DBMB Eceran Juli 2023

DINAS KESEHATAN KABUPATEN MAPPI
INSTALASI FARMASI KABUPATEN MAPPI
DOKUMEN BUKTI MUTASI BARANG(DBMB)
A Atas Permintaan IF Kabupaten : Mappi

B Atas Perintah Alamat : Jln. Kalimantan Kepi
Diberikan Kepada : Puskesmas Amazu
Alamat : Distrik Kaibar
x) Coret Yang Tidak Perlu Berdasarkan : Pemintaan LPLPO bulan Juni
Tanggal DBMB : 0 Mei 2023
Pengiriman Koli :
SATUAN /
NO NAMA OBAT / BMHP JUMLAH SUMBER / TAHUN NO BATCH ED
KEMASAN
A OBAT - OBATAN
1 Air untuk injeksi 25 ml Ampul DAU 2023 E-KAT 3G1G2J057 10/24
2 Alopurinol tablet 100 mg tablet DAU 2023 NON E-KAT HTAL0C21029 01/24
3 Ambroksol tablet 30 mg tablet DAK 2022 NON E-KAT 2206-06-146 06/24
4 Amitriptilin tab 25 mg tablet DAK 2022 E-KAT 22AT1001 04/26
5 Aminofilin 200 mg tablet DAK 2022 E-KAT 22CH001 08/24
6 Amlodipin tablet 10 mg tablet DAK 2019 E-KAT F81260B 06/23
6 Amlodipin tablet 10 mg tablet DAK 2021 E-KAT JE0151 11/23
7 Amlodipin tablet 10 mg tablet DAK 2022 NON E-KAT 2205-02-327 05/24
8 Amlodipin tablet 5 mg tablet DAK 2020 E-KAT A00003RS 12/24
9 Amoksisilin kaplet 250 mg kaplet DAK 2022 NON E-KAT 2206-01-51 06/25
4 Amoksisilin kaplet 500 mg kaplet DAK REG 2022 E-KAT TANXB22985 01/24
11 Amoksisilin sirup kering 125 mg/5ml btl 60 ml DAK 2021 E KAT B10080 08/24
12 Amoksisilin sirup kering 125 mg/5ml btl 60 ml DAK 2022 E KAT B10260 12/24
13 Ampicilin serbuk injeksi 1000 mg/ml ktk 10 DAK 2022 NON E-KAT PSG31351 06/24
14 Ampicilin serbuk injeksi 1000 mg/ml ktk 10 DAK 2021 NON E-KAT 46,436,034 5/25
7 Ampicilin serbuk injeksi 1000 mg/ml ktk 10 DAK 2020 E-KAT 36436033 09/24
15 Antalgin tab 500 mg tablet DAK 2022 NON E-KAT 2206-05-142 06/25
16 Antalgin/Metamizol inj 1000 mg/2ml Ampul DAK 2022 E-KAT F1M659 12/25
19 Antasida Doen I Tablet Kunyah tablet DAK 2022 E-KAT A12361 12/24
20 Antasida Doen II suspensi btl 60 ml DAK 2022 E-KAT C19228 03/25
21 Antasida Doen II suspensi btl 60 ml DAK 2021 E-CAT J19103 10/24
Anti Bakteri DOEN salep kombinasi:
22 Basitrasin 500 IU/g + Polimiksin 10.000 tube DAU 2023 E-KAT 22BA1004 12/26
IU/g
AntiFungi Doen Salep whitfield, Kombinasi:

17 pot 30 g DAK 2020 E-KAT 18SF052B
asam salisilat 3% + asam benzoat 6%
23 Antihemoroid, Kombinasi supp DAK 2022 E-KAT B2032OW 02/24

23 Antihemoroid, Kombinasi supp DAU 2023 E-KAT C31006W 03/25
25 Asam Askorbat ( Vit C ) tab 500 mg tablet DAK 2022 E-KAT T12058BA 12/23
26 Asam Askorbat ( Vit C ) tab 500 mg tablet DAU 2023 E-KAT C23031 03/25
27 Asam Askorbat (Vit C) tab 250 mg tablet DAK 2022 E-KAT 29,803,202 02/24
28 Asam Askorbat (Vit C) tab 50 mg tablet DAK 2021 E KAT H00394BJ 8/23
29 Asam Askorbat (Vit C) tab 50 mg tablet DAK 2022 E-KAT 21,316,111 11/23
30 Asam Folat 400 µl tablet DAK 2021 E-KAT 2106-02-365 07/23
31 Asam Folat 400 µl tablet DAK 2022 E-KAT 2203-03-305 03/25
32 Asam Mefenamat tab 500 mg tablet DAK 2022 E-KAT ATMECA21139 01/24
33 Asam traneksamat 500 mg Tablet DAU 2023 E-KAT KTTACA31010 02/25
34 Asam traneksamat injeksi Ampul DAK 2022 E KAT 4,120,070 01/25
35 Asam traneksamat tab tablet DAK 2022 NON E KAT 1.24KJ001 01/24
36 Asiklovir tablet 200 mg tablet DAK 2021 NON E-KAT 46,303,002 6/23
37 Asiklovir tablet 200 mg tablet DAK 2020 E.KAT D8111OJ 4/23
38 Asiklovir tablet 400 mg tablet DAK 2022 NON E KAT 46,304,046 11/23
39 Atropine inj 0,25 mg/ml vial DAK 2022 E KAT 9621H0204A 08/24
40 Bedak Salisil serbuk 2% ktk 50 gram DAK 2022 NON E-KAT H210835 06/27
42 Benzatin Benzil penisillin 1,2 jt inj vial DAK 2022 E-KAT 5632003 08/24
44 Benzatin Benzil penisillin 2,4 jt inj vial DAK 2022 E-KAT 56319003 08/24
45 Betahistin 6 mg tablet RELOKASI 52J0569 1023
46 Betametason krim 0,1% tube 5 g DAU 2023 E-KAT C3094W 03/25
47 BIOSAT 1,5 Serum Anti Tetanus (ATS) inj ampul DAK 2022 E-KAT 12/23
1500 IU 4,202,121
48 Bufacetin (Kloramfenicol salep kulit 2%) tube 15 g

49 Cefixime 200 mg kapsul DAU 2023 E-KAT TCETA20407 12/24
50 Cetirizine 10 mg tablet DAU 2023 E-KAT 2303-12-332 03/25
51 Clindamicin 300 mg Kapsul DAK 2022 E-KAT A20261 02/25
52 Codein 10 mg tablet DAK 2022 E-CAT C20652J 03/26
53 Deksametason Injeksi 5 mg/ml ampul DAK 2022 E-KAT 56,337,043 03/25
54 Deksametason tab 0,5 mg tablet DAK 2022 E-KAT 26013112 12/25
54 Deksametason tab 0,5 mg tablet DAU 2023 E-KAT 2304-02-150 04/25
55 Dextrose 40% Ampul RELOKASI B91C52A 03/24
56 Diazepam injeksi 5 mg/ml - 2 ml amp DAK 2022 E-CAT F2H22900 08/24
56 Diazepam injeksi 5 mg/ml - 2 ml amp DAU 2023 E-KAT F2K372 10/24
57 Diazepam tablet 2 mg tablet DAK 2022 E KAT A3125DY 04/25
58 Difenhidramin HCl inj 10 mg/ml (HCl) ampul DAK 2022 E-KAT 56342016-2 06/24
59 Difenhidramin HCl inj 10 mg/ml (HCl) Ampul DAU 2023 E-KAT 66342001 02/26
60 Digoksin tablet DAK 2022 NON E-KAT A08610EZ 05/24
61 Doksisiklin kapsul 100 mg kapsul
62 Domperidon tablet 10 mg tablet DAK 2022 E-KAT HTD8DB16099 11/23
63 Domperidone sirup/suspensi 5 mg/5 ml btl DAK 2022 E-KAT A19227 01/25
64 Dopamet Metildopa tablet 250 mg tablet DAK 2022 NON E-KAT B23441008 05/25
65 Epinefrin (Adrenalin) injeksi 1 mg/ml ampul DAK 2022 E KAT 9621I0268A 09/23
(0,1%)
66 Eritromisin kaplet 500 mg ktk 100 DAK 2022 NON E-KAT T01055BB 01/25
67 Eritromisin sirup 200 mg/5 ml btl 60 ml DAK 2022 E-KAT 7,110,001 11/24
68 Eritromisin sirup 200 mg/5 ml btl 60 ml DAK 2021 NON E.KAT D11002J 4/26
69 Fenitoin sodium kapsul 100 mg tablet DAK 2022 E-KAT A21335 07/25
70 Fenobarbital tablet 30 mg tablet DAK 2021 E-KAT D10336BJ 03/26
70 Fenobarbital tablet 30 mg tablet RELOKASI 2022 D30321N 02/25
71 Fitomenadion (Vit K) 10 mg tablet DAK 2022 E-KAT 56,381,004 06/24
72 Fitomenadion (Vit K) injeksi i.m 2 mg/ml ampul DAK 2022 E-KAT 1,120,922,001 09/24
72 Fitomenadion (Vit K) injeksi i.m 2 mg/ml ampul DAU 2023 E-KAT TPHNA20023 11/24
73 Fitomenadion (Vit K1) injeksi i.m 10 mg/ml ampul

74 Fluconazole kap 150 mg kapsul DAU 2023 E-KAT B30294 02/25
75 Furosemid injeksi 10 mg/ml amp
76 Furosemid tablet 40 mg tablet DAK 2021 E-KAT 20FU2014 10/25
77 Garam Oralit 200 ml sachet DAK 2022 E-KAT 56,373,014 01/26
77 Garam Oralit 200 ml sachet DAU 2023 E-KAT 56,373,198 11/24
78 Gentamisin sulfate SK 0.1 % Tube DAU 2023 E-KAT J23549W 10/24
79 Gentamisin sulfate SM 3,5 Gram Tube 3,5 g
80 Gentamisin sulfate TM 0,3% btl 5 ml
81 Gentien Violet botol
82 Glibenklamid tablet 5 mg tablet DAK 2020 E. KAT 19,001,003 01/24
83 Glibenklamid tablet 5 mg tablet DAK REG E-CAT 2019 1,809,065 10/23
84 Glimeperid 1 mg tablet
85 Gliseril Guayakolat tablet 100 mg tablet
86 Glukosa larutan infus 10% btl 500 ml
87 Glukosa larutan infus 5% btl 500 ml RELOKASI A95A51A 01/24
88 Glukosa larutan infus 5% btl 500 ml
89 Griseofulvin tab 125 mg tablet DAK 2022 E-KAT I11495BJ 08/24
89 Griseofulvin tab 125 mg tablet DAU 2023 E-KAT 2304-01-176 04/25
90 Guafenesin OGB 100 mg tablet DAK 2022 NON E-KAT 2206-02-155 06/25
90 Guafenesin OGB 100 mg tablet DAU 2023 E-KAT 2303-04-55 03/25
91 Haloperidol inj Ampul
92 Haloperidol tab 5 mg tablet BUFFER PROVINSI A21518 08/25
93 Hidroklortiazid 25 mg tablet DAK 2022 E-KAT H11166BJ 07/26
93 Hidroklortiazid 25 mg tablet DAU 2023 E-KAT C30387N 03/25
94 Hidrokortison krim 2,5% tube DAK 2022 E-KAT F21195W 06/24
94 Hidrokortison krim 2,5% tube DAU 2023 E-KAT
95 Hyoscine Butybromide tablet DAK 2022 E-KAT T11204BA 11/24
96 Hyoscine Butybromide 20 mg Inj Ampul DAK 2022 E-KAT 9622A0005A 01/25
97 Ibuprofen tablet 200 mg tablet DAK 2022 E-KAT 2204-09-177 04/24
97 Ibuprofen tablet 200 mg tablet DAU 2023 E-KAT 2304-02-177 04/26
98 Ibuprofen tablet 400 mg tablet DAK 2022 E-KAT 2204-39-134 04/26
99 Ichtyol salep pot DAK 2022 NON E-KAT 22,111,010 07/27
100 INH 100 mg Tab Ktk 100 DAK 2022 NON E-KAT G10937BJ 06/23
101 Isosorbid Dinitrat tab 5 mg tablet
102 KAEN 3A sol btl 500 ml DAK 2021 E-KAT 50D74A 04/23
103 KAEN 3A sol btl 500 ml DAK 2022 E-KAT A74C52A 02/24
104 Kalsium Glukonat inj iv 10%(100mg/ml) vial DAK 2022 E-KAT 53I3003 08/25
104 Kalsium Glukonat inj iv 10%(100mg/ml) vial DAU 2023 E-KAT 53J3011 09/25
105 Kalsium Laktat (Kalk) tab 500 mg tablet DAK REG E-CAT 2021 A01205 6/23
106 Kalsium Laktat (Kalk) tab 500 mg tablet DAK 2022 E-KAT A12238 11/24
107 Kaptopril 25 mg ktk 100 DAK 2020 NON E-KAT L92880B 11/24
108 Kaptopril 25 mg tablet DAK 2021 NON E-KAT 51K0270 10/24
109 Kaptopril 25 mg tablet DAK 2022 E-KAT 56,324,035 03/24
110 Kaptopril 50 mg tablet LEBIH 51H0058 08/24
110 Kaptopril 50 mg tablet DAK 2020 NON E KAT 50K0169 11/23
110 Kaptopril 50 mg tablet DAK 2021 NON E KAT 51K0270 10/24
110 Kaptopril 50 mg tablet DAK 2022 NON E KAT 52L0620 11/25
111 Ketoprofen Supp Supp DAU 2023 E-KAT C31242W 03/26
111 Ketokonazol 2% Cream tube
31 Ketokonazol tablet 200 mg tablet DAU 2023 E-KAT 2303-11-103 03/26
113 Ketorolac inj ampul
114 klopidogrel 75 mg tablet
115 Kloramfenicol salep mata 1% tube 5 g RELOKASI 00454138 08/23
116 Kloramfenicol Tetes telinga 3% btl DAK 2022 NON E KAT D0656171 08/24
117 Kloramfenikol 250 mg tablet DAK 2022 NON E-KAT 2206-01-251 06/24
117 Kloramfenikol 500 mg tablet DAU 2023 E-KAT B23881013 07/25
118 Klorfeniramin Maleat (CTM) tab 4 mg tablet DAK 2022 NON E-KAT 2206-07-152 06/24
118 Klorfeniramin Maleat (CTM) tab 4 mg tablet DAU 2023 E-KAT 2304-14-152 04/26
119 Klorpromazin tablet 100 mg tablet
120 Kombinasi: Ergotamin 1 mg + Kafein 50 mg tablet DAK REG 2020 E KAT J00585B 09/23
121 Kombinasi: Ergotamin 1 mg + Kafein 50 mg tablet DAK 2022 E KAT J00586B 09/23
122 Kotrimoksazol 240 mg/5ml sirup btl 60 ml DAK 2022 E-KAT A12208 11/24
123 Kotrimoksazol tablet 480 mg tablet DAK 2021 E-KAT A11325 08/24
123 Kotrimoksazol tablet 480 mg tablet DAK 2022 E-KAT A11515 09/24
124 Kuinin tablet 200 mg (222 mg sebagai tablet
garam)
125 Lidokain injeksi 2% (HCl) amp DAU 2023 NON E-KAT 56362082-2 11/26
125 Lidokain injeksi 2% (HCl) amp DAU 2023 E-KAT 0230333 02/25
126 Lidokain Komp,Injeksi,Kombinasi : Ampul DAU 2023 E-KAT 66815003 02/25
127 Lidokain Komp,Injeksi,Kombinasi : ampul DAK 2022 E-KAT 56815011-2 07/26
128 Lodomer Haloperidol tab 2 mg tablet DAK 2022 E-KAT A22434 11/24
129 Loperamide tablet 2 mg tablet DAU 2023 E-KAT
130 Loperamide tablet 2 mg tablet DAK 2021 E-KAT 10,329 09/25
131 Loratadine tab 10 mg tablet DAK 2019 E-CAT A90288 08/23
131 Loratadine tab 10 mg tablet DAU 2023 E-KAT 2304-02-331 04/25
132 Magnesium sulfat injeksi (20%-25ml) vial DAK 2022 E-KAT B7IF51B 06/23
133 Magnesium sulfat injeksi (40%-25ml) vial DAK 2022 E-KAT B73H51B 08/23
Medroksiprogesteron asetat injeksi 150
134 vial
mg/3ml
135 Metformin HCl tablet 500 mg tablet DAK 2022 E-KAT 40,882 03/24
136 Metilergometrin Maleat 0,125 mg tab tablet DAK 2022 E-KAT A20105J 01/27
137 Metilergometrin Maleat injeksi 0.2 mg/ml ampul DAK 2022 E-KAT 5,212,427 11/23
138 Metilprednisolon tablet 4 mg tablet DAK 2022 E-KAT HTMPSD16282 11/23
139 Metilprednisolon tablet 8 mg tablet DAK 2022 E-KAT 2201-02-172 01/24
138 Metilprednisolon tablet 4 mg tablet DAU 2023 E-KAT 2303-02-171 03/25
139 Metilprednisolon tablet 8 mg tablet DAU 2023 E-KAT 2301-03-172 01/25
140 Metoclopramide inj 5 mg Ampul DAK 2022 E-KAT 1,120,111 11/24
141 Metoclopramide tab 5 mg tablet DAK 2022 E-KAT J11245BJ 09/25
142 Metronidazol suspensi botol DAK 2022 NON E-KAT 2207-01-99 07/24
143 Metronidazol tablet 500 mg tablet DAK 2022 NON E-KAT 2106-02-129 06/24
144 Metronidazole tablet 250 mg tablet
145 Meviton multivitamin tablet DAK 2022 NON E-KAT A1J342A 09/25
146 Miconazol krim/salep 2% tube 10 g DAU 2023 E-KAT 32,344,610 10/25
147 Miniaspi 80 mg tablet DAK 2022 E-KAT A21031 06/24
148 N-Asetil sistein 200 mg tablet DAK 2022 E-KAT 22AS1037 04/24
149 Natrium Klorida larutan infus 0,9% btl 500 ml DAK 2022 E-KAT 420,203 01/27
150 Neo Diagon Antapulgit 650 mg tablet DAK REG E-CAT 2019 9D073105 4/24
151 Nifedipin tablet 10 mg tablet DAK 2021 NON E-KAT 51K4213 10/24
152 Nifedipin tablet 10 mg tablet DAK 2019 NON E-Cat FG1470B 08/23
153 Nistatin drops 100.000 IU/g botol DAK 2022 E-KAT 56,372,002 02/25
154 Nistatin tablet salut 500.000 IU/g tablet DAK 2022 E-KAT 56,371,001 01/25
155 Nistatin tablet salut 500.000 IU/g tablet DAK 2020 E. KAT 26,371,002 08/22
156 Nistatin tablet vaginal 100.000 IU/g tablet DAK 2021 E-KAT 46,372,003 07/24
159 OBH btl
160 Oksitosin 1 mg/ml inj ampul DAK 2022 E-KAT 9622A0001A 12/24
161 Omeprazol 40 mg injeksi amp DAK 2022 E-KAT 56820100-1 03/24
162 Omeprazol kapsul 20 mg kapsul DAK 2022 E-KAT A20216J 01/24
163 Omeprazol kapsul 20 mg kapsul DAK 2021 NON E-KAT 2105-02-51 05/23
164 Oralit 200 mg sachet DAU 2023 E-KAT 56373198 11/24
165 Papaverin tablet 40 mg tablet DAK 2022 NON E KAT 2206-03-156 6/24
166 Papaverin tablet 40 mg tablet DAK 2021 NON E-KAT 2106-02-156 06/23
167 Parasetamol Drop 60/0.6 ml Btl 15 ml DAK 2022 E-KAT C29234 03/25
168 Parasetamol syrup btl 60 ml DAK 2022 E-KAT A20014 01/25
169 Parasetamol tablet 500 mg tablet DAK 2022 NON E-KAT 2106-34-117 10/23
170 Parasetamol tablet 500 mg tablet DAU 2023 E-KAT 2106-34-117 10/23
171 Phenol gliserol tetes telinga 10% btl DAK 2022 E-KAT 22LC006 03/24
172 Pil KB Kombinasi tablet DAK 2022 NON E-KAT 2,193,096 07/27
173 Piracetam tablet 800 mg tablet DAK 2021 NON E-KAT 210,716,701 11/23
174 Piracetam tablet 800 mg tablet DAK 2022 NON E-KAT TSJ80351 08/24
175 Pirantel pamoat 125 mg tablet DAK 2022 E-KAT 1,109,225 09/24
49 Pirantel pamoat 125 mg tablet DAK 2021 E-KAT 110,622 06/24
176 Pirantel pamoat susp 125 mg/ml btl DAK 2022 NON E-KAT A200306R 09/23
177 Piridoksin HCl (Vit B6) tablet 10 mg tablet DAK 2022 E-KAT 23,604,202 02/24
178 Piroksikam tablet 20 mg tablet DAK 2022 NON E-KAT 2206-03-144 06/24
179 Prednison tablet 5 mg tablet DAK 2022 E-KAT 26,301,110 10/25
180 Primakuin tablet 15 mg tablet DAK 2022 E-KAT 56,386,002 01/25
181 Propanolol HCl tablet 10 mg tablet DAU 2023 E-KAT 54A0630 10/27
182 Propiltiourasil tablet 100 mg tablet DAK 2022 E-KAT 53G1209 06/26
182 Propiltiourasil tablet 100 mg tablet DAU 2023 E-KAT 53I0476 10/26
183 Protofen (Ketoprofen supositoria 100 mg) supp DAU 2023 E-KAT
184 Ranitidin injeksi 25 mg/2 ml amp DAK 2022 E-KAT PIL31751 10/25
185 Ranitidin tablet 150 mg tablet LEBIH 52L4190 11/23
186 Ranitidin tablet 150 mg tablet
187 Ringer Laktat larutan infus btl 500 ml DAK 2022 E-KAT 411,202 11/26
188 Risperidon tablet DAK 2022 E-KAT 53A0842 11/24
188 Risperidon tablet DAU 2023 E-KAT 54A0798 11/25
Simvastastin 10 mg tablet DAU 2023 NON E-KAT HTSVND26760 11/24
Simvastastin 10 mg tablet DAU 2023 E-KAT
189 Salbutamol 2 mg tablet tablet DAK 2022 E-KAT 27,401,201 01/24
190 Salbutamol nebules 0,1% ktk 10 DAK 2022 NON E-KAT 5,112,176 10/23
191 Salbutamol tablet 4 mg tablet DAK 2022 E-KAT 27,505,201 01/24
192 Salep 2-4,Kombinasi : As Salisilat 2% + pot DAK 2022 E-KAT L17103 12/24
Belerang Endap 4%
193 Scabimid krim tube
194 Sefadroksil kapsul 500 mg kapsul DAK 2022 NON E-KAT 2206-22-57 06/24
195 Sefadroksil Sirup Kering 125 mg btl DAK 2022 E-KAT 2203-09-188 03/24
35 Sefotaksim inj 1 g vial DAU 2023 E-KAT 54A0685 12/24
36 Seftriakson inj 1 g vial DAU 2023 E-KAT 53J0464 09/24
198 Serum Anti Bisa Ular Polivalen Inj ktk 1 vial
50mlABUII)
199 Sianokobalamin (VIT B12) 50 mg tab tablet DAK 2022 E-KAT K11613BJ1 10/26
Sianokobalamin (VIT B12) injeksi 500
200 ampul DAK 2022 E-KAT I020852 10/24
mcg/ml
200 ampul DAU 2023 E-KAT
mcg/ml
202 Simvastatin tablet 20 mg tablet
203 Siprofloksasin tablet 500 mg tablet DAK 2022 E-KAT HTCFXC16684 12/25
204 Spironolakton 25 mg tablet DAK 2022 E-KAT 53A4185 12/23
205 Sulfadiazine Silver / perak sulfadiazin krim tube 35 g DAK 2022 NON E-KAT 2BH1836 08/25
1%
205 Sulfadiazine Silver / perak sulfadiazin krim tube 35 g DAU 2023 E-KAT 3CC0521 03/26
1%
206 Tetrasiklin HCl kapsul 500 mg kapsul DAK 2022 NON E-KAT 2206-02-52 6/24
207 Tiamin HCl (Vit B1) tablet 50 mg tablet DAK 2022 E-KAT 20,517,111 11/23
208 Tramadol inj 50 mg/ml amp DAK 2021 NON E-KAT
209 Tramadol kapsul 50 mg ktk 50 DAK 2019 NON E-Cat F917625 7/24
210 Triheksifenidil hidroklorida 2 mg tablet DAK 2022 E-KAT A22271 11/27
211 Vitamin B Kompleks tablet tablet DAK 2022 E.KAT 2109-11-379 04/24
211 Vitamin B Kompleks tablet tablet DAU 2023 E-KAT 2304-05-379 04/25
212 Zegavit ktk 50 RELOKASI KTZEGA14622 08/23
213 Zinc Dispersibel tab 20 mg tablet DAK 2022 E-KAT 5,649,009 01/25
213 Zinc Dispersibel tab 20 mg tablet DAU 2023 E-KAT 2304-01-350 04/25
214 Zinc Syr botol DAK 2022 E-KAT 21C187 03/24
B TAMBAHAN
2 Bisacodil 5 mg tablet DAK 2022 E-KAT 1,208,009 11/23
7 Caviplex syr botol DAK 2022 NON E-KAT F1357101 12/24
11 Curcuma syr botol DAK 2022 NON E-KAT 22B0282 04/24
12 Curcuma tablet kotak/120 DAK 2022 E-KAT 22B0210 04/24
13 Diamicron MR ktk 100 DAU 2017 620,770 12/23
Dulcolax Supp Adult 10 mg (Bisacodil
14 supp DAK 2022 E-KAT 22,030,216 02/25
suppositoria 10 mg)
15 Dulcolax Supp Adult 5 mg (Bisacodil supp DAK 2021 E-KAT 19,121,510 09/24
suppositoria 5 mg)
16 Dulcolax Supp Adult 5 mg (Bisacodil supp DAK 2022 E-KAT 22,020,166 02/25
suppositoria 5 mg)
17 Dumin Rektal tube DAK 2021 NON E-KAT X2397134 09/23
24 N-Asetil sistein 200 mg (Pycostein) tablet DAK 2021 NON E-KAT HP120 08/23
26 Norit btl 40 DAK 2021 NON E-KAT GD00171 03/24
27 Norit btl 40 DAK 2022 NON E-KAT RL00271 03/27
30 Pehavral ktk 100 DAK 2021 NON E-KAT 46,185,010 7/21
34 STESOLID Diazepam enema 10 mg/2,5 mL tube DAK 2021 NON E-KAT X23691710 08/24
35 STESOLID Diazepam enema 10 mg/2,5 mL tube DAK 2022 E-KAT B2670201 5/25
36 STESOLID Diazepam enema 5 mg/2,5 mL tube DAK 2021 NON E-KAT A23681701 01/24
37 STESOLID Diazepam enema 5 mg/2,5 mL tube DAK 2022 E-KAT B2669202 04/25
40 Vitamin D 1000 IU tablet DAK 2022 E-KAT 22H0183 07/24
41 Vitamin E 300 IU kapsul DAK 2022 NON E-KAT 1AJ2030 10/23
43 Zypraz 0,5 mg tab ktk 50
C BAHAN MEDIS HABIS PAKAI (BMHP)

1 2 way folley catheter no. 16 unit DAK 2021 NON E-KAT 16-G-16E 07/26
2 2 way folley catheter no. 18 unit DAK 2021 E-KAT 9,082,188 07/26
3 2 way folley catheter no. 20 unit DAK 2021 E-KAT 24,072,188 06/26
4 2 way folley ballon catheter no. 8 unit DAK 2022 E-KAT 2,111,830 12/26
5 2way folley ballon catheter no. 10 unit DAK 2022 E-KAT G220860611 07/27
6 2 way folley ballon catheter no. 16 unit DAK 2022 E-KAT 22-G-20A 12/26
7 2way folley ballon catheter no. 20 unit DAK 2022 E-KAT 22-G-20A 12/26
8 3 way stop cock unit JKN 2017 10,071,788 11/21
9 3S INVEST Eko gips 10 cm x 2.7 m roll DAK 2018 181,116 11/21
10 3S INVEST Eko gips 10 cm x 2.7 m roll DAK 2019 E-KAT 051016 7/23
11 3S INVEST Eko gips 10 cm x 2.7 m roll DAK 2020 E-KAT 170,718 11/21
12 3S INVEST Eko gips 15 cm x 2.7 m roll DAK 2018 141,116 7/23
15 3S INVEST Eko gips 7.5 cm x 2.7 m roll DAK 2022 E-KAT 2,203,023 03/25
16 3S INVEST Eko gips 7.5 cm x 2.7 m roll DAK 2019 E-KAT 130,916 7/23
17 3S INVEST Eko gips 7.5 cm x 2.7 m roll DAK 2020 E-KAT 170,718 08/27
18 AESCULAP BLADES / CARBON STEEL ktk 100 DAU 2023 E-KAT 4,513,668,093 08/27
SCALPEL BLADES #10
20 AESCULAP BLADES / CARBON STEEL ktk 100 DAU 2023 E-KAT 4513668200 08/27
SCALPEL BLADES #15
21 AESCULAP BLADES / CARBON STEEL ktk 100 DAU 2023 E-KAT 4,513,561,019 08/27
SCALPEL BLADES #20
AESCULAP BLADES / CARBON STEEL
21 ktk 100 RELOKASI 080123 01/28
SCALPEL BLADES #20
22 Alat suntik sekali pakai 1 ml ktk 100 DAU 2023 E-KAT 26,112,288 10/27
23 Alat suntik sekali pakai 10 ml ktk 100 DAU 2023 E-KAT 08032388 02/28
24 Alat suntik sekali pakai 2.5 ml unit DAK 2021 E-KAT 26,681,988 10/27
25 Alat suntik sekali pakai 2.5 ml unit DAK 2022 E-KAT 21,092,188 08/26
26 Alat suntik sekali pakai 3 ml KTK 100 DAU 2023 E-KAT 04112288 10/27
27 Alat suntik sekali pakai 20 ml unit DAK 2022 E-KAT 04022288 01/27
27 Alat suntik sekali pakai 20 ml KTK 100 DAU 2023 E-KAT 11,042,388 03/28
28 Alat suntik sekali pakai 5 ml ktk 100 DAK 2022 E-KAT 28,032,288 02/27
29 Alat suntik sekali pakai 5 ml unit DAU 2023 E-KAT 14,032,388 02/28
Alat Suntik Sekali Pakai Otomatis Rusak
30 unit DAK 2020 E-KAT 20,001 01/25
0.05 ml
31 Alat Suntik Sekali Pakai Otomatis Rusak unit DAK 2021 E-KAT 1,807,401 07/23
0.05 ml
32 unit DAK 2022 E-KAT 1,807,401 06/23
0.05 ml
Alat Suntik Sekali Pakai Otomatis Rusak 0.5
33 unit DAK 2021 E-KAT 20,080,311 09/25
ml (Oneject II)
32 Alat Suntik Sekali Pakai Otomatis Rusak unit DAU 2023 E-KAT
0.05 ml
33 Alat Suntik Sekali Pakai Otomatis Rusak 0.5 unit DAU 2023 E-KAT 20,080,309 09/25
ml (Oneject II)
34 unit DAK 2022 E-KAT 22,080,302 12/26
ml (Oneject II)
35 Alcohol Swab ktk 100 DAK 2022 E-KAT 01092188 08/24
35 Alcohol Swab ktk 100 DAU 2023 E-KAT 12,012,388 12/25
36 Alkohol 70% btl 1 L DAK 2021 NON E-KAT 21,062,188
37 Alkohol 70% btl 1 L DAK 2022 E-KAT 17,062,288 05/26
38 Alkohol 70% btl 1 L BTT 2022 17,062,288 05/26
39 Apron unit DAK NF 2020 08/24
40 Aseptic gel 500 cc (Aseptan) btl SILFA DAK NON FISIK 21 03092188 08/24
41 Blood lancet ktk 100 DAK 2021 E-KAT 01071988 06/24
41 Blood lancet ktk 100 DAK 2022 E-KAT 01072288 06/25
42 CARESTART MALARIA HRP2/Pldh Ktk 25 DAK NON FISIK 2023 E-KAT RMR23D041 08/25
(Pf/PAN) Combo Cassete 25 test/dus.
43 Cotton Aplicator Steril bks 100 DAK 2022 NON E-KAT 22,122,188 11/26
44 Cotton Aplicator Steril bks 100 DAK 2020 NON E-KAT 22,122,188 11/26
45 Endotracheal tube Regular Plain uncuff unit DAK 2022 E-KAT 20FT43 05/25
steril 4 mm
46 Endotracheal Tube Regular Plain Uncuff, unit DAK 2021 NON E-KAT 107H20 04/25
steril 3,5 mm
47 Endotracheal Tube Regular Plain Uncuff, unit DAK 2022 E-KAT 19GT31 06/24
steril 3,5 mm
Endotracheal Tube (ETT) Tanpa Cuff 6 unit DAU 2023 E-KAT 02122288 11/27
Endotracheal Tube (ETT) Tanpa Cuff 7 unit DAU 2023 E-KAT 02122288 11/27
Endotracheal Tube (ETT) Tanpa Cuff 8 unit DAU 2023 E-KAT 19,112,288 10/27
49 Feeding Tube FR 5 100 cm piece DAK 2021 E-KAT 21,022,088 01/25
51 Feeding Tube FR 6 100 cm piece DAK 2022 NON E-KAT 190,905 05/24
53 Gown non woven Pak 10 DAK 2022 E-KAT 4510005648/074-02-22 06/25
54 Halogen Lamp potometer 5010 12v/20w unit DAK 2016 NON E-KAT 055487001
55 Hidrogen Peroksida Botol DAK 2022 E-KAT 1,102,188 09/24
56 Infus set anak unit DAK 2021 E-KAT 31,052,188 04/26
57 Infus set anak unit DAK 2022 NON E-KAT 20G23K8801 07/25
58 Infus set dewasa unit DAK 2022 E-KAT 22C15K8902 03/27
59 Jarum hecting kulit GT 10 ktk 12 DAK 2021 NON E-KAT 207,666 -
60 Jarum hecting kulit GT 14 ktk 12 DAK 2021 NON E-KAT 20,712,202 -
61 Jarum hecting otot GR 13 ktk 12 DAK 2021 NON E-KAT 20,712,202 -
59 Jarum hecting kulit GT 10 ktk 12 DAK 2022 NON E-KAT 207,666 -
60 Jarum hecting kulit GT 14 ktk 12 DAK 2022 NON E-KAT MD227995 -
61 Jarum hecting otot GR 13 ktk 12 DAK 2022 NON E-KAT 207,666 -
63 Kapas berlemak 500 gram roll DAK 2019 E-KAT 1,908
64 Kapas pembalut 250 gram roll DAK 2022 E-KAT - -
65 Kapas pembalut 250 gram roll DAK 2021 E-KAT 07062188 -
66 Kasa Hydrophil 40 x 80 cm roll DAU 2023 E-KAT 052788MX
67 Kasa kompres 40/40 steril lembar DAK 2022 E-KAT 23,052,288 04/27
68 Kertas puyer pak 1000 DAK 2022 NON E-KAT - -
Kertas saring pak - -
69 Leukoplast 5 cm x 4,5 m roll DAK 2020 E-KAT 94,414,909 10/26
70 Leukoplast 7,5 cm x 4,5 m roll DAK 2020 E-KAT 94,414,909 10/26
71 Leukoplast 7,5 cm x 4,5 m roll DAU 2023 E-KAT
72 Maxiflow Bayi (masker oksigen) unit DAK AFFIRMASI 07121788 02/24
73 Maxiflow Dewasa (masker oksigen) unit DAK AFFIRMASI 07121789 08/23
MICROLIT Tips for Micropipettes-MT-1-up
74 pack DAK 2020 BMHP MICRO200
to 200 µl
MICROLIT Tips for Micropipettes-MT-II-up
75 pack
to 1 ml
MICROLIT Tips for Micropipettes-MTSP-up
76 pack
to 10 µl (white tips 100 pcs)
77 My Jelly 82 gram tube DAU 2023 E-KAT 6,032,388 02/26
78 Nurse cap ktk 100 DAK 2021 E-KAT 9/22
79 Nurse cap ktk 100 DAK 2022 E-KAT 11,603,020,404 03/27
80 Objeck Glass Frosted 7105 ktk 72 DAK YANKESDAS 2020 TBC 1,601,917 6/21
81 Onemed Lysol btl 1 L JKN 2019 E.Kat 2,081,888 08/26
17 Onemed Surgical Mask Plus 3 Ply Plus ktk 50 DAK NON FISIK 2021 21,603,910,810 08/26
Earloop
82 Onemed Surgical Mask Plus 3 Ply Plus ktk 50 DAK 2022 E-KAT 21,603,910,810 08/26
Earloop
83 Onemed U Pad Steril 60 x 90 cm unit LEBIH 25,112,288 10/27
84 Onemed Ultra One Test Hamil unit DAU 2023 E-KAT 12092288V 08/25
84 Onemed Ultra One Test Hamil ktk 50 DAU 2023 E-KAT
85 Oxyflow Nasal Oxygen Anak unit DAK 2022 E-KAT 26032288TI 02/26
86 Oxyflow Nasal Oxygen Bayi unit DAK 2022 E-KAT 31032288TI 02/28
87 Oxyflow Nasal Oxygen Dewasa unit DAK 2022 E-KAT 24032288TI 02/26
88 Pengisian tabung oksigen Besar tabung 2020 - -
89 Pengisian tabung oksigen sedang tabung 2019 - -
90 Pharmafix (5 cm x 500 cm) unit DAK 2022 E-KAT I5K21 10/26
91 Plastik obat besar 8,9 x 13 pak 1000 DAK 2020 NON E-KAT
92 Plastik obat Sedang 7 x 10 pak 1000 JKN 2022
93 Plastik obat Sedang 7 x 9 pak 1000 DAK 2020 NON E-KAT
94 Plesterin ktk 200 RELOKASI 11,062,188 05/26
95 Povidone Iodine btl 300 ml DAK 2021 NON E-KAT 07062188 05/24
96 Povidone Iodine btl 300 ml DAK 2022 NON E-KAT 20,062,288 05/26
PRO CREPE PEMBALUT ELASTIS UKURAN
97 roll DAK 2022 E-CAT 42,101 03/27
10 CM X 4,55 M
98 PRO CREPE PEMBALUT ELASTIS UKURAN roll DAK 2021 E-KAT 2,104,088 5/26
10 CM X 4,55 M
99 roll DAK 2021 E-KAT 2,104,087
15 CM X 4,55 M
100 roll DAK 2022 E-CAT 62,102 03/27
15 CM X 4,55 M
101 PRO CREPE PEMBALUT ELASTIS UKURAN roll DAK 2022 E-CAT 32,101 03/27
7.5 CM X 4,55 M
102 PRO CREPE PEMBALUT ELASTIS UKURAN roll DAK 2021 E-KAT 2,104,080 06/25
7.5 CM X 4,55 M
98 roll DAU 2023 E-KAT 12,340,003 04/28
10 CM X 4,55 M
100 roll DAU 2023 E-KAT 12,360,003 04/28
15 CM X 4,55 M
102 PRO CREPE PEMBALUT ELASTIS UKURAN roll DAU 2023 E-KAT 1,230,003 04/28
7.5 CM X 4,55 M
103 Rivanol btl 300 ml DAK 2022 E-KAT 21,072,288 06/25
23 Safeglove Examination Gloves L Nitril ktk 100 DAU 2023 E-KAT 5,410,007,064 01/26
105 Safeglove Examination Gloves M ktk 100 DAU 2023 E-KAT 05/24
107 Safeglove Examination Gloves S ktk 100 DAU 2023 E-KAT 07/27
105 Safeglove Examination Gloves M ktk 100 BTT 2022 06-77-04-7 05/24
106 Safeglove Examination Gloves M Nitril ktk 100 DAK 2022 E-KAT 4510005648/074-02-22 06/25
107 Safeglove Examination Gloves S ktk 100 BTT 2022 116-07-7 07/27
108 Safeglove Examination Gloves S Nitril ktk 100 DAK 2022 E-KAT 4510005648/074-02-22 06/25
109 Safeglove PP no. 7 ktk 50 DAK 2022 E-KAT 57,003,468 02/27
110 Safeglove PP no. 7,5 ktk 50
111 Safeglove PP no. 8 ktk 50 DAK 2022 E-KAT 966,241,797 02/27
109 Safeglove PP no. 7 ktk 50 DAU 2023 E-KAT 57,005,770 09/27
110 Safeglove PP no. 7,5 ktk 50 DAU 2023 E-KAT 57,505,782 09/27
111 Safeglove PP no. 8 ktk 50 DAU 2023 E-KAT 58,005,317 07/27
112 Sarung tangan ginekologi Pasang DAU 2023 E-KAT 14,042,388 03/28
113 SMI Catgut Cromic 3/0 HR 30 mm dengan Ktk 12 DAU 2023 E-KAT 211206 11/26
jarum bedah
SMI Catgut Plain 2/0 HR 37 mm dengan
114 Ktk 12 DAU 2023 E-CAT 221001 09/27
jarum bedah
SMI Catgut Silk Black 2/0 HR 30 mm dengan
115 Ktk 12 DAU 2023 E-KAT 220101 12/26
jarum bedah
SMI Catgut Silk Black 3/0 HR 30 mm dengan
115 Ktk 12 DAU 2023 E-KAT 210907 11/26
jarum bedah
116 Stik asam urat (Easytouch) btl DAK 2022 NON E-KAT UAS21A09CA1 09/23
118 Stik gula darah ( Inezco) btl DAK 2022 E-KAT WG22G10GU-GEE 03/24
119 Stik gula darah (Easytouch) btl DAK 2022 NON E-KAT G0521A26CU 09/23
118 Stik gula darah ( Inezco) btl DAU 2023 E-KAT
117 Stik asam urat (Easytouch) btl DAU 2023 E-KAT UAS22615B77 05/24
120 Stik gula darah (Easytouch) btl DAU 2023 E-KAT GOS22602A8Q 05/24
122 Stik kolesterol (Easytouch) btl DAU 2023 E-KAT CHS22707B75 06/24
123 Stik pemeriksaan HB (Easytouch) btl RELOKASI HBS21A07AAM 09/23
125 Stik pemeriksaan HB (Quickcheck) btl DAU 2023 E-KAT HbM2080028 06/24
126 Stik pemeriksaan HB (Quickcheck) btl DAK NON FISIK 2023 HbM2080027 06/24
127 Stomach Tube 14 unit DAK 2022 E-KAT 28,012,288,122 12/24
128 Stomach Tube 18 FR 125 cm
129 Suction Catheter FR. 10 unit DAK 2022 E-KAT 04032288 02/27
132 Suction Catheter FR. 16 unit DAK 2021 E-KAT 12,022,088 01/27
129 Suction Catheter FR. 10 unit DAU 2023 E-KAT 16,032,388 02/28
136 Suction Catheter FR. 8 unit DAU 2023 E-KAT 160,032,388 02/28
137 SURFLO IV CATH 20 ktk 50 DAK 2022 E-KAT 220129SF 12/26
138 SURFLO IV CATH 22 ktk 50 DAK 2022 E-KAT 2205155E 04/27
140 SURFLO IV CATH 26 ktk 50 DAK 2022 E-KAT 2,210,498 04/26
138 SURFLO IV CATH 22 unit DAU 2023 E-KAT 230225SE 01/28
139 SURFLO IV CATH 24 unit DAU 2023 E-KAT 230303SC 02/28
140 SURFLO IV CATH 26 unit DAU 2023 E-KAT 1,420,839 08/27
141 Tabung 3 ml (tutup merah) box
142 Tabung EDTA 0,5 ml (tutup ungu) box
143 Tabung EDTA 3 ml (tutup ungu) box
144 Uji Dengue IgG/IgM Test DAK 2022 E-KAT G2101I 06/23
145 Umbilical Cord Klem ktk 50 DAU 2023 E-KAT 6,042,388 03/28
146 urine bag unit DAK 2022 E-KAT 24,032,288 02/27
147 urine bag unit DAK 2021 E-KAT 15,062,188 05/26
147 urine bag unit DAU 2023 E-KAT
148 Uritest Reagent Strip 11 G tube 100 strip
149 Urocare Folley Catheter no. 18 unit DAK 2021 E-KAT 2,111,830 12/26
150 Urocare Folley Catheter no. 20 unit DAK 2021 E-KAT 04092188
151 Urocare Folley Catheter Ped no. 10 unit DAK 2022 E-KAT 103H20 04/25
152 Folley catheter Ped no. 8 unit DAK 2022 E-KAT 20-G-11E 04/25
153 Wing Needle 23 G unit DAU 2023 E-KAT 28,032,388 02/28
153 Wing Needle 25 G unit DAU 2023 E-KAT 30,032,388 02/28
154 SD HIV Syphilis Combo ktk 25 DAK 2022 E-KAT 06ADH011A 04/24
155 Masker N95 ktk 10 DAK 2021 NON E-KAT 4,210,810 08/26
D HIV/AIDS, IMS
1 KOH 10% Btl 100 ml JKN 2018 REAGENSIA
E PROGRAM TBC
1 Objek gelas bertepi putih ktk/72 BUFFER PROV 9/22
2 Objeck Glass Frosted 7105 ktk 72 DAK YANKESDAS 2020 TBC 1,601,917
3 Box Slide Buah DAK YANKESDAS 2020 TBC BOXSLIDE 07/24
4 Masker Bedah Khusus TBC ktk 50 BUFFER PROVINSI 21
67 Sputum Pot Buah DAU 2023 E-KAT 3,003,288 02/28
F MALARIA
1 Reagensia Giemza btl 100 ml BUFFER PROVINSI 211022-6M 12/24
2 Oil Emersion btl 500 ml JKN 2018 REAGENSIA HX60598399
3 Object Glass 7101 ktk 72 DAU 2023 E-KAT 90,223 02/28
4 Lar.metanol btl 100 ml DAK 2020 NON E-KAT
G BHP :
1 Tabung EDTA 3 ml (tutup ungu) box JKN 2019 BMHP NON-CAT KJ030K3E 7/20
2 Tabung EDTA 0,5 ml (tutup ungu) box JKN 2019 BMHP NON-CAT KJ002 05/22
3 Water one btl 1 L JKN 2019 BMHP E-Cat 12,097 04/22
4 Lar. Turk btl 100 ml RELOKASI 8/21
5 Larutan Anisol btl 100 ml JKN 2019 REAGENSIA btl500 5/23
6 Lar. Amonium oksalat 1% btl 500 ml JKN 2019 REAGENSIA btlml100
7 Lar. Natrum Sitrat 3,8% btl 100 ml JKN 2018 REAGENSIA 8/21
8 Lar. EDTA 10% btl 100 ml JKN 2019 REAGENSIA 100ml 08/21
9 Lar.HCL 0,1N btl 100 ml JKN 2019 HCL 6/21
10 JAYAMAS Onemed HCl 0,1 N 100 ml botol JKN 2018 E.Kat 10,171,888 8/20
11 Reagent Gol Darah (Anti-A, B, AB) 10 ml x 3 paket JKN 2018 REAGENSIA 184,068 8/20
btl
12 Reagent Gol Darah Anti-D paket JKN 2018 REAGENSIA 131,068
13 Micropiper fix vol 1000 µl unit JKN 2017 17,080,217
14 Micropiper fix vol 200 µl unit JKN 2017 17,080,215
15 Micropiper fix vol 5 µl unit JKN 2017 17,080,209 10/23
16 Onelab Cover Glass 18 x 18 mm pack DAK Reguler 2016 E-Catalog 2016-04 3/22
17 Onelab Cover Glass 18 x 18 mm pack JKN 2017 2017-03 12/20
18 Onelab Cover Glass 18 x 18 mm pack JKN 2018 E.Kat 18x18
19 Spirtus Btl 1 ltr JKN 2018 REAGENSIA 7/19
20 Podofilin Tingtur 10 - 25% btl 250 ml DAU 2017 1180150901
21 Tabung reaksi kaca 12 cm pcs DAK Reguler 2016 Non E-Catalog 9820TST 3/20
22 Precicontrol multichem roche (PU kimia KIT/20X5 ml JKN 2018 REAGENSIA 1,911,801
darah)
23 Kertas EKG roll DAK 2018 BMHP 318,545,767
24 Tawas kg DAK 2018 BMHP
25 Kaporit kg DAK 2018 BMHP
I Reagen Photometer :
1 Cholesterol 4 x 100 ml JKN 2020 REAGENSIA 19,002 7/21
2 Creatinine 200 ml JKN 2020 REAGENSIA 18,003 9/20
3 Glucose 4 x 100 ml JKN 2020 REAGENSIA 18,004 11/19
4 GOT (ASAT) 20x 50ml JKN 2020 REAGENSIA 18,003 9/20
5 GPT (ALAT) 20x 50ml JKN 2020 REAGENSIA 19,001 1/20
6 Hemoglobin 10x500 ml JKN 2020 REAGENSIA 18,001 10/20
7 Uric Acid 4 x 100 ml JKN 2020 REAGENSIA 19,001 12/20
8 Urea 2 X 100 JKN 2020 REAGENSIA 19,002
J Reagen Hematology Analyzer ( SYSMEX X5 ) :

1 Cell Pack (PK-30L) 20 L/Box JKN 2018 REAGENSIA Am8078 7/20
2 Stromatolyzer - 4DL XS 2 L/Box JKN 2019 REAGENSIA AM9006 5/20
3 Stromatolyzer - 4DS (FFS-800A) 42 ml/Sach JKN 2019 REAGENSIA AM9007 4/20
4 Sulfolyzer (SLS-210A) 500 ml/Btl JKN 2019 REAGENSIA Am8008
5 e-Check XS (L,N,H) 3x1,5 ml/Set JKN 2018 REAGENSIA 5/20
6 Cell Clean (CL-50) 50 ml/Btl JKN 2020 REAGENSIA A9010
K BHP GIGI
1 Eugenol cairan btl 10 ml DAK 2018 E KAT E71161W 5/21
2 Eugenol cairan btl 10 ml SILPA KPS 2019 E71161W 7/20
3 OCO (remover staint) bahan untuk btl DAK 2018 BMHP 014-01-045
memutihkan gigi
OCO (remover staint) bahan untuk
4 btl SILPA KPS 2019
memutihkan gigi
OCO (remover staint) bahan untuk
5 btl JKN KAPITASI 2020 0919 1/20
memutihkan gigi
6 Fuji 9 ART minipack (5g powder, 4g liquid, unit DAK 2018 BMHP 1,701,171 01/21
2g cocoa butter)
7 Fuji 9 ART minipack (5g powder, 4g liquid, unit SILPA KPS 2019 1,801,241 03/22
2g cocoa butter)
8 Fluocal solute / Ftor lux botol JKN KAPITASI 2020 0299 12/21
Fuji 9 ART minipack (5g powder, 4g liquid,
9 unit JKN KAPITASI 2020 1,812,141 07/22
2g cocoa butter)
10 Fuji 9 GP (1-1) Gold Label 9 GP GC set SILPA KPS 2019 1,907,161 5/19
11 Fuji 9 GP (1-1) Gold Label 9 GP GC set DAK 2018 BMHP 1,606,011 12/22
12 Fuji 9 GP (1-1) Gold Label 9 GP GC set JKN KAPITASI 2020 1,912,201 06/22
13 Fuji II LC Mini Pack #A2/Gold Label 2 LC GC ktk SILPA KPS 2019 1,906,061 12/22
14 Fuji II LC Mini Pack #A2/Gold Label 2 LC GC ktk JKN KAPITASI 2020 1,912,201 2/20
15 Dentin Conditioner Mini Pack 6 gr btl DAK 2018 BMHP 1,702,101 01/22
16 Dentin Conditioner Mini Pack 6 gr btl SILPA KPS 2019 1,901,161 01/22
17 Dentin Conditioner Mini Pack 6 gr btl JKN KAPITASI 2020 1,901,101 7/21
18 Devitalisasi non arsen/pulp x btl DAK 2018 BMHP 1,881,808 07/22
19 Devitalisasi non arsen/pulp x btl SILPA KPS 2019 0519 07/23
20 Devitalisasi non arsen/pulp x btl JKN KAPITASI 2020 0620 11/20
21 Elite 100 Mini Pack-35 g powder,30g liquid Unit DAK 2018 BMHP 1,711,101
22 Bur diamond high speed unit JKN KAPITASI 2020 608,011 06/22
23 Elite 100 powder 125 gr GC Unit SILPA KPS 2019 1,906,031 06/22
24 Elite 100 powder 125 gr GC Unit JKN KAPITASI 2020 1,906,031 6/21
25 Solare 2 ml Anterior A2 Unit DAK 2018 BMHP 1,806,261 08/21
26 Solare 2 ml Anterior A2 Unit SILPA KPS 2019 1,808,282 01/23
27 Solare 2 ml Anterior A2 Unit JKN KAPITASI 2020 2,001,172 6/19
28 Solare X 2 ml posterior A3 Unit DAK 2018 BMHP 1,607,011 02/22
29 Solare X 2 ml posterior A3 Unit SILPA KPS 2019 1,902,063 02/22
30 Solare X 2 ml posterior A3 Unit JKN KAPITASI 2020 1,902,152 02/22
31 Solare X 2 ml posterior A2 Unit SILPA KPS 2019 1,902,142 07/22
32 Solare X 2 ml posterior A2 Unit JKN KAPITASI 2020 1,906,191 08/22
33 Spongestant/surgispon pak JKN KAPITASI 2020 0919008 4/20
34 Master Flow A3 Biodinamica syringe DAU 2017 16 09/22
35 Master Flow A3 Biodinamica syringe SILPA KPS 2019 726/19 04/23
36 Master Flow A3 Biodinamica syringe JKN KAPITASI 2020 237/20
37 Articulatiry paper pak DAK 2018 BMHP RIAKL10605810461
38 Articulatiry paper pak SILPA KPS 2019
39 Articulatiry paper pak JKN KAPITASI 2020
40 Micro brus dochen unit DAK 2018 BMHP 10/21
41 Micro brus dochen unit SILPA KPS 2019 22-0239B
42 Micro brus dochen/cotisen unit JKN KAPITASI 2020 08/23
43 Master bond Biodinamica unit JKN KAPITASI 2020 526/20 4/21
44 G-premio Bond btl DAK 2018 BMHP N961829 1/20
45 GC tooth mousse 10 X 40g tube Unit DAK 2018 BMHP 180131E 09/22
46 GC tooth mousse 10 X 40g tube Unit JKN KAPITASI 2020 191031c
47 Calsium hidroksida (Hycal) box JKN KAPITASI 2020 180020 08/22
48 Calsium hidroksida (Hycal) box SILPA KPS 2019 19044 7/20
49 Bioseal Biodinamica ktk DAU 2017 504/17 11/21
50 Bioseal Biodinamica ktk SILPA KPS 2019 247/19 21
51 Celluloid Strip Svenska unit DAK 2018 BMHP 1,921,116 10/19
52 Caviton WHITE 30 g btl DAK 2018 BMHP 1,710,161 06/21
53 Caviton WHITE 30 g btl SILPA KPS 2019 1,906,181 01/22
54 Caviton WHITE 30 g btl JKN KAPITASI 2020 2,001,211 7/21
55 Cresotin big 2/pust btl DAK 2018 BMHP 0718 06/22
56 Cresotin big 2/pust btl SILPA KPS 2019 0719 07/22
57 Cresotin big 2/pust btl JKN KAPITASI 2020 0719 5/21
58 Homospon/spongestant isi 10 box DAK 2018 BMHP TO19021-1 05/22
59 Homospon/spongestant isi 10 box SILPA KPS 2019 U619008
60 Cotton Roll(medium) pak DAU 2017 Dau2017
61 Cotton Roll(medium) pak JKN KAPITASI 2020 03/25
62 Jarum citojet Unit JKN KAPITASI 2020 2,044,375 2/21
63 TKF btl DAK 2018 BMHP 19818 04/22
64 TKF btl SILPA KPS 2019 308/19 04/22
65 TKF btl JKN KAPITASI 2020 308/19 09/22
66 CHKM btl JKN KAPITASI 2020 780/19
67 CHKM btl DAK 2018 BMHP 80517 04/22
68 CHKM btl SILPA KPS 2019 292/19 4/21
69 Etsa 3M Unit DAK 2018 BMHP N966996 4/21
70 Etsa 3M Unit SILPA KPS 2019 N966996 09/22
71 Etsa 3M Unit JKN KAPITASI 2020 NA38302 11/21
72 Etil Klorida Spray btl 100 ml DAK 2020 NON E-KAT 1910924B 1/22
73 Etil Klorida Spray btl 100 ml SILPA KPS 2019 181,114 07/22
74 Actino Etching Liquid 10 ml Denpro btl SILPA KPS 2019 1,401,908 04/22
75 Actino Etching Liquid 10 ml Denpro btl JKN KAPITASI 2020 1,152,004,151 09/22
76 Betadin obat kumur btl 100 ml SILPA KPS 2019 JB19072
77 Calsium hydroxide P.A Biodinamica btl SILPA KPS 2019
78 Calsium hydroxide P.A Biodinamica btl JKN KAPITASI 2020 02/24
79 3 Mix :(3 All) : Liquid + powder unit SILPA KPS 2019 01/22
80 3 Mix :(3 All) : Liquid + powder unit JKN KAPITASI 2020 03/23
81 Topical Anasthetic Gel (rasa buah ) unit JKN KAPITASI 2020 d200312 06/22
82 Topical Anasthetic Gel (rasa buah ) unit SILPA KPS 2019 D190810B
L OBAT KB
1 KB II Implan pcs BKKBN 0100001 12/23
2 Dermafix 5 x 7 cm pcs BKKBN 07011988 06/25
3 Duk Lubang Disposable 25 x 30cm pcs BKKBN 23,072,088 08/23
4 Gestin F3 ( KB 3 Bln) ktk 20 BKKBN 1,131,007 04/22
5 Pil KB Lymestrenol Ktk 100 BKKBN F708588
6 Pehacain inj ktk 20 BKKBN 7/23
7 Andalan 3 bln ktk 20 vial BKKBN 73,702,419 7/21
8 Disp 3 ml ktk 20 BKKBN 16,305 7/21
9 Disp 3 ml ktk 100 BKKBN 16,305 0
10 Safety box unit BUFFER PROV - 0
11 Safety box unit JKN 2018 E. kat 2/21
12 IUD ktk 2 BKKBN 20,214 06/23
13 Kondom BOX 144 BKKBN
M BUFFER STOCK PROVINSI

1 Alat suntik sekali pakai 5 ml unit BUFFER PROVINSIVAKSINASI 23 522FG0001 05/27
2 unit BUFFER PROVINSIVAKSINASI 23 S22HAB001 -
0.05 ml (Oneject II)
3 unit BUFFER PROVINSIVAKSINASI 22 S22ABK005 12/26
ml (Oneject II)
4 Alat Suntik Sekali Pakai Otomatis Rusak 0.5 unit BUFFER PROVINSI21 VAKSINASI 20,112 08/25
ml (Oneject II)
5 unit BUFFER PROVINSIVAKSINASI 23 C22DCL009 03/27
ml (Oneject II)
Alat Suntik Sekali Pakai Otomatis Rusak 3
6 unit BUFFER PROVINSIVAKSINASI 22 S21LFG001 11/26
ml (Oneject II)
7 Albendazole 400 tab ktk 100 BUFFER PROVINSI 120,205,152 02/24
8 Albendazole Syr botol
9 Alcohol Swab ktk 100 DAK YANKESDAS 2020 HIV 04052088 5/25
10 Alcohol Swab pcs BUFFER PROVINSI21 VAKSINASI G3406 07/25
11 Alcohol Swab pcs BUFFER PROVINSI VAKSINASI GM2109154 09/26
12 Amitriptilin 25 mg ktk 100 BUFFER PROVINSI A1430JY 10/25
13 Amoksisilin kaplet 500 mg kaplet BUFFER PROVINSI TANXB23616 09/24
14 Amoksisilin sirup Forte 250 mg/5ml btl 60 ml
15 Artesunate injeksi Ampul BUFFER PROVINSI LA220745 06/25
16 Asiklovir tablet 400 mg tablet BUFFER PROVINSI 26,304,037 06/23
17 Azitromisin tab ktk 20
18 Bionicom Zinc tablet BUFFER PROVINSI JH4051 08/23
19 CARESTART MALARIA HRP2/Pldh Ktk 25
(Pf/PAN) Combo Cassete 25 test/dus
20 Catridge GenXpert MTB pak 10 BUFFER PROVINSI 10,006,117,014 11/24
21 Darplex/Arterakin = DHP + Pieraquin ktk 9 BUFFER PROVINSI 221,208 12/24
22 Diazepam injeksi 5 mg/ml - 2 ml amp BUFFER PROVINSI F2H229 08/24
23 Dietilkarbamasin Sitrat tab tablet BUFFER PROVINSI 1,203,154 03/24
24 Epinefrin (Adrenalin) injeksi 1 mg/ml ampul
(0,1%)
25 Favipiravir 200 mg / Avigam tablet
26 Fenobarbital inj i.m/i.v 50 mg/ml ampul BUFFER PROVINSI 46803001R 12/25
27 Gentamisin inj 40 mg/ml amp BUFFER PROVINSI 22GT3042 06/24
28 Gentamisin inj 40 mg/ml amp BUFFER PROVINSI 21GT3037 05/23
29 INH 300mg tablet BUFFER PROVINSI NIB9592A 10/23
30 Klorokuin 150 mg ktk 100 BUFFER PROVINSI C0016B 02/25
31 Klorpromazin inj 25 mg amp BUFFER PROVINSI 46,329,001 06/23
Kombinasi : ferro fumarat 60 mg + as.folat

32 KTK 100 BUFFER PROVINSI E20980W 05/25
0,4 mg tablet salut gula (tambah darah)
33 Masker N95 Dream Can Type II R Pieces BUFFER PROVINSI ME0IL-K261011030 -

34 MB Anak blister BUFFER PROVINSI B.LR4050 11/24
35 MB Dewasa blister BUFFER PROVINSI BMF0987 02/26
36 Mineral mix sachet BUFFER PROVINSI 2,207,079 07/24
37 Natrium Diklofenak 25 mg tab tablet BUFFER PROVINSI 56,364,004 05/25
39 OAT FDC KAT.1 & 3 paket BUFFER PROVINSI K22353J 10/25
40 OAT FDC KAT.1 DOSIS HARIAN paket BUFFER PROVINSI ICI1106 06/25
41 OAT FDC KAT.2 paket
42 OAT FDC Kat.anak paket BUFFER PROVINSI 22PK2005 05/24
43 Oksitetrasiklin HCl SM 1% tube BUFFER PROVINSI E20998W 06/25
44 Oseltamivire 75 mg Kapsul
45 PB Anak blister BUFFER PROVINSI B.KX9068 04/24
46 PB Dewasa blister BUFFER PROVINSI B.LH2422 05/24
47 Primakuin tablet 15 mg ktk 100 BUFFER PROVINSI 56,386,006 10/24
48 Rapid Test HIV 1 / SD Bioline test BUFFER PROVINSI 03ADG044A 11/23
49 Rapid Test HIV 2/ Standard Q test BUFFER PROVINSI 5353B41AC 10/24
50 Rapid Test HIV 3/TURKLAB Rapindo test BUFFER PROVINSI HIV022206 10/24
51 RDT ANTIGEN (LIMING BIO) KTK 20
52 RDT Frambusia ktk 20
53 Reagensia Zehl Nielsen Paket BUFFER PROVINSI LOT 017/2022 08/24
54 Retinol (vit A) 100.000 IU btl 50 BUFFER PROVINSI 122900W 09/25
55 Retinol (vit A) 200.000 IU btl 50 BUFFER PROVINSI D20837W 04/25
56 Rifampisin 75 MG/INH 50 mg tablet BUFFER PROVINSI NRT2244A 07/24
57 Rifapentin 300 mg/ INH 300 mg tablet BUFFER PROVINSI NIE2249A 07/24
58 RPR (Fokus) test BUFFER PROVINSI 2,211,009 06/23
59 Safety box 12,5 L unit BUFFER PROVINSIVAKSINASI 23 - -
60 SD Bioline HBsAg test BUFFER PROVINSI H22034 08/24
61 SD HIV Syphilis Combo (INDEC) test BUFFER PROVINSI K22016 10/24
62 SD Bioline Syphilis test BUFFER PROVINSI J22028 09/24
SD BIOLINE Tes Malaria Pf + Pv Combo /
63 Ktk 25 KEMENKES 2022 - -
Parascreen
64 SD BIOLINE Tes Malaria Pf + Pv Combo / ktk 25 BUFFER PROVINSI 05EDH004A 04/24

Parascreen
65 SD BIOLINE Tes Malaria Pf + Pv Combo / ktk 25 PERDAKI 2023 05EDH005C 06/24

Parascreen
66 Sivit - Zinc botol 30
67 Sputum Pot Buah BUFFER PROVINSI 20610A015 09/27
68 Tuberkulin PPD RT 23 SSI vial BUFFER PROVINSI 6,500,222 01/24
69 Vitamin B6 25 mg tablet BUFFER PROVINSI 23,701,106 06/23
TOT
Yang mengeluarkan
Yang menerima
(......................)
(......................)
Mengetahui
Kasie Kefarmasian Kab. Mappi
Yang Menyerahkan
Diyany, S.Si., Apt

(......................) NIP. 19791015 200502 2 007
Catatan :
- Setelah di tandatangani dan di stempel, 2(dua) lembar dikirim kembali ke IFK, 1(satu) lembar
arsip penerima.
- Bila barang yang diterima tidak sesuai dengan DBMB mohon segera di informasikan ke IFK.
HARGA
SATUAN/KEMA TOTAL
SAN
Rp 2,960 Rp -
Rp 99 Rp -
Rp 360 Rp -
Rp 219 Rp -
Rp 108 Rp -
Rp 80 Rp -
Rp 80 Rp -
Rp 187 Rp -
Rp 83 Rp -
Rp 530 Rp -
251 Rp -
Rp 2,300 Rp -
Rp 2,300 Rp -
Rp 176,000 Rp -
Rp 176,000 Rp -
Rp 176,000 Rp -
Rp 313 Rp -
Rp 700 Rp -
Rp 55 Rp -
Rp 3,400 Rp -
Rp 1,775 Rp -
Rp 5,000 Rp -
Rp 5,620 Rp -
Rp 3,280 Rp -
Rp 4,063 Rp -
Rp 225 Rp -
Rp 1,725 Rp -
Rp 142 Rp -
Rp 51 Rp -
Rp 51 Rp -
Rp 47 Rp -
Rp 47 Rp -
Rp 133 Rp -
Rp 1,724 Rp -
Rp 2,088 Rp -
Rp 2,970 Rp -
Rp 990 Rp -
Rp 596 Rp -
Rp 473 Rp -
Rp 1,718 Rp -
Rp 1,142 Rp -
Rp 11,500 Rp -
Rp 18,200 Rp -
Rp - Rp -
Rp 1,500 Rp -
Rp 138,925 Rp -
Rp -
Rp 1,449 Rp -
Rp 81 Rp -
Rp 630 Rp -
Rp 623 Rp -
Rp 1,012 Rp -
Rp 38 Rp -
Rp 72 Rp -
Rp - Rp -
Rp 2,048 Rp -
Rp 2,048 Rp -
Rp 77 Rp -
Rp 902 Rp -
Rp 1,443 Rp -
Rp 104 Rp -
Rp -
Rp 82 Rp -
Rp 2,633 Rp -
Rp 3,950 Rp -
Rp 1,893 Rp -
Rp 1,280 Rp -
Rp 8,083 Rp -
Rp 26,950 Rp -
Rp 158 Rp -
Rp 183 Rp -
Rp 183 Rp -
Rp 847 Rp -
Rp 1,595 Rp -
Rp 3,819 Rp -
Rp -
Rp 20,700 Rp -
Rp -
Rp 94 Rp -
Rp 280 Rp -
Rp 666 Rp -
Rp - Rp -
Rp -
Rp -
Rp -
Rp 149 Rp -
Rp 149 Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 220 Rp -
Rp 320 Rp -
Rp 215 Rp -
Rp 103 Rp -
Rp -
Rp -
Rp 149 Rp -
Rp 150 Rp -
Rp 2,558 Rp -
Rp -
Rp 1,050 Rp -
Rp 7,605 Rp -
Rp 165 Rp -
Rp 167 Rp -
Rp 231 Rp -
Rp 10,900 Rp -
Rp -
Rp -
Rp 11,500 Rp -
Rp 11,500 Rp -
Rp 6,199 Rp -
Rp 13,200 Rp -
Rp 69 Rp -
Rp 63 Rp -
Rp 21,000 Rp -
Rp 440 Rp -
Rp 75 Rp -
Rp 63 Rp -
Rp 63 Rp -
Rp 63 Rp -
Rp 63 Rp -
Rp 7,011 Rp -
Rp -
Rp 449 Rp -
Rp -
Rp -
Rp - Rp -
Rp 19,800 Rp -
Rp 579 Rp -
Rp 2,942 Rp -
Rp 76 Rp -
Rp 53 Rp -
Rp -
Rp -
Rp 216 Rp -
Rp 2,205 Rp -
Rp 240 Rp -
Rp 132 Rp -
Rp -
Rp - Rp -
Rp 1,426 Rp -
Rp 1,665 Rp -
Rp 924 Rp -
Rp 87 Rp -
Rp 81 Rp -
Rp 237 Rp -
Rp 150 Rp -
Rp 134 Rp -
Rp 4,480 Rp -
Rp 5,100 Rp -
Rp -
Rp 102 Rp -
Rp 235 Rp -
Rp 1,069 Rp -
Rp 124 Rp -
Rp 271 Rp -
Rp 202 Rp -
Rp 348 Rp -
Rp 2,373 Rp -
Rp 118 Rp -
Rp 3,950 Rp -
Rp 213 Rp -
Rp -
Rp 1,200 Rp -
Rp 4,505 Rp -
Rp 93 Rp -
Rp 347 Rp -
Rp 6,900 Rp -
Rp 275 Rp -
Rp 297 Rp -
Rp 135 Rp -
Rp 15,000 Rp -
Rp 957 Rp -
Rp 1,056 Rp -
Rp 550 Rp -
Rp 747 Rp -
Rp 550 Rp -
Rp -
Rp 1,608 Rp -
Rp 5,599 Rp -
Rp 149 Rp -
Rp 440 Rp -
Rp 666 Rp -
Rp 465 Rp -
Rp 440 Rp -
Rp 5,556 Rp -
Rp 1,218 Rp -
Rp 109 Rp -
Rp 150 Rp -
Rp 3,300 Rp -
Rp 54 Rp -
Rp 2,000 Rp -
Rp 2,000 Rp -
Rp 381 Rp -
Rp 381 Rp -
Rp 12,698 Rp -
Rp 76 Rp -
Rp 200 Rp -
Rp 83 Rp -
Rp 294 Rp -
Rp 84 Rp -
Rp 480 Rp -
Rp 540 Rp -
Rp 7,011 Rp -
Rp 3,000 Rp -
Rp -
Rp -
Rp 7,703 Rp -
Rp 133 Rp -
Rp 240 Rp -
Rp 122
Rp 55 Rp -
Rp 201,000 Rp -
Rp 71 Rp -
Rp 2,600 Rp -
Rp -
Rp 814 Rp -
Rp 4,294 Rp -
Rp 7,320 Rp -
Rp 6,900 Rp -
Rp -
Rp 48 Rp -
Rp 1,240 Rp -
Rp -
Rp -
Rp 270 Rp -
Rp 250 Rp -
Rp 20,700 Rp -
Rp 21,934 Rp -
Rp 348 Rp -
Rp 64 Rp -
Rp 4,400 Rp -
Rp 28,500 Rp -
Rp 65 Rp -
Rp 64 Rp -
Rp 66 Rp -
Rp 444,600 Rp -
Rp 275 Rp -
Rp 203 Rp -
Rp 5,397 Rp -
Rp -
Rp 246 Rp -
Rp 13,000 Rp -
Rp 22,100 Rp -
Rp 140,000 Rp -
Rp 5,085 Rp -
Rp 4,325 Rp -
Rp 4,325 Rp -
Rp 5,085 Rp -
Rp 265,000 Rp -
Rp - Rp -
Rp 34,000 Rp -
Rp 34,000 Rp -
Rp 121,000 Rp -
Rp 201,000 Rp -
Rp 260 Rp -
Rp 66,000 Rp -
Rp 420 Rp -
Rp 424 Rp -
Rp 3,450 Rp -
Rp -
Rp -
Rp -
Rp 9,680 Rp -
Rp 9,680 Rp -
Rp 2,438 Rp -
Rp 3,080 Rp -
Rp 11,440 Rp -
Rp 8,800 Rp -
Rp 8,800 Rp -
Rp 58,842 Rp -
Rp 56,843 Rp -
Rp 39,178 Rp -
Rp 91,700 Rp -
Rp 70,785 Rp -
Rp 69,061 Rp -
Rp 15,400 Rp -
Rp 15,400 Rp -
Rp 30,083 Rp -
Rp -
Rp 320,832 Rp -
Rp 320,832 Rp -
Rp 320,832 Rp -
Rp 320,832 Rp -
Rp 75,075 Rp -
Rp 126,984 Rp -
Rp 751 Rp -
Rp 578 Rp -
Rp 75,075 Rp -
Rp 715 Rp -
Rp 83,694 Rp -
Rp 64,900 Rp -
Rp 87,734 Rp -
Rp 1,650 Rp -
Rp 1,530 Rp -
Rp 1,530 Rp -
Rp 1,530 Rp -
Rp 1,787 Rp -
Rp 1,405 Rp -
Rp 1,205 Rp -
Rp 9,000 Rp -
Rp 11,544 Rp -
Rp 14,000 Rp -
Rp 35,343 Rp -
Rp -
Rp -
Rp 1,650 Rp -
Rp 5,950 Rp -
Rp 8,880 Rp -
Rp 494,700 Rp -
Rp 159,000 Rp -
Rp 159,000 Rp -
Rp 10,780 Rp -
Rp 16,140 Rp -
Rp 10,700 Rp -
Rp 30,030
Rp 30,030
Rp 30,030
Rp 7,656 Rp -
Rp 7,656 Rp -
Rp 14,900 Rp -
Rp 7,656 Rp -
Rp 37,400 Rp -
Rp -
Rp 9,000 Rp -
Rp -
Rp 30,636 Rp -
Rp 28,194 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp 45,000 Rp -
Rp -
Rp 14,520 Rp -
Rp - Rp -
Rp 237,094 Rp -
Rp 1,600 Rp -
Rp 30,000 Rp -
Rp -
Rp 43,300 Rp -
Rp 43,300 Rp -
Rp 43,300 Rp -
Rp -
Rp 47,672 Rp -
Rp 14,520 Rp -
Rp 36,937 Rp -
Rp 129,300 Rp -
Rp -
Rp -
Rp 39,890 Rp -
Rp 20,748 Rp -
Rp 32,190 Rp -
Rp 48,455 Rp -
Rp 22,880 Rp -
Rp 48,000 Rp -
Rp 22,880 Rp -
Rp -
Rp 3,031 Rp -
Rp 141,414 Rp -
Rp 5,500 Rp -
Rp 5,500 Rp -
Rp 5,500 Rp -
Rp - Rp -
Rp - Rp -
Rp 32,190 Rp -
Rp - Rp -
Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp 34,465 Rp -
Rp 41,910 Rp -
Rp 45,460 Rp -
Rp 38,667 Rp -
Rp 33,000 Rp -
Rp 27,830 Rp -
Rp 5,772 Rp -
Rp 39,604 Rp -
Rp 48,410 Rp -
Rp 33,830 Rp -
Rp 5,772 Rp -
Rp 51,948 Rp -
51,948 Rp -
51,948 Rp -
Rp 125,208 Rp -
Rp 58,830 Rp -
Rp 125,208 Rp -
Rp 58,830 Rp -
Rp 221,220 Rp -
Rp -
Rp 221,220 Rp -
Rp 287,586 Rp -
Rp 287,586 Rp -
Rp 287,586 Rp -
Rp 19,913 Rp -
Rp 376,308 Rp -
Rp 395,688 Rp -
Rp 243,108 Rp -
Rp 241,872 Rp -
Rp 178,650 Rp -
Rp 182,500 Rp -
Rp 178,650 Rp -
Rp -
Rp 176,500 Rp -
Rp 176,500 Rp -
Rp 301,500 Rp -
Rp -
Rp 445,000 Rp -
Rp 445,000 Rp -
Rp 7,744 Rp -
Rp -
Rp 4,345 Rp -
Rp 5,649 Rp -
Rp 4,345 Rp -
Rp 5,649 Rp -
Rp 4,345 Rp -
Rp 5,649 Rp -
Rp 5,431 Rp -
Rp 7,018 Rp -
Rp 5,645 Rp -
Rp 5,645 Rp -
Rp 27,000 Rp -
Rp 27,000 Rp -
Rp 42,150 Rp -
Rp 7,911 Rp -
Rp 7,911 Rp -
Rp 18,642 Rp -
Rp -
Rp -
Rp -
Rp 39,600 Rp -
Rp 116,883 Rp -
Rp 4,235 Rp -
Rp 13,750 Rp -
Rp -
Rp -
Rp 11,440 Rp -
Rp 11,440 Rp -
Rp 40,040 Rp -
Rp 37,500 Rp -
Rp 1,703 Rp -
Rp 1,703 Rp -
Rp 17,724 Rp -
Rp -
Rp -
Rp -
Rp -
Rp 20,748 Rp -
Rp 75,436 Rp -
Rp 35,321 Rp -
Rp -
Rp 2,860 Rp -
Rp -
Rp 374,998 Rp -
Rp 22,005 Rp -
Rp 18,304 Rp -
Rp -
Rp -
Rp 163,900 Rp -
Rp 163,900 Rp -
Rp 163,900 Rp -
Rp 250,000 Rp -
Rp 100,000 Rp -
Rp 33,750 Rp -
Rp 127,000 Rp -
Rp 29,000 Rp -
Rp 13,728 Rp -
Rp 432,000 Rp -
Rp 337,500 Rp -
Rp 499,776 Rp -
Rp 499,776 Rp -
Rp 499,776 Rp -
Rp 282,433 Rp -
Rp 157,180 Rp -
Rp 157,180 Rp -
Rp 67,500 Rp -
Rp 561,719 Rp -
Rp 8,000 Rp -
Rp 4,725,000 Rp -
Rp 60,750 Rp -
Rp 67,500 Rp -
Rp 67,500 Rp -
Rp -
Rp -
Rp 895,000 Rp -
Rp 1,090,000 Rp -
Rp 2,489,400 Rp -
Rp 2,737,900 Rp -
Rp 1,730,700 Rp -
Rp 2,525,050 Rp -
Rp 845,000 Rp -
Rp 600,000 Rp -
Rp -
Rp 3,025,000 Rp -
Rp 2,863,000 Rp -
Rp 1,118,000 Rp -
Rp 2,903,000 Rp -
Rp 1,589,000 Rp -
Rp -
Rp -
Rp -
Rp 23,100 Rp -
Rp 230,175 Rp -
Rp 249,300 Rp -
Rp 210,000 Rp -
Rp 337,500 Rp -
Rp 846,200 Rp -
Rp 462,000 Rp -
Rp 785,400 Rp -
Rp 958,000 Rp -
Rp 884,250 Rp -
Rp 1,170,400 Rp -
Rp 365,600 Rp -
Rp 1,170,400 Rp -
Rp 137,700 Rp -
Rp 149,100 Rp -
Rp 184,800 Rp -
Rp 351,000 Rp -
Rp 380,200 Rp -
Rp 354,200 Rp -
Rp 187,650 Rp -
Rp 346,500 Rp -
Rp 203,300 Rp -
Rp 446,600 Rp -
Rp 246,584 Rp -
Rp 267,100 Rp -
Rp 352,660 Rp -
Rp 246,584 Rp -
Rp 267,100 Rp -
Rp 352,660 Rp -
Rp 267,100 Rp -
Rp 352,660 Rp -
Rp 130,900 Rp -
Rp 198,901 Rp -
Rp 215,500 Rp -
Rp 246,400 Rp -
Rp 200,475 Rp -
Rp 315,600 Rp -
Rp 254,100 Rp -
Rp 270,000 Rp -
Rp 292,500 Rp -
Rp 275,800 Rp -
Rp 400,400 Rp -
Rp 1,181,250 Rp -
Rp 2,180,250 Rp -
Rp 3,252,200 Rp -
Rp 269,500 Rp -
Rp 233,200 Rp -
Rp 292,354 Rp -
Rp 316,700 Rp -
Rp 222,750 Rp -
Rp 174,150 Rp -
Rp 188,600 Rp -
Rp 231,000 Rp -
Rp 151,200 Rp -
Rp 163,800 Rp -
Rp 500,500 Rp -
Rp 133,650 Rp -
Rp 144,800 Rp -
Rp 58,471 Rp -
Rp 87,780 Rp -
Rp 210,000 Rp -
Rp 98,010 Rp -
Rp 106,200 Rp -
Rp 101,640 Rp -
Rp 92,400 Rp -
Rp 89,100 Rp -
Rp 96,500 Rp -
Rp 247,995 Rp -
Rp 268,700 Rp -
Rp 273,000 Rp -
Rp 455,000 Rp -
Rp 455,000 Rp -
Rp 270,800 Rp -
Rp 92,400 Rp -
Rp 35,100 Rp -
Rp 47,200 Rp -
Rp 49,000 Rp -
Rp 328,100 Rp -
Rp 357,000 Rp -
Rp 259,000 Rp -
Rp 175,900 Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 165,000 Rp -
Rp -
Rp -
Rp 14,000 Rp -
Rp 19,644 Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp - Rp -
Rp - Rp -
Rp 1,255 Rp -
Rp 1,185 Rp -
Rp - Rp -
Rp 569 Rp -
Rp 52,500 Rp -
Rp -
Rp 105,380 Rp -
Rp 9,750 Rp -
Rp 79 Rp -
Rp 17,300 Rp -
Rp 201 Rp -
Rp -
Rp 69,898 Rp -
Rp 24,800 Rp -
Rp -
Rp 594 Rp -
Rp -
Rp 252,400 Rp -
Rp 25,659 Rp -
Rp 1,735 Rp -
Rp 16,800 Rp -
Rp -
Rp -
Rp 1,700 Rp -
Rp 16,775 Rp -
Rp 7,950 Rp -
Rp 321 Rp -
Rp 150,600 Rp -
Rp -
26,500 Rp -
Rp 19,400 Rp -
Rp 31,928 Rp -
Rp 51,858 Rp -
Rp 2,981 Rp -
Rp 3,845 Rp -
Rp 416,696 Rp -
Rp 495,247 Rp -
Rp -
Rp 312,428 Rp -
Rp 3,845 Rp -
Rp -
Rp 12,328 Rp -
Rp 15,304 Rp -
Rp 29,600 Rp -
Rp 8,391 Rp -
Rp 10,500 Rp -
Rp 11,440 Rp -
Rp -
Rp -
Rp 206,593 Rp -
Rp 33,413 Rp -
Rp 34,550 Rp -
Rp 1,087 Rp -
Rp 6,921 Rp -
Rp 240,002 Rp -
Rp - Rp -
Rp 7,120 Rp -
Rp 17,498 Rp -
Rp 8,096 Rp -
Rp 253,300 Rp -
Rp 253,300 Rp -
Rp - Rp -
Rp -
Rp 2,200 Rp -
Rp 608,280 Rp -
Rp 222 Rp -
TOTAL
engeluarkan
..............)
getahui
asian Kab. Mappi
y, S.Si., Apt
15 200502 2 007

Diberikan Kepada : Puskesmas Kumaban
Alamat : Distrik Tizain
x) Coret Yang Tidak Perlu Berdasarkan : Pemintaan Eceran
Pengiriman Koli :
HARGA
NO NAMA OBAT / BMHP SATUAN / JUMLAH SUMBER / TAHUN NO BATCH ED TOTAL
SATUAN/KE
KEMASAN
MASAN
Tanggal DBMB : 16/07/2023

A OBAT-OBATAN
1 Asiklovir tablet 400 mg tablet 1000 DAK 2022 NON E KAT 46,304,046 11/23 Rp 473 Rp 473,000
2 Ibuprofen tablet 400 mg tablet 1000 DAK 2022 E-KAT 2204-39-134 04/26 Rp 231 Rp 231,000
3 Metronidazol tablet 500 mg tablet 1000 DAK 2022 NON E-KAT 2106-02-129 06/24 Rp 213 Rp 213,000
4 Omeprazol kapsul 20 mg kapsul 90 DAK 2022 E-KAT A20216J 01/24 Rp 149 Rp 13,410
5 Retinol (vit A) 100.000 IU btl 50 1 BUFFER PROVINSI 122900W 09/25 Rp 33,413 Rp 33,413
BAHAN MEDIS HABIS PAKAI

B
(BMHP)
1 Onemed Ultra One Test Hamil unit 100 DAU 2023 E-KAT 12092288V 08/25 Rp 3,031 Rp 303,100
2 SURFLO IV CATH 24 unit 50 DAU 2023 E-KAT 230303SC 02/28 Rp 7,911 Rp 395,550
3 Infus set dewasa unit 20 DAK 2022 E-KAT 22C15K8902 03/27 Rp 28,194 Rp 563,880
CARESTART MALARIA HRP2/Pldh DAK NON FISIK 2023 E-

4 Ktk 25 37 RMR23D041 08/25 Rp 494,700 Rp 18,303,900
(Pf/PAN) Combo Cassete 25 test/dus. KAT
TOTAL Rp 20,530,253
Yang menerima Yang mengeluarkan
(......................) (......................)
Mengetahui
Yang Menyerahkan Kasie Kefarmasian Kab. Mappi
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Kepi
Alamat : Distrik Obaa
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Asam Askorbat (Vit C) tab 50 mg tablet 20000 DAK 2022 E-KAT 21,316,111 11/23 Rp 51 Rp 1,020,000
2 Griseofulvin tab 125 mg tablet 5000 DAK 2022 E-KAT I11495BJ 08/24 Rp 220 Rp 1,100,000
3 Kotrimoksazol tablet 480 mg tablet 10000 DAK 2021 E-KAT A11325 08/24 Rp 240 Rp 2,400,000
4 Miconazol krim/salep 2% tube 10 g 48 DAU 2023 E-KAT 32,344,610 10/25 Rp 4,505 Rp 216,240
5 Magnesium sulfat injeksi (40%-25ml) vial 10 DAK 2022 E-KAT B73H51B 08/23 Rp 5,100 Rp 51,000
6 Ringer Laktat larutan infus btl 500 ml 60 BUFFER PROVINSI 411,202 11/26 Rp 7,703 Rp 462,180
7 Vitamin B Kompleks tablet tablet 10000 DAK 2022 E.KAT 2109-11-379 04/24 Rp 64 Rp 640,000

B
(BMHP)
1 Infus set dewasa unit 50 DAK 2022 E-KAT 22C15K8902 03/27 Rp 28,194 Rp 1,409,700
2 Safeglove Examination Gloves M ktk 100 10 BTT 2022 06-77-04-7 05/24 Rp 125,208 Rp 1,252,080
3 Sarung tangan ginekologi Pasang 20 DAU 2023 E-KAT 14,042,388 03/28 Rp 19,913 Rp 398,260

A OBAT-OBATAN
1 Asam Mefenamat tab 500 mg tablet 1000 DAK 2022 E-KAT ATMECA21139 01/24 Rp 133 Rp 133,000
2 Klorfeniramin Maleat (CTM) tab 4 mg tablet 1000 DAK 2022 NON E-KAT 2206-07-152 06/24 Rp 76 Rp 76,000
3 Garam Oralit 200 ml sachet 500 DAK 2022 E-KAT 56,373,014 01/26 Rp 280 Rp 140,000
4 Guafenesin OGB 100 mg tablet 1000 DAK 2022 NON E-KAT 2206-02-155 06/25 Rp 215 Rp 215,000
5 Metilprednisolon tablet 4 mg tablet 500 DAK 2022 E-KAT HTMPSD16282 11/23 Rp 124 Rp 62,000
7 Oksitosin 1 mg/ml inj ampul 20 DAK 2022 E-KAT 9622A0001A 12/24 Rp 1,608 Rp 32,160
8 Salbutamol nebules 0,1% ktk 10 3 DAK 2022 NON E-KAT 5,112,176 10/23 Rp 201,000 Rp 603,000
9 OAT FDC KAT.1 & 3 paket 8 BUFFER PROVINSI K22353J 10/25 Rp 416,696 Rp 3,333,568
10 OAT FDC KAT.1 DOSIS HARIAN paket 8 BUFFER PROVINSI ICI1106 06/25 Rp 495,247 Rp 3,961,976

B
(BMHP)
1 Kasa Hydrophil 40 x 80 cm roll 5 DAU 2023 E-KAT 052788MX Rp 237,094 Rp 1,185,470
2 SMI Catgut Silk Black 2/0 HR 30 mm Ktk 12 2 DAU 2023 E-KAT 220101 12/26 Rp 243,108 Rp 486,216
dengan jarum bedah
3 Stik asam urat (Easytouch) btl 10 DAK 2022 NON E-KAT UAS21A09CA1 09/23 Rp 178,650 Rp 1,786,500
4 Stik pemeriksaan HB (Easytouch) btl 5 RELOKASI HBS21A07AAM 09/23 Rp -

A OBAT-OBATAN
1 Klorfeniramin Maleat (CTM) tab 4 mg tablet 3000 DAK 2022 NON E-KAT 2206-07-152 06/24 Rp 76 Rp 228,000
2 Antasida Doen I Tablet Kunyah tablet 3000 DAK 2022 E-KAT A12361 12/24 Rp 55 Rp 165,000
3 Metformin HCl tablet 500 mg tablet 2500 DAK 2022 E-KAT 40,882 03/24 Rp 102 Rp 255,000
5 Parasetamol syrup btl 60 ml 100 DAK 2022 E-KAT A20014 01/25 Rp 1,218 Rp 121,800
7 Salbutamol 2 mg tablet tablet 500 DAK 2022 E-KAT 27,401,201 01/24 Rp 55 Rp 27,500
8 Simvastastin 10 mg tablet 500 BUFFER PROVINSI HTSVND26760 11/24 Rp 650 Rp 325,000
9 Sefadroksil kapsul 500 mg kapsul 500 DAK 2022 NON E-KAT 2206-22-57 06/24 Rp 814 Rp 407,000
10 Zinc Dispersibel tab 20 mg tablet 2000 DAK 2022 E-KAT 5,649,009 01/25 Rp 275 Rp 550,000
B BAHAN MEDIS HABIS PAKAI

(BMHP)
1 Alat suntik sekali pakai 3 ml KTK 100 2 DAU 2023 E-KAT 04112288 10/27 Rp 75,075 Rp 150,150
3 Safeglove Examination Gloves S ktk 100 10 BTT 2022 116-07-7 07/27 Rp 125,208 Rp 1,252,080
4 Sarung tangan ginekologi Pasang 100 DAU 2023 E-KAT 14,042,388 03/28 Rp 19,913 Rp 1,991,300
5 Safeglove PP no. 7 ktk 50 2 DAU 2023 E-KAT 57,005,770 09/27 Rp 287,586 Rp 575,172
6 PRO CREPE PEMBALUT ELASTIS roll 12 DAK 2021 E-KAT 2,104,080 06/25 Rp 5,772 Rp 69,264
UKURAN 7.5 CM X 4,55 M

A OBAT-OBATAN

A OBAT-OBATAN
1 Asam Askorbat (Vit C) tab 250 mg tablet 3000 DAK 2022 E-KAT 29,803,202 02/24 Rp 142 Rp 426,000

B
(BMHP)
1 Aseptic gel 500 cc (Aseptan) btl 12 SILFA DAK NON FISIK 21 03092188 08/24 Rp 45,000 Rp 540,000
2 Alkohol 70% btl 1 L 10 DAK 2022 E-KAT 17,062,288 05/26 Rp 35,343 Rp 353,430
3 Oxyflow Nasal Oxygen Anak unit 20 DAK 2022 E-KAT 26032288TI 02/26 Rp 5,500 Rp 110,000
4 Oxyflow Nasal Oxygen Dewasa unit 20 DAK 2022 E-KAT 24032288TI 02/26 Rp 5,500 Rp 110,000
5 Maxiflow Dewasa (masker oksigen) unit 20 DAK AFFIRMASI 07121789 08/24 Rp 36,937 Rp 738,742
6 Stik kolesterol (Easytouch) btl 10 DAU 2023 E-KAT CHS22707B75 06/24 Rp 301,500 Rp 3,015,000
7 Stik pemeriksaan HB (Quickcheck) btl 1 DAU 2023 E-KAT HbM2080028 06/24 Rp 445,000 Rp 445,000
TOTAL Rp 49,675,874
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Tim P3K Kunjungan Kanonik Uskup ke Eci
Alamat : Distrik Assue
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Etil Klorida Spray btl 100 ml 1 DAK 2022 NON E-KAT 1910924B 1/24 Rp 455,000 Rp 455,000
2 Zegavit ktk 50 5 RELOKASI KTZEGA14622 08/23 Rp 444,600 Rp 2,223,000
3 Zinc Dispersibel tab 20 mg tablet 200 DAK 2022 E-KAT 5,649,009 01/25 Rp 275 Rp 55,000

(BHMP)
1 Kasa kompres 40/40 steril lembar 20 DAK 2022 E-KAT 23,052,288 04/27 Rp 1,600 Rp 32,000
C ALAT KESEHATAN
1 Tas P3K unit 1 INVENTARIS DINKES
2 Gunting unit 1 INVENTARIS DINKES
3 Pingset unit 1 INVENTARIS DINKES
4 Nerbeken unit 1 INVENTARIS DINKES
5 Tensi unit 1 INVENTARIS DINKES
6 Stesoscope unit 1 INVENTARIS DINKES
TOTAL Rp 2,765,000
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Kota-1
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
3 OAT FDC Kat.anak paket 5 RELOKASI 22PK2005 05/24 Rp 312,428 Rp 1,562,140
TOTAL Rp 8,857,684
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : RSUD MAPPI
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 OAT FDC KAT.1 & 3 paket 10 BUFFER PROVINSI K22353J 10/25 Rp 416,696 Rp -
2 OAT FDC Kat.anak paket 1 BUFFER PROVINSI 22PK2005 05/24 Rp 312,428 Rp -

B
(BMHP)
1 Catridge GenXpert MTB pak 10 3 BUFFER PROVINSI 10,006,117,014 11/24 Rp 252,400 Rp 757,200
2 Sputum Pot Buah 200 BUFFER PROVINSI 20610A015 09/27 Rp 2,200 Rp 440,000

A OBAT-OBATAN
2 Bisacodil 5 mg tablet 200 DAK 2022 E-KAT 1,208,009 11/23 Rp 246 Rp 49,200
3 Fitomenadion (Vit K) injeksi i.m 2 ampul 20 DAU 2023 E-KAT TPHNA20023 11/24 Rp 3,819 Rp 76,380
mg/ml
4 Ibuprofen tablet 200 mg tablet 1000 DAK 2022 E-KAT 2204-09-177 04/24 Rp 165 Rp -
6 Kotrimoksazol tablet 480 mg tablet 2000 DAK 2021 E-KAT A11325 08/24 Rp 240 Rp 480,000
8 Omeprazol 40 mg injeksi amp 20 DAK 2022 E-KAT 56820100-1 03/24 Rp 5,599 Rp 111,980
9 Kaptopril 25 mg tablet 1000 DAK 2022 E-KAT 56,324,035 03/24 Rp 75 Rp 37,500
11 Salep 2-4,Kombinasi : As Salisilat 2% pot 12 DAK 2022 E-KAT L17103 12/24 Rp 2,600 Rp 31,200
+ Belerang Endap 4%
13 Tiamin HCl (Vit B1) tablet 50 mg tablet 1000 DAK 2022 E-KAT 20,517,111 11/23 Rp 64 Rp 64,000

B
(BMHP)
1 AESCULAP BLADES / CARBON STEEL ktk 100 1 DAU 2023 E-KAT 4,513,561,019 08/27 Rp 320,832 Rp 320,832
SCALPEL BLADES #20
3 Safeglove Examination Gloves M ktk 100 10 BTT 2022 06-77-04-7 05/24 Rp 125,208 Rp -
4 Safeglove Examination Gloves S ktk 100 10 BTT 2022 116-07-7 07/27 Rp 125,208 Rp -
SMI Catgut Silk Black 2/0 HR 30 mm
5 Ktk 12 2 DAU 2023 E-KAT 220101 12/26 Rp 243,108 Rp 486,216
dengan jarum bedah

A OBAT-OBATAN

B
(BMHP)
1 Masker Bedah Khusus TBC ktk 50 50 BUFFER PROVINSI 21 Rp -

A BAHAN MEDIS HABIS PAKAI
(BMHP)
TOTAL Rp 13,447,350
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Bade
Alamat : Distrik Edera
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
2 OAT FDC Kat.anak paket 1 BUFFER PROVINSI 22PK2005 05/24 Rp 312,428 Rp 312,428

B
(BMHP)

A OBAT-OBATAN
2 Bisacodil 5 mg tablet 200 DAK 2022 E-KAT 1,208,009 11/23 Rp 246 Rp 49,200
3 Fitomenadion (Vit K) injeksi i.m 2 ampul 20 DAU 2023 E-KAT TPHNA20023 11/24 Rp 3,819 Rp 76,380
mg/ml
11 Salep 2-4,Kombinasi : As Salisilat 2% pot 12 DAK 2022 E-KAT L17103 12/24 Rp 2,600 Rp 31,200
+ Belerang Endap 4%
13 Tiamin HCl (Vit B1) tablet 50 mg tablet 1000 DAK 2022 E-KAT 20,517,111 11/23 Rp 64 Rp 64,000

B
(BMHP)
1 AESCULAP BLADES / CARBON STEEL ktk 100 1 DAU 2023 E-KAT 4,513,561,019 08/27 Rp 320,832 Rp 320,832
SCALPEL BLADES #20
SMI Catgut Silk Black 2/0 HR 30 mm
5 Ktk 12 2 DAU 2023 E-KAT 220101 12/26 Rp 243,108 Rp 486,216
dengan jarum bedah

A OBAT-OBATAN
1 Cetirizine 10 mg tablet 500 DAU 2023 E-KAT 2303-12-332 03/25 Rp 81 Rp 40,500
2 Deksametason tab 0,5 mg tablet 1000 DAK 2022 E-KAT 26013112 12/25 Rp 38 Rp 38,000
3 Ketokonazol tablet 200 mg tablet 100 DAU 2023 E-KAT 2303-11-103 03/26 Rp 449 Rp 44,900
4 Salbutamol nebules 0,1% ktk 10 5 DAK 2022 NON E-KAT 5,112,176 10/23 Rp 201,000 Rp 1,005,000
5 Papaverin tablet 40 mg tablet 1000 DAK 2022 NON E KAT 2206-03-156 6/24 Rp 465 Rp 465,000

B
(BMHP)
1 Safeglove PP no. 7 ktk 50 2 DAK 2022 E-KAT 57,003,468 02/27 Rp 221,220 Rp 442,440
2 Safeglove PP no. 7,5 ktk 50 2 DAU 2023 E-KAT 57,505,782 09/27 Rp 287,586 Rp 575,172
3 Stik asam urat (Easytouch) btl 10 DAK 2022 NON E-KAT UAS21A09CA1 09/23 Rp 178,650 Rp 1,786,500
4 Stik gula darah (Easytouch) btl 10 DAU 2023 E-KAT GOS22602A8Q 05/24 Rp 176,500 Rp 1,765,000
TOTAL Rp 23,699,158
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Asset
Alamat : Distrik Syahca Me
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Asam Askorbat (Vit C) tab 50 mg tablet 1000 DAK 2022 E-KAT 21,316,111 11/23 Rp 51 Rp 51,000
3 Amlodipin tablet 5 mg tablet 250 DAK 2020 E-KAT A00003RS 12/24 Rp 83 Rp 20,750

B
(BMHP)
Alat Suntik Sekali Pakai Otomatis
1 unit 100 DAK 2021 E-KAT 20,080,311 09/25 Rp 1,530 Rp 153,000
Rusak 0.5 ml (Oneject II)
2 Kasa Hydrophil 40 x 80 cm roll 3 DAU 2023 E-KAT 052788MX Rp 237,094 Rp 711,282
SD BIOLINE Tes Malaria Pf + Pv
3 ktk 25 11 BUFFER PROVINSI 05EDH004A 04/24 Rp 253,300 Rp 2,786,300
Combo / Parascreen
TOTAL Rp 4,288,832
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Haju
Alamat : Distrik Haju
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Lidokain injeksi 2% (HCl) amp 50 DAU 2023 E-KAT 0230333 02/25 Rp 1,426 Rp 71,300
2 Nifedipin tablet 10 mg tablet 500 DAK 2020 NON E-KAT 51K4213 10/24 Rp 297 Rp 148,500

(BMHP)
1 Stik gula darah (Easytouch) btl 5 DAU 2023 E-KAT GOS22602A8Q 05/24 Rp 176,500 Rp 882,500
3 Stik pemeriksaan HB (Quickcheck) btl 1 DAU 2023 E-KAT HbM2080028 06/24 Rp 445,000 Rp 445,000

A
(BMHP)
1 Safeglove Examination Gloves L Nitril ktk 100 10 DAU 2023 E-KAT 5,410,007,064 01/26 Rp 51,948 Rp 519,480
3 Safeglove PP no. 7,5 ktk 50 2 DAU 2023 E-KAT 57,505,782 09/27 Rp 287,586 Rp 575,172
TOTAL Rp 5,601,322
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Wonggi
Alamat : Distrik Passue Bawah
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Asam traneksamat injeksi Ampul 10 DAK 2022 E KAT 4,120,070 01/25 Rp 2,088 Rp 20,880
2 Gentamisin inj 40 mg/ml amp 5 BUFFER PROVINSI 22GT3042 06/24 Rp 16,775 Rp 83,875
Fitomenadion (Vit K) injeksi i.m 2
3 ampul 20 DAU 2023 E-KAT TPHNA20023 11/24 Rp 3,819 Rp 76,380
mg/ml
4 Lidokain injeksi 2% (HCl) amp 20 DAU 2023 E-KAT 0230333 02/25 Rp 1,426 Rp 28,520

A OBAT-OBATAN
2 Antalgin tab 500 mg tablet 2000 DAK 2022 NON E-KAT 2206-05-142 06/25 Rp 313 Rp 626,000
3 Asiklovir tablet 400 mg tablet 500 DAK 2022 NON E KAT 46,304,046 11/23 Rp 473 Rp 236,500
4 Kalsium Laktat (Kalk) tab 500 mg tablet 2000 DAK REG E-CAT 2021 A01205 6/23 Rp 69 Rp 138,000
5 Kotrimoksazol tablet 480 mg tablet 10000 DAK 2021 E-KAT A11325 08/24 Rp 240 Rp 2,400,000
8 Gentamisin sulfate SK 0.1 % Tube 20 DAU 2023 E-KAT J23549W 10/24 Rp - Rp -
9 Guafenesin OGB 100 mg tablet 5000 DAK 2022 NON E-KAT 2206-02-155 06/25 Rp 215 Rp 1,075,000
10 Parasetamol tablet 500 mg tablet 1000 DAU 2023 E-KAT 2106-34-117 10/23 Rp 150 Rp 150,000
11 Prednison tablet 5 mg tablet 500 DAK 2022 E-KAT 26,301,110 10/25 Rp 83 Rp 41,500
12 Parasetamol syrup btl 60 ml 100 DAK 2022 E-KAT A20014 01/25 Rp 1,218 Rp 121,800

(BMHP)
1 AESCULAP BLADES / CARBON STEEL ktk 100 1 DAU 2023 E-KAT 4513668200 08/27 Rp 320,832 Rp 320,832
SCALPEL BLADES #15
TOTAL Rp 9,426,355
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Yame
Alamat : Distrik Yakomi
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
2 Alopurinol tablet 100 mg tablet 300 DAU 2023 NON E-KAT HTAL0C21029 01/24 Rp 99 Rp -
5 Aminofilin 200 mg tablet 300 DAK 2022 E-KAT 22CH001 08/24 Rp 108 Rp -
6 Amlodipin tablet 10 mg tablet 500 DAK 2021 E-KAT JE0151 11/23 Rp 80 Rp -
19 Antasida Doen I Tablet Kunyah tablet 2000 DAK 2022 E-KAT A12361 12/24 Rp 55 Rp -
211 Vitamin B Kompleks tablet tablet 2000 DAK 2022 E.KAT 2109-11-379 04/24 Rp 64 Rp 128,000
40 OAT FDC KAT.1 DOSIS HARIAN paket 1 BUFFER PROVINSI ICI1106 06/25 Rp 495,247 Rp 495,247

B
(BMHP)
4 Masker Bedah Khusus TBC ktk 50 20 BUFFER PROVINSI 21 Rp -
TOTAL Rp 623,247
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Amazu
Alamat : Distrik Kaibar
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Amoksisilin kaplet 250 mg kaplet 2000 DAK 2022 NON E-KAT 2206-01-51 06/25 Rp 530 Rp 1,060,000
2 Griseofulvin tab 125 mg tablet 2000 DAK 2022 E-KAT I11495BJ 08/24 Rp 220 Rp 440,000
3 ampul 100 DAK 2022 E-KAT I020852 10/24 Rp 1,240 Rp 124,000
mcg/ml
Salep 2-4,Kombinasi : As Salisilat 2%
5 pot 48 DAK 2022 E-KAT L17103 12/24 Rp 2,600 Rp 124,800
+ Belerang Endap 4%

(BMHP)

A OBAT-OBATAN
1 Antalgin tab 500 mg tablet 30 DAK 2022 NON E-KAT 2206-05-142 06/25 Rp 313 Rp 9,390
2 Primakuin tablet 15 mg ktk 100 5 BUFFER PROVINSI 56,386,006 10/24 Rp 29,600 Rp 148,000

B
(BMHP)
Alat Suntik Sekali Pakai Otomatis
1 unit 500 DAK 2021 E-KAT 20,080,311 09/25 Rp 1,530 Rp 765,000
Rusak 0.5 ml (Oneject II)
CARESTART MALARIA HRP2/Pldh DAK NON FISIK 2023 E-

2 Ktk 25 23 RMR23D041 08/25 Rp 494,700 Rp 11,378,100
(Pf/PAN) Combo Cassete 25 test/dus. KAT
TOTAL Rp 16,878,450
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Yeloba
Alamat : Distrik Bamgi
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
2 Artesunate injeksi Ampul 5 BUFFER PROVINSI LA220745 06/25 Rp 69,898 Rp 349,490
3 Deksametason Injeksi 5 mg/ml ampul 5 DAK 2022 E-KAT 56,337,043 03/25 Rp 1,012 Rp 5,060
6 Kalsium Laktat (Kalk) tab 500 mg tablet 300 DAK REG E-CAT 2021 A01205 6/23 Rp 69 Rp 20,700
TOTAL Rp 2,569,580
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Sahapikiah
Alamat : Distrik Venaha
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Albendazole 400 tab ktk 100 6 BUFFER PROVINSI 120,205,152 02/24 Rp 52,500 Rp 315,000
2 Asam traneksamat injeksi Ampul 10 DAK 2022 E KAT 4,120,070 01/25 Rp 2,088 Rp 20,880
4 Sefotaksim inj 1 g vial 20 DAU 2023 E-KAT 54A0685 12/24 Rp 7,320 Rp 146,400
5 Seftriakson inj 1 g vial 20 DAU 2023 E-KAT 53J0464 09/24 Rp 6,900 Rp 138,000
Rp -
B
(BMHP)
SD BIOLINE Tes Malaria Pf + Pv
1 ktk 25 27 BUFFER PROVINSI 05EDH004A 04/24 Rp 253,300 Rp 6,839,100
Combo / Parascreen
4 ICON CS btl 1 L 2 DAK 2021 E-KAT
TOTAL Rp 9,555,410
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Eci
Alamat : Distrik Assue
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 Kloramfenicol salep mata 1% tube 5 g 20 RELOKASI 00454138 08/23 Rp - Rp -
3 Parasetamol tablet 500 mg tablet 10000 DAU 2023 E-KAT 2106-34-117 10/23 Rp 150 Rp 1,500,000
5 Sefadroksil kapsul 500 mg kapsul 1000 DAK 2022 NON E-KAT 2206-22-57 06/24 Rp 814 Rp 814,000

B
(BMHP)
1 Alat suntik sekali pakai 1 ml ktk 100 1 DAU 2023 E-KAT 26,112,288 10/27 Rp 75,075 Rp 75,075
2 SMI Catgut Plain 2/0 HR 37 mm Ktk 12 1 DAU 2023 E-CAT 221001 09/27 Rp 395,688 Rp 395,688
dengan jarum bedah
3 SMI Catgut Silk Black 2/0 HR 30 mm Ktk 12 1 DAU 2023 E-KAT 220101 12/26 Rp 243,108 Rp 243,108
dengan jarum bedah
4 My Jelly 82 gram tube 2 DAU 2023 E-KAT 6,032,388 02/26 Rp 39,890 Rp 79,780
TOTAL Rp 11,103,803
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Kota-2
Alamat : Distrik Nambaioman Bapai
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 MB Anak blister 12 BUFFER PROVINSI B.LR4050 11/24 Rp 31,928 Rp 383,136
2 MB Dewasa blister 12 BUFFER PROVINSI BMF0987 02/26 Rp 51,858 Rp 622,296
TOTAL Rp 1,005,432
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : IFK
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A BAHAN MEDIS HABIS PAKAI
(BMHP)
1 Pharmafix (5 cm x 500 cm) unit 1 DAK 2022 E-KAT I5K21 10/26 Rp 32,190 Rp -
3 Leukoplast 7,5 cm x 4,5 m roll 1 DAK 2020 E-KAT 94,414,909 10/26 Rp 43,300 Rp 43,300
Tanggal DBMB :05/07/2023

A OBAT-OBATAN
212 Zegavit ktk 50 6 RELOKASI KTZEGA14622 08/23 Rp 444,600 Rp 2,667,600
TOTAL Rp 2,870,900
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Kotiak
Alamat : Distrik Passue
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
1 OAT FDC Kat.anak paket 5 RELOKASI 22PK2005 05/24 Rp 312,428 Rp 1,562,140
TOTAL Rp 1,562,140
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt

NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

Diberikan Kepada : Puskesmas Kabe
Alamat : Distrik Minyamur
Pengiriman Koli :
HARGA
SATUAN/KE
KEMASAN
MASAN

A OBAT-OBATAN
2 Amitriptilin 25 mg ktk 100 1 BUFFER PROVINSI A1430JY 10/25 Rp 17,300 Rp 17,300
3 Ampicilin serbuk injeksi 1000 mg/ml ktk 10 1 DAK 2020 E-KAT 36436033 09/24 Rp 176,000 Rp 176,000
4 Domperidon tablet 10 mg tablet 300 DAK 2022 E-KAT HTD8DB16099 11/23 Rp 82 Rp 24,600
5 Deksametason tab 0,5 mg tablet 500 DAK 2022 E-KAT 26013112 12/25 Rp 38 Rp 19,000
6 Curcuma tablet kotak/120 3 DAK 2022 E-KAT 22B0210 04/24 Rp 140,000 Rp 420,000
9 Prednison tablet 5 mg tablet 500 DAK 2022 E-KAT 26,301,110 10/25 Rp 83 Rp 41,500
12 Sulfadiazine Silver / perak sulfadiazin tube 35 g 5 DAK 2022 NON E-KAT 2BH1836 08/25 Rp 20,700 Rp 103,500
krim 1%

(BMHP)
1 Kasa Hydrophil 40 x 80 cm roll 2 DAU 2023 E-KAT 052788MX Rp 237,094 Rp 474,188
2 Hidrogen Peroksida Botol 2 DAK 2022 E-KAT 1,102,188 09/24 Rp 9,000 Rp 18,000
4 My Jelly 82 gram tube 5 DAU 2023 E-KAT 6,032,388 02/26 Rp 39,890 Rp 199,450

A OBAT-OBATAN
2 Seftriakson inj 1 g vial 10 DAU 2023 E-KAT 53J0464 09/24 Rp 6,900 Rp 69,000
3 Sulfadiazine Silver / perak sulfadiazin tube 35 g 5 DAK 2022 NON E-KAT 2BH1836 08/25 Rp 20,700 Rp 103,500
krim 1%

B
(BMHP)
PRO CREPE PEMBALUT ELASTIS
2 roll 5 DAK 2021 E-KAT 2,104,088 5/26 Rp 45,460 Rp 227,300
UKURAN 10 CM X 4,55 M
3 SD Bioline HBsAg test 25 BUFFER PROVINSI H22034 08/24 Rp 7,120 Rp 178,000
4 SD HIV Syphilis Combo (INDEC) test 25 BUFFER PROVINSI K22016 10/24 Rp 17,498 Rp 437,438
TOTAL Rp 4,568,526
\
(......................) (......................)
Mengetahui
(......................) Diyany, S.Si., Apt
NIP. 19791015 200502 2 007
Catatan :
arsip penerima.

DBMB Eceran Juli 2023

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DINAS KESEHATAN KABUPATEN MAPPI

INSTALASI FARMASI KABUPATEN MAPPI

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

AntiFungi Doen Salep whitfield, Kombinasi:

23 Antihemoroid, Kombinasi supp DAK 2022 E-KAT B2032OW 02/24

48 Bufacetin (Kloramfenicol salep kulit 2%) tube 15 g

73 Fitomenadion (Vit K1) injeksi i.m 10 mg/ml ampul

C BAHAN MEDIS HABIS PAKAI (BMHP)

J Reagen Hematology Analyzer ( SYSMEX X5 ) :

M BUFFER STOCK PROVINSI

Kombinasi : ferro fumarat 60 mg + as.folat

33 Masker N95 Dream Can Type II R Pieces BUFFER PROVINSI ME0IL-K261011030 -

64 SD BIOLINE Tes Malaria Pf + Pv Combo / ktk 25 BUFFER PROVINSI 05EDH004A 04/24

65 SD BIOLINE Tes Malaria Pf + Pv Combo / ktk 25 PERDAKI 2023 05EDH005C 06/24

Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 16/07/2023

BAHAN MEDIS HABIS PAKAI

CARESTART MALARIA HRP2/Pldh DAK NON FISIK 2023 E-

Yang menerima Yang mengeluarkan

(......................) Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 26/06/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 03/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 07/07/2023

B BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 10/07/2023

Tanggal DBMB : 24/07/2023

BAHAN MEDIS HABIS PAKAI

(......................) Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 24/07/2023

B BAHAN MEDIS HABIS PAKAI

Yang menerima Yang mengeluarkan

(......................) Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 10/07/2023

(......................) Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 07/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 10/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 07/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 07/07/2023

(......................) Diyany, S.Si., Apt

DOKUMEN BUKTI MUTASI BARANG(DBMB)

A Atas Permintaan IF Kabupaten : Mappi

Tanggal DBMB : 07/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 10/07/2023

BAHAN MEDIS HABIS PAKAI

Tanggal DBMB : 14/07/2023

BAHAN MEDIS HABIS PAKAI