SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU

(SBBK)
NO : /Farm/PKM-P. Cahu/2015 Tanggal
UNIT KERJA : PUSTU Juking Pajang Berdasarkan

NO NAMA OBAT SATUAN HARGA JUMLAH

1 Abocate No. 20 Pcs Rp. 8,565.00 2
2 Abocate No. 22 Pcs Rp. 17,600.00 2
3 Abocate No. 24 Pcs Rp. 17,600.00 0
4 Alat suntik sekali pakai 1 ml Pcs Rp. 1,250.00 10
5 Alat suntik sekali pakai 2,5ml Pcs Rp. 1,142.00 0
6 Alat suntik sekali pakai 3 ml Pcs Rp. 1,142.00 10
7 Alat suntik sekali pakai 5 ml Pcs Rp. 1,142.00 10
8 Allopurinol 100mg tablet Tablet Rp. 90.00 100
9 Ambroxol 100mg tabltab Tablet Rp. 168.00 0
10 Ambroxol 15mg/5ml sirup Botol Rp. 4,425.00 5
11 Amlodipin 5mg tab Tablet Rp. 197.00 0
12 Amlodipin 10mg tab Tablet Rp. 197.00 0
13 Amitrippilin 25 mg tab Tablet Rp. - 0
14 Aminopillin inj. 24mg/5ml Tablet Rp. 3,300.00 0
15 Aminopillin 200mg tablet Tablet Rp. 86.00 0
16 Amoksisilin 250mg capsul Capsul Rp. 220.00 0
17 Amoksisilin 500 mg tablet Tablet Rp. 279.00 200
18 Amoksisilin sirup krng 125 mg Botol Rp. 2,560.00 5
19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 10,395.00 100
20 Antalgin 500 mg tablet Tablet Rp. 164.00 0
21 Antasida doen srp Botol Rp. 2,213.00 5
22 Antasida doen tablet Tablet Rp. 73.00 100
23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. - 0
24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 525.00 0
25 Antiparkinson tab Tablet Rp. - 0
26 Antimigrain Kombinasi tablet Tablet Rp. 149.00 0
27 Antihaemaroid suppositoria Supp Rp. - 0
28 Aqua pro injeksi Vial Rp. 4,000.00 0
29 Asiklovir 200mg tablet Tablet Rp. 245.00 0
30 Asiklovir 400mg tablet Tablet Rp. 354.00 0
31 Asiklovir cream Tube Rp. - 0
32 As. Ascorbat 50 mg tab Tablet Rp. 105.00 0
33 As. ascorbat 250 mg tab Tablet Rp. 154.00 0
34 As. Mefenamatt 500 mg tab Tablet Rp. 122.00 100
35 As. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 2,025.00 0
36 Asetosal 100mg tablet Tablet Rp. - 0
37 Asetosal 500mg tablet Tablet Rp. - 0
38 Atropin sulfat inj. 0.25mg/ml Ampul Rp. - 0
39 Atropin sulfat 0.5mg tablet Tablet Rp. - 0
40 Benzatil penisilin 1,2,juta IU/vial injeksi Vial Rp. - 0
41 Benzatil penisilin 2,4,juta IU/vial injeksi Vial Rp. - 0
42 Betametason cream Tube Rp. 1,669.00 5

43 Catgut benang bedah no.2/0,3/0 Pcs Rp. 29,333.00 0
44 Calcidol syr Botol Rp. - 0
45 Caviplex tablet Tablet Rp. 470.00 0

46 Caviplex Syr Botol Rp. 6,156.00 0
47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 190.00 50
48 Cimetidine tab Tablet Rp. - 0
49 Captopril 12,5 mg tab Tablet Rp. 79.00 100
50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 495.00 60
51 Dexsametason 0,5 mg tab Tablet Rp. 68.00 100
52 Dexsametason 5 mg/ml inj Ampul Rp. 1,750.00 10
53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. - 0
54 Difenhidramin Hcl Inj Ampul Rp. 1,160.00 0
55 Diazepam 5mg/2ml inj Ampul Rp. 2,605.00 0
56 Diazepam 5mg tab Tablet Rp. - 0
57 Diazepam 2mg tab Tablet Rp. 35.00 0
58 Digoksin 0,25 tablet Tablet Rp. 96.00 0
59 Doksisiklin 100mg capsul Capsul Rp. - 0
60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 174.00 100
61 Domperidom syr/ Vesverum syr Botol Rp. 3,490.00 5
62 Dulcolax 5mg tab Tablet Rp. 1,145.00 0
63 Dulcolax supp Supp Rp. - 0
64 Efedrin tab Tablet Rp. - 0
65 Epineprin HCL (adrenalin) Inj 0,1% /1ml Ampul Rp. 5,143.00 0
66 Ektrak beladon 100mg tab Tablet Rp. - 0
67 Erytromisin 250mg cap Capsul Rp. 509.00 0
68 Erytromisin 500mg tab Tablet Rp. 1,023.00 0
69 Erytromisin 125mg/5ml srp krg Botol Rp. 8,090.00 5
70 Etyl klorida semprot Botol Rp. 115,500.00 0
71 Etanol 70% 1000 ml Botol Rp. 32,500.00 0
72 Etakridina (rivanol) lar. 0.1% Botol Rp. 10,625.00 0
73 Etambuthol HCL 500mg tablet Tablet Rp. - 0
74 Famotidine tab Tablet Rp. - 0
75 Fenobarbital inj. Ampul Rp. 1,980.00 0
76 Fenobarbital 30mg tab. Tablet Rp. - 0
77 Fenol gliserol Botol Rp. - 0
78 Fitomenadion 10mg tab Tablet Rp. 697.00 0
79 Fitomenadion 10mg/ml inj Ampul Rp. 2,833.00 0
80 Folley Cateter no. 16 Pcs Rp. 12,000.00 0
81 Folley Cateter no. 18 Pcs Rp. 12,000.00 0
82 Furosemid 10mg/ml inj Ampul Rp. 1,926.00 50
83 Furosemid 40mg tab Tablet Rp. 92.00 0
84 Garam oralit Sachet Rp. 322.00 50
85 Gentamisin salep 0.1% Tube Rp. 2,019.00 0
86 Gentamisin tetes mata 0.3% Botol Rp. - 0
87 Gentian violet Botol Rp. 3,125.00 0
88 Glibenklamid 5mg tablet Tablet Rp. - 0
89 Gliseril guaiacolat 100mg tab Tablet Rp. 35.00 250
90 Griseufulvin 125mg tab Tablet Rp. 224.00 200
91 Glukosa lar. Infus 5% Botol Rp. 5,844.00 0
92 Hidrocortison krim 2,5% Tube Rp. 3,576.00 5
93 Haloperidol 0.5mg tablet Tablet Rp. 66.00 0
94 Haloperidol 1.5mg tablet Tablet Rp. 91.00 0
95 Haloperidol 5mg tablet Tablet Rp. - 0

96 Hidroklortiazid HCT 25mg tab Tablet Rp. - 0

. Inj Ampul Rp. 0 .00 100 145 NGT Nasogastric Tube no.00 0 116 Kloramfenicol 125mg/5 susp Botol Rp. 0 123 Klorpromazine HCL 100mg tab Tablet Rp. 0 115 Ketorolac 30mg inj Ampul Rp.00 0 138 Metronidazol 500mg tab Tablet Rp. 10 Tube Rp. 0 120 Klorfeniramini Maleat 4mg tab Tablet Rp.00 200 118 Kloramfenicol tts telinga 3 % Botol Rp. 57.00 0 130 Lidokain komp.00 0 128 Lisol Botol Rp.000.485.000.896. . 0 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 2. 8. 891. 152.00 0 131 Masker Ktk/50"s Rp. . 25. 0 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 0 112 Ketoconazole 2 % krim Tube Rp.633. Infus 0.00 0 143 Neurobion inj Ampul Rp.000. .850. 2.228. 0 135 Methilergometrin maleat inj Ampul Rp.00 0 98 Ibuprofen 400mg tab Tablet Rp.000.000.00 0 110 Kasa Pembalut 4m X 3cm Rol Rp.00 0 136 Methilergometrin maleat tab Tablet Rp. 0 122 Klorpromazine HCL 25mg tab Tablet Rp. 2. 8. 5mg/2ml Ampul Rp. 0 137 Metronidazol 250mg tab Tablet Rp.00 0 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 5. 25.00 0 113 Ketoconazole 200mg tab Tablet Rp. 320. 0 124 Klorpromazine HCL inj. 0 134 Metoclorprofamid 10mg tab Tablet Rp.00 0 99 Ibuprofen 200mg tab Tablet Rp. . . .00 0 144 Neurodex tab Tablet Rp.000 IU/g tab vag Tablet Rp. 0 129 Lidokain 2 % inj Ampul Rp. 10. 2. . 4. 116. 0 125 Kotrimoxazol 120mg tab Tablet Rp.00 0 109 Kasa Pembalut 2m X 80cm Rol Rp. 22.300.00 0 101 Infusion set dewasa Pcs Rp.665. .00 5 117 Kloramfenicol kapsul 250 mg Capsul Rp.00 3 119 Kloramfenicol salep mata 1% Tube Rp.00 0 126 Kotrimoxazol 480mg tab Tablet Rp.20 200 106 Kapas pembalut 500gr Rol Rp.00 0 107 Karbamazepin 200mg tab Tablet Rp. . 8. 8. .9% Botol Rp.050. . 121. . . 0 133 Metilprednisolon inj Ampul Rp.00 200 100 Infusion set anak Pcs Rp. 146. 0 105 Kalsium laktat 500mg tab Tablet Rp.00 0 114 Ketorolac 10mg inj Ampul Rp. 300. .00 200 121 Kloroquin 250mg tab Tablet Rp. 600. 4.298.00 0 141 Natrium Diklofenak 25mg tab Tablet Rp. 157. 929. . 97 Hufalysin syr Botol Rp. 1.00 50 142 Natrium klorida lar.00 0 140 Microlax enema Tube Rp.00 0 127 Kotrimoxazol Suspensi Botol Rp.390.918.600. 79. 0 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 50. 20. 169.000. . . 3. 0 146 Nistatin 100.00 0 139 Miconazole cream Tube Rp.00 0 102 Intunal Forte tablet Tablet Rp.00 0 103 Isoniazid 300mg tab Tablet Rp.

00 50 .147 Nistatin 500. .000 IU tablet Tablet Rp. 115. 0 148 Nipedipin tab Tablet Rp.

00 0 163 Piroksikam 10mg tab Tablet Rp.00 0 169 Prednison tab Tablet Rp.00 0 196 Surgical Blade Pcs Rp. . 91. 8. 3. 10. 0 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 529. 554. 125.00 0 182 Sarung tangan steril No. 330. 0 177 Rifampisin 300mg capsul Capsul Rp.200. .344.000. 109. 265.00 0 189 Sefotaxim inj Vial Rp. 0 187 Salisil bedak 2% Pot Rp. 93. .00 0 181 Salbutamol 2mg tablet Tablet Rp.00 0 175 Ranitidine 25mg / 2ml inj Ampul Rp.00 0 183 Sarung tangan steril No. 7 Pcs Rp. .00 0 198 Tablet tambah darah sachet Rp.00 0 166 Pyrantel pamoat tab Tablet Rp.00 0 171 Propanolol HCL 40mg tablet Tablet Rp.00 100 165 Plester 5 yard X 2 inc Rol Rp.00 0 173 Ramabion capsule Capsul Rp. 0 195 Siprofloksasin HCL 500mg tablet Tablet Rp.500.00 0 157 Parasetamol 100mg tab Tablet Rp. 0 180 Ringer laktat lar infus Botol Rp. 0 178 Rifampisin 450mg tab Tablet Rp.149 Obat batuk hitam Botol Rp. 126. 0 176 Reserpine 0. 2. . 0 179 Rifampisin 600mg tab Tablet Rp. 0 158 Parasetamol 500mg tab Tablet Rp. 0 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp.00 300 159 Papaverin tab Tablet Rp. 15.00 10 . .535.00 0 168 Povidon iodida 10% 300ml Botol Rp.688.00 250 170 Primakuin 15mg tab Tablet Rp. 0 160 Piracetam 400mg tab Tablet Rp. 7. 0 188 Sefadroxil 500mg capsul Capsul Rp. 8 Pcs Rp.174.00 0 162 Piridoksin 10mg tab Tablet Rp.000.00 0 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 0 174 Ranitidine 150mg tablet Tablet Rp.5 Pcs Rp. 1. 1. 10. 2. .00 0 194 Simvastatin 10mg tablet Tablet Rp. . 6.386.00 100 164 Piroksikam 20mg tab Tablet Rp.000. 0 156 Parasetamol 120mg/5ml srp Botol Rp.000. 3/0 Pcs Rp. 1. . . 0 155 Parasetamol drops 100mg/ 1ml Botol Rp. .200.850. .00 5 153 Oksitosin 10IU/ml inj Ampul Rp.974. 11.500. 20.00 0 192 Sianokobalamin (vit B12) inj Ampul Rp.00 0 154 Omeperazole capsule Capsul Rp. 10. 15.00 0 186 Salep 2-4 komb Pot Rp.00 0 184 Sarung tangan steril No. 5. 85. .646.00 10 193 Silk benang bedah sutra No. 0 150 Oksitetrasiklin inj Vial Rp. . . 0 191 Selang Oksigen Pcs Rp. 128.000.333. . 7. 0 190 Seftriakson inj Vial Rp. 5.1mg tab Tablet Rp. .00 0 197 Sulfacetamid tts mata 15% Botol Rp.00 0 161 Piracetam 1gr tab Vial Rp.00 0 185 Sarung tangan steril No. 10.000.00 0 167 Povidon iodida 10% 30ml Botol Rp. . 3. 35.5 Pcs Rp. 133.

199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 409. . 0 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.00 0 .

0 203 Tramadol 50mg kasul Capsul Rp. . 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.500. 7. 112.201 Thiamin Hcl 50mg tab Tablet Rp. SRI RAHAYU NIP.. 514. 19700306 200212 2006 . 522. . 16 Januari 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. NIP. .00 0 202 Thiamin Hcl 100mg/ml inj Ampul Rp.00 0 204 Ultraproct N suppositoria Supp Rp. 0 TO TAL P.00 100 208 Gentamisin Injeksi Ampul Rp.00 200 207 Zinc Tablet Rp. 53. . 0 205 Urine Bag Pcs Rp.00 0 206 Vitamin B komplek tab Tablet Rp. Cahu. 0 209 Suntik KB 3 Bln Vial Rp. Puruk Cahu FITRI AGUSYANI NIP.

U

: 16 Januari 2015
: LPLO Pustu

TOTAL KETERANGAN

Rp. 17,130.00
Rp. 35,200.00
Rp. -
Rp. 12,500.00
Rp. -
Rp. 11,420.00
Rp. 11,420.00
Rp. 9,000.00
Rp. -
Rp. 22,125.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 55,800.00
Rp. 12,800.00
Rp. ###
Rp. -
Rp. 11,065.00
Rp. 7,300.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 12,200.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 8,345.00

Rp. -
Rp. -
Rp. -

Rp. -
Rp. 9,500.00
Rp. -
Rp. 7,900.00
Rp. 29,700.00
Rp. 6,800.00
Rp. 17,500.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 17,400.00
Rp. 17,450.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 40,450.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 96,300.00
Rp. -
Rp. 16,100.00
Rp. -
Rp. -
Rp. -
Rp. -
Rp. 8,750.00
Rp. 44,800.00
Rp. -
Rp. 17,880.00
Rp. -
Rp. -
Rp. -

Rp. -

60.00 Rp.440. - Rp. - Rp.684. - Rp.000. 20.00 Rp. - Rp. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp.250. - Rp. - Rp. - Rp.300. - Rp. - Rp.00 Rp. - Rp.00 Rp. 6.000. - Rp. - Rp. - Rp. 24. 5. - Rp. - Rp. - .00 Rp. - Rp. 11. - Rp. - Rp. - Rp.Rp. - Rp. - Rp.00 Rp. - Rp. - Rp. - Rp. 60.200. - Rp. - Rp. - Rp. - Rp. 7. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp.000. - Rp. - Rp. - Rp.

5. - Rp.750.Rp.00 .

12. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp. - Rp. - Rp. - Rp. - Rp. - Rp.Rp.500.900. - Rp. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp. - Rp. - Rp. - Rp. - Rp.250. - Rp. - Rp.00 Rp. - Rp. - Rp. - Rp. - Rp. 11. - Rp. - Rp. - Rp. 8.000. - Rp. - Rp. - Rp. - Rp.230.00 Rp.740. 10. 22. - Rp. - Rp.600. 23.00 Rp. 25. - Rp.00 . - Rp. - Rp. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp.

- Rp.Rp. - .

### 6 Januari 2015 Puskesmas YANI 0003 2002 . 22. 52.200.400. - Rp. - Rp. - Rp. - Rp.00 Rp. - Rp. - Rp.00 Rp. Rp. - Rp.

21 Antasida doen srp Botol Rp. .5mg tablet Tablet Rp.00 100 Rp.560. 35 As. 28 Aqua pro injeksi Vial Rp. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 1. 33 As. 0 Rp. 29 Asiklovir 200mg tablet Tablet Rp. 0 Rp. 0. 17 Amoksisilin 500 mg tablet Tablet Rp. 17.669. 0 Rp. 2. . Mefenamatt 500 mg tab Tablet Rp. 31 Asiklovir cream Tube Rp. 4. 197. . 2. 1.00 0 Rp.5ml Pcs Rp.425.juta IU/vial injeksi Vial Rp. 1. . 17. 0 Rp.00 4 Rp.300. 27 Antihaemaroid suppositoria Supp Rp. 164. 220. 4.00 100 Rp.00 0 Rp.142. 0 Rp.00 0 Rp.00 0 Rp.565. 38 Atropin sulfat inj. 245.00 5 Rp. 20 Antalgin 500 mg tablet Tablet Rp. 149. 90. 197. 41 Benzatil penisilin 2. 3.00 0 Rp. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. 2. 30 Asiklovir 400mg tablet Tablet Rp. 11 Amlodipin 5mg tab Tablet Rp. 0 Rp. . 354. 10 Ambroxol 15mg/5ml sirup Botol Rp. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Muara Bumban Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH 1 Abocate No.00 0 Rp.025. 86. 73.00 0 Rp. 22 Antasida doen tablet Tablet Rp. 12 Amlodipin 10mg tab Tablet Rp.00 0 Rp.00 100 Rp. 5 Alat suntik sekali pakai 2.00 0 Rp. 525. 0 Rp.600. . 34 As.600.00 200 Rp. 154.00 100 Rp. . 32 As. 3 Abocate No. 18 Amoksisilin sirup krng 125 mg Botol Rp. 2 Abocate No. 13 Amitrippilin 25 mg tab Tablet Rp. 168.142. 0 Rp.00 2 Rp. 0 Rp. . 16 Amoksisilin 250mg capsul Capsul Rp. 122. 20 Pcs Rp.00 100 Rp. 105.juta IU/vial injeksi Vial Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp. Ascorbat 50 mg tab Tablet Rp. 9 Ambroxol 100mg tabltab Tablet Rp.000. 24mg/5ml Tablet Rp. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.00 5 Rp. 25 Antiparkinson tab Tablet Rp.00 0 Rp. 39 Atropin sulfat 0.213.00 0 Rp. 26 Antimigrain Kombinasi tablet Tablet Rp.00 2 Rp. 22 Pcs Rp. .250.142.2. 10. 42 Betametason cream Tube Rp.00 10 Rp.00 10 Rp.00 0 Rp. 8 Allopurinol 100mg tablet Tablet Rp. 7 Alat suntik sekali pakai 5 ml Pcs Rp.00 120 Rp. . 6 Alat suntik sekali pakai 3 ml Pcs Rp.00 100 Rp. 40 Benzatil penisilin 1. 14 Aminopillin inj. 0 Rp.00 0 Rp. . 0 Rp.00 0 Rp. ascorbat 250 mg tab Tablet Rp. 1.395. . SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.25mg/ml Ampul Rp. 37 Asetosal 500mg tablet Tablet Rp.00 0 Rp. 36 Asetosal 100mg tablet Tablet Rp.4. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 24 Pcs Rp. 8.00 4 Rp. 279. 1. 15 Aminopillin 200mg tablet Tablet Rp.

333.3/0 Pcs Rp.00 0 Rp. 29. 44 Calcidol syr Botol Rp. .2/0. . 45 Caviplex tablet Tablet Rp. 470. 0 Rp.43 Catgut benang bedah no.00 0 Rp.

576.500. 94 Haloperidol 1.160. 48 Cimetidine tab Tablet Rp. 49 Captopril 12. . 87 Gentian violet Botol Rp.00 10 Rp. 0 Rp. Infus 5% Botol Rp.00 0 Rp. .00 100 Rp. 59 Doksisiklin 100mg capsul Capsul Rp. 1.00 5 Rp.00 5 Rp. 82 Furosemid 10mg/ml inj Ampul Rp. 174.00 50 Rp.5 mg tab Tablet Rp. . 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.000.00 0 Rp. 86 Gentamisin tetes mata 0. 72 Etakridina (rivanol) lar. .1% Botol Rp.1% /1ml Ampul Rp. 3. 83 Furosemid 40mg tab Tablet Rp.019.023. 0 Rp. 697. 2. 35. 75 Fenobarbital inj. 80 Folley Cateter no.00 250 Rp. . 12. .46 Caviplex Syr Botol Rp. 32. . 56 Diazepam 5mg tab Tablet Rp.125. 95 Haloperidol 5mg tablet Tablet Rp. 79.5mg tablet Tablet Rp. 8.00 0 Rp. 1. 5.00 0 Rp. 509. 68.00 0 Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 0 Rp.00 0 Rp.5% Tube Rp. 0 Rp. 79 Fitomenadion 10mg/ml inj Ampul Rp.605. 66.00 60 Rp. 91 Glukosa lar. 61 Domperidom syr/ Vesverum syr Botol Rp. 0 Rp. 51 Dexsametason 0. 88 Glibenklamid 5mg tablet Tablet Rp.00 0 Rp. 2. 16 Pcs Rp. 63 Dulcolax supp Supp Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp. . 84 Garam oralit Sachet Rp.625. 2.5 mg tab Tablet Rp. 89 Gliseril guaiacolat 100mg tab Tablet Rp. 71 Etanol 70% 1000 ml Botol Rp. . 58 Digoksin 0. 12. 76 Fenobarbital 30mg tab.00 0 Rp.926. . ### 0 Rp. 0 Rp. 0 Rp. 57 Diazepam 2mg tab Tablet Rp.25 tablet Tablet Rp. 0 Rp. 1. 0 Rp. 77 Fenol gliserol Botol Rp.00 0 Rp. 68 Erytromisin 500mg tab Tablet Rp.00 0 Rp.00 0 Rp. 64 Efedrin tab Tablet Rp. 224. 78 Fitomenadion 10mg tab Tablet Rp. 0 Rp. .145. 190. 92 Hidrocortison krim 2.1% Tube Rp.844. 3.980.156.00 100 Rp. 322. 1. 62 Dulcolax 5mg tab Tablet Rp. 69 Erytromisin 125mg/5ml srp krg Botol Rp.00 0 Rp.00 100 Rp.00 0 Rp.00 0 Rp. . Ampul Rp.00 0 Rp. 85 Gentamisin salep 0. Tablet Rp. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 0 Rp. 90 Griseufulvin 125mg tab Tablet Rp.00 5 Rp. 74 Famotidine tab Tablet Rp.00 100 Rp. 0 Rp.00 10 Rp.143. 67 Erytromisin 250mg cap Capsul Rp.090. 65 Epineprin HCL (adrenalin) Inj 0. 3.00 0 Rp. 96.750. 54 Difenhidramin Hcl Inj Ampul Rp. 52 Dexsametason 5 mg/ml inj Ampul Rp. 70 Etyl klorida semprot Botol Rp.5mg tablet Tablet Rp.00 0 Rp. 91. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 10. 35.00 0 Rp.833. 92.00 0 Rp.00 100 Rp. .00 0 Rp. . 18 Pcs Rp. 6. 1. 55 Diazepam 5mg/2ml inj Ampul Rp. 0 Rp.00 5 Rp.000. 0 Rp.3% Botol Rp. 81 Folley Cateter no. 93 Haloperidol 0. 5. 495.490.00 0 Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 1. . 0.

. 0 Rp. .96 Hidroklortiazid HCT 25mg tab Tablet Rp.

50.00 6 Rp. 0 Rp.00 0 Rp. . 115 Ketorolac 30mg inj Ampul Rp. 121 Kloroquin 250mg tab Tablet Rp. 8. 0 Rp.000.00 50 Rp. . 105 Kalsium laktat 500mg tab Tablet Rp.050. 138 Metronidazol 500mg tab Tablet Rp. 600. 5. 4. . 10 Tube Rp.918. 122 Klorpromazine HCL 25mg tab Tablet Rp. 2. 2.000 IU/g tab vag Tablet Rp.600.633. 320. 8.000.298. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 3. Infus 0. 121.00 0 Rp.00 10 Rp. . . 98 Ibuprofen 400mg tab Tablet Rp.00 0 Rp. 8. .00 5 Rp.000. 157. 144 Neurodex tab Tablet Rp. 0 Rp. 137 Metronidazol 250mg tab Tablet Rp. . Inj Ampul Rp. 891. 146 Nistatin 100.00 5 Rp. . .00 0 Rp. .00 0 Rp. 79. 119 Kloramfenicol salep mata 1% Tube Rp. 20.00 0 Rp.000. 126 Kotrimoxazol 480mg tab Tablet Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 123 Klorpromazine HCL 100mg tab Tablet Rp. 143 Neurobion inj Ampul Rp. 142 Natrium klorida lar. 134 Metoclorprofamid 10mg tab Tablet Rp. 57.00 100 Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp. 139 Miconazole cream Tube Rp. 152. 0 Rp. 0 Rp.00 0 Rp. 107 Karbamazepin 200mg tab Tablet Rp. . 300.00 0 Rp. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 109 Kasa Pembalut 2m X 80cm Rol Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 5mg/2ml Ampul Rp.00 0 Rp. 929.390.485. 113 Ketoconazole 200mg tab Tablet Rp.00 100 Rp.00 0 Rp.00 200 Rp. 99 Ibuprofen 200mg tab Tablet Rp. 8.00 0 Rp. . 112 Ketoconazole 2 % krim Tube Rp. . 146. 0 Rp. 0 Rp.228. 103 Isoniazid 300mg tab Tablet Rp.9% Botol Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. . 101 Infusion set dewasa Pcs Rp. 0 Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 0 Rp. 0 Rp. 22. 133 Metilprednisolon inj Ampul Rp. 131 Masker Ktk/50"s Rp.665.00 0 Rp. 0 Rp. 114 Ketorolac 10mg inj Ampul Rp. 0 Rp.00 500 Rp. 130 Lidokain komp. 4. 118 Kloramfenicol tts telinga 3 % Botol Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. . 0 Rp.000.00 0 Rp. 10. 0 Rp. 0 Rp. 128 Lisol Botol Rp. 127 Kotrimoxazol Suspensi Botol Rp.20 0 Rp. 140 Microlax enema Tube Rp.00 3 Rp. 2. 124 Klorpromazine HCL inj. 2.00 100 Rp. 106 Kapas pembalut 500gr Rol Rp.00 0 Rp.850. 1. 0 Rp.00 50 Rp.00 0 Rp. 0 Rp. 145 NGT Nasogastric Tube no. . . 97 Hufalysin syr Botol Rp.000.00 0 Rp. 102 Intunal Forte tablet Tablet Rp. . 169. 25. 0 Rp. .300. 100 Infusion set anak Pcs Rp. 25.896.00 0 Rp.00 0 Rp. 116. 129 Lidokain 2 % inj Ampul Rp. 135 Methilergometrin maleat inj Ampul Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp.00 0 Rp. 136 Methilergometrin maleat tab Tablet Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp.

. 148 Nipedipin tab Tablet Rp.000 IU tablet Tablet Rp. . 115.00 0 Rp. 0 Rp.147 Nistatin 500.

196 Surgical Blade Pcs Rp. 5.00 0 Rp. 163 Piroksikam 10mg tab Tablet Rp. 85. 0 Rp. 10.00 50 Rp. 159 Papaverin tab Tablet Rp. 529. 177 Rifampisin 300mg capsul Capsul Rp. 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 0 Rp.00 0 Rp. 173 Ramabion capsule Capsul Rp. 154 Omeperazole capsule Capsul Rp.535.200. . 5. 160 Piracetam 400mg tab Tablet Rp. 187 Salisil bedak 2% Pot Rp. . 166 Pyrantel pamoat tab Tablet Rp.00 0 Rp. 152 Oksitetrasiklin Hcl salep 1% Tube Rp.000. 0 Rp.149 Obat batuk hitam Botol Rp.00 100 Rp.000. . 158 Parasetamol 500mg tab Tablet Rp. 330. 167 Povidon iodida 10% 30ml Botol Rp. 20. 171 Propanolol HCL 40mg tablet Tablet Rp. 190 Seftriakson inj Vial Rp. 191 Selang Oksigen Pcs Rp.00 0 Rp. 0 Rp. 169 Prednison tab Tablet Rp.5 Pcs Rp. .174. 0 Rp. 0 Rp.646. 164 Piroksikam 20mg tab Tablet Rp. 194 Simvastatin 10mg tablet Tablet Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 180 Ringer laktat lar infus Botol Rp. 35.200.00 0 Rp. 0 Rp. 178 Rifampisin 450mg tab Tablet Rp. .00 0 Rp.00 0 Rp. 183 Sarung tangan steril No. . .00 0 Rp. 7. 188 Sefadroxil 500mg capsul Capsul Rp.00 0 Rp. 10. . 0 Rp. 181 Salbutamol 2mg tablet Tablet Rp.00 0 Rp. 2.000.00 0 Rp. 7.000. 189 Sefotaxim inj Vial Rp. .00 0 Rp.500.00 10 Rp. 15. 10.00 0 Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp. . 109. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 6. 0 Rp. 197 Sulfacetamid tts mata 15% Botol Rp.688. 93. 0 Rp. 174 Ranitidine 150mg tablet Tablet Rp. 7 Pcs Rp. .00 10 Rp. 1. 125. 0 Rp. 3/0 Pcs Rp. 198 Tablet tambah darah sachet Rp.5 Pcs Rp. 0 Rp.500. 0 Rp. 554. . 153 Oksitosin 10IU/ml inj Ampul Rp.00 0 Rp. 150 Oksitetrasiklin inj Vial Rp.00 0 Rp.00 0 Rp. 1. 168 Povidon iodida 10% 300ml Botol Rp. 192 Sianokobalamin (vit B12) inj Ampul Rp. 0 Rp. 0 Rp.00 0 Rp. 156 Parasetamol 120mg/5ml srp Botol Rp.00 200 Rp. 157 Parasetamol 100mg tab Tablet Rp. . 3. 193 Silk benang bedah sutra No. . 11. .000. 3. 10. 0 Rp. 185 Sarung tangan steril No.00 0 Rp. .00 0 Rp. 1.00 0 Rp.00 0 Rp. 15. 91. 165 Plester 5 yard X 2 inc Rol Rp.974. 170 Primakuin 15mg tab Tablet Rp. 128.00 0 Rp. 0 Rp. 182 Sarung tangan steril No.1mg tab Tablet Rp.00 0 Rp.850. 186 Salep 2-4 komb Pot Rp. 133.386. 8. 8 Pcs Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp.333. 265. 179 Rifampisin 600mg tab Tablet Rp.00 50 Rp.00 3 Rp.344.00 10 Rp. 162 Piridoksin 10mg tab Tablet Rp. . 176 Reserpine 0.000. 126. 2. 0 Rp. 184 Sarung tangan steril No. . 161 Piracetam 1gr tab Vial Rp. .00 0 Rp.

. .199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 0 Rp. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.00 0 Rp. 409.

00 0 Rp. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. 0 Rp. SRI RAHAYU NIP.00 0 Rp. 206 Vitamin B komplek tab Tablet Rp. Cahu. NIP. 208 Gentamisin Injeksi Ampul Rp. 0 Rp. 207 Zinc Tablet Rp. 522.00 0 Rp. 0 Rp. . 53. . . 202 Thiamin Hcl 100mg/ml inj Ampul Rp.. 7.00 300 Rp. 205 Urine Bag Pcs Rp.00 0 Rp. 204 Ultraproct N suppositoria Supp Rp. 0 Rp.201 Thiamin Hcl 50mg tab Tablet Rp. 514. 112. . Puruk Cahu FITRI AGUSYANI NIP. 26 Januari 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 19700306 200212 2006 .500. TO TAL Rp. 203 Tramadol 50mg kasul Capsul Rp. 209 Suntik KB 3 Bln Vial Rp. P.

00 27.000.00 9.26 Januari 2015 LPLO Pustu TOTAL KETERANGAN 17.00 12.00 35.200.00 - - - - - 26.420.00 - - 11.00 - - - 11.00 11.00 .00 - 12.400.700.800.500.00 16.800.00 - - - - - - 24.300.065.00 - - - - - - - 6.00 17.000.00 7.130.420.00 - - 21.900.676.200.

- - - .

750.00 - - - 8.500.400.450.700.00 17.600.00 6.300.900.00 - - - - - - 102.00 - - - - - 8. - - - 7.00 - - - - - - - - - - - - - - 32.00 22.800.095.00 - 11.200.00 10.00 29.00 - - - .880.00 17.700.450.00 - 17.00 40.

- .

000. - 7.00 15.00 - - .00 - - - - - - - - - - - - - - - - - 20.600.500.200.850.00 - - - - 15.800.000.910.900.00 - 12.00 - - 8.00 - - 16.00 - - - - 46.00 - - 14.490.00 - 6.00 11.684.250.00 - - 30.

- - .

900.00 - - - - 10.00 - - 13.00 - - - - - - - - - - - - - - - - - - - - - - - - 26.00 - - - - 17.550.00 22.880.000.000.00 - 11.250.00 - - - 11.740. - - - - 116.450.00 .

-
-

-
-
-
-
-
33,600.00
-
-
-
###

nuari 2015
esmas

2002

SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU
(SBBK)
NO : /Farm/PKM-P. Cahu/2015 Tanggal :
UNIT KERJA : PUSTU Juking Pajang Berdasarkan :

NO NAMA OBAT SATUAN HARGA JUMLAH

1 Abocate No. 20 Pcs Rp. 8,565.00 2 Rp.
2 Abocate No. 22 Pcs Rp. 17,600.00 2 Rp.
3 Abocate No. 24 Pcs Rp. 17,600.00 0 Rp.
4 Alat suntik sekali pakai 1 ml Pcs Rp. 1,250.00 10 Rp.
5 Alat suntik sekali pakai 2,5ml Pcs Rp. 1,142.00 0 Rp.
6 Alat suntik sekali pakai 3 ml Pcs Rp. 1,142.00 10 Rp.
7 Alat suntik sekali pakai 5 ml Pcs Rp. 1,142.00 10 Rp.
8 Allopurinol 100mg tablet Tablet Rp. 90.00 100 Rp.
9 Ambroxol 100mg tabltab Tablet Rp. 168.00 0 Rp.
10 Ambroxol 15mg/5ml sirup Botol Rp. 4,425.00 5 Rp.
11 Amlodipin 5mg tab Tablet Rp. 197.00 0 Rp.
12 Amlodipin 10mg tab Tablet Rp. 197.00 0 Rp.
13 Amitrippilin 25 mg tab Tablet Rp. - 0 Rp.
14 Aminopillin inj. 24mg/5ml Tablet Rp. 3,300.00 0 Rp.
15 Aminopillin 200mg tablet Tablet Rp. 86.00 0 Rp.
16 Amoksisilin 250mg capsul Capsul Rp. 220.00 0 Rp.
17 Amoksisilin 500 mg tablet Tablet Rp. 279.00 200 Rp.
18 Amoksisilin sirup krng 125 mg Botol Rp. 2,560.00 5 Rp.
19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 10,395.00 100 Rp.
20 Antalgin 500 mg tablet Tablet Rp. 164.00 0 Rp.
21 Antasida doen srp Botol Rp. 2,213.00 5 Rp.
22 Antasida doen tablet Tablet Rp. 73.00 100 Rp.
23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. - 0 Rp.
24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 525.00 0 Rp.
25 Antiparkinson tab Tablet Rp. - 0 Rp.
26 Antimigrain Kombinasi tablet Tablet Rp. 149.00 0 Rp.
27 Antihaemaroid suppositoria Supp Rp. - 0 Rp.
28 Aqua pro injeksi Vial Rp. 4,000.00 0 Rp.
29 Asiklovir 200mg tablet Tablet Rp. 245.00 0 Rp.
30 Asiklovir 400mg tablet Tablet Rp. 354.00 0 Rp.
31 Asiklovir cream Tube Rp. - 0 Rp.
32 As. Ascorbat 50 mg tab Tablet Rp. 105.00 0 Rp.
33 As. ascorbat 250 mg tab Tablet Rp. 154.00 0 Rp.
34 As. Mefenamatt 500 mg tab Tablet Rp. 122.00 100 Rp.
35 As. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 2,025.00 0 Rp.
36 Asetosal 100mg tablet Tablet Rp. - 0 Rp.
37 Asetosal 500mg tablet Tablet Rp. - 0 Rp.
38 Atropin sulfat inj. 0.25mg/ml Ampul Rp. - 0 Rp.
39 Atropin sulfat 0.5mg tablet Tablet Rp. - 0 Rp.
40 Benzatil penisilin 1,2,juta IU/vial injeksi Vial Rp. - 0 Rp.
41 Benzatil penisilin 2,4,juta IU/vial injeksi Vial Rp. - 0 Rp.
42 Betametason cream Tube Rp. 1,669.00 5 Rp.

43 Catgut benang bedah no.2/0,3/0 Pcs Rp. 29,333.00 0 Rp.
44 Calcidol syr Botol Rp. - 0 Rp.
45 Caviplex tablet Tablet Rp. 470.00 0 Rp.

88 Glibenklamid 5mg tablet Tablet Rp. 92 Hidrocortison krim 2. 49 Captopril 12. 80 Folley Cateter no. 63 Dulcolax supp Supp Rp.00 0 Rp.00 100 Rp. 0 Rp.00 5 Rp. 3.46 Caviplex Syr Botol Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 3.00 0 Rp.00 0 Rp. 68. 65 Epineprin HCL (adrenalin) Inj 0. .00 0 Rp. 1. 66. 0 Rp. 96. 5. 18 Pcs Rp.00 0 Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 71 Etanol 70% 1000 ml Botol Rp. . 59 Doksisiklin 100mg capsul Capsul Rp. 70 Etyl klorida semprot Botol Rp. 1. 0 Rp. 1. 5. 0 Rp.1% Botol Rp. .576.156. 6. 1. 190.625.000. . 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp.500. 91. 72 Etakridina (rivanol) lar. 0 Rp.00 100 Rp. 0 Rp. 58 Digoksin 0. 0 Rp. 51 Dexsametason 0.00 200 Rp. 0 Rp.00 50 Rp. 0 Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.00 0 Rp. 10.00 5 Rp. Ampul Rp. 1.00 0 Rp. 0 Rp. 81 Folley Cateter no.833.00 10 Rp. 174. 54 Difenhidramin Hcl Inj Ampul Rp.143. 0 Rp.00 50 Rp. 322. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 67 Erytromisin 250mg cap Capsul Rp.5 mg tab Tablet Rp. .160. 79. . 697. 93 Haloperidol 0. . .00 0 Rp. 77 Fenol gliserol Botol Rp. 55 Diazepam 5mg/2ml inj Ampul Rp.605. 84 Garam oralit Sachet Rp.5mg tablet Tablet Rp. 3. 509. 92. Tablet Rp.500. 12. 89 Gliseril guaiacolat 100mg tab Tablet Rp. 224.145.1% Tube Rp.5% Tube Rp. 57 Diazepam 2mg tab Tablet Rp. 56 Diazepam 5mg tab Tablet Rp. 35. Infus 5% Botol Rp.00 0 Rp.490.00 0 Rp.00 0 Rp.00 250 Rp.00 0 Rp. . 1. 78 Fitomenadion 10mg tab Tablet Rp.980. 95 Haloperidol 5mg tablet Tablet Rp. 75 Fenobarbital inj. 52 Dexsametason 5 mg/ml inj Ampul Rp. 2. 8. 0. 68 Erytromisin 500mg tab Tablet Rp.750. 32.000. 115.1% /1ml Ampul Rp.090. 83 Furosemid 40mg tab Tablet Rp.00 0 Rp. 0 Rp. . 82 Furosemid 10mg/ml inj Ampul Rp.00 0 Rp. 91 Glukosa lar.844.019.00 0 Rp. 90 Griseufulvin 125mg tab Tablet Rp. 0 Rp. . 35. 87 Gentian violet Botol Rp.00 0 Rp.926. 64 Efedrin tab Tablet Rp. . 69 Erytromisin 125mg/5ml srp krg Botol Rp. 61 Domperidom syr/ Vesverum syr Botol Rp.00 60 Rp. 0 Rp.25 tablet Tablet Rp.00 0 Rp.00 0 Rp. 94 Haloperidol 1. 12.00 0 Rp.5 mg tab Tablet Rp. 2. 2.00 5 Rp.5mg tablet Tablet Rp. 85 Gentamisin salep 0.00 50 Rp.023.125. 495. 16 Pcs Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp.00 100 Rp.00 0 Rp. 48 Cimetidine tab Tablet Rp.3% Botol Rp. 76 Fenobarbital 30mg tab. 74 Famotidine tab Tablet Rp.00 0 Rp. . . 86 Gentamisin tetes mata 0. . 62 Dulcolax 5mg tab Tablet Rp. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp.00 0 Rp.

. .96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp.

00 100 Rp.00 0 Rp.00 0 Rp. 135 Methilergometrin maleat inj Ampul Rp. 146. 102 Intunal Forte tablet Tablet Rp. 140 Microlax enema Tube Rp. . 106 Kapas pembalut 500gr Rol Rp. 50. 110 Kasa Pembalut 4m X 3cm Rol Rp. 2.00 0 Rp.00 0 Rp. . 115 Ketorolac 30mg inj Ampul Rp. 121. 119 Kloramfenicol salep mata 1% Tube Rp.228.390. . 118 Kloramfenicol tts telinga 3 % Botol Rp. 8.00 0 Rp.000. 8. 0 Rp.00 0 Rp. . 5mg/2ml Ampul Rp. . 123 Klorpromazine HCL 100mg tab Tablet Rp. 5. 133 Metilprednisolon inj Ampul Rp. 2. 600. 130 Lidokain komp. 127 Kotrimoxazol Suspensi Botol Rp. 0 Rp. Infus 0. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 4. 0 Rp. 146 Nistatin 100. 20.000. 134 Metoclorprofamid 10mg tab Tablet Rp.600. 105 Kalsium laktat 500mg tab Tablet Rp. 114 Ketorolac 10mg inj Ampul Rp. 0 Rp.00 0 Rp. 0 Rp. 0 Rp. 145 NGT Nasogastric Tube no. 8. 129 Lidokain 2 % inj Ampul Rp. .918.000. 142 Natrium klorida lar. 157. 99 Ibuprofen 200mg tab Tablet Rp.00 0 Rp. 57. 0 Rp.00 200 Rp. . 929.00 5 Rp. 139 Miconazole cream Tube Rp. 143 Neurobion inj Ampul Rp.20 200 Rp. 136 Methilergometrin maleat tab Tablet Rp.00 3 Rp. 0 Rp.485. 141 Natrium Diklofenak 25mg tab Tablet Rp.00 0 Rp.000. 0 Rp. 300. Inj Ampul Rp. 320. 113 Ketoconazole 200mg tab Tablet Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 107 Karbamazepin 200mg tab Tablet Rp. 121 Kloroquin 250mg tab Tablet Rp. 100 Infusion set anak Pcs Rp.00 0 Rp. 122 Klorpromazine HCL 25mg tab Tablet Rp. 126 Kotrimoxazol 480mg tab Tablet Rp. 116.00 0 Rp. .00 0 Rp. . 144 Neurodex tab Tablet Rp.896. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp.00 0 Rp.00 0 Rp. 0 Rp. 0 Rp. 2. 97 Hufalysin syr Botol Rp. 152. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. . 3. 137 Metronidazol 250mg tab Tablet Rp.00 200 Rp.00 0 Rp. 10. 0 Rp.00 0 Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp. 2. 0 Rp.00 0 Rp. 103 Isoniazid 300mg tab Tablet Rp. 138 Metronidazol 500mg tab Tablet Rp.665. 0 Rp. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.000. 891.000 IU/g tab vag Tablet Rp. 98 Ibuprofen 400mg tab Tablet Rp. . 79. 109 Kasa Pembalut 2m X 80cm Rol Rp. 8. 0 Rp. 25.298.00 200 Rp.000. 101 Infusion set dewasa Pcs Rp.00 0 Rp. . 25.00 0 Rp. 1. 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. .00 0 Rp. . . 116 Kloramfenicol 125mg/5 susp Botol Rp. 22. .050.00 0 Rp. 124 Klorpromazine HCL inj.9% Botol Rp.850. 112 Ketoconazole 2 % krim Tube Rp.00 50 Rp. . 0 Rp. 169. 10 Tube Rp. 131 Masker Ktk/50"s Rp.00 0 Rp.00 0 Rp. .00 0 Rp. 128 Lisol Botol Rp. 0 Rp. 4. .633.300.

.147 Nistatin 500.000 IU tablet Tablet Rp. 115. . 0 Rp. 148 Nipedipin tab Tablet Rp.00 50 Rp.

. 126. 178 Rifampisin 450mg tab Tablet Rp. 163 Piroksikam 10mg tab Tablet Rp.00 0 Rp. 154 Omeperazole capsule Capsul Rp. 10. 170 Primakuin 15mg tab Tablet Rp. 161 Piracetam 1gr tab Vial Rp.00 0 Rp. 8 Pcs Rp. 162 Piridoksin 10mg tab Tablet Rp. 133. 10. 157 Parasetamol 100mg tab Tablet Rp.149 Obat batuk hitam Botol Rp. .200. 0 Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 10. 0 Rp.00 0 Rp.00 0 Rp. 177 Rifampisin 300mg capsul Capsul Rp.344.00 0 Rp. 0 Rp. . 3. 185 Sarung tangan steril No. .000. 529.333.00 0 Rp. 15. 0 Rp. 184 Sarung tangan steril No. 7 Pcs Rp. 0 Rp. 2. 168 Povidon iodida 10% 300ml Botol Rp.000. 20. 85.00 0 Rp.386. 0 Rp. .535.00 0 Rp. . 0 Rp.000. 0 Rp. 0 Rp. .174.000. . 7.00 100 Rp. 166 Pyrantel pamoat tab Tablet Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp. 0 Rp. 180 Ringer laktat lar infus Botol Rp.00 5 Rp.500. 0 Rp. .00 0 Rp. 181 Salbutamol 2mg tablet Tablet Rp.500.646. 5. 0 Rp. 10. 2. 158 Parasetamol 500mg tab Tablet Rp. 156 Parasetamol 120mg/5ml srp Botol Rp. 109. 197 Sulfacetamid tts mata 15% Botol Rp. 35. 183 Sarung tangan steril No. 3/0 Pcs Rp.00 0 Rp. 160 Piracetam 400mg tab Tablet Rp.00 0 Rp. . 93. 11.1mg tab Tablet Rp. 5. 91.00 0 Rp.00 0 Rp.5 Pcs Rp. 0 Rp. 193 Silk benang bedah sutra No. 164 Piroksikam 20mg tab Tablet Rp. 165 Plester 5 yard X 2 inc Rol Rp. 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 173 Ramabion capsule Capsul Rp. .00 10 Rp. 174 Ranitidine 150mg tablet Tablet Rp.00 300 Rp. 169 Prednison tab Tablet Rp. 192 Sianokobalamin (vit B12) inj Ampul Rp.850. 196 Surgical Blade Pcs Rp. 0 Rp. 8.00 0 Rp.00 100 Rp. .688. 1.00 10 Rp.00 0 Rp.000. 190 Seftriakson inj Vial Rp. 150 Oksitetrasiklin inj Vial Rp.000. 330.5 Pcs Rp.00 0 Rp. 186 Salep 2-4 komb Pot Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp.00 0 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp. 0 Rp. 153 Oksitosin 10IU/ml inj Ampul Rp.00 0 Rp. 188 Sefadroxil 500mg capsul Capsul Rp.00 0 Rp. 189 Sefotaxim inj Vial Rp.974. 182 Sarung tangan steril No. 128.200. 125. 6. . 179 Rifampisin 600mg tab Tablet Rp. . 198 Tablet tambah darah sachet Rp. 1. . . 554. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 194 Simvastatin 10mg tablet Tablet Rp.00 0 Rp.00 0 Rp. 15. . 1. 7. 0 Rp. 191 Selang Oksigen Pcs Rp.00 0 Rp.00 250 Rp. 265. .00 0 Rp.00 0 Rp. 167 Povidon iodida 10% 30ml Botol Rp. 3. . 0 Rp.00 0 Rp. 187 Salisil bedak 2% Pot Rp. 0 Rp. 176 Reserpine 0. 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 159 Papaverin tab Tablet Rp.

200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.00 0 Rp. 0 Rp. .199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 409. .

201 Thiamin Hcl 50mg tab Tablet Rp. 19700306 200212 2006 . 522.00 0 Rp. . 205 Urine Bag Pcs Rp.00 200 Rp. NIP. 0 Rp. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. 207 Zinc Tablet Rp. 203 Tramadol 50mg kasul Capsul Rp. . 204 Ultraproct N suppositoria Supp Rp.500.. 0 Rp. 112. . TO TAL Rp. Cahu. 0 Rp. Puruk Cahu FITRI AGUSYANI NIP. SRI RAHAYU NIP. P. 208 Gentamisin Injeksi Ampul Rp. 7. 0 Rp. 514.00 0 Rp. 206 Vitamin B komplek tab Tablet Rp. .00 100 Rp.00 0 Rp. 25 Pebruari 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. 53. 209 Suntik KB 3 Bln Vial Rp.

00 - 11.26 Pebruari 2015 LPLO Pustu TOTAL KETERANGAN 17.00 - 12.420.00 11.065.00 9.00 - - - - - - - - - - - 12.00 ### - 11.00 - - - - - - - 8.130.00 7.00 35.420.345.200.300.800.00 .00 - - - - - - 55.125.800.500.000.00 12.00 - 22.200.

- - - .

00 - 7.880.500.300.100.00 29.00 - - - - 8.700.800.00 - - - - - - - 17.00 17.00 - 17.750.00 6.450. - 9.00 17.450.00 - - - - - - - 40.900.00 - - - .500.00 - 16.800.00 44.00 - - - - - - - - - - - - 96.400.

- .

200.684. - - 24.300.00 - - - - - - - - - - 20.440.000.00 - - .250.000.00 - - - - - - - - - - - - - - - - - - - - 7.00 6.00 60.00 - 5.00 - - - - - 11.00 - - 60.000.

00 . - 5.750.

230.250.00 - - - - 10.600.00 .00 - - - - - 25.00 12. - - - 8.00 - - - - - - - - - - - - - - - - - - - - - - 11.740.00 - - - - 23.900.00 - - - - - 22.000.500.

- - .

- - - - - 22.00 - - ### bruari 2015 smas 2002 .00 52.200.400.

0 Rp. 0 Rp. 2 Abocate No. . 10. 17. 31 Asiklovir cream Tube Rp. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp.00 100 Rp. 21 Antasida doen srp Botol Rp. 4. 0 Rp. Mefenamatt 500 mg tab Tablet Rp.00 100 Rp. 8 Allopurinol 100mg tablet Tablet Rp. 3 Abocate No. 27 Antihaemaroid suppositoria Supp Rp. 1. 11 Amlodipin 5mg tab Tablet Rp. 28 Aqua pro injeksi Vial Rp.300. 15 Aminopillin 200mg tablet Tablet Rp. 26 Antimigrain Kombinasi tablet Tablet Rp. .00 5 Rp. 38 Atropin sulfat inj.5mg tablet Tablet Rp.025.560.142. . 5 Alat suntik sekali pakai 2. 0 Rp.00 2 Rp. 73. . .00 0 Rp. 20 Pcs Rp. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 41 Benzatil penisilin 2.00 100 Rp.00 10 Rp. 168. . 354. 245. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P. 18 Amoksisilin sirup krng 125 mg Botol Rp.juta IU/vial injeksi Vial Rp. 0 Rp. 0 Rp.00 0 Rp. 16 Amoksisilin 250mg capsul Capsul Rp. 1. 25 Antiparkinson tab Tablet Rp. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 30 Asiklovir 400mg tablet Tablet Rp. ascorbat 250 mg tab Tablet Rp. 4.00 0 Rp.142.juta IU/vial injeksi Vial Rp. 29 Asiklovir 200mg tablet Tablet Rp. 154.00 0 Rp. 32 As. 35 As. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. . 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 7 Alat suntik sekali pakai 5 ml Pcs Rp. 24mg/5ml Tablet Rp. 33 As. Ascorbat 50 mg tab Tablet Rp. 40 Benzatil penisilin 1.600.5ml Pcs Rp. 197. 17.600.4.00 0 Rp. 1.00 0 Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp.2. 8.00 0 Rp.00 100 Rp.250.00 100 Rp. 0 Rp.213. 37 Asetosal 500mg tablet Tablet Rp.565.00 4 Rp. 0 Rp. 22 Antasida doen tablet Tablet Rp.00 10 Rp.425.00 100 Rp. 24 Pcs Rp. 22 Pcs Rp. 12 Amlodipin 10mg tab Tablet Rp. .00 5 Rp. 2. 39 Atropin sulfat 0. 220. 149. 2.00 0 Rp.142.669. .000.395. 42 Betametason cream Tube Rp. 122. 164.25mg/ml Ampul Rp. 1. 0 Rp. 3.00 0 Rp.00 0 Rp. 9 Ambroxol 100mg tabltab Tablet Rp. 197.00 0 Rp. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Muara Bumban Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH 1 Abocate No.00 0 Rp. . 0 Rp. . 86. 36 Asetosal 100mg tablet Tablet Rp. 20 Antalgin 500 mg tablet Tablet Rp. .00 0 Rp. 13 Amitrippilin 25 mg tab Tablet Rp. 105. 90. 1.00 2 Rp.00 0 Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp. 0. 17 Amoksisilin 500 mg tablet Tablet Rp. 525.00 0 Rp. 2.00 4 Rp. 14 Aminopillin inj. 34 As.00 200 Rp. 0 Rp. 279.00 120 Rp.

43 Catgut benang bedah no. 29. 44 Calcidol syr Botol Rp. 0 Rp. . 470. .00 0 Rp. 45 Caviplex tablet Tablet Rp.00 0 Rp.333.2/0.3/0 Pcs Rp.

56 Diazepam 5mg tab Tablet Rp. Ampul Rp. 85 Gentamisin salep 0. 1. . 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp.5 mg tab Tablet Rp. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 0 Rp. 51 Dexsametason 0. 58 Digoksin 0.00 0 Rp. 84 Garam oralit Sachet Rp. 49 Captopril 12. . 61 Domperidom syr/ Vesverum syr Botol Rp. 59 Doksisiklin 100mg capsul Capsul Rp.00 0 Rp.00 0 Rp. 509. 92. 0 Rp. 1. 0.500.00 5 Rp. 96. 65 Epineprin HCL (adrenalin) Inj 0.00 10 Rp.500. 70 Etyl klorida semprot Botol Rp.00 0 Rp.00 0 Rp. 0 Rp. 1. 80 Folley Cateter no.00 10 Rp.000.605. 57 Diazepam 2mg tab Tablet Rp.5mg tablet Tablet Rp. 68 Erytromisin 500mg tab Tablet Rp.5% Tube Rp.00 5 Rp.490.125.00 0 Rp. . . 77 Fenol gliserol Botol Rp. 12.019.833.00 250 Rp. 32. 35.000.00 0 Rp. 174.926.156. 62 Dulcolax 5mg tab Tablet Rp.00 0 Rp.160. 63 Dulcolax supp Supp Rp.00 5 Rp. 89 Gliseril guaiacolat 100mg tab Tablet Rp. 54 Difenhidramin Hcl Inj Ampul Rp. 16 Pcs Rp. 0 Rp.00 50 Rp.143. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 86 Gentamisin tetes mata 0.1% /1ml Ampul Rp.00 0 Rp. 0 Rp.1% Tube Rp. 72 Etakridina (rivanol) lar. . 88 Glibenklamid 5mg tablet Tablet Rp.00 100 Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp. 3. 6. . 93 Haloperidol 0. 87 Gentian violet Botol Rp.145. 2.00 0 Rp.090.023. 79. 0 Rp.46 Caviplex Syr Botol Rp. .750. . 0 Rp. 115. 0 Rp. 91 Glukosa lar. 8. 3.00 0 Rp.00 0 Rp. . 55 Diazepam 5mg/2ml inj Ampul Rp.00 5 Rp.25 tablet Tablet Rp.00 100 Rp.00 0 Rp. 71 Etanol 70% 1000 ml Botol Rp. 5. 74 Famotidine tab Tablet Rp. 0 Rp.00 60 Rp. 0 Rp. 83 Furosemid 40mg tab Tablet Rp. 1. 95 Haloperidol 5mg tablet Tablet Rp. 0 Rp. 2.00 0 Rp.00 0 Rp. 64 Efedrin tab Tablet Rp.00 100 Rp. . 68.00 100 Rp. 12. 3. 90 Griseufulvin 125mg tab Tablet Rp.5 mg tab Tablet Rp. Infus 5% Botol Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 0 Rp. 48 Cimetidine tab Tablet Rp. 79 Fitomenadion 10mg/ml inj Ampul Rp. 697. Tablet Rp. 91. 82 Furosemid 10mg/ml inj Ampul Rp. 2.625.00 0 Rp. 81 Folley Cateter no. . 66. 0 Rp. 495. 75 Fenobarbital inj. 35.844. . 94 Haloperidol 1. 76 Fenobarbital 30mg tab.00 100 Rp. .00 0 Rp.576. 52 Dexsametason 5 mg/ml inj Ampul Rp.00 0 Rp.980. 10. . 78 Fitomenadion 10mg tab Tablet Rp. 224.00 0 Rp.00 0 Rp. 67 Erytromisin 250mg cap Capsul Rp. 5. 1. . 18 Pcs Rp.5mg tablet Tablet Rp. 1.3% Botol Rp.1% Botol Rp.00 0 Rp.00 0 Rp. 0 Rp. 322. 190. 69 Erytromisin 125mg/5ml srp krg Botol Rp. 92 Hidrocortison krim 2.

0 Rp.96 Hidroklortiazid HCT 25mg tab Tablet Rp. . .

144 Neurodex tab Tablet Rp.000. 79. 929.00 0 Rp. 0 Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp. 10. 137 Metronidazol 250mg tab Tablet Rp. 0 Rp.00 50 Rp.918. 5. 0 Rp. 121. 0 Rp. . 4. .00 0 Rp. . 115 Ketorolac 30mg inj Ampul Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp.9% Botol Rp. 25.00 0 Rp. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.000.00 0 Rp. 2. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 0 Rp.300. 891. 20. 3. 133 Metilprednisolon inj Ampul Rp.00 0 Rp. . 106 Kapas pembalut 500gr Rol Rp. 146. 0 Rp. 0 Rp.00 5 Rp. 105 Kalsium laktat 500mg tab Tablet Rp. 130 Lidokain komp.00 0 Rp. . 4. 136 Methilergometrin maleat tab Tablet Rp.00 0 Rp. 152. 135 Methilergometrin maleat inj Ampul Rp. 2. 112 Ketoconazole 2 % krim Tube Rp.665. . 5mg/2ml Ampul Rp.600.00 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp.00 0 Rp. 57.00 500 Rp. 8. 100 Infusion set anak Pcs Rp.00 0 Rp. 109 Kasa Pembalut 2m X 80cm Rol Rp. 122 Klorpromazine HCL 25mg tab Tablet Rp. . 121 Kloroquin 250mg tab Tablet Rp. . 157.00 0 Rp.000 IU/g tab vag Tablet Rp.00 0 Rp.000.00 100 Rp. 128 Lisol Botol Rp.00 0 Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 142 Natrium klorida lar. .298.00 0 Rp. 0 Rp. 2. 123 Klorpromazine HCL 100mg tab Tablet Rp.000. .00 5 Rp.00 6 Rp. 97 Hufalysin syr Botol Rp. 131 Masker Ktk/50"s Rp. 119 Kloramfenicol salep mata 1% Tube Rp.00 3 Rp.228. 0 Rp. 0 Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.00 0 Rp. 102 Intunal Forte tablet Tablet Rp. 0 Rp. 1. 126 Kotrimoxazol 480mg tab Tablet Rp. . 110 Kasa Pembalut 4m X 3cm Rol Rp. 138 Metronidazol 500mg tab Tablet Rp.20 0 Rp. 145 NGT Nasogastric Tube no. 107 Karbamazepin 200mg tab Tablet Rp. .000.00 0 Rp. 0 Rp. 129 Lidokain 2 % inj Ampul Rp. 8. Infus 0. 0 Rp. . 0 Rp.850. 0 Rp.00 0 Rp. 114 Ketorolac 10mg inj Ampul Rp. 101 Infusion set dewasa Pcs Rp. 8. 8.00 200 Rp. 600. 98 Ibuprofen 400mg tab Tablet Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp.050. 127 Kotrimoxazol Suspensi Botol Rp. 116. 103 Isoniazid 300mg tab Tablet Rp. . 50.00 0 Rp. 2.633. 169. . 0 Rp. 300.896.00 100 Rp.000. 118 Kloramfenicol tts telinga 3 % Botol Rp.390. 10 Tube Rp. . 143 Neurobion inj Ampul Rp. 99 Ibuprofen 200mg tab Tablet Rp. . 25. 0 Rp. 134 Metoclorprofamid 10mg tab Tablet Rp. 320.485.00 10 Rp.00 50 Rp. 140 Microlax enema Tube Rp. 113 Ketoconazole 200mg tab Tablet Rp.00 100 Rp. . 124 Klorpromazine HCL inj. 0 Rp. .00 0 Rp. 139 Miconazole cream Tube Rp. 146 Nistatin 100. 22. Inj Ampul Rp.

0 Rp. .00 0 Rp.147 Nistatin 500. 148 Nipedipin tab Tablet Rp. 115.000 IU tablet Tablet Rp. .

133.00 0 Rp. . 1.00 0 Rp. 154 Omeperazole capsule Capsul Rp.386. 0 Rp. 160 Piracetam 400mg tab Tablet Rp. 196 Surgical Blade Pcs Rp. 0 Rp.000.00 0 Rp. 5. 15. . 198 Tablet tambah darah sachet Rp. 2.00 0 Rp. 176 Reserpine 0. 155 Parasetamol drops 100mg/ 1ml Botol Rp. 186 Salep 2-4 komb Pot Rp. 0 Rp. . 91.00 0 Rp. 184 Sarung tangan steril No.200. . 180 Ringer laktat lar infus Botol Rp.149 Obat batuk hitam Botol Rp.00 50 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp. 0 Rp. 179 Rifampisin 600mg tab Tablet Rp. .00 0 Rp. 0 Rp. 197 Sulfacetamid tts mata 15% Botol Rp. 174 Ranitidine 150mg tablet Tablet Rp. .200.646.174. 0 Rp. 5. 125. 158 Parasetamol 500mg tab Tablet Rp.00 100 Rp.00 10 Rp. 0 Rp. 192 Sianokobalamin (vit B12) inj Ampul Rp. . 185 Sarung tangan steril No.00 10 Rp. 190 Seftriakson inj Vial Rp. . 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 0 Rp. .000.00 0 Rp. .00 0 Rp. 194 Simvastatin 10mg tablet Tablet Rp.850. 7. 1. 164 Piroksikam 20mg tab Tablet Rp. 0 Rp.00 0 Rp.00 0 Rp. 10.00 0 Rp. 0 Rp.00 0 Rp.688. 168 Povidon iodida 10% 300ml Botol Rp. 8. 10. . 330.5 Pcs Rp. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 128.333. 152 Oksitetrasiklin Hcl salep 1% Tube Rp.00 0 Rp. 85. 3. 1. 3. 175 Ranitidine 25mg / 2ml inj Ampul Rp. . 153 Oksitosin 10IU/ml inj Ampul Rp.00 0 Rp. . . 188 Sefadroxil 500mg capsul Capsul Rp. 35. 3/0 Pcs Rp. 0 Rp. 7. 20. .344. 11. 157 Parasetamol 100mg tab Tablet Rp. 165 Plester 5 yard X 2 inc Rol Rp. 159 Papaverin tab Tablet Rp. 191 Selang Oksigen Pcs Rp.00 0 Rp. .00 0 Rp. 169 Prednison tab Tablet Rp.00 200 Rp. 150 Oksitetrasiklin inj Vial Rp.00 0 Rp.000.000. 10. 163 Piroksikam 10mg tab Tablet Rp. 8 Pcs Rp.00 0 Rp.000. . 0 Rp.974. 183 Sarung tangan steril No. 167 Povidon iodida 10% 30ml Botol Rp. 7 Pcs Rp. 178 Rifampisin 450mg tab Tablet Rp. . 161 Piracetam 1gr tab Vial Rp.00 3 Rp.535. 0 Rp. 529. 10.500. 0 Rp. 15. 0 Rp. 0 Rp. 182 Sarung tangan steril No. 181 Salbutamol 2mg tablet Tablet Rp. 193 Silk benang bedah sutra No.00 0 Rp. 187 Salisil bedak 2% Pot Rp. 109.500.1mg tab Tablet Rp. 162 Piridoksin 10mg tab Tablet Rp.00 0 Rp.00 50 Rp. 554.000.00 10 Rp. 126.00 0 Rp. 2. 265.00 0 Rp. 0 Rp. 6. 173 Ramabion capsule Capsul Rp.00 0 Rp.00 0 Rp. 93.5 Pcs Rp. 177 Rifampisin 300mg capsul Capsul Rp. 0 Rp. 156 Parasetamol 120mg/5ml srp Botol Rp. 166 Pyrantel pamoat tab Tablet Rp. . 189 Sefotaxim inj Vial Rp. 170 Primakuin 15mg tab Tablet Rp.

409. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. . 0 Rp.199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. .00 0 Rp.

19700306 200212 2006 . 205 Urine Bag Pcs Rp. 514. 0 Rp. .201 Thiamin Hcl 50mg tab Tablet Rp.00 300 Rp. 53.500.00 0 Rp. 112. NIP. 208 Gentamisin Injeksi Ampul Rp. 0 Rp. . 207 Zinc Tablet Rp. TO TAL Rp. 0 Rp.00 0 Rp. . 7. 204 Ultraproct N suppositoria Supp Rp. 203 Tramadol 50mg kasul Capsul Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp.. 209 Suntik KB 3 Bln Vial Rp. SRI RAHAYU NIP. 0 Rp. 206 Vitamin B komplek tab Tablet Rp. .00 0 Rp. Cahu. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. P. Puruk Cahu FITRI AGUSYANI NIP. 522.00 0 Rp. 25 Pebruari 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu …….

26 Februari 2015 LPLO Pustu TOTAL KETERANGAN 17.000.420.00 - - - - - 26.676.200.800.00 - 12.00 7.000.00 - - 21.400.00 17.00 - - - - - - 24.300.00 27.00 - - - - - - - 6.800.900.00 .700.420.00 11.00 9.00 16.130.500.200.00 - - - 11.00 35.00 12.00 - - 11.065.

- - - .

00 - 17.500.00 22.750.700.00 - - - - - - 102.095.400.00 10.00 - 11.00 6.00 - - - - - 8.00 - - - - - - - - - - - - - - 32.00 - - - .00 17.00 - - - 8.00 17.00 29.450.800.450.700.880.300.00 40.200. - - - 7.600.900.

- .

900.000.490.00 - - 16.910.00 11.500.00 - - 14. - 7.600.000.00 - - 30.684.200.00 - - - - - - - - - - - - - - - - - 20.00 - - - - 46.00 - 12.00 - - .850.00 15.00 - - 8.00 - - - - 15.00 - 6.250.800.

- - .

550.00 - - - 11.00 - - - - 17.250.00 - - - - 10.00 - - - - - - - - - - - - - - - - - - - - - - - - 26.900.450.00 - - 13.740. - - - - 116.00 - 11.00 22.000.000.880.00 .

- - .

600.00 - - - ### ebruari 2015 esmas 2002 . - - - - - 33.

142. 20 Pcs Rp.00 0 Rp. . 41 Benzatil penisilin 2. 0 Rp. 31 Asiklovir cream Tube Rp.025. 245.00 100 Rp. 29.250.5ml Pcs Rp. 0 Rp.560.00 5 Rp. 354. 149. 36 Asetosal 100mg tablet Tablet Rp.00 10 Rp.142. 4.2/0.300. 2. 1. ascorbat 250 mg tab Tablet Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp.00 0 Rp. 220. 25 Antiparkinson tab Tablet Rp. 26 Antimigrain Kombinasi tablet Tablet Rp. 9 Ambroxol 100mg tabltab Tablet Rp.00 0 Rp. 11 Amlodipin 5mg tab Tablet Rp.00 100 Rp. . 5 Alat suntik sekali pakai 2. 44 Calcidol syr Botol Rp.juta IU/vial injeksi Vial Rp. 0 Rp.juta IU/vial injeksi Vial Rp. 21 Antasida doen srp Botol Rp. 0 Rp. Ascorbat 50 mg tab Tablet Rp. 35 As.00 0 Rp. 33 As. Cahu /2015 Tanggal : UNIT KERJA : PUSTU Muara Jaan Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH 1 Abocate No. 17.00 10 Rp. 1.00 0 Rp. 24mg/5ml Tablet Rp.00 0 Rp. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 525. 34 As. 197. 164. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.2.00 5 Rp. 3 Abocate No.00 0 Rp. 86.00 0 Rp. 29 Asiklovir 200mg tablet Tablet Rp. 0 Rp.00 0 Rp. 3.142. 470. 0 Rp. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 10. 38 Atropin sulfat inj. 0 Rp. 90. 32 As. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.00 0 Rp. 17 Amoksisilin 500 mg tablet Tablet Rp.00 0 Rp. . 279. 8.00 0 Rp. .25mg/ml Ampul Rp. 105. 2. 17.600.00 100 Rp. . Mefenamatt 500 mg tab Tablet Rp.4. 43 Catgut benang bedah no. .00 50 Rp. . 37 Asetosal 500mg tablet Tablet Rp. 45 Caviplex tablet Tablet Rp. 1.213.00 5 Rp.00 50 Rp. 15 Aminopillin 200mg tablet Tablet Rp. 42 Betametason cream Tube Rp.669. . 4.00 0 Rp. . 12 Amlodipin 10mg tab Tablet Rp. 30 Asiklovir 400mg tablet Tablet Rp. 8 Allopurinol 100mg tablet Tablet Rp. 20 Antalgin 500 mg tablet Tablet Rp.5mg tablet Tablet Rp. 154.565. 22 Antasida doen tablet Tablet Rp.600.333. 7 Alat suntik sekali pakai 5 ml Pcs Rp. 0 Rp. 24 Pcs Rp.00 0 Rp.00 0 Rp.00 0 Rp. 1.3/0 Pcs Rp. 0 Rp. 0 Rp.00 0 Rp.00 0 Rp. 168. 0 Rp. 73. . 14 Aminopillin inj. 2.425.000. 39 Atropin sulfat 0. 2 Abocate No.00 0 Rp. 27 Antihaemaroid suppositoria Supp Rp. 1. . 16 Amoksisilin 250mg capsul Capsul Rp. 0 Rp. 28 Aqua pro injeksi Vial Rp.00 0 Rp. .00 100 Rp. 0. . 22 Pcs Rp. 13 Amitrippilin 25 mg tab Tablet Rp.00 0 Rp.395. 197. 122. 4 Alat suntik sekali pakai 1 ml Pcs Rp. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. 18 Amoksisilin sirup krng 125 mg Botol Rp. 40 Benzatil penisilin 1. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp.00 5 Rp.

86 Gentamisin tetes mata 0.5mg tablet Tablet Rp. 82 Furosemid 10mg/ml inj Ampul Rp. 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp.00 10 Rp. 6.00 5 Rp.926.576.00 0 Rp.00 0 Rp. 68 Erytromisin 500mg tab Tablet Rp. 0 Rp. 1. Tablet Rp.00 0 Rp.00 50 Rp. 70 Etyl klorida semprot Botol Rp.46 Caviplex Syr Botol Rp.019. 0 Rp.125. 0 Rp.156.00 0 Rp.25 tablet Tablet Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 75 Fenobarbital inj. 93 Haloperidol 0. 0 Rp.00 0 Rp.750. 509.500. 1. 49 Captopril 12. 0 Rp. Infus 5% Botol Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 32. 66. 12.00 0 Rp. 91 Glukosa lar.00 0 Rp.00 0 Rp.625. 83 Furosemid 40mg tab Tablet Rp. . 79. 2.023. 0 Rp.00 0 Rp. 0 Rp. 224. 77 Fenol gliserol Botol Rp. 16 Pcs Rp. 697.145. 69 Erytromisin 125mg/5ml srp krg Botol Rp.605. 1. 62 Dulcolax 5mg tab Tablet Rp.490. 85 Gentamisin salep 0.00 5 Rp. 71 Etanol 70% 1000 ml Botol Rp. . 58 Digoksin 0. 0 Rp.1% Tube Rp. 96. 90 Griseufulvin 125mg tab Tablet Rp. 322. 57 Diazepam 2mg tab Tablet Rp.980. .00 0 Rp. 81 Folley Cateter no. 89 Gliseril guaiacolat 100mg tab Tablet Rp. 35. 74 Famotidine tab Tablet Rp. . . .833.00 100 Rp. .000. Ampul Rp. 78 Fitomenadion 10mg tab Tablet Rp. 2. 68. 1. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.00 0 Rp. 1. 67 Erytromisin 250mg cap Capsul Rp. 64 Efedrin tab Tablet Rp. 91. 0 Rp. 63 Dulcolax supp Supp Rp.00 0 Rp. 88 Glibenklamid 5mg tablet Tablet Rp.00 100 Rp. 0 Rp. 55 Diazepam 5mg/2ml inj Ampul Rp. 174.00 0 Rp. 51 Dexsametason 0.5mg tablet Tablet Rp.00 0 Rp.844. 2. .00 0 Rp. 95 Haloperidol 5mg tablet Tablet Rp. .1% /1ml Ampul Rp. . .00 0 Rp. . 12.090.1% Botol Rp. 3. 5. 92 Hidrocortison krim 2. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. .5 mg tab Tablet Rp.500.00 0 Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp.160. .00 0 Rp.00 0 Rp.000. 92.00 100 Rp. 72 Etakridina (rivanol) lar. 56 Diazepam 5mg tab Tablet Rp.143. 52 Dexsametason 5 mg/ml inj Ampul Rp. 0. 8. 3. 54 Difenhidramin Hcl Inj Ampul Rp. 35.00 0 Rp.00 10 Rp. . 87 Gentian violet Botol Rp. 80 Folley Cateter no.00 0 Rp. 190. 3. 0 Rp.5 mg tab Tablet Rp. 5. 59 Doksisiklin 100mg capsul Capsul Rp.00 60 Rp. 65 Epineprin HCL (adrenalin) Inj 0.00 5 Rp. .00 0 Rp. 0 Rp. 1. 94 Haloperidol 1.00 100 Rp. 495. 0 Rp.3% Botol Rp. 48 Cimetidine tab Tablet Rp.00 0 Rp. 76 Fenobarbital 30mg tab.00 0 Rp.5% Tube Rp. 84 Garam oralit Sachet Rp. 115. 0 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp. 18 Pcs Rp. 10. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 0 Rp.

300.00 0 Rp. 0 Rp.298.00 0 Rp.00 0 Rp. 97 Hufalysin syr Botol Rp. 4. 107 Karbamazepin 200mg tab Tablet Rp. 8.000. 122 Klorpromazine HCL 25mg tab Tablet Rp.485. 144 Neurodex tab Tablet Rp. 140 Microlax enema Tube Rp. . 138 Metronidazol 500mg tab Tablet Rp. 5mg/2ml Ampul Rp.000. 50. 142 Natrium klorida lar. 0 Rp. 0 Rp.00 50 Rp.896. 99 Ibuprofen 200mg tab Tablet Rp. 127 Kotrimoxazol Suspensi Botol Rp.00 0 Rp. 136 Methilergometrin maleat tab Tablet Rp. 129 Lidokain 2 % inj Ampul Rp. .00 500 Rp.000. 0 Rp. 147 Nistatin 500. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 130 Lidokain komp. . . 0 Rp.00 0 Rp. 105 Kalsium laktat 500mg tab Tablet Rp.00 0 Rp. 0 Rp. 121 Kloroquin 250mg tab Tablet Rp.00 0 Rp. 22. 0 Rp.00 0 Rp. 118 Kloramfenicol tts telinga 3 % Botol Rp.00 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp. 8. 98 Ibuprofen 400mg tab Tablet Rp. 115 Ketorolac 30mg inj Ampul Rp.00 5 Rp. . . 145 NGT Nasogastric Tube no. . 3. 128 Lisol Botol Rp.00 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. 169.00 0 Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 121. 20. 157. 2. 10.00 0 Rp.228. . .918.00 0 Rp.850.665. 146 Nistatin 100. 600. . 116 Kloramfenicol 125mg/5 susp Botol Rp. 0 Rp. 929. 137 Metronidazol 250mg tab Tablet Rp.00 0 Rp. 0 Rp. 2. 10 Tube Rp.600. . . 102 Intunal Forte tablet Tablet Rp.00 0 Rp. 100 Infusion set anak Pcs Rp.00 0 Rp. . 0 Rp. .00 5 Rp. 135 Methilergometrin maleat inj Ampul Rp. . Infus 0. 109 Kasa Pembalut 2m X 80cm Rol Rp. 0 Rp. 300. . 0 Rp. 106 Kapas pembalut 500gr Rol Rp. 123 Klorpromazine HCL 100mg tab Tablet Rp.00 200 Rp. 4. 0 Rp. .390. 8. 152. 0 Rp. . .000. 143 Neurobion inj Ampul Rp. 0 Rp. 8.000 IU/g tab vag Tablet Rp. .050.00 100 Rp. 131 Masker Ktk/50"s Rp. . 79. 114 Ketorolac 10mg inj Ampul Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp. 5. 112 Ketoconazole 2 % krim Tube Rp.00 0 Rp.000 IU tablet Tablet Rp.00 0 Rp.00 5 Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 103 Isoniazid 300mg tab Tablet Rp. 134 Metoclorprofamid 10mg tab Tablet Rp. 1. Inj Ampul Rp.633. 133 Metilprednisolon inj Ampul Rp. 25.00 0 Rp.9% Botol Rp. 116. 146. 2. 126 Kotrimoxazol 480mg tab Tablet Rp. 119 Kloramfenicol salep mata 1% Tube Rp. 891.000. 101 Infusion set dewasa Pcs Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 320. 148 Nipedipin tab Tablet Rp. 0 Rp. 139 Miconazole cream Tube Rp.000. 0 Rp.00 100 Rp.00 100 Rp. 2. 110 Kasa Pembalut 4m X 3cm Rol Rp. 0 Rp. . 0 Rp.00 0 Rp. 124 Klorpromazine HCL inj.00 0 Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.00 0 Rp. 25. 0 Rp. 0 Rp.

176 Reserpine 0.00 0 Rp.00 10 Rp. 265. 85. . 163 Piroksikam 10mg tab Tablet Rp. 153 Oksitosin 10IU/ml inj Ampul Rp.00 0 Rp. . 0 Rp.00 0 Rp. 194 Simvastatin 10mg tablet Tablet Rp. 185 Sarung tangan steril No. 191 Selang Oksigen Pcs Rp. 161 Piracetam 1gr tab Vial Rp. 162 Piridoksin 10mg tab Tablet Rp.535. 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 8 Pcs Rp. . 8.00 10 Rp. 197 Sulfacetamid tts mata 15% Botol Rp. 0 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp.200.00 0 Rp.333. .00 0 Rp.00 0 Rp.00 10 Rp. 128.00 0 Rp.00 0 Rp. 35. 3. 0 Rp.00 0 Rp. 0 Rp. 2. 1. 150 Oksitetrasiklin inj Vial Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 2. . 15.00 500 Rp. . 3/0 Pcs Rp.000. 109. 165 Plester 5 yard X 2 inc Rol Rp. . . 192 Sianokobalamin (vit B12) inj Ampul Rp. 7 Pcs Rp. 10. 0 Rp.00 100 Rp. . 174 Ranitidine 150mg tablet Tablet Rp. . 0 Rp.00 50 Rp. 158 Parasetamol 500mg tab Tablet Rp. 10.00 0 Rp. 10. 175 Ranitidine 25mg / 2ml inj Ampul Rp.174. 20. 91. 0 Rp.200. 155 Parasetamol drops 100mg/ 1ml Botol Rp. 0 Rp. 167 Povidon iodida 10% 30ml Botol Rp. 186 Salep 2-4 komb Pot Rp. 11. 0 Rp. . 190 Seftriakson inj Vial Rp. 3.00 0 Rp. 5. 5. 0 Rp. 15. .5 Pcs Rp.149 Obat batuk hitam Botol Rp.1mg tab Tablet Rp. . 183 Sarung tangan steril No. 0 Rp. 187 Salisil bedak 2% Pot Rp.00 0 Rp.000. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 0 Rp. .000. 125. 154 Omeperazole capsule Capsul Rp.500. 409. 93.974. 170 Primakuin 15mg tab Tablet Rp.850. 0 Rp.00 0 Rp. 184 Sarung tangan steril No. 133. 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 160 Piracetam 400mg tab Tablet Rp. 177 Rifampisin 300mg capsul Capsul Rp. 554. 330. 159 Papaverin tab Tablet Rp.00 0 Rp. . 198 Tablet tambah darah sachet Rp. . 157 Parasetamol 100mg tab Tablet Rp.00 0 Rp.00 0 Rp.00 0 Rp. . 6. 0 Rp. 182 Sarung tangan steril No. 164 Piroksikam 20mg tab Tablet Rp. 178 Rifampisin 450mg tab Tablet Rp. . 529. 0 Rp.000.00 0 Rp. 126. . 169 Prednison tab Tablet Rp. 196 Surgical Blade Pcs Rp. 1. 189 Sefotaxim inj Vial Rp.500. 173 Ramabion capsule Capsul Rp.00 0 Rp. 181 Salbutamol 2mg tablet Tablet Rp. 7. 0 Rp. 166 Pyrantel pamoat tab Tablet Rp.000. 10. .00 50 Rp.00 0 Rp. 0 Rp.5 Pcs Rp.00 0 Rp. 188 Sefadroxil 500mg capsul Capsul Rp. 0 Rp. 156 Parasetamol 120mg/5ml srp Botol Rp.386. 7.00 0 Rp.00 0 Rp. 0 Rp. 193 Silk benang bedah sutra No. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. . 180 Ringer laktat lar infus Botol Rp.688. 168 Povidon iodida 10% 300ml Botol Rp. 179 Rifampisin 600mg tab Tablet Rp.00 0 Rp.344.00 0 Rp. 0 Rp.000. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp.

0 Rp. . 205 Urine Bag Pcs Rp. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. 19700306 200212 2006 . 203 Tramadol 50mg kasul Capsul Rp. NIP.00 0 Rp. 0 Rp.. 53. 209 Suntik KB 3 Bln Vial Rp. 7. 514. Puruk Cahu FITRI AGUSYANI NIP. 207 Zinc Tablet Rp. 112. . Puruk Cahu. 0 Rp. . . . 206 Vitamin B komplek tab Tablet Rp. TO TAL Rp. SRI RAHAYU NIP. Maret 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 202 Thiamin Hcl 100mg/ml inj Ampul Rp.500. 0 Rp.00 200 Rp. 204 Ultraproct N suppositoria Supp Rp. 208 Gentamisin Injeksi Ampul Rp. 0 Rp.00 0 Rp.00 0 Rp.201 Thiamin Hcl 50mg tab Tablet Rp.

065.00 12.00 - - - - 12.125.250.300.900.00 - - - .00 101.420.800.420.800.250.200.00 - - 11.00 22.00 - - - - - - 12.00 7.00 11.00 - 16.00 - - - - - - 8.00 - - - - - - 27.25 Maret 2015 LPLO Pustu TOTAL KETERANGAN - - - - - 11.345.

880.00 - 11.00 17.00 29.00 - - - - - - 102.700.450.500.00 - 7. - 9.400.00 40.00 17.00 6.600.00 - - - - - 17.300.500.900.00 - - - - .450.800.00 - - - - - - - - - - - - - - - - - - - - - - 17.

480.00 60.700.000.000.900.250.200.44.00 - - - - .490.00 15.00 - - - - - 15.00 - - 12.00 - - - - - - - - - - - - - - - - - 20.500.00 - - - - - 30.00 - - - - - - - - - - 16.00 11.

450.00 - - - - 42.00 - - - - - - - - - - - - - - - - - - - - - - - 26.00 - - - 11.00 - - 13.600.00 - - .500.250.000.880.740.00 - - 22. - - - - 116.00 - - - - - 12.

00 aret 2015 esmas 2002 . - - - - - 22.695.00 - - - 1.027.400.

- 31 Asiklovir cream Tube Rp.00 0 Rp. - 6 Alat suntik sekali pakai 3 ml Pcs Rp. 149.00 23 Antibakteri DOEN komb (basitrasinpollimiksin) sal Tube Rp. 0 Rp.00 8 Allopurinol 100mg tablet Tablet Rp.420. - 15 Aminopillin 200mg tablet Tablet Rp.345.00 0 Rp. 1. - 12 Amlodipin 10mg tab Tablet Rp.25mg/ml Ampul Rp. 2.420. - 30 Asiklovir 400mg tablet Tablet Rp. - 13 Amitrippilin 25 mg tab Tablet Rp.600.395. 105. - 4 Alat suntik sekali pakai 1 ml Pcs Rp. - 21 Antasida doen srp Botol Rp.300. 86. 0. 0 Rp.00 10 Rp. - 28 Aqua pro injeksi Vial Rp.300.00 0 Rp.025. 279. 17. - 33 As. . - 26 Antimigrain Kombinasi tablet Tablet Rp. - 27 Antihaemaroid suppositoria Supp Rp. 220. - 34 As.600.00 0 Rp. 4. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.00 100 Rp. - 16 Amoksisilin 250mg capsul Capsul Rp. 12. - 2 Abocate No. - 10 Ambroxol 15mg/5ml sirup Botol Rp. 24mg/5ml Tablet Rp. .565. - 5 Alat suntik sekali pakai 2.00 11 Amlodipin 5mg tab Tablet Rp. - 14 Aminopillin inj. ascorbat 250 mg tab Tablet Rp. 197.142. .00 100 Rp. 10. 0 Rp. 7.00 0 Rp.00 0 Rp. 8. 0 Rp. - 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.00 18 Amoksisilin sirup krng 125 mg Botol Rp. 22. - 17 Amoksisilin 500 mg tablet Tablet Rp.00 0 Rp. 0 Rp. 24 Pcs Rp. 0 Rp. - 29 Asiklovir 200mg tablet Tablet Rp. 12. 0 Rp. 0 Rp.900. - 25 Antiparkinson tab Tablet Rp. 3. 354. 168. 154.00 . 20 Pcs Rp. 22 Pcs Rp.00 0 Rp. - 41 Benzatil penisilin 2. 17. 1.2.00 0 Rp. . 1. 11. Ascorbat 50 mg tab Tablet Rp. - 40 Benzatil penisilin 1. 0 Rp.250. 90.142. - 20 Antalgin 500 mg tablet Tablet Rp. 27. Mefenamatt 500 mg tab Tablet Rp. 73. 9. 122.00 5 Rp. 0 Rp. 1.00 5 Rp.000.juta IU/vial injeksi Vial Rp.200.00 0 Rp.142. . - 38 Atropin sulfat inj.213. 8. .juta IU/vial injeksi Vial Rp.00 0 Rp.00 0 Rp. 2.5ml Pcs Rp.000. 1. - 22 Antasida doen tablet Tablet Rp.425. . Cahu/2015 Tanggal : 25 Maret 2015 UNIT KERJA : PUSTU Juking Pajang Berdasark : LPLO Pustu NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. .4.00 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp.00 35 As.00 0 Rp.00 0 Rp. - 42 Betametason cream Tube Rp. 245. - 36 Asetosal 100mg tablet Tablet Rp. - 39 Atropin sulfat 0. 11.00 0 Rp. . 0 Rp.125.00 5 Rp. 197.00 10 Rp.00 100 Rp. 164.560.00 0 Rp. - 37 Asetosal 500mg tablet Tablet Rp. .800.5mg tablet Tablet Rp. 2. 4.00 0 Rp.00 0 Rp.00 0 Rp. Tranexamat 250mg capsul/ Kalnex 250mg ca Capsul Rp. - 3 Abocate No.00 0 Rp.00 9 Ambroxol 100mg tabltab Tablet Rp. .669.00 0 Rp. 525.00 7 Alat suntik sekali pakai 5 ml Pcs Rp.00 100 Rp.00 0 Rp. - 32 As.

00 0 Rp. - . 470. 0 Rp.2/0. 29. - 45 Caviplex tablet Tablet Rp.333.43 Catgut benang bedah no.00 0 Rp. .3/0 Pcs Rp. - 44 Calcidol syr Botol Rp.

Infus 5% Botol Rp. 12.090.00 100 Rp. 0 Rp. 12.400. - 92 Hidrocortison krim 2. 697. . 0 Rp.00 0 Rp.00 0 Rp. 40. 91. .00 0 Rp.605. 35. 174. 8.625. .750.00 250 Rp. - 88 Glibenklamid 5mg tablet Tablet Rp. - 75 Fenobarbital inj. - 76 Fenobarbital 30mg tab. - 81 Folley Cateter no. 1. - 64 Efedrin tab Tablet Rp.00 10 Rp.019. 115. - 56 Diazepam 5mg tab Tablet Rp. Tablet Rp. - 68 Erytromisin 500mg tab Tablet Rp.00 50 Rp. .00 0 Rp. .980. - 67 Erytromisin 250mg cap Capsul Rp. 224.156.25 tablet Tablet Rp.00 0 Rp.00 70 Etyl klorida semprot Botol Rp. - 78 Fitomenadion 10mg tab Tablet Rp.00 0 Rp. 509.00 0 Rp. - 59 Doksisiklin 100mg capsul Capsul Rp. - 51 Dexsametason 0. 17. . 0 Rp. 6. 0 Rp. . 0 Rp. 17.500.5mg tablet Tablet Rp. Ampul Rp. 2. 0 Rp. 6.490. - 63 Dulcolax supp Supp Rp.00 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 5. - 55 Diazepam 5mg/2ml inj Ampul Rp. 32.1% Tube Rp. . - . - 95 Haloperidol 5mg tablet Tablet Rp.00 0 Rp.5 mg tab Tablet Rp.00 0 Rp. 0 Rp. 0 Rp. 495. 0 Rp.5mg tablet Tablet Rp. - 65 Epineprin HCL (adrenalin) Inj 0. 92. 2.145.00 100 Rp.00 0 Rp. - 72 Etakridina (rivanol) lar.00 0 Rp. 18 Pcs Rp.750. 1.800. - 73 Etambuthol HCL 500mg tablet Tablet Rp. - 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp.46 Caviplex Syr Botol Rp. 2. - 54 Difenhidramin Hcl Inj Ampul Rp. .00 0 Rp. 96. 8. - 84 Garam oralit Sachet Rp. - 66 Ektrak beladon 100mg tab Tablet Rp. - 74 Famotidine tab Tablet Rp.00 0 Rp. - 69 Erytromisin 125mg/5ml srp krg Botol Rp. 190. 16 Pcs Rp. 9.00 0 Rp. 3.00 90 Griseufulvin 125mg tab Tablet Rp. - 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 0 Rp. - 89 Gliseril guaiacolat 100mg tab Tablet Rp.3% Botol Rp. 0 Rp. 7.00 0 Rp.1% Botol Rp.500.00 0 Rp. - 83 Furosemid 40mg tab Tablet Rp. . 17. - 86 Gentamisin tetes mata 0. .450. - 77 Fenol gliserol Botol Rp. - 57 Diazepam 2mg tab Tablet Rp. 3. - 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. - 58 Digoksin 0.1% /1ml Ampul Rp.00 0 Rp.00 0 Rp.125.450. 35.00 5 Rp.5 mg tab Tablet Rp.900.00 0 Rp.00 0 Rp. 0. . 322. 5. .00 48 Cimetidine tab Tablet Rp. 0 Rp. 3.143. 66. - 71 Etanol 70% 1000 ml Botol Rp. 1. 0 Rp.00 52 Dexsametason 5 mg/ml inj Ampul Rp.926. 1. 0 Rp.5% Tube Rp. - 87 Gentian violet Botol Rp.00 100 Rp.833.00 5 Rp.00 0 Rp.00 0 Rp.500.00 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. - 85 Gentamisin salep 0.576.500. - 82 Furosemid 10mg/ml inj Ampul Rp.00 61 Domperidom syr/ Vesverum syr Botol Rp. - 93 Haloperidol 0. 1.00 0 Rp.00 0 Rp.00 91 Glukosa lar.00 100 Rp.023.00 0 Rp. - 80 Folley Cateter no.160.000. . 79. 68. 10. - 94 Haloperidol 1.400. - 49 Captopril 12. 1.00 0 Rp. 22.000.00 62 Dulcolax 5mg tab Tablet Rp.844.

96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp. . - .

- 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp.00 100 Rp. .00 0 Rp. 0 Rp. Inj Ampul Rp. 97 Hufalysin syr Botol Rp. - 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 0 Rp. 3.00 100 Rp. 8.00 200 Rp. 0 Rp. - 100 Infusion set anak Pcs Rp. 10 Tube Rp. 0 Rp. 15. . - 113 Ketoconazole 200mg tab Tablet Rp. - 122 Klorpromazine HCL 25mg tab Tablet Rp.00 0 Rp. 891. 2. .480. 16. 50. - 112 Ketoconazole 2 % krim Tube Rp. 0 Rp.00 0 Rp.000. . . - 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. - 124 Klorpromazine HCL inj. 8. 300. 0 Rp.00 0 Rp.00 5 Rp. - 131 Masker Ktk/50"s Rp. .00 127 Kotrimoxazol Suspensi Botol Rp.00 0 Rp. 79.00 0 Rp. 44. .00 0 Rp.700. - .900. - 102 Intunal Forte tablet Tablet Rp.00 0 Rp.500.00 145 NGT Nasogastric Tube no. - 140 Microlax enema Tube Rp. 169. 0 Rp.000. 0 Rp.00 0 Rp. 25.00 139 Miconazole cream Tube Rp. 57.00 0 Rp. 8.000. 4.200.665.633. . - 119 Kloramfenicol salep mata 1% Tube Rp. .9% Botol Rp. - 125 Kotrimoxazol 120mg tab Tablet Rp.00 100 Rp.298.000 IU/g tab vag Tablet Rp. 2.896. - 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. . 60. . 0 Rp. - 136 Methilergometrin maleat tab Tablet Rp. - 129 Lidokain 2 % inj Ampul Rp. - 135 Methilergometrin maleat inj Ampul Rp. 157.00 5 Rp. - 103 Isoniazid 300mg tab Tablet Rp.00 0 Rp.00 0 Rp. - 123 Klorpromazine HCL 100mg tab Tablet Rp.485.00 0 Rp. 929.00 0 Rp. 5mg/2ml Ampul Rp. .00 99 Ibuprofen 200mg tab Tablet Rp.00 0 Rp. 11.000. 2. 8. 20. 0 Rp. 0 Rp. - 114 Ketorolac 10mg inj Ampul Rp. - 110 Kasa Pembalut 4m X 3cm Rol Rp. . 600. . 0 Rp. .850. - 137 Metronidazol 250mg tab Tablet Rp.00 117 Kloramfenicol kapsul 250 mg Capsul Rp. 15. 22. .00 50 Rp. 121.600.00 98 Ibuprofen 400mg tab Tablet Rp. 320. 4.050.000. - 109 Kasa Pembalut 2m X 80cm Rol Rp.00 121 Kloroquin 250mg tab Tablet Rp.00 50 Rp. 152.00 0 Rp.300. . - 146 Nistatin 100.300. - 101 Infusion set dewasa Pcs Rp.00 500 Rp. 146. - 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.228.250.00 0 Rp. 10. 0 Rp. - 134 Metoclorprofamid 10mg tab Tablet Rp. 0 Rp.00 0 Rp. - 144 Neurodex tab Tablet Rp.918. - 138 Metronidazol 500mg tab Tablet Rp.00 142 Natrium klorida lar. 5. - 105 Kalsium laktat 500mg tab Tablet Rp. 0 Rp. - 106 Kapas pembalut 500gr Rol Rp. - 143 Neurobion inj Ampul Rp. 7. 1. 0 Rp. - 130 Lidokain komp.490. - 107 Karbamazepin 200mg tab Tablet Rp.000. - 116 Kloramfenicol 125mg/5 susp Botol Rp.20 0 Rp.000.390. 30. 2. - 141 Natrium Diklofenak 25mg tab Tablet Rp. 12.00 118 Kloramfenicol tts telinga 3 % Botol Rp. 25.00 0 Rp. 0 Rp. 116.00 0 Rp. - 126 Kotrimoxazol 480mg tab Tablet Rp. Infus 0.00 5 Rp. - 115 Ketorolac 30mg inj Ampul Rp.00 128 Lisol Botol Rp. - 133 Metilprednisolon inj Ampul Rp. 0 Rp.00 0 Rp. . 20.000.

750. .147 Nistatin 500.00 . - 148 Nipedipin tab Tablet Rp. 5.000 IU tablet Tablet Rp. 115.00 50 Rp. 0 Rp.

1. .333. 91.00 157 Parasetamol 100mg tab Tablet Rp.646. 133. - 173 Ramabion capsule Capsul Rp.00 100 Rp.00 .00 0 Rp. 128.00 0 Rp. . 42.00 0 Rp. 15. .00 0 Rp.00 100 Rp. 6. - 156 Parasetamol 120mg/5ml srp Botol Rp.974. 11.675. - 161 Piracetam 1gr tab Vial Rp. 11.200. - 181 Salbutamol 2mg tablet Tablet Rp.00 0 Rp.174. 109. 0 Rp. 8.500.00 0 Rp. 20.688. 10. - 169 Prednison tab Tablet Rp. . - 176 Reserpine 0.00 5 Rp.000. .000. - 166 Pyrantel pamoat tab Tablet Rp.00 10 Rp. - 178 Rifampisin 450mg tab Tablet Rp.5 Pcs Rp. 10. 3/0 Pcs Rp. 0 Rp.5 Pcs Rp.00 0 Rp. - 197 Sulfacetamid tts mata 15% Botol Rp. 5. 0 Rp. - 153 Oksitosin 10IU/ml inj Ampul Rp. . - 188 Sefadroxil 500mg capsul Capsul Rp. 0 Rp. - 180 Ringer laktat lar infus Botol Rp.600.500. 22. - 163 Piroksikam 10mg tab Tablet Rp.00 0 Rp.00 0 Rp. - 192 Sianokobalamin (vit B12) inj Ampul Rp. - 195 Siprofloksasin HCL 500mg tablet Tablet Rp. - 174 Ranitidine 150mg tablet Tablet Rp. 5. .00 10 Rp. 0 Rp.00 0 Rp. . - 167 Povidon iodida 10% 30ml Botol Rp.00 0 Rp. 0 Rp. - 186 Salep 2-4 komb Pot Rp.00 0 Rp. - 187 Salisil bedak 2% Pot Rp. - 160 Piracetam 400mg tab Tablet Rp. 10. 1. - 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. - 198 Tablet tambah darah sachet Rp. .900. 0 Rp.000.00 0 Rp. 15. - 196 Surgical Blade Pcs Rp. - 150 Oksitetrasiklin inj Vial Rp. 10. - 191 Selang Oksigen Pcs Rp. 7 Pcs Rp.00 189 Sefotaxim inj Vial Rp. 2. . - 175 Ranitidine 25mg / 2ml inj Ampul Rp. . 7. 35.535. - 154 Omeperazole capsule Capsul Rp. 125.00 0 Rp. 7.000. - 152 Oksitetrasiklin Hcl salep 1% Tube Rp.00 0 Rp. .1mg tab Tablet Rp. 0 Rp.344. - 179 Rifampisin 600mg tab Tablet Rp. - 194 Simvastatin 10mg tablet Tablet Rp.00 0 Rp. - 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. . - 183 Sarung tangan steril No. - 162 Piridoksin 10mg tab Tablet Rp.00 193 Silk benang bedah sutra No.200. .00 159 Papaverin tab Tablet Rp.00 0 Rp.149 Obat batuk hitam Botol Rp. 0 Rp. - 170 Primakuin 15mg tab Tablet Rp. - 155 Parasetamol drops 100mg/ 1ml Botol Rp. 85. - 158 Parasetamol 500mg tab Tablet Rp. 0 Rp. 126. 554. 0 Rp. 2. 330. .00 0 Rp. 0 Rp. - 164 Piroksikam 20mg tab Tablet Rp. - 171 Propanolol HCL 40mg tablet Tablet Rp.500. .00 0 Rp. 52. 12.00 0 Rp. 0 Rp. . 93. 0 Rp. - 190 Seftriakson inj Vial Rp. - 182 Sarung tangan steril No.000. 7. - 177 Rifampisin 300mg capsul Capsul Rp. - 168 Povidon iodida 10% 300ml Botol Rp.850.00 0 Rp. 3. - 185 Sarung tangan steril No. 8 Pcs Rp. 529. - 184 Sarung tangan steril No. 0 Rp.000. 0 Rp. 1. 3.386. 0 Rp.00 0 Rp. 0 Rp.00 165 Plester 5 yard X 2 inc Rol Rp.740.00 500 Rp.00 0 Rp. .00 0 Rp. 265.000.00 0 Rp.00 0 Rp.

. 40.00 .199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 409. 0 Rp.00 100 Rp.900. - 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.

200. 7. 0 Rp. - TO TAL Rp. . - 202 Thiamin Hcl 100mg/ml inj Ampul Rp. Maret 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. - 206 Vitamin B komplek tab Tablet Rp. 53. - 208 Gentamisin Injeksi Ampul Rp.201 Thiamin Hcl 50mg tab Tablet Rp.00 0 Rp. .00 0 Rp. - 209 Suntik KB 3 Bln Vial Rp. 11. 0 Rp..00 100 Rp. 522.00 207 Zinc Tablet Rp. Puruk Cahu FITRI AGUSYANI NIP. 514. 711. . - 204 Ultraproct N suppositoria Supp Rp. 0 Rp. - 203 Tramadol 50mg kasul Capsul Rp.00 0 Rp. 0 Rp.00 0 Rp. 19790811 200003 2002 .745. 112. .00 Puruk Cahu. NIP.500. - 205 Urine Bag Pcs Rp.

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90.00 20 Rp.00 0 Rp. 0 Rp. 0 Rp.juta IU/vial injeksi Vial Rp. 26.25mg/ml Ampul Rp. 12. 17. 0 Rp.5ml Pcs Rp.00 36 Asetosal 100mg tablet Tablet Rp. 10. . 1.2.00 0 Rp.00 100 Rp. 154.00 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. - 45 Caviplex tablet Tablet Rp. 0 Rp. 24.800. 0 Rp.00 0 Rp. 2. - 2 Abocate No.00 5 Rp. 279.400. .125.00 5 Rp. 0 Rp. .00 120 Rp.00 11 Amlodipin 5mg tab Tablet Rp.065. 245.00 22 Antasida doen tablet Tablet Rp. 149.00 8 Allopurinol 100mg tablet Tablet Rp. 2.600. 1. - . - 40 Benzatil penisilin 1. 11. . 0 Rp.900. 17. 220. - 41 Benzatil penisilin 2.142. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 12. 197. 122. 1.2/0.142. 73. - 5 Alat suntik sekali pakai 2. - 44 Calcidol syr Botol Rp. 29. - 29 Asiklovir 200mg tablet Tablet Rp.00 18 Amoksisilin sirup krng 125 mg Botol Rp. 0 Rp.025. 0 Rp.00 50 Rp.00 10 Ambroxol 15mg/5ml sirup Botol Rp. - 13 Amitrippilin 25 mg tab Tablet Rp.300.00 100 Rp. - 33 As. - 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.juta IU/vial injeksi Vial Rp. 11. 22.00 0 Rp.333. .00 100 Rp.00 100 Rp.00 7 Alat suntik sekali pakai 5 ml Pcs Rp. - 20 Antalgin 500 mg tablet Tablet Rp. - 28 Aqua pro injeksi Vial Rp.00 35 As.00 9 Ambroxol 100mg tabltab Tablet Rp. 164. 525. . 24mg/5ml Tablet Rp.00 17 Amoksisilin 500 mg tablet Tablet Rp.840. 168. 22.250.4.00 0 Rp.00 0 Rp.600.00 0 Rp.200. .400. 101.000.425.00 0 Rp. - 34 As.00 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 354. 27. - 3 Abocate No. - 14 Aminopillin inj. Cahu/2015 Tanggal : 25 Maret 2015 UNIT KERJA : PUSTU Muara Bumban Berdasarkan : LPLO Pustu NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.213.395.00 0 Rp. .00 0 Rp.5mg tablet Tablet Rp.500.250. 24 Pcs Rp. . 3. 0 Rp. 7. 9. - 4 Alat suntik sekali pakai 1 ml Pcs Rp. - 15 Aminopillin 200mg tablet Tablet Rp. - 37 Asetosal 500mg tablet Tablet Rp.00 10 Rp. - 39 Atropin sulfat 0. 470.00 0 Rp.00 0 Rp. - 32 As.00 100 Rp. - 27 Antihaemaroid suppositoria Supp Rp. - 6 Alat suntik sekali pakai 3 ml Pcs Rp.00 30 Asiklovir 400mg tablet Tablet Rp. - 25 Antiparkinson tab Tablet Rp.300.560.00 50 Rp.00 0 Rp. 4. 1. 8. - 12 Amlodipin 10mg tab Tablet Rp. 0.00 0 Rp.00 0 Rp.142. 105. 0 Rp. - 31 Asiklovir cream Tube Rp.00 0 Rp.00 0 Rp. 1.669.00 5 Rp.3/0 Pcs Rp. .420.00 0 Rp.000. 0 Rp. 20 Pcs Rp. 2. Mefenamatt 500 mg tab Tablet Rp. - 21 Antasida doen srp Botol Rp. - 42 Betametason cream Tube Rp. .565. - 26 Antimigrain Kombinasi tablet Tablet Rp. - 38 Atropin sulfat inj. 86. ascorbat 250 mg tab Tablet Rp. 8. . Ascorbat 50 mg tab Tablet Rp. 22 Pcs Rp. - 43 Catgut benang bedah no. - 16 Amoksisilin 250mg capsul Capsul Rp.00 0 Rp. 4.00 0 Rp. 197.

00 0 Rp. 3.00 0 Rp.880. - 76 Fenobarbital 30mg tab. - 71 Etanol 70% 1000 ml Botol Rp.1% Botol Rp.3% Botol Rp. 224. 1. - 92 Hidrocortison krim 2.750. - 49 Captopril 12.125. 5. 6.160.500.00 90 Griseufulvin 125mg tab Tablet Rp. - 94 Haloperidol 1. 8. 17.5mg tablet Tablet Rp. 2. - 87 Gentian violet Botol Rp. - 48 Cimetidine tab Tablet Rp. 79.00 0 Rp. 8.00 100 Rp. Tablet Rp.576. - 75 Fenobarbital inj.143. . 0 Rp.145. - 59 Doksisiklin 100mg capsul Capsul Rp.5% Tube Rp. 0 Rp.00 0 Rp. - 51 Dexsametason 0.00 50 Rp.00 0 Rp. - 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp.000. 0 Rp. 0 Rp. - . - 86 Gentamisin tetes mata 0. - 80 Folley Cateter no. 0 Rp.00 0 Rp. 3. 0 Rp. . 22.00 61 Domperidom syr/ Vesverum syr Botol Rp. - 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 35.00 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp.1% /1ml Ampul Rp.1% Tube Rp.00 93 Haloperidol 0.00 0 Rp.25 tablet Tablet Rp. 1. 16 Pcs Rp.00 62 Dulcolax 5mg tab Tablet Rp. - 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp. 8. 495. - 65 Epineprin HCL (adrenalin) Inj 0. - 77 Fenol gliserol Botol Rp.000.00 10 Rp.00 0 Rp.750.00 69 Erytromisin 125mg/5ml srp krg Botol Rp. 509. 0 Rp. . 18 Pcs Rp.5mg tablet Tablet Rp. - 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. . - 74 Famotidine tab Tablet Rp. 6. - 63 Dulcolax supp Supp Rp.625. . 102. 16. 12.833.00 5 Rp. - 68 Erytromisin 500mg tab Tablet Rp. .500. 0. 697. 0 Rp.00 0 Rp.00 250 Rp. 0 Rp.090. 174. 92. 0 Rp.300. .00 0 Rp. 17. - 96 Hidroklortiazid HCT 25mg tab Tablet Rp. - 83 Furosemid 40mg tab Tablet Rp.5 mg tab Tablet Rp. 0 Rp. - 58 Digoksin 0.926. 32.00 0 Rp. 1.700.00 0 Rp. 91. 35. Infus 5% Botol Rp.500.00 70 Etyl klorida semprot Botol Rp. - 88 Glibenklamid 5mg tablet Tablet Rp.844.00 5 Rp.00 2 Rp. 2.00 100 Rp.00 0 Rp.156.00 0 Rp. 2. 190. - 85 Gentamisin salep 0. 1. 0 Rp.00 52 Dexsametason 5 mg/ml inj Ampul Rp. . Ampul Rp.00 0 Rp.5 mg tab Tablet Rp. 1. 3.00 0 Rp. 1.00 0 Rp. 5. - 57 Diazepam 2mg tab Tablet Rp. - 55 Diazepam 5mg/2ml inj Ampul Rp. . - 89 Gliseril guaiacolat 100mg tab Tablet Rp. 10. - 56 Diazepam 5mg tab Tablet Rp. . 96.00 91 Glukosa lar. 115.00 0 Rp.00 0 Rp. 0 Rp. 66.00 100 Rp. 17.800. 68. . .00 0 Rp. - 54 Difenhidramin Hcl Inj Ampul Rp.019. - 73 Etambuthol HCL 500mg tablet Tablet Rp. - 78 Fitomenadion 10mg tab Tablet Rp. . - 72 Etakridina (rivanol) lar.00 0 Rp. - 67 Erytromisin 250mg cap Capsul Rp. - 81 Folley Cateter no.00 0 Rp. 0 Rp. . - 95 Haloperidol 5mg tablet Tablet Rp.00 0 Rp. 322. 0 Rp.180. - 82 Furosemid 10mg/ml inj Ampul Rp.980. - 84 Garam oralit Sachet Rp.450. - 64 Efedrin tab Tablet Rp.400. .00 0 Rp.023.00 0 Rp. - 66 Ektrak beladon 100mg tab Tablet Rp.490.605.46 Caviplex Syr Botol Rp. 12.00 0 Rp.

00 0 Rp. - 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp.00 5 Rp.300.000.00 0 Rp. - 98 Ibuprofen 400mg tab Tablet Rp.700. .000. - 123 Klorpromazine HCL 100mg tab Tablet Rp. - 106 Kapas pembalut 500gr Rol Rp. 30. . 25. 0 Rp. - 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 300. 0 Rp.00 0 Rp. 0 Rp. 50.00 50 Rp.00 0 Rp. 3. - 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 0 Rp. 0 Rp. 11. 891. - 124 Klorpromazine HCL inj.200. 2.00 0 Rp. 929. 15. - 102 Intunal Forte tablet Tablet Rp. 1. 5mg/2ml Ampul Rp.000.485. - 109 Kasa Pembalut 2m X 80cm Rol Rp. - 131 Masker Ktk/50"s Rp.250.00 0 Rp.00 121 Kloroquin 250mg tab Tablet Rp. . 7. - . 60. 0 Rp. 20.00 0 Rp.633. 0 Rp.300. 8. 4. Infus 0.000. - 126 Kotrimoxazol 480mg tab Tablet Rp.000. - 134 Metoclorprofamid 10mg tab Tablet Rp. 0 Rp. - 114 Ketorolac 10mg inj Ampul Rp.00 0 Rp.000.00 128 Lisol Botol Rp. - 116 Kloramfenicol 125mg/5 susp Botol Rp.00 500 Rp.00 142 Natrium klorida lar. - 122 Klorpromazine HCL 25mg tab Tablet Rp. - 120 Klorfeniramini Maleat 4mg tab Tablet Rp. - 147 Nistatin 500. . - 115 Ketorolac 30mg inj Ampul Rp. 15. 157.390. - 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. - 103 Isoniazid 300mg tab Tablet Rp. .500.896. - 133 Metilprednisolon inj Ampul Rp. - 144 Neurodex tab Tablet Rp. - 146 Nistatin 100.00 0 Rp. 0 Rp. - 113 Ketoconazole 200mg tab Tablet Rp. 4.00 0 Rp.00 100 Rp. - 101 Infusion set dewasa Pcs Rp. 2. Inj Ampul Rp. . 152.228.00 0 Rp.00 100 Rp.00 0 Rp. 97 Hufalysin syr Botol Rp. - 129 Lidokain 2 % inj Ampul Rp. .00 139 Miconazole cream Tube Rp. 8. .918. . . - 141 Natrium Diklofenak 25mg tab Tablet Rp.050. - 119 Kloramfenicol salep mata 1% Tube Rp. 20. 0 Rp.00 0 Rp.00 0 Rp. 121. . 16.00 127 Kotrimoxazol Suspensi Botol Rp. 320. - 130 Lidokain komp. 79. 57.00 118 Kloramfenicol tts telinga 3 % Botol Rp. 0 Rp.000. 115.00 200 Rp. 0 Rp. - 110 Kasa Pembalut 4m X 3cm Rol Rp.00 0 Rp. 0 Rp. .9% Botol Rp.850.000 IU tablet Tablet Rp. 10. .298. 0 Rp.00 0 Rp. - 148 Nipedipin tab Tablet Rp. . - 112 Ketoconazole 2 % krim Tube Rp. - 125 Kotrimoxazol 120mg tab Tablet Rp. - 138 Metronidazol 500mg tab Tablet Rp. - 107 Karbamazepin 200mg tab Tablet Rp. 0 Rp.00 100 Rp.00 50 Rp.600. 0 Rp.490. 116.00 0 Rp. - 143 Neurobion inj Ampul Rp. - 135 Methilergometrin maleat inj Ampul Rp. 25.00 0 Rp. 5. 8.00 99 Ibuprofen 200mg tab Tablet Rp. 8. - 140 Microlax enema Tube Rp. - 100 Infusion set anak Pcs Rp. - 105 Kalsium laktat 500mg tab Tablet Rp. 2. 169.20 0 Rp.665. 12.00 5 Rp. 10 Tube Rp.00 0 Rp. .000.900. . 0 Rp.00 0 Rp. .000 IU/g tab vag Tablet Rp. 2. 0 Rp. .00 117 Kloramfenicol kapsul 250 mg Capsul Rp. 0 Rp. - 137 Metronidazol 250mg tab Tablet Rp. 146.00 145 NGT Nasogastric Tube no.00 0 Rp. 22. 600. .00 0 Rp. - 136 Methilergometrin maleat tab Tablet Rp.00 0 Rp.

- 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp.688. 109. . 554. .00 0 Rp.500. 25.200.00 0 Rp. 1. 6. 0 Rp. - 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 10. . 330. . - 168 Povidon iodida 10% 300ml Botol Rp.00 0 Rp. 7 Pcs Rp. 3.00 0 Rp. 0 Rp. - 174 Ranitidine 150mg tablet Tablet Rp. . .000.00 0 Rp. - 154 Omeperazole capsule Capsul Rp. - 165 Plester 5 yard X 2 inc Rol Rp. 2. 22. 0 Rp.850. . - 183 Sarung tangan steril No.000.00 50 Rp.000.250.174. - 173 Ramabion capsule Capsul Rp. 0 Rp. 15. 0 Rp. . 0 Rp.00 0 Rp. - 197 Sulfacetamid tts mata 15% Botol Rp. - 182 Sarung tangan steril No.00 0 Rp. - 178 Rifampisin 450mg tab Tablet Rp. .00 159 Papaverin tab Tablet Rp. - 171 Propanolol HCL 40mg tablet Tablet Rp.00 164 Piroksikam 20mg tab Tablet Rp. 0 Rp. - 196 Surgical Blade Pcs Rp. - 184 Sarung tangan steril No. 0 Rp.00 300 Rp.00 0 Rp.00 10 Rp.00 0 Rp. 3. 11. - 161 Piracetam 1gr tab Vial Rp. - 150 Oksitetrasiklin inj Vial Rp. 11. . 10. 85.386.00 10 Rp.00 0 Rp. . 126. 8. - 187 Salisil bedak 2% Pot Rp.000. - 181 Salbutamol 2mg tablet Tablet Rp. 2. 26. . - 195 Siprofloksasin HCL 500mg tablet Tablet Rp.00 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp.5 Pcs Rp. - 162 Piridoksin 10mg tab Tablet Rp. 0 Rp. - . - 194 Simvastatin 10mg tablet Tablet Rp. - 198 Tablet tambah darah sachet Rp.333.740.00 0 Rp. 265. 10.00 0 Rp.00 0 Rp. 3/0 Pcs Rp. 128. 5.000.00 0 Rp.00 250 Rp. 0 Rp. .00 0 Rp. 15. - 167 Povidon iodida 10% 30ml Botol Rp. 8 Pcs Rp.00 189 Sefotaxim inj Vial Rp.00 193 Silk benang bedah sutra No. - 176 Reserpine 0. 7.1mg tab Tablet Rp.149 Obat batuk hitam Botol Rp. 20.00 0 Rp. - 160 Piracetam 400mg tab Tablet Rp. - 192 Sianokobalamin (vit B12) inj Ampul Rp.00 0 Rp. 5. 0 Rp. . 93.344. 10. - 179 Rifampisin 600mg tab Tablet Rp. - 169 Prednison tab Tablet Rp. 0 Rp. .000.900. 529.535. - 158 Parasetamol 500mg tab Tablet Rp. - 185 Sarung tangan steril No. - 188 Sefadroxil 500mg capsul Capsul Rp.00 0 Rp. - 157 Parasetamol 100mg tab Tablet Rp.00 0 Rp. - 163 Piroksikam 10mg tab Tablet Rp. - 166 Pyrantel pamoat tab Tablet Rp. 125. 0 Rp. . 91. - 180 Ringer laktat lar infus Botol Rp.450. 0 Rp.00 0 Rp. 1. 0 Rp.200.646.974. - 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 7.00 0 Rp. 0 Rp. - 186 Salep 2-4 komb Pot Rp. 0 Rp. - 191 Selang Oksigen Pcs Rp. 133. .00 0 Rp.5 Pcs Rp.00 0 Rp. 10.00 100 Rp.00 0 Rp. 409. - 153 Oksitosin 10IU/ml inj Ampul Rp.00 0 Rp. - 190 Seftriakson inj Vial Rp.000.00 0 Rp. . - 175 Ranitidine 25mg / 2ml inj Ampul Rp. 35.00 0 Rp. 0 Rp. . - 155 Parasetamol drops 100mg/ 1ml Botol Rp. - 156 Parasetamol 120mg/5ml srp Botol Rp. - 177 Rifampisin 300mg capsul Capsul Rp.00 170 Primakuin 15mg tab Tablet Rp. 0 Rp. 1. 23.500.500. - 152 Oksitetrasiklin Hcl salep 1% Tube Rp.

Puruk Cahu FITRI AGUSYANI NIP.00 0 Rp. - 209 Suntik KB 3 Bln Vial Rp. .. Maret 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 0 Rp. 0 Rp.340. - 206 Vitamin B komplek tab Tablet Rp. NIP.00 0 Rp. - 203 Tramadol 50mg kasul Capsul Rp. 522. 824.00 0 Rp. - 204 Ultraproct N suppositoria Supp Rp. - 202 Thiamin Hcl 100mg/ml inj Ampul Rp. 514. SRI RAHAYU NIP. . 112. 19700306 200212 2006 .201 Thiamin Hcl 50mg tab Tablet Rp. 0 Rp.500. - TO TAL Rp. 53. Cahu.00 Puruk.00 0 Rp.00 0 Rp. 7. . - 208 Gentamisin Injeksi Ampul Rp. - 205 Urine Bag Pcs Rp. - 207 Zinc Tablet Rp. 0 Rp. . 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.

2015 KETERANGAN .

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105. - 40 Benzatil penisilin 1. 17. - 31 Asiklovir cream Tube Rp. 3. .5ml Pcs Rp. .669.00 0 Rp.00 100 Rp. - 42 Betametason cream Tube Rp. 0 Rp. 26. - 39 Atropin sulfat 0. 0 Rp. 0 Rp.00 5 Rp. 8. 17. - 27 Antihaemaroid suppositoria Supp Rp. . . - 28 Aqua pro injeksi Vial Rp.00 0 Rp.000. - 45 Caviplex tablet Tablet Rp. 4.00 17 Amoksisilin 500 mg tablet Tablet Rp. ascorbat 250 mg tab Tablet Rp. - 29 Asiklovir 200mg tablet Tablet Rp. .250. 0 Rp. . SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P. 4. 2.00 0 Rp. 149.00 7 Alat suntik sekali pakai 5 ml Pcs Rp.300. 0 Rp.00 0 Rp.00 35 As.00 0 Rp. 22.400. - 33 As.00 20 Rp. - 30 Asiklovir 400mg tablet Tablet Rp.00 0 Rp.00 18 Amoksisilin sirup krng 125 mg Botol Rp. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp.00 0 Rp.213.025. - 32 As. 245. .565.560.00 0 Rp. 197. 12.00 0 Rp.00 0 Rp. 11. 1. - 6 Alat suntik sekali pakai 3 ml Pcs Rp.00 0 Rp. - 43 Catgut benang bedah no. 27. - 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.4. 0.00 0 Rp. 354.200. .00 0 Rp. . 164.00 22 Antasida doen tablet Tablet Rp.00 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp.00 0 Rp.00 100 Rp. 73.00 0 Rp. - 44 Calcidol syr Botol Rp.00 0 Rp. Mefenamatt 500 mg tab Tablet Rp.00 0 Rp.00 0 Rp. 20 Pcs Rp.25mg/ml Ampul Rp.00 0 Rp. 154. 0 Rp.juta IU/vial injeksi Vial Rp.00 5 Rp. 86. - 14 Aminopillin inj.00 0 Rp. - 20 Antalgin 500 mg tablet Tablet Rp.395. .00 9 Ambroxol 100mg tabltab Tablet Rp. - 21 Antasida doen srp Botol Rp. 0 Rp.2/0. 1.00 0 Rp. 7. - 25 Antiparkinson tab Tablet Rp. - 12 Amlodipin 10mg tab Tablet Rp. - 15 Aminopillin 200mg tablet Tablet Rp. - 13 Amitrippilin 25 mg tab Tablet Rp. 90.00 0 Rp. - 5 Alat suntik sekali pakai 2. 168.00 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp.000.142.142. - 8 Allopurinol 100mg tablet Tablet Rp. 220.3/0 Pcs Rp. - 26 Antimigrain Kombinasi tablet Tablet Rp. Cahu/2015 Tanggal : 25 Maret 2015 UNIT KERJA : PUSTU Muara Untu Berdasarkan : LPLO Pustu NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. 122. 9. 525. - 36 Asetosal 100mg tablet Tablet Rp.142. 197. - 16 Amoksisilin 250mg capsul Capsul Rp. 24 Pcs Rp. 1. .00 100 Rp. - 2 Abocate No.00 100 Rp. 10. 2. 12. 0 Rp. 0 Rp. - 34 As.2.800.600. Ascorbat 50 mg tab Tablet Rp. 1.5mg tablet Tablet Rp. - 10 Ambroxol 15mg/5ml sirup Botol Rp.00 120 Rp.333. - . - 41 Benzatil penisilin 2. - 38 Atropin sulfat inj. 0 Rp.425. 0 Rp.00 0 Rp. 0 Rp.300. .600. 279. 24mg/5ml Tablet Rp. 470. - 11 Amlodipin 5mg tab Tablet Rp.00 0 Rp. 29. - 3 Abocate No. - 4 Alat suntik sekali pakai 1 ml Pcs Rp. 2. 22 Pcs Rp.065.900.00 0 Rp. - 37 Asetosal 500mg tablet Tablet Rp.840. 1.juta IU/vial injeksi Vial Rp.

5 mg tab Tablet Rp. 0 Rp. 91. - 75 Fenobarbital inj. - 48 Cimetidine tab Tablet Rp. .00 0 Rp. 8. 0 Rp.00 100 Rp.00 0 Rp. 1.00 100 Rp.5mg tablet Tablet Rp.00 0 Rp.00 0 Rp.00 0 Rp.00 0 Rp.500.00 0 Rp.00 0 Rp.1% Botol Rp. . - 79 Fitomenadion 10mg/ml inj Ampul Rp. 17. - 85 Gentamisin salep 0.00 0 Rp.00 0 Rp.800.00 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 0 Rp. - 58 Digoksin 0.5mg tablet Tablet Rp. - 95 Haloperidol 5mg tablet Tablet Rp.300. 32. 3. - 63 Dulcolax supp Supp Rp.090. 79.00 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 2.844.900. - 78 Fitomenadion 10mg tab Tablet Rp. - 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.500.00 0 Rp.00 100 Rp. - 82 Furosemid 10mg/ml inj Ampul Rp. 0 Rp.019.00 0 Rp. 5. 0 Rp. 509. 16 Pcs Rp. . 0 Rp. 224. 2. 0 Rp. 0 Rp. - 54 Difenhidramin Hcl Inj Ampul Rp. 2. - 72 Etakridina (rivanol) lar. . .00 0 Rp. - . - 59 Doksisiklin 100mg capsul Capsul Rp. - 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp.00 0 Rp.000.00 0 Rp. 18 Pcs Rp. 174. 0 Rp. 10. .145.25 tablet Tablet Rp. - 57 Diazepam 2mg tab Tablet Rp. - 73 Etambuthol HCL 500mg tablet Tablet Rp. 12. .143.490. - 77 Fenol gliserol Botol Rp. - 94 Haloperidol 1.00 0 Rp. 0.750. . - 49 Captopril 12. 35. Ampul Rp.3% Botol Rp.00 0 Rp.156. - 81 Folley Cateter no.160.980. .605.00 10 Rp. - 96 Hidroklortiazid HCT 25mg tab Tablet Rp. . 1.00 0 Rp. - 55 Diazepam 5mg/2ml inj Ampul Rp.576. . 1. 0 Rp. 115.00 0 Rp.00 0 Rp. . - 70 Etyl klorida semprot Botol Rp.500. 3. 0 Rp. - 87 Gentian violet Botol Rp.00 69 Erytromisin 125mg/5ml srp krg Botol Rp.926. - 93 Haloperidol 0. 0 Rp. 6.00 52 Dexsametason 5 mg/ml inj Ampul Rp.46 Caviplex Syr Botol Rp. 0 Rp. 3. - 83 Furosemid 40mg tab Tablet Rp. - 80 Folley Cateter no. 190.00 0 Rp. 6. - 68 Erytromisin 500mg tab Tablet Rp.00 0 Rp.00 0 Rp. 7. - 56 Diazepam 5mg tab Tablet Rp. - 66 Ektrak beladon 100mg tab Tablet Rp.00 0 Rp. . - 67 Erytromisin 250mg cap Capsul Rp. 68. 0 Rp. 0 Rp. 12. . - 88 Glibenklamid 5mg tablet Tablet Rp. - 61 Domperidom syr/ Vesverum syr Botol Rp. 697.1% /1ml Ampul Rp. - 64 Efedrin tab Tablet Rp.00 0 Rp. - 74 Famotidine tab Tablet Rp. - 65 Epineprin HCL (adrenalin) Inj 0. - 91 Glukosa lar. 1.00 0 Rp. - 90 Griseufulvin 125mg tab Tablet Rp. 66. - 84 Garam oralit Sachet Rp.125. 102. - 76 Fenobarbital 30mg tab.000.833. . - 89 Gliseril guaiacolat 100mg tab Tablet Rp. - 86 Gentamisin tetes mata 0.00 0 Rp.625. 322. 92.00 0 Rp.00 0 Rp. 1. 35.1% Tube Rp. 495.023. 5.00 0 Rp.00 0 Rp.5 mg tab Tablet Rp. 1. Infus 5% Botol Rp. - 92 Hidrocortison krim 2.00 0 Rp. Tablet Rp. - 62 Dulcolax 5mg tab Tablet Rp. - 71 Etanol 70% 1000 ml Botol Rp. 96. - 51 Dexsametason 0.5% Tube Rp.

- 120 Klorfeniramini Maleat 4mg tab Tablet Rp. - 101 Infusion set dewasa Pcs Rp.00 139 Miconazole cream Tube Rp. - 124 Klorpromazine HCL inj. 0 Rp. Inj Ampul Rp. - 103 Isoniazid 300mg tab Tablet Rp. - 119 Kloramfenicol salep mata 1% Tube Rp. - 147 Nistatin 500.390. 22.500. - 100 Infusion set anak Pcs Rp. - 98 Ibuprofen 400mg tab Tablet Rp. 0 Rp. . . - 143 Neurobion inj Ampul Rp.00 0 Rp. - 131 Masker Ktk/50"s Rp.00 145 NGT Nasogastric Tube no. - 133 Metilprednisolon inj Ampul Rp. 0 Rp.00 121 Kloroquin 250mg tab Tablet Rp.00 0 Rp. 600. 20. .00 117 Kloramfenicol kapsul 250 mg Capsul Rp. 1. - 116 Kloramfenicol 125mg/5 susp Botol Rp.485. 0 Rp. 2. 0 Rp. 0 Rp. 5.00 0 Rp.00 0 Rp.00 0 Rp.20 0 Rp.665.896. 2. 4. . - 135 Methilergometrin maleat inj Ampul Rp.00 100 Rp. - 130 Lidokain komp. 11. 97 Hufalysin syr Botol Rp. 3. 10 Tube Rp. 12. - 129 Lidokain 2 % inj Ampul Rp.00 5 Rp.00 50 Rp.00 0 Rp. - 118 Kloramfenicol tts telinga 3 % Botol Rp.00 0 Rp. - 112 Ketoconazole 2 % krim Tube Rp. - 109 Kasa Pembalut 2m X 80cm Rol Rp.850. - 113 Ketoconazole 200mg tab Tablet Rp. .200.00 0 Rp. 8.00 0 Rp. - 122 Klorpromazine HCL 25mg tab Tablet Rp.000 IU tablet Tablet Rp. .00 500 Rp. 57.00 5 Rp. 30.000 IU/g tab vag Tablet Rp. . 20.900. 0 Rp. 16. .250. . 0 Rp. - 140 Microlax enema Tube Rp. 0 Rp.00 0 Rp. . . - 141 Natrium Diklofenak 25mg tab Tablet Rp. 0 Rp.490. 25.00 128 Lisol Botol Rp. . Infus 0. 0 Rp. - 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.00 0 Rp. - 142 Natrium klorida lar.918.000. .600. - 137 Metronidazol 250mg tab Tablet Rp.00 127 Kotrimoxazol Suspensi Botol Rp. 116. 929.00 0 Rp. - 110 Kasa Pembalut 4m X 3cm Rol Rp. 891. 25. - 126 Kotrimoxazol 480mg tab Tablet Rp.300.00 0 Rp. - 148 Nipedipin tab Tablet Rp. 0 Rp. - 123 Klorpromazine HCL 100mg tab Tablet Rp. 0 Rp. - 125 Kotrimoxazol 120mg tab Tablet Rp. 0 Rp.00 0 Rp.00 100 Rp. - 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. - 102 Intunal Forte tablet Tablet Rp. 8. - 115 Ketorolac 30mg inj Ampul Rp. 0 Rp. 300.000. .633. . 121.050. 0 Rp. 79. - 138 Metronidazol 500mg tab Tablet Rp.00 0 Rp. 169. - 144 Neurodex tab Tablet Rp.9% Botol Rp. 8.000. - 106 Kapas pembalut 500gr Rol Rp.00 0 Rp. - 146 Nistatin 100.000. .00 0 Rp.298. . - 107 Karbamazepin 200mg tab Tablet Rp. - 114 Ketorolac 10mg inj Ampul Rp. - 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. . - 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 157.000.00 0 Rp.00 0 Rp. 0 Rp.228.00 0 Rp.00 0 Rp. - . 320. 2. 10. 0 Rp. - 136 Methilergometrin maleat tab Tablet Rp. - 99 Ibuprofen 200mg tab Tablet Rp.00 0 Rp. 152. . - 134 Metoclorprofamid 10mg tab Tablet Rp.00 0 Rp. 50.00 0 Rp. 5mg/2ml Ampul Rp.000.00 0 Rp. 15. 115. 146.000. 0 Rp. 8. 4.00 0 Rp. - 105 Kalsium laktat 500mg tab Tablet Rp. 2.

- 177 Rifampisin 300mg capsul Capsul Rp. 0 Rp. 0 Rp.00 189 Sefotaxim inj Vial Rp.00 0 Rp. - 198 Tablet tambah darah sachet Rp. - 194 Simvastatin 10mg tablet Tablet Rp.00 0 Rp.00 0 Rp. 0 Rp.646.149 Obat batuk hitam Botol Rp.00 100 Rp. 3. - 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp.00 193 Silk benang bedah sutra No.5 Pcs Rp. 265. .00 0 Rp. 0 Rp. .000.00 165 Plester 5 yard X 2 inc Rol Rp. - 153 Oksitosin 10IU/ml inj Ampul Rp. - 182 Sarung tangan steril No. - 160 Piracetam 400mg tab Tablet Rp. 0 Rp.00 0 Rp. 7. 0 Rp. 15. 1. 0 Rp.500.200. .344. - 185 Sarung tangan steril No.000. 13. 1. - 166 Pyrantel pamoat tab Tablet Rp.250.00 50 Rp. - 152 Oksitetrasiklin Hcl salep 1% Tube Rp. - 181 Salbutamol 2mg tablet Tablet Rp. - 183 Sarung tangan steril No.386.00 0 Rp.974. - 162 Piridoksin 10mg tab Tablet Rp. 0 Rp. 93. 125. .00 0 Rp. - 184 Sarung tangan steril No. - 163 Piroksikam 10mg tab Tablet Rp. 25. 0 Rp.174. - 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. . 10. 11. - 178 Rifampisin 450mg tab Tablet Rp. - 164 Piroksikam 20mg tab Tablet Rp. - 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. - 154 Omeperazole capsule Capsul Rp. .00 0 Rp.00 10 Rp. - 157 Parasetamol 100mg tab Tablet Rp. - 176 Reserpine 0.00 0 Rp. . . - 158 Parasetamol 500mg tab Tablet Rp. 1.00 0 Rp.000.00 0 Rp. - 170 Primakuin 15mg tab Tablet Rp. 85. - 167 Povidon iodida 10% 30ml Botol Rp.00 0 Rp. 133. . 109.00 196 Surgical Blade Pcs Rp. .500. 12. 0 Rp. . . 0 Rp.850. - 186 Salep 2-4 komb Pot Rp. 409. 0 Rp.00 0 Rp. 3/0 Pcs Rp. - 191 Selang Oksigen Pcs Rp.00 0 Rp.000.500. 11.00 0 Rp.00 0 Rp.200. 126.00 0 Rp. - 150 Oksitetrasiklin inj Vial Rp. 10.450. - 179 Rifampisin 600mg tab Tablet Rp.00 0 Rp. - 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 5.000. - 190 Seftriakson inj Vial Rp. - 175 Ranitidine 25mg / 2ml inj Ampul Rp. 0 Rp. . 10. - 171 Propanolol HCL 40mg tablet Tablet Rp. 7.00 0 Rp. - . . 5. 330. - 197 Sulfacetamid tts mata 15% Botol Rp. - 156 Parasetamol 120mg/5ml srp Botol Rp.00 300 Rp. - 161 Piracetam 1gr tab Vial Rp.00 0 Rp.5 Pcs Rp.00 0 Rp.00 0 Rp.535. - 173 Ramabion capsule Capsul Rp.740. 529. . 0 Rp. 7 Pcs Rp.1mg tab Tablet Rp. 2.00 0 Rp. - 187 Salisil bedak 2% Pot Rp.333. 20.00 50 Rp. . 91. - 188 Sefadroxil 500mg capsul Capsul Rp. - 155 Parasetamol drops 100mg/ 1ml Botol Rp. 35.000. - 174 Ranitidine 150mg tablet Tablet Rp. - 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. . . - 169 Prednison tab Tablet Rp. 0 Rp. 3. 554. 8. - 192 Sianokobalamin (vit B12) inj Ampul Rp. 0 Rp.00 159 Papaverin tab Tablet Rp.00 0 Rp.00 0 Rp. 0 Rp. 26. 2.600. 0 Rp.00 0 Rp. .00 0 Rp. 6.00 0 Rp. - 168 Povidon iodida 10% 300ml Botol Rp. 10. 8 Pcs Rp.688. 15. 0 Rp. 128. - 180 Ringer laktat lar infus Botol Rp.

00 100 Rp. .00 0 Rp. 471. 514.00 207 Zinc Tablet Rp.200. - 206 Vitamin B komplek tab Tablet Rp. 7. - 204 Ultraproct N suppositoria Supp Rp. - 203 Tramadol 50mg kasul Capsul Rp.00 Puruk Cahu.201 Thiamin Hcl 50mg tab Tablet Rp. .085. 19790811 200003 2002 . 0 Rp. 522. 0 Rp.. . - 208 Gentamisin Injeksi Ampul Rp.00 0 Rp. - 209 Suntik KB 3 Bln Vial Rp. - 205 Urine Bag Pcs Rp. - TO TAL Rp.00 0 Rp. 0 Rp.00 0 Rp. 53. 112. NIP. 11. Puruk Cahu FITRI AGUSYANI NIP. 0 Rp. Maret 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. . - 202 Thiamin Hcl 100mg/ml inj Ampul Rp.500.

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00 0 Rp. 2.00 100 Rp. 38 Atropin sulfat inj. 1. 1. .00 0 Rp. 18 Amoksisilin sirup krng 125 mg Botol Rp.395. 2. 10 Ambroxol 15mg/5ml sirup Botol Rp.00 10 Rp.425. 21 Antasida doen srp Botol Rp. 3.5ml Pcs Rp. 10. . 20 Pcs Rp. 33 As. . 16 Amoksisilin 250mg capsul Capsul Rp.00 0 Rp. 37 Asetosal 500mg tablet Tablet Rp. 14 Aminopillin inj.600.000. 3 Abocate No.00 0 Rp. 24mg/5ml Tablet Rp. 28 Aqua pro injeksi Vial Rp.00 0 Rp. 245. 30 Asiklovir 400mg tablet Tablet Rp. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 25 Antiparkinson tab Tablet Rp. 17.00 50 Rp. . 17.250.5mg tablet Tablet Rp.00 100 Rp. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.600. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. 9 Ambroxol 100mgtab Tablet Rp. 1.00 0 Rp.00 5 Rp. Ascorbat 50 mg tab Tablet Rp.00 0 Rp. 4. 8. 22 Pcs Rp. 197. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp.00 0 Rp. 220. 279. 40 Benzatil penisilin 1. 0 Rp. 0.25mg/ml Ampul Rp. 0 Rp. 32 As. 354. Mefenamatt 500 mg tab Tablet Rp.juta IU/vial injeksi Vial Rp.00 5 Rp. 24 Pcs Rp. . 22 Antasida doen tablet Tablet Rp. 90. 525. 86. 149. 164.00 0 Rp. 27 Antihaemaroid suppositoria Supp Rp. 39 Atropin sulfat 0. . . 4. 105.00 0 Rp. 0 Rp.00 0 Rp. 11 Amlodipin 5mg tab Tablet Rp. Cahu /2015 Tanggal : UNIT KERJA : PUSTU Muara Jaan Berdasarka : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. .00 100 Rp. . . 29 Asiklovir 200mg tablet Tablet Rp.00 0 Rp.142. 0 Rp.142. 4 Alat suntik sekali pakai 1 ml Pcs Rp. 0 Rp.300. 13 Amitrippilin 25 mg tab Tablet Rp.213. .142.00 0 Rp. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 8 Allopurinol 100mg tablet Tablet Rp. 154.00 20 Rp.00 120 Rp. 26 Antimigrain Kombinasi tablet Tablet Rp.2. ascorbat 250 mg tab Tablet Rp.00 0 Rp. 35 As.025. 0 Rp. 17 Amoksisilin 500 mg tablet Tablet Rp. 0 Rp.00 60 Rp. 168. 34 As.00 0 Rp. 15 Aminopillin 200mg tablet Tablet Rp.00 0 Rp. 7 Alat suntik sekali pakai 5 ml Pcs Rp. 36 Asetosal 100mg tablet Tablet Rp. 2 Abocate No. 31 Asiklovir cream Tube Rp. 12 Amlodipin 10mg tab Tablet Rp. 0 Rp. 0 Rp.560.00 0 Rp. 197.00 0 Rp. 2. 122. 1. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp.565. 0 Rp.00 50 Rp.00 0 Rp. 5 Alat suntik sekali pakai 2. 73. 20 Antalgin 500 mg tablet Tablet Rp.

00 0 Rp.juta IU/vial injeksi Vial Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 29.00 0 Rp.00 0 Rp. 45 Caviplex tablet Tablet Rp. 2. 0 Rp. 470.00 0 Rp. 190. 35. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp.4. 79. 1. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp.156. 0 Rp. 0 Rp. 56 Diazepam 5mg tab Tablet Rp. 54 Difenhidramin Hcl Inj Ampul Rp. 44 Calcidol syr Botol Rp.5 mg tab Tablet Rp. 48 Cimetidine tab Tablet Rp. 42 Betametason cream Tube Rp. .00 100 Rp.333.605. . .00 0 Rp.5 mg tab Tablet Rp. . 0 Rp.00 10 Rp.41 Benzatil penisilin 2. 49 Captopril 12.00 5 Rp. 46 Caviplex Syr Botol Rp.160.750. 52 Dexsametason 5 mg/ml inj Ampul Rp. 0 Rp. 55 Diazepam 5mg/2ml inj Ampul Rp. . 495. 43 Catgut benang bedah no. 1. 68.00 100 Rp.2/0.3/0 Pcs Rp.00 10 Rp. 57 Diazepam 2mg tab Tablet Rp. 51 Dexsametason 0. .00 0 Rp. 6.669. 1.00 0 Rp.

833. 8.00 0 Rp.00 0 Rp. 68 Erytromisin 500mg tab Tablet Rp.1% Tube Rp. .000.00 0 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp. 12. 95 Haloperidol 5mg tablet Tablet Rp. . . Tablet Rp.00 0 Rp.00 0 Rp.5mg tablet Tablet Rp. 8. 2. 0 Rp. 74 Famotidine tab Tablet Rp. 8. 157. 71 Etanol 70% 1000 ml Botol Rp.500. 63 Dulcolax supp Supp Rp. 174. 103 Isoniazid 300mg tab Tablet Rp. 100 Infusion set anak Pcs Rp.000. 75 Fenobarbital inj. 67 Erytromisin 250mg cap Capsul Rp. 3.00 0 Rp.1% Botol Rp.00 0 Rp. . . 3. 5. 0 Rp. 59 Doksisiklin 100mg capsul Capsul Rp. 76 Fenobarbital 30mg tab.00 0 Rp. 66.00 100 Rp.00 0 Rp. 0 Rp.490. 82 Furosemid 10mg/ml inj Ampul Rp.00 5 Rp. 102 Intunal Forte tablet Tablet Rp.00 5 Rp.926.576.00 250 Rp. 0 Rp.500. 80 Folley Cateter no. . 224. 83 Furosemid 40mg tab Tablet Rp. 92.00 0 Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 77 Fenol gliserol Botol Rp.1% /1ml Ampul Rp. 509.00 0 Rp. .00 0 Rp.00 0 Rp. 64 Efedrin tab Tablet Rp. 0. 3. 121. 58 Digoksin 0. 322. 1. 0 Rp. .00 5 Rp. 65 Epineprin HCL (adrenalin) Inj 0. 97 Hufalysin syr Botol Rp. 10.125. . . 81 Folley Cateter no. 98 Ibuprofen 400mg tab Tablet Rp. Ampul Rp. 101 Infusion set dewasa Pcs Rp. 72 Etakridina (rivanol) lar.023.090.00 5 Rp. 78 Fitomenadion 10mg tab Tablet Rp. 105 Kalsium laktat 500mg tab Tablet Rp. 0 Rp. 0 Rp. 62 Dulcolax 5mg tab Tablet Rp. 12. 89 Gliseril guaiacolat 100mg tab Tablet Rp.000. 87 Gentian violet Botol Rp. 115. 0 Rp. 0 Rp. 0 Rp. 32. 1. .00 5 Rp. 697.00 100 Rp. .00 0 Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 16 Pcs Rp.00 0 Rp.5% Tube Rp. 99 Ibuprofen 200mg tab Tablet Rp. 92 Hidrocortison krim 2. . 73 Etambuthol HCL 500mg tablet Tablet Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.145.000.980.00 0 Rp.00 0 Rp.00 100 Rp.896.00 0 Rp. 1. 0 Rp. 2. 79 Fitomenadion 10mg/ml inj Ampul Rp. 1.00 0 Rp. 96. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp. 85 Gentamisin salep 0. 18 Pcs Rp. 91. 90 Griseufulvin 125mg tab Tablet Rp. 94 Haloperidol 1. 70 Etyl klorida semprot Botol Rp. 5.00 0 Rp.00 0 Rp.00 0 Rp.019. 93 Haloperidol 0.625.00 0 Rp.5mg tablet Tablet Rp. 0 Rp. 88 Glibenklamid 5mg tablet Tablet Rp. 891. 0 Rp. 35.143. 84 Garam oralit Sachet Rp. 8. Infus 5% Botol Rp. 86 Gentamisin tetes mata 0.25 tablet Tablet Rp. . 69 Erytromisin 125mg/5ml srp krg Botol Rp. . 0 Rp. 91 Glukosa lar.844. .3% Botol Rp.00 0 Rp.

.00 0 Rp. . 25.665. 118 Kloramfenicol tts telinga 3 % Botol Rp.228. 10. 0 Rp. 115 Ketorolac 30mg inj Ampul Rp.000.050. 117 Kloramfenicol kapsul 250 mg Capsul Rp.00 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp.106 Kapas pembalut 500gr Rol Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp.00 0 Rp.000. 109 Kasa Pembalut 2m X 80cm Rol Rp.00 0 Rp. 25.633. 300.00 5 Rp. 20. 320.00 0 Rp. 119 Kloramfenicol salep mata 1% Tube Rp. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. . 107 Karbamazepin 200mg tab Tablet Rp. . 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.00 500 Rp. 4. . 0 Rp. . 114 Ketorolac 10mg inj Ampul Rp. 2. 2. 0 Rp. 0 Rp. 2.00 3 Rp. 112 Ketoconazole 2 % krim Tube Rp. . 121 Kloroquin 250mg tab Tablet Rp.850. 0 Rp. 0 Rp.00 0 Rp.00 0 Rp.

485. . 123 Klorpromazine HCL 100mg tab Tablet Rp. 0 Rp. . 10 Tube Rp. 162 Piridoksin 10mg tab Tablet Rp. 0 Rp. 145 NGT Nasogastric Tube no. 144 Neurodex tab Tablet Rp.122 Klorpromazine HCL 25mg tab Tablet Rp.500. 161 Piracetam 1gr tab Vial Rp. 7.300.00 0 Rp.00 0 Rp. 116. 2. 0 Rp. 109. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp.974. 0 Rp. . 165 Plester 5 yard X 2 inc Rol Rp.386. 1.00 0 Rp. . 554. 0 Rp.00 0 Rp. 148 Nipedipin tab Tablet Rp. 137 Metronidazol 250mg tab Tablet Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp.000 IU/g tab vag Tablet Rp. 0 Rp.000.9% Botol Rp.390.00 0 Rp.00 0 Rp. 20. 8.00 50 Rp. 79. 149 Obat batuk hitam Botol Rp. . 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 0 Rp. . 138 Metronidazol 500mg tab Tablet Rp. 85. 143 Neurobion inj Ampul Rp. 5. 135 Methilergometrin maleat inj Ampul Rp.00 200 Rp. 154 Omeperazole capsule Capsul Rp. . 50. 0 Rp. 160 Piracetam 400mg tab Tablet Rp.000.535. .00 0 Rp. 167 Povidon iodida 10% 30ml Botol Rp.00 100 Rp. 130 Lidokain komp. 22. .00 0 Rp. 139 Miconazole cream Tube Rp. .00 0 Rp.00 0 Rp. 0 Rp. 150 Oksitetrasiklin inj Vial Rp.918. 133 Metilprednisolon inj Ampul Rp. 600.00 0 Rp. 126.00 100 Rp. 166 Pyrantel pamoat tab Tablet Rp. 134 Metoclorprofamid 10mg tab Tablet Rp. 163 Piroksikam 10mg tab Tablet Rp. 152. 0 Rp.00 0 Rp. 0 Rp. 140 Microlax enema Tube Rp.00 0 Rp. . . 0 Rp. 929. 136 Methilergometrin maleat tab Tablet Rp. 35. 93. 158 Parasetamol 500mg tab Tablet Rp. 0 Rp. 153 Oksitosin 10IU/ml inj Ampul Rp. 1.000.00 0 Rp.00 50 Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. . . Infus 0.00 0 Rp. 146 Nistatin 100.00 5 Rp. 168 Povidon iodida 10% 300ml Botol Rp.600. 141 Natrium Diklofenak 25mg tab Tablet Rp. 0 Rp. 124 Klorpromazine HCL inj.00 0 Rp. 0 Rp. 146.344. 128 Lisol Botol Rp. 15. 0 Rp. 127 Kotrimoxazol Suspensi Botol Rp. 159 Papaverin tab Tablet Rp. 169 Prednison tab Tablet Rp. 131 Masker Ktk/50"s Rp. 156 Parasetamol 120mg/5ml srp Botol Rp. . 142 Natrium klorida lar.000 IU tablet Tablet Rp.00 100 Rp. Inj Ampul Rp. . 3.00 0 Rp. 126 Kotrimoxazol 480mg tab Tablet Rp. 11. . . 0 Rp. 5mg/2ml Ampul Rp.00 0 Rp. 169. . 157 Parasetamol 100mg tab Tablet Rp.00 0 Rp.00 5 Rp.688. 4. 5.00 0 Rp. 129 Lidokain 2 % inj Ampul Rp. 0 Rp. 0 Rp.298. 2. 147 Nistatin 500. . 164 Piroksikam 20mg tab Tablet Rp. . 0 Rp.

. 125.200. 91. . 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp.00 0 Rp. 183 Sarung tangan steril No.00 10 Rp. 182 Sarung tangan steril No.000. 176 Reserpine 0. 0 Rp.000.00 0 Rp. 330.00 0 Rp. 181 Salbutamol 2mg tablet Tablet Rp. 179 Rifampisin 600mg tab Tablet Rp. . 0 Rp. 5. 10. 173 Ramabion capsule Capsul Rp.5 Pcs Rp.00 0 Rp. 7.000. 184 Sarung tangan steril No. 174 Ranitidine 150mg tablet Tablet Rp. 178 Rifampisin 450mg tab Tablet Rp. 133. 10. .00 0 Rp. 6. 175 Ranitidine 25mg / 2ml inj Ampul Rp.00 0 Rp.1mg tab Tablet Rp. 180 Ringer laktat lar infus Botol Rp. 185 Sarung tangan steril No. 128. 177 Rifampisin 300mg capsul Capsul Rp. .00 0 Rp. 0 Rp. 0 Rp.5 Pcs Rp.170 Primakuin 15mg tab Tablet Rp. . 0 Rp.000.00 0 Rp. 10. . 7 Pcs Rp.00 0 Rp. 0 Rp. 8 Pcs Rp. 10. 171 Propanolol HCL 40mg tablet Tablet Rp.

00 0 Rp. 0 Rp. 0 Rp. 409. SRI RAHAYU NIP.00 5 Rp. Puruk Cahu PUNGKAS HUSADA FITRI AGUSYANI NIP. . 0 Rp. .00 50 Rp.00 0 Rp. 19871221 201001 2 011 NIP. . 3. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 8. 194 Simvastatin 10mg tablet Tablet Rp. 206 Vitamin B komplek tab Tablet Rp.333. 3/0 Pcs Rp. 191 Selang Oksigen Pcs Rp.174. 0 Rp. 0 Rp. . T O TAL Rp. 193 Silk benang bedah sutra No. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. .00 200 Rp.00 0 Rp.500. 190 Seftriakson inj Vial Rp.200. . 198 Tablet tambah darah sachet Rp. 201 Thiamin Hcl 50mg tab Tablet Rp. 3. 265. 1. .00 0 Rp. 0 Rp. 205 Urine Bag Pcs Rp. . 192 Sianokobalamin (vit B12) inj Ampul Rp. 0 Rp.186 Salep 2-4 komb Pot Rp. 2. April 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. .000.00 100 Rp. 188 Sefadroxil 500mg capsul Capsul Rp. 514. 529. 19700306 200212 2006 . 0 Rp. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 197 Sulfacetamid tts mata 15% Botol Rp.500. 15. 208 Gentamisin Injeksi Ampul Rp. 187 Salisil bedak 2% Pot Rp. 0 Rp. 0 Rp.. 207 Zinc Tablet Rp.850. 0 Rp. 189 Sefotaxim inj Vial Rp.00 10 Rp. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 204 Ultraproct N suppositoria Supp Rp.00 0 Rp. 203 Tramadol 50mg kasul Capsul Rp. .00 10 Rp. 53.00 0 Rp. 7.00 0 Rp. 209 Suntik KB 3 Bln Vial Rp. 196 Surgical Blade Pcs Rp. 112. . 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. Puruk Cahu.

00 - - - - - - 12.420.400.400.00 11.25 April 2015 LPLO Pustu TOTAL KET - - - - - 22.00 - - - - - - .00 - - - 7.900.250.00 12.00 22.820.00 - - - - 12.00 27.00 - 8.125.00 - - - - 26.840.00 11.200.800.300.

500.780.800.00 - - - .900.00 - 11.00 - - 7. - - - - - 30.600.00 17.00 - 6.

00 - - - - - - 102.00 40.450.00 - 15.00 - - - - - - 44.300.450. - - 17.00 22.625.480.00 - - - - - - - - .400.750.00 - 8.00 - - - - - - - - - - - - - - - 10.400.095.00 17.

250.684.00 - .00 - 6.500. - - - - - - - - - - 20.00 - 12.

300.675.00 - - - - - - - - - - - - - 7.00 - 234.00 - - - - - - - 12.00 - 11.000.600.00 .900.00 - - 18.400.490. - - - 7.00 - - - - - - - - - - - 7.600.00 - - 30.

000. - - - - - - - - - - - - - 100.00 - - .

400.00 - - - - - - - 22.00 15 skesmas 3 2002 . - - 52.139.250.740.900.00 - 19.00 - - - 11.000.250.00 22.00 - - 13.00 - - - 1.924.

17. 197. 279.juta IU/vial injeksi Vial Rp.4. 17. 17 Amoksisilin 500 mg tablet Tablet Rp.669.2. 0 Rp. 0 Rp. 0 Rp. 22 Pcs Rp.00 0 Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp.600. ascorbat 250 mg tab Tablet Rp. . 22 Antasida doen tablet Tablet Rp. 37 Asetosal 500mg tablet Tablet Rp.00 5 Rp. 8. 8 Allopurinol 100mg tablet Tablet Rp. . 5 Alat suntik sekali pakai 2. 3 Abocate No. 2.00 0 Rp.00 15 Rp.00 15 Rp. 40 Benzatil penisilin 1. 35 As. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. 154. 0 Rp. 0 Rp. 220.00 0 Rp. 39 Atropin sulfat 0. 0 Rp. 7 Alat suntik sekali pakai 5 ml Pcs Rp. Mefenamatt 500 mg tab Tablet Rp.250. 41 Benzatil penisilin 2. .00 0 Rp. 354. 27 Antihaemaroid suppositoria Supp Rp.000.00 0 Rp. .00 0 Rp. 4. 2. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 1.425.25mg/ml Ampul Rp.00 100 Rp. . 16 Amoksisilin 250mg capsul Capsul Rp. .00 0 Rp. 4.00 0 Rp.025.560.00 0 Rp. 1.00 0 Rp.00 0 Rp.142. 0 Rp. 1. 105. 30 Asiklovir 400mg tablet Tablet Rp. 2. 122.5ml Pcs Rp.00 5 Rp. 245. 21 Antasida doen srp Botol Rp.00 0 Rp.00 0 Rp. 24 Pcs Rp.00 0 Rp.00 0 Rp. 15 Aminopillin 200mg tablet Tablet Rp. 73. 11 Amlodipin 5mg tab Tablet Rp.00 100 Rp. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 197.00 100 Rp.00 0 Rp.213. 24mg/5ml Tablet Rp. 3.00 0 Rp. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 38 Atropin sulfat inj. 14 Aminopillin inj. Ascorbat 50 mg tab Tablet Rp. 168. . .juta IU/vial injeksi Vial Rp. .142. 1. 1. 525. 0 Rp. 0 Rp.600. 0 Rp. 36 Asetosal 100mg tablet Tablet Rp. . 29 Asiklovir 200mg tablet Tablet Rp. 164. 86. 18 Amoksisilin sirup krng 125 mg Botol Rp. 10. 10 Ambroxol 15mg/5ml sirup Botol Rp. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 20 Pcs Rp. 25 Antiparkinson tab Tablet Rp. 0. 9 Ambroxol 100mg tatab Tablet Rp. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Juking Pajang Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No.00 5 Rp.00 0 Rp.00 0 Rp.00 0 Rp.395.300.565.00 0 Rp.00 0 Rp. 90. 34 As. 28 Aqua pro injeksi Vial Rp. 2 Abocate No. 20 Antalgin 500 mg tablet Tablet Rp. 12 Amlodipin 10mg tab Tablet Rp. 13 Amitrippilin 25 mg tab Tablet Rp.5mg tablet Tablet Rp. 32 As. 0 Rp. .00 100 Rp. 26 Antimigrain Kombinasi tablet Tablet Rp. 31 Asiklovir cream Tube Rp. 33 As. . 42 Betametason cream Tube Rp.142. 149.

0 Rp.2/0.156. 1.160. 46 Caviplex Syr Botol Rp.00 100 Rp.3/0 Pcs Rp. 55 Diazepam 5mg/2ml inj Ampul Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp.00 10 Rp. 79. . .00 0 Rp.00 0 Rp.00 0 Rp. 48 Cimetidine tab Tablet Rp. 470. 2. 6. 190. . 56 Diazepam 5mg tab Tablet Rp.00 100 Rp. 29.00 0 Rp.333.00 0 Rp.605. 68. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 45 Caviplex tablet Tablet Rp.00 0 Rp. 49 Captopril 12. . 1. 54 Difenhidramin Hcl Inj Ampul Rp. 0 Rp. 495. 0 Rp. 35.00 50 Rp. 44 Calcidol syr Botol Rp.750. 0 Rp.5 mg tab Tablet Rp. . 52 Dexsametason 5 mg/ml inj Ampul Rp.43 Catgut benang bedah no. 51 Dexsametason 0. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 57 Diazepam 2mg tab Tablet Rp.5 mg tab Tablet Rp.00 0 Rp.

0 Rp. 3. 12. 83 Furosemid 40mg tab Tablet Rp.00 0 Rp. 81 Folley Cateter no. 71 Etanol 70% 1000 ml Botol Rp.000. 99 Ibuprofen 200mg tab Tablet Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 61 Domperidom syr/ Vesverum syr Botol Rp.500. 1. Infus 5% Botol Rp. 57.00 0 Rp.00 0 Rp.00 0 Rp.00 0 Rp.896. 73 Etambuthol HCL 500mg tablet Tablet Rp. 3. 5. .00 0 Rp. 1.00 0 Rp. 91. 8.00 0 Rp. 62 Dulcolax 5mg tab Tablet Rp.00 0 Rp. 74 Famotidine tab Tablet Rp.00 5 Rp. 92. 0 Rp. .00 0 Rp. 2. 12.000. . 69 Erytromisin 125mg/5ml srp krg Botol Rp. 106 Kapas pembalut 500gr Rol Rp. 32. 67 Erytromisin 250mg cap Capsul Rp. 63 Dulcolax supp Supp Rp. . 59 Doksisiklin 100mg capsul Capsul Rp. 20. 10. 0 Rp. 66 Ektrak beladon 100mg tab Tablet Rp.00 5 Rp. 79 Fitomenadion 10mg/ml inj Ampul Rp.1% Botol Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 8. 0 Rp.5% Tube Rp. . 89 Gliseril guaiacolat 100mg tab Tablet Rp.00 5 Rp.926. 97 Hufalysin syr Botol Rp.00 0 Rp. 0 Rp.00 0 Rp. 157. 1.1% Tube Rp. 3.145.1% /1ml Ampul Rp. .090. 72 Etakridina (rivanol) lar. 115.833.143.00 100 Rp.980. 92 Hidrocortison krim 2. 2.00 0 Rp. 0 Rp. 75 Fenobarbital inj. .58 Digoksin 0. . 16 Pcs Rp.25 tablet Tablet Rp. 0.00 100 Rp. 0 Rp. . 174. 8. 64 Efedrin tab Tablet Rp. 224. 101 Infusion set dewasa Pcs Rp. 0 Rp.023. 18 Pcs Rp. 0 Rp. 93 Haloperidol 0.000. 96. 0 Rp. 121. 509. 95 Haloperidol 5mg tablet Tablet Rp.00 100 Rp.490.850. 65 Epineprin HCL (adrenalin) Inj 0. 68 Erytromisin 500mg tab Tablet Rp. 1.00 0 Rp. 86 Gentamisin tetes mata 0. 0 Rp. 88 Glibenklamid 5mg tablet Tablet Rp. 322. 0 Rp.00 0 Rp.00 0 Rp. . 891. 70 Etyl klorida semprot Botol Rp.00 0 Rp. . 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp.00 0 Rp. 66.019.3% Botol Rp. 87 Gentian violet Botol Rp. 77 Fenol gliserol Botol Rp. 78 Fitomenadion 10mg tab Tablet Rp.844. 0 Rp. 94 Haloperidol 1.500. 5. 35. 85 Gentamisin salep 0. 100 Infusion set anak Pcs Rp. . 90 Griseufulvin 125mg tab Tablet Rp. 107 Karbamazepin 200mg tab Tablet Rp. . 76 Fenobarbital 30mg tab.625. 105 Kalsium laktat 500mg tab Tablet Rp.00 0 Rp.00 0 Rp.5mg tablet Tablet Rp. 8. .00 0 Rp.00 0 Rp.125. Tablet Rp.20 0 Rp. Ampul Rp.576. 98 Ibuprofen 400mg tab Tablet Rp. 0 Rp. 102 Intunal Forte tablet Tablet Rp.00 0 Rp. 697.00 0 Rp. .000.00 0 Rp.00 0 Rp. 91 Glukosa lar. 80 Folley Cateter no. 84 Garam oralit Sachet Rp. 103 Isoniazid 300mg tab Tablet Rp.00 0 Rp. 82 Furosemid 10mg/ml inj Ampul Rp. .00 250 Rp.5mg tablet Tablet Rp.

110 Kasa Pembalut 4m X 3cm Rol Rp.665. 109 Kasa Pembalut 2m X 80cm Rol Rp. 0 Rp. 25. 2. 0 Rp. 2.108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 25. 300.00 500 Rp.00 0 Rp. . 0 Rp. 4. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 10. . 114 Ketorolac 10mg inj Ampul Rp.000. 0 Rp.228.00 0 Rp. . 116 Kloramfenicol 125mg/5 susp Botol Rp. . 112 Ketoconazole 2 % krim Tube Rp. 0 Rp. 118 Kloramfenicol tts telinga 3 % Botol Rp.000. .050. 120 Klorfeniramini Maleat 4mg tab Tablet Rp.00 5 Rp.00 0 Rp.00 0 Rp. 320. 2.00 0 Rp.00 300 Rp. 113 Ketoconazole 200mg tab Tablet Rp. . 119 Kloramfenicol salep mata 1% Tube Rp. 121 Kloroquin 250mg tab Tablet Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp.633.00 0 Rp. 115 Ketorolac 30mg inj Ampul Rp.

125 Kotrimoxazol 120mg tab Tablet Rp.390. .500. . Inj Ampul Rp. 168 Povidon iodida 10% 300ml Botol Rp. 165 Plester 5 yard X 2 inc Rol Rp. 146.386.00 5 Rp. 5.00 50 Rp.00 0 Rp.485. 2. 152. 131 Masker Ktk/50"s Rp. .00 0 Rp. . 125. 0 Rp. 161 Piracetam 1gr tab Vial Rp. 157 Parasetamol 100mg tab Tablet Rp.00 0 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp.600. 140 Microlax enema Tube Rp.00 0 Rp. 2. 4. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp.918. 7. 156 Parasetamol 120mg/5ml srp Botol Rp.00 0 Rp. 20. 126. 50.00 0 Rp.000.00 0 Rp. 22.344. 170 Primakuin 15mg tab Tablet Rp. 164 Piroksikam 20mg tab Tablet Rp. 1.00 50 Rp. 133 Metilprednisolon inj Ampul Rp.000 IU/g tab vag Tablet Rp. 1. 0 Rp. 124 Klorpromazine HCL inj. 138 Metronidazol 500mg tab Tablet Rp. 3. 0 Rp. .00 0 Rp. 93. . 554. 158 Parasetamol 500mg tab Tablet Rp. 142 Natrium klorida lar. 0 Rp. 0 Rp. 929. 0 Rp. 129 Lidokain 2 % inj Ampul Rp.00 0 Rp. 139 Miconazole cream Tube Rp. 0 Rp. 0 Rp.00 0 Rp. 147 Nistatin 500.298.00 500 Rp. .00 0 Rp. 0 Rp.00 5 Rp.00 0 Rp.00 0 Rp. 109.00 0 Rp. 162 Piridoksin 10mg tab Tablet Rp. 10 Tube Rp.00 0 Rp. 167 Povidon iodida 10% 30ml Botol Rp. 0 Rp. . 169 Prednison tab Tablet Rp. 0 Rp. 128 Lisol Botol Rp. 150 Oksitetrasiklin inj Vial Rp. 0 Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp.300. 35.00 0 Rp. 85. 149 Obat batuk hitam Botol Rp. 130 Lidokain komp. 137 Metronidazol 250mg tab Tablet Rp. . 116.00 50 Rp. 166 Pyrantel pamoat tab Tablet Rp. 145 NGT Nasogastric Tube no. 600. 159 Papaverin tab Tablet Rp. 1. 123 Klorpromazine HCL 100mg tab Tablet Rp.00 0 Rp. 127 Kotrimoxazol Suspensi Botol Rp. . .00 0 Rp. . 11. 0 Rp. .00 0 Rp.000 IU tablet Tablet Rp. 115.00 0 Rp.646. 15. 143 Neurobion inj Ampul Rp.00 0 Rp.00 100 Rp.00 100 Rp. 148 Nipedipin tab Tablet Rp. .974. 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 126 Kotrimoxazol 480mg tab Tablet Rp. 8.00 100 Rp. 5. .000.9% Botol Rp. . . 136 Methilergometrin maleat tab Tablet Rp. Infus 0.535. 135 Methilergometrin maleat inj Ampul Rp. 160 Piracetam 400mg tab Tablet Rp. . 146 Nistatin 100. 0 Rp. 144 Neurodex tab Tablet Rp. 163 Piroksikam 10mg tab Tablet Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 169.00 0 Rp. 133.122 Klorpromazine HCL 25mg tab Tablet Rp. 0 Rp.00 0 Rp. 0 Rp. 0 Rp. 154 Omeperazole capsule Capsul Rp. 153 Oksitosin 10IU/ml inj Ampul Rp. 0 Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 5mg/2ml Ampul Rp. 79.688. 134 Metoclorprofamid 10mg tab Tablet Rp. .000.

180 Ringer laktat lar infus Botol Rp. . .200. .5 Pcs Rp.1mg tab Tablet Rp. 179 Rifampisin 600mg tab Tablet Rp. 176 Reserpine 0. 178 Rifampisin 450mg tab Tablet Rp. 91. 182 Sarung tangan steril No. 184 Sarung tangan steril No.172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. . 10. 174 Ranitidine 150mg tablet Tablet Rp. 7 Pcs Rp. 0 Rp. 177 Rifampisin 300mg capsul Capsul Rp. .000. 10.5 Pcs Rp. 128.00 0 Rp. 330.00 0 Rp.000. 0 Rp.00 0 Rp.00 0 Rp. 10. 7. 0 Rp. 10. 175 Ranitidine 25mg / 2ml inj Ampul Rp. 0 Rp.00 0 Rp. 0 Rp. 173 Ramabion capsule Capsul Rp. 8 Pcs Rp.00 0 Rp. 6. 183 Sarung tangan steril No. 5. 185 Sarung tangan steril No.000. . 181 Salbutamol 2mg tablet Tablet Rp. . 0 Rp.00 0 Rp.000.00 0 Rp.

.00 0 Rp. 198 Tablet tambah darah sachet Rp. April 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. ..00 0 Rp. . 8. 205 Urine Bag Pcs Rp. 192 Sianokobalamin (vit B12) inj Ampul Rp. 3. 7. 190 Seftriakson inj Vial Rp. 188 Sefadroxil 500mg capsul Capsul Rp. TO TAL Rp. 1. 209 Suntik KB 3 Bln Vial Rp.00 100 Rp. 112. 2. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.200. 0 Rp. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.850.00 0 Rp. NIP. 208 Gentamisin Injeksi Ampul Rp. 265. . 15.00 10 Rp. 204 Ultraproct N suppositoria Supp Rp. . 0 Rp. 203 Tramadol 50mg kasul Capsul Rp. 191 Selang Oksigen Pcs Rp. Puruk Cahu. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. 0 Rp. 0 Rp. Puruk Cahu FITRI AGUSYANI NIP. .00 10 Rp.333. 206 Vitamin B komplek tab Tablet Rp.500. 3. 194 Simvastatin 10mg tablet Tablet Rp.00 0 Rp.00 100 Rp. SRI RAHAYU NIP. 0 Rp.000. 201 Thiamin Hcl 50mg tab Tablet Rp.00 0 Rp.00 0 Rp. . . 0 Rp. 522. 529.500. 187 Salisil bedak 2% Pot Rp. 514. 19700306 200212 2006 . .00 0 Rp.186 Salep 2-4 komb Pot Rp. 53. 193 Silk benang bedah sutra No.00 200 Rp. 0 Rp. 207 Zinc Tablet Rp. 196 Surgical Blade Pcs Rp. 189 Sefotaxim inj Vial Rp. 409. 197 Sulfacetamid tts mata 15% Botol Rp.00 0 Rp. . 0 Rp. 3/0 Pcs Rp. 0 Rp.174. 195 Siprofloksasin HCL 500mg tablet Tablet Rp.00 0 Rp. 0 Rp.

200.00 - - - 7.00 12.00 - - - - - - - - - - - 12.125.00 - - - - - - - 8.AHU 25 April 2015 LPLO Pustu TOTAL KET - - - - - 17.00 9.900.300.345.130.00 17.130.000.00 - 22.00 .800.00 - - - - - - 27.

00 17.500.800. - - - - 9.900.500.00 - 6.00 - 7.00 - - - - - .

00 - - - - - - - 40.00 15.450.450.00 - - - - - - - - - .00 - - - - - - - - - - - - - - - - - - - 8.480.750.400.00 - - - - - - 44.00 22.400.00 17.700. - - 17.

250.000. - - - - - - - - 20.00 - .00 90.500.00 - - 12.

675.00 - - 7.600.00 - - - - - 12.200.000.00 - 42.00 - - - - - - - 7.00 - - - 5.750.00 - - - - - - - - - - 16.300.900.500.00 11.00 - - 30. - - - - 15.00 - - - - - - - .490.

- - - - - - - - - - - - - - .

400.00 - - - 764.00 - - - - - 22.365.000.00 - - - - - 22. - - 52.00 15 kesmas 3 2002 .900.00 - 40.900.740.00 - - - 11.

7 Alat suntik sekali pakai 5 ml Pcs Rp. 22 Antasida doen tablet Tablet Rp. 16 Amoksisilin 250mg capsul Capsul Rp. 37 Asetosal 500mg tablet Tablet Rp.5mg tablet Tablet Rp. 2.00 0 Rp. Mefenamatt 500 mg tab Tablet Rp. 12 Amlodipin 10mg tab Tablet Rp. 0 Rp. 197. 164. 105. 2 Abocate No.425. . Ascorbat 50 mg tab Tablet Rp. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Muara Bumban Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. 5 Alat suntik sekali pakai 2.000.00 100 Rp. .00 0 Rp.2. 90. 20 Pcs Rp.00 0 Rp. 11 Amlodipin 5mg tab Tablet Rp. 24 Pcs Rp.5ml Pcs Rp. 1. 26 Antimigrain Kombinasi tablet Tablet Rp. 220. . 17.00 0 Rp. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 20 Antalgin 500 mg tablet Tablet Rp. 8 Allopurinol 100mg tablet Tablet Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp. 36 Asetosal 100mg tablet Tablet Rp.395. 4 Alat suntik sekali pakai 1 ml Pcs Rp. 31 Asiklovir cream Tube Rp.00 0 Rp. 0. 10. . 1. 0 Rp.600.00 0 Rp. 24mg/5ml Tablet Rp.00 0 Rp. 21 Antasida doen srp Botol Rp. 38 Atropin sulfat inj. 18 Amoksisilin sirup krng 125 mg Botol Rp.juta IU/vial injeksi Vial Rp.00 0 Rp. 122. .565. 525. 0 Rp.juta IU/vial injeksi Vial Rp.00 5 Rp.300.00 0 Rp. 0 Rp. ascorbat 250 mg tab Tablet Rp. 0 Rp.00 100 Rp. 0 Rp.00 15 Rp. 29 Asiklovir 200mg tablet Tablet Rp. 28 Aqua pro injeksi Vial Rp.4. 154.00 100 Rp.00 100 Rp.00 0 Rp. 41 Benzatil penisilin 2.00 0 Rp.600.00 0 Rp. 279. 149. 0 Rp. 14 Aminopillin inj. 17. 33 As.142. 1. .669. 86.00 0 Rp. 1. Tranexamat 250mg capsul/ Kalnex 250mg c Capsul Rp. 32 As.00 0 Rp. 1. 15 Aminopillin 200mg tablet Tablet Rp.250.00 0 Rp. 354.00 100 Rp. 2. 34 As. 3 Abocate No.560. 42 Betametason cream Tube Rp.00 5 Rp. 0 Rp. . 168. .00 50 Rp. 197.213.00 0 Rp. 8. 22 Pcs Rp. 4.25mg/ml Ampul Rp.00 10 Rp. . 23 Antibakteri DOEN komb (basitrasinpollimiksin) s Tube Rp.00 0 Rp.142. 0 Rp. 30 Asiklovir 400mg tablet Tablet Rp.142. 27 Antihaemaroid suppositoria Supp Rp. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 13 Amitrippilin 25 mg tab Tablet Rp. 0 Rp. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml Ampul Rp. 25 Antiparkinson tab Tablet Rp. . 73. 17 Amoksisilin 500 mg tablet Tablet Rp. 245. 4. 9 Ambroxol 100mg tab Tablet Rp. .00 0 Rp. 35 As.00 0 Rp. 3. 39 Atropin sulfat 0.025. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P. 2. 40 Benzatil penisilin 1. 0 Rp. .00 0 Rp.00 120 Rp.

. 470. 51 Dexsametason 0.00 2 Rp.00 200 Rp.00 0 Rp.3/0 Pcs Rp.00 0 Rp.333.750. 52 Dexsametason 5 mg/ml inj Ampul Rp.160. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 1. 46 Caviplex Syr Botol Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 1.00 0 Rp. 45 Caviplex tablet Tablet Rp. 495. . 0 Rp. 44 Calcidol syr Botol Rp. 190.00 10 Rp.605. 2. 0 Rp.156. 54 Difenhidramin Hcl Inj Ampul Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 0 Rp. 68.00 0 Rp. 56 Diazepam 5mg tab Tablet Rp.00 0 Rp. 49 Captopril 12.00 0 Rp. 48 Cimetidine tab Tablet Rp. 79.2/0. 57 Diazepam 2mg tab Tablet Rp. 55 Diazepam 5mg/2ml inj Ampul Rp.00 0 Rp. 35. 29.00 100 Rp.5 mg tab Tablet Rp. . 0 Rp. .5 mg tab Tablet Rp. . 6.43 Catgut benang bedah no.

00 0 Rp.500.844. 0 Rp. 97 Hufalysin syr Botol Rp. 2. Ampul Rp. 0 Rp.00 0 Rp. 5.00 0 Rp.00 0 Rp. Tablet Rp.000.1% /1ml Ampul Rp. 157.1% Tube Rp.00 50 Rp. 0 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp. 0 Rp. . 12. . 78 Fitomenadion 10mg tab Tablet Rp. 1. . 91 Glukosa lar.00 0 Rp.00 0 Rp. 103 Isoniazid 300mg tab Tablet Rp. 8.00 0 Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 0 Rp. . 18 Pcs Rp. 85 Gentamisin salep 0. 67 Erytromisin 250mg cap Capsul Rp. 101 Infusion set dewasa Pcs Rp. .00 0 Rp. 224.490.5% Tube Rp.000.1% Botol Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 75 Fenobarbital inj.25 tablet Tablet Rp. 35.625.926. 1. . . 98 Ibuprofen 400mg tab Tablet Rp. 70 Etyl klorida semprot Botol Rp.00 250 Rp. 174. 0 Rp. 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp. 83 Furosemid 40mg tab Tablet Rp.00 100 Rp. 91.00 0 Rp. 3. 96.00 0 Rp.143. 63 Dulcolax supp Supp Rp. 57.00 5 Rp. 86 Gentamisin tetes mata 0. 71 Etanol 70% 1000 ml Botol Rp. 92. 64 Efedrin tab Tablet Rp. 2. 88 Glibenklamid 5mg tablet Tablet Rp. 80 Folley Cateter no. Infus 5% Botol Rp. 16 Pcs Rp. 81 Folley Cateter no. 62 Dulcolax 5mg tab Tablet Rp. 0 Rp.3% Botol Rp. 121. 107 Karbamazepin 200mg tab Tablet Rp. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp.00 0 Rp.090. 1.000. 102 Intunal Forte tablet Tablet Rp.833.00 0 Rp. 322. 106 Kapas pembalut 500gr Rol Rp. .125.00 0 Rp.00 0 Rp. 5.58 Digoksin 0. 93 Haloperidol 0. 115. 105 Kalsium laktat 500mg tab Tablet Rp. 99 Ibuprofen 200mg tab Tablet Rp. . 66.980. 0 Rp. 95 Haloperidol 5mg tablet Tablet Rp. 3.023. 10. 69 Erytromisin 125mg/5ml srp krg Botol Rp. 20. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. .00 0 Rp.896. 0 Rp.00 0 Rp.145. 84 Garam oralit Sachet Rp. 65 Epineprin HCL (adrenalin) Inj 0.576. 76 Fenobarbital 30mg tab. 3.850.00 100 Rp.00 100 Rp. 92 Hidrocortison krim 2. 697. 73 Etambuthol HCL 500mg tablet Tablet Rp. 0 Rp. 891.00 0 Rp.00 0 Rp. 74 Famotidine tab Tablet Rp. 87 Gentian violet Botol Rp.20 0 Rp.5mg tablet Tablet Rp.00 0 Rp. 0.000. 12. .00 0 Rp. .00 0 Rp.00 0 Rp. 94 Haloperidol 1. 1.5mg tablet Tablet Rp.00 0 Rp.00 0 Rp. . 8. . 0 Rp.00 100 Rp. 100 Infusion set anak Pcs Rp. 68 Erytromisin 500mg tab Tablet Rp. 8.019. 72 Etakridina (rivanol) lar. 77 Fenol gliserol Botol Rp. 82 Furosemid 10mg/ml inj Ampul Rp.00 0 Rp. 0 Rp. 59 Doksisiklin 100mg capsul Capsul Rp. 0 Rp. 509. 32.500. 89 Gliseril guaiacolat 100mg tab Tablet Rp. . .00 5 Rp. 0 Rp. 90 Griseufulvin 125mg tab Tablet Rp. 8.

00 0 Rp. 0 Rp. 10. .00 500 Rp.00 0 Rp.000. 121 Kloroquin 250mg tab Tablet Rp. 2. . . 0 Rp.00 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp. 112 Ketoconazole 2 % krim Tube Rp.665.00 0 Rp.228. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 119 Kloramfenicol salep mata 1% Tube Rp. 109 Kasa Pembalut 2m X 80cm Rol Rp. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 114 Ketorolac 10mg inj Ampul Rp. 118 Kloramfenicol tts telinga 3 % Botol Rp. 4. . 300. 0 Rp. . 0 Rp.00 0 Rp.633. 115 Ketorolac 30mg inj Ampul Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp. 2. 25. 2. 0 Rp.000. 320.00 5 Rp. 25.050. 117 Kloramfenicol kapsul 250 mg Capsul Rp. .00 0 Rp.00 0 Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp.108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp.

00 500 Rp. . 0 Rp. 158 Parasetamol 500mg tab Tablet Rp. 169.122 Klorpromazine HCL 25mg tab Tablet Rp. . 140 Microlax enema Tube Rp. 0 Rp.00 100 Rp.390. 35. 85. . . 0 Rp. 5mg/2ml Ampul Rp. 152 Oksitetrasiklin Hcl salep 1% Tube Rp.000. 123 Klorpromazine HCL 100mg tab Tablet Rp. 135 Methilergometrin maleat inj Ampul Rp. 154 Omeperazole capsule Capsul Rp.00 0 Rp.00 50 Rp. 15. 0 Rp. 0 Rp.00 0 Rp. 125. 165 Plester 5 yard X 2 inc Rol Rp. 2. . 146 Nistatin 100. 0 Rp. Infus 0.974. 22. 0 Rp.300. 159 Papaverin tab Tablet Rp. 0 Rp. . 142 Natrium klorida lar.000 IU/g tab vag Tablet Rp. 170 Primakuin 15mg tab Tablet Rp. 164 Piroksikam 20mg tab Tablet Rp. 79.00 0 Rp. 129 Lidokain 2 % inj Ampul Rp. .688. 168 Povidon iodida 10% 300ml Botol Rp. 163 Piroksikam 10mg tab Tablet Rp. 5.00 5 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp.00 0 Rp.00 0 Rp. 115. 147 Nistatin 500.00 0 Rp.00 0 Rp. 126 Kotrimoxazol 480mg tab Tablet Rp. 600. 143 Neurobion inj Ampul Rp. 166 Pyrantel pamoat tab Tablet Rp. 93. 0 Rp.00 0 Rp. . 0 Rp. 0 Rp.646. 0 Rp. 167 Povidon iodida 10% 30ml Botol Rp. 139 Miconazole cream Tube Rp.00 50 Rp. 162 Piridoksin 10mg tab Tablet Rp. 136 Methilergometrin maleat tab Tablet Rp.00 0 Rp. 4.00 0 Rp. 554. 11.00 0 Rp.00 0 Rp. . 0 Rp. .00 0 Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp.00 0 Rp.000. 1.918. 155 Parasetamol drops 100mg/ 1ml Botol Rp. 2. 1. 133 Metilprednisolon inj Ampul Rp.344.00 0 Rp. 157 Parasetamol 100mg tab Tablet Rp.485.535. 131 Masker Ktk/50"s Rp. 160 Piracetam 400mg tab Tablet Rp. 152. 130 Lidokain komp. 8. 3. 137 Metronidazol 250mg tab Tablet Rp. 0 Rp. 150 Oksitetrasiklin inj Vial Rp.00 5 Rp.00 0 Rp. 146. 0 Rp. 5. . 145 NGT Nasogastric Tube no. . 161 Piracetam 1gr tab Vial Rp. 1. 126. 127 Kotrimoxazol Suspensi Botol Rp. 0 Rp. 50. 141 Natrium Diklofenak 25mg tab Tablet Rp.386. . 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 148 Nipedipin tab Tablet Rp.00 6 Rp. Inj Ampul Rp. 153 Oksitosin 10IU/ml inj Ampul Rp. . 7. 124 Klorpromazine HCL inj. 20.00 100 Rp.00 250 Rp. 138 Metronidazol 500mg tab Tablet Rp. 0 Rp. 10 Tube Rp. 156 Parasetamol 120mg/5ml srp Botol Rp.00 0 Rp. 133.298. 134 Metoclorprofamid 10mg tab Tablet Rp. 0 Rp.000.9% Botol Rp. . . . 125 Kotrimoxazol 120mg tab Tablet Rp.00 0 Rp.00 100 Rp. 144 Neurodex tab Tablet Rp. 116.500.00 0 Rp.00 100 Rp. 149 Obat batuk hitam Botol Rp.000 IU tablet Tablet Rp. 169 Prednison tab Tablet Rp. 128 Lisol Botol Rp. 109.600. . 929.00 0 Rp. .00 0 Rp.

182 Sarung tangan steril No. 174 Ranitidine 150mg tablet Tablet Rp. 10. . 6. 330. 0 Rp. 0 Rp. 8 Pcs Rp.00 0 Rp.00 0 Rp.000. . 0 Rp. .00 0 Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp.5 Pcs Rp. 178 Rifampisin 450mg tab Tablet Rp. 180 Ringer laktat lar infus Botol Rp. 7. 10. 0 Rp.00 0 Rp.00 0 Rp.00 0 Rp. 10. 185 Sarung tangan steril No. 0 Rp. .5 Pcs Rp.000.000.172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. .200. 179 Rifampisin 600mg tab Tablet Rp.1mg tab Tablet Rp.000. 5. 128. 91. 184 Sarung tangan steril No. 0 Rp.00 0 Rp. 183 Sarung tangan steril No. . 181 Salbutamol 2mg tablet Tablet Rp. . 10. 173 Ramabion capsule Capsul Rp. 7 Pcs Rp.00 0 Rp. 177 Rifampisin 300mg capsul Capsul Rp. 176 Reserpine 0.

500. 112. Puruk Cahu FITRI AGUSYANI NIP.00 0 Rp. 0 Rp.00 5 Rp. . 0 Rp. . 522. 8. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. SRI RAHAYU NIP. 3/0 Pcs Rp. 208 Gentamisin Injeksi Ampul Rp. 187 Salisil bedak 2% Pot Rp. 197 Sulfacetamid tts mata 15% Botol Rp.333.850. 203 Tramadol 50mg kasul Capsul Rp. 209 Suntik KB 3 Bln Vial Rp. 0 Rp. . 206 Vitamin B komplek tab Tablet Rp. TO TAL Rp.00 200 Rp. 190 Seftriakson inj Vial Rp. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr. 191 Selang Oksigen Pcs Rp. 0 Rp. 2. 201 Thiamin Hcl 50mg tab Tablet Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp..00 0 Rp. 409. 189 Sefotaxim inj Vial Rp. . 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp.00 0 Rp. 0 Rp. 265. 188 Sefadroxil 500mg capsul Capsul Rp. . 1.00 0 Rp. 0 Rp. . 205 Urine Bag Pcs Rp. 204 Ultraproct N suppositoria Supp Rp. 7. 194 Simvastatin 10mg tablet Tablet Rp.00 0 Rp.00 10 Rp. 514. NIP. .00 0 Rp. Puruk Cahu. 0 Rp. 0 Rp. April 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. .200.500. 15.00 10 Rp.174. 0 Rp. .00 30 Rp. 3.00 0 Rp. . 192 Sianokobalamin (vit B12) inj Ampul Rp. 198 Tablet tambah darah sachet Rp. 196 Surgical Blade Pcs Rp. 3.186 Salep 2-4 komb Pot Rp. 53. 19700306 200212 2006 . 529.000. 207 Zinc Tablet Rp. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 0 Rp.00 0 Rp. 193 Silk benang bedah sutra No.00 100 Rp.

00 202.420.200.400.00 - - - - - 26.300.00 - - - - - - - - - - - 12.00 12.00 11.125.00 9.00 - - - 7.000.900.00 27.400.00 22.130.500.800.UK CAHU 25 April 2015 LPLO Pustu TOTAL KET - - - - - 17.00 - - - - - - - .00 8.

666.00 17.00 - - - - - 7.500.600.00 - 13.00 - - - - - .900.58.

00 15.00 40.00 22.700.00 12.100.00 - - - - - - - - - - - - - - - - - - - 8.300.400.480.450.750. - - 8.00 - - - - - - 44.00 - - - - - - - - .700.00 - - - - - - - 102.

00 - .00 - - - 12.250.500. - - - - - - - - 20.

00 - - 7. - - - - 15.00 - - .500.750.00 - 42.00 - - - - - - - 16.425.00 12.675.00 - - - - - - - 7.900.00 - - 7.00 - - - - 23.250.00 13.300.00 - - - - - - 5.600.00 - - - - 10.900.788.200.

- - - - - - - - - - - - - - .

-
-
52,900.00
-
-
-
11,740.00
-
-
-
-
19,250.00
22,000.00
-
-
-
-
-
-
-
22,400.00
15,660.00
-
-
1,049,709.00

5
kesmas

2002

SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU
(SBBK)
NO : /Farm/PKM-P. Cahu/2015 Tanggal :
UNIT KERJA : PUSTU Muara Untu Berdasarkan :

NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL

1 Abocate No. 20 Pcs Rp. 8,565.00 0 Rp.
2 Abocate No. 22 Pcs Rp. 17,600.00 0 Rp.
3 Abocate No. 24 Pcs Rp. 17,600.00 0 Rp.
4 Alat suntik sekali pakai 1 ml Pcs Rp. 1,250.00 0 Rp.
5 Alat suntik sekali pakai 2,5ml Pcs Rp. 1,142.00 0 Rp.
6 Alat suntik sekali pakai 3 ml Pcs Rp. 1,142.00 15 Rp.
7 Alat suntik sekali pakai 5 ml Pcs Rp. 1,142.00 10 Rp.
8 Allopurinol 100mg tablet Tablet Rp. 90.00 100 Rp.
9 Ambroxol 100mg tab Tablet Rp. 168.00 50 Rp.
10 Ambroxol 15mg/5ml sirup Botol Rp. 4,425.00 5 Rp.
11 Amlodipin 5mg tab Tablet Rp. 197.00 0 Rp.
12 Amlodipin 10mg tab Tablet Rp. 197.00 0 Rp.
13 Amitrippilin 25 mg tab Tablet Rp. - 0 Rp.
14 Aminopillin inj. 24mg/5ml Tablet Rp. 3,300.00 0 Rp.
15 Aminopillin 200mg tablet Tablet Rp. 86.00 0 Rp.
16 Amoksisilin 250mg capsul Capsul Rp. 220.00 120 Rp.
17 Amoksisilin 500 mg tablet Tablet Rp. 279.00 100 Rp.
18 Amoksisilin sirup krng 125 mg Botol Rp. 2,560.00 5 Rp.
19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml Ampul Rp. 10,395.00 0 Rp.
20 Antalgin 500 mg tablet Tablet Rp. 164.00 0 Rp.
21 Antasida doen srp Botol Rp. 2,213.00 0 Rp.
22 Antasida doen tablet Tablet Rp. 73.00 100 Rp.
23 Antibakteri DOEN komb (basitrasinpollimiksin) s Tube Rp. - 0 Rp.
24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 525.00 0 Rp.
25 Antiparkinson tab Tablet Rp. - 0 Rp.
26 Antimigrain Kombinasi tablet Tablet Rp. 149.00 0 Rp.
27 Antihaemaroid suppositoria Supp Rp. - 0 Rp.
28 Aqua pro injeksi Vial Rp. 4,000.00 0 Rp.
29 Asiklovir 200mg tablet Tablet Rp. 245.00 0 Rp.
30 Asiklovir 400mg tablet Tablet Rp. 354.00 0 Rp.
31 Asiklovir cream Tube Rp. - 0 Rp.
32 As. Ascorbat 50 mg tab Tablet Rp. 105.00 0 Rp.
33 As. ascorbat 250 mg tab Tablet Rp. 154.00 0 Rp.
34 As. Mefenamatt 500 mg tab Tablet Rp. 122.00 100 Rp.
35 As. Tranexamat 250mg capsul/ Kalnex 250mg c Capsul Rp. 2,025.00 100 Rp.
36 Asetosal 100mg tablet Tablet Rp. - 0 Rp.
37 Asetosal 500mg tablet Tablet Rp. - 0 Rp.
38 Atropin sulfat inj. 0.25mg/ml Ampul Rp. - 0 Rp.
39 Atropin sulfat 0.5mg tablet Tablet Rp. - 0 Rp.
40 Benzatil penisilin 1,2,juta IU/vial injeksi Vial Rp. - 0 Rp.
41 Benzatil penisilin 2,4,juta IU/vial injeksi Vial Rp. - 0 Rp.
42 Betametason cream Tube Rp. 1,669.00 0 Rp.

43 Catgut benang bedah no.2/0,3/0 Pcs Rp. 29,333.00 2 Rp.
44 Calcidol syr Botol Rp. - 0 Rp.
45 Caviplex tablet Tablet Rp. 470.00 0 Rp.
46 Caviplex Syr Botol Rp. 6,156.00 0 Rp.
47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 190.00 0 Rp.
48 Cimetidine tab Tablet Rp. - 0 Rp.
49 Captopril 12,5 mg tab Tablet Rp. 79.00 100 Rp.
50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 495.00 0 Rp.
51 Dexsametason 0,5 mg tab Tablet Rp. 68.00 200 Rp.
52 Dexsametason 5 mg/ml inj Ampul Rp. 1,750.00 10 Rp.
53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. - 0 Rp.
54 Difenhidramin Hcl Inj Ampul Rp. 1,160.00 0 Rp.
55 Diazepam 5mg/2ml inj Ampul Rp. 2,605.00 0 Rp.
56 Diazepam 5mg tab Tablet Rp. - 0 Rp.
57 Diazepam 2mg tab Tablet Rp. 35.00 0 Rp.

58 Digoksin 0,25 tablet Tablet Rp. 96.00 0 Rp.
59 Doksisiklin 100mg capsul Capsul Rp. - 0 Rp.
60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 174.00 50 Rp.
61 Domperidom syr/ Vesverum syr Botol Rp. 3,490.00 0 Rp.
62 Dulcolax 5mg tab Tablet Rp. 1,145.00 0 Rp.
63 Dulcolax supp Supp Rp. - 0 Rp.
64 Efedrin tab Tablet Rp. - 0 Rp.
65 Epineprin HCL (adrenalin) Inj 0,1% /1ml Ampul Rp. 5,143.00 0 Rp.
66 Ektrak beladon 100mg tab Tablet Rp. - 0 Rp.
67 Erytromisin 250mg cap Capsul Rp. 509.00 0 Rp.
68 Erytromisin 500mg tab Tablet Rp. 1,023.00 100 Rp.
69 Erytromisin 125mg/5ml srp krg Botol Rp. 8,090.00 5 Rp.
70 Etyl klorida semprot Botol Rp. 115,500.00 0 Rp.
71 Etanol 70% 1000 ml Botol Rp. 32,500.00 0 Rp.
72 Etakridina (rivanol) lar. 0.1% Botol Rp. 10,625.00 0 Rp.
73 Etambuthol HCL 500mg tablet Tablet Rp. - 0 Rp.
74 Famotidine tab Tablet Rp. - 0 Rp.
75 Fenobarbital inj. Ampul Rp. 1,980.00 0 Rp.
76 Fenobarbital 30mg tab. Tablet Rp. - 0 Rp.
77 Fenol gliserol Botol Rp. - 0 Rp.
78 Fitomenadion 10mg tab Tablet Rp. 697.00 0 Rp.
79 Fitomenadion 10mg/ml inj Ampul Rp. 2,833.00 0 Rp.
80 Folley Cateter no. 16 Pcs Rp. 12,000.00 0 Rp.
81 Folley Cateter no. 18 Pcs Rp. 12,000.00 0 Rp.
82 Furosemid 10mg/ml inj Ampul Rp. 1,926.00 0 Rp.
83 Furosemid 40mg tab Tablet Rp. 92.00 0 Rp.
84 Garam oralit Sachet Rp. 322.00 0 Rp.
85 Gentamisin salep 0.1% Tube Rp. 2,019.00 0 Rp.
86 Gentamisin tetes mata 0.3% Botol Rp. - 0 Rp.
87 Gentian violet Botol Rp. 3,125.00 0 Rp.
88 Glibenklamid 5mg tablet Tablet Rp. - 0 Rp.
89 Gliseril guaiacolat 100mg tab Tablet Rp. 35.00 250 Rp.
90 Griseufulvin 125mg tab Tablet Rp. 224.00 100 Rp.
91 Glukosa lar. Infus 5% Botol Rp. 5,844.00 0 Rp.
92 Hidrocortison krim 2,5% Tube Rp. 3,576.00 0 Rp.
93 Haloperidol 0.5mg tablet Tablet Rp. 66.00 0 Rp.
94 Haloperidol 1.5mg tablet Tablet Rp. 91.00 0 Rp.
95 Haloperidol 5mg tablet Tablet Rp. - 0 Rp.
96 Hidroklortiazid HCT 25mg tab Tablet Rp. - 0 Rp.
97 Hufalysin syr Botol Rp. 8,896.00 5 Rp.
98 Ibuprofen 400mg tab Tablet Rp. 157.00 100 Rp.
99 Ibuprofen 200mg tab Tablet Rp. 121.00 100 Rp.
100 Infusion set anak Pcs Rp. 8,000.00 0 Rp.
101 Infusion set dewasa Pcs Rp. 8,000.00 0 Rp.
102 Intunal Forte tablet Tablet Rp. 891.00 0 Rp.
103 Isoniazid 300mg tab Tablet Rp. - 0 Rp.
104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. - 0 Rp.
105 Kalsium laktat 500mg tab Tablet Rp. 57.20 0 Rp.
106 Kapas pembalut 500gr Rol Rp. 20,850.00 0 Rp.
107 Karbamazepin 200mg tab Tablet Rp. - 0 Rp.

000. 110 Kasa Pembalut 4m X 3cm Rol Rp. 320.00 0 Rp. 119 Kloramfenicol salep mata 1% Tube Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp.00 0 Rp.050. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 10. 4. 109 Kasa Pembalut 2m X 80cm Rol Rp. 115 Ketorolac 30mg inj Ampul Rp.00 0 Rp. 0 Rp. . . 114 Ketorolac 10mg inj Ampul Rp. .000. 300.00 0 Rp. 0 Rp. . 117 Kloramfenicol kapsul 250 mg Capsul Rp. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.228. 2.00 0 Rp.00 500 Rp. 0 Rp. 2. . 0 Rp.00 5 Rp.00 0 Rp. . 25. 121 Kloroquin 250mg tab Tablet Rp. 2. 112 Ketoconazole 2 % krim Tube Rp. 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp.633.108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp.00 0 Rp. 25. 118 Kloramfenicol tts telinga 3 % Botol Rp.665.

0 Rp. 0 Rp. 3.00 0 Rp. . . .918.00 100 Rp. 125. 554. . . 133. 135 Methilergometrin maleat inj Ampul Rp. 79. Infus 0.000. 160 Piracetam 400mg tab Tablet Rp.00 0 Rp. 156 Parasetamol 120mg/5ml srp Botol Rp. 0 Rp.9% Botol Rp. . 165 Plester 5 yard X 2 inc Rol Rp. Inj Ampul Rp.00 0 Rp.00 0 Rp. 0 Rp. 7. 157 Parasetamol 100mg tab Tablet Rp. 171 Propanolol HCL 40mg tablet Tablet Rp.646. 146 Nistatin 100.00 0 Rp. 0 Rp. 929.00 100 Rp. . 142 Natrium klorida lar. 0 Rp.00 0 Rp. 5mg/2ml Ampul Rp. 145 NGT Nasogastric Tube no.688. 5. .390. 126. . 0 Rp.00 5 Rp. 169.122 Klorpromazine HCL 25mg tab Tablet Rp. 148 Nipedipin tab Tablet Rp. 1. 144 Neurodex tab Tablet Rp. 149 Obat batuk hitam Botol Rp.300.298.485. 11. .386. 2. 130 Lidokain komp.00 0 Rp. 0 Rp.00 0 Rp. .600. 158 Parasetamol 500mg tab Tablet Rp.00 0 Rp. 131 Masker Ktk/50"s Rp.00 250 Rp. 93.00 0 Rp. .535. 10 Tube Rp. 166 Pyrantel pamoat tab Tablet Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 150 Oksitetrasiklin inj Vial Rp. 0 Rp. 169 Prednison tab Tablet Rp. 164 Piroksikam 20mg tab Tablet Rp. 5. 20. 0 Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 152 Oksitetrasiklin Hcl salep 1% Tube Rp. . 153 Oksitosin 10IU/ml inj Ampul Rp. 134 Metoclorprofamid 10mg tab Tablet Rp.00 100 Rp. 170 Primakuin 15mg tab Tablet Rp. 8. 163 Piroksikam 10mg tab Tablet Rp. 0 Rp.00 0 Rp. 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. 50. 116. 109. 15. 146.00 0 Rp. .00 0 Rp. 35. 128 Lisol Botol Rp. 0 Rp. . 136 Methilergometrin maleat tab Tablet Rp.00 0 Rp.00 0 Rp. 85. . 143 Neurobion inj Ampul Rp. 167 Povidon iodida 10% 30ml Botol Rp. 0 Rp. 0 Rp. 126 Kotrimoxazol 480mg tab Tablet Rp.00 0 Rp. 115. . 137 Metronidazol 250mg tab Tablet Rp.00 5 Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp.000. 1. 4. 154 Omeperazole capsule Capsul Rp. .00 0 Rp. 159 Papaverin tab Tablet Rp.344.000. 127 Kotrimoxazol Suspensi Botol Rp. 129 Lidokain 2 % inj Ampul Rp. 22. 139 Miconazole cream Tube Rp. 161 Piracetam 1gr tab Vial Rp.00 0 Rp.00 100 Rp. 600.00 50 Rp.00 0 Rp. 123 Klorpromazine HCL 100mg tab Tablet Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 152. 147 Nistatin 500.00 6 Rp.000 IU/g tab vag Tablet Rp.974. 2. 0 Rp. 140 Microlax enema Tube Rp.500.00 0 Rp.00 50 Rp. 138 Metronidazol 500mg tab Tablet Rp.00 500 Rp. 162 Piridoksin 10mg tab Tablet Rp. 124 Klorpromazine HCL inj. 133 Metilprednisolon inj Ampul Rp. .000 IU tablet Tablet Rp. 1. 168 Povidon iodida 10% 300ml Botol Rp. 0 Rp. 0 Rp.00 0 Rp.

0 Rp. 330. . 0 Rp. .00 0 Rp. 5. . 180 Ringer laktat lar infus Botol Rp. 10. 176 Reserpine 0. 173 Ramabion capsule Capsul Rp. 7. 177 Rifampisin 300mg capsul Capsul Rp. 182 Sarung tangan steril No.00 0 Rp. 0 Rp.172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 174 Ranitidine 150mg tablet Tablet Rp.00 0 Rp. . 0 Rp.000.1mg tab Tablet Rp. 183 Sarung tangan steril No. 6.5 Pcs Rp. .00 0 Rp.5 Pcs Rp.00 0 Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp. 10.00 0 Rp. 10.00 0 Rp. 128. 0 Rp.000. 181 Salbutamol 2mg tablet Tablet Rp. .000. 91.000. 10. 184 Sarung tangan steril No.00 0 Rp. 7 Pcs Rp. 179 Rifampisin 600mg tab Tablet Rp. 8 Pcs Rp. 185 Sarung tangan steril No. 0 Rp. 178 Rifampisin 450mg tab Tablet Rp.200. .

188 Sefadroxil 500mg capsul Capsul Rp. 514.500. 191 Selang Oksigen Pcs Rp. 196 Surgical Blade Pcs Rp. .00 0 Rp. . 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.00 200 Rp.00 0 Rp. .00 0 Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp.174. 192 Sianokobalamin (vit B12) inj Ampul Rp. 529.00 0 Rp. . 0 Rp. TO TAL Rp. SRI RAHAYU NIP. 1. 193 Silk benang bedah sutra No. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 190 Seftriakson inj Vial Rp.850. 8. 3.00 30 Rp. 53. April 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 15. . 0 Rp. 201 Thiamin Hcl 50mg tab Tablet Rp. 112. . 2. 207 Zinc Tablet Rp.00 0 Rp. 0 Rp. 7. 206 Vitamin B komplek tab Tablet Rp. 204 Ultraproct N suppositoria Supp Rp. 522.186 Salep 2-4 komb Pot Rp. Puruk Cahu.000. 0 Rp. . 208 Gentamisin Injeksi Ampul Rp. 187 Salisil bedak 2% Pot Rp.00 0 Rp.00 5 Rp. 198 Tablet tambah darah sachet Rp. 194 Simvastatin 10mg tablet Tablet Rp. 203 Tramadol 50mg kasul Capsul Rp.00 0 Rp.. 197 Sulfacetamid tts mata 15% Botol Rp. . 0 Rp. 0 Rp. 3. 209 Suntik KB 3 Bln Vial Rp. 205 Urine Bag Pcs Rp. 3/0 Pcs Rp. NIP.00 0 Rp.333. 265. 189 Sefotaxim inj Vial Rp.00 10 Rp. . 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 409.500. 19700306 200212 2006 . 0 Rp. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp.00 100 Rp.00 10 Rp.200. Puruk Cahu FITRI AGUSYANI NIP. . 0 Rp. 0 Rp. 0 Rp.

400.200.00 202.800.500.00 9.000.00 22.00 - - - - - - - - - - - 12.400.00 27.00 8.300.125.00 11.00 - - - 7.UK CAHU 25 April 2015 LPLO Pustu TOTAL KET - - - - - 17.00 12.900.00 - - - - - - - .00 - - - - - 26.130.420.

500.666.00 - - - - - .00 17.00 - 13.58.00 - - - - - 7.600.900.

00 - - - - - - 44.00 15.400.00 40.00 22.00 - - - - - - - - - - - - - - - - - - - 8.100.300.750.450.700.480.00 - - - - - - - 102.00 - - - - - - - - .00 12.700. - - 8.

- - - - - - - - 20.00 - - - 12.500.250.00 - .

00 - - 7.600.00 - - - - 10.900.788.00 - - - - - - - 16.00 - - - - - - 5.00 - - .900.00 12.250.500.00 13.750.00 - - 7.200.425.300.00 - - - - - - - 7. - - - - 15.675.00 - 42.00 - - - - 23.

- - - - - - - - - - - - - - .

900.049.00 - - 1.00 - - - - 19. - - 52.000.00 - - - 11.660.00 5 kesmas 2002 .740.250.00 - - - - - - - 22.709.00 15.400.00 22.

00 0 Rp. 105. 25 Antiparkinson tab Tablet Rp. 20 Pcs Rp. 17 Amoksisilin 500 mg tablet Tablet Rp.00 5 Rp.00 0 Rp. . . 12 Amlodipin 10mg tab Tablet Rp. 21 Antasida doen srp Botol Rp.142. 2 Abocate No.669.00 5 Rp. 1.00 50 Rp.00 0 Rp. 22 Pcs Rp.00 0 Rp. 41 Benzatil penisilin 2. 9 Ambroxol 100mg tatab Tablet Rp. 5 Alat suntik sekali pakai 2. 2.5mg tablet Tablet Rp. . 35 As.juta IU/vial injeksi Vial Rp. 279.00 0 Rp. . 149.00 0 Rp. 6 Alat suntik sekali pakai 3 ml Pcs Rp.00 60 Rp.000.560.00 0 Rp.4. . 37 Asetosal 500mg tablet Tablet Rp. 34 As.25mg/ml Ampul Rp. . Mefenamatt 500 mg tab Tablet Rp. 1. 0 Rp. 0 Rp. 1. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 26 Antimigrain Kombinasi tablet Tablet Rp.00 0 Rp.00 0 Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp.300. 122. . 10.00 10 Rp.00 0 Rp.00 10 Rp. 0 Rp. 8.600. 354. 0 Rp. 18 Amoksisilin sirup krng 125 mg Botol Rp.00 100 Rp. 28 Aqua pro injeksi Vial Rp. . 30 Asiklovir 400mg tablet Tablet Rp. 15 Aminopillin 200mg tablet Tablet Rp.425. 7 Alat suntik sekali pakai 5 ml Pcs Rp.025. 39 Atropin sulfat 0. 17.00 100 Rp. 168. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 11 Amlodipin 5mg tab Tablet Rp. 0 Rp.2.juta IU/vial injeksi Vial Rp. 1. 154. ascorbat 250 mg tab Tablet Rp. 0.00 0 Rp. 22 Antasida doen tablet Tablet Rp. Ascorbat 50 mg tab Tablet Rp.00 0 Rp.00 0 Rp. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : 954 /Farm/PKM-P. 2. 23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp.5ml Pcs Rp. 16 Amoksisilin 250mg capsul Capsul Rp. 3. 17. 32 As.00 50 Rp. 29 Asiklovir 200mg tablet Tablet Rp.142. 33 As. 164. 2. 24 Pcs Rp. 4.213. 525. 197. 4.00 100 Rp. .00 0 Rp. 73.600. 13 Amitrippilin 25 mg tab Tablet Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp. 36 Asetosal 100mg tablet Tablet Rp. 20 Antalgin 500 mg tablet Tablet Rp. 8 Allopurinol 100mg tablet Tablet Rp.00 0 Rp. 0 Rp.00 100 Rp. 3 Abocate No.00 5 Rp. 197.00 0 Rp. . 220. 1. 24mg/5ml Tablet Rp. 27 Antihaemaroid suppositoria Supp Rp.250.565. 90.142.00 50 Rp. 86.00 20 Rp. . 31 Asiklovir cream Tube Rp.395. Cahu /2015 Tanggal : UNIT KERJA : PUSTU Muara Jaan Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. . 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 40 Benzatil penisilin 1. 0 Rp. 42 Betametason cream Tube Rp. 38 Atropin sulfat inj. 14 Aminopillin inj. 245. 0 Rp.00 0 Rp. 0 Rp. 0 Rp. 0 Rp.

00 10 Rp. 46 Caviplex Syr Botol Rp. . 49 Captopril 12. 96.145.00 0 Rp. 62 Dulcolax 5mg tab Tablet Rp. 174.00 50 Rp. 59 Doksisiklin 100mg capsul Capsul Rp.00 0 Rp. . 29. 44 Calcidol syr Botol Rp.00 5 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp.605. 470. 0 Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 1. . 6. 68.25 tablet Tablet Rp. 51 Dexsametason 0. 79.00 50 Rp. 56 Diazepam 5mg tab Tablet Rp.2/0. 52 Dexsametason 5 mg/ml inj Ampul Rp.5 mg tab Tablet Rp. 190. 1. 0 Rp. 2.00 200 Rp. 0 Rp. 54 Difenhidramin Hcl Inj Ampul Rp. .750. 0 Rp.00 10 Rp.00 0 Rp. 495. 48 Cimetidine tab Tablet Rp. 58 Digoksin 0. 0 Rp. .156.490. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp.00 0 Rp. 0 Rp.333.00 50 Rp.160. 35.43 Catgut benang bedah no.3/0 Pcs Rp. 55 Diazepam 5mg/2ml inj Ampul Rp. 1.5 mg tab Tablet Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp. 3. . .00 100 Rp.00 0 Rp. 45 Caviplex tablet Tablet Rp. 63 Dulcolax supp Supp Rp.00 7 Rp. 57 Diazepam 2mg tab Tablet Rp.00 0 Rp.

12. 8.00 0 Rp. .00 0 Rp. 320.000. 0 Rp. . 99 Ibuprofen 200mg tab Tablet Rp.00 2 Rp. 509. 95 Haloperidol 5mg tablet Tablet Rp. 91. . 2. 2. 10.00 4 Rp. 72 Etakridina (rivanol) lar.00 5 Rp.633. 25. 157.023.00 0 Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 891.1% /1ml Ampul Rp. 76 Fenobarbital 30mg tab.896.00 250 Rp. 92 Hidrocortison krim 2. 1. 0 Rp. .5mg tablet Tablet Rp.00 3 Rp. 102 Intunal Forte tablet Tablet Rp. 97 Hufalysin syr Botol Rp. 70 Etyl klorida semprot Botol Rp.64 Efedrin tab Tablet Rp.00 0 Rp.00 0 Rp. Ampul Rp.000.500. 8. 0 Rp.019. 1. 79 Fitomenadion 10mg/ml inj Ampul Rp.00 0 Rp. 5. 66 Ektrak beladon 100mg tab Tablet Rp. 0 Rp.625.00 0 Rp.000. .1% Botol Rp. 0.000.980. .576. 100 Infusion set anak Pcs Rp. 121.625. 5. .850.3% Botol Rp. 83 Furosemid 40mg tab Tablet Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp. 88 Glibenklamid 5mg tablet Tablet Rp.00 0 Rp. 8.00 0 Rp. 35.00 0 Rp.20 0 Rp. 0 Rp. 90 Griseufulvin 125mg tab Tablet Rp.00 0 Rp.125.090.926.844.00 5 Rp.000. 0 Rp.143. 105 Kalsium laktat 500mg tab Tablet Rp.00 0 Rp. 0 Rp. . 2. 106 Kapas pembalut 500gr Rol Rp.00 0 Rp. 82 Furosemid 10mg/ml inj Ampul Rp. 0 Rp. Tablet Rp. 75 Fenobarbital inj. 85 Gentamisin salep 0. 80 Folley Cateter no. Infus 5% Botol Rp. 98 Ibuprofen 400mg tab Tablet Rp. 20.00 0 Rp. 67 Erytromisin 250mg cap Capsul Rp. 66. 91 Glukosa lar. 68 Erytromisin 500mg tab Tablet Rp.00 0 Rp. . 10.5% Tube Rp. 8.00 0 Rp. 2. 0 Rp. 697. 84 Garam oralit Sachet Rp.00 0 Rp. 107 Karbamazepin 200mg tab Tablet Rp. 12. 0 Rp. 1. 3. 224. 0 Rp. 109 Kasa Pembalut 2m X 80cm Rol Rp.1% Tube Rp. 77 Fenol gliserol Botol Rp.000. 86 Gentamisin tetes mata 0.833.00 0 Rp. . 57. 103 Isoniazid 300mg tab Tablet Rp. 92.00 0 Rp. 115. 101 Infusion set dewasa Pcs Rp. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp. 74 Famotidine tab Tablet Rp. 322. 0 Rp.00 0 Rp. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 87 Gentian violet Botol Rp. 71 Etanol 70% 100 ml Botol Rp. 0 Rp.00 0 Rp.00 5 Rp. 0 Rp.00 5 Rp.00 0 Rp. .00 0 Rp. 93 Haloperidol 0. 94 Haloperidol 1. .00 100 Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp. 112 Ketoconazole 2 % krim Tube Rp.00 0 Rp. 16 Pcs Rp. 3. . 81 Folley Cateter no. 78 Fitomenadion 10mg tab Tablet Rp. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 18 Pcs Rp. 0 Rp. . 89 Gliseril guaiacolat 100mg tab Tablet Rp. 69 Erytromisin 125mg/5ml srp krg Botol Rp. 65 Epineprin HCL (adrenalin) Inj 0. .5mg tablet Tablet Rp.00 0 Rp. . 113 Ketoconazole 200mg tab Tablet Rp.

152.00 500 Rp. 2. 25. 79. 124 Klorpromazine HCL inj. . 121 Kloroquin 250mg tab Tablet Rp. .050.00 0 Rp.00 0 Rp. 929. 0 Rp. 133 Metilprednisolon inj Ampul Rp.665. 131 Masker Ktk/50"s Rp. 123 Klorpromazine HCL 100mg tab Tablet Rp. 127 Kotrimoxazol Suspensi Botol Rp. 115 Ketorolac 30mg inj Ampul Rp.00 0 Rp. 0 Rp. 126 Kotrimoxazol 480mg tab Tablet Rp. . 300. . 2. .114 Ketorolac 10mg inj Ampul Rp.00 0 Rp. 122 Klorpromazine HCL 25mg tab Tablet Rp. . . 50. . 0 Rp. 0 Rp.228.00 0 Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp. 130 Lidokain komp.485. 0 Rp.00 0 Rp. 1.00 0 Rp. 2. 0 Rp. 129 Lidokain 2 % inj Ampul Rp.000. 4. 119 Kloramfenicol salep mata 1% Tube Rp.298.00 5 Rp. 128 Lisol Botol Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 5mg/2ml Ampul Rp. 0 Rp. 118 Kloramfenicol tts telinga 3 % Botol Rp. 120 Klorfeniramini Maleat 4mg tab Tablet Rp.00 0 Rp. Inj Ampul Rp. . . 0 Rp.00 5 Rp. 0 Rp. 116 Kloramfenicol 125mg/5 susp Botol Rp. 125 Kotrimoxazol 120mg tab Tablet Rp.

0 Rp. 133. 163 Piroksikam 10mg tab Tablet Rp. . 165 Plester 5 yard X 2 inc Rol Rp.000. 0 Rp. 170 Primakuin 15mg tab Tablet Rp. 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp.000. 0 Rp. 139 Miconazole cream Tube Rp. 179 Rifampisin 600mg tab Tablet Rp.00 0 Rp. 149 Obat batuk hitam Botol Rp. 135 Methilergometrin maleat inj Ampul Rp. 0 Rp. 116.00 0 Rp.500. . 137 Metronidazol 250mg tab Tablet Rp. 7 Pcs Rp. . 181 Salbutamol 2mg tablet Tablet Rp.000 IU/g tab vag Tablet Rp. 10. 140 Microlax enema Tube Rp. .00 5 Rp. 6.00 0 Rp. 0 Rp. . . 0 Rp. 177 Rifampisin 300mg capsul Capsul Rp. 161 Piracetam 1gr tab Vial Rp. 0 Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp. 93.134 Metoclorprofamid 10mg tab Tablet Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 2. 7. 0 Rp.00 0 Rp.918. 0 Rp. 174 Ranitidine 150mg tablet Tablet Rp. 173 Ramabion capsule Capsul Rp.00 0 Rp.600. 169 Prednison tab Tablet Rp. 168 Povidon iodida 10% 300ml Botol Rp.00 100 Rp.00 0 Rp. 178 Rifampisin 450mg tab Tablet Rp. 4.00 0 Rp.00 100 Rp. 164 Piroksikam 20mg tab Tablet Rp. 0 Rp. . 11. . . 156 Parasetamol 120mg/5ml srp Botol Rp. 157 Parasetamol 100mg tab Tablet Rp.00 0 Rp.00 0 Rp. . 171 Propanolol HCL 40mg tablet Tablet Rp.00 0 Rp. 159 Papaverin tab Tablet Rp. 330. 8.00 200 Rp. . Infus 0. 22. 144 Neurodex tab Tablet Rp. 183 Sarung tangan steril No. 0 Rp. 125. 146. 169. 143 Neurobion inj Ampul Rp.200. 3. 155 Parasetamol drops 100mg/ 1ml Botol Rp. . .5 Pcs Rp.9% Botol Rp.000. 180 Ringer laktat lar infus Botol Rp. 5.000. 141 Natrium Diklofenak 25mg tab Tablet Rp. 167 Povidon iodida 10% 30ml Botol Rp. 5. 85.390. 15. 600. 554.1mg tab Tablet Rp. . 0 Rp.386. 154 Omeperazole capsule Capsul Rp.00 100 Rp. 10.00 0 Rp. 109. 147 Nistatin 500. 142 Natrium klorida lar. .300. 0 Rp. 0 Rp. 153 Oksitosin 10IU/ml inj Ampul Rp. 160 Piracetam 400mg tab Tablet Rp.00 0 Rp.00 0 Rp.00 0 Rp. 0 Rp. 136 Methilergometrin maleat tab Tablet Rp.00 0 Rp. 146 Nistatin 100. 166 Pyrantel pamoat tab Tablet Rp. 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 158 Parasetamol 500mg tab Tablet Rp. 0 Rp.00 0 Rp. 176 Reserpine 0.00 0 Rp.344. 91. 145 NGT Nasogastric Tube no. 35. 20. 150 Oksitetrasiklin inj Vial Rp. 5.00 5 Rp.00 0 Rp. 0 Rp.00 300 Rp. 0 Rp.00 0 Rp.00 0 Rp. 128. 182 Sarung tangan steril No.688.00 0 Rp. 10 Tube Rp.000 IU tablet Tablet Rp.535. .00 0 Rp. 126. 0 Rp.00 0 Rp. . 148 Nipedipin tab Tablet Rp. 162 Piridoksin 10mg tab Tablet Rp.974. . . 138 Metronidazol 500mg tab Tablet Rp. 1. . . 0 Rp.

0 Rp.000.00 100 Rp. 0 Rp. 8. 192 Sianokobalamin (vit B12) inj Ampul Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. 186 Salep 2-4 komb Pot Rp.00 0 Rp.000. 265.00 0 Rp. 53. 8 Pcs Rp.184 Sarung tangan steril No. 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 15. 190 Seftriakson inj Vial Rp.000. 514. 529.00 0 Rp.00 0 Rp.00 0 Rp. 0 Rp. 0 Rp.00 0 Rp. .00 0 Rp. .00 0 Rp. 0 Rp. .200. 10. 0 Rp. 409. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 194 Simvastatin 10mg tablet Tablet Rp. 10.00 0 Rp. 198 Tablet tambah darah sachet Rp. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 189 Sefotaxim inj Vial Rp. 3/0 Pcs Rp. . 196 Surgical Blade Pcs Rp. 191 Selang Oksigen Pcs Rp.174.00 10 Rp. 0 Rp. 2. 7. 188 Sefadroxil 500mg capsul Capsul Rp. 3. 3.00 0 Rp. 187 Salisil bedak 2% Pot Rp. 203 Tramadol 50mg kasul Capsul Rp. . .00 10 Rp.850.500. 197 Sulfacetamid tts mata 15% Botol Rp.5 Pcs Rp.333. . 185 Sarung tangan steril No. 201 Thiamin Hcl 50mg tab Tablet Rp. . 193 Silk benang bedah sutra No. 1.

0 Rp.204 Ultraproct N suppositoria Supp Rp. 25 Mei 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 207 Zinc Tablet Rp. 30 Rp. Puruk Cahu PUNGKAS HUSADA FITRI AGUSYANI NIP. Cahu. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.00 0 Rp. P. 209 Suntik KB 3 Bln Vial Rp. 208 Gentamisin Injeksi Ampul Rp. 19700306 200212 2006 . . 0 Rp. 206 Vitamin B komplek tab Tablet Rp. 0 Rp. SRI RAHAYU NIP. 112. TO TAL Rp. .. 7. 19871221 201001 2 011 NIP.500. . .00 0 Rp. 205 Urine Bag Pcs Rp.

00 12.800.00 - 11.00 11.00 17.25 Mei 2015 LPLO Pustu TOTAL KET - - - - - 22.420.250.065.00 7.00 8.820.00 11.00 22.00 103.125.700.00 9.000.900.00 - - - - - - - - .00 - - - - - - 12.840.00 - - - 12.200.300.400.950.00 - - - - - 27.

00 43.600.00 - - .450.700.500.092.600.00 - - 7.750.00 17.00 - - - - - 8.500.00 24.00 - 11.00 17. - - 23.00 13.900.

00 - - - - 44.625.750.480.000.00 - - - - - - - - - - - - - 10.700.250.095.00 - - 14. - - - - - 40.00 - - - - - .00 - 8.00 - 5.304.00 15.00 - - - - - - - - - 30.450.00 - 15.

- - 20.00 - - - - - - .500.00 - - - 12.00 - - - - - - 11.250.490.

-
-
-
-
16,900.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7,675.00
-
25,500.00
-
-
-
-
-
12,600.00
-
234,400.00
-
-
18,600.00
-
-
-
-
-
-
-
-
-
-
-
-
-
50,000.00

-
-
-
-
52,900.00
-
-
-
11,740.00
-
-
-
-
-
22,000.00
-
-
-
-
-

-
-
-
-
-
-
1,140,071.00

esmas

2002

SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU
(SBBK)
NO : /Farm/PKM-P. Cahu/2015 Tanggal : 25 Mei 2015
UNIT KERJA : PUSTU Juking Pajang Berdasarkan : LPLO Pustu bln April

NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL

1 Abocate No. 20 Pcs Rp. 8,565.00 0 Rp. -
2 Abocate No. 22 Pcs Rp. 17,600.00 0 Rp. -
3 Abocate No. 24 Pcs Rp. 17,600.00 0 Rp. -
4 Alat suntik sekali pakai 1 ml Pcs Rp. 1,250.00 0 Rp. -
5 Alat suntik sekali pakai 2,5ml Pcs Rp. 1,142.00 0 Rp. -
6 Alat suntik sekali pakai 3 ml Pcs Rp. 1,142.00 20 Rp. 22,840.00
7 Alat suntik sekali pakai 5 ml Pcs Rp. 1,142.00 15 Rp. 17,130.00
8 Allopurinol 100mg tablet Tablet Rp. 90.00 100 Rp. 9,000.00
9 Ambroxol 100mg tatab Tablet Rp. 168.00 100 Rp. 16,800.00
10 Ambroxol 15mg/5ml sirup Botol Rp. 4,425.00 5 Rp. 22,125.00
11 Amlodipin 5mg tab Tablet Rp. 197.00 60 Rp. 11,820.00
12 Amlodipin 10mg tab Tablet Rp. 197.00 0 Rp. -
13 Amitrippilin 25 mg tab Tablet Rp. - 0 Rp. -
14 Aminopillin inj. 24mg/5ml Tablet Rp. 3,300.00 0 Rp. -
15 Aminopillin 200mg tablet Tablet Rp. 86.00 0 Rp. -
16 Amoksisilin 250mg capsul Capsul Rp. 220.00 0 Rp. -
17 Amoksisilin 500 mg tablet Tablet Rp. 279.00 200 Rp. 55,800.00
18 Amoksisilin sirup krng 125 mg Botol Rp. 2,560.00 5 Rp. 12,800.00
19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml) Ampul Rp. 10,395.00 10 Rp. 103,950.00
20 Antalgin 500 mg tablet Tablet Rp. 164.00 0 Rp. -
21 Antasida doen srp Botol Rp. 2,213.00 5 Rp. 11,065.00
22 Antasida doen tablet Tablet Rp. 73.00 100 Rp. 7,300.00
23 Antibakteri DOEN komb (basitrasinpollimiksin) salep Tube Rp. - 0 Rp. -
24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 525.00 0 Rp. -
25 Antiparkinson tab Tablet Rp. - 0 Rp. -
26 Antimigrain Kombinasi tablet Tablet Rp. 149.00 0 Rp. -
27 Antihaemaroid suppositoria Supp Rp. - 0 Rp. -
28 Aqua pro injeksi Vial Rp. 4,000.00 0 Rp. -
29 Asiklovir 200mg tablet Tablet Rp. 245.00 100 Rp. 24,500.00
30 Asiklovir 400mg tablet Tablet Rp. 354.00 0 Rp. -
31 Asiklovir cream Tube Rp. - 0 Rp. -
32 As. Ascorbat 50 mg tab Tablet Rp. 105.00 0 Rp. -
33 As. ascorbat 250 mg tab Tablet Rp. 154.00 0 Rp. -
34 As. Mefenamatt 500 mg tab Tablet Rp. 122.00 100 Rp. 12,200.00
35 As. Tranexamat 250mg capsul/ Kalnex 250mg cap Capsul Rp. 2,025.00 0 Rp. -
36 Asetosal 100mg tablet Tablet Rp. - 0 Rp. -
37 Asetosal 500mg tablet Tablet Rp. - 0 Rp. -
38 Atropin sulfat inj. 0.25mg/ml Ampul Rp. - 0 Rp. -
39 Atropin sulfat 0.5mg tablet Tablet Rp. - 0 Rp. -
40 Benzatil penisilin 1,2,juta IU/vial injeksi Vial Rp. - 0 Rp. -
41 Benzatil penisilin 2,4,juta IU/vial injeksi Vial Rp. - 0 Rp. -
42 Betametason cream Tube Rp. 1,669.00 0 Rp. -

750.00 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp.00 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 29.600.160.00 52 Dexsametason 5 mg/ml inj Ampul Rp. - 49 Captopril 12.780.00 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp.00 100 Rp.5 mg tab Tablet Rp.00 100 Rp. 13. 0 Rp.00 0 Rp.333.00 51 Dexsametason 0. 7. 68. 17.00 0 Rp. 190. . 0 Rp. 495.2/0. 0 Rp.3/0 Pcs Rp.00 0 Rp.43 Catgut benang bedah no. - 45 Caviplex tablet Tablet Rp.750.5 mg tab Tablet Rp. 35. 1. 47.00 50 Rp. 11.00 46 Caviplex Syr Botol Rp.500.00 5 Rp. 1.900. - 54 Difenhidramin Hcl Inj Ampul Rp. 79. .00 0 Rp. . 30. - 48 Cimetidine tab Tablet Rp.00 10 Rp.00 10 Rp. 0 Rp.156. .00 55 Diazepam 5mg/2ml inj Ampul Rp.000.605. 6. - 44 Calcidol syr Botol Rp. 2. - 56 Diazepam 5mg tab Tablet Rp. - . 470.00 200 Rp.600. 24. - 57 Diazepam 2mg tab Tablet Rp.

5% Tube Rp.00 100 Rp. 1. . - 74 Famotidine tab Tablet Rp.58 Digoksin 0. 115. 0 Rp. 102.00 100 Rp. Ampul Rp. 2.00 0 Rp.00 5 Rp.145. - 73 Etambuthol HCL 500mg tablet Tablet Rp. - 66 Ektrak beladon 100mg tab Tablet Rp.00 100 Infusion set anak Pcs Rp.00 100 Rp.896.850.500.880. - 77 Fenol gliserol Botol Rp.20 0 Rp. - 87 Gentian violet Botol Rp. - 103 Isoniazid 300mg tab Tablet Rp. 0 Rp. - 81 Folley Cateter no.00 0 Rp. - 65 Epineprin HCL (adrenalin) Inj 0.00 84 Garam oralit Sachet Rp. - 94 Haloperidol 1. 697.400. - 105 Kalsium laktat 500mg tab Tablet Rp.980. 7. 0 Rp.844.00 120 Rp. 0 Rp.00 98 Ibuprofen 400mg tab Tablet Rp. .3% Botol Rp.5mg tablet Tablet Rp. 44.00 0 Rp. - 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 0 Rp. - 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.480. 509.625. - 76 Fenobarbital 30mg tab.143.00 0 Rp. 1. . - 79 Fitomenadion 10mg/ml inj Ampul Rp.00 50 Rp. - 83 Furosemid 40mg tab Tablet Rp. . 0 Rp. 0 Rp.875.00 0 Rp.5mg tablet Tablet Rp. .00 68 Erytromisin 500mg tab Tablet Rp.00 5 Rp. 8. - 88 Glibenklamid 5mg tablet Tablet Rp. 17. 96.1% Tube Rp. Tablet Rp.00 0 Rp.080.00 0 Rp.00 0 Rp. - 71 Etanol 70% 100 ml Botol Rp. 0 Rp.926.25 tablet Tablet Rp.1% Botol Rp.00 0 Rp.00 0 Rp. .000.000. - 97 Hufalysin syr Botol Rp. - 67 Erytromisin 250mg cap Capsul Rp.023. 891. 17.00 0 Rp. .00 0 Rp. 0 Rp.833. 35. 224. 0 Rp.625.00 0 Rp. 2. 1.00 5 Rp.450. . 61.019. - 95 Haloperidol 5mg tablet Tablet Rp. - 63 Dulcolax supp Supp Rp. 0.600. 15. 18 Pcs Rp.00 90 Griseufulvin 125mg tab Tablet Rp. - 80 Folley Cateter no. - 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.1% /1ml Ampul Rp. 0 Rp.000. .00 93 Haloperidol 0. .00 500 Rp. 0 Rp.00 5 Rp. .00 0 Rp.00 100 Rp.000. 0 Rp.700. 17.00 91 Glukosa lar.400.450. - 82 Furosemid 10mg/ml inj Ampul Rp.00 61 Domperidom syr/ Vesverum syr Botol Rp. 3. 3. 0 Rp. 8. 4. - 106 Kapas pembalut 500gr Rol Rp. 66. 57. 91.576. .00 3 Rp. 12. - 75 Fenobarbital inj.00 69 Erytromisin 125mg/5ml srp krg Botol Rp. 5.00 99 Ibuprofen 200mg tab Tablet Rp. - 59 Doksisiklin 100mg capsul Capsul Rp.00 0 Rp.300. 121. 16 Pcs Rp. 17. 157. - 78 Fitomenadion 10mg tab Tablet Rp. 1. - 107 Karbamazepin 200mg tab Tablet Rp. .00 70 Etyl klorida semprot Botol Rp. - 89 Gliseril guaiacolat 100mg tab Tablet Rp. - 101 Infusion set dewasa Pcs Rp. - . 8.00 0 Rp.00 100 Rp. Infus 5% Botol Rp.00 0 Rp. 10. 5. 20. 322.00 0 Rp. 12. 3. 92. 40.00 0 Rp. 12.00 0 Rp.100. - 102 Intunal Forte tablet Tablet Rp. 2.00 0 Rp.00 72 Etakridina (rivanol) lar. 0 Rp. .090. 174. 8. 22.490. .500. - 85 Gentamisin salep 0. - 92 Hidrocortison krim 2. - 64 Efedrin tab Tablet Rp.00 62 Dulcolax 5mg tab Tablet Rp. - 86 Gentamisin tetes mata 0.125.

250. 25.00 5 Rp. . - 109 Kasa Pembalut 2m X 80cm Rol Rp. 320. - 113 Ketoconazole 200mg tab Tablet Rp. 300. 0 Rp. 2. . - 115 Ketorolac 30mg inj Ampul Rp.00 300 Rp. 2.00 0 Rp.00 0 Rp.633. - 114 Ketorolac 10mg inj Ampul Rp.000.00 0 Rp.000. 20. .000. 0 Rp.00 . 10. 0 Rp. - 110 Kasa Pembalut 4m X 3cm Rol Rp. - 116 Kloramfenicol 125mg/5 susp Botol Rp. 4.00 117 Kloramfenicol kapsul 250 mg Capsul Rp.108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 90. - 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.00 0 Rp.665. - 112 Ketoconazole 2 % krim Tube Rp.050.00 0 Rp.

500.490. .500. 3.918. 42.00 0 Rp. . - 129 Lidokain 2 % inj Ampul Rp. 16. - 160 Piracetam 400mg tab Tablet Rp. 116. 50.688.00 0 Rp.200.00 139 Miconazole cream Tube Rp. . . . - 147 Nistatin 500. 85. - 153 Oksitosin 10IU/ml inj Ampul Rp.00 5 Rp. 169. 10 Tube Rp. 146.974.390. 7. 600. 0 Rp.000.000. 4. 12.00 0 Rp. 0 Rp.500. . 0 Rp. 152.00 5 Rp. 0 Rp. 0 Rp.300. 0 Rp. 1.00 0 Rp. 2.00 0 Rp.00 100 Rp.00 50 Rp. - 126 Kotrimoxazol 480mg tab Tablet Rp.00 100 Rp.00 157 Parasetamol 100mg tab Tablet Rp. 0 Rp. 0 Rp. - 136 Methilergometrin maleat tab Tablet Rp.00 128 Lisol Botol Rp. 7. 0 Rp.00 500 Rp.00 0 Rp. 0 Rp. 30. - 152 Oksitetrasiklin Hcl salep 1% Tube Rp. 5. - 135 Methilergometrin maleat inj Ampul Rp. - 119 Kloramfenicol salep mata 1% Tube Rp. 0 Rp.00 145 NGT Nasogastric Tube no. 11. - 164 Piroksikam 20mg tab Tablet Rp.00 500 Rp. 115. 126.118 Kloramfenicol tts telinga 3 % Botol Rp. - 162 Piridoksin 10mg tab Tablet Rp. .00 50 Rp. 5. 0 Rp. 15. - 155 Parasetamol drops 100mg/ 1ml Botol Rp. . - 131 Masker Ktk/50"s Rp. - . - 154 Omeperazole capsule Capsul Rp. . . 0 Rp. - 134 Metoclorprofamid 10mg tab Tablet Rp. 35. 554.00 165 Plester 5 yard X 2 inc Rol Rp. 109. . . 0 Rp. 8.00 0 Rp. 2. - 166 Pyrantel pamoat tab Tablet Rp. Inj Ampul Rp. 11.00 0 Rp. 25.00 0 Rp.000 IU/g tab vag Tablet Rp.00 0 Rp. - 144 Neurodex tab Tablet Rp. - 163 Piroksikam 10mg tab Tablet Rp. . .00 0 Rp. 22.298. 1. .00 50 Rp.675.00 142 Natrium klorida lar.228. 79. - 141 Natrium Diklofenak 25mg tab Tablet Rp. 12. 1. - 125 Kotrimoxazol 120mg tab Tablet Rp. - 167 Povidon iodida 10% 30ml Botol Rp.00 121 Kloroquin 250mg tab Tablet Rp. 7.00 0 Rp.9% Botol Rp. - 138 Metronidazol 500mg tab Tablet Rp. . 2.00 0 Rp.00 159 Papaverin tab Tablet Rp. - 122 Klorpromazine HCL 25mg tab Tablet Rp.00 0 Rp. - 156 Parasetamol 120mg/5ml srp Botol Rp.000. - 130 Lidokain komp.000 IU tablet Tablet Rp. . - 158 Parasetamol 500mg tab Tablet Rp. - 146 Nistatin 100. .900. .00 0 Rp. - 123 Klorpromazine HCL 100mg tab Tablet Rp.00 0 Rp. 5.750. - 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. - 143 Neurobion inj Ampul Rp.485.646.00 0 Rp. 0 Rp. 0 Rp. Infus 0.600.00 0 Rp. - 150 Oksitetrasiklin inj Vial Rp. . 0 Rp.00 100 Rp. - 133 Metilprednisolon inj Ampul Rp.300. - 124 Klorpromazine HCL inj.00 0 Rp. 0 Rp.000. - 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 5mg/2ml Ampul Rp. - 161 Piracetam 1gr tab Vial Rp. - 137 Metronidazol 250mg tab Tablet Rp. - 148 Nipedipin tab Tablet Rp.00 149 Obat batuk hitam Botol Rp.600. 929.535. 20. 0 Rp.00 127 Kotrimoxazol Suspensi Botol Rp. 0 Rp.344.00 0 Rp. - 140 Microlax enema Tube Rp. - 120 Klorfeniramini Maleat 4mg tab Tablet Rp.

0 Rp. - . 0 Rp.00 0 Rp. 15.1mg tab Tablet Rp. - 171 Propanolol HCL 40mg tablet Tablet Rp. 128.00 0 Rp. . 0 Rp. - 173 Ramabion capsule Capsul Rp.168 Povidon iodida 10% 300ml Botol Rp.00 0 Rp. - 169 Prednison tab Tablet Rp. - 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp.00 0 Rp. 125. . - 177 Rifampisin 300mg capsul Capsul Rp. 93. - 174 Ranitidine 150mg tablet Tablet Rp.386. - 176 Reserpine 0.00 0 Rp. 330. 133.00 0 Rp. - 175 Ranitidine 25mg / 2ml inj Ampul Rp. . . 0 Rp. - 170 Primakuin 15mg tab Tablet Rp.

7. 91.000. 1. - 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 25 Mei 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu …….000. 3. 0 Rp. 0 Rp. . . - 179 Rifampisin 600mg tab Tablet Rp. 529.00 100 Rp.5 Pcs Rp. - 184 Sarung tangan steril No. 22. - 196 Surgical Blade Pcs Rp. - 202 Thiamin Hcl 100mg/ml inj Ampul Rp.00 0 Rp.900. - 180 Ringer laktat lar infus Botol Rp.00 0 Rp. - 181 Salbutamol 2mg tablet Tablet Rp.00 0 Rp. 5.00 0 Rp. 0 Rp. 1. . 10.00 0 Rp. 10. . - 187 Salisil bedak 2% Pot Rp. - 205 Urine Bag Pcs Rp.00 0 Rp.400.00 200 Rp.00 0 Rp. 0 Rp.00 0 Rp.. 19700306 200212 2006 . NIP. .00 10 Rp. 0 Rp. 0 Rp. 15.000. 10. 40.00 100 Rp.00 0 Rp. - 185 Sarung tangan steril No. 409. 22. . - 186 Salep 2-4 komb Pot Rp.00 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. 0 Rp. 8 Pcs Rp.283.00 201 Thiamin Hcl 50mg tab Tablet Rp.333. - 204 Ultraproct N suppositoria Supp Rp. 514.00 0 Rp. .00 10 Rp. 53. - 209 Suntik KB 3 Bln Vial Rp. - TO TAL Rp. 3/0 Pcs Rp.200. 2. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.850.00 0 Rp.00 0 Rp. 0 Rp. - 183 Sarung tangan steril No.000. 10.000. 8.178 Rifampisin 450mg tab Tablet Rp. 52.00 189 Sefotaxim inj Vial Rp.174.200.00 0 Rp.500. . 3.780. SRI RAHAYU NIP. - 188 Sefadroxil 500mg capsul Capsul Rp. - 191 Selang Oksigen Pcs Rp.740.00 193 Silk benang bedah sutra No.00 207 Zinc Tablet Rp. . 0 Rp. 7 Pcs Rp.00 0 Rp. - 197 Sulfacetamid tts mata 15% Botol Rp.900. .00 Puruk Cahu.000. 522. Puruk Cahu FITRI AGUSYANI NIP. 265. - 203 Tramadol 50mg kasul Capsul Rp. 0 Rp. - 182 Sarung tangan steril No. 6. 0 Rp. . - 198 Tablet tambah darah sachet Rp. . 112. - 192 Sianokobalamin (vit B12) inj Ampul Rp.5 Pcs Rp.500. 7. - 195 Siprofloksasin HCL 500mg tablet Tablet Rp. - 194 Simvastatin 10mg tablet Tablet Rp. - 208 Gentamisin Injeksi Ampul Rp. 11. - 206 Vitamin B komplek tab Tablet Rp. - 190 Seftriakson inj Vial Rp.00 0 Rp. 0 Rp.

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4. 1.00 0 Rp. 0 Rp. 0 Rp. 0 Rp. 39 Atropin sulfat 0. 6 Alat suntik sekali pakai 3 ml Pcs Rp.00 50 Rp. 4. 1. .142. . 90. 36 Asetosal 100mg tablet Tablet Rp. . 220.00 100 Rp. 29 Asiklovir 200mg tablet Tablet Rp.250. 149. 3.00 0 Rp. 18 Amoksisilin sirup krng 125 mg Botol Rp. 35 As. 73. 14 Aminopillin inj.00 15 Rp. 3 Abocate No. 10. . Mefenamatt 500 mg tab Tablet Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp.142. 33 As. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp. 354.00 0 Rp.00 100 Rp.565.213. 12 Amlodipin 10mg tab Tablet Rp. 42 Betametason cream Tube Rp.5mg tablet Tablet Rp. 34 As. . 105. 30 Asiklovir 400mg tablet Tablet Rp. 1. . 2. 32 As.00 0 Rp. 2 Abocate No. 16 Amoksisilin 250mg capsul Capsul Rp. 0.25mg/ml Ampul Rp. 0 Rp.600. 40 Benzatil penisilin 1.395. 0 Rp. 11 Amlodipin 5mg tab Tablet Rp.000. 28 Aqua pro injeksi Vial Rp. .300. 15 Aminopillin 200mg tablet Tablet Rp. 13 Amitrippilin 25 mg tab Tablet Rp. 20 Pcs Rp. .00 0 Rp. . 0 Rp.00 7 Rp. Ascorbat 50 mg tab Tablet Rp.00 20 Rp.00 10 Rp.669. 37 Asetosal 500mg tablet Tablet Rp.00 0 Rp.00 60 Rp. 86. 17. 2. 17.00 100 Rp. 1. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Muara Bumban Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. 9 Ambroxol 100mg tab Tablet Rp.00 0 Rp. 197.142. . 31 Asiklovir cream Tube Rp.00 0 Rp.600. 279. 168. 8 Allopurinol 100mg tablet Tablet Rp. 8. 20 Antalgin 500 mg tablet Tablet Rp.00 200 Rp. 17 Amoksisilin 500 mg tablet Tablet Rp.00 0 Rp. ascorbat 250 mg tab Tablet Rp.00 0 Rp. 24mg/5ml Tablet Rp.2. 0 Rp. 525. 38 Atropin sulfat inj. Tranexamat 250mg capsul/ Kalnex 250mg c Capsul Rp.00 0 Rp.560. 26 Antimigrain Kombinasi tablet Tablet Rp. 7 Alat suntik sekali pakai 5 ml Pcs Rp. 122.00 5 Rp. 23 Antibakteri DOEN komb (basitrasinpollimiksin) s Tube Rp.juta IU/vial injeksi Vial Rp. 0 Rp.00 0 Rp.00 100 Rp.4. 0 Rp. 5 Alat suntik sekali pakai 2.00 0 Rp.00 5 Rp. 41 Benzatil penisilin 2. 0 Rp. 164.00 0 Rp.025. 0 Rp.00 0 Rp. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml Ampul Rp. 245.juta IU/vial injeksi Vial Rp. 24 Pcs Rp.00 0 Rp. 27 Antihaemaroid suppositoria Supp Rp. .00 0 Rp. 154. 21 Antasida doen srp Botol Rp.00 0 Rp. 22 Pcs Rp. 25 Antiparkinson tab Tablet Rp. .5ml Pcs Rp. 197. 1. 22 Antasida doen tablet Tablet Rp. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P.425. 2.

50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp.00 0 Rp.2/0. 54 Difenhidramin Hcl Inj Ampul Rp. 56 Diazepam 5mg tab Tablet Rp.00 5 Rp. 51 Dexsametason 0. . 0 Rp.605. 49 Captopril 12. 55 Diazepam 5mg/2ml inj Ampul Rp.333.145.5 mg tab Tablet Rp. . 46 Caviplex Syr Botol Rp. 470.5 mg tab Tablet Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp. 48 Cimetidine tab Tablet Rp.00 100 Rp.00 0 Rp. 45 Caviplex tablet Tablet Rp.160.490.00 50 Rp. 52 Dexsametason 5 mg/ml inj Ampul Rp. 1. 174. 1. 0 Rp. 44 Calcidol syr Botol Rp. . 59 Doksisiklin 100mg capsul Capsul Rp. 0 Rp. 79.00 100 Rp. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 1. . . 0 Rp. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp. 62 Dulcolax 5mg tab Tablet Rp.00 0 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp.00 0 Rp.00 5 Rp.156.25 tablet Tablet Rp. 68. 96.00 0 Rp. 495. 35. .43 Catgut benang bedah no. 6. 0 Rp.00 10 Rp. 190.750. 29.00 200 Rp.00 0 Rp. . 2. 63 Dulcolax supp Supp Rp.00 10 Rp. 3.3/0 Pcs Rp.00 50 Rp. 58 Digoksin 0. 57 Diazepam 2mg tab Tablet Rp. 0 Rp.

00 0 Rp.00 100 Rp. 70 Etyl klorida semprot Botol Rp. 92.844.00 250 Rp. 83 Furosemid 40mg tab Tablet Rp. . 224. 0 Rp. 108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. 3. 85 Gentamisin salep 0. 8. 0 Rp.00 0 Rp. 12. Infus 5% Botol Rp.000. 88 Glibenklamid 5mg tablet Tablet Rp.833. 87 Gentian violet Botol Rp.00 50 Rp.00 0 Rp.00 0 Rp. 71 Etanol 70% 100 ml Botol Rp.00 0 Rp. 1. 121. . 0 Rp. 106 Kapas pembalut 500gr Rol Rp. .20 0 Rp. . 25. 1.896. 79 Fitomenadion 10mg/ml inj Ampul Rp. 16 Pcs Rp.500. . 18 Pcs Rp. 101 Infusion set dewasa Pcs Rp.00 5 Rp. 0 Rp.00 5 Rp. Ampul Rp.850. . 73 Etambuthol HCL 500mg tablet Tablet Rp. 322.625.576.00 0 Rp. 891. 81 Folley Cateter no. 115. . . 67 Erytromisin 250mg cap Capsul Rp.00 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp. 10. 77 Fenol gliserol Botol Rp.625. 157. 107 Karbamazepin 200mg tab Tablet Rp. Tablet Rp. .00 2 Rp. . 112 Ketoconazole 2 % krim Tube Rp. . 99 Ibuprofen 200mg tab Tablet Rp. 94 Haloperidol 1. 109 Kasa Pembalut 2m X 80cm Rol Rp. 2. 103 Isoniazid 300mg tab Tablet Rp.00 0 Rp. 75 Fenobarbital inj.64 Efedrin tab Tablet Rp.00 0 Rp. 97 Hufalysin syr Botol Rp. .00 0 Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp. 0 Rp. 72 Etakridina (rivanol) lar. 0 Rp. 78 Fitomenadion 10mg tab Tablet Rp. 12.1% Botol Rp. 5. 2.00 0 Rp. 80 Folley Cateter no. .00 0 Rp. .633. 8. 91. 66 Ektrak beladon 100mg tab Tablet Rp.00 0 Rp. 20.00 0 Rp. 5 Rp. 0 Rp. 8. 0 Rp.5mg tablet Tablet Rp.000.00 0 Rp. 68 Erytromisin 500mg tab Tablet Rp.00 0 Rp. 0 Rp. 57. 10. 0 Rp. 8. 65 Epineprin HCL (adrenalin) Inj 0. 320. 509. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp.125.5% Tube Rp. 69 Erytromisin 125mg/5ml srp krg Botol Rp. 89 Gliseril guaiacolat 100mg tab Tablet Rp.926. 66. 84 Garam oralit Sachet Rp. 105 Kalsium laktat 500mg tab Tablet Rp.00 100 Rp. 76 Fenobarbital 30mg tab. 74 Famotidine tab Tablet Rp. 0 Rp. 0 Rp. 90 Griseufulvin 125mg tab Tablet Rp.00 120 Rp. 102 Intunal Forte tablet Tablet Rp.00 0 Rp. 100 Infusion set anak Pcs Rp.00 0 Rp.3% Botol Rp.023.980. 35.5mg tablet Tablet Rp. 86 Gentamisin tetes mata 0. 0 Rp.00 0 Rp. 2.000. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 93 Haloperidol 0.090. .00 0 Rp. 98 Ibuprofen 400mg tab Tablet Rp. 1.00 0 Rp. 697. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.000.1% /1ml Ampul Rp. 5.00 0 Rp.000.00 100 Rp.00 0 Rp. 3.143. 0 Rp.000. .1% Tube Rp. 95 Haloperidol 5mg tablet Tablet Rp.019. 2. 91 Glukosa lar.00 2 Rp. 92 Hidrocortison krim 2.00 0 Rp. 82 Furosemid 10mg/ml inj Ampul Rp. 0.

130 Lidokain komp.00 0 Rp. .00 5 Rp. 127 Kotrimoxazol Suspensi Botol Rp. 124 Klorpromazine HCL inj.485. . 118 Kloramfenicol tts telinga 3 % Botol Rp. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp.114 Ketorolac 10mg inj Ampul Rp. 129 Lidokain 2 % inj Ampul Rp.00 0 Rp. 2. 0 Rp. 119 Kloramfenicol salep mata 1% Tube Rp. 126 Kotrimoxazol 480mg tab Tablet Rp.665. 116 Kloramfenicol 125mg/5 susp Botol Rp.298. 0 Rp. 0 Rp. 2. 152. 115 Ketorolac 30mg inj Ampul Rp.050. 4.00 0 Rp. 117 Kloramfenicol kapsul 250 mg Capsul Rp. . 2. 929. 0 Rp. 122 Klorpromazine HCL 25mg tab Tablet Rp. 5mg/2ml Ampul Rp.00 6 Rp. . 1. 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. .00 0 Rp. 25. 300. 0 Rp.000. .00 0 Rp. .228. 120 Klorfeniramini Maleat 4mg tab Tablet Rp. 133 Metilprednisolon inj Ampul Rp. 0 Rp. 123 Klorpromazine HCL 100mg tab Tablet Rp.00 0 Rp.00 100 Rp.00 5 Rp. 50. Inj Ampul Rp. . 128 Lisol Botol Rp. 0 Rp. 121 Kloroquin 250mg tab Tablet Rp. 0 Rp. . 131 Masker Ktk/50"s Rp. 79.00 500 Rp. .

35. 0 Rp. 177 Rifampisin 300mg capsul Capsul Rp.00 100 Rp.600. . 0 Rp. 0 Rp. 115. 0 Rp. 0 Rp.386.00 0 Rp.000 IU/g tab vag Tablet Rp. 1.00 500 Rp.00 0 Rp. 109. 8. 172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 158 Parasetamol 500mg tab Tablet Rp. 163 Piroksikam 10mg tab Tablet Rp. 178 Rifampisin 450mg tab Tablet Rp. . 0 Rp. .918. 7. . 137 Metronidazol 250mg tab Tablet Rp.5 Pcs Rp. 554.688. 167 Povidon iodida 10% 30ml Botol Rp. 179 Rifampisin 600mg tab Tablet Rp.1mg tab Tablet Rp.00 250 Rp. 166 Pyrantel pamoat tab Tablet Rp. 153 Oksitosin 10IU/ml inj Ampul Rp.134 Metoclorprofamid 10mg tab Tablet Rp.00 0 Rp.00 0 Rp. 10 Tube Rp. 91. 0 Rp. 0 Rp. 0 Rp. 116. .00 0 Rp. 146 Nistatin 100. 0 Rp. 10.500. 3. 136 Methilergometrin maleat tab Tablet Rp. 5.00 10 Rp.00 0 Rp.390.300.00 0 Rp. 168 Povidon iodida 10% 300ml Botol Rp. 149 Obat batuk hitam Botol Rp.000. 182 Sarung tangan steril No.00 0 Rp.000.535. 169 Prednison tab Tablet Rp. 169. 1. 164 Piroksikam 20mg tab Tablet Rp. 142 Natrium klorida lar. 2. 0 Rp. 181 Salbutamol 2mg tablet Tablet Rp. 139 Miconazole cream Tube Rp. 4.000. 0 Rp. 600. 160 Piracetam 400mg tab Tablet Rp. 161 Piracetam 1gr tab Vial Rp. 133. . 15. . 152 Oksitetrasiklin Hcl salep 1% Tube Rp.000.00 500 Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp. . 171 Propanolol HCL 40mg tablet Tablet Rp. 0 Rp.00 0 Rp.00 0 Rp. 5.00 8 Rp.00 0 Rp. 148 Nipedipin tab Tablet Rp. 7 Pcs Rp.00 0 Rp. .646.00 0 Rp. 141 Natrium Diklofenak 25mg tab Tablet Rp. 144 Neurodex tab Tablet Rp. 11.974. .200. .00 0 Rp.00 100 Rp. 159 Papaverin tab Tablet Rp. 22. 93. 126. 165 Plester 5 yard X 2 inc Rol Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp. .00 10 Rp. . . 0 Rp. . 143 Neurobion inj Ampul Rp. 154 Omeperazole capsule Capsul Rp. 170 Primakuin 15mg tab Tablet Rp.9% Botol Rp. 147 Nistatin 500.00 0 Rp. 0 Rp. . 85.00 0 Rp. 157 Parasetamol 100mg tab Tablet Rp. 174 Ranitidine 150mg tablet Tablet Rp. 176 Reserpine 0.00 0 Rp. 150 Oksitetrasiklin inj Vial Rp.00 100 Rp. 146. 125. 0 Rp.00 0 Rp.00 0 Rp.344. 162 Piridoksin 10mg tab Tablet Rp. 183 Sarung tangan steril No. 138 Metronidazol 500mg tab Tablet Rp. 140 Microlax enema Tube Rp. 6. 145 NGT Nasogastric Tube no.00 0 Rp. 180 Ringer laktat lar infus Botol Rp. 156 Parasetamol 120mg/5ml srp Botol Rp. 10. 5. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 20. 135 Methilergometrin maleat inj Ampul Rp. . 330.00 0 Rp. Infus 0. 0 Rp. .00 0 Rp.00 0 Rp.000 IU tablet Tablet Rp. 128. . 0 Rp. 173 Ramabion capsule Capsul Rp.

00 0 Rp. 0 Rp. 196 Surgical Blade Pcs Rp.174. 198 Tablet tambah darah sachet Rp. .00 0 Rp. 191 Selang Oksigen Pcs Rp.00 100 Rp. 3.200. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. 186 Salep 2-4 komb Pot Rp. 1. 10. 2. 194 Simvastatin 10mg tablet Tablet Rp. 185 Sarung tangan steril No. .500.333. 201 Thiamin Hcl 50mg tab Tablet Rp. 187 Salisil bedak 2% Pot Rp. 188 Sefadroxil 500mg capsul Capsul Rp.00 10 Rp.00 0 Rp. 189 Sefotaxim inj Vial Rp. .00 10 Rp. 3. 192 Sianokobalamin (vit B12) inj Ampul Rp. 0 Rp. 0 Rp.00 0 Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. 0 Rp.5 Pcs Rp. 8 Pcs Rp. 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp.00 0 Rp. 10.00 0 Rp.000.00 0 Rp. 203 Tramadol 50mg kasul Capsul Rp.00 0 Rp. 15. 0 Rp. . 7. 197 Sulfacetamid tts mata 15% Botol Rp. 8. 53.850. .00 0 Rp. .000.00 0 Rp. 0 Rp. 265. . 529. 195 Siprofloksasin HCL 500mg tablet Tablet Rp.000. 193 Silk benang bedah sutra No.184 Sarung tangan steril No. . 514. 0 Rp. 409. 190 Seftriakson inj Vial Rp. 3/0 Pcs Rp.

205 Urine Bag Pcs Rp. 25 Mei 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 30 Rp.204 Ultraproct N suppositoria Supp Rp. TO TAL Rp. . SRI RAHAYU NIP.500.. 207 Zinc Tablet Rp. 206 Vitamin B komplek tab Tablet Rp. 112. . 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.00 0 Rp. 522.00 0 Rp. 209 Suntik KB 3 Bln Vial Rp. 208 Gentamisin Injeksi Ampul Rp. 0 Rp. 19700306 200212 2006 . 7. Puruk Cahu FITRI AGUSYANI NIP.00 0 Rp. Puruk Cahu. NIP. 0 Rp. .

UK CAHU 25 Mei 2015 LPLO Pustu TOTAL KET - - - - - 22.500.130.00 - 11.00 17.800.00 17.00 7.700.00 11.00 - - - - - - - - .125.00 - - - 12.00 103.00 - - - - - 55.300.920.820.00 - - - - - - 24.000.065.950.200.00 - 22.00 9.840.00 17.

- - 23.00 17.450.00 - - - - - 17.00 30.00 17.00 - 11.00 - - .750.00 - - 7.600.400.600.500.780.500.900.00 24.00 13.

00 - - - - - .00 12.00 - - - - - - 44.00 - 40.00 22.100.250.00 - - - - - 8.700.00 - - - - - - - - - - - 4. - - - 61.00 15.00 - - - - - - - - 20.600.400.000.00 - 5.750.480.080.450.

- - 20.00 - - - .500.250.788.200.425.00 13.00 - - - 12.00 - - - - - 15.00 - - 7.

00 - - - 17.280.900.000.250.880.00 12. - - - - 16.00 - - - - 23.900.500.00 - - 12.00 - - - - - - - - - - - - - 100.00 - - - - - - - - - - - - - - 116.00 10.600.500.00 - 42.00 .

00 - - - - - .900.00 - - - 11.740.000.00 - - - - - 22. - - - - 52.

253.241.00 15 kesmas 2002 . - - - - - - 1.

00 0 Rp. 13 Amitrippilin 25 mg tab Tablet Rp.000. 1. .250. 105. 1. 168. 7 Alat suntik sekali pakai 5 ml Pcs Rp.00 0 Rp.00 0 Rp.00 0 Rp. 90.00 100 Rp. 24 Antimalaria DOEN komb (suldox) tab Tablet Rp.00 5 Rp.juta IU/vial injeksi Vial Rp. 38 Atropin sulfat inj. 154. 17. 26 Antimigrain Kombinasi tablet Tablet Rp. Cahu/2015 Tanggal : UNIT KERJA : PUSTU Muara Untu Berdasarkan : NO NAMA OBAT SATUAN HARGA JUMLAH TOTAL 1 Abocate No. 8. 0.2. 122. 0 Rp. 33 As. 28 Aqua pro injeksi Vial Rp.00 0 Rp. 25 Antiparkinson tab Tablet Rp. . 39 Atropin sulfat 0. 0 Rp.00 0 Rp. Tranexamat 250mg capsul/ Kalnex 250mg c Capsul Rp.142. 17.600.00 0 Rp.600.00 100 Rp.00 0 Rp. 10 Ambroxol 15mg/5ml sirup Botol Rp. 86. 525. 3 Abocate No. 41 Benzatil penisilin 2.00 0 Rp. 4 Alat suntik sekali pakai 1 ml Pcs Rp.00 0 Rp. 14 Aminopillin inj. ascorbat 250 mg tab Tablet Rp. 16 Amoksisilin 250mg capsul Capsul Rp.00 120 Rp. 15 Aminopillin 200mg tablet Tablet Rp.213.00 0 Rp. 1. 19 Antalgin 250 mg/ml inj (Noralges inj 500mg/2 ml Ampul Rp. 22 Pcs Rp.00 10 Rp.00 0 Rp. 24 Pcs Rp. 1. 31 Asiklovir cream Tube Rp. . 8 Allopurinol 100mg tablet Tablet Rp.300.juta IU/vial injeksi Vial Rp. 40 Benzatil penisilin 1.00 100 Rp. . 149.00 5 Rp.395.00 0 Rp. Ascorbat 50 mg tab Tablet Rp. 354. 197. .5mg tablet Tablet Rp.25mg/ml Ampul Rp. .142.00 0 Rp.5ml Pcs Rp. 34 As. 2. 27 Antihaemaroid suppositoria Supp Rp. SURAT BUKTI BARANG KELUAR PUSKESMAS PURUK CAHU (SBBK) NO : /Farm/PKM-P. 6 Alat suntik sekali pakai 3 ml Pcs Rp. 0 Rp.425. 29 Asiklovir 200mg tablet Tablet Rp. 9 Ambroxol 100mg tab Tablet Rp. 23 Antibakteri DOEN komb (basitrasinpollimiksin) s Tube Rp. 4.00 0 Rp. 164. 0 Rp. 18 Amoksisilin sirup krng 125 mg Botol Rp.00 0 Rp. .00 0 Rp. . 0 Rp. 0 Rp. 0 Rp. 0 Rp. 220.00 100 Rp. 20 Antalgin 500 mg tablet Tablet Rp.00 100 Rp. 0 Rp. 4. 20 Pcs Rp.669.565. 3.00 0 Rp. 10. 5 Alat suntik sekali pakai 2. 11 Amlodipin 5mg tab Tablet Rp. 36 Asetosal 100mg tablet Tablet Rp. 73.560. . 2. 245. 32 As. . 30 Asiklovir 400mg tablet Tablet Rp. 197. 21 Antasida doen srp Botol Rp. 12 Amlodipin 10mg tab Tablet Rp. 0 Rp.142.00 50 Rp. 37 Asetosal 500mg tablet Tablet Rp. 2 Abocate No. 35 As.025. 2.00 0 Rp. .00 15 Rp. 22 Antasida doen tablet Tablet Rp. 17 Amoksisilin 500 mg tablet Tablet Rp.00 0 Rp. . 24mg/5ml Tablet Rp.4. Mefenamatt 500 mg tab Tablet Rp. 0 Rp. 1. 279. 42 Betametason cream Tube Rp.

5 mg tab Tablet Rp. 1. 79. 52 Dexsametason 5 mg/ml inj Ampul Rp. 44 Calcidol syr Botol Rp. 1. 0 Rp. 54 Difenhidramin Hcl Inj Ampul Rp. 47 Ceterizine 10mg cap / Lerzin capsul Capsul Rp.2/0.00 200 Rp. 49 Captopril 12.5 mg tab Tablet Rp. 46 Caviplex Syr Botol Rp.750. 2. 45 Caviplex tablet Tablet Rp.00 0 Rp. 0 Rp.00 0 Rp.00 0 Rp. 190.156.160. 6.00 0 Rp. 0 Rp.00 0 Rp. 495.3/0 Pcs Rp. 35. . . 68.00 10 Rp. 53 Diethylcarbamazin sitrat 100mg tab Tablet Rp. 50 Captopril 25mg tab/ Dexacap 25mg tab Tablet Rp.333. 55 Diazepam 5mg/2ml inj Ampul Rp. 29. 57 Diazepam 2mg tab Tablet Rp. 470.605.00 0 Rp. . . 48 Cimetidine tab Tablet Rp.00 0 Rp. 0 Rp. 51 Dexsametason 0.43 Catgut benang bedah no.00 2 Rp. .00 100 Rp. 56 Diazepam 5mg tab Tablet Rp.

509. 88 Glibenklamid 5mg tablet Tablet Rp.00 50 Rp. 1. 0 Rp. 0 Rp. 82 Furosemid 10mg/ml inj Ampul Rp. 106 Kapas pembalut 500gr Rol Rp. Tablet Rp. 8. 0.000. .00 100 Rp.576. 83 Furosemid 40mg tab Tablet Rp. 0 Rp. 61 Domperidom syr/ Vesverum syr Botol Rp.090. 94 Haloperidol 1. 1.5% Tube Rp. 0 Rp. 92.00 0 Rp. 70 Etyl klorida semprot Botol Rp. 8.00 0 Rp. 115. 86 Gentamisin tetes mata 0. 92 Hidrocortison krim 2.00 0 Rp. 96 Hidroklortiazid HCT 25mg tab Tablet Rp. 97 Hufalysin syr Botol Rp. 2.00 0 Rp. .3% Botol Rp. 0 Rp. 87 Gentian violet Botol Rp. .25 tablet Tablet Rp. 103 Isoniazid 300mg tab Tablet Rp.1% Botol Rp. 95 Haloperidol 5mg tablet Tablet Rp. 1. 104 Isosorbit Dinitrat 5mg tab sublingual Tablet Rp.00 0 Rp. 98 Ibuprofen 400mg tab Tablet Rp.00 0 Rp.980. 91. 32. 0 Rp. 322. 81 Folley Cateter no.00 5 Rp. 84 Garam oralit Sachet Rp.000. 20. 3. 3.00 0 Rp.00 0 Rp. . 100 Infusion set anak Pcs Rp.019. 79 Fitomenadion 10mg/ml inj Ampul Rp.833. 0 Rp. 3.00 0 Rp. . 69 Erytromisin 125mg/5ml srp krg Botol Rp. 66 Ektrak beladon 100mg tab Tablet Rp. 93 Haloperidol 0.1% /1ml Ampul Rp. . 107 Karbamazepin 200mg tab Tablet Rp.500.023.00 0 Rp. . 101 Infusion set dewasa Pcs Rp. 8.00 0 Rp. 0 Rp. 102 Intunal Forte tablet Tablet Rp.125.00 0 Rp.00 0 Rp. . 62 Dulcolax 5mg tab Tablet Rp.00 0 Rp. 0 Rp. . 75 Fenobarbital inj. 0 Rp.00 0 Rp.20 0 Rp. 35. 1. Infus 5% Botol Rp.1% Tube Rp.00 0 Rp. 16 Pcs Rp. 174. 891. 72 Etakridina (rivanol) lar. 121. . 0 Rp.00 250 Rp.850.00 100 Rp.00 100 Rp.500.625.00 0 Rp. 96. 157.5mg tablet Tablet Rp.00 0 Rp. 12. . 224.000. 80 Folley Cateter no.00 5 Rp. 68 Erytromisin 500mg tab Tablet Rp. 63 Dulcolax supp Supp Rp.00 0 Rp.58 Digoksin 0. 0 Rp. 2. . 697. 8. 67 Erytromisin 250mg cap Capsul Rp.490. 85 Gentamisin salep 0.00 0 Rp. . 10. 71 Etanol 70% 1000 ml Botol Rp. 0 Rp. 18 Pcs Rp. .00 0 Rp. . 74 Famotidine tab Tablet Rp. 78 Fitomenadion 10mg tab Tablet Rp.844. 91 Glukosa lar. 60 Domperidom 10mg tab/ Vesverum 10mg tab Tablet Rp.00 0 Rp. 5. 99 Ibuprofen 200mg tab Tablet Rp. 64 Efedrin tab Tablet Rp. 12.926.000. 89 Gliseril guaiacolat 100mg tab Tablet Rp. 76 Fenobarbital 30mg tab.143. 66.00 0 Rp.896. Ampul Rp. . 105 Kalsium laktat 500mg tab Tablet Rp.00 100 Rp. 0 Rp. 57. 59 Doksisiklin 100mg capsul Capsul Rp. 65 Epineprin HCL (adrenalin) Inj 0.00 0 Rp. 73 Etambuthol HCL 500mg tablet Tablet Rp. 0 Rp.145.00 0 Rp.5mg tablet Tablet Rp. 90 Griseufulvin 125mg tab Tablet Rp. 5.00 0 Rp. 77 Fenol gliserol Botol Rp.

116 Kloramfenicol 125mg/5 susp Botol Rp. 0 Rp. 2. . .00 0 Rp.00 500 Rp. 110 Kasa Pembalut 4m X 3cm Rol Rp. 112 Ketoconazole 2 % krim Tube Rp. 120 Klorfeniramini Maleat 4mg tab Tablet Rp.633.665. 109 Kasa Pembalut 2m X 80cm Rol Rp.050. 119 Kloramfenicol salep mata 1% Tube Rp. 2. 0 Rp. 113 Ketoconazole 200mg tab Tablet Rp. 0 Rp.108 Kasa kompres 40 x 40 steril/ 16 X 16 cm Ktk Rp. . 2. 320. 115 Ketorolac 30mg inj Ampul Rp.00 0 Rp. 114 Ketorolac 10mg inj Ampul Rp.00 0 Rp. 10. 117 Kloramfenicol kapsul 250 mg Capsul Rp.00 0 Rp.00 0 Rp.00 0 Rp.228. . 25. 0 Rp. 121 Kloroquin 250mg tab Tablet Rp. 300.000.000.00 0 Rp. 4. . 118 Kloramfenicol tts telinga 3 % Botol Rp.00 5 Rp. 25. 111 Kasa Pembalut Hidrofil 4m X 15cm/ 9m X 10cm Rol Rp. 0 Rp. .

000. 133 Metilprednisolon inj Ampul Rp. 0 Rp.00 0 Rp. 600. 132 Metilprednisolon 4mg tab/ Vadrol 4mg tab Tablet Rp. 145 NGT Nasogastric Tube no. 0 Rp. 146. 148 Nipedipin tab Tablet Rp.9% Botol Rp.918. Infus 0. 85. 0 Rp. 169 Prednison tab Tablet Rp.00 5 Rp. 135 Methilergometrin maleat inj Ampul Rp.00 0 Rp. . 35. 2. . 167 Povidon iodida 10% 30ml Botol Rp. 152. 126.386.00 0 Rp. 7.646. . 126 Kotrimoxazol 480mg tab Tablet Rp. 164 Piroksikam 20mg tab Tablet Rp.974. 1. 929. 8. 0 Rp.00 0 Rp. . 130 Lidokain komp.500.00 0 Rp.00 100 Rp. 124 Klorpromazine HCL inj. 154 Omeperazole capsule Capsul Rp. . 125. 162 Piridoksin 10mg tab Tablet Rp.00 0 Rp.00 0 Rp.300. 15. 139 Miconazole cream Tube Rp.00 5 Rp. 169. 79. 168 Povidon iodida 10% 300ml Botol Rp. 140 Microlax enema Tube Rp.00 6 Rp. 0 Rp.00 0 Rp.00 100 Rp. 5. 134 Metoclorprofamid 10mg tab Tablet Rp. . . 0 Rp. 5. 137 Metronidazol 250mg tab Tablet Rp. 11. 138 Metronidazol 500mg tab Tablet Rp.00 0 Rp. . 170 Primakuin 15mg tab Tablet Rp. Inj Ampul Rp.00 250 Rp. 50.00 0 Rp. 171 Propanolol HCL 40mg tablet Tablet Rp. 0 Rp.00 0 Rp. 153 Oksitosin 10IU/ml inj Ampul Rp. 131 Masker Ktk/50"s Rp. 1.00 0 Rp. 163 Piroksikam 10mg tab Tablet Rp.00 100 Rp. 0 Rp. 554. 1. 0 Rp. 155 Parasetamol drops 100mg/ 1ml Botol Rp.000 IU/g tab vag Tablet Rp.535. 159 Papaverin tab Tablet Rp.000 IU tablet Tablet Rp. 0 Rp. 149 Obat batuk hitam Botol Rp. .390. 3.00 0 Rp.485.00 0 Rp. 156 Parasetamol 120mg/5ml srp Botol Rp.000. 129 Lidokain 2 % inj Ampul Rp. 133. 141 Natrium Diklofenak 25mg tab Tablet Rp.00 0 Rp. 0 Rp.00 50 Rp. 147 Nistatin 500. 158 Parasetamol 500mg tab Tablet Rp. 5mg/2ml Ampul Rp. . . 136 Methilergometrin maleat tab Tablet Rp.000. .00 0 Rp. 125 Kotrimoxazol 120mg tab Tablet Rp. .00 0 Rp.600. . 152 Oksitetrasiklin Hcl salep 1% Tube Rp.00 0 Rp.688. 142 Natrium klorida lar.00 100 Rp. 151 Oksitetrasiklin Hcl salep kulit 3% Tube Rp. 20. 157 Parasetamol 100mg tab Tablet Rp. 128 Lisol Botol Rp. 0 Rp. 0 Rp. .344. 160 Piracetam 400mg tab Tablet Rp. 2. 109. 146 Nistatin 100. 115. 93. .00 0 Rp. 144 Neurodex tab Tablet Rp. 165 Plester 5 yard X 2 inc Rol Rp.122 Klorpromazine HCL 25mg tab Tablet Rp. 143 Neurobion inj Ampul Rp.00 500 Rp. .298. .00 0 Rp.00 0 Rp. 166 Pyrantel pamoat tab Tablet Rp. 4. . 116. 123 Klorpromazine HCL 100mg tab Tablet Rp. 127 Kotrimoxazol Suspensi Botol Rp. 161 Piracetam 1gr tab Vial Rp. 10 Tube Rp. 0 Rp. 0 Rp.00 50 Rp. 22. 150 Oksitetrasiklin inj Vial Rp. 0 Rp. 0 Rp. 0 Rp.

00 0 Rp. 0 Rp.000. 7 Pcs Rp.5 Pcs Rp. 0 Rp. 5.1mg tab Tablet Rp.00 0 Rp.00 0 Rp.000. . 177 Rifampisin 300mg capsul Capsul Rp.5 Pcs Rp. 6. 0 Rp. 183 Sarung tangan steril No. 0 Rp. . . . 173 Ramabion capsule Capsul Rp. 128. 176 Reserpine 0.00 0 Rp. 330.200. 184 Sarung tangan steril No. 7. 10.000. 0 Rp.00 0 Rp. 178 Rifampisin 450mg tab Tablet Rp. 10.000. 181 Salbutamol 2mg tablet Tablet Rp. 8 Pcs Rp. 185 Sarung tangan steril No. . 10. 174 Ranitidine 150mg tablet Tablet Rp. 180 Ringer laktat lar infus Botol Rp.172 Propilthiourasil (PTU) 100mg tablet Tablet Rp. 10. 182 Sarung tangan steril No.00 0 Rp. . 0 Rp. .00 0 Rp. 175 Ranitidine 25mg / 2ml inj Ampul Rp. 179 Rifampisin 600mg tab Tablet Rp. 91.00 0 Rp.

194 Simvastatin 10mg tablet Tablet Rp. 7. 192 Sianokobalamin (vit B12) inj Ampul Rp.174. 0 Rp.00 0 Rp. 204 Ultraproct N suppositoria Supp Rp.00 30 Rp. 190 Seftriakson inj Vial Rp. 201 Thiamin Hcl 50mg tab Tablet Rp. 196 Surgical Blade Pcs Rp. 188 Sefadroxil 500mg capsul Capsul Rp. 8. . 199 Tetrasiklin Hcl cap 250mg cap Capsul Rp. .00 0 Rp. 3/0 Pcs Rp. 19700306 200212 2006 . 193 Silk benang bedah sutra No.000. . 195 Siprofloksasin HCL 500mg tablet Tablet Rp. 189 Sefotaxim inj Vial Rp.00 100 Rp. 0 Rp.00 10 Rp.00 5 Rp. . 265. 203 Tramadol 50mg kasul Capsul Rp. 522. 19790811 200003 2002 Mengetahui Kepala Puskesmas Puruk Cahu dr.00 200 Rp.500.00 0 Rp. SRI RAHAYU NIP. 206 Vitamin B komplek tab Tablet Rp. . 3.200. 200 Tetrasiklin Hcl cap 500mg cap Capsul Rp. . 0 Rp. 15. 197 Sulfacetamid tts mata 15% Botol Rp. Puruk Cahu FITRI AGUSYANI NIP.00 0 Rp.333.00 0 Rp. 0 Rp. 112. . 187 Salisil bedak 2% Pot Rp.00 0 Rp. Puruk Cahu. 1. 0 Rp.850. 2. TO TAL Rp.00 0 Rp.186 Salep 2-4 komb Pot Rp. NIP. 514. . 53.. 0 Rp. 3. 191 Selang Oksigen Pcs Rp. 208 Gentamisin Injeksi Ampul Rp. 529. 25 Mei 2015 Yang Menerima Kordinator Farmasi Puskesmas Petugas pustu ……. 198 Tablet tambah darah sachet Rp. 0 Rp. 0 Rp. 202 Thiamin Hcl 100mg/ml inj Ampul Rp. . . 207 Zinc Tablet Rp. 409. 209 Suntik KB 3 Bln Vial Rp.00 10 Rp. 0 Rp.00 0 Rp.500. 205 Urine Bag Pcs Rp. 0 Rp.

00 9.130.900.00 12.800.400.00 202.300.UK CAHU 25 Mei 2015 LPLO Pustu TOTAL KET - - - - - 17.400.200.500.00 - - - - - - - .00 11.420.00 - - - 7.00 8.00 22.00 27.00 - - - - - - - - - - - 12.125.00 - - - - - 26.000.

00 - - - - - .666.00 - - - - - 7.500.58.600.00 - 13.00 17.900.

400.00 15.00 - - - - - - - 102.700.00 - - - - - - - - .00 - - - - - - 44. - - 8.100.00 - - - - - - - - - - - - - - - - - - - 8.480.700.00 12.300.00 22.450.750.00 40.

250.00 - .00 - - - 12. - - - - - - - - 20.500.

675.00 - 42. - - - - 15.750.00 - - - - 23.00 - - - - 10.500.900.00 - - - - - - - 16.200.788.00 12.300.00 - - 7.00 - - 7.425.00 - - .00 - - - - - - - 7.250.00 - - - - - - 5.00 13.900.600.

- - - - - - - - - - - - - - .

000.00 22.660.900.709.00 - - 1.00 - - - - - - - 22.740. - - 52.049.250.00 15.00 15 kesmas 2002 .00 - - - - 19.400.00 - - - 11.

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