LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS : KILO PELAPORAN BULAN : DESEMBER

KECAMATAN : KILO PERMINTAAN BULAN : JANUARI
KABUPATEN : DOMPU TAHUN : 2021
PROPINSI : NUSA TENGGARA BARAT

STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN

NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA KADALUARSA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM TAAN
1 2 3 4 5 6 7 8=4+7 9 10 = (8-9-11) 11 12= 10+(7*50%) 14 15 16
Alat Kesehatan
1 Alat Suntik sekali pakai 0,5 ml Pcs 21 031738 DAK 2017 21 4 17 6 1/6/2022 ###
2 Alat suntik sekali pakai 1 ml Pcs 155 0610 DAK 2020 155 36 119 54 9/6/2026 ###
3 Alat suntik sekali pakai 3 ml Pcs 683 0710 DAK 2020 400 1083 258 825 387 9/7/2026 ###
4 Alat suntik sekali pakai 5 ml Pcs 464 0710 DAK 2020 464 42 422 63 9/7/2026 ###
5 Alat Suntik sekali pakai 10 ml Pcs 100 ###
6 Alat Suntik sekali pakai 20 ml Pcs 100 ###
7 Alkohol Swab Pcs 740 GM2109153 DAK 2020 200 940 340 600 510 09/09/2026 1000 ###
8 Blade Sterile (Mess) Pcs 143 311020 DAK 2020 100 243 53 190 79.5 31/10/2025 100 ###
9 Blood Tranfusion set Pcs 18 28032088 DAK 2021 18 0 18 0 28/02/2025 ###
10 Blood Lancet Pcs 700 20069 DAK 2020 300 1000 100 900 150 31/03/2025 ###
Catgut Cromic / Benang Bedah No. 3/0 dengan jarum
11 bedah Pcs 90 2103030 DAK 2021 90 3 87 4.5 30/4/2026 ###

12 Catgut Plain 3/0 Pcs 130 2103050 DAK 2021 130 16 114 24 30/4/2026 ###
13 Cathejell® Lidocain Tube 20 ###
14 Dermavix Pcs 10 17702088 DAK 2021 10 0 10 0 30/6/2025 ###
15 Foley Catheter 2 Way No. 18 Pcs 13 20191017 DAK 2020 13 3 10 4.5 16/10/2024 ###
16 Foley Catheter 2 Way No. 20 Pcs 17 02071988 DAK 2020 17 2 15 3 30/6/2024 ###
17 Gel Dopler USG Botol ###
18 Infusion set anak Pcs 336 25101988 DAK 2021 336 56 280 84 30/9/2024 ###
19 Infusion set dewasa Pcs 232 26042188 DAK 2021 100 332 97 235 145.5 31/3/2026 ###
20 Iv Catheter no. 16 Pcs ###
21 IV Catheter No. 18 Pcs 140 20G2706J DAK 2021 140 28 112 42 30/6/2025 ###
22 IV Catheter No. 20 Pcs 322 21A2706J DAK 2021 100 422 58 364 87 31/12/2025 ###
23 IV Catheter No. 22 Pcs 221 21C0906J DAK 2021 100 321 61 260 91.5 28/2/2026 ###
24 IV Catheter No. 24 Pcs 177 210320 DAK 2021 100 277 48 229 72 28/2/2026 ###
25 Kapas Pembalut / Absorben 500 g Pcs 6 22022188 DAK 2021 6 12 6 6 9 31/1/2026 6 ###
26 Kasa Hidrofil panjang 42 m x 110 cm Rol 2 2108767 DBHCHT 5 7 3 4 4.5 31/8/2026 5 ###
27 Kasa Hidrofil steril 16 x 16 cm Kotak 56 01122088 DAK 2021 50 106 27 79 40.5 30/11/2025 50 ###
28 Masker Ear Lop Pcs 5000 ###
29 Masker Tis On Pcs 5000 ###
30 Masker N95 Pcs 20 20200329 APBN II 20 0 20 0 28/3/2022 ###

Page 1
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
31 Masker Nebule Anak Pcs 13 19502088 DAK 2020 13 0 13 0 30/4/2024 ###

Page 2
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
32 Masker Nebule Dewasa Pcs 5 06012188 DAK 2021 5 2 3 3 31/12/2024 3
33 Masker Non Rebreting Pcs ###
34 Masker Rebreting Pcs
35 Nasal Canula Anak Pcs 10 08122088 DAK 2021 10 0 10 0 30/11/2024 ###
36 Nasal Canula Bayi Pcs 10 15022188 DAK 2021 10 0 10 0 31/1/2025 ###
37 Nasal Canula Dewasa Pcs 13 18032188 DAK 2021 13 0 13 0 28/2/2025 ###
38 Needle No. 25 G x 25 mm Pcs 18 180120 DAK 2018 18 0 18 0 31/12/2022 ###
39 Pembalut Gips Pcs ###
40 Plester 5 yards x 2 inch Pcs 30 ###
41 Plester/ Prarmavix/Polivix Pcs 12 2107575 DAK 2021 30 42 7 35 10.5 31/7/2024 20 ###
42 Plesterin Bulat Soft 200/box
43 Sarung Tangan Latex Powder L Pcs 3000 ###
44 Sarung tangan Latex Powder Free no. M Pcs 3000 ###
45 Sarung tangan Latex Powder Free no. S Pcs ###
46 Sarung Tangan Non Steril L Pcs 4000 ###
47 Sarung tangan non steril M Pcs 4000 ###
48 Sarung Tangan Panjang (Obgyn) Pcs ###
49 Sarung Tangan Steril No. 7 Pcs 60 2A1126724SPZA DAK 2021 60 48 12 72 28/2/2026 200 ###
50 Sarung Tangan Steril No. 7,5 Pcs 200 ###
51 Scalvin 25 Pcs ###
52 Silk (Benang Bedah Sutera) No. 3/0 Rol ###

53 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum Pcs 112 2103030 DAK 2021 112 7 105 10.5 30/4/2026 ###
bedah
54 Stomach Tube/NGT No. 12 Pcs ###
55 Stomach Tube/NGT No. 18 Pcs ###
56 Surgical Needles / jarum hecting kulit Pcs 48 DAK 2018 48 0 48 0 ,- ###
57 Surgical Needles / jarum hecting Otot Pcs 24 DAK 2018 24 0 24 0 ,- ###
58 Tes kehamilan Pcs 383 26082088 DAK 2021 150 533 48 485 72 31/7/2023 ###
59 Underpad Pcs 134 12012188 DAK2021 100 234 83 151 124.5 1/12/2030 100 ###
60 Urine bag Pcs 15 11210402 DAK 2020 15 4 11 6 30/4/2026 ###
61 Plesterin Bulat Soft Pcs 170 10072088 DAK 2020 200 370 20 350 30 30/6/2025 200 ###
62 Kasa Hidrofil panjang 36 m x 80 cm Rol ###
###
Bahan Laboratorium ###
1 Blue Tip Bungkus ###
2 Cover Gelass Box 1 ###
3 Drabkin Botol ###
4 Diluent Mindray 20 Liter (M - 30 D) Galon ###
5 EZ Cleanser Mindray 100 mL ( M 30 E ) Botol ###
6 Golongan Darah (A,B,AB + Rhesus anti D) Lembar 1 ###

Page 3
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
7 Giemsa 100ml Botol ###

Page 4
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
8 Human Hemoglobin Tes ( Dabkin) Kit ###
9 HCl 0,1N 100ml Botol ###
10 Hydrogen Pyroxide 3% 100ml Botol ###
11 Kertas Lensa Miscroscope Exempler
12 Kertas Saring Whatman No.1 Box ###
13 Kertas Printer Roll 1 ###
14 Kartu Golongan Darah lembar
15 Lyse Mindray 500 mL (M - 30 CFL ) Botol
16 Micropet MT-I 200 UI Pcs ###
17 Micropet MT-II 1000 UI Pcs ###
18 Oil Imersi 100ml Botol
19 Probe Cleanser mindray 17 mL ( M - 30 P) Botol ###
20 Rak Tabung Pcs
21 RDT Combo Card (Tes Malaria) kuning Kotak
22 Reagen ZN (TB) kotak ###
23 RINSE Galon ###
24 Slide (Object Glass) Box 8 DAK 2019 8 0 8 0 ,- ###
25 Stick Benechek Glucosa Kotak 20 ###
26 Stick Benechek Asam Urat Kotak 20 ###
27 Stick Benechek Cholesterol Kotak 20 ###
28 Stick Test Asam Urat Easy Touch Kotak 20 ###
29 Stick Test Gula Darah Easy Touch Kotak 20 ###
30 Stick Test Kolesterol Easy Touch Kotak 20 ###
31 Stick Nesco Asam Urat Box/25
32 Stick Nesco Cholesterol Box/10
33 Stick Nesco Glucosa Box/25
34 Stick SD HIV 1/2 3.0 Pcs 234 20210417 DID 234 24 210 36 15/4/2023
35 Stick FOKUS HIV TEST (KOTAK @ 25 TEST) Pcs
36 Stick VIKIA HIV TEST (KOTAK @ 25 TEST) Pcs ###
37 Stik REAGEN SYPHILIS (KOTAK @ 25) Pcs 180 20210414 DID 180 17 163 25.5 13/4/2023 ###
38 Stick HBsAg Strip/ VITOCHECK Pcs 133 K20047 APBN 2020 100 233 28 205 42 31/10/2022 ###
39 Stick Hb Strip ( Hemoglobin Mission / Acon) Box 9 HbM0120031 DAK 2021 2 11 0 11 0 19/08/2022 10
40 Stick Virotec Dengue Combo /DBD Box
41 Stik Urin 3 P s'100 Pcs ###
42 Stik Urin 10 P s'100 Pcs ###
43 Tabung EDTA Tutup Ungu Box/100 182 210311 DID-COVID 19 100 282 29 253 43.5 28/2/2023 100 ###
44 Test Iodium Botol ###
45 Urine Rapid Test (Gluko Protein Tes) Pcs 50 09082188 DAK 2021 20 70 4 66 6 31/7/2024 20 ###
46 Widal 4 x 5 mL ( Tulip ) Set 1 410101 DAK 2021 1 0 1 0 1/6/2022 ###
47 Yellow Tip Bungkus 1 ###

Page 5
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
48 Golongan Darah A Vial 1 ###
49 Golongan Darah B Vial 1 ###
50 Golongan Darah AB Vial 1 ###
51 Golongan Darah D Vial 1 ###
52 Hb Strip (Hb Mission/Acon) (Covid-19) Kotak ###
53 Stick Test Asam Urat Easy Touch (Covid-19) Kotak ###
54 Stick Test Gula Darah Easy Touch (Covid-19) Kotak ###
55 Masker HIV Pcs ###
###
OBAT - OBATAN ###
Tablet, Kaplet, Kapsul dan Serbuk ###
1 Albendazol tablet 400 mg Tablet 1999 E10677BJ APBN 2021 1999 3 1996 30/4/2023 ###
2 Alopurinol tablet 100 mg Tablet 1498 2111-02-106 DAK 2021 2000 3498 1203 2295 1804.5 30/11/2023 2000 ###
3 Aminofilin tablet 200 mg Tablet ###
4 Amitriptilin HCl tablet salut 25 mg Tablet 13 A1402AV DAK 2018 13 13 0 19.5 1/1/2022 300 ###
5 Amlodipin tablet 10 mg Tablet 4525 MG09B008 DAK 2021 3000 7525 1525 6000 2287.5 30/7/2023 3000 ###
6 Amlodipin tablet 5 mg Tablet 495 20091 DAK 2021 900 1395 175 1220 262.5 31/1/2023 1000 ###
7 Amoksisilin kaplet 500 mg Kaplet 9339 TAMXB12248 DAK 2021 4000 13339 4855 8484 7282.5 30/4/2023 5000 ###

8 Antasida DOEN tablet,kombinasi: Mg-Hidroksida Tablet 6446 A10944 DAK 2021 3000 9446 1751 7695 2626.5 21/6/2024 3000 ###
200mg+Al. Hidroksida. 200 mg

9 Anti Malaria tablet kombinasi (Dehidroartemisin + Kotak 210502 APBN 2021 1 1 0 1 0 21/5/2023 2 ###
Piperaquin)

10 Antimigren,
Kofein 50 mg
kombinasi: Ergotamin Tartrat 1 mg + Tablet ###

Asam Asetil Salisilat/Asetosal tablet 80 mg ( Miniaspi

11 ) Tablet ###

12 Asam Askorbat (Vitamin C) tablet 250 mg Tablet ###

13 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 3773 H90185BI DAK 2020 2000 5773 1439 4334 2158.5 31/7/2022 2000 ###
14 Asam Folat tablet 1 mg Tablet 500 211-05-365 DAK 2021 500 160 340 240 31/10/2023 ###
15 Asam Mefenamat kaplet 500 mg Kaplet 5850 HTMECA11497 DAK 2021 4000 9850 1772 8078 2658 28/2/2023 4000 ###
16 Asetylcysteine 200 mg Tablet 3512 FG 2431 DAK 2021 3512 1206 2306 1809 31/7/2023 6000 ###
17 Asiklovir tablet 400 mg Tablet 80 36304084 DAK 2021 80 0 80 0 30/11/2022 ###
18 Atapulgit tablet 600 mg Tablet 4000 ###
19 Calsium Laktat (Kalk) tablet 500 mg Tablet 2160 2104-03-153 DAK 2021 2160 450 1710 675 30/4/2023 ###
20 Captopril tablet 12,5 mg Tablet 487 K92845B DAK 2020 487 287 200 430.5 31/10/2024 2000 ###
21 Captopril tablet 25 mg Tablet 2000 ###
22 Carbamazepin tablet 200 mg Tablet ###
23 Cetirizin tablet 10 mg Tablet 1985 JC1391 DAK 2021 1000 2985 585 2400 877.5 31/3/2023 ###
24 Ciprofloksasin 500 mg (ktk 100 tab) Kaplet ###
25 Clindamisin 150 mg tablet Tablet ###
26 Clindamisin 300 mg tablet Tablet ###

Page 6
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
27 Cloramfenikol kapsul 250 mg Kapsul ###

Page 7
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
28 Cloramfenikol kapsul 500 mg Kapsul ###
29 Clorfeniramin Maleat (CTM) tablet 4 mg Tablet 5916 20313105 DAK 2020 4000 9916 1718 8198 2577 31/5/2024 ###
30 Clorpromazin tablet 100 mg Tablet 421 J005335 DID COVID 19 421 64 357 96 31/10/2022 ###
Cotrimoksazol tablet kombinasi: Sulfametoksazol
31 400 mg +Trimetropin 80 mg Tablet 4580 A01081 DAK 2020 2000 6580 180 6400 270 20/5/2023 ###

32 Curcuma tablet untuk hepatoprotector/Cavicur Tablet ###

33 Deksametason tablet 0,5 mg Tablet 100 2102-03-150 DAK 2021 100 60 40 90 28/2/2023 6000 ###
34 Diazepam tablet 2 mg Tablet 283 A 3110 IX DAK 2021 283 62 221 93 30/9/2024 ###
35 Diazepam tablet 5 mg Tablet A11202 APBN 2021 100 100 0 100 0 31/7/2025 ###
36 Digoksin tablet 0,25 mg Tablet ###
37 Dimenhidrinat tablet Tablet ###
38 Doksisiklin 100 mg Kaplet ###
39 Domperidon tablet 10 mg Tablet 4850 JE2151 DAK 2021 4850 420 4430 630 31/05/2024 ###
40 Eritromicin Kapsul 250 mg Tablet ###
41 Eritromicin Kapsul 500 mg Tablet ###
42 Fenobarbital tablet 30 mg Tablet ###
43 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 138 36381003 DAK 2021 138 8 130 12 31/1/2023 ###
44 Furosemid tablet 40 mg Tablet 500 D10308BJ DAK 2021 500 90 410 135 31/3/2025 ###
45 Garam Oralit untuk 200 ml air Sachet 589 P 05003 BK APBN 2021 589 225 364 337.5 31/5/2022 ###
46 Glibenklamid tablet 5 mg Tablet 1738 1701009 DAK 2018 2000 3738 768 2970 1152 30/4/2022 2000 ###
47 Glimepiride tablet 1 mg Tablet 250 51E0750 DAK 2021 250 0 250 0 30/4/2023 500 ###
48 Glimepiride tablet 2 mg Tablet ###
49 Griseofulvin tablet 125 mg Tablet 1390 C90471B DAK 2021 1390 100 1290 150 28/2/2024 ###
50 Haloperidol tablet 0,5 mg Tablet 80 A 1801 DX DAK 2020 80 0 80 0 30/4/2025 ###
51 Haloperidol tablet 1,5 mg Tablet ###
52 Haloperidol tablet 5 mg Tablet 358 A01247 DAK 2020 358 174 184 261 30/6/2023 300 ###
53 Hidroklorotiazid (HCT) tablet 25 mg Tablet ###
54 Ibuprofen tablet 200 mg Tablet ###
55 Ibuprofen tablet 400 mg Tablet 4085 2104-14-134 DAK 2021 4085 2038 2047 3057 30/4/2023 4000 ###
56 Isoniazid tablet 100 mg Tablet ###
57 Isosorbid Dinitrat tablet sublingual 5 mg Tablet ###
58 Ketokonazol tablet 200 mg Tablet 1760 HTKCZB2090 DAK 2021 1000 2760 400 2360 600 31/3/2023 ###
59 Kombipak (Azitromisin + Cefixim) Tablet ###
60 Loperamid tablet 2 mg Tablet 2000 ###
61 Loratadin tablet 10 mg Tablet 2000 ###
62 Metformin tablet 500 mg Tablet 2338 HTMFNA03125 DAK 2020 2338 350 1988 525 30/6/2022 ###
63 Metilergometrin Maleat Tablet Tablet ###
64 Metilprednisolon tablet 4 mg Tablet 1810 M02CY022 DAK 2020 1810 1510 300 2265 31/5/2022 3000 ###
65 Metoclopramide 10 mg Tablet ###
66 Metronidazol tablet 250 mg Tablet ###

Page 8
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
67 Metronidazol tablet 500 mg Tablet 500 ###
68 Mineral Mix Sachet ###
69 MDT Combi Dewasa MB ( Merah ) Box ###
70 MDT Combi Dewasa PB ( Hijau ) Box ###
71 MDT Combi Anak MB ( Orange ) Box ###
72 Natrium Diklofenak tablet 25 mg Tablet 3220 G12162J DAK 2021 3220 300 2920 450 30/6/2026 ###
73 Natrium Diklofenak tablet 50 mg Tablet 4392 52B0071 DAK 2020 4392 1570 2822 2355 31/1/2024 ###
74 Nifedipin tablet 10 mg Tablet 30 DB0821B DAK 2018 30 0 30 0 1/4/2022 500 ###
75 Nistatin tablet salut 500.000 IU/g Tablet ###
76 Nistatin tablet vaginal 100.000 IU/g (ovula) Tab Ovula ###
77 OAT Kategori 1,3 FDC Paket 11 36461013 APBN 2021 11 1 10 1.5 31/1/2023 ###
78 OAT Kategori 2 FDC Paket 2 26471040-3 APBN 2020 2 0 2 0 30/6/2022 ###
79 OAT Kategori Anak FDC Paket
80 OAT Kategori Kombipak Paket ###
81 Omeprazol kapsul 30 mg Kapsul 2470 KOPZB10577 DAK 2021 2000 4470 1050 3420 1575 31/01/2023 2000 ###
82 Parasetamol tablet 500 mg (Covid-19) Tablet ###
83 Pirantel tablet 125 mg Tablet ###
84 Piridoksin HCl (Vitamin B6) tablet 10 mg Tablet ###
85 Piroxicam tablet 20 mg Tablet ###
86 Prednison tablet 5 mg Tablet 1130 1005049 DAK 2020 1130 180 950 270 31/5/2022 ###
87 Primakuin tablet 15 mg Tablet 100 36386001-2 APBN 2021 100 0 100 0 31/8/2023 ###
88 Propanolol HCl tablet 10 mg Tablet ###
89 Propiltiourasil tablet 100 mg Tablet 100 ###
90 Quinin (Kina) tablet 200 mg Tablet ###
91 Ranitidin tablet 150 mg Tablet 4080 1103059 DAK 2021 2000 6080 692 5388 1038 31/3/2023 2000 ###
92 Resperidon 1 mg Tablet ###
93 Resperidon 2 mg Tablet ###
94 Resperidon 3 mg Tablet ###
95 Retinol (vitamin A) kapsul 100,000 IU (Biru) Tablet B02749W APBN 2021 50 50 0 50 0 31/7/2023 ###
96 Retinol (vitamin A) kapsul 200,000 IU (Merah) Tablet 539 D90479Y APBN 2020 500 1039 47 992 70.5 30/4/2022 ###
97 Salbutamol tablet 2 mg Tablet 2000 ###
98 Salbutamol tablet 4 mg Tablet 2000 ###
99 Simvastatin tablet 10 mg Tablet 1000
100 Simvastatin tablet 20 mg Tablet 2819 061060-1 DAK 2020 1000 3819 503 3316 754.5 30/6/2022 ###
101 Tablet Tambah Darah Sachet 16083 A10528 APBN 2021 8000 24083 3543 20540 5314.5 31/3/2023 ###
102 Teofilin Tablet Tablet ###
103 Tetrasiklin HCl kapsul 250 mg Kapsul ###
104 Tetrasiklin HCl kapsul 500 mg Kapsul ###
105 Tiamfenikol kapsul 500 mg Kapsul ###
106 Tiamin HCl (Vitamin B1) tablet 50 mg Tablet ###

Page 9
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
107 Triheksifenidil HCl tablet 2 mg Tablet 591 LK133 DAK 2020 591 126 465 189 31/1/2023 ###

Page 10
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
108 Vitamin B Kompleks tablet Tablet 40 2111-101-379 DAK 2021 2000 2040 148 1892 222 30/11/2023 5000
109 Zink tablet dispersibel Tablet 510 46496057 DAK 2021 500 1010 725 285 1087.5 31/10/2024 2000 ###
110 Ciprofloxacin 500 mg (Covid-19) Tablet 1280 2011/01/108 DID COVID 19 1280 240 1040 360 30/11/2022 ###
111 Domperidon 10 mg (Covid-19) Tablet ###
112 Risperidon 2 mg (Covid-19) Tablet 300 5160127 DID COVID 19 300 30 270 45 31/7/2023 ###
113 Piridoksin HCl tablet 10 mg (Covid-19) Tablet 845 J00532BJ BTT 845 133 712 199.5 30/9/2023 ###
114 Sivit Zink (Multivitamin) Tablet 3241 A02293 APBN 2020 3241 1141 2100 1711.5 30/11/2022 ###
115 Vitamin C 500 mg Tablet 4200 A01913 APBN 2020 4200 0 4200 0 31/10/2022 ###
116 Piroxicam 20 mg (Covid-19) Tablet 3260 2010-07-144 DID COVID 19 3260 135 3125 202.5 31/10/2022 ###
117 Parasetamol tablet 500 mg Tablet 8494 TPG40450 DAK 2021 5200 13694 4368 9326 6552 30/6/2023 5000
118 Haloperidol 1,5 mg (Covid-19) Tablet 200 A 1913 XX DID COVID 19 200 0 200 0 30/6/2025 ###
###
Sirup, Suspensi dan Drop ###

1 Amoksisilin sirup kering 125 mg/5ml Btl 60 ml 287 B00166 DAK 2020 287 83 204 124.5 30/6/2023 ###

2 Antasida DOEN suspensi Btl 60 ml 79 E10063N DAK 2021 79 46 33 69 31/5/2023 100 ###
3 Cloramfenikol Suspensi 125 mg/ml Botol ###

4 Cotrimoksazol Suspensi komb: Sulfametoksazol 200 Btl 60 ml 122 A93113 DAK 2020 122 26 96 39 30/11/2022 ###
mg + Trimetoprim 40 mg / 5 ml
5 Domperidon suspensi 5 mg/5 ml Botol 127 E39109 DAK 2021 127 26 101 39 31/5/2024 ###
6 Metronidazole Suspensi Botol ###
7 Parasetamol sirup 120 mg/5 ml Btl 60 ml 370 A00879 DAK 2020 370 151 219 226.5 31/3/2023 ###
###
Injeksi dan Pelarut ###
1 Aminofilin injeksi Ampul ###
2 Ampisilin injeksi 1000 mg/vial Vial 10 16436026 DAK 2018 10 0 10 0 30/6/2022 ###
3 Aqua pro Injeksi steril, bebas pirogen Vial 2 79B50B DAK 2020 2 0 2 0 10/2/2023 10 ###
4 Aquades, pelarut 1 liter Botol ###
5 Artesunate Injeksi Vial ###
6 Atropin Injeksi Ampul ###
7 Clorpromazin injeksi i.m. 25 mg/ml Ampul
8 Deksametason injeksi Ampul 234 26337077 DAK 2020 234 61 173 91.5 31/12/2022 100 ###
9 Diazepam injeksi 5 mg / ml - 2 ml Ampul 4 FOH678 DAK 2020 4 1 3 1.5 31/8/2023 ###
10 Difenhidramin injeksi Ampul 49 46342013-1 DAK 2021 49 10 39 15 31/7/2023 30 ###
11 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 12 9621B0033A DAK 2020 12 2 10 3 28/2/2023 ###

12 Fenobarbital injeksi i.m. 50 mg/ml - 2 ml Ampul ###

13 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 58 46478013 DAK 2021 58 22 36 33 31/3/2023 30 ###

Page 11
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
14 Furosemid Injeksi Ampul ###

Page 12
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN

15 Gentamicin Injeksi 40 mg/ mL Ampul ###

16 Glukonas Kalsikus 10% injeksi Ampul 10 4911814 DAK 2021 10 0 10 0 30/9/2024 ###

17 Haloperidol injeksi 50 mg base/ml (Haldol) Ampul ###

18 Kombinasi Ipratropium Bromida 0,5 mg + Salbutamol Vial 50 ###

2,5 mg nebule (Farbivent/Combivent)
19 Lidokain komp. injeksi, Kombinasi: Lidokain HCl 2%
+ Epinefrin 1:80.000 - 2 ml Ampul 267 36815006 DAK 2021 210 477 86 391 129 31/7/2024 ###
20 Magnesium Sulfat inj (IV) 20% - 25 ml Vial ###
21 Magnesium Sulfat inj (IV) 40% - 25 ml Vial 8 95F50B DID COVID 19 8 0 8 0 26/6/2022 ###

22 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 8 9620B0048A DAK 2020 8 4 4 6 28/2/2023 ###

23 Oksitosin injeksi 10 IU / ml - 1 ml Ampul 172 9619L0477A DAK 2020 172 35 137 52.5 30/11/2022 ###
24 Omeprazole Injeksi Vial 2 4300419 DAK 2020 2 2 0 3 1/2/2022 ###
25 Qina injeksi (kotak 100 ampul) Ampul ###
26 Meprovent Inhaler Ampul 31 N1H007 DAK 2021 30 61 34 27 51 31/8/2023 50
###
Tetes Mata, Tetes Telinga, Salep dan sed. Topikal ###
1 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 Tube 60 21BA1002 DAK 2021 50 110 38 72 57 30/9/2025 50
IU/g + Polimiksin 10.000 IU/g
2 Antifungi DOEN Kombinasi: Asam Benzoat 6% + Pot ###
Asam Salisilat 3%
3 Asiklovir salep kulit Tube 10 ###
4 Betametason krim 0.1% Tube 124 G12144W DAK 2021 50 174 40 134 60 3/8/2023 50 ###
5 Cloramfenikol salep kulit 0,2 % ( Bufacetin) Tube 60 6103 DAK 2021 60 3 57 4.5 30/6/2024
6 Cloramfenikol Salep mata 1 % Tube 21 I91866W DAK 2020 24 45 18 27 27 30/9/2022 24 ###
7 Cloramfenikol tetes mata 0,5 % Btl 10 ml 20 ###
8 Cloramfenikol tetes telinga 0,1 % ( Erlamycetin) Btl 10 ml 31 D.0656068 DAK 2021 20 51 16 35 24 30/3/2024 20 ###
9 Fenol Gliserol 10 % tetes telinga Botol 1 20LMO14 DAK 2021 1 0 1 0 31/12/2022 ###
10 Gentian Violet larutan 1 % Btl 10 ml ###
11 Hidrokortison krim 2,5 % Tube 93 F00505T APBN 2020 93 8 85 12 30/6/2024 ###
12 Ketokonazole Cream 2% Tube 25 090551 DAK 2021 25 0 25 0 30/9/2023 ###
13 Mikonazol salep 2 % Tube 72 H91502W DAK 2020 72 22 50 33 31/8/2023 ###
14 Oksitetrasiklin HCl salep mata 1 % Tube ###
15 Perak Sulfadiazin krim 1 % Tube 5 1AG1310 DAK 2021 5 3 2 4.5 31/7/2024 5 ###
Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang
16 Endap 4% Pot 8 4808035 APBN 2021 8 2 6 3 31/8/2022 24
17 Salisil Bedak 2 % Kotak 21 F10700S DAK 2021 20 41 17 24 25.5 30/6/2026 25
18 Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang Pot G17114 DID COVID 19 20 20 0 20 0 31/7/2024 ###
Endap 4%
###

Page 13
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
Suppositoria dan Larutan Rektal ###

1 Antihemoroid DOEN supositoria, kombinasi: Bismut Supp 10 ###

subgalat 150 mg + Heksaklorofen 2,5 mg
2 Bisakodil Suppositoria 5 mg (Dulcolax anak) Supp 26 19091245 DAK 2021 26 0 26 0 31/8/2023 ###
3 Bisakodil Suppositoria 10 mg (Dulcolax Dewasa) Supp 20 ###
4 Diazepam Larutan Rektal 5 mg/2,5 ml ( Stesolit) Tube
5 Diazepam Larutan Rektal 10 mg/2,5 ml ( Stesolit) Tube
###
Desinfektan dan Antiseptik ###
1 Etakridin ( Rivanol ) larutan 0,1% Btl 300 ml 10 ###
2 Etanol 70% Btl 1000 ml 10 ###
3 E-care hand R ( Antiseptik ) Btl 500 ml 48 200741EM DAK 2021 20 68 9 59 13.5 31/7/2023 ###
4 E care hand Wash (Sabun Cair 500 mL) Btl 500 ml ###
5 Antiseptik kumur Botol ###
6 Lisol, mengandung Kresol tersabun 50% Btl 1000 ###
7 Paraformaldehid/Formalin cair Btl 1000 ###
8 Povidon Iodida 10 % Btl 60 ml 27 5012188 DAK 2021 27 0 27 0 31/12/2023 30 ###
9 Povidon Iodida 10 % Btl 300 ml 9 24102086 DAK 2021 9 5 4 7.5 30/6/2023 20 ###
###
###
Larutan Elektrolit dan Cairan Infus ###
1 Glukosa larutan infus 5 % steril, produk lokal Btl 500 ml 28 210104 DAK 2021 60 88 2 86 3 31/12/2023 ###
2 Glukosa larutan infus 10 % steril, produk lokal Btl 500 ml 20 210101 DAK 2021 20 0 20 0 31/12/2023 ###

3 Natrium Klorida larutan infus 0,9 % steril, produk Btl 500 ml 254 E212D08 DAK 2021 100 354 126 228 189 5/4/2024 100 ###
lokal
4 Ringer Laktat larutan infus steril, produk lokal Btl 500 ml 331 210910A DAK 2021 200 531 242 289 363 31/8/2026 300 ###
5 Ringer Asetat (Asering) larutan infus steril Btl 500 ml 10 50199A DAK 2020 10 4 6 6 30/9/2023 ###
6 Cairan Infus WIDABES 500 mL Btl 500 ml ###
###
Obat Gigi
1 Calsidor (Kalsium Hidroksida) Kotak 1
2 Cavit Set 1 ###
3 Etil Klorida spray Kaleng 1 ###
4 Eugenol larutan Botol 1
5 Iodoform Pasta Kotak 1 ###
6 Klorfenol Kamfer Menthol (CHKM)/Camphenol Btl 10 ml 1 ###
7 Temporary Stopping Fletcher serbuk & cairan Btl 100 ml 1 ###
8 Devitalisasi Pasta Arsen Set 1 ###
9 Fletcher set (serbuk & larutan) Set 1 ###
10 Fluor tablet 1 mg Tablet 10

Page 14
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
11 Fuji GC IX Besar Set 1

Page 15
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
12 Fuji GC IX Kecil Set 1
13 Glass Ionomer ART Set 1
14 Tri Kresol Formalin (TKF) Set 1
15 White spot/tooth mouse Set 1
16 Xylestesin Gel/tropical anesthesi gel Tube 1
17 D-Pulp 7,5 G Box 1
18 Pulp. X 6g Box 1
19 Komposit R Tube 1
20 Spongostan Box 1

Vaksin dan Serum

1 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) Vial 3 4700221 DAK 2021 2 5 1 4 1.5 31/8/2023

2 Serum Anti Tetanus injeksi 250.000 IU/ampul (ATS) Vial 1 P100178575A DAK 2021 2 3 0 3 0 31/10/2022
(Tetagram)
3 Serum Anti Rabies 2 mL Vial
4 Serum Anti Rabies 10 mL Vial
5 Vaksin BCG Vial
6 Vaksin TT Vial
7 Vaksin DPT / DPT-HB / DPT-HB-Hib Vial
8 Verorab Serbuk Injeksi 2,5 IU Ampul
9 Hepatitis B Imunoglobin (Hbig) Bayi VIAL
10 Hepatitis B Petugas (Dewasa) Vial

DANA JKN
1 Alkohol Swab Sensi 100's Box
2 Regulator Oksigen Set 1 DANA JKN 1 0 1 0 ,-
3 Blood Lanset 28G RNM 100's Box
4 Tourniquet Buah
5 Plester Ultrafix 10 Cm x 5 Cm Kotak
6 Plester Ultrafix 5 Cm x 5 Cm Kotak
7 Plester Ultrafix 5 Cm x 1 Cm Pcs
8 Kasa Steril 16 x 16 Cm Kotak
9 Sarung Tangan Steril 7,5 Pcs
10 IV Catheter No. 20 Pcs
11 IV Catheter No. 22 Pcs
12 Nasal Canula Oksigen Bayi Pcs 8 0111788 DANA JKN 8 0 8 0
13 Nasal Canula Oksigen Anak Pcs 8 23122088 DANA JKN 8 0 8 0 30/11/2024

Page 16
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
14 Nasal Canula Oksigen Dewasa Pcs
15 Underpad Pcs 2 O1022188 DANA JKN 2 2 0 3
16 Klip Obat 8 x 12 cm Pcs
17 Klip Obat 11 x 17 cm Pcs
18 Calcium Lactate 500 mg Tablet
19 Dexamethasone 0,5 mg Tablet
20 Domperidon 10 mg Tablet
21 Garam Oralit Sachet
22 Ibuprofen 200 mg Tablet
23 Ibuprofen 400 mg Tablet
24 Ketoconazole 200 mg Tablet
25 Metronidazol 500 mg Tablet
26 Vitamin B6 10 mg Tablet
27 Zink Tablet
28 Domperidon Sirup Botol
29 Gentamicin Salep Tube
30 Salisil Bedak Botol
31 Alkohol 70% 1 L Botol
32 SABU Vial
33 Strip HIV Monotes Kotak
34 Stik Kolesterol Easy Touch Kotak 0 CHS21424B5B DANA JKN 2 2 1 1 1.5 31/3/2023
35 Stik Asam Urat Easy Touch Kotak UAS21530A6B DANA JKN 2 2 0 2 0 30/4/2023
36 Stik Gula Darah Easy Touch Kotak 0 GOS21507A63 DANA JKN 2 2 0 2 0 30/4/2023
37 Stik Hb Easy Touch Kotak
38 Alat Pemeriksaan GCV Easy Touch Set
39 Alat Pemeriksaan GCHb Easy Touch Set
40 Lubricant Jelly Tablet
41 Spoit 1 cc Pcs
41 Attapulgit/ Molagit Tablet
41 Fitomenadion Injeksi 2 mg/ml Ampul
42 Plesterin Roll 15 cm x 5 m Kotak
43 Combivent Ampul
44 Sarung Tangan Non Steril M Pcs 300 219143032LTZA DANA JKN 1200 1500 1191 309 1786.5 30/6/2026
45 Sarung Tangan Non Steril L Pcs 300 2103813 DANA JKN 500 800 800 0 1200 30/3/2026

APD COVID-19
1 APD Lengkap Set 6 .- DID COVID-19 6 0 6 0 .-
2 Akacide Botol 1 0S28N2988 DID COVID-19 1 0 1 0 30/6/2023
3 Surgical Gown Pcs 19 BTT 19 0 19 0
4 Sarung Tangan Industri OM (L) Pair

Page 17
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
5 Sarung Tangan Industri OM (M) Pair

Page 18
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
6 Sepatu Boots Ap Deluxe NO-41 Pair
7 Topi ( Surgeon Cap) OM Pcs
8 Masker NIOSH N95 Set
9 Masker Kain Scuba (Dewasa) Pcs
10 Masker Kain Scuba (Anak) Pcs
11 Sarung Tangan non steril L Pcs
12 Alas Sepatu/ Shoe Cover OM Pcs
13 Masker N95 Pcs 16 A19282002 APBD COVID 19 16 0 16 0 1/10/2024
14 sarung Tangan non steril M Pcs
15 Sarung tangan non steril S Latex Pcs 150 2021504103 DID 2021 150 150 0 225 1/7/2026 1000
16 T. Handrub 250 ml Botol
17 Sarung Tangan non steril Set
18 Sarung Tangan karet (Flock Lining) Set
19 Sepatu Boot No.40 & 41 Set
20 Sarung Tangan steril No. 7 pcs 200
21 Sarung Tangan steril No. 7,5 Set 200
22 Sarung Tangan steril No. 8 pcs
23 Sarung Tangan Obgyn Pcs 70 BTT 50 120 34 86 51 100
24 Faceshield Pcs 9 APBD COVID 19 9 0 9 0
25 Faceshield Kacamata Pcs
26 Nurse Cap Pcs 90 APBD COVID 19 90 0 90 0
27 Sepatu Boot No.42 Set 0 0
28 Masker Bedah Pcs 2356 13200912 BTT 4000 6356 2156 4200 3234 30/9/2025 4000
29 T. Handrub 500 ml Botol
30 T. Handrub 100 ml Botol 8 200495 DID COVID-19 8 0 8 0 30/4/2023
31 Kacamata Google Pcs 22 .- BANTUAN 22 0 22 0
32 Sarung Tangan Panjang Set
33 Helm & Kaca Pelindung Set
34 Sepatu Boot Set
35 Masker Kain Polos Head Loop Pcs
36 Masker Kain Polos Ear Loop Pcs
37 Sarung Tangan Non steril L Pcs 36 200760704 DID COVID 19 36 28 8 42 30/6/2025 5000
38 Sarung Tangan Non Streril M Pcs 5000
39 Baju APRON Pcs 39 .- APBD COVID 19 39 0 39 0
40 BAJU (Cover All Suit / Hamzat Suit) Pcs 41 .- APBD COVID 19 41 0 41 0
41 Termogun Pcs
42 Gold Trion Tablet
43 Farbion Tablet
44 Vitamin C 250 mg Tablet 300 F00266BJ DID COVID 19 300 0 300 0 31/5/2023
45 Seloxy Tablet 60 51E0123 APBD COVID 19 60 0 60 0 30/6/2022

Page 19
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
46 Sars covid antibody test Pcs
47 RI-GHA Rapid Test Pcs 42 C19.011 DINKES PROV NTB 42 3 39 4.5 31/10/2022
48 APD (Faceshield)
49 APD (Baju Cover ALL) Set
50 APD (Cover Sepatu)
51 Alat suntik sekali pakai 3 ml Pcs
52 Plester Pharmafix/Polifix Kotak
53 Kasa Hidrofil Panjang 42 m x 110 cm Rol
54 Etanol 70% 1 L Botol 4 5072188 BTT COVID 3 7 1 6 1.5 30/6/2025 10
55 Vaksin Covid 19 (Sinovac) Singel Dosis Vial
56 Vaksin Covid 19 (Sinovac) @2 Dosis Vial 259 202109208G APBD2021 1230 1489 1406 83 2109 29/3/2022
57 Vaksin Covid 19 (Sinovac) @10 Dosis Vial 2/3/2022
58 Vaksin Moderna @14 Dosis Vial 3 083D21A APBD 2021 3 3 0 4.5 31/12/2021
59 Vaksin Moderna @10 Dosis Vial 007G21A APBD 2021 120 120 45 75 67.5 28/2/2022
60 Vaksin Astrazeneca Vial
61 Vaksin Pfizer @6 Dosis Vial FL533 APBD 2021 234 234 206 28 309 28/2/2022
62 Pelarut NaCl 0,9% 10 ml Flush B83I51A APBN COVID 2021 1404 1404 1236 168 1854 14/9/2023
63 ADS 0,3 ml Pcs 210b35 APBN COVID 19 1404 1404 1236 168 1854 30/9/2026
64 ADS 0,5 ml Pcs 560 21174 APBN COVID 19 3660 4220 3304 916 4956 30/11/2026
65 Alkohol Swab Pcs 478 210512ASQ015 APBN COVID 19 4464 4942 4250 692 6375 31/10/2024
66 Safety Box 5 L Pcs 4 13286J19 APBN COVID 19 42 46 36 10 54
APD Imunisasi Covid 19 Paket
Hand Sanitizer 100 ml Botol
67 Facesield Pcs
Sarung Tangan Non Steril Pasang
Masker Bedah Pcs
68 Rapid Antigen Whole Power Pcs 147 20101110 APBD I 200 347 224 123 336 9/11/2022

UMUM GRATIS JKN TOTAL

JUMLAH KUNJUNGAN 390 766 1156
JUMLAH RESEP 1171 2242 3413

MENGETAHUI, YANG MENYERAHKAN, YANG MEMINTA, YANG MENERIMA,

KEPALA DINAS KESEHATAN KAB. DOMPU KEPALA UPTD IFP DOMPU KEPALA UPTD PUSKESMAS PENGELOLA OBAT PUSKESMAS

Maman, SKM., M.Mkes. Indi Hartini, A.Md.Farm. Rusdi, SKM. apt. Fahru Rahman, S.Farm.

Page 20
 STOK PENERI PERSE JUMLAH PEMA STOK STOK TANGGAL PERMIN
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMBERIAN
AWAL MAAN DIAAN EXPIRED KAIAN AKHIR OPTIMUM KADALUARSA TAAN
NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 197107171997031008 NRPK. 23.7.0509401

Page 21