LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUSKESMAS

DINAS KESEHATAN KABUPATEN LAMPUNG TENGAH

TAHUN 2017

PUSKESMAS : BULAN :
KECAMATAN : TAHUN :
KABUPATEN : LAMPUNG TENGAH
PROVINSI : LAMPUNG
JUMLAH PUSKESMAS PEMBANTU :

STOK PEMBERIAN
Harga Stok PENERI - PERSEDI PEMAKAI SISA Harga
NO NAMA OBAT SATUAN OPTIMU PERMINTAAN KET.
Satuan Awal MAAN AAN AN STOK Total PKD
M DAK PROG
PROP
OBAT

1 Air Untuk Injeksi 25 ml Botol, 25 ml ( 2,750)

2 Air Untuk Injeksi 20 ml Botol, 25 ml ( 2,000)

3 Albendazol tablet 400 Mg Kotak, strip 5 x 6 tablet ( 296)

4 Albendazole Suspensi 200 mg/5ml Dus, 10 Dus @ 1 Botol @ 10 ml ( 3,849)

5 Alopurinol tablet 100 mg Kotak, strip 10 x 10 tablet ( 110)

6 Alopurinol tablet 100 mg Kotak, strip 10 x 10 tablet ( 90)

7 Alopurinol tablet 300 mg Kotak, strip 10 x 10 tablet ( 224)

8 Aminofillin injeksi 24 mg/ml 10 ml @ 30 amp Kotak, 30 ampul ( 3,345)

9 Aminofillin tablet 200 mg Kotak, strip 10 x 10 tablet ( 80)

10 Amitriptilin tablet 25 mg Kotak, strip 10 x 10 tablet ( 143)

11 Amlodipin tablet 10 mg Kotak, strip 3 x 10 tablet ( 148)

12 Amlodipin tablet 10 mg Kotak, strip 3 x 10 tablet ( 104)

13 Amlodipin tablet 5 mg Kotak, strip 3 x 10 tablet ( 105)

14 Amlodipin tablet 5 mg Kotak, strip 3 x 10 tablet ( 105)

15 Amoksillin kaplet 500 mg Kotak, strip 10 x 10 kaplet ( 232)

16 Amoksillin kaplet 500 mg Kotak, strip 10 x 10 kaplet ( 190)

17 Amoksillin kapsul 250 mg Kotak, strip 10 x 10 kapsul ( 195)

18 Amoksillin kapsul 250 mg Kotak, strip 10 x 10 kapsul ( 195)

19 Amoksillin sirup kering 125 mg /5ml Botol 60 ml ( 2,090)

20 Amoksillin sirup kering 125 mg /5ml Botol 60 ml ( 2,445)

21 Amoksillin sirup kering 125 mg /5ml Botol 60 ml ( 4,070)

22 Amoksillin sirup kering forte 250 mg /5ml Botol 60 ml ( 3,984)

23 Antalgin tablet 500 mg Kotak, strip 10 x 10 tablet ( 116)

Antasida DOEN I tablet kunyah, kombinasi : Aluminium
24 Kotak, strip 10 x 10 tablet ( 72)
Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN I tablet kunyah, kombinasi : Aluminium
25 Kotak, strip 10 x 10 tablet ( 162)
Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN I tablet kunyah, kombinasi : Aluminium
26 Kotak, strip 10 x 10 tablet ( 62)
Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
27 Botol 60 ml ( 2,025)
200 mg/5 ml, Magnesium Hidroksida 200 mg/ 5 ml.
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
28 Botol 60 ml ( 2,160)
200 mg/5 ml, Magnesium Hidroksida 200 mg/ 5 ml.
29 Anti Bakteri Basitrin 500 m/l + Polimiskin 10.000 iu/g (tube) 25 Tube ( 2,924)
Antifungi DOEN Salep Kombinasi : Asam Benzoat 6 % Asam
30 Kotak, 24 Pot, Pot 30 gram ( 4,158)
Salisilat 3 %
Antihemoroid, Kombinasi : bismut subgalat 150 mg heksaklorofen
31 Dus ( 10 ) ( 3,045)
2,5 mg lidocain 10 mg seng oksida 120 mg
32 Antimigren Ergotamin tatrat 1mg+kofein50 mg Kotak, strip 10 x 10 tablet ( 135)
33 Asam Asetilsalisilat tablet 80 mg Kotak, strip 10 x 10 tablet ( 114)

34 Asam Askorbat (Vitamin C) tablet 250 mg Kotak, strip 10 x 10 tablet ( 125)

35 Asam Askorbat (Vitamin C) tablet 50 mg Kotak, strip 10 x 10 tablet ( 95)

36 Asam Askorbat (Vitamin C) tablet 50 mg Kotak, strip 10 x 10 tablet ( 104)

37 Asam Folat Kotak, strip 10 x 10 tablet ( 63)

38 Asam Mefenamat tablet 500 mg Kotak, strip 10 x 10 tablet ( 106)

39 Asam Mefenamat tablet 500 mg Kotak, strip 10 x 10 tablet ( 176)

40 Asiklovir crem 5 % Kotak, 25 tube ( 2,152)

41 Asiklovir tablet 200 mg Kotak, strip 10 x 10 tablet ( 249)

42 Asiklovir tablet 200 mg Kotak, strip 10 x 10 tablet ( 239)

43 Asiklovir tablet 200 mg Kotak, strip 10 x 10 tablet ( 237)

44 Asiklovir tablet 400 mg Kotak, strip 10 x 10 tablet ( 349)

45 Atenolol tablet 50 mg Kotak, strip 10 x 10 tablet ( 330)

46 Atropin injeksi 0,25 mg / ml Kotak, 100 ampul ( 1,672)

47 Atropin Sulfat tab 0,5 mg Kotak, strip 10 x 10 tablet ( 74)

48 Attapulgite 600 mg tablet Kotak, strip 10 x 10 tablet ( 95)

49 Attapulgite 600 mg tablet Kotak, strip 10 x 10 tablet ( 145)

50 Betahistin tablet 6 mg Kotak, strip 3 x 10 tablet ( 149)

51 Betametason Krim 0,1 % (Sebagai Valerat) ( Skizone) Dus, 25 Tube ( 3,388)

52 Bisoprolol tablet 5 mg Kotak, strip 10 x 10 tablet ( 330)

53 Deksametason injeksi i.v./i.m. 5 mg/ml Kotak, 100 ampul ( 2,002)

54 Deksametason injeksi i.v./i.m. 5 mg/ml Kotak, 100 ampul ( 1,500)

55 Deksametason tablet 0,5 mg Kotak, 100 Tablet ( 44)

56 Deksametason tablet 0,5 mg Kotak, strip 10 x 10 tablet ( 62)

57 Desoksimetason Krim 0,25 % Tube ( 10,000)

58 Diazepam larutan rektal 5 mg Tube ( 11,517)

59 Diazepam tablet 5 mg Kotak, strip 10 x 10 tablet ( 103)

60 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Dus, 30 ampul @ 1 ml ( 1,176)

61 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul ( 1,054)

62 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Kotak, 30 ampul ( 960)

63 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul ( 117)

64 Digoksin 0,25 mg Kotak, strip 10 x 10 tablet ( 105)

65 Doksisiklin kapsul 100 mg Kotak, strip 10 x 10 kapsul ( 220)

66 Doksisiklin kapsul 100 mg Kotak, strip 10 x 10 kapsul ( 269)

67 Domperidon suspensi Botol, 60 ml ( 3,000)

68 Domperidon tablet 10 mg Kotak, strip 10 x 10 tablet ( 118)

69 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) Ampul ( 8,100)

70 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) Kotak, 30 ampul ( 2,204)

71 Erytromisin sirup 200 mg/5 ml @ 60 ml Botol, 60 ml ( 6,700)

72 Erytromisin sirup 200 mg/5 ml @ 60 ml Botol, 60 ml ( 7,220)

73 Erytromisin sirup 200 mg/5 ml @ 60 ml Botol, 60 ml ( 7,700)

74 Erytromisin tablet 500 mg Kotak, strip 10 x 10 tablet ( 730)

75 Erytromisin tablet 250 mg Kotak, strip 10 x 10 tablet ( 566)

76 Etanol 70 % @ 100 ml Botol, 100 ml ( 2,500)

77 Etanol 70 % @ 100 ml Botol, 100 ml ( 2,500)

78 FDC Anak Paket ( 214,985)

79 FDC Kategoi I Paket ( 359,985)

80 Fenitoin kapsul 100 mg Botol 100 Kapsul ( 133)

81 Fenitoin kapsul 100 mg Botol 100 Kapsul ( 154)

82 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul ( 1,800)

83 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul ( 1,969)

84 Fitomenadion injeksi Ampul ( 3,550)

85 Fitomenadion tablet (Vit.K1) tablet/kaplet salut gula 10 mg Kotak, strip 10 x 10 tablet ( 695)

86 Fitomenadion tablet (Vit.K1) tablet/kaplet salut gula 10 mg Kotak, strip 10 x 10 tablet ( 579)

87 Fitomenadion tablet (Vit.K1) tablet/kaplet salut gula 10 mg Kotak, strip 10 x 10 tablet ( 634)

88 Fluoksetin kapsul 20 mg Kapsul ( 419)

89 Fluoksetin kapsul 20 mg Kotak, strip 5 x 10 tablet ( 250)

90 Furosemid tablet 40 mg Kotak, strip 10 x 10 tablet ( 80)

91 Furosemid tablet 40 mg Kotak, strip 10 x 10 tablet ( 85)

92 Furosemid tablet 40 mg Kotak, strip 10 x 10 tablet ( 85)

93 Garam Oralit @ 100 saschet Kotak, 100 Sachet ( 285)

94 Garam Oralit @ 100 saschet Kotak, 100 Sachet ( 264)

95 Gentamisin Salep Kulit 0,1 % Kotak, 10 tube ( 1,350)

96 Gentamisin Salep Mata 0,3 % tube 3,5 gr Tube 3,5 gr ( 2,600)

97 Gentamisin Salep Mata 0,3 % tube 3,5 gr Tube 3,5 gr ( 2,830)

98 Gentamisin Tetes Mata Botol, 5 ml ( 4,000)

99 Glibenklamida tablet 5 mg Kotak, strip 10 x 10 tablet ( 56)

100 Glibenklamida tablet 5 mg Kotak, strip 10 x 10 tablet ( 56)

101 Glimepirid tablet 1 mg Kotak, strip 10 x 10 tablet ( 218)

102 Glimepiride tablet 2 mg Kotak, blister 5 x 10 tablet ( 289)

103 Glimepiride tablet 3 mg Kotak, blister 5 x 10 tablet ( 319)

104 Glukosa larutan infus 5 % steril Botol plastik 500 ml ( 5,200)

105 Glukosa larutan infus 5 % steril Botol plastik 500 ml ( 5,200)

106 Glukosa larutan infus 5 % steril Botol plastik 500 ml ( 6,900)

107 Griseofulvin tablet 125 mg Dus, 10 strip x 10 tablet ( 209)

108 Haloperidol injeksi 5 mg Kotak, 12 ampul ( 4,974)

109 Haloperidol injeksi 50 mg/ml Kotak, 5 ampul ( 83,333)

110 Haloperidol tablet 1,5 mg Kotak, strip 10 x 10 tablet ( 66)

111 Haloperidol tablet 2 mg Kotak, strip 10 x 10 tablet ( 110)

112 Haloperidol tablet 5 mg Kotak, strip 10 x 10 tablet ( 75)

113 Haloperidol tablet 5 mg Kotak, strip 10 x 10 tablet ( 96)

114 Hidroklorotiazid tablet 25 mg Kotak, strip 10 x 10 tablet ( 149)

115 Hidrokortison krim 2,5 % Tube 5 gr ( 2,798)

116 Hidrokortison krim 2,5 % Tube 5 gr ( 2,650)

117 Hidrokortison krim 2,5 % Tube 5 gr ( 2,650)

118 Ibuprofen suspensi 100 mg/5 ml Botol 60 ml ( 2,475)

119 Ibuprofen tablet 200 mg Kotak, strip 10 x 10 tablet ( 105)

120 Ibuprofen tablet 400 mg Kotak, strip 10 x 10 tablet ( 150)

121 Ibuprofen tablet 400 mg Kotak, strip 10 x 10 tablet ( 127)

122 Ibuprofen tablet 400 mg Kotak, strip 10 x 10 tablet ( 127)

123 Isoniazid 100 mg Kotak, strip 10 x 10 tablet ( 71)

124 Isoniazid 300 mg Kotak, strip 10 x 10 tablet ( 173)

125 Issosorbid Dinitrat 5 mg Kotak, strip 10 x 10 tablet ( 88)

126 Kalsium Glukonat Injeksi 100 mg/ml Dus, 24 amp @ 10 ml ( 9,955)

127 Kalsium Karbonat 500 mg Kaplet 30 ( 430)

128 Kalsium Laktat (Kalk) tablet 500 mg Kotak, strip 10 x 10 tablet ( 63)

129 Kalsium Laktat (Kalk) tablet 500 mg Kotak, strip 10 x 10 tablet ( 70)

130 Kaptopril tablet/kaplet scored 12,5 mg Kotak, strip 10 x 10 tablet ( 62)

131 Kaptopril tablet/kaplet scored 12,5 mg Kotak, strip 10 x 10 tablet ( 59)

132 Kaptopril tablet/kaplet scored 25 mg Kotak, strip 10 x 10 tablet ( 84)

133 Kaptopril tablet/kaplet scored 25 mg Kotak, strip 10 x 10 tablet ( 84)

134 Kaptopril tablet/kaplet scored 25 mg Kotak, strip 10 x 10 tablet ( 68)

135 Karbamazepin tablet 200 mg Kotak, strip 10 x 10 tablet ( 270)

136 Ketokonazol Tablet Kotak, strip 5 x 10 tablet ( 280)

137 Ketokonazol krim 2 % Tube 10 gr ( 2,569)

138 Ketokonazol krim 2 % Tube 10 gr ( 2,545)

139 Klindamisin kapsul 150 mg Kotak, strip 5 x 10 kapsul ( 361)

140 Klindamisin kapsul 300 mg Kotak, strip 5 x 10 kapsul ( 603)

141 Kloramfenikol kapsul 500 mg Kotak, strip 10 x 10 kapsul ( 1,007)

142 Kloramfenikol salep kulit 2% Box, 24 Tube @ 15 gram ( 3,091)

143 Kloramfenikol salep mata 1 % Tube 5 gr ( 1,600)

144 Kloramfenikol salep mata 1 % Tube 5 gr ( 1,798)

145 Klorfeniramina Maleat (CTM) tablet 4 mg Kotak, strip 10 x 10 tablet ( 42)

146 Klorpromazin tablet salut 100 mg (HCl) Kotak, strip 10 x 10 tablet ( 149)

147 Klorpromazin tablet salut 100 mg (HCl) Kotak, strip 10 x 10 tablet ( 162)

148 Klorpromazin tablet salut 25 mg Kotak, strip 10 x 10 tablet ( 68)

149 Klorpromazin tablet salut 25 mg Kotak, strip 10 x 10 tablet ( 148)

150 Kodein Tab 10 mg Kotak, strip 10 x 10 tablet ( 550)

Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :
151 Botol 60 ml ( 2,140)
Sulfametoksazol 200 mg + Trimetoprim 40 mg
Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :
152 Botol 60 ml ( 2,035)
Sulfametoksazol 200 mg + Trimetoprim 40 mg
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+
153 Kotak, strip 10 x 10 tablet ( 151)
trimetoprim 80 mg
Kotrimoksazol forte (dewasa) kombinasi: sulfametoksazol 800 mg
154 Kotak, strip 10 x 10 tablet ( 308)
trimetoprim 160 mg
155 Kuinin Tab 200 Mg (222 Mg sebagai Garam ) Kotak / 60 Tablet ( 670)

156 Lansoprazol kapsul 30 mg Kotak, Strip 2 x 10 kapsul ( 319)

157 Lidokain injeksi 2% (HCL) Kotak, 100 ampul ( 1,845)

158 Lidokain injeksi 2% (HCL) Kotak, 100 ampul ( 860)

159 Lidokain injeksi 2% (HCl) + Epinefrin 1: 80.000 - 2 ml Dus 30 ampul ( 1,845)

160 Loperamide 2 mg tablet ( 80)

161 Loratadin tablet 10 mg Kotak, strip 5 x 10 kapsul ( 154)

162 Loratadin tablet/kapsul/kaplet 10 mg Kotak, strip 10 x 10 tablet ( 154)

163 Loratadin tablet/kapsul/kaplet 10 mg Kotak, strip 10 x 10 tablet ( 134)

164 Magnesium sulfat injeksi 20% Ampul @ 25 mL ( 3,200)

165 Magnesium sulfat injeksi 40% Ampul @ 25 mL ( 3,650)

166 Metformin HCl tablet 500 mg Kotak, strip 10 x 10 tablet ( 113)

167 Metformin HCl tablet 500 mg Kotak, strip 10 x 10 tablet ( 100)

168 Metformin HCl tablet 850 mg Kotak, strip 10 x 10 tablet ( 185)

169 Metil Prednisolon 4 mg Kotak, strip 10 x 10 tablet ( 194)

170 Metilergometrin Injeksi 0,2 mg/ml Kotak, 100 ampul ( 2,984)

171 Metilergometrin Injeksi 0,2 mg/ml Kotak, 10 ampul @ 5 ml ( 2,684)

172 Metilergometrin Maleat tablet 0,125 mg Kotak, strip 10 x 10 tablet ( 154)

173 Metoklorpropamide 10 mg @ 100 tab Kotak, strip 10 x 10 tablet ( 90)

174 Metronidazol Syr 125 mg/ 5 ml Botol ( 3,800)

175 Metronidazol tablet 500 mg Kotak, strip 10 x 10 tablet ( 164)

176 Metronidazol tablet 500 mg Kotak, strip 10 x 10 tablet ( 133)

177 Metronidazol tablet 250 mg Kotak, strip 10 x 10 tablet ( 123)

178 Metronidazol tablet 250 mg Kotak, strip 10 x 10 tablet ( 94)

179 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gr ( 3,250)

180 N. Acetil Sistein tab 200 mg @ 60 tab Kotak, strip 6 x 10 tablet ( 426)

181 Nacl larutan infus 0,9 % steril Botol plastik 500 ml ( 4,700)

182 Nacl larutan infus 0,9 % steril Botol plastik 500 ml ( 6,900)

183 Nacl larutan infus 0,9 % steril Botol plastik 500 ml ( 6,410)

184 Natrium diklofenak tablet 25 mg Kotak, strip 5 x 10 tablet salut enterik ( 145)

185 Natrium diklofenak tablet 25 mg Kotak, strip 5 x 10 tablet salut enterik ( 133)

186 Natrium diklofenak tablet 50 mg Kotak, strip 5 x 10 tablet salut enterik ( 200)

187 Natrium diklofenak tablet 50 mg Kotak, strip 5 x 10 tablet salut enterik ( 159)

188 Nifedipin tablet 10 mg Kotak, strip 10 x10 tablet salut selaput ( 108)

189 Nifedipin tablet 10 mg Kotak, strip 10 x10 tablet salut selaput ( 110)

190 Nistatin vaginal tablet 100.000 IU/ g Kotak, strip 10 x10 tablet salut selaput ( 640)

191 Nistatin vaginal tablet 100.000 IU/ g Kotak, strip 10 x10 tablet salut selaput ( 523)

192 Nistatin vaginal tablet 500.000 IU/ g Kotak, strip 10 x10 tablet salut selaput ( 745)

193 Oksitetrasikllin sk 3 % Kotak, 25 tube ( 1,529)

194 Oksitosin Inj 10 IU/ml @ ampul 1 ml Ampul ( 2,200)

195 Oksitosin Inj 10 IU/ml @ ampul 1 ml Ampul ( 1,900)

196 Omeprazol kapsul/kaplet 20 mg Kotak, strip 3 x 10 kapsul ( 211)

197 Omeprazol kapsul/kaplet 20 mg Kotak, strip 3 x 10 kapsul ( 160)

198 Omeprazol kapsul/kaplet 20 mg Kotak, strip 3 x 10 kapsul ( 160)

199 Omeprazol inj 40 mg/ 10 ml box /1 vial ( 16,997)

200 Ondansetron tablet 4 mg Kotak, Strip 2 x 6 tablet ( 472)

201 Parasetamol drop 100 mg/ml Dus, botol 15 ml ( 5,200)

202 Parasetamol sirup 120 mg / 5 ml Botol, 60 ml ( 1,438)

203 Parasetamol sirup 120 mg / 5 ml Botol, 60 ml ( 1,074)

204 Parasetamol tablet 500 mg Kotak, strip 10 x 10 tablet ( 56)

205 Parasetamol tablet 500 mg Kotak, strip 10 x 10 tablet ( 80)

206 Pirantel tablet score (base) 125 mg Dus, 25 catch cover @ 1 strip @ 4 tablet ( 298)

207 Pirantel tablet score (base) 125 mg Dus, 25 catch cover @ 1 strip @ 4 tablet ( 291)

208 Piridoksin (Vitamin B6) Injeksi Amp 100 ( 980)

209 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Kotak, strip 10 x 10 tablet ( 118)

210 Povidon Iodida larutan 10% 300 ml Botol 300 ml ( 14,203)

211 Povidon Iodida larutan 10% 300 ml Botol 300 ml ( 14,203)

212 Povidon Iodida larutan 10% 60 ml Botol 60 ml ( 6,550)

213 Prednison 5 mg kaplet 10 x 10 tablet ( 96)

214 Propanolol tablet 10 mg ( HCl ) Kotak, strip 10 x 10 tablet ( 65)

215 Propanolol tablet 10 mg ( HCl ) Kotak, strip 10 x 10 tablet ( 60)

216 Propiltiourasil tablet 100 mg Botol 100 tablet ( 319)

217 Ranitidin tablet 150 mg Kotak, strip 10 x 10 tablet ( 98)

218 Retinol (Vitamin A) 100.000 IU Botol 50 kapsul lunak ( 284)

219 Ringer Laktat larutan infus steril Botol plastik 500 ml ( 7,150)
220 Risperidon tablet 2 mg Kotak, strip 5 x 10 tablet ( 1,008)

221 Risperidon tablet 2 mg Kotak, strip 5 x 10 tablet ( 495)

222 Salbutamol cairan ih 0,1% (Ventolin Nebules) Dus, 4x5 Botol Plastik @2,5 ml ( 4,000)

223 Salbutamol tablet 2 mg (sebagai Sulfat) Kotak, strip 10 x 10 tablet ( 59)

224 Salbutamol tablet 2 mg (sebagai Sulfat) Kotak, strip 10 x 10 tablet ( 66)

225 Salbutamol tablet 4 mg Kotak, strip 10 x 10 tablet ( 83)

226 Salep Antiseptik 10 gr (Betadine ) tube ( 11,433)

227 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Pot 30 gram ( 2,429)

228 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Pot 30 gram ( 2,000)

229 Salisil Bedak 2 % @ 50 gr Kotak ( 1,250)

230 Salisil Bedak 2 % @ 50 gr Kotak ( 1,250)

231 Salisil Bedak 2 % @ 50 gr Kotak ( 1,025)

232 Scabimite Cream Tube ( 12,155)

233 Sefadroksil kapsul/kaplet 500 mg Kotak, strip 10 x 10 kapsul ( 509)

234 Sefadroksil kapsul/kaplet 500 mg Kotak, strip 10 x 10 kapsul ( 516)

235 Sefadroksil Sirup Kering 125 mg/5 ml botol ( 3,984)

236 Serum ABU Poli inj 5ml Dus (10 Vial) ( 462,000)

237 Serum ATS 1500 ui/ Amp Dus (10 Vial) ( 126,500)

238 Setirizin kapsul 10 mg Kotak, strip 10 x 10 kapsul ( 91)

239 Setirizin kapsul 10 mg Kotak, strip 10 x 10 kapsul ( 143)

240 Setirizin Sirup 5 mg/5 ml Botol 60 ml ( 2,850)

241 Sianokobalamin (vitamin B12) injeksi 500 mcg Dus 100 ampul 1 ml ( 1,098)

242 Sianokobalamin (vitamin B12) injeksi 500 mcg Dus 100 ampul 1 ml ( 916)

243 Simvastatin 10 mg Kotak, strip 3 x 10 tablet ( 131)

244 Siprofloksasin tablet scored 500 mg Kotak, strip 10 x 10 tablet ( 255)

245 Siprofloksasin tablet scored 500 mg Kotak, strip 10 x 10 tablet ( 281)

246 Spiramisin tablet 500 mg Kotak, strip 5 x 10 tablet ( 1,499)

247 Spironolakton 25 mg Kotak, strip 10 x 10 tablet ( 294)

248 Tetagam (Human Tetanus Imunoglobulin injeksi 250 IU) Dus, 1 Prfilled syringe @ 1 ml ( 170,000)

249 Tetrasiklin kapsul/kaplet 250 mg Kotak, strip 10 x 10 kapsul ( 149)

250 Tetrasiklin kapsul/kaplet 250 mg Kotak, strip 10 x 10 kapsul ( 163)

251 Tetrasiklin tablet/kapsul/kaplet 500 mg Kotak, strip 10 x 10 kapsul ( 310)

252 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Kotak, strip 10 x 10 tablet ( 86)

253 Triheksifenidil tablet/kapsul/kaplet 2 mg Kotak, strip 10 x 10 tablet ( 88)

254 Triheksifenidil tablet/kapsul/kaplet 2 mg Kotak, strip 10 x 10 tablet ( 40)

255 Triheksifenidil tablet/kapsul/kaplet 2 mg Kotak, strip 10 x 10 tablet ( 1,176)

256 Valproat (Depakote tablet 250 mg) Botol, 100 tablet ( 1,750)

257 Vitamin B Kompleks tablet Kotak, strip 10 x 10 tablet ( 115)

258 Vitamin B Kompleks tablet Kotak, strip 10 x 10 tablet ( 107)

259 Zinc Sirup 10 mg/ml Dus, botol 100 ml ( 14,980)

260 Zinc tablet dispersible 20 mg Kotak, strip 10 x 10 tablet ( 474)

261 Zinc tablet dispersible 20 mg Kotak, strip 10 x 10 tablet ( 514)

SUB TOTAL

OBAT RAWAT INAP

262 Ampisillin serbuk Inj i.v 1000 mg/vial @ 10 vial Kotak, 10 ampul ( 5,100)

263 Asam Traneksamat Inj 50 mg/ml @ 10 amp-5 ml Kotak, 10 ampul ( 2,950)

264 Asam Traneksamat Inj 50 mg/ml @ 10 amp-5 ml Kotak, 10 ampul ( 2,445)

265 Gentamisin injeksi 40 mg/ ml Dus, 5 ampul @ 2 ml ( 3,083)

266 Gentamisin injeksi 40 mg/ ml Dus, 5 ampul @ 2 ml ( 3,399)

267 Ketorolak injeksi 30 mg/ml Dus, 12 ampul @ 1 ml ( 1,290)

268 Ketorolak injeksi 30 mg/ml Dus, 12 ampul @ 1 ml ( 2,300)

269 Ketorolak injeksi 30 mg/ml Dus, 12 ampul @ 1 ml ( 1,290)

270 Ondansetron injeksi 4 mg/ 2 ml Dus, 5 Ampul @ 2 ml ( 1,650)

271 Ranitidin injeksi 25 mg/ml Dus, 10 Ampul @ 2 ml ( 1,390)

272 Sefotaksim injeksi 1 gr @ 10 vial Dus, 10 Ampul @ 1 gr ( 2,950)

273 Sefotaksim injeksij 1 gr @ 10 vial Dus, 10 Ampul @ 1 gr ( 5,500)

274 Tramadol injeksi 50 mg/ml Kotak, 5 ampul @ 2 mL ( 1,800)

SUB TOTAL

BAHAN MEDIS HABIS PAKAI

275 Alat Suntik 1 ml @ 100 bh Kotak, 100 pcs ( 911.05)

276 Alat Suntik 1 ml @ 100 bh Kotak, 100 pcs ( 904.70)

277 Alat Suntik 3 ml @ 100 bh Kotak, 100 pcs ( 739)

278 Alat Suntik 3 ml @ 100 bh Kotak, 100 pcs ( 1,212)

279 Alat Suntik 3 ml @ 100 bh Kotak, 100 pcs 899.25

280 Alat Suntik 5 ml @ 100 bh Kotak, 100 pcs ( 1,038)

281 Alat Suntik 5 ml @ 100 bh Kotak, 100 pcs ( 1,020)

282 Alat Suntik 5 ml @ 100 bh Kotak, 100 pcs 1011.52

283 Alkohol Swab Box ( 21,800)

284 Cat Gut Plain 3/0 HR 20 MM Pcs ( 36,585)

285 Cat Gut Chromic 3/0 HR 26 MM Pcs ( 33,645)

286 Cat Gut Chromic 3/0 HR 30 MM Pcs ( 22,844)

287 Cat Gut Chromic 3/0 HR 30 MM Pcs ( 35,015)

288 Cat Gut Chromic 3/0 HR 37 MM Pcs ( 34,170)

289 Foley Catheter 14 Pcs ( 11,990)

290 Foley Catheter 16 Pcs ( 11,990)

291 Foley Catheter 18 Pcs ( 11,990)

292 Foley Catheter 18 Pcs ( 12,501)

293 Hanscone Non Steril Kotak, 100 Pcs ( 499)
294 Hanscone Steril Kotak, 50 Pcs ( 4,100)

295 Hanscone Steril Ukuran 7 (Surgical Gloves Steril 7) Pcs ( 7,865)

296 Hanscone Steril Ukuran 7,5 (Surgical Gloves Steril 7,5) Pcs ( 7,865)

297 Infus Set Dewasa (Polyfusion Infus Set 20 drop/ml) Pcs ( 6,435)

298 infusion set anak Pcs ( 5,610)

299 infusion set anak Pcs ( 5,559)

300 Infusion Set Dewasa Pcs ( 6,142)

IV Canula with Injection Port, Snap Fit Cap Surutable Wings No
301 Pcs ( 12,078)
18
IV Canula with Injection Port, Snap Fit Cap Surutable Wings No
302 Pcs ( 13,458)
26
303 IV Chateter no.18 @ 50 bh Kotak, 50 Pcs ( 6,600)

304 IV Chateter no.20 @ 50 bh Kotak, 50 Pcs ( 7,785)

305 IV Chateter no.20 @ 50 bh Kotak, 50 Pcs ( 6,600)

306 IV Chateter no.22 @ 50 bh Kotak, 50 Pcs ( 7,785)

307 IV Chateter no.22 @ 50 bh Kotak, 50 Pcs ( 6,600)

308 IV Chateter no.24 @ 50 bh Kotak, 50 Pcs ( 7,785)

309 IV Chateter no.24 @ 50 bh Kotak, 50 Pcs ( 6,600)

310 Kapas 250 gr Roll ( 7,500)

311 Kapas 250 gr Roll ( 16,080)

312 Kapas 250 gr Roll ( 13,925)

313 Kapas 500 gr Roll ( 29,190)

314 Kapas 1000 gr Roll ( 37,700)

315 Kasa 2 x 80 cm Roll ( 9,516)

316 Kasa 2 x 80 cm Roll ( 7,530)

317 Kasa 4 x 15 cm Roll ( 2,688)

318 Kasa 4 x 15 cm Roll ( 2,092)

319 kasa steril 16 x 16 Roll ( 7,140)

320 kasa steril 16 x 16 Sacet ( 5,740)

321 kasa steril 40 x40 Roll ( 1,942)

322 kasa steril 40 x40 PCS 1532.5

323 Masker 20 pcs Kotak, 20 Pcs ( 1,125)

324 Masker Kotak, 20 Pcs ( 693)

325 Masker 20 pcs Kotak, 20 Pcs ( 2,100)

326 Pharmafix (Non Woven Dresing For Fixation Size 10 cm x 50 cm) Box ( 51,305)

327 Pharmafix (Non Woven Dresing For Fixation Size 5 cm x 50 cm) Box ( 27,000)

328 Plaster Roll ( 30,030)

329 Plester Roll 7,5 cm x 4,5 m ( Leukoplast) Roll ( 35,532)

330 Paper Tape /SCM x 9.14m roll 16077.5

331 Silk no 2/0 HR 30 MM dgn jarum Bedah Pcs ( 22,844)

332 Silk no 3/0 HR 30 MM dgn jarum Bedah Pcs ( 22,844)

333 Surgical Scrub 500 ml Botol 500 ml 91977.6

334 Stomach Tube 85 cm no 12 pcs 8033.3

335 Stomach Tube 85 cm no 14 pcs 8033.3

336 Stomach Tube 85 cm no 16 pcs 8033.3

337 Stomach Tube 85 cm no 18 pcs 8033.3

338 Urine Bag Pcs ( 6,105)

339 Urine Bag Pcs ( 4,000)

340 Urine Bag Tro-Urocol Plus Urine Bag Steril Pcs ( 8,070)

341 Eugenol cairan Botol, 100 ml ( 18,100)

TOTAL

UMUM BPJS LAIN-LAIN TOTAL KUNJUNGAN R/

KUNJUNGAN R/ Rawat Jalan : Rawat Jalan : Rawat Jalan : Rawat Jalan :

Rawat Inap : Rawat Inap : Rawat Inap : Rawat Inap :

Mengetahui : Gunung Sugih, ...................... 2017

Kepala Puskesmas ............................ Pengelola Obat Puskesmas

....................................... .......................................
NIP. NIP.