1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. SISA STOK PER 31 DESEMBER 2021 ADALAH SISA STOK PER 31 DESEMBER 2021 DI SATUAN KERJA
3. PREDIKSI PENGADAAN TAHUN 2022 ADALAH PREDIKSI JUMLAH YANG DIRENCANAKAN UNTUK DIADAKAN TAHUN 2022
4. PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 ADALAH PEMAKAIAN RATA-RATA PER BULAN DI SATKER SELAMA TAHUN 2021
5. PREDIKSI SISA STOK 31 DESEMBER 2022 ADALAH SISA STOK PER 31 DESEMBER 2021 DITAMBAH PREDIKSI PENGADAAN TAHUN 2022 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2021)
6. JUMLAH KEBUTUHAN TAHUN 2023 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
7. RENCANA KEBUTUHAN TAHUN 2023 ADALAH JUMLAH KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2022
8. RENCANA PENGADAAN TAHUN 2023 ADALAH RENCANA UNTUK PENGADAAN DI TAHUN 2023 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
9. RENCANA PENGADAAN TAHUN 2022 ADALAH OTOMATIS TERISI DARI SISTEM JIKA SATKER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2022
10. REALISASI PENGADAAN TAHUN 2021 ADALAH REALISASI PENGADAAN OBAT JKN BAIK E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2021

RENCANA KEBUTUHAN OBAT PADA (FKTP) TAHUN 2023

SATUAN KERJA : PUSKESMAS SUNGAI DURI

PREDIKSI PEMAKAIAN PREDIKSI SISA JUMLAH RENCANA RENCANA RENCANA REALISASI

NO NAMA OBAT SATUAN SISA STOK PER 31 PENGADAAN RATA-RATA PER STOK 31 KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN PENGADAAN KETERANGAN
DESEMBER 2022 TAHUN 2022 BULAN SELAMA DESEMBER 2022 TAHUN 2022 TAHUN 2023 TAHUN 2023 TAHUN 2023 TAHUN 2023
2022

(d) = (a)+(b)-
(a) (b) (c) (e) = (c) x 18 (f) = (e) - (d) (g) (h) (i) (j)
(12x(c))
1 Abacavir 300 mg Tablet/kaplet/kapsul 0 0 0 0 0 0 0 0 0
2 Acetil Sistein Kapsul 0 0 0 0 200 200 3600 0 0
3 Air untuk injeksi Botol 250 ml 0 0 0 0 0 0 20 0 0
4 Air untuk injeksi ampul/vial/botol 10 mL 0 0 0 0 0 0 20 0 0
5 Air untuk injeksi Botol 100 ml 0 0 0 0 0 0 20 0 0
6 Air untuk injeksi amp 20 ml ampul/vial/botol 0 0 0 0 0 0 20 0 0
7 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 10 20 0 0 200 200 80 0 0
8 Albendazol susp 200 mg/5 ml Botol 0 0 0 0 0 0 0 0 0
9 Albendazol tab 400 mg tablet/kapsul/kaplet 160 0 0 100 7000 6900 200 0 0
10 Alcohol Swab Box 0 0 0 0 0 0 200 0 0
11 Alopurinol tab 100 mg Tab 0 1000 0 1000 0 -1000 10000 0 0
12 Alopurinol tab 300 mg tablet/kapsul/kaplet 0 1200 0 1200 0 -1200 4500 0 0
13 Ambroxol 150mg Tab 0 1000 0 1000 0 -1000 6500 0 0
14 Ambroxol Syr Btl 0 0 0 0 0 0 450 0 0
15 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0 0 0 0 0 0 0 0 0
16 Aminofilin tab 150 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
17 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
18 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 126 0 0 126 0 -126 900 0 0
19 Amlodipin tab 10 mg tablet/kapsul/kaplet 8170 1000 0 9170 0 -9170 9000 0 0
20 Amlodipin tab 5 mg tablet/kapsul/kaplet 0 1000 0 1000 0 -1000 11000 0 0
21 Amoksisilin drops 100 mg/ml Botol @20 ml 0 0 0 0 0 0 120 0 0
22 Amoksisilin sir forte 250 mg/5 botol 60 ml 0 0 0 0 0 0 250 0 0
ml
23 Amoksisilin sir kering 125 mg/5 Botol 20 0 0 20 0 -20 550 0 0
ml
24 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
25 Amoksisilin tab 500 mg tablet/kapsul/kaplet 700 2500 0 3200 0 -3200 36000 0 0
26 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0 0 0 0 0 40 0 0
27 Ampisilin serb inj 250 mg/vial Vial 0 0 0 0 0 0 40 0 0
28 Anestesi Gigi Pcs 0 0 0 0 0 0 90 0 0
Antasida, kombinasi :
aluminium hidroksida 200 mg
29 tablet/kapsul/kaplet 2400 5000 0 7400 0 -7400 45000 0 0
+ magnesium hidroksida 200
mg

Antasida, kombinasi :
aluminium hidroksida 200 mg
30 botol 60 ml 185 100 0 285 0 -285 1100 0 0
+ magnesium hidroksida 200
mg

Antifungi salep, kombinasi :

31 asam benzoat 6%+ asam pot 30 g 0 0 0 0 0 0 220 0 0
salisilat 3%

Antihemoroid, kombinasi:
bismut subgalat 150 mg +
32 heksaklorofen 2,5 mg + Suppositoria 25 0 0 25 0 -25 450 0 0
lidokain lidokain 10 mg+ seng
oksida 120 mg + sup ad 2 g
33 Antiseptic Gel 1000mL Botol 0 0 0 0 0 0 40 0 0
34 APD Anti Air Pcs 0 0 0 0 0 0 20 0 0
35 Articulating Paper Pcs 0 0 0 0 0 0 20 0 0
Asam asetilsalisilat (asetosal)
36 tab 80 mg tablet/kapsul/kaplet 0 2000 0 2000 0 -2000 5500 0 0

Asam askorbat (vitamin C) tab

37 250 mg Tab 0 0 0 0 0 0 9000 0 0

Asam askorbat (vitamin C) tab

38 50 mg tablet/kapsul/kaplet 0 0 0 0 0 0 9000 0 0
39 Asam folat tab 0,4 mg tablet/kapsul/kaplet 400 500 0 900 0 -900 2000 0 0
40 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0

tablet/kapsul/kaplet/
41 Asam mefenamat kaps 500 mg kaptab 23200 1000 0 24200 0 -24200 30000 0 0
42 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 500 0 500 0 -500 2000 0 0
43 Asiklovir tab 400 mg tablet/kapsul/kaplet 850 0 0 850 0 -850 2000 0 0
44 Atapulgit 600 mg tablet/kapsul/kaplet 0 0 0 0 0 0 2000 0 0
45 Atapulgit tablet 650 mg tablet/kapsul/kaplet 0 500 0 500 0 -500 2000 0 0
46 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
47 Atenolol tab 50 mg tablet/kapsul/kaplet 500 1500 0 2000 0 -2000 1000 0 0
Atropin inj 0,25 mg/ml
48 (i.m./i.v./s.k) Ampul 0 0 0 0 0 0 200 0 0
49 Bahan Tambahan Gigi Set 0 0 0 0 0 0 20 0 0
50 Bedak salisil serb 2% Dus/Sachet/Plastik 0 0 0 0 0 0 220 0 0
51 Betahistin Besilate 6mg Tablet 0 0 0 0 0 0 1800 0 0
52 Betametason krim 0,1% tube 5 gram 0 20 0 20 0 -20 450 0 0
53 Betametason krim 0,5 mg/g Tube 5 10 0 15 0 -15 450 0 0
54 Betametason salep 0,1% tube 5 gram 0 0 0 0 0 0 450 0 0
55 Bisakodil sup 10 mg Suppositoria 0 0 0 0 0 0 200 0 0
56 Bisakodil sup 5 mg Suppositoria 50 0 0 50 0 -50 200 0 0
57 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0 200 0 0
58 Bisoprolol 1,25mg Tablet 0 0 0 0 0 0 1800 0 0
59 Bisoprolol 10mg Tablet 0 0 0 0 0 0 4500 0 0
60 Bisoprolol 2,5mg Tablet 0 0 0 0 0 0 5500 0 0
61 Bisoprolol 5mg Tablet 0 0 0 0 0 0 5500 0 0
62 Blood Lancet Box 0 0 0 0 0 0 250 0 0
63 Bone Wax Pcs 0 0 0 0 0 0 20 0 0
64 Bromheksin Tablet 0 0 0 0 0 0 4000 0 0
65 Calsium Hidroksida Pcs 0 0 0 0 0 0 20 0 0
66 Candesartan 16mg Tablet 0 0 0 0 0 0 4000 0 0
67 Candesartan 8mg Tablet 0 0 0 0 0 0 4000 0 0
68 Cat Gut Plain 2/0 Pcs 0 0 0 0 0 0 900 0 0
69 Cat Gut Plain 3/0 Pcs 0 0 0 0 0 0 900 0 0
70 Celluloid Strip Pcs 0 0 0 0 0 0 20 0 0
71 Citoject Unit 0 0 0 0 0 0 2 0 0
72 Cotoon Roll Pcs 0 0 0 0 0 0 20 0 0
Deksametason inj 5 mg/ml
73 ampul/vial 0 0 0 0 0 0 900 0 0
(i.v./i.m.)
74 Deksametason tab 0,5 mg tablet/kapsul/kaplet 60 15000 0 15060 0 -15060 54000 0 0
75 Dental Instrument Set Unit 0 0 0 0 0 0 2 0 0
76 Dentin Conditioner PCs 0 0 0 0 0 0 2 0 0
77 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 5 0 0 5 0 -5 200 0 0

78 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 8 10 0 18 0 -18 200 0 0

79 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 22 15 0 37 0 -37 100 0 0

80 Diazepam tab 2 mg tablet/kapsul/kaplet 0 0 0 0 0 0 400 0 0
81 Diazepam tab 5 mg tablet/kapsul/kaplet 145 50 0 195 0 -195 400 0 0
82 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
83 Difenhidramin inj 10 mg/ml ampul/vial 10 40 0 50 0 -50 1500 0 0
(i.v./i.m.)
84 Digoksin tab 0,25 mg tablet/kapsul/kaplet 700 3000 0 3700 0 -3700 4000 0 0
85 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 0 0 0 0 0 0 200 0 0
86 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 200 0 0 200 0 -200 900 0 0
87 Domperidon susp 5 mg/5 ml botol @60 ml 0 5 0 5 0 -5 200 0 0
88 Domperidon tab 10 mg tablet/kapsul/kaplet 230 600 0 830 0 -830 2000 0 0
89 Epinefrin (adrenalin) inj 1 Ampul 110 0 0 110 0 -110 200 0 0
mg/ml
90 Ergotamin tab 1 mg Tab 0 0 0 0 0 0 200 0 0
91 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0 0 0 0 0 100 0 0
92 Eritromisin tab 500 mg tablet/kapsul/kaplet 100 0 0 100 0 -100 400 0 0
93 Etanol 70% cairan Botol @ 300mL 0 0 0 0 0 0 100 0 0
94 Etanol 70% cairan Botol @ 1000mL 0 0 0 0 0 0 40 0 0
95 Etil klorida semprot 100 ml Botol 0 0 0 0 0 0 20 0 0
96 Eugenol Pcs 0 0 0 0 0 0 20 0 0
97 Fenitoin Na kaps 100 mg Kaps 0 0 0 0 0 0 900 0 0
Fitomenadion (vitamin K 1) inj
98 2 mg/ml (i.m.) ampul/vial 70 60 0 130 0 -130 800 0 0

Fitomenadion (vitamin K 1) tab

99 sal 10 mg Tab sal 200 100 0 300 0 -300 900 0 0
100 Foley Catheter No. 16 Pcs 0 0 0 0 0 0 550 0 0
101 Foley Catheter No. 18 Pcs 0 0 0 0 0 0 550 0 0
102 Framisetin Sulfat Tulle 1% Patch 0 0 0 0 0 0 100 0 0
Furosemid inj 10 mg/ml
103 ampul/vial 0 0 0 0 0 0 450 0 0
(i.v./i.m.)
104 Furosemid tab 40 mg tablet/kapsul/kaplet 0 0 0 0 0 0 3600 0 0
Garam oralit kombinasi :
natrium klorida 0,52 g + kalium
105 klorida 0,30 g + trinatrium sachet 1800 0 0 1800 0 -1800 1200 0 0
sitrat 0,58 g + glukosa anhidrat
2,7 g
106 Gentamisin salep mata 0,3% Tube 0 0 0 0 0 0 90 0 0
107 Gentamisin tts mata 0,3% Botol 30 5 0 35 0 -35 90 0 0
108 Glibenklamid tab 5 mg tablet/kapsul/kaplet 100 600 0 700 0 -700 5400 0 0
109 Glimepirid tab 1 mg tablet/kapsul/kaplet 100 0 0 100 0 -100 5400 0 0
110 Glimepirid tab 2 mg tablet/kapsul/kaplet 0 0 0 0 0 0 5400 0 0
111 Glukosa Larutan Infus 10% Botol 15 20 0 35 0 -35 200 0 0
steril 500 ml
112 Glukosa Larutan Infus 40% Ampul @25 ml 0 0 0 0 0 0 200 0 0
Glukosa Larutan Infus 5% steril
113 250 ml Botol 0 0 0 0 0 0 1800 0 0

Glukosa Larutan Infus 5% steril

114 500 ml Botol 200 0 200 0 -200 1800 0 0

Griseofulvin (micronized) tab

115 125 mg tablet/kapsul/kaplet 0 0 0 0 0 0 900 0 0

Griseofulvin (micronized) tab

116 scored 250 mg tablet/kapsul/kaplet 200 0 0 200 0 -200 900 0 0
117 Guaifenesin Tablet 0 0 0 0 0 0 9000 0 0
118 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0 0 0 0 0 180 0 0
119 Haloperidol tab 5 mg tablet/kapsul/kaplet 270 0 0 270 0 -270 450 0 0
120 Haloperidol tts 2 mg/ml botol 0 0 0 0 0 0 0 0 0
121 Hepatitis B imunoglobulin Ampul 2 0 0 2 0 -2 12 0 0
(human) inj 150 IU/1,5 ml
122 Hidrogen peroksida cairan 3% Botol 0 0 0 0 0 0 12 0 0
123 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 300 0 0 300 0 -300 900 0 0
124 Hidrokortison krim 2,5% tube @ 5 g 0 21 0 21 0 -21 500 0 0
125 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0 900 0 0

Human tetanus imunoglobulin

126 Ampul 3 4 0 7 0 -7 12 0 0
inj 250 UI (i.m.)

Human tetanus imunoglobulin

127 Ampul 0 0 0 0 0 0 12 0 0
inj 500 UI (i.m.)

128 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 46 0 0 46 0 -46 450 0 0

129 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 5 0 5 0 -5 450 0 0
130 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0 4500 0 0
131 Ibuprofen tab 400 mg tablet/kapsul/kaplet 500 3000 0 3500 0 -3500 4000 0 0
132 Infuset Anak Pcs 0 0 0 0 0 0 1000 0 0
133 Infuset Dewasa Pcs 0 0 0 0 0 0 1000 0 0
Ipratropium bromida aerosol
134 Botol 0 0 0 0 0 0 90 0 0
20 mcg/semprot
135 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 1000 100 0 1100 0 -1100 1500 0 0
136 IV Cath Wing Anak Pcs 0 0 0 0 0 0 40 0 0
137 IV Catheter No 18 Pcs 0 0 0 0 0 0 1800 0 0
138 IV Catheter No 20 Pcs 0 0 0 0 0 0 1800 0 0
139 IV Catheter No 22 Pcs 0 0 0 0 0 0 1800 0 0
140 IV Catheter No 24 Pcs 0 0 0 0 0 0 1800 0 0
141 Jarum Citoject Box 0 0 0 0 0 0 90 0 0
142 Jarum Hecting No 70 (Besar) Pcs 0 0 0 0 0 0 200 0 0
143 Kalsium glukonat inj 100 mg/ml ampul/vial 15 0 0 15 0 -15 100 0 0
144 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0 200 0 0
145 Kalsium laktat (kalk) tab 500 tablet/kapsul/kaplet 0 0 0 0 0 0 12600 0 0
mg
146 Kapas Ball @ 1 Kg 0 0 0 0 0 0 20 0 0
147 Kaptopril tab 12,5 mg tablet/kaplet 500 2800 0 3300 0 -3300 9000 0 0
148 Kaptopril tab 25 mg tablet/kaplet 0 0 0 0 0 0 4500 0 0
149 Kaptopril tab 50 mg tablet/kaplet 0 800 0 800 0 -800 4500 0 0
150 Karbamazepin Tab 200 mg Tablet 150 920 0 1070 0 -1070 2800 0 0
151 Kasa Gulung 10cm Roll 0 0 0 0 0 0 360 0 0
152 Kasa Gulung 80 cm Roll 0 0 0 0 0 0 150 0 0
153 Kasa Steril Box 0 0 0 0 0 0 1800 0 0
154 Ketokonazol tab 200 mg tablet/kapsul/kaplet 100 2100 0 2200 0 -2200 3600 0 0
155 Ketorolac Inj Ampul 0 0 0 0 0 0 2700 0 0
156 Klindamisin kaps 150 mg Kaps 0 500 0 500 0 -500 400 0 0
157 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 0 0 0 0 0 1100 0 0
158 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0 550 0 0
159 Kloramfenikol salep 2% tube 15g 0 0 0 0 0 0 300 0 0
160 Kloramfenikol salep mata 1% tube @ 5 gram 9 14 0 23 0 -23 300 0 0
Kloramfenikol susp 125 mg/5
161 botol 60 ml 0 0 0 0 0 0 100 0 0
ml

162 Kloramfenikol tetes telinga 3% Botol 0 0 0 0 0 0 300 0 0

163 Kloramfenikol tts mata 0,5% botol 14 0 0 14 0 -14 300 0 0
164 Kloramfenikol tts mata 1% Botol 0 0 0 0 0 0 300 0 0
165 Klorheksidin lar 0,2% Botol 0 0 0 0 0 0 15 0 0
166 Klorheksidin lar 15% Botol 0 0 0 0 0 0 15 0 0
tablet salut
167 Klorpromazin tab sal 100 mg selaput/kaplet salut 200 0 0 200 0 -200 300 0 0
selaput
168 Klozapin tab 100 mg tablet 0 0 0 0 0 0 300 0 0
169 Klozapin tab 25 mg tablet 0 0 0 0 0 0 300 0 0
Kombinasi : B1 + B2 + B12
170 5000mcg Ampul 0 0 0 0 0 0 500 0 0

Kombinasi : ergotamin 1 mg+

171 kafein 50 mg tablet/kapsul/kaplet 600 0 0 600 0 -600 300 0 0

Kombinasi : Ferro fumarat 60

172 mg + asam folat 0,4 mg tab tablet salut gula 3600 1050 0 4650 0 -4650 18000 0 0
salut
Kombinasi: Ipratropium
173 bromida 0,5 mg + Salbutamol Ampul/vial 0 0 0 0 0 0 40 0 0
2,5 mg, cairan ih
Kombinasi: kaolin 550 mg +
174 pektin 20 mg Tab 0 0 0 0 0 0 1800 0 0

Komibinasi: lidokain +
medisinal creosote phenol +
175 Botol 0 0 0 0 0 0 40 0 0
eugenol + benzil alkohol,
cairan
176 Komposit Flowable Set 0 0 0 0 0 0 12 0 0
177 Komposit resin A2 Set 0 0 0 0 0 0 12 0 0
178 Komposit resin A3 Set 0 0 0 0 0 0 12 0 0
Kotrimoksazol (dewasa)
179 kombinasi : sulfametoksazol tab/kaptab 0 0 0 0 0 0 900 0 0
400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa)
180 kombinasi : sulfametoksazol tab/kaptab 1100 1000 0 2100 0 -2100 900 0 0
800 mg+ trimetoprim 160 mg

Kotrimoksazol kombinasi tiap 5

181 ml suspensi : sulfametoksazol botol 60 mL 50 0 0 50 0 -50 240 0 0
200 mg + trimetoprim 40 mg

182 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 10 0 0 10 0 -10 100 0 0

183 Lidokain gel 2% syringe/syringe plastik 0 0 0 0 0 0 15 0 0
184 Lidokain inj 2% (infiltr/p.v.) ampul/vial 20 10 0 30 0 -30 900 0 0
185 Lidokain salep 5% Tube 0 0 0 0 0 0 15 0 0
186 Lidokain spray oral 10% botol 0 0 0 0 0 0 15 0 0
187 Light Cure Unit 0 0 0 0 0 0 1 0 0
188 Loperamid tab 2 mg Tab 0 0 0 0 0 0 900 0 0
189 Loratadin tab 10 mg tablet/kapsul/kaplet 1100 1500 0 2600 0 -2600 6300 0 0
190 Mag slang Pcs 0 0 0 0 0 0 150 0 0
191 Magnesium sulfat inj 20% ampul/vial @25 ml 5 0 0 5 0 -5 90 0 0
192 Magnesium sulfat inj 20% ampul/vial 0 0 0 0 0 0 90 0 0
193 Magnesium sulfat inj 40% ampul/vial 0 0 0 0 0 0 90 0 0
194 Magnesium sulfat inj 40% ampul/vial @25 ml 0 0 0 0 0 0 90 0 0
Magnesium sulfat serb, ktg 30
195 g Sachet 0 0 0 0 0 0 90 0 0
196 Manitol lar infus 20% Botol @ 250 ml 0 0 0 0 0 0 90 0 0
197 Manitol lar infus 20% Botol @ 100 ml 0 0 0 0 0 0 90 0 0
198 Manitol lar infus 20% Botol @ 500 ml 0 0 0 0 0 0 90 0 0
199 Masker Box @50 pcs 0 0 0 0 0 0 400 0 0
200 Mata bur poles komposit Unit 0 0 0 0 0 0 3 0 0
201 Mata bur preparasi Unit 0 0 0 0 0 0 3 0 0
202 Mebendazol sir 100 mg/5 ml Botol 0 0 0 0 0 0 220 0 0
203 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0 220 0 0
204 Mecobalamin Inj Amp 0 0 0 0 0 0 1800 0 0
205 Metformin tab 500 mg tablet/kapsul/kaplet 0 2000 0 2000 0 -2000 9000 0 0
206 Metformin tab 850 mg tablet/kapsul/kaplet 200 2000 0 2200 0 -2200 9000 0 0
207 Metilergometrin inj 0,2 mg/ml ampul/vial 3 0 0 3 0 -3 450 0 0

208 Metilergometrin tab salut tablet/kaplet salut 0 0 0 0 0 0 450 0 0

0,125 mg selaput
209 Metilprednisolon 4mg Tablet 0 0 0 0 0 0 21600 0 0
210 Metilprednisolon 8mg Tablet 0 0 0 0 0 0 9000 0 0
211 Metilprednisolon inj 125 mg/2 ampul/vial 0 0 0 0 0 0 450 0 0
ml
212 Metoklopramid inj 5 mg/ml ampul/vial 0 0 0 0 0 0 90 0 0
213 Metoklopramid tab 10 mg tablet/kapsul/kaplet 200 0 0 200 0 -200 540 0 0
214 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0 540 0 0
215 Metronidazol tab 500 mg tablet/kapsul/kaplet 600 0 0 600 0 -600 1800 0 0
216 Microbrush Pcs 0 0 0 0 0 0 15 0 0
217 Mikonazol krim 2% tube 0 0 0 0 0 0 1080 0 0
218 Mikonazol serb 2% botol / sachet 7 0 0 7 0 -7 240 0 0
219 NaCl 0,9% Larutan Botol @500 ml 0 60 0 60 0 -60 9000 0 0
220 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 0 400 0 400 0 -400 1800 0 0
tablet salut
221 Natrium diklofenak tab 25 mg enterik/kaplet salut 300 3800 0 4100 0 -4100 18000 0 0
enterik
 tablet salut
222 Natrium diklofenak tab 50 mg enterik/kaplet salut 50 0 0 50 0 -50 18000 0 0
enterik
223 Nifedipin kaps 10 mg tablet/kapsul/kaplet 200 0 0 200 0 -200 1800 0 0
224 Nistatin susp 100.000 UI/ml botol/vial 10 0 0 10 0 -10 240 0 0
tablet salut gula/kaplet
225 Nistatin tab salut 500.000 UI 0 0 0 0 0 0 200 0 0
salut gula

226 Nistatin tab vaginal 100.000 UI tablet/kaplet 90 0 0 90 0 -90 500 0 0

Oksimetazolin tts hidung

227 botol @ 10 mL 0 0 0 0 0 0 100 0 0
0,025%
Oksimetazolin tts hidung
228 botol @ 10 mL 0 0 0 0 0 0 100 0 0
0,050%
229 Oksimeter Pcs 0 0 0 0 0 0 10 0 0
230 Oksitetrasiklin 1% Salep Mata tube 150 0 0 150 0 -150 1000 0 0
231 Oksitosin inj 10 UI/ml ampul/vial 100 100 0 200 0 -200 1500 0 0
232 Olopatadin tts mata 0,1% Botol 0 0 0 0 0 0 200 0 0
233 Omeprazol inj 40 mg/10 ml ampul/vial 110 0 0 110 0 -110 200 0 0
234 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 1800 0 1800 0 -1800 7200 0 0
235 Ondancentron Inj Amp 0 0 0 0 0 0 4500 0 0
236 Parasetamol sir 120 mg/5 ml botol @ 60 mL 35 35 0 70 0 -70 1000 0 0
237 Parasetamol Supp 125mg Tube 0 0 0 0 0 0 240 0 0
238 Parasetamol Supp 250mg Tube 0 0 0 0 0 0 240 0 0
239 Parasetamol tab 500 mg tablet/kapsul/kaplet 2000 5400 0 7400 0 -7400 22000 0 0
240 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 5 20 0 25 0 -25 240 0 0
241 Partus Set Set 0 0 0 0 0 0 1 0 0
242 Pehacain Inj Ampul 0 0 0 0 0 0 400 0 0
243 Pen Light Pcs 0 0 0 0 0 0 6 0 0
244 Penghisal Lendir Bayi Pcs 0 0 0 0 0 0 6 0 0
245 Perak sulfadiazin krim 1% Tube 16 0 0 16 0 -16 40 0 0
246 Permetrin krim 5 % Tube 30 g 0 0 0 0 0 0 100 0 0
247 Permetrin krim 5 % Tube 15 g 0 0 0 0 0 0 100 0 0
248 Permetrin krim 5 % Tube 10 g 70 0 0 70 0 -70 100 0 0
249 Piracetam Inj Ampul 0 0 0 0 0 0 60 0 0
250 Pirantel pamoat susp 125 mg/5 Botol 0 0 0 0 0 0 100 0 0
ml
251 Pirantel pamoat tab 500 mg Tab 0 0 0 0 0 0 400 0 0
Pirantel pamoat tab scored 125
252 tablet/kapsul/kaplet 400 100 0 500 0 -500 200 0 0
mg
Piridoksin (vitamin B6) tab 10
253 tab/kap/kapl 100 1400 0 1500 0 -1500 7200 0 0
mg
254 Plester Roll Roll 0 0 0 0 0 0 160 0 0
255 Povidon iodin lar 100 mg/ml botol 30 mL 0 0 0 0 0 0 360 0 0
256 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0 0 0 0 0 180 0 0
257 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0 0 0 0 0 90 0 0
258 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0 0 0 0 0 20 0 0
259 Prednison tab 5 mg tablet/kapsul/kaplet 500 0 0 500 0 -500 1800 0 0
260 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0 1800 0 0
261 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0 1800 0 0
262 Ranitidin Injeksi Ampul 0 0 0 0 0 0 3600 0 0
263 Ranitidin tab 150 mg tablet/kapsul/kaplet 200 1600 0 1800 0 -1800 18000 0 0
264 Rapid Test HBSAg Pcs 0 0 0 0 0 0 600 0 0
265 Rapid Test HIV Pcs 0 0 0 0 0 0 600 0 0
266 Rapid Test Malaria Pcs 0 0 0 0 0 0 600 0 0
267 Rapid Test Sifilis Pcs 0 0 0 0 0 0 600 0 0
268 Reagen Dietil Neelsen Btl 0 0 0 0 0 0 6 0 0
269 Reagen Giemsa 500mL Btl 0 0 0 0 0 0 1 0 0
270 Reagen Golongan Darah Pcs 0 0 0 0 0 0 6 0 0
271 Reagen HCl 0,1 N 500mL Pcs 0 0 0 0 0 0 1 0 0
272 Reagen Widal Pcs 0 0 0 0 0 0 3 0 0
Retinol (vitamin A) kaps lunak
273 100.000 UI kaps lunak 0 0 0 0 0 0 1800 0 0

Retinol (vitamin A) kaps lunak

274 200.000 UI kaps lunak 0 0 0 0 0 0 1800 0 0
275 Ringer Laktat Larutan Botol @ 500mL 0 70 0 70 0 -70 5400 0 0
276 Ringer Laktat Larutan Botol @ 100mL 0 0 0 0 0 0 900 0 0
277 Risperidon tab sal 1 mg tablet/kapsul/kaplet 0 0 0 0 0 0 900 0 0
278 Risperidon tab sal 2 mg tablet/kapsul/kaplet 80 0 0 80 0 -80 900 0 0
279 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0 0 0 0 0 0 900 0 0
280 Salbutamol tab 2 mg tablet/kapsul/kaplet 1000 0 0 1000 0 -1000 5400 0 0
281 Salbutamol tab 4 mg tablet/kapsul/kaplet 1000 0 0 1000 0 -1000 5400 0 0
Salep 2-4, kombinasi : asam
282 salisilat 2 %+ belerang endap 4 pot 15 gram 10 20 0 30 0 -30 240 0 0
%
Salep 2-4, kombinasi : asam
283 salisilat 2 %+ belerang endap 4 pot 30 gram 0 0 0 0 0 0 240 0 0
%
284 Salive Ejector PCs 0 0 0 0 0 0 12 0 0
285 Sarung tangan L Box 0 0 0 0 0 0 50 0 0
286 Sarung tangan M Box 0 0 0 0 0 0 180 0 0
287 Sarung tangan M Non Powder Box 0 0 0 0 0 0 40 0 0
288 Sarung Tangan Steril No. 7 Pcs 0 0 0 0 0 0 1400 0 0
289 Sarung Tangan Steril Panjang NoPcs 0 0 0 0 0 0 150 0 0
290 Sarung tangan XL Box 0 0 0 0 0 0 30 0 0
291 Scaller Electric Unit 0 0 0 0 0 0 1 0 0
292 Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0 0 0 0
293 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 1000 2700 0 3700 0 -3700 5300 0 0
Sefadroksil sir kering 125 mg/5
294 botol @ 60 mL 150 0 0 150 0 -150 210 0 0
ml
Sefadroksil sir kering 250 mg/5
295 botol @ 60 mL 0 0 0 0 0 0 210 0 0
ml
296 Selang O2 Anak Pcs 0 0 0 0 0 0 1000 0 0
297 Selang O2 Dewasa Pcs 0 0 0 0 0 0 1000 0 0
Serum anti bisa ular : A.B.U. I
298 (khusus ular dari luar Papua) Vial 0 0 0 0 0 0 12 0 0
inj (i.m./i.v.)
Serum anti bisa ular :A.B.U.II
299 (khusus ular dari Papua) inj Vial 0 0 0 0 0 0 12 0 0
(i.m./i.v.)
Serum antidifteri (A.D.S) inj
300 Vial 0 0 0 0 0 0 12 0 0
(i.m./i.v.) Inj i.m 10.000 UI/

301 Serum antirabies inj 100 UI/ml Vial 0 0 0 0 0 0 12 0 0

302 Serum antirabies inj 200 UI/ml Vial 0 0 0 0 0 0 12 0 0

Serum antitetanus (A.T.S) (i.m.)

303 Vial 0 0 0 0 0 0 12 0 0
Inj 10.000 UI/vial (i.m /i.v.)

Serum antitetanus (A.T.S) inj

304 Ampul 2 0 0 2 0 -2 12 0 0
1500 UI/amp (i.m.)
Serum antitetanus (A.T.S) inj
305 Vial 0 0 0 0 0 0 12 0 0
20.000 UI/vial (i.m /i.v.)
Serum antitetanus (A.T.S) inj
306 Ampul/vial 0 0 0 0 0 0 12 0 0
5.000 IU/mL (i.m)
307 Set Tang Cabut Gigi Anak Unit 0 0 0 0 0 0 1 0 0
308 Set Tang Cabut Gigi Dewasa Unit 0 0 0 0 0 0 1 0 0
309 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0 0 0 0 0 400 0 0
310 Setirizin Tablet Tabel 0 0 0 0 0 0 9000 0 0
Sianokobalamin (vitamin B12)
311 ampul/vial 0 0 0 0 0 0 90 0 0
inj 500 mcg/ml
Sianokobalamin (vitamin B12)
312 tablet/kapsul/kaplet 0 0 0 0 0 0 5400 0 0
tab 50 mcg
313 Silk 2/0 Pcs 0 0 0 0 0 0 630 0 0
314 Silk 3/0 Pcs 0 0 0 0 0 0 630 0 0
tablet/kapsul/kaplet/
tablet salut
315 Simvastatin tab sal 10 mg selaput/kaplet salut 0 1800 0 1800 0 -1800 9000 0 0
selaput

tablet/kapsul/kaplet/
tablet salut
316 Simvastatin tab sal 20 mg selaput/kaplet salut 4200 1400 0 5600 0 -5600 9000 0 0
selaput
Simvastatin tab sal selaput 40
317 Tab sal 0 0 0 0 0 0 3600 0 0
mg
tablet salut
Siprofloksasin tab scored 500
318 mg selaput/kaplet salut 1100 0 0 1100 0 -1100 3600 0 0
selaput
319 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0 0 0 0 0 900 0 0
320 Spuit 1cc Box 0 0 0 0 0 0 15 0 0
321 Spuit 3cc Box 0 0 0 0 0 0 15 0 0
322 Spuit 5 cc Box 0 0 0 0 0 0 15 0 0
323 Sputum Pot Pcs 0 0 0 0 0 0 1000 0 0
324 Stik Asam Urat Box 0 0 0 0 0 0 600 0 0
325 Stik Gula Darah Box 0 0 0 0 0 0 600 0 0
326 Stik Kolesterol Box 0 0 0 0 0 0 1200 0 0
Streptomisin serb inj 1.000
327 mg/vial ampul/vial 0 0 0 0 0 0 30 0 0
328 Tablet Tambah Darah Tablet 0 0 0 0 0 0 46800 0 0
329 Tensimeter Pcs 0 0 0 0 0 0 12 0 0
330 Terbutalin cairan ih 2,5 mg/ml Botol 0 0 0 0 0 0 12 0 0
331 Tetanus toxoid inj Ampul 0 0 0 0 0 0 12 0 0
332 Tetrakain tts mata 0,5% Botol 0 0 0 0 0 0 90 0 0
333 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0 900 0 0
334 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0 500 0 500 0 -500 900 0 0
335 Tetrasiklin Salep Mata 1% Tube 0 0 0 0 0 0 200 0 0
336 Thermometer Digital Pcs 0 0 0 0 0 0 12 0 0
337 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 100 2300 0 2400 0 -2400 9000 0 0
338 Timolol tts mata 0,25% botol @ 5 mL 0 0 0 0 0 0 100 0 0
339 Timolol tts mata 0,5% botol @ 5 mL 0 0 0 0 0 0 100 0 0
340 Tooth Mouse Pcs 0 0 0 0 0 0 12 0 0
341 Tooth Skin Remover Pcs 0 0 0 0 0 0 12 0 0
342 Traneksamat Inj Amp 0 0 0 0 0 0 400 0 0
343 Transfusion Set Pcs 0 0 0 0 0 0 500 0 0
344 Ultrasonic Gel Btol @ 500mL 0 0 0 0 0 0 2 0 0
345 Umbilicard Cord Pcs 0 0 0 0 0 0 500 0 0
346 Underpad Pcs 0 0 0 0 0 0 200 0 0
347 Urea krim 10 % Tube/pot 0 0 0 0 0 0 50 0 0
348 Urea krim 20 % Tube/pot 0 0 0 0 0 0 50 0 0
349 Urin Bag Pcs 0 0 0 0 0 0 700 0 0
350 Valproat sir 250 mg/5 ml botol @ 120 ml 0 5 0 5 0 -5 50 0 0
tablet salut enterik/
351 Valproat tab sal 250 mg 0 0 0 0 0 0 2000 0 0
kaplet salut enterik
352 Vitamin B kompleks tablet 0 3700 0 3700 0 -3700 11000 0 0
Tablet/kapsul/kaplet/
Vitamin C 500 mg minimal non tab sal selaput/kaplet
353 0 0 0 0 0 0 2000 0 0
acidic 250 mg sal selaput/tab sal
gula/kaplet sal gula
354 Zinc drops 10 mg/ml Botol 0 0 0 0 0 0 30 0 0
355 Zinc sir 20 mg/5 ml botol 40 0 0 40 0 -40 100 0 0
356 Zinc tab disp 20 mg tablet dispersible 500 0 0 500 0 -500 2000 0 0