0 0 0 0 0
137 JKN 60 0 60 12 0 48
tube 5 gram

tube 5 gram
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN -2 0 -2 3 0 -5
144 JKN 0 0 0 0 0
ml - btl 60 ml
148 Kapas berlemak 500 g JKN -2 0 -2 2 0 -4
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0

155 JKN 3510 0 3510 80 0 3430
ktk 10 X 10 kapsul
157 Kloramfenikol tetes mata 0,5 JKN 7 0 7 6 0 1

%
158 mg JKN 0 0 0 0 0

mg
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0

166 - ktk 10 x 10 tablet JKN -140 0 -140 160 0 -300

167 mg/mL JKN 21 0 21 5 0 16
168 JKN 0 0 0 0 0
salut
salut

ktk 10 x 10 tablet
172 Metronidazol tab 500 mg JKN 115 0 115 210 0 -95
177 MY JELLY 82 G - JKN 0 0 0 2 0 -2
178 JKN 0 0 0 0 0

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg
184 Nistatin tablet salut 500.000 JKN 0 0 0 0 0

IU
185 IU JKN 0 0 0 0 0

186 JKN 0 0 0 30 0 -30
IU/ g
187 Oksitosin inj. 10 IU/ml JKN 50 0 50 0 0 50
191 JKN 30 0 30 12 0 18
10mL
192 Paracetamol 500mg Tablet JKN 1300 0 1300 3400 0 1300
mg/5ml -
195 Perak Sulfadiazin Cream - JKN 6 0 6 2 0 4
198 Piridoksina HCl tab 10 mg - JKN 0 0 0 4 0 -4
200 btl 300 ml JKN 0 0 0 1 0 -1

201 300 ml JKN 6 0 6 0 6
ATTAPULGITE 630MG
tablet
206 (sebagai Sulfat) - ktk 10 x 10 JKN 0 0 0 11 0 -11
tablet


mg
tablet

219 JKN 0 0 0 0 0
Bawah Anak

taring atas anak
228 Tourniquet JKN -3 0 -3 1 0 -4
tablet

FDC (Tenofovir
600) Tablet
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
60 tablet

Paket Kat I

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
288 mg/ml RAWAT INAP 100 0 100 0 100
PERSALINAN
JKN
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN

PERSALINAN
PERSALINAN

PERSALINAN
JKN

PERSALINAN
JKN
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

btl 30 ml
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
INAP

INAP
JKN RAWAT

INAP
JKN RAWAT
JKN RAWAT
INAP
JKN RAWAT
INAP

INAP
349 12 ampul @ 1 ml INAP 5 0 5 0 5

350 0 0 0 0 0
10 x 10 tablet INAP
JKN RAWAT
INAP

INAP
353 Injeksi INAP 161 161 90 0 71

354 98 0 98 0 98
Injeksi INAP
355 522 0 522 26 0 496
Injeksi - INAP

INAP
INAP

INAP
JKN RAWAT

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
371 Aminofilin injeksi 24 mg/ml DAK 0 0 0 0 0
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
x 10 tablet
mg/ 5 ml

kunyah,kombinasi :
200 mg
381 Antasida DOEN II suspensi DAK -8 0 -8 24 0 -32


kombinasi
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
393 DAK 0 0 0 0 0
Tablet -
care
395 Asering Lart infus DAK 88 0 88 88 88
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 DAK 166 0 166 0 166
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500
412 Kloramfenikol TM DAK 4 0 4 7 0 -3

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
0,1 % (sebagai HCl)
426 Onemed DAK 4 0 4 0 4
salut gula 10 mg
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
mg -
439 Glukosa larutan infus 5 % DAK 152 0 152 20 0 132

steril -
440 steril - btl 500 ml DAK 1 0 1 0 1
441 Handscoen Steril - DAK -20 0 -20 30 0 -50
443 I.V. Catheter 18 DAK 98 0 98 9 0 89
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 269 0 269 18 0 251
448 I.V. Catheter 24 DAK 121 0 121 12 0 109
449 IBUPROFEN 200 - DAK 0 0 0 0
ml
sublingual 5 mg
459 DAK 14 0 14 0 14
250 g

250 g
462 KASA HYDROFIL 40X80 DAK -2 0 -2 2 0 -4

10 Cm
466 DAK -48 0 -48 16 0 -64
Husada
lokal
469 Ketokonazol krim 2% DAK 4 4 9 0 -5
470 Kloramfenikol kapsul 250 mg DAK 20 0 20 60 0 -40

471 % DAK 0 0 0 0 0

472 % DAK 4 0 4 6 0 -2

473 DAK 0 0 0 0 0 0
mg
474 Klorfeniramin Maleat tab 4 DAK 5048 0 5048 0 5048

mg
475 (CHKM) - DAK 3 0 3 0 3
476 Klorpromazin 100 mg tab - DAK 0 0 0 0 0
478 DAK 148 0 148 190 0 -42
Trimetoprim 80 mg
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
486 Lysol DAK 1 0 1 0 1
487 DAK 21 0 21 0 21
- 25 ml

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0

491 DAK 508 508 0 508
0,125 mg

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1621 0 1621 60 0 1561
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19
502 Natrium Diklofenak tablet 50 DAK 0 0 470 0 -470

mg
503 0,9 % - DAK 21 0 21 0 21

504 DAK 67 0 67 34 0 33
0,9 % -
0,9 % - btl 500 ml
507 Nifedipin tablet 10 mg DAK 0 0 0 0 0
508 DAK -7 0 -7 9 0 -16
IU/ g
509 Oksitetrasiklin HCl salep mata DAK 8 0 8 0 8

1%
510 Oksitosin inj. 10 IU/ml DAK 0 0 0 9 0 -9
512 DAK 0 0 0 54 0 -54
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
515 Parasetamol tablet 500 mg - DAK 0 0 0 2000 0 -2000
ktk 10 x 10 tablet
518 mg DAK 0 0 0 0 0
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml

btl 60 ml

ATTAPULGITE 630MG
kapsul lunak
533 DAK 0 0 0 0 0
kapsul lunak
534 Ringer laktat inf - DAK 111 0 111 0 111


I-
542 I- DAK 0 0 0 0 0

552 Stik HB - DAK 6 0 6 0 6
558 HIV DAK 0 0 0 0 0


560 DAK 0 0 0 0 0
-

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode Jun-21

6 Aminofilin injeksi 24 mg/ml APBD 30 0 30 5 0 25 30
7 Amitriptillin 25 mg APBD 0 0 0 0 0 100
9 APBD 0 0 0 0 0 0
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein
13 Asam Askorbat (Vitamin C) APBD 0 0 0 0 0 5000

tablet 50 mg
16 Asiklovir krim 5% - tube 5 APBD 0 0 0 0 0 0
gram
17 gram APBD 17 0 17 2 0 15 50

18 APBD 0 0 0 0 0
Laboratorium -
26 Fenobarbital tablet 30 mg APBD 1 0 1 1 0 0 100
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 9 0 9 5 0 4 30

5 Cm
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 50 0 50 4 0 46
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0
46 Metoklopramide Injeksi 5 APBD 0 0 0 0 0 0 100
mg / ml
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA
69 THIAMPHENICOL 500 TAB APBD 0 0 0 0 0 0 500
72 Urine bag APBD 7 0 7 0 7 50
76 Acetylcystein 200 mg - JKN 0 0 0 0 0 0
78 Alat Suntik sekali pakai - 3 ml JKN 0 0 0 0 0 0

82 JKN 270 0 270 90 0 180 1000
10 x 10 tablet
83 Aminofilin tablet 200 mg - btl JKN 200 0 200 0 200

100 tablet
84 x 10 tablet JKN 0 0 0 0 0 0

85 JKN 0 0 0 0 0 0
x 10 tablet
87 JKN 0 0 0 0 0
kunyah,kombinasi :
89 Aluminium Hidroksida 200 mg JKN 0 0 0 0
kunyah

suppositoria
93 JKN 3000 0 3000 820 0 2180 5000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN 0 0 0 0 0 0 500
103 Captopril 25mg Tablet JKN 0 0 0 0 0 0 5000
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0
109 Deksametason injeksi JKN 0 0 0 0 0 200
112 Difenhidramin injeksi i.m. 10 JKN 56 0 56 19 0 37 30

mg/ml (HCl)
119 FOLEY 18 - JKN 2 0 2 2 0 0
124 Gentamisin salep kulit 0,1% JKN 48 0 48 3 0 45 50
125 Gentamisin Tetes Mata - JKN 22 0 22 7 0 15 30
127 Glibenklamide tablet 5 mg JKN 710 0 710 350 0 360 5000
128 Glimepiride tablet 2 mg - ktk 5 JKN 0 0 0 0 0 1000
x 10 tablet
129 Glove/Handscun JKN 3000 0 3000 2100 0 900 5000
131 Glyceryl Guaiacolate 100mg JKN 7200 0 7200 1200 0 6000
Tablet
132 H2O2 3% JKN 0 0 0 0 0 0
133 H2O2 3% 100mL JKN 0 0 0 0 0
137 JKN 48 0 48 12 0 36
tube 5 gram
138 JKN 94 0 94 0 94
tube 5 gram
139 Hyosin N Butilbromide injeksi JKN 5 0 5 0 5

10 mg
140 I.V Catheter 26 JKN -5 0 -5 3 0 -8
143 Ibuprofen 400 mg Tablet JKN 0 0 0 0 0 2000
144 ml - btl 60 ml JKN 0 0 0 0 0
146 isosorbid dinitrat tab JKN 780 0 780 20 0 760
sublingual 5 mg
154 Klindamisin kapsul 150 mg - JKN 0 0 0 0 0 500
ktk 10 x 10 kapsul
155 ktk 10 X 10 kapsul JKN 3430 0 3430 130 0 3300
Kloramfenikol suspensi 125

156 JKN 54 0 54 9 0 45
%

mg
159 mg JKN 0 0 0 0 0
160 Kotrimoksasol susp. - JKN 0 0 0 0 0 0 100
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0 20
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0
166 Metformin HCl tablet 500 mg JKN 0 0 0 0 0 0 5000

- ktk 10 x 10 tablet
167 mg/mL JKN 16 0 16 5 0 11
168 0,125 mg - ktk 10 x 10 tablet JKN 0 0 0 0 0
salut
169 JKN 400 0 400 80 0 320 300
salut
Metilprednisolon tablet 4 mg -
170 ktk 10 x 10 tablet JKN 0 0 0 0 0
173 Metronidazole 500mg Tablet JKN 4680 0 4680 320 0 4360 1000
175 Miconazole krim 2 % JKN 15 0 15 6 0 9 25
177 MY JELLY 82 G - JKN -2 0 -2 2 0 -4
178 JKN 0 0 0 0 0
179 Natrium Diklofenak tab 25 mg JKN 0 0 0 0 0 0

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg

184 IU JKN 0 0 0 0 0

185 IU JKN 0 0 0 0 0

186 JKN 0 0 0 0 0 0
IU/ g
187 Oksitosin inj. 10 IU/ml JKN 50 0 50 0 0 50
191 Omeprazole 40mg/10mL JKN 18 0 18 12 0 6
10mL
193 Parasetamol sirup 120 JKN 180 0 180 24 0 156 100
mg/5ml -
198 Piridoksina HCl tab 10 mg - JKN 0 0 0 0 0 0
200 Povidon Iodida larutan 10% - JKN -1 0 -1 1 0 -2
btl 300 ml
201 300 ml JKN 6 0 6 0 6
202 Prednison 5 mg JKN 0 0 0 0 0 2000
PULAREX ACTIVATED
204 JKN 253 0 253 0 253
ATTAPULGITE 630MG
tablet
206 (sebagai Sulfat) - ktk 10 x 10 JKN 0 0 0 0 0 0 1000
tablet


mg
tablet
219 Tang Pencabut Gigi Geraham JKN 0 0 0 0 0

Bawah Anak
Tang pencabut gigi seri dan
220 taring atas anak JKN 0 0 0 0 0
225 Tiamin HCl tab 50 mg - JKN 7990 0 7990 760 0 7230 5000
228 Tourniquet JKN -4 0 -4 1 0 -5
tablet

FDC (Tenofovir
600) Tablet
244 Garam Oralit 200 ml PROGRAM 649 0 649 230 0 419 1000
HALDOL DECANOAS injeksi
246 PROGRAM 9 0 9 0 9
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
255 Nevirapin tablet 200 mg - btl PROGRAM 0 0 0 0 0
60 tablet
256 60 tablet PROGRAM 0 0 0 0 0 0
Obat Anti Tuberculosis FDC

257 PROGRAM 3 0 3 0 3
Paket Kat I
258 Obat Antituberkulosis FDC PROGRAM 0 0 0 0 0
Kategori 1 - paket

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 RAWAT INAP 40 0 40 0 40
- 10 mg
285 Hyosin N Butilbromide injeksi RAWAT INAP 15 0 15 0 15

- 10 mg
288 RAWAT INAP 100 0 100 0 100
mg/ml
JKN
291 Alat Suntik sekali pakai - 1 ml 72 0 72 0 72 300
PERSALINAN

PERSALINAN
JKN
293 Blood set PERSALINAN 0 0 0 0 0
JKN
294 Folley 18 - 0 0 0 0 0
PERSALINAN
JKN
295 Gelang Identitas Pasien 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN
297 Handscoon Panjang siku - PERSALINAN 99 0 99 0 99
JKN
298 I.V. Catheter 18 2 0 2 0 2 200
PERSALINAN
PERSALINAN
300 MY JELLY 82 G - JKN 32 0 32 0 32

PERSALINAN
JKN
301 Spuit 10 cc PERSALINAN 102 0 102 0 102
302 Umbilical Clamp - JKN 131 0 131 0 131

PERSALINAN
JKN
303 Underpad steril - PERSALINAN 82 0 82 0 82
JKN
304 Urine bag 0 0 0 0 0
PERSALINAN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0 5
311 Desinfektan (klorin 5,25%) -1 ALOKON 0 0 0 0 0 5
L
312 L ALOKON 1 0 1 0 1
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

329 btl 30 ml ALOKON 5 0 5 0 5
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
JKN RAWAT
341 Buscopan Injeksi 0 0 0 0 0
INAP
JKN RAWAT
342 Citicholin inj INAP 0 0 0 0 0
343 Citicholin inj. JKN RAWAT 0 0 0 0 0

INAP
INAP

INAP
JKN RAWAT
346 Furosemid injeksi 10 mg/ml INAP 0 0 0 0 0
347 Furosemide injeksi 10 mg / ml JKN RAWAT 40 0 40 0 40

INAP
JKN RAWAT
348 Glibenklamide tablet 5mg INAP 610 0 610 0 610

349 5 0 5 0 5
12 ampul @ 1 ml INAP
350 0 0 0 0 0 500
10 x 10 tablet INAP
351 Mersibion Inj - JKN RAWAT 0 0 0 0 0

INAP
JKN RAWAT
352 Metamizol Inj - INAP 0 0 0 0 0

353 71 71 5 0 66
Injeksi INAP
354 98 0 98 0 98 50
Injeksi INAP
355 Ranitidine 25mg/2mL 2mL JKN RAWAT 496 0 496 26 0 470 100
Injeksi - INAP
JKN RAWAT
356 Seftriakson injeksi 1 g INAP 0 0 0 0 0
JKN RAWAT
357 Seftriaksone serbuk Injeksi 1 g 0 0 0 0 0
INAP
JKN RAWAT
358 Thiamfilex Kapsul 500mg 241 0 241 0 241
INAP
359 Ventolin Nebulizer - Glaxco JKN RAWAT 188 0 188 5 5 183

INAP
360 Acetylcystein 200 mg - DAK 200 0 200 450 450 -250
Alat suntik sekali pakai 0.05

365 DAK 0 0 0 0 0
ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
374 x 10 tablet DAK 0 0 0 0 0

375 DAK 20 0 20 0 20 5000
x 10 tablet
376 DAK 5 0 5 0 5
x 10 tablet
377 Amlodipin tablet 5 mg - ktk 3 DAK 3025 0 3025 875 0 2150 3000
x 10 tablet
378 Amoksisilin kaplet 500 mg DAK 2471 0 2471 0 2471 3000
mg/ 5 ml
kunyah,kombinasi :
380 Aluminium Hidroksida 200 mg DAK 0 0 0 0 0 0 5000
200 mg
381 Antasida DOEN II suspensi DAK -32 0 -32 24 0 -56 100

Antihemoroid DOEN
383 DAK 0 0 0 0 0
kombinasi
387 Asam Askorbat (Vitamin C) DAK 0 0 0 0 0
tablet 50 mg
388 tablet 50 mg DAK 600 0 600 0 600
390 100 tablet DAK 10 0 10 0 10

391 DAK 430 0 430 0 430
100 tablet
393 Tablet - DAK 0 0 0 0 0
ASEPTAN + DISPS 500ML - E-

394 care DAK 0 0 0 0 0
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 75C+JARUM 1/2 22 M R DAK 0 0 0 0 0 100
Catgut - PLAIN 3/0

404 DAK 21 0 21 0 21
70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500
412 Decacetin Tetes Mata / DAK -3 0 -3 7 0 -10
Kloramfenikol TM

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
422 Domperidon Tablet 10 mg DAK 534 0 534 60 0 474 1000
Epinefrin (Adrenalin) injeksi
424 DAK 0 0 0 0 0
0,1 % (sebagai HCl)
426 DAK 4 0 4 0 4
Onemed
Fitomenadion (Vit.K1) tablet
429 salut gula 10 mg DAK 0 0 0 0 0
431 FOLEY 16 - DAK 3 0 3 0 3 20
432 Folley 18 - DAK 22 0 22 0 22 20
435 Furosemid tablet 40 mg DAK 20 0 20 60 0 -40
438 DAK 0 0 0 0 0
mg -
439 DAK 132 0 132 20 0 112 200
steril -
440 Glukosa larutan infus 5 % DAK 1 0 1 0 1

steril - btl 500 ml
443 I.V. Catheter 18 DAK 89 0 89 9 0 80
445 I.V. Catheter 20 - DAK 0 0 0 0 0 200
447 I.V. Catheter 22 DAK 251 0 251 18 0 233
448 I.V. Catheter 24 DAK 109 0 109 12 0 97
449 IBUPROFEN 200 - DAK 0 0 0 0
450 DAK 0 0 0 0 0
ml
453 Infuset Dewasa DAK 211 0 211 34 0 177 300
Isosorbid Dinitrat tablet
457 sublingual 5 mg DAK 0 0 0 0 0
459 250 g DAK 14 0 14 0 14
460 DAK 10 0 10 0 10
250 g

10 Cm
466 Husada DAK 0 0 0 0 0 0
Kertas Puyer/Kertas roti -
468 DAK 0 0 0 0 0
lokal
471 Kloramfenikol tetes mata 0,5 DAK 0 0 0 0 0
%
472 Kloramfenikol tetes telinga 3 DAK 0 0 0 0 0 0

%
473 mg DAK 0 0 0 0 0 0
mg
475 (CHKM) - DAK 3 0 3 0 3
478 Sulfametoksazol 400 mg DAK 0 0 0 0 0 0
Trimetoprim 80 mg
479 DAK 0 0 0 0 0 2000
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 0 0 0 0 0
484 DAK 0 0 0 0 0
486 Lysol DAK 1 0 1 0 1 0
487 - 25 ml DAK 21 0 21 0 21

- 25 ml
- 25 ml
490 Metformin HCl tablet 500 mg DAK 0 0 0 0 0

- ktk 10 x 10 tablet
491 0,125 mg DAK 508 508 0 508

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1561 0 1561 60 0 1501
494 Metronidazol tablet 500 mg DAK 0 0 0 0 0 0
495 Metronidazol tablet 500 mg DAK 32 0 32 0 32 0
496 DAK 17 17 0 17 0
(Nitrat) - tube 10 gram
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 5 0 14
Natrium Diklofenak tablet 50

502 DAK 0 0 0 0 0
mg
503 Natrium Klorida larutan infus DAK 21 0 21 0 21 100

0,9 % -
504 0,9 % - DAK 33 0 33 34 0 -1

505 0,9 % - btl 500 ml DAK 25 0 25 0 25
508 Nistatin vaginal tablet 100.000 DAK 0 0 0 0 0 0
IU/ g

1%
512 Parasetamol sirup 120 DAK 0 0 0 0 0 0
mg/5ml
513 mg/5ml - DAK 0 0 0 0 0
Parasetamol tablet 500 mg -
515 ktk 10 x 10 tablet DAK 0 0 0 0
516 Perak Sulfadiazin Cream - DAK 0 0 0 0 0 10
518 Piridoksin (vitamin B6) tab 10 DAK 0 0 0 0 0
mg
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

btl 300 ml
523 btl 60 ml DAK 4 0 4 0 4

ATTAPULGITE 630MG
kapsul lunak
533 kapsul lunak DAK 0 0 0 0 0

538 Salisilat 2% + Belerang endap DAK 0 0 0 0 0 0

541 DAK 0 0 0 0 0
I-

I-

551 Stik Glucose (BENECHECK) DAK 5 0 5 5 0 0 20
552 Stik HB - DAK 6 0 6 6 0 0
558 HIV DAK 0 0 0 0 0

559 DAK 0 0 0 0 0
Injeksi (Serum Anti Tetanus)

560 DAK 0 0 0 0 0
-
561 Tiamin Hcl ( Vit B1 ) Tablet 50 DAK 0 0 0 0 0 5000

mg
564 Vit B12 - DAK 0 0 0 0 0
566 Vitamin B Kompleks tab - DAK 2440 0 2440 390 0 2050 3000
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode Jul-21

9 APBD -19 0 -19 21 0 -40
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein

tablet 50 mg
gram
17 gram APBD 17 0 17 0 17

18 APBD 0 0 0 0 0
Laboratorium -
25 Etil Klorida semprot APBD 0 0 0 2 0 -2
26 Fenobarbital tablet 30 mg APBD 1 0 1 30 0 -29
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 9 0 9 0 9 20

5 Cm
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 50 0 50 0 50
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0 50
46 Metoklopramide Injeksi 5 APBD 0 0 0 5 0 -5
mg / ml
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA

82 JKN 270 0 270 90 0 180
10 x 10 tablet

100 tablet
84 x 10 tablet JKN -129 0 -129 43 0 -172

85 JKN -51 0 -51 17 0 -68
x 10 tablet
86 Amoksisilin kaplet 500 mg JKN -758 0 -758 760 0 -1518
87 JKN 0 0 0 0 0
kunyah,kombinasi :
kunyah

suppositoria
93 JKN 3000 0 3000 0 3000 3000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN -10 0 -10 4 0 -14
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0

112 mg/ml (HCl) JKN 56 0 56 19 0 37
116 Etil Klorida Semprot JKN 0 0 0 2 0 -2
119 FOLEY 18 - JKN 2 0 2 6 0 -4
126 Glibenklamide tablet 5 mg JKN -170 0 -170 450 0 -620
128 x 10 tablet JKN 0 0 0 0 0
131 JKN 7200 0 7200 700 0 6500
Tablet
132 H2O2 3% JKN -8 0 -8 2 0 -10
133 H2O2 3% 100mL JKN 0 0 0 0 0
135 Handscoon Steril JKN 11 0 11 20 0 -9
137 JKN 48 0 48 12 0 36
tube 5 gram

tube 5 gram
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN -5 0 -5 3 0 -8
144 JKN 0 0 0 0 0
ml - btl 60 ml
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0

155 JKN 3430 0 3430 80 0 3350
ktk 10 X 10 kapsul
157 Kloramfenikol tetes mata 0,5 JKN 1 0 1 6 0 -5 30

%
158 mg JKN 0 0 0 0 0

mg
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0

166 - ktk 10 x 10 tablet JKN -300 0 -300 160 0 -460

167 mg/mL JKN 16 0 16 5 0 11
168 JKN 0 0 0 0 0
salut
salut

ktk 10 x 10 tablet
172 Metronidazol tab 500 mg JKN -95 0 -95 210 0 -305
177 MY JELLY 82 G - JKN -2 0 -2 2 0 -4
178 JKN 0 0 0 0 0

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg

IU
185 IU JKN 0 0 0 0 0

186 JKN -30 0 -30 30 0 -60
IU/ g
191 JKN 18 0 18 12 0 6
10mL
mg/5ml -
200 btl 300 ml JKN -1 0 -1 1 0 -2

201 300 ml JKN 6 0 6 0 6
ATTAPULGITE 630MG
tablet
tablet


mg
tablet

219 JKN 0 0 0 0 0
Bawah Anak

taring atas anak
228 Tourniquet JKN -4 0 -4 1 0 -5
tablet

FDC (Tenofovir
600) Tablet
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
60 tablet

Paket Kat I

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
288 mg/ml RAWAT INAP 100 0 100 0 100
PERSALINAN
JKN
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN

PERSALINAN
PERSALINAN

PERSALINAN
JKN

PERSALINAN
JKN
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

btl 30 ml
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
INAP

INAP
JKN RAWAT

INAP
JKN RAWAT
JKN RAWAT
INAP
JKN RAWAT
INAP

INAP
349 12 ampul @ 1 ml INAP 5 0 5 0 5

350 0 0 0 0 0 500
10 x 10 tablet INAP
JKN RAWAT
INAP

INAP
353 Injeksi INAP 71 71 90 0 -19

354 98 0 98 0 98 50
Injeksi INAP
355 496 0 496 26 0 470
Injeksi - INAP

INAP
INAP

INAP
JKN RAWAT
360 Acetylcystein 200 mg - DAK 200 0 200 450 450 -250

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
x 10 tablet
mg/ 5 ml

kunyah,kombinasi :
200 mg


kombinasi
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
393 DAK 0 0 0 0 0
Tablet -
care
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 DAK 166 0 166 0 166
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500
412 Kloramfenikol TM DAK -3 0 -3 7 0 -10

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
0,1 % (sebagai HCl)
426 Onemed DAK 4 0 4 0 4
salut gula 10 mg
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
435 Furosemid tablet 40 mg DAK 20 0 20 60 0 -40
mg -

steril -
440 steril - btl 500 ml DAK 1 0 1 0 1
443 I.V. Catheter 18 DAK 89 0 89 9 0 80
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 251 0 251 18 0 233
448 I.V. Catheter 24 DAK 109 0 109 12 0 97
449 IBUPROFEN 200 - DAK 0 0 0 0
ml
sublingual 5 mg
459 DAK 14 0 14 0 14
250 g

250 g

10 Cm
466 DAK -64 0 -64 16 0 -80
Husada
lokal
469 Ketokonazol krim 2% DAK -5 -5 9 0 -14
470 Kloramfenikol kapsul 250 mg DAK -40 0 -40 60 0 -100

471 % DAK 0 0 0 0 0

472 % DAK -2 0 -2 6 0 -8

473 DAK 0 0 0 0 0 0
mg

mg
475 (CHKM) - DAK 3 0 3 0 3
478 DAK -42 0 -42 190 0 -232
Trimetoprim 80 mg
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
486 Lysol DAK 1 0 1 0 1
487 DAK 21 0 21 0 21 20
- 25 ml

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0

491 DAK 508 508 0 508
0,125 mg

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1561 0 1561 60 0 1501
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19

mg
503 0,9 % - DAK 21 0 21 0 21

504 DAK 33 0 33 34 0 -1
0,9 % -
0,9 % - btl 500 ml
508 DAK -16 0 -16 9 0 -25
IU/ g

1%
510 Oksitosin inj. 10 IU/ml DAK -9 0 -9 9 0 -18 EXP
512 DAK -54 0 -54 54 0 -108
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
515 Parasetamol tablet 500 mg - DAK -2000 0 -2000 2000 0 -4000
ktk 10 x 10 tablet
518 mg DAK 0 0 0 0 0
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml

btl 60 ml

ATTAPULGITE 630MG
531 Ranitidin tablet 150 mg DAK 148 148 620 0 -472 2000
kapsul lunak
533 DAK 0 0 0 0 0
kapsul lunak


I-
542 I- DAK 0 0 0 0 0

552 Stik HB - DAK 6 0 6 0 6
558 HIV DAK 0 0 0 0 0


560 DAK 0 0 0 0 0
-

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002
Periode Feb-21

9 APBD -40 0 -40 21 0 -61
mg/ 5 ml
10 APBD 0 0 0 0 0 0
ml
Ergotamin kofein

tablet 50 mg
gram
17 gram APBD 17 0 17 0 17

18 APBD 0 0 0 0 0
Laboratorium -
25 Etil Klorida semprot APBD -2 0 -2 2 0 -4
26 Fenobarbital tablet 30 mg APBD -29 0 -29 30 0 -59
29 mg - APBD 0 0 0 0 0
30 Glukosa 40 % APBD 9 0 9 0 9 20

5 Cm
43 Lysol APBD 0 0 0 0 0
44 inj.0.200 mg-1ml APBD 50 0 50 0 50
45 inj.0.200 mg-1ml - APBD 0 0 0 0 0 50
46 Metoklopramide Injeksi 5 APBD -5 0 -5 5 0 -10
mg / ml
KESGA
55 Med APBD 0 0 0 0 0
56 APBD 0 0 0 0 0
KESGA

82 JKN 180 0 180 90 0 90
10 x 10 tablet

100 tablet
84 x 10 tablet JKN -172 0 -172 43 0 -215

85 JKN -68 0 -68 17 0 -85
x 10 tablet
86 Amoksisilin kaplet 500 mg JKN -1518 0 -1518 760 0 -2278
87 JKN 0 0 0 0 0
kunyah,kombinasi :
kunyah

suppositoria
93 JKN 3000 0 3000 0 3000 3000
250 mg
94 JKN 0 0 0 0 0
100 tablet

Tablet

97 JKN 0 0 0 0 0
mg/ml
102 blood lancet - JKN -14 0 -14 4 0 -18
104 Catgut JKN 0 0 0 0 0
105 Catgut - JKN 0 0 0 0 0
106 Cavit JKN 2 0 2 0 2
108 Corong JKN 0 0 0 0 0
109 Deksametason tablet 0,5 mg JKN 399 399 560 0 -161

112 mg/ml (HCl) JKN 37 0 37 19 0 18
114 Erythromycin 250mg Tablet - JKN 0 0 0 20 0 -20
116 Etil Klorida Semprot JKN -2 0 -2 2 0 -4
119 FOLEY 18 - JKN -4 0 -4 6 0 -10
122 Folley Chateter 16 JKN 0 0 0 3 0 -3
126 Glibenklamide tablet 5 mg JKN -620 0 -620 450 0 -1070
128 x 10 tablet JKN 0 0 0 0 0
129 Glove/Handscun JKN 900 0 900 2100 0 -1200
131 JKN 6500 0 6500 700 0 5800
Tablet
132 H2O2 3% JKN -10 0 -10 2 0 -12
133 H2O2 3% 100mL JKN 0 0 0 0 0
135 Handscoon Steril JKN -9 0 -9 20 0 -29
137 JKN 36 0 36 12 0 24
tube 5 gram

tube 5 gram
139 10 mg JKN 5 0 5 0 5
140 I.V Catheter 26 JKN -8 0 -8 3 0 -11
144 JKN 0 0 0 0 0
ml - btl 60 ml
154 ktk 10 x 10 kapsul JKN 0 0 0 0 0

155 JKN 3350 0 3350 80 0 3270
ktk 10 X 10 kapsul
157 Kloramfenikol tetes mata 0,5 JKN -5 0 -5 6 0 -11 30

%
158 mg JKN 0 0 0 0 0

mg
161 LEUKOPLAST 2,5 x 4,5 - JKN 0 0 0 0 0
30 ampul @ 2 ml
164 Mess 11 - JKN 0 0 0 0 0

166 - ktk 10 x 10 tablet JKN -460 0 -460 160 0 -620

167 mg/mL JKN 11 0 11 5 0 6
168 JKN 0 0 0 0 0
salut
salut

ktk 10 x 10 tablet
172 Metronidazol tab 500 mg JKN -305 0 -305 210 0 -515
177 MY JELLY 82 G - JKN -4 0 -4 2 0 -6
178 JKN 0 0 0 0 0

181 enterik 25 mg JKN 0 0 0 0 0

182 JKN 0 0 0 0 0
enterik 50 mg

IU
185 IU JKN 0 0 0 0 0

186 JKN -60 0 -60 30 0 -90
IU/ g
191 JKN 6 0 6 12 0 -6
10mL
mg/5ml -
200 btl 300 ml JKN -2 0 -2 1 0 -3

201 300 ml JKN 6 0 6 0 6
ATTAPULGITE 630MG
tablet
tablet


mg
tablet

219 JKN 0 0 0 0 0
Bawah Anak

taring atas anak
228 Tourniquet JKN -5 0 -5 1 0 -6
tablet

FDC (Tenofovir
600) Tablet
50mg/ml
248 Kondom - PROGRAM 1440 0 1440 0 1440
60 tablet

Paket Kat I

Efaviren -
Zidovudin 300 mg +
tablet
Zidovudin 300 mg +
tablet
284 - 10 mg RAWAT INAP 40 0 40 0 40

285 - 10 mg RAWAT INAP 15 0 15 0 15
288 mg/ml RAWAT INAP 100 0 100 0 100
PERSALINAN
JKN
JKN
293 Blood set 0 0 0 0 0
PERSALINAN
294 Folley 18 - JKN 0 0 0 0 0

PERSALINAN

PERSALINAN
PERSALINAN

PERSALINAN
JKN

PERSALINAN
JKN
JKN
301 Spuit 10 cc 102 0 102 0 102
PERSALINAN
JKN
302 Umbilical Clamp - 131 0 131 0 131
PERSALINAN

PERSALINAN
JKN

309 Alkohol 70% 1 L ALOKON 0 0 0 0 0
311 L ALOKON 0 0 0 0 0

312 ALOKON 1 0 1 0 1
L
317 Kondom ALOKON 290 0 290 0 290
318 Kondom ALOKON 824 0 824 0 824
323 Pil KB ALOKON 2320 0 2320 0 2320
324 Pil KB ALOKON 154 0 154 0 154
325 Pil KB ALOKON 390 0 390 0 390
328 btl 1000 ml ALOKON 1 0 1 0 1

btl 30 ml
331 Suntik KB ALOKON 164 0 164 0 164
332 Suntik KB ALOKON 208 0 208 0 208
333 Suntik KB - ALOKON 450 0 450 0 450
334 Suntik KB - ALOKON 1000 0 1000 0 1000
337 Susuk KB - ALOKON 58 0 58 0 58
ml INAP
INAP

INAP
JKN RAWAT

INAP
JKN RAWAT
JKN RAWAT
INAP
JKN RAWAT
INAP

INAP
349 12 ampul @ 1 ml INAP 5 0 5 0 5

350 0 0 0 0 0 500
10 x 10 tablet INAP
JKN RAWAT
INAP

INAP
353 Injeksi INAP -19 -19 90 0 -109

354 98 0 98 0 98 50
Injeksi INAP
355 470 0 470 26 0 444
Injeksi - INAP

INAP
INAP

INAP
JKN RAWAT
360 Acetylcystein 200 mg - DAK -250 0 -250 450 450 -700

ml soloshot -
366 Alkohol 70% 1 L DAK 13 0 13 0 13
367 Alkohol 95% - DAK 1 0 1 0 1
x 10 tablet
375 x 10 tablet DAK 20 0 20 0 20

x 10 tablet
x 10 tablet
mg/ 5 ml

kunyah,kombinasi :
200 mg


kombinasi
387 tablet 50 mg DAK 0 0 0 0 0

388 DAK 600 0 600 0 600
tablet 50 mg
390 100 tablet DAK 10 0 10 0 10

391 100 tablet DAK 430 0 430 0 430
393 DAK 0 0 0 0 0
Tablet -
care
396 Asiklovir 400 mg DAK 13 0 13 0 13

gram
403 DAK 166 0 166 0 166
404 Catgut - PLAIN 3/0 DAK 21 0 21 0 21

70C+JARUM 1/2 25M R
405 Cavit DAK 1 0 1 0 1
406 Cavit DAK 1 0 1 0 1
407 Clobazam 10 mg DAK 500 0 500 0 500
408 Clozapine 25 mg - DAK 500 0 500 0 500
412 Kloramfenikol TM DAK -10 0 -10 7 0 -17

414 Dermafix 10 x 25 cm DAK 3 0 3 0 3
0,1 % (sebagai HCl)
426 Onemed DAK 4 0 4 0 4
salut gula 10 mg
431 FOLEY 16 - DAK 3 0 3 0 3
432 Folley 18 - DAK 22 0 22 0 22
435 Furosemid tablet 40 mg DAK -40 0 -40 60 0 -100
437 Glimepiride tablet 2 mg DAK 80 0 80 90 0 -10
mg -

steril -
440 steril - btl 500 ml DAK 1 0 1 0 1
443 I.V. Catheter 18 DAK 80 0 80 9 0 71
445 I.V. Catheter 20 - DAK 0 0 0 0 0
447 I.V. Catheter 22 DAK 233 0 233 18 0 215
448 I.V. Catheter 24 DAK 97 0 97 12 0 85
449 IBUPROFEN 200 - DAK 0 0 0 0
ml
sublingual 5 mg
459 DAK 14 0 14 0 14
250 g

250 g
461 Kaptopril tablet 25 mg DAK 5 0 5 549 0 -544 3000

10 Cm
466 DAK -80 0 -80 16 0 -96
Husada
lokal
469 Ketokonazol krim 2% DAK -14 -14 9 0 -23
470 Kloramfenikol kapsul 250 mg DAK -100 0 -100 60 0 -160

471 % DAK 0 0 0 0 0

472 % DAK -8 0 -8 6 0 -14

473 DAK 0 0 0 0 0 0
mg

mg
475 (CHKM) - DAK 3 0 3 0 3
478 DAK -232 0 -232 190 0 -422
Trimetoprim 80 mg
Trimetoprim 80 mg
480 Leukoplast 7,5x4,5 DAK 18 0 18 0 18
486 Lysol DAK 1 0 1 0 1
487 DAK 21 0 21 0 21 20
- 25 ml

- 25 ml
489 - 25 ml DAK 0 0 0 0 0

490 - ktk 10 x 10 tablet DAK 0 0 0 0 0

491 DAK 508 508 0 508
0,125 mg

ktk 10 x 10 tablet
493 - ktk 10 x 10 tablet DAK 1501 0 1501 60 0 1441
498 My Jelly DAK 0 0 0 0 0
499 My Jelly - DAK 19 0 19 0 19

mg
503 0,9 % - DAK 21 0 21 0 21

504 DAK -1 0 -1 34 0 -35
0,9 % -
0,9 % - btl 500 ml
508 DAK -25 0 -25 9 0 -34
IU/ g

1%
510 Oksitosin inj. 10 IU/ml DAK -18 0 -18 9 0 -27 EXP
512 DAK -108 0 -108 54 0 -162
mg/5ml
513 DAK 0 0 0 0 0
mg/5ml -
515 Parasetamol tablet 500 mg - DAK -4000 0 -4000 2000 0 -6000
ktk 10 x 10 tablet
518 mg DAK 0 0 0 0 0
520 Polifix 10x5 - DAK 0 0 0 0 0
521 btl 300 ml DAK 0 0 0 0 0

522 DAK 10 0 10 0 10
btl 300 ml

btl 60 ml

ATTAPULGITE 630MG
531 Ranitidin tablet 150 mg DAK -472 -472 620 0 -1092 2000
kapsul lunak
533 DAK 0 0 0 0 0
kapsul lunak

539 Salisil Bedak 2 % DAK 2 0 2 3 0 -1

I-
542 I- DAK 0 0 0 0 0

552 Stik HB - DAK 6 0 6 0 6
558 HIV DAK 0 0 0 0 0


560 DAK 0 0 0 0 0
-

mg
564 Vit B12 - DAK 0 0 0 0 0
Yang
menyerahkan
NIP. 196702041990021001 NIP. NIP. 196902272002121006 NIP. 198305252021212005
1967012220090
11002

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547 Siprofloksasin tablet 500 mg DAK 0 0 0 0 0

548 Siprofloksasin tablet 500 mg DAK 551 0 551 210 0 341

559 Tetagam 250UI/mL 1mL DAK 0 0 0 0 0

560 Tetrasiklin HCl kapsul 250 mg DAK 0 0 0 0 0

2 Alat Suntik sekali pakai - 1 ml APBD 0 0 0 0 0 0

13 Asam Askorbat (Vitamin C) APBD 0 0 0 0 0

Blood Glucose Test Strip 50' -

40 Kasa pembalut Hidrofil 4 M x APBD 0 0 0 0 0

78 Alat Suntik sekali pakai - 3 ml JKN 522 0 522 370 0 152

79 Alat Suntik sekali pakai - 5 ml JKN 142 0 142 219 -77

83 Aminofilin tablet 200 mg - btl JKN 0 0 0 0 0 200

Amlodipin tablet 5 mg - ktk 3

90 antihemoroid, kombinasi : JKN 0 0 0 0 0

95 Asam Mefenamat 500mg JKN 11049 0 11049 980 0 10069

96 asam mefenamat kapl 500 mg JKN 0 0 0 0 0

Asam traneksamat injeksi 50

Difenhidramin injeksi i.m. 10

138 Hidrokortison krim 2,5 % - JKN 94 0 94 0 94

Kloramfenikol kapsul 250 mg -

157 Kloramfenikol tetes mata 0,5 JKN 25 0 25 6 0 19 30

159 Klorfeniramin Maleat tab 4 JKN 0 0 0 0 0

Metformin HCl tablet 500 mg

metilergometrin cairan inj 0,2

170 Metilprednisolon tablet 4 mg - JKN 0 0 0 0 0

180 Natrium Diklofenak tab 50 mg JKN 0 0 0 0 0

natrium diklofenak tab sal

natrium diklofenak tab sal

183 nistatin tab vaginal 100.000 IU JKN 0 0 0 0 0

184 Nistatin tablet salut 500.000 JKN 0 0 0 0 0 200

Nistatin vaginal tablet 100.000

Povidon Iodida larutan 10%

Salep 2-4 , Kombinasi: Asam

208 Salisil Bedak 2 % - ktk 50 gram JKN 0 0 0 0 0

209 Simvastatin tab sal selaput 10 JKN 1220 0 1220 90 0 1130

Tang Pencabut Gigi Geraham

220 Tang pencabut gigi seri dan JKN 0 0 0 0 0

234 Antimalaria DOEN kombinasi PROGRAM 0 0 0 0 0

257 Obat Anti Tuberculosis FDC PROGRAM 3 0 3 0 3

271 Tenofovir (TDF) 300mg Tablet PROGRAM 270 0 270 0 270

272 Tenofovir + Lamivudin + PROGRAM 30 0 30 0 30

Hyosin N Butilbromide injeksi

286 Karbozokrom injeksi 10mg/ml RAWAT INAP 0 0 0 0 0

287 Karbozokrom injeksi 10mg/ml RAWAT INAP 200 0 200 0 200

294 Folley 18 - JKN 0 0 0 0 0

295 Gelang Identitas Pasien JKN 131 0 131 0 131

297 Handscoon Panjang siku - JKN 99 0 99 0 99

299 Mucus Extractor - JKN 131 0 131 0 131

303 Underpad steril - JKN 82 0 82 0 82

305 Alat Suntik sekali pakai - 3 ml ALOKON 46 0 46 0 46

306 Alat Suntik sekali pakai - 3 ml ALOKON 142 0 142 0 142

307 Alat Suntik sekali pakai - 3 ml ALOKON 57 0 57 0 57

308 Alat Suntik sekali pakai - 3 ml ALOKON 1140 0 1140 0 1140

Desinfektan (klorin 5,25%) -1

329 Povidon Iodida larutan 10% - ALOKON 5 0 5 0 5

342 Citicholin inj JKN RAWAT 0 0 0 0 0

344 Furamin Injeksi JKN RAWAT 0 0 0 0 0

348 Glibenklamide tablet 5mg JKN RAWAT 1220 0 1220 0 1220

Loperamid tablet 2 mg - ktk JKN RAWAT

352 Metamizol Inj - JKN RAWAT 0 0 0 0 0

Piracetam 1 gr/5 mL 5 mL JKN RAWAT

356 Seftriakson injeksi 1 g JKN RAWAT 0 0 0 0 0

358 Thiamfilex Kapsul 500mg JKN RAWAT 241 0 241 0 241

362 Alat Suntik sekali pakai - 3 ml DAK 2523 0 2523 0 2523