Lampiran BA Pemeriksaan Fisik Persediaan Obat, BMHP dan Vaksin Per 30 Juni 2023

PUSKESMAS JEUMPA
DINAS KESEHATAN KABUPATEN BIREUEN

Stok Awal (1 Penerimaan/ Pengeluaran/ Sisa Barang Per

No. Nama Barang Satuan Harga Nilai (Rp)
Januari 2023) Penambahan Pemakaian 30 Juni 2023

1 Air untuk injeksi ampul/vial/botol 10 mL

2 Air untuk injeksi Botol 100 ml

3 Air untuk injeksi Botol 250 ml

4 Air untuk injeksi amp 20 ml ampul/vial/botol 74 30 69 35 2,030 71,050

5 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL -

6 Albendazol susp 200 mg/5 ml Botol -

7 Albendazol tab 400 mg tablet/kapsul/kaplet 12200 0 12200 0 367 -

8 Alopurinol tab 100 mg Tab 1498 5000 4521 1,977 89 175,953

9 Alopurinol tab 300 mg tablet/kapsul/kaplet -

10 Aminofilin inj 24 mg/ml ampul/vial 10 ml -

11 Aminofilin tab 150 mg tablet/kapsul/kaplet -

12 Aminofilin Tab 200 mg tablet/kapsul/kaplet -

13 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 382 600 565 417 173 72,141

14 Amlodipin tab 10 mg tablet/kapsul/kaplet -

15 Amlodipin tab 5 mg tablet/kapsul/kaplet 1390 9000 8374 2,016 55 110,880

16 Amoksisilin drops 100 mg/ml Botol @15 ml -

17 Amoksisilin drops 100 mg/ml Botol @20 ml -
18 Amoksisilin drops 100 mg/ml Botol @10 ml -
19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml -
20 Amoksisilin sir kering 125 mg/5 ml Botol 152 400 415 137 4,590 628,830

21 Amoksisilin tab 250 mg tablet/kapsul/kaplet -

22 Amoksisilin tab 500 mg tablet/kapsul/kaplet 2242 19000 19182 2,060 231 475,860

23 Ampisilin serb inj 1000 mg/vial ampul/vial -

24 Ampisilin serb inj 250 mg/vial Vial -

25 Anestetik lokal gigi kombinasi : lidokain hcl 2% + ampul/vial -

epinefrin 1 : 80.000 inj 2 ml

26 Antasida, kombinasi : aluminium hidroksida 200 tablet/kapsul/kaplet 2661 7000 8077 1,584 99 156,816
mg + magnesium hidroksida 200 mg

27 Antasida, kombinasi : aluminium hidroksida 200 botol 60 ml -

mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

28 levodopa 100 mg Kaps -

29 Antifungi salep, kombinasi : asam benzoat 6%+ pot 30 g 37 48 53 32 3,637 116,384

asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

30 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 Suppositoria 18 70 88 0 3,260 -
mg+ seng oksida 120 mg + sup ad 2 g

31 Aquadest cairan 500 ml Botol 500 ml -

32 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial -

33 Articulating paper kertas warna penanda oklusi Kertas warna penanda -

oklusi

34 Asam asetat tetes telinga 2% Botol -

35 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet -

36 Asam askorbat (vitamin C) tab 250 mg Tab -

37 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet 4813 4000 8813 0 42 -

38 Asam folat tab 0,4 mg tablet/kapsul/kaplet -

39 Asam folat tab 1 mg tablet/kapsul/kaplet 550 1800 2309 41 45 1,845

40 Asam folat tab 5 mg Tab -

41 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet -

42 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/ 3203 7000 6861 3,342 117 391,014
kaptab

43 Asam retinoat krim 0,05% Tube/pot -

44 Asam retinoat krim 0,1% Tube @ 10 gram -
45 Asam retinoat krim 0,1% Tube @ 20 gram -
46 Asam salisilat lar 0,1% Botol -
47 Asam salisilat salep 10% Tube -
48 Asam salisilat salep 2% Tube -
49 Asam salisilat salep 5% Tube -

50 Asiklovir tab 200 mg tablet/kapsul/kaplet -

51 Asiklovir tab 400 mg tablet/kapsul/kaplet 471 600 597 474 815 386,310

52 Atapulgit 600 mg tablet/kapsul/kaplet -

53 Atapulgit tab 630 mg tablet/kapsul/kaplet -

54 Atapulgit tablet 650 mg tablet/kapsul/kaplet -

55 Atapulgit tablet 750 mg Tab -

56 Atenolol tab 100 mg tablet/kapsul/kaplet -

57 Atenolol tab 50 mg tablet/kapsul/kaplet -

58 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul -

59 Atropin tab 0,5 mg Tab -
60 Bahan tumpatan sementara lar, serb Botol -

61 Bedak salisil serb 2% Dus/Sachet/Plastik 195 200 261 134 6,600 884,400

62 Betahistin tab 6 mg tablet/kapsul/kaplet 483 1800 1489 794 92 73,048

63 Betametason krim 0,1% tube 5 gram -

64 Betametason krim 0,5 mg/g Tube 65 150 104 111 2,100 233,100
65 Betametason salep 0,1% tube 5 gram -
66 Betametason tts mata 1 mg/ml botol @5 ml -

67 Betametason tts mata 1 mg/ml catchcover, botol 0,6 -

mL
68 Bisakodil sup 10 mg Suppositoria 19 0 11 8 4,325 34,600
69 Bisakodil sup 5 mg Suppositoria -

70 Bisakodil tab sal 5 mg tablet/kapsul/kaplet -

71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml -

72 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules -

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml -

74 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules -

75 Budesonid serb ih 100 mcg/dosis Botol -

76 Budesonid serb ih 200 mcg/dosis 100 dosis -
77 Budesonid serb ih 200 mcg/dosis 200 dosis -
78 Copper T set/buah -
79 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 83 0 20 63 968 60,984

80 Deksametason tab 0,5 mg tablet/kapsul/kaplet -

81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL -

82 Diazepam enema 5 mg/2,5 ml ( Stesolid ) tube @ 2,5 mL 5 0 2 3 13,546 40,638
83 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 5 0 0 5 1,545 7,725

84 Diazepam tab 2 mg tablet/kapsul/kaplet 123 300 421 2 70 140

85 Diazepam tab 5 mg tablet/kapsul/kaplet 63 100 110 53 114 6,042

86 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 208 -

87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 30 0 30 0 825 -

88 Digoksin tab 0,25 mg tablet/kapsul/kaplet -

89 Diltiazem kaps SR 100 mg tablet/kapsul/kaplet -

90 Diltiazem kaps SR 200 mg tablet/kapsul/kaplet -

91 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet -

92 Doksisiklin kaps 100 mg tablet/kapsul/kaplet -

93 Dolutegravir tab 50 mg tablet/kapsul/kaplet -

94 Domperidon susp 5 mg/5 ml botol @60 ml -

95 Domperidon tab 10 mg tablet/kapsul/kaplet 2746 9000 9097 2,649 75 198,675

96 Efavirenz tab 200 mg Tablet -

tablet salut
97 Efavirenz tab sal 600 mg selaput/kaplet salut -
selaput

98 Epinefrin (adrenalin) inj 1 mg/ml Ampul 5 0 0 5 1,170 5,850

99 Ergotamin tab 1 mg Tab -

100 Eritromisin kaps 250 mg tablet/kapsul/kaplet -

101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 72 120 181 11 15,728 173,008

102 Eritromisin tab 500 mg tablet/kapsul/kaplet 969 1000 1556 413 900 371,700

tablet salut gula/kaplet

103 Estrogen terkonjugasi tab sal 0,625 mg -
salut gula

104 Etambutol tab 400 mg tablet/kapsul/kaplet -

105 Etanol 70% cairan 70% Botol 9 0 3 6 3,744 22,464

106 Etil klorida semprot 100 ml Botol -
107 Etonogestrel implan 68 mg Set -
108 Eugenol Botol -
109 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml -
110 Fenitoin Na kaps 100 mg Kaps -
111 Fenitoin Na kaps 30 mg Kaps -
112 Fenobarbital tab 100 mg Tab -

113 Fenobarbital tab 30 mg tablet/kapsul/kaplet -

114 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab -

115 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab -

116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 1,465 -

117 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 520 500 403 617 781 481,877

118 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet -

119 Fluoksetin kaps 10 mg tablet/kapsul/kaplet -

120 Fluoksetin kaps 20 mg tablet/kapsul/kaplet -

121 Fluor kapl 1 mg Kaplet -
122 Fluor sediaan topikal Tube -
123 Formokresol Botol -
124 Framisetin Sulfat Tulle 1% Patch -
125 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial -

126 Furosemid tab 40 mg tablet/kapsul/kaplet 216 -

127 Galactose microparticle 200-400 mg Vial -

micropart/ml

128 Garam Fe, setara dengan Fe elemental 15 mg/5 Botol -

mL

129 Garam Fe, setara dengan Fe elemental 60 mg Sachet -

130 Garam Fe, setara dengan Fe elemental 60 mg Botol -

Garam oralit kombinasi : natrium klorida 0,52 g +

131 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + sachet 235 400 460 175 280 49,000
glukosa anhidrat 2,7 g
132 Gentamisin salep mata 0,3% Tube -
133 Gentamisin tts mata 0,3% Botol -

134 Glass ionomer ART (Atraumatic Restorative Sachet -

Treatment) cocoa butter 5 g

135 Glass ionomer ART (Atraumatic Restorative Botol -

Treatment) lar
Glass ionomer ART (Atraumatic Restorative
136 Treatment) serb Vial -

137 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet -

138 Glibenklamid tab 5 mg tablet/kapsul/kaplet 354 1000 830 524 137 71,788

139 Glikuidon tab 30 mg tablet/kapsul/kaplet -

140 Glimepirid tab 1 mg tablet/kapsul/kaplet -

141 Glimepirid tab 2 mg tablet/kapsul/kaplet -

142 Glipizid tab 5 mg tablet/kapsul/kaplet -

143 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet -

144 Gliserin tts 100 mg/ml Botol -

145 Glukosa Larutan Infus 10% steril 100 ml Botol -
146 Glukosa Larutan Infus 10% steril 250 ml Botol -
147 Glukosa Larutan Infus 10% steril 500 ml Botol -
148 Glukosa Larutan Infus 40% Ampul @25 ml -
149 Glukosa Larutan Infus 5% steril 100 ml Botol -
150 Glukosa Larutan Infus 5% steril 250 ml Botol -
151 Glukosa Larutan Infus 5% steril 500 ml Botol 40 40 45 35 6,627 231,945

152 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet 65 200 65 200 210 42,000

153 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet -

154 Gutta percha dan paper points 15 - 40 mm Roll -

155 Gutta percha dan paper points 45 - 80 mm Roll -
156 Haloperidol inj 5 mg/ml (i.m.) Vial -

157 Haloperidol tab 0,5 mg tablet/kapsul/kaplet -

158 Haloperidol tab 1,5 mg tablet/kapsul/kaplet -

159 Haloperidol tab 2 mg tablet/kapsul/kaplet -

160 Haloperidol tab 5 mg tablet/kapsul/kaplet 546 2500 1948 1,098 54 59,292

161 Haloperidol tts 2 mg/ml botol -

162 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 Ampul -

ml
163 Hidrogen peroksida cairan 3% Botol -

164 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet -

165 Hidrokortison krim 2,5% tube @ 5 g 93 1200 1039 254 2,325 590,550
166 Hidrokortison serb inj 100 mg Vial -

167 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet -

168 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul -

169 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul -

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml -

171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml -

172 Ibuprofen tab 200 mg tablet/kapsul/kaplet -

173 Ibuprofen tab 400 mg tablet/kapsul/kaplet 1613 7500 7113 2,000 199 398,000

174 Ipratropium bromida aerosol 20 mcg/semprot Botol -

175 Ipratropium bromida cairan ih 0,025% Botol -

176 Isoniazid tab 100 mg Tab -
177 Isoniazid tab 300 mg Tab -

178 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet -

179 IUD Cu T 380 A Set -

180 IUD Levonorgestrel Set -
181 Kalamin Tube -
182 Kalsium glukonat inj 100 mg/ml ampul/vial -
183 Kalsium hidroksida bubuk, pasta Tube -

184 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet -

185 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet 1067 4000 3568 1,499 60 89,940

186 Kaptopril tab 12,5 mg tablet/kapsul/kaplet 635 800 878 557 68 37,876

187 Kaptopril tab 25 mg tablet/kaplet -

188 Kaptopril tab 50 mg tablet/kaplet -
189 Karbamazepin sir 100 mg/5 ml Botol -
190 Karbamazepin Tab 200 mg Tablet 450 400 540 310 216 66,960
191 Karbogliserin tts telinga 10 % Botol -
192 Ketokonazol tab 200 mg tablet/kapsul/kaplet 734 1000 1497 237 260 61,620

193 Klindamisin kaps 150 mg Kaps -

194 Klindamisin kaps 300 mg tablet/kapsul/kaplet -
195 Klofazimin, micronized kaps 50 mg Kapsul -
196 Klofazimin, micronizedkaps 100 mg kapsul -

197 Klonidin tab 0,15 mg tablet/kapsul/kaplet -

198 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 750 1000 1023 727 614 446,378

199 Kloramfenikol salep mata 1% tube @ 5 gram -

200 Kloramfenikol serb inj 1.000 mg/ml vial/ampul -
201 Kloramfenikol susp 125 mg/5 ml botol 60 ml -
202 Kloramfenikol tetes telinga 3% Botol 34 21 13 8,000 104,000
203 Kloramfenikol tts mata 0,5% botol -
204 Kloramfenikol tts mata 1% Botol -

205 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 5199 30000 31191 4,008 55 220,440

206 Klorfenol kamfer mentol (CHKM) Botol -

207 Klorheksidin lar 0,2% Botol -
208 Klorheksidin lar 15% Botol -
209 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial -
210 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial -
211 Klorpromazin tab sal 100 mg tablet 260 3000 2862 398 675 268,650
212 Klorpromazin tab sal 25 mg Tab sal -
213 Klortalidon tab 50 mg Tab -
214 Klozapin tab 100 mg tablet -
215 Klozapin tab 25 mg tablet 220 1600 1295 525 473 248,325

216 Kodein tab 10 mg tablet/kapsul/kaplet 80 400 378 102 605 61,710

217 Komb: Deksametason 0,1% Thymol 5% Botol -

Paraklorphenol 30
Kombinasi (DHP) : dihidroartemisin 40 mg +
218 Piperakuin 320 mg tab sal selaput tablet 0 9 9 0 1,900 -

219 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg Tab dispersible -

+ Nevirapin 50 mg) Ped Triple FDC
Kombinasi : artemether 20 mg + lumefantrin 120
220 tablet/kapsul/kaplet -
mg

221 Kombinasi : Desogestrel 150 mcg Etinilestradiol Tab -

30 mcg
222 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet -

223 Kombinasi : Ferro fumarat 60 mg + asam folat tablet salut gula 1387 64970 2207 17,080 257 4,389,560
0,4 mg tab salut

224 Kombinasi : levonorgestrel 150 mcg + tab salut gula -

etinilestradiol 30 mcg

225 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 Tab -

mg

226 Kombinasi : Tenofovir 300 mg + Lamivudin 300 Tab -

mg + Efavirenz 600 mg

227 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab -

228 Kombinasi: Ipratropium bromida 0,5 mg + Ampul/vial -

Salbutamol 2,5 mg, cairan ih
229 Kombinasi: kaolin 550 mg + pektin 20 mg Tab -

230 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 Tab -

mg, tab 250 mg
Kombinasi: Tenofovir 300 mg + Lamivudin 300
231 mg + Dolutegravir 50 mg, tablet tablet/kapsul/kaplet -

232 Komibinasi: lidokain + medisinal creosote phenol Botol -

+ eugenol + benzil alkohol, cairan
233 Komposit resin Set -

234 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 240 -

sulfametoksazol 400 mg+ trimetoprim 80 mg

235 Kotrimoksazol (dewasa) kombinasi : tab/kaptab -

sulfametoksazol 800 mg+ trimetoprim 160 mg

236 Kotrimoksazol kombinasi tiap 5 ml suspensi : botol 60 mL -

sulfametoksazol 200 mg + trimetoprim 40 mg

237 Kuinin inj 25% (i.v.) Vial -

238 Kuinin tab 200 mg tablet/kapsul/kaplet -

239 Laktulosa sir 3,335 g/5 ml botol @ 60 mL -

240 Lamivudin (3TC) tab 150 mg tablet/kapsul/kaplet -

241 Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik @500 ml -

gr, KCl 0,15 gr, NaCl 4,3 gr)

242 Larutan mengandung Elektrolit (Kalium Klorida) Botol -

243 Larutan mengandung Elektrolit (KCl 0,15%, NaCL Botol -

0,9%) (KN1)
Larutan mengandung Elektrolit (KCl 0,3%,NaCl
244 0,9%) (KN2) Botol -

Larutan mengandung Elektrolit (Na 130 mEq, K 4

245 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Botol plastik @500 ml -
Ringer Asetat
Larutan mengandung Elektrolit (Na 130 mEq, K 4
246 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Softbag @ 500 ml -
Ringer Asetat

Larutan mengandung Elektrolit (Sodium Lactate

247 sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Botol -
Calcium Chloride 0.2 gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
248 Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Botol -
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)

249 Larutan mengandung Karbohidrat (Fructose 120 Botol -

g, glucose 66 g, Xylitol 60 g/ L)

Larutan mengandung Karbohidrat (Fructose 15

250 softbag -
mg, glucose monohydrate 30 mg, xylitol 15 mg)
251 Larutan mengandung Karbohidrat (Fructose 200 Botol -
g, glucose 110 g, Xylitol 100 g/ L)
Larutan mengandung Karbohidrat (Fructose 60 g,
252 glucose 33 g, Xylitol 30 g/ L) Botol -

253 Larutan mengandung Karbohidrat (Maltose 10%) Botol -

Larutan mengandung Karbohidrat + Elektrolit

(25.00g dextrose anhidrat, 3.00 g sodium
254 chloride, 0.15 g potassium chloride, 0.10 g Botol plastik @500 ml -
calcium chloride dihydrate dan 1.55 g sodium
lactate)

Larutan mengandung Karbohidrat + Elektrolit

255 (25.00g maltose, 3.00 g sodium chloride, 0.15 g Botol plastik @500 ml -
potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)

Larutan mengandung Karbohidrat + Elektrolit

256 (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) Botol -

Larutan mengandung Karbohidrat + Elektrolit

257 (Dextrose 5%, NaCL 0,45%, KCl) (HSD) Botol -

Larutan mengandung Karbohidrat + Elektrolit

258 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + Botol -
elektrolit)

Larutan mengandung Karbohidrat + Elektrolit

259 (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Botol -
Laktat 3,1 g, air untuk injeksi ad 1000 ml)

Larutan mengandung Karbohidrat + Elektrolit

260 (Glukosa 55 g ; Natrium Chloride 9 g, air untuk Botol -
injeksi ad 1000 ml) (D5-NS)

Larutan mengandung Karbohidrat + Elektrolit

261 (Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS) botol/softbag -

262 Larutan mengandung Karbohidrat + Elektrolit Botol -

(Glukosa: 25,0 g; NaCl: 4,5 g)

263 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 100 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) mL

264 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 500 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) mL

265 Larutan mengandung Karbohidrat + Elektrolit Botol -

(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS)

Larutan mengandung Karbohidrat + Elektrolit

266 (Larutan nutrisi kombinasi infus per L: Na. Botol -
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl
90mEQ, Asetat 38mEQ, Sorbitol 50g)

267 Larutan mengandung Karbohidrat + Elektrolit Botol -

(Larutan Ringer & Glukosa 5%)

268 Larutan mengandung Karbohidrat + Elektrolit Botol -

(NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)

Larutan mengandung Karbohidrat + Elektrolit

269 (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) Botol -

Larutan mengandung Karbohidrat + Elektrolit

270 (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Glukosa Botol -
100 gr)
Larutan mengandung Karbohidrat + Elektrolit
271 (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Botol -
Dekstrosa 27 gr) (KA EN 3B)
Larutan mengandung Karbohidrat + Elektrolit
272 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Botol -
Dekstrosa 27 gr) (KA EN 3A)

273 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set -

274 Lidokain gel 2% syringe/syringe plastik -

275 Lidokain inj 2% (infiltr/p.v.) ampul/vial -

276 Lidokain salep 5% Tube -
277 Lidokain spray oral 10% botol -

278 Linestrenol tab 0,5 mg tablet/kapsul/kaplet -

279 Liquor carbonis detergens lar 5% Botol -

280 Loperamid tab 2 mg Tab -
281 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput -

282 Loratadin tab 10 mg tablet/kapsul/kaplet 3659 8000 11540 119 117 13,923

283 Lorazepam tab 0,5 mg tablet/kapsul/kaplet -

284 Lorazepam tab 1 mg tablet/kapsul/kaplet -

285 Lorazepam tab sal 2 mg Tab sal -

286 Magnesium sulfat inj 20% ampul/vial @25 ml 2 12 14 0 4,120 -

287 Magnesium sulfat inj 20% ampul/vial -

288 Magnesium sulfat inj 40% ampul/vial @25 ml 2 12 14 0 -

289 Magnesium sulfat inj 40% ampul/vial -

290 Magnesium sulfat serb, ktg 30 g Sachet -
291 Manitol lar infus 20% Botol @ 100 ml -
292 Manitol lar infus 20% Botol @ 250 ml -
293 Manitol lar infus 20% Botol @ 500 ml -
294 Mebendazol sir 100 mg/5 ml Botol -
295 Mebendazol tab 100 mg Tan -

296 Mebendazol tab 500 mg tablet/kapsul/kaplet -

297 Medroksi progesteron asetat inj 150 mg/ml ampul/vial -

Metenamin mandelat (heksamin mandelat) tab
298 salut enterik 500 mg Tab salut -

299 Metformin tab 500 mg tablet/kapsul/kaplet 731 2400 2532 599 77 46,123

300 Metformin tab 850 mg tablet/kapsul/kaplet -

301 Metilergometrin inj 0,2 mg/ml ampul/vial 30 25 40 15 1,069 16,035
302 Metilergometrin tab salut 0,125 mg tablet -
303 Metilprednisolon inj 125 mg/2 ml ampul/vial -
304 Metoklopramid inj 5 mg/ml ampul/vial -

305 Metoklopramid tab 10 mg tablet/kapsul/kaplet -

306 Metoklopramid tab 5 mg tablet/kapsul/kaplet -

307 Metronidazol lar inf 5 mg/ml botol -

308 Metronidazol susp 125 mg/5 ml Botol @ 100 ml -
309 Metronidazol susp 125 mg/5 ml Botol @ 60 ml -

310 Metronidazol tab 250 mg tablet/kapsul/kaplet -

311 Metronidazol tab 500 mg tablet/kapsul/kaplet 1134 2000 2180 954 150 143,100

312 Mikonazol krim 2% tube 54 504 480 78 1,900 148,200

313 Mikonazol serb 2% botol / sachet -

Mineral Mix (Bismuth Subcitrate Tripotasium,

314 Copper sulfate, Magnesium Chloride Anhydrous, Sachet 160 0 0 160 2,981 476,960
Potassium Chloride, Zinc Acetate)

315 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet -

316 NaCl 0,9% Larutan Botol @250 ml -

317 NaCl 0,9% Larutan Ampul/botol @ 10 mL -

318 NaCl 0,9% Larutan Botol @25 ml -

319 NaCl 0,9% Larutan Botol @500 ml 82 80 154 8 6,900 55,200
320 NaCl 0,9% Larutan Botol @100 ml -

321 NaCl 0,9% Larutan Botol @1.000 mL -

322 NaCl 3% Larutan Botol plastik @500 ml -

323 Natrium diklofenak tab 25 mg tablet 115 -

324 Natrium diklofenak tab 50 mg tablet 4367 5000 7313 2,054 131 269,074
325 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL -
326 Natrium hipoklorit cairan konsentrat 5% Botol -
327 Natrium tiosulfat inj 25% (i.v.) Ampul -

328 Nevirapin tab 200 mg tablet/kapsul/kaplet -

329 Nifedipin kaps 10 mg tablet/kapsul/kaplet -

330 Nistatin susp 100.000 UI/ml botol/vial -

331 Nistatin tab salut 500.000 UI tablet -
332 Nistatin tab vaginal 100.000 UI tablet/kaplet -
333 Norepinefrin inj 1 mg/ml ampul/vial -
334 Obat Anti Tuberculosis FDC Kategori Anak paket 5 5 248,710 1,243,550
335 Obat Anti Tuberculosis FDC Kategori I paket 479,267 -
336 Obat Anti Tuberculosis FDC Kategori II paket -

337 Obat Anti Tuberculosis FDC Kategori Sisipan paket -

338 Obat Anti Tuberculosis Kombipak Anak Paket -

339 Obat Anti Tuberculosis Kombipak Dewasa paket -
340 Oksigen ih, gas dlm tabung Botol -
341 Oksimetazolin tts hidung 0,025% botol @ 10 mL -
342 Oksimetazolin tts hidung 0,050% botol @ 10 mL -
343 Oksitetrasiklin 1% Salep Mata tube -
344 Oksitosin inj 10 UI/ml ampul/vial 20 100 30 90 1,023 92,070
345 Olopatadin tts mata 0,1% Botol -
346 Omeprazol inj 40 mg/10 ml ampul/vial 140 150 199 91 9,000 819,000

347 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 600 600 0 129 -

348 Paraformaldehid tab 1 g Tab -

349 Parasetamol sir 120 mg/5 ml botol @ 60 mL -

350 Parasetamol tab 500 mg tablet/kapsul/kaplet 2554 48500 4495 6,559 223 1,462,657

351 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL -

352 Pasta devitalisasi (non arsen) Tube -
353 Pasta pengisi saluran akar (pasta) Tube -
354 Perak nitrat lar 20% Botol -
355 Perak sulfadiazin krim 1% Tube 4 2 3 3 18,557 55,671
356 Permetrin krim 5 % Tube 10 g 17 180 129 68 6,580 447,440
357 Permetrin krim 5 % Tube 30 g -
358 Permetrin krim 5 % Tube 15 g -
359 Pirantel pamoat susp 125 mg/5 ml Botol -
360 Pirantel pamoat tab 500 mg Tab -

361 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet -

362 Pirantel pamoat tab scored 250 mg Tab -

363 Piridoksin (vitamin B6) inj 100 mg/ml Ampul -
364 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 3193 1400 2079 1,514 72 109,008

365 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet -

366 Povidon iodin lar 100 mg/ml Botol 300 ml -

367 Povidon iodin lar 100 mg/ml botol @ 1.000 mL -
368 Povidon iodin lar 100 mg/ml botol 30 mL -
369 Povidon iodin lar 100 mg/ml botol @ 60 mL -
370 Povidon iodin lar obat kumur 1% Botol -
371 Povidon iodin tts mata 2,5% botol/strip -

372 Prednison tab 5 mg tablet/kapsul/kaplet 6904 15000 15863 6,041 73 440,993

373 Primakuin tab 15 mg Tab 0 30 24 6 242 1,452

374 Probenesid tab 500 mg tablet/kapsul/kaplet -

375 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial -

376 Propiltiourasil tab 100 mg tablet/kapsul/kaplet -

377 Propranolol tab 10 mg tablet/kapsul/kaplet -

378 Ranitidin tab 150 mg tablet/kapsul/kaplet 777 5500 5374 1,903 85 161,755

379 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak -

380 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak 30 3250 4 490 642 314,580

381 Rifampisin kaps 300 mg tablet/kapsul/kaplet -

382 Rifapentin tablet 150 mg tablet/kapsul/kaplet 5,495 -

383 Ringer Laktat Larutan Botol 131 900 642 389 8,400 3,267,600

384 Risperidon tab sal 1 mg tablet/kapsul/kaplet -

385 Risperidon tab sal 2 mg tablet/kapsul/kaplet 333 2200 2158 375 123 46,125

386 Salbutamol cairan ih 1 mg/mL ampul/vial/botol -

387 Salbutamol sir 2 mg/5 ml Botol -

388 Salbutamol tab 2 mg tablet/kapsul/kaplet 1311 4000 3358 1,953 51 99,603

Salep 2-4, kombinasi : asam salisilat 2 %+

389 belerang endap 4 % pot 15 gram 78 100 142 36 1,475 53,100

390 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram -

belerang endap 4 %

391 Sefadroksil kaps 250 mg tablet/kapsul/kaplet -

392 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet -

393 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL -

394 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL -

395 Serum anti bisa ular : A.B.U. I (khusus ular dari Vial 2 2 3 1 517,132 517,132
luar Papua) inj (i.m./i.v.)

396 Serum anti bisa ular :A.B.U.II (khusus ular dari Vial -
Papua) inj (i.m./i.v.)

397 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial -

10.000 UI/
398 Serum antirabies inj 100 UI/ml Vial -
399 Serum antirabies inj 200 UI/ml Vial -

400 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial Vial -

(i.m /i.v.)

401 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 2 25 27 0 140,188 -

402 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial -

(i.m /i.v.)

403 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial -

404 Setirizin sir 5 mg/5 ml. botol @ 60 mL -

405 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial 55 0 17 38 1,066 40,508

406 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet 1090 0 380 710 44 31,240

407 Simvastatin tab sal 10 mg tablet 2329 7500 8476 1,353 73 98,769
408 Simvastatin tab sal 20 mg tablet -
409 Simvastatin tab sal selaput 40 mg Tab sal -
410 Siprofloksasin tab scored 500 mg tablet -

411 Spironolakton tab 25 mg tablet/kapsul/kaplet -

Stannous pyrophosphate 27,6 mg sodium

412 pyrophosphate/vial Vial -

413 Streptomisin serb inj 1.000 mg/vial ampul/vial -

414 Surgical ginggival pack Tube -
415 Tenofovir tab 300 mg tablet -
416 Terbutalin cairan ih 2,5 mg/ml Botol -
417 Terbutalin inj 0,5 mg/ml ampul/vial -
418 Tetanus toxoid inj Ampul -
419 Tetrakain tts mata 0,5% Botol -

420 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet -

421 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet -

422 Tetrasiklin Salep Mata 1% Tube -

423 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet -

424 Timolol tts mata 0,25% botol @ 5 mL -

425 Timolol tts mata 0,5% botol @ 5 mL -
426 Tropikamid tts mata 1% Botol @ 5 ml -
427 Tropikamid tts mata 1% Botol @ 0,6 ml -
428 Urea krim 10 % Tube/pot -
429 Urea krim 20 % Tube/pot -
430 Vaksin BCG inj (i.k) Vial -
431 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial -

432 Vaksin Hepatitis Rekombinan Inj Prefilled Vial -

Injection Device (Uniject) 0,5 ml (i.m)

433 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial -

434 Vaksin Influenza Vial -

435 Vaksin Japanese Enchepalitis (J.E) Vial -
436 Vaksin jerap difteri tetanus (DT) Vial -
437 Vaksin jerap difteri tetanus (Td) Vial -
438 Vaksin kombinasi DPT-HB-Hib Vial -

439 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial -

440 Vaksin Meningitis Meningokokus Vial -

441 Vaksin polio IPV inj 0,5 ml Vial -

442 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial -

booster

443 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial -

444 Vaksin Yellow Fever Vial -

445 Valproat sir 250 mg/5 ml botol @ 120 ml -
446 Valproat tab lepas lambat 250 mg tabet -
447 Valproat tab lepas lambat 500 mg tabet -
448 Valproat tab sal enterik 250 mg tablet -
449 Vitamin B kompleks tablet 1875 13000 12126 2,749 60 164,940

450 Vitamin C 500 mg minimal non acidic 250 mg Tablet -

451 Zidovudin kaps 100 mg tablet/kapsul/kaplet -

452 Zinc drops 10 mg/ml Botol -

453 Zinc sir 20 mg/5 ml botol -
454 Zinc tab disp 20 mg tablet dispersible 1312 2800 3083 1,029 253 260,337
455 Clobazam tab 10 mg tab 461 0 220 241 384 92,544
456 Kloramfenikol salep kulit 2% Tube 123 912 757 278 3,760 1,045,280
457 Triheksifenidil tab 2 mg Tab 490 5500 4960 1,030 63 64,890
458 Pehacain Injeksi 70 220 175 115 3,142 361,330
459 MB Dewasa Blister 8 5 2 11 51,858 570,438
460 Cetirizin tab 10 mg Tab 52 -
461 MB Anak Blister -
462 PB Anak Blister -
463 PB Dewasa Blister -
464 Tuber Kulin PPD R T Vial -
465 Benzatin Penisillin 2,4 juta IU Vial -
Retinol 200,000Iu ( Vit A Merah) Program
466 Tab -
Stunting
467 Flufenazine Dekanoat Injeksi Ampul -
468 Pyridoksin ( B6 ) 100 mg tab Tab -
469 Cyloserine 250 mg Tab -
470 Levofloxacin 250 mg tab Tab -
471 Kanamycin 1 gr Vial -
472 Ethambutol 400 mg tab Tab -
473 Ethionamide 250 mg tab Tab -
474 Moxifloxacin Tab -
475 Bedaquiline Tab -
476 Linezolid Tab -
477 Clofazimine Tab -
478 Trifluoperazine Hcl 5 mg Tab -
479 Halloperidol decanoad inj 50 mg Ampul -
480 Azitromicin 500 mg Talet -
481 Kloroquin 150 mg Talet -
482 Becefort Tab Tab -
483 OAT KDT Dosis harian Paket 398,365 -
484 Favipiravir 200 mg Tab -
485 Alat Suntik Sekali Pakai 1 ml pcs 60 300 232 128 658 84,160
486 Alat Suntik Sekali Pakai 3 ml 429 800 797 432 1,000 432,000
487 Alat Suntik Sekali Pakai 5 ml pcs 196 300 324 172 1,034 177,848
488 Alat Suntik Sekali Pakai 10 ml pcs 100 110 33 167 1,008 168,253
489 Alkohol Swab tablet 688 3300 2682 1,306 132 172,392

490 Catgut / Benang Bedah No. 3/0 dengan jarum pcs 5,575 -
bedah chromix
Catgut / Benang Bedah No. 3/0 dengan jarum
491 bedah plain pcs 48 0 14 34 5,575 189,550

492 Infusion Set Anak pcs 79 0 4 75 4,000 300,000

493 Infusion Set Dewasa pcs 121 100 190 31 8,066 250,046
494 IV Catheter No. 18 G pcs -
495 IV Catheter No. 20 G pcs 60 50 40 70 15,140 1,059,800
496 IV Catheter No. 22 G pcs 60 100 160 0 -
497 IV Catheter No. 24 G pcs 99 100 102 97 15,140 1,468,580
498 Kapas Pembalut / Absorben 250 gram rol 3 8 6 5 18,539 92,695
499 Kasa Pembalut 40 m x 80 cm rol 2 15 13 4 153,000 612,000
500 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic pcs 146 50 103 93 2,415 224,595
501 Masker pcs -
502 Plester 5 yards x 2 inch rol -
503 Urine bag Ampul 3 10 13 13 3,000 39,000
504 Sarung tangan Steril 7 pcs 0 1200 1200 0 8,705 -
505 Sarung tangan 7 tablet -
506 Folley Catheter No. 18 vial -
507 Blood Slide vial 72 216 216 72 312 22,464
Silk (Benang Bedah Sutera) No 3/0 dengan
508 Ampul -
jarum bedah
509 Pembalut Gips tablet -
510 Sputum Pot kotak 0 1200 934 266 2,650 704,900
511 Reagen Nelson botol 7 15 22 0 187,333 -
512 Etakridin ( Rivanol ) larutan 0,1% - 300 ml botol -
513 my jelly pcs -
514 plester Cannofix pcs 152 200 133 219 6,882 1,507,158
515 Bisturi no 22 pcs -
516 Planotest -
517 sarung tangan L pcs 1,127 -
518 sarung tangan M pcs 660 2300 2460 500 1,127 563,700
519 Blood Lancets Pcs -
520 Aseptic Gel 500 cc + Dispenser Botol 74,000 -
521 Sarung Tangan Obgyn Pcs -
522 Masker N95 Pcs -
523 Safety Box 2,5 liter Pcs -
524 Umbrical Cord Klem Pcs 4,521 -
525 sarung tangan s pcs -
526 Nasal Oxigen 0,2 cannula Ukrn M pcs 30 0 3 27 7,098 191,646
527 Nasal Oxigen 0,2 cannula Ukrn S pcs 10 0 10 0 7,098 -
528 Nasal Oxigen 0,2 cannula Ukrn L Pcs 80 20 60 40 7,098 283,920
529 Box Slide Pcs -
530 Sarung Tangan Steril 7,5 pcs 100 300 400 200 9,900 1,980,000
531 Plester Farmafix 5x 500 cm Roll 0 40 32 8 32,190 257,520
532 Cartridge Genexpert Buah 252,400 -
533 Virocheck Hbs Ag Strep 191 600 558 233 7,219 1,682,027
534 Masker N95 Covid-19 Pcs 160 0 0 160 27,375 4,380,000
535 Baju APD Pcs 69 50 40 79 175,000 13,825,000
536 Kacamata APD Pcs -
537 Septalkan Btl -
538 Helm APD Pcs -
539 VTM torax Pcs -
540 Fokus Syphilis PCS -
541 Fokus New HIV 1/2 3 line DAK Program PCS -
542 Kasa hidofil 16 cm x16 cm Roll -
543 Rapit Test Antigen -
544 Kasa Hidrofil 80x80 Roll -
545 Kasa Hidrofil 3x15 Roll -
546 Masker TB Pcs 0 950 768 182 706 128,492
547 Sarung tangan 7,5 Pcs -
548 SD HIV 1/2 Rapid 1 Pcs -
549 SD HIV 1/2 Rapid 2 Pcs 11,500 -
550 SD HIV 1/2 Rapid 3 Pcs 25 0 0 25 11,440 286,000
551 RDT DBD Combo Pcs -
552 Telura/ATR IV/A Tab 6,359 -
553 RDT Anti HCV Pcs -
554 Pyrazinamid 500 mg tab -
555 Vaccine Carier/Pendingin Box -
556 OBH AFI 100 ml Botol 100 ml -
557 Alive Biocom-C 50 tab 710 500 484 726 864 627,264
558 Acrip tega botol 30 tab 3,499 -
559 Duviral botol 60 tab -
560 Neviral botol 60 tab -
561 Alprazolam 0,5 mg Tab 195 0 142 53 78 4,134
562 Alkohol swab P2P Pcs 440 132 58,080
563 Blood Lancets P2p Pcs 5,906 154 909,524
564 Stik gula Benechek P2p Botol 129 3,200 412,800
565 Vaksin BCG ( Rutin ) Vial 30 159 151 38 88,288 3,354,944
566 Pelarut BCG ( Rutin ) Fls 30 160 152 38 -
567 Vaksin Td ( Rutin ) Vial 40 50 80 10 20,721 207,210
568 Vaksin Dt ( Rutin ) Vial 30 0 10 20 31,273 625,460
569 Vaksin MR (CAMPAK) ( Rutin ) Vial 190 80 255 15 151,225 2,268,375
570 Pelarut MR campak ( Rutin ) Fls 190 80 255 15 -
571 Vaksin Hepatitis B ( Rutin ) Vial 80 100 161 19 23,490 446,310
572 Vaksin IPV ( Rutin ) Vial 14 20 34 0 142,793 -
573 Vaksin DPT ( Rutin ) Vial 40 200 184 56 77,336 4,330,816
574 Vaksin Polio (BOPV) ( Rutin ) Vial 54 100 124 30 19,540 586,200
575 Spuit 5 ml ( Rutin ) Pcs 50 400 450 0 1,470 -
576 Spuit 0,5 Ml ( rutin ) Pcs 1600 400 1500 500 1,190 595,000
577 Spuit 0,05 ml ( Rutin ) Pcs 100 400 500 0 1,460 -
578 Droper ( Rutin ) Pcs -
579 Safety Box ( Rutin ) Pcs -
580 Pfizer ( covid ) Vial -
581 Pelarut 0,9 % nacl ( covid ) Vial -
582 Alkohol Swab ( covid ) Pcs -
583 Spuit 3 Ml ( covid ) Pcs -
584 Spuit 0,3 Ml ( covid ) Pcs -
585 Spuit 0,5 Ml ( covid ) Pcs -
586 Safety Box ( covid ) Pcs -
587 Masker N 95 TB Pcs 0 120 63 57 20,000 1,140,000
588 Hand Sanitizer covid 19 botol -
589 Cavit D3 tab -
590 Imunvit tab -
591 Vaksin PCV ( Rutin ) Vial 0 50 0 45 3,400,000 153,000,000
592 Sarung tangan / Shamrock Supreme M P2P Pcs 2500 1600 900 1,104 993,600
593 Sarung tangan / Shamrock Supreme L P2P Pcs 1400 600 800 1,126 900,800
594 Calnic Plus 100 ml Botol -
595 Busmin Syr Botol -
596 Hand Sanitizer 500 ml p2p Botol -
597 Masker Earlop Baymed BPJS pcs 812 -
598 Gown G5001-SF-N P2P Pcs -
599 Ketoralak inj Ampul 100 42 58 923 53,534
600 Fluconazole 150 mg Cap -
601 Vaksin polio OPV 2 vial -
602 Dropper Vaksin Polio OPV 2 pcs -
603 Masker Earlop / Steril MaskP2P Bok 42,500 -
604 Procurma Syr 60 ml Botol 200 117 83 11,500 954,500
605 Dextrofen syr Botol -
606 Masker program malaria Pcs -
607 Lamprene Kapsul -
608 Sarung tangan Program malaria pcs -
609 CDR Btl -
610 Pen Marker Pcs -
611 Pengukur suhu P2P / Fridge-tag 2 Unit -

612 Isoniazid (H) 300 mg/ Rifapentine (P) 300 mg (HP) Tablet 6,546 -

613 Rapid test HIV 1/2 & Shypylis Combo Test 0 350 150 200 17,497 3,499,400
614 HBIg Pcs -
615 Masker N95 Aero Pro Pcs -
616 Asta Plus Tab -
617 Vaksin Inovac Vial -
231,701,692

Bireuen, 12 Juli 2023

Bendahara Barang Penanggung Jawab Apotik

Triana Fitri, SKM Zulaida, A.Md.Farm

NIP. 19770917 200701 2 002 NIP. 19821010 201408 2 003

Mengetahui,
Kepala Puskesmas Jeumpa

dr. Asmaul Husna

NIP. 19800708 201001 2 001
 Lampiran BA Pemeriksaan Fisik Persediaan OBAT Per 30 Juni 2023
PUSKESMAS JEUMPA
DINAS KESEHATAN KABUPATEN BIREUEN

Stok Awal (1 Penerimaan/ Pengeluaran/ Sisa Barang Per 30 Juni

No. Nama Barang Satuan Harga Nilai (Rp)
Januari 2023) Penambahan Pemakaian 2023

1 Air untuk injeksi ampul/vial/ -

botol 10 mL
2 Air untuk injeksi Botol 100 ml -
3 Air untuk injeksi Botol 250 ml -

4 Air untuk injeksi amp 20 ml ampul/vial/ 74 30 69 35 2,030 71,050

botol

5 Air untuk injeksi amp 25 ml ampul/vial/ 0 -

botol 25 mL
6 Albendazol susp 200 mg/5 ml Botol 0 -

7 Albendazol tab 400 mg tablet/kapsul/ 12200 12,200 0 367 -

kaplet
8 Alopurinol tab 100 mg Tab 1498 5000 4,521 1,977 89 175,953

9 Alopurinol tab 300 mg tablet/kapsul/ 0 -

kaplet

10 Aminofilin inj 24 mg/ml ampul/vial 10 0 -

ml

11 Aminofilin tab 150 mg tablet/kapsul/ 0 -

kaplet

12 Aminofilin Tab 200 mg tablet/kapsul/ 0 -

kaplet

13 Amitriptilin tab sal 25 mg tablet/kapsul/ 382 600 565 417 173 72,141
kaplet

14 Amlodipin tab 10 mg tablet/kapsul/ 0 -

kaplet

15 Amlodipin tab 5 mg tablet/kapsul/ 1390 9000 8,374 2,016 55 110,880

kaplet
16 Amoksisilin drops 100 mg/ml Botol @15 ml 0 -
17 Amoksisilin drops 100 mg/ml Botol @20 ml 0 -
18 Amoksisilin drops 100 mg/ml Botol @10 ml 0 -
19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0 -
20 Amoksisilin sir kering 125 mg/5 ml Botol 152 400 415 137 4,590 628,830

21 Amoksisilin tab 250 mg tablet/kapsul/ 0 -

kaplet

22 Amoksisilin tab 500 mg tablet/kapsul/ 2242 19000 19,182 2,060 231 475,860
kaplet
23 Ampisilin serb inj 1000 mg/vial ampul/vial 0 -
24 Ampisilin serb inj 250 mg/vial Vial 0 -

25 Anestetik lokal gigi kombinasi : lidokain hcl 2% + ampul/vial 0 -

epinefrin 1 : 80.000 inj 2 ml

26 Antasida, kombinasi : aluminium hidroksida 200 tablet/kapsul/ 2661 7000 8,077 1,584 99 156,816
mg + magnesium hidroksida 200 mg kaplet

27 Antasida, kombinasi : aluminium hidroksida 200 botol 60 ml 0 -

mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

28 levodopa 100 mg Kaps 0 -

29 Antifungi salep, kombinasi : asam benzoat 6%+ pot 30 g 37 48 53 32 3,637 116,384

asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

30 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 Suppositoria 18 70 88 3,260 -
mg+ seng oksida 120 mg + sup ad 2 g

31 Aquadest cairan 500 ml Botol 500 ml 0 -

32 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial 0 -

Kertas warna
33 Articulating paper kertas warna penanda oklusi penanda 0 -
oklusi

34 Asam asetat tetes telinga 2% Botol 0 -

tablet/
35 Asam asetilsalisilat (asetosal) tab 80 mg 0 -
kapsul/kaplet
36 Asam askorbat (vitamin C) tab 250 mg Tab 0 -
tablet/
37 Asam askorbat (vitamin C) tab 50 mg 4813 4000 8,813 42 -
kapsul/kaplet

38 Asam folat tab 0,4 mg tablet/ 0 -

kapsul/kaplet

39 Asam folat tab 1 mg tablet/ 550 1800 2,309 41 45 1,845

kapsul/kaplet
40 Asam folat tab 5 mg Tab 0 -

41 Asam mefenamat kaps 250 mg tablet/ 0 -

kapsul/kaplet
tablet/
42 Asam mefenamat kaps 500 mg kapsul/ 3203 7000 6,861 3,342 117 391,014
kaplet/kaptab
43 Asam retinoat krim 0,05% Tube/pot 0 -
44 Asam retinoat krim 0,1% Tube @ 10 gram 0 -
45 Asam retinoat krim 0,1% Tube @ 20 gram 0 -
46 Asam salisilat lar 0,1% Botol 0 -
47 Asam salisilat salep 10% Tube 0 -
48 Asam salisilat salep 2% Tube 0 -
49 Asam salisilat salep 5% Tube 0 -
tablet/
50 Asiklovir tab 200 mg kapsul/kaplet 0 -

51 Asiklovir tab 400 mg tablet/ 471 600 597 474 815 386,310
kapsul/kaplet
tablet/
52 Atapulgit 600 mg kapsul/kaplet 0 -

53 Atapulgit tab 630 mg tablet/ 0 -

kapsul/kaplet
54 Atapulgit tablet 650 mg tablet/ 0 -
kapsul/kaplet
55 Atapulgit tablet 750 mg Tab 0 -
56 Atenolol tab 100 mg tablet/ 0 -
kapsul/kaplet
tablet/
57 Atenolol tab 50 mg kapsul/kaplet 0 -

58 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 -

59 Atropin tab 0,5 mg Tab 0 -
60 Bahan tumpatan sementara lar, serb Botol 0 -

61 Bedak salisil serb 2% Dus/Sachet/ 195 200 261 134 6,600 884,400
Plastik

62 Betahistin tab 6 mg tablet/ 483 1800 1,489 794 92 73,048

kapsul/kaplet
63 Betametason krim 0,1% tube 5 gram 0 -
64 Betametason krim 0,5 mg/g Tube 65 150 104 111 2,100 233,100
65 Betametason salep 0,1% tube 5 gram 0 -
66 Betametason tts mata 1 mg/ml botol @5 ml 0 -

67 Betametason tts mata 1 mg/ml catchcover, 0 -

botol 0,6 mL
68 Bisakodil sup 10 mg Suppositoria 19 11 8 4,325 34,600
69 Bisakodil sup 5 mg Suppositoria 0 -

70 Bisakodil tab sal 5 mg tablet/ 0 -

kapsul/kaplet
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 -

72 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules 0 -

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 -

74 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules 0 -

75 Budesonid serb ih 100 mcg/dosis Botol 0 -

76 Budesonid serb ih 200 mcg/dosis 100 dosis 0 -
77 Budesonid serb ih 200 mcg/dosis 200 dosis 0 -
78 Copper T set/buah 0 -
79 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 83 20 63 968 60,984

80 Deksametason tab 0,5 mg tablet/ 0 -

kapsul/kaplet
81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 -
82 Diazepam enema 5 mg/2,5 ml ( Stesolid ) tube @ 2,5 mL 5 2 3 13,546 40,638
83 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 5 0 5 1,545 7,725

84 Diazepam tab 2 mg tablet/kapsul/ 123 300 421 2 70 140

kaplet

85 Diazepam tab 5 mg tablet/kapsul/ 63 100 110 53 114 6,042

kaplet

86 Dietilkarbamazin tab 100 mg tablet/kapsul/ 0 208 -

kaplet
87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 30 30 0 825 -

88 Digoksin tab 0,25 mg tablet/ 0 -

kapsul/kaplet
tablet/
89 Diltiazem kaps SR 100 mg kapsul/kaplet 0 -

90 Diltiazem kaps SR 200 mg tablet/ 0 -

kapsul/kaplet
tablet/
91 Dimenhidrinat tab 50 mg kapsul/kaplet 0 -

92 Doksisiklin kaps 100 mg tablet/ 0 -

kapsul/kaplet
tablet/
93 Dolutegravir tab 50 mg 0 -
kapsul/kaplet
94 Domperidon susp 5 mg/5 ml botol @60 ml 0 -

95 Domperidon tab 10 mg tablet/ 2746 9000 9,097 2,649 75 198,675

kapsul/kaplet
96 Efavirenz tab 200 mg Tablet 0 -

tablet salut
97 Efavirenz tab sal 600 mg selaput/kaplet 0 -
salut selaput

98 Epinefrin (adrenalin) inj 1 mg/ml Ampul 5 0 5 1,170 5,850

99 Ergotamin tab 1 mg Tab 0 -

100 Eritromisin kaps 250 mg tablet/ 0 -

kapsul/kaplet
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 72 120 181 11 15,728 173,008

102 Eritromisin tab 500 mg tablet/ 969 1000 1,556 413 900 371,700
kapsul/kaplet
tablet salut
103 Estrogen terkonjugasi tab sal 0,625 mg gula/kaplet 0 -
salut gula

104 Etambutol tab 400 mg tablet/ 0 -

kapsul/kaplet
105 Etanol 70% cairan 70% Botol 9 3 6 3,744 22,464
106 Etil klorida semprot 100 ml Botol 0 -
107 Etonogestrel implan 68 mg Set 0 -
108 Eugenol Botol 0 -
109 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml 0 -
110 Fenitoin Na kaps 100 mg Kaps 0 -
111 Fenitoin Na kaps 30 mg Kaps 0 -
112 Fenobarbital tab 100 mg Tab 0 -

113 Fenobarbital tab 30 mg tablet/ 0 -

kapsul/kaplet

114 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 0 -

115 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 0 -

116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 0 1,465 -

117 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 520 500 403 617 781 481,877

118 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet 0 -

119 Fluoksetin kaps 10 mg tablet/ 0 -

kapsul/kaplet
tablet/
120 Fluoksetin kaps 20 mg kapsul/kaplet 0 -

121 Fluor kapl 1 mg Kaplet 0 -

122 Fluor sediaan topikal Tube 0 -
123 Formokresol Botol 0 -
124 Framisetin Sulfat Tulle 1% Patch 0 -
125 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0 -

126 Furosemid tab 40 mg tablet/ 0 216 -

kapsul/kaplet

127 Galactose microparticle 200-400 mg Vial 0 -

micropart/ml
Garam Fe, setara dengan Fe elemental 15 mg/5
128 mL Botol 0 -

129 Garam Fe, setara dengan Fe elemental 60 mg Sachet 0 -

130 Garam Fe, setara dengan Fe elemental 60 mg Botol 0 -

Garam oralit kombinasi : natrium klorida 0,52 g +

131 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + sachet 235 400 460 175 280 49,000
glukosa anhidrat 2,7 g
132 Gentamisin salep mata 0,3% Tube 0 -
133 Gentamisin tts mata 0,3% Botol 0 -

134 Glass ionomer ART (Atraumatic Restorative Sachet 0 -

Treatment) cocoa butter 5 g
Glass ionomer ART (Atraumatic Restorative
135 Treatment) lar Botol 0 -

136 Glass ionomer ART (Atraumatic Restorative Vial 0 -

Treatment) serb
tablet/
137 Glibenklamid tab 2,5 mg kapsul/kaplet 0 -

138 Glibenklamid tab 5 mg tablet/ 354 1000 830 524 137 71,788
kapsul/kaplet
tablet/
139 Glikuidon tab 30 mg 0 -
kapsul/kaplet

140 Glimepirid tab 1 mg tablet/ 0 -

kapsul/kaplet

141 Glimepirid tab 2 mg tablet/ 0 -

kapsul/kaplet

142 Glipizid tab 5 mg tablet/ 0 -

kapsul/kaplet

143 Gliseril trinitrat tab 0,5 mg tablet/ 0 -

kapsul/kaplet
144 Gliserin tts 100 mg/ml Botol 0 -
145 Glukosa Larutan Infus 10% steril 100 ml Botol 0 -
146 Glukosa Larutan Infus 10% steril 250 ml Botol 0 -
147 Glukosa Larutan Infus 10% steril 500 ml Botol 0 -
148 Glukosa Larutan Infus 40% Ampul @25 ml 0 -
149 Glukosa Larutan Infus 5% steril 100 ml Botol 0 -
150 Glukosa Larutan Infus 5% steril 250 ml Botol 0 -
151 Glukosa Larutan Infus 5% steril 500 ml Botol 40 40 45 35 6,627 231,945

152 Griseofulvin (micronized) tab 125 mg tablet/ 65 200 65 200 210 42,000
kapsul/kaplet

153 Griseofulvin (micronized) tab scored 250 mg tablet/ 0 -

kapsul/kaplet
154 Gutta percha dan paper points 15 - 40 mm Roll 0 -
155 Gutta percha dan paper points 45 - 80 mm Roll 0 -
156 Haloperidol inj 5 mg/ml (i.m.) Vial 0 -
tablet/
157 Haloperidol tab 0,5 mg 0 -
kapsul/kaplet

158 Haloperidol tab 1,5 mg tablet/ 0 -

kapsul/kaplet

159 Haloperidol tab 2 mg tablet/ 0 -

kapsul/kaplet

160 Haloperidol tab 5 mg tablet/ 546 2500 1,948 1,098 54 59,292

kapsul/kaplet
161 Haloperidol tts 2 mg/ml botol 0 -

162 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 Ampul 0 -

ml
163 Hidrogen peroksida cairan 3% Botol 0 -

164 Hidroklorotiazid tab 25 mg tablet/ 0 -

kapsul/kaplet
165 Hidrokortison krim 2,5% tube @ 5 g 93 1200 1,039 254 2,325 590,550
166 Hidrokortison serb inj 100 mg Vial 0 -

167 Hiosina butilbromida tab 10 mg tablet/ 0 -

kapsul/kaplet

168 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul 0 -

169 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul 0 -

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 -

171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 -

172 Ibuprofen tab 200 mg tablet/ 0 -

kapsul/kaplet

173 Ibuprofen tab 400 mg tablet/ 1613 7500 7,113 2,000 199 398,000
kapsul/kaplet

174 Ipratropium bromida aerosol 20 mcg/semprot Botol 0 -

175 Ipratropium bromida cairan ih 0,025% Botol 0 -

176 Isoniazid tab 100 mg Tab 0 -
177 Isoniazid tab 300 mg Tab 0 -
tablet/
178 Isosorbid dinitrat tab 5 mg kapsul/kaplet 0 -

179 IUD Cu T 380 A Set 0 -

180 IUD Levonorgestrel Set 0 -
181 Kalamin Tube 0 -
182 Kalsium glukonat inj 100 mg/ml ampul/vial 0 -
183 Kalsium hidroksida bubuk, pasta Tube 0 -

184 Kalsium karbonat tab 500 mg tablet/ 0 -

kapsul/kaplet

185 Kalsium laktat (kalk) tab 500 mg tablet/ 1067 4000 3,568 1,499 60 89,940
kapsul/kaplet
tablet/
186 Kaptopril tab 12,5 mg kapsul/kaplet 635 800 878 557 68 37,876

187 Kaptopril tab 25 mg tablet/kaplet 0 -

188 Kaptopril tab 50 mg tablet/kaplet 0 -
189 Karbamazepin sir 100 mg/5 ml Botol 0 -
190 Karbamazepin Tab 200 mg Tablet 450 400 540 310 216 66,960
191 Karbogliserin tts telinga 10 % Botol 0 -

192 Ketokonazol tab 200 mg tablet/ 734 1000 1,497 237 260 61,620
kapsul/kaplet
193 Klindamisin kaps 150 mg Kaps 0 -
194 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 -
195 Klofazimin, micronized kaps 50 mg Kapsul 0 -
196 Klofazimin, micronizedkaps 100 mg kapsul 0 -
197 Klonidin tab 0,15 mg tablet/ 0 -
kapsul/kaplet
tablet/
198 Kloramfenikol kaps 250 mg kapsul/kaplet 750 1000 1,023 727 614 446,378

199 Kloramfenikol salep mata 1% tube @ 5 gram 0 -

200 Kloramfenikol serb inj 1.000 mg/ml vial/ampul 0 -
201 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0 -
202 Kloramfenikol tetes telinga 3% Botol 34 21 13 8,000 104,000
203 Kloramfenikol tts mata 0,5% botol 0 -
204 Kloramfenikol tts mata 1% Botol 0 -

205 Klorfeniramin tab 4 mg tablet/ 5199 30000 31,191 4,008 55 220,440

kapsul/kaplet
206 Klorfenol kamfer mentol (CHKM) Botol 0 -
207 Klorheksidin lar 0,2% Botol 0 -
208 Klorheksidin lar 15% Botol 0 -
209 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 0 -
210 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0 -
211 Klorpromazin tab sal 100 mg tablet 260 3000 2,862 398 675 268,650
212 Klorpromazin tab sal 25 mg Tab sal 0 -
213 Klortalidon tab 50 mg Tab 0 -
214 Klozapin tab 100 mg tablet 0 -
215 Klozapin tab 25 mg tablet 220 1600 1,295 525 473 248,325

216 Kodein tab 10 mg tablet/ 80 400 378 102 605 61,710

kapsul/kaplet
Komb: Deksametason 0,1% Thymol 5%
217 Paraklorphenol 30 Botol 0 -

218 Kombinasi (DHP) : dihidroartemisin 40 mg + tablet 9 9 0 1,900 -

Piperakuin 320 mg tab sal selaput

219 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg Tab dispersible 0 -

+ Nevirapin 50 mg) Ped Triple FDC

220 Kombinasi : artemether 20 mg + lumefantrin 120 tablet/ 0 -

mg kapsul/kaplet

221 Kombinasi : Desogestrel 150 mcg Etinilestradiol Tab 0 -

30 mcg
222 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 -

223 Kombinasi : Ferro fumarat 60 mg + asam folat tablet salut gul 1387 64970 49,277 17,080 257 4,389,560
0,4 mg tab salut

224 Kombinasi : levonorgestrel 150 mcg + tab salut gula 0 -

etinilestradiol 30 mcg

225 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 Tab 0 -

mg
Kombinasi : Tenofovir 300 mg + Lamivudin 300
226 mg + Efavirenz 600 mg Tab 0 -

227 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab 0 -

Kombinasi: Ipratropium bromida 0,5 mg +

228 Salbutamol 2,5 mg, cairan ih Ampul/vial 0 -

229 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 -

Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50
230 mg, tab 250 mg Tab 0 -

231 Kombinasi: Tenofovir 300 mg + Lamivudin 300 tablet/ 0 -

mg + Dolutegravir 50 mg, tablet kapsul/kaplet
Komibinasi: lidokain + medisinal creosote phenol
232 + eugenol + benzil alkohol, cairan Botol 0 -

233 Komposit resin Set 0 -

234 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0 240 -

sulfametoksazol 400 mg+ trimetoprim 80 mg

235 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0 -

sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol kombinasi tiap 5 ml suspensi :

236 botol 60 mL 0 -
sulfametoksazol 200 mg + trimetoprim 40 mg

237 Kuinin inj 25% (i.v.) Vial 0 -

238 Kuinin tab 200 mg tablet/ 0 -

kapsul/kaplet
239 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 -

240 Lamivudin (3TC) tab 150 mg tablet/ 0 -

kapsul/kaplet

241 Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik 0 -

gr, KCl 0,15 gr, NaCl 4,3 gr) @500 ml

242 Larutan mengandung Elektrolit (Kalium Klorida) Botol 0 -

Larutan mengandung Elektrolit (KCl 0,15%, NaCL

243 0,9%) (KN1) Botol 0 -

244 Larutan mengandung Elektrolit (KCl 0,3%,NaCl Botol 0 -

0,9%) (KN2)
Larutan mengandung Elektrolit (Na 130 mEq, K 4
245 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Botol plastik 0 -
Ringer Asetat @500 ml

Larutan mengandung Elektrolit (Na 130 mEq, K 4

246 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Softbag @ 500 0 -
Ringer Asetat ml

Larutan mengandung Elektrolit (Sodium Lactate

247 sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Botol 0 -
Calcium Chloride 0.2 gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
248 Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Botol 0 -
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)

Larutan mengandung Karbohidrat (Fructose 120

249 g, glucose 66 g, Xylitol 60 g/ L) Botol 0 -

250 Larutan mengandung Karbohidrat (Fructose 15 softbag 0 -

mg, glucose monohydrate 30 mg, xylitol 15 mg)

251 Larutan mengandung Karbohidrat (Fructose 200 Botol 0 -

g, glucose 110 g, Xylitol 100 g/ L)
Larutan mengandung Karbohidrat (Fructose 60 g,
252 glucose 33 g, Xylitol 30 g/ L) Botol 0 -

253 Larutan mengandung Karbohidrat (Maltose 10%) Botol 0 -

 Larutan mengandung Karbohidrat + Elektrolit
(25.00g dextrose anhidrat, 3.00 g sodium Botol plastik
254 chloride, 0.15 g potassium chloride, 0.10 g 0 -
@500 ml
calcium chloride dihydrate dan 1.55 g sodium
lactate)
 Larutan mengandung Karbohidrat + Elektrolit
255 (25.00g maltose, 3.00 g sodium chloride, 0.15 g Botol plastik 0 -
potassium chloride, 0.10 g calcium chloride @500 ml
dihydrate dan 1.55 g sodium lactate)

Larutan mengandung Karbohidrat + Elektrolit

256 (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

257 (Dextrose 5%, NaCL 0,45%, KCl) (HSD) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

258 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + Botol 0 -
elektrolit)

Larutan mengandung Karbohidrat + Elektrolit

259 (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Botol 0 -
Laktat 3,1 g, air untuk injeksi ad 1000 ml)

Larutan mengandung Karbohidrat + Elektrolit

260 (Glukosa 55 g ; Natrium Chloride 9 g, air untuk Botol 0 -
injeksi ad 1000 ml) (D5-NS)

Larutan mengandung Karbohidrat + Elektrolit

261 (Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS) botol/softbag 0 -

262 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Glukosa: 25,0 g; NaCl: 4,5 g)

263 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 100 mL

264 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 500 mL

265 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS)

Larutan mengandung Karbohidrat + Elektrolit

266 (Larutan nutrisi kombinasi infus per L: Na. Botol 0 -
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl
90mEQ, Asetat 38mEQ, Sorbitol 50g)

267 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Larutan Ringer & Glukosa 5%)

Larutan mengandung Karbohidrat + Elektrolit

268 (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

269 (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

270 (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Glukosa Botol 0 -
100 gr)
Larutan mengandung Karbohidrat + Elektrolit
271 (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Botol 0 -
Dekstrosa 27 gr) (KA EN 3B)
Larutan mengandung Karbohidrat + Elektrolit
272 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Botol 0 -
Dekstrosa 27 gr) (KA EN 3A)

273 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ 0 -

set
syringe/
274 Lidokain gel 2% syringe plastik 0 -

275 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 -

276 Lidokain salep 5% Tube 0 -
277 Lidokain spray oral 10% botol 0 -
tablet/
278 Linestrenol tab 0,5 mg kapsul/kaplet 0 -

279 Liquor carbonis detergens lar 5% Botol 0 -

280 Loperamid tab 2 mg Tab 0 -
281 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput 0 -
tablet/
282 Loratadin tab 10 mg kapsul/kaplet 3659 8000 11,540 119 117 13,923

283 Lorazepam tab 0,5 mg tablet/ 0 -

kapsul/kaplet
tablet/
284 Lorazepam tab 1 mg kapsul/kaplet 0 -

285 Lorazepam tab sal 2 mg Tab sal 0 -

ampul/vial
286 Magnesium sulfat inj 20% @25 ml 2 12 14 0 4,120 -

287 Magnesium sulfat inj 20% ampul/vial 0 -

ampul/vial
288 Magnesium sulfat inj 40% @25 ml 2 12 14 0 -

289 Magnesium sulfat inj 40% ampul/vial 0 -

290 Magnesium sulfat serb, ktg 30 g Sachet 0 -
291 Manitol lar infus 20% Botol @ 100 ml 0 -
292 Manitol lar infus 20% Botol @ 250 ml 0 -
293 Manitol lar infus 20% Botol @ 500 ml 0 -
294 Mebendazol sir 100 mg/5 ml Botol 0 -
295 Mebendazol tab 100 mg Tan 0 -

296 Mebendazol tab 500 mg tablet/ 0 -

kapsul/kaplet
297 Medroksi progesteron asetat inj 150 mg/ml ampul/vial 0 -

298 Metenamin mandelat (heksamin mandelat) tab Tab salut 0 -

salut enterik 500 mg

299 Metformin tab 500 mg tablet/ 731 2400 2,532 599 77 46,123
kapsul/kaplet
tablet/
300 Metformin tab 850 mg kapsul/kaplet 0 -

301 Metilergometrin inj 0,2 mg/ml ampul/vial 30 25 40 15 1,069 16,035

302 Metilergometrin tab salut 0,125 mg tablet 0 -
303 Metilprednisolon inj 125 mg/2 ml ampul/vial 0 -
304 Metoklopramid inj 5 mg/ml ampul/vial 0 -

305 Metoklopramid tab 10 mg tablet/ 0 -

kapsul/kaplet
tablet/
306 Metoklopramid tab 5 mg kapsul/kaplet 0 -

307 Metronidazol lar inf 5 mg/ml botol 0 -

308 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0 -
309 Metronidazol susp 125 mg/5 ml Botol @ 60 ml 0 -
310 Metronidazol tab 250 mg tablet/ 0 -
kapsul/kaplet
tablet/
311 Metronidazol tab 500 mg kapsul/kaplet 1134 2000 2,180 954 150 143,100

312 Mikonazol krim 2% tube 54 504 480 78 1,900 148,200

313 Mikonazol serb 2% botol / sachet 0 -

Mineral Mix (Bismuth Subcitrate Tripotasium,

314 Copper sulfate, Magnesium Chloride Anhydrous, Sachet 160 0 160 2,981 476,960
Potassium Chloride, Zinc Acetate)

315 N-asetil sistein kaps 200 mg tablet/kapsul/ 0 -

kaplet
316 NaCl 0,9% Larutan Botol @250 ml 0 -
Ampul/botol
317 NaCl 0,9% Larutan @ 10 mL 0 -

318 NaCl 0,9% Larutan Botol @25 ml 0 -

319 NaCl 0,9% Larutan Botol @500 ml 82 80 154 8 6,900 55,200
320 NaCl 0,9% Larutan Botol @100 ml 0 -
Botol @1.000
321 NaCl 0,9% Larutan mL 0 -

322 NaCl 3% Larutan Botol plastik 0 -

@500 ml
323 Natrium diklofenak tab 25 mg tablet 0 115 -
324 Natrium diklofenak tab 50 mg tablet 4367 5000 7,313 2,054 131 269,074
325 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 -
326 Natrium hipoklorit cairan konsentrat 5% Botol 0 -
327 Natrium tiosulfat inj 25% (i.v.) Ampul 0 -

328 Nevirapin tab 200 mg tablet/ 0 -

kapsul/kaplet
tablet/
329 Nifedipin kaps 10 mg kapsul/kaplet 0 -

330 Nistatin susp 100.000 UI/ml botol/vial 0 -

331 Nistatin tab salut 500.000 UI tablet 0 -
332 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 -
333 Norepinefrin inj 1 mg/ml ampul/vial 0 -
334 Obat Anti Tuberculosis FDC Kategori Anak paket 5 0 5 248,710 1,243,550
335 Obat Anti Tuberculosis FDC Kategori I paket 0 479,267 -
336 Obat Anti Tuberculosis FDC Kategori II paket 0 -
337 Obat Anti Tuberculosis FDC Kategori Sisipan paket 0 -
338 Obat Anti Tuberculosis Kombipak Anak Paket 0 -
339 Obat Anti Tuberculosis Kombipak Dewasa paket 0 -
340 Oksigen ih, gas dlm tabung Botol 0 -
341 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0 -
342 Oksimetazolin tts hidung 0,050% botol @ 10 mL 0 -
343 Oksitetrasiklin 1% Salep Mata tube 0 -
344 Oksitosin inj 10 UI/ml ampul/vial 20 100 30 90 1,023 92,070
345 Olopatadin tts mata 0,1% Botol 0 -
346 Omeprazol inj 40 mg/10 ml ampul/vial 140 150 199 91 9,000 819,000

347 Omeprazol kaps 20 mg tablet/ 600 600 0 129 -

kapsul/kaplet
348 Paraformaldehid tab 1 g Tab 0 -
349 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 -
tablet/
350 Parasetamol tab 500 mg kapsul/kaplet 2554 48500 44,495 6,559 223 1,462,657

351 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 -

352 Pasta devitalisasi (non arsen) Tube 0 -
353 Pasta pengisi saluran akar (pasta) Tube 0 -
354 Perak nitrat lar 20% Botol 0 -
355 Perak sulfadiazin krim 1% Tube 4 2 3 3 18,557 55,671
356 Permetrin krim 5 % Tube 10 g 17 180 129 68 6,580 447,440
357 Permetrin krim 5 % Tube 30 g 0 -
358 Permetrin krim 5 % Tube 15 g 0 -
359 Pirantel pamoat susp 125 mg/5 ml Botol 0 -
360 Pirantel pamoat tab 500 mg Tab 0 -

361 Pirantel pamoat tab scored 125 mg tablet/ 0 -

kapsul/kaplet
362 Pirantel pamoat tab scored 250 mg Tab 0 -
363 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 -
364 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 2193 1400 2,079 1,514 72 109,008

365 Piridoksin (vitamin B6) tab 25 mg tablet/ 0 -

kapsul/kaplet
366 Povidon iodin lar 100 mg/ml Botol 300 ml 0 -
367 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 -
368 Povidon iodin lar 100 mg/ml botol 30 mL 0 -
369 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 -
370 Povidon iodin lar obat kumur 1% Botol 0 -
371 Povidon iodin tts mata 2,5% botol/strip 0 -

372 Prednison tab 5 mg tablet/ 6904 15000 15,863 6,041 73 440,993

kapsul/kaplet
373 Primakuin tab 15 mg Tab 30 24 6 242 1,452

374 Probenesid tab 500 mg tablet/ 0 -

kapsul/kaplet

375 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial 0 -

376 Propiltiourasil tab 100 mg tablet/ 0 -

kapsul/kaplet

377 Propranolol tab 10 mg tablet/ 0 -

kapsul/kaplet

378 Ranitidin tab 150 mg tablet/ 777 6500 5,374 1,903 85 161,755
kapsul/kaplet
379 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak 0 -
380 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak 30 3250 2,790 490 642 314,580

381 Rifampisin kaps 300 mg tablet/ 0 -

kapsul/kaplet

382 Rifapentin tablet 150 mg tablet/ 0 5,495 -

kapsul/kaplet
383 Ringer Laktat Larutan Botol 131 900 642 389 8,400 3,267,600

384 Risperidon tab sal 1 mg tablet/ 0 -

kapsul/kaplet

385 Risperidon tab sal 2 mg tablet/ 333 2200 2,158 375 123 46,125
kapsul/kaplet
386 Salbutamol cairan ih 1 mg/mL ampul/vial/ 0 -
botol
387 Salbutamol sir 2 mg/5 ml Botol 0 -
388 Salbutamol tab 2 mg tablet/ 1311 4000 3,358 1,953 51 99,603
kapsul/kaplet
Salep 2-4, kombinasi : asam salisilat 2 %+
389 belerang endap 4 % pot 15 gram 78 100 142 36 1,475 53,100

390 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram 0 -

belerang endap 4 %
tablet/
391 Sefadroksil kaps 250 mg kapsul/kaplet 0 -

392 Sefadroksil kaps/tab 500 mg tablet/ 0 -

kapsul/kaplet
393 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL 0 -
394 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL 0 -
Serum anti bisa ular : A.B.U. I (khusus ular dari
395 luar Papua) inj (i.m./i.v.) Vial 2 2 3 1 517,132 517,132

396 Serum anti bisa ular :A.B.U.II (khusus ular dari Vial 0 -
Papua) inj (i.m./i.v.)
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
397 Vial 0 -
10.000 UI/
398 Serum antirabies inj 100 UI/ml Vial 0 -
399 Serum antirabies inj 200 UI/ml Vial 0 -

400 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial Vial 0 -

(i.m /i.v.)

401 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 2 25 27 0 140,188 -

402 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial 0 -

(i.m /i.v.)

403 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial 0 -

404 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 -

405 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial 55 17 38 1,066 40,508

406 Sianokobalamin (vitamin B12) tab 50 mcg tablet/ 1090 380 710 44 31,240
kapsul/kaplet
407 Simvastatin tab sal 10 mg tablet 2329 7500 8,476 1,353 73 98,769
408 Simvastatin tab sal 20 mg tablet 0 -
409 Simvastatin tab sal selaput 40 mg Tab sal 0 -
410 Siprofloksasin tab scored 500 mg tablet 0 -

411 Spironolakton tab 25 mg tablet/ 0 -

kapsul/kaplet

412 Stannous pyrophosphate 27,6 mg sodium Vial 0 -

pyrophosphate/vial
413 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 -
414 Surgical ginggival pack Tube 0 -
415 Tenofovir tab 300 mg tablet 0 -
416 Terbutalin cairan ih 2,5 mg/ml Botol 0 -
417 Terbutalin inj 0,5 mg/ml ampul/vial 0 -
418 Tetanus toxoid inj Ampul 0 -
419 Tetrakain tts mata 0,5% Botol 0 -

420 Tetrasiklin kaps 250 mg tablet/ 0 -

kapsul/kaplet

421 Tetrasiklin kaps 500 mg tablet/ 0 -

kapsul/kaplet
422 Tetrasiklin Salep Mata 1% Tube 0 -

423 Tiamin (vitamin B1) tab 50 mg tablet/ 2929 8000 10,929 0 -

kapsul/kaplet
424 Timolol tts mata 0,25% botol @ 5 mL 0 -
425 Timolol tts mata 0,5% botol @ 5 mL 0 -
426 Tropikamid tts mata 1% Botol @ 5 ml 0 -
427 Tropikamid tts mata 1% Botol @ 0,6 ml 0 -
428 Urea krim 10 % Tube/pot 0 -
429 Urea krim 20 % Tube/pot 0 -
430 Vaksin BCG inj (i.k) Vial 0 -
431 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0 -

432 Vaksin Hepatitis Rekombinan Inj Prefilled Vial 0 -

Injection Device (Uniject) 0,5 ml (i.m)

433 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial 0 -

434 Vaksin Influenza Vial 0 -

435 Vaksin Japanese Enchepalitis (J.E) Vial 0 -
436 Vaksin jerap difteri tetanus (DT) Vial 0 -
437 Vaksin jerap difteri tetanus (Td) Vial 0 -
438 Vaksin kombinasi DPT-HB-Hib Vial 0 -

439 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial 0 -

440 Vaksin Meningitis Meningokokus Vial 0 -

441 Vaksin polio IPV inj 0,5 ml Vial 0 -

442 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial 0 -

booster
443 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 -
444 Vaksin Yellow Fever Vial 0 -
445 Valproat sir 250 mg/5 ml botol @ 120 ml 0 -
446 Valproat tab lepas lambat 250 mg tabet 0 -
447 Valproat tab lepas lambat 500 mg tabet 0 -
448 Valproat tab sal enterik 250 mg tablet 0 -
449 Vitamin B kompleks tablet 1875 13000 12,126 2,749 60 164,940

450 Vitamin C 500 mg minimal non acidic 250 mg Tablet 0 -

451 Zidovudin kaps 100 mg tablet/ 0 -

kapsul/kaplet
452 Zinc drops 10 mg/ml Botol 0 -
453 Zinc sir 20 mg/5 ml botol 0 -
454 Zinc tab disp 20 mg tablet dispersib 1312 2800 3,083 1,029 253 260,337
455 Clobazam tab 10 mg tab 461 220 241 384 92,544
456 Kloramfenikol salep kulit 2% Tube 123 912 757 278 3,760 1,045,280
457 Triheksifenidil tab 2 mg Tab 490 5500 4,960 1,030 63 64,890
458 Pehacain Injeksi 70 220 175 115 3,142 361,330
459 MB Dewasa Blister 8 5 2 11 51,858 570,438
460 Cetirizin tab 10 mg Tab 0 52 -
461 MB Anak Blister 0 -
462 PB Anak Blister 0 -
463 PB Dewasa Blister 0 -
464 Tuber Kulin PPD R T Vial 0 -
465 Benzatin Penisillin 2,4 juta IU Vial 0 -

466 Retinol 200,000Iu ( Vit A Merah) Program Tab 0 -

Stunting
467 Flufenazine Dekanoat Injeksi Ampul 0 -
468 Pyridoksin ( B6 ) 100 mg tab Tab 0 -
469 Cyloserine 250 mg Tab 0 -
470 Levofloxacin 250 mg tab Tab 0 -
471 Kanamycin 1 gr Vial 0 -
472 Ethambutol 400 mg tab Tab 0 -
473 Ethionamide 250 mg tab Tab 0 -
474 Moxifloxacin Tab 0 -
475 Bedaquiline Tab 0 -
476 Linezolid Tab 0 -
477 Clofazimine Tab 0 -
478 Trifluoperazine Hcl 5 mg Tab 0 -
479 Halloperidol decanoad inj 50 mg Ampul 0 -
480 Azitromicin 500 mg Talet 0 -
481 Kloroquin 150 mg Talet 0 -
482 Becefort Tab Tab 0 -
483 OAT KDT Dosis harian Paket 0 398,365 -
484 Favipiravir 200 mg Tab 0 -
485 Alat Suntik Sekali Pakai 1 ml pcs 0 -
486 Alat Suntik Sekali Pakai 3 ml 0 -
487 Alat Suntik Sekali Pakai 5 ml pcs 0 -
488 Alat Suntik Sekali Pakai 10 ml pcs 0 -
489 Alkohol Swab tablet 0 -

490 Catgut / Benang Bedah No. 3/0 dengan jarum pcs 0 -

bedah chromix

491 Catgut / Benang Bedah No. 3/0 dengan jarum pcs 0 -

bedah plain
492 Infusion Set Anak pcs 0 -
493 Infusion Set Dewasa pcs 0 -
494 IV Catheter No. 18 G pcs 0 -
495 IV Catheter No. 20 G pcs 0 -
496 IV Catheter No. 22 G pcs 0 -
497 IV Catheter No. 24 G pcs 0 -
498 Kapas Pembalut / Absorben 250 gram rol 0 -
499 Kasa Pembalut 40 m x 80 cm rol 0 -
500 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic pcs 0 -
501 Masker pcs 0 -
502 Plester 5 yards x 2 inch rol 0 -
503 Urine bag Ampul 0 -
504 Sarung tangan Steril 7 pcs 0 -
505 Sarung tangan 7 tablet 0 -
506 Folley Catheter No. 18 vial 0 -
507 Blood Slide vial 0 -

508 Silk (Benang Bedah Sutera) No 3/0 dengan Ampul 0 -

jarum bedah
509 Pembalut Gips tablet 0 -
510 Sputum Pot kotak 0 -
511 Reagen Nelson botol 0 -
512 Etakridin ( Rivanol ) larutan 0,1% - 300 ml botol 0 -
513 my jelly pcs 0 -
514 plester Cannofix pcs 0 -
515 Bisturi no 22 pcs 0 -
516 Planotest 0 -
517 sarung tangan L pcs 0 -
518 sarung tangan M pcs 0 -
519 Blood Lancets Pcs 0 -
520 Aseptic Gel 500 cc + Dispenser Botol 0 -
521 Sarung Tangan Obgyn Pcs 0 -
522 Masker N95 Pcs 0 -
523 Safety Box 2,5 liter Pcs 0 -
524 Umbrical Cord Klem Pcs 0 -
525 sarung tangan s pcs 0 -
526 Nasal Oxigen 0,2 cannula Ukrn M pcs 0 -
527 Nasal Oxigen 0,2 cannula Ukrn S pcs 0 -
528 Nasal Oxigen 0,2 cannula Ukrn L Pcs 0 -
529 Box Slide Pcs 0 -
530 Sarung Tangan Steril 7,5 pcs 0 -
531 Plester Farmafix 5x 500 cm Roll 0 -
532 Cartridge Genexpert Buah 0 -
533 Virocheck Hbs Ag Strep 0 -
534 Masker N95 Covid-19 Pcs 0 -
535 Baju APD Pcs 0 -
536 Kacamata APD Pcs 0 -
537 Septalkan Btl 0 -
538 Helm APD Pcs 0 -
539 VTM torax Pcs 0 -
540 Fokus Syphilis PCS 0 -
541 Fokus New HIV 1/2 3 line DAK Program PCS 0 -
542 Kasa hidofil 16 cm x16 cm Roll 0 -
543 Rapit Test Antigen 0 -
544 Kasa Hidrofil 80x80 Roll 0 -
545 Kasa Hidrofil 3x15 Roll 0 -
546 Masker TB Pcs 0 -
547 Sarung tangan 7,5 Pcs 0 -
548 SD HIV 1/2 Rapid 1 Pcs 0 -
549 SD HIV 1/2 Rapid 2 Pcs 0 -
550 SD HIV 1/2 Rapid 3 Pcs 0 -
551 RDT DBD Combo Pcs 0 -
552 Telura/ATR IV/A Tab 0 6,359 -
553 RDT Anti HCV Pcs 0 -
554 Pyrazinamid 500 mg tab 0 -
555 Vaccine Carier/Pendingin Box 0 -
556 OBH AFI 100 ml Botol 100 ml 0 -
557 Alive Biocom-C 50 tab 710 500 484 726 864 627,264
558 Acrip tega botol 30 tab 0 3,499 -
559 Duviral botol 60 tab 0 -
560 Neviral botol 60 tab 0 -
561 Alprazolam 0,5 mg Tab 195 142 53 78 4,134
562 Alkohol swab P2P Pcs 0 -
563 Blood Lancets P2p Pcs 0 -
564 Stik gula Benechek P2p Botol 0 -
565 Vaksin BCG ( Rutin ) Vial 0 -
566 Pelarut BCG ( Rutin ) Fls 0 -
567 Vaksin Td ( Rutin ) Vial 0 -
568 Vaksin Dt ( Rutin ) Vial 0 -
569 Vaksin MR (CAMPAK) ( Rutin ) Vial 0 -
570 Pelarut MR campak ( Rutin ) Fls 0 -
571 Vaksin Hepatitis B ( Rutin ) Vial 0 -
572 Vaksin IPV ( Rutin ) Vial 0 -
573 Vaksin DPT ( Rutin ) Vial 0 -
574 Vaksin Polio (BOPV) ( Rutin ) Vial 0 -
575 Spuit 5 ml ( Rutin ) Pcs 0 -
576 Spuit 0,5 Ml ( rutin ) Pcs 0 -
577 Spuit 0,05 ml ( Rutin ) Pcs 0 -
578 Droper ( Rutin ) Pcs 0 -
579 Safety Box ( Rutin ) Pcs 0 -
580 Pfizer ( covid ) Vial 0 -
581 Pelarut 0,9 % nacl ( covid ) Vial 0 -
582 Alkohol Swab ( covid ) Pcs 0 -
583 Spuit 3 Ml ( covid ) Pcs 0 -
584 Spuit 0,3 Ml ( covid ) Pcs 0 -
585 Spuit 0,5 Ml ( covid ) Pcs 0 -
586 Safety Box ( covid ) Pcs 0 -
587 Masker N 95 TB Pcs 0 -
588 Hand Sanitizer covid 19 botol 0 -
589 Cavit D3 tab 0 -
590 Imunvit tab 0 -
591 Vaksin PCV ( Rutin ) Vial 0 -
592 Sarung tangan / Shamrock Supreme M P2P Pcs 0 -
593 Sarung tangan / Shamrock Supreme L P2P Pcs 0 -
594 Calnic Plus 100 ml Botol 0 -
595 Busmin Syr Botol 0 -
596 Hand Sanitizer 500 ml p2p Botol 0 -
597 Masker Earlop Baymed BPJS pcs 0 -
598 Gown G5001-SF-N P2P Pcs 0 -
599 Ketoralak inj Ampul 100 42 58 923 53,534
600 Fluconazole 150 mg Cap 0 -
601 Vaksin polio OPV 2 vial 0 -
602 Dropper Vaksin Polio OPV 2 pcs 0 -
603 Masker Earlop / Steril MaskP2P Bok 0 -
604 Procurma Syr 60 ml Botol 200 117 83 11,500 954,500
605 Dextrofen syr Botol 0 -
606 Masker program malaria Pcs 0 -
607 Lamprene Kapsul 0 -
608 Sarung tangan Program malaria pcs 0 -
609 CDR Btl 0 -
610 Pen Marker Pcs 0 -
611 Pengukur suhu P2P / Fridge-tag 2 Unit 0 -

612 Isoniazid (H) 300 mg/ Rifapentine (P) 300 mg (HP) Tablet 0 6,546 -

613 Rapid test HIV 1/2 & Shypylis Combo Test 0 -

614 HBIg Pcs 0 -
615 Masker N95 Aero Pro Pcs 0 -
616 Asta Plus Tab 0 -
617 Vaksin Inovac Vial 0 -
0
0
0 27,289,427

Bireuen, 12 Juli 2023

Bendahara Barang Penanggung Jawab Apotik

Triana Fitri, SKM Zulaida, A.Md.Farm

NIP. 19770917 200701 2 002 NIP. 19821010 201408 2 003

Mengetahui,
Kepala Puskesmas Jeumpa

dr. Asmaul Husna

NIP. 19800708 201001 2 001
 Lampiran BA Pemeriksaan Fisik Persediaan BMHP Per 30 Juni 2023
PUSKESMAS JEUMPA
DINAS KESEHATAN KABUPATEN BIREUEN

Stok Awal (1 Penerimaan/ Pengeluaran/ Sisa Barang Per 30 Juni

No. Nama Barang Satuan Harga Nilai (Rp)
Januari 2023) Penambahan Pemakaian 2023
1 Air untuk injeksi ampul/vial/ 0 -
botol 10 mL
2 Air untuk injeksi Botol 100 ml 0 -
3 Air untuk injeksi Botol 250 ml 0 -

4 Air untuk injeksi amp 20 ml ampul/vial/ 0 -

botol

5 Air untuk injeksi amp 25 ml ampul/vial/ 0 -

botol 25 mL
6 Albendazol susp 200 mg/5 ml Botol 0 -

7 Albendazol tab 400 mg tablet/kapsul/ 0 -

kaplet
8 Alopurinol tab 100 mg Tab 0 -

9 Alopurinol tab 300 mg tablet/kapsul/ 0 -

kaplet

10 Aminofilin inj 24 mg/ml ampul/vial 10 0 -

ml

11 Aminofilin tab 150 mg tablet/kapsul/ 0 -

kaplet

12 Aminofilin Tab 200 mg tablet/kapsul/ 0 -

kaplet

13 Amitriptilin tab sal 25 mg tablet/kapsul/ 0 -

kaplet

14 Amlodipin tab 10 mg tablet/kapsul/ 0 -

kaplet

15 Amlodipin tab 5 mg tablet/kapsul/ 0 -

kaplet
16 Amoksisilin drops 100 mg/ml Botol @15 ml 0 -
17 Amoksisilin drops 100 mg/ml Botol @20 ml 0 -
18 Amoksisilin drops 100 mg/ml Botol @10 ml 0 -
19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0 -
20 Amoksisilin sir kering 125 mg/5 ml Botol 0 -

21 Amoksisilin tab 250 mg tablet/kapsul/ 0 -

kaplet

22 Amoksisilin tab 500 mg tablet/kapsul/ 0 -

kaplet
23 Ampisilin serb inj 1000 mg/vial ampul/vial 0 -
24 Ampisilin serb inj 250 mg/vial Vial 0 -

25 Anestetik lokal gigi kombinasi : lidokain hcl 2% + ampul/vial 0 -

epinefrin 1 : 80.000 inj 2 ml

26 Antasida, kombinasi : aluminium hidroksida 200 tablet/kapsul/ 0 -

mg + magnesium hidroksida 200 mg kaplet

Antasida, kombinasi : aluminium hidroksida 200

27 mg + magnesium hidroksida 200 mg botol 60 ml 0 -

Anti Parkinson kombinasi : benzerasid 25 mg +

28 levodopa 100 mg Kaps 0 -

29 Antifungi salep, kombinasi : asam benzoat 6%+ pot 30 g 0 -

asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

30 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 Suppositoria 0 -
mg+ seng oksida 120 mg + sup ad 2 g

31 Aquadest cairan 500 ml Botol 500 ml 0 -

32 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial 0 -

Kertas warna
33 Articulating paper kertas warna penanda oklusi penanda 0 -
oklusi

34 Asam asetat tetes telinga 2% Botol 0 -

35 Asam asetilsalisilat (asetosal) tab 80 mg tablet/ 0 -

kapsul/kaplet
36 Asam askorbat (vitamin C) tab 250 mg Tab 0 -

37 Asam askorbat (vitamin C) tab 50 mg tablet/ 0 -

kapsul/kaplet
tablet/
38 Asam folat tab 0,4 mg kapsul/kaplet 0 -

39 Asam folat tab 1 mg tablet/ 0 -

kapsul/kaplet
40 Asam folat tab 5 mg Tab 0 -
tablet/
41 Asam mefenamat kaps 250 mg 0 -
kapsul/kaplet
tablet/
42 Asam mefenamat kaps 500 mg kapsul/ 0 -
kaplet/kaptab
43 Asam retinoat krim 0,05% Tube/pot 0 -
44 Asam retinoat krim 0,1% Tube @ 10 gram 0 -
45 Asam retinoat krim 0,1% Tube @ 20 gram 0 -
46 Asam salisilat lar 0,1% Botol 0 -
47 Asam salisilat salep 10% Tube 0 -
48 Asam salisilat salep 2% Tube 0 -
49 Asam salisilat salep 5% Tube 0 -

50 Asiklovir tab 200 mg tablet/ 0 -

kapsul/kaplet

51 Asiklovir tab 400 mg tablet/ 0 -

kapsul/kaplet
tablet/
52 Atapulgit 600 mg kapsul/kaplet 0 -

53 Atapulgit tab 630 mg tablet/ 0 -

kapsul/kaplet

54 Atapulgit tablet 650 mg tablet/ 0 -

kapsul/kaplet
55 Atapulgit tablet 750 mg Tab 0 -

56 Atenolol tab 100 mg tablet/ 0 -

kapsul/kaplet
tablet/
57 Atenolol tab 50 mg kapsul/kaplet 0 -
58 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 -
59 Atropin tab 0,5 mg Tab 0 -
60 Bahan tumpatan sementara lar, serb Botol 0 -

61 Bedak salisil serb 2% Dus/Sachet/ 0 -

Plastik

62 Betahistin tab 6 mg tablet/ 0 -

kapsul/kaplet
63 Betametason krim 0,1% tube 5 gram 0 -
64 Betametason krim 0,5 mg/g Tube 0 -
65 Betametason salep 0,1% tube 5 gram 0 -
66 Betametason tts mata 1 mg/ml botol @5 ml 0 -

67 Betametason tts mata 1 mg/ml catchcover, 0 -

botol 0,6 mL
68 Bisakodil sup 10 mg Suppositoria 0 -
69 Bisakodil sup 5 mg Suppositoria 0 -

70 Bisakodil tab sal 5 mg tablet/ 0 -

kapsul/kaplet
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 -

72 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules 0 -

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 -

74 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules 0 -

75 Budesonid serb ih 100 mcg/dosis Botol 0 -

76 Budesonid serb ih 200 mcg/dosis 100 dosis 0 -
77 Budesonid serb ih 200 mcg/dosis 200 dosis 0 -
78 Copper T set/buah 0 -
79 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 0 -
tablet/
80 Deksametason tab 0,5 mg kapsul/kaplet 0 -

81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 -

82 Diazepam enema 5 mg/2,5 ml ( Stesolid ) tube @ 2,5 mL 0 -
83 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 0 -

84 Diazepam tab 2 mg tablet/kapsul/ 0 -

kaplet

85 Diazepam tab 5 mg tablet/kapsul/ 0 -

kaplet

86 Dietilkarbamazin tab 100 mg tablet/kapsul/ 0 -

kaplet
87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 0 -
tablet/
88 Digoksin tab 0,25 mg 0 -
kapsul/kaplet

89 Diltiazem kaps SR 100 mg tablet/ 0 -

kapsul/kaplet

90 Diltiazem kaps SR 200 mg tablet/ 0 -

kapsul/kaplet

91 Dimenhidrinat tab 50 mg tablet/ 0 -

kapsul/kaplet

92 Doksisiklin kaps 100 mg tablet/ 0 -

kapsul/kaplet
tablet/
93 Dolutegravir tab 50 mg kapsul/kaplet 0 -

94 Domperidon susp 5 mg/5 ml botol @60 ml 0 -

95 Domperidon tab 10 mg tablet/ 0 -

kapsul/kaplet
96 Efavirenz tab 200 mg Tablet 0 -

tablet salut
97 Efavirenz tab sal 600 mg selaput/kaplet 0 -
salut selaput

98 Epinefrin (adrenalin) inj 1 mg/ml Ampul 0 -

99 Ergotamin tab 1 mg Tab 0 -

100 Eritromisin kaps 250 mg tablet/ 0 -

kapsul/kaplet
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 -

102 Eritromisin tab 500 mg tablet/ 0 -

kapsul/kaplet
tablet salut
103 Estrogen terkonjugasi tab sal 0,625 mg gula/kaplet 0 -
salut gula
tablet/
104 Etambutol tab 400 mg 0 -
kapsul/kaplet
105 Etanol 70% cairan 70% Botol 0 -
106 Etil klorida semprot 100 ml Botol 0 -
107 Etonogestrel implan 68 mg Set 0 -
108 Eugenol Botol 0 -
109 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml 0 -
110 Fenitoin Na kaps 100 mg Kaps 0 -
111 Fenitoin Na kaps 30 mg Kaps 0 -
112 Fenobarbital tab 100 mg Tab 0 -

113 Fenobarbital tab 30 mg tablet/ 0 -

kapsul/kaplet

114 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 0 -

115 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 0 -

116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 0 -

117 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 -

118 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet 0 -

119 Fluoksetin kaps 10 mg tablet/ 0 -

kapsul/kaplet

120 Fluoksetin kaps 20 mg tablet/ 0 -

kapsul/kaplet
121 Fluor kapl 1 mg Kaplet 0 -
122 Fluor sediaan topikal Tube 0 -
123 Formokresol Botol 0 -
124 Framisetin Sulfat Tulle 1% Patch 0 -
125 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0 -

126 Furosemid tab 40 mg tablet/ 0 -

kapsul/kaplet
Galactose microparticle 200-400 mg
127 micropart/ml Vial 0 -

128 Garam Fe, setara dengan Fe elemental 15 mg/5 Botol 0 -

mL
129 Garam Fe, setara dengan Fe elemental 60 mg Sachet 0 -

130 Garam Fe, setara dengan Fe elemental 60 mg Botol 0 -

Garam oralit kombinasi : natrium klorida 0,52 g +

131 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + sachet 0 -
glukosa anhidrat 2,7 g
132 Gentamisin salep mata 0,3% Tube 0 -
133 Gentamisin tts mata 0,3% Botol 0 -

134 Glass ionomer ART (Atraumatic Restorative Sachet 0 -

Treatment) cocoa butter 5 g
Glass ionomer ART (Atraumatic Restorative
135 Treatment) lar Botol 0 -

136 Glass ionomer ART (Atraumatic Restorative Vial 0 -

Treatment) serb

137 Glibenklamid tab 2,5 mg tablet/ 0 -

kapsul/kaplet
tablet/
138 Glibenklamid tab 5 mg kapsul/kaplet 0 -

139 Glikuidon tab 30 mg tablet/ 0 -

kapsul/kaplet

140 Glimepirid tab 1 mg tablet/ 0 -

kapsul/kaplet
tablet/
141 Glimepirid tab 2 mg kapsul/kaplet 0 -

142 Glipizid tab 5 mg tablet/ 0 -

kapsul/kaplet

143 Gliseril trinitrat tab 0,5 mg tablet/ 0 -

kapsul/kaplet
144 Gliserin tts 100 mg/ml Botol 0 -
145 Glukosa Larutan Infus 10% steril 100 ml Botol 0 -
146 Glukosa Larutan Infus 10% steril 250 ml Botol 0 -
147 Glukosa Larutan Infus 10% steril 500 ml Botol 0 -
148 Glukosa Larutan Infus 40% Ampul @25 ml 0 -
149 Glukosa Larutan Infus 5% steril 100 ml Botol 0 -
150 Glukosa Larutan Infus 5% steril 250 ml Botol 0 -
151 Glukosa Larutan Infus 5% steril 500 ml Botol 0 -
tablet/
152 Griseofulvin (micronized) tab 125 mg kapsul/kaplet 0 -

153 Griseofulvin (micronized) tab scored 250 mg tablet/ 0 -

kapsul/kaplet
154 Gutta percha dan paper points 15 - 40 mm Roll 0 -
155 Gutta percha dan paper points 45 - 80 mm Roll 0 -
156 Haloperidol inj 5 mg/ml (i.m.) Vial 0 -
tablet/
157 Haloperidol tab 0,5 mg kapsul/kaplet 0 -

158 Haloperidol tab 1,5 mg tablet/ 0 -

kapsul/kaplet

159 Haloperidol tab 2 mg tablet/ 0 -

kapsul/kaplet
tablet/
160 Haloperidol tab 5 mg 0 -
kapsul/kaplet
161 Haloperidol tts 2 mg/ml botol 0 -
Hepatitis B imunoglobulin (human) inj 150 IU/1,5
162 ml Ampul 0 -

163 Hidrogen peroksida cairan 3% Botol 0 -

164 Hidroklorotiazid tab 25 mg tablet/ 0 -

kapsul/kaplet
165 Hidrokortison krim 2,5% tube @ 5 g 0 -
166 Hidrokortison serb inj 100 mg Vial 0 -
tablet/
167 Hiosina butilbromida tab 10 mg kapsul/kaplet 0 -

168 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul 0 -

169 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul 0 -

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 -

171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 -
tablet/
172 Ibuprofen tab 200 mg kapsul/kaplet 0 -

173 Ibuprofen tab 400 mg tablet/ 0 -

kapsul/kaplet

174 Ipratropium bromida aerosol 20 mcg/semprot Botol 0 -

175 Ipratropium bromida cairan ih 0,025% Botol 0 -

176 Isoniazid tab 100 mg Tab 0 -
177 Isoniazid tab 300 mg Tab 0 -

178 Isosorbid dinitrat tab 5 mg tablet/ 0 -

kapsul/kaplet
179 IUD Cu T 380 A Set 0 -
180 IUD Levonorgestrel Set 0 -
181 Kalamin Tube 0 -
182 Kalsium glukonat inj 100 mg/ml ampul/vial 0 -
183 Kalsium hidroksida bubuk, pasta Tube 0 -

184 Kalsium karbonat tab 500 mg tablet/ 0 -

kapsul/kaplet

185 Kalsium laktat (kalk) tab 500 mg tablet/ 0 -

kapsul/kaplet
tablet/
186 Kaptopril tab 12,5 mg kapsul/kaplet 0 -

187 Kaptopril tab 25 mg tablet/kaplet 0 -

188 Kaptopril tab 50 mg tablet/kaplet 0 -
189 Karbamazepin sir 100 mg/5 ml Botol 0 -
190 Karbamazepin Tab 200 mg Tablet 0 -
191 Karbogliserin tts telinga 10 % Botol 0 -

192 Ketokonazol tab 200 mg tablet/ 0 -

kapsul/kaplet
193 Klindamisin kaps 150 mg Kaps 0 -
194 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 -
195 Klofazimin, micronized kaps 50 mg Kapsul 0 -
196 Klofazimin, micronizedkaps 100 mg kapsul 0 -
tablet/
197 Klonidin tab 0,15 mg kapsul/kaplet 0 -

198 Kloramfenikol kaps 250 mg tablet/ 0 -

kapsul/kaplet
199 Kloramfenikol salep mata 1% tube @ 5 gram 0 -
200 Kloramfenikol serb inj 1.000 mg/ml vial/ampul 0 -
201 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0 -
202 Kloramfenikol tetes telinga 3% Botol 0 -
203 Kloramfenikol tts mata 0,5% botol 0 -
204 Kloramfenikol tts mata 1% Botol 0 -

205 Klorfeniramin tab 4 mg tablet/ 0 -

kapsul/kaplet
206 Klorfenol kamfer mentol (CHKM) Botol 0 -
207 Klorheksidin lar 0,2% Botol 0 -
208 Klorheksidin lar 15% Botol 0 -
209 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 0 -
210 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0 -
211 Klorpromazin tab sal 100 mg tablet 0 -
212 Klorpromazin tab sal 25 mg Tab sal 0 -
213 Klortalidon tab 50 mg Tab 0 -
214 Klozapin tab 100 mg tablet 0 -
215 Klozapin tab 25 mg tablet 0 -
tablet/
216 Kodein tab 10 mg kapsul/kaplet 0 -

217 Komb: Deksametason 0,1% Thymol 5% Botol 0 -

Paraklorphenol 30

218 Kombinasi (DHP) : dihidroartemisin 40 mg + tablet 0 -

Piperakuin 320 mg tab sal selaput
Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg
219 + Nevirapin 50 mg) Ped Triple FDC Tab dispersible 0 -

220 Kombinasi : artemether 20 mg + lumefantrin 120 tablet/ 0 -

mg kapsul/kaplet

221 Kombinasi : Desogestrel 150 mcg Etinilestradiol Tab 0 -

30 mcg
222 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 -

223 Kombinasi : Ferro fumarat 60 mg + asam folat tablet salut gula 0 -

0,4 mg tab salut

224 Kombinasi : levonorgestrel 150 mcg + tab salut gula 0 -

etinilestradiol 30 mcg

225 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 Tab 0 -

mg

226 Kombinasi : Tenofovir 300 mg + Lamivudin 300 Tab 0 -

mg + Efavirenz 600 mg

227 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab 0 -

228 Kombinasi: Ipratropium bromida 0,5 mg + Ampul/vial 0 -

Salbutamol 2,5 mg, cairan ih
229 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 -
Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50
230 mg, tab 250 mg Tab 0 -

231 Kombinasi: Tenofovir 300 mg + Lamivudin 300 tablet/ 0 -

mg + Dolutegravir 50 mg, tablet kapsul/kaplet

232 Komibinasi: lidokain + medisinal creosote phenol Botol 0 -

+ eugenol + benzil alkohol, cairan
233 Komposit resin Set 0 -

234 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0 -

sulfametoksazol 400 mg+ trimetoprim 80 mg

235 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0 -

sulfametoksazol 800 mg+ trimetoprim 160 mg

236 Kotrimoksazol kombinasi tiap 5 ml suspensi : botol 60 mL 0 -

sulfametoksazol 200 mg + trimetoprim 40 mg

237 Kuinin inj 25% (i.v.) Vial 0 -

tablet/
238 Kuinin tab 200 mg kapsul/kaplet 0 -

239 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 -

240 Lamivudin (3TC) tab 150 mg tablet/ 0 -

kapsul/kaplet
Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik
241 0 -
gr, KCl 0,15 gr, NaCl 4,3 gr) @500 ml

242 Larutan mengandung Elektrolit (Kalium Klorida) Botol 0 -

243 Larutan mengandung Elektrolit (KCl 0,15%, NaCL Botol 0 -

0,9%) (KN1)

244 Larutan mengandung Elektrolit (KCl 0,3%,NaCl Botol 0 -

0,9%) (KN2)
Larutan mengandung Elektrolit (Na 130 mEq, K 4
245 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Botol plastik 0 -
Ringer Asetat @500 ml

Larutan mengandung Elektrolit (Na 130 mEq, K 4 Softbag @ 500

246 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) 0 -
ml
Ringer Asetat

Larutan mengandung Elektrolit (Sodium Lactate

247 sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Botol 0 -
Calcium Chloride 0.2 gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
248 Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Botol 0 -
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)

249 Larutan mengandung Karbohidrat (Fructose 120 Botol 0 -

g, glucose 66 g, Xylitol 60 g/ L)

250 Larutan mengandung Karbohidrat (Fructose 15 softbag 0 -

mg, glucose monohydrate 30 mg, xylitol 15 mg)

251 Larutan mengandung Karbohidrat (Fructose 200 Botol 0 -

g, glucose 110 g, Xylitol 100 g/ L)

252 Larutan mengandung Karbohidrat (Fructose 60 g, Botol 0 -

glucose 33 g, Xylitol 30 g/ L)

253 Larutan mengandung Karbohidrat (Maltose 10%) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

(25.00g dextrose anhidrat, 3.00 g sodium Botol plastik
254 chloride, 0.15 g potassium chloride, 0.10 g 0 -
@500 ml
calcium chloride dihydrate dan 1.55 g sodium
lactate)

Larutan mengandung Karbohidrat + Elektrolit

255 (25.00g maltose, 3.00 g sodium chloride, 0.15 g Botol plastik 0 -
potassium chloride, 0.10 g calcium chloride @500 ml
dihydrate dan 1.55 g sodium lactate)

256 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)
 Larutan mengandung Karbohidrat + Elektrolit
257 (Dextrose 5%, NaCL 0,45%, KCl) (HSD) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

258 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + Botol 0 -
elektrolit)

Larutan mengandung Karbohidrat + Elektrolit

259 (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Botol 0 -
Laktat 3,1 g, air untuk injeksi ad 1000 ml)

Larutan mengandung Karbohidrat + Elektrolit

260 (Glukosa 55 g ; Natrium Chloride 9 g, air untuk Botol 0 -
injeksi ad 1000 ml) (D5-NS)

261 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 -

(Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS)

262 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Glukosa: 25,0 g; NaCl: 4,5 g)

263 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 100 mL

264 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 -

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 500 mL

Larutan mengandung Karbohidrat + Elektrolit

265 (Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS) Botol 0 -

Larutan mengandung Karbohidrat + Elektrolit

266 (Larutan nutrisi kombinasi infus per L: Na. Botol 0 -
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl
90mEQ, Asetat 38mEQ, Sorbitol 50g)

267 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(Larutan Ringer & Glukosa 5%)

268 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)

269 Larutan mengandung Karbohidrat + Elektrolit Botol 0 -

(NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr)

Larutan mengandung Karbohidrat + Elektrolit

270 (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Glukosa Botol 0 -
100 gr)
Larutan mengandung Karbohidrat + Elektrolit
271 (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Botol 0 -
Dekstrosa 27 gr) (KA EN 3B)
Larutan mengandung Karbohidrat + Elektrolit
272 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Botol 0 -
Dekstrosa 27 gr) (KA EN 3A)

273 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ 0 -

set

274 Lidokain gel 2% syringe/ 0 -

syringe plastik
275 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 -
276 Lidokain salep 5% Tube 0 -
277 Lidokain spray oral 10% botol 0 -

278 Linestrenol tab 0,5 mg tablet/ 0 -

kapsul/kaplet
279 Liquor carbonis detergens lar 5% Botol 0 -
280 Loperamid tab 2 mg Tab 0 -
281 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput 0 -

282 Loratadin tab 10 mg tablet/ 0 -

kapsul/kaplet

283 Lorazepam tab 0,5 mg tablet/ 0 -

kapsul/kaplet

284 Lorazepam tab 1 mg tablet/ 0 -

kapsul/kaplet
285 Lorazepam tab sal 2 mg Tab sal 0 -

286 Magnesium sulfat inj 20% ampul/vial 0 -

@25 ml
287 Magnesium sulfat inj 20% ampul/vial 0 -

288 Magnesium sulfat inj 40% ampul/vial 0 -

@25 ml
289 Magnesium sulfat inj 40% ampul/vial 0 -
290 Magnesium sulfat serb, ktg 30 g Sachet 0 -
291 Manitol lar infus 20% Botol @ 100 ml 0 -
292 Manitol lar infus 20% Botol @ 250 ml 0 -
293 Manitol lar infus 20% Botol @ 500 ml 0 -
294 Mebendazol sir 100 mg/5 ml Botol 0 -
295 Mebendazol tab 100 mg Tan 0 -

296 Mebendazol tab 500 mg tablet/ 0 -

kapsul/kaplet
297 Medroksi progesteron asetat inj 150 mg/ml ampul/vial 0 -
Metenamin mandelat (heksamin mandelat) tab
298 salut enterik 500 mg Tab salut 0 -

299 Metformin tab 500 mg tablet/ 0 -

kapsul/kaplet

300 Metformin tab 850 mg tablet/ 0 -

kapsul/kaplet
301 Metilergometrin inj 0,2 mg/ml ampul/vial 0 -
302 Metilergometrin tab salut 0,125 mg tablet 0 -
303 Metilprednisolon inj 125 mg/2 ml ampul/vial 0 -
304 Metoklopramid inj 5 mg/ml ampul/vial 0 -
tablet/
305 Metoklopramid tab 10 mg kapsul/kaplet 0 -

306 Metoklopramid tab 5 mg tablet/ 0 -

kapsul/kaplet
307 Metronidazol lar inf 5 mg/ml botol 0 -
308 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0 -
309 Metronidazol susp 125 mg/5 ml Botol @ 60 ml 0 -
tablet/
310 Metronidazol tab 250 mg kapsul/kaplet 0 -

311 Metronidazol tab 500 mg tablet/ 0 -

kapsul/kaplet
312 Mikonazol krim 2% tube 0 -
313 Mikonazol serb 2% botol / sachet 0 -

Mineral Mix (Bismuth Subcitrate Tripotasium,

314 Copper sulfate, Magnesium Chloride Anhydrous, Sachet 0 -
Potassium Chloride, Zinc Acetate)

315 N-asetil sistein kaps 200 mg tablet/kapsul/ 0 -

kaplet
316 NaCl 0,9% Larutan Botol @250 ml 0 -

317 NaCl 0,9% Larutan Ampul/botol 0 -

@ 10 mL
318 NaCl 0,9% Larutan Botol @25 ml 0 -
319 NaCl 0,9% Larutan Botol @500 ml 0 -
320 NaCl 0,9% Larutan Botol @100 ml 0 -

321 NaCl 0,9% Larutan Botol @1.000 0 -

mL
Botol plastik
322 NaCl 3% Larutan @500 ml 0 -

323 Natrium diklofenak tab 25 mg tablet 0 -

324 Natrium diklofenak tab 50 mg tablet 0 -
325 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 -
326 Natrium hipoklorit cairan konsentrat 5% Botol 0 -
327 Natrium tiosulfat inj 25% (i.v.) Ampul 0 -

328 Nevirapin tab 200 mg tablet/ 0 -

kapsul/kaplet
tablet/
329 Nifedipin kaps 10 mg kapsul/kaplet 0 -

330 Nistatin susp 100.000 UI/ml botol/vial 0 -

331 Nistatin tab salut 500.000 UI tablet 0 -
332 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 -
333 Norepinefrin inj 1 mg/ml ampul/vial 0 -
334 Obat Anti Tuberculosis FDC Kategori Anak paket 0 -
335 Obat Anti Tuberculosis FDC Kategori I paket 0 -
336 Obat Anti Tuberculosis FDC Kategori II paket 0 -
337 Obat Anti Tuberculosis FDC Kategori Sisipan paket 0 -
338 Obat Anti Tuberculosis Kombipak Anak Paket 0 -
339 Obat Anti Tuberculosis Kombipak Dewasa paket 0 -
340 Oksigen ih, gas dlm tabung Botol 0 -
341 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0 -
342 Oksimetazolin tts hidung 0,050% botol @ 10 mL 0 -
343 Oksitetrasiklin 1% Salep Mata tube 0 -
344 Oksitosin inj 10 UI/ml ampul/vial 0 -
345 Olopatadin tts mata 0,1% Botol 0 -
346 Omeprazol inj 40 mg/10 ml ampul/vial 0 -

347 Omeprazol kaps 20 mg tablet/ 0 -

kapsul/kaplet
348 Paraformaldehid tab 1 g Tab 0 -
349 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 -

350 Parasetamol tab 500 mg tablet/ 0 -

kapsul/kaplet
351 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 -
352 Pasta devitalisasi (non arsen) Tube 0 -
353 Pasta pengisi saluran akar (pasta) Tube 0 -
354 Perak nitrat lar 20% Botol 0 -
355 Perak sulfadiazin krim 1% Tube 0 -
356 Permetrin krim 5 % Tube 10 g 0 -
357 Permetrin krim 5 % Tube 30 g 0 -
358 Permetrin krim 5 % Tube 15 g 0 -
359 Pirantel pamoat susp 125 mg/5 ml Botol 0 -
360 Pirantel pamoat tab 500 mg Tab 0 -

361 Pirantel pamoat tab scored 125 mg tablet/ 0 -

kapsul/kaplet
362 Pirantel pamoat tab scored 250 mg Tab 0 -
363 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 -
364 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 0 -

365 Piridoksin (vitamin B6) tab 25 mg tablet/ 0 -

kapsul/kaplet
366 Povidon iodin lar 100 mg/ml Botol 300 ml 0 -
367 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 -
368 Povidon iodin lar 100 mg/ml botol 30 mL 0 -
369 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 -
370 Povidon iodin lar obat kumur 1% Botol 0 -
371 Povidon iodin tts mata 2,5% botol/strip 0 -

372 Prednison tab 5 mg tablet/ 0 -

kapsul/kaplet
373 Primakuin tab 15 mg Tab 0 -

374 Probenesid tab 500 mg tablet/ 0 -

kapsul/kaplet
Prokain benzilpenisilin serb inj 3 juta UI/vial
375 (i.m.) ampul/vial 0 -

376 Propiltiourasil tab 100 mg tablet/ 0 -

kapsul/kaplet

377 Propranolol tab 10 mg tablet/ 0 -

kapsul/kaplet
tablet/
378 Ranitidin tab 150 mg kapsul/kaplet 0 -

379 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak 0 -

380 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak 0 -

381 Rifampisin kaps 300 mg tablet/ 0 -

kapsul/kaplet

382 Rifapentin tablet 150 mg tablet/ 0 -

kapsul/kaplet
383 Ringer Laktat Larutan Botol 0 -

384 Risperidon tab sal 1 mg tablet/ 0 -

kapsul/kaplet

385 Risperidon tab sal 2 mg tablet/ 0 -

kapsul/kaplet

386 Salbutamol cairan ih 1 mg/mL ampul/vial/ 0 -

botol
387 Salbutamol sir 2 mg/5 ml Botol 0 -
tablet/
388 Salbutamol tab 2 mg kapsul/kaplet 0 -

389 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 15 gram 0 -

belerang endap 4 %

390 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram 0 -

belerang endap 4 %
tablet/
391 Sefadroksil kaps 250 mg kapsul/kaplet 0 -

392 Sefadroksil kaps/tab 500 mg tablet/ 0 -

kapsul/kaplet
393 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL 0 -
394 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL 0 -

395 Serum anti bisa ular : A.B.U. I (khusus ular dari Vial 0 -
luar Papua) inj (i.m./i.v.)
Serum anti bisa ular :A.B.U.II (khusus ular dari
396 Papua) inj (i.m./i.v.) Vial 0 -
397 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial 0 -
10.000 UI/
398 Serum antirabies inj 100 UI/ml Vial 0 -
399 Serum antirabies inj 200 UI/ml Vial 0 -

400 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial Vial 0 -

(i.m /i.v.)

401 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 0 -

402 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial 0 -

(i.m /i.v.)

403 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial 0 -

404 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 -

405 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial 0 -

tablet/
406 Sianokobalamin (vitamin B12) tab 50 mcg kapsul/kaplet 0 -

407 Simvastatin tab sal 10 mg tablet 0 -

408 Simvastatin tab sal 20 mg tablet 0 -
409 Simvastatin tab sal selaput 40 mg Tab sal 0 -
410 Siprofloksasin tab scored 500 mg tablet 0 -

411 Spironolakton tab 25 mg tablet/ 0 -

kapsul/kaplet

412 Stannous pyrophosphate 27,6 mg sodium Vial 0 -

pyrophosphate/vial
413 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 -
414 Surgical ginggival pack Tube 0 -
415 Tenofovir tab 300 mg tablet 0 -
416 Terbutalin cairan ih 2,5 mg/ml Botol 0 -
417 Terbutalin inj 0,5 mg/ml ampul/vial 0 -
418 Tetanus toxoid inj Ampul 0 -
419 Tetrakain tts mata 0,5% Botol 0 -

420 Tetrasiklin kaps 250 mg tablet/ 0 -

kapsul/kaplet

421 Tetrasiklin kaps 500 mg tablet/ 0 -

kapsul/kaplet
422 Tetrasiklin Salep Mata 1% Tube 0 -

423 Tiamin (vitamin B1) tab 50 mg tablet/ 0 -

kapsul/kaplet
424 Timolol tts mata 0,25% botol @ 5 mL 0 -
425 Timolol tts mata 0,5% botol @ 5 mL 0 -
426 Tropikamid tts mata 1% Botol @ 5 ml 0 -
427 Tropikamid tts mata 1% Botol @ 0,6 ml 0 -
428 Urea krim 10 % Tube/pot 0 -
429 Urea krim 20 % Tube/pot 0 -
430 Vaksin BCG inj (i.k) Vial 0 -
431 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0 -

432 Vaksin Hepatitis Rekombinan Inj Prefilled Vial 0 -

Injection Device (Uniject) 0,5 ml (i.m)

433 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial 0 -

434 Vaksin Influenza Vial 0 -

435 Vaksin Japanese Enchepalitis (J.E) Vial 0 -
436 Vaksin jerap difteri tetanus (DT) Vial 0 -
437 Vaksin jerap difteri tetanus (Td) Vial 0 -
438 Vaksin kombinasi DPT-HB-Hib Vial 0 -

439 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial 0 -

440 Vaksin Meningitis Meningokokus Vial 0 -

441 Vaksin polio IPV inj 0,5 ml Vial 0 -

442 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial 0 -

booster
443 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 -
444 Vaksin Yellow Fever Vial 0 -
445 Valproat sir 250 mg/5 ml botol @ 120 ml 0 -
446 Valproat tab lepas lambat 250 mg tabet 0 -
447 Valproat tab lepas lambat 500 mg tabet 0 -
448 Valproat tab sal enterik 250 mg tablet 0 -
449 Vitamin B kompleks tablet 0 -

450 Vitamin C 500 mg minimal non acidic 250 mg Tablet 0 -

451 Zidovudin kaps 100 mg tablet/ 0 -

kapsul/kaplet
452 Zinc drops 10 mg/ml Botol 0 -
453 Zinc sir 20 mg/5 ml botol 0 -
454 Zinc tab disp 20 mg tablet dispersible 0 -
455 Clobazam tab 10 mg tab 0 -
456 Kloramfenikol salep kulit 2% Tube 0 -
457 Triheksifenidil tab 2 mg Tab 0 -
458 Pehacain Injeksi 0 -
459 MB Dewasa Blister 0 -
460 Cetirizin tab 10 mg Tab 0 -
461 MB Anak Blister 0 -
462 PB Anak Blister 0 -
463 PB Dewasa Blister 0 -
464 Tuber Kulin PPD R T Vial 0 -
465 Benzatin Penisillin 2,4 juta IU Vial 0 -

466 Retinol 200,000Iu ( Vit A Merah) Program Tab 0 -

Stunting
467 Flufenazine Dekanoat Injeksi Ampul 0 -
468 Pyridoksin ( B6 ) 100 mg tab Tab 0 -
469 Cyloserine 250 mg Tab 0 -
470 Levofloxacin 250 mg tab Tab 0 -
471 Kanamycin 1 gr Vial 0 -
472 Ethambutol 400 mg tab Tab 0 -
473 Ethionamide 250 mg tab Tab 0 -
474 Moxifloxacin Tab 0 -
475 Bedaquiline Tab 0 -
476 Linezolid Tab 0 -
477 Clofazimine Tab 0 -
478 Trifluoperazine Hcl 5 mg Tab 0 -
479 Halloperidol decanoad inj 50 mg Ampul 0 -
480 Azitromicin 500 mg Talet 0 -
481 Kloroquin 150 mg Talet 0 -
482 Becefort Tab Tab 0 -
483 OAT KDT Dosis harian Paket 0 -
484 Favipiravir 200 mg Tab 0 -
485 Alat Suntik Sekali Pakai 1 ml pcs 60 300 232 128 658 84,160
486 Alat Suntik Sekali Pakai 3 ml 429 800 797 432 1,000 432,000
487 Alat Suntik Sekali Pakai 5 ml pcs 196 300 324 172 1,034 177,848
488 Alat Suntik Sekali Pakai 10 ml pcs 100 100 33 167 1,008 168,253
489 Alkohol Swab tablet 688 3300 2,682 1306 132 172,392

490 Catgut / Benang Bedah No. 3/0 dengan jarum pcs 0 5,575 -
bedah chromix
Catgut / Benang Bedah No. 3/0 dengan jarum
491 bedah plain pcs 48 14 34 5,575 189,550

492 Infusion Set Anak pcs 79 4 75 4,000 300,000

493 Infusion Set Dewasa pcs 121 100 190 31 8,066 250,046
494 IV Catheter No. 18 G pcs 0 -
495 IV Catheter No. 20 G pcs 60 50 40 70 15,140 1,059,800
496 IV Catheter No. 22 G pcs 60 100 160 -
497 IV Catheter No. 24 G pcs 99 100 102 97 15,140 1,468,580
498 Kapas Pembalut / Absorben 250 gram rol 3 8 6 5 18,539 92,695
499 Kasa Pembalut 40 m x 80 cm rol 2 15 13 4 153,000 612,000
500 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic pcs 146 50 103 93 2,415 224,595
501 Masker pcs 0 -
502 Plester 5 yards x 2 inch rol 0 -
503 Urine bag Ampul 3 10 0 13 3,000 39,000
504 Sarung tangan Steril 7 pcs 1200 1,200 8,705 -
505 Sarung tangan 7 tablet 0 -
506 Folley Catheter No. 18 vial 0 -
507 Blood Slide vial 72 216 216 72 312 22,464
Silk (Benang Bedah Sutera) No 3/0 dengan
508 jarum bedah Ampul 0 -

509 Pembalut Gips tablet 0 -

510 Sputum Pot kotak 1200 934 266 2,650 704,900
511 Reagen Nelson botol 7 15 22 187,333 -
512 Etakridin ( Rivanol ) larutan 0,1% - 300 ml botol 0 -
513 my jelly pcs 0 -
514 plester Cannofix pcs 152 200 133 219 6,882 1,507,158
515 Bisturi no 22 pcs 0 -
516 Planotest 0 -
517 sarung tangan L pcs 0 1,127 -
518 sarung tangan M pcs 660 2300 2,460 500 1,127 563,700
519 Blood Lancets Pcs 0 -
520 Aseptic Gel 500 cc + Dispenser Botol 0 74,000 -
521 Sarung Tangan Obgyn Pcs 0 -
522 Masker N95 Pcs 0 -
523 Safety Box 2,5 liter Pcs 0 -
524 Umbrical Cord Klem Pcs 0 4,521 -
525 sarung tangan s pcs 0 -
526 Nasal Oxigen 0,2 cannula Ukrn M pcs 30 3 27 7,098 191,646
527 Nasal Oxigen 0,2 cannula Ukrn S pcs 10 10 7,098 -
528 Nasal Oxigen 0,2 cannula Ukrn L Pcs 80 20 60 40 7,098 283,920
529 Box Slide Pcs 0 -
530 Sarung Tangan Steril 7,5 pcs 100 300 200 200 9,900 1,980,000
531 Plester Farmafix 5x 500 cm Roll 40 32 8 32,190 257,520
532 Cartridge Genexpert Buah 0 252,400 -
533 Virocheck Hbs Ag Strep 191 600 558 233 7,219 1,682,027
534 Masker N95 Covid-19 Pcs 160 0 160 27,375 4,380,000
535 Baju APD Pcs 69 50 40 79 175,000 13,825,000
536 Kacamata APD Pcs 1 1 -
537 Septalkan Btl 0 -
538 Helm APD Pcs 0 -
539 VTM torax Pcs 0 -
540 Fokus Syphilis PCS 0 -
541 Fokus New HIV 1/2 3 line DAK Program PCS 0 -
542 Kasa hidofil 16 cm x16 cm Roll 0 -
543 Rapit Test Antigen 0 -
544 Kasa Hidrofil 80x80 Roll 0 -
545 Kasa Hidrofil 3x15 Roll 0 -
546 Masker TB Pcs 950 768 182 706 128,492
547 Sarung tangan 7,5 Pcs 0 -
548 SD HIV 1/2 Rapid 1 Pcs 0 -
549 SD HIV 1/2 Rapid 2 Pcs 0 11,500 -
550 SD HIV 1/2 Rapid 3 Pcs 25 0 25 11,440 286,000
551 RDT DBD Combo Pcs 0 -
552 Telura/ATR IV/A Tab 0 -
553 RDT Anti HCV Pcs 0 -
554 Pyrazinamid 500 mg tab 0 -
555 Vaccine Carier/Pendingin Box 0 -
556 OBH AFI 100 ml Botol 100 ml 0 -
557 Alive Biocom-C 50 tab 0 -
558 Acrip tega botol 30 tab 0 -
559 Duviral botol 60 tab 0 -
560 Neviral botol 60 tab 0 -
561 Alprazolam 0,5 mg Tab 0 -
562 Alkohol swab P2P Pcs 5000 4,560 440 132 58,080
563 Blood Lancets P2p Pcs 7000 1,094 5906 154 909,524
564 Stik gula Benechek P2p Botol 141 12 129 3,200 412,800
565 Vaksin BCG ( Rutin ) Vial 0 -
566 Pelarut BCG ( Rutin ) Fls 0 -
567 Vaksin Td ( Rutin ) Vial 0 -
568 Vaksin Dt ( Rutin ) Vial 0 -
569 Vaksin MR (CAMPAK) ( Rutin ) Vial 0 -
570 Pelarut MR campak ( Rutin ) Fls 0 -
571 Vaksin Hepatitis B ( Rutin ) Vial 0 -
572 Vaksin IPV ( Rutin ) Vial 0 -
573 Vaksin DPT ( Rutin ) Vial 0 -
574 Vaksin Polio (BOPV) ( Rutin ) Vial 0 -
575 Spuit 5 ml ( Rutin ) Pcs 0 -
576 Spuit 0,5 Ml ( rutin ) Pcs 0 -
577 Spuit 0,05 ml ( Rutin ) Pcs 0 -
578 Droper ( Rutin ) Pcs 0 -
579 Safety Box ( Rutin ) Pcs 0 -
580 Pfizer ( covid ) Vial 0 -
581 Pelarut 0,9 % nacl ( covid ) Vial 0 -
582 Alkohol Swab ( covid ) Pcs 0 -
583 Spuit 3 Ml ( covid ) Pcs 0 -
584 Spuit 0,3 Ml ( covid ) Pcs 0 -
585 Spuit 0,5 Ml ( covid ) Pcs 0 -
586 Safety Box ( covid ) Pcs 0 -
587 Masker N 95 TB Pcs 120 63 57 20,000 1,140,000
588 Hand Sanitizer covid 19 botol 0 -
589 Cavit D3 tab 0 -
590 Imunvit tab 0 -
591 Vaksin PCV ( Rutin ) Vial 0 -
592 Sarung tangan / Shamrock Supreme M P2P Pcs 2500 1,600 900 1,104 993,600
593 Sarung tangan / Shamrock Supreme L P2P Pcs 1400 600 800 1,126 900,800
594 Calnic Plus 100 ml Botol 0 -
595 Busmin Syr Botol 0 -
596 Hand Sanitizer 500 ml p2p Botol 0 -
597 Masker Earlop Baymed BPJS pcs 0 812 -
598 Gown G5001-SF-N P2P Pcs 0 -
599 Ketoralak inj Ampul 0 -
600 Fluconazole 150 mg Cap 0 -
601 Vaksin polio OPV 2 vial 0 -
602 Dropper Vaksin Polio OPV 2 pcs 0 -
603 Masker Earlop / Steril MaskP2P Bok 0 42,500 -
604 Procurma Syr 60 ml Botol 0 -
605 Dextrofen syr Botol 0 -
606 Masker program malaria Pcs 0 -
607 Lamprene Kapsul 0 -
608 Sarung tangan Program malaria pcs 0 -
609 CDR Btl 0 -
610 Pen Marker Pcs 0 -
611 Pengukur suhu P2P / Fridge-tag 2 Unit 0 -

612 Isoniazid (H) 300 mg/ Rifapentine (P) 300 mg (HP) Tablet 0 -

613 Rapid test HIV 1/2 & Shypylis Combo Test 350 150 200 17,497 3,499,400
614 HBIg Pcs 0 -
615 Masker N95 Aero Pro Pcs 0 -
616 Asta Plus Tab 0 -
617 Vaksin Inovac Vial 0 -

38,997,950

Bireuen, 12 Juli 2023

Bendahara Barang Penanggung Jawab Apotik

Triana Fitri, SKM Zulaida, A.Md.Farm

NIP. 19770917 200701 2 002 NIP. 19821010 201408 2 003

Mengetahui,
Kepala Puskesmas Jeumpa

dr. Asmaul Husna

NIP. 19800708 201001 2 001
 Lampiran BA Pemeriksaan Fisik Persediaan Vaksin Per 30 Juni 2023
PUSKESMAS JEUMPA
DINAS KESEHATAN KABUPATEN BIREUEN

Stok Awal (1
Penerimaan/ Pengeluaran/ Sisa Barang Per 30
No. Nama Barang Satuan Januari Penambahan Pemakaian Juni 2023 Harga Nilai (Rp)
2023)

1 Air untuk injeksi ampul/vial/

botol 10 mL
2 Air untuk injeksi Botol 100 ml
3 Air untuk injeksi Botol 250 ml

4 Air untuk injeksi amp 20 ml ampul/vial/

botol
ampul/vial/
5 Air untuk injeksi amp 25 ml botol 25 mL
6 Albendazol susp 200 mg/5 ml Botol

7 Albendazol tab 400 mg tablet/kapsul/

kaplet
8 Alopurinol tab 100 mg Tab

9 Alopurinol tab 300 mg tablet/kapsul/

kaplet
ampul/vial 10
10 Aminofilin inj 24 mg/ml ml

11 Aminofilin tab 150 mg tablet/kapsul/

kaplet

12 Aminofilin Tab 200 mg tablet/kapsul/

kaplet

13 Amitriptilin tab sal 25 mg tablet/kapsul/

kaplet

14 Amlodipin tab 10 mg tablet/kapsul/

kaplet

15 Amlodipin tab 5 mg tablet/kapsul/

kaplet
16 Amoksisilin drops 100 mg/ml Botol @15 ml
17 Amoksisilin drops 100 mg/ml Botol @20 ml
18 Amoksisilin drops 100 mg/ml Botol @10 ml
19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml
20 Amoksisilin sir kering 125 mg/5 ml Botol

21 Amoksisilin tab 250 mg tablet/kapsul/

kaplet

22 Amoksisilin tab 500 mg tablet/kapsul/

kaplet
23 Ampisilin serb inj 1000 mg/vial ampul/vial
24 Ampisilin serb inj 250 mg/vial Vial
Anestetik lokal gigi kombinasi : lidokain hcl 2% +
25 epinefrin 1 : 80.000 inj 2 ml ampul/vial

Antasida, kombinasi : aluminium hidroksida 200

26 mg + magnesium hidroksida 200 mg tablet/kapsul/
kaplet

Antasida, kombinasi : aluminium hidroksida 200

27 mg + magnesium hidroksida 200 mg botol 60 ml

28 Anti Parkinson kombinasi : benzerasid 25 mg + Kaps

levodopa 100 mg
Antifungi salep, kombinasi : asam benzoat 6%+
29 asam salisilat 3% pot 30 g

Antihemoroid, kombinasi: bismut subgalat 150

30 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 Suppositoria
mg+ seng oksida 120 mg + sup ad 2 g

31 Aquadest cairan 500 ml Botol 500 ml

32 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial

Kertas warna
33 Articulating paper kertas warna penanda oklusi
penanda oklusi

34 Asam asetat tetes telinga 2% Botol

tablet/
35 Asam asetilsalisilat (asetosal) tab 80 mg kapsul/kaplet
36 Asam askorbat (vitamin C) tab 250 mg Tab

37 Asam askorbat (vitamin C) tab 50 mg tablet/

kapsul/kaplet
tablet/
38 Asam folat tab 0,4 mg kapsul/kaplet
tablet/
39 Asam folat tab 1 mg kapsul/kaplet
40 Asam folat tab 5 mg Tab
tablet/
41 Asam mefenamat kaps 250 mg kapsul/kaplet
tablet/
42 Asam mefenamat kaps 500 mg kapsul/
kaplet/kaptab
43 Asam retinoat krim 0,05% Tube/pot
44 Asam retinoat krim 0,1% Tube @ 10 gram
45 Asam retinoat krim 0,1% Tube @ 20 gram
46 Asam salisilat lar 0,1% Botol
47 Asam salisilat salep 10% Tube
48 Asam salisilat salep 2% Tube
49 Asam salisilat salep 5% Tube
tablet/
50 Asiklovir tab 200 mg kapsul/kaplet

51 Asiklovir tab 400 mg tablet/

kapsul/kaplet
tablet/
52 Atapulgit 600 mg kapsul/kaplet
tablet/
53 Atapulgit tab 630 mg kapsul/kaplet
tablet/
54 Atapulgit tablet 650 mg kapsul/kaplet
55 Atapulgit tablet 750 mg Tab
tablet/
56 Atenolol tab 100 mg kapsul/kaplet
tablet/
57 Atenolol tab 50 mg kapsul/kaplet
58 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
59 Atropin tab 0,5 mg Tab
60 Bahan tumpatan sementara lar, serb Botol
61 Bedak salisil serb 2% Dus/Sachet/
Plastik
tablet/
62 Betahistin tab 6 mg kapsul/kaplet
63 Betametason krim 0,1% tube 5 gram
64 Betametason krim 0,5 mg/g Tube
65 Betametason salep 0,1% tube 5 gram
66 Betametason tts mata 1 mg/ml botol @5 ml
catchcover,
67 Betametason tts mata 1 mg/ml botol 0,6 mL
68 Bisakodil sup 10 mg Suppositoria
69 Bisakodil sup 5 mg Suppositoria

70 Bisakodil tab sal 5 mg tablet/

kapsul/kaplet
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml

72 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml

74 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules

75 Budesonid serb ih 100 mcg/dosis Botol

76 Budesonid serb ih 200 mcg/dosis 100 dosis
77 Budesonid serb ih 200 mcg/dosis 200 dosis
78 Copper T set/buah
79 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial

80 Deksametason tab 0,5 mg tablet/

kapsul/kaplet
81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
82 Diazepam enema 5 mg/2,5 ml ( Stesolid ) tube @ 2,5 mL
83 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial

84 Diazepam tab 2 mg tablet/kapsul/

kaplet

85 Diazepam tab 5 mg tablet/kapsul/

kaplet

86 Dietilkarbamazin tab 100 mg tablet/kapsul/

kaplet
87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
tablet/
88 Digoksin tab 0,25 mg kapsul/kaplet
tablet/
89 Diltiazem kaps SR 100 mg kapsul/kaplet
tablet/
90 Diltiazem kaps SR 200 mg kapsul/kaplet

91 Dimenhidrinat tab 50 mg tablet/

kapsul/kaplet
tablet/
92 Doksisiklin kaps 100 mg kapsul/kaplet
tablet/
93 Dolutegravir tab 50 mg kapsul/kaplet
94 Domperidon susp 5 mg/5 ml botol @60 ml
tablet/
95 Domperidon tab 10 mg kapsul/kaplet
96 Efavirenz tab 200 mg Tablet

tablet salut
97 Efavirenz tab sal 600 mg selaput/kaplet
salut selaput

98 Epinefrin (adrenalin) inj 1 mg/ml Ampul

99 Ergotamin tab 1 mg Tab
tablet/
100 Eritromisin kaps 250 mg kapsul/kaplet
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml
tablet/
102 Eritromisin tab 500 mg kapsul/kaplet
tablet salut
103 Estrogen terkonjugasi tab sal 0,625 mg gula/kaplet
salut gula
tablet/
104 Etambutol tab 400 mg kapsul/kaplet
105 Etanol 70% cairan 70% Botol
106 Etil klorida semprot 100 ml Botol
107 Etonogestrel implan 68 mg Set
108 Eugenol Botol
109 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml
110 Fenitoin Na kaps 100 mg Kaps
111 Fenitoin Na kaps 30 mg Kaps
112 Fenobarbital tab 100 mg Tab
tablet/
113 Fenobarbital tab 30 mg kapsul/kaplet

114 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab

115 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab

116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial

117 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal

118 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet

tablet/
119 Fluoksetin kaps 10 mg kapsul/kaplet
tablet/
120 Fluoksetin kaps 20 mg kapsul/kaplet
121 Fluor kapl 1 mg Kaplet
122 Fluor sediaan topikal Tube
123 Formokresol Botol
124 Framisetin Sulfat Tulle 1% Patch
125 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial

126 Furosemid tab 40 mg tablet/

kapsul/kaplet
Galactose microparticle 200-400 mg
127 micropart/ml Vial

Garam Fe, setara dengan Fe elemental 15 mg/5

128 mL Botol

129 Garam Fe, setara dengan Fe elemental 60 mg Sachet

130 Garam Fe, setara dengan Fe elemental 60 mg Botol

Garam oralit kombinasi : natrium klorida 0,52 g +

131 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + sachet
glukosa anhidrat 2,7 g
132 Gentamisin salep mata 0,3% Tube
133 Gentamisin tts mata 0,3% Botol
Glass ionomer ART (Atraumatic Restorative
134 Treatment) cocoa butter 5 g Sachet

Glass ionomer ART (Atraumatic Restorative

135 Treatment) lar Botol

Glass ionomer ART (Atraumatic Restorative

136 Treatment) serb Vial
137 Glibenklamid tab 2,5 mg tablet/
kapsul/kaplet
138 Glibenklamid tab 5 mg tablet/
kapsul/kaplet
tablet/
139 Glikuidon tab 30 mg kapsul/kaplet
tablet/
140 Glimepirid tab 1 mg kapsul/kaplet
tablet/
141 Glimepirid tab 2 mg kapsul/kaplet

142 Glipizid tab 5 mg tablet/

kapsul/kaplet
tablet/
143 Gliseril trinitrat tab 0,5 mg kapsul/kaplet
144 Gliserin tts 100 mg/ml Botol
145 Glukosa Larutan Infus 10% steril 100 ml Botol
146 Glukosa Larutan Infus 10% steril 250 ml Botol
147 Glukosa Larutan Infus 10% steril 500 ml Botol
148 Glukosa Larutan Infus 40% Ampul @25 ml
149 Glukosa Larutan Infus 5% steril 100 ml Botol
150 Glukosa Larutan Infus 5% steril 250 ml Botol
151 Glukosa Larutan Infus 5% steril 500 ml Botol
tablet/
152 Griseofulvin (micronized) tab 125 mg kapsul/kaplet
tablet/
153 Griseofulvin (micronized) tab scored 250 mg kapsul/kaplet
154 Gutta percha dan paper points 15 - 40 mm Roll
155 Gutta percha dan paper points 45 - 80 mm Roll
156 Haloperidol inj 5 mg/ml (i.m.) Vial
tablet/
157 Haloperidol tab 0,5 mg kapsul/kaplet
tablet/
158 Haloperidol tab 1,5 mg kapsul/kaplet
tablet/
159 Haloperidol tab 2 mg kapsul/kaplet

160 Haloperidol tab 5 mg tablet/

kapsul/kaplet
161 Haloperidol tts 2 mg/ml botol
Hepatitis B imunoglobulin (human) inj 150 IU/1,5
162 ml Ampul

163 Hidrogen peroksida cairan 3% Botol

tablet/
164 Hidroklorotiazid tab 25 mg kapsul/kaplet
165 Hidrokortison krim 2,5% tube @ 5 g
166 Hidrokortison serb inj 100 mg Vial
tablet/
167 Hiosina butilbromida tab 10 mg kapsul/kaplet

168 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul

169 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml

171 Ibuprofen sir 200 mg/5 ml botol @ 60 ml
tablet/
172 Ibuprofen tab 200 mg kapsul/kaplet
tablet/
173 Ibuprofen tab 400 mg kapsul/kaplet

174 Ipratropium bromida aerosol 20 mcg/semprot Botol

175 Ipratropium bromida cairan ih 0,025% Botol

176 Isoniazid tab 100 mg Tab
177 Isoniazid tab 300 mg Tab
tablet/
178 Isosorbid dinitrat tab 5 mg kapsul/kaplet
179 IUD Cu T 380 A Set
180 IUD Levonorgestrel Set
181 Kalamin Tube
182 Kalsium glukonat inj 100 mg/ml ampul/vial
183 Kalsium hidroksida bubuk, pasta Tube

184 Kalsium karbonat tab 500 mg tablet/

kapsul/kaplet
tablet/
185 Kalsium laktat (kalk) tab 500 mg kapsul/kaplet
tablet/
186 Kaptopril tab 12,5 mg kapsul/kaplet
187 Kaptopril tab 25 mg tablet/kaplet
188 Kaptopril tab 50 mg tablet/kaplet
189 Karbamazepin sir 100 mg/5 ml Botol
190 Karbamazepin Tab 200 mg Tablet
191 Karbogliserin tts telinga 10 % Botol
tablet/
192 Ketokonazol tab 200 mg kapsul/kaplet
193 Klindamisin kaps 150 mg Kaps
194 Klindamisin kaps 300 mg tablet/kapsul/kaplet
195 Klofazimin, micronized kaps 50 mg Kapsul
196 Klofazimin, micronizedkaps 100 mg kapsul
tablet/
197 Klonidin tab 0,15 mg kapsul/kaplet
tablet/
198 Kloramfenikol kaps 250 mg kapsul/kaplet
199 Kloramfenikol salep mata 1% tube @ 5 gram
200 Kloramfenikol serb inj 1.000 mg/ml vial/ampul
201 Kloramfenikol susp 125 mg/5 ml botol 60 ml
202 Kloramfenikol tetes telinga 3% Botol
203 Kloramfenikol tts mata 0,5% botol
204 Kloramfenikol tts mata 1% Botol
tablet/
205 Klorfeniramin tab 4 mg kapsul/kaplet
206 Klorfenol kamfer mentol (CHKM) Botol
207 Klorheksidin lar 0,2% Botol
208 Klorheksidin lar 15% Botol
209 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
210 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
211 Klorpromazin tab sal 100 mg tablet
212 Klorpromazin tab sal 25 mg Tab sal
213 Klortalidon tab 50 mg Tab
214 Klozapin tab 100 mg tablet
215 Klozapin tab 25 mg tablet
tablet/
216 Kodein tab 10 mg kapsul/kaplet

217 Komb: Deksametason 0,1% Thymol 5% Botol

Paraklorphenol 30
Kombinasi (DHP) : dihidroartemisin 40 mg +
218 Piperakuin 320 mg tab sal selaput tablet

Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg

219 + Nevirapin 50 mg) Ped Triple FDC Tab dispersible
220 Kombinasi : artemether 20 mg + lumefantrin 120 tablet/
mg kapsul/kaplet
Kombinasi : Desogestrel 150 mcg Etinilestradiol
221 30 mcg Tab
222 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet
Kombinasi : Ferro fumarat 60 mg + asam folat
223 0,4 mg tab salut tablet salut gula

Kombinasi : levonorgestrel 150 mcg +

224 etinilestradiol 30 mcg tab salut gula

225 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 Tab

mg
Kombinasi : Tenofovir 300 mg + Lamivudin 300
226 mg + Efavirenz 600 mg Tab

Kombinasi : zidovudin 300 mg +lamivudin 150

227 mg Tab

Kombinasi: Ipratropium bromida 0,5 mg +

228 Salbutamol 2,5 mg, cairan ih Ampul/vial

229 Kombinasi: kaolin 550 mg + pektin 20 mg Tab

Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50
230 mg, tab 250 mg Tab

Kombinasi: Tenofovir 300 mg + Lamivudin 300 tablet/

231 mg + Dolutegravir 50 mg, tablet kapsul/kaplet

232 Komibinasi: lidokain + medisinal creosote phenol Botol

+ eugenol + benzil alkohol, cairan
233 Komposit resin Set

234 Kotrimoksazol (dewasa) kombinasi : tab/kaptab

sulfametoksazol 400 mg+ trimetoprim 80 mg

235 Kotrimoksazol (dewasa) kombinasi : tab/kaptab

sulfametoksazol 800 mg+ trimetoprim 160 mg

236 Kotrimoksazol kombinasi tiap 5 ml suspensi : botol 60 mL

sulfametoksazol 200 mg + trimetoprim 40 mg

237 Kuinin inj 25% (i.v.) Vial

238 Kuinin tab 200 mg tablet/

kapsul/kaplet
239 Laktulosa sir 3,335 g/5 ml botol @ 60 mL
tablet/
240 Lamivudin (3TC) tab 150 mg kapsul/kaplet

241 Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik

gr, KCl 0,15 gr, NaCl 4,3 gr) @500 ml

242 Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (KCl 0,15%, NaCL

243 0,9%) (KN1) Botol

Larutan mengandung Elektrolit (KCl 0,3%,NaCl

244 0,9%) (KN2) Botol

Larutan mengandung Elektrolit (Na 130 mEq, K 4 Botol plastik

245 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) @500 ml
Ringer Asetat
Larutan mengandung Elektrolit (Na 130 mEq, K 4 Softbag @ 500
246 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) ml
Ringer Asetat

Larutan mengandung Elektrolit (Sodium Lactate

247 sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Botol
Calcium Chloride 0.2 gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
248 Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Botol
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)

Larutan mengandung Karbohidrat (Fructose 120

249 g, glucose 66 g, Xylitol 60 g/ L) Botol

Larutan mengandung Karbohidrat (Fructose 15

250 mg, glucose monohydrate 30 mg, xylitol 15 mg) softbag

Larutan mengandung Karbohidrat (Fructose 200

251 g, glucose 110 g, Xylitol 100 g/ L) Botol

252 Larutan mengandung Karbohidrat (Fructose 60 g, Botol

glucose 33 g, Xylitol 30 g/ L)

253 Larutan mengandung Karbohidrat (Maltose 10%) Botol

Larutan mengandung Karbohidrat + Elektrolit

(25.00g dextrose anhidrat, 3.00 g sodium Botol plastik
254 chloride, 0.15 g potassium chloride, 0.10 g @500 ml
calcium chloride dihydrate dan 1.55 g sodium
lactate)

Larutan mengandung Karbohidrat + Elektrolit

(25.00g maltose, 3.00 g sodium chloride, 0.15 g Botol plastik
255 potassium chloride, 0.10 g calcium chloride @500 ml
dihydrate dan 1.55 g sodium lactate)

Larutan mengandung Karbohidrat + Elektrolit

256 (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) Botol

Larutan mengandung Karbohidrat + Elektrolit

257 (Dextrose 5%, NaCL 0,45%, KCl) (HSD) Botol

Larutan mengandung Karbohidrat + Elektrolit

258 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + Botol
elektrolit)

Larutan mengandung Karbohidrat + Elektrolit

259 (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Botol
Laktat 3,1 g, air untuk injeksi ad 1000 ml)

Larutan mengandung Karbohidrat + Elektrolit

260 (Glukosa 55 g ; Natrium Chloride 9 g, air untuk Botol
injeksi ad 1000 ml) (D5-NS)

Larutan mengandung Karbohidrat + Elektrolit

261 botol/softbag
(Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS)

Larutan mengandung Karbohidrat + Elektrolit

262 (Glukosa: 25,0 g; NaCl: 4,5 g) Botol

263 Larutan mengandung Karbohidrat + Elektrolit botol/softbag

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 100 mL

264 Larutan mengandung Karbohidrat + Elektrolit botol/softbag

(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) @ 500 mL

265 Larutan mengandung Karbohidrat + Elektrolit Botol

(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS)

Larutan mengandung Karbohidrat + Elektrolit

(Larutan nutrisi kombinasi infus per L: Na.
266 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl Botol
90mEQ, Asetat 38mEQ, Sorbitol 50g)

Larutan mengandung Karbohidrat + Elektrolit

267 (Larutan Ringer & Glukosa 5%) Botol

Larutan mengandung Karbohidrat + Elektrolit

268 (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B) Botol
 Larutan mengandung Karbohidrat + Elektrolit
269 (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) Botol

Larutan mengandung Karbohidrat + Elektrolit

270 (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Glukosa Botol
100 gr)
Larutan mengandung Karbohidrat + Elektrolit
271 (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Botol
Dekstrosa 27 gr) (KA EN 3B)
Larutan mengandung Karbohidrat + Elektrolit
272 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Botol
Dekstrosa 27 gr) (KA EN 3A)
pack/ sachet/
273 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) set

274 Lidokain gel 2% syringe/

syringe plastik
275 Lidokain inj 2% (infiltr/p.v.) ampul/vial
276 Lidokain salep 5% Tube
277 Lidokain spray oral 10% botol
tablet/
278 Linestrenol tab 0,5 mg kapsul/kaplet
279 Liquor carbonis detergens lar 5% Botol
280 Loperamid tab 2 mg Tab
281 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput
tablet/
282 Loratadin tab 10 mg kapsul/kaplet
tablet/
283 Lorazepam tab 0,5 mg kapsul/kaplet

284 Lorazepam tab 1 mg tablet/

kapsul/kaplet
285 Lorazepam tab sal 2 mg Tab sal
ampul/vial
286 Magnesium sulfat inj 20% @25 ml
287 Magnesium sulfat inj 20% ampul/vial
ampul/vial
288 Magnesium sulfat inj 40% @25 ml
289 Magnesium sulfat inj 40% ampul/vial
290 Magnesium sulfat serb, ktg 30 g Sachet
291 Manitol lar infus 20% Botol @ 100 ml
292 Manitol lar infus 20% Botol @ 250 ml
293 Manitol lar infus 20% Botol @ 500 ml
294 Mebendazol sir 100 mg/5 ml Botol
295 Mebendazol tab 100 mg Tan

296 Mebendazol tab 500 mg tablet/

kapsul/kaplet
297 Medroksi progesteron asetat inj 150 mg/ml ampul/vial
Metenamin mandelat (heksamin mandelat) tab
298 salut enterik 500 mg Tab salut

299 Metformin tab 500 mg tablet/

kapsul/kaplet
tablet/
300 Metformin tab 850 mg kapsul/kaplet
301 Metilergometrin inj 0,2 mg/ml ampul/vial
302 Metilergometrin tab salut 0,125 mg tablet
303 Metilprednisolon inj 125 mg/2 ml ampul/vial
304 Metoklopramid inj 5 mg/ml ampul/vial
tablet/
305 Metoklopramid tab 10 mg kapsul/kaplet
tablet/
306 Metoklopramid tab 5 mg kapsul/kaplet
307 Metronidazol lar inf 5 mg/ml botol
308 Metronidazol susp 125 mg/5 ml Botol @ 100 ml
309 Metronidazol susp 125 mg/5 ml Botol @ 60 ml
tablet/
310 Metronidazol tab 250 mg kapsul/kaplet
tablet/
311 Metronidazol tab 500 mg kapsul/kaplet
312 Mikonazol krim 2% tube
313 Mikonazol serb 2% botol / sachet

Mineral Mix (Bismuth Subcitrate Tripotasium,

314 Copper sulfate, Magnesium Chloride Anhydrous, Sachet
Potassium Chloride, Zinc Acetate)

315 N-asetil sistein kaps 200 mg tablet/kapsul/

kaplet
316 NaCl 0,9% Larutan Botol @250 ml
Ampul/botol
317 NaCl 0,9% Larutan @ 10 mL
318 NaCl 0,9% Larutan Botol @25 ml
319 NaCl 0,9% Larutan Botol @500 ml
320 NaCl 0,9% Larutan Botol @100 ml
Botol @1.000
321 NaCl 0,9% Larutan mL
Botol plastik
322 NaCl 3% Larutan @500 ml
323 Natrium diklofenak tab 25 mg tablet
324 Natrium diklofenak tab 50 mg tablet
325 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL
326 Natrium hipoklorit cairan konsentrat 5% Botol
327 Natrium tiosulfat inj 25% (i.v.) Ampul
tablet/
328 Nevirapin tab 200 mg kapsul/kaplet
tablet/
329 Nifedipin kaps 10 mg kapsul/kaplet
330 Nistatin susp 100.000 UI/ml botol/vial
331 Nistatin tab salut 500.000 UI tablet
332 Nistatin tab vaginal 100.000 UI tablet/kaplet
333 Norepinefrin inj 1 mg/ml ampul/vial
334 Obat Anti Tuberculosis FDC Kategori Anak paket
335 Obat Anti Tuberculosis FDC Kategori I paket
336 Obat Anti Tuberculosis FDC Kategori II paket

337 Obat Anti Tuberculosis FDC Kategori Sisipan paket

338 Obat Anti Tuberculosis Kombipak Anak Paket

339 Obat Anti Tuberculosis Kombipak Dewasa paket
340 Oksigen ih, gas dlm tabung Botol
341 Oksimetazolin tts hidung 0,025% botol @ 10 mL
342 Oksimetazolin tts hidung 0,050% botol @ 10 mL
343 Oksitetrasiklin 1% Salep Mata tube
344 Oksitosin inj 10 UI/ml ampul/vial
345 Olopatadin tts mata 0,1% Botol
346 Omeprazol inj 40 mg/10 ml ampul/vial
tablet/
347 Omeprazol kaps 20 mg kapsul/kaplet
348 Paraformaldehid tab 1 g Tab
349 Parasetamol sir 120 mg/5 ml botol @ 60 mL
tablet/
350 Parasetamol tab 500 mg kapsul/kaplet
351 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL
352 Pasta devitalisasi (non arsen) Tube
353 Pasta pengisi saluran akar (pasta) Tube
354 Perak nitrat lar 20% Botol
355 Perak sulfadiazin krim 1% Tube
356 Permetrin krim 5 % Tube 10 g
357 Permetrin krim 5 % Tube 30 g
358 Permetrin krim 5 % Tube 15 g
359 Pirantel pamoat susp 125 mg/5 ml Botol
360 Pirantel pamoat tab 500 mg Tab
tablet/
361 Pirantel pamoat tab scored 125 mg kapsul/kaplet
362 Pirantel pamoat tab scored 250 mg Tab
363 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
364 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl

365 Piridoksin (vitamin B6) tab 25 mg tablet/

kapsul/kaplet
366 Povidon iodin lar 100 mg/ml Botol 300 ml
367 Povidon iodin lar 100 mg/ml botol @ 1.000 mL
368 Povidon iodin lar 100 mg/ml botol 30 mL
369 Povidon iodin lar 100 mg/ml botol @ 60 mL
370 Povidon iodin lar obat kumur 1% Botol
371 Povidon iodin tts mata 2,5% botol/strip
tablet/
372 Prednison tab 5 mg kapsul/kaplet
373 Primakuin tab 15 mg Tab
tablet/
374 Probenesid tab 500 mg
kapsul/kaplet

375 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial

tablet/
376 Propiltiourasil tab 100 mg kapsul/kaplet
tablet/
377 Propranolol tab 10 mg kapsul/kaplet

378 Ranitidin tab 150 mg tablet/

kapsul/kaplet
379 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
380 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak

381 Rifampisin kaps 300 mg tablet/

kapsul/kaplet
tablet/
382 Rifapentin tablet 150 mg kapsul/kaplet
383 Ringer Laktat Larutan Botol

384 Risperidon tab sal 1 mg tablet/

kapsul/kaplet
tablet/
385 Risperidon tab sal 2 mg kapsul/kaplet
ampul/vial/
386 Salbutamol cairan ih 1 mg/mL botol
387 Salbutamol sir 2 mg/5 ml Botol
tablet/
388 Salbutamol tab 2 mg kapsul/kaplet
Salep 2-4, kombinasi : asam salisilat 2 %+
389 belerang endap 4 % pot 15 gram

Salep 2-4, kombinasi : asam salisilat 2 %+

390 belerang endap 4 % pot 30 gram

391 Sefadroksil kaps 250 mg tablet/

kapsul/kaplet
tablet/
392 Sefadroksil kaps/tab 500 mg kapsul/kaplet
393 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL
394 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL
Serum anti bisa ular : A.B.U. I (khusus ular dari
395 luar Papua) inj (i.m./i.v.) Vial

Serum anti bisa ular :A.B.U.II (khusus ular dari

396 Papua) inj (i.m./i.v.) Vial
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
397 10.000 UI/ Vial
398 Serum antirabies inj 100 UI/ml Vial
399 Serum antirabies inj 200 UI/ml Vial
Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial
400 (i.m /i.v.) Vial

401 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul

402 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial

(i.m /i.v.)

403 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial

404 Setirizin sir 5 mg/5 ml. botol @ 60 mL

405 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial

tablet/
406 Sianokobalamin (vitamin B12) tab 50 mcg kapsul/kaplet
407 Simvastatin tab sal 10 mg tablet
408 Simvastatin tab sal 20 mg tablet
409 Simvastatin tab sal selaput 40 mg Tab sal
410 Siprofloksasin tab scored 500 mg tablet
tablet/
411 Spironolakton tab 25 mg kapsul/kaplet
Stannous pyrophosphate 27,6 mg sodium
412 pyrophosphate/vial Vial

413 Streptomisin serb inj 1.000 mg/vial ampul/vial

414 Surgical ginggival pack Tube
415 Tenofovir tab 300 mg tablet
416 Terbutalin cairan ih 2,5 mg/ml Botol
417 Terbutalin inj 0,5 mg/ml ampul/vial
418 Tetanus toxoid inj Ampul
419 Tetrakain tts mata 0,5% Botol
tablet/
420 Tetrasiklin kaps 250 mg kapsul/kaplet
tablet/
421 Tetrasiklin kaps 500 mg kapsul/kaplet
422 Tetrasiklin Salep Mata 1% Tube
tablet/
423 Tiamin (vitamin B1) tab 50 mg kapsul/kaplet
424 Timolol tts mata 0,25% botol @ 5 mL
425 Timolol tts mata 0,5% botol @ 5 mL
426 Tropikamid tts mata 1% Botol @ 5 ml
427 Tropikamid tts mata 1% Botol @ 0,6 ml
428 Urea krim 10 % Tube/pot
429 Urea krim 20 % Tube/pot
430 Vaksin BCG inj (i.k) Vial
431 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
Vaksin Hepatitis Rekombinan Inj Prefilled
432 Injection Device (Uniject) 0,5 ml (i.m) Vial

433 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial

434 Vaksin Influenza Vial

435 Vaksin Japanese Enchepalitis (J.E) Vial
436 Vaksin jerap difteri tetanus (DT) Vial
437 Vaksin jerap difteri tetanus (Td) Vial
438 Vaksin kombinasi DPT-HB-Hib Vial

439 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial

440 Vaksin Meningitis Meningokokus Vial

441 Vaksin polio IPV inj 0,5 ml Vial
Vaksin rabies, untuk manusia serb inj (s.k./i.k) +
442 booster Vial

443 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial

444 Vaksin Yellow Fever Vial

445 Valproat sir 250 mg/5 ml botol @ 120 ml
446 Valproat tab lepas lambat 250 mg tabet
447 Valproat tab lepas lambat 500 mg tabet
448 Valproat tab sal enterik 250 mg tablet
449 Vitamin B kompleks tablet

450 Vitamin C 500 mg minimal non acidic 250 mg Tablet

451 Zidovudin kaps 100 mg tablet/

kapsul/kaplet
452 Zinc drops 10 mg/ml Botol
453 Zinc sir 20 mg/5 ml botol
454 Zinc tab disp 20 mg tablet dispersible
455 Clobazam tab 10 mg tab
456 Kloramfenikol salep kulit 2% Tube
457 Triheksifenidil tab 2 mg Tab
458 Pehacain Injeksi
459 MB Dewasa Blister
460 Cetirizin tab 10 mg Tab
461 MB Anak Blister
462 PB Anak Blister
463 PB Dewasa Blister
464 Tuber Kulin PPD R T Vial
465 Benzatin Penisillin 2,4 juta IU Vial
Retinol 200,000Iu ( Vit A Merah) Program
466 Stunting Tab

467 Flufenazine Dekanoat Injeksi Ampul

468 Pyridoksin ( B6 ) 100 mg tab Tab
469 Cyloserine 250 mg Tab
470 Levofloxacin 250 mg tab Tab
471 Kanamycin 1 gr Vial
472 Ethambutol 400 mg tab Tab
473 Ethionamide 250 mg tab Tab
474 Moxifloxacin Tab
475 Bedaquiline Tab
476 Linezolid Tab
477 Clofazimine Tab
478 Trifluoperazine Hcl 5 mg Tab
479 Halloperidol decanoad inj 50 mg Ampul
480 Azitromicin 500 mg Talet
481 Kloroquin 150 mg Talet
482 Becefort Tab Tab
483 OAT KDT Dosis harian Paket
484 Favipiravir 200 mg Tab
485 Alat Suntik Sekali Pakai 1 ml pcs
486 Alat Suntik Sekali Pakai 3 ml
487 Alat Suntik Sekali Pakai 5 ml pcs
488 Alat Suntik Sekali Pakai 10 ml pcs
489 Alkohol Swab tablet
Catgut / Benang Bedah No. 3/0 dengan jarum
490 bedah chromix pcs

Catgut / Benang Bedah No. 3/0 dengan jarum

491 bedah plain pcs

492 Infusion Set Anak pcs

493 Infusion Set Dewasa pcs
494 IV Catheter No. 18 G pcs
495 IV Catheter No. 20 G pcs
496 IV Catheter No. 22 G pcs
497 IV Catheter No. 24 G pcs
498 Kapas Pembalut / Absorben 250 gram rol
499 Kasa Pembalut 40 m x 80 cm rol
500 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic pcs
501 Masker pcs
502 Plester 5 yards x 2 inch rol
503 Urine bag Ampul
504 Sarung tangan Steril 7 pcs
505 Sarung tangan 7 tablet
506 Folley Catheter No. 18 vial
507 Blood Slide vial
Silk (Benang Bedah Sutera) No 3/0 dengan
508 jarum bedah Ampul

509 Pembalut Gips tablet

510 Sputum Pot kotak
511 Reagen Nelson botol
512 Etakridin ( Rivanol ) larutan 0,1% - 300 ml botol
513 my jelly pcs
514 plester Cannofix pcs
515 Bisturi no 22 pcs
516 Planotest
517 sarung tangan L pcs
518 sarung tangan M pcs
519 Blood Lancets Pcs
520 Aseptic Gel 500 cc + Dispenser Botol
521 Sarung Tangan Obgyn Pcs
522 Masker N95 Pcs
523 Safety Box 2,5 liter Pcs
524 Umbrical Cord Klem Pcs
525 sarung tangan s pcs
526 Nasal Oxigen 0,2 cannula Ukrn M pcs
527 Nasal Oxigen 0,2 cannula Ukrn S pcs
528 Nasal Oxigen 0,2 cannula Ukrn L Pcs
529 Box Slide Pcs
530 Sarung Tangan Steril 7,5 pcs
531 Plester Farmafix 5x 500 cm Roll
532 Cartridge Genexpert Buah
533 Virocheck Hbs Ag Strep
534 Masker N95 Covid-19 Pcs
535 Baju APD Pcs
536 Kacamata APD Pcs
537 Septalkan Btl
538 Helm APD Pcs
539 VTM torax Pcs
540 Fokus Syphilis PCS
541 Fokus New HIV 1/2 3 line DAK Program PCS
542 Kasa hidofil 16 cm x16 cm Roll
543 Rapit Test Antigen
544 Kasa Hidrofil 80x80 Roll
545 Kasa Hidrofil 3x15 Roll
546 Masker TB Pcs
547 Sarung tangan 7,5 Pcs
548 SD HIV 1/2 Rapid 1 Pcs
549 SD HIV 1/2 Rapid 2 Pcs
550 SD HIV 1/2 Rapid 3 Pcs
551 RDT DBD Combo Pcs
552 Telura/ATR IV/A Tab
553 RDT Anti HCV Pcs
554 Pyrazinamid 500 mg tab
555 Vaccine Carier/Pendingin Box
556 OBH AFI 100 ml Botol 100 ml
557 Alive Biocom-C 50 tab
558 Acrip tega botol 30 tab
559 Duviral botol 60 tab
560 Neviral botol 60 tab
561 Alprazolam 0,5 mg Tab
562 Alkohol swab P2P Pcs
563 Blood Lancets P2p Pcs
564 Stik gula Benechek P2p Botol
565 Vaksin BCG ( Rutin ) Vial 30 159 151 38 88,288 3,354,944
566 Pelarut BCG ( Rutin ) Fls 30 160 152 38 -
567 Vaksin Td ( Rutin ) Vial 40 60 90 10 20,721 207,210
568 Vaksin Dt ( Rutin ) Vial 30 10 20 31,273 625,460
569 Vaksin MR (CAMPAK) ( Rutin ) Vial 190 80 255 15 151,225 2,268,375
570 Pelarut MR campak ( Rutin ) Fls 190 80 255 15 -
571 Vaksin Hepatitis B ( Rutin ) Vial 80 100 161 19 23,490 446,310
572 Vaksin IPV ( Rutin ) Vial 14 20 34 0 142,793 -
573 Vaksin DPT ( Rutin ) Vial 40 200 184 56 77,336 4,330,816
574 Vaksin Polio (BOPV) ( Rutin ) Vial 54 100 124 30 19,540 586,200
575 Spuit 5 ml ( Rutin ) Pcs 50 400 450 0 1,470 -
576 Spuit 0,5 Ml ( rutin ) Pcs 1600 400 1500 500 1,190 595,000
577 Spuit 0,05 ml ( Rutin ) Pcs 100 400 500 0 1,460 -
578 Droper ( Rutin ) Pcs 120 2 -
579 Safety Box ( Rutin ) Pcs 2 -
580 Pfizer ( covid ) Vial 2 -
581 Pelarut 0,9 % nacl ( covid ) Vial 2 -
582 Alkohol Swab ( covid ) Pcs 2 -
583 Spuit 3 Ml ( covid ) Pcs 2 -
584 Spuit 0,3 Ml ( covid ) Pcs 2 -
585 Spuit 0,5 Ml ( covid ) Pcs 2 -
586 Safety Box ( covid ) Pcs 2 -
587 Masker N 95 TB Pcs 2 -
588 Hand Sanitizer covid 19 botol 2 -
589 Cavit D3 tab 2 -
590 Imunvit tab 2 -
591 Vaksin PCV ( Rutin ) Vial 0 50 5 45 3,400,000 153,000,000
592 Sarung tangan / Shamrock Supreme M P2P Pcs 2 -
593 Sarung tangan / Shamrock Supreme L P2P Pcs 2 -
594 Calnic Plus 100 ml Botol -
595 Busmin Syr Botol -
596 Hand Sanitizer 500 ml p2p Botol
597 Masker Earlop Baymed BPJS pcs
598 Gown G5001-SF-N P2P Pcs
599 Ketoralak inj Ampul
600 Fluconazole 150 mg Cap
601 Vaksin polio OPV 2 vial
602 Dropper Vaksin Polio OPV 2 pcs
603 Masker Earlop / Steril MaskP2P Bok
604 Procurma Syr 60 ml Botol
605 Dextrofen syr Botol
606 Masker program malaria Pcs
607 Lamprene Kapsul
608 Sarung tangan Program malaria pcs
609 CDR Btl
610 Pen Marker Pcs
611 Pengukur suhu P2P / Fridge-tag 2 Unit
612 Isoniazid (H) 300 mg/ Rifapentine (P) 300 mg (HP) Tablet
613 Rapid test HIV 1/2 & Shypylis Combo Test
614 HBIg Pcs
615 Masker N95 Aero Pro Pcs
616 Asta Plus Tab
617 Vaksin Inovac Vial

165,414,315

Bireuen, 12 Juli 2023

Bendahara Barang Penanggung Jawab Apotik

Triana Fitri, SKM Zulaida, A.Md.Farm

NIP. 19770917 200701 2 002 NIP. 19821010 201408 2 003

Mengetahui,
Kepala Puskesmas Jeumpa

dr. Asmaul Husna

NIP. 19800708 201001 2 001