Lplpo 2023

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLP
PUSKESMAS KEDUNGWUNGU
PUSKESMAS : KEDUNGWUNGU
KECAMATAN : KRANGKENG
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : JANUARI 2023 2022
PROPINSI PERMINTAAN BULAN/PERIODE : FEBRUARI 2023
STOK PENERIM PERSEDIA PEMAKA STOK

NO NAMA OBAT SATUAN STOK AKHIR
AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
1 Air Raksa Dental use botol - - - - -
2 Alat suntik sekali pakai 1 ml set 900 - 900 200 700
3 Alat suntik sekali pakai 2,5 ml set 100 - 100 48 52
4 Alat suntik sekali pakai 3 ml set 1,500 - 1,500 100 1,400
5 Alat suntik sekali pakai 5 ml set 700 - 700 - 700
6 Alat suntik sekali pakai 50 cc set 210 - 210 - 210
7 Albendazol tablet 400 mg tablet 45,500 - 45,500 - 45,500
8 Allopurinol tablet 100 mg tablet 5,100 - 5,100 1,100 4,000
9 Aminofilin tablet 200 mg tablet - - - - -
10 Aminofilin injeksi 24 mg/ml ampul - - - - -
11 Amitripilin tablet salut 25 mg (HCL) tablet 30 - 30 - 30
12 Amoksisillin kapsul 250 mg kapsul - - - - -
13 Amoksisillin kapsul 500 mg kapsul 9,000 - 9,000 3,000 6,000
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 400 - 400 100 300
15 Ampisillin kapsul 500 mg kapsul - - - - -
16 Ampisillin sirup kering 125 mg/5 ml botol - - - - -
17 Antalgin tablet 500 mg tablet - - - - -
18 Antalgin injeksi 250 mg/ml ampul - - - - -
Antasida DOEN I tablet kunyah, kombinasi :
19 Aluminium Hidroksida 200 mg + Magnesium tablet 7,500 - 7,500 1,600 5,900
Hidroksida 200 mg
Antibakteri DOEN salep kombinasi : Basitrasin
20 tube - - - - -
500 IU/g + polimiksin 10.000 IU/g
Antihemoroid DOEN kombinasi : Bismut Subgalat
21 supp - - - - -
150 mg + Heksaklorofen 250 mg
Antifungi DOEN Kombinasi : Asam Benzoat 6% +
22 pot 216 - 216 - 216
Asam Salisilat 3%
Antimigren : Ergotamin tartrat 1 mg + Kofein 50
23 tablet - - - - -
mg
Antiparkinson DOEN tablet kombinasi : Karbidopa
24 tablet - - - - -
25 mg + Levodopa 250 mg
25 Aqua Pro Injeksi Steril, bebas pirogen vial 60 - 60 - 60
26 Aquadest steril - 500 ml botol - - - - -
27 Asam Askorbat tablet 50 mg tablet 4,500 - 4,500 1,200 3,300
28 Asam Askorbat tablet 25 mg tablet - - - - -
29 Asam Klorida 0.1 N - 100 ml botol - - - - -
30 Asam Sulfosalisilat 20 % - 100 ml botol - - - - -
31 Asetosal tablet 100 mg tablet - - - - -
33 Atropin Sulfat tablet 0,5 mg tablet - - - - -
34 Atropin tetes mata 0,5% botol - - - - -
Atropin sulfat injeksi l.m/lv/s.k. 0,25 mg/mL - 1
35 ampul 18 - 18 - 18
mL
36 Benzatin Benzil Pen inj 1,2 jt IU/vial ampul - - - - -
38 Besi sirup botol - - - - -
39 Betametason krim 0,1 % tube - - - - -
40 Catgut / Benang Bedah No. 2/0 - 3/0 set 60 - 60 12 48
41 Cefadroxil DS 125 mg/5 ml sirup 200 - 200 - 200
42 Cetirizin Sirup sirup 200 - 200 - 200
43 Ciprofloxacin 500 mg tablet 6,000 - 6,000 400 5,600
44 Dapson tablet 100 mg tablet - - - - -
45 Deksametason Injeksi I.v. 5 mg/ml ampul 65 - 65 - 65
46 Deksametason 0.5 mg tablet - - - - -
47 Dekstran 70-larutan infus 6% steril botol - - - - -
Dekstrometorfan sirup 10 mg/5 ml
48 botol - - - - -
(HBr)/Dextrofen
49 Dekstrometorfan tablet 15 mg (HBr) tablet - - - - -
50 Desinfektan 500 ml botol 10 - 10 - 10
51 Devitalisai Pasta (Non Arsen) botol - - - - -
52 Diazepam Injeksi 5mg/ml ampul 38 - 38 - 38
53 Diazepam tablet 2 mg tablet - - - - -
54 Diazepam tablet 5 mg tablet 400 - 400 15 385
55 Dietilkarbamazin Sitrat tablet 100 mg tablet - - - - -
56 Difenhidramin injeksi I.M. 10 mg/ml (HCL) ampul 74 - 74 - 74
57 Digoksin tablet 0,25 mg tablet - - - - -
58 Dimenhidrinat 50 mg tablet 1,000 - 1,000 100 900
59 Doksisiklin 100 mg kapsul 3,100 - 3,100 - 3,100
60 Efedrin tablet 25 mg (HCL) tablet - - - - -
61 Ekstrak Belladona tablet 10 mg tablet - - - - -
62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul - - - - -
63 Etakridin larutan 0,1% botol - - - - -

64 Etambutol HCl tablet 250 mg tablet - - - - -
65 Etanol 70% 100 ml botol - - - - -
66 Eter Anestetik botol - - - - -
67 Etil Klorida botol - - - - -
68 Eugenol cairan botol - - - - -
69 Fenitoin Natrium Injeksi 50 mg/ml ampul - - - - -
70 Fenitoin Natrium kapsul 100 mg kapsul - - - - -
71 Fenitoin Natrium Injeksi 30 mg ampul - - - - -
72 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul 5 - 5 - 5
73 Fenobarbital tablet 100 mg tablet - - - - -
75 Fenoksimetil Pen tablet 250 mg tablet - - - - -
77 Fenol Gliserol tetes telinga 10% botol - - - - -
78 Fitomenadion injeksi 10 mg/ml ampul 90 - 90 - 90
79 Fitomenadion tablet salut 10 mg tablet 300 - 300 100 200
80 Fluor tablet 0,5 mg tablet - - - - -
81 Furosemid tablet 40 mg tablet 800 - 800 200 600
82 Ferinokresol botol - - - - -
83 Gameksan lotion 1 % botol - - - - -
84 Garam Oralit 200 ml air kantong 4200 - 4,200 - 4,200
85 Garam Oralit 1000 ml air kantong - - - - -
86 Gentian Violet Larutan 1 % botol - - - - -
87 Glass Ionomer Cement (GC IX) set - - - - -
88 Glibenklamida tablet 5 mg tablet 6,500 - 6,500 400 6,100
89 Gliseril Guayakolat tablet 100 mg tablet - - - - -
90 Gliserin botol - - - - -
91 Glukosa larutan infus 5% botol - - - - -
93 Glukosa larutan infus 40% steril botol - - - - -
94 Griseofulvin tablet 125 mg tablet - - - - -
95 Gutta Percha Points stik - - - - -
96 Haloperidol tablet 0,5 mg tablet - - - - -
97 Haloperidol tablet 1,5 mg tablet 700 - 700 - 700
98 Haloperidol 5 mg tablet - 600 600 - 600
99 Hidroklortiazida tablet 25 mg tablet - - - - -
100 Hidrokortison krim 2,5% tube 864 - 864 216 648
101 Ibuprofen tablet 200 mg tablet - - - - -
102 Ibuprofen tablet 400 mg tablet 6,000 - 6,000 1,100 4,900
103 Ibuprofen sirup 200/ 5 ml botol - - - - -
104 Infusion set anak set 200 - 200 - 200
105 Infusion set dewasa set 975 - 975 - 975
106 Insulin Reguler injeksi 40 IU/ml vial - - - - -
107 Idiol Kapsul Lunak kapsul - - - - -
108 Ipeka 0,14 % syr botol - - - - -
109 Isoniazid tablet 300 mg tablet - - - - -
110 Isosorbid Dinitrat tab subl 5 mg tablet - - - - -
111 Jarum jahit (Bedah No. 9 s/d 14) kotak - - - - -
112 Kalium Permanganat serbuk - 5 mg set - - - - -
113 Kalsium glukonat inj ampul - - - - -
114 Kalsium Hidroksida Pasta kotak - - - - -
115 Kalsium Laktat tablet 500 mg tablet 9,500 - 9,500 2,700 6,800
116 Kapas Berlemak 500 gram roll - - - - -
117 Kapas Pembalut/Absorben 250 g roll 14 - 14 1 13
118 Karbamazepin tablet 200 mg tablet - - - - -
119 Kasa Hidrofil 18 m x 22 cm roll - - - - -
120 Kasa Hidrofil Steril 16 cm x 16 cm roll 480 - 480 80 400
121 Kasa Pembalut Hidrofil 4 m x 10 cm roll 46 - 46 5 41
122 Kasa Pembalut Hidrofil 4 m x 5 cm roll - - - - -
123 Kasa Kompres 40 m x 40 m roll 100 - 100 - 100
124 Ketamin Injeksi 10 mg/ml vial - - - - -
125 Ketokonazole krim tube 204 - 204 - 204
126 Klindamycin 150 mg tablet 1,200 - 1,200 150 1,050
127 Klofazimin kapsul 100 mg microzine kapsul - - - - -
128 Kloramfenikol kapsul 250 mg kapsul - - - - -
129 Kloramfenikol salep mata 1% tube - - - - -
130 Kloramfenikol salep kulit 2% tube 144 - 144 24 120
131 Kloramfenikol tetes telinga 3 % botol - - - - -
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 4,500 - 4,500 - 4,500
133 Kloroquin Fosfat tablet 250 mg tablet - - - - -
134 Klorpromazin injeksi i.m 25 mg/ml-2ml (HCL) ampul - - - - -
135 Klorpromazin injeksi i.m 5 mg/ml (HCL) ampul - - - - -
136 Klorpromazin tablet salut 25 mg (HCL) tablet - - - - -
137 Klorpromazin tablet salut 100 mg (HCl) tablet - - - - -
138 Klorpropamid tablet 100 mg tablet - - - - -
139 Kodein HCl tablet 10 mg tablet - - - - -
Kombinasi Pirimetamin 25 mg + Sulfadoksin 500
140 tablet - - - - -
mg
141 Kotrimoksazol pedia tablet 120 mg tablet - - - - -
142 Kotrimoksazol suspensi 240 mg botol 1,500 - 1,500 - 1,500
143 Kotrimoksazol tablet 480 mg tablet 3,200 - 3,200 400 2,800
144 Kuinin Di HCl injeksi 25%-2 ml ampul - - - - -
145 Kuinin (kina) tablet 200 mg tablet - - - - -
146 Larutan Benedict botol - - - - -
147 Larutan Eosin 2% botol - - - - -
148 Larutan Etanol Asam botol - - - - -
149 Larutan Gabbet botol - - - - -
150 Larutan Giemsa Stain botol - - - - -
151 Larutan Karbol Fuksin botol - - - - -
152 Larutan Kinyoun botol - - - - -
153 Larutan Metilen Biru botol - - - - -
154 Larutan Turk botol - - - - -
Lidokain comp injeksi 2% (HCL) + Epinefrin 1 :
155 ampul 320 - 320 - 320
80.000-2 ml
156 Lidokain inj 2% ampul 328 - 328 - 328
157 Lisol botol - - - - -
158 Loratadin 10 mg tablet 900 - 900 100 800
159 Magnesium Sulfat inj (IV) 20%-25 ml vial 66 - 66 8 58
160 Magnesium Sulfat inj (IV) 40%-25 ml vial 195 - 195 10 185
161 Magnesium Sulfat serbuk 30 gram kotak - - - - -
162 Mebendazol sirup 100 mg / 5 ml botol - - - - -
163 Mebendazol tablet 100 mg tablet - - - - -
164 Metanol botol - - - - -
165 Metilergometrin Maleat tablet salut 0,125 mg tablet 1,700 - 1,700 - 1,700
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 305 - 305 2 303
167 Metilprednisolon 4 mg tablet 4,900 - 4,900 600 4,300
168 Metronidazol tablet 250 mg tablet - - - - -
169 Monoklor Kamfer Menthol (CHKM) botol - - - - -
170 Mummifying Pasta kotak - - - - -
171 Nasal oxygen canul M pcs 28 - 28 - 28
172 Nasal oxygen canul L pcs 40 - 40 - 40
173 Nasal oxygen canul S pcs 53 - 53 - 53
174 Nasal oxygen canul XS pcs 18 - 18 - 18
175 Natrium Bikarbonat tablet 500 mg tablet - - - - -
176 Natrium Fluoresein tetes mata 2 % botol - - - - -
177 Natrium Klorida larutan infus 0,9 % botol 60 - 60 - 60
178 Natrium Thiosulfat injeksi I.v. 25 % ampul - - - - -
179 Nistatin tablet salut 500.000 IU/g tablet 1000 - 1,000 - 1,000
180 Nistatin Vaginal tablet salut 100.000 IU/g tablet 2,700 - 2,700 2,200 500
181 OAT Katagori 1 dewasa paket - - - - -
184 OAT Sisipan dewasa paket - - - - -
185 OAT Katagori anak paket - - - - -
186 Obat Batuk Hitam ( O.B.H.) botol - - - - -
187 Oksigen Gas dalam tabung tabung - - - - -
188 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml vial - - - - -
189 Oksitetrasiklin HCL salep mata 1 % tube - - - - -
190 Oksitetrasiklin HCL salep kulit 3 % tube - - - - -
191 Oksitosin injeksi 10 UI/ml-1 ml ampul 799 - 799 10 789
192 Paraformaldehid tablet 1 g tablet - - - - -
193 Parasetamol drop 60 mg/ 0.6 ml botol - - - - -
194 Parasetamol sirup 120 mg / 5 ml botol 600 - 600 100 500
195 Parasetamol tablet 100 mg tablet - - - - -
196 Parasetamol tablet 500 mg tablet 18,000 - 18,000 6,000 12,000
197 Pembalut Gips roll - - - - -
198 Perfenazin tablet 4 mg tablet - - - - -
200 Permetrin krim 5% (Scabimite) tube - - - - -
201 Petidin HCl injeksi 50 mgml - 2 ml ampul - - - - -
202 Pilokarpin tetes mata 2 % (HCL/Nitrat) botol - - - - -
203 Piperazin sirup 20 % botol - - - - -
204 Piperazin tablet 500 mg tablet - - - - -
205 Pirantel tab score (base) 125 mg tablet - - - - -
206 Piridoksin tablet 10 mg (HCl) tablet - - - - -
207 Plester 5 yards x 2 inch roll 25 - 25 - 25
208 Polikresulen botol - - - - -
209 Polipeptida kombinasi DOEN Lar infus botol - - - - -
210 Povidon Iodida lar 10 % - 10 ml botol - - - - -
215 Prazikuantel tablet 600 mg tablet - - - - -
216 Prednison tablet 5 mg tablet 4,500 - 4,500 400 4,100
217 Primakuin tablet 15 mg tablet - - - - -
218 Prokain Benzil Pen 3 jt IU / vial inj vial - - - - -
219 Propanolol tablet 40 mg (HCL) tablet - - - - -
221 Propiltiourasil tablet 100 mg tablet - - - - -
222 Rabies Immune Globulin (Human) 150 IU/ml vial - - - - -
223 Reserpin tablet 0,10 mg tablet - - - - -
225 Retinol (Vit. A) 100.000 IU kapsul kapsul - - - - -
226 Retinol (Vit. A) 200.000 IU kapsul kapsul 1,350 - 1,350 - 1,350
227 Rifampisin kapsul 300 mg tablet - - - - -
230 Ringer Laktat larutan infus botol 300 - 300 20 280
231 Salbutamol tab 2 mg tablet 12,500 - 12,500 300 12,200
Salep 2-4, kombinasi: Asam Salisilat 2% +
232 pot 48 - 48 - 48
Belerang endap 4%
233 Salisil bedak 2% kotak 150 - 150 - 150
234 Salisil Spritus 10% botol - - - - -
235 Semen Seng Fosfat serbuk dan cairan kotak - - - - -
236 Serum ABU I polivalen inj 5 ml vial - - - - -
237 Serum ABU II Polivalen inj 50 ml vial - - - - -
238 Serum Anti Rabies Injeksi vial - - - - -
239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 - 30 - 30
240 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - -

241 Sianokobalamin injeksi 500 mcg ampul - - - - -
Silk (Benang Bedah Sutera) No. 3/0 dengan jarum
242 kotak 36 - 36 12 24
bedah
243 Silver Amalgam serbuk set - - - - -
244 Spons Gelatin cubicles set - - - - -
245 Streptomisin Sulfat serbuk injeksi 1000 mg vial - - - - -
247 Sulfa Conus Kerucut (preparat) set - - - - -
248 Sulfadimidin tablet 500 mg tablet - - - - -
249 Sulfasetamida Natrium tts mata 15 % botol - - - - -
250 Suspensi Seng Insulin inj 40 IU/ml vial - - - - -
251 Syntetic Filling Material set - - - - -
252 Tablet Tambah Darah tablet 515,500 - 515,500 - 515,500
253 Temporary Stopping Fletcher serbuk dan cairan set - - - - -
254 Tetrakain HCl tetes mata 0,5% botol - - - - -

255 Tetrasiklin kapsul 250 mg kapsul - - - - -
257 Tiamin injeksi 100 mg/ml ampul - - - - -
258 Tiamin tablet 50 mg (HCL/Nitrat) tablet - - - - -
259 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul - - - - -
260 Triheksifenidil tablet 2 mg tablet 304 - 304 - 304
261 Trikresol Formalin (TKF) cairan set - - - - -
262 Vaksin Rabies kering untuk manusia ampul - - - - -
263 Domperidon 10 mg tablet 2,300 - 2,300 800 1,500
264 Vitamin B Kompleks tablet tablet 9,000 - 9,000 1,800 7,200
265 Captopril 12,5 mg tablet 9,500 - 9,500 1,500 8,000
266 Captopril 25 mg tablet 14,000 - 14,000 2,000 12,000
267 Cloramphenicol Tetes Mata 10% tube - - - - -
268 IV Catheter no 22 set 100 - 100 20 80
269 Mutivitamin Ibu Hamil/Hemafort kapsul 4,500 - 4,500 4,500 -
270 Multivitamin Anak botol - - - - -
271 Natrium diklofenak 50 mg tablet - - - - -
273 Atropin 0,5 mg tablet - - - - -
274 Domperidon Syrup botol 100 - 100 - 100
275 Molexdryl Syrup botol - - - - -
276 Dextral Syrup botol - - - - -
277 Aqua proinjeksi steril botol 29 - 29 - 29
278 Iodum Test tube - - - - -
279 Handscoon Steril no 7 pcs 1,200 - 1,200 15 1,185
280 Handscon Steril no 6,5 (umum) pcs - - - - -
281 Metformin 500 mg tablet 8,600 - 8,600 1,200 7,400
282 Mikonazol krim 2 % tube 72 - 72 - 72
283 Simvastatin tab salut 10 mg tablet 2,000 - 2,000 800 1,200
285 Handscoon Steril no 7,5 pcs 600 - 600 - 600
286 IV Catheter No. 24 G Set 108 - 108 25 83
287 Nifedipin 10 mg tablet - - - - -
288 Herbakof Syrup botol 2,520 - 2,520 1,080 1,440
289 Amlodipin besylate 5 mg tablet - - - - -
290 Vitamin B 12 50 mg tablet 300 - 300 100 200
291 Vitamin C Kap 500 mg tablet - - - - -
292 Gentamicin Sulfate Tts Mata 0,3 % botol - - - - -
293 Acyclofir tab 200 mg Tablet - - - - -
295 Handscoon Non Steril L Pcs 1,100 - 1,100 900 200
296 Ranitidin tab 150 mg tablet 9,000 - 9,000 3,900 5,100
297 Ranitidin HCL injeksi ampul 90 - 90 - 90
298 Zink tab dispersible 20 mg Tablet 3,000 - 3,000 700 2,300
299 Asam Mefenamat 500 mg tablet 10,000 - 10,000 1,200 8,800
300 Hemorograd Kapsul - - - - -
301 Poly catheter no. 18 set 10 - 10 - 10
302 Poly catheter no. 20 set 60 - 60 10 50
303 Alat suntik sekali pakai 20 cc Pcs 230 - 230 - 230
305 Hustab syrup botol - - - - -
306 Masker pcs 4,000 - 4,000 1,000 3,000
307 Masker oksigen anak pcs 41 - 41 - 41
308 Masker oksigen dewasa pcs 26 - 26 - 26
309 Masker nebulizer anak pcs 29 - 29 - 29
310 Masker nebulizer dewasa pcs 32 - 32 - 32
311 Cyprofloksasin 500 tablet - - - - -
312 Acyclofir krim tube 50 - 50 25 25
313 Cetirizine tablet 900 - 900 - 900
314 Dulcolac supp anak 5ml supp - - - - -
315 Dulcolac supp dewasa 10ml supp - - - - -
316 Gentamicin Sulfate Salep Mata 0,3 % tube - - - - -
317 Gentamicin Salep kulit 0.1% tube - - - - -
318 Gentamicin Inj ampul 8 - 8 - 8
319 Kassa 2x80 roll 72 - 72 - 72
320 Acetylcystein 200 mg tablet - - - - -
321 Calsium Gluconas ampul - - - - -
322 Umbilikal klem set 40 - 40 - 40
323 Biolysin botol - - - - -
324 Etanol 70% 1000 ml botol - - - - -
325 Bisakodil tab 5 mg tablet 300 - 300 100 200
326 Kassa Hidrofil 36x80 set 5 - 5 - 5
327 Kloramfenikol susp 125mg/5ml botol - - - - -
328 Omeprazole 200 mg kapsul 1,800 - 1,800 400 1,400
329 Urine Bag set 41 - 41 10 31
330 Kassa pembalut 2x80 set - - - - -
331 Handscoon non steril M sett 600 - 600 100 500
332 Xylocain 2% gel - - - - -
333 Xylocain Sprai 10 mg botol - - - - -
334 Bricasma 0.5 mg/ml ampul - - - - -
335 Bricasma 5mg/ 2 ml Respul - - - - -
336 Metronidazole Infus botol 8 - 8 - 8
337 Ampisillin 1000 mg ampul - - - - -
338 kloramfenikol tetes mata botol - - - - -
339 Alkohol Swab 2 Ply pcs - - - - -
340 Alkohol Swab 4 Ply pcs 300 - 300 100 200
341 Ambroxol sirup - - - - -
342 Blood Lancet pcs 300 - 300 200 100
343 Handscoon Steril no. 6 set 300 - 300 - 300
344 Ketokonazole 200 mg tablet 3,200 - 3,200 200 3,000
345 IV Catheter no. 20 set 183 - 183 20 163
346 Metoklopramid 10 mg Tablet 2,500 - 2,500 100 2,400
347 Pulmicort Resp 0.5mg/ l In 2 ml pcs - - - - -
348 Pulmicort Resp 0.25 mg/ l In 2 ml pcs - - - - -
349 Poly catheter No 16 pcs 42 - 42 1 41
350 Transfusion Set pcs 531 - 531 - 531
351 USG Gel botol 9 - 9 2 7
352 Atapulgit (Antidiare) tablet - - - - -
353 Under Pad pcs 40 - 40 - 40
354 Diazepam lar rektal 5 mg/ 2.5 ml tube - - - - -
356 Plester Aximed 5 x 10 cm pcs - - - - -
357 Plester Polifix 5 x 5 cm pcs - - - - -
358 Handscoon Non Steril S pcs 300 - 300 - 300
359 Clobazam 10 mg tablet - - - - -
360 Flufenazine Deconoat 25mg/ml ampul - - - - -
361 Haloperidol 5mg/ml ampul - - - - -
362 Trifluoperazine HCL 5 mg tablet 90 200 290 - 290
363 Asiklovir 400 mg tablet 3,200 - 3,200 1,800 1,400
364 Gemfibrozil 300 mg kapsul 100 - 100 - 100
365 Suction Catheter No. 14 pcs - - - - -
366 Albendazol sirup botol - - - - -
367 Bisoprolol 10 mg tablet - - - - -
368 Bisoprolol 2.5 mg (Concor) tablet - - - - -
369 Eritromisin 250 mg kapsul - - - - -
370 3-way pcs 34 - 34 - 34
371 3-way with extention pcs 30 - 30 - 30
372 Amlodipin besylate 10 mg tablet 1,500 - 1,500 300 1,200
374 Asetosal 80 mg tablet 300 - 300 100 200
375 Hand rub 5 L botol 5 - 5 - 5
376 Hand Rub 500 ml botol - - - - -
377 Stimuno Forte tablet 1,170 - 1,170 180 990
378 Stimuno Sirup stik - - - - -
379 Metronidazole suspensi 125 mg/ 5 ml botol 200 - 200 - 200
380 Mucus Suction set - - - - -
381 Mometasone furoat krim 0.1% tube 60 - 60 - 60
382 Klozapine 25 mg tablet 0 - - 0 -
383 Alopurinol 300 mg tablet 1800 - 1,800 100 1,700
384 Manitol larutan infus 20% botol 5 - 5 5
385 Risperidon 2 mg tablet 0 200 200 200
386 Serum anti bisa ular : A.B.U botol 3 - 3 3
1 Erlamicetin zalf mata tube - - - -

2 Licobevit / Tyamin tablet - - - - -
3 Aquabides botol - - -
4 Nistatin tablet - - - - -
5 Disposible 30 cc set - - - -
6 Cahteter Foley set - - - - -
7 Myomergin Injeksi ampul - - - - -
8 Sensi Gloves M set - - - - -
9 Aleron tablet - - - - -
10 Urinal Bag tablet - - - - -
11 Prednison tablet - - - - -
12 IV Catheter no 18 set - - - - -
14 Paracetamol tablet - - - - -
15 Yusimox Syrup botol - - - - -
18 Umbilicam Cosa set - - - - -
19 Metformin tablet - - - - -
20 Diometa tablet - - - - -
21 Antasid tablet - - - - -
22 Zalf 24 tube - - - - -
23 Ranitidin tablet - - - - -
25 Amoxicillin syr botol - - - - -
26 Vitamin B 1 botol - - -
UMUM
TIDAK JKN JUMLAH
BAYAR
JUMLAH KUNJUNGAN RESEP BAYAR
554 1,137 1,691
Mengetahui : Yang Menyerahkan Yang Meminta

Kepala Dinas Kesehatan Kabupaten Indramayu Kepala UPTD Farmasi Kepala UPTD Puskesmas Ked
dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest

NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
JANUARI 2023 2022 UPTD FARMASI

FEBRUARI 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
N APBN ASKES APBD I APBD II PROGRAMLAIN-LAIN
10 11 12 13 14 15 16 17
500
2,000
5,000
100
100
3,000
100
84
3,000
500
500
10
500
500
500
1,000
3,000
240
300
3,000
320
100
100
48
3,000
500
1,000
1,000
40
512
100
150
200
6,000
5,000
60
100
20
48
3,000
500
3,000
2,000
2,000
100
1,000
200
100
200
2,880
`
3,000
144
500
500
100
500
5
200
200
600
500
300
10
1,000
10
20
200
10
500
2,000
100
500
500
50
Yang Meminta Yang Menerima
a UPTD Puskesmas Kedungwungu Petugas Puskesmas Kedungwungu
dr. Devi Septiani Lestari apt. Fretty Setiawati, S.Farm

NIP. 19900906 201903 2 010 NIP. 19930707 201903 2 018
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : FEBRUARI 2023
PROPINSI PERMINTAAN BULAN/PERIODE : MARET 2023

AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
3 Alat suntik sekali pakai 2,5 ml set 52 - 52 - 52
7 Albendazol tablet 400 mg tablet 45,500 - 45,500 300 45,200
8 Allopurinol tablet 100 mg tablet 4,000 - 4,000 - 4,000
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 300 - 300 - 300
19 Aluminium Hidroksida 200 mg + Magnesium tablet 5,900 - 5,900 600 5,300
Hidroksida 200 mg
20 tube - - - - -
21 supp - - - - -
22 pot 216 - 216 - 216
Asam Salisilat 3%
23 tablet - - - - -
mg
24 tablet - - - - -
27 Asam Askorbat tablet 50 mg tablet 3,300 - 3,300 - 3,300
35 ampul 18 - 18 - 18
mL
40 Catgut / Benang Bedah No. 2/0 - 3/0 set 48 - 48 - 48
48 botol - - - - -
(HBr)/Dextrofen
52 Diazepam Injeksi 5mg/ml ampul 38 - 38 38 -
54 Diazepam tablet 5 mg tablet 385 - 385 - 385
58 Dimenhidrinat 50 mg tablet 900 - 900 - 900

65 Etanol 70% 100 ml botol - - - - -
81 Furosemid tablet 40 mg tablet 600 - 600 - 600
84 Garam Oralit 200 ml air kantong 4200 - 4,200 - 4,200
97 Haloperidol tablet 1,5 mg tablet 700 - 700 - 700
98 Haloperidol 5 mg tablet 600 - 600 - 600
102 Ibuprofen tablet 400 mg tablet 4,900 - 4,900 100 4,800
105 Infusion set dewasa set 975 - 975 125 850
108 Ipeka 0,14 % syr botol - - - - -
117 Kapas Pembalut/Absorben 250 g roll 13 - 13 - 13
121 Kasa Pembalut Hidrofil 4 m x 10 cm roll 41 - 41 - 41
125 Ketokonazole krim tube 204 - 204 36 168
126 Klindamycin 150 mg tablet 1,050 - 1,050 100 950
130 Kloramfenikol salep kulit 2% tube 120 - 120 24 96
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 4,500 - 4,500 2,500 2,000
140 tablet - - - - -
mg
143 Kotrimoksazol tablet 480 mg tablet 2,800 - 2,800 - 2,800
155 ampul 320 - 320 - 320
80.000-2 ml
156 Lidokain inj 2% ampul 328 - 328 - 328
158 Loratadin 10 mg tablet 800 - 800 - 800
159 Magnesium Sulfat inj (IV) 20%-25 ml vial 58 - 58 - 58
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 303 - 303 25 278
167 Metilprednisolon 4 mg tablet 4,300 - 4,300 - 4,300
177 Natrium Klorida larutan infus 0,9 % botol 60 - 60 - 60
179 Nistatin tablet salut 500.000 IU/g tablet 1000 - 1,000 - 1,000
180 Nistatin Vaginal tablet salut 100.000 IU/g tablet 500 - 500 - 500
230 Ringer Laktat larutan infus botol 280 - 280 - 280
231 Salbutamol tab 2 mg tablet 12,200 - 12,200 2,200 10,000
232 pot 48 - 48 24 24
Belerang endap 4%
233 Salisil bedak 2% kotak 150 - 150 49 101

242 kotak 24 - 24 - 24
bedah

260 Triheksifenidil tablet 2 mg tablet 304 - 304 10 294
263 Domperidon 10 mg tablet 1,500 - 1,500 - 1,500
265 Captopril 12,5 mg tablet 8,000 - 8,000 500 7,500
266 Captopril 25 mg tablet 12,000 - 12,000 - 12,000
268 IV Catheter no 22 set 80 - 80 - 80
269 Mutivitamin Ibu Hamil/Hemafort kapsul - - - - -
277 Aqua proinjeksi steril botol 29 - 29 10 19
281 Metformin 500 mg tablet 7,400 - 7,400 400 7,000
283 Simvastatin tab salut 10 mg tablet 1,200 - 1,200 400 800
286 IV Catheter No. 24 G Set 83 - 83 - 83
288 Herbakof Syrup botol 1,440 - 1,440 360 1,080
290 Vitamin B 12 50 mg tablet 200 - 200 - 200
295 Handscoon Non Steril L Pcs 200 - 200 - 200
296 Ranitidin tab 150 mg tablet 5,100 - 5,100 100 5,000
297 Ranitidin HCL injeksi ampul 90 - 90 - 90
298 Zink tab dispersible 20 mg Tablet 2,300 - 2,300 - 2,300
306 Masker pcs 3,000 - 3,000 1,000 2,000
312 Acyclofir krim tube 25 - 25 - 25
313 Cetirizine tablet 900 - 900 - 900
319 Kassa 2x80 roll 72 - 72 - 72
324 Etanol 70% 1000 ml botol - - - - -
325 Bisakodil tab 5 mg tablet 200 - 200 - 200
328 Omeprazole 200 mg kapsul 1,400 - 1,400 200 1,200
329 Urine Bag set 31 - 31 - 31
331 Handscoon non steril M sett 500 - 500 200 300
332 Xylocain 2% gel - - - - -
340 Alkohol Swab 4 Ply pcs 200 - 200 200 -
342 Blood Lancet pcs 100 - 100 100 -
344 Ketokonazole 200 mg tablet 3,000 - 3,000 - 3,000
345 IV Catheter no. 20 set 163 - 163 - 163
346 Metoklopramid 10 mg Tablet 2,400 - 2,400 - 2,400
349 Poly catheter No 16 pcs 41 - 41 - 41
353 Under Pad pcs 40 - 40 - 40
358 Handscoon Non Steril S pcs 300 - 300 100 200
362 Trifluoperazine HCL 5 mg tablet 290 - 290 - 290
363 Asiklovir 400 mg tablet 1,400 - 1,400 - 1,400
364 Gemfibrozil 300 mg kapsul 100 - 100 100 -
370 3-way pcs 34 - 34 - 34
372 Amlodipin besylate 10 mg tablet 1,200 - 1,200 200 1,000
374 Asetosal 80 mg tablet 200 - 200 - 200
377 Stimuno Forte tablet 990 - 990 - 990
385 Risperidon 2 mg tablet 200 - 200 200

22 Zalf 24 tube - - - - -
UMUM
TIDAK JKN JUMLAH
BAYAR
450 1,075 1,525


NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
FEBRUARI 2023 UPTD FARMASI

MARET 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
10 11 12 13 14 15 16 17
500
2,000
5,000
100
100
3,000
100
84
3,000
500
500
10
500
500
500
1,000
3,000
240
300
3,000
320
100
100
48
3,000
500
1,000
1,000
40
512
100
150
200
6,000
5,000
60
100
20
48
3,000
500
3,000
2,000
2,000
100
1,000
200
100
200
2,880
`
3,000
144
500
500
100
500
5
200
200
600
500
300
10
1,000
10
20
200
10
500
2,000
100
500
500
50

NIP. 19900906 201903 2 010 NIP. 19930707 201903 2 018
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : MARET 2023
PROPINSI PERMINTAAN BULAN/PERIODE : APRIL 2023

AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
7 Albendazol tablet 400 mg tablet 45,200 - 45,200 1,800 43,400
8 Allopurinol tablet 100 mg tablet 4,000 - 4,000 800 3,200
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 300 - 300 200 100
19 Aluminium Hidroksida 200 mg + Magnesium tablet 5,300 - 5,300 1,300 4,000
Hidroksida 200 mg
20 tube - - - - -
21 supp - - - - -
22 pot 216 - 216 - 216
Asam Salisilat 3%
23 tablet - - - - -
mg
24 tablet - - - - -
27 Asam Askorbat tablet 50 mg tablet 3,300 - 3,300 500 2,800
35 ampul 18 - 18 - 18
mL
43 Ciprofloxacin 500 mg tablet 5,400 - 5,400 - 5,400
48 botol - - - - -
(HBr)/Dextrofen
52 Diazepam Injeksi 5mg/ml ampul - - - - -

65 Etanol 70% 100 ml botol - - - - -
78 Fitomenadion injeksi 10 mg/ml ampul 90 - 90 30 60
79 Fitomenadion tablet salut 10 mg tablet 100 - 100 - 100
81 Furosemid tablet 40 mg tablet 600 - 600 200 400
84 Garam Oralit 200 ml air kantong 4200 - 4,200 4,200 -
88 Glibenklamida tablet 5 mg tablet 5,800 - 5,800 - 5,800
97 Haloperidol tablet 1,5 mg tablet 700 - 700 300 400
98 Haloperidol 5 mg tablet 600 - 600 - 600
102 Ibuprofen tablet 400 mg tablet 4,800 - 4,800 500 4,300
108 Ipeka 0,14 % syr botol - - - - -
125 Ketokonazole krim tube 168 - 168 48 120
126 Klindamycin 150 mg tablet 950 - 950 450 500
130 Kloramfenikol salep kulit 2% tube 96 - 96 96 -
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 2,000 - 2,000 2,000 -
140 tablet - - - - -
mg
155 ampul 320 - 320 50 270
80.000-2 ml
156 Lidokain inj 2% ampul 328 - 328 58 270
158 Loratadin 10 mg tablet 800 - 800 - 800
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 278 - 278 - 278
171 Nasal oxygen canul M pcs 28 - 28 1 27
172 Nasal oxygen canul L pcs 40 - 40 2 38
174 Nasal oxygen canul XS pcs 18 - 18 1 17
177 Natrium Klorida larutan infus 0,9 % botol 60 - 60 10 50
179 Nistatin tablet salut 500.000 IU/g tablet 1000 - 1,000 100 900
194 Parasetamol sirup 120 mg / 5 ml botol 300 - 300 300 -
230 Ringer Laktat larutan infus botol 280 - 280 40 240
231 Salbutamol tab 2 mg tablet 10,000 - 10,000 700 9,300
232 pot 24 - 24 - 24
Belerang endap 4%
233 Salisil bedak 2% kotak 101 - 101 50 51

242 kotak 24 - 24 12 12
bedah

260 Triheksifenidil tablet 2 mg tablet 294 - 294 - 294
265 Captopril 12,5 mg tablet 7,500 - 7,500 500 7,000
266 Captopril 25 mg tablet 12,000 - 12,000 500 11,500
269 Mutivitamin Ibu Hamil/Hemafort kapsul - - - - -
274 Domperidon Syrup botol 100 - 100 100 -
277 Aqua proinjeksi steril botol 19 - 19 - 19
283 Simvastatin tab salut 10 mg tablet 800 - 800 400 400
288 Herbakof Syrup botol 1,080 - 1,080 1,080 -
290 Vitamin B 12 50 mg tablet 200 - 200 200 -
295 Handscoon Non Steril L Pcs 200 - 200 200 -
296 Ranitidin tab 150 mg tablet 5,000 - 5,000 1,000 4,000
297 Ranitidin HCL injeksi ampul 90 - 90 25 65
306 Masker pcs 2,000 - 2,000 1,000 1,000
312 Acyclofir krim tube 25 - 25 - 25
313 Cetirizine tablet 900 - 900 100 800
319 Kassa 2x80 roll 72 - 72 - 72
324 Etanol 70% 1000 ml botol - - - - -
328 Omeprazole 200 mg kapsul 1,200 - 1,200 600 600
329 Urine Bag set 31 - 31 - 31
331 Handscoon non steril M sett 300 - 300 300 -
332 Xylocain 2% gel - - - - -
336 Metronidazole Infus botol 8 - 8 2 6
342 Blood Lancet pcs - - - - -
346 Metoklopramid 10 mg Tablet 2,400 - 2,400 - 2,400
353 Under Pad pcs 40 - 40 20 20
358 Handscoon Non Steril S pcs 200 - 200 100 100
363 Asiklovir 400 mg tablet 1,400 - 1,400 50 1,350
364 Gemfibrozil 300 mg kapsul - - - - -
370 3-way pcs 34 - 34 - 34
372 Amlodipin besylate 10 mg tablet 1,000 - 1,000 1,000 -
374 Asetosal 80 mg tablet 200 - 200 - 200
377 Stimuno Forte tablet 990 - 990 390 600

22 Zalf 24 tube - - - - -
UMUM
TIDAK JKN JUMLAH
BAYAR
579 1,431 2,010


NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
MARET 2023 UPTD FARMASI

APRIL 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
10 11 12 13 14 15 16 17
6,000
300
6,000
144
100
400
96
300
10
1,000
1,000
500
5,000
40
40
500
3,000
500
6,000
480
144
192
6,000
1,000
1,000
144
144
300
900
18,000
10
6,000
60
96
100
96
1,000
500
5,000
2,000
500
3,000
3,000
1,000
1,000
2,880
6,000 `
1,000
120
1,000
1,200
3,000
500
2,000
1,000
1,800
1,200
1,000
1,000
500
1,000
5
1,000
100
20
500
500
500
5,000
300
20

NIP. 19900906 201903 2 010 NIP. 19930707 201903 2 018
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : APRIL 2023
PROPINSI PERMINTAAN BULAN/PERIODE : MEI 2023

AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
7 Albendazol tablet 400 mg tablet 45,200 - 45,200 1,800 43,400
8 Allopurinol tablet 100 mg tablet 4,000 - 4,000 2,400 1,600
11 Amitripilin tablet salut 25 mg (HCL) tablet 30 - 30 30 -
13 Amoksisillin kapsul 500 mg kapsul 4,400 2,000 6,400 4,400 2,000
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 300 100 400 300 100
19 Aluminium Hidroksida 200 mg + Magnesium tablet 5,300 2,000 7,300 2,300 5,000
Hidroksida 200 mg
20 tube - - - - -
21 supp - - - - -
22 pot 216 - 216 - 216
Asam Salisilat 3%
23 tablet - - - - -
mg
24 tablet - - - - -
27 Asam Askorbat tablet 50 mg tablet 3,300 - 3,300 1,300 2,000
35 ampul 18 - 18 - 18
mL
40 Catgut / Benang Bedah No. 2/0 - 3/0 set 48 36 84 36 48
48 botol - - - - -
(HBr)/Dextrofen
52 Diazepam Injeksi 5mg/ml ampul - - - - -

65 Etanol 70% 100 ml botol - - - - -
72 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul 5 - 5 2 3
79 Fitomenadion tablet salut 10 mg tablet 100 500 600 100 500
81 Furosemid tablet 40 mg tablet 600 600 1,200 400 800
84 Garam Oralit 200 ml air kantong 4200 500 4,700 4,200 500
91 Glukosa larutan infus 5% botol - 40 40 - 40
97 Haloperidol tablet 1,5 mg tablet 700 - 700 274 426
98 Haloperidol 5 mg tablet 600 - 600 200 400
100 Hidrokortison krim 2,5% tube 600 - 600 600 -
102 Ibuprofen tablet 400 mg tablet 4,800 1,000 5,800 800 5,000
108 Ipeka 0,14 % syr botol - - - - -
115 Kalsium Laktat tablet 500 mg tablet 5,700 2,000 7,700 4,700 3,000
125 Ketokonazole krim tube 168 - 168 - 168
126 Klindamycin 150 mg tablet 950 - 950 550 400
130 Kloramfenikol salep kulit 2% tube 96 72 168 120 48
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 2,000 2,000 4,000 2,500 1,500
140 tablet - - - - -
mg
155 ampul 420 - 420 - 420
80.000-2 ml
156 Lidokain inj 2% ampul 270 - 270 30 240
158 Loratadin 10 mg tablet 800 500 1,300 - 1,300
165 Metilergometrin Maleat tablet salut 0,125 mg tablet 1,700 - 1,700 300 1,400
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 278 - 278 - 278
177 Natrium Klorida larutan infus 0,9 % botol 60 - 60 10 50
179 Nistatin tablet salut 500.000 IU/g tablet 1000 - 1,000 100 900
194 Parasetamol sirup 120 mg / 5 ml botol 300 900 1,200 400 800
196 Parasetamol tablet 500 mg tablet 10,000 2,000 12,000 11,000 1,000
216 Prednison tablet 5 mg tablet 3,800 - 3,800 1,300 2,500
230 Ringer Laktat larutan infus botol 280 60 340 65 275
231 Salbutamol tab 2 mg tablet 10,000 - 10,000 1,000 9,000
232 pot 24 24 48 24 24
Belerang endap 4%
233 Salisil bedak 2% kotak 101 6 107 87 20

242 kotak 24 24 48 12 36
bedah

260 Triheksifenidil tablet 2 mg tablet 294 - 294 294 -
264 Vitamin B Kompleks tablet tablet 6,000 2,000 8,000 2,500 5,500
265 Captopril 12,5 mg tablet 7,500 - 7,500 1,500 6,000
266 Captopril 25 mg tablet 12,000 - 12,000 100 11,900
269 Mutivitamin Ibu Hamil/Hemafort kapsul - 1,000 1,000 1,000 -
272 Natrium diklofenak 25 mg tablet - 1,000 1,000 500 500
277 Aqua proinjeksi steril botol 19 - 19 5 14
282 Mikonazol krim 2 % tube 72 - 72 24 48
283 Simvastatin tab salut 10 mg tablet 800 500 1,300 700 600
288 Herbakof Syrup botol 1,080 720 1,800 1,080 720
290 Vitamin B 12 50 mg tablet 200 500 700 200 500
295 Handscoon Non Steril L Pcs 200 200 400 300 100
296 Ranitidin tab 150 mg tablet 5,000 1,000 6,000 2,500 3,500
297 Ranitidin HCL injeksi ampul 90 - 90 25 65
306 Masker pcs 2,000 200 2,200 1,200 1,000
312 Acyclofir krim tube 25 - 25 25 -
313 Cetirizine tablet 900 500 1,400 100 1,300
319 Kassa 2x80 roll 72 - 72 - 72
322 Umbilikal klem set 40 - 40 26 14
324 Etanol 70% 1000 ml botol - - - - -
328 Omeprazole 200 mg kapsul 1,200 600 1,800 1,200 600
329 Urine Bag set 31 - 31 - 31
331 Handscoon non steril M sett 300 200 500 300 200
332 Xylocain 2% gel - - - - -
340 Alkohol Swab 4 Ply pcs - 500 500 - 500
342 Blood Lancet pcs - - - - -
346 Metoklopramid 10 mg Tablet 2,400 - 2,400 200 2,200
351 USG Gel botol 6 5 11 3 8
353 Under Pad pcs 40 10 50 20 30
358 Handscoon Non Steril S pcs 200 200 400 200 200
363 Asiklovir 400 mg tablet 1,400 - 1,400 50 1,350
364 Gemfibrozil 300 mg kapsul - - - - -
370 3-way pcs 34 - 34 - 34
372 Amlodipin besylate 10 mg tablet 1,000 1,000 2,000 1,400 600
374 Asetosal 80 mg tablet 200 100 300 - 300
377 Stimuno Forte tablet 990 - 990 990 -
381 Mometasone furoat krim 0.1% tube 60 - 60 20 40

22 Zalf 24 tube - - - - -
UMUM
TIDAK JKN JUMLAH
BAYAR
376 867 1,243


NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
APRIL 2023 UPTD FARMASI

MEI 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
10 11 12 13 14 15 16 17
6,000
300
4,000
144
100
400
96
300
10
1,000
1,000
500
5,000
2,000
500
6,000
480
144
192
6,000
1,000
144
144
300
18,000
10
6,000
60
96
100
96
1,000
500
3,000
3,000
500
3,000
1,000
1,000
2,880
`
1,000
120
1,000
1,200
3,000
500
2,000
1,000
1,800
1,200
1,000
500
1,000
5
1,000
100
20
500
500
6,000
300
20

NIP. 19900906 201903 2 010 NIP. 19930707 201903 2 018
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : MEI 2023
PROPINSI PERMINTAAN BULAN/PERIODE : JUNI 2023

AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
1 Air Raksa Dental use botol 0 0 0 - -
2 Alat suntik sekali pakai 1 ml set 600 0 600 600
3 Alat suntik sekali pakai 2,5 ml set 52 0 52 28 24
4 Alat suntik sekali pakai 3 ml set 1100 0 1,100 100 1,000
5 Alat suntik sekali pakai 5 ml set 590 0 590 - 590
6 Alat suntik sekali pakai 50 cc set 210 0 210 - 210
7 Albendazol tablet 400 mg tablet 43400 0 43,400 33,100 10,300
8 Allopurinol tablet 100 mg tablet 1600 0 1,600 1,100 500
9 Aminofilin tablet 200 mg tablet 0 0 - - -
10 Aminofilin injeksi 24 mg/ml ampul 0 0 - - -
11 Amitripilin tablet salut 25 mg (HCL) tablet 30 0 30 30 -
12 Amoksisillin kapsul 250 mg kapsul 0 0 - - -
13 Amoksisillin kapsul 500 mg kapsul 2000 2,000 2,000 -
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 100 - 100 100 -
15 Ampisillin kapsul 500 mg kapsul 0 0 - - -
16 Ampisillin sirup kering 125 mg/5 ml botol 0 0 - - -
17 Antalgin tablet 500 mg tablet 0 0 - - -
18 Antalgin injeksi 250 mg/ml ampul 0 0 - - -
19 Aluminium Hidroksida 200 mg + Magnesium tablet 5000 - 5,000 1,500 3,500
Hidroksida 200 mg
20 tube 0 0 - - -
21 supp 0 0 - - -
22 pot 216 0 216 24 192
Asam Salisilat 3%
23 tablet 0 0 - - -
mg
24 tablet 0 0 - - -
25 Aqua Pro Injeksi Steril, bebas pirogen vial 60 0 60 - 60
26 Aquadest steril - 500 ml botol 0 0 - - -
27 Asam Askorbat tablet 50 mg tablet 2000 0 2,000 1,500 500
28 Asam Askorbat tablet 25 mg tablet 0 0 - - -
29 Asam Klorida 0.1 N - 100 ml botol 0 0 - - -
30 Asam Sulfosalisilat 20 % - 100 ml botol 0 0 - - -
31 Asetosal tablet 100 mg tablet 0 0 - - -
33 Atropin Sulfat tablet 0,5 mg tablet 0 0 - - -
34 Atropin tetes mata 0,5% botol 0 0 - - -
35 ampul 18 0 18 - 18
mL
36 Benzatin Benzil Pen inj 1,2 jt IU/vial ampul 0 0 - - -
38 Besi sirup botol 0 0 - - -
39 Betametason krim 0,1 % tube 0 0 - - -
41 Cefadroxil DS 125 mg/5 ml sirup 200 0 200 - 200
42 Cetirizin Sirup sirup 200 0 200 - 200
43 Ciprofloxacin 500 mg tablet 5000 0 5,000 500 4,500
44 Dapson tablet 100 mg tablet 0 0 - - -
45 Deksametason Injeksi I.v. 5 mg/ml ampul 65 0 65 - 65
46 Deksametason 0.5 mg tablet 0 0 - - -
47 Dekstran 70-larutan infus 6% steril botol 0 0 - - -
48 botol 0 0 - - -
(HBr)/Dextrofen
49 Dekstrometorfan tablet 15 mg (HBr) tablet 0 0 - - -
50 Desinfektan 500 ml botol 10 0 10 - 10
51 Devitalisai Pasta (Non Arsen) botol 0 0 - - -
52 Diazepam Injeksi 5mg/ml ampul 0 0 - - -
53 Diazepam tablet 2 mg tablet 0 0 - - -
54 Diazepam tablet 5 mg tablet 265 0 265 5 260
55 Dietilkarbamazin Sitrat tablet 100 mg tablet 0 0 - - -
56 Difenhidramin injeksi I.M. 10 mg/ml (HCL) ampul 74 0 74 - 74
57 Digoksin tablet 0,25 mg tablet 0 0 - - -
58 Dimenhidrinat 50 mg tablet 900 0 900 - 900
59 Doksisiklin 100 mg kapsul 3100 0 3,100 - 3,100
60 Efedrin tablet 25 mg (HCL) tablet 0 0 - - -
61 Ekstrak Belladona tablet 10 mg tablet 0 0 - - -
62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul 0 0 - - -
63 Etakridin larutan 0,1% botol 0 0 - - -

64 Etambutol HCl tablet 250 mg tablet 0 0 - - -
65 Etanol 70% 100 ml botol 0 0 - - -
66 Eter Anestetik botol 0 0 - - -
67 Etil Klorida botol 0 0 - - -
68 Eugenol cairan botol 0 0 - - -
69 Fenitoin Natrium Injeksi 50 mg/ml ampul 0 0 - - -
70 Fenitoin Natrium kapsul 100 mg kapsul 0 0 - - -
71 Fenitoin Natrium Injeksi 30 mg ampul 0 0 - - -
72 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul 5 0 5 2 3
73 Fenobarbital tablet 100 mg tablet 0 0 - - -
75 Fenoksimetil Pen tablet 250 mg tablet 0 0 - - -
77 Fenol Gliserol tetes telinga 10% botol 0 0 - - -
78 Fitomenadion injeksi 10 mg/ml ampul 90 0 90 - 90
80 Fluor tablet 0,5 mg tablet 0 0 - - -
82 Ferinokresol botol 0 0 - - -
83 Gameksan lotion 1 % botol 0 0 - - -
84 Garam Oralit 200 ml air kantong 500 - 500 100 400
85 Garam Oralit 1000 ml air kantong 0 0 - - -
86 Gentian Violet Larutan 1 % botol 0 0 - - -
87 Glass Ionomer Cement (GC IX) set 0 0 - - -
88 Glibenklamida tablet 5 mg tablet 5000 0 5,000 500 4,500
89 Gliseril Guayakolat tablet 100 mg tablet 0 0 - - -
90 Gliserin botol 0 0 - - -
91 Glukosa larutan infus 5% botol 0 40 40 - 40
92 Glukosa larutan infus 10% botol 0 0 - - -
93 Glukosa larutan infus 40% steril botol 0 0 - - -
94 Griseofulvin tablet 125 mg tablet 0 0 - - -
95 Gutta Percha Points stik 0 0 - - -
96 Haloperidol tablet 0,5 mg tablet 0 0 - - -
97 Haloperidol tablet 1,5 mg tablet 700 0 700 274 426
98 Haloperidol 5 mg tablet 600 0 600 200 400
99 Hidroklortiazida tablet 25 mg tablet 0 0 - - -
100 Hidrokortison krim 2,5% tube 600 0 600 600 -
101 Ibuprofen tablet 200 mg tablet 0 0 - - -
102 Ibuprofen tablet 400 mg tablet 5000 - 5,000 1,000 4,000
103 Ibuprofen sirup 200/ 5 ml botol 0 0 - - -
104 Infusion set anak set 200 0 200 - 200
105 Infusion set dewasa set 850 0 850 - 850
106 Insulin Reguler injeksi 40 IU/ml vial 0 0 - - -
107 Idiol Kapsul Lunak kapsul 0 0 - - -
108 Ipeka 0,14 % syr botol 0 0 - - -
109 Isoniazid tablet 300 mg tablet 0 0 - - -
110 Isosorbid Dinitrat tab subl 5 mg tablet 0 0 - - -
111 Jarum jahit (Bedah No. 9 s/d 14) kotak 0 0 - - -
112 Kalium Permanganat serbuk - 5 mg set 0 0 - - -
113 Kalsium glukonat inj ampul 0 0 - - -
114 Kalsium Hidroksida Pasta kotak 0 0 - - -
115 Kalsium Laktat tablet 500 mg tablet 3000 - 3,000 2,500 500
116 Kapas Berlemak 500 gram roll 0 0 - - -
117 Kapas Pembalut/Absorben 250 g roll 13 0 13 - 13
118 Karbamazepin tablet 200 mg tablet 0 0 - - -
119 Kasa Hidrofil 18 m x 22 cm roll 0 0 - - -
120 Kasa Hidrofil Steril 16 cm x 16 cm roll 272 0 272 80 192
121 Kasa Pembalut Hidrofil 4 m x 10 cm roll 41 0 41 15 26
122 Kasa Pembalut Hidrofil 4 m x 5 cm roll 0 0 - - -
123 Kasa Kompres 40 m x 40 m roll 100 0 100 - 100
124 Ketamin Injeksi 10 mg/ml vial 0 0 - - -
125 Ketokonazole krim tube 168 0 168 48 120
126 Klindamycin 150 mg tablet 400 0 400 150 250
127 Klofazimin kapsul 100 mg microzine kapsul 0 0 - - -
128 Kloramfenikol kapsul 250 mg kapsul 0 0 - - -
129 Kloramfenikol salep mata 1% tube 0 0 - - -
131 Kloramfenikol tetes telinga 3 % botol 0 0 - - -
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 1500 - 1,500 1,500 -
133 Kloroquin Fosfat tablet 250 mg tablet 0 0 - - -
134 Klorpromazin injeksi i.m 25 mg/ml-2ml (HCL) ampul 0 0 - - -
135 Klorpromazin injeksi i.m 5 mg/ml (HCL) ampul 0 0 - - -
136 Klorpromazin tablet salut 25 mg (HCL) tablet 0 0 - - -
137 Klorpromazin tablet salut 100 mg (HCl) tablet 0 0 - - -
138 Klorpropamid tablet 100 mg tablet 0 0 - - -
139 Kodein HCl tablet 10 mg tablet 0 0 - - -
140 tablet 0 0 - - -
mg
141 Kotrimoksazol pedia tablet 120 mg tablet 0 0 - - -
142 Kotrimoksazol suspensi 240 mg botol 1500 0 1,500 - 1,500
143 Kotrimoksazol tablet 480 mg tablet 2200 0 2,200 400 1,800
144 Kuinin Di HCl injeksi 25%-2 ml ampul 0 0 - - -
145 Kuinin (kina) tablet 200 mg tablet 0 0 - - -
146 Larutan Benedict botol 0 0 - - -
147 Larutan Eosin 2% botol 0 0 - - -
148 Larutan Etanol Asam botol 0 0 - - -
149 Larutan Gabbet botol 0 0 - - -
150 Larutan Giemsa Stain botol 0 0 - - -
151 Larutan Karbol Fuksin botol 0 0 - - -
152 Larutan Kinyoun botol 0 0 - - -
153 Larutan Metilen Biru botol 0 0 - - -
154 Larutan Turk botol 0 0 - - -
155 ampul 420 0 420 - 420
80.000-2 ml
156 Lidokain inj 2% ampul 240 0 240 60 180
157 Lisol botol 0 0 - - -
158 Loratadin 10 mg tablet 1800 - 1,800 500 1,300
159 Magnesium Sulfat inj (IV) 20%-25 ml vial 58 0 58 - 58
160 Magnesium Sulfat inj (IV) 40%-25 ml vial 185 0 185 - 185
161 Magnesium Sulfat serbuk 30 gram kotak 0 0 - - -
162 Mebendazol sirup 100 mg / 5 ml botol 0 0 - - -
163 Mebendazol tablet 100 mg tablet 0 0 - - -
164 Metanol botol 0 0 - - -
165 Metilergometrin Maleat tablet salut 0,125 mg tablet 1400 0 1,400 700 700
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 278 0 278 - 278
167 Metilprednisolon 4 mg tablet 4300 0 4,300 300 4,000
168 Metronidazol tablet 250 mg tablet 0 0 - - -
169 Monoklor Kamfer Menthol (CHKM) botol 0 0 - - -
170 Mummifying Pasta kotak 0 0 - - -
171 Nasal oxygen canul M pcs 28 0 28 - 28
172 Nasal oxygen canul L pcs 40 0 40 - 40
173 Nasal oxygen canul S pcs 53 0 53 - 53
174 Nasal oxygen canul XS pcs 18 0 18 - 18
175 Natrium Bikarbonat tablet 500 mg tablet 0 0 - - -
176 Natrium Fluoresein tetes mata 2 % botol 0 0 - - -
177 Natrium Klorida larutan infus 0,9 % botol 60 0 60 10 50
178 Natrium Thiosulfat injeksi I.v. 25 % ampul 0 0 - - -
179 Nistatin tablet salut 500.000 IU/g tablet 1000 0 1,000 100 900
180 Nistatin Vaginal tablet salut 100.000 IU/g tablet 500 0 500 - 500
181 OAT Katagori 1 dewasa paket 0 0 - - -
184 OAT Sisipan dewasa paket 0 0 - - -
185 OAT Katagori anak paket 0 0 - - -
186 Obat Batuk Hitam ( O.B.H.) botol 0 0 - - -
187 Oksigen Gas dalam tabung tabung 0 0 - - -
188 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml vial 0 0 - - -
189 Oksitetrasiklin HCL salep mata 1 % tube 0 0 - - -
190 Oksitetrasiklin HCL salep kulit 3 % tube 0 0 - - -
191 Oksitosin injeksi 10 UI/ml-1 ml ampul 687 33 720 - 720
192 Paraformaldehid tablet 1 g tablet 0 0 - - -
193 Parasetamol drop 60 mg/ 0.6 ml botol 0 0 - - -
195 Parasetamol tablet 100 mg tablet 0 0 - - -
196 Parasetamol tablet 500 mg tablet 1000 - 1,000 1,000 -
197 Pembalut Gips roll 0 - - -
198 Perfenazin tablet 4 mg tablet 0 0 - - -
200 Permetrin krim 5% (Scabimite) tube 0 0 - - -
201 Petidin HCl injeksi 50 mgml - 2 ml ampul 0 0 - - -
202 Pilokarpin tetes mata 2 % (HCL/Nitrat) botol 0 0 - - -
203 Piperazin sirup 20 % botol 0 0 - - -
204 Piperazin tablet 500 mg tablet 0 0 - - -
205 Pirantel tab score (base) 125 mg tablet 0 0 - - -
206 Piridoksin tablet 10 mg (HCl) tablet 0 0 - - -
207 Plester 5 yards x 2 inch roll 25 0 25 - 25
208 Polikresulen botol 0 0 - - -
209 Polipeptida kombinasi DOEN Lar infus botol 0 0 - - -
210 Povidon Iodida lar 10 % - 10 ml botol 0 0 - - -
215 Prazikuantel tablet 600 mg tablet 0 0 - - -
216 Prednison tablet 5 mg tablet 2500 0 2,500 500 2,000
217 Primakuin tablet 15 mg tablet 0 0 - - -
218 Prokain Benzil Pen 3 jt IU / vial inj vial 0 0 - - -
219 Propanolol tablet 40 mg (HCL) tablet 0 0 - - -
221 Propiltiourasil tablet 100 mg tablet 0 0 - - -
222 Rabies Immune Globulin (Human) 150 IU/ml vial 0 0 - - -
223 Reserpin tablet 0,10 mg tablet 0 0 - - -
225 Retinol (Vit. A) 100.000 IU kapsul kapsul 0 0 - - -
226 Retinol (Vit. A) 200.000 IU kapsul kapsul 1350 0 1,350 - 1,350
227 Rifampisin kapsul 300 mg tablet 0 0 - - -
230 Ringer Laktat larutan infus botol 275 - 275 - 275
231 Salbutamol tab 2 mg tablet 9000 0 9,000 - 9,000
232 pot 24 - 24 - 24
Belerang endap 4%
233 Salisil bedak 2% kotak 20 - 20 20 -
234 Salisil Spritus 10% botol 0 0 - - -
235 Semen Seng Fosfat serbuk dan cairan kotak 0 0 - - -
236 Serum ABU I polivalen inj 5 ml vial 0 0 - - -
237 Serum ABU II Polivalen inj 50 ml vial 0 0 - - -
238 Serum Anti Rabies Injeksi vial 0 0 - - -
239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 0 30 1 29
240 Serum Anti Tetanus Inj 20.000 IU/vial vial 0 0 - - -

241 Sianokobalamin injeksi 500 mcg ampul 0 0 - - -
242 kotak 36 - 36 12 24
bedah
243 Silver Amalgam serbuk set 0 0 - - -
244 Spons Gelatin cubicles set 0 0 - - -
245 Streptomisin Sulfat serbuk injeksi 1000 mg vial 0 0 - - -
247 Sulfa Conus Kerucut (preparat) set 0 0 - - -
248 Sulfadimidin tablet 500 mg tablet 0 0 - - -
249 Sulfasetamida Natrium tts mata 15 % botol 0 0 - - -
250 Suspensi Seng Insulin inj 40 IU/ml vial 0 0 - - -
251 Syntetic Filling Material set 0 0 - - -
252 Tablet Tambah Darah tablet 166050 0 166,050 166,050 -
253 Temporary Stopping Fletcher serbuk dan cairan set 0 0 - - -
254 Tetrakain HCl tetes mata 0,5% botol 0 0 - - -

255 Tetrasiklin kapsul 250 mg kapsul 0 0 - - -
257 Tiamin injeksi 100 mg/ml ampul 0 0 - - -
258 Tiamin tablet 50 mg (HCL/Nitrat) tablet 0 0 - - -
259 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul 0 0 - - -
260 Triheksifenidil tablet 2 mg tablet 294 0 294 294 -
261 Trikresol Formalin (TKF) cairan set 0 0 - - -
262 Vaksin Rabies kering untuk manusia ampul 0 0 - - -
263 Domperidon 10 mg tablet 1000 0 1,000 - 1,000
264 Vitamin B Kompleks tablet tablet 5500 - 5,500 1,700 3,800
265 Captopril 12,5 mg tablet 6000 0 6,000 1,500 4,500
266 Captopril 25 mg tablet 11900 0 11,900 11,900 -
267 Cloramphenicol Tetes Mata 10% tube 0 0 - - -
268 IV Catheter no 22 set 30 0 30 - 30
269 Mutivitamin Ibu Hamil/Hemafort kapsul 0 - - - -
270 Multivitamin Anak botol 0 0 - - -
271 Natrium diklofenak 50 mg tablet 0 0 - - -
272 Natrium diklofenak 25 mg tablet 500 - 500 - 500
273 Atropin 0,5 mg tablet 0 0 - - -
274 Domperidon Syrup botol 100 0 100 100 -
275 Molexdryl Syrup botol 0 0 - - -
276 Dextral Syrup botol 0 0 - - -
277 Aqua proinjeksi steril botol 14 0 14 14 -
278 Iodum Test tube 0 0 - - -
279 Handscoon Steril no 7 pcs 1100 0 1,100 100 1,000
280 Handscon Steril no 6,5 (umum) pcs 0 0 - - -
281 Metformin 500 mg tablet 5000 0 5,000 1,000 4,000
282 Mikonazol krim 2 % tube 48 0 48 - 48
283 Simvastatin tab salut 10 mg tablet 600 - 600 100 500
285 Handscoon Steril no 7,5 pcs 600 0 600 - 600
286 IV Catheter No. 24 G Set 57 0 57 7 50
287 Nifedipin 10 mg tablet 0 0 - - -
288 Herbakof Syrup botol 720 - 720 720 -
289 Amlodipin besylate 5 mg tablet 0 0 - - -
290 Vitamin B 12 50 mg tablet 500 - 500 300 200
291 Vitamin C Kap 500 mg tablet 0 0 - - -
292 Gentamicin Sulfate Tts Mata 0,3 % botol 0 0 - - -
293 Acyclofir tab 200 mg Tablet 0 0 - - -
295 Handscoon Non Steril L Pcs 100 - 100 100 -
296 Ranitidin tab 150 mg tablet 3500 - 3,500 1,000 2,500
297 Ranitidin HCL injeksi ampul 65 0 65 27 38
298 Zink tab dispersible 20 mg Tablet 2000 0 2,000 2,000 -
299 Asam Mefenamat 500 mg tablet 5500 0 5,500 1,500 4,000
300 Hemorograd Kapsul 0 0 - - -
301 Poly catheter no. 18 set 10 0 10 - 10
303 Alat suntik sekali pakai 20 cc Pcs 230 0 230 - 230
304 Alat suntik sekali pakai 10 cc Pcs 423 0 423 21 402
305 Hustab syrup botol 0 0 - - -
306 Masker pcs 3000 - 3,000 1,000 2,000
307 Masker oksigen anak pcs 41 0 41 2 39
308 Masker oksigen dewasa pcs 26 0 26 - 26
309 Masker nebulizer anak pcs 29 0 29 - 29
310 Masker nebulizer dewasa pcs 32 0 32 - 32
311 Cyprofloksasin 500 tablet 0 0 - - -
312 Acyclofir krim tube 25 0 25 25 -
313 Cetirizine tablet 1300 - 1,300 - 1,300
314 Dulcolac supp anak 5ml supp 0 0 - - -
315 Dulcolac supp dewasa 10ml supp 0 0 - - -
316 Gentamicin Sulfate Salep Mata 0,3 % tube 0 0 - - -
317 Gentamicin Salep kulit 0.1% tube 0 0 - - -
318 Gentamicin Inj ampul 8 0 8 - 8
319 Kassa 2x80 roll 72 0 72 - 72
320 Acetylcystein 200 mg tablet 0 0 - - -
321 Calsium Gluconas ampul 0 0 - - -
322 Umbilikal klem set 14 0 14 - 14
323 Biolysin botol 0 0 - - -
324 Etanol 70% 1000 ml botol 0 0 - - -
325 Bisakodil tab 5 mg tablet 200 0 200 - 200
326 Kassa Hidrofil 36x80 set 5 0 5 5 -
327 Kloramfenikol susp 125mg/5ml botol 0 0 - - -
328 Omeprazole 200 mg kapsul 600 0 600 200 400
329 Urine Bag set 31 0 31 11 20
330 Kassa pembalut 2x80 set 0 0 - - -
331 Handscoon non steril M sett 200 0 200 - 200
332 Xylocain 2% gel 0 0 - - -
333 Xylocain Sprai 10 mg botol 0 0 - - -
334 Bricasma 0.5 mg/ml ampul 0 0 - - -
335 Bricasma 5mg/ 2 ml Respul 0 0 - - -
336 Metronidazole Infus botol 8 0 8 - 8
337 Ampisillin 1000 mg ampul 0 0 - - -
338 kloramfenikol tetes mata botol 0 0 - - -
339 Alkohol Swab 2 Ply pcs 0 0 - - -
340 Alkohol Swab 4 Ply pcs 500 0 500 - 500
341 Ambroxol sirup 0 0 - - -
342 Blood Lancet pcs 0 0 - - -
343 Handscoon Steril no. 6 set 300 0 300 - 300
344 Ketokonazole 200 mg tablet 2700 0 2,700 - 2,700
345 IV Catheter no. 20 set 150 0 150 50 100
346 Metoklopramid 10 mg Tablet 2200 0 2,200 - 2,200
347 Pulmicort Resp 0.5mg/ l In 2 ml pcs 0 0 - - -
348 Pulmicort Resp 0.25 mg/ l In 2 ml pcs 0 0 - - -
349 Poly catheter No 16 pcs 41 0 41 30 11
350 Transfusion Set pcs 531 0 531 - 531
351 USG Gel botol 8 0 8 1 7
352 Atapulgit (Antidiare) tablet 0 0 - - -
353 Under Pad pcs 30 0 30 - 30
354 Diazepam lar rektal 5 mg/ 2.5 ml tube 0 0 - - -
356 Plester Aximed 5 x 10 cm pcs 0 0 - - -
357 Plester Polifix 5 x 5 cm pcs 0 0 - - -
358 Handscoon Non Steril S pcs 200 0 200 200 -
359 Clobazam 10 mg tablet 0 0 - - -
360 Flufenazine Deconoat 25mg/ml ampul 0 0 - - -
361 Haloperidol 5mg/ml ampul 0 0 - - -
363 Asiklovir 400 mg tablet 1350 0 1,350 - 1,350
364 Gemfibrozil 300 mg kapsul 0 0 - - -
365 Suction Catheter No. 14 pcs 0 0 - - -
366 Albendazol sirup botol 0 0 - - -
367 Bisoprolol 10 mg tablet 0 0 - - -
368 Bisoprolol 2.5 mg (Concor) tablet 0 0 - - -
369 Eritromisin 250 mg kapsul 0 0 - - -
370 3-way pcs 34 0 34 - 34
371 3-way with extention pcs 30 0 30 - 30
372 Amlodipin besylate 10 mg tablet 600 0 600 600 -
374 Asetosal 80 mg tablet 300 0 300 300 -
375 Hand rub 5 L botol 5 0 5 - 5
376 Hand Rub 500 ml botol 0 0 - - -
377 Stimuno Forte tablet 990 0 990 990 -
378 Stimuno Sirup stik 0 0 - - -
379 Metronidazole suspensi 125 mg/ 5 ml botol 200 0 200 - 200
380 Mucus Suction set 0 0 - - -
381 Mometasone furoat krim 0.1% tube 40 0 40 40 -
382 Klozapine 25 mg tablet 0 0 - 0 -
383 Alopurinol 300 mg tablet 1600 0 1,600 - 1,600
384 Manitol larutan infus 20% botol 5 0 5 5
386 Serum anti bisa ular : A.B.U botol 3 0 3 3
1 Erlamicetin zalf mata tube 0 0 - -

2 Licobevit / Tyamin tablet 0 0 - - -
3 Aquabides botol 0 - -
4 Nistatin tablet 0 0 - - -
5 Disposible 30 cc set 0 0 - -
6 Cahteter Foley set 0 0 - - -
7 Myomergin Injeksi ampul 0 0 - - -
8 Sensi Gloves M set 0 0 - - -
9 Aleron tablet 0 0 - - -
10 Urinal Bag tablet 0 0 - - -
11 Prednison tablet 0 0 - - -
12 IV Catheter no 18 set 0 0 - - -
14 Paracetamol tablet 0 0 - - -
15 Yusimox Syrup botol 0 0 - - -
18 Umbilicam Cosa set 0 0 - - -
19 Metformin tablet 0 0 - - -
20 Diometa tablet 0 0 - - -
21 Antasid tablet 0 0 - - -
22 Zalf 24 tube 0 0 - - -
23 Ranitidin tablet 0 0 - - -
25 Amoxicillin syr botol 0 0 - - -
26 Vitamin B 1 botol 0 - -
UMUM
TIDAK JKN JUMLAH
BAYAR


NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
MEI 2023 UPTD FARMASI

JUNI 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
10 11 12 13 14 15 16 17
6,000
300
4,000
144
100
400
96
300
10
1,000
1,000
500
5,000
2,000
500
6,000
480
144
192
6,000
1,000
144
144
300
18,000
10
6,000
60
96
100
96
1,000
500
3,000
3,000
500
3,000
1,000
1,000
2,880
`
1,000
120
1,000
1,200
3,000
500
1,000
1,800
1,200
1,000
500
1,000
5
1,000
100
20
500
500
6,000
300
20
dr. Devi Septiani Lestari H.Munawir,S.Kep.Ners

NIP. 19900906 201903 2 010 NIP. 19770406 200212 1 010
KABUPATEN : INDRAMAYU PELAPORAN BULAN/PERIODE : JJUNI 2023
PROPINSI PERMINTAAN BULAN/PERIODE : JULI 2023

AWAL AAN AN IAN OPT
1 2 3 4 5 6 7 8 9
1 Air Raksa Dental use botol 0 0 0 - -
2 Alat suntik sekali pakai 1 ml set 600 200 800 600
3 Alat suntik sekali pakai 2,5 ml set 24 0 24 - 24
4 Alat suntik sekali pakai 3 ml set 1000 1000 2,000 5 1,995
5 Alat suntik sekali pakai 5 ml set 590 400 990 - 590
6 Alat suntik sekali pakai 50 cc set 210 25 235 - 235
7 Albendazol tablet 400 mg tablet 43400 0 43,400 33,100 10,300
8 Allopurinol tablet 100 mg tablet 500 600 1,100 1,100 -
9 Aminofilin tablet 200 mg tablet 0 0 - - -
10 Aminofilin injeksi 24 mg/ml ampul 0 4 4 - 4
11 Amitripilin tablet salut 25 mg (HCL) tablet 30 0 30 30 -
12 Amoksisillin kapsul 250 mg kapsul 0 0 - - -
13 Amoksisillin kapsul 500 mg kapsul 2000 6000 8,000 2,000 6,000
14 Amoksisillin sirup kering 125 mg/ 5 ml botol 0 200 - - -
15 Ampisillin kapsul 500 mg kapsul 0 0 - - -
16 Ampisillin sirup kering 125 mg/5 ml botol 0 0 - - -
17 Antalgin tablet 500 mg tablet 0 0 - - -
18 Antalgin injeksi 250 mg/ml ampul 0 0 - - -
19 Aluminium Hidroksida 200 mg + Magnesium tablet 3500 5000 8,500 - -
Hidroksida 200 mg
20 tube 0 0 - - -
21 supp 0 0 - - -
22 pot 216 0 216 24 192
Asam Salisilat 3%
23 tablet 0 0 - - -
mg
24 tablet 0 0 - - -
25 Aqua Pro Injeksi Steril, bebas pirogen vial 60 20 80 - -
26 Aquadest steril - 500 ml botol 0 0 - - -
27 Asam Askorbat tablet 50 mg tablet 500 0 500 - -
28 Asam Askorbat tablet 25 mg tablet 0 0 - - -
29 Asam Klorida 0.1 N - 100 ml botol 0 0 - - -
30 Asam Sulfosalisilat 20 % - 100 ml botol 0 0 - - -
33 Atropin Sulfat tablet 0,5 mg tablet 0 0 - - -
34 Atropin tetes mata 0,5% botol 0 0 - - -
35 ampul 18 0 18 - 18
mL
38 Besi sirup botol 0 0 - - -
40 Catgut / Benang Bedah No. 2/0 - 3/0 set 24 24 48 - -
41 Cefadroxil DS 125 mg/5 ml sirup 0 60 60 50 10
42 Cetirizin Sirup sirup 200 100 300 50 250
43 Ciprofloxacin 500 mg tablet 4500 1000 5,500 200 5,300
44 Dapson tablet 100 mg tablet 0 0 - - -
45 Deksametason Injeksi I.v. 5 mg/ml ampul 65 20 85 - -
46 Deksametason 0.5 mg tablet 0 0 - - -
47 Dekstran 70-larutan infus 6% steril botol 0 0 - - -
48 botol 0 0 - - -
(HBr)/Dextrofen
49 Dekstrometorfan tablet 15 mg (HBr) tablet 0 0 - - -
50 Desinfektan 500 ml botol 10 0 10 - 10
51 Devitalisai Pasta (Non Arsen) botol 0 0 - - -
52 Diazepam Injeksi 5mg/ml ampul 0 0 - - -
53 Diazepam tablet 2 mg tablet 0 0 - - -
54 Diazepam tablet 5 mg tablet 265 0 265 5 260
55 Dietilkarbamazin Sitrat tablet 100 mg tablet 0 0 - - -
56 Difenhidramin injeksi I.M. 10 mg/ml (HCL) ampul 74 0 74 - 74
57 Digoksin tablet 0,25 mg tablet 0 0 - - -
58 Dimenhidrinat 50 mg tablet 900 0 900 - 900
59 Doksisiklin 100 mg kapsul 3100 0 3,100 - 3,100
60 Efedrin tablet 25 mg (HCL) tablet 0 0 - - -
61 Ekstrak Belladona tablet 10 mg tablet 0 0 - - -
62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul 0 0 - - -
63 Etakridin larutan 0,1% botol 0 0 - - -

64 Etambutol HCl tablet 250 mg tablet 0 0 - - -
65 Etanol 70% 100 ml botol 0 0 - - -
66 Eter Anestetik botol 0 0 - - -
67 Etil Klorida botol 0 0 - - -
68 Eugenol cairan botol 0 0 - - -
69 Fenitoin Natrium Injeksi 50 mg/ml ampul 0 0 - - -
70 Fenitoin Natrium kapsul 100 mg kapsul 0 0 - - -
71 Fenitoin Natrium Injeksi 30 mg ampul 0 0 - - -
72 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul 5 0 5 2 3
77 Fenol Gliserol tetes telinga 10% botol 0 0 - - -
78 Fitomenadion injeksi 10 mg/ml ampul 0 30 30 30 -
79 Fitomenadion tablet salut 10 mg tablet 300 200 500 - -
80 Fluor tablet 0,5 mg tablet 0 0 - - -
82 Ferinokresol botol 0 0 - - -
83 Gameksan lotion 1 % botol 0 0 - - -
84 Garam Oralit 200 ml air kantong 400 100 500 - 500
85 Garam Oralit 1000 ml air kantong 0 0 - - -
86 Gentian Violet Larutan 1 % botol 0 0 - - -
87 Glass Ionomer Cement (GC IX) set 0 0 - - -
88 Glibenklamida tablet 5 mg tablet 5000 0 5,000 500 4,500
89 Gliseril Guayakolat tablet 100 mg tablet 0 0 - - -
90 Gliserin botol 0 0 - - -
91 Glukosa larutan infus 5% botol 40 20 60 - 60
92 Glukosa larutan infus 10% botol 0 0 - - -
93 Glukosa larutan infus 40% steril botol 0 0 - - -
94 Griseofulvin tablet 125 mg tablet 0 0 - - -
95 Gutta Percha Points stik 0 0 - - -
96 Haloperidol tablet 0,5 mg tablet 0 0 - - -
97 Haloperidol tablet 1,5 mg tablet 700 0 700 274 426
98 Haloperidol 5 mg tablet 600 0 600 200 400
99 Hidroklortiazida tablet 25 mg tablet 0 0 - - -
100 Hidrokortison krim 2,5% tube 0 96 96 48 48
101 Ibuprofen tablet 200 mg tablet 0 0 - - -
102 Ibuprofen tablet 400 mg tablet 4000 4000 8,000 500 7,500
103 Ibuprofen sirup 200/ 5 ml botol 0 0 - - -
104 Infusion set anak set 200 0 200 - 200
105 Infusion set dewasa set 850 0 850 - 850
106 Insulin Reguler injeksi 40 IU/ml vial 0 0 - - -
107 Idiol Kapsul Lunak kapsul 0 0 - - -
108 Ipeka 0,14 % syr botol 0 0 - - -
109 Isoniazid tablet 300 mg tablet 0 0 - - -
110 Isosorbid Dinitrat tab subl 5 mg tablet 0 0 - - -
111 Jarum jahit (Bedah No. 9 s/d 14) kotak 0 0 - - -
112 Kalium Permanganat serbuk - 5 mg set 0 0 - - -
113 Kalsium glukonat inj ampul 0 0 - - -
114 Kalsium Hidroksida Pasta kotak 0 0 - - -
115 Kalsium Laktat tablet 500 mg tablet 500 5000 5,500 1,500 4,000
116 Kapas Berlemak 500 gram roll 0 0 - - -
117 Kapas Pembalut/Absorben 250 g roll 13 0 13 - 13
118 Karbamazepin tablet 200 mg tablet 0 0 - - -
119 Kasa Hidrofil 18 m x 22 cm roll 0 0 - - -
120 Kasa Hidrofil Steril 16 cm x 16 cm roll 272 0 272 80 192
121 Kasa Pembalut Hidrofil 4 m x 10 cm roll 26 0 26 26 -
122 Kasa Pembalut Hidrofil 4 m x 5 cm roll 0 0 - - -
123 Kasa Kompres 40 m x 40 m roll 100 0 100 - 100
124 Ketamin Injeksi 10 mg/ml vial 0 0 - - -
125 Ketokonazole krim tube 168 0 168 48 120
126 Klindamycin 150 mg tablet 400 0 400 150 250
127 Klofazimin kapsul 100 mg microzine kapsul 0 0 - - -
128 Kloramfenikol kapsul 250 mg kapsul 0 0 - - -
129 Kloramfenikol salep mata 1% tube 0 0 - - -
131 Kloramfenikol tetes telinga 3 % botol 0 0 - - -
132 Klorfeniramin maleat (CTM) tab 4 mg tablet 0 3000 3,000 1,000 2,000
133 Kloroquin Fosfat tablet 250 mg tablet 0 0 - - -
134 Klorpromazin injeksi i.m 25 mg/ml-2ml (HCL) ampul 0 0 - - -
135 Klorpromazin injeksi i.m 5 mg/ml (HCL) ampul 0 0 - - -
136 Klorpromazin tablet salut 25 mg (HCL) tablet 0 0 - - -
137 Klorpromazin tablet salut 100 mg (HCl) tablet 0 0 - - -
138 Klorpropamid tablet 100 mg tablet 0 0 - - -
139 Kodein HCl tablet 10 mg tablet 0 0 - - -
140 tablet 0 0 - - -
mg
141 Kotrimoksazol pedia tablet 120 mg tablet 0 0 - - -
142 Kotrimoksazol suspensi 240 mg botol 1500 100 1,600 - 1,600
143 Kotrimoksazol tablet 480 mg tablet 1800 600 2,400 - 2,400
144 Kuinin Di HCl injeksi 25%-2 ml ampul 0 0 - - -
145 Kuinin (kina) tablet 200 mg tablet 0 0 - - -
146 Larutan Benedict botol 0 0 - - -
147 Larutan Eosin 2% botol 0 0 - - -
148 Larutan Etanol Asam botol 0 0 - - -
149 Larutan Gabbet botol 0 0 - - -
150 Larutan Giemsa Stain botol 0 0 - - -
151 Larutan Karbol Fuksin botol 0 0 - - -
152 Larutan Kinyoun botol 0 0 - - -
153 Larutan Metilen Biru botol 0 0 - - -
154 Larutan Turk botol 0 0 - - -
155 ampul 420 120 540 30 510
80.000-2 ml
156 Lidokain inj 2% ampul 180 200 380 - 380
157 Lisol botol 0 0 - - -
158 Loratadin 10 mg tablet 1300 600 1,900 - 1,900
159 Magnesium Sulfat inj (IV) 20%-25 ml vial 58 0 58 58 -
160 Magnesium Sulfat inj (IV) 40%-25 ml vial 185 10 195 185 10
161 Magnesium Sulfat serbuk 30 gram kotak 0 0 - - -
162 Mebendazol sirup 100 mg / 5 ml botol 0 0 - - -
163 Mebendazol tablet 100 mg tablet 0 0 - - -
164 Metanol botol 0 0 - - -
165 Metilergometrin Maleat tablet salut 0,125 mg tablet 700 200 900 - -
166 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 278 175 453 5 448
167 Metilprednisolon 4 mg tablet 4000 1000 5,000 - 5,000
169 Monoklor Kamfer Menthol (CHKM) botol 0 0 - - -
170 Mummifying Pasta kotak 0 0 - - -
171 Nasal oxygen canul M pcs 28 0 28 - 28
172 Nasal oxygen canul L pcs 40 0 40 - 40
173 Nasal oxygen canul S pcs 53 4 57 - 57
174 Nasal oxygen canul XS pcs 18 0 18 - 18
175 Natrium Bikarbonat tablet 500 mg tablet 0 0 - - -
176 Natrium Fluoresein tetes mata 2 % botol 0 0 - - -
177 Natrium Klorida larutan infus 0,9 % botol 50 40 90 - -
178 Natrium Thiosulfat injeksi I.v. 25 % ampul 0 0 - - -
179 Nistatin tablet salut 500.000 IU/g tablet 1000 0 1,000 100 900
180 Nistatin Vaginal tablet salut 100.000 IU/g tablet 500 0 500 - 500
184 OAT Sisipan dewasa paket 0 0 - - -
185 OAT Katagori anak paket 0 0 - - -
186 Obat Batuk Hitam ( O.B.H.) botol 0 0 - - -
187 Oksigen Gas dalam tabung tabung 0 0 - - -
188 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml vial 0 0 - - -
189 Oksitetrasiklin HCL salep mata 1 % tube 0 0 - - -
190 Oksitetrasiklin HCL salep kulit 3 % tube 0 0 - - -
191 Oksitosin injeksi 10 UI/ml-1 ml ampul 687 33 720 - 720
192 Paraformaldehid tablet 1 g tablet 0 0 - - -
193 Parasetamol drop 60 mg/ 0.6 ml botol 0 0 - - -
194 Parasetamol sirup 120 mg / 5 ml botol 400 400 800 200 600
195 Parasetamol tablet 100 mg tablet 0 0 - - -
196 Parasetamol tablet 500 mg tablet 0 12000 12,000 1,600 10,400
197 Pembalut Gips roll 0 - - -
200 Permetrin krim 5% (Scabimite) tube 0 0 - - -
201 Petidin HCl injeksi 50 mgml - 2 ml ampul 0 0 - - -
202 Pilokarpin tetes mata 2 % (HCL/Nitrat) botol 0 0 - - -
203 Piperazin sirup 20 % botol 0 0 - - -
204 Piperazin tablet 500 mg tablet 0 0 - - -
205 Pirantel tab score (base) 125 mg tablet 0 0 - - -
206 Piridoksin tablet 10 mg (HCl) tablet 0 0 - - -
207 Plester 5 yards x 2 inch roll 25 0 25 - 25
208 Polikresulen botol 0 0 - - -
209 Polipeptida kombinasi DOEN Lar infus botol 0 0 - - -
215 Prazikuantel tablet 600 mg tablet 0 0 - - -
216 Prednison tablet 5 mg tablet 2000 2000 4,000 300 3,700
217 Primakuin tablet 15 mg tablet 0 0 - - -
218 Prokain Benzil Pen 3 jt IU / vial inj vial 0 0 - - -
221 Propiltiourasil tablet 100 mg tablet 0 0 - - -
222 Rabies Immune Globulin (Human) 150 IU/ml vial 0 0 - - -
225 Retinol (Vit. A) 100.000 IU kapsul kapsul 0 0 - - -
226 Retinol (Vit. A) 200.000 IU kapsul kapsul 1350 0 1,350 - 1,350
230 Ringer Laktat larutan infus botol 275 200 475 10 465
231 Salbutamol tab 2 mg tablet 9000 0 9,000 - 9,000
232 pot 24 20 44 - 44
Belerang endap 4%
233 Salisil bedak 2% kotak 0 100 100 22 78
234 Salisil Spritus 10% botol 0 0 - - -
235 Semen Seng Fosfat serbuk dan cairan kotak 0 0 - - -
236 Serum ABU I polivalen inj 5 ml vial 0 0 - - -
237 Serum ABU II Polivalen inj 50 ml vial 0 0 - - -
238 Serum Anti Rabies Injeksi vial 0 0 - - -
239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 0 30 1 29
240 Serum Anti Tetanus Inj 20.000 IU/vial vial 0 0 - - -

241 Sianokobalamin injeksi 500 mcg ampul 0 0 - - -
242 kotak 24 12 36 - 36
bedah
243 Silver Amalgam serbuk set 0 0 - - -
244 Spons Gelatin cubicles set 0 0 - - -
247 Sulfa Conus Kerucut (preparat) set 0 0 - - -
248 Sulfadimidin tablet 500 mg tablet 0 0 - - -
249 Sulfasetamida Natrium tts mata 15 % botol 0 0 - - -
250 Suspensi Seng Insulin inj 40 IU/ml vial 0 0 - - -
251 Syntetic Filling Material set 0 0 - - -
252 Tablet Tambah Darah tablet 166050 0 166,050 166,050 -
253 Temporary Stopping Fletcher serbuk dan cairan set 0 0 - - -
254 Tetrakain HCl tetes mata 0,5% botol 0 0 - - -

257 Tiamin injeksi 100 mg/ml ampul 0 0 - - -
258 Tiamin tablet 50 mg (HCL/Nitrat) tablet 0 0 - - -
259 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul 0 0 - - -
260 Triheksifenidil tablet 2 mg tablet 294 0 294 294 -
261 Trikresol Formalin (TKF) cairan set 0 0 - - -
262 Vaksin Rabies kering untuk manusia ampul 0 0 - - -
263 Domperidon 10 mg tablet 1000 200 1,200 300 900
264 Vitamin B Kompleks tablet tablet 3800 6000 9,800 1,000 8,800
265 Captopril 12,5 mg tablet 4500 3000 7,500 1,000 6,500
266 Captopril 25 mg tablet 0 19700 19,700 19,700 -
267 Cloramphenicol Tetes Mata 10% tube 0 0 - - -
269 Mutivitamin Ibu Hamil/Hemafort kapsul 0 - - - -
270 Multivitamin Anak ( Lyctacur Suplemen) botol 0 408 408 24 384
271 Natrium diklofenak 50 mg tablet 0 0 - - -
272 Natrium diklofenak 25 mg tablet 500 1000 1,500 400 1,100
273 Atropin 0,5 mg tablet 0 0 - - -
274 Domperidon Syrup botol 100 0 100 100 -
275 Molexdryl Syrup botol 0 0 - - -
276 Dextral Syrup botol 0 0 - - -
277 Aqua proinjeksi steril botol 0 20 20 - 20
278 Iodum Test tube 0 0 - - -
279 Handscoon Steril no 7 pcs 1100 0 1,100 100 1,000
280 Handscon Steril no 6,5 (umum) pcs 0 0 - - -
281 Metformin 500 mg tablet 4000 4000 8,000 200 7,800
282 Mikonazol krim 2 % tube 48 48 96 - 96
283 Simvastatin tab salut 10 mg tablet 500 1000 1,500 300 1,200
285 Handscoon Steril no 7,5 pcs 600 0 600 - 600
286 IV Catheter No. 24 G Set 50 50 100 40 60
287 Nifedipin 10 mg tablet 0 0 - - -
288 Herbakof Syrup botol 0 1080 1,080 432 648
289 Amlodipin besylate 5 mg tablet 0 0 - - -
290 Vitamin B 12 50 mg tablet 200 200 400 200 200
291 Vitamin C Kap 500 mg tablet 0 0 - - -
292 Gentamicin Sulfate Tts Mata 0,3 % botol 0 0 - - -
293 Acyclofir tab 200 mg Tablet 0 0 - - -
295 Handscoon Non Steril L Pcs 0 200 200 200 -
296 Ranitidin tab 150 mg tablet 2500 4000 6,500 1,300 5,200
297 Ranitidin HCL injeksi ampul 38 25 63 38 25
298 Zink tab dispersible 20 mg Tablet 2000 0 2,000 2,000 -
299 Asam Mefenamat 500 mg tablet 4000 4000 8,000 - -
300 Hemorograd Kapsul 0 0 - -
303 Alat suntik sekali pakai 20 cc Pcs 230 50 280 - -
304 Alat suntik sekali pakai 10 cc Pcs 402 100 502 - -
305 Hustab syrup botol 0 0 - - -
306 Masker pcs 2000 2000 4,000 700 3,300
307 Masker oksigen anak pcs 41 0 41 2 39
308 Masker oksigen dewasa pcs 26 0 26 - 26
309 Masker nebulizer anak pcs 29 0 29 - 29
310 Masker nebulizer dewasa pcs 32 0 32 - 32
311 Cyprofloksasin 500 tablet 0 0 - - -
312 Acyclofir krim tube 25 0 25 25 -
313 Cetirizine tablet 1300 600 1,900 300 1,600
314 Dulcolac supp anak 5ml supp 0 0 - - -
315 Dulcolac supp dewasa 10ml supp 0 0 - - -
316 Gentamicin Sulfate Salep Mata 0,3 % tube 0 0 - - -
317 Gentamicin Salep kulit 0.1% tube 0 0 - - -
318 Gentamicin Inj ampul 8 0 8 - 8
319 Kassa 2x80 roll 72 0 72 - 72
320 Acetylcystein 200 mg tablet 0 0 - - -
321 Calsium Gluconas ampul 0 0 - - -
322 Umbilikal klem set 14 0 14 - 14
323 Biolysin botol 0 0 - - -
324 Etanol 70% 1000 ml botol 0 0 - - -
325 Bisakodil tab 5 mg tablet 0 200 200 - -
326 Kassa Hidrofil 36x80 set 5 0 5 5 -
327 Kloramfenikol susp 125mg/5ml botol 0 0 - - -
328 Omeprazole 200 mg kapsul 400 1200 1,600 800 800
329 Urine Bag set 31 0 31 11 20
330 Kassa pembalut 2x80 set 0 0 - - -
331 Handscoon non steril M sett 200 200 400 100 300
332 Xylocain 2% gel 0 0 - - -
333 Xylocain Sprai 10 mg botol 0 0 - - -
334 Bricasma 0.5 mg/ml ampul 0 0 - - -
335 Bricasma 5mg/ 2 ml Respul 0 0 - - -
336 Metronidazole Infus botol 8 0 8 - 8
337 Ampisillin 1000 mg ampul 0 0 - - -
338 kloramfenikol tetes mata botol 0 0 - - -
339 Alkohol Swab 2 Ply pcs 0 0 - - -
340 Alkohol Swab 4 Ply pcs 500 200 700 - -
341 Ambroxol sirup 0 0 - - -
342 Blood Lancet pcs 0 0 - - -
343 Handscoon Steril no. 6 set 300 0 300 - 300
344 Ketokonazole 200 mg tablet 2700 1000 3,700 - -
345 IV Catheter no. 20 set 100 50 150 1 149
346 Metoklopramid 10 mg Tablet 2200 400 2,600 - 2,600
347 Pulmicort Resp 0.5mg/ l In 2 ml pcs 0 0 - - -
348 Pulmicort Resp 0.25 mg/ l In 2 ml pcs 0 0 - - -
349 Poly catheter No 16 pcs 41 0 41 30 11
350 Transfusion Set pcs 531 2 533 - 533
351 USG Gel botol 7 6 13 - 13
352 Atapulgit (Antidiare) tablet 0 0 - - -
353 Under Pad pcs 30 0 30 - 30
356 Plester Aximed 5 x 10 cm pcs 0 0 - - -
357 Plester Polifix 5 x 5 cm pcs 0 0 - - -
358 Handscoon Non Steril S pcs 0 200 200 200 -
359 Clobazam 10 mg tablet 0 0 - - -
360 Flufenazine Deconoat 25mg/ml ampul 0 0 - - -
361 Haloperidol 5mg/ml ampul 0 0 - - -
363 Asiklovir 400 mg tablet 1350 1000 2,350 - -
364 Gemfibrozil 300 mg kapsul 0 100 100 - 100
365 Suction Catheter No. 14 pcs 0 0 - - -
366 Albendazol sirup botol 0 0 - - -
367 Bisoprolol 10 mg tablet 0 0 - - -
368 Bisoprolol 2.5 mg (Concor) tablet 0 0 - - -
369 Eritromisin 250 mg kapsul 0 0 - - -
370 3-way pcs 34 0 34 - 34
371 3-way with extention pcs 30 0 30 - 30
372 Amlodipin besylate 10 mg tablet 0 2000 2,000 - -
374 Asetosal 80 mg tablet 0 200 200 - -
375 Hand rub 5 L botol 5 0 5 - 5
376 Hand Rub 500 ml botol 0 0 - - -
377 Stimuno Forte tablet 990 0 990 990 -
378 Stimuno Sirup stik 0 2520 2,520 432 2,088
379 Metronidazole suspensi 125 mg/ 5 ml botol 200 100 300 50 250
381 Mometasone furoat krim 0.1% tube 40 0 40 40 -
382 Klozapine 25 mg tablet 0 0 - 0 -
383 Alopurinol 300 mg tablet 1600 0 1,600 - 1,600
384 Manitol larutan infus 20% botol 5 0 5 5
386 Serum anti bisa ular : A.B.U botol 3 2 5 5
1 Erlamicetin zalf mata tube 0 0 - -

2 Licobevit / Tyamin tablet 0 0 - - -
3 Aquabides botol 0 - -
4 Nistatin tablet 0 200 200 - 200
5 Disposible 30 cc set 0 0 - -
6 Cahteter Foley set 0 0 - - -
7 Myomergin Injeksi ampul 0 0 - - -
8 Sensi Gloves M set 0 0 - - -
9 Aleron tablet 0 0 - - -
10 Urinal Bag tablet 0 0 - - -
11 Prednison tablet 0 0 - - -
15 Yusimox Syrup botol 0 0 - - -
18 Umbilicam Cosa set 0 0 - - -
19 Metformin tablet 0 0 - - -
20 Diometa tablet 0 0 - - -
21 Antasid tablet 0 0 - - -
22 Zalf 24 tube 0 0 - - -
23 Ranitidin tablet 0 0 - - -
25 Amoxicillin syr botol 0 0 - - -
26 Vitamin B 1 botol 0 - -
UMUM
TIDAK JKN JUMLAH
BAYAR


NIP. 19680508 200501 1 007 NIP. 19850601 200902 2 001 NIP. 19900906 201903 2
TAAN OBAT (LPLPO)
JJUNI 2023 UPTD FARMASI

JULI 2023 PUSKESMAS
PERMINTAA PEMBERIAN
JUMLAH
10 11 12 13 14 15 16 17
6,000
300
4,000
144
100
400
96
300
10
1,000
1,000
500
5,000
2,000
500
6,000
480
144
192
6,000
1,000
144
144
300
18,000
10
6,000
60
96
100
96
1,000
500
3,000
3,000
500
3,000
1,000
1,000
2,880
`
1,000
120
1,000
1,200
3,000
500
1,000
1,800
1,200
1,000
500
1,000
5
1,000
100
20
500
500
6,000
300
20
dr. Devi Septiani Lestari H.Munawir,S.Kep.Ners

NIP. 19900906 201903 2 010 NIP. 19770406 200212 1 010

Lplpo 2023

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Lplpo 2023

Diunggah oleh

Hak Cipta:

Format Tersedia

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLP

STOK PENERIM PERSEDIA PEMAKA STOK

62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul - - - - -

63 Etakridin larutan 0,1% botol - - - - -

239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 - 30 - 30

240 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - -

253 Temporary Stopping Fletcher serbuk dan cairan set - - - - -

254 Tetrakain HCl tetes mata 0,5% botol - - - - -

1 Erlamicetin zalf mata tube - - - -

554 1,137 1,691

Mengetahui : Yang Menyerahkan Yang Meminta

dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest

JANUARI 2023 2022 UPTD FARMASI

dr. Devi Septiani Lestari apt. Fretty Setiawati, S.Farm

STOK PENERIM PERSEDIA PEMAKA STOK

62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul - - - - -

63 Etakridin larutan 0,1% botol - - - - -

239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 - 30 - 30

240 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - -

253 Temporary Stopping Fletcher serbuk dan cairan set - - - - -

254 Tetrakain HCl tetes mata 0,5% botol - - - - -

1 Erlamicetin zalf mata tube - - - -

450 1,075 1,525

Mengetahui : Yang Menyerahkan Yang Meminta

dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest

FEBRUARI 2023 UPTD FARMASI

dr. Devi Septiani Lestari apt. Fretty Setiawati, S.Farm

STOK PENERIM PERSEDIA PEMAKA STOK

62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul - - - - -

63 Etakridin larutan 0,1% botol - - - - -

239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 - 30 - 30

240 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - -

253 Temporary Stopping Fletcher serbuk dan cairan set - - - - -

254 Tetrakain HCl tetes mata 0,5% botol - - - - -

1 Erlamicetin zalf mata tube - - - -

579 1,431 2,010

Mengetahui : Yang Menyerahkan Yang Meminta

dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest

MARET 2023 UPTD FARMASI

dr. Devi Septiani Lestari apt. Fretty Setiawati, S.Farm

STOK PENERIM PERSEDIA PEMAKA STOK

62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul - - - - -

63 Etakridin larutan 0,1% botol - - - - -

239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 - 30 - 30

240 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - -

253 Temporary Stopping Fletcher serbuk dan cairan set - - - - -

254 Tetrakain HCl tetes mata 0,5% botol - - - - -

1 Erlamicetin zalf mata tube - - - -

376 867 1,243

Mengetahui : Yang Menyerahkan Yang Meminta

dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest

APRIL 2023 UPTD FARMASI

dr. Devi Septiani Lestari apt. Fretty Setiawati, S.Farm

STOK PENERIM PERSEDIA PEMAKA STOK

62 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul 0 0 - - -

63 Etakridin larutan 0,1% botol 0 0 - - -

239 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 30 0 30 1 29

240 Serum Anti Tetanus Inj 20.000 IU/vial vial 0 0 - - -

253 Temporary Stopping Fletcher serbuk dan cairan set 0 0 - - -

254 Tetrakain HCl tetes mata 0,5% botol 0 0 - - -

1 Erlamicetin zalf mata tube 0 0 - -

Mengetahui : Yang Menyerahkan Yang Meminta

dr. H. Wawan Ridwan, MM Hani Handayani dr. Devi Septiani Lest