1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. SISA STOK PER 31 DESEMBER 2022 ADALAH SISA STOK PER 31 DESEMBER 2022 DI SATUAN KERJA
3. PREDIKSI PENGADAAN TAHUN 2023 ADALAH PREDIKSI JUMLAH YANG DIRENCANAKAN UNTUK DIADAKAN TAHUN 2023
4. PEMAKAIAN RATA-RATA PER BULAN SELAMA 2022 ADALAH PEMAKAIAN RATA-RATA PER BULAN DI SATKER SELAMA TAHUN
5. PREDIKSI SISA STOK 31 DESEMBER 2023 ADALAH SISA STOK PER 31 DESEMBER 2022 DITAMBAH PREDIKSI PENGADAAN TAH
6. JUMLAH KEBUTUHAN TAHUN 2024 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2022 DIKALI 18 BULAN DALAM SA
7. RENCANA KEBUTUHAN TAHUN 2024 ADALAH JUMLAH KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI D
8. RENCANA PENGADAAN TAHUN 2024 ADALAH RENCANA UNTUK PENGADAAN DI TAHUN 2024 DALAM SATUAN TERKECIL SE
9. RENCANA PENGADAAN TAHUN 2023 ADALAH OTOMATIS TERISI DARI SISTEM JIKA SATKER TELAH MENGIRIMKAN PELAPOR
10. REALISASI PENGADAAN TAHUN 2022 ADALAH REALISASI PENGADAAN OBAT JKN BAIK E-PURCHASING MAUPUN MANUAL

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP

SATUAN KERJA : Dinas Kesehatan Kab. Gianyar

NO NAMA OBAT SATUAN

1 Air untuk injeksi ampul/vial/botol 1

2 Air untuk injeksi Botol 100 ml
3 Air untuk injeksi Botol 250 ml
4 Air untuk injeksi amp 20 ml ampul/vial/botol
5 Air untuk injeksi amp 25 ml ampul/vial/botol 2
6 Albendazol susp 200 mg/5 ml Botol
7 Albendazol tab 400 mg tablet/kapsul/kapl
8 Alopurinol tab 100 mg Tab
9 Alopurinol tab 300 mg tablet/kapsul/kapl
10 Aminofilin inj 24 mg/ml ampul/vial 10 ml
11 Aminofilin tab 150 mg tablet/kapsul/kapl
12 Aminofilin Tab 200 mg tablet/kapsul/kapl
13 Amitriptilin tab sal 25 mg tablet/kapsul/kapl
14 Amlodipin tab 10 mg tablet/kapsul/kapl
15 Amlodipin tab 5 mg tablet/kapsul/kapl
16 Amoksisilin drops 100 mg/ml Botol @10 ml
17 Amoksisilin drops 100 mg/ml Botol @15 ml
18 Amoksisilin drops 100 mg/ml Botol @20 ml
19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml
20 Amoksisilin sir kering 125 mg/5 ml Botol
21 Amoksisilin tab 250 mg tablet/kapsul/kapl
22 Amoksisilin tab 500 mg tablet/kapsul/kapl
23 Ampisilin serb inj 1000 mg/vial ampul/vial
24 Ampisilin serb inj 250 mg/vial Vial
25 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 ampul/vial
ml
26 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium tablet/kapsul/kapl
hidroksida 200 mg
27 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium botol 60 ml
hidroksida 200 mg
28 Antibakteri kombinasi : Basitrasin 500 UI/g + Polimiksin B 10.000 UI/g Tube

29 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% pot 30 g

30 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Suppositoria
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g

31 Aquadest cairan 500 ml Botol 500 ml

32 Articulating paper kertas warna penanda oklusi Kertas warna penan
33 Asam asetat tetes telinga 2% Botol
34 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kapl
35 Asam askorbat (vitamin C) tab 250 mg Tab
36 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kapl
37 Asam folat tab 0,4 mg tablet/kapsul/kapl
38 Asam folat tab 1 mg tablet/kapsul/kapl
39 Asam folat tab 5 mg Tab
40 Asam mefenamat kaps 250 mg tablet/kapsul/kapl
41 Asam mefenamat kaps 500 mg tablet/kapsul/kapl
42 Asam retinoat krim 0,05% Tube/pot
43 Asam salisilat salep 10% Tube
44 Asam salisilat salep 2% Tube
45 Asam salisilat salep 5% Tube
46 Asetazolamid tab 250 mg tablet/kapsul/kapl
47 Asiklovir tab 200 mg tablet/kapsul/kapl
48 Asiklovir tab 400 mg tablet/kapsul/kapl
49 Atapulgit 600 mg tablet/kapsul/kapl
50 Atapulgit tab 630 mg tablet/kapsul/kapl
51 Atapulgit tablet 650 mg tablet/kapsul/kapl
52 Atapulgit tablet 750 mg Tab
53 Atenolol tab 100 mg tablet/kapsul/kapl
54 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
55 Atropin tab 0,5 mg Tab
56 Bahan tumpatan sementara lar, serb Botol
57 Bedak salisil serb 2% Dus/Sachet/Plastik
58 Benzatin benzilpenisilin inj 1,2 juta UI/ml (i.m.) Vial
59 Benzatin benzilpenisilin inj 2,4 juta UI/ml (i.m.) Vial
60 Betahistin tab 6 mg tablet/kapsul/kapl
61 Betametason krim 0,1% tube 5 gram
62 Betametason krim 0,5 mg/g Tube
63 Bisakodil sup 10 mg Suppositoria
 64 Bisakodil sup 5 mg Suppositoria
65 Bisakodil tab sal 5 mg tablet/kapsul/kapl
66 Bisoprolol tab 2,5 mg tablet/kapsul/kapl
67 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml
68 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
69 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml
70 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
71 Budesonid serb ih 200 mcg/dosis 100 dosis
72 Budesonid serb ih 200 mcg/dosis 200 dosis
73 Dapson tab 100 mg Tab
74 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial
75 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
76 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL
77 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial
78 Diazepam tab 2 mg tablet/kapsul/kapl
79 Diazepam tab 5 mg tablet/kapsul/kapl
80 Dietilkarbamazin tab 100 mg tablet/kapsul/kapl
81 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
82 Dimenhidrinat tab 50 mg tablet/kapsul/kapl
83 Doksisiklin kaps 100 mg tablet/kapsul/kapl
84 Domperidon susp 5 mg/5 ml botol @60 ml
85 Domperidon tab 10 mg tablet/kapsul/kapl
86 Ekstrak Herba meniran (Phyllanthi niruri herba) Kapsul
87 Ekstrak Herba meniran (Phyllanthi niruri herba) Botol
88 Epinefrin (adrenalin) inj 1 mg/ml Ampul
89 Ergotamin tab 1 mg Tablet/kapsul/kapl
90 Eritromisin kaps 250 mg tablet/kapsul/kapl
91 Eritromisin sir 200 mg/5 ml Botol @ 60 ml
92 Eritromisin tab 500 mg tablet/kapsul/kapl
93 Etambutol tab 400 mg tablet/kapsul/kapl
94 Etanol 70% cairan 70% Botol
95 Etil klorida semprot 100 ml Botol
96 Etonogestrel implan 68 mg Set
97 Eugenol Botol
98 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml
99 Fenitoin Na kaps 100 mg Kaps
100 Fenitoin Na kaps 30 mg Kaps
101 Fenobarbital inj 50 mg/ml Ampul
102 Fenobarbital tab 100 mg Tab
103 Fenobarbital tab 30 mg tablet/kapsul/kapl
104 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
105 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
106 Ferrakrilum cairan 1% Botol
107 Ferro Sulfat sir 150 mg/5 ml botol
108 Ferro Sulfat tab sal selaput 300 mg tablet salut selapu
109 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial
110 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
111 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/ka
112 Flufenazin Dekanoat inj 25 mg/ml (i.m) Vial
113 Fluoksetin kaps 10 mg tablet/kapsul/kapl
114 Fluoksetin kaps 20 mg tablet/kapsul/kapl
115 Fluor kapl 1 mg Kaplet
116 Fluor sediaan topikal Tube
117 Flutikason propionat cairan ih 0,5 mg/dosis Botol
118 Formokresol Botol
119 Fraksi dari ekstrak campuran Daun bungur (Lagerstroemiae speciosae Kapsul
folium) dan Kulit kayu manis (Cinnamomi burmannii cortex)

120 Fraksi dari ekstrak Kulit kayu manis (Cinnamomi burmannii cortex) Kaplet

121 Framisetin Sulfat Tulle 1% Patch

122 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial
123 Furosemid tab 40 mg tablet/kapsul/kaple
124 Galactose microparticle 200-400 mg micropart/ml Vial
125 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + sachet
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
126 Gentamisin salep mata 0,3% Tube
127 Gentamisin tts mata 0,3% Botol
128 Glibenklamid tab 2,5 mg tablet/kapsul/kaple
129 Glibenklamid tab 5 mg tablet/kapsul/kaple
130 Glimepirid tab 1 mg tablet/kapsul/kaple
131 Glimepirid tab 2 mg tablet/kapsul/kaple
132 Glimepirid tab 3 mg tablet/kapsul/kapl
133 Glimepirid tab 4 mg tablet/kapsul/kapl
134 Glipizid tab 10 mg tablet/kapsul/kapl
135 Glipizid tab 5 mg tablet/kapsul/kaple
136 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kapl
137 Gliserol obat luar 100 ml Botol
138 Glukosa Larutan Infus 10% steril 100 ml Botol
139 Glukosa Larutan Infus 10% steril 250 ml Botol
140 Glukosa Larutan Infus 10% steril 500 ml Botol
141 Glukosa Larutan Infus 40% Ampul @25 ml
142 Glukosa Larutan Infus 5% steril 100 ml Botol
143 Glukosa Larutan Infus 5% steril 250 ml Botol
144 Glukosa Larutan Infus 5% steril 500 ml Botol
145 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kapl
146 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kapl
147 Griseofulvin tab 500 mg Tablet/kapsul/kapl
148 Haloperidol Dekanoat inj 50 mg/ml Vial
149 Haloperidol inj 5 mg/ml (i.m.) Vial
150 Haloperidol tab 0,5 mg tablet/kapsul/kapl
151 Haloperidol tab 1,5 mg tablet/kapsul/kapl
152 Haloperidol tab 2 mg tablet/kapsul/kapl
153 Haloperidol tab 5 mg tablet/kapsul/kapl
154 Haloperidol tts 2 mg/ml botol
155 Hepatitis B imunoglobulin (human) inj 110 IU Ampul
156 Hepatitis B imunoglobulin (human) inj 200 IU Ampul
157 Hepatitis B imunoglobulin (human) Inj 220 IU Ampul
158 Hidrogen peroksida cairan 3% Botol
159 Hidroklorotiazid tab 25 mg tablet/kapsul/kapl
160 Hidrokortison krim 1% tube @ 5 g
161 Hidrokortison krim 2,5% tube @ 5 g
162 Hidrokortison serb inj 100 mg Vial
163 Hiosina butilbromida tab 10 mg tablet/kapsul/kapl
164 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
165 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
166 Ibuprofen sir 100 mg/5 ml botol @ 60 ml
167 Ibuprofen sir 200 mg/5 ml botol @ 60 ml
168 Ibuprofen tab 200 mg tablet/kapsul/kapl
169 Ibuprofen tab 400 mg tablet/kapsul/kapl
170 Ipratropium bromida aerosol 20 mcg/semprot Botol
171 Ipratropium bromida cairan ih 0,025% Botol
172 Isoniazid tab 100 mg Tablet/kapsul/kapl
173 Isoniazid tab 300 mg Tablet/kapsul/kapl
174 Isosorbid dinitrat tab 5 mg tablet/kapsul/kapl
175 Kalamin Tube
176 Kalium Klorida tab lepas lambat 600 mg tab
177 Kalsium glukonat inj 100 mg/ml ampul/vial
178 Kalsium hidroksida bubuk, pasta Tube
179 Kalsium hipoklorit serb Sachet
180 Kalsium karbonat tab 500 mg tablet/kapsul/kapl
181 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kapl
182 Kaptopril tab 12,5 mg tablet/kaplet
183 Kaptopril tab 25 mg tablet/kaplet
184 Karbamazepin sir 100 mg/5 ml Botol
185 Karbamazepin Tab 200 mg Tablet/kapsul/kapl
186 Karbogliserin tts telinga 10 % Botol
187 Ketokonazol krim 2% Tube 10 g
188 Ketokonazol scalp sol 2% botol
189 Ketokonazol tab 200 mg tablet/kapsul/kapl
190 Klindamisin kaps 150 mg Tablet/kapsul/kapl
191 Klindamisin kaps 300 mg tablet/kapsul/kapl
192 Klofazimin, micronized kaps 50 mg Kapsul
193 Klofazimin, micronizedkaps 100 mg kapsul
194 Kloramfenikol kaps 250 mg tablet/kapsul/kapl
195 Kloramfenikol salep mata 1% tube @ 5 gram
196 Kloramfenikol serb inj 1.000 mg/ml vial/ampul
197 Kloramfenikol susp 125 mg/5 ml botol 60 ml
198 Kloramfenikol tetes telinga 3% Botol
199 Kloramfenikol tts mata 0,5% botol
200 Kloramfenikol tts mata 1% Botol
201 Klorfeniramin tab 4 mg tablet/kapsul/kapl
202 Klorfenol kamfer mentol (CHKM) Botol
203 Klorheksidin lar 0,2% Botol
204 Klorheksidin lar 15% Botol
205 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
206 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
207 Klorpromazin tab sal 100 mg tablet salut selapu
208 Klorpromazin tab sal 25 mg Tab sal
209 Kodein tab 10 mg tablet/kapsul/kapl
210 Kodein tab 15 mg tablet/kapsul/kapl
211 Kodein tab 20 mg tablet/kapsul/kapl
212 Kolkisin tab 500 mcg Tablet/kapsul/kapl
213 Komb: Deksametason 0,1% Thymol 5% Paraklorphenol 30 Botol
214 Kombinasi (DHP) : dihidroartemisin 20 mg + Piperakuin 160 mg tab tablet dispersible
dispersible
215 Kombinasi : artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kapl
216 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kapl
217 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg tab salut gula
218 Kombinasi : triamsinolon asetonoid + dimetil-klortetrasiklin pasta Pasta tube

219 Kombinasi ekstrak Herba seledri (Apii graveolentis herba) dan ekstrak Kapsul
Daun kumis kucing (Orthosiphonis staminei folium)
220 Kombinasi ekstrak Ikan gabus (Ophiocephali striati), ekstrak Buah jeruk Sachet
(Citri sinensidis fructus), dan ekstrak Rimpang kunyit (Curcumae longae
rhizoma)

221 Kombinasi: Ipratropium bromida 0,5 mg + Salbutamol 2,5 mg, cairan ih Ampul/vial

222 Kombinasi: kaolin 550 mg + pektin 20 mg Tab

223 Kombinasi: lidokain + medisinal creosote phenol + eugenol + benzil Botol
alkohol, cairan
224 Komposit resin Set
225 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ tab/kaptab
trimetoprim 80 mg
226 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ tab/kaptab
trimetoprim 160 mg
227 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol 200 mg + botol 60 mL
trimetoprim 40 mg
228 Kuinin tab 200 mg tablet/kapsul/kapl
229 Laktulosa sir 3,335 g/5 ml botol @ 60 mL
230 Larutan mengandung elektrolit (CaCl2H2O 0,165 gr, KCl 0,15 gr, NaCl 4,3 Botol plastik @500
gr)
231 Larutan mengandung Elektrolit (Kalium Klorida) Botol
232 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol
233 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
234 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 Botol plastik @ 50
mEq, Asetat 28 mEq) Ringer Asetat
235 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 Softbag @ 500 ml
mEq, Asetat 28 mEq) Ringer Asetat
236 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

237 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Botol

Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5 mmol/l,
Magnesium 1.0 mmol/l, Chloride 118 mmol/l, Acetate 24 mmol/l, Malate
5.0 mmol/l)

238 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol 60 Botol

g/ L)
239 Larutan mengandung Karbohidrat (Fructose 15 mg, glucose monohydrate softbag
30 mg, xylitol 15 mg)
240 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Xylitol Botol
100 g/ L)
241 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol
g/ L)
242 Larutan mengandung Karbohidrat (Maltose 10%) Botol
243 Larutan mengandung Karbohidrat + Elektrolit (25.00g dextrose anhidrat, Botol plastik @500
3.00 g sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)

244 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g Botol plastik @500
sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)

245 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol
Sorbitol 50 gr/L)
246 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL 0,45%, Botol
KCl) (HSD)
247 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, glucose 66 Botol
g, Xylitol 60 g/ L + elektrolit)
248 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, Botol
KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
249 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
250 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 110.0 g; NaCl: botol/softbag
1.80 g) (D10-1/5NS)
251 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol
g)
252 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 botol/softbag @ 1
g) (D5-1/4NS)
253 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 botol/softbag @ 5
g) (D5-1/4NS)
254 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol
g) (D5-1/2NS)
255 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi Botol
infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ,
Asetat 38mEQ, Sorbitol 50g)

256 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol
5%)
257 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.125 gr, Dekstrosa Botol
18.75 gr) (KA EN 1B)
258 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
259 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Na Botol
Lactate 2.24 g, Glukosa 100 gr)
260 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
261 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat Botol
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
262 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set
263 Lidokain gel 2% syringe/syringe pla
264 Lidokain inj 2% (infiltr/p.v.) ampul/vial
265 Lidokain salep 5% Tube
266 Lidokain spray topikal 10% botol
267 Linestrenol tab 0,5 mg tablet/kapsul/kapl
268 Liquor carbonis detergens lar 5% Botol
269 Lisinopril tab 10 mg tablet/kapsul/kapl
270 Lisinopril tab 5 mg tablet/kapsul/kapl
271 Loratadin tab 10 mg tablet/kapsul/kapl
272 Lorazepam tab 0,5 mg tablet/kapsul/kapl
273 Lorazepam tab 1 mg tablet/kapsul/kapl
274 Lorazepam tab sal 2 mg Tab sal
275 Magnesium sulfat inj 20% ampul/vial
276 Magnesium sulfat inj 20% ampul/vial @25 ml
277 Magnesium sulfat inj 40% ampul/vial
278 Magnesium sulfat inj 40% ampul/vial @25 ml
279 Magnesium sulfat serb, ktg 30 g Sachet
280 Manitol lar infus 20% Botol @ 500 ml
281 Manitol lar infus 20% Botol @ 100 ml
282 Manitol lar infus 20% Botol @ 250 ml
283 Mebendazol sir 100 mg/5 ml Botol
284 Mebendazol tab 100 mg Tablet/kapsul/kapl
285 Mebendazol tab 500 mg tablet/kapsul/kapl
286 Medroksi progesteron asetat inj 150 mg/ml ampul/vial
287 Metadon sir 50 mg/5 ml Botol 1000 ml
288 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut

289 Metformin tab 500 mg tablet/kapsul/kapl

290 Metformin tab 850 mg tablet/kapsul/kapl
291 Metildopa tab 250 mg tablet/kapsul/kapl
292 Metilergometrin inj 0,2 mg/ml ampul/vial
293 Metilergometrin tab salut 0,125 mg tablet/kaplet salut
294 Metilprednisolon inj 125 mg ampul/vial
295 Metoklopramid inj 5 mg/ml ampul/vial
296 Metoklopramid tab 10 mg tablet/kapsul/kapl
297 Metoklopramid tab 5 mg tablet/kapsul/kapl
298 Metronidazol susp 125 mg/5 ml Botol @ 60 ml
299 Metronidazol susp 125 mg/5 ml Botol @ 100 ml
300 Metronidazol tab 250 mg tablet/kapsul/kapl
301 Metronidazol tab 500 mg tablet/kapsul/kapl
302 Mikonazol krim 2% tube
303 Mikonazol serb 2% botol / sachet
304 Mometason furoat krim 0,1% Tube 5 gram
305 Mometason furoat krim 0,1% tube 10 gram
306 N-asetil sistein kaps 200 mg tablet/kapsul/kapl
307 N-asetil Sistein sir 100 mg/5ml botol
308 NaCl 0,9% Larutan Botol @500 ml
309 NaCl 0,9% Larutan Botol @1.000 mL
310 NaCl 0,9% Larutan Botol @250 ml
311 NaCl 0,9% Larutan Botol @25 ml
312 NaCl 0,9% Larutan Ampul/botol @ 10
313 NaCl 0,9% Larutan Botol @100 ml
314 NaCl 3% Larutan Botol plastik @500
315 Natrium bikarbonat tab 500 mg tablet/kapsul/kapl
316 Natrium diklofenak tab 25 mg tablet salut enteri
317 Natrium diklofenak tab 50 mg tablet salut enteri
318 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL
319 Natrium fluoresein tetes mata 2% Botol
320 Natrium hipoklorit cairan konsentrat 5% Botol
321 Natrium tiosulfat inj 25% (i.v.) Ampul
322 Nistatin susp 100.000 UI/ml botol/vial
323 Nistatin tab salut 500.000 UI tablet salut gula/ka
324 Nistatin tab vaginal 100.000 UI tablet/kaplet
325 Oksigen ih, gas dlm tabung Botol
326 Oksimetazolin tts hidung 0,025% botol @ 10 mL
327 Oksimetazolin tts hidung 0,050% botol @ 10 mL
328 Oksitetrasiklin 1% Salep Mata tube
329 Oksitosin inj 10 UI/ml ampul/vial
330 Olopatadin tts mata 0,1% Botol
331 Omeprazol inj 40 mg ampul/vial
332 Omeprazol kaps 20 mg tablet/kapsul/kapl
333 Parasetamol sir 120 mg/5 ml botol @ 60 mL
334 Parasetamol tab 500 mg tablet/kapsul/kapl
335 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL
336 Pasta devitalisasi (non arsen) Tube
337 Pasta pengisi saluran akar (pasta) Tube
338 Perak sulfadiazin krim 1% Tube
339 Permetrin krim 5 % Tube 30 g
340 Permetrin krim 5 % Tube 15 g
341 Permetrin krim 5 % Tube 10 g
342 Pilokarpin tetes mata 2% Catchcover, botol
343 Pilokarpin tetes mata 2% Botol 5 ml
344 Pirantel pamoat susp 125 mg/5 ml Botol
345 Pirantel pamoat tab scored 125 mg tablet/kapsul/kapl
346 Pirantel pamoat tab scored 250 mg Tab
347 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl
348 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kapl
349 Povidon iodin lar 100 mg/ml botol 30 mL
350 Povidon iodin lar 100 mg/ml botol @ 60 mL
351 Povidon iodin lar 100 mg/ml Botol 300 ml
352 Povidon iodin lar 100 mg/ml botol @ 1.000 mL
353 Povidon iodin lar obat kumur 1% Botol
354 Povidon iodin tts mata 2,5% botol/strip
355 Prazikuantel tab scored 600 mg Tab
356 Prednison tab 5 mg tablet/kapsul/kapl
357 Probenesid tab 500 mg tablet/kapsul/kapl
358 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial
359 Propranolol tab 10 mg tablet/kapsul/kapl
360 Ranitidin tab 150 mg tablet/kapsul/kapl
361 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
362 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak
363 Rifampisin kaps 300 mg tablet/kapsul/kapl
364 Ringer Laktat Larutan Botol
365 Risperidon tab sal 2 mg tablet/kapsul/kapl
366 Salbutamol cairan ih 1 mg/mL ampul/vial/botol
367 Salbutamol tab 2 mg tablet/kapsul/kapl
368 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 15 gram
369 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 30 gram
370 Sefadroksil drops 150 mg/ml botol
371 Sefadroksil kaps 250 mg tablet/kapsul/kapl
372 Sefadroksil kaps/tab 500 mg tablet/kapsul/kapl
373 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL
374 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL
375 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.) Vial

376 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial

377 Serum antirabies inj 100 UI/ml Vial

378 Serum antirabies inj 200 UI/ml Vial
379 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
380 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
381 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
382 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial
383 Setirizin sir 5 mg/5 ml. botol @ 60 mL
384 Setirizin tab 10 mg tablet/kapsul/kapl
385 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial
386 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kapl
387 Simvastatin tab sal 10 mg tablet/kapsul/kaple
388 Simvastatin tab sal 20 mg tablet/kapsul/kaple
389 Simvastatin tab sal selaput 40 mg Tab salut selaput
390 Siprofloksasin tab scored 500 mg tablet salut selapu
391 Spironolakton tab 25 mg tablet/kapsul/kapl
392 Streptomisin serb inj 1.000 mg/vial ampul/vial
393 Surgical ginggival pack Tube
394 Terbutalin cairan ih 2,5 mg/ml Botol
395 Terbutalin inj 0,5 mg/ml ampul/vial
396 Tetanus toxoid inj Ampul
397 Tetrakain tts mata 0,5% Botol
398 Tetrasiklin kaps 250 mg tablet/kapsul/kapl
399 Tetrasiklin kaps 500 mg tablet/kapsul/kapl
400 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kapl
401 Timolol tts mata 0,25% botol @ 5 mL
402 Timolol tts mata 0,5% botol @ 5 mL
403 Tropikamid tts mata 0,5% Catchcover, botol
404 Tropikamid tts mata 0,5% Botol @ 5 ml
405 Tropikamid tts mata 1% Botol @ 0,6 ml
406 Tropikamid tts mata 1% Botol @ 5 ml
407 Urea krim 10 % Tube/pot
408 Urea krim 20 % Tube/pot
409 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
410 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml Vial
(i.m)
411 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
412 Vaksin polio IPV inj 0,5 ml Vial
413 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
414 Valproat sir 250 mg/5 ml botol @ 120 ml
415 Valproat tab lepas lambat 250 mg tabet lepas lambat
416 Valproat tab lepas lambat 500 mg tabet lepas lambat
417 Valproat tab sal enterik 250 mg tablet salut enterik
418 Vitamin B kompleks tablet
419 Zinc drops 10 mg/ml Botol
420 Zinc sir 20 mg/5 ml botol
421 Zinc tab disp 20 mg tablet dispersible
TUAN KERJA
N UNTUK DIADAKAN TAHUN 2023
PER BULAN DI SATKER SELAMA TAHUN 2022
DITAMBAH PREDIKSI PENGADAAN TAHUN 2023 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2022)
AMA 2022 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / P
BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2023
UN 2024 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DI
TKER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2023
IK E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2022

TINGKAT PERTAMA (FKTP) TAHUN 2024

SISA STOK PER 31 PREDIKSI PEMAKAIAN PREDIKSI SISA STOK 31 JUMLAH

DESEMBER 2022 PENGADAAN RATA-RATA PER DESEMBER 2023 KEBUTUHAN
TAHUN 2023 BULAN SELAMA TAHUN 2024
2022

(a) (b) (c) (d) = (a)+(b)-(12x(c)) (e) = (c) x 18

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AN TAHUN 2022)
L / AMPUL / VIAL / TUBE / SACCHET / PUFF

TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2024 BERDASARKAN

RENCANA RENCANA RENCANA REALISASI KETERANGAN

KEBUTUHAN PENGADAAN PENGADAAN PENGADAAN
TAHUN 2024 TAHUN 2024 TAHUN 2023 TAHUN 2022

(f) = (e) - (d) (g) (h) (i) (j)

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