BERITA ACARA STOK OPNAME PERSEDIAAN FARMASI PER 31 DESEMBER 2022

Nomor : 442/1710

Pada hari ini Sabtu tanggal tiga puluh satu bulan Desember tahun Dua ribu dua puluh tiga, yang
bertanda tangan dibawah ini :

Nama : Suwarno, S. Kep.Ns

NIP : 197110712 199203 1 012
Jabatan : Kepala UPTD Puskesmas Bojongsari Kab.Purbalingga

Sesuai dengan jabatan dan kewenangannya sebagai Kepala UPTD Puskesmas Bojongsari telah
melakukan pemeriksaan fisik persediaan obat yang dikelola oleh :

Nama : apt. Grah Retno Cahyaningrum,S.Farm.

NIP : 19930111 202012 2 011
Jabatan : Pengelola Obat UPTD Puskesmas Bojongsari Kab. Purbalingga

Berdasarkan hasil pelaksanaan stok opname persedian farmasi diperoleh saldo persediaan per 31
Desember 2022 pada UPTD Puskesmas Bojongsari senilai Rp 363.743.220,50 (Tiga Ratus enam
puluh tiga juta tujuh ratus empat puluh tiga ribu dua ratus dua puluh koma lima puluh rupiah) dengan
rincian sebagai berikut :

No. Nama Barang Nilai Keterangan

1 Obat-Obatan 239,471,922.50 Rincian Terlampir
2 Obat lainnya 31,923,905.00 Rincian Terlampir
3 Bahan lainnya 92,347,393.00 Rincian Terlampir
Total 363,743,220.50 Rincian Terlampir

Demikian Berita Acara Persediaan ini dibuat untuk dapat diketahui dan dipergunakan sebagaimana
mestinya.

Purbalingga, 31 Desember 2022

Petugas Pengelola Obat Kepala UPTD Puskesmas Bojongsari
UPTD Puskesmas Bojongsari

apt. Grah Retno Cahyaningrum, S.Farm Suwarno, S. Kep.Ns

NIP. 19930111 202012 2 011 NIP. 19710712 199203 1 012
 STOK OPNAME OBAT TAHUN 2022
PUSKESMAS : UPTD PUSKESMAS BOJONGSARI

SISA STOK
NO NAMA OBAT SATUAN DKK PS
Jumlah DKK+PS Tot Harga DKK+PS
Jumlah Harga Total Harga Jumlah Harga Total Harga

2 Acyclovir 400 mg tablet Tablet 764 407 310,948 0 0 764 310,948

3 Albendazol 400 mg Tablet 112 380 42,560 0 0 112 42,560
4 Alopurinol 100mg Tablet 1,197 90 107,730 0 0 1,197 107,730
5 Ambroxol Tablet 0 0 11,123 104.00 1,156,792 11,123 1,156,792
7 Aminofilin 200 mg Tablet 0 0 2,055 269.00 552,795 2,055 552,795
8 Amitriptilin HCl 25 mg Tablet 65 167 10,855 0 0 65 10,855
9 Amlodipin 10mg Tablet 11,282 70 789,740 0 0 11,282 789,740
11 Amoksisilin 500 mg Caplet 33,169 201 6,666,969 0 0 33,169 6,666,969
12 Amoksisilin Srp Krng 125mg/5ml @ 6 Botol 484 4,269.00 2,066,196 0 0 484 2,066,196
18 Antasida Doen tab. Tablet 0 0 19,333 111.00 2,145,963 19,333 2,145,963
19 Antasida sirop Botol 0 0 226 2611.00 590,086 226 590,086
21 As. Mefenamat 500 mg Kapsul 17,585 111 1,951,935 0 0 17,585 1,951,935
22 Asam Askorbat (Vit.C) tab.50 mg Tablet 0 0 29,355 135.00 3,962,925 29,355 3,962,925
23 Asam folat 1mg Tablet 0 0 12,840 56.00 719,040 12,840 719,040
24 Asetosal 100 mg Tablet 0 0 649 540.00 350,460 649 350,460
26 Bekarbon (Norit) Tablet 200 465 93,000 0 0 200 93,000
27 Betahistin mesilat 6mg Tablet 0 0 1,856 302.00 560,512 1,856 560,512
31 Captopril 25 mg (A) Tablet 2,030 75 152,250 0 0 2,030 152,250
33 Cefadroxil 500 mg Tablet 6,541 759 4,964,619 0 0 6,541 4,964,619
37 Citerizine 10mg Tablet 3,757 83 311,831 0 0 3,757 311,831
39 Clozapine 25mg Tablet 0 0 725 1154.00 836,650 725 836,650
40 Cyprofloxacin 500 mg Tablet 0 0 1,347 434.00 584,598 1,347 584,598
41 Deksametason tab.0,5 mg Tablet 0 0 20,671 106.00 2,191,126 20,671 2,191,126
44 Diazepam tab. 2mg Tablet 129 86 11,094 0 0 129 11,094
46 Digoxin 0,25mg Tablet 4,818 125 602,250 0 0 4,818 602,250
47 Dimenhydrinat 50mg Tablet 4,431 108 478,548 0 0 4,431 478,548
48 Doksisiklin 100 mg Kapsul 10 269 2,690 0 0 10 2,690
49 Donperidon 10mg Tablet 0 0 1,227 210.00 257,670 1,227 257,670
50 Donperidon 5mg/5ml suspensi Botol 86 2,296 197,456 0 0 86 197,456
52 Ergotamin cofein Tablet 60 185 11,100 0 0 60 11,100
55 Erytromicyn sirup Botol 0 0 26 12210.00 317,460 26 317,460
56 Erytromycin 500 mg Capsul 2,280 775 1,767,000 0 0 2,280 1,767,000
59 Fenobarbital 30mg Tablet 50 171 8,550 0 0 50 8,550
63 Fitomenadion Vit K 1 tab.10 mg Tablet 1,017 748 760,716 0 0 1,017 760,716
64 Furosemid tab.40 mg Tablet 0 0 1,627 246.00 400,242 1,627 400,242
65 Garam Oralit 200 ml air Bungkus 1,709 257 439,213 0 0 1,709 439,213
67 Glibenklamid tab. 5 mg Tablet 190 83 15,770 0 0 190 15,770
68 Gliseril Guaiakolat tab.100 mg Tablet 0 0 15,566 97.00 1,509,902 15,566 1,509,902
71 Haloperidol 5 mg Tablet 1,074 54 57,996 0 0 1,074 57,996
72 Hemorogad Kapsul 0 0 176 1358.00 239,008 176 239,008
74 Hidroklorotiazid (HCT) tab. 25mg Tablet 312 148 46,176 0 0 312 46,176
76 Ibuprofen tab.400 mg Tablet 0 0 8,579 346.00 2,968,334 8,579 2,968,334
77 Iburofen suspensi 100mg/5ml @ 60 Botol 0 0 90 3720.00 334,800 90 334,800
78 Iburofen suspensi 200mg/5ml @ 60 mBotol 30 3,200 96,000 0 0 30 96,000
81 Isorbid Dinitrat 5mg Tablet 0 0 195 167.00 32,565 195 32,565
83 Kalsium Laktat (Kalk) tab.500 mg (A) Tablet 35,744 138 4,932,672 0 0 35,744 4,932,672
86 Ketokonasol 200mg Tablet 1,427 252 359,604 0 0 1,427 359,604
88 Klindamicyn 300 mg Kapsul 0 0 772 1067.00 823,724 772 823,724
89 Kloramfenikol kap.250 mg Kapsul 90 550 49,500 0 0 90 49,500
90 Kloramphenikol suspensi 125mg/5ml Botol 26 2,100 54,600 0 0 26 54,600
91 Klorfeneramin Maleat(CTM) 4 mg (A) Tablet 0 0 36,280 81.00 2,938,680 36,280 2,938,680
94 Klorpromazin HCl 100mg tab. salut Tablet 0 0 1,777 260.00 462,020 1,777 462,020
96 Kotrimoksazol Suspensi Botol 0 0 48 3078.00 147,744 48 147,744
97 Kotrimoksazol tab. Dws 480mg Tablet 2,367 70 165,690 0 0 2,367 165,690
102 Loratadin 10mg Tablet 0 0 1,078 141.00 151,998 1,078 151,998
105 Metformin 500mg Tablet 3,779 220 831,380 0 0 3,779 831,380
106 Metil Prednisolon 4mg Tablet 0 0 14,278 169.00 2,412,982 14,278 2,412,982
107 Metilergometrin Maleat 0,125 mg Tablet 710 214 151,940 0 0 710 151,940
111 Metronidazol 500 mg Tablet 0 0 2,090 212.00 443,080 2,090 443,080
113 Na diklofenak 50 mg Tablet 0 0 4,003 182.00 728,546 4,003 728,546
114 Natrium Bicarbonat Tablet 3,901 66 257,466 0 0 3,901 257,466
116 Neo Diaform/Stopdiar Tablet 9,693 275 2,665,575 0 0 9,693 2,665,575
117 Nifedipin 10mg Tablet 0 0 1,036 223.00 231,028 1,036 231,028
122 Obat Anti TBC Kat I (FDC) paket 1 416,969 416,969 0 0 1 416,969
126 Obat Batuk Hitam (OBH) cairan Botol 0 0 301 4943.00 1,487,843 301 1,487,843
129 Omepazole 20 mg Kapsul 5,895 368 2,169,360 0 0 5,895 2,169,360
134 Parasetamol sirup 120 mg/5 ml (A) Botol 515 1,160 597,400 0 0 515 597,400
136 Parasetamol 500mg (A) Tablet 0 0 25,751 153.00 3,939,903 25,751 3,939,903
142 Piridoksin Hcl.(Vit B6) 10 mg Tablet 21,654 224 4,850,496 0 0 21,654 4,850,496
144 Prednison tab.5 mg (A) @ 100 Tablet 8,235 73 601,155 0 0 8,235 601,155
148 PTU 100mg Tablet 0 0 1,771 496.00 878,416 1,771 878,416
151 Ranitidin 150mg Tablet 0 0 5,042 188.00 947,896 5,042 947,896
153 Retinol (Vit.A) 100.000 UI tab. Kapsul 100 305 30,500 0 0 100 30,500
154 Retinol (Vit.A) 200.000 UI tab. Kapsul 100 553 55,300 0 0 100 55,300
157 Risperidone 2 mg Tablet 1,305 287 374,535 0 0 1,305 374,535
159 Salbutamol 4 mg Tablet 0 0 2,365 181.00 428,065 2,365 428,065
160 Sianocobalamin 50 mg/Vit B12 (A) @1 Tablet 28,056 63 1,767,528 0 0 28,056 1,767,528
163 Simvastatin 10 mg Tablet 0 0 746 446.00 332,716 746 332,716
165 Tablet Tambah Darah Tablet 21,746 352 7,654,592 0 0 21,746 7,654,592
 SISA STOK
NO NAMA OBAT SATUAN DKK PS
Jumlah DKK+PS Tot Harga DKK+PS
Jumlah Harga Total Harga Jumlah Harga Total Harga
170 Thiamin Hcl (Vit.B1)tab.50 mg (A) @10Tablet 0 0 18,184 230.00 4,182,320 18,184 4,182,320
172 Thiampenicole 500mg Kapsul 390 1,247 486,330 0 0 390 486,330
174 Traneksamik Acid 500 mg Kapsul 886 1,712 1,516,832 0 0 886 1,516,832
175 Trifluoperazine 5mg Tablet sal 500 405 202,500 0 0 500 202,500
176 Triheksifenidil (THP) 2mg Tablet 1,500 63 94,500 0 0 1,500 94,500
177 Truvit (multivit) syr @ 60 mL Botol 0 0 126 3482.00 438,732 126 438,732
178 Vitamin B Complx tab (A) @100 Tablet 0 0 19,810 82.00 1,624,420 19,810 1,624,420
181 Zink Tablet Kotak 2,463 208 512,304 0 0 2,463 512,304
182 Herbakoff @60 mL Botol 486 14,402 6,999,372 0 0 486 6,999,372
183 Hiosiamin bromida tablet 0 0 4,358 848.00 3,695,584 4,358 3,695,584
184 N-asetil sistein tablet Tablet 2,963 304 900,752 0 0 2,963 900,752
186 Stimuno capsul Kapsul 2,370 1,958 4,640,460 0 0 2,370 4,640,460
187 Glimepiride 2mg Tablet 0 0 893 224.00 200,032 893 200,032
214 Bisakodil tab 0 0 0 296 365.00 108,040 296 108,040
215 Nistatin drop 0 86 11,605 998,030 0 0 86 998,030
216 Pramolta 0 0 0 5 3750.00 18,750 5 18,750
220 Amlodipin 5 mg 0 0 0 3,496 53.00 185,288 3,496 185,288
0 0 0 66,300,534 0 46,518,735 112,819,269
1 Aminofilina inj. 24 mg/ml -10 ml Ampul 8 2,604 20,832 0 0 8 20,832
3 Ampisilin Injeksi 1 Gram Vial 10 8,591 85,910 0 0 10 85,910
5 Aqua Pro inj. Steril Vial 0 0 68 2648.00 180,064 68 180,064
11 Deksametason inj 5mg/ml-1ml ampul 75 924 69,300 0 0 75 69,300
14 Diazepam inj. 5mg/ml-2ml Ampul 33 1,545 50,985 0 0 33 50,985
15 Difenhidramin HCl inj Ampul 27 781 21,087 0 0 27 21,087
16 Ephineprin /Adrenalin inj Ampul 19 1,850 35,150 0 0 19 35,150
18 Fenobarbital Inj. 50 mg /ml--2ml Ampul 15 1,700 25,500 0 0 15 25,500
20 Fitomenadion (Vit. K1) Inj.2mg/ml Ampul 360 1,566 563,760 0 0 360 563,760
22 Gentamycin inj 40mg/5ml Ampul 25 3,355 83,875 0 0 25 83,875
24 Glukosa larutan infus 5% steril Botol 20 7,363 147,260 0 0 20 147,260
25 Glukosa calsicus 10%steril @ 20 mL Ampul 18 5,723 103,014 0 0 18 103,014
29 Lidocain Injeksi 2%-2ml Ampul 50 847 42,350 0 0 50 42,350
30 Metilergometrin Inj 0,2mg/ml - 1ml Ampul 130 1,023 132,990 0 0 130 132,990
32 Metronidazol Infus Botol 10 5,885 58,850 0 0 10 58,850
33 MgSO4 20% @25 mL Botol 8 3,254 26,032 0 0 8 26,032
34 MgSO4 40 % @25 mL Botol 0 0 62 4127.00 255,874 62 255,874
35 Na Cl Infus 0.9% Botol 61 6,840 417,240 0 0 61 417,240
37 Oksitocin inj 10 UI/ml Ampul 580 1,126 653,080 0 0 580 653,080
38 Pehacain / Lidocain comp. Inj Ampul 0 0 287 803.00 230,461 287 230,461
40 Ringer Laktat lar. infus steril Botol 66 7,630 503,580 0 0 66 503,580
45 Serum Bisa Ular (ABU) Bio Save @ 5 m Vial 2 517,132 1,034,264 0 0 2 1,034,264
53 Haloperidol inj 0 10 109,000 1,090,000 0 0 10 1,090,000
56 Tuberkulin Inj 0 2 608,280 1,216,560 0 0 2 1,216,560
59 Meproven Inhalasi 0 15 3,502 52,530 0 0 15 52,530
0 0 0 0 6,434,149 0 666,399 7,100,548
1 Acyclovir 5% Ceam Tube 0 0 220 3,381 743,820 220 743,820
2 Anestesi Lokal spray (Ethyl Chlorida) Botol 0 0 2 388,978 777,956 2 777,956
3 Anti Bakteri DOEN salep Tube 9 6,051 54,459 0 0 9 54,459
4 Anti Fungi DOEN Kombinasi. Pot 45 4,798 215,910 0 0 45 215,910
5 Antihaemoroid supp Suppo 134 3,167 424,378 0 0 134 424,378
6 Betametason krim 0,1% Tube 0 0 573 2421.00 1,387,233 573 1,387,233
8 Diazepam Rektal 5mg/2,5ml (stesolid) Tube 11 34,848 383,328 0 0 11 383,328
10 Etanol 70 % @1000 mL Botol 137 18,700 2,561,900 0 0 137 2,561,900
12 Gentamisin Salep Kulit Tube 0 0 512 2,800 1,433,600 512 1,433,600
18 Hydrokortison Cream Tube 197 2,325 458,025 0 0 197 458,025
19 Ketokonasole/Solinfec cream Tube 167 2,370 395,790 0 0 167 395,790
20 Ketoprofen supp 100mg/Protofen Suppo 0 0 16 1998.00 31,968 16 31,968
21 Kloramfenikol tetes telinga 3% Botol 0 0 163 8114.00 1,322,582 163 1,322,582
22 Klorfeson cream @10 g Tube 49 3,266 160,034 0 0 49 160,034
27 Myconazole cream Tube 258 1,900 490,200 0 0 258 490,200
28 Nistatin tablet vagina 100.000 IU Ovul 178 598 106,444 0 0 178 106,444
29 Oxycan (O2) Spray (A) Botol 2 47,500 94,999 0 0 2 94,999
32 Povidon Iodine 30 ml Botol 85 3,014 256,190 0 0 85 256,190
34 Salep 2-4 Kombinasi 0 394 2,333 919,202 0 0 394 919,202
35 Salisil Bedak 2 % 0 161 3,785 609,385 0 0 161 609,385
36 Stericide 5L Drigen 20 752,400 15,048,000 0 0 20 15,048,000
37 Surface Disinfectant (STERECIDE) Spra 0 41 87,120 3,571,920 0 0 41 3,571,920
41 Sterizyem5 L 0 0 0 3 719,280 2,157,840 3 2,157,840
42 Viorex no rinse 500ml Botol 14 65,340 914,760 0 0 14 914,760
43 Viorex no rinse 5 ltr drigen 27 649,990 17,549,730 0 0 27 17,549,730
49 Ichtyol 0 0 0 68 4225.00 287,300 68 287,300
50 Neocenta 0 0 0 13 10463.00 136,019 13 136,019
51 Scabimite 0 0 0 186 11352.00 2,111,472 186 2,111,472
52 GOM 0 0 0 133 3090.00 410,970 133 410,970
0 44,214,654 0 10,800,760 55,015,414
1 Gentamycin tetes mata Botol 0 0 56 8,974 502,544 56 502,544
2 Kloramfenikol salep mata 1% Tube 0 0 334 7,723 2,579,482 334 2,579,482
4 Kloramfenikol tetes mata @ 10 ml Botol 0 0 342 7,784 2,662,128 342 2,662,128
5 Oksitetrasiklin Hcl salep mata Tube 371 3,500 1,298,500 0 0 371 1,298,500
0 1,298,500 0 5,744,154 7,042,654
10 Temporary Filling material/Cavit / cavi Rol 1 138,300 138,300 0 0 1 138,300
13 DISPOSIBEL DENTAL NEEDL 0 0 0 125 944 117,938 125 117,938
14 FUJI IX GP 1-1 0 0 0 3 915,750 2,747,250 3 2,747,250
15 CELLULOSE MATRIX STRIP 0 0 0 1 194,250 194,250 1 194,250
 SISA STOK
NO NAMA OBAT SATUAN DKK PS
Jumlah DKK+PS Tot Harga DKK+PS
Jumlah Harga Total Harga Jumlah Harga Total Harga
16 FUJI II LC 1-1 MINI PACK 5 GR 0 0 0 1 399,600 399,600 1 399,600
17 ORABLOK INJ 0 0 0 50 8,991 449,550 50 449,550
0 138,300 180 3,908,588 180 4,046,888
1 Alkohol swab (box@100 pcs) Pcs 31,800 127 4,038,600 0 0 31,800 4,038,600
3 Blood Lanceset Autometic (Terumo) Pcs 1,800 125 225,000 0 0 1,800 225,000
5 Blood Tranfusion set Pcs 0 0 10 6000.00 60,000 10 60,000
8 Catgut/benang bedah 3/0 cromic tan Zak 50 23,000 1,150,000 0 0 50 1,150,000
9 Catgut/benang bedah 3/0 plain denga Pcs 12 29,900 358,800 0 0 12 358,800
12 Dressing tulle (Cuticell Clasic) 10 x 10 Pcs 40 7,000 280,000 0 0 40 280,000
14 FolleyCat, 2 way latex No.18 Box 10 11,000 110,000 0 0 10 110,000
15 Hanskun non steril S @100pcs Box 0 0 30 97,500 2,925,000 30 2,925,000
16 Hanskun non steril M @100pcs Box 0 0 60 97,500 5,850,000 60 5,850,000
17 Hanskun non steril L @100pcs Pasang 0 0 104 144210.00 14,997,840 104 14,997,840
18 Hanskun steril No. 6,5 Pasang 65 11,000 715,000 0 0 65 715,000
19 Hanskun steril No. 7 Pasang 40 11,000 440,000 0 0 40 440,000
20 Hanskun steril No. 7,5 Pasang 62 6,660 412,920 0 0 62 412,920
21 Hanskun Gynecolog Steril No. 7 Pasang 10 17,400 174,000 0 0 10 174,000
23 Hypafix/plester putih non alergenik 5 Roll 29 49,500 1,435,500 0 0 29 1,435,500
24 Infusion set Anak(PKD 2) Drigen 2 6,000 12,000 0 0 2 12,000
25 Infusion set Dewasa (PKD 1) Roll 5 7,370 36,850 0 0 5 36,850
26 Intravena Kateter no 20 Set 35 4,818 168,630 0 0 35 168,630
27 Intravena Kateter no 22 Set 80 4,818 385,440 0 0 80 385,440
30 Jarum Disposible Pcs 1,720 311 534,920 0 0 1,720 534,920
32 Jarum hecting (Eye Needle) Fig.2 @ 12 Sachet 6 265,300 1,591,800 0 0 6 1,591,800
33 Jarum hecting (Eye Needle) Fig.3 @ 12 Sachet 2 265,300 530,600 0 0 2 530,600
34 Kapas Pembalut 250 mg Pcs 27 20,600 556,200 0 0 27 556,200
35 Kasa Panjang 36m x 80 cm Zak 12 147,327 1,767,924 0 0 12 1,767,924
37 Kasa Pembalut Hidrofil 4m x10cm Roll 180 2,734 492,120 0 0 180 492,120
38 Kasa Pembalut Hidrofil 4m x3cm Pcs 290 840 243,600 0 0 290 243,600
39 Kasa steril 16x16 Roll 295 7,050 2,079,750 0 0 295 2,079,750
40 Masker Earloop Roll 0 0 250 500 125,000 250 125,000
41 Masker Hijab Box 2,000 3,475 6,950,000 0 0 2,000 6,950,000
42 Masker tali/tie on/Stardex Box 0 0 9,350 500 4,675,000 9,350 4,675,000
44 Nasa Canula S Pcs 5 6,150 30,750 0 0 5 30,750
45 Nasa Canula M Pcs 3 4,996 14,988 0 0 3 14,988
46 Nasa Canula L Pcs 37 4,996 184,852 0 0 37 184,852
47 Nasa Canula XS Pcs 2 4,996 9,992 0 0 2 9,992
49 Pembalut Elastis/ tenso/poly 7,5cm Botol 15 61,538 923,070 0 0 15 923,070
51 Plaster (LEUKOPLAST) 7.5cm x 4.5m Roll 10 43,300 433,000 0 0 10 433,000
56 Plester IV film/Leukomed (Steril) 6 x Box 250 3,250 812,500 0 0 250 812,500
57 Plasterin (plaster bulat) Set 2,700 389 1,051,218 0 0 2,700 1,051,218
58 Pot sputum steril Roll 200 825 165,000 0 0 200 165,000
59 Safety box Set 140 5,382 753,480 0 0 140 753,480
60 Silk (Benang Bedah Sutera ) no 3/0 Set 48 16,600 796,800 0 0 48 796,800
63 Soloschot Syringe/ADS 0,05 ml Set 120 1,453 174,360 0 0 120 174,360
64 Soloschot Syringe/ADS 0,5 ml Kit 400 1,165 466,000 0 0 400 466,000
65 Spuit 1ml Kit 3,121 957 2,986,797 0 0 3,121 2,986,797
66 Spuit 3 ml (Nippro) Pcs 2,585 888 2,295,480 0 0 2,585 2,295,480
67 Spuit 5 ml Pcs 963 968 932,184 0 0 963 932,184
70 Tes Pack (tes kehamilan) box 0 0 250 2000.00 500,000 250 500,000
72 Urine bag Pcs 22 5,877 129,294 0 0 22 129,294
73 Wing needle Sachet 0 0 30 14850.00 445,500 30 445,500
82 Masker KN 95 Dreamcan (ME01L-K) 0 100 19,900 1,990,000 0 0 100 1,990,000
93 Coverall 0 100 111,800 11,180,000 0 0 100 11,180,000
98 Apron lengan 0 0 0 60 7200.00 432,000 60 432,000
109 Nursecup 0 0 0 4 33,500 134,000 4 134,000
0 Intravena No 18 0 225 4,818 1,084,050 0 0 225 1,084,050
0 Masker N95 Nios 0 50 76,000 3,800,000 0 0 50 3,800,000
0 Gown 0 0 0 100 50,000 5,000,000 100 5,000,000
0 apron (tanpa lengan) 0 0 0 0 40 5000.00 200,000 40 200,000
0 0 54,903,469 0 35,344,340 90,247,809
11 Extran Netral @2500 mL mL 1 1,216,560 1,216,560 0 0 1 1,216,560
14 Glucose (dengan standar) @4x100 mL mL 2 421,800 843,600 0 0 2 843,600
15 Haemoglobin lart/Drabskin @500 mL mL 14 69,930 979,020 0 0 14 979,020
41 Salmonella Typhi H @5 mL mL 1 134,310 134,310 0 0 1 134,310
42 Salmonella Typhi O @5 mL mL 1 134,310 134,310 0 0 1 134,310
47 Strip HbsAg @25 strp Strip 325 7,338 2,384,850 0 0 325 2,384,850
51 strip urine 3 parameter @100 Stk Stik 800 1,098 878,400 0 0 800 878,400
53 Trigliserida @4x100 mL ml 5 1,347,651 6,738,255 0 0 5 6,738,255
64 Anti A @100 mL mL 5 130,980 654,900 0 0 5 654,900
65 Anti B @100 mL mL 3 130,980 392,940 0 0 3 392,940
66 Anti D @100 mL mL 3 229,770 689,310 0 0 3 689,310
77 rapid antigen (biosensor) 0 175 36,364 6,363,700 0 0 175 6,363,700
78 Rapid-1 HIV (HIV-AIDS SD) 0 300 20,400 6,120,000 0 0 300 6,120,000
85 Rapid 1 HIV Sypilis Duo 0 250 17,575 4,393,750 0 0 250 4,393,750
0 0 31,923,905 0 0 31,923,905
2 BCG 0 8 97,780 782,240 0 0 8 782,240
5 Hb 0 0 88 25,839 2,273,832 0 0 88 2,273,832
6 TD 0 17 18,128 308,176 0 0 17 308,176
7 DPT-HB-HIB 0 8 85,103 680,824 0 0 8 680,824
8 OPV 0 15 21,494 322,410 0 0 15 322,410
9 IPV 0 18 157,072 2,827,296 0 0 18 2,827,296
0 0 7,194,778 0 0 0 7,194,778
 SISA STOK
NO NAMA OBAT SATUAN DKK PS
Jumlah DKK+PS Tot Harga DKK+PS
Jumlah Harga Total Harga Jumlah Harga Total Harga
0 Bisturi No 11 0 0 0 0 100 4,400 440,000 100 440,000
0 Spuit 10 cc 0 0 0 0 20 1382.00 27,640 20 27,640
0 Klep Tali pusar 0 0 0 0 300 1500.00 450,000 300 450,000
0 Spuit 50 cc 0 0 0 0 7 3712.00 25,984 7 25,984
0 Spuit ADS 0,3 ml 0 40 1,255 50,200 0 0 40 50,200
0 Spuit 20 cc 0 0 0 0 51 1760.00 89,760 51 89,760
0 Kertas Lakmus 0 0 0 0 2 50000.00 100,000 2 100,000
0 0 0 0 0 50,200 0 1,133,384 1,183,584
0 Ultrasound gel 0 0 0 0 16 16500.00 264,000 16 264,000
0 Povidon iodin 1000 ml 0 0 0 0 2 53700.00 107,400 2 107,400
0 0 0 0 0 0 0 371,400 371,400
0 Masker Earloop HIV 0 400 2,290 916,000 0 0 400 916,000
0 0 0 0 0 916,000 0 0 0 916,000
0 Herbakof tablet 0 244 2,498 609,512 0 0 244 609,512
0 Herbacold tablet 0 600 2,498 1,498,800 0 0 600 1,498,800
0 INH 300mg / Rifapentin 300 mg 0 150 6,546 981,900 0 0 150 981,900
0 Isoniazide (INH) 300 mg 0 150 150 22,500 0 0 150 22,500
0 Iodine test, vial @10ml 0 52 34,000 1,768,000 0 0 52 1,768,000
0 Diazepam 5 mg 0 300 108 32,400 0 0 300 32,400
0 0 0 0 0 4,913,112 0 0 0 4,913,112
0 PCV 0 12 3,400,000 40,800,000 0 0 12 40,800,000
0 MR 0 1 167,860 167,860 0 0 1 167,860
0 0 0 0 0 40,967,860 0 0 0 40,967,860
SISA STOK
ORAL 117,732,381.00
PROGRAM HIV/AIDS 0.00
INJEKSI 7,100,548.00
TOPIKAL 55,386,814.00
OBAT MATA 7,042,654.00
OBAT GIGI 4,046,887.50
VAKSIN/SERUM 48,162,638.00
JUMLAH 239,471,922.50
REAGENSIA 31,923,905.00
JUMLAH 31,923,905.00
ALKES PERSEDIAAN 0.00
ALKES HABIS PAKAI 92,347,393.00
JUMLAH 92,347,393.00
HIBAH
JUMLAH TOTAL 363,743,220.50
363,743,221
Purbalingga, 31 Desember 2022
Petugas Pengelola Obat Bendahara Barang
UPTD Puskesmas Bojongsari UPTD Puskesmas Bojongsari

apt. Grah Retno Cahyaningrum, S.Farm Ika Permatasari, A.Md. Farm

NIP. 19930111 202012 2 011 Mengetahui, NIP. 19860123 202221 2 002
Kepala UPTD Puskesmas Bojongsari Kab.Purbalingga

Suwarno, S. Kep.Ns
NIP. 19710712 199203 1 012
 PEMERINTAH KABUPATEN PURBALINGGA
DINAS KESEHATAN KABUPATEN PURBALINGGA
Alamat : Jalan Jendral S Parman Nomor 21 Telp.0281 891034 Fax 93278

BERITA ACARA SERAH TERIMA BARANG

Nomer : 442/

Pada hari ini Selasa tanggal sepuluh bulan Januari tahun Dua ribu dua puluh tiga, yang bertanda tangan dibawah ini :

1. Nama : Edot Yuniana, S,Farm., Apt

NIP : 19780621 200312 2 011
Jabatan : Pengurus Barang Pembantu Dinas Kesehatan Kabupaten Purbalingga
Selanjutnya disebut sebagai Pihak Pertama
2. Nama : apt. Grah Retno Cahyaningrum,S.Farm.
NIP : 19930111 202012 2 011
Jabatan : Pengelola Obat UPTD Puskesmas Bojongsari Kab. Purbalingga
Selanjutnya disebut sebagai Pihak Kedua

PIHAK KESATU dan PIHAK KEDUA telah melakukan Rekonsiliasi Aset Persediaan Obat, Obat lainnya dan Bahan lainnya pada tahun 2022
dengan hasil sebagai berikut

PENERIMAAN
No. Uraian STOK AWAL PENGELUARAN SISA STOK
APBD BLUD RELOKASI DINKES JMLH

1 Obat 109,539,478.00 49,983,970.00 142,514,341.00 1,540,636.00 828,471,683.43 1,022,510,630.43 892,578,185.93 239,471,922.50

2 Obat lainnya 343,616,408.00 14,652,000.00 36,774,347.00 0.00 92,601,177.00 144,027,524.00 455,720,027.00 31,923,905.00

3 Bahan lainnya 96,323,780.00 24,025,000.00 39,967,940.00 0.00 329,417,320.00 393,410,260.00 397,386,647.00 92,347,393.00

Jumlah Keseluruhan 549,479,666.00 88,660,970.00 219,256,628.00 1,540,636.00 1,250,490,180.43 1,559,948,414.43 1,745,684,859.93 363,743,220.50

Pihak Pertama menyerahkan barang berupa obat dan perbekes yang mutasi melalui SBBK ( Surat Bukti Barang Keluar ) dan Faktur Droping
Selama tahun 2022 kepada Pihak Kedua, dan Pihak Kedua menyatakan telah menerima barang tersebut dengan rincian sebagai berikut :

Demikian berita acara ini dibuat untuk dapat digunakan Oleh Pihak yang berkepentingan seperlunya.

Purbalingga, 10 Januari 2023

Pihak Pertama Pihak Kedua

Edot Yuniana, S,Farm., Apt apt. Grah Retno Cahyaningrum,S.Farm.

NIP 19780621 200312 2 011 NIP. 19930111 202012 2 011

Mengetahui,
Ka Sie Kefarmasian dan Alkes

Drs. Sugeng Santoso,Apt

NIP 19670420 200501 1 003