LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) JKN

PUSKESMAS MALEBER TAHUN 2023

PUSKESMAS : MALEBER
KECAMATAN : MALEBER
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : JANUARI/2023
PROPINSI : JAWA BARAT

STOK STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL AKHIR

1 2 3 4 5 6 7 8
A. O B A T
1 Air Raksa Dental Use Botol - - - - -
2 Albendazole Tablet 400 mg Tablet - - - - -
3 Albendazole susp 200 mg/5 ml Botol - - - - -
4 Alopurinol Tablet 100 mg Tablet 1,000 - 1,000 200 800
5 Alopurinol Tablet 300 mg Tablet - - - - -
6 Alprazolam tablet 1 mg Tablet - - - - -
7 Ambroksol Tablet 30 mg Tablet 19,507 - 19,507 2,050 17,457
8 Ambroksol sirup 15 mg/5 ml Botol - - - - -
9 Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - - - -
10 Aminofillin Tablet 200 mg Tablet - - - - -
11 Amitriptillin Hcl Tablet Salut 25 mg Tablet 1,460 - 1,460 50 1,410
12 Amlodipin Tablet 5 mg Tablet 31,460 - 31,460 790 30,670
13 Amlodipin Tablet 10 mg Tablet 17,950 - 17,950 1,053 16,897
14 Amoksisillin Kapsul 250 mg Kapsul - - - - -
15 Amoksisillin Kaplet 500 mg Kaplet 25,000 - 25,000 - 25,000
16 Amoksisillin Serbuk Injeksi 1000 mg vial - - - - -
17 Amoksisillin Sirup Kering 125 mg/5ml Botol - - - - -
18 Amoksisillin Double Strengh Sirup Kering 250
Botol
mg/5 ml - - - - -
19 Ampisilin Kapsul 250 mg Kapsul - - - - -
20 Ampisillin Kaplet 500 mg Tablet - - - - -
21 Ampisilin Sirup 125 mg / 5 ml Botol - - - - -
22 Ampisillin Injeksi 1000 mg Vial - - - - -
23 Analgetik Plus Tablet - - - - -
24 Antasida Doen Suspensi Kombinasi :
Magnesium Hidroksida 200 mg+ Alumunium Botol
Hidroksida 200 mg/5 ml 124 - 124 124 -
25 Antasida Doen Tablet, Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium Hidroksida 200 Tablet
mg 25,492 - 25,492 1,370 24,122
26 Antasida Plus Tablet Tablet - - - - -
27 Antalgin (Metampiron) Tablet 500 mg Tablet 3,675 - 3,675 1,510 2,165
28 Antalgin Injeksi 250 mg/ml-2ml Ampul - - - - -
29 Anti Bakteri DOEN Salep Kombinasi :
Basitrasin 500 IU/g + Polimiksin 1000 Tube
IU/g - - - - -
30 Anti Hemoroid Doen komb Supp - - - - -
31 Anti Fungi DOEN Kombinasi :
Pot
Asam Benzoat 6% + Asam Salisilat 3% 343 - 343 5 338
32 Antimigren DOEN Kombinasi :
Tablet
Ergotamin Tartrat 1 mg + Kofein 50 mg - - - - -
33 Anti Diare Suspensi Botol - - - - -
34 Anti Diare Tablet Tablet - - - - -
35 Anti Dotum Oral Tablet Tablet - - - - -
36 Anti Hipertensi Kapsul Tablet - - - - -
37 Antihistamin Tablet kombinasi Tablet 8,237 - 8,237 8,237 -
38 Antispasmodik Tablet Tablet - - - - -
39 Antitusiva Sirup Botol - - - - -
40 Antitusiva Tablet Tablet - - - - -
41 Asam Folat Tablet 1 mg Tablet - - - - -
42 Asam Askorbat (Vit. C) Tablet 50 mg Tablet - - - - -
43 Asam Mefenamat Kapsul 500 mg Kapsul 20,000 - 20,000 1,015 18,985
44 Acetylsistein tablet Tablet 4,800 - 4,800 - 4,800
45 Asetosal Tablet 80 mg Tablet - - - - -
46 Asetosal Tablet 100 mg Tablet - - - - -
47 Asetosal Tablet 500 mg Tablet - - - - -
48 Asiklovir Krim 5 % Tube - - - - -
49 Asiklovir Tablet 200 mg Tablet - - - - -
50 Asiklovir Tablet 400 mg Tablet - - - - -
51 Attapulgit Tablet - - - - -
52 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - - -
53
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial
- - - - -
54 Bahan Tambal Sementara Set - - - - -
55 Benzatin Benzil Penisilin injeksi Vial - - - - -
56 Betahistin Mesilat 6 mg Tablet 2,000 - 2,000 - 2,000
57 Betametason Krim 0,1 %- 5g - - - - -
58 Bisakodil Tablet 5 mg Tablet 200 - 200 - 200
59 Bisoprolol Tablet 5 mg Tablet - - - - -
60 Bromheksin 8 mg Tablet - - - - -
61 Cresotin Pasta Botol - - - - -
62 Cresotin Liquid No 2 Botol - - - - -
63 Deksametason Injeksi 5mg/ml-1ml Ampul - - - - -
64 Deksametason Tablet 0,5 mg Tablet 9,960 - 9,960 65 9,895
65 Devitalisasi Pasta (Non Arsen) Botol - - - - -
66 Diazepam tablet 2 mg Tablet - - - - -
67 Diazepam tablet 5 mg Tablet - - - - -
68 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - - - -
69 Diazepam Larutan Rektal 5 mg/ml Supp - - - - -
70 Diazepam Larutan Rektal 10 mg/ml Supp - - - - -
71 Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - - - -
72 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - - - -
73 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - - - -
74 Digoksin Tablet 0,25 mg Tablet - - - - -
75 Dimenhidrinat Tablet 50 mg Tablet 1,000 - 1,000 - 1,000
76 Domperidon Tablet 10 mg Tablet 990 - 990 168 822
77 Donperidon Suspensi 5 mg/5ml Botol 88 - 88 88 -
78 Efedrin Hcl Tablet 25 mg Tablet - - - - -
79 Ekstrak Belladone Tablet 10 mg Tablet - - - - -
80 Epinefrin HCl / Bitartrat
(Epinefrina / Adrenalina) Injeksi Ampul
0,1%/- 1ml - - - - -
81 Eritromisin Kapsul 250 mg Kapsul - - - - -
82 Eritromisin Kapsul 500 mg Kapsul - - - - -
83 Eritromisin Sirup 200 mg / 5 ml Botol - - - - -
84 Etambutol Tablet 500 mg Tablet - - - - -
85 Etanol 70 % 100 ml Botol - - - - -
86 Etil Klorida Semprot -100 ml Botol - - - - -
 87 Eugenol Cairan -10 ml Botol - - - - -
88 Fenitoin Natrium Kapsul 100 mg Kapsul 30 - 30 - 30
89 Fenobarbital tablet 30 mg Tablet 415 - 415 - 415
90 Fenobarbital injeksi 50 mg / ml Ampul - - - - -
91 Fenoksimeti Penisilin 250 mg tablet Tablet - - - - -
92 Fenoksimeti Penisilin 500 mg tablet Tablet - - - -
93 Fenol Gliserol TK Botol 162 - 162 2 160
94 Flufenazine decanoat injeksi 25 mg/ml Ampul - - - - -
95 Flukonazole tablet 150 mg Tablet - - - - -
96 Fitomenadion tablet 10 mg Tablet 350 - 350 20 330
97
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul
- - - - -
98 Furosemid Tablet 40 mg Tablet 360 - 360 360 -
99 Furosemid injeksi Ampul - - - - -
100 Garam Oralit I serbuk, kombinasi :
( Nacl 0,52 gr, Kalium Klorida 0,30
Kantong
gr, Trinatrium Sitrat dihidrat 0,58 gr, Glukosa
Anhidrat 2,70 g )200 ml Air - - - - -
101 Gemfibrozil Tablet 600 mg Tablet - - - - -
102 Gentian Violet Botol - - - - -
103 Gentamisin injeksi 80 mg / 2 ml Vial - - - - -
104 Gentamisin Salep Kulit 0,1 % Tube - - - - -
105 Glass Ionomer Set - - - - -
106 Glibenklamid Tablet 5 mg Tablet - - - - -
107 Glimepiride 2 mg Tablet 15,000 - 15,000 - 15,000
108 Gliseril Guayakolat Tablet 100 mg Tablet - - - - -
109 Gliseril Guayakolat sirup Botol - - - - -
110 Glukonas Kalsikus injeksi Ampul 24 - 24 - 24
111 Glukosa Larutan Infus 5 % Botol - - - - -
112 Glukosa Larutan Infus10 % Botol - - - - -
113 Griseofulvin Tablet 125 mg,micronized Tablet - - - - -
114 Griseofulvin Tablet 500 mg,micronized Tablet 3,000 - 3,000 - 3,000
115 Haloperidol Tablet 0,5 mg Tablet - - - - -
116 Haloperidol Tablet 1,5 mg Tablet - - - - -
117 Haloperidol Tablet 5 mg Tablet - - - - -
118 Haloperidol injeksi 5 mg/ml Ampul - - - - -
119 Haloperidol injeksi 50 mg/ml Ampul - - - - -
120 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - - - -
121 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - - - -
122 Hidrokortison Krim 2,5 % Tube 408 - 408 24 384
123 Ibuprofen Tablet 200 mg Tablet 5,000 - 5,000 508 4,492
124 Ibuprofen Tablet 400 mg Tablet 3,902 - 3,902 3,902 -
125 Ibuprofen Suspensi 100 mg/5 ml Botol - - - - -
126 Ichtyol salep Kulit Pot - - - - -
127 Isoniazid tablet 100 mg Tablet - - - - -
128 Isoniazid tablet 300 mg Tablet - - - - -
129 Isosorbid Dinitrat 5 mg Tablet - - - - -
130 Kalium Diklofenak Tablet 25 mg Tablet - - - - -
131
Kalium Diklofenak Tablet 50 mg Tablet
- - - - -
132 Kalsium Hidroksida Pasta Tube - - - - -
133 Kalsium Laktat Tablet 500 mg Tablet 20,000 - 20,000 - 20,000
134 Kaptopril 12,5 mg Tablet 1,660 - 1,660 20 1,640
135 Kaptopril 25 mg Tablet - - - - -
136 Karbamazepin Tablet 200 mg Tablet - - - - -
137 Ketokonazole Krim 2 % - 15 gr Tube 96 - 96 - 96
138 Ketokonazole Tablet 200 mg Tablet - - - - -
139 Ketoprofen Tablet 100 mg Tablet - - - - -
140 Ketoprofen Injeksi 100 mg / 1 ml Ampul - - - - -
141 Ketorolac 10 mg injeksi Ampul - - - - -
142 Ketorolac 30 mg injeksi Ampul - - - - -
143 Klindamisin Kapsul 150 mg Kapsul - - - - -
144 Klindamisin Kapsul 300 mg Kapsul - - - - -
145 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
146 Kloramfenikol suspensi125mg/5 ml Botol - - - - -
147 Kloramfenikol Salep Mata 1%-3,5 g Tube - - - - -
148 Kloramfenikol Salep Kulit 2% Tube 120 - 120 17 103
149 Kloramfenikol Tetes Mata -5 ml Botol 4 - 4 4 -
150 Kloramfenikol Tetes Telinga 3%-5 ml Botol - - - - -
151 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 25,000 - 25,000 - 25,000
152 Klorpromazin Hcl Tablet Salut 25 mg Tablet - - - - -
153 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - - - -
154 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - - - -
155 Kombinasi Ipatropium Bromide + Salbutamol
Sulphate for inhalation 2,5 Vial
ml - - - - -
156 Kombipak Cefixime+ Azithromisin Kotak - - - - -
157 Kotrimoksazol Pedriatik Tablet, Kombinasi :
Sulfametoksazol 100 mg + Trimetroprim 20 Tablet
mg - - - - -
158 Kotrimoksazol Tablet, Kombinasi :
Sulfametoksazol 400 mg + Trimetroprim 80 Tablet
mg - 258
258 - 258
159 Kotrimoksazol Suspensi Kombinasi :
Sulfametoksazol 200 mg + Trimetroprim 40 Botol
mg/5 ml - - - - -
160 Lansoprazole 30 mg Kapsul Tablet 3,385 - 3,385 565 2,820
161 Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat 28 Botol
mEq) /Asering - - - - -
162 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr) - - - - -
163
Larutan mengadung Karbohidrat + Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na Botol
Lactat 2,24 gr, Dekstrosa 27 gr)
- - - - -
164 Lidokain injeksi 2 % Ampul 200 - 200 - 200
165 Lidokain Komp Injeksi, Kombinasi :
Lidokain Hcl 2% +Epinefrin 1 : 80.000- Ampul
2 ml - - - - -
166 Lidokain Spray Botol - - - - -
167 Loperamid Tablet 2 mg Tablet - - - - -
168 Loratadin tablet 10 mg Tablet 500 - 500 200 300
169 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - - - -
170 Loperamid Tablet 2 mg Tablet - - - - -
171 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - - - -
172 Magnesium Sulfat (IV) 40 %-25 ml Ampul - - - - -
173 MB Anak Blister - - - - -
174 MB Dewasa Blister - - - - -
175 Meloksikam tablet 15 mg Tablet 110 - 110 110 -
176 Meloksikam Suppositoria Supp - - - - -
177 Metformin Hcl Tablet 500 mg Tablet 20,000 - 20,000 - 20,000
178 Metformin 850 mg Tablet 5,000 - 5,000 - 5,000
179 Metildopa 250 mg tablet Tablet 3,350 - 3,350 60 3,290
180 Methisoprinol 500 mg Tablet 1,940 - 1,940 - 1,940
181 Metilergometrin Maleat (Metergin) Tablet
Tablet
0,125 mg 300 - 300 - 300
182
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul
100 - 100 - 100
183 Metilprednisolon tablet 4 mg Tablet 5,000 - 5,000 - 5,000
184 Metoklopramid 10 mg Tablet - - - - -
185 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - - - -
186 Metronidazol Tablet 250 mg Tablet - - - - -
187 Metronidazole Tablet 500 mg Tablet 10,000 - 10,000 - 10,000
188 Metronidazole sirup 125 mg/ml Botol - - - - -
189 Metronidazole Infus 500 mg /100 ml Ampul - - - - -
190 Mikonazole KrIm 2 % - 10 gr Tube - - - - -
191 Multivitamin + Mineral tablet Tablet - - - - -
192 Multivitamin sirup Botol - - - - -
193 Mummifying Pasta Botol - - - - -
194 Natrium Bikarbonat Tablet 500 mg Tablet - - - - -
195 Natrum Diklofenak Tablet 25 mg Tablet - - - - -
196 Natrium Diklofenak Tablet 50 mg Tablet 15,000 - 15,000 - 15,000
197
Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol
- - - - -
198 Nipedifin Tablet 10 mg Tablet - - - - -
199 Nistatin suspensi 100.000 IU/ml Botol - - - - -
200 Nistatin 100.000 IU/gram Tablet Vagina Tablet - - - - -
201 Nistatin 500.000 IU/gram Tablet Salut Tablet - - - - -
202 Obat Antitiuberkolosis Kategori Anak Paket - - - - -
203
Obat Antitiuberkolosis Kategori 1 Dewasa Paket
- - - - -
204
Obat Antitiuberkolosis Kategori 2 Dewasa Paket
- - - - -
205
Obat Antitiuberkolosis Kategori 3 Dewasa Paket
- - - - -
206 Obat Anti Tuberkulosis FDC Kat Anak Paket - - - - -
207 Obat Anti Tuberkulosis FDC Kat I & II Paket - - - - -
208 Obat Anti Tuberkulosis FDC Kat I & III Paket - - - - -
209
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket
- - - - -
210 Obat Batuk Hitam (OBH) Cairan 100 ml Botol - - - - -
211 Obat Batuk Cair Sirup (Ekspektoran) Botol - - - - -
212 Obat Batuk Hitam Plus Sirup Botol - - - - -
213 Obat Flu Sirup Botol - - - - -
214
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
- - - - -
215 Oksiterasiklin Salep Mata 1%-3,5g Tube - - - - -
216 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - - - - -
217 Oksitosin Injeksi 10 IU/ml-1ml Ampul - - - - -
218 Omeprazole injeksi 40mg/10ml Ampul - - - - -
219 Omeprazole Kapsul 20 mg Tablet 6,000 - 6,000 - 6,000
220 Ondansetron inj 4 mg/ 2 mL Ampul - - - - -
221 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - - - -
222 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - - - -
223 Parasetamol Sirup 120 mg/5ml-60 ml Botol - - - - -
224 Parasetamol Tablet 500 mg Tablet 65,294 - 65,294 2,438 62,856
225 PB Anak Blister - - - - -
226 PB Dewasa Blister - - - - -
227 Pehacain injeksi Ampul - - - - -
228 Perak Sulfadiazin krim 1 % 35 gr Tube - - - - -
229 Permetrin krim 5 % Tube 150 - 150 - 150
230 Piracetam Tablet 400 mg Tablet - - - - -
231 Piracetam Tablet 800 mg Tablet - - - - -
232 Piroksikam Tablet 20 mg Tablet - - - - -
233 Pirantel Pamoat Tablet 365 mg (Setara dng 125
Tablet
mg Basa) - - - - -
234 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 6,116 - 6,116 1,569 4,547
235 Povidon Iodida 10% 30 ml Botol - - - - -
236 Povidon Iodida 10% 60 ml Botol - - - - -
237 Povidon Iodida 10% 300 ml Botol - - - - -
238 Prednison Tablet 5 mg Tablet - - - - -
239 Primakuin tablet 15 mg Tablet - - - - -
240
Prokain Benzil Penisilin Injeksi 3,000,000 IU Vial
- - - - -
241 Propanolol Hcl Tablet 40 mg Tablet - - - - -
242 Propilturasil Tablet 100 mg Tablet - - - - -
243 Ranitidin Injeksi 25 mg / ml Ampul - - - - -
244 Ranitidin Tablet 150 mg Tablet 5,000 - 5,000 - 5,000
245 Retinol (Vit. A) 100.000 IU Kapsul Kapsul - - - - -
246 Retinol (Vit. A) 200.000 IU Kapsul Kapsul - - - - -
247 Reserpin Tablet 0, 25 mg Tablet - - - - -
248 Rifampisin Tablet 450 mg Tablet - - - - -
249 Ringer Laktat Larutan Infus Steril 500 ml Botol - - - - -
250 Salbutamol Tablet 2 mg Tablet 67 - 67 67 -
251 Salbutamol Tablet 4 mg Tablet 480 - 480 45 435
252 Salbutamol solution for Inhalation single dose
Ampul
units 2,5 ml - - - - -
253 Salep 2-4 Kombinasi :
Asam Salisilat 2 % + Belerang Endap 4 Pot
% - 30 gram 296 - 296 13 283
254 Salisil bedak 2% -50 gr Kotak 150 - 150 150 -
255 Salep Luka Bakar Tube - - - - -
256
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol
- - - - -
257 Sefadroksil Tablet 500 mg Tablet 5,000 - 5,000 280 4,720
258 Sefiksim Kapsul 100 mg Kapsul - - - - -
259 Sefiksim 400 mg + Azitromisin 1000 mg Paket - - - - -
260 Sefotaksim Injeksi 1 gr Ampul - - - - -
261 Seftriakson Injeksi 1 gr / vial Ampul - - - - -
262 Semen Seng Fosfat Serbuk & Cairan Botol - - - - -
263 Setirizin Tablet 10 mg Tablet 30,000 - 30,000 100 29,900
264 Setirizin Sirup 5 mg / 5 ml Botol - - - - -
265 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul - - - - -
266 Sianokobalamin Tablet 50 mcg Tablet - - - - -
267 Silver Amalgam Serbuk 65-75% Botol - - - - -
268 Simetidin 200 mg Tablet Tablet - - - - -
269 Simvastatin Tablet 10 mg Tablet - - - - -
270 Siprofloksasin 500mg Tablet 984 - 984 4 980
271 Spironolakton Tablet 25 mg Tablet 830 - 830 - 830
272 Sulfacetamid Tetes Mata 15 %-5ml Botol - - - - -
273 Tablet Tambah Darah Kombinasi:
Besi II Sulfat 200 mg + Asam Folat Tablet
0,25 mg - - - - -
 274 Temporary Stopping Fletcher (Fletcher) Serbuk
Set
& Cairan - - - - -
275 Trikesol formalin ( T K F ) Cairan 10 ml Botol - - - - -
276 Tetrasiklin Kapsul 250 mg Kapsul - - - - -
277 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
278
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul
- - - - -
279
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet
15,000 - 15,000 - 15,000
280 Thiamfenikol Kapsul 500 mg Kapsul - - - - -
281 Tramadol Injeksi 50 mg/ ml Ampul - - - - -
282 Tramadol Tablet 50 mg Tablet - - - - -
283
Triheksifenidil Hidroklorida Tablet 2 mg Tablet
- - - - -
284
Tablet
Triheksifenidil Hidroklorida Tablet 2 mg - - - - -
285 Vitamin B .Komplek Tablet Tablet 64,726 - 64,726 940 63,786
286 Vitamin Neurotropik Tablet Tablet 11,607 - 11,607 290 11,317
287 Zinc Tablet 20 mg Tablet - - - - -
288 Zinc Sulfat 20 mg/5 ml Tablet - - - - -
289 Aminofillin Tablet 150 mg Tablet - - - - -
290 Asam Folat Tablet 0,4 mg Tablet 950 - 950 - 950
291 Gentamisin Sulfat tetes mata 0,3% Botol 96 - 96 17 79
292 Obat Kumur Botol - - - - -
293 Salep Betametason + Neomisin Tube - - - - -
294 Salep Kloramfenikol + Hidrokortison Tube - - - - -
295 Propanolol 10mg Tablet - - - - -
296 Tablet Pemanis Botol - - - - -
297 Bisakodil Suppositoria 5 mg Supp 12 - 12 - 12
298 Obat Batuk Herbal (Herbakof) Botol 500 - 500 58 442
299 Amoksisillin Drops Botol - - - - -
300 Tablet Hepatoprotector (Curcuma) Pot - - - - -
301 Simvastatin 20mg Tablet - - - - -
302 Klozapine 25mg Tablet - - - - -
303 Bisoprolol 2,5mg Tablet 2,000 - 2,000 - 2,000
304 Vitamin C 500mg Tablet - - - - -
305 RAMVIT-C C 500mg Tablet 29,444 - 29,444 453 28,991
306 Vitamin D 1000 IU Tablet - - - - -
307 Multivitamin Tablet Kombinasi VitC,Vit D, Zinc,
Tablet
Folic Acid 34,616 - 34,616 1,790 32,826
308 Multivitamin Syrup Tablet 388 - 388 33 355
309 Risperidon 2 mg Tablet - - - - -
310 Alpara Tablet Tablet 1,741 - 1,741 485 1,256
311 Asam Traneksamat Tablet 500 - 500 - 500
312 Novagrip Flu Batuk Tablet Tablet 10,000 - 10,000 - 10,000
313 FORNERO TABLET Tablet 10,000 - 10,000 - 10,000
B. BAHAN MEDIS HABIS PAKAI (BMHP) - - - - -
1 Abbocath No 18 ( IV Chateter 18 ) Buah - - - - -
2 Abbocath No 20 ( IV Chateter 20 ) Buah - - - - -
3 Abbocath No 22 ( IV Chateter 22 ) Buah - - - - -
4 Abbocath No 24 ( IV Chateter 24 ) Buah - - - - -
5 Alat Gula, Kolesterol, Asam Urat Unit - - - - -
6 Alat Suntik Sekali Pakai 1 ml Set - - - - -
7 Alat Suntik Sekali Pakai 3 ml Set - - - - -
8 Alat Suntik Sekali Pakai 3 ml Set - - - - -
 9 Alat Suntik Sekali Pakai 5 ml Set - - - - -
10 Alat Suntik Sekali Pakai 10 ml Set - - - - -
11 Alkohol Swab Kotak 2,500 - 2,500 300 2,200
12 Auto Disposable Syringe (ADS) 0,05 ml Set - - - - -
13 Auto Disposable Syringe (ADS) 0,5 ml Set - - - - -
14 Auto Disposable Syringe (ADS) 5 ml Set - - - - -
15 Blood Set Set 2 - 2 - 2
16 Catgut/Benang Bedah No.2/0 Plain Sachet - - - - -
17 Catgut/Benang Bedah No.3/0 Cromic Sachet - - - - -
18 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - - - - -
19 Etanol 70 % 1.000 ml Botol 30 - 30 - 30
20 Eter Alkohol Botol - - - - -
21 Folley Catheter no 14 Set - - - - -
22 Folley Catheter no 16 Set 30 - 30 - 30
23 Folley Catheter no 18 Set 30 - 30 - 30
24 Infus set Anak Set - - - - -
25 Infus set Anak Set - - - - -
26 Infus set Dewasa Set 100 - 100 - 100
27 Iodina Test Botol - - - - -
28 Kaca Slide Pcs - - - - -
29 Kapas Berlemak 500 gram Bungkus - - - - -
30 Kapas Pembalut / Adsorbens 250 gram Bungkus - - - - -
31 Kassa Pembalut 2 m x 80 cm Rol - - - - -
32 Kassa Pembalut Hidrofil 4 m x 3 cm Rol - - - - -
33 Kassa Pembalut Hidrofil 4 m x 15 cm Rol - - - - -
34 Kassa Hidrofil Steril 16 x 16 Kotak 100 - 100 - 100
35 Kassa Kompres 40 x 40 steril Bungkus - - - - -
36 Kertas Puyer Pcs - - - - -
37 Kertas Saring Lembar - - - - -
38 Kertas Lensa Lembar - - - - -
39 Lysol 1,000 ml Botol - - - - -
40 Masker Buah 1,550 - 1,550 100 1,450
41 Masker Ear Loop Buah 8,000 - 8,000 - 8,000
42 Masker Head Loop Buah - - - - -
43 Masker Rajawali Buah - - - - -
44 Masker Head Loop Buah - - - - -
45 Masker N 95 Pcs - - - - -
46 Minyak Imersi Botol - - - - -
47 Plester Kertas Rol - - - - -
48 Polifix Rol 50 - 50 - 50
49 Pot Dahak Pcs - - - - -
50 Rapid 2 HIV Fokus Test - - - - -
51 Rapid HIV 1 (SD HIV) Test - - - - -
52 Test
Rapid HIV 2 (Intec HIV) - - - - -
53 Test
Rapid HIV 2 (Biomeriux HIV) - - - - -
54 Test
Rapid Tes SD Bioline HBSAG - - - - -
55 Test
Rapid Test Syphilis - - - - -
56 Test
Reagen CD 4 Control - - - - -
57 Test
Reagen CD 4 - - - - -
58 Botol
Reagen Ziehl Nielsen - - - - -
59 Test
RPR Test Syphilis - - - - -
 60 Sachet
Silk( Benang Bedah Sutra ) No 3/0 72 - 72 - 72
61 Pcs
Safety Box - - - - -
62 Pcs
Sarung tangan Steril No 6 - - - - -
63 Pcs
Sarung tangan Steril No 7 150 - 150 - 150
64 Pcs
Sarung tangan Steril No 7,5 - - - - -
65 Pcs
Sarung tangan Steril No 7,5 140 - 140 - 140
66 Sarung tangan Non Steril S Pcs 2,700 - 2,700 - 2,700
67 Sarung tangan Non Steril M Pcs 4,800 - 4,800 - 4,800
68 Sarung tangan Non Steril L Pcs 3,400 - 3,400 - 3,400
69 Sountimer Buah - - - - -
70 Stik Pemeriksaan Gula Darah Test - - - - -
71
Test
Stik Pemeriksaan Gula Darah Benecheck - - - - -
72
Test
Stik Pemeriksaan Gula Darah One Touch Verio - - - - -
73 Stik Pemeriksaan Kolesterol Test - - - - -
74 Stik Pemeriksaan Kolesterol Benecheck Test - - - - -
75 Stik Pemeriksaan Asam Urat Test - - - - -
76 Stik Pemeriksaan Asam Urat Benecheck Test - - - - -
77 Supratul Lembar - - - - -
78 Urine Bag set 50 - 50 10 40
79 Wing Neddle No 23 Set - - - - -
80 Blood Lancet Pcs - - - - -
81 Cairan Antiseptik Botol 500 ml Botol 35 - 35 - 35
82 Bisturi Pcs 20 - 20 - 20
83 Cairan Antiseptik Botol 5 Liter Botol - - - - -
84 3 Surface Desintfectan 5L Botol 3 - 3 - 3
85 Cairan Desinfektan 5 Liter Botol - - - - -
86 High Level Desintfectan/sterald Botol 1 - 1 - 1
87 Cairan Detergen 5 Liter Botol - - - - -
88 Gel USG Botol 38 - 38 1 37
89 IV Dressing Pcs - - - - -
90 Mucus Extractor Pcs - - - - -
91 Nasal Oxygen Anak Pcs 5 - 5 - 5
92 Nasal Oxygen Bayi Pcs 25 - 25 - 25
93 Nasal Oxygen Dewasa Pcs 100 - 100 - 100
94 Plester Bulat Non Woven Pcs - - - - -
95 Plester Transparan Pcs - - - - -
96 PP test Pcs 500 - 500 - 500
97 Sarung tangan Steril No 6,5 Pcs - - - - -
98 Sarung Tangan Obgyn Steril Pcs - - - - -
99 Stik Pemeriksaan Hb Pcs - - - - -
100 Umbilical Cord Klem Steril Nylon Pcs - - - - -
101 Underpad 60x90 cm Non Steril Pcs - - - - -
102 Stik Gula Darah Baru Pcs - - - - -
103 Stik Asam Urat Baru Pcs - - - - -
104 Stik Hb Test 100 - 100 - 100
105 ChOLESTROL chod-pap Kit - - - - -
106 Creatinin mod iaffe Kit - - - - -
107 Glucosa God-pap Kit - - - - -
108 GOT (AST) mod iffe Kit - - - - -
109 GPT Kit - - - - -
110 Trigliserida GPO-PAP Kit - - - - -
111 Urea UV-auto,Urease/GLDH Kit - - - - -
112 Urid Acid TBHA Kit - - - - -
113 Dumacon Auto Kit - - - - -
114 Micropipet 5,0-50 Ul Kit - - - - -
115 Micropipet 10-100UL Kit - - - - -
116 Tabung Vacutainer Kit - - - - -
117 HGB Drab Kin Kit - - - - -
118 Nasal Kanul Dewasa Pcs - - - - -
119 Nasal Kanul Anak Pcs - - - - -
120 Nasal Kanul Anak Pcs - - - - -
121 Coveral II (APD) Non Woven Pcs - - - - -
122 Coveral II (APD) Non Woven Pcs 100 - 100 - 100
123 Kantong Plastik Kuning 60cmx100cm Pak - - - - -
124 Kantong Plastik Kuning 80cmx120cm Pak 10 - 10 - 10
125 Kantong Plastik Hitam 60cmx100cm Pak - - - - -
126 Kantong Plastik Hitam 80cmx120cm Pak 10 - 10 - 10
127 Forsch Medical Disposible Gown Pcs - - - - -
C. SERUM DAN VAKSIN - - - - -
1 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I Vial - - - - -
)
2 Serum Anti Rabies untuk manusia Vial - - - - -
3 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I
Ampul
) - - - - -
4 Serum Anti Tetanus (ATS) Injeksi 20.000
Vial
IU/ampul 10 - 10 - 10
5 Human Tetanus Imunoglobin inj 250 IU Vial - - - - -
6 Vaksin BCG Ampul - - - - -
7 Vaksin Campak 10 Dosis Vial - - - - -
8 Vaksin DT Vial - - - - -
9 Vaksin TD Vial - - - - -
10 Vaksin DTP-HB Vial - - - - -
11 Vaksin DPT-HB/Hib Vial - - - - -
12 Vaksin HB Uniject Pcs - - - - -
13 Vaksin MR (VVM.A) Vial - - - - -
14 Vaksin Polio Vial - - - - -
15 Vaksin Polio IPV 5 Dosis Vial - - - - -
16 Vaksin Polio 10 IPV Dosis Vial - - - - -
17 Vaksin TT Vial - - - - -
18 Buku Kontrak - - - - -
19 - - - - -
20 - - - -
- - - -
BPJS
UMUM JUMLAH
JUMLAH KUNJUNGAN RESEP PBI NON PBI
684 3,196 274 4,154

Kuningan, 07 FEBRUARI 2023

Yang Melaporkan
Mengetahui Pengelola Obat
Kepala UPTD Puskesmas Maleber

ILAH LILAHSAH,S.ST,M.Keb apt.SHEILA JULLYAN,S.Farm.

NIP. 19771215 199804 2 001 SIPA : 503/KPTS.54-SIPA/XI/2018
*-
-
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) JKN
PUSKESMAS MALEBER TAHUN 2023

PUSKESMAS : MALEBER
KECAMATAN : MALEBER
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : FEBRUARI/2023
PROPINSI : JAWA BARAT

STOK STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL AKHIR

1 2 3 4 5 6 7 8
A. O B A T
1 Air Raksa Dental Use Botol - - - - -
2 Albendazole Tablet 400 mg Tablet - - - - -
3 Albendazole susp 200 mg/5 ml Botol - - - - -
4 Alopurinol Tablet 100 mg Tablet 800 - 800 450 350
5 Alopurinol Tablet 300 mg Tablet - - - - -
6 Alprazolam tablet 1 mg Tablet - - - - -
7 Ambroksol Tablet 30 mg Tablet 17,457 - 17,457 2,400 15,057
8 Ambroksol sirup 15 mg/5 ml Botol - - - - -
9 Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - - - -
10 Aminofillin Tablet 200 mg Tablet - - - - -
11 Amitriptillin Hcl Tablet Salut 25 mg Tablet 1,410 - 1,410 - 1,410
12 Amlodipin Tablet 5 mg Tablet 30,670 - 30,670 780 29,890
13 Amlodipin Tablet 10 mg Tablet 16,897 - 16,897 1,750 15,147
14 Amoksisillin Kapsul 250 mg Kapsul - - - - -
15 Amoksisillin Kaplet 500 mg Kaplet 25,000 - 25,000 400 24,600
16 Amoksisillin Serbuk Injeksi 1000 mg vial - - - - -
17 Amoksisillin Sirup Kering 125 mg/5ml Botol - - - - -
18 Amoksisillin Double Strengh Sirup Kering 250
Botol
mg/5 ml - - - - -
19 Ampisilin Kapsul 250 mg Kapsul - - - - -
20 Ampisillin Kaplet 500 mg Tablet - - - - -
21 Ampisilin Sirup 125 mg / 5 ml Botol - - - - -
22 Ampisillin Injeksi 1000 mg Vial - - - - -
23 Analgetik Plus Tablet - - - - -
24 Antasida Doen Suspensi Kombinasi :
Magnesium Hidroksida 200 mg+ Alumunium Botol
Hidroksida 200 mg/5 ml - - - - -
25 Antasida Doen Tablet, Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium Hidroksida 200 Tablet
mg 24,122 - 24,122 200 23,922
26 Antasida Plus Tablet Tablet - - - - -
27 Antalgin (Metampiron) Tablet 500 mg Tablet 2,165 - 2,165 1,464 701
28 Antalgin Injeksi 250 mg/ml-2ml Ampul - - - - -
29 Anti Bakteri DOEN Salep Kombinasi :
Basitrasin 500 IU/g + Polimiksin 1000 Tube
IU/g - - - - -
30 Anti Hemoroid Doen komb Supp - - - - -
31 Anti Fungi DOEN Kombinasi :
Pot
Asam Benzoat 6% + Asam Salisilat 3% 338 - 338 7 331
32 Antimigren DOEN Kombinasi :
Tablet
Ergotamin Tartrat 1 mg + Kofein 50 mg - - - - -
33 Anti Diare Suspensi Botol - - - - -
34 Anti Diare Tablet Tablet - - - - -
35 Anti Dotum Oral Tablet Tablet - - - - -
36 Anti Hipertensi Kapsul Tablet - - - - -
37 Antihistamin Tablet kombinasi Tablet - - - - -
38 Antispasmodik Tablet Tablet - - - - -
39 Antitusiva Sirup Botol - - - - -
40 Antitusiva Tablet Tablet - - - - -
41 Asam Folat Tablet 1 mg Tablet - - - - -
42 Asam Askorbat (Vit. C) Tablet 50 mg Tablet - - - - -
43 Asam Mefenamat Kapsul 500 mg Kapsul 18,985 - 18,985 1,100 17,885
44 Acetylsistein tablet Tablet 4,800 - 4,800 - 4,800
45 Asetosal Tablet 80 mg Tablet - - - - -
46 Asetosal Tablet 100 mg Tablet - - - - -
47 Asetosal Tablet 500 mg Tablet - - - - -
48 Asiklovir Krim 5 % Tube - - - - -
49 Asiklovir Tablet 200 mg Tablet - - - - -
50 Asiklovir Tablet 400 mg Tablet - - - - -
51 Attapulgit Tablet - - - - -
52 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - - -
53
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial
- - - - -
54 Bahan Tambal Sementara Set - - - - -
55 Benzatin Benzil Penisilin injeksi Vial - - - - -
56 Betahistin Mesilat 6 mg Tablet 2,000 - 2,000 - 2,000
57 Betametason Krim 0,1 %- 5g - - - - -
58 Bisakodil Tablet 5 mg Tablet 200 - 200 - 200
59 Bisoprolol Tablet 5 mg Tablet - - - - -
60 Bromheksin 8 mg Tablet - - - - -
61 Cresotin Pasta Botol - - - - -
62 Cresotin Liquid No 2 Botol - - - - -
63 Deksametason Injeksi 5mg/ml-1ml Ampul - - - - -
64 Deksametason Tablet 0,5 mg Tablet 9,895 - 9,895 2,030 7,865
65 Devitalisasi Pasta (Non Arsen) Botol - - - - -
66 Diazepam tablet 2 mg Tablet - - - - -
67 Diazepam tablet 5 mg Tablet - - - - -
68 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - - - -
69 Diazepam Larutan Rektal 5 mg/ml Supp - - - - -
70 Diazepam Larutan Rektal 10 mg/ml Supp - - - - -
71 Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - - - -
72 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - - - -
73 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - - - -
74 Digoksin Tablet 0,25 mg Tablet - - - - -
75 Dimenhidrinat Tablet 50 mg Tablet 1,000 - 1,000 - 1,000
76 Domperidon Tablet 10 mg Tablet 822 - 822 120 702
77 Donperidon Suspensi 5 mg/5ml Botol - - - - -
78 Efedrin Hcl Tablet 25 mg Tablet - - - - -
79 Ekstrak Belladone Tablet 10 mg Tablet - - - - -
 80 Epinefrin HCl / Bitartrat
(Epinefrina / Adrenalina) Injeksi Ampul
0,1%/- 1ml - - - - -
81 Eritromisin Kapsul 250 mg Kapsul - - - - -
82 Eritromisin Kapsul 500 mg Kapsul - - - - -
83 Eritromisin Sirup 200 mg / 5 ml Botol - - - - -
84 Etambutol Tablet 500 mg Tablet - - - - -
85 Etanol 70 % 100 ml Botol - - - - -
86 Etil Klorida Semprot -100 ml Botol - - - - -
87 Eugenol Cairan -10 ml Botol - - - - -
88 Fenitoin Natrium Kapsul 100 mg Kapsul 30 - 30 - 30
89 Fenobarbital tablet 30 mg Tablet 415 - 415 - 415
90 Fenobarbital injeksi 50 mg / ml Ampul - - - - -
91 Fenoksimeti Penisilin 250 mg tablet Tablet - - - - -
92 Fenoksimeti Penisilin 500 mg tablet Tablet - - - - -
93 Fenol Gliserol TK Botol 160 - 160 9 151
94 Flufenazine decanoat injeksi 25 mg/ml Ampul - - - - -
95 Flukonazole tablet 150 mg Tablet - - - - -
96 Fitomenadion tablet 10 mg Tablet 330 - 330 - 330
97
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul
- - - - -
98 Furosemid Tablet 40 mg Tablet - - - - -
99 Furosemid injeksi Ampul - - - - -
100 Garam Oralit I serbuk, kombinasi :
( Nacl 0,52 gr, Kalium Klorida 0,30
gr, Trinatrium Sitrat dihidrat 0,58 gr, Glukosa Kantong
Anhidrat 2,70 g )200 ml Air - - - - -
101 Gemfibrozil Tablet 600 mg Tablet - - - - -
102 Gentian Violet Botol - - - - -
103 Gentamisin injeksi 80 mg / 2 ml Vial - - - - -
104 Gentamisin Salep Kulit 0,1 % Tube - - - - -
105 Glass Ionomer Set - - - - -
106 Glibenklamid Tablet 5 mg Tablet - - - - -
107 Glimepiride 2 mg Tablet 15,000 - 15,000 - 15,000
108 Gliseril Guayakolat Tablet 100 mg Tablet - - - - -
109 Gliseril Guayakolat sirup Botol - - - - -
110 Glukonas Kalsikus injeksi Ampul 24 - 24 - 24
111 Glukosa Larutan Infus 5 % Botol - - - - -
112 Glukosa Larutan Infus10 % Botol - - - - -
113 Griseofulvin Tablet 125 mg,micronized Tablet - - - - -
114 Griseofulvin Tablet 500 mg,micronized Tablet 3,000 - 3,000 282 2,718
115 Haloperidol Tablet 0,5 mg Tablet - - - - -
116 Haloperidol Tablet 1,5 mg Tablet - - - - -
117 Haloperidol Tablet 5 mg Tablet - - - - -
118 Haloperidol injeksi 5 mg/ml Ampul - - - - -
119 Haloperidol injeksi 50 mg/ml Ampul - - - - -
120 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - - - -
121 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - - - -
122 Hidrokortison Krim 2,5 % Tube 384 - 384 25 359
123 Ibuprofen Tablet 200 mg Tablet 4,492 - 4,492 2,225 2,267
124 Ibuprofen Tablet 400 mg Tablet - - - - -
125 Ibuprofen Suspensi 100 mg/5 ml Botol - - - - -
126 Ichtyol salep Kulit Pot - - - - -
127 Isoniazid tablet 100 mg Tablet - - - - -
128 Isoniazid tablet 300 mg Tablet - - - - -
129 Isosorbid Dinitrat 5 mg Tablet - - - - -
130 Kalium Diklofenak Tablet 25 mg Tablet - - - - -
131
Kalium Diklofenak Tablet 50 mg Tablet
- - - - -
132 Kalsium Hidroksida Pasta Tube - - - - -
133 Kalsium Laktat Tablet 500 mg Tablet 20,000 - 20,000 - 20,000
134 Kaptopril 12,5 mg Tablet 1,640 - 1,640 - 1,640
135 Kaptopril 25 mg Tablet - - - - -
136 Karbamazepin Tablet 200 mg Tablet - - - - -
137 Ketokonazole Krim 2 % - 15 gr Tube 96 - 96 2 94
138 Ketokonazole Tablet 200 mg Tablet - - - - -
139 Ketoprofen Tablet 100 mg Tablet - - - - -
140 Ketoprofen Injeksi 100 mg / 1 ml Ampul - - - - -
141 Ketorolac 10 mg injeksi Ampul - - - - -
142 Ketorolac 30 mg injeksi Ampul - - - - -
143 Klindamisin Kapsul 150 mg Kapsul - - - - -
144 Klindamisin Kapsul 300 mg Kapsul - - - - -
145 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
146 Kloramfenikol suspensi125mg/5 ml Botol - - - - -
147 Kloramfenikol Salep Mata 1%-3,5 g Tube - - - - -
148 Kloramfenikol Salep Kulit 2% Tube 103 - 103 35 68
149 Kloramfenikol Tetes Mata -5 ml Botol - - - - -
150 Kloramfenikol Tetes Telinga 3%-5 ml Botol - - - - -
151 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 25,000 - 25,000 200 24,800
152 Klorpromazin Hcl Tablet Salut 25 mg Tablet - - - - -
153 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - - - -
154 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - - - -
155 Kombinasi Ipatropium Bromide + Salbutamol
Sulphate for inhalation 2,5 Vial
ml - - - - -
156 Kombipak Cefixime+ Azithromisin Kotak - - - - -
157 Kotrimoksazol Pedriatik Tablet, Kombinasi :
Sulfametoksazol 100 mg + Trimetroprim 20 Tablet
mg - - - - -
158 Kotrimoksazol Tablet, Kombinasi :
Sulfametoksazol 400 mg + Trimetroprim 80 Tablet
mg 60 198
258 - 258
159 Kotrimoksazol Suspensi Kombinasi :
Sulfametoksazol 200 mg + Trimetroprim 40 Botol
mg/5 ml - - - - -
160 Lansoprazole 30 mg Kapsul Tablet 2,820 - 2,820 360 2,460
161 Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat 28 Botol
mEq) /Asering - - - - -
162 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr) - - - - -
163
Larutan mengadung Karbohidrat + Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na Botol
Lactat 2,24 gr, Dekstrosa 27 gr)
- - - - -
164 Lidokain injeksi 2 % Ampul 200 - 200 - 200
165 Lidokain Komp Injeksi, Kombinasi :
Lidokain Hcl 2% +Epinefrin 1 : 80.000- Ampul
2 ml - - - - -
166 Lidokain Spray Botol - - - - -
167 Loperamid Tablet 2 mg Tablet - - - - -
168 Loratadin tablet 10 mg Tablet 300 - 300 100 200
169 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - - - -
170 Loperamid Tablet 2 mg Tablet - - - - -
171 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - - - -
172 Magnesium Sulfat (IV) 40 %-25 ml Ampul - - - - -
173 MB Anak Blister - - - - -
174 MB Dewasa Blister - - - - -
175 Meloksikam tablet 15 mg Tablet - - - - -
176 Meloksikam Suppositoria Supp - - - - -
177 Metformin Hcl Tablet 500 mg Tablet 20,000 - 20,000 - 20,000
178 Metformin 850 mg Tablet 5,000 - 5,000 - 5,000
179 Metildopa 250 mg tablet Tablet 3,290 - 3,290 40 3,250
180 Methisoprinol 500 mg Tablet 1,940 - 1,940 - 1,940
181 Metilergometrin Maleat (Metergin) Tablet
Tablet
0,125 mg 300 - 300 - 300
182
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul
100 - 100 - 100
183 Metilprednisolon tablet 4 mg Tablet 5,000 - 5,000 - 5,000
184 Metoklopramid 10 mg Tablet - - - - -
185 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - - - -
186 Metronidazol Tablet 250 mg Tablet - - - - -
187 Metronidazole Tablet 500 mg Tablet 10,000 - 10,000 - 10,000
188 Metronidazole sirup 125 mg/ml Botol - - - - -
189 Metronidazole Infus 500 mg /100 ml Ampul - - - - -
190 Mikonazole KrIm 2 % - 10 gr Tube - - - - -
191 Multivitamin + Mineral tablet Tablet - - - - -
192 Multivitamin sirup Botol - - - - -
193 Mummifying Pasta Botol - - - - -
194 Natrium Bikarbonat Tablet 500 mg Tablet - - - - -
195 Natrum Diklofenak Tablet 25 mg Tablet - - - - -
196 Natrium Diklofenak Tablet 50 mg Tablet 15,000 - 15,000 100 14,900
197
Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol
- - - - -
198 Nipedifin Tablet 10 mg Tablet - - - - -
199 Nistatin suspensi 100.000 IU/ml Botol - - - - -
200 Nistatin 100.000 IU/gram Tablet Vagina Tablet - - - - -
201 Nistatin 500.000 IU/gram Tablet Salut Tablet - - - - -
202 Obat Antitiuberkolosis Kategori Anak Paket - - - - -
203
Obat Antitiuberkolosis Kategori 1 Dewasa Paket
- - - - -
204
Obat Antitiuberkolosis Kategori 2 Dewasa Paket
- - - - -
205
Obat Antitiuberkolosis Kategori 3 Dewasa Paket
- - - - -
206 Obat Anti Tuberkulosis FDC Kat Anak Paket - - - - -
207 Obat Anti Tuberkulosis FDC Kat I & II Paket - - - - -
208 Obat Anti Tuberkulosis FDC Kat I & III Paket - - - - -
209
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket
- - - - -
210 Obat Batuk Hitam (OBH) Cairan 100 ml Botol - - - - -
211 Obat Batuk Cair Sirup (Ekspektoran) Botol - - - - -
212 Obat Batuk Hitam Plus Sirup Botol - - - - -
213 Obat Flu Sirup Botol - - - - -
214
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
- - - - -
215 Oksiterasiklin Salep Mata 1%-3,5g Tube - - - - -
216 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - - - - -
217 Oksitosin Injeksi 10 IU/ml-1ml Ampul - - - - -
218 Omeprazole injeksi 40mg/10ml Ampul - - - - -
219 Omeprazole Kapsul 20 mg Tablet 6,000 - 6,000 350 5,650
220 Ondansetron inj 4 mg/ 2 mL Ampul - - - - -
221 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - - - -
222 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - - - -
223 Parasetamol Sirup 120 mg/5ml-60 ml Botol - - - - -
224 Parasetamol Tablet 500 mg Tablet 62,856 - 62,856 7,798 55,058
225 PB Anak Blister - - - - -
226 PB Dewasa Blister - - - - -
227 Pehacain injeksi Ampul - - - - -
228 Perak Sulfadiazin krim 1 % 35 gr Tube - - - - -
229 Permetrin krim 5 % Tube 150 - 150 15 135
230 Piracetam Tablet 400 mg Tablet - - - - -
231 Piracetam Tablet 800 mg Tablet - - - - -
232 Piroksikam Tablet 20 mg Tablet - - - - -
233 Pirantel Pamoat Tablet 365 mg (Setara dng 125
Tablet
mg Basa) - - - - -
234 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 4,547 - 4,547 1,116 3,431
235 Povidon Iodida 10% 30 ml Botol - - - - -
236 Povidon Iodida 10% 60 ml Botol - - - - -
237 Povidon Iodida 10% 300 ml Botol - - - - -
238 Prednison Tablet 5 mg Tablet - - - - -
239 Primakuin tablet 15 mg Tablet - - - - -
240
Prokain Benzil Penisilin Injeksi 3,000,000 IU Vial
- - - - -
241 Propanolol Hcl Tablet 40 mg Tablet - - - - -
242 Propilturasil Tablet 100 mg Tablet - - - - -
243 Ranitidin Injeksi 25 mg / ml Ampul - - - - -
244 Ranitidin Tablet 150 mg Tablet 5,000 - 5,000 130 4,870
245 Retinol (Vit. A) 100.000 IU Kapsul Kapsul - - - - -
246 Retinol (Vit. A) 200.000 IU Kapsul Kapsul - - - - -
247 Reserpin Tablet 0, 25 mg Tablet - - - - -
248 Rifampisin Tablet 450 mg Tablet - - - - -
249 Ringer Laktat Larutan Infus Steril 500 ml Botol - - - - -
250 Salbutamol Tablet 2 mg Tablet - - - - -
251 Salbutamol Tablet 4 mg Tablet 435 - 435 75 360
252 Salbutamol solution for Inhalation single dose
Ampul
units 2,5 ml - - - - -
253 Salep 2-4 Kombinasi :
Asam Salisilat 2 % + Belerang Endap 4 Pot
% - 30 gram 283 - 283 29 254
254 Salisil bedak 2% -50 gr Kotak - - - - -
255 Salep Luka Bakar Tube - - - - -
256
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol
- - - - -
257 Sefadroksil Tablet 500 mg Tablet 4,720 - 4,720 490 4,230
258 Sefiksim Kapsul 100 mg Kapsul - - - - -
259 Sefiksim 400 mg + Azitromisin 1000 mg Paket - - - - -
260 Sefotaksim Injeksi 1 gr Ampul - - - - -
261 Seftriakson Injeksi 1 gr / vial Ampul - - - - -
262 Semen Seng Fosfat Serbuk & Cairan Botol - - - - -
263 Setirizin Tablet 10 mg Tablet 29,900 - 29,900 - 29,900
264 Setirizin Sirup 5 mg / 5 ml Botol - - - - -
265 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul - - - - -
266 Sianokobalamin Tablet 50 mcg Tablet - - - - -
267 Silver Amalgam Serbuk 65-75% Botol - - - - -
268 Simetidin 200 mg Tablet Tablet - - - - -
269 Simvastatin Tablet 10 mg Tablet - - - - -
270 Siprofloksasin 500mg Tablet 980 - 980 - 980
271 Spironolakton Tablet 25 mg Tablet 830 - 830 - 830
272 Sulfacetamid Tetes Mata 15 %-5ml Botol - - - - -
273 Tablet Tambah Darah Kombinasi:
Besi II Sulfat 200 mg + Asam Folat Tablet
0,25 mg - - - - -
274 Temporary Stopping Fletcher (Fletcher) Serbuk
Set
& Cairan - - - - -
275 Trikesol formalin ( T K F ) Cairan 10 ml Botol - - - - -
276 Tetrasiklin Kapsul 250 mg Kapsul - - - - -
277 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
278
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul
- - - - -
279
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet
15,000 - 15,000 1,509 13,491
280 Thiamfenikol Kapsul 500 mg Kapsul - - - - -
281 Tramadol Injeksi 50 mg/ ml Ampul - - - - -
282 Tramadol Tablet 50 mg Tablet - - - - -
283
Triheksifenidil Hidroklorida Tablet 2 mg Tablet
- - - - -
284
Tablet
Triheksifenidil Hidroklorida Tablet 2 mg - - - - -
285 Vitamin B .Komplek Tablet Tablet 63,786 - 63,786 2,590 61,196
286 Vitamin Neurotropik Tablet Tablet 11,317 - 11,317 1,557 9,760
287 Zinc Tablet 20 mg Tablet - - - - -
288 Zinc Sulfat 20 mg/5 ml Tablet - - - - -
289 Aminofillin Tablet 150 mg Tablet - - - - -
290 Asam Folat Tablet 0,4 mg Tablet 950 - 950 - 950
291 Gentamisin Sulfat tetes mata 0,3% Botol 79 - 79 12 67
292 Obat Kumur Botol - - - - -
293 Salep Betametason + Neomisin Tube - - - - -
294 Salep Kloramfenikol + Hidrokortison Tube - - - - -
295 Propanolol 10mg Tablet - - - - -
296 Tablet Pemanis Botol - - - - -
297 Bisakodil Suppositoria 5 mg Supp 12 - 12 - 12
298 Obat Batuk Herbal (Herbakof) Botol 442 - 442 70 372
 299 Amoksisillin Drops Botol - - - - -
300 Tablet Hepatoprotector (Curcuma) Pot - - - - -
301 Simvastatin 20mg Tablet - - - - -
302 Klozapine 25mg Tablet - - - - -
303 Bisoprolol 2,5mg Tablet 2,000 - 2,000 - 2,000
304 Vitamin C 500mg Tablet - - - - -
305 RAMVIT-C C 500mg Tablet 28,991 - 28,991 290 28,701
306 Vitamin D 1000 IU Tablet - - - - -
307 Multivitamin Tablet Kombinasi VitC,Vit D, Zinc,
Tablet
Folic Acid 32,826 - 32,826 2,780 30,046
308 Multivitamin Syrup Tablet 355 - 355 64 291
309 Risperidon 2 mg Tablet - - - - -
310 Alpara Tablet Tablet 1,256 - 1,256 990 266
311 Asam Traneksamat Tablet 500 - 500 20 480
312 Novagrip Flu Batuk Tablet Tablet 10,000 - 10,000 - 10,000
313 FORNERO TABLET Tablet 10,000 - 10,000 - 10,000
B. BAHAN MEDIS HABIS PAKAI (BMHP) - - - - -
1 Abbocath No 18 ( IV Chateter 18 ) Buah - - - - -
2 Abbocath No 20 ( IV Chateter 20 ) Buah - - - - -
3 Abbocath No 22 ( IV Chateter 22 ) Buah - - - - -
4 Abbocath No 24 ( IV Chateter 24 ) Buah - - - - -
5 Alat Gula, Kolesterol, Asam Urat Unit - - - - -
6 Alat Suntik Sekali Pakai 1 ml Set - - - - -
7 Alat Suntik Sekali Pakai 3 ml Set - - - - -
8 Alat Suntik Sekali Pakai 3 ml Set - - - - -
9 Alat Suntik Sekali Pakai 5 ml Set - - - - -
10 Alat Suntik Sekali Pakai 10 ml Set - - - - -
11 Alkohol Swab Kotak 2,200 - 2,200 - 2,200
12 Auto Disposable Syringe (ADS) 0,05 ml Set - - - - -
13 Auto Disposable Syringe (ADS) 0,5 ml Set - - - - -
14 Auto Disposable Syringe (ADS) 5 ml Set - - - - -
15 Blood Set Set 2 - 2 - 2
16 Catgut/Benang Bedah No.2/0 Plain Sachet - - - - -
17 Catgut/Benang Bedah No.3/0 Cromic Sachet - - - - -
18 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - - - - -
19 Etanol 70 % 1.000 ml Botol 30 - 30 - 30
20 Eter Alkohol Botol - - - - -
21 Folley Catheter no 14 Set - - - - -
22 Folley Catheter no 16 Set 30 - 30 - 30
23 Folley Catheter no 18 Set 30 - 30 - 30
24 Infus set Anak Set - - - - -
25 Infus set Anak Set - - - - -
26 Infus set Dewasa Set 100 - 100 - 100
27 Iodina Test Botol - - - - -
28 Kaca Slide Pcs - - - - -
29 Kapas Berlemak 500 gram Bungkus - - - - -
30 Kapas Pembalut / Adsorbens 250 gram Bungkus - - - - -
31 Kassa Pembalut 2 m x 80 cm Rol - - - - -
32 Kassa Pembalut Hidrofil 4 m x 3 cm Rol - - - - -
33 Kassa Pembalut Hidrofil 4 m x 15 cm Rol - - - - -
34 Kassa Hidrofil Steril 16 x 16 Kotak 100 - 100 - 100
35 Kassa Kompres 40 x 40 steril Bungkus - - - - -
36 Kertas Puyer Pcs - - - - -
37 Kertas Saring Lembar - - - - -
38 Kertas Lensa Lembar - - - - -
39 Lysol 1,000 ml Botol - - - - -
40 Masker Buah 1,450 - 1,450 900 550
41 Masker Ear Loop Buah 8,000 - 8,000 - 8,000
42 Masker Head Loop Buah - - - - -
43 Masker Rajawali Buah - - - - -
44 Masker Head Loop Buah - - - - -
45 Masker N 95 Pcs - - - - -
46 Minyak Imersi Botol - - - - -
47 Plester Kertas Rol - - - - -
48 Polifix Rol 50 - 50 - 50
49 Pot Dahak Pcs - - - - -
50 Rapid 2 HIV Fokus Test - - - - -
51 Rapid HIV 1 (SD HIV) Test - - - - -
52 Test
Rapid HIV 2 (Intec HIV) - - - - -
53 Test
Rapid HIV 2 (Biomeriux HIV) - - - - -
54 Test
Rapid Tes SD Bioline HBSAG - - - - -
55 Test
Rapid Test Syphilis - - - - -
56 Test
Reagen CD 4 Control - - - - -
57 Test
Reagen CD 4 - - - - -
58 Botol
Reagen Ziehl Nielsen - - - - -
59 Test
RPR Test Syphilis - - - - -
60 Sachet
Silk( Benang Bedah Sutra ) No 3/0 72 - 72 - 72
61 Pcs
Safety Box - - - - -
62 Pcs
Sarung tangan Steril No 6 - - - - -
63 Pcs
Sarung tangan Steril No 7 150 - 150 - 150
64 Pcs
Sarung tangan Steril No 7,5 - - - - -
65 Pcs
Sarung tangan Steril No 7,5 140 - 140 - 140
66 Sarung tangan Non Steril S Pcs 2,700 - 2,700 - 2,700
67 Sarung tangan Non Steril M Pcs 4,800 - 4,800 200 4,600
68 Sarung tangan Non Steril L Pcs 3,400 - 3,400 - 3,400
69 Sountimer Buah - - - - -
70 Stik Pemeriksaan Gula Darah Test - - - - -
71
Test
Stik Pemeriksaan Gula Darah Benecheck - - - - -
72
Test
Stik Pemeriksaan Gula Darah One Touch Verio - - - - -
73 Stik Pemeriksaan Kolesterol Test - - - - -
74 Stik Pemeriksaan Kolesterol Benecheck Test - - - - -
75 Stik Pemeriksaan Asam Urat Test - - - - -
76 Stik Pemeriksaan Asam Urat Benecheck Test - - - - -
77 Supratul Lembar - - - - -
 78 Urine Bag set 40 - 40 - 40
79 Wing Neddle No 23 Set - - - - -
80 Blood Lancet Pcs - - - - -
81 Cairan Antiseptik Botol 500 ml Botol 35 - 35 - 35
82 Bisturi Pcs 20 - 20 - 20
83 Cairan Antiseptik Botol 5 Liter Botol - - - - -
84 3 Surface Desintfectan 5L Botol 3 - 3 - 3
85 Cairan Desinfektan 5 Liter Botol - - - - -
86 High Level Desintfectan/sterald Botol 1 - 1 1 -
87 Cairan Detergen 5 Liter Botol - - - - -
88 Gel USG Botol 37 - 37 7 30
89 IV Dressing Pcs - - - - -
90 Mucus Extractor Pcs - - - - -
91 Nasal Oxygen Anak Pcs 5 - 5 - 5
92 Nasal Oxygen Bayi Pcs 25 - 25 - 25
93 Nasal Oxygen Dewasa Pcs 100 - 100 - 100
94 Plester Bulat Non Woven Pcs - - - - -
95 Plester Transparan Pcs - - - - -
96 PP test Pcs 500 - 500 - 500
97 Sarung tangan Steril No 6,5 Pcs - - - - -
98 Sarung Tangan Obgyn Steril Pcs - - - - -
99 Stik Pemeriksaan Hb Pcs - - - - -
100 Umbilical Cord Klem Steril Nylon Pcs - - - - -
101 Underpad 60x90 cm Non Steril Pcs - - - - -
102 Stik Gula Darah Baru Pcs - - - - -
103 Stik Asam Urat Baru Pcs - - - - -
104 Stik Hb Test 100 - 100 100 -
105 ChOLESTROL chod-pap Kit - - - - -
106 Creatinin mod iaffe Kit - - - - -
107 Glucosa God-pap Kit - - - - -
108 GOT (AST) mod iffe Kit - - - - -
109 GPT Kit - - - - -
110 Trigliserida GPO-PAP Kit - - - - -
111 Urea UV-auto,Urease/GLDH Kit - - - - -
112 Urid Acid TBHA Kit - - - - -
113 Dumacon Auto Kit - - - - -
114 Micropipet 5,0-50 Ul Kit - - - - -
115 Micropipet 10-100UL Kit - - - - -
116 Tabung Vacutainer Kit - - - - -
117 HGB Drab Kin Kit - - - - -
118 Nasal Kanul Dewasa Pcs - - - - -
119 Nasal Kanul Anak Pcs - - - - -
120 Nasal Kanul Anak Pcs - - - - -
121 Coveral II (APD) Non Woven Pcs - - - - -
122 Coveral II (APD) Non Woven Pcs 100 - 100 - 100
123 Kantong Plastik Kuning 60cmx100cm Pak - - - - -
124 Kantong Plastik Kuning 80cmx120cm Pak 10 - 10 - 10
125 Kantong Plastik Hitam 60cmx100cm Pak - - - - -
126 Kantong Plastik Hitam 80cmx120cm Pak 10 - 10 - 10
127 Forsch Medical Disposible Gown Pcs - - - - -
C. SERUM DAN VAKSIN - - - - -
 1 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I Vial - - - - -
)
2 Serum Anti Rabies untuk manusia Vial - - - - -
3 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I
Ampul
) - - - - -
4 Serum Anti Tetanus (ATS) Injeksi 20.000
Vial
IU/ampul 10 - 10 - 10
5 Human Tetanus Imunoglobin inj 250 IU Vial - - - - -
6 Vaksin BCG Ampul - - - - -
7 Vaksin Campak 10 Dosis Vial - - - - -
8 Vaksin DT Vial - - - - -
9 Vaksin TD Vial - - - - -
10 Vaksin DTP-HB Vial - - - - -
11 Vaksin DPT-HB/Hib Vial - - - - -
12 Vaksin HB Uniject Pcs - - - - -
13 Vaksin MR (VVM.A) Vial - - - - -
14 Vaksin Polio Vial - - - - -
15 Vaksin Polio IPV 5 Dosis Vial - - - - -
16 Vaksin Polio 10 IPV Dosis Vial - - - - -
17 Vaksin TT Vial - - - - -
18 Buku Kontrak - - - - -
19 - - - - -
20 - - - - -

BPJS
UMUM JUMLAH
JUMLAH KUNJUNGAN RESEP PBI NON PBI
538 2,744 283 3,565

Kuningan, 09 Maret 2023

Yang Melaporkan
Mengetahui Pengelola Obat
Kepala UPTD Puskesmas Maleber

ILAH LILAHSAH,S.ST,M.Keb apt.SHEILA JULLYAN,S.Farm.

NIP. 19771215 199804 2 001 SIPA : 503/KPTS.54-SIPA/XI/2018
*-
-
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) JKN
PUSKESMAS MALEBER TAHUN 2023

PUSKESMAS : MALEBER
KECAMATAN : MALEBER
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : FEBRUARI/2023
PROPINSI : JAWA BARAT

STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL

1 2 3 4 5 6
A. O B A T
1 Air Raksa Dental Use Botol - - -
2 Albendazole Tablet 400 mg Tablet - - -
3 Albendazole susp 200 mg/5 ml Botol - - -
4 Alopurinol Tablet 100 mg Tablet 350 - 350
5 Alopurinol Tablet 300 mg Tablet - - -
6 Alprazolam tablet 1 mg Tablet - - -
7 Ambroksol Tablet 30 mg Tablet 15,057 - 15,057
8 Ambroksol sirup 15 mg/5 ml Botol - - -
9 Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
10 Aminofillin Tablet 200 mg Tablet - - -
11 Amitriptillin Hcl Tablet Salut 25 mg Tablet 1,410 - 1,410
12 Amlodipin Tablet 5 mg Tablet 29,890 - 29,890
13 Amlodipin Tablet 10 mg Tablet 15,147 - 15,147
14 Amoksisillin Kapsul 250 mg Kapsul - - -
15 Amoksisillin Kaplet 500 mg Kaplet 24,600 - 24,600
16 Amoksisillin Serbuk Injeksi 1000 mg vial - - -
17 Amoksisillin Sirup Kering 125 mg/5ml Botol - - -
18 Amoksisillin Double Strengh Sirup Kering 250
Botol
mg/5 ml - - -
19 Ampisilin Kapsul 250 mg Kapsul - - -
20 Ampisillin Kaplet 500 mg Tablet - - -
21 Ampisilin Sirup 125 mg / 5 ml Botol - - -
22 Ampisillin Injeksi 1000 mg Vial - - -
23 Analgetik Plus Tablet - - -
24 Antasida Doen Suspensi Kombinasi :
Magnesium Hidroksida 200 mg+ Alumunium Botol
Hidroksida 200 mg/5 ml - - -
25 Antasida Doen Tablet, Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium Hidroksida 200 Tablet
mg 23,922 - 23,922
26 Antasida Plus Tablet Tablet - - -
27 Antalgin (Metampiron) Tablet 500 mg Tablet 701 - 701
28 Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
29 Anti Bakteri DOEN Salep Kombinasi :
Basitrasin 500 IU/g + Polimiksin 1000 Tube
IU/g - - -
30 Anti Hemoroid Doen komb Supp - - -
31 Anti Fungi DOEN Kombinasi :
Pot
Asam Benzoat 6% + Asam Salisilat 3% 331 - 331
32 Antimigren DOEN Kombinasi :
Tablet
Ergotamin Tartrat 1 mg + Kofein 50 mg - - -
33 Anti Diare Suspensi Botol - - -
34 Anti Diare Tablet Tablet - - -
35 Anti Dotum Oral Tablet Tablet - - -
36 Anti Hipertensi Kapsul Tablet - - -
37 Antihistamin Tablet kombinasi Tablet - - -
38 Antispasmodik Tablet Tablet - - -
39 Antitusiva Sirup Botol - - -
40 Antitusiva Tablet Tablet - - -
41 Asam Folat Tablet 1 mg Tablet - - -
42 Asam Askorbat (Vit. C) Tablet 50 mg Tablet - - -
43 Asam Mefenamat Kapsul 500 mg Kapsul 17,885 - 17,885
44 Acetylsistein tablet Tablet 4,800 - 4,800
45 Asetosal Tablet 80 mg Tablet - - -
46 Asetosal Tablet 100 mg Tablet - - -
47 Asetosal Tablet 500 mg Tablet - - -
48 Asiklovir Krim 5 % Tube - - -
49 Asiklovir Tablet 200 mg Tablet - - -
50 Asiklovir Tablet 400 mg Tablet - - -
51 Attapulgit Tablet - - -
52 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
53
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial
- - -
54 Bahan Tambal Sementara Set - - -
55 Benzatin Benzil Penisilin injeksi Vial - - -
56 Betahistin Mesilat 6 mg Tablet 2,000 - 2,000
57 Betametason Krim 0,1 %- 5g - - -
58 Bisakodil Tablet 5 mg Tablet 200 - 200
59 Bisoprolol Tablet 5 mg Tablet - - -
60 Bromheksin 8 mg Tablet - - -
61 Cresotin Pasta Botol - - -
62 Cresotin Liquid No 2 Botol - - -
63 Deksametason Injeksi 5mg/ml-1ml Ampul - - -
64 Deksametason Tablet 0,5 mg Tablet 7,865 - 7,865
65 Devitalisasi Pasta (Non Arsen) Botol - - -
66 Diazepam tablet 2 mg Tablet - - -
67 Diazepam tablet 5 mg Tablet - - -
68 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
69 Diazepam Larutan Rektal 5 mg/ml Supp - - -
70 Diazepam Larutan Rektal 10 mg/ml Supp - - -
 71 Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
72 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - -
73 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul - - -
74 Digoksin Tablet 0,25 mg Tablet - - -
75 Dimenhidrinat Tablet 50 mg Tablet 1,000 - 1,000
76 Domperidon Tablet 10 mg Tablet 702 - 702
77 Donperidon Suspensi 5 mg/5ml Botol - - -
78 Efedrin Hcl Tablet 25 mg Tablet - - -
79 Ekstrak Belladone Tablet 10 mg Tablet - - -
80 Epinefrin HCl / Bitartrat
(Epinefrina / Adrenalina) Injeksi Ampul
0,1%/- 1ml - - -
81 Eritromisin Kapsul 250 mg Kapsul - - -
82 Eritromisin Kapsul 500 mg Kapsul - - -
83 Eritromisin Sirup 200 mg / 5 ml Botol - - -
84 Etambutol Tablet 500 mg Tablet - - -
85 Etanol 70 % 100 ml Botol - - -
86 Etil Klorida Semprot -100 ml Botol - - -
87 Eugenol Cairan -10 ml Botol - - -
88 Fenitoin Natrium Kapsul 100 mg Kapsul 30 - 30
89 Fenobarbital tablet 30 mg Tablet 415 - 415
90 Fenobarbital injeksi 50 mg / ml Ampul - - -
91 Fenoksimeti Penisilin 250 mg tablet Tablet - - -
92 Fenoksimeti Penisilin 500 mg tablet Tablet - - -
93 Fenol Gliserol TK Botol 151 - 151
94 Flufenazine decanoat injeksi 25 mg/ml Ampul - - -
95 Flukonazole tablet 150 mg Tablet - - -
96 Fitomenadion tablet 10 mg Tablet 330 - 330
97
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul
- - -
98 Furosemid Tablet 40 mg Tablet - - -
99 Furosemid injeksi Ampul - - -
100 Garam Oralit I serbuk, kombinasi :
( Nacl 0,52 gr, Kalium Klorida 0,30
Kantong
gr, Trinatrium Sitrat dihidrat 0,58 gr, Glukosa
Anhidrat 2,70 g )200 ml Air - - -
101 Gemfibrozil Tablet 600 mg Tablet - - -
102 Gentian Violet Botol - - -
103 Gentamisin injeksi 80 mg / 2 ml Vial - - -
104 Gentamisin Salep Kulit 0,1 % Tube - - -
105 Glass Ionomer Set - - -
106 Glibenklamid Tablet 5 mg Tablet - - -
107 Glimepiride 2 mg Tablet 15,000 - 15,000
108 Gliseril Guayakolat Tablet 100 mg Tablet - - -
109 Gliseril Guayakolat sirup Botol - - -
110 Glukonas Kalsikus injeksi Ampul 24 - 24
111 Glukosa Larutan Infus 5 % Botol - - -
112 Glukosa Larutan Infus10 % Botol - - -
113 Griseofulvin Tablet 125 mg,micronized Tablet - - -
114 Griseofulvin Tablet 500 mg,micronized Tablet 2,718 - 2,718
115 Haloperidol Tablet 0,5 mg Tablet - - -
116 Haloperidol Tablet 1,5 mg Tablet - - -
117 Haloperidol Tablet 5 mg Tablet - - -
118 Haloperidol injeksi 5 mg/ml Ampul - - -
119 Haloperidol injeksi 50 mg/ml Ampul - - -
120 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - -
121 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - -
122 Hidrokortison Krim 2,5 % Tube 359 - 359
123 Ibuprofen Tablet 200 mg Tablet 2,267 - 2,267
124 Ibuprofen Tablet 400 mg Tablet - - -
125 Ibuprofen Suspensi 100 mg/5 ml Botol - - -
126 Ichtyol salep Kulit Pot - - -
127 Isoniazid tablet 100 mg Tablet - - -
128 Isoniazid tablet 300 mg Tablet - - -
129 Isosorbid Dinitrat 5 mg Tablet - - -
130 Kalium Diklofenak Tablet 25 mg Tablet - - -
131
Kalium Diklofenak Tablet 50 mg Tablet
- - -
132 Kalsium Hidroksida Pasta Tube - - -
133 Kalsium Laktat Tablet 500 mg Tablet 20,000 - 20,000
134 Kaptopril 12,5 mg Tablet 1,640 - 1,640
135 Kaptopril 25 mg Tablet - - -
136 Karbamazepin Tablet 200 mg Tablet - - -
137 Ketokonazole Krim 2 % - 15 gr Tube 94 - 94
138 Ketokonazole Tablet 200 mg Tablet - - -
139 Ketoprofen Tablet 100 mg Tablet - - -
140 Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
141 Ketorolac 10 mg injeksi Ampul - - -
142 Ketorolac 30 mg injeksi Ampul - - -
143 Klindamisin Kapsul 150 mg Kapsul - - -
144 Klindamisin Kapsul 300 mg Kapsul - - -
145 Kloramfenikol Kapsul 250 mg Kapsul - - -
146 Kloramfenikol suspensi125mg/5 ml Botol - - -
147 Kloramfenikol Salep Mata 1%-3,5 g Tube - - -
148 Kloramfenikol Salep Kulit 2% Tube 68 - 68
149 Kloramfenikol Tetes Mata -5 ml Botol - - -
150 Kloramfenikol Tetes Telinga 3%-5 ml Botol - - -
151 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 24,800 - 24,800
152 Klorpromazin Hcl Tablet Salut 25 mg Tablet - - -
153 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - -
154 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
155 Kombinasi Ipatropium Bromide + Salbutamol
Sulphate for inhalation 2,5 Vial
ml - - -
156 Kombipak Cefixime+ Azithromisin Kotak - - -
157 Kotrimoksazol Pedriatik Tablet, Kombinasi :
Sulfametoksazol 100 mg + Trimetroprim 20 Tablet
mg - - -
158 Kotrimoksazol Tablet, Kombinasi :
Sulfametoksazol 400 mg + Trimetroprim 80 Tablet
mg
198 - 198
159 Kotrimoksazol Suspensi Kombinasi :
Sulfametoksazol 200 mg + Trimetroprim 40 Botol
mg/5 ml - - -
160 Lansoprazole 30 mg Kapsul Tablet 2,460 - 2,460
161 Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat 28 Botol
mEq) /Asering - - -
162 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr) - - -
163
Larutan mengadung Karbohidrat + Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na Botol
Lactat 2,24 gr, Dekstrosa 27 gr)
- - -
164 Lidokain injeksi 2 % Ampul 200 - 200
165 Lidokain Komp Injeksi, Kombinasi :
Lidokain Hcl 2% +Epinefrin 1 : 80.000- Ampul
2 ml - - -
166 Lidokain Spray Botol - - -
167 Loperamid Tablet 2 mg Tablet - - -
168 Loratadin tablet 10 mg Tablet 200 - 200
169 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
170 Loperamid Tablet 2 mg Tablet - - -
171 Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
172 Magnesium Sulfat (IV) 40 %-25 ml Ampul - - -
173 MB Anak Blister - - -
174 MB Dewasa Blister - - -
175 Meloksikam tablet 15 mg Tablet - - -
176 Meloksikam Suppositoria Supp - - -
177 Metformin Hcl Tablet 500 mg Tablet 20,000 - 20,000
178 Metformin 850 mg Tablet 5,000 - 5,000
179 Metildopa 250 mg tablet Tablet 3,250 - 3,250
180 Methisoprinol 500 mg Tablet 1,940 - 1,940
181 Metilergometrin Maleat (Metergin) Tablet
Tablet
0,125 mg 300 - 300
182
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul
100 - 100
183 Metilprednisolon tablet 4 mg Tablet 5,000 - 5,000
184 Metoklopramid 10 mg Tablet - - -
185 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
186 Metronidazol Tablet 250 mg Tablet - - -
187 Metronidazole Tablet 500 mg Tablet 10,000 - 10,000
188 Metronidazole sirup 125 mg/ml Botol - - -
189 Metronidazole Infus 500 mg /100 ml Ampul - - -
190 Mikonazole KrIm 2 % - 10 gr Tube - - -
191 Multivitamin + Mineral tablet Tablet - - -
192 Multivitamin sirup Botol - - -
193 Mummifying Pasta Botol - - -
194 Natrium Bikarbonat Tablet 500 mg Tablet - - -
195 Natrum Diklofenak Tablet 25 mg Tablet - - -
196 Natrium Diklofenak Tablet 50 mg Tablet 14,900 - 14,900
197
Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol
- - -
198 Nipedifin Tablet 10 mg Tablet - - -
199 Nistatin suspensi 100.000 IU/ml Botol - - -
200 Nistatin 100.000 IU/gram Tablet Vagina Tablet - - -
201 Nistatin 500.000 IU/gram Tablet Salut Tablet - - -
202 Obat Antitiuberkolosis Kategori Anak Paket - - -
203
Obat Antitiuberkolosis Kategori 1 Dewasa Paket
- - -
204
Obat Antitiuberkolosis Kategori 2 Dewasa Paket
- - -
205
Obat Antitiuberkolosis Kategori 3 Dewasa Paket
- - -
206 Obat Anti Tuberkulosis FDC Kat Anak Paket - - -
207 Obat Anti Tuberkulosis FDC Kat I & II Paket - - -
208 Obat Anti Tuberkulosis FDC Kat I & III Paket - - -
209
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket
- - -
210 Obat Batuk Hitam (OBH) Cairan 100 ml Botol - - -
211 Obat Batuk Cair Sirup (Ekspektoran) Botol - - -
212 Obat Batuk Hitam Plus Sirup Botol - - -
213 Obat Flu Sirup Botol - - -
214
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
- - -
215 Oksiterasiklin Salep Mata 1%-3,5g Tube - - -
216 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - - -
217 Oksitosin Injeksi 10 IU/ml-1ml Ampul - - -
218 Omeprazole injeksi 40mg/10ml Ampul - - -
219 Omeprazole Kapsul 20 mg Tablet 5,650 - 5,650
220 Ondansetron inj 4 mg/ 2 mL Ampul - - -
221 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - -
222 Parasetamol drop 100 mg/ml btl @15ml
Botol
(60mg/0,6ml) - - -
223 Parasetamol Sirup 120 mg/5ml-60 ml Botol - - -
224 Parasetamol Tablet 500 mg Tablet 55,058 - 55,058
225 PB Anak Blister - - -
226 PB Dewasa Blister - - -
227 Pehacain injeksi Ampul - - -
228 Perak Sulfadiazin krim 1 % 35 gr Tube - - -
229 Permetrin krim 5 % Tube 135 - 135
230 Piracetam Tablet 400 mg Tablet - - -
231 Piracetam Tablet 800 mg Tablet - - -
232 Piroksikam Tablet 20 mg Tablet - - -
233 Pirantel Pamoat Tablet 365 mg (Setara dng 125
Tablet
mg Basa) - - -
234 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 3,431 - 3,431
235 Povidon Iodida 10% 30 ml Botol - - -
236 Povidon Iodida 10% 60 ml Botol - - -
237 Povidon Iodida 10% 300 ml Botol - - -
238 Prednison Tablet 5 mg Tablet - - -
239 Primakuin tablet 15 mg Tablet - - -
240
Prokain Benzil Penisilin Injeksi 3,000,000 IU Vial
- - -
241 Propanolol Hcl Tablet 40 mg Tablet - - -
242 Propilturasil Tablet 100 mg Tablet - - -
243 Ranitidin Injeksi 25 mg / ml Ampul - - -
244 Ranitidin Tablet 150 mg Tablet 4,870 - 4,870
245 Retinol (Vit. A) 100.000 IU Kapsul Kapsul - - -
246 Retinol (Vit. A) 200.000 IU Kapsul Kapsul - - -
247 Reserpin Tablet 0, 25 mg Tablet - - -
248 Rifampisin Tablet 450 mg Tablet - - -
249 Ringer Laktat Larutan Infus Steril 500 ml Botol - - -
250 Salbutamol Tablet 2 mg Tablet - - -
251 Salbutamol Tablet 4 mg Tablet 360 - 360
252 Salbutamol solution for Inhalation single dose
Ampul
units 2,5 ml - - -
253 Salep 2-4 Kombinasi :
Asam Salisilat 2 % + Belerang Endap 4 Pot
% - 30 gram 254 - 254
254 Salisil bedak 2% -50 gr Kotak - - -
255 Salep Luka Bakar Tube - - -
256
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol
- - -
257 Sefadroksil Tablet 500 mg Tablet 4,230 - 4,230
258 Sefiksim Kapsul 100 mg Kapsul - - -
259 Sefiksim 400 mg + Azitromisin 1000 mg Paket - - -
260 Sefotaksim Injeksi 1 gr Ampul - - -
261 Seftriakson Injeksi 1 gr / vial Ampul - - -
262 Semen Seng Fosfat Serbuk & Cairan Botol - - -
263 Setirizin Tablet 10 mg Tablet 29,900 - 29,900
264 Setirizin Sirup 5 mg / 5 ml Botol - - -
265 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul - - -
266 Sianokobalamin Tablet 50 mcg Tablet - - -
267 Silver Amalgam Serbuk 65-75% Botol - - -
268 Simetidin 200 mg Tablet Tablet - - -
269 Simvastatin Tablet 10 mg Tablet - - -
270 Siprofloksasin 500mg Tablet 980 - 980
271 Spironolakton Tablet 25 mg Tablet 830 - 830
272 Sulfacetamid Tetes Mata 15 %-5ml Botol - - -
273 Tablet Tambah Darah Kombinasi:
Besi II Sulfat 200 mg + Asam Folat Tablet
0,25 mg - - -
274 Temporary Stopping Fletcher (Fletcher) Serbuk
Set
& Cairan - - -
275 Trikesol formalin ( T K F ) Cairan 10 ml Botol - - -
276 Tetrasiklin Kapsul 250 mg Kapsul - - -
277 Tetrasiklin Kapsul 500 mg Kapsul - - -
278
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul
- - -
279
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet
13,491 - 13,491
280 Thiamfenikol Kapsul 500 mg Kapsul - - -
281 Tramadol Injeksi 50 mg/ ml Ampul - - -
282 Tramadol Tablet 50 mg Tablet - - -
283
Triheksifenidil Hidroklorida Tablet 2 mg Tablet
- - -
284
Tablet
Triheksifenidil Hidroklorida Tablet 2 mg - - -
285 Vitamin B .Komplek Tablet Tablet 61,196 - 61,196
286 Vitamin Neurotropik Tablet Tablet 9,760 - 9,760
287 Zinc Tablet 20 mg Tablet - - -
288 Zinc Sulfat 20 mg/5 ml Tablet - - -
289 Aminofillin Tablet 150 mg Tablet - - -
290 Asam Folat Tablet 0,4 mg Tablet 950 - 950
291 Gentamisin Sulfat tetes mata 0,3% Botol 67 - 67
292 Obat Kumur Botol - - -
293 Salep Betametason + Neomisin Tube - - -
294 Salep Kloramfenikol + Hidrokortison Tube - - -
295 Propanolol 10mg Tablet - - -
296 Tablet Pemanis Botol - - -
297 Bisakodil Suppositoria 5 mg Supp 12 - 12
298 Obat Batuk Herbal (Herbakof) Botol 372 - 372
299 Amoksisillin Drops Botol - - -
300 Tablet Hepatoprotector (Curcuma) Pot - - -
301 Simvastatin 20mg Tablet - - -
302 Klozapine 25mg Tablet - - -
303 Bisoprolol 2,5mg Tablet 2,000 - 2,000
304 Vitamin C 500mg Tablet - - -
305 RAMVIT-C C 500mg Tablet 28,701 - 28,701
306 Vitamin D 1000 IU Tablet - - -
307 Multivitamin Tablet Kombinasi VitC,Vit D, Zinc,
Tablet
Folic Acid 30,046 - 30,046
308 Multivitamin Syrup Tablet 291 - 291
 309 Risperidon 2 mg Tablet - - -
310 Alpara Tablet Tablet 266 - 266
311 Asam Traneksamat Tablet 480 - 480
312 Novagrip Flu Batuk Tablet Tablet 10,000 - 10,000
313 FORNERO TABLET Tablet 10,000 - 10,000
B. BAHAN MEDIS HABIS PAKAI (BMHP) - - -
1 Abbocath No 18 ( IV Chateter 18 ) Buah - - -
2 Abbocath No 20 ( IV Chateter 20 ) Buah - - -
3 Abbocath No 22 ( IV Chateter 22 ) Buah - - -
4 Abbocath No 24 ( IV Chateter 24 ) Buah - - -
5 Alat Gula, Kolesterol, Asam Urat Unit - - -
6 Alat Suntik Sekali Pakai 1 ml Set - - -
7 Alat Suntik Sekali Pakai 3 ml Set - - -
8 Alat Suntik Sekali Pakai 3 ml Set - - -
9 Alat Suntik Sekali Pakai 5 ml Set - - -
10 Alat Suntik Sekali Pakai 10 ml Set - - -
11 Alkohol Swab Kotak 2,200 - 2,200
12 Auto Disposable Syringe (ADS) 0,05 ml Set - - -
13 Auto Disposable Syringe (ADS) 0,5 ml Set - - -
14 Auto Disposable Syringe (ADS) 5 ml Set - - -
15 Blood Set Set 2 - 2
16 Catgut/Benang Bedah No.2/0 Plain Sachet - - -
17 Catgut/Benang Bedah No.3/0 Cromic Sachet - - -
18 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - - -
19 Etanol 70 % 1.000 ml Botol 30 - 30
20 Eter Alkohol Botol - - -
21 Folley Catheter no 14 Set - - -
22 Folley Catheter no 16 Set 30 - 30
23 Folley Catheter no 18 Set 30 - 30
24 Infus set Anak Set - - -
25 Infus set Anak Set - - -
26 Infus set Dewasa Set 100 - 100
27 Iodina Test Botol - - -
28 Kaca Slide Pcs - - -
29 Kapas Berlemak 500 gram Bungkus - - -
30 Kapas Pembalut / Adsorbens 250 gram Bungkus - - -
31 Kassa Pembalut 2 m x 80 cm Rol - - -
32 Kassa Pembalut Hidrofil 4 m x 3 cm Rol - - -
33 Kassa Pembalut Hidrofil 4 m x 15 cm Rol - - -
34 Kassa Hidrofil Steril 16 x 16 Kotak 100 - 100
35 Kassa Kompres 40 x 40 steril Bungkus - - -
36 Kertas Puyer Pcs - - -
37 Kertas Saring Lembar - - -
38 Kertas Lensa Lembar - - -
39 Lysol 1,000 ml Botol - - -
40 Masker Buah 550 - 550
41 Masker Ear Loop Buah 8,000 - 8,000
42 Masker Head Loop Buah - - -
43 Masker Rajawali Buah - - -
44 Masker Head Loop Buah - - -
45 Masker N 95 Pcs - - -
46 Minyak Imersi Botol - - -
47 Plester Kertas Rol - - -
48 Polifix Rol 50 - 50
49 Pot Dahak Pcs - - -
50 Rapid 2 HIV Fokus Test - - -
51 Rapid HIV 1 (SD HIV) Test - - -
52 Test
Rapid HIV 2 (Intec HIV) - - -
53 Test
Rapid HIV 2 (Biomeriux HIV) - - -
54 Test
Rapid Tes SD Bioline HBSAG - - -
55 Test
Rapid Test Syphilis - - -
56 Test
Reagen CD 4 Control - - -
57 Test
Reagen CD 4 - - -
58 Botol
Reagen Ziehl Nielsen - - -
59 Test
RPR Test Syphilis - - -
60 Sachet
Silk( Benang Bedah Sutra ) No 3/0 72 - 72
61 Pcs
Safety Box - - -
62 Pcs
Sarung tangan Steril No 6 - - -
63 Pcs
Sarung tangan Steril No 7 150 - 150
64 Pcs
Sarung tangan Steril No 7,5 - - -
65 Pcs
Sarung tangan Steril No 7,5 140 - 140
66 Sarung tangan Non Steril S Pcs 2,700 - 2,700
67 Sarung tangan Non Steril M Pcs 4,600 - 4,600
68 Sarung tangan Non Steril L Pcs 3,400 - 3,400
69 Sountimer Buah - - -
70 Stik Pemeriksaan Gula Darah Test - - -
71
Test
Stik Pemeriksaan Gula Darah Benecheck - - -
72
Test
Stik Pemeriksaan Gula Darah One Touch Verio - - -
73 Stik Pemeriksaan Kolesterol Test - - -
74 Stik Pemeriksaan Kolesterol Benecheck Test - - -
75 Stik Pemeriksaan Asam Urat Test - - -
76 Stik Pemeriksaan Asam Urat Benecheck Test - - -
77 Supratul Lembar - - -
78 Urine Bag set 40 - 40
79 Wing Neddle No 23 Set - - -
 80 Blood Lancet Pcs - - -
81 Cairan Antiseptik Botol 500 ml Botol 35 - 35
82 Bisturi Pcs 20 - 20
83 Cairan Antiseptik Botol 5 Liter Botol - - -
84 3 Surface Desintfectan 5L Botol 3 - 3
85 Cairan Desinfektan 5 Liter Botol - - -
86 High Level Desintfectan/sterald Botol - - -
87 Cairan Detergen 5 Liter Botol - - -
88 Gel USG Botol 30 - 30
89 IV Dressing Pcs - - -
90 Mucus Extractor Pcs - - -
91 Nasal Oxygen Anak Pcs 5 - 5
92 Nasal Oxygen Bayi Pcs 25 - 25
93 Nasal Oxygen Dewasa Pcs 100 - 100
94 Plester Bulat Non Woven Pcs - - -
95 Plester Transparan Pcs - - -
96 PP test Pcs 500 - 500
97 Sarung tangan Steril No 6,5 Pcs - - -
98 Sarung Tangan Obgyn Steril Pcs - - -
99 Stik Pemeriksaan Hb Pcs - - -
100 Umbilical Cord Klem Steril Nylon Pcs - - -
101 Underpad 60x90 cm Non Steril Pcs - - -
102 Stik Gula Darah Baru Pcs - - -
103 Stik Asam Urat Baru Pcs - - -
104 Stik Hb Test - - -
105 ChOLESTROL chod-pap Kit - - -
106 Creatinin mod iaffe Kit - - -
107 Glucosa God-pap Kit - - -
108 GOT (AST) mod iffe Kit - - -
109 GPT Kit - - -
110 Trigliserida GPO-PAP Kit - - -
111 Urea UV-auto,Urease/GLDH Kit - - -
112 Urid Acid TBHA Kit - - -
113 Dumacon Auto Kit - - -
114 Micropipet 5,0-50 Ul Kit - - -
115 Micropipet 10-100UL Kit - - -
116 Tabung Vacutainer Kit - - -
117 HGB Drab Kin Kit - - -
118 Nasal Kanul Dewasa Pcs - - -
119 Nasal Kanul Anak Pcs - - -
120 Nasal Kanul Anak Pcs - - -
121 Coveral II (APD) Non Woven Pcs - - -
122 Coveral II (APD) Non Woven Pcs 100 - 100
123 Kantong Plastik Kuning 60cmx100cm Pak - - -
124 Kantong Plastik Kuning 80cmx120cm Pak 10 - 10
125 Kantong Plastik Hitam 60cmx100cm Pak - - -
126 Kantong Plastik Hitam 80cmx120cm Pak 10 - 10
127 Forsch Medical Disposible Gown Pcs - - -
C. SERUM DAN VAKSIN - - -
1 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I Vial - - -
)
2 Serum Anti Rabies untuk manusia Vial - - -
3 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I
) Ampul
- - -
4 Serum Anti Tetanus (ATS) Injeksi 20.000
Vial
IU/ampul 10 - 10
5 Human Tetanus Imunoglobin inj 250 IU Vial - - -
6 Vaksin BCG Ampul - - -
7 Vaksin Campak 10 Dosis Vial - - -
8 Vaksin DT Vial - - -
9 Vaksin TD Vial - - -
10 Vaksin DTP-HB Vial - - -
11 Vaksin DPT-HB/Hib Vial - - -
12 Vaksin HB Uniject Pcs - - -
13 Vaksin MR (VVM.A) Vial - - -
14 Vaksin Polio Vial - - -
15 Vaksin Polio IPV 5 Dosis Vial - - -
16 Vaksin Polio 10 IPV Dosis Vial - - -
17 Vaksin TT Vial - - -
18 Buku Kontrak - - -
19 - - -
20 - - -

BPJS
UMUM JUMLAH
JUMLAH KUNJUNGAN RESEP PBI NON PBI
538 2,744 283 3,565

Kuningan, 09 Maret 2023

Yang Melaporkan
Mengetahui Pengelola Obat
Kepala UPTD Puskesmas Maleber

ILAH LILAHSAH,S.ST,M.Keb apt.SHEILA JULLYAN,S.Farm.

NIP. 19771215 199804 2 001 SIPA : 503/KPTS.54-SIPA/XI/2018
OBAT (LPLPO) JKN
23

ERIODE : FEBRUARI/2023

STOK
PEMAKAIAN
AKHIR

7 8

- -
- -
- -
- 350 *-
- -
- -
500 14,557
- -
- -
- -
- 1,410
1,050 28,840
600 14,547
- -
- 24,600
- -
- -

- -
- -
- -
- -
- -
- -

- -

- 23,922
- -
201 500
- -
 - -
- -

- 331

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
400 17,485
- 4,800
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
200 1,800
- -
- 200
- -
- -
- -
- -
- -
- 7,865
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 1,000
- 702
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- 30
- 415
- -
- -
- -
- 151
- -
- -
- 330

- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- 15,000
- -
- -
- 24
- -
- -
- -
- 2,718
- -
- -
- -
- -
- -
- -
- -
- 359
- 2,267
- -
- -
- -
- -
- -
- -
- -

- -
- -
- 20,000
- 1,640
- -
- -
- 94
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 68
- -
- -
- 24,800
- -
- -
- -
- -
- -

- -

- 198

- -
- 2,460

- -

- -

- -
- 200

- -
- -
- -
- 200
- -
- -
- -
- -
- -
- -
- -
- -
- 20,000
- 5,000
- 3,250
- 1,940

- 300

- 100
- 5,000
- -
- -
- -
- 10,000
- -
- -
- -
- -
- -
- -
- -
- -
- 14,900

- -
- -
- -
- -
- -
- -

- -

- -

- -
- -
- -
- -

- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- 5,650
- -

- -

- -
- -
- 55,058
- -
- -
- -
- -
- 135
- -
- -
- -

- -
- 3,431
- -
- -
- -
- -
- -

- -
- -
- -
- -
- 4,870
- -
- -
- -
- -
- -
- -
- 360

- -

- 254
- -
- -

- -
- 4,230
- -
- -
- -
- -
- -
- 29,900
- -
- -
- -
- -
- -
- -
- 980
- 830
- -

- -

- -
- -
- -
- -

- -

- 13,491
- -
- -
- -

- -

- -
- 61,196
- 9,760
- -
- -
- -
- 950
- 67
- -
- -
- -
- -
- -
- 12
- 372
- -
- -
- -
- -
- 2,000
- -
- 28,701
- -

- 30,046
- 291
- -
- 266
- 480
- 10,000
- 10,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 2,200
- -
- -
- -
- 2
- -
- -
- -
- 30
- -
- -
- 30
- 30
- -
- -
- 100
- -
- -
- -
- -
- -
- -
- -
- 100
- -
- -
- -
- -
- -
- 550
- 8,000
- -
- -
- -
- -
- -
- -
- 50
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 72
- -
- -
- 150
- -
- 140
- 2,700
- 4,600
- 3,400
- -
- -

- -

- -
- -
- -
- -
- -
- -
- 40
- -
- -
- 35
- 20
- -
- 3
- -
- -
- -
- 30
- -
- -
- 5
- 25
- 100
- -
- -
- 500
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 100
- -
- 10
- -
 - 10
- -
- -
- -
- -

- -

- 10
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

09 Maret 2023
Melaporkan
gelola Obat

JULLYAN,S.Farm.
TS.54-SIPA/XI/2018
-