3.10 Ep 2 LPDP

LAPORAN PENERIMAAN DAN LEMBAR PERMINTAAN OBAT
Kode Puskesmas : P3517130201 Bulan : Januari

Puskesmas : JELAKOMBO Tahun : 2021
Kecamatan : JOMBANG
Kabupaten : Jombang
Provinsi : Jawa Timur
Pemakai Stok
Kelas Sumber Stok Peneri Persedi Pemakai Stok Sub Sisa Permintaa
No. Nama Obat & Perbekalan Kesehatan Satuan an Rata- Gudang Stok Opt KET
Terapi Dana Awal maan aan an unit Stok n
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 1526 1,526 0 0 0 1,526 1,526 0
2 Albendazol suspensi fles APBN 20 0 0 0 0
3 Albothyl concentrat fles 0 0 0 0 0 0
4 Alopurinol tablet 100 mg tablet 1.2 APBD '18 4220 2,000 6,220 590 590 4,400 1,230 5,630 1,770
5 Ambroxol tab 30 mg tablet 0 0 0 0 0 0
6 Aminofilin tablet 200 mg tablet 26.1 APBD '18 1215 1,215 1,215 1,215 0 0 0 3,645
7 Aminofilina injeksi 24 mg/ml - 10 ml ampul 26.1 0 0 0 0 0 0
8 Amitriptilin HCl tablet salut 25 mg tablet 23.2 PROG' 18 396 396 4 4 0 392 392 12
9 Amlodipin tablet 5 mg tablet APBD II '20 13287 6,000 19,287 7,668 7,668 11,100 519 11,619 23,004
10 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 71566 10,000 81,566 51,626 51,626 29,000 940 29,940 154,878 ED
11 Amoksisilin kapsul 250 mg kapsul 6.21 0 0 0 0 0 0 0
12 Amoksisilin sirup kering 125 mg/5ml botol 6.21 0 0 0 0 0 0 0
13 Amoksisilin sirup kering Forte 250 mg/5ml botol 6.21 0 0 0 0 0 0 0
14 Ampisilin serbuk injeksi im/iv 1000 mg/ml vial 6.21 0 0 0 0 0 0 0
15 Antalgin (Metampiron) tablet 500 mg tablet 1.2 0 0 0 0 0 0 0
16 Antalgin injeksi 250 mg/ml - 2 ml ampul 1.2 0 0 0 0 0 0 0
17 Antasida DOEN suspensi botol 25.1 DAK '19 553 553 8 8 450 95 545 24
18 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 10265 10,265 647 647 7,600 2,018 9,618 1,941
19 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU/g + Polimiksin 10.000 IU/g tube 18.2 0 0 0 0 0 0
20 Anti Hemoroid DOEN Kombinasi supp 25.3 APBD II '20 257 200 457 30 30 200 227 427 90
21 Antifungi DOEN Kombinasi:Asam Benzoat 6% + Asam Salisilat 3% pot 18.3 85 85 3 3 48 34 82 9
22 Antimigren:Ergotamin Tartrat 1 mg + Kofein 50 mg tablet 7.2 0 0 0 0 0 0
23 Antiparkinson DOEN tablet kombinasi:Karbidopa 25 mg + Levodopa 250 mg tablet 9 0 0 0 0 0 0
24 Aqua pro Injeksi steril 25 ml, bebas pirogen vial 20.3 DAK'19 230 120 350 20 20 120 210 330 60
25 Aquadest steril 500 ml botol 30 0 0 0 0 0 0
26 Asam Asetilsalisilat (Asetosal) tablet 100 mg tablet 1.2 0 0 0 0 0 0
27 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 595 200 795 80 80 200 515 715 240
28 Asam Asetilsalisilat (Asetosal) tablet 500 mg tablet 1.2 0 0 0 0 0 0
29 Asam Askorbat (Vit C) tablet 100 mg tablet 29 0 0 0 0 0 0
30 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 29979 29,979 774 774 27,000 2,205 29,205 2,322
31 Asam Mefenamat tablet salut selaput 500 mg tablet DAK '19 33780 10,000 43,780 2,183 2,183 40,000 1,597 41,597 6,549
32 Asetilsistein kapsul APBD II '20 10490 5,600 16,090 995 995 14,000 1,095 15,095 2,985
33 Asam Traneksamat injeksi ampul 0 0 0 0 0 0
34 Asam Traneksamat kapsul 250 mg kapsul 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
35 Asam Traneksamat kapsul 500 mg kapsul 0 0 0 0 0 0

36 Asiklovir krim 5% tube 0 0 0 0 0 0
37 Asiklovir tablet 400 mg tablet APBD II '20 271 271 25 25 200 46 246 75
38 Atapulgit tablet 600 mg tablet APBD II '20 1198 500 1,698 163 163 1,000 535 1,535 489
39 Atropin injeksi im/iv/sk 0,25 mg/ml - 1 ml ( Sulfat ) vial 25.4 0 0 0 0 0 0 0
40 Atropin Sulfat tablet 0,5 mg tablet 25.4 0 0 0 0 0 0 0
41 Bekarbon tablet tablet 0 0 0 0 0 0 0
42 Benzatin Bensil Penisillin 2,4 juta IU/Vial vial 6.2.1 0 0 0 0 0 0 0
43 Betahistin Mesilat tablet 6 mg tablet 0 0 0 0 0 0 0
44 Betametason krim 0,5 mg/g tube APBD II '20 64 75 139 16 16 75 48 123 48
45 Bisacodyl suppositoria 10 mg dewasa suppo 0 0 0 0 0 0 0
46 Bisacodyl supposituria anak suppo 0 0 0 0 0 0 0
47 Bisoprolol tab 5 mg ampul APBD II '20 0 500 500 0 0 500 0 500 0
48 Cefotaxime inj. 1.000 mg vial 0 0 0 0 0 0 0
49 D 40 Inj ampul 0 0 0 0 0 0 0
50 Deksametason injeksi iv. 5 mg/ml - 1 ml ampul 3 DAK '19 8 8 0 0 3 5 8 0
51 Deksametason tablet 0,5 mg tablet 16.4 0 0 0 0 0 0 0
52 Dekstran 70 - larutan infus 6% steril botol 11.2 0 0 0 0 0 0 0
53 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol 26.2 0 0 0 0 0 0 0
54 Dekstrometorfan tablet 15 mg ( HBr ) tablet 26.2 0 0 0 0 0 0 0
55 Diazepam injeksi 5 mg/ml - 2 ml ampul 5 0 0 0 0 0 0 0
56 Diazepam lar rektal 10mg/ 2,5 ml (Stesolid) tube 5 0 0 0 0 0 0 0
57 Diazepam tablet 2 mg tablet 5 APBD II '20 320 320 211 211 0 109 109 633
58 Diazepam tablet 5 mg tablet 5 0 0 0 0 0 0 0
59 Dietilkarbamazin Sitrat ta.100 mg tablet 6.1.2 0 0 0 0 0 0 0
60 Difenhidramin inj im.10 mg/ml-1 ml ( HCl ) ampul 3 30 30 0 0 28 2 30 0
61 Digoksin tablet 0,25 mg tablet 17.5 APBD II '20 593 593 45 45 500 48 548 135
62 Dimenhidrinat tablet 50 mg tablet DAK'19 1,704 1,704 0 0 1,500 204 1,704 0
63 Domperidon tablet 10 mg tablet DAK'19 1,327 1,327 0 0 1,000 327 1,327 0
64 Efedrin HCl tablet 25 mg ( HCl ) tablet 26.1 0 0 0 0 0 0 0
65 Ekstrak Belladon tablet 10 mg tablet 25.4 0 0 0 0 0 0 0
66 Epinefrina ( Adrenalina ) Injeksi 0,1% - 1 ml ( HCl ) ampul 3 APBD II '20 10 10 2 2 3 5 8 6
67 Erytromycin kapsul 500 mg tablet 4,357 4,357 37 37 3,400 920 4,320 111
68 Erytromycin kapsul 250 mg tablet 0 0 0 0 0 0 0
69 Erytromycin sirup 200 mg/5 ml botol 0 0 0 0 0 0 0
70 Etakridin ( Rivanol ) larutan 0,1% botol 6.2.4 0 0 0 0 0 0 0
71 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin injeksi 50 mg/ml ampul 5 0 0 0 0 0 0 0
73 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 2,035 500 2,535 485 485 2,000 50 2,050 1,455
74 Fenitoin Natrium kapsul 30 mg kapsul 5 0 0 0 0 0 0 0
75 Fenobarbital inj im/iv 50 mg/ml 1ml ampul 5 0 0 0 0 0 0 0
76 Fenobarbital tablet 100 mg tablet 5 0 0 0 0 0 0 0
78 Fenol Gliserol tetes telinga 10% botol 28.2 0 0 0 0 0 0 0
79 Fitomenadion (Vit.K1) injeksi 2 mg/ml - 1 ml ampul 10.2 APBD '18 30 30 0 0 30 30 0
80 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10.2 DAK '19 587 587 65 65 500 22 522 195
Pemakai Stok
Rata Pkm
81 Fluphenazin Decanoate 25mg/ml (Sikzonoate Inj) ampul 0 0 0 0 0 0 0

82 Furosemid injeksi iv/im 10 mg/ml ampul 0 0 0 0 0 0 0
83 Furosemid tablet 40 mg tablet 14 APBD '17 931 931 112 112 0 819 819 336
84 Gameksan lotion 1 % botol 18.5 0 0 0 0 0 0 0
85 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 1,191 1,191 137 137 700 354 1,054 411
86 Gentamisin injeksi 40 mg/ml (sbg Sulfat) ampul 0 0 0 0 0 0 0
88 Gentamisin salep kulit 0,1 % tube 0 0 0 0 0 0 0
89 Gentian Violet larutan 1 % botol 14.2 0 0 0 0 0 0 0
90 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 16,723 2,000 18,723 1,530 1,530 17,000 193 17,193 4,590
91 Glimepiride 1 mg APBD II '20 2,213 400 2,613 310 310 1,400 903 2,303 930
92 Glimepiride 2 mg tablet APBD II '20 812 2,000 2,812 770 770 2,000 42 2,042 2,310
93 Gliserin 100 ml botol 20.2 0 0 0 0 0 0 0
94 Glukosa larutan infus 5 % botol 20.2 0 0 0 0 0 0 0
95 Griseovulvin tablet 125 mg,micronized tablet DAK'19 700 700 50 50 500 150 650 150
96 Haldol Decanoat 50 mg/ml inj ampul APBD II '20 5 5 0 0 5 5 0
97 Haloperidol 5mg/ml inj ampul 23.4 0 0 0 0 0 0 0
98 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 910 1,000 1,910 105 105 1,800 5 1,805 315
99 Haloperidol tablet 1,5 mg tablet 23.4 0 0 0 0 0 0 0
100 Haloperidol tablet 5 mg tablet 23.4 APBD II '20 625 625 0 0 200 425 625 0
101 Hidrogen Peroksida cairan 3% botol 0 0 0 0 0 0 0
102 Hidroklorotiazid (HCT) tablet 25 mg tablet 15 0 0 0 0 0 0 0
103 Hidrokortison krim 2,5 % tube 18.4 APDB '18 179 179 3 3 144 32 176 9
104 Ibuprofen suspensi 100mg/ 5 ml botol 1.2 0 0 0 0 0 0 0
105 Ibuprofen tablet 200 mg tablet 1.2 0 0 0 0 0 0 0
107 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 573 573 60 60 500 13 513 180
108 Kandesartan tablet 16 mg tablet 1,460 1,460 0 0 1,460 1,460 0
109 Kalium Permanganat serbuk pot 13.1 44 44 0 0 0 44 44
110 Kalsium Glukonat inj 100mg/ml / Ca Gluconas botol 0 0 0 0 0 0 0
111 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 8,687 4,000 12,687 1,092 1,092 10,800 795 11,595 3,276
112 Kaptopril tablet 25 mg tablet 0 0 0 0 0 0 0
114 Karbamazepin tablet 200 mg tablet APBD II '20 2,000 2,000 0 0 1,500 500 2,000 0
115 Karbogliserin tetes telinga 10 % botol APBD II '20 89 24 113 4 4 24 85 109 12
116 Ketokonazol tablet 200 mg ampul APBD II '20 675 300 975 35 35 600 340 940 105
117 Klopidogrel tablet 75 mg tablet 0 0 0 0 0 0 0
118 Kloramfenikol kapsul 250 mg kapsul 6.2.2 0 0 0 0 0 0 0
119 Kloramfenikol salep mata 1 % tube 21.21 DAK '19 177 120 297 10 10 264 23 287 30
120 Kloramfenikol suspensi 125 mg/5 ml botol DAK '19 142 142 0 0 50 92 142 0
121 Kloramfenikol salep kulit 2% botol APBD II '20 92 24 116 8 8 24 84 108 24
120 Kloramfenikol tetes mata botol 0 0 0 0 0 0 0 0
122 Kloramfenikol tetes telinga 3 % botol 0 0 0 0 0 0 0 0
123 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 15,746 15,746 1,392 1,392 13,800 554 14,354 4,176
124 Klorpromazin injeksi 25 mg/ml - 1 ml ( HCl ) ampul 25.4 0 0 0 0 0
125 Klorpromazin injeksi 5 mg/ml - 1 ml ( HCl ) ampul 25.4 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
126 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 1,468 1,468 125 125 1,000 343 1,343 375
127 Klorpromazin tablet salut 25 mg ( HCl ) tablet 25.4 0 0 0 0 0 0 0
128 Kodein tablet 10 mg tablet 26.2 APBD II '20 161 400 561 27 27 400 134 534 81
129 Kombinasi ekstrak Plasenta 100 mg, Neomisin Sulfat 5 g/gram tube tube 0 0 0 0 0 0 0
130 Kombinasi gameksan 10 mg, Asam usnat 10 mg/g tube 0 0 0 0 0 0 0
131 Kombinasi Metampiron, ekstrak Belladona, Papaverin HCl tablet tablet 0 0 0 0 0 0 0
132 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml botol 6.2.2 APBD II '20 65 65 2 2 0 63 63 6
133 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 3,076 1,000 4,076 144 144 3,500 432 3,932 432
134 Kotrimoksazol tablet pediatrik, kombinasi:Sulfametoksazol 100 mg + Trimetoprim 20 mg tablet 6.2.2 0 0 0 0 0 0 0
135 Larutan elektrolit D5 - 1/2 NS botol 0 0 0 0 0 0 0
137 Lidokain HCl 2% ampul 0 0 0 0 0 0 0
138 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml ampul 14.1 APBD '18 206 206 206 206 0 0 0 618
139 Lisinopril tablet 10 mg tablet APBD II '20 1,080 1,080 115 115 500 465 965 345
140 Loratadin tablet 10 mg tablet DAK '19 772 772 21 21 300 451 751 63
141 Magnesium Sulfat injeksi (iv) 20 % - 25 ml ampul 5 0 0 0 0 0 0 0
143 Metamizole inj 1 gr / 2 ml vial 0 0 0 0 0 0 0
144 Metformin HCl tablet 500 mg tablet 0 0 0 0 0 0 0
145 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg tablet 22.1 80 80 0 0 0 80 80 0
146 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 22.1 APBD II '20 10 10 0 0 0 10 10 0
147 Metil prednisolon tablet 4 mg ampul APBD II '20 738 1,000 1,738 65 65 1,000 673 1,673 195
148 Metoklopramide tablet 10 mg tablet 0 0 0 0 0 0 0
149 Metronidazol tablet 250 mg tablet 6.2.2 0 0 0 0 0 0 0
151 Mikonazol cream tube APBD II '20 56 147 203 124 124 48 31 79 372
152 Mineral Mix Kombinasi sachet 2,225 2,225 0 0 0 2,225 2,225 0
153 Natrium Bikarbonat tablet 500 mg tablet 4.1 0 0 0 0 0 0 0
154 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0 0 0 0
155 Natrium Klorida larutan infus 0,9 % steril botol 20.2 0 0 0 0 0 0 0
156 Nifedipin tablet 10 mg tablet 0 0 0 0 0 0 0
157 Nistatin tablet salut 500.000 IU/g tablet 0 0 0 0 0 0 0
158 Nistatin tablet vaginal 100.000 IU/g tablet 6.3 74 74 0 0 0 74 74 0
159 Obat Batuk Hitam ( O.B.H. ) cairan botol 26.3 0 0 0 0 0 0 0
160 Oksitetrasiklin HCl salep kulit 3 % tube 18.2 0 0 0 0 0 0 0
161 Oksitetrasiklin HCl salep mata 1 % ( HCl ) tube 21.2.2 0 0 0 0 0 0 0
162 Oksitetrasiklin HCl injeksi i.m. 50 mg/ml vial 6.2.2 0 0 0 0 0 0 0
163 Oksitosin injeksi 10 IU/ml - 1 ml ampul 22.1 0 0 0 0 0 0 0
164 Omeprazol injeksi 40 mg/ 10 ml vial 0 0 0 0 0 0 0
165 Omeprazol kapsul 20 mg kapsul 0 0 0 0 0 0 0
166 Parasetamol sirup 120 mg/5 ml botol 1.2 APBD II '20 432 432 16 16 360 56 416 48
167 Parasetamol tablet 100 mg tablet 1.2 0 0 0 0 0 0 0
168 Parasetamol tablet 500 mg tablet 1.2 DAK '19 14,966 14,966 1,659 1,659 10,500 2,807 13,307 4,977
169 Permitrin krim 5% tube 0 0 0 0 0 0 0
170 Pirantel sirup 125mg/5ml botol 6.1.1 0 0 0 0 0 0 0
171 Pirantel tablet score ( base ) 125 mg tablet 6.1.1 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
172 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 7,813 3,000 10,813 127 127 9,100 1,586 10,686 381
173 Piridoksin (Vit.B6) tablet 25 mg ( HCl ) 0 0 0 0 0 0 0
174 Piroksikam tablet 20 mg tablet 0 0 0 0 0 0 0
175 Polikresulen 3,6 mg / ml konsentrat 14.2 0 0 0 0 0 0 0
176 Povidon Iodida 10 %, 30 ml botol 0 0 0 0 0 0 0
177 Povidon Iodida 10 %, 300 ml botol DAK '19 27 27 0 0 27 0 27 0
178 Prednison tablet 5 mg tablet 16.4 APBD '18 6,392 2,000 8,392 746 746 5,500 2,146 7,646 2,238
179 Prokain Penisilin inj 3 jt vial 0 0 0 0 0 0 0
180 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 5,223 5,223 0 0 500 4,723 5,223 0
181 Propiltiourasil tablet 100 mg (PTU ) tablet 16.3 0 0 0 0 0 0 0
182 Propranolol tablet 40 mg (HCl) tablet 7.1 0 0 0 0 0 0 0
183 Ranitidin injeksi 25 mg/ml ampul 0 0 0 0 0 0 0
184 Ranitidin tablet 150 mg tablet 0 0 0 0 0 0 0
185 Ringer Asetat larutan infus steril botol 20.2 0 0 0 0 0 0 0
186 Ringer Laktat larutan infus steril botol 20.2 APBD II '20 20 20 0 0 17 3 20 0
187 Risperidon 2 mg tablet APBD II '20 1,870 1,870 60 60 1,500 310 1,810 180
188 Salbutamol 2,5 mg respulles (Komb Ipratropium Br 0,5mg+Salbutamol2,5mgnebules) Combivent ampul 26.1 APBD II '20 20 20 0 0 0 20 20 0
189 Salbutamol Inhaler 100 mcg/dosis pot 0 0 0 0 0 0 0
190 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,214 500 1,714 70 70 1,300 344 1,644 210
191 Salbutamol tablet 4 mg ( sebagai sulfat ) tablet 26.1 0 0 0 0 0 0 0
192 Salep 2-4 , Kombinasi:Asam Salisilat 2% + Belerang Endap 4% pot 18.4 DAK'19 138 48 186 16 16 144 26 170 48
193 Salisil Bedak 2 % kotak 18.8 0 0 0 0 0 0 0
194 Scabicid Cream tube 10 gram tube 0 0 0 0 0 0 0
195 Sefadroksil kapsul 500 mg kapsul 0 0 0 0 0 0 0
196 Sefadroksil sirup kering 125 mg/ 5 ml botol 0 0 0 0 0 0 0
197 Sefiksim kapsul 100 mg kapsul 0 0 0 0 0 0 0
198 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) vial 0 0 0 0 0 0 0
199 Serum Anti Difteri 20.000 SI/vial (A.D.S.) ampul 0 0 0 0 0 0 0
200 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) ampul 0 0 0 0 0 0 0
201 Sianokobalamin (Vit.B12) injeksi 500 mcg - ml ampul 10.1 0 0 0 0 0 0 0
202 Simetidin tablet 200 mg tablet 0 0 0 0 0 0 0
203 Simvastatin tablet 10 mg tablet 0 0 0 0 0 0 0
204 Siprofloksasin tablet 500 mg (sebagai HCl) tablet 0 0 0 0 0 0 0
205 Sulfadimidin tablet 500 mg tablet 0 0 0 0 0 0 0
206 Sulfasetamida Natrium tetes mata 15 % botol 0 0 0 0 0 0 0
207 Tetrasiklin kapsul 250 mg kapsul 21.2 0 0 0 0 0 0 0
209 Tiamfenikol kapsul 500 mg kapsul 0 0 0 0 0 0 0
210 Tiamin (Viamin B1) tablet 50 mg (HCl / Mononitrat ) tablet 29 0 0 0 0 0 0 0
211 Tiamin (Vit B1) tablet 100 mg tablet 29 0 0 0 0 0 0 0
212 Tiamin (Vitamin B1) injeksi 100 mg/ml-1 ml ampul 29 0 0 0 0 0 0 0
213 Triamcinolone acetate krim tube 0 0 0 0 0 0 0
214 Trifluoperazine tablet 5 mg tablet 0 0 0 0 0 0 0
215 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,340 600 1,940 75 75 1,100 765 1,865 225
216 Vitamin B Kompleks tablet tablet 29 APBD II '20 8,776 10,000 18,776 2,601 2,601 16,000 175 16,175 7,803
217 Zinc sirup 10 mg/ml botol 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
218 Zinc tablet 20 mg tablet APBD II '20 295 295 128 128 0 167 167 384
0 0 0 0 0 0 0
0 0 0 0 0 0 0
PERBEKALAN KESEHATAN 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 0 0 0 0 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 0 0 0 0 0 0 0 0 0
217 Alat suntik sekali pakai 1 ml set 32 0 0 0 0 0 0 0
218 Alat suntik sekali pakai 3 ml set 32 APBD II '20 3,000 3,000 0 0 3,000 0 3,000 0
219 Alat suntik sekali pakai 5 ml set 32 APBD II '20 80 80 2 2 0 78 78 6
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 0 0 0 0 0 0 0 0
222 Blood Transfusion Set set 32 APBD II '20 5 5 0 0 3 2 5 0
223 Blue Tip / MT II 0 0 0 0 0 0 0 0
224 Catgut / Benang Bedah No. 2/0 Khromic biji 32 APBD II '20 12 12 0 0 0 12 12 0
226 Catgut / Benang Bedah No. 2/0 plain biji 32 APBD II '20 11 11 0 0 0 11 11 0
227 Catgut / Benang Bedah No. 3/0 plain biji APBD II '20 12 12 0 0 0 12 12 0
228 Foley Catheter No. 16 set APBD II '20 10 10 0 0 8 2 10 0
DAK NON
FISIK 2021
Gown biji / BOK 0 0 0 0 0
DAK NON
FISIK 2021
Hazmat biji / BOK 0 0 0 0
DAK NON
FISIK 2021
Handsanitiser botol / BOK 0 0 0 0
230 Hansaplast biji 0 0 0 0 0 0 0
231 Hands shoen non steril No. 7 biji 0 0 0 0 0 0 0
232 Hands shoen steril No. 7 pasang 0 0 0 0 0 0 0
233 Infusion set anak set APBD II '20 5 5 0 0 3 2 5 0
234 Infusion set dewasa set APBD II '20 5 5 1 1 0 4 4 3
235 IV Catether No. 18 set APBD II '20 5 5 0 0 3 2 5 0
239 Jarum jahit bedah No. 9 s/d 14 biji 0 0 0 0 0 0 0
240 Kapas Berlemak 500 gram bungkus 0 0 0 0 0 0 0
241 Kapas Pembalut / Absorben 250 gram bungkus APBD II '20 10 10 3 3 6 1 7 9
242 Kasa Kompres 40/40 steril bungkus 0 0 0 0 0 0 0
243 Kasa Pembalut 2 m x 80 cm biji APBD II '20 61 61 0 0 0 61 61 0
244 Kasa pembalut 40 x 80 cm rol 0 0 0 0 0 0 0
245 Masker Nebul Anak set APBD II '20 5 5 0 0 4 1 5 0
246 Masker Nebul Dewasa set APBD II '20 5 5 0 0 4 1 5 0
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
248 Kasa Pembalut Hidrofil 4 m x 3 cm hidrofil/elastic rol 0 0 0 0 0 0 0

249 Kasa Pembalut Hidrofil 4 m x 15 cm hidrofil/elastic rol APBD II '20 115 115 8 8 90 17 107 24
250 Kasa Steril 16 x 16 cm rol APBD '16 16 16 0 0 0 16 16 0
251 Maag Slang No. 16 biji 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0 0 0 0
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0 0 0 0
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
256 Plester roll APBD II '20 10 10 4 4 5 1 6 12
257 Silk biji APBD I '20 10 10 0 0 10 10 0
258 Safety Box 2,5 L lembar 0 0 0 0 0 0 0
259 Safety Box 5 L lembar 0 0 0 0 0 0 0
265 Safety Box 5 L - COVID biji APBN 21 0 0 0 0 0 0 0
260 Urine bag steril 2 LT biji 0 0 0 0 0 0 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 790 790 740 740 0 50 50 2,220
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
REAGEN LABORATORIUM 0 0 0 0
263 EDTA Powder botol 31 0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
265 Larutan Asam asetat 6% botol 31 0 0 0 0 0 0 0
266 Larutan Asam Klorida 0,1 N botol 31 0 0 0 0 0 0 0
267 Larutan Asam Klorida 2 % botol 31 0 0 0 0 0 0 0
268 Larutan Asam sulfosalisilat botol 31 0 0 0 0 0 0 0
269 Larutan Ba Cl2 botol 31 0 0 0 0 0 0 0
270 Larutan Benedict botol 31 0 0 0 0 0 0 0
271 Larutan Eosin 2% botol 31 0 0 0 0 0 0 0
272 Larutan Ether Alkohol botol 31 0 0 0 0 0 0 0
273 Larutan Faucheet botol 31 0 0 0 0 0 0 0
274 Larutan Giemsa Stain botol 0 0 0 0 0 0 0
275 Larutan HCl-alkohol /Lart. Etanol asam botol 0 0 0 0 0 0 0
276 Larutan Karbol Fuksin botol 0 0 0 0 0 0 0
277 Larutan Metilen Biru botol 0 0 0 0 0 0 0
278 Larutan Rees Ecker botol 0 0 0 0 0 0 0
279 Larutan Shlessinger botol 0 0 0 0 0 0 0
280 Larutan Turk botol 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
282 Oil imersion botol 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
283 Reagen Asam Urat set 0 0 0 0 0 0 0

284 Reagen Golongan Darah Antigen A set 0 0 0 0 0 0 0
285 Reagen Golongan Darah Antigen B set 0 0 0 0 0 0 0
286 Reagen Gula Darah set 0 0 0 0 0 0 0
287 Reagen Kolesterol set 0 0 0 0 0 0 0
288 Reagen Urin Stik 10 Parameter set 0 0 0 0 0 0 0
289 Reagen Widal (AO, BO,H,O) set 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
291 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, RPR 0/012) set APBN'20 470 470 100 100 350 20 370 300
292 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0 0
293 Reagen HBSAg+Droper APBN'20 360 360 25 25 275 60 335 75
294 Reagen HIV R1 (SD) APBN'20 425 300 725 75 75 575 75 650 225
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
297 Reagen Sypilis 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
299 Etil Klorida spray botol 14.1 0 0 0 0 0 0 0
300 Eugenol cairan botol 14.1 DAK'19 3 3 0 0 2 1 3 0
301 Fluor tablet 0,5 mg tablet 14.1 0 0 0 0 0 0 0
302 Glass Ionomer Cement ART set 14.1 DAK'19 2 2 0 0 2 0 2 0
303 Kalsium Hidroksida Pasta set 14.1 0 0 0 0 0 0 0
304 Monochlorkamfer mentol ( CHKM ) botol 14.1 3 3 0 0 2 1 3 0
305 Mummifying Pasta botol 0 0 0 0 0 0 0
306 Povidon Iodine obat kumur botol 0 0 0 0 0 0 0
307 Semen Seng Fosfat serbuk dan cairan botol 0 0 0 0 0 0 0
308 Silver Amalgam serbuk 65 - 75 % botol 0 0 0 0 0 0 0
309 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan botol 0 0 0 0 0 0 0
310 Tri Kresol Formalin botol 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0
Flu Burung : 0 0 0 0
311 Oseltamivir kapsul 75 mg kapsul 0 0 0 0 0 0 0
Gizi : 0 0 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 400 350 750 50 50 350 350 700 150
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 3,548 3,250 6,798 100 100 3,250 3,448 6,698 300
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 74,949 74,949 2,556 2,556 0 72,393 72,393 7,668
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
317 MB Dewasa blister APBN 20 6 6 12 0 0 6 6 12 0
Pemakai Stok
Rata Pkm
318 PB Anak blister 0 0 0 0 0 0 0

319 PB Dewasa blister 0 0 0 0 0 0 0
Anti Malaria : 0 0 0 0
320 ACT ( Artesunate + Amodiaquin ) Arsuamoon tablet 0 0 0 0 0 0 0
321 ACT ( Dehidro Artemisin + Piperaquin ) Arterakine tablet 0 0 0 0 0 0 0
322 Artemeter inj. 80 mg/ml ampul 0 0 0 0 0 0 0
323 Artesunate inj. kotak 0 0 0 0 0 0 0
324 Doksisiklin kapsul 100 mg kapsul 0 0 0 0 0 0 0
325 Kina dihidroklorida inj. 25 %-2ml ampul 0 0 0 0 0 0 0
326 Kina tablet 200 mg tablet 0 0 0 0 0 0 0
327 Primakuin tablet 15 mg tablet 0 0 0 0 0 0 0
Anti TBC : 0 0 0 0
328 Ethambutol tablet 400 mg tablet 0 0 0 0 0 0 0
330 FDC KIT I / III paket APBN'20 14 14 2 2 12 0 12 6
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
334 OAT Kategori I paket 0 0 0 0 0 0 0
335 OAT Kategori II paket 0 0 0 0 0 0 0
336 OAT Kategori III paket 0 0 0 0 0 0 0
337 OAT Sisipan paket 0 0 0 0 0 0 0
338 Cartridge TCM tablet 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0
339 Vaksin BCG bayi vial 0 0 0 0 0 0 0
340 Vaksin Campak vial 0 0 0 0 0 0 0
341 HB Uniject 0,5 ml ampul 0 0 0 0 0 0 0
KIA : 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
344 Urine Rapid Test pak 0 0 0 0 0 0 0
345 Progesteron Depo inj ( 3 bulan ) vial 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
347 Metronidazole 500 mg inj vial 0 0 0 0 0 0 0
348 Calcium Gluconas inj ampul 0 0 0 0 0 0 0
349 Catgut Chromic 1/0 set 0 0 0 0 0 0 0
350 Kantung Urine Dewasa set 0 0 0 0 0 0 0
351 Rapid Test Siphilis set 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
353 Implant KB / Levonogestrel 75 mg set 0 0 0 0 0 0 0
354 Transfusion Set set 0 0 0 0 0 0 0
355 Pil Kontrasepsi ( Microdiol ) strip 0 0 0 0 0 0 0
ANTI RETROVIRAL: 0 0 0 0 0
356 Nevirapine (NVP) 200 mg set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
358 Lamivudine (3TC) 150 mg set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
359 Zidofudine (ZDV) 300 mg + Lamivudine (3TC) 150 mg set 0 0 0 0 0 0 0

360 Tenofovir 300 mg (TDF) set 0 0 0 0 0 0 0
361 Tenovofir 300 mg (TDF) + Lamivudin 300 mg (3TC)+ Efavirennz 600 mg set 0 0 0 0 0 0 0
362 Dolutegravir 50 mg set 0 0 0 0 0 0 0
363 Tenovovir 300 mg (TDF) + Lamivudin 300 mg (3TC) + Dolutegravir 50 mg (DTG) set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

JUMLAH KUNJUNGAN RESEP
278 518 796
Jombang, ………………………
Mengetahui Yang Melaporkan
Kepala BLUD Puskesmas Jelakombo Pengelola Obat Puskesmas Jelakombo
drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Februari

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 1,526 1,526 1,526 763 0 0 0 4,578 6,500
2 Albendazol susp APBN 20 0 0 0
3 Albothyl concentrat fles 0 0 0 0 0 0 0
4 Alopurinol tablet 100 mg tablet 1.2 APBD '18 5,630 5,630 470 530 3,900 1,260 5,160 1,410
5 Ambroxol tab 30 mg tablet 0 0 0 0 0 0 0
6 Aminofilin tablet 200 mg tablet 26.1 APBD '18 0 0 0 608 0 0 0
7 Aminofilina injeksi 24 mg/ml - 10 ml ampul 26.1 0 0 0 0 0 0 0
8 Amitriptilin HCl tablet salut 25 mg tablet 23.2 PROG' 18 392 392 0 2 392 392 0
9 Amlodipin tablet 5 mg tablet APBD II '20 11,619 11,619 0 3,834 11,100 519 11,619 0
10 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 29,940 29,940 1,685 26,656 27,000 1,255 28,255 5,055
18 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 9,618 9,618 956 802 7,600 1,062 8,662 2,868
19 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU/g + Polimiksin 10.000 IU/g tube 18.2 0 0 0 0 0 0 0
20 Anti Hemoroid DOEN Kombinasi supp 25.3 APBD II '20 427 427 60 45 200 167 367 180
22 Antimigren:Ergotamin Tartrat 1 mg + Kofein 50 mg tablet 7.2 0 0 0 0 0 0 0
23 Antiparkinson DOEN tablet kombinasi:Karbidopa 25 mg + Levodopa 250 mg tablet 9 0 0 0 0 0 0 0
24 Aqua pro Injeksi steril 25 ml, bebas pirogen vial 20.3 DAK'19 330 330 30 25 0 300 300 90
25 Aquadest steril 500 ml botol 30 0 0 0 0 0 0 0
26 Asam Asetilsalisilat (Asetosal) tablet 100 mg tablet 1.2 0 0 0 0 0 0 0
29 Asam Askorbat (Vit C) tablet 100 mg tablet 29 0 0 0 0 0 0 0
30 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 29,205 29,205 1,707 1,241 24,000 3,498 27,498 5,121
31 Asam Mefenamat tablet salut selaput 500 mg tablet DAK '19 41,597 41,597 2,730 2,457 36,500 2,367 38,867 8,190
32 Asetilsistein APBD II '20 15,095 15,095 916 956 13,800 379 14,179 2,748
33 Asam Traneksamat injeksi ampul 0 0 0 0 0 0 0
34 Asam Traneksamat kapsul 250 mg kapsul 0 0 0 0 0 0 0
36 Asiklovir krim 5% tube 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
38 Atapulgit tablet 600 mg tablet APBD II '20 1,535 1,535 126 145 900 509 1,409 378
44 Betametason krim 0,5 mg/g tube APBD II '20 123 123 20 18 50 53 103 60
47 Bisoprolol tab 5 mg ampul APBD II '20 500 500 0 0 500 0 500 0
49 D 40 Inj ampul 0 0 0 0 0 0 0
71 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
73 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 2,050 2,050 1,528 1,007 522 0 522 4,584
79 Fitomenadion (Vit.K1) injeksi 2 mg/ml - 1 ml ampul 10.2 APBD '18 30 30 0 0 0 30 30 0
80 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10.2 DAK '19 522 522 50 58 300 172 472 150 200
Pemakai Stok
Rata Pkm
83 Furosemid tablet 40 mg tablet 14 APBD '17 819 819 819 466 0 0 0 2,457 5,000
85 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 1,054 1,054 130 134 600 324 924 390 1,000
90 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 17,193 17,193 1,385 1,458 15,000 808 15,808 4,155
91 Glimepiride 1 mg APBD II '20 2,303 2,303 445 378 1,400 458 1,858 1,335 2,000
92 Glimepiride 2 mg tablet APBD II '20 2,042 2,042 850 810 1,000 192 1,192 2,550
96 Haldol Decanoat 50 mg/ml inj ampul APBD II '20 5 5 0 0 5 0 5 0
98 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,805 1,805 210 158 1,500 95 1,595 630 500
107 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 513 513 40 50 200 273 473 120 200
108 Kandesartan tablet 16 mg tablet 1,460 1,460 1,460 730 0 0 4,380
109 Kalium Permanganat serbuk 44 44 2 1 0 42 42 6
111 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 11,595 11,595 0 546 10,800 795 11,595 0
114 Karbamazepin tablet 200 mg tablet APBD II '20 2,000 2,000 0 0 1,500 500 2,000 0
116 Ketokonazol tablet 200 mg ampul APBD II '20 940 940 60 48 600 280 880 180 200
119 Kloramfenikol salep mata 1 % tube 21.21 DAK '19 287 287 5 8 244 38 282 15
121 Kloramfenikol salep kulit 2% botol APBD II '20 108 108 6 7 24 78 102 18
120 Kloramfenikol tetes mata botol 0 0 0 0 0 0 0
122 Kloramfenikol tetes telinga 3 % botol 0 0 0 0 0 0 0
123 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 14,354 14,354 1,243 1,318 11,000 2,111 13,111 3,729 3,000
126 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 1,343 1,343 373 249 500 470 970 1,119
Pemakai Stok
Rata Pkm
128 Kodein tablet 10 mg tablet 26.2 APBD II '20 534 534 134 81 400 0 400 402 2,000
133 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 3,932 3,932 220 182 3,000 712 3,712 660
138 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml ampul 14.1 APBD '18 0 0 0 103 0 0 0
139 Lisinopril tablet 10 mg tablet APBD II '20 965 965 60 88 500 405 905 180
147 Metil prednisolon tablet 4 mg ampul APBD II '20 1,673 1,673 150 108 1,000 523 1,523 450
158 Nistatin tablet vaginal 100.000 IU/g tablet 6.3 74 74 15 8 0 59 59 45 100
168 Parasetamol tablet 500 mg tablet 1.2 DAK '19 13,307 13,307 1,908 1,784 7,500 3,899 11,399 5,724 6,000
172 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 10,686 10,686 1,069 598 8,100 1,517 9,617 3,207 3,000
Pemakai Stok
Rata Pkm

178 Prednison tablet 5 mg tablet 16.4 APBD '18 7,646 7,646 2,734 1,740 3,500 1,412 4,912 8,202 8,000
180 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 5,223 5,223 20 10 500 4,703 5,203 60
187 Risperidon 2 mg tablet APBD II '20 1,810 1,810 0 30 1,500 310 1,810 0
188 Salbutamol 2,5 mg respulles (Komb Ipratropium Br 0,5mg+Salbutamol2,5mgnebules) Combivent ampul 26.1 APBD II '20 20 20 0 0 20 20 0
190 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,644 1,644 150 110 1,300 194 1,494 450 500
215 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,865 1,865 130 103 1,100 635 1,735 390 400
216 Vitamin B Kompleks tablet tablet 29 APBD II '20 16,175 16,175 2,133 2,367 13,000 1,042 14,042 6,399 7,000
218 Zinc tablet 20 mg tablet APBD II '20 167 167 53 91 0 114 114 159 200
0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
0 0 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 0 0 0 0 0 0 0 0
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 0 0 0 0 0 0 0
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 0 0 0 0 0 0 0
223 Blue Tip / MT II set 32 0 0 0 0 0 0 0
224 Catgut / Benang Bedah No. 2/0 Khromic biji 32 APBD II '20 12 12 0 0 12 12 0
226 Catgut / Benang Bedah No. 2/0 plain biji 32 APBD II '20 11 11 0 0 11 11 0
227 Catgut / Benang Bedah No. 3/0 plain biji APBD II '20 12 12 0 0 12 12 0
DAK NON
FISIK 2021
Gown biji / BOK 0 0 0 0 0 0
DAK NON
FISIK 2021
Hazmat biji / BOK 0 0 0 0 0 0
DAK NON
FISIK 2021
Handsanitiser botol / BOK 0 0 0 0 0 0
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0 0 0 0 0 0
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 50 50 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
REAGEN LABORATORIUM 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

290 Xylol botol 0 0 0 0 0 0 0
292 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0 0 0 0
294 Reagen HIV R1 (SD) APBN'20 650 650 137 106 475 38 513 411
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 3,810 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 700 700 243 147 0 457 457 729
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 6,698 6,698 1,789 895 0 4,909 4,909 5,367
315 Yodiol kapsul 0 0 0 1 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
Anti Malaria : 0 0 0 0 0 0
Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
ANTI RETROVIRAL: 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

295 456 751
Jombang, ………………………

NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Maret

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakaia Stok Stok

Kelas Sumber Stok Peneri Persedi Pemakai Sisa Permintaa
No. Nama Obat & Perbekalan Kesehatan Satuan n Rata- Gudang Sub Stok Opt KET
Terapi Dana Awal maan aan an Rata Pkm unit
Stok n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 0 0 0 763 0 0 0 0
2 Albendazol susp APBN 20 0 2,800 2,800 0 0 0 2,800 2,800 0
2 Albothyl concentrat fles 0 0 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 5,160 5,160 1,960 1,215 3,200 0 3,200 5,880
8 Amlodipin tablet 5 mg tablet APBD II '20 11,619 11,619 519 260 11,100 0 11,100 1,557
18 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU/g + Polimiksin 10.000 IU/gtube 18.2 0 0 0 0 0 0 0
31 Asetilsistein APBD II '20 14,179 5,600 19,779 1,151 1,034 17,400 1,228 18,628 3,453
Pemakaia Stok Stok
Stok n
37 Atapulgit tablet 600 mg tablet APBD II '20 1,409 300 1,709 95 111 1,200 414 1,614 285
48 D 40 Inj ampul 0 0 0 0 0 0 0
56 Diazepam tablet 2 mg tablet 5 APBD II '20 0 0 0 55 0 0 0
62 Domperidon tablet 10 mg tablet DAK'19 1,227 200 1,427 44 72 1,200 183 1,383 132
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 522 522 0 764 522 0 522 0
79 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10.2 DAK '19 472 200 672 95 73 500 77 577 285
Pemakaia Stok Stok
Stok n
82 Furosemid tablet 40 mg tablet 14 APBD '17 0 0 0 410 0 0 0

84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 924 1,800 2,724 48 89 2,400 276 2,676 144
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 15,808 15,808 2,796 2,091 12,000 1,012 13,012 8,388
90 Glimepiride 1 mg APBD II '20 1,858 2,000 3,858 150 298 3,400 308 3,708 450
91 Glimepiride 2 mg tablet APBD II '20 1,192 1,192 480 665 0 712 712 1,440
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,595 500 2,095 230 220 1,500 365 1,865 690
107 Kandesartan tablet 16 mg tablet 0 0 -1,460 0 0 1,460 1,460 -4,380
109 Kalium Permanganat serbuk 42 42 6 4 36 36 18
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 11,595 11,595 3,183 1,592 7,300 1,112 8,412 9,549
112 Karbamazepin tablet 200 mg tablet APBD II '20 2,000 2,000 500 250 1,000 500 1,500 1,500
114 Ketokonazol tablet 200 mg ampul APBD II '20 880 200 1,080 60 60 800 220 1,020 180
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 13,111 13,111 1,415 1,329 10,000 1,696 11,696 4,245
124 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 970 970 225 299 500 245 745 675
Pemakaia Stok Stok
Stok n
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 400 500 900 100 117 800 0 800 300
130 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5botol ml 6.2.2 APBD II '20 50 50 3 8 0 47 47 9
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg tablet
(Kotrim adult)
6.2.2 APBD II '20 3,712 3,712 170 195 3,000 542 3,542 510
132 Kotrimoksazol tablet pediatrik, kombinasi:Sulfametoksazol 100 mg + Trimetoprimtablet
20 mg 6.2.2 0 0 0 0 0 0 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 1,523 1,000 2,523 1,119 635 1,000 404 1,404 3,357
156 Nistatin tablet vaginal 100.000 IU/g tablet 6.3 59 100 159 9 12 100 50 150 27
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 9,617 3,000 12,617 827 948 10,100 1,690 11,790 2,481
Pemakaia Stok Stok
Stok n

176 Prednison tablet 5 mg tablet 16.4 APBD '18 4,912 8,000 12,912 760 1,747 10,500 1,652 12,152 2,280
178 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 5,203 5,203 5,203 2,612 0 0 0 15,609 ed
184 Ringer Laktat larutan infus steril botol 20.2 APBD II '20 20 20 2 1 13 5 18 6 6
185 Risperidon 2 mg tablet APBD II '20 1,810 1,810 390 195 1,110 310 1,420 1,170 2,100
186 Salbutamol 2,5 mg respulles (Komb Ipratropium Br 0,5mg+Salbutamol2,5mgnebules)
ampul Combivent
26.1 APBD II '20 20 20 0 0 20 20 0
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,494 500 1,994 624 387 1,200 170 1,370 1,872
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,735 400 2,135 110 120 1,500 525 2,025 330
0 0 0 0 0 0 0
Pemakaia Stok Stok
Stok n
0 0 0 0 0 0 0
PERBEKALAN KESEHATAN 0 0 0 0 0 0
223 Blue Tip / MT II 0 1,000 1,000 0 0 1,000 1,000 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
DAK NON
FISIK 2021
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakaia Stok Stok
Stok n

253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 50 1,000 1,050 0 0 1,000 50 1,050 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakaia Stok Stok
Stok n

290 Xylol botol 0 0 0 0 0 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 4,909 4,909 527 1,158 4,382 0 4,382 1,581
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 67,200 67,200 0 2,597 67,200 0 67,200 0
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Pemakaia Stok Stok
Stok n
Anti TBC : 0 0 0 0 0 0
330 FDC KIT I / III paket APBN'20 10 10 20 6 4 14 0 14 18
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakaia Stok Stok
Stok n
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

276 545 821
Jombang, 25 Maret 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : April

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok Stok

No. Nama Obat & Perbekalan Kesehatan Satuan an Rata- Gudang Sub Stok Opt KET
Terapi Dana Awal maan aan an Pkm unit
Stok n
Rata
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 0 0 0 0 0 0 0
2 Albendazol susp APBN 20 2,800 2,800 0 0 2,800 2,800 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 3,200 3,200 470 1,215 2,640 90 2,730 1,410
7 Amitriptilin HCl tablet salut 25 mg tablet 23.2 PROG' 18 392 392 392 196 0 0 0 1,176
8 Amlodipin tablet 5 mg tablet APBD II '20 11,100 11,100 1,722 1,121 9,300 78 9,378 5,166
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 26,423 26,423 1,424 1,628 24,000 999 24,999 4,272
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 530 530 185 240 200 145 345 555
31 Asetilsistein APBD II '20 18,628 18,628 1,578 1,365 16,800 250 17,050 4,734
Pemakai Stok Stok
Stok n
Rata
36 Asiklovir tablet 400 mg tablet APBD II '20 191 191 110 83 0 81 81 330 500
37 Atapulgit tablet 600 mg tablet APBD II '20 1,614 1,614 123 109 1,200 291 1,491 369
48 D 40 Inj ampul 0 0 0 0 0 0 0
49 Deksametason injeksi iv. 5 mg/ml - 1 ml ampul 3 DAK '19 8 8 8 4 0 0 24
59 Difenhidramin inj im.10 mg/ml-1 ml ( HCl ) ampul 3 0 0 0 15 0 0 0
62 Domperidon tablet 10 mg tablet DAK'19 1,383 1,383 1,203 624 0 180 180 3,609
66 Erytromycin kapsul 500 mg tablet 4,017 4,017 374 277 2,900 743 3,643 1,122
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 2,676 2,676 50 49 2,400 226 2,626 150
90 Glimepiride 1 mg APBD II '20 3,708 3,708 400 275 2,400 908 3,308 1,200
91 Glimepiride 2 mg tablet APBD II '20 712 712 290 385 0 422 422 870
94 Griseovulvin tablet 125 mg,micronized tablet DAK'19 600 600 600 315 0 0 0 1,800
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,865 1,865 195 213 1,500 170 1,670 585
107 Kandesartan tablet 16 mg tablet 1,460 1,460 30 -715 0 1,430 1,430 90
112 Karbamazepin tablet 200 mg tablet APBD II '20 1,500 1,500 500 500 500 500 1,000 1,500
113 Karbogliserin tetes telinga 10 % botol APBD II '20 111 111 9 12 24 78 102 27
114 Ketokonazol tablet 200 mg ampul APBD II '20 1,020 1,020 60 60 800 160 960 180
Pemakai Stok Stok
Stok n
Rata
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 800 800 0 50 800 0 800 0
138 Loratadin tablet 10 mg tablet DAK '19 631 631 302 186 300 29 329 906 500
149 Mikonazol cream tube APBD II '20 113 113 2 6 72 39 111 6
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 11,790 11,790 735 781 8,000 3,055 11,055 2,205
Pemakai Stok Stok
Stok n
Rata
176 Prednison tablet 5 mg tablet 16.4 APBD '18 12,152 12,152 696 728 8,500 2,956 11,456 2,088
178 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 0 0 0 2,602 0 0 0
180 Propranolol tablet 40 mg (HCl) tablet 7.1 0 0 0 0 0 0 0 200
185 Risperidon 2 mg tablet APBD II '20 1,420 1,420 340 365 800 280 1,080 1,020
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,370 1,370 0 312 1,200 170 1,370 0
190 Salep 2-4 , Kombinasi:Asam Salisilat 2% + Belerang Endap 4% pot 18.4 DAK'19 187 187 8 12 120 59 179 24
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 2,025 2,025 615 363 0 1,410 1,410 1,845
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 9,356 9,356 976 3,831 6,000 2,380 8,380 2,928
216 Zinc tablet 20 mg tablet APBD II '20 54 54 54 57 0 0 0 162 500
0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
0 0 0 0 0 0 0
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
DAK NON
FISIK 2021
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 1,050 1,050 0 0 0 1,050 1,050 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
290 Xylol botol 0 0 0 0 0 0 0
292 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
300 Eugenol cairan botol 14.1 DAK'19 3 3 3 2 0 0 0 9 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 4,382 4,382 128 328 0 4,254 4,254 384
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
317 MB Dewasa blister APBN 20 40 40 4 4 0 36 36 12
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

271 469 740
Jombang, 24 April 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Mei

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok Stok

Terapi Dana Awal maan aan an Stok n
Rata Pkm unit
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 0 0 0 0 0 0 0 0
2 Albendazol susp APBN 20 2,800 2,800 0 0 0 2,800 2,800 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,730 2,730 610 540 1,640 480 2,120 1,830
8 Amlodipin tablet 5 mg tablet APBD II '20 9,378 9,378 65 894 7,800 1,513 9,313 195
31 Asetilsistein APBD II '20 17,050 17,050 598 1,088 13,900 2,552 16,452 1,794
37 Atapulgit tablet 600 mg tablet APBD II '20 1,491 1,491 121 122 1,200 170 1,370 363
Pemakai Stok Stok
Rata Pkm unit

48 D 40 Inj ampul 0 0 0 0 0 0 0
49 Deksametason injeksi iv. 5 mg/ml - 1 ml ampul 3 DAK '19 0 50 50 0 4 50 0 50 0
59 Difenhidramin inj im.10 mg/ml-1 ml ( HCl ) ampul 3 0 60 60 0 0 60 0 60 0
62 Domperidon tablet 10 mg tablet DAK'19 180 3,000 3,180 158 681 3,000 22 3,022 474
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
90 Glimepiride 1 mg APBD II '20 3,308 3,308 210 305 2,400 698 3,098 630
91 Glimepiride 2 mg tablet APBD II '20 422 422 390 340 0 32 32 1,170
Pemakai Stok Stok
Rata Pkm unit

107 Kandesartan tablet 16 mg tablet 1,430 1,430 60 45 0 1,370 1,370 180
112 Karbamazepin tablet 200 mg tablet APBD II '20 1,000 1,000 0 250 500 500 1,000 0
114 Ketokonazol tablet 200 mg ampul APBD II '20 960 960 30 45 800 130 930 90
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 10,567 10,567 971 1,050 7,500 2,096 9,596 2,913
136 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml ampul 14.1 APBD '18 0 120 120 0 0 120 0 120 0
Pemakai Stok Stok
Rata Pkm unit

166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 7,673 10,400 18,073 1,967 1,957 12,900 3,206 16,106 5,901
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 11,055 11,055 913 824 8,000 2,142 10,142 2,739
178 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 0 0 0 0 0 0 0
180 Propranolol tablet 40 mg (HCl) tablet 7.1 0 1,000 1,000 0 0 1,000 0 1,000 0
185 Risperidon 2 mg tablet APBD II '20 1,080 1,080 90 215 800 190 990 270
Pemakai Stok Stok
Rata Pkm unit

213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,410 1,410 130 373 0 1,280 1,280 390
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 8,380 4,000 12,380 3,915 2,446 7,500 965 8,465 11,745
216 Zinc tablet 20 mg tablet APBD II '20 0 0 0 27 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
DAK NON
FISIK 2021
Pemakai Stok Stok
Rata Pkm unit

247 KI 5 ml set 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 10 0 10 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 1,050 1,050 0 0 1,050 0 1,050 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
Pemakai Stok Stok
Rata Pkm unit

281 Metanol botol 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
300 Eugenol cairan botol 14.1 DAK'19 0 3 3 0 2 3 0 3 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 61,600 61,600 0 2,800 0 61,600 61,600 0
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok Stok
Rata Pkm unit

Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 1 1 1 1 0 0 0 3
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
335 OAT Kategori II paket 0 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
Pemakai Stok Stok
Rata Pkm unit
UMUM JKN JML

260 522 782
Jombang, 25 Mei 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Juni

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Kelas Sumber Stok Peneri Persedi Pemakai Stok Sisa Permintaa
Terapi Dana Awal maan aan an Sub unit Stok n
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
2 Albendazol susp APBN 20 2,800 2,800 0 0 0 2,800 2,800 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,120 2,120 660 635 1,140 320 1,460 1,980 500
8 Amlodipin tablet 5 mg tablet APBD II '20 9,313 9,313 2,310 1,188 6,300 703 7,003 6,930
18 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU/g + Polimiksin 10.000 IU/g
tube 18.2 0 0 0 0 0 0 0
31 Asetilsistein APBD II '20 16,452 16,452 995 797 13,900 1,557 15,457 2,985
37 Atapulgit tablet 600 mg tablet APBD II '20 1,370 1,370 238 180 500 632 1,132 714
Pemakai Stok
Rata Pkm

48 D 40 Inj ampul 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 1,159 1,159 340 240 500 319 819 1,020 200
66 Erytromycin kapsul 500 mg tablet 3,255 3,255 3,255 1,822 0 0 0 9,765
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 460 460 360 211 0 100 100 1,080 1,500
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 6,522 6,522 2,095 3,048 3,000 1,427 4,427 6,285 2,000
90 Glimepiride 1 mg APBD II '20 3,098 3,098 1,220 715 0 1,878 1,878 3,660
Pemakai Stok
Rata Pkm

94 Griseovulvin tablet 125 mg,micronized tablet DAK'19 0 0 0 0 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,505 1,505 380 273 1,000 125 1,125 1,140
112 Karbamazepin tablet 200 mg tablet APBD II '20 1,000 1,000 30 15 500 470 970 90
124 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 552 552 357 179 0 195 195 1,071
130 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg botol / 5 ml 6.2.2 APBD II '20 38 38 2 3 0 36 36 6
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg tablet
(Kotrim adult)
6.2.2 APBD II '20 3,317 3,317 163 143 2,500 654 3,154 489
132 Kotrimoksazol tablet pediatrik, kombinasi:Sulfametoksazol 100 mg + Trimetoprim
tablet
20 mg 6.2.2 0 0 0 0 0 0 0
136 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + Epinefrin 1:80.000 - 2 mlampul 14.1 APBD '18 120 120 2 1 90 28 118 6
Pemakai Stok
Rata Pkm

145 Metil prednisolon tablet 4 mg ampul APBD II '20 1,244 1,244 0 0 0 1,244 1,244 0
150 Mineral Mix Kombinasi sachet 2,225 2,225 0 0 2,225 2,225 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 10,142 10,142 1,858 1,386 8,000 284 8,284 5,574
176 Prednison tablet 5 mg tablet 16.4 APBD '18 10,506 10,506 1,163 1,057 8,000 1,343 9,343 3,489
180 Propranolol tablet 40 mg (HCl) tablet 7.1 1,000 1,000 0 0 1,000 0 1,000 0
185 Risperidon 2 mg tablet APBD II '20 990 990 90 90 800 100 900 270
186 Salbutamol 2,5 mg respulles (Komb Ipratropium Br 0,5mg+Salbutamol2,5mgnebules)
ampul Combivent
26.1 APBD II '20 20 20 0 0 0 20 20 0
Pemakai Stok
Rata Pkm

213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,280 1,280 305 218 0 975 975 915
0 0 0 0 0 0 0
0 0 0 0 0 0 0
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
228 Foley Catheter No. 16 set APBD II '20 10 10 0 0 10 10 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
Pemakai Stok
Rata Pkm
DAK NON
FISIK 2021
236 IV Catether No. 20 set APBD II '20 5 5 0 0 5 5 0
247 KI 5 ml set 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

281 Metanol botol 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
291 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, RPR 0/012) set APBN'20 230 200 430 230 140 200 0 200 690
293 Reagen HBSAg+Droper APBN'20 122 240 362 95 65 225 42 267 285
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 61,600 61,600 290 145 0 61,310 61,310 870
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 0 0 1 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

357 Efaviren 600mg set 0 0 0 0 0 0 0
363 Tenovovir 300 mg (TDF) + Lamivudin 300 mg (3TC) + Dolutegravir 50 mg (DTG)
set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

313 525 838
Jombang, 25 Mei 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Juli

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Kelas Sumber Stok Peneri Persedia Pemakai Stok Sisa Permintaa
Terapi Dana Awal maan an an Sub unit Stok n
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
2 Albendazol susp botol APBN 20 2,800 280 3,080 0 0 280 2,800 3,080 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 1,460 2,000 3,460 580 620 2,400 480 2,880 1,740
8 Amlodipin tablet 5 mg tablet APBD II '20 7,003 7,003 2,035 2,173 3,300 1,668 4,968 6,105
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 21,811 10,000 31,811 2,312 2,052 28,000 1,499 29,499 6,936
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 6,449 6,449 649 620 5,000 800 5,800 1,947
37 Atapulgit tablet 600 mg tablet APBD II '20 1,132 1,132 147 193 500 485 985 441
Pemakai Stok
Rata Pkm

48 D 40 Inj ampul 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 819 500 1,319 250 295 500 569 1,069 750
62 Domperidon tablet 10 mg tablet DAK'19 2,909 2,909 1,155 634 1,000 754 1,754 3,465
66 Erytromycin kapsul 500 mg tablet 0 2,000 2,000 0 1,628 2,000 0 2,000 0
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 100 2,400 2,500 100 230 2,400 0 2,400 300
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 2,428 500 2,928 136 138 2,500 292 2,792 408
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 4,427 10,000 14,427 2,000 2,048 10,000 2,427 12,427 6,000
90 Glimepiride 1 mg APBD II '20 1,878 1,878 850 1,035 0 1,028 1,028 2,550
Pemakai Stok
Rata Pkm
102 Hidrokortison krim 2,5 % tube 18.4 APDB '18 127 72 199 11 12 144 44 188 33
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 4,753 4,753 535 922 2,000 2,218 4,218 1,605
112 Karbamazepin tablet 200 mg tablet APBD II '20 970 970 390 210 500 80 580 1,170
117 Kloramfenikol salep mata 1 % tube 21.21 DAK '19 263 24 287 3 2 264 20 284 9
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrimtablet
adult) 6.2.2 APBD II '20 3,154 3,154 40 102 2,500 614 3,114 120
132 Kotrimoksazol tablet pediatrik, kombinasi:Sulfametoksazol 100 mg + Trimetoprim 20 mg
tablet 6.2.2 0 0 0 0 0 0 0
138 Loratadin tablet 10 mg tablet DAK '19 0 0 0 0 0 0 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 1,244 1,000 2,244 45 23 1,720 479 2,199 135
Pemakai Stok
Rata Pkm

166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 14,257 14,257 837 1,343 10,900 2,520 13,420 2,511
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 8,284 8,284 912 1,385 6,000 1,372 7,372 2,736
186 Salbutamol 2,5 mg respulles (Komb Ipratropium Br 0,5mg+Salbutamol2,5mgnebules)ampul
Combivent26.1 APBD II '20 20 20 0 0 0 20 20 0
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,347 1,000 2,347 170 97 2,000 177 2,177 510
Pemakai Stok
Rata Pkm

213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 975 975 60 183 0 915 915 180
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 4,728 4,728 997 2,367 2,500 1,231 3,731 2,991
0 0 0 0 0 0 0
0 0 0 0 0 0 0
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
DAK NON
FISIK 2021
239 Jarum jahit bedah No. 9 s/d 14 biji 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
247 KI 5 ml set 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 1,050 1,050 0 0 1,050 0 1,050 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 375 450 825 0 13 450 375 825 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 4,194 1,600 5,794 96 48 1,600 4,098 5,698 288
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 61,310 78,400 139,710 7,620 3,955 0 132,090 132,090 22,860
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
333 OAT Anak paket 0 0 0 0 0 0 0

Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
0
UMUM JKN JML

275 624 899
Jombang, 24 Juli 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Agustus

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Kelas Sumber Stok Peneri Persedia Pemakai Stok Sub Sisa
No. Nama Obat & Perbekalan Kesehatan Satuan an Rata- Gudang Stok Opt
Terapi Dana Awal maan an an unit Stok
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14
OBAT
2 Albendazol susp APBN 20 3,080 3,080 3,080 1,540 0 0 0 9,240
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,880 2,880 460 520 2,400 20 2,420 1,380
8 Amlodipin tablet 5 mg tablet APBD II '20 4,968 4,968 1,845 1,940 0 3,123 3,123 5,535
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 5,800 5,800 212 431 4,000 1,588 5,588 636
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 17,772 17,772 13,359 8,316 0 4,413 4,413 40,077
37 Atapulgit tablet 600 mg tablet APBD II '20 985 985 145 146 500 340 840 435
Pemakai Stok
Rata Pkm

48 D 40 Inj ampul 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 1,069 1,069 330 290 500 239 739 990
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 2,400 2,400 300 200 1,900 200 2,100 900
Pemakai Stok
Rata Pkm
90 Glimepiride 1 mg APBD II '20 1,028 1,028 1,028 939 0 0 0 3,084
91 Glimepiride 2 mg tablet APBD II '20 0 0 0 0 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,125 1,125 175 88 0 950 950 525
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 4,218 4,218 1,325 930 2,000 893 2,893 3,975
112 Karbamazepin tablet 200 mg tablet APBD II '20 580 580 440 415 0 140 140 1,320
Pemakai Stok
Rata Pkm
145 Metil prednisolon tablet 4 mg ampul APBD II '20 2,199 2,199 0 23 0 2,199 2,199 0
166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 13,420 13,420 0 419 10,900 2,520 13,420 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 7,372 7,372 2,026 1,469 4,000 1,346 5,346 6,078
Pemakai Stok
Rata Pkm

214 Vitamin B Kompleks tablet tablet 29 APBD II '20 3,731 3,731 3,731 2,364 0 0 0 11,193
0 0 0 0 0 0 0
0 0 0 0 0 0 0
222 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 0 5,500 5,500 500 250 5,000 0 5,000 1,500
223 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 5,000 5,000 200 100 4,800 0 4,800 600
223 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 0 0 0 0 0 0
225 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
Pemakai Stok
Rata Pkm
DAK NON
FISIK 2021
DAK NON
FISIK 2021
DAK NON
FISIK 2021
249 KI 5 ml set 0 0 0 0 0 0 0
255 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
256 Normject 2 ml set 0 0 0 0 0 0 0
257 Normject 5 ml set 0 0 0 0 0 0 0
259 Silk biji APBD I '20 10 10 0 0 0 10 10 0
262 Safety Box 5 L - COVID biji APBN 21 0 25 25 0 0 25 0 25 0
264 Under Pad biji 0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Pemakai Stok
Rata Pkm
0 0 0 0 0 0 0
266 KOH 10 % botol 31 0 0 0 0 0 0 0
283 Metanol botol 0 0 0 0 0 0 0
292 Xylol botol 0 0 0 0 0 0 0
297 Reagen HIV R2 0 0 0 0 0 0 0
298 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
299 Dentorit botol 14.1 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
313 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 825 825 450 225 0 375 375 1,350
314 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 5,698 5,698 1,688 892 0 4,010 4,010 5,064
315 Tablet Tambah Darah ( TTD ) tablet APBD II 20 132,090 132,090 0 3,810 0 132,090 132,090 0
316 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
317 MB Anak blister 0 0 0 0 0 0 0
319 PB Anak blister 0 0 0 0 0 0 0
Anti TBC : 0 0 0 0 0 0
332 FDC kit II paket 0 0 0 0 0 0 0
333 INH 100 mg tablet 0 0 0 0 0 0 0
334 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
343 Kondom set 0 0 0 0 0 0 0
344 IUD botol 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
347 Spuit KB bj 0 0 0 0 0 0 0
353 Urine Strip set 0 0 0 0 0 0 0
358 Efaviren 600mg set 0 0 0 0 0 0 0
365 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

251 547 798
Jombang, 25 Agustus 2021


NIP. 196812132005012011 NIP.199012132020122007
Permintaa
KET
n
15 16
4,520
1,000
6,000
100
3,000 pengeluaran antasida tab hanya sedikit dikarenakan menghabiskan stok antasida sirup
1,000
14,000
300
Permintaa
KET
n
48
500
500
Permintaa
KET
n
500
1,000 subt furosemid kosong
1,000
3,000
48
Permintaa
KET
n
Permintaa
KET
n
48
Permintaa
KET
n
20
Permintaa
KET
n
100 minta ed panjang, stok di pkm ed 12/21
250 minta ed panjang, stok di pkm ed 10/21

Permintaa
KET
n
Permintaa
KET
n
Kode Puskesmas : P3517130201 Bulan : September

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Kelas Sumber Peneri Persedia Pemakai Stok Sub Sisa Permintaa
No. Nama Obat & Perbekalan Kesehatan Satuan Stok Awal an Rata- Gudang Stok Opt KET
Terapi Dana maan an an unit Stok n
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 0 4,000 4,000 0 0 4,000 0 4,000 0
2 Albendazol susp APBN 20 0 0 0 1,540 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,420 1,000 3,420 435 448 2,400 585 2,985 1,305
8 Amlodipin tablet 5 mg tablet APBD II '20 3,123 4,500 7,623 1,905 1,875 4,500 1,218 5,718 5,715
16 Antasida DOEN suspensi botol 25.1 DAK '19 0 200 200 0 118 200 0 200 0
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 5,588 1,000 6,588 1,800 1,006 3,000 1,788 4,788 5,400
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 4,413 14,000 18,413 4,413 8,886 14,000 0 14,000 13,239
31 Asetilsistein APBD II '20 8,928 8,928 752 1,674 5,600 2,576 8,176 2,256
37 Atapulgit tablet 600 mg tablet APBD II '20 840 840 135 140 500 205 705 405
48 D 40 Inj ampul 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

56 Diazepam tablet 2 mg tablet 5 APBD II '20 0 300 300 0 0 300 0 300 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 739 500 1,239 235 283 500 504 1,004 705
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
90 Glimepiride 1 mg APBD II '20 0 0 0 514 0 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 950 500 1,450 250 213 500 700 1,200 750
101 Hidroklorotiazid (HCT) tablet 25 mg tablet 15 0 500 500 0 0 500 0 500 0
106 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 0 500 500 20 149 300 180 480 60
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 2,893 3,000 5,893 2,132 1,729 3,000 761 3,761 6,396
112 Karbamazepin tablet 200 mg tablet APBD II '20 140 140 140 290 0 0 0 420
Pemakai Stok
Rata Pkm

118 Kloramfenikol suspensi 125 mg/5 ml botol DAK '19 0 0 0 0 0 0 0
119 Kloramfenikol salep kulit 2% botol APBD II '20 23 48 71 8 10 48 15 63 24
120 Kloramfenikol tetes mata botol 0 50 50 0 0 50 0 50 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 2,199 2,199 394 197 1,805 0 1,805 1,182
150 Mineral Mix Kombinasi sachet 2,225 2,225 2,225 1,113 0 0 0 6,675
166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 13,420 13,420 0 0 10,900 2,520 13,420 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 5,346 5,346 1,961 1,994 3,000 385 3,385 5,883
Pemakai Stok
Rata Pkm

185 Risperidon 2 mg tablet APBD II '20 680 680 120 140 560 560 360
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 2,067 2,067 700 405 1,000 367 1,367 2,100
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 0 0 0 1,866 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
PERBEKALAN KESEHATAN 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 0 6,400 6,400 0 0 6,400 0 6,400 0
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 5,000 0 5,000 0 250 5,000 5,000 0
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 4,800 1,000 5,800 3,400 1,800 2,400 0 2,400 10,200
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 0 0 0 0 0 0
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
Pemakai Stok
Rata Pkm

DAK NON
FISIK 2021
Gown biji / BOK 0 35 35 0 0 35 0 35 0
DAK NON
FISIK 2021
Hazmat biji / BOK 0 35 35 0 0 35 0 35 0
DAK NON
FISIK 2021
Handsanitiser botol / BOK 0 8 8 0 0 8 0 8 0
247 KI 5 ml set 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0 120 120 0 0 120 0 120 0
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0 1,000 1,000 0 0 1,000 0 1,000 0
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
256 Plester roll APBD II '20 0 20 20 0 1 20 0 20 0
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0
261 Under Pad biji 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
REAGEN LABORATORIUM 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm

281 Metanol botol 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
291 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, RPR 0/012) set APBN'20 132 200 332 14 29 300 18 318 42
294 Reagen HIV R1 (SD) APBN'20 75 300 375 52 86 300 23 323 156
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
299 Etil Klorida spray botol 14.1 0 2 2 0 0 2 0 2 0
304 Monochlorkamfer mentol ( CHKM ) botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0 0
Flu Burung : 0 0 0 0 0
Gizi : 0 0 0 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 4,010 4,010 2,529 2,109 1,481 0 1,481 7,587
315 Yodiol kapsul 0 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Anti Malaria : 0 0 0 0 0
Pemakai Stok
Rata Pkm

Anti TBC : 0 0 0 0 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0
KIA : 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

230 460 690
Jombang, 25 September 2021

Pemakai Stok
Rata Pkm

NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : Oktober

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok
Rata Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 4,000 4,000 4,000 2,000 0 0 0 12,000 2,000
2 Albendazol susp APBN 20 0 0 0 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,985 2,985 475 455 2,400 110 2,510 1,425 4,000
8 Amlodipin tablet 5 mg tablet APBD II '20 5,718 5,718 4,070 2,988 1,500 148 1,648 12,210 10,000
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 4,788 4,788 687 1,244 3,000 1,101 4,101 2,061
20 Antifungi DOEN Kombinasi:Asam Benzoat 6% + Asam Salisilat 3% pot 18.3 49 49 0 0 0 49 49 0 48
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 0 0 0 0 0 0 0 5,000 peningkatan resep UMUM & KIA
31 Asetilsistein APBD II '20 8,176 8,176 777 765 5,600 1,799 7,399 2,331
37 Atapulgit tablet 600 mg tablet APBD II '20 705 705 165 150 500 40 540 495 500
Pemakai Stok
Rata Pkm

48 D 40 Inj ampul 0 0 0 0 0 0 0
56 Diazepam tablet 2 mg tablet 5 APBD II '20 300 300 61 31 200 39 239 183 500
60 Digoksin tablet 0,25 mg tablet 17.5 APBD II '20 0 0 0 137 0 0 0 0 300
61 Dimenhidrinat tablet 50 mg tablet DAK'19 1,004 1,004 460 348 444 100 544 1,380 1,500
65 Epinefrina ( Adrenalina ) Injeksi 0,1% - 1 ml ( HCl ) ampul 3 APBD II '20 8 8 7 4 0 1 1 21 20
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
78 Fitomenadion (Vit.K1) injeksi 2 mg/ml - 1 ml ampul 10.2 APBD '18 30 30 30 15 0 0 0 90 10
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 2,468 2,468 418 332 1,800 250 2,050 1,254
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 6,097 6,097 830 2,600 4,000 1,267 5,267 2,490 6,000
90 Glimepiride 1 mg APBD II '20 0 0 0 0 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,200 1,200 150 200 500 550 1,050 450
101 Hidroklorotiazid (HCT) tablet 25 mg tablet 15 500 500 60 30 300 140 440 180
Pemakai Stok
Rata Pkm

107 Kandesartan tablet 16 mg tablet 1,220 1,220 45 55 1,175 0 1,175 135
108 Kalsium Glukonat inj 100mg/ml / Ca Gluconas botol 0 0 0 0 0 0 0 10
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 3,761 3,761 1,925 2,029 0 1,836 1,836 5,775 6,000
110 Kaptopril tablet 25 mg tablet 0 0 0 0 0 0
112 Karbamazepin tablet 200 mg tablet APBD II '20 0 0 0 70 0 0 0 0 3,000
120 Kloramfenikol tetes mata botol 50 50 0 0 50 0 50 0
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 3,922 3,922 1,099 1,106 2,500 323 2,823 3,297
124 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 0 0 0 0 0 0 0
136 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml ampul 14.1 APBD '18 110 110 110 57 0 0 0 330 100
139 Magnesium Sulfat injeksi (iv) 20 % - 25 ml ampul 5 0 0 0 0 0 0 0 2
143 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg tablet 22.1 0 0 0 0 0 0 0
144 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 22.1 APBD II '20 10 10 10 5 0 0 30
145 Metil prednisolon tablet 4 mg ampul APBD II '20 1,805 1,805 1,805 1,100 0 0 0 5,415 300
150 Mineral Mix Kombinasi sachet 0 0 0 1,113 0 0 0 0
153 Natrium Klorida larutan infus 0,9 % steril botol 20.2 0 0 0 0 0 0 0 0 20
Pemakai Stok
Rata Pkm
161 Oksitosin injeksi 10 IU/ml - 1 ml ampul 22.1 0 0 0 0 0 0 0 0 5

166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 13,420 13,420 749 375 10,800 1,871 12,671 2,247
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 3,385 3,385 1,627 1,794 1,000 758 1,758 4,881 10,000
175 Povidon Iodida 10 %, 300 ml botol DAK '19 22 22 22 12 0 0 0 66 25
176 Prednison tablet 5 mg tablet 16.4 APBD '18 7,326 7,326 0 257 5,600 1,726 7,326 0
184 Ringer Laktat larutan infus steril botol 20.2 APBD II '20 16 16 9 5 0 7 7 27 20
201 Simvastatin tablet 10 mg tablet 0 5,000 5,000 180 90 4,000 820 4,820 540
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 0 0 0 0 0 0 0
216 Zinc tablet 20 mg tablet APBD II '20 0 0 0 0 0 0 0 7,000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
PERBEKALAN KESEHATAN 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 6,400 0 6,400 0 0 6,400 0 6,400 0
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 5,000 4,800 9,800 0 0 9,800 0 9,800 0
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 2,400 2,400 500 1,950 1,900 0 1,900 1,500 4,800
223 Blue Tip / MT II 1,000 1,000 0 0 0 1,000 1,000 0
DAK NON
FISIK 2021
Gown biji / BOK 35 35 0 0 35 0 35
DAK NON
FISIK 2021
Hazmat biji / BOK 35 35 0 0 35 35
DAK NON
FISIK 2021
233 Infusion set anak set APBD II '20 5 5 2 1 3 0 3 6 5
234 Infusion set dewasa set APBD II '20 4 4 4 2 0 0 0 12 10
235 IV Catether No. 18 set APBD II '20 4 4 2 2 0 2 2 6 5
241 Kapas Pembalut / Absorben 250 gram bungkus APBD II '20 3 3 2 3 1 0 1 6 10
244 Kasa pembalut 40 x 80 cm rol 0 0 0 0 0 0 0 0
245 Masker Nebul Anak set APBD II '20 5 5 2 1 3 0 3 6 5
246 Masker Nebul Dewasa set APBD II '20 1 1 0 2 1 0 1 0 5
247 KI 5 ml set 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 120 120 0 0 120 0 120
DAK NON
FISIK 2021
Masker Bedah biji / BOK 1,000 1,000 0 0 1,000 0 1,000
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
257 Silk biji APBD I '20 10 10 0 0 0 10 10 0

261 Under Pad biji 0 0 0 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
REAGEN LABORATORIUM 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
299 Etil Klorida spray botol 14.1 2 2 0 0 2 0 2 0 4 TAMBAHAN KEBUTUHAN UNTU
302 Glass Ionomer Cement ART set 14.1 DAK'19 2 2 1 1 0 1 1 3 5
Pemakai Stok
Rata Pkm

0 0 0 0 0 0 0
0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0 0
Flu Burung : 0 0 0 0 0
Gizi : 0 0 0 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 1,481 1,481 80 1,305 0 1,401 1,401 240
315 Yodiol kapsul 0 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
317 MB Dewasa blister APBN 20 27 27 11 6 0 16 16 33 6 pasien baru
318 PB Anak blister 0 0 0 0 0 0 0
Anti Malaria : 0 0 0 0 0
Anti TBC : 0 0 0 0 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0
KIA : 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
Pemakai Stok
Rata Pkm
352 Urine Strip set 0 0 0 0 0 0 0

357 Efaviren 600mg set 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

259 508 767
Jombang, 25 Oktober 2021


NIP. 196812132005012011 NIP.199012132020122007
Kode Puskesmas : P3517130201 Bulan : November

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok Stok

Stok n
Rata
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 0 0 0 2,000 0 0 0
2 Albendazol susp APBN 20 0 0 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 2,510 2,510 2,510 1,493 0 0 7,530
8 Amlodipin tablet 5 mg tablet APBD II '20 1,648 1,648 1,648 2,859 0 0 4,944
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 18,955 18,955 18,955 10,225 0 0 56,865
16 Antasida DOEN suspensi botol 25.1 DAK '19 190 190 190 100 0 0 570
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 4,101 4,101 4,101 2,394 0 0 12,303
19 Anti Hemoroid DOEN Kombinasi supp 25.3 APBD II '20 34 34 34 35 0 0 102
20 Antifungi DOEN Kombinasi:Asam Benzoat 6% + Asam Salisilat 3% pot 18.3 49 49 49 25 0 0 147
23 Aqua pro Injeksi steril 25 ml, bebas pirogen vial 20.3 DAK'19 130 130 130 65 0 0 390
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 0 0 0 0 0 0 0
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 11,801 11,801 11,801 7,000 0 0 35,403
30 Asam Mefenamat tablet salut selaput 500 mg tablet DAK '19 18,961 18,961 18,961 10,375 0 0 56,883
31 Asetilsistein APBD II '20 7,399 7,399 7,399 4,088 0 0 22,197
Pemakai Stok Stok
Stok n
Rata
36 Asiklovir tablet 400 mg tablet APBD II '20 636 636 636 318 0 0 1,908
37 Atapulgit tablet 600 mg tablet APBD II '20 540 540 540 353 0 0 1,620
43 Betametason krim 0,5 mg/g tube APBD II '20 109 109 109 57 0 0 327
46 Bisoprolol tab 5 mg ampul APBD II '20 350 350 350 185 0 0 1,050
48 D 40 Inj ampul 0 0 0 0 0 0 0
60 Digoksin tablet 0,25 mg tablet 17.5 APBD II '20 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 544 544 544 502 0 0 1,632
62 Domperidon tablet 10 mg tablet DAK'19 1,468 1,468 1,468 734 0 0 4,404
65 Epinefrina ( Adrenalina ) Injeksi 0,1% - 1 ml ( HCl ) ampul 3 APBD II '20 1 1 1 4 0 0 3
66 Erytromycin kapsul 500 mg tablet 1,580 1,580 1,580 963 0 0 4,740
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 1,580 1,580 1,580 910 0 0 4,740
79 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10.2 DAK '19 0 0 0 44 0 0 0
Pemakai Stok Stok
Stok n
Rata
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 2,050 2,050 2,050 1,234 0 0 6,150
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 5,267 5,267 5,267 3,049 0 0 15,801
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 1,050 1,050 1,050 600 0 0 3,150
99 Haloperidol tablet 5 mg tablet 23.4 APBD II '20 239 239 239 175 0 0 717
101 Hidroklorotiazid (HCT) tablet 25 mg tablet 15 440 440 440 250 0 0 1,320
102 Hidrokortison krim 2,5 % tube 18.4 APDB '18 96 96 96 77 0 0 288
106 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 455 455 455 240 0 0 1,365
107 Kandesartan tablet 16 mg tablet 1,175 1,175 1,175 610 0 0 3,525
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 1,836 1,836 1,836 1,881 0 0 5,508
112 Karbamazepin tablet 200 mg tablet APBD II '20 0 0 0 0 0 0 0
113 Karbogliserin tetes telinga 10 % botol APBD II '20 51 51 51 31 0 0 153
114 Ketokonazol tablet 200 mg ampul APBD II '20 740 740 740 370 0 0 2,220
117 Kloramfenikol salep mata 1 % tube 21.21 DAK '19 0 0 0 0 0 0 0
119 Kloramfenikol salep kulit 2% botol APBD II '20 59 59 59 32 0 0 177
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 2,823 2,823 2,823 1,961 0 0 8,469
Pemakai Stok Stok
Stok n
Rata
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 640 640 640 326 0 0 1,920
130 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml botol 6.2.2 APBD II '20 20 20 20 16 0 0 60
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 2,688 2,688 2,688 1,449 0 0 8,064
137 Lisinopril tablet 10 mg tablet APBD II '20 160 160 160 98 0 0 480
145 Metil prednisolon tablet 4 mg ampul APBD II '20 0 0 0 903 0 0 0
149 Mikonazol cream tube APBD II '20 72 72 72 37 0 0 216
150 Mineral Mix Kombinasi sachet 0 0 0 0 0 0 0
156 Nistatin tablet vaginal 100.000 IU/g tablet 6.3 124 124 124 62 0 0 372
164 Parasetamol sirup 120 mg/5 ml botol 1.2 APBD II '20 253 253 253 139 0 0 759
166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 12,671 12,671 12,671 6,710 0 0 38,013
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 1,758 1,758 1,758 1,693 0 0 5,274
Pemakai Stok Stok
Stok n
Rata
175 Povidon Iodida 10 %, 300 ml botol DAK '19 0 0 0 11 0 0 0
176 Prednison tablet 5 mg tablet 16.4 APBD '18 7,326 7,326 7,326 3,663 0 0 21,978
180 Propranolol tablet 40 mg (HCl) tablet 7.1 1,000 1,000 1,000 500 0 0 3,000
184 Ringer Laktat larutan infus steril botol 20.2 APBD II '20 7 7 7 8 0 0 21
185 Risperidon 2 mg tablet APBD II '20 410 410 410 280 0 0 1,230
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,249 1,249 1,249 684 0 0 3,747
190 Salep 2-4 , Kombinasi:Asam Salisilat 2% + Belerang Endap 4% pot 18.4 DAK'19 72 72 72 36 0 0 216
201 Simvastatin tablet 10 mg tablet 4,820 4,820 4,820 2,500 0 0 14,460
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 595 595 595 343 0 0 1,785
0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
0 0 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 6,400 0 6,400 6,400 3,200 0 0 0 19,200
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 9,800 0 9,800 9,800 4,900 0 0 0 29,400
218 Alat suntik sekali pakai 3 ml set 32 APBD II '20 3,000 3,000 3,000 1,500 0 0 9,000
219 Alat suntik sekali pakai 5 ml set 32 APBD II '20 50 50 50 25 0 0 150
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 1,900 0 1,900 1,900 1,200 0 0 0 5,700
222 Blood Transfusion Set set 32 APBD II '20 5 5 5 3 0 0 15
223 Blue Tip / MT II 1,000 1,000 1,000 500 0 0 3,000
DAK NON
FISIK 2021
Gown biji / BOK 35 35 35 18
DAK NON
FISIK 2021
Hazmat biji / BOK 35 35 35 18
DAK NON
FISIK 2021
Handsanitiser botol / BOK 8 8 8 4
233 Infusion set anak set APBD II '20 3 3 3 3 0 0 9
234 Infusion set dewasa set APBD II '20 0 0 0 2 0 0 0
241 Kapas Pembalut / Absorben 250 gram bungkus APBD II '20 1 1 1 2 0 0 3
243 Kasa Pembalut 2 m x 80 cm biji APBD II '20 55 55 55 28 0 0 165
245 Masker Nebul Anak set APBD II '20 3 3 3 3 0 0 9
246 Masker Nebul Dewasa set APBD II '20 1 1 1 1 0 0 3
247 KI 5 ml set 0 0 0 0 0 0 0
249 Kasa Pembalut Hidrofil 4 m x 15 cm hidrofil/elastic rol APBD II '20 50 50 50 25 0 0 150
Pemakai Stok Stok
Stok n
Rata
250 Kasa Steril 16 x 16 cm rol APBD '16 0 0 0 3 0 0 0
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 120 120 120 60
DAK NON
FISIK 2021
Masker Bedah biji / BOK 1,000 1,000 1,000 500
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
256 Plester roll APBD II '20 18 18 18 10 0 0 54
257 Silk biji APBD I '20 10 10 10 5 0 0 30
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 1,000 1,000 1,000 500 0 0 3,000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
REAGEN LABORATORIUM 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
290 Xylol botol 0 0 0 0 0 0 0
291 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, RPR 0/012) set APBN'20 301 301 301 159 0 0 903
293 Reagen HBSAg+Droper APBN'20 65 65 65 57 0 0 195
294 Reagen HIV R1 (SD) APBN'20 306 306 306 162 0 0 918
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
300 Eugenol cairan botol 14.1 DAK'19 3 3 3 2 0 0 9
302 Glass Ionomer Cement ART set 14.1 DAK'19 1 1 1 1 0 0 3
0 0 0 0 0 0 0
0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0
Flu Burung : 0 0 0 0
Gizi : 0 0 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 192 192 192 96 0 0 576
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 1,401 1,401 1,401 741 0 0 4,203
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 75,450 75,450 75,450 41,945 0 0 226,350
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
317 MB Dewasa blister APBN 20 16 16 16 14 0 0 48
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
Anti Malaria : 0 0 0 0
Anti TBC : 0 0 0 0
330 FDC KIT I / III paket APBN'20 6 6 6 4 0 0 18
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0
KIA : 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
ANTI RETROVIRAL: 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

0 0 0
Jombang, ………………………
Kepala BLUD Puskesmas …………………………… Pengelola Obat Puskesmas
………………………………….. ……………………………………………
NIP. …………………….. NIP. ………………………………….
Kode Puskesmas : P3517130201 Bulan : Desember

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok Stok

Stok n
Rata
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
2 Albendazol susp APBN 20 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 0 0 0 1,255 0 0 0
8 Amlodipin tablet 5 mg tablet APBD II '20 0 0 0 824 0 0 0
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 0 0 0 9,478 0 0 0
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 0 0 0 2,051 0 0 0
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 0 0 0 0 0 0 0
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 0 0 0 5,901 0 0 0
30 Asam Mefenamat tablet salut selaput 500 mg tablet DAK '19 0 0 0 9,481 0 0 0
31 Asetilsistein APBD II '20 0 0 0 3,700 0 0 0
Pemakai Stok Stok
Stok n
Rata
36 Asiklovir tablet 400 mg tablet APBD II '20 0 0 0 318 0 0 0
37 Atapulgit tablet 600 mg tablet APBD II '20 0 0 0 270 0 0 0
46 Bisoprolol tab 5 mg ampul APBD II '20 0 0 0 175 0 0 0
48 D 40 Inj ampul 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 0 0 0 272 0 0 0
62 Domperidon tablet 10 mg tablet DAK'19 0 0 0 734 0 0 0
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 0 0 0 790 0 0 0
Pemakai Stok Stok
Stok n
Rata
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 0 0 0 1,025 0 0 0
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 0 0 0 2,634 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 0 0 0 525 0 0 0
106 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 0 0 0 228 0 0 0
107 Kandesartan tablet 16 mg tablet 0 0 0 588 0 0 0
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 0 0 0 918 0 0 0
112 Karbamazepin tablet 200 mg tablet APBD II '20 0 0 0 0 0 0 0
114 Ketokonazol tablet 200 mg ampul APBD II '20 0 0 0 370 0 0 0
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 0 0 0 1,412 0 0 0
Pemakai Stok Stok
Stok n
Rata
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 0 0 0 320 0 0 0
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 0 0 0 1,344 0 0 0
137 Lisinopril tablet 10 mg tablet APBD II '20 0 0 0 80 0 0 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 0 0 0 0 0 0 0
150 Mineral Mix Kombinasi sachet 0 0 0 0 0 0 0
166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 0 0 0 6,336 0 0 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 0 0 0 879 0 0 0
Pemakai Stok Stok
Stok n
Rata
176 Prednison tablet 5 mg tablet 16.4 APBD '18 0 0 0 3,663 0 0 0
185 Risperidon 2 mg tablet APBD II '20 0 0 0 205 0 0 0
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 0 0 0 625 0 0 0
201 Simvastatin tablet 10 mg tablet 0 0 0 2,410 0 0 0
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 0 0 0 298 0 0 0
0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
0 0 0 0 0 0 0
PERBEKALAN KESEHATAN 0
218 Alat suntik sekali pakai 3 ml set 32 APBD II '20 0 0 0 1,500 0 0 0
223 Blue Tip / MT II 0 0 0 500 0 0 0
DAK NON
FISIK 2021
Gown biji / BOK 0
DAK NON
FISIK 2021
Hazmat biji / BOK 0
DAK NON
FISIK 2021
Handsanitiser botol / BOK 0
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 0 0 0 5 0 0 0
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 0 0 0 500 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0
REAGEN LABORATORIUM 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
290 Xylol botol 0 0 0 0 0 0 0
294 Reagen HIV R1 (SD) APBN'20 0 0 0 153 0 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0
OBAT PROGRAM 0
Flu Burung : 0
Gizi : 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 0 0 0 96 0 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 0 0 0 701 0 0 0
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 0 0 0 37,725 0 0 0
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
Anti Malaria : 0
Anti TBC : 0
331 FDC kit II paket 0 0 0 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0
KIA : 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
ANTI RETROVIRAL: 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

0 0 0
Jombang, ………………………
………………………………….. ……………………………………………
NIP. …………………….. NIP. ………………………………….
Kode Puskesmas : P3517130201 Bulan : Januari - Desember

Kecamatan : JOMBANG
Kabupaten : Jombang
Pemakai Stok Stok

Kelas Sumber Stok Peneri Pemakai Sisa Permintaa
No. Nama Obat & Perbekalan Kesehatan Satuan Persediaan an Rata- Gudang Sub Stok Opt KET
Terapi Dana Awal maan an Pkm unit
Stok n
Rata
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 1,526 4,000 5,526 5,526 461 0 0
2 Albendazol susp APBN 20 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 4,220 5,000 9,220 9,220 768 0 0
5 Aminofilin tablet 200 mg tablet 26.1 APBD '18 1,215 0 1,215 1,215 101 0 0
8 Amlodipin tablet 5 mg tablet APBD II '20 13,287 10,500 23,787 23,787 1,982 0 0
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 71,566 20,000 91,566 91,566 7,631 0 0
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 10,265 1,000 11,265 11,265 939 0 0
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 595 900 1,495 1,495 125 0 0
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 29,979 14,000 43,979 43,979 3,665 0 0
30 Asam Mefenamat tablet salut selaput 500 mg tablet DAK '19 33,780 10,000 43,780 43,780 3,648 0 0
31 Asetilsistein APBD II '20 10,490 11,200 21,690 21,690 1,808 0 0
Pemakai Stok Stok
Stok n
Rata
36 Asiklovir tablet 400 mg tablet APBD II '20 271 800 1,071 1,071 89 0 0
37 Atapulgit tablet 600 mg tablet APBD II '20 1,198 800 1,998 1,998 167 0 0
46 Bisoprolol tab 5 mg ampul APBD II '20 0 500 500 500 42 0 0
48 D 40 Inj ampul 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 1,704 1,000 2,704 2,704 225 0 0
62 Domperidon tablet 10 mg tablet DAK'19 1,327 3,200 4,527 4,527 377 0 0
66 Erytromycin kapsul 500 mg tablet 4,357 2,000 6,357 6,357 530 0 0
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 2,035 2,900 4,935 4,935 411 0 0
Pemakai Stok Stok
Stok n
Rata
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 1,191 2,300 3,491 3,491 291 0 0
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 16,723 12,000 28,723 28,723 2,394 0 0
90 Glimepiride 1 mg APBD II '20 2,213 2,400 4,613 4,613 384 0 0
91 Glimepiride 2 mg tablet APBD II '20 812 2,000 2,812 2,812 234 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 910 2,000 2,910 2,910 243 0 0
106 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 573 500 1,073 1,073 89 0 0
107 Kandesartan tablet 16 mg tablet 1,460 0 1,460 1,460 122 0 0
109 Kalium Permanganat serbuk 44 44 44 0 0 0
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 8,687 7,000 15,687 15,687 1,307 0 0
112 Karbamazepin tablet 200 mg tablet APBD II '20 2,000 0 2,000 2,000 167 0 0
114 Ketokonazol tablet 200 mg ampul APBD II '20 675 500 1,175 1,175 98 0 0
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 15,746 0 15,746 15,746 1,312 0 0
124 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 1,468 0 1,468 1,468 122 0 0
Pemakai Stok Stok
Stok n
Rata
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 161 900 1,061 1,061 88 0 0
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 3,076 1,000 4,076 4,076 340 0 0
137 Lisinopril tablet 10 mg tablet APBD II '20 1,080 0 1,080 1,080 90 0 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 738 3,000 3,738 3,738 312 0 0
150 Mineral Mix Kombinasi sachet 2,225 0 2,225 2,225 185 0 0
166 Parasetamol tablet 500 mg tablet 1.2 DAK '19 14,966 10,400 25,366 25,366 2,114 0 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 7,813 6,000 13,813 13,813 1,151 0 0
Pemakai Stok Stok
Stok n
Rata
176 Prednison tablet 5 mg tablet 16.4 APBD '18 6,392 10,000 16,392 16,392 1,366 0 0
178 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 5,223 0 5,223 5,223 435 0 0
180 Propranolol tablet 40 mg (HCl) tablet 7.1 0 1,000 1,000 1,000 83 0 0
185 Risperidon 2 mg tablet APBD II '20 1,870 0 1,870 1,870 156 0 0
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,214 2,000 3,214 3,214 268 0 0
201 Simvastatin tablet 10 mg tablet 0 5,000 5,000 5,000 417 0 0
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,340 1,000 2,340 2,340 195 0 0
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 8,776 16,000 24,776 24,776 2,065 0 0
0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
0 0 0 0 0 0 0
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 0 6,400 6,400 6,400 533 0 0 0 19,200
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 0 10,300 10,300 10,300 858 0 0 0 30,900
218 Alat suntik sekali pakai 3 ml set 32 APBD II '20 3,000 0 3,000 3,000 250 0 0
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 6,000 6,000 6,000 500 2,400 0 2,400 18,000
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 48 48 48 4 2,400 0 2,400 144
223 Blue Tip / MT II 0 1,000 1,000 1,000 83 0 0
DAK NON
FISIK 2021
Gown biji / BOK 0 35 35 35 3 0
DAK NON
FISIK 2021
DAK NON
FISIK 2021
247 KI 5 ml set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
253 Masker biji 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0 120 120 120 10 0
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0 1,000 1,000 1,000 83 0
254 Normject 2 ml set 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 0 10 10 1 0 0
265 Safety Box 5 L - COVID biji APBN 21 0 250 250 250 21 0 0 750
261 Under Pad biji 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 790 1,000 1,790 1,790 149 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
290 Xylol botol 0 0 0 0 0 0 0
294 Reagen HIV R1 (SD) APBN'20 425 600 1,025 1,025 85 0 0
295 Reagen HIV R2 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 400 800 1,200 1,200 100 0 0
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 3,548 4,850 8,398 8,398 700 0 0
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 74,949 78,400 153,349 153,349 12,779 0 0
315 Yodiol kapsul 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
Anti TBC : 0 0 0 0 0 0
331 FDC kit II paket 0 1 1 1 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0
KIA : 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0
Pemakai Stok Stok
Stok n
Rata
364 INH 300 mg tab 0 0 0 0 0 0 0
UMUM JKN JML

0 0 0
Jombang, ………………………
………………………………….. ……………………………………………
NIP. …………………….. NIP. ………………………………….
Kode Puskesmas : P3517130201 Bulan : Januari - September

Kecamatan : JOMBANG
Kabupaten : Jombang
Stok
Kelas Sumber Stok Peneri Persedia Pemakaia Pemakaian Stok Sub Sisa Permintaa
No. Nama Obat & Perbekalan Kesehatan Satuan Gudang Stok Opt KET
Terapi Dana Awal maan an n Rata-Rata unit Stok n
Pkm
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 APBN 20 1,526 4,000 5,526 1,526 170 4,000 0 4,000
2 Albendazol susp APBN 20 0 3,080 3,080 3,080 342 0 0 0
2 Albothyl concentrat fles 0 0 0 0 0 0 0 0
3 Alopurinol tablet 100 mg tablet 1.2 APBD '18 4,220 5,000 9,220 6,235 693 2,400 585 2,985
4 Ambroxol tab 30 mg tablet 0 0 0 0 0 0 0 0
5 Aminofilin tablet 200 mg tablet 26.1 APBD '18 1,215 0 1,215 1,215 135 0 0 0
6 Aminofilina injeksi 24 mg/ml - 10 ml ampul 26.1 0 0 0 0 0 0 0 0
8 Amlodipin tablet 5 mg tablet APBD II '20 13,287 10,500 23,787 18,069 2,008 4,500 1,218 5,718
9 Amoksisilin kaplet 500 mg kaplet 6.21 DAK '19 71,566 20,000 91,566 71,117 7,902 20,000 449 20,449
10 Amoksisilin kapsul 250 mg kapsul 6.21 0 0 0 0 0 0 0 0
11 Amoksisilin sirup kering 125 mg/5ml botol 6.21 0 0 0 0 0 0 0 0
12 Amoksisilin sirup kering Forte 250 mg/5ml botol 6.21 0 0 0 0 0 0 0 0
13 Ampisilin serbuk injeksi im/iv 1000 mg/ml vial 6.21 0 0 0 0 0 0 0 0
14 Antalgin (Metampiron) tablet 500 mg tablet 1.2 0 0 0 0 0 0 0 0
15 Antalgin injeksi 250 mg/ml - 2 ml ampul 1.2 0 0 0 0 0 0 0 0
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+Al. Hidroksida. 200 mg tablet 25.1 DAK '19 10,265 1,000 11,265 6,477 720 3,000 1,788 4,788
18 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU/g + Polimiksin 10.000 IU/g tube 18.2 0 0 0 0 0 0 0 0
21 Antimigren:Ergotamin Tartrat 1 mg + Kofein 50 mg tablet 7.2 0 0 0 0 0 0 0 0
22 Antiparkinson DOEN tablet kombinasi:Karbidopa 25 mg + Levodopa 250 mg tablet 9 0 0 0 0 0 0 0 0
24 Aquadest steril 500 ml botol 30 0 0 0 0 0 0 0 0
25 Asam Asetilsalisilat (Asetosal) tablet 100 mg tablet 1.2 0 0 0 0 0 0 0 0
26 Asam Asetilsalisilat (Asetosal) tablet 80 mg tablet 1.2 APBD II '20 595 900 1,495 1,495 166 0 0 0
27 Asam Asetilsalisilat (Asetosal) tablet 500 mg tablet 1.2 0 0 0 0 0 0 0 0
28 Asam Askorbat (Vit C) tablet 100 mg tablet 29 0 0 0 0 0 0 0 0
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 DAK '19 29,979 14,000 43,979 29,979 3,331 14,000 0 14,000
31 Asetilsistein APBD II '20 10,490 11,200 21,690 13,514 1,502 5,600 2,576 8,176
32 Asam Traneksamat injeksi ampul 0 0 0 0 0 0 0 0
33 Asam Traneksamat kapsul 250 mg kapsul 0 0 0 0 0 0 0 0
34 Asam Traneksamat kapsul 500 mg kapsul 0 0 0 0 0 0 0 0
35 Asiklovir krim 5% tube 0 0 0 0 0 0 0 0
36 Asiklovir tablet 400 mg tablet APBD II '20 271 800 1,071 435 48 300 336 636
37 Atapulgit tablet 600 mg tablet APBD II '20 1,198 800 1,998 1,293 144 500 205 705
38 Atropin injeksi im/iv/sk 0,25 mg/ml - 1 ml ( Sulfat ) vial 25.4 0 0 0 0 0 0 0 0
39 Atropin Sulfat tablet 0,5 mg tablet 25.4 0 0 0 0 0 0 0 0
40 Bekarbon tablet tablet 0 0 0 0 0 0 0 0
41 Benzatin Bensil Penisillin 2,4 juta IU/Vial vial 6.2.1 0 0 0 0 0 0 0 0
42 Betahistin Mesilat tablet 6 mg tablet 0 0 0 0 0 0 0 0
44 Bisacodyl suppositoria 10 mg dewasa suppo 0 0 0 0 0 0 0 0
45 Bisacodyl supposituria anak suppo 0 0 0 0 0 0 0 0
47 Cefotaxime inj. 1.000 mg vial 0 0 0 0 0 0 0 0
Stok
Pkm
48 D 40 Inj ampul 0 0 0 0 0 0 0 0
50 Deksametason tablet 0,5 mg tablet 16.4 0 0 0 0 0 0 0 0
51 Dekstran 70 - larutan infus 6% steril botol 11.2 0 0 0 0 0 0 0 0
52 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol 26.2 0 0 0 0 0 0 0 0
53 Dekstrometorfan tablet 15 mg ( HBr ) tablet 26.2 0 0 0 0 0 0 0 0
54 Diazepam injeksi 5 mg/ml - 2 ml ampul 5 0 0 0 0 0 0 0 0
55 Diazepam lar rektal 10mg/ 2,5 ml (Stesolid) tube 5 0 0 0 0 0 0 0 0
57 Diazepam tablet 5 mg tablet 5 0 0 0 0 0 0 0 0
58 Dietilkarbamazin Sitrat ta.100 mg tablet 6.1.2 0 0 0 0 0 0 0 0
61 Dimenhidrinat tablet 50 mg tablet DAK'19 1,704 1,000 2,704 1,700 189 500 504 1,004
62 Domperidon tablet 10 mg tablet DAK'19 1,327 3,200 4,527 3,059 340 1,000 468 1,468
63 Efedrin HCl tablet 25 mg ( HCl ) tablet 26.1 0 0 0 0 0 0 0 0
64 Ekstrak Belladon tablet 10 mg tablet 25.4 0 0 0 0 0 0 0 0
66 Erytromycin kapsul 500 mg tablet 4,357 2,000 6,357 4,432 492 1,500 425 1,925
67 Erytromycin kapsul 250 mg tablet 0 0 0 0 0 0 0 0
68 Erytromycin sirup 200 mg/5 ml botol 0 0 0 0 0 0 0 0
69 Etakridin ( Rivanol ) larutan 0,1% botol 6.2.4 0 0 0 0 0 0 0 0
70 Etanol 70% botol 6.2.4 0 0 0 0 0 0 0 0
71 Fenitoin injeksi 50 mg/ml ampul 5 0 0 0 0 0 0 0 0
72 Fenitoin Natrium kapsul 100 mg kapsul 5 APBD II '20 2,035 2,900 4,935 3,115 346 1,400 420 1,820
73 Fenitoin Natrium kapsul 30 mg kapsul 5 0 0 0 0 0 0 0 0
74 Fenobarbital inj im/iv 50 mg/ml 1ml ampul 5 0 0 0 0 0 0 0 0
75 Fenobarbital tablet 100 mg tablet 5 0 0 0 0 0 0 0 0
76 Fenobarbital tablet 30 mg tablet 5 0 0 0 0 0 0 0 0
77 Fenol Gliserol tetes telinga 10% botol 28.2 0 0 0 0 0 0 0 0
80 Fluphenazin Decanoate 25mg/ml (Sikzonoate Inj) ampul 0 0 0 0 0 0 0 0
81 Furosemid injeksi iv/im 10 mg/ml ampul 0 0 0 0 0 0 0 0
82 Furosemid tablet 40 mg tablet 14 APBD '17 931 0 931 931 103 0 0 0
83 Gameksan lotion 1 % botol 18.5 0 0 0 0 0 0 0 0
84 Garam Oralit untuk 200 ml air sak 20.1 PROG '19 1,191 2,300 3,491 1,023 114 2,300 168 2,468
85 Gentamisin injeksi 40 mg/ml (sbg Sulfat) ampul 0 0 0 0 0 0 0 0
86 Gentamisin injeksi 80 mg/ml (sbg Sulfat) ampul 0 0 0 0 0 0 0 0
87 Gentamisin salep kulit 0,1 % tube 0 0 0 0 0 0 0 0
88 Gentian Violet larutan 1 % botol 14.2 0 0 0 0 0 0 0 0
89 Glibenklamid tablet 5 mg tablet 16.1.1 APBD II '20 16,723 12,000 28,723 22,626 2,514 6,000 97 6,097
90 Glimepiride 1 mg APBD II '20 2,213 2,400 4,613 4,613 513 0 0 0
91 Glimepiride 2 mg tablet APBD II '20 812 2,000 2,812 2,812 312 0 0 0
92 Gliserin 100 ml botol 20.2 0 0 0 0 0 0 0 0
93 Glukosa larutan infus 5 % botol 20.2 0 0 0 0 0 0 0 0
96 Haloperidol 5mg/ml inj ampul 23.4 0 0 0 0 0 0 0 0
97 Haloperidol tablet 0,5 mg tablet 23.4 APBD II '20 910 2,000 2,910 1,710 190 500 700 1,200
98 Haloperidol tablet 1,5 mg tablet 23.4 0 0 0 0 0 0 0 0
100 Hidrogen Peroksida cairan 3% botol 0 0 0 0 0 0 0 0
101 Hidroklorotiazid (HCT) tablet 25 mg tablet 15 0 500 500 0 0 500 0 500
103 Ibuprofen suspensi 100mg/ 5 ml botol 1.2 0 0 0 0 0 0 0 0
104 Ibuprofen tablet 200 mg tablet 1.2 0 0 0 0 0 0 0 0
105 Ibuprofen tablet 400 mg tablet 1.2 0 0 0 0 0 0 0 0
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Pkm
106 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17.1 573 500 1,073 593 66 300 180 480
107 Kandesartan tablet 16 mg tablet 1,460 0 1,460 240 27 0 1,220 1,220
108 Kalsium Glukonat inj 100mg/ml / Ca Gluconas botol 0 0 0 0 0 0 0 0
109 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 APBD II '20 8,687 7,000 15,687 11,926 1,325 3,000 761 3,761
110 Kaptopril tablet 25 mg tablet 0 0 0 0 0 0 0 0
111 Kaptopril tablet 50 mg tablet 0 0 0 0 0 0 0 0
112 Karbamazepin tablet 200 mg tablet APBD II '20 2,000 0 2,000 2,000 222 0 0 0
114 Ketokonazol tablet 200 mg ampul APBD II '20 675 500 1,175 435 48 600 140 740
115 Klopidogrel tablet 75 mg tablet 0 0 0 0 0 0 0 0
116 Kloramfenikol kapsul 250 mg kapsul 6.2.2 0 0 0 0 0 0 0 0
120 Kloramfenikol tetes mata botol 0 50 50 0 0 50 0 50 0
121 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 DAK '19 15,746 0 15,746 11,824 1,314 2,500 1,422 3,922
122 Klorpromazin injeksi 25 mg/ml - 1 ml ( HCl ) ampul 25.4 0 0 0 0 0 0 0 0
123 Klorpromazin injeksi 5 mg/ml - 1 ml ( HCl ) ampul 25.4 0 0 0 0 0 0 0 0
124 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25.4 DAK '19 1,468 0 1,468 1,468 163 0 0 0
125 Klorpromazin tablet salut 25 mg ( HCl ) tablet 25.4 0 0 0 0 0 0 0 0
126 Kodein tablet 10 mg tablet 26.2 APBD II '20 161 900 1,061 409 45 640 12 652
127 Kombinasi ekstrak Plasenta 100 mg, Neomisin Sulfat 5 g/gram tube tube 0 0 0 0 0 0 0 0
128 Kombinasi gameksan 10 mg, Asam usnat 10 mg/g tube 0 0 0 0 0 0 0 0
129 Kombinasi Metampiron, ekstrak Belladona, Papaverin HCl tablet tablet 0 0 0 0 0 0 0 0
131 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg + Trimetoprim 80 mg (Kotrim adult) tablet 6.2.2 APBD II '20 3,076 1,000 4,076 1,178 131 2,000 898 2,898
132 Kotrimoksazol tablet pediatrik, kombinasi:Sulfametoksazol 100 mg + Trimetoprim 20 mg tablet 6.2.2 0 0 0 0 0 0 0 0
133 Larutan elektrolit D5 - 1/2 NS botol 0 0 0 0 0 0 0 0
134 Larutan elektrolit D5 - 1/4 NS botol 0 0 0 0 0 0 0 0
135 Lidokain HCl 2% ampul 0 0 0 0 0 0 0 0
137 Lisinopril tablet 10 mg tablet APBD II '20 1,080 0 1,080 885 98 0 195 195
141 Metamizole inj 1 gr / 2 ml vial 0 0 0 0 0 0 0 0
142 Metformin HCl tablet 500 mg tablet 0 0 0 0 0 0 0 0
145 Metil prednisolon tablet 4 mg ampul APBD II '20 738 3,000 3,738 1,933 215 1,805 0 1,805
146 Metoklopramide tablet 10 mg tablet 0 0 0 0 0 0 0 0
147 Metronidazol tablet 250 mg tablet 6.2.2 0 0 0 0 0 0 0 0
148 Metronidazol tablet 500 mg tablet 6.2.2 0 0 0 0 0 0 0 0
150 Mineral Mix Kombinasi sachet 2,225 0 2,225 2,225 247 0 0 0
151 Natrium Bikarbonat tablet 500 mg tablet 4.1 0 0 0 0 0 0 0 0
152 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0 0 0 0 0
153 Natrium Klorida larutan infus 0,9 % steril botol 20.2 0 0 0 0 0 0 0 0
154 Nifedipin tablet 10 mg tablet 0 0 0 0 0 0 0 0
155 Nistatin tablet salut 500.000 IU/g tablet 0 0 0 0 0 0 0 0
157 Obat Batuk Hitam ( O.B.H. ) cairan botol 26.3 0 0 0 0 0 0 0 0
158 Oksitetrasiklin HCl salep kulit 3 % tube 18.2 0 0 0 0 0 0 0 0
159 Oksitetrasiklin HCl salep mata 1 % ( HCl ) tube 21.2.2 0 0 0 0 0 0 0 0
160 Oksitetrasiklin HCl injeksi i.m. 50 mg/ml vial 6.2.2 0 0 0 0 0 0 0 0
161 Oksitosin injeksi 10 IU/ml - 1 ml ampul 22.1 0 0 0 0 0 0 0 0
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Pkm
162 Omeprazol injeksi 40 mg/ 10 ml vial 0 0 0 0 0 0 0 0

163 Omeprazol kapsul 20 mg kapsul 0 0 0 0 0 0 0 0
165 Parasetamol tablet 100 mg tablet 1.2 0 0 0 0 0 0 0 0
167 Permitrin krim 5% tube 0 0 0 0 0 0 0 0
168 Pirantel sirup 125mg/5ml botol 6.1.1 0 0 0 0 0 0 0 0
169 Pirantel tablet score ( base ) 125 mg tablet 6.1.1 0 0 0 0 0 0 0 0
170 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 APBD II '20 7,813 6,000 13,813 10,428 1,159 3,000 385 3,385
171 Piridoksin (Vit.B6) tablet 25 mg ( HCl ) 0 0 0 0 0 0 0 0
172 Piroksikam tablet 20 mg tablet 0 0 0 0 0 0 0 0
173 Polikresulen 3,6 mg / ml konsentrat 14.2 0 0 0 0 0 0 0 0
174 Povidon Iodida 10 %, 30 ml botol 0 0 0 0 0 0 0 0
176 Prednison tablet 5 mg tablet 16.4 APBD '18 6,392 10,000 16,392 9,066 1,007 5,600 1,726 7,326
177 Prokain Penisilin inj 3 jt vial 0 0 0 0 0 0 0 0
178 Propanolol tablet 10 mg (HCl) tablet 7.1 APBD '18 5,223 0 5,223 5,223 580 0 0 0
179 Propiltiourasil tablet 100 mg (PTU ) tablet 16.3 0 0 0 0 0 0 0 0
180 Propranolol tablet 40 mg (HCl) tablet 7.1 0 1,000 1,000 0 0 1,000 0 1,000
181 Ranitidin injeksi 25 mg/ml ampul 0 0 0 0 0 0 0 0
182 Ranitidin tablet 150 mg tablet 0 0 0 0 0 0 0 0
183 Ringer Asetat larutan infus steril botol 20.2 0 0 0 0 0 0 0 0
185 Risperidon 2 mg tablet APBD II '20 1,870 0 1,870 1,310 146 0 560 560
187 Salbutamol Inhaler 100 mcg/dosis pot 0 0 0 0 0 0 0 0
188 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26.1 APBD'18 1,214 2,000 3,214 1,847 205 1,000 367 1,367
189 Salbutamol tablet 4 mg ( sebagai sulfat ) tablet 26.1 0 0 0 0 0 0 0 0
191 Salisil Bedak 2 % kotak 18.8 0 0 0 0 0 0 0 0
192 Scabicid Cream tube 10 gram tube 0 0 0 0 0 0 0 0
193 Sefadroksil kapsul 500 mg kapsul 0 0 0 0 0 0 0 0
194 Sefadroksil sirup kering 125 mg/ 5 ml botol 0 0 0 0 0 0 0 0
195 Sefiksim kapsul 100 mg kapsul 0 0 0 0 0 0 0 0
196 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) vial 0 0 0 0 0 0 0 0
197 Serum Anti Difteri 20.000 SI/vial (A.D.S.) ampul 0 0 0 0 0 0 0 0
198 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) ampul 0 0 0 0 0 0 0 0
199 Sianokobalamin (Vit.B12) injeksi 500 mcg - ml ampul 10.1 0 0 0 0 0 0 0 0
200 Simetidin tablet 200 mg tablet 0 0 0 0 0 0 0 0
201 Simvastatin tablet 10 mg tablet 0 0 0 0 0 0 0 0
202 Siprofloksasin tablet 500 mg (sebagai HCl) tablet 0 0 0 0 0 0 0 0
203 Sulfadimidin tablet 500 mg tablet 0 0 0 0 0 0 0 0
204 Sulfasetamida Natrium tetes mata 15 % botol 0 0 0 0 0 0 0 0
205 Tetrasiklin kapsul 250 mg kapsul 21.2 0 0 0 0 0 0 0 0
206 Tetrasiklin kapsul 500 mg kapsul 21.2 0 0 0 0 0 0 0 0
207 Tiamfenikol kapsul 500 mg kapsul 0 0 0 0 0 0 0 0
208 Tiamin (Viamin B1) tablet 50 mg (HCl / Mononitrat ) tablet 29 0 0 0 0 0 0 0 0
209 Tiamin (Vit B1) tablet 100 mg tablet 29 0 0 0 0 0 0 0 0
210 Tiamin (Vitamin B1) injeksi 100 mg/ml-1 ml ampul 29 0 0 0 0 0 0 0 0
211 Triamcinolone acetate krim tube 0 0 0 0 0 0 0 0
212 Trifluoperazine tablet 5 mg tablet 0 0 0 0 0 0 0 0
213 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 APBD II '20 1,340 1,000 2,340 1,655 184 685 0 685
214 Vitamin B Kompleks tablet tablet 29 APBD II '20 8,776 16,000 24,776 24,776 2,753 0 0 0
215 Zinc sirup 10 mg/ml botol 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
PERBEKALAN KESEHATAN 0 0 0 0 0 0 0 0
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Pkm
263 Alat suntik sekali pakai 0,5 ml One Ject - COVID biji APBD II '21 0 6,400 6,400 0 0 6,400 0 6,400 0
263 Alat suntik sekali pakai 0,5 ml Top Point - COVID biji APBD II '21 0 5,500 5,500 500 56 5,000 0 5,000 1,500
217 Alat suntik sekali pakai 1 ml set 32 0 0 0 0 0 0 0 0
218 Alat suntik sekali pakai 3 ml set 32 APBD II '20 3,000 0 3,000 0 0 3,000 0 3,000
264 Alkohol Swabs (AC Swabs) 2% * biji APBD II '21 0 6,000 6,000 3,600 400 2,400 0 2,400 10,800
223 Blue Tip / MT II 0 1,000 1,000 0 0 0 1,000 1,000
DAK NON
FISIK 2021
Gown biji / BOK 0 35 35 0 0 35 0 35
DAK NON
FISIK 2021
Hazmat biji / BOK 0 35 35 0 0 35 0 35
DAK NON
FISIK 2021
Handsanitiser botol / BOK 0 8 8 0 0 8 0 8
230 Hansaplast biji 0 0 0 0 0 0 0 0
231 Hands shoen non steril No. 7 biji 0 0 0 0 0 0 0 0
232 Hands shoen steril No. 7 pasang 0 0 0 0 0 0 0 0
239 Jarum jahit bedah No. 9 s/d 14 biji 0 0 0 0 0 0 0 0
240 Kapas Berlemak 500 gram bungkus 0 0 0 0 0 0 0 0
242 Kasa Kompres 40/40 steril bungkus 0 0 0 0 0 0 0 0
244 Kasa pembalut 40 x 80 cm rol 0 0 0 0 0 0 0 0
247 KI 5 ml set 0 0 0 0 0 0 0 0
248 Kasa Pembalut Hidrofil 4 m x 3 cm hidrofil/elastic rol 0 0 0 0 0 0 0 0
251 Maag Slang No. 16 biji 0 0 0 0 0 0 0 0
252 Maag Slang No. 18 biji 0 0 0 0 0 0 0 0
253 Masker biji 0 0 0 0 0 0 0 0
DAK NON
FISIK 2021
Masker N95 biji / BOK 0 120 120 0 0 120 0 120
DAK NON
FISIK 2021
Masker Bedah biji / BOK 0 1,000 1,000 0 0 1,000 0 1,000
254 Normject 2 ml set 0 0 0 0 0 0 0 0
255 Normject 5 ml set 0 0 0 0 0 0 0 0
257 Silk biji APBD I '20 10 0 10 0 0 0 10 10
258 Safety Box 2,5 L lembar 0 0 0 0 0 0 0 0
Stok
Pkm
259 Safety Box 5 L lembar 0 0 0 0 0 0 0 0

260 Urine bag steril 2 LT biji 0 0 0 0 0 0 0 0
261 Under Pad biji 0 0 0 0 0 0 0 0
262 Yellow tip / MT I set APBD II '20 790 1,000 1,790 790 88 0 1,000 1,000
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 #REF! #REF! #REF! #REF! 0 0 0
REAGEN LABORATORIUM 0 0 0 0 0 0 0 0
263 EDTA Powder botol 31 0 0 0 0 0 0 0 0
264 KOH 10 % botol 31 0 0 0 0 0 0 0 0
265 Larutan Asam asetat 6% botol 31 0 0 0 0 0 0 0 0
266 Larutan Asam Klorida 0,1 N botol 31 0 0 0 0 0 0 0 0
267 Larutan Asam Klorida 2 % botol 31 0 0 0 0 0 0 0 0
268 Larutan Asam sulfosalisilat botol 31 0 0 0 0 0 0 0 0
269 Larutan Ba Cl2 botol 31 0 0 0 0 0 0 0 0
270 Larutan Benedict botol 31 0 0 0 0 0 0 0 0
271 Larutan Eosin 2% botol 31 0 0 0 0 0 0 0 0
272 Larutan Ether Alkohol botol 31 0 0 0 0 0 0 0 0
273 Larutan Faucheet botol 31 0 0 0 0 0 0 0 0
274 Larutan Giemsa Stain botol 0 0 0 0 0 0 0 0
275 Larutan HCl-alkohol /Lart. Etanol asam botol 0 0 0 0 0 0 0 0
276 Larutan Karbol Fuksin botol 0 0 0 0 0 0 0 0
277 Larutan Metilen Biru botol 0 0 0 0 0 0 0 0
278 Larutan Rees Ecker botol 0 0 0 0 0 0 0 0
279 Larutan Shlessinger botol 0 0 0 0 0 0 0 0
280 Larutan Turk botol 0 0 0 0 0 0 0 0
281 Metanol botol 0 0 0 0 0 0 0 0
282 Oil imersion botol 0 0 0 0 0 0 0 0
283 Reagen Asam Urat set 0 0 0 0 0 0 0 0
284 Reagen Golongan Darah Antigen A set 0 0 0 0 0 0 0 0
285 Reagen Golongan Darah Antigen B set 0 0 0 0 0 0 0 0
286 Reagen Gula Darah set 0 0 0 0 0 0 0 0
287 Reagen Kolesterol set 0 0 0 0 0 0 0 0
288 Reagen Urin Stik 10 Parameter set 0 0 0 0 0 0 0 0
289 Reagen Widal (AO, BO,H,O) set 0 0 0 0 0 0 0 0
290 Xylol botol 0 0 0 0 0 0 0 0
292 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0 0 0 0 0
294 Reagen HIV R1 (SD) APBN'20 425 600 1,025 702 78 300 23 323
295 Reagen HIV R2 0 0 0 0 0 0 0 0
296 Reagen HIV R3 0 0 0 0 0 0 0 0
297 Reagen Sypilis 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0 0 0
298 Dentorit botol 14.1 0 0 0 0 0 0 0 0
299 Etil Klorida spray botol 14.1 0 2 2 0 0 2 0 2
301 Fluor tablet 0,5 mg tablet 14.1 0 0 0 0 0 0 0 0
303 Kalsium Hidroksida Pasta set 14.1 0 0 0 0 0 0 0 0
305 Mummifying Pasta botol 0 0 0 0 0 0 0 0
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306 Povidon Iodine obat kumur botol 0 0 0 0 0 0 0 0

307 Semen Seng Fosfat serbuk dan cairan botol 0 0 0 0 0 0 0 0
308 Silver Amalgam serbuk 65 - 75 % botol 0 0 0 0 0 0 0 0
309 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan botol 0 0 0 0 0 0 0 0
310 Tri Kresol Formalin botol 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
OBAT PROGRAM 0 0 0 0 0 0 0 0
Flu Burung : 0 0 0 0 0 0 0 0
311 Oseltamivir kapsul 75 mg kapsul 0 0 0 0 0 0 0 0
Gizi : 0 0 0 0 0 0 0 0
312 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul APBD II 20 400 800 1,200 1,008 112 192 0 192
313 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul PROG'19 3,548 4,850 8,398 6,917 769 1,481 0 1,481
314 Tablet Tambah Darah ( TTD ) tablet APBD II 20 74,949 78,400 153,349 69,459 7,718 0 83,890 83,890
315 Yodiol kapsul 0 0 0 0 0 0 0 0
Anti Lepra : 0 0 0 0 0 0 0 0
316 MB Anak blister 0 0 0 0 0 0 0 0
318 PB Anak blister 0 0 0 0 0 0 0 0
319 PB Dewasa blister 0 0 0 0 0 0 0 0
Anti Malaria : 0 0 0 0 0 0 0 0
320 ACT ( Artesunate + Amodiaquin ) Arsuamoon tablet 0 0 0 0 0 0 0 0
321 ACT ( Dehidro Artemisin + Piperaquin ) Arterakine tablet 0 0 0 0 0 0 0 0
322 Artemeter inj. 80 mg/ml ampul 0 0 0 0 0 0 0 0
323 Artesunate inj. kotak 0 0 0 0 0 0 0 0
324 Doksisiklin kapsul 100 mg kapsul 0 0 0 0 0 0 0 0
325 Kina dihidroklorida inj. 25 %-2ml ampul 0 0 0 0 0 0 0 0
326 Kina tablet 200 mg tablet 0 0 0 0 0 0 0 0
327 Primakuin tablet 15 mg tablet 0 0 0 0 0 0 0 0
Anti TBC : 0 0 0 0 0 0 0 0
328 Ethambutol tablet 400 mg tablet 0 0 0 0 0 0 0 0
329 Ethambutol tablet 500 mg tablet 0 0 0 0 0 0 0 0
331 FDC kit II paket 0 1 1 1 0 0 0 0
332 INH 100 mg tablet 0 0 0 0 0 0 0 0
333 OAT Anak paket 0 0 0 0 0 0 0 0
334 OAT Kategori I paket 0 0 0 0 0 0 0 0
335 OAT Kategori II paket 0 0 0 0 0 0 0 0
336 OAT Kategori III paket 0 0 0 0 0 0 0 0
337 OAT Sisipan paket 0 0 0 0 0 0 0 0
338 Cartridge TCM tablet 0 0 0 0 0 0 0 0
Imunisasi : 0 0 0 0 0 0 0 0
339 Vaksin BCG bayi vial 0 0 0 0 0 0 0 0
340 Vaksin Campak vial 0 0 0 0 0 0 0 0
341 HB Uniject 0,5 ml ampul 0 0 0 0 0 0 0 0
KIA : 0 0 0 0 0 0 0 0
342 Kondom set 0 0 0 0 0 0 0 0
343 IUD botol 0 0 0 0 0 0 0 0
344 Urine Rapid Test pak 0 0 0 0 0 0 0 0
345 Progesteron Depo inj ( 3 bulan ) vial 0 0 0 0 0 0 0 0
346 Spuit KB bj 0 0 0 0 0 0 0 0
347 Metronidazole 500 mg inj vial 0 0 0 0 0 0 0 0
348 Calcium Gluconas inj ampul 0 0 0 0 0 0 0 0
349 Catgut Chromic 1/0 set 0 0 0 0 0 0 0 0
350 Kantung Urine Dewasa set 0 0 0 0 0 0 0 0
351 Rapid Test Siphilis set 0 0 0 0 0 0 0 0
352 Urine Strip set 0 0 0 0 0 0 0 0
353 Implant KB / Levonogestrel 75 mg set 0 0 0 0 0 0 0 0
Stok
Pkm
354 Transfusion Set set 0 0 0 0 0 0 0 0

355 Pil Kontrasepsi ( Microdiol ) strip 0 0 0 0 0 0 0 0
ANTI RETROVIRAL: 0 0 0 0 0 0 0 0
356 Nevirapine (NVP) 200 mg set 0 0 0 0 0 0 0 0
357 Efaviren 600mg set 0 0 0 0 0 0 0 0
358 Lamivudine (3TC) 150 mg set 0 0 0 0 0 0 0 0
359 Zidofudine (ZDV) 300 mg + Lamivudine (3TC) 150 mg set 0 0 0 0 0 0 0 0
360 Tenofovir 300 mg (TDF) set 0 0 0 0 0 0 0 0
361 Tenovofir 300 mg (TDF) + Lamivudin 300 mg (3TC)+ Efavirennz 600 mg set 0 0 0 0 0 0 0 0
362 Dolutegravir 50 mg set 0 0 0 0 0 0 0 0
363 Tenovovir 300 mg (TDF) + Lamivudin 300 mg (3TC) + Dolutegravir 50 mg (DTG) set 0 0 0 0 0 0 0 0
364 INH 300 mg tab 0 0 0 0 0 0 0 0
UMUM JKN JML

0 0 0
Jombang, 25 September 2021


NIP. 196812132005012011 NIP.199012132020122007

3.10 Ep 2 LPDP

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LAPORAN PENERIMAAN DAN LEMBAR PERMINTAAN OBAT

Kode Puskesmas : P3517130201 Bulan : Januari

35 Asam Traneksamat kapsul 500 mg kapsul 0 0 0 0 0 0

81 Fluphenazin Decanoate 25mg/ml (Sikzonoate Inj) ampul 0 0 0 0 0 0 0

248 Kasa Pembalut Hidrofil 4 m x 3 cm hidrofil/elastic rol 0 0 0 0 0 0 0

283 Reagen Asam Urat set 0 0 0 0 0 0 0

318 PB Anak blister 0 0 0 0 0 0 0

359 Zidofudine (ZDV) 300 mg + Lamivudine (3TC) 150 mg set 0 0 0 0 0 0 0

UMUM JKN JML

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Februari

174 Piroksikam tablet 20 mg tablet 0 0 0 0 0 0 0

250 Kasa Steril 16 x 16 cm rol APBD '16 16 16 2 1 0 14 14 6

285 Reagen Golongan Darah Antigen B set 0 0 0 0 0 0 0

UMUM JKN JML

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Maret

Pemakaia Stok Stok

82 Furosemid tablet 40 mg tablet 14 APBD '17 0 0 0 410 0 0 0

172 Piroksikam tablet 20 mg tablet 0 0 0 0 0 0 0

250 Kasa Steril 16 x 16 cm rol APBD '16 14 14 0 1 0 14 14 0

285 Reagen Golongan Darah Antigen B set 0 0 0 0 0 0 0

UMUM JKN JML

Jombang, 25 Maret 2021

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : April

Pemakai Stok Stok

UMUM JKN JML

Jombang, 24 April 2021

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Mei

Pemakai Stok Stok

42 Betahistin Mesilat tablet 6 mg tablet 0 0 0 0 0 0 0

95 Haldol Decanoat 50 mg/ml inj ampul APBD II '20 5 5 0 0 5 0 5 0

146 Metoklopramide tablet 10 mg tablet 0 0 0 0 0 0 0

199 Sianokobalamin (Vit.B12) injeksi 500 mcg - ml ampul 10.1 0 0 0 0 0 0 0

237 IV Catether No. 22 set APBD II '20 5 5 0 0 0 5 5 0

279 Larutan Shlessinger botol 0 0 0 0 0 0 0

320 ACT ( Artesunate + Amodiaquin ) Arsuamoon tablet 0 0 0 0 0 0 0

UMUM JKN JML

Jombang, 25 Mei 2021

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Juni

41 Benzatin Bensil Penisillin 2,4 juta IU/Vial vial 6.2.1 0 0 0 0 0 0 0

92 Gliserin 100 ml botol 20.2 0 0 0 0 0 0 0

141 Metamizole inj 1 gr / 2 ml vial 0 0 0 0 0 0 0

192 Scabicid Cream tube 10 gram tube 0 0 0 0 0 0 0

268 Larutan Asam sulfosalisilat botol 31 0 0 0 0 0 0 0

355 Pil Kontrasepsi ( Microdiol ) strip 0 0 0 0 0 0 0

UMUM JKN JML

Jombang, 25 Mei 2021

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Juli

44 Bisacodyl suppositoria 10 mg dewasa suppo 0 0 0 0 0 0 0

152 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0 0 0 0

207 Tiamfenikol kapsul 500 mg kapsul 0 0 0 0 0 0 0

333 OAT Anak paket 0 0 0 0 0 0 0

UMUM JKN JML

Jombang, 24 Juli 2021

drg. Dyah Suharti apt. Erni Nur Widyastuti, S.Farm.

Kode Puskesmas : P3517130201 Bulan : Agustus

39 Atropin Sulfat tablet 0,5 mg tablet 25.4 0 0 0 0 0 0 0