Ugd Lplpo

Pemerintah Kabupaten Parigi Mout
DINAS KESEHATAN
Jl. Matalemo, Desa Bambalemo Kec. Parigi Kab
LAPORAN PEMAKAIAN DAN LEMBAR PERM
(LPLPO) DAK 2022
NAMA POSKESDES/PUSTU : GUNUNG SARI

KECAMATAN : BOLANO LAMBUNU
KABUPATEN : PARIGI MOUTONG
PROVINSI : SULAWESI TENGAH
PERSEDIAAN AWAL
SEPTEMBER
Harga
NO. NAMA OBAT Satuan
Satuan
PUSTU / JUMLAH
POSKESDES HARGA (Rp)
1 2 3 4 5 6
OBAT-OBATAN DAK 2022
1 Air untuk injeksi Botol 25 ml 2,650 -
2 Alopurinol tablet 100 mg Tablet 89 -
3 Ambroxol tablet 30 mg Tablet 333 -

4 Aminofilin tablet 200 mg Tablet 246 -
5 Amitriptilin tablet salut 25 mg Tablet 204 -
6 Amlodipin tablet 10 mg Tablet 75 -
8 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 3,885 -
9 Amoksisilin tablet 500 mg Tablet 231 -
Ampisilin serbuk injeksi 1000 mg/vial Vial 9,900 -

10
Anestetik lokal gigi kombinasi : lidokain
hcl 2% + epinefrin 1 : 80.000 injeksi 2 ml ampul 4,455 -
11
Pehacain)
Antasida tablet, kombinasi : aluminium
hidroksida 200 mg + magnesium Tablet 54 -
12
hidroksidasuspensi,
Antasida 200 mg kombinasi :
aluminium hidroksida 200 mg + Botol 60 ml 1,756 -
13
magnesium hidroksida 200 mg
Antifungi salep, kombinasi : asam
Pot 30 g 3,670 -
14 benzoat 6%+ asam
Antihemoroid, salisilat
kombinasi: 3%
bismut
subgalat 150 mg + heksaklorofen 2,5 mg
Suppositoria 3,260 -
15 + lidokain lidokain 10 mg+ seng oksida
120 mg + sup
Antibakteri ad kombinasi
salep 2g : Basitracin
Tube 10 gram 3,509 -
16 500 IU/gr, Polimiksin 10.000 IU/gr
Anti Parkinson tablet, kombinasi :
Tablet 904 -
17 benzerasid 25 mg + levodopa 100 mg
Asam asetilsalisilat (asetosal) tablet 80
Tablet 90 -
18 mg
Asam askorbat (vitamin C) tablet 50 mg Tablet 46 -

19
Asam askorbat (vitamin C) tablet 500 mg Tablet 225 -

20
Asam folat tablet 1 mg Tablet 61 -

21
Asam mefenamat tablet 500 mg Tablet 117 -

22
Asam Traneksamat tablet 500 mg Tablet 1,910 -

23
Asiklovir krim 5% Tube 5 gram 6,549 -

24
Asiklovir tablet 400 mg Tablet 1,414 -

25
Atapulgit tablet 650 mg Tablet 332 -

26
Atropin injeksi 0,25 mg/ml Ampul 1,718 -

27
Bedak salisil serbuk 2% Dus 50 gram 9,300 -

28
Betahistin tablet 6 mg Tablet 93 -

29
Betametason krim 0,1% Tube 5 gram 1,520 -

30
Bisakodil supppo 10 mg Suppositoria 4,325 -

31
Bisakodil supppo 5 mg Suppositoria 5,085 -

32
Bisakodil tablet salut 5 mg Tablet 216 -

33
Deksametason injeksi 5 mg/ml Ampul 968 -

34
Deksametason tablet 0,5 mg Tablet 155 -

35
Diazepam enema 5 mg/2,5 ml Tube @ 2,5 mL 13,546 -

36
Diazepam injeksi 5 mg/ml Ampul 1,545 -
37
Diazepam tablet 5 mg Tablet 109 -

38
Difenhidramin injeksi 10 mg/ml Ampul 825 -

39
Digoksin tablet 0,25 mg Tablet 253 -

40
Diltiazem tablet 30 mg Tablet 141 -

41
Dimenhidrinat tablet 50 mg Tablet 109 -

42
Doksisiklin kapsul 100 mg Kapsul 292 -

43
Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,401 -

44
Domperidon tablet 10 mg Tablet 76 -

45
Epinefrin (adrenalin) injeksi 1 mg/ml Ampul 1,740 -

46
Eritromisin sirup 200 mg/5 ml Botol 60 ml 19,360 -

47
Eritromisin tablet 500 mg Tablet 900 -

48
Etanol cairan 70% Botol 1000 ml 37,638 -

49
Etil klorida semprot 100 ml Botol 100 ml 234,876 -

50
Eugenol Botol 10 ml 20,175 -

51
Fitomenadion (vitamin K 1) injeksi 2
Ampul 9,340 -
52 mg/ml
Fitomenadion (vitamin K 1) tablet salut
Tablet 781 -
53 10 mg
Furosemid injeksi 10 mg/ml (i.v./i.m.) Ampul 978 -

54
Furosemid tablet 40 mg Tablet 342 -

55
Gentamisin tts mata 0,3% Botol 5 ml 5,170 -

56
Gentamisin salep kulit 0,1% Tube 5 gram 5,633 -

57
Gentian violet larutan 1% Botol 10 ml 3,918 -

58
Glibenklamid tablet 5 mg Tablet 260 -

59
Glimepirid tablet 1 mg Tablet 97 -
60
Glimepirid tablet 2 mg Tablet 123 -

61
Gliseril Guaiakolat tablet 100 mg Tablet 243 -

62
Glukosa Larutan Infus 40% Botol 25 ml 7,000 -

63
Glukosa Larutan Infus 5% steril Botol 500 ml 6,627 -

64
Griseofulvin (micronized) tablet 125 mg Tablet 210 -

65
Haloperidol tablet 2 mg Tablet 82 -

66
Haloperidol tablet 5 mg Tablet 54 -

67
Hidroklorotiazid tablet 25 mg Tablet 148 -

68
Hidrokortison krim 2,5% Tube 5 gram 2,325 -

69
Hiosina butilbromida tablet 10 mg Tablet 1,050 -

70
Ibuprofen sirup 100 mg/5 ml Botol @ 60 ml 2,339 -

71
Ibuprofen tablet 400 mg Tablet 215 -

72
Imunodulator (ekstrak Phyllanthus niruri
Botol 60 ml 38,351 -
73 25 mg) Sirup
Isosorbid dinitrat tablet 5 mg Tablet 100 -

74
Kalsium glukonat injeksi 10% Ampul 6,255 -

75
Kalsium laktat (kalk) tablet 500 mg Tablet 61 -

76
Kaptopril tablet 25 mg Tablet 75 -

77
Karbogliserin tts telinga 10 % Botol 5 ml 3,300 -

78
Ketokonazol krim 2% Tube 10 gram 2,420 -

79
Ketokonazol tablet 200 mg Tablet 260 -

80
Kloramfenikol kapsul 250 mg Kapsul 666 -

81
Kloramfenikol salep mata 1% Tube 5 gram 3,800 -

82
Kloramfenikol suspensi 125 mg/5 ml Botol 60 ml 11,400 -
83
Kloramfenikol tetes telinga 1% Botol 10 ml 15,096 -

84
Kloramfenikol tts mata 0,5% Botol 5 ml 21,201 -

85
Klorfeniramin tablet 4 mg Tablet 124 -

86
Klorpromazin tablet salut 100 mg Tablet 698 -

87
Kodein tablet 10 mg Tablet 605 -

88
Kolkisin tablet 0,5 mg Tablet 677 -

89
Kombinasi : ergotamin 1 mg+ kafein 50
Tablet 315 -
90 mg
Kombinasi : Ipratropium bromida 0,5 mg
Ampul 3,952 -
91 + Salbutamol 2,5 mg, cairan ih
Kombinasi: Kaolin 700 mg + Pektin 66
Botol 60 ml 7,992 -
92 mg
Kombinasi analgetik + multivitamin tablet
: Metampiron 500 mg, Vitamin B1 50 mg,
Tablet 599 -
93 Vitamin B6 100 mg, Vitamin B12 100
Kombinasi
mcg obat flu tablet : Triprolidine
HCL 2,5 mg, Pseudoephedrin HCl 30 Tablet 1,127 -
94 Kombinasi obat batuk anak syrup :
mg, Paracetamol
Parasetamol
Kombinasi 130 500
mg, mg
Multivitamin Anak/Dewasa
Dexchlorpheniramine maleat 1 mg, Botol 60 ml 23,776 -
95 tablet : Vitamin B1 HCL 1,5 mg, vitamin
Thiocol
B2 0,25 20mg,mg, sorbitol
vitamin B6with
HCLchocolate,
0,25 mg,
flavor q.s
vitamin C 12,5 mg, kalsium pantotenat Tablet 417 -
96 Kombinasi Multivitamin tablet : Vitamin C
1,5
500mg,mg,nikotimanid
Vitamin B1 10 15 mg, asam
Vitaminfolat
B2
Kombinasi
0,5mg,
10 Multivitamin
mg,Vitamin
Besi (II)B6
glukonat anak syrup
107,5 mg,
5 mg, Vitamin : L-
B12 Tablet 2,078 -
97 lysine
cooper HCl 200 mg,
glukonate beta-carotene
1,182 mg 20 1000
100 mg, Calcium panthotenant mg,
iu, vitamin B1 3 mg, vitamin B2
Nicotinamide 50 mg, Vitamin E 30 mg 2 mg,
Botol 60 ml 22,311 -
98 vitamin B6 1 mg, vitamin B12 10 mcg,
Kotrimoksazol
vitamin C 50 mg, (dewasa) kombinasi
nicotinamide : d-
20 mg,
sulfametoksazol 400 mg+ trimetoprim 80 Tablet 127 -
99 panthenol 3 mg, curcuminoid 2 mg
mg
Kotrimoksazol kombinasi tiap 5 ml
suspensi : sulfametoksazol 200 mg + Botol 60 ml 2,119 -
100
trimetoprim 40 mg
Laktulosa sir 3,335 g/5 ml Botol 60 ml 12,533 -
101
Lidokain inj 2% (infiltr/p.v.) Ampul 891 -

102
Loperamid tablet 2 mg Tablet 72 -

103
Loratadin tablet 10 mg Tablet 117 -

104
Magnesium sulfat injeksi 20% Ampul 4,120 -

105
Magnesium sulfat injeksi 40% Ampul 4,700 -
106
Meloksikam tablet 7,5 mg Tablet 666 -

107
Metamizole Sodium Monohydrate Injeksi
Ampul 3,045 -
108 500 mg/ml
Metformin tablet 500 mg Tablet 77 -

109
Metilergometrin injeksi 0,2 mg/ml Ampul 1,079 -

110
Metilergometrin tablet salut 0,125 mg Tablet 214 -

111
Metilprednisolon tablet 4 mg Tablet 102 -

112
Metoklopramid injeksi 5 mg/ml Ampul 1,983 -

113
Metoklopramid tablet 10 mg Tablet 66 -

114
Metronidazol larutan infus 5 mg/ml Botol 100 ml 5,885 -

115
Metronidazol tablet 500 mg Tablet 366 -

116
Mikonazol krim 2% Tube 10 gram 1,900 -

117
N-asetil sistein kapsul 200 mg Kapsul 320 -

118
NaCl 0,9% larutan Infus Botol 500 ml 6,900 -

119
Natrium diklofenak tablet 50 mg Tablet 272 -

120
Nifedipin kapsul 10 mg Kapsul 255 -

121
Nistatin suspensi 100.000 UI/ml Botol 12 ml 12,299 -

122
Nistatin tablet salut 500.000 UI Tablet 869 -

123
Nistatin tablet vaginal 100.000 UI Tablet 550 -

124
Obat Batuk Hitam (OBH) syrup Botol 100 ml 6,327 -

125
Oksitetrasiklin 1% Salep Mata Tube 3,5 gram 5,927 -

126
Oksitetrasiklin HCl salep kulit 3% Tube 5 gram 3,685 -

127
Oksitosin injeksi 10 UI/ml Ampul 1,473 -

128
Omeprazol injeksi 40 mg/10 ml Vial 5,346 -
129
Omeprazol kapsul 20 mg Tablet 475 -

130
Papaverin tablet 40 mg Tablet 355 -

131
Parasetamol sirup 120 mg/5 ml Botol 60 ml 1,171 -

132
Parasetamol tablet 500 mg Tablet 222 -

133
Parasetamol tts 60 mg/0,6 ml Botol 15 ml 5,204 -

134
Parasetamol Infus 1000 mg/100 ml Botol 100 ml 8,880 -

135
Perak sulfadiazin krim 1% Tube 35 gram 96,237 -

136
Permetrin krim 5 % Tube 15 gram 11,466 -

137
Pirantel pamoat suspensi 125 mg/5 ml Botol 10 ml 10,900 -

138
Piridoksin (vitamin B6) tablet 10 mg Tablet 72 -

139
Piroksikam kapsul 20 mg Kapsul 263 -

140
Povidon iodin larutan 100 mg/ml Botol 300 ml 25,445 -

141
Prednison tablet 5 mg Tablet 73 -

142
Propiltiourasil tablet 100 mg Tablet 444 -

143
Propranolol tablet 10 mg Tablet 63 -

144
Ranitidin tablet 150 mg Tablet 86 -

145
Ranitidin injeksi 25 mg/2 ml Ampul 3,760 -

146
Ringer Laktat Larutan Botol 500 ml 7,703 -

147
Salbutamol tablet 4 mg Tablet 67 -

148
Salep 2-4, kombinasi : asam salisilat 2 %
Tube 30 gram 2,521 -
149 + belerang endap 4 %
Sefadroksil kapsul 500 mg Kapsul 1,221 -

150
Sefadroksil sirup kering 125 mg/5 ml Botol 60 mL 9,929 -

151
Setirizine Hydrochloride (HCL) tablet 10
Tablet 52 -
152 mg
Setirizin sirup 5 mg/5 ml Botol 60 mL 2,236 -

153
Sianokobalamin (vitamin B12) injeksi
Ampul 1,066 -
154 500 mcg/ml
Sianokobalamin (vitamin B12) tablet 50
Tablet 44 -
155 mcg
Simvastatin tablet salut 10 mg Tablet 73 -

156
Siprofloksasin tablet scored 500 mg Tablet 260 -

157
Spironolakton tablet 25 mg Tablet 222 -

158
Tetrasiklin kapsul 500 mg Kapsul 1,153 -

159
Tiamin (vitamin B1) tablet 50 mg Tablet 239 -

160
Thiamin (vitamin B1) injeksi 100 mg/ml Vial 14,685 -

161
Vitamin B kompleks Tablet 60 -

162
Zinc sirup 20 mg/5 ml Botol 60 ml 2,511 -

163
Zinc tablet dispersible 20 mg Tablet 615 -

164
OBAT GIGI -
165
Gutta Percha # 45 - 80 Ktk 77,165 -

166
Kalsium Hidroksida Pasta Ktk 411,255 -

167
Klorfenol kamfer mentol (CHKM) Botol 108,558 -

168
Pasta pengisi saluran akar pasta Ktk 392,385 -

169
Glass ionometer ART (Atraumatic
Restorative Treatment) serbuk dan Ktk 863,136 -
170
Larutan
Komposit resin Set 1,181,928 -
171
Devitalisasi Pasta non Arsen Ktk 392,496 -

172
Surgical ginggival pack Ktk -

173
Articulating paper Ktk 286,380 -

174
Caviton / Tumpatan sementara (Orafil) Botol 253,080 -
175
Semen Seng Fosfat serbuk dan cairan Box 295,260 -

176
Asam mefenamat tablet 500 mg Tablet 425 -

177
Methyl prednisolon 4 mg Tablet 596 -

178
Deksametason tablet 0,5 mg Tablet 190 -

179
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197
JUMLAH -
BMHP DAK 2022
Catgut plain 2/0 + jarum 1/2 GT 35 mm Pcs 5,693 -
1
Catgut plain 3/0 + jarum 1/2 GT 35 mm Pcs 5,693 -

2
Catgut Chromic 2/0 + jarum 1/2 GT 35
Pcs 5,693 -
3 mm
Pcs 5,693 -
4 mm
Silk 2/0 + jarum 1/2 GT 35 mm Pcs 4,146 -

5
Silk 3/0 + jarum 1/2 GT 35 mm Pcs 4,146 -

6
Folley Catheter two way No. 12 Pcs 13,100 -

7

8

9

10

11
Surgical glove steril size 7.0 Pasang 10,120 -

12
Surgical glove steril size 7.5 Pasang 10,120 -

13
Gloves surgical Non Steril S Pcs 1,265 -

14
Gloves surgical Non Steril M Pcs 1,265 -

15
Gloves surgical Non Steril L Pcs 1,265 -

16
Gloves Obgyn Pasang 49,335 -

17
Infus Set Dewasa Y Type Pcs 8,982 -

18
Infus Set Anak Pcs 8,982 -

19
Kasa Hydrophil 40 yard x 80 cm Roll 181,907 -

20
Kasa hydrophil steril uk 16 x 16 Pcs 575 -

21
Disposable Syringe 1 cc Pcs 1,110 -
22

23

24

25
Plester Roll Kain 7,5 cm x 4,5 m Roll 43,300 -

26
Nurse Cap Pcs 505 -

27
IV Catheter 18G (NIPRO SAFELET
CATH IV CANNULA PU RADIOPAQUE Pcs 5,590 -
28
CATHETER
IV 18G(NIPRO
Catheter 20G X 1-1/4 SAFELET
INCH (32MM))
29
CATHETER 20GX1-1/4
IV Catheter 22G (NIPROINCH (32MM))
SAFELET
30
CATHETER
IV 22GX1
Catheter 24G INCHSAFELET
(NIPRO (25MM))
31
CATHETER 24GX3/4 INCH (19MM))
IV Catheter WP 26G Pcs 4,715 -
32
Rivanol 0,1 % Botol 300 ml 6,926 -

33
Oneclean/Lysol Botol 1000 ml 63,360 -

34
Umbilical Cord Klem Steril Nylon Pcs 2,070 -

35
Alkohol Swab 2 ply Pcs 121 -

36
My Jelly Tube 82 gram 35,460 -

37
Blood Lancet 28G Pcs 316 -

38
Urine Bag Pcs 7,970 -

39
Surgical Blade No. 15 Pcs 643 -

40
Surgical Blade No. 21 Pcs 643 -

41
Disposible Masker N95 Pcs 7,978 -

42
Disposible Masker Earloop Pcs 777 -

43
BAYMED CHLORHEXIDINE 0.5% 500
Botol 500 ml 36,489 -
44 ML (Handrub)
Antiseptik gel Botol 500 ml 31,800 -
45
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JUMLAH
-
bupaten Parigi Moutong
S KESEHATAN
emo Kec. Parigi Kab. Parigi Moutong
AN LEMBAR PERMINTAAN OBAT
PO) DAK 2022
BULAN : SEPTEMBER
TAHUN : 2023
KET
PENERIMAAN PENGELUARAN
STOK AKHIR SEPTEMBER
SEPTEMBER SEPTEMBER
PUSTU / JUMLAH PUSTU / JUMLAH PUSTU / JUMLAH

POSKESDES HARGA (Rp) POSKESDES HARGA (Rp) POSKESDES HARGA (Rp)
7 8 9 10 11 12
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Lambunu, 30 September 2023

Kepala Keperawatan
Wijiono
NIP.
Pemerintah Kabupaten Parigi Mout
DINAS KESEHATAN
Jl. Matalemo, Desa Bambalemo Kec. Parigi Kab
LAPORAN PEMAKAIAN DAN LEMBAR PERM
(LPLPO) DAK 2021
NAMA RUANGAN : UGD/KEPERAWATAN

KECAMATAN : BOLANO LAMBUNU
KABUPATEN : PARIGI MOUTONG
PROVINSI : SULAWESI TENGAH
PERSEDIAAN AWAL
SEPTEMBER
Harga
NO. NAMA OBAT Satuan
Satuan
PUSTU / JUMLAH
POSKESDES HARGA (Rp)
1 2 3 4 5 6
OBAT-OBATAN DAK 2022
1 Air untuk injeksi Ampul 25 ml 2,650 -
2 Alopurinol tablet 100 mg Tablet 89 -
3 Ambroxol tablet 30 mg Tablet 330 -
4 Aminofilin tablet 200 mg Tablet 231 -
5 Aminofilin injeksi 24 mg/ml Ampul 30 ml 2,836 -
8 Amoksisilin tablet 500 mg Tablet 231 -
9 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 2,050 -
10 Ampisilin serbuk injeksi 1000 mg Vial 1000 mg 9,900 -

Antibakteri salep kombinasi : Basitracin
11 Tube 10 gram 11,000 -
500 IU/gr, Polimiksin 10.000 IU/gr
Antidiare kombinasi sirup : Kaolin 700
12 Botol 60 ml 7,920 -
mg, Pektin 66 Kombinasi
Antihemoroid mg Suppo :
Bismuth Subgallate 150 mg,
13 Suppo 2 gr 3,260 -
Hexachlorophene 2.5 mg, Lignocaine 10
mg, Zinc Oxide120 mg
Antifungi salep kombinasi : Asam
14 Pot 30 gram 3,637 -
Benzoat 6% + Asam Salisilat 3%
Anti Parkinson kombinasi : benzerasid
15 Tablet 904 -
25 mg + levodopa 100 mg
Anestetik lokal gigi kombinasi : Lidokain
16 Ampul 847 -
HCl 2% + epinefrin 1 : 80.000 inj 2 ml
Antasida tablet, kombinasi : Aluminium
17 hidroksida 200 mg + Magnesium Tablet 54 -
hidroksida 200 mg
Antasida sirup, kombinasi : Aluminium
18 hidroksida 200 mg + Magnesium Botol 60 ml 1,756 -
hidroksida 200 mg
Asam asetilsalisilat (asetosal) tablet 80
19 Tablet 89 -
mg
20 Asam askorbat (vitamin C) tablet 50 mg Tablet 46 -
21 Asam askorbat (vitamin C) tablet 500 mg Tablet 225 -
22 Asam folat tablet 1 mg Tablet 61 -
23 Asam Mefenamat tablet 500 mg Tablet 117 -
24 Asiklovir krim 5% Tube 5 gram 6,826 -
25 Asiklovir tablet 400 mg Tablet 429 -
26 Atapulgit tablet 650 mg Tablet 296 -
27 Atropin injeksi 0,25 mg/ml Ampul 1 ml 1,718 -
28 Bedak Salisil serbuk 2% Pot 100 gram 8,800 -
29 Betahistine Mesylate tablet 6 mg Tablet 92 -
30 Betametason krim 0,1% Tube 4,415 -
31 Bisakodil tablet 5 mg Tablet 216 -
32 Bisakodil suppo 5 mg Suppo 5,085 -
33 Bisakodil suppo 10 mg Suppo 4,325 -
34 Deksametason tablet 0,5 mg Tablet 97 -
35 Deksametason injeksi 5 mg/ml Ampul 1 ml 968 -
36 Dextrose anhydrat 40% Ampul 25 ml 7,000 -

37 Diazepam injeksi 5 mg/ml Ampul 2 ml 1,545 -
38 Diazepam enema 5 mg/2,5 ml Alubag 28,908 -
39 Diazepam tablet 2 mg Tablet 70 -
40 Diazepam tablet 5 mg Tablet 108 -
41 Difenhidramin injeksi 10 mg/ml Ampul 1 ml 825 -
42 Digoksin tablet 0,25 mg Tablet 243 -
43 Diltiazem tablet 30 mg Tablet 140 -
44 Dimenhidrinat tablet 50 mg Tablet 109 -
45 Doksisiklin kapsul 100 mg Kapsul 289 -
46 Domperidon tablet 10 mg Tablet 75 -
47 Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,401 -
48 Epinefrin (adrenalin) injeksi 0,1% Ampul 1 ml 1,740 -
49 Eritromisin sirup kering 200 mg/5 ml Botol 60 ml 7,436 -
50 Eritromisin tablet 500 mg Tablet 1,657 -
51 Etanol cairan 70% Botol 1000 ml 33,000 -
52 Etil klorida spray Botol 100 ml 223,175 -
53 Eugenol Botol 10 ml 20,175 -

Fitomenadion (vitamin K 1) injeksi 2
54 Ampul 1 ml 1,452 -
mg/ml
55 Fitomenadion (vitamin K 1) tablet 10 mg Tablet 781 -
56 Furosemid injeksi 10 mg/ml Ampul 2 ml 969 -
57 Furosemid tablet 40 mg Tablet 326 -
58 Gentamisin tetes mata 0,3% Botol 5 ml 5,170 -
59 Gentamisin salep kulit 0,1% Tube 5 gram 4,510 -

60 Gentian violet larutan 1% Botol 10 ml 3,520 -
61 Glibenklamid tablet 5 mg Tablet 87 -
62 Glimepirid tablet 1 mg Tablet 96 -
63 Gliseril Guaiakolat tablet 100 mg Tablet 193 -
64 Glukosa larutan Infus 5% Botol 500 ml 6,627 -
65 Griseofulvin (micronized) tablet 125 mg Tablet 210 -
66 Haloperidol tablet 0,5 mg Tablet 53 -
67 Haloperidol tablet 1,5 mg Tablet 57 -
68 Haloperidol tablet 2 mg Tablet 81 -
69 Haloperidol tablet 5 mg Tablet 54 -
70 Hidroklorotiazid tablet 25 mg Tablet 148 -
71 Hidrokortison asetat krim 2,5% Tube 5 gram 2,325 -
72 Hyocine n-butilbromida 10 mg Tablet 1,050 -
73 Ibuprofen sirup 100 mg/5 ml Botol 60 ml 2,339 -
74 Ibuprofen tablet 400 mg Tablet 347 -
75 Isosorbid dinitrat tablet 5 mg Tablet 99 -
76 Kalsium glukonat injeksi 100 mg/ml Ampul 10 ml 6,199 -
77 Kalsium laktat tablet 500 mg Tablet 60 -
78 Kaptopril tablet 25 mg Tablet 75 -
79 Karbamazepin tablet 200 mg Tablet 216 -
80 Karbogliserin tetes telinga 10 % Botol 5 ml 3,300 -
81 Ketokonazol krim 2% Tube 10 gram 4,400 -
82 Ketokonazol tablet 200 mg Tablet 260 -

83 Kloramfenikol tetes telinga 1% Botol 10 ml 14,410 -
84 Kloramfenikol tetes mata 0,5% Botol 10 ml 19,910 -
85 Kloramfenikol salep mata 1% Tube 12,100 -
86 Kloramfenikol kapsul 250 mg Kapsul 660 -
87 Kloramfenikol Suspensi 125 mg/5 ml Botol 60 ml 5,352 -
88 Klorfeniramin maleat tablet 4 mg Tablet 66 -
89 Klorpromazin tablet 100 mg Tablet 656 -
90 Klorpromazin tablet 25 mg Tablet 208 -
91 Kodein tablet 10 mg Tablet 605 -
92 Kolkisin tablet 0,5 mg Tablet 671 -

Kombinasi : Ipratropium Br 0,5 mg+
93 Ampul 3,916 -
Salbutamol 2,5 mg nebules
Kombinasi (DHP) : Dihidroartemisin 40
94 mg + Piperakuin 320 mg tablet salut Tablet 1,900 -
selaput
Kombinasi : Ergotamin 1 mg+ Kafein 50
95 Tablet 305 -
mg tablet analgetik + multivitamin tablet
Kombinasi
: Metampiron 500 mg, Vitamin B1 50 mg,
96 Tablet 588 -
Vitamin B6 100 mg, Vitamin B12 100
Kombinasi
mcg obat flu tablet : Triprolidine
97 HCL 2,5 mg,
Kombinasi Pseudoephedrin
obat batuk anak syrupHCl: 30 Tablet 1,057 -
mg, Paracetamol
Parasetamol
Kombinasi 500 mg
130 mg, anak/dewasa
Multivitamin
98 Dexchlorpheniramine
tablet : Vitamin B1 HCL maleat 1 mg,
1,5 mg, vitamin Botol 60 ml 22,770 -
Thiocol
B2 0,25 20
mg,mg, sorbitol
vitamin B6with
HCLchocolate,
0,25 mg,
99 Kombinasi
flavor Multivitamin
vitaminq.sC 12,5 anakpantotenat
mg, kalsium syrup : L- Tablet 380 -
lysine
1,5 mg,HCl 200 mg, beta-carotene
nikotimanid 10 mg, asam folat1000
iu, vitamin B1 3 mg, vitamin B2
0,5 mg, Besi (II) glukonat 107,5 mg, 2 mg,
100 Botol 60 ml 21,868 -
vitamin
cooper B6 1 mg, vitamin
glukonate 1,182 mg B12 10 mcg,
Kotrimoksazol
vitamin C 50 mg, (dewasa) tablet 20
nicotinamide kombinasi
mg, d-
101 :panthenol
Sulfametoksazol 400 mg+ Trimetoprim
3 mg, curcuminoid 2 mg Tablet 126 -
80 mg
Kotrimoksazol kombinasi tiap 5 ml
102 suspensi : Sulfametoksazol 200 mg + Botol 60 ml 2,100 -
Trimetoprim 40 mg
103 Laktulosa sirup 3,335 g/5 ml Botol 63,030 -
104 Lidokain injeksi 2% Ampul 2 ml 891 -
105 Loperamid tablet 2 mg Tablet 81 -

106 Magnesium sulfat injeksi 20% Vial 4,120 -
107 Magnesium sulfat injeksi 40% Vial 4,700 -
108 Meloksikam tablet 7,5 mg Tablet 660 -

Metamizole Sodium Monohydrate Injeksi
109 Ampul 2 ml 3,045 -
500 mg/ml
110 Metformin tablet 500 mg Tablet 77 -
111 Metilergometrin injeksi 0,2 mg/ml Ampul 1 ml 1,069 -
112 Metilergometrin tablet 0,125 mg Tablet 214 -
113 Metilprednisolon tablet 4 mg Tablet 102 -
114 Metoklopramid injeksi 5 mg/ml Ampul 2 ml 1,983 -
115 Metoklopramid tablet 10 mg Tablet 66 -
116 Metronidazol larutan infus 5 mg/ml Botol 100 ml 5,885 -
117 Metronidazol tablet 500 mg Tablet 150 -
118 Miconazole Krim 2% Tube 10 gram 1,900 -
119 N-asetil sistein kapsul 200 mg Kapsul 317 -
120 NaCl 0,9% larutan Infus Botol 500 ml 6,900 -
121 Natrium diklofenak tablet 50 mg Tablet 109 -
122 Nifedipin kapsul 10 mg Kapsul 266 -
123 Nystatin tablet vaginal 100.000 UI Tablet 550 -
124 Nystatin tablet 500.000 UI Tablet 869 -
125 Nystatin drops 100.000 IU/ml Botol 12 ml 12,299 -
126 Obat Batuk Hitam (OBH) syrup Botol 100 ml 5,720 -
127 Oksitosin injeksi 10 UI/ml Ampul 1 ml 1,473 -
128 Oksitetrasiklin Salep Mata 1% Tube 3,5 gram 3,500 -

129 Oksitetrasiklin HCl salep kulit 3% Tube 5 gram 3,300 -
130 Omeprazol kapsul 20 mg Kapsul 129 -
131 Omeprazol kapsul 20 mg Kapsul 5,242 -
132 Omeprazol serbuk injeksi 40 mg/10 ml Vial 40 mg 5,346 -

Box, 10 strip @
133 Papaverin tablet 40 mg 29,590 -
10 tablet
134 Parasetamol tetes 60 mg/0,6 ml Botol 15 ml 5,204 -
135 Parasetamol sirup 120 mg/5 ml Botol 60 ml 1,160 -
136 Parasetamol tablet 500 mg Tablet 165 -
137 Peral Sulfadiazine Krim 1% Tube 35 gram 18,557 -
138 Permetrin krim 5 % Tube 30 gram 11,250 -
139 Pirantel pamoat tablet scored 125 mg Tablet 341 -
140 Pirantel Pamoat suspensi 125 mg/5ml Botol 10 ml 18,810 -
141 Piridoksin (Vit. B6) tablet 10 mg Tablet 183 -
142 Piroksikam kapsul 20 mg Kapsul 203 -
143 Povidon iodin larutan 100 mg/ml Botol 300 ml 25,200 -
144 Prednison tablet 5 mg Tablet 73 -
145 Primakuin tablet 15 mg Tablet 242 -
146 Propiltiourasil tablet 10 mg Tablet 440 -
147 Propranolol tablet 10 mg Tablet 63 -
148 Ranitidin injeksi 25 mg/2 ml Ampul 2 ml 858 -
149 Ranitidin tablet 150 mg Tablet 85 -
150 Ringer laktat larutan Infus Botol 500 ml 7,703 -
151 Salbutamol tablet 4 mg Tablet 67 -

Salep 2-4, kombinasi : Asam salisilat 2 %
152 Pot 15 gram 1,475 -
+ Belerang endap 4 %
153 Sefadroksil sirup 125 mg/5 ml Botol 60 ml 6,560 -
154 Sefadroksil kapsul 500 mg Kapsul 1,210 -

Setirizine Hydrochloride (HCL) tablet 10
155 Tablet 52 -
mg
Setirizine Hydrochloride (HCL) sirup 5
156 Botol 60 ml 2,215 -
mg/5 ml
Sianokobalamin (vitamin B12) injeksi
157 Ampul 1 ml 1,066 -
500 mcg/ml
Sianokobalamin (vitamin B12) tablet 50
158 Tablet 44 -
mcg
159 Simvastatin tablet 10 mg Tablet 73 -
160 Siprofloksasin tablet 500 mg Tablet 260 -
161 Spironolakton tablet 25 mg Tablet 220 -
162 Tetrasiklin kapsul 500 mg Kapsul 834 -
163 Thiamin (vitamin B1) tablet 50 mg Tablet 60 -
164 Thiamin (vitamin B1) injeksi 100 mg/ml Vial 14,984 -
165 Vitamin B kompleks tablet Tablet 120 -
166 Zinc tablet 20 mg Tablet 253 -
167 Zinc sirup 20 mg/5 ml Botol 60 ml 2,489 -
168 OBAT GIGI -
169 Gutta Percha # 45 - 80 Ktk 76,450 -
170 Kalsium Hidroksida Pasta Ktk 260,920 -
171 Klorfenol kamfer mentol (CHKM) Botol 108,240 -
172 Pasta pengisi saluran akar pasta Ktk 370,700 -

Glass ionometer ART (Atraumatic
173 Restorative Treatment) serbuk dan Ktk 842,490 -
Larutan
174 Komposit resin Set 816,530 -
175 Devitalisasi Pasta non Arsen Ktk 401,060 -
176 Articulating paper Ktk 288,530 -
177 Aplicators / Micro Brush Box 226,600 -
178 Bonding / Adper Singel Bond Botol 1,265,550 -
179 Caviton / Tumpatan sementara (Orafil) Botol 170,390 -
180 ETSA / Scotbond universal Etchan Box 284,350 -
181 LC A2 / Solare Sculpt #A2 Box 361,570 -
182 LC A3 / Solare Sculpt #A3 Box 374,000 -
183 Trichloro Formalin (TKF) Box 115,500 -
184 Semen Seng Fosfat serbuk dan cairan Box 283,910 -
185 Oco / Poliren Box 157,300 -
-
JUMLAH -
1 Catgut plain 2/0 + jarum 1/2 GT 35 mm pcs 4,336
2 Catgut plain 3/0 + jarum 1/2 GT 35 mm pcs 4,336 -

3 pcs 4,336 -
mm
4 pcs 4,336 -
mm
5 Silk 2/0 + jarum 1/2 GT 35 mm pcs 3,089 -
6 Silk 3/0 + jarum 1/2 GT 35 mm pcs 3,089 -
7 Folley Catheter two way No. 12 pcs 9,045 -
12 Surgical glove steril size 7.0 psg 7,810 -
16 Gloves surgical Non Steril S pcs 1,713 -
17 Gloves surgical Non Steril M pcs 1,713 -
18 Gloves surgical Non Steril L pcs 1,713 -
19 Gloves Obgyn Pasang 21,850 -
20 Infus Set Dewasa Y Type Pcs 7,130 -
21 Infus Set Anak Pcs 7,129 -
22 Kasa Hydrophil 40 m x 80 cm Roll 156,600 -

23 Kasa hydrophil steril uk 16 x 16 Pcs 575 -
24 Disposable Syringe 1 cc Pcs 748 -
27 Disposable Syringe 10 cc Pcs 1,064 -
28 Pembalut Elastis 10 cm x 4,55 m Roll 46,100 -
29 Plester Roll Kain 7,5 cm x 4,5 m Roll 37,371 -
30 Nasal Oksigen Bayi Pcs 6,325 -
31 Nasal Oksigen Anak Pcs 6,325 -
32 Nasal Oksigen Dewasa Pcs 6,325 -
33 Nurse Cap Pcs 385 -
34 IV Catheter WP 18G Pcs 4,370 -
39 Rivanol 0,1 % Botol 300 ml 7,920 -
40 Oneclean Botol 1000 ml 13,200 -
41 Umbilical Cord Klem Steril Nylon Pcs 2,070 -
42 Alkohol Swab 2 ply Pcs 138 -
43 M-Y Jelly Tube 82 gram 33,982 -
44 Blood Lancet 26G Pcs 106 -
45 Urine Bag Pcs 5,865 -

46 Surgical Blade No. 15 Pcs 561 -
47 Surgical Blade No. 21 Pcs 561 -
48 Disposible Masker N95 Pcs 14,375 -
49 Disposible Masker Earloop Pcs 700 -
50 Aseptic Gel Botol 500 ml 31,800 -

Aseptan Antiseptic Liquid with
51 Botol 500 ml 41,580 -
Moisturizer For Hand Rub
52 VeroChek HIV Kotak 227,979 -
53 Repusche syphilis kotak 252,770 -
54 Surgical glove steril size 7.0 psg 102 -
55 Surgical glove steril size 7.5 psg 102 -
56 Disposible Masker N95 pcs 14,375 -
JUMLAH
-
bupaten Parigi Moutong
S KESEHATAN
emo Kec. Parigi Kab. Parigi Moutong
AN LEMBAR PERMINTAAN OBAT
PO) DAK 2021
BULAN : SEPTEMBER
TAHUN : 2023
KET
PENERIMAAN PENGELUARAN
STOK AKHIR SEPTEMBER
SEPTEMBER SEPTEMBER
PUSTU / JUMLAH PUSTU / JUMLAH PUSTU / JUMLAH

POSKESDES HARGA (Rp) POSKESDES HARGA (Rp) POSKESDES HARGA (Rp)
7 8 9 10 11 12
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Lambunu, 30 September 2023

Kepala Keperawatan
Wijiono
NIP.

Ugd Lplpo

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Pemerintah Kabupaten Parigi Mout

NAMA POSKESDES/PUSTU : GUNUNG SARI

3 Ambroxol tablet 30 mg Tablet 333 -

5 Amitriptilin tablet salut 25 mg Tablet 204 -

6 Amlodipin tablet 10 mg Tablet 75 -

7 Amlodipin tablet 5 mg Tablet 55 -

8 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 3,885 -

9 Amoksisilin tablet 500 mg Tablet 231 -

Ampisilin serbuk injeksi 1000 mg/vial Vial 9,900 -

Asam askorbat (vitamin C) tablet 50 mg Tablet 46 -

Asam askorbat (vitamin C) tablet 500 mg Tablet 225 -

Asam folat tablet 1 mg Tablet 61 -

Asam mefenamat tablet 500 mg Tablet 117 -

Asam Traneksamat tablet 500 mg Tablet 1,910 -

Asiklovir krim 5% Tube 5 gram 6,549 -

Asiklovir tablet 400 mg Tablet 1,414 -

Atapulgit tablet 650 mg Tablet 332 -

Atropin injeksi 0,25 mg/ml Ampul 1,718 -

Bedak salisil serbuk 2% Dus 50 gram 9,300 -

Betahistin tablet 6 mg Tablet 93 -

Betametason krim 0,1% Tube 5 gram 1,520 -

Bisakodil supppo 10 mg Suppositoria 4,325 -

Bisakodil supppo 5 mg Suppositoria 5,085 -

Bisakodil tablet salut 5 mg Tablet 216 -

Deksametason injeksi 5 mg/ml Ampul 968 -

Deksametason tablet 0,5 mg Tablet 155 -

Diazepam enema 5 mg/2,5 ml Tube @ 2,5 mL 13,546 -

Diazepam tablet 5 mg Tablet 109 -

Difenhidramin injeksi 10 mg/ml Ampul 825 -

Digoksin tablet 0,25 mg Tablet 253 -

Diltiazem tablet 30 mg Tablet 141 -

Dimenhidrinat tablet 50 mg Tablet 109 -

Doksisiklin kapsul 100 mg Kapsul 292 -

Domperidon suspensi 5 mg/5 ml Botol 60 ml 2,401 -

Domperidon tablet 10 mg Tablet 76 -

Epinefrin (adrenalin) injeksi 1 mg/ml Ampul 1,740 -

Eritromisin sirup 200 mg/5 ml Botol 60 ml 19,360 -

Eritromisin tablet 500 mg Tablet 900 -

Etanol cairan 70% Botol 1000 ml 37,638 -

Etil klorida semprot 100 ml Botol 100 ml 234,876 -

Eugenol Botol 10 ml 20,175 -

Furosemid injeksi 10 mg/ml (i.v./i.m.) Ampul 978 -

Furosemid tablet 40 mg Tablet 342 -

Gentamisin tts mata 0,3% Botol 5 ml 5,170 -

Gentamisin salep kulit 0,1% Tube 5 gram 5,633 -

Gentian violet larutan 1% Botol 10 ml 3,918 -

Glibenklamid tablet 5 mg Tablet 260 -

Glimepirid tablet 2 mg Tablet 123 -

Gliseril Guaiakolat tablet 100 mg Tablet 243 -

Glukosa Larutan Infus 40% Botol 25 ml 7,000 -

Glukosa Larutan Infus 5% steril Botol 500 ml 6,627 -

Griseofulvin (micronized) tablet 125 mg Tablet 210 -

Haloperidol tablet 2 mg Tablet 82 -

Haloperidol tablet 5 mg Tablet 54 -

Hidroklorotiazid tablet 25 mg Tablet 148 -

Hidrokortison krim 2,5% Tube 5 gram 2,325 -

Hiosina butilbromida tablet 10 mg Tablet 1,050 -

Ibuprofen sirup 100 mg/5 ml Botol @ 60 ml 2,339 -

Ibuprofen tablet 400 mg Tablet 215 -

Isosorbid dinitrat tablet 5 mg Tablet 100 -

Kalsium glukonat injeksi 10% Ampul 6,255 -

Kalsium laktat (kalk) tablet 500 mg Tablet 61 -

Kaptopril tablet 25 mg Tablet 75 -