Format Neraca Obat BHP Reagen DAK APBD DBHCHT 31 Des 2019 PKM - FIX

PEMERINTAH KABUPATEN SUMENEP
DINAS KESEHATAN
Jl. Dr. Cipto No. 33 Telp. (0328) 662122, Fax (0328) 672270
SUMENEP
KODE POS 69417

LAPORAN : PENERIMAAN DAN PENGELUARAN BAHAN MEDIS PAKAI HABIS DANA APBD
PER 31 DESEMBER 2019
7
SALDO SISA PER 31 DESEMBER 2019
NO NAMA OBAT SATUAN Harga Satuan
PUSK GFK Jumlah
1 2 3 5 13 14
1 Infusion set dewasa set 4,400 - #REF! #REF! #REF!

2 Kapas Pembalut/Adsorben 250 gr bks 14,520 - #REF! #REF! #REF!
3 Spuit 3 cc pcs 650.00 - #REF! #REF! #REF!
4 Spuit 5 cc pcs 750.00 - #REF! #REF! #REF!
5 Easy Touch Glucose test strip pcs 120,000 - #REF!
6 Easy Touch Cholesterol test strip pcs 215,000 - #REF!
7 Nesco Glucose test strip pcs 120,000 -
8 Nesco Uric Acid test strip pcs 131,000 -
9 Nesco Cholesterol test strip pcs 220,000 -
10 Benecheck Uric Acid test strip pcs 153,000 -
11 Benecheck Blood Glucose test strip pcs 163,000 -
12 Benecheck Cholesterol test strip pcs 253,000 -
13 Accu-check Performa Gucose test strip pcs 420,000 -
Mengetahui Sumenep, ............

Kepala Puskesmas Sapeken Pengelola Obat
SUHARTO, SKM DEWI SARIGATI, A.Md.Kep

NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
NO NAMA OBAT SATUAN Harga Satuan
PUSK GFK Jumlah
1 2 3 5 13 14
1116
93
21
29
NERACA BAHAN MEDIS PAKAI HABIS DANA ALOKASI KHUSUS (DAK)
DINAS KESEHATAN KABUPATEN SUMENEP
Saldo Sisa Per 31 Desember 2019

NO NAMA OBAT KEMASAN Harga Satuan
Apotik Gudang Jml
1 Alat Suntik 1 ml pcs 650.00 - - -

2 Alat Suntik 1 ml pcs 698.70 -
3 Alat Suntik 2,5 ml pcs 650.00 - - -
4 Alat Suntik 3 ml pcs 650.00 - - -
7 Alat Suntik 5 ml pcs 750.00 - 1,200 1,200
9 Alkohol 70% 1 L btl 21,500.00 - - -
10 Alkohol 70% 1 L btl 25,000.00 -
11 Alkohol Swab pcs 100.00 20 - 20
12 Antiseptik Hand Rub 10 btl@500 ml (1650B) botol 608,000.00 - - -
13 Antiseptik Hand Rub 5L (1650G) galon 5L 580,000.00 - - -
14 Aseptic gel 500 ml + dispenser botol 22,000.00 - 15 15
15 Blood Transfusion Set pcs 3,600.00 - 32 32
16 Bracket handwash plastik pcs 17,600.00 -
Catgut chromic / Benang bedah No. 2/0 dengan jarum

17 pcs 32,800.00 - 12 12
26 mm

18 pcs 33,503.13 -
26 mm

19 pcs 34,369.44 -
26 mm
20 Catgut chromic / Benang bedah No. 3/0 dengan jarum 24x70 cm/kotak 32,800.00 - 12 12
21 Catgut chromic / Benang bedah No. 3/0 dengan jarum 24x70 cm/kotak 33,607.44 -
22 Catgut plain / Benang bedah No. 2/0 dengan jarum 24x70 cm/kotak 34,300.00 - 12 12
23 Catgut plain / Benang bedah No. 2/0 dengan jarum 24x70 cm/kotak 33,607.44 -
24 Catgut plain / Benang bedah No. 3/0 dengan jarum pcs 34,300.00 6 14 20
25 Catgut plain / Benang bedah No. 3/0 dengan jarum pcs 35,136.44 -
26 Dermafix T 10 x 12 cm pcs 6,309.00 -
DAK 2011 -6 .
Apotik Gudang Jml

32 Examination Glove size L pcs 462.00 - - -
33 Examination Glove size L pcs 356.20 -
34 Examination Gloves size M psg 462.00 - - -
35 Examination Gloves size M psg 356.20 -
36 Examination Gloves size S psg 462.00 - - -
37 Examination Gloves size S psg 356.20 -
38 Film IV dressing 6x7 P (ID67P) pcs 2,200.00 -

39 Fixomul stretch 5x5 rol 37,440.00 -
40 Folley catheter 2 way no. 16 pcs 11,000.00 - - -
41 Folley catheter 2 way no. 18 pcs 11,000.00 - - -
42 Folley catheter 2 way no. 18 8,000.00 -
43 Gips 10 cm x 2,7 m rol 39,750.00 -
44 Gips 5 cm x 2,7 m rol 24,500.00 -
45 Gips 7,5 cm x 2,7 m rol 28,000.00 -
46 Infus set anak pcs 3,500.00 37 157 194
47 Infus set dewasa pcs 3,200.00 9 250 259
48 IV Catheter NP pen type no. 18 pcs 6,000.00 -
51 IV Catheter trovensite 22 G pcs 23,100.00 -
52 IV Catheter trovensite 24 G pcs 23,100.00 -
53 IV Catheter WP with wings & port no. 26 pcs 8,659.00 -
54 IV. Catheter No. 18 pcs 3,800.00 216 - 216
55 IV. Catheter No. 18 pcs 5,600.00 -
56 IV. Catheter No. 20 pcs 3,800.00 189 88 277
62 Kantong Kencing Pee and Pee pcs 22,000.00 -
63 Kapas - kasa berlemak 500 gr pcs 16,500.00 -
64 Kapas pembalut/absorben 250 gram bungkus 12,500.00 - - -
65 Kapas pembalut/absorben 250 gram bungkus 12,250.00 -
66 Kasa hidrofil 40 x 80 cm pcs 105,000.00 -
67 Kasa Hydrofil steril 16 x 16 5,500.00 -
68 Kasa hydrofil uk. 40 x 80 cm rol 108,500.00 -
69 Kasa kompres 40/40 steril rol 1,618.00 -
70 Kasa kompres 40/40 steril 1,600.00 -
DAK 2011 -7 .
Apotik Gudang Jml
71 Kasa pembalut 4 x 15 cm elastic rol 2,240.00 - 10 10

72 Kasa pembalut 4 x 15 cm elastic 2,100.00 -
73 Kasa pembalut 4 x 3 cm elastic rol 590.00 -
74 Kasa pembalut hydrofil 4 x 10 cm rol 1,600.00 -
75 Kasa pembalut hydrofil 4 x 10 cm 1,500.00 -
76 Kasa pembalut hydrofil 4 x 5 cm rol 800.00 -
77 Kasa pembalut hydrofil 4 x 5 cm 750.00 -
78 Lidokain 2% & CHG 0,05% cathejell (CA125) tube 41,600.00 -
79 Lifo Scrub Handwash 500 ml botol 90,000.00 -
80 Lisol 1 L botol 41,000.00 -
81 Masker box / 50 pcs 1,122.00 - 100 100
82 Masker earloop pcs 440.00 -
83 Masker earloop pcs 22,000.00 -
84 My Jelly 82 gram tube 29,546.00 4 75 79
85 My Jelly 82 gram 29,549.00 -
86 Nasal oxygen cannula size L pcs 6,600.00 - 2 2
87 Nasal oxygen cannula size M pcs 6,600.00 - 16 16
88 Nasal oxygen cannula size S pcs 6,600.00 -
89 Nasal oxygen cannula size XS pcs 6,600.00 -
90 Novo fine 32 G jarum untuk pen insulin pcs 2,090.00 - 500 500
91 Odex 500 ml antiseptic-desinfectan botol 88,000.00 - 34 34
92 Oxyflow nasal oksigen pcs 5,500.00 -
93 Paper Tape 2,5 x 9,14 rol 8,150.00 -
94 Pharmafix 10 x 500 cm rol 51,035.00 -
97 Plester non woven fixation 5cm x 10m roll 44,767.00 - - -
98 Pot Sputum pot 2,728.00 - 680 680

99 Povidon Iodida larutan 10 % botol 18,000.00 -
100 Rivanol 300 ml botol 2,550.00 - 5 5
101 Rivanol 300 ml 3,000.00 -
102 Safeglove PP no. 6 psg 4,180.00 -
103 Safeglove PP no. 7 psg 4,180.00 -
104 Safeglove PP no. 8 psg 4,180.00 - 410 410
105 Sarung Tangan Obgyn / Obgyn Glove psg 19,360.00 - 200 200
106 Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah12 x 3 x 75 cm/kotak 19,700.00 8 - 8
107 Stabimed Desinfektan 1000 ml botol 620,000.00 - - -

108 Steril Pouch with Indicator 9 x 26 cm pcs 422.18 - 2,600 2,600
109 Steril Pouch with Indicator 9 x 26 cm 422.23 -
DAK 2011 -8 .
Apotik Gudang Jml
110 Sterile Water for Inhalation with O2 Humidifier adapter botol 52,000.00 -
111 Stomach tube 16FR 125 cm pcs 7,744.00 -
112 Stomach tube 18FR 125 cm pcs 7,744.00 -
113 Surgical tape 2" (18352) rol 15,333.33 - 126 126
114 Urine bag 2 L pcs 4,215.00 - - -
115 Urine bag with hanger pcs 5,500.00 -
116 Utravix 5 x 5 cm roll 19,250.00 -
117 Wing Needle 21G pcs 925.00 - - -
118 Wing Needle 23G pcs 925.00 - - -
119 Wing Needle 25G pcs 925.00 - - -
120 IV. Catheter No. 26 pcs 5 143 148
-
-
4,370,202,849
Mengetahui, Sumenep, ..................
Kepala Puskesmas Sapeken saldo yg lalu Pengelola Obat
Temuan BPK (tidak sesuai harga perolehan)

NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
DAK 2011 -9 .
DINAS KESEHATAN
Jl. Dr. Cipto No.33 Telp. (0328) 662122, Fax (0328) 672270
SUMENEP
KODE POS 69417
LAPORAN : PENERIMAAN DAN PENGELUARAN OBAT DANA APBD

No NAMA OBAT Kemasan Harga Satuan
Apotik Gudang Jumlah
1 2 3 5 13 14 asss
-
Analog insulin fast acting inj 100 IU/mL,
vial/cartridge disposible/penfill cartridge pen 87,000.00
1 (NOVORAPID) -
Analog insulinintermediate acting combine with short
or long acting inj 100 IU/mL, vial/cartridge pen 110,968.00
2 disposible/penfill cartridge (NOVOMIX 30) -
3 Antalgin tablet 500 mg tab 385.00 -
4 Trifluoperasin 5 mg tab 296.00 - #REF! #REF!
5 A2 Z250 XT/FILTEX Z250 XT WARNA A2 pcs 186,766.00 - #REF! #REF!
6 A3 P60 posterior /FILTEX P60 WARNA A3 pcs 215,504.00 - #REF! #REF!
7 Albendazol suspensi 200 mg/5 ml botol 10 ml 4,000.00 - #REF! #REF!
8 Albendazol tab 400 mg tablet 366.00 - #REF! #REF!
9 Allopurinol 100 mg tabl 86.00 - #REF! #REF!
10 Altera srp / Desloratadine 2,5 mg/5 ml botol 60 ml 49,500.00 - #REF! #REF!
11 Amaropo Plus tablet 2,200.00 - #REF! #REF!
12 Amaropo Plus tablet 2,286.90 - #REF! #REF!
13 Ambroksol syrup 15 mg/5 ml botol 5,060.00 - #REF! #REF!
14 Ambroksol tablet 30 mg tab 99.00 - #REF! #REF!
15 Aminophilin tab 200 mg tablet 137.50 - #REF! #REF!
16 Aminophyllin injeksi 24 mg / ml vial 3,822.00 - #REF! #REF!
17 Amitriptilin 25 mg tab 112.00 - #REF! #REF!
18 Amlodipin 10 mg tablet 93.00 130 70 200 #REF! #REF!
19 Amlodipin 10 mg tablet 330.00 - #REF! #REF!
20 Amlodipin tab 5 mg tablet 187.00 90 150 240 #REF! #REF!
21 Amlodipin tab 5 mg tablet 70.00 - #REF! #REF!
22 Amoksisilin kapsul 250 mg kapsul 211.00 -
23 Amoksisilin syr Forte 250 mg/5 ml botol 4,070.00 - #REF! #REF!
24 Amoksisilin tab 500 mg tablet 261.00 - #REF! #REF!
Antalgidon inj
(Metampiron250mg,amidopirin50mg,lidokain vial 10ml 15,400.00
25 15mg/ml) 16 - 16 #REF! #REF!
26 Antasida DOEN suspensi botol 60 ml 2,160.00 - #REF! #REF!
27 Antasida DOEN tablet kunyah tablet 72.00 - #REF! #REF!

28 Anti Bakteri DOEN salep kombinasi tube 2,516.00 - #REF! #REF!
Antihemorrhoid (Bismuth subgalat 150 mg +
29 heksaklorofen 2,5 mg) suppo 3,300.00 - #REF! #REF!
30 Asam Askorbat (Vitamin C) tablet 50 mg tablet 95.00 -
1 2 3 5 13 14 asss
31 Asam Mefenamat 500 mg tablet 175.78 - #REF! #REF!
32 Asam Traneksamat injeksi ampul 2,949.98 - #REF! #REF!
Asam Traneksamat injeksi ampul 1,748.00 -
33 Asering 5 infus botol 500 ml 24,200.00 - #REF! #REF!
34 Asetosal 80 mg tablet 148.00 - #REF! #REF!
35 Asiklovir krim tube 3,080.00 - #REF! #REF!
36 Asiklovir krim tube 2,750.00 - #REF! #REF!
37 Asiklovir tab 400 mg tablet 336.00 -
38 Asiklovir tablet 200 mg tablet 237.00 - #REF! #REF!
39 ATS 1500 IU (Biosat 1,5) ampul 1 ml 130,999.00 - #REF! #REF!
40 Becefort sirup botol 60 ml 17,358.00 - #REF! #REF!
41 Becefort tablet tablet 1,548.36 - #REF! #REF!
42 Betahistin mesilat tab 6 mg tablet 924.00 - - - #REF! #REF!
43 Betametason krim 0.1 % (sebagai valerat) tube 1,520.00 - #REF! #REF!
44 Betaserc (Betahistin 24 mg) tablet 7,050.00 - #REF! #REF!
45 Bio ATP tablet 2,310.00 - #REF! #REF!
46 Bio ATP tablet 2,354.00 - #REF! #REF!
47 Bioneuron inj (B1 100 mg,B6 200 mg,B12 1000 mcg) ampul 4,340.60 - #REF! #REF!
48 Bioron injeksi (vitamin neurotropik) ampul 4,180.00 - - - #REF! #REF!
49 Bioron injeksi (vitamin neurotropik) ampul 5,412.00 - #REF! #REF!
50 Bioron tablet (vitamin neurotropik) tablet 968.00 - #REF! #REF!
53 Bisoprolol 2,5 mg (CONCOR) tablet 626.00 - #REF! #REF!
54 Bisoprolol 5 mg tablet 645.00 - #REF! #REF!
55 Bonding / cairan dasar tumpatan btl 308,000.00 - #REF! #REF!
56 Bromheksin 8 mg tablet 279.40 -
57 CAL LC pcs 183,000.00 - #REF! #REF!
58 Calplus (Bahan pengisi saluran akar) syringe 181,500.00 - #REF! #REF!
59 Cardismo (Isosorbid Mononitrat 20 mg) tablet 2,640.00 260 250 510 #REF! #REF!
60 Cardismo (Isosorbid Mononitrat 20 mg) tablet 2,712.60 - #REF! #REF!
61 Caviton (Tambalan cavitas sementara) btl 30 gr 137,500.00 - #REF! #REF!
62 Celluloid strip ktk 100's 110,000.00 - #REF! #REF!
63 CELLULOSE MATRIX STRIP pcs 151,000.00 - #REF! #REF!
64 Cercul (Citicholin) inj ampul 16,500.00 - #REF! #REF!
65 Citicolin inj 250 mg/2 ml ampul 5,940.00 - #REF! #REF!
66 Clopidogrel tablet 1,318.00 - #REF! #REF!
67 Creshopen (Bahan sterilisasi lengkap pada saluran aka botol 396,000.00 - #REF! #REF!
68 Cresotin Liquid syringe dlm dos 181,500.00 - #REF! #REF!
69 Cresotin Liquid No. 2 syringe dlm dos 160,500.00 - #REF! #REF!
70 Cystone tablet 2,651.00 - 100 100
71 Decafil (Aminofilin tab 150 mg) tablet 139.00 300 800 1,100 #REF! #REF!
72 Deksametason injeksi i.v 5 mg / ml ampul 1,580.00 - #REF! #REF!
73 Denpro Cal LC pot 399,300.00 - #REF! #REF!
74 Dentin Conditioner (Cavitas sebelum tumpatan) ktkt 133,100.00 - #REF! #REF!
75 Dextamin CTM 2 mg tablet 1,815.00 - #REF! #REF!
76 Dextamine srp botol 29,700.00 - #REF! #REF!
77 Dextamine tab tablet 1,749.00 - #REF! #REF!
78 Dextral Forte tablet 770.00 - #REF! #REF!
1 2 3 5 13 14 asss
79 Dextral Forte tablet 800.80 - #REF! #REF!
80 Dextral sirup botol 60 ml 8,800.00 - #REF! #REF!
81 Dextral sirup botol 60 ml 9,570.00 - #REF! #REF!
82 Dextral tablet tablet 440.00 - #REF! #REF!
83 Dextrofen syr botol 60 ml 11,330.00 - #REF! #REF!
84 Difenhidramin injeksi 10 mg / ml ampul 8,085.00 - #REF! #REF!
85 Digoksin tab 0,25 mg tab 97.00 - #REF! #REF!
86 Digoksin tab 0,25 mg tab 104.00 - #REF! #REF!
87 Dios tablet 4,033.33 - #REF! #REF!
88 Dios tablet 4,216.67 -
89 Domperidon susp 5 mg/5 ml botol 14,300.00 - #REF! #REF!
90 Domperidon susp 5 mg/5 ml botol 15,180.00 -
91 Domperidon tablet tablet 167.00 - #REF! #REF!
92 Dormi Compositum tablet 1,694.00 - #REF! #REF!
93 Enbatic Salep (Neomisin Basitrasin) tube 16,500.00 - #REF! #REF!
94 Eritromisin 500 mg tablet 1,125.30 - #REF! #REF!
95 Eritromisin syr kering 200 mg/5 ml botol 7,700.00 -
96 Eritromisin tab 250 mg tablet 497.00 - #REF! #REF!
97 Etambutol 500 mg tablet 451.00 - #REF! #REF!
98 Etanol 70 % btl 100 ml 2,500.00 - #REF! #REF!
99 Etchant gel vial vial 120,227.00 - #REF! #REF!
100 Etil Klorida Spray 100 ml btl 100 ml 104,500.00 - #REF! #REF!
101 Famotidin 40 mg tablet 220.00 - #REF! #REF!
102 Fenoksimetil penisilin (Penisilin V) tab 500 mg tablet 510.00 -
103 Ferro Sulfat 200 mg + Asam Folat 0,25 mg tablet 42.00 -
104 Fluocort N tube 18,700.00 - #REF! #REF!
105 Fuji 1-1 Gold Label P/L 30 g/10 ml 137,500.00 - #REF! #REF!
106 Furamin inj (Vit. B1 + Fursultiamin 2,5 mg/ml) ampul 12,100.00 5 20 25 #REF! #REF!
107 Furosemide inj 10 mg/ml ampul 1,333.00 - #REF! #REF!
108 Furosemide inj 10 mg/ml ampul 1,829.00 - #REF! #REF!
109 Furosemide tab 40 mg tablet 85.00 -
110 Garam Oralit sachet 288.00 -
111 Gemfibrozil 300 mg kapsul 372.00 - - - #REF! #REF!
112 Gemfibrozil 300 mg kapsul 289.00 - #REF! #REF!
113 Gentamisin inj 40 mg/ml ampul 3,399.00 - #REF! #REF!
114 Gentamisin salep kulit 0,1% tube 5 gr 1,650.00 - #REF! #REF!
115 Gentamisin salep kulit 0,1% tube 5 gr 2,090.00 - #REF! #REF!
116 Gentamisin sulfat salep mata (genoint salep mata) tube 3,5 gr 2,600.00 - #REF! #REF!
117 Glibenklamid tab 5 mg tablet 99.00 - #REF! #REF!
118 Glibenklamid tab 5 mg tablet 119.00 - #REF! #REF!
119 Glibenklamid tab 5 mg tab 56.00 - #REF! #REF!
120 Glikuidon tab 30 mg tablet 950.00 - #REF! #REF!
121 Glimepiride 1 mg tablet 174.00 - #REF! #REF!
122 Glimepiride 1 mg tablet 265.00 - #REF! #REF!
123 Glimepiride 2 mg tablet 207.00 244 - 244
124 Gliseril Guaiakolat 100 mg tablet 126.50 - #REF! #REF!
125 Gliseril Guaiakolat 100 mg tablet 127.60 - #REF! #REF!
126 Gliserin larutan 50 % btl 100 ml 5,333.00 - #REF! #REF!
127 Glukosa larutan infus 10% btl 500 ml 5,700.00 - #REF! #REF!
1 2 3 5 13 14 asss
128 Glukosa larutan infus 5% btl 500 ml 5,200.00 - #REF! #REF!
129 Griseofulvin tab 125 mg tablet 209.00 - - - #REF! #REF!
130 Haloperidol 1,5 mg tablet 69.00 -
131 Haloperidol 5 mg tablet 96.00 - #REF! #REF!
132 Hemafort (anti anemia Fe + Asam Folat) tablet 814.00 - #REF! #REF!
133 Hemafort (anti anemia Fe + Asam Folat) tablet 834.90 - #REF! #REF!
134 Hemorogard kapsul 1,552.10 - #REF! #REF!
135 Hepagard tablet 2,750.00 110 - 110 #REF! #REF!
136 Hepagard tablet 2,795.10 - #REF! #REF!
137 Hepagard tablet 2,794.00 - #REF! #REF!
138 Hidrokortison krim 2, 5 % tube 2,798.00 - #REF! #REF!
139 Hiosin Butilbromid inj 20 mg/ml ampul 4,500.00 - #REF! #REF!
140 Hiosin Butilbromid inj 20 mg/ml ampul 20,460.00 - #REF! #REF!
Human insulin fast acting inj 100 IU/ml, cartridge

pen 80,502.00
disposible/penfill cartridge (ACTRAPID HM PENFILL)
141 - #REF! #REF!
142 Human Tetanus Imunoglobulin i.m 250 IU (Tetagam) prefilled syringe 176,800.00 - #REF! #REF!
143 Hustab tab tablet 436.70 - #REF! #REF!
144 Hustab tab tablet 432.67 - #REF! #REF!
145 Ibuprofen 400 mg tablet 150.00 - #REF! #REF!
146 Ibuprofen susp 100 mg/ 5ml botol 3,499.00 - #REF! #REF!
147 Ibuprofen tablet 200 mg tab 110.00 - #REF! #REF!
148 Isosorbid Dinitrat tab sublingual 5 mg tablet 88.00 - #REF! #REF!
149 Kalium Diklofenak 50 mg tablet 737.00 - #REF! #REF!
152 Kaloba sirup botol 110,000.00 - #REF! #REF!
153 Kaloba tablet tablet 6,757.14 - #REF! #REF!
154 Kalsium Laktat tab 500 mg tablet 70.00 - #REF! #REF!
155 Kaptopril tablet 12,5mg tab 62.00 - #REF! #REF!
156 Kaptopril tablet 25 mg tab 84.00 - #REF! #REF!
157 Karbogliserin tetes telinga 10% btl 100 mg/1 ml 2,042.00 - #REF! #REF!
158 Ketokonazol krim 2% tube 15 gr 4,700.00 - #REF! #REF!
159 Ketokonazol tablet 200 mg tablet 1,872.00 - #REF! #REF!
160 Ketoprofen inj 100 mg ampul 6,710.00 4 30 34 #REF! #REF!
161 Ketoprofen inj 100 mg ampul 13,552.00 - #REF! #REF!
162 Ketoprofen inj 100 mg ampul 6,710.00 - #REF! #REF!
163 Klindamisin kapsul 150mg kapsul 759.00 - - -
164 Klindamisin kapsul 150mg kapsul 715.00 -
165 Klindamisin kapsul 150mg kapsul 990.00 -
166 Klindamisin kapsul 300mg kapsul 603.00 - - -
167 Klobazam 10 mg tablet 900.00 -
168 Kloramfenicol kapsul 250 mg kapsul 249.00 -
169 Kloramfenicol suspensi 125 mg / ml botol 5,192.00 -
170 Kloramfenikol salep mata 1% tube 1,600.00 -
171 Kloramfenikol tetes mata (Reco) botol 5 ml 6,380.00 -
172 Kloramfenikol tetes telinga (Reco) botol 10 ml 7,150.00 -
173 Kloramfenikol tetes telinga (Reco) botol 10 ml 7,370.00 -
174 Klorfeniramin Maleat (CTM) tablet 36.00 -
1 2 3 5 13 14 asss
175 Kodein 10 mg tablet 500.00 118 1,300 1,418
176 Kodein 15 mg tablet 850.00 44 - 44
177 Kodein 20 mg tablet 1,100.00 105 200 305
Kotrimoksasol suspensi kombinasi suffametoksasol
178 200mg dan trimetoprim 40 mg / 5 ml botol 2,167.00 -
Kotrimoksasol tab kombinasi suffametoksasol 400mg
179 dan trimetoprim 80 mg tablet 138.00 -
180 Lanzoprasol 30 mg kapsul 473.00 -
181 Lapifed tab tablet 913.00 -
182 Lexacrol sirup botol 100 ml 16,500.00 -
183 Lexacrol sirup botol 100 ml 21,340.00 -
184 Lexacrol tablet tablet 513.33 80 - 80
185 Lidokain inj 2 % + epinefrin 1 : 80000 - 2 ml ampul 1,363.00 -
186 Lisinopril 10 mg tablet 259.00 -
187 Lisinopril 10 mg tablet 600.00 -
188 Loperamide 2 mg tablet 89.00 -
189 Lytakur / Multivit syr. botol 60 ml 13,200.00 -
190 MASTER BOND pcs 237,000.00 -
191 Meloksikam 15 mg tab tablet 506.00 -
192 Meloksikam 15 mg tab tablet 512.60 -
193 Mersibion 5000 inj ampul 4,620.00 -
194 Mertigo SR tablet 5,071.00 -
195 Metamizol inj 500 mg/ml ampul 3,500.00 -
196 Metampiron tablet 500 mg tablet 385.00 34 - 34
197 Metaneuron tab kotak/300 tab 342,595.00 -
198 Metaneuron tab tab 1,141.98 587 7,200 7,787
199 Metformin 850 mg tablet 150.00 -
200 Methisoprinol sirup botol 60 ml 55,000.00 -
201 Methisoprinol tablet tablet 3,300.00 -
202 Metilergometrin Maleat tab salut 0,125 mg tablet 198.00 -
203 Metilprednisolon 4 mg tablet 205.02 -
204 Metoklopramide 5 mg tablet 108.00 -
205 Metoklopramide inj 5 mg/ml ampul 1,980.00 10 - 10
206 Metoklopramide inj 5 mg/ml ampul 3,960.00 -
207 Metoklopramide sir 5 mg/5 ml (Lexapram syrup) botol 60 ml 2,600.00 -
208 Metronidasol infus 500 mg / 100ml botol 8,110.00 -
209 Metronidasol infus 500 mg / 100ml botol 9,949.00 -
210 Metronidasole tablet 500 mg tab 160.00 -
211 Metronidasole tablet 250 mg tab 110.00 -
212 MICRON SUPERIOR pcs 270,000.00 -
213 Molexdine gargle botol 190 ml 9,460.00 -
214 Molexflu sirup botol 60 ml 6,600.00 -
215 Molexflu sirup botol 60 ml 6,710.00 -
216 Molexflu tablet tablet 396.00 -
217 N-asetil sistein tab 350.00 330 4,000 4,330
218 Natrium Klorida larutan infus 0,9% btl 500 ml 4,700.00 -
219 Nebacetin powder botol 5 gr 20,350.00 -
220 Nebacetin salep (Neomisin 5 mg,Basitrasin 250 IU) tube 5 gr 17,204.00 -
221 Neo Kaominal sirup botol 60 ml 7,700.00 -
1 2 3 5 13 14 asss
222 Neo Kaominal sirup botol 60 ml 7,920.00 -
223 Neomisin basitrasin salep kulit tube 17,204.00 -
224 Nifedipin 10 mg tablet 110.00 -
225 Norages injeksi ampul 9,020.00 -
226 Norages injeksi ampul 9,185.00 -
227 Novaheksin 8 mg (Bromheksin) tablet 275.00 -
228 Noza tablet 770.00 -
229 Noza tablet 797.50 -
230 Nystatin tablet salut 500.00 IU / gram tab 640.00 -
231 Nystatin vaginal tablet salut 100.00 IU / gram tabl 480.00 -
232 Ocugard tablet 4,727.80 -
233 Oksimetazolin tetes hidung 0,025 % (ILIADIN) botol 32,549.00 -
234 Oksimetazolin tetes hidung 0,050 % (ILIADIN) botol 34,320.00 -
235 Oksitetrasiklin injeksi vial 11,000.00 -
236 Oksitetrasiklin salep kulit 3 % tube 1,980.00 56 3 59
237 Oksitetrasiklin salep mata 1% tube 3,5 gr 3,630.00 -
238 Omeprazol inj 40 mg/10 ml ampul 9,898.00 - - -
239 Omeprazol kap 20 mg kapsul 211.00 -
240 Ondansetron 4 mg tablet 716.00 -
241 Ondansetron injeksi 4 mg/2 ml ampul 1,070.00 -
242 Ondansetron injeksi 4 mg/2 ml ampul 2,400.00 -
243 Osteotin tablet 3,281.67 -
244 Ostovel (Kalsitriol 0,25 mcg) softcap 1,650.00 -
245 Parasetamol drop 100 mg/ml @ 15 ml 60 mg/0,6 ml 6,649.00 -
246 Parasetamol drop 100 mg/ml @ 15 ml 60 mg/0,6 ml 5,200.00 -
247 Parasetamol syr 120 mg/5 ml btl 60 ml 1,438.00 -
248 Parasetamol tab 500 mg tablet 79.00 -
249 Pehacain inj ampul 3,080.00 - 60 60
250 Pehacain inj (Lidokain + Adrenalin) ampul 3,113.00 -
251 Pirasetam 800 mg tab tablet 759.00 -
252 Pirasetam 800 mg tab tablet 765.60 -
253 Pirasetam inj ampul 5,500.00 -
254 Piroksikam 20 mg / Licofel tablet 132.00 -
255 Piroksikam kapsul 20 mg tablet 132.00 -
256 Povidon Iodida larutan 10% btl 300 ml 14,203.00 -
257 Povidon Iodida larutan 10% btl 30 ml 2,163.00 -
258 Prednison 5 mg tablet 73.00 545 400 ce
259 Prednison 5 mg tablet 114.00 -
260 Propanolol tab 10 mg tablet 58.00 -
263 Ranitidin injeksi 25 mg / 2 ml ampul 1,140.05 -
264 Ranitidin tablet 150 mg tablet 120.00 -
265 Salbutamol tablet 2 mg tablet 59.00 -
266 Salbutamol tablet 4 mg tablet 89.00 -
267 Saldona Forte (Carbazochrome Na Sulfonat 30 mg) tablet 3,652.00 -
268 Salep 2 - 4 pot 30 gram 2,000.00 -
269 Salep 2 - 4 pot 30 gram 2,796.00 -
270 Salisil bedak 2 % kotak 1,250.00 -
1 2 3 5 13 14 asss
271 Scotchbond Etchant botol pack plastik 107,800.00 -
272 Scotchbond Etchant botol pack plastik 231,000.00 -
273 Sefadroksil syrup kering 125 mg / 5 ml botol 4,896.00 3 - 3
274 Sefadroksil syrup kering 125 mg / 5 ml botol 4,185.00 -
275 Sefadroksil syrup kering 250 mg / 5 ml botol 5,940.00 -
276 Seftriakson injeksi 1 gr vial 10,450.00 6 237 243
277 Seftriakson injeksi 1 gr vial 4,483.00 -
278 Seftriakson injeksi 1 gr vial 10,450.00 -
279 Setirizin 10 mg tablet 181.00 -
280 Sianokobalamin 50 mcg tablet 57.00 -
281 Sianokobalamin inj 500 mcg ampul 2,640.00 69 59 128
282 Simvastatin tab 10 mg tablet 117.00 215 150 365
283 Simvastatin tab 10 mg tablet 169.01 -
284 Simvastatin tab 20 mg tablet 229.00 780 120 900
285 Simvastatin tab 20 mg tablet 205.00 -
286 Siprofloksasin infus 2% vial 200 ml 13,000.00 -
287 Siprofloksasin tablet 500 mg (sebagai HCl) tab 283.69 -
288 Skincol (Sukralfat gel) tube 30 gr 137,500.00 -
289 Solathim 500 mg (Tiamfenikol) kapsul 1,320.00 -
290 Solathim 500 mg (Tiamfenikol) kapsul 1,210.00 -
291 Spironolakton 25 mg tab tablet 195.00 -
292 Stimuno syr botol 60 ml 22,000.00 -
293 Syntocinon (Oksitosin 10 IU/2 ml) ampul 13,915.00 - 10 10
294 Tebokan tablet 5,841.00 - 130 130
295 Tensigard tablet 2,126.67 - 30 30
296 Tetrasiklin capsul 250 mg kapsul 149.00 330 100 430
297 Tetrasiklin capsul 500 mg kapsul 300.00 80 80
298 Thiamfilex suspensi (Tiamfenikol 125 mg/5 ml) botol 60 ml 6,600.00 -
299 Thiamin injeksi 100 mg / ml ampul 1,320.00 -
300 Tiamazol 5 mg (THYROZOL 5) tablet 661.00 -
301 Tiamfenikol 500 mg kapsul 615.34 -
302 Tiamfenikol syr 125 mg/5 ml (Solathim syr) botol 60 ml 7,150.00 -
303 Topical Gel (Anestesi dalam bentuk gel dengan aneka pot 137,500.00 -
304 Tramadol 50 mg kapsul kapsul 321.86 -
305 Tramadol inj 50 mg/ml ampul 2,395.00 -
Trampara (Tramadol HCl 37.5 mg+Parasetamol 325
306 mg) tablet 5,280.00 80 630 710
307 TRICRESOL FORMALIN pcs 72,000.00 -
308 Unthecol (Hiosin Butilbromid) tablet 2,200.00 -
309 Vermox / Mebendazol 500 mg tablet 7,139.90 -
310 Vitamin B Kompleks tablet 107.00 -
311 Vitamin B Kompleks tablet 89.00 -
312 Vitamin B1 100 mg/ml inj ampul 1,136.67 23 - 23
313 Zentra tablet 990.00 -
314 Zinc tablet 20 mg tablet 474.00 -
315 Zircum Kid / Zinc syr 20 mg/5 ml btl 60 ml 7,400.00 -
316 Glimepiride 4 mg tablet - 200 200
1 2 3 5 13 14 asss
-
Mengetahui Sumenep, ..................


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
NERACA OBAT DANA ALOKASI KHUSUS (DAK)
DINAS KESEHATAN KABUPATEN SUMENEP

Apotik Gudang Jml
1 Akarbose 50 mg tab 562.00 -
2 Albendazol susp 200 mg/5 ml botol 4,000.00 -
3 Albendazol tablet 400 mg tab 404.00 -
4 Albendazol tablet 400 mg tab 366.00 -
5 Allopurinol 100 mg tab 89.00 - - -
6 Allopurinol 300 mg tab 187.00 260 2,320 2,580
7 Allopurinol 300 mg tab 210.00 -
8 Alprazolam 0.25 mg tab 316.00 -
9 Alprazolam 0.5 mg tab 88.00 -
10 Alprazolam 1 mg tab 143.00 -
11 Alprazolam 1 mg tab 120.00 -
12 Ambroksol syrup 15 mg/ml btl 60 ml 5,500.00 -
13 Ambroksol syrup 15 mg/ml botol 3,520.00 -
14 Ambroksol tablet 30 mg tab 198.00 -
15 Ambroksol tablet 30 mg tab 143.00 -
16 Aminofilin tab 150 mg tab 139.00 -
17 Aminophilin inj 24 mg / ml ampul 2,998.00 -
Aminophilin tab 200 mg 110.00 -

18 tab
19 Amitriptilin tab salut 25 mg (HCl) tab 120.00 55 2200 2,255
20 Amlodipin 10 mg tab 145.00 -
23 Amoksisilin kap 250 mg tab 196.00 -
26 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,628.00 - - -
27 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,473.00 -
28 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,400.00 -
29 Amoksisilin syrup 125 mg / 5 ml btl 60 ml 1,881.00 -
30 Amoksisilin syrup 125 mg / 5 ml btl 60 ml 3,500.00 -
Amoksisilin tab 500 mg tab 190.00 -

31
Amoksisilin tab 500 mg tab 233.00 -

32
33 Ampisllin injeksi 1000 mg vial 8,237.00 -
34 Analog insulin long acting inj 100 UI/ml (Levemir Flexpen) flexpen 3 ml 85,000.00 -
Prepared by WINDOWS 03/08/2023 Page 19
Apotik Gudang Jml
35 Analog insulin mix acting inj 100 UI/ml (Novomix Flexpen) unit 110,000.00 -
Analog insulin rapid acting inj 100 UI/ml/insulin aspart (Novorapid unit 87,000.00 -
36 Flexpen)
37 Antasida DOEN suspensi botol 2,025.00 - - -
38 Antasida DOEN suspensi tab 1,995.00 -
39 Antasida DOEN tablet kunyah tab 62.00 700 101,900 102,600
40 Antasida DOEN tablet kunyah tab 54.00 -
41 Anti Bisa Ular Serum vial 5 ml 479,996.00 -
42 Anti Bisa Ular Serum BIOSAT SABU) vial 5 ml 512,204.00 2 - 2
43 Anti migren tab 173.00 -
44 Antibakteri DOEN : Basitrasin 500 IU/g + Polimiksin 10000 IU/g tube 2,750.00 -
47 Antihemoroid doen kombinasi supp 3,045.00 - 30 30
48 Antihemoroid doen kombinasi supp 3,167.00 -
49 Antiparkinson / Levopar tab 1,298.00 110 - 110
50 Antiparkinson / Levopar tab 1,030.00 -
51 Aqua Pro injeksi steril bebas pirogen vial 2,750.00 - - -
52 Aqua Pro injeksi steril bebas pirogen (OTSU - WI) vial 2,860.00 - - -
53 Asam asetyl salisilat 100 mg tab 95.70 -
54 Asam askorbat (Vitamin C) tablet 50 mg tab 104.00 220 300 520
55 Asam askorbat (Vitamin C) tablet 50 mg tab 105.00 -
56 Asam Folat 0,4 mg (Profolat) tab 55.00 -
57 Asam Folat 0,4 mg (Profolat) tab 52.00 -
58 Asam Folat tab 1 mg tab 75.00 210 300 510
59 Asam Fusidat krim 20% / Fucilex Krim tube 4,699.00 -
60 Asam Mefenamat 500 mg tab tab 100.00 -
61 Asam Mefenamat 500 mg tab tab 103.00 -
62 Asam Pipemidat 400 mg / Urinter tab 1,400.00 -
63 Asam Traneksamat inj 100 mg/ml amp 1,945.00 7 - 7
64 Asam Traneksamat inj 50 mg/ml vial 1,956.00 -
65 Asering 5 infus btl 500 ml 22,000.00 -
66 Asering infus botol 9,275.00 -
67 Asering infus softbag 9,646.00 -
68 Asering larutan infus / BES softbag 9,646.00 -
69 Asetil Sistein tab 200 mg tab 350.00 -
70 Asetosal 80 mg (Miniaspi) tab 92.00 84 200 284
71 Asetosal 80 mg (Miniaspi) tab 99.00 -
72 Asiklovir 200 mg tab 240.00 70 - 70
73 Asiklovir krim 5 % tube 5 gram 2,750.00 18 2 20

Apotik Gudang Jml
74 Asiklovir tab 400 mg tab 365.00 110 100 210
75 Asiklovir tab 400 mg tab 380.00 -
76 Atorvastatin 10 mg tab 1,100.00 -
77 Atropin inj i.m/i.v/s.k/ 0.25 mg/ml (sulfat) amp 1,540.00 - - -
78 Atropin inj i.m/i.v/s.k/ 0.25 mg/ml (sulfat) amp 1,595.00 -
79 ATS 1500 IU vial 126,500.00 -
80 ATS 1500 IU (BIOSAT) vial 130,999.00 -
81 Attapulgit (New Antides) tab 136.00 80 - 80
82 Attapulgit (Pularex) tab 162.00 90 300 390
83 Attapulgit (Pularex) tab 140.00 -
84 Azithromycin 500 mg tab 1,888.00 -
85 Azithromycin srp ker 200 mg/5 ml botol 29,898.00 -
86 Becefort tab 1,540.00 -
87 Becefort tab 1,548.36 -
16,500.00 -
88 Becefort sirup botol 60 ml
Besi ( II ) sulfat 200 mg + asam folat 0,25 mg tablet (tablet tambah
sase 355.00 610 163,600 164,210
darah kombinasi)
89
90 Betahistine mesilate tab 6 mg tab 149.00 -
91 Betahistine mesilate tab 6 mg tab 110.00 -
92 Betametason krim 0.1 % 5 gram tube 1,349.00 - 0 -
93 Betametason krim 0.1 % 5 gram tube 1,340.00 -
94 Betametason krim 0.1 % 5 gram tube 3,350.00 -
2,355.98 -
95 Bio ATP tab
300.00 76 60 136
96 Bisakodil tab 5 mg tab
97 Bisoprolol 10 mg ( Concor 10 mg ) tab 2,950.00 -
98 Bisoprolol 2,5 mg (Concor 2,5 mg ) tab 597.00 270 - 270
99 Bisoprolol 2,5 mg (Concor) tab 635.00 -
100 Bisoprolol 5 mg tab 236.00 -
101 Bisoprolol 5 mg tab 260.00 -
Budesonid cairan inhalasi 0,25mg/mL, respoules 2 mL (Pulmicort 9,725.00 40 - 40

102 Respules) can
103 Chlorfeniramina Maleat 4 mg (CTM) tab 42.00 760 600 1,360
104 Chlorfeniramina Maleat 4 mg (CTM) tab 22.00 -
105 Chlorfeniramina Maleat 4 mg (CTM) tab 23.00 -
106 Citicholine injeksi amp 8,250.00 -
107 D5 - ¼ NS botol 9,350.00 -
108 D5 - ¼ NS botol 9,724.00 -
109 D5 - ½ NS botol 9,400.00 -

Apotik Gudang Jml
110 D5 - ½ NS botol 9,776.00 -
111 D5 - NS botol 8,025.00 -
112 D5 - NS botol 8,346.00 -
113 Deksametason inj i.v 5 mg / ml amp 1,567.00 50 30 80
114 Deksametason inj i.v 5 mg / ml amp 1,097.00 -
115 Deksametason tab 0.5 mg tab 88.00 - - -
116 Deksametason tab 0.5 mg tab 41.00 -
117 Deksametason tab 0.5 mg tab 32.00 -
118 Desoksimetason 0,25% (Denomix) tube 10,000.00 -
119 Desoksimetason 0,25% (Denomix) tube 10,400.00 -
120 Dextral syrup btl 7,854.00 10 12 22
121 Dextral syrup botol 9,350.00 -
122 Diazepam Enema 10 mg/2,5 ml / Stesolid Enema 10 tube 18,279.00 - 5 5
123 Diazepam injeksi 5 mg / ml amp 8,761.50 34 160 194
124 Diazepam injeksi 5 mg / ml amp 1,735.00 -
125 Diazepam rektal 5 mg / 2,5 ml (Stesolid) tube 11,517.00 -
126 Diazepam tab 5 mg tab 117.00 130 1,460 1,590
127 Diazepam tab 5 mg tab 109.00 -
128 Difenhidramin inj i.m 10 mg /ml ( HCl ) amp 1,060.00 37 423 460
129 Difenhidramin inj i.m 10 mg /ml ( HCl ) amp 1,095.00 -
130 Digoxin inj 0.25 mg/ml / Fargoxin amp 25,300.00 -
131 Digoxin tab 0,25 mg tab 105.00 120 800 920
132 Digoxin tab 0,25 mg tab 104.00 -
133 Diltiazem 30 mg tab 135.00 180 300 480
134 Diltiazem SR 100 mg (Herbesser CD 100) tab 4,460.00 - -
135 Diltiazem SR 100 mg (Herbesser CD 100) tab 4,290.00 -
136 Dimenhidrinat tab 50 mg tab 105.00 - - -
137 Dimenhidrinat tab 50 mg tab 99.00 -
138 Domperidon 10 mg tab 95.00 100 300 400
139 Domperidon 10 mg tab 85.00 -
140 Domperidon 10 mg tab 91.00 -
141 Domperidon susp 5 mg / 5 ml botol 3,000.00 - - -
142 Domperidon susp 5 mg / 5 ml botol 2,700.00 -
143 Dopamin inj 40 mg/ml / Cetadop amp 6,160.00 -
144 Dulcolax supp adult 10 mg supp 5,800.00 -
145 Dulcolax supp infant 5 mg supp 6,000.00 - 18 18
146 Dulcolax supp infant 5 mg supp 5,670.00 -
147 Epinefrin / Adrenalin inj 0.1 ml (sebagai Hcl) amp 1,749.00 69 100 169
148 Epinefrin / Adrenalin inj 0.1 ml (sebagai Hcl) amp 1,408.00 -
149 Ergotamin 1mg + kafein 50 mg tab 173.00 4 200 204

Apotik Gudang Jml
150 Erithromisin syrup 200 mg / 5 ml btl 60 ml 6,150.00 7 7
151 Erithromisin kapsul 500 mg tab 770.00 100 100 200
152 Erithromisin kapsul 500 mg tab 730.00 -
153 Eritromisin 250 mg kapsul 546.00 -
154 Esomeprazole inj 40 mg amp 39,600.00 -
155 Esomeprazole inj 40 mg amp 39,759.00 -
156 Etambutol 250 mg tab 366.00 - 200 200
157 Etil Klorida Spray via/can/100ml 165,000.00 - - -
158 Eugenol 12 botol @ 10 ml/dos 18,100.00 -
159 Famotidine tab 20mg tab 113.00 -
160 Famotidine tab 40 mg tab 176.84 -
161 Fenitoin inj 50 mg/ml amp 3,738.00 9 90 99
162 Fenobarbital tab 30 mg tab 62.00 -
163 Fenobarbital tab 30 mg tab 171.00 -
164 Fenol Gliserol tetes telinga 10 % btl 2,590.00 10 26 36
165 Fenol Gliserol tetes telinga 10 % botol 1,008.00 -
166 Fenoterol 100 mcg (Berotec) box 80,000.00 -
167 Fitomenadion (vitamin K1) 2 mg/ml amp 3,550.00 -
168 Fitomenadion (vitamin K1) 2 mg/ml amp 3,682.00 -
169 Fitomenadion tab salut gula10 mg (Vit. K1) tab 686.00 205 100 305
170 Fitomenadion tab salut gula10 mg (Vit. K1) tab 710.00 -
171 Furosemide injeksi 10 mg/ml amp 2,059.00 58 250 308
172 Furosemide injeksi 10 mg/ml amp 1,333.00 -
173 Furosemide injeksi 10 mg/ml amp 2,059.00 -
174 Furosemide tab 40 mg tab 80.00 302 600 902
175 Furosemide tab 40 mg tab 77.00 -
176 Gabapentin 300 mg tab 1,000.00 -
177 Garam Oralit 200 ml sachet 292.00 400 2,300 2,700
178 Garam Oralit 200 ml sachet 257.00 -
179 Gemfibrosil kapsul 300 mg tab 364.00 -
180 Gemfibrosil kapsul 300 mg tab 372.00 -
Gentamicin sulfat tetes mata 0,3 % botol 4,170.00 -

181
182 Gentamisin salep mata 0,3% (Genoint) tube 2,960.00 -
183 Gentamycin inj 40 mg/ml ampul 3,386.00 -
184 Gentamycin inj 40 mg/ml ampul 3,509.00 -
185 Gentamycin salep kulit 0.1 % tube 1,760.00 -
186 Geriavita tab tab 2,126.67 -
187 Glibenclamida 5 mg tab 110.00 590 600 1,190
188 Glibenclamida 5 mg tab 119.00 -

Apotik Gudang Jml
189 Gliklazid 60 mg lepas lambat / Diamicron MR 60 tab 3,014.00 -
190 Gliklazid 80 mg tab 210.00 -
191 Glikuidon 30 mg tab 1,055.00 -
192 Glimepiride 1 mg tab 194.00 -
198 Gliseril Guaikolat tab 100 mg tab 198.00 360 400 760
199 Gliseril Guaikolat tab 100 mg tab 121.00 -
200 Glukosa larutan infus 10 % btl 500 ml 7,500.00 -
201 Glukosa larutan infus 40 % steril - 25 ml ampul 1,452.00 -
202 Glukosa larutan infus 40 % steril - 25 ml ampul 9,900.00 -
203 Glukosa larutan infus 5 % btl 500 ml 6,900.00 -
204 Griseofulvin 500 mg tab 849.00 -
205 Griseofulvin tab 125 mg tab 245.00 -
206 Griseofulvin tab 125 mg tab 224.00 -
207 Haloperidol 0,5 mg tab 56.00 70 400 470
208 Haloperidol 0,5 mg tab 55.00 -
209 Haloperidol 1,5 mg tab 61.00 5 - 5
210 Haloperidol 1,5 mg tab 59.00 -
211 Haloperidol 5 mg tab 69.00 80 - 80
212 Hepagard tab 2,795.10 -
213 Hidroklortiazida tab 25 mg tab 149.00 380 - 380
214 Hidroklortiazida tab 25 mg tab 155.00 -
215 Hidrokortison krim 2.5 % tube 2,640.00 -
216 Hiosin Butilbromid inj (Spashi) amp 9,900.00 -
217 Human tetanus imunoglobulinim 250 IU (Tetagam) unit 170,000.00 - 50 50
218 Human tetanus imunoglobulinim 250 IU (Tetagam) unit 176,800.00 -
432.67 -
219 HUSTAB/Bromheksin 8mg,diphenhidramin 25mg,parasetamol 400mg tab
220 Ibuprofen 200 mg tab tab 102.00 -
221 Ibuprofen 200 mg tab tab 105.00 -
222 Ibuprofen 400 mg tab 111.00 - - -
223 Ibuprofen 400 mg tab 370.00 -
224 Ibuprofen suspensi 100 mg / ml btl 60 ml 2,475.00 - 11 11
225 Ibuprofen suspensi 100 mg / ml btl 60 ml 4,465.00 -
226 Insulin analog long acting 100 IU/ml / Lantus pen 83,950.00 -

Apotik Gudang Jml
4,550.00 17 20 37
227 Ipratropium inhalasi 0,5 mg + Salbutamol 2,5 mg / Combivent UDV vial
228 Irbesartan 150 mg tab 483.00 -
231 Isosorbid Dinitrat sublingual 5 mg (ISDN) tab 90.00 200 100 300
232 Isosorbid Dinitrat sublingual 5 mg (ISDN) tab 89.00 -
233 Ka En 1B botol 9,644.00 -
234 Ka En 3A botol 10,285.00 -
235 Ka En 3A btl / 500 ml 10,696.00 -
236 Ka En 3B botol 10,285.00 -
237 Ka En 3B botol 10,696.00 -
238 Ka En Mg3 larutan infus softbag 9,984.00 -
239 Kalium Diklofenak tablet 50 mg tab 682.00 -
240 Kalsitriol 0,25 mcg / Ostovel softcap 1,650.00 - 30 30
241 Kalsium Glukonas inj 10% amp 10,351.00 - 24 24
242 Kalsium Laktat tab 500 mg tab 59.00 740 100 840
243 Kalsium Laktat tab 500 mg tab 56.00 -
244 Kalsium Laktat / Novakal tab 147.40 -
245 Kandesartan 8 mg tab 519.00 -
246 Kaptopril 12.5 mg tab 62.00 -
247 Kaptopril 12.5 mg tab 108.90 -
248 Kaptopril 25 mg tab 80.00 460 - 460
249 Kaptopril 25 mg tab 75.00 -
253 Karbamazepin tab 200 mg tab 228.00 222 600 822
254 Karbamazepin tab 200 mg tab 230.00 -
255 Ketoconazole krim 2 % tube 15 gr 2,596.00 14 5 19
256 Ketoconazole krim 2 % tube 15 gr 2,518.00 -
257 Ketokonazol Scalp Solution 2% / Fungasol SS botol 24,200.00 -
258 Ketokonazole tab 200 mg tab 280.00 40 - 40
259 Ketokonazole tab 200 mg tab 288.00 -
260 Ketoprofen injeksi 100 mg amp 6,160.00 -
261 Ketoprofen suppo (Fetik) supp 2,640.00 -
262 Ketoprofen suppo (Suprafenid) supp 2,789.00 -
263 Ketoprofen suppo (Suprafenid) supp 2,380.00 -
Ketoprofen tab 100 mg tab 1,342.00 -

264

Apotik Gudang Jml
265 Ketorolac inj 30 mg / ml amp 1,100.00 2 - 2
266 Ketorolac inj 30 mg / ml amp 1,045.00 -
267 Klindamisin 150 mg kap 796.40 -
270 Klindamisin 300 mg kapsul tab 578.00 -
271 Klobazam 10 mg tab 967.00 -
272 Klobazam 10 mg tab 739.00 -
273 Klopidogrel 75 mg tab 1,318.00 -
274 Kloramfenicol 250 mg kapsul tab 310.00 256 - 256
275 Kloramfenicol 250 mg kapsul kap 227.00 -
276 Kloramfenicol 250 mg kapsul kap 462.00 -
277 Kloramfenicol Salep Mata 1 % tube 1,810.00 6 29 35
278 Kloramfenicol Salep Mata 1 % tube 1,881.00 -
279 Kloramfenicol suspensi 125 mg/5 ml btl 60 ml 3,955.00 - - -
280 Kloramfenicol suspensi 125 mg/5 ml btl 60 ml 4,700.00 -
281 Kloramfenicol Tetes Mata 0.5 % btl 5 ml 7,150.00 -
282 Kloramfenicol tetes telinga 3 % 5 ml botol 1,599.00 -
283 Kloramfenikol 500 mg / Chloramex kap 1,090.00 -
284 Kloramfenikol Tetes Mata 0,5% / Reco botol 10 ml 7,150.00 -
285 Klorpromazin HCl tablet salut 100 mg (HCL) tab 162.00 454 - 454
286 Klorpromazin HCl tablet salut 100 mg (HCL) tab 147.00 -
287 Klozapin 100 mg tab 3,288.00 -
288 Klozapin 25 mg tab 1,121.00 -
289 Kodein 10 mg btl 250 tablet 550.00 -
290 Kodein 10 mg btl 250 tablet 571.00 -
291 Kodein 15 mg tab 950.00 -
292 Kodein 15 mg tab 987.00 -
293 Kodein 20 mg tab 1,250.00 -
294 Kodein 20 mg tab 1,299.00 -
Kotrimoksasol suspensi (komb sulfametoksazol 200 mg+trimetoprim

btl 60 ml 2,286.00 7 3 10
40 mg/5 ml suspensi)
295
Kotrimoksasol suspensi (komb sulfametoksazol 200 mg+trimetoprim
btl 60 ml 2,052.00 -
40 mg/5 ml suspensi)
296
297 Kotrimoksasol tab 480 mg tab 129.00 190 100 290
298 Kotrimoksasol tab 480 mg tab 125.00 -
299 Kotrimoksazol Forte 960 mg tab 299.00 90 - 90
300 Laktulosa sir. 3,3335 gr/5 ml botol 15,060.00 -
301 Lansoprazol 30 mg kap 315.00 -
302 Lanzoprazol 30 mg kap 303.00 -

Apotik Gudang Jml
303 Lapifed tab 1,870.00 -
494.00 -
304 Levofloksasin 500 mg tab
305 Levofloksasin tetes mata 0,5% / Optiflox botol 18,000.00 -
306 Lexacrol syrup btl 14,850.00 -
307 Lexacrol syrup btl 17,600.00 -
Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain jel 2% (Xylocain 41,600.00 - 6 6

308 JELLY 2%) syringe
Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain spray oral 10% 177,216.00 - 24 24

309 (Xylocain SPRAY) botol
310 Lidokain inj 2% amp 1,149.00 - 300 300
311 Lidokain injeksi 2 % (Hcl+epinefrin) 1 : 80.000 - 2 ml vial 1,145.00 46 60 106
Lidokain injeksi 2 % (Hcl+epinefrin) 1 : 80.000 - 2 ml vial 1,937.00 -

312
313 Lisinopril 10 mg tab 319.00 -
314 Lisinopril 10 mg tab 259.00 -
315 Lisol btl 1000 ml 19,999.10 -
316 Loperamid 2 mg tab 80.00 -
317 Loratadin 10 mg tab 123.00 -
318 Lorazepam 0,5 mg / Merlopam tab 355.00 -
319 Lorazepam 2 mg tab 779.00 -
320 Lorazepam 2 mg tab 810.00 -
321 Lorazepam 2 mg (Ativan) tab 1,000.00 -
322 Magnesium Sulfat inj 20 % - 25 ml vial 3,200.00 12 - 12
323 Magnesium Sulfat inj 20 % - 25 ml vial 3,328.00 -
324 Magnesium Sulfat inj 40 % - 25 ml vial 3,650.00 11 - 11
325 Magnesium Sulfat inj 40 % - 25 ml vial 3,796.00 -
326 Mannitol infus 20% 250 ml botol 28,275.00 -
327 Mebendazol tab 500 mg / Vermox tab 9,150.00 -
328 Meloxicam 15 mg tab 770.00 -
329 Meloxicam 7,5 mg tab 660.00 -
330 Metamizol inj amp 2,900.00 70 - 70
331 Metamizol inj amp 3,500.00 -
332 Metampiron tablet 500 mg tab 242.00 -
333 Metampiron injeksi 250 mg ampul 1,200.00 -
334 Metformin 850 mg tab 150.00 - - -
335 Metformin Hcl 500 mg tab tab 102.00 60 - 60
336 Metformin Hcl 500 mg tab tab 94.00 -
337 Metildopa tab 250 mg / Dopamet tab 946.00 100 400 500
338 Metilergometrin Maleat inj 0.200 mg-1 ml amp 2,959.00 - 205 205

Apotik Gudang Jml
339 Metilergometrin Maleat inj 0.200 mg-1 ml amp 3,685.00 -
340 Metilergometrin Maleat tab salut 0.125 mg tab 286.00 400 - 400
341 Metilprednisolon 16 mg tab 516.00 -
342 Metilprednisolon 4 mg tab 150.00 346 - 346
345 Metisoprinol 500 mg tab 3,300.00 -
346 Metisoprinol srp 250 mg/5 ml botol 55,000.00 -
347 Metoklopramid 10 mg tab 85.00 148 - 148
348 Metoklopramid 10 mg tab 80.00 -
351 Metoklopramid drop 2 mg/ ml / Gavistal drop botol 3,900.00 -
352 Metoklopramid inj 5 mg/ml amp 3,395.00 -
353 Metoklopramid inj 5 mg/ml (Gavistal) amp 6,600.00 -
354 Metoklopramid syr 5 ml / 5 ml (Lexapram) botol 2,580.00 -
355 Metronidasol infus ktk 1 vial 100 ml 8,110.00 6 28 34
356 Metronidasol infus botol 24,000.00 -
357 Metronidasole tab 250 mg tab 230.00 -
358 Metronidasole tab 250 mg tab 122.80 - 100 100
359 Metronidasole tab 500 mg tab 113.00 238 - 238
363 Metronidazol ovula 500 mg (Vagizol) ovula 4,100.00 -
364 Metronidazol susp 125 mg/5 ml botol 3,950.00 4 24 28
365 Mineral Mix sachet 2,920.00 -
366 Molagit tablet tab 481.07 -
367 Molexflu tab 388.67 -
368 Molexflu tab 304.33 -
369 Molexflu syrup btl 6,600.00 - - -
370 Molexflu syrup botol 5,390.00 -
371 Natrium Diklofenak 25 mg tab 128.00 -
372 Natrium Diklofenak 50 mg tab 159.00 312 - 312
375 Natrium Klorida larutan infus 0.9 % btl 500 ml 6,410.00 -
376 Neo Kaominal sirup botol 7,920.00 -
377 Nifedipin 10 mg tab tab 99.00 -
378 Nifedipin 20 mg (Adalat Oros) tab 3,285.00 -

Apotik Gudang Jml
379 Nistatin tablet salut 500.000 IU/g tab 790.00 -
380 Nistatin tablet salut 500.000 IU/g tab 640.00 -
381 Nistatin vaginal tablet 100.000 IU/g tab 523.00 - 800 800
382 Nistatin vaginal tablet 100.000 IU/g tab 560.00 -
383 Norages injeksi amp 8,470.00 - - -
384 Norages injeksi amp 8,726.00 -
385 Novo Twist 32 G x 5 mm pcs 2,083.00 -
386 Oksibiotic injeksi 10 IU/ml - 1 ml vial 7,700.00 -
387 Oksigen 1 m ³ tabung 44,000.00 -
388 Oksigen 6 m ³ tabung 77,000.00 -
389 Oksitetrasiklin salep kulit 3 % 5 gram tube 5 gram 1,870.00 -
390 Oksitosin injeksi 10 IU/ml - 1 ml amp 1,900.00 - 101 101
391 Oksitosin injeksi 10 IU/ml - 1 ml amp 1,199.00 -
392 Omeprazol serb inj 40 mg vial 9,898.00 -
393 Omeprazole 20 mg tab 140.00 128 30 158
394 Omeprazole 20 mg tab 130.00 -
395 Omeprazole 20 mg kap 139.00 -
396 Ondansetron 4 mg tab 455.00 -
397 Ondansetron 4 mg tab 1,540.00 -
398 Ondansetron 8 mg tab 2,475.00 -
399 Ondansetron inj 4 mg/2 ml amp 1,254.00 -
400 Osteotin kap 3,281.67 102 - 102
401 Oxymetazolin tts hidung 0,025% (Iliadin) botol 31,300.00 -
405 Parasetamol 100 mg/ml drops (60 mg/0,6 ml) btl 15 ml 5,200.00 -
406 Parasetamol 100 mg/ml drops (60 mg/0,6 ml) btl 15 ml 6,649.00 -
407 Parasetamol 1000 mg/100 ml infus btl 100 ml 48,400.00 15 - 15
408 Parasetamol 1000 mg/100 ml infus btl 100 ml 11,610.00 -
409 Parasetamol srp 125 mg/ 5 ml botol 1,010.00 8 183 191
410 Parasetamol srp 125 mg/ 5 ml botol 1,107.00 -
411 Parasetamol tab 100 mg tab 32.23 -
414 Permetrin krim 5% (Scabimite) tube 12,155.00 -
415 Permetrin krim 5% (Scabimite) tube 11,825.00 -
416 Pirantel Pamoat tablet ( base )125 mg tab score 287.00 -
417 Pirantel Pamoat tablet ( base )125 mg tab 319.00 -
418 Pirasetam 1 gram injeksi amp 5,500.00 -

Apotik Gudang Jml
419 Pirasetam 1 gram injeksi amp 6,490.00 -
420 Pirasetam 800 mg tab 792.00 -
421 Piridoksin (Vitamin B6) tab 10 mg (Hcl) tab 118.00 -
422 Piridoksin (Vitamin B6) tab 10 mg (Hcl) tab 123.00 -
423 Piridoksin (Vitamin B6) 25 mg tab 60.00 -
424 Piroksikam 20 mg tablet tab 105.60 -
425 Piroksikam 20 mg tablet tab 352.00 -
426 Povidon Iodida larutan 10 % btl 300 cc 17,999.30 -
428 Povidon Iodida larutan 10 % 60 ml 3,699.30 -
429 Povidon Iodida larutan 10 % 60 ml 3,700.00 -
431 Povidon Iodine (Ecodine) btl 1 L 79,649.90 - 7 7
432 Povidon Iodine (Ecodine) btl 1 L 79,650.00 -
433 Pravastatin 20 mg tab 2,090.00 -
434 Prednison tab 5 mg tab 76.00 -
435 Prednison tab 5 mg tab 68.00 -
436 Propanolol 10 mg tab 60.00 280 100 380
437 Propanolol 40 mg tab 74.00 120 480 600
438 Ranitidin inj 25 mg/ml amp 1,155.00 - - -
439 Ranitidine inj 25 mg/2 ml amp 1,458.00 -
440 Ranitidine tab 150 mg tab 98.00 -
441 Reco tetes telinga botol 6,050.00 18 4 22
442 Retinol (Vitamin A) 100.000 IU kapsul lunak kap 260.00 -
443 Ringer Dekstrosa larutan infus botol 8,550.00 -
444 Ringer Laktat larutan infus btl 500 ml 7,150.00 -
445 Risperidon 2 mg tab 273.00 -
446 Salbutamol 0,1% (Ventolin Nebules) nebule 3,999.99 -
447 Salbutamol 2 mg tab 78.00 -
448 Salbutamol 4 mg tab 80.00 370 400 770
451 Salbutamol MDI aerosol 100 mcg/dosis / Salbulin botol 29,400.00 -
452 Salbutamol serb inh 200 mcg (Ventolin Rotacap) tab 450.00 -
453 Salbutamol sir 2 mg/5 ml botol 4,446.00 - - -
454 Salep 2-4 kombinasi asam salisilat 2 % belerang endap 4 % pot 2,620.00 22 - 22
455 Salep 2-4 kombinasi asam salisilat 2 % belerang endap 4 % pot 1,800.00 -
456 Salisil Bedak 2% box 50 gr 2,200.00 - 2 2
457 Salisyl talk 2 % ktk 50 gram 1,120.00 -
458 Sefadroksil 250 mg kap 690.00 -

Apotik Gudang Jml
459 Sefadroxil 500 mg kapsul tab 450.00 98 100 198
460 Sefadroxil 500 mg kapsul tab 682.00 -
461 Sefadroxil 500 mg kapsul kap 627.00 -
462 Sefadroxil sirup kering 250 mg/5 ml botol 7,100.00 -
465 Sefadroxil syr kering 125 mg / 5 ml btl 60 ml 3,980.00 -
466 Sefaleksin 500 mg kap 678.00 -
467 Sefepim serbuk inj 1000 mg vial 30,000.00 -

468 Sefiksim 100 mg kap 750.00 -
469 Sefiksim srp ker 100 mg/5 ml botol 6,150.00 -
470 Sefotaksim injeksi 1 gram vial 4,482.00 26 30 56
471 Sefotaksim injeksi 1 gram vial 4,282.00 -
472 Sefotaksim injeksi 1 gram vial 4,200.00 -
473 Seftriaxone injeksi 1 gr/vial vial 9,350.00 -
474 Seftriaxone injeksi 1 gr/vial vial 4,483.00 -
475 Sefuroksim 500 mg (Zinnat) tab 5,999.95 -
476 Seledoxyn 10 mg tab 17.35 -
477 Setirizin 10 mg tab 143.00 -
478 Setirizin 10 mg tab 90.00 -
479 Setirizin sir 5 mg/5 ml botol 2,915.00 -
480 Setirizin sir 5 mg/5 ml botol 2,850.00 -
481 Sianokobalamin inj 500 mcg/ml amp 1,087.00 -
482 Sianokobalamin inj 500 mcg/ml amp 1,035.00 -
483 Sianokobalamin tablet 50 mcg tab 46.00 170 100 270
484 Sianokobalamin tablet 50 mcg tab 49.00 -
485 Sianokobalamin tablet 50 mcg tab 57.00 -
486 Simetidin tab 200 mg tab 135.30 -
1,231.21 -
487 Simvastatin 20 mg tab
205.00 -
488 Simvastatin 20 mg tab
Simvastatin tablet 10 mg tab 111.00 -

489
Simvastatin tablet 10 mg tab 110.00 -

490
491 Siprofloksasin 500 mg tab tab 240.00 70 - 70
492 Siprofloksasin 500 mg tab tab 265.00 -
493 Siprofloksasin 500 mg tab tab 385.00 -
494 Siprofloksasin infus 2 % btl 100 ml 9,699.00 -
495 Spiramisin 500 mg tab 1,780.00 -
496 Spironolakton 100 mg tab 699.00 -

Apotik Gudang Jml
497 Stimuno sirup botol 60 ml 20,900.00 -
498 Sucralfate gel anti keloid (Skincol gel) tube 30 gr 137,500.00 - 3 3
6,789.00 -
499 Sukralfat susp 500 mg/5 ml botol
500 Sulfadiazin Silver Krim 1% tube 35 gr 20,700.00 -
501 Taburia sachet 660.00 -
502 Tamsulosin 0.4 mg lepas lambat / Harnal Ocas tab 4,799.00 -
503 Tensigard tab 2,126.67 -
504 Terbutalin 2,5 mg tab tab 89.00 20 - 20
505 Terbutalin cairan inhalasi / Bricasma Respules 2,5 mg/ml nebules 7,124.00 -
506 Terbutalin inj 0,5 mg/ml (Bricasma inj sk/iv 0,5 mg/ml) amp 11,500.00 12 65 77
507 Terbutalin inj 0,5 mg/ml (Bricasma inj sk/iv 0,5 mg/ml) amp 11,960.00 -
508 Tetrasiklin kap 250 mg tab 166.00 -
509 Tetrasiklin kap 500 mg tab 310.00 -
510 Thiamfenicol kap 500 mg tab 1,067.00 -
511 Thiamfilex suspensi btl 60 ml 7,150.00 -
512 Thiamin Hcl tab 50 mg tab 91.00 210 200 410
513 Thiamin Hcl tab 50 mg tab 82.00 -
514 Thiamin Hcl tab 50 mg tab 85.00 -
515 Thiamin inj 100 mg / ml amp 1,136.67 -
516 Thyrozol 10 mg tab 1,195.00 -
517 Tiamazol 5 mg / Thyrozol 5mg tab 630.00 50 200 250
518 Tiamfenikol 500 mg / Solathim kap 1,056.00 -
519 Timolol Maleat Tetes Mata 0,25% / Isotic Adretor botol 10,400.00 -
520 Topiramat 25 mg (Topamax) tab 3,950.00 -
523 Tramadol HCl injeksi 50 mg/ml amp 1,710.00 -
524 Tramadol HCl injeksi 50 mg/ml amp 1,764.00 -
525 Tramadol kapsul 50 mg kapsul 321.20 -
526 Triheksifenidil tablet 2 mg tab 41.00 120 300 420
527 Triheksifenidil tablet 2 mg tab 85.00 -
528 Valproat 250 mg (Depakote) tab 1,750.00 -
529 Valproat syr 250 mg/ 5 ml botol 15,789.00 -
530 Valproat syr 250 mg/ 5 ml botol 22,987.00 -
531 Valsartan 160 mg tab 999.00 -
532 Ventolin Rotahaler alat hirup 200 mcg box 6,550.00 -
533 Vit B1 100 mg,B6 100 mg, B12 200 mcg / Bioron tab tab 979.00 -
534 Vit B1 100 mg,B6 200 mg, B12 5000 mcg / Mersibion inj amp 3 ml 4,840.00 -
535 Vitamin B Komplek tab tab 115.00 - - -

Apotik Gudang Jml
536 Vitamin B Komplek tab tab 83.00 -
537 WIDA RD botol 8,892.00 -
538 Zinc elemental 10 mg/ml (Zincpro drops) botol 10,798.69 -
539 Zinc syr 20 mg/ 5 ml botol 4,789.00 -
540 Zinc syr 20 mg/ 5 ml botol 2,972.00 -
541 Zinc tab dispersible tab 514.00 180 500 680
542 Zinc tab dispersible tab 524.00 -
543 Zircum Kid syr 20 mg / 5 ml botol 6,290.00 -

-
-
Mengetahui, Sumenep, ..........


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017

DINAS KESEHATAN
SUMENEP
KODE POS 69417
LAPORAN : PENERIMAAN DAN PENGELUARAN OBAT DANA BAGI HASIL CUKAI HASIL TEMBAKAU (DBHCHT)
SATU Harga SALDO SISA PER 31 DESEMBER 2019

NAMA OBAT
No AN Jumlah
Pusk GFK
Sisa
1 2 3 5 13 14
1 Pro TB kid 2 (lanjutan) blister/28 tab 92,400.00 - - - 972 972

2 Pro TB Kid 3 (intensif) blister/28 tab 130,900.00 - - - #REF! #REF!
3 TB Vit 6 sirup 225ml botol 43,450.00 25 - 25 #REF! #REF!
4 Curliv Plus box 60 tab tablet 253,000.00 - - -
5 Curliv Plus sirup botol 44,000.00 15 - 15
6 ADS 10.000 IU unit 2,035,000.00 - - -
#REF! #REF!
#REF! #REF!
Mengetahui Sumenep, ..............


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
DINAS KESEHATAN
SUMENEP
KODE POS 69417
LAPORAN PERSEDIAAN REAGEN LABORATORIUM DANA APBD

NO NAMA OBAT SATUAN Harga Satuan SALDO SISA PER 31 DESEMBER 2019
Pusk GFK Jumlah
1 2 3 5 12 13 14
1 Lyse medonic kit 5,621,000.00 -

2 Diliuent Medonic kit 3,702,600.00 -
3 Boule cleaning Kit kit 5,610,000.00 -
4 Cell pack sysmex kit 2,607,000.00 3 3
5 stromatolyser 4DL sysmex kit 4,021,435.00 2 2
6 stromatolyser 4DS sysmex kit 3,764,310.00 -
7 sulfolyser sysmex kit 983,730.00 -
8 cell clean kit 1,650,550.00 -
9 kontrol normal DL medonic kit 2,062,500.00 -
10 kontrol normal DL sysmex kit 1,383,400.00 -
11 Cholesterol PAP SL 6x100 ml + Std kit 3,413,300.00 30 30
12 Creatinin Jaffe 2x125 ml kit 819,500.00 3 3
13 AST/GOT SL 4x62,5 ml kit 1,911,250.00 -
14 ALT/GPT SL 4x62,5 ml kit 1,911,250.00 -
15 Glucose PAP SL 6x100 ml + Std kit 1,856,800.00 30 30
16 Triglyceride Mono SL New 6x50 ml + Std kit 3,549,700.00 -
17 Uric Acid Mono SL 6x50 ml + Std kit 2,648,800.00 30 30
18 Bilirubin T/D 2x125 ml kit 1,119,800.00 3 3
19 HDL Precipitant 250 ml kit 1,818,300.00 1 1
20 LDL Precipitant 250 ml kit 2,586,650.00 1 1
21 ALP (DEA) 2x62,5 ml kit 928,400.00 -
22 Albumin BCG 2x125 ml kit 819,500.00 -
23 Urea UV SL 4x62,5 ml kit 1,692,900.00 -
24 Total Protein 2x125 ml kit 1,037,850.00 -
25 Rematoid Factor (RF) 100 Test kit 682,000.00 -
26 Widal O,H,A,B set 902,000.00 2 2
27 Strip Urine 10P box 725,000.00 -
28 Plano Test 50 Strip box 110,000.00 -
29 Salmonella IgG/IgM (25 Strip) box 2,409,000.00 -
30 NS-1 Dengue (25 Test) box 5,750,000.00 2 2
31 CRP box 506,000.00 -
32 Golongan Darah A, B, Rhesus set 635,000.00 -
33 Formalin Test (50 Test) box 2,300,000.00 -
34 Borax Test (50 Test) box 2,150,000.00 -
35 Rodamin B Test (50 Test) box 2,550,000.00 -
36 Methanyl Yellow Test box 2,150,000.00 -
37 HbsAg (40 Test) box 550,000.00 10 10
38 HbsAb (25 Test) box 506,000.00 10 10
39 Red Tube box 291,500.00 -
40 Needle Holder Injection (100 Pcs/Pack) box 542,300.00 -
41 Holder Injection (100 Pcs/Pack) box 163,900.00 -
42 Terumo Needle 25Gx1 box 110,000.00 -
43 Terumo Needle 23Gx1 box 110,000.00 -
44 Oil Emersi 50 ml kit 462,000.00 2 2
45 Narkoba 5 Parameter box 2,475,000.00 -
46 Tourniquet pcs 22,000.00 -
47 Blue Tips pcs 154,000.00 3 3
48 Yellow Tips pcs 258,500.00 2 2
49 Jas Laboratorium Lengan Panjang pcs 187,000.00 -
50 Mikropipet 5ul pcs 2,064,150.00 -
53 Lampu Photometer Original pcs 638,000.00 -
54 Rongent Film 30x40 box 2,058,100.00 -
Reagen Pencuci Film Rongent (Developer
55 + Fixer) kit 2,200,000.00 -
56 Malaria box 2 2
57 HIV box 4 4
58 kertas thermal pcs 20 20
59 k3 EDTA merah box 4 4
60 k3 EDTA ungu box 4 4
61 NaCl 0,1 % botol 1 1


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
DINAS KESEHATAN
SUMENEP
KODE POS 69417
LAPORAN PERSEDIAAN REAGEN LABORATORIUM DANA DAK


NO NAMA REAGEN KEMASAN Harga Satuan
1 2 3 5 12 13 14
1 Reagen Ress Ecker botol 152,500 -

2 Turk botol 32,500 -
3 Kartu golongan darah box 70,000 10 10
4 KOH 10% botol 20,900 -
5 Cryotube / sampel cup tube 434 -
6 Objeck glass box 20,746.00 -
7 Cover glass box 125,741.00 -
8 Autoclick Lancing Device pcs 17,413.00 -
9 Blood lancet box 14,564.00 18 18
-
-


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017
DINAS KESEHATAN
SUMENEP
KODE POS 69417
LAPORAN PERSEDIAAN REAGEN LABORATORIUM DANA DBHCHT

NO NAMA OBAT SATUAN Harga Satuan SALDO SISA PER 31 DESEMBER 2019
Pusk GFK Jumlah
1 2 3 5 12 13 14
1 Mantoux test box 1,250,000 -

2 Onemed Gluco protein pcs 1,045 -
3 Onemed Detecto HbS Ag pcs 4,048 -
Mengetahui Sumenep, ...............


NIP. 19690329 199203 1 007 NIP. 19871207 201001 2 017

Format Neraca Obat BHP Reagen DAK APBD DBHCHT 31 Des 2019 PKM - FIX

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Format Neraca Obat BHP Reagen DAK APBD DBHCHT 31 Des 2019 PKM - FIX

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PEMERINTAH KABUPATEN SUMENEP

KODE POS 69417

1 Infusion set dewasa set 4,400 - #REF! #REF! #REF!

Mengetahui Sumenep, ............

SUHARTO, SKM DEWI SARIGATI, A.Md.Kep

Saldo Sisa Per 31 Desember 2019

1 Alat Suntik 1 ml pcs 650.00 - - -

15 Blood Transfusion Set pcs 3,600.00 - 32 32

16 Bracket handwash plastik pcs 17,600.00 -

Catgut chromic / Benang bedah No. 2/0 dengan jarum

Catgut chromic / Benang bedah No. 2/0 dengan jarum

Catgut chromic / Benang bedah No. 2/0 dengan jarum

31 Dermafix T 5 x 7 cm pcs 1,629.00 -

35 Examination Gloves size M psg 356.20 -

36 Examination Gloves size S psg 462.00 - - -

37 Examination Gloves size S psg 356.20 -

38 Film IV dressing 6x7 P (ID67P) pcs 2,200.00 -

71 Kasa pembalut 4 x 15 cm elastic rol 2,240.00 - 10 10

97 Plester non woven fixation 5cm x 10m roll 44,767.00 - - -

98 Pot Sputum pot 2,728.00 - 680 680

107 Stabimed Desinfektan 1000 ml botol 620,000.00 - - -

SUHARTO, SKM DEWI SARIGATI, A.Md.Kep

SALDO SISA PER 31 DESEMBER 2019

27 Antasida DOEN tablet kunyah tablet 72.00 - #REF! #REF!

Human insulin fast acting inj 100 IU/ml, cartridge

Mengetahui Sumenep, ..................

SUHARTO, SKM DEWI SARIGATI, A.Md.Kep

Saldo Sisa Per 31 Desember 2019

1 Akarbose 50 mg tab 562.00 -

2 Albendazol susp 200 mg/5 ml botol 4,000.00 -

3 Albendazol tablet 400 mg tab 404.00 -

4 Albendazol tablet 400 mg tab 366.00 -

5 Allopurinol 100 mg tab 89.00 - - -

6 Allopurinol 300 mg tab 187.00 260 2,320 2,580

7 Allopurinol 300 mg tab 210.00 -

8 Alprazolam 0.25 mg tab 316.00 -

9 Alprazolam 0.5 mg tab 88.00 -

10 Alprazolam 1 mg tab 143.00 -

11 Alprazolam 1 mg tab 120.00 -

12 Ambroksol syrup 15 mg/ml btl 60 ml 5,500.00 -

13 Ambroksol syrup 15 mg/ml botol 3,520.00 -

14 Ambroksol tablet 30 mg tab 198.00 -

15 Ambroksol tablet 30 mg tab 143.00 -

16 Aminofilin tab 150 mg tab 139.00 -

17 Aminophilin inj 24 mg / ml ampul 2,998.00 -

Aminophilin tab 200 mg 110.00 -

20 Amlodipin 10 mg tab 145.00 -

21 Amlodipin 10 mg tab 93.00 -

22 Amlodipin 5 mg tab 85.00 -

23 Amoksisilin kap 250 mg tab 196.00 -

24 Amoksisilin kap 250 mg tab 195.00 -

25 Amoksisilin kap 250 mg tab 184.00 -

26 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,628.00 - - -

27 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,473.00 -

28 Amoksisilin sir ker Forte 250 mg/5 ml botol 3,400.00 -

29 Amoksisilin syrup 125 mg / 5 ml btl 60 ml 1,881.00 -

30 Amoksisilin syrup 125 mg / 5 ml btl 60 ml 3,500.00 -

Amoksisilin tab 500 mg tab 190.00 -

Amoksisilin tab 500 mg tab 233.00 -

38 Antasida DOEN suspensi tab 1,995.00 -

39 Antasida DOEN tablet kunyah tab 62.00 700 101,900 102,600

40 Antasida DOEN tablet kunyah tab 54.00 -

41 Anti Bisa Ular Serum vial 5 ml 479,996.00 -