RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP) TAHUN 2024

SATUAN KERJA : PUSKESMAS KROMENGAN

NO NAMA OBAT SATUAN SISA STOK PER 31 PREDIKSI PEMAKAIAN RATA PREDIKSI SISA STOK JUMLAH RENCANA
DESEMBER 2022 PENGADAAN RATA PER BULAN 31 KEBUTUHAN KEBUTUHAN
(a) (b) (c) (d) = (a)+(b)- (e) = (c) x 18 (f) = (e) - (d)
(12x(c))
1 Air untuk injeksi ampul/vial/botol 10 mL 0 0 0 0 0 0

2 Air untuk injeksi Botol 100 ml 0 0 0 0 0 0

3 Air untuk injeksi Botol 250 ml 0 0 0 0 0 0

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

5 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 440 200 19 412 342 -70

6 Albendazol susp 200 mg/5 ml Botol 0 0 0 0 0 0

7 Albendazol tab 400 mg tablet/kapsul/kaplet 0 0 0 0 0 0

8 Alopurinol tab 100 mg Tab 2200 1000 227 476 4086 3610

9 Alopurinol tab 300 mg tablet/kapsul/kaplet 0 0 0 0 0 0

10 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0 12 0 12 0 -12

11 Aminofilin tab 150 mg tablet/kapsul/kaplet 0 0 0 0 0 0

12 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0

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

14 Amlodipin tab 10 mg tablet/kapsul/kaplet 29300 18000 2300 19700 41400 21700

15 Amlodipin tab 5 mg tablet/kapsul/kaplet 240 54000 2100 29040 37800 8760

16 Amoksisilin drops 100 mg/ml Botol @15 ml 0 0 0 0 0 0

17 Amoksisilin drops 100 mg/ml Botol @10 ml 0 0 0 0 0 0

18 Amoksisilin drops 100 mg/ml Botol @20 ml 0 0 0 0 0 0

19 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0 0 0 0 0 0

20 Amoksisilin sir kering 125 mg/5 ml Botol 0 240 3 204 54 -150

21 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

22 Amoksisilin tab 500 mg tablet/kapsul/kaplet 1600 9800 111 10068 1998 -8070

23 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0 0 0 0 0

24 Ampisilin serb inj 250 mg/vial Vial 0 0 0 0 0 0

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

epinefrin 1 : 80.000 inj 2 ml
26 Antasida, kombinasi : aluminium hidroksida 200 tablet/kapsul/kaplet 33000 0 358 28704 6444 -22260
mg + magnesium hidroksida 200 mg
27 Antasida, kombinasi : aluminium hidroksida 200 botol 60 ml 0 400 58 -296 1044 1340
mg + magnesium hidroksida 200 mg
28 Antibakteri kombinasi : Basitrasin 500 UI/g + Tube 0 0 0 0 0 0
Polimiksin B 10.000 UI/g
29 Antifungi salep, kombinasi : asam benzoat pot 30 g 24 120 0 144 0 -144
6%+ asam salisilat 3%
30 Antihemoroid, kombinasi: bismut subgalat 150 mg Suppositoria 32 260 10 172 180 8
+ heksaklorofen 2,5 mg + lidokain lidokain 10 mg+
31 seng oksida
Aquadest 120 mg
cairan 500+ml
sup ad Botol 500 ml 0 0 0 0 0 0

32 Articulating paper kertas warna penanda Kertas warna penanda oklusi 0 0 0 0 0 0

oklusi
33 Asam asetat tetes telinga 2% Botol 0 0 0 0 0 0

34 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet 0 1000 60 280 1080 800

35 Asam askorbat (vitamin C) tab 250 mg Tab 792 23900 674 16604 12132 -4472

36 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet 0 0 0 0 0 0

37 Asam folat tab 0,4 mg tablet/kapsul/kaplet 0 0 0 0 0 0

38 Asam folat tab 1 mg tablet/kapsul/kaplet 0 1200 0 1200 0 -1200

39 Asam folat tab 5 mg Tab 0 0 0 0 0 0

40 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

41 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/kaptab 5125 17600 1000 10725 18000 7275

42 Asam retinoat krim 0,05% Tube/pot 0 0 0 0 0 0

43 Asam salisilat salep 10% Tube 0 0 0 0 0 0

44 Asam salisilat salep 2% Tube 0 0 0 0 0 0

45 Asam salisilat salep 5% Tube 0 0 0 0 0 0

46 Asetazolamid tab 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

47 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0

48 Asiklovir tab 400 mg tablet/kapsul/kaplet 40 6000 5 5980 90 -5890

49 Atapulgit 600 mg tablet/kapsul/kaplet 0 0 0 0 0 0

50 Atapulgit tab 630 mg tablet/kapsul/kaplet 0 0 0 0 0 0

51 Atapulgit tablet 650 mg tablet/kapsul/kaplet 4100 1000 62 4356 1116 -3240

52 Atapulgit tablet 750 mg Tab 0 0 0 0 0 0

53 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0

54 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 13 40 1 41 18 -23

55 Atropin tab 0,5 mg Tab 0 0 0 0 0 0

 56 Bahan tumpatan sementara lar, serb Botol 0 2 0 2 0 -2

57 Bedak salisil serb 2% Dus/Sachet/Plastik 787 0 1 775 18 -757

58 Benzatin benzilpenisilin inj 1,2 juta UI/ml Vial 0 0 0 0 0 0

(i.m.)
59 Benzatin benzilpenisilin inj 2,4 juta UI/ml Vial 0 0 0 0 0 0
(i.m.)
60 Betahistin tab 6 mg tablet/kapsul/kaplet 630 1600 111 898 1998 1100

61 Betametason krim 0,1% tube 5 gram 38 100 10 18 180 162

62 Betametason krim 0,5 mg/g Tube 0 0 0 0 0 0

63 Bisakodil sup 10 mg Suppositoria 0 24 0 24 0 -24

64 Bisakodil sup 5 mg Suppositoria 0 24 0 24 0 -24

65 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 200 0 200 0 -200

66 Bisoprolol tab 2,5 mg tablet/kapsul/kaplet 196 3260 61 2724 1098 -1626

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

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

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

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

ml
71 Budesonid serb ih 200 mcg/dosis 100 dosis 0 0 0 0 0 0

72 Budesonid serb ih 200 mcg/dosis 200 dosis 0 0 0 0 0 0

73 Dapson tab 100 mg Tab 0 0 0 0 0 0

74 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 637 0 7 553 126 -427

75 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 40 0 40 0 -40

76 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 0 40 5 -20 90 110

77 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 4 50 1 42 18 -24

78 Diazepam tab 2 mg tablet/kapsul/kaplet 136 100 5 176 90 -86

79 Diazepam tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

80 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0

81 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 86 90 10 56 180 124

82 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 830 600 31 1058 558 -500

83 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 0 0 0 0 0 0

84 Domperidon susp 5 mg/5 ml botol @60 ml 0 150 2 126 36 -90

85 Domperidon tab 10 mg tablet/kapsul/kaplet 2800 6400 300 5600 5400 -200

86 Ekstrak Herba meniran (Phyllanthi niruri Kapsul 0 0 0 0 0 0

herba)
87 Ekstrak Herba meniran (Phyllanthi niruri Botol 0 0 0 0 0 0
herba)
88 Epinefrin (adrenalin) inj 1 mg/ml Ampul 40 11 2 27 36 9

89 Ergotamin tab 1 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

90 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

91 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0 0 0 0 0

92 Eritromisin tab 500 mg tablet/kapsul/kaplet 0 600 0 600 0 -600

93 Etambutol tab 400 mg tablet/kapsul/kaplet 0 0 0 0 0 0

94 Etanol 70% cairan 70% Botol 0 90 2 66 36 -30

95 Etil klorida semprot 100 ml Botol 2 22 1 12 18 6

96 Etonogestrel implan 68 mg Set 0 0 0 0 0 0

97 Eugenol Botol 0 0 0 0 0 0

98 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml 0 0 0 0 0 0

99 Fenitoin Na kaps 100 mg Kaps 0 1000 21 748 378 -370

100 Fenitoin Na kaps 30 mg Kaps 0 0 0 0 0 0

101 Fenobarbital inj 50 mg/ml Ampul 0 0 0 0 0 0

102 Fenobarbital tab 100 mg Tab 0 0 0 0 0 0

103 Fenobarbital tab 30 mg tablet/kapsul/kaplet 0 0 0 0 0 0

104 Fenoksimetil penisilin (penisilin V) tab 250 Tab 0 0 0 0 0 0

mg
105 Fenoksimetil penisilin (penisilin V) tab 500 Tab 0 0 0 0 0 0
mg
106 Ferrakrilum cairan 1% Botol 0 0 0 0 0 0

107 Ferro Sulfat sir 150 mg/5 ml botol 0 0 0 0 0 0

108 Ferro Sulfat tab sal selaput 300 mg tablet salut selaput 0 0 0 0 0 0

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

110 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 500 0 500 0 -500

111 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/kaplet salut gu 134 0 6 62 108 46

112 Flufenazin Dekanoat inj 25 mg/ml (i.m) Vial 0 0 0 0 0 0

113 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

114 Fluoksetin kaps 20 mg tablet/kapsul/kaplet 0 0 0 0 0 0

115 Fluor kapl 1 mg Kaplet 0 0 0 0 0 0

116 Fluor sediaan topikal Tube 0 0 0 0 0 0

117 Flutikason propionat cairan ih 0,5 mg/dosis Botol 0 0 0 0 0 0

118 Formokresol Botol 0 0 0 0 0 0

119 Fraksi dari ekstrak campuran Daun bungur Kapsul 0 0 0 0 0 0

(Lagerstroemiae speciosae folium) dan Kulit kayu
120 manis (Cinnamomi
Fraksi dari burmannii
ekstrak Kulit cortex)
kayu manis Kaplet 0 0 0 0 0 0
(Cinnamomi burmannii cortex)
121 Framisetin Sulfat Tulle 1% Patch 0 0 0 0 0 0

122 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0 60 3 24 54 30

123 Furosemid tab 40 mg tablet/kapsul/kaplet 134 700 6 762 108 -654

124 Galactose microparticle 200-400 mg Vial 0 0 0 0 0 0

micropart/ml
125 Garam oralit kombinasi : natrium klorida 0,52 g + sachet 0 0 0 0 0 0
kalium klorida 0,30 g + trinatrium sitrat 0,58 g +
glukosa anhidrat
126 Gentamisin salep2,7 g 0,3%
mata Tube 20 120 2 116 36 -80

127 Gentamisin tts mata 0,3% Botol 50 80 6 58 108 50

128 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

129 Glibenklamid tab 5 mg tablet/kapsul/kaplet 31700 0 480 25940 8640 -17300

130 Glimepirid tab 1 mg tablet/kapsul/kaplet 0 0 0 0 0 0

131 Glimepirid tab 2 mg tablet/kapsul/kaplet 32000 0 153 30164 2754 -27410

132 Glimepirid tab 3 mg tablet/kapsul/kaplet 0 0 0 0 0 0

133 Glimepirid tab 4 mg tablet/kapsul/kaplet 0 0 0 0 0 0

134 Glipizid tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

135 Glipizid tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

136 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

137 Gliserol obat luar 100 ml Botol 0 0 0 0 0 0

138 Glukosa Larutan Infus 10% steril 100 ml Botol 0 0 0 0 0 0

139 Glukosa Larutan Infus 10% steril 250 ml Botol 0 0 0 0 0 0

140 Glukosa Larutan Infus 10% steril 500 ml Botol 0 0 0 0 0 0

141 Glukosa Larutan Infus 40% Ampul @25 ml 0 24 0 24 0 -24

142 Glukosa Larutan Infus 5% steril 100 ml Botol 0 0 0 0 0 0

143 Glukosa Larutan Infus 5% steril 250 ml Botol 0 0 0 0 0 0

144 Glukosa Larutan Infus 5% steril 500 ml Botol 27 40 3 31 54 23

145 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet 0 0 0 0 0 0

146 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

147 Griseofulvin tab 500 mg Tablet/kapsul/kaplet 0 2000 37 1556 666 -890

148 Haloperidol Dekanoat inj 50 mg/ml Vial 0 0 0 0 0 0

149 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0 0 0 0 0

150 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

151 Haloperidol tab 1,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

152 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0 0 0 0 0

153 Haloperidol tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

154 Haloperidol tts 2 mg/ml botol 0 0 0 0 0 0

155 Hepatitis B imunoglobulin (human) inj 110 IU Ampul 0 0 0 0 0 0

156 Hepatitis B imunoglobulin (human) inj 200 IU Ampul 0 0 0 0 0 0

157 Hepatitis B imunoglobulin (human) Inj 220 IU Ampul 0 0 0 0 0 0

158 Hidrogen peroksida cairan 3% Botol 0 0 0 0 0 0

159 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 200 1000 0 1200 0 -1200

160 Hidrokortison krim 1% tube @ 5 g 0 0 0 0 0 0

161 Hidrokortison krim 2,5% tube @ 5 g 34 224 9 150 162 12

162 Hidrokortison serb inj 100 mg Vial 0 0 0 0 0 0

163 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

164 Human tetanus imunoglobulin inj 250 UI Ampul 0 0 0 0 0 0

(i.m.)
165 Human tetanus imunoglobulin inj 500 UI Ampul 0 0 0 0 0 0
(i.m.)
166 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 7 260 13 111 234 123

167 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 0 0 0 0 0

168 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0

169 Ibuprofen tab 400 mg tablet/kapsul/kaplet 28100 0 1100 14900 19800 4900

170 Ipratropium bromida aerosol 20 Botol 0 0 0 0 0 0

mcg/semprot
171 Ipratropium bromida cairan ih 0,025% Botol 0 0 0 0 0 0
172 Isoniazid tab 100 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

173 Isoniazid tab 300 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

174 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 36 400 13 280 234 -46

175 Kalamin Tube 0 0 0 0 0 0

176 Kalium Klorida tab lepas lambat 600 mg tab 0 0 0 0 0 0

177 Kalsium glukonat inj 100 mg/ml ampul/vial 0 0 0 0 0 0

178 Kalsium hidroksida bubuk, pasta Tube 0 0 0 0 0 0

179 Kalsium hipoklorit serb Sachet 0 0 0 0 0 0

180 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0

181 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet 3115 2900 324 2127 5832 3705

182 Kaptopril tab 12,5 mg tablet/kaplet 0 12000 0 12000 0 -12000

183 Kaptopril tab 25 mg tablet/kaplet 6200 104000 1854 87952 33372 -54580

184 Karbamazepin sir 100 mg/5 ml Botol 0 0 0 0 0 0

185 Karbamazepin Tab 200 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

186 Karbogliserin tts telinga 10 % Botol 0 0 0 0 0 0

187 Ketokonazol krim 2% Tube 10 g 14 52 1 54 18 -36

188 Ketokonazol scalp sol 2% botol 0 0 0 0 0 0

189 Ketokonazol tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0

190 Klindamisin kaps 150 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

191 Klindamisin kaps 300 mg tablet/kapsul/kaplet 506 2800 74 2418 1332 -1086

192 Klofazimin, micronized kaps 50 mg Kapsul 0 0 0 0 0 0

193 Klofazimin, micronizedkaps 100 mg kapsul 0 0 0 0 0 0

194 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

195 Kloramfenikol salep mata 1% tube @ 5 gram 0 168 0 168 0 -168

196 Kloramfenikol serb inj 1.000 mg/ml vial/ampul 0 0 0 0 0 0

197 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0 120 0 120 0 -120

198 Kloramfenikol tetes telinga 3% Botol 6 140 5 86 90 4

199 Kloramfenikol tts mata 0,5% botol 0 140 0 140 0 -140

200 Kloramfenikol tts mata 1% Botol 0 0 0 0 0 0

201 Klorfeniramin tab 4 mg (ctm) tablet/kapsul/kaplet 4518 7500 835 1998 15030 13032

202 Klorfenol kamfer mentol (CHKM) Botol 0 2 0 2 0 -2

203 Klorheksidin lar 0,2% Botol 0 0 0 0 0 0

204 Klorheksidin lar 15% Botol 0 0 0 0 0 0

205 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 0 0 0 0 0 0

206 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0 0 0 0 0 0

207 Klorpromazin tab sal 100 mg tablet salut selaput/kaplet salut 0 0 0 0 0 0

208 Klorpromazin tab sal 25 mg Tab sal 0 0 0 0 0 0

209 Kodein tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

210 Kodein tab 15 mg tablet/kapsul/kaplet 0 0 0 0 0 0

211 Kodein tab 20 mg tablet/kapsul/kaplet 0 0 0 0 0 0

212 Kolkisin tab 500 mcg Tablet/kapsul/kaplet 0 0 0 0 0 0

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

Paraklorphenol 30
214 Kombinasi (DHP) : dihidroartemisin 20 mg + tablet dispersible 0 0 0 0 0 0
Piperakuin 160 mg tab dispersible
215 Kombinasi : artemether 20 mg + lumefantrin tablet/kapsul/kaplet 0 0 0 0 0 0
120 mg
216 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 0 0 0 0 0

217 Kombinasi : levonorgestrel 150 mcg + tab salut gula 0 0 0 0 0 0

etinilestradiol 30 mcg
218 Kombinasi : triamsinolon asetonoid + dimetil- Pasta tube 0 48 4 0 72 72
klortetrasiklin pasta
219 Kombinasi ekstrak Herba seledri (Apii graveolentis Kapsul 0 0 0 0 0 0
herba) dan ekstrak Daun kumis kucing
220 (Orthosiphonis
Kombinasi ekstrak staminei folium)
Ikan gabus (Ophiocephali Sachet 0 0 0 0 0 0
striati), ekstrak Buah jeruk (Citri sinensidis fructus),
221 Kombinasi: Ipratropium bromida 0,5 mglongae
dan ekstrak Rimpang kunyit (Curcumae + Ampul/vial 0 0 0 0 0 0
rhizoma)
Salbutamol 2,5 mg, cairan ih
222 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 0 0 0 0 0

223 Kombinasi: lidokain + medisinal creosote phenol + Botol 0 0 0 0 0 0

eugenol + benzil alkohol, cairan
224 Komposit resin Set 0 0 0 0 0 0

225 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 6120 0 31 5748 558 -5190

sulfametoksazol 400 mg+ trimetoprim 80 mg
226 Kotrimoksazol (dewasa) kombinasi : tab/kaptab 0 0 0 0 0 0
sulfametoksazol 800 mg+ trimetoprim 160
227 Kotrimoksazol kombinasi tiap 5 ml suspensi : botol 60 mL 800 0 0 800 0 -800
sulfametoksazol 200 mg + trimetoprim 40
228 Kuinin tab 200 mg tablet/kapsul/kaplet 0 0 0 0 0 0

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

230 Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik @500 ml 0 0 0 0 0 0
gr, KCl 0,15 gr, NaCl 4,3 gr)
231 Larutan mengandung Elektrolit (Kalium Botol 0 0 0 0 0 0
Klorida)
232 Larutan mengandung Elektrolit (KCl 0,15%, Botol 0 0 0 0 0 0
NaCL 0,9%) (KN1)
233 Larutan mengandung Elektrolit (KCl Botol 0 0 0 0 0 0
0,3%,NaCl 0,9%) (KN2)
234 Larutan mengandung Elektrolit (Na 130 mEq, Softbag @ 500 ml 0 0 0 0 0 0
K 4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
235 Ringer
LarutanAsetat
mengandung Elektrolit (Na 130 mEq, Botol plastik @ 500 ml 0 60 4 12 72 60
K 4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
Ringer Asetat
236 Larutan mengandung Elektrolit (Sodium Lactate sol Botol 0 0 0 0 0 0
(50%) 113 gr/L, Potassium Chloride 0.3 gr/L,
237 Calcium Chloride 0.2 gr/L,
Larutan mengandung Elektrolit (Tiap 1000 ml Botol 0 0 0 0 0 0
mengandung electrolit: Sodium 145 mmol/l,
Potassium 4.0 mmol/l, Calcium 2.5(Fructose
238 Larutan mengandung Karbohidrat mmol/l, 120 g, Botol 0 0 0 0 0 0
Magnesium
glucose 66 g,1.0 mmol/l,
Xylitol 60 g/Chloride
L) 118 mmol/l,
239 Larutan mengandung Karbohidrat (Fructose 15 mg, softbag 0 0 0 0 0 0
glucose monohydrate 30 mg, xylitol
240 Larutan mengandung Karbohidrat (Fructose 200 g, Botol 0 0 0 0 0 0
glucose 110 g, Xylitol 100 g/ L)
241 Larutan mengandung Karbohidrat (Fructose 60 g, Botol 0 0 0 0 0 0
glucose 33 g, Xylitol 30 g/ L)
242 Larutan mengandung Karbohidrat (Maltose Botol 0 0 0 0 0 0
10%)
243 Larutan mengandung Karbohidrat + Elektrolit Botol plastik @500 ml 0 0 0 0 0 0
(25.00g dextrose anhidrat, 3.00 g sodium chloride,
0.15 g potassium
244 Larutan mengandung chloride,
Karbohidrat + Elektrolit Botol plastik @500 ml 0 0 0 0 0 0
(25.00g maltose, 3.00 g sodium chloride, 0.15 g
potassium
245 Larutan chloride, 0.10
mengandung g calcium+chloride
Karbohidrat Elektrolit Botol 0 0 0 0 0 0
dihydrate danK,1.55
(Acetate, Na, g Mg, Sorbitol
Cl, Ca,
246 Larutan mengandung Karbohidrat + Botol 0 0 0 0 0 0
Elektrolit (Dextrose 5%, NaCL 0,45%, KCl) (HSD)
247 Larutan mengandung Karbohidrat + Botol 0 0 0 0 0 0
Elektrolit (Fructose 120 g, glucose 66 g, Xylitol 60
248 g/ L + elektrolit)
Larutan mengandung Karbohidrat + Elektrolit Botol 0 0 0 0 0 0
(Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat
3,1 g, air untuk injeksi Karbohidrat
249 Larutan mengandung ad + Elektrolit Botol 0 0 0 0 0 0
(Glukosa 55 g ; Natrium Chloride 9 g, air untuk
injeksi ad 1000 ml) (D5-NS)
250 Larutan mengandung Karbohidrat + Elektrolit botol/softbag 0 0 0 0 0 0
(Glukosa: 110.0 g; NaCl: 1.80 g)
251 Larutan mengandung Karbohidrat + Botol 0 0 0 0 0 0
Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 g)
252 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 100 mL 0 0 0 0 0 0
(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-
253 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 500 mL 0 10 0 10 0 -10
(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-
254 Larutan mengandung Karbohidrat + Elektrolit Botol 0 10 0 10 0 -10
(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-
255 Larutan mengandung Karbohidrat + Elektrolit Botol 0 0 0 0 0 0
(Larutan nutrisi kombinasi infus per L: Na. 100mEQ,
K 18mEQ,
256 Larutan Ca. 4mEQ, Mg
mengandung Karbohidrat + Elektrolit Botol 0 0 0 0 0 0
(Larutan Ringer & Glukosa 5%)
257 Larutan mengandung Karbohidrat + Elektrolit (NaCl Botol 0 0 0 0 0 0
1.125 gr, Dekstrosa 18.75 gr)
258 Larutan mengandung Karbohidrat + Elektrolit (NaCl Botol 0 0 0 0 0 0
1.75 g, KCL 1.5g, Glukosa 100
259 Larutan mengandung Karbohidrat + Elektrolit (NaCl Botol 0 0 0 0 0 0
1.75 g, KCL 1.5g, Na Lactate
260 Larutan mengandung Karbohidrat + Elektrolit (Nacl Botol 33 60 3 57 54 -3
1.75 gr, KCl 1.5 gr, Na Lactat
261 Larutan mengandung Karbohidrat + Elektrolit Botol 0 0 0 0 0 0
(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL
262 Levonorgestrel implan 2 rods, 75 mg (3-4 pack/ sachet/ set 0 0 0 0 0 0
tahun)
263 Lidokain gel 2% syringe/syringe plastik 0 0 0 0 0 0

264 Lidokain inj 2% (infiltr/p.v.) ampul/vial 69 170 27 -85 486 571

265 Lidokain salep 5% Tube 0 0 0 0 0 0

266 Lidokain spray topikal 10% botol 0 0 0 0 0 0

267 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

268 Liquor carbonis detergens lar 5% Botol 0 0 0 0 0 0

269 Lisinopril tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

270 Lisinopril tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

271 Loratadin tab 10 mg tablet/kapsul/kaplet 8 6000 56 5336 1008 -4328

272 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

273 Lorazepam tab 1 mg tablet/kapsul/kaplet 0 0 0 0 0 0

274 Lorazepam tab sal 2 mg Tab sal 0 0 0 0 0 0

275 Magnesium sulfat inj 20% ampul/vial 0 0 0 0 0 0

276 Magnesium sulfat inj 20% ampul/vial @25 ml 0 30 1 18 18 0

277 Magnesium sulfat inj 40% ampul/vial 0 0 0 0 0 0

278 Magnesium sulfat inj 40% ampul/vial @25 ml 0 30 1 18 18 0

279 Magnesium sulfat serb, ktg 30 g Sachet 0 0 0 0 0 0

280 Manitol lar infus 20% Botol @ 500 ml 0 0 0 0 0 0

281 Manitol lar infus 20% Botol @ 100 ml 0 0 0 0 0 0

282 Manitol lar infus 20% Botol @ 250 ml 0 0 0 0 0 0

283 Mebendazol sir 100 mg/5 ml Botol 0 0 0 0 0 0

284 Mebendazol tab 100 mg Tablet/kapsul/kaplet 0 0 0 0 0 0

285 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0

286 Medroksi progesteron asetat inj 150 mg/ml ampul/vial 0 0 0 0 0 0

287 Metadon sir 50 mg/5 ml Botol 1000 ml 0 0 0 0 0 0

288 Metenamin mandelat (heksamin mandelat) Tab salut 0 0 0 0 0 0
tab salut enterik 500 mg
289 Metformin tab 500 mg tablet/kapsul/kaplet 7800 76200 670 75960 12060 -63900

290 Metformin tab 850 mg tablet/kapsul/kaplet 0 0 0 0 0 0

291 Metildopa tab 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

292 Metilergometrin inj 0,2 mg/ml ampul/vial 0 0 0 0 0 0

293 Metilergometrin tab salut 0,125 mg tablet/kaplet salut selaput 223 300 6 451 108 -343

294 Metilprednisolon inj 125 mg ampul/vial 0 0 0 0 0 0

295 Metoklopramid inj 5 mg/ml ampul/vial 0 0 0 0 0 0

296 Metoklopramid tab 10 mg tablet/kapsul/kaplet 246 3300 5 3486 90 -3396

297 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0 0 0 0 0 0

298 Metronidazol susp 125 mg/5 ml Botol @ 60 ml 0 0 0 0 0 0

299 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0 0 0 0 0 0

300 Metronidazol tab 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

301 Metronidazol tab 500 mg tablet/kapsul/kaplet 1005 1400 51 1793 918 -875

302 Mikonazol krim 2% tube 64 32 8 0 144 144

303 Mikonazol serb 2% botol / sachet 0 0 0 0 0 0

304 Mometason furoat krim 0,1% Tube 5 gram 0 0 0 0 0 0

305 Mometason furoat krim 0,1% tube 10 gram 0 0 0 0 0 0

306 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 16453 0 389 11785 7002 -4783

307 N-asetil Sistein sir 100 mg/5ml botol 0 0 0 0 0 0

308 NaCl 0,9% Larutan Botol @1.000 mL 0 0 0 0 0 0

309 NaCl 0,9% Larutan Botol @500 ml 403 200 50 3 900 897

310 NaCl 0,9% Larutan Botol @250 ml 0 0 0 0 0 0

311 NaCl 0,9% Larutan Botol @25 ml 0 0 0 0 0 0

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

313 NaCl 0,9% Larutan Botol @100 ml 0 0 0 0 0 0

314 NaCl 3% Larutan Botol plastik @500 ml 0 0 0 0 0 0

315 Natrium bikarbonat tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0

316 Natrium diklofenak tab 25 mg tablet salut enterik/kaplet salut 0 0 0 0 0 0

317 Natrium diklofenak tab 50 mg tablet salut enterik/kaplet salut 23215 0 1205 8755 21690 12935

318 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 0 0 0 0 0

319 Natrium fluoresein tetes mata 2% Botol 0 0 0 0 0 0

320 Natrium hipoklorit cairan konsentrat 5% Botol 0 0 0 0 0 0

321 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0 0 0 0 0

322 Nistatin susp 100.000 UI/ml botol/vial 0 0 0 0 0 0

323 Nistatin tab salut 500.000 UI tablet salut gula/kaplet salut gu 0 0 0 0 0 0

324 Nistatin tab vaginal 100.000 UI tablet/kaplet 119 400 82 -465 1476 1941

325 Oksigen ih, gas dlm tabung Botol 0 0 0 0 0 0

326 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0 0 0 0 0 0

327 Oksimetazolin tts hidung 0,050% botol @ 10 mL 0 0 0 0 0 0

328 Oksitetrasiklin 1% Salep Mata tube 140 0 0 140 0 -140

329 Oksitosin inj 10 UI/ml ampul/vial 0 0 0 0 0 0

330 Olopatadin tts mata 0,1% Botol 0 0 0 0 0 0

331 Omeprazol inj 40 mg ampul/vial 119 0 14 -49 252 301

332 Omeprazol kaps 20 mg tablet/kapsul/kaplet 1211 10500 182 9527 3276 -6251

333 Parasetamol sir 120 mg/5 ml botol @ 60 mL 1068 0 17 864 306 -558

334 Parasetamol tab 500 mg tablet/kapsul/kaplet 55170 0 4749 -1818 85482 87300

335 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 200 0 200 0 -200

336 Pasta devitalisasi (non arsen) Tube 0 0 0 0 0 0

337 Pasta pengisi saluran akar (pasta) Tube 0 0 0 0 0 0

338 Perak sulfadiazin krim 1% Tube 0 12 0 12 0 -12

339 Permetrin krim 5 % Tube 10 g 0 0 0 0 0 0

340 Permetrin krim 5 % Tube 30 g 454 0 9 346 162 -184

341 Permetrin krim 5 % Tube 15 g 0 0 0 0 0 0

342 Pilokarpin tetes mata 2% Catchcover, botol 0,6 ml 0 0 0 0 0 0

343 Pilokarpin tetes mata 2% Botol 5 ml 0 0 0 0 0 0

344 Pirantel pamoat susp 125 mg/5 ml Botol 0 0 0 0 0 0

345 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet 0 0 0 0 0 0

346 Pirantel pamoat tab scored 250 mg Tab 0 0 0 0 0 0

347 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 0 6000 30 5640 540 -5100

348 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet 0 0 0 0 0 0

349 Povidon iodin lar 100 mg/ml botol 30 mL 0 0 0 0 0 0

350 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0 0 0 0 0

351 Povidon iodin lar 100 mg/ml Botol 300 ml 0 100 0 100 0 -100

352 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0 0 0 0 0

353 Povidon iodin lar obat kumur 1% Botol 66 50 2 92 36 -56

354 Povidon iodin tts mata 2,5% botol/strip 0 0 0 0 0 0

355 Prazikuantel tab scored 600 mg Tab 0 0 0 0 0 0

356 Prednison tab 5 mg tablet/kapsul/kaplet 0 500 0 500 0 -500

357 Probenesid tab 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0

358 Prokain benzilpenisilin serb inj 3 juta UI/vial ampul/vial 0 0 0 0 0 0

(i.m.)
359 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0 0 0 0 0

360 Ranitidin tab 150 mg tablet/kapsul/kaplet 60196 0 290 56716 5220 -51496

361 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0 0 0 0 0 0

362 Ringer Laktat Larutan Botol 493 200 0 693 0 -693

363 Risperidon tab sal 2 mg tablet/kapsul/kaplet 0 0 0 0 0 0

364 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0 0 0 0 0 0

365 Salbutamol tab 2 mg tablet/kapsul/kaplet 822 2200 201 610 3618 3008

366 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram 24 24 0 48 0 -48

belerang endap 4 %
367 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 15 gram 0 0 0 0 0 0
belerang endap 4 %
368 Sefadroksil drops 150 mg/ml botol 0 0 0 0 0 0

369 Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

370 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 4285 0 134 2677 2412 -265

371 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL 0 120 0 120 0 -120

372 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL 0 0 0 0 0 0

373 Serum anti bisa ular : A.B.U. I (khusus ular Vial 0 3 0 3 0 -3

dari luar Papua) inj (i.m./i.v.)
374 Serum anti bisa ular :A.B.U.II (khusus ular Vial 0 0 0 0 0 0
dari Papua) inj (i.m./i.v.)
375 Serum antirabies inj 100 UI/ml Vial 0 0 0 0 0 0

376 Serum antirabies inj 200 UI/ml Vial 0 0 0 0 0 0

377 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 Vial 0 0 0 0 0 0

UI/vial (i.m /i.v.)
378 Serum antitetanus (A.T.S) inj 1500 UI/amp Ampul 0 0 0 0 0 0
(i.m.)
379 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial 0 0 0 0 0 0
(i.m /i.v.)
380 Serum antitetanus (A.T.S) inj 5.000 IU/mL Ampul/vial 0 0 0 0 0 0
(i.m)
381 Setirizin sir 5 mg/5 ml. botol @ 60 mL 195 0 6 123 108 -15

382 Setirizin tab 10 mg tablet/kapsul/kaplet 27859 0 940 16579 16920 341

383 Sianokobalamin (vitamin B12) inj 500 ampul/vial 0 0 0 0 0 0

mcg/ml
384 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet 2176 9800 511 5844 9198 3354

385 Simvastatin tab sal 10 mg tablet/kapsul/kaplet/tablet salu 3044 16000 263 15888 4734 -11154

386 Simvastatin tab sal 20 mg tablet/kapsul/kaplet/tablet salu 0 0 0 0 0 0

387 Simvastatin tab sal selaput 40 mg Tab salut selaput 0 0 0 0 0 0

388 Siprofloksasin tab scored 500 mg tablet salut selaput/kaplet salut 10317 0 138 8661 2484 -6177

389 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0 0 0 0 0

390 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 0 0 0 0 0

391 Surgical ginggival pack Tube 0 0 0 0 0 0

392 Terbutalin cairan ih 2,5 mg/ml Botol 0 0 0 0 0 0

393 Terbutalin inj 0,5 mg/ml ampul/vial 0 0 0 0 0 0

394 Tetanus toxoid inj Ampul 0 0 0 0 0 0

395 Tetrakain tts mata 0,5% Botol 0 0 0 0 0 0

396 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0 0 0 0 0

397 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0 0 0 0 0 0

398 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 1754 10000 180 9594 3240 -6354

399 Timolol tts mata 0,25% botol @ 5 mL 0 0 0 0 0 0

400 Timolol tts mata 0,5% botol @ 5 mL 0 0 0 0 0 0

401 Tropikamid tts mata 0,5% Botol @ 5 ml 0 0 0 0 0 0

402 Tropikamid tts mata 0,5% Catchcover, botol 0,6 ml 0 0 0 0 0 0

403 Tropikamid tts mata 1% Botol @ 5 ml 0 0 0 0 0 0

404 Tropikamid tts mata 1% Botol @ 0,6 ml 0 0 0 0 0 0

405 Urea krim 10 % Tube/pot 0 0 0 0 0 0

406 Urea krim 20 % Tube/pot 0 0 0 0 0 0

407 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0 0 0 0 0 0

408 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 0 0 0 0 0

409 Valproat sir 250 mg/5 ml botol @ 120 ml 0 0 0 0 0 0

410 Valproat tab lepas lambat 250 mg tabet lepas lambat/kaplet lepas 0 0 0 0 0 0

411 Valproat tab lepas lambat 500 mg tabet lepas lambat/kaplet lepas 0 0 0 0 0 0

412 Valproat tab sal enterik 250 mg tablet salut enterik/ kaplet salut 0 0 0 0 0 0

413 Vitamin B kompleks tablet 47340 0 1320 31500 23760 -7740

414 Zinc drops 10 mg/ml Botol 0 0 0 0 0 0

415 Zinc sir 20 mg/5 ml botol 0 0 0 0 0 0

416 Zinc tab disp 20 mg tablet dispersible 2000 7000 307 5316 5526 210

Mengetahui,
Kepala UPT Puskesmas Kromengan

drg.Dewi Aminah Yuni Rosafiana

NIP. 19720607 200501 2 008
RENCANA RENCANA REALISASI KETERANGAN
PENGADAAN PENGADAAN PENGADAAN
(g) (h) (i) (j)

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Penanggung Jawab Farmasi

Angga Budi Prasetyo, S.Farm.,Apt

NIP. 199003282020121006