Ba So Obat Dan BMHP 2022

PEMERINTAH KABUPATEN SOPPENG DINAS KESEHATAN
UPTD PUSAT KESEHATAN MASYARAKAT SALOTUNGO

JALAN TUJUH WALI-WALI TELP.(0484) 23003 KEL.LALABATARILAU, KEC.LALABATA, KAB.SOPPENG 90812
Website : www.pkm-salotungo.soppengkab.go.id Email : puskesmas.salotungo@gmail.com
BERITA ACARA STOK OPNAME

OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) UNIT APOTEK
NO : 08/PKM.ST/TU/I/2022
Pada hari ini Senin tanggal Tiga Puluh Satu Bulan Januari tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :
1. Nama : Hj. Nirtati, SKM

Nip : 19660211 198803 2 005
Jabatan : Kepala UPTD Puskesmas Salotungo
2. Nama : Yusdiana, S.Si.,Apt, MM
Nip : 19841111 201101 2 016
Jabatan : Penanggujawab Apotek
Menyatakan telah melakukan stok opname obat dan bahan medis habis pakai (BMHP) tahun 2022 sebagaimana
terlampir dalam berita acara Stok opname.
Adapun data hasil Stok Opname obat dan bahan medis habis pakai terlampir.
Demikian berita acara ini dibuat untuk dapat diketahui dan dipergunakan sebagaimana mestinya.
Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek
Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
LAMPIRAN BERITA ACARA OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) UNIT APOTEK SUMBER DANA APBD
BULAN JANUARI 2022
PEMAKAIAN
PERSEDIAAN PERSEDIAAN
NO NAMA OBAT SATUAN HARGA AWAL PENERIMAAN AKHIR
DISTRIBUSI EXP RETUR RUSAK
1 2 3 4 5 6 7 8 9 10 11
OBAT - -
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 494.00 -
3 Albendazol Sirup Botol 4,600.00 -
4 Albothyl cons.(policresulen) Botol 5ml 33,000.00 -
5 Alopurinol tablet 100 mg Tablet 99.00 -
6 Alprazolam 0,5 mg tablet Tablet 88.00 -
7 Amitripilin HCl tablet salut 25 mg Tablet 165.00 -
8 Amlodiphin tablet 5 mg Tablet 74.00 -
9 Amlodiphin tablet 5 mg Tablet 55.00 803.00 803 -
10 Amlodiphin tablet 10 mg Tablet 95.00 - -
11 Amoksisilin kaplet 500 mg Kaplet 265.00 2,501.00 1,269 1,232.00
12 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 2,050.00 53.00 24 29
13 Ampisilin kaplet 500 mg Kaplet 265.00 -
14 Ampisilin serbuk injeksi Vial 9,473.00 -
15 Antalgin /Metampiron tab 500 mg Tablet 176.00 -
16 Antasida DOEN tablet kombinasi Tablet 60.00 1,220.00 1,220 -
17 Antasida Sirup Botol 60 ml 1,759.00 185.00 118 67
18 Anti bakteri DOEN Tube 3,490.00 -
19 Antifungi DOEN kombinasi Pot 2,310.00 -
20 Antihemorhoid DOEN kombinasi Supp 3,642.00 - - -
21 Antimigrain DOEN kombinasi Tablet 199.00 -
22 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 6,027.00 3,991 2,036
22 Asam Mefenamat tablet 500 mg Tablet 103.00 -
23 Asam Mefenamat tablet 500 mg Tablet 297.00 916.00 539 377
24 Asering Infus Botol 500ml 9,000.00 - -
25 Asetil sitein Tablet 394.00 60.00 17 43
26 Asiklovir cream Tube 4,382.40 40.00 9 31
27 Asiklovir tablet 400 mg Tablet 425.00 144.00 108 36.00
28 Aspilet Tablet 163.00 - -
29 Attapulgit (New Antides) Tablet 149.00 - -
30 Betahistin Mesilat 6 mg tab Tablet 241.10 844.00 221 623.00
31 Betametason krim 0,1 % Tube 1,420.00 -
32 Betametason krim 0,1 % Tube 1,515.00 68.00 14 54
33 Burnazin cream Tablet 33,000.00 -
34 Captopril 25 mg Tablet 80.00 -
35 Cavida gel 15 gram Tube 41,000.00 1.00 - 1
36 Cefadroxyl 500 mg Kapsul 492.00 -
37 Cefadroxyl syrup kering 125 mg/5ml Botol 60 ml 4,360.00 60.00 12 48
38 Cendo Xitrol ED Botol 35,200.00 -
39 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 3,061.00 64.00 36 28
40 Ciproloxacin 500 mg isi 100 tab Tablet 281.00 - -
41 Clobazam Tablet 384.00 286.00 59 227
42 Clozapin 25 mg 1,550.00 -
43 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 8.00 3 5.00
44 Deksametason tablet 0,5 mg Tablet 146.00 -
45 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1,156.00 -
46 Digoksin tablet 0,25 mg Tablet 104.00 -
47 Diazepam 2 mg Tablet 86.00 44.00 - 44
48 Diltiazem HCl Tablet 142.00 -
49 Dimenhidrinat Tablet 114.00 -
51 Doksisiklin tablet 100 mg Tablet 264.00 -
51 Domperidon Tablet 96.00 - -
52 Domperidon Tablet 75.00 1,000.00 406 594
53 Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,862.00 -
54 Epineprin HCl/bitartrat (adrenalin) inj. Ampul 1,518.00 -
55 Eritromisin 250 mg Kapsul 636.00 -
56 Eritromisin 500 mg Kapsul 781.00 37.00 25 12.00
57 Famotidine 20 mg Tablet 132.00 -
58 Fenitoin natrium kapsul 100 mg Kapsul 146.00 -
59 Fenobarbital Inj.50 mg/ml Ampul 2,265.00 -
60 Fenobarbital tablet 30 mg Tablet 177.00 96.00 - 96.00
61 Fenol Gliserol Tetes Telinga 10 % Botol 2,246.00 -
62 Fitomenadion ( vit k ) tablet salut 10 mg Tablet 818.00 -
63 Furosemid tablet 40 mg Tablet 82.00 -
64 Garam oralit untuk 200 ml air Sachet 275.00 293.00 293 -
65 Gentamisin Inj.80 mg/2 ml Ampul 3,545.00 -
66 Gentian Violet Botol 1,980.00 -
67 Glibenklamid tablet 5 mg Tablet 137.00 410.00 50 360.00
68 Glimepiride tab 2 mg Tablet 207.00 - -
69 Glukosa larutan infus 5 % steril Botol 7,363.00 4.00 - 4
70 Griseofulvin tablet 125 mg, micronized Tablet 238.00 -
71 Haloperidol tablet 1,5 mg Tablet 64.43 -
72 Haloperidol tablet 5 mg Tablet 56.00 185.00 - 185
73 Hidrocortison cream 2,5 % Tube 2,648.00 60.00 11 49.00
74 Hidroklortiazida tablet 25 mg Tablet 178.00 -
75 Hyoscine-N-butilbromide 10 mg tab Tablet 1,662.00 -
76 Ibuprofen syrup 100mg/5 ml Botol 60 ml 2,858.00 55.00 13 42
77 Ibuprofen tablet 200 mg Tablet 264.00 -
78 Isosorbit dinitrat tablet sublungual 5 mg Tablet 95.00 -
79 Kaen - 3 B Botol 11,314.00 -
80 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 3,980.00 1,515 2,465
81 Karbamazepin tab 200 mg Tablet 306.00 -
82 Ketokonazol Krim 2% Tube 2,694.00 16.00 11 5.00
83 Ketokonazol tab Tablet 286.00 -
84 Ketorolac injeksi 30 mg Ampul 1,045.00 -
85 Kloramfenikol kapsul 250 mg Kapsul 329.00 70.00 - 70.00
86 Kloramfenikol salep mata 1 % Tube 2,013.00 -
87 Kloramfenikol sirup Botol 60 ml 4,000.00 -
88 Kloramfenikol tetes telinga 3 % Botol 9,749.30 3.00 - 3
89 Klorfeniramin maleat ( CTM ) tablet 4 mg Tablet 26.00 -
90 Klorpromazin HCl tablet salut 100 mg Tablet 170.00 -
91 Kodein HCl tablet 10 mg Tablet 657.00 70.00 35 35
92 Kotrimoksazol dewasa tablet Tablet 133.00 495.00 130 365.00
93 Kotrimoksazol suspensi Botol 60 ml 2,052.00 -
94 Lanzoprasole kapsul 30 mg Kapsul 278.00 2,855.00 952 1,903
95 Lidokain kompositum injeksi Ampul 1,405.00 -
96 Loperamid tablet Tablet 90.00 -
97 Loratadin tablet 10 mg Tablet 136.00 237.00 198 39
98 Magnesium sulfat inj. 40% Ampul 3,650.00 -
99 Meloksikam tablet 15 mg Tablet 1,350.00 -
100 Metformin tab. 850 mg Tablet 167.00 -
101 Metformin tab 500 mg Tablet 77.00 2,345.00 695 1,650
102 Metilergometrin maleat inj. 0,200 mg - 1 ml Ampul 3,399.00 -
103 Metilergometrin maleat tablet salut 0,125 mg Tablet 245.00 200.00 45 155
104 Metilprednisolon tablet 4 mg Tablet 102.00 1,629.00 686 943
105 Metoklorpropamid injeksi (Sotatic) Ampul 4,554.00 4.00 - 4
106 Metoklorpropamid sirup Botol 60 ml 2,700.00 -
107 Metoklorpropamid tab 10 mg Tablet 87.00 -
109 Metronidazol tablet 500 mg Tablet 350.00 -
110 Miconasol cream Tube 3,926.00 9.00 - 9
111 Miconasol cream Tube 1,900.00 50.00 34 16
112 Multivitamin sirup anak Botol 16,500.00 -
113 Mineral Mix Pcs 3,116.00 -
114 NA. Diklofenak tablet 50 mg Tablet 145.00 1,893.00 1,232 661
115 Natrium klorida larutan infus 0,9 % steril Botol 6,410.00 -
116 Natrium klorida larutan infus 0,9 % steril Botol 6,900.00 13.00 - 13
117 Nifedipine tablet 10 mg Tablet 123.00 -
118 Nistatin 100.000 iu / tablet vaginal Tablet 645.00 - -
119 Nistatin 500.000 iu tablet salut Tablet 857.00 -
120 Novabion Tablet 202.40 -
121 OAT FDC Kategori I Paket 447,791.00 -
122 OAT FDC Kategori II Paket 1,592,731.00 -
123 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 48.00 - 48
124 Oksitetrasiklin HCl salep 3 % Tube 3,047.00 -
125 Oksitetrasiklin HCl salep mata Tube 2,774.00 24.00 20 4.00
126 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 1,232.00 -
127 Omeprasol Tablet 147.00 -
128 Papaverin HCl tab Tablet 137.50 -
129 Parasetamol drops Botol 15 ml 7,646.00 42.00 2 40.00
128 Parasetamol sirup 120 mg / 5 ml Botol 60 ml 5,478.00 -
129 Parasetamol tablet 500 mg Tablet 60.00 -
130 Parasetamol tablet 500 mg Tablet 165.00 1,961.00 1,799 162.00
131 Piracetam injeksi 1 g/ 5 ml Ampul 2,090.00 -
132 Piracetam tablet 800 mg Tablet 781.00 -
133 Piridoksin HCl tablet 10 mg Tablet 150.00 -
134 Piroksicam 20 mg kapsul Kapsul 169.40 -
135 Prednison tablet 5 mg Tablet 74.00 -
136 Propiltiourasil tablet 100 mg Tablet 741.40 -
137 Propranolol HCl tablet 10 mg Tablet 69.00 -
138 Provital Plus tablet Tablet 7,150.00 -
139 Pyrantel suspensi Botol 9,100.00 -
140 Ranitidin injeksi Ampul 1,188.00 -
141 Ranitidin tablet Tablet 122.00 - -
142 Retinol ( vit. A ) kapsul 100.000 iu Kapsul 327.00 -
144 Ringer laktak larutan infus steril Botol 7,630.00 9.00 1 8
145 Risperidone 2 mg Tablet 347.00 -
146 Salbutamol tablet 2 mg Tablet 64.00 -
147 Salbutamol tablet 4 mg Tablet 123.00 156.00 18 138
148 Salep 2 - 4 kombinasi Pot 3,017.00 8.00 6 2
149 Salisil bedak 2 % Pot 7,500.00 -
150 Scabimite 5 % krim Tube 12,155.00 -
151 Serbuk PK Kristal Pot 5 g 2,585.00 -
152 Sianokobalamin tablet Tablet 51.00 -
153 Simvastatin tablet 10 mg Tablet 73.00 1,897.00 542 1,355
154 Simvastatin tablet 20 mg Tablet 225.00 -
155 Stesolid Rectal Tablet 14,459.00 -
156 Tablet tambah darah kombinasi Tablet 409.00 6,880.00 2,397 4,483
157 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 96.00 -
158 Tramadol tablet Tablet 374.00 -
159 Triheksifenidil hidroklorida tablet 2 mg Tablet 80.00 -
160 Vaksin rabies vero Vial 187,000.00 -
161 Ventolin Nebulizer Ampul 12,976.00 -
162 Vitamin B kompleks tablet Tablet 132.00 -
163 Vitamin Neurotropik Kombinasi Tablet 550.00 -
164 Vitka Infant ( Fitomenadion 2 mg )injeksi Ampul 4,236.00 -
165 Yodium povidon larutan 10 % 60 ml Botol 4,255.00 -
167 Zink Sirup Botol 3,285.00 -
168 Zink Tablet Tablet 604.00 -
169 Oseltamivir Tablet 20182,50 -
170 Vitamin c 500 mg Tablet 618,75 -
171 Zivit sinc Tablet 2,500.00 70.00 70 -
172 Tenolam Tablet 209,130.00 60.00 60 -
173 Cotrimoksazole 960 mg Tablet 325.00 40.00 30 10.00
174 Stimuno Tablet -
- -
PERBEKALAN KESEHATAN -
175 Alat suntik sekali pakai 0,5 ml Pcs 1,426.00 -
176 Alat suntik sekali pakai 3 ml Pcs 1,016.40 69.00 1 68
177 Alat suntik sekali pakai 1 ml Pcs 743.98 40.00 - 40
178 Alat suntik sekali pakai 5 ml Pcs 1,201.75 34.00 - 34
179 Infusion set dewasa Set 5,445.00 17.00 1 16
180 IV. Catheter No. 18 Pcs 14,625.00 - - -
181 IV. Catheter No. 20 Pcs 12,631.00 35.00 - 35
184 Urine Bag Pcs 4,933.50 2.00 - 2.00
LAMPIRAN BERITA ACARA OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) UNIT APOTEK SUMBER DANA JKN
BULAN JANUARI 2022
PERSEDIAAN PEMAKAIAN PERSEDIAAN
NO NAMA OBAT SATUAN HARGA PENERIMAAN
AWAL DISTRIBUSI EXP RETUR RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 Allopurinol 100 mg Tablet 288.75 1,127 175 952
2 Allopurinol 100 mg Tablet 89.00 3,200 - 3,200
3 Amlodipine 10 mg Tablet 158.44 415.00 395 20
4 Ambroxol Sirup Botol 6,099.50 127 10 117
5 Ambroxol Tablet Tablet 180.00 - -
6 Ambeven tab Tablet 2,664.20 - -
6 Asam Tranexamat Tablet 1,365.00 - -
7 Asam Tranexamat Tablet 1,053.00 468 93 375
8 Captopril 25 mg Tablet 170.00 - -
9 Cetrizin tab Tablet 126,5 1,473 701 772
10 CefadroXil capsul 500 mg Kapsul 808.50 990 194 796
11 Combantrin Sirup Botol 18,563.00 6 3 3
12 Caviplex tab Tablet 1,280.00 - -
13 Ciprofloxacin 500 mg Tablet 554,4 328 125 203
14 Domperidone tablet Tablet 173.07 247 247 -
15 Domperidon suspensi 5 mg/5 ml Botol 60 ml 7,175.30 24 24 -
16 Dexametason tablet 0.5 mg Botol 60 ml 121.00 1,032 1,032 -
17 Gentamicin Salep Kulit Tube 4,620.00 22 15 7
18 Gliseril Guaiakolat 100 mg Tablet 154.00 844 844 -
19 Ibuprofen 200 mg Tablet 291.50 489 209 280
20 Ibuprofen 200 mg Tablet 320.10 1,000.00 - 1,000
21 Ketokonazole 200 mg Tablet 611.60 490 80 410
22 Klorfeniramin Maleat (CTM) Tablet 57,2 1,795 305 1,490
23 Kotrimoksazol syr Botol 5,170.00 14 1 13
24 Meloxicam 15 mg Tablet 317.90 809 216 593
25 Metronidazole 500 mg Tablet 317.90 283 75 208
26 Ondansentron Injeksi Ampul 7,999.97 5 - 5
27 Oksitetrasiklin Hcl salep 3 % Tube 3,575.00 31 14 17
28 Oksitetrasiklin Hcl salep 3 % Tube 3,410.00 50 - 50
29 Piridoksin HCl tablet 10 mg Tablet 264.00 1,298 1,298 -
30 Piridoksin HCl tablet 10 mg Tablet 258.50 2,500 923 1,577
31 Parasetamol syr syrup 5,130.40 - - -
32 Sianokobalamin (Vit.B12) Tablet 66.00 1,420 1,420 -
33 Sianokobalamin (Vit.B12) Tablet 97.90 2,915 446 2,469
34 Salisil bedak 2 % Pot 7,700.00 - - -
35 Salisil bedak 2 % Pot 7,700.00 27 22 5
36 Scabimite Krim Tablet 52,272.00 - - -
37 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 271.24 3,037 1,200 1,837
38 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 173.80 3,139 - 3,139
39 Ventolin Nebulizer Ampul 15,571.65 5 1 4
40 Vitamin B Compleks Tablet 137.50 2,313 1,991 322
41 Zink Sirup Botol 7,480.00 63 15 48
42 Zink Tablet Tablet 291.50 695 155 540
43 Scopma Tablet 1,376.00 - - -
44 Furosemid 40 mg Tablet 207.90 500 - 500
45 Entrostop (attapulgit) Tablet 1,000.00 7 - 7
46 Neurosanbe Injeksi Ampul 7,500.00 9 - 9
47 Provital Plus Tablet 7,524.00 325 85 240
48 Ranitidin Injeksi Injeksi 3,500.00 16 - 16
1 Masker Nebulizer Adult PCS 25,300.00 7 - 7
2 Masker Nebulizer Pediatrik PCS 25,300.00 11 - 11
3 Handscoen Non steril PASANG 5,060.00 -
4 KIT Gown Periksa PCS 45,120.00 -
5 Cateter 18 PCS 12,000.00 10 - 10
LAMPIRAN BERITA ACARA OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) UNIT APOTEK SUMBER DANA BOK
BULAN JANUARI 2022
1 2 3 4 5 6 7 8 9 10 11
OBAT
-
1 Handschon non steril Set 4,400.00 -
2 Masker Set 1,752.00 - - -
3 Masker Set 2,145.00 - - -
4 Masker Set 1,100.00 - - -
5 Masker KN95 Set 42,300.00 -
-
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NO : 91/PKM.ST/TU/II/2022
Pada hari ini Senin tanggal Dua Puluh Delapan Bulan Februari tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN FEBRUARI 2022
PEMAKAIAN
1 2 3 4 5 6 7 8 9 10 11
OBAT - -
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 494.00 - -
9 Amlodiphin tablet 5 mg Tablet 55.00 - - -
11 Amoksisilin kaplet 500 mg Kaplet 265.00 1,232.00 1,232 -
16 Antasida DOEN tablet kombinasi Tablet 60.00 - -
17 Antasida Sirup Botol 60 ml 1,759.00 67.00 67 -
20 Antihemorhoid DOEN kombinasi Supp 3,642.00 - -
22 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 2,036.00 2,036 -
23 Asam Mefenamat tablet 500 mg Tablet 297.00 377.00 377 -
25 Asetil sitein Tablet 394.00 43.00 - 43
27 Asiklovir tablet 400 mg Tablet 425.00 36.00 30 6
30 Betahistin Mesilat 6 mg tab Tablet 241.10 623.00 185 438
32 Betametason krim 0,1 % Tube 1,515.00 54.00 18 36
39 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 3,061.00 28.00 28 -
40 Ciproloxacin 500 mg isi 100 tab Tablet 281.00 -
41 Clobazam Tablet 384.00 227.00 53 174
42 Clozapin 25 mg 1,550.00 -
43 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 5.00 - 5.00
47 Diazepam 2 mg Tablet 86.00 44.00 3 41
51 Domperidon Tablet 96.00 -
52 Domperidon Tablet 75.00 594.00 151 443
56 Eritromisin 500 mg Kapsul 781.00 12.00 12 -
64 Garam oralit untuk 200 ml air Sachet 275.00 - -
68 Glimepiride tab 2 mg Tablet 207.00 -
79 Kaen - 3 B Botol 11,314.00 -
80 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 2,465.00 1,010 1,455
82 Ketokonazol Krim 2% Tube 2,694.00 5.00 5 -
85 Kloramfenikol kapsul 250 mg Kapsul 329.00 70.00 - 70.00
88 Kloramfenikol tetes telinga 3 % Botol 9,749.30 3.00 - 3
91 Kodein HCl tablet 10 mg Tablet 657.00 35.00 - 35
92 Kotrimoksazol dewasa tablet Tablet 133.00 365.00 32 333
93 Kotrimoksazol suspensi Botol 60 ml 2,052.00 -
97 Loratadin tablet 10 mg Tablet 136.00 39.00 39 -
101 Metformin tab 500 mg Tablet 77.00 1,650.00 255 1,395
104 Metilprednisolon tablet 4 mg Tablet 102.00 943.00 685 258
105 Metoklorpropamid injeksi (Sotatic) Ampul 4,554.00 4.00 - 4
111 Miconasol cream Tube 1,900.00 16.00 - 16
114 NA. Diklofenak tablet 50 mg Tablet 145.00 661.00 661 -
116 Natrium klorida larutan infus 0,9 % steril Botol 6,900.00 13.00 - 13
118 Nistatin 100.000 iu / tablet vaginal Tablet 645.00 -
123 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 48.00 48 -
125 Oksitetrasiklin HCl salep mata Tube 2,774.00 4.00 4 -
129 Parasetamol drops Botol 15 ml 7,646.00 40.00 11 29
130 Parasetamol tablet 500 mg Tablet 165.00 162.00 162 -
141 Ranitidin tablet Tablet 122.00 -
144 Ringer laktak larutan infus steril Botol 7,630.00 8.00 3 5
147 Salbutamol tablet 4 mg Tablet 123.00 138.00 - 138
148 Salep 2 - 4 kombinasi Pot 3,017.00 2.00 2 -
153 Simvastatin tablet 10 mg Tablet 73.00 1,355.00 170 1,185
171 Zivit sinc Tablet 2,500.00 - -
172 Tenolam Tablet 209,130.00 - -
173 Cotrimoksazole 960 mg Tablet 325.00 10.00 - 10
174 Stimuno Tablet - -
-
180 IV. Catheter No. 18 Pcs 14,625.00 -
181 IV. Catheter No. 20 Pcs 12,631.00 35.00 1 34
184 Urine Bag Pcs 4,933.50 2.00 1 1.00
-

1 2 3 4 5 6 7 8 9 10 11
OBAT
1 Allopurinol 100 mg Tablet 288.75 952 160 792

3 Amlodipine 10 mg Tablet 158.44 20.00 - 20
5 Ambroxol Tablet Tablet 180.00 -
6 Ambeven tab Tablet 2,664.20 -
6 Asam Tranexamat Tablet 1,365.00 -
9 Cetrizin tab Tablet 126,5 772 772 -
11 Combantrin Sirup Botol 18,563.00 3 - 3
12 Caviplex tab Tablet 1,280.00 -
14 Domperidone tablet Tablet 173.07 - -
15 Domperidon suspensi 5 mg/5 ml Botol 60 ml 7,175.30 - -
16 Dexametason tablet 0.5 mg Botol 60 ml 121.00 - -
17 Gentamicin Salep Kulit Tube 4,620.00 7 7 -
18 Gliseril Guaiakolat 100 mg Tablet 154.00 - -
19 Ibuprofen 200 mg Tablet 291.50 280 280 -
20 Ibuprofen 200 mg Tablet 320.10 1,000.00 26 974
22 Klorfeniramin Maleat (CTM) Tablet 57,2 1,490 303 1,187
25 Metronidazole 500 mg Tablet 317.90 208 75 133
26 Ondansentron Injeksi Ampul 7,999.97 5 - 5
27 Oksitetrasiklin Hcl salep 3 % Tube 3,575.00 17 17 -
29 Piridoksin HCl tablet 10 mg Tablet 264.00 - -
31 Parasetamol syr syrup 5,130.40 - -
32 Sianokobalamin (Vit.B12) Tablet 66.00 - -
33 Sianokobalamin (Vit.B12) Tablet 97.90 2,469 1,605 864
34 Salisil bedak 2 % Pot 7,700.00 - -
35 Salisil bedak 2 % Pot 7,700.00 5 5 -
36 Scabimite Krim Tablet 52,272.00 - -
37 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 271.24 1,837 1,479 358
38 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 173.80 3,139 - 3,139
39 Ventolin Nebulizer Ampul 15,571.65 4 1 3
40 Vitamin B Compleks Tablet 137.50 322 322 -
41 Zink Sirup Botol 7,480.00 48 12 36
43 Scopma Tablet 1,376.00 - - -
45 Entrostop (attapulgit) Tablet 1,000.00 7 7 -
46 Neurosanbe Injeksi Ampul 7,500.00 9 - 9
48 Ranitidin Injeksi Injeksi 3,500.00 16 - 16
4 KIT Gown Periksa PCS 45,120.00 -
5 Cateter 18 PCS 12,000.00 10 1 9

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,752.00 - - -
3 Masker Set 2,145.00 - - -
4 Masker Set 1,100.00 - - -
5 Masker KN95 Set 42,300.00 -
-
-
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 47 246 948
- 47 246 948
- 0 2 6
- - - -
- - - -
- - - -
- - - -
- 3 13 52
- - - -
- - - -
- - - -
- - - -
- 78 407 1,566
- - - -
- - - -
- - - -
- - - -
- 0 0 1
- 1 6 23
- - - -
- - - -
- 7 37 142
- - - -
- 1 4 14
- - - -
- - - -
- - - -
- - - -
- 0 2 6
- - - -
- 1 6 22
- - - -
- 2 11 41
- - - -
- - - -
- - - -
- - - -
- - - -
- 0 1 2
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
594 - - -
- - - -
- - - -
- 0 2 9
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1 6 23
- - - -
- - - -
- - - -
- - - -
- - - -
- 1 4 14
- - - -
- - - -
- 1 3 12
- - - -
- - - -
- - - -
- 39 202 777
- - - -
- 0 1 4
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1 6 25
- - - -
- 26 134 514
- - - -
- - - -
- 2 8 30
- - - -
- - - -
- - - -
- 10 51 196
- - - -
- 1 6 23
- 26 137 527
- - - -
- - - -
- - - -
- - - -
- - - -
- 0 1 4
- - - -
- - - -
- - - -
- 25 132 508
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 2 10 37
- - - -
- 0 1 3
- - - -
- - - -
- - - -
- 0 2 8
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 0 1 2
- - - -
- - - -
- - - -
- 0 0 2
- - - -
- - - -
- - - -
- - - -
- 7 34 131
- - - -
- - - -
- 78 404 1,555
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
#VALUE! - - -
- - -
- - -
0 0 1
- - -
- - - -
- 0 0 1
- - - -
- 0 0 2
- #REF! #REF! #REF!
- - - -
- 0 0 1
- 0 0 2
- - - -
- #REF! #REF! #REF!
- #REF! #REF! #REF!
#VALUE!

NO : 116/PKM.ST/TU/III/2022
Pada hari ini, Kamis tanggal Tiga Puluh Satu Bulan Maret tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : MARET 2022
PEMAKAIAN
NO NAMA OBAT SATUAN HARGA PERSEDIAAN PENERIMAAN PERSEDIAAN
1 2 3 4 5 6 7 8 9 10 11
OBAT - -
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 494.00 - - -
9 Amlodiphin tablet 5 mg Tablet 55.00 - 3,450 2,235 1,215.00
11 Amoksisilin kaplet 500 mg Kaplet 265.00 - 4,000 1,338 2,662.00
12 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 2,050.00 21.00 80 15 86
16 Antasida DOEN tablet kombinasi Tablet 60.00 1,600 81 1,519.00
17 Antasida Sirup Botol 60 ml 1,759.00 - 177 157 20
20 Antihemorhoid DOEN kombinasi Supp 3,642.00 10 - 10
22 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 182.50 - -
23 Asam Mefenamat tablet 500 mg Tablet 297.00 - 1,600 697 903
24 Asering Infus Botol 500ml 9,000.00 -
25 Asetil sitein Tablet 394.00 43.00 6 37
26 Asiklovir cream Tube 4,382.40 30.00 25.00 11 44
27 Asiklovir tablet 400 mg Tablet 425.00 6.00 300 98 208
28 Aspilet Tablet 163.00 -
29 Attapulgit (New Antides) Tablet 149.00 -
32 Betametason krim 0,1 % Tube 1,515.00 36.00 36 -
33 Betametason krim 0,1 % Tube 1,520.00 25 25 -
40 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 3,061.00 - -
41 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 2,215.00 - 50.00 34 16
43 Clobazam Tablet 384.00 174.00 53 121
44 Clozapin 25 mg 1,550.00 -
45 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 5.00 - 5.00
49 Diazepam 2 mg Tablet 86.00 41.00 100.00 4 137
54 Domperidon Tablet 75.00 443.00 1,000.00 516 927
58 Eritromisin 500 mg Kapsul 781.00 - -
66 Garam oralit untuk 200 ml air Sachet 275.00 200.00 56 144
70 Glimepiride tab 2 mg Tablet 207.00 -
71 Glimepiride tab 2 mg Tablet 123.00 300.00 - 300.00
76 Hidrocortison cream 2,5 % Tube 2,648.00 31.00 25.00 14 42.00
79 Ibuprofen syrup 100mg/5 ml Botol 60 ml 2,858.00 27.00 25.00 17 35
82 Kaen - 3 B Botol 11,314.00 -
83 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,455.00 500 345 1,610
85 Ketokonazol Krim 2% Tube 2,694.00 - -
88 Kloramfenikol kapsul 250 mg Kapsul 329.00 70.00 10 60.00
91 Kloramfenikol tetes telinga 3 % Botol 9,749.30 3.00 3 -
94 Kodein HCl tablet 10 mg Tablet 657.00 35.00 200.00 55 180
95 Kotrimoksazol dewasa tablet Tablet 133.00 333.00 200.00 - 533
96 Kotrimoksazol suspensi Botol 60 ml 2,052.00 20.00 - 20.00
97 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,235.00 1,000 855 1,380
100 Loperamid tablet Tablet 81.00 500.00 116 384.00
101 Loratadin tablet 10 mg Tablet 136.00 - -
102 Loratadin tablet 10 mg Tablet 117.00 1,000.00 193 807
106 Metformin tab 500 mg Tablet 77.00 1,395.00 500.00 582 1,313
109 Metilergometrin maleat tablet salut 0,125 mg Tablet 261.00 200.00 - 200
110 Metilprednisolon tablet 4 mg Tablet 102.00 258.00 3,000.00 520 2,738
111 Metoklorpropamid injeksi (Sotatic) Ampul 4,554.00 4.00 4 -
116 Miconasol cream Tube 3,926.00 4.00 4 -
120 NA. Diklofenak tablet 50 mg Tablet 145.00 - -
121 NA. Diklofenak tablet 50 mg Tablet 109.00 - 3,050.00 904 2,146
123 Natrium klorida larutan infus 0,9 % steril Botol 6,900.00 13.00 12 1
128 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 - 144.00 144 -
130 Oksitetrasiklin HCl salep mata Tube 2,774.00 - -
136 Parasetamol sirup 120 mg / 5 ml Botol 60 ml 1,160.00 100.00 33 67
138 Parasetamol tablet 500 mg Tablet 165.00 - 5,000.00 3,187 1,813.00
144 Prednison tablet 5 mg Tablet 73.00 100.00 30 70.00
151 Ranitidin tablet Tablet 85.00 2,000.00 100 1,900
154 Ringer laktak larutan infus steril Botol 7,630.00 5.00 20.00 10 15 -
157 Salbutamol tablet 4 mg Tablet 123.00 138.00 100.00 16 222
158 Salep 2 - 4 kombinasi Pot 3,017.00 - 22.00 10 12
163 Simvastatin tablet 10 mg Tablet 73.00 1,185.00 341 844
Yodium povidon larutan 10 % 60 ml Botol 4,255.00 -
Yodium povidon larutan 10 % 1000 ml Botol 149,314.00 -
179 Zivit sinc Tablet 2,500.00 -
180 Tenolam Tablet 209,130.00 10.00 1 9
181 Cotrimoksazole 960 mg Tablet 325.00 10.00 200.00 60 150
182 Stimuno Tablet 1,763.00 - 390.00 332 58.00
183 Azitromycin 500 mg Tablet 15,400.00 - 40.00 - 40.00
184 Favipiravir Tablet 22,500.00 - 200.00 - 200.00
-
187 Alat suntik sekali pakai 1 ml Pcs 743.98 40.00 2 38
189 Infusion set dewasa Set 5,445.00 13.00 25.00 6 32
195 Kertas Puyer Press Pcs 82.50 12,000.00 2,000 10,000
196 Urine Bag Pcs 4,933.50 1.00 10.00 1 10.00
197 Handsanitizer (Heclin) Btl 52,900.00 1.00 1
- -

1 2 3 4 5 6 7 8 9 10 11
OBAT

3 Amlodipine 10 mg Tablet 158.44 20.00 - 20
8 Asam ascorbat (Vit.C) Tablet 182.50 2,900.00 2,872 28
9 Betahistine Tablet 243.10 500.00 - 500
10 Captopril 25 mg Tablet 170.00 500.00 50 450
11 Cetrizin tab Tablet 126,5 - -
12 CefadroXil capsul 500 mg Kapsul 808.50 658 500.00 232 926
13 Combantrin Sirup Botol 18,563.00 3 3 -
16 Domperidone tablet Tablet 173.07 -
18 Dexametason tablet 0.5 mg Botol 60 ml 121.00 500.00 349 151
19 Gentamicin Salep Kulit Tube 4,620.00 -
20 Gliseril Guaiakolat 100 mg Tablet 154.00 -
21 Ibuprofen 200 mg Tablet 291.50 - -
22 Ibuprofen 200 mg Tablet 320.10 974.00 198 776
24 Klorfeniramin Maleat (CTM) Tablet 57,2 1,187 500.00 471 1,216
26 Meloxicam 15 mg Tablet 317.90 372 300.00 263 409
27 Metronidazole 500 mg Tablet 278.30 133 500.00 60 573
28 Ondansentron Injeksi Ampul 7,999.97 5 2 3
29 Oksitetrasiklin Hcl salep 3 % Tube 3,575.00 - -
30 Oksitetrasiklin Hcl salep 3 % Tube 3,410.00 46 50.00 18 78
32 Piridoksin HCl tablet 10 mg Tablet 258.50 - 4,250.00 1,661 2,589
33 Parasetamol syr syrup 5,130.40 -
34 Sianokobalamin (Vit.B12) Tablet 66.00 -
35 Sianokobalamin (Vit.B12) Tablet 97.90 864 847 17
37 Salisil bedak 2 % Pot 7,700.00 - 30.00 12 18
38 Scabimite Krim Tablet 52,272.00 -
39 Tiamin HCl mononitrat ( vit. B. 1 ) table Tablet 271.24 358 358 -
40 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 Tablet 173.80 3,139 2,997 142
41 Ventolin Nebulizer Ampul 15,571.65 3 - 3
42 Vitamin B Compleks Tablet 137.50 - 4,200.00 3,268 932
43 Zink Sirup Botol 7,480.00 36 20 16
44 Zink Tablet Tablet 291.50 277 500.00 180 597
45 Scopma Tablet 1,376.00 - -
47 Entrostop (attapulgit) Tablet 1,000.00 - -
48 Neurosanbe Injeksi Ampul 7,500.00 9 4 5
50 Ranitidin Injeksi Injeksi 3,500.00 16 9 7
4 KIT Gown Periksa PCS 45,120.00 3.00 3 -
5 Cateter 18 PCS 12,000.00 9 1 8

AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,752.00 - - -
3 Masker Set 2,145.00 - - -
4 Masker Set 1,100.00 - 50 50 -
5 Masker KN95 Set 42,300.00 -
-
-
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
51 268 1,029
51 268 1,029
1 3 12
- - -
- - -
- - -
3 16 62
6 31 121
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 1 5
0 1 5
0 2 8
4 20 75
- - -
- - -
10 51 197
- - -
1 7 28
- - -
- - -
- - -
- - -
- - -
0 1 2
- - -
- - -
- - -
2 11 41
2 11 41
- - -
- - -
- - -
- - -
- - -
0 1 3
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
2 11 43
- - -
- - -
2 8 31
- - -
- - -
- - -
- - -
- - -
- - -
1 3 11
- - -
- - -
1 3 13
- - -
- - -
- - -
13 69 265
- - -
- - -
- - -
- - -
0 2 8
- - -
- - -
- - -
- - -
- - -
2 11 42
- - -
- - -
33 171 658
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
22 116 448
- - -
2 10 40
20 104 400
- - -
- - -
- - -
- - -
- - -
- - -
0 1 3
- - -
- - -
- - -
- - -
- - -
0 2 9
0 2 9
- - -
- - -
- - -
- - -
- - -
- - -
6 29 111
- - -
- - -
- - -
- - -
- - -
0 1 4
- - -
- - -
123 637 2,452
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 2 8
- - -
- - -
1 3 12
0 2 8
- - -
- - -
- - -
- - -
13 68 262
- - -
- - -
45 233 896
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 1 3
0 0 2
0 0 2
#REF! #REF! #REF!
- - -
0 1 3
0 0 2
0 0 2
#REF! #REF! #REF!
- - -
0 0 2
0 0 2
0 1 4
- - -
#REF! #REF! #REF!
#REF! #REF! #REF!
#REF! #REF! #REF!

NO : 150/PKM.ST/TU/IV/2022
Pada hari ini, Sabtu tanggal Tiga Puluh Bulan April tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : APRIL 2022
PEMAKAIAN
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00
2 Albendazol tablet 400 mg Tablet 494.00 - -
3 Albendazol Sirup Botol 4,600.00
4 Albothyl cons.(policresulen) Botol 5ml 33,000.00
5 Alopurinol tablet 100 mg Tablet 99.00
6 Alprazolam 0,5 mg tablet Tablet 88.00
7 Amitripilin HCl tablet salut 25 mg Tablet 165.00
8 Amlodiphin tablet 5 mg Tablet 74.00
9 Amlodiphin tablet 5 mg Tablet 55.00 1,215.00 5,500 1,436 5,279.00
11 Amoksisilin kaplet 500 mg Kaplet 265.00 2,662.00 855 1,807.00
16 Antasida DOEN tablet kombinasi Tablet 60.00 1,519.00 307 1,212.00
17 Antasida Sirup Botol 60 ml 1,759.00 20.00 200 20 200
20 Antihemorhoid DOEN kombinasi Supp 3,642.00 10.00 3 7
22 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 -
23 Asam Mefenamat tablet 500 mg Tablet 297.00 903.00 500 428 975
25 Asetil sitein Tablet 394.00 37.00 37 -
27 Asiklovir tablet 400 mg Tablet 425.00 208.00 80 128
32 Betametason krim 0,1 % Tube 1,515.00 - -
33 Burnazin cream Tablet 33,000.00 - -
39 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 3,061.00 16.00 50.00 24 42
41 Clobazam Tablet 384.00 121.00 22 99
42 Clozapin 25 mg 1,550.00 -
43 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 5.00 - 5 -
47 Diazepam 2 mg Tablet 86.00 137.00 - 137
52 Domperidon Tablet 75.00 927.00 500.00 501 926
64 Garam oralit untuk 200 ml air Sachet 275.00 144.00 100.00 97 147
68 Glimepiride tab 2 mg Tablet 207.00 300.00 120 180.00
69 Glukosa larutan infus 5 % steril Botol 7,363.00 4.00 4 -
72 Haloperidol tablet 5 mg Tablet 56.00 185.00 - 185 -
75 Hyoscine-N-butilbromide 10 mg tab Tablet 1,662.00 500.00 55 445
79 Kaen - 3 B Botol 11,314.00 -
80 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,610.00 1,120 490
82 Ketokonazol Krim 2% Tube 2,694.00 -
85 Kloramfenikol kapsul 250 mg Kapsul 329.00 60.00 - 60 -
88 Kloramfenikol tetes telinga 3 % Botol 9,749.30 -
89 Klorfeniramin maleat ( CTM ) tablet 4 mg Tablet 26.00 - -
91 Kodein HCl tablet 10 mg Tablet 657.00 180.00 60 120
92 Kotrimoksazol dewasa tablet Tablet 133.00 533.00 70 463
93 Kotrimoksazol suspensi Botol 60 ml 2,052.00 20.00 2 18.00
94 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,380.00 1,500 542 2,338
96 Loperamid tablet Tablet 81.00 384.00 200.00 86 498.00
97 Loratadin tablet 10 mg Tablet 136.00 807.00 300 717 390
101 Metformin tab 500 mg Tablet 77.00 1,313.00 490 823
102 Metilergometrin maleat inj. 0,200 mg - 1 ml Ampul 3,399.00 73.00 73 -
105 Metilprednisolon tablet 4 mg Tablet 102.00 2,738.00 643 2,095
106 Metoklorpropamid injeksi (Sotatic) Ampul 4,554.00 -
109 Metoklorpropamid tab 5 mg Tablet 129.00 - -
111 Miconasol cream Tube 3,926.00 -
112 Miconasol cream Tube 1,900.00 3.00 3 -
115 NA. Diklofenak tablet 50 mg Tablet 145.00 - -
116 NA. Diklofenak tablet 50 mg Tablet 109.00 2,146.00 1,000.00 756 2,390
118 Natrium klorida larutan infus 0,9 % steril Botol 6,900.00 1.00 1 -
125 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 48.00 48 -
127 Oksitetrasiklin HCl salep mata Tube 2,774.00 50.00 - 50.00
129 Omeprasol Tablet 147.00 - -
131 Parasetamol sirup 120 mg / 5 ml Botol 60 ml 1,160.00 67.00 50.00 32 85
133 Parasetamol tablet 500 mg Tablet 165.00 1,813.00 3,000.00 1,020 3,793.00
138 Prednison tablet 5 mg Tablet 74.00 70.00 100.00 4 166.00
144 Ranitidin tablet Tablet 122.00 1,900.00 1,016 884
147 Ringer laktak larutan infus steril Botol 7,630.00 -
154 Serbuk PK Kristal Pot 5 g 2,585.00 - -
156 Simvastatin tablet 10 mg Tablet 73.00 844.00 500.00 605 739
159 Tablet tambah darah kombinasi Tablet 409.00 1,297.00 697 600
166 Vitamin B kompleks tablet Tablet 137.50 1,000.00 100 900.00
175 Zivit sinc Tablet 2,500.00 -
176 Tenolam Tablet 209,130.00 9.00 3 6
177 Cotrimoksazole 960 mg Tablet 325.00 150.00 60 90
178 Stimuno Tablet 1,763.00 58.00 300.00 30 328.00
179 Azitromycin 500 mg Tablet 15,400.00 40.00 - 40.00
180 Favipiravir Tablet 22,500.00 200.00 - 200.00
-
191 Kertas Puyer Press Pcs 82.50 10,000.00 10,000 -
192 Urine Bag Pcs 4,933.50 10.00 1 9.00
2

1 2 3 4 5 6 7 8 9 10 11
OBAT

3 Amlodipine 10 mg Tablet 158.44 20.00 20 -
4 Ambroxol Sirup Botol 6,099.50 4 4 -
8 Asam ascorbat (Vit.C) Tablet 182.50 28 28 -
9 Betahistine Tablet 243.10 500 - 500
10 Captopril 25 mg Tablet 170.00 450 145 305
11 Cetrizin tab Tablet 126,5 -
13 Combantrin Sirup Botol 18,563.00 - -
16 Domperidone tablet Tablet 173.07 -
18 Dexametason tablet 0.5 mg Botol 60 ml 121.00 151 122 29
19 Gentamicin Salep Kulit Tube 4,620.00 50.00 1 49
20 Gliseril Guaiakolat 100 mg Tablet 154.00 -
21 Ibuprofen 200 mg Tablet 291.50 -
22 Ibuprofen 200 mg Tablet 320.10 776.00 232 544
24 Klorfeniramin Maleat (CTM) Tablet 57,2 1,216 500.00 343 1,373
27 Metronidazole 500 mg Tablet 278.30 573 500.00 88 985
28 Ondansentron Injeksi Ampul 7,999.97 3 3 -
29 Oksitetrasiklin Hcl salep 3 % Tube 3,575.00 -
33 Parasetamol syr syrup 5,130.40 -
Parasetamol drop botol 10,725.00 10.00 - 10
34 Sianokobalamin (Vit.B12) Tablet 66.00 -
35 Sianokobalamin (Vit.B12) Tablet 97.90 17 7 10
37 Salisil bedak 2 % Pot 7,700.00 18 18 -
39 Tiamin HCl mononitrat ( vit. B. 1 ) tablet Tablet 271.24 - -
40 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 m Tablet 173.80 142 2,000.00 145 1,997
41 Ventolin Nebulizer Ampul 15,571.65 3 - 3
42 Vitamin B Compleks Tablet 137.50 932 873 59
43 Zink Sirup Botol 7,480.00 16 16 -
Zink Tablet Tablet 402.60 500.00 - 500
45 Scopma Tablet 1,376.00 -
47 Entrostop (attapulgit) Tablet 1,000.00 -
48 Neurosanbe Injeksi Ampul 7,500.00 5 2 3
50 Ranitidin Injeksi Injeksi 3,500.00 7 2 5
4 KIT Gown Periksa PCS 45,120.00 - - -
5 Cateter 18 PCS 12,000.00 8 2 6

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,752.00 - - -
3 Masker Set 2,145.00 - - -
4 Masker Set 1,100.00 - 50 50 -
5 Masker KN95 Set 42,300.00 -
-
-
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
33 171 658
33 171 658
0 2 9
- - -
- - -
- - -
12 61 236
1 4 15
- - -
- - -
0 1 2
- - -
- - -
- - -
- - -
1 7 28
1 7 28
0 1 5
3 16 62
- - -
- - -
1 4 15
- - -
- - -
- - -
- - -
- - -
- - -
1 3 10
- - -
1 5 18
- - -
1 4 17
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
4 19 75
- - -
- - -
1 4 15
5 24 92
0 1 3
- - -
- - -
- - -
1 3 11
- - -
2 11 42
1 3 12
- - -
- - -
- - -
43 224 862
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
2 12 46
3 14 54
0 0 2
21 108 417
- - -
3 17 66
28 143 552
- - -
- - -
- - -
19 98 377
3 15 56
- - -
25 129 495
25 129 495
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 1
0 0 1
- - -
- - -
- - -
- - -
- - -
- - -
2 10 37
- - -
- - -
- - -
- - -
- - -
0 1 5
- - -
- - -
39 204 785
- - -
- - -
- - -
- - -
- - -
0 1 3
- - -
- - -
- - -
- - -
- - -
39 203 782
- - -
- - -
- - -
- - -
- - -
0 1 5
0 1 4
- - -
- - -
- - -
- - -
23 121 465
- - -
- - -
27 139 536
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 1
0 1 2
0 1 2
#REF! #REF! #REF!
- - -
0 0 1
0 1 2
0 1 2
#REF! #REF! #REF!
- - -
0 1 4
0 1 2
0 1 5
- - -
#REF! #REF! #REF!
#REF! #REF! #REF!
#REF! #REF! #REF!

NO : 193/PKM.ST/TU/V/2022
Pada hari ini, Selasa tanggal Tiga Puluh Satu Bulan Mei tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : MEI 2022
NO NAMA OBAT SATUAN HARGA PENERIMAAN PEMAKAIAN EXP RETUR RUSAK
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 380.00 -
8 Amlodiphin tablet 5 mg Tablet 55.00 5,279.00 1,127 4,152.00
11 Amoksisilin kaplet 500 mg Kaplet 265.00 1,807.00 1,504 303
16 Antasida DOEN tablet kombinasi Tablet 60.00 1,212.00 293 919
17 Antasida Sirup Botol 60 ml 1,756.00 200.00 49 151.00
20 Antihemorhoid DOEN kombinasi Supp 3,260.00 7.00 - 7
22 Asam Mefenamat tablet 500 mg Tablet 297.00 975.00 696 279.00
24 Asetil sitein Tablet 394.00 -
25 Asiklovir cream Tube 4,382.40 37.00 6 31.00
29 ARV Dewasa Tablet 209,130.00 -
30 Azithromycin 500 mg 15,400.00 40.00 - 40
31 Betahistin Mesilat 6 mg tab Tablet 241.10 162.00 162
32 Betametason krim 0,1 % Tube 1,520.00 36.00 25.00 - 61.00
35 Cavida gel 15 gram Tube 41,000.00 1.00 1
39 Cetirizin Syrup Botol 60 ml 3,061.00 42.00 36 6
40 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 2,215.00 -
42 Clobazam Tablet 384.00 99.00 200.00 23 276
43 Clozapin 25 mg 1,550.00 -
44 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 -
48 Diazepam 2 mg Tablet 86.00 137.00 - 137.00
52 Domperidon Tablet 75.00 926.00 400.00 508 818
57 Eugenol cairan Pcs 38,130.00 -
61 Fenobarbital tablet 30 mg Tablet 177.00 96.00 - 96
69 Glibenklamid tablet 5 mg Tablet 137.00 -
71 Glibenklamid tablet 5 mg Tablet 137.00 270.00 - 270.00
72 Glukosa larutan infus 5 % steril Botol 6,627.00 -
75 Haloperidol tablet 5 mg Tablet 56.00 -
78 Hyoscine-N-butilbromide 10 mg tab Tablet 1,662.00 645.00 27 618.00
79 Ibuprofen syrup 100mg/5 ml Botol 60 ml 2,858.00 19.00 16 3.00
82 Kaen - 3 B Botol 11,314.00 -
83 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 490.00 2,000.00 1,010 1,480.00
89 Kloramfenikol kapsul 250 mg Kapsul 329.00 -
95 Kodein HCl tablet 10 mg Tablet 657.00 120.00 10 110.00
97 Kotrimoksazol 960 mg Tablet (HIV) Tablet 325.00 90.00 - 90
100 Lidokain spray Botol 177,216.00 -
101 Loperamid tablet Tablet 81.00 498.00 55 443
102 Loratadin tablet 10 mg Tablet 136.00 390.00 390
103 Loratadin tablet 10 mg Tablet 117.00 1,000.00 239 761
107 Metformin tab 500 mg Tablet 77.00 823.00 300 523
117 Miconasol cream Tube 1,900.00 -
119 NA. Diklofenak tablet 50 mg Tablet 109.00 2,390.00 995 1,395.00
125 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 -
128 Oseltamivir Phosphate Kapsul 75 mg 20,182.50 -
132 Parasetamol tablet 500 mg Tablet 165.00 3,793.00 974 2,819
137 Prednison tablet 5 mg Tablet 74.00 166.00 - 166
142 Ranitidin injeksi Ampul 858.00 -
143 Ranitidin tablet Tablet 122.00 884.00 877 7
144 Ranitidin tablet Tablet 85.00 500.00 - 500
150 Salbutamol tablet 4 mg Tablet 123.00 216.00 17 199.00
151 Salep 2 - 4 kombinasi Pot 3,017.00 7.00 24.00 3 28
156 Simvastatin tablet 10 mg Tablet 73.00 739.00 500.00 587 652.00
159 Stimuno Tablet 1,763.00 328.00 58 270
160 Tablet tambah darah kombinasi Tablet 409.00 600.00 2,010.00 1,475 1,135.00
162 Tramadol tablet Tablet 374.00
165 Vitamin B kompleks tablet Tablet 137.50 900.00 900
167 Vitamin C 500 mg Tablet 618.75 -
170 Zivit Zink -
171 Tenolam 209,130.00 6.00 - 6.00
175 Handschon Steril Set -
176 Infusion set Dewasa Pcs 5,445.00 27.00 - 27.00
181 Kertas Puyer Press Pcs 82.50 -
182 Masker Pcs -
183 Masker N95 Pcs -
184 Urine Bag Pcs 4,933.50 9.00 - 9
NO NAMA OBAT SATUAN HARGA PENERIMAAN PEMAKAIAN EXP RETUR
AWAL AKHIR
RUSAK
1 2 3 4 5 6 7 8 9 10 11
OBAT

Allopurinol 100 mg Tablet 89.00 3,200 Err:507 3,200
2 Amlodipin 10 mg Tablet 218.56 3,000.00 275 2,725
2 Ambroxol Sirup Botol 6,099.50 -
5 Asam Ascorbat 50 mg Tablet 219.78 3,000.00 485 2,515
6 Betahistin Maleat tablet Tablet 243.10 500 58 442
7 Cetrizin tab Tablet 157.49 -
9 Ciproloxacin 500 mg isi 100 tab Tablet 554.40 113 100 13.00
10 Cefadroxil 500 mg Tablet 808.50 436 500.00 374 562
11 Domperidon suspensi 5 mg/5 ml Botol 60 ml 6,715.50 50.00 - 50.00
12 Deksametason tab Tablet 121.00 29 29
Deksametason tab Tablet 115.96 1,500.00 34 1,466
Furosemid Tablet Tablet 207.90 500 20 480
13 Guefenisin tablet Tablet 141.63 3,000.00 356 2,644
16 Ketokonazol 200 mg Tablet 611.60 320 51 269
17 Klorfeniramin Maleat (CTM) Tablet 57.20 1,373 157 1,216
18 Kotrimoksazol Sirup Botol 5,170.00 9 - 9
19 Metronidazol 500 mg Tablet 278.30 985 - 985
21 Ondansentron Injeksi Ampul 7,999.97 -
22 Oksitetrasiklin Hcl Salep 3% Tube 3,410.00 45 50.00 20 75
23 Piridoksin HCl tablet 10 mg Tablet 155.06 2,000.00 653 1,347.00
24 Parasetamol Drops Botol 10,725.00 10 1 9
25 Sianokobalamin (Vit. B12) Tablet 97.90 10 10
Sianokobalamin (Vit. B12) Tablet 123.48 3,000.00 520 2,480
26 Salisil bedak 2 % Pot 4,273.50 30.00 10 20.00
28 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 mg Tablet 173.80 1,997 97 1,900.00
29 Ventolin Nebulizer Ampul 15,571.65 3 3
30 Vitamin B Compleks Tablet 137.50 59 59
Vitamin B Compleks Tablet 155.06 3,000.00 1,430 1,570
31 Zink Sirup Botol 6,227.10 50.00 22 28
33 Zink Tablet Tablet 402.60 500 - 500
PERBEKALAN FARMASI -
34 Kateter No. 18 Pcs 12,000.00 6 - 6
35 Masker Nebulizer Adult Pcs 25,300.00 7 - 7
36 Masker Nebulizer Pediatrik Pcs 25,300.00 11 - 11
35

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 100.00 100 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 233/PKM.ST/TU/VI/2022
Pada hari ini, Kamis tanggal Tiga Puluh Bulan Juni tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : JUNI 2022
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 380.00 100.00 1 99
8 Amlodiphin tablet 5 mg Tablet 55.00 4,152.00 968 3,184.00
11 Amoksisilin kaplet 500 mg Kaplet 265.00 303.00 303
12 Amoksisilin kaplet 500 mg Kaplet 231.00 4,200.00 1,995 2,205
17 Antasida DOEN tablet kombinasi Tablet 60.00 919.00 502 417
21 Antihemorhoid DOEN kombinasi Supp 3,260.00 7.00 - 7
24 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 600.00 589 11
25 Asam Mefenamat tablet 500 mg Tablet 297.00 279.00 1,200.00 1,116 363.00
29 Asiklovir tablet 400 mg Tablet 425.00 80.00 - 80.00
33 Azithromycin 500 mg 15,400.00 40.00 - 40
34 Betahistin Mesilat 6 mg tab Tablet 241.10 -
35 Betametason krim 0,1 % Tube 1,520.00 61.00 5 56.00
38 Cavida gel 15 gram Tube 41,000.00 -
40 Cefadroxyl syrup kering 125 mg/5ml Botol 60 ml 4,360.00 9.00 30.00 19 20
42 Cetirizin Syrup Botol 60 ml 3,061.00 6.00 - 6
43 Cetirizin Syrup Botol 60 ml 22,153.00 -
44 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 2,215.00 50.00 - 50
46 Clobazam Tablet 384.00 276.00 29 247
47 Clozapin 25 mg 1,550.00 -
52 Diazepam 2 mg Tablet 86.00 137.00 6 131.00
57 Domperidon Tablet 75.00 818.00 691 127
84 Ibuprofen syrup 100mg/5 ml Botol 60 ml 2,858.00 3.00 - 3.00
86 Ibuprofen tablet 400 mg Tablet -
88 Kaen - 3 B Botol 11,314.00 -
89 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,480.00 500.00 1,310 670.00
108 Loratadin tablet 10 mg Tablet 136.00 -
109 Loratadin tablet 10 mg Tablet 117.00 761.00 500.00 701 560
113 Metformin tab 500 mg Tablet 77.00 523.00 130 393
117 Metilprednisolon tablet 4 mg Tablet 102.00 1,382.00 996 386
125 NA. Diklofenak tablet 50 mg Tablet 109.00 1,395.00 1,750.00 1,370 1,775.00
140 Parasetamol tablet 500 mg Tablet 165.00 2,819.00 1,910 909
151 Ranitidin tablet Tablet 122.00 7.00 7
152 Ranitidin tablet Tablet 85.00 500.00 2,000.00 1,566 934
164 Simvastatin tablet 10 mg Tablet 73.00 652.00 1,000.00 1,053 599.00
167 Stimuno Tablet 1,763.00 270.00 60 210
168 Tablet tambah darah kombinasi Tablet 409.00 1,135.00 3,000.00 418 3,717.00
169 Tiamin HCl mononitrat ( vit. B. 1 ) tablet 50 m Tablet 96.00 -
174 Vitamin B kompleks tablet Tablet 3,000.00 - 3,000
179 Zivit Zink -
180 Tenolam 209,130.00 6.00 - 6.00
185 Infusion set Dewasa Pcs 5,445.00 27.00 - 27.00
191 Masker Pcs -
193 Urine Bag Pcs 4,933.50 9.00 3 6
AWAL RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
-
1 Allopurinol 100 mg Tablet 288.75 71 71 -
Allopurinol 100 mg Tablet 89.00 3,200 290 2,910
2 Amlodipin 10 mg Tablet 218.56 2,725 405 2,320
4 Asam Tranexamat Tablet 1,053.00 78 - 78
5 Asam Ascorbat 50 mg Tablet 219.78 2,515 600.00 2,782 333
8 Captopril 25 mg Tablet 170.00 220 1,000.00 31 1,189
9 Ciproloxacin 500 mg isi 100 tab Tablet 554.40 13 - 13.00
10 Cefadroxil 500 mg Tablet 808.50 562 351 211
11 Domperidon suspensi 5 mg/5 ml Botol 60 ml 6,715.50 50 22 28.00
12 Deksametason tab Tablet 121.00 -
Deksametason tab Tablet 115.96 1,466 331 1,135
13 Guefenisin tablet Tablet 141.63 2,644 1,628 1,016
15 Ibuprofen 200 mg Tablet 320.10 430 1,000.00 512 918
17 Klorfeniramin Maleat (CTM) Tablet 57.20 1,216 476 740
18 Kotrimoksazol Sirup Botol 5,170.00 9 - 9
19 Metronidazol 500 mg Tablet 278.30 985 142 843
20 Meloxicam 15 mg Tablet 317.90 2 - 2
22 Oksitetrasiklin Hcl Salep 3% Tube 3,410.00 75 10 65
23 Piridoksin HCl tablet 10 mg Tablet 155.06 1,347 3,000.00 1,915 2,432.00
24 Parasetamol Drops Botol 10,725.00 9 - 9
25 Sianokobalamin (Vit. B12) Tablet 97.90 -
Sianokobalamin (Vit. B12) Tablet 123.48 2,480 467 2,013
26 Salisil bedak 2 % Pot 4,273.50 20 30.00 15 35.00
28 Tiamin HCl mononitrat ( vit. B. 1 ) ta Tablet 173.80 1,900 1,764 136.00
30 Vitamin B Compleks Tablet 137.50 -
Vitamin B Compleks Tablet 155.06 1,570 1,570
31 Zink Sirup Botol 6,227.10 28 50.00 42 36
33 Zink Tablet Tablet 402.60 500 - 500
34 Kateter No. 18 Pcs 12,000.00 6 3 3
35

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 100.00 100 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 285/PKM.ST/TU/VII/2022
Pada hari ini, Kamis tanggal Tiga Puluh Satu Bulan Juli tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : JULI 2022
NO NAMA OBAT SATUAN HARGA PERSEDIAAN PENERIMAAN PEMAKAIAN EXP RETUR RUSAK PERSEDIAAN
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
2 Albendazol tablet 400 mg Tablet 380.00 99.00 - 99
8 Amlodiphin tablet 5 mg Tablet 55.00 3,184.00 845 2,339.00
11 Amoksisilin kaplet 500 mg Kaplet 265.00 -
12 Amoksisilin kaplet 500 mg Kaplet 231.00 2,205.00 2,000.00 1,845 2,360
17 Antasida DOEN tablet kombinasi Tablet 60.00 417.00 1,000.00 386 1,031
21 Antihemorhoid DOEN kombinasi Supp 3,260.00 7.00 10.00 17
24 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 11.00 3,000.00 723 2,288
25 Asam Mefenamat tablet 500 mg Tablet 297.00 363.00 700.00 672 391.00
26 Asam Mefenamat tablet 500 mg Tablet 117.00 300.00 - 300
34 Azithromycin 500 mg 15,400.00 40.00 - 25 15
43 Cetirizin Syrup Botol 60 ml 3,061.00 6.00 6
45 Cetirizin Syrup 5 mg/ 5 ml Botol 60 ml 2,215.00 50.00 30 20
46 Ciproloxacin 500 mg isi 100 tab Tablet 500.00 - 500.00
47 Clobazam Tablet 384.00 247.00 30 217
48 Clozapin 25 mg 1,550.00 -
71 Favipiravir Tablet 22,500.00 200.00 - 200
76 Glimepiride tab 2 mg Tablet 123.00 15.00 500.00 140 375.00
85 Ibuprofen syrup 100mg/5 ml Botol 60 ml 3.00 30.00 4 29.00
87 Ibuprofen tablet 400 mg Tablet 500.00 50 450
89 Kaen - 3 B Botol 11,314.00 -
90 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 670.00 1,000.00 1,210 460.00
104 Kotrimoksazol 960 mg Tablet (HIV) Tablet 325.00 -
106 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,252.00 567 685
110 Loratadin tablet 10 mg Tablet 117.00 560.00 2,000.00 1,187 1,373
114 Metformin tab 500 mg Tablet 77.00 393.00 600.00 710 283
118 Metilprednisolon tablet 4 mg Tablet 102.00 386.00 2,000.00 970 1,416
124 Miconasol cream Tube 1,900.00 16.00 24.00 21 19
126 NA. Diklofenak tablet 50 mg Tablet 109.00 1,775.00 1,208 567.00
139 Parasetamol drops Botol 15 ml 7,646.00 8.00 8
141 Parasetamol tablet 500 mg Tablet 165.00 909.00 3,000.00 2,223 1,686
146 Prednison tablet 5 mg Tablet 74.00 166.00 6 160
153 Ranitidin tablet Tablet 85.00 934.00 3,000.00 1,368 2,566
165 Simvastatin tablet 10 mg Tablet 73.00 599.00 1,000.00 470 1,129.00
168 Stimuno Tablet 1,763.00 210.00 210
169 Tablet tambah darah kombinasi Tablet 409.00 3,717.00 2,239 1,478.00
175 Vitamin B kompleks tablet Tablet 3,000.00 3,000.00 2,053 3,947
180 Zivit Zink -
181 Tenolam 209,130.00 6.00 - 6
186 Infusion set Dewasa Pcs 5,445.00 27.00 26 1.00
188 IV. Catheter No. 22 Pcs 12,631.00 7.00 7
189 IV. Catheter No. 24 Pcs 14,625.00 4.00 4
192 Masker Pcs -
194 Urine Bag Pcs 4,933.50 6.00 4 2
AWAL RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
-
1 Allopurinol 100 mg Tablet 288.75 - -
Allopurinol 100 mg Tablet 89.00 2,910 609 2,301
4 Asam Tranexamat Tablet 1,053.00 78 78
5 Asam Ascorbat 50 mg Tablet 219.78 333 600.00 933
6 Betahistin Maleat tablet Tablet 243.10 193 300.00 297 196
8 Captopril 25 mg Tablet 170.00 1,189 70 1,119
9 Ciproloxacin 500 mg isi 100 tab Tablet 554.40 13 10 3.00
10 Cefadroxil 500 mg Tablet 808.50 211 207 4
Deksametason tab Tablet 115.96 1,135 322 813
13 Guefenisin tablet Tablet 141.63 1,016 593 423
17 Klorfeniramin Maleat (CTM) Tablet 57.20 740 1,000.00 759 981
18 Kotrimoksazol Sirup Botol 5,170.00 9 4 5
20 Meloxicam 15 mg Tablet 317.90 2 2
23 Piridoksin HCl tablet 10 mg Tablet 155.06 2,432 1,385 1,047.00
24 Parasetamol Drops Botol 10,725.00 9 5 4
Sianokobalamin (Vit. B12) Tablet 123.48 2,013 1,968 45
26 Salisil bedak 2 % Pot 4,273.50 35 23 12.00
28 Tiamin HCl mononitrat ( vit. B. 1 ) tablet Tablet 173.80 136 131 5.00
Vitamin B Compleks Tablet 155.06 -
31 Zink Sirup Botol 6,227.10 36 36
32 Zink Tablet Tablet 291.50 42 42
34 Kateter No. 18 Pcs 12,000.00 3 3
35

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 100.00 100 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 312/PKM.ST/TU/VIII/2022
Pada hari ini, Rabu tanggal Tiga Puluh Satu Bulan Agustus tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : AGUSTUS 2022
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
12 Amoksisilin kaplet 500 mg Kaplet 231.00 2,360.00 1,000.00 2,830 530
18 Antasida Sirup Botol 60 ml 1,756.00 20.00 100.00 54 66.00
24 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 46.41 2,288.00 4,000.00 4,718 1,570
25 Asam Mefenamat tablet 500 mg Tablet 297.00 391.00 391
Asam Mefenamat tablet 500 mg Tablet 117.00 300.00 1,500.00 413 1,387
27 Asetil sitein Tablet 394.00 2,580.00 1,596 984
28 Asiklovir cream Tube 4,382.40 27.00 - 27.00
33 Azithromycin 500 mg 15,400.00 15.00 - 15
39 Cefadroxyl 500 mg Kapsul 830.00 500.00 73 427.00
45 Ciproloxacin 500 mg isi 100 tab Tablet 500.00 61 439.00
46 Clobazam Tablet 384.00 217.00 101 116
47 Clozapin 25 mg 1,550.00 -
66 Fenobarbital tablet 30 mg Tablet 177.00 -
68 Fitomenadion ( vit k ) tablet salut 10 mg Tablet 873.00 100.00 - 100.00
70 Favipiravir Tablet 22,500.00 -
84 Ibuprofen syrup 100mg/5 ml Botol 60 ml 29.00 - 29.00
86 Ibuprofen tablet 400 mg Tablet 450.00 500.00 274 676
88 Kaen - 3 B Botol 11,314.00 -
89 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 460.00 2,000.00 1,070 1,390.00
101 Kodein HCl tablet 10 mg Tablet 657.00 80.00 100.00 90 90.00
103 Kotrimoksazol 960 mg Tablet (HIV) Tablet 325.00 200.00 40 160
104 Kotrimoksazol suspensi Botol 60 ml 2,052.00 5.00 30.00 3 32.00
105 Lanzoprasole kapsul 30 mg Kapsul 278.00 685.00 1,500.00 1,059 1,126
109 Loratadin tablet 10 mg Tablet 117.00 1,373.00 1,000.00 1,161 1,212
113 Metformin tab 500 mg Tablet 77.00 283.00 1,400.00 910 773
115 Metilergometrin maleat tablet salut 0,125 mg Tablet 245.00 3.00 3 -
117 Metilprednisolon tablet 4 mg Tablet 102.00 1,416.00 1,000.00 1,087 1,329
124 Multivitamin sirup anak Botol 16,500.00 48.00 5 43
125 NA. Diklofenak tablet 50 mg Tablet 109.00 567.00 533 34.00
126 Natrium klorida larutan infus 0,9 % steril Botol 6,840.00 - -
127 Nifedipine tablet 10 mg Tablet 123.00 - -
129 Nistatin 500.000 iu tablet salut Tablet 857.00 - -
130 Novabion Tablet 202.40 - -
131 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,273.00 48.00 - 48.00
133 Oksitetrasiklin HCl salep mata Tube 2,774.00 10.00 - 10.00
138 Parasetamol drops Botol 15 ml 7,646.00 -
140 Parasetamol tablet 500 mg Tablet 165.00 1,686.00 3,000.00 2,127 2,559
152 Ranitidin tablet Tablet 85.00 2,566.00 1,000.00 1,422 2,144
158 Salbutamol tablet 4 mg Tablet 123.00 29.00 - 29.00
164 Simvastatin tablet 10 mg Tablet 73.00 1,129.00 872 257.00
167 Stimuno Tablet 1,763.00 600.00 183 417
168 Tablet tambah darah kombinasi Tablet 409.00 1,478.00 3,450.00 2,774 2,154.00
179 Zivit Zink -
180 Tenolam 209,130.00 12.00 4 8.00
181 Permethrin 5% cream MK 11,466.00 10.00 - 10.00
182 Alat suntik sekali pakai 1 ml Pcs 743.98 5.00 5 -
183 Alat suntik sekali pakai 5 ml Pcs 1,201.75 2.00 2 -
185 Infusion set Dewasa Pcs 5,445.00 1.00 1 -
186 IV. Catheter No. 20 Pcs 12,631.00 5.00 5 -
187 IV. Catheter No. 22 Pcs 12,631.00 - -
190 Kertas Puyer Press Pcs 82.50 - -
191 Masker Pcs 1,385.00 50.00 50 -
193 Urine Bag Pcs 4,933.50 2.00 2 -
NO NAMA OBAT SATUAN HARGA PERSEDIAAN PENERIMAAN PEMAKAIAN EXP RETUR PERSEDIAAN
AWAL AKHIR
RUSAK
1 2 3 4 5 6 7 8 9 10 11
OBAT

7 Asam Ascorbat 50 mg Tablet 219.78 -
8 Betahistin Maleat tablet Tablet 243.10 196 700.00 250 646
10 Captopril 25 mg Tablet 170.00 1,119 70 1,049
11 Ciproloxacin 500 mg isi 100 tab Tablet 554.40 3 3 -
12 Cefadroxil 500 mg Tablet 808.50 4 4 -
15 Deksametason tab Tablet 115.96 813 413 400
16 Furosemid Tablet Tablet 207.90 455 6 449
17 Guefenisin tablet Tablet 141.63 423 2,000.00 1,213 1,210
21 Klorfeniramin Maleat (CTM) Tablet 57.20 981 963 18
22 Kotrimoksazol Sirup Botol 5,170.00 5 5 -
24 Meloxicam 15 mg Tablet 317.90 -
27 Piridoksin HCl tablet 10 mg Tablet 155.06 1,047 3,000.00 2,079 1,968.00
28 Parasetamol Drops Botol 10,725.00 4 18.00 7 15
30 Sianokobalamin (Vit. B12) Tablet 123.48 45 3,000.00 1,870 1,175
31 Salisil bedak 2 % Pot 4,273.50 12 30.00 16 26.00
33 Tiamin HCl mononitrat ( vit. B. 1 ) tablet Tablet 173.80 5 3,000.00 663 2,342.00
37 Zink Sirup Botol 6,227.10 48.00 31 17
1 Kateter No. 18 Pcs 12,000.00 -

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 - - -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 367/PKM.ST/TU/IX/2022
Pada hari ini, Jumat tanggal Tiga Puluh Bulan September tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : SEPTEMBER 2022
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
8 Amlodiphin tablet 5 mg Tablet 55.00 1,044.00 5,500.00 1,367 5,177.00
12 Amoksisilin kaplet 500 mg Kaplet 231.00 530.00 2,000.00 1,540 990
13 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 2,050.00 19.00 90.00 43 66
17 Antasida DOEN tablet kombinasi Tablet 60.00 309.00 1,500.00 293 1,516
18 Antasida Sirup Botol 60 ml 1,756.00 66.00 100.00 140 26.00
26 Asam Mefenamat tablet 500 mg Tablet 117.00 1,387.00 701 686
28 Asetil sitein Tablet 394.00 984.00 1,020.00 1,328 676
34 Azithromycin 500 mg 15,400.00 15.00 - 15
36 Betametason krim 0,1 % Tube 1,520.00 14.00 50.00 15 49.00
40 Cefadroxyl 500 mg Kapsul 830.00 427.00 396 31.00
46 Ciproloxacin 500 mg isi 100 tab Tablet 439.00 500.00 104 835.00
47 Clobazam Tablet 384.00 116.00 200.00 92 224
48 Clozapin 25 mg 1,550.00 -
50 Desoximetason salep kulit Tube 18,719.00 12.00 - 12
58 Domperidon Tablet 75.00 990.00 900.00 396 1,494
69 Fitomenadion ( vit k ) tablet salut 10 mg Tablet 873.00 100.00 - 100.00
74 Gentamisin salep Tube 3,650.00 24.00 - 24
78 Glibenklamid tablet 5 mg Tablet 137.00 100.00 100.00 - 200.00
86 Ibuprofen syrup 100mg/5 ml Botol 60 ml 29.00 - 29 -
88 Ibuprofen tablet 400 mg Tablet 676.00 462 214
90 Kaen - 3 B Botol 11,314.00 -
91 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,390.00 2,000.00 1,390 2,000.00
99 Kloramfenikol salep kulit Tube 3,794.00 24.00 - 24
104 Kodein HCl tablet 10 mg Tablet 657.00 90.00 200.00 110 180.00
108 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,126.00 846 280
109 Lidokain spray Botol 177,216.00 - -
110 Loperamid tablet Tablet 81.00 188.00 100.00 152 136
112 Loratadin tablet 10 mg Tablet 117.00 1,212.00 1,000.00 2,021 191
118 Metilergometrin maleat tablet salut 0,125 mg Tablet 245.00 - -
119 Metilergometrin maleat tablet salut 0,125 mg Tablet 261.00 190.00 200.00 45 345
128 NA. Diklofenak tablet 50 mg Tablet 109.00 34.00 19 15.00
129 NA. Diklofenak tablet 25 mg Tablet - 2,800.00 1,391 1,409.00
135 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,402.00 48.00 15 33.00
144 Parasetamol tablet 500 mg Tablet 165.00 2,559.00 2,000.00 2,399 2,160
149 Prednison tablet 5 mg Tablet 74.00 160.00 6 154
156 Ranitidin tablet Tablet 85.00 2,144.00 500.00 1,068 1,576
163 Salbutamol tablet 4 mg Tablet 67.61 100.00 - 100.00
166 Salisil bedak 2 % Botol 12,000.00 30.00 - 30.00
173 Stimuno Tablet 1,763.00 417.00 337 80
174 Sucralfat Botol 6,130.00 50.00 4 46
183 Vitamin C 500 mg Tablet Tablet 618.75 -
186 Zivit Zink Botol -
187 Tenolam Botol 209,130.00 8.00 5 3.00
188 Permethrin 5% cream MK Tube 11,466.00 10.00 20.00 - 30.00
190 Alat suntik sekali pakai 1 ml Pcs 743.98 - -
191 Alat suntik sekali pakai 5 ml Pcs 1,201.75 - -
193 Infusion set Dewasa Pcs 5,445.00 - -
198 Kertas Puyer Press Pcs 82.50 - -
199 Masker Pcs 1,385.00 - 50.00 50 -
201 Urine Bag Pcs 4,933.50 - -
NO NAMA OBAT SATUAN HARGA PERSEDIAAN PENERIMAAN PEMAKAIAN EXP RETUR PERSEDIAAN
AWAL RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT

2 Allopurinol 100 mg Tablet 89.00 2,301 239 2,062
3 Amlodipin 10 mg Tablet 218.56 1,410 745 665
10 Captopril 25 mg Tablet 170.00 1,049 66 983
11 Ciproloxacin 500 mg isi 100 tab Tablet 554.40 - -
12 Cefadroxil 500 mg Tablet 808.50 - -
13 Domperidon suspensi 5 mg/5 ml Botol 60 ml 6,715.50 8.00 45.00 18 35.00
15 Deksametason tab Tablet 115.96 400 500.00 383 517
16 Furosemid Tablet Tablet 207.90 449 - 449
17 Guefenisin tablet Tablet 141.63 1,210 2,000.00 1,622 1,588
18 Gentamicin Salep Kulit Tube 4,620.00 3 3 -
19 Ibuprofen 200 mg Tablet 320.10 60 60 -
21 Klorfeniramin Maleat (CTM) Tablet 57.20 18 18 -
22 Kotrimoksazol Sirup Botol 5,170.00 - -
27 Piridoksin HCl tablet 10 mg Tablet 127,65 1,968.00 2,000.00 1,334 2,634.00
28 Parasetamol Drops Botol 10,725.00 15 15 -
30 Sianokobalamin (Vit. B12) Tablet 105,45 1,175 2,000.00 800 2,375
31 Salisil bedak 2 % Pot 4,273.50 26.00 17 9.00
33 Tiamin HCl mononitrat ( vit. B. 1 ) table Tablet 105,45 2,342.00 2,000.00 812 3,530.00
37 Zink Sirup Botol 7,700.00 17 48.00 19 46
39 Zink Tablet Tablet 402.60 20 1,000.00 223 797
1 Kateter No. 18 Pcs 12,000.00 -

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 400/PKM.ST/TU/X/2022
Pada hari ini, Senin tanggal Tiga Puluh Satu Bulan Oktober tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : OKTOBER 2022
AWAL AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 -
3 Albendazol Sirup Botol 4,600.00 - -
4 Albothyl cons.(policresulen) Botol 5ml 18,150.00 - -
5 Alopurinol tablet 100 mg Tablet 89.00 - -
6 Alprazolam 0,5 mg tablet Tablet 88.00 - -
7 Amitripilin HCl tablet salut 25 mg Tablet 123.00 - -
12 Amoksisilin kaplet 500 mg Kaplet 231.00 990.00 3,000.00 2,136 1,854
13 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 2,050.00 66.00 100.00 39 127
18 Antasida Sirup Botol 60 ml 1,756.00 26.00 80.00 79 27 -
21 Antihemorhoid DOEN kombinasi Supp 3,260.00 9.00 30.00 13 26
22 Antimigrain DOEN kombinasi Tablet 199.00 - -
23 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 - -
25 Asam Mefenamat tablet 500 mg Tablet 297.00 - -
26 Asam Mefenamat tablet 500 mg Tablet 117.00 686.00 1,000.00 804 882
27 Asam folat Tablet 3,000.00 - 3,000
29 Asetil sitein Tablet 394.00 676.00 1,620.00 1,188 1,108
30 Asiklovir cream Tube 4,382.40 25.00 5 20 -
34 ARV Dewasa/TELADO Tablet 209,130.00 5.00 1 4.00
35 Azithromycin 500 mg 15,400.00 15.00 - 15
36 Betahistin Mesilat 6 mg tab Tablet 241.10 1,500.00 388 1,112.00
38 Burnazin cream Tablet 33,000.00 - -
39 Captopril 25 mg Tablet 80.00 - -
41 Cefadroxyl 500 mg Kapsul 830.00 31.00 1,000.00 441 590.00
48 Clobazam Tablet 384.00 224.00 83 141
49 Clozapin 25 mg 1,550.00 -
59 Domperidon Tablet 75.00 1,494.00 465 1,029
70 Fitomenadion ( vit k ) tablet salut 10 m Tablet 873.00 100.00 43 57.00
75 Gentamisin salep Tube 3,650.00 24.00 26.00 26 24
78 Glimepiride tab 2 mg Tablet 123.00 155.00 500.00 245 410.00
79 Glibenklamid tablet 5 mg Tablet 137.00 200.00 - 200.00
86 Hyoscine-N-butilbromide 10 mg tab Tablet 1,662.00 366.00 500.00 119 747.00
87 Ibuprofen syrup 100mg/5 ml Botol 60 ml - -
89 Ibuprofen tablet 400 mg Tablet 214.00 1,250.00 612 852
90 Isosorbit dinitrat tablet sublungual 5 m Tablet 95.00 -
91 Kaen - 3 B Botol 11,314.00 -
92 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 2,000.00 1,000.00 1,280 1,720.00
100 Kloramfenikol salep kulit/Bufacetin Tube 3,794.00 24.00 - 24
103 Klorfeniramin maleat ( CTM ) tablet 4 Tablet 26.00 -
106 Kotrimoksazol dewasa tablet Tablet 133.00 190.00 - 190.00
108 Kotrimoksazol suspensi Botol 60 ml 2,052.00 27.00 5 22 -
109 Lanzoprasole kapsul 30 mg Kapsul 278.00 280.00 1,500.00 676 1,104
113 Loratadin tablet 10 mg Tablet 117.00 191.00 4,000.00 2,396 1,795
118 Metilergometrin maleat inj. 0,200 mg - Ampul 3,399.00 -
119 Metilergometrin maleat tablet salut 0, Tablet 245.00 -
120 Metilergometrin maleat tablet salut 0, Tablet 261.00 345.00 40 305
128 Multivitamin sirup anak Botol 16,500.00 6.00 48.00 33 21
129 NA. Diklofenak tablet 50 mg Tablet 109.00 15.00 - 15.00
130 NA. Diklofenak tablet 25 mg Tablet 1,409.00 2,600.00 1,866 2,143.00
131 Natrium klorida larutan infus 0,9 % ster Botol 6,840.00 -
133 Miniaspi Tablet 100.00 30 70.00
136 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,402.00 33.00 - 33.00
138 Oksitetrasiklin HCl salep mata Tube 2,774.00 1.00 25.00 5 21.00
143 Parasetamol drops Botol 15 ml 7,646.00 86.00 15 71 -
144 Parasetamol sirup 120 mg / 5 ml Botol 60 ml 1,160.00 28.00 - 28
145 Parasetamol tablet 500 mg Tablet 165.00 2,160.00 830.00 2,464 526
148 Piridoksin HCl tablet 10 mg Tablet 150.00 3,000.00 - 3,000
149 Piridoksin HCl tablet 25 mg Tablet 400.00 10 390
158 Ranitidin tablet Tablet 85.00 1,576.00 1,000.00 1,622 954
164 Salbutamol tablet 4 mg Tablet 123.00 18.00 18 -
168 Salisil bedak 2 % Botol 12,000.00 30.00 20 10.00
171 Sianokobalamin tablet Tablet 51.00 3,000.00 238 2,762.00
175 Stimuno Tablet 1,763.00 80.00 600.00 530 150
176 Sucralfat Botol 6,130.00 46.00 3 43
178 Tiamin HCl mononitrat ( vit. B. 1 ) tabl Tablet 96.00 -
189 Tenolam Botol 209,130.00 3.00 3 -
190 Permethrin 5% cream MK Tube 11,466.00 30.00 1 29.00
192 Alat suntik sekali pakai 1 ml Pcs 743.98 -
193 Alat suntik sekali pakai 5 ml Pcs 1,201.75 -
195 Infusion set Dewasa Pcs 5,445.00 -
201 Masker Pcs 1,385.00 - -
203 Urine Bag Pcs 4,933.50 -
NO NAMA OBAT SATUAN HARGA AWAL PENERIMAAN PEMAKAIAN EXP RETUR AKHIR
RUSAK
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 Allopurinol 100 mg Tablet 288.75 -
3 Amlodipin 10 mg Tablet 218.56 665 650 15
8 Betahistin Maleat tablet Tablet 243.10 192 192 -
12 Cefadroxil 500 mg Tablet 808.50 -
13 Domperidon suspensi 5 mg/5 m Botol 60 ml 6,715.50 35.00 22 13.00
15 Deksametason tab Tablet 115.96 517 - 517
17 Guefenisin tablet Tablet 141.63 1,588 1,000.00 1,624 964
18 Gentamicin Salep Kulit Tube 4,620.00 - -
19 Ibuprofen 200 mg Tablet 320.10 - -
20 Ketokonazol 200 mg Tablet 611.60 50 100.00 43 107
21 Klorfeniramin Maleat (CTM) Tablet 57.20 - -
22 Kotrimoksazol Sirup Botol 5,170.00 -
23 Metronidazol 500 mg Tablet 278.30 353 200.00 186 367
26 Oksitetrasiklin Hcl Salep 3% Tube 3,410.00 1 1 -
27 Piridoksin HCl tablet 10 mg Tablet 127,65 2,634.00 1,642 992.00
28 Parasetamol Drops Botol 10,725.00 - -
30 Sianokobalamin (Vit. B12) Tablet 105,45 2,375 2,375 -
31 Salisil bedak 2 % Pot 4,273.50 9.00 9 -
33 Tiamin HCl mononitrat ( vit. B. Tablet 105,45 3,530.00 880 2,650.00
37 Zink Sirup Botol 7,700.00 46 13 33
1 Kateter No. 18 Pcs 12,000.00 -

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-
PERMINTAA
N
13
500
2,000
3,000
50
STOK
OPTIMUM
12
-
-
-
-
-
-
-
-

NO : 450/PKM.ST/TU/XI/2022
Pada hari ini, Senin tanggal Tiga Puluh Bulan November tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
BULAN : NOVEMBER 2022
NO NAMA OBAT SATUAN HARGA AWAL PENERIMAAN PEMAKAIAN EXP RETUR RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 - -
3 Albendazol Sirup Botol 4,600.00 - - -
4 Albothyl cons.(policresulen) Botol 5ml 18,150.00 - - -
5 Alopurinol tablet 100 mg Tablet 89.00 - - -
6 Alprazolam 0,5 mg tablet Tablet 88.00 - - -
7 Amitripilin HCl tablet salut 25 mg Tablet 123.00 - - -
14 Ampisilin kaplet 500 mg Kaplet 265.00 - -
15 Ampisilin serbuk injeksi Vial 9,473.00 - -
16 Antalgin /Metampiron tab 500 mg Tablet 176.00 - -
17 Antasida DOEN tablet kombinasi Tablet 60.00 876.00 2,000.00 1,159 1,717
18 Antasida Sirup Botol 60 ml 1,756.00 - - -
19 Anti bakteri DOEN Tube 3,490.00 - -
20 Antifungi DOEN kombinasi Pot 2,310.00 - -
21 Antihemorhoid DOEN kombinasi Supp 3,260.00 26.00 20.00 28 18
22 Antimigrain DOEN kombinasi Tablet 199.00 - - -
23 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 - - -
25 Asam Mefenamat tablet 500 mg Tablet 297.00 - - -
26 Asam Mefenamat tablet 500 mg Tablet 117.00 882.00 1,000.00 842 1,040
27 Asam folat Tablet 3,000.00 620 2,380
28 Asering Infus Botol 500ml 9,000.00 - - -
29 Asetil sitein Tablet 394.00 1,108.00 2,640.00 1,228 2,520
30 Asiklovir cream Tube 4,382.40 - - -
31 Asiklovir cream Tube 5,550.00 - 26.00 - 26.00
32 Asiklovir tablet 400 mg Tablet 425.00 35.00 35 -
33 Aspilet Tablet 163.00 - - -
34 Attapulgit (New Antides) Tablet 149.00 - - -
35 ARV Dewasa/TELADO Tablet 209,130.00 4.00 2 2.00
36 Azithromycin 500 mg 15,400.00 15.00 - 15
37 Betahistin Mesilat 6 mg tab Tablet 241.10 1,112.00 578 534.00
39 Burnazin cream Tablet 33,000.00 - - -
40 Captopril 25 mg Tablet 80.00 - - -
41 Cavida gel 15 gram Tube 50,600.00 10.00 5 5
42 Cefadroxyl 500 mg Kapsul 830.00 590.00 700.00 259 1,031.00
43 Cefadroxyl syrup kering 125 mg/5ml Botol 60 ml 4,360.00 9.00 - 9
44 Cendo Xitrol ED Botol 35,200.00 - -
45 Cetirizin Syrup Botol 60 ml 3,061.00 - -
46 Cetirizin Syrup Botol 60 ml 2,215.00 - -
49 Clobazam Tablet 384.00 141.00 200.00 41 300
49 Clozapin 25 mg 1,550.00 - -
50 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 - -
51 Deksametason tablet 0,5 mg Tablet 146.00 - -
53 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1,346.00 - -
54 Digoksin tablet 0,25 mg Tablet 104.00 - -
56 Diltiazem HCl Tablet 142.00 - -
57 Dimenhidrinat Tablet 121.00 - -
58 Doksisiklin tablet 100 mg Tablet 309.00 - -
59 Doksisiklin tablet 100 mg Tablet 264.00 - -
60 Domperidon Tablet 75.00 1,029.00 549 480
61 Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,862.00 - -
62 Epineprin HCl/bitartrat (adrenalin) inj. Ampul 1,518.00 - -
71 Fitomenadion ( vit k ) tablet salut 10 m Tablet 873.00 57.00 100.00 19 138.00
76 Gentamisin salep Tube 3,650.00 24.00 9 15
77 Gentamisin salep Tube 5,170.00 - 24.00 - 24
78 Gentamisin Tetes Mata Botol - 24.00 - 24
79 Gentian Violet Botol 1,980.00 - -
80 Glibenklamid tablet 5 mg Tablet 137.00 - -
88 Hidroklortiazida tablet 25 mg Tablet 178.00 - -
90 Ibuprofen syrup 100mg/5 ml Botol 60 ml -
92 Ibuprofen tablet 400 mg Tablet 215.00 852.00 1,000.00 837 1,015
93 Isosorbit dinitrat tablet sublungual 5 m Tablet 95.00 -
94 Kaen - 3 B Botol 11,314.00 -
95 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,720.00 1,000.00 980 1,740.00
103 Kloramfenikol salep kulit/Bufacetin Tube 3,794.00 24.00 1 23
106 Klorfeniramin maleat ( CTM ) tablet 4 Tablet 26.00 -
109 Kotrimoksazol dewasa tablet 480 mg Tablet 133.00 190.00 500.00 - 190 500.00
111 Kotrimoksazol suspensi Botol 60 ml 2,052.00 - -
112 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,104.00 1,000.00 811 1,293
120 Metformin tab 500 mg Tablet 77.00 915.00 3,200.00 1,632 2,483
121 Metilergometrin maleat inj. 0,200 mg - Ampul 3,399.00 -
122 Metilergometrin maleat tablet salut 0, Tablet 245.00 -
123 Metilergometrin maleat tablet salut 0, Tablet 261.00 305.00 40 265
124 Metilprednisolon tablet 4 mg Tablet 102.00 1,706.00 1,500.00 729 2,477
132 NA. Diklofenak tablet 50 mg Tablet 109.00 15.00 1,500.00 15 1,500
133 NA. Diklofenak tablet 25 mg Tablet 2,143.00 1,961 182
134 Natrium klorida larutan infus 0,9 % ster Botol 6,840.00 -
136 Miniaspi Tablet 70.00 30 40.00
139 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,402.00 33.00 24 9.00
146 Parasetamol drops Botol 15 ml 7,646.00 - -
148 Parasetamol tablet 500 mg Tablet 165.00 526.00 200.00 726 -
149 Parasetamol tablet 500 mg Tablet 257.00 1,400.00 1,400 -
152 Piridoksin HCl tablet 10 mg Tablet 150.00 3,000.00 150 2,850
153 Piridoksin HCl tablet 25 mg Tablet 390.00 50 340
162 Ranitidin tablet Tablet 85.00 954.00 6,000.00 2,759 4,195
168 Salbutamol tablet 4 mg Tablet 123.00 - -
172 Salisil bedak 2 % Botol 12,000.00 10.00 30.00 12 28.00
175 Sianokobalamin tablet Tablet 51.00 2,762.00 2,535 227.00
176 Sianokobalamin tablet Tablet 44.00 3,000.00 3,000
177 Simvastatin tablet 10 mg Tablet 73.00 567.00 4,000.00 1,545 3,022.00
180 Stimuno Tablet 1,763.00 150.00 600.00 281 469
181 Sucralfat Botol 6,130.00 43.00 - 43
183 Tiamin HCl mononitrat ( vit. B. 1 ) tabl Tablet 96.00 -
188 Vitamin B kompleks tablet Tablet 60.00 1,750.00 8,000.00 5,389 4,361
194 Tenolam Botol 209,130.00 - 10.00 9 1.00
195 Permethrin 5% cream MK Tube 11,466.00 29.00 12 17
196 Alat suntik sekali pakai 3 ml Pcs 1,016.40 3.00 3 -
206 Masker Pcs 1,385.00 -
208 Urine Bag Pcs 4,933.50 -
NO NAMA OBAT SATUAN HARGA AWAL PENERIMAAN PEMAKAIAN EXP RETUR AKHIR
RUSAK
1 2 3 4 5 6 7 8 9 10 11
OBAT
3 Amlodipin 10 mg Tablet 218.56 15 15 -
4 Ambroxol Sirup Botol 6,099.50 - -
6 Asam Tranexamat Tablet 1,053.00 500 - 500
8 Betahistin Maleat tablet Tablet 243.10 - -
13 Domperidon suspensi 5 mg/5 m
Botol 60 ml 6,715.50 13.00 - 13.00
15 Deksametason tab Tablet 115.96 517 2,800.00 822 2,495
17 Guefenisin tablet Tablet 141.63 964 2,000.00 1,225 1,739
21 Klorfeniramin Maleat (CTM) Tablet 57.20 3,000.00 86 2,914
26 Oksitetrasiklin Hcl Salep 3% Tube 3,410.00 - 50.00 7 43
27 Piridoksin HCl tablet 10 mg Tablet 127,65 992.00 992 -
Parasetamol Tablet Tablet 250.00 2,000.00 178 1,822
30 Sianokobalamin (Vit. B12) Tablet 105,45 - -
31 Salisil bedak 2 % Pot 4,273.50 - -
33 Tiamin HCl mononitrat ( vit. B. Tablet 105,45 2,650.00 690 1,960
37 Zink Sirup Botol 7,700.00 33 - 33
1 Kateter No. 18 Pcs 12,000.00 -

1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 1,100.00 250.00 250 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

NO : 498/PKM.ST/TU/XII/2022
Pada hari ini, Sabtu tanggal Tiga Puluh Satu Bulan Desember tahun Dua Ribu Dua Puluh Dua, kami yang bertanda tangan di bawah ini :

Nip : 19660211 198803 2 005
Nip : 19841111 201101 2 016

Nip. : 19660211 198803 2 005 Nip. 19844111 201101 2 016
LAMPIRAN BERITA ACARA OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) UNIT APOTEK SUMBER DANA
BULAN : DESEMBER 2022
NO NAMA OBAT SATUAN HARGA PERSEDIAAN AWAL PENERIMAAN PEMAKAIAN EXP RETUR RUSAK PERSEDIAAN
AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 1/2 DAD Botol 9,500.00 - -
3 Albendazol Sirup Botol 4,600.00 - - -
4 Albothyl cons.(policresulen) Botol 5ml 18,150.00 - - -
5 Alopurinol tablet 100 mg Tablet 89.00 - - -
6 Alprazolam 0,5 mg tablet Tablet 88.00 - - -
7 Amitripilin HCl tablet salut 25 mg Tablet 123.00 - - -
11 Amoksisilin kaplet 500 mg Kaplet 265.00 - -
14 Ampisilin kaplet 500 mg Kaplet 265.00 - - -
15 Ampisilin serbuk injeksi Vial 9,473.00 - - -
16 Antalgin /Metampiron tab 500 mg Tablet 176.00 - - -
17 Antasida DOEN tablet kombinasi Tablet 60.00 1,717.00 2,000.00 879 2,838
18 Antasida Sirup Botol 60 ml 1,756.00 - - -
19 Anti bakteri DOEN Tube 3,490.00 - - -
20 Antifungi DOEN kombinasi Pot 2,310.00 - -
22 Antimigrain DOEN kombinasi Tablet 199.00 - - -
23 Asam Askorbat ( vit. C ) tablet 50 mg Tablet 120.00 - - -
25 Asam Mefenamat tablet 500 mg Tablet 297.00 - - -
26 Asam Mefenamat tablet 500 mg Tablet 117.00 1,040.00 1,500.00 1,191 1,349
27 Asam folat Tablet 2,380.00 1,270 1,110
28 Asering Infus Botol 500ml 9,000.00 - - -
29 Asetil sitein Tablet 320.00 2,520.00 1,044 1,476
30 Asiklovir cream Tube 4,382.40 - - -
31 Asiklovir cream Tube 5,550.00 26.00 21.00 26 21.00
32 Asiklovir tablet 400 mg Tablet 425.00 - - -
33 Aspilet Tablet 163.00 - - -
34 Attapulgit (New Antides) Tablet 149.00 - - -
35 ARV Dewasa/TELADO Tablet 209,130.00 2.00 6.00 3 5.00
36 Azithromycin 500 mg 15,400.00 15.00 15.00 - 30
37 Betahistin Mesilat 6 mg tab Tablet 92.00 534.00 1,000.00 412 1,122.00
38 Betametason krim 0,1 % Tube 1,520.00 21.00 25.00 22 24.00
39 Burnazin cream Tablet 33,000.00 - - -
40 Captopril 25 mg Tablet 80.00 - - -
42 Cefadroxyl 500 mg Kapsul 830.00 1,031.00 440 591.00
44 Cendo Xitrol ED Botol 35,200.00 - - -
45 Cetirizin Syrup Botol 60 ml 3,061.00 - - -
46 Cetirizin Syrup Botol 60 ml 2,215.00 - - -
48 Ciproloxacin 500 mg isi 100 tab Tablet 260.00 689.00 100 589.00
49 Clobazam Tablet 387.00 300.00 52 248
49 Clozapin 25 mg 1,550.00 - - -
50 Deksametason inj 5 mg/ml -1 ml Ampul 1,210.00 - - -
51 Deksametason tablet 0,5 mg Tablet 146.00 - - -
53 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1,346.00 - - -
54 Digoksin tablet 0,25 mg Tablet 104.00 - - -
56 Diltiazem HCl Tablet 142.00 - - -
57 Dimenhidrinat Tablet 121.00 - - -
58 Doksisiklin tablet 100 mg Tablet 309.00 - - -
59 Doksisiklin tablet 100 mg Tablet 264.00 - - -
60 Domperidon Tablet 75.00 480.00 1,000.00 298 1,182
61 Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,862.00 - - -
62 Epineprin HCl/bitartrat (adrenalin) inj. Ampul 1,518.00 - - -
63 Eritromisin 250 mg Kapsul 636.00 - - -
64 Eritromisin 500 mg Kapsul 781.00 - - -
65 Eugenol cairan Pcs 38,130.00 - -
66 Famotidine 20 mg Tablet 132.00 - -
67 Fenitoin natrium kapsul 100 mg Kapsul 146.00 - -
68 Fenobarbital Inj.50 mg/ml Ampul 2,265.00 - -
69 Fenobarbital tablet 30 mg Tablet 177.00 - -
70 Fenol Gliserol Tetes Telinga 10 % Botol 2,246.00 - -
71 Fitomenadion ( vit k ) tablet salut 10 mg Tablet 781.00 138.00 3 135.00
72 Furosemid tablet 40 mg Tablet 82.00 - -
73 Favipiravir Tablet 22,500.00 - -
75 Gentamisin Inj.80 mg/2 ml Ampul 3,545.00 - -
76 Gentamisin salep Tube 3,650.00 15.00 26.00 18 23
77 Gentamisin salep Tube 3,650.00 24.00 16 8
78 Gentamisin Tetes Mata Botol 5,170.00 24.00 9 15
79 Gentian Violet Botol 1,980.00 - - -
80 Glibenklamid tablet 5 mg Tablet 137.00 - - -
81 Glimepiride tab 2 mg Tablet 123.00 270.00 1,000.00 335 935.00
82 Glibenklamid tablet 5 mg Tablet 137.00 120.00 100.00 - 220.00
83 Glukosa larutan infus 5 % steril Botol 6,627.00 - -
84 Griseofulvin tablet 125 mg, micronized Tablet 238.00 - -
85 Haloperidol tablet 1,5 mg Tablet 64.43 - -
86 Haloperidol tablet 5 mg Tablet 56.00 - -
88 Hidroklortiazida tablet 25 mg Tablet 178.00 - - -
90 Ibuprofen syrup 100mg/5 ml Botol 60 ml - -
91 Ibuprofen tablet 200 mg Tablet 264.00 - -
92 Ibuprofen tablet 400 mg Tablet 215.00 1,015.00 1,000.00 929 1,086
93 Isosorbit dinitrat tablet sublungual 5 mg Tablet 95.00 - -
94 Kaen - 3 B Botol 11,314.00 - -
95 Kalsium laktak ( kalak ) tablet 500 mg Tablet 63.00 1,740.00 620 1,120.00
96 Karbamazepin tab 200 mg Tablet 306.00 - -
97 Ketokonazol Krim 2% Tube 2,694.00 - -
98 Ketokonazol tab Tablet 286.00 - -
99 Ketorolac injeksi 30 mg Ampul 1,045.00 - -
100 Ketorolac injeksi 30 mg Ampul 1,089.00 - -
101 Kloramfenikol kapsul 250 mg Kapsul 329.00 - -
102 Kloramfenikol salep mata 1 % Tube 2,013.00 - -
103 Kloramfenikol salep kulit/Bufacetin Tube 3,794.00 23.00 - 23
104 Kloramfenikol sirup Botol 60 ml 4,000.00 - -
105 Kloramfenikol tetes telinga 3 % Botol 9,749.30 - -
106 Klorfeniramin maleat ( CTM ) tablet 4 mg Tablet 26.00 - -
107 Klorpromazin HCl tablet salut 100 mg Tablet 170.00 - -
109 Kotrimoksazol dewasa tablet 480 mg Tablet 133.00 500.00 44 456.00
110 Kotrimoksazol 960 mg Tablet (HIV) Tablet 325.00 10.00 100.00 - 110
111 Kotrimoksazol suspensi Botol 60 ml 2,052.00 - -
112 Lanzoprasole kapsul 30 mg Kapsul 278.00 1,293.00 1,000.00 908 1,385
115 Loratadin tablet 10 mg Tablet 136.00 - -
117 Meloksikam tablet 15 mg Tablet 1,320.00 - -
118 Meloksikam tablet 15 mg Tablet 1,350.00 - -
119 Metformin tab. 850 mg Tablet 167.00 - -
120 Metformin tab 500 mg Tablet 77.00 2,483.00 2,000.00 940 3,543
121 Metilergometrin maleat inj. 0,200 mg - 1 ml Ampul 3,399.00 - -
122 Metilergometrin maleat tablet salut 0,125 mg Tablet 245.00 - -
125 Metoklorpropamid injeksi (Sotatic) Ampul 4,554.00 - -
126 Metoklorpropamid sirup Botol 60 ml 2,700.00 - -
129 Metronidazol tablet 500 mg Tablet 350.00 - -
131 Multivitamin sirup anak Botol 16,500.00 19.00 - 19
132 NA. Diklofenak tablet 50 mg Tablet 109.00 1,500.00 3,000.00 1,180 3,320
133 NA. Diklofenak tablet 25 mg Tablet 115.00 182.00 112 70
136 Miniaspi Tablet 89.81 40.00 - 40.00
139 Obat batuk hitam ( O. B. H ) cairan Botol 60 ml 14,402.00 9.00 20.00 10 19.00
140 Oksitetrasiklin HCl salep 3 % Tube 3,047.00 - -
141 Oksitetrasiklin HCl salep mata Tube 3,531.81 11.00 25.00 10 26.00
142 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 1,232.00 - -
143 Omeprasol Tablet 147.00 - -
144 Oseltamivir Phosphate Kapsul 75 mg 20,182.50 - -
145 Papaverin HCl tab Tablet 137.50 - -
146 Parasetamol drops Botol 15 ml 7,646.00 - -
147 Parasetamol sirup 120 mg / 5 ml Botol 60 ml 1,160.00 10.00 - 10
148 Parasetamol tablet 500 mg Tablet 165.00 - - -
149 Parasetamol tablet 500 mg Tablet 257.00 - - -
150 Piracetam injeksi 1 g/ 5 ml Ampul 2,090.00 - -
151 Piracetam tablet 800 mg Tablet 781.00 - -
152 Piridoksin HCl tablet 10 mg Tablet 150.00 2,850.00 976 1,874
153 Piridoksin HCl tablet 25 mg Tablet 127.65 340.00 70 270
154 Piroksicam 20 mg kapsul Kapsul 169.40 - -
162 Ranitidin tablet Tablet 85.00 4,195.00 3,000.00 1,030 6,165
170 Salep 2 - 4 kombinasi Pot 3,017.00 5.00 19.00 1 23
172 Salisil bedak 2 % Botol 12,000.00 28.00 28 -
175 Sianokobalamin tablet Tablet 51.00 227.00 227 -
176 Sianokobalamin tablet Tablet 44.00 3,000.00 1,547 1,453
177 Simvastatin tablet 10 mg Tablet 73.00 3,022.00 1,352 1,670.00
180 Stimuno Tablet 1,763.00 469.00 600.00 439 630
181 Sucralfat Botol 6,130.00 43.00 - 43
182 Tablet tambah darah kombinasi Tablet 409.00 5,915.00 1,537 4,378.00
188 Vitamin B kompleks tablet Tablet 60.00 4,361.00 5,900.00 3,508 6,753
194 Tenolam Botol 209,130.00 1.00 15.00 2 14.00
195 Permethrin 5% cream MK Tube 11,466.00 17.00 1 16
196 Alat suntik sekali pakai 3 ml Pcs 1,016.40 - -
206 Masker Pcs 1,385.00 -
208 Urine Bag Pcs 4,933.50 -
-
-
NO NAMA OBAT SATUAN HARGA PERSEDIAAN AWAL PENERIMAAN PEMAKAIAN EXP RETUR PERSEDIAAN
RUSAK AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
3 Amlodipin 10 mg Tablet 218.56 - -
4 Ambroxol Sirup Botol 6,099.50 - -
8 Betahistin Maleat tablet Tablet 243.10 -
13 Domperidon suspensi 5 mg/5 ml Botol 60 ml 6,715.50 13.00 - 13.00
15 Deksametason tab Tablet 105.45 2,495 876 1,619
16 Furosemid Tablet Tablet 207.90 449 2 447
17 Guefenisin tablet Tablet 318.75 1,739 2,000.00 698 3,041
20 Ketokonazol 200 mg Tablet 611.60 57 200.00 44 213
21 Klorfeniramin Maleat (CTM) Tablet 86.58 2,914 351 2,563
27 Piridoksin HCl tablet 10 mg Tablet 127,65 - -
Parasetamol Tablet Tablet 250.00 1,822 500.00 1,799 523
30 Sianokobalamin (Vit. B12) Tablet 105,45 -
33 Tiamin HCl mononitrat ( vit. B. 1 ) ta Tablet 138.75 1,960.00 410 1,550
37 Zink Sirup Botol 7,700.00 33 - 33
1 Kateter No. 18 Pcs 12,000.00 -
PEMAKAIAN PERSEDIAAN
NO NAMA OBAT SATUAN HARGA PERSEDIAAN AWAL PENERIMAAN AKHIR
1 2 3 4 5 6 7 8 9 10 11
OBAT
-
2 Masker Set 900.90 250.00 250 -
3 Masker KN95 Set 19,800.00 -
-
-
-
-

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PEMERINTAH KABUPATEN SOPPENG DINAS KESEHATAN

UPTD PUSAT KESEHATAN MASYARAKAT SALOTUNGO

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

1 Allopurinol 100 mg Tablet 288.75 952 160 792

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

1 Allopurinol 100 mg Tablet 288.75 792 192 600

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

1 Allopurinol 100 mg Tablet 288.75 600 250 350

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

1 Allopurinol 100 mg Tablet 288.75 350 279 71

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

1 Allopurinol 100 mg Tablet 288.75 - -

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

1 Allopurinol 100 mg Tablet 288.75 - -

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek

Hj. Nirtati, SKM Yusdiana, S.Si,Apt,MM

PERSEDIAAN PEMAKAIAN PERSEDIAAN

BERITA ACARA STOK OPNAME

1. Nama : Hj. Nirtati, SKM

Kepala UPTD Puskesmas Salotungo Penanggung Jawab Apotek