Lplpo 2022

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO
UPT PUSKESMAS ANYAR

PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Januari 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Februari 2022
KABUPATEN : SERANG
PROVINSI : BANTEN
SATU STOK PENERI PERSE PEMAKA STOK STOK

NO NAMA OBAT
AN AWAL MAAN DIAAN IAN AKHIR OPT
1 2 3 4 5 6 7 8 9
1 Alat Suntik 1 ml Set 460 - 460 151 309 181
2 Alat suntik 20 ml Set 150 - 150 150 - 180
3 Alat Suntik 3 ml Set 591 200 791 189 602 227
4 Alat suntik 5 ml set 290 - 290 69 221 83
5 Albendazole Tablet - - - - - -
6 Allopurinol 100 mg Tablet 3,600 - 3,600 220 3,380 264
7 Ambroxol sirup 15 mg/ml Botol - - - - - -
8 Ambroxol tablet 30 mg Tablet - - - - - -
9 Aminophilin 200 mg Tablet - - - - - -
10 Aminophilin inj Ampul - - - - - -
11 Amitriptillin tab 25 mg Tablet 670 - 670 70 600 84
12 Amlodipin 5 mg Tablet - - - - - -
13 Amlodipin 10 mg Tablet 7,068 1,000 8,068 1,820 6,248 2,184
14 Amoxicillin Inj Vial - - - - - -
15 Amoxicillin Syrup Forte 250 mg/ml Botol 54 120 174 23 151 28
16 Amoxisilin 125 mg syr Botol - - - - - -
17 Amoxisilin 250 mg Kapsul 425 - 425 300 125 360
18 Amoxisilin 500 mg Kapsul 15,109 - 15,109 2,614 12,495 3,137
19 Ampicillin 1 gr injeksi Ampul 141 - 141 - 141 -
20 Antalgin 500 mg Tablet - - - - - -
21 Antasida Doen Tablet 7,634 2,000 9,634 1,404 8,230 1,685
22 Antasida Doen Sirup Botol 62 - 62 35 27 42
23 Anti vertigo (Betahistin maleat) Tablet - - - - - -
24 Antifungi Doen Salep pot - - - - - -
25 Antihaemoroid Doen Komb. Supp Supp 30 - 30 20 10 24
26 Antimigrain Doen Komb. Tablet - - - - - -
27 Aqua Pro inj Steril 25 ml Ampul 73 - 73 7 66 8
28 Artesunate inj Ampul - - - - - -
29 Asam Asetilsalisilat 100mg Tablet - - - - - -
30 Asam Askorbat 250 mg Tablet - - - - - -
31 Asam Askorbat 50 mg Tablet 106 3,000 3,106 586 2,520 703
32 Asam Mefenamat 500 mg Tablet 4,419 5,000 9,419 1,271 8,148 1,525
33 Asam Traneksamat inj 250 mg / ml Ampul - - - - - -
34 Asering 500 cc Botol - - - - - -
35 Asiclovir 400 mg Tablet 2,293 - 2,293 120 2,173 144
NO NAMA OBAT
36 Asiclovir cream Tube - - - - - -
37 Atrofin Sulfat inj 0,25 mg / ml Ampul - - - - - -
38 Attapulgit 650 mg (neo diagon) Tablet 3,393 - 3,393 174 3,219 209
39 Azythromycin 500 mg Tablet - - - - - -
40 Benzatin Benzilpenisillin 1,2 Juta IU/Vial Vial - - - - - -
41 Betamethason Krim Tube - - - - - -
42 Bisacodyl Tablet - - - - - -
43 Bisturi set - - - - - -
44 Ca glukonas Vial 24 - 24 - 24 -
45 Calsium Hidroksida Pasta (Dorident) Set - - - - - -
46 Captopril 12,5 mg Tablet 7,716 - 7,716 493 7,223 592
47 Captopril 25 mg Tablet - - - - - -
48 Cat- Gut/Benang Bedah Set - - - - - -
49 Cefadroxil 250 mg syr Botol - - - - - -
50 Cefadroxyl sirup kering 125mg/ml Botol - - - - - -
51 Cefadroxyl 500 mg Kapsul - - - - - -
52 Cefixime 100 mg Kapsul Kapsul - - - - - -
53 Cendo Lyteers Botol - - - - - -
54 Cetirizine Tablet - - - - - -
55 Cetirizine 5 mg/5 ml Syrup 60 ml Botol - - - - - -
56 Cimetidine 200 mg Tablet - - - - - -
57 Clobazam 10 mg Tablet 425 - 425 20 405 24
58 Clozapine 25 mg Tablet 360 - 360 30 330 36
59 Composit (Diafil) Tube - - - - - -
60 Cresophene Botol - - - - - -
61 Deksametason 0,5 mg Tablet - - - - - -
62 Deksametason inj 5 mg Ampul 79 - 79 2 77 2
63 Devitalisasi pasta (non arsen) Botol - - - - - -
64 Dextrose 40% inj Ampul - - - - - -
65 Diazepam inj 5 mg / ml Ampul 40 - 40 - 40 -
66 Diazepam rektal 5mg /2.5 ml (Stesolid) Tube 11 - 11 3 8 4
67 Dietylcarbamazin Sitrat 100 mg Tablet - - - - - -
68 Difenhidramin HCL inj 10 mg/ml Ampul 46 - 46 - 46 -
69 Digoksin 0,25 mg Tablet - - - - - -
70 Diltiazem HCl 30 mg Tablet - - - - - -
71 Doksisiklin 100 mg Capsul - - - - - -
72 Domperidon susp 5mg/ml Botol 146 - 146 20 126 24
73 Domperidone tab Tablet 2,559 1,000 3,559 253 3,306 304
74 Ekstraks Belladona tab 10 mg Tablet - - - - - -
75 Epinefrin HCL inj 0,1%-1 ml Ampul 94 - 94 - 94 -
76 Erythromycin 500 mg Tablet Salut Tablet - - - - - -
77 Erytromisin syr Botol - - - - - -
78 Etakridin ( Rivanol ) 0.1% Botol - - - - - -
79 Etanol 70% - 1.000 ml Botol 4 - 4 1 3 1
80 Etanol 70% - 100 ml Botol 90 - 90 - 90 -
NO NAMA OBAT
81 Etilklorida Semprot - 100 ml Botol - - - - - -
82 Eugenol cairan Botol 10 - 10 10 - 12
83 FDC KAT II Paket - - - - - -
84 FDC Kat. I Paket 10 10 20 8 12 10
85 Fenobarbital inj Ampul - - - - - -
86 Fenol Glicerol TT Botol 57 - 57 3 54 4
87 Fitomenadion 10 mg Tablet 600 - 600 53 547 64
88 Fitomenadion inj 10 mg / ml Ampul 24 - 24 - 24 -
89 Fluconazole 150 mg Tablet - - - - - -
90 Fluoxetine 10 mg Tablet - - - - - -
91 Fluphenazine Decanoate Ampul 20 10 30 8 22 10
92 Foley Catheter Set - - - - - -
93 Furalex Tablet - - - - - -
94 Furosemida 40 mg Tablet - - - - - -
95 Furosemida inj 10 mg/ml Ampul - - - - - -
96 Garam Oralit 200 ml Sachet 352 100 452 123 329 148
97 Gentamisin TT 2% tube - - - - - -
98 Gentamycine inj Ampul - - - - - -
99 Gentamycine salep mata 0,3 % (genoitol) Tube 74 - 74 1 73 1
100 Gentamysin tetes mata 0,3% Botol 91 24 115 19 96 23
101 Glass Ionomer cement untuk gigi posterior Set - - - - - -
102 Glibenklamid 5 mg Tablet 3,181 - 3,181 165 3,016 198
103 Gliseril Guaiacolat 100 mg Tablet - - - - - -
104 Glucosa 5% Botol - 20 20 - 20 -
105 Glukosa 10 % Botol 20 - 20 - 20 -
106 Griseovulfin 125 mg Tablet 255 200 455 200 255 240
107 Haloperidol 5 mg Tablet 130 - 130 60 70 72
108 Haloperidol decanoat Ampul - - - - - -
109 Haloperidol inj Ampul - - - - - -
110 Hand schoon steril 7,5 pcs - - - - - -
111 Handscrub (Cutisoft) Botol - - - - - -
112 Hidrocortison Cream 2,5% Tube 109 - 109 44 65 53
113 Hidroklortiazid (HCT) Tablet - - - - - -
114 Hyoscine-N-Butilbromide 20 mg/ml inj Ampul - - - - - -
115 Hyoscine-N-Butilbromide 10 mg Tablet 316 500 816 200 616 240
116 I.V catheter no : 18 Set 199 - 199 28 171 34
119 I.V Catheter no 26 Set 85 - 85 2 83 2
120 I.V Catheter No.22 Set 130 - 130 4 126 5
121 Ibuprofen 200 mg Tablet - - - - - -
122 Ibuprofen 400 mg Tablet 5,000 - 5,000 - 5,000 -
123 Infus Set Anak Set 193 - 193 48 145 58
124 Infus Set Dewasa Set 103 - 103 19 84 23
125 Isosorbit Dinitrat 5 mg Tablet - - - - - -
NO NAMA OBAT
126 IV. Catheter no. 16 Set - - - - - -
127 Kalium Permanganat Serbuk Pot - - - - - -
128 Kalsium Laktas 500 mg Tablet 9,808 5,000 14,808 2,734 12,074 3,281
129 Kanamycin inj Vial - - - - - -
130 Kapas Pembalut Adsorben Rol 10 - 10 1 9 1
131 Kasa 36 m x 80 cm Rol 5 - 5 1 4 1
132 Kasa Elastis 15 CM X 4,55 CM Roll 3 - 3 - 3 -
133 Kasa Kompres 40/40 Steril Bungkus - - - - - -
134 Kasa Pemb.Hidropil 4mx10cm Rol - - - - - -
135 Kasa Pemb.Hidropil 4mx15cm Rol 45 - 45 - 45 -
136 Kassa 16 x 16 cm Steril Kotak 57 - 57 57 - 68
137 Ketokonazol cream 2 % Tube - - - - - -
138 Ketokonazol Tab Tablet 192 500 692 110 582 132
139 Ketorolac Ampul - - - - - -
140 Klindamisin kap 150 mg Kapsul - - - - - -
142 Kloramfenikol 250 mg Kapsul - - - - - -
143 Kloramfenikol SM 1% Tube 195 - 195 8 187 10
144 Kloramfenikol suspensi Botol - 60 60 - 60 -
145 Kloramfenikol TT (erlamycetin) Botol 66 - 66 27 39 32
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet 21 - 21 21 - 25
147 Klorpromazin tab 100 mg Tablet 284 - 284 282 2 338
148 Kotrimoksazol 480 mg Tablet 2,756 - 2,756 36 2,720 43
149 Kotrimoksazol susp. Botol 87 - 87 8 79 10
150 Laxadin Emulsi 60 ml Botol - - - - - -
151 Levofloxacin tab 500 mg Tablet - - - - - -
152 Lidocain Jelly 2 % Tube - - - - - -
Lidocain kombinasi inj : lidokain HCl 2% +
153 Ampul
Epinefrin 1:80.000 30 - 30 - 30 -
154 Lidokain inj Ampul 252 100 352 46 306 55
155 Loperamide 2 mg tab Tablet - - - - - -
156 Loratadine 10 mg Tablet 182 - 182 174 8 209
157 Lysol 1 Ltr Botol - - - - - -
158 Magnesium Sulfat 20 % Ampul 134 - 134 14 120 17
159 Magnesium Sulfat 40 % Vial 20 - 20 - 20 -
160 Masker pcs - - - - - -
161 MDT MB Anak Blister - - - - - -
162 MDT MB Dewasa Blister 4 - 4 1 3 1
163 MDT PB Anak blister - - - - - -
164 MDT PB Dewasa Blister - - - - - -
165 Meloxicam 15 Tablet - - - - - -
166 Metformin 500 mg Tablet 1,493 3,000 4,493 2,413 2,080 2,896
167 Metildopa tab 250 mg Tablet - - - - - -
168 Metilergometrin Maleat 0,125 mg Tablet 229 - 229 - 229 -
169 Metilergometrin Maleat inj Ampul - - - - - -
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet 431 1,000 1,431 651 780 781
171 Metoclorpropamid injeksi Ampul - - - - - -
172 Metoclorpropamid 10 mg Tablet - - - - - -
173 Metronidazol 250mg Tablet - - - - - -
174 Metronidazol 500 mg/ml infus Botol - - - - - -
175 Metronidazol 500mg Tablet 2,904 - 2,904 21 2,883 25
176 Miconazole cream Tube - - - - - -
177 Mumifiying pasta Botol - - - - - -
178 Nalokson Hcl inj Vial - - - - - -
179 Nasal Cannula Anak Set 48 10 58 4 54 5
180 Nasal Cannula Dewasa Set - - - - - -
181 Natrium Bicarbonat 500 mg Tablet - - - - - -
182 Natrium Bicarbonat lar 8,4 % Botol - - - - - -
183 Natrium dikloffenak tab 25 mg Tablet - - - - - -
184 Natrium dikloffenak tab 50 mg Tablet 2,430 1,000 3,430 580 2,850 696
185 Natrium Klorida 0,9% Botol 99 - 99 14 85 17
186 Neo K (fitomenadion 2 mg/ml) Ampul 73 30 103 25 78 30
187 Neokolina syr Botol - - - - - -
188 Nifedipin tab Tablet - - - - - -
189 Nistatin Vaginal tab 100.000 IU Tablet 155 - 155 - 155 -
190 Nistatin Vaginal tab 500.000 IU Tablet - - - - - -
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket 1 2 3 2 1 2
193 Ofloxacin Tablet - - - - - -
194 Oksitetrasiklin HCL inj Vial - - - - - -
195 Oksitetrasiklin HCL SK 3% Tube - - - - - -
196 Oksitetrasiklin HCL SM 1% Tube - - - - - -
197 Oksitosin Inj Vial 847 - 847 32 815 38
198 Omeprazol kap 20 mg Kapsul 2,420 - 2,420 40 2,380 48
199 Papaverin 40 mg Tablet - - - - - -
200 Parasetamol 100 mg Tablet - - - - - -
201 Parasetamol 160 mg supp supp - - - - - -
203 Parasetamol 500 mg Tablet 10,741 10,000 20,741 6,613 14,128 7,936
205 Parasetamol Sirup Botol 251 100 351 101 250 121
206 Peahavral tab Tablet - - - - - -
207 Perak Sulfadiazin 1 % Tube 4 - 4 - 4 -
208 Pine oil 7,0%+benzyl clorophenol 0,6% Botol - - - - - -
209 Pirantel Pamoat 125 mg Tablet - - - - - -
210 Piridoksin HCL 10 mg Tablet 201 - 201 52 149 62
211 Piridoksin HCL 25 mg Tablet 600 - 600 - 600 -
212 Piroksikam 20 mg Tablet - - - - - -
213 Plester 10 yard x 1 inch Roll - - - - - -
214 Plester 5 yards x 1 inc Roll - - - - - -
NO NAMA OBAT
215 Povidon Yodida 30 ml Botol - - - - - -
217 Prednison 5 mg Tablet 4,326 - 4,326 20 4,306 24
218 Primaquine Tablet - - - - - -
219 Propanolol HCL 40 mg Tablet - - - - - -
220 Ranitidine Tablet 8,734 - 8,734 442 8,292 530
221 Ranitidine Inj Ampul - - - - - -
222 Retinol 100.000 IU Kapsul 300 200 500 500 - 600
223 Retinol 200.000 iu Kapsul 3,150 6,000 9,150 4,560 4,590 5,472
224 Ringer Laktat Botol 121 - 121 40 81 48
225 Risperidon tab 2 mg Tablet 230 1,000 1,230 581 649 697
226 Salbutamol 2 mg Tablet 2,445 - 2,445 258 2,187 310
227 Salbutamol 4 mg Tablet - - - - - -
228 Salep 2-4 Kombinasi Pot - - - - - -
229 Salisil Bedak 2% - 50 gr Kotak 21 - 21 21 - 25
230 Sanadril syr Botol - - - - - -
231 Sanvita syr Botol - - - - - -
232 Semen Seng Fosfat Set - - - - - -
233 Serum ABU I Vial 22 - 22 - 22 -
234 Serum ADS Ampul - - - - - -
235 Serum ATS 1.500 IU Vial 38 - 38 5 33 6
236 Sianokobalamin inj. Ampul - - - - - -
237 Sianokobalamin tab Tablet 2,009 500 2,509 1,110 1,399 1,332
238 Silk Benang Bedah Sutra Set 89 72 161 27 134 32
239 Simvastatin 10 mg Kapsul - - - - - -
240 Siprofloksasin 250 mg Tablet - - - - - -
241 Siprofloxacin 500 mg Tablet 2,677 500 3,177 408 2,769 490
242 Spironolactone Tablet - - - - - -
243 Tablet tambah darah Tablet 353,529 - 353,529 8,539 344,990 10,247
244 Temporary Stopping Fletcher Set - - - - - -
245 Tetrakain 0,5 % T.M (PANTOCAIN) Botol - - - - - -
246 Tetrasiklin 250 mg Tablet - - - - - -
248 Thiamin HCL 50 mg Tablet 2,209 600 2,809 1,362 1,447 1,634
249 Thiamin HCL inj Ampul - - - - - -
250 Tiamfenikol kap 500 mg Kapsul - - - - - -
251 Tramadol inj Ampul - - - - - -
252 Transfusi Bag Set - - - - - -
253 Triamcinolone asetonide cream Tube - - - - - -
254 Trifluoperazine Tablet - - - - - -
255 Trihexyphenidyl 2 mg Tablet 686 1,000 1,686 462 1,224 554
256 Urine Bag Set 55 - 55 16 39 19
257 Vaksin rabies verro Vial - - - - - -
258 Ventolin Nebules 2,5 mg Ampul - - - - - -
259 Vitamin B.Komplek Tablet 9 - 9 9 - 11
NO NAMA OBAT
260 Zinc Dispersible tab Tablet - - - - - -
261 Zink Syrup (ZIRCUM KID SYRUP) Botol 39 36 75 18 57 22
262 Permethrin Cream Tube 79 20 99 61 38 73
264 Handscoon Non Steril S Kotak 10 15 25 13 12 16
265 Handscoon Non Steril M Kotak 9 15 24 16 8 19
266 Handscoon Non Steril L Kotak 6 10 16 10 6 12
267 Foley Catheter no.16 Set 32 - 32 4 28 5
268 Foley Catheter no.18 Set 30 - 30 - 30 -
269 Fenitoin 100 mg Kapsul - - - - - -
270 Simvastatin 20 mg Kapsul 1,854 - 1,854 210 1,644 252
271 Kloramfenikol Salep Kulit 2% (bufacetin) Tube 72 72 144 44 100 53
272 Acetylcystein 200 mg Kapsul 7,457 2,640 10,097 2,436 7,661 2,923
273 Omeprazole injeksi Ampul 26 - 26 26 - 31
274 Paracetamol Drops Botol 15 ml Botol 104 - 104 18 86 22
275 Albendazol syrup Botol - - - - - -
276 Gentamycine salep Mata 0,1 % Tube - - - - - -
277 Megatik gel Tube - - - - - -
278 Minyak kayu putih Botol - - - - - -
279 Protexirek syrup Botol - - - - - -
280 Litacur Syirup Botol - - - - - -
281 Quantdex Syrup Botol - - - - - -
282 zink pro drop Botol - - - - - -
283 Piroxicam 10 mg Tablet - - - - - -
284 Underped Pcs 45 - 45 45 - 54
285 Swab Alcohol Box 10 - 10 2 8 2
286 dekacetin (kloramfenikol TM) btl - - - - - -
287 catgut plan 3/0 + jarum 1/2 GT35mm box - - - - - -
288 Cefixime syrup botol - - - - - -
289 Sarung Tangan Panjang Steril obgyn pcs - - - - - -
290 Antiseptik Pembersih Tangan (Aseptic Gel) botol 49 - 49 5 44 6
291 Isoniazid Tablets BP 100 mg tablet 68 - 68 - 68 -
Silk Benang Bedah Sutra (silk 3/0 + jarum 1/2 -
292 kotak/36
GT 35 mm) - - - - -
293 sterizyme botol 2 - 2 2 - 2
294 USG Gel botol - - - - - -
295 Leukomed kotak 6 - 6 - 6 -
296 Glucosa Test Strip (stik gula darah) kotak - - - - - -
297 Total Colesterol Test Strip (kolestrol) kotak - - - - - -
298 Uric Test Strip (stik asam urat) kotak - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
300 glimepiride 2 mg tablet 280 - 280 195 85 234
301 umbilical cord klem steril kotak/50 - - - - - -
302 mineral mix sachet - - - - - -
303 tumpatan sementara pot - - - - - -
NO NAMA OBAT
304 pasta desinfeksi saluran akar tube - - - - - -
305 pasta desinfeksi saluran akar botol - - - - - -
306 etching + bonding syringe + botol - - - - - -
307 desinfeksi saluran akar botol - - - - - -
308 cairan pembersih gigi poliren botol - - - - - -
pasta desinfeksi saluran akar yang tidak -
309 pot
mengandung arsen - - - - -
310 resin komposite tube - - - - - -
311 ibuprofen syrup botol - - - - - -
312 masker ktk/50 - 33 33 33 - 40
313 asam folat tablet - - - - - -
314 combivent vial - - - - - -
315 stik urine box - - - - - -
316 allupurinol 300 mg tab 1,520 - 1,520 1,520 - 1,824
317 plester cuticell clasic 10 cm x 10 cm roll - - - - - -
318 oxigen mask / nasal canula dewasa unit 15 20 35 1 34 1
319 salbutamol 2 mg tab - - - - - -
320 RDT URINE DIPCARD kotak/25 - - - - - -
321 PLUS URINE TEST STRIPS (TUBE 150) KOTAK - - - - - -
322 HAND sanitizer (softanol) botol - - - - - -
323 Lodomer (halopuridol 2 mg) tablet - - - - - -
324 Wanmed Dermavix Plester Non woven ktk 7 - 7 4 3 5
325 catgut chromic unit - - - - - -
326 catgut t-plain unit 127 12 139 29 110 35
327 Novachlor (kloramfenikol 250 mg) kapsul - - - - - -
328 risperidon 2 mg tab - - - - - -
329 INTEC one step anti-HIV (1 & 2) tri line test card box -
- - - - -
330 SD BIOLINE dengue IgG/IgM box - - - - - -
SD BIOLINE HBsAg WB (multi) test (BOX, ONE -
331 box
STEP HBsAg Test) - - - - -
332 SD BIOLINE Leptospire IgG/IgM box - - - - - -
333 SD HIV-1V2 3,0 (MULTI) KIT box - - - - - -
334 SD Syphilis Elisa 3,0 box - - - - - -
335 TES HIV 1/2/0 TRI - LINE TEST box - - - - - -
336 VACUTAINER K3 EDTA 3 ML UNGGU box - - - - - -
337 examination glove lain lain size s box 24 - 24 - 24 -
338 masker (tali) lain lain box - - - - - -
339 ONEMAD alcohol swab box 18 - 18 - 18 -
340 ONEMAD blood lanset l 28 - 28 - 28 -
341 ONEMAD SAFETY BOX LAIN LAIN 5 L UNIT - - - - - -
342 ONEMAD DISPOSIBLE SYRNG UNIT 2,400 - 2,400 - 2,400 -
343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

42 - - 42 -
344 KASSA KECIL STERIL HD NIPRO pcs 40 - 40 40 - 48
NO NAMA OBAT
345 MEDITAPE 3 inchi pcs 9 - 9 - 9 -
346 SARUNG TANGAN STERIL 7 pasang - - - - - -
347 cresotin pasta botol 4 - 4 - 4 -
348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

- - - - - -
TRIASTI AID Desposable 3 ply facemask ear
349 pcs
loop - - - - - -
350 DIALAB anti AB monoclonal ampul - - - - - -
351 Miniaspi tablet salut enterik 80 mg tablet - - - - - -
352 Sarung tangan steril 6,5 pasang - - - - - -
353 Geriavita captabs salut selaput tablet - - - - - -
354 masker N95 pcs 50 - 50 - 50 -
355 POLIAID 5000 ML Jeriken 1 - 1 - 1 -
356 Povidone Iodine 60 ML botol - - - - - -
DOLUTEGRAVIR CAPLET 50 MG
357 (DOLUTEGRAVIR+LAMIVUDINE+TENOFOVIR Tablet
/50/300/300MG) 60 - 60 60 - 72
TENOFOVIR|LAMIVUDINE|EFAVIRENZ (TDF|
358 3TC|EFV) TABLET 300 MG|300 MG|600 MG Tablet
(TENOLAM E )/TABLET - 180 180 120 60 144
359 OB HERBAL HERBACOLD PERMEN Kotak 8 - 8 - 8 -
360 OB HERBAL HERBAPAIN PERMEN Kotak 6 - 6 - 6 -
361 STIMUNO FORTE 10 KAPSUL Box 3 - 3 - 3 -
362 STIMUNO SIRUP KERING 60 ML Botol 7 - 7 - 7 -
363 HALOPERIDOL 1,5 MG tablet - 100 100 10 90 12
364 MASKER KERTAS 3 PLY (PROGRAM) box - 76 76 10 66 12
365 SOFT PAD 60 X 90 pcs - 100 100 18 82 22
366 KOMBIPAK 1 KKOMBINASI (FDC) box - 1 1 - 1 -
367 PAKET STOP TB KATEGORI 1 HARIAN box - 2 2 - 2 -
368 ADS 5 ML pcs - 100 100 50 50 60
BIVALENT ORAL POLIOMYELITIS VACCINE
369 vial
TYPES 1 & 3 DROPS - 80 80 20 60 24
370 ADS 0,5 ML Pcs - 700 700 350 350 420
371 ADS 0,05 ML Pcs - 200 200 100 100 120
372 PENTABIO VAKSIN DTP-HB-HIB 2,5 ML vial - 100 100 55 45 66
373 BCG VACCINE SERBUK 1 ML vial - 40 40 24 16 29
VAKSIN HEPATITIS B REKOMBINAN 20
374 unit
MCG/ML - 90 90 90 108
375 VAKSIN IPV 2,5 ML vial - 50 50 21 29 25
376 VAKSIN JERAP DT 5 ML vial - 30 30 10 20 12
377 VAKSIN MEALES RUBELLA 0,5 ML vial - 45 45 11 34 13
-
- - - -
501,827 48,625 548,473 49,226 501,226 57,932
JUMLAH
NO NAMA OBAT
JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

GAKIN
JUMLAH
Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Kepala Dinas Kesehatan Kab/Kota Kepala Seksi Penyimpanan dan Distribusi Kepala UPT Puskesmas Anyar
A.n Kepala Bidang SDK
Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)
DOKUMEN NOMOR TANGGAL

GUDANG FARMASI
PUSKESMAS 31-01- 2022
21
PERMIN PERSEDIAAN
JUMLAH KET
TAAN APBD 1 APBD 2 ASKES LAIN2
10 11 12 13 14 15 16
100
100 ED 130
-
-
-
500
-
-
-
-
-
-
-
-
-
-
5,000
-
-
-
-
100
-
-
20
-
-
-
-
-
1,000
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
120
-
-
-
-
-
5,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5
-
PERMIN PERSEDIAAN
JUMLAH KET
-
- ED 10
-
5
-
-
-
-
-
-
-
-
-
-
-
100
-
-
-
24
-
-
-
-
-
300
-
-
-
-
-
72
-
-
1,000
-
-
-
-
-
-
-
-
50
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
3
-
100
-
-
100
72
-
-
2,000
2,000
-
-
-
72
5,000
-
-
-
-
-
-
-
-
-
2,000
10
-
-
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
2,000
-
-
-
-
-
72
-
-
-
50
-
-
-
500
20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
10,000
-
100
-
-
-
-
-
-
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
40
-
-
-
72
100
-
-
-
-
-
-
-
4,000
-
-
-
500
-
-
-
-
-
-
2,000
-
-
-
-
-
-
-
10
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
5,000
36
100
-
20
20
20
-
-
-
-
48
5,280
10 ED 20
-
-
-
-
-
-
-
-
-
-
-
5
-
-
-
50
-
-
-
- ED 2
-
-
-
-
-
-
2,000
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
- ED 1390
-
-
-
-
-
-
-
12
48
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
- ED 60
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
IMUNI GRATIS/ JUMLAH

SASI KTP
1.165
Yang Menerima
Petugas Puskesmas
Neno Octal Iriani, Apt

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Februari 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Maret 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
2 Alat suntik 20 ml Set - - - - - -
4 Alat suntik 5 ml set 221 - 221 - 221 -
6 Allopurinol 100 mg Tablet 3,380 500 3,880 340 3,540 408
13 Amlodipin 10 mg Tablet 6,248 - 6,248 1,217 5,031 1,460
15 Amoxicillin Syrup Forte 250 mg/ml Botol 151 - 151 37 114 44
21 Antasida Doen Tablet 8,230 - 8,230 1,548 6,682 1,858
25 Antihaemoroid Doen Komb. Supp Supp 10 20 30 20 10 24
31 Asam Askorbat 50 mg Tablet 2,520 1,000 3,520 1,945 1,575 2,334
32 Asam Mefenamat 500 mg Tablet 8,148 - 8,148 946 7,202 1,135
NO NAMA OBAT
43 Bisturi set - - - - - -
62 Deksametason inj 5 mg Ampul 77 200 277 - 277 -
66 Diazepam rektal 5mg /2.5 ml (Stesolid) Tube 8 - 8 - 8 -
73 Domperidone tab Tablet 3,306 - 3,306 117 3,189 140
79 Etanol 70% - 1.000 ml Botol 3 - 3 - 3 -
80 Etanol 70% - 100 ml Botol 90 - 90 - 90 -
NO NAMA OBAT
82 Eugenol cairan Botol - - - - - -
84 FDC Kat. I Paket 12 5 17 3 14 4
91 Fluphenazine Decanoate Ampul 22 5 27 8 19 10
99 Gentamycine salep mata 0,3 % (genoitol) Tube 73 - 73 - 73 -
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 20 - 20 - 20 -
106 Griseovulfin 125 mg Tablet 255 300 555 - 555 -
107 Haloperidol 5 mg Tablet 70 - 70 70 - 84
112 Hidrocortison Cream 2,5% Tube 65 72 137 44 93 53
115 Hyoscine-N-Butilbromide 10 mg Tablet 616 500 1,116 191 925 229
117 I.V catheter no : 20 Set 158 - 158 - 158 -
119 I.V Catheter no 26 Set 83 - 83 - 83 -
120 I.V Catheter No.22 Set 126 - 126 - 126 -
124 Infus Set Dewasa Set 84 50 134 12 122 14
NO NAMA OBAT
128 Kalsium Laktas 500 mg Tablet 12,074 - 12,074 3,381 8,693 4,057
131 Kasa 36 m x 80 cm Rol 4 3 7 3 4 4
136 Kassa 16 x 16 cm Steril Kotak - - - - - -
138 Ketokonazol Tab Tablet 582 - 582 50 532 60
144 Kloramfenikol suspensi Botol 60 - 60 - 60 -
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet - - - - - -
147 Klorpromazin tab 100 mg Tablet 2 - 2 - 2 -
153 Ampul
Epinefrin 1:80.000 30 - 30 - 30 -
154 Lidokain inj Ampul 306 - 306 32 274 38
156 Loratadine 10 mg Tablet 8 - 8 8 - 10
157 Lysol 1 Ltr Botol - - - - - -
160 Masker pcs - - - - - -
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet 780 800 1,580 224 1,356 269
179 Nasal Cannula Anak Set 54 - 54 3 51 4
184 Natrium dikloffenak tab 50 mg Tablet 2,850 500 3,350 610 2,740 732
185 Natrium Klorida 0,9% Botol 85 20 105 4 101 5
186 Neo K (fitomenadion 2 mg/ml) Ampul 78 - 78 11 67 13
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket 1 2 3 1 2 1
210 Piridoksin HCL 10 mg Tablet 149 - 149 149 - 179
NO NAMA OBAT
222 Retinol 100.000 IU Kapsul - 650 650 100 550 120
223 Retinol 200.000 iu Kapsul 4,590 - 4,590 112 4,478 134
224 Ringer Laktat Botol 81 40 121 11 110 13
225 Risperidon tab 2 mg Tablet 649 1,000 1,649 561 1,088 673
229 Salisil Bedak 2% - 50 gr Kotak - - - - - -
233 Serum ABU I Vial 22 - 22 4 18 5
235 Serum ATS 1.500 IU Vial 33 - 33 5 28 6
237 Sianokobalamin tab Tablet 1,399 1,000 2,399 1,111 1,288 1,333
238 Silk Benang Bedah Sutra Set 134 - 134 17 117 20
248 Thiamin HCL 50 mg Tablet 1,447 2,000 3,447 1,332 2,115 1,598
255 Trihexyphenidyl 2 mg Tablet 1,224 500 1,724 495 1,229 594
256 Urine Bag Set 39 10 49 1 48 1
259 Vitamin B.Komplek Tablet - - - - - -
NO NAMA OBAT
263 Alat Suntik 10 ml Set 100 - 100 - 100 -
270 Simvastatin 20 mg Kapsul 1,644 - 1,644 130 1,514 156
273 Omeprazole injeksi Ampul - 10 10 - 10 -
284 Underped Pcs - - - - - -
285 Swab Alcohol Box 8 5 13 4 9 5
292 kotak/36
GT 35 mm) - - - - -
293 sterizyme botol - 4 4 - 4 -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
300 glimepiride 2 mg tablet 85 400 485 120 365 144
NO NAMA OBAT
309 pot
312 masker ktk/50 - 33 33 33 - 40
316 allupurinol 300 mg tab - - - - - -
318 oxigen mask / nasal canula dewasa unit 34 - 34 2 32 2
324 Wanmed Dermavix Plester Non woven ktk 3 - 3 1 2 1
- - - - -
331 box

42 - - 42 -
344 KASSA KECIL STERIL HD NIPRO pcs - - - - - -
NO NAMA OBAT
345 MEDITAPE 3 inchi pcs 9 - 9 1 8 1

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 50 - 50 - 50 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 60 - 60 60 - 72
363 HALOPERIDOL 1,5 MG tablet 90 - 90 10 80 12
364 MASKER KERTAS 3 PLY (PROGRAM) box 66 - 66 11 55 13
365 SOFT PAD 60 X 90 pcs 82 - 82 44 38 53
366 KOMBIPAK 1 KKOMBINASI (FDC) box 1 - 1 - 1 -
367 PAKET STOP TB KATEGORI 1 HARIAN box 2 2 4 - 4 -
368 ADS 5 ML pcs 50 100 150 100 50 120
369 vial
TYPES 1 & 3 DROPS 60 40 100 60 40 72
370 ADS 0,5 ML Pcs 350 500 850 500 350 600
371 ADS 0,05 ML Pcs 100 100 200 100 100 120
372 PENTABIO VAKSIN DTP-HB-HIB 2,5 ML vial 45 60 105 84 21 101
373 BCG VACCINE SERBUK 1 ML vial 16 40 56 28 28 34
374 unit
MCG/ML 40 40 - 40 -
375 VAKSIN IPV 2,5 ML vial 29 30 59 17 42 20
376 VAKSIN JERAP DT 5 ML vial 20 - 20 20 - 24
377 VAKSIN MEALES RUBELLA 0,5 ML vial 34 35 69 33 36 40
388 SAFETY BOX 5 LITER Pcs - 25 25 10 15 12
- - - -
501,226 29,520 528,744 86,362 444,384 102,342
JUMLAH
NO NAMA OBAT

GAKIN
JUMLAH


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
100
100
200
-
-
500
-
-
-
-
-
-
1,000
-
60
200
5,000
-
-
-
1,000
100
-
-
30
-
30
-
-
-
2,000
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,000
120
-
-
-
-
-
10,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5
-
PERMIN PERSEDIAAN
JUMLAH KET
3
-
-
-
-
24
-
-
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
96
-
-
1,000
-
-
-
-
-
-
-
-
50
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
3,000
-
2
6
-
100
-
-
200
72
-
-
2,000
2,000
-
-
-
72
10,000
-
-
-
-
-
-
-
-
-
2,000
20
30 ED 22
-
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
2,000
-
-
-
-
-
96
-
-
-
50
100
-
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
10,000
-
100
-
-
-
-
-
400
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
20
-
-
-
96
100
-
-
-
- ED 2
-
10
-
2,000
-
-
-
500
-
-
-
-
-
-
2,000
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
100
-
20
20
20
10
-
-
-
48
5,280
-
-
-
-
-
-
-
-
-
-
-
-
5
-
-
-
50
-
-
-
-
-
-
-
-
-
-
2,000
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
-
-
-
-
-
-
-
-
12
48
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET

SASI KTP
1.153
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Maret 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : April 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
22 Antasida Doen Sirup Botol 11 - 11 11 - 13
25 Antihaemoroid Doen Komb. Supp Supp 10 30 40 - 40 -
27 Aqua Pro inj Steril 25 ml Ampul 52 30 82 9 73 11
31 Asam Askorbat 50 mg Tablet 1,575 2,000 3,575 727 2,848 872
32 Asam Mefenamat 500 mg Tablet 7,202 - 7,202 1,288 5,914 1,546
NO NAMA OBAT
43 Bisturi set - - - - - -
44 Ca glukonas Vial 24 - 24 24 - 29
57 Clobazam 10 mg Tablet 345 - 345 345 - 414
79 Etanol 70% - 1.000 ml Botol 3 - 3 1 2 1
80 Etanol 70% - 100 ml Botol 90 - 90 - 90 -
NO NAMA OBAT
84 FDC Kat. I Paket 14 - 14 7 7 8
86 Fenol Glicerol TT Botol 50 24 74 5 69 6
91 Fluphenazine Decanoate Ampul 19 - 19 2 17 2
96 Garam Oralit 200 ml Sachet 361 - 361 68 293 82
100 Gentamysin tetes mata 0,3% Botol 110 - 110 27 83 32
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 20 - 20 - 20 -
106 Griseovulfin 125 mg Tablet 555 - 555 23 532 28
107 Haloperidol 5 mg Tablet - - - - - -
115 Hyoscine-N-Butilbromide 10 mg Tablet 925 500 1,425 194 1,231 233
124 Infus Set Dewasa Set 122 50 172 14 158 17
NO NAMA OBAT
130 Kapas Pembalut Adsorben Rol 7 2 9 2 7 2
131 Kasa 36 m x 80 cm Rol 4 6 10 1 9 1
147 Klorpromazin tab 100 mg Tablet 2 - 2 - 2 -
153 Ampul
Epinefrin 1:80.000 30 - 30 - 30 -
156 Loratadine 10 mg Tablet - - - - - -
157 Lysol 1 Ltr Botol - - - - - -
158 Magnesium Sulfat 20 % Ampul 76 30 106 - 106 -
160 Masker pcs - - - - - -
162 MDT MB Dewasa Blister 2 6 8 2 6 2
168 Metilergometrin Maleat 0,125 mg Tablet 229 - 229 1 228 1
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet 1,356 500 1,856 527 1,329 632
189 Nistatin Vaginal tab 100.000 IU Tablet 155 - 155 11 144 13
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket 2 - 2 - 2 -
210 Piridoksin HCL 10 mg Tablet - - - - - -
211 Piridoksin HCL 25 mg Tablet 442 400 842 169 673 203
NO NAMA OBAT
222 Retinol 100.000 IU Kapsul 550 - 550 - 550 -
225 Risperidon tab 2 mg Tablet 1,088 500 1,588 590 998 708
233 Serum ABU I Vial 18 - 18 2 16 2
235 Serum ATS 1.500 IU Vial 28 10 38 7 31 8
237 Sianokobalamin tab Tablet 1,288 1,000 2,288 638 1,650 766
248 Thiamin HCL 50 mg Tablet 2,115 1,600 3,715 553 3,162 664
256 Urine Bag Set 48 - 48 2 46 2
NO NAMA OBAT
261 Zink Syrup (ZIRCUM KID SYRUP) Botol 87 - 87 11 76 13
267 Foley Catheter no.16 Set 22 10 32 6 26 7
270 Simvastatin 20 mg Kapsul 1,514 - 1,514 1,514 - 1,817
273 Omeprazole injeksi Ampul 10 - 10 - 10 -
284 Underped Pcs - - - - - -
290 Antiseptik Pembersih Tangan (Aseptic Gel) botol 37 - 37 - 37 -
292 kotak/36
GT 35 mm) - - - - -
293 sterizyme botol 4 - 4 - 4 -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
300 glimepiride 2 mg tablet 365 2,000 2,365 145 2,220 174
NO NAMA OBAT
309 pot
312 masker ktk/50 - 30 30 30 - 36
324 Wanmed Dermavix Plester Non woven ktk 2 - 2 2 - 2
- - - - -
331 box

42 - - 42 -
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 50 - 50 - 50 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET - 300 300 60 240 72
363 HALOPERIDOL 1,5 MG tablet 80 - 80 70 10 84
364 MASKER KERTAS 3 PLY (PROGRAM) box 55 - 55 - 55 -
365 SOFT PAD 60 X 90 pcs 38 100 138 41 97 49
367 PAKET STOP TB KATEGORI 1 HARIAN box 4 - 4 - 4 -
368 ADS 5 ML pcs 50 100 150 50 100 60
369 vial
TYPES 1 & 3 DROPS 40 50 90 67 23 80
370 ADS 0,5 ML Pcs 350 500 850 550 300 660
371 ADS 0,05 ML Pcs 100 - 100 - 100 -
374 unit
MCG/ML 40 100 140 120 20 144
376 VAKSIN JERAP DT 5 ML vial - 20 20 20 - 24
388 SAFETY BOX 5 LITER Pcs 15 - 15 5 10 6
- - - -
444,384 34,040 476,154 111,639 366,785 132,558
JUMLAH
NO NAMA OBAT

GAKIN
JUMLAH


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
100
100
300
-
-
-
-
-
-
-
-
-
2,000
-
60
200
5,000
-
-
-
1,000
200
-
-
-
-
-
-
-
-
2,000
2,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
96
-
-
24 ED 24
-
-
1,000
-
-
-
-
-
-
1,000
120
-
- ED 317
- ED 130
-
-
10,000
-
-
-
-
10
-
-
-
-
-
-
-
-
-
-
-
20
5
-
PERMIN PERSEDIAAN
JUMLAH KET
3
-
-
-
-
-
-
-
-
-
-
-
-
100
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
96
-
-
500
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
3,000
-
2
-
-
100
-
-
200
72
-
-
2,000
2,000
500
-
-
72
2,000
-
-
-
-
-
-
-
100
-
2,000
20
-
-
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
2,000
-
-
-
-
-
96
-
-
-
50
100
-
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
-
-
-
-
-
500
400
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
20
-
-
1,000
96
100
-
-
-
-
-
10
-
2,000
48
-
-
500
-
-
-
-
-
-
1,000
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
100
-
20
20
20
10
-
-
1,000 ED 1.414
48
5,280
-
50
-
-
-
-
-
-
-
-
-
-
5
-
-
-
50
-
-
-
-
-
-
-
-
-
-
-
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
-
-
-
-
-
-
-
-
20
48
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET

SASI KTP
1.075
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : April 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Mei 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
17 Amoxisilin 250 mg Kapsul 5 - 5 - 5 -
22 Antasida Doen Sirup Botol - - - - - -
31 Asam Askorbat 50 mg Tablet 2,848 1,000 3,848 494 3,354 593
NO NAMA OBAT
41 Betamethason Krim Tube - 16 16 - 16 -
43 Bisturi set - - - - - -
44 Ca glukonas Vial - 24 24 - 24 -
47 Captopril 25 mg Tablet - 300 300 60 240 72
54 Cetirizine Tablet - 300 300 199 101 239
57 Clobazam 10 mg Tablet - 200 200 - 200 -
58 Clozapine 25 mg Tablet 100 100 200 130 70 156
62 Deksametason inj 5 mg Ampul 276 20 296 5 291 6
65 Diazepam inj 5 mg / ml Ampul 40 20 60 - 60 -
66 Diazepam rektal 5mg /2.5 ml (Stesolid) Tube 6 10 16 1 15 1
79 Etanol 70% - 1.000 ml Botol 2 - 2 1 1 1
80 Etanol 70% - 100 ml Botol 90 82 172 - 172 -
NO NAMA OBAT
84 FDC Kat. I Paket 7 16 23 15 8 18
99 Gentamycine salep mata 0,3 % (genoitol) Tube 71 - 71 71 - 85
100 Gentamysin tetes mata 0,3% Botol 83 - 83 22 61 26
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 20 - 20 2 18 2
107 Haloperidol 5 mg Tablet - 200 200 60 140 72
115 Hyoscine-N-Butilbromide 10 mg Tablet 1,231 300 1,531 304 1,227 365
122 Ibuprofen 400 mg Tablet 5,000 - 5,000 190 4,810 228
123 Infus Set Anak Set 140 - 140 140 - 168
NO NAMA OBAT
130 Kapas Pembalut Adsorben Rol 7 2 9 - 9 -
131 Kasa 36 m x 80 cm Rol 9 - 9 1 8 1
132 Kasa Elastis 15 CM X 4,55 CM Roll 3 - 3 3 - 4
137 Ketokonazol cream 2 % Tube - 45 45 - 45 -
141 Klindamisin kap 300 mg Kapsul - 500 500 20 480 24
143 Kloramfenikol SM 1% Tube 179 48 227 4 223 5
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet - 800 800 - 800 -
147 Klorpromazin tab 100 mg Tablet 2 - 2 2 - 2
149 Kotrimoksazol susp. Botol 57 100 157 5 152 6
153 Ampul
Epinefrin 1:80.000 30 - 30 30 - 36
157 Lysol 1 Ltr Botol - - - - - -
158 Magnesium Sulfat 20 % Ampul 106 - 106 - 106 -
160 Masker pcs - - - - - -
NO NAMA OBAT
190 Nistatin Vaginal tab 500.000 IU Tablet - 200 200 - 200 -
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket 2 - 2 2 - 2
198 Omeprazol kap 20 mg Kapsul 2,340 - 2,340 - 2,340 -
205 Parasetamol Sirup Botol 332 - 332 54 278 65
211 Piridoksin HCL 25 mg Tablet 673 400 1,073 123 950 148
NO NAMA OBAT
225 Risperidon tab 2 mg Tablet 998 500 1,498 720 778 864
233 Serum ABU I Vial 16 - 16 - 16 -
235 Serum ATS 1.500 IU Vial 31 10 41 6 35 7
237 Sianokobalamin tab Tablet 1,650 - 1,650 472 1,178 566
243 Tablet tambah darah Tablet 213,780 58,770 272,550 8,640 263,910 10,368
256 Urine Bag Set 46 - 46 1 45 1
NO NAMA OBAT
260 Zinc Dispersible tab Tablet - 500 500 - 500 -
267 Foley Catheter no.16 Set 26 10 36 - 36 -
270 Simvastatin 20 mg Kapsul - 500 500 50 450 60
273 Omeprazole injeksi Ampul 10 - 10 1 9 1
274 Paracetamol Drops Botol 15 ml Botol 59 60 119 10 109 12
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
300 glimepiride 2 mg tablet 2,220 - 2,220 115 2,105 138
NO NAMA OBAT
309 pot
312 masker ktk/50 - 30 30 30 - 36
324 Wanmed Dermavix Plester Non woven ktk - - - - - -
326 catgut t-plain unit 165 - 165 12 153 14
- - - - -
331 box

42 - - 42 -
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 50 - 50 - 50 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 240 - 240 90 150 108
361 STIMUNO FORTE 10 KAPSUL Box 3 - 3 1 2 1
363 HALOPERIDOL 1,5 MG tablet 10 - 10 10 - 12
365 SOFT PAD 60 X 90 pcs 97 60 157 38 119 46
367 PAKET STOP TB KATEGORI 1 HARIAN box 4 - 4 1 3 1
368 ADS 5 ML pcs 100 - 100 100 - 120
369 vial
TYPES 1 & 3 DROPS 23 50 73 57 16 68
370 ADS 0,5 ML Pcs 300 400 700 500 200 600
371 ADS 0,05 ML Pcs 100 - 100 100 - 120
374 unit
MCG/ML 20 80 100 50 50 60
376 VAKSIN JERAP DT 5 ML vial - 20 20 20 - 24
388 SAFETY BOX 5 LITER Pcs 10 - 10 - 10 -
389 ERGOTAMINA TARTAT Tablet - 400 400 - 400 -
390 FUJI IX GP A3 1-1 Box - 1 1 - 1 -
391 KASA HIDROPHILE 16X16 CM HUSADA Box - 9 9 - 9 -
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet - 500 500 - 500 -
366,785 89,974 456,759 36,369 420,390 43,643
JUMLAH

BPJS GAKIN
JUMLAH 570 360


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
-
100
100
-
-
-
-
-
-
-
-
-
2,000
-
120
200
5,000
-
-
-
1,000
200
-
-
10
-
-
-
-
-
-
2,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
96
-
-
-
-
-
1,000
-
-
-
-
-
-
2,000
120
-
-
- ED 77
-
-
10,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5
-
PERMIN PERSEDIAAN
JUMLAH KET
5
-
-
-
-
-
-
-
-
-
-
-
-
100
-
100
-
-
- ED 54
24
-
-
-
-
-
-
-
-
-
-
-
-
-
-
500
50
-
-
-
-
-
-
100 ED 140
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
-
3,000
-
2
-
-
100
-
-
200
72
200
-
2,000
2,000
500
-
-
72
2,000
-
-
-
-
-
-
30
100
-
2,000
20
-
-
-
-
-
-
-
-
5,000
-
- ED 24
-
PERMIN PERSEDIAAN
JUMLAH KET
2,000
-
-
-
-
-
96
-
-
-
50
100
-
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
100
-
-
-
-
500
400
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
20
-
-
1,000
96
100
-
-
-
-
-
10
-
2,000
96
-
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
100
-
20
20
20
-
-
-
1,000
24
2,640
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
50
-
-
-
-
-
-
-
-
-
-
-
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
-
-
-
-
-
-
-
-
20
48
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
50
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET

SASI KTP
930
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Mei 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Juni 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
18 Amoxisilin 500 mg Kapsul 5,539 5,000 10,539 5,924 4,615 7,109
22 Antasida Doen Sirup Botol - 200 200 1 199 1
31 Asam Askorbat 50 mg Tablet 3,354 - 3,354 603 2,751 724
NO NAMA OBAT
41 Betamethason Krim Tube 16 - 16 16 - 19
43 Bisturi set - - - - - -
47 Captopril 25 mg Tablet 240 - 240 150 90 180
54 Cetirizine Tablet 101 - 101 91 10 109
68 Difenhidramin HCL inj 10 mg/ml Ampul 46 - 46 1 45 1
79 Etanol 70% - 1.000 ml Botol 1 - 1 - 1 -
80 Etanol 70% - 100 ml Botol 172 - 172 - 172 -
NO NAMA OBAT
84 FDC Kat. I Paket 8 10 18 7 11 8
99 Gentamycine salep mata 0,3 % (genoitol) Tube - - - - - -
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 18 - 18 - 18 -
107 Haloperidol 5 mg Tablet 140 100 240 60 180 72
116 I.V catheter no : 18 Set 133 50 183 25 158 30
119 I.V Catheter no 26 Set 79 - 79 - 79 -
123 Infus Set Anak Set - 100 100 - 100 -
NO NAMA OBAT
131 Kasa 36 m x 80 cm Rol 8 - 8 2 6 2
132 Kasa Elastis 15 CM X 4,55 CM Roll - - - - - -
137 Ketokonazol cream 2 % Tube 45 - 45 21 24 25
141 Klindamisin kap 300 mg Kapsul 480 2,000 2,480 - 2,480 -
145 Kloramfenikol TT (erlamycetin) Botol 1 - 1 1 - 1
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet 800 - 800 - 800 -
147 Klorpromazin tab 100 mg Tablet - - - - - -
148 Kotrimoksazol 480 mg Tablet 2,606 - 2,606 - 2,606 -
153 Ampul
Epinefrin 1:80.000 - - - - - -
157 Lysol 1 Ltr Botol - - - - - -
159 Magnesium Sulfat 40 % Vial 20 - 20 1 19 1
160 Masker pcs - - - - - -
NO NAMA OBAT
186 Neo K (fitomenadion 2 mg/ml) Ampul 60 - 60 - 60 -
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket - 2 2 - 2 -
207 Perak Sulfadiazin 1 % Tube 4 - 4 1 3 1
NO NAMA OBAT
217 Prednison 5 mg Tablet 4,187 - 4,187 - 4,187 -
225 Risperidon tab 2 mg Tablet 778 1,000 1,778 490 1,288 588
228 Salep 2-4 Kombinasi Pot - 48 48 - 48 -
233 Serum ABU I Vial 16 - 16 4 12 5
235 Serum ATS 1.500 IU Vial 35 10 45 7 38 8
237 Sianokobalamin tab Tablet 1,178 - 1,178 310 868 372
248 Thiamin HCL 50 mg Tablet 4,072 - 4,072 285 3,787 342
256 Urine Bag Set 45 - 45 11 34 13
NO NAMA OBAT
260 Zinc Dispersible tab Tablet 500 - 500 - 500 -
270 Simvastatin 20 mg Kapsul 450 1,000 1,450 195 1,255 234
272 Acetylcystein 200 mg Kapsul 13,737 - 13,737 1,274 12,463 1,529
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
NO NAMA OBAT
309 pot
312 masker ktk/50 - 33 33 33 - 40
326 catgut t-plain unit 153 - 153 15 138 18
- - - - -
331 box

42 - - 42 -
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 50 - 50 - 50 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 150 - 150 60 90 72
361 STIMUNO FORTE 10 KAPSUL Box 2 - 2 2 - 2
362 STIMUNO SIRUP KERING 60 ML Botol 7 - 7 7 - 8
363 HALOPERIDOL 1,5 MG tablet - - - - - -
365 SOFT PAD 60 X 90 pcs 119 50 169 76 93 91
367 PAKET STOP TB KATEGORI 1 HARIAN box 3 - 3 - 3 -
368 ADS 5 ML pcs - 100 100 100 - 120
369 vial
TYPES 1 & 3 DROPS 16 70 86 43 43 52
370 ADS 0,5 ML Pcs 200 400 600 300 300 360
371 ADS 0,05 ML Pcs - 200 200 100 100 120
374 unit
MCG/ML 50 50 100 70 30 84
375 VAKSIN IPV 2,5 ML vial 6 - 6 6 - 7
376 VAKSIN JERAP DT 5 ML vial - 50 50 20 30 24
388 SAFETY BOX 5 LITER Pcs 10 - 10 - 10 -
389 ERGOTAMINA TARTAT Tablet 400 - 400 - 400 -
390 FUJI IX GP A3 1-1 Box 1 - 1 - 1 -
391 KASA HIDROPHILE 16X16 CM HUSADA Box 9 - 9 - 9 -
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet 500 - 500 - 500 -
393 ONEMED PLESTERIN PLESTER 10 X 5 CM Box

- 10 10 - 10 -
420,390 29,849 450,239 42,032 408,207 50,438
JUMLAH

BPJS GAKIN
JUMLAH 535 440


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
100
100
400
-
-
2,000
-
-
-
-
-
-
2,000
-
120
200
5,000
5,000 ED
-
-
5,000
-
-
-
20
-
-
-
-
-
1,000
2,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
1,000
-
-
120
-
-
-
-
-
1,000
-
-
-
-
-
-
2,000
120
-
-
-
-
-
10,000
-
-
-
-
-
-
-
-
-
-
50
500
-
-
-
-
20
-
-
PERMIN PERSEDIAAN
JUMLAH KET
5
-
-
-
-
24
1,000
-
-
-
-
-
-
200
-
100
-
-
-
24
-
500
-
-
-
200
-
-
-
-
-
24
-
-
500
-
-
-
-
-
-
-
50
50
100
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
-
3
5
100
-
-
200
96
200
-
-
-
500
-
-
72
2,000
-
-
-
-
-
-
30
100
-
2,000
20
-
-
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
3,000
-
-
-
-
-
96
-
-
20
50
100
-
-
2,000
-
60
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
100
-
1
-
-
500
600
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
40
-
1,000
1,000
96
100
-
-
-
2
-
10
-
3,000
96
-
-
1,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20 ED 10
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
-
-
100
-
20
20
20
-
-
-
1,000
24
2,640
10
-
-
-
-
-
-
-
-
-
-
-
3
-
-
-
50
-
-
-
-
-
-
-
-
-
-
-
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
1,000
-
10
-
-
-
-
-
20
48
24
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-

SASI KTP
975
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Juni 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Juli 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
6 Allopurinol 100 mg Tablet 2,921 2,000 4,921 181 4,740 217
11 Amitriptillin tab 25 mg Tablet 290 100 390 120 270 144
31 Asam Askorbat 50 mg Tablet 2,751 1,000 3,751 863 2,888 1,036
NO NAMA OBAT
43 Bisturi set - - - - - -
47 Captopril 25 mg Tablet 90 - 90 90 - 108
54 Cetirizine Tablet 10 - 10 10 - 12
57 Clobazam 10 mg Tablet 170 100 270 30 240 36
62 Deksametason inj 5 mg Ampul 286 - 286 286 - 343
72 Domperidon susp 5mg/ml Botol 73 100 173 22 151 26
73 Domperidone tab Tablet 2,616 500 3,116 243 2,873 292
75 Epinefrin HCL inj 0,1%-1 ml Ampul 94 - 94 3 91 4
79 Etanol 70% - 1.000 ml Botol 1 - 1 - 1 -
80 Etanol 70% - 100 ml Botol 172 - 172 1 171 1
NO NAMA OBAT
84 FDC Kat. I Paket 11 5 16 9 7 11
87 Fitomenadion 10 mg Tablet 318 200 518 106 412 127
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 18 - 18 - 18 -
109 Haloperidol inj Ampul - 25 25 - 25 -
120 I.V Catheter No.22 Set 118 - 118 118 - 142
123 Infus Set Anak Set 100 100 200 1 199 1
NO NAMA OBAT
131 Kasa 36 m x 80 cm Rol 6 3 9 5 4 6
132 Kasa Elastis 15 CM X 4,55 CM Roll - 5 5 - 5 -
141 Klindamisin kap 300 mg Kapsul 2,480 - 2,480 10 2,470 12
144 Kloramfenikol suspensi Botol 60 - 60 1 59 1
145 Kloramfenikol TT (erlamycetin) Botol - - - - - -
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet 800 - 800 800 - 960
153 Ampul
Epinefrin 1:80.000 - - - - - -
157 Lysol 1 Ltr Botol - - - - - -
160 Masker pcs - - - - - -
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet 1,479 - 1,479 1,402 77 1,682
179 Nasal Cannula Anak Set 41 20 61 9 52 11
184 Natrium dikloffenak tab 50 mg Tablet 2,337 1,000 3,337 1,100 2,237 1,320
191 O.B.H.Sirup Botol - - - - - -
198 Omeprazol kap 20 mg Kapsul 2,320 - 2,320 - 2,320 -
NO NAMA OBAT
225 Risperidon tab 2 mg Tablet 1,288 - 1,288 610 678 732
226 Salbutamol 2 mg Tablet 1,135 500 1,635 200 1,435 240
228 Salep 2-4 Kombinasi Pot 48 48 96 3 93 4
233 Serum ABU I Vial 12 2 14 - 14 -
235 Serum ATS 1.500 IU Vial 38 10 48 7 41 8
237 Sianokobalamin tab Tablet 868 - 868 850 18 1,020
248 Thiamin HCL 50 mg Tablet 3,787 - 3,787 1,495 2,292 1,794
255 Trihexyphenidyl 2 mg Tablet 1,419 - 1,419 460 959 552
256 Urine Bag Set 34 20 54 1 53 1
NO NAMA OBAT
264 Handscoon Non Steril S Kotak 5 12 17 17 - 20
265 Handscoon Non Steril M Kotak 3 10 13 13 - 16
266 Handscoon Non Steril L Kotak 17 - 17 10 7 12
270 Simvastatin 20 mg Kapsul 1,255 500 1,755 210 1,545 252
272 Acetylcystein 200 mg Kapsul 12,463 - 12,463 2,479 9,984 2,975
273 Omeprazole injeksi Ampul 7 10 17 4 13 5
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 2 - 2 - 2 -
NO NAMA OBAT
309 pot
312 masker ktk/50 - 33 33 33 - 40
- - - - -
331 box
340 ONEMAD blood lanset l 28 - 28 3 25 4

42 - 1 41 1
NO NAMA OBAT
347 cresotin pasta botol 4 - 4 4 - 5

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 50 - 50 5 45 6
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 90 - 90 30 60 36
361 STIMUNO FORTE 10 KAPSUL Box - - - - - -
362 STIMUNO SIRUP KERING 60 ML Botol - - - - - -
365 SOFT PAD 60 X 90 pcs 93 100 193 29 164 35
368 ADS 5 ML pcs - 100 100 - 100 -
369 vial
TYPES 1 & 3 DROPS 43 60 103 68 35 82
370 ADS 0,5 ML Pcs 300 400 700 300 400 360
371 ADS 0,05 ML Pcs 100 100 200 100 100 120
374 unit
MCG/ML 30 70 100 61 39 73
375 VAKSIN IPV 2,5 ML vial - 30 30 21 9 25
376 VAKSIN JERAP DT 5 ML vial 30 30 60 34 26 41
390 FUJI IX GP A3 1-1 Box 1 - 1 - 1 -
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet 500 - 500 210 290 252

10 20 30 1 29 1
408,207 36,500 444,707 48,483 396,224 58,180
JUMLAH

BPJS GAKIN
JUMLAH 701 583


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
-
100
300
-
-
1,000
-
-
-
-
-
-
2,000
-
120
200
5,000
5,000
-
-
3,000
-
-
-
20
-
-
-
-
-
2,000
2,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
2,000
-
-
120
-
-
-
-
-
1,000
-
-
-
-
-
-
2,000
120
-
-
-
-
-
10,000
30 ED 282
-
-
-
5
-
-
-
-
-
50
1,000
-
-
-
-
20
5
-
PERMIN PERSEDIAAN
JUMLAH KET
5
-
-
-
-
24
1,000
-
-
-
-
-
-
200
-
100
-
-
-
24
-
500
-
-
-
300
-
-
-
-
-
96
-
-
1,000
50
50
-
-
50 ED 108
-
-
-
100
100
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
2
3
-
100
-
-
200
96
200
-
-
-
500
-
-
72
2,000
-
-
-
-
-
-
30
100
-
2,000
20
-
10
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
3,000
-
-
-
-
-
96
-
-
-
50
100
-
-
3,000
20
30
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
100
-
1
-
-
500
1,400
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
-
-
1,000
1,000
-
100
-
-
-
-
-
-
-
3,000
96
-
-
1,000
-
-
-
-
-
-
4,000
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
-
-
100
-
20
20
10
-
-
-
1,000
-
5,280
10
-
-
-
-
-
-
-
-
-
-
-
5
-
-
-
50
-
-
-
-
-
-
-
-
-
-
300
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
50
-
1,000
-
-
-
-
-
-
-
20
96
24
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
- ED 4
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-

SASI KTP
1.284
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Juli 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Agustus 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
6 Allopurinol 100 mg Tablet 4,740 1,000 5,740 360 5,380 432
15 Amoxicillin Syrup Forte 250 mg/ml Botol 124 - 124 91 33 109
19 Ampicillin 1 gr injeksi Ampul 141 - 141 9 132 11
35 Asiclovir 400 mg Tablet 1,584 - 1,584 1,584 - 1,901
NO NAMA OBAT
43 Bisturi set - - - - - -
62 Deksametason inj 5 mg Ampul - 100 100 4 96 5
72 Domperidon susp 5mg/ml Botol 151 100 251 20 231 24
79 Etanol 70% - 1.000 ml Botol 1 - 1 1 - 1
80 Etanol 70% - 100 ml Botol 171 5 176 11 165 13
NO NAMA OBAT
84 FDC Kat. I Paket 7 16 23 8 15 10
91 Fluphenazine Decanoate Ampul 1 - 1 1 - 1
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 18 - 18 - 18 -
107 Haloperidol 5 mg Tablet 250 - 250 30 220 36
109 Haloperidol inj Ampul 25 - 25 25 - 30
120 I.V Catheter No.22 Set - 50 50 - 50 -
NO NAMA OBAT
131 Kasa 36 m x 80 cm Rol 4 3 7 - 7 -
137 Ketokonazol cream 2 % Tube 3 - 3 3 - 4
141 Klindamisin kap 300 mg Kapsul 2,470 - 2,470 - 2,470 -
153 Ampul
Epinefrin 1:80.000 - - - - - -
156 Loratadine 10 mg Tablet - 500 500 - 500 -
157 Lysol 1 Ltr Botol - - - - - -
159 Magnesium Sulfat 40 % Vial 19 10 29 2 27 2
160 Masker pcs - - - - - -
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet 77 - 77 77 - 92
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket - 2 2 2 - 2
207 Perak Sulfadiazin 1 % Tube 3 - 3 2 1 2
211 Piridoksin HCL 25 mg Tablet 547 - 547 547 - 656
NO NAMA OBAT
220 Ranitidine Tablet 6,827 - 6,827 865 5,962 1,038
222 Retinol 100.000 IU Kapsul 550 250 800 800 - 960
223 Retinol 200.000 iu Kapsul 4,127 4,250 8,377 4,456 3,921 5,347
226 Salbutamol 2 mg Tablet 1,435 1,000 2,435 343 2,092 412
228 Salep 2-4 Kombinasi Pot 93 - 93 11 82 13
233 Serum ABU I Vial 14 - 14 2 12 2
235 Serum ATS 1.500 IU Vial 41 - 41 8 33 10
237 Sianokobalamin tab Tablet 18 1,000 1,018 20 998 24
241 Siprofloxacin 500 mg Tablet 3,058 1,000 4,058 612 3,446 734
248 Thiamin HCL 50 mg Tablet 2,292 1,600 3,892 2,126 1,766 2,551
255 Trihexyphenidyl 2 mg Tablet 959 500 1,459 410 1,049 492
256 Urine Bag Set 53 - 53 5 48 6
NO NAMA OBAT
261 Zink Syrup (ZIRCUM KID SYRUP) Botol 198 - 198 198 - 238
264 Handscoon Non Steril S Kotak - 12 12 12 - 14
265 Handscoon Non Steril M Kotak - 10 10 10 - 12
266 Handscoon Non Steril L Kotak 7 - 7 7 - 8
271 Kloramfenikol Salep Kulit 2% (bufacetin) Tube 118 - 118 54 64 65
273 Omeprazole injeksi Ampul 13 10 23 2 21 2
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
293 sterizyme botol 4 - 4 4 - 5
294 USG Gel botol - - - - - -
295 Leukomed kotak 6 - 6 1 5 1
299 Bisturi kotak/100 2 - 2 - 2 -
300 glimepiride 2 mg tablet 1,950 300 2,250 70 2,180 84
NO NAMA OBAT
309 pot
312 masker ktk/50 - 35 35 35 - 42
- - - - -
331 box

41 - 1 40 1
NO NAMA OBAT
347 cresotin pasta botol - - - - - -

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 45 - 45 - 45 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 60 - 60 60 - 72
365 SOFT PAD 60 X 90 pcs 164 - 164 37 127 44
368 ADS 5 ML pcs 100 100 200 100 100 120
369 vial
TYPES 1 & 3 DROPS 35 60 95 55 40 66
370 ADS 0,5 ML Pcs 400 500 900 400 500 480
371 ADS 0,05 ML Pcs 100 100 200 100 100 120
374 unit
MCG/ML 39 80 119 39 80 47
388 SAFETY BOX 5 LITER Pcs 8 25 33 8 25 10
390 FUJI IX GP A3 1-1 Box 1 - 1 - 1 -
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet 290 - 290 290 - 348

29 - 29 5 24 6
394 POVIDONE IODINE 100 ML Botol - 5 5 - 5 -
396,224 52,561 448,785 59,702 389,083 71,642

JUMLAH

BPJS GAKIN
JUMLAH 644 567


NIP. 19700825 1992032004 NIP. NIP. 196905152010012001
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
-
100
400
-
-
-
-
-
-
-
-
-
2,000
-
240
200
5,000
5,000
-
-
2,000
-
-
-
-
-
30
-
-
-
2,000
2,000
-
-
1,000 ED 1.544
PERMIN PERSEDIAAN
JUMLAH KET
-
-
4,000
-
-
120
-
-
-
-
-
2,000
-
-
-
-
-
-
2,000
120
-
-
-
-
-
10,000
-
-
-
-
5
-
-
-
-
-
-
1,000
-
-
-
-
20
-
-
PERMIN PERSEDIAAN
JUMLAH KET
5
-
-
-
-
-
1,000
-
-
-
-
-
-
200
-
200
-
-
-
72
-
500
-
-
-
300
-
-
- ED 14
-
-
144
-
-
1,000
50
50
-
-
-
-
-
-
100
100
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
2
-
-
100
-
-
200
120
-
-
-
-
500
-
-
72
5,000
-
-
-
-
-
-
30
200
-
2,000
20
-
10
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
4,000
-
-
-
-
-
120
-
-
-
50
100
-
-
2,000
20
30
-
-
- ED 16
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
100
-
4
-
-
500
2,000
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
-
-
1,000
1,000
-
100
-
-
-
-
-
-
-
3,000
48
-
-
1,000
-
-
-
-
-
-
4,000
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
-
72 ED 177
50
-
20
20
10
10
-
-
1,000
144
5,280
-
-
-
-
-
-
-
-
-
-
-
-
7
-
-
-
50
-
-
-
2 ED 4
-
-
-
-
-
-
300
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
100
-
1,000
-
-
-
-
-
-
-
20
96
24
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-

SASI KTP
1.211
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Agustus 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : September 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
15 Amoxicillin Syrup Forte 250 mg/ml Botol 33 - 33 33 - 40
19 Ampicillin 1 gr injeksi Ampul 132 - 132 132 - 158
27 Aqua Pro inj Steril 25 ml Ampul 42 30 72 9 63 11
35 Asiclovir 400 mg Tablet - - - - - -
NO NAMA OBAT
41 Betamethason Krim Tube - 72 72 26 46 31
43 Bisturi set - - - - - -
54 Cetirizine Tablet - 500 500 30 470 36
55 Cetirizine 5 mg/5 ml Syrup 60 ml Botol - 100 100 12 88 14
62 Deksametason inj 5 mg Ampul 96 - 96 - 96 -
68 Difenhidramin HCL inj 10 mg/ml Ampul 45 30 75 45 30 54
79 Etanol 70% - 1.000 ml Botol - - - - - -
80 Etanol 70% - 100 ml Botol 165 - 165 165 - 198
NO NAMA OBAT
84 FDC Kat. I Paket 15 - 15 12 3 14
91 Fluphenazine Decanoate Ampul - - - - - -
96 Garam Oralit 200 ml Sachet 251 - 251 148 103 178
102 Glibenklamid 5 mg Tablet 2,026 300 2,326 241 2,085 289
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 18 - 18 - 18 -
109 Haloperidol inj Ampul - 25 25 3 22 4
112 Hidrocortison Cream 2,5% Tube 25 - 25 25 - 30
123 Infus Set Anak Set 196 - 196 - 196 -
NO NAMA OBAT
130 Kapas Pembalut Adsorben Rol 10 5 15 2 13 2
131 Kasa 36 m x 80 cm Rol 7 - 7 4 3 5
135 Kasa Pemb.Hidropil 4mx15cm Rol 45 - 45 5 40 6
137 Ketokonazol cream 2 % Tube - 48 48 2 46 2
141 Klindamisin kap 300 mg Kapsul 2,470 - 2,470 - 2,470 -
153 Ampul
Epinefrin 1:80.000 - - - - - -
156 Loratadine 10 mg Tablet 500 2,000 2,500 - 2,500 -
157 Lysol 1 Ltr Botol - - - - - -
159 Magnesium Sulfat 40 % Vial 27 10 37 2 35 2
160 Masker pcs - - - - - -
NO NAMA OBAT
170 Metil Prednisolon 4 mg Tablet - - - - - -
176 Miconazole cream Tube - 72 72 10 62 12
184 Natrium dikloffenak tab 50 mg Tablet 4,557 2,000 6,557 2,350 4,207 2,820
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket - 4 4 2 2 2
NO NAMA OBAT
222 Retinol 100.000 IU Kapsul - 400 400 50 350 60
226 Salbutamol 2 mg Tablet 2,092 1,000 3,092 294 2,798 353
233 Serum ABU I Vial 12 - 12 - 12 -
235 Serum ATS 1.500 IU Vial 33 - 33 5 28 6
237 Sianokobalamin tab Tablet 998 1,500 2,498 100 2,398 120
248 Thiamin HCL 50 mg Tablet 1,766 2,000 3,766 2,911 855 3,493
255 Trihexyphenidyl 2 mg Tablet 1,049 - 1,049 484 565 581
256 Urine Bag Set 48 - 48 2 46 2
NO NAMA OBAT
261 Zink Syrup (ZIRCUM KID SYRUP) Botol - - - - - -
264 Handscoon Non Steril S Kotak - 12 12 12 - 14
265 Handscoon Non Steril M Kotak - 10 10 10 - 12
266 Handscoon Non Steril L Kotak - - - - - -
270 Simvastatin 20 mg Kapsul 1,950 1,000 2,950 90 2,860 108
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
293 sterizyme botol - - - - - -
294 USG Gel botol - - - - - -
295 Leukomed kotak 5 - 5 1 4 1
299 Bisturi kotak/100 2 - 2 1 1 1
NO NAMA OBAT
309 pot
312 masker ktk/50 - 35 35 35 - 42
- - - - -
331 box

40 - - 40 -
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 45 - 45 - 45 -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET - - - - - -
359 OB HERBAL HERBACOLD PERMEN Kotak 8 - 8 3 5 4
360 OB HERBAL HERBAPAIN PERMEN Kotak 6 - 6 4 2 5
365 SOFT PAD 60 X 90 pcs 127 - 127 54 73 65
367 PAKET STOP TB KATEGORI 1 HARIAN box 1 - 1 1 - 1
368 ADS 5 ML pcs 100 20 120 80 40 96
369 vial
TYPES 1 & 3 DROPS 40 20 60 48 12 58
370 ADS 0,5 ML Pcs 500 - 500 300 200 360
371 ADS 0,05 ML Pcs 100 100 200 100 100 120
374 unit
MCG/ML 80 20 100 80 20 96
377 VAKSIN MEALES RUBELLA 0,5 ML vial 36 10 46 46 - 55
389 ERGOTAMINA TARTAT Tablet 400 - 400 400 - 480
390 FUJI IX GP A3 1-1 Box 1 - 1 1 - 1
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet - - - - - -

24 - 24 5 19 6
394 POVIDONE IODINE 100 ML Botol 5 - 5 5 - 6
395 POVIDONE IODINE 1000 ML Botol 1 - 1 - 1 -
396 BETAHISTIN 6 MG Tablet - 500 500 40 460 48
389,083 54,211 443,294 62,494 380,800 74,993

JUMLAH

BPJS GAKIN
JUMLAH 818 838

Kepala Bidang SDK
Hj. Iis Isnawati, S.ST., M.Kes Yenni Kesuma, SKM.MM.Kes

NIP. 197601012007012034 NIP. NIP. 197408222002122003
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
100
100
400
100
-
500
-
-
-
-
-
-
2,000
-
240
200
5,000
5,000
30 ED 129
-
1,000
100
-
-
10
-
-
-
-
-
2,000
2,000
-
-
1,000
PERMIN PERSEDIAAN
JUMLAH KET
24
-
5,000
-
-
120
-
-
-
-
-
2,000
-
-
50
-
-
-
2,000
120
-
-
-
-
-
10,000
-
-
-
-
-
-
- ED 45
-
-
-
-
1,000
-
-
-
-
20
-
100 ED 153
PERMIN PERSEDIAAN
JUMLAH KET
5
-
-
-
-
-
1,000
-
-
-
-
-
-
200
-
500
-
-
-
72
-
500
-
-
-
300
-
-
-
-
-
144
-
-
1,000
50
-
-
-
-
-
-
-
100
100
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
-
10
-
100
-
-
200
120
-
-
-
-
500
-
-
72
10,000
-
-
-
-
-
-
90
400
-
-
20
-
-
-
-
-
-
-
-
5,000
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
-
-
-
-
120
-
-
30
100
100
-
-
2,000
20
30
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
10,000
-
100
-
4
-
-
500
2,000
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
80
-
1,000
2,000
-
100
-
-
-
-
-
10
-
3,000
48
-
-
1,000
-
-
-
-
-
-
5,000
-
-
-
-
-
-
-
-
-
-
10,000
PERMIN PERSEDIAAN
JUMLAH KET
-
72
50
-
25
25
10
10
-
-
1,000
48
5,280
10
- ED 55
-
-
-
-
-
-
-
-
-
-
-
-
-
-
50
-
-
-
2
-
-
-
-
-
-
300
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
100
-
1,000
-
15
-
-
-
-
-
20
96
24
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
-
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
- ED 400
- ED 1
-
PERMIN PERSEDIAAN
JUMLAH KET
300
5
10
1

SASI KTP
1.656
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : September 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : Oktober 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
4 Alat suntik 5 ml set 182 100 282 16 266 19
15 Amoxicillin Syrup Forte 250 mg/ml Botol - - - - - -
19 Ampicillin 1 gr injeksi Ampul - 30 30 - 30 -
22 Antasida Doen Sirup Botol 84 100 184 35 149 42
NO NAMA OBAT
41 Betamethason Krim Tube 46 72 118 48 70 58
43 Bisturi set - - - - - -
50 Cefadroxyl sirup kering 125mg/ml Botol - 60 60 18 42 22
54 Cetirizine Tablet 470 500 970 60 910 72
55 Cetirizine 5 mg/5 ml Syrup 60 ml Botol 88 100 188 19 169 23
61 Deksametason 0,5 mg Tablet - 4,000 4,000 1,345 2,655 1,614
68 Difenhidramin HCL inj 10 mg/ml Ampul 30 - 30 10 20 12
79 Etanol 70% - 1.000 ml Botol - - - - - -
80 Etanol 70% - 100 ml Botol - - - - - -
NO NAMA OBAT
83 FDC KAT II Paket - 1 1 - 1 -
84 FDC Kat. I Paket 3 16 19 9 10 11
88 Fitomenadion inj 10 mg / ml Ampul 24 - 24 24 - 29
96 Garam Oralit 200 ml Sachet 103 - 103 103 - 124
99 Gentamycine salep mata 0,3 % (genoitol) Tube - 48 48 10 38 12
104 Glucosa 5% Botol 20 - 20 - 20 -
105 Glukosa 10 % Botol 18 - 18 - 18 -
109 Haloperidol inj Ampul 22 - 22 14 8 17
112 Hidrocortison Cream 2,5% Tube - 72 72 20 52 24
115 Hyoscine-N-Butilbromide 10 mg Tablet 2,196 1,000 3,196 278 2,918 334
124 Infus Set Dewasa Set 19 - 19 19 - 23
NO NAMA OBAT
131 Kasa 36 m x 80 cm Rol 3 5 8 3 5 4
137 Ketokonazol cream 2 % Tube 46 72 118 5 113 6
143 Kloramfenikol SM 1% Tube 172 - 172 172 - 206
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet - 4,000 4,000 1,500 2,500 1,800
153 Ampul
Epinefrin 1:80.000 - - - - - -
154 Lidokain inj Ampul 78 - 78 78 - 94
156 Loratadine 10 mg Tablet 2,500 - 2,500 - 2,500 -
157 Lysol 1 Ltr Botol - - - - - -
160 Masker pcs - - - - - -
NO NAMA OBAT
176 Miconazole cream Tube 62 48 110 16 94 19
191 O.B.H.Sirup Botol - - - - - -
192 OAT Kat Anak Paket 2 - 2 - 2 -
207 Perak Sulfadiazin 1 % Tube 1 - 1 1 - 1
210 Piridoksin HCL 10 mg Tablet - 1,000 1,000 69 931 83
NO NAMA OBAT
227 Salbutamol 4 mg Tablet - 2,000 2,000 - 2,000 -
229 Salisil Bedak 2% - 50 gr Kotak - 36 36 24 12 29
233 Serum ABU I Vial 12 5 17 15 2 18
235 Serum ATS 1.500 IU Vial 28 10 38 4 34 5
237 Sianokobalamin tab Tablet 2,398 - 2,398 98 2,300 118
248 Thiamin HCL 50 mg Tablet 855 3,000 3,855 1,621 2,234 1,945
255 Trihexyphenidyl 2 mg Tablet 565 500 1,065 480 585 576
256 Urine Bag Set 46 - 46 3 43 4
259 Vitamin B.Komplek Tablet - 3,000 3,000 - 3,000 -
NO NAMA OBAT
264 Handscoon Non Steril S Kotak - 18 18 14 4 17
265 Handscoon Non Steril M Kotak - 15 15 11 4 13
273 Omeprazole injeksi Ampul 15 10 25 - 25 -
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 1 - 1 - 1 -
NO NAMA OBAT
309 pot
312 masker ktk/50 - 40 40 40 - 48
- - - - -
331 box
337 examination glove lain lain size s box 24 - 24 24 - 29

40 - 2 38 2
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 45 - 45 15 30 18
355 POLIAID 5000 ML Jeriken 1 - 1 1 - 1
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET - 240 240 120 120 144
364 MASKER KERTAS 3 PLY (PROGRAM) box 30 15 45 15 30 18
365 SOFT PAD 60 X 90 pcs 73 - 73 59 14 71
367 PAKET STOP TB KATEGORI 1 HARIAN box - - - - - -
368 ADS 5 ML pcs 40 100 140 90 50 108
369 vial
TYPES 1 & 3 DROPS 12 40 52 22 30 26
370 ADS 0,5 ML Pcs 200 572 772 300 472 360
371 ADS 0,05 ML Pcs 100 - 100 - 100 -
374 unit
MCG/ML 20 60 80 50 30 60
377 VAKSIN MEALES RUBELLA 0,5 ML vial - 50 50 30 20 36
389 ERGOTAMINA TARTAT Tablet - - - - - -
390 FUJI IX GP A3 1-1 Box - - - - - -
391 KASA HIDROPHILE 16X16 CM HUSADA Box 9 - 9 9 - 11
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet - 300 300 210 90 252

19 - 19 2 17 2
395 POVIDONE IODINE 1000 ML Botol 1 1 2 - 2 -
396 BETAHISTIN 6 MG Tablet 460 - 460 40 420 48
397 POLISEPTIK 1000 ML Botol - 3 3 - 3 -
398 ISONIAZID 100 MG Box - 1 1 - 1 -
399 MR PELARUT Pcs - 50 50 30 20 36
400 BCG PELARUT Pcs - 40 40 18 22 22
401 DROPPER POLIO Pcs - 40 40 10 30 12
402 PREVENAR 13 CAIRAN INJEKSI 0,5 ML vial - 43 43 - 43 -
- - -
- - -
380,800 63,471 444,271 57,317 386,954 68,780
JUMLAH

BPJS GAKIN
JUMLAH 960 838

Kepala Bidang SDK
Hj. Iis Isnawati, S.ST., M.Kes Hj. Yenni Kesuma, SKM.MM.Kes

NIP. 197601012007012034 NIP. NIP. 197408222002122003
OBAT (LPLPO)

GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
100
100
400
-
-
-
-
-
-
-
-
-
-
-
240
200
5,000
3,000
-
-
1,000
100
-
-
10
-
-
-
-
-
1,000
1,000
-
-
1,000
PERMIN PERSEDIAAN
JUMLAH KET
24
-
5,000
-
-
120
-
-
-
-
-
2,000
-
-
60
-
-
-
1,000
50
-
-
-
-
-
10,000
-
-
-
-
10
-
30
-
-
-
-
-
-
-
-
-
20
5
100
PERMIN PERSEDIAAN
JUMLAH KET
5
2
-
-
-
-
-
- ED 24
-
-
-
-
-
200
-
500
-
-
48
-
-
500
-
-
-
300
-
-
-
-
-
144
-
-
500
50
-
50
-
-
-
-
-
100
200
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
-
10
-
100
-
-
200
-
-
-
-
-
500
48 ED 161
-
72
10,000
-
-
50
-
-
-
90
400
-
-
20
-
-
-
-
-
-
-
-
5,000
-
-
10
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
-
-
-
-
48
-
-
50
100
100
-
-
-
20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20
5,000
-
100
-
4
-
-
500
1,000
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
-
-
-
-
80
-
500
-
-
100
-
-
-
10 ED 10
-
-
-
1,000
48
-
-
1,000
-
-
-
-
-
-
3,000
-
-
-
-
-
-
-
-
-
-
1,000
PERMIN PERSEDIAAN
JUMLAH KET
-
72
50
100
25
25
10
10
-
-
500
48
5,280
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
50
-
-
-
2
-
-
-
-
-
-
-
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
40
-
100
-
1,000
-
15
-
-
-
-
-
20
96
24
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
2
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
5
10
1
-
-
-
-
-
-
-

SASI KTP
1.798
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005
UPT PUSKESMAS ANYAR
PUSKESMAS : ANYAR PELAPORAN BULAN / PERIODE : Oktober 2022
KECAMATAN : ANYAR PERMINTAAN BULAN / PERIODE : November - Desember 2022
KABUPATEN : SERANG
PROVINSI : BANTEN

NO NAMA OBAT
1 2 3 4 5 6 7 8 9
13 Amlodipin 10 mg Tablet 6,660 - 6,660 2,450 4,210 2,940
15 Amoxicillin Syrup Forte 250 mg/ml Botol - - - - - -
17 Amoxisilin 250 mg Kapsul 5 - 5 5 - 6
22 Antasida Doen Sirup Botol 149 100 249 34 215 41
NO NAMA OBAT
41 Betamethason Krim Tube 70 72 142 14 128 17
43 Bisturi set - - - - - -
44 Ca glukonas Vial 24 - 24 1 23 1
50 Cefadroxyl sirup kering 125mg/ml Botol 42 60 102 25 77 30
54 Cetirizine Tablet 910 500 1,410 40 1,370 48
55 Cetirizine 5 mg/5 ml Syrup 60 ml Botol 169 50 219 13 206 16
61 Deksametason 0,5 mg Tablet 2,655 4,000 6,655 3,179 3,476 3,815
62 Deksametason inj 5 mg Ampul 85 - 85 - 85 -
72 Domperidon susp 5mg/ml Botol 189 - 189 - 189 -
79 Etanol 70% - 1.000 ml Botol - - - - - -
80 Etanol 70% - 100 ml Botol - - - - - -
NO NAMA OBAT
83 FDC KAT II Paket 1 - 1 - 1 -
84 FDC Kat. I Paket 10 6 16 8 8 10
88 Fitomenadion inj 10 mg / ml Ampul - - - - - -
96 Garam Oralit 200 ml Sachet - 500 500 - 500 -
104 Glucosa 5% Botol 20 - 20 3 17 4
105 Glukosa 10 % Botol 18 - 18 - 18 -
109 Haloperidol inj Ampul 8 25 33 8 25 10
119 I.V Catheter no 26 Set 65 - 65 65 - 78
124 Infus Set Dewasa Set - - - - - -
NO NAMA OBAT
131 Kasa 36 m x 80 cm Rol 5 3 8 1 7 1
132 Kasa Elastis 15 CM X 4,55 CM Roll 5 - 5 2 3 2
135 Kasa Pemb.Hidropil 4mx15cm Rol 40 - 40 10 30 12
143 Kloramfenikol SM 1% Tube - - - - - -
146 Klorfeniramin Maleat ( CTM ) 4mg Tablet 2,500 5,000 7,500 4,355 3,145 5,226
149 Kotrimoksazol susp. Botol 25 100 125 26 99 31
153 Ampul
Epinefrin 1:80.000 - - - - - -
154 Lidokain inj Ampul - - - - - -
156 Loratadine 10 mg Tablet 2,500 - 2,500 27 2,473 32
157 Lysol 1 Ltr Botol - - - - - -
159 Magnesium Sulfat 40 % Vial 35 - 35 1 34 1
160 Masker pcs - - - - - -
NO NAMA OBAT
176 Miconazole cream Tube 94 48 142 29 113 35
179 Nasal Cannula Anak Set 7 - 7 7 - 8
184 Natrium dikloffenak tab 50 mg Tablet 6,107 - 6,107 1,290 4,817 1,548
191 O.B.H.Sirup Botol - - - - - -
207 Perak Sulfadiazin 1 % Tube - - - - - -
210 Piridoksin HCL 10 mg Tablet 931 600 1,531 519 1,012 623
NO NAMA OBAT
229 Salisil Bedak 2% - 50 gr Kotak 12 36 48 40 8 48
233 Serum ABU I Vial 2 10 12 - 12 -
235 Serum ATS 1.500 IU Vial 34 - 34 5 29 6
237 Sianokobalamin tab Tablet 2,300 500 2,800 192 2,608 230
241 Siprofloxacin 500 mg Tablet 3,974 1,000 4,974 875 4,099 1,050
255 Trihexyphenidyl 2 mg Tablet 585 500 1,085 450 635 540
256 Urine Bag Set 43 - 43 2 41 2
259 Vitamin B.Komplek Tablet 3,000 1,000 4,000 2,594 1,406 3,113
NO NAMA OBAT
260 Zinc Dispersible tab Tablet 500 - 500 325 175 390
264 Handscoon Non Steril S Kotak 4 13 17 17 - 20
265 Handscoon Non Steril M Kotak 4 13 17 17 - 20
284 Underped Pcs - - - - - -
292 kotak/36
GT 35 mm) - - - - -
294 USG Gel botol - - - - - -
299 Bisturi kotak/100 1 - 1 - 1 -
NO NAMA OBAT
309 pot
312 masker ktk/50 - 40 40 40 - 48
- - - - -
331 box
337 examination glove lain lain size s box - - - - - -

38 - - 38 -
NO NAMA OBAT

- - - - - -
349 pcs
loop - - - - - -
354 masker N95 pcs 30 - 30 - 30 -
355 POLIAID 5000 ML Jeriken - - - - - -
/50/300/300MG) - - - - - -
(TENOLAM E )/TABLET 120 300 420 150 270 180
359 OB HERBAL HERBACOLD PERMEN Kotak 5 - 5 5 - 6
360 OB HERBAL HERBAPAIN PERMEN Kotak 2 - 2 2 - 2
365 SOFT PAD 60 X 90 pcs 14 - 14 14 - 17
367 PAKET STOP TB KATEGORI 1 HARIAN box - - - - - -
368 ADS 5 ML pcs 50 100 150 100 50 120
369 vial
TYPES 1 & 3 DROPS 30 40 70 65 5 78
370 ADS 0,5 ML Pcs 472 200 672 372 300 446
371 ADS 0,05 ML Pcs 100 - 100 30 70 36
374 unit
MCG/ML 30 50 80 50 30 60
389 ERGOTAMINA TARTAT Tablet - - - - - -
390 FUJI IX GP A3 1-1 Box - - - - - -
391 KASA HIDROPHILE 16X16 CM HUSADA Box - - - - - -
NO NAMA OBAT
392 VITAMIN C 500 MG Tablet 90 - 90 90 - 108

17 - 17 4 13 5
394 POVIDONE IODINE 100 ML Botol 10 10 20 1 19 1
395 POVIDONE IODINE 1000 ML Botol 2 1 3 1 2 1
396 BETAHISTIN 6 MG Tablet 420 - 420 100 320 120
397 POLISEPTIK 1000 ML Botol 3 3 6 - 6 -
398 ISONIAZID 100 MG Box 1 - 1 - 1 -
399 MR PELARUT Pcs 20 30 50 10 40 12
400 BCG PELARUT Pcs 22 40 62 62 - 74
401 DROPPER POLIO Pcs 30 40 70 65 5 78
402 PREVENAR 13 CAIRAN INJEKSI 0,5 ML vial 43 - 43 43 - 52
403 RIFTIN TABLET 150 MG Tablet - 48 48 - 48 -
404 SAFETY BOX 5 LITER (BIAN) Pcs - 25 25 25 30
405 ADS 0,5 ML (BIAN) Pcs - 6,000 6,000 1,175 4,825 1,410
406 ADS 5 ML (BIAN) Pcs - 700 700 140 560 168
407 VAKSIN MEALES RUBELLA 0,5 ML (BIAN) Vial

- 700 700 140 560 168
- - -
386,954 54,685 441,639 102,734 338,905 123,281
JUMLAH

BPJS GAKIN
JUMLAH 814 856

Kepala Bidang SDK
Hj. Iis Isnawati, S.ST., M.Kes Hj. Yenni Kesuma, SKM.MM.Kes

NIP. 197601012007012034 NIP. NIP. 197408222002122003
OBAT (LPLPO)
mber 2022
GUDANG FARMASI
21
PERMIN PERSEDIAAN
JUMLAH KET
10 11 12 13 14 15 16
200
100
400
-
-
500
-
-
-
-
-
-
4,000
-
240
200
5,000
5,000
-
-
4,000
-
-
-
30
-
-
-
-
-
4,000
3,000
-
-
1,000
PERMIN PERSEDIAAN
JUMLAH KET
-
-
5,000
-
-
120
-
-
-
-
1,000
2,000
-
-
-
-
-
-
1,000
-
-
-
-
-
-
10,000
-
-
-
-
-
-
-
-
-
-
-
1,000
-
-
-
-
20
5
50
PERMIN PERSEDIAAN
JUMLAH KET
5
2
-
-
-
-
500
-
-
-
-
-
-
200
-
-
-
-
48
-
-
500
-
-
-
-
-
-
-
-
-
144
-
-
500
50
50
50
50 ED 60
-
-
-
-
100
200
PERMIN PERSEDIAAN
JUMLAH KET
-
-
10,000
-
4
5
2
100
-
-
200
-
200
-
-
-
500
48
-
72
10,000
-
-
50
-
-
-
90
400
-
-
20
-
-
-
-
-
-
-
-
5,000
-
-
10
PERMIN PERSEDIAAN
JUMLAH KET
5,000
-
-
-
-
-
72
-
-
50
100
-
-
-
2,000
40
30
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
20
20,000
-
-
-
4
-
-
1,000
1,000
-
10
-
PERMIN PERSEDIAAN
JUMLAH KET
20
10
-
-
-
1,000
-
-
-
100
-
-
-
-
100
-
-
-
-
-
-
-
500
48
-
-
1,000
-
-
-
-
-
-
1,000
-
-
-
-
-
-
-
-
-
-
5,000
PERMIN PERSEDIAAN
JUMLAH KET
500
72
100
-
30
30
20
10
-
-
500
48
5,280
-
-
-
-
-
-
-
-
-
-
-
100
-
-
-
-
50
-
-
-
2
-
-
-
-
-
2
500
200
-
-
PERMIN PERSEDIAAN
JUMLAH KET
-
-
-
-
-
-
-
-
80
-
100
-
1,000
-
15
-
-
-
-
-
20
96
-
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100
PERMIN PERSEDIAAN
JUMLAH KET
2
100
-
-
-
-
100
-
-
-
15
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
30
PERMIN PERSEDIAAN
JUMLAH KET
-
5
10
1
500
-
-
-
-
-
-

SASI KTP
67 1.737
Yang Menerima
Petugas Puskesmas

NIP. 199510172019032005

Lplpo 2022

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO

UPT PUSKESMAS ANYAR

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

393 ONEMED PLESTERIN PLESTER 10 X 5 CM Box

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 42

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

393 ONEMED PLESTERIN PLESTER 10 X 5 CM Box

JUMLAH KUNJUNGAN RESEP UMUM ASKES ASTEK JPS/

Mengetahui/Menyetujui Yang Menyerahkan : Yang Meminta

Hj. Euis Sukmawati, S.Farm., Apt dr. Sumeri

DOKUMEN NOMOR TANGGAL

IMUNI GRATIS/ JUMLAH

Neno Octal Iriani, Apt

SATU STOK PENERI PERSE PEMAKA STOK STOK

343 YELLOW TIP MIKROLIT LAIN LAIN 200 MUI BAG 41

348 indec, genbi hepalisa HBsAg (VIROCHECK) PCS

393 ONEMED PLESTERIN PLESTER 10 X 5 CM Box

396,224 52,561 448,785 59,702 389,083 71,642