LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS
KECAMATAN : DOMPU KOTA PELAPORAN BULAN : AGUSTUS
KABUPATEN : DOMPU PERMINTAAN BULAN : SEPTEMBER
PROVINSI : DOMPU KOTA TAHUN : 2023
: NTB

NO NAMA OBAT / ALKES SATUAN STOCK NO.BATCH SUMBER DANA TANGGAL HARGA SATUAN PENERIM PERSEDI JUMLAH PEMAKAI TOTAL STOCK STOCK TOTAL HARGA STOCK PERMINT PEMBER
AWAL KADALUARSA AAN AAN EXPIRED AN SUB UNIT GUDANG AKHIR OPTIMUM AAN IAN
1 2 3 4 5 6 7 8 9 10 = 4+9 11 12 = (10- 13 14 15 16 17 = 18 19
11-15) 12+(9*50
%)
APBN
ALAT KESEHATAN
1 Cool Box 5,5 liter BOX APBD I 2021 Rp 230.000 0 0 0 Rp - 0
OBAT-OBATAN
2 Albendazole 400 mg Tablet 1110098 APBD 1 2022 Oct-23 100 100 100 0 Rp - 150
Albendazole 400 mg Tablet XK3J APBD 1 2023 Mar-25 Rp 295,5 7400 7400 7400 0 Rp - 11100
3 Cycloserin 250 mg KAPSUL 0 0 0 0
4 DHP Frimal (Kotak @9 Tablet) Tablet 3 220513 APBD I 2021 May-24 Rp 1.901,00 3 0 3 3 Rp 5.703 0
5 Favipiravir 200 mg Tablet 300 H10149N APBD I Aug-24 Rp 10.399,00 300 300 0 Rp - 300
6 Garam Oralit sachet 0 46373056LD APBD Jun-24 Rp 280,00 600 600 250 350 350 Rp 98.000 550 600
7 Primaquin 15 mg Tablet 0 363860001 APBD I Aug-23 Rp 242,00 0 0 0 Rp - 0
8 Rifampicin 75 Mg dan INH 50 mg Tablet 0 0 0 Rp - 0
9 Tablet Tambah Darah Tablet 8400 C30475N APBD I 2023 Mar-25 Rp 238,00 17900 26300 8600 17700 17700 Rp 4.212.600 17550
10 MDT Combi Anak MB ( Kuning) Blister MF9000 APBD I 2023 Oct-25 2 2 2 0 Rp - 3
11 MDT Combi Dewasa MB (Merah) Blister 0 LV2196 APBD I 2023 Nov-25 5 5 5 0 Rp - 7,5
12 OAT Kat Anak Blister G112296J APBD I 2024 Jun-24 Rp 259.036,00 0 0 0 0 5
13 OAT KAT I Blister 0 56461078 APBD I 2023 Sep-25 Rp 440.412,00 0 0 0 0
14 Kit Stop TB Blister 0 0 0 Rp - 0
15 Paket Kit TB Box A005248 APBD I OKT-2023 Rp 409.461,00 10 10 10 0 15 10
16 Pot Sputum Pot Sep-27 Rp 2.624,00 100 100 100 0 Rp - 150
17 Retinol 200.000 IU (Merah) Kapsul F21209W APBD I Mei-25 Rp 586,00 0 0 0 Rp 586 0
18 Retinol 100.000 IU (Biru) Kapsul E20910W APBD I Jun-25 Rp 324,00 0 0 0 Rp 324 0
19 Taburia Suplemen Kesmas Sachet 22PMB029 APBD Des-24 Rp 633,00 0 0 0 Rp 633 0
20 Masker 3 Ply Hijab Head Loop 2 pcs 20201105MB APBD I 2022 11/11/2023 Rp 347,00 0 0 0 0
21 Tuberkulin TB Vial 6500222 APBD I 2023 Jan-24 Rp 608.280,00 1 1 0 1 1 Rp 608.280
22 Rifapentin 150 mg TB Tablet IJ7323 APBD I Sep-24 Rp 5.525,00 48 48 48 0 Rp -

23 Isoniazid 300 mg Tablet 62 62 62 0 Rp -

INJEKSI DAN PELARUT
24 Metronidazole Infus 500 mg (KIA) Botol 7 SX2E063 APBD 1 2023 Jun-24 Rp 5.885,00 7 1 6 6 Rp 35.310 1
25 MgSO4 20% (KIA) Vial 3 B77K51B APBD 1 2023 Nov-23 Rp 3.760,00 3 0 3 3 Rp 11.280 0
26 MgSO4 40% (KIA) Vial 12 B91D52A APBD 1 2023 Apr-24 Rp 4.290,00 12 0 12 12 Rp 51.480 0
27 Phytomenadion inj 2 mg/ml (KIA) Ampul 96 56478034 APBD 1 2023 Sep-24 Rp 1.452,00 96 0 96 96 Rp 139.392 0 30
28 Gentamycin Inj 40 mg/ml (KIA) Ampul 36 22GT3048 APBD 1 2023 Jun-24 Rp 3.355,00 36 0 36 36 Rp 120.780 0
TETES MATA, TETES TELINGA, SALEP DAN SEDIAAN

LABORATORIUM
29 RDT DBD Virotec Dengue Kombo 10 0 0 0 Rp - 0 30
30 Virotec Dengue Kombo (P2M) Pcs 10 H22023 APBD 1 Aug-24 10 0 10 10 0
31 Rapid Antigen (Whole Power) Pcs 0 2108E APBD 1 Jul-23 Rp - 20 20 20 0 0 Rp - 30 20
32 Rapit tes HIV 1/2 Diagnostar Pcs 25 H22028 APBD I Aug-24 Rp 11.500,00 150 175 125 50 50 Rp 575.000 200 100
33 RDT Malaria ( Carestart Malaria PT/PAN HRP 2/PL DN Ag Test Rp 9.878,00 0 0 0 Rp - 0
34 Stik HbSAg Test 175 H22035 APBD I Aug-24 Rp 9.300,00 50 225 100 125 125 Rp 1.162.500 125 100
35 Rapid Test Syphillis Pcs 225 J22027 APBD I Sep-24 Rp 9.300,00 50 275 125 150 150 150 100
36 Reagen ZN Kit 016/2022 APBD I 2023 Agt-2023 Rp 187.703,00 0 0 0 0
37 Standar Q HIV 1/3 Ab 3-Line pcs 25 5352AFAc APBD I Oct-23 Rp 11.700,00 25 0 25 25 0
VAKSIN
38 RABIES VACCINE INACTIVATED Vial 12 148IMO45 01/07/2024 12 9 3 3 Rp - 9 20
Serum Anti Rabies Vial 0 0 0 Rp - 0 20
39 Hepatitis B Imunoglobin (HbIg) Bayi Vial 5 HIMAF00053 APBD I 03/2024 Rp 1.350.000 5 5 0 Rp - 5
LOGISTIC VAR
40 Pelarut Vial 12 065154002 Des-25 12 9 3 3 Rp - 9 20
41 ADS 3 ml Pcs 12 216301 Mei-26 12 9 3 3 Rp - 9 20
VAKSIN RUTIN
42 Vaksin BCG ( Bacillus Calmette-Guérin ) Vial 0370MA120 APBD 1 Aug-23 Rp 88.288,00 0 0 0 Rp - 0
Vaksin BCG ( Bacillus Calmette-Guérin ) Vial 9 0371MA052 APBD 1 01/2024 Rp 88.288,00 9 5 4 Rp 353.152 5
Vaksin DPT-HB-HIB ( PentaBIO ) Vial 5043221 APBD 2 30/09//2023 40 39
43 Vaksin DPT-HB-HIB ( PentaBIO ) Vial 27 5043421 APBD 1 09//2023 Rp 77.366,36 27 27 0 Rp - 27
44 Vaksin DPT-HB-HIB ( PentaBIO ) Vial 0 5043921 APBD 1 11/2023 0 0 0 0
45 Vaksin BOPV ( Bivalent Oral Polio Vaccine ) Vial 18 2053522 APBD 1 31/4/2024 Rp 19,364 18 18 0 Rp - 18

46 Vaksin BOPV ( Bivalent Oral Polio Vaccine ) Vial 2053622 31/4/2024 0 0 0 0

Vaksin BOPV ( Bivalent Oral Polio Vaccine ) Vial 2056322 28/02/2025 70 70 11 59 46
47 Vaksin HB-0 ( Hepatitis B-0 ) Vial 3654221 APBD 1 1/9/2024 Rp 23,490 0 0 0 Rp - 0
48 Vaksin HB-0 ( Hepatitis B-0 ) Vial 58 3657721 APBD 1 02/2025 58 15 43 15
Vaksin Td ( Tetanus Diptheria ) Vial 14 0411622 APBD 2 18/05/2025 19 33 6 27 15,5
49 Vaksin Td ( Tetanus Diptheria ) Vial 0411920 APBD 1 31/5/2023 Rp 20,72 0 0 0 Rp - 0
50 Vaksin IPV ( Inactivated Polio Vaccine ) Vial 0 2101221 APBD 1 Aug-24 Rp 142,79 0 0 0 Rp - 0
51 Vaksin IPV ( Inactivated Polio Vaccine ) 13 2100722 Jun-25 15 28 6 22 13,5
52 Vaksin MR ( Measless Rubela ) Vial 0121W133 APBD 1 30/4/2024 Rp 151,23 0 0 0 Rp - 0
53 Vaksin PCV ( Pneumococcal Conjugate Vaccine ) Vial 0 6E4177 APBD 1 Mar-25 Rp 1.141,55 0 0 0 Rp - 0
Vaksin PCV ( Pneumococcal Conjugate Vaccine ) Vial 6L6832 APBD 1 31/05/2025 Rp 1.142,55 61 61 24 37 Rp 42.274 54,5
PELARUT RUTIN
54 Pelarut MR Ampul 068051129 APBD 1 30/6/2025 Rp - 0 0 0 Rp - 0
55 Pelarut BCG Ampul 0700S4020 APBD 1 Jul-24 Rp 88.288,00 0 0 0 Rp - 0
56 Pelarut BCG Ampul 9 0701S40090 APBD 1 Jul-25 Rp 88.288,00 9 5 4 Rp 353.152 5
LOGISTIC RUTIN
Pipet Tetes BOPV ( Bivalent Oral Polio Vaccine ) Pieces 10106522 APBD 0 70 70 11 59
57 Pipet Tetes BOPV ( Bivalent Oral Polio Vaccine ) Pieces 18 10101722 APBD 1 Rp - 18 18 0 Rp - 18
58 Ads 0.5 ml Pieces 1808407 APBD 1 31/03/2023 Rp 1.190,0 0 0 0 0
59 Ads 0.5 ml Pieces 0 19105 APBD 1 12/2023 0 0 0 0
Ads 0.5 ml Pieces C22CCL020 APBD 2 01/02/2027 300 300 170
60 Spuit 0.05 ml ( ONEJECT ) Pieces 171 20001 APBD 1 Jan-25 Rp 1.460,00 171 100 71 Rp 103.660 100
61 Spuit 5 ml ( ONEJECT ) Pieces 188 20501 APBD 1 Feb-25 Rp 1.460,00 188 11 177 Rp 258.420 11
62 Safety Box 2.5 L Pieces 5 APBD 1 Rp 5.382,00 5 5 0 Rp - 5
VAKSIN BIAN
63 Vaksin MR ( Measless Rubela ) VIAL 131 0121WI62 APBD 1 31/07/2024 Rp - 131 6 125 Rp - 6
64 Pelarut Vaksin MR ( Measless Rubela ) VIAL 131 0681S1123 APBD 1 28/02/2026 131 6 125 Rp - 6
LOGISTIC BIAN
65 Spuit 0.5 ml ( ONEJECT ) AMPULE 1808409 APBD 1 3/3/2023 Rp - 0 0 0 Rp - 0
66 Safety Box 2.5 L PIECES APBD 1 Rp 5.382,00 0 0 0 Rp - 0
VAKSIN BIAS
67 Vaksin DT ( Diptheria Tetanus ) VIAL 19 400222 APBD 1 31/05/2025 Rp 33.063,06 19 0 19 Rp 628.198 0
68 Vaksin Td ( Tetanus Diptheria ) Vial 0 411322 APBD 1 18/05/2025 Rp 20,721 0 0 0 Rp - 0
VAKSIN COVID

69 Vaksin Indovac Sara Cov-2 RBD RECOMBINANT Vial 0 24801122 APBD 1 18/03/2023 Rp - 0 0 0 Rp - 0
70 PFIZER COVAX @ 6 DOSIS Vial 0 FX2761 APBD 2022 02/02/2023 0 0 0 Rp - 0
71 PFIZER COVAX @ 6 DOSIS Vial 0 FY7381 APBD 2022 28/03/2023 0 0 0 Rp - 0
72 INAVAC @ 5 DOSIS Vial 0 ACCL012 APBD 2022 22/05/2023 0 0 0 Rp - 0
Sinopharm @ 2 Dosis Vial 0 202107B1604 APBD 2023 01/07/2023 0 0 0 Rp - 0
PELARUT COVID
73 Nacl 0.9 % AMPUL 0 B832 0 0 0 Rp - 0
74 Pelarut Ampule 0 B83K51A 14/11/2023 RP. 3.280,00 0 0 0 0
LOGISTIC COVID
75 Alkohol Swab Pieces 1108 213662 APBD 1 01/10/2024 Rp 70,00 1108 1108 0 Rp - 1108
76 Alkohol Swab Pieces 2136253 APBD 1 30/09/2025 Rp 70,00 0 0 0 Rp - 0
Alkohol Swab Pieces GM2011243 APBD 2 01/11/2025 0
77 Alat Suntik 0,3 ml Pcs 2110125 17/10/2026 0 0 0 Rp - 0
78 Alat Suntik 0,3 ml Pcs 2110126 17/10/2026 Rp 1.185,00 0 0 0 0
79 Alat Suntik 3 ml Pcs 211357 0 0 0 Rp - 0
80 Safety Box 2.5 L Box 37 APBD 1 Rp 5.382,00 37 37 0 Rp - 37
81 Safety Box 2.5 L Box APBD 1 Rp 5.382,00 0 0 0 Rp - 0
82 Spuit 0,5 ml Pcs C22CCK013 APBD 2 28/02/2027 Rp 5.382,00 0 0 0 Rp - 0
DANA DAK
BAHAN MEDIS HABIS PAKAI (BMHP)
83 Alat Suntik sekali pakai 1 ml Pcs 433 0410 DAK 2022 09/04/2027 Rp 1.023,00 433 60 373 373 Rp 381.579 60 200
84 Alat Suntik sekali pakai 3 ml Pcs 0 0 0 Rp - 0 1000
85 Alat Suntik sekali pakai 5 ml Pcs 626 0412 DAK 2021 09/04/2027 Rp 1.056,00 626 63 5 558 563 Rp 594.528 63 500
86 Alkohol swab Pcs 0 0 0 Rp - 0 1000
87 Blade Sterile (Mess) Serenity carbon Pcs 121 K1052 DAK 2022 Mar-27 Rp 646,43 121 35 86 86 Rp 55.593 35 100
88 Blood Lancet Pcs 1100 20069 DAK 2021 Mar-25 Rp 125,48 1100 200 900 900 Rp 112.932 200
89 Blood TransfusiSet Stera Pcs 51 28032088 DAK 2021 Feb-25 Rp 3.600,00 51 3 4 44 48 Rp 172.800 3 50
90 Catgut Chromic (Absorbable Suture Sterile) Pcs 6 2103030 DAK 2021 Apr-26 Rp 5.500,00 6 0 6 6 Rp 33.000 0 100
91 Catgut Plain 3/0 HR 37 mm@25 Pcs 144 2010140 DAK 2022 Oct-25 Rp 5.445,00 144 5 139 139 Rp 756.855 5 48
92 Dermafix @ 10 Pcs Pcs 1 15112188 DAK 2021 Oct-26 Rp 13.310,00 1 1 0 0 Rp - 1 50
93 Female Catheter no. 16 Pcs 7 20191115 DAK 2021 Nov-24 Rp 7.461,00 7 0 7 7 Rp 52.227 0
94 Foley Catheter no. 18 Pcs 7 20191017 DAK 2022 Oct-24 Rp 14.341,00 7 3 4 4 Rp 57.364 3 20
95 Infus Set Anak Pcs 114 03082088 DAK 2022 31/07/2025 Rp 3.850,00 114 7 2 105 107 Rp 411.950 7 100
96 Infus Set Dewasa Pcs 243 1211010 DAK 2023 Oct-27 Rp 3.520,00 243 39 204 204 Rp 718.080 39 200

97 IV Catheter no. 18 Pcs 152 20G2706J DAK 2022 30/06/2025 Rp 4.818,00 152 5 147 147 Rp 708.246 5
98 IV Catheter no. 20 Pcs 25 21K2806J DAK 2022 30/11/2026 Rp 5.347,00 25 5 4 16 20 Rp 106.940 5 200
99 IV Catheter no. 22 Pcs 1 20108D003 DAK 2022 Aug-27 Rp 4.862,00 1 -3 4 0 4 Rp 19.448 -3 200
100 IV Catheter no. 24 Pcs 67 21320 DAK 2021 28/02/2026 Rp 12.804,00 67 22 45 45 Rp 576.180 22 200
101 Jarum Kulit GT 14 Pcs 51 DAK 2022 Rp 1.500,00 51 0 51 51 Rp 76.500 0
102 Jarum Otot GR 14 Pcs 33 DAK 2022 Rp 1.500,00 33 0 33 33 Rp 49.500 0
103 Kapas Pembalut 500 gr Bungkus 8 20042288 DAK 2022 Mar-27 Rp 31.944,00 8 0 8 8 Rp 255.552 0
104 Kasa panjang 42y x 110 cm Poli Kassa Roll 9 2212 DAK 2023 Dec-27 Rp 218.900 5 14 5 9 9 Rp 1.970.100 7,5 10
105 Kassa Steril pcs 0 0 0 Rp - 0 50
106 Masker Nebule Anak Pcs 0 0 0 Rp - 0 20
107 Masker Nebule Dewasa Pcs 0 0 0 Rp - 0 20
108 Nasal Canula Bayi Pcs 5 04042288TI DAK 2022 Mar-26 Rp 6.050,00 5 0 5 5 Rp 30.250 0
109 Nasal Canula Anak Pcs 9 01190702 DAK 2022 Jul-24 Rp 22.100,00 9 1 8 8 Rp 176.800 1 5
110 Nasal Canula DEWASA Pcs 6 17032188 DAK 2022 Feb-25 Rp 6.050,00 6 0 6 6 Rp 36.300 0 10
111 Polifix / Hipavix 5mx5cm Roll 12 21111049 DAK 2022 Nov-24 Rp 42.041,00 12 3 9 9 Rp 378.369 3 50
112 Plester Semilas Medical Tape-Wave (Plester) Roll 28 113020028 DAK 2022 Jul-25 Rp 14.778,00 28 0 28 28 Rp 413.784 0 50
113 Plesterin Bulat Soft (Box @200 Pcs) 200/box 2600 23022288 DAK 2022 31/01/2027 Rp 192,50 2600 200 2400 2400 Rp 462.000 200
114 Sarung Tangan Steril no.7 Pcs 195 103239138 DAK 2022 Mar-26 Rp 4.987,50 195 18 5 172 177 Rp 882.788 18 300
115 Sarung Tangan Non Steril L Pcs 0 7217306137 DAK 2022 Apr-25 Rp 545,50 1000 1000 0 1000 1000 Rp 545.500 500 500
116 Sarung Tangan Non Steril M Pcs 2700 22030102 DAK 2023 Feb-27 Rp 630,00 1000 3700 1600 2100 2100 Rp 1.323.000 2100 3000
117 Sarung Tangan Non Steril S Pcs 2000 22030101 DAK 2023 Feb-27 Rp 630,00 2000 0 2000 2000 Rp 1.260.000 0 1000
118 Sarung Tangan Obgyn pairs 85 1042288 DAK 2022 Mar-27 Rp 19.118 85 13 72 72 Rp 1.376.496 13 100
119 Silk 3/0 Pcs 129 20012388 DAK 2022 Des-27 129 1 2 126 128 Rp - 1 160
120 Test kehamilan Pcs 345 09022388 DAK 2022 Feb-25 Rp 2.090,00 345 3 342 342 Rp 714.780 3
121 Urine Bag Pcs 19 11210523 DAK 2021 May-26 Rp 4.706,00 19 1 18 18 Rp 84.708 1
122 Under Pad (Soft Pad 60 x 90 cm) Pcs 70 22042288 DAK 2022 Mar-27 Rp 3.630,00 70 30 40 40 Rp 145.200 30 500
123 Alkohol Swab (P2M) Pcs 9200 20417A008 DAK 2022 Agt-27 Rp 125,00 9200 250 8950 8950 Rp 1.118.750 250
124 Blood Lancet (P2M) Pcs 9600 20407A025 DAK 2022 Okt-27 Rp 79,00 9600 0 9600 9600 Rp 758.400 0
OBAT-OBATAN
125 Acetylsistein 200 mg Kapsul 0 0 0 Rp - 0 6000
126 Allopurinol 100 mg Tablet 2307-04-106 DAK 2023 Jul-25 1000 1000 0 1000 1000 Rp - 500 2000
127 Allopurinol 300 mg Tablet 600 HTAL0D22054 DAK 2022 Mar-24 Rp 200,00 1000 1600 500 1100 1100 Rp 220.000 1000
128 Amlodipin 10 mg Tablet 1500 30823 DAK 2023 Mar-25 Rp 72,00 10000 11500 7200 4300 4300 Rp 309.600 12200 10000
129 Amlodipin 5 mg Tablet 0 0 0 Rp - 0 10000

130 Amoxicillin 500 mg Tablet 3000 30123 DAK 2023 Mar-26 Rp 211,00 8000 11000 4260 40 6700 6740 Rp 1.422.140 8260 10000
131 Antasida DOEN Tablet Tablet 3600 A11023 DAK 2022 Jul-24 Rp 54,00 6000 9600 5140 60 4400 4460 Rp 240.840 8140 10000
132 Asam asetil salisilat Tablet 100 56826003 DAK 2023 Nov-24 100 0 100 100 0
133 Asam Ascorbaat 50 mg Tablet 3700 G202212N DAK 2022 Jul-24 Rp 183,00 5000 8700 3000 5700 5700 Rp 1.043.100 5500 6000
134 Asam Mefenamat Tablet 3300 2302066 DAK 2023 Feb-25 Rp 111,00 3300 930 70 2300 2370 Rp 263.070 930 3000
135 Attapulgit 600mg (Pularex) Tablet 1900 09101 DAK 2021 Sep-24 Rp 250,00 1900 780 20 1100 1120 Rp 280.000 780 2000
136 Betahistine Tablet 0 52J0570 DAK 2022 Oct-23 Rp 88,00 300 300 300 0 0 Rp - 450 1000
137 Calcium Lactate Tablet 2600 A20882 DAK 2022 Apr-25 Rp 60,00 2600 1300 1300 1300 Rp 78.000 1300 2000
138 Captopril 12,5 mg Tablet 100 563230001 DAK 2022 Jan-24 Rp 68,00 100 0 100 100 Rp 6.800 0
139 Captopril 25 mg Tablet 500 56324044 DAK 2022 Jun-24 Rp 75,00 500 0 500 500 Rp 37.500 0
140 Cefadroxil Monohidrinat 500 mg Kapsul 0 22101257 DAK 2022 Oct-26 Rp 1.100,00 0 0 0 Rp - 0 5000
141 Cetirizine Tablet Tablet 3900 AG3B661 DAK 2022 Jan-25 Rp 50,00 5000 8900 3900 100 4900 5000 Rp 250.000 6400 7000
142 Colcisine Tablet 660 21H119 DAK 2022 Aug-24 Rp 649,00 660 150 510 510 Rp 330.990 150
143 Chlorpheniramin Maleat (CTM) 4 mg ( Trifachlor) Tablet 4200 2207099 DAK 2022 Jul-25 Rp 70,00 4200 3300 300 600 900 Rp 63.000 3300 6000
144 Cotrimoxazol 480 mg Tablet 0 0 0 Rp - 0 3000
145 Chlorampenicol 500 mg (Cloramex 500) Tablet 100 A23881010 DAK 2022 Aug-24 Rp 1.174,00 100 0 100 100 Rp 117.400 0
146 Ciprofloxacin 500 mg Tablet 0 0 0 Rp - 0 3000
147 Dexamethasone 0,5 mg Tablet 0 221013150 DAK 2022 Oct-24 Rp 90,00 0 0 0 Rp - 0 6000
148 Dimenhydrinat 50 mg Tablet 200 691862B DAK 2022 Jun-24 Rp 109,00 200 0 200 200 Rp 21.800 0
149 Domperidon 10 mg Tablet 230613149 DAK 2023 Jun-25 Rp 157,00 2000 2000 100 100 1800 1900 Rp 298.300 1100 2000
150 Ergotamin Tablet 100 J00585B DAK 2021 Sep-23 Rp 308,00 100 0 100 100 Rp 30.800 0
151 Furosemide 40 mg Tablet 200 D10308BJ DAK 2022 Mar-25 Rp 209,00 200 0 200 200 Rp 41.800 0
152 Griseovulfin 125 mg Tablet 0 0 0 Rp - 0
153 Glimepiride 2 mg Tablet 0 0 0 Rp - 0 5000
154 Ibuprofen 400 mg Tablet 6600 2303-50-134 DAK 2023 Mar-25 Rp 198,00 8000 14600 10 4890 9700 9700 Rp 1.920.600 8890 10000
155 Loperamide (Primodiar 2 mg) Tablet 0 AC2801 DAK 2022 Mar-26 Rp 70,00 500 500 0 500 500 Rp 35.000 250 1000
156 Ketokonazole 200 mg Tablet 400 KTKCZB12095 DAK 2022 Nov-23 Rp 260,00 400 0 400 400 Rp 104.000 0
157 Methyl Ergometrin 0,125 MG Tablet 0 0 0 Rp - 0
158 Metronidazole 500 mg (Selesnizole) Tablet 0 0 0 Rp - 0 5000
159 Metformine 500 mg Tablet 3910 HTMFNB25429 DAK 2022 Sep-24 Rp 77,00 3910 2110 1800 1800 Rp 138.600 2110 6000
160 Natrium Diklofenak 25 mg Tablet 0 0 0 Rp - 0 5000
161 Natrium Diklofenak 50 mg Tablet 2305-03-362 DAK 2023 May-25 Rp 147,00 3000 3000 1000 2000 2000 Rp 294.000 2500 5000
162 Nifedipinn 10 mg Tablet 0 0 0 Rp - 0 1000
163 Nystatin 500.000 iu Tablet 100 563710002 DAK 2022 May-25 Rp 869,00 100 0 100 100 Rp 86.900 0

164 Nystatin 100.000 iu (VAGINAL) Tablet 60 56372008 DAK 2022 Aug-25 Rp 550,00 60 0 60 60 Rp 33.000 0
165 Omeprazole Cap Kapsul 200 230604280 DAK 2023 Jun-25 Rp 237,00 1000 1200 400 800 800 Rp 189.600 900 5000
166 Paracetamol 500 mg (Trifamol) Tablet 5300 2207062 DAK 2022 Jun-26 Rp 200,00 10000 15300 10440 60 4800 4860 Rp 972.000 15440 16000
167 piroxicam Tablet 0 0 0 Rp - 0 3000
168 Phytomenadion 10 mg Tablet 56381007 DAK 2023 Oct-25 Rp 781,00 100 100 100 0 0 Rp - 150
169 Propylthiouracil Tablet 300 53H0262 DAK 2022 Jul-26 Rp 405,00 300 0 300 300 Rp 121.500 0
170 Pyrantel Pamoate 125 mg Tablet 0 0 0 Rp - 0
171 Ranitidine 150 mg Tablet 0 0 0 Rp - 0 5000
172 Simvastatin 10 mg Tablet 4800 SVND24647 DAK 2022 Aug-24 Rp 115,00 4800 200 4600 4600 Rp 529.000 200
173 Simvastatin 20 mg Tablet 4700 2303-12-335 DAK 2023 Mar-25 Rp 179,00 2000 5000 0 5000 5000 Rp 895.000 1000 1000
174 Salbutamol 2 mg Tablet 200 27421208 DAK 2022 Aug-24 Rp 50,00 200 0 200 200 Rp 10.000 0 1000
175 Salbutamol 4 mg Tablet 500 27510209 DAK 2023 Sep-24 Rp 65,00 500 110 90 300 390 Rp 25.350 110 1000
176 Vitamin B 12 Tablet 500 120263N DAK 2023 Sep-24 Rp 44,00 500 0 500 500 Rp 22.000 0 5000
177 Vitamin B Kompleks Tablet 2305-52-379 DAK 2023 May-25 Rp 62,00 7000 7000 1700 5300 5300 Rp 328.600 5200 5000
178 Zinc Sulfate monohidrate 20 mg Tablet 2306-02-350 DAK 2023 Jun-23 Rp 191,00 7000 7000 3960 40 3000 3040 Rp 580.640 7460 5000
179 Vitamin B6 Tablet A30094N DAK 2023 Jan-25 2800 2800 0 2800 2800 Rp - 1400 3000
SIRUP, SUSPENSI DAN DROP
180 Amoxicillin Syr 250 mg/5ml Botol 159 B10223 DAK 2022 12/2024 Rp 3.510,00 159 0 159 159 Rp 558.090 0
181 Cetirizine sirup Botol 120 AH2621 DAK 2022 Aug-24 Rp 2.153,00 120 0 120 120 Rp 258.360 0
182 Cotrimoxazol Suspensi 240 mg/5ml Botol 0 0 0 Rp - 0
183 Paracetamol Sirup 120 mg/5ml Botol 199 A12246 DAK 2022 1/2024 Rp 1.160,00 199 0 199 199 Rp 230.840 0
INJEKSI DAN PELARUT
184 Atropin Sulfate Ampul 8 9621M0364A DAK 2022 Dec-24 Rp 1.718,00 8 0 8 8 Rp 13.744 0
185 Ampicilin Injeksi 0 0 0 0 Rp - 0
186 Aqua DM 1000 ml Botol 0 0 0 0 Rp - 0 10
187 Diphenhydramin inj Ampul 55 463420142 DAK 2021 Nov-23 Rp 825,00 55 5 50 50 Rp 41.250 5
188 Dexametason inj 4mg/ml Ampul 142 46337073 Jun-24 Rp 5.271,24 142 2 140 140 Rp 737.974 2
189 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 0 0 0 Rp - 0 10
190 Gluconat Calcium Inj 100 mg/ml Ampul 15 BN4911814 DAK 2022 Sep-24 Rp 5.987,00 15 0 15 15 Rp 89.805 0
191 Lidokain komp. injeksi, Kombinasi: Lidokain HCl 2% + Ampul 166 56815013 DAK 2022 Aug-26 Rp 891,00 166 16 150 150 Rp 133.650 16 300
192 Lidokain Hcl 2% Ampul 81 56362059-1 DAK 2022 Sep-26 Rp 847,00 81 62 19 19 Rp 16.093 62 200
193 Meprovent Inj Ampul 1 N2D028 DAK 2022 Apr-24 Rp 3.677,00 1 1 0 0 Rp - 1 100
194 Methyl Ergometrin Inj 0,2 mg/ml Ampul 3 4911833 DAK 2021 Aug-23 Rp 1.023,00 3 0 3 3 Rp 3.069 0 10
195 MgSO4 40% Vial 6 B98L51B DAK 2022 29/12/2023 Rp 4.290,00 6 0 6 6 Rp 25.740 0

196 Omeprazole Inj 40 mg/ml Ampul 46820061 DAK 2021 Jun-23 Rp 5.346,00 0 0 0 0 Rp - 0 20
197 Oxytocin Injeksi Ampul 133 962200076A DAK 2022 Mar-25 Rp 1.298,00 133 13 120 120 Rp 155.760 13 100
198 Aqua Pro Injeksi Flesh 3G1G2L010 DAK 2023 Dec-24 Rp 2.955,00 10 10 0 10 10 Rp 29.550 5 20
TETES MATA, TETES TELINGA, SALEP DAN SEDIAAN
199 Anti Bakteri DOEN salep kombinasi: Bacitracin 500 IU/g + Tube 0 0 0 Rp - 0 100
200 Betamethasone cream Tube 75 C31231W DAK 2023 Mar-25 Rp 1.520,00 75 75 0 0 Rp - 75 100
201 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 Rp - 0 100
202 Chloramphenicol Tetes Telinga (Erlamycetin) Botol 0 0 0 Rp - 0 50
203 Chloramphenicol Salep mata Tube 46 C31002W DAK 2023 Mar-26 Rp 3.800,00 46 12 34 34 Rp 129.200 12 24
204 Hydrochlortison salep Kulit Tube 120 F21197W DAK 2022 Jun-24 Rp 2.325,00 120 70 2 48 50 Rp 116.250 70 100
205 Ketokonazole Cream Tube 0 0 0 Rp - 0 100
206 Miconazole Tube 0 C20554W DAK 2022 Mar-25 Rp 1.900,00 0 0 0 0 Rp - 0 100
207 perak sulfaduazine Tube 0 0 0 Rp - 0 10
208 Bedak Salisyl 2% Tube 0 0 0 Rp - 0 20
SUPPOSITORIA
209 Bisacodyl / Dulcolax 10 mg Supp 3 F107005 DAK 2021 Jun-25 Rp 4.325,00 3 0 3 3 Rp 12.975 0 10
210 Antihemoroid supp 0 0 0 Rp - 0 30
ANTISEPTIK DAN DESINFEKTAN 0
211 Alkohol Botol 10 2022033065 DAK 2022 Nov-23 Rp 58.000,00 10 4 6 6 Rp 348.000 4 10
212 Povidon 300 ml Botol 11 D36207 DAK 2022 Apr-25 Rp 24.750,00 11 3 8 8 Rp 198.000 3 10
213 Serum Anti Tetanus injeksi 250.000 IU/ampul (ATS) Vial 0 0 0 Rp - 0 10
214 Serum Anti Bisa Ular /Biosave SABU Vial 0 0 0 Rp - 0 10
LARUTAN ELEKTROLIT DAN CAIRAN INFUS
215 Glucosa 5% (D5%) 500 ml Botol 51 H222B30 DAK 2022 Feb-24 Rp 6.627,00 51 0 0 51 51 Rp 337.977 0
216 Natrium Chlorida (NaCl) 0,9% Botol 32 E222D20 DAK 2022 Apr-25 Rp 6.900,00 40 72 11 6 55 61 Rp 420.900 31 20
217 Ringer Laktat Botol 29 520304 DAK 2022 Feb-26 Rp 7.703,00 100 129 52 4 73 77 Rp 593.131 102 40
GIGI
218 Sponestan / Surgipson Pcs 3 1121005 DAK 2022 Oct-24 Rp 50.500,00 3 0 3 3 0
219 Ethyl Chloride Botol 0 0 0 Rp - 0 10
LABORATORIUM
220 Human Hemoglobin kotak 0 0 0 Rp - 0
221 Human Triglyserid kotak 1 2104 DAK 2022 Aug-23 Rp 4.750.000 1 0 1 1 Rp 4.750.000 0
222 Stik Benecheck Asam Urat @25 STIP/BOX Pcs 2 U22096072 DAK 2022 Mar-24 Rp 6.315,00 2 2 0 0 Rp - 2

223 Stik Nesco Colesterol @10 STIP/BOX Pcs CHS21A15AAS DAK 2022 Mar-23 0 0 0 Rp - 0
224 Stik Benecek Cholestrol @10 STIP/BOX Pcs C22128080 DAK 2023 Des-23 Rp. 25.722.50 0 0 0 0
225 Stik Benecek Glucose @10 STIP/BOX Pcs 18 18 4 14 14 4
226 Stik Urin 10 Parameter kotak 0 0 0 0
227 Benecheck plus Monitoring PTM Box 0 0 0 0
228 Stik Benecheck Glukosa (P2M) Box 166 G22205050 DAK 2022 May-24 Rp 166.900,00 166 0 166 166 Rp 27.705.400 0
229 Diluent M30 Mindray Galon 0 2023020302 DAK 2023 Feb-25 0 0 0 Rp - 0
230 Rinse Galon 0 2022051001 DAK 2023 May-24 0 0 0 Rp - 0
231 Lyse Mindray 500 ml Botol 0 2022061401 DAK 2023 Jun-24 0 0 0 Rp - 0
232 EZ Cleanser 100 ml Galon 0 2023010701 DAK 2023 Jan-24 0 0 0 Rp - 0
Gluco Protein Test Pcs 20
DANA DID, BTT & DBHCHT COVID
BMHP
233 APRON White pcs 15 DID 2021 Rp 1.560,00 50 65 10 55 55 Rp 85.800 35
234 APD LENGKAP set 7 BTT 2021 Rp 1.000.000 7 0 7 7 Rp 7.000.000 0
235 Cover All Suit pcs 28 DID COVID 19 Rp 150.000 28 0 28 28 Rp 4.200.000 0
236 Faceshield (APBD COVID) pcs 10 BTT 2021 Rp 55.000 10 0 10 10 Rp 550.000 0
237 Masker Ear Loop pcs 4050 01210710 DID 2021 31/07/2027 Rp - 4050 1350 2700 2700 Rp - 1350
238 3M Particulate N95-8210 pcs 6 BTT 2021 Rp 3.250 6 0 6 6 Rp 19.500 0
239 Sarung Tangan Obgyn pairs 0 0 0 0
240 Surgical Gown Water Proff pcs 8 DID 2021 Rp 150.000 8 0 8 8 Rp 1.200.000 0
241 Thermo Gun Omron pcs 1 0520RAR Kemenkes Rp 649.000 1 0 1 1 Rp 649.000 0
OBAT-OBATAN
242 Allopurinol 100 mg Tablet 0 0 0 Rp - 0
243 Cavicur Tablet 0 0 0 Rp - 0 3000
244 Piridoxin (B6) Tablet 0 0 0 Rp - 0
ANTISEPTIK DAN DESINFECTAN
245 Alkacide (DESINFEKTAN) Botol 1 1S16N0906 DID 2021 Mar-24 Rp 2.702.700 1 0 1 1 Rp 2.702.700 0
246 E-Care Hand Rub Botol 0 0 0 Rp - 0 50
247 E-Care Hand Wash botol 1 20916L DID 2021 Sep-23 Rp 31.501,80 1 1 0 0 Rp - 1 50
INJEKSI DAN PELARUT
248 MgSO4 20% Vial 16 77A51B DAK 2021 31/11/2023 Rp 3.760,00 16 0 16 16 Rp 60.160 0
HIBAH
249 NURSE CUP pcs 0 0 0 0 Rp - 0 100

250 BAJU (Cover All Suit /Hazmat Suit) baju BOHO Pcs 2 Rp 150.000 2 0 2 2 Rp 300.000 0
251 Kacamata pcs 12 Rp - 12 0 12 12 Rp - 0
JKN
252 Methylprednisolone 8 mg Tablet 0 T08067BB JKN 8/2024 Rp 360,00 0 0 0 Rp - 0
253 Glimepiiride 2 mg Tablet 270 M4012 JKN 08/2024 Rp 400,00 270 270 0 0 Rp - 270
254 Nifedipin 10 mg Tablet 60 53A4215 JKN Dec-25 Rp 200,00 60 60 0 0 Rp - 60
255 Simvastatin 20 mg Tablet 221104335 JKN Nov-24 Rp 260,00 0 0 0 Rp - 0
256 Simvastatin 10 mg Tablet 0 AL0931 JKN Dec-24 0 0 0 Rp - 0
257 Infus Set Dewasa Pcs 0 0 0 Rp - 0
258 Ethyl Chloride Pcs 0 0 0 Rp - 0
259 Alat Suntik 3 ml Pcs 30 28112288 JKN Oct-27 300 330 278 52 52 Rp - 428
260 Antasida DOEN Tablet Tablet 0 0 0 Rp - 0
261 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 0 0 0 Rp - 0
262 Masker Nebul Anak Pcs 6 221150 JKN 6 0 6 6 Rp - 0
263 Masker Nebul Dewasa Pcs 1 09062288TI JKN 1 0 1 1 Rp - 0
264 Amlodipine 5 mg Tablet 0 0 0 Rp - 0
265 Amlodipine 10 mg Tablet 0 2206004 JKN Jun-24 0 0 0 Rp - 0
266 Amoxicillin 500 mg Tablet 0 TAMXB23849 JKN Dec-24 0 0 0 Rp - 0
267 Acetylsistein 200 mg Kapsul 0 22AS1298 JKN Nov-24 1000 1000 1000 0 0 Rp - 1500
268 Cotrimoxazole 480 mg Tablet 0 24166 JKN Nov-24 0 0 0 Rp - 0
269 Zinc Sulfate monohidrate 20 mg Tablet 0 1212045 JKN Dec-24 0 0 0 Rp - 0
270 Metronidazole 500 mg Tablet 0 21531 JKN Nov-25 200 200 200 0 0 Rp - 300
271 Gentamycin Salep Kulit Tube 0 JKN 0 0 0 Rp - 0
272 Chloramphenicol Salep mata Tube 0 00458011 JKN Dec-22 0 0 0 Rp - 0
273 Erlamycetin Tetes Telinga Tube 5 D.0657116 JKN Jun-24 5 5 0 0 Rp - 5
274 Dexamethasone 0,5 mg Tablet 700 K20736N JKN Nov-24 1000 1700 1700 0 0 Rp - 2200
275 Ciprofloxacin 500 mg Tablet 0 03710195 JKN Oct-24 200 200 200 0 0 Rp - 300
276 Domperidon 10 mg Tablet 100 2302-01-149 JKN Feb-26 100 100 0 0 Rp - 100
277 Ranitidine 150 mg Tablet 400 HTRNTB26412 JKN Dec-24 400 400 0 0 Rp - 400
278 IV Catheter No. 20 Pcs 102021 JKN Sep-26 50 50 0 50 50 Rp - 25
279 IV Catheter No. 22 Pcs 230410 JKN Mar-28 50 50 15 35 35 Rp - 40
280 IV Catheter No. 24 Pcs 230310 JKN Feb-28 50 50 0 50 50 Rp - 25
281 Combivent Vial 2984207 JKN Sep-24 20 20 5 15 15 Rp - 15

UMUM GRATIS JKN TOTAL

JUMLAH KUNJUNGAN 350 0 3353 3703
JUMLAH RESEP 751 0 8409 9160

YANG MEMINTA, YANG MENERIMA,

an. KEPALA UPTD PUSKESMAS PENGELOLA OBAT PUSKESMAS

apt. Putra Pratama Rahmadin,

NIP. 19930831 202012 1 005