PEMERINTAH KABUPATEN TASIKMALAYA

D I N A S K E S E H A T A N DAN PENGENDALIAN PENDUDUK

UPTD PUSKESMAS SALOPA
Jln Raya Salopa No 226 Desa Mandalahayu Kec. Salopa Kode Pos 46192

LAMPIRAN BERITA ACARA PEMERIKSAAN BARANG (OBAT-OBATAN)

UPTD PUSKESMAS SALOPA
DINAS KESEHATAN DAN PENGENDALIAN PENDUDUK
KABUPATEN TASIKMALAYA
TAHUN 2021
Sumber Anggaran DAK
MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
1 Alat Suntik Sekali Pakai 1 ml Set 1,360 1,700 2,892 168 650 109,200
2 Alat Suntik Sekali Pakai 10 ml Set 25 - 25 - 1,450 -
3 Alat Suntik Sekali Pakai 2,5 ml Set 3,097 6,450 7,613 1,934 880 1,701,920
4 Alat Suntik Sekali Pakai 5 ml Set 1,579 1,400 2,680 299 1,100 328,900
5 Alat Suntik Auto Disable Siringe 0,5 m Set - 36,924 36,924 - 1,190 -
6 Alat Suntik Auto Disable Siringe 5 ml set - 201 201 - 1,100 -
7 Albendazol Tablet 400 mg Tablet - 8,500 8,500 - 367 -
8 Alkohol Swab pcs 2,154 28,899 31,053 - 95 -
9 Allopurinol Tablet 100 mg Tablet 150 700 850 - 105 -
10 Alprazolam Tablet 0,25 mg Tablet - - - - - -
11 Alprazolam Tablet 0,5 mg tablet - - - - - -
12 Alprazolam Tablet 1 mg Tablet - 200 - 200 128 25,600
13 Ambroksol Tablet 30 mg Tablet - - - - - -
14 Aminofilin Injeksi 24 mg/ml - 10 ml Ampul - - - - - -
15 Aminofilin Tablet 200 mg Tablet - - - - - -
16 Amitriptyline Tablet 25 mg Tablet 500 200 500 200 167 33,400
17 Amlodipine Tablet 5 mg Tablet - - - - - -
18 Amoksisilin Injeksi 1000 mg vial - - - - - -
19 Amoksisilin Sirup Kering 125 mg/5 ml Botol - 500 500 - 2,051 -
20 Amoksisilin Sirup Kering 250 mg/5 ml Botol - - - - - -
21 Amoksisilin Tablet 250 mg Tablet - - - - - -
22 Amoksisilin Tablet 500 mg Tablet 29,255 48,000 76,288 967 201 194,367
23 Antalgin Injeksi 250 mg/ml - 2 ml Ampul - - - - - -
24 Antalgin Tablet 500 mg Tablet - - - - - -
25 Antasida Sirup 400 mg/5 ml Botol 464 500 810 154 1,679 258,566
26 Antasida Tablet 400 mg Tablet 4,520 47,000 45,633 5,887 54 317,898
27 Anti Bakteri Doen Salep Kom Pot 304 200 504 - 2,924 -
28 Anti Fungi Doen Kom Pot 124 168 242 50 4,798 239,900
29 Anti Hemoroid Doen Kom Supp - - - - - -
30 Anti Migren Doen Tablet - - - - - -
31 Aqua Pro Injeksi Steril 20 ml Vial 27 - 27 - 2,226 -
32 Asam Askorbat Tablet 50 mg Tablet - - - - - -
33 Asam Mefenamat Tablet 500 mg Tablet - 5,000 1,590 3,410 111 378,510
34 Asetosal Tablet 500 Tablet - - - - - -
35 Asiklovir krim 5%, 5 gr Tube - - - - - -
36 Asiklovir Tablet 200 mg Tablet - - - - - -
37 Atropin Sulfat Injeksi 0,25 mg/ml Ampul 10 - 10 - 1,639 -
38 Bedak Salisil 2%- 50 mg Kotak - - - - - -
39 Betameson Krim 0,1% Tube - - - - - -
40 Catgut Chromic 2-0 pcs - - - - 8,371 -
41 Catgut Chromic 3-0 pcs 123 48 171 - 8,371 -
42 Catgut Plain 2-0 pcs - - - - 8,371 -
43 Catgut Plain 3-0 pcs 128 288 416 - 8,371 -
44 Deksametason Injeksi 5 mg/ml Ampul 109 200 256 53 924 48,972
45 Deksametason Tablet 0,5 mg Tablet - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
46 Diazepam Injeksi 5 mg/ml Ampul 23 - 23 - 104 -
47 Diazepam Tablet 5 mg Tablet 575 800 1,062 313 109 34,117
48 Diazepam Tablet 2 mg Tablet - - - - - -
49 Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - - - - -
50 Difenhidramin HCl Inj 10 mg/ml Ampul 31 - 1 30 1,095 32,850
51 Digoksin Tablet 0,25 mg Tablet - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
52 Doksisiklin 100 mg kapsul Kapsul - - - - - -
53 Efedrin HCl Tablet 25 mg Tablet - - - - - -
54 Ekstrak Beladona Tablet 10 mg Tablet - - - - - -
55 Epinefrin HCl/Bitartrat Injeksi 0,1% Ampul - - - - - -
56 Eritromisin Sirup Kering 200 mg/5ml Botol - - - - - -
57 Eritromisin tablet 250 mg Tablet - - - - - -
58 Eritromisin Tablet 500 mg Tablet 2,397 - 2,397 - 750 -
59 Etakridin (Rivanol ) 0,1% Botol - - - - - -
60 Etanol 70 % -100 ml Botol 201 84 285 - 3,577 -
61 Etanol 70 % -1000 ml Botol - - - - 25,000 -
62 Fenobarbital Inj 50 mg/ml Ampul 251 - 251 - 3,682 -
63 Fenobarbital Tablet 30 mg Tablet - - - - - -
64 Fenol Gliserol Tetes Telinga 10 mg Botol - - - - - -
65 Fitomenadion (Vit.K1) Inj 2 mg/ml Ampul 1,989 180 2,077 92 3,682 338,744
66 Fitomenadion (Vit.K1) Tablet Salut 10 Tablet - - - - - -
67 Flufenazine Injeksi 25 mg/ml Ampul - - - - - -
68 Foley Catheter 16 Set - - - - - -
69 Foley Catheter 18 Set - - - - - -
70 Furosemid Injeksi 10 mg/ml Ampul - - - - - -
71 Furosemid Tablet 40 mg Tablet - - - - 360 -
72 Garam Oralit Serbuk 200 ml Sachet 301 200 399 102 257 26,214
73 Gentamisin Injeksi 40 mg/ml - 2 ml Ampul - - - - 3,000 -
74 Gentamisin Salep Kulit 0,1% Tube - - - - - -
75 Gentamisin Tetes Mata 0,3% Botol 48 192 240 - 4,232 -
76 Gentian Violet larutan 1%-10 ml Botol - - - - - -
77 Glibenklamid Tablet 5 mg Tablet - - - - 690 -
78 Gliseril Guaiakolat Tablet 100 mg Tablet 4,178 - 4,178 - 187 -
79 Glukosa Infus 10% Botol - - - - - -
80 Glukosa Infus 5% Botol 130 80 172 38 7,363 279,794
81 Griseofulvin Tablet 125 mg Tablet - - - - - -
82 Haloperidol Injeksi 5 mg/ml Ampul - 25 1 24 1,190 28,560
83 Haloperidol Tablet 0,5 mg Tablet - - - - - -
84 Haloperidol Tablet 5 mg Tablet - 300 150 150 60 9,000
85 Hidroklorotiazid Tablet 25 mg Tablet - - - - - -
86 Hidrokortison Krim 2,5 % Tube 67 100 167 - 2,250 -
87 Ibuprofen Tablet 200 mg Tablet - - - - - -
88 Infusion Set Anak Set 269 100 369 - 9,000 -
89 Infusion Set Dewasa Set 528 400 928 - 3,225 -
90 Isosorbid Dinitrat Tablet 5 mg Tablet 210 300 257 253 89 22,517
91 IV Catheter 18 Set 119 500 614 5 5,500 27,500
92 IV Catheter 20 Set 98 400 433 65 5,500 357,500
93 IV Catheter 22 Set 149 200 349 - 5,298 -
94 IV Catheter 24 Set 172 250 328 94 5,298 498,012
95 Kalium Diklofenak Tablet 25 mg Tablet - - - - - -
96 Kalium Diklofenak Tablet 50 mg Tablet - - - - - -
97 Kalsium Glukonas Inj. Ampul 362 - 362 - 10,351 -
98 Kalsium Hidroksida Pasta Tube - - - - - -
99 Kalsium Laktat Tablet 500 mg Tablet 3,970 19,000 20,569 2,401 60 144,060
100 Kapas Pembalut 250 mg Rol 6 - 6 - 11,363 -
101 Kaptopril Tablet 12,5 mg Tablet - - - - - -
102 Kaptopril Tablet 25 mg Tablet - - - - - -
103 Karbamazepin Tablet 200 mg Botol 725 400 920 205 189 38,745
104 Karbon Aktif Tablet 125 mg Tablet - - - - - -
105 Kasa Kompres 40 cm x 40 cm Rol 122 100 222 - 1,490 -
106 Kasa Pembalut 36 m x 80 cm Rol - 3 3 - 103,947 -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
107 Kasa Pembalut 4 m x 10 cm Rol 95 250 332 13 606 7,878
108 Kasa Pembalut 4 m x 15 cm Rol 115 200 267 48 2,100 100,800
109 Kasa Pembalut 4 m x 3 cm Rol 89 50 80 59 590 34,810
110 Kasa Steril 16 cm x 16 cm Kotak - - - - - -
111 Klindamisin Kapsul 150 mg Kapsul - - - - - -
112 Klobazam Tablet 10 mg Tablet - - - - - -
113 Kloramfenikol Kapsul 250 mg Kapsul - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
114 Kloramfenikol Salep Mata 1% Tube 85 168 253 - 2,007 -
115 Kloramfenikol Tetes Telinga 3% Botol - - - - - -
116 Klorfeneramin (CTM) Tablet 4 mg Tablet 17,987 15,000 31,957 1,030 24 24,720
117 Klorokuin Tablet 150 mg Tablet - - - - - -
118 Klorpromazin HCl Tab 100 mg Tablet 230 - 115 115 157 18,055
119 Klozapin Tablet 25 mg Tablet 1,560 - 635 925 1,121 1,036,925
120 Kombinasi: kaolin 550 mg + pektin 20 Tablet - - - - - -
121 Kotrimoksazol Suspensi 240 mg/5 ml Botol 354 700 944 110 2,099 230,890
122 Kotrimoksazol Tablet 480 mg Tablet 2,377 600 2,977 - 133 -
123 Lidokain Komp Inj Ampul 292 60 352 - 1,229 -
124 Lisol 50%-1000 ml Botol 2 3 2 3 40,700 122,100
125 Loratadine Tablet 10 mg Tablet 30 - 30 - 131 -
126 Magnesium Sulfat Inj 20 %-25 ml Vial - - - - - -
127 Magnesium Sulfat Inj 40 %-25 ml Vial - 159 26 133 4,090 543,970
128 Masker Tali/Karet Buah - 3,500 1,750 1,750 1,240 2,170,000
129 Metilergometrin Maleat Tablet Tablet 810 - 810 - 210 -
130 Metilergometrin Meleat Inj 0,2 mg Ampul 1,020 - 450 570 2,959 1,686,630
131 Metoklopramid Inj 5 mg/ml Ampul - - - - - -
132 Metoklopramid Tablet 5 mg Tablet - - - - 110 -
133 Metronidazol Infus 5 mg/ml Botol - - - - - -
134 Metronidazol Tablet 250 mg Tablet - - - - - -
135 Metronidazol Tablet 500 mg Tablet - - - - - -
136 Miconazole Salep Kulit Tube - 48 - 48 3,414 163,872
137 Monoklamper Mentol Cair Botol - - - - - -
138 Multivitamin Kaplet Tablet - - - - - -
139 Multivitamin Sirup Botol - - - - - -
140 Nasal Oksigen L pcs - - - - 6,254 -
141 Nasal Oksigen M pcs - - - - 6,254 -
142 Nasal Oksigen S pcs - - - - - -
143 Natrium Bikarbonat Tablet 500 mg Tablet - - - - - -
144 Natrium Diklofenak Tablet 50 mg Tablet - 2,500 2,500 - 123 -
145 Natrium Klorida Infus 0,9% 500 ml Botol 156 240 337 59 7,390 436,010
146 Nifedipin Tablet 10 mg Tablet 75 - 75 - - -
147 Nistatin Tablet Vagina 100.000 IU/g Ovula - 100 25 75 5,500 412,500
148 OAT FDC Katagori 1 Paket 19 116 129 6 414,310 2,485,860
149 OAT FDC Kategori 2 Paket 2 9 10 1 1,384,977 1,384,977
150 OAT FDC Kategori Anak Paket 2 6 6 2 248,120 496,240
151 OAT Kategori 1 Kombipak Paket - - - - - -
152 OAT Sisipan Paket - - - - - -
153 Obat Batuk Hitam 100 ml Botol - - - - - -
154 Oksitetrasiklin HCl Salep 3% Tube - - - - - -
155 Oksitetrasiklin HCl Salep Mata 1% Tube 73 550 382 241 3,499 843,259
156 Oksitosin Inj 10 IU/ml-1ml Ampul 5 2,026 1,131 900 1,126 1,013,400
157 Omeprazole Tablet 20 mg Tablet - - - - - -
158 Parasetamol Sirup 120 mg/5ml Botol 545 1,400 1,845 100 1,159 115,900
159 Parasetamol Tablet 500 mg Tablet - - - - - -
160 Pirantel Pamoat Tab 125 mg Tablet - - - - - -
161 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 11,880 - 11,880 - 60 -
162 Piroksikam Tablet 10 mg Tablet - - - - - -
163 Plester 2,5 cm x 4,5 m Rol 20 20 25 15 14,809 222,135
164 Povidon lodine 10 %-30 ml Botol - - - - 3,054 -
165 Povidon lodine 10 %-300 ml Botol - - - - 18,000 -
166 Prednison Tab 5 mg Tablet 8,032 2,000 9,142 890 68 60,520
167 Primakuin Tab 15 mg Tablet - - - - - -
168 Propanolol HCL Tab 40 mg Tablet - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
169 Ranitidin Injeksi 25 mg/ml Ampul - - - - - -
170 Ranitidin Tablet 150 mg Tablet - 4,500 4,500 - 112 -
171 Retinol (VIT A) Kapsul 100.000 IU Kapsul - 1,050 1,050 - 307 -
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul - 8,750 8,750 - 552 -
173 Ringer Laktat Infus 500 ml Botol 287 3,700 3,159 828 7,630 6,317,640
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
174 Risperidon Tablet 1 mg Tablet 500 200 695 5 240 1,200
175 Risperidon Tablet 2 mg Tablet 1,513 1,400 2,463 450 123 55,350
176 Salbutamol Sulfat Liquid Nebules 2,5 Botol - - - - - -
177 Salbutamol Tab 2 mg Tablet 867 - 867 - 61 -
178 Salep 2-4 Komb Pot - 360 306 54 2,333 125,982
179 Sarung Tangan Non Steril L Buah - - - - 1,251 -
180 Sarung Tangan Non Steril M Buah - 500 500 - 1,309 -
181 Sarung Tangan Non Steril S Buah - 2,500 1,500 1,000 1,309 1,309,000
182 Sefadroksil Tablet 500 mg Tablet - - - - - -
183 Serum Anti Bisa Ular Polivalen Inj 5ml Vial 1 10 9 2 517,132 1,034,264
184 Serum Anti Difteri Vial - - - - - -
185 Serum Anti Tetanus Inj 1.500 IU Ampul 9 - 6 3 130,000 390,000
186 Serum Anti Tetanus Inj 20.000 IU Ampul - - - - - -
187 Serum Anti Tetanus Inj 250 IU Ampul - - - - - -
188 Sianokobalamin (Vit B12) Inj 500mcg Ampul 159 200 286 73 969 70,737
189 Sianokobalamin (Vit B12) Tablet 100 Tablet 500 - 500 - 49 -
190 Silk 2-0 pcs - - - - 15,000 -
191 Silk 3-0 pcs 222 - 222 - 2,601 -
192 Simvastatin 10 mg Tablet - 600 600 - 117 -
193 Siprofloksasin Kaplet 500 mg Tablet - - - - - -
194 Sulfasetamida Natrium Tetes Mata 15 Botol - - - - - -
195 Tablet Tambah Darah Tablet - 184,570 184,570 - 226 -
196 Tablet Tambah Darah + Multivitamin Tablet - - - - - -
197 Tetrasiklin HCl Kapsul 250 mg Kapsul - - - - - -
198 Tetrasiklin HCl Kapsul 500 mg Kapsul - - - - 310 -
199 Tiamin HCl (Vit B1) Inj 100 mg/ml-1m Ampul 21 - 21 - 760 -
200 Tiamin HCl/Mononitrat (Vit B1) Tab Tablet 80 - 80 - 85 -
201 Triheksifenidil tablet 2 mg Tablet 240 1,800 1,500 540 63 34,020
202 Urine Bag Set 76 100 176 - 4,740 -
203 Vaksin Anti Rabies Vial - - - - - -
204 Vaksin BCG Vial - 230 230 - 66,154 -
205 Vaksin DPT-HB-HIB/Pentabio Vial - 527 527 - 85,103 -
206 Vaksin DT Vial - 99 99 - 19,195 -
207 Vaksin HB uniject Saset - 600 600 - 25,839 -
208 Vaksin IPV Polio 5 ds Vial - 300 300 - 144,540 -
209 Vaksin MR Vial - 400 400 - 166,265 -
210 Vaksin Polio Vial - 700 700 - 21,494 -
211 Vaksin Td Vial - 240 240 - 18,128 -
212 Vitamin B Complek Tablet Tablet 10,219 15,000 25,219 - 89 -
213 Wingneedle 25 Set - - - - 16,995 -
214 Zink Sulfat Tablet 20 mg Tablet - 2,000 - 2,000 524 1,048,000
215 Ambroksol sirup 15 mg/5ml Botol 51 - 51 - 4,335 -
216 Antihemoroid tablet tablet - - - - 508 -
217 Bioplacenton Tulle Set - - - - - -
218 Budenocid serbuk 200 mcg botol - - - - - -
219 Budenosid Cairan 0,25 mg/0,5 in 2 ml vial - - - - 9,725 -
220 Budenosid cairan 0,5 mg/1 in 2 ml vial - - - - 13,242 -
221 Hand Sanitizer 500 ml Botol 3 25 12 16 65,340 1,045,440
222 Hand Sanitizer Refill Galon - 1 - 1 649,990 649,990
223 Hand Soap 500 ml Botol 3 20 11 12 67,650 811,800
224 Hand Soap Refill Galon - 1 - 1 554,400 554,400
225 HIV 1 Bio line SD HIV box - 1,300 1,300 - 11,975 -
226 HIV 2 FOCUS Rapid Test box - - - - - -
227 HIV 3 VIKIA Rapid Test box - - - - - -
228 Kapas pembalut 40 x 80 cm set - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
229 KDN 1 D 2,5 % Botol - - - - - -
230 Klonazepam 2 mg Tablet - - - - - -
231 Klorampenikol Salep Kulit 2% Tube - - - - - -
232 Kombinasi Obat Batuk Pilek Sirup Botol - - - - - -
233 Kombinasi Obat Batuk Pilek Tablet Tabler - - - - - -
234 Masker Oksigen Set - - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
235 Nipedipin Tablet Lepas Lambat 30 mg Tablet - - - - - -
236 Permetrin 5 % Tube 59 60 95 24 11,825 283,800
237 Plester 5 Yard x 2 inch set - - - - - -
238 Plester 7,5 cm x 4,5 m Rol 3 20 23 - 37,371 -
239 Pot Dahak Buah - 1,000 1,000 - 2,139 -
240 Probiotik serbuk Sachet - - - - - -
241 Prokaterol cairan 50 mcg Vial - - - - 10,070 -
242 pulmicort nebb Ampul - - - - - -
243 Reagen ZN kit - 5 5 - 256,735 -
244 Safety Box Pcs - 222 222 - 22,433 -
245 Selang suction set - - - - - -
246 Sodium Divalproat 500 mg Kaplet - - - - 5,800 -
247 Sodium Divalproat 250 mg Kaplet - - - - - -
248 Test Kit Hbs Ag Paket - 1,400 1,400 - 7,801 -
249 Test Kit Malaria Paket - - - - - -
250 Test Kit Syphilis Paket - 900 900 - 9,300 -
251 Triheksifenidil tablet 1 mg Tablet - - - - 22,433 -
252 Triofluoferazin 5mg Tablet - - - - - -
253 Underpad Dewasa Bungkus - - - - - -
254 Urinal Bag (with hanger) Pcs 138 - 37 101 7,314 738,714
255 GigasepInstru AF disenfection 2 Lt 2 - - 2 29,550 59,100
256 Gigazyme cleaning 2 lt 2 - 1 1 11,600 11,600
257 Prokaterol serbuk - - - - 11,200 -
258 Metformin 500 mg Tablet 4,170 3,000 5,655 1,515 77 116,655
259 Ambroxol sirup 15/5ml - - -
260 Sarung Tangan Steril - 10 - 10 66,165 661,650
261 Simvastatin 10 mg 0 0 0
262 Vaksin Campak - - - - 11,200 -
263 Sipilis Hexagon Rapid test - - - - - -
264 Bensatin Bensil penisilin - - - - - -
265 Reagen HBS Ag - - - - - -
266 Ampisilin injeksi 33 - - 33 66,000 2,178,000
267 Natrium Tiroksin - - - - - -
268 Cetrizine tablet 10 mg 622 - 622 - 90 -
269 Sefadroksil syrup 125 mg/5 ml 78 - 78 - 5,000 -
270 Albendazol syrup 400 mg - - - - - -
271 Teralyn 1 - - 1 883,500 883,500
272 Halloperidol 2 mg 141 - 75 66 84 5,544
273 Asam Askorbat Tablet 500 mg Tablet - - - - - -
274 Taburia - 4,260 4,260 - 605 -
275 APD Set - 78 78 - 98,450 -
276 Kartu Vaksinasi Covid - 20 20 - -
277 Vaksin Corona Vac ( SARS-CoV-inactivated) - 5,800 5,800 - 211,282 -
278 vaksin Corona Vac Multidosis - 794 794 - 1,339,440 -
279 vaksin Astrazeneca (Thailand @10 dosis) - 108 108 - -
280 vaksin Moderna - 8 8 - -
281 vaksin Sinofarm - 2,938 2,938 - -
282 vaksin Coronavac ( 2 dosis) - 4,875 4,875 - -
283 Vaksin Astrazeneca (France @8 dosis) - 60 60 - -
284 albendazol syrup 200 mg/5 ml - 10 ml - 500 - 500 4,000 2,000,000
285 NaCl 0,9% 10 mL - 450 450 - -
286 Vaksin Pfizer (Comirnaty) @6 dosis - 450 450 - -
287 ADS 0,3 mL - 2,700 2,700 - -
288 ADS 0,05 mL - 1,011 1,011 - -
TOTAL 39,472,683
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9

Tasikmalaya, 31 Desember 2021

Mengetahui,
Kepala UPTD Puskesmas Salopa Pengelola Obat Puskesmas Salopa

Cucu Hikmat, SKM, M. MKes Nurhayati Wijaya, S.Kep., Ners

NIP: 19640728 199403 1 004 NIP. 19821102 200501 2 007
 PEMERINTAH KABUPATEN TASIKMALAYA
D I N A S K E S E H A T A N DAN PENGENDALIAN PENDUDUK
UPTD PUSKESMAS SALOPA
Jln Raya Salopa No 226 Desa Mandalahayu Kec. Salopa Kode Pos 46192

LAMPIRAN BERITA ACARA PEMERIKSAAN BARANG (OBAT-OBATAN)

UPTD PUSKESMAS SALOPA
DINAS KESEHATAN DAN PENGENDALIAN PENDUDUK
KABUPATEN TASIKMALAYA
TAHUN 2021
Sumber Anggaran JKN
MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
1 2 3 4 5 6 7 8 9
1 Alat Suntik Sekali Pakai 1 ml Set 969 - 244 725 693 502,425
2 Alat Suntik Sekali Pakai 10 ml Set 765 - 514 251 1,690 424,190
3 Alat Suntik Sekali Pakai 2,5 ml Set 1,700 - 1,111 589 682 401,698
4 Alat Suntik Sekali Pakai 5 ml Set 449 - 50 399 982 391,746
5 Albendazol susp 200 mg/5 mL Botol - - - - -
6 Albendazol Tablet 400 mg Tablet - - - - -
7 Alkohol Swab pcs - 3,200 1,630 1,570 250 392,500
8 Allopurinol Tablet 100 mg Tablet 7,699 - 7,600 99 105 10,395
9 Alopurinol tab 300 mg Tablet - - - - 355 -
10 Alprazolam Tablet 0,25 mg Tablet - - - - -
11 Ambroksol Tablet 30 mg Tablet 4,518 20,000 10,474 14,044 180 2,527,920
12 Ambroxol 15 mg/5 ml Syrup Botol 60 ml 20 200 124 96 4,500 432,000
13 Amilorid tab 5 mg Tablet - - - - -
14 Aminofilin Injeksi 24 mg/ml - 10 ml Ampul - - - - -
15 Aminofilin Tablet 200 mg Tablet - - - - 91 -
16 Amiodaron tab 200 mg Tablet - - - - -
17 Amitriptilin tab sal 25 mg Tablet - - - - -
18 Amlodipine Tablet 10 mg Tablet 44,754 - 35,869 8,885 99 879,615
19 Amlodipine Tablet 25 mg Tablet - - - - -
20 Amlodipine Tablet 5 mg Tablet 16,402 21,000 9,019 28,383 53 1,504,299
21 Amoksisilin Injeksi 1000 mg vial - - - - 5,865 -
22 Amoksisilin Sirup Kering 125 mg/5 ml Botol 2,315 - 1,136 1,179 6,000 7,074,000
23 Amoksisilin Sirup Kering 250 mg/5 ml Botol - - - - 3,473 -
24 Amoksisilin Tablet 250 mg Tablet - 2,500 - 2,500 400 1,000,000
25 Amoksisilin Tablet 500 mg Tablet 25,670 20,000 26,670 19,000 400 7,600,000
26 Ampisilin serb inj 1000 mg/Vial Vial - - - - -
27 Analog insulin : rapid acting (inj 100 UI/ml (kem Vial - - - - -
28 Analog insulin :long acting (inj 100 UI/ml (kemas Vial - - - - -
29 Analog insulin :mix insulin (inj 100 UI/ml (kemas Vial - - - - -
30 Antalgin Injeksi 250 mg/ml - 2 ml Ampul - - - - -
31 Antalgin Tablet 500 mg Tablet 1,110 - 250 860 290 249,400
32 Antasida Sirup 400 mg/5 ml Botol - - - - -
33 Antasida Tablet 400 mg Tablet 20,000 - 300 19,700 58 1,142,600
34 Anti bakteri DOEN Salep Tube - - - - -
35 Anti Fungi Doen Kom Pot - - - - 5,060 -
36 Anti Hemoroid Doen Kom Supp 89 - 25 64 3,167 202,688
37 Anti Migren Doen Tablet - - - - 167 -
38 Antimalaria kombinasi : sulfadoksin 500 mg + pirim
Kapsul - - - - -
39 Antiparkinson DOEN tablet kombinasi : Benser Kapsul - - - - -
40 Aqua Pro Injeksi Steril 20 ml Vial 106 120 98 128 2,650 339,200
41 Artemether inj 80 mg/mL Vial - - - - -
42 Artesunat serb inj 60 mg/mL (i.v./i.m.) Vial - - - - -
43 Asam asetilsalisilat (asetosal) tab 100 mg Tablet - - - - 130 -
44 Asam asetilsalisilat (asetosal) tab 80 mg Tablet 270 - 270 - 105 -
45 Asam asetilsalisilat tab 500 mg Tablet - - - - -
46 Asam askorbat (vitamin C) tab 250 mg Tablet - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
47 Asam askorbat (vitamin C) tab 50 mg Tablet 6,666 10,000 10,748 5,918 42 248,556
48 Asam folat tab 0,4 mg Tablet - - - - -
49 Asam folat tab 1 mg Tablet - - - - 70 -
50 Asam folat tab 5 mg Tablet - - - - -
51 Asam mefenamat Kaps 250 mg Kapsul - - - - -
52 Asam Mefenamat Tablet 500 mg Tablet 7,269 2,000 6,219 3,050 340 1,037,000
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
53 Asam pipemidat kapsul 400 mg Kapsul - - - - -
54 Asam traneksamat injeksi 100 mg/ml - 5ml Ampul 17 - 4 13 6,490 84,370
55 Asiklovir 5% krim Tube 5 gr 380 50 320 110 3,750 412,500
56 Asiklovir tab 200 mg Tablet 723 - 723 - 399 -
57 Asiklovir tab 400 mg Tablet 1,000 1,000 1,040 960 407 390,720
58 Atapulgit 600mg Tablet 2,661 500 3,161 - 280 -
59 Atenolol tab 100 mg Tablet - - - - -
60 Atenolol tab 50 mg Tablet - - - - -
61 Atropin Sulfat Injeksi 0,25 mg/ml Ampul 100 - 10 90 2,318 208,620
62 Atropin Sulfat Tablet 0,5mg Tablet - - - - -
63 Azitromisin sir kering 200 mg/ 5 mL Botol 60 ml - - - - -
64 Azitromisin Tab 500 mg Tablet - 1,200 - 1,200 2,754 3,304,800
65 Benzatin penisilin inj 2,4 juta UI/mL (i.m.) Vial - - - - -
66 Benzatin penisilin inj 1,2 juta UI/mL (i.m.) Vial - - - - -
67 Betameson Krim 0,1% Tube 491 75 531 35 1,540 53,900
68 Bisakodil suppositoria 10 mg Supp - - - - -
69 Bisakodil suppositoria 5 mg Supp - - - - 20,200 -
70 Bisakodil tab salut 5 mg Tab salut - 300 73 227 500 113,500
71 Bisoprolol tab 2,5 mg Tab - - - - -
72 Bisoprolol tab 5 mg Tablet - - - - -
73 Catgut Chromic 2-0 pcs - - - - -
74 Catgut Chromic 3-0 pcs 3 - 3 - 138,020 -
75 Catgut Plain 2-0 pcs - - - - -
76 Catgut Plain 3-0 pcs - 216 107 109 7,000 763,000
77 Dapson tab scored 100 mg Tab scored - - - - -
78 Deksametason Injeksi 5 mg/ml Ampul - 300 - 300 924 277,200
79 Deksametason Tablet 0,5 mg Tablet 47,394 - 38,089 9,305 100 930,500
80 Desoksimetason krim 0,25% Tube 15 g - - - - -
81 Devitalisasi Pasta Botol - - - - - -
82 Diazepam Injeksi 5 mg/ml Ampul - - - - -
83 Diazepam lar rektal 10 mg/2,5 mL Lar rektal - - - - 21,600 -
84 Diazepam lar rektal 5 mg/2,5 mL Lar rektal - - - - 15,170 -
85 Diazepan Tablet 2 mg Tablet - - - - -
86 Diazepan Tablet 5 mg Tablet - - - - -
87 Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - - - -
88 Difenhidramin HCl Inj 10 mg/ml Ampul - - - - 1,054 -
89 Digoksin Tablet 0,25 mg Tablet - - - - -
90 Diltiazem HCl tab 30 mg Tablet - - - - -
91 Diltiazem Kaps SR 100 mg Kaps - - - - -
92 Diltiazem Kaps SR 200 mg Kaps - - - - -
93 Dimenhidrinat tab 50 mg Tablet - - - - -
94 Doksazosin tab 1 mg Tab - - - - -
95 Doksazosin tab 2 mg Tab - - - - -
96 Doksisiklin 100 mg kapsul Kapsul 76 - 76 - 300 -
97 Domperidon suspensi/sirup 5 mg/5 ml Botol 60 ml 70 100 88 82 2,087 171,134
98 Domperidon tab 10 mg Tablet 1,894 1,000 1,904 990 290 287,100
99 Domperidon tetes 5 mg/mL Botol 10 ml - - - - -
100 Efedrin HCl Tablet 25 mg Tablet - - - - -
101 Ekstrak Beladona Tablet 10 mg Tablet - - - - -
102 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 100 - 89 11 10,480 115,280
103 Ergokalsiferol (vitamin D2) Kaps 50.000 UI Kapsul - - - - -
104 Ergokalsiferol (vitamin D2) susp 10.000 UI/mL Botol - - - - -
105 Ergotamin tab 1 mg Tablet 1,990 - 50 1,940 185 358,900
106 Eritromisin Kaps 250 mg Kapsul - - - - -
107 Eritromisin Sirup Kering 200 mg/5ml Botol - - - - -
108 Eritromisin Tablet 500 mg Tablet - - - - -
109 Etakridin (Rivanol ) 0,1% Botol - - - - 3,150 -
110 Etanol 70 % -100 ml Botol 184 - 54 130 8,450 1,098,500
111 Etanol 70 % -1000 ml Botol 2 2 2 2 44,500 89,000
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
112 Etil klorida semprot 100 mL Botol 58 - 15 43 227,500 9,782,500
113 Eugenol Cairan Botol 10 10 2 18 20,150 362,700
114 Fenitoin Na inj 50 mg/mL Ampul - - - - -
115 Fenitoin Na Kaps 100 mg Kapsul - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
116 Fenitoin Na Kaps 50 mg Kapsul - - - - -
117 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul - - - - 4,168 -
118 Fenobarbital tab 100 mg Tablet - - - - -
119 Fenobarbital Tablet 30 mg Tablet 300 - 30 270 171 46,170
120 Fenol Gliserol Tetes Telinga 10 mg Botol 63 - 63 - 2,764 -
121 Fenoterol HBr aerosol 100 mcg/puff Botol - - - - -
122 Fenoterol HBr cairan ih 0,1% Botol - - - - -
123 Fitomenadion (Vit.K1) Inj 2 mg/ml Ampul - - - - 4,167 -
124 Fitomenadion (Vit.K1) Tablet Salut 10 mg Tablet 1,252 1,000 570 1,682 748 1,258,136
125 Flufenazine Injeksi 25 mg/ml Ampul - - - - -
126 Fluor kapl 1 mg Kapsul - - - - -
127 Fluor tab 0,5 mg Tablet - - - - -
128 Foley Catheter 16 Set 150 - 40 110 13,400 1,474,000
129 Foley Catheter 18 Set 100 50 50 100 8,253 825,300
130 Formokresol Botol - - - - -
131 Furosemid Injeksi 10 mg/ml Ampul - 10 - 10 7,000 70,000
132 Furosemid Tablet 40 mg Tablet 6,081 - 4,675 1,406 82 115,292
133 Garam Oralit Serbuk 200 ml Sachet - - - - -
134 Gemfibrozil kapsul/kaplet 300 mg Kapsul 8,435 - 8,177 258 371 95,718
135 Gentamisin Injeksi 40 mg/ml - 2 ml Ampul 100 - 27 73 6,207 453,111
136 Gentamisin Salep Kulit 0,1% Tube 544 864 1,135 273 4,000 1,092,000
137 Gentamisin Salep mata 0,3% Tube 3,5 g - - - - -
138 Gentamisin Tetes Mata 0,3% Botol 462 - 159 303 11,249 3,408,447
139 Gentian Violet larutan 1%-10 ml Botol - 48 40 8 3,500 28,000
140 Glass ionomer ART (Atraumatic Restorative Tre Sachet - - - - -
141 Glass ionomer ART (Atraumatic Restorative Tre Botol - - - - -
142 Glass ionomer ART (Atraumatic Restorative Trea
Cocoa butter - - - - 427,500 -
143 Glibenklamid Tablet 5 mg Tablet 10,725 - 6,075 4,650 119 553,350
144 Gliklazid Tablet 80 mg Tablet - - - - -
145 Gliklazid Tablet MR 30 mg Tablet - - - - -
146 Gliklazid Tablet SR 60 mg Tablet - - - - -
147 Glimepirid tab 1 mg Tablet - - - - -
148 Glimepirid tab 2 mg Tablet - - - - -
149 Glimepirid tab 3 mg Tablet - - - - -
150 Glimepirid tab 4 mg Tablet - - - - -
151 Glipizid tab 10 mg Tablet - - - - -
152 Glipizid tab 5 mg Tablet - - - - -
153 Gliseril guaiakolat sirup 50 mg/5ml Botol 100 ml 14 100 14 100 9,000 900,000
154 Gliseril guaiakolat Tablet 100 mg Tablet 40,561 7,000 32,990 14,571 100 1,457,100
155 Gliseril trinitrat Kaps SR 2,5 mg Kaps - - - - -
156 Gliseril trinitrat Kaps SR 5 mg Kaps - - - - -
157 Gliseril trinitrat tab sublingual 0,5 mg Tablet sub. - - - - -
158 Glukosa larutan infus 10 % steril Botol 500 ml 20 - 7 13 8,182 106,366
159 Glukosa larutan infus 5% Steril Botol 500 ml - - - - -
160 Griseofulvin (micronized) tab 125 mg Tablet 7,141 5,000 10,164 1,977 500 988,500
161 Haloperidol inj 5 mg/mL (i.m.) Vial - - - - -
162 Haloperidol tab 0,5 mg Tablet - - - - -
163 Haloperidol tab 1,5 mg Tablet - - - - -
164 Haloperidol tab 2 mg Tablet - - - - -
165 Haloperidol tab 5 mg Tablet - - - - -
166 Haloperidol tts 2 mg/mL Botol - - - - -
167 Hidroklorotiazid Tablet 25 mg Tablet 320 10,000 320 10,000 148 1,480,000
168 Hidrokortison Krim 2,5 % Tube 1,134 - 1,111 23 2,475 56,925
169 Hidrokortison serb inj 100 mg/Vial Vial - - - - -
170 Human insulin : intermediate acting inj 100 UI/ml Vial - - - - -
171 Human insulin : mix insulin inj 100 UI/ml (kemasa Vial - - - - -
172 Human insulin : short acting inj 100 UI/ml (kemas Vial - - - - -
173 Ibuprofen sir 100 mg/5 mL Botol - - - - 2,250 -
174 Ibuprofen sir 200 mg/5 mL Botol - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
175 Ibuprofen tab 200 mg Tablet 4,337 4,000 6,617 1,720 300 516,000
176 Ibuprofen tab 400 mg Tablet - - - - -
177 Imidapril tab 10 mg Tab - - - - -
178 Imidapril tab 5 mg Tab - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
179 Infusion Set Anak Set 57 100 22 135 8,624 1,164,240
180 Infusion Set Dewasa Set 36 750 309 477 7,767 3,704,859
181 Ipratropium bromida ih 20mcg/puff Botol - - - - -
182 Ipratropium bromida ih padat 20 mcg puff - - - - -
183 Ipratropium bromida nebulizer 0,025% Botol - - - - -
184 Irbesartan tab 150 mg Tab - - - - -
185 Irbesartan tab 300 mg Tab - - - - -
186 Isosorbid Dinitrat Tablet 10 mg Tablet - - - - -
187 Isosorbid Dinitrat Tablet 5 mg Tablet - - - - 89 -
188 IV Catheter 18 Set 105 350 104 351 9,355 3,283,605
189 IV Catheter 20 Set 36 250 - 286 9,355 2,675,530
190 IV Catheter 22 Set - - - - 3,800 -
191 IV Catheter 24 Set 35 - - 35 3,800 133,000
192 IV Catheter 26 Set 84 50 50 84 9,355 785,820
193 Kalamin Botol - - - - -
194 Kalium aspartat tab 300 mg Tablet - - - - -
195 Kalium Diklofenak Tablet 25 mg Tablet - - - - -
196 Kalium Diklofenak Tablet 50 mg Tablet - - - - 885 -
197 Kalsium glukonat inj 100 mg/mL Ampul - - - - -
198 Kalsium Hidroksida Pasta Tube - 1 - 1 275,000 263,000
199 Kalsium Laktat Tablet 500 mg Tablet 30,000 - 7,459 22,541 63 1,420,083
200 Kandesartan tab 16 mg Tab - - - - -
201 Kandesartan tab 8 mg Tab - - - - -
202 Kapas Pembalut 250 mg Rol 6 10 6 10 19,000 190,000
203 Kaporit Ember - - - - -
204 Kaptopril Tablet 12,5 mg Tablet 8,190 - 4,986 3,204 66 211,464
205 Kaptopril Tablet 25 mg Tablet 7,134 - 6,330 804 160 128,640
206 Kaptopril Tablet 50 mg Tablet - - - - -
207 Karbamazepin sir 100 mg/5 mL Botol - - - - -
208 Karbamazepin tab 200 mg Tablet - - - - -
209 Karbo adsorben tab 0,5 g Tablet - - - - -
210 Karvediol Kaps 6,25 mg Kaps - - - - -
211 Kasa Kompres 40 cm x 40 cm Rol - - - - 1,648 -
212 Kasa Pembalut 4 m x 10 cm Rol 345 - 210 135 1,545 208,575
213 Kasa Pembalut 4 m x 15 cm Rol - - - - -
214 Kasa Pembalut 4 m x 3 cm Rol - - - - -
215 Kasa Pembalut 40 m x 80 cm Rol 6 10 8 8 150,000 1,200,000
216 Kasa Steril 16 cm x 16 cm Kotak 235 - 111 124 4,500 558,000
217 Ketamin inj 100 mg/mL (i.v.) Ampul - - - - -
218 Ketamin inj 50 mg/mL (i.v.) Ampul - - - - -
219 Ketokonazol krim 2% 10 g Tube 10 g - 100 5 95 5,300 503,500
220 Ketokonazol tab 200 mg Tablet 800 - 800 - 450 -
221 Ketorolac injeksi 30 mg/ml Ampul 206 - 138 68 1,089 74,052
222 Klindamisin Kapsul 150 mg Kapsul - - - - 1,550 -
223 Klindamisin kapsul/kaplet 300 mg Kapsul 2,485 1,000 2,783 702 1,500 1,053,000
224 Klobazam Tablet 10 mg Tablet - - - - -
225 Klofazimin, micronizedKaps 100 mg Kapsul - - - - -
226 Klonidin tab 0,15 mg Tab - - - - -
227 Klopidogrel tab 75 mg Tab - 300 30 270 575 155,250
228 Kloramfenikol Kapsul 250 mg Kapsul - - - - 620 -
229 Kloramfenikol salep kulit 2% Pot - - - - 5,250 -
230 Kloramfenikol Salep Mata 1% Tube 243 - 192 51 6,800 346,800
231 Kloramfenikol susp 125 mg/5 mL Botol - - - - -
232 Kloramfenikol Tetes mata 1% Botol 52 - 52 - 9,250 -
233 Kloramfenikol Tetes Telinga 3% Botol 302 - 240 62 8,800 545,600
234 Klorfeniramin maleat tab 4 mg (CTM) Tablet 10,230 22,000 22,300 9,930 100 993,000
235 Klorfenol kamfer mentol (CHKM) Botol - 1 - 1 132,000 132,000
236 Klorokuin Tablet 150 mg Tablet - - - - -
237 Klorpromazin HCl Tab 100 mg Tablet - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
238 Klorpromazin inj 25 mg/mL (i.m.) Vial - - - - -
239 Klorpromazin inj 5 mg/mL (i.m.) Vial - - - - -
240 Klorpromazin tablet sal 25 mg Tablet salut - - - - -
241 Klortalidon tab 50 mg Tablet - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
242 Klozapin Tablet 25 mg Tablet 2,000 - - 2,000 1,121 2,242,000
243 Kodein tab 10 mg Tablet - 5,000 65 4,935 600 2,961,000
244 Kolekalsiferol (vitamin D3) Kaps lunak 0,25 mc Kaps lunak - - - - -
245 Kolekalsiferol (vitamin D3) Kaps lunak 0,5 mcg Kaps lunak - - - - -
246 Kombinasi: kaolin 550 mg + pektin 20 mg Tablet - 1,000 64 936 290 271,440
247 Kotrimoksazol (dewasa) 480 mg : sulfametoksazol Tablet
400 mg 5,109 - 4,742 367 133 48,811
248 Kotrimoksazol 240 mg : sulfametoksazol 200 m Tablet - - - - 2,052 -
249 Kotrimoksazol forte kombinasi 960 mg: sulfametoksazol
Tablet 8 - - - - -
250 Kotrimoksazol Suspensi 240 mg/5 ml Botol 492 - 43 449 2,190 983,310
251 Kuinin inj 25% (i.v.) Vial - - - - -
252 Kuinin tab 200 mg Tablet - - - - -
253 Lansoprazol Inj 30 mg / ml serbuk Vial - - - - -
254 Lansoprazol kapsul/kaplet 30 mg Kapsul - - - - 303 -
255 Levothyroxine Natrium Tablet 100 mcg Tablet - - - - -
256 Lidokain Gel 2% tube 10 g - - - - -
257 Lidokain inj 1 % (infltr) Ampul - - - - -
258 Lidokain inj 2% (infiltr/p.v.) Ampul 247 - 57 190 1,951 370,690
259 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.00 Ampul 1,667 600 1,854 413 2,212 913,556
260 Lidokain semprot 15% (HCl) Botol - - - - -
261 Lisinopril tab 10 mg Tablet - - - - -
262 Lisinopril tab 20 mg Tablet - - - - -
263 Lisinopril tab 5 mg Tablet - - - - -
264 Lisol 50%-1000 ml Botol - - - - 41,000 -
265 Loperamid tablet 2 mg Tablet 737 5,000 1,808 3,929 200 785,800
266 Loratadin tab 10 mg Tablet 151 1,000 156 995 300 298,500
267 Magnesium Sulfat Inj 20 %-25 ml Vial 9 - 9 - 3,328 -
268 Magnesium Sulfat Inj 40 %-25 ml Vial 10 - 10 - 3,796 -
269 Masker Tali/Karet Buah 11,409 - 7,009 4,400 2,000 8,800,000
270 Mebendazol sir 50 mg/mL Botol - - - - -
271 Mebendazol tab 100 mg Tablet - - - - -
272 Mebendazol tab 500 mg Tablet - - - - -
273 Metformin HCl tab 500 mg Tablet 16,570 2,000 16,965 1,605 220 353,100
274 Metformin tab 850 mg Tablet - - - - 155 -
275 Metildopa tab sal 250 mg Tab - 500 - 500 2,851 1,425,500
276 Metilergometrin inj 0,2 mg/ml - 1 ml Ampul - - - - -
277 Metilergometrin tab salut 0,125 mg Tablet 4,530 - 2,468 2,062 224 461,888
278 Metilprednisolon tab 16 mg Tab - - - - -
279 Metilprednisolon tab 4 mg Tab 5,000 - 2,139 2,861 290 829,690
280 Metilprednisolon tab 8 mg Tab - - - - -
281 Metoklopramid Inj 5 mg/ml Ampul - - - - -
282 Metoklopramid tab 10 mg Tablet - - - - -
283 Metoklopramid tab 5 mg Tablet 74 - 74 - 121 -
284 Metronidazol Infus 5 mg/ml Botol - - - - -
285 Metronidazol ovula 500 mg Supp - - - - 3,850 -
286 Metronidazol sir 125 mg/5 mL Botol - - - - 27,500 -
287 Metronidazol Tablet 250 mg Tablet - - - - -
288 Metronidazol Tablet 500 mg Tablet 5,286 4,000 6,628 2,658 400 1,063,200
289 Mikonazol Krim 2% Tube 414 720 661 473 4,700 2,223,100
290 Monoklamper Mentol Cair Botol - - - - -
291 Multivitamin Kaplet Tablet - - - - 600 -
292 Multivitamin Sirup Botol 227 200 363 64 7,000 448,000
293 Mummifying Pasta Botol - - - - -
294 Nasal Oksigen L pcs - - - - -
295 Nasal Oksigen M pcs - - - - -
296 Nasal Oksigen S pcs - - - - -
297 Natrium Bikarbonat inj. iv 8,4% ampul 25 ml - 12 - 12 26,759 321,108
298 Natrium Bikarbonat Tablet 500 mg Tablet 254 6,000 1,844 4,410 90 396,900
299 Natrium Diklofenak Tablet 50 mg Tablet 3,592 2,000 3,967 1,625 240 390,000
300 Natrium Klorida Infus 0,9% 500 ml Botol - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
301 Natrium tiosulfat inj 25% (i.v.) Vial - - - - -
302 Nifedipin tab SR 20 mg Tab - - - - -
303 Nifedipin tab SR 30 mg Tab - - - - -
304 Nifedipin Tablet 10 mg Tablet 2,649 3,000 3,894 1,755 170 298,350
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
305 Nistatin susp 100.000 UI/mL Botol 51 - 31 20 35,750 715,000
306 Nistatin tab salut 500.000 UI Tablet salut - - - - 598 -
307 Nistatin Tablet Vagina 100.000 IU/g Ovula 381 - 207 174 560 97,440
308 OAT FDC Katagori 1 Paket - - - - -
309 OAT FDC Kategori 2 Paket - - - - -
310 OAT FDC Kategori Anak Paket - - - - -
311 OAT Katagori 1 Kombipak Paket - - - - -
312 OAT Sisipan Paket - - - - -
313 Obat Batuk Hitam 100 ml Botol 112 200 239 73 6,050 441,650
314 Ofloxacin tablet 200 mg Tablet - - - - -
315 Ofloxacin tablet 400 mg Tablet - - - - -
316 Oksimetazolin tts hidung 0,050% Botol - - - - -
317 Oksitetrasiklin HCl Salep Kulit 3% Tube 825 - 825 - 4,530 -
318 Oksitetrasiklin HCl Salep Mata 1% Tube 36 - 36 - 2,668 -
319 Oksitosin Inj 10 IU/ml-1ml Ampul 360 - 360 - 1,199 -
320 Olopatadin tetes mata 0,1% Botol - - - - -
321 Omeprazol inj 40 mg/10 mL Ampul - - - - 16,997 -
322 Omeprazole Tablet 20 mg Tablet 785 2,520 1,260 2,045 400 818,000
323 Ondansetron inj 4 mg/ 2 mL Ampul 2 ml 80 100 89 91 5,000 455,000
324 Ondasetron tab 4mg Tablet - - - - 472 -
325 Paraformaldehid tab 1 g Tablet - - - - -
326 Parasetamol tts 60 mg/0,6 mL Botol - - - - -
327 Parasetamol Sirup 120 mg/5ml Botol 1,696 - 289 1,407 1,181 1,661,667
328 Parasetamol Tablet 500 mg Tablet 266,418 - 107,009 159,409 180 28,693,620
329 Pasta devitalisasi (non arsen) Tube 1 1 - 2 338,000 676,000
330 Permetrin Krim 5 % Tube 10 g 61 - 61 - 11,825 -
331 Pirantel pamoat susp 125 mg/5 mL Botol - - - - -
332 Pirantel Pamoat Tab 125 mg Tablet - - - - -
333 Piridoksin (vitamin B6) inj 100 mg/mL Ampul - - - - -
334 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 9,422 10,000 10,498 8,924 120 1,070,880
335 Piroksikam Tablet 10 mg Tablet - - - - 130 -
336 Plester 2,5 cm x 4,5 m Rol - 30 7 23 24,000 552,000
337 Polikresulen 10 ml Botol - - - - 35,600 -
338 Povidon Iodida larutan 10% 100 ml Botol - - - - 18,900 -
339 Povidon Iodida larutan 10% 30 ml Botol 4 - 4 - 3,045 -
340 Povidon Iodida larutan 10% 300 ml Botol 23 - 16 7 35,909 251,363
341 Prazikuantel tab scored 300 mg Tablet score - - - - -
342 Prazikuantel tab scored 600 mg Tablet score - - - - -
343 Prednison Tab 5 mg Tablet 11,520 5,000 1,677 14,843 62 920,266
344 Primakuin Tab 15 mg Tablet - - - - -
345 Probenesid 500 mg Tablet - - - - -
346 Prokain benzilpenisilin inj 1 juta UI/Vial Vial - - - - -
347 Prokain benzilpenisilin inj 3 juta UI/Vial Vial - - - - -
348 Propanolol HCL Tab 40 mg Tablet - - - - -
349 Propiltiourasil 100 mg Tablet - - - - -
350 Ramipril tab 10 mg Tab - - - - -
351 Ramipril tab 2,5 mg Tab - - - - -
352 Ramipril tab 5 mg Tab - - - - -
353 Ranitidin Injeksi 25 mg/ml Ampul 205 1,000 408 797 814 648,758
354 Ranitidin Tablet 150 mg Tablet 5,487 2,500 6,652 1,335 250 333,750
355 Reserpin Tablet 0,10 mg Tablet - - - - -
356 Reserpin Tablet 0,25 mg Tablet - - - - -
357 Retinol (VIT A) Kapsul 100.000 IU Kapsul - - - - -
358 Retinol (VIT A) Kapsul 200.000 IU Kapsul - - - - -
359 Ringer Laktat Infus 500 ml Botol - - - - -
360 Risperidon Tablet 1 mg Tablet - - - - -
361 Risperidon Tablet 2 mg Tablet - - - - -
362 Salbutamol 2 mg Tablet 7,769 - 6,510 1,259 67 84,353
363 Salbutamol 4 mg Tablet - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
364 Salbutamol aerosol 100 mcg Botol - - - - -
365 Salbutamol cairan serb ih 200 mcg/Kaps + rotaha Botol - - - - -
366 Salbutamol cairan serb ih 200 mcg/Kaps tanpa ro kaps - - - - -
367 Salbutamol sir 2 mg/5 ml Botol 100 ml - - - - -
368 Salbutamol Sulfat Liquid Nebules 2,5 ml Botol 38 - 38 - 11,990 -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
369 Salep 2-4 Komb Pot 36 - 36 - 2,797 -
370 Salisil Bedak 2 %-50 g pot 50g 43 - 43 - 5,500 -
371 Sarung Tangan Non Steril L Buah 1,980 - 1,300 680 2,100 1,428,000
372 Sarung Tangan Non Steril M Buah 2,131 - 1,531 600 1,655 992,730
373 Sarung Tangan Non Steril S Buah 9,996 8,000 11,396 6,600 2,250 14,850,000
374 Sefadroksil kapsul/kaplet 250 mg kapsul - - - - -
375 Sefadroksil kapsul/kaplet 500 mg kapsul 7,372 4,000 9,161 2,211 890 1,967,790
376 Sefadroksil sirup kering 125 mg/5ml Botol 60 ml 154 240 249 145 3,800 551,000
377 Sefiksim kapsul/kaplet 100 mg kapsul 554 - 554 - 2,370 -
378 Sefiksim sirup kering 100 mg/5 ml Botol 30 ml - - - - -
379 Sefotaksim inj 1 g Vial 792 - 492 300 4,482 1,344,600
380 Seftriakson inj 1 g Vial 34 - 25 9 4,708 42,372
381 Semen Seng Fospat Serbuk Botol 1 - - 1 306,500 306,500
382 Serum Anti Bisa Ular Polivalen Inj 5ml Vial - - - - -
383 Serum Anti Difteri 10.000 UI/Vial Vial - - - - -
384 Serum Anti Tetanus Inj 1.500 IU Ampul - - - - -
385 Serum Anti Tetanus Inj 20.000 IU Ampul - - - - -
386 Serum Anti Tetanus Inj 250 IU Ampul - - - - -
387 Serum antirabies inj 100 UI/mL Vial - - - - -
388 Serum antirabies inj 200 UI/mL Vial - - - - -
389 Setirizin sirup 5 mg/5 mL Botol - - - - -
390 Setirizin tablet 10 mg Tablet 6,000 1,000 6,776 224 350 78,400
391 Sianokobalamin (Vit B12) Inj 500 mcg/ml-1ml Ampul 3 - 3 - 1,087 -
392 Sianokobalamin (Vit B12) Tablet 100 mg Tablet 2,000 - 250 1,750 49 85,750
393 Silk 2-0 pcs - - - - -
394 Silk 3-0 pcs - - - - 113,300 -
395 Simvastatin 10 mg Tablet - 2,010 270 1,740 400 696,000
396 Simvastatin 20 mg tabet salut - - - - -
397 Siprofloksasin Kaplet 500 mg Tablet 1,529 2,000 1,789 1,740 650 1,131,000
398 Spironolakton 25 mg Tablet - - - - 244 -
399 Streptomisin 1000 mg/Vial Vial - - - - -
400 Sulfasetamida Natrium Tetes Mata 15 % Botol - - - - 26,200 -
401 Tablet Tambah Darah (Fe II Fumarat) Tablet - 10,000 2,660 7,340 226 1,658,840
402 Tablet Tambah Darah + Multivitamin Tablet - - - - -
403 Telmisartan tab 40 mg Tab - - - - -
404 Tempoprary Stopping Fletcher Serbuk Set 4 - - 4 214,500 858,000
405 Teofilin tab 100 mg Tab - - - - -
406 Teofilin tab 150 mg Tab - - - - -
407 Teofilin tab SR 300 mg Tab - - - - -
408 Terbutalin cairan ih 2,5 mg/mL unit - - - - -
409 Terbutalin tab 2,5 mg Tab - - - - -
410 Tetrasiklin HCl Kapsul 250 mg Kapsul - - - - -
411 Tetrasiklin HCl Kapsul 500 mg Kapsul 510 1,000 970 540 700 378,000
412 Tiamin HCl (Vit B1) Inj 100 mg/ml-1ml Ampul - - - - -
413 Tiamin HCl/Mononitrat (Vit B1) Tab 50 mg Tablet 4,334 2,000 4,531 1,803 300 540,900
414 Tiotropium serb ih 18 mcg + handihaller Botol - - - - -
415 Tiotropium serb ih 18 mcg, refill Botol - - - - -
416 Tramadol injeksi 50 mg/ml Ampul - - - - 1,800 -
417 Transfusi set set - - - - -
418 Trifluoperazin tab sal 5 mg Tab sal - - - - -
419 Triheksifenidil 2 mg Tablet - - - - -
420 Urine Bag Set 21 100 3 118 6,336 747,648
421 Valproat tab sal 250 mg Tab sal - - - - -
422 Valproat tab sal 500 mg Tab sal - - - - -
423 Valproat sir 250 mg/5 mL Botol 120 ml - - - - -
424 Valsartan tab 160 mg Tab - - - - -
425 Valsartan tab 80 mg Tab - - - - -
426 Verapamil tab 240 mg Tab - - - - -
427 Verapamil tab 80 mg Tab - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
428 Vitamin B Kompleks Tablet Tablet 14,325 10,000 19,824 4,501 250 1,125,250
429 Wingneedle 25 Set - - - - -
430 Yodium Kapsul Lunak Kapsul - - - - -
431 Zinc 10 mg Sachet - - - - -
432 Zinc 10 mg/mL Botol - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
433 Zinc 20 mg/5 mL Botol - - - - -
434 Zink Sulfat Tablet 20 mg Tablet 64 2,500 1,269 1,295 900 1,165,500
435 Kodein tab 20 mg tablet - - - - -
436 Sianokobalamin (vitamin B12) 50 mcg tablet - - - - -
437 KAEN 1B botol - - - - -
438 Kasa Pembalut 2 x 80 cm pcs - - - - -
439 Sarung tangan steril psg - - - - -
440 Umbilical Cord Klem Steril Nylon buah 814 200 468 546 3,200 1,747,200
441 Sabun Cuci Tangan botol - - - - -
442 Selang NGT 16FR pcs - - - - -
443 Tulle Dressing pcs - - - - -
444 Pembalut Absorbent pcs - - - - -
445 Pembalut Luka Steril pcs - - - - -
446 Pembalut Luka Tahan Air roll - - - - -
447 Plester IV pcs - - - - -
448 Perban Elastis pcs - - - - -
449 Gel USG botol - - - - -
450 Anastan tablet tablet - - - - -
451 Ciproheptadin tablet - - - - -
452 Dionicol tablet 3,862 - 2,572 1,290 1,290 1,664,100
453 Erlamicetin Tetes Telinga botol - - - - -
454 Inamid tablet - - - - -
455 Inflason tablet - - - - -
456 Lodecon tablet - - - - -
457 Peditox botol - - - - -
458 Piroksikam Tablet 20 mg Tablet 16,580 4,000 13,235 7,345 300 2,203,500
459 Solvita Sirup botol - - - - -
460 Zelona tablet - - - - -
461 Harsen 0,5mg tablet - - - - -
462 Torniquet pcs - - - - -
463 vitamin syrup botol - - - - -
464 ciprofloksasin 500 mg tablet - - - - -
465 Betahistin 6 mg 700 500 787 413 750 309,750
466 Alat Suntik Sekali Pakai 0,5 ml Set - 2,000 100 1,900 2,500 4,750,000
467 Alat Suntik Sekali Pakai 3 ml Set 85 1,300 391 994 950 944,698
468 Antitusif kombinasi syrup/Poncolin D Syrup botol - - - - -
469 Bioplacenton Tulle Set - - - - 193,700 -
470 Bisturi no 11 Set 161 100 48 213 5,000 1,065,000
471 Ekspektoran kombinasi syrup/Fortusin botol - 115 35 80 14,200 1,136,000
472 Hidrokortison Krim 1% tube - - - - -
473 Hiosin Butilbromid 10 mg tablet Tablet - - - - 1,650 -
474 Hiosin Butilbromid injeksi 20 mg/ml Ampul - - - - 11,450 -
475 Human humasen plus Glucosa tes strip Set - - - - 252,300 -
476 Kapas-Kasa Berlemak 500 g buah - - - - 16,500 -
477 Kasa Pembalut 2 x 80 cm roll - - - - 7,700 -
478 Ketoprofen suppositoria 100 mg supp - - - - 2,789 -
479 Leukoplast hospital 2,50 cm x 4,5 m roll 46 - 46 - 12,076 -
480 Leukoplast hospital 7,50 cm x 4,5 m roll - - - - 35,532 -
481 Levofloksasin tablet/kapsul/kaplet 500 Tablet - 1,000 11 989 1,300 1,285,700
482 Mas Surgical Gloves Sterile 6,5 set 402 - 5 397 5,455 2,165,437
483 Mas Surgical Gloves Sterile 7 set 179 - 147 32 4,000 128,000
484 Meloksikam tablet 7,5 mg Tablet - 5,000 3,047 1,953 400 781,200
485 Meptin inhalation vial - - - - 6,000 -
486 Metampiron 500mg+ Vit B1 50mg+ Vit B6 100m Tablet - - - - - -
487 Norit Tablet 500 mg Tablet 823 - 823 - 410 -
488 Obat anti diare/Anstrep botol 90 - 40 50 5,990 299,500
489 Obat Batuk Flu/Lodecon tablet - - - - -
490 Obat Flu Kombinasi Syirup/Solafluz botol - - - - -
491 Obat Flu Kombinasi Tablet/Transifar Tablet 3,325 1,500 4,342 483 400 193,200
492 Obat Flu Syirup Bayi/Anacetine Syr botol - 100 100 - 10,500 -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
493 Salep Luka Bakar/Neocenta Gell tube - - - - 18,140 -
494 Sarung Tangan Panjang 6,5 Pasang - - - - -
495 Sarung Tangan Panjang 6,5 Pasang - - - - -
496 Tiamfenikol syr/Solathim syr botol 118 - 93 25 9,390 234,750
497 Tramadol Hcl 50 mg Tablet - - - - -
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
498 Vit B1 100 mg, Vit B6 100 mg, Vit B12 200 mcg Tablet 1,559 4,000 3,683 1,876 800 1,500,800
499 Bonding Resin ( Master Bond ) set 1 - - 1 364,000 364,000
500 Etching resin komposit Set 1 - - 1 290,000 290,000
501 Kombinasi Dexamethason dan Dexchlorpheniram Tab 4,000 1,000 4,230 770 400 308,000
502 Resin komposit 3M set 1 - - 1 338,000 338,000
503 Safety box pcs 119 10 26 103 25,000 2,575,000
504 Masker n95 buah 180 - 7 173 55,000 9,515,000
505 Gom 32 - 30 2 5,500 11,000
506 Kaporit serbuk 2 - 2 - 60,000 -
507 Kaporit tablet 3 - 3 - 82,500 -
508 Povidon Iodida larutan 10% 60 ml 99 - 75 24 7,950 190,800
509 Povidon Iodida larutan 10% 120 ml - - - - -
510 Ultrasonic gel buat usg 10 - 9 1 24,900 24,900
511 Sulfadiazine silver 18 - 14 4 20,700 82,800
512 No rinse antimicrobial galon 5 L 2 - - 2 649,990 1,299,980
513 Antimicrobial Liquid soap Galon 5 L 1 - - 1 720,000 720,000
514 Flusinolon asetonid krim 0,025% 150 - - 150 2,505 375,750
515 Abbocath No 16 100 - 1 99 5,364 531,036
516 Amubag 2 - 2 - 806,818 -
517 Balon Penghisap Resusitasi 1 - - 1 97,278 97,278
518 Catheter Umbilical No. 3,5 5 - - 5 87,273 436,365
519 Cavitron 5 - - 5 113,182 565,910
520 Chkm 4 - - 4 195,455 781,820
521 Dextrose 40% 30 - 4 26 10,909 283,634
522 Fletcher 5 - - 5 81,818 409,090
523 Fuji Gic Art 2 - 1 1 909,091 909,091
524 Hand sanitizer 60 48 12 96 50,000 4,800,000
525 Hand soap scrub 60 - - 60 24,545 1,472,700
526 Jelly usg 10 - - 10 17,273 172,730
527 Kateter penghisap uk 18 10 - 1 9 7,727 69,543
528 Larutan Yodium 4 - - 4 100,000 400,000
529 Masker Nebulizer+wadah Ventolin 4 - - 4 47,273 189,092
530 Pipa Lambung No 8 2 - - 2 50,000 100,000
531 Mas Surgical Gloves Sterile 6 set 200 - 35 165 5,455 899,993
532 Mas Surgical Gloves Sterile 8 set 200 - 2 198 5,455 1,079,991
533 Selang 02 30 - - 30 7,909 237,270
534 Semen Base 4 - - 4 431,818 1,727,272
535 Tkf 4 - - 4 190,909 763,636
536 Multivitamin kurkumin 3,000 2,000 3,810 1,190 900 1,071,000
537 Asam askorbat 500 mg 10,000 - 1,050 8,950 640 5,728,000
538 Mas Surgical Gloves Sterile 7.5 set - - - - 890 -
539 propranolol tab 10 mg - 5,000 10 4,990 51 254,041
540 protofen suppo - 40 - 40 1,998 79,920
541 Asam Traneksamat tab 500 mg/Lexatrans tablet - 1,000 30 970 1,500 1,455,000
542 Lactulose syr 3.35 g/5 mL - 60 mL botol - 50 6 44 34,500 1,518,000
543 Meptin Nebu ampul - 28 - 28 11,000 308,000
544 Widahes botol - 10 - 10 208,500 2,085,000
545 Hand Sanitizer refill botol - 1 - 1 425,000 425,000
546 Hand Soap refill botol - 1 - 1 250,000 250,000
547 sarung tangan panjang steril 7.5 pasang - 10 2 8 41,800 334,400
548 Hevit-C 500 mg tablet - 1000 - 1,000 825 825,000
549 Prove D3 1000 IU tablet - 300 30 270 3,660 988,200
550 Pulmicort Nebu ampul - 20 3 17 40,320 685,440
551 3 way stopcock pcs - 10 - 10 8,000 80,000
552 dispodible syringe 20 ml pcs - 50 - 50 2,500 125,000
553 kateter penghisap 10 Fr pcs - 2 - 2 10,000 20,000
554 Sefiksim kapsul 200 mg Kapsul - 2000 - 2,000 4,550 9,100,000
555 disposible syring 50 mL set - 20 1 19 7,250 137,750
 MUTASI OBAT
NO NAMA OBAT Satuan STOK PENERIMA STOK HARGA JUMLAH
KELUAR
AWAL AN AKHIR SATUAN HARGA
TOTAL 173,326,886

Tasikmalaya, 31 Desember 2021

Mengetahui,
Kepala UPTD Puskesmas Salopa Pengelola Obat Puskesmas Salopa

H. Cucu Hikmat, SKM, M. MKes Nurhayati Wijaya, S.Kep., Ners

NIP: 19640728 199403 1 004 NIP. 19821102 200501 2 007