No

Nama Obat

Satuan

Masuk
35,000

2,030.00

180

Tablet

86.00

200

Tablet

90.00

200

Tablet

330.00

180

Tablet

211.00

21,600

Botol

4,045.00

2,700

Antasida DOEN I tablet kunyah,

kombinasi : Aluminium
Hidroksida 200 mg Magnesium
Hidroksida 200 mg

Tablet

75.00

20,000

Antasida DOEN II suspensi,

kombinasi : Aluminium
Hidroksida 200 mg/5 ml
Magnesium Hidroksida 200 mg/5
ml

Botol

2,100.00

300

Dus @ 50 gram

1,250.00

1,200

Tube 5 gr

1,520.00

500

12

Bedak salisil serbuk 2%

Betametason krim 0,1%
(sebagai Valerat)
Deksametason tablet 0,5 mg

Tablet

68.00

800

13

Gentamisin injeksi 40 mg/ ml

Ampul

3,399.00

50

14

Glukosa larutan infus 10 % steril

botol @ 500 ml

5,700.00

20

15

Glukosa larutan infus 5 % steril botol @ 500 ml

5,200.00

20

16
17
18

Hidrokortison krim 2,5 %

Tube 5 gr

2,798.00

Ibuprofen tablet 200 mg

Tablet

110.00

Tablet

149.00

648
13,000
4,500

Tablet

70.00

45,000

Tablet

80.00

6,400

Tablet

51.00

30,000

3
4
5
6
7

10
11

19
20
21

Tablet

Harga
312.40

Amoksisilin tablet 500 mg

Air untuk injeksi (Aqua pro
Injeks) 20 ml
Alopurinol tablet/kapsul/kaplet
100 mg

Vial 20 ml

Aminofilin tablet scored 200 mg

Amlodipin tablet 10 mg
Amoksisilin kapsul/kaplet 250
mg
Amoksisilin sirup kering forte
250 mg/5 ml

Ibuprofen tablet 400 mg

Kalsium Laktat (Kalk)
tablet/kapsul/kaplet 500 mg
Kaptopril tablet scored 25 mg
Klorfeniramina Maleat (CTM)
tablet/kapsul/kaplet 4 mg

22

Kotrimoksazol DOEN I (dewasa)

kombinasi : Sulfametoksazol 400
mg Trimetoprim 80 mg

23

Kotrimoksazol Suspensi komb:

Sulfametoksazol 200 mg +
Botol @ 60 ml
Trimetoprim 40 mg / 5 ml

24

Metilergometrin Maleat
(Metilergometrin) tablet salut
0,125 mg

25
26
27
28
29
30
31
32
33
34
35
36

149.00

1,600

2,145.00

1,200

Tablet

154.00

200

Metronidazol tablet 500 mg

Tablet

160.00

13,000

Nifedipin tablet/kapsul 10 mg

Tablet

100.00

700

Botol

5,200.00

150

Botol

1,438.00

4,500

89.00

220,000

296.00

200

2,163.00

15

14,203.00

30

120.00
5,200.00

3,400
1,600

2,000.00

264

107.00

24,000

Parasetamol drop 100 mg/ml btl

@15ml (60mg/0,6ml)
Parasetamol sirup 120 mg / 5 ml

Kaplet

Parasetamol tablet 500 mg

Tablet
Pirantel tablet score (base) 125
Tablet
mg
Povidon Iodida larutan 10% 30
botol @ 30 ml
ml
Povidon Iodida larutan 10% 300
botol @ 300 ml
ml
Ranitidin tablet 150 mg
Tablet
Ringer Laktat larutan infus

botol 500 ml

Salep 2-4 , Kombinasi : Asam

Salisilat 2% + Belerang endap Pot @ 30 gram
4%
Vitamin B Kompleks tablet

Tablet

37

Alat Suntik Sekali Pakai - 1 cc

Tuberculin 27G x 1/2"(stera)

Pcs

650.00

2,000

38

Alat Suntik Sekali Pakai - 10

cc x 21G x 1 1/2"(stera)

Pcs

925.00

100

39

Alat Suntik Sekali Pakai - 2.5

cc x 23G x 1 1/4"(stera)

Pcs

650.00

2,400

40

Alat Suntik Sekali Pakai - 5 cc

x 22G x 1 1/4"(stera)

Pcs

750.00

600

41

Infus Set, IV, Wing needle Infusion Set Pediatric (60

drops/ml)(Stera Infusion Set
Pediatric (60 drops/ml))

Pcs

3,500.00

200

42
43

IV Catheter Jerco 1 (18G)

IV Catheter Jerco 1 (20G)

Pcs
Pcs

7,334.00
7,334.00

250
250

44
45

IV Catheter Jerco 1 (22G)

IV Catheter Jerco 1 (24G)

Pcs
Pcs

7,334.00
7,334.00

400
400

46

Kasa, Verband, Kapas - kasa

Hydrofil 40 x 80cm ( SURYA
HUSADA KASA HIDROFIL 40 x
80 cm)

Rol

104,500.00

12

47

Kasa, Verband, Kapas - kasa

sterile (AHMADARIS kasa
steril DRC / 16 pad 16 x 16
cm )

Box

7,900.00

400

48

Kasa, Verband, Kapas - Kapas

Pembalut
Hydrofil(AHMADARIS DRC
250gr)

Rol

24,000.00

26

Total

Keluar
9,175

Sisa
25,825

Masuk
10,934,000.00

Keluar
2,866,270.00

Sisa
8,067,730.00

175

365,400.00

10,150.00

355,250.00

200

17,200.00

17,200.00

200

18,000.00

18,000.00

180

59,400.00

59,400.00

495

21,105

4,557,600.00

104,445.00

4,453,155.00

247

2,453

10,921,500.00

999,115.00

9,922,385.00

2,999

17,001

1,500,000.00

224,925.00

1,275,075.00

300

630,000.00

126

1,074

1,500,000.00

157,500.00

1,342,500.00

21

479

760,000.00

31,920.00

728,080.00

170

630

54,400.00

11,560.00

42,840.00

50

169,950.00

169,950.00

20

114,000.00

114,000.00

20

104,000.00

104,000.00

45
707
339

603
12,293
4,161

1,813,104.00
1,430,000.00
670,500.00

125,910.00
77,770.00
50,511.00

1,687,194.00
1,352,230.00
619,989.00

1,590

43,410

3,150,000.00

111,300.00

3,038,700.00

390

6,010

512,000.00

31,200.00

480,800.00

3,500

26,500

1,530,000.00

178,500.00

1,351,500.00

630,000.00

470

1,130

238,400.00

70,030.00

168,370.00

145

1,055

2,574,000.00

311,025.00

2,262,975.00

200

30,800.00

12,132

2,080,000.00

700

70,000.00

70,000.00

150

780,000.00

780,000.00

500

4,000

6,471,000.00

719,000.00

5,752,000.00

9,068

210,932

19,580,000.00

807,052.00

18,772,948.00

200

59,200.00

11

32,445.00

30

426,090.00

280

3,400
1,320

408,000.00
8,320,000.00

1,456,000.00

408,000.00
6,864,000.00

16

248

528,000.00

32,000.00

496,000.00

4,829

19,171

2,568,000.00

516,703.00

2,051,297.00

700

1,300

1,300,000.00

455,000.00

845,000.00

100

92,500.00

2,350

1,560,000.00

600

450,000.00

36

164

700,000.00

250
250

1,833,500.00
1,833,500.00

868

50

138,880.00

8,652.00
-

32,500.00
-

126,000.00

30,800.00
1,941,120.00

59,200.00
23,793.00
426,090.00

92,500.00
1,527,500.00
450,000.00

574,000.00

1,833,500.00
1,833,500.00

30
95

370
305

2,933,600.00
2,933,600.00

220,020.00
696,730.00

12

1,254,000.00

10

390

3,160,000.00

79,000.00

3,081,000.00

25

624,000.00

24,000.00

600,000.00

103,651,689.00

10,673,668.00

92,978,021.00

2,713,580.00
2,236,870.00
1,254,000.00

Keterangan

PT. IGM
PT. Kimia Farma
PT. MBS
Marin Liza
PT. MBS
PT. IGM
PT. Holi

PT. MPI

PT. Sapta Sari

PT. Sapta Sari
PT. Kimia Farma
PT. IGM
PT. IGM
PT. IGM
PT. IGM
PT. Kimia Farma
Rajawali
PT. Holi
PT. IGM
PT. MPI
PT. Sapta Sari

PT. Holi

Marin Liza

PT. Kimia Farma

PT. Kimia Farma
PT. AAM
PT. IGM
PT. IGM
PT. IGM
PT. Holi
PT. IGM
PT. IGM
PT. AAM
PT. IGM
Marin Liza
PT. Kimia Farma
PT. Alphatirta Medica
PT. Alphatirta Medica
PT. Alphatirta Medica
PT. Alphatirta Medica

PT. Alphatirta Medica

Rajawali
Rajawali

Rajawali
Rajawali
PT. IGM

Rajawali

Rajawali

LAPORAN OBAT JKN

UPT PUSKESMAS PALIMA

BULAN DESEMBER 201

No

Nama Obat

Satuan

Stok Awal

Penerimaan

Air untuk Injeksi 20 ml

Vial

180

Alat Suntik Sekali Pakai 1 cc Stera

Pcs

2,000

Alat Suntik Sekali Pakai 10 cc Stera

Pcs

100

Alat Suntik Sekali Pakai 2,5 cc Stera

Pcs

2,400

Alat Suntik Sekali Pakat 5 cc Stera

Pcs

600

Allopurinol 100 mg

Tablet

200

Aminofillin tablet 200 mg

Tablet

200

Amlodipine 10 mg

Tablet

180

Amoksicillin 500 mg

Tablet

35,000

10

Amoksicillin sirup 250 mg/5ml

Botol

2,700

11

Amoksisillin kapsul 250 mg

Kapsul

21,600

12

Antasida Sirup

Botol

300

13

Antasida tablet

Tablet

20,000

14

Bedak Salisil 2%

PCS

1,200

15

Betametason Krim 0,1%

Tube

500

16

Captopril 25 mg

Tablet

6,400

17

CTM 4 mg

Tablet

30,000

18

Deksametason tablet 0,5 mg

Tablet

800

19

Gentamisin Injeksi 40 mg/ml

Ampul

50

20

Glukosa larutan infus 10% steril

Botol

20

21

Glukosa larutan infus 5% steril

Botol

20

22

Hidrokortison Krim 2,5%

Tube

648

23

Ibuprofen tablet 200 mg

Tablet

13,000

24

Ibuprofen tablet 400 mg

Tablet

4,500

25

Infusion set Anak Stera

Pcs

200

26

Jelco 18

Pcs

250

27

Jelco 20

Pcs

250

28

Jelco 22

Pcs

400

29

Jelco 24

Pcs

400

30

Kalk tablet 500 mg

Tablet

31

Kasa Hidrofil 40x80

Pcs

12

32

Kapas Pembalut Hidrofil 250

Pcs

26

33

Kasa Steril 16x16

Pcs

400

34

Kotrimoksazol dewasa

Tablet

1,600

35

Kotrimoksazol suspensi

Botol

1,200

36

Mertonidazol tablet 500 mg

Tablet

13,000

37

Metilergometrin Maleat

Tablet

200

38

Nipedipin tablet 10 mg

Tablet

700

39

Paracetamol drop

Botol

150

40

Paracetamol sirup 120mg/5 ml

Botol

4,500

45,000

41

Paracetamol tablet 500 mg

Tablet

220,000

42

Povidon Iodida larutan 10% 30 ml

Botol

15

43

Povidon Iodida larutan 10% 300 ml

Botol

30

44

Pyrantel tablet 125 mg

Tablet

200

45

Ranitidin tablet 150 mg

Tablet

3,400

46

Ringer Laktat larutan infus

Botol

1,600

47

Salep 2-4 kombinasi

48

Vitamin B Kompleks tablet

Mengetahui
Kepala UPT Puskesmas Palimanan

drg. Hj. Retno Widowati

NIP. 19661025 200112 2 001

Pot
Tablet

264
24,000

Petugas Pusk

Teti Nury
NIP. 19831031 20

PORAN OBAT JKN

SKESMAS PALIMANAN

AN DESEMBER 2015

Januari

Februari

Total
Pemakaian

100

600

700

100

100

2,400

50

50

2,350

600

600

200

200

200

200

180

180

Persediaan

Desember

180
2,000

Sisa Stok
175
1,300

35,000

421

4363

4391

9175

25,825

2,700

20

84

143

247

2,453

21,600

495

495

21,105

300

20,000

540

2459

2999

17,001

1,200

126

126

1,074

500

21

21

479

6,400

121

269

390

6,010

30,000

3500

3500

26,500

800

170

170

630

300

50

50

20

20

20

20

648

45

45

603

13,000

707

707

12,293

4,500

64

275

339

4,161

200

23

13

36

164

250

250

250

250

400

15

15

30

370

400

27

68

95

305

45,000

1590

1590

12

12

26

25

400

10

10

390

1,600

180

290

470

1,130

1,200

32

113

145

1,055

13,000

274

594

868

12,132

200

200

700

700

150

150

208

255

500

4,500

37

43,410

4,000

220,000

9068

9068

15

11

30

30

200

200

3,400

3,400

1,600

80

200

280

1,320

264

16

16

248

2004

2825

4829

24,000
460,395

Petugas Puskesmas

Teti Nuryanti
NIP. 19831031 200604 2 011

36,911

210,932

19,171
423,484

175
1,300
100
2,350
600
200
200
180
25,825
2,453
21,105
300
17,001
1,074
479
6,010
26,500
630

50
20
20
603
12,293
4,161
164
250
250
370
305
43,410
12
25
390
1,130
1,055
12,132
200
700
150
4,000

210,932
11
30
200
3,400
1,320
248
19,171