LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) 2023 FORM :

PUSKESMAS MALEBER

PUSKESMAS : MALEBER DOKUMEN NOMOR

KECAMATAN : MALEBER DINKES KABUPATEN
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : JANUARI/2023 UPTD GFK
PROVINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : FEBRUARI/2023 UPTD PUSKESMAS 442.7/ /PKM-MLBR/2023

PEMBERIAN
NO NAMA SEDIAAN SATUAN STOK
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN
OPT.
PKD ASKES APBD I APBD II PROGRAM
A. OBAT
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 850 850 850 - 1,700
5 Alopurinol Tablet 300 mg Tablet 1,700 1,700 340 1,360 680
6 Alprazolam tablet 1 mg Tablet - - - - -
7 Ambroksol Tablet 30 mg Tablet - - - - -
8 Ambroksol sirup 15 mg/5 ml Botol 50 50 - 50 -
9 Aminofillin Injeksi 24 mg/ml-10 ml Ampul - 10 10 - 10 -
10 Aminofillin Tablet 200 mg Tablet 1,000 1,000 - 1,000 -
11 Amitriptillin Hcl Tablet Salut 25 mg Tablet - - - - -
12 Amlodipin Tablet 5 mg Tablet 3,000 3,000 130 2,870 260
13 Amlodipin Tablet 10 mg Tablet - - - - -
14 Amoksisillin Kapsul 250 mg Kapsul - - - - -
15 Amoksisillin Kaplet 500 mg Kaplet 4,900 4,900 2,549 2,351 5,098
16 Amoksisillin Serbuk Injeksi 1000 mg vial - - - - -
17 Amoksisillin Sirup Kering 125 mg/5ml Botol 85 85 - 85 -
18 Amoksisillin Double Strengh Sirup Kering 250 mg/5 ml
Botol 23 100 123 65 58 130
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 Hidroksida 200 mg/5 Botol
ml - - - - -
25
Antasida Doen Tablet, Kombinasi : Magnesium
Tablet
Hidroksida 200 mg+ Alumunium Hidroksida 200 mg
- 10,000 10,000 - 10,000 -
26 Antasida Plus Tablet Tablet - - - - -
27 Antalgin (Metampiron) Tablet 500 mg Tablet - - - - -
28 Antalgin Injeksi 250 mg/ml-2ml Ampul - - - - -
29 Anti Bakteri DOEN Salep Kombinasi : Tube - - - - -
30 Anti Hemoroid Doen komb Supp 17 50 67 - 67 -
31 Anti Fungi DOEN Kombinasi : Pot 65 65 - 65 -
32 Antimigren DOEN Kombinasi : Tablet 390 390 - 390 -
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 490 490 - 490 -
42 Asam Askorbat (Vit. C) Tablet 50 mg Tablet 965 965 - 965 -
43 Asam Mefenamat Kapsul 500 mg Kapsul - - - - -
44 Acetylsistein tablet Tablet 1,730 1,730 - 1,730 -
45 Asetosal Tablet 80 mg Tablet 70 70 - 70 -
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 810 810 - 810 -
52 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 30 30 - 30 -
53 Aqua Pro Injeksi Steril, bebas Pirogen 1 Liter Vial 30 30 60 - 60 -
54 Bahan Tambal Sementara Set - - - - -
55 Benzatin Benzil Penisilin injeksi Vial - - - - -
56 Betahistin Mesilat 6 mg Tablet 450 450 - 450 -
57 Betametason Krim 0,1 %- 5g Tube 41 41 - 41 -
58 Bisakodil suppositoria 10 mg Supp - - - - -
59 Bisoprolol Tablet 2,5 mg Tablet 80 80 - 80 -
60 Bromheksin 8 mg Tablet - - - - -
61 Cresotin Pasta Botol - - - - -
62 Cresotin Liquid No 2 Botol - - - - -
63 Deksametason Injeksi 5mg/ml-1ml Ampul 20 20 - 20 -
64 Deksametason Tablet 0,5 mg Tablet 2,675 2,675 - 2,675 -
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 25 25 - 25 -
69 Diazepam Larutan Rektal 5 mg/ml Supp 10 10 - 10 -
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 Digoksin Tablet 0,25 mg Tablet - - - - -
74 Dimenhidrinat Tablet 50 mg Tablet 840 840 - 840 -
75 Domperidon Tablet 10 mg Tablet - - - - -
76 Donperidon Suspensi 5 mg/5ml Botol - - - - -
77 Efedrin Hcl Tablet 25 mg Tablet - - - - -
78 Ekstrak Belladone Tablet 10 mg Tablet - - - - -
79 Epinefrin HCl / Bitartrat Ampul 5 5 - 5 -
80 Eritromisin Kapsul 250 mg Kapsul - - - - -
81 Eritromisin Kapsul 500 mg Kapsul - - - - -
82 Eritromisin Sirup 200 mg / 5 ml Botol - - - - -
83 Etambutol Tablet 500 mg Tablet - - - - -
84 Etanol 70 % 100 ml Botol - - - - -
85 Etil Klorida Semprot -100 ml Botol 2 2 - 2 -
86 Eugenol Cairan -10 ml Botol - - - - -
87 Fenitoin Natrium Kapsul 100 mg Kapsul 90 90 - 90 -
88 Fenobarbital tablet 30 mg Tablet - - - - -
89 Fenobarbital injeksi 50 mg / ml Ampul 30 30 - 30 -
90 Fenoksimeti Penisilin 250 mg tablet Tablet - - - - -
91 Fenoksimeti Penisilin 500 mg tablet Tablet - - - - -
92 Fenol Gliserol TK Botol - - - - -
93 Flufenazine decanoat injeksi 25 mg/ml Ampul - - - - -
94 Flukonazole tablet 150 mg Tablet - - - - -
 95 Fitomenadion tablet 10 mg Tablet - 100 100 - 100 -
96 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 80 100 180 - 180 -
97 Furosemid Tablet 40 mg Tablet - 100 100 - 100 -
98 Furosemid injeksi Ampul - - - - -
99 Garam Oralit I serbuk, kombinasi :
( Nacl 0,52 gr, Kalium Klorida 0,30 gr,
Kantong
Trinatrium Sitrat dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air - - - - -
100 Gemfibrozil Tablet 600 mg Tablet - - - - -
101 Gentian Violet Botol - - - - -
102 Gentamisin injeksi 80 mg / 2 ml Vial - - - - -
103 Gentamisin Salep Kulit 0,1 % Tube - - - - -
104 Glass Ionomer Set - - - - -
105 Glibenklamid Tablet 5 mg Tablet 1,450 1,450 - 1,450 -
106 Glimepiride 2 mg Tablet 2,800 2,800 - 2,800 -
107 Gliseril Guayakolat Tablet 100 mg Tablet - - - - -
108 Gliseril Guayakolat sirup Botol - - - - -
109 Glukonas Kalsikus injeksi Ampul 20 20 - 20 -
110 Glukosa Larutan Infus 5 % Botol 20 20 - 20 -
111 Glukosa Larutan Infus10 % Botol 20 20 - 20 -
112 Griseofulvin Tablet 125 mg,micronized Tablet - - - - -
113 Haloperidol Tablet 0,5 mg Tablet - - - - -
114 Haloperidol Tablet 1,5 mg Tablet 15,545 15,545 - 15,545 -
115 Haloperidol Tablet 5 mg Tablet 2,045 2,045 - 2,045 -
116 Haloperidol injeksi 5 mg/ml Ampul - - - - -
117 Haloperidol injeksi 50 mg/ml Ampul - - - - -
118 Hidroklortiazid (HCT) Tablet 25 mg Tablet - - - - -
119 Hidrokortison Krim 2,5 % Tube 46 46 - 46 -
120 Ibuprofen Tablet 200 mg Tablet - - - - -
121 Ibuprofen Tablet 400 mg Tablet 3,000 3,000 - 3,000 -
122 Ibuprofen Suspensi 100 mg/5 ml Botol - - - - -
123 Ichtyol salep Kulit Pot - - - - -
124 Isoniazid tablet 100 mg Tablet - - - - -
125 Isoniazid tablet 300 mg Tablet - - - - -
126 Isosorbid Dinitrat 5 mg Tablet - - - - -
127 Kalium Diklofenak Tablet 25 mg Tablet - - - - -
128 Kalium Diklofenak Tablet 50 mg Tablet - - - - -
129 Kalsium Hidroksida Pasta Tube - - - - -
130 Kalsium Laktat Tablet 500 mg Tablet 4,280 4,280 - 4,280 -
131 Kaptopril 12,5 mg Tablet 3,000 3,000 - 3,000 -
132 Kaptopril 25 mg Tablet 2,000 2,000 - 2,000 -
133 Karbamazepin Tablet 200 mg Tablet - - - - -
134 Ketokonazole Krim 2 % - 15 gr Tube 30 30 - 30 -
135 Ketokonazole Tablet 200 mg Tablet 420 420 - 420 -
136 Ketoprofen Tablet 100 mg Tablet - - - - -
137 Ketoprofen Injeksi 100 mg / 1 ml Ampul - - - - -
138 Ketorolac 10 mg injeksi Ampul - - - - -
139 Ketorolac 30 mg injeksi Ampul - - - - -
140 Klindamisin Kapsul 150 mg Kapsul - - - - -
141 Klindamisin Kapsul 300 mg Kapsul 200 200 - 200 -
142 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
143 Kloramfenikol suspensi125mg/5 ml Botol - - - - -
144 Kloramfenikol Salep Mata 1%-3,5 g Tube - - - - -
145 Kloramfenikol Salep Kulit 2% Tube 21 21 - 21 -
146 Kloramfenikol Tetes Mata -5 ml Botol 20 20 - 20 -
147 Kloramfenikol Tetes Telinga 3%-5 ml Botol 51 51 - 51 -
148 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 9,650 9,650 - 9,650 -
149 Klorpromazin Hcl Tablet Salut 25 mg Tablet - 500 500 - 500 -
150 Klorpromazin Hcl Tablet Salut 100 mg Tablet 290 290 - 290 -
151 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - - - -
152 Kombinasi Ipatropium Bromide + Salbutamol
Vial - - - - -
Sulphate for inhalation 2,5 ml
153 Kombipak Cefixime+ Azithromisin Kotak - - - - -
154 Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet - - - - -
155 Kotrimoksazol Tablet, Kombinasi : Tablet - - - - -
156
Kotrimoksazol Suspensi Kombinasi :
Botol
Sulfametoksazol 200 mg + Trimetroprim 40 mg/5 ml
95 95 - 95 -
157 Lansoprazole 30 mg Kapsul Tablet - - - - -
158 Larutan mengadung Elektrolit Botol - - - - -
159 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr) 60 20 80 - 80 -
160 Larutan mengadung Elektrolit
Botol - - - - -
(Nacl 1,125 gr , Dekstrosa 18,75 gr)
161 Larutan mengadung Karbohidrat + Elektrolit Botol - - - - -
162 Lidokain injeksi 2 % Tablet 45 45 - 45 -
163 Lidokain Komp Injeksi, Kombinasi : Ampul - - - - -
164 Lidokain Spray Botol - - - - -
165 Loperamid Tablet 2 mg Tablet 480 480 - 480 -
166 Loratadin tablet 10 mg Tablet - - - - -
167 Magnesium Sulfat (IV) 20 %-25 ml Ampul - 50 50 - 50 -
168 Magnesium Sulfat (IV) 40 %-25 ml Ampul - 43 43 - 43 -
169 MB Anak Blister - - - - -
170 MB Dewasa Blister - - - - -
171 Meloksikam tablet 15 mg Tablet - - - - -
172 Meloksikam Suppositoria Supp - - - - -
173 Metformin Hcl Tablet 500 mg Tablet 1,640 1,640 - 1,640 -
174 Metformin 850 mg Tablet 1,950 1,950 - 1,950 -
175 Metildopa 250 mg tablet Tablet - - - - -
176 Methisoprinol 500 mg Tablet - - - - -
177
Metilergometrin Maleat (Metergin) Tablet 0,125 mg Tablet 120 120 - 120 -
178 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 197 197 - 197 -
179 Metilprednisolon tablet 4 mg Tablet 2,000 2,000 - 2,000 -
180 Metoklopramid 10 mg Tablet - - - - -
181 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - - - -
182 Metronidazol Tablet 250 mg Tablet - - - - -
183 Metronidazole Tablet 500 mg Tablet 2,000 2,000 - 2,000 -
184 Metronidazole sirup 125 mg/ml Botol 40 40 - 40 -
185 Metronidazole Infus 500 mg /100 ml Ampul 50 50 100 - 100 -
186 Mikonazole KrIm 2 % - 10 gr Tube 29 -
187 Multivitamin + Mineral tablet Tablet - 3,000 3,000 - 3,000 -
188 Multivitamin sirup Botol - - - - -
189 Mummifying Pasta Botol - - - - -
190 Natrium Bikarbonat Tablet 500 mg Tablet - - - - -
191 Natrum Diklofenak Tablet 25 mg Tablet - - - - -
192 Natrium Diklofenak Tablet 50 mg Tablet 1,700 1,700 - 1,700 -
193 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol 95 95 - 95 -
194 Nipedifin Tablet 10 mg Tablet - - - - -
195 Nistatin suspensi 100.000 IU/ml Botol 24 50 74 - 74 -
196 Nistatin 100.000 IU/gram Tablet Vagina - - - - -
197 Nistatin 500.000 IU/gram Tablet Salut Tablet 100 100 - 100 -
198 Obat Antitiuberkolosis Kategori Anak Paket - - - - -
199 Obat Antitiuberkolosis Kategori 1 Dewasa Paket - - - - -
200 Obat Antitiuberkolosis Kategori 2 Dewasa Paket - - - - -
201 Obat Antitiuberkolosis Kategori 2 Dewasa Paket - - - - -
202 Obat Anti Tuberkulosis FDC Kat Anak Paket - - - - -
203 Obat Anti Tuberkulosis FDC Kat I & II Paket - - - - -
204 Obat Anti Tuberkulosis FDC Kat I & III Paket - - - - -
205 Obat Anti Tuberkulosis FDC Kat I & III Paket 16 16 - 16 -
206 Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - - - - -
207 Obat Batuk Hitam (OBH) Cairan 100 ml Botol - - - - -
208 Obat Batuk Cair Sirup (Ekspektoran) Botol - - - - -
209 Obat Batuk Hitam Plus Sirup Botol - - - - -
210 Obat Flu Sirup Botol - - - - -
211 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - - - - -
212 Oksiterasiklin Salep Mata 1%-3,5g Tube - 50 50 - 50 -
213 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - - - - -
214 Oksitosin Injeksi 10 IU/ml-1ml Ampul 250 250 - 250 -
215 Omeprazole injeksi 40mg/10ml Ampul - 30 30 - 30 -
216 Omeprazole Kapsul 20 mg Kapsul 660 660 - 660 -
217 Ondansetron inj 4 mg/ 2 mL Ampul - - - - -
218 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol - - - - -
219
Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol
- - - - -
220 Parasetamol Sirup 120 mg/5ml-60 ml Botol 190 190 - 190 -
221 Parasetamol Tablet 100 mg Tablet - - - - -
222 Parasetamol Tablet 500 mg Tablet - 16,500 16,500 - 16,500 -
223 PB Anak Blister - - - - -
224 PB Dewasa Blister - - - - -
225 Pehacain injeksi Ampul - - - - -
226 Perak Sulfadiazin krim 1 % 35 gr Tube - - - - -
227 Permetrin krim 5 % Tube 17 17 - 17 -
228 Piracetam Tablet 400 mg Tablet - - - - -
229 Piracetam Tablet 800 mg Tablet - - - - -
230 Piroksikam Tablet 20 mg Tablet - - - - -
231 Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg Bas Tablet - - - - -
232 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - - - - -
233 Piridoksin Hcl (Vit.B6) Tablet 25 mg Tablet - - - - -
234 Povidon Iodida 10% 30 ml Botol - - - - -
235 Povidon Iodida 10% 60 ml Botol - - - - -
236 Povidon Iodida 10% 300 ml Botol - - - - -
237 Prednison Tablet 5 mg Tablet 1,210 1,210 - 1,210 -
238 Primakuin tablet 15 mg Tablet - - - - -
239 Prokain Benzil Penisilin Injeksi 3,000,000 IU Vial - - - - -
240 Propanolol Hcl Tablet 40 mg Tablet - - - - -
241 Propanolol Hcl Tablet 10 mg Tablet 100 100 - 100 -
242 Propilturasil Tablet 100 mg Tablet - - - - -
243 Ranitidin Injeksi 25 mg / ml Ampul - - - - -
244 Ranitidin Tablet 150 mg Tablet 710 710 - 710 -
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 210 210 - 210 -
250 Salbutamol 2mg Tablet 100 100 - 100 -
251 Salbutamol Tablet 4 mg Tablet - - - -
252 Salbutamol solution for Inhalation single dose units 2,5 Ampul - - - - -
253 Salep 2-4 Kombinasi : Pot 48 48 - 48 -
254 Salisil bedak 2% -50 gr Kotak - - - - -
255 Salep Luka Bakar Tube - - - - -
256 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 84 84 - 84 -
257 Sefadroksil Tablet 500 mg Tablet - - - - -
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 800 800 - 800 -
264 Setirizin Sirup 5 mg / 5 ml Botol 20 20 - 20 -
265 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul - 200 200 - 200 -
266 Sianokobalamin Tablet 50 mcg Tablet 430 430 - 430 -
267 Silver Amalgam Serbuk 65-75% Botol - - - - -
268 Simetidin 200 mg Tablet Tablet - - - - -
269 Simvastatin Tablet 10 mg Tablet 775 775 - 775 -
270 Simvastatin Tablet 20 mg Tablet - - - - -
271 Siprofloksasin 500mg Tablet 670 670 - 670 -
272 Spironolakton Tablet 25 mg Tablet 350 350 - 350 -
273 Sulfacetamid Tetes Mata 15 %-5ml Botol - - - - -
274 Tablet Tambah Darah Kombinasi: Tablet 25,000 25,000 - 25,000 -
275 Temporary Stopping Fletcher (Fletcher) Serbuk &
Set - - - - -
Cairan
276 Trikesol formalin ( T K F ) Cairan 10 ml Botol - - - - -
277 Tetrasiklin Kapsul 250 mg Kapsul - - - - -
278 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
279 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - - - - -
280 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 1,130 500 1,630 - 1,630 -
281 Thiamfenikol Kapsul 500 mg Kapsul - - - - -
282 Tramadol Injeksi 50 mg/ ml Ampul - - - - -
283 Tramadol Tablet 50 mg Tablet - - - - -
284 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 26,735 26,735 - 26,735 -
285 Vitamin B .Komplek Tablet Tablet - - - - -
286 Vitamin Neurotropik Tablet Tablet 1,500 1,500 - 1,500 -
287 Zinc Sulfat 20 mg/5 ml Botol 55 55 - 55 -
288 Zinc Sulfat 20 mg Tablet 1,000 1,000 - 1,000 -
289 Hepatorotector tablet (Curcuma) Tablet - - - - -
290 Obat Batuk Herbal Botol - - - - -
291 Obat Kumur Botol - - - - -
292 Salep Kloramfenikol + Hidrokortison Tube - - - - -
293 Tablet Pemanis Botol - - - - -
294 Bahan Pembersih Kavitas Botol - - - - -
295 Flour Gel Botol - - - - -
296 Glass Lonomer Posterior set - - - - -
297 Hyposol 3% Botol - - - - -
298 Paramonochlorofenol/CHKM Botol - - - - -
299 Saliva Ejector Pcs - - - - -
300 Salep Betametason + Neomisin Tube - - - - -
301 Bahan Pemutih Gigi Pot - - - - -
302 Metronidazol Inj Ampul - - - - -
303 Box Slide Pcs - - - - -
304 Klozapine 100 mg Tablet 385 385 - 385 -
305 Klozapine 25mg Tablet 1,628 1,628 - 1,628 -
306 Mineral Mix Sachet - - - - -
307 Risperidon 2mg Tablet 2,710 2,710 - 2,710 -
308 Budensoid Cairan Inhalasi (Pulmicort) Respules - - - - -
309 Box Object Glass isi 50 Grey Orange Pcs - - - - -
310 Vitamin C 500mg Tablet 1,300 3,000 4,300 - 4,300 -
311 Multivitamin Tablet - - - - -
312 Poli Aid 1 Liter Botol - 10 10 - 10 -
313 Trifluoperazine Hcl Tablet 5 mg Tablet - - - - -
314 Divalproex Sodium 250mg Tablet 100 100 - 100 -
315 Calcetin Calcium Hydroxide Paste Botol - - - - -
316 Pilp-X Pot - - - - -
317 Karbogliserin Tetes Telinga Botol - - - - -
318 Larvasida Paket - - - - -
319 Kalsitrol Kapsul Lunak 0,5 mcg Kapsul 1,520 1,520 - 1,520 -
320 Vitamin D 1000IU Tablet 1,800 2,000 3,800 - 3,800 -
321 Hiosina Butilbromid 10MG Tablet 100 100 200 - 200 -
322 Larvasida Paket - 5 5 - 5 -
323 Malathione/Insektisida 500mg Botol - 1 1 - 1 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) - - - - -
1 Abbocath No 18 ( IV Chateter 18 ) Buah 50 50 100 - 100 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 60 60 - 60 -
3 Abbocath No 22 ( IV Chateter 22 ) Buah 50 50 100 - 100 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 20 20 - 20 -
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 5 ml Set 400 400 - 400 -
9 Alat Suntik Sekali Pakai 10 ml Set - - - - -
10 Alkohol Swab Kotak 8,900 8,900 - 8,900 -
11 Auto Disposable Syringe (ADS) 0,05 ml Set 300 300 - 300 -
12 Auto Disposable Syringe (ADS) 0,5 ml Set 1,600 1,600 - 1,600 -
13 Auto Disposable Syringe (ADS) 5 ml Set 1,000 1,000 - 1,000 -
14 Blood Set Set - - - - -
15 Catgut/Benang Bedah No.2/0 PLAIN Sachet 12 12 - 12 -
16 Catgut/Benang Bedah No.3/0 Cromic Sachet 20 20 -
17 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - - - - -
18 Etanol 70 % 1.000 ml Botol - - - - -
19 Eter Alkohol Botol - - - - -
20 Folley Catheter no 14 Set - - - - -
21 Folley Catheter no 16 Set - - - - -
22 Folley Catheter no 18 Set - - - - -
23 Infus set Anak Set - - - - -
24 Infus set Dewasa Set 45 45 - 45 -
25 Iodina Test Botol 40 40 - 40 -
26 Kaca Slide Pcs - - - - -
27 Kapas Berlemak 500 gram Bungkus - - - - -
28 Kapas Pembalut / Adsorbens 250 gram Bungkus - - - - -
29 Kassa Pembalut 2 m x 80 cm Rol 36 36 - 36 -
30 Kassa Pembalut Hidrofil 4 m x 3 cm Rol - - - - -
31 Kassa Pembalut Hidrofil 4 m x 15 cm Rol - - - - -
32 Kassa Hidrofil Steril 16 x 16 Kotak - - - - -
33 Kassa Kompres 40 x 40 steril Bungkus - - - - -
34 Kertas Puyer Bungkus - - - - -
35 Kertas Saring Lembar - - - - -
36 Kertas Lensa Lembar - - - - -
37 Lysol 1,000 ml Botol - - - - -
38 Masker Buah - - - - -
39 Masker Kain Headloop KEMKES Pcs - - - - -
40 Masker Kain Earloop KEMKES Pcs - - - - -
41 Masker N 96 Pcs 50 50 - 50 -
42 Masker KN95 Pcs - - - - -
43 Minyak Imersi Botol - - - - -
44 Plester Kertas Rol - - - - -
45 Polifix 5 cm x 5 m Rol 3 3 - 3 -
46 Pot Dahak Pcs 200 200 - 200 -
47 Rapid 2 HIV Fokus Test - - - - -
48 Rapid HIV 1+2KHB Test - - - - -
49 Rapid Test HIV 1/2 Vikia DS Test - - - - -
50 Rapid HIV 1 (SD HIV) Test - - - - -
51 Rapid HIV 2 (Intec HIV) Test - - - - -
52 Rapid HIV 2 (Biomeriux HIV) Test - - - - -
53 Rapid Tes SD Bioline HBSAG Test - - - - -
54 Hepatitis B Imunoglobulin inj 220 IU (Hbig) Vial - - - - -
55 Rapid Test Syphilis Test - - - - -
56 Reagen CD 4 Control Test - - - - -
57 Reagen CD 4 Test - - - - -
58 Reagen Ziehl Nielsen Botol - - - - -
59 RPR Test Syphilis Test - - - - -
60 Silk( Benang Bedah Sutra ) No 3/0 Sachet 12 12 - 12 -
61 Safety Box Pcs 190 190 - 190 -
62 Sarung tangan Steril No 6 Pcs - - - - -
63 Sarung tangan Steril No 7 Pcs - - - - -
64 Sarung tangan Steril No 7,5 Pcs - - - - -
65 Sarung tangan Non Steril S Pcs 1,200 1,200 - 1,200 -
66 Sarung tangan Non Steril M Pcs - - - - -
67 Sarung tangan Non Steril L Pcs - - - - -
68 Sountimer Buah 1 1 - 1 -
69 Stik Pemeriksaan Gula Darah Test 14,000 14,000 - 14,000 -
70 Stik Pemeriksaan Kolesterol Test - - - - -
71 Stik Pemeriksaan Asam Urat Test - - - - -
72 Supratul Lembar - - - - -
73 Urine Bag set - - - - -
74 Wing Neddle No 23 Set - - - - -
75 Blood Lancet Pcs 18,700 18,700 - 18,700 -
76 Cairan Antiseptik Botol 500 ml Botol - - - - -
77 Rapin HIV Oncoprobe Test - - - - -
78 Steryzime Dual Enzymatis 5 Lt Galon - - - - -
79 Sterald 30 High Level Surface Desinfektan 5Lt Galon - - - - -
80 Gentamisin Sulfat Tetes Mata 0,3% Botol - - - - -
81 Bioplacenton Tulle 10 x 10 Lembar - - - - -
82 Vikia Biumeric Test - - - - -
83 Sterald Galon - - - - -
84 Hepatitis B Imunolobin syringe - - - - -
85 Slide - - - - -
86 IV Catheter 20 Pcs - - - - -
87 Stericide 3 Surface Desinfektan 5Lt Galon - - - - -
88 Serum Tetagam P Injeksi PFS - - - - -
89 Biosave Serum ABU Injeksi Vial - - - - -
90 Baju APD (COVER ALL) Pcs - - - - -
91 Sepatu Boot Saffety Pcs - - - - -
92 Kacatamata Google Pcs - - - - -
93 Sarung Tangan Karet Latex Pcs - - - - -
94 Rapid Test Kit Covid-19 Test - - - - -
95 VTM & Swab Dacron Citodia Pcs - - - - -
96 VTM + Swab (KH Medial) Test - - - - -
 97 Panbio Covid-19 Antigen Test - - - - -
98 ADS 0,5 ml Alokasi Pcs - - - - -
99 Alkohol Swab Alokasi Pcs 10,000 10,000 - 10,000 -
100 Safety Box Alokasi Pcs - - - - -
101 Parafilm Pcs - - - - -
102 Vaccum Tube Sterile EDTA K-3 (3ml Pcs - - - - -
103 Vaccum Tube Sterile Clot Activator(3ml Pcs - - - - -
104 Umbilical Cord Klem Steril Nylon Pcs 50 50 - 50 -
105 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 Tetanus (ATS) Injeksi 1.500 IU/ampul Ampul - - - - -
4 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul Vial - - - - -
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 Vaksin Campak Bias Vial - - - - -
19 Vaksin Covid-19 (10 d0sis) Vial - - - - -
20 - - - - -

BPJS
UMUM JAMKES ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR

684 3443 27 4154

Mengetahui / Menyetujui: Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi & Perbekalan Kepala UPTD Puskesmas Maleber Petugas UPTD Puskesmas Ma
Kabupaten Kuningan Kabupaten Kuningan

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

………………………………….. ..........................……………………… NIP. 19771215 199804 2 001 SIPA : 503/KPTS.54 - SIPA/XI/
NIP NIP.

KETERANGAN:
Lembar Putih : Gudang Farmasi & Perbekalan
Lembar Biru : Dinas Kesehatan Kabupaten
Lembar Kuning : UPTD Puskesmas
FORM : LPLPO

TANGGAL

Jumlah

LAIN-LAIN
PTD Puskesmas Maleber

A JULLYAN.S.Farm
/KPTS.54 - SIPA/XI/2018
 STOK
AKHIR
Abbocath No 20 ( IV Chateter 20 ) Buah 50 - 50 20 30 40
Alat Suntik Sekali Pakai 5 ml Set 480 - 480 - 480 -
Alkohol Swab Kotak 9,900 - 9,900 500 9,400 1,000
Set
Auto Disposable Syringe (ADS) 0,05 ml 300 - 300 - 300 -
Set
Auto Disposable Syringe (ADS) 0,5 ml 2,000 - 2,000 100 1,900 200
Auto Disposable Syringe (ADS) 5 ml Set 1,000 - 1,000 - 1,000 -
Infus set Dewasa Set 100 - 100 - 100 -
Kassa Pembalut 2 m x 80 cm Rol 50 - 50 - 50 -
Masker N 96 Pcs 50 - 50 - 50 -
Polifix 5 cm x 5 m Rol 5 - 5 - 5 -
Pot Dahak Pcs 600 - 600 - 600 -
Safety Box Pcs 212 - 212 - 212 -
Sarung tangan Non Steril S Pcs 400 - 400 300 100 600
Sarung tangan Non Steril M Pcs 300 - 300 100 200 200
Stik Pemeriksaan Gula Darah Test 5,035 - 5,035 - 5,035 -
Urine Bag set 20 - 20 - 20 -
Blood Lancet Pcs 10,830 - 10,830 930 9,900 1,860
Cairan Antiseptik Botol 500 ml Botol 5 - 5 4 1 8
Umbilical Cord Klem Steril Nylon Pcs 50 - 50 - 50 -
Vaksin BCG Ampul 2 - 2 - 2 -
Vaksin HB Uniject Pcs 21 - 21 - 21 -
Vaksin MR (VVM.A) Vial 3 - 3 - 3 -
Vaksin Polio IPV 5 Dosis Vial 5 - 5 - 5 -
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) 2023 FORM : LPLPO
PUSKESMAS MALEBER

PUSKESMAS : MALEBER DOKUMEN NOMOR TANGGAL

KECAMATAN : MALEBER DINKES KABUPATEN
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : JANUARI/2023 UPTD GFK
PROVINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : FEBRUARI/2023 UPTD PUSKESMAS 442.7/ /PKM-MLBR/2023

PEMBERIAN
Jumlah
NO NAMA SEDIAAN SATUAN STOK
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN
OPT.
PKD ASKES APBD I APBD II PROGRAM LAIN-LAIN
A. OBAT
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
5 Alopurinol Tablet 300 mg Tablet
6 Alprazolam tablet 1 mg Tablet
7 Ambroksol Tablet 30 mg Tablet
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
12 Amlodipin Tablet 5 mg Tablet
13 Amlodipin Tablet 10 mg Tablet
14 Amoksisillin Kapsul 250 mg Kapsul
15 Amoksisillin Kaplet 500 mg Kaplet
16 Amoksisillin Serbuk Injeksi 1000 mg vial
17 Amoksisillin Sirup Kering 125 mg/5ml Botol
18 Amoksisillin Double Strengh Sirup Kering 250 mg/5 ml
Botol

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 Hidroksida 200 mg/5 Botol
ml
25
Antasida Doen Tablet, Kombinasi : Magnesium
Tablet
Hidroksida 200 mg+ Alumunium Hidroksida 200 mg

26 Antasida Plus Tablet Tablet

27 Antalgin (Metampiron) Tablet 500 mg Tablet
28 Antalgin Injeksi 250 mg/ml-2ml Ampul
29 Anti Bakteri DOEN Salep Kombinasi : Tube
30 Anti Hemoroid Doen komb Supp
31 Anti Fungi DOEN Kombinasi : Pot
32 Antimigren DOEN Kombinasi : Tablet
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
44 Acetylsistein tablet Tablet
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 1 Liter Vial
54 Bahan Tambal Sementara Set
55 Benzatin Benzil Penisilin injeksi Vial
56 Betahistin Mesilat 6 mg Tablet
57 Betametason Krim 0,1 %- 5g Tube
58 Bisakodil suppositoria 10 mg Supp
59 Bisoprolol Tablet 2,5 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
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 Digoksin Tablet 0,25 mg Tablet
74 Dimenhidrinat Tablet 50 mg Tablet
75 Domperidon Tablet 10 mg Tablet
76 Donperidon Suspensi 5 mg/5ml Botol
77 Efedrin Hcl Tablet 25 mg Tablet
78 Ekstrak Belladone Tablet 10 mg Tablet
79 Epinefrin HCl / Bitartrat Ampul
 80 Eritromisin Kapsul 250 mg Kapsul
81 Eritromisin Kapsul 500 mg Kapsul
82 Eritromisin Sirup 200 mg / 5 ml Botol
83 Etambutol Tablet 500 mg Tablet
84 Etanol 70 % 100 ml Botol
85 Etil Klorida Semprot -100 ml Botol
86 Eugenol Cairan -10 ml Botol
87 Fenitoin Natrium Kapsul 100 mg Kapsul
88 Fenobarbital tablet 30 mg Tablet
89 Fenobarbital injeksi 50 mg / ml Ampul
90 Fenoksimeti Penisilin 250 mg tablet Tablet
91 Fenoksimeti Penisilin 500 mg tablet Tablet
92 Fenol Gliserol TK Botol
93 Flufenazine decanoat injeksi 25 mg/ml Ampul
94 Flukonazole tablet 150 mg Tablet
95 Fitomenadion tablet 10 mg Tablet
96 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul
97 Furosemid Tablet 40 mg Tablet
98 Furosemid injeksi Ampul
99 Garam Oralit I serbuk, kombinasi :
( Nacl 0,52 gr, Kalium Klorida 0,30 gr,
Kantong
Trinatrium Sitrat dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air
100 Gemfibrozil Tablet 600 mg Tablet
101 Gentian Violet Botol
102 Gentamisin injeksi 80 mg / 2 ml Vial
103 Gentamisin Salep Kulit 0,1 % Tube
104 Glass Ionomer Set
105 Glibenklamid Tablet 5 mg Tablet
106 Glimepiride 2 mg Tablet
107 Gliseril Guayakolat Tablet 100 mg Tablet
108 Gliseril Guayakolat sirup Botol
109 Glukonas Kalsikus injeksi Ampul
110 Glukosa Larutan Infus 5 % Botol
111 Glukosa Larutan Infus10 % Botol
112 Griseofulvin Tablet 125 mg,micronized Tablet
113 Haloperidol Tablet 0,5 mg Tablet
114 Haloperidol Tablet 1,5 mg Tablet
115 Haloperidol Tablet 5 mg Tablet
116 Haloperidol injeksi 5 mg/ml Ampul
117 Haloperidol injeksi 50 mg/ml Ampul
118 Hidroklortiazid (HCT) Tablet 25 mg Tablet
119 Hidrokortison Krim 2,5 % Tube
120 Ibuprofen Tablet 200 mg Tablet
121 Ibuprofen Tablet 400 mg Tablet
122 Ibuprofen Suspensi 100 mg/5 ml Botol
123 Ichtyol salep Kulit Pot
124 Isoniazid tablet 100 mg Tablet
125 Isoniazid tablet 300 mg Tablet
126 Isosorbid Dinitrat 5 mg Tablet
127 Kalium Diklofenak Tablet 25 mg Tablet
128 Kalium Diklofenak Tablet 50 mg Tablet
129 Kalsium Hidroksida Pasta Tube
130 Kalsium Laktat Tablet 500 mg Tablet
131 Kaptopril 12,5 mg Tablet
132 Kaptopril 25 mg Tablet
133 Karbamazepin Tablet 200 mg Tablet
134 Ketokonazole Krim 2 % - 15 gr Tube
135 Ketokonazole Tablet 200 mg Tablet
136 Ketoprofen Tablet 100 mg Tablet
137 Ketoprofen Injeksi 100 mg / 1 ml Ampul
138 Ketorolac 10 mg injeksi Ampul
139 Ketorolac 30 mg injeksi Ampul
140 Klindamisin Kapsul 150 mg Kapsul
141 Klindamisin Kapsul 300 mg Kapsul
142 Kloramfenikol Kapsul 250 mg Kapsul
143 Kloramfenikol suspensi125mg/5 ml Botol
144 Kloramfenikol Salep Mata 1%-3,5 g Tube
145 Kloramfenikol Salep Kulit 2% Tube
146 Kloramfenikol Tetes Mata -5 ml Botol
147 Kloramfenikol Tetes Telinga 3%-5 ml Botol
148 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet
149 Klorpromazin Hcl Tablet Salut 25 mg Tablet
150 Klorpromazin Hcl Tablet Salut 100 mg Tablet
151 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul
152 Kombinasi Ipatropium Bromide + Salbutamol
Vial
Sulphate for inhalation 2,5 ml
153 Kombipak Cefixime+ Azithromisin Kotak
154 Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
155 Kotrimoksazol Tablet, Kombinasi : Tablet
156
Kotrimoksazol Suspensi Kombinasi :
Botol
Sulfametoksazol 200 mg + Trimetroprim 40 mg/5 ml

157 Lansoprazole 30 mg Kapsul Tablet

158 Larutan mengadung Elektrolit Botol
159 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr)
160 Larutan mengadung Elektrolit
Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr)
161 Larutan mengadung Karbohidrat + Elektrolit Botol
162 Lidokain injeksi 2 % Tablet
163 Lidokain Komp Injeksi, Kombinasi : Ampul
164 Lidokain Spray Botol
165 Loperamid Tablet 2 mg Tablet
166 Loratadin tablet 10 mg Tablet
167 Magnesium Sulfat (IV) 20 %-25 ml Ampul
168 Magnesium Sulfat (IV) 40 %-25 ml Ampul
169 MB Anak Blister
170 MB Dewasa Blister
171 Meloksikam tablet 15 mg Tablet
172 Meloksikam Suppositoria Supp
173 Metformin Hcl Tablet 500 mg Tablet
174 Metformin 850 mg Tablet
175 Metildopa 250 mg tablet Tablet
176 Methisoprinol 500 mg Tablet
177
Metilergometrin Maleat (Metergin) Tablet 0,125 mg Tablet

178 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul

179 Metilprednisolon tablet 4 mg Tablet
180 Metoklopramid 10 mg Tablet
181 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul
182 Metronidazol Tablet 250 mg Tablet
183 Metronidazole Tablet 500 mg Tablet
184 Metronidazole sirup 125 mg/ml Botol
185 Metronidazole Infus 500 mg /100 ml Ampul
186 Metronidazole Infus 500mg/100ml Botol
187 Mikonazole KrIm 2 % - 10 gr Tube
188 Multivitamin + Mineral tablet Tablet
189 Multivitamin sirup Botol
190 Mummifying Pasta Botol
191 Natrium Bikarbonat Tablet 500 mg Tablet
192 Natrum Diklofenak Tablet 25 mg Tablet
193 Natrium Diklofenak Tablet 50 mg Tablet
194 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol
195 Nipedifin Tablet 10 mg Tablet
196 Nistatin suspensi 100.000 IU/ml Botol
197 Nistatin 100.000 IU/gram Tablet Vagina
198 Nistatin 500.000 IU/gram Tablet Salut Tablet
199 Obat Antitiuberkolosis Kategori Anak Paket
200 Obat Antitiuberkolosis Kategori 1 Dewasa Paket
201 Obat Antitiuberkolosis Kategori 2 Dewasa Paket
202 Obat Antitiuberkolosis Kategori 2 Dewasa Paket
203 Obat Anti Tuberkulosis FDC Kat Anak Paket
204 Obat Anti Tuberkulosis FDC Kat I & II Paket
205 Obat Anti Tuberkulosis FDC Kat I & III Paket
206 Obat Anti Tuberkulosis FDC Kat I & III Paket
207 Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket
208 Obat Batuk Hitam (OBH) Cairan 100 ml Botol
209 Obat Batuk Cair Sirup (Ekspektoran) Botol
210 Obat Batuk Hitam Plus Sirup Botol
211 Obat Flu Sirup Botol
212 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
213 Oksiterasiklin Salep Mata 1%-3,5g Tube
214 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube
215 Oksitosin Injeksi 10 IU/ml-1ml Ampul
216 Omeprazole injeksi 40mg/10ml Ampul
217 Omeprazole Kapsul 20 mg Kapsul
218 Ondansetron inj 4 mg/ 2 mL Ampul
219
Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol

220 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol

221 Parasetamol Sirup 120 mg/5ml-60 ml Botol
222 Parasetamol Tablet 100 mg Tablet
223 Parasetamol Tablet 500 mg Tablet
224 PB Anak Blister
225 PB Dewasa Blister
226 Pehacain injeksi Ampul
227 Perak Sulfadiazin krim 1 % 35 gr Tube
228 Permetrin krim 5 % Tube
229 Piracetam Tablet 400 mg Tablet
230 Piracetam Tablet 800 mg Tablet
231 Piroksikam Tablet 20 mg Tablet
232 Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg Ba Tablet
233 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet
234 Piridoksin Hcl (Vit.B6) Tablet 25 mg Tablet
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 Propanolol Hcl Tablet 10 mg Tablet
243 Propilturasil Tablet 100 mg Tablet
244 Ranitidin Injeksi 25 mg / ml Ampul
245 Ranitidin Tablet 150 mg Tablet
246 Retinol (Vit. A) 100.000 IU Kapsul Kapsul
247 Retinol (Vit. A) 200.000 IU Kapsul Kapsul
248 Reserpin Tablet 0, 25 mg Tablet
249 Rifampisin Tablet 450 mg Tablet
250 Ringer Laktat Larutan Infus Steril 500 ml Botol
251 Salbutamol 2mg Tablet
252 Salbutamol Tablet 4 mg Tablet
253 Salbutamol solution for Inhalation single dose units 2,5 Ampul
254 Salep 2-4 Kombinasi :
Asam Salisilat 2 % + Belerang Endap 4 % - Pot
30 gram
255 Salisil bedak 2% -50 gr Kotak
256 Salep Luka Bakar Tube
257 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol
258 Sefadroksil Tablet 500 mg Tablet
259 Sefiksim Kapsul 100 mg Kapsul
260 Sefiksim 400 mg + Azitromisin 1000 mg Paket
261 Sefotaksim Injeksi 1 gr Ampul
262 Seftriakson Injeksi 1 gr / vial Ampul
263 Semen Seng Fosfat Serbuk & Cairan Botol
264 Setirizin Tablet 10 mg Tablet
265 Setirizin Sirup 5 mg / 5 ml Botol
266 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul
267 Sianokobalamin Tablet 50 mcg Tablet
268 Silver Amalgam Serbuk 65-75% Botol
269 Simetidin 200 mg Tablet Tablet
270 Simvastatin Tablet 10 mg Tablet
271 Simvastatin Tablet 20 mg Tablet
272 Siprofloksasin 500mg Tablet
273 Spironolakton Tablet 25 mg Tablet
274 Sulfacetamid Tetes Mata 15 %-5ml Botol
275 Tablet Tambah Darah Kombinasi:
Tablet
Besi II Sulfat 200 mg + Asam Folat 0,25 mg
276 Temporary Stopping Fletcher (Fletcher) Serbuk &
Set
Cairan
277 Trikesol formalin ( T K F ) Cairan 10 ml Botol
278 Tetrasiklin Kapsul 250 mg Kapsul
279 Tetrasiklin Kapsul 500 mg Kapsul
280 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul
281 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet
282 Thiamfenikol Kapsul 500 mg Kapsul
283 Tramadol Injeksi 50 mg/ ml Ampul
284 Tramadol Tablet 50 mg Tablet
285 Triheksifenidil Hidroklorida Tablet 2 mg Tablet
286 Vitamin B .Komplek Tablet Tablet
287 Vitamin Neurotropik Tablet Tablet
288 Zinc Sulfat 20 mg/5 ml Botol
289 Zinc Sulfat 20 mg Tablet
290 Hepatorotector tablet (Curcuma) Tablet
291 Obat Batuk Herbal Botol
292 Obat Kumur Botol
293 Salep Kloramfenikol + Hidrokortison Tube
294 Tablet Pemanis Botol
295 Bahan Pembersih Kavitas Botol
296 Flour Gel Botol
297 Glass Lonomer Posterior set
298 Hyposol 3% Botol
299 Paramonochlorofenol/CHKM Botol
300 Saliva Ejector Pcs
301 Salep Betametason + Neomisin Tube
302 Bahan Pemutih Gigi Pot
303 Metronidazol Inj Ampul
304 Box Slide Pcs
305 Klozapine 100 mg Tablet
306 Klozapine 25mg Tablet
307 Mineral Mix Sachet
308 Risperidon 2mg Tablet
309 Budensoid Cairan Inhalasi (Pulmicort) Respules
310 Box Object Glass isi 50 Grey Orange Pcs
311 Vitamin C 500mg Tablet
312 Multivitamin Tablet
313 Poli Aid 1 Liter Botol
314 Trifluoperazine Hcl Tablet 5 mg Tablet
315 Divalproex Sodium 250mg Tablet
316 Calcetin Calcium Hydroxide Paste Botol
317 Pilp-X Pot
318 Karbogliserin Tetes Telinga Botol
319 Larvasida Paket
320 Kalsitrol Kapsul Lunak 0,5 mcg Kapsul
321 Vitamin D 1000IU Tablet

1 B. BAHAN MEDIS HABIS PAKAI (BMHP)

2 Abbocath No 18 ( IV Chateter 18 ) Buah
3 Abbocath No 20 ( IV Chateter 20 ) Buah
4 Abbocath No 22 ( IV Chateter 22 ) Buah
5 Abbocath No 24 ( IV Chateter 24 ) Buah
6 Alat Gula, Kolesterol, Asam Urat Unit
7 Alat Suntik Sekali Pakai 1 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
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
16 Catgut/Benang Bedah No.3/0 Cromic Sachet
17 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol
18 Etanol 70 % 1.000 ml Botol
19 Eter Alkohol Botol
20 Folley Catheter no 14 Set
21 Folley Catheter no 16 Set
22 Folley Catheter no 18 Set
23 Infus set Anak Set
24 Infus set Dewasa Set
25 Iodina Test Botol
26 Kaca Slide Pcs
27 Kapas Berlemak 500 gram Bungkus
28 Kapas Pembalut / Adsorbens 250 gram Bungkus
29 Kassa Pembalut 2 m x 80 cm Rol
30 Kassa Pembalut Hidrofil 4 m x 3 cm Rol
31 Kassa Pembalut Hidrofil 4 m x 15 cm Rol
32 Kassa Hidrofil Steril 16 x 16 Kotak
33 Kassa Kompres 40 x 40 steril Bungkus
34 Kertas Puyer Bungkus
35 Kertas Saring Lembar
36 Kertas Lensa Lembar
37 Lysol 1,000 ml Botol
38 Masker Buah
39 Masker Kain Headloop KEMKES Pcs
40 Masker Kain Earloop KEMKES Pcs
41 Masker N 96 Pcs
42 Masker KN95 Pcs
43 Minyak Imersi Botol
44 Plester Kertas Rol
45 Polifix 5 cm x 5 m Rol
46 Pot Dahak Pcs
47 Rapid 2 HIV Fokus Test
48 Rapid HIV 1+2KHB Test
49 Rapid Test HIV 1/2 Vikia DS Test
50 Rapid HIV 1 (SD HIV) Test
51 Rapid HIV 2 (Intec HIV) Test
52 Rapid HIV 2 (Biomeriux HIV) Test
53 Rapid Tes SD Bioline HBSAG Test
54 Hepatitis B Imunoglobulin inj 220 IU (Hbig) Vial
55 Rapid Test Syphilis Test
56 Reagen CD 4 Control Test
57 Reagen CD 4 Test
58 Reagen Ziehl Nielsen Botol
59 RPR Test Syphilis Test
60 Silk( Benang Bedah Sutra ) No 3/0 Sachet
61 Safety Box Pcs
62 Sarung tangan Steril No 6 Pcs
63 Sarung tangan Steril No 7 Pcs
64 Sarung tangan Steril No 7,5 Pcs
65 Sarung tangan Non Steril S Pcs
66 Sarung tangan Non Steril M Pcs
67 Sarung tangan Non Steril L Pcs
68 Sountimer Buah
69 Stik Pemeriksaan Gula Darah Test
70 Stik Pemeriksaan Kolesterol Test
71 Stik Pemeriksaan Asam Urat Test
72 Supratul Lembar
73 Urine Bag set
74 Wing Neddle No 23 Set
75 Blood Lancet Pcs
76 Cairan Antiseptik Botol 500 ml Botol
77 Rapin HIV Oncoprobe Test
78 Steryzime Dual Enzymatis 5 Lt Galon
79 Sterald 30 High Level Surface Desinfektan 5Lt Galon
80 Gentamisin Sulfat Tetes Mata 0,3% Botol
81 Bioplacenton Tulle 10 x 10 Lembar
82 Vikia Biumeric Test
83 Sterald Galon
84 Hepatitis B Imunolobin syringe
85 Slide
 86 IV Catheter 20 Pcs
87 Stericide 3 Surface Desinfektan 5Lt Galon
88 Serum Tetagam P Injeksi PFS
89 Biosave Serum ABU Injeksi Vial
90 Baju APD (COVER ALL) Pcs
91 Sepatu Boot Saffety Pcs
92 Kacatamata Google Pcs
93 Sarung Tangan Karet Latex Pcs
94 Rapid Test Kit Covid-19 Test
95 VTM & Swab Dacron Citodia Pcs
96 VTM + Swab (KH Medial) Test
97 Panbio Covid-19 Antigen Test
98 ADS 0,5 ml Alokasi Pcs
99 Alkohol Swab Alokasi Pcs
100 Safety Box Alokasi Pcs
101 Parafilm Pcs
102 Vaccum Tube Sterile EDTA K-3 (3ml Pcs
103 Vaccum Tube Sterile Clot Activator(3ml Pcs
104 Umbilical Cord Klem Steril Nylon Pcs
1 C. SERUM DAN VAKSIN
2 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I )
Vial

3 Serum Anti Rabies untuk manusia Vial

4 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul Ampul
5 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul Vial
6 Human Tetanus Imunoglobin inj 250 IU Vial
7 Vaksin BCG Ampul
8 Vaksin Campak 10 Dosis Vial
9 Vaksin DT Vial
10 Vaksin TD Vial
11 Vaksin DTP-HB Vial
12 Vaksin DPT-HB/Hib Vial
13 Vaksin HB Uniject Pcs
14 Vaksin MR (VVM.A) Vial
15 Vaksin Polio Vial
16 Vaksin Polio IPV 5 Dosis Vial
17 Vaksin Polio 10 IPV Dosis Vial
18 Vaksin TT Vial
19 Vaksin Campak Bias Vial
20 Vaksin Covid-19 (10 d0sis) Vial

BPJS
UMUM JAMKES ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR

684 3443 27 4154

Mengetahui / Menyetujui: Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi & Perbekalan Kepala UPTD Puskesmas Maleber Petugas UPTD Puskesmas Maleber
Kabupaten Kuningan Kabupaten Kuningan

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

………………………………….. ..........................……………………… NIP. 19771215 199804 2 001 SIPA : 503/KPTS.54 - SIPA/XI/2018
NIP NIP.

KETERANGAN:
Lembar Putih : Gudang Farmasi & Perbekalan
Lembar Biru : Dinas Kesehatan Kabupaten
Lembar Kuning : UPTD Puskesmas