Laporan Obat Tahun 2023

1
LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS : 1012244

PUSKESMAS : PENAWAR JAYA
KECAMATAN : BANJAR MARGO
KABUPATEN : TULANG BAWANG
PROPINSI : LAMPUNG
STOK PENERIMAAN
HARGA HARGA PER
NO NAMA OBAT SATUAN KMSN SATUAN KEMASAN AWAL APBD I APBD II
1 2 3 4 5 6 7 8 9
1 Acetil Cystein kapsul kotak 304 304 0
2 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550 0
3 Alopurinol tablet 100 mg tablet 100 tablet/kotak 87 87 0
5 Alprazolam tablet 1 mg tablet 100 tablet/kotak 99 99 0
6 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml - 3,300 0
7 Ambroxol tab 30 mg tablet 100 tablet/kotak - 8,593 0
8 Aminofilin tablet 200mg tablet 100 tablet/kotak - 8,000 0
9 Aminofilina injeksi 24 mg/ml ampul ktk 30 ampul@10 - 121,500 0
ml
10 Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 177 177 0
11 Amlodipine Tablet 5 mg tablet 30 tablet/kotak 53 53 0
12 Amlodipine Tablet 10 mg tablet 30 tablet/kotak - 5,610 0
13 Amicillin 1000 mg inj vial 10 vial/kotak 8,591 8,591 0
14 Amoksisilin kapsul 250 mg tablet 100 tablet/kotak - 38,799 0
15 Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 201 201 0
16 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498 3,498 0
17 Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak - 20,115 0
18 Antasida DOEN II suspensi komb botol botol 60 ml 1,694 1,694 0
19 Antasida DOEN tablet tablet 100 tablet/kotak 54 54 0
20 Anti Bakteri DOEN salep kombinasi:Bacitracin- tube 25 tube/kotak 3,509 3,509 0
polymixin B krim
21 Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 3,250 3,250 0
22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477 3,477 0
Asam Benzoat 6% + Asam Salisilat 3%
23 Antimalaria DOEN kombinasi tablet 100 tablet/kotak - 51,800 0
24 Antimigren: Ergotamin Tartrat 1mg +Kofein 50mg tablet 100 tablet/botol 185 185 0
25 Antiparkinson DOEN tablet Kombinasi benzerazid 25 tablet 100 tablet/kotak 904 904 0
mg levodopa 100 mg ( Levopar)
26 Aqua pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650 2,650 0
27 Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak - 179,550 0
28 Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 tablet/kotak 42 42 0
29 Asam folat tablet 1 mg tablet 100 tablet/botol 42 42 0
30 Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 111 111 0
31 Asiklovir krim 5% tube 25 tube/kotak 5,044 5,044 0
32 Asiklovir tablet 200 mg tablet 100 tablet/kotak - 52,404 0
33 Asiklovir tablet 400 mg tablet 100 tablet/kotak 405 405 0
34 Atropin sulfat inj ampul ampul 1,718 1,718 0
35 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial vial 10 vial/kotak 14,430 14,430 0
36 Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet 30 tablet/sachet 226 226 0
37 Betametason krim 0,1% tube tube 2,997 2,997 0
38 Captopril 12,5 mg tablet 100 tab/kotak 65 65 0
39 Captopril 25 mg tablet 100 tablet/kotak 75 75 0
40 Clozapine 25 mg tablet 100 tablet/kotak 477 477 0
41 Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580 158,000 0
42 Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62 6,200 0
43 DHP tablet (Prog : malaria) tablet 9 tablet/kotak - 32,101 0
44 Diazepam tab.2 mg tablet 100 tablet / kotak 70 70.0 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
46 Diazepam inj 5 mg / ml ampul 30 ampul/kotak 1,545 1,545 0
47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054 31,620 0
48 Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143 14,300 0
49 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 0
50 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
51 Domperidone tablet 10mg tablet 100 tablet/kotak 167 16,700 0
52 Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38 38,000 0
53 Epinefrina HCl/Bitartrat ( Epinefrina / Adrenalina ) ampul 30 ampul/kotak 8,100 243,000 0
Injeksi 0,1% - 1 ml
54 Ergakalsiferol (vitamin D3/D2) kapsul 50000 UI/ml (D- tablet tablet - 650 0
Vit FT)
55 Ergakalsiferol (vitamin D3/D2) suspensi 10000 UI/ml botol botol - 8,000 0
(D-Vit syrup)
56 Eritromisin kapsul 250mg tablet 120 tablet/kotak 494 59,230 0
57 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
58 Etanol 70% cairan botol 300 ml/botol 9,124 9,124 0
60 Etakridin / rivanol botol 60 ml/botol 3,740 3,740 0
62 FDC kategori anak paket kotak 214,990 214,990 0
63 FDC OAT Sisipan paket kotak - - 0
64 FDC OAT Kategori I dosis harian paket kotak 409,461 409,461 0
65 FDC OAT Kategori I paket kotak 389,344 389,344 0
66 FDC OAT Kategori II paket kotak 1,297,894 1,297,894 0
67 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
68 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0
69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800 54,000 0
70 Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220 22,000 0
71 Fenol Gliserol tetes telinga 10% (Karbogliserin 10%) botol 24 botol/kotak 2,042 49,008 0
72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml ampul 10 ampul/kotak 4,698 46,980 0
73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417 102,510 0
74 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634 63,400 0
75 Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829 45,725 0
76 Furosemid tablet 40 mg tablet 100 tablet/kotak 85 8,500 0
77 Garam oralit untuk 200 ml air (Prog : diare) sachet 100 sachet/kotak 292 29,200 0
78 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0
79 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
80 Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,355 3,355 0
81 Gentian Violet larutan 1 % botol botol - 900 0
82 Glibenklamid tablet 5 mg tablet 101 tablet/kotak 82 82 0
83 Glimepiride tablet 2 mg tablet 50 tablet/kotak - 21,800 0
84 Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 172 172 0
85 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet - 1,500 0
86 Glukonas Kalsikus 10 % ampul ampul 5,723 5,723 0
87 Glukosa larutan infus 10% steril (Produk lokal) botol 500 ml/botol 5,700 5,700 0
88 Glukosa larutan infus 40% steril (Produk lokal) botol botol 1,960 1,960 0
89 Glukosa larutan infus 5% steril (Produk lokal) botol 500 ml/botol 6,627 6,627 0
90 Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 210 210 0
91 Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
92 Haloperidol tablet 5 mg tablet 100 tablet/kotak 54 54 0
93 HCT tablet 100 tablet/kotak 148 148 0
95 Hidrokortison krim 2,5% tiube 24 tube/kotak 2,325 2,325 0
96 Ibuprofen sirup 100mg / 5ml botol botol - 3,499 0
97 Ibuprofen suspensi 200mg / 5ml botol botol 3,200 3,200 0
98 Ibuprofen tablet 200 mg tablet 100 tablet/botol 116 11,550 0
99 Ibuprofen tablet 400 mg tablet 100 tablet 190 190 0
100 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 86 86 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
101 Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 60 60 0
102 Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243 24,300 0
103 Ketokenazol tablet 200mg tablet 50 tablet/kotak 554 27,675 0
104 Ketokonazol krim 2% tube 12 tube/kotak 4,700 56,400 0
105 Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823 182,250 0
106 Ketorolak inj 10 mg ampul 5 ampul/kotak - 40,400 0
107 Ketorolak inj 30 mg ampul 6 ampul/kotak 847 847 0
108 Klindamisin 150 mg tablet 50 tablet/kotak 382 19,100 0
110 Kloramfenikol salp kulit / Bufacetin* tube tube 3,266 3,266 0
111 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
112 Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51 5,100 0
114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml (SK.720 : ampul 30 ampul/kotak 1,021 30,630 0
kemasan 2 ml)
115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950 28,500 0
116 Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149 14,900 0
117 Kodein 10 mg tablet tablet 100 tablet/kotak 600 600 0
118 Kotrimoksazol Susp komb: Sulfametoksazol 200mg + botol botol 60 ml 2,190 2,190 0
Trimetoprim 40 mg
119 Kotrimoksazol tablet komb: Sulfametoksazol 400mg + tablet 100 tablet/kotak 126 126 0
Trimetoprim 80 mg
120 Lansoprazol inj 30 mg/ml ampul 1 ampul/kotak 82,042 82,042 0
121 Lidokain 2% ampul 30 ampul/kotak 847 847 0
122 Lidokain Kompositum ampul 30 ampul/kotak 803 803 0
123 Loperamide 2 mg tablet kotak 77 77 0
124 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak - 20,780 0
125 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090 4,090 0
126 Mebendazol tablet 100 mg tablet 30 tablet/kotak - 6,840 0
127 Metformin tablet 100 tablet/kotak 39 39 0
128 Metilergometrin Maleat (Metilergometrin) tab salut tablet 100 tablet/kotak 224 224 0
0,125 mg
129 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 ampul/kotak 1,023 1,023 0
130 Metilprednisolon tablet 4 mg tablet 30 tablet/kotak 102 102 0
132 Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070 20,700 0
133 Metoklopramid 5 mg tablet 100 tablet/kotak 120 120 0
134 Metronidazol Infus 500mg/100ml botol botol 100 ml 5,885 5,885 0
135 Metronidazol tablet 250 mg tablet 100 tablet/kotak - 19,305 0
136 Metronidazol tablet 500 mg tablet kotak 403 403 0
137 Mikonazol krim/ salep 2 % tube tube - 3,000 0
138 Mineral mix (Prog. Gizi) sachet 40 sachet/kotak - 98,000 0
139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200 0
140 Natrium Diklofenac 50 mg tablet 50 tablet/kotak 100 100 0
141 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
142 Natrium Klorida larutan infus 0,9 % steril (Produk botol botol 4,900 4,900 0
lokal)
143 Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 825 825 0
144 Nistatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 550 550 0
145 Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak - 78,540 0
146 Obat Kusta MB strip strip 31,760 31,760 0
147 Obat Kusta PB strip strip 12,569 12,569 0
148 Obat Batuk Hitam botol botol 6,044 6,044 0
149 Ofloxacin 200 mg Tab Salut Selulose tablet 100 tablet/kotak - 20,650 0
151 Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 3,500 3,500 0
152 Oksitosin injeksi 10IU/ml-1ml ampul 100 ampul/kotak 1,126 1,126 0
153 Omeprazol kapsul 20mg tablet 30 tablet/kotak 407 407 0
154 ondansetron tablet 4 mg tablet 30 tablet/kotak - - 0
155 ondansetron tablet 8 mg tablet 30 tablet/kotak 270 270 0
156 Ondansetron inj 4 mg/ 2 ml ampul ampul 881 881 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
157 Papaverin tablet 40mg tablet 100 tablet/kotak - - 0
158 Paracetamol drop 100 mg/ml botol botol - - 0
159 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160 1,160 0
160 Parasetamol tablet 500 mg tablet 100 tablet/kotak 222 222 0
161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
162 Pirantel tablet 125 mg tablet 30 tablet/kotak 420 12,595 0
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 131 131 0
164 Piroksikam 20 mg tablet 100 tablet/kotak 220 220 0
165 Povidon Iodida larutan 10% botol botol 60 ml 7,552 7,552 0
167 Prednisone tablet 5 mg tablet 100 tablet/kotak 69 69 0
168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400 0
169 Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404 40,442 0
170 Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 814 814 0
171 Ranitidin tablet 150 mg tablet 100 kaplet/kotak 85 85 0
172 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 50 kapsul/botol 553 553 0
173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 50 kapsul/botol 553 553 0
174 Riseridon 2 mg tablet kotak 124 124 0
175 Ringer Laktat larutan infus steril botol botol 500 ml 7,630 7,630 0
176 Salbutamol 2 mg tablet 100 tablet/kotak 67 67 0
177 Salbutamol 4 mg tablet 100 tablet/kotak - - 0
178 Salbutamol inshalasi/ aerosol 100 mcg/dosis (ventolin nebu nebu 22,200 22,200 0
inheler)
179 Salbutamol cairan 1 mg/ml ampul ampul 4,844 4,844 0
180 Salep 2-4 Komb : As Salisilat 2 % + Belerang endap 2 % pot pot 2,333 2,333 0
181 Salisil Bedak 2% kotak kotak - - 0
182 Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855 25,650 0
183 Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042 52,100 0
184 sefadroksil sirup kering 125mg/5ml botol botol 3,800 3,800 0
185 Sefotaksim inj 1 gr vial 2 vial/kotak 2,850 2,850 0
186 Sefriakson serbuk injeksi 1 g/vial vial vial 2,745 2,745 0
187 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) vial Dus, 10 vial @ 5 ml 517,132 517,132 0
188 Serum Anti Tetanus injeksi 1.500 IU/ampul (A.T.S) ampul Dus, 10 ampul @ 1 140,188 140,188 0
ml
189 Setrizin tablet 10 mg tablet 100 tablet/kotak 49 49 0
190 Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 ampul/kotak 916 91,600 0
191 Sianokobalamin (vit B12) tab 50 mcg tablet 100 tablet/kotak 45 45 0
192 Simvastatin tablet 10 mg tablet 50 tablet/kotak 150 150 0
193 Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 248 248 0
194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak - 20,700 0
195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tablet 1000 tablet/botol 151 151 0
196 Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400 27,000 0
197 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 63 63 0
198 Vaksin anti Rabies / Verorab vial Dus, 1 vial @ 1 154,391 154,391 0
dosis + syringe
199 Vitamin B komplek tablet tablet 100 tablet/kotak 57 57 0
200 Zinc sirup 20 mg/ 5 ml botol botol 2,511 2,511 0
201 Zinc Tab 20 mg tablet 100 tablet/kotak 216 216 0
PERBEKALAN KESEHATAN
204 Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 psc 1,210 1,210 0
206 Alat suntik sekali pakai 1 ml pcs kotak/ 100 psc 100,344 100,344 0
209 Alkohol Swab pcs kotak/ 100 psc 14,100 14,100 0
210 Aqua bides 20 liter galon galon 174,000 174,000 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
211 Blood lanced kotak kotak 16,893 16,893 0
212 Catridge TCM TEST TEST 253,200 253,200 0
213 Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081 26,081 0
215 Exell tulle pcs kotak / psc - - 0
216 Foley cateter pcs pcs - - 0
217 Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500 90,500 0
218 Hand scub (4% clorhexidine) botol botol 42,863 42,863 0
219 Handscoon steril uk 7 pcs kotak 678,150 5,267 0
220 Handscoon steril uk 7,5 pcs kotak 678,150 5,270 0
221 Handscoon uk 6,5 50 pcs kotak 8,713 8,713 0
222 Handscoon uk 7 50 pcs kotak 8,713 8,713 0
223 Handscoon S 100 pcs kotak 87,601 87,601 0
224 Handscoon M 100 pcs kotak 87,601 87,601 0
225 Handscoon L 100 pcs kotak 87,601 87,601 0
226 Infus set anak set 50 set/kotak 9,047 82,500 0
227 Infus set dewasa set 50 set/kotak 7,755 339,250 0
228 IV Catheter No. 18 G set 50 set/kotak 7,044 385,000 0
230 IV Chateter No. 22 G set 50 set/kotak 7,044 385,000 0
234 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178 29,178 0
235 Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350 226,350 0
236 Kassa Hidrofil steril uk. 16x16 (surya husada) pcs 16 lembar/kotak 7,641 7,641 0
237 Kertas Puyer pack ball/ 10 pack - - 0
238 Klip Plastik 10 x 7 KP pack ball/ 10 pack - - 0
239 Klip Plastik 13x8,7 KP pack ball/ 10 pack - - 0
240 Lisol 1liter botol botol - - 0
241 Masker ear loop pcs 50 pcs/kotak 38,775 38,775 0
242 Masker head loop pcs 50 pcs/kotak 38,775 38,775 0
243 Masker KN95 pcs 50 pcs/kotak 82,700 82,700 0
244 Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
245 Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
246 Silk ( Benang Bedah Sutera ) No. 3/0 dg jarum bedah pcs 36pcs/kotak 46,842 46,842 0
247 Stefanol botol botol 69,300 69,300 0
248 Strip Asam urat 50 strip box box 156,975 156,975 0
249 Strip gula 50 strip box box 161,000 161,000 0
250 Strip kolesterol 50 strip box box 257,225 257,225 0
251 Umbilical cord nylon one med (Klem tali pusat) pcs kotak/ 50 psc - - 0
252 UnderPad_L pcs 10 pcs/kotak 100,848 100,848 0
253 Urine Bag Pcs Pcs - - 0
254 Waterone botol botol 15,246 15,246 0
- -
0BAT GIGI
260 Bonding / single bond botol botol 246,000 246,000 0

261 Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000 390,000 0
262 Etching 3 M botol botol 123,050 123,050 0
263 Etil klorida spray botol botol 175,010 175,010 0
264 Eugenol botol botol 20,150 20,150 0
265 Glass Ionomer Cement (GC IX) ART paket botol 423,800 423,800 0
266 Imicryl / sealing of fissures botol botol 206,555 206,555 0
267 Kalsium Hidroksida Pasta paket kotak 87,500 87,500 0
268 Klorfenol Kamfer Mentol (CHKM) paket botol 52,500 52,500 0
269 Mummifying Pasta kotak kotak - - 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
270 Nova compo A1 syr botol 242,295 242,295 0
273 Nova compo A3,5 syr botol 242,295 242,295 0
274 Nova compo HF A2 syr botol 299,100 299,100 0
275 Semen Seng Fosfat serbuk / filling paket botol 221,155 221,155 0
276 Semen Seng Fosfat cairan / lutting paket botol 321,300 321,300 0
277 CAVITA Tambalan sementara botol botol 136,300 136,300 0
278 TKF botol botol 57,640 57,640 0
IMUNISASI RUTIN
281 BCG ampul ampul 88,891 88,891.0 0

282 CAMPAK ampul ampul 28,204 28,204.0 0
283 DT ampul ampul 16,500 16,500.0 0
284 HB.0 / HEP.B UNIJECT ampul ampul 23,490 23,490.0 0
285 IPV vial vial 144,540 144,540.0 0
286 PENTAVALEN / DPT-HB-HIB vial vial 77,366 77,366.0 0
287 POLIO ampul ampul 19,540 19,540.0 0
288 PCV ampul ampul 0 0.0 0
289 Td ampul ampul 16,480 16,480.0 0
290 MR ampul ampul 151,150 151,150.0 0
291 safety box pcs pcs 16,500 16,500.0 0
OBAT TAMBAHAN NON GENERIK
294 Becefort syr botol 60 mL/botol 17,523 17,523 0

295 Curcuma kotak kotak 48,202 48,202 0
296 Dextrofen syr botol botol 60 ml 11,655 11,655 0
297 Dulcolac / bisakodil supp 10 mg supp supp 4,325 4,325 0
299 Febrinex syr Botol Botol 15,999 15,999 0
300 Herbacof Tablet 4 tablet/strip 2,498 2,498 0
301 Noza Tablet kotak 100 tablet 805 805 0
302 Pehavral Tablet kotak 100 tablet 993 993 0
303 Stimuno forte Tablet 10 tablet/strip 1,958 1,958 0
304 Stimuno syr Tablet 100 tablet/kotak 28,374 28,374 0
305 Sukralfat susp botol botol 5,034 5,034 0
306 Ichtiyol salp kapsul kotak 100 kapsul 6,886 6,886 0
307 140,337 140,337 0
308 27,088 27,088 0
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9
322
JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

UMUM
JUMLAH KUNJUNGAN RESEP TIDAK BAYAR

BAYAR
............
Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

Kepala Dinas Kesehatan Kepala Seksi Pelayanan Farmasi dan Kestrad Kepala UPT.Puskesmas
Kabupaten Tulang Bawang Dinas Kesehatan Kab.Tulang Bawang
H.Fatoni, S.Kep,MM Aziza, S.Kep ……………………………………………

NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001 NIP. ..........................................
MINTAAN OBAT (LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : Januari KABUPATEN
TAHUN : 2023 PROPINSI
PENERIMAAN STOK PEMAKAIA

LAIN- PERSEDIAA PENGELUARA STOK AKHIR N RATA- PERMINTAA
DAK ASKES LAIN TOTAL N N AKHIR DALAM RATA S/D N NO
(………..) RUPIAH BULAN INI
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 0 1
0 0 0 0 0 2
0 0 0 0 0 0 3
0 0 0 0 0 0 4
0 0 0 0 0 0 5
0 0 0 0 0 0 6
0 0 0 0 0 0 7
0 0 0 0 0 0 8
0 0 0 0 0 0 9
0 0 0 0 0 0 10
0 0 0 0 0 0 11
0 0 0 0 0 0 12
0 0 0 0 0 0 13
0 0 0 0 0 0 14
0 0 0 0 0 0 15
0 0 0 0 0 0 16
0 0 0 0 0 0 17
0 0 0 0 0 0 18
0 0 0 0 0 0 19
0 0 0 0 0 0 20
0 0 0 0 0 0 21
0 0 0 0 0 0 22
0 0 0 0 0 0 23
0 0 0 0 0 0 24
0 0 0 0 0 0 25
0 0 0 0 0 0 26
0 0 0 0 0 0 27
0 0 0 0 0 0 28
0 0 0 0 0 0 29
0 0 0 0 0 0 30
0 0 0 0 0 0 31
0 0 0 0 0 0 32
0 0 0 0 0 0 33
0 0 0 0 0 0 34
0 0 0 0 0 0 35
0 0 0 0 0 0 36
0 0 0 0 0 0 37
0 0 0 0 0 0 38
0 0 0 0 0 0 39
0 0 0 0 0 0 40
0 0 0 0 0 0 41
0 0 0 0 0 0 42
0 0 0 0 0 0 43
0 0 0 0 0 0 44
0 0 0 0 0 0 45
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 46
0 0 0 0 0 0 47
0 0 0 0 0 0 48
0 0 0 0 0 0 49
0 0 0 0 0 0 50
0 0 0 0 0 0 51
0 0 0 0 0 0 52
0 0 0 0 0 0 53
0 0 0 0 0 0 54
0 0 0 0 0 0 55
0 0 0 0 0 0 56
0 0 0 0 0 0 57
0 0 0 0 0 0 58
0 0 0 0 0 0 59
0 0 0 0 0 0 60
0 0 0 0 0 0 61
0 0 0 0 0 0 62
0 0 0 0 0 0 63
0 0 0 0 0 0 64
0 0 0 0 0 0 65
0 0 0 0 0 0 66
0 0 0 0 0 0 67
0 0 0 0 0 0 68
0 0 0 0 0 0 69
0 0 0 0 0 0 70
0 0 0 0 0 0 71
0 0 0 0 0 0 72
0 0 0 0 0 0 73
0 0 0 0 0 0 74
0 0 0 0 0 0 75
0 0 0 0 0 0 76
0 0 0 0 0 0 77
0 0 0 0 0 0 78
0 0 0 0 0 0 79
0 0 0 0 0 0 80
0 0 0 0 0 0 81
0 0 0 0 0 0 82
0 0 0 0 0 0 83
0 0 0 0 0 0 84
0 0 0 0 0 0 85
0 0 0 0 0 0 86
0 0 0 0 0 0 87
0 0 0 0 0 0 88
0 0 0 0 0 0 89
0 0 0 0 0 0 90
0 0 0 0 0 0 91
0 0 0 0 0 0 92
0 0 0 0 0 0 93
0 0 0 0 0 0 94
0 0 0 0 0 0 95
0 0 0 0 0 0 96
0 0 0 0 0 0 97
0 0 0 0 0 0 98
0 0 0 0 0 0 99
0 0 0 0 0 0 100
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 101
0 0 0 0 0 0 102
0 0 0 0 0 0 103
0 0 0 0 0 0 104
0 0 0 0 0 0 105
0 0 0 0 0 0 106
0 0 0 0 0 0 107
0 0 0 0 0 0 108
0 0 0 0 0 0 109
0 0 0 0 0 0 110
0 0 0 0 0 0 111
0 0 0 0 0 0 112
0 0 0 0 0 0 114
0 0 0 0 0 0 115
0 0 0 0 0 0 116
0 0 0 0 0 0 117
0 0 0 0 0 0 118
0 0 0 0 0 0 119
0 0 0 0 0 0 120
0 0 0 0 0 0 121
0 0 0 0 0 0 122
0 0 0 0 0 0 123
0 0 0 0 0 0 124
0 0 0 0 0 0 125
0 0 0 0 0 0 126
0 0 0 0 0 0 127
0 0 0 0 0 0 128
0 0 0 0 0 0 129
0 0 0 0 0 0 130
0 0 0 0 0 0 131
0 0 0 0 0 0 132
0 0 0 0 0 0 133
0 0 0 0 0 0 134
0 0 0 0 0 0 135
0 0 0 0 0 0 136
0 0 0 0 0 0 137
0 0 0 0 0 0 138
0 0 0 0 0 0 139
0 0 0 0 0 0 140
0 0 0 0 0 0 141
0 0 0 0 0 0 142
0 0 0 0 0 0 143
0 0 0 0 0 0 144
0 0 0 0 0 0 145
0 0 0 0 0 0 146
0 0 0 0 0 0 147
0 0 0 0 0 0 148
0 0 0 0 0 0 149
0 0 0 0 0 0 150
0 0 0 0 0 0 151
0 0 0 0 0 0 152
0 0 0 0 0 0 153
0 0 0 0 0 0 154
0 0 0 0 0 0 155
0 0 0 0 0 0 156
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 157
0 0 0 0 0 0 158
0 0 0 0 0 0 159
0 0 0 0 0 0 160
0 0 0 0 0 0 161
0 0 0 0 0 0 162
0 0 0 0 0 0 163
0 0 0 0 0 0 164
0 0 0 0 0 0 165
0 0 0 0 0 0 166
0 0 0 0 0 0 167
0 0 0 0 0 0 168
0 0 0 0 0 0 169
0 0 0 0 0 0 170
0 0 0 0 0 0 171
0 0 0 0 0 0 172
0 0 0 0 0 0 173
0 0 0 0 174
0 0 0 0 0 0 175
0 0 0 0 0 0 176
0 0 0 0 0 0 177
0 0 0 0 0 0 178
0 0 0 0 0 0 179
0 0 0 0 0 0 180
0 0 0 0 0 0 181
0 0 0 0 0 0 182
0 0 0 0 0 0 183
0 0 0 0 0 0 184
0 0 0 0 0 0 185
0 0 0 0 0 0 186
0 0 0 0 0 0 187
0 0 0 0 0 0 188
0 0 0 0 0 0 189
0 0 0 0 0 0 190
0 0 0 0 0 0 191
0 0 0 0 0 0 192
0 0 0 0 0 0 193
0 0 0 0 0 0 194
0 0 0 0 0 0 195
0 0 0 0 0 0 196
0 0 0 0 0 0 197
0 0 0 0 0 0 198
0 0 0 0 0 0 199
0 0 0 0 0 0 200
0 0 0 0 0 0 201
0 0 0 0 0
204
0 0 0 0 0 0 205
0 0 0 0 0 0 206
0 0 0 0 0 0 207
0 0 0 0 0 0 208
0 0 0 0 0 0 209
0 0 0 0 0 0 210
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 211
0 0 0 0 0 0 212
0 0 0 0 0 0 213
0 0 0 0 0 0 215
0 0 0 0 0 0 216
0 0 0 0 0 0 217
0 0 0 0 0 0 218
0 0 0 0 0 0 219
0 0 0 0 0 0 220
0 0 0 0 0 0 221
0 0 0 0 0 0 222
0 0 0 0 0 0 223
0 0 0 0 0 0 224
0 0 0 0 0 0 225
0 0 0 0 0 0 226
0 0 0 0 0 0 227
0 0 0 0 0 0 228
0 0 0 0 0 0 229
0 0 0 0 0 0 230
0 0 0 0 0 0 231
0 0 0 0 0 0 232
0 0 0 0 0 0 234
0 0 0 0 0 0 235
0 0 0 0 0 0 236
0 0 0 0 0 0 237
0 0 0 0 0 0 238
0 0 0 0 0 0 239
0 0 0 0 0 0 240
0 0 0 0 0 0 241
0 0 0 0 0 0 242
0 0 0 0 0 0 243
0 0 0 0 0 0 244
0 0 0 0 0 0 245
0 0 0 0 0 0 246
0 0 0 0 0 0 247
0 0 0 0 0 0 248
0 0 0 0 0 0 249
0 0 0 0 0 0 250
0 0 0 0 0 0 251
0 0 0 0 0 0 252
0 0 0 0 0 0 253
0 0 0 0 0 0 254
0 0 0 0 0 0 260
0 0 0 0 0 0 261
0 0 0 0 0 0 262
0 0 0 0 0 0 263
0 0 0 0 0 0 264
0 0 0 0 0 0 265
0 0 0 0 0 0 266
0 0 0 0 0 0 267
0 0 0 0 0 0 268
0 0 0 0 0 0 269
10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 270
0 0 0 0 0 0 271
0 0 0 0 0 0 272
0 0 0 0 0 0 273
0 0 0 0 0 0 274
0 0 0 0 0 0 275
0 0 0 0 0 0 276
0 0 0 0 0 0 277
0 0 0 0 0 0 278
0 0 0 0 0 0 281
0 0 0 0 0 0 282
0 0 0 0 0 0 283
0 0 0 0 0 0 284
0 0 0 0 0 0 285
0 0 0 0 0 0 286
0 0 0 0 0 0 287
0 0 0 0 0 0 288
0 0 0 0 0 0 289
0 0 0 0 0 0 290
0 0 0 0 0 0 291
0 0 0 0 0
0 0 0 0 0 0 294
0 0 0 0 0 0 295
0 0 0 0 0 0 296
0 0 0 0 0 0 297
0 0 0 0 0 0 298
0 0 0 0 0 0 299
0 0 0 0 0 0 300
0 0 0 0 0 0 301
0 0 0 0 0 0 302
0 0 0 0 0 0 303
0 0 0 0 0 0 304
0 0 0 0 0 0 305
0 0 0 0 0 0 306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
10 11 12 13 14 15 16 17 18 19 1
322
ma/Melapor
.Puskesmas Petugas Gudang Farmasi
Puskesmas……………..
……………………… ……………………………………………
......................... NIP. ..........................................
2

PROPINSI : LAMPUNG
STOK PENERIMAAN
HARGA HARGA PER
NAMA OBAT SATUAN KMSN SATUAN KEMASAN AWAL APBD I APBD II DAK ASKES
2 3 4 5 6 7 8 9 10 11
Acetil Cystein kapsul kotak 304 304 0
ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550 0
Alopurinol tablet 100 mg tablet 100 tablet/kotak 87 87 0
Alprazolam tablet 1 mg tablet 100 tablet/kotak 99 99 0
Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml - 3,300 0
Ambroxol tab 30 mg tablet 100 tablet/kotak - 8,593 0
Aminofilin tablet 200mg tablet 100 tablet/kotak - 8,000 0
Aminofilina injeksi 24 mg/ml ampul ktk 30 ampul@10 - 121,500 0
ml
Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 177 177 0
Amlodipine Tablet 5 mg tablet 30 tablet/kotak 53 53 0
Amlodipine Tablet 10 mg tablet 30 tablet/kotak - 5,610 0
Amicillin 1000 mg inj vial 10 vial/kotak 8,591 8,591 0
Amoksisilin kapsul 250 mg tablet 100 tablet/kotak - 38,799 0
Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 201 201 0
Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498 3,498 0
Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak - 20,115 0
Antasida DOEN II suspensi komb botol botol 60 ml 1,694 1,694 0
Antasida DOEN tablet tablet 100 tablet/kotak 54 54 0
Anti Bakteri DOEN salep tube 25 tube/kotak 3,509 3,509 0
kombinasi:Bacitracin-polymixin B krim
Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 3,250 3,250 0
Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477 3,477 0
Antimalaria DOEN kombinasi tablet 100 tablet/kotak - 51,800 0
Antimigren: Ergotamin Tartrat 1mg +Kofein tablet 100 tablet/botol 185 185 0
50mg
Antiparkinson DOEN tablet Kombinasi
benzerazid 25 mg levodopa 100 mg tablet 100 tablet/kotak 904 904 0
( Levopar)
Aqua pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650 2,650 0
Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak - 179,550 0
Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 tablet/kotak 42 42 0
Asam folat tablet 1 mg tablet 100 tablet/botol 42 42 0
Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 111 111 0
Asiklovir krim 5% tube 25 tube/kotak 5,044 5,044 0
Asiklovir tablet 200 mg tablet 100 tablet/kotak - 52,404 0
Asiklovir tablet 400 mg tablet 100 tablet/kotak 405 405 0
Atropin sulfat inj ampul ampul 1,718 1,718 0
Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial vial 10 vial/kotak 14,430 14,430 0
Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet 30 tablet/sachet 226 226 0
Betametason krim 0,1% tube tube 2,997 2,997 0
Captopril 12,5 mg tablet 100 tab/kotak 65 65 0
Captopril 25 mg tablet 100 tablet/kotak 75 75 0
Clozapine 25 mg tablet 100 tablet/kotak 477 477 0
Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580 158,000 0
Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62 6,200 0
DHP tablet (Prog : malaria) tablet 9 tablet/kotak - 32,101 0
Diazepam tab.2 mg tablet 100 tablet / kotak 70 70.0 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Diazepam inj 5 mg / ml ampul 30 ampul/kotak 1,545 1,545 0
Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054 31,620 0
Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143 14,300 0
Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 0
Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
Domperidone tablet 10mg tablet 100 tablet/kotak 167 16,700 0
Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38 38,000 0
Epinefrina HCl/Bitartrat ( Epinefrina /
Adrenalina ) ampul 30 ampul/kotak 8,100 243,000 0
Injeksi 0,1% - 1(vitamin
Ergakalsiferol ml D3/D2) kapsul 50000 tablet tablet - 650 0
UI/ml (D-Vit FT)
Ergakalsiferol (vitamin D3/D2) suspensi botol botol - 8,000 0
10000 UI/ml (D-Vit syrup)
Eritromisin kapsul 250mg tablet 120 tablet/kotak 494 59,230 0
Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
Etanol 70% cairan botol 300 ml/botol 9,124 9,124 0
Etakridin / rivanol botol 60 ml/botol 3,740 3,740 0
FDC kategori anak paket kotak 214,990 214,990 0
FDC OAT Sisipan paket kotak - - 0
FDC OAT Kategori I dosis harian paket kotak 409,461 409,461 0
FDC OAT Kategori I paket kotak 389,344 389,344 0
FDC OAT Kategori II paket kotak 1,297,894 1,297,894 0
Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0
Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800 54,000 0
Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220 22,000 0
Fenol Gliserol tetes telinga 10% botol 24 botol/kotak 2,042 49,008 0
(Karbogliserin 10%)
Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul 10 ampul/kotak 4,698 46,980 0
ml
Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417 102,510 0
Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634 63,400 0
Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829 45,725 0
Furosemid tablet 40 mg tablet 100 tablet/kotak 85 8,500 0
Garam oralit untuk 200 ml air (Prog : diare) sachet 100 sachet/kotak 292 29,200 0
Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0
Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,355 3,355 0
Gentian Violet larutan 1 % botol botol - 900 0
Glibenklamid tablet 5 mg tablet 101 tablet/kotak 82 82 0
Glimepiride tablet 2 mg tablet 50 tablet/kotak - 21,800 0
Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 172 172 0
Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet - 1,500 0
Glukonas Kalsikus 10 % ampul ampul 5,723 5,723 0
Glukosa larutan infus 10% steril (Produk botol 500 ml/botol 5,700 5,700 0
lokal)
Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960 0
lokal)
lokal)
Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 210 210 0
Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
Haloperidol tablet 5 mg tablet 100 tablet/kotak 54 54 0
HCT tablet 100 tablet/kotak 148 148 0
Hidrokortison krim 2,5% tiube 24 tube/kotak 2,325 2,325 0
Ibuprofen sirup 100mg / 5ml botol botol - 3,499 0
Ibuprofen suspensi 200mg / 5ml botol botol 3,200 3,200 0
Ibuprofen tablet 200 mg tablet 100 tablet/botol 116 11,550 0
Ibuprofen tablet 400 mg tablet 100 tablet 190 190 0
Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 86 86 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 60 60 0
Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243 24,300 0
Ketokenazol tablet 200mg tablet 50 tablet/kotak 554 27,675 0
Ketokonazol krim 2% tube 12 tube/kotak 4,700 56,400 0
Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823 182,250 0
Ketorolak inj 10 mg ampul 5 ampul/kotak - 40,400 0
Ketorolak inj 30 mg ampul 6 ampul/kotak 847 847 0
Klindamisin 150 mg tablet 50 tablet/kotak 382 19,100 0
Kloramfenikol salp kulit / Bufacetin* tube tube 3,266 3,266 0
Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51 5,100 0
Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 ampul/kotak 1,021 30,630 0
(SK.720 : kemasan 2 ml)
Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950 28,500 0
Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149 14,900 0
Kodein 10 mg tablet tablet 100 tablet/kotak 600 600 0
Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190 0
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
Sulfametoksazol 400mg + Trimetoprim 80 tablet 100 tablet/kotak 126 126 0
mg
Lansoprazol inj 30 mg/ml ampul 1 ampul/kotak 82,042 82,042 0
Lidokain 2% ampul 30 ampul/kotak 847 847 0
Lidokain Kompositum ampul 30 ampul/kotak 803 803 0
Loperamide 2 mg tablet kotak 77 77 0
Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak - 20,780 0
Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090 4,090 0
Mebendazol tablet 100 mg tablet 30 tablet/kotak - 6,840 0
Metformin tablet 100 tablet/kotak 39 39 0
Metilergometrin Maleat (Metilergometrin) tablet 100 tablet/kotak 224 224 0
tab salut 0,125 mg
Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 ampul/kotak 1,023 1,023 0
Metilprednisolon tablet 4 mg tablet 30 tablet/kotak 102 102 0
Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070 20,700 0
Metoklopramid 5 mg tablet 100 tablet/kotak 120 120 0
Metronidazol Infus 500mg/100ml botol botol 100 ml 5,885 5,885 0
Metronidazol tablet 250 mg tablet 100 tablet/kotak - 19,305 0
Metronidazol tablet 500 mg tablet kotak 403 403 0
Mikonazol krim/ salep 2 % tube tube - 3,000 0
Mineral mix (Prog. Gizi) sachet 40 sachet/kotak - 98,000 0
Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200 0
Natrium Diklofenac 50 mg tablet 50 tablet/kotak 100 100 0
Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0
(Produk lokal)
Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 825 825 0
Nistatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 550 550 0
Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak - 78,540 0
Obat Kusta MB strip strip 31,760 31,760 0
Obat Kusta PB strip strip 12,569 12,569 0
Obat Batuk Hitam botol botol 6,044 6,044 0
Ofloxacin 200 mg Tab Salut Selulose tablet 100 tablet/kotak - 20,650 0
Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 3,500 3,500 0
Oksitosin injeksi 10IU/ml-1ml ampul 100 ampul/kotak 1,126 1,126 0
Omeprazol kapsul 20mg tablet 30 tablet/kotak 407 407 0
ondansetron tablet 4 mg tablet 30 tablet/kotak - - 0
ondansetron tablet 8 mg tablet 30 tablet/kotak 270 270 0
Ondansetron inj 4 mg/ 2 ml ampul ampul 881 881 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Papaverin tablet 40mg tablet 100 tablet/kotak - - 0
Paracetamol drop 100 mg/ml botol botol - - 0
Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160 1,160 0
Parasetamol tablet 500 mg tablet 100 tablet/kotak 222 222 0
Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
Pirantel tablet 125 mg tablet 30 tablet/kotak 420 12,595 0
Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 131 131 0
Piroksikam 20 mg tablet 100 tablet/kotak 220 220 0
Povidon Iodida larutan 10% botol botol 60 ml 7,552 7,552 0
Prednisone tablet 5 mg tablet 100 tablet/kotak 69 69 0
Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400 0
Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404 40,442 0
Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 814 814 0
Ranitidin tablet 150 mg tablet 100 kaplet/kotak 85 85 0
Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 kapsul/botol 553 553 0
Lunak
Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 50 kapsul/botol 553 553 0
Riseridon 2 mg tablet kotak 124 124 0
Ringer Laktat larutan infus steril botol botol 500 ml 7,630 7,630 0
Salbutamol 2 mg tablet 100 tablet/kotak 67 67 0
Salbutamol 4 mg tablet 100 tablet/kotak - - 0
Salbutamol inshalasi/ aerosol 100 nebu nebu 22,200 22,200 0
mcg/dosis (ventolin inheler)
Salbutamol cairan 1 mg/ml ampul ampul 4,844 4,844 0
Salep 2-4 Komb : As Salisilat 2 % + Belerang pot pot 2,333 2,333 0
endap 2 %
Salisil Bedak 2% kotak kotak - - 0
Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855 25,650 0
Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042 52,100 0
sefadroksil sirup kering 125mg/5ml botol botol 3,800 3,800 0
Sefotaksim inj 1 gr vial 2 vial/kotak 2,850 2,850 0
Sefriakson serbuk injeksi 1 g/vial vial vial 2,745 2,745 0
Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial @ 5 ml 517,132 517,132 0
(ABU I)
Serum Anti Tetanus injeksi 1.500 IU/ampul ampul Dus, 10 ampul @ 1 140,188 140,188 0
(A.T.S) ml
Setrizin tablet 10 mg tablet 100 tablet/kotak 49 49 0
Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 ampul/kotak 916 91,600 0
Sianokobalamin (vit B12) tab 50 mcg tablet 100 tablet/kotak 45 45 0
Simvastatin tablet 10 mg tablet 50 tablet/kotak 150 150 0
Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 248 248 0
Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak - 20,700 0
Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 tablet/botol 151 151 0
mg
Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400 27,000 0
Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 63 63 0
Vaksin anti Rabies / Verorab vial Dus, 1 vial @ 1 154,391 154,391 0
dosis + syringe
Vitamin B komplek tablet tablet 100 tablet/kotak 57 57 0
Zinc sirup 20 mg/ 5 ml botol botol 2,511 2,511 0
Zinc Tab 20 mg tablet 100 tablet/kotak 216 216 0
0
Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 psc 1,210 1,210 0
Alat suntik sekali pakai 1 ml pcs kotak/ 100 psc 100,344 100,344 0
Alkohol Swab pcs kotak/ 100 psc 14,100 14,100 0
Aqua bides 20 liter galon galon 174,000 174,000 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Blood lanced kotak kotak 16,893 16,893 0
Catridge TCM TEST TEST 253,200 253,200 0
Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081 26,081 0
Exell tulle pcs kotak / psc - - 0
Foley cateter pcs pcs - - 0
Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500 90,500 0
Hand scub (4% clorhexidine) botol botol 42,863 42,863 0
Handscoon steril uk 7 pcs kotak 678,150 5,267 0
Handscoon steril uk 7,5 pcs kotak 678,150 5,270 0
Handscoon uk 6,5 50 pcs kotak 8,713 8,713 0
Handscoon uk 7 50 pcs kotak 8,713 8,713 0
Handscoon S 100 pcs kotak 87,601 87,601 0
Handscoon M 100 pcs kotak 87,601 87,601 0
Handscoon L 100 pcs kotak 87,601 87,601 0
Infus set anak set 50 set/kotak 9,047 82,500 0
Infus set dewasa set 50 set/kotak 7,755 339,250 0
IV Catheter No. 18 G set 50 set/kotak 7,044 385,000 0
IV Chateter No. 22 G set 50 set/kotak 7,044 385,000 0
Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178 29,178 0
Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350 226,350 0
Kassa Hidrofil steril uk. 16x16 (surya pcs 16 lembar/kotak 7,641 7,641 0
husada)
Kertas Puyer pack ball/ 10 pack - - 0
Klip Plastik 10 x 7 KP pack ball/ 10 pack - - 0
Klip Plastik 13x8,7 KP pack ball/ 10 pack - - 0
Lisol 1liter botol botol - - 0
Masker ear loop pcs 50 pcs/kotak 38,775 38,775 0
Masker head loop pcs 50 pcs/kotak 38,775 38,775 0
Masker KN95 pcs 50 pcs/kotak 82,700 82,700 0
Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 46,842 46,842 0
jarum bedah
Stefanol botol botol 69,300 69,300 0
Strip Asam urat 50 strip box box 156,975 156,975 0
Strip gula 50 strip box box 161,000 161,000 0
Strip kolesterol 50 strip box box 257,225 257,225 0
Umbilical cord nylon one med (Klem tali pcs kotak/ 50 psc - - 0
pusat)
UnderPad_L pcs 10 pcs/kotak 100,848 100,848 0
Urine Bag Pcs Pcs - - 0
Waterone botol botol 15,246 15,246 0
- - 0
0BAT GIGI
Bonding / single bond botol botol 246,000 246,000 0
Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000 390,000 0
Etching 3 M botol botol 123,050 123,050 0
Etil klorida spray botol botol 175,010 175,010 0
Eugenol botol botol 20,150 20,150 0
Glass Ionomer Cement (GC IX) ART paket botol 423,800 423,800 0
Imicryl / sealing of fissures botol botol 206,555 206,555 0
Kalsium Hidroksida Pasta paket kotak 87,500 87,500 0
Klorfenol Kamfer Mentol (CHKM) paket botol 52,500 52,500 0
Mummifying Pasta kotak kotak - - 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Nova compo A1 syr botol 242,295 242,295 0
Nova compo A3,5 syr botol 242,295 242,295 0
Nova compo HF A2 syr botol 299,100 299,100 0
Semen Seng Fosfat serbuk / filling paket botol 221,155 221,155 0
Semen Seng Fosfat cairan / lutting paket botol 321,300 321,300 0
CAVITA Tambalan sementara botol botol 136,300 136,300 0
TKF botol botol 57,640 57,640 0
0
IMUNISASI RUTIN
BCG ampul ampul 88,891 88,891.0 0

CAMPAK ampul ampul 28,204 28,204.0 0
DT ampul ampul 16,500 16,500.0 0
HB.0 / HEP.B UNIJECT ampul ampul 23,490 23,490.0 0
IPV vial vial 144,540 144,540.0 0
PENTAVALEN / DPT-HB-HIB vial vial 77,366 77,366.0 0
POLIO ampul ampul 19,540 19,540.0 0
PCV ampul ampul 0 0.0 0
Td ampul ampul 16,480 16,480.0 0
MR ampul ampul 151,150 151,150.0 0
safety box pcs pcs 16,500 16,500.0 0
0
Becefort syr botol 60 mL/botol 17,523 17,523 0

Curcuma kotak kotak 48,202 48,202 0
Dextrofen syr botol botol 60 ml 11,655 11,655 0
Dulcolac / bisakodil supp 10 mg supp supp 4,325 4,325 0
Febrinex syr Botol Botol 15,999 15,999 0
Herbacof Tablet 4 tablet/strip 2,498 2,498 0
Noza Tablet kotak 100 tablet 805 805 0
Pehavral Tablet kotak 100 tablet 993 993 0
Stimuno forte Tablet 10 tablet/strip 1,958 1,958 0
Stimuno syr Tablet 100 tablet/kotak 28,374 28,374 0
Sukralfat susp botol botol 5,034 5,034 0
Ichtiyol salp kapsul kotak 100 kapsul 6,886 6,886 0
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11

UMUM

BAYAR
............


NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001 NIP. ..........................................
PLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : Februari KABUPATEN
N STOK PEMAKAIA
LAIN- PERSEDIAA PENGELUAR STOK AKHIR N RATA- PERMINTAA
LAIN TOTAL N AN AKHIR DALAM RATA S/D N NO NAMA OBAT
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 0 1 Acetil Cystein
0 0 0 0 2 ACT (Artesunat + Amodiaquin ) tablet
0 0 0 0 0 3 Alopurinol tablet 100 mg
0 0 0 0 0 5 Alprazolam tablet 1 mg
0 0 0 0 0 6 Ambroxol sirup 15 mg/ 5 ml
0 0 0 0 0 7 Ambroxol tab 30 mg
0 0 0 0 0 8 Aminofilin tablet 200mg
0 0 0 0 0 9 Aminofilina injeksi 24 mg/ml
0 0 0 0 0 10 Amitriptillin tablet salut 25 mg
0 0 0 0 0 11 Amlodipine Tablet 5 mg
0 0 0 0 0 13 Amicillin 1000 mg inj
0 0 0 0 0 14 Amoksisilin kapsul 250 mg
0 0 0 0 0 16 Amoksisilin sirup kering 125 mg/ 5 ml
0 0 0 0 0 17 Antalgin (Metampiron) tablet 500 mg
0 0 0 0 0 18 Antasida DOEN II suspensi komb
0 0 0 0 0 19 Antasida DOEN tablet
0 0 0 0 0 20 Anti Bakteri DOEN salep
0 0 0 0 0 21 Anti Hemoroid DOEN Kombinasi
0 0 0 0 0 22 Antifungi DOEN Kombinasi:
0 0 0 0 0 23 Antimalaria DOEN kombinasi
0 0 0 0 0 24 Antimigren: Ergotamin Tartrat 1mg +Kofein
50mg
0 0 0 0 0 25 benzerazid 25 mg levodopa 100 mg
0 0 0 0 0 26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen
0 0 0 0 0 27 Arthemeter injeksi 1 ml : 80 mg
0 0 0 0 0 28 Asam Askorbat ( Vit C ) tablet 50 mg
0 0 0 0 0 29 Asam folat tablet 1 mg
0 0 0 0 0 30 Asam Mefenamat tablet 500 mg
0 0 0 0 0 31 Asiklovir krim 5%
0 0 0 0 0 32 Asiklovir tablet 200 mg
0 0 0 0 0 34 Atropin sulfat inj
0 0 0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial
0 0 0 0 0 36 Besi (II ) Sulfat + asam folat 0.25 tab / TTD*
0 0 0 0 0 37 Betametason krim 0,1%
0 0 0 0 0 38 Captopril 12,5 mg
0 0 0 0 0 39 Captopril 25 mg
0 0 0 0 0 40 Clozapine 25 mg
0 0 0 0 0 41 Deksametason injeksi 5mg.ml-1ml
0 0 0 0 0 42 Deksametason tablet 0,5 mg
0 0 0 0 0 43 DHP tablet (Prog : malaria)
0 0 0 0 0 44 Diazepam tab.2 mg
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 46 Diazepam inj 5 mg / ml
0 0 0 0 0 47 Difenhidramin HCl injeksi 10 mg/ml-1ml
0 0 0 0 0 48 Digoksin tablet 0,25 mg
0 0 0 0 0 49 Domperidon suspensi/sirup 5 mg/5ml
0 0 0 0 0 50 Domperidon tetes/ 5 mg/ml
0 0 0 0 0 51 Domperidone tablet 10mg
0 0 0 0 0 52 Ekstrak Belladon tablet 10 mg
0 0 0 0 0 53 Adrenalina )
54 Ergakalsiferol ml D3/D2) kapsul 50000
0 0 0 0 0
UI/ml (D-Vit FT)
0 0 0 0 0 55 Ergakalsiferol (vitamin D3/D2) suspensi
0 0 0 0 0 56 Eritromisin kapsul 250mg
0 0 0 0 0 57 Eritromisin sirup 200mg/5ml
0 0 0 0 0 58 Etanol 70% cairan
0 0 0 0 0 60 Etakridin / rivanol
0 0 0 0 0 62 FDC kategori anak
0 0 0 0 0 63 FDC OAT Sisipan
0 0 0 0 0 64 FDC OAT Kategori I dosis harian
0 0 0 0 0 65 FDC OAT Kategori I
0 0 0 0 0 66 FDC OAT Kategori II
0 0 0 0 0 67 Fenitoin Natrium injeksi 50 mg/ml
0 0 0 0 0 68 Fenitoin Natrium Kapsul 100 mg
0 0 0 0 0 69 Fenobarbital Injeksi i.m/i.v 50 mg/ml
0 0 0 0 0 70 Fenobarbital tablet 100 mg
0 0 0 0 0 71 Fenol Gliserol tetes telinga 10%
(Karbogliserin 10%)
0 0 0 0 0 72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1
ml
0 0 0 0 0 73 Fitomenadion (Vit.K1) injeksi 2mg/ml
0 0 0 0 0 74 Fitomenadion (Vit.K1)tab salut gula 10 mg
0 0 0 0 0 75 Furosemid inj 40 mg/ml
0 0 0 0 0 76 Furosemid tablet 40 mg
0 0 0 0 0 77 Garam oralit untuk 200 ml air (Prog : diare)
0 0 0 0 0 78 Gentamicin salep mata 0,3 % (genoint )
0 0 0 0 0 79 Gentamicin tetes mata 0,3 % (genoint )
0 0 0 0 0 80 Gentamisin injeksi 40 mg/ml
0 0 0 0 0 81 Gentian Violet larutan 1 %
0 0 0 0 0 82 Glibenklamid tablet 5 mg
0 0 0 0 0 83 Glimepiride tablet 2 mg
0 0 0 0 0 84 Gliseril Guayacolat tablet 100 mg
0 0 0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg (nitral)
0 0 0 0 0 86 Glukonas Kalsikus 10 %
0 0 0 0 0 87 Glukosa larutan infus 10% steril (Produk
lokal)
lokal)
0 0 0 0 0 89 Glukosa larutan infus 5% steril (Produk lokal)
0 0 0 0 0 90 Griseofulvin tablet 125 mg, micronized
0 0 0 0 0 91 Haloperidol inj 50 mg/ml (haldol decanoas)
0 0 0 0 0 92 Haloperidol tablet 5 mg
0 0 0 0 0 93 HCT
0 0 0 0 0 95 Hidrokortison krim 2,5%
0 0 0 0 0 96 Ibuprofen sirup 100mg / 5ml
0 0 0 0 0 97 Ibuprofen suspensi 200mg / 5ml
0 0 0 0 0 98 Ibuprofen tablet 200 mg
0 0 0 0 0 100 Isosorbid Dinitrat tablet sublingual 5 mg
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 101 Kalsium Laktat tab 500 mg
0 0 0 0 0 102 Karbamazepin tablet 200 mg
0 0 0 0 0 103 Ketokenazol tablet 200mg
0 0 0 0 0 104 Ketokonazol krim 2%
0 0 0 0 0 105 Ketoprofen tablet 100 mg
0 0 0 0 0 106 Ketorolak inj 10 mg
0 0 0 0 0 108 Klindamisin 150 mg
0 0 0 0 0 110 Kloramfenikol salp kulit / Bufacetin*
0 0 0 0 0 111 Kloramfenikol tetes telinga 3%
0 0 0 0 0 112 Klorfeniramin Maleat (CTM) tablet
0 0 0 0 0 114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml
0 0 0 0 0 116 Klorpromazin HCl tablet salut 100 mg
0 0 0 0 0 117 Kodein 10 mg tablet
0 0 0 0 0 118 Kotrimoksazol Susp komb: Sulfametoksazol
200mg + Trimetoprim 40 mg
0 0 0 0 0 119 Kotrimoksazol tablet komb: Sulfametoksazol
400mg + Trimetoprim 80 mg
0 0 0 0 0 120 Lansoprazol inj 30 mg/ml
0 0 0 0 0 121 Lidokain 2%
0 0 0 0 0 122 Lidokain Kompositum
0 0 0 0 0 123 Loperamide 2 mg
0 0 0 0 0 124 Magnesium Sulfat inj (IV) 20% - 25 ml
0 0 0 0 0 126 Mebendazol tablet 100 mg
0 0 0 0 0 127 Metformin
0 0 0 0 0 128 Metilergometrin Maleat (Metilergometrin)
tab salut 0,125 mg
0 0 0 0 0 129 Metilergometrin Maleat inj 0,200 mg-1 ml
0 0 0 0 0 130 Metilprednisolon tablet 4 mg
0 0 0 0 0 132 Metoklopramid inj 5 mg/ml
0 0 0 0 0 133 Metoklopramid 5 mg
0 0 0 0 0 134 Metronidazol Infus 500mg/100ml
0 0 0 0 0 135 Metronidazol tablet 250 mg
0 0 0 0 0 137 Mikonazol krim/ salep 2 %
0 0 0 0 0 138 Mineral mix (Prog. Gizi)
0 0 0 0 0 139 Natrium Bikarbonat inj i.v 8,4% (meylon)
0 0 0 0 0 140 Natrium Diklofenac 50 mg
0 0 0 0 0 141 Natrium Diklofenak 25 mg
0 0 0 0 0 142 Natrium Klorida larutan infus 0,9 % steril
(Produk lokal)
0 0 0 0 0 143 Nistatin tablet salut 500.000 IU
0 0 0 0 0 144 Nistatin vaginal tablet 100.000 UI
0 0 0 0 0 145 Noretisteron tablet 5 mg (Primolut N)
0 0 0 0 0 146 Obat Kusta MB
0 0 0 0 0 147 Obat Kusta PB
0 0 0 0 0 148 Obat Batuk Hitam
0 0 0 0 0 149 Ofloxacin 200 mg Tab Salut Selulose
0 0 0 0 0 151 Oksitetrasiklin HCl salep mata 1 %
0 0 0 0 0 152 Oksitosin injeksi 10IU/ml-1ml
0 0 0 0 0 153 Omeprazol kapsul 20mg
0 0 0 0 0 154 ondansetron tablet 4 mg
0 0 0 0 0 156 Ondansetron inj 4 mg/ 2 ml
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 157 Papaverin tablet 40mg
0 0 0 0 0 158 Paracetamol drop 100 mg/ml
0 0 0 0 0 159 Parasetamol sirup 120 mg / 5 ml
0 0 0 0 0 160 Parasetamol tablet 500 mg
0 0 0 0 0 161 Pirantel sirup 125mg/5ml
0 0 0 0 0 162 Pirantel tablet 125 mg
0 0 0 0 0 163 Piridoksin HCl (Vit.B6) tablet 10 mg
0 0 0 0 0 164 Piroksikam 20 mg
0 0 0 0 0 165 Povidon Iodida larutan 10%
0 0 0 0 0 167 Prednisone tablet 5 mg
0 0 0 0 0 168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial
0 0 0 0 0 169 Propiltiourasil tablet 100 mg
0 0 0 0 0 170 Ranitidin inj.25mg/2ml
0 0 0 0 0 171 Ranitidin tablet 150 mg
0 0 0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul Lunak
0 0 0 0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak
0 0 0 174 Riseridon 2 mg
0 0 0 0 0 175 Ringer Laktat larutan infus steril
0 0 0 0 0 176 Salbutamol 2 mg
0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 100 mcg/dosis
(ventolin inheler)
0 0 0 0 0 179 Salbutamol cairan 1 mg/ml
0 0 0 0 0 180 Salep 2-4 Komb : As Salisilat 2 % + Belerang
endap 2 %
0 0 0 0 0 181 Salisil Bedak 2%
0 0 0 0 0 182 Sefadroksil kapsul 250 mg
0 0 0 0 0 184 sefadroksil sirup kering 125mg/5ml
0 0 0 0 0 185 Sefotaksim inj 1 gr
0 0 0 0 0 186 Sefriakson serbuk injeksi 1 g/vial
0 0 0 0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 ml
(ABU I)
0 0 0 0 0 188 Serum Anti Tetanus injeksi 1.500 IU/ampul
(A.T.S)
0 0 0 0 0 189 Setrizin tablet 10 mg
0 0 0 0 0 190 Sianokobalamin (vit B12) injeksi 500mcg-ml
0 0 0 0 0 191 Sianokobalamin (vit B12) tab 50 mcg
0 0 0 0 0 192 Simvastatin tablet 10 mg
0 0 0 0 0 193 Siproflaxacin tablet 500 mg
0 0 0 0 0 194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml
0 0 0 0 0 195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50
mg
0 0 0 0 0 196 Tramadol inj 50mg/5ml
0 0 0 0 0 197 Triheksifenidil Hidroklorida tablet 2 mg
0 0 0 0 0 198 Vaksin anti Rabies / Verorab
0 0 0 0 0 199 Vitamin B komplek tablet
0 0 0 0 0 200 Zinc sirup 20 mg/ 5 ml
0 0 0 0 0 201 Zinc Tab 20 mg
0 0 0 0 0
204 Alat suntik sekali pakai 0,05 ml
0 0 0 0 0 205 Alat suntik sekali pakai 0,5 ml
0 0 0 0 0 206 Alat suntik sekali pakai 1 ml
0 0 0 0 0 209 Alkohol Swab
0 0 0 0 0 210 Aqua bides 20 liter
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 211 Blood lanced
0 0 0 0 0 212 Catridge TCM
0 0 0 0 0 213 Cut gut chromic 3/0
0 0 0 0 0 215 Exell tulle
0 0 0 0 0 216 Foley cateter
0 0 0 0 0 217 Hand rub (0,5% clorhexidine+isoropyl 70%)
0 0 0 0 0 218 Hand scub (4% clorhexidine)
0 0 0 0 0 219 Handscoon steril uk 7
0 0 0 0 0 220 Handscoon steril uk 7,5
0 0 0 0 0 221 Handscoon uk 6,5
0 0 0 0 0 222 Handscoon uk 7
0 0 0 0 0 223 Handscoon S
0 0 0 0 0 224 Handscoon M
0 0 0 0 0 225 Handscoon L
0 0 0 0 0 226 Infus set anak
0 0 0 0 0 227 Infus set dewasa
0 0 0 0 0 228 IV Catheter No. 18 G
0 0 0 0 0 229 IV Catheter No. 20 G
0 0 0 0 0 230 IV Chateter No. 22 G
0 0 0 0 0 231 IV Catheter No. 24 G
0 0 0 0 0 232 IV Catheter No. 26 G
0 0 0 0 0 234 Kapas Pembalut / Absorben 250 gram
0 0 0 0 0 235 Kasa Pembalut Hidrofil 40 x 80 cm
0 0 0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya husada)
0 0 0 0 0 237 Kertas Puyer
0 0 0 0 0 238 Klip Plastik 10 x 7 KP
0 0 0 0 0 239 Klip Plastik 13x8,7 KP
0 0 0 0 0 240 Lisol 1liter
0 0 0 0 0 241 Masker ear loop
0 0 0 0 0 242 Masker head loop
0 0 0 0 0 243 Masker KN95
0 0 0 0 0 244 Plester 2,5 x 4,5
0 0 0 0 0 245 Plester 7,5 x 4,5
0 0 0 0 0 246 Silk ( Benang Bedah Sutera ) No. 3/0 dg
jarum bedah
0 0 0 0 0 247 Stefanol
0 0 0 0 0 248 Strip Asam urat 50 strip
0 0 0 0 0 249 Strip gula 50 strip
0 0 0 0 0 250 Strip kolesterol 50 strip
0 0 0 0 0 251 Umbilical cord nylon one med (Klem tali
pusat)
0 0 0 0 0 252 UnderPad_L
0 0 0 0 0 253 Urine Bag
0 0 0 0 0 254 Waterone
0BAT GIGI
0 0 0 0 0 260 Bonding / single bond
0 0 0 0 0 261 Devitalisasi Pasta (Non Arsen) / Denpro
0 0 0 0 0 262 Etching 3 M
0 0 0 0 0 263 Etil klorida spray
0 0 0 0 0 264 Eugenol
0 0 0 0 0 265 Glass Ionomer Cement (GC IX) ART
0 0 0 0 0 266 Imicryl / sealing of fissures
0 0 0 0 0 267 Kalsium Hidroksida Pasta
0 0 0 0 0 268 Klorfenol Kamfer Mentol (CHKM)
0 0 0 0 0 269 Mummifying Pasta
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 270 Nova compo A1
0 0 0 0 0 271 Nova compo A2
0 0 0 0 0 272 Nova compo A3
0 0 0 0 0 273 Nova compo A3,5
0 0 0 0 0 274 Nova compo HF A2
0 0 0 0 0 275 Semen Seng Fosfat serbuk / filling
0 0 0 0 0 276 Semen Seng Fosfat cairan / lutting
0 0 0 0 0 277 CAVITA Tambalan sementara
0 0 0 0 0 278 TKF
IMUNISASI RUTIN
0 0 0 0 0 281 BCG
0 0 0 0 0 282 CAMPAK
0 0 0 0 0 283 DT
0 0 0 0 0 284 HB.0 / HEP.B UNIJECT
0 0 0 0 0 285 IPV
0 0 0 0 0 286 PENTAVALEN / DPT-HB-HIB
0 0 0 0 0 287 POLIO
0 0 0 0 0 288 PCV
0 0 0 0 0 289 Td
0 0 0 0 0 290 MR
291 safety box
0 0 0 0 0
0 0 0 0 0 294 Becefort syr

0 0 0 0 0 295 Curcuma
0 0 0 0 0 296 Dextrofen syr
0 0 0 0 0 297 Dulcolac / bisakodil supp 10 mg
0 0 0 0 0 299 Febrinex syr
0 0 0 0 0 300 Herbacof
0 0 0 0 0 301 Noza
0 0 0 0 0 302 Pehavral
0 0 0 0 0 303 Stimuno forte
0 0 0 0 0 304 Stimuno syr
0 0 0 0 0 305 Sukralfat susp
0 0 0 0 0 306 Ichtiyol salp
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
322
JUMLAH KUNJUNGAN RESEP
............
Mengetahui/Menyetujui :
Petugas Gudang Farmasi Kepala Dinas Kesehatan
Puskesmas…………….. Kabupaten Tulang Bawang
…………………………………………… H.Fatoni, S.Kep,MM

NIP. .......................................... NIP.19730808 200501 1 008
3
: 1012244
: PENAWAR JAYA
: BANJAR MARGO
: TULANG BAWANG BULAN
: LAMPUNG TAHUN
STOK PENERIMAAN
HARGA HARGA PER LAIN- PERSEDIAA PENGELUARA
SATUAN KMSN SATUAN KEMASAN AWAL APBD I APBD II DAK ASKES LAIN TOTAL N N
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kapsul kotak 304 304 0 0 0
tablet 24 tab/Kotak 1,856 44,550 0 0 0
tablet 100 87 87 0 0 0
tablet/kotak
tablet 30 200 200 0 0 0
tablet/kotak
tablet 100 99 99 0 0 0
tablet/kotak
botol botol 60 ml - 3,300 0 0 0
tablet 100 - 8,593 0 0 0
tablet/kotak
tablet 100 - 8,000 0 0 0
tablet/kotak
ktk 30
ampul ampul@10 - 121,500 0 0 0
ml
100
tablet 177 177 0 0 0
tablet/kotak
tablet 30 53 53 0 0 0
tablet/kotak
tablet 30 - 5,610 0 0 0
tablet/kotak
vial 10 vial/kotak 8,591 8,591 0 0 0
tablet 100 - 38,799 0 0 0
tablet/kotak
tablet 100 201 201 0 0 0
tablet/kotak
botol botol 60 ml 3,498 3,498 0 0 0
tablet 100 - 20,115 0 0 0
tablet/kotak
botol botol 60 ml 1,694 1,694 0 0 0
tablet 100 54 54 0 0 0
tablet/kotak
tube 25 3,509 3,509 0 0 0
tube/kotak
supp 10 3,250 3,250 0 0 0
supp/kotak
pot 24 pot/kotak 3,477 3,477 0 0 0
tablet 100 - 51,800 0 0 0
tablet/kotak
tablet 100 185 185 0 0 0
tablet/botol
tablet 100 904 904 0 0 0
tablet/kotak
vial 10 vial/kotak 2,650 2,650 0 0 0
ampul 6 - 179,550 0 0 0
ampul/kotak
tablet 100 42 42 0 0 0
tablet/kotak
tablet 100 42 42 0 0 0
tablet/botol
tablet 100 111 111 0 0 0
tablet/kotak
tube 25 5,044 5,044 0 0 0
tube/kotak
tablet 100 - 52,404 0 0 0
tablet/kotak
tablet 100 405 405 0 0 0
tablet/kotak
ampul ampul 1,718 1,718 0 0 0
vial 10 vial/kotak 14,430 14,430 0 0 0
30
sachet tablet/sache 226 226 0 0 0
t
tube tube 2,997 2,997 0 0 0
tablet 100 65 65 0 0 0
tab/kotak
tablet 100 75 75 0 0 0
tablet/kotak
tablet 100 477 477 0 0 0
tablet/kotak
ampul 100 1,580 158,000 0 0 0
ampul/kotak
tablet 100 62 6,200 0 0 0
tablet/kotak
tablet 9 - 32,101 0 0 0
tablet/kotak
100 tablet /
tablet
kotak 70 70.0 0 0 0
100 tablet /
tablet
kotak 70 70.0 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
ampul 30 1,545 1,545 0 0 0
ampul/kotak
ampul 30 1,054 31,620 0 0 0
ampul/kotak
tablet 100 143 14,300 0 0 0
tablet/kotak
botol botol 3,333 3,333 0 0 0
botol botol 15,600 15,600 0 0 0
tablet 100 167 16,700 0 0 0
tablet/kotak
tablet 1000 38 38,000 0 0 0
tablet/botol
ampul 30 8,100 243,000 0 0 0
ampul/kotak
tablet tablet - 650 0 0 0
botol botol - 8,000 0 0 0
tablet 120 494 59,230 0 0 0
tablet/kotak
botol botol 7,220 7,220 0 0 0
botol 300 ml/botol 9,124 9,124 0 0 0
botol 1000 30,931 30,931 0 0 0
ml/botol
botol 60 ml/botol 3,740 3,740 0 0 0
botol 300 ml/botol 8,160 8,160 0 0 0
paket kotak 214,990 214,990 0 0 0
paket kotak - - 0 0 0
paket kotak 409,461 409,461 0 0 0
paket kotak 389,344 389,344 0 0 0
paket kotak 1,297,894 1,297,894 0 0 0
ampul ampul 20,250 20,250 0 0 0
kapsul botol 133 13,300 0 0 0
ampul 30 1,800 54,000 0 0 0
ampul/kotak
tablet 100 220 22,000 0 0 0
tablet/kotak
botol 24 2,042 49,008 0 0 0
botol/kotak
ampul 10 4,698 46,980 0 0 0
ampul/kotak
ampul 30 3,417 102,510 0 0 0
ampul/kotak
tablet 100 634 63,400 0 0 0
tablet/botol
ampul 25 1,829 45,725 0 0 0
ampul/kotak
tablet 100 85 8,500 0 0 0
tablet/kotak
sachet 100 292 29,200 0 0 0
sachet/kotak
tube tube 2,600 2,600 0 0 0
botol 5 ml/botol 3,194 3,194 0 0 0
ampul 5 3,355 3,355 0 0 0
ampul/kotak
botol botol - 900 0 0 0
tablet 101 82 82 0 0 0
tablet/kotak
tablet 50 - 21,800 0 0 0
tablet/kotak
tablet 1000 172 172 0 0 0
tablet/botol
tablet tablet - 1,500 0 0 0
ampul ampul 5,723 5,723 0 0 0
botol 500 ml/botol 5,700 5,700 0 0 0
botol botol 1,960 1,960 0 0 0
botol 500 ml/botol 6,627 6,627 0 0 0
tablet 100 210 210 0 0 0
tablet/kotak
ampul ampul 83,333 83,333 0 0 0
tablet 100 54 54 0 0 0
tablet/kotak
tablet 100 148 148 0 0 0
tablet/kotak
tablet 100 54 54 0 0 0
tablet/kotak
tiube 24 2,325 2,325 0 0 0
tube/kotak
botol botol 3,200 3,200 0 0 0
tablet 100 116 11,550 0 0 0
tablet/botol
tablet 100 tablet 190 190 0 0 0
tablet 100 86 86 0 0 0
tablet/kotak
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
tablet 100 60 60 0 0 0
tablet/kotak
tablet 100 243 24,300 0 0 0
tablet/kotak
tablet 50 554 27,675 0 0 0
tablet/kotak
tube 12 4,700 56,400 0 0 0
tube/kotak
tablet 100 1,823 182,250 0 0 0
tablet/kotak
ampul 5 - 40,400 0 0 0
ampul/kotak
ampul 6 847 847 0 0 0
ampul/kotak
tablet 50 382 19,100 0 0 0
tablet/kotak
tablet 50 527 26,350 0 0 0
tablet/kotak
tube tube 3,266 3,266 0 0 0
botol botol 1,599 1,599 0 0 0
tablet 100 51 5,100 0 0 0
tablet/kotak
ampul 30 1,021 30,630 0 0 0
ampul/kotak
ampul 30 950 28,500 0 0 0
ampul/kotak
tablet 100 149 14,900 0 0 0
tablet/kotak
tablet 100 600 600 0 0 0
tablet/kotak
botol botol 60 ml 2,190 2,190 0 0 0
tablet 100 126 126 0 0 0
tablet/kotak
ampul 1 82,042 82,042 0 0 0
ampul/kotak
ampul 30 847 847 0 0 0
ampul/kotak
ampul 30 803 803 0 0 0
ampul/kotak
tablet kotak 77 77 0 0 0
vial 10 vial/kotak - 20,780 0 0 0
vial 10 vial/kotak 4,090 4,090 0 0 0
tablet 30 - 6,840 0 0 0
tablet/kotak
tablet 100 39 39 0 0 0
tablet/kotak
tablet 100 224 224 0 0 0
tablet/kotak
ampul 30 1,023 1,023 0 0 0
ampul/kotak
tablet 30 102 102 0 0 0
tablet/kotak
tablet 100 206 206 0 0 0
tablet/kotak
ampul 10 2,070 20,700 0 0 0
ampul/kotak
tablet 100 120 120 0 0 0
tablet/kotak
botol botol 100 5,885 5,885 0 0 0
ml
tablet 100 - 19,305 0 0 0
tablet/kotak
tube tube - 3,000 0 0 0
sachet 40 - 98,000 0 0 0
sachet/kotak
ampul ampul 6,200 6,200 0 0 0
tablet 50 100 100 0 0 0
tablet/kotak
tablet kotak 174 8,700 0 0 0
botol botol 4,900 4,900 0 0 0
tablet 100 825 825 0 0 0
tablet/kotak
tablet 100 550 550 0 0 0
tablet/kotak
tablet 30 - 78,540 0 0 0
tablet/kotak
strip strip 31,760 31,760 0 0 0
strip strip 12,569 12,569 0 0 0
botol botol 6,044 6,044 0 0 0
tablet 100 - 20,650 0 0 0
tablet/kotak
tablet 100 - 32,700 0 0 0
tablet/kotak
tube 25 3,500 3,500 0 0 0
tube/kotak
ampul 100 1,126 1,126 0 0 0
ampul/kotak
tablet 30 407 407 0 0 0
tablet/kotak
tablet 30 - - 0 0 0
tablet/kotak
tablet 30 270 270 0 0 0
tablet/kotak
ampul ampul 881 881 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
tablet 100 - - 0 0 0
tablet/kotak
botol botol - - 0 0 0
60 ml botol 60 ml 1,160 1,160 0 0 0
tablet 100 222 222 0 0 0
tablet/kotak
botol botol 8,250 8,250 0 0 0
tablet 30 420 12,595 0 0 0
tablet/kotak
tablet 100 131 131 0 0 0
tablet/kotak
tablet 100 220 220 0 0 0
tablet/kotak
botol botol 60 ml 7,552 7,552 0 0 0
botol botol 300 ml 26,139 26,139 0 0 0
tablet 100 69 69 0 0 0
tablet/kotak
vial 30 vial/kotak 10,780 323,400 0 0 0
tablet 100 404 40,442 0 0 0
tablet/botol
ampul 25 814 814 0 0 0
ampul/kotak
tablet 100 85 85 0 0 0
kaplet/kotak
kapsul 50 553 553 0 0 0
kapsul/botol
kapsul 50 553 553 0 0 0
kapsul/botol
tablet kotak 124 124 0
botol botol 500 ml 7,630 7,630 0 0 0
tablet 100 67 67 0 0 0
tablet/kotak
tablet 100 - - 0 0 0
tablet/kotak
nebu nebu 22,200 22,200 0 0 0
ampul ampul 4,844 4,844 0 0 0
pot pot 2,333 2,333 0 0 0
kotak kotak - - 0 0 0
tablet 30 855 25,650 0 0 0
tablet/kotak
tablet 50 1,042 52,100 0 0 0
tablet/kotak
botol botol 3,800 3,800 0 0 0
vial 2 vial/kotak 2,850 2,850 0 0 0
vial vial 2,745 2,745 0 0 0
vial Dus, 10 vial 517,132 517,132 0 0 0
@ 5 ml
Dus, 10
ampul ampul @ 1 140,188 140,188 0 0 0
ml
100
tablet 49 49 0 0 0
tablet/kotak
ampul 100 916 91,600 0 0 0
ampul/kotak
tablet 100 45 45 0 0 0
tablet/kotak
tablet 50 150 150 0 0 0
tablet/kotak
tablet 100 248 248 0 0 0
tablet/kotak
ampul 30 - 20,700 0 0 0
ampul/kotak
tablet 1000 151 151 0 0 0
tablet/botol
ampul 5 5,400 27,000 0 0 0
ampul/kotak
tablet 100 63 63 0 0 0
tablet/kotak
Dus, 1 vial
vial @ 1 dosis + 154,391 154,391 0 0 0
syringe
100
tablet 57 57 0 0 0
tablet/kotak
botol botol 2,511 2,511 0 0 0
tablet 100 216 216 0 0 0
tablet/kotak
0 0 0
pcs kotak/ 100 1,210 1,210 0

psc
pcs kotak/ 100 1,190 1,190 0 0 0
psc
pcs kotak/ 100 100,344 100,344 0 0 0
psc
pcs kotak/ 100 100,344 100,344 0 0 0
psc
pcs kotak/ 100 104,734 104,734 0 0 0
psc
pcs kotak/ 100 14,100 14,100 0 0 0
psc
galon galon 174,000 174,000 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kotak kotak 16,893 16,893 0 0 0
TEST TEST 253,200 253,200 0 0 0
pcs 12 pcs/kotak 26,081 26,081 0 0 0
pcs kotak / psc - - 0 0 0
pcs pcs - - 0 0 0
botol botol 90,500 90,500 0 0 0
botol botol 42,863 42,863 0 0 0
pcs kotak 678,150 5,267 0 0 0
pcs kotak 678,150 5,270 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
set 50 set/kotak 9,047 82,500 0 0 0
set 50 set/kotak 7,755 339,250 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
Bungkus Bungkus 29,178 29,178 0 0 0
Rol Rol 226,350 226,350 0 0 0
16
pcs lembar/kota 7,641 7,641 0 0 0
k 10
ball/
pack - - 0 0 0
pack
pack ball/ 10 - - 0 0 0
pack
pack ball/ 10 - - 0 0 0
pack
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 82,700 82,700 0 0 0
Rol Rol 14,810 14,810 0 0 0
Rol Rol 43,300 43,300 0 0 0
pcs 36pcs/kotak 46,842 46,842 0 0 0
botol botol 69,300 69,300 0 0 0
box box 156,975 156,975 0 0 0
box box 161,000 161,000 0 0 0
box box 257,225 257,225 0 0 0
pcs kotak/ 50 - - 0 0 0
psc
pcs 10 100,848 100,848 0 0 0
pcs/kotak
Pcs Pcs - - 0 0 0
botol botol 15,246 15,246 0 0 0
- - 0
botol botol 246,000 246,000 0 0 0

paket kotak 390,000 390,000 0 0 0
botol botol 123,050 123,050 0 0 0
botol botol 175,010 175,010 0 0 0
botol botol 20,150 20,150 0 0 0
paket botol 423,800 423,800 0 0 0
botol botol 206,555 206,555 0 0 0
paket kotak 87,500 87,500 0 0 0
paket botol 52,500 52,500 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 299,100 299,100 0 0 0
paket botol 221,155 221,155 0 0 0
paket botol 321,300 321,300 0 0 0
botol botol 136,300 136,300 0 0 0
botol botol 57,640 57,640 0 0 0
0
ampul ampul 88,891 88,891.0 0 0 0
ampul ampul 28,204 28,204.0 0 0 0
ampul ampul 16,500 16,500.0 0 0 0
ampul ampul 23,490 23,490.0 0 0 0
vial vial 144,540 144,540.0 0 0 0
vial vial 77,366 77,366.0 0 0 0
ampul ampul 19,540 19,540.0 0 0 0
ampul ampul 0 0.0 0 0 0
ampul ampul 16,480 16,480.0 0 0 0
ampul ampul 151,150 151,150.0 0 0 0
pcs pcs 16,500 16,500.0 0

0 0 0
60
botol 17,523 17,523 0 0 0
mL/botol
kotak kotak 48,202 48,202 0 0 0
botol 60
botol 11,655 11,655 0 0 0
ml
supp supp 4,325 4,325 0 0 0
supp supp 5,085 5,085 0 0 0
Botol Botol 15,999 15,999 0 0 0

4
Tablet 2,498 2,498 0 0 0
tablet/strip
kotak 100
Tablet 805 805 0 0 0
tablet100
kotak
Tablet 993 993 0 0 0
tablet
10
Tablet 100 1,958 1,958 0 0 0
tablet/strip
Tablet tablet/kota 28,374 28,374 0 0 0
botol k
botol 5,034 5,034 0 0 0
kotak 100
kapsul 6,886 6,886 0 0 0
kapsul
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15

UMUM
TIDAK BAYAR
BAYAR
Yang Menyerahkan Yang Menerima/Melapor

Kepala Seksi Pelayanan Farmasi dan Kestrad Kepala UPT.Puskesmas Petugas Gudang Farmasi
Dinas Kesehatan Kab.Tulang Bawang Puskesmas……………..
Aziza, S.Kep …………………………………………… ……………………………………………

NIP. 19741011 200804 2 001 NIP. .......................................... NIP. ..........................................
LAPORAN PEMAKAIAN OBAT D

: Maret KABUPATEN : TULANG BAWANG
: 2023 PROPINSI : LAMPUNG
STOK PEMAKAIA
AKHIR N RATA- PERMINTAA HARGA HARGA PER
STOK AKHIR DALAM RATA S/D N NO NAMA OBAT SATUAN KMSN SATUAN KEMASAN
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 1 Acetil Cystein kapsul kotak 304 304
0 0 2 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550
0 0 0 3 Alopurinol tablet 100 mg tablet 100 87 87
tablet/kotak
0 0 0 4 Alopurinol tablet 300 mg tablet 30 200 200
tablet/kotak
0 0 0 5 Alprazolam tablet 1 mg tablet 100 99 99
tablet/kotak
0 0 0 6 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml - 3,300
0 0 0 7 Ambroxol tab 30 mg tablet 100 - 8,593
tablet/kotak
0 0 0 8 Aminofilin tablet 200mg tablet 100 - 8,000
tablet/kotak
ktk 30
0 0 0 9 Aminofilina injeksi 24 mg/ml ampul ampul@10 - 121,500
10 Amitriptillin tablet salut 25 mg ml
100
0 0 0 tablet 177 177
tablet/kotak
0 0 0 11 Amlodipine Tablet 5 mg tablet 30 53 53
tablet/kotak
0 0 0 12 Amlodipine Tablet 10 mg tablet 30 - 5,610
tablet/kotak
0 0 0 13 Amicillin 1000 mg inj vial 10 vial/kotak 8,591 8,591
0 0 0 14 Amoksisilin kapsul 250 mg tablet 100 - 38,799
tablet/kotak
0 0 0 15 Amoksisilin kapsul 500 mg tablet 100 201 201
tablet/kotak
0 0 0 16 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498 3,498
0 0 0 17 Antalgin (Metampiron) tablet 500 mg tablet 100 - 20,115
tablet/kotak
0 0 0 18 Antasida DOEN II suspensi komb botol botol 60 ml 1,694 1,694
0 0 0 19 Antasida DOEN tablet tablet 100 54 54
tablet/kotak
0 0 0 20 Anti Bakteri DOEN salep tube 25 3,509 3,509
kombinasi:Bacitracin-polymixin B krim tube/kotak
0 0 0 21 Anti Hemoroid DOEN Kombinasi supp 10 3,250 3,250
supp/kotak
0 0 0 22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477 3,477
0 0 0 23 Antimalaria DOEN kombinasi tablet 100 - 51,800
tablet/kotak
0 0 0 24 Antimigren: Ergotamin Tartrat 1mg +Kofein tablet 100 185 185
50mg
Antiparkinson DOEN tablet Kombinasi tablet/botol
0 0 0 25 benzerazid 25 mg levodopa 100 mg tablet 100 904 904
tablet/kotak
0 0 0 26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650 2,650
0 0 0 27 Arthemeter injeksi 1 ml : 80 mg ampul 6 - 179,550
ampul/kotak
0 0 0 28 Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 42 42
tablet/kotak
0 0 0 29 Asam folat tablet 1 mg tablet 100 42 42
tablet/botol
0 0 0 30 Asam Mefenamat tablet 500 mg tablet 100 111 111
tablet/kotak
0 0 0 31 Asiklovir krim 5% tube 25 5,044 5,044
tube/kotak
0 0 0 32 Asiklovir tablet 200 mg tablet 100 - 52,404
tablet/kotak
0 0 0 33 Asiklovir tablet 400 mg tablet 100 405 405
tablet/kotak
0 0 0 34 Atropin sulfat inj ampul ampul 1,718 1,718
0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt vial 10 vial/kotak 14,430 14,430
IU/vial 30
0 0 0 36 Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet tablet/sache 226 226
37 Betametason krim 0,1% t
0 0 0 tube tube 2,997 2,997
0 0 0 38 Captopril 12,5 mg tablet 100 65 65
tab/kotak
0 0 0 39 Captopril 25 mg tablet 100 75 75
tablet/kotak
0 0 0 40 Clozapine 25 mg tablet 100 477 477
tablet/kotak
0 0 0 41 Deksametason injeksi 5mg.ml-1ml ampul 100 1,580 158,000
ampul/kotak
0 0 0 42 Deksametason tablet 0,5 mg tablet 100 62 6,200
tablet/kotak
0 0 0 43 DHP tablet (Prog : malaria) tablet 9 - 32,101
tablet/kotak
44 Diazepam tab.2 mg 100 tablet /
0 0 0 tablet
kotak 70 70.0
0 0 0 tablet
kotak 70 70.0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 46 Diazepam inj 5 mg / ml ampul 30 1,545 1,545
ampul/kotak
0 0 0 47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 1,054 31,620
ampul/kotak
0 0 0 48 Digoksin tablet 0,25 mg tablet 100 143 14,300
tablet/kotak
0 0 0 49 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333
0 0 0 50 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600
0 0 0 51 Domperidone tablet 10mg tablet 100 167 16,700
tablet/kotak
0 0 0 52 Ekstrak Belladon tablet 10 mg tablet 1000 38 38,000
Epinefrina HCl/Bitartrat ( Epinefrina / tablet/botol
0 0 0 53 Adrenalina ) ampul 30 8,100 243,000
ml ampul/kotak
0 0 0 54 Ergakalsiferol D3/D2) kapsul 50000 tablet tablet - 650
UI/ml (D-Vit FT)
0 0 0 55 Ergakalsiferol (vitamin D3/D2) suspensi botol botol - 8,000
0 0 0 56 Eritromisin kapsul 250mg tablet 120 494 59,230
tablet/kotak
0 0 0 57 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220
0 0 0 58 Etanol 70% cairan botol 300 ml/botol 9,124 9,124
0 0 0 59 Etanol 96% cairan botol 1000 30,931 30,931
ml/botol
0 0 0 60 Etakridin / rivanol botol 60 ml/botol 3,740 3,740
0 0 0 61 Etakridin / rivanol botol 300 ml/botol 8,160 8,160
0 0 0 62 FDC kategori anak paket kotak 214,990 214,990
0 0 0 63 FDC OAT Sisipan paket kotak - -
0 0 0 64 FDC OAT Kategori I dosis harian paket kotak 409,461 409,461
0 0 0 65 FDC OAT Kategori I paket kotak 389,344 389,344
0 0 0 66 FDC OAT Kategori II paket kotak 1,297,894 1,297,894
0 0 0 67 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250
0 0 0 68 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300
0 0 0 69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 1,800 54,000
ampul/kotak
0 0 0 70 Fenobarbital tablet 100 mg tablet 100 220 22,000
tablet/kotak
0 0 0 71 Fenol Gliserol tetes telinga 10% botol 24 2,042 49,008
(Karbogliserin 10%) botol/kotak
0 0 0 72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul 10 4,698 46,980
ml ampul/kotak
0 0 0 73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 3,417 102,510
ampul/kotak
0 0 0 74 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 634 63,400
tablet/botol
0 0 0 75 Furosemid inj 40 mg/ml ampul 25 1,829 45,725
ampul/kotak
0 0 0 76 Furosemid tablet 40 mg tablet 100 85 8,500
tablet/kotak
0 0 0 77 Garam oralit untuk 200 ml air (Prog : diare) sachet 100 292 29,200
sachet/kotak
0 0 0 78 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600
0 0 0 79 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194
0 0 0 80 Gentamisin injeksi 40 mg/ml ampul 5 3,355 3,355
ampul/kotak
0 0 0 81 Gentian Violet larutan 1 % botol botol - 900
0 0 0 82 Glibenklamid tablet 5 mg tablet 101 82 82
tablet/kotak
0 0 0 83 Glimepiride tablet 2 mg tablet 50 - 21,800
tablet/kotak
0 0 0 84 Gliseril Guayacolat tablet 100 mg tablet 1000 172 172
tablet/botol
0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet - 1,500
0 0 0 86 Glukonas Kalsikus 10 % ampul ampul 5,723 5,723
0 0 0 87 Glukosa larutan infus 10% steril (Produk botol 500 ml/botol 5,700 5,700
lokal)
0 0 0 88 Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960
lokal)
0 0 0 89 Glukosa larutan infus 5% steril (Produk botol 500 ml/botol 6,627 6,627
lokal)
0 0 0 90 Griseofulvin tablet 125 mg, micronized tablet 100 210 210
tablet/kotak
0 0 0 91 Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333
0 0 0 92 Haloperidol tablet 5 mg tablet 100 54 54
tablet/kotak
0 0 0 93 HCT tablet 100 148 148
tablet/kotak
0 0 0 94 Haloperidol tablet 5 mg tablet 100 54 54
tablet/kotak
0 0 0 95 Hidrokortison krim 2,5% tiube 24 2,325 2,325
tube/kotak
0 0 0 96 Ibuprofen sirup 100mg / 5ml botol botol - 3,499
0 0 0 97 Ibuprofen suspensi 200mg / 5ml botol botol 3,200 3,200
0 0 0 98 Ibuprofen tablet 200 mg tablet 100 116 11,550
tablet/botol
0 0 0 99 Ibuprofen tablet 400 mg tablet 100 tablet 190 190
0 0 0 100 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 86 86
tablet/kotak
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 101 Kalsium Laktat tab 500 mg tablet 100 60 60
tablet/kotak
0 0 0 102 Karbamazepin tablet 200 mg tablet 100 243 24,300
tablet/kotak
0 0 0 103 Ketokenazol tablet 200mg tablet 50 554 27,675
tablet/kotak
0 0 0 104 Ketokonazol krim 2% tube 12 4,700 56,400
tube/kotak
0 0 0 105 Ketoprofen tablet 100 mg tablet 100 1,823 182,250
tablet/kotak
0 0 0 106 Ketorolak inj 10 mg ampul 5 - 40,400
ampul/kotak
0 0 0 107 Ketorolak inj 30 mg ampul 6 847 847
ampul/kotak
0 0 0 108 Klindamisin 150 mg tablet 50 382 19,100
tablet/kotak
0 0 0 109 Klindamisin 300 mg tablet 50 527 26,350
tablet/kotak
0 0 0 110 Kloramfenikol salp kulit / Bufacetin* tube tube 3,266 3,266
0 0 0 111 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599
0 0 0 112 Klorfeniramin Maleat (CTM) tablet tablet 100 51 5,100
tablet/kotak
0 0 0 114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 1,021 30,630
(SK.720 : kemasan 2 ml) ampul/kotak
0 0 0 115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 950 28,500
ampul/kotak
0 0 0 116 Klorpromazin HCl tablet salut 100 mg tablet 100 149 14,900
tablet/kotak
0 0 0 117 Kodein 10 mg tablet tablet 100 600 600
tablet/kotak
0 0 0 118 Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
0 0 0 119 Sulfametoksazol 400mg + Trimetoprim 80 tablet 100 126 126
tablet/kotak
0 0 0 120 mg
Lansoprazol inj 30 mg/ml ampul 1 82,042 82,042
ampul/kotak
0 0 0 121 Lidokain 2% ampul 30 847 847
ampul/kotak
0 0 0 122 Lidokain Kompositum ampul 30 803 803
ampul/kotak
0 0 0 123 Loperamide 2 mg tablet kotak 77 77
0 0 0 124 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak - 20,780
0 0 0 125 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090 4,090
0 0 0 126 Mebendazol tablet 100 mg tablet 30 - 6,840
tablet/kotak
0 0 0 127 Metformin tablet 100 39 39
tablet/kotak
0 0 0 128 Metilergometrin Maleat (Metilergometrin) tablet 100 224 224
tab salut 0,125 mg tablet/kotak
0 0 0 129 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 1,023 1,023
ampul/kotak
0 0 0 130 Metilprednisolon tablet 4 mg tablet 30 102 102
tablet/kotak
0 0 0 131 Metilprednisolon tablet 8 mg tablet 100 206 206
tablet/kotak
0 0 0 132 Metoklopramid inj 5 mg/ml ampul 10 2,070 20,700
ampul/kotak
0 0 0 133 Metoklopramid 5 mg tablet 100 120 120
tablet/kotak
0 0 0 134 Metronidazol Infus 500mg/100ml botol botol 100 5,885 5,885
ml
0 0 0 135 Metronidazol tablet 250 mg tablet 100 - 19,305
tablet/kotak
0 0 0 136 Metronidazol tablet 500 mg tablet kotak 403 403
0 0 0 137 Mikonazol krim/ salep 2 % tube tube - 3,000
0 0 0 138 Mineral mix (Prog. Gizi) sachet 40 - 98,000
sachet/kotak
0 0 0 139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200
0 0 0 140 Natrium Diklofenac 50 mg tablet 50 100 100
tablet/kotak
0 0 0 141 Natrium Diklofenak 25 mg tablet kotak 174 8,700
0 0 0 142 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900
(Produk lokal)
0 0 0 143 Nistatin tablet salut 500.000 IU tablet 100 825 825
tablet/kotak
0 0 0 144 Nistatin vaginal tablet 100.000 UI tablet 100 550 550
tablet/kotak
0 0 0 145 Noretisteron tablet 5 mg (Primolut N) tablet 30 - 78,540
tablet/kotak
0 0 0 146 Obat Kusta MB strip strip 31,760 31,760
0 0 0 147 Obat Kusta PB strip strip 12,569 12,569
0 0 0 148 Obat Batuk Hitam botol botol 6,044 6,044
0 0 0 149 Ofloxacin 200 mg Tab Salut Selulose tablet 100 - 20,650
tablet/kotak
0 0 0 150 Ofloxacin 400 mg Tab Salut Selulose tablet 100 - 32,700
tablet/kotak
0 0 0 151 Oksitetrasiklin HCl salep mata 1 % tube 25 3,500 3,500
tube/kotak
0 0 0 152 Oksitosin injeksi 10IU/ml-1ml ampul 100 1,126 1,126
ampul/kotak
0 0 0 153 Omeprazol kapsul 20mg tablet 30 407 407
tablet/kotak
0 0 0 154 ondansetron tablet 4 mg tablet 30 - -
tablet/kotak
0 0 0 155 ondansetron tablet 8 mg tablet 30 270 270
tablet/kotak
0 0 0 156 Ondansetron inj 4 mg/ 2 ml ampul ampul 881 881
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 157 Papaverin tablet 40mg tablet 100 - -
tablet/kotak
0 0 0 158 Paracetamol drop 100 mg/ml botol botol - -
0 0 0 159 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160 1,160
0 0 0 160 Parasetamol tablet 500 mg tablet 100 222 222
tablet/kotak
0 0 0 161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250
0 0 0 162 Pirantel tablet 125 mg tablet 30 420 12,595
tablet/kotak
0 0 0 163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 131 131
tablet/kotak
0 0 0 164 Piroksikam 20 mg tablet 100 220 220
tablet/kotak
0 0 0 165 Povidon Iodida larutan 10% botol botol 60 ml 7,552 7,552
0 0 0 166 Povidon Iodida larutan 10% botol botol 300 ml 26,139 26,139
0 0 0 167 Prednisone tablet 5 mg tablet 100 69 69
tablet/kotak
0 0 0 168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400
0 0 0 169 Propiltiourasil tablet 100 mg tablet 100 404 40,442
tablet/botol
0 0 0 170 Ranitidin inj.25mg/2ml ampul 25 814 814
ampul/kotak
0 0 0 171 Ranitidin tablet 150 mg tablet 100 85 85
kaplet/kotak
0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 553 553
Lunak kapsul/botol
0 0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 50 553 553
kapsul/botol
0 0 0 174 Riseridon 2 mg tablet kotak 124 124
0 0 0 175 Ringer Laktat larutan infus steril botol botol 500 ml 7,630 7,630
0 0 0 176 Salbutamol 2 mg tablet 100 67 67
tablet/kotak
0 0 0 177 Salbutamol 4 mg tablet 100 - -
tablet/kotak
0 0 0 178 Salbutamol inshalasi/ aerosol 100 nebu nebu 22,200 22,200
0 0 0 179 Salbutamol cairan 1 mg/ml ampul ampul 4,844 4,844
0 0 0 180 Salep 2-4 Komb : As Salisilat 2 % + Belerang pot pot 2,333 2,333
endap 2 %
0 0 0 181 Salisil Bedak 2% kotak kotak - -
0 0 0 182 Sefadroksil kapsul 250 mg tablet 30 855 25,650
tablet/kotak
0 0 0 183 Sefadroksil kapsul 500 mg tablet 50 1,042 52,100
tablet/kotak
0 0 0 184 sefadroksil sirup kering 125mg/5ml botol botol 3,800 3,800
0 0 0 185 Sefotaksim inj 1 gr vial 2 vial/kotak 2,850 2,850
0 0 0 186 Sefriakson serbuk injeksi 1 g/vial vial vial 2,745 2,745
0 0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial 517,132 517,132
(ABU I) @ 5 ml
Dus, 10
0 0 0 188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul ampul @ 1 140,188 140,188
(A.T.S) ml
0 0 0 189 Setrizin tablet 10 mg tablet 100 49 49
tablet/kotak
0 0 0 190 Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 916 91,600
ampul/kotak
0 0 0 191 Sianokobalamin (vit B12) tab 50 mcg tablet 100 45 45
tablet/kotak
0 0 0 192 Simvastatin tablet 10 mg tablet 50 150 150
tablet/kotak
0 0 0 193 Siproflaxacin tablet 500 mg tablet 100 248 248
tablet/kotak
0 0 0 194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 - 20,700
ampul/kotak
0 0 0 195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 151 151
mg tablet/botol
0 0 0 196 Tramadol inj 50mg/5ml ampul 5 5,400 27,000
ampul/kotak
0 0 0 197 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 63 63
tablet/kotak
Dus, 1 vial
0 0 0 198 Vaksin anti Rabies / Verorab vial @ 1 dosis + 154,391 154,391
199 Vitamin B komplek tablet syringe
100
0 0 0 tablet 57 57
tablet/kotak
0 0 0 200 Zinc sirup 20 mg/ 5 ml botol botol 2,511 2,511
0 0 0 201 Zinc Tab 20 mg tablet 100 216 216
tablet/kotak
0 0 0
204 Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 1,210 1,210
psc
0 0 0 205 Alat suntik sekali pakai 0,5 ml pcs kotak/ 100 1,190 1,190
psc
0 0 0 206 Alat suntik sekali pakai 1 ml pcs kotak/ 100 100,344 100,344
psc
psc
psc
0 0 0 209 Alkohol Swab pcs kotak/ 100 14,100 14,100
psc
0 0 0 210 Aqua bides 20 liter galon galon 174,000 174,000
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 211 Blood lanced kotak kotak 16,893 16,893
0 0 0 212 Catridge TCM TEST TEST 253,200 253,200
0 0 0 213 Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081 26,081
0 0 0 215 Exell tulle pcs kotak / psc - -
0 0 0 216 Foley cateter pcs pcs - -
0 0 0 217 Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500 90,500
0 0 0 218 Hand scub (4% clorhexidine) botol botol 42,863 42,863
0 0 0 219 Handscoon steril uk 7 pcs kotak 678,150 5,267
0 0 0 220 Handscoon steril uk 7,5 pcs kotak 678,150 5,270
0 0 0 221 Handscoon uk 6,5 50 pcs kotak 8,713 8,713
0 0 0 222 Handscoon uk 7 50 pcs kotak 8,713 8,713
0 0 0 223 Handscoon S 100 pcs kotak 87,601 87,601
0 0 0 224 Handscoon M 100 pcs kotak 87,601 87,601
0 0 0 225 Handscoon L 100 pcs kotak 87,601 87,601
0 0 0 226 Infus set anak set 50 set/kotak 9,047 82,500
0 0 0 227 Infus set dewasa set 50 set/kotak 7,755 339,250
0 0 0 228 IV Catheter No. 18 G set 50 set/kotak 7,044 385,000
0 0 0 230 IV Chateter No. 22 G set 50 set/kotak 7,044 385,000
0 0 0 234 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178 29,178
0 0 0 235 Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350 226,350
16
0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya pcs lembar/kota 7,641 7,641
husada) k 10
0 0 0 237 Kertas Puyer pack ball/ - -
pack
0 0 0 238 Klip Plastik 10 x 7 KP pack ball/ 10 - -
pack
0 0 0 239 Klip Plastik 13x8,7 KP pack ball/ 10 - -
pack
0 0 0 240 Lisol 1liter botol botol - -
0 0 0 241 Masker ear loop pcs 50 pcs/kotak 38,775 38,775
0 0 0 242 Masker head loop pcs 50 pcs/kotak 38,775 38,775
0 0 0 243 Masker KN95 pcs 50 pcs/kotak 82,700 82,700
0 0 0 244 Plester 2,5 x 4,5 Rol Rol 14,810 14,810
0 0 0 245 Plester 7,5 x 4,5 Rol Rol 43,300 43,300
0 0 0 246 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 46,842 46,842
jarum bedah
0 0 0 247 Stefanol botol botol 69,300 69,300
0 0 0 248 Strip Asam urat 50 strip box box 156,975 156,975
0 0 0 249 Strip gula 50 strip box box 161,000 161,000
0 0 0 250 Strip kolesterol 50 strip box box 257,225 257,225
0 0 0 251 Umbilical cord nylon one med (Klem tali pcs kotak/ 50 - -
pusat) psc
0 0 0 252 UnderPad_L pcs 10 100,848 100,848
pcs/kotak
0 0 0 253 Urine Bag Pcs Pcs - -
0 0 0 254 Waterone botol botol 15,246 15,246
- -
0BAT GIGI
0 0 0 260 Bonding / single bond botol botol 246,000 246,000
0 0 0 261 Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000 390,000
0 0 0 262 Etching 3 M botol botol 123,050 123,050
0 0 0 263 Etil klorida spray botol botol 175,010 175,010
0 0 0 264 Eugenol botol botol 20,150 20,150
0 0 0 265 Glass Ionomer Cement (GC IX) ART paket botol 423,800 423,800
0 0 0 266 Imicryl / sealing of fissures botol botol 206,555 206,555
0 0 0 267 Kalsium Hidroksida Pasta paket kotak 87,500 87,500
0 0 0 268 Klorfenol Kamfer Mentol (CHKM) paket botol 52,500 52,500
0 0 0 269 Mummifying Pasta kotak kotak - -
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
0 0 0 270 Nova compo A1 syr botol 242,295 242,295
0 0 0 273 Nova compo A3,5 syr botol 242,295 242,295
0 0 0 274 Nova compo HF A2 syr botol 299,100 299,100
0 0 0 275 Semen Seng Fosfat serbuk / filling paket botol 221,155 221,155
0 0 0 276 Semen Seng Fosfat cairan / lutting paket botol 321,300 321,300
0 0 0 277 CAVITA Tambalan sementara botol botol 136,300 136,300
0 0 0 278 TKF botol botol 57,640 57,640
IMUNISASI RUTIN
0 0 0 281 BCG ampul ampul 88,891 88,891.0

0 0 0 282 CAMPAK ampul ampul 28,204 28,204.0
0 0 0 283 DT ampul ampul 16,500 16,500.0
0 0 0 284 HB.0 / HEP.B UNIJECT ampul ampul 23,490 23,490.0
0 0 0 285 IPV vial vial 144,540 144,540.0
0 0 0 286 PENTAVALEN / DPT-HB-HIB vial vial 77,366 77,366.0
0 0 0 287 POLIO ampul ampul 19,540 19,540.0
0 0 0 288 PCV ampul ampul 0 0.0
0 0 0 289 Td ampul ampul 16,480 16,480.0
0 0 0 290 MR ampul ampul 151,150 151,150.0
291 safety box pcs pcs 16,500 16,500.0
0 0 0
294 Becefort syr 60

0 0 0 botol 17,523 17,523
mL/botol
0 0 0 295 Curcuma kotak kotak 48,202 48,202
296 Dextrofen syr botol 60
0 0 0 botol 11,655 11,655
ml
0 0 0 297 Dulcolac / bisakodil supp 10 mg supp supp 4,325 4,325
0 0 0 298 Dulcolac / bisakodil supp 5 mg supp supp 5,085 5,085
0 0 0 299 Febrinex syr Botol Botol 15,999 15,999
300 Herbacof 4
0 0 0 Tablet 2,498 2,498
tablet/strip
kotak 100
0 0 0 301 Noza Tablet 805 805
tablet100
kotak
0 0 0 302 Pehavral Tablet 993 993
tablet
10
0 0 0 303 Stimuno forte Tablet 1,958 1,958
100
tablet/strip
0 0 0 304 Stimuno syr Tablet tablet/kota 28,374 28,374
0 0 0 305 Sukralfat susp botol k
botol 5,034 5,034
306 Ichtiyol salp kotak 100
0 0 0 kapsul 6,886 6,886
kapsul
307 140,337 140,337
308 27,088 27,088
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5 6
322
0
JUMLAH TOTAL SISA STOK BULA
UMUM

BAYAR
............
Mengetahui/Menyetujui : Yang Menyerahkan

Kepala Dinas Kesehatan Kepala Seksi Pelayanan Farmasi dan Kestrad
H.Fatoni, S.Kep,MM Aziza, S.Kep

NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001
4
AN PEMAKAIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : April KABUPATEN
STOK PENERIMAAN STOK PEMAKAIA

AWAL APBD I APBD II DAK ASKES LAIN TOTAL N N AKHIR DALAM RATA S/D N NO
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 1
0 0 0 0 0 2
0 0 0 0 0 0 3
0 0 0 0 0 0 4
0 0 0 0 0 0 5
0 0 0 0 0 0 6
0 0 0 0 0 0 7
0 0 0 0 0 0 8
0 0 0 0 0 0 9
0 0 0 0 0 0 10
0 0 0 0 0 0 11
0 0 0 0 0 0 12
0 0 0 0 0 0 13
0 0 0 0 0 0 14
0 0 0 0 0 0 15
0 0 0 0 0 0 16
0 0 0 0 0 0 17
0 0 0 0 0 0 18
0 0 0 0 0 0 19
0 0 0 0 0 0 20
0 0 0 0 0 0 21
0 0 0 0 0 0 22
0 0 0 0 0 0 23
0 0 0 0 0 0 24
0 0 0 0 0 0 25
0 0 0 0 0 0 26
0 0 0 0 0 0 27
0 0 0 0 0 0 28
0 0 0 0 0 0 29
0 0 0 0 0 0 30
0 0 0 0 0 0 31
0 0 0 0 0 0 32
0 0 0 0 0 0 33
0 0 0 0 0 0 34
0 0 0 0 0 0 35
0 0 0 0 0 0 36
0 0 0 0 0 0 37
0 0 0 0 0 0 38
0 0 0 0 0 0 39
0 0 0 0 0 0 40
0 0 0 0 0 0 41
0 0 0 0 0 0 42
0 0 0 0 0 0 43
0 0 0 0 0 0 44
0 0 0 0 0 0 45
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 46
0 0 0 0 0 0 47
0 0 0 0 0 0 48
0 0 0 0 0 0 49
0 0 0 0 0 0 50
0 0 0 0 0 0 51
0 0 0 0 0 0 52
0 0 0 0 0 0 53
0 0 0 0 0 0 54
0 0 0 0 0 0 55
0 0 0 0 0 0 56
0 0 0 0 0 0 57
0 0 0 0 0 0 58
0 0 0 0 0 0 59
0 0 0 0 0 0 60
0 0 0 0 0 0 61
0 0 0 0 0 0 62
0 0 0 0 0 0 63
0 0 0 0 0 0 64
0 0 0 0 0 0 65
0 0 0 0 0 0 66
0 0 0 0 0 0 67
0 0 0 0 0 0 68
0 0 0 0 0 0 69
0 0 0 0 0 0 70
0 0 0 0 0 0 71
0 0 0 0 0 0 72
0 0 0 0 0 0 73
0 0 0 0 0 0 74
0 0 0 0 0 0 75
0 0 0 0 0 0 76
0 0 0 0 0 0 77
0 0 0 0 0 0 78
0 0 0 0 0 0 79
0 0 0 0 0 0 80
0 0 0 0 0 0 81
0 0 0 0 0 0 82
0 0 0 0 0 0 83
0 0 0 0 0 0 84
0 0 0 0 0 0 85
0 0 0 0 0 0 86
0 0 0 0 0 0 87
0 0 0 0 0 0 88
0 0 0 0 0 0 89
0 0 0 0 0 0 90
0 0 0 0 0 0 91
0 0 0 0 0 0 92
0 0 0 0 0 0 93
0 0 0 0 0 0 94
0 0 0 0 0 0 95
0 0 0 0 0 0 96
0 0 0 0 0 0 97
0 0 0 0 0 0 98
0 0 0 0 0 0 99
0 0 0 0 0 0 100
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 101
0 0 0 0 0 0 102
0 0 0 0 0 0 103
0 0 0 0 0 0 104
0 0 0 0 0 0 105
0 0 0 0 0 0 106
0 0 0 0 0 0 107
0 0 0 0 0 0 108
0 0 0 0 0 0 109
0 0 0 0 0 0 110
0 0 0 0 0 0 111
0 0 0 0 0 0 112
0 0 0 0 0 0 114
0 0 0 0 0 0 115
0 0 0 0 0 0 116
0 0 0 0 0 0 117
0 0 0 0 0 0 118
0 0 0 0 0 0 119
0 0 0 0 0 0 120
0 0 0 0 0 0 121
0 0 0 0 0 0 122
0 0 0 0 0 0 123
0 0 0 0 0 0 124
0 0 0 0 0 0 125
0 0 0 0 0 0 126
0 0 0 0 0 0 127
0 0 0 0 0 0 128
0 0 0 0 0 0 129
0 0 0 0 0 0 130
0 0 0 0 0 0 131
0 0 0 0 0 0 132
0 0 0 0 0 0 133
0 0 0 0 0 0 134
0 0 0 0 0 0 135
0 0 0 0 0 0 136
0 0 0 0 0 0 137
0 0 0 0 0 0 138
0 0 0 0 0 0 139
0 0 0 0 0 0 140
0 0 0 0 0 0 141
0 0 0 0 0 0 142
0 0 0 0 0 0 143
0 0 0 0 0 0 144
0 0 0 0 0 0 145
0 0 0 0 0 0 146
0 0 0 0 0 0 147
0 0 0 0 0 0 148
0 0 0 0 0 0 149
0 0 0 0 0 0 150
0 0 0 0 0 0 151
0 0 0 0 0 0 152
0 0 0 0 0 0 153
0 0 0 0 0 0 154
0 0 0 0 0 0 155
0 0 0 0 0 0 156
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 157
0 0 0 0 0 0 158
0 0 0 0 0 0 159
0 0 0 0 0 0 160
0 0 0 0 0 0 161
0 0 0 0 0 0 162
0 0 0 0 0 0 163
0 0 0 0 0 0 164
0 0 0 0 0 0 165
0 0 0 0 0 0 166
0 0 0 0 0 0 167
0 0 0 0 0 0 168
0 0 0 0 0 0 169
0 0 0 0 0 0 170
0 0 0 0 0 0 171
0 0 0 0 0 0 172
0 0 0 0 0 0 173
0 0 0 0 174
0 0 0 0 0 0 175
0 0 0 0 0 0 176
0 0 0 0 0 0 177
0 0 0 0 0 0 178
0 0 0 0 0 0 179
0 0 0 0 0 0 180
0 0 0 0 0 0 181
0 0 0 0 0 0 182
0 0 0 0 0 0 183
0 0 0 0 0 0 184
0 0 0 0 0 0 185
0 0 0 0 0 0 186
0 0 0 0 0 0 187
0 0 0 0 0 0 188
0 0 0 0 0 0 189
0 0 0 0 0 0 190
0 0 0 0 0 0 191
0 0 0 0 0 0 192
0 0 0 0 0 0 193
0 0 0 0 0 0 194
0 0 0 0 0 0 195
0 0 0 0 0 0 196
0 0 0 0 0 0 197
0 0 0 0 0 0 198
0 0 0 0 0 0 199
0 0 0 0 0 0 200
0 0 0 0 0 0 201
0 0 0 0 0 0
0 204
0 0 0 0 0 0 205
0 0 0 0 0 0 206
0 0 0 0 0 0 207
0 0 0 0 0 0 208
0 0 0 0 0 0 209
0 0 0 0 0 0 210
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 211
0 0 0 0 0 0 212
0 0 0 0 0 0 213
0 0 0 0 0 0 215
0 0 0 0 0 0 216
0 0 0 0 0 0 217
0 0 0 0 0 0 218
0 0 0 0 0 0 219
0 0 0 0 0 0 220
0 0 0 0 0 0 221
0 0 0 0 0 0 222
0 0 0 0 0 0 223
0 0 0 0 0 0 224
0 0 0 0 0 0 225
0 0 0 0 0 0 226
0 0 0 0 0 0 227
0 0 0 0 0 0 228
0 0 0 0 0 0 229
0 0 0 0 0 0 230
0 0 0 0 0 0 231
0 0 0 0 0 0 232
0 0 0 0 0 0 234
0 0 0 0 0 0 235
0 0 0 0 0 0 236
0 0 0 0 0 0 237
0 0 0 0 0 0 238
0 0 0 0 0 0 239
0 0 0 0 0 0 240
0 0 0 0 0 0 241
0 0 0 0 0 0 242
0 0 0 0 0 0 243
0 0 0 0 0 0 244
0 0 0 0 0 0 245
0 0 0 0 0 0 246
0 0 0 0 0 0 247
0 0 0 0 0 0 248
0 0 0 0 0 0 249
0 0 0 0 0 0 250
0 0 0 0 0 0 251
0 0 0 0 0 0 252
0 0 0 0 0 0 253
0 0 0 0 0 0 254
0
0 0 0 0 0 0 260
0 0 0 0 0 0 261
0 0 0 0 0 0 262
0 0 0 0 0 0 263
0 0 0 0 0 0 264
0 0 0 0 0 0 265
0 0 0 0 0 0 266
0 0 0 0 0 0 267
0 0 0 0 0 0 268
0 0 0 0 0 0 269
7 8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 0 270
0 0 0 0 0 0 271
0 0 0 0 0 0 272
0 0 0 0 0 0 273
0 0 0 0 0 0 274
0 0 0 0 0 0 275
0 0 0 0 0 0 276
0 0 0 0 0 0 277
0 0 0 0 0 0 278
0
0 0 0 0 0 0 281
0 0 0 0 0 0 282
0 0 0 0 0 0 283
0 0 0 0 0 0 284
0 0 0 0 0 0 285
0 0 0 0 0 0 286
0 0 0 0 0 0 287
0 0 0 0 0 0 288
0 0 0 0 0 0 289
0 0 0 0 0 0 290
0 291
0 0 0 0 0 0
0 0 0 0 0 0 294
0 0 0 0 0 0 295
0 0 0 0 0 0 296
0 0 0 0 0 0 297
0 0 0 0 0 0 298
0 0 0 0 0 0 299
0 0 0 0 0 0 300
0 0 0 0 0 0 301
0 0 0 0 0 0 302
0 0 0 0 0 0 303
0 0 0 0 0 0 304
0 0 0 0 0 0 305
0 0 0 0 0 0 306
0 307
0 308
309
310
311
312
313
314
315
316
317
318
319
320
321
7 8 9 10 11 12 13 14 15 16 17 18 19 1
322
AL SISA STOK BULAN INI (Rp.) 0
Yang Menerima/Melapor
n Kestrad Kepala UPT.Puskesmas Petugas Gudang Farmasi
…………………………………………… ……………………………………………
NIP. .......................................... NIP. ..........................................
5
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
PROPINSI : LAMPUNG
STOK PENERIMAAN
HARGA HARGA PER LAIN-
NAMA OBAT SATUAN KMSN SATUAN KEMASAN AWAL APBD I APBD II DAK ASKES LAIN
(………..)
2 3 4 5 6 7 8 9 10 11 12
Alopurinol tablet 100 mg tablet 100 87 87 0
tablet/kotak
Alopurinol tablet 300 mg tablet 30 200 200 0
tablet/kotak
Alprazolam tablet 1 mg tablet 100 99 99 0
tablet/kotak
Ambroxol tab 30 mg tablet 100 - 8,593 0
tablet/kotak
Aminofilin tablet 200mg tablet 100 - 8,000 0
tablet/kotak
ktk 30
Aminofilina injeksi 24 mg/ml ampul ampul@10 - 121,500 0
ml
100
Amitriptillin tablet salut 25 mg tablet 177 177 0
tablet/kotak
Amlodipine Tablet 5 mg tablet 30 53 53 0
tablet/kotak
Amlodipine Tablet 10 mg tablet 30 - 5,610 0
tablet/kotak
Amoksisilin kapsul 250 mg tablet 100 - 38,799 0
tablet/kotak
Amoksisilin kapsul 500 mg tablet 100 201 201 0
tablet/kotak
Antalgin (Metampiron) tablet 500 mg tablet 100 - 20,115 0
tablet/kotak
Antasida DOEN tablet tablet 100 54 54 0
tablet/kotak
Anti Bakteri DOEN salep tube 25 3,509 3,509 0
Anti Hemoroid DOEN Kombinasi supp 10 3,250 3,250 0
supp/kotak
Antimalaria DOEN kombinasi tablet 100 - 51,800 0
tablet/kotak
Antimigren: Ergotamin Tartrat 1mg +Kofein tablet 100 185 185 0
50mg
benzerazid 25 mg levodopa 100 mg tablet 100 904 904 0
( Levopar) tablet/kotak
Arthemeter injeksi 1 ml : 80 mg ampul 6 - 179,550 0
ampul/kotak
Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 42 42 0
tablet/kotak
Asam folat tablet 1 mg tablet 100 42 42 0
tablet/botol
Asam Mefenamat tablet 500 mg tablet 100 111 111 0
tablet/kotak
Asiklovir krim 5% tube 25 5,044 5,044 0
tube/kotak
Asiklovir tablet 200 mg tablet 100 - 52,404 0
tablet/kotak
Asiklovir tablet 400 mg tablet 100 405 405 0
tablet/kotak
Benzatin Benzil Penicillin injeksi 1,2 jt IU/vial vial 10 vial/kotak 14,430 14,430 0
30
Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet tablet/sache 226 226 0
t
Captopril 12,5 mg tablet 100 65 65 0
tab/kotak
Captopril 25 mg tablet 100 75 75 0
tablet/kotak
Clozapine 25 mg tablet 100 477 477 0
tablet/kotak
Deksametason injeksi 5mg.ml-1ml ampul 100 1,580 158,000 0
ampul/kotak
Deksametason tablet 0,5 mg tablet 100 62 6,200 0
tablet/kotak
DHP tablet (Prog : malaria) tablet 9 - 32,101 0
tablet/kotak
100 tablet /
Diazepam tab.2 mg tablet
kotak 70 70.0 0
100 tablet /
Diazepam tab.5 mg tablet
kotak 70 70.0 0
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12
Diazepam inj 5 mg / ml ampul 30 1,545 1,545 0
ampul/kotak
Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 1,054 31,620 0
ampul/kotak
Digoksin tablet 0,25 mg tablet 100 143 14,300 0
tablet/kotak
Domperidone tablet 10mg tablet 100 167 16,700 0
tablet/kotak
Ekstrak Belladon tablet 10 mg tablet 1000 38 38,000 0
Adrenalina ) ampul 30 8,100 243,000 0
ml ampul/kotak
Ergakalsiferol D3/D2) kapsul 50000 tablet tablet - 650 0
UI/ml (D-Vit FT)
Eritromisin kapsul 250mg tablet 120 494 59,230 0
tablet/kotak
Etanol 96% cairan botol 1000 30,931 30,931 0
ml/botol
Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 1,800 54,000 0
ampul/kotak
Fenobarbital tablet 100 mg tablet 100 220 22,000 0
tablet/kotak
Fenol Gliserol tetes telinga 10% botol 24 2,042 49,008 0
Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul 10 4,698 46,980 0
ml ampul/kotak
Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 3,417 102,510 0
ampul/kotak
Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 634 63,400 0
tablet/botol
Furosemid inj 40 mg/ml ampul 25 1,829 45,725 0
ampul/kotak
Furosemid tablet 40 mg tablet 100 85 8,500 0
tablet/kotak
Garam oralit untuk 200 ml air (Prog : diare) sachet 100 292 29,200 0
sachet/kotak
Gentamisin injeksi 40 mg/ml ampul 5 3,355 3,355 0
ampul/kotak
Glibenklamid tablet 5 mg tablet 101 82 82 0
tablet/kotak
Glimepiride tablet 2 mg tablet 50 - 21,800 0
tablet/kotak
Gliseril Guayacolat tablet 100 mg tablet 1000 172 172 0
tablet/botol
Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet - 1,500 0
lokal)
lokal)
lokal)
Griseofulvin tablet 125 mg, micronized tablet 100 210 210 0
tablet/kotak
Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
Haloperidol tablet 5 mg tablet 100 54 54 0
tablet/kotak
HCT tablet 100 148 148 0
tablet/kotak
Haloperidol tablet 5 mg tablet 100 54 54 0
tablet/kotak
Hidrokortison krim 2,5% tiube 24 2,325 2,325 0
tube/kotak
Ibuprofen tablet 200 mg tablet 100 116 11,550 0
tablet/botol
Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 86 86 0
tablet/kotak
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12
Kalsium Laktat tab 500 mg tablet 100 60 60 0
tablet/kotak
Karbamazepin tablet 200 mg tablet 100 243 24,300 0
tablet/kotak
Ketokenazol tablet 200mg tablet 50 554 27,675 0
tablet/kotak
Ketokonazol krim 2% tube 12 4,700 56,400 0
tube/kotak
Ketoprofen tablet 100 mg tablet 100 1,823 182,250 0
tablet/kotak
Ketorolak inj 10 mg ampul 5 - 40,400 0
ampul/kotak
Ketorolak inj 30 mg ampul 6 847 847 0
ampul/kotak
Klindamisin 150 mg tablet 50 382 19,100 0
tablet/kotak
Klindamisin 300 mg tablet 50 527 26,350 0
tablet/kotak
Klorfeniramin Maleat (CTM) tablet tablet 100 51 5,100 0
tablet/kotak
Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 1,021 30,630 0
Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 950 28,500 0
ampul/kotak
Klorpromazin HCl tablet salut 100 mg tablet 100 149 14,900 0
tablet/kotak
Kodein 10 mg tablet tablet 100 600 600 0
tablet/kotak
Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190 0
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
Sulfametoksazol 400mg + Trimetoprim 80 tablet 100 126 126 0
mg tablet/kotak
Lansoprazol inj 30 mg/ml ampul 1 82,042 82,042 0
ampul/kotak
Lidokain 2% ampul 30 847 847 0
ampul/kotak
Lidokain Kompositum ampul 30 803 803 0
ampul/kotak
Mebendazol tablet 100 mg tablet 30 - 6,840 0
tablet/kotak
Metformin tablet 100 39 39 0
tablet/kotak
Metilergometrin Maleat (Metilergometrin) tablet 100 224 224 0
Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 1,023 1,023 0
ampul/kotak
Metilprednisolon tablet 4 mg tablet 30 102 102 0
tablet/kotak
Metilprednisolon tablet 8 mg tablet 100 206 206 0
tablet/kotak
Metoklopramid inj 5 mg/ml ampul 10 2,070 20,700 0
ampul/kotak
Metoklopramid 5 mg tablet 100 120 120 0
tablet/kotak
Metronidazol Infus 500mg/100ml botol botol 100 5,885 5,885 0
ml
Metronidazol tablet 250 mg tablet 100 - 19,305 0
tablet/kotak
Mineral mix (Prog. Gizi) sachet 40 - 98,000 0
sachet/kotak
Natrium Diklofenac 50 mg tablet 50 100 100 0
tablet/kotak
(Produk lokal)
Nistatin tablet salut 500.000 IU tablet 100 825 825 0
tablet/kotak
Nistatin vaginal tablet 100.000 UI tablet 100 550 550 0
tablet/kotak
Noretisteron tablet 5 mg (Primolut N) tablet 30 - 78,540 0
tablet/kotak
Ofloxacin 200 mg Tab Salut Selulose tablet 100 - 20,650 0
tablet/kotak
Ofloxacin 400 mg Tab Salut Selulose tablet 100 - 32,700 0
tablet/kotak
Oksitetrasiklin HCl salep mata 1 % tube 25 3,500 3,500 0
tube/kotak
Oksitosin injeksi 10IU/ml-1ml ampul 100 1,126 1,126 0
ampul/kotak
Omeprazol kapsul 20mg tablet 30 407 407 0
tablet/kotak
ondansetron tablet 4 mg tablet 30 - - 0
tablet/kotak
ondansetron tablet 8 mg tablet 30 270 270 0
tablet/kotak
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12
Papaverin tablet 40mg tablet 100 - - 0
tablet/kotak
Parasetamol tablet 500 mg tablet 100 222 222 0
tablet/kotak
Pirantel tablet 125 mg tablet 30 420 12,595 0
tablet/kotak
Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 131 131 0
tablet/kotak
Piroksikam 20 mg tablet 100 220 220 0
tablet/kotak
Prednisone tablet 5 mg tablet 100 69 69 0
tablet/kotak
Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400 0
Propiltiourasil tablet 100 mg tablet 100 404 40,442 0
tablet/botol
Ranitidin inj.25mg/2ml ampul 25 814 814 0
ampul/kotak
Ranitidin tablet 150 mg tablet 100 85 85 0
kaplet/kotak
Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 553 553 0
Lunak kapsul/botol
Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 50 553 553 0
kapsul/botol
Salbutamol 2 mg tablet 100 67 67 0
tablet/kotak
Salbutamol 4 mg tablet 100 - - 0
tablet/kotak
Salep 2-4 Komb : As Salisilat 2 % + Belerang pot pot 2,333 2,333 0
endap 2 %
Sefadroksil kapsul 250 mg tablet 30 855 25,650 0
tablet/kotak
Sefadroksil kapsul 500 mg tablet 50 1,042 52,100 0
tablet/kotak
Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial 517,132 517,132 0
(ABU I) @ 5 ml
Dus, 10
Serum Anti Tetanus injeksi 1.500 IU/ampul ampul ampul @ 1 140,188 140,188 0
(A.T.S) ml
Setrizin tablet 10 mg tablet 100 49 49 0
tablet/kotak
Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 916 91,600 0
ampul/kotak
Sianokobalamin (vit B12) tab 50 mcg tablet 100 45 45 0
tablet/kotak
Simvastatin tablet 10 mg tablet 50 150 150 0
tablet/kotak
Siproflaxacin tablet 500 mg tablet 100 248 248 0
tablet/kotak
Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 - 20,700 0
ampul/kotak
Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 151 151 0
mg tablet/botol
Tramadol inj 50mg/5ml ampul 5 5,400 27,000 0
ampul/kotak
Triheksifenidil Hidroklorida tablet 2 mg tablet 100 63 63 0
tablet/kotak
Dus, 1 vial
Vaksin anti Rabies / Verorab vial @ 1 dosis + 154,391 154,391 0
syringe
100
Vitamin B komplek tablet tablet 57 57 0
tablet/kotak
Zinc Tab 20 mg tablet 100 216 216 0
tablet/kotak
0
Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 1,210 1,210 0
psc
Alat suntik sekali pakai 0,5 ml pcs kotak/ 100 1,190 1,190 0
psc
Alat suntik sekali pakai 1 ml pcs kotak/ 100 100,344 100,344 0
psc
psc
psc
Alkohol Swab pcs kotak/ 100 14,100 14,100 0
psc
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12
Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500 90,500 0
16
Kassa Hidrofil steril uk. 16x16 (surya pcs lembar/kota 7,641 7,641 0
husada) k 10
Kertas Puyer pack ball/ - - 0
pack
Klip Plastik 10 x 7 KP pack ball/ 10 - - 0
pack
Klip Plastik 13x8,7 KP pack ball/ 10 - - 0
pack
Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
jarum bedah
Umbilical cord nylon one med (Klem tali pcs kotak/ 50 - - 0
pusat) psc
UnderPad_L pcs 10 100,848 100,848 0
pcs/kotak
- - 0
0BAT GIGI
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12
0
IMUNISASI RUTIN
BCG ampul ampul 88,891 88,891.0 0

DT ampul ampul 16,500 16,500.0 0
IPV vial vial 144,540 144,540.0 0
Td ampul ampul 16,480 16,480.0 0
MR ampul ampul 151,150 151,150.0 0
0

60
Becefort syr botol 17,523 17,523 0
mL/botol
botol 60
Dextrofen syr botol 11,655 11,655 0
ml
4
Herbacof Tablet 2,498 2,498 0
tablet/strip
kotak 100
Noza Tablet 805 805 0
tablet100
kotak
Pehavral Tablet 993 993 0
tablet
10
Stimuno forte Tablet 100 1,958 1,958 0
tablet/strip
Stimuno syr Tablet tablet/kota 28,374 28,374 0
Sukralfat susp botol k
botol 5,034 5,034 0
kotak 100
Ichtiyol salp kapsul 6,886 6,886 0
kapsul
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
(………..)
2 3 4 5 6 7 8 9 10 11 12

UMUM

BAYAR
............

H.Fatoni, S.Kep,MM Aziza, S.Kep …………………………………………… …………………

NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001 NIP. ..........................................
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
BULAN : Mei KABUPATEN : TULANG BAWANG
TAHUN : 2023 PROPINSI : LAMPUNG
STOK PEMAKAIA
PERSEDIAA PENGELUARA STOK AKHIR N RATA- PERMINTAA
TOTAL N N AKHIR DALAM RATA S/D N NO NAMA OBAT SATUAN
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 1 Acetil Cystein kapsul
0 0 0 0 2 ACT (Artesunat + Amodiaquin ) tablet tablet
0 0 0 0 0 3 Alopurinol tablet 100 mg tablet
0 0 0 0 0 4 Alopurinol tablet 300 mg tablet
0 0 0 0 0 5 Alprazolam tablet 1 mg tablet
0 0 0 0 0 6 Ambroxol sirup 15 mg/ 5 ml botol
0 0 0 0 0 7 Ambroxol tab 30 mg tablet
0 0 0 0 0 8 Aminofilin tablet 200mg tablet
0 0 0 0 0 9 Aminofilina injeksi 24 mg/ml ampul
0 0 0 0 0 10 Amitriptillin tablet salut 25 mg tablet
0 0 0 0 0 11 Amlodipine Tablet 5 mg tablet
0 0 0 0 0 12 Amlodipine Tablet 10 mg tablet
0 0 0 0 0 13 Amicillin 1000 mg inj vial
0 0 0 0 0 14 Amoksisilin kapsul 250 mg tablet
0 0 0 0 0 15 Amoksisilin kapsul 500 mg tablet
0 0 0 0 0 16 Amoksisilin sirup kering 125 mg/ 5 ml botol
0 0 0 0 0 17 Antalgin (Metampiron) tablet 500 mg tablet
0 0 0 0 0 18 Antasida DOEN II suspensi komb botol
0 0 0 0 0 19 Antasida DOEN tablet tablet
0 0 0 0 0 20 Anti Bakteri DOEN salep tube
0 0 0 0 0 21 Anti Hemoroid DOEN Kombinasi supp
0 0 0 0 0 22 Antifungi DOEN Kombinasi: pot
0 0 0 0 0 23 Antimalaria DOEN kombinasi tablet
0 0 0 0 0 24 Antimigren: Ergotamin Tartrat 1mg tablet
+Kofein 50mg DOEN tablet Kombinasi
Antiparkinson
0 0 0 0 0 25 benzerazid 25 mg levodopa 100 mg tablet
0 0 0 0 0 26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial
0 0 0 0 0 27 Arthemeter injeksi 1 ml : 80 mg ampul
0 0 0 0 0 28 Asam Askorbat ( Vit C ) tablet 50 mg tablet
0 0 0 0 0 29 Asam folat tablet 1 mg tablet
0 0 0 0 0 30 Asam Mefenamat tablet 500 mg tablet
0 0 0 0 0 31 Asiklovir krim 5% tube
0 0 0 0 0 32 Asiklovir tablet 200 mg tablet
0 0 0 0 0 33 Asiklovir tablet 400 mg tablet
0 0 0 0 0 34 Atropin sulfat inj ampul
0 0 0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt vial
IU/vial
0 0 0 0 0 36 Besi (II ) Sulfat + asam folat 0.25 tab / sachet
TTD*
0 0 0 0 0 37 Betametason krim 0,1% tube
0 0 0 0 0 38 Captopril 12,5 mg tablet
0 0 0 0 0 39 Captopril 25 mg tablet
0 0 0 0 0 40 Clozapine 25 mg tablet
0 0 0 0 0 41 Deksametason injeksi 5mg.ml-1ml ampul
0 0 0 0 0 42 Deksametason tablet 0,5 mg tablet
0 0 0 0 0 43 DHP tablet (Prog : malaria) tablet
0 0 0 0 0 44 Diazepam tab.2 mg tablet
0 0 0 0 0 45 Diazepam tab.5 mg tablet
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 46 Diazepam inj 5 mg / ml ampul
0 0 0 0 0 47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul
0 0 0 0 0 48 Digoksin tablet 0,25 mg tablet
0 0 0 0 0 49 Domperidon suspensi/sirup 5 mg/5ml botol
0 0 0 0 0 50 Domperidon tetes/ 5 mg/ml botol
0 0 0 0 0 51 Domperidone tablet 10mg tablet
0 0 0 0 0 52 Ekstrak Belladon tablet 10 mg tablet
0 0 0 0 0 53 Adrenalina ) ampul
54 Ergakalsiferol ml D3/D2) kapsul
0 0 0 0 0 tablet
50000 UI/ml (D-Vit FT)
0 0 0 0 0 55 Ergakalsiferol (vitamin D3/D2) suspensi botol
0 0 0 0 0 56 Eritromisin kapsul 250mg tablet
0 0 0 0 0 57 Eritromisin sirup 200mg/5ml botol
0 0 0 0 0 58 Etanol 70% cairan botol
0 0 0 0 0 59 Etanol 96% cairan botol
0 0 0 0 0 60 Etakridin / rivanol botol
0 0 0 0 0 61 Etakridin / rivanol botol
0 0 0 0 0 62 FDC kategori anak paket
0 0 0 0 0 63 FDC OAT Sisipan paket
0 0 0 0 0 64 FDC OAT Kategori I dosis harian paket
0 0 0 0 0 65 FDC OAT Kategori I paket
0 0 0 0 0 66 FDC OAT Kategori II paket
0 0 0 0 0 67 Fenitoin Natrium injeksi 50 mg/ml ampul
0 0 0 0 0 68 Fenitoin Natrium Kapsul 100 mg kapsul
0 0 0 0 0 69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul
0 0 0 0 0 70 Fenobarbital tablet 100 mg tablet
0 0 0 0 0 71 Fenol Gliserol tetes telinga 10% botol
(Karbogliserin 10%)
0 0 0 0 0 72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul
1 ml
0 0 0 0 0 73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul
0 0 0 0 0 74 Fitomenadion (Vit.K1)tab salut gula 10 tablet
mg
0 0 0 0 0 75 Furosemid inj 40 mg/ml ampul
0 0 0 0 0 76 Furosemid tablet 40 mg tablet
0 0 0 0 0 77 Garam oralit untuk 200 ml air (Prog : sachet
diare)
0 0 0 0 0 78 Gentamicin salep mata 0,3 % (genoint ) tube
0 0 0 0 0 79 Gentamicin tetes mata 0,3 % (genoint ) botol
0 0 0 0 0 80 Gentamisin injeksi 40 mg/ml ampul
0 0 0 0 0 81 Gentian Violet larutan 1 % botol
0 0 0 0 0 82 Glibenklamid tablet 5 mg tablet
0 0 0 0 0 83 Glimepiride tablet 2 mg tablet
0 0 0 0 0 84 Gliseril Guayacolat tablet 100 mg tablet
0 0 0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg tablet
(nitral)
0 0 0 0 0 86 Glukonas Kalsikus 10 % ampul
0 0 0 0 0 87 Glukosa larutan infus 10% steril (Produk botol
lokal)
lokal)
lokal)
0 0 0 0 0 90 Griseofulvin tablet 125 mg, micronized tablet
0 0 0 0 0 91 Haloperidol inj 50 mg/ml (haldol ampul
decanoas)
0 0 0 0 0 92 Haloperidol tablet 5 mg tablet
0 0 0 0 0 93 HCT tablet
0 0 0 0 0 94 Haloperidol tablet 5 mg tablet
0 0 0 0 0 95 Hidrokortison krim 2,5% tiube
0 0 0 0 0 96 Ibuprofen sirup 100mg / 5ml botol
0 0 0 0 0 97 Ibuprofen suspensi 200mg / 5ml botol
0 0 0 0 0 98 Ibuprofen tablet 200 mg tablet
0 0 0 0 0 99 Ibuprofen tablet 400 mg tablet
0 0 0 0 0 100 Isosorbid Dinitrat tablet sublingual 5 mg tablet
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 101 Kalsium Laktat tab 500 mg tablet
0 0 0 0 0 102 Karbamazepin tablet 200 mg tablet
0 0 0 0 0 103 Ketokenazol tablet 200mg tablet
0 0 0 0 0 104 Ketokonazol krim 2% tube
0 0 0 0 0 105 Ketoprofen tablet 100 mg tablet
0 0 0 0 0 106 Ketorolak inj 10 mg ampul
0 0 0 0 0 107 Ketorolak inj 30 mg ampul
0 0 0 0 0 108 Klindamisin 150 mg tablet
0 0 0 0 0 109 Klindamisin 300 mg tablet
0 0 0 0 0 110 Kloramfenikol salp kulit / Bufacetin* tube
0 0 0 0 0 111 Kloramfenikol tetes telinga 3% botol
0 0 0 0 0 112 Klorfeniramin Maleat (CTM) tablet tablet
0 0 0 0 0 114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul
0 0 0 0 0 115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul
0 0 0 0 0 116 Klorpromazin HCl tablet salut 100 mg tablet
0 0 0 0 0 117 Kodein 10 mg tablet tablet
Kotrimoksazol Susp komb:
0 0 0 0 0 118 Sulfametoksazol 200mg + Trimetoprim botol
Kotrimoksazol tablet komb:
0 0 0 0 0 119 40 mg
Sulfametoksazol 400mg + Trimetoprim tablet
0 0 0 0 0 120 80 mg
Lansoprazol inj 30 mg/ml ampul
0 0 0 0 0 121 Lidokain 2% ampul
0 0 0 0 0 122 Lidokain Kompositum ampul
0 0 0 0 0 123 Loperamide 2 mg tablet
0 0 0 0 0 124 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 0 0 0 125 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 0 0 0 126 Mebendazol tablet 100 mg tablet
0 0 0 0 0 127 Metformin tablet
0 0 0 0 0 128 Metilergometrin Maleat tablet
(Metilergometrin) tab salut 0,125 mg
0 0 0 0 0 129 Metilergometrin Maleat inj 0,200 mg-1 ampul
ml
0 0 0 0 0 130 Metilprednisolon tablet 4 mg tablet
0 0 0 0 0 131 Metilprednisolon tablet 8 mg tablet
0 0 0 0 0 132 Metoklopramid inj 5 mg/ml ampul
0 0 0 0 0 133 Metoklopramid 5 mg tablet
0 0 0 0 0 134 Metronidazol Infus 500mg/100ml botol
0 0 0 0 0 135 Metronidazol tablet 250 mg tablet
0 0 0 0 0 136 Metronidazol tablet 500 mg tablet
0 0 0 0 0 137 Mikonazol krim/ salep 2 % tube
0 0 0 0 0 138 Mineral mix (Prog. Gizi) sachet
0 0 0 0 0 139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul
0 0 0 0 0 140 Natrium Diklofenac 50 mg tablet
0 0 0 0 0 141 Natrium Diklofenak 25 mg tablet
0 0 0 0 0 142 Natrium Klorida larutan infus 0,9 % steril botol
(Produk lokal)
0 0 0 0 0 143 Nistatin tablet salut 500.000 IU tablet
0 0 0 0 0 144 Nistatin vaginal tablet 100.000 UI tablet
0 0 0 0 0 145 Noretisteron tablet 5 mg (Primolut N) tablet
0 0 0 0 0 146 Obat Kusta MB strip
0 0 0 0 0 147 Obat Kusta PB strip
0 0 0 0 0 148 Obat Batuk Hitam botol
0 0 0 0 0 149 Ofloxacin 200 mg Tab Salut Selulose tablet
0 0 0 0 0 150 Ofloxacin 400 mg Tab Salut Selulose tablet
0 0 0 0 0 151 Oksitetrasiklin HCl salep mata 1 % tube
0 0 0 0 0 152 Oksitosin injeksi 10IU/ml-1ml ampul
0 0 0 0 0 153 Omeprazol kapsul 20mg tablet
0 0 0 0 0 154 ondansetron tablet 4 mg tablet
0 0 0 0 0 155 ondansetron tablet 8 mg tablet
0 0 0 0 0 156 Ondansetron inj 4 mg/ 2 ml ampul
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 157 Papaverin tablet 40mg tablet
0 0 0 0 0 158 Paracetamol drop 100 mg/ml botol
0 0 0 0 0 159 Parasetamol sirup 120 mg / 5 ml 60 ml
0 0 0 0 0 160 Parasetamol tablet 500 mg tablet
0 0 0 0 0 161 Pirantel sirup 125mg/5ml botol
0 0 0 0 0 162 Pirantel tablet 125 mg tablet
0 0 0 0 0 163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet
0 0 0 0 0 164 Piroksikam 20 mg tablet
0 0 0 0 0 165 Povidon Iodida larutan 10% botol
0 0 0 0 0 166 Povidon Iodida larutan 10% botol
0 0 0 0 0 167 Prednisone tablet 5 mg tablet
0 0 0 0 0 168 Prokain Benzil Penicillin G injeksi 3 jt vial
IU/vial
0 0 0 0 0 169 Propiltiourasil tablet 100 mg tablet
0 0 0 0 0 170 Ranitidin inj.25mg/2ml ampul
0 0 0 0 0 171 Ranitidin tablet 150 mg tablet
0 0 0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul
Lunak
0 0 0 0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul kapsul
Lunak
0 0 0 174 Riseridon 2 mg tablet
0 0 0 0 0 175 Ringer Laktat larutan infus steril botol
0 0 0 0 0 176 Salbutamol 2 mg tablet
0 0 0 0 0 177 Salbutamol 4 mg tablet
0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 100 nebu
0 0 0 0 0 179 Salbutamol cairan 1 mg/ml ampul
0 0 0 0 0 180 Salep 2-4 Komb : As Salisilat 2 % + pot
Belerang endap 2 %
0 0 0 0 0 181 Salisil Bedak 2% kotak
0 0 0 0 0 182 Sefadroksil kapsul 250 mg tablet
0 0 0 0 0 183 Sefadroksil kapsul 500 mg tablet
0 0 0 0 0 184 sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 185 Sefotaksim inj 1 gr vial
0 0 0 0 0 186 Sefriakson serbuk injeksi 1 g/vial vial
0 0 0 0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 vial
ml (ABU I)
0 0 0 0 0 188 Serum Anti Tetanus injeksi 1.500 ampul
IU/ampul (A.T.S)
0 0 0 0 0 189 Setrizin tablet 10 mg tablet
0 0 0 0 0 190 Sianokobalamin (vit B12) injeksi 500mcg- ampul
ml
0 0 0 0 0 191 Sianokobalamin (vit B12) tab 50 mcg tablet
0 0 0 0 0 192 Simvastatin tablet 10 mg tablet
0 0 0 0 0 193 Siproflaxacin tablet 500 mg tablet
0 0 0 0 0 194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ampul
ml
0 0 0 0 0 195 Tiamin HCl / Mononitrat (Vit.B1) tablet tablet
50 mg
0 0 0 0 0 196 Tramadol inj 50mg/5ml ampul
0 0 0 0 0 197 Triheksifenidil Hidroklorida tablet 2 mg tablet
0 0 0 0 0 198 Vaksin anti Rabies / Verorab vial
0 0 0 0 0 199 Vitamin B komplek tablet tablet
0 0 0 0 0 200 Zinc sirup 20 mg/ 5 ml botol
0 0 0 0 0 201 Zinc Tab 20 mg tablet
0 0 0 0 0
204 Alat suntik sekali pakai 0,05 ml pcs
0 0 0 0 0 205 Alat suntik sekali pakai 0,5 ml pcs
0 0 0 0 0 206 Alat suntik sekali pakai 1 ml pcs
0 0 0 0 0 209 Alkohol Swab pcs
0 0 0 0 0 210 Aqua bides 20 liter galon
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 211 Blood lanced kotak
0 0 0 0 0 212 Catridge TCM TEST
0 0 0 0 0 213 Cut gut chromic 3/0 pcs
0 0 0 0 0 215 Exell tulle pcs
0 0 0 0 0 216 Foley cateter pcs
0 0 0 0 0 217 Hand rub (0,5% clorhexidine+isoropyl botol
70%)
0 0 0 0 0 218 Hand scub (4% clorhexidine) botol
0 0 0 0 0 219 Handscoon steril uk 7 pcs
0 0 0 0 0 220 Handscoon steril uk 7,5 pcs
0 0 0 0 0 221 Handscoon uk 6,5 50 pcs
0 0 0 0 0 222 Handscoon uk 7 50 pcs
0 0 0 0 0 223 Handscoon S 100 pcs
0 0 0 0 0 224 Handscoon M 100 pcs
0 0 0 0 0 225 Handscoon L 100 pcs
0 0 0 0 0 226 Infus set anak set
0 0 0 0 0 227 Infus set dewasa set
0 0 0 0 0 228 IV Catheter No. 18 G set
0 0 0 0 0 230 IV Chateter No. 22 G set
0 0 0 0 0 234 Kapas Pembalut / Absorben 250 gram Bungkus
0 0 0 0 0 235 Kasa Pembalut Hidrofil 40 x 80 cm Rol
0 0 0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya pcs
husada)
0 0 0 0 0 237 Kertas Puyer pack
0 0 0 0 0 238 Klip Plastik 10 x 7 KP pack
0 0 0 0 0 239 Klip Plastik 13x8,7 KP pack
0 0 0 0 0 240 Lisol 1liter botol
0 0 0 0 0 241 Masker ear loop pcs
0 0 0 0 0 242 Masker head loop pcs
0 0 0 0 0 243 Masker KN95 pcs
0 0 0 0 0 244 Plester 2,5 x 4,5 Rol
0 0 0 0 0 245 Plester 7,5 x 4,5 Rol
0 0 0 0 0 246 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs
jarum bedah
0 0 0 0 0 247 Stefanol botol
0 0 0 0 0 248 Strip Asam urat 50 strip box
0 0 0 0 0 249 Strip gula 50 strip box
0 0 0 0 0 250 Strip kolesterol 50 strip box
0 0 0 0 0 251 Umbilical cord nylon one med (Klem tali pcs
pusat)
0 0 0 0 0 252 UnderPad_L pcs
0 0 0 0 0 253 Urine Bag Pcs
0 0 0 0 0 254 Waterone botol
0BAT GIGI
0 0 0 0 0 260 Bonding / single bond botol
0 0 0 0 0 261 Devitalisasi Pasta (Non Arsen) / Denpro paket
0 0 0 0 0 262 Etching 3 M botol
0 0 0 0 0 263 Etil klorida spray botol
0 0 0 0 0 264 Eugenol botol
0 0 0 0 0 265 Glass Ionomer Cement (GC IX) ART paket
0 0 0 0 0 266 Imicryl / sealing of fissures botol
0 0 0 0 0 267 Kalsium Hidroksida Pasta paket
0 0 0 0 0 268 Klorfenol Kamfer Mentol (CHKM) paket
0 0 0 0 0 269 Mummifying Pasta kotak
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
0 0 0 0 0 270 Nova compo A1 syr
0 0 0 0 0 273 Nova compo A3,5 syr
0 0 0 0 0 274 Nova compo HF A2 syr
0 0 0 0 0 275 Semen Seng Fosfat serbuk / filling paket
0 0 0 0 0 276 Semen Seng Fosfat cairan / lutting paket
0 0 0 0 0 277 CAVITA Tambalan sementara botol
0 0 0 0 0 278 TKF botol
IMUNISASI RUTIN
0 0 0 0 0 281 BCG ampul

0 0 0 0 0 282 CAMPAK ampul
0 0 0 0 0 283 DT ampul
0 0 0 0 0 284 HB.0 / HEP.B UNIJECT ampul
0 0 0 0 0 285 IPV vial
0 0 0 0 0 286 PENTAVALEN / DPT-HB-HIB vial
0 0 0 0 0 287 POLIO ampul
0 0 0 0 0 288 PCV ampul
0 0 0 0 0 289 Td ampul
0 0 0 0 0 290 MR ampul
291 safety box pcs
0 0 0 0 0
0 0 0 0 0 294 Becefort syr botol

0 0 0 0 0 295 Curcuma kotak
0 0 0 0 0 296 Dextrofen syr botol
0 0 0 0 0 297 Dulcolac / bisakodil supp 10 mg supp
0 0 0 0 0 298 Dulcolac / bisakodil supp 5 mg supp
0 0 0 0 0 299 Febrinex syr Botol
0 0 0 0 0 300 Herbacof Tablet
0 0 0 0 0 301 Noza Tablet
0 0 0 0 0 302 Pehavral Tablet
0 0 0 0 0 303 Stimuno forte Tablet
0 0 0 0 0 304 Stimuno syr Tablet
0 0 0 0 0 305 Sukralfat susp botol
0 0 0 0 0 306 Ichtiyol salp kapsul
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PEMAKAIA
RUPIAH BULAN INI
13 14 15 16 17 18 19 1 2 3
322
0
JUM
UMUM

BAYAR
............
Petugas Gudang Farmasi Kepala Dinas Kesehatan Kepala Seksi Pelayanan Fa
…………………………………………… H.Fatoni, S.Kep,MM

NIP. .......................................... NIP.19730808 200501 1 008
6
BAWANG BULAN : Juni

TAHUN : 2023
STOK PENERIMAAN
HARGA HARGA PER LAIN- PERSEDIAA PENGELUARA STOK
KMSN SATUAN KEMASAN AWAL APBD I APBD II DAK ASKES LAIN TOTAL N N AKHIR
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
kotak 304 304 0 0 0 0 0
24 tab/Kotak 1,856 44,550 0 0 0 0
100 87 87 0 0 0 0
tablet/kotak
30 200 200 0 0 0 0
tablet/kotak
100 99 99 0 0 0 0
tablet/kotak
botol 60 ml - 3,300 0 0 0 0
100 - 8,593 0 0 0 0
tablet/kotak
100 - 8,000 0 0 0 0
tablet/kotak
ktk 30
ampul@10 - 121,500 0 0 0 0
ml
100 177 177 0 0 0 0
tablet/kotak
30 53 53 0 0 0 0
tablet/kotak
30 - 5,610 0 0 0 0
tablet/kotak
10 vial/kotak 8,591 8,591 0 0 0 0
100 - 38,799 0 0 0 0
tablet/kotak
100 201 201 0 0 0 0
tablet/kotak
botol 60 ml 3,498 3,498 0 0 0 0
100 - 20,115 0 0 0 0
tablet/kotak
botol 60 ml 1,694 1,694 0 0 0 0
100 54 54 0 0 0 0
tablet/kotak
25 3,509 3,509 0 0 0 0
tube/kotak
10 3,250 3,250 0 0 0 0
supp/kotak
24 pot/kotak 3,477 3,477 0 0 0 0
100 - 51,800 0 0 0 0
tablet/kotak
100 185 185 0 0 0 0
tablet/botol
100 904 904 0 0 0 0
tablet/kotak
10 vial/kotak 2,650 2,650 0 0 0 0
6 - 179,550 0 0 0 0
ampul/kotak
100 42 42 0 0 0 0
tablet/kotak
100 42 42 0 0 0 0
tablet/botol
100 111 111 0 0 0 0
tablet/kotak
25 5,044 5,044 0 0 0 0
tube/kotak
100 - 52,404 0 0 0 0
tablet/kotak
100 405 405 0 0 0 0
tablet/kotak
ampul 1,718 1,718 0 0 0 0
10 vial/kotak 14,430 14,430 0 0 0 0
30
tablet/sache 226 226 0 0 0 0
t
tube 2,997 2,997 0 0 0 0
100 65 65 0 0 0 0
tab/kotak
100 75 75 0 0 0 0
tablet/kotak
100 477 477 0 0 0 0
tablet/kotak
100 1,580 158,000 0 0 0 0
ampul/kotak
100 62 6,200 0 0 0 0
tablet/kotak
9 - 32,101 0 0 0 0
tablet/kotak
100 tablet /
kotak 70 70.0 0 0 0 0
100 tablet /
kotak 70 70.0 0 0 0 0
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
30 1,545 1,545 0 0 0 0
ampul/kotak
30 1,054 31,620 0 0 0 0
ampul/kotak
100 143 14,300 0 0 0 0
tablet/kotak
botol 3,333 3,333 0 0 0 0
botol 15,600 15,600 0 0 0 0
100 167 16,700 0 0 0 0
tablet/kotak
1000 38 38,000 0 0 0 0
tablet/botol
30 8,100 243,000 0 0 0 0
ampul/kotak
tablet - 650 0 0 0 0
botol - 8,000 0 0 0 0
120 494 59,230 0 0 0 0
tablet/kotak
botol 7,220 7,220 0 0 0 0
300 ml/botol 9,124 9,124 0 0 0 0
1000 30,931 30,931 0 0 0 0
ml/botol
60 ml/botol 3,740 3,740 0 0 0 0
300 ml/botol 8,160 8,160 0 0 0 0
kotak 214,990 214,990 0 0 0 0
kotak - - 0 0 0 0
kotak 409,461 409,461 0 0 0 0
kotak 389,344 389,344 0 0 0 0
kotak 1,297,894 1,297,894 0 0 0 0
ampul 20,250 20,250 0 0 0 0
botol 133 13,300 0 0 0 0
30 1,800 54,000 0 0 0 0
ampul/kotak
100 220 22,000 0 0 0 0
tablet/kotak
24 2,042 49,008 0 0 0 0
botol/kotak
10 4,698 46,980 0 0 0 0
ampul/kotak
30 3,417 102,510 0 0 0 0
ampul/kotak
100 634 63,400 0 0 0 0
tablet/botol
25 1,829 45,725 0 0 0 0
ampul/kotak
100 85 8,500 0 0 0 0
tablet/kotak
100 292 29,200 0 0 0 0
sachet/kotak
tube 2,600 2,600 0 0 0 0
5 ml/botol 3,194 3,194 0 0 0 0
5 3,355 3,355 0 0 0 0
ampul/kotak
botol - 900 0 0 0 0
101 82 82 0 0 0 0
tablet/kotak
50 - 21,800 0 0 0 0
tablet/kotak
1000 172 172 0 0 0 0
tablet/botol
tablet - 1,500 0 0 0 0
ampul 5,723 5,723 0 0 0 0
500 ml/botol 5,700 5,700 0 0 0 0
botol 1,960 1,960 0 0 0 0
500 ml/botol 6,627 6,627 0 0 0 0
100 210 210 0 0 0 0
tablet/kotak
ampul 83,333 83,333 0 0 0 0
100 54 54 0 0 0 0
tablet/kotak
100 148 148 0 0 0 0
tablet/kotak
100 54 54 0 0 0 0
tablet/kotak
24 2,325 2,325 0 0 0 0
tube/kotak
botol - 3,499 0 0 0 0
botol 3,200 3,200 0 0 0 0
100 116 11,550 0 0 0 0
tablet/botol
100 tablet 190 190 0 0 0 0
100 86 86 0 0 0 0
tablet/kotak
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
100 60 60 0 0 0 0
tablet/kotak
100 243 24,300 0 0 0 0
tablet/kotak
50 554 27,675 0 0 0 0
tablet/kotak
12 4,700 56,400 0 0 0 0
tube/kotak
100 1,823 182,250 0 0 0 0
tablet/kotak
5 - 40,400 0 0 0 0
ampul/kotak
6 847 847 0 0 0 0
ampul/kotak
50 382 19,100 0 0 0 0
tablet/kotak
50 527 26,350 0 0 0 0
tablet/kotak
tube 3,266 3,266 0 0 0 0
botol 1,599 1,599 0 0 0 0
100 51 5,100 0 0 0 0
tablet/kotak
30 1,021 30,630 0 0 0 0
ampul/kotak
30 950 28,500 0 0 0 0
ampul/kotak
100 149 14,900 0 0 0 0
tablet/kotak
100 600 600 0 0 0 0
tablet/kotak
botol 60 ml 2,190 2,190 0 0 0 0
100 126 126 0 0 0 0
tablet/kotak
1 82,042 82,042 0 0 0 0
ampul/kotak
30 847 847 0 0 0 0
ampul/kotak
30 803 803 0 0 0 0
ampul/kotak
kotak 77 77 0 0 0 0
10 vial/kotak - 20,780 0 0 0 0
10 vial/kotak 4,090 4,090 0 0 0 0
30 - 6,840 0 0 0 0
tablet/kotak
100 39 39 0 0 0 0
tablet/kotak
100 224 224 0 0 0 0
tablet/kotak
30 1,023 1,023 0 0 0 0
ampul/kotak
30 102 102 0 0 0 0
tablet/kotak
100 206 206 0 0 0 0
tablet/kotak
10 2,070 20,700 0 0 0 0
ampul/kotak
100 120 120 0 0 0 0
tablet/kotak
botol 100 5,885 5,885 0 0 0 0
ml
100 - 19,305 0 0 0 0
tablet/kotak
kotak 403 403 0 0 0 0
tube - 3,000 0 0 0 0
40 - 98,000 0 0 0 0
sachet/kotak
ampul 6,200 6,200 0 0 0 0
50 100 100 0 0 0 0
tablet/kotak
kotak 174 8,700 0 0 0 0
botol 4,900 4,900 0 0 0 0
100 825 825 0 0 0 0
tablet/kotak
100 550 550 0 0 0 0
tablet/kotak
30 - 78,540 0 0 0 0
tablet/kotak
strip 31,760 31,760 0 0 0 0
strip 12,569 12,569 0 0 0 0
botol 6,044 6,044 0 0 0 0
100 - 20,650 0 0 0 0
tablet/kotak
100 - 32,700 0 0 0 0
tablet/kotak
25 3,500 3,500 0 0 0 0
tube/kotak
100 1,126 1,126 0 0 0 0
ampul/kotak
30 407 407 0 0 0 0
tablet/kotak
30 - - 0 0 0 0
tablet/kotak
30 270 270 0 0 0 0
tablet/kotak
ampul 881 881 0 0 0 0
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
100 - - 0 0 0 0
tablet/kotak
botol - - 0 0 0 0
botol 60 ml 1,160 1,160 0 0 0 0
100 222 222 0 0 0 0
tablet/kotak
botol 8,250 8,250 0 0 0 0
30 420 12,595 0 0 0 0
tablet/kotak
100 131 131 0 0 0 0
tablet/kotak
100 220 220 0 0 0 0
tablet/kotak
botol 60 ml 7,552 7,552 0 0 0 0
botol 300 ml 26,139 26,139 0 0 0 0
100 69 69 0 0 0 0
tablet/kotak
30 vial/kotak 10,780 323,400 0 0 0 0
100 404 40,442 0 0 0 0
tablet/botol
25 814 814 0 0 0 0
ampul/kotak
100 85 85 0 0 0 0
kaplet/kotak
50 553 553 0 0 0 0
kapsul/botol
50 553 553 0 0 0 0
kapsul/botol
kotak 124 124 0 0
botol 500 ml 7,630 7,630 0 0 0 0
100 67 67 0 0 0 0
tablet/kotak
100 - - 0 0 0 0
tablet/kotak
nebu 22,200 22,200 0 0 0 0
ampul 4,844 4,844 0 0 0 0
pot 2,333 2,333 0 0 0 0
kotak - - 0 0 0 0
30 855 25,650 0 0 0 0
tablet/kotak
50 1,042 52,100 0 0 0 0
tablet/kotak
botol 3,800 3,800 0 0 0 0
2 vial/kotak 2,850 2,850 0 0 0 0
vial 2,745 2,745 0 0 0 0
Dus, 10 vial 517,132 517,132 0 0 0 0
@ 5 ml
Dus, 10
ampul @ 1 140,188 140,188 0 0 0 0
ml
100 49 49 0 0 0 0
tablet/kotak
100 916 91,600 0 0 0 0
ampul/kotak
100 45 45 0 0 0 0
tablet/kotak
50 150 150 0 0 0 0
tablet/kotak
100 248 248 0 0 0 0
tablet/kotak
30 - 20,700 0 0 0 0
ampul/kotak
1000 151 151 0 0 0 0
tablet/botol
5 5,400 27,000 0 0 0 0
ampul/kotak
100 63 63 0 0 0 0
tablet/kotak
Dus, 1 vial
@ 1 dosis + 154,391 154,391 0 0 0 0
syringe
100 57 57 0 0 0 0
tablet/kotak
botol 2,511 2,511 0 0 0 0
100 216 216 0 0 0 0
tablet/kotak
0 0 0 0
kotak/ 100 1,210 1,210 0

psc
kotak/ 100 1,190 1,190 0 0 0 0
psc
kotak/ 100 100,344 100,344 0 0 0 0
psc
kotak/ 100 100,344 100,344 0 0 0 0
psc
kotak/ 100 104,734 104,734 0 0 0 0
psc
kotak/ 100 14,100 14,100 0 0 0 0
psc
galon 174,000 174,000 0 0 0 0
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
kotak 16,893 16,893 0 0 0 0
TEST 253,200 253,200 0 0 0 0
12 pcs/kotak 26,081 26,081 0 0 0 0
kotak / psc - - 0 0 0 0
pcs - - 0 0 0 0
botol 90,500 90,500 0 0 0 0
botol 42,863 42,863 0 0 0 0
kotak 678,150 5,267 0 0 0 0
kotak 678,150 5,270 0 0 0 0
kotak 8,713 8,713 0 0 0 0
kotak 8,713 8,713 0 0 0 0
kotak 87,601 87,601 0 0 0 0
kotak 87,601 87,601 0 0 0 0
kotak 87,601 87,601 0 0 0 0
50 set/kotak 9,047 82,500 0 0 0 0
50 set/kotak 7,755 339,250 0 0 0 0
50 set/kotak 7,044 385,000 0 0 0 0
50 set/kotak 7,044 385,000 0 0 0 0
50 set/kotak 7,044 385,000 0 0 0 0
50 set/kotak 7,044 385,000 0 0 0 0
50 set/kotak 7,044 385,000 0 0 0 0
Bungkus 29,178 29,178 0 0 0 0
Rol 226,350 226,350 0 0 0 0
16
lembar/kota 7,641 7,641 0 0 0 0
k 10
ball/ - - 0 0 0 0
pack
ball/ 10 - - 0 0 0 0
pack
ball/ 10 - - 0 0 0 0
pack
botol - - 0 0 0 0
50 pcs/kotak 38,775 38,775 0 0 0 0
50 pcs/kotak 38,775 38,775 0 0 0 0
50 pcs/kotak 82,700 82,700 0 0 0 0
Rol 14,810 14,810 0 0 0 0
Rol 43,300 43,300 0 0 0 0
36pcs/kotak 46,842 46,842 0 0 0 0
botol 69,300 69,300 0 0 0 0
box 156,975 156,975 0 0 0 0
box 161,000 161,000 0 0 0 0
box 257,225 257,225 0 0 0 0
kotak/ 50 - - 0 0 0 0
psc
10 100,848 100,848 0 0 0 0
pcs/kotak
Pcs - - 0 0 0 0
botol 15,246 15,246 0 0 0 0
- - 0
botol 246,000 246,000 0 0 0 0

kotak 390,000 390,000 0 0 0 0
botol 123,050 123,050 0 0 0 0
botol 175,010 175,010 0 0 0 0
botol 20,150 20,150 0 0 0 0
botol 423,800 423,800 0 0 0 0
botol 206,555 206,555 0 0 0 0
kotak 87,500 87,500 0 0 0 0
botol 52,500 52,500 0 0 0 0
kotak - - 0 0 0 0
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16
botol 242,295 242,295 0 0 0 0
botol 242,295 242,295 0 0 0 0
botol 242,295 242,295 0 0 0 0
botol 242,295 242,295 0 0 0 0
botol 299,100 299,100 0 0 0 0
botol 221,155 221,155 0 0 0 0
botol 321,300 321,300 0 0 0 0
botol 136,300 136,300 0 0 0 0
botol 57,640 57,640 0 0 0 0
ampul 88,891 88,891.0 0 0 0 0
ampul 28,204 28,204.0 0 0 0 0
ampul 16,500 16,500.0 0 0 0 0
ampul 23,490 23,490.0 0 0 0 0
vial 144,540 144,540.0 0 0 0 0
vial 77,366 77,366.0 0 0 0 0
ampul 19,540 19,540.0 0 0 0 0
ampul 0 0.0 0 0 0 0
ampul 16,480 16,480.0 0 0 0 0
ampul 151,150 151,150.0 0 0 0 0
pcs 16,500 16,500.0 0

0 0 0 0
60
17,523 17,523 0 0 0 0
mL/botol
kotak 48,202 48,202 0 0 0 0
botol 60
11,655 11,655 0 0 0 0
ml
supp 4,325 4,325 0 0 0 0
supp 5,085 5,085 0 0 0 0
Botol 15,999 15,999 0 0 0 0

4
2,498 2,498 0 0 0 0
tablet/strip
kotak 100
805 805 0 0 0 0
tablet100
kotak
993 993 0 0 0 0
tablet
10
100 1,958 1,958 0 0 0 0
tablet/strip
tablet/kota 28,374 28,374 0 0 0 0
k
botol 5,034 5,034 0 0 0 0
kotak 100
6,886 6,886 0 0 0 0
kapsul
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
(………..)
4 5 6 7 8 9 10 11 12 13 14 15 16

UMUM
TIDAK BAYAR

Aziza, S.Kep …………………………………………… ……………………………………………

NIP. 19741011 200804 2 001 NIP. .......................................... NIP. ..........................................
7
LAPORAN PEMAKAIAN OBAT DAN LEMBA
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
PROPINSI : LAMPUNG
STOK PEMAKAIA STOK

DALAM RATA S/D N NO NAMA OBAT SATUAN KMSN SATUAN KEMASAN AWAL
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 1 Acetil Cystein kapsul kotak 304 304 0
0 2 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550 0
0 0 3 Alopurinol tablet 100 mg tablet 100 87 87 0
tablet/kotak
0 0 4 Alopurinol tablet 300 mg tablet 30 200 200 0
tablet/kotak
0 0 5 Alprazolam tablet 1 mg tablet 100 99 99 0
tablet/kotak
0 0 6 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml - 3,300 0
0 0 7 Ambroxol tab 30 mg tablet 100 - 8,593 0
tablet/kotak
0 0 8 Aminofilin tablet 200mg tablet 100 - 8,000 0
tablet/kotak
ktk 30
0 0 9 Aminofilina injeksi 24 mg/ml ampul ampul@10 - 121,500 0
10 Amitriptillin tablet salut 25 mg ml
100
0 0 tablet 177 177 0
tablet/kotak
0 0 11 Amlodipine Tablet 5 mg tablet 30 53 53 0
tablet/kotak
0 0 12 Amlodipine Tablet 10 mg tablet 30 - 5,610 0
tablet/kotak
0 0 13 Amicillin 1000 mg inj vial 10 vial/kotak 8,591 8,591 0
0 0 14 Amoksisilin kapsul 250 mg tablet 100 - 38,799 0
tablet/kotak
0 0 15 Amoksisilin kapsul 500 mg tablet 100 201 201 0
tablet/kotak
0 0 16 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498 3,498 0
0 0 17 Antalgin (Metampiron) tablet 500 mg tablet 100 - 20,115 0
tablet/kotak
0 0 18 Antasida DOEN II suspensi komb botol botol 60 ml 1,694 1,694 0
0 0 19 Antasida DOEN tablet tablet 100 54 54 0
tablet/kotak
0 0 20 Anti Bakteri DOEN salep tube 25 3,509 3,509 0
0 0 21 Anti Hemoroid DOEN Kombinasi supp 10 3,250 3,250 0
supp/kotak
0 0 22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477 3,477 0
0 0 23 Antimalaria DOEN kombinasi tablet 100 - 51,800 0
tablet/kotak
0 0 24 Antimigren: Ergotamin Tartrat 1mg +Kofein tablet 100 185 185 0
50mg
0 0 25 benzerazid 25 mg levodopa 100 mg tablet 100 904 904 0
tablet/kotak
0 0 26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650 2,650 0
0 0 27 Arthemeter injeksi 1 ml : 80 mg ampul 6 - 179,550 0
ampul/kotak
0 0 28 Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 42 42 0
tablet/kotak
0 0 29 Asam folat tablet 1 mg tablet 100 42 42 0
tablet/botol
0 0 30 Asam Mefenamat tablet 500 mg tablet 100 111 111 0
tablet/kotak
0 0 31 Asiklovir krim 5% tube 25 5,044 5,044 0
tube/kotak
0 0 32 Asiklovir tablet 200 mg tablet 100 - 52,404 0
tablet/kotak
0 0 33 Asiklovir tablet 400 mg tablet 100 405 405 0
tablet/kotak
0 0 34 Atropin sulfat inj ampul ampul 1,718 1,718 0
0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt vial 10 vial/kotak 14,430 14,430 0
IU/vial 30
0 0 36 Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet tablet/sache 226 226 0
37 Betametason krim 0,1% t
0 0 tube tube 2,997 2,997 0
0 0 38 Captopril 12,5 mg tablet 100 65 65 0
tab/kotak
0 0 39 Captopril 25 mg tablet 100 75 75 0
tablet/kotak
0 0 40 Clozapine 25 mg tablet 100 477 477 0
tablet/kotak
0 0 41 Deksametason injeksi 5mg.ml-1ml ampul 100 1,580 158,000 0
ampul/kotak
0 0 42 Deksametason tablet 0,5 mg tablet 100 62 6,200 0
tablet/kotak
0 0 43 DHP tablet (Prog : malaria) tablet 9 - 32,101 0
tablet/kotak
0 0 tablet
kotak 70 70.0 0
0 0 tablet
kotak 70 70.0 0
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 46 Diazepam inj 5 mg / ml ampul 30 1,545 1,545 0
ampul/kotak
0 0 47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 1,054 31,620 0
ampul/kotak
0 0 48 Digoksin tablet 0,25 mg tablet 100 143 14,300 0
tablet/kotak
0 0 49 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 0
0 0 50 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
0 0 51 Domperidone tablet 10mg tablet 100 167 16,700 0
tablet/kotak
0 0 52 Ekstrak Belladon tablet 10 mg tablet 1000 38 38,000 0
0 0 53 Adrenalina ) ampul 30 8,100 243,000 0
ml ampul/kotak
0 0 54 Ergakalsiferol D3/D2) kapsul tablet tablet - 650 0
0 0 55 Ergakalsiferol (vitamin D3/D2) suspensi botol botol - 8,000 0
0 0 56 Eritromisin kapsul 250mg tablet 120 494 59,230 0
tablet/kotak
0 0 57 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
0 0 58 Etanol 70% cairan botol 300 ml/botol 9,124 9,124 0
0 0 59 Etanol 96% cairan botol 1000 30,931 30,931 0
ml/botol
0 0 60 Etakridin / rivanol botol 60 ml/botol 3,740 3,740 0
0 0 61 Etakridin / rivanol botol 300 ml/botol 8,160 8,160 0
0 0 62 FDC kategori anak paket kotak 214,990 214,990 0
0 0 63 FDC OAT Sisipan paket kotak - - 0
0 0 64 FDC OAT Kategori I dosis harian paket kotak 409,461 409,461 0
0 0 65 FDC OAT Kategori I paket kotak 389,344 389,344 0
0 0 66 FDC OAT Kategori II paket kotak 1,297,894 1,297,894 0
0 0 67 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
0 0 68 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0
0 0 69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 1,800 54,000 0
ampul/kotak
0 0 70 Fenobarbital tablet 100 mg tablet 100 220 22,000 0
tablet/kotak
0 0 71 Fenol Gliserol tetes telinga 10% botol 24 2,042 49,008 0
0 0 72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul 10 4,698 46,980 0
ml ampul/kotak
0 0 73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 3,417 102,510 0
ampul/kotak
0 0 74 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 634 63,400 0
tablet/botol
0 0 75 Furosemid inj 40 mg/ml ampul 25 1,829 45,725 0
ampul/kotak
0 0 76 Furosemid tablet 40 mg tablet 100 85 8,500 0
tablet/kotak
0 0 77 Garam oralit untuk 200 ml air (Prog : diare) sachet 100 292 29,200 0
sachet/kotak
0 0 78 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0
0 0 79 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
0 0 80 Gentamisin injeksi 40 mg/ml ampul 5 3,355 3,355 0
ampul/kotak
0 0 81 Gentian Violet larutan 1 % botol botol - 900 0
0 0 82 Glibenklamid tablet 5 mg tablet 101 82 82 0
tablet/kotak
0 0 83 Glimepiride tablet 2 mg tablet 50 - 21,800 0
tablet/kotak
0 0 84 Gliseril Guayacolat tablet 100 mg tablet 1000 172 172 0
tablet/botol
0 0 85 Gliseril trinitrat tab sublingual 0,5mg (nitral) tablet tablet - 1,500 0
0 0 86 Glukonas Kalsikus 10 % ampul ampul 5,723 5,723 0
0 0 87 Glukosa larutan infus 10% steril (Produk botol 500 ml/botol 5,700 5,700 0
lokal)
0 0 88 Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960 0
lokal)
0 0 89 Glukosa larutan infus 5% steril (Produk botol 500 ml/botol 6,627 6,627 0
lokal)
0 0 90 Griseofulvin tablet 125 mg, micronized tablet 100 210 210 0
tablet/kotak
0 0 91 Haloperidol inj 50 mg/ml (haldol decanoas) ampul ampul 83,333 83,333 0
0 0 92 Haloperidol tablet 5 mg tablet 100 54 54 0
tablet/kotak
0 0 93 HCT tablet 100 148 148 0
tablet/kotak
0 0 94 Haloperidol tablet 5 mg tablet 100 54 54 0
tablet/kotak
0 0 95 Hidrokortison krim 2,5% tiube 24 2,325 2,325 0
tube/kotak
0 0 96 Ibuprofen sirup 100mg / 5ml botol botol - 3,499 0
0 0 97 Ibuprofen suspensi 200mg / 5ml botol botol 3,200 3,200 0
0 0 98 Ibuprofen tablet 200 mg tablet 100 116 11,550 0
tablet/botol
0 0 99 Ibuprofen tablet 400 mg tablet 100 tablet 190 190 0
0 0 100 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 86 86 0
tablet/kotak
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 101 Kalsium Laktat tab 500 mg tablet 100 60 60 0
tablet/kotak
0 0 102 Karbamazepin tablet 200 mg tablet 100 243 24,300 0
tablet/kotak
0 0 103 Ketokenazol tablet 200mg tablet 50 554 27,675 0
tablet/kotak
0 0 104 Ketokonazol krim 2% tube 12 4,700 56,400 0
tube/kotak
0 0 105 Ketoprofen tablet 100 mg tablet 100 1,823 182,250 0
tablet/kotak
0 0 106 Ketorolak inj 10 mg ampul 5 - 40,400 0
ampul/kotak
0 0 107 Ketorolak inj 30 mg ampul 6 847 847 0
ampul/kotak
0 0 108 Klindamisin 150 mg tablet 50 382 19,100 0
tablet/kotak
0 0 109 Klindamisin 300 mg tablet 50 527 26,350 0
tablet/kotak
0 0 110 Kloramfenikol salp kulit / Bufacetin* tube tube 3,266 3,266 0
0 0 111 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
0 0 112 Klorfeniramin Maleat (CTM) tablet tablet 100 51 5,100 0
tablet/kotak
0 0 114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 1,021 30,630 0
0 0 115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 950 28,500 0
ampul/kotak
0 0 116 Klorpromazin HCl tablet salut 100 mg tablet 100 149 14,900 0
tablet/kotak
0 0 117 Kodein 10 mg tablet tablet 100 600 600 0
tablet/kotak
0 0 118 Kotrimoksazol Susp komb: Sulfametoksazol botol botol 60 ml 2,190 2,190 0
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
0 0 119 Sulfametoksazol 400mg + Trimetoprim 80 tablet 100 126 126 0
tablet/kotak
0 0 120 mg
Lansoprazol inj 30 mg/ml ampul 1 82,042 82,042 0
ampul/kotak
0 0 121 Lidokain 2% ampul 30 847 847 0
ampul/kotak
0 0 122 Lidokain Kompositum ampul 30 803 803 0
ampul/kotak
0 0 123 Loperamide 2 mg tablet kotak 77 77 0
0 0 124 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak - 20,780 0
0 0 125 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090 4,090 0
0 0 126 Mebendazol tablet 100 mg tablet 30 - 6,840 0
tablet/kotak
0 0 127 Metformin tablet 100 39 39 0
tablet/kotak
0 0 128 Metilergometrin Maleat (Metilergometrin) tablet 100 224 224 0
0 0 129 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 1,023 1,023 0
ampul/kotak
0 0 130 Metilprednisolon tablet 4 mg tablet 30 102 102 0
tablet/kotak
0 0 131 Metilprednisolon tablet 8 mg tablet 100 206 206 0
tablet/kotak
0 0 132 Metoklopramid inj 5 mg/ml ampul 10 2,070 20,700 0
ampul/kotak
0 0 133 Metoklopramid 5 mg tablet 100 120 120 0
tablet/kotak
0 0 134 Metronidazol Infus 500mg/100ml botol botol 100 5,885 5,885 0
ml
0 0 135 Metronidazol tablet 250 mg tablet 100 - 19,305 0
tablet/kotak
0 0 136 Metronidazol tablet 500 mg tablet kotak 403 403 0
0 0 137 Mikonazol krim/ salep 2 % tube tube - 3,000 0
0 0 138 Mineral mix (Prog. Gizi) sachet 40 - 98,000 0
sachet/kotak
0 0 139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200 0
0 0 140 Natrium Diklofenac 50 mg tablet 50 100 100 0
tablet/kotak
0 0 141 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
0 0 142 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0
(Produk lokal)
0 0 143 Nistatin tablet salut 500.000 IU tablet 100 825 825 0
tablet/kotak
0 0 144 Nistatin vaginal tablet 100.000 UI tablet 100 550 550 0
tablet/kotak
0 0 145 Noretisteron tablet 5 mg (Primolut N) tablet 30 - 78,540 0
tablet/kotak
0 0 146 Obat Kusta MB strip strip 31,760 31,760 0
0 0 147 Obat Kusta PB strip strip 12,569 12,569 0
0 0 148 Obat Batuk Hitam botol botol 6,044 6,044 0
0 0 149 Ofloxacin 200 mg Tab Salut Selulose tablet 100 - 20,650 0
tablet/kotak
0 0 150 Ofloxacin 400 mg Tab Salut Selulose tablet 100 - 32,700 0
tablet/kotak
0 0 151 Oksitetrasiklin HCl salep mata 1 % tube 25 3,500 3,500 0
tube/kotak
0 0 152 Oksitosin injeksi 10IU/ml-1ml ampul 100 1,126 1,126 0
ampul/kotak
0 0 153 Omeprazol kapsul 20mg tablet 30 407 407 0
tablet/kotak
0 0 154 ondansetron tablet 4 mg tablet 30 - - 0
tablet/kotak
0 0 155 ondansetron tablet 8 mg tablet 30 270 270 0
tablet/kotak
0 0 156 Ondansetron inj 4 mg/ 2 ml ampul ampul 881 881 0
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 157 Papaverin tablet 40mg tablet 100 - - 0
tablet/kotak
0 0 158 Paracetamol drop 100 mg/ml botol botol - - 0
0 0 159 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160 1,160 0
0 0 160 Parasetamol tablet 500 mg tablet 100 222 222 0
tablet/kotak
0 0 161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
0 0 162 Pirantel tablet 125 mg tablet 30 420 12,595 0
tablet/kotak
0 0 163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 131 131 0
tablet/kotak
0 0 164 Piroksikam 20 mg tablet 100 220 220 0
tablet/kotak
0 0 165 Povidon Iodida larutan 10% botol botol 60 ml 7,552 7,552 0
0 0 166 Povidon Iodida larutan 10% botol botol 300 ml 26,139 26,139 0
0 0 167 Prednisone tablet 5 mg tablet 100 69 69 0
tablet/kotak
0 0 168 Prokain Benzil Penicillin G injeksi 3 jt IU/vial vial 30 vial/kotak 10,780 323,400 0
0 0 169 Propiltiourasil tablet 100 mg tablet 100 404 40,442 0
tablet/botol
0 0 170 Ranitidin inj.25mg/2ml ampul 25 814 814 0
ampul/kotak
0 0 171 Ranitidin tablet 150 mg tablet 100 85 85 0
kaplet/kotak
0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 553 553 0
Lunak kapsul/botol
0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul kapsul 50 553 553 0
Lunak kapsul/botol
0 0 174 Riseridon 2 mg tablet kotak 124 124 0
0 0 175 Ringer Laktat larutan infus steril botol botol 500 ml 7,630 7,630 0
0 0 176 Salbutamol 2 mg tablet 100 67 67 0
tablet/kotak
0 0 177 Salbutamol 4 mg tablet 100 - - 0
tablet/kotak
0 0 178 Salbutamol inshalasi/ aerosol 100 nebu nebu 22,200 22,200 0
0 0 179 Salbutamol cairan 1 mg/ml ampul ampul 4,844 4,844 0
0 0 180 Salep 2-4 Komb : As Salisilat 2 % + Belerang pot pot 2,333 2,333 0
endap 2 %
0 0 181 Salisil Bedak 2% kotak kotak - - 0
0 0 182 Sefadroksil kapsul 250 mg tablet 30 855 25,650 0
tablet/kotak
0 0 183 Sefadroksil kapsul 500 mg tablet 50 1,042 52,100 0
tablet/kotak
0 0 184 sefadroksil sirup kering 125mg/5ml botol botol 3,800 3,800 0
0 0 185 Sefotaksim inj 1 gr vial 2 vial/kotak 2,850 2,850 0
0 0 186 Sefriakson serbuk injeksi 1 g/vial vial vial 2,745 2,745 0
0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial 517,132 517,132 0
(ABU I) @ 5 ml
Dus, 10
0 0 188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul ampul @ 1 140,188 140,188 0
(A.T.S) ml
0 0 189 Setrizin tablet 10 mg tablet 100 49 49 0
tablet/kotak
0 0 190 Sianokobalamin (vit B12) injeksi 500mcg-ml ampul 100 916 91,600 0
ampul/kotak
0 0 191 Sianokobalamin (vit B12) tab 50 mcg tablet 100 45 45 0
tablet/kotak
0 0 192 Simvastatin tablet 10 mg tablet 50 150 150 0
tablet/kotak
0 0 193 Siproflaxacin tablet 500 mg tablet 100 248 248 0
tablet/kotak
0 0 194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 - 20,700 0
ampul/kotak
0 0 195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 151 151 0
mg tablet/botol
0 0 196 Tramadol inj 50mg/5ml ampul 5 5,400 27,000 0
ampul/kotak
0 0 197 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 63 63 0
tablet/kotak
Dus, 1 vial
0 0 198 Vaksin anti Rabies / Verorab vial @ 1 dosis + 154,391 154,391 0
199 Vitamin B komplek tablet syringe
100
0 0 tablet 57 57 0
tablet/kotak
0 0 200 Zinc sirup 20 mg/ 5 ml botol botol 2,511 2,511 0
0 0 201 Zinc Tab 20 mg tablet 100 216 216 0
tablet/kotak
0 0 0
204 Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 1,210 1,210 0
psc
0 0 205 Alat suntik sekali pakai 0,5 ml pcs kotak/ 100 1,190 1,190 0
psc
0 0 206 Alat suntik sekali pakai 1 ml pcs kotak/ 100 100,344 100,344 0
psc
psc
psc
0 0 209 Alkohol Swab pcs kotak/ 100 14,100 14,100 0
psc
0 0 210 Aqua bides 20 liter galon galon 174,000 174,000 0
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 211 Blood lanced kotak kotak 16,893 16,893 0
0 0 212 Catridge TCM TEST TEST 253,200 253,200 0
0 0 213 Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081 26,081 0
0 0 215 Exell tulle pcs kotak / psc - - 0
0 0 216 Foley cateter pcs pcs - - 0
0 0 217 Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500 90,500 0
0 0 218 Hand scub (4% clorhexidine) botol botol 42,863 42,863 0
0 0 219 Handscoon steril uk 7 pcs kotak 678,150 5,267 0
0 0 220 Handscoon steril uk 7,5 pcs kotak 678,150 5,270 0
0 0 221 Handscoon uk 6,5 50 pcs kotak 8,713 8,713 0
0 0 222 Handscoon uk 7 50 pcs kotak 8,713 8,713 0
0 0 223 Handscoon S 100 pcs kotak 87,601 87,601 0
0 0 224 Handscoon M 100 pcs kotak 87,601 87,601 0
0 0 225 Handscoon L 100 pcs kotak 87,601 87,601 0
0 0 226 Infus set anak set 50 set/kotak 9,047 82,500 0
0 0 227 Infus set dewasa set 50 set/kotak 7,755 339,250 0
0 0 228 IV Catheter No. 18 G set 50 set/kotak 7,044 385,000 0
0 0 230 IV Chateter No. 22 G set 50 set/kotak 7,044 385,000 0
0 0 234 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178 29,178 0
0 0 235 Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350 226,350 0
16
0 0 236 Kassa Hidrofil steril uk. 16x16 (surya pcs lembar/kota 7,641 7,641 0
husada) k 10
0 0 237 Kertas Puyer pack ball/ - - 0
pack
0 0 238 Klip Plastik 10 x 7 KP pack ball/ 10 - - 0
pack
0 0 239 Klip Plastik 13x8,7 KP pack ball/ 10 - - 0
pack
0 0 240 Lisol 1liter botol botol - - 0
0 0 241 Masker ear loop pcs 50 pcs/kotak 38,775 38,775 0
0 0 242 Masker head loop pcs 50 pcs/kotak 38,775 38,775 0
0 0 243 Masker KN95 pcs 50 pcs/kotak 82,700 82,700 0
0 0 244 Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
0 0 245 Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
0 0 246 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 46,842 46,842 0
jarum bedah
0 0 247 Stefanol botol botol 69,300 69,300 0
0 0 248 Strip Asam urat 50 strip box box 156,975 156,975 0
0 0 249 Strip gula 50 strip box box 161,000 161,000 0
0 0 250 Strip kolesterol 50 strip box box 257,225 257,225 0
0 0 251 Umbilical cord nylon one med (Klem tali pcs kotak/ 50 - - 0
pusat) psc
0 0 252 UnderPad_L pcs 10 100,848 100,848 0
pcs/kotak
0 0 253 Urine Bag Pcs Pcs - - 0
0 0 254 Waterone botol botol 15,246 15,246 0
- - 0
0BAT GIGI
0 0 260 Bonding / single bond botol botol 246,000 246,000 0
0 0 261 Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000 390,000 0
0 0 262 Etching 3 M botol botol 123,050 123,050 0
0 0 263 Etil klorida spray botol botol 175,010 175,010 0
0 0 264 Eugenol botol botol 20,150 20,150 0
0 0 265 Glass Ionomer Cement (GC IX) ART paket botol 423,800 423,800 0
0 0 266 Imicryl / sealing of fissures botol botol 206,555 206,555 0
0 0 267 Kalsium Hidroksida Pasta paket kotak 87,500 87,500 0
0 0 268 Klorfenol Kamfer Mentol (CHKM) paket botol 52,500 52,500 0
0 0 269 Mummifying Pasta kotak kotak - - 0
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
0 0 270 Nova compo A1 syr botol 242,295 242,295 0
0 0 273 Nova compo A3,5 syr botol 242,295 242,295 0
0 0 274 Nova compo HF A2 syr botol 299,100 299,100 0
0 0 275 Semen Seng Fosfat serbuk / filling paket botol 221,155 221,155 0
0 0 276 Semen Seng Fosfat cairan / lutting paket botol 321,300 321,300 0
0 0 277 CAVITA Tambalan sementara botol botol 136,300 136,300 0
0 0 278 TKF botol botol 57,640 57,640 0
0
IMUNISASI RUTIN
0 0 281 BCG ampul ampul 88,891 88,891.0 0

0 0 282 CAMPAK ampul ampul 28,204 28,204.0 0
0 0 283 DT ampul ampul 16,500 16,500.0 0
0 0 284 HB.0 / HEP.B UNIJECT ampul ampul 23,490 23,490.0 0
0 0 285 IPV vial vial 144,540 144,540.0 0
0 0 286 PENTAVALEN / DPT-HB-HIB vial vial 77,366 77,366.0 0
0 0 287 POLIO ampul ampul 19,540 19,540.0 0
0 0 288 PCV ampul ampul 0 0.0 0
0 0 289 Td ampul ampul 16,480 16,480.0 0
0 0 290 MR ampul ampul 151,150 151,150.0 0
0 0 0
294 Becefort syr 60

0 0 botol 17,523 17,523 0
mL/botol
0 0 295 Curcuma kotak kotak 48,202 48,202 0
296 Dextrofen syr botol 60
0 0 botol 11,655 11,655 0
ml
0 0 297 Dulcolac / bisakodil supp 10 mg supp supp 4,325 4,325 0
0 0 298 Dulcolac / bisakodil supp 5 mg supp supp 5,085 5,085 0
0 0 299 Febrinex syr Botol Botol 15,999 15,999 0
300 Herbacof 4
0 0 Tablet 2,498 2,498 0
tablet/strip
kotak 100
0 0 301 Noza Tablet 805 805 0
tablet100
kotak
0 0 302 Pehavral Tablet 993 993 0
tablet
10
0 0 303 Stimuno forte Tablet 1,958 1,958 0
100
tablet/strip
0 0 304 Stimuno syr Tablet tablet/kota 28,374 28,374 0
0 0 305 Sukralfat susp botol k
botol 5,034 5,034 0
306 Ichtiyol salp kotak 100
0 0 kapsul 6,886 6,886 0
kapsul
307 140,337 140,337 0
308 27,088 27,088 0
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PEMAKAIA STOK
RUPIAH BULAN INI
17 18 19 1 2 3 4 5 6 7
322
0
JUMLAH TOTAL SISA STOK BULAN INI (Rp
UMUM

BAYAR
............


NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001
7
AIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : Juli KABUPATEN

APBD I APBD II DAK ASKES LAIN TOTAL N N AKHIR DALAM RATA S/D N NO
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 1
0 0 0 0 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
0 0 0 0 0 6
0 0 0 0 0 7
0 0 0 0 0 8
0 0 0 0 0 9
0 0 0 0 0 10
0 0 0 0 0 11
0 0 0 0 0 12
0 0 0 0 0 13
0 0 0 0 0 14
0 0 0 0 0 15
0 0 0 0 0 16
0 0 0 0 0 17
0 0 0 0 0 18
0 0 0 0 0 19
0 0 0 0 0 20
0 0 0 0 0 21
0 0 0 0 0 22
0 0 0 0 0 23
0 0 0 0 0 24
0 0 0 0 0 25
0 0 0 0 0 26
0 0 0 0 0 27
0 0 0 0 0 28
0 0 0 0 0 29
0 0 0 0 0 30
0 0 0 0 0 31
0 0 0 0 0 32
0 0 0 0 0 33
0 0 0 0 0 34
0 0 0 0 0 35
0 0 0 0 0 36
0 0 0 0 0 37
0 0 0 0 0 38
0 0 0 0 0 39
0 0 0 0 0 40
0 0 0 0 0 41
0 0 0 0 0 42
0 0 0 0 0 43
0 0 0 0 0 44
0 0 0 0 0 45
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 46
0 0 0 0 0 47
0 0 0 0 0 48
0 0 0 0 0 49
0 0 0 0 0 50
0 0 0 0 0 51
0 0 0 0 0 52
0 0 0 0 0 53
0 0 0 0 0 54
0 0 0 0 0 55
0 0 0 0 0 56
0 0 0 0 0 57
0 0 0 0 0 58
0 0 0 0 0 59
0 0 0 0 0 60
0 0 0 0 0 61
0 0 0 0 0 62
0 0 0 0 0 63
0 0 0 0 0 64
0 0 0 0 0 65
0 0 0 0 0 66
0 0 0 0 0 67
0 0 0 0 0 68
0 0 0 0 0 69
0 0 0 0 0 70
0 0 0 0 0 71
0 0 0 0 0 72
0 0 0 0 0 73
0 0 0 0 0 74
0 0 0 0 0 75
0 0 0 0 0 76
0 0 0 0 0 77
0 0 0 0 0 78
0 0 0 0 0 79
0 0 0 0 0 80
0 0 0 0 0 81
0 0 0 0 0 82
0 0 0 0 0 83
0 0 0 0 0 84
0 0 0 0 0 85
0 0 0 0 0 86
0 0 0 0 0 87
0 0 0 0 0 88
0 0 0 0 0 89
0 0 0 0 0 90
0 0 0 0 0 91
0 0 0 0 0 92
0 0 0 0 0 93
0 0 0 0 0 94
0 0 0 0 0 95
0 0 0 0 0 96
0 0 0 0 0 97
0 0 0 0 0 98
0 0 0 0 0 99
0 0 0 0 0 100
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 101
0 0 0 0 0 102
0 0 0 0 0 103
0 0 0 0 0 104
0 0 0 0 0 105
0 0 0 0 0 106
0 0 0 0 0 107
0 0 0 0 0 108
0 0 0 0 0 109
0 0 0 0 0 110
0 0 0 0 0 111
0 0 0 0 0 112
0 0 0 0 0 114
0 0 0 0 0 115
0 0 0 0 0 116
0 0 0 0 0 117
0 0 0 0 0 118
0 0 0 0 0 119
0 0 0 0 0 120
0 0 0 0 0 121
0 0 0 0 0 122
0 0 0 0 0 123
0 0 0 0 0 124
0 0 0 0 0 125
0 0 0 0 0 126
0 0 0 0 0 127
0 0 0 0 0 128
0 0 0 0 0 129
0 0 0 0 0 130
0 0 0 0 0 131
0 0 0 0 0 132
0 0 0 0 0 133
0 0 0 0 0 134
0 0 0 0 0 135
0 0 0 0 0 136
0 0 0 0 0 137
0 0 0 0 0 138
0 0 0 0 0 139
0 0 0 0 0 140
0 0 0 0 0 141
0 0 0 0 0 142
0 0 0 0 0 143
0 0 0 0 0 144
0 0 0 0 0 145
0 0 0 0 0 146
0 0 0 0 0 147
0 0 0 0 0 148
0 0 0 0 0 149
0 0 0 0 0 150
0 0 0 0 0 151
0 0 0 0 0 152
0 0 0 0 0 153
0 0 0 0 0 154
0 0 0 0 0 155
0 0 0 0 0 156
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 157
0 0 0 0 0 158
0 0 0 0 0 159
0 0 0 0 0 160
0 0 0 0 0 161
0 0 0 0 0 162
0 0 0 0 0 163
0 0 0 0 0 164
0 0 0 0 0 165
0 0 0 0 0 166
0 0 0 0 0 167
0 0 0 0 0 168
0 0 0 0 0 169
0 0 0 0 0 170
0 0 0 0 0 171
0 0 0 0 0 172
0 0 0 0 0 173
0 0 0 174
0 0 0 0 0 175
0 0 0 0 0 176
0 0 0 0 0 177
0 0 0 0 0 178
0 0 0 0 0 179
0 0 0 0 0 180
0 0 0 0 0 181
0 0 0 0 0 182
0 0 0 0 0 183
0 0 0 0 0 184
0 0 0 0 0 185
0 0 0 0 0 186
0 0 0 0 0 187
0 0 0 0 0 188
0 0 0 0 0 189
0 0 0 0 0 190
0 0 0 0 0 191
0 0 0 0 0 192
0 0 0 0 0 193
0 0 0 0 0 194
0 0 0 0 0 195
0 0 0 0 0 196
0 0 0 0 0 197
0 0 0 0 0 198
0 0 0 0 0 199
0 0 0 0 0 200
0 0 0 0 0 201
0 0 0 0 0
204
0 0 0 0 0 205
0 0 0 0 0 206
0 0 0 0 0 207
0 0 0 0 0 208
0 0 0 0 0 209
0 0 0 0 0 210
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 211
0 0 0 0 0 212
0 0 0 0 0 213
0 0 0 0 0 215
0 0 0 0 0 216
0 0 0 0 0 217
0 0 0 0 0 218
0 0 0 0 0 219
0 0 0 0 0 220
0 0 0 0 0 221
0 0 0 0 0 222
0 0 0 0 0 223
0 0 0 0 0 224
0 0 0 0 0 225
0 0 0 0 0 226
0 0 0 0 0 227
0 0 0 0 0 228
0 0 0 0 0 229
0 0 0 0 0 230
0 0 0 0 0 231
0 0 0 0 0 232
0 0 0 0 0 234
0 0 0 0 0 235
0 0 0 0 0 236
0 0 0 0 0 237
0 0 0 0 0 238
0 0 0 0 0 239
0 0 0 0 0 240
0 0 0 0 0 241
0 0 0 0 0 242
0 0 0 0 0 243
0 0 0 0 0 244
0 0 0 0 0 245
0 0 0 0 0 246
0 0 0 0 0 247
0 0 0 0 0 248
0 0 0 0 0 249
0 0 0 0 0 250
0 0 0 0 0 251
0 0 0 0 0 252
0 0 0 0 0 253
0 0 0 0 0 254
0 0 0 0 0 260
0 0 0 0 0 261
0 0 0 0 0 262
0 0 0 0 0 263
0 0 0 0 0 264
0 0 0 0 0 265
0 0 0 0 0 266
0 0 0 0 0 267
0 0 0 0 0 268
0 0 0 0 0 269
8 9 10 11 12 13 14 15 16 17 18 19 1
0 0 0 0 0 270
0 0 0 0 0 271
0 0 0 0 0 272
0 0 0 0 0 273
0 0 0 0 0 274
0 0 0 0 0 275
0 0 0 0 0 276
0 0 0 0 0 277
0 0 0 0 0 278
0 0 0 0 0 281
0 0 0 0 0 282
0 0 0 0 0 283
0 0 0 0 0 284
0 0 0 0 0 285
0 0 0 0 0 286
0 0 0 0 0 287
0 0 0 0 0 288
0 0 0 0 0 289
0 0 0 0 0 290
291
0 0 0 0 0
0 0 0 0 0 294
0 0 0 0 0 295
0 0 0 0 0 296
0 0 0 0 0 297
0 0 0 0 0 298
0 0 0 0 0 299
0 0 0 0 0 300
0 0 0 0 0 301
0 0 0 0 0 302
0 0 0 0 0 303
0 0 0 0 0 304
0 0 0 0 0 305
0 0 0 0 0 306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
8 9 10 11 12 13 14 15 16 17 18 19 1
322
TOK BULAN INI (Rp.) 0
Yang Menerima/Melapor
Kepala UPT.Puskesmas Petugas Gudang Farmasi
…………………………………………… ……………………………………………
NIP. .......................................... NIP. ..........................................
8
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
PROPINSI : LAMPUNG
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Alprazolam tablet 1 mg tablet 100 tablet/kotak 99 99 0
Ambroxol tab 30 mg tablet 100 tablet/kotak - 8,593 0
Aminofilin tablet 200mg tablet 100 tablet/kotak - 8,000 0
Aminofilina injeksi 24 mg/ml ampul ktk 30 ampul@10 - 121,500 0
ml
Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 177 177 0
Amlodipine Tablet 5 mg tablet 30 tablet/kotak 53 53 0
Amlodipine Tablet 10 mg tablet 30 tablet/kotak - 5,610 0
Amoksisilin kapsul 250 mg tablet 100 tablet/kotak - 38,799 0
Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 201 201 0
Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak - 20,115 0
Antasida DOEN tablet tablet 100 tablet/kotak 54 54 0
Anti Bakteri DOEN salep tube 25 tube/kotak 3,509 3,509 0
Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 3,250 3,250 0
Antimalaria DOEN kombinasi tablet 100 tablet/kotak - 51,800 0
Antimigren: Ergotamin Tartrat 1mg tablet 100 tablet/botol 185 185 0
Antiparkinson
benzerazid 25 mg levodopa 100 mg tablet 100 tablet/kotak 904 904 0
( Levopar)
Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak - 179,550 0
Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 tablet/kotak 42 42 0
Asam folat tablet 1 mg tablet 100 tablet/botol 42 42 0
Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 111 111 0
Asiklovir krim 5% tube 25 tube/kotak 5,044 5,044 0
Asiklovir tablet 200 mg tablet 100 tablet/kotak - 52,404 0
Asiklovir tablet 400 mg tablet 100 tablet/kotak 405 405 0
Benzatin Benzil Penicillin injeksi 1,2 jt vial 10 vial/kotak 14,430 14,430 0
IU/vial
Besi (II ) Sulfat + asam folat 0.25 tab / sachet 30 tablet/sachet 226 226 0
TTD*
Captopril 12,5 mg tablet 100 tab/kotak 65 65 0
Captopril 25 mg tablet 100 tablet/kotak 75 75 0
Clozapine 25 mg tablet 100 tablet/kotak 477 477 0
Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580 158,000 0
Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62 6,200 0
DHP tablet (Prog : malaria) tablet 9 tablet/kotak - 32,101 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Diazepam inj 5 mg / ml ampul 30 ampul/kotak 1,545 1,545 0
Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054 31,620 0
Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143 14,300 0
Domperidone tablet 10mg tablet 100 tablet/kotak 167 16,700 0
Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38 38,000 0
Adrenalina ) ampul 30 ampul/kotak 8,100 243,000 0
Ergakalsiferol ml D3/D2) kapsul tablet tablet - 650 0
Eritromisin kapsul 250mg tablet 120 tablet/kotak 494 59,230 0
Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800 54,000 0
Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220 22,000 0
Fenol Gliserol tetes telinga 10% botol 24 botol/kotak 2,042 49,008 0
(Karbogliserin 10%)
Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul 10 ampul/kotak 4,698 46,980 0
1 ml
Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417 102,510 0
Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634 63,400 0
Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829 45,725 0
Furosemid tablet 40 mg tablet 100 tablet/kotak 85 8,500 0
Garam oralit untuk 200 ml air (Prog : sachet 100 sachet/kotak 292 29,200 0
diare)
Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,355 3,355 0
Glibenklamid tablet 5 mg tablet 101 tablet/kotak 82 82 0
Glimepiride tablet 2 mg tablet 50 tablet/kotak - 21,800 0
Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 172 172 0
Gliseril trinitrat tab sublingual 0,5mg tablet tablet - 1,500 0
(nitral)
lokal)
lokal)
lokal)
Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 210 210 0
Haloperidol inj 50 mg/ml (haldol ampul ampul 83,333 83,333 0
decanoas)
HCT tablet 100 tablet/kotak 148 148 0
Hidrokortison krim 2,5% tiube 24 tube/kotak 2,325 2,325 0
Ibuprofen tablet 200 mg tablet 100 tablet/botol 116 11,550 0
Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 86 86 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 60 60 0
Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243 24,300 0
Ketokenazol tablet 200mg tablet 50 tablet/kotak 554 27,675 0
Ketokonazol krim 2% tube 12 tube/kotak 4,700 56,400 0
Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823 182,250 0
Ketorolak inj 10 mg ampul 5 ampul/kotak - 40,400 0
Ketorolak inj 30 mg ampul 6 ampul/kotak 847 847 0
Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51 5,100 0
Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 ampul/kotak 1,021 30,630 0
Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950 28,500 0
Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149 14,900 0
Kodein 10 mg tablet tablet 100 tablet/kotak 600 600 0
Sulfametoksazol 200mg + Trimetoprim 40 botol botol 60 ml 2,190 2,190 0
Kotrimoksazol
mg tablet komb:
mg
Lidokain 2% ampul 30 ampul/kotak 847 847 0
Lidokain Kompositum ampul 30 ampul/kotak 803 803 0
Mebendazol tablet 100 mg tablet 30 tablet/kotak - 6,840 0
Metformin tablet 100 tablet/kotak 39 39 0
Metilergometrin Maleat tablet 100 tablet/kotak 224 224 0
(Metilergometrin) tab salut 0,125 mg
Metilergometrin Maleat inj 0,200 mg-1 ampul 30 ampul/kotak 1,023 1,023 0
ml
Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070 20,700 0
Metoklopramid 5 mg tablet 100 tablet/kotak 120 120 0
Metronidazol Infus 500mg/100ml botol botol 100 ml 5,885 5,885 0
Metronidazol tablet 250 mg tablet 100 tablet/kotak - 19,305 0
Mineral mix (Prog. Gizi) sachet 40 sachet/kotak - 98,000 0
Natrium Diklofenac 50 mg tablet 50 tablet/kotak 100 100 0
(Produk lokal)
Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 825 825 0
Nistatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 550 550 0
Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak - 78,540 0
Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 3,500 3,500 0
Oksitosin injeksi 10IU/ml-1ml ampul 100 ampul/kotak 1,126 1,126 0
Omeprazol kapsul 20mg tablet 30 tablet/kotak 407 407 0
ondansetron tablet 4 mg tablet 30 tablet/kotak - - 0
ondansetron tablet 8 mg tablet 30 tablet/kotak 270 270 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Papaverin tablet 40mg tablet 100 tablet/kotak - - 0
Parasetamol tablet 500 mg tablet 100 tablet/kotak 222 222 0
Pirantel tablet 125 mg tablet 30 tablet/kotak 420 12,595 0
Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 131 131 0
Piroksikam 20 mg tablet 100 tablet/kotak 220 220 0
Prednisone tablet 5 mg tablet 100 tablet/kotak 69 69 0
Prokain Benzil Penicillin G injeksi 3 jt vial 30 vial/kotak 10,780 323,400 0
IU/vial
Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404 40,442 0
Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 814 814 0
Ranitidin tablet 150 mg tablet 100 kaplet/kotak 85 85 0
Lunak
Lunak
Salbutamol 2 mg tablet 100 tablet/kotak 67 67 0
Salbutamol 4 mg tablet 100 tablet/kotak - - 0
Salep 2-4 Komb : As Salisilat 2 % + pot pot 2,333 2,333 0
Belerang endap 2 %
Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855 25,650 0
Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042 52,100 0
Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial @ 5 ml 517,132 517,132 0
(ABU I)
Serum Anti Tetanus injeksi 1.500 ampul Dus, 10 ampul @ 1 140,188 140,188 0
IU/ampul (A.T.S) ml
Setrizin tablet 10 mg tablet 100 tablet/kotak 49 49 0
Sianokobalamin (vit B12) injeksi 500mcg- ampul 100 ampul/kotak 916 91,600 0
ml
Sianokobalamin (vit B12) tab 50 mcg tablet 100 tablet/kotak 45 45 0
Simvastatin tablet 10 mg tablet 50 tablet/kotak 150 150 0
Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 248 248 0
Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak - 20,700 0
Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 tablet/botol 151 151 0
mg
Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400 27,000 0
Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 63 63 0
Vaksin anti Rabies / Verorab vial Dus, 1 vial @ 1 154,391 154,391 0
dosis + syringe
Vitamin B komplek tablet tablet 100 tablet/kotak 57 57 0
Zinc Tab 20 mg tablet 100 tablet/kotak 216 216 0
0
Alkohol Swab pcs kotak/ 100 psc 14,100 14,100 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
Hand rub (0,5% clorhexidine+isoropyl botol botol 90,500 90,500 0
70%)
Kassa Hidrofil steril uk. 16x16 (surya pcs 16 lembar/kotak 7,641 7,641 0
husada)
Kertas Puyer pack ball/ 10 pack - - 0
Klip Plastik 10 x 7 KP pack ball/ 10 pack - - 0
Klip Plastik 13x8,7 KP pack ball/ 10 pack - - 0
Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
jarum bedah
Umbilical cord nylon one med (Klem tali pcs kotak/ 50 psc - - 0
pusat)
UnderPad_L pcs 10 pcs/kotak 100,848 100,848 0
- - 0
0BAT GIGI
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11
0
IMUNISASI RUTIN
BCG ampul ampul 88,891 88,891.0 0

DT ampul ampul 16,500 16,500.0 0
IPV vial vial 144,540 144,540.0 0
Td ampul ampul 16,480 16,480.0 0
MR ampul ampul 151,150 151,150.0 0
0
Becefort syr botol 60 mL/botol 17,523 17,523 0

Dextrofen syr botol botol 60 ml 11,655 11,655 0
Herbacof Tablet 4 tablet/strip 2,498 2,498 0
Noza Tablet kotak 100 tablet 805 805 0
Pehavral Tablet kotak 100 tablet 993 993 0
Stimuno forte Tablet 10 tablet/strip 1,958 1,958 0
Stimuno syr Tablet 100 tablet/kotak 28,374 28,374 0
Sukralfat susp botol botol 5,034 5,034 0
Ichtiyol salp kapsul kotak 100 kapsul 6,886 6,886 0
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
HARGA HARGA PER
2 3 4 5 6 7 8 9 10 11

UMUM

BAYAR
............


NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001 NIP. ..........................................
LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : Agustus KABUPATEN
N STOK PEMAKAIA
LAIN TOTAL N N AKHIR DALAM RATA S/D N NO NAMA OBAT
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 1 Acetil Cystein
50mg
0 0 0 0 0 26 (Aqua
Levopar)
0 0 0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt
IU/vial
0 0 0 0 0 38 Captopril 12,5 mg
0 0 0 0 0 39 Captopril 25 mg
0 0 0 0 0 40 Clozapine 25 mg
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0
(Karbogliserin 10%)
ml
0 0 0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg
(nitral)
lokal)
lokal)
lokal)
0 0 0 0 0 93 HCT
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
0 0 0 0 0 119 Sulfametoksazol 400mg + Trimetoprim 80
0 0 0 0 0 120 mg
Lansoprazol inj 30 mg/ml
0 0 0 0 0 121 Lidokain 2%
0 0 0 0 0 127 Metformin
tab salut 0,125 mg
(Produk lokal)
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul
Lunak
Lunak
0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 100
endap 2 %
(ABU I)
(A.T.S)
mg
0 0 0 0 0 200 Zinc sirup 20 mg/ 5 ml
0 0 0 0 0 201 Zinc Tab 20 mg
0 0 0 0 0
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 213 Cut gut chromic 3/0
0 0 0 0 0 221 Handscoon uk 6,5
0 0 0 0 0 222 Handscoon uk 7
0 0 0 0 0 228 IV Catheter No. 18 G
0 0 0 0 0 229 IV Catheter No. 20 G
0 0 0 0 0 230 IV Chateter No. 22 G
0 0 0 0 0 231 IV Catheter No. 24 G
0 0 0 0 0 232 IV Catheter No. 26 G
0 0 0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya
husada)
0 0 0 0 0 238 Klip Plastik 10 x 7 KP
0 0 0 0 0 239 Klip Plastik 13x8,7 KP
0 0 0 0 0 240 Lisol 1liter
0 0 0 0 0 243 Masker KN95
0 0 0 0 0 244 Plester 2,5 x 4,5
0 0 0 0 0 245 Plester 7,5 x 4,5
jarum bedah
0 0 0 0 0 247 Stefanol
pusat)
0 0 0 0 0 252 UnderPad_L
0 0 0 0 0 253 Urine Bag
0 0 0 0 0 254 Waterone
0BAT GIGI
0 0 0 0 0 262 Etching 3 M
0 0 0 0 0 264 Eugenol
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 270 Nova compo A1
0 0 0 0 0 271 Nova compo A2
0 0 0 0 0 272 Nova compo A3
0 0 0 0 0 273 Nova compo A3,5
0 0 0 0 0 278 TKF
IMUNISASI RUTIN
0 0 0 0 0 281 BCG
0 0 0 0 0 282 CAMPAK
0 0 0 0 0 283 DT
0 0 0 0 0 284 HB.0 / HEP.B UNIJECT
0 0 0 0 0 285 IPV
0 0 0 0 0 287 POLIO
0 0 0 0 0 288 PCV
0 0 0 0 0 289 Td
0 0 0 0 0 290 MR
291 safety box
0 0 0 0 0

0 0 0 0 0 295 Curcuma
0 0 0 0 0 300 Herbacof
0 0 0 0 0 301 Noza
0 0 0 0 0 302 Pehavral
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
N STOK PEMAKAIA
12 13 14 15 16 17 18 19 1 2
322
............
…………………………………………… H.Fatoni, S.Kep,MM

NIP. .......................................... NIP.19730808 200501 1 008
9
:
:
:
: LAMPUNG TAHUN
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kapsul kotak 304 304 0 0 0 0
tablet 24 tab/Kotak 1,856 44,550 0 0 0
tablet 100 tablet/kotak 87 87 0 0 0
botol botol 60 ml - 3,300 0 0 0
tablet 100 tablet/kotak - 8,593 0 0 0
ampul ktk 30 ampul@10 - 121,500 0 0 0
ml
vial 10 vial/kotak 8,591 8,591 0 0 0
botol botol 60 ml 3,498 3,498 0 0 0
botol botol 60 ml 1,694 1,694 0 0 0
tube 25 tube/kotak 3,509 3,509 0 0 0
supp 10 supp/kotak 3,250 3,250 0 0 0
pot 24 pot/kotak 3,477 3,477 0 0 0
tablet 100 tablet/botol 185 185 0 0 0
vial 10 vial/kotak 2,650 2,650 0 0 0
ampul 6 ampul/kotak - 179,550 0 0 0
tube 25 tube/kotak 5,044 5,044 0 0 0
ampul ampul 1,718 1,718 0 0 0
vial 10 vial/kotak 14,430 14,430 0 0 0
sachet 30 tablet/sachet 226 226 0 0 0
tube tube 2,997 2,997 0 0 0
tablet 100 tab/kotak 65 65 0 0 0
ampul 100 ampul/kotak 1,580 158,000 0 0 0
tablet 100 tablet/kotak 62 6,200 0 0 0
tablet 100 tablet / kotak 70 70.0 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
botol botol 3,333 3,333 0 0 0
botol botol 15,600 15,600 0 0 0
tablet 1000 tablet/botol 38 38,000 0 0 0
botol botol 7,220 7,220 0 0 0
botol 300 ml/botol 9,124 9,124 0 0 0
botol 1000 ml/botol 30,931 30,931 0 0 0
botol 60 ml/botol 3,740 3,740 0 0 0
botol 300 ml/botol 8,160 8,160 0 0 0
paket kotak 214,990 214,990 0 0 0
paket kotak 409,461 409,461 0 0 0
paket kotak 389,344 389,344 0 0 0
paket kotak 1,297,894 1,297,894 0 0 0
ampul ampul 20,250 20,250 0 0 0
kapsul botol 133 13,300 0 0 0
botol 24 botol/kotak 2,042 49,008 0 0 0
sachet 100 sachet/kotak 292 29,200 0 0 0
tube tube 2,600 2,600 0 0 0
botol 5 ml/botol 3,194 3,194 0 0 0
ampul ampul 5,723 5,723 0 0 0
botol 500 ml/botol 5,700 5,700 0 0 0
botol botol 1,960 1,960 0 0 0
botol 500 ml/botol 6,627 6,627 0 0 0
ampul ampul 83,333 83,333 0 0 0
tiube 24 tube/kotak 2,325 2,325 0 0 0
botol botol 3,200 3,200 0 0 0
tablet 100 tablet 190 190 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
tube 12 tube/kotak 4,700 56,400 0 0 0
tablet 100 tablet/kotak 1,823 182,250 0 0 0
ampul 6 ampul/kotak 847 847 0 0 0
tube tube 3,266 3,266 0 0 0
botol botol 1,599 1,599 0 0 0
ampul 30 ampul/kotak 950 28,500 0 0 0
botol botol 60 ml 2,190 2,190 0 0 0
vial 10 vial/kotak - 20,780 0 0 0
vial 10 vial/kotak 4,090 4,090 0 0 0
botol botol 100 ml 5,885 5,885 0 0 0
tube tube - 3,000 0 0 0
sachet 40 sachet/kotak - 98,000 0 0 0
ampul ampul 6,200 6,200 0 0 0
tablet kotak 174 8,700 0 0 0
botol botol 4,900 4,900 0 0 0
strip strip 31,760 31,760 0 0 0
strip strip 12,569 12,569 0 0 0
botol botol 6,044 6,044 0 0 0
tube 25 tube/kotak 3,500 3,500 0 0 0
tablet 30 tablet/kotak - - 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
60 ml botol 60 ml 1,160 1,160 0 0 0
botol botol 8,250 8,250 0 0 0
botol botol 60 ml 7,552 7,552 0 0 0
botol botol 300 ml 26,139 26,139 0 0 0
vial 30 vial/kotak 10,780 323,400 0 0 0
tablet 100 kaplet/kotak 85 85 0 0 0
kapsul 50 kapsul/botol 553 553 0 0 0
botol botol 500 ml 7,630 7,630 0 0 0
nebu nebu 22,200 22,200 0 0 0
ampul ampul 4,844 4,844 0 0 0
pot pot 2,333 2,333 0 0 0
botol botol 3,800 3,800 0 0 0
vial 2 vial/kotak 2,850 2,850 0 0 0
vial vial 2,745 2,745 0 0 0
vial Dus, 10 vial @ 5 ml 517,132 517,132 0 0 0
ampul Dus, 10 ampul @ 1 140,188 140,188 0 0 0
ml
vial Dus, 1 vial @ 1 154,391 154,391 0 0 0
dosis + syringe
botol botol 2,511 2,511 0 0 0
0 0 0
pcs kotak/ 100 psc 1,210 1,210 0

pcs kotak/ 100 psc 1,190 1,190 0 0 0
pcs kotak/ 100 psc 100,344 100,344 0 0 0
pcs kotak/ 100 psc 100,344 100,344 0 0 0
pcs kotak/ 100 psc 104,734 104,734 0 0 0
pcs kotak/ 100 psc 14,100 14,100 0 0 0
galon galon 174,000 174,000 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kotak kotak 16,893 16,893 0 0 0
TEST TEST 253,200 253,200 0 0 0
pcs 12 pcs/kotak 26,081 26,081 0 0 0
pcs pcs - - 0 0 0
botol botol 90,500 90,500 0 0 0
botol botol 42,863 42,863 0 0 0
pcs kotak 678,150 5,267 0 0 0
pcs kotak 678,150 5,270 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
set 50 set/kotak 9,047 82,500 0 0 0
set 50 set/kotak 7,755 339,250 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
Rol Rol 226,350 226,350 0 0 0
pcs 16 lembar/kotak 7,641 7,641 0 0 0
pack ball/ 10 pack - - 0 0 0
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 82,700 82,700 0 0 0
Rol Rol 14,810 14,810 0 0 0
Rol Rol 43,300 43,300 0 0 0
pcs 36pcs/kotak 46,842 46,842 0 0 0
botol botol 69,300 69,300 0 0 0
box box 156,975 156,975 0 0 0
box box 161,000 161,000 0 0 0
box box 257,225 257,225 0 0 0
pcs kotak/ 50 psc - - 0 0 0
pcs 10 pcs/kotak 100,848 100,848 0 0 0
Pcs Pcs - - 0 0 0
botol botol 15,246 15,246 0 0 0
- - 0
botol botol 246,000 246,000 0 0 0

paket kotak 390,000 390,000 0 0 0
botol botol 123,050 123,050 0 0 0
botol botol 175,010 175,010 0 0 0
botol botol 20,150 20,150 0 0 0
paket botol 423,800 423,800 0 0 0
botol botol 206,555 206,555 0 0 0
paket kotak 87,500 87,500 0 0 0
paket botol 52,500 52,500 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 299,100 299,100 0 0 0
paket botol 221,155 221,155 0 0 0
paket botol 321,300 321,300 0 0 0
botol botol 136,300 136,300 0 0 0
botol botol 57,640 57,640 0 0 0
0
ampul ampul 88,891 88,891.0 0 0 0
ampul ampul 28,204 28,204.0 0 0 0
ampul ampul 16,500 16,500.0 0 0 0
ampul ampul 23,490 23,490.0 0 0 0
vial vial 144,540 144,540.0 0 0 0
vial vial 77,366 77,366.0 0 0 0
ampul ampul 19,540 19,540.0 0 0 0
ampul ampul 16,480 16,480.0 0 0 0
ampul ampul 151,150 151,150.0 0 0 0
pcs pcs 16,500 16,500.0 0

0 0 0
botol 60 mL/botol 17,523 17,523 0 0 0
kotak kotak 48,202 48,202 0 0 0
botol botol 60 ml 11,655 11,655 0 0 0
supp supp 4,325 4,325 0 0 0
supp supp 5,085 5,085 0 0 0
Botol Botol 15,999 15,999 0 0 0
Tablet 4 tablet/strip 2,498 2,498 0 0 0
Tablet kotak 100 tablet 805 805 0 0 0
Tablet 100 tablet/kotak 28,374 28,374 0 0 0
botol botol 5,034 5,034 0 0 0
kapsul kotak 100 kapsul 6,886 6,886 0 0 0
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15

UMUM
TIDAK BAYAR
BAYAR

Aziza, S.Kep …………………………………………… ……………………………………………

NIP. 19741011 200804 2 001 NIP. .......................................... NIP. ..........................................
LAPORAN PEMAKAIAN OBAT
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
: September KABUPATEN : TULANG BAWANG
: 2023 PROPINSI : LAMPUNG
STOK PEMAKAIA
STOK AKHIR N RATA- PERMINTAA HARGA
AKHIR DALAM RATA S/D N NO NAMA OBAT SATUAN KMSN SATUAN
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 1 Acetil Cystein kapsul kotak 304
0 0 2 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856
0 0 0 3 Alopurinol tablet 100 mg tablet 100 tablet/kotak 87
0 0 0 4 Alopurinol tablet 300 mg tablet 30 tablet/kotak 200
0 0 0 5 Alprazolam tablet 1 mg tablet 100 tablet/kotak 99
0 0 0 6 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml -
0 0 0 7 Ambroxol tab 30 mg tablet 100 tablet/kotak -
0 0 0 8 Aminofilin tablet 200mg tablet 100 tablet/kotak -
0 0 0 9 Aminofilina injeksi 24 mg/ml ampul ktk 30 ampul@10 -
ml
0 0 0 10 Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 177
0 0 0 11 Amlodipine Tablet 5 mg tablet 30 tablet/kotak 53
0 0 0 12 Amlodipine Tablet 10 mg tablet 30 tablet/kotak -
0 0 0 13 Amicillin 1000 mg inj vial 10 vial/kotak 8,591
0 0 0 14 Amoksisilin kapsul 250 mg tablet 100 tablet/kotak -
0 0 0 15 Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 201
0 0 0 16 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498
0 0 0 17 Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak -
0 0 0 18 Antasida DOEN II suspensi komb botol botol 60 ml 1,694
0 0 0 19 Antasida DOEN tablet tablet 100 tablet/kotak 54
0 0 0 20 Anti Bakteri DOEN salep tube 25 tube/kotak 3,509
0 0 0 21 Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 3,250
0 0 0 22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477
0 0 0 23 Antimalaria DOEN kombinasi tablet 100 tablet/kotak -
0 0 0 24 Antimigren: Ergotamin Tartrat 1mg tablet 100 tablet/botol 185
Antiparkinson
0 0 0 25 benzerazid 25 mg levodopa 100 mg tablet 100 tablet/kotak 904
0 0 0 26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650
0 0 0 27 Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak -
0 0 0 28 Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 tablet/kotak 42
0 0 0 29 Asam folat tablet 1 mg tablet 100 tablet/botol 42
0 0 0 30 Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 111
0 0 0 31 Asiklovir krim 5% tube 25 tube/kotak 5,044
0 0 0 32 Asiklovir tablet 200 mg tablet 100 tablet/kotak -
0 0 0 33 Asiklovir tablet 400 mg tablet 100 tablet/kotak 405
0 0 0 34 Atropin sulfat inj ampul ampul 1,718
0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt vial 10 vial/kotak 14,430
IU/vial
0 0 0 36 Besi (II ) Sulfat + asam folat 0.25 tab / TTD* sachet 30 tablet/sachet 226
0 0 0 37 Betametason krim 0,1% tube tube 2,997
0 0 0 38 Captopril 12,5 mg tablet 100 tab/kotak 65
0 0 0 39 Captopril 25 mg tablet 100 tablet/kotak 75
0 0 0 40 Clozapine 25 mg tablet 100 tablet/kotak 477
0 0 0 41 Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580
0 0 0 42 Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62
0 0 0 43 DHP tablet (Prog : malaria) tablet 9 tablet/kotak -
0 0 0 44 Diazepam tab.2 mg tablet 100 tablet / kotak 70
0 0 0 45 Diazepam tab.5 mg tablet 100 tablet / kotak 70
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 46 Diazepam inj 5 mg / ml ampul 30 ampul/kotak 1,545
0 0 0 47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054
0 0 0 48 Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143
0 0 0 49 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333
0 0 0 50 Domperidon tetes/ 5 mg/ml botol botol 15,600
0 0 0 51 Domperidone tablet 10mg tablet 100 tablet/kotak 167
0 0 0 52 Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38
0 0 0 53 Adrenalina ) ampul 30 ampul/kotak 8,100
0 0 0 tablet tablet -
0 0 0 55 Ergakalsiferol (vitamin D3/D2) suspensi botol botol -
0 0 0 56 Eritromisin kapsul 250mg tablet 120 tablet/kotak 494
0 0 0 57 Eritromisin sirup 200mg/5ml botol botol 7,220
0 0 0 58 Etanol 70% cairan botol 300 ml/botol 9,124
0 0 0 59 Etanol 96% cairan botol 1000 ml/botol 30,931
0 0 0 60 Etakridin / rivanol botol 60 ml/botol 3,740
0 0 0 61 Etakridin / rivanol botol 300 ml/botol 8,160
0 0 0 62 FDC kategori anak paket kotak 214,990
0 0 0 63 FDC OAT Sisipan paket kotak -
0 0 0 64 FDC OAT Kategori I dosis harian paket kotak 409,461
0 0 0 65 FDC OAT Kategori I paket kotak 389,344
0 0 0 66 FDC OAT Kategori II paket kotak 1,297,894
0 0 0 67 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250
0 0 0 68 Fenitoin Natrium Kapsul 100 mg kapsul botol 133
0 0 0 69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800
0 0 0 70 Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220
0 0 0 71 Fenol Gliserol tetes telinga 10% botol 24 botol/kotak 2,042
(Karbogliserin 10%)
0 0 0 72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ampul 10 ampul/kotak 4,698
ml
0 0 0 73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417
0 0 0 74 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634
0 0 0 75 Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829
0 0 0 76 Furosemid tablet 40 mg tablet 100 tablet/kotak 85
0 0 0 77 Garam oralit untuk 200 ml air (Prog : diare) sachet 100 sachet/kotak 292
0 0 0 78 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600
0 0 0 79 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194
0 0 0 80 Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,355
0 0 0 81 Gentian Violet larutan 1 % botol botol -
0 0 0 82 Glibenklamid tablet 5 mg tablet 101 tablet/kotak 82
0 0 0 83 Glimepiride tablet 2 mg tablet 50 tablet/kotak -
0 0 0 84 Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 172
0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg tablet tablet -
(nitral)
0 0 0 86 Glukonas Kalsikus 10 % ampul ampul 5,723
0 0 0 87 Glukosa larutan infus 10% steril (Produk botol 500 ml/botol 5,700
lokal)
0 0 0 88 Glukosa larutan infus 40% steril (Produk botol botol 1,960
lokal)
0 0 0 89 Glukosa larutan infus 5% steril (Produk botol 500 ml/botol 6,627
lokal)
0 0 0 90 Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 210
0 0 0 91 Haloperidol inj 50 mg/ml (haldol ampul ampul 83,333
decanoas)
0 0 0 92 Haloperidol tablet 5 mg tablet 100 tablet/kotak 54
0 0 0 93 HCT tablet 100 tablet/kotak 148
0 0 0 94 Haloperidol tablet 5 mg tablet 100 tablet/kotak 54
0 0 0 95 Hidrokortison krim 2,5% tiube 24 tube/kotak 2,325
0 0 0 96 Ibuprofen sirup 100mg / 5ml botol botol -
0 0 0 97 Ibuprofen suspensi 200mg / 5ml botol botol 3,200
0 0 0 98 Ibuprofen tablet 200 mg tablet 100 tablet/botol 116
0 0 0 99 Ibuprofen tablet 400 mg tablet 100 tablet 190
0 0 0 100 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 86
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 101 Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 60
0 0 0 102 Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243
0 0 0 103 Ketokenazol tablet 200mg tablet 50 tablet/kotak 554
0 0 0 104 Ketokonazol krim 2% tube 12 tube/kotak 4,700
0 0 0 105 Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823
0 0 0 106 Ketorolak inj 10 mg ampul 5 ampul/kotak -
0 0 0 107 Ketorolak inj 30 mg ampul 6 ampul/kotak 847
0 0 0 108 Klindamisin 150 mg tablet 50 tablet/kotak 382
0 0 0 109 Klindamisin 300 mg tablet 50 tablet/kotak 527
0 0 0 110 Kloramfenikol salp kulit / Bufacetin* tube tube 3,266
0 0 0 111 Kloramfenikol tetes telinga 3% botol botol 1,599
0 0 0 112 Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51
0 0 0 114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 ampul/kotak 1,021
0 0 0 115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950
0 0 0 116 Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149
0 0 0 117 Kodein 10 mg tablet tablet 100 tablet/kotak 600
0 0 0 118 Sulfametoksazol 200mg + Trimetoprim 40 botol botol 60 ml 2,190
0 0 0 119 mg
Sulfametoksazol 400mg + Trimetoprim 80 tablet 100 tablet/kotak 126
0 0 0 120 mg
Lansoprazol inj 30 mg/ml ampul 1 ampul/kotak 82,042
0 0 0 121 Lidokain 2% ampul 30 ampul/kotak 847
0 0 0 122 Lidokain Kompositum ampul 30 ampul/kotak 803
0 0 0 123 Loperamide 2 mg tablet kotak 77
0 0 0 124 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak -
0 0 0 125 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090
0 0 0 126 Mebendazol tablet 100 mg tablet 30 tablet/kotak -
0 0 0 127 Metformin tablet 100 tablet/kotak 39
0 0 0 128 Metilergometrin Maleat (Metilergometrin) tablet 100 tablet/kotak 224
tab salut 0,125 mg
0 0 0 129 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 ampul/kotak 1,023
0 0 0 130 Metilprednisolon tablet 4 mg tablet 30 tablet/kotak 102
0 0 0 131 Metilprednisolon tablet 8 mg tablet 100 tablet/kotak 206
0 0 0 132 Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070
0 0 0 133 Metoklopramid 5 mg tablet 100 tablet/kotak 120
0 0 0 134 Metronidazol Infus 500mg/100ml botol botol 100 ml 5,885
0 0 0 135 Metronidazol tablet 250 mg tablet 100 tablet/kotak -
0 0 0 136 Metronidazol tablet 500 mg tablet kotak 403
0 0 0 137 Mikonazol krim/ salep 2 % tube tube -
0 0 0 138 Mineral mix (Prog. Gizi) sachet 40 sachet/kotak -
0 0 0 139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200
0 0 0 140 Natrium Diklofenac 50 mg tablet 50 tablet/kotak 100
0 0 0 141 Natrium Diklofenak 25 mg tablet kotak 174
0 0 0 142 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900
(Produk lokal)
0 0 0 143 Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 825
0 0 0 144 Nistatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 550
0 0 0 145 Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak -
0 0 0 146 Obat Kusta MB strip strip 31,760
0 0 0 147 Obat Kusta PB strip strip 12,569
0 0 0 148 Obat Batuk Hitam botol botol 6,044
0 0 0 149 Ofloxacin 200 mg Tab Salut Selulose tablet 100 tablet/kotak -
0 0 0 150 Ofloxacin 400 mg Tab Salut Selulose tablet 100 tablet/kotak -
0 0 0 151 Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 3,500
0 0 0 152 Oksitosin injeksi 10IU/ml-1ml ampul 100 ampul/kotak 1,126
0 0 0 153 Omeprazol kapsul 20mg tablet 30 tablet/kotak 407
0 0 0 154 ondansetron tablet 4 mg tablet 30 tablet/kotak -
0 0 0 155 ondansetron tablet 8 mg tablet 30 tablet/kotak 270
0 0 0 156 Ondansetron inj 4 mg/ 2 ml ampul ampul 881
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 157 Papaverin tablet 40mg tablet 100 tablet/kotak -
0 0 0 158 Paracetamol drop 100 mg/ml botol botol -
0 0 0 159 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160
0 0 0 160 Parasetamol tablet 500 mg tablet 100 tablet/kotak 222
0 0 0 161 Pirantel sirup 125mg/5ml botol botol 8,250
0 0 0 162 Pirantel tablet 125 mg tablet 30 tablet/kotak 420
0 0 0 163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 131
0 0 0 164 Piroksikam 20 mg tablet 100 tablet/kotak 220
0 0 0 165 Povidon Iodida larutan 10% botol botol 60 ml 7,552
0 0 0 166 Povidon Iodida larutan 10% botol botol 300 ml 26,139
0 0 0 167 Prednisone tablet 5 mg tablet 100 tablet/kotak 69
0 0 0 168 Prokain Benzil Penicillin G injeksi 3 jt vial 30 vial/kotak 10,780
IU/vial
0 0 0 169 Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404
0 0 0 170 Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 814
0 0 0 171 Ranitidin tablet 150 mg tablet 100 kaplet/kotak 85
0 0 0 172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 kapsul/botol 553
Lunak
0 0 0 173 Retinol (Vitamin A) 100.000 IU Kapsul kapsul 50 kapsul/botol 553
Lunak
0 0 0 174 Riseridon 2 mg tablet kotak 124
0 0 0 175 Ringer Laktat larutan infus steril botol botol 500 ml 7,630
0 0 0 176 Salbutamol 2 mg tablet 100 tablet/kotak 67
0 0 0 177 Salbutamol 4 mg tablet 100 tablet/kotak -
0 0 0 178 Salbutamol inshalasi/ aerosol 100 nebu nebu 22,200
0 0 0 179 Salbutamol cairan 1 mg/ml ampul ampul 4,844
0 0 0 180 Salep 2-4 Komb : As Salisilat 2 % + pot pot 2,333
Belerang endap 2 %
0 0 0 181 Salisil Bedak 2% kotak kotak -
0 0 0 182 Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855
0 0 0 183 Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042
0 0 0 184 sefadroksil sirup kering 125mg/5ml botol botol 3,800
0 0 0 185 Sefotaksim inj 1 gr vial 2 vial/kotak 2,850
0 0 0 186 Sefriakson serbuk injeksi 1 g/vial vial vial 2,745
0 0 0 187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial @ 5 ml 517,132
(ABU I)
0 0 0 188 Serum Anti Tetanus injeksi 1.500 IU/ampul ampul Dus, 10 ampul @ 1 140,188
(A.T.S) ml
0 0 0 189 Setrizin tablet 10 mg tablet 100 tablet/kotak 49
0 0 0 190 Sianokobalamin (vit B12) injeksi 500mcg- ampul 100 ampul/kotak 916
ml
0 0 0 191 Sianokobalamin (vit B12) tab 50 mcg tablet 100 tablet/kotak 45
0 0 0 192 Simvastatin tablet 10 mg tablet 50 tablet/kotak 150
0 0 0 193 Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 248
0 0 0 194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak -
0 0 0 195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 tablet/botol 151
mg
0 0 0 196 Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400
0 0 0 197 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 63
0 0 0 198 Vaksin anti Rabies / Verorab vial Dus, 1 vial @ 1 154,391
dosis + syringe
0 0 0 199 Vitamin B komplek tablet tablet 100 tablet/kotak 57
0 0 0 200 Zinc sirup 20 mg/ 5 ml botol botol 2,511
0 0 0 201 Zinc Tab 20 mg tablet 100 tablet/kotak 216
0 0 0
204 Alat suntik sekali pakai 0,05 ml pcs kotak/ 100 psc 1,210
0 0 0 205 Alat suntik sekali pakai 0,5 ml pcs kotak/ 100 psc 1,190
0 0 0 206 Alat suntik sekali pakai 1 ml pcs kotak/ 100 psc 100,344
0 0 0 209 Alkohol Swab pcs kotak/ 100 psc 14,100
0 0 0 210 Aqua bides 20 liter galon galon 174,000
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 211 Blood lanced kotak kotak 16,893
0 0 0 212 Catridge TCM TEST TEST 253,200
0 0 0 213 Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081
0 0 0 215 Exell tulle pcs kotak / psc -
0 0 0 216 Foley cateter pcs pcs -
0 0 0 217 Hand rub (0,5% clorhexidine+isoropyl 70%) botol botol 90,500
0 0 0 218 Hand scub (4% clorhexidine) botol botol 42,863
0 0 0 219 Handscoon steril uk 7 pcs kotak 678,150
0 0 0 220 Handscoon steril uk 7,5 pcs kotak 678,150
0 0 0 221 Handscoon uk 6,5 50 pcs kotak 8,713
0 0 0 222 Handscoon uk 7 50 pcs kotak 8,713
0 0 0 223 Handscoon S 100 pcs kotak 87,601
0 0 0 224 Handscoon M 100 pcs kotak 87,601
0 0 0 225 Handscoon L 100 pcs kotak 87,601
0 0 0 226 Infus set anak set 50 set/kotak 9,047
0 0 0 227 Infus set dewasa set 50 set/kotak 7,755
0 0 0 228 IV Catheter No. 18 G set 50 set/kotak 7,044
0 0 0 230 IV Chateter No. 22 G set 50 set/kotak 7,044
0 0 0 234 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178
0 0 0 235 Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350
0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya pcs 16 lembar/kotak 7,641
husada)
0 0 0 237 Kertas Puyer pack ball/ 10 pack -
0 0 0 238 Klip Plastik 10 x 7 KP pack ball/ 10 pack -
0 0 0 239 Klip Plastik 13x8,7 KP pack ball/ 10 pack -
0 0 0 240 Lisol 1liter botol botol -
0 0 0 241 Masker ear loop pcs 50 pcs/kotak 38,775
0 0 0 242 Masker head loop pcs 50 pcs/kotak 38,775
0 0 0 243 Masker KN95 pcs 50 pcs/kotak 82,700
0 0 0 244 Plester 2,5 x 4,5 Rol Rol 14,810
0 0 0 245 Plester 7,5 x 4,5 Rol Rol 43,300
0 0 0 246 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 46,842
jarum bedah
0 0 0 247 Stefanol botol botol 69,300
0 0 0 248 Strip Asam urat 50 strip box box 156,975
0 0 0 249 Strip gula 50 strip box box 161,000
0 0 0 250 Strip kolesterol 50 strip box box 257,225
0 0 0 251 Umbilical cord nylon one med (Klem tali pcs kotak/ 50 psc -
pusat)
0 0 0 252 UnderPad_L pcs 10 pcs/kotak 100,848
0 0 0 253 Urine Bag Pcs Pcs -
0 0 0 254 Waterone botol botol 15,246
-
0BAT GIGI
0 0 0 260 Bonding / single bond botol botol 246,000
0 0 0 261 Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000
0 0 0 262 Etching 3 M botol botol 123,050
0 0 0 263 Etil klorida spray botol botol 175,010
0 0 0 264 Eugenol botol botol 20,150
0 0 0 265 Glass Ionomer Cement (GC IX) ART paket botol 423,800
0 0 0 266 Imicryl / sealing of fissures botol botol 206,555
0 0 0 267 Kalsium Hidroksida Pasta paket kotak 87,500
0 0 0 268 Klorfenol Kamfer Mentol (CHKM) paket botol 52,500
0 0 0 269 Mummifying Pasta kotak kotak -
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
0 0 0 270 Nova compo A1 syr botol 242,295
0 0 0 273 Nova compo A3,5 syr botol 242,295
0 0 0 274 Nova compo HF A2 syr botol 299,100
0 0 0 275 Semen Seng Fosfat serbuk / filling paket botol 221,155
0 0 0 276 Semen Seng Fosfat cairan / lutting paket botol 321,300
0 0 0 277 CAVITA Tambalan sementara botol botol 136,300
0 0 0 278 TKF botol botol 57,640
IMUNISASI RUTIN
0 0 0 281 BCG ampul ampul 88,891

0 0 0 282 CAMPAK ampul ampul 28,204
0 0 0 283 DT ampul ampul 16,500
0 0 0 284 HB.0 / HEP.B UNIJECT ampul ampul 23,490
0 0 0 285 IPV vial vial 144,540
0 0 0 286 PENTAVALEN / DPT-HB-HIB vial vial 77,366
0 0 0 287 POLIO ampul ampul 19,540
0 0 0 288 PCV ampul ampul 0
0 0 0 289 Td ampul ampul 16,480
0 0 0 290 MR ampul ampul 151,150
291 safety box pcs pcs 16,500
0 0 0
0 0 0 294 Becefort syr botol 60 mL/botol 17,523

0 0 0 295 Curcuma kotak kotak 48,202
0 0 0 296 Dextrofen syr botol botol 60 ml 11,655
0 0 0 297 Dulcolac / bisakodil supp 10 mg supp supp 4,325
0 0 0 298 Dulcolac / bisakodil supp 5 mg supp supp 5,085
0 0 0 299 Febrinex syr Botol Botol 15,999
0 0 0 300 Herbacof Tablet 4 tablet/strip 2,498
0 0 0 301 Noza Tablet kotak 100 tablet 805
0 0 0 302 Pehavral Tablet kotak 100 tablet 993
0 0 0 303 Stimuno forte Tablet 10 tablet/strip 1,958
0 0 0 304 Stimuno syr Tablet 100 tablet/kotak 28,374
0 0 0 305 Sukralfat susp botol botol 5,034
0 0 0 306 Ichtiyol salp kapsul kotak 100 kapsul 6,886
307 140,337
308 27,088
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19 1 2 3 4 5
322
0
JUMLAH TOTAL SISA STOK BUL
UMUM

BAYAR
............


NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001
10
BULAN : Oktober
TAHUN : 2023

HARGA PER LAIN- PERSEDIAA PENGELUARA STOK AKHIR N RATA- PERMINTAA
KEMASAN AWAL APBD I APBD II DAK ASKES LAIN TOTAL N N AKHIR DALAM RATA S/D N
6 7 8 9 10 11 12 13 14 15 16 17 18 19
304 0 0 0 0 0 0
44,550 0 0 0 0 0
87 0 0 0 0 0 0
200 0 0 0 0 0 0
99 0 0 0 0 0 0
3,300 0 0 0 0 0 0
8,593 0 0 0 0 0 0
8,000 0 0 0 0 0 0
121,500 0 0 0 0 0 0
177 0 0 0 0 0 0
53 0 0 0 0 0 0
5,610 0 0 0 0 0 0
8,591 0 0 0 0 0 0
38,799 0 0 0 0 0 0
201 0 0 0 0 0 0
3,498 0 0 0 0 0 0
20,115 0 0 0 0 0 0
1,694 0 0 0 0 0 0
54 0 0 0 0 0 0
3,509 0 0 0 0 0 0
3,250 0 0 0 0 0 0
3,477 0 0 0 0 0 0
51,800 0 0 0 0 0 0
185 0 0 0 0 0 0
904 0 0 0 0 0 0
2,650 0 0 0 0 0 0
179,550 0 0 0 0 0 0
42 0 0 0 0 0 0
42 0 0 0 0 0 0
111 0 0 0 0 0 0
5,044 0 0 0 0 0 0
52,404 0 0 0 0 0 0
405 0 0 0 0 0 0
1,718 0 0 0 0 0 0
14,430 0 0 0 0 0 0
226 0 0 0 0 0 0
2,997 0 0 0 0 0 0
65 0 0 0 0 0 0
75 0 0 0 0 0 0
477 0 0 0 0 0 0
158,000 0 0 0 0 0 0
6,200 0 0 0 0 0 0
32,101 0 0 0 0 0 0
70.0 0 0 0 0 0 0
70.0 0 0 0 0 0 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
1,545 0 0 0 0 0 0
31,620 0 0 0 0 0 0
14,300 0 0 0 0 0 0
3,333 0 0 0 0 0 0
15,600 0 0 0 0 0 0
16,700 0 0 0 0 0 0
38,000 0 0 0 0 0 0
243,000 0 0 0 0 0 0
650 0 0 0 0 0 0
8,000 0 0 0 0 0 0
59,230 0 0 0 0 0 0
7,220 0 0 0 0 0 0
9,124 0 0 0 0 0 0
30,931 0 0 0 0 0 0
3,740 0 0 0 0 0 0
8,160 0 0 0 0 0 0
214,990 0 0 0 0 0 0
- 0 0 0 0 0 0
409,461 0 0 0 0 0 0
389,344 0 0 0 0 0 0
1,297,894 0 0 0 0 0 0
20,250 0 0 0 0 0 0
13,300 0 0 0 0 0 0
54,000 0 0 0 0 0 0
22,000 0 0 0 0 0 0
49,008 0 0 0 0 0 0
46,980 0 0 0 0 0 0
102,510 0 0 0 0 0 0
63,400 0 0 0 0 0 0
45,725 0 0 0 0 0 0
8,500 0 0 0 0 0 0
29,200 0 0 0 0 0 0
2,600 0 0 0 0 0 0
3,194 0 0 0 0 0 0
3,355 0 0 0 0 0 0
900 0 0 0 0 0 0
82 0 0 0 0 0 0
21,800 0 0 0 0 0 0
172 0 0 0 0 0 0
1,500 0 0 0 0 0 0
5,723 0 0 0 0 0 0
5,700 0 0 0 0 0 0
1,960 0 0 0 0 0 0
6,627 0 0 0 0 0 0
210 0 0 0 0 0 0
83,333 0 0 0 0 0 0
54 0 0 0 0 0 0
148 0 0 0 0 0 0
54 0 0 0 0 0 0
2,325 0 0 0 0 0 0
3,499 0 0 0 0 0 0
3,200 0 0 0 0 0 0
11,550 0 0 0 0 0 0
190 0 0 0 0 0 0
86 0 0 0 0 0 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
60 0 0 0 0 0 0
24,300 0 0 0 0 0 0
27,675 0 0 0 0 0 0
56,400 0 0 0 0 0 0
182,250 0 0 0 0 0 0
40,400 0 0 0 0 0 0
847 0 0 0 0 0 0
19,100 0 0 0 0 0 0
26,350 0 0 0 0 0 0
3,266 0 0 0 0 0 0
1,599 0 0 0 0 0 0
5,100 0 0 0 0 0 0
30,630 0 0 0 0 0 0
28,500 0 0 0 0 0 0
14,900 0 0 0 0 0 0
600 0 0 0 0 0 0
2,190 0 0 0 0 0 0
126 0 0 0 0 0 0
82,042 0 0 0 0 0 0
847 0 0 0 0 0 0
803 0 0 0 0 0 0
77 0 0 0 0 0 0
20,780 0 0 0 0 0 0
4,090 0 0 0 0 0 0
6,840 0 0 0 0 0 0
39 0 0 0 0 0 0
224 0 0 0 0 0 0
1,023 0 0 0 0 0 0
102 0 0 0 0 0 0
206 0 0 0 0 0 0
20,700 0 0 0 0 0 0
120 0 0 0 0 0 0
5,885 0 0 0 0 0 0
19,305 0 0 0 0 0 0
403 0 0 0 0 0 0
3,000 0 0 0 0 0 0
98,000 0 0 0 0 0 0
6,200 0 0 0 0 0 0
100 0 0 0 0 0 0
8,700 0 0 0 0 0 0
4,900 0 0 0 0 0 0
825 0 0 0 0 0 0
550 0 0 0 0 0 0
78,540 0 0 0 0 0 0
31,760 0 0 0 0 0 0
12,569 0 0 0 0 0 0
6,044 0 0 0 0 0 0
20,650 0 0 0 0 0 0
32,700 0 0 0 0 0 0
3,500 0 0 0 0 0 0
1,126 0 0 0 0 0 0
407 0 0 0 0 0 0
- 0 0 0 0 0 0
270 0 0 0 0 0 0
881 0 0 0 0 0 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
- 0 0 0 0 0 0
- 0 0 0 0 0 0
1,160 0 0 0 0 0 0
222 0 0 0 0 0 0
8,250 0 0 0 0 0 0
12,595 0 0 0 0 0 0
131 0 0 0 0 0 0
220 0 0 0 0 0 0
7,552 0 0 0 0 0 0
26,139 0 0 0 0 0 0
69 0 0 0 0 0 0
323,400 0 0 0 0 0 0
40,442 0 0 0 0 0 0
814 0 0 0 0 0 0
85 0 0 0 0 0 0
553 0 0 0 0 0 0
553 0 0 0 0 0 0
124 0 0 0 0
7,630 0 0 0 0 0 0
67 0 0 0 0 0 0
- 0 0 0 0 0 0
22,200 0 0 0 0 0 0
4,844 0 0 0 0 0 0
2,333 0 0 0 0 0 0
- 0 0 0 0 0 0
25,650 0 0 0 0 0 0
52,100 0 0 0 0 0 0
3,800 0 0 0 0 0 0
2,850 0 0 0 0 0 0
2,745 0 0 0 0 0 0
517,132 0 0 0 0 0 0
140,188 0 0 0 0 0 0
49 0 0 0 0 0 0
91,600 0 0 0 0 0 0
45 0 0 0 0 0 0
150 0 0 0 0 0 0
248 0 0 0 0 0 0
20,700 0 0 0 0 0 0
151 0 0 0 0 0 0
27,000 0 0 0 0 0 0
63 0 0 0 0 0 0
154,391 0 0 0 0 0 0
57 0 0 0 0 0 0
2,511 0 0 0 0 0 0
216 0 0 0 0 0 0
0 0 0 0 0 0
1,210 0
1,190 0 0 0 0 0 0
100,344 0 0 0 0 0 0
100,344 0 0 0 0 0 0
104,734 0 0 0 0 0 0
14,100 0 0 0 0 0 0
174,000 0 0 0 0 0 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
16,893 0 0 0 0 0 0
253,200 0 0 0 0 0 0
26,081 0 0 0 0 0 0
- 0 0 0 0 0 0
- 0 0 0 0 0 0
90,500 0 0 0 0 0 0
42,863 0 0 0 0 0 0
5,267 0 0 0 0 0 0
5,270 0 0 0 0 0 0
8,713 0 0 0 0 0 0
8,713 0 0 0 0 0 0
87,601 0 0 0 0 0 0
87,601 0 0 0 0 0 0
87,601 0 0 0 0 0 0
82,500 0 0 0 0 0 0
339,250 0 0 0 0 0 0
385,000 0 0 0 0 0 0
385,000 0 0 0 0 0 0
385,000 0 0 0 0 0 0
385,000 0 0 0 0 0 0
385,000 0 0 0 0 0 0
29,178 0 0 0 0 0 0
226,350 0 0 0 0 0 0
7,641 0 0 0 0 0 0
- 0 0 0 0 0 0
- 0 0 0 0 0 0
- 0 0 0 0 0 0
- 0 0 0 0 0 0
38,775 0 0 0 0 0 0
38,775 0 0 0 0 0 0
82,700 0 0 0 0 0 0
14,810 0 0 0 0 0 0
43,300 0 0 0 0 0 0
46,842 0 0 0 0 0 0
69,300 0 0 0 0 0 0
156,975 0 0 0 0 0 0
161,000 0 0 0 0 0 0
257,225 0 0 0 0 0 0
- 0 0 0 0 0 0
100,848 0 0 0 0 0 0
- 0 0 0 0 0 0
15,246 0 0 0 0 0 0
- 0
246,000 0 0 0 0 0 0
390,000 0 0 0 0 0 0
123,050 0 0 0 0 0 0
175,010 0 0 0 0 0 0
20,150 0 0 0 0 0 0
423,800 0 0 0 0 0 0
206,555 0 0 0 0 0 0
87,500 0 0 0 0 0 0
52,500 0 0 0 0 0 0
- 0 0 0 0 0 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
242,295 0 0 0 0 0 0
242,295 0 0 0 0 0 0
242,295 0 0 0 0 0 0
242,295 0 0 0 0 0 0
299,100 0 0 0 0 0 0
221,155 0 0 0 0 0 0
321,300 0 0 0 0 0 0
136,300 0 0 0 0 0 0
57,640 0 0 0 0 0 0
88,891.0 0 0 0 0 0 0
28,204.0 0 0 0 0 0 0
16,500.0 0 0 0 0 0 0
23,490.0 0 0 0 0 0 0
144,540.0 0 0 0 0 0 0
77,366.0 0 0 0 0 0 0
19,540.0 0 0 0 0 0 0
0.0 0 0 0 0 0 0
16,480.0 0 0 0 0 0 0
151,150.0 0 0 0 0 0 0
16,500.0 0
0 0 0 0 0 0
17,523 0 0 0 0 0 0
48,202 0 0 0 0 0 0
11,655 0 0 0 0 0 0
4,325 0 0 0 0 0 0
5,085 0 0 0 0 0 0
15,999 0 0 0 0 0 0
2,498 0 0 0 0 0 0
805 0 0 0 0 0 0
993 0 0 0 0 0 0
1,958 0 0 0 0 0 0
28,374 0 0 0 0 0 0
5,034 0 0 0 0 0 0
6,886 0 0 0 0 0 0
140,337 0
27,088 0
6 7 8 9 10 11 12 13 14 15 16 17 18 19
MLAH TOTAL SISA STOK BULAN INI (Rp.) 0
AR
yerahkan Yang Menerima/Melapor

Farmasi dan Kestrad Kepala UPT.Puskesmas Petugas Gudang Farmasi
ab.Tulang Bawang Puskesmas……………..
S.Kep …………………………………………… ……………………………………………

200804 2 001 NIP. .......................................... NIP. ..........................................
11
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
PROPINSI : LAMPUNG
STOK PENERIMAAN
HARGA HARGA PER
NO NAMA OBAT SATUAN KMSN SATUAN KEMASAN AWAL APBD I APBD II DAK
1 2 3 4 5 6 7 8 9 10
1 Acetil Cystein kapsul kotak 304 304 0
2 ACT (Artesunat + Amodiaquin ) tablet tablet 24 tab/Kotak 1,856 44,550 0
5 Alprazolam tablet 1 mg tablet 100 tablet/kotak 99 99 0
6 Ambroxol sirup 15 mg/ 5 ml botol botol 60 ml - 3,300 0
7 Ambroxol tab 30 mg tablet 100 tablet/kotak - 8,593 0
8 Aminofilin tablet 200mg tablet 100 tablet/kotak - 8,000 0
9 Aminofilina injeksi 24 mg/ml ampul ktk 30 ampul@10 - 121,500 0
ml
10 Amitriptillin tablet salut 25 mg tablet 100 tablet/kotak 177 177 0
11 Amlodipine Tablet 5 mg tablet 30 tablet/kotak 53 53 0
12 Amlodipine Tablet 10 mg tablet 30 tablet/kotak - 5,610 0
13 Amicillin 1000 mg inj vial 10 vial/kotak 8,591 8,591 0
14 Amoksisilin kapsul 250 mg tablet 100 tablet/kotak - 38,799 0
15 Amoksisilin kapsul 500 mg tablet 100 tablet/kotak 201 201 0
16 Amoksisilin sirup kering 125 mg/ 5 ml botol botol 60 ml 3,498 3,498 0
17 Antalgin (Metampiron) tablet 500 mg tablet 100 tablet/kotak - 20,115 0
18 Antasida DOEN II suspensi komb botol botol 60 ml 1,694 1,694 0
19 Antasida DOEN tablet tablet 100 tablet/kotak 54 54 0
20 Anti Bakteri DOEN salep tube 25 tube/kotak 3,509 3,509 0
21 Anti Hemoroid DOEN Kombinasi supp 10 supp/kotak 3,250 3,250 0
22 Antifungi DOEN Kombinasi: pot 24 pot/kotak 3,477 3,477 0
23 Antimalaria DOEN kombinasi tablet 100 tablet/kotak - 51,800 0
24 Antimigren: Ergotamin Tartrat 1mg tablet 100 tablet/botol 185 185 0
Antiparkinson
25 benzerazid 25 mg levodopa 100 mg tablet 100 tablet/kotak 904 904 0
26 (Aqua
Levopar)
pro Injeksi steril, bebas pirogen vial 10 vial/kotak 2,650 2,650 0
27 Arthemeter injeksi 1 ml : 80 mg ampul 6 ampul/kotak - 179,550 0
28 Asam Askorbat ( Vit C ) tablet 50 mg tablet 100 tablet/kotak 42 42 0
29 Asam folat tablet 1 mg tablet 100 tablet/botol 42 42 0
30 Asam Mefenamat tablet 500 mg tablet 100 tablet/kotak 111 111 0
31 Asiklovir krim 5% tube 25 tube/kotak 5,044 5,044 0
32 Asiklovir tablet 200 mg tablet 100 tablet/kotak - 52,404 0
33 Asiklovir tablet 400 mg tablet 100 tablet/kotak 405 405 0
34 Atropin sulfat inj ampul ampul 1,718 1,718 0
35 Benzatin Benzil Penicillin injeksi 1,2 jt vial 10 vial/kotak 14,430 14,430 0
IU/vial
36 Besi (II ) Sulfat + asam folat 0.25 tab / sachet 30 tablet/sachet 226 226 0
TTD*
37 Betametason krim 0,1% tube tube 2,997 2,997 0
38 Captopril 12,5 mg tablet 100 tab/kotak 65 65 0
39 Captopril 25 mg tablet 100 tablet/kotak 75 75 0
40 Clozapine 25 mg tablet 100 tablet/kotak 477 477 0
41 Deksametason injeksi 5mg.ml-1ml ampul 100 ampul/kotak 1,580 158,000 0
42 Deksametason tablet 0,5 mg tablet 100 tablet/kotak 62 6,200 0
43 DHP tablet (Prog : malaria) tablet 9 tablet/kotak - 32,101 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
46 Diazepam inj 5 mg / ml ampul 30 ampul/kotak 1,545 1,545 0
47 Difenhidramin HCl injeksi 10 mg/ml-1ml ampul 30 ampul/kotak 1,054 31,620 0
48 Digoksin tablet 0,25 mg tablet 100 tablet/kotak 143 14,300 0
49 Domperidon suspensi/sirup 5 mg/5ml botol botol 3,333 3,333 0
50 Domperidon tetes/ 5 mg/ml botol botol 15,600 15,600 0
51 Domperidone tablet 10mg tablet 100 tablet/kotak 167 16,700 0
52 Ekstrak Belladon tablet 10 mg tablet 1000 tablet/botol 38 38,000 0
53 Adrenalina ) ampul 30 ampul/kotak 8,100 243,000 0
54 Ergakalsiferol ml D3/D2) kapsul tablet tablet - 650 0
55 Ergakalsiferol (vitamin D3/D2) suspensi botol botol - 8,000 0
56 Eritromisin kapsul 250mg tablet 120 tablet/kotak 494 59,230 0
57 Eritromisin sirup 200mg/5ml botol botol 7,220 7,220 0
62 FDC kategori anak paket kotak 214,990 214,990 0
63 FDC OAT Sisipan paket kotak - - 0
64 FDC OAT Kategori I dosis harian paket kotak 409,461 409,461 0
65 FDC OAT Kategori I paket kotak 389,344 389,344 0
66 FDC OAT Kategori II paket kotak 1,297,894 1,297,894 0
67 Fenitoin Natrium injeksi 50 mg/ml ampul ampul 20,250 20,250 0
68 Fenitoin Natrium Kapsul 100 mg kapsul botol 133 13,300 0
69 Fenobarbital Injeksi i.m/i.v 50 mg/ml ampul 30 ampul/kotak 1,800 54,000 0
70 Fenobarbital tablet 100 mg tablet 100 tablet/kotak 220 22,000 0
71 Fenol Gliserol tetes telinga 10% botol 24 botol/kotak 2,042 49,008 0
(Karbogliserin 10%)
72 Fitomenadion (Vit.K1) injeksi 10 mg/ml - ampul 10 ampul/kotak 4,698 46,980 0
1 ml
73 Fitomenadion (Vit.K1) injeksi 2mg/ml ampul 30 ampul/kotak 3,417 102,510 0
74 Fitomenadion (Vit.K1)tab salut gula 10 mg tablet 100 tablet/botol 634 63,400 0
75 Furosemid inj 40 mg/ml ampul 25 ampul/kotak 1,829 45,725 0
76 Furosemid tablet 40 mg tablet 100 tablet/kotak 85 8,500 0
77 Garam oralit untuk 200 ml air (Prog : sachet 100 sachet/kotak 292 29,200 0
diare)
78 Gentamicin salep mata 0,3 % (genoint ) tube tube 2,600 2,600 0
79 Gentamicin tetes mata 0,3 % (genoint ) botol 5 ml/botol 3,194 3,194 0
80 Gentamisin injeksi 40 mg/ml ampul 5 ampul/kotak 3,355 3,355 0
81 Gentian Violet larutan 1 % botol botol - 900 0
82 Glibenklamid tablet 5 mg tablet 101 tablet/kotak 82 82 0
83 Glimepiride tablet 2 mg tablet 50 tablet/kotak - 21,800 0
84 Gliseril Guayacolat tablet 100 mg tablet 1000 tablet/botol 172 172 0
85 Gliseril trinitrat tab sublingual 0,5mg tablet tablet - 1,500 0
(nitral)
86 Glukonas Kalsikus 10 % ampul ampul 5,723 5,723 0
87 Glukosa larutan infus 10% steril (Produk botol 500 ml/botol 5,700 5,700 0
lokal)
88 Glukosa larutan infus 40% steril (Produk botol botol 1,960 1,960 0
lokal)
89 Glukosa larutan infus 5% steril (Produk botol 500 ml/botol 6,627 6,627 0
lokal)
90 Griseofulvin tablet 125 mg, micronized tablet 100 tablet/kotak 210 210 0
91 Haloperidol inj 50 mg/ml (haldol ampul ampul 83,333 83,333 0
decanoas)
93 HCT tablet 100 tablet/kotak 148 148 0
95 Hidrokortison krim 2,5% tiube 24 tube/kotak 2,325 2,325 0
96 Ibuprofen sirup 100mg / 5ml botol botol - 3,499 0
97 Ibuprofen suspensi 200mg / 5ml botol botol 3,200 3,200 0
98 Ibuprofen tablet 200 mg tablet 100 tablet/botol 116 11,550 0
99 Ibuprofen tablet 400 mg tablet 100 tablet 190 190 0
100 Isosorbid Dinitrat tablet sublingual 5 mg tablet 100 tablet/kotak 86 86 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
101 Kalsium Laktat tab 500 mg tablet 100 tablet/kotak 60 60 0
102 Karbamazepin tablet 200 mg tablet 100 tablet/kotak 243 24,300 0
103 Ketokenazol tablet 200mg tablet 50 tablet/kotak 554 27,675 0
104 Ketokonazol krim 2% tube 12 tube/kotak 4,700 56,400 0
105 Ketoprofen tablet 100 mg tablet 100 tablet/kotak 1,823 182,250 0
106 Ketorolak inj 10 mg ampul 5 ampul/kotak - 40,400 0
107 Ketorolak inj 30 mg ampul 6 ampul/kotak 847 847 0
110 Kloramfenikol salp kulit / Bufacetin* tube tube 3,266 3,266 0
111 Kloramfenikol tetes telinga 3% botol botol 1,599 1,599 0
112 Klorfeniramin Maleat (CTM) tablet tablet 100 tablet/kotak 51 5,100 0
114 Klorpromazin HCl injeksi 25 mg/ml - 1 ml ampul 30 ampul/kotak 1,021 30,630 0
115 Klorpromazin HCl injeksi 5 mg/ml - 2 ml ampul 30 ampul/kotak 950 28,500 0
116 Klorpromazin HCl tablet salut 100 mg tablet 100 tablet/kotak 149 14,900 0
117 Kodein 10 mg tablet tablet 100 tablet/kotak 600 600 0
118 Sulfametoksazol 200mg + Trimetoprim 40 botol botol 60 ml 2,190 2,190 0
119 mg
120 mg
121 Lidokain 2% ampul 30 ampul/kotak 847 847 0
122 Lidokain Kompositum ampul 30 ampul/kotak 803 803 0
123 Loperamide 2 mg tablet kotak 77 77 0
124 Magnesium Sulfat inj (IV) 20% - 25 ml vial 10 vial/kotak - 20,780 0
125 Magnesium Sulfat inj (IV) 40% - 25 ml vial 10 vial/kotak 4,090 4,090 0
126 Mebendazol tablet 100 mg tablet 30 tablet/kotak - 6,840 0
127 Metformin tablet 100 tablet/kotak 39 39 0
128 Metilergometrin Maleat (Metilergometrin) tablet 100 tablet/kotak 224 224 0
tab salut 0,125 mg
129 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 30 ampul/kotak 1,023 1,023 0
132 Metoklopramid inj 5 mg/ml ampul 10 ampul/kotak 2,070 20,700 0
133 Metoklopramid 5 mg tablet 100 tablet/kotak 120 120 0
134 Metronidazol Infus 500mg/100ml botol botol 100 ml 5,885 5,885 0
135 Metronidazol tablet 250 mg tablet 100 tablet/kotak - 19,305 0
136 Metronidazol tablet 500 mg tablet kotak 403 403 0
137 Mikonazol krim/ salep 2 % tube tube - 3,000 0
138 Mineral mix (Prog. Gizi) sachet 40 sachet/kotak - 98,000 0
139 Natrium Bikarbonat inj i.v 8,4% (meylon) ampul ampul 6,200 6,200 0
140 Natrium Diklofenac 50 mg tablet 50 tablet/kotak 100 100 0
141 Natrium Diklofenak 25 mg tablet kotak 174 8,700 0
142 Natrium Klorida larutan infus 0,9 % steril botol botol 4,900 4,900 0
(Produk lokal)
143 Nistatin tablet salut 500.000 IU tablet 100 tablet/kotak 825 825 0
144 Nistatin vaginal tablet 100.000 UI tablet 100 tablet/kotak 550 550 0
145 Noretisteron tablet 5 mg (Primolut N) tablet 30 tablet/kotak - 78,540 0
146 Obat Kusta MB strip strip 31,760 31,760 0
147 Obat Kusta PB strip strip 12,569 12,569 0
148 Obat Batuk Hitam botol botol 6,044 6,044 0
151 Oksitetrasiklin HCl salep mata 1 % tube 25 tube/kotak 3,500 3,500 0
152 Oksitosin injeksi 10IU/ml-1ml ampul 100 ampul/kotak 1,126 1,126 0
153 Omeprazol kapsul 20mg tablet 30 tablet/kotak 407 407 0
154 ondansetron tablet 4 mg tablet 30 tablet/kotak - - 0
155 ondansetron tablet 8 mg tablet 30 tablet/kotak 270 270 0
156 Ondansetron inj 4 mg/ 2 ml ampul ampul 881 881 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
157 Papaverin tablet 40mg tablet 100 tablet/kotak - - 0
158 Paracetamol drop 100 mg/ml botol botol - - 0
159 Parasetamol sirup 120 mg / 5 ml 60 ml botol 60 ml 1,160 1,160 0
160 Parasetamol tablet 500 mg tablet 100 tablet/kotak 222 222 0
161 Pirantel sirup 125mg/5ml botol botol 8,250 8,250 0
162 Pirantel tablet 125 mg tablet 30 tablet/kotak 420 12,595 0
163 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 100 tablet/kotak 131 131 0
164 Piroksikam 20 mg tablet 100 tablet/kotak 220 220 0
167 Prednisone tablet 5 mg tablet 100 tablet/kotak 69 69 0
168 Prokain Benzil Penicillin G injeksi 3 jt vial 30 vial/kotak 10,780 323,400 0
IU/vial
169 Propiltiourasil tablet 100 mg tablet 100 tablet/botol 404 40,442 0
170 Ranitidin inj.25mg/2ml ampul 25 ampul/kotak 814 814 0
171 Ranitidin tablet 150 mg tablet 100 kaplet/kotak 85 85 0
172 Retinol (Vitamin A) 200.000 IU Kapsul kapsul 50 kapsul/botol 553 553 0
Lunak
173 Retinol (Vitamin A) 100.000 IU Kapsul kapsul 50 kapsul/botol 553 553 0
Lunak
174 Riseridon 2 mg tablet kotak 124 124 0
175 Ringer Laktat larutan infus steril botol botol 500 ml 7,630 7,630 0
176 Salbutamol 2 mg tablet 100 tablet/kotak 67 67 0
177 Salbutamol 4 mg tablet 100 tablet/kotak - - 0
178 Salbutamol inshalasi/ aerosol 100 nebu nebu 22,200 22,200 0
179 Salbutamol cairan 1 mg/ml ampul ampul 4,844 4,844 0
180 Salep 2-4 Komb : As Salisilat 2 % + pot pot 2,333 2,333 0
Belerang endap 2 %
181 Salisil Bedak 2% kotak kotak - - 0
182 Sefadroksil kapsul 250 mg tablet 30 tablet/kotak 855 25,650 0
183 Sefadroksil kapsul 500 mg tablet 50 tablet/kotak 1,042 52,100 0
184 sefadroksil sirup kering 125mg/5ml botol botol 3,800 3,800 0
185 Sefotaksim inj 1 gr vial 2 vial/kotak 2,850 2,850 0
186 Sefriakson serbuk injeksi 1 g/vial vial vial 2,745 2,745 0
187 Serum Anti Bisa Ular Polivalen injeksi 5 ml vial Dus, 10 vial @ 5 ml 517,132 517,132 0
(ABU I)
188 Serum Anti Tetanus injeksi 1.500 ampul Dus, 10 ampul @ 1 140,188 140,188 0
IU/ampul (A.T.S) ml
189 Setrizin tablet 10 mg tablet 100 tablet/kotak 49 49 0
190 Sianokobalamin (vit B12) injeksi 500mcg- ampul 100 ampul/kotak 916 91,600 0
ml
191 Sianokobalamin (vit B12) tab 50 mcg tablet 100 tablet/kotak 45 45 0
192 Simvastatin tablet 10 mg tablet 50 tablet/kotak 150 150 0
193 Siproflaxacin tablet 500 mg tablet 100 tablet/kotak 248 248 0
194 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml ampul 30 ampul/kotak - 20,700 0
195 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tablet 1000 tablet/botol 151 151 0
mg
196 Tramadol inj 50mg/5ml ampul 5 ampul/kotak 5,400 27,000 0
197 Triheksifenidil Hidroklorida tablet 2 mg tablet 100 tablet/kotak 63 63 0
198 Vaksin anti Rabies / Verorab vial Dus, 1 vial @ 1 154,391 154,391 0
dosis + syringe
199 Vitamin B komplek tablet tablet 100 tablet/kotak 57 57 0
200 Zinc sirup 20 mg/ 5 ml botol botol 2,511 2,511 0
201 Zinc Tab 20 mg tablet 100 tablet/kotak 216 216 0
0
209 Alkohol Swab pcs kotak/ 100 psc 14,100 14,100 0
210 Aqua bides 20 liter galon galon 174,000 174,000 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
211 Blood lanced kotak kotak 16,893 16,893 0
212 Catridge TCM TEST TEST 253,200 253,200 0
213 Cut gut chromic 3/0 pcs 12 pcs/kotak 26,081 26,081 0
215 Exell tulle pcs kotak / psc - - 0
216 Foley cateter pcs pcs - - 0
217 Hand rub (0,5% clorhexidine+isoropyl botol botol 90,500 90,500 0
70%)
218 Hand scub (4% clorhexidine) botol botol 42,863 42,863 0
219 Handscoon steril uk 7 pcs kotak 678,150 5,267 0
220 Handscoon steril uk 7,5 pcs kotak 678,150 5,270 0
221 Handscoon uk 6,5 50 pcs kotak 8,713 8,713 0
222 Handscoon uk 7 50 pcs kotak 8,713 8,713 0
223 Handscoon S 100 pcs kotak 87,601 87,601 0
224 Handscoon M 100 pcs kotak 87,601 87,601 0
225 Handscoon L 100 pcs kotak 87,601 87,601 0
226 Infus set anak set 50 set/kotak 9,047 82,500 0
227 Infus set dewasa set 50 set/kotak 7,755 339,250 0
230 IV Chateter No. 22 G set 50 set/kotak 7,044 385,000 0
234 Kapas Pembalut / Absorben 250 gram Bungkus Bungkus 29,178 29,178 0
235 Kasa Pembalut Hidrofil 40 x 80 cm Rol Rol 226,350 226,350 0
236 Kassa Hidrofil steril uk. 16x16 (surya pcs 16 lembar/kotak 7,641 7,641 0
husada)
237 Kertas Puyer pack ball/ 10 pack - - 0
238 Klip Plastik 10 x 7 KP pack ball/ 10 pack - - 0
239 Klip Plastik 13x8,7 KP pack ball/ 10 pack - - 0
240 Lisol 1liter botol botol - - 0
241 Masker ear loop pcs 50 pcs/kotak 38,775 38,775 0
242 Masker head loop pcs 50 pcs/kotak 38,775 38,775 0
243 Masker KN95 pcs 50 pcs/kotak 82,700 82,700 0
244 Plester 2,5 x 4,5 Rol Rol 14,810 14,810 0
245 Plester 7,5 x 4,5 Rol Rol 43,300 43,300 0
246 Silk ( Benang Bedah Sutera ) No. 3/0 dg pcs 36pcs/kotak 46,842 46,842 0
jarum bedah
247 Stefanol botol botol 69,300 69,300 0
248 Strip Asam urat 50 strip box box 156,975 156,975 0
249 Strip gula 50 strip box box 161,000 161,000 0
250 Strip kolesterol 50 strip box box 257,225 257,225 0
251 Umbilical cord nylon one med (Klem tali pcs kotak/ 50 psc - - 0
pusat)
252 UnderPad_L pcs 10 pcs/kotak 100,848 100,848 0
253 Urine Bag Pcs Pcs - - 0
254 Waterone botol botol 15,246 15,246 0
- - 0
0BAT GIGI
260 Bonding / single bond botol botol 246,000 246,000 0
261 Devitalisasi Pasta (Non Arsen) / Denpro paket kotak 390,000 390,000 0
262 Etching 3 M botol botol 123,050 123,050 0
263 Etil klorida spray botol botol 175,010 175,010 0
264 Eugenol botol botol 20,150 20,150 0
265 Glass Ionomer Cement (GC IX) ART paket botol 423,800 423,800 0
266 Imicryl / sealing of fissures botol botol 206,555 206,555 0
267 Kalsium Hidroksida Pasta paket kotak 87,500 87,500 0
268 Klorfenol Kamfer Mentol (CHKM) paket botol 52,500 52,500 0
269 Mummifying Pasta kotak kotak - - 0
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
273 Nova compo A3,5 syr botol 242,295 242,295 0
274 Nova compo HF A2 syr botol 299,100 299,100 0
275 Semen Seng Fosfat serbuk / filling paket botol 221,155 221,155 0
276 Semen Seng Fosfat cairan / lutting paket botol 321,300 321,300 0
277 CAVITA Tambalan sementara botol botol 136,300 136,300 0
278 TKF botol botol 57,640 57,640 0
0
IMUNISASI RUTIN
281 BCG ampul ampul 88,891 88,891.0 0
282 CAMPAK ampul ampul 28,204 28,204.0 0
283 DT ampul ampul 16,500 16,500.0 0
284 HB.0 / HEP.B UNIJECT ampul ampul 23,490 23,490.0 0
285 IPV vial vial 144,540 144,540.0 0
286 PENTAVALEN / DPT-HB-HIB vial vial 77,366 77,366.0 0
287 POLIO ampul ampul 19,540 19,540.0 0
288 PCV ampul ampul 0 0.0 0
289 Td ampul ampul 16,480 16,480.0 0
290 MR ampul ampul 151,150 151,150.0 0
0
294 Becefort syr botol 60 mL/botol 17,523 17,523 0

295 Curcuma kotak kotak 48,202 48,202 0
296 Dextrofen syr botol botol 60 ml 11,655 11,655 0
299 Febrinex syr Botol Botol 15,999 15,999 0
300 Herbacof Tablet 4 tablet/strip 2,498 2,498 0
301 Noza Tablet kotak 100 tablet 805 805 0
302 Pehavral Tablet kotak 100 tablet 993 993 0
303 Stimuno forte Tablet 10 tablet/strip 1,958 1,958 0
304 Stimuno syr Tablet 100 tablet/kotak 28,374 28,374 0
305 Sukralfat susp botol botol 5,034 5,034 0
306 Ichtiyol salp kapsul kotak 100 kapsul 6,886 6,886 0
307 140,337 140,337 0
308 27,088 27,088 0
309
310
311
312
313
314
315
316
317
318
319
320
321
STOK PENERIMAAN
HARGA HARGA PER
1 2 3 4 5 6 7 8 9 10
322

UMUM

BAYAR
............


NIP.19730808 200501 1 008 NIP. 19741011 200804 2 001 NIP. ..........................................
AAN OBAT (LPLPO)
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
BULAN : November KABUPATEN
ENERIMAAN STOK PEMAKAIA

ASKES LAIN TOTAL N N AKHIR DALAM RATA S/D N NO NAMA OBAT
11 12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 1 Acetil Cystein
50mg
0 0 0 0 0 26 (Aqua
Levopar)
0 0 0 0 0 35 Benzatin Benzil Penicillin injeksi 1,2 jt
IU/vial
0 0 0 0 0 38 Captopril 12,5 mg
0 0 0 0 0 39 Captopril 25 mg
0 0 0 0 0 40 Clozapine 25 mg
11 12 13 14 15 16 17 18 19 1 2
0 0 0 0 0
(Karbogliserin 10%)
ml
0 0 0 0 0 85 Gliseril trinitrat tab sublingual 0,5mg (nitral)
lokal)
lokal)
lokal)
0 0 0 0 0 93 HCT
11 12 13 14 15 16 17 18 19 1 2
200mg + Trimetoprim
Kotrimoksazol 40 mg
tablet komb:
0 0 0 0 0 119 Sulfametoksazol 400mg + Trimetoprim 80
0 0 0 0 0 120 mg
Lansoprazol inj 30 mg/ml
0 0 0 0 0 121 Lidokain 2%
0 0 0 0 0 127 Metformin
tab salut 0,125 mg
(Produk lokal)
11 12 13 14 15 16 17 18 19 1 2
Lunak
Lunak
0 0 0 0 0 178 Salbutamol inshalasi/ aerosol 100
endap 2 %
(ABU I)
(A.T.S)
mg
0 0 0 0 0 200 Zinc sirup 20 mg/ 5 ml
0 0 0 0 0 201 Zinc Tab 20 mg
0 0 0 0 0
11 12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 213 Cut gut chromic 3/0
0 0 0 0 0 221 Handscoon uk 6,5
0 0 0 0 0 222 Handscoon uk 7
0 0 0 0 0 228 IV Catheter No. 18 G
0 0 0 0 0 229 IV Catheter No. 20 G
0 0 0 0 0 230 IV Chateter No. 22 G
0 0 0 0 0 231 IV Catheter No. 24 G
0 0 0 0 0 232 IV Catheter No. 26 G
0 0 0 0 0 236 Kassa Hidrofil steril uk. 16x16 (surya
husada)
0 0 0 0 0 238 Klip Plastik 10 x 7 KP
0 0 0 0 0 239 Klip Plastik 13x8,7 KP
0 0 0 0 0 240 Lisol 1liter
0 0 0 0 0 243 Masker KN95
0 0 0 0 0 244 Plester 2,5 x 4,5
0 0 0 0 0 245 Plester 7,5 x 4,5
jarum bedah
0 0 0 0 0 247 Stefanol
pusat)
0 0 0 0 0 252 UnderPad_L
0 0 0 0 0 253 Urine Bag
0 0 0 0 0 254 Waterone
0BAT GIGI
0 0 0 0 0 262 Etching 3 M
0 0 0 0 0 264 Eugenol
11 12 13 14 15 16 17 18 19 1 2
0 0 0 0 0 270 Nova compo A1
0 0 0 0 0 271 Nova compo A2
0 0 0 0 0 272 Nova compo A3
0 0 0 0 0 273 Nova compo A3,5
0 0 0 0 0 278 TKF
IMUNISASI RUTIN
0 0 0 0 0 281 BCG
0 0 0 0 0 282 CAMPAK
0 0 0 0 0 283 DT
0 0 0 0 0 284 HB.0 / HEP.B UNIJECT
0 0 0 0 0 285 IPV
0 0 0 0 0 287 POLIO
0 0 0 0 0 288 PCV
0 0 0 0 0 289 Td
0 0 0 0 0 290 MR
291 safety box
0 0 0 0 0

0 0 0 0 0 295 Curcuma
0 0 0 0 0 300 Herbacof
0 0 0 0 0 301 Noza
0 0 0 0 0 302 Pehavral
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
11 12 13 14 15 16 17 18 19 1 2
322
............
……… …………………………………………… H.Fatoni, S.Kep,MM

......... NIP. .......................................... NIP.19730808 200501 1 008
12
:
:
:
: LAMPUNG TAHUN
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kapsul kotak 304 304 0 0 0
tablet 24 tab/Kotak 1,856 44,550 0 0 0
botol botol 60 ml - 3,300 0 0 0
ampul ktk 30 ampul@10 - 121,500 0 0 0
ml
vial 10 vial/kotak 8,591 8,591 0 0 0
botol botol 60 ml 3,498 3,498 0 0 0
botol botol 60 ml 1,694 1,694 0 0 0
tube 25 tube/kotak 3,509 3,509 0 0 0
supp 10 supp/kotak 3,250 3,250 0 0 0
pot 24 pot/kotak 3,477 3,477 0 0 0
vial 10 vial/kotak 2,650 2,650 0 0 0
tube 25 tube/kotak 5,044 5,044 0 0 0
ampul ampul 1,718 1,718 0 0 0
vial 10 vial/kotak 14,430 14,430 0 0 0
sachet 30 tablet/sachet 226 226 0 0 0
tube tube 2,997 2,997 0 0 0
tablet 100 tab/kotak 65 65 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
botol botol 3,333 3,333 0 0 0
botol botol 15,600 15,600 0 0 0
botol botol 7,220 7,220 0 0 0
botol 300 ml/botol 9,124 9,124 0 0 0
botol 1000 ml/botol 30,931 30,931 0 0 0
botol 60 ml/botol 3,740 3,740 0 0 0
botol 300 ml/botol 8,160 8,160 0 0 0
paket kotak 214,990 214,990 0 0 0
paket kotak 409,461 409,461 0 0 0
paket kotak 389,344 389,344 0 0 0
paket kotak 1,297,894 1,297,894 0 0 0
ampul ampul 20,250 20,250 0 0 0
kapsul botol 133 13,300 0 0 0
botol 24 botol/kotak 2,042 49,008 0 0 0
sachet 100 sachet/kotak 292 29,200 0 0 0
tube tube 2,600 2,600 0 0 0
botol 5 ml/botol 3,194 3,194 0 0 0
ampul ampul 5,723 5,723 0 0 0
botol 500 ml/botol 5,700 5,700 0 0 0
botol botol 1,960 1,960 0 0 0
botol 500 ml/botol 6,627 6,627 0 0 0
ampul ampul 83,333 83,333 0 0 0
tiube 24 tube/kotak 2,325 2,325 0 0 0
botol botol 3,200 3,200 0 0 0
tablet 100 tablet 190 190 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
tube 12 tube/kotak 4,700 56,400 0 0 0
tube tube 3,266 3,266 0 0 0
botol botol 1,599 1,599 0 0 0
botol botol 60 ml 2,190 2,190 0 0 0
vial 10 vial/kotak - 20,780 0 0 0
vial 10 vial/kotak 4,090 4,090 0 0 0
botol botol 100 ml 5,885 5,885 0 0 0
tube tube - 3,000 0 0 0
sachet 40 sachet/kotak - 98,000 0 0 0
ampul ampul 6,200 6,200 0 0 0
tablet kotak 174 8,700 0 0 0
botol botol 4,900 4,900 0 0 0
strip strip 31,760 31,760 0 0 0
strip strip 12,569 12,569 0 0 0
botol botol 6,044 6,044 0 0 0
tube 25 tube/kotak 3,500 3,500 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
60 ml botol 60 ml 1,160 1,160 0 0 0
botol botol 8,250 8,250 0 0 0
botol botol 60 ml 7,552 7,552 0 0 0
botol botol 300 ml 26,139 26,139 0 0 0
vial 30 vial/kotak 10,780 323,400 0 0 0
tablet 100 kaplet/kotak 85 85 0 0 0
botol botol 500 ml 7,630 7,630 0 0 0
nebu nebu 22,200 22,200 0 0 0
ampul ampul 4,844 4,844 0 0 0
pot pot 2,333 2,333 0 0 0
botol botol 3,800 3,800 0 0 0
vial 2 vial/kotak 2,850 2,850 0 0 0
vial vial 2,745 2,745 0 0 0
vial Dus, 10 vial @ 5 ml 517,132 517,132 0 0 0
ampul Dus, 10 ampul @ 1 140,188 140,188 0 0 0
ml
vial Dus, 1 vial @ 1 154,391 154,391 0 0 0
dosis + syringe
botol botol 2,511 2,511 0 0 0
0 0 0
pcs kotak/ 100 psc 1,210 1,210 0

pcs kotak/ 100 psc 1,190 1,190 0 0 0
pcs kotak/ 100 psc 100,344 100,344 0 0 0
pcs kotak/ 100 psc 100,344 100,344 0 0 0
pcs kotak/ 100 psc 104,734 104,734 0 0 0
pcs kotak/ 100 psc 14,100 14,100 0 0 0
galon galon 174,000 174,000 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
kotak kotak 16,893 16,893 0 0 0
TEST TEST 253,200 253,200 0 0 0
pcs 12 pcs/kotak 26,081 26,081 0 0 0
pcs pcs - - 0 0 0
botol botol 90,500 90,500 0 0 0
botol botol 42,863 42,863 0 0 0
pcs kotak 678,150 5,267 0 0 0
pcs kotak 678,150 5,270 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
50 pcs kotak 8,713 8,713 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
100 pcs kotak 87,601 87,601 0 0 0
set 50 set/kotak 9,047 82,500 0 0 0
set 50 set/kotak 7,755 339,250 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
set 50 set/kotak 7,044 385,000 0 0 0
Rol Rol 226,350 226,350 0 0 0
pcs 16 lembar/kotak 7,641 7,641 0 0 0
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 38,775 38,775 0 0 0
pcs 50 pcs/kotak 82,700 82,700 0 0 0
Rol Rol 14,810 14,810 0 0 0
Rol Rol 43,300 43,300 0 0 0
pcs 36pcs/kotak 46,842 46,842 0 0 0
botol botol 69,300 69,300 0 0 0
box box 156,975 156,975 0 0 0
box box 161,000 161,000 0 0 0
box box 257,225 257,225 0 0 0
pcs kotak/ 50 psc - - 0 0 0
pcs 10 pcs/kotak 100,848 100,848 0 0 0
Pcs Pcs - - 0 0 0
botol botol 15,246 15,246 0 0 0
- - 0
botol botol 246,000 246,000 0 0 0

paket kotak 390,000 390,000 0 0 0
botol botol 123,050 123,050 0 0 0
botol botol 175,010 175,010 0 0 0
botol botol 20,150 20,150 0 0 0
paket botol 423,800 423,800 0 0 0
botol botol 206,555 206,555 0 0 0
paket kotak 87,500 87,500 0 0 0
paket botol 52,500 52,500 0 0 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 242,295 242,295 0 0 0
syr botol 299,100 299,100 0 0 0
paket botol 221,155 221,155 0 0 0
paket botol 321,300 321,300 0 0 0
botol botol 136,300 136,300 0 0 0
botol botol 57,640 57,640 0 0 0
0
ampul ampul 88,891 88,891.0 0 0 0
ampul ampul 28,204 28,204.0 0 0 0
ampul ampul 16,500 16,500.0 0 0 0
ampul ampul 23,490 23,490.0 0 0 0
vial vial 144,540 144,540.0 0 0 0
vial vial 77,366 77,366.0 0 0 0
ampul ampul 19,540 19,540.0 0 0 0
ampul ampul 16,480 16,480.0 0 0 0
ampul ampul 151,150 151,150.0 0 0 0
pcs pcs 16,500 16,500.0 0

0 0 0
botol 60 mL/botol 17,523 17,523 0 0 0
kotak kotak 48,202 48,202 0 0 0
botol botol 60 ml 11,655 11,655 0 0 0
supp supp 4,325 4,325 0 0 0
supp supp 5,085 5,085 0 0 0
Botol Botol 15,999 15,999 0 0 0
Tablet 100 tablet/kotak 28,374 28,374 0 0 0
botol botol 5,034 5,034 0 0 0
kapsul kotak 100 kapsul 6,886 6,886 0 0 0
140,337 140,337 0
27,088 27,088 0
STOK PENERIMAAN
(………..)
3 4 5 6 7 8 9 10 11 12 13 14 15

UMUM
TIDAK BAYAR
BAYAR

Aziza, S.Kep …………………………………………… ……………………………………………

NIP. 19741011 200804 2 001 NIP. .......................................... NIP. ..........................................
: Desember
: 2023
STOK PEMAKAIA
STOK AKHIR N RATA- PERMINTAA
AKHIR DALAM RATA S/D N
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
STOK PEMAKAIA
RUPIAH BULAN INI
16 17 18 19

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Laporan Obat Tahun 2023

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LAPORAN PEMAKAIAN OBAT DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KODE PUSKESMAS : 1012244

260 Bonding / single bond botol botol 246,000 246,000 0

281 BCG ampul ampul 88,891 88,891.0 0

OBAT TAMBAHAN NON GENERIK

294 Becefort syr botol 60 mL/botol 17,523 17,523 0

JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR

Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

H.Fatoni, S.Kep,MM Aziza, S.Kep ……………………………………………

PENERIMAAN STOK PEMAKAIA

KODE PUSKESMAS : 1012244

BCG ampul ampul 88,891 88,891.0 0

OBAT TAMBAHAN NON GENERIK

Becefort syr botol 60 mL/botol 17,523 17,523 0

JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR

Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

H.Fatoni, S.Kep,MM Aziza, S.Kep ……………………………………………

OBAT TAMBAHAN NON GENERIK

0 0 0 0 0 294 Becefort syr

JUMLAH KUNJUNGAN RESEP

…………………………………………… H.Fatoni, S.Kep,MM

pcs kotak/ 100 1,210 1,210 0

botol botol 246,000 246,000 0 0 0

ampul ampul 88,891 88,891.0 0 0 0

ampul ampul 28,204 28,204.0 0 0 0

ampul ampul 16,500 16,500.0 0 0 0

ampul ampul 23,490 23,490.0 0 0 0

vial vial 144,540 144,540.0 0 0 0

vial vial 77,366 77,366.0 0 0 0

ampul ampul 19,540 19,540.0 0 0 0

ampul ampul 0 0.0 0 0 0

ampul ampul 16,480 16,480.0 0 0 0

ampul ampul 151,150 151,150.0 0 0 0

pcs pcs 16,500 16,500.0 0

supp supp 5,085 5,085 0 0 0

Botol Botol 15,999 15,999 0 0 0

JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

Yang Menyerahkan Yang Menerima/Melapor

Aziza, S.Kep …………………………………………… ……………………………………………

KODE PUSKESMAS : 1012244

0 0 0 281 BCG ampul ampul 88,891 88,891.0

OBAT TAMBAHAN NON GENERIK

294 Becefort syr 60

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR

Mengetahui/Menyetujui : Yang Menyerahkan

H.Fatoni, S.Kep,MM Aziza, S.Kep

STOK PENERIMAAN STOK PEMAKAIA

AL SISA STOK BULAN INI (Rp.) 0

BCG ampul ampul 88,891 88,891.0 0

OBAT TAMBAHAN NON GENERIK

JUMLAH TOTAL SISA STOK BULAN INI (Rp.)

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR

Mengetahui/Menyetujui : Yang Menyerahkan Yang Menerima/Melapor

H.Fatoni, S.Kep,MM Aziza, S.Kep …………………………………………… …………………

0 0 0 0 0 281 BCG ampul

OBAT TAMBAHAN NON GENERIK

0 0 0 0 0 294 Becefort syr botol

JUMLAH KUNJUNGAN RESEP

…………………………………………… H.Fatoni, S.Kep,MM

BAWANG BULAN : Juni

kotak/ 100 1,210 1,210 0