PEMERINTAH KABUPATEN BANGLI

DINAS KESEHATAN
Telp. (0366) 91043, Fax. 0366-93030
www.dikes.banglikab.go.id email : dikes@banglikab.go.id

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) OBAT UMUM SUMBER DAK
DOK NO TGL KET
PUSKESMAS/PUSTU : BINYAN LAPORAN BULAN/PERIODE : JULI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE : AGUSTUS 2023 PUSK
KABUPATEN : BANGLI

NO NAMA OBAT SATUAN STOK AWAL PEMBERIAAN

PERSEDIAA OBAT
PENERIMAAN PEMAKIAN STOK AKHIR PERMINTAAN
N ED/RUSAK
HARGA JUMLAH TOTAL APBD/APBN P2 KIA/GIZI LAIN KET ED
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
1 Alopurinol tablet 100 mg tablet 105 -
2 Ambroxol sirup 15 mg/5 ml 4180
Ambroxol sirup 15 mg/5 ml 3,850

3 Aminofilina injeksi 24 mg/ml - 10 ml ampul 2,789

4 Amlodipin 5 mg tablet 78 50 - 30 20 50
5 Amoksisilin kaplet 500 mg kaplet 249
6 Amoksisilin kaplet 500 mg kaplet 253

7 Amoksisilin sirup kering 125 mg/5ml botol 4,400 4

4 - -
8 Antasida DOEN II Suspensi.Komb botol 2,129

Antasida DOEN tab,kombinasi: Mg-

9 Hidroksida 200 mg + Al. Hidroksida. tablet 58
200 mg

Anti Bakteri DOEN salep kombinasi:

10 Basitrasin 500 IU/g + Polimiksin tube 6,600
10.000 IU/g (Top Oint)

Antihemoroid DOEN kombinasi :

11 Bismut Subgalat 150 mg + supp 3,167
Heksaklorofen 250 mg

12 Antimigren: Ergotamin Tartrat 1 mg + tablet 185

Kofein 50 mg

13 Asam Askorbat (Vit C) tablet 50 mg tablet 105

14 Asam Askorbat (Vit C) tablet 50 mg tablet 105

15 Asam Mefenamat tablet salut selaput 253 50 -

500 mg 50 - 100
16 Asam Mefenamat tablet salut selaput 275
500 mg
17 Asiklovir krim 5% tube 2,860
18 Asiklovir tablet 200 mg tablet 660
19 Asiklovir tablet 400 mg tablet 405 -
20 Attapulgit (Pularek) tab 600 mg tablet 162 -
21 Betahistin mesilat tab 6 mg tablet 110 20 50 20 50 -
22 Betametason krim 0.1% tube 1,430 - 3 - 3 -
23 Bisakodil tab 5 mg tablet 319
24 Cetirizine syr 5 mg/ml botol 2,915
25 Cetirizine tab 10 mg tablet 90

26 Deksametason Injeksi I.v. 5 mg/ml ampul 1,567

27 Deksametason Injeksi I.v. 5 mg/ml 1,097

28 Deksametason tablet 0,5 mg tablet 41 - -

- - 100
29 Deksametason tablet 0,5 mg 88

30 Desoksimetason krim 0,25% tube 10,920

31 Diazepam Injeksi 5mg/ml ampul 1,735

32 Diazepam tablet 5 mg tablet 114

33 Difenhidramin Injeksi I.M. 10 mg/ml ampul 1,095

(HCL)
34 Digoksin tablet 0,25 mg tablet 104
35 Dimenhidrinat tab 50 mg tablet 105
36 Doksisiklin kapsul 100 mg kapsul 280
37 Domperidon suspensi 5 mg/5ml botol 6,600
38 Domperidon tab 10 mg tablet 95
39 Domperidon tab 10 mg 220
40 Dulcolac 10 mg SUPP Supp 5,900
Epinefrin (Adrenalin) injeksi 0,1%
41 ampul 1,408
(sebagai HCL)
42 Eritromisin kapsul 500 mg kapsul 730
43 Eritromisin sirup 200 mg/5 ml botol 14,300
44 Fenobarbital tablet 30 mg tablet 171
Fitomenadion (Vit.K1) tablet salut
45 tablet 758
gula 10 mg
46 Fitomenadion inj ampul 4,167
47 Fitomenadion inj ampul 3,682
48 Flukonazol 150 mg tablet 18,720
49 Furosemid tablet 40 mg tablet 82
Garam Oralit I serbuk Kombinasi :
Natrium 0,70 g ,Kalium klorida 0,30 g,
50 saset 440 15 -
Tribatrium Sitrt dihidrat 0,58 g
- 10 5 10
51 Gentamisin salep mata (Genoint) tube 2,960

52 Gentamisin salep kulit 0,1% tube

53 Gentamisin sulfat tetes mata 0,3% botol 4,232 2

-
54 Glibenklamid tablet 5 mg tablet 119
55 Glibenklamid tablet 5 mg tablet 220
56 Glimepiride 2 mg tablet 207
67 Glukosa larutan infus 5% botol 7,363
Griseofulvin tablet 125 mg,
58 tablet 224
micronized
59 Hidroklorotiazida tablet 25 mg tablet 155
60 Hidrokortison krim 1 % tube 2,974
61 Hidrokortison krim 2,5 % tube 2,639 2 - - 2 - 3
Hidrokortison krim 2,5 % 2,475
62 Ibuprofen suspensi 100 mg/5ml botol 2,721
63 Ibuprofen tablet 200 mg Tablet 150
64 Ibuprofen tablet 400 mg tablet 308

65 Isosorbid Dinitrat tablet sublingual 5 tablet 90

mg

66 Isosorbid Dinitrat tablet sublingual 5 143

mg

67 Kalsium laktat (Kalk) tablet 500 ml tablet 63

68 Kalsium laktat (Kalk) tablet 500 ml tablet 165

69 Kaptopril tablet 12,5 mg tablet 66 70 - - 70 -

70 Kaptopril tablet 25 mg tablet 165 80 - 50 30 100
71 Ketokonazol krim 2% tube 2,596
72 Ketokonazol tab 200 mg tablet 253
73 Ketoprofen supp (Suprafenid) supp 2,380
74 Kloramfenikol salep mata 1% tube 2,007
75 Kloramfenikol salep mata 1% tube 5,500
 Kloramfenikol salep kulit 2%
76 tube 3,242
(Bufacetin)

77 Kloramfenikol suspesi 125 mg/5 ml botol 5,015

78 Kloramfenikol tetes mata 0,5% (Reco botol 3,250

TM)
Kloramfenikol tetes mata 0,5% (Reco
79 8,800
TM)
80 Kloramfenikol tetes telinga 3 % botol 8,800

81 Klorfeniramin Maleat (CTM) tablet 4 tablet 23

mg

82 Klorfeniramin Maleat (CTM) tablet 4 tablet 66 30 -

mg 30 - 100
83 Kodein 10 mg tablet 571
Kotrimosazol DOEN I (dewasa)
84 Kombinasi : Sulfametoksazol 400 mg, tablet 133
Trimetoprim 80 mg

Kotrimosazol Suspensi
85 Kombinasi :Sulfametoksazol 200 mg + botol 2,167
Trimetoprim 40 mg/ 5 ml

Kotrimosazol Suspensi
Kombinasi :Sulfametoksazol 200 mg + 2,190
Trimetoprim 40 mg/ 5 ml
86 Lidokain injeksi 2% ampul - 3 - 3 -
87 Lidokain injeksi 2% ampul 1,226
Lidokain injeksi 2% (HCL) + Epinefrin
88 1 : 80.000-2 ml ampul 1,210

Lidokain injeksi 2% (HCL) + Epinefrin

89 ampul 1,291
1 : 80.000-2 ml
90 Loratadin tablet 131
91 Madu Kele 275,000

92 Magnesium sulfat inj (IV) 40%-25ml ampul 3,796

93 Magnesium sulfat inj (IV)20%-25ml ampul 3,328

Magnesium sulfat inj (IV)20%-25ml 11,000

94 Metformin HCl tab 500 mg tablet 102

95 Metilprednisolon tablet 16 mg tablet 551
96 Metilprednisolon tablet 4 mg tablet 143
97 Metilergometrin Meliat tablet 224
98 Metilergometrin Meliat Injeksi ampul 2,959
99 Metoklorpramide 5 mg tablet 121
100 Metronidazole infus botol 8,110
101 Metronidazole ovula (vagizol) ovula 3,590
102 Metronidazole syr 125mg/5ml botol 3,950
103 Metronidazole tablet 500 mg teblet 113
104 Miconazol krim/salep 2% (nitrat) tube 3,414
105 N-asetil sistein 200 mg tablet 373
106 Natrium diklofenak tab 25 mg tablet 145
107 Natrium diklofenak tab 25 mg 137
108 Natrium diklofenak tab 50 mg tablet 115
109 Natrium diklofenak tab 50 mg 123

110 Natrium Klorida larutan infus 0,9 % botol 6,410

111 Nistatin tablet salut 500.000 IU/g tablet 843

112 Nistatin Vaginal tablet salut 100.000 560 6

IU/g 6 -
Nistatin Vaginal tablet salut 100.000
113 598
IU/g
114 Ofloksasin tab 200 mg tablet 440
Oksimetazolin tetes hidung 0,025%
115 botol 32,549
(iliadin drops)
Oksimetazolin tetes hidung 0,050%
116 (iliadin spray) botol 34,320

117 Oksitetrasiklin HCl salep mata 1 % tube 2,500

118 Oksitosin injeksi 10 IU/ml - 1 ml ampul 1,199

119 Omeprazole kaps 20 mg kapsul 327
120 Omeprazole kaps 20 mg 550

121 Ondansetron inj 2mg/ml (4 mg/2 ml) ampul 1,124

122 Parasetamol infus botol 11,610

123 Parasetamol infus botol 12,389
124 parasetamol drops botol 6,649
125 Parasetamol sirup 120 mg/5 ml botol 1,181
126 Parasetamol sirup 120 mg/5 ml botol 1,181
127 Parasetamol tablet 500 mg tablet 107 60 - 60 - 100
Parasetamol tablet 500 mg 220

128 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 131

129 Piroksikam 10 mg tablet 80

130 Povidon Iodida 10 % 300 ml botol 19,800
131 Prednison tablet 5 mg tablet 73
132 Ranitidin tab 150 mg tablet 220
134 Ringer Laktat larutan infus botol 7,630
135 Risperidon 2 mg tablet -
136 Salbutamol 2 mg tablet 67 -
137 Salbutamol 2 mg tablet 67
138 Salbutamol 4 mg tablet 86 30 50 40 40 100
139 Salbutamol 4 mg tablet 154
140 Salbutamol 4 mg 83

Salep 2-4 , Kombinasi: Asam Salisilat

141 2% + Belerang Endap 4% pot 2,797

142 Salisil Bedak 2 % bks 6,600

143 Sefadroksil syr kering 125mg/ml botol 4,189

144 Sefadroksil syr kering 250 mg/5 ml botol 5,549

Sianokobalamin (Vit.B12) injeksi 500

145 ampul 1,104 15
mcg-ml - 15 - -
146 Sianokobalamin (Vit.B12) tablet tablet
147 Simvastatin 20 mg tablet 217
149 Sulvadiazine silver 35 gr tube 20,700
150 Tetagam botol 242,000
160 Tetagam 188,663
161 Tetrasiklin HCl kapsul 500 mg kapsul 310
Tiamin HCl / Mononitrat (Vit.B1)
167 tablet 91
tablet 50 mg
Tiamin HCl / Mononitrat (Vit.B1)
168 tablet 187
tablet 50 mg
169 Triheksifenidil tablet 2 mg tablet 275
Ventolin inhaler (Salbutamol
170 botol 77,000
inh/aerosol 100 mcg/dosis)
171 Vitamin B Kompleks tablet tablet 118
172 Zinc Sulfat syr 60 ml botol 3,171
177 Zinc Sulfat syr 60 ml 2,972
178 Zinc tablet 20 mg tablet 524
179 Zincpro drops botol 6,281 -
180 SF tablet 350
Cefadroxil 500 mg tablet 100
Vitamin B 6 Tablet
Asam Folat tablet
Kloramfenikol tetes telinga 3 % tablet

OBAT PROGRAM -
MALARIA -
1 ACT (Artesunate + Amodiaquin tablet 57,585
2 Primakuin tablet 15 mg tablet 253

3 ACT (Dehidro Artemisin + tablet 2,134

Piperaquine)(D-ARTEPP)
-
DIARE -
1 Garam Oralit 200 ml air saset 257
-
KECACINGAN -
1 Albendazol tablet 400 mg tablet 403
-
TB PARU (OAT FDC ) -
1 Obat Anti Tuberculosis 1 paket 389,344
2 Obat Anti Tuberculosis 2 paket 1,384,983
-
OAT Kombipak -
1 Katagori 1 paket 317,018
2 Obat Anti Tuberculosis Anak paket 248,120
-
GIZI -

Retinol ( vitamin A ) 100.000 IU

1 kapsul 306
Kapsul Lunak Bayi ( 6 - 11 bln )

Retinol ( vitamin A ) 200.000 IU

2 Kapsul Lunak Balita ( 11- 59 bln kapsul 552
)

Retinol ( vitamin A ) 200.000 IU

Kapsul Lunak Balita ( 11- 59 bln kapsul 517
)
-
OBAT GIGI -
1 Etil klorida spray botol 165,000
2 Eugenol cairan botol 20,087
3 Xylocain spray botol 330,000
TOTAL OBAT (A)

BMHP
1 Acon urinalisys 100 test test 2,560
2 Alat suntik sekali pakai 1 ml pcs 871.50
924

3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924

Alat suntik sekali pakai 2,5 ml/3 ml 932

4 Alat suntik sekali pakai 5 ml pcs 974

Alat suntik sekali pakai 5 ml 1,038
Alat suntik sekali pakai 5 ml 1033
5 Alkohol 70% 100 ml botol 2,790
Alkohol 70% 100 ml 4,875
6 Alkohol 70% 1000 ml botol 53,900
7 Alkohol 70% 1000 ml botol 21,500
8 Alkohol 70% 300 ml botol 11,625.00
9 Alkohol 70% 300 ml botol 7,150.00
10 Alkohol swab pcs 112
11 Alkohol swab/ coton swab pcs 1,114
12 Apron pack 50,000
13 Arm Sling L pcs 16,632
14 Arm Sling M pcs 16,632
15 Arm Sling S pcs 16,632
16 Blood lancet pcs 153
17 Blood lancet pcs 147

18 Catgut / Benang Bedah No. 2/0 3

dengan jarum bedah 1941.13 3 -
Catgut / Benang Bedah No. 2/0 34,263
dengan jarum bedah
Catgut / Benang Bedah No. 3/0
19 pcs 34,263
dengan jarum bedah
20 Cell Clean (CL-50) botol 1,197,900
21 Cito brush pcs 1,500
22 Cuticell clasic 10x10 cm pcs 5,520
23 E-Care surgical tape 1" ktk 98,000
24 Feeding tube pcs 8,085
25 Focus RPR Syfilis test 4,180
26 Folley Catheter No.16 pcs 11,550
27 Folley Catheter No.16 pcs 12,722
28 Folley Catheter No.18 pcs 11,550
29 Folley Catheter No.18 pcs 12,722
30 Gelang pasien anak pcs 1,350
31 Gelang pasien dewasa pcs 1,350
32 Gol. Darah (anti AB) 91,625
33 Hanscoon Nonsteril L psg 2,310
Hanscoon Nonsteril L 1,275.34
34 Hanscoon steril 7,5 psg 2,930
Hanscoon steril 7,5 psg 8,659.20
35 Hanscoon steril 8 psg 2,930
Hipavix 5 x 5 cm rol 68,700
36 Infusion set anak set 5,100
Infusiont Set-Y type with injection
37 pcs 4,975
port/INFUSET DEWASA
Infusiont Set-Y type with injection
5,100
port/INFUSET DEWASA
Infusiont Set-Y type with injection
38 pcs 8,867
port/INFUSET DEWASA
39 IV Catheter No. 22 G pcs 6,380
40 Jarum jahit (bedah) no.10 (otot) bungkus 27,500
41 Jarum jahit (bedah) No.13 (kulit) bungkus 27,500
42 Jarum jahit (bedah) no.13 (otot) bungkus 27,500
43 Jarum jahit (bedah) No.14 (kulit) bungkus 27,500
44 Jarum jahit (bedah) no.14 (otot) bungkus 27,500
45 Jarum jahit (bedah) No.9 (kulit) bungkus 27,500
46 Jarum jahit (bedah) no.9(otot) bungkus 27,500
47 Kapas 500 gram bks 20,000
48 Kapas lidi pcs 140

49 Kapas Pembalut / Absorben 250 14,070

gram bks
50 Kasa Hidrofil 40 x 80 rol 135,300
Kasa Hidrofil steril uk. 16 x 16 (isi 16
51 kotak 3,850
lembar)
Kasa Hidrofil steril uk. 16 x 16 (isi 16
7,935.20
lembar)
Kasa Hidrofil steril uk. 18 x 22 (isi 12
52 kotak 5,800
lembar)
53 Kasa Hidrofile 3 yard x5 cm roll @10 1,461
54 Kasa Hidrofile 30 yard x 80 cm roll 73,025
55 Kasa Hidrofile 30 yard x 80 cm roll 101,200
56 Kasa Hidrofile 3yard x15 cm roll 1,645
57 Kasa Kompres 40/40 steril bks 1,600
58 Kasa Pembalut 2 m x 80 cm bks 9,000
59 Kasa Pembalut Elastis 3 inchi rol 22,000
60 Kasa Pembalut Elastis 4 inchi rol 25,000

61 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,500

62 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,575

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750

64 Kasa Pembalut Hidrofil 4 m x 5 cm rol 788

Kasa Pembalut Hidrofil 4 m x 3 cm rol

65 Kertas perkamen bks 24,970

66 Klip 10x7 cm bal 99,000
67 klip Besar (13x18,7)cm bks 9,000
68 klip Besar (13x18,7)cm pcs 127
klip Besar (13x18,7)cm 10,000
69 Klip Kecil (5x8) cm pcs
70 Klip Tanggung (15x10) cm bks 10,000
71 Klip Tanggung (15x10) cm bks

72 Levin tube 125 No.16 (selang NGT) pcs 8,662.00

73 Lysol botol 45,100.00

74 Masker pcs 360.36
Masker 2,350.00
75 Masker N 95 pcs 8,500
76 my jelly 82 gram botol
77 Nasal oxygen L pcs
7277.000
Nasal oxygen L 7,277.00

78 Nasal oxygen S pcs

7277.000
79 Nurse cap pcs 351.00

Nurse cap 600.00

80 Obgyn glove psg

19,950
Obgyn glove
20,328
81 Pembalut Gips 3 inchi rol 15,000.00

82 Pembalut Gips 4 inchi rol 17,500.00

83 Pembalut Gips 6 inchi rol 42,000.00

Plesterin nonwoven uk 5 x5 cm one
84 med roll 24,948.00
Plesterin nonwoven uk 5 x5 cm one
med
85 Povidon iodin 60 ml botol 4,961

86 PP tes (onemed tes hamil) pcs 1,997

87 Safety box dus 16,501

88 Sarung Tangan Steril 6,5 psg 2,930.40

89 Sarung Tangan Steril 7 psg 2,930

90 Sendok syr pcs 1,485

91 Silk (Benang Bedah Sutera) No. 3/0 23,125.00

dengan jarum bedah
92 Silk black 2/0 pcs 24,025.00

93 Umbilical cord klem pcs 1,365

94 Underpad (perlak sekali pakai)60x90 pcs 4,371

Underpad (perlak sekali pakai)60x91 3,749

95 USG gel 250 onemed / Ultra sonik gel botol 13,842

96 infusien set dewasa pcs

TAMBAHAN BMHP PROGRAM 2015 -

1 Kotak kaca isi 2 (kecil)/box slide kotak -
2 MDT Combi blister 39,880
3 Pot dahak pot 1,750
Pot dahak pot 5,154
4 Reagen TB/Ziel Nelsen paket 257,000
5 Slide frosted kotak 20,747.00
6 Sound timer pcs -
7 Tissue lensa lembar -
-

TAMBAHAN BMHP PROGRAM 2016 -

1 Blood lancet kotak 14,566

2 Cryotube tube 2,000
3 Mikropipet biru tube 250
4 Mikropipet ukuran 61 pcs 1,614
5 Parafilm pcs 599,500
6 Masker N-95 pcs 19,500
Masker N-96
Stik Pemeriksaan
1 Glukosa test Sinocare pcs
2 Kolesterol test Mission strip
3 Hemoglobin strip test test 8,652
4 Uric Acid Strip test strip 3,762

TAMBAHAN BMHP PROGRAM P2

2020
1 SD HIV 1/2 3.0 D 30T 11,400

2 OGXMTB/RIF-50-Xpert MTB/RIF 50 259,175

(Catridge)

3 Trepocheck Syphilis (Rapid Test test 9,425

Syphilis RB-TS25:25 Tes) Tahap II

4 Diagnotar Test (GCHIV-402A) Rapid 3 test 13,411

KHB Diagnostic Kit for HIV (1+2)

5 test 12,500
Rapid 2
6 SD Bio Line (Reagen I)/HIV test 11,975
7 Tuberkulin PPD RT-23 vial 620,950
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAMBAHAN OBAT DAN BMHP

TAHUN 2021
Besi Fumarat + Asam Folat (TTD)
1 Program Gizi tablet 354

Besi Fumarat + Asam Folat (TTD)

tablet 354
Program Gizi

2 Sarung tangan Nitrile Golden Gloves pasang 2,431.00

Size M
Sarung tangan Nitrile Golden Gloves
Size M
Sarung tangan Nitrile Golden Gloves
3 pasang 2,431.00
Size L
4 Masker Bedah Stopamed pcs 2,290.00
5 Albendazole 400 mg tablet 431
6 Azitromycin tablet 500 mg tablet 1,888
7 Levofloxacin 500 mg tablet 824
8 Oxygen Mask dewasa pcs 11,130
9 Jelco IV Cath (Abocat) 20G pcs 7,909

10 Diagnostar DS HIV 1/2 One Step test 12,527

Rapid Test (GCHIV-402A)
11 Alkohol Swab pcs 128
Rapid test Syphiis RB-TS 25:25 Test
12 Tahap 1 (trepocheck) test 9,300

13 Dextrose 10% 500 ml (Satoria) botol 7,200.00

14 Sodium Chloride 0,9% 500 ml botol 6,800.00

(Satoria)
15 Ringer Laktat 500 ml (Satoria) botol 7,630.00

16 Masker bedah (Aksamed FaceMask pcs 1,540

Ear Loop)
Handscon non steril M (SPMED
17 pasang 2,970.00
Gloves POWDERED Free M)
18 OAT FDC Kategori I paket 415,469.00
Ekstrak tanaman Phylantus niruri 50
19 kapsul 1,815.00
mg (Stimuno Kapsul)
Ekstrak tanaman Phylantus niruri 50
20 mg (Stimuno Sirup) botol 19,690

21 HerbaCold tablet 1,034.00

22 Herbapain tablet 1,194.00
23 Ramuan Kebugaran (Jeg Seger) bungkus

24 Ramuan Kencing Manis (Semanis) bungkus

Ramuan Tekanan Darah Tinggi

25 bungkus
(Tensiun)
26 Alopurinol 100 mg tablet 105
27 Dexametasone injeksi ampul 1,097
28 Prednison 5 mg tablet 73
29 Simvastatin 20 mg tablet 217
30 Diazepam 5 mg tablet 109
Chlorpheniramin Maleat tab 4 mg
31 (Indofarma) tablet 24

TOTAL TAMBAHAN OBAT BMHP 2021

Obat 2020
1 Lanzoprasole kapsul 303
2 Aseptan Gel 500 cc+dispenser botol 22000.000
3 Bioplacenton Tulle 10x10 pcs 10400.000
4 Bisoprolol 5 mg tablet 645.000
5 Eritromisin kaps 250 mg kapsul 566.000
6 Flukonazol 150 mg tablet 22000.000
7 Folley Catheter No.16 12721.500
8 Folley Catheter No.18 12721.500
9 Sarung Tangan Steril 6,5 2930.000
10 Sefadroksil kaps 500mg 530.000
Tablet tambah darah (ferro fumarat
11 setara dgn Fe elemen 60 mg dan tablet
asam folat 0,40 mg) 350.000
Ventolin inhaler (Salbutamol
12 botol
inh/aerosol 100 mcg/dosis) 63750.000
13 Wing Needle No. 21 G pcs 5770.000
14 Wing Needle No. 23 G pcs 5770.000
15 Laxadine emulsi 60 ml botol 12450.000
Obat Tambahan september
Demacolin syr botol
Curcuma plus syr botol
POVIDON 60 ML botol

Mengetahui/menyetujui Yang menyerahkan Yang meminta Yang menerima

Kepala Dinas Kesehatan Kab.Bangli Kepala UPT Gudang Farmasi Kepala Puskesmas Pengelola obat puskesmas Pengelola obat pustu

NIP.
14

4
4
2
2