LAPORAN PEMAKAIAN DAN LEMBAR PERM

UPT PUSKESMAS JERUKELEGI I

KABUPATEN CILACAP

SALDO AWAL
NO NAMA OBAT SATUAN HARGA
JUMLAH
100001 ACT Tablet Tablet 4125 0
0100002 Acyclovir Krem Tube 3,000 297
0 Acyclovir Krem Tube 2,152 14
0 Acyclovir Krem Tube 2,960 93
0100003 Acyclovir Tablet 200 mg Tablet 388 0
0100004 Acyclovir Tablet 400 mg Tablet 336 1338
0 Acyclovir Tablet 400mg Tablet 349 1000
0100005 Adona AC. Injeksi Ampul 21,317 0
0100006 Adona AC. Tablet Tablet 2,330 0
0100007 Akita Tablet Tablet 499 0
0100008 Albendazol Tablet 400 mg Tablet 370 0
0100009 Alinamin F Injeksi Ampul 11,877 0
0100010 Allopurinol Tablet 100 mg Tablet 86 37993
0100011 Ambroxol Tablet Tablet 144 0
0100012 Aminofilin Injeksi Ampul 3,345 90
0100013 Aminofilin Tablet 200 mg Tablet 90 1242
0100014 Amitriptilin Tablet Tablet 120 0
0 Amitriptilin Tablet Tablet 112 280
0100015 Amoksisillin Kapsul 250 mg Kapsul 289 0
0100016 Amoksisillin Kaplet 500 mg Kaplet 240 111
0 Amoksisillin Kaplet 500 mg Kaplet 272 19942
0100017 Amoksisillin INJ / Pehamoksil Injeksi 1 gr. Vial 9,000 50
0 Amoksisillin INJ / Pehamoksil Injeksi 1 gr. Vial 7,500 40
0 Amoksisillin INJ / Pehamoksil Injeksi 1 gr. Vial 7,875 120
0100018 Amoksisillin Syrup 125 mg / 5 ml Botol 3,700 10
0 Amoksisillin Syrup 125 mg/5ml Botol 2,445 659
0100019 Ampisillin Kapsul 250 mg Kapsul 269 0
0100020 Ampisillin Kaplet 500 mg Kaplet 381 0
0100021 Ampisillin Injeksi iv 1000 mg Vial 4,282 0
0100022 Ampisillin Syrup 125 mg / 5ml Botol 4,000 0
0100023 Antalgin Injeksi 250 mg / ml - 2ml Ampul 1,112 0
0100024 Antalgin Tablet 500 mg Tablet 67 0
0100025 Antasida Doen syrup Botol 2,160 192
0100026 Antasida Doen Tablet 500 mg Tablet 62 10000
0 Antasida Doen Tablet 500 mg Tablet 75 4315
0100027 Anti Bakteri Doen (Basitrasin+Polimiksin) Salep Tube 2,517 6
0100028 Anti Hemoroid Supp Suppo 2,200 30
0 Anti Hemoroid Supp Suppo 3,045 40
0100029 Antimigren Doen Komb ( Ergo + Koff ) Tablet Tablet 123 0
0100030 Aqua Pro injeksi Vial 5,500 0
0 Aqua Pro injeksi Vial 2,200 234
0100031 Aquagel / Pelumas Catheter Tube - 0
0100032 Arthesunat Injeksi Ampul - 0
0100033 As.Benz.3% +As.Salisilat 6% / Whitfield Pot 1,719 7
0100034 Asam Askorbat / Vit C tablet 50 mg Tablet 95 327
0 Asam Askorbat / Vit C tablet 50 mg Tablet 104 3215
0100035 Asam Mefenamat / NovastanTablet 500 mg Tablet 106 2350
0100036 Asam Traneksamat / Clonex Kapsul Kapsul 890 178
0 Asam Traneksamat/ Cloonex kapsul Kap;sul 2,650 300
0100037 Asam Traneksamat Injeksi Ampul 4,100 20
0 Asam Traneksamat Injeksi Ampul 4,000 20
0100038 Asetosal Tablet 100 mg Tablet 148 0
0100039 Asifit Kapsul Kapsul 1,583 0
0100040 Aspar K Tablet Tablet 1,566 0
0100041 Aspilet / Aspimec Tablet Tablet 404 0
0100042 Atropin Sulfat Injeksi 0,25 mg Ampul 932 0
0 Atropin Sulfat Injeksi 0,25 mg Ampul 1,350 0
0100043 Atropin Sulfat Tablet Tablet 39 0
0100044 Baby Cough Syrup Botol 3,300 0
0100045 Balsem Geliga Pot 4,600 0
0100046 Batugin Elixir Syrup Botol 10,230 0
0100047 Becefort Tablet Tablet 1,548 0
0100048 Bekarbon / Norit Tablet Tablet 29 0
0100049 Besi II Sulfat / Tablet Tambah Darah Tablet 63 0
0100050 Betametason Krem Tube 1,520 77
0 Betametason krem tube 1,380 66
0100051 Betomin Plex Tablet Tablet - 0
0100052 Bioneuron Injeksi Ampul - 0
0100053 Bioplacenton / Bismecon Jelly Tube - 0
0100054 Brocon Tablet Tablet - 0
0100055 Bronchifar Tablet Tablet - 0
0100056 Bufacomb In Ora Base Tube 13,200 4
0100057 Buscopan Injeksi Ampul - 0
0100058 Captopril Tabet 12,5 mg Tablet 90 0
0100059 Captopril Tablet 25 mg Tablet 84 2706
0 Captopril Tablet 25 mg Tablet 68 4000
0100060 Caranal Tablet Tablet 713 0
0100061 Cefadroxil 500 mg Kapsul Kapsul 509 2560
0 Cefadroxil 500 mg Kapsul Kapsul 510 600
0100062 Cimetidin Tablet Tablet 108 0
0100063 Clindamysin Kapsul Kapsul 553 150
0100064 Cortison Injeksi Vial 5,443 0
0100065 Cotrimoxazole Syrup Botol 3,960 0
0100066 Cotrimoxazol Syrup Botol 2,350 270
0100067 Cotrimoxazole Tablet 480 mg Dewasa Tablet 165 71
0100068 Cotrimoxzazol tablet 480 mg Dewasa Tablet 152 0
0100069 Cotrimoxazole Tablet Pediatrik Tablet - 0
0100070 Curcuma Tablet 200 mg Tablet 569 0
0100071 Cyprofloxacin Kaplet 500 mg Kaplet 255 2505
0 Cyprofloxacin Kaplet 500 mg Kaplet 281 1600
0100073 Dexamethason Injeksi 5 mg / ml Ampul 1,580 297
0100074 Dexamethason Tablet 0,5 mg Tablet 87 81
0100075 Deksametason Tablet 0.5 mg Tablet 68 71
0 Deksametason Tablet 0.5 mg Tablet 82 10000
0100076 Dextamin Tablet Tablet 18 0
0100077 Dexromethorphan syirup Botol 2,865 0
0100078 Dextromethorphan Tablet Tablet 110 0
0100079 Diazepam Injeksi 10 mg / 2 ml Ampul 12,400 0
0100080 Diazepam Tablet 2 mg Tablet 32 3851
0100081 Diazepam Tablet 5 mg Tablet 911 0
0100082 Difenhidramin HCL Injeksi 10 mg / ml Ampul 1,050 389
0100083 Digoxin Tablet 0,25 mg Tablet 97 0
0100084 Diltiazen Tablet Tablet 134 200
0100085 Dimenhidrinat Tablet Tablet 96 729
0 Dimenhidrinat Tablet Tablet 95 412
0100086 Domperidon / Vesperum Tablet Tablet 167 160
0 Domperidon/Vesperum kapsul Kapsul 118 1084
0100087 Doxycyclin 100 mg Kapsul Kapsul 253 0
0100088 Dulcolax Suppo Anak Suppo - 0
0100089 Dulcolax Suppo Dewasa Suppo 5,800 22
0100090 Efedrin Tablet Tablet 51 0
0100091 Ekstrak Belladone Tablet 10 mg Tablet 26 0
0100092 Embacetrin Syrup Botol - 0
0100093 Enkasari Botol 14,674 0
0100094 Enzymfort Tablet Tablet 801 0
0100095 Epinefrin / Adrenalin Injeksi Ampul 8,100 30
0100096 Erlaquin / Kloroquin Tablet Tablet 68 0
0100097 Erythromycin Kapsul 500 mg Kapsul 930 0
0100098 Erythromycin Syrup Botol - 0
0100099 Etamidon Injeksi 250 mg / ml -15 ml Vial - 0
0100100 Ethambutol Tablet 500 mg Tablet 574 0
0100101 Fatica Tablet Tablet - 0
0100102 Fenidryl Syrup Botol - 0
0100103 Fenitoin Natrium 100 mg Kapsul 121 0
0 Finitoin Natrium 100 mg Kapsul 133 740
0100102 Fenitoin Natrium 30 mg Kapsul 73 0
0100103 Fenobarbital Injeksi Ampul 1,560 30
0 Fenobarbital Injeksi Ampul 1,716 0
0100104 Fenobarbital Tablet 30 mg Tablet 65 0
0 Fenobarbital Tablet 30mg Tablet 56 780
0100105 Fenolgliserol Tetes Telinga 10 % Botol 1,008 2
0 Fenolgliserol Tetes Telinga 10 % Botol 2,042 92
0100106 Fitbon Tablet Tablet 2,200 0
0100107 Fitomenadion Injeksi 10 mg / ml Ampul 3,417 180
0100108 Fitomenadion Tablet salut 10 mg Tablet 691 274
0 Fitomenadion Tablet salut 10 mg Tablet 579 0
0100109 Flutop C Syrup Botol - 0
0100110 Fundifar Tablet Tablet 611 0
0100111 Furosemid Tablet 40 mg Tablet 118 0
0 Furosemid Tablet 40 mg Tablet 78 166
0 Furosemid inj Ampul 8,300 20
0100112 Gabiten Tablet Tablet 884 0
0100113 Gameksan Emulsi Botol 2,200 0
0100114 Gemfibrozil Kapsul Kapsul 292 0
0100115 Genalten Krem Tube - 0
0100116 Gentamycin Krem Tube 1,837 97
0100117 Gentamycin Tetes Mata 0,3 % Botol 4,000 36
0100118 Gentian Violet Botol 450 12
0 Gentian Violet Tablet 895 141
0100119 Glibenklamid Tablet 5 mg Tablet 72 4200
0 Glibenklamid Tablet 5 mg Tablet 54 4090
0 Glibenklamid Tablet 5 mg Tablet 56 1000
0100120 Gliserilguaiacolat Tablet 100 mg Tablet 28 311
0 Gliserilguaiacolat Tablet 100 mg Tablet 28 0
0 Gliserilguaiacolat Tablet 100 mg Tablet 180 2500
0100121 Gliserin 100 ml Botol 4,730 0
0100122 Glukose Infus 40 % Botol 14,528 0
0100123 Glukose Infus 5 % Steril Botol 5,200 2
0 Glukose Infus 5 % Steril Botol 6,900 135
0100124 Griseovulfin Tablet 125 mcg Tablet 240 0
0 Griseovulfin Tablet 125 mcg Tablet 219 425
0100125 H.C.T. Tablet 25 mg Tablet 36 0
0100126 Haloperidol Tablet 5 mg Tablet 122 0
0 Halopuridol tablet 5 mg Tablet 88 777
0100127 Haloperidol Tablet 1,5 mg Tablet 83 0
0100128 Hemorogard Kapsul Kapsul 1,411 0
0100129 Hepagard Kapsul Kapsul 2,541 0
0100130 Hicogel Tube - 0
0100131 Hidrokortison Krem 2,5 % Tube 2,979 0
0 Hidrtkortison Krem 2,5 % Tube 2,798 4
0 Hidrtkortison Krem 2,5 % Tube 2,650 175
0100132 Hitrol Kapsul Kapsul - 0
0100133 I.N.H.Tablet 300 mg Tablet 97 1289
0100135 Ibuprofen Tablet 200 mg Tablet 116 0
0100136 Ibuprofen Tablet 400 mg Tablet 127 1520
0100137 Ichthyol Salep Pot 3,500 24
0100138 Imulan Kapsul Kapsul - 0
0100139 Imulan Syrup Botol 15,180 0
0100140 Iodiol Soft Kapsul Kapsul 930 0
0100141 Isosorbitdinitrat Sublingual 5 mg Tablet 88 0
0100142 Kalium Diklofenak Tablet 50 mg Tablet 708 0
0100143 Kalsium Laktat Tablet 500 mg Tablet 52 178
0 Kalsium Laktat Tablet 500 mg Tablet 30 108
0 Kalsium Laktat Tablet 500 mg Tablet 63 2017
0100144 Ketokonazol Tablet 200 m Tablet 465 400
0100145 Khinin dihidroklorida Injeksi 25 % Ampul 3,466 0
0100146 Khuinin Tablet Tablet 530 0
0100147 Klonidin Tablet 0,15 mg Tablet 205 0
0 Klonidin Tablet 0,15 mg Tablet 139 1000
0100148 Kloramphenikol / Chloracol Syrup Botol 3,955 36
0100149 Kloramphenikol / Colsancetin Injeksi Vial 8,900 0
0100150 Kloramphenikol Kapsul 250 mg Kapsul 231 100
0 Kloramphenikol Kapsul 500 mg Kapsul 1,007 1162
0100151 Kloramphenikol Salep Mata Tube 1,563 8
0 Kloramphebikol Salep Mata Tube 1,798 105
0100152 Kloramphenikol Tetes Mata Botol 6,500 0
0100153 Kloramphenikol Tetes Telinga Botol 2,400 14
0100154 Klorfeniramin Maleat / C.T.M. 4 mg Tablet 24 14974
0 Klorfeniramin Maleat / C.T.M. 4 mg Tablet 42 11702
0100155 Klorpromazin Injeksi Ampul 733 0
0100156 Klorpromazin Tablet 100 mg Tablet 162 140
0100157 Kodein HCL Tablet 10 mg Tablet 427 0
0100158 Levetran Salep Pot - 0
0100159 Lidokain+ Epineprin Komp. Injeksi Ampul 1,845 90
0100160 Lincomycin Kapsul 500 mg Kapsul 650 0
 0100161 Loratadin Tablet Tablet 330 270
0 Loratadin Tablet Tablet 154 0
0100162 Magnesium inj Ampul 199,475 0
0100163 Meganeuron Tablet Tablet - 0
0100164 Meloxicam Tablet 15 mg Tablet 1,199 0
0100165 Metakresol Kondensat / Albothyl Botol 26,500 0
0100166 Metformin Tablet Tablet 113 3794
0100167 Methyl Ergometrin Maleat Inj. Ampul 1,182 0
0100168 Methyl Ergometrin Maleat Tablet Tablet 110 0
0100169 Methyl Prednisolon Tablet 205 1160
0100170 Metoklopropamid / Ethiferan Injeksi Ampul 1,000 0
0100171 Metoklopropamid / Norvorm Syrup Botol 2,100 0
0100172 Metoklopropamid Tablet 10 mg Tablet 110 0
0100173 Metronidazol Tabet 250 mg Tablet 80 0
0100174 Metronidazol Tabet 500 mg Tablet 133 2311
0100175 Miconazole Krem Tube 3,000 198
0100176 Mineral Mix Sachet 2,450 0
0100177 Mirabion Kapsul Kapsul - 0
0100178 Multivitamin + DHA / Truvit Syrup Botol - 0
0100179 Multivitaplex Tablet Tablet - 0
0100180 Natrium Bikarbonat Tabet Tablet 13 0
0100181 Natrium Diklofenak / Voltadex Tablet 50 mg Tablet 159 1100
0100182 Natrium Klorida Botol 6,410 68
0100183 Natrium Thio Sulfas Injeksi Ampul - 0
0100184 Neo Diaform Tablet Tablet 99 6876
0100185 Neo Kaominal Syrup Botol 5,445 0
0100186 Nephrolit Kapsul Kapsul 644 0
0100187 Neurodial Tablet Tablet 859 0
0100188 Neurophyl Injeksi 5000 Ampul - 0
0100189 Neurovit E Tablet Tablet - 0
0100190 Nifedipin / Farmalat Tablet Tablet 100 0
0100191 Nifedipin Tablet 104 265
0100192 Nistatin Tablet Tablet 600 0
0100193 Nistatin Tablet Vagina 100.000 IU Tablet 480 102
0100194 Nodiar Tablet Tablet - 0
0100195 Norelut Tablet Tablet - 0
0100196 Obat Anti Tuberkulosis I & III ( FDC ) Paket 359,985 9
0100197 Obat Anti Tuberkulosis I & III ( FDC ) Paket 214,990 0
0100198 Obat Anti Tuberkulosis I & III ( FDC ) Paket 359,985 0
0100199 Obat Anti Tuberkulosis III Paket - 0
0100200 Obat Anti Tuberkulosis Kategori Anak Paket 214,990 0
0100201 Obat Anti Tuberkulosis Sisipan Paket 160,001 0
0100202 Obat Batuk Hitam (OBH) Botol 1,950 13
0100203 Obat Batuk Hitam (OBH) Botol 2,250 223
0100204 Obat Batuk Pepermint ( OBP) Syrup Botol - 0
0100205 Oksitetrasiklin HCL Injeksi Vial 3,100 0
0100206 Oksitetrasiklin HCL Salep Kulit 3 % Tube 851 41
0100207 Oksitetrasiklin Salep Mata 1 % Tube 1,920 15
0 Oksietrasiklin Salep Mata 1 % Tube 1,600 0
0100206 Oksitoksin / Phytogen Injeksi Ampul 2,200 230
0100207 Omeprazol Kapsul Kapsul 211 0
0 Omeprazol Kapsul Kapsul 160 240
0100208 Optixitrol / Oregan Tetes Mata Botol 8,840 0
 0100209 Oralit 200 ml / Garam Oralit Sase 345 0
0 Oralit 200 ml / Garam Oralit Sase 292 0
0100210 Omeneuron Tablet 1,540 240
0100210 Papaverin HCL Injeksi Ampul 530 0
0100211 Papaverin HCL Tablet 40 mg Tablet 99 0
0100212 Paracetamol Syrup 120 mg / 5ml Botol 1,438 25
0 Paracetamol Syrup 120 mg / 5ml Botol 1,074 152
0100213 Paracetamol Tablet 100 mg Tablet 42 0
0100214 Paracetamol Tablet 500 mg Tablet 89 1415
0 Paracetamol Tablet 500 mg Tablet 56 23309
0100215 Pehacain Injeksi Ampul 3,274 0
0100216 Pehavral Tablet Tablet - 0
0100217 Pethidin Injeksi Ampul 1,192 0
0100218 Phenoksimethyl P.Tablet 250 mg Tablet 262 0
0100219 Phenoksimethyl P.Tablet 500 mg Tablet 465 0
0100220 Phenylbutason Tablet Tablet 72 0
0100221 Piracetam Injeksi 1 gr. Ampul 5,500 0
0100222 Piracetam Tablet Tablet 502 0
0 Piracetam Tablet Tablet 194 40
0100223 Pirantel Pamoat Tablet 125 mg Basa Tablet 320 24
0 Pirantel Pamoat Tablet 125 mg Basa Tablet 311 167
0 Pirantel Pamoat Tablet 125 mg Basa Tablet 298 1397
0100224 Pirazinamid Tablet Tablet 234 0
0100225 Piridoksin HCL ( Vit B6 ) Tablet 10 mg Tablet 19 110
0 Piridoksin HCL ( Vit B6 ) Tablet 10 mg Tablet 17 851
0 Piridoksin HCL ( Vit B6 ) Tablet 10 mg Tablet 118 4230
0100226 Piroksikam Tablet 10 mg Tablet 90 80
0100227 Piroksikam Tablet 20 mg Tablet 105 0
0 Piroksikam Tablet 20 mg Tablet 120 20
0100228 Prednison Tablet 5 mg Tablet 52 0
0 Prednison Tablet 5 mg Tablet 245 4435
0100229 Primaquin Tablet Tablet 93 0
0100230 Procain Benzil P.Injeksi 3 Juta IU Vial 5,583 100
0100231 Procydin / Pronicy Tablet Tablet - 0
0100232 Prolaxan / Melaxan Tablet Tablet - 0
0100233 Prolipid Kapsul Kapsul - 0
0100234 Prometazin Krem Tube - 0
0100235 Propanolol Tablet 10 mg Tablet 58 200
0100236 Propanolol Tablet 40 mg Tablet 110 0
0100237 Propiltiourasil Tablet / PTU Tablet 272 0
0100238 Protofen / Ketoprofen Tablet Tablet - 0
0100239 Protofen Suppo Suppo 2,722 0
0 Protofen/Ketoprofen Suppo Suppo 2,789 15
0100240 Ranitidin inj Ampul 1,140 181
0 Ranitidin inj Ampul 2,333 200
0100241 Ranitidin Tablet 150 mg Tablet 120 6154
0 Ranitidin Tablet 150 mg Tablet 105 3000
0100242 Reserpin Tablet 0,25 mg Tablet 103 0
0100243 Reserpin Tablet 0,25 mg Tablet 88 197
0100244 Retinol Kaps Lunak (Vit A) 100.000 IU Kapsul 260 0
0100245 Retinol Kaps Lunak ( Vit A)200.000 IU Kapsul 459 0
0100246 Rheumaneer Kapsul Kapsul - 0
0100247 Rifampisin Kapsul 300 mg Kapsul 480 583
 0100248 Rifampisin Kapsul 450 mg Kapsul 660 0
0100249 Ringer Laktat Infus Steril Botol 5,200 2
0 Ringer Laktat Infus Steril Botol 7,150 340
0100250 Sacchorit Tablet Tablet - 0
0100251 Salbutamol 2 mg Tablet Tablet 84 0
0100252 Salbutamol 4 mg Tablet Tablet 389 1545
0 Salbutamol 4 mg Tablet Tablet 97 100
0 Salbutamol 4 mg Tablet Tablet 83 1000
0100253 Salep 2 - 4 Pot 2,000 32
0 Salep 2 - 4 Pot 2,429 96
0100254 Salicyl bedak 2 % Bungkus 1,250 218
0100255 Scopma Plus Tablet Tablet 1,409 0
0100256 Scopma Tablet Tablet 1,040 0
0100257 Serum ABU Polivalen Injeksi 5 ml Vial 464,950 10
0 Serum ABU Polivalen Injeksi 5 ml Vial 473,000 10
0100258 Serum ATS 1.500 IU/ml Injeksi Ampul 126,500 0
Tetagam injeksi IM 250 U I Ampul 170,000 12
0100259 Sianokobalamin Injeksi 500 mcg / ml-ml Ampul 1,077 200
0 Sianokobalamin Injeksi 500 mcg / ml-ml Ampul 1,098 100
0100260 Sianokobalamin Tablet ( Vit B 12 ) Tablet 15 933
0 Sianokobalamin Tablet ( Vit B 12 ) Tablet 13 450
0100261 Sinvastatin Tablet 10 mg Tablet 513 0
0 Sinvastatin Tablet 10 mg Tablet 169 0
0100262 Spasi Inj/Hyosine Botilbrimide inj 20mg/ml Ampul 4,500 29
0100263 Spashi Tablet Tablet - 0
0100264 Spasminal Tablet Tablet - 0
0100265 Stesolid Rectal 5 mg Tube 11,517 3
0 Stesolid Rectal 5 mg Tube 11,525 0
0100266 Streptomycin Injeksi 1 gr Vial 3,570 0
0100267 Sulfacetamid Tetes Mata Botol 3,445 0
0100268 Sulfadimidin Tablet Tablet - 0
0100269 Tamiflu Tablet Tablet 12,972 0
0100270 Tensigard Tablet 1,536 0
0100271 Tetracyclin Hcl Kapsul 250 mg Kapsul - 0
0100272 Tetracyklin Hcl Kapsul 500mg Kpsul 300 110
0100273 Theocodil Syrup Botol - 0
0100274 Thyamphenikol / Thiamex Kapsul 500 mg Kapsul 616 0
0100275 Tiamin HCL ( Vit BI ) Injeksi Ampul 457 0
0100276 Tiamin HCL ( Vit BI ) Tablet Tablet 38 543
0100277 Tiamin HCL ( Vit BI ) Tablet Tablet 37 15688
0100278 Tramadol Kapsul Kapsul 330 0
0100279 Transifar Tablet Tablet 343 290
0100280 Trihexilfenidil Tablet Tablet 41 1352
0100281 Urispas Tablet Tablet - 0
0100282 Vasvita Tablet Tablet 206 0
0100283 Vicalsin / Omevita Syrup Botol 7,704 0
0 Vicalsin sirup / Curbion sirup Botol 8,770 5
0100284 Vitamin B Komplek Tablet Tablet 22 0
0 Vitamin B Komplek Tablet Tablet 107 100
0 Vitamin B Komplek Tablet Tablet 115 14325
0100285 Xanvit sirup Botol 10,890 0
0100286 Xanvit Tablet Tablet - 0
0100287 Zink Tablet Tablet 432 0
0100286 Abocath No. 18 / IV Catheter No.18 Set 4,700 50
0100289 Abocath No. 20 / IV. Catheter No. 20 Set 4,700 159
0 Abocath No. 20 / IV. Catheter No. 20 Set 7,788 0
0 Abocath No. 20/ IV Catheter No. 20 Set 3,800 68
0100290 Abocath No. 22 / IV. Catheter No. 22 Set 4,700 218
0100291 Abocath No. 24 / IV Catheter No. 24 Set 7,788 0
0 Abocath No. 24 / IV Catheter No. 24 Set 3,800 134
0100291 Aboc ath No. 26/ IV Cateheter No. 26 Set 4,100 0
0 Aboc ath No. 26/ IV Cateheter No. 26 Set 4,700 50
0100292 Alat Suntik 0,05 ml / BCG Set - 0
0100293 Alat Suntik 0,5 ml / DPT Set - 0
0100294 Alat Suntik 1 ml Biji - 0
0100295 Alat Suntik 2,5 cc Biji 611 0
0100296 Alat Suntik 3 cc Biji 789 1000
0 Alat Suntik 3 cc Biji 650 200
0100297 Alat Suntik 5 cc Biji 734 0
0 Alat Suntik 5 cc Biji 750 1400
0100300 Alat Suntik 10 cc set 925 200
0100301 Blangko Resep Buku - 0
0100302 Buku Rekapan Sub Unit Buku - 0
0100303 Catgut Plain No.3/0 Rol 5,583 0
0 Catgut Plain No.3/0 Rol 3,423 60
0100304 Catgut Plain No.2 / 0 Rol 6,583 24
0 Catgut Plain No.2 / 0 Rol 3,423 36
0100305 Etakridin Larutan / Rivanol Kompres Botol 2,212 7
0 Etakridin Larutan / Rivanol Kompres Botol 2,550 0
0100306 Etanol 70 % Botol 2,500 1345
0100307 Folly Catheter No. 16 Set 8,000 44
0100308 Folly Catheter No. 18 Set 8,000 25
0100309 Folly Catheter No. 20 Set 9,000 0
0100310 Gas Oksigen M3 - 0
0100311 Infus Set Anak Set 3,500 350
0100312 Infus Set Dewasa Set 3,200 328
0100313 Jarum Jahit Kulit dan Otot Biji 3,787 0
0100314 Jarum Suntik/ Needle 23 G Biji 600 0
0100315 Kalium Permanganat Pot - 0
0100316 Kantong Jenazah Set 165,000 0
0100317 Kapas Berlemak Rol - 0
0100318 Kapas Pembalut 250 gr Rol 7,500 0
0 Kapas Pembalut 250 gr Rol 24,000 22
0100319 Kaporit drum 25,000 0
0100320 Kartu Stok Obat Lembar - 0
0100321 Kasa Kompres 40 x 40 steril Rol - 0
0100322 Kasa Pembalut 2 m x 80 cm Rol 7,700 40
0 Kasa Pembalut 2 m x 80 cm Rol 9,400 30
0100323 Kasa Pembalut 4 x 3 cm Rol 240 0
0100324 Kasa Pembalut 4 x15 cm Rol 2,800 0
0100325 Kertas Puyer Lembar 12 0
0100326 Larutan Asam Klorida 0,1 N 100 ml Botol - 0
0100327 Larutan Asam Sulfosalisilat Botol - 0
0100328 Larutan Benedick Botol - 0
0100329 Larutan Eosin Botol - 0
0100330 Larutan Etanol Asam Botol - 0
0100331 Larutan Giemsa Stain Botol - 0
0100332 Larutan Karbon Fuksin Botol - 0
0100333 Larutan Metilen Biru Botol - 0
0100334 Larutan Turk 100 ml Botol - 0
0100335 Lysol 1000 ml Botol - 0
0100336 Masker Set 1,015 0
250 Masker Set 330 1100
0100337 Minyak Kayu Putih 127 ml Botol - 0
0100338 Minyak Kayu Putih 67 ml Botol - 0
0100339 Minyak Telon 30 ml Botol - 0
0100340 Minyak Telon 60 ml Botol - 0
0100341 Paraformaldehid Tablet 1 gr Tablet - 0
0100342 Pharmafix / Hypafix / Ultrafix Rol - 0
0100343 Plastik Klip Besar Biji - 0
0100344 Plastik Klip Sedang Biji - 0
0100345 Plastik Klip Kecil Biji - 0
0100346 Plester 5 yard x 2 inch Rol 12,076 20
100347 povidon Iodina 10 % 30 ml Botol 2,900 59
0 povidon Iodina 10 % 30 ml Botol 4,400 50
0100348 Povidon Iodida 10% 300 ml Botol 18,000 0
0100349 Povidon Iodida 10% 1000 ml Botol 14,500 0
0100350 Sarung Tangan Set 325 0
0 Sarung Tangan Set 499 500
0100351 Silk no.2 / 0 Rol 1,407 24
0100352 Silk no.3 / 0 Rol 3,958 24
0100353 Sofratul / Daryantule / Lumatule Lembar - 0
0100354 Tas Kresek Obat Biji - 0
0100355 Urine Bag Biji 6,240 0
0 Urine Bag Biji 3,000 36
0100356 Wing Nedle / Scalp Vein Nedle 23 G Set - 0
0100357 Wing Nedle / Scalp Vein Nedle 25 G Set - 0
0100358 Wing Nedle / Scalp Vein Nedle 27 G Set - 0
0100359 Air Raksa Botol 110,000 0
0100360 Devitalisasi Pasta Botol 429,000 0
0100361 Etil Klorida Semprot Botol 71,640 0
0 Etil Klorida Semprot Botol 105,000 12
0100362 Eugenol Botol 45,833 49
0100363 Glass Isomer Cement / Fuji IX, II Botol 433,292 0
0100364 Kalsium Hidroksida Pasta Tube 327,000 0
0100365 Monoklormetolkamfer / ChKM Botol 107,000 0
0100366 Mumifiying Pasta Tube 146,100 0
0100367 Semen Seng Fosfat Serbuk & Cairan Botol 93,500 0
0100368 Silver Amalgam Serbuk Botol 345,000 0
0100369 Spon Gelatin Cubitus 1x1x1cm Biji 10,434 0
0100370 Temporary Stopping Fletcher Botol 34,000 0
0100371 TKF(Formokresol Pengganti TKF) Botol 100,000 0
0100372 Albumin Botol - 0
0100373 Alkalin Fosfatase Botol - 0
0100374 Asam Urat Kit - 0
0100375 Bilirubin Total / Direct Botol - 0
0100376 Dengue Kit - 0
0100377 Gamma Glutamyl Transferase Botol - 0
0100378 Glukosa Botol - 0
0100379 HIV Test Kit - 0
0100380 Kolesterol Botol - 0
0100381 Kreatinin Botol - 0
0100382 Malaria Dus - 0
0100383 SGOT Botol - 0
0100384 SGPT Botol - 0
0100385 TB Test Kit - 0
0100386 Total Protein Botol - 0
0100387 Trigliserida Botol - 0
0100388 Ureum Kit - 0
0100389 Obat KLB Paket - 0
0100390 ACT Plus Tablet - 0
0100391 Gentamycin Inj. 80 mg Ampul 5,363 0
0100392 Dextran 76 % Botol - 0
0100393 Magnesium Sulfat Inj. 40 % Vial 6,000 96
0 Magnesium Sulfat Inj. 40 % Vial 3,650 30
0100394 Glukonas Kalsikus Inj. 10 % Vial - 0
0100395 Metronidazol Inj. 500 mg Vial - 0
0100396 Depo Progresteron Inj. Vial 5,968 0
0100397 Chromic Catgut No. 1 Sachet - 0
0100398 Urin Strip Set 127,650 0
0100399 Rapid Test Set - 0
0100400 Implant KB Set - 0
0100401 Transfusion Set Buah 8,100 0
0100402 Abocath No. 18 / IV Catheter No. 18 Set - 0
0100403 KONDOM SUTRA SET - 0
0100404 Loperamid Tablet Tab 89 240
0100405 Amlodipin set 330 390
0100406 Betahistine Tablet 6 mg set 924 0
0 Betahistine Tablet 6 mg set 149 560
0100407 Bromhexin Tablet 8 MG set 39 0
0100408 Cuticel Clasic 10x10cm lembar 5,198 30
0100409 Furosemid inj. Sachet 8,300 0
0100410 Cutgut Chromic No. 2 dan 3 Sachet - 0
0100411 Levofloxacim Tablet 500 mg Ktk 50 tab - 0
0100412 Sefotaksim Inj. 1 GR vials 4,898 50
0100413 Magnesium Sulfat 20 % Inj Ampul 3,200 20
0100414 Seftriasxon Inj. 1 GR Ampul 8,000 0
0100415 Spyramicin tabblet 500 gr Vial - 0
0100416 Inj Kontrasepsi 3 bulan Vial - 0
0100417 Lubrican Jelly streil Pcs 44,010 10
0100418 Natrium Trioksin Tablet Tablet 1,550 0
0100419 Ketorolac Inj. 10 GR Ampul 2,300 12
0100420 Tetrasiklin Salep Mata Tube - 0
0100421 Dextran Infus 76 % Btl 500ml - 0
0100422 Tramadol Inj. Btl 6,402 0
0100423 Karbamazepin Tablet Tablet - 0
0100424 Fitogen Tablet - 0
0100425 Clobazam 10 mg Tablet 950 0
0100426 Stopdiar Tablet - 0
0100427 Kondom Wanita Set - 0
0100428 Povidon Iodin 10 % 60 ml Botol 3,700 0
0100429 Alprazolam Tablet Tablet 214 349
0100430 Blender Set 1,290,000 0
0100431 Dermisan 5O2 btl - 0
0100432 Glimepirid 2 mg Tablet tablet 289 1097
0100433 Spironolacton Tablet 25 mg ktk 346 0
0100434 Paracetamol Drop Botol 5,280 0
0100435 Bio ATP ktk 2,355 0
0100436 Elsiron Tablet ktk 348 0
0100437 Omeneuron Tablet ktk 1,540 290
0100438 Omecold ktk 254 0
0100439 Molagit Tablet tab 190 0
0 Molagit/Antalpugit/Puralex tab 145 1600
0100440 Neocenta Cream tube 9,726 0
0100441 Vidabion tab 429 1200
0100442 Ibupropen syrup 100mg/60ml Botol 2,475 50
0100443 Dermisan Antiseptik 200 ml Botol 88,000 0
0100444 Ambroxol syr 60ml Botol 3,300 0
0100445 Dietyhl Carbamazin kotak 100 tab Tablet 45 0
0100446 Kasa 4 x 5 Rool Rol 30,350 800
0100447 Kasa 4 x10 Rool Rol 30,350 365
0100448 Kasa 16x16 Rool Rol 7,900 43
0100449 Folly Cateter No. 11 set 7,722 0
0100450 Donperidon syrup botol 3,333 96
0 Donperidon syrup botol 3,000 50
0100451 Bisopralol tablet 5 mg - 0
0100452 Sitirizin 10 mg 0
0100453 Asam Folat 1 mg Tablet 48 9281
0100454 Nutralix / Omeneuron t ablet Tablet 550 0
0100455 Aceptn Liquid botol 30,000 5
0100456 Supratul Pcs 5,198 0
0100457 Fixomul Strecth 5 x 5 cm Rol 37,440 9
0100458 Lubrican Jelly streil Pcs 44,010 7
0100459 Ventolinenabulese 5Mg Pcs 4,000 40
0100460 Monitoring ystem set 199,970 0
0100461 Glucose Test strip botol 151,942 0
0100462 Cholesterol Total test strip botol 0
0100463 Tranfusi Set set 6,700 40
0100464 Alkohol swab Pcs 100 500
0100465 Glukosamin tablet Tablet 2525 60
0100466 Plastik kresek lembar 100 0
0100467 Plastik polos lembar 100 0
0 0 0 0 294021
@ VAKSI N 0 0
1 BCG Ampul 52492 14
2 Polio Vial 18370 35
3 Campak Vial 25641 13
4 DPT.HB.Hib Vial 49960 24
5 Td Vial 16181 -
6 TT Vial 13475 -
7 DT Vial 16412 -
8 DPT.HB. Vial 0 -
9 HB.U Vial 19096 1
0 Jumlah 2 0 211627 87
@ OBAT JKN 0 0
 1 Antalgin 50mg tablet 187.76 3460
2 Aspilet tablet 670.45 185
3 Cefotaxim inj ampul 7425 300
4 Colcacitin in Vial 11700 0
5 Deksametason 0.5mg tablet 33 4000
6 Digoxin tablet 143 504
7 Gleseriguayakolat 100mg tablet 50 1700
8 Intranidazol tablet 265 2100
9 Issorbidinitart 5mg tablet 141.47 50
10 Levertan salep pot 3300 50
11 Lidocain ampul 1569 300
12 Meloxicam 15mg tablet 1198 0
13 Metergin inj ampul 5347 0
14 Metroclopropamid inj ampul 4400 45
15 Myomergin inj Ampul 534.7 20
16 Pehacain inj ampul 3113 140
17 Piracetam 400mg tablet 451 480
18 Piracetam inj ampul 5500 15
19 Piroxicam 20mg tablet 135.7 0
20 Pronalges soppo Suppo 14500 0
21 Properetik 160mg Suppo 7333 48
22 Properetik 80mg Suppo 6875 36
23 Pytogin Inj Ampul 6600 140
24 Sancabion tablet 4290 16250
25 Sinvastatin 10mg tablet 308 0
26 Ventolinnabulese 5mg tablet 10361 5
0 0 0 0
Jumlah total 96,431.08 ###

JUMLAH KUNJUNGAN RESEP

UMUM 835
ASKES / BPJS 0
UKS 2
JAMKESMAS 817
Kartu sehat 3
Lain-2 0
GRATIS 15
J U M LAH 1672

Kepala UPT Puskesmas Jeruklegi I Kepala UPT Instalasi P

Kesehatan Kabupaten

dr. Retno Purwati Rahayu

NIP.19750227 2003122 003
EMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
NOMOR TANGGAL
PELAPORAN BULAN ; April 2017 DOK IPK

SALDO AWAL PENAMBAHAN PENGURANGAN SALDO AKHIR

HARGA JUMLAH HARGA JUMLAH HARGA JUMLAH HARGA
- 0 - 0 0 0 -
891,000 0 - 0 0 297 891,000
30,128 0 - 0 0 14 30,128
275,280 0 - 21 62160 72 213,120
- 0 - 0 0 0 -
449,568 0 - 43 14448 1295 435,120
349,000 0 - 0 0 1000 349,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
3,267,398 0 - 175 15050 37818 3,252,348
- 0 - 0 0 0 -
301,050 0 - 0 0 90 301,050
111,780 0 - 10 900 1232 110,880
- 0 - 0 0 0 -
31,360 0 - 0 0 280 31,360
- 0 - 0 0 0 -
26,640 0 - 90 21600 21 5,040
5,424,224 0 - 4022 1093984 15920 4,330,240
450,000 0 - 0 0 50 450,000
300,000 0 - 0 0 40 300,000
945,024 0 - 0 0 120 945,024
37,000 0 - 2 7400 8 29,600
1,611,255 0 - 157 383865 502 1,227,390
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
414,720 0 - 36 77760 156 336,960
620,000 0 - 0 0 10000 620,000
323,625 0 - 1457 109275 2858 214,350
15,102 0 - 0 0 6 15,102
66,000 0 - 0 0 30 66,000
121,800 0 - 0 0 40 121,800
- 0 - 0 0 0 -
- 0 - 0 0 0 -
514,800 0 - 0 0 234 514,800
- 0 - 0 0 0 -
- 0 - 0 0 0 -
12,033 0 - 5 8595 2 3,438
31,065 0 - 60 5700 267 25,365
334,360 0 - 732 76128 2483 258,232
 249,100 2000 212,000 1490 157940 2860 303,160
158,420 0 - 0 0 178 158,420
795,000 0 - 0 0 300 795,000
82,000 0 - 0 0 20 82,000
80,000 0 - 0 0 20 80,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
117,040 0 - 5 7600 72 109,440
91,080 0 - 9 12420 57 78,660
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
52,800 0 - 0 0 4 52,800
- 0 - 0 0 0 -
- 0 - 0 0 0 -
227,304 0 - 234 19656 2472 207,648
272,000 0 - 0 0 4000 272,000
- 0 - 0 0 0 -
1,303,040 0 - 180 91620 2380 1,211,420
306,000 0 - 0 0 600 306,000
- 0 - 0 0 0 -
82,950 0 - 0 0 150 82,950
- 0 - 0 0 0 -
- 0 - 0 0 0 -
634,500 0 - 95 223250 175 411,250
11,715 0 - 0 0 71 11,715
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
638,775 0 - 175 44625 2330 594,150
449,600 0 - 0 0 1600 449,600
469,260 0 - 0 0 297 469,260
7,047 0 - 0 0 81 7,047
4,793 0 - 0 0 71 4,793
816,500 0 - 161 13145.65 9839 803,354
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 10 124,000 1 12400 9 111,600
122,847 0 - 21 669.9 3830 122,177
 - 0 - 0 0 0 -
408,450 0 - 0 0 389 408,450
- 0 - 0 0 0 -
26,800 0 - 0 0 200 26,800
69,984 0 - 0 0 729 69,984
39,140 0 - 135 12825 277 26,315
26,720 0 - 0 0 160 26,720
127,912 0 - 175 20650 909 107,262
- 0 - 0 0 0 -
- 0 - 0 0 0 -
127,600 0 - 0 0 22 127,600
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
243,000 0 - 30 243000 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
98,420 500 66,500 700 93100 540 71,820
- 0 - 0 0 0 -
46,800 0 - 30 46800 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
43,368 0 - 773 42978.8 7 389
2,016 0 - 0 0 2 2,016
187,864 0 - 22 44924 70 142,940
- 0 - 0 0 0 -
615,060 0 - 180 615060 0 -
189,334 0 - 36 24876 238 164,458
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
12,948 300 23,400 166 12948 300 23,400
166,000 0 - 0 0 20 166,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
178,189 0 - 24 44088 73 134,101
144,000 0 - 15 60000 21 84,000
5,400 0 - 0 0 12 5,400
126,195 0 - 1 895 140 125,300
302,400 0 - 0 0 4200 302,400
220,860 0 - 5 270 4085 220,590
56,000 0 - 0 0 1000 56,000
 8,708 0 - 0 0 311 8,708
- 0 - 0 0 0 -
450,000 0 - 1093 196740 1407 253,260
- 0 - 0 0 0 -
- 0 - 0 0 0 -
10,400 0 - 0 0 2 10,400
931,500 0 - 52 358800 83 572,700
- 0 - 0 0 0 -
93,075 0 - 90 19710 335 73,365
- 0 - 0 0 0 -
- 0 - 0 0 0 -
68,555 0 - 90 7940.7 687 60,614
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
11,192 0 - 2 5596 2 5,596
463,750 0 - 51 135150 124 328,600
- 0 - 0 0 0 -
125,033 0 - 32 3104 1257 121,929
- 0 - 0 0 0 -
193,040 0 - 303 38481 1217 154,559
84,000 0 - 1 3500 23 80,500
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
9,256 0 - 121 6292 57 2,964
3,262 0 - 0 0 108 3,262
127,071 5000 315,000 2205 138915 4812 303,156
186,000 0 - 50 23250 350 162,750
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
139,000 0 - 0 0 1000 139,000
142,380 0 - 31 122605 5 19,775
- 0 - 0 0 0 -
23,100 0 - 0 0 100 23,100
1,170,134 1000 1,007,000 672 676704 1490 1,500,430
12,504 0 - 0 0 8 12,504
188,790 0 - 18 32364 87 156,426
- 0 - 0 0 0 -
33,600 0 - 0 0 14 33,600
359,376 0 - 3159 75816 11815 283,560
491,484 0 - 852 35784 10850 455,700
- 0 - 0 0 0 -
22,680 0 - 130 21060 10 1,620
- 0 - 0 0 0 -
- 0 - 0 0 0 -
166,050 0 - 0 0 90 166,050
- 0 - 0 0 0 -
 89,100 0 - 60 19800 210 69,300
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
426,825 0 - 137 15412.5 3657 411,413
- 0 - 0 0 0 -
- 0 - 0 0 0 -
237,800 0 - 50 10250 1110 227,550
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
307,363 0 - 126 16758 2185 290,605
594,000 0 - 12 36000 186 558,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
174,900 0 - 300 47700 800 127,200
435,880 0 - 3 19230 65 416,650
- 0 - 0 0 0 -
680,724 0 - 88 8712 6788 672,012
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
27,560 0 - 30 3120 235 24,440
- 0 - 0 0 0 -
48,960 0 - 2 960 100 48,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
3,239,865 16 5,759,760 5 1799925 20 7,199,700
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
25,350 0 - 0 0 13 25,350
501,750 0 - 90 202500 133 299,250
- 0 - 0 0 0 -
- 0 - 0 0 0 -
34,891 0 - 2 1702 39 33,189
28,800 0 - 0 0 15 28,800
- 0 - 0 0 0 -
506,000 0 - 30 66000 200 440,000
- 0 - 0 0 0 -
38,400 0 - 0 0 240 38,400
- 0 - 0 0 0 -
 - 0 - 0 0 0 -
- 0 - 0 0 0 -
369,600 0 - 240 369600 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
35,950 0 - 9 12942 16 23,008
163,248 50 53,700 100 107400 102 109,548
- 0 - 0 0 0 -
125,935 0 - 1396 124244 19 1,691
1,305,304 0 - 5790 324240 17519 981,064
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
7,760 0 - 35 6790 5 970
7,680 0 - 0 0 24 7,680
51,937 0 - 0 0 167 51,937
416,306 0 - 0 0 1397 416,306
- 0 - 0 0 0 -
2,050 0 - 0 0 110 2,050
14,807 0 - 31 539.4 820 14,268
499,140 0 - 1364 160952 2866 338,188
7,200 0 - 0 0 80 7,200
- 0 - 0 0 0 -
2,400 0 - 0 0 20 2,400
- 0 - 0 0 0 -
1,086,531 0 - 291 71292.09 4144 1,015,239
- 0 - 0 0 0 -
558,330 0 - 0 0 100 558,330
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
11,580 0 - 0 0 200 11,580
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
41,835 10 27,890 10 27890 15 41,835
206,340 0 - 0 0 181 206,340
466,560 0 - 0 0 200 466,560
738,480 0 - 2174 260880 3980 477,600
315,000 0 - 0 0 3000 315,000
- 0 - 0 0 0 -
17,336 0 - 0 0 197 17,336
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
279,840 0 - 10 4800 573 275,040
 - 0 - 0 0 0 -
10,400 0 - 0 0 2 10,400
2,431,000 1000 7,150,000 413 2952950 927 6,628,050
- 0 - 0 0 0 -
- 0 - 0 0 0 -
600,248 0 - 182 70708.82 1363 529,539
9,749 0 - 16 1559.84 84 8,189
83,000 0 - 0 0 1000 83,000
64,000 0 - 11 22000 21 42,000
233,184 0 - 0 0 96 233,184
272,500 0 - 16 20000 202 252,500
- 0 - 0 0 0 -
- 0 - 0 0 0 -
4,649,500 0 - 0 0 10 4,649,500
4,730,000 0 - 0 0 10 4,730,000
- 0 - 0 0 0 -
2,040,000 0 - 2 340000 10 1,700,000
215,400 0 - 0 0 200 215,400
109,800 0 - 0 0 100 109,800
13,622 0 - 49 715.4 884 12,906
5,895 0 - 0 0 450 5,895
- 0 - 0 0 0 -
- 0 - 0 0 0 -
130,500 0 - 9 40500 20 90,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
34,551 10 115,170 0 0 13 149,721
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
33,000 0 - 10 3000 100 30,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
20,634 0 - 30 1140 513 19,494
580,456 0 - 1069 39553 14619 540,903
- 0 - 0 0 0 -
99,569 0 - 50 17167 240 82,402
55,770 0 - 30 1237.5 1322 54,533
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
43,850 0 - 1 8770 4 35,080
- 0 - 0 0 0 -
10,700 0 - 0 0 100 10,700
1,647,375 0 - 1353 155595 12972 1,491,780
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
 235,000 0 - 50 235000 0 -
747,300 0 - 32 150400 127 596,900
- 0 - 0 0 0 -
258,400 0 - 0 0 68 258,400
1,024,600 0 - 45 211500 173 813,100
- 0 - 0 0 0 -
509,200 100 380,000 83 315400 151 573,800
- 0 - 0 0 0 -
235,000 0 - 50 235000 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
789,000 0 - 100 78900 900 710,100
130,000 0 - 0 0 200 130,000
- 0 - 0 0 0 -
1,050,000 0 - 0 0 1400 1,050,000
185,000 0 - 0 0 200 185,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
205,406 0 - 0 0 60 205,406
158,000 0 - 0 0 24 158,000
123,244 0 - 0 0 36 123,244
15,484 0 - 0 0 7 15,484
- 0 - 0 0 0 -
3,362,500 0 - 10 25000 1335 3,337,500
352,000 0 - 0 0 44 352,000
200,000 0 - 0 0 25 200,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
1,225,000 0 - 49 171500 301 1,053,500
1,049,600 300 960,000 103 329600 525 1,680,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
528,000 0 - 1 24000 21 504,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
308,000 0 - 0 0 40 308,000
282,000 0 - 0 0 30 282,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
 - 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
363,000 3000 990,000 1300 429000 2800 924,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
241,520 40 483,040 20 241520 40 483,040
171,100 0 - 9 26100 50 145,000
220,000 0 - 0 0 50 220,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
249,500 0 - 200 99800 300 149,700
33,775 0 - 0 0 24 33,775
95,000 0 - 0 0 24 95,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
108,000 0 - 0 0 36 108,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
1,260,000 0 - 6 630000 6 630,000
2,245,817 0 - 0 0 49 2,245,817
- 2 866,584 0 0 2 866,584
- 2 654,000 0 0 2 654,000
- 2 214,000 0 0 2 214,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 2 200,000 0 0 2 200,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
 - 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
576,000 0 - 0 0 96 576,000
109,500 0 - 0 0 30 109,500
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
21,360 0 - 0 0 240 21,360
128,700 0 - 268 88440 122 40,260
- 0 - 0 0 0 -
83,440 0 - 220 32780 340 50,660
- 0 - 0 0 0 -
155,940 0 - 0 0 30 155,940
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
244,900 0 - 0 0 50 244,900
64,000 0 - 0 0 20 64,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
440,104 0 - 0 0 10 440,104
- 0 - 0 0 0 -
27,600 0 - 0 0 12 27,600
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
74,686 0 - 29 6206 320 68,480
 - 0 - 0 0 0 -
- 0 - 0 0 0 -
317,033 0 - 17 4913 1080 312,120
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
446,600 300 462,000 375 577500 215 331,100
- 0 - 0 0 0 -
- 0 - 0 0 0 -
232,000 0 - 0 0 1600 232,000
- 0 - 0 0 0 -
514,800 0 - 816 350064 384 164,736
123,750 0 - 0 0 50 123,750
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
24,280,000 0 - 0 0 800 24,280,000
11,077,750 0 - 0 0 365 11,077,750
339,700 0 - 0 0 43 339,700
- 0 - 0 0 0 -
319,968 0 - 4 13332 92 306,636
150,000 0 - 0 0 50 150,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
445,488 0 - 273 13104 9008 432,384
- 0 - 0 0 0 -
150,000 0 - 1 30000 4 120,000
- 0 - 0 0 0 -
336,960 0 - 0 0 9 336,960
308,073 0 - 0 0 7 308,073
160,000 0 - 25 100000 15 60,000
- 0 - 0 0 0 -
- 0 - 0 0 0 -
- 0 - 0 0 0 -
268,000 0 - 0 0 40 268,000
50,000 0 - 100 10000 400 40,000
151,500 0 - 0 0 60 151,500
- 0 - 0 0 0 -
- 0 - 0 0 0 -
124,716,699 13644 20,064,044 40237 17448012.6 267428 127,332,730

734,888 10 524,920 11 577412 13 682,396

642,950 20 367,400 44 808280 11 202,070
333,333 10 256,410 12 307692 11 282,051
1,199,040 50 2,498,000 38 1898480 36 1,798,560
- 0 - 0 0 - -
- 30 404,250 10 134750 20 269,500
- 0 - 0 - -
- 0 - 0 - -
19,096 50 954,800 51 973896 - -
2,929,307 170 5,005,780 166 4,700,510 91 3,234,577
 649649.6 0 0 1030 193392.8 2430 456256.8
124033.25 0 0 185 124033.25 0 0
2227500 0 0 30 222750 270 2004750
0 0 0 0 0 0 0
132000 0 0 2030 66990 1970 65010
72072 0 0 104 14872 400 57200
85000 0 0 1500 75000 200 10000
556500 0 0 0 0 2100 556500
7073.5 0 0 50 7073.5 0 0
165000 0 0 26 85800 24 79200
470700 0 0 0 0 300 470700
0 0 0 0 0 0 0
0 0 0 0 0 0 0
198000 0 0 15 66000 30 132000
10694 0 0 0 0 20 10694
435820 0 0 0 0 140 435820
216480 0 0 180 81180 300 135300
82500 0 0 0 0 15 82500
0 0 0 0 0 0 0
0 0 0 0 0 0 0
351984 0 0 8 58664 40 293320
247500 0 0 2 13750 34 233750
924000 0 0 0 0 140 924000
69712500 0 0 4050 17374500 12200 52338000
0 0 0 0 0 0 0
51805 0 0 5 51805 0 0
76,720,811 - - 9,215 18,435,811 20,613.00 58,285,001
204,366,817 13,814 25,069,824 49,618 40,584,333 288,132 188,852,308

Kepala UPT Instalasi Perbekalan Yang Menerima

Kesehatan Kabupaten Cilacap

I s m a d i
NIP. NIP. 19610212 19831 001
Mengetahui
Kepala Dinas Kesehatan
Kabupaten Cilacap

NIP
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