So Obat Apbd April 2022

LAPORAN STOK AKHIR OBAT BULAN MARET TAHUN 2022
UPT PKM CILEDUG

JL. Raden Patah
NO. NAMA BARANG SATUAN HARGA SATUAN STOK AWAL MARET PENERIMAAN MARET PEMAKAIAN MARET
PUSTU PONED UGD RAWAT APOTEK GUDANG TOTAL STOK PUSTU PONED UGD RAWAT APOTEK GUDANG TOTAL PUSTU PONED
INAP AWAL INAP PENERIMAAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Obat
1 Alopurinol tablet 100 mg Tablet 87.00 0 0 - -
2 Ambroksol Syrup Botol 5,500.00 0 0 - -
3 Ambroksol tablet 30 mg Tablet 190.00 0 0 - -
4 Aminofillin tablet 150 mg Tablet - 0 0 - -
5 Aminofillin tablet 200 mg Tablet 113.30 0 0 - -
6 Amlodipin 10 mg Tablet 70.00 5000 0 5,000.00 -
7 Amlodipin tablet 5 mg Tablet 53.00 0 0 - 2100.00 5100.00 7,200.00
8 Amoksilin kaplet 500 mg Kaplet 330.00 0 0 - -
9 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 2,800.00 30 0 30.00 -
10 Amoksilin sirup kering 250 mg/ 5 ml - 60 ml Botol 3,498.00 3 50 53.00 10.00 10.00
11 Antasida DOEN I tablet kunyah, kombinasi : Tablet 58.00 0 0 - -
Aluminium Hidroksida 200 mg + Magnesium
Hidroksida 200 mg
12 Antasida DOEN II suspensi, kombinasi : Botol 1,679.00 55 200 255.00 -
Aluminium Hidroksida 200 mg /5 ml +
Magnesium Hidroksida 200 mg /5 ml - 60 ml
13 Anti Bakteri DOEN salep kombinasi : Tube 3,035.00 0 0 - -

Basitrasin 500 IU/g + Polimiksin 10.000 IU/g
14 Anti Hemmoroid Kapsul : Ekstrak Graptophylli Kapsul 1,518.00 0 0 - -

Folium 80% + Citrus Bioflavonoid 20% /
HAEMOROGARD
15 Anti Hemmoroid Suppositoria DOEN Supp 3,250.00 0 60 60.00 -
kombinasi : Bismut subgalat 150 mg +
Heksaklorofen 2,5 mg
16 Anti Tetanus Serum ( ATS ) 1500 IU Ampul 130,999.00 0 0 - -
17 Antibiotik Topikal Jelly ( Neomycin Sulfate Tube - 0 0 - -
0,5% + Placenta Ekstrak 10 %) - 15 gr /
BIOPLACENTON
18 Antidiare suspensi (Kaolin 700 mg + Pectin Botol - 0 0 - -
66 mg) - 60 ml / NEO KAOMINAL
19 Antidiare tablet (Kaolin 550 mg + Pectin 20 Tablet - 0 0 - -
mg ) / NEO DIAFORM
20 Antifungi DOEN kombinasi As. Benzoat 6% + Pot 4,798.00 0 0 - -
As. Salisilat 3% - 30 gr / WHITEFIELD
21 Antiinfeksi Topikal dengan Kortikosteroid Krim Tube 8,030.00 0 0 - -
/ KLORFESON / COLIPRED
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
22 Antimigren : Ergotamin Tartrat 1 mg + Kofein Tablet 185.00 0 0 - -
50 mg
23 Antiseptik & kortikosteroid Tetes mata Botol - 0 0 - -
(Neomycin 3,5 mg, Polymixin B Sulfat 10.000
IU, Dexamethason 1,0 mg) - 5 ml / CENDO
XITROL EYE DROPS
24 Aqua pro injeksi steril, bebas pirogen 20 ml Vial - 0 0 - -
25 Aqua pro injeksi steril, bebas pirogen 25 ml Vial 2,650.00 0 10 10.00 -
26 Artesunate Injeksi 500 ml / 5 ml Ampul 39,000.00 0 0 - -
27 Asam Asetilsalisilat tablet 80 mg / Tablet 89.00 0 200 200.00 -
ASPIMEC/MINIASPI
28 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 42.00 600 1000 1,600.00 -
29 Asam Mefenamat kaplet 500 mg Kaplet 195.00 0 0 - -
30 Asering infus Botol 8,800.00 0 0 - -
31 Asiklovir krim 5 % -5 gr Tube 3,500.00 18 50 68.00 25.00 25.00
32 Asiklovir tablet 400 mg Tablet 407.00 0 0 - -
33 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) Ampul 1,639.00 0 0 - -
- 1 ml
34 Attapulgit Tablet 630 mg / PULAREX / NEW Tablet 145.00 0 0 - -
ANTIDES
35 Besi II Sulfat 180 mg + Asam Folat 400 mcg Tablet 226.00 799 11200 11,999.00 3000.00 3,000.00
(tablet tambah darah kombinasi)
36 Besi II Sulfat 200 mg + Asam Folat 0,25 mg Tablet - 0 0 - -
(tablet tambah darah kombinasi)
37 Betahistin Mesilat tablet 6 mg Tablet 88.00 405 900 1,305.00 -
38 Betametason Krim 0.1 % (sebagai valerat) - 5 Tube 1,430.00 0 0 - -
gr
39 Bisacodyl 5 mg / BICOLAX Tablet 319.00 0 0 - -
40 Bisoprolol tablet 2,5 mg / CONCOR Tablet 626.00 0 0 - -
41 Bisoprolol tablet 5 mg Tablet 137.00 30 150 180.00 -
42 Borax Gliserin (GOM) 10 % - 8 mL Botol 3,500.00 0 72 72.00 24.00 24.00
43 Bromheksin larutan 2mg/ml (untuk Nebulizer) Botol 84,920.00 0 1 1.00 -
- 50 ml / BISOLVON
44 Bromheksin tablet 8 mg Tablet 165.00 0 0 - -
45 Bromheksin tablet 8 mg (MOSAVON) Tablet - 0 0 - -
46 Buscopan Inj Ampul 37,700.00 0 0 - -
47 Ceftriaxone Serbuk Injeksi 1000 mg Vial 4,708.00 0 0 - -
48 Cetirizine 10 mg Tablet 90.00 0 0 - -
49 Cetirizine Sirup Botol 2,090.00 0 0 - -
50 Dehydro Artemisin 40 mg + Piperaquin 320 Tablet 1,900.00 0 0 - -
mg ( DHP )
51 Deksametason injeksi 5 mg/ml-1ml Ampul 924.00 0 20 20.00 -
52 Deksametason tablet 0,5 mg Tablet 99.00 0 5000 5,000.00 -
53 Dekstrometorfan tablet 15 mg (HBr) Tablet - 0 0 - -
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
54 Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml Botol - 0 0 - -
55 Difenhidramin injeksi 10 mg/ml / ETADRYL Ampul 781.00 0 2 2.00 -

56 Digoksin tablet 0,25 mg Tablet 104.00 0 0 - -
57 Doksisiklin kapsul 100 mg Kapsul 275.00 0 0 - -
58 Domperidon tablet 10 mg Tablet 71.00 183 1300 1,483.00 200.00 200.00
59 Efedrin tablet 25 mg (HCl) Tablet 160.00 0 0 - -
60 Epinefrin ( Adrenalin ) injeksi 0,1 % (sebagai Ampul 1,515.00 0 5 5.00 -
HCl) - 1 ml
61 Eritromisin kapsul 500 mg Kapsul 770.00 0 0 - -
62 Eritromisin sirup 200 mg 5 /ml - 60 ml Botol 6,462.00 0 0 - -
63 Fenol Gliserol tetes telinga 10 % - 5 ml Botol 3,300.00 0 0 - -
64 Fitomenadion(Vit. K1) tablet salut gula 10 mg Tablet 748.00 125 100 225.00 -
65 Furosemid tablet 40 mg Tablet 82.00 0 0 - -

66 Furosemide Injeksi 10 mg/ml Ampul 1,333.00 0 0 - -
67 Garam Oralit I serbuk, kombinasi : Natrium Sachet 295.00 25 300 325.00 150.00 150.00
0,52 g, Kalium klorida 0,30 g , Trinatrium sitrat
dihidrat 0,58 g, Glukosa anhidrat 2,7 g
68 Gemfibrozil 300 mg kapsul Kapsul 300.00 0 200 200.00 -
69 Gentamycin salep kulit 0,1% - 5 gr Tube 3,410.00 0 0 - -
70 Glibenklamid tablet 5 mg Tablet 82.00 0 0 - -
71 Gliseril Guaiakolat tablet 100 mg Tablet 250.00 0 0 - -
72 Glucose Larutan Infus 10% Steril Kolf 7,200.00 0 2 2.00 -
73 Glucose Larutan Infus 5% steril - 500 ml Kolf 6,627.00 0 2 2.00 -
74 Griseofulvin tablet 125 mg Tablet 210.00 0 300 300.00 -
75 Hidroklortiazid (HCT) tablet 25 mg Tablet 155.00 0 0 - -
76 Hidrokortison krim 2,5 % - 5 gr Tube 2,475.00 0 0 - -
77 Hyoscine - N - Butilbromide tablet 10 mg / Tablet 1,050.00 0 0 - -
SCOPMA/SCOPAMIN
78 Ibuprofen tablet 400 mg Tablet 245.00 0 0 - -
79 Ichtyol salep kulit - 15 gr Pot 6,200.00 0 24 24.00 -
80 Isosorbid dinitrat ( ISDN ) Injeksi 1 mg/ml Ampul 22,297.00 0 0 - -
81 Isosorbid dinitrat (ISDN) tablet sublingual 5 Tablet 86.00 0 0 - -
mg
82 Kalium Diklofenak tablet 50 mg Tablet - 0 0 - -
83 Kalium permanganat (PK) serbuk - 5 gr Pot - 0 0 - -
84 Kalsium Gluconat inj 100 mg/ml Ampul 10,351.00 0 0 - -
85 Kalsium laktat (Kalk) tablet 500 mg Tablet 60.00 400 4000 4,400.00 2400.00 2,400.00
86 Kaptopril tablet 25 mg Tablet 175.00 0 0 - -
87 Ketokonazol tablet 200 mg Tablet 288.00 225 750 975.00 -
88 Klindamisin kapsul 300 mg Kapsul 1,500.00 0 200 200.00 200.00 200.00
89 Kloramfenikol kapsul 250 mg Kapsul - 0 0 - -
3
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
90 Kloramfenikol salep mata 1% - 5 gr Tube 2,007.00 0 24 24.00 11.00 31.00 42.00
91 Kloramfenikol suspensi 125 mg/5ml - 60 ml Botol 5,015.00 0 0 - -
92 Kloramfenikol Tetes Mata 0,5 % - 5 mL / Botol 8,250.00 0 0 - -
RECO
93 Kloramfenikol Tetes Telinga 3 % - 5 mL Botol 8,200.00 0 0 - -
94 Klorfeniramin maleat (CTM) tablet 4 mg Tablet 23.00 0 0 - -
95 Kotrimoksazol DOEN I (dewasa) kombinasi : Tablet 133.00 0 200 200.00 -
Sulfametoksazol 400 mg + Trimetoprim 80 mg
96 Kotrimoksazol DOEN II (pedriatik) kombinasi : Tablet - 0 0 - -

Sulfametoksazol 100 mg + Trimetoprim 20 mg
97 Kotrimoksazol Suspensi kombinasi : Botol 2,190.00 0 0 - -

Sulfametoksazol 200 mg + Trimetoprim 40
mg/ 5 ml - 60 ml
98 Kuinin (Kina ) tab. 200 mg Tablet - 0 0 - -
99 Levertran salep - 15 gr Pot 4,500.00 0 48 48.00 -
100 Lidokain comp injeksi (Lidocain 2% (HCl) + Ampul 1,229.00 0 30 30.00 -
Epinefrin 1 : 80.000) - 2 ml
101 Lidokain injeksi 2% - 2 ml Ampul 1,140.00 0 0 - -
102 Lidokain Spray Oral 10 % / Xylocaine Spray Botol 177,216.00 0 0 - -
103 Linkomisin kapsul 500 mg Kapsul - 0 0 - -

104 Loperamid tablet 2 mg Tablet 77.00 0 0 - 200.00 200.00
105 Loratadin tablet 10 mg Tablet 131.00 0 0 - -
106 Lytacur syrup Botol - 0 0 - -
107 Mebendazol tablet 100 mg Tablet - 0 0 - -
108 Metampiron (Antalgin) tablet 500 mg Tablet 350.00 200 0 200.00 400.00 1000.00 1,400.00
109 Metformin HCl tablet 500 mg Tablet 77.00 0 0 - -
110 Methyl Prednisolone 4 mg Tablet 102.00 100 200 300.00 200.00 100.00 300.00
111 Metilergometrin Maleat (Metilergometrin) Tablet 224.00 0 0 - -
tablet salut 0,125 mg
112 Metoklopramid injeksi / PRIMPERAN Ampul - 0 0 - -
113 Metoklopramid tablet 10 mg / METOLON Tablet 85.00 0 0 - -
114 Metronidazol tablet 500 mg Tablet 133.00 0 0 - -
115 Mikonazol krim/ salep 2 % (Nitrat) - 10 gr Tube 3,414.00 1 72 73.00 24.00 24.00
116 Minyak Kayu Putih 210 ml Botol - 0 0 - -
117 Multivit Sirup - 60 ml / Botol 13,200.00 0 75 75.00 -
SUPRALYSIN/LYSMIN/BIOVITAN
118 Multivit Tablet / PEHAVRAL Tablet 935.00 0 0 - -
119 N-Asetil sistein 200 mg Tablet 850.00 0 0 - 180.00 540.00 720.00
120 Natrium Bikarbonat tablet 500 mg Tablet - 0 0 - -
121 Natrium Diklofenak tablet 50 mg Tablet 123.00 0 0 - -
4
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
122 Natrium Klorida larutan 0,9%, 25 ml (untuk Botol 4,700.00 0 0 - -
Nebulizer)
123 Natrium Klorida larutan infus 0,9% - 500 ml Kolf 6,800.00 0 9 9.00 -
124 Nifedipin tablet 10 mg Tablet 231.00 23 200 223.00 -
125 Nistatin tablet salut 500.000 IU/g Tablet 843.00 0 0 - -
126 Nistatin tablet salut 500.000 IU/g Tablet - 0 0 - -
127 Nistatin vaginal tablet 100.000 IU/g Tablet 598.00 0 0 - -
128 Obat Analgetik (Antalgin 250 mg ; Amidopyrin Vial - 0 0 - -
50 mg ; Lidocain HCl 10 mg ) / ETAMIDON
INJEKSI
129 Obat Analgetik - antipiretik - batuk kaplet Kaplet - 0 0 - -
(Paracetamol 500 mg, Dextromethorphan HBr
15 mg, Phenylpropanolamine HCL 12,5 mg,
Chlorpeniramine Maleat 2 mg, ) / ALPARA
KAPLET
130 Obat Analgetik - vitamin B kompleks kaplet Tablet - 0 0 - -
(Parasetamol 500 mg, Vitamin B6 100 mg,
Vitamin B1 50 mg, Vitamin B12 100 mcg) /
ERLAGIN
131 Obat Analgetik kombinasi dengan Psikotropik Tablet - 0 0 - -
kaplet (Metampiron 500 mg, Diazepam 2 mg)
/ METANEURON
132 Obat Antiinfluenza kaplet ( Paracetamol 500 Kaplet - 0 0 - -
mg. Phenylpropanolamin HCl 12,5 mg+
Chlorpheniramin Maleat 2 mg ) /
MOLEXFLU KAPLET
133 Obat Antiinfluenza syrup ( Parasetamol 125 Botol - 0 0 - -
mg, Phenylprophanolamine HCl 3.125 mg,
Chlorpheniramine Maleate 0.5 mg ) - 60 ml /
MOLEXFLU SYRUP
134 Obat Antitusif - ekspektorant sirup Botol - 0 0 - -
( Diphenhydramin HCl 12,5 mg+ Ammonium
Chlorida 125 mg+ Sodium Citrat 50 mg+
Menthol 1 mg ) - 60 ml / MOLEXDRYL
SYRUP
135 Obat batuk Hitam (OBH) Cairan -100 ml non Botol 6,500.00 0 72 72.00 72.00 72.00
Alkohol
136 Obat Dekongestan, antiinfluenza tablet Tablet - 0 0 - -
(Tripolidin HCL 2,5 mg, Pseudoefedrin HCL
30 mg) / FLUTROP
137 Obat Neuramialgikum tablet (Vit.B1 100 mg, Tablet - 0 0 - -
Vit.B6 200 mg, Vit.B12 250 mcg ) /
NUTRIFAR
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
138 Obat Pencernaan tablet (Diastase 200 mg, Tablet 550.00 0 0 - -
Pankreatin 100 mg) / LYBROZYM
139 Obat Preparat Flebitis dan Varises ( Heparin Tube - 0 0 - -
20.000 IU ) - 20 gr / THROMBOPHOP GEL
140 Obat spasmodikum tablet (Metampiron 500 Tablet - 0 0 - -

mg, Ekstrak Belladona 10 mg, Papaverin HCl
25 mg) / SPASMINAL
141 Obat Tetes mata kombinasi antiseptik & Botol - 0 0 - -
kortikosteroid (Dexamethason Sod.Phosfate
1,0 mg, Neomycin Sulphate setara Neomycin
base 3,5 mg, Polymixin B Sulfat 6000 IU) - 5
ml / ALETROL
142 Obat Vasokonstriktor dan antihistamin tablet ( Tablet - 0 0 - -
Phenylpropanolamin HCl 15 mg+
Chlorpheniramin Maleat 2 mg ) /
NALGESTAN
143 Oksitetrasiklin HCl salep kulit 3 % - 5 gr Tube - 0 0 - -
144 Oksitetrasiklin HCl salep mata 1 % - 5 gr Tube - 0 0 - -
145 Omeprazol kapsul 20 mg Kapsul 129.00 147 0 147.00 -
146 Omeprazole Injeksi Vial 5,093.00 0 0 - 5.00 5.00 10.00
147 Ondansentron 4 mg Tablet - 0 0 - -
148 Ondansentron Injeksi 2 mg/ml Ampul 873.00 0 5 5.00 -
149 Papaverin tablet 40 mg Tablet - 0 0 - -
150 Parasetamol drops 15 ml Botol 4,976.00 0 96 96.00 96.00 96.00
151 Parasetamol sirup 120 mg / 5ml - 60 ml Botol 1,181.00 0 100 100.00 200.00 200.00 400.00
152 Parasetamol Suppos 80 mg Suppositoria 6,000.00 0 0 - -
153 Parasetamol tablet 500 mg Tablet 135.00 0 0 - -
154 Parasetamol tablet 100 mg Tablet - 0 0 - -
155 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 131.00 0 0 - -
156 Piroksikam tablet 10 mg Tablet 107.80 505 2700 3,205.00 500.00 500.00
157 Polikresulen (kondensasi) 10 ml / APTIL Botol - 0 0 - -
158 Povidon Iodida larutan 10 % - 300 ml Botol 21,010.00 0 0 - -
159 Povidon Iodida larutan 10 % - 60 ml Botol - 0 0 - -
160 Prednison tablet 5 mg Tablet 73.00 0 0 - -
161 Propanolol tablet 10 mg (HCl) Tablet 56.00 0 0 - -
162 Propiltiourasil tablet 100 mg Tablet 385.00 0 0 - -
163 Pulmicort Respules 0,5 mg/ml / Budesonide Respules 14,267.00 0 10 10.00 -
164 Ranitidin injeksi 25 mg/ml Ampul 814.00 0 0 - -
165 Ranitidin tablet 150 mg Tablet 85.00 220 800 1,020.00 -
166 Ringer Laktat larutan infus - 500 ml Kolf 7,630.00 0 0 - -
167 Saccaharine Tablet Tablet - 0 0 - -
168 Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Botol 12,540.00 0 15 15.00 -
VENTOLIN
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
169 Salbutamol tablet 2 mg (sebagai sulfat) Tablet 48.00 0 0 - -
170 Salbutamol tablet 4 mg Tablet - 0 0 - -
171 Salep 2-4 kombinasi : Asam Salisilat 2 % + Pot 2,333.00 24 72 96.00 -
Belerang endap 4 % - 30 gr
172 Salep kulit analgetika (Metil salilsilat 11%, Tube - 0 0 - -
Mentol 6%, Eugenol 1,5%) - 30 gr /
PAINKILLA
173 Salep kulit kombinasi antiinfeksi dgn Tube - 0 0 - -
kortikosteroid (Betamethasone 1 mg,
Neomycin sulfat 5 mg) - 5 gr / BEVALEX
174 Salisil Bedak 2 % - 50 gr Kotak 3,300.00 0 0 - -
175 Scabimite Krim / Permetrin Krim 5% ( Anti Tube 11,466.00 0 8 8.00 13.00 5.00 18.00
Scabies )
176 Sefadroksil Kapsul 500 mg Kapsul 575.00 0 0 - -
177 Serum Anti Bisa Ular Injeksi 5 ml Vial 512,204.00 0 0 - -
178 Sianokobalamin (vitamin B12) tablet 50 mcg Tablet 43.00 0 0 - -
179 Simvastatin tablet 10 mg Tablet 117.00 0 0 - -
180 Simvastatin tablet 20 mg Tablet 150.00 350 4500 4,850.00 1250.00 1,250.00
181 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 248.00 63 600 663.00 200.00 200.00
182 Sulfadiazine Perak 1% Tube 20,700.00 2 14 16.00 -
183 Sulfasetamida Natrium tetes mata 15 % - 5 Botol - 0 0 - -
ml
184 Tetrasiklin Kapsul 250 mg Kapsul - 0 0 - -
185 Tetrasiklin kapsul 500 mg Kapsul - 0 0 - -
186 Thiamfenikol kapsul 500 mg Kapsul 900.00 58 100 158.00 -
187 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet 91.00 0 0 - -
188 Tramadol Injeksi 50 mg/ml Ampul 1,764.00 0 0 - -

189 Vitamin B Komplek dengan Vit. C dosis tinggi Tablet 1,407.66 0 0 - -
Kaplet (Vit. B1 15 mg, Vit. B2 10 mg, Vit. B6 5
mg, Vit. B12 100 mcg, Vit. C 500 mg, Vit. E
30 mg, Ca. Pantothenate 20 mg,
Nikotinamide 50 mg) / BECEFORT
190 Vitamin B Kompleks tablet Tablet 118.00 0 0 - -
191 Zinc Sirup Botol 2,489.00 0 72 72.00 -
192 Zinc tablet 20 mg Tablet 208.00 0 0 - -
Obat Program TB Paru 0 0 - -
193 Isoniazid (INH) Profilaksis 100 mg Tablet 231.00 0 0 - -
194 OAT Kombipak Paket 317,018.00 0 0 - -
195 Obat FDC Kategori 1 Paket 415,467.00 0 0 - -
196 Obat FDC Kategori 2 Paket 1,384,977.00 0 0 - 15.00 15.00 30.00
197 Obat FDC Anak Paket 248,120.00 0 0 - 10.00 10.00 20.00
198 Obat FDC Sisipan Paket - 0 0 - -
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
199 Piridoksin (Vitamin B6) Tablet 25 mg (Prog Tablet 222.00 0 0 - -
TB Paru)
200 Tuberculin PPD RT 23 SSI Vial 625,800.00 0 5 5.00 5.00 5.00
Obat Program IMS 0 0 - -
201 Benzatin Penicilin 2,4 Jt Vial 14,500.00 0 0 - -
202 Flukonazole 150 Mg Tablet - 0 0 - -
203 Kanamisin injeksi 1 gr Vial - 0 0 - -
204 Kombipak IMS Paket 312,310.00 0 0 - -
205 Levofloksasin tablet 500 mg Tablet 734.16 0 0 - -
206 Pyrimethamine 25 Mg Tablet - 0 0 - -
207 Sefiksim kapsul 100 mg Kapsul 387.00 0 0 - 100.00 500.00 600.00
Obat Program Filariasis 0 0 - -
208 Dietilkarbamazin Sitrat tablet 100 mg Tablet - 0 0 - -
Obat Program Kecacingan 0 0 - -
209 Albendazole Suspensi Botol 4,000.00 0 0 - -
210 Albendazole tablet 400 mg Tablet 380.00 0 0 - -
211 Pirantel tablet score (base) 125 mg Tablet 287.00 0 0 - -
Obat Program Gizi 0 0 - -
212 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 306.00 0 0 - -
213 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 552.00 0 0 - -
Obat Kejiwaan 0 0 - -
214 Alprazolam tablet 1 mg Tablet 120.00 0 0 - -
215 Amitriptilin tablet salut 25 mg (HCl) Tablet 167.00 33 200 233.00 -
216 Clobazam tablet 10 mg Tablet 384.00 0 0 - -
217 Diazepam injeksi 5 mg /ml - 2 ml Ampul 1,735.00 2 0 2.00 -
218 Diazepam tablet 2 mg Tablet 86.00 69 0 69.00 -
219 Diazepam tablet 5 mg Tablet - 0 0 - -
220 Diazepam tube Rectal 5 mg/ml / STESOLID Tube 12,573.00 3 0 3.00 -
221 Fenitoin Kapsul 100 mg Kapsul 595.00 0 0 - -
222 Fenobarbital tablet 30 mg Tablet 182.00 0 0 - -
223 Fluoxetin tablet 10 mg Kotak 2,420.00 0 0 - -
/ANTIPRESTIN/FORANSI
224 Fluoxetin tablet 20 mg / PRESTIN Tablet 250.00 0 0 - -
225 Haloperidol Inj 5 mg/ml Ampul 7,250.00 0 3 3.00 -
226 Haloperidol Decanoat 50mg/mL Ampul 97,500.00 0 0 - -
227 Haloperidol tablet 1,5 mg Tablet 59.00 230 500 730.00 -
228 Haloperidol tablet 5 mg Tablet 60.00 0 0 - -
229 Imipramin tablet 25 mg / TOFRANIL Tablet - 0 0 - -
230 Karbamazepin tablet 200 mg Tablet 245.00 0 0 - -
231 Klorpromazin 25 mg Tablet - 0 0 - -
232 Klorpromazin tablet salut 100 mg (HCl) Tablet 157.00 122 500 622.00 100.00 100.00
233 Kodein tablet 10 mg Tablet 571.00 0 0 - -
234 Risperidon tablet 2 mg Tablet 123.00 500 1000 1,500.00 500.00 500.00
235 Sertralin tablet / NUDEP Tablet 2,600.00 0 0 - -
8
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
236 Sikzonoat Inj 25 mg/ml Ampul 63,813.00 0 0 - -
237 Triheksifenidil tablet 2 mg Tablet 63.00 262 1500 1,762.00 1000.00 1,000.00
Obat Gigi 0 0 - -
238 Artikulating Paper Buku 15,500.00 0 0 - -
239 Bur Arkansas High Speed Buah 29,950.00 0 0 - -
240 Bur Diamod High Speed PAK 198,000.00 0 1 1.00 -
241 Bur High Speed Kotak 200,000.00 0 0 - -
242 Bur Low Speed Kotak 235,000.00 0 0 - -
243 Cavit Pot 109,714.00 0 0 - -
244 Celluloid strip SET 93,500.00 0 1 1.00 -
245 CHKM Botol 65,000.00 0 0 - -
246 Cresopen Botol 160,500.00 0 1 1.00 -
247 Dentin Conditioner Botol 130,000.00 0 0 - -
248 Devitalisasi Pasta (Non Arsen) Btl / ktk 710,320.00 0 0 - -
249 Disclosing Agent Tube - 0 0 - -
250 Disposible saliva ejektor PAK 87,000.00 0 2 2.00 -
251 ENDO-FROST/Propane/Butane/Cek Vitalitas Botol 139,150.00 0 0 - -
Gigi
252 Etil Chlorida spray - 100 ml Botol - 0 0 - -
253 Eugenol cairan - 15 ml Botol 20,087.00 0 0 - -
254 Formokresol 25 g Botol 300,000.00 0 0 - -
255 Glass Ionomer Cement ART (GCIX) / FUJI IX SET 560,000.00 0 0 - -
256 Glass Ionomer Radiopak / FUJI VII SET 690,000.00 0 0 - -

257 Kalsium Hidroksida pasta / CALCIDOR / SET 133,000.00 0 1 1.00 -
DYCAL
258 Macro gold + propylen + EDTA SET 388,791.00 0 0 - -
259 Mummifying Pasta / Iodoform Btl / ktk 64,000.00 0 0 - -
260 Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 Ampul - 0 0 - -
ml + Adrenalin 12.5 mcg ) / PEHACAIN
261 Oil Spray 170 ml Botol 372,000.00 0 0 - -
262 Oil Spray 500 ml Botol - 0 0 - -
263 Pulperyl 13 ml Botol 195,000.00 0 0 - -
264 Semen Seng Fosfat (Powder 30 gr, Liquid 10 SET - 0 0 - -
ml)
265 Spon Gelatin Cubicels / Spongostan/ PCS - 0 0 - -
Haemospon
266 Temporary Stopping Fletcher Serbuk Pot 32,000.00 0 1 1.00 -
(Powder)
267 Tetric Bonding 6 gr Botol 260,925.00 0 0 - -
268 Tetric N Ceram / Tambalan Sinar (4 syringe, Paket 1,720,393.00 0 0 - -
etching, bonding)
269 Tetric N Ceram Refill (A2, A3, A3,5) Tube 260,925.00 0 0 - -
270 Tooth Mouse (CPPACP) Tube 225,000.00 0 0 - -
9
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
271 Total Etch Refill 2 gr Tube 120,227.00 0 0 - -
272 Trikresol Formalin (TKF) 3/10ml 72,000.00 0 0 - -
273 Xylestesin Adrenalin inj / SCANDONEST Ampul - 0 0 - -
274 Xylestesin Non Adrenalin inj Ampul - 0 0 - -
Perbekalan Kesehatan 0 0 - -
275 Alat Suntik Sekali Pakai 0,05 ml PCS 1,550.00 0 0 - -
276 Alat Suntik Sekali Pakai 0,5 ml PCS 1,185.00 0 0 - 1840.00 2200.00 4,040.00
277 Alat Suntik Sekali Pakai 1 ml PCS 1,361.00 0 0 - -
278 Alat Suntik sekali pakai 10 ml PCS 1,100.00 0 0 - -
279 Alat Suntik sekali pakai 20 ml PCS 10,000.00 0 35 35.00 -
280 Alat Suntik Sekali Pakai 3 ml PCS 818.00 0 0 - -
281 Alat Suntik sekali pakai 5 ml PCS 1,583.00 0 0 - -
282 Alat Suntik sekali pakai 50 ml (Tanpa Jarum) PCS 3,900.00 0 5 5.00 -
283 Alkohol Swab (BMHP) PCS 95.00 0 0 - 1840.00 2200.00 4,040.00

284 Benang Bedah Catgut Chromic 2/0 -100 m Cassete - 0 0 - -
285 Benang Bedah Catgut Chromic No. 2/0 HRG- Sachet - 0 0 - -
38,90 cm ( Jarum Tapper 0 )
286 Benang Bedah Catgut Chromic No. 3/0 HRG- Sachet - 0 0 - -
38,90 cm ( Jarum Tapper 0 )
287 Benang Bedah Catgut Chromic No.2/0 HR PCS 36,500.00 0 0 - -
27,75 cm (Jarum Tapper 0)
288 Benang Bedah Catgut Chromic No.3/0 HR PCS 34,004.00 0 0 - -
27,75 cm (Jarum Tapper 0)
289 Benang Bedah Catgut No. 2/0 - 3/0 dengan PCS - 0 0 - -
jarum bedah
290 Benang Bedah Catgut Plain 3/0 -100 m Cassete - 0 0 - -
291 Benang Bedah Lyofil Catgut Chromic 3/0 Roll - 0 0 - -
100m
292 Benang Bedah Silk 2/0 HR 27,75 cm Sachet 35,077.00 0 0 - -
293 Benang Bedah Silk 3/0 HR 27,75 cm Sachet 35,077.00 0 0 - -
294 Benang Bedah Silk Black 3/0 -100 m Cassete 360,000.00 0 0 - -
295 Benang Bedah Silk No. 2/0 - 3/0 dengan PCS - 0 0 - -
jarum bedah
296 Benang Operasi Chromic Catgut Without Buah 7,583.40 0 0 - -
Needle 2.0
297 Benang Operasi Chromic Catgut Without Buah 7,583.40 0 0 - -
Needle 3.0
298 Benang Operasi Silk Without Needle 2.0 Buah 3,958.40 0 0 - -
299 Benang Operasi Silk Without Needle 3.0 Buah 3,958.40 0 0 - -
300 Blood set PCS 13,976.00 0 0 - -
301 Cannafix / Pharamplast Buah - 0 0 - -
302 Cannofix IV Fixation 6 x 8 cm PCS 6,820.00 0 0 - -
10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
303 Catgut Chromic No. 2/0-3/0 + Jarum 1/2 GT PCS - 0 0 - -
35 mm
304 Catgut Chromic No. 3/0 100 m Cassete - 0 0 - -
305 Catgut Chromic No. 3/0 75 cm + Jarum Taper PCS - 0 0 - -
26 mm
306 Cervical Collar Universal PCS 114,000.00 0 1 1.00 -
307 Dental Film Hanshin Kotak - 0 0 - -
308 Dermafix T 5 x 7 cm PCS 1,629.00 0 0 - -
309 DUK Lubang 25x30 Steril (Diameter 5 cm) + Sachet 6,863.00 0 0 - -
Perekat
310 Elektroda Skintact Foam 43 x 51 mm PAK 87,000.00 0 0 - -
311 Endotracheal Tube (ETT) Cuffed (Anak) Size PCS 9,600.00 0 0 - -
2,0
312 Endotracheal Tube (ETT) Cuffed (Anak) Size PCS 9,600.00 0 0 - -
3,0
313 Endotracheal Tube (ETT) Cuffed (Dewasa) PCS 13,100.00 0 0 - -
Size 6,5
Size 7,0
Size 7,5
316 Endotracheal Tube (ETT) cuffed (Dewasa) PCS 13,100.00 0 0 - -
size 8,0
317 Etakridin (Rivanol) Larutan 0,1 % - 300 ml Botol 3,222.00 0 20 20.00 -
318 Etanol 96% Botol - 0 0 - -
319 Etanol 70 % - 1 L Botol 27,500.00 0 0 - -
320 Etanol 70 % - 100 ml Botol 4,445.00 0 0 - -
321 Folley Cateter No.16 G PCS 11,565.00 0 2 2.00 -
322 Folley Cateter No.18 G PCS 11,565.00 0 0 - -
323 Gel USG/EKG Botol 16,000.00 0 1 1.00 -
324 Guedel Airway Anak Size 40 mm PCS 12,210.00 0 0 - -
327 Guedel Airway Dewasa Size 100 mm PCS 12,574.00 0 0 - -
330 Hypafix 5 cm x 5m Roll - 0 0 - -
331 Infusion Set Anak PCS 6,400.00 0 0 - -
332 Infusion Set Dewasa PCS 5,950.00 0 0 - -
333 IV. Catheter No.16 G PCS 8,750.00 0 0 - -
336 IV. Catheter No.22 G PCS 5,786.00 0 2 2.00 -
337 IV. Catheter No.24 G PCS 15,180.00 0 10 10.00 -
11
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
338 Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT PCS 16,200.00 0 0 - -
339 Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR PCS 13,500.00 0 0 - -
340 Jelly Steril 5 gr Sachet 2,200.50 0 5 5.00 -
341 Kacamata Goggle Protective PCS 40,000.00 0 0 - -
342 Kantong Urin PCS 5,500.00 0 6 6.00 -
343 Kapas Pembalut / absorben 250 gram BUNGKUS 13,400.00 0 20 20.00 -
344 Kassa Hidrofil Steril uk. 16 x 16 Kotak 8,000.00 0 0 - -
345 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 Roll 153,200.00 0 0 - -
cm
346 Kassa pembalut hidrofil 4m x 10 cm Roll 1,898.00 0 0 - -
347 Kassa steril mengandung obat (Framycetin) / Lembar - 0 0 - -
LOMATUL / DARYANTUL
348 Kertas EKG Roll 187,000.00 0 0 - -
349 Kertas USG Sony 110 HG Roll 299,999.70 0 0 - -
350 HAND SANITIZER GEL Botol 26,500.00 0 0 - -
351 Larutan Clorin 5,25% - 1 L (Desinfektan Alat) Botol - 0 0 - -
352 Larutan Desinfectan - 1 L (Desinfektan Botol 43,750.00 0 0 - -

Ruangan)
353 Larutan Enzymatic / Sterizyme ( Desinfektan Galon 712,800.00 0 0 - -
Alat ) 5 Liter
354 Larutan H2O2 3% Botol 3,360.00 0 2 2.00 -
355 Larutan Konsentrat untuk Antiseptik dan Botol 700,000.00 0 0 - -
Desinfectan Instrumen/Peralatan Kedokteran
Aldehyd Free / BIOFILM 1 Liter
356 Lysol Konsentrat 1 Liter Botol 40,700.00 0 0 - -

357 Masker Bedah Lembar - 0 0 - -
358 Masker Ear loop BOX 21,945.00 0 0 - -
359 Masker Earlopp Hijab Kotak 15,700.00 0 530 530.00 -
360 Masker N 95 PCS 8,636.36 0 0 - -
361 Masker N 95 (Covid-19) PCS 78,750.00 0 0 - -
362 Masker nebulizer set anak PCS 19,470.00 0 0 - -
363 Masker nebulizer set dewasa PCS 19,470.00 0 0 - -
364 Masker O2 / Maxiflow bayi PCS 8,280.00 0 0 - -
365 Masker O2 Dewasa PCS 8,178.00 0 0 - -
366 Masker O2/ Maxiflow Anak PCS 8,178.00 0 0 - -
367 Masker-Plus 3 ply plus earloop Kotak 45,000.00 0 80 80.00 -
368 Mitella ( Kain Segitiga ) PCS 7,920.00 0 3 3.00 -
369 Nasal Anak PCS 6,930.00 0 0 - -
370 Plester 5 yard X 2 inch Roll - 0 0 - -
371 Plester non alergi 0,5 inch / MICROPORE Roll 4,875.29 0 0 - -
372 Plester non alergi 5cm x 9,1m / MICROPORE Roll 15,333.34 0 0 - -
12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
373 Plester Tranparan 10 cm x 25 cm ( Anti Air PCS 31,500.00 0 0 - -
dan Bakteri )
374 Plesterin Roll Non Woven Uk. 10 cm x 5 m Roll 41,360.00 0 0 - -
375 Plesterin Roll Non Woven Uk. 5 cm x 5 m Roll 23,760.00 0 0 - -
376 Resuscitator Anak PCS 460,000.00 0 1 1.00 -
377 Resuscitator Bayi PCS 460,000.00 0 1 1.00 -
378 Resuscitator Dewasa PCS 460,000.00 0 1 1.00 -
379 Safety Box 2,5 L PCS 13,900.00 0 0 - -
380 Sarung Tangan Kotak 130,000.00 0 200 200.00 -
381 Spalk Kayu SET 61,600.00 0 5 5.00 -
382 Suction Catheter No. 12 ( Anak ) PCS 4,345.00 0 0 - -
383 Suction Catheter No. 16 ( Dewasa ) PCS 4,345.00 0 0 - -
384 Suction Catheter No. 6 ( Bayi ) PCS 4,345.00 0 0 - -
385 Suction Catheter No. 8 ( Bayi ) PCS 4,345.00 0 0 - -
386 Surgical blade no.11 (Pisau Bedah) PCS 2,790.00 0 5 5.00 -
387 Three Way Stopcock PCS 12,631.00 0 4 4.00 -
388 Wing Needle No. 19 PCS 1,400.00 0 0 - -
Embalage 0 0 - -
392 Kantong Kresek obat + cetakan, ukuran 15 x Lembar 200.00 0 0 - -
30
393 Kertas Perkamen ( ukuran 8 x 11 ) Pak /1000lbr 9,000.20 0 0 - -
394 Plastik Klip 13 x 8,7 Pak /100lbr - 0 0 - -
395 Plastik Obat dg klip + cetakan, ukuran 10 x 15 Lembar 167.00 0 0 - -
cm
396 Plastik Obat dg klip + cetakan, ukuran 7 x 10 Lembar 111.00 0 0 - -
cm
397 Sendok obat PCS 220.00 0 1000 1,000.00 1000.00 1,000.00
Akupuntur 0 0 - -
398 Jarum Akupuntur 13 mm Ktk/100 - 0 0 - -
401 Jarum telinga (press needle) Ktk/100 - 0 0 - -
402 Moxa Roll Kotak - 0 0 - -
Obat Poned 0 0 - -
403 Apron plastik Lembar 2,950.00 0 490 490.00 -
404 Asam Traneksamat Injeksi 500 mg/ 5 ml / Ampul 1,945.00 0 0 - -
HEMOSTATIK INJ.
405 Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg / Ampul 3,682.00 0 0 - -
ml / VIT.KA / VIT. K NEONATAL
406 Fitomenadion (Vit. K) Dewasa injeksi 10 Ampul 1,733.33 0 0 - -
mg/ml
13
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
407 Ikat Tali Pusat ( Umbilical Cord klem ) PCS 1,800.00 0 0 - -
408 Metildopa 250 mg Tablet 946.00 0 0 - -
409 Metilergometrin maleat injeksi 0,200 mg - 1 ml Ampul 1,023.00 0 0 - -
410 MgSO4 40 % injeksi Botol 3,796.00 0 0 - -

411 Misoprostol Tablet 0,2 mg Tablet 5,500.00 0 0 - -
412 Misoprostol tablet 0,2 mg / NOPROSTOL Tablet - 0 0 - -
413 Nasal dewasa / Oxyflow dewasa PCS 6,000.00 0 0 - -
414 Nasal infant/ Oxyflow neonatal PCS 6,600.00 0 0 - -
415 Natrium Bicarbonat injeksi Ampul 6,448.00 0 0 - -
416 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 1,126.00 0 0 - -
417 Penghisap Lendir Bayi Baru Lahir PCS 6,000.00 0 0 - -
418 Sarung Tangan panjang obgyn No. 6,5 Pasang 43,010.00 0 43 43.00 -
419 Sarung Tangan panjang obgyn No. 7 Pasang 19,000.00 0 45 45.00 -
420 Sarung Tangan panjang obgyn No. 7,5 Pasang 54,500.00 0 0 - -
421 Sarung tangan steril/Surgical gloves steril No. Pasang 5,863.00 0 0 - -
6,5
7
7,5
424 Sungkup bayi SET 14,520.00 0 0 - -
425 Tanda Pengenal (ID Band) Bayi PCS 1,078.00 0 0 - -
426 Tanda Pengenal (ID Band) Ibu PCS 1,078.00 0 0 - -
427 Under Pad 60 x 90 cm PCS 4,620.00 0 10 10.00 10.00 10.00
428 Valethamate Br 8 mg /ml inj / EPIDOSIN INJ. Ampul - 0 0 - -
Tambahan 0 0 - -
429 Alas Sepatu Paket - 0 0 - -
430 Alat Pelindung Diri/Coverall (APD) (Covid-19) PCS 113,636.36 0 0 - -
431 Alat Suntik Sekali Pakai 0,3 ml (Pfizer) PCS 1,255.00 0 0 - 1874.00 1874.00 3,748.00
432 Alat Suntik Sekali Pakai 3 ml (Pfizer) PCS 569.00 0 0 - 203.00 203.00 406.00
433 Alkohol Swab (Pfizer) PCS 79.00 0 0 - 1734.00 1734.00 3,468.00
434 Alumunium Foil PCS 22,727.27 0 0 - -
435 Antimicrobial Botol 500 ML / SOFTANOL Botol 55,000.00 0 0 - -
436 Antimicrobial Liquid Soap 500 ml / VIOREX Botol 74,250.00 0 0 - -
437 APD Paket Paket 98,450.00 0 0 - -
438 Azitromisin 500 mg Tablet 1,778.00 0 0 - -
439 Betadine Kumur ( Gargle ) 190 ml Botol 29,700.00 0 0 - -
440 Breathing Circuit & Nasal Canula SET 613,636.36 0 0 - -
441 Carbon + Hepa Filter Set PCS 1,100,000.00 0 0 - -
442 Chloroquine Phosphate Tab 150 mg Tablet 1,506.00 0 0 - -
14
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
443 Curcuma xanthorizae ext 50 mg, Zinc Sulfate Kaplet 750.00 0 0 - -
125 mg, Lysine HCl 125 mg / KURKUMEX
444 Favipiravir Tab 200 mg Tablet 14,850.00 0 0 - -

445 Fluoxetin/Kalxetin Tablet 10 mg Kaplet 2,420.00 0 0 - -
446 Germicidal Disposable Wipe Paket - 0 0 - -
447 Gown Protective PCS 24,750.00 0 0 - -
448 HME FIlter PCS 35,000.00 0 0 - -
449 Ivermectin Tab 12 mg Tablet 5,600.00 0 0 - -
450 Kantong Plastik Kuning Uk 100 x 80 PCS 2,025.00 0 0 - -
453 Kantong Udara Nafas PCS 10,000.00 0 0 - -
454 Kartu Pasien Buku 1,000.00 0 0 - -
455 Larutan Desinfektan NaOCl 5% 500 ml Botol 33,750.00 0 0 - -
456 M-I Gown PCS 27,272.72 0 0 - -
457 Masker FFP2 PCS - 0 0 - -
458 Masker Kain Headloop dan Earloop PCS 5,500.00 0 0 - -
459 Masker Oksigen Non Rebreathing Anak PCS 12,240.00 0 0 - -
460 Masker Oksigen Non Rebreathing Dewasa PCS 12,000.00 0 0 - -
461 Metalfoam Catalyst MnO2 PCS 7,500,000.00 0 0 - -
462 Metalfoam Catalyst TiO2 PCS 7,500,000.00 0 0 - -
463 Methisoprinol 500 mg / ISOPRINOSINE Tablet 13,427.00 0 0 - -
464 Methisoprinol 500 mg Tab Tablet 13,427.00 0 0 - -
465 Natrium Klorida 0,9 % 10 ml (Pfizer) Botol 3,280.00 0 0 - 149.00 149.00 298.00
466 Needle 23 G PCS - 0 0 - -
467 Nurse Cap PCS 350.00 0 750 750.00 -
468 One Clean Botol 11,000.00 0 0 - -
469 Oseltamivir 75 mg (Covid-19) Tablet 8,940.00 0 0 - -
470 Parafilm Kotak 500,000.00 0 0 - -
471 Plastik Biohazard Paket - 0 0 - -
472 Remdesivir Inj 100 mg Vial 129,500.00 0 0 - -
473 Safety Box 5 L (Pfizer) PCS 14,000.00 0 0 - 1.00 1.00 2.00
474 Sarung Tangan Non-Steril (Nitril) BOX 194,650.00 0 0 - -
475 Sepatu Boot (Covid-19) Pasang 60,000.00 0 0 - -
476 Shoe Cover Pasang 1,000.00 0 750 750.00 -
477 Solida (Kit APD Tk II) PCS 32,000.00 0 0 - -
478 Surface Disinfectant Botol 500 ML / Botol 87,120.00 0 89 89.00 -
STERICIDE
479 Surgical Gown PCS 52,000.00 0 900 900.00 50.00 50.00
480 Temp Deodorizing Filter PCS 3,000,000.00 0 0 - -
481 Vitamin C 500 mg + B Kompleks (Selkom C) Tablet 1,225.00 0 0 - -
482 Vitamin C 500 mg Inj Ampul 25,750.00 0 0 - -
15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Vaksin 0 0 - -
483 BCG + Pelarut BCG Paket 59,950.00 0 0 - 37.00 80.00 117.00
484 Campak + Pelarut Campak Vial 28,204.00 0 0 - -
485 DPT-HB Combo Vial - 0 0 - -
486 DPT-HB-HiB Pentavalen Vial 76,285.00 0 80 80.00 59.00 80.00 139.00
487 DT Vial 17,450.00 0 97 97.00 -
488 HB Uniject PCS 20,900.00 0 50 50.00 87.00 38.00 125.00
489 IPV Vial 154,230.00 0 10 10.00 7.00 7.00
490 Polio + Dropper Polio Paket 19,954.00 0 20 20.00 65.00 50.00 115.00
491 Safety Box 5L PCS 14,000.00 0 0 - 22.00 22.00 44.00
492 SAR (Hyperhab 1 ml) Vial 1,653,399.00 0 0 - -
493 Td Vial 16,480.00 0 90 90.00 2.00 2.00
494 TT Vial - 0 0 - -
495 VAKSIN ANTI RABIES ( VERORAB) Vial 165,000.00 0 0 - -
496 Vaksin Anti Rabies (Rabivax-S) Vial 165,000.00 0 0 - -
497 Vaksin Comirnaty Pfizer Vial - 0 0 - 149.00 149.00
498 Vaksin HbIg Vial 1,325,000.00 0 0 - -
499 Vaksin Meningitis Formening Vial 135,000.00 0 0 - -
500 Vaksin Menivax ACYW 135 Vial - 0 0 - -
501 Vaksin MR + Pelarut Vaksin MR Vial 151,150.00 0 0 - -
502 Vaksin SARS-CoV-2 Vial 1,339,440.50 0 74 74.00 -
503 Vaksin SARS-CoV-2 (2 Dosis) Vial - 0 0 - 80.00 200.00 280.00
504 Vaksin SARS-CoV-2 (AstraZeneca) Vial 581,607.39 0 0 - 30.00 90.00 120.00
505 Vaksin SARS-CoV-2 (Moderna) Vial - 0 0 - -
506 Vaksin SARS-CoV-2 (Single Dose) Ampul - 0 0 - -
507 Vaksin SARS-CoV-2 (Sinopharm) Vial - 0 0 - -
Tambahan Obat Program 0 0 - -
508 Bingkai KKJH PCS - 0 0 - -
509 Clozapine Tab 25 mg Tablet 1,121.00 75 200 275.00 -
510 Cycloserin (CS) Kaps 250 mg Kapsul 3,940.00 0 0 - -
511 Dolutegravir (50mg) Tablet 1,350.33 0 0 - -
512 Face Shield (Covid-19) PCS 100,000.00 0 0 - -
513 Kartu Kesehatan Jemaah Haji (KKJH) PCS - 0 0 - -
514 Kondom Ukuran 52 mm PCS 358.00 0 0 - -
515 Kotrimoksazol DOEN I (dewasa) Kombinasi : Tablet 325.00 0 0 - -
Sulfametoksazol 800 mg + Trimetoprim 160
mg (Prog HIV)
516 Linezolid (Lnz) Tab 600 mg Tablet 11,828.00 0 0 - -
517 Masker Kain (Covid-19) PCS - 0 0 - -
518 Masker KN 95 PCS - 0 0 - -
519 Obat FDC Kategori I Dosis Harian Paket 418,971.00 0 0 - -
520 Primaquine Tab 15 mg Tablet 235.00 0 0 - -
521 Sarung Tangan Panjang Karet (Covid-19) Pasang 84,375.00 0 0 - -
522 Tali KKJH PCS - 0 0 - -
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Obat HIV AIDS 0 0 - -
523 Abacavir (ABC) 300 mg Tablet 2,218.95 0 0 - -
524 Efavirenz ( EFV ) 600 mg ( 30 Tablet / Botol ) Tablet 6,630.00 0 0 - -
525 Isoniazid (INH) 300 mg Tablet 150.00 0 0 - -

526 Lamivudine ( 3TC ) 150 mg ( 60 Tablet / Botol Tablet 1,560.00 0 0 - -
)
527 Lopinavir ( LPV ) 200 mg + Ritonavir ( R ) 50 Tablet 6,600.00 0 0 - -
mg ( 120 Tablet / Botol )
528 Nevirapine ( NVP ) 200 mg ( 60 Tablet / Tablet 2,800.00 0 0 - -
Botol )
529 Rilpivirine ( RPV ) 25 mg Tablet 3,091.00 0 0 - -
530 Tenofovir ( TDF ) 300 mg ( 30 Tablet / Botol ) Tablet 8,424.00 0 0 - -
531 Tenofovir ( TDF ) 300 mg + Emtricitabine Tablet 4,655.00 0 0 - -

( FTC ) 200 mg ( 30 Tablet / Botol )
532 Tenofovir (TDF) + Lamivudine (3TC) 300 mg Tablet 2,793.86 0 0 - -
+ Dolutegravir (DTG) 50 mg
533 Triple FDC ( Tenofovir ( TDF ) + Lamivudine Tablet 6,630.00 0 0 - -
( 3TC ) + Efavirenz ( EFV ) ( 300 / 300 / 600 )
( 30 Tablet / Botol )
534 Zidovudin 100 mg ( 60 tab/ btl ) Tablet 1,700.00 0 0 - -
535 Zidovudine ( ZDV ) 300 mg + Lamivudine Tablet 3,848.00 0 0 - -
( 3TC ) 150 mg ( 60 Tablet / Botol )
536 Zidovudine ( ZDV ) sirup ( 50 mg / 5 ml ) Botol 30,357.00 0 0 - -
JUMLAH - - - - 10,887.00 45,472.00 56,359.00 - - - - 20,949.00 17,907.00 38,856.00 - -
Mengetahui / Menyetujui, Mengetahui / Menerima, Mengetahui / Menyerahkan, Mengetahui,

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi Kepala PKM Ciledug Pengurus Barang Pembantu Puskesmas
dr. DINI ANGGRAENI,MM Ratna Sumirat, S.Si, M.Farm, Apt drg.Hj.RR.Sri Wahyu Hermiati,M.Si Suprihartiwi, AMF
NIP. 197705012005012010 NIP. 197805101997022001 NIP. 19620120 199203 2 003 NIP. 197601172009022004
17
PEMAKAIAN MARET STOK AKHIR MARET NILAI STOK AKHIR
UGD RAWAT APOTEK GUDANG TOTAL PUSTU PONED UGD RAWAT APOTEK GUDANG TOTAL STOK
INAP PEMAKAIAN INAP AKHIR
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
2100 2,100.00 - - - - 2,900.00 - 2,900.00 203,000.00
410 2100 2,510.00 - - - - 1,690.00 3,000.00 4,690.00 248,570.00
0 - - - - - - - - -
30 30.00 - - - - - - - -
6 10 16.00 - - - - 7.00 40.00 47.00 164,406.00
0 - - - - - - - - -
30 30.00 - - - - 25.00 200.00 225.00 377,775.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 60.00 60.00 195,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
18
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 10.00 10.00 26,500.00
0 - - - - - - - - -
0 - - - - - - 200.00 200.00 17,800.00
100 100.00 - - - - 500.00 1,000.00 1,500.00 63,000.00

0 - - - - - - - - -
0 - - - - - - - - -
3 3.00 - - - - 15.00 75.00 90.00 315,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
2799 3000 5,799.00 - - - - 1,000.00 8,200.00 9,200.00 2,079,200.00
0 - - - - - - - - -
130 130.00 - - - - 275.00 900.00 1,175.00 103,400.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
30 30.00 - - - - - 150.00 150.00 20,550.00
0 24 24.00 - - - - 24.00 48.00 72.00 252,000.00
0 - - - - - - 1.00 1.00 84,920.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 20.00 20.00 18,480.00

0 - - - - - - 5,000.00 5,000.00 495,000.00
0 - - - - - - - - -
19
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 1,562.00

0 - - - - - - - - -
0 - - - - - - - - -
213 200 413.00 - - - - 170.00 1,100.00 1,270.00 90,170.00
0 - - - - - - - - -
0 - - - - - - 5.00 5.00 7,575.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
80 80.00 - - - - 45.00 100.00 145.00 108,460.00
0 - - - - - - - - -
0 - - - - - - - - -
100 150 250.00 - - - - 75.00 150.00 225.00 66,375.00
0 - - - - - - 200.00 200.00 60,000.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 14,400.00
0 - - - - - - 2.00 2.00 13,254.00
0 - - - - - - 300.00 300.00 63,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 24.00 24.00 148,800.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
2800 2400 5,200.00 - - - - - 1,600.00 1,600.00 96,000.00
0 - - - - - - - - -
110 110.00 - - - - 115.00 750.00 865.00 249,120.00
142 200 342.00 - - - - 58.00 - 58.00 87,000.00
0 - - - - - - - - -
20
21 22 23 24 25 26 27 28 29 30 31 32 33
6 11 17.00 - - - - 5.00 44.00 49.00 98,343.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
200 200.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 48.00 48.00 216,000.00
0 - - - - - - 30.00 30.00 36,870.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 200.00 200.00 15,400.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
600 400 1,000.00 - - - - - 600.00 600.00 210,000.00
0 - - - - - - - - -
300 200 500.00 - - - - - 100.00 100.00 10,200.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
22 24 46.00 - - - - 3.00 48.00 51.00 174,114.00
0 - - - - - - - - -
0 - - - - - - 75.00 75.00 990,000.00
0 - - - - - - - - -
0 180 180.00 - - - - 180.00 360.00 540.00 459,000.00
0 - - - - - - - - -
0 - - - - - - - - -
21
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - 9.00 9.00 61,200.00

0 - - - - - 23.00 200.00 223.00 51,513.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
72 72 144.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
22
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
147 147.00 - - - - - - - -
5 5 10.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 5.00 5.00 4,365.00
0 - - - - - - - - -
0 - - - - - - 192.00 192.00 955,392.00
134 134.00 - - - - 66.00 300.00 366.00 432,246.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
605 500 1,105.00 - - - - 400.00 2,200.00 2,600.00 280,280.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 10.00 10.00 142,670.00
0 - - - - - - - - -
70 70.00 - - - - 150.00 800.00 950.00 80,750.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 15.00 15.00 188,100.00
23
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
8 8.00 - - - - 16.00 72.00 88.00 205,304.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
5 13 18.00 - - - - 8.00 - 8.00 91,728.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
1585 1250 2,835.00 - - - - 15.00 3,250.00 3,265.00 489,750.00
250 200 450.00 - - - - 13.00 400.00 413.00 102,424.00
2 2.00 - - - - - 14.00 14.00 289,800.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
58 58.00 - - - - - 100.00 100.00 90,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 72.00 72.00 179,208.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
15 15 30.00 - - - - - - - -
10 10 20.00 - - - - - - - -
0 - - - - - - - - -
24
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
5 5 10.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
14 100 114.00 - - - - 86.00 400.00 486.00 188,082.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
-37 - 37.00 - - - - 70.00 200.00 270.00 45,090.00
0 - - - - - - - - -
2 2.00 - - - - - - - -
69 69.00 - - - - - - - -
0 - - - - - - - - -
3 3.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 3.00 3.00 21,750.00
0 - - - - - - - - -
0 - - - - - 230.00 500.00 730.00 43,070.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
100 100 200.00 - - - - 122.00 400.00 522.00 81,954.00
0 - - - - - - - - -
160 500 660.00 - - - - 840.00 500.00 1,340.00 164,820.00
0 - - - - - - - - -
25
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
262 1000 1,262.00 - - - - 1,000.00 500.00 1,500.00 94,500.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 198,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 93,500.00
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 160,500.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 174,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 133,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 32,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
26
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
1840 1840 3,680.00 - - - - - 360.00 360.00 426,600.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 35.00 35.00 350,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 5.00 5.00 19,500.00
1840 1840 3,680.00 - - - - - 360.00 360.00 34,200.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
27
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 114,000.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 20.00 20.00 64,440.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 23,130.00
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 16,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - - F
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 11,572.00
0 - - - - - - 10.00 10.00 151,800.00
28
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 5.00 5.00 11,002.50
0 - - - - - - - - -
0 - - - - - - 6.00 6.00 33,000.00
0 - - - - - - 20.00 20.00 268,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 2.00 2.00 6,720.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 530.00 530.00 8,321,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 80.00 80.00 3,600,000.00
0 - - - - - - 3.00 3.00 23,760.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
29
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 1.00 1.00 460,000.00
0 - - - - - - 1.00 1.00 460,000.00
0 - - - - - - 1.00 1.00 460,000.00
0 - - - - - - - - -
0 - - - - - - 200.00 200.00 26,000,000.00
0 - - - - - - 5.00 5.00 308,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 5.00 5.00 13,950.00
0 - - - - - - 4.00 4.00 50,524.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 2,000.00 2,000.00 440,000.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 490.00 490.00 1,445,500.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
30
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 43.00 43.00 1,849,430.00
0 - - - - - - 45.00 45.00 855,000.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 20.00 20.00 92,400.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
1874 1874 3,748.00 - - - - - - - -

203 203 406.00 - - - - - - - -
1734 1734 3,468.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
31
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
149 149 298.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 750.00 750.00 262,500.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
1 1 2.00 - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 750.00 750.00 750,000.00
0 - - - - - - - - -
0 - - - - - - 89.00 89.00 7,753,680.00
50 50 100.00 - - - - - 850.00 850.00 44,200,000.00

0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
32
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
37 37 74.00 - - - - - 43.00 43.00 2,577,850.00
0 - - - - - - - - -
0 - - - - - - - - -
59 59 118.00 - - - - - 101.00 101.00 7,704,785.00
0 - - - - - - 97.00 97.00 1,692,650.00
87 87 174.00 - - - - - 1.00 1.00 20,900.00
7 7 14.00 - - - - - 3.00 3.00 462,690.00
65 65 130.00 - - - - - 5.00 5.00 99,770.00
22 22 44.00 - - - - - - - -
0 - - - - - - - - -
2 2 4.00 - - - - - 88.00 88.00 1,450,240.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 149.00 149.00 -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - 74.00 74.00 99,118,597.00
80 80 160.00 - - - - - 120.00 120.00 -
30 30 60.00 - - - - - 60.00 60.00 34,896,443.40
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
-50 - 50.00 - - - - 125.00 200.00 325.00 364,325.00
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
33
21 22 23 24 25 26 27 28 29 30 31 32 33
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
0 - - - - - - - - -
- - 21,585.00 20,949.00 42,534.00 - - - - 10,251.00 42,430.00 52,681.00 260,219,198.90
Tangerang, 16 Maret 2021
Yang Membuat,
Pengelola Obat
Suprihartiwi, AMF
NIP. 197601172009022004
34
LAPORAN STOK AKHIR OBAT BULAN MARET TAHUN 2022
UPT PKM CILEDUG
JL. Raden Patah
NO. NAMA BARANG SATUAN HARGA SATUAN STOK AW

PUSTU PONED
1 2 3 4 5 6
Obat
1 Alopurinol tablet 100 mg Tablet 87.00
2 Ambroksol Syrup Botol 5,500.00
3 Ambroksol tablet 30 mg Tablet 190.00
4 Aminofillin tablet 150 mg Tablet 0.00
6 Amlodipin 10 mg Tablet 70.00
7 Amlodipin tablet 5 mg Tablet 53.00
8 Amoksilin kaplet 500 mg Kaplet 330.00
9 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 2,800.00
10 Amoksilin sirup Ikering

Antasida DOEN tablet250 mg/ 5kombinasi
kunyah, ml - 60 ml: Botol 3,498.00
11 Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium Tablet 58.00
Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200
12 mg /5 ml - 60 ml Botol 1,679.00
Anti Bakteri DOEN salep kombinasi : Basitrasin 500
13 IU/g + Polimiksin 10.000 IU/g Tube 3,035.00
Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium
14 80% + Citrus Bioflavonoid 20% / HAEMOROGARD Kapsul 1,518.00
Anti Hemmoroid Suppositoria DOEN kombinasi :
15 Bismut subgalat 150 mg + Heksaklorofen 2,5 mg Supp 3,250.00
16 Anti Tetanus Serum ( ATS ) 1500 IU Ampul 130,999.00

Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% +
17 Placenta Ekstrak 10 %) - 15 gr / BIOPLACENTON Tube 0.00
Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60
18 ml / NEO KAOMINAL Botol 0.00
Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / NEO
19 DIAFORM Tablet 0.00
Antifungi DOEN kombinasi As. Benzoat 6% + As.
20 Salisilat 3% - 30 gr / WHITEFIELD Pot 4,798.00
Antiinfeksi Topikal dengan Kortikosteroid Krim /
21 KLORFESON / COLIPRED Tube 8,030.00
22 Antimigren
Antiseptik &: kortikosteroid
Ergotamin Tartrat 1 mg
Tetes + Kofein
mata 50 mg3,5
(Neomycin Tablet 185.00
mg, Polymixin B Sulfat 10.000 IU, Dexamethason 1,0
23 mg) - 5 ml / CENDO XITROL EYE DROPS Botol 0.00
24 Aqua pro injeksi steril, bebas pirogen 20 ml Vial 0.00
25 Aqua pro injeksi steril, bebas pirogen 25 ml Vial 2,650.00
26 Artesunate Injeksi 500 ml / 5 ml Ampul 39,000.00
27 Asam Asetilsalisilat tablet 80 mg / ASPIMEC/MINIASPI Tablet 89.00
28 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 42.00
29 Asam Mefenamat kaplet 500 mg Kaplet 195.00
30 Asering infus Botol 8,800.00
31 Asiklovir krim 5 % -5 gr Tube 3,500.00
32 Asiklovir tablet 400 mg Tablet 407.00
33 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml Ampul 1,639.00
34 Attapulgit Tablet 630 mg / PULAREX / NEW ANTIDES Tablet 145.00
35 Azitromisin 500 mg Tablet 1,778.00

Besi II Sulfat 180 mg + Asam Folat 400 mcg (tablet
36 tambah darah kombinasi) Tablet 226.00
Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet
39 Betadine Kumur ( Gargle ) 190 ml Botol 29,700.00
40 Betahistin Mesilat tablet 6 mg Tablet 88.00
41 Betametason Krim 0.1 % (sebagai valerat) - 5 gr Tube 1,430.00
42 Bisacodyl 5 mg / BICOLAX Tablet 319.00
43 Bisoprolol tablet 2,5 mg / CONCOR Tablet 626.00
44 Bisoprolol tablet 5 mg Tablet 137.00
45 Borax Gliserin (GOM) 10 % - 8 mL Botol 3,500.00

Bromheksin larutan 2mg/ml (untuk Nebulizer) - 50
46 ml / BISOLVON Botol 84,920.00
47 Bromheksin tablet 8 mg Tablet 165.00
48 Bromheksin tablet 8 mg (MOSAVON) Tablet 0.00

49 Buscopan Inj Ampul 37,700.00
50 Ceftriaxone Serbuk Injeksi 1000 mg Vial 4,708.00
51 Cetirizine 10 mg Tablet 90.00
52 Cetirizine Sirup Botol 2,090.00

Curcuma xanthorizae ext 50 mg, Zinc Sulfate 125 mg,
53 Lysine HCl 125 mg / KURKUMEX Kaplet 750.00
54 Deksametason injeksi 5 mg/ml-1ml Ampul 924.00
55 Deksametason tablet 0,5 mg Tablet 99.00
56 Dekstrometorfan tablet 15 mg (HBr) Tablet 0.00
57 Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml Botol 0.00
58 Difenhidramin injeksi 10 mg/ml / ETADRYL Ampul 781.00
59 Digoksin tablet 0,25 mg Tablet 104.00
60 Doksisiklin kapsul 100 mg Kapsul 275.00
61 Domperidon tablet 10 mg Tablet 71.00
62 Efedrin tablet 25 mg (HCl) Tablet 160.00
63 Epinefrin ( Adrenalin ) injeksi 0,1 % (sebagai HCl) - 1 ml Ampul 1,515.00
64 Eritromisin kapsul 500 mg Kapsul 770.00
65 Eritromisin sirup 200 mg 5 /ml - 60 ml Botol 6,462.00
66 Favipiravir Tab 200 mg Tablet 14,850.00
67 Fenol Gliserol tetes telinga 10 % - 5 ml Botol 3,300.00
68 Fitomenadion(Vit. K1) tablet salut gula 10 mg Tablet 748.00
69 Furosemid tablet 40 mg Tablet 82.00
70 Furosemide
Garam OralitInjeksi 10 mg/ml
I serbuk, kombinasi : Natrium 0,52 g, Ampul 1,333.00
Kalium klorida 0,30 g , Trinatrium sitrat dihidrat 0,58 g,
71 Glukosa anhidrat 2,7 g Sachet 295.00
72 Gemfibrozil 300 mg kapsul Kapsul 300.00
73 Gentamycin salep kulit 0,1% - 5 gr Tube 3,410.00
74 Glibenklamid tablet 5 mg Tablet 82.00
75 Gliseril Guaiakolat tablet 100 mg Tablet 250.00

76 Glucose Larutan Infus 10% Steril Kolf 7,200.00
77 Glucose Larutan Infus 5% steril - 500 ml Kolf 6,627.00
78 Griseofulvin tablet 125 mg Tablet 210.00
79 Hidroklortiazid (HCT) tablet 25 mg Tablet 155.00
80 Hidrokortison krim 2,5 % - 5 gr Tube 2,475.00

Hyoscine - N - Butilbromide tablet 10 mg /
81 SCOPMA/SCOPAMIN Tablet 1,050.00
82 Ibuprofen tablet 400 mg Tablet 245.00
83 Ichtyol salep kulit - 15 gr Pot 6,200.00
84 Isosorbid dinitrat ( ISDN ) Injeksi 1 mg/ml Ampul 22,297.00
85 Isosorbid dinitrat (ISDN) tablet sublingual 5 mg Tablet 86.00
86 Ivermectin Tab 12 mg Tablet 5,600.00
87 Kalium Diklofenak tablet 50 mg Tablet 0.00
88 Kalium permanganat (PK) serbuk - 5 gr Pot 0.00
89 Kalsium Gluconat inj 100 mg/ml Ampul 10,351.00
90 Kalsium laktat (Kalk) tablet 500 mg Tablet 60.00
91 Kaptopril tablet 25 mg Tablet 175.00
92 Ketokonazol tablet 200 mg Tablet 288.00
93 Klindamisin kapsul 300 mg Kapsul 1,500.00
94 Kloramfenikol kapsul 250 mg Kapsul 0.00
95 Kloramfenikol salep mata 1% - 5 gr Tube 2,007.00
96 Kloramfenikol suspensi 125 mg/5ml - 60 ml Botol 5,015.00
97 Kloramfenikol Tetes Mata 0,5 % - 5 mL / RECO Botol 8,250.00
98 Kloramfenikol Tetes Telinga 3 % - 5 mL Botol 8,200.00
99 Klorfeniramin maleat (CTM) tablet 4 mg Tablet 23.00

Kotrimoksazol DOEN I (dewasa) kombinasi :
100 Sulfametoksazol 400 mg + Trimetoprim 80 mg Tablet 133.00
Kotrimoksazol DOEN II (pedriatik) kombinasi :
Kotrimoksazol Suspensi kombinasi : Sulfametoksazol
102 200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml Botol 2,190.00
103 Kuinin (Kina ) tab. 200 mg Tablet 0.00
104 Levertran salep - 15 gr Pot 4,500.00

Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 :
105 80.000) - 2 ml Ampul 1,229.00
106 Lidokain injeksi 2% - 2 ml Ampul 1,140.00
107 Lidokain Spray Oral 10 % / Xylocaine Spray Botol 177,216.00
108 Linkomisin kapsul 500 mg Kapsul 0.00
109 Loperamid tablet 2 mg Tablet 77.00
110 Loratadin tablet 10 mg Tablet 131.00
111 Lytacur syrup Botol 0.00
112 Mebendazol tablet 100 mg Tablet 0.00
113 Metampiron (Antalgin) tablet 500 mg Tablet 350.00
114 Metformin HCl tablet 500 mg Tablet 77.00
115 Methisoprinol 500 mg / ISOPRINOSINE Tablet 13,427.00
116 Methisoprinol 500 mg Tab Tablet 13,427.00
117 Methyl Prednisolone 4 mg Tablet 102.00

Metilergometrin Maleat (Metilergometrin) tablet salut
118 0,125 mg Tablet 224.00
119 Metoklopramid injeksi / PRIMPERAN Ampul 0.00
120 Metoklopramid tablet 10 mg / METOLON Tablet 85.00
121 Metronidazol tablet 500 mg Tablet 133.00
122 Mikonazol krim/ salep 2 % (Nitrat) - 10 gr Tube 3,414.00
123 Minyak Kayu Putih 210 ml Botol 0.00

Multivit Sirup - 60 ml /
124 SUPRALYSIN/LYSMIN/BIOVITAN Botol 13,200.00
125 Multivit Tablet / PEHAVRAL Tablet 935.00
126 N-Asetil sistein 200 mg Tablet 850.00
127 Natrium Bikarbonat tablet 500 mg Tablet 0.00
128 Natrium Diklofenak tablet 50 mg Tablet 123.00
129 Natrium Klorida larutan 0,9%, 25 ml (untuk Nebulizer) Botol 4,700.00

130 Natrium Klorida larutan infus 0,9% - 500 ml Kolf 6,800.00
131 Nifedipin tablet 10 mg Tablet 231.00
132 Nistatin tablet salut 500.000 IU/g Tablet 0.00
134 Nistatin vaginal tablet 100.000 IU/g Tablet 598.00

Obat Analgetik
Obat Analgetik -(Antalgin 250- batuk
antipiretik mg ; Amidopyrin
kaplet 50 mg ;
135 Lidocain HCl 10
(Paracetamol 500mgmg,
) / ETAMIDON INJEKSI HBr 15 mg,
Dextromethorphan Vial 0.00
Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine
136 Obat
Maleat 2 mg, ) -/vitamin
Analgetik ALPARA KAPLET kaplet
B kompleks Kaplet 0.00
(Parasetamol 500 mg, Vitamin B6 100 mg, Vitamin B1
137 50 mg,
Obat Vitamin kombinasi
Analgetik B12 100 mcg) / Psikotropik
dengan ERLAGIN kaplet Tablet 0.00
(Metampiron 500 mg, Diazepam 2 mg) /
138 METANEURON
Obat Antiinfluenza kaplet ( Paracetamol 500 mg. Tablet 0.00
Phenylpropanolamin
Obat HCl (12,5
Antiinfluenza syrup mg+ Chlorpheniramin
Parasetamol 125 mg,
139 Maleat 2 mg ) / MOLEXFLU
Phenylprophanolamine KAPLET
HCl 3.125 mg, Kaplet 0.00
Chlorpheniramine Maleate 0.5sirup
Obat Antitusif - ekspektorant mg )( -Diphenhydramin
60 ml /
140 HCl
MOLEXFLU
12,5 mg+SYRUP
Ammonium Chlorida 125 mg+ Sodium Botol 0.00
Citrat 50 mg+ Menthol 1 mg ) - 60 ml / MOLEXDRYL
141 SYRUP Botol 0.00
142 Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol Botol 6,500.00
Obat Dekongestan, antiinfluenza tablet (Tripolidin
143 HCL 2,5 mg, Pseudoefedrin HCL 30 mg) / FLUTROP Tablet 0.00
Obat Neuramialgikum tablet (Vit.B1 100 mg, Vit.B6
144 200 mg, Vit.B12 250 mcg ) / NUTRIFAR Tablet 0.00
Obat Pencernaan tablet (Diastase 200 mg, Pankreatin
145 100 mg) / LYBROZYM Tablet 550.00
Obat Preparat Flebitis dan Varises ( Heparin 20.000
146 IU ) - 20
Obat gr / THROMBOPHOP
spasmodikum GEL
tablet (Metampiron 500 mg, Tube 0.00
Ekstrak
Obat Belladona
Tetes 10 mg, Papaverin
mata kombinasi HCl
antiseptik & 25 mg) /
kortikosteroid
147 SPASMINAL
(Dexamethason Sod.Phosfate 1,0 mg, Neomycin Tablet 0.00
Sulphate setara Neomycin base 3,5 mg, Polymixin B
148 Sulfat 6000 IU) - 5 ml / ALETROL Botol 0.00
Obat Vasokonstriktor dan antihistamin tablet
( Phenylpropanolamin HCl 15 mg+ Chlorpheniramin
149 Maleat 2 mg ) / NALGESTAN Tablet 0.00
150 Oksitetrasiklin HCl salep kulit 3 % - 5 gr Tube 0.00
151 Oksitetrasiklin HCl salep mata 1 % - 5 gr Tube 0.00
152 Omeprazol kapsul 20 mg Kapsul 129.00
153 Omeprazole Injeksi Vial 5,093.00
154 Ondansentron 4 mg Tablet 0.00
155 Ondansentron Injeksi 2 mg/ml Ampul 873.00

156 Oseltamivir 75 mg (Covid-19) Tablet 8,940.00
157 Papaverin tablet 40 mg Tablet 0.00
158 Parasetamol drops 15 ml Botol 4,976.00
159 Parasetamol sirup 120 mg / 5ml - 60 ml Botol 1,181.00

Supposito
160 Parasetamol Suppos 80 mg ria 6,000.00
161 Parasetamol tablet 500 mg Tablet 135.00
163 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 131.00
164 Piroksikam tablet 10 mg Tablet 107.80
165 Polikresulen (kondensasi) 10 ml / APTIL Botol 0.00
166 Povidon Iodida larutan 10 % - 300 ml Botol 21,010.00
167 Povidon Iodida larutan 10 % - 60 ml Botol 0.00
168 Prednison tablet 5 mg Tablet 73.00
169 Propanolol tablet 10 mg (HCl) Tablet 56.00
170 Propiltiourasil tablet 100 mg Tablet 385.00
171 Pulmicort Respules 0,5 mg/ml / Budesonide Respules 14,267.00
172 Ranitidin injeksi 25 mg/ml Ampul 814.00
173 Ranitidin tablet 150 mg Tablet 85.00
174 Remdesivir Inj 100 mg Vial 129,500.00
175 Ringer Laktat larutan infus - 500 ml Kolf 7,630.00
176 Saccaharine Tablet Tablet 0.00
177 Salbutamol 2.5 mg/ ml (untuk Nebulizer) Botol 12,540.00
178 Salbutamol tablet 2 mg (sebagai sulfat) Tablet 48.00
179 Salbutamol tablet 4 mg Tablet 0.00

Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang
180 endap 4 % - 30 gr Pot 2,333.00
Salep kulit analgetika (Metil salilsilat 11%, Mentol 6%,
181 Eugenol 1,5%)
Salep kulit - 30 gr antiinfeksi
kombinasi / PAINKILLAdgn kortikosteroid Tube 0.00
(Betamethasone 1 mg, Neomycin sulfat 5 mg) - 5 gr /
182 BEVALEX Tube 0.00
183 Salisil Bedak 2 % - 50 gr Kotak 3,300.00
184 Scabimite Krim / Permetrin Krim 5% ( Anti Scabies ) Tube 11,466.00
185 Sefadroksil Kapsul 500 mg Kapsul 575.00
186 Serum Anti Bisa Ular Injeksi 5 ml Vial 512,204.00
187 Sianokobalamin (vitamin B12) tablet 50 mcg Tablet 43.00
188 Simvastatin tablet 10 mg Tablet 117.00
190 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 248.00
191 Sulfadiazine Perak 1% Tube 20,700.00
192 Sulfasetamida Natrium tetes mata 15 % - 5 ml Botol 0.00
193 Tetrasiklin Kapsul 250 mg Kapsul 0.00
194 Tetrasiklin kapsul 500 mg Kapsul 0.00
195 Thiamfenikol kapsul 500 mg Kapsul 900.00
196 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet 91.00

Vitamin B Komplek dengan Vit. C dosis tinggi Kaplet
197 Tramadol
(Vit. B1 15Injeksi 50B2
mg, Vit. mg/ml
10 mg, Vit. B6 5 mg, Vit. B12 Ampul 1,764.00
100 mcg, Vit. C 500 mg, Vit. E 30 mg, Ca. Pantothenate
198 20 mg, Nikotinamide 50 mg) / BECEFORT Tablet 1,407.66
199 Vitamin B Kompleks tablet Tablet 118.00
200 Vitamin C 500 mg + B Kompleks (Selkom C) Tablet 1,225.00
201 Vitamin C 500 mg Inj Ampul 25,750.00
202 Zinc Sirup Botol 2,489.00
203 Zinc tablet 20 mg Tablet 208.00
OBAT PROGRAM TB PARU
204 3HR Rifampisin 75 mg / Isoniazid 50 mg (TPT) Tablet 0.00
205 Cycloserin (CS) Kaps 250 mg Kapsul 3,940.00
206 Ethambutol 100 mg (TPT) Tablet 0.00
207 Ethambutol 400 mg Tablet 0.00
208 Etionamide 125 mg Tablet 0.00

210 Isoniazid (INH) Profilaksis 100 mg Tablet 231.00
211 Levofloxacin (Lfx) 100 mg (TPT) Tablet 0.00
212 Levofloxacin 250 mg Tablet 0.00
213 Linezolid (Lnz) Tab 600 mg Tablet 11,828.00
214 OAT Kombipak Paket 317,018.00
215 Obat FDC Kategori 1 Paket 415,467.00
216 Obat FDC Kategori 2 Paket 1,384,977.00
217 Obat FDC Anak Paket 248,120.00
218 Obat FDC Kategori I Dosis Harian Paket 418,971.00
219 Obat FDC Sisipan Paket 0.00
220 Pirazinamid 500 mg Tablet 0.00
221 Piridoksin (Vitamin B6) Tablet 25 mg (Program) Tablet 222.00
222 Rifapentin 150 mg (TPT) Tablet 0.00
223 Tuberculin PPD RT 23 SSI Vial 625,800.00
OBAT PROGRAM IMS
224 Benzatin Penicilin 2,4 Jt Vial 14,500.00
225 Flukonazole 150 Mg Tablet 0.00
226 Kanamisin injeksi 1 gr Vial 0.00
227 Kombipak IMS Paket 312,310.00
228 Levofloksasin tablet 500 mg Tablet 734.16
229 MDT MB Dewasa Paket 0.00
230 Pyrimethamine 25 Mg Tablet 0.00
231 Sefiksim kapsul 100 mg Kapsul 387.00
OBAT PROGRAM FILARIASIS
232 Dietilkarbamazin Sitrat tablet 100 mg Tablet 0.00
OBAT PROGRAM KECACINGAN

233 Albendazole Suspensi Botol 4,000.00
234 Albendazole tablet 400 mg Tablet 380.00
235 Pirantel tablet score (base) 125 mg Tablet 287.00
OBAT PROGRAM GIZI

Mineral Mix (Kalium Klorida 1.792 g, Trikalium Sitrat
0.648, Magnesium Klorida 0.608, Seng Asetat 0.066,
236 Tembaga Sulfat 0.011) Sachet 0.00
237 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 306.00
OBAT KEJIWAAN
239 Alprazolam tablet 1 mg Tablet 120.00
240 Amitriptilin tablet salut 25 mg (HCl) Tablet 167.00
241 Clobazam tablet 10 mg Tablet 384.00
242 Clozapine Tab 25 mg Tablet 1,121.00
243 Diazepam injeksi 5 mg /ml - 2 ml Ampul 1,735.00
244 Diazepam tablet 2 mg Tablet 86.00
246 Diazepam tube Rectal 5 mg/ml / STESOLID Tube 12,573.00
247 Fenitoin Kapsul 100 mg Kapsul 595.00
248 Fenobarbital tablet 30 mg Tablet 182.00
249 Fluoxetin tablet 10 mg /ANTIPRESTIN/FORANSI Kotak 2,420.00
250 Fluoxetin tablet 20 mg / PRESTIN Tablet 250.00
251 Fluoxetin/Kalxetin Tablet 10 mg Kaplet 2,420.00
252 Haloperidol Inj 5 mg/ml Ampul 7,250.00
253 Haloperidol Decanoat 50mg/mL Ampul 97,500.00
254 Haloperidol tablet 1,5 mg Tablet 59.00
255 Haloperidol tablet 5 mg Tablet 60.00
256 Imipramin tablet 25 mg / TOFRANIL Tablet 0.00
257 Karbamazepin tablet 200 mg Tablet 245.00

258 Klorpromazin 25 mg Tablet 0.00
259 Klorpromazin tablet salut 100 mg (HCl) Tablet 157.00
260 Kodein tablet 10 mg Tablet 571.00
261 Risperidon tablet 2 mg Tablet 123.00
262 Sertralin tablet / NUDEP Tablet 2,600.00
263 Sikzonoat Inj 25 mg/ml Ampul 63,813.00
264 Triheksifenidil tablet 2 mg Tablet 63.00
OBAT GIGI
265 Artikulating Paper Buku 15,500.00
266 Bur Arkansas High Speed Buah 29,950.00
267 Bur Diamod High Speed PAK 198,000.00
268 Bur High Speed Kotak 200,000.00
269 Bur Low Speed Kotak 235,000.00
270 Cavit Pot 109,714.00
271 Celluloid strip SET 93,500.00
272 CHKM Botol 65,000.00
273 Cresopen Botol 160,500.00
274 Dentin Conditioner Botol 130,000.00
275 Devitalisasi Pasta (Non Arsen) Btl / ktk 710,320.00
276 Disclosing Agent Tube 0.00
277 Disposible saliva ejektor PAK 87,000.00
278 ENDO-FROST/Propane/Butane/Cek Vitalitas Gigi Botol 139,150.00
279 Etil Chlorida spray - 100 ml Botol 0.00
280 Eugenol cairan - 15 ml Botol 20,087.00
281 Formokresol 25 g Botol 300,000.00
282 Glass Ionomer Cement ART (GCIX) / FUJI IX SET 560,000.00
283 Glass Ionomer Radiopak / FUJI VII SET 690,000.00

284 Kalsium Hidroksida pasta / CALCIDOR / DYCAL SET 133,000.00
285 Macro gold + propylen + EDTA SET 388,791.00
286 Mummifying Pasta / Iodoform Btl / ktk 64,000.00

Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml +
287 Adrenalin 12.5 mcg ) / PEHACAIN Ampul 0.00
288 Oil Spray 170 ml Botol 372,000.00
289 Oil Spray 500 ml Botol 0.00
290 Pulperyl 13 ml Botol 195,000.00
291 Semen Seng Fosfat (Powder 30 gr, Liquid 10 ml) SET 0.00
292 Spon Gelatin Cubicels / Spongostan/ Haemospon PCS 0.00
293 Temporary Stopping Fletcher Serbuk (Powder) Pot 32,000.00
294 Tetric Bonding 6 gr Botol 260,925.00

Tetric N Ceram / Tambalan Sinar (4 syringe, etching,
295 bonding) Paket 1,720,393.00
296 Tetric N Ceram Refill (A2, A3, A3,5) Tube 260,925.00
297 Tooth Mouse (CPPACP) Tube 225,000.00
298 Total Etch Refill 2 gr Tube 120,227.00
299 Trikresol Formalin (TKF) 3/10ml 72,000.00
300 Xylestesin Adrenalin inj / SCANDONEST Ampul 0.00
301 Xylestesin Non Adrenalin inj Ampul 0.00
PERBEKALAN KESEHATAN
302 Alas Sepatu Paket 0.00
303 Alat Pelindung Diri/Coverall (APD) (Covid-19) PCS 113,636.36
304 Alat Suntik Sekali Pakai 0,05 ml PCS 1,550.00
306 Alat Suntik Sekali Pakai 1 ml PCS 1,361.00
307 Alat Suntik sekali pakai 10 ml PCS 1,100.00
309 Alat Suntik Sekali Pakai 3 ml PCS 818.00

311 Alat Suntik sekali pakai 50 ml (Tanpa Jarum) PCS 3,900.00
312 Alkohol Swab (BMHP) PCS 95.00
313 Alumunium Foil PCS 22,727.27
314 Antimicrobial Botol 500 ML / SOFTANOL Botol 55,000.00
315 Antimicrobial Liquid Soap 500 ml / VIOREX Botol 74,250.00
316 APD Paket Paket 98,450.00
317 Benang Bedah Catgut Chromic 2/0 -100 m Cassete 0.00

Benang Bedah Catgut Chromic No. 2/0 HRG-38,90 cm
318 ( Jarum Tapper 0 ) Sachet 0.00
Benang Bedah Catgut Chromic No.2/0 HR 27,75 cm
320 (Jarum Tapper 0) PCS 36,500.00
Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum
322 bedah PCS 0.00
323 Benang Bedah Catgut Plain 3/0 -100 m Cassete 0.00
324 Benang Bedah Lyofil Catgut Chromic 3/0 100m Roll 0.00
325 Benang Bedah Silk 2/0 HR 27,75 cm Sachet 35,077.00
327 Benang Bedah Silk Black 3/0 -100 m Cassete 360,000.00
328 Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah PCS 0.00
329 Benang Operasi Chromic Catgut Without Needle 2.0 Buah 7,583.40
331 Benang Operasi Silk Without Needle 2.0 Buah 3,958.40
333 Blood set PCS 13,976.00
334 Breathing Circuit & Nasal Canula SET 613,636.36
335 Cannafix / Pharamplast Buah 0.00
336 Cannofix IV Fixation 6 x 8 cm PCS 6,820.00

337 Catgut Chromic No. 2/0-3/0 + Jarum 1/2 GT 35 mm PCS 0.00
338 Catgut Chromic No. 3/0 100 m Cassete 0.00
339 Catgut Chromic No. 3/0 75 cm + Jarum Taper 26 mm PCS 0.00
340 Cervical Collar Universal PCS 114,000.00
341 Dental Film Hanshin Kotak 0.00
342 Dermafix T 5 x 7 cm PCS 1,629.00
343 DUK Lubang 25x30 Steril (Diameter 5 cm) + Perekat Sachet 6,863.00
344 Elektroda Skintact Foam 43 x 51 mm PAK 87,000.00
345 Endotracheal Tube (ETT) Cuffed (Anak) Size 2,0 PCS 9,600.00
347 Endotracheal Tube (ETT) Cuffed (Dewasa) Size 6,5 PCS 13,100.00
350 Endotracheal Tube (ETT) cuffed (Dewasa) size 8,0 PCS 13,100.00
351 Etakridin (Rivanol) Larutan 0,1 % - 300 ml Botol 3,222.00
352 Etanol 96% Botol 0.00
353 Etanol 70 % - 1 L Botol 27,500.00
354 Etanol 70 % - 100 ml Botol 4,445.00
355 Face Shield (Covid-19) PCS 100,000.00
356 Folley Cateter No.16 G PCS 11,565.00
358 Gel USG/EKG Botol 16,000.00
359 Germicidal Disposable Wipe Paket 0.00
360 Gown Protective PCS 24,750.00
361 Guedel Airway Anak Size 40 mm PCS 12,210.00

364 Guedel Airway Dewasa Size 100 mm PCS 12,574.00
367 HME FIlter PCS 35,000.00
368 Hypafix 5 cm x 5m Roll 0.00
369 Infusion Set Anak PCS 6,400.00
370 Infusion Set Dewasa PCS 5,950.00
371 IV. Catheter No.16 G PCS 8,750.00
376 Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT PCS 16,200.00
377 Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR PCS 13,500.00
378 Jelly Steril 5 gr Sachet 2,200.50
379 Kacamata Goggle Protective PCS 40,000.00
380 Kantong Udara Nafas PCS 10,000.00
381 Kantong Urin PCS 5,500.00
382 Kapas Pembalut / absorben 250 gram BUNGKUS 13,400.00
383 Kartu Pasien Buku 1,000.00
384 Kassa Hidrofil Steril uk. 16 x 16 Kotak 8,000.00
385 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm Roll 153,200.00
386 Kassa pembalut hidrofil 4m x 10 cm Roll 1,898.00

Kassa steril mengandung obat (Framycetin) /
387 LOMATUL / DARYANTUL Lembar 0.00
388 Kertas EKG Roll 187,000.00

Larutan Antiseptik (ASEPTAN) / Desinfectan handrub
389 Kertas USG Sony
mengandung zat 110
aktifHG
dengan kadar minimal Roll 299,999.70
Chlorhexidine Gluconate 0,5% (Aseptan 500 cc +
390 dispenser) Botol 34,650.00
391 Larutan Clorin 5,25% - 1 L (Desinfektan Alat) Botol 0.00
392 Larutan Desinfectan - 1 L (Desinfektan Ruangan) Botol 43,750.00
393 Larutan Desinfektan NaOCl 5% 500 ml Botol 33,750.00

Larutan Enzymatic / Sterizyme ( Desinfektan Alat ) 5
394 Liter Galon 712,800.00
395 Larutan
Larutan H2O2 3% untuk Antiseptik dan Desinfectan
Konsentrat Botol 3,360.00
Instrumen/Peralatan Kedokteran Aldehyd Free /
396 BIOFILM 1 Liter Botol 700,000.00
397 Lysol Konsentrat 1 Liter Botol 40,700.00
398 M-I Gown PCS 27,272.72
399 Masker Bedah Lembar 0.00
400 Masker Ear loop BOX 21,945.00
401 Masker Earlopp Hijab Kotak 15,700.00
402 Masker FFP2 PCS 0.00
403 Masker Kain Headloop dan Earloop PCS 5,500.00
404 Masker KN 95 PCS 0.00
405 Masker N 95 PCS 8,636.36
406 Masker N 95 (Covid-19) PCS 78,750.00
407 Masker nebulizer set anak PCS 19,470.00
408 Masker nebulizer set dewasa PCS 19,470.00
409 Masker O2 / Maxiflow bayi PCS 8,280.00
410 Masker O2 Dewasa PCS 8,178.00
411 Masker O2/ Maxiflow Anak PCS 8,178.00
412 Masker Oksigen Non Rebreathing Anak PCS 12,240.00
413 Masker Oksigen Non Rebreathing Dewasa PCS 12,000.00
414 Masker-Plus 3 ply plus earloop Kotak 45,000.00
415 Mitella ( Kain Segitiga ) PCS 7,920.00
416 Nasal Anak PCS 6,930.00
417 Needle 23 G PCS 0.00

418 Nurse Cap PCS 350.00
419 One Clean Botol 11,000.00
420 Parafilm Kotak 500,000.00
421 Plastik Biohazard Paket 0.00
422 Plester 5 yard X 2 inch Roll 0.00
423 Plester non alergi 0,5 inch / MICROPORE Roll 4,875.29
424 Plester non alergi 5cm x 9,1m / MICROPORE Roll 15,333.34

Plester Tranparan 10 cm x 25 cm ( Anti Air dan
425 Bakteri ) PCS 31,500.00
426 Plesterin Roll Non Woven Uk. 10 cm x 5 m Roll 41,360.00
428 Resuscitator Anak PCS 460,000.00
429 Resuscitator Bayi PCS 460,000.00
430 Resuscitator Dewasa PCS 460,000.00
431 Safety Box 2,5 L PCS 13,900.00
432 Sarung Tangan Kotak 130,000.00
433 Sarung Tangan Non-Steril (Nitril) BOX 194,650.00
434 Sarung Tangan Panjang Karet (Covid-19) Pasang 84,375.00
435 Sepatu Boot (Covid-19) Pasang 60,000.00
436 Shoe Cover Pasang 1,000.00
437 Solida (Kit APD Tk II) PCS 32,000.00
438 Spalk Kayu SET 61,600.00
439 Suction Catheter No. 12 ( Anak ) PCS 4,345.00
440 Suction Catheter No. 16 ( Dewasa ) PCS 4,345.00
441 Suction Catheter No. 6 ( Bayi ) PCS 4,345.00
443 Surface Disinfectant Botol 500 ML / STERICIDE Botol 87,120.00
444 Surgical blade no.11 (Pisau Bedah) PCS 2,790.00

445 Surgical Gown PCS 52,000.00
446 Three Way Stopcock PCS 12,631.00
447 Wing Needle No. 19 PCS 1,400.00
EMBALAGE
451 Kantong Kresek obat + cetakan, ukuran 15 x 30 Lembar 200.00
452 Kantong Plastik Kuning Uk 100 x 80 PCS 2,025.00

Pak
455 Kertas Perkamen ( ukuran 8 x 11 ) /1000lbr 9,000.20
Pak
456 Plastik Klip 13 x 8,7 /100lbr 0.00
457 Plastik Obat dg klip + cetakan, ukuran 10 x 15 cm Lembar 167.00
459 Sendok obat PCS 220.00
AKUPUNTUR
460 Jarum Akupuntur 13 mm Ktk/100 0.00
463 Jarum telinga (press needle) Ktk/100 0.00
464 Moxa Roll Kotak 0.00
OBAT PONED
465 Apron plastik Lembar 2,950.00

Asam Traneksamat Injeksi 500 mg/ 5 ml /
466 HEMOSTATIK INJ. Ampul 1,945.00
Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg / ml /
467 VIT.KA / VIT. K NEONATAL Ampul 3,682.00
468 Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml Ampul 1,733.33

469 Ikat Tali Pusat ( Umbilical Cord klem ) PCS 1,800.00
470 Metildopa 250 mg Tablet 946.00
471 Metilergometrin maleat injeksi 0,200 mg - 1 ml Ampul 1,023.00
472 MgSO4 40 % injeksi Botol 3,796.00
473 Misoprostol Tablet 0,2 mg Tablet 5,500.00
474 Misoprostol tablet 0,2 mg / NOPROSTOL Tablet 0.00
475 Nasal dewasa / Oxyflow dewasa PCS 6,000.00
476 Nasal infant/ Oxyflow neonatal PCS 6,600.00
477 Natrium Bicarbonat injeksi Ampul 6,448.00
478 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 1,126.00
479 Penghisap Lendir Bayi Baru Lahir PCS 6,000.00
480 Sarung Tangan panjang obgyn No. 6,5 Pasang 43,010.00
481 Sarung Tangan panjang obgyn No. 7 Pasang 19,000.00
483 Sarung tangan steril/Surgical gloves steril No. 6,5 Pasang 5,863.00
484 Sarung tangan steril/Surgical gloves steril No. 7 Pasang 3,938.00
486 Sungkup bayi SET 14,520.00
487 Tanda Pengenal (ID Band) Bayi PCS 1,078.00
488 Tanda Pengenal (ID Band) Ibu PCS 1,078.00
489 Under Pad 60 x 90 cm PCS 4,620.00
490 Valethamate Br 8 mg /ml inj / EPIDOSIN INJ. Ampul 0.00
TAMBAHAN
491 Hand Sanitizer Gel Botol 0.00

Ipratropium Bromide 0,5 mg + Salbutamol Sulfate 2,5
492 mg (Meprovent 2,5 ml) Ampul 0.00
VAKSIN
493 Alat Suntik Sekali Pakai 0,3 ml (Pfizer) PCS 1,255.00

494 Alat Suntik Sekali Pakai 3 ml (Pfizer) PCS 569.00
495 Alkohol Swab (Pfizer) PCS 79.00
496 BCG + Pelarut BCG Paket 59,950.00
497 Campak + Pelarut Campak Vial 28,204.00
498 DPT-HB Combo Vial 0.00
499 DPT-HB-HiB Pentavalen Vial 76,285.00
500 DT Vial 17,450.00
501 HB Uniject PCS 20,900.00
502 IPV Vial 154,230.00
503 Natrium Klorida 0,9 % 10 ml (Pfizer) Botol 3,280.00
504 Polio + Dropper Polio Paket 19,954.00
505 Safety Box 5 L (Pfizer) PCS 14,000.00
506 Safety Box 5L PCS 14,000.00
507 SAR (Hyperhab 1 ml) Vial 1,653,399.00
508 Td Vial 16,480.00
509 TT Vial 0.00
510 VAKSIN ANTI RABIES ( VERORAB) Vial 165,000.00
511 Vaksin Anti Rabies (Rabivax-S) Vial 165,000.00
512 Vaksin Comirnaty Pfizer Vial 0.00
513 Vaksin HbIg Vial 1,325,000.00
514 Vaksin Meningitis Formening Vial 135,000.00
515 Vaksin Menivax ACYW 135 Vial 0.00
516 Vaksin MR + Pelarut Vaksin MR Vial 151,150.00
517 Vaksin SARS-CoV-2 Vial 1,339,440.50
518 Vaksin SARS-CoV-2 (2 Dosis) Vial 0.00
519 Vaksin SARS-CoV-2 (AstraZeneca) Vial 581,607.39
520 Vaksin SARS-CoV-2 (Moderna) Vial 0.00

521 Vaksin SARS-CoV-2 (Single Dose) Ampul 0.00
522 Vaksin SARS-CoV-2 (Sinopharm) Vial 0.00
TAMBAHAN OBAT PROGRAM
523 Bingkai KKJH PCS 0.00
524 Kartu Kesehatan Jemaah Haji (KKJH) PCS 0.00
525 Masker Kain (Covid-19) PCS 0.00
526 Tali KKJH PCS 0.00
OBAT HIV AIDS
527 3HP Isoniazid 300 mg / Rifapentin 300 mg Tablet 0.00
528 Abacavir ( ABC ) 120 mg / Lamivudine ( 3TC ) 60 mg Tablet 0.00
529 Abacavir (ABC) 300 mg Tablet 2,218.95
530 Dolutegravir ( DTG ) 50 mg Tablet 1,350.33
531 Efavirenz ( EFV ) 200 mg ( 90 Tablet / Botol ) Tablet 0.00
532 Efavirenz ( EFV ) 600 mg ( 30 Tablet / Botol ) Tablet 6,630.00
533 Isoniazid (INH) 300 mg Tablet 150.00
534 Kondom Ukuran

Kotrimoksazol 52 mm
DOEN I (dewasa) Kombinasi : PCS 358.00
Sulfametoksazol 800 mg / Trimetoprim 160 mg (Prog
535 HIV) Tablet 325.00
536 Lamivudine ( 3TC ) 150 mg ( 60 Tablet / Botol ) Tablet 1,560.00

Lopinavir ( LPV ) 200 mg / Ritonavir ( R ) 50 mg ( 120
537 Tablet / Botol ) Tablet 6,600.00
538 Nevirapine ( NVP ) 200 mg ( 60 Tablet / Botol ) Tablet 2,800.00
539 Rilpivirine ( RPV ) 25 mg Tablet 3,091.00
540 Tenofovir ( TDF ) 300 mg ( 30 Tablet / Botol ) Tablet 8,424.00

Tenofovir ( TDF ) 300 mg / Emtricitabine ( FTC ) 200
541 mg ( 30 Tablet / Botol ) Tablet 4,655.00
Tenofovir (TDF) 300 mg / Lamivudine (3TC) 300 mg /
542 Triple
Dolutegravir (DTG) 50 (mg
FDC ( Tenofovir TDF ) 300 mg / Lamivudine Tablet 2,793.86
( 3TC ) 300 mg / Efavirenz ( EFV ) 600 mg ( 30 Tablet /
543 Botol ) Tablet 6,630.00
544 Zidovudin 100 mg ( 60 tab/ btl ) Tablet 1,700.00

Zidovudine ( ZDV ) 300 mg / Lamivudine ( 3TC ) 150
546 Zidovudine ( ZDV ) sirup ( 50 mg / 5 ml ) Botol 30,357.00
OBAT PROGRAM MALARIA
547 Chloroquine Phosphate Tab 150 mg Tablet 1,506.00
548 Dehydro Artemisin 40 mg + Piperaquin 320 mg ( DHP ) Tablet 1,900.00
549 Primaquine Tab 15 mg Tablet 235.00

JUMLAH - -
Mengetahui / Menyetujui, Mengetahui / Menerima,

Kepala Dinas Kesehatan Kepala UPT Instalasi Farmasi
dr. DINI ANGGRAENI,MM Ratna Sumirat, S.Si, M.Farm, Apt

NIP. 197705012005012010 NIP. 197805101997022001
STOK AWAL MARET PENERIMAAN MARET
UGD RAWAT APOTEK GUDANG TOTAL PUSTU PONED UGD RAWAT APOTEK
INAP STOK INAP
AWAL
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5000 0 5000 0
0 0 0
0 0 0
30 0 30 0
3 50 53 50
0 0 0
55 200 255 0
0 0 0
0 0 0
30 30 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
16 16 16
0 0 0
200 200 0
600 1000 1600 0
0 0 0
0 0 0
25 25 0
0 0 0
0 0 0
0 0 0
0 0 0
799 11200 11999 7000
0 0 0
0 0 0
0 0 0
405 900 1305 0
0 0 0
0 0 0
0 0 0
30 150 180 0
0 0 0
1 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5000 5000 0
0 0 0
0 0 0
0 0 0
0 0 0
183 1300 1483 1000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
125 100 225 0
0 0 0
0 0 0
25 300 325 150
200 200 100
0 0 0
0 0 0
0 0 0
2 2 1
2 2 0
300 300 0
0 0 0
0 0 0
0 0 0
0 0 0
24 24 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
400 4000 4400 4000
0 0 0
225 750 975 0
200 200 200
0 0 0
0 0 10
0 0 0
0 0 0
0 0 0
0 0 0
200 200 200
0 0 0
0 0 0
0 0 0
48 48 0
30 30 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 0 200 400
0 0 0
0 0 0
0 0 0
100 200 300 300
0 0 0
0 0 0
0 0 0
0 0 0
1 72 73 24
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
14 14 5
23 200 223 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
147 0 147 0
0 0 5
0 0 0
5 5 0
0 0 0
0 0 0
97 97 0
0 0 100
0 0 0
0 0 0
0 0 0
0 0 0
505 2700 3205 800
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 10 10
0 0 0
220 800 1020 0
0 0 0
0 0 0
0 0 0
15 15 5
0 0 0
0 0 0
24 72 96 0
0 0 0
0 0 0
0 0 0
8 8 13
0 0 0
0 0 0
0 0 0
0 0 0
350 4500 4850 1850
63 600 663 400
2 14 16 6
0 0 0
0 0 0
0 0 0
58 100 158 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
36 36 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 15
0 0 0
0 0 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 100
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 40
0 0 0
0 0 0
0 0
0 0 0
33 200 233 100
0 0 0
75 200 275 200
2 0 2 0
69 0 69 0
0 0 0 0
3 0 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
230 500 730 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
122 200 322 100
0 0 0 0
500 1000 1500 500
0 0 0
0 0 0
262 1500 1762 1000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1
0 0 0
1 1 0
0 0 0
0 0 0
0 0 0
2 2 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 3820
0 0 0
0 0 0
37 37 2
0 0 0
0 0 0
5 5 0
0 0 3820
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2
0 0 0
1 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 0
10 10 0
0 0 0
0 0 0
5 5 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
530 530 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 0
0 0 0
0 0 0
750 750 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 0
1 1 0
1 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
750 750 0
0 0 0
5 5 0
0 0 0
0 0 0
0 0 0
0 0 0
89 89 19
5 5 0
970 970 170
4 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 1000 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
490 490 50
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
43 43 0
45 45 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
20 20 10
0 0
0 0
0 0
0 1914
0 164
0 1914
30 30 60
0 0
0 0
20 20 30
98 98 8
50 50 88
0 0
0 164
20 20 70
0 18
0 38
0 0
76 76 46
0 0
0 0
0 0
0 164
0 0
0 0
0 0
100 100 50
0 0
10 10 263
0 159
0 0
0 134
0 0
0 0
0 0
0 0
0 0
0 72
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
- - 5,781.00 44,222.00 50,003.00 - - - - 31,923.00
Mengetahui / Menerima, Mengetahui / Menyerahkan, Mengetahui,

Kepala UPT Instalasi Farmasi Kepala PKM Ciledug Pengurus Barang Pembantu Puskesma
tna Sumirat, S.Si, M.Farm, Apt dr. Hj. Siti Nikmah, MKM Suprihartiwi, AMF
NIP. 197805101997022001 NIP. 1974 NIP. 197601172009022004
N MARET PERSEDIAAN PEMAKAIAN M
GUDANG TOTAL PUSTU PONED UGD RAWAT INAP APOTEK RAWAT
PENERIMAAN INAP
17 18 22
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10400 10400 5000
5100 5100 0
0 0 0
0 0 30
0 50 53
0 0 0
0 0 55
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 16 16
0 0 0
0 0 0
0 0 600
0 0 0
0 0 0
25 25 0
0 0 0
0 0 0
0 0 0
0 0 0
0 7000 7799
0 0 0
136000 136000 0
0 0 0
0 0 405
0 0 0
0 0 0
0 0 0
0 0 30
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1000 1183
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 125
0 0 0
0 0 0
0 150 175
0 100 100
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 5 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 4000 4400
0 0 0
0 0 225
0 200 200
0 0 0
31 41 10
0 0 0
0 0 0
0 0 0
0 0 0
0 200 200
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 200 0
0 0 0
0 0 0
0 0 0
1000 1400 600
0 0 0
0 0 0
0 0 0
100 400 400
0 0 0
0 0 0
0 0 0
0 0 0
0 24 25
0 0 0
0 0 0
0 0 0
540 540 0
0 0 0
0 0 0
0 0 0
0 5 5
0 0 23
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 147
5 10 5
0 0 0
0 0 0
0 0 0
0 0 0
96 96 0
200 300 100
0 0 0
0 0 0
0 0 0
0 0 0
0 800 1305
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 10 10
0 0 0
0 0 220
0 0 0
0 0 0
0 0 0
0 5 5
0 0 0
0 0 0
0 0 24
0 0 0
0 0 0
0 0 0
5 18 13
0 0 0
0 0 0
0 0 0
0 0 0
0 1850 2200
0 400 463
0 6 8
0 0 0
0 0 0
0 0 0
0 0 58
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
15 30 15
0 0 0
10 20 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
500 600 100
0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0
40 80 40
0 0 0
0 0 0
0 0
0 0 0
0 100 133
0 0 0
0 200 275
0 0 2
0 0 69
0 0 0
0 0 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 230
0 0 0
0 0 0
0 0 0
0 0 0
0 100 222
0 0 0
0 500 1000
0 0 0
0 0 0
0 1000 1262
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
3820 7640 3820
0 0 0
0 0 0
0 2 2
0 0 0
0 0 0
0 0 0
3820 7640 3820
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 5 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 19 19
0 0 0
0 170 170
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 1000 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 50 50
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 20 10
0 0 0
0 0
0 0 0
0 0 0
0 0
1914 3828 1914

164 328 164
1914 3828 1914
80 140 60
0 0 0
0 0 0
80 110 30
0 8 8
38 126 88
0 0 0
164 328 164
50 120 70
18 36 18
38 76 38
0 0 0
0 46 46
0 0 0
0 0 0
0 0 0
164 328 164
0 0 0
0 0 0
0 0 0
0 50 50
0 0 0
253 516 263
159 318 159
0 0 0
134 268 134
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
72 144 72
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
152,659.00 184,582.00 - - - - 37,704.00 -
Mengetahui, Yang Membuat,

ngurus Barang Pembantu Puskesmas Pengelola Obat
Suprihartiwi, AMF Suprihartiwi, AMF

NIP. 197601172009022004 NIP. 1976011720090220
PEMAKAIAN MARET STOK AKHIR MARET
APOTEK GUDANG TOTAL PUSTU PONED UGD RAWAT APOTEK GUDANG
PEMAKAIAN INAP
23 24 25 26 27 28 29 30 31
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
3550 - 3550 1450 10400
- 0 0 5100
- 0 0 0
21 - 21 9 0
15 50 65 38 0
- 0 0 0
55 - 55 0 200
- 0 0 0
- 0 0 0
- 0 0 30
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
16 16 32 0 0
- 0 0 0
- 0 0 200
600 - 600 0 1000
- 0 0 0
- 0 0 0
- 0 0 50
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
7000 7000 14000 799 4200
- 0 0 0
- 0 0 136000
- 0 0 0
180 - 180 225 900
- 0 0 0
- 0 0 0
- 0 0 0
30 - 30 0 150
- 0 0 0
- 0 0 1
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 5000
- 0 0 0
0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
350 1000 1350 833 300
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
35 - 35 90 100
- 0 0 0
- 0 0 0
175 150 325 0 150
100 100 200 0 100
- 0 0 0
- 0 0 0
- 0 0 0
1 1 2 0 1
- 0 0 2
- 0 0 300
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
2 5 7 3 19
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
3500 4000 7500 900 0
- 0 0 0
150 - 150 75 750
60 200 260 140 0
- 0 0 0
5 10 15 5 21
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
20 200 220 180 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 48
- 0 0 30
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 200
- 0 0 0
- 0 0 0
- 0 0 0
350 400 750 250 600
- 0 0 0
- 0 0 0
- 0 0 0
250 300 550 150 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
25 24 49 0 48
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 540
- 0 0 0
- 0 0 0
- 0 0 0
5 5 10 0 9
- 0 23 200
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
147 - 147 0 0
5 5 10 0 0
- 0 0 0
- 0 0 5
- 0 0 0
- 0 0 0
- 0 0 193
58 100 158 42 100
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
1230 800 2030 75 1900
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
10 10 20 0 0
- 0 0 0
68 - 68 152 800
- 0 0 0
- 0 0 0
- 0 0 0
5 5 10 0 10
- 0 0 0
- 0 0 0
7 - 7 17 72
- 0 0 0
- 0 0 0
- 0 0 0
13 13 26 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
2200 1850 4050 0 2650
130 400 530 333 200
4 6 10 4 8
- 0 0 0
- 0 0 0
- 0 0 0
- 0 58 100
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 36
- 0 0 0
0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
15 15 30 0 0
- 0 0 0
10 10 20 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
40 100 140 60 400
0 0
- 0 0 0
0 0
- 0 0 0
- 0 0 0
- 0 0 0
0 0
40 40 80 0 0
- 0 0 0
- 0 0 0
0 0
- 0 0
60 100 160 73 73
- 0 0 0
45 200 245 230 230
2 - 2 0 0
11 - 11 58 58
- 0 0 0
- 0 3 3
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 230 230
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
120 100 220 102 102
- 0 0 0
300 500 800 700 700
- 0 0 0
- 0 0 0
350 1000 1350 912 912
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
- 0 0
- 0 0
- 0 0
3820 3820 7640 0
- 0 0
- 0 0
2 2 4 0
- 0 0
- 0 0
- 0 0
3820 3820 7640 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
2 2 4 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
5 5 10 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
19 19 38 0
- 0 0
170 170 340 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
0 0
50 50 100 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
10 10 20 0
- 0 0
0 0
- 0 0
- 0 0
0 0
1914 1914 3828 0

164 164 328 0
1914 1914 3828 0
60 60 120 0
- 0 0
- 0 0
30 30 60 0
8 8 16 0
88 88 176 0
- 0 0
164 164 328 0
70 70 140 0
18 18 36 0
38 38 76 0
- 0 0
46 46 92 0
- 0 0
- 0 0
- 0 0
164 164 328 0
- 0 0
- 0 0
- 0 0
50 50 100 0
- 0 0
263 263 526 0
159 159 318 0
- 0 0
134 134 268 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
72 72 144 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
0 0
- 0 0
- 0 0
- 0 0
30,982.00 31,923.00 62,905.00 - - - 2,308.00 6,722.00 157,423.00
Yang Membuat,
Pengelola Obat
Suprihartiwi, AMF
NIP. 197601172009022004
NILAI STOK AKHIR
TOTAL STOK
AKHIR
32 33
0 0
0 0
0 0
0 0
0 0
11850 829500
5100 270300
0 0
9 25200
38 132924
0 0
200 335800
0 0
0 0
30 97500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 17800
1000 42000
0 0
0 0
50 175000
0 0
0 0
0 0
0 0
4999 1129774
0 0
136000 0
0 0
1125 99000
0 0
0 0
0 0
150 20550
0 0
1 84920
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5000 495000
0 0
0 0
0 0
0 0
0 0
1133 80443
0 0
0 0
0 0
0 0
0 0
0 0
190 142120
0 0
0 0
150 44250
100 30000
0 0
0 0
0 0
1 7200
2 13254
300 63000
0 0
0 0
0 0
0 0
22 136400
0 0
0 0
0 0
0 0
0 0
0 0
900 54000
0 0
825 237600
140 210000
0 0
26 52182
0 0
0 0
0 0
0 0
180 23940
0 0
0 0
0 0
48 216000
30 36870
0 0
0 0
0 0
200 15400
0 0
0 0
0 0
850 297500
0 0
0 0
0 0
150 15300
0 0
0 0
0 0
0 0
48 163872
0 0
0 0
0 0
540 459000
0 0
0 0
0 0
9 61200
223 51513
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 4365
0 0
0 0
193 960368
142 167702
0 0
0 0
0 0
0 0
1975 212905
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
952 80920
0 0
0 0
0 0
10 125400
0 0
0 0
89 207637
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2650 397500
533 132184
12 248400
0 0
0 0
0 0
158 142200
0 0
0 0
0 0
0 0
0 0
0 0
36 89604
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
460 178020
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
146 24382
0 0
460 515660
0 0
116 9976
0 0
6 75438
0 0
0 0
0 0
0 0
0 0
0 0
0 0
460 27140
0 0
0 0
0 0
0 0
204 32028
0 0
1400 172200
0 0
0 0
1824 114912
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
166,453.00 8,491,529.00
LAPORAN STOK AKHIR OBAT BULAN APRIL TAHUN 2022
UPT PKM CILEDUG
JL. Raden Patah
NO. NAMA BARANG SATUAN HARGA SATUAN STOK

PUSTU PONED
1 2 3 4 5 6
Obat
10 Amoksilin sirup Ikering

Antasida DOEN tablet250 mg/ 5kombinasi
kunyah, ml - 60 ml: Botol 3,498.00
11 Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium Tablet 58.00
12 mg /5 ml - 60 ml Botol 1,679.00

22 Antimigren
Antiseptik &: kortikosteroid
Ergotamin Tartrat 1 mg
Tetes + Kofein
mata 50 mg3,5
(Neomycin Tablet 185.00




70 Furosemide
Garam OralitInjeksi 10 mg/ml
I serbuk, kombinasi : Natrium 0,52 g, Ampul 1,333.00




105 80.000) - 2 ml Ampul 1,229.00

118 0,125 mg Tablet 224.00



Obat Analgetik
Obat Analgetik -(Antalgin 250- batuk
antipiretik mg ; Amidopyrin
kaplet 50 mg ;
135 Lidocain HCl 10
(Paracetamol 500mgmg,
) / ETAMIDON INJEKSI HBr 15 mg,
Dextromethorphan Vial 0.00
136 Obat
Maleat 2 mg, ) -/vitamin
Analgetik ALPARA KAPLET kaplet
B kompleks Kaplet 0.00
137 50 mg,
Obat Vitamin kombinasi
Analgetik B12 100 mcg) / Psikotropik
dengan ERLAGIN kaplet Tablet 0.00
138 METANEURON
Obat Antiinfluenza kaplet ( Paracetamol 500 mg. Tablet 0.00
Phenylpropanolamin
Obat HCl (12,5
Antiinfluenza syrup mg+ Chlorpheniramin
Parasetamol 125 mg,
139 Maleat 2 mg ) / MOLEXFLU
Phenylprophanolamine KAPLET
HCl 3.125 mg, Kaplet 0.00
Chlorpheniramine Maleate 0.5sirup
Obat Antitusif - ekspektorant mg )( -Diphenhydramin
60 ml /
140 HCl
MOLEXFLU
12,5 mg+SYRUP
Ammonium Chlorida 125 mg+ Sodium Botol 0.00
146 IU ) - 20
Obat gr / THROMBOPHOP
spasmodikum GEL
tablet (Metampiron 500 mg, Tube 0.00
Ekstrak
Obat Belladona
Tetes 10 mg, Papaverin
mata kombinasi HCl
antiseptik & 25 mg) /
kortikosteroid
147 SPASMINAL
(Dexamethason Sod.Phosfate 1,0 mg, Neomycin Tablet 0.00


Supposito

180 endap 4 % - 30 gr Pot 2,333.00
181 Eugenol 1,5%)
Salep kulit - 30 gr antiinfeksi
kombinasi / PAINKILLAdgn kortikosteroid Tube 0.00

197 Tramadol
(Vit. B1 15Injeksi 50B2
mg, Vit. mg/ml
10 mg, Vit. B6 5 mg, Vit. B12 Ampul 1,764.00

OBAT PROGRAM IMS

OBAT PROGRAM
Mineral GIZIKlorida 1.792 g, Trikalium Sitrat
Mix (Kalium
OBAT KEJIWAAN

OBAT GIGI
270 Cavit Pot 109,714.00
272 CHKM Botol 65,000.00



295 bonding) Paket 1,720,393.00


322 bedah PCS 0.00

353 Etanol 70 % - 1 L Botol 27,500.00
354 Etanol 70 % - 100 ml Botol 4,445.00



389 Kertas USG Sony
mengandung zat 110
aktifHG
dengan kadar minimal Roll 299,999.70

394 Liter Galon 712,800.00
395 Larutan
Larutan H2O2 3% untuk Antiseptik dan Desinfectan
Konsentrat Botol 3,360.00
398 M-I Gown PCS 27,272.72
405 Masker N 95 PCS 8,636.36


425 Bakteri ) PCS 31,500.00
431 Safety Box 2,5 L PCS 13,900.00

EMBALAGE

Pak
Pak
AKUPUNTUR
OBAT PONED


489 Under Pad 60 x 90 cm PCS 4,620.00
TAMBAHAN

VAKSIN

500 DT Vial 17,450.00
502 IPV Vial 154,230.00
508 Td Vial 16,480.00
509 TT Vial 0.00

OBAT HIV AIDS
534 Kondom Ukuran

Kotrimoksazol 52 mm
DOEN I (dewasa) Kombinasi : PCS 358.00


542 Triple
Dolutegravir (DTG) 50 (mg
FDC ( Tenofovir TDF ) 300 mg / Lamivudine Tablet 2,793.86


JUMLAH - -


NIP. 197705012005012010 NIP. 197805101997022001
STOK AWAL APRIL PENERIMAAN APRIL
UGD RAWAT APOTEK GUDANG TOTAL STOK PUSTU PONED UGD RAWAT APOTEK
INAP AWAL INAP
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1450 10400 11850
0 5100 5100
0 0 0
9 0 9
38 0 38
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0 200 200
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0 30 30
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0 200 200 100
0 1000 1000 1000
0 0 0
0 0 0
0 50 50
0 0 0
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0 0 0
799 4200 4999 3500
0 0 0
0 136000 136000 5600
0 0 0
225 900 1125 300
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0 150 150 -
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900 0 900 4400
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75 750 825 600
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5 21 26 11
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180 0 180 -
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0 48 48 -
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0 0 0 -
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250 600 850 900
0 0 0 5000
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150 0 150 800
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42 100 142 -
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75 1900 1975 1200
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152 800 952 -
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- - 6,722.00 164,961.00 171,683.00 - - - - 30,588.00

Kepala UPT Instalasi Farmasi Kepala PKM Ciledug Pengurus Barang Pembantu Puskes
NIP. 197805101997022001 NIP. 1974 NIP. 19760117200902200
N APRIL PEMAKAIAN APRIL
GUDANG TOTAL PUSTU PONED UGD RAWAT APOTEK GUDANG TOTAL
PENERIMAAN INAP PEMAKAIAN
17 18 19 20 21 22 23 24 25
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 1450 - 1450
- 0 - 0
- 0 - 0
- 0 9 - 9
- 0 38 - 38
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- 0 - 0
- 0 - 0
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- 0 - 0
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- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
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10000 11000 980 1000 1980
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- 0 - 0
- 0 - 0
- 0 - 0
3 3 - 0
- 0 - 0
- 0 - 0
- 3500 4299 3500 7799
- 0 - 0
- 5600 5100 5600 10700
- 0 - 0
- 300 250 300 550
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
1000 1000 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 100 60 100 160
- 0 - 0
- 0 - 0
- 150 150 150 300
- 100 60 100 160
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- 0 - 0
- 0 - 0
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- 0 - 0
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- 0 - 0
- 0 - 0
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7000 11400 3500 4400 7900
- 0 - 0
- 600 340 600 940
- 0 - 0
- 0 - 0
- 11 7 11 18
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- 0 - 0
- 0 - 0
- 0 - 0
200 200 - 0
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- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
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600 1500 980 900 1880
5000 10000 5000 5000 10000
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2000 2800 450 800 1250
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- 48 48 48 96
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- 180 60 180 240
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- 60 60 60 120
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204 408 204 204 408

17 34 17 17 34
204 408 204 204 408
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- 70 70 70 140
- 30 30 30 60
100 200 100 100 200
60 105 45 45 90
17 34 17 17 34
50 100 50 50 100
2 4 2 2 4
11 22 11 11 22
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17 34 17 17 34
2 3 1 1 2
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18 33 12 15 27
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29,515.00 60,103.00 - - - - 28,609.00 30,588.00 59,197.00
Tangerang, 16 APRIL 2021

gurus Barang Pembantu Puskesmas Pengelola Obat

NIP. 197601172009022004 NIP. 197601172009022004
STOK AKHIR APRIL NILAI STOK AKHIR
PUSTU PONED UGD RAWAT APOTEK GUDANG TOTAL STOK
INAP AKHIR
26 27 28 29 30 31 32 33
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10400 10400 728000
5100 5100 270300
0 0 0
0 0 0
0 0 0
0 0 0
200 200 335800
0 0 0
0 0 0
30 30 97500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
40 100 140 12460
20 10000 10020 420840
0 0 0
0 0 0
50 50 175000
0 0 0
3 3 4917
0 0 0
0 0 0
0 700 700 158200
0 0 0
500 130400 130900 0
0 0 0
275 600 875 77000
0 0 0
0 0 0
0 0 0
150 150 20550
0 0 0
1 1 84920
0 0 0
0 0 0
0 0 0
0 0 0
1000 1000 90000
0 0 0
0 0 0
0 0 0
5000 5000 495000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
300 300 21300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
130 0 130 97240
0 0 0
0 0 0
0 0 0
40 0 40 12000
0 0 0
0 0 0
0 0 0
1 1 7200
2 2 13254
300 300 63000
0 0 0
0 0 0
0 0 0
0 0 0
19 19 117800
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1800 2600 4400 264000
0 0 0
335 150 485 139680
0 0 0
0 0 0
9 10 19 38133
0 0 0
0 0 0
0 0 0
0 0 0
200 200 26600
0 0 0
0 0 0
0 0 0
48 48 216000
30 30 36870
0 0 0
0 0 0
0 0 0
200 200 15400
0 0 0
0 0 0
0 0 0
170 300 470 164500
0 0 0
0 0 0
0 0 0
500 1200 1700 173400
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
120 360 480 408000
0 0 0
0 0 0
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5 5 34000
200 200 46200
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4 4 3492
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143 0 143 711568
100 100 118100
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75 700 775 83545
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800 800 68000
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0 0 0
0 2100 2100 315000
200 200 49600
8 8 165600
0 0 0
0 0 0
0 0 0
100 100 90000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
36 36 89604
0 0 0
0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
140 200 340 131580
0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
53 0 53 8851
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
610 0 610 35990
80 0 80 4800
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0
670 0 670 82410
0 0 0
0 0 0
912 0 912 57456
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 93500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 174000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 32000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
16 16 17600
32 32 320000
0 0 0
0 0 0
5 5 19500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 10 340040
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 114000
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 64440
0 0 0
0 0 0
0 0 0
0 0 0
8 8 92520
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 10 64000
0 0 0
0 0 0
0 0 0
0 0 0
2 2 11572
10 10 151800
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 6720
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
530 530 8321000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 23760
0 0 0
0 0 0
750 750 262500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 460000
1 1 460000
1 1 460000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
750 750 750000
0 0 0
5 5 308000
0 0 0
0 0 0
0 0 0
0 0 0
70 70 6098400
5 5 13950
700 700 36400000
4 4 50524
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2000 2000 440000
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
380 380 1121000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 7592
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
43 43 1849430
45 45 855000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 92400
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 2997500
0 0 0
0 0 0
0 0 0
60 60 1047000
0 0 0
15 15 2313450
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
22 22 362560
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1325000
0 0 0
0 0 0
10 10 1511500
0 0 0
0 0 0
13 13 7560896.07
3 3 6 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
- - - - 6,625.00 163,888.00 170,513.00 82,370,390.07
LAPORAN STOK AKHIR OBAT BULAN MEI TAHUN 2022
UPT PKM CILEDUG
JL. Raden Patah
NO. NAMA BARANG SATUAN HARGA SATUAN STOK A

PUSTU PONED
1 2 3 4 5 6
Obat
Antasida DOEN I tablet kunyah, kombinasi :

11 Hidroksida 200 mg Tablet 58.00
Antasida DOEN II suspensi, kombinasi : Aluminium

12 mg /5 ml - 60 ml Botol 1,679.00


22 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 185.00
Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5




70 Furosemide Injeksi 10 mg/ml Ampul 1,333.00
Garam Oralit I serbuk, kombinasi : Natrium 0,52 g,


105 80.000) - 2 ml Ampul 1,229.00
118 0,125 mg Tablet 224.00

Obat Analgetik (Antalgin 250 mg ; Amidopyrin 50 mg ;
135 Lidocain HCl 10 mg ) / ETAMIDON INJEKSI Vial 0.00
Obat Analgetik - antipiretik - batuk kaplet

(Paracetamol 500 mg, Dextromethorphan HBr 15 mg,
136 Maleat 2 mg, ) / ALPARA KAPLET Kaplet 0.00
Obat Analgetik - vitamin B kompleks kaplet

137 50 mg, Vitamin B12 100 mcg) / ERLAGIN Tablet 0.00
Obat Analgetik kombinasi dengan Psikotropik kaplet

138 METANEURON Tablet 0.00
Obat Antiinfluenza kaplet ( Paracetamol 500 mg.

Phenylpropanolamin HCl 12,5 mg+ Chlorpheniramin
139 Maleat 2 mg ) / MOLEXFLU KAPLET Kaplet 0.00
Obat Antiinfluenza syrup ( Parasetamol 125 mg,

Phenylprophanolamine HCl 3.125 mg,
140 MOLEXFLU SYRUP Botol 0.00
Obat Antitusif - ekspektorant sirup ( Diphenhydramin

HCl 12,5 mg+ Ammonium Chlorida 125 mg+ Sodium

146 IU ) - 20 gr / THROMBOPHOP GEL Tube 0.00
Obat spasmodikum tablet (Metampiron 500 mg,

Ekstrak Belladona 10 mg, Papaverin HCl 25 mg) /
147 SPASMINAL Tablet 0.00
Obat Tetes mata kombinasi antiseptik & kortikosteroid
(Dexamethason Sod.Phosfate 1,0 mg, Neomycin

Supposito
180 endap 4 % - 30 gr Pot 2,333.00
181 Eugenol 1,5%) - 30 gr / PAINKILLA Tube 0.00
Salep kulit kombinasi antiinfeksi dgn kortikosteroid

197 Tramadol Injeksi 50 mg/ml Ampul 1,764.00

(Vit. B1 15 mg, Vit. B2 10 mg, Vit. B6 5 mg, Vit. B12
OBAT PROGRAM IMS
OBAT PROGRAM GIZI

OBAT KEJIWAAN
OBAT GIGI
270 Cavit Pot 109,714.00
272 CHKM Botol 65,000.00


295 bonding) Paket 1,720,393.00
322 bedah PCS 0.00


353 Etanol 70 % - 1 L Botol 27,500.00
354 Etanol 70 % - 100 ml Botol 4,445.00

389 Kertas USG Sony 110 HG Roll 299,999.70

mengandung zat aktif dengan kadar minimal
394 Liter Galon 712,800.00
395 Larutan H2O2 3% Botol 3,360.00
Larutan Konsentrat untuk Antiseptik dan Desinfectan

398 M-I Gown PCS 27,272.72
405 Masker N 95 PCS 8,636.36
425 Bakteri ) PCS 31,500.00
431 Safety Box 2,5 L PCS 13,900.00
EMBALAGE
Pak
Pak
AKUPUNTUR
OBAT PONED

489 Under Pad 60 x 90 cm PCS 4,620.00
TAMBAHAN

VAKSIN
500 DT Vial 17,450.00
502 IPV Vial 154,230.00

508 Td Vial 16,480.00
509 TT Vial 0.00
OBAT HIV AIDS

534 Kondom Ukuran 52 mm PCS 358.00
Kotrimoksazol DOEN I (dewasa) Kombinasi :

542 Dolutegravir (DTG) 50 mg Tablet 2,793.86
Triple FDC ( Tenofovir ( TDF ) 300 mg / Lamivudine


JUMLAH - -


NIP. 197705012005012010 NIP. 197805101997022001
STOK AWAL MEI PENERIMAAN MEI
INAP STOK INAP
AWAL
7 8 9 10 11 12 13 14 15 16
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
10400 10400 2000
5100 5100 5100
0 0 -
0 0 -
0 0 60
0 0 -
200 200 100
0 0 -
0 0 -
30 30 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
40 100 140 -
20 10000 10020 3000
0 0 -
0 0 -
50 50 25
0 0 -
3 3 -
0 0 -
0 0 -
0 700 700 700
0 0 -
500 130400 130900 17300

0 0 -
275 600 875 600
0 0 -
0 0 -
0 0 -
150 150 -
0 0 -
1 1 -
0 0 -
0 0 -
0 0 -
0 0 -
1000 1000 500
0 0 -
0 0 -
0 0 -
5000 5000 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
300 300 300
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
130 0 130 -
0 0 -
0 0 -
0 0 50
40 0 40 -
0 0 -
0 0 -
0 0 -
1 1 -
2 2 -
300 300 -
0 0 -
0 0 -
0 0 -
0 0 -
19 19 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
1800 2600 4400 1000
0 0 -
335 150 485 250
0 0 -
0 0 -
9 10 19 20
0 0 -
0 0 25
0 0 -
0 0 -
200 200 -
0 0 -
0 0 100
0 0 -
48 48 -
30 30 30
0 0 -
0 0 -
0 0 -
200 200 -
0 0 -
0 0 -
0 0 -
170 300 470 1100
0 0 -
0 0 -
0 0 -
500 1200 1700 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 48
0 0 -
0 0 -
0 0 -
120 360 480 -
0 0 -
0 0 -
0 0 -
5 5 4
200 200 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
4 4 2
0 0 -
0 0 -
143 0 143 -
100 100 100
0 0 -
0 0 -
0 0 -
0 0 -
75 700 775 700
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
800 800 600
0 0 -
0 0 -
0 0 -
5 5 -
0 0 -
0 0 -
72 72 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 2100 2100 2100
200 200 -
8 8 -
0 0 -
0 0 -
0 0 -
100 100 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
36 36 36
0 0 -
0 0 0 84
0 0 -
0 0 -
0 0 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 15
0 0 -
0 0 5
0 0 -
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0 0 -
0 0 -
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0 0 2
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
140 200 340 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
53 0 53 100
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
610 0 610 300
80 0 80 200
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
670 0 670 300
0 0 -
0 0 -
912 0 912 300
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
1 1 -
0 0 -
0 0 -
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2 2 -
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1 1 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
16 16 -
32 32 -
0 0 -
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5 5 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
10 10 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 -
1 1 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
20 20 5
0 0 -
0 0 -
0 0 -
0 0 -
8 8 -
0 0 -
0 0 1
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
10 10 -
0 0 -
0 0 -
0 0 -
0 0 -
2 2 -
10 10 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
2 2 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
530 530 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
3 3 -
0 0 -
0 0 -
750 750 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
1 1 1
1 1 1
1 1 1
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
750 750 -
0 0 -
5 5 -
0 0 -
0 0 -
0 0 -
0 0 -
70 70 -
5 5 -
700 700 75
4 4 -
0 0 -
0 0 -
0 0 -
0 0 -
0
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
2000 2000 -
0
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0
380 380 70
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
2 2 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
43 43 -
45 45 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
20 20 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
50 50 20
0 0 -
0 0 -
0 0 56
60 60 -
0 0 38
15 15 12
0 0 -
0 0 70
0 0 -
0 0 -
0 0 -
22 22 7
0 0 -
0 0 -
0 0 -
0 0 -
1 1 -
0 0 -
0 0 -
10 10 15
0 0 -
0 0 -
13 13 4
3 3 6 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
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0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
- - 6,625.00 163,888.00 170,513.00 - - - - 30,272.00

Kepala UPT Instalasi Farmasi Kepala PKM Ciledug Pengurus Barang Pembantu Puskesmas
NIP. 197805101997022001 NIP. 1974 NIP. 197601172009022004
N MEI PEMAKAIAN MEI
17 18 19 20 21 22 23 24 25
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 2000 2000 2000 4000
- 5100 4900 5100 10000
- 0 - 0
- 0 - 0
60 120 53 60 113
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- 0 - 0
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- 0 - 0
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5 5 - 0
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100 100 - 0
- 3000 2500 3000 5500
- 0 - 0
- 0 - 0
- 25 14 25 39
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 700 700 700 1400
- 0 - 0
- 17300 16130 17300 33430

- 0 - 0
- 600 320 600 920
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
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- 0 - 0
- 500 360 500 860
- 0 - 0
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- 0 - 0
- 0 - 0
- 300 230 300 530
- 0 - 0
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100 150 50 50 100

200 200 - 0
- 0 - 0
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- 0 - 0
- 0 - 0
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- 0 - 0
- 0 - 0
- 0 - 0
3500 4500 2580 1000 3580
- 0 - 0
700 950 320 250 570
- 0 - 0
- 0 - 0
30 50 15 20 35
- 0 - 0
25 50 25 25 50
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
100 200 100 100

- 0 - 0
- 0 - 0
- 30 30 30 60
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
- 0 - 0
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- 0 - 0
1000 2100 980 1100 2080
7000 7000 - 0
- 0 - 0
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72 120 48 48 96
- 0 - 0
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- 700 775 700 1475
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1000 1000 - 0
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- 600 250 600 850
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- 2100 2060 2100 4160
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- 36 36 36 72
1000 1000 - 0
0
84 168 84 84 168
- 0 - 0
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15 30 15 15 30
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5 10 5 5 10
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2 4 2 2 4
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100 100 - 0
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0
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200 300 63 100 163
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10 10 - 0
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700 1000 120 300 420
300 500 210 200 410
- 0 - 0
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700 1000 340 300 640
- 0 - 0
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700 1000 340 300 640
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18,145.00 48,417.00 - - - - 29,029.00 30,272.00 59,301.00
Tangerang, 16 MEI 2021


NIP. 197601172009022004 NIP. 197601172009022004
STOK AKHIR MEI NILAI STOK AKHIR
INAP AKHIR
26 27 28 29 30 31 32 33
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 8400 8400 588000
200 0 200 10600
0 0 0
0 0 0
7 0 7 24486
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43 100 143 240097
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30 30 97500
0 0 0
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0 0 0
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0 0 0
5 5 13250
0 0 0
200 200 17800

520 7000 7520 315840
0 0 0
0 0 0
11 25 36 126000
0 0 0
3 3 4917
0 0 0
0 0 0
0 0 0 0
0 0 0
1670 113100 114770 0

0 0 0
555 0 555 48840
0 0 0
0 0 0
0 0 0
150 150 20550
0 0 0
1 1 84920
0 0 0
0 0 0
0 0 0
0 0 0
140 500 640 57600
0 0 0
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0 0 0
5000 5000 495000
0 0 0
0 0 0
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0 0 0
70 0 70 4970
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 50 50 14750
200 200 60000
0 0 0
0 0 0
0 0 0
1 1 7200
2 2 13254
300 300 63000
0 0 0
0 0 0
0 0 0
0 0 0
19 19 117800
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
220 5100 5320 319200
0 0 0
265 600 865 249120
0 0 0
0 0 0
14 20 34 68238
0 0 0
0 0 0 0
0 0 0
0 0 0
200 200 26600
0 0 0
100 0 100 219000

0 0 0
48 48 216000
0 0 0 0
0 0 0
0 0 0
0 0 0
200 200 15400
0 0 0
0 0 0
0 0 0
290 200 490 171500
7000 7000 539000
0 0 0
0 0 0
1200 1200 122400
0 0 0
0 0 0
0 0 0
0 0 0
0 24 24 81936
0 0 0
0 0 0
0 0 0
360 360 306000
0 0 0
0 0 0
0 0 0
0 1 1 6800
200 200 46200
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100 100 59800
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55 0 55 64955
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1000 1000 73000
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350 200 550 46750
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5 5 62700
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72 72 167976
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40 0 40 6000
200 200 49600
8 8 165600
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100 100 90000
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0 0 0
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1000 1000 208000
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0
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0 0 0
300 300 116100
0
0 0 0
0
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0 0 0
0 0 0
0
0 0 0
0 0 0
0 0 0
0
0 0 0
90 100 190 31730
0 0 0
0 0 0
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0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
10 10 72500
0 0 0
790 400 1190 70210
70 100 170 10200
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0 0 0
630 400 1030 126690
0 0 0
0 0 0
872 400 1272 80136
0 0 0
0 0 0
0 0 0
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1 1 93500
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0 0 0
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0 0 0
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0 0 0
0 0 0
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16 16 17600
32 32 320000
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5 5 19500
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0 0 0
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0 0 0
0 0 0
0 0 0
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10 10 340040
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0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
1 1 114000
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 15 15 48330
0 0 0
0 0 0
0 0 0
0 0 0
8 8 92520
0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 10 64000
0 0 0
0 0 0
0 0 0
0 0 0
2 2 11572
10 10 151800
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 6720
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
530 530 8321000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 23760
0 0 0
0 0 0
750 750 262500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
750 750 750000
0 0 0
5 5 308000
0 0 0
0 0 0
0 0 0
0 0 0
70 70 6098400
5 5 13950
0 625 625 32500000
4 4 50524
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2000 2000 440000
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 310 310 914500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 7592
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
43 43 1849430
45 45 855000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 92400
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 30 30 1798500
0 0 0
0 0 0
0 40 40 3051400
60 60 1047000
0 100 100 2090000
0 50 50 7711500
0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 15 15 247200
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1325000
0 0 0
0 0 0
0 40 40 6046000
0 0 0
0 0 0
0 9 9 5234466.51
3 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
- - - - 6,752.00 151,761.00 158,513.00 87,977,982.51
LAPORAN STOK AKHIR OBAT BULAN JUNI TAHUN 2022
UPT PKM CILEDUG
JL. Raden Patah
NO. NAMA BARANG SATUAN HARGA SATUAN STOK A

PUSTU PONED
1 2 3 4 5 6
Obat
Antasida DOEN I tablet kunyah, kombinasi :

11 Hidroksida 200 mg Tablet 58.00
Antasida DOEN II suspensi, kombinasi : Aluminium

12 mg /5 ml - 60 ml Botol 1,679.00


22 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 185.00
Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5




70 Furosemide Injeksi 10 mg/ml Ampul 1,333.00
Garam Oralit I serbuk, kombinasi : Natrium 0,52 g,


105 80.000) - 2 ml Ampul 1,229.00
118 0,125 mg Tablet 224.00

Obat Analgetik (Antalgin 250 mg ; Amidopyrin 50 mg ;
135 Lidocain HCl 10 mg ) / ETAMIDON INJEKSI Vial 0.00
Obat Analgetik - antipiretik - batuk kaplet

(Paracetamol 500 mg, Dextromethorphan HBr 15 mg,
136 Maleat 2 mg, ) / ALPARA KAPLET Kaplet 0.00
Obat Analgetik - vitamin B kompleks kaplet

137 50 mg, Vitamin B12 100 mcg) / ERLAGIN Tablet 0.00
Obat Analgetik kombinasi dengan Psikotropik kaplet

138 METANEURON Tablet 0.00
Obat Antiinfluenza kaplet ( Paracetamol 500 mg.

Phenylpropanolamin HCl 12,5 mg+ Chlorpheniramin
139 Maleat 2 mg ) / MOLEXFLU KAPLET Kaplet 0.00
Obat Antiinfluenza syrup ( Parasetamol 125 mg,

Phenylprophanolamine HCl 3.125 mg,
140 MOLEXFLU SYRUP Botol 0.00
Obat Antitusif - ekspektorant sirup ( Diphenhydramin

HCl 12,5 mg+ Ammonium Chlorida 125 mg+ Sodium

146 IU ) - 20 gr / THROMBOPHOP GEL Tube 0.00
Obat spasmodikum tablet (Metampiron 500 mg,

Ekstrak Belladona 10 mg, Papaverin HCl 25 mg) /
147 SPASMINAL Tablet 0.00
Obat Tetes mata kombinasi antiseptik & kortikosteroid
(Dexamethason Sod.Phosfate 1,0 mg, Neomycin

Supposito
180 endap 4 % - 30 gr Pot 2,333.00
181 Eugenol 1,5%) - 30 gr / PAINKILLA Tube 0.00
Salep kulit kombinasi antiinfeksi dgn kortikosteroid

197 Tramadol Injeksi 50 mg/ml Ampul 1,764.00

(Vit. B1 15 mg, Vit. B2 10 mg, Vit. B6 5 mg, Vit. B12
OBAT PROGRAM IMS
OBAT PROGRAM GIZI

OBAT KEJIWAAN
OBAT GIGI
270 Cavit Pot 109,714.00
272 CHKM Botol 65,000.00


295 bonding) Paket 1,720,393.00
322 bedah PCS 0.00


353 Etanol 70 % - 1 L Botol 27,500.00
354 Etanol 70 % - 100 ml Botol 4,445.00

389 Kertas USG Sony 110 HG Roll 299,999.70

mengandung zat aktif dengan kadar minimal
394 Liter Galon 712,800.00
395 Larutan H2O2 3% Botol 3,360.00
Larutan Konsentrat untuk Antiseptik dan Desinfectan

398 M-I Gown PCS 27,272.72
405 Masker N 95 PCS 8,636.36
425 Bakteri ) PCS 31,500.00
431 Safety Box 2,5 L PCS 13,900.00
EMBALAGE
Pak
Pak
AKUPUNTUR
OBAT PONED

489 Under Pad 60 x 90 cm PCS 4,620.00
TAMBAHAN

VAKSIN
500 DT Vial 17,450.00
502 IPV Vial 154,230.00

508 Td Vial 16,480.00
509 TT Vial 0.00
OBAT HIV AIDS

534 Kondom Ukuran 52 mm PCS 358.00
Kotrimoksazol DOEN I (dewasa) Kombinasi :

542 Dolutegravir (DTG) 50 mg Tablet 2,793.86
Triple FDC ( Tenofovir ( TDF ) 300 mg / Lamivudine


JUMLAH - -


NIP. 197705012005012010 NIP. 197805101997022001
STOK AWAL JUNI PENERIMAAN JUNI
INAP STOK INAP
AWAL
7 8 9 10 11 12 13 14 15 16
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 8400 8400 2000
200 - 200 5100
- 0 -
- 0 -
7 - 7 60
- 0 -
43 100 143 100
- 0 -
- 0 -
30 30 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
5 5 -
- 0 -
200 200 -
520 7000 7520 3000
- 0 -
- 0 -
11 25 36 25
- 0 -
3 3 -
- 0 -
- 0 -
0 - 0 700
- 0 -
1670 113100 114770 17300

- 0 -
555 - 555 600
- 0 -
- 0 -
- 0 -
150 150 -
- 0 -
1 1 -
- 0 -
- 0 -
- 0 -
- 0 -
140 500 640 500
- 0 -
- 0 -
- 0 -
5000 5000 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
70 - 70 300
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 24
- 0 -
- 0 -
- 0 -
0 50 50 50
200 200 -
- 0 -
- 0 -
- 0 -
1 1 -
2 2 -
300 300 -
- 0 -
- 0 -
- 0 -
- 0 -
19 19 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
220 5100 5320 1000
- 0 -
265 600 865 250
- 0 -
- 0 -
14 20 34 20
- 0 -
0 - 0 25
- 0 -
- 0 -
200 200 -
- 0 -
100 - 100 100

- 0 -
48 48 -
0 - 0 30
- 0 -
- 0 -
- 0 -
200 200 -
- 0 -
- 0 -
- 0 -
290 200 490 1100
7000 7000 -
- 0 -
- 0 -
1200 1200 -
- 0 -
- 0 -
- 0 -
- 0 -
0 24 24 48
- 0 -
- 0 -
- 0 -
360 360 -
- 0 -
- 0 -
- 0 -
0 1 1 4
200 200 -
- 0 -
- 0 -
100 100 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 2 2 2
- 0 -
- 0 -
- 0 -
55 - 55 100
- 0 -
- 0 -
- 0 -
- 0 -
0 - 0 700
- 0 -
- 0 -
- 0 -
1000 1000 -
- 0 -
- 0 -
- 0 -
- 0 -
350 200 550 600
- 0 -
- 0 -
- 0 -
5 5 -
- 0 -
- 0 -
72 72 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
40 - 40 2100
200 200 400
8 8 -
- 0 -
- 0 -
- 0 -
100 100 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 - 0 36
1000 1000 -
0
0 - 0 84
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 - 0 15
- 0 -
0 - 0 5
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 - 0 2
0
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
300 300 -
0
- 0 -
0
- 0 -
- 0 -
- 0 -
0
- 0 -
- 0 -
- 0 -
0
- 0 -
90 100 190 100
- 0 -
- 0 100
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
10 10 -
- 0 -
790 400 1190 300
70 100 170 200
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
630 400 1030 300
- 0 -
- 0 -
872 400 1272 300
0
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
1 1 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
2 2 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
1 1 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
16 16 -
32 32 -
- 0 -
- 0 -
5 5 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
10 10 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
1 1 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 15 15 5
- 0 -
- 0 -
- 0 -
- 0 -
8 8 -
- 0 -
0 - 0 1
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
10 10 -
- 0 -
- 0 -
- 0 -
- 0 -
2 2 -
10 10 -
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- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
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- 0 -
- 0 -
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- 0 -
- 0 -
- 0 -
- 0 -
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2 2 -
- 0 -
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- 0 -
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530 530 -
- 0 -
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- 0 -
- 0 -
- 0 -
- 0 -
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- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
3 3 -
- 0 -
- 0 -
750 750 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 - 0 1
0 - 0 1
0 - 0 1
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
750 750 -
- 0 -
5 5 -
- 0 -
- 0 -
- 0 -
- 0 -
70 70 -
5 5 -
0 625 625 75
4 4 -
- 0 -
- 0 -
- 0 -
- 0 -
0
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
2000 2000 -
0
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 0
0 310 310 70
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
2 2 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
43 43 -
45 45 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
20 20 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
0 30 30 20
- 0 -
- 0 -
0 40 40 56
60 60 -
0 100 100 38
0 50 50 12
- 0 -
0 - 0 70
- 0 -
- 0 -
- 0 -
0 15 15 7
- 0 -
- 0 -
- 0 -
- 0 -
1 1 -
- 0 -
- 0 -
0 40 40 15
- 0 -
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0 9 9 4
3 3 -
- 0 -
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- 0 -
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- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- - 7,002.00 151,761.00 158,513.00 - - - - 30,796.00

Kepala UPT Instalasi Farmasi Kepala PKM Ciledug Pengurus Barang Pembantu Puskesma
NIP. 197805101997022001 NIP. 1974 NIP. 197601172009022004
N JUNI PEMAKAIAN JUNI
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320 320 - 0
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320 320 - 0
20 40 20 20 40
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- 0 - 0
40 96 56 56 112
- 0 - 0
- 38 38 38 76
- 12 12 12 24
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90 160 70 70 140
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51,989.00 - - - - 28,524.00 30,796.00 59,320.00
Tangerang, 16 JUNI 2021


NIP. 197601172009022004 NIP. 197601172009022004
STOK AKHIR JUNI NILAI STOK AKHIR
INAP AKHIR
26 27 28 29 30 31 32 33
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 8400 8400 588000
0 0 0 0
0 0 0
0 0 0
0 0 0 0
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63 100 163 273677
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30 30 97500
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0 0 0
0 0 0
0 0 0
0 0 0
5 5 13250
0 0 0
200 200 17800

2735 7000 9735 408870
0 0 0
0 0 0
4 25 29 101500
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3 3 4917
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0 0 0
0 0 0 0
0 0 0
1089 113100 114189 0

0 0 0
208 0 208 18304
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0 0 0
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150 150 20550
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1 1 84920
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177 500 677 60930
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5000 5000 495000
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110 0 110 7810
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14 0 14 46200
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0 50 50 14750
200 200 60000
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1 1 7200
2 2 13254
300 300 63000
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19 19 117800
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0 0 0
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0 0 0
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540 5100 5640 338400
0 0 0
15 600 615 177120
0 0 0
0 0 0
16 20 36 72252
0 0 0
2 0 2 16500
0 0 0
0 0 0
200 200 26600
0 0 0
180 0 180 394200

0 0 0
48 48 216000
0 0 0 0
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0 0 0
0 0 0
200 200 15400
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0 0 0
0 0 0
226 200 426 149100
7000 7000 539000
0 0 0
0 0 0
1200 1200 122400
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0 0 0
0 0 0
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0 24 24 81936
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0 0 0
0 0 0
360 360 306000
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0 0 0
0 0 0
0 1 1 6800
200 200 46200
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0 0 0
100 100 59800
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0 2 2 1746
0 0 0
0 0 0
0 0 0
58 0 58 68498
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0 0 0
0 0 0
0 0 0
471 0 471 50773.8
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0 0 0
0 0 0
1000 1000 73000
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423 200 623 52955
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5 5 62700
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72 72 167976
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73 0 73 10950
267 200 467 115816
8 8 165600
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0 0 0
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100 100 90000
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0 0 0
0 0 0
0 0 0
18 0 18 44802
1000 1000 208000
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0
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300 300 116100
0
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0
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0
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0
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36 100 136 22712
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70 0 70 78470
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10 10 72500
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765 400 1165 68735
100 100 200 12000
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690 400 1090 68670
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32 32 320000
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1 1 114000
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2 15 17 54774
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8 8 92520
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10 10 64000
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10 10 151800
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2 2 6720
0 0 0
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530 530 8321000
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0 0 0
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3 3 23760
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750 750 262500
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750 750 750000
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5 5 308000
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70 70 6098400
5 5 13950
0 625 625 32500000
4 4 50524
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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2000 2000 440000
0 0
0 0 0
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0 310 310 914500
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2 2 7592
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43 43 1849430
45 45 855000
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20 20 92400
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0 0 0
0 30 30 1798500
0 0 0
0 0 0
0 40 40 3051400
60 60 1047000
0 100 100 2090000
0 50 50 7711500
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0 0 0 0
0 0 0
0 0 0
0 0 0
0 15 15 247200
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1325000
0 0 0
0 0 0
0 40 40 6046000
0 0 0
0 0 0
0 9 9 5234466.51
3 3 0
0 0 0
0 0 0
0
0 0 0
0 0 0
0 0 0
0 0 0
0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
- - - - 9,024.00 160,785.00 88,443,020.31

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LAPORAN STOK AKHIR OBAT BULAN MARET TAHUN 2022

UPT PKM CILEDUG

13 Anti Bakteri DOEN salep kombinasi : Tube 3,035.00 0 0 - -

14 Anti Hemmoroid Kapsul : Ekstrak Graptophylli Kapsul 1,518.00 0 0 - -

55 Difenhidramin injeksi 10 mg/ml / ETADRYL Ampul 781.00 0 2 2.00 -

65 Furosemid tablet 40 mg Tablet 82.00 0 0 - -

96 Kotrimoksazol DOEN II (pedriatik) kombinasi : Tablet - 0 0 - -

97 Kotrimoksazol Suspensi kombinasi : Botol 2,190.00 0 0 - -

103 Linkomisin kapsul 500 mg Kapsul - 0 0 - -

140 Obat spasmodikum tablet (Metampiron 500 Tablet - 0 0 - -

188 Tramadol Injeksi 50 mg/ml Ampul 1,764.00 0 0 - -

256 Glass Ionomer Radiopak / FUJI VII SET 690,000.00 0 0 - -

283 Alkohol Swab (BMHP) PCS 95.00 0 0 - 1840.00 2200.00 4,040.00

352 Larutan Desinfectan - 1 L (Desinfektan Botol 43,750.00 0 0 - -

356 Lysol Konsentrat 1 Liter Botol 40,700.00 0 0 - -

410 MgSO4 40 % injeksi Botol 3,796.00 0 0 - -

444 Favipiravir Tab 200 mg Tablet 14,850.00 0 0 - -

482 Vitamin C 500 mg Inj Ampul 25,750.00 0 0 - -

525 Isoniazid (INH) 300 mg Tablet 150.00 0 0 - -

531 Tenofovir ( TDF ) 300 mg + Emtricitabine Tablet 4,655.00 0 0 - -

Mengetahui / Menyetujui, Mengetahui / Menerima, Mengetahui / Menyerahkan, Mengetahui,

30 30.00 - - - - 25.00 200.00 225.00 377,775.00

0 - - - - - - 60.00 60.00 195,000.00

100 100.00 - - - - 500.00 1,000.00 1,500.00 63,000.00

2799 3000 5,799.00 - - - - 1,000.00 8,200.00 9,200.00 2,079,200.00

130 130.00 - - - - 275.00 900.00 1,175.00 103,400.00

0 - - - - - - 20.00 20.00 18,480.00

0 - - - - - - 2.00 2.00 1,562.00

0 - - - - - - 200.00 200.00 60,000.00

0 - - - - - - 9.00 9.00 61,200.00

0 - - - - - - 1.00 1.00 32,000.00

1840 1840 3,680.00 - - - - - 360.00 360.00 34,200.00

0 - - - - - - 1.00 1.00 114,000.00

0 - - - - - - 20.00 20.00 64,440.00

0 - - - - - - 2.00 2.00 6,720.00

0 - - - - - - 2,000.00 2,000.00 440,000.00

1874 1874 3,748.00 - - - - - - - -

50 50 100.00 - - - - - 850.00 850.00 44,200,000.00

Tangerang, 16 Maret 2021

NO. NAMA BARANG SATUAN HARGA SATUAN STOK AW

1 Alopurinol tablet 100 mg Tablet 87.00

2 Ambroksol Syrup Botol 5,500.00

3 Ambroksol tablet 30 mg Tablet 190.00

4 Aminofillin tablet 150 mg Tablet 0.00

5 Aminofillin tablet 200 mg Tablet 113.30

6 Amlodipin 10 mg Tablet 70.00

7 Amlodipin tablet 5 mg Tablet 53.00

8 Amoksilin kaplet 500 mg Kaplet 330.00

9 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 2,800.00

10 Amoksilin sirup Ikering

16 Anti Tetanus Serum ( ATS ) 1500 IU Ampul 130,999.00

24 Aqua pro injeksi steril, bebas pirogen 20 ml Vial 0.00

25 Aqua pro injeksi steril, bebas pirogen 25 ml Vial 2,650.00

26 Artesunate Injeksi 500 ml / 5 ml Ampul 39,000.00

27 Asam Asetilsalisilat tablet 80 mg / ASPIMEC/MINIASPI Tablet 89.00

28 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 42.00

29 Asam Mefenamat kaplet 500 mg Kaplet 195.00

30 Asering infus Botol 8,800.00

31 Asiklovir krim 5 % -5 gr Tube 3,500.00

32 Asiklovir tablet 400 mg Tablet 407.00

33 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml Ampul 1,639.00

34 Attapulgit Tablet 630 mg / PULAREX / NEW ANTIDES Tablet 145.00