LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

DINAS KESEHATAN KABUPATEN BINTAN

PUSKESMAS : KELONG BULAN

KECAMATAN : BINTAN PESISIR TAHUN
HARGA PENERIM PERSEDI PEMAKA STOK STOK PERMINT
NO NAMA OBAT SATUAN STOK AWAL
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
1 A C T ( Artesunat 50 mg + Amodiaquin 200 mg ) tablet tablet Rp 1,409 0 0 0 0
2 Artemeter Injeksi @ 1ml ampul ampul Rp 12,500 0 0 0 0
3 Artesunat Injeksi vial Rp 19,000 0 0 0 0
4 Albendazol tablet 400 mg tablet Rp 451 0 0 0 0
5 Alopurinol tablet 100 mg tablet Rp 89 1,105 0 1,105 160 945 3,000
6 Alprazolam tab 0,5 mg tablet Rp 88 0 0 0 0
7 Alprazolam tab 1 mg tablet Rp 120 0 0 0 0
8 Ambroksol sirup 15 mg/5 ml. @ 60 ml. botol Rp 4,887 0 0 0 0
9 Ambroksol tablet 30 mg tablet Rp 231 2,070 2000 4,070 1,563 2,507 4,000
10 Aminofilin injeksi 24 mg / ml @ 10 ml ampul Rp 2,736 0 0 0 0
11 Aminofilin tablet 200 mg tablet Rp 97 0 0 0 0
12 Amitriptilin HCl tablet salut 25 mg tablet Rp 202 100 0 100 1 99
13 Amlodipin 10 mg tablet tablet Rp 74 3,042 5000 8,042 2,240 5,802 5,000
14 Amlodipin tablet 5 mg tablet Rp 55 3,078 5500 8,578 1,530 7,048 4,000
15 Amoksisilin 100 mg/ml drop kering botol Rp 22,990 0 0 0 0
16 Amoksisilin capsul 250 mg kapsul Rp 209 0 0 0 0
17 Amoksisilin injeksi 1000 mg vial Rp 10,123 0 0 0 0
18 Amoksisilin kaplet 500 mg kaplet Rp 231 200 0 200 164 36 4,000
19 Amoksisilin sirup kering 125 mg / 5 ml botol Rp 2,600 127 0 127 14 113 50
20 Amoksisilin sirup kering 250 mg / 5 ml botol Rp 3,846 0 0 0 0
21 Ampisilin serbuk injeksi 1000 mg vial Rp 2,887 0 0 0 0
Antasida DOEN I tablet komb : Al(OH) 200 mg + Mg (OH) 200
22 tablet Rp 54 1500 3,504 1,384 2,120 4,000
mg 2,004
Antasida DOEN II susp. 60 ml.komb.:Al(OH) 200 mg/5 ml.
23 +Mg(OH) 200 mg/5 ml botol Rp 1,756 0 0 0 50
0
Anti Bakteri DOEN salap komb : Basitrasin 500 IU/g +
24 Polimiksin 1000 IU/g tube Rp 3,477 0 0 0
0

25 Anti Fungi DOEN komb : As. Benzoat 6 % + As. Salisilat 3 % pot Rp 3,637 0 0 0
0
26 Anti Hemoroid DOEN kombinasi supp Rp 3,260 45 0 45 35 10
Anti Malaria DOEN kombinasi : Pirimetamin 25 mg +
27 tablet Rp 546 0 0 0
Sulfadoksin 500 mg 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
28 Anti Migren DOEN kombinasi : Ergotamin Tartrat 1 mg + tablet Rp 255 100 100 100
Koffein 50 mg 0
29 Anti Skabies (Permetrin) 5% krim 10 gr tube Rp 11,825 35 0 35 5 30 20
30 Aqua Dest Steril 500 ml botol Rp 12,100 0 0 0 0
31 Aqua Pro Injeksi steril 25 ml botol Rp 2,860 0 0 0 0 50
32 Asam Asetil Salisilat ( Asetosal ) tablet 80 mg tablet Rp 89 388 0 388 388
33 Asam Askorbat tablet 50 mg tablet Rp 46 2,454 1000 3,454 495 2,959 3,000
34 Asam Askorbat tablet 250 mg tablet Rp 141 1,400 1000 2,400 190 2,210 2,000
35 Asam Askorbat tablet 500 mg dalam bentuk buffer (Lavit C) tablet Rp 2,553 2000 3,030 490 2,540 3,000
36 Asam Folat tablet 0.4 mg tablet Rp 45 1,030 0 1,030 160 870 1,000
37 Asam Mefenamat capsul 250 mg capsul Rp 150 0 0 0 0
38 Asam Mefenamat kaplet 500 mg kaplet Rp 117 0 0 0 0 4,000
39 Asam Traneksamat injeksi 100 mg @ 5 ml ampul Rp 1,880 0 0 0 0
40 Asam Traneksamat tablet 500 mg tablet Rp 1,910 440 100 540 160 380 1,000
41 Asetil sisterina 100mg/5ml drop kering botol Rp 50,820 0 0 0 0
42 Asetil sisteina 200 mg kapsul kapsul Rp 317 0 0 0 0 3,000
43 Asiatikosida krim 1 % @ 10 g tube Rp 56,100 0 0 0 0
44 Asiklovir krim 5 % @ 5 gram tube Rp 6,272 0 50 50 3 47 100
45 Asiklovir tablet 200 mg tablet Rp 376 1,060 0 1,060 90 970
46 Asiklovir tablet 400 mg tablet Rp 750 896 0 896 120 776
47 Atropin Sulfat Injeksi 0,25mg/ml-1 ml. ampul Rp 1,718 2 10 12 2 10 10
48 Atropin Sulfat Tetes Mata 0,5 % @ 5 ml. tablet Rp 13,500 0 0 0 0
49 Attapulgite tablet 600 mg tablet Rp 187 385 300 685 88 597 600
50 Benzatin Benzil Penisillin injeksi 2,4 Juta IU vial Rp 16,675 0 0 0 0
51 Besi (Fe) 15 mg per 15 ml suspensi 120 ml botol Rp 44,000 0 0 0 0
52 Betahistin Mesilat tablet 6 mg tablet Rp 92 1,278 0 1,278 540 738 3,000
53 Betametason Krem 0,1 % @ 5 g tube Rp 1,520 78 25 103 16 87 100
Betamethasone valerat 0.1 %, Gentamycin sulfat 0.1% krim
54 (Benoson G) tube Rp 76,590 0 0 0 20
55 Betamethasone valerat 0.1 %, Miconazole nitrate 2% krim (Benoson tube Rp 70,152 0 0 0 20
M)
56 Betametason 0,1%, Neomisin 0,5% krim (Nisagon) tube Rp 9,546 0 0 0
57 Bisakodil suppositoria 10 mg dewasa supp Rp 4,325 11 12 23 23 20
58 Bisakodil suppositoria 5 mg anak-anak supp Rp 5,085 26 0 26 12 14 24
59 Bisakodil tablet 10 mg tablet Rp 337 0 0 0 0 500
60 Bisakodil tablet 5 mg tablet Rp 216 0 0 0 0 500
61 Bisoprolol tablet 5 mg tablet Rp 316 0 0 0
62 Borax Gliserin solutio 15 ml. botol Rp 3,850 22 0 22 4 18 15
63 Bromheksin sirup 100 ml botol Rp 13,320 0 0 0 0 50
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
64 Bromheksin tablet 8 mg tablet Rp 383 579 100 679 120 559 3,000
65 Cefadroksil 125 mg / 5 ml sirup kering @ 60ml botol Rp 4,086 0 0 0 0 100
66 Cefadroksil 250 mg / 5 ml sirup kering @ 60 ml botol Rp 5,826 0 0 0 0 100
67 Cefadroksil kapsul 500 mg capsul Rp 932 538 4000 4,538 738 3,800 2,000
68 Cefixime 100 mg capsul Rp 463 0 0 0 0 4,000
69 Cefixime 100 mg/5 ml sirup kering @ 30ml botol Rp 5,195 0 0 0 0 50
70 Cefotaksim injeksi 1 g vial Rp 3,050 0 0 0 0 20
71 Ceftriakson injeksi 1 g vial Rp 2,899 0 0 0 0 20
72 Carboxymetyhlcelulose (Cendo Cenfresh) eye drop 5 ml Botol Rp 44,511 12 0 12 2 10 20
73 Cendo Lyteers eye drop 15 ml Botol Rp 30,969 22 0 22 22 20
74 Cendo Xitrol eye drop 5 ml Botol Rp 33,000 0 0 0 0
Tiap ml mengandung, Dexamethasone sodium phosphate setara
75 dengan Dexamethasone 1 mg Neomycin sulfate setara dengan botol Rp 20,091 0 0 0
Neomycin 3,5 mg Polymyxin B sulfate 6000 IU (Alletrol) 0
73 Cetirizina Hcl 10 mg/ml tetes botol Rp 82,973 0 0 0
74 Cetirizina kapsul 10 mg kapsul Rp 52 2,293 1000 3,293 621 2,672 4,000
75 Cetirizina sirup 5 mg / 5 ml @ 60 ml botol Rp 3,861 124 0 124 124
Cimetidin tablet 200 mg tablet Rp 348 0 0 0 0 500
76 Ciprofloksasin kaplet 500 mg kaplet Rp 260 0 0 0 0 2,000
77 Ciprofloksasin tetes mata 3 mg\/ml minidose 0.6 ml strip Rp 6,383 20 0 20 4 16 7
78 Clindamisin Capsul 150 mg capsul Rp 754 0 0 0
79 Clobazam 10 mg tablet Rp 384 0 0 0
80 Deksametason injeksi 5 mg / ml - 1 ml ampul Rp 968 62 0 62 20 42 100
81 Deksametason tablet 0,5 mg tablet Rp 106 0 0 0 0 5,000
82 Diazepam injeksi 5 mg / ml - 2 ml ampul Rp 10,162 20 0 20 20
83 Diazepam larutan Rectal 5 mg/2.5 ml tube Rp 14,459 0 0 0 0
84 Diazepam Enema 5 mg/2,5 ml tube Rp 13,546 0 0 0 5
85 Diazepam tablet 2 mg tablet Rp 242 168 0 168 37 131
86 Diazepam tablet 5 mg tablet Rp 108 182 0 182 82 100
87 Difenhidramin HCl injeksi 10 mg / ml - 1 ml ampul Rp 825 0 0 0 0 20
88 Digoksin tablet 0,25 mg tablet Rp 124 100 0 100 100
89 Dimenhidrinat tablet 50 mg tablet Rp 109 856 0 856 270 586 2,000
90 Doksisiklin capsul 100 mg capsul Rp 289 0 0 0 0
91 Domperidon 5 mg/ml drop @ 10ml botol Rp 9,931 0 0 0 0
92 Domperidon Suspensi 5mg/5ml @ 60 ml botol Rp 2,401 0 0 0 0 50
93 Domperidon tablet 10 mg tablet Rp 75 2,217 1500 3,717 389 3,328 2,000
94 Efedrin HCl tablet 25 mg tablet Rp 182 0 0 0 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
95 Ekstrak Plasenta Gel @ 15 g tube Rp 21,645 40 20 60 10 50 40
96 Ekstrak Centella Asiatica 1% salep (Tekasol) tube Rp 51,171 0 0 0
97 Epinefrin HCl (Adrenalin) inj 0,1 % - 1 ml ampul Rp 1,740 16 0 16 16
98 Eritromisin kaplet 500 mg kaplet Rp 900 0 0 0 0
99 Eritromisin sirup 200 mg / 5 ml botol Rp 7,893 0 0 0 0
100 Etakridin ( Rivanol ) larutan 0,1 % @ 300 ml. botol Rp 31,913 10 0 10 10
101 Etambutol tablet 250 mg tablet Rp 178 0 0 0 0
102 Etanol larutan 70 % @ 100 ml. botol Rp 5,335 38 10 48 10 38 10
103 Etanol larutan 70 % @ 300 ml. botol Rp 39,572 0 0 0 0
104 Etanol larutan 70 % @ 1000 ml. botol Rp 113,609 02 2 2
105 Etil Klorida semprot @100 ml botol Rp 176,601 4 5 9 4 5 3
106 Eugenol cairan 10 ml. botol Rp 20,175 0 0 0 0
107 Fenilbutazon tablet 200 mg tablet Rp 69 0 0 0 0
108 Fenobarbital injeksi 50 mg / ml - 2 ml ampul Rp 1,700 30 0 30 30
109 Fenobarbital tablet 100 mg tablet Rp 276 0 0 0 0
110 Fenobarbital tablet 30 mg tablet Rp 197 755 0 755 30 725
111 Fenol Gliserol Tetes Telinga 10% botol Rp 3,300 48 48 48
112 Fero Sulfat tablet 300 mg (tablet tambah darah) tablet Rp 43 18,385 0 18,385 3,280 15,105
113 Fitomenadion (Vitamin K1) injeksi 10 mg/ml - 1 ml ampul Rp 3,959 0 0 0 0 25
114 Fitomenadion (Vitamin K1) tablet salut gula 10 mg tablet Rp 781 0 0 0 0 1,000
115 Fitomenadion (Vitamin K1) 2 mg/ml injeksi ampul Rp 1,452 0 0 0 0 25
116 Flavoksat HCl tab. 200 mg tablet Rp 6,233 0 0 0 0
117 Flukonazol 150 mg kapsul kapsul Rp 20,700 0 0 0 0
118 Flouksetin kaps 10 mg kapsul Rp 547 0 0 0
119 Framisetin sulfat gauze dressing 10 cm x 10 cm lembar Rp 26,340 109 0 109 109
120 Furosemid injeksi 10 mg/ml @ 2 ml. ampul Rp 969 0 0 0 0 5
121 Furosemid tablet 40 mg tablet Rp 514 495 0 495 20 475 200
122 Gameksan Emulsi 1 % botol Rp 4,400 0 0 0 0
123 Garam Oralit untuk 200 ml air sachet Rp 263 110 500 610 84 526
124 Gemfibrozil capsul 300 mg capsul Rp 436 0 0 0 0
125 Gemfibrozil capsul 600 mg capsul Rp 853 0 0 0 0
126 Gentamisin injeksi 40 mg/ml @ 2ml ampul Rp 3,545 0 0 0 0
127 Gentamisin injeksi 80 mg vial Rp 3,355 0 0 0 0
128 Gentamisin salep kulit 5 g tube Rp 6,272 0 0 0 0 50
129 Gentamisin Sulfat tetes mata 0.3% botol Rp 4,885 0 0 0 0
130 Gentian Violet larutan 1 % 10 ml botol Rp 3,850 13 0 13 13
131 Glibenklamid tablet 5 mg tablet Rp 137 233 0 233 55 178 3,000
132 Glimepiride tablet 1 mg tablet Rp 200 0 0 0 0 3,000
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
133 Glimepiride tablet 2 mg tablet Rp 123 0 0 0 0 3,000
134 Gliseril Guayakolat tablet 100 mg tablet Rp 332 2,664 1500 4,164 776 3,388 4,000
135 Gliserin larutan 50% @ 100 ml botol Rp 6,600 0 0 0 0
136 Griseofulvin tablet 125 mg, micronized tablet Rp 223 0 0 0 0
137 Griseofulvin 500 mg tab tablet Rp 1,040 0 0 0 0
138 Haloperidol 5 mg tablet tablet Rp 81 0 0 0 0
139 Haloperidol tablet 1,5 mg tablet Rp 74 200 0 200 200
140 Haloperidol tablet 2 mg tablet Rp 54 0 0 0 0
141 Haloperidol decanoat inj 50 mg/ml ampul Rp 101,300 10 0 10 10
142 Hidroklortiazida tablet 25 mg tablet Rp 145 300 0 300 300 200
143 Hidrokortison krim 2,5 % @ 5g. tube Rp 2,325 83 0 83 4 79 50
144 Hyoscine-N-Butilbromide injeksi ampul Rp 10,120 0 0 0 0 20
145 Hyoscine-N-Butilbromide tablet 10 mg tablet Rp 1,050 438 0 438 20 418 2,000
146 Ibuprofen Suspensi 100 mg / 5 ml botol Rp 2,339 0 0 0 0
147 Ibuprofen tablet 200 mg tablet Rp 155 2,426 1000 3,426 594 2,832 5,000
148 Ibuprofen tablet 400 mg tablet Rp 215 1,430 0 1,430 1,430 0 5,000
149 Ichtyol ( Salap Hitam ) pot Rp 9,935 19 0 19 19
Ipratrium Br 21 mcg, Salbutamol Sulfat 120 mcg perhirup
150 (Combivent) botol Rp 4,550 32 30 62 12 50 30
151 Isoniazid tablet 100 mg tablet Rp 79 100 0 100 100
152 Isoniazid tablet 300 mg tablet Rp 170 291 0 291 291
153 Isosorbid Dinitrat tablet sublingual 5 mg tablet Rp 99 189 0 189 189
154 Jelly (Ecolab aquagel sterile) 82 g tube Rp 32,505 1 0 1 1 5
155 Jelly USG @ 250 g botol Rp 14,472 1 0 1 1 5
156 Kalium diklofenak 25 mg tablet tablet Rp 410 0 0 0 0
157 Kalium diklofenak 50 mg tablet tablet Rp 440 0 0 0 0
158 Kalium Permanganat serbuk 5 g. pot Rp 5,500 12 0 12 12
159 Kalsium Glukonat injeksi 10% (100 mg/ml) @ 10 ml ampul Rp 6,199 5 0 5 5 5
160 Kalsium Laktat tablet 500 mg tablet Rp 60 1,988 1500 3,488 640 2,848 3,000
161 Kanamycin injeksi 1 gram vial Rp 17,871 30 0 30 1 29
162 Kaolin Pektin sirup botol Rp 15,400 0 0 0 0
163 Kaptopril tablet 12,5 mg tablet Rp 68 0 0 0 0 5,000
164 Kaptopril tablet 25 mg tablet Rp 75 0 0 0 0 5,000
165 Kaptopril tablet 50 mg tablet Rp 134 0 0 0 0 5,000
166 Karbamazepin tablet 200 mg tablet Rp 230 0 0 0 0
167 Karbol (Fenol) Gliserol tetes telinga 10% @ 5 ml botol Rp 2,590 5 0 5 4 1
168 Ketokonazol krim 2 % @ 10 g. tube Rp 5,328 27 25 52 6 46 50
169 Ketokonazol tablet 200 mg tablet Rp 260 726 0 726 53 673
170 Ketoprofen injeksi 100 mg @ 1 ml ampul Rp 5,933 0 0 0 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
171 Ketoprofen tablet 100 mg tablet Rp 1,417 0 0 0 0
172 Ketoprofen Supp 100 mg supp Rp 2,380 30 0 30 30
173 Ketorolac 30 mg/ml injeksi @ 1ml ampul Rp 923 0 0 0 0
174 Kloramfenikol capsul 250 mg capsul Rp 255 0 0 0 0
175 Kloramfenikol salap mata 1 % @ 3,5 g. tube Rp 3,800 0 0 0 0 100
176 Kloramfenikol suspensi 125 mg / 5 ml. @ 60 ml. botol Rp 4,000 0 0 0 0
177 Klobazam tab 10 mg tablet Rp 739 0 0 0 0
178 Klozapin tab 25 mg tablet Rp 473 0 0 0 0
179 Kloramfenikol tetes mata 0,5 % botol Rp 11,330 0 0 0
180 Kloramfenikol tetes mata 0,5 % + Deksametason botol Rp 14,541 46 0 46 4 42 20
181 Kloramfenikol tetes telinga 3 % @ 5 ml botol Rp 16,206 44 0 44 7 37 20
183 Klorfeniramin Maleat ( CTM ) tablet 4 mg tablet Rp 86 3,576 1296 4,872 1,231 3,641 5,000
184 Klorheksidin lar 0.2% (larutan kumur antiseptik gigi) @ 60 ml botol Rp 35,742 24 47 2 45
23
185 Klorokuin tablet 150 mg tablet Rp 58 0 0 0 0
186 Klorpromazin HCl injeksi 25 mg / ml - 1 ml ampul Rp 2,681 0 0 0 0
187 Klorpromazin HCl tablet salut 25 mg tablet Rp 24 0 0 0 0
188 Klorpromazin HCl tablet salut 100 mg tablet Rp 603 0 0 0 0
189 Kodein Fosfat tablet 10 mg tablet Rp 605 0 0 0 0 100
190 Kombinasi anti alergi lotion 100 ml (Kalamin 8%, botol Rp 18,981 6 40 5 35
Difenhidramin HCl 1%, Kamfer 0.1%, Gliserol alkohol 2%) 34
Kombinasi krim mengandung Metilsalisilat 110 mg, Menthol
191 tube Rp 10,545 0 0 0 30
60 mg, Eugenol 15 mg (Lespain)
Kotrimoksazol susp. komb. : Sulfametoksazol 200 mg. +
192 botol Rp 2,100 0 42 42 20
Trimetoprim 40 mg/5ml 42
Kotrimoksazol tab dewasa komb : Sulfametoksazol 400
193 tablet Rp 126 0 605 60 545 500
mg+Trimetoprim 80 mg 605
Kotrimoksazol tab dewasa komb : Sulfametoksazol 800
194 mg+Trimetoprim 160 mg kaplet Rp 512 0 0 0
0
195 Krim untuk nyeri @30 gr tube Rp 14,850 20 20 40 6 34 40
196 Kuinin ( Kina ) tablet 200 mg tablet Rp 737 0 0 0 0
197 Kuinin Injeksi IV 25 % sebagai 2HCl - 2 ml ampul Rp 6,510 0 0 0 0
198 Lactobacillus sachet Rp 5,572 477 300 777 200 577 700
199 Lanzoprazol Kapsul 30 mg kaplet Rp 278 1,374 0 1,374 626 748 3,000
200 Larutan infus Glukosa 10% steril @ 500 ml. botol Rp 7,500 5 0 5 5
201 Larutan infus Glukosa 40% steril botol Rp 1,525 0 0 0 0
202 Larutan infus Glukosa 5% steril @ 500 ml botol Rp 6,900 43 0 43 43
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
203 Larutan Infus Ringer Laktat steril @ 500 ml botol Rp 8,825 37 20 57 15 42
204 Larutan NaCl 0,225 %+ Dextrose 5 % ( cairan 1 : 4 ) infus @ botol Rp 9,840 0 0 0
500 ml. 0

205 Larutan NaCl 1,75 g, KCl 1,5 g, Na Laktat 2,24 g, Dextrose 27 g botol Rp 11,314 0 20 20
@ 500 ml (KaEN 3B) 20
206 Larutan Natrium Klorida Infus 0,9 % steril @ 500 ml. botol Rp 6,900 85 20 105 20 85
207 Lidocain HCL 2% + Epinefrin 1:80.000 inj @ 2 ml ampul Rp 847 23 0 23 23
208 Lidocain injeksi 2 % @ 2 ml ampul Rp 891 270 0 270 20 250
203 Lidocain jelly 2% 10 gr syringe Rp 40,000 0 0 0 0
204 Lidocain semprot 10 % botol Rp 149,100 0 0 0 0
205 Linkomisin capsul 500 mg capsul Rp 197 0 0 0 0
206 Lisol solutio 1000 ml. botol Rp 47,150 0 0 0 0
207 Loperamid tablet 2 mg tablet Rp 89 1,280 0 1,280 120 1,160 200
208 Loratadin tablet 10 mg tablet Rp 117 0 0 0 0 3,000
209 Lorazepam tablet 2 mg tablet Rp 932 97 0 97 97 0
210 Magnesium Sulfat injeksi (IV) 20 % - 25 ml vial Rp 3,200 0 1 1 1
211 Magnesium Sulfat injeksi (IV) 40 % - 25 ml vial Rp 3,650 18 0 18 5 13 5
212 Mantoux test (PPD 2 UT 1,5) vial Rp 777,000 0 0 0 0
213 Mebendazol tablet 100 mg tablet Rp 141 0 0 0 0
214 Meloksikam capsul 15 mg capsul Rp 894 1,134 1000 2,134 492 1,642 3,000
215 Metampiron ( Antalgin ) injeksi 500 mg /1 ml ampul Rp 3,050 0 0 0 0
216 Metampiron ( Antalgin ) tablet 500 mg tablet Rp 453 0 0 0 0
217 Metformin tablet 500 mg tablet Rp 77 460 0 460 170 290 5,000
218 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul Rp 1,069 0 2 2 2 5
219 Metilergometrin Maleat tablet salut 0,125 mg tablet Rp 242 414 300 714 30 684 500
220 Metilprednisolon tablet 4 mg tablet Rp 102 0 0 0 0 4,000
221 Metoklopramid drop 2 mg/ml @ 10 ml botol Rp 5,200 0 0 0 0
222 Metoklopramid injeksi 5 mg/ml @ 2 ml ampul Rp 3,904 0 0 0 0
223 Metoklopramid syrup @ 60 ml. botol Rp 2,750 0 0 0 0
224 Metoklorpramid tablet 10 mg tablet Rp 66 0 0 0 0 500
225 Metronidazol infus botol Rp 10,250 0 2 2 2
226 Metronidazol sirup 125 mg/5ml botol Rp 3,800 0 0 0 0
227 Metronidazol tablet 250 mg tablet Rp 98 0 0 0 0
228 Metronidazol tablet 500 mg tablet Rp 317 895 0 895 55 840
229 Mikonazol krim 2 % @ 10 g tube Rp 1,900 81 0 81 2 79 25
Multivitamin anak sirup dengan kalsium pidolat 300 mg,
230 botol Rp 46,620 92 0 92 5 87
fruktooligosakarida 300 mg dan kurkuminoid 2 mg per 5 ml
231 Multivitamin dan mineral tetes sirup@ 15 ml botol Rp 19,250 0 0 0 0
232 Multivitamin mineral dengan zat besi tablet dewasa tablet Rp 1,023 0 0 0 0 1,000
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11

Multivitamin As folat 1 mg, B-caroten 10.000 IU, Vit B1 10 mg, Vit

233 B2 2,5 mg, nikotinamid 20mg, Vit B6 12 mg, Ca Pantothenate 7,5 Kapsul Rp 1,915 0 0 0 2,000
mg, Vit B12 4 mcg, Vit C 100 mg, Vit D 400 IU, p-Iodida 100 mcg, Fe
90 mg, Cu 0.1 mg, Ca Laktat 250 mg, NaF 1 mg (Folamil ) 0
234 Multivitamin Fe 30 mg, Asam Folat 200 mcg, Vitamin B12 2 mcg per
5 ml (Ferri Kid Sirup) botol Rp 22,339 0 0 0 0

Vitamin A 4,000 IU, vitamin C 50 mg, vitamin D 400 IU, vitamin E 10

235 mg, vitamin B1 3 mg, vitamin B2 3 mg, vitamin B6 2 mg, vitamin B12 tablet Rp 1,142 2000 3,700 950 2,750 3,000
2 mcg, nicotinamide 20 mg, Ca pantothenate 5 mg, folic acid 1 mg,
biotin 0.1 mg, Fe fumarate 20 mg, Ca 100 mg, copper 0.5 mg,
manganese 0.5 mg, Mg 1 mg, Zn 0.25 mg (Pehavral) 1,700

236 Amilase 4500 U, Protease 4050 U, Lipase 180 U dan simetikon 44 tablet Rp 957 0 0 0
mg per tablet (Vitazym Plus)

237 Curcuma xanthorrhiza Extract 20 mg (mengandung Curcuminoid tablet Rp 800 0 90 90

15%) (Cavicur) 90
238 Calcium carbonate 766 mg, Magnesium Hydroxide 372,5 mg, zinc 5 tablet Rp 5,106 0 0 0
mg, Vitamin D3 2,5 mcg, Boron 1 mg (Formical B)
239 Natrium Bikarbonat tablet 500 mg tablet Rp 10 0 0 0
240 Natrium Diklofenak emulgel tube Rp 16,040 0 20 20 2 18 30
241 Natrium Diklofenak tab. 25 mg tablet Rp 142 0 0 0 0 3,000
242 Natrium Diklofenak tab. 50 mg tablet Rp 109 0 0 0 0 3,000
243 Natrium Heparina gel @ 20 g tube Rp 26,585 0 18 18 18 30
244 Natrium Tiosulfat injeksi 25 % - 10 ml ampul Rp 14,768 0 0 0 0
245 Natrium laurilsulfoasetat, Natrium sulfat, Sorbitol, PEG 400 enema tube Rp 29,360 0 0 0 20
@ 5 ml (Mikrolax) 0
246 Neurotropik (Vit B1 100 mg, Vit B6 200 mg, Vit B12) injeksi ampul Rp 6,160 0 0 0 0
247 Neurotropik (Vit B1 100 mg, Vit B6 200 mg, Vit B12) tablet Rp 1,045 479 0 479 479 0 3,000
248 Nifedipin tablet 10 mg tablet Rp 383 421 0 421 60 361 300
249 Nistatin oral drop botol Rp 38,500 10 0 10 10 0
250 Nistatin tablet salut 500.000 IU tablet Rp 881 100 0 100 100
251 Nistatin tablet vaginal 100.000 IU / g tablet Rp 645 0 0 0 0
252 Norepinefrin inj 1 mg/ml ampul Rp 55,248 0 0 0 0
252 Norit (Carbo adsorben) tablet tube Rp 11,000 0 0 0 0
253 Noskapin 25 mg kapsul Rp 5,585 0 0 0
254 Obat Anti Malaria/OAM (DHP) tablet Rp 2,000 45 0 45 45
255 Obat Anti Tuberkulosis Kategori Anak ( FDC ) paket Rp 267,400 0 0 0 0
256 Obat Anti Tuberkulosis Kategori I ( FDC ) paket Rp 430,539 2 0 2 2
257 Obat Anti Tuberkulosis Kategori II ( FDC ) paket Rp 1,492,574 0 0 0 0
258 Obat Anti Tuberkulosis Kategori III paket Rp 154,000 0 0 0 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
259 Obat Anti Tuberkulosis Sisipan paket Rp 66,000 0 0 0 0
260 Obat Plus
OBH Batuk Hitam
100 ( O B H ) sirup200
ml (Paracetamol 100mg,
ml.pseudoefedrin 3 mg, botol Rp 7,493 0 0 0 0
261 CTM 0.5mg, Amonium klorida 25 mg, Succus liquiritiae 75 mg botol Rp 12,100 0 0 0 0
262 per 5ml)
Oksimetazolin tts hidung 0.025% @10 ml botol Rp 40,326 0 0 0 0
263 Oksimetazolin tts hidung 0.05% @10 ml botol Rp 36,000 0 0 0 0
264 Oksitetrasiklin HCl injeksi i.m 50 mg/ ml - 10 ml vial Rp 3,255 0 0 0 0
265 Oksitetrasiklin HCl salap 3 % 5 g tube Rp 2,398 57 25 82 12 70 75
266 Oksitetrasiklin HCl salap mata 1 % @ 3,5 g. tube Rp 2,600 0 0 0 0 50
267 Oksitoksin inj 10 IU / ml-1 ml ampul Rp 1,398 0 100 100 100
268 Omeprazol capsul 20 mg capsul Rp 129 0 0 0 0 2,000
Omeprazol injeksi vial Rp 11,245 30 10 40 12 28 20
269 Ondansetron injeksi 4mg/2ml @ 2ml ampul Rp 963 0 0 0 0 30
270 Ondansetron tablet 8mg tablet Rp 2,967 0 510 510 510 1,000
271 Pancreatin komb. tablet tablet Rp 3,080 0 0 0 0 500
272 Papaverin inj 40 mg / ml ampul Rp 716 0 0 0 0
273 Papaverin tablet 40 mg tablet Rp 766 0 0 0 0
274 Parasetamol 125 mg rektal Suppos Rp 37,762 12 12 24 3 21 12
275 Parasetamol 250 mg rektal Suppos Rp 55,944 12 0 12 12 12
276 Parasetamol drop 100 mg/ml @ 10ml botol Rp 5,204 0 0 0 0
277 Parasetamol syr 120mg / 5 ml @ 60 ml botol Rp 1,160 272 0 272 272
278 Parasetamol tablet 500 mg tablet Rp 337 3,000 500 3,500 2,341 1,159 6,000
279 Perak sulfadiazin krim 1% tube Rp 27,528 0 0 0 0
280 Permetrin krim 5 % tube Rp 11,250 0 0 0
281 Pirantel tablet 125 mg tablet Rp 331 100 100 200 200
282 Pirantel pamoat susp 125 mg/5 ml botol Rp 10,900 9 0 9 9 0 20
283 Pirasetam inj ampul Rp 2,021 0 0 0 0
284 Pirasetam tablet 400 mg tablet Rp 983 100 0 100 100
285 Piratiazin teoklat 40 mg, Piridoksin HCl 30 mg tablet tablet Rp 2,933 0 0 0 0
286 Pirazinamid tablet 500 mg tablet Rp 248 0 0 0 0
287 Piridoksin tablet 10 mg tablet Rp 72 341 0 341 171 170 2,000
288 Piridoksin injeksi 1 ml. ampul Rp 1,050 0 0 0 0
289 Piroksikam capsul 10 mg capsul Rp 132 5,495 5200 10,695 840 9,855
290 Piroksikam tablet 20 mg tablet Rp 149 2,071 1000 3,071 478 2,593 2,000
291 Povidon Iodida 10 % 30 ml botol Rp 3,110 30 10 40 2 38
292 Povidon Iodida 10 % 300 ml botol Rp 20,700 0 0 0 0
293 Prednison tablet 5 mg tablet Rp 73 427 2000 2,427 473 1,954
294 Primakuin tablet 15 mg tablet Rp 258 200 0 200 200
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
295 Prokain Benzil Penisillin injeksi 3 Juta IU vial Rp 375 0 0 0 0
296 Propanolol HCl tablet 40 mg tablet Rp 343 200 0 200 200
297 Propanolol tablet 10 mg tablet Rp 69 0 0 0 0
298 Propiltiourasil tablet 100 mg tablet Rp 440 200 0 200 200
299 Psidii folium 250 mg/5ml @ 60 ml botol Rp 53,613 0 0 0 0
300 Ranitidine Inj 25 mg/ml @ 2 ml ampul Rp 858 0 0 0 50
301 Ranitidine tablet 150 mg tablet Rp 85 243 0 243 243 0 3,000
302 Reserpin tablet 0,10 mg tablet Rp 26 0 0 0 0
303 Reserpin tablet 0,25 mg tablet Rp 45 0 0 0 0
304 Retinol (Vitamin A) Dosis Tinggi 100.000 IU capsul Rp 327 0 0 0 0
305 Retinol (Vitamin A) Dosis Tinggi 200.000 IU capsul Rp 582 150 0 150 5 145
306 Rifampisin capsul 300 mg capsul Rp 785 0 0 0 0
307 Rifampisin kaplet 450 mg kaplet Rp 1,031 0 0 0 0
308 Rifampisin kaplet 600 mg kaplet Rp 1,420 0 0 0 0
309 Risperidon tab sal 2 mg tablet Rp 130 100 0 100 100 0
310 Salap 2 - 4 Kombinasi : As.Salisilat 2 % + Belerang Endap 4 % @ pot Rp 1,475 0 0 0 20
30 g 0
312 Salbutamol inhalasi 100 mcg/dosis @ 200 dosis botol Rp 145,364 0 0 0 0 10
313 Salbutamol Nebules cairan ih 0.1% @ 2.5ml ampul Rp 5,400 12 0 12 12 40
314 Salbutamol tablet 2 mg tablet Rp 51 1,400 300 1,700 373 1,327 700
315 Salbutamol tablet 4 mg tablet Rp 67 2,106 300 2,406 209 2,197 700
316 Salisil Bedak 2 % @ 50 g dus Rp 6,600 35 0 35 35
317 Serum Anti Bisa Ular I injeksi (ABU I) (im/iv) @ 5ml vial Rp 517,132 1 0 1 1
318 Serum Anti Difteri injeksi 20.000 IU / vial (ADS) vial Rp 732,848 0 0 0 0
319 Serum Anti Tetanus injeksi 1.500 IU/ml (ATS) @1 ml ampul Rp 140,188 0 0 0 0
320 Serum Anti Tetanus injeksi 20.000 IU / Vial (ATS) vial Rp 130,999 0 0 0 0
321 Sianokobalamin injeksi 500 mcg/ml - 1 ml ampul Rp 1,066 124 0 124 124
322 Sianokobalamin tablet 50 mcg tablet Rp 44 7,352 7000 14,352 960 13,392
323 Simvastatin tablet 10 mg tablet Rp 73 1,632 500 2,132 400 1,732 3,000
324 Simvastatin 20 mg tablet tablet Rp 150 840 0 840 250 590 3,000
325 Streptomisin injeksi 1500 mg / ml @ 15 ml. vial Rp 54,840 0 0 0 0
326 Teofilin Tablet 150 mg tablet Rp 310 0 0 0 0
327 Terbutalin tablet 2,5 mg tablet Rp 88 0 0 0 0
328 Tetrasiklin HCl kapsul 500 mg capsul Rp 777 0 0 0 0
329 Tiamfenikol capsul 500 mg capsul Rp 1,205 0 0 0 0
330 Tiamin HCl injeksi 100 mg / ml - 1 ml ampul Rp 1,035 0 0 0 0
331 Tiamin HCl tablet 50 mg tablet Rp 246 6,001 5200 11,201 250 10,951
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
332 Timolol 0.5% tetes mata 5 ml botol Rp 12,100 20 0 20 20
333 Tramadol capsul 50 mg capsul Rp 361 0 0 0 0
334 Tramadol Injeksi 50 mg/ml @ 2ml ampul Rp 6,383 0 0 0 0
335 Triheksifenidil Hidroklorida tab 2 mg tablet Rp 63 100 0 100 100
336 Tripolidin Hcl 1.25mg, Pseudoefedrin Hcl 30mg/5ml @60 ml botol Rp 11,267 0 55 55
55
337 Tripolidin HCl 2.5 mg, Pseudoefedrin 60 mg tablet tablet Rp 1,593 1,602 1000 2,602 586 2,016 3,000
338 Vitamin B-Kompleks tablet tablet Rp 60 1,500 2000 3,500 580 2,920 5,000
339 Vitamin D3 1000 IU tablet tablet Rp 2,872 0 0 0 0 1,000
340 Vitamin B1 100 mg, B6 200 mg, B12 200 mcg, vit E 30 mg per tablet tablet Rp 1,787 0 0 0 2,000
341 (Lapibion)
Zinc siup 20 mg/5 ml @ 60 ml botol Rp 2,489 0 0 0 20
342 Zinc tablet dispersible 20 mg tablet Rp 536 1,273 1000 2,273 420 1,853
BAHAN HABIS PAKAI
343 Alat Suntik Sekali Pakai 1 ml pcs Rp 1,050 0 100 100 22 78 200
344 Alat Suntik Sekali Pakai 3 ml pcs Rp 1,000 513 100 613 220 393 200
345 Alat Suntik Sekali Pakai 5 ml pcs Rp 1,100 0 100 100 100 200
346 Alat Suntik Sekali Pakai 10 ml pcs Rp 1,200 0 0 0 200
347 Alcohol swab pcs Rp 126 1030 300 1,330 300 1,030 500
348 Antiseptik tangan dengan dibilas 500 ml botol Rp 79,000 0 0 0
349 Antiseptik tangan tanpa dibilas 500 ml botol Rp 72,500 8 9 17 1 16 9
350 Arm sling ukuran S pcs Rp 17,424 2 2 2
351 Arm sling ukuran M pcs Rp 17,424 1 1 1
352 Arm sling ukuran L pcs Rp 17,424 1 1 1
353 Autoclick lancing device pcs Rp 18,287 2 2 2
354 Bracket hand wash plastik pcs Rp 19,360 5 5 5
355 Bistury / mata pisau bedah pcs Rp 575 0 0 0 100
356 Blood lancet pcs Rp 145 900 300 1,200 200 1,000 300
357 Box Slide (kotak slides) isi untuk 50 slides kotak Rp 14,080 0 0 0
358 Cat Gut Chromic No. 2/0 DS 19 mm pcs Rp 29,806 12 12 12 12
359 Cat Gut Chromic No. 3/0 DS 19 mm pcs Rp 29,806 0 0 0
360 Cat Gut Plain No. 2/0 DS 19 mm pcs Rp 29,806 33 33 33 12
361 Cat Gut Plain No. 3/0 DS 19 mm pcs Rp 29,806 38 38 38
362 Cervical collar universal (neck collar) pcs Rp 127,776 1 1 1
363 Disposible Blood Transfution set Rp 17,595 5 5 5 10
364 Feeding tube 3,5 fr (3,5cm) set Rp 8,841 0 0 0
365 Folley Catheter 2. W 30 cc No.14 pcs Rp 13,320 7 7 7
366 Folley Catheter 2. W 30 cc No.16 pcs Rp 13,320 7 7 7
367 Folley Catheter 2. W 30 cc No.18 pcs Rp 13,320 11 11 11
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
368 Handscoon No.6 non steril pasang Rp 3,000 0 0
369 Handscoon No.6.5 non steril pasang Rp 3,000 0 0
370 Handscoon No.7.5 non steril pasang Rp 3,000 0 0
371 Handscoon No.6.5 steril pasang Rp 5,400 0 0 0
372 Handscoon No.7 steril pasang Rp 5,400 0 0 0
373 Handscoon No.7.5 steril pasang Rp 5,400 35 35 35
374 Handscoon (gloves) ukuran L pcs Rp 392 200 350 550 200 350 200
375 Handscoon (gloves) ukuran M pcs Rp 392 0 0 0 500
376 Handscoon (gloves) ukuran S pcs Rp 564 0 0 0 500
377 Handschoon obgyn steril pasang Rp 30,819 0 0 0
378 I.V. Canula Venocath No. 20 pcs Rp 16,088 0 0 0
379 I.V. Canula Venocath No. 22 pcs Rp 16,088 90 90 90
380 I.V. Canula Venocath No. 26 pcs Rp 14,824 12 12 12
381 I.V. Catheter Nomor 18 pcs Rp 18,426 37 37 4 33
382 I.V. Catheter Nomor 20 pcs Rp 18,426 78 78 2 76
383 I.V. Catheter Nomor 22 pcs Rp 18,426 82 82 5 77
384 I.V. Catheter Nomor 24 pcs Rp 18,426 55 100 155 10 145 100
385 Infus Set Anak set Rp 3,500 0 0 0 100
386 Infus Set Dewasa set Rp 7,192 7 7 7 0 100
387 Kapas Berlemak 500 gram roll Rp 41,575 0 0 0 0
388 Kapas Pembalut / Absorben 250 gram roll Rp 26,273 1 1 0 1
389 Kasa Hidrofil 40 x 80 cm roll Rp 158,180 4 2 6 2 4 5
390 Kasa hidrofil 36 x 80 cm roll Rp 147,327 0 0 0
391 Kasa Hidrofil Steril 18 x 22 cm (isi 12 lbr) bungkus Rp 7,500 0 0 0 50
392 Kasa Kompres 40 cm x 40 cm bungkus Rp 1,600 44 44 5 39
393 Kasa Pembalut 16 x 16 steril kotak Rp 8,000 0 0 0 50
394 Kasa Pembalut 2 m x 80 cm bungkus Rp 10,780 16 16 16
395 Kasa Pembalut Hidrofil 4 m x 10 cm roll Rp 2,035 24 2 26 4 22 50
396 Kasa Pembalut Hidrofil 4 m x 15 cm roll Rp 2,838 10 10 5 5 50
397 Kasa Pembalut Hidrofil 4 m x 3 cm roll Rp 85,800 36 20 56 20 36 50
398 Kasa Pembalut Hidrofil 4 m x 5 cm roll Rp 102,300 53 20 73 10 63 50
399 Elastic Verban 15 cm x 4.55m (Tensocrepe) roll Rp 44,300 0 0 0 0
400 Mask (sungkup) oksigen anak pcs Rp 8,400 0 0 0 50
401 Mask (sungkup) oksigen dewasa pcs Rp 8,400 0 0 0 50
402 Masker hi oxygen dewasa (non rebreathing mask) pcs Rp 14,137 0 0 0
403 Masker Disposible 3 ply pcs Rp 990 956 1000 1,956 200 1,756 300
404 Masker 4 ply earloop kotak Rp 72,655 0 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
405 Masker N95 pcs Rp 19,500 140 140 140
406 Nasal canula anak pcs Rp 4,200 0 0 0 50
407 Nasal canula bayi pcs Rp 4,200 0 0 0 50
408 Nasal canula dewasa pcs Rp 4,200 0 0 50
406 Needle 23 G pcs Rp 311 313 313 40 273
407 Needle 24 G pcs Rp 311 232 232 40 192 200
408 Needle 25 G pcs Rp 311 66 66 34 32 200
409 NGT (Naso Gastric Tube/stomach tube) no.14 pcs Rp 12,870 7 7 7
410 NGT (Naso Gastric Tube/stomach tube) no.16 pcs Rp 12,870 10 10 10
411 NGT (Naso Gastric Tube/stomach tube) no.18 pcs Rp 12,870 7 7 7
412 Pembalut elastis ukuran 4 inci (10 cm x 4.55 m) roll Rp 37,500 22 22 22
413 Pembalut elastis ukuran 6 inci (15 cm x 4.55 m) roll Rp 48,100 24 24 2 22
414 Pembalut Gips roll Rp 5,600 0 0 0
415 Plester 5 cm x 5 m roll Rp 16,500 15 7 22 5 17 15
416 Plester kertas 9.2 m X 2,5 cm dengan pemotong roll Rp 8,575 0 0 0
417 Plester Tahan Air ( 25 cm x 10 cm ) pcs Rp 14,459 8 8 2 6 10
418 Plester transparan 5 m X 1,25 cm roll Rp 16,500 0 0 0
419 Penjepit Tali Pusat pcs Rp 2,430 32 32 32
420 S i l k ( Benang Bedah Sutera ) No. 1 DS 24 mm sachet Rp 31,040 0 0 0 12
421 S i l k ( Benang Bedah Sutera ) No. 2/0 DS 19 mm sachet Rp 31,765 0 0 0
422 S i l k ( Benang Bedah Sutera ) No. 3/0 DS 19 mm sachet Rp 31,125 0 0 0 12
423 S i l k ( Benang Bedah Sutera ) No. 4/0 DS 19 mm sachet Rp 31,765 0 0 0
424 Safety Box kotak Rp 20,182 0 0 2
425 Speculum vaginal disposible pcs Rp 11,220 100 100 100
426 Three (3) way pcs Rp 12,631 15 15 15
427 Underpad ukuran 60x90 cm steril pcs Rp 48,840 0 0 0
428 Underpad (120X100) pcs Rp 66,600 0 0
429 Urine Bag set Rp 8,804 38 38 38
PERBEKALAN KESEHATAN GIGI
430 Air Raksa Dental Use 100 G. botol Rp 220,000
431 Bahan pengisi saluran akar gigi set Rp 234,025
432 Bonding refill set Rp 509,000 1
434 Cairan Irigasi NaOCl 5% dan EDTA 5% inf 1000 ml botol Rp 158,125
435 Devitalisasi Pasta ( Non Arsen ) botol Rp 255,800 1
436 Echant (etching) set Rp 113,850 1
437 Glass Ionomer semen (serbuk + larutan) set Rp 362,667
438 Gutta percha kotak Rp 37,400
439 Kalsium Hidroksida pasta @ 2 tube set Rp 1,063,700
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
440 Klorfenol Kamfer Mentol ( CHKM ) cairan 10 ml. botol Rp 71,667 1
441 Micro brush ktk Rp 185,500
442 Micro Aplicator kotak Rp 54,251
443 Mummifying Pasta botol Rp 600,600
444 Semen Seng Fosfat serbuk & Cairan set Rp 159,000
445 Silver Amalgam serbuk 65 - 75 % 1 oz set Rp 410,300
446 Spons gelatin Cubicles 1 x 1 x 1 cm @ 24 pcs kotak Rp 106,700 1
447 Temporary Stopping Fletcher serbuk 100 g. & cairan set Rp 199,100
448 Trikresol Formalin (TKF) botol Rp 77,333
449 Tumpatan Composite (Light cured) set Rp 854,000
450 Tumpatan Composite Anterior A2/B2 Tube Rp 572,600 1
451 Tumpatan Composite Anterior A3 Tube Rp 269,500 1
452 Tumpatan Composite Anterior A3.5 Tube Rp 572,600
453 Tumpatan sementara (Caviton) set Rp 132,900 1
456 Turbocaina (pengganti cresophene) ktk Rp 404,800
BAHAN LABORATORIUM (REAGEN KIMIA)
457 Dect Glass / cover glass pcs Rp 138 0 0 0
459 Fixer 20 lt jerigen Rp 759,000 0 0 0
460 Film Rongent dental 3 x 4 pcs Rp 18,227 0 0 0
461 Film Rongent uk 24 x 30 pcs Rp 4,670 0 0 0
462 Film Rongent uk 30 x 40 pcs Rp 7,680 0 0 0
463 Film Rongent uk 35 x 35 pcs Rp 8,100 0 0 0
464 Filter Paper pcs Rp 1,150 0 0 0
466 Larutan Anisol 100 ml botol Rp 611,086 0 0 0
467 Larutan Asam Asetat6% 100 ml botol Rp 18,000 0 0 0
468 Larutan Asam Klorida 0,1N 100 ml botol Rp 10,560 0 0 0
469 Larutan Asam sulfosalisilat 20 % 100 ml. botol Rp 271,000 0 0 0
470 Larutan Benedict 100 ml. botol Rp 17,900 0 0 0
471 Larutan Eosin 2 % 100 ml. botol Rp 165,000 0 0 0
472 Larutan Etanol Asam 3% 100 ml. botol Rp 48,510 0 0 0
473 Larutan Giemsa Stain 100 ml. botol Rp 540,000 0 0 0
474 Larutan H2O2 3% @ 100 ml botol Rp 30,000 0 0 0
475 Larutan Hayem 100 ml botol Rp 45,500 0 0 0
476 Larutan Karbol Fuchsin 100 ml. botol Rp 121,296 0 0 0
477 Larutan KOH 10% 100 ml botol Rp 18,730 0 0 0
478 Larutan Mersi Oil 100 ml botol Rp 750,000 0 0 0
479 Larutan Metanol 100 ml. botol Rp 37,800 0 0 0
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11
480 Larutan Metilen Biru 100 ml. botol Rp 51,492 0 0
481 Larutan Natrium Citras 3 % @100 ml botol Rp 18,000 0 0 0
482 Larutan Ress echer 100 ml botol Rp 42,000 0 0 0
483 Larutan Turk 100 ml. botol Rp 23,240 0 0 0 0
484 Larutan Ziehl Nielsen paket Rp 178,750 0 0 0
485 Lidi Vagina pcs Rp 1,167 0 0 0
486 Object glass / Slide Glass pcs Rp 269 0 0 0
487 Pot Sputum pcs Rp 3,900 85 85 85
488 Rapid test for Dengue IgG/IgM pcs Rp 22,631 108 108 10 98 50
489 Rapid test for Dengue Ns1 pcs Rp 34,890 0 0 0
490 Rapid test HBsAg Antigen (Prog utk Bumil) pcs Rp 4,453 78 78 30 48 50
491 Rapid test for Malaria Pan/Pf pcs Rp 47,397 0 0 0 0 100
492 Rapid test for Malaria Pf dan Pv pcs Rp 53,260 0 0 0
493 Rapid test HIV 1/2 pcs Rp 15,377 0 0 0
494 Rapid test HIV Lini 2 (triline) pcs Rp 57,684 0 0 0
495 Rapid test HIV Lini 3 pcs Rp 13,735 0 0 0
496 Rapid test HIV Lini I pcs Rp 85,894 71 71 15 56 100
497 Rapid test sipilis pcs Rp 13,904 59 59 25 34 100
498 Reagen Pemeriksa Gol Darah Anti A @10 ml botol Rp 68,200 0 0 0 1
499 Reagen Pemeriksa Gol Darah Anti B @ 10 ml botol Rp 68,200 0 0 0 1
500 Reagen Pemeriksa Gol Darah (Fortress A & B) set Rp 214,000 0 0 0 1
501 RPR pcs Rp 5,218 0 0
502 Stick asam urat pcs Rp 14,090 432 200 632 100 532 100
503 Stick cholestrol pcs Rp 27,341 451 200 651 51 600 100
504 Stick gula darah pcs Rp 12,327 312 200 512 200 312 100
505 Stick Hemoglobin pcs Rp 9,956 0 0 0 300
506 Tabung Hematokrit pcs Rp 1,510 0 0 0
507 Tabung Vacutener tutup ungu dengan anti koagulan 3 ml pcs Rp 1,847 0 0 0 200
508 Tabung Vacutener Warna merah plain pcs Rp 1,847 0 0 0 0
509 Tes Kehamilan pcs Rp 990 89 100 189 23 166
510 TPHA pcs Rp 19,435 0 0 0
511 Tourniquet pcs Rp 42,200 0 0 0
512 Urinalysa 10 Parameter pcs Rp 112,776 0 0 1
513 Urinalysa 3 Parameter pcs Rp 869 172 100 272 78 194 2
JUMLAH TOTAL PERSEDIAAN
NO NAMA OBAT SATUAN HARGA STOK AWAL PENERIM PERSEDI PEMAKA STOK STOK PERMINT
SATUAN AAN AAN IAN AKHIR OPTIMUM AAN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11

UMUM BPJS KTP JUMLAH

JUMLAH KUNJUNGAN RESEP
18 368 506 892

Menyetujui Yang Menyerahkan Yang Melapor Petugas Pengel

Kepala Dinas Kesehatan Kepala Balai Pengelola Farmasi dan Alkes Kepala Puskesmas Puskesm
Kabupaten Bintan Kabupaten Bintan

(..........................................) (......................................) (NENI YULIANTI, S.ST) (apt. SUCI NUZUL RA

NIP. 19810711 200903 2 005
: DESEMBER
: 2022
PEMBERI TOTAL
KET
AN HARGA
12 13=4*9 14

600 sudah
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14

500 sudah
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
300 sudah

500 sudah

200 sudah

500 sudah
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14

300 sudah
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14

500 sudah
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14
 PEMBERI TOTAL KET
AN HARGA
12 13=4*9 14

Petugas Pengelola Obat

Puskesmas

UCI NUZUL RAHMAH, S.Farm)