LAPORAN PEMAKAIAN ALOKASI COVID 19

PUSKESMAS : PAKIS BARU LAPORAN BLN : APRIL 20 DOKUMEN

KECAMATAN : NAWANGAN MINGGU KE : DUA GFK
KABUPATEN : PACITAN PUSKESMAS

(DALAM ANGKA)
SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL
AWAL AAN AN(5+6) N
(7-8)
1 2 3 4 5 6 7 8 9 10
1 ALKOHOL 70 % 1 L btl 66,550.00 4 4 4 -
2 APD+FACESHIELD+SEPATU set 401,500.00 3 3 2 1 -
3 APD+FACESHIELD+SEPATU set - - -
4 APD+HELM+SEPATU set - - -
5 APD+HELM+SEPATU set - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 2 2 2 -
7 COVERALL + SARUNG SEPATU set 110,000.00 4 4 4 -
8 COVERALL pcs - - -
9 COVERALL pcs - - -
10 HANDSCOEN L psg - - -
11 HANDSCOEN S psg - - -
12 KACA MATA SAFETY WIPRO bh 33,000.00 2 2 2 -
13 MASKER pcs 386.10 50 50 50 - -
14 MASKER KAIN pcs - - -
15 MASKER N95 pcs 21,736.00 3 3 2 1 -
16 NURSE CAP bh - - -
17 PRODESTAN btl 66,319.00 8 8 8 -
18 RDT COVID test - - -
19 SPRAYER bh 1,122,000.00 1 1 1 -
20 THERMOGUN bh 2,090,000.00 - - -
21 - - -
22 - - -
23 - - -
24 - - -
25 - - -

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN PAKIS BARU

RETNO HANDAYANI, S. Farm., Apt. dr. SUNU PAMADYO T.I

NIP. 19790701 201001 2 018 NIP 198003012008011025
AN ALOKASI COVID 19
NOMOR TGL

440/ /408.36.18/2020 4/9/2020

(DALAM RUPIAH)

PERSEDIAAN( STOCK AKHIR KET

PENERIMAAN PEMAKAIAN
5+6) (7-8)

11 12 13 14 15
266,200 266,200 - 266,200
1,204,500 1,204,500 803,000 401,500
- - - -
- - - -
- - - -
1,404,700 1,404,700 - 1,404,700
440,000 440,000 - 440,000
- - - -
- - - -
- - - -
- - - -
66,000 66,000 - 66,000
19,305 19,305 19,305 -
- - - -
65,208 65,208 43,472 21,736
- - - -
530,552 530,552 - 530,552
- - - -
1,122,000 1,122,000 - 1,122,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -

TANGGAL : 9-Apr-20

KEPALA PUSKESMAS PETUGAS PUSKESMAS

PAKIS BARU PAKIS BARU

dr. SUNU PAMADYO T.I HADI WALUYO

NIP 198003012008011025 NIP 197005112014061001
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : PAKIS BARU LAPORAN BLN : APRIL 20 DOKUMEN NOMOR
KECAMATAN : NAWANGAN MINGGU KE : TIGA GFK
KABUPATEN : PACITAN PUSKESMAS 440/ /403.36.18/2020

(DALAM ANGKA) (DALAM RUPIAH)

SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL PENERIMAAN
PERSEDIAAN(
AWAL AAN AN(5+6) N 5+6)
(7-8)
1 2 3 4 5 6 7 8 9 10 11 12
1 ALKOHOL 70 % 1 L btl 66,550.00 4 16 20 20 266,200 1,064,800 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 1 1 1 401,500 - 401,500
3 APD+FACESHIELD+SEPATU set - - - - - -
4 APD+HELM+SEPATU set - - - - - -
5 APD+HELM+SEPATU set - - - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 2 6 8 1 7 1,404,700 4,214,100 5,618,800
7 COVERALL +SARUNG SEPATU set 110,000.00 4 4 4 440,000 - 440,000
8 COVERALL pcs - 4 4 4 - - -
9 COVERALL pcs - 8 8 8 - - -
10 HANDSCOEN L psg - - - - - -
11 HANDSCOEN S psg 55,100.00 - 10 10 10 - 551,000 551,000
12 KACA MATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000 - 66,000
13 MASKER pcs 386.10 - - - - - -
14 MASKER KAIN pcs 4,000.00 - 100 100 60 40 - 400,000 400,000
15 MASKER N95 pcs 21,736.00 1 10 11 11 21,736 217,360 239,096
16 NURSE CAP bh 1,500.00 - 100 100 100 - 150,000 150,000
17 PRODESTAN btl 66,319.00 8 8 1 7 530,552 - 530,552
18 RDT COVID test - - - - - -
19 SPRAYER bh 1,122,000.00 1 1 1 - 1,122,000 - 1,122,000
20 THERMOGUN bh 2,090,000.00 - - - - - -
21 KACAMATA GOGGLE pcs 30,000.00 - 20 20 1 19 - 600,000 600,000
22 MASKER BEDAH ktk 415,000.00 - 10 10 10 - 4,150,000 4,150,000
23 APD SET ( POSKO JERUK) set - 2 2 2 - - -
24 MASKER BEDAH (POS JERUK ) pcs - 26 26 11 15 - - -
25 SARUNG TANGAN S(JERUK) psg - 52 52 11 41 - - -
26
27
28
29
30
31
32
33
34
35

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN PAKIS BARU

RETNO HANDAYANI, S. Farm., Apt. dr. SUNU PAMADYO T.I

NIP. 19790701 201001 2 018 NIP 198003012008011025
KAIAN ALOKASI COVID 19
NOMOR TGL

440/ /403.36.18/2020 4/17/2020

(DALAM RUPIAH)

STOCK AKHIR KET

PEMAKAIAN
(7-8)

13 14 15
- 1,331,000
- 401,500
- -
- -
- -
702,350 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
240,000 160,000
- 239,096
- 150,000
66,319 464,233
- -
1,122,000 -
- -
30,000 570,000
- 4,150,000
- -
- -
- -

TANGGAL : 17-Apr-20

PETUGAS PUSKESMAS
PAKIS BARU

HADI WALUYO
NIP 197005112014061001
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : PAKIS BARU LAPORAN BLN : APRIL 20 DOKUMEN NOMOR
KECAMATAN : NAWANGAN MINGGU KE : EMPAT GFK
KABUPATEN : PACITAN PUSKESMAS 440/ /408.36.18/2020

(DALAM ANGKA) (DALAM RUPIAH)

SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL PENERIMAAN
PERSEDIAAN(
AWAL AAN AN(5+6) N 5+6)
(7-8)
1 2 3 4 5 6 7 8 9 10 11 12
1 ALKOHOL 70 % 1 L btl 66,550.00 20 20 20 1,331,000 - 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 1 1 1 - 401,500 - 401,500
3 APD+FACESHIELD+SEPATU set - - - - - -
4 APD+HELM+SEPATU set - - - - - -
5 APD+HELM+SEPATU set - - - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 7 7 7 4,916,450 - 4,916,450
7 COVERALL +SARUNG SEPATU set 110,000.00 4 4 4 440,000 - 440,000
8 COVERALL pcs 4 4 4 - - -
9 COVERALL pcs 8 8 8 - - -
10 HANDSCOEN L psg - - - - - -
11 HANDSCOEN S psg 55,100.00 10 10 10 551,000 - 551,000
12 KACAMATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000 - 66,000
13 MASKER pcs 386.00 - - - - - -
14 MASKER KAIN pcs 4,000.00 40 40 40 160,000 - 160,000
15 MASKER N95 pcs 21,736.00 11 11 1 10 239,096 - 239,096
16 NURSE CAP bh 1,500.00 100 100 100 150,000 - 150,000
17 PRODESTAN btl 66,319.00 7 7 1 6 464,233 - 464,233
18 RDT COVID test - - - - - -
19 SPRAYER bh 1,122,000.00 - - - - - -
20 THERMOGUN bh 2,090,000.00 - - - - - -
21 KACAMATA GOGGLE pcs 30,000.00 19 19 19 570,000 - 570,000
22 MASKER BEDAH ktk 415,000.00 10 10 1 9 4,150,000 - 4,150,000
23 APD SET (POSKO JERUK) set 2 2 2 - - -
24 MASKER BEDAH ( POS JERUK) pcs 15 15 12 3 - - -
25 SARUNG TANGAN S(JERUK) psg 41 41 14 27 - - -
26 - - - - - -
27 - - - - - -
28 - - - - - -
29 - - - - - -
30 - - - - - -
31 - - - - - -
32 - - - - - -
33 - - - - - -
34 - - - - - -
35

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN PAKIS BARU

RETNO HANDAYANI, S. Farm., Apt. dr. SUNU PAMADYO T.I

NIP. 19790701 201001 2 018 NIP 198003012008011025
KAIAN ALOKASI COVID 19
NOMOR TGL

440/ /408.36.18/2020 4/30/2020

(DALAM RUPIAH)

STOCK AKHIR KET

PEMAKAIAN
(7-8)

13 14 15
- 1,331,000
401,500 -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
21,736 217,360
- 150,000
66,319 397,914
- -
- -
- -
- 570,000
415,000 3,735,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

TANGGAL : 4/30/2020

PETUGAS PUSKESMAS
PAKIS BARU

HADI WALUYO
NIP 197005112014061001
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : PAKIS BARU LAPORAN BLN : MEI 20 DOKUMEN NOMOR
KECAMATAN : NAWANGAN MINGGU KE : SATU GFK
KABUPATEN : PACITAN PUSKESMAS 440/ /403.36.18/2020

(DALAM ANGKA) (DALAM RUPIAH)

SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL PENERIMAAN
PERSEDIAAN(
AWAL AAN AN(5+6) N 5+6)
(7-8)
1 2 3 4 5 6 7 8 9 10 11 12
1 ALKOHOL 70 % 1 L btl 66,550.00 20 20 20 1,331,000 - 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 - - - - - -
3 APD+FACESHIELD+SEPATU set - - - - - -
4 APD+HELM+SEPATU set - - - - - -
5 APD+HELM+SEPATU set - - - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 7 7 7 4,916,450 - 4,916,450
7 COVERALL+ SARUNG SEPATU set 110,000.00 4 4 4 440,000 - 440,000
8 COVERALL PUTIH pcs 4 2 6 6 - - -
9 COVERALL pcs 8 8 8 - - -
10 HANDSCOEN L psg - - - - - -
11 HANDSCOEN S psg 55,100.00 10 10 10 551,000 - 551,000
12 KACAMATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000 - 66,000
13 MASKER pcs 386.00 - - - - - -
14 MASKER KAIN pcs 4,000.00 40 40 40 160,000 - 160,000
15 MASKER N95 pcs 21,736.00 10 10 10 217,360 - 217,360
16 NURSE CAP bh 1,500.00 100 100 100 150,000 - 150,000
17 PRODESTAN btl 66,319.00 6 6 6 397,914 - 397,914
18 RDT COVID test - - - - - -
19 SPRAYER bh 1,122,000.00 - - - - - -
20 THERMOGUN bh 2,090,000.00 - - - - - -
21 KACAMATA GOGGLE pcs 30,000.00 19 19 19 570,000 - 570,000
22 MASKER BEDAH ktk 415,000.00 9 20 29 29 3,735,000 8,300,000 12,035,000
23 APD SET ( POSKO JERUK) set 2 2 2 - - -
24 MASKER BEDAH POS JERUK) pcs 8,300.00 3 46 49 3 46 24,900 381,800 406,700
25 SARUNG TANGAN S (JERUK) psg 1,102.00 27 46 73 1 72 29,754 50,692 80,446
26 NURSE CAP ( JERUK ) pcs 1,500.00 - 46 46 46 - 69,000 69,000
27 COVERALL ( POS JERUK ) pcs - 2 2 2 - - -
28 COVER ALL REUSE pcs 640,000.00 - 4 4 4 - 2,560,000 2,560,000
29 FACE SHIELD pcs 99,000.00 - 5 5 5 - 495,000 495,000
30 MASKER N95 PCS 82,500.00 - 35 35 35 - 2,887,500 2,887,500
31 - - - - - -
32 - - - - - -
33 - - - - - -
34 - - - - - -
35

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN PAKIS BARU

RETNO HANDAYANI, S. Farm., Apt. dr. SUNU PAMADYO T.I

NIP. 19790701 201001 2 018 NIP.198003012008011025
KAIAN ALOKASI COVID 19
NOMOR TGL

440/ /403.36.18/2020 5/5/2020

(DALAM RUPIAH)

STOCK AKHIR KET

PEMAKAIAN
(7-8)

13 14 15
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
24,900 381,800
1,102 79,344
- 69,000
- -
- 2,560,000
- 495,000
- 2,887,500
- -
- -
- -
- -

TANGGAL : 5/5/2020

PETUGAS PUSKESMAS
PAKIS BARU

HADI WALUYO
NIP. 197005112014061001
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : LAPORAN BLN : MEI 20 DOKUMEN
KECAMATAN : MINGGU KE : GFK
KABUPATEN : PACITAN PUSKESMAS

(DALAM ANGKA)
SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL
AWAL AAN AN(5+6) N
(7-8)
1 2 3 4 5 6 7 8 9 10
1 ALKOHOL 70 % 1 L btl 66,550.00 20 20 20 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 - - - -
3 APD+FACESHIELD+SEPATU set - - - -
4 APD+HELM+SEPATU set - - - -
5 APD+HELM+SEPATU set - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 7 7 7 4,916,450
7 COVERALL +SARUNG SEPATU set 110,000.00 4 4 4 440,000
8 COVERALL PUTIH pcs 6 6 6 -
9 COVERALL pcs 8 8 8 -
10 HANDSCOEN L psg - - - -
11 HANDSCOEN S psg 55,100.00 10 10 10 551,000
12 KACA MATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000
13 MASKER pcs 386.00 - - - -
14 MASKER KAIN pcs 4,000.00 40 40 40 160,000
15 MASKER N95 pcs 21,736.00 10 10 10 217,360
16 NURSE CAP bh 1,500.00 100 100 100 150,000
17 PRODESTAN btl 66,319.00 6 6 6 397,914
18 RDT COVID test - - - -
19 SPRAYER bh 1,122,000.00 - - - -
20 THERMOGUN bh 2,090,000.00 - - - -
21 KACAMATA GOGGLE pcs 30,000.00 19 19 19 570,000
22 MASKER BEDAH ktk 415,000.00 29 29 29 12,035,000
23 APD SET ( POSKO JERUK) set 2 2 2 -
24 MASKER BEDAH ( PS JERUK) pcs 8,300.00 46 46 46 381,800
25 SARUNG TANGAN S (JERUK) psg 1,102.00 72 72 72 79,344
26 NURSE CAP ( POS JERUK ) pcs 1,500.00 46 46 46 69,000
27 COVERALL pcs 2 2 2 -
28 COVERALL REUSE pcs 640,000.00 4 4 4 2,560,000
29 FACE SHIELD pcs 99,000.00 5 5 5 495,000
30 MASKER N95 PCS 82,500.00 35 35 35 2,887,500
31 - - - -
32 - - - -
33 - - - -
35

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN .............................

RETNO HANDAYANI, S. Farm., Apt. ………………………….

NIP. 19790701 201001 2 018 NIP………………………
N ALOKASI COVID 19
NOMOR
(DALAM RUPIAH)
PERSEDIAAN( STOCK AKHIR
PENERIMAAN PEMAKAIAN
5+6)
11 12 13
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- 381,800
- 79,344
- 69,000
- -
- 2,560,000
- 495,000
- 2,887,500
- -
- -
- -
TANGGAL :
KEPALA PUSKESMAS
.............................
………………………….
NIP………………………
TGL
KET
(7-8)
14 15
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- 381,800
- 79,344
- 69,000
- -
- 2,560,000
- 495,000
- 2,887,500
- -
- -
- -
2020
PETUGAS PUSKESMAS
..............................
………………………….
NIP………………………
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : LAPORAN BLN : MEI 20 DOKUMEN
KECAMATAN : MINGGU KE : GFK
KABUPATEN : PACITAN PUSKESMAS

(DALAM ANGKA)
SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL
AWAL AAN AN(5+6) N
(7-8)
1 2 3 4 5 6 7 8 9 10
1 ALKOHOL 70 % 1 L btl 66,550.00 20 20 20 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 - - - -
3 APD+FACESHIELD+SEPATU set - - - -
4 APD+HELM+SEPATU set - - - -
5 APD+HELM+SEPATU set - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 7 7 7 4,916,450
7 COVERALL+SARUNG SEPATU set 110,000.00 4 4 4 440,000
8 COVERALL pcs 6 6 6 -
9 COVERALL pcs 8 8 8 -
10 HANDSCOEN L psg - - - -
11 HANDSCOEN S psg 55,100.00 10 10 10 551,000
12 KACAMATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000
13 MASKER pcs 386.00 - - - -
14 MASKER KAIN pcs 4,000.00 40 40 40 160,000
15 MASKER N95 pcs 21,736.00 10 10 10 217,360
16 NURSE CAP bh 1,500.00 100 100 100 150,000
17 PRODESTAN btl 66,319.00 6 6 6 397,914
18 RDT COVID test - - - -
19 SPRAYER bh 1,122,000.00 - - - -
20 THERMOGUN bh 2,090,000.00 - - - -
21 KACAMATA GOGGLE pcs 30,000.00 19 19 19 570,000
22 MASKER BEDAH ktk 415,000.00 29 29 29 12,035,000
23 APD SET (POS JERUK) set 2 2 2 -
24 MASKER BEDAH (JERUK) pcs 46 46 46 -
25 SARUNG TANGAN S (JERUK) psg 72 72 72 -
26 46 46 46 -
27 2 2 2 -
28 4 4 4 -
29 5 5 5 -
30 35 35 35 -
31 - - - -
32 - - - -
33 - - - -
34 - - - -
35 -

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN .............................

RETNO HANDAYANI, S. Farm., Apt. ………………………….

NIP. 19790701 201001 2 018 NIP………………………
N ALOKASI COVID 19
NOMOR
(DALAM RUPIAH)
PERSEDIAAN( STOCK AKHIR
PENERIMAAN PEMAKAIAN
5+6)
11 12 13
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TANGGAL :
KEPALA PUSKESMAS
.............................
………………………….
NIP………………………
TGL
KET
(7-8)
14 15
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2020
PETUGAS PUSKESMAS
..............................
………………………….
NIP………………………
 LAPORAN PEMAKAIAN ALOKASI COVID 19
PUSKESMAS : LAPORAN BLN : MEI 20 DOKUMEN
KECAMATAN : MINGGU KE : GFK
KABUPATEN : PACITAN PUSKESMAS

(DALAM ANGKA)
SATU HARGA STOCK
No NAMA OBAT
AN SATUAN (Rp.) STOCK PENERIM PERSEDIA PEMAKAIA
AKHIR STOCK AWAL
AWAL AAN AN(5+6) N
(7-8)
1 2 3 4 5 6 7 8 9 10
1 ALKOHOL 70 % 1 L btl 66,550.00 20 20 20 1,331,000
2 APD+FACESHIELD+SEPATU set 401,500.00 - - - -
3 APD+FACESHIELD+SEPATU set - - - -
4 APD+HELM+SEPATU set - - - -
5 APD+HELM+SEPATU set - - - -
6 ASEPTIC GEL 5 LT galon 702,350.00 7 7 7 4,916,450
7 COVERALL+SARUNG SEPATU set 110,000.00 4 4 4 440,000
8 COVERALL pcs 6 6 6 -
9 COVERALL pcs 8 8 8 -
10 HANDSCOEN L psg - - - -
11 HANDSCOEN S psg 55,100.00 10 10 10 551,000
12 KACAMATA SAFETY WIPRO bh 33,000.00 2 2 2 66,000
13 MASKER pcs 386.00 - - - -
14 MASKER KAIN pcs 4,000.00 40 40 40 160,000
15 MASKER N95 pcs 21,736.00 10 10 10 217,360
16 NURSE CAP bh 1,500.00 100 100 100 150,000
17 PRODESTAN btl 66,319.00 6 6 6 397,914
18 RDT COVID test - - - -
19 SPRAYER bh 1,122,000.00 - - - -
20 THERMOGUN bh 2,090,000.00 - - - -
21 KACAMATA GOGGLE pcs 30,000.00 19 19 19 570,000
22 MASKER BEDAH ktk 415,000.00 29 29 29 12,035,000
23 APD SET (POS JERUK) set 2 2 2 -
24 MASKER BEDAH (JERUK) pcs 46 46 46 -
25 SARUNG TANGAN S (JERUK) psg 72 72 72 -
26 46 46 46 -
27 2 2 2 -
28 4 4 4 -
29 5 5 5 -
30 35 35 35 -
31 - - - -
32 - - - -
33 - - - -
34 - - - -
35

MENGETAHUI,
KEPALA UPT GUDANG FARMASI KEPALA PUSKESMAS
DINAS KESEHATAN KAB. PACITAN .............................

RETNO HANDAYANI, S. Farm., Apt. ………………………….

NIP. 19790701 201001 2 018 NIP………………………
N ALOKASI COVID 19
NOMOR
(DALAM RUPIAH)
PERSEDIAAN( STOCK AKHIR
PENERIMAAN PEMAKAIAN
5+6)
11 12 13
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TANGGAL :
KEPALA PUSKESMAS
.............................
………………………….
NIP………………………
TGL
KET
(7-8)
14 15
- 1,331,000
- -
- -
- -
- -
- 4,916,450
- 440,000
- -
- -
- -
- 551,000
- 66,000
- -
- 160,000
- 217,360
- 150,000
- 397,914
- -
- -
- -
- 570,000
- 12,035,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2020
PETUGAS PUSKESMAS
..............................
………………………….
NIP………………………