LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BLUD

PUSKESMAS : KOKOP LAPORAN BULAN :

KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN Desa :
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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I OBAT JKN
1 Acyclovir salep Ampul
2 Air untuk Injeksi 25 ml Tablet
3 Alopurinol tablet 100 mg Tablet
4 Alopurinol tablet 300 mg Tablet
5 Ambroxol Tablet Botol
6 Ambroxol syrup botol
7 Aminofilin Tablet Ampul
8 Aminofilin injeksi 24 mg/ml Tablet
9 Amitripyllin salut 25 mg Tablet
10 Amlodipin tablet 5 mg Vial
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet
14 Amlodipin 10mg Tablet
15 Amoksisilin tablet 500 mg Tablet
16 Ampicillin 500 mg Botol
17 Ampicillin syrup kering 125mg Vial
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida

20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml
21 Asam asetilsalisilat ( asetosal ) Tablet
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss
24 Asam Mefenamat kaplet 500 mg Ampul
25 Asam traneksamat injeksi 50 mg/ml Tablet
26 Asiklovir tablet 400 mg Tablet
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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27 Atapulgit tablet 600 mg Ampul
28 Atropin injeksi 0,25 mg/ml Botol
29 Atropin Sulfat tetes mata 0,5% Dus
30 Bedak salisil serbuk 2% tablet
31 Betahistin tab Tube
32 Betametason krim 0,1% (sebagai Valerat) supp
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet
35 Bisoprolol tablet 2,5 mg ampul
36 Citicoline Botol
37 Cystone ( obat batu ginjal ) Ampul
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet
40 Deksametason tablet 0,5 mg Ampul
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet
42 Diazepam tablet 5 mg Ampul
43 Diazepam inj Ampul
44 Difenhidramin injeksi i.v./i.m. Tablet
45 Digoksin tablet 0,25 mg tablet
46 Domperidon tablet 10 mg botol
47 Domperidon suspensi/sirup 5 mg/5 ml tablet
48 Dopamet tablet
49 Eritromisin kapsul 500 mg Botol
50 Eritromisin sirup kering 200 mg/ 5 ml vial
51 Esomeprazole sodium 40 mg / vial tablet
52 Etambutol tablet 500 mg Botol
53 Etanol 70% cairan Botol
54 Eugenol cairan tablet
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul
57 Furosemide inj tablet
58 Furosemide tablet 40 mg sach
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium

59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g
60 Gentamisin injeksi 40 mg/ ml Tube
61 Gentamisin salep mata 0,3% Botol
62 Gentamisin tetes mata 0,3% Tube
63 Gentamicin salep kulit Botol
64 Gentian Violet 10ml Tablet
65 Glibenklamid tablet 5 mg Tablet
66 Glikazid tab 80 mg Tablet
67 Glimepiride tablet 1 mg Tablet
68 Glimepiride tablet 2 mg Tablet
69 Gliseryl Guaicolat tab Tablet
70 Glucodex tablet botol
71 Glukosa larutan infus 10 % steril botol
72 Glukosa larutan infus 5 % steril Botol
73 Glukosa larutan 40 % tablet
74 Griseofulvin tablet 125 mg tablet
75 Haloperidol tablet 0,5 mg tablet
76 Haloperidol tablet 1,5 mg Tube
77 Hidrokortison krim 2,5 % tablet
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet
79 Hidroklorotiazid 25 mg tablet
80 Hiosin butilbromid tab( SCOPMA ) tablet
81 Hiosin butilbromid injeksi 20 mg/ml ampul
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM )
83 Ibuprofen tablet 400 mg botol
84 Ibuprofen suspensi 200 mg/5 ml tablet
85 Isosorbid dinitrat 5 mg tablet
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet
87 Kaptopril tablet scored 12,5 mg tablet
88 Kaptopril tablet scored 25 mg tablet
89 Karbamazepin Tablet 200 mg supp
90 Ketoprofen suppositoria Tube
91 Ketokonazol tablet 200 mg tablet
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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92 Ketokonazol krim 2% Tablet
93 Kloramfenikol kapsul 500 mg Tube
94 Kloramfenikol salep mata 1 % Botol
95 Klorampenikol TT ( Reco TT ) tablet
96 Klorfeniramina Maleat (CTM) 4 mg Tablet
97 Kloramfenicol salep kulit tube
98 Kodein tablet 10 mg Tablet
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg

Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium

105 Tablet
choloride 300mg , SASA 300mg, OBH

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort

Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,

108 tablet
Pseudoefedrin HCl 30 mg, Noza
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664

113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B

Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung

elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin
120 Laxadin syrup Ampul
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet
122 Loperamid tablet 2 mg tablet
123 Loratadine 10 mg botol
124 Magnesium sulfat injeksi 20% botol
125 Magnesium sulfat injeksi 40% Ampul
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial

Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap

127 Tablet
10 ml injeksi; Antagidon
128 Metampiron 500mg Tablet
129 Metformin HCl tablet 500 mg Tablet
130 Metilergometrin Maleat tablet salut 0,125 mg ampul
131 Metilergometrin inj 0,2 mg/ml tablet
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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132 Metilprednisolon tablet 4 mg tablet
133 Metilprednisolon tablett 8 mg Botol
134 Metoklopramide sirup 5 mg/ 5 ml Tablet
135 Metoklopramide tablet 5 mg ampul
136 Metoclopamide injeksi tablet
137 Metronidazol tablet 500 mg botol
138 Metronidazol infus 500 mg/100 ml tube
139 Mikonazol krim/salep 2 % (Nitrat) botol
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet
141 Nifedipin tablet 10 mg tablet
142 Nifedipin tablet 30 mg, Adalat Oros botol
143 Nacl 0,9% tablet
144 Natrium Diklofenak tablet 25 mg tablet
145 Natrium Diklofenak tablet 50 mg tablet
146 Nistatin Tablet Botol
147 Nistatin Drop botoll
148 Ofloksasin tetes telinga 3 % Ampul
149 Oksitosin inj 10 IU/ml Ampul
150 Omperazol injeksi Kaplet ss
151 Omeprazol kapsul/ kaplet 20 mg Ampul
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet
153 Ondansetron tablet 4 mg tube
154 Oxytetraxiliin salep kulit botol
155 Parasetamol sirup 120 mg / 5 ml Tablet
156 Parasetamol tablet 500 mg botol
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul
158 Phenobarbital injeksi Tablet
159 Phenobarbital 30 mg tube
160 Permetrin krim 5% ; Scabimide Cream Tablet
161 Piracetam 400 mg ampul
162 Piracetam 3 g injeksi tablet
163 Pirantel tablet 125 mg Tablet
164 Piroxicam 20 mg Tablet
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet
166 Prednison tablet 5 mg Tablet
167 Propanolol tablet 10 mg ( HCl ) Tablet
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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168 Propanolol tablet 40 mg ( HCl ) vial
169 Prokain Benzilpenisilin injeksi Ampul
170 Ranitidin injeksi 25 mg/ml tablet
171 Ranitidin tablet 150 mg tablet
172 Rifampicin 450 mg botol
173 Ringer Laktat larutan infus Botol
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

176 Salbutamol tablet 2 mg (sebagai Sulfat) tube

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

178 Sefadroksil kapsul/kaplet 500 mg botol

179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss
180 Sefiksim kapsul/kaplet 100 mg botol
181 Sefiksim sirup kering 100 mg/ 5 ml vial
182 Sefotaksim injeksi 1 g vial
183 Seftriakson serbuk injeksi 1 g/vial vial
184 Setirizin 10 mg kapsul botol
185 Setirizin sirup 5 mg/5 ml vial
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul
187 TETAGAM ampul
188 Sianokobalamin (vitamin B12) injeksi tablet
189 Simvastatin tablet 10 mg tablet
190 Simvastatin tablet 20 mg tablet
191 Siprofloksasin tablet scored 500 mg botol
192 Siprofloksasin infus 2 % tablet
193 Spironolakton 25 mg botol
194 Sukralfat susp 500 mg/5 mL kapsul
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet
197 Terbutalin 2,5 mg Ampul
198 Tramadol injeksi 50 mg/ml tablet
199 Thiamin tablet ( Vit B1 ) tablet
200 Thiamin inj ( Vit B1 ) Ampul
201 Thiamphenicol 500mg tablet
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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202 Thiamphenicol syrup botol
203 Vitamin B Kompleks tablet botol
204 Zinc sir 10 mg/mL botol
205 Zinc drop 10 mg/mL tablet
206 Zinc Tablet dispersible 20 mg 0
207 Kalium diclofenak 50mg 0
208 Perak Sulfadiazine cream 0
209 Desoximetasone cream 0
210 Herbakof syr 100ml botol
211 Stimuno syr 100ml botol
212 Stimuno capsul forte botol

OBAT dan BAHAN PERAWATAN GIGI Box

1 Bonding Set
2 Artikulating Paper Box'50Ampul
3 Calpul citojeck Btl
4 Ch Km Box'10
5 Curaspon Box'20s
6 Dental Needle Pcs
7 Devitalisasi Pasta Set
8 Diamond Bor / Mata Bor Box
9 Ethca btl
10 Etil Klorida Semprot Botol 10 ml
11 Eugenol cairan pcs
12 Formokresol pcs
13 Glass Ionomer Cement Botol
14 H2O2 100ml Botol
15 H2O2 800ml Pcs
16 Kalsium Hidroksida Pasta Set
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs
18 Mumifikasi Pasta Box
19 OCO (Pembersih karang gigi) Set
20 Polising Bor Pcs
21 Semen seng fosfat Set
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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22 Topical Floridasi / Preventive Carries Box
23 Tumpatan Sementara 0
0
0
0
BAHAN MEDIS HABIS PAKAI
1 Alat suntik sekali pakai 1 ml biji
2 Alat suntik sekali pakai 3 ml biji
3 Alat suntik sekali pakai 5 ml Dus,100
4 Alkohol Swab /100 pcz Dus
5 Antiseptik Hand Rub 10 btl@ 500ml biji
6 blood lancet Dus'24
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji
8 Cathejell Lidocain 2% & CHG 0.05% biji
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS
10 Cutimed Sorbact Swab 7cm x 9cm Tube
11 Duoderm hydroactive gel 15 gr Set
12 FolLey Chateter No. 14 Set
13 FolLey Chateter No. 16 Set
14 FolLey Chateter No.18 Dus, 100
15 Handscoon Non Steril Pasang
16 Handscoon Steril biji
17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin

19 Jarum Jahit set

20 jell cateter biji
21 Kapas Pembalut hydrofil 250 gr biji
22 Kasa Hydrofil steril 16 x16 cm biji
23 Kasa pembalut hidrofil 2 x 80 cm biji
24 Kasa pembalut hidrofil 4 x 10 cm biji
25 Kasa pembalut hidrofil 4 x 5 cm biji
26 Kasa pembalut hidrofil 4 x 80 cm biji
27 Kasa pembalut hidrofil 4 x15 cm box = 50's
28 Leukomed IV Film pcs
29 Masker / box pcs
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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30 Masker Nebulizer Anak pcs
31 Masker Nebulizer Dewasa biji
32 Medicut No. 18 biji
33 Medicut No. 20 biji
34 Medicut No. 22 biji
35 Medicut No. 24 pcs
36 Mess/ Pisau Bedah biji
37 Mucus extrator pcs
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs
42 Oksigen Masker Anak pcs
43 Oksigen Masker Dewasa biji
44 Pharmafix biji
45 plester 2,5 cm x 4,5 cm biji
46 Sarung tangan obgyn pcs
47 Silk Black 3/0 DS 24/biji Set
48 Strip asam urat Set
49 strip colesterol Set
50 Strip Gula darah pcs
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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51 Stomach Tube FR 12 / NGT pcs
52 Stomach Tube FR 16 / NGT pcs
53 Suction Catheter FR 12 / 16 biji
54 Surgical Tape 1" ( Plaster /Leukoplast) biji
55 Test kehamilan biji
56 Umbilical Clamp pcs
57 Underpad box
58 Urine Bag 0
59 Prontosan 350ml
60 Fixomule
61 cutget chromic
62 Rivanol
63 Needle 23
64 needle 24
65 Stabimite
66 Lysol
67 Povidon Iodine
68 Reagen Creatinin
69 Reagen SGOT
70 Sysmex cellclean rutin
71 sysmex cellpack diluent
72 sysmex sulfolyser 500ml
73 sysmex stromatolyser 4dl
74 sysmec stromatolyser 4ds
75 Reagen Urea
76 Reagen trigliserida kit
77 Reagen HDL
78 Reagen golongan darah Anti A
79 Reagen golongan darah Anti B
80 Reagen golongan darah Anti D
81 Reagen golongan darah Anti AB
82 Salmonella Typhi H
83 Salmonella Typhi O
84 Salmonella Typhi AO
85 Salmonella Paratyphi BO
86 strip urine
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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87 Medicut No. 26
YANG MENERIMA YANG MELAPOR
PETUGAS GUDANG OBAT BIDAN / PERAWAT DESA

Dwi Satria W, S.Kep.Ns

NIP : 19900419 201903 1 005

MENGETAHUI
KEPALA PUSKESMAS KOKOP

HJ.WINARTI,SST.Bd.MMKES
Nip : 197106201991022003
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : FEBRUARI
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

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60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
59 Prontosan 350ml 0 0 0
60 Fixomule 0 0 0
61 cutget chromic 0 0 0
62 Rivanol 0 0 0
63 Needle 23 0 0 0
64 needle 24 0 0 0
65 Stabimite 0 0 0
66 Lysol 0 0 0
67 Povidon Iodine 0 0 0
68 Reagen Creatinin 0 0 0
69 Reagen SGOT
70 Sysmex cellclean rutin
71 sysmex cellpack diluent
72 sysmex sulfolyser 500ml
73 sysmex stromatolyser 4dl
74 sysmec stromatolyser 4ds
75 Reagen Urea
76 Reagen trigliserida
77 Reagen HDL
78 Reagen golongan darah Anti A
79 Reagen golongan darah Anti B
80 Reagen golongan darah Anti D
81 Reagen golongan darah Anti AB
82 Salmonella Typhi H
83 Salmonella Typhi O
84 Salmonella Typhi AO
85 Salmonella Paratyphi BO
86 strip urine
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
87 Medicut No. 26
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : MARET
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit set 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : APRIL
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : MEI
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 TETAGAM ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit set 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : JUNI
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium

105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0

Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0
0 #REF! #REF! #REF!
0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0
Sysmex cellclean rutin 0
sysmex cellpack diluent 0
sysmex sulfolyser 500ml 0
sysmex stromatolyser 4dl 0
sysmec stromatolyser 4ds 0
Reagen Urea 0
Reagen trigliserida 0
Reagen HDL 0
Reagen golongan darah Anti A 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : JULI
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit set 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : AGUSTUS
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Ampul
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Tricresolfomalina Box 0 0 0
9 Attaque gel box 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : SEPTEMBER
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : OKTOBER
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit set 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : NOVEMBER
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Tablet
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit box 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
 LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT BPJS
PUSKESMAS : KOKOP LAPORAN BULAN : DESEMBER
KECAMATAN : KOKOP TAHUN : 2023
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0
5 Ambroxol Tablet Botol 0 0 0
6 Ambroxol syrup botol 0 0 0
7 Aminofilin Tablet Ampul 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0
14 Amlodipin 10mg Tablet 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0
16 Ampicillin 500 mg Botol 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

19 tablet
Hidroksida 200 mg Magnesium Hidroksida 200 mg 0 0 0
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
20 botol
200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0
31 Betahistin tab Tube 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0
36 Citicoline Botol 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0
Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5
38 Ampul
mg Salbutamol 2,5 mg cairan inhalasi 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0
43 Diazepam inj Ampul 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0
48 Dopamet tablet 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0
53 Etanol 70% cairan Botol 0 0 0
54 Eugenol cairan tablet 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
57 Furosemide inj tablet 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0
Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium
59 klorida 0.30 g trinatrium sitrat dihidrat 0.58 g glukosa anhidrat Ampul
2.70 g 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0
63 Gentamicin salep kulit Botol 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0
70 Glucodex tablet botol 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0
Human tetanus imunoglobulinn injeksi i.m. 250 UI
82 tablet
( TETAGAM ) 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0
Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg,
99 Botol
Paracetamol; Hustab 0 0 0
Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg,
100 Ampul
Dextromethorphan 3,75mg; Alpara 0 0 0
Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg,
101 Ampul
vit B12 5000mcg 0 0 0
Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit
102 Tablet
B12 200mcg 0 0 0

Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga

103 Tablet
sulfat 0,4mg, Vit C 100mg, As. Folat 2mg, Faktor Intrinsik 25mg
0 0 0

Komb.Multivitamin Syr Curcuminoid

104 6mg,VitA,D,B1,B2,B6,B12,C,Beta karoten,Lysin 200mg, DHA botol
16mg
0 0 0
Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium
105 Tablet
choloride 300mg , SASA 300mg, OBH 0 0 0

Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin,

106 Tablet
Natrium Fluorida, Lexavit
0 0 0

Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100

107 mcg, Ca Pantotenat 20 mg, Nikotinamida 50 mg, Vit C 500 mg, tablet
Vit E 30 mg;Becefort
0 0 0
Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg,
108 tablet
Pseudoefedrin HCl 30 mg, Noza 0 0 0
Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin
109 tablet
HCl 60 mg ;Zentra 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8

112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet

0 0 0
Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664
113 tablet
mg:kalium klorida 1,32 mg ; cendo lyters 0 0 0
Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg
114 Tablet
Trimetoprim 80 mg 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
115 botol
Trimetoprim 40 mg / 5 ml 0 0 0
Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3
116 botol
mEq,Asetat 28 mEq ) .;Asering 0 0 0
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa
117 botol
7,3 % dan elektrolit) 500 ml; Aminofluid 0 0 0

Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl

118 Botol
1,5 gr , Na lactat 2,24 gr,Dekstrosa 27 gr );KAEN 3B
0 0 0
Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung
elektrolit : sodium 145 mmol/l,potasium 4,0 mmol/l ,Calcium 2,5
119 Botol
mmol/l,Magnesium 1.0 mmol.l ,Chloride 118 mmol/l Acetat 24
mmol/l ,Malate 5,0 mmol/l ) ;Ringerfurdin 0 0 0
120 Laxadin syrup Ampul 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0
123 Loratadine 10 mg botol 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0 0 0
Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap
127 Tablet
10 ml injeksi; Antagidon 0 0 0
128 Metampiron 500mg Tablet 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0
136 Metoclopamide injeksi tablet 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0
143 Nacl 0,9% tablet 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0
146 Nistatin Tablet Botol 0 0 0
147 Nistatin Drop botoll 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0
159 Phenobarbital 30 mg tube 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0
161 Piracetam 400 mg ampul 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0
172 Rifampicin 450 mg botol 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0

175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet

0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0

177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul

0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0
187 Serum Anti Antitetanus 1.500 UI ( ATS ) ampul 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0
193 Spironolakton 25 mg botol 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0
202 Thiamphenicol syrup botol 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
204 Zinc sir 10 mg/mL botol 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0
209 Desoximetasone cream 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0
211 Stimuno syr 100ml botol 0 0 0
212 Stimuno capsul forte botol 0 0 0

0 #REF! #REF! #REF!

0 #REF! #REF! #REF!
OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0
1 Bonding Set 0 0 0
2 Artikulating Paper Box'50Ampul 0 0 0
3 Calpul citojeck Btl 0 0 0
4 Ch Km Box'10 0 0 0
5 Curaspon Box'20s 0 0 0
6 Dental Needle Pcs 0 0 0
7 Devitalisasi Pasta Set 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0
9 Ethca btl 0 0 0
10 Etil Klorida Semprot Botol 10 ml 0 0 0
11 Eugenol cairan pcs 0 0 0
12 Formokresol pcs 0 0 0
13 Glass Ionomer Cement Botol 0 0 0
14 H2O2 100ml Botol 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
15 H2O2 800ml Pcs 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0
18 Mumifikasi Pasta Box 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0
20 Polising Bor Pcs 0 0 0
21 Semen seng fosfat Set 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0
23 Tumpatan Sementara 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BAHAN MEDIS HABIS PAKAI biji 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0
6 blood lancet Dus'24 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0
15 Handscoon Non Steril Pasang 0 0 0
16 Handscoon Steril biji 0 0 0

17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji
0 0 0

18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin
0 0 0
19 Jarum Jahit set 0 0 0
20 jell cateter biji 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0
28 Leukomed IV Film pcs 0 0 0
29 Masker / box pcs 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0
32 Medicut No. 18 biji 0 0 0
33 Medicut No. 20 biji 0 0 0
34 Medicut No. 22 biji 0 0 0
35 Medicut No. 24 pcs 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0
37 Mucus extrator pcs 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0
42 Oksigen Masker Anak pcs 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0
44 Pharmafix biji 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0
46 Sarung tangan obgyn pcs 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0
48 Strip asam urat Set 0 0 0
49 strip colesterol Set 0 0 0
50 Strip Gula darah pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
51 Stomach Tube FR 12 / NGT pcs 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0
55 Test kehamilan biji 0 0 0
56 Umbilical Clamp pcs 0 0 0
57 Underpad box 0 0 0
58 Urine Bag 0 0 0 0
Prontosan 350ml 0 0 0
Fixomule 0 0 0
cutget chromic 0 0 0
Rivanol 0 0 0
Needle 23 0 0 0
needle 24 0 0 0
Stabimite 0 0 0
Lysol 0 0 0
Povidon Iodine 0 0 0
Reagen Creatinin 0 0 0
Reagen SGOT 0 0 0
Sysmex cellclean rutin 0 0 0
sysmex cellpack diluent 0 0 0
sysmex sulfolyser 500ml 0 0 0
sysmex stromatolyser 4dl 0 0 0
sysmec stromatolyser 4ds 0 0 0
Reagen Urea 0 0 0
Reagen trigliserida 0 0 0
Reagen HDL 0 0 0
Reagen golongan darah Anti A 0 0 0
Reagen golongan darah Anti B 0 0 0
Reagen golongan darah Anti D 0 0 0
Reagen golongan darah Anti AB 0 0 0
Salmonella Typhi H 0 0 0
Salmonella Typhi O 0 0 0
Salmonella Typhi AO 0 0 0
Salmonella Paratyphi BO 0 0 0
strip urine 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8
Medicut No. 26 0 0 0
MENGETAHUI YANG MENERIMA
KEPALA PUSKESMAS KOKOP PETUGAS GUDANG OBAT

HJ.WINARTI,SST.Bd.MMKES Dwi Satria W, S.Kep.Ns

Nip : 197106201991022003 NIP : 19900419 201903 1 005
REKAP PENERIMAAN OBAT PUSKESMAS TAHUN 2023

PUSKESMAS : KOKOP
KECAMATAN : KOKOP
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN

JANUARI
1 2 3 4
I OBAT JKN
1 Acyclovir salep Ampul 0
2 Air untuk Injeksi 25 ml Tablet 0
3 Alopurinol tablet 100 mg Tablet 0
4 Alopurinol tablet 300 mg Tablet 0
5 Ambroxol Tablet Botol 0
6 Ambroxol syrup botol 0
7 Aminofilin Tablet Ampul 0
8 Aminofilin injeksi 24 mg/ml Tablet 0
9 Amitripyllin salut 25 mg Tablet 0
10 Amlodipin tablet 5 mg Vial 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0
14 Amlodipin 10mg Tablet 0
15 Amoksisilin tablet 500 mg Tablet 0
16 Ampicillin 500 mg Botol 0
17 Ampicillin syrup kering 125mg Vial 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0
19 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg M tablet 0
20 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml botol 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0
24 Asam Mefenamat kaplet 500 mg Ampul 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0
26 Asiklovir tablet 400 mg Tablet 0
27 Atapulgit tablet 600 mg Ampul 0
28 Atropin injeksi 0,25 mg/ml Botol 0
29 Atropin Sulfat tetes mata 0,5% Dus 0
30 Bedak salisil serbuk 2% tablet 0
31 Betahistin tab Tube 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0
35 Bisoprolol tablet 2,5 mg ampul 0
36 Citicoline Botol 0
37 Cystone ( obat batu ginjal ) Ampul 0
38 Combivent UDV - Kombinasi : Ipratropium bromida inhalasi 0,5 mg SalbutamolAmpul 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0
40 Deksametason tablet 0,5 mg Ampul 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0
42 Diazepam tablet 5 mg Ampul 0
43 Diazepam inj Ampul 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0
45 Digoksin tablet 0,25 mg tablet 0
46 Domperidon tablet 10 mg botol 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0
48 Dopamet tablet 0
49 Eritromisin kapsul 500 mg Botol 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0
51 Esomeprazole sodium 40 mg / vial tablet 0
52 Etambutol tablet 500 mg Botol 0
53 Etanol 70% cairan Botol 0
54 Eugenol cairan tablet 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0
57 Furosemide inj tablet 0
58 Furosemide tablet 40 mg sach 0
59 Garam oralit I serbuk,kombinasi : Natrium klorida 0,52 g kalium klorida 0.30 g tAmpul 0
60 Gentamisin injeksi 40 mg/ ml Tube 0
61 Gentamisin salep mata 0,3% Botol 0
62 Gentamisin tetes mata 0,3% Tube 0
63 Gentamicin salep kulit Botol 0
64 Gentian Violet 10ml Tablet 0
65 Glibenklamid tablet 5 mg Tablet 0
66 Glikazid tab 80 mg Tablet 0
67 Glimepiride tablet 1 mg Tablet 0
68 Glimepiride tablet 2 mg Tablet 0
69 Gliseryl Guaicolat tab Tablet 0
70 Glucodex tablet botol 0
71 Glukosa larutan infus 10 % steril botol 0
72 Glukosa larutan infus 5 % steril Botol 0
73 Glukosa larutan 40 % tablet 0
74 Griseofulvin tablet 125 mg tablet 0
75 Haloperidol tablet 0,5 mg tablet 0
76 Haloperidol tablet 1,5 mg Tube 0
77 Hidrokortison krim 2,5 % tablet 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasien TB ) tablet 0
79 Hidroklorotiazid 25 mg tablet 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0
 81 Hiosin butilbromid injeksi 20 mg/ml ampul 0
82 Human tetanus imunoglobulinn injeksi i.m. 250 UI ( TETAGAM ) tablet 0
83 Ibuprofen tablet 400 mg botol 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0
85 Isosorbid dinitrat 5 mg tablet 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0
87 Kaptopril tablet scored 12,5 mg tablet 0
88 Kaptopril tablet scored 25 mg tablet 0
89 Karbamazepin Tablet 200 mg supp 0
90 Ketoprofen suppositoria Tube 0
91 Ketokonazol tablet 200 mg tablet 0
92 Ketokonazol krim 2% Tablet 0
93 Kloramfenikol kapsul 500 mg Tube 0
94 Kloramfenikol salep mata 1 % Botol 0
95 Klorampenikol TT ( Reco TT ) tablet 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0
97 Kloramfenicol salep kulit tube 0
98 Kodein tablet 10 mg Tablet 0
99 Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mg, Paracetamol; Hustab Botol 0
100 Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,125 mg, Dextromethorphan 3,Ampul 0
101 Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, vit B6 100mg, vit B12 5000m Tablet 0
102 Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 200mg, vit B12 200mcg Tablet 0
103 Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg, tembaga sulfat 0,4mg, Vit Tablet 0
104 Komb.Multivitamin Syr Curcuminoid 6mg,VitA,D,B1,B2,B6,B12,C,Beta karote botol 0
105 Komb.Obat Batuk Hitam Syr, Succus liguiritiac 500mg, amonium choloride 3 Tablet 0
106 Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multivitamin, Natrium FluoridaTablet 0
107 Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vit B12 100 mcg, Ca Pantoten tablet 0
108 Komb. Obat Flu Paracetamol 500mg, Tripolidine 2,5 mg, Pseudoefedrin HCl 3 tablet 0
109 Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, Pseudoefedrin HCl 60 mg ;Zetablet 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Trampara tablet 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0
112 Komb. Metamizol 500 mg dan diazepam 2 mg; Metaneuron tablet 0
113 Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8,664 mg:kalium klorida 1,3tablet 0
114 Kotrimoksazol (dewasa) kombinasi : Sulfametoksazol 400 mg Trimetoprim 80 Tablet 0
115 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg /botol 0
116 Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109 mEq,Ca 3 mEq,Asetat 28 mbotol 0
117 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan elektro botol 0
118 Larutan Mengandung karbohidrat + elektrolit (Nacl 1,75 gt,Kcl 1,5 gr , Na lact Botol 0
119 Larutan mengandung Elektrolit ( Tiap 1000 ml mengandung elektrolit : sodiu Botol 0
120 Laxadin syrup Ampul 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0
122 Loperamid tablet 2 mg tablet 0
123 Loratadine 10 mg botol 0
124 Magnesium sulfat injeksi 20% botol 0
125 Magnesium sulfat injeksi 40% Ampul 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norages inj vial 0
127 Metampiron 500mg, Piramidon 75mg, lidocain HCL 20mg tiap 10 ml injeksi; A Tablet 0
128 Metampiron 500mg Tablet 0
129 Metformin HCl tablet 500 mg Tablet 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0
131 Metilergometrin inj 0,2 mg/ml tablet 0
132 Metilprednisolon tablet 4 mg tablet 0
133 Metilprednisolon tablett 8 mg Botol 0
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0
135 Metoklopramide tablet 5 mg ampul 0
136 Metoclopamide injeksi tablet 0
137 Metronidazol tablet 500 mg botol 0
138 Metronidazol infus 500 mg/100 ml tube 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusin tablet 0
141 Nifedipin tablet 10 mg tablet 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0
143 Nacl 0,9% tablet 0
144 Natrium Diklofenak tablet 25 mg tablet 0
145 Natrium Diklofenak tablet 50 mg tablet 0
146 Nistatin Tablet Botol 0
147 Nistatin Drop botoll 0
148 Ofloksasin tetes telinga 3 % Ampul 0
149 Oksitosin inj 10 IU/ml Ampul 0
150 Omperazol injeksi Kaplet ss 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0
153 Ondansetron tablet 4 mg tube 0
154 Oxytetraxiliin salep kulit botol 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0
156 Parasetamol tablet 500 mg botol 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0
158 Phenobarbital injeksi Tablet 0
159 Phenobarbital 30 mg tube 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0
161 Piracetam 400 mg ampul 0
162 Piracetam 3 g injeksi tablet 0
163 Pirantel tablet 125 mg Tablet 0
164 Piroxicam 20 mg Tablet 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0
166 Prednison tablet 5 mg Tablet 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0
168 Propanolol tablet 40 mg ( HCl ) vial 0
169 Prokain Benzilpenisilin injeksi Ampul 0
170 Ranitidin injeksi 25 mg/ml tablet 0
171 Ranitidin tablet 150 mg tablet 0
172 Rifampicin 450 mg botol 0
173 Ringer Laktat larutan infus Botol 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0
175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolin Inhaler ) tablet 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0
177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% kapsul 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0
180 Sefiksim kapsul/kaplet 100 mg botol 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0
182 Sefotaksim injeksi 1 g vial 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0
184 Setirizin 10 mg kapsul botol 0
185 Setirizin sirup 5 mg/5 ml vial 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0
187 TETAGAM ampul 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0
189 Simvastatin tablet 10 mg tablet 0
190 Simvastatin tablet 20 mg tablet 0
191 Siprofloksasin tablet scored 500 mg botol 0
192 Siprofloksasin infus 2 % tablet 0
193 Spironolakton 25 mg botol 0
194 Sukralfat susp 500 mg/5 mL kapsul 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0
197 Terbutalin 2,5 mg Ampul 0
198 Tramadol injeksi 50 mg/ml tablet 0
199 Thiamin tablet ( Vit B1 ) tablet 0
200 Thiamin inj ( Vit B1 ) Ampul 0
201 Thiamphenicol 500mg tablet 0
202 Thiamphenicol syrup botol 0
203 Vitamin B Kompleks tablet botol 0
204 Zinc sir 10 mg/mL botol 0
205 Zinc drop 10 mg/mL tablet 0
206 Zinc Tablet dispersible 20 mg 0 0
207 Kalium diclofenak 50mg 0 0
208 Perak Sulfadiazine cream 0 0
209 Desoximetasone cream 0 0
210 Herbakof syr 100ml botol 0
211 Stimuno syr 100ml botol 0
212 Stimuno capsul forte botol 0
0
0
0
 #REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
### #REF! #REF! #REF!
### #REF! #REF! #REF!
0 OBAT dan BAHAN PERAWATAN GIGI Box 0
1 Bonding Set 0
2 Artikulating Paper Box'50Amp 0
3 Calpul citojeck Btl 0
4 Ch Km Box'10 0
5 Curaspon Box'20s 0
6 Dental Needle Pcs 0
7 Devitalisasi Pasta Set 0
8 Tricresolfomalina Box 0
9 Attaque gel btl 0
10 Etil Klorida Semprot Botol 10 m 0
11 Eugenol cairan pcs 0
12 Formokresol pcs 0
13 Glass Ionomer Cement Botol 0
14 H2O2 100ml Botol 0
15 H2O2 800ml Pcs 0
16 Kalsium Hidroksida Pasta Set 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0
18 Mumifikasi Pasta Box 0
19 OCO (Pembersih karang gigi) Set 0
20 Polising Bor Pcs 0
21 Semen seng fosfat Set 0
22 Topical Floridasi / Preventive Carries Box 0
23 Tumpatan Sementara 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 BAHAN MEDIS HABIS PAKAI 0 0
1 Alat suntik sekali pakai 1 ml biji 0
2 Alat suntik sekali pakai 3 ml biji 0
3 Alat suntik sekali pakai 5 ml Dus,100 0
4 Alkohol Swab /100 pcz Dus 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0
6 blood lancet Dus'24 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0
 9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0
11 Duoderm hydroactive gel 15 gr Set 0
12 FolLey Chateter No. 14 Set 0
13 FolLey Chateter No. 16 Set 0
14 FolLey Chateter No.18 Dus, 100 0
15 Handscoon Non Steril Pasang 0
16 Handscoon Steril biji 0
17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( 20 drop/ml ) biji 0
18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( 60 drop/ml ) lusin 0
19 Jarum Jahit set 0
20 jell cateter biji 0
21 Kapas Pembalut hydrofil 250 gr biji 0
22 Kasa Hydrofil steril 16 x16 cm biji 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0
28 Leukomed IV Film pcs 0
29 Masker / box pcs 0
30 Masker Nebulizer Anak pcs 0
31 Masker Nebulizer Dewasa biji 0
32 Medicut No. 18 biji 0
33 Medicut No. 20 biji 0
34 Medicut No. 22 biji 0
35 Medicut No. 24 pcs 0
36 Mess/ Pisau Bedah biji 0
37 Mucus extrator pcs 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0
42 Oksigen Masker Anak pcs 0
43 Oksigen Masker Dewasa biji 0
44 Pharmafix biji 0
45 plester 2,5 cm x 4,5 cm biji 0
46 Sarung tangan obgyn pcs 0
47 Silk Black 3/0 DS 24/biji Set 0
48 Strip asam urat Set 0
49 strip colesterol Set 0
50 Strip Gula darah pcs 0
51 Stomach Tube FR 12 / NGT pcs 0
52 Stomach Tube FR 16 / NGT pcs 0
53 Suction Catheter FR 12 / 16 biji 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0
55 Test kehamilan biji 0
56 Umbilical Clamp pcs 0
57 Underpad box 0
58 Urine Bag 0 0
59 Prontosan 350ml 0 0
60 Fixomule 0 0
61 cutget chromic 0 0
62 Rivanol 0 0
63 Needle 23 0 0
64 needle 24 0 0
65 Stabimite 0 0
66 Lysol 0 0
67 Povidon Iodine 0 0
68 Reagen Creatinin 0 0
69 Reagen SGOT 0 0
70 Sysmex cellclean rutin 0 0
71 sysmex cellpack diluent 0 0
72 sysmex sulfolyser 500ml 0 0
73 sysmex stromatolyser 4dl 0 0
74 sysmec stromatolyser 4ds 0 0
75 Reagen Urea 0 0
76 Reagen trigliserida kit 0
77 Reagen HDL 0 0
78 Reagen golongan darah Anti A 0 0
79 Reagen golongan darah Anti B 0 0
80 Reagen golongan darah Anti D 0 0
81 Reagen golongan darah Anti AB 0 0
82 Salmonella Typhi H 0 0
83 Salmonella Typhi O 0 0
84 Salmonella Typhi AO 0 0
85 Salmonella Paratyphi BO 0 0
86 strip urine 0 0
87 Medicut No. 26 0 0

MENGETAHUI
KEPALA PUSKESMAS KOKOP

HJ.WINARTI,SST.Bd.MMKES
Nip : 197106201991022003
 BULAN
PEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS SEPTEMBER OKTOBER NOPEMBER
5 6 7 8 9 10 11 12 13 14

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
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
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
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
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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
0 0 0 0 0 0 0 0 0 0

YANG MENERIMA
PETUGAS GUDANG OBAT

Dwi Satria W, S.Kep.Ns

NIP : 19900419 201903 1 005
 TOTAL
DESEMBER PENERIMAAN
15 16

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
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
0 0
0 0
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0 0
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0 0
0 0
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0 0
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0 0
0 0
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0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0
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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!
0 #REF!
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
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
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0 0
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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
0 0
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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

NG MENERIMA
AS GUDANG OBAT

atria W, S.Kep.Ns
00419 201903 1 005
REKAP PEMAKAIAN OBAT PUSKESMAS TAHUN 2023

PUSKESMAS : KOKOP
KECAMATAN : KOKOP
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR

NO NAMA OBAT SATUAN

JANUARI PEBRUARI MARET APRIL
1 2 3 4 5 6 7
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0 0
5 Ambroxol Tablet Botol 0 0 0 0
6 Ambroxol syrup botol 0 0 0 0
7 Aminofilin Tablet Ampul 0 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0 0
14 Amlodipin 10mg Tablet 0 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0 0
16 Ampicillin 500 mg Botol 0 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0 0
19 Antasida DOEN I tablet kunyah, kombinasi : Alum tablet 0 0 0 0
20 Antasida DOEN II suspensi, kombinasi : Aluminiu botol 0 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0 0
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0 0
31 Betahistin tab Tube 0 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0 0
36 Citicoline Botol 0 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0 0
38 Combivent UDV - Kombinasi : Ipratropium bromida Ampul
i 0 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0 0
43 Diazepam inj Ampul 0 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0 0
48 Dopamet tablet 0 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0 0
53 Etanol 70% cairan Botol 0 0 0 0
54 Eugenol cairan tablet 0 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0 0
57 Furosemide inj tablet 0 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0 0
59 Garam oralit I serbuk,kombinasi : Natrium klorida 0,Ampul 0 0 0 0
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0 0
63 Gentamicin salep kulit Botol 0 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0 0
65 Glibenklamid tablet 5 mg Tablet 0 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0 0
70 Glucodex tablet botol 0 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasi tablet 0 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0 0
 81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0 0
82 Human tetanus imunoglobulinn injeksi i.m. 250 UI tablet 0 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0 0
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0 0
99 Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mBotol 0 0 0 0
100 Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,12 Ampul 0 0 0 0
101 Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, v Tablet 0 0 0 0
102 Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 Tablet 0 0 0 0
103 Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg,Tablet 0 0 0 0
104 Komb.Multivitamin Syr Curcuminoid 6mg,VitA,D,B1botol 0 0 0 0
105 Komb.Obat Batuk Hitam Syr, Succus liguiritiac 5 Tablet 0 0 0 0
106 Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, mulTablet 0 0 0 0
107 Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vi tablet 0 0 0 0
108 Komb. Obat Flu Paracetamol 500mg, Tripolidine 2 tablet 0 0 0 0
109 Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, P tablet 0 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Tramtablet 0 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0 0
112 Komb. Metamizol 500 mg dan diazepam 2 mg; Me tablet 0 0 0 0
113 Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8tablet 0 0 0 0
114 Kotrimoksazol (dewasa) kombinasi : Sulfametoksa Tablet 0 0 0 0
115 Kotrimoksazol Suspensi komb: Sulfametoksazol 200botol 0 0 0 0
116 Larutan mengandung Elektrolit ( Na 130 mEq,Cl 10 botol 0 0 0 0
117 Larutan mengandung Asam Amino (Asam Amino 30botol g, 0 0 0 0
118 Larutan Mengandung karbohidrat + elektrolit (NaclBotol
1 0 0 0 0
119 Larutan mengandung Elektrolit ( Tiap 1000 ml mengBotol 0 0 0 0
120 Laxadin syrup Ampul 0 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0 0
123 Loratadine 10 mg botol 0 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norage vial 0 0 0 0
127 Metampiron 500mg, Piramidon 75mg, lidocain HCL Tablet2 0 0 0 0
128 Metampiron 500mg Tablet 0 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0 0
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0 0
136 Metoclopamide injeksi tablet 0 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofus tablet 0 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0 0
143 Nacl 0,9% tablet 0 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0
146 Nistatin Tablet Botol 0 0 0 0
147 Nistatin Drop botoll 0 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0 0
159 Phenobarbital 30 mg tube 0 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0 0
161 Piracetam 400 mg ampul 0 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0 0
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0 0
172 Rifampicin 450 mg botol 0 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0 0
175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolitablet 0 0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0 0
177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belera kapsul 0 0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0 0
187 TETAGAM ampul 0 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0 0
193 Spironolakton 25 mg botol 0 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0 0
202 Thiamphenicol syrup botol 0 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0 0
204 Zinc sir 10 mg/mL botol 0 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0 0
209 Desoximetasone cream 0 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0 0
211 Stimuno syr 100ml botol 0 0 0 0
212 Stimuno capsul forte botol 0 0 0 0
### #REF! #REF! #REF! 0 0 0
### #REF! #REF! #REF! 0 0 0
0 OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0 0
1 Bonding Set 0 0 0 0
2 Artikulating Paper Box'50Amp 0 0 0 0
3 Calpul citojeck Btl 0 0 0 0
4 Ch Km Box'10 0 0 0 0
5 Curaspon Box'20s 0 0 0 0
6 Dental Needle Pcs 0 0 0 0
7 Devitalisasi Pasta Set 0 0 0 0
8 Tricresolfomalina Box 0 0 0 0
9 Attaque gel btl 0 0 0 0
10 Etil Klorida Semprot Botol 10 m 0 0 0 0
11 Eugenol cairan pcs 0 0 0 0
12 Formokresol pcs 0 0 0 0
13 Glass Ionomer Cement Botol 0 0 0 0
14 H2O2 100ml Botol 0 0 0 0
15 H2O2 800ml Pcs 0 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0 0
18 Mumifikasi Pasta Box 0 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0 0
20 Polising Bor Pcs 0 0 0 0
21 Semen seng fosfat Set 0 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0 0
23 Tumpatan Sementara 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 BAHAN MEDIS HABIS PAKAI 0 0 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0 0
6 blood lancet Dus'24 0 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0 0
 9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0 0
15 Handscoon Non Steril Pasang 0 0 0 0
16 Handscoon Steril biji 0 0 0 0
17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( biji 0 0 0 0
18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( lusin 0 0 0 0
19 Jarum Jahit set 0 0 0 0
20 jell cateter biji 0 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0 0
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0 0
28 Leukomed IV Film pcs 0 0 0 0
29 Masker / box pcs 0 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0 0
32 Medicut No. 18 biji 0 0 0 0
33 Medicut No. 20 biji 0 0 0 0
34 Medicut No. 22 biji 0 0 0 0
35 Medicut No. 24 pcs 0 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0 0
37 Mucus extrator pcs 0 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0 0
42 Oksigen Masker Anak pcs 0 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0 0
44 Pharmafix biji 0 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0 0
46 Sarung tangan obgyn pcs 0 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0 0
48 Strip asam urat Set 0 0 0 0
49 strip colesterol Set 0 0 0 0
50 Strip Gula darah pcs 0 0 0 0
51 Stomach Tube FR 12 / NGT pcs 0 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0 0
55 Test kehamilan biji 0 0 0 0
56 Umbilical Clamp pcs 0 0 0 0
57 Underpad box 0 0 0 0
58 Urine Bag 0 0 0 0 0
59 Prontosan 350ml 0 0 0 0 0
60 Fixomule 0 0 0 0 0
61 cutget chromic 0 0 0 0 0
62 Rivanol 0 0 0 0 0
63 Needle 23 0 0 0 0 0
64 needle 24 0 0 0 0 0
65 Stabimite 0 0 0 0 0
66 Lysol 0 0 0 0 0
67 Povidon Iodine 0 0 0 0 0
68 Reagen Creatinin 0 0 0 0 0
69 Reagen SGOT 0 0 0 0 0
70 Sysmex cellclean rutin 0 0 0 0 0
71 sysmex cellpack diluent 0 0 0 0 0
72 sysmex sulfolyser 500ml 0 0 0 0 0
73 sysmex stromatolyser 4dl 0 0 0 0 0
74 sysmec stromatolyser 4ds 0 0 0 0 0
75 Reagen Urea 0 0 0 0 0
76 Reagen trigliserida kit 0 0 0 0
77 Reagen HDL 0 0 0 0 0
78 Reagen golongan darah Anti A 0 0 0 0 0
79 Reagen golongan darah Anti B 0 0 0 0 0
80 Reagen golongan darah Anti D 0 0 0 0 0
81 Reagen golongan darah Anti AB 0 0 0 0 0
82 Salmonella Typhi H 0 0 0 0 0
83 Salmonella Typhi O 0 0 0 0 0
84 Salmonella Typhi AO 0 0 0 0 0
85 Salmonella Paratyphi BO 0 0 0 0 0
86 strip urine 0 0 0 0 0
87 Medicut No. 26 0 0 0 0 0

MENGETAHUI
KEPALA PUSKESMAS KOKOP

HJ.WINARTI,SST.Bd.MMKES
Nip : 197106201991022003
 BULAN
MEI JUNI JULI AGUSTUS SEPTEMBER OKTOBER NOPEMBER DESEMBER TOTAL PEMAKAIAN
8 9 10 11 12 13 14 15 16

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YANG MENERIMA
PETUGAS GUDANG OBAT

Dwi Satria W, S.Kep.Ns

NIP : 19900419 201903 1 005
REKAP SISA OBAT PUSKESMAS TAHUN 2023

PUSKESMAS : KOKOP
KECAMATAN : KOKOP
KABUPATEN : BANGKALAN
PROPINSI : JAWA TIMUR
BULAN
NO NAMA OBAT SATUAN
JANUARI PEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS SEPTEMBER
1 2 3 4 5 6 7 8 9 10 11 12
I OBAT JKN
1 Acyclovir salep Ampul 0 0 0 0 0 0 0 0 0
2 Air untuk Injeksi 25 ml Tablet 0 0 0 0 0 0 0 0 0
3 Alopurinol tablet 100 mg Tablet 0 0 0 0 0 0 0 0 0
4 Alopurinol tablet 300 mg Tablet 0 0 0 0 0 0 0 0 0
5 Ambroxol Tablet Botol 0 0 0 0 0 0 0 0 0
6 Ambroxol syrup botol 0 0 0 0 0 0 0 0 0
7 Aminofilin Tablet Ampul 0 0 0 0 0 0 0 0 0
8 Aminofilin injeksi 24 mg/ml Tablet 0 0 0 0 0 0 0 0 0
9 Amitripyllin salut 25 mg Tablet 0 0 0 0 0 0 0 0 0
10 Amlodipin tablet 5 mg Vial 0 0 0 0 0 0 0 0 0
11 Amocixillin serbuk inj i.v 1000 mg / vial Botol 0 0 0 0 0 0 0 0 0
12 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0 0 0 0 0 0 0
13 Amoksisilin sirup kering forte 250 mg/5 ml Tablet 0 0 0 0 0 0 0 0 0
14 Amlodipin 10mg Tablet 0 0 0 0 0 0 0 0 0
15 Amoksisilin tablet 500 mg Tablet 0 0 0 0 0 0 0 0 0
16 Ampicillin 500 mg Botol 0 0 0 0 0 0 0 0 0
17 Ampicillin syrup kering 125mg Vial 0 0 0 0 0 0 0 0 0
18 Ampicillin serbuk inj i.v 1000 mg/ml Tablet 0 0 0 0 0 0 0 0 0
19 Antasida DOEN I tablet kunyah, kombinasi : Alum tablet 0 0 0 0 0 0 0 0 0
20 Antasida DOEN II suspensi, kombinasi : Aluminium botol 0 0 0 0 0 0 0 0 0
21 Asam asetilsalisilat ( asetosal ) Tablet 0 0 0 0 0 0 0 0 0
22 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0 0 0 0 0 0 0
23 Asam Askorbat (Vitamin C) tablet 50 mg Kaplet ss 0 0 0 0 0 0 0 0 0
24 Asam Mefenamat kaplet 500 mg Ampul 0 0 0 0 0 0 0 0 0
25 Asam traneksamat injeksi 50 mg/ml Tablet 0 0 0 0 0 0 0 0 0
26 Asiklovir tablet 400 mg Tablet 0 0 0 0 0 0 0 0 0
27 Atapulgit tablet 600 mg Ampul 0 0 0 0 0 0 0 0 0
28 Atropin injeksi 0,25 mg/ml Botol 0 0 0 0 0 0 0 0 0
29 Atropin Sulfat tetes mata 0,5% Dus 0 0 0 0 0 0 0 0 0
30 Bedak salisil serbuk 2% tablet 0 0 0 0 0 0 0 0 0
31 Betahistin tab Tube 0 0 0 0 0 0 0 0 0
32 Betametason krim 0,1% (sebagai Valerat) supp 0 0 0 0 0 0 0 0 0
33 Bisakodil suppositoria 5 mg ( dulcolax supp ) supp 0 0 0 0 0 0 0 0 0
34 Bisakodil suppositoria 10 mg ( dulcolax supp ) Tablet 0 0 0 0 0 0 0 0 0
35 Bisoprolol tablet 2,5 mg ampul 0 0 0 0 0 0 0 0 0
36 Citicoline Botol 0 0 0 0 0 0 0 0 0
37 Cystone ( obat batu ginjal ) Ampul 0 0 0 0 0 0 0 0 0
38 Combivent UDV - Kombinasi : Ipratropium bromida A i mpul 0 0 0 0 0 0 0 0 0
39 Deksametason injeksi i.v./i.m. 5 mg/ml tablet 0 0 0 0 0 0 0 0 0
40 Deksametason tablet 0,5 mg Ampul 0 0 0 0 0 0 0 0 0
41 Diazepam larutan rektal 5 mg/2,5 mL ( Stesolid ) tablet 0 0 0 0 0 0 0 0 0
42 Diazepam tablet 5 mg Ampul 0 0 0 0 0 0 0 0 0
43 Diazepam inj Ampul 0 0 0 0 0 0 0 0 0
44 Difenhidramin injeksi i.v./i.m. Tablet 0 0 0 0 0 0 0 0 0
45 Digoksin tablet 0,25 mg tablet 0 0 0 0 0 0 0 0 0
46 Domperidon tablet 10 mg botol 0 0 0 0 0 0 0 0 0
47 Domperidon suspensi/sirup 5 mg/5 ml tablet 0 0 0 0 0 0 0 0 0
48 Dopamet tablet 0 0 0 0 0 0 0 0 0
49 Eritromisin kapsul 500 mg Botol 0 0 0 0 0 0 0 0 0
50 Eritromisin sirup kering 200 mg/ 5 ml vial 0 0 0 0 0 0 0 0 0
51 Esomeprazole sodium 40 mg / vial tablet 0 0 0 0 0 0 0 0 0
52 Etambutol tablet 500 mg Botol 0 0 0 0 0 0 0 0 0
53 Etanol 70% cairan Botol 0 0 0 0 0 0 0 0 0
54 Eugenol cairan tablet 0 0 0 0 0 0 0 0 0
55 Fitomenadion (Vit.K1) tablet salut gula 10 mg Ampul 0 0 0 0 0 0 0 0 0
56 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0 0 0 0 0 0 0
57 Furosemide inj tablet 0 0 0 0 0 0 0 0 0
58 Furosemide tablet 40 mg sach 0 0 0 0 0 0 0 0 0
59 Garam oralit I serbuk,kombinasi : Natrium klorida 0,Ampul 0 0 0 0 0 0 0 0 0
60 Gentamisin injeksi 40 mg/ ml Tube 0 0 0 0 0 0 0 0 0
61 Gentamisin salep mata 0,3% Botol 0 0 0 0 0 0 0 0 0
62 Gentamisin tetes mata 0,3% Tube 0 0 0 0 0 0 0 0 0
63 Gentamicin salep kulit Botol 0 0 0 0 0 0 0 0 0
64 Gentian Violet 10ml Tablet 0 0 0 0 0 0 0 0 0
 65 Glibenklamid tablet 5 mg Tablet 0 0 0 0 0 0 0 0 0
66 Glikazid tab 80 mg Tablet 0 0 0 0 0 0 0 0 0
67 Glimepiride tablet 1 mg Tablet 0 0 0 0 0 0 0 0 0
68 Glimepiride tablet 2 mg Tablet 0 0 0 0 0 0 0 0 0
69 Gliseryl Guaicolat tab Tablet 0 0 0 0 0 0 0 0 0
70 Glucodex tablet botol 0 0 0 0 0 0 0 0 0
71 Glukosa larutan infus 10 % steril botol 0 0 0 0 0 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0 0 0 0 0 0
73 Glukosa larutan 40 % tablet 0 0 0 0 0 0 0 0 0
74 Griseofulvin tablet 125 mg tablet 0 0 0 0 0 0 0 0 0
75 Haloperidol tablet 0,5 mg tablet 0 0 0 0 0 0 0 0 0
76 Haloperidol tablet 1,5 mg Tube 0 0 0 0 0 0 0 0 0
77 Hidrokortison krim 2,5 % tablet 0 0 0 0 0 0 0 0 0
78 Hepagard Capsul ( kesehatan fungsi hati untuk pasi tablet 0 0 0 0 0 0 0 0 0
79 Hidroklorotiazid 25 mg tablet 0 0 0 0 0 0 0 0 0
80 Hiosin butilbromid tab( SCOPMA ) tablet 0 0 0 0 0 0 0 0 0
81 Hiosin butilbromid injeksi 20 mg/ml ampul 0 0 0 0 0 0 0 0 0
82 Human tetanus imunoglobulinn injeksi i.m. 250 UI tablet 0 0 0 0 0 0 0 0 0
83 Ibuprofen tablet 400 mg botol 0 0 0 0 0 0 0 0 0
84 Ibuprofen suspensi 200 mg/5 ml tablet 0 0 0 0 0 0 0 0 0
85 Isosorbid dinitrat 5 mg tablet 0 0 0 0 0 0 0 0 0
86 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet 0 0 0 0 0 0 0 0 0
87 Kaptopril tablet scored 12,5 mg tablet 0 0 0 0 0 0 0 0 0
88 Kaptopril tablet scored 25 mg tablet 0 0 0 0 0 0 0 0 0
89 Karbamazepin Tablet 200 mg supp 0 0 0 0 0 0 0 0 0
90 Ketoprofen suppositoria Tube 0 0 0 0 0 0 0 0 0
91 Ketokonazol tablet 200 mg tablet 0 0 0 0 0 0 0 0 0
92 Ketokonazol krim 2% Tablet 0 0 0 0 0 0 0 0 0
93 Kloramfenikol kapsul 500 mg Tube 0 0 0 0 0 0 0 0 0
94 Kloramfenikol salep mata 1 % Botol 0 0 0 0 0 0 0 0 0
95 Klorampenikol TT ( Reco TT ) tablet 0 0 0 0 0 0 0 0 0
96 Klorfeniramina Maleat (CTM) 4 mg Tablet 0 0 0 0 0 0 0 0 0
97 Kloramfenicol salep kulit tube 0 0 0 0 0 0 0 0 0
98 Kodein tablet 10 mg Tablet 0 0 0 0 0 0 0 0 0
99 Komb. Bronhexin Hcl 8mg, Diphenhidramin Hcl 25mBotol 0 0 0 0 0 0 0 0 0
100 Komb. Parasetamol 125 mg, CTM 0.5 mg, PPA 3,12 Ampul 0 0 0 0 0 0 0 0 0
101 Komb. Vit Neurotropik 5000 injeksi vit BI 100mg, v Tablet 0 0 0 0 0 0 0 0 0
102 Komb. Vit Neurotropik tablet vit BI 100mg, vit B6 Tablet 0 0 0 0 0 0 0 0 0
103 Komb.Besi II Fumarat 300mg, Mangan sulfat 0,4mg,Tablet 0 0 0 0 0 0 0 0 0
104 Komb.Multivitamin Syr Curcuminoid 6mg,VitA,D,B1botol 0 0 0 0 0 0 0 0 0
105 Komb.Obat Batuk Hitam Syr, Succus liguiritiac 5 Tablet 0 0 0 0 0 0 0 0 0
106 Komb. Calsium Lactat 250mg, Fe90mg, as.Folat, multTablet 0 0 0 0 0 0 0 0 0
107 Komb. Multivitamin Vit B1 15 mg, Vit B2 10 mg, Vi tablet 0 0 0 0 0 0 0 0 0
108 Komb. Obat Flu Paracetamol 500mg, Tripolidine 2 tablet 0 0 0 0 0 0 0 0 0
109 Komb. Obat pilek Tab./Komb. Tripolidine 2,5 mg, P tablet 0 0 0 0 0 0 0 0 0
110 Komb. Tramodol Hcl 37, Paracetamol 325 mg. Tramtablet 0 0 0 0 0 0 0 0 0
111 Komb.Vit. Neurotropik, Vit.E, ATP; Bio ATP tablet 0 0 0 0 0 0 0 0 0
112 Komb. Metamizol 500 mg dan diazepam 2 mg; Me tablet 0 0 0 0 0 0 0 0 0
113 Kombinasi tetes mata 2,5 mg/ml : Natrium klorida 8tablet 0 0 0 0 0 0 0 0 0
114 Kotrimoksazol (dewasa) kombinasi : Sulfametoksa Tablet 0 0 0 0 0 0 0 0 0
115 Kotrimoksazol Suspensi komb: Sulfametoksazol 200botol 0 0 0 0 0 0 0 0 0
116 Larutan mengandung Elektrolit ( Na 130 mEq,Cl 109botol 0 0 0 0 0 0 0 0 0
117 Larutan mengandung Asam Amino (Asam Amino 30botol g, 0 0 0 0 0 0 0 0 0
118 Larutan Mengandung karbohidrat + elektrolit (NaclBotol
1 0 0 0 0 0 0 0 0 0
119 Larutan mengandung Elektrolit ( Tiap 1000 ml mengBotol 0 0 0 0 0 0 0 0 0
120 Laxadin syrup Ampul 0 0 0 0 0 0 0 0 0
121 Lidokain injeksi 2% (HCl) + Epinefrin 1:80000-2ml tablet 0 0 0 0 0 0 0 0 0
122 Loperamid tablet 2 mg tablet 0 0 0 0 0 0 0 0 0
123 Loratadine 10 mg botol 0 0 0 0 0 0 0 0 0
124 Magnesium sulfat injeksi 20% botol 0 0 0 0 0 0 0 0 0
125 Magnesium sulfat injeksi 40% Ampul 0 0 0 0 0 0 0 0 0
126 Metamizol Sodium Liquid injeksi 500mg/1ml; Norage vial 0 0 0 0 0 0 0 0 0
127 Metampiron 500mg, Piramidon 75mg, lidocain HCL T2ablet 0 0 0 0 0 0 0 0 0
128 Metampiron 500mg Tablet 0 0 0 0 0 0 0 0 0
129 Metformin HCl tablet 500 mg Tablet 0 0 0 0 0 0 0 0 0
130 Metilergometrin Maleat tablet salut 0,125 mg ampul 0 0 0 0 0 0 0 0 0
131 Metilergometrin inj 0,2 mg/ml tablet 0 0 0 0 0 0 0 0 0
132 Metilprednisolon tablet 4 mg tablet 0 0 0 0 0 0 0 0 0
133 Metilprednisolon tablett 8 mg Botol 0 0 0 0 0 0 0 0 0
134 Metoklopramide sirup 5 mg/ 5 ml Tablet 0 0 0 0 0 0 0 0 0
135 Metoklopramide tablet 5 mg ampul 0 0 0 0 0 0 0 0 0
136 Metoclopamide injeksi tablet 0 0 0 0 0 0 0 0 0
137 Metronidazol tablet 500 mg botol 0 0 0 0 0 0 0 0 0
138 Metronidazol infus 500 mg/100 ml tube 0 0 0 0 0 0 0 0 0
139 Mikonazol krim/salep 2 % (Nitrat) botol 0 0 0 0 0 0 0 0 0
140 Modified fluid gelatin BM 3000 lar inf 4 % ; Gelofusitablet 0 0 0 0 0 0 0 0 0
141 Nifedipin tablet 10 mg tablet 0 0 0 0 0 0 0 0 0
142 Nifedipin tablet 30 mg, Adalat Oros botol 0 0 0 0 0 0 0 0 0
143 Nacl 0,9% tablet 0 0 0 0 0 0 0 0 0
144 Natrium Diklofenak tablet 25 mg tablet 0 0 0 0 0 0 0 0 0
145 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0 0 0 0 0 0
146 Nistatin Tablet Botol 0 0 0 0 0 0 0 0 0
147 Nistatin Drop botoll 0 0 0 0 0 0 0 0 0
148 Ofloksasin tetes telinga 3 % Ampul 0 0 0 0 0 0 0 0 0
149 Oksitosin inj 10 IU/ml Ampul 0 0 0 0 0 0 0 0 0
150 Omperazol injeksi Kaplet ss 0 0 0 0 0 0 0 0 0
151 Omeprazol kapsul/ kaplet 20 mg Ampul 0 0 0 0 0 0 0 0 0
152 Ondansetron inj 2 mg/ 2 mL ( 4mg/2ml ) tablet 0 0 0 0 0 0 0 0 0
153 Ondansetron tablet 4 mg tube 0 0 0 0 0 0 0 0 0
154 Oxytetraxiliin salep kulit botol 0 0 0 0 0 0 0 0 0
155 Parasetamol sirup 120 mg / 5 ml Tablet 0 0 0 0 0 0 0 0 0
156 Parasetamol tablet 500 mg botol 0 0 0 0 0 0 0 0 0
157 Parasetamol tetes 60 mg/ 0,6 ml Ampul 0 0 0 0 0 0 0 0 0
158 Phenobarbital injeksi Tablet 0 0 0 0 0 0 0 0 0
159 Phenobarbital 30 mg tube 0 0 0 0 0 0 0 0 0
160 Permetrin krim 5% ; Scabimide Cream Tablet 0 0 0 0 0 0 0 0 0
161 Piracetam 400 mg ampul 0 0 0 0 0 0 0 0 0
162 Piracetam 3 g injeksi tablet 0 0 0 0 0 0 0 0 0
163 Pirantel tablet 125 mg Tablet 0 0 0 0 0 0 0 0 0
164 Piroxicam 20 mg Tablet 0 0 0 0 0 0 0 0 0
165 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 0 0 0 0 0 0 0 0 0
166 Prednison tablet 5 mg Tablet 0 0 0 0 0 0 0 0 0
167 Propanolol tablet 10 mg ( HCl ) Tablet 0 0 0 0 0 0 0 0 0
168 Propanolol tablet 40 mg ( HCl ) vial 0 0 0 0 0 0 0 0 0
169 Prokain Benzilpenisilin injeksi Ampul 0 0 0 0 0 0 0 0 0
170 Ranitidin injeksi 25 mg/ml tablet 0 0 0 0 0 0 0 0 0
171 Ranitidin tablet 150 mg tablet 0 0 0 0 0 0 0 0 0
172 Rifampicin 450 mg botol 0 0 0 0 0 0 0 0 0
173 Ringer Laktat larutan infus Botol 0 0 0 0 0 0 0 0 0
174 Salbutamol cairan ih 0,1 % Ventolin nebul Vial 0 0 0 0 0 0 0 0 0
175 Salbutamol inhalasi/aerosol 100 mcg/dosis ( Ventolitablet 0 0 0 0 0 0 0 0 0
176 Salbutamol tablet 2 mg (sebagai Sulfat) tube 0 0 0 0 0 0 0 0 0
177 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belera kapsul 0 0 0 0 0 0 0 0 0
178 Sefadroksil kapsul/kaplet 500 mg botol 0 0 0 0 0 0 0 0 0
179 Sefadroksil sirup kering 125 mg/5ml Kaplet ss 0 0 0 0 0 0 0 0 0
180 Sefiksim kapsul/kaplet 100 mg botol 0 0 0 0 0 0 0 0 0
181 Sefiksim sirup kering 100 mg/ 5 ml vial 0 0 0 0 0 0 0 0 0
182 Sefotaksim injeksi 1 g vial 0 0 0 0 0 0 0 0 0
183 Seftriakson serbuk injeksi 1 g/vial vial 0 0 0 0 0 0 0 0 0
184 Setirizin 10 mg kapsul botol 0 0 0 0 0 0 0 0 0
185 Setirizin sirup 5 mg/5 ml vial 0 0 0 0 0 0 0 0 0
186 Serum Anti Bisa Ular I Inj.5 ml ( ABU I ) ampul 0 0 0 0 0 0 0 0 0
187 TETAGAM ampul 0 0 0 0 0 0 0 0 0
188 Sianokobalamin (vitamin B12) injeksi tablet 0 0 0 0 0 0 0 0 0
189 Simvastatin tablet 10 mg tablet 0 0 0 0 0 0 0 0 0
190 Simvastatin tablet 20 mg tablet 0 0 0 0 0 0 0 0 0
191 Siprofloksasin tablet scored 500 mg botol 0 0 0 0 0 0 0 0 0
192 Siprofloksasin infus 2 % tablet 0 0 0 0 0 0 0 0 0
193 Spironolakton 25 mg botol 0 0 0 0 0 0 0 0 0
194 Sukralfat susp 500 mg/5 mL kapsul 0 0 0 0 0 0 0 0 0
195 Tetrasiklin tablet/kapsul/kaplet 250 mg kapsul 0 0 0 0 0 0 0 0 0
196 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet 0 0 0 0 0 0 0 0 0
197 Terbutalin 2,5 mg Ampul 0 0 0 0 0 0 0 0 0
198 Tramadol injeksi 50 mg/ml tablet 0 0 0 0 0 0 0 0 0
199 Thiamin tablet ( Vit B1 ) tablet 0 0 0 0 0 0 0 0 0
200 Thiamin inj ( Vit B1 ) Ampul 0 0 0 0 0 0 0 0 0
201 Thiamphenicol 500mg tablet 0 0 0 0 0 0 0 0 0
202 Thiamphenicol syrup botol 0 0 0 0 0 0 0 0 0
203 Vitamin B Kompleks tablet botol 0 0 0 0 0 0 0 0 0
204 Zinc sir 10 mg/mL botol 0 0 0 0 0 0 0 0 0
205 Zinc drop 10 mg/mL tablet 0 0 0 0 0 0 0 0 0
206 Zinc Tablet dispersible 20 mg 0 0 0 0 0 0 0 0 0 0
207 Kalium diclofenak 50mg 0 0 0 0 0 0 0 0 0 0
208 Perak Sulfadiazine cream 0 0 0 0 0 0 0 0 0 0
209 Desoximetasone cream 0 0 0 0 0 0 0 0 0 0
210 Herbakof syr 100ml botol 0 0 0 0 0 0 0 0 0
211 Stimuno syr 100ml botol 0 0 0 0 0 0 0 0 0
212 Stimuno capsul forte botol 0 0 0 0 0 0 0 0 0
### #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
0 OBAT dan BAHAN PERAWATAN GIGI Box 0 0 0 0 0 0 0 0 0
1 Bonding Set 0 0 0 0 0 0 0 0 0
2 Artikulating Paper Box'50Amp 0 0 0 0 0 0 0 0 0
3 Calpul citojeck Btl 0 0 0 0 0 0 0 0 0
4 Ch Km Box'10 0 0 0 0 0 0 0 0 0
5 Curaspon Box'20s 0 0 0 0 0 0 0 0 0
6 Dental Needle Pcs 0 0 0 0 0 0 0 0 0
7 Devitalisasi Pasta Set 0 0 0 0 0 0 0 0 0
8 Diamond Bor / Mata Bor Box 0 0 0 0 0 0 0 0 0
9 Ethca btl 0 0 0 0 0 0 0 0 0
10 Etil Klorida Semprot Botol 10 m 0 0 0 0 0 0 0 0 0
11 Eugenol cairan pcs 0 0 0 0 0 0 0 0 0
12 Formokresol pcs 0 0 0 0 0 0 0 0 0
13 Glass Ionomer Cement Botol 0 0 0 0 0 0 0 0 0
14 H2O2 100ml Botol 0 0 0 0 0 0 0 0 0
15 H2O2 800ml Pcs 0 0 0 0 0 0 0 0 0
16 Kalsium Hidroksida Pasta Set 0 0 0 0 0 0 0 0 0
17 Komposit / Tumpatan dengan sinar / Lightcure Pcs 0 0 0 0 0 0 0 0 0
18 Mumifikasi Pasta Box 0 0 0 0 0 0 0 0 0
19 OCO (Pembersih karang gigi) Set 0 0 0 0 0 0 0 0 0
20 Polising Bor Pcs 0 0 0 0 0 0 0 0 0
21 Semen seng fosfat Set 0 0 0 0 0 0 0 0 0
22 Topical Floridasi / Preventive Carries Box 0 0 0 0 0 0 0 0 0
23 Tumpatan Sementara 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 0 0 0 0 0 0
0 BAHAN MEDIS HABIS PAKAI 0 0 0 0 0 0 0 0 0 0
1 Alat suntik sekali pakai 1 ml biji 0 0 0 0 0 0 0 0 0
2 Alat suntik sekali pakai 3 ml biji 0 0 0 0 0 0 0 0 0
3 Alat suntik sekali pakai 5 ml Dus,100 0 0 0 0 0 0 0 0 0
4 Alkohol Swab /100 pcz Dus 0 0 0 0 0 0 0 0 0
5 Antiseptik Hand Rub 10 btl@ 500ml biji 0 0 0 0 0 0 0 0 0
6 blood lancet Dus'24 0 0 0 0 0 0 0 0 0
7 Catgut Benang Bedah Plain 3/0HR 20 /37 biji 0 0 0 0 0 0 0 0 0
8 Cathejell Lidocain 2% & CHG 0.05% biji 0 0 0 0 0 0 0 0 0
9 Cucicell Classic 10 cm x 10 cm /Soffratulle PCS 0 0 0 0 0 0 0 0 0
10 Cutimed Sorbact Swab 7cm x 9cm Tube 0 0 0 0 0 0 0 0 0
11 Duoderm hydroactive gel 15 gr Set 0 0 0 0 0 0 0 0 0
12 FolLey Chateter No. 14 Set 0 0 0 0 0 0 0 0 0
13 FolLey Chateter No. 16 Set 0 0 0 0 0 0 0 0 0
14 FolLey Chateter No.18 Dus, 100 0 0 0 0 0 0 0 0 0
15 Handscoon Non Steril Pasang 0 0 0 0 0 0 0 0 0
16 Handscoon Steril biji 0 0 0 0 0 0 0 0 0
17 Infus Set, IV, Wing Neddle - Infusion Set Dewasa ( biji 0 0 0 0 0 0 0 0 0
18 Infus Set, IV, Wing Neddle - Infusion Set Pediatric ( lusin 0 0 0 0 0 0 0 0 0
19 Jarum Jahit set 0 0 0 0 0 0 0 0 0
20 jell cateter biji 0 0 0 0 0 0 0 0 0
21 Kapas Pembalut hydrofil 250 gr biji 0 0 0 0 0 0 0 0 0
22 Kasa Hydrofil steril 16 x16 cm biji 0 0 0 0 0 0 0 0 0
23 Kasa pembalut hidrofil 2 x 80 cm biji 0 0 0 0 0 0 0 0 0
24 Kasa pembalut hidrofil 4 x 10 cm biji 0 0 0 0 0 0 0 0 0
25 Kasa pembalut hidrofil 4 x 5 cm biji 0 0 0 0 0 0 0 0 0
26 Kasa pembalut hidrofil 4 x 80 cm biji 0 0 0 0 0 0 0 0 0
27 Kasa pembalut hidrofil 4 x15 cm box = 50's 0 0 0 0 0 0 0 0 0
28 Leukomed IV Film pcs 0 0 0 0 0 0 0 0 0
29 Masker / box pcs 0 0 0 0 0 0 0 0 0
30 Masker Nebulizer Anak pcs 0 0 0 0 0 0 0 0 0
31 Masker Nebulizer Dewasa biji 0 0 0 0 0 0 0 0 0
32 Medicut No. 18 biji 0 0 0 0 0 0 0 0 0
33 Medicut No. 20 biji 0 0 0 0 0 0 0 0 0
34 Medicut No. 22 biji 0 0 0 0 0 0 0 0 0
35 Medicut No. 24 pcs 0 0 0 0 0 0 0 0 0
36 Mess/ Pisau Bedah biji 0 0 0 0 0 0 0 0 0
37 Mucus extrator pcs 0 0 0 0 0 0 0 0 0
38 Nasal Anak - Nasal Oksigen, O2 cannula, size M pcs 0 0 0 0 0 0 0 0 0
39 Nasal Anak - Nasal Oksigen, O2 cannula, size S pcs 0 0 0 0 0 0 0 0 0
40 Nasal Anak - Nasal Oksigen, O2 cannula, size XS pcs 0 0 0 0 0 0 0 0 0
41 Nasal Dewasa - Nasal Oksigen,O2 cannula, size L pcs 0 0 0 0 0 0 0 0 0
42 Oksigen Masker Anak pcs 0 0 0 0 0 0 0 0 0
43 Oksigen Masker Dewasa biji 0 0 0 0 0 0 0 0 0
44 Pharmafix biji 0 0 0 0 0 0 0 0 0
45 plester 2,5 cm x 4,5 cm biji 0 0 0 0 0 0 0 0 0
46 Sarung tangan obgyn pcs 0 0 0 0 0 0 0 0 0
47 Silk Black 3/0 DS 24/biji Set 0 0 0 0 0 0 0 0 0
48 Strip asam urat Set 0 0 0 0 0 0 0 0 0
49 strip colesterol Set 0 0 0 0 0 0 0 0 0
50 Strip Gula darah pcs 0 0 0 0 0 0 0 0 0
51 Stomach Tube FR 12 / NGT pcs 0 0 0 0 0 0 0 0 0
52 Stomach Tube FR 16 / NGT pcs 0 0 0 0 0 0 0 0 0
53 Suction Catheter FR 12 / 16 biji 0 0 0 0 0 0 0 0 0
54 Surgical Tape 1" ( Plaster /Leukoplast) biji 0 0 0 0 0 0 0 0 0
55 Test kehamilan biji 0 0 0 0 0 0 0 0 0
56 Umbilical Clamp pcs 0 0 0 0 0 0 0 0 0
57 Underpad box 0 0 0 0 0 0 0 0 0
58 Urine Bag 0 0 0 0 0 0 0 0 0 0
59 Prontosan 350ml 0 0 0 0 0 0 0 0 0 0
60 Fixomule 0 0 0 0 0 0 0 0 0 0
61 cutget chromic 0 0 0 0 0 0 0 0 0 0
62 Rivanol 0 0 0 0 0 0 0 0 0 0
63 Needle 23 0 0 0 0 0 0 0 0 0 0
64 needle 24 0 0 0 0 0 0 0 0 0 0
65 Stabimite 0 0 0 0 0 0 0 0 0 0
66 Lysol 0 0 0 0 0 0 0 0 0 0
67 Povidon Iodine 0 0 0 0 0 0 0 0 0 0
68 Reagen Creatinin 0 0 0 0 0 0 0 0 0 0
69 Reagen SGOT 0 0 0 0 0 0 0 0 0 0
70 Sysmex cellclean rutin 0 0 0 0 0 0 0 0 0 0
71 sysmex cellpack diluent 0 0 0 0 0 0 0 0 0 0
72 sysmex sulfolyser 500ml 0 0 0 0 0 0 0 0 0 0
73 sysmex stromatolyser 4dl 0 0 0 0 0 0 0 0 0 0
74 sysmec stromatolyser 4ds 0 0 0 0 0 0 0 0 0 0
75 Reagen Urea 0 0 0 0 0 0 0 0 0 0
86 strip urine 0 0 0 0 0 0 0 0 0 0
87 Medicut No. 26 0 0 0 0 0 0 0 0 0 0

MENGETAHUI
KEPALA PUSKESMAS KOKOP

HJ.WINARTI,SST.Bd.MMKES
Nip : 197106201991022003
OKTOBER NOPEMBER DESEMBER
13 14 15

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YANG MENERIMA
PETUGAS GUDANG OBAT

Dwi Satria W, S.Kep.Ns

NIP : 19900419 201903 1 005