FORMAT :1

PEMERINTAH KABUPATEN BANGGAI

DINAS KESEHATAN
PUSKESMAS …………………………………..
Jl. …………………………….No ………………. Telp (o461)…………………

DAFTAR PENERIMAAN PENGADAAN OBAT DAN BAHAN MEDIK HABIS PAKAI ( BMHP )
TAHUN 20…….

Instansi : Dinas Kesehatan

Kabupaten : Banggai
Provinsi : Sulawesi Tengah
Sumber Anggaran : DAK (Dana Alokasi Khusus )
Kategori : Obat

Harga Satuan
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a b c d e f g h i j k l m n o p q r s
442/…/IFK/…./20….
A I nstalasi Farmasi Kabupaten SEDIAAN TABLET/KAPSUL

1 Ambroxol Tab
2 Acyclovir Tab 200 mg Tab -
3 Acyclovir Tab 400 mg Tab -
4 Alupurinol Tab 100 mg Tab -
5 Alprazolam tab 0,5 mg Tab -
6 Aminophyllin Tab 200 mg Tab -
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab -
8 Ampicillin Caplet 500 mg Tab -
9 Amlodipine 5 Mg Tab -
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab -
11 Antalgin Tab 500 mg Tab -
Antasida Doen Tab Kombinasi Tab -
Attapulgit 600 mg tablet (5 x 10 tab) Tab -
Asam Ascorbat (Vit C) Tab 50 mg Tab -
Asam Mefenamat Tab 500 mg Tab -
Betahistin Tb Tab -
Calsium Laktat (Calk) Tab 500 mg Tab -
Captopril Tab 25 mg Tab -
CarbamazeineTab Tab -
Cefadroxil Capsul 500 mg Tab -
Cetirizine Tb Tab -
Chloramphenicol Caps 250 mg Tab -
Chlorpheniramin Maleat (CTM) Tab 4 mg Tab -
Chlorpromazin HCl Tab Salut 25 mg Tab -
Chlorpromazin HCl Tab Salut 100 mg Tab -
Ciprofloxacin Capl 500 mg Tab -
Cimetidine Tab 200 mg Tab -
Clonidine Tab -
Cotrimoksazol Ped Tablet 120 mg Tab -
Cotrimoksazol Dewasa Tab 480 mg/ Tab -
Cyanocobalamin (Vit B12) Tab Tab -
Dexametason Tab 0,5 mg Tab -
Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab -
Diazepam Tab 5 mg ( @ 100 = @ 250 ) Tab -
Domperidome ( @100 = @50 ) Tab -
Ephedrin HCl Tab 25 mg Tab -
Erytromysin 500 mg Tab Tab -
Fitomenadion (Vit K) Tab Salut 10 mg Tab -
Furosemid Tablet 40 mg Tab -
Glibenklamid Tab 5 mg Tab -
Gliseril Guaiyacolat Tab 100 mg Tab -
Griseofulvin Tab 125 mg micronized Tab -
Haloperidol Tab 1,5 mg Tab -
Haloperidol Tab 5 mg Tab -
Hidroklorothiazid (HCT) Tab 25 mg Tab -
Ibuprofen Tab 200 mg Tab -
Ibuprofen Tab 400 mg Tab -
Isosorbid Dinitrat Tab 5 mg Tab -
Komb. Pirimetamin 25 mg + Sulfadoxin 500 mTab -
Ketoconzol Tab Tab -
LansoprasolenTb Tab -
Levofloxacin Tab 500 mg Tab -
Loperamide Tab Tab -
Loratadin tab 10 mg Tab -
 Harga Satuan
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Dst……………………………………
 Harga Satuan
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Meloksikam 15 Mg Tab -
Metform Tb Tab -
Methyl Prednisolon Tb Tab -
Metronidazole Tab 250 mg Tab -
Metronidasole 500 Tab -
Metoclopramide Tab 10 mg Tab -
Natrium Diklofenak Tab 50 mg Tab -
Nifedipin Tab 10 mg Tab -
Ofloxacin Tab 400 mg Tab -
Omeprasole Tab -
Papaverin Tab 40 mg Tab -
Paracetamol Tab 500 mg Tab -
Phenobarbital Tab 30 mg Tab -
Piridoxyn HCl Tab 10 mg Tab -
Prednison Tab 5 mg Tab -
Piroxicam Caps 20 mg Tab -
PropilTioUrasil (PTU) Tab 100 mg Tab -
Propanolol HCl Tab 40 mg Tab -
Pyrantel HCl Tab 125 mg Tab -
Ranitidine Tab 150 mg Tab -
Retinol 100.000 Iu (Biru) Tab -
Retinol 200.000 Iu (Merah) Tab -
Salbutamol Tab 4 mg Tab -
Selviplex Tab -
Simvastatin Tab -
Tablet Tambah Darah Tab -
Tetracyclin HCl Caps 250 mg Tab -
Tetracyclin HCl Caps 500 mg Tab -
Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab -
Trihexylfenidil Tab -
Vitamin B Compleks Tab Tab -
Zink Tab -
SEDIAN SIRUP -
Ambroxol Sy Btl -
Amoxicillin Syrup Kering 125 mg / 5 ml Btl -
Ampicillin Syrup Kering 125 mg / 5 ml Btl -
Antasida Doen Susp Kombinasi Btl -
Antidiare syr Btl -
Antiinfluensa Syr (Erlaflu) Btl -
Cotrimoksazol Susp Btl -
Cefadroxil Syr Btl -
Cetirizine Syr Btl -
Domperidome Sy Btl -
erytromysin Syrup Kering Btl -
Garam Oralit 200 ml Air Btl -
Ibuprofen Syr Btl -
Metocloperamide Syr Btl -
Multivit Syr Btl -
Obat Batuk Hitam (OBH) Cairan Btl -
Paracetamol Syrup 100 mg / 5 ml Btl -
Paracetamol Drops 10 ml Btl -
Pyrantel Syr Btl -
Zinc Syr Btl -
SEDIAAN STERIL -
Ampicillin 1 gram Inj Amp -
Aminopyllin Inj Amp -
Aqua Pro Injeksi Steril Bebas Pirogen Amp -
Asering - Asetat Ringer Amp -
Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp -
Cefotaxim 1 g Inj Amp -
Clorpromazine inj Amp -
Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp -
Dexametason Inj 5 mg / ml - 1 ml Amp -
Diazepam Inj Amp -
Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp -
Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% Amp -
Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp -
Furocemide Inj Amp -
Glukosa Lar Infus 5% Steril Amp -
 Harga Satuan
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KA EN 3B Amp -
Ketorolac Inj ( @ 12 = @ 6 ) Amp -
Lidocain Comp. Inj/Pehacain Inj. Amp -
Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp -
Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp -
Metocloperamide Inj Amp -
Natrium Klorida 0,9% Larutan Infus Steril Amp -
Ondansetron Inj Amp -
Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 Amp -
Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Amp -
Phenobarbital Inj Amp -
Ranitidine inj ( @ 25 = @ 10 ) Amp -
Ringer Laktat Lar Infus Steril Amp -
Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp -
Vit B1, B6, B12 Inj Amp -
SEDIAAN LUAR -
Aciclovir cream (25 Tube) Tub -
AntiHemoroid Doen Kombinasi Tub -
Antifungi SK Tub -
Betametason Cream 0,1% (25 Tube) Tub -
Chloramphenicol Salep Kulit 1% (24 tube) Tub -
Chloramphenicol Salep Mata 1% (24 tube) Tub -
Chloramphenicol Tetes mata (25 Btl) Tub -
Chloramphenicol Tetes Telinga (24 Btl) Tub -
Diasepam Rectal ( Stesolid ) Tub -
Etakridina laktat (Rivanol) Tub -
Ethyl Klorida Semprot Tub -
Gentian Violet Lar 1% Tub -
Hidrokortison Cream 2,5% Tub -
Ketoconazol SK Btl -
Mikonazole Sk Btl -
Mycorine Powder Btl -
Oxytetracyclin HCl Salep Kulit 3% Btl -
Oxytetracyklin HCl Salep Mata (@25) Tub -
Povidon Iodium Lar 60 ml Tub -
Povidon Iodium Lar 300 ml Tub -
Povidon Iodium Lar 1000 ml Tub -
Salep 2-4 Kombinasi Tub -
Salisil Talk/Bedak 2% Tub -
Scabimite Tub -
BMHP -
Alat Suntik Sekali Pakai 1 ml Pcs -
Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs -
Alat Suntik Sekali Pakai 5 ml Pcs -
Alat Suntik Sekali Pakai 10 ml Pcs -
Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs -
Catgut/Benang Bedah no 2/0-3/0 (Plain)) Pcs -
Canula Adult & Childr Pcs -
Canula Adult & Childr Pcs -
E-Care Alcohol Swab Pcs -
Etanol 70 % Pcs -
FM Crepe 7,5 cm x 4,55 m Pcs -
FM Crepe 10 cm x 4,55 m Pcs -
Folly Cath 18 Pcs -
Folly Cath 20 Pcs -
Handscoon 7 Pcs -
Handscoon L -
Handscoon M -
Infusion Set Anak Pcs -
Infusion Set Dewasa Pcs -
i.v. Cathether 18 G Rol -
i.v. Cathether 20 G Rol -
i.v. Cathether 22 G Rol -
i.v. Cathether 24 G Rol -
i.v. Cathether 26 G Rol -
Kapas Pembalut/Adsorben 100 g Rol -
Kapas Pembalut/Adsorben 250 g Rol -
Kasa Kompres 40/40 Steril Pcs -
Kasa Pembalut 2 m x 80 cm Rol -
 Harga Satuan
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Kasa Pembalut hidrofil 4 m x 15 cm Rol -
Kasa Pembalut hidrofil 4 m x 3 cm Rol -
Kasa Hidrofil 16 x 16 Pcs -
Kasa 40 x 80 Btl -
LISOL Rol -
Masker Rol -
Masker -
Poligyp 5 cm x 2,7 m Pcs -
Polifix 5 cm x 1 m Pcs -
Poliband Btl -
Policlean Handrub 500 ml Pcs -
Plester 7,5 yard x 2 inch (Besar) Rol -
Plester 5 yard x 2 inch (2,25 x 5 ) Pcs -
Silk (Benang Bedah Sutra) no 3 / 0 Pcs -
NGT Pcs -
Urine bag Pcs -
Aqua Gell Pcs -
Catejeel Pcs -
Scalvien Pcs -
Do Care Wash Gloves Antiseptic Pcs -
Feding Tube Pcs -
Feding Tube Pcs -
Feding Tube Pcs -
Feding Tube Pcs -
IV Cath 16 Pcs -
-
Tambahan : -
-
Bisacodyl Supp 5 mg Supp -
Salbutamol Syr Btl -
Phenol Glycerol Btl -
Anti Influenza (Noza) tab -
Miniaspi Tab -
multivitamin (LVB) Tab -
Analgetik Inj (antrain ) Amp -
Phenitoin Inj Amp -
Griseofulvin 500 mg Tab Tab -
Oxymetazoline Spray 0,05 % Btl -
Oxymetazoline Drop 0,025 % Btl -
Asam tranexamat Inj amp -
Ipratropium Inh Unit -
Amoxicillin 250 Kap -
As Folat 10 Mg -
Canula Infant -
Ceftriaxone 1 gr Inj -
Handscoon 7,5 Pcs -
Na metamizol (Novaldo) amp -
Acetil Cystein Kap -
Calcium Gluconas Inj amp -