Oktober - Betul

Laporan Obat Kegiatan Ambugelu
Nopember 2015 di Alun-alun Besuki

( Laporan Penerimaan dan Laporan Pemakaian Obat )
Obat Yg Obat Yg
No Nama Obat SAT Sisa Obat Ket
Dibawa Dipakai
1 Alat Suntik sekali pakai 2,5 cc set 200 - 200
2 Aminophylline 200 tab 90 - 90
3 Amoxicillin 500 tab 285 - 285
4 Amoxicillin syr btl 4 - 4
5 Antalgin 500 tab - - 0
6 Antasida tab 247 - 247
7 Antasida syr btl 5 - 5
8 Asam Mefenamat 500 tab 232 - 232
9 Betametasone oint tube 10 - 10
10 Captopril 12,5 tab - - 0
11 Captopril 25 tab - - 0
12 Chloramphenikol Salep Mata tube 1 - 1
13 Chloramphenikol syr btl 5 - 5
14 Chlorpheniramine (CTM) tab 365 - 365
15 Cimetidine tab 180 - 180
16 Ciprofloxacin 500 mg tab 276 - 276
17 Cotrimoxazole syr btl 3 - 3
18 Dexametason inj amp 100 - 100
19 Dexamethasone tab 262 - 262
20 Diphenhidramin inj. amp 19 - 19
21 Gentian Violet btl 5 - 5
22 GG (gliseril guaiacolat) tab 780 - 780
23 Glibenklamid tab 90 - 90
24 Ibuprofen 400 tab 206 - 206
25 Ibuprofen syr btl 4 - 4
26 Ketokonazol krim tube 3 - 3
27 Loperamid 2 mg tab 84 - 84
28 Metronidazole 500 tab 83 - 83
29 Na Diklofenak 50 mg tab 100 - 100
30 OBH syr 100 ml btl 9 - 9
31 Oxytetracycline salep kulit tube 15 - 15
32 Oxytetracycline Salep Mata tube 5 - 5
33 Paracetamol 500 tab 364 - 364
34 Paracetamol syr btl 5 - 5
35 Ranitidine 150 mg tab 182 - 182
36 Salbutamol 4 mg tab 100 - 100
37 Salep 2-4 btl 4 - 4
38 Salycil Bedak 2% ktk 4 - 4
39 Vit. B12 inj amp 42 - 42
40 Vit.B Complex tab 370 - 370
41 Vit.B1 50 mg tab 700 - 700
42 Vit.B6 (pyridoxine) tab 1,000 - 1000
44 Zinc Tablet Diare tab 150 - 150
Penanggung Jawab Ambugelu
PURWANTO, S.Kep
LPLPO Obat Kegiatan BBM (Bermalam Bersama Masyarakat)
29/10/2015, Di Desa Tamansari
Obat Yg Obat Yg
Dibawa Dipakai
1 Alat Suntik sekali pakai 2,5 ml set 370 #VALUE! 170

2 Albendazole tab 400 mg tab 28 #VALUE! 28
3 Alkohol 70% 1000 ml btl 1 #VALUE! 1
4 Alopurinol 100 tab 94 #VALUE! 94
5 Ambroxol 30 mg tab 156 #VALUE! 56
6 Aminophylline inj. amp 30 #VALUE! 30
7 Amoxicillin 500 tab 729 #VALUE! 729
8 Amoxicillin syr btl 5 #VALUE! 5
9 Antalgin 500 tab 256 #VALUE! 6
10 Antasida tab 622 #VALUE! 622
11 Antibakteri DOEN salep tube 10 #VALUE! 10
12 Antifungi DOEN salep tube 10 #VALUE! 10
13 Antimigren (ergotamin-kofein) tab 100 #VALUE! 100
14 Asam Mefenamat 500 tab 281 #VALUE! 181
15 Betametasone oint tube 8 #VALUE! 8
16 Captopril 25 tab 240 #VALUE! 240
17 Chloramphenikol syr btl 5 #VALUE! 5
18 Chlorpheniramine (CTM) tab 532 #VALUE! 532
19 Cimetidine tab 200 #VALUE! 200
20 Cotrimoxazole paed 120mg tab 180 #VALUE! 180
21 Cotrimoxazole syr btl 8 #VALUE! 8
22 Cotrimoxazole 480mg tab 227 #VALUE! 227
23 Dexamethasone tab 324 #VALUE! 224
24 Dexamethasone inj. amp 191 #VALUE! 91
25 Diphenhydramine inj. amp 88 #VALUE! 88
26 Garam Oralit sase 300 #VALUE! 300
27 Gentamisin salep kulit tube 10 #VALUE! 10
28 Gentian Violet btl 9 #VALUE! 9
29 GG (gliseril guaiacolat) tab 900 #VALUE! 900
30 Glibenklamide 5 mg tab 80 #VALUE! 80
31 Griseofulvin tab 95 #VALUE! 95
32 HCT (hidrochlortiazid) tab 1,000 #VALUE! 1,000
33 Hydrocortisone oint tube 22 #VALUE! 22
34 Ibuprofen 400 tab 295 #VALUE! 95
35 Infus Set Anak (Paed) set 2 #VALUE! -
36 Infus Set Dewasa (Adult) set 2 #VALUE! -
37 Kalk (calcium laktat) tab 900 #VALUE! 900
38 Kapas Pembalut 250 gr rol 1 #VALUE! 1
39 Kasa Pembalut 4 x 15 / 4 x 10 rol 8 #VALUE! 8
40 Kasa Pembalut 4m x 3cm / 4 x 5 rol 16 #VALUE! 16
41 Ketokonazol krim tube 3 #VALUE! 3
Obat Yg Obat Yg
Dibawa Dipakai
42 Lidocaine Comp. Inj. amp 29 #VALUE! 29

43 Loperamid 2 mg tab 95 #VALUE! 95
44 Masker set 100 #VALUE! 100
45 Metoklopramid 10 mg tab 100 #VALUE! 100
46 Metronidazole 500 tab 490 #VALUE! 490
47 Na Diklofenak 50 mg tab 148 #VALUE! 48
48 Nifedipin 10 mg tab 100 #VALUE! 100
49 Oxytetracycline salep kulit tube 25 #VALUE! 25
50 Papaverin 40 mg tab 200 #VALUE! 200
51 Paracetamol syr btl 17 #VALUE! 17
52 Paracetamol 100 mg tab 160 #VALUE! 60
53 Paracetamol 500 tab 497 #VALUE! 497
54 Prednisone tab 184 #VALUE! 184
55 Ranitidine 150 mg tab 98 #VALUE! 98
56 Rivanol btl 1 #VALUE! 1
57 RL infus btl 5 #VALUE! 5
58 Salbutamol 4 mg tab 164 #VALUE! 164
59 Salycil Bedak 2% ktk 20 #VALUE! 20
60 Sarung Tangan Steril set - #VALUE! 0
61 Tetracycline 250 kaps - #VALUE! 1000
62 Vit.B Complex tab 1,200 #VALUE! 1200
63 Vit.B1 inj. amp - #VALUE! 30
64 Vit.B1 50 mg (Thiamin) tab 950 #VALUE! 950
65 Vit.B12 inj. (cyanocobalamin) amp 184 #VALUE! 184
66 Vit.B6 (pyridoxine) tab 1,100 #VALUE! 1100
67 Ephinefrin injeksi amp 30 #VALUE! 0
68 Yodium Povidon 30 ml btl 2 #VALUE! 2
69 Zinc Tablet Diare tab 200 #VALUE! 200
70 Loratadin tab - #VALUE! 0
71 Tiamfenicol 500mg tab 200 #VALUE! 200
72 Paracetamol drop btl 10 #VALUE! 10
Sumbermalang, 21 Oktober 2015
Kepala UPTD Puskesmas Sumbermalang
A M R O Z I, S.Kep.Ns
NIP. 19641008 198503 1 004
Laporan Obat Kegiatan Prolanis
Bulan September 2015
Obat Yg Obat Yg
Dibawa Dipakai
1 Acyclovir 400 tab 100 100
2 Allopurinol 400 tab 100 100
3 Ambroxol tab 100 100
4 Aminophillin tab 30 30
5 Amoxicillin 500 mg tab 163 163
6 Antalgin 500 tab 200 200
7 Antasida tab 186 186
8 Asam Mefenamat 500 tab 200 200
9 Attapulgit tab - -
10 Captopril 25 tab 165 165
11 Cimetidin tab 120 120
12 CTM tab 200 200
13 Diphenhydramin inj amp 30 30
14 Epinefrin inj. amp - -
15 GG (gliseril guaiacolat) tab 450 450

16 Glibenklamid tab tab 100 100
17 Griseofulvin tab 100 100
18 Ibuprofen 400 tab 200 200
19 Kalk tab 1,400 1,400
20 Loperamid tab 100 100
21 Paracetamol 500 tab 200 200
22 Piroksikam tab 280 280
23 Spet 2,5 cc / 3 cc tab 100 100
24 Vit.B Complex tab 400 400
25 Vit.B1 50 mg tab 1,000 1000
26 Vit.B12 inj. amp 168 168
27 Dexametason tab 100 100
Prednison tab 100 100
Salicyl Bedak ktk 4 4
Penanggung Jawab Kegiatan
AHMAD SUFYAN
Keterangan : '- Kegiatan dilaksanakan pada :

- Tanggal & Tempat : -
Sisa Obat
CARA PAKAI FILE OBAT INI :
1. Ubah Nama Tanggal & Bulan
2. Masukkan data "Stok Akhir Laporan bulan lalu" ke "stok awal" LPLPO Gudang, LPLPO Apotek, & LPLPO UGD
3. Hapus angka2 di Obat Keluar Gudang (kecuali angka di kolom kuning, karena itu rumus)
4. Hapus angka di Penerimaan LPLPO Gudang
5. Hapus angka di Pemakaian LPLPO Apotek
6. Hapus angka di Pemakaian LPLPO UGD
7. Lihat lagi Stok akhir di Print out LPLPO Gudang, Apotek & UGD bulan sebelumnya, cocokkan dengan angka-angk
8. Jika ada Obat datang dari GFK ato sumber lain, masukkan di kolom penerimaan LPLPO Gudang
9. Masukkan data pemakaian obat di Obat Keluar Gudang
10. Putihkan Angka di Pemakaian & Stok Akhir Print Apotek, setelah itu di cetak & diberikan ke petugas apotek untuk d
11. Putihkan Angka di Pemakaian & Stok Akhir Print UGD setelah itu di cetak & diberikan ke petugas UGD untuk diker
12. Masukkan data pemakaian obat dari petugas apotek ke Pemakaian di LPLPO Apotek, maka otomatis Pemakaian
13. Masukkan data pemakaian obat dari petugas UGD ke Pemakaian di LPLPO UGD, maka otomatis Pemakaian & S
14. Ubah Angka2 di Pemakaian Rata-rata LKO
15. Ubah bulan & Tahun
16. Laporan Obat pun siap di cetak, karena sdh otomatis terisi semua.
17. Cetak LPLPO Baru, LKO, Lap. Ob generik, Lap. Ob Generik (2).
18. Jika diinginkan Neraca Obat juga bisa dicetak, tapi revisilah dahulu daftar harga & kemasan
O Apotek, & LPLPO UGD
ocokkan dengan angka-angka stok awal yang ada di Komputer anda, klo gak sama, ubah, samakan dg print out
an ke petugas apotek untuk dikerjakan, lalu hitamkan lagi angka tersebut setelah dicetak.
ke petugas UGD untuk dikerjakan, lalu hitamkan lagi angka tersebut setelah dicetak.
k, maka otomatis Pemakaian & Stok Akhir di Print Apotek akan terisi
aka otomatis Pemakaian & Stok Akhir di Print UGD akan terisi
OBAT KELUAR GUDANG
Bulan Oktober 2015
Ke BP/ KIA / BPG / Laborat / Expired / Kembali ke

Ke Apotek Ke UGD / Perawatan Pustu / Ponkesdes
No SAT GFK
DAK DAU Askes JKN Lain2 DAK DAU Askes JKN Lain2 DAK DAU Askes JKN Lain2 Total DAK DAU Askes JKN
A OBAT - OBATAN -
1 Air untuk injeksi ampul 25 ml btl 12 6 6
2 Albendazol suspensi 200 mg/5 ml btl -
3 Albendazol tablet 400 mg Tab -
4 Alopurinol tablet 100 mg Tab - 100
5 Alopurinol tablet 300 mg tab -
6 Alprazolam tablet 0,25 mg tab -
8 Alprazolam tablet 1 mg tab -
9 Ambroxol sirup 15 mg/ml btl -
11 Ambroxol tablet 30 mg Tab 100 - 400
12 Aminofilin injeksi 24 mg/ml Amp 30 30
13 Aminofilin tablet 150 mg tab -
14 Aminofilin tablet 200 mg Tab 300 100 - 300
15 Amitriptilin tablet salut 25 mg (HCl) Tab -
16 Amlodipin tablet 10 mg tab -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab -
19 Amoksisilin kapsul/kaplet 250 mg Kaps -
20 Amoksisilin kapsul/kaplet 500 mg Tab 600 - 1,400
21 Amoksisilin serbuk injeksi 1000 mg vial -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 20 - 60
23 Amoxsan tab 500 mg tab -
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial -
27 Antasida DOEN I tablet kunyah, kombinasi : Aluminium

Hidroksida 200 mg Magnesium Hidroksida 200 mg Tab 200 100 - 900
Antasida DOEN II suspensi, kombi : Aluminium
28 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
mg/5 ml Btl 5 - 40
Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g
29 + Polimiksin 10.000 IU/g Tube -
Antifungi DOEN Kombinasi: Asam Benzoat 6% + Asam
30 Salisilat 3% pot - 10
Antihemoroid DOEN kombinasi : Bismut subgalat 150
31 mg Heksaklorofen 2,5 mg Supp - 10
Antimalaria DOEN kombinasi : Pirimetamin tablet 25
32 mg Sulfadoksin tablet 500 mg tab -
Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50
33 mg Tab - 100
34 Antrain inj amp -
35 Aqua pro Injeksi steril, bebas pirogen Amp -
36 Artemether injeksi 80 mg/ml amp -
37 Artesunate injeksi, vial 60 mg vial -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab -
41 Asam Askorbat (Vitamin C) tablet 100 mg tab -
43 Asam Folat tablet 1 mg tab -
44 Asam Mefenamat kapsul/kaplet 250 mg tab -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 100 300 - 200
47 Asiklovir krim 5% Tube - 10
48 Asiklovir tablet 200 mg Tab -
49 Asiklovir tablet 400 mg tab -
51 Atapulgit tablet 600 mg tab -
52 Atenolol tablet 100 mg tab -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp -
55 Atropin Sulfat tablet 0,5 mg tab -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial -
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
58 (tablet tambah darah kombinasi ) tab -
59 Betahistin Mesilat tablet 6 mg tab -
60 Betametason krim 0,1 % (sebagai Valerat) Tube -
61 Bioplacenton tube -
62 Bisakodil suppositoria 10 mg supp -
63 Bisoprolol tablet 5 mg tab -
64 Bromheksin tablet 8 mg tab -
65 Buscopan inj amp -
66 Cetirizin sirup 5 mg/5 ml btl -
67 Cetirizine tablet 10 mg tab -
68 Clobazam tablet 10 mg tab -
69 Clobetasol krim 0,05% tube -
70 Dapson tablet 100 mg tab -
71 Deksametason injeksi i.v. 5 mg/ml Amp -
72 Deksametason injeksi i.v. 5 mg/ml amp -
73 Deksametason tablet 0,5 mg Tab 500 - 200 - - - 900 -
74 Dekstran 70 - larutan infus 6% steril btl -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl -
76 Dekstrometorfan tablet 15 mg (HBr) tab -
78 Diazepam injeksi 5 mg/ml Amp 3 -
79 Diazepam tablet 2 mg Tab -
81 Dietilkarbamazin Sitrat tablet 100 mg tab -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 30 - 150
83 Digoksin tablet 0,25 mg Tab -
84 Diltiazem HCl tablet 30 mg tab -
85 Dimenhidrinat tablet 50 mg tab -
86 Doksisiklin kapsul/kaplet 100 mg kaps -
87 Domperidon suspensi 5 mg/5 ml btl -
88 Domperidon tablet 10 mg Tab -
89 Efedrin tablet 25 mg (HCl) tab -
90 Ekstraks Belladona tablet 10 mg Tab -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp -
92 Eritromisin kapsul/kaplet 250 mg kaps -
94 Eritromisin sirup 200 mg/ 5 ml Btl -
95 Etakridin larutan 0,1% (Rivanol) Btl -
96 Etambutol tablet 250 mg (HCl) tab -
97 Etambutol tablet salut 500 mg (HCl) tab -
98 Etanol 70% cairan ( 30 ml ) btl -
99 Famotidine tablet 20 mg tab -
101 Fenilbutason tablet 200 mg tab -
102 Fenitoin kapsul/kaplet 100 mg kaps -
103 Fenitoin Natrium injeksi 50 mg/ml amp -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp -
106 Fenobarbital tablet 100 mg tab -
108 Fenoksimetil Penisilin tablet 250 mg tab -
110 Fenol Gliserol tetes telinga 10% Btl -
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 100 -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp -
113 Flukonazol tablet 150 mg tab -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp -
115 Furosemid tablet 40 mg Tab -
116 Garam Oralit I serbuk Sac 100 - 200
117 Gemfibrozil kapsul/kaplet 300 mg kaps -
118 Gemfibrozil tablet 600 mg tab -
119 Gentamisin injeksi 40 mg/ ml amp -
120 Gentamisin salep kulit 0.1% tube 10 - 10
121 Gentamisin Sulfat tetes mata 0,3 % btl -
122 Gentian Violet larutan 1 % Btl 7 - 15
123 Glibenklamida tablet 5 mg Tab -
124 Glimepiride tablet 1 mg tab -
129 Gliquidon tablet 30 mg tab -
130 Gliseril Gualakolat tablet 100 mg Tab - 1,000
131 Gliserin btl -
132 Glukosa larutan infus 10 % steril Btl -
134 Glukosa larutan infus 5 % steril Btl - 5
135 Griseofulvin tablet 125 mg Tab - 100
136 Haloperidol inj 50 mg/mL amp -
137 Haloperidol tablet 0,5 mg tab -
139 Haloperidol tablet 5 mg tab -
140 HCT 25 mg (Hidroklortiazid) Tab -
141 Hidrokortison krim 1% tube -
142 Hidrokortison krim 2,5 % Tube 5 - 59
143 Hyoscine -N-Butilbromide tablet 10 mg tab -
144 Ibuprofen suspensi 100 mg/5 ml btl -
146 Ibuprofen tablet 200 mg Tab 100 -
147 Ibuprofen tablet 200 mg tab -
148 Ibuprofen tablet 400 mg Tab 200 - 600
150 Iodiol kapsul lunak kaps -
151 Isoniazid tablet 100 mg Tab -
152 Isoniazid tablet 300 mg tab -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab -
154 Itrakonazol kapsul/kaplet 100 mg kaps -
155 Kalium Diklofenak tablet 25 mg tab -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab -
158 Kaptopril tablet 12,5 mg Tab -
159 Kaptopril tablet 25 mg Tab - 600
160 Kaptopril tablet 50 mg tab -
161 Karbamazepin tablet 200 mg Tab -
162 Ketokonazol krim 2% tube -
163 Ketokonazol tablet 200 mg Tab - 100
164 Ketoprofen injeksi 100 mg amp -
165 Ketoprofen tablet 100 mg tab -
166 Ketorolac injeksi 10 mg amp -
168 Klindamisin kapsul/kaplet 150 mg kaps -
169 Klindamisin kapsul/kaplet 300 mg kaps 50 -
170 Klomifen tablet 50 mg tab -
171 Klonidin tablet 0,15 mg tab -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps -
174 Kloramfenikol salep mata 1 % Tube -
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl - 5
176 Kloramfenikol suspensi 125 mg/ 5 ml btl -
177 Kloramfenicol tetes mata 0,5% Btl -
178 Kloramfenikol tetes telinga 3 % btl 5 -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 300 - 2,300
180 Klorokuin tablet 250 mg tab -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp -
183 Klorpromazin tablet salut 100 mg (HCl) tab -
184 Klorpromazin tablet salut 25 mg (HCl) Tab 30 30
185 Kodein tablet 10 mg tab -
Kotrimoksazol DOEN I (dewasa) kombinasi :
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab - 300
Kotrimoksazol DOEN II (pediatrik) kombinasi :
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab - 320 680
Kotrimoksazol Suspensi komb: Sulfametoksazol 200
190 mg + Trimetoprim 40 mg / 5 ml Btl 8 170 170
191 Kuinin (Kina) tablet 200 mg tab -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp -
194 Lacto B sase -
195 Lamivudine tablet 150 mg tab -
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109
196 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) btl -
Larutan mengandung Elektrolit (NaCl 1.125 gr,
197 Dekstrosa 18.75 gr) (KAEN 1B) btl -
Larutan mengandung Karbohidrat + Elektrolit (Nacl
1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr)
198 (KAEN 3B) btl -

2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr)
199 (KAEN 3A) btl -
200 Lanzoprazol kapsul/kaplet 30 mg tab -
201 Levofloksasin tablet 500 mg tab -
203 Lidokain injeksi 2% amp -
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml
205 ( Lidokain Comp. Inj ) Amp - 90
206 Lidokain jeli 2% pot -
207 Linkomisin kapsul/kaplet 500 mg kaps -
208 Lisinopril tablet 10 mg tab -
210 Loperamid tablet 2 mg tab - 100
211 Loratadin tablet 10 mg tab -
212 Lorazepam tablet 2 mg tab -
213 Lytacur btl -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial -
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp -
216 Mebendazol sirup 100 mg / 5 ml btl -
217 Mebendazol tablet 100 mg tab -
218 Meloksikam suppositoria supp -
219 Meloksikam tablet 15 mg tab -
220 Meloksikam tablet 7,5 mg tab -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp -
222 Metampiron injeksi 250 mg (Antalgin) Amp -
223 Metampiron injeksi 250 mg amp -
224 Metampiron tablet 500 mg (Antalgin) Tab 400 200 - 1,300
225 Metampiron tablet 500 mg tab -
226 Metformin HCl tablet 500 mg tab -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 2 -
Metilergometrin Maleat (Metilergometrin) tablet salut
Tab
229 0,125 mg - 100
230 Metilprednisolon injeksi 500 mg amp -
231 Metilprednisolon tablet 16 mg tab -
234 Metoklopramide injeksi 5 mg/ml amp -
235 Metoklopramide sirup 5 mg/ 5 ml btl -
236 Metoklopramide tablet 10 mg Tab - 100
237 Metoklopramide tablet 5 mg tab -
238 Metronidazol infus 500 mg/100 ml btl -
239 Metronidazol tablet 250 mg Tab -
240 Metronidazol tablet 500 mg Tab 200 100 - 400
241 Metronidazol tablet 500 mg tab -
242 Mikonazol krim/salep 2 % (Nitrat) tube -
243 Mineral Mix, kombinasi sase -
244 Momethason krim 0,1 % tube -
246 Morfin injeksi 10 mg/ml amp -
247 Morfin tablet 10 mg tab -
248 Natrium Diklofenak tablet 25 mg Tab -
249 Natrium Diklofenak tablet 50 mg Tab 50 - 500
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl -
251 Neurobion 5000 injeksi amp -
252 Nevirapin tablet 200 mg tab -
253 Nifedipin tablet 10 mg tab - 100
254 Nistatin tablet salut 500.000 IU/ g Tab - 100
255 Nistatin vaginal tablet 100.000 IU/ g supp -
256 Norages inj amp 30 -
257 Obat Antituberkulosis FDC Kategori 1 pak -
259 Obat Antituberkulosis FDC Kategori Anak pak -
260 Obat Antituberkulosis FDC Sisipan pak -
261 Obat Antituberkulosis Kategori 1 dewasa pak -
262 Obat Antituberkulosis Kategori anak pak -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl - 10
264 Obat Batuk Hitam ( O.B.H. ) cairan btl -
265 Ofloxacin tablet 200 mg tab -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp -
268 Oksitetrasiklin HCl salep mata 1 % Tube 5 5 - 12
269 Oksitetrasiklin salep kulit 3% Tube - 50
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp -
271 Omeprazol kapsul/kaplet 20 mg kaps -
272 Oseltamivir kapsul/kaplet 75 mg kaps -
273 Papaverin injeksi 40 mg/ml amp -
274 Papaverin tablet 40 mg Tab -
275 Parasetamol drops btl 3 -
276 Parasetamol sirup 120 mg / 5 ml Btl 18 - 114
277 Parasetamol tablet 100 mg Tab - 100
278 Parasetamol tablet 500 mg Tab 500 - 1,100
279 Perfenazin tablet 4 mg (HCl) tab -
280 Permetrin krim 5% tube -
281 Petidin injeksi 50 mg/ml amp -
282 Piracetam injeksi 1 g/5 ml amp -
285 Piracetam tablet 1200 mg tab -
288 Pirantel sirup 125 mg/5 ml btl -
289 Pirantel tablet score (base) 125 mg Tab -
290 Pirazinamid tablet 500 mg tab -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab -
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps - 100
294 Povidon Iodida larutan 10% btl -
295 Povidon Iodida larutan 10% 30mL Btl - 1
296 Povidon Iodida larutan 10% 300 mL Btl -
298 Pravastatin tablet 20 mg tab -
299 Prednison tablet 5 mg Tab - 100
300 Primakuin tablet 15 mg tab -
301 Primperan inj amp -
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial -
303 Propanolol tablet 10 mg ( HCl ) tab -
304 Propanolol tablet 40 mg (HCl) tab -
305 Propiltiourasil tablet 100 mg (PTU) Tab -
306 Ramipril tablet 2,5 mg tab -
307 Ramipril tablet 5 mg tab -
308 Ranitidin injeksi 25 mg/2 ml amp 25 -
309 Ranitidin tablet 150 mg Tab 200 - 388
310 Ranitidin tablet 150 mg tab -
311 Reserpin tablet 0,10 mg tab -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps -
315 Rifampisin kapsul/kaplet 300 mg kapl -
317 Rifampisin tablet salut 450 mg kapl -
318 Ringer Laktat larutan infus (RL) Btl -
319 Risperidon tablet 1 mg tab -
322 SABU I Vial 1 1
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab - 300
Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang
325 endap 4% Pot -
326 Salisil Bedak 2 % Ktk - 10
327 Salisil Bedak 2 % ktk -
328 Sanmol syr btl -
329 Sanmol tab tab -
330 Sefadroksil kapsul/kaplet 250 mg kaps -
331 Sefadroksil kapsul/kaplet 500 mg tab -
332 Sefadroksil kapsul/kaplet 500 mg kaps 100 -
333 Sefadroksil sirup kering 125 mg/5ml btl -
334 Sefaleksin kapsul/kaplet 250 mg kaps -
336 Sefazolin injeksi 1 g amp -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab -
338 Sefiksim kapsul/kaplet 100 mg kaps -
339 Sefiksim sirup kering 100 mg/ 5 ml btl -
340 Sefotaksim injeksi 0,5 g amp -
341 Sefotaksim injeksi 1 g vial -
342 Seftazidim injeksi 1 g amp -
343 Seftriakson injeksi 1 g vial -
344 Seftriakson injeksi 1 g amp -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp 3 3
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp - 100
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab -
348 Simetidin tablet 200 mg Tab - 100
349 Simvastatin tablet 10 mg Tab 30 -
350 Simvastatin tablet 20 mg tab -
352 Siprofloksasin infus 2% btl -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 200 - 400
355 Spasminal tab tab -
356 Spiramisin tablet 500 mg tab -
357 Spironolakton tablet 100 mg tab -
359 Stavudin tablet 30 mg tab -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl -
361 Sulfasalazin tablet 500 mg tab -
362 Sulfasetamida Natrium tetes mata 15 % Btl -
363 Syntosinon inj amp -
364 Tamoksifen tablet 20 mg tab -
365 Tetrakain HCl tetes mata 0,5% btl -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps -
367 Tetrasiklin kapsul/kaplet 500 mg Kaps -
368 Tiamfenikol kapsul/kaplet 250 mg kaps -
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab - 2,000
371 Tiamin (Vitamin B1) 100 mg tablet tab -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 60 60
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp -
374 Tramadol injeksi 50 mg/ml amp -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps -
377 Transamin tab tab -
378 Trifluoperazin tablet 5 mg tab -
379 Triheksifenidil tablet 2 mg Tab -
380 Ulsikur inj amp -
381 Valdimex Injeksi 5mg/ml (i.v.) amp -
382 Valdimex tablet 5 mg tab -
383 Verapamil tablet 80 mg (HCl) tab -
384 Vicillin 1gr inj vial 20 -
385 Vitamin B Kompleks tablet Tab - 2,000
386 Zidovudin tablet 100 mg tab -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab -

388 Zinc drop 10 mg/mL btl -
389 Zinc tablet 20 mg tab - 500
-
B PERBEKALAN KESEHATAN -
1 Alat suntik sekali pakai 1 ml set -
2 Alat suntik sekali pakai 2,5 ml set 200 - 700
5 Catgut/benang bedah no.2/0 dengan jarum bedah set -
7 Infusion set anak Set 45 -
8 Infusion set dewasa Set 50 -
9 IV Catheter No. 20 G Set -
10 IV Catheter No. 22 G Set 50 -
12 Kapas Berlemak 500 gram Bks -
13 Kapas Pembalut / Absorben 250 gram Bks 1 - 3
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk -
15 Kasa Hidrofil uk. 36 m x 80 cm rol -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - 20
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 50 - 30
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol -
20 Kasa Pembalut Elastic 4 inchi rol -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol -
22 Kasa Pembalut Elastic 10 cm x 4,5m rol -
23 Pembalut Gips 3 ichi Rol -
24 Plester 5 yards x 2 inch Rol 2 -
Silk (Benang Bedah Sutera) No. 3/0 dengan jarum
25 bedah Sac - 36
26 Ultrafix 5x5 rol -
27 Urine Bag Set -
28 Foley Catheter set -
29 Handscoon (Sarung Tangan Steril) Set 210 90 -
30 Masker set 50 -
-
C OBAT GIGI -
1 Etil Klorida spray btl -
2 Eugenol cairan btl -
3 Formokresol cairan btl -
4 Glass Ionomer Cement ART btl -
5 Gutta Percha dan Paper points 15-40 mm btl -
7 Kalsium Hidroksida Pasta btl -
8 Klorfenol kamfer Menthol ( CHKM ) btl -
9 Komposit resin btl -
10 Devitalisasi Pasta (Non Arsen) btl -
11 Mummifying Pasta btl -
12 Semen Seng Fosfat serbuk dan cairan btl -
Temporary Stopping Fletcher (Fletcher) serbuk dan
13 cairan btl -
-
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN -
1 Alinamin F tablet tab -
2 Antiparkinson DOEN Tab Komb Tab -
3 Combifen syr btl -
4 Coparcetin tab 200 -
5 Dexanta tablet tab -
6 Etafen syr btl -
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl -
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl - 3
8 Farizol tablet tab -
9 Fe Sirup btl 1 1
Gastrusid sirup btl 10
10 Grafadon tab -
11 H2O2 3% 800 cc btl 1 -
12 Helixim syr btl -
13 Histigo tablet tab -
15 Kalium Permanganat Serbuk Pot -
16 Lexapram tablet tab -
Lostacef tab -
17 Mes / Pisau bh -
18 Mirasic syr btl -
19 Molacort tab 200 -
20 Neurosanbe inj. amp 20 -
Novabion tab 100 -
21 Novaflox tab -
22 Novalgin injeksi amp -
23 Novamog tab -
24 Novaxifen tab -
25 Pimtracol syr btl -
26 Sarung Tangan Obgyn set -
27 Scopamin Inj box -
28 Stesolid supp. tube -
29 Sufratul lbr -
30 Tidifar tab -
31 Transamin inj. amp -
Trifaneuro tab 100 -
32 Trolit sase -
33 Urocare Set -
34 Vixal syr btl -
Pustu / Ponkesdes Kegiatan Luar Gedung Jumlah Keluar Total
Keluar
Lain2 Total DAK DAU Askes JKN Lain2 Total DAK DAU Askes JKN Lain2
-
- - 18 - - - - 18
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
400 - 500 - - - - 500
- - 30 - - - - 30
- - - - - - - -
300 10 10 710 - - - - 710
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
1,400 - 2,000 - - - - 2,000
- - - - - - - -
60 - 80 - - - - 80
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
900 66 66 1,266 - - - - 1,266
40 - 45 - - - - 45
- - - - - - - -
10 - 10 - - - - 10
10 - 10 - - - - 10
- - - - - - - -
100 - 100 - - - - 100

- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
200 38 38 638 - - - - 638
- - - - - - - -
10 - 10 - - - - 10
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
900 - - 1,600 - - - - 1,600
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 3 - - - - 3
- - - - - - - -
- - - - - - - -
- - - - - - - -
150 - 180 - - - - 180
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 100 - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
200 - 300 - - - - 300
- - - - - - - -
- - - - - - - -
- - - - - - - -
10 - 20 - - - - 20
- - - - - - - -
15 5 5 27 - - - - 27
- 10 10 10 - - - - 10
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
1,000 20 20 1,020 - - - - 1,020
- - - - - - - -
- - - - - - - -
- - - - - - - -
5 - - - 5 - - 5
100 - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
59 - 64 - - - - 64
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 100 - - - - 100
- - - - - - - -
600 39 39 839 - - - - 839
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 20 20 20 - - - - 20
600 65 65 665 - - - - 665
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 50 - - - - 50
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
5 - - - 5 - - 5
- - - - - - - -
- - - - - - - -
- - 5 - - - - 5
2,300 - 2,600 - - - - 2,600
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 30 - - - 30
- - - - - - - -
- - - - - - - -
- - - - - - - -
300 - 300 - - - - 300
1,000 - 320 680 - - - 1,000

- 1 1 179 - - - - 179
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
90 - - - 90 - - 90
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 6 6 106 - - - - 106
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
1,300 180 180 2,080 - - - - 2,080
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 2 - - - - 2
100 - 100 - - - - 100

- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
400 - 700 - - - - 700
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
500 - 550 - - - - 550
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
100 - 100 - - - - 100
- - - - - - - -
- - - - - 30 - 30
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
10 1 1 11 - - - - 11
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
12 - 22 - - - - 22
50 2 2 52 - - - - 52
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 3 - - - - 3
114 - 132 - - - - 132
100 - 100 - - - - 100
1,100 36 36 1,636 - - - - 1,636
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
- - - - - - - -
1 - 1 - - - - 1
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 25 - 25
388 - 200 - 388 - - 588
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 1 - - - 1
- - - - - - - -
300 - 300 - - - - 300
- - - - - - - -
10 - 10 - - - - 10
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 100 - - - - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 3 - - - 3
100 - 100 - - - - 100
- - - - - - - -
100 - 100 - - - - 100
- - 30 - - - - 30
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
400 10 10 610 - - - - 610
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
2,000 100 100 2,100 - - - - 2,100
- - - - - - - -
- - 60 - - - - 60
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 20 - 20
2,000 30 30 2,030 - - - - 2,030
- - - - - - - -
- - - - - - - -
- - - - - - - -
500 - 500 - - - - 500
- - - - - - - -
- - - - - - - -
- - - - - - - -
700 - 900 - - - - 900
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 45 - - - - 45
- - 50 - - - - 50
- - - - - - - -
- - 50 - - - - 50
- - - - - - - -
- - - - - - - -
3 - - - - 4 - 4
- - - - - - - -
- - - - - - - -
- - - - - - - -
20 - 20 - - - - 20
30 - 80 - - - - 80
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 2 - - - - 2
36 - 36 - - - - 36
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 210 - - 90 - 300
- - 50 - - - - 50
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 200 - 200
- - - - - - - -
- - - - - - - -
- - - - - - - -
3 - - - - 3 - 3
- - - - - - - -
- - - 1 - - - 1
- -
- - - - - - - -
- - - 1 - - - 1
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 200 - 200
- - - - - 20 - 20
- - - - - 100 - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 100 - 100
- - - - - - - -
- - - - - - - -
- - - - - - - -
LAPORAN PERPETUAL BARANG PERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS
KABUPATEN SITUBONDO
TAHUN 2015
PUSKESMAS : SUMBERMALANG
BULAN : OKTOBER
SALDO AWAL MUTASI MASUK MUTASI KELUAR SALDO

NO NAMA BARANG
Harga Satuan Harga Harga
unit/bh/set Jumlah TGL unit/bh/set Jumlah TGL unit/bh/set Jumlah unit/bh/set
(Rp) Satuan (Rp) Satuan (Rp)
A OBAT - OBATAN 1
1 Air untuk injeksi ampul 25 ml 60 btl 3,509.00 210,540 - btl - 60 btl
1 12 3,509 42,108 48 btl
31 6 3,509 21,054 42 btl
60 btl 3,509.00 210,540 - btl - 18 btl 3,509 63,162 42 btl
3 Albendazol tablet 400 mg 628 Tab 344.00 216,032 - tab - - tab 344.00 - 628 tab
628 Tab 344.00 216,032 - tab - - tab 344.00 - 628 tab
4 Alopurinol tablet 100 mg 3,463 Tab 86.00 297,818 - tab - 3,463 tab
24 100 tab 86.00 8,600 3,363 tab
3,463 Tab 86.00 297,818 - tab - 100 tab 86.00 8,600 3,363 tab
11 Ambroxol tablet 30 mg 3,916 Tab 126.50 495,374 - tab - 3,916 tab
7 100 tab 126.50 12,650 3,816 tab
2 100 tab 126.50 12,650 3,716 tab
6 200 tab 126.50 25,300 3,516 tab
24 100 tab 126.50 12,650 3,416 tab
3,916 Tab 126.50 495,374 - tab - 500 tab 126.50 63,250 3,416 tab
12 Aminofilin injeksi 24 mg/ml 450 Amp 3,822.00 1,719,900 - amp - 450 amp
31 30 3,822.00 114,660 420 amp
450 Amp 3,822.00 1,719,900 - amp - 30 amp 3,822.00 114,660 420 amp
14 Aminofilin tablet 200 mg 3,885 Tab 80.00 310,800 - tab - 3,885 tab
7 300 tab 80.00 24,000 3,585 tab
1 100 tab 80.00 8,000 3,485 tab
6 100 tab 80.00 8,000 3,385 tab
18 10 tab 80.00 800 3,375 tab
24 100 tab 80.00 8,000 3,275 tab
24 100 tab 80.00 8,000 3,175 tab
3,885 Tab 80.00 310,800 - tab - 710 tab 80.00 56,800 3,175 tab
20 Amoksisilin kapsul/kaplet 500 mg 16,647 Tab 261.00 4,344,867 - kapl - 16,647 kapl
7 600 kapl 261.00 156,600 16,047 kapl
2 200 kapl 261.00 52,200 15,847 kapl
6 300 kapl 261.00 78,300 15,547 kapl
20 100 kapl 261.00 26,100 15,447 kapl
24 400 kapl 261.00 104,400 15,047 kapl
24 200 kapl 261.00 52,200 14,847 kapl
24 200 kapl 261.00 52,200 14,647 kapl
16,647 Tab 261.00 4,344,867 - kapl - 2,000 kapl 261.00 522,000 14,647 kapl
22 Amoksisilin sirup kering 125 mg/ 5 ml 792 Btl 2,445.00 1,936,440 - btl - 792 btl
7 20 btl 2,445.00 48,900 772 btl
2 10 btl 2,445.00 24,450 762 btl
NO NAMA BARANG
20 50 btl 2,445.00 122,250 712 btl
792 Btl 2,445.00 1,936,440 - btl - 80 btl 2,445.00 195,600 712 btl
23 Amoxsan tab 500 mg 400 tab 3,161.00 1,264,400 - kaps - - kaps 3,161.00 - 400 kaps
400 tab 3,161.00 1,264,400 - kaps - - kaps 3,161.00 - 400 kaps
Antasida DOEN I tablet kunyah, kombinasi :
27 Aluminium Hidroksida 200 mg Magnesium tab - 7,252 tab
Hidroksida 200 mg 7,252 Tab 72.00 522,144 -
7 200 tab 72.00 14,400 7,052 tab
1 100 tab 72.00 7,200 6,952 tab
2 100 tab 72.00 7,200 6,852 tab
6 200 tab 72.00 14,400 6,652 tab
24 200 tab 72.00 14,400 6,452 tab
24 200 tab 72.00 14,400 6,252 tab
24 200 tab 72.00 14,400 6,052 tab
18 66 tab 72.00 4,752 5,986 tab
7,252 Tab 72.00 522,144 - tab - 1,266 tab 72.00 91,152 5,986 tab
Antasida DOEN II suspensi, kombi :
28 Aluminium Hidroksida 200 mg/5 ml Btl btl - 423 btl
Magnesium Hidroksida 200 mg/5 ml 423 2,160.00 913,680 -
1 5 btl 2,160.00 10,800 418 btl
2 10 btl 2,160.00 21,600 408 btl
24 10 btl 2,160.00 21,600 398 btl
24 20 btl 2,160.00 43,200 378 btl
423 Btl 2,160.00 913,680 - btl - 45 btl 2,160.00 97,200 378 btl
2,516.00
29 Anti Bakteri DOEN salep kombinasi: tube tube tube
Basitrasin 500 IU/g + Polimiksin 10.000 IU/g 539 Tube 2,516.00 1,356,124 - - - - 539
539 Tube 2,516.00 1,356,124 - tube - - tube 2,516.00 - 539 tube
Antifungi DOEN Kombinasi: Asam Benzoat
30 6% + Asam Salisilat 3% 151 pot 1,904.00 287,504 - pot - 151 pot
2 10 pot 1,904.00 19,040 141 pot
151 pot 1,904.00 287,504 - pot - 10 pot 1,904.00 19,040 141 pot
Antihemoroid DOEN kombinasi : Bismut
31 subgalat 150 mg Heksaklorofen 2,5 mg 60 Supp 2,450.00 147,000 - supp - 60 supp
2 10 supp 2,450.00 24,500 50 supp
60 Supp 2,450.00 147,000 - supp - 10 supp 2,450.00 24,500 50 supp
Antimigren tablet: Ergotamin Tartrat 1 mg +
33 Kofein 50 mg 2,200 Tab 123.00 270,600 - tab - 2,200 tab
2 100 tab 123.00 12,300 2,100 tab
2,200 Tab 123.00 270,600 - tab - 100 tab 123.00 12,300 2,100 tab
45 Asam Mefenamat kapsul/kaplet 500 mg 1,822 Tab 112.00 204,064 - tab - 1,822 tab
7 100 tab 112.00 11,200 1,722 tab
1 300 tab 112.00 33,600 1,422 tab
6 100 tab 112.00 11,200 1,322 tab
20 100 tab 112.00 11,200 1,222 tab
18 38 tab 112.00 4,256 1,184 tab
1,822 Tab 112.00 204,064 - tab - 638 tab 112.00 71,456 1,184 tab
47 Asiklovir krim 5% 162 Tube 3,150.00 510,300 - tube - 162 tube
24 10 tube 3,150.00 31,500 152 tube
162 Tube 3,150.00 510,300 - tube - 10 tube 3,150.00 31,500 152 tube
48 Asiklovir tablet 200 mg 50 Tab 237.00 11,850 - tab - - tab 237.00 - 50 tab
NO NAMA BARANG
50 Tab 237.00 11,850 - tab - - tab 237.00 - 50 tab
49 Asiklovir tablet 400 mg 1,050 tab 336.00 352,800 - tab - - tab 336.00 - 1,050 tab
1,050 tab 336.00 352,800 - tab - - tab 336.00 - 1,050 tab
60 Betametason krim 0,1 % (sebagai Valerat) 51 Tube 1,520.00 77,520 - tube - - tube 1,520.00 - 51 tube
51 Tube 1,520.00 77,520 - tube - - tube 1,520.00 - 51 tube
61 Bioplacenton 1 tube 12,650.00 12,650 - tube - - tube 12,650.00 - 1 tube
1 tube 12,650.00 12,650 - tube - - tube 12,650.00 - 1 tube
65 Buscopan inj 18 amp 21,758.00 391,644 - amp - - amp 21,758.00 - 18 amp
18 amp 21,758.00 391,644 - amp - - amp 21,758.00 - 18 amp
67 Cetirizine tablet 10 mg 50 tab 313.50 15,675 - tab - - tab 313.50 - 50 tab
50 tab 313.50 15,675 - tab - - tab 313.50 - 50 tab
71 Deksametason injeksi i.v. 5 mg/ml 1,300 Amp 1,580.00 2,054,000 - amp - - amp 1,580.00 - 1,300 amp
1,300 Amp 1,580.00 2,054,000 - amp - - amp 1,580.00 - 1,300 amp
73 Deksametason tablet 0,5 mg 4,958 Tab 62.00 307,396 - tab - 4,958 tab
7 500 tab 62.00 31,000 4,458 tab
1 200 tab 62.00 12,400 4,258 tab
2 100 tab 62.00 6,200 4,158 tab
6 200 tab 62.00 12,400 3,958 tab
24 200 tab 62.00 12,400 3,758 tab
24 200 tab 62.00 12,400 3,558 tab
24 200 tab 62.00 12,400 3,358 tab
4,958 Tab 62.00 307,396 - tab - 1,600 tab 62.00 99,200 3,358 tab
78 Diazepam injeksi 5 mg/ml 241 Amp 2,344.00 564,904 - amp - 241 amp
1 3 amp 2,344.00 7,032 238 amp
241 Amp 2,344.00 564,904 - amp - 3 amp 2,344.00 7,032 238 amp
79 Diazepam tablet 2 mg 1,152 Tab 35.00 40,320 - tab - - tab 35.00 - 1,152 tab
1,152 Tab 35.00 40,320 - tab - - tab 35.00 - 1,152 tab
80 Diazepam tablet 5 mg 250 Tab 56.00 14,000 - tab - - tab 56.00 - 250 tab
250 Tab 56.00 14,000 - tab - - tab 56.00 - 250 tab
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) 1,091 Amp 1,050.00 1,145,550 - amp - 1,091 amp
1 30 amp 1,050.00 31,500 1,061 amp
2 30 amp 1,050.00 31,500 1,031 amp
20 30 amp 1,050.00 31,500 1,001 amp
24 90 amp 1,050.00 94,500 911 amp
1,091 Amp 1,050.00 1,145,550 - amp - 180 amp 1,050.00 189,000 911 amp
83 Digoksin tablet 0,25 mg 200 Tab 97.00 19,400 - tab - - tab 97.00 - 200 tab
200 Tab 97.00 19,400 - tab - - tab 97.00 - 200 tab
85 Dimenhidrinat tablet 50 mg 500 tab 104.00 52,000 - tab - - tab 104.00 - 500 tab
500 tab 104.00 52,000 - tab - - tab 104.00 - 500 tab
87 Domperidon suspensi 5 mg/5 ml 7 btl 3,624.00 25,368 - btl - - btl 3,624.00 - 7 btl
7 btl 3,624.00 25,368 - btl - - btl 3,624.00 - 7 btl
90 Ekstraks Belladona tablet 10 mg 300 Tab 38.00 11,400 - tab - - tab 38.00 - 300 tab
300 Tab 38.00 11,400 - tab - - tab 38.00 - 300 tab
Epinefrin (Adrenalin) injeksi 0,1 % (sebagai
91
HCl) 88 Amp 8,100.00 712,800 - amp - - amp 8,100.00 - 88 amp
88 Amp 8,100.00 712,800 - amp - - amp 8,100.00 - 88 amp
92 Eritromisin kapsul/kaplet 250 mg 180 kaps 337.04 60,667 - kaps - - kaps 337.04 - 180 kaps
180 kaps 337.04 60,667 - kaps - - kaps 337.04 - 180 kaps
93 Eritromisin kapsul/kaplet 500 mg 1,376 kaps 864.25 1,189,208 - kaps - - kaps 864.25 - 1,376 kaps
1,376 kaps 864.25 1,189,208 - kaps - - kaps 864.25 - 1,376 kaps
NO NAMA BARANG
94 Eritromisin sirup 200 mg/ 5 ml 36 Btl 7,700.00 277,200 - btl - - btl 7,700.00 - 36 btl
36 Btl 7,700.00 277,200 - btl - - btl 7,700.00 - 36 btl
95 Etakridin larutan 0,1% (Rivanol) 8 Btl 3,223.00 25,784 - btl - - btl 3,223.00 - 8 btl
8 Btl 3,223.00 25,784 - btl - - btl 3,223.00 - 8 btl
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml 94 Amp 1,716.00 161,304 - amp - - amp 1,716.00 - 94 amp
94 Amp 1,716.00 161,304 - amp - - amp 1,716.00 - 94 amp
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg 1,500 Tab 630.00 945,000 - tab - 1,500 tab
7 100 tab 630.00 63,000 1,400 tab
1,500 Tab 630.00 945,000 - tab - 100 tab 630.00 63,000 1,400 tab
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml 507 Amp 3,417.00 1,732,419 - amp - - amp 3,417.00 - 507 amp
507 Amp 3,417.00 1,732,419 - amp - - amp 3,417.00 - 507 amp
115 Furosemid tablet 40 mg 2,000 Tab 85.00 170,000 - tab - - tab 85.00 - 2,000 tab
2,000 Tab 85.00 170,000 - tab - - tab 85.00 - 2,000 tab
116 Garam Oralit I serbuk 6,000 Sac 288.00 1,728,000 - sase - 6,000 sase
7 100 sase 288.00 28,800 5,900 sase
2 100 sase 288.00 28,800 5,800 sase
6 100 sase 288.00 28,800 5,700 sase
6,000 Sac 288.00 1,728,000 - sase - 300 sase 288.00 86,400 5,700 sase
119 Gentamisin injeksi 40 mg/ ml 75 amp 3,399.00 254,925 - amp - - amp 3,399.00 - 75 amp
75 amp 3,399.00 254,925 - amp - - amp 3,399.00 - 75 amp
120 Gentamisin salep kulit 0.1% 145 tube 1,650.00 239,250 - tube - 145 tube
7 10 tube 1,650.00 16,500 135 tube
24 10 tube 1,650.00 16,500 125 tube
145 tube 1,650.00 239,250 - tube - 20 tube 1,650.00 33,000 125 tube
122 Gentian Violet larutan 1 % 59 Btl 900.00 53,100 - btl - 59 btl
7 7 btl 900.00 6,300 52 btl
2 5 btl 900.00 4,500 47 btl
20 10 btl 900.00 9,000 37 btl
18 5 btl 900.00 4,500 32 btl
59 Btl 900.00 53,100 - btl - 27 btl 900.00 24,300 32 btl
123 Glibenklamida tablet 5 mg 3,100 Tab 56.00 173,600 - tab - 3,100 tab
18 10 tab 56.00 560 3,090 tab
3,100 Tab 56.00 173,600 - tab - 10 tab 56.00 560 3,090 tab
130 Gliseril Gualakolat tablet 100 mg 17,896 Tab 44.00 787,424 - tab - 17,896 tab
24 1,000 tab 44.00 44,000 16,896 tab
18 20 tab 44.00 880 16,876 tab
17,896 Tab 44.00 787,424 - tab - 1,020 tab 44.00 44,880 16,876 tab
132 Glukosa larutan infus 10 % steril 4 Btl 5,727.00 22,908 - btl - - btl 5,727.00 - 4 btl
4 Btl 5,727.00 22,908 - btl - - btl 5,727.00 - 4 btl
134 Glukosa larutan infus 5 % steril 358 Btl 5,200.00 1,861,600 - btl - 358 btl
2 5 btl 5,200.00 26,000 353 btl
358 Btl 5,200.00 1,861,600 - btl - 5 btl 5,200.00 26,000 353 btl
135 Griseofulvin tablet 125 mg 2,185 Tab 209.00 456,665 - tab - 2,185 tab
2 100 tab 209.00 20,900 2,085 tab
2,185 Tab 209.00 456,665 - tab - 100 tab 209.00 20,900 2,085 tab
140 HCT 25 mg (Hidroklortiazid) 3,727 Tab 36.00 134,172 - tab - - tab 36.00 - 3,727 tab
3,727 Tab 36.00 134,172 - tab - - tab 36.00 - 3,727 tab
142 Hidrokortison krim 2,5 % 614 Tube 2,798.00 1,717,972 - tube - 614 tube
NO NAMA BARANG
1 5 tube 2,798.00 13,990 609 tube
2 10 tube 2,798.00 27,980 599 tube
6 24 tube 2,798.00 67,152 575 tube
24 25 tube 2,798.00 69,950 550 tube
614 Tube 2,798.00 1,717,972 - tube - 64 tube 2,798.00 179,072 550 tube
146 Ibuprofen tablet 200 mg 1,000 Tab 110.00 110,000 - tab - 1,000 tab
7 100 tab 110.00 11,000 900 tab
1,000 Tab 110.00 110,000 - tab - 100 tab 110.00 11,000 900 tab
148 Ibuprofen tablet 400 mg 5,520 Tab 150.00 828,000 - tab - 5,520 tab
7 200 tab 150.00 30,000 5,320 tab
2 100 tab 150.00 15,000 5,220 tab
6 100 tab 150.00 15,000 5,120 tab
24 100 tab 150.00 15,000 5,020 tab
24 100 tab 150.00 15,000 4,920 tab
24 200 tab 150.00 30,000 4,720 tab
18 39 tab 150.00 5,850 4,681 tab
5,520 Tab 150.00 828,000 - tab - 839 tab 150.00 125,850 4,681 tab
151 Isoniazid tablet 100 mg 1,800 Tab 44.00 79,200 - tab - - tab 44.00 - 1,800 tab
1,800 Tab 44.00 79,200 - tab - - tab 44.00 - 1,800 tab
153 Isosorbid Dinitrat tablet sublingual 5 mg 500 Tab 88.00 44,000 - tab - - tab 88.00 - 500 tab
500 Tab 88.00 44,000 - tab - - tab 88.00 - 500 tab
157 Kalsium Laktat (Kalk) tablet 500 mg 24,078 Tab 81.40 1,959,949 - tab - - tab 81.40 - 24,078 tab
24,078 Tab 81.40 1,959,949 - tab - - tab 81.40 - 24,078 tab
158 Kaptopril tablet 12,5 mg 20 Tab 62.00 1,240 - tab - 20 tab
20 Tab 62.00 1,240 - tab - 20 tab 62.00 1,240 - tab
159 Kaptopril tablet 25 mg 6,522 Tab 84.00 547,848 - tab - 6,522 tab
24 200 tab 84.00 16,800 6,322 tab
24 200 tab 84.00 16,800 6,122 tab
24 200 tab 84.00 16,800 5,922 tab
18 65 tab 84.00 5,460 5,857 tab
6,522 Tab 84.00 547,848 - tab - 665 tab 84.00 55,860 5,857 tab
161 Karbamazepin tablet 200 mg 200 Tab 243.00 48,600 - tab - - tab 243.00 - 200 tab
200 Tab 243.00 48,600 - tab - - tab 243.00 - 200 tab
162 Ketokonazol krim 2% 205 tube 2,569.00 526,645 - tube - - tube 2,569.00 - 205 tube
163 Ketokonazol tablet 200 mg 1,550 Tab 300.00 465,000 - tab - 1,550 tab
24 100 tab 300.00 30,000 1,450 tab
1,550 Tab 300.00 465,000 - tab - 100 tab 300.00 30,000 1,450 tab
169 Klindamisin kapsul/kaplet 300 mg 100 kaps 205.00 20,500 - kaps - 100 kaps
7 50 kaps 205.00 10,250 50 kaps
169 Klindamisin kapsul/kaplet 300 mg 100 kaps 205.00 20,500 - kaps - 50 kaps 205.00 10,250 50 kaps
173 Kloramfenikol kapsul/kaplet 250 mg 1,150 Kaps 356.40 409,860 - kaps - - kaps 356.40 - 1,150 kaps
1,150 Kaps 356.40 409,860 - kaps - - kaps 356.40 - 1,150 kaps
175 Kloramfenikol suspensi 125 mg/ 5 ml 47 Btl 3,700.00 173,900 - btl - 47 btl
2 5 btl 3,700.00 18,500 42 btl
47 Btl 3,700.00 173,900 - btl - 5 btl 3,700.00 18,500 42 btl
178 Kloramfenikol tetes telinga 3 % 24 btl 2,200.00 52,800 - btl - 24 btl
7 5 btl 2,200.00 11,000 19 btl
24 btl 2,200.00 52,800 - btl - 5 btl 2,200.00 11,000 19 btl
NO NAMA BARANG
179 Klorfeniramina Maleat (CTM) tablet 4 mg 60,786 Tab 91.30 5,549,762 - tab - 60,786 tab
7 300 tab 91.30 27,390 60,486 tab
2 1,000 tab 91.30 91,300 59,486 tab
6 1,000 tab 91.30 91,300 58,486 tab
24 300 tab 91.30 27,390 58,186 tab
60,786 Tab 91.30 5,549,762 - tab - 2,600 tab 91.30 237,380 58,186 tab
184 Klorpromazin tablet salut 25 mg (HCl) 200 Tab 168.00 33,600 - tab - 200 tab
31 30 tab 168.00 5,040 170 tab
200 Tab 168.00 33,600 - tab - 30 tab 168.00 5,040 170 tab
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg tab - 7,873 tab
7,873 Tab 138.00 1,086,474 -
2 100 tab 138.00 13,800 7,773 tab
24 200 tab 138.00 27,600 7,573 tab
7,873 Tab 138.00 1,086,474 - tab - 300 tab 138.00 41,400 7,573 tab
Kotrimoksazol DOEN II (pediatrik)
189 kombinasi : Sulfametoksazol 100 mg tab - 10,632 tab
Trimetoprim 20 mg 10,632 Tab 72.00 765,504 -
24 1,000 tab 72.00 72,000 9,632 tab
10,632 Tab 72.00 765,504 - tab - 1,000 tab 72.00 72,000 9,632 tab
Kotrimoksazol Suspensi komb:
190 Sulfametoksazol 200 mg + Trimetoprim 40 mg btl - 859 btl
/ 5 ml 859 Btl 2,167.00 1,861,453 -
7 8 btl 2,167.00 17,336 851 btl
31 170 btl 2,167.00 368,390 681 btl
18 1 btl 2,167.00 680 btl
859 Btl 2,167.00 1,861,453 - btl - 179 btl 2,167.00 387,893 680 btl
Larutan mengandung Elektrolit (Na 130 mEq,
196 Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) btl btl - - btl 9,000.00 - 500 btl
(ASERING) 500 9,000.00 4,500,000 -
500 btl 9,000.00 4,500,000 - btl - - btl 9,000.00 - 500 btl
197
Larutan mengandung Elektrolit (NaCl 1.125
btl 9,000.00 btl - - btl 9,000.00 - 30 btl
gr, Dekstrosa 18.75 gr) (KAEN 1B) 30 270,000 -
30 btl 9,000.00 270,000 - btl - - btl 9,000.00 - 30 btl
10,000.00
198 Larutan mengandung Karbohidrat + Elektrolit btl btl - - btl 10,000.00 - 500 btl
(Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr,
Dekstrosa 27 gr) (KAEN 3B) 500 5,000,000 -
500 btl 10,000.00 5,000,000 - btl - - btl 10,000.00 - 500 btl
Larutan mengandung Karbohidrat + Elektrolit 10,000.00
199 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr btl btl - - btl 10,000.00 - 325 btl
Dekstrosa 27 gr) (KAEN 3A) 325 3,250,000 -
325 btl 10,000.00 3,250,000 - btl - - btl 10,000.00 - 325 btl
203 Lidokain injeksi 2% 534 amp 573.00 305,982 - amp - - amp 573.00 - 534 amp
534 amp 573.00 305,982 - amp - - amp 573.00 - 534 amp
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
205 80.000 - 2ml ( Lidokain Comp. Inj ) 897 Amp 1,363.00 1,222,611 - amp - 897 amp
24 90 amp 1,363.00 122,670 807 amp
897 Amp 1,363.00 1,222,611 - amp - 90 amp 1,363.00 122,670 807 amp
210 Loperamid tablet 2 mg 337 tab 91.55 30,852 - tab - 337 tab
24 100 tab 91.55 9,155 237 tab
18 6 tab 91.55 549 231 tab
NO NAMA BARANG
337 tab 91.55 30,852 - tab - 106 tab 91.55 9,704 231 tab
211 Loratadin tablet 10 mg 900 tab 154.00 138,600 - tab - - tab 154.00 - 900 tab
900 tab 154.00 138,600 - tab - - tab 154.00 - 900 tab
214 Magnesium Sulfat inj (IV) 20% - 25 ml 21 Vial 6,600.00 138,600 - amp - - amp 6,600.00 - 21 amp
21 Vial 6,600.00 138,600 - amp - - amp 6,600.00 - 21 amp
224 Metampiron tablet 500 mg (Antalgin) 38,730 Tab 220 & 126,5 6,769,345 - tab - 38,730 tab
1 200 tab 126.50 25,300 38,530 tab
2 200 tab 126.50 25,300 38,330 tab
6 300 tab 126.50 37,950 38,030 tab
7 400 tab 126.50 50,600 37,630 tab
18 180 tab 126.50 22,770 37,450 tab
24 200 tab 126.50 25,300 37,250 tab
24 300 tab 126.50 37,950 36,950 tab
24 300 tab 126.50 37,950 36,650 tab
38,730 Tab 220 & 126,5 6,769,345 - tab - 2,080 tab 220 & 126,5 263,120 36,650 tab
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml 204 Amp 3,499.00 713,796 - amp - 204 amp
1 2 amp 3,499.00 6,998 202 amp
204 Amp 3,499.00 713,796 - amp - 2 amp 3,499.00 6,998 202 amp
Metilergometrin Maleat (Metilergometrin)
229 tablet salut 0,125 mg 600 Tab 140.00 84,000 - tab - 600 tab
20 100 tab 140.00 14,000 500 tab
600 Tab 140.00 84,000 - tab - 100 tab 140.00 14,000 500 tab
233 Metilprednisolon tablet 8 mg 30 tab 300.00 9,000 - tab - - tab 300.00 - 30 tab
30 tab 300.00 9,000 - tab - - tab 300.00 - 30 tab
236 Metoklopramide tablet 10 mg 1,200 Tab 110.00 132,000 - tab - 1,200 tab
24 100 tab 110.00 11,000 1,100 tab
1,200 Tab 110.00 132,000 - tab - 100 tab 110.00 11,000 1,100 tab
240 Metronidazol tablet 500 mg 7,673 Tab 160.00 1,227,680 - tab - 7,673 tab
7 200 tab 160.00 32,000 7,473 tab
1 100 tab 160.00 16,000 7,373 tab
2 200 tab 160.00 32,000 7,173 tab
24 100 tab 160.00 16,000 7,073 tab
24 100 tab 160.00 16,000 6,973 tab
7,673 Tab 160.00 1,227,680 - tab - 700 tab 160.00 112,000 6,973 tab
242 Mikonazol krim/salep 2 % (Nitrat) 4 tube 3,000.00 12,000 - tube - - tube 3,000.00 - 4 tube
249 Natrium Diklofenak tablet 50 mg 3,288 Tab 176.00 578,688 - tab - 3,288 tab
7 50 tab 176.00 8,800 3,238 tab
6 100 tab 176.00 17,600 3,138 tab
24 100 tab 176.00 17,600 3,038 tab
24 300 tab 176.00 52,800 2,738 tab
3,288 Tab 176.00 578,688 - tab - 550 tab 176.00 96,800 2,738 tab
4,700.00
btl btl btl
250 Natrium Klorida larutan infus 0,9 % (NaCl) 1,089 Btl 4,700.00 5,118,300 - - - - 1,089
1,089 Btl 4,700.00 5,118,300 - btl - - btl 4,700.00 - 1,089 btl
NO NAMA BARANG
253 Nifedipin tablet 10 mg 2,300 tab 110.00 253,000 - tab - 2,300 tab
2 100 tab 110.00 11,000 2,200 tab
2,300 tab 110.00 253,000 - tab - 100 tab 110.00 11,000 2,200 tab
254 Nistatin tablet salut 500.000 IU/ g 800 Tab 640.00 512,000 - tab - 800 tab
24 100 tab 640.00 64,000 700 tab
800 Tab 640.00 512,000 - tab - 100 tab 640.00 64,000 700 tab
256 Norages inj 65 amp 7,000.00 455,000 - amp - 65 amp
1 30 amp 7,000.00 210,000 35 amp
65 amp 7,000.00 455,000 - amp - 30 amp 7,000.00 210,000 35 amp
263 Obat Batuk Hitam ( O.B.H. ) cairan 439 Btl 5,940.00 2,607,660 - btl - 439 btl
2 10 btl 5,940.00 59,400 429 btl
18 1 btl 5,940.00 5,940 428 btl
439 Btl 5,940.00 2,607,660 - btl - 11 btl 5,940.00 65,340 428 btl
268 Oksitetrasiklin HCl salep mata 1 % 48 Tube 2,772.00 133,056 - tube - 48 tube
7 5 tube 2,772.00 13,860 43 tube
1 5 tube 2,772.00 13,860 38 tube
20 12 tube 2,772.00 33,264 26 tube
269 Oksitetrasiklin salep kulit 3% 416 Tube 2,010.00 836,160 - tube - 416 tube
2 25 tube 2,010.00 50,250 391 tube
24 25 tube 2,010.00 50,250 366 tube
18 2 tube 2,010.00 4,020 364 tube
270 Oksitosin injeksi 10 IU/ml - 1 ml 137 Amp 2,200.00 301,400 - amp - - amp 2,200.00 - 137 amp
137 Amp 2,200.00 301,400 - amp - - amp 2,200.00 - 137 amp
274 Papaverin tablet 40 mg 7,800 Tab 119.00 928,200 - tab - - tab 119.00 - 7,800 tab
7,800 Tab 119.00 928,200 - tab - - tab 119.00 - 7,800 tab
275 Parasetamol drops 185 btl 5,200.00 962,000 - btl - 185 btl
7 3 btl 5,200.00 15,600 182 btl
185 btl 5,200.00 962,000 - btl - 3 btl 5,200.00 15,600 182 btl
276 Parasetamol sirup 120 mg / 5 ml 638 Btl 1,438.00 917,444 - btl - 638 btl
7 18 btl 1,438.00 25,884 620 btl
20 84 btl 1,438.00 120,792 536 btl
24 10 btl 1,438.00 14,380 526 btl
24 20 btl 1,438.00 28,760 506 btl
638 Btl 1,438.00 917,444 - btl - 132 btl 1,438.00 189,816 506 btl
277 Parasetamol tablet 100 mg 860 Tab 32.00 27,520 - tab - 860 tab
24 100 tab 32.00 3,200 760 tab
860 Tab 32.00 27,520 - tab - 100 tab 32.00 3,200 760 tab
278 Parasetamol tablet 500 mg 35,044 Tab 79.00 2,768,476 - tab - 35,044 tab
7 500 tab 79.00 39,500 34,544 tab
2 200 tab 79.00 15,800 34,344 tab
6 300 tab 79.00 23,700 34,044 tab
24 300 tab 79.00 23,700 33,744 tab
24 300 tab 79.00 23,700 33,444 tab
18 36 tab 79.00 2,844 33,408 tab
35,044 Tab 79.00 2,768,476 - tab - 1,636 tab 79.00 129,244 33,408 tab
283 Piracetam injeksi 3 g/15 ml 480 amp 6,270.00 3,009,600 - amp - - amp 6,270.00 - 480 amp
NO NAMA BARANG
480 amp 6,270.00 3,009,600 - amp - - amp 6,270.00 - 480 amp
tab tab 17.39 tab
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) 1,100 Tab 17.39 19,129 - - - - 1,100
tab tab 17.39 tab
1,100 Tab 17.39 19,129 - - - - 1,100
293 Piroksikam kapsul/kaplet/tablet 20 mg 1,900 kaps 100.10 190,190 - kaps - 1,900 kaps
24 100 kaps 100.10 10,010 1,800 kaps
1,900 kaps 100.10 190,190 - kaps - 100 kaps 100.10 10,010 1,800 kaps
295 Povidon Iodida larutan 10% 30mL 12 Btl 2,163.00 25,956 - btl - 12 btl
24 1 btl 2,163.00 2,163 11 btl
12 Btl 2,163.00 25,956 - btl - 1 btl 2,163.00 2,163 11 btl
299 Prednison tablet 5 mg 28,264 Tab 151.80 4,290,475 - tab - 28,264 tab
20 100 tab 151.80 15,180 28,164 tab
28,264 Tab 151.80 4,290,475 - tab - 100 tab 151.80 15,180 28,164 tab
301 Primperan inj 165 amp 5,500.00 907,500 - amp - - amp 5,500.00 - 165 amp
165 amp 5,500.00 907,500 - amp - - amp 5,500.00 - 165 amp
305 Propiltiourasil tablet 100 mg (PTU) 200 Tab 284.00 56,800 - tab - - tab 284.00 - 200 tab
200 Tab 284.00 56,800 - tab - - tab 284.00 - 200 tab
308 Ranitidin injeksi 25 mg/2 ml 25 amp 1,500.00 37,500 - amp - 25 amp
308 Ranitidin injeksi 25 mg/2 ml 25 amp 1,500.00 37,500 - amp - 25 amp 1,500.00 37,500 - amp
309 Ranitidin tablet 150 mg 3,388 Tab 120.00 406,560 - tab - 3,388 tab
7 200 tab 120.00 24,000 3,188 tab
24 388 tab 120.00 46,560 2,800 tab
3,388 Tab 120.00 406,560 - tab - 588 tab 120.00 70,560 2,800 tab
322 SABU I 1 Vial 398,420.00 398,420 - amp - 1 amp
322 SABU I 1 Vial 398,420.00 398,420 - amp - 1 amp 398,420.00 398,420 - amp
4,164 Tab 96.80 403,075 - tab - 4,164 tab

324 Salbutamol tablet 4 mg (sebagai Sulfat)
2 100 tab 96.80 9,680 4,064 tab
24 100 tab 96.80 9,680 3,964 tab
24 100 tab 96.80 9,680 3,864 tab
4,164 Tab 96.80 403,075 - tab - 300 tab 97.00 29,040 3,864 tab
Salep 2-4 , Kombinasi: Asam Salisilat 2% +
325 Belerang endap 4% 54 Pot 1,800.00 97,200 - pot - - pot 1,800.00 - 54 pot
54 Pot 1,800.00 97,200 - pot - - pot 1,800.00 - 54 pot
326 Salisil Bedak 2 % 327 Ktk 1,250.00 408,750 - ktk - 327 ktk
2 10 ktk 1,250.00 12,500 317 ktk
327 Ktk 1,250.00 408,750 - ktk - 10 ktk 1,250.00 12,500 317 ktk
328 Sanmol syr 23 btl 10,384.00 238,832 - btl - - btl 10,384.00 - 23 btl
23 btl 10,384.00 238,832 - btl - - btl 10,384.00 - 23 btl
332 Sefadroksil kapsul/kaplet 500 mg 1,000 kaps 509.00 509,000 - kaps - 1,000 kaps
1 100 kaps 509.00 50,900 900 kaps
1,000 kaps 509.00 509,000 - kaps - 100 kaps 509.00 50,900 900 kaps
341 Sefotaksim injeksi 1 g 560 vial 2,950.00 1,652,000 - amp - - amp 2,950.00 - 560 amp
560 vial 2,950.00 1,652,000 - amp - - amp 2,950.00 - 560 amp
343 Seftriakson injeksi 1 g 128 vial 3,300.00 422,400 - amp - - amp 3,300.00 - 128 amp
128 vial 3,300.00 422,400 - amp - - amp 3,300.00 - 128 amp
amp amp
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) 3 Amp 137,500.00 412,500 - - 3
NO NAMA BARANG
3 Amp 137,500.00 412,500 - amp - 3 amp 137,500.00 412,500 - amp
Sianokobalamin (vitamin B12) injeksi 500
346 mcg 3,491 Amp 1,078.00 3,763,298 - amp - 3,491 amp
2 100 amp 1,078.00 107,800 3,391 amp
3,491 Amp 1,078.00 3,763,298 - amp - 100 amp 1,078.00 107,800 3,391 amp
348 Simetidin tablet 200 mg 4,610 Tab 110.84 510,972 - tab - 4,610 tab
2 100 tab 110.84 11,084 4,510 tab
4,610 Tab 110.84 510,972 - tab - 100 tab 110.84 11,084 4,510 tab
349 Simvastatin tablet 10 mg 30 Tab 169.00 5,070 - tab - 30 tab
30 Tab 169.00 5,070 - tab - 30 tab 169.00 5,070 - tab
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab tab tab
4,436 255.00 1,131,180 - - 4,436
7 200 tab 255.00 51,000 4,236 tab
2 100 tab 255.00 25,500 4,136 tab
24 100 tab 255.00 25,500 4,036 tab
24 100 tab 255.00 25,500 3,936 tab
24 100 tab 255.00 25,500 3,836 tab
18 10 tab 255.00 2,550 3,826 tab
4,436 Tab 255.00 1,131,180 - tab - 610 tab 255.00 155,550 3,826 tab
363 Syntosinon inj 19 amp 12,045.00 228,855 - amp - - amp 12,045.00 - 19 amp
19 amp 12,045.00 228,855 - amp - - amp 12,045.00 - 19 amp
366 Tetrasiklin kapsul/kaplet 250 mg 7,900 Kaps 149.00 1,177,100 - kaps - - kaps 149.00 - 7,900 kaps
7,900 Kaps 149.00 1,177,100 - kaps - - kaps 149.00 - 7,900 kaps
367 Tetrasiklin kapsul/kaplet 500 mg 2,521 Kaps 300.30 757,056 - kaps - - kaps 300.30 - 2,521 kaps
2,521 Kaps 300.30 757,056 - kaps - - kaps 300.30 - 2,521 kaps
369 Tiamfenikol kapsul/kaplet 500 mg 600 kaps 616.00 369,600 - kaps - - kaps 616.00 - 600 kaps
600 kaps 616.00 369,600 - kaps - - kaps 616.00 - 600 kaps
370
Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) 28,060 Tab 69.30 1,944,558 -
tab - 28,060 tab
2 1,000 tab 69.30 69,300 27,060 tab
18 100 tab 69.30 6,930 26,960 tab
20 1,000 tab 69.30 69,300 25,960 tab
28,060 Tab 69.30 1,944,558 - tab - 2,100 tab 69.30 145,530 25,960 tab
372 Tiamin (Vitamin B1) injeksi 100 mg/ml 328 Amp 680.00 223,040 - amp - 328 amp
31 60 amp 680.00 40,800 268 amp
328 Amp 680.00 223,040 - amp - 60 amp 680.00 40,800 268 amp
379 Triheksifenidil tablet 2 mg 100 Tab 40.00 4,000 - tab - - tab 40.00 - 100 tab
100 Tab 40.00 4,000 - tab - - tab 40.00 - 100 tab
380 Ulsikur inj 34 amp 7,480.00 254,320 - amp - - amp 7,480.00 - 34 amp
34 amp 7,480.00 254,320 - amp - - amp 7,480.00 - 34 amp
384 Vicillin 1gr inj 20 vial 8,500.00 170,000 - vial - 20 vial
20 vial 8,500.00 170,000 - vial - 20 vial 8,500.00 170,000 - vial
385 Vitamin B Kompleks tablet 52,343 Tab 107 & 34,1 2,684,701 - tab - 52,343 tab
2 1,000 tab 107.00 107,000 51,343 tab
20 1,000 tab 107.00 107,000 50,343 tab
18 30 tab 107.00 3,210 50,313 tab
52,343 Tab 107 & 34,1 2,684,701 - tab - 2,030 tab 107.00 217,210 50,313 tab
388 Zinc drop 10 mg/mL 53 btl 12,840.00 680,520 - btl - - btl 12,840.00 - 53 btl
388 Zinc drop 10 mg/mL 53 btl 12,840.00 680,520 - btl - - btl 12,840.00 - 53 btl
NO NAMA BARANG
389 Zinc tablet 20 mg 6,038 tab 474.00 2,862,012 - tab - 6,038 tab
2 100 tab 474.00 47,400 5,938 tab
24 200 tab 474.00 94,800 5,738 tab
24 200 tab 474.00 94,800 5,538 tab
6,038 tab 474.00 2,862,012 - tab - 500 tab 474.00 237,000 5,538 tab
1 117,827,938 - 6,770,790 1
B PERBEKALAN KESEHATAN 1
1 Alat suntik sekali pakai 1 ml 200 set 625.00 125,000 - set - - set 625.00 - 200 set
200 set 625.00 125,000 - set - - set 625.00 - 200 set
2 Alat suntik sekali pakai 2,5 ml 14,785 set 1038 & 1089 15,856,830 - set - 14,785 set
1 200 set 1,038.00 207,600 14,585 set
2 100 set 1,038.00 103,800 14,485 set
6 200 set 1,038.00 207,600 14,285 set
20 100 set 1,038.00 103,800 14,185 set
24 100 set 1,038.00 103,800 14,085 set
24 100 set 1,038.00 103,800 13,985 set
24 100 set 1,038.00 103,800 13,885 set
14,785 set 1038 & 1089 15,856,830 - set - 900 set 1,038.00 934,200 13,885 set
Catgut/benang bedah no.2/0 dengan jarum
5 bedah 197 set 5,583.33 1,099,916 - set - - set 5,583.33 - 197 set
197 set 5,583.33 1,099,916 - set - - set 5,583.33 - 197 set
7 Infusion set anak 624 Set 3,500.00 2,184,000 - set - 624 set
1 45 set 3,500.00 157,500 579 set
624 Set 3,500.00 2,184,000 - set - 45 set 3,500.00 157,500 579 set
8 Infusion set dewasa 478 Set 3,509.00 1,677,302 - set - 478 set
1 50 set 3,509.00 175,450 428 set
478 Set 3,509.00 1,677,302 - set - 50 set 3,509.00 175,450 428 set
9 IV Catheter No. 20 G 514 Set 9,185.00 4,721,090 - set - - set 9,185.00 - 514 set
514 Set 9,185.00 4,721,090 - set - - set 9,185.00 - 514 set
10 IV Catheter No. 22 G 199 Set 9,185.00 1,827,815 - set - 199 set
1 50 set 9,185.00 459,250 149 set
199 Set 9,185.00 1,827,815 - set - 50 set 9,185.00 459,250 149 set
11 IV Catheter No. 24 G 427 Set 9,185.00 3,921,995 - set - - set 9,185.00 - 427 set
427 Set 9,185.00 3,921,995 - set - - set 9,185.00 - 427 set
13 Kapas Pembalut / Absorben 250 gram 110 Bks 12,500.00 1,375,000 - rol - 110 rol
1 1 rol 12,500.00 12,500 109 rol
24 1 rol 12,500.00 12,500 108 rol
24 1 rol 12,500.00 12,500 107 rol
24 1 rol 12,500.00 12,500 106 rol
110 Bks 12,500.00 1,375,000 - rol - 4 rol 12,500.00 50,000 106 rol
Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / 5,800.00
14 kotak 54 ktk 5,800.00 313,200 - rol - - rol - 54 rol
54 ktk 5,800.00 313,200 - rol - - rol 5,800.00 - 54 rol
17 Kasa Pembalut Hidrofil 4 m x 5 2,749 Rol 750.00 2,061,750 - rol - 2,749 rol
2 20 rol 750.00 15,000 2,729 rol
2,749 Rol 750.00 2,061,750 - rol - 20 rol 750.00 15,000 2,729 rol
18 Kasa Pembalut Hidrofil 4 m x 10 cm 1,253 Rol 1,500.00 1,879,500 - rol - 1,253 rol
1 50 rol 1,500.00 75,000 1,203 rol
2 10 rol 1,500.00 15,000 1,193 rol
NO NAMA BARANG
24 10 rol 1,500.00 15,000 1,183 rol
24 10 rol 1,500.00 15,000 1,173 rol
1,253 Rol 1,500.00 1,879,500 - rol - 80 rol 1,500.00 120,000 1,173 rol
rol rol rol 33,000.00 rol
19 Kasa Pembalut Elastic 3 inchi (medicrepe) 71 33,000.00 2,343,000 - - - - 71
71 rol 33,000.00 2,343,000 - rol - - rol 33,000.00 - 71 rol
21 Kasa Pembalut Elastic 7,5 cm x 4,5m 52 rol 33,000.00 1,716,000 - rol - - rol 33,000.00 - 52 rol
52 rol 33,000.00 1,716,000 - rol - - rol 33,000.00 - 52 rol
22 Kasa Pembalut Elastic 10 cm x 4,5m 60 rol 41,800.00 2,508,000 - rol - - rol 41,800.00 - 60 rol
60 rol 41,800.00 2,508,000 - rol - - rol 41,800.00 - 60 rol
23 Pembalut Gips 3 ichi 10 Rol 23,485.00 234,850 - rol - - rol 23,485.00 - 10 rol
10 Rol 23,485.00 234,850 - rol - - rol 23,485.00 - 10 rol
24 Plester 5 yards x 2 inch 25 Rol 23,624.70 590,618 - rol - 25 rol
1 2 23,624.70 47,249 23 rol
25 Rol 23,624.70 590,618 - rol - 2 rol 23,624.70 47,249 23 rol
Silk (Benang Bedah Sutera) No. 3/0 dengan
25 jarum bedah 173 Sac 3,055.56 528,612 - bh - 173 bh
2 36 bh 3,055.56 110,000 137 bh
173 Sac 3,055.56 528,612 - bh - 36 bh 3,055.56 110,000 137 bh
27 Urine Bag 20 Set 3,000.00 60,000 - set - - set 3,000.00 - 20 set
20 Set 3,000.00 60,000 - set - - set 3,000.00 - 20 set
28 Foley Catheter 10 set 8,000.00 80,000 - set - - set 8,000.00 - 10 set
10 set 8,000.00 80,000 - set - - set 8,000.00 - 10 set
29 Handscoon (Sarung Tangan Steril) 1,060 Set 4,249.30 4,504,258 - set - 1,060 set
1 200 set 4,249.30 849,860 860 set
1 100 set 4,249.30 424,930 760 set
1,060 Set 4,249.30 4,504,258 - set - 300 set 4,249.30 1,274,790 760 set
30 Masker 202 set 440 & 1100 88,880 - set - 202 set
1 50 set 440.00 22,000 152 set
202 set 440 & 1100 88,880 - set - 50 set 440.00 22,000 152 set
J U M LAH 49,697,615 - 3,365,440 1
C OBAT GIGI 1
J U M LAH - - - 1
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN 1
3 Combifen syr 5 btl 11,000.00 55,000 - btl - - btl 11,000.00 - 5 btl
5 btl 11,000.00 55,000 - btl - - btl 11,000.00 - 5 btl
4 Coparcetin 300 tab 350.00 105,000 - tab - 300 tab
1 200 tab 350.00 70,000 100 tab
300 tab 350.00 105,000 - tab - 200 tab 350.00 70,000 100 tab
6 Etafen syr 5 btl 7,000.00 35,000 - btl - - btl 7,000.00 - 5 btl
5 btl 7,000.00 35,000 - btl - - btl 7,000.00 - 5 btl
Etanol 70% cairan ( 100 ml ) (Alkohol) 14 Btl 2,500.00 35,000 - Btl - - Btl 2,500.00 - 14 Btl
14 Btl 2,500.00 35,000 - Btl - - Btl 2,500.00 - 14 Btl
7 Etanol 70% cairan ( 1 liter ) (Alkohol) 15 Btl 2,500.00 37,500 - Btl - 15 Btl
2 1 Btl 2,500.00 2,500 14 Btl
24 1 Btl 2,500.00 2,500 13 Btl
24 1 Btl 2,500.00 2,500 12 Btl
15 Btl 2,500.00 37,500 - Btl - 3 Btl 2,500.00 7,500 12 Btl
NO NAMA BARANG
9 Fe Sirup 1 btl - - - btl - 1 btl - - 0 btl
1 btl - - - btl - 1 btl - - 0 btl
Gastrusid sirup 20 btl 4,500.00 90,000 - btl - - btl 4,500.00 - 20 btl
20 btl 4,500.00 90,000 - btl - - btl 4,500.00 - 20 btl
10 Grafadon 200 tab 155.00 31,000 - tab - - tab 155.00 - 200 tab
200 tab 155.00 31,000 - tab - - tab 155.00 - 200 tab
11 H2O2 3% 800 cc 4 btl - - - btl - 1 btl - - 3 btl
4 btl - - - btl - 1 btl - - 3 btl
12 Helixim syr 5 btl 10,000.00 50,000 - btl - - btl 10,000.00 - 5 btl
5 btl 10,000.00 50,000 - btl - - btl 10,000.00 - 5 btl
14 IV Catheter No. 18 G 100 Set 9,185.00 918,500 - Set - - Set 9,185.00 - 100 Set
100 Set 9,185.00 918,500 - Set - - Set 9,185.00 - 100 Set
15 Kalium Permanganat Serbuk 5 Pot - - - Pot - - Pot - - 5 Pot
5 Pot - - - Pot - - Pot - - 5 Pot
Lostacef 50 tab 660.00 33,000 - tab - - tab 660.00 - 50 tab
50 tab 660.00 33,000 - tab - - tab 660.00 - 50 tab
18 Mirasic syr 5 btl 5,000.00 25,000 - btl - - btl 5,000.00 - 5 btl
5 btl 5,000.00 25,000 - btl - - btl 5,000.00 - 5 btl
19 Molacort 200 tab 265.00 53,000 - tab - 200 tab
200 tab 265.00 53,000 - tab - 200 tab 265.00 53,000 0 tab
20 Neurosanbe inj. 60 amp 5000 & 7500 325,000 - amp - 60 amp
1 10 amp 7,500.00 75,000 50 amp
1 10 amp 5,000.00 50,000 40 amp
60 amp 5000 & 7500 325,000 - amp - 20 amp 5000 & 7500 125,000 40 amp
Novabion 100 tab 260.00 26,000 - tab - 100 tab
100 tab 260.00 26,000 - tab - 100 tab 260.00 26,000 0 tab
21 Novaflox 300 tab 450.00 135,000 - tab - - tab 450.00 - 300 tab
300 tab 450.00 135,000 - tab - - tab 450.00 - 300 tab
23 Novamog 200 tab 400.00 80,000 - tab - - tab 400.00 - 200 tab
200 tab 400.00 80,000 - tab - - tab 400.00 - 200 tab
24 Novaxifen 200 tab 250.00 50,000 - tab - - tab 250.00 - 200 tab
200 tab 250.00 50,000 - tab - - tab 250.00 - 200 tab
26 Sarung Tangan Obgyn 50 set 4,249.00 212,450 - set - - set 4,249.00 - 50 set
50 set 4,249.00 212,450 - set - - set 4,249.00 - 50 set
30 Tidifar 200 tab 260.00 52,000 - tab - - tab 260.00 - 200 tab
200 tab 260.00 52,000 - tab - - tab 260.00 - 200 tab
Trifaneuro 100 tab 300.00 30,000 - sase - 100 sase
100 tab 300.00 30,000 - sase - 100 sase 300.00 30,000 0 sase
32 Trolit 6 sase 13,333.33 80,000 - sase - - sase 13,333.33 - 6 sase
6 sase 13,333.33 80,000 - sase - - sase 13,333.33 - 6 sase
dst 1
J U M LAH 2,458,450 - 311,500 1
1
J U M LAH TOTAL (A+B+C+D) ### - ### 1
MENGETAHUI Sumbermalang, 31 Oktober 2015

NO NAMA BARANG
KEPALA UPTD PUSKESMAS SUMBERMALANG PENGELOLA OBAT
A M R O Z I, S.Kep.Ns JONI HARDIANTO

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
3,509.00 210,540 1 1 2
3,509.00 168,432 UGD 0 1 1
3,509.00 147,378 Laborat 0 1 1
3,509.00 147,378 - 147,378 1 1 2
344.00 216,032 - 216,032 1 1 2
344.00 216,032 - 216,032 1 1 2
86.00 297,818 - 297,818 1 1 2
86.00 289,218 Ponkesdes Tlogosari 297,818 (8,600) 0 1 1
86.00 289,218 - 289,218 1 1 2
126.50 495,374 - 495,374 1 1 2
126.50 482,724 apotek 495,374 (12,650) 0 1 1
126.50 470,074 ponkesdes kalirejo 482,724 (12,650) 0 1 1
126.50 444,774 ponkesdes sumberargo 470,074 (25,300) 0 1 1
126.50 432,124 - 432,124 1 1 2
3,822.00 1,719,900 - 1,719,900 1 1 2
3,822.00 1,605,240 exp 1,719,900 (114,660) 0 1 1
3,822.00 1,605,240 - 1,605,240 1 1 2
80.00 310,800 - 310,800 1 1 2
80.00 286,800 apotek 310,800 (24,000) 0 1 1
80.00 278,800 UGD 286,800 (8,000) 0 1 1
80.00 270,800 Ponkesdes Sumberargo 278,800 (8,000) 0 1 1
80.00 270,000 Ambugelu 270,800 (800) 0 1 1
80.00 262,000 Polindes Taman 270,000 (8,000) 0 1 1
80.00 254,000 Polindes Alastengah 262,000 (8,000) 0 1 1
80.00 254,000 - 254,000 1 1 2
261.00 4,344,867 - 4,344,867 1 1 2
261.00 4,188,267 Apotek 4,344,867 (156,600) 0 1 1
261.00 4,136,067 Ponkesdes Kalirejo 4,188,267 (52,200) 0 1 1
261.00 4,057,767 ponkesdes sumberargo 4,136,067 (78,300) 0 1 1
261.00 4,031,667 Pustu Plalangan 4,057,767 (26,100) 0 1 1
261.00 3,927,267 Ponkesdes Tlogosari 4,031,667 (104,400) 0 1 1
261.00 3,875,067 Polindes Taman 3,927,267 (52,200) 0 1 1
261.00 3,822,867 Polindes Alastengah 3,875,067 (52,200) 0 1 1
261.00 3,822,867 - 3,822,867 1 1 2
2,445.00 1,936,440 - 1,936,440 1 1 2
2,445.00 1,887,540 Apotek 1,936,440 (48,900) 0 1 1
2,445.00 1,863,090 ponkesdes kalirejo 1,887,540 (24,450) 0 1 1
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
2,445.00 1,740,840 Pustu Plalangan 1,863,090 (122,250) 0 1 1
2,445.00 1,740,840 - 1,740,840 1 1 2
3,161.00 1,264,400 - 1,264,400 1 1 2
3,161.00 1,264,400 - 1,264,400 1 1 2
72.00 522,144
- 522,144 1 1 2
72.00 507,744 apotek 522,144 (14,400) 0 1 1
72.00 500,544 UGD 507,744 (7,200) 0 1 1
72.00 450,144 Polindes Taman 464,544 (14,400) 0 1 1
72.00 430,992 Ambugelu 435,744 (4,752) 0 1 1
72.00 430,992 - 430,992 1 1 2
2,160.00 913,680
- 913,680 1 1 2
2,160.00 902,880 UGD 913,680 (10,800) 0 1 1
2,160.00 881,280 ponkesdes kalirejo 902,880 (21,600) 0 1 1
2,160.00 859,680 Polindes Taman 881,280 (21,600) 0 1 1
2,160.00 816,480 Polindes Alastengah 859,680 (43,200) 0 1 1
2,160.00 816,480 - 816,480 1 1 2
2,516.00 1,356,124 - 1,356,124 1 1 2

2,516.00 1,356,124 - 1,356,124 1 1 2
1,904.00 287,504 - 287,504 1 1 2

1,904.00 268,464 Ponkesdes Kalirejo 287,504 (19,040) 0 1 1
1,904.00 268,464 - 268,464 1 1 2
2,450.00 147,000 - 147,000 1 1 2

2,450.00 122,500 - 122,500 1 1 2
123.00 270,600 - 270,600 1 1 2
123.00 258,300 - 258,300 1 1 2
112.00 204,064 - 204,064 1 1 2
112.00 192,864 apotek 204,064 (11,200) 0 1 1
112.00 159,264 UGD 192,864 (33,600) 0 1 1
112.00 136,864 Pustu Plalangan 148,064 (11,200) 0 1 1
112.00 132,608 Ambugelu 136,864 (4,256) 0 1 1
112.00 132,608 - 132,608 1 1 2
3,150.00 510,300 - 510,300 1 1 2
3,150.00 478,800 Polindes Taman 510,300 (31,500) 0 1 1
3,150.00 478,800 - 478,800 1 1 2
237.00 11,850 - 11,850 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
237.00 11,850 - 11,850 1 1 2
336.00 352,800 - 352,800 1 1 2
336.00 352,800 - 352,800 1 1 2
1,520.00 77,520 - 77,520 1 1 2
1,520.00 77,520 - 77,520 1 1 2
12,650.00 12,650 - 12,650 1 1 2
12,650.00 12,650 - 12,650 1 1 2
21,758.00 391,644 - 391,644 1 1 2
21,758.00 391,644 - 391,644 1 1 2
313.50 15,675 - 15,675 1 1 2
313.50 15,675 - 15,675 1 1 2
1,580.00 2,054,000 - 2,054,000 1 1 2
1,580.00 2,054,000 - 2,054,000 1 1 2
62.00 307,396 - 307,396 1 1 2
62.00 276,396 Apotek 307,396 (31,000) 0 1 1
62.00 263,996 UGD 276,396 (12,400) 0 1 1
62.00 257,796 Ponkesdes Kalirejo 263,996 (6,200) 0 1 1
62.00 220,596 Polindes Taman 232,996 (12,400) 0 1 1
62.00 208,196 - 208,196 1 1 2
2,344.00 564,904 - 564,904 1 1 2
2,344.00 557,872 UGD 564,904 (7,032) 0 1 1
2,344.00 557,872 - 557,872 1 1 2
35.00 40,320 - 40,320 1 1 2
35.00 40,320 - 40,320 1 1 2
56.00 14,000 - 14,000 1 1 2
56.00 14,000 - 14,000 1 1 2
1,050.00 1,145,550 - 1,145,550 1 1 2
1,050.00 1,114,050 UGD 1,145,550 (31,500) 0 1 1
1,050.00 1,082,550 Ponkesdes Kalirejo 1,114,050 (31,500) 0 1 1
1,050.00 1,051,050 Pustu Plalangan 1,082,550 (31,500) 0 1 1
1,050.00 956,550 Ponkesdes Tlogosari 1,051,050 (94,500) 0 1 1
1,050.00 956,550 - 956,550 1 1 2
97.00 19,400 - 19,400 1 1 2
97.00 19,400 - 19,400 1 1 2
104.00 52,000 - 52,000 1 1 2
104.00 52,000 - 52,000 1 1 2
3,624.00 25,368 - 25,368 1 1 2
3,624.00 25,368 - 25,368 1 1 2
38.00 11,400 - 11,400 1 1 2
38.00 11,400 - 11,400 1 1 2
8,100.00 712,800 - 712,800 1 1 2
8,100.00 712,800 - 712,800 1 1 2
337.04 60,667 - 60,667 1 1 2
337.04 60,667 - 60,667 1 1 2
864.25 1,189,208 - 1,189,208 1 1 2
864.25 1,189,208 - 1,189,208 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
7,700.00 277,200 - 277,200 1 1 2
7,700.00 277,200 - 277,200 1 1 2
3,223.00 25,784 - 25,784 1 1 2
3,223.00 25,784 - 25,784 1 1 2
1,716.00 161,304 - 161,304 1 1 2
1,716.00 161,304 - 161,304 1 1 2
630.00 945,000 - 945,000 1 1 2
630.00 882,000 Apotek 945,000 (63,000) 0 1 1
630.00 882,000 - 882,000 1 1 2
3,417.00 1,732,419 - 1,732,419 1 1 2
3,417.00 1,732,419 - 1,732,419 1 1 2
85.00 170,000 - 170,000 1 1 2
85.00 170,000 - 170,000 1 1 2
288.00 1,728,000 - 1,728,000 1 1 2
288.00 1,699,200 Apotek 1,728,000 (28,800) 0 1 1
288.00 1,641,600 - 1,641,600 1 1 2
3,399.00 254,925 - 254,925 1 1 2
3,399.00 254,925 - 254,925 1 1 2
1,650.00 239,250 - 239,250 1 1 2
1,650.00 222,750 Apotek 239,250 (16,500) 0 1 1
1,650.00 206,250 - 206,250 1 1 2
900.00 53,100 - 53,100 1 1 2
900.00 46,800 Apotek 53,100 (6,300) 0 1 1
900.00 33,300 Pustu Plalangan 42,300 (9,000) 0 1 1
900.00 28,800 Ambugelu 33,300 (4,500) 0 1 1
900.00 28,800 - 28,800 1 1 2
56.00 173,600 - 173,600 1 1 2
56.00 173,040 Ambugelu 173,600 (560) 0 1 1
56.00 173,040 - 173,040 1 1 2
44.00 787,424 - 787,424 1 1 2
44.00 742,544 Ambugelu 743,424 (880) 0 1 1
44.00 742,544 - 742,544 1 1 2
5,727.00 22,908 - 22,908 1 1 2
5,727.00 22,908 - 22,908 1 1 2
5,200.00 1,861,600 - 1,861,600 1 1 2
5,200.00 1,835,600 - 1,835,600 1 1 2
209.00 456,665 - 456,665 1 1 2
209.00 435,765 - 435,765 1 1 2
36.00 134,172 - 134,172 1 1 2
36.00 134,172 - 134,172 1 1 2
2,798.00 1,717,972 - 1,717,972 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
2,798.00 1,703,982 UGD 1,717,972 (13,990) 0 1 1
2,798.00 1,608,850 ponkesdes sumberargo 1,676,002 (67,152) 0 1 1
2,798.00 1,538,900 Ponkesdes Tlogosari 1,608,850 (69,950) 0 1 1
2,798.00 1,538,900 - 1,538,900 1 1 2
110.00 110,000 - 110,000 1 1 2
110.00 99,000 Apotek 110,000 (11,000) 0 1 1
110.00 99,000 - 99,000 1 1 2
150.00 828,000 - 828,000 1 1 2
150.00 798,000 Apotek 828,000 (30,000) 0 1 1
150.00 738,000 Polindes Taman 753,000 (15,000) 0 1 1
150.00 702,150 Ambugelu 708,000 (5,850) 0 1 1
150.00 702,150 - 702,150 1 1 2
44.00 79,200 - 79,200 1 1 2
44.00 79,200 - 79,200 1 1 2
88.00 44,000 - 44,000 1 1 2
88.00 44,000 - 44,000 1 1 2
81.40 1,959,949 - 1,959,949 1 1 2
81.40 1,959,949 - 1,959,949 1 1 2
62.00 1,240 - 1,240 1 1 2
62.00 - - - 1 0 1
84.00 547,848 - 547,848 1 1 2
84.00 514,248 Polindes Taman 531,048 (16,800) 0 1 1
84.00 491,988 Ambugelu 497,448 (5,460) 0 1 1
84.00 491,988 - 491,988 1 1 2
243.00 48,600 - 48,600 1 1 2
243.00 48,600 - 48,600 1 1 2
2,569.00 526,645 - 526,645 1 1 2
2,569.00 526,645 - 526,645 1 1 2
300.00 465,000 - 465,000 1 1 2
300.00 435,000 - 435,000 1 1 2
205.00 20,500 - 20,500 1 1 2
205.00 10,250 Apotek 20,500 (10,250) 0 1 1
205.00 10,250 - 10,250 1 1 2
356.40 409,860 - 409,860 1 1 2
356.40 409,860 - 409,860 1 1 2
3,700.00 173,900 - 173,900 1 1 2
3,700.00 155,400 - 155,400 1 1 2
2,200.00 52,800 - 52,800 1 1 2
2,200.00 41,800 Apotek 52,800 (11,000) 0 1 1
2,200.00 41,800 - 41,800 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
91.30 5,549,762 - 5,549,762 1 1 2
91.30 5,522,372 Apotek 5,549,762 (27,390) 0 1 1
91.30 5,312,382 - 5,312,382 1 1 2
168.00 33,600 - 33,600 1 1 2
168.00 28,560 Program Jiwa 33,600 (5,040) 0 1 1
168.00 28,560 - 28,560 1 1 2
138.00 1,086,474
- 1,086,474 1 1 2
138.00 1,045,074 - 1,045,074 1 1 2
72.00 765,504
- 765,504 1 1 2
72.00 693,504 - 693,504 1 1 2
2,167.00 1,861,453
- 1,861,453 1 1 2
2,167.00 1,844,117 Apotek 1,861,453 (17,336) 0 1 1
2,167.00 1,475,727 exp 1,844,117 (368,390) 0 1 1
2,167.00 1,473,560 Ambugelu 1,473,560 - 0 1 1
2,167.00 1,473,560 - 1,473,560 1 1 2
9,000.00 4,500,000
- 4,500,000 1 1 2
9,000.00 4,500,000 - 4,500,000 1 1 2
9,000.00 270,000 - 270,000 1 1 2
9,000.00 270,000 - 270,000 1 1 2
10,000.00 5,000,000
- 5,000,000 1 1 2
10,000.00 5,000,000 - 5,000,000 1 1 2
10,000.00 3,250,000
- 3,250,000 1 1 2
10,000.00 3,250,000 - 3,250,000 1 1 2
573.00 305,982 - 305,982 1 1 2
573.00 305,982 - 305,982 1 1 2
1,363.00 1,222,611 - 1,222,611 1 1 2
1,363.00 1,099,941 Polindes Alastengah 1,222,611 (122,670) 0 1 1
1,363.00 1,099,941 - 1,099,941 1 1 2
91.55 30,852 - 30,852 1 1 2
91.55 21,148 Ambugelu 21,697 (549) 0 1 1
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
91.55 21,148 - 21,148 1 1 2
154.00 138,600 - 138,600 1 1 2
154.00 138,600 - 138,600 1 1 2
6,600.00 138,600 - 138,600 1 1 2
6,600.00 138,600 - 138,600 1 1 2
220 & 126,5 6,769,345 - 6,769,345 1 1 2
220 & 126,5 6,744,045 UGD 6,769,345 (25,300) 0 1 1
220 & 126,5 6,718,745 Polindes Kalirejo 6,744,045 (25,300) 0 1 1
220 & 126,5 6,680,795 Ponkesdes Sumberargo 6,718,745 (37,950) 0 1 1
220 & 126,5 6,630,195 Apotek 6,680,795 (50,600) 0 1 1
220 & 126,5 6,607,425 Ambugelu 6,630,195 (22,770) 0 1 1
220 & 126,5 6,582,125 Ponkesdes Tlogosari 6,607,425 (25,300) 0 1 1
220 & 126,5 6,544,175 Polindes Taman 6,582,125 (37,950) 0 1 1
220 & 126,5 6,506,225 Polindes Alastengah 6,544,175 (37,950) 0 1 1
220 & 126,5 6,506,225 - 6,506,225 1 1 2
3,499.00 713,796 - 713,796 1 1 2
3,499.00 706,798 UGD 713,796 (6,998) 0 1 1
3,499.00 706,798 - 706,798 1 1 2
140.00 84,000 - 84,000 1 1 2
140.00 70,000 Pustu Plalangan 84,000 (14,000) 0 1 1
140.00 70,000 - 70,000 1 1 2
300.00 9,000 - 9,000 1 1 2
300.00 9,000 - 9,000 1 1 2
110.00 132,000 - 132,000 1 1 2
110.00 121,000 - 121,000 1 1 2
160.00 1,227,680 - 1,227,680 1 1 2
160.00 1,195,680 Apotek 1,227,680 (32,000) 0 1 1
160.00 1,179,680 UGD 1,195,680 (16,000) 0 1 1
160.00 1,131,680 Polindes Taman 1,147,680 (16,000) 0 1 1
160.00 1,115,680 - 1,115,680 1 1 2
3,000.00 12,000 - 12,000 1 1 2
3,000.00 12,000 - 12,000 1 1 2
176.00 578,688 - 578,688 1 1 2
176.00 569,888 Apotek 578,688 (8,800) 0 1 1
176.00 552,288 Ponkesdes Sumberargo 569,888 (17,600) 0 1 1
176.00 534,688 Polindes Taman 552,288 (17,600) 0 1 1
176.00 481,888 Pilondes Alastengah 534,688 (52,800) 0 1 1
176.00 481,888 - 481,888 1 1 2
4,700.00 5,118,300 - 5,118,300 1 1 2

4,700.00 5,118,300 - 5,118,300 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
110.00 253,000 - 253,000 1 1 2
110.00 242,000 - 242,000 1 1 2
640.00 512,000 - 512,000 1 1 2
640.00 448,000 - 448,000 1 1 2
7,000.00 455,000 - 455,000 1 1 2
7,000.00 245,000 UGD 455,000 (210,000) 0 1 1
7,000.00 245,000 - 245,000 1 1 2
5,940.00 2,607,660 - 2,607,660 1 1 2
5,940.00 2,542,320 Ambugelu 2,548,260 (5,940) 0 1 1
5,940.00 2,542,320 - 2,542,320 1 1 2
2,772.00 133,056 - 133,056 1 1 2
2,772.00 119,196 Apotek 133,056 (13,860) 0 1 1
2,772.00 105,336 UGD 119,196 (13,860) 0 1 1
2,772.00 72,072 Pustu Plalangan 105,336 (33,264) 0 1 1
2,772.00 72,072 - 72,072 1 1 2
2,010.00 836,160 - 836,160 1 1 2
2,010.00 735,660 Ponkesdes Tlogosari 785,910 (50,250) 0 1 1
2,010.00 731,640 Ambugelu 735,660 (4,020) 0 1 1
2,010.00 731,640 - 731,640 1 1 2
2,200.00 301,400 - 301,400 1 1 2
2,200.00 301,400 - 301,400 1 1 2
119.00 928,200 - 928,200 1 1 2
119.00 928,200 - 928,200 1 1 2
5,200.00 962,000 - 962,000 1 1 2
5,200.00 946,400 Apotek 962,000 (15,600) 0 1 1
5,200.00 946,400 - 946,400 1 1 2
1,438.00 917,444 - 917,444 1 1 2
1,438.00 891,560 Apotek 917,444 (25,884) 0 1 1
1,438.00 770,768 Pustu Plalangan 891,560 (120,792) 0 1 1
1,438.00 756,388 Polindes Taman 770,768 (14,380) 0 1 1
1,438.00 727,628 - 727,628 1 1 2
32.00 27,520 - 27,520 1 1 2
32.00 24,320 - 24,320 1 1 2
79.00 2,768,476 - 2,768,476 1 1 2
79.00 2,728,976 Apotek 2,768,476 (39,500) 0 1 1
79.00 2,689,476 Ponkesdes Sumberargo 2,713,176 (23,700) 0 1 1
79.00 2,665,776 Polindes Taman 2,689,476 (23,700) 0 1 1
79.00 2,639,232 Ambugelu 2,642,076 (2,844) 0 1 1
79.00 2,639,232 - 2,639,232 1 1 2
6,270.00 3,009,600 - 3,009,600 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
6,270.00 3,009,600 - 3,009,600 1 1 2
17.39 19,129 - 19,129 1 1 2
17.39 19,129 - 19,129 1 1 2

100.10 190,190 - 190,190 1 1 2
100.10 180,180 - 180,180 1 1 2
2,163.00 25,956 - 25,956 1 1 2
2,163.00 23,793 - 23,793 1 1 2
151.80 4,290,475 - 4,290,475 1 1 2
151.80 4,275,295 Pustu Plalangan 4,290,475 (15,180) 0 1 1
151.80 4,275,295 - 4,275,295 1 1 2
5,500.00 907,500 - 907,500 1 1 2
5,500.00 907,500 - 907,500 1 1 2
284.00 56,800 - 56,800 1 1 2
284.00 56,800 - 56,800 1 1 2
1,500.00 37,500 - 37,500 1 1 2
1,500.00 - - - 1 0 1
120.00 406,560 - 406,560 1 1 2
120.00 382,560 Apotek 406,560 (24,000) 0 1 1
120.00 336,000 - 336,000 1 1 2
398,420.00 398,420 - 398,420 1 1 2
398,420.00 - - - 1 0 1
96.80 403,075 - 403,075 1 1 2

96.80 383,715 Polindes Taman 393,395 (9,680) 0 1 1
96.80 374,035 - 374,035 1 1 2
1,800.00 97,200 - 97,200 1 1 2
1,800.00 97,200 - 97,200 1 1 2
1,250.00 408,750 - 408,750 1 1 2
1,250.00 396,250 - 396,250 1 1 2
10,384.00 238,832 - 238,832 1 1 2
10,384.00 238,832 - 238,832 1 1 2
509.00 509,000 - 509,000 1 1 2
509.00 458,100 UGD 509,000 (50,900) 0 1 1
509.00 458,100 - 458,100 1 1 2
2,950.00 1,652,000 - 1,652,000 1 1 2
2,950.00 1,652,000 - 1,652,000 1 1 2
3,300.00 422,400 - 422,400 1 1 2
3,300.00 422,400 - 422,400 1 1 2
137,500.00 412,500 - 412,500 1 1 2

SALDO
Ket
Harga
Jumlah
Satuan (Rp)
137,500.00 - - - 1 0 1
1,078.00 3,763,298 - 3,763,298 1 1 2
1,078.00 3,655,498 - 3,655,498 1 1 2
110.84 510,972 - 510,972 1 1 2
110.84 499,888 - 499,888 1 1 2
169.00 5,070 - 5,070 1 1 2
169.00 - - - 1 0 1
255.00 1,131,180 - 1,131,180 1 1 2

255.00 1,080,180 Apotek 1,131,180 (51,000) 0 1 1
255.00 1,003,680 Polindes Taman 1,029,180 (25,500) 0 1 1
255.00 978,180 Polindes Alastengah 1,003,680 (25,500) 0 1 1
255.00 975,630 Ambugelu 978,180 (2,550) 0 1 1
255.00 975,630 - 975,630 1 1 2
12,045.00 228,855 - 228,855 1 1 2
12,045.00 228,855 - 228,855 1 1 2
149.00 1,177,100 - 1,177,100 1 1 2
149.00 1,177,100 - 1,177,100 1 1 2
300.30 757,056 - 757,056 1 1 2
300.30 757,056 - 757,056 1 1 2
616.00 369,600 - 369,600 1 1 2
616.00 369,600 - 369,600 1 1 2
69.30 1,944,558 - 1,944,558 1 1 2
69.30 1,868,328 Ambugelu 1,875,258 (6,930) 0 1 1
69.30 1,799,028 Pustu Plalangan 1,868,328 (69,300) 0 1 1
69.30 1,799,028 - 1,799,028 1 1 2
680.00 223,040 - 223,040 1 1 2
680.00 182,240 exp 223,040 (40,800) 0 1 1
680.00 182,240 - 182,240 1 1 2
40.00 4,000 - 4,000 1 1 2
40.00 4,000 - 4,000 1 1 2
7,480.00 254,320 - 254,320 1 1 2
7,480.00 254,320 - 254,320 1 1 2
8,500.00 170,000 - 170,000 1 1 2
8,500.00 - - - 1 0 1
107 & 34,1 2,684,701 - 2,684,701 1 1 2
107 & 34,1 2,577,701 Ponkesdes Kalirejo 2,684,701 (107,000) 0 1 1
107 & 34,1 2,470,701 Pustu Plalangan 2,577,701 (107,000) 0 1 1
107 & 34,1 2,467,491 Ambugelu 2,470,701 (3,210) 0 1 1
107 & 34,1 2,467,491 - 2,467,491 1 1 2
12,840.00 680,520 - 680,520 1 1 2
12,840.00 680,520 - 680,520 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
474.00 2,862,012 - 2,862,012 1 1 2
474.00 2,719,812 Polindes Taman 2,814,612 (94,800) 0 1 1
474.00 2,625,012 - 2,625,012 1 1 2
1 111,057,147 - 111,057,147 0 1 1
- - 0 1 1
625.00 125,000 - 125,000 1 1 2
625.00 125,000 - 125,000 1 1 2
1038 & 1089 15,856,830 - 15,856,830 1 1 2
1038 & 1089 15,649,230 UGD 15,856,830 (207,600) 0 1 1
1038 & 1089 15,545,430 Ponkesdes Kalirejo 15,649,230 (103,800) 0 1 1
1038 & 1089 15,337,830 Ponkesdes Sumberargo 15,545,430 (207,600) 0 1 1
1038 & 1089 15,234,030 Pustu Plalangan 15,337,830 (103,800) 0 1 1
1038 & 1089 15,130,230 Ponkesdes Tlogosari 15,234,030 (103,800) 0 1 1
1038 & 1089 15,026,430 Polindes Taman 15,130,230 (103,800) 0 1 1
1038 & 1089 14,922,630 Polindes Alastengah 15,026,430 (103,800) 0 1 1
1038 & 1089 14,922,630 - 14,922,630 1 1 2
5,583.33 1,099,916 - 1,099,916 1 1 2
5,583.33 1,099,916 - 1,099,916 1 1 2
3,500.00 2,184,000 - 2,184,000 1 1 2
3,500.00 2,026,500 UGD 2,184,000 (157,500) 0 1 1
3,500.00 2,026,500 - 2,026,500 1 1 2
3,509.00 1,677,302 - 1,677,302 1 1 2
3,509.00 1,501,852 UGD 1,677,302 (175,450) 0 1 1
3,509.00 1,501,852 - 1,501,852 1 1 2
9,185.00 4,721,090 - 4,721,090 1 1 2
9,185.00 4,721,090 - 4,721,090 1 1 2
9,185.00 1,827,815 - 1,827,815 1 1 2
9,185.00 1,368,565 UGD 1,827,815 (459,250) 0 1 1
9,185.00 1,368,565 - 1,368,565 1 1 2
9,185.00 3,921,995 - 3,921,995 1 1 2
9,185.00 3,921,995 - 3,921,995 1 1 2
12,500.00 1,375,000 - 1,375,000 1 1 2
12,500.00 1,362,500 UGD 1,375,000 (12,500) 0 1 1
12,500.00 1,337,500 Polindes Taman 1,350,000 (12,500) 0 1 1
12,500.00 1,325,000 - 1,325,000 1 1 2
5,800.00 313,200 - 313,200 1 1 2

5,800.00 313,200 - 313,200 1 1 2
750.00 2,061,750 - 2,061,750 1 1 2
750.00 2,046,750 - 2,046,750 1 1 2
1,500.00 1,879,500 - 1,879,500 1 1 2
1,500.00 1,804,500 UGD 1,879,500 (75,000) 0 1 1
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
1,500.00 1,759,500 - 1,759,500 1 1 2
33,000.00 2,343,000 - 2,343,000 1 1 2

33,000.00 2,343,000 - 2,343,000 1 1 2
33,000.00 1,716,000 - 1,716,000 1 1 2
33,000.00 1,716,000 - 1,716,000 1 1 2
41,800.00 2,508,000 - 2,508,000 1 1 2
41,800.00 2,508,000 - 2,508,000 1 1 2
23,485.00 234,850 - 234,850 1 1 2
23,485.00 234,850 - 234,850 1 1 2
23,624.70 590,618 - 590,618 1 1 2
23,624.70 543,368 UGD 590,618 (47,249) 0 1 1
23,624.70 543,368 - 543,368 1 1 2
3,055.56 528,612 - 528,612 1 1 2
3,055.56 418,612 - 418,612 1 1 2
3,000.00 60,000 - 60,000 1 1 2
3,000.00 60,000 - 60,000 1 1 2
8,000.00 80,000 - 80,000 1 1 2
8,000.00 80,000 - 80,000 1 1 2
4,249.30 4,504,258 - 4,504,258 1 1 2
4,249.30 3,654,398 UGD 4,504,258 (849,860) 0 1 1
4,249.30 3,229,468 UGD 3,654,398 (424,930) 0 1 1
4,249.30 3,229,468 - 3,229,468 1 1 2
440.00 88,880 - 88,880 1 1 2
440.00 66,880 UGD 88,880 (22,000) 0 1 1
440.00 66,880 - 66,880 1 1 2
1 46,332,176 - 46,332,176 0 1 1
- - 0 1 1
1 - - - 0 1 1
- - 0 1 1
11,000.00 55,000 - 55,000 1 1 2
11,000.00 55,000 - 55,000 1 1 2
350.00 105,000 - 105,000 1 1 2
350.00 35,000 UGD 105,000 (70,000) 0 1 1
350.00 35,000 - 35,000 1 1 2
7,000.00 35,000 - 35,000 1 1 2
7,000.00 35,000 - 35,000 1 1 2
2,500.00 35,000 - 35,000 1 1 2
2,500.00 35,000 - 35,000 1 1 2
2,500.00 37,500 - 37,500 1 1 2
2,500.00 30,000 - 30,000 1 1 2
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
- - - - 1 0 1
- - - - 1 0 1
4,500.00 90,000 - 90,000 1 1 2
4,500.00 90,000 - 90,000 1 1 2
155.00 31,000 - 31,000 1 1 2
155.00 31,000 - 31,000 1 1 2
- - - - 1 1 2
- - - - 1 1 2
10,000.00 50,000 - 50,000 1 1 2
10,000.00 50,000 - 50,000 1 1 2
9,185.00 918,500 - 918,500 1 1 2
9,185.00 918,500 - 918,500 1 1 2
- - - - 1 1 2
- - - - 1 1 2
660.00 33,000 - 33,000 1 1 2
660.00 33,000 - 33,000 1 1 2
5,000.00 25,000 - 25,000 1 1 2
5,000.00 25,000 - 25,000 1 1 2
265.00 53,000 - 53,000 1 1 2
265.00 - - - 1 0 1
5000 & 7500 325,000 - 325,000 1 1 2
5,000.00 250,000 UGD 325,000 (75,000) 0 1 1
5,000.00 200,000 0 1 1
5,000.00 200,000 - 200,000 1 1 2
260.00 26,000 - 26,000 1 1 2
260.00 - - - 1 0 1
450.00 135,000 - 135,000 1 1 2
450.00 135,000 - 135,000 1 1 2
400.00 80,000 - 80,000 1 1 2
400.00 80,000 - 80,000 1 1 2
250.00 50,000 - 50,000 1 1 2
250.00 50,000 - 50,000 1 1 2
4,249.00 212,450 - 212,450 1 1 2
4,249.00 212,450 - 212,450 1 1 2
260.00 52,000 - 52,000 1 1 2
260.00 52,000 - 52,000 1 1 2
300.00 30,000 - 30,000 1 1 2
300.00 - - - 1 0 1
13,333.33 80,000 - 80,000 1 1 2
13,333.33 80,000 - 80,000 1 1 2
0 1 1
1 2,146,950 0 1 1
0 1 1
### 0 1 1
159,536,273.18
er 2015
SALDO
Ket
Harga
Jumlah
Satuan (Rp)
1 016
LPLPO GUDANG OBAT
31 Oktober 2015
Stok Awal Penerimaan Pemakaian
No Nama Obat SAT
DAK DAU Askes JKN Lain2 Total DAK DAU Askes JKN Lain2 Total DAK DAU Askes JKN Lain2 Total DAK
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl 60 - - - - 60 - - - - - - 18 - - - - 18 42
2 Albendazol suspensi 200 mg/5 ml btl - - - - - - - - - - - - - - - - - - -
3 Albendazol tablet 400 mg Tab 240 388 - - - 628 - - - - - - - - - - - - 240
4 Alopurinol tablet 100 mg Tab 3,463 - - - - 3,463 - - - - - - 100 - - - - 100 3,363
5 Alopurinol tablet 300 mg tab - - - - - - - - - - - - - - - - - - -
6 Alprazolam tablet 0,25 mg tab - - - - - - - - - - - - - - - - - - -
7 Alprazolam tablet 0,5 mg tab - - - - - - - - - - - - - - - - - - -
8 Alprazolam tablet 1 mg tab - - - - - - - - - - - - - - - - - - -
9 Ambroxol sirup 15 mg/ml btl - - - - - - - - - - - - - - - - - - -
10 Ambroxol sirup 15 mg/ml btl - - - - - - - - - - - - - - - - - - -
11 Ambroxol tablet 30 mg Tab 3,916 - - - - 3,916 - - - - - - 500 - - - - 500 3,416
12 Aminofilin injeksi 24 mg/ml Amp 90 - 90 270 - 450 - - - - - - 30 - - - - 30 60
13 Aminofilin tablet 150 mg tab - - - - - - - - - - - - - - - - - - -
14 Aminofilin tablet 200 mg Tab 3,885 - - - - 3,885 - - - - - - 710 - - - - 710 3,175
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - - - - - - - - - - - - - - - - -
16 Amlodipin tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
17 Amlodipin tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - - - - - - - - - - - - - - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps - - - - - - - - - - - - - - - - - - -
20 Amoksisilin kapsul/kaplet 500 mg Tab 16,647 - - - - 16,647 - - - - - - 2,000 - - - - 2,000 14,647
21 Amoksisilin serbuk injeksi 1000 mg vial - - - - - - - - - - - - - - - - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 792 - - - - 792 - - - - - - 80 - - - - 80 712
23 Amoxsan tab 500 mg tab - 400 - - - 400 - - - - - - - - - - - - -
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - - - - - - - - - - - - - - - - -
Antasida DOEN I tablet kunyah, kombinasi : Aluminium

27 Hidroksida 200 mg Magnesium Hidroksida 200 mg Tab 7,252 - - - - 7,252 - - - - - - 1,266 - - - - 1,266 5,986
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
28 mg/5 ml Btl 423 - - - - 423 - - - - - - 45 - - - - 45 378
Anti Bakteri DOEN salep kombinasi: Basitrasin 500
29 IU/g + Polimiksin 10.000 IU/g Tube 494 - 45 - - 539 - - - - - - - - - - - - 494
30 Salisilat 3% pot 151 - - - - 151 - - - - - - 10 - - - - 10 141
31 mg Heksaklorofen 2,5 mg Supp 60 - - - - 60 - - - - - - 10 - - - - 10 50
32 mg Sulfadoksin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
33 mg Tab 2,200 - - - - 2,200 - - - - - - 100 - - - - 100 2,100
34 Antrain inj amp - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
35 Aqua pro Injeksi steril, bebas pirogen Amp - - - - - - - - - - - - - - - - - - -
36 Artemether injeksi 80 mg/ml amp - - - - - - - - - - - - - - - - - - -
37 Artesunate injeksi, vial 60 mg vial - - - - - - - - - - - - - - - - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - - - - - - - - - - - - - - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab - - - - - - - - - - - - - - - - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab - - - - - - - - - - - - - - - - - - -
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
42 Asam Askorbat (Vitamin C) tablet 250 mg tab - - - - - - - - - - - - - - - - - - -
43 Asam Folat tablet 1 mg tab - - - - - - - - - - - - - - - - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - - - - - - - - - - - - - - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 1,822 - - - - 1,822 - - - - - - 638 - - - - 638 1,184
46 Asam Mefenamat kapsul/kaplet 500 mg tab - - - - - - - - - - - - - - - - - - -
47 Asiklovir krim 5% Tube 25 - 137 - - 162 - - - - - - 10 - - - - 10 15
48 Asiklovir tablet 200 mg Tab 50 - - - - 50 - - - - - - - - - - - - 50
49 Asiklovir tablet 400 mg tab 1,050 - - - - 1,050 - - - - - - - - - - - - 1,050
51 Atapulgit tablet 600 mg tab - - - - - - - - - - - - - - - - - - -
52 Atenolol tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
53 Atenolol tablet 50 mg tab - - - - - - - - - - - - - - - - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - - - - - - - - - - - - - - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - - - - - - - - - - - - - - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - - - - - - - - - - - - - - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - - - - - - - - - - - - - - - - -
58 (tablet tambah darah kombinasi ) tab - - - - - - - - - - - - - - - - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - - - - - - - - - - - - - - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 51 - - - - 51 - - - - - - - - - - - - 51
61 Bioplacenton tube - 1 - - - 1 - - - - - - - - - - - - -
62 Bisakodil suppositoria 10 mg supp - - - - - - - - - - - - - - - - - - -
63 Bisoprolol tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
64 Bromheksin tablet 8 mg tab - - - - - - - - - - - - - - - - - - -
65 Buscopan inj amp - 18 - - - 18 - - - - - - - - - - - - -
66 Cetirizin sirup 5 mg/5 ml btl - - - - - - - - - - - - - - - - - - -
67 Cetirizine tablet 10 mg tab 50 - - - - 50 - - - - - - - - - - - - 50
68 Clobazam tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
69 Clobetasol krim 0,05% tube - - - - - - - - - - - - - - - - - - -
70 Dapson tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 1,300 - - - - 1,300 - - - - - - - - - - - - 1,300
72 Deksametason injeksi i.v. 5 mg/ml amp - - - - - - - - - - - - - - - - - - -
73 Deksametason tablet 0,5 mg Tab 4,958 - - - - 4,958 - - - - - - 1,600 - - - - 1,600 3,358
74 Dekstran 70 - larutan infus 6% steril btl - - - - - - - - - - - - - - - - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - - - - - - - - - - - - - - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - - - - - - - - - - - - - - -
77 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - - - - - - - - - - - - - - -
78 Diazepam injeksi 5 mg/ml Amp 51 190 - - - 241 - - - - - - 3 - - - - 3 48
79 Diazepam tablet 2 mg Tab 1,152 - - - - 1,152 - - - - - - - - - - - - 1,152
80 Diazepam tablet 5 mg Tab - 250 - - - 250 - - - - - - - - - - - - -
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 1,091 - - - - 1,091 - - - - - - 180 - - - - 180 911
83 Digoksin tablet 0,25 mg Tab 200 - - - - 200 - - - - - - - - - - - - 200
84 Diltiazem HCl tablet 30 mg tab - - - - - - - - - - - - - - - - - - -
85 Dimenhidrinat tablet 50 mg tab 500 - - - - 500 - - - - - - - - - - - - 500
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - - - - - - - - - - - - - - - - -
87 Domperidon suspensi 5 mg/5 ml btl 7 - - - - 7 - - - - - - - - - - - - 7
88 Domperidon tablet 10 mg Tab - - - - - - - - - - - - - - - - - - -
89 Efedrin tablet 25 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
90 Ekstraks Belladona tablet 10 mg Tab - - 300 - - 300 - - - - - - - - - - - - -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp - - 88 - - 88 - - - - - - - - - - - - -
92 Eritromisin kapsul/kaplet 250 mg kaps 180 - - - - 180 - - - - - - - - - - - - 180
93 Eritromisin kapsul/kaplet 500 mg kaps 1,376 - - - - 1,376 - - - - - - - - - - - - 1,376
94 Eritromisin sirup 200 mg/ 5 ml Btl 36 - - - - 36 - - - - - - - - - - - - 36
95 Etakridin larutan 0,1% (Rivanol) Btl 8 - - - - 8 - - - - - - - - - - - - 8
96 Etambutol tablet 250 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - - - - - - - - - - - - - - - - -
99 Famotidine tablet 20 mg tab - - - - - - - - - - - - - - - - - - -
100 Famotidine tablet 40 mg tab - - - - - - - - - - - - - - - - - - -
101 Fenilbutason tablet 200 mg tab - - - - - - - - - - - - - - - - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - - - - - - - - - - - - - - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - - - - - - - - - - - - - - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - - - - - - - - - - - - - - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp - 94 - - - 94 - - - - - - - - - - - - -
106 Fenobarbital tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
107 Fenobarbital tablet 30 mg tab - - - - - - - - - - - - - - - - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - - - - - - - - - - - - - - - - -
109 Fenoksimetil Penisilin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
110 Fenol Gliserol tetes telinga 10% Btl - - - - - - - - - - - - - - - - - - -
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 1,100 400 - - - 1,500 - - - - - - - 100 - - - 100 1,100
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 420 87 - - - 507 - - - - - - - - - - - - 420
113 Flukonazol tablet 150 mg tab - - - - - - - - - - - - - - - - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - - - - - - - - - - - - - - - - -
115 Furosemid tablet 40 mg Tab 2,000 - - - - 2,000 - - - - - - - - - - - - 2,000
116 Garam Oralit I serbuk Sac 6,000 - - - - 6,000 - - - - - - 300 - - - - 300 5,700
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - - - - - - - - - - - - - - - - -
118 Gemfibrozil tablet 600 mg tab - - - - - - - - - - - - - - - - - - -
119 Gentamisin injeksi 40 mg/ ml amp 75 - - - - 75 - - - - - - - - - - - - 75
120 Gentamisin salep kulit 0.1% tube 65 - 80 - - 145 - - - - - - 20 - - - - 20 45
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - - - - - - - - - - - - - - - - -
122 Gentian Violet larutan 1 % Btl 59 - - - - 59 - - - - - - 27 - - - - 27 32
123 Glibenklamida tablet 5 mg Tab 3,100 - - - - 3,100 - - - - - - 10 - - - - 10 3,090
124 Glimepiride tablet 1 mg tab - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
129 Gliquidon tablet 30 mg tab - - - - - - - - - - - - - - - - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 17,896 - - - - 17,896 - - - - - - 1,020 - - - - 1,020 16,876
131 Gliserin btl - - - - - - - - - - - - - - - - - - -
132 Glukosa larutan infus 10 % steril Btl 4 - - - - 4 - - - - - - - - - - - - 4
133 Glukosa larutan infus 40 % steril Btl - - - - - - - - - - - - - - - - - - -
134 Glukosa larutan infus 5 % steril Btl 315 - 43 - - 358 - - - - - - - - 5 - - 5 315
135 Griseofulvin tablet 125 mg Tab 2,185 - - - - 2,185 - - - - - - 100 - - - - 100 2,085
136 Haloperidol inj 50 mg/mL amp - - - - - - - - - - - - - - - - - - -
137 Haloperidol tablet 0,5 mg tab - - - - - - - - - - - - - - - - - - -
138 Haloperidol tablet 1,5 mg tab - - - - - - - - - - - - - - - - - - -
139 Haloperidol tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 3,727 - - - - 3,727 - - - - - - - - - - - - 3,727
141 Hidrokortison krim 1% tube - - - - - - - - - - - - - - - - - - -
142 Hidrokortison krim 2,5 % Tube 614 - - - - 614 - - - - - - 64 - - - - 64 550
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl - - - - - - - - - - - - - - - - - - -
145 Ibuprofen suspensi 200 mg/5 ml btl - - - - - - - - - - - - - - - - - - -
146 Ibuprofen tablet 200 mg Tab 1,000 - - - - 1,000 - - - - - - 100 - - - - 100 900
147 Ibuprofen tablet 200 mg tab - - - - - - - - - - - - - - - - - - -
148 Ibuprofen tablet 400 mg Tab 5,520 - - - - 5,520 - - - - - - 839 - - - - 839 4,681
149 Ibuprofen tablet 400 mg tab - - - - - - - - - - - - - - - - - - -
150 Iodiol kapsul lunak kaps - - - - - - - - - - - - - - - - - - -
151 Isoniazid tablet 100 mg Tab 1,800 - - - - 1,800 - - - - - - - - - - - - 1,800
152 Isoniazid tablet 300 mg tab - - - - - - - - - - - - - - - - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab 500 - - - - 500 - - - - - - - - - - - - 500
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - - - - - - - - - - - - - - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - - - - - - - - - - - - - - - - -
156 Kalium Diklofenak tablet 50 mg tab - - - - - - - - - - - - - - - - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 24,078 - - - - 24,078 - - - - - - - - - - - - 24,078
158 Kaptopril tablet 12,5 mg Tab 20 - - - - 20 - - - - - - 20 - - - - 20 -
159 Kaptopril tablet 25 mg Tab 6,522 - - - - 6,522 - - - - - - 665 - - - - 665 5,857
160 Kaptopril tablet 50 mg tab - - - - - - - - - - - - - - - - - - -
161 Karbamazepin tablet 200 mg Tab 200 - - - - 200 - - - - - - - - - - - - 200
162 Ketokonazol krim 2% tube 115 - 90 - - 205 - - - - - - - - - - - - 115
163 Ketokonazol tablet 200 mg Tab 1,550 - - - - 1,550 - - - - - - 100 - - - - 100 1,450
164 Ketoprofen injeksi 100 mg amp - - - - - - - - - - - - - - - - - - -
165 Ketoprofen tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
166 Ketorolac injeksi 10 mg amp - - - - - - - - - - - - - - - - - - -
167 Ketorolac injeksi 30 mg amp - - - - - - - - - - - - - - - - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - - - - - - - - - - - - - - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 100 - - - - 100 - - - - - - 50 - - - - 50 50
170 Klomifen tablet 50 mg tab - - - - - - - - - - - - - - - - - - -
171 Klonidin tablet 0,15 mg tab - - - - - - - - - - - - - - - - - - -
172 Klonidin tablet 0,15 mg tab - - - - - - - - - - - - - - - - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 1,150 - - - - 1,150 - - - - - - - - - - - - 1,150
174 Kloramfenikol salep mata 1 % Tube - - - - - - - - - - - - - - - - - - -
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl - - 47 - - 47 - - - - - - - - 5 - - 5 -
No Nama Obat SAT
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - - - - - - - - - - - - - - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - - - - - - - - - - - - - - - - -
178 Kloramfenikol tetes telinga 3 % btl 24 - - - - 24 - - - - - - 5 - - - - 5 19
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 60,786 - - - - 60,786 - - - - - - 2,600 - - - - 2,600 58,186
180 Klorokuin tablet 250 mg tab - - - - - - - - - - - - - - - - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - - - - - - - - - - - - - - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - - - - - - - - - - - - - - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab - 200 - - - 200 - - - - - - - 30 - - - 30 -
185 Kodein tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 7,873 - - - - 7,873 - - - - - - 300 - - - - 300 7,573
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 9,952 680 - - - 10,632 - - - - - - 320 680 - - - 1,000 9,632
190 mg + Trimetoprim 40 mg / 5 ml Btl 859 - - - - 859 - - - - - - 179 - - - - 179 680
191 Kuinin (Kina) tablet 200 mg tab - - - - - - - - - - - - - - - - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - - - - - - - - - - - - - - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - - - - - - - - - - - - - - - - -
194 Lacto B sase - - - - - - - - - - - - - - - - - - -
195 Lamivudine tablet 150 mg tab - - - - - - - - - - - - - - - - - - -
196 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) btl 500 - - - - 500 - - - - - - - - - - - - 500
197 Dekstrosa 18.75 gr) (KAEN 1B) btl 30 - - - - 30 - - - - - - - - - - - - 30
198 (KAEN 3B) btl 500 - - - - 500 - - - - - - - - - - - - 500
2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27
199 gr) (KAEN 3A) btl 325 - - - - 325 - - - - - - - - - - - - 325
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - - - - - - - - - - - - - - - - -
201 Levofloksasin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
202 Levofloksasin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
203 Lidokain injeksi 2% amp 534 - - - - 534 - - - - - - - - - - - - 534
204 Lidokain injeksi 2% amp - - - - - - - - - - - - - - - - - - -
205 ( Lidokain Comp. Inj ) Amp 647 - 250 - - 897 - - - - - - - - 90 - - 90 647
206 Lidokain jeli 2% pot - - - - - - - - - - - - - - - - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - - - - - - - - - - - - - - - - -
208 Lisinopril tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
209 Lisinopril tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
210 Loperamid tablet 2 mg tab 337 - - - - 337 - - - - - - 106 - - - - 106 231
211 Loratadin tablet 10 mg tab 900 - - - - 900 - - - - - - - - - - - - 900
212 Lorazepam tablet 2 mg tab - - - - - - - - - - - - - - - - - - -
213 Lytacur btl - - - - - - - - - - - - - - - - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial - 21 - - - 21 - - - - - - - - - - - - -
No Nama Obat SAT
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - - - - - - - - - - - - - - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - - - - - - - - - - - - - - - - -
217 Mebendazol tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
218 Meloksikam suppositoria supp - - - - - - - - - - - - - - - - - - -
219 Meloksikam tablet 15 mg tab - - - - - - - - - - - - - - - - - - -
220 Meloksikam tablet 7,5 mg tab - - - - - - - - - - - - - - - - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - - - - - - - - - - - - - - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp - - - - - - - - - - - - - - - - - - -
223 Metampiron injeksi 250 mg amp - - - - - - - - - - - - - - - - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 38,730 - - - - 38,730 - - - - - - 2,080 - - - - 2,080 36,650
225 Metampiron tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
226 Metformin HCl tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
227 Metformin HCl tablet 850 mg tab - - - - - - - - - - - - - - - - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 204 - - - - 204 - - - - - - 2 - - - - 2 202
Tab
229 0,125 mg 600 - - - - 600 - - - - - - 100 - - - - 100 500
230 Metilprednisolon injeksi 500 mg amp - - - - - - - - - - - - - - - - - - -
231 Metilprednisolon tablet 16 mg tab - - - - - - - - - - - - - - - - - - -
232 Metilprednisolon tablet 4 mg tab - - - - - - - - - - - - - - - - - - -
233 Metilprednisolon tablet 8 mg tab 30 - - - - 30 - - - - - - - - - - - - 30
234 Metoklopramide injeksi 5 mg/ml amp - - - - - - - - - - - - - - - - - - -
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - - - - - - - - - - - - - - - - -
236 Metoklopramide tablet 10 mg Tab 1,200 - - - - 1,200 - - - - - - 100 - - - - 100 1,100
237 Metoklopramide tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - - - - - - - - - - - - - - - - -
239 Metronidazol tablet 250 mg Tab - - - - - - - - - - - - - - - - - - -
240 Metronidazol tablet 500 mg Tab 7,673 - - - - 7,673 - - - - - - 700 - - - - 700 6,973
241 Metronidazol tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 4 - - - - 4 - - - - - - - - - - - - 4
243 Mineral Mix, kombinasi sase - - - - - - - - - - - - - - - - - - -
244 Momethason krim 0,1 % tube - - - - - - - - - - - - - - - - - - -
245 Momethason krim 0,1 % tube - - - - - - - - - - - - - - - - - - -
246 Morfin injeksi 10 mg/ml amp - - - - - - - - - - - - - - - - - - -
247 Morfin tablet 10 mg tab - - - - - - - - - - - - - - - - - - -
248 Natrium Diklofenak tablet 25 mg Tab - - - - - - - - - - - - - - - - - - -
249 Natrium Diklofenak tablet 50 mg Tab 3,288 - - - - 3,288 - - - - - - 550 - - - - 550 2,738
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 689 - 400 - - 1,089 - - - - - - - - - - - - 689
251 Neurobion 5000 injeksi amp - - - - - - - - - - - - - - - - - - -
252 Nevirapin tablet 200 mg tab - - - - - - - - - - - - - - - - - - -
253 Nifedipin tablet 10 mg tab 2,300 - - - - 2,300 - - - - - - 100 - - - - 100 2,200
254 Nistatin tablet salut 500.000 IU/ g Tab 800 - - - - 800 - - - - - - 100 - - - - 100 700
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - - - - - - - - - - - - - - - - -
256 Norages inj amp - - - 65 - 65 - - - - - - - - - 30 - 30 -
257 Obat Antituberkulosis FDC Kategori 1 pak - - - - - - - - - - - - - - - - - - -
258 Obat Antituberkulosis FDC Kategori 2 pak - - - - - - - - - - - - - - - - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - - - - - - - - - - - - - - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - - - - - - - - - - - - - - - - -
262 Obat Antituberkulosis Kategori anak pak - - - - - - - - - - - - - - - - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 439 - - - - 439 - - - - - - 11 - - - - 11 428
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - - - - - - - - - - - - - - - - -
265 Ofloxacin tablet 200 mg tab - - - - - - - - - - - - - - - - - - -
266 Ofloxacin tablet 400 mg tab - - - - - - - - - - - - - - - - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - - - - - - - - - - - - - - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube 48 - - - - 48 - - - - - - 22 - - - - 22 26
269 Oksitetrasiklin salep kulit 3% Tube 416 - - - - 416 - - - - - - 52 - - - - 52 364
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 100 - 37 - - 137 - - - - - - - - - - - - 100
271 Omeprazol kapsul/kaplet 20 mg kaps - - - - - - - - - - - - - - - - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - - - - - - - - - - - - - - - - -
273 Papaverin injeksi 40 mg/ml amp - - - - - - - - - - - - - - - - - - -
274 Papaverin tablet 40 mg Tab 7,800 - - - - 7,800 - - - - - - - - - - - - 7,800
275 Parasetamol drops btl 185 - - - - 185 - - - - - - 3 - - - - 3 182
276 Parasetamol sirup 120 mg / 5 ml Btl 638 - - - - 638 - - - - - - 132 - - - - 132 506
277 Parasetamol tablet 100 mg Tab 860 - - - - 860 - - - - - - 100 - - - - 100 760
278 Parasetamol tablet 500 mg Tab 35,044 - - - - 35,044 - - - - - - 1,636 - - - - 1,636 33,408
279 Perfenazin tablet 4 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
280 Permetrin krim 5% tube - - - - - - - - - - - - - - - - - - -
281 Petidin injeksi 50 mg/ml amp - - - - - - - - - - - - - - - - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - - - - - - - - - - - - - - - - -
283 Piracetam injeksi 3 g/15 ml amp - - 400 80 - 480 - - - - - - - - - - - - -
284 Piracetam injeksi 3 g/15 ml amp - - - - - - - - - - - - - - - - - - -
285 Piracetam tablet 1200 mg tab - - - - - - - - - - - - - - - - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - - - - - - - - - - - - - - - - -
289 Pirantel tablet score (base) 125 mg Tab - - - - - - - - - - - - - - - - - - -
290 Pirazinamid tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 1,100 - - - - 1,100 - - - - - - - - - - - - 1,100
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - - - - - - - - - - - - - - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 1,900 - - - - 1,900 - - - - - - 100 - - - - 100 1,800
294 Povidon Iodida larutan 10% btl - - - - - - - - - - - - - - - - - - -
295 Povidon Iodida larutan 10% 30mL Btl 12 - - - - 12 - - - - - - 1 - - - - 1 11
296 Povidon Iodida larutan 10% 300 mL Btl - - - - - - - - - - - - - - - - - - -
297 Povidon Iodida larutan 10% btl - - - - - - - - - - - - - - - - - - -
298 Pravastatin tablet 20 mg tab - - - - - - - - - - - - - - - - - - -
299 Prednison tablet 5 mg Tab 28,264 - - - - 28,264 - - - - - - 100 - - - - 100 28,164
300 Primakuin tablet 15 mg tab - - - - - - - - - - - - - - - - - - -
301 Primperan inj amp 165 - - - - 165 - - - - - - - - - - - - 165
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - - - - - - - - - - - - - - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - - - - - - - - - - - - - - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab 200 - - - - 200 - - - - - - - - - - - - 200
306 Ramipril tablet 2,5 mg tab - - - - - - - - - - - - - - - - - - -
307 Ramipril tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
308 Ranitidin injeksi 25 mg/2 ml amp - - - 25 - 25 - - - - - - - - - 25 - 25 -
309 Ranitidin tablet 150 mg Tab 3,000 - 388 - - 3,388 - - - - - - 200 - 388 - - 588 2,800
310 Ranitidin tablet 150 mg tab - - - - - - - - - - - - - - - - - - -
311 Reserpin tablet 0,10 mg tab - - - - - - - - - - - - - - - - - - -
312 Reserpin tablet 0,25 mg tab - - - - - - - - - - - - - - - - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - - - - - - - - - - - - - - - - -
314 Retinol (Vitamin A) 200.000 IU kapsul lunak kaps - - - - - - - - - - - - - - - - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - - - - - - - - - - - - - - - - -
316 Rifampisin kapsul/kaplet 600 mg kapl - - - - - - - - - - - - - - - - - - -
317 Rifampisin tablet salut 450 mg kapl - - - - - - - - - - - - - - - - - - -
318 Ringer Laktat larutan infus (RL) Btl - - - - - - - - - - - - - - - - - - -
319 Risperidon tablet 1 mg tab - - - - - - - - - - - - - - - - - - -
322 SABU I Vial - 1 - - - 1 - - - - - - - 1 - - - 1 -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab - - - - - - - - - - - - - - - - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 4,164 - - - - 4,164 - - - - - - 300 - - - - 300 3,864
325 endap 4% Pot 54 - - - - 54 - - - - - - - - - - - - 54
326 Salisil Bedak 2 % Ktk 327 - - - - 327 - - - - - - 10 - - - - 10 317
327 Salisil Bedak 2 % ktk - - - - - - - - - - - - - - - - - - -
328 Sanmol syr btl - 23 - - - 23 - - - - - - - - - - - - -
329 Sanmol tab tab - - - - - - - - - - - - - - - - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - - - - - - - - - - - - - - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - - - - - - - - - - - - - - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 1,000 - - - - 1,000 - - - - - - 100 - - - - 100 900
333 Sefadroksil sirup kering 125 mg/5ml btl - - - - - - - - - - - - - - - - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - - - - - - - - - - - - - - - - -
335 Sefaleksin kapsul/kaplet 500 mg kaps - - - - - - - - - - - - - - - - - - -
336 Sefazolin injeksi 1 g amp - - - - - - - - - - - - - - - - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - - - - - - - - - - - - - - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - - - - - - - - - - - - - - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - - - - - - - - - - - - - - - - -
340 Sefotaksim injeksi 0,5 g amp - - - - - - - - - - - - - - - - - - -
341 Sefotaksim injeksi 1 g vial - - 560 - - 560 - - - - - - - - - - - - -
342 Seftazidim injeksi 1 g amp - - - - - - - - - - - - - - - - - - -
343 Seftriakson injeksi 1 g vial 88 - 40 - - 128 - - - - - - - - - - - - 88
344 Seftriakson injeksi 1 g amp - - - - - - - - - - - - - - - - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp - 3 - - - 3 - - - - - - - 3 - - - 3 -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 3,491 - - - - 3,491 - - - - - - 100 - - - - 100 3,391
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - - - - - - - - - - - - - - - - -
348 Simetidin tablet 200 mg Tab 4,610 - - - - 4,610 - - - - - - 100 - - - - 100 4,510
349 Simvastatin tablet 10 mg Tab 30 - - - - 30 - - - - - - 30 - - - - 30 -
350 Simvastatin tablet 20 mg tab - - - - - - - - - - - - - - - - - - -
351 Simvastatin tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
352 Siprofloksasin infus 2% btl - - - - - - - - - - - - - - - - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 4,436 - - - - 4,436 - - - - - - 610 - - - - 610 3,826
355 Spasminal tab tab - - - - - - - - - - - - - - - - - - -
356 Spiramisin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
357 Spironolakton tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
358 Spironolakton tablet 25 mg tab - - - - - - - - - - - - - - - - - - -
359 Stavudin tablet 30 mg tab - - - - - - - - - - - - - - - - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - - - - - - - - - - - - - - - - -
361 Sulfasalazin tablet 500 mg tab - - - - - - - - - - - - - - - - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl - - - - - - - - - - - - - - - - - - -
363 Syntosinon inj amp - 19 - - - 19 - - - - - - - - - - - - -
364 Tamoksifen tablet 20 mg tab - - - - - - - - - - - - - - - - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - - - - - - - - - - - - - - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 7,900 - - - - 7,900 - - - - - - - - - - - - 7,900
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 2,521 - - - - 2,521 - - - - - - - - - - - - 2,521
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - - - - - - - - - - - - - - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 600 - - - - 600 - - - - - - - - - - - - 600
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 28,060 - - - - 28,060 - - - - - - 2,100 - - - - 2,100 25,960
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - - - - - - - - - - - - - - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 328 - - - - 328 - - - - - - 60 - - - - 60 268
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - - - - - - - - - - - - - - - - -
374 Tramadol injeksi 50 mg/ml amp - - - - - - - - - - - - - - - - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - - - - - - - - - - - - - - -
376 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - - - - - - - - - - - - - - -
377 Transamin tab tab - - - - - - - - - - - - - - - - - - -
378 Trifluoperazin tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
379 Triheksifenidil tablet 2 mg Tab - 100 - - - 100 - - - - - - - - - - - - -
380 Ulsikur inj amp - 34 - - - 34 - - - - - - - - - - - - -
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - - - - - - - - - - - - - - - - -
382 Valdimex tablet 5 mg tab - - - - - - - - - - - - - - - - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - - - - - - - - - - - - - - - - -
384 Vicillin 1gr inj vial - - - 20 - 20 - - - - - - - - - 20 - 20 -
385 Vitamin B Kompleks tablet Tab 52,343 - - - - 52,343 - - - - - - 2,030 - - - - 2,030 50,313
386 Zidovudin tablet 100 mg tab - - - - - - - - - - - - - - - - - - -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - - - - - - - - - - - - - - - - -

388 Zinc drop 10 mg/mL btl 53 - - - - 53 - - - - - - - - - - - - 53
389 Zinc tablet 20 mg tab 6,038 - - - - 6,038 - - - - - - 500 - - - - 500 5,538
- - - - -
B PERBEKALAN KESEHATAN - - - - -
1 Alat suntik sekali pakai 1 ml set - - - 200 - 200 - - - - - - - - - - - - -
2 Alat suntik sekali pakai 2,5 ml set 14,785 - - - - 14,785 - - - - - - 900 - - - - 900 13,885
3 Alat suntik sekali pakai 3 ml set - - - - - - - - - - - - - - - - - - -
4 Alat suntik sekali pakai 5 ml set - - - - - - - - - - - - - - - - - - -
5 Catgut/benang bedah no.2/0 dengan jarum bedah set 197 - - - - 197 - - - - - - - - - - - - 197
6 Catgut/benang bedah no.3/0 dengan jarum bedah set - - - - - - - - - - - - - - - - - - -
7 Infusion set anak Set 226 - - 398 - 624 - - - - - - 45 - - - - 45 181
8 Infusion set dewasa Set 478 - - - - 478 - - - - - - 50 - - - - 50 428
No Nama Obat SAT
9 IV Catheter No. 20 G Set 404 - - 110 - 514 - - - - - - - - - - - - 404
10 IV Catheter No. 22 G Set 99 - - 100 - 199 - - - - - - 50 - - - - 50 49
11 IV Catheter No. 24 G Set 317 - - 110 - 427 - - - - - - - - - - - - 317
12 Kapas Berlemak 500 gram Bks - - - - - - - - - - - - - - - - - - -
13 Kapas Pembalut / Absorben 250 gram Bks 82 - - 28 - 110 - - - - - - - - - 4 - 4 82
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk 54 - - - - 54 - - - - - - - - - - - - 54
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - - - - - - - - - - - - - - - - -
16 Kasa Hidrofil uk. 40 m x 80 cm rol - - - - - - - - - - - - - - - - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 2,749 - - - - 2,749 - - - - - - 20 - - - - 20 2,729
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 1,253 - - - - 1,253 - - - - - - 80 - - - - 80 1,173
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol 71 - - - - 71 - - - - - - - - - - - - 71
20 Kasa Pembalut Elastic 4 inchi rol - - - - - - - - - - - - - - - - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol 52 - - - - 52 - - - - - - - - - - - - 52
22 Kasa Pembalut Elastic 10 cm x 4,5m rol 60 - - - - 60 - - - - - - - - - - - - 60
23 Pembalut Gips 3 ichi Rol 10 - - - - 10 - - - - - - - - - - - - 10
24 Plester 5 yards x 2 inch Rol 25 - - - - 25 - - - - - - 2 - - - - 2 23
25 bedah Sac 173 - - - - 173 - - - - - - 36 - - - - 36 137
26 Ultrafix 5x5 rol - - - - - - - - - - - - - - - - - - -
27 Urine Bag Set 20 - - - - 20 - - - - - - - - - - - - 20
28 Foley Catheter set 10 - - - - 10 - - - - - - - - - - - - 10
29 Handscoon (Sarung Tangan Steril) Set 970 - - 90 - 1,060 - - - - - - 210 - - 90 - 300 760
30 Masker set 202 - - - - 202 - - - - - - 50 - - - - 50 152
- - - - -
C OBAT GIGI - - - - -
1 Etil Klorida spray btl - - - - - - - - - - - - - - - - - - -
2 Eugenol cairan btl - - - - - - - - - - - - - - - - - - -
3 Formokresol cairan btl - - - - - - - - - - - - - - - - - - -
4 Glass Ionomer Cement ART btl - - - - - - - - - - - - - - - - - - -
5 Gutta Percha dan Paper points 15-40 mm btl - - - - - - - - - - - - - - - - - - -
6 Gutta Percha dan Paper points 45-80 mm btl - - - - - - - - - - - - - - - - - - -
7 Kalsium Hidroksida Pasta btl - - - - - - - - - - - - - - - - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - - - - - - - - - - - - - - - - -
9 Komposit resin btl - - - - - - - - - - - - - - - - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - - - - - - - - - - - - - - - - -
11 Mummifying Pasta btl - - - - - - - - - - - - - - - - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - - - - - - - - - - - - - - - - -
13 cairan btl - - - - - - - - - - - - - - - - - - -
- - - - -
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN - - - - -
1 Alinamin F tablet tab - - - - - - - - - - - - - - - - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - - - - - - - - - - - - - - - - -
3 Combifen syr btl - - - 5 - 5 - - - - - - - - - - - - -
4 Coparcetin tab - - - 300 - 300 - - - - - - - - - 200 - 200 -
5 Dexanta tablet tab - - - - - - - - - - - - - - - - - - -
6 Etafen syr btl - - - 5 - 5 - - - - - - - - - - - - -
No Nama Obat SAT
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl 14 - - - - 14 - - - - - - - - - - - - 14
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl - - - 15 - 15 - - - - - - - - - 3 - 3 -
8 Farizol tablet tab - - - - - - - - - - - - - - - - - - -
9 Fe Sirup btl - 1 - - - 1 - - - - - - - 1 - - - 1 -
Gastrusid sirup btl - - - 20 - 20 - - - - - - - - - - - - -
10 Grafadon tab - - - 200 - 200 - - - - - - - - - - - - -
11 H2O2 3% 800 cc btl - 4 - - - 4 - - - - - - - 1 - - - 1 -
12 Helixim syr btl - - - 5 - 5 - - - - - - - - - - - - -
13 Histigo tablet tab - - - - - - - - - - - - - - - - - - -
14 IV Catheter No. 18 G Set - - - 100 - 100 - - - - - - - - - - - - -
15 Kalium Permanganat Serbuk Pot 5 - - - - 5 - - - - - - - - - - - - 5
16 Lexapram tablet tab - - - - - - - - - - - - - - - - - - -
Lostacef tab - - - 50 - 50 - - - - - - - - - - - - -
17 Mes / Pisau bh - - - - - - - - - - - - - - - - - - -
18 Mirasic syr btl - - - 5 - 5 - - - - - - - - - - - - -
19 Molacort tab - - - 200 - 200 - - - - - - - - - 200 - 200 -
20 Neurosanbe inj. amp - - - 60 - 60 - - - - - - - - - 20 - 20 -
Novabion tab - - - 100 - 100 - - - - - - - - - 100 - 100 -
21 Novaflox tab - - - 300 - 300 - - - - - - - - - - - - -
22 Novalgin injeksi amp - - - - - - - - - - - - - - - - - - -
23 Novamog tab - - - 200 - 200 - - - - - - - - - - - - -
24 Novaxifen tab - - - 200 - 200 - - - - - - - - - - - - -
25 Pimtracol syr btl - - - - - - - - - - - - - - - - - - -
26 Sarung Tangan Obgyn set - - - 50 - 50 - - - - - - - - - - - - -
27 Scopamin Inj box - - - - - - - - - - - - - - - - - - -
28 Stesolid supp. tube - - - - - - - - - - - - - - - - - - -
29 Sufratul lbr - - - - - - - - - - - - - - - - - - -
30 Tidifar tab - - - 200 - 200 - - - - - - - - - - - - -
31 Transamin inj. amp - - - - - - - - - - - - - - - - - - -
Trifaneuro tab - - - 100 - 100 - - - - - - - - - 100 - 100 -
32 Trolit sase - - - 6 - 6 - - - - - - - - - - - - -
33 Urocare Set - - - - - - - - - - - - - - - - - - -
34 Vixal syr btl - - - - - - - - - - - - - - - - - - -
No Nama Obat SAT
]
No Nama Obat SAT
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No Nama Obat SAT
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No Nama Obat SAT
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Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - 42
- - - - -
388 - - - 628
- - - - 3,363
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 3,416
- 90 270 - 420
- - - - -
- - - - 3,175
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 14,647
- - - - -
- - - - 712
400 - - - 400
- - - - -
- - - - -
- - - - -
- - - - 5,986
- - - - 378
- 45 - - 539
- - - - 141
- - - - 50
- - - - -
- - - - 2,100
- - - - -
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 1,184
- - - - -
- 137 - - 152
- - - - 50
- - - - 1,050
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 51
1 - - - 1
- - - - -
- - - - -
- - - - -
18 - - - 18
- - - - -
- - - - 50
- - - - -
- - - - -
- - - - -
- - - - 1,300
- - - - -
- - - - 3,358
- - - - -
- - - - -
- - - - -
- - - - -
190 - - - 238
- - - - 1,152
250 - - - 250
- - - - -
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - 911
- - - - 200
- - - - -
- - - - 500
- - - - -
- - - - 7
- - - - -
- - - - -
- 300 - - 300
- 88 - - 88
- - - - 180
- - - - 1,376
- - - - 36
- - - - 8
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
94 - - - 94
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
300 - - - 1,400
87 - - - 507
- - - - -
- - - - -
- - - - 2,000
- - - - 5,700
- - - - -
- - - - -
- - - - 75
- 80 - - 125
- - - - -
- - - - 32
- - - - 3,090 17,000
- - - - - 136
- - - - - 2 100,000 200,000
- - - - - 2 50,000 100,000
- - - - - 50 25,000 1,250,000
- - - - - 54 12,500 675,000
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - - 54 7,500 405,000
- - - - 16,876 54 2,000 108,000
- - - - - 54 2,500 135,000
- - - - 4 54 2,500 135,000
- - - - - 136 125 17,000
- 38 - - 353 3,025,000
- - - - 2,085
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 3,727
- - - - -
- - - - 550
- - - - -
- - - - -
- - - - -
- - - - 900
- - - - -
- - - - 4,681
- - - - -
- - - - -
- - - - 1,800
- - - - -
- - - - 500
- - - - -
- - - - -
- - - - -
- - - - 24,078
- - - - -
- - - - 5,857
- - - - -
- - - - 200
- 90 - - 205
- - - - 1,450
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 50
- - - - -
- - - - -
- - - - -
- - - - 1,150
- - - - -
- 42 - - 42
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - -
- - - - -
- - - - 19
- - - - 58,186
- - - - -
- - - - -
- - - - -
- - - - -
170 - - - 170
- - - - -
- - - - -
- - - - -
- - - - 7,573
- - - - 9,632
- - - - 680
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 500
- - - - 30
- - - - 500
- - - - 325
- - - - -
- - - - -
- - - - -
- - - - 534
- - - - -
- 160 - - 807
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 231
- - - - 900
- - - - -
- - - - -
21 - - - 21
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 36,650
- - - - -
- - - - -
- - - - -
- - - - 202
- - - - 500
- - - - -
- - - - -
- - - - -
- - - - 30
- - - - -
- - - - -
- - - - 1,100
- - - - -
- - - - -
- - - - -
- - - - 6,973
- - - - -
- - - - 4
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 2,738
- 400 - - 1,089
- - - - -
- - - - -
- - - - 2,200
- - - - 700
- - - - -
- - 35 - 35
- - - - -
- - - - -
- - - - -
- - - - -
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - -
- - - - -
- - - - 428
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 26
- - - - 364
- 37 - - 137
- - - - -
- - - - -
- - - - -
- - - - 7,800
- - - - 182
- - - - 506
- - - - 760
- - - - 33,408
- - - - -
- - - - -
- - - - -
- - - - -
- 400 80 - 480
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 1,100
- - - - -
- - - - 1,800
- - - - -
- - - - 11
- - - - -
- - - - -
- - - - -
- - - - 28,164
- - - - -
- - - - 165
- - - - -
- - - - -
- - - - -
- - - - 200
- - - - -
- - - - -
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - -
- - - - 2,800
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 3,864
- - - - 54
- - - - 317
- - - - -
23 - - - 23
- - - - -
- - - - -
- - - - -
- - - - 900
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- 560 - - 560
- - - - -
- 40 - - 128
- - - - -
- - - - -
- - - - 3,391
- - - - -
- - - - 4,510
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - 3,826
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
19 - - - 19
- - - - -
- - - - -
- - - - 7,900
- - - - 2,521
- - - - -
- - - - 600
- - - - 25,960
- - - - -
- - - - 268
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
100 - - - 100
34 - - - 34
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 50,313
- - - - -
- - - - -
- - - - 53
- - - - 5,538
- - 200 - 200
- - - - 13,885
- - - - -
- - - - -
- - - - 197
- - - - -
- - 398 - 579
- - - - 428
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - 110 - 514
- - 100 - 149
- - 110 - 427
- - - - -
- - 24 - 106
- - - - 54
- - - - -
- - - - -
- - - - 2,729
- - - - 1,173
- - - - 71
- - - - -
- - - - 52
- - - - 60
- - - - 10
- - - - 23
- - - - 137
- - - - -
- - - - 20
- - - - 10
- - - - 760
- - - - 152
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - 5 - 5
- - 100 - 100
- - - - -
- - 5 - 5
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
- - - - 14
- - 12 - 12
- - - - -
- - - - -
- - 20 - 20
- - 200 - 200
3 - - - 3
- - 5 - 5
- - - - -
- - 100 - 100
- - - - 5
- - - - -
- - 50 - 50
- - - - -
- - 5 - 5
- - - - -
- - 40 - 40
- - - - -
- - 300 - 300
- - - - -
- - 200 - 200
- - 200 - 200
- - - - -
- - 50 - 50
- - - - -
- - - - -
- - - - -
- - 200 - 200
- - - - -
- - - - -
- - 6 - 6
- - - - -
- - - - -
470,783
Stok Akhir Total
Keterangan
DAU Askes JKN Stok
Lain2
\\\\\\\\
LPLPO APOTEK Lembar R/ :
31 Oktober 2015 Generik :
Stok Peneri Pema Stok

No Nama Obat SAT Ket
Awal maan kaian Akhir
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl - - - -
2 Albendazol suspensi 200 mg/5 ml btl - - - -
3 Albendazol tablet 400 mg Tab 30 - - 30
4 Alopurinol tablet 100 mg Tab 118 - 10 108
5 Alopurinol tablet 300 mg tab - - - -
6 Alprazolam tablet 0,25 mg tab - - - -
8 Alprazolam tablet 1 mg tab - - - -
9 Ambroxol sirup 15 mg/ml btl - - - -
11 Ambroxol tablet 30 mg Tab 195 100 45 250
12 Aminofilin injeksi 24 mg/ml Amp - - - -
13 Aminofilin tablet 150 mg tab - - - -
14 Aminofilin tablet 200 mg Tab 80 300 49 331
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - -
16 Amlodipin tablet 10 mg tab - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps 239 - 10 229
20 Amoksisilin kapsul/kaplet 500 mg Tab 144 600 354 390
21 Amoksisilin serbuk injeksi 1000 mg vial - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - 20 15 5
23 Amoxsan tab 500 mg tab - - - -
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - -

27 Hidroksida 200 mg Magnesium Hidroksida 200 mg Tab 240 200 270 170

28 mg/5 ml Btl 15 - 2 13
29 IU/g + Polimiksin 10.000 IU/g Tube 25 - 1 24
30 Salisilat 3% pot 6 - - 6
31 mg Heksaklorofen 2,5 mg Supp - - - -
32 mg Sulfadoksin tablet 500 mg tab - - - -
33 mg Tab 100 - - 100
34 Antrain inj amp - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp - - - -
36 Artemether injeksi 80 mg/ml amp - - - -
37 Artesunate injeksi, vial 60 mg vial - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab 20 - 20 -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 600 - 600 -
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - -
43 Asam Folat tablet 1 mg tab - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 320 100 250 170
47 Asiklovir krim 5% Tube 23 - 1 22
48 Asiklovir tablet 200 mg Tab 50 - 20 30
49 Asiklovir tablet 400 mg tab 160 - - 160
51 Atapulgit tablet 600 mg tab - - - -
52 Atenolol tablet 100 mg tab - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - -
58 (tablet tambah darah kombinasi ) tab - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 20 - - 20
61 Bioplacenton tube - - - -
62 Bisakodil suppositoria 10 mg supp - - - -
63 Bisoprolol tablet 5 mg tab - - - -
64 Bromheksin tablet 8 mg tab - - - -
65 Buscopan inj amp - - - -
66 Cetirizin sirup 5 mg/5 ml btl - - - -
67 Cetirizine tablet 10 mg tab - - - -
68 Clobazam tablet 10 mg tab - - - -
69 Clobetasol krim 0,05% tube - - - -
70 Dapson tablet 100 mg tab - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp - - - -
72 Deksametason injeksi i.v. 5 mg/ml amp - - - -
73 Deksametason tablet 0,5 mg Tab 252 500 295 457
74 Dekstran 70 - larutan infus 6% steril btl - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - -
78 Diazepam injeksi 5 mg/ml Amp - - - -
79 Diazepam tablet 2 mg Tab - - - -
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp - - - -
83 Digoksin tablet 0,25 mg Tab - - - -
84 Diltiazem HCl tablet 30 mg tab - - - -
85 Dimenhidrinat tablet 50 mg tab - - - -
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - -
87 Domperidon suspensi 5 mg/5 ml btl 5 - - 5
88 Domperidon tablet 10 mg Tab 110 - 4 106
89 Efedrin tablet 25 mg (HCl) tab - - - -
90 Ekstraks Belladona tablet 10 mg Tab - - - -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp - - - -
92 Eritromisin kapsul/kaplet 250 mg kaps - - - -
93 Eritromisin kapsul/kaplet 500 mg kaps 124 - - 124
94 Eritromisin sirup 200 mg/ 5 ml Btl 8 - 1 7
95 Etakridin larutan 0,1% (Rivanol) Btl - - - -
96 Etambutol tablet 250 mg (HCl) tab - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - -
99 Famotidine tablet 20 mg tab - - - -
101 Fenilbutason tablet 200 mg tab - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp - - - -
106 Fenobarbital tablet 100 mg tab - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - -
110 Fenol Gliserol tetes telinga 10% Btl 11 - 1 10
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 30 100 130 -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp - - - -
113 Flukonazol tablet 150 mg tab - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - -
115 Furosemid tablet 40 mg Tab 95 - - 95
116 Garam Oralit I serbuk Sac - 100 - 100
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - -
118 Gemfibrozil tablet 600 mg tab - - - -
119 Gentamisin injeksi 40 mg/ ml amp - - - -
120 Gentamisin salep kulit 0.1% tube - 10 - 10
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - -
122 Gentian Violet larutan 1 % Btl 5 7 1 11
123 Glibenklamida tablet 5 mg Tab 53 - 7 46
124 Glimepiride tablet 1 mg tab - - - -
129 Gliquidon tablet 30 mg tab - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 942 - 317 625
131 Gliserin btl - - - -
132 Glukosa larutan infus 10 % steril Btl - - - -
135 Griseofulvin tablet 125 mg Tab 290 - 10 280
136 Haloperidol inj 50 mg/mL amp - - - -
137 Haloperidol tablet 0,5 mg tab - - - -
139 Haloperidol tablet 5 mg tab - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 560 - 24 536
141 Hidrokortison krim 1% tube - - - -
142 Hidrokortison krim 2,5 % Tube 13 - 6 7
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl 1 - - 1
145 Ibuprofen suspensi 200 mg/5 ml btl - - - -
146 Ibuprofen tablet 200 mg Tab - 100 - 100
147 Ibuprofen tablet 200 mg tab - - - -
148 Ibuprofen tablet 400 mg Tab 390 200 215 375
150 Iodiol kapsul lunak kaps - - - -
151 Isoniazid tablet 100 mg Tab - - - -
152 Isoniazid tablet 300 mg tab - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab - - - -
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 762 - - 762
158 Kaptopril tablet 12,5 mg Tab - - - -
159 Kaptopril tablet 25 mg Tab 291 - 62 229
160 Kaptopril tablet 50 mg tab - - - -
161 Karbamazepin tablet 200 mg Tab 90 - - 90
162 Ketokonazol krim 2% tube 3 - - 3
163 Ketokonazol tablet 200 mg Tab 85 - 10 75
164 Ketoprofen injeksi 100 mg amp - - - -
165 Ketoprofen tablet 100 mg tab - - - -
166 Ketorolac injeksi 10 mg amp - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 20 50 - 70
170 Klomifen tablet 50 mg tab - - - -
171 Klonidin tablet 0,15 mg tab - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 220 - 10 210
174 Kloramfenikol salep mata 1 % Tube 2 - 1 1
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 9 - - 9
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - -
178 Kloramfenikol tetes telinga 3 % btl - 5 - 5
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 155 300 452 3
180 Klorokuin tablet 250 mg tab - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab - - - -
185 Kodein tablet 10 mg tab - - - -
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 125 - 10 115
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 170 - - 170
190 mg + Trimetoprim 40 mg / 5 ml Btl 6 8 5 9
191 Kuinin (Kina) tablet 200 mg tab - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - -
194 Lacto B sase - - - -
195 Lamivudine tablet 150 mg tab - - - -
196 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) btl - - - -
197 Dekstrosa 18.75 gr) (KAEN 1B) btl - - - -
198 (KAEN 3B) btl - - - -
2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27
199 gr) (KAEN 3A) btl - - - -
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - -
201 Levofloksasin tablet 500 mg tab - - - -
203 Lidokain injeksi 2% amp - - - -
205 ( Lidokain Comp. Inj ) Amp - - - -
206 Lidokain jeli 2% pot - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - -
208 Lisinopril tablet 10 mg tab - - - -
210 Loperamid tablet 2 mg tab 232 - - 232
211 Loratadin tablet 10 mg tab - - - -
212 Lorazepam tablet 2 mg tab - - - -
213 Lytacur btl - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial - - - -
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - -
217 Mebendazol tablet 100 mg tab - - - -
218 Meloksikam suppositoria supp - - - -
219 Meloksikam tablet 15 mg tab - - - -
220 Meloksikam tablet 7,5 mg tab - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp - - - -
223 Metampiron injeksi 250 mg amp - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 105 400 215 290
225 Metampiron tablet 500 mg tab - - - -
226 Metformin HCl tablet 500 mg tab - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp - - - -
Tab
229 0,125 mg 120 - - 120
230 Metilprednisolon injeksi 500 mg amp - - - -
231 Metilprednisolon tablet 16 mg tab - - - -
234 Metoklopramide injeksi 5 mg/ml amp - - - -
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - -
236 Metoklopramide tablet 10 mg Tab 225 - 6 219
237 Metoklopramide tablet 5 mg tab - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - -
239 Metronidazol tablet 250 mg Tab 3 - - 3
240 Metronidazol tablet 500 mg Tab 120 200 97 223
241 Metronidazol tablet 500 mg tab - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 4 - - 4
243 Mineral Mix, kombinasi sase - - - -
244 Momethason krim 0,1 % tube - - - -
246 Morfin injeksi 10 mg/ml amp - - - -
247 Morfin tablet 10 mg tab - - - -
248 Natrium Diklofenak tablet 25 mg Tab - - - -
249 Natrium Diklofenak tablet 50 mg Tab 100 50 10 140
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl - - - -
251 Neurobion 5000 injeksi amp - - - -
252 Nevirapin tablet 200 mg tab - - - -
253 Nifedipin tablet 10 mg tab - - - -
254 Nistatin tablet salut 500.000 IU/ g Tab - - - -
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - -
256 Norages inj amp - - - -
257 Obat Antituberkulosis FDC Kategori 1 pak - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - -
262 Obat Antituberkulosis Kategori anak pak - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 11 - 1 10
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - -
265 Ofloxacin tablet 200 mg tab - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube 5 5 3 7
269 Oksitetrasiklin salep kulit 3% Tube 24 - - 24
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp - - - -
271 Omeprazol kapsul/kaplet 20 mg kaps - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - -
273 Papaverin injeksi 40 mg/ml amp - - - -
274 Papaverin tablet 40 mg Tab 990 - - 990
275 Parasetamol drops btl 6 3 1 8
276 Parasetamol sirup 120 mg / 5 ml Btl 7 18 17 8
277 Parasetamol tablet 100 mg Tab - - - -
278 Parasetamol tablet 500 mg Tab 150 500 460 190
279 Perfenazin tablet 4 mg (HCl) tab - - - -
280 Permetrin krim 5% tube - - - -
281 Petidin injeksi 50 mg/ml amp - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - -
285 Piracetam tablet 1200 mg tab - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - -
289 Pirantel tablet score (base) 125 mg Tab 84 - - 84
290 Pirazinamid tablet 500 mg tab - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 1,000 - 15 985
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 180 - - 180
294 Povidon Iodida larutan 10% btl - - - -
295 Povidon Iodida larutan 10% 30mL Btl - - - -
296 Povidon Iodida larutan 10% 300 mL Btl - - - -
298 Pravastatin tablet 20 mg tab - - - -
299 Prednison tablet 5 mg Tab 695 - 10 685
300 Primakuin tablet 15 mg tab - - - -
301 Primperan inj amp - - - -
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab - - - -
306 Ramipril tablet 2,5 mg tab - - - -
307 Ramipril tablet 5 mg tab - - - -
308 Ranitidin injeksi 25 mg/2 ml amp - - - -
309 Ranitidin tablet 150 mg Tab 90 200 40 250
310 Ranitidin tablet 150 mg tab - - - -
311 Reserpin tablet 0,10 mg tab - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - -
317 Rifampisin tablet salut 450 mg kapl - - - -
318 Ringer Laktat larutan infus (RL) Btl - - - -
319 Risperidon tablet 1 mg tab - - - -
322 SABU I Vial - - - -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab 144 - - 144
325 endap 4% Pot 8 - - 8
326 Salisil Bedak 2 % Ktk 9 - 1 8
327 Salisil Bedak 2 % ktk - - - -
328 Sanmol syr btl - - - -
329 Sanmol tab tab - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 6 - - 6
333 Sefadroksil sirup kering 125 mg/5ml btl - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - -
336 Sefazolin injeksi 1 g amp - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - -
340 Sefotaksim injeksi 0,5 g amp - - - -
341 Sefotaksim injeksi 1 g vial - - - -
342 Seftazidim injeksi 1 g amp - - - -
343 Seftriakson injeksi 1 g vial - - - -
344 Seftriakson injeksi 1 g amp - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp - - - -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp - - - -
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - -
348 Simetidin tablet 200 mg Tab - - - -
349 Simvastatin tablet 10 mg Tab 30 - 10 20
350 Simvastatin tablet 20 mg tab - - - -
352 Siprofloksasin infus 2% btl - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 150 200 56 294
355 Spasminal tab tab - - - -
356 Spiramisin tablet 500 mg tab - - - -
357 Spironolakton tablet 100 mg tab - - - -
359 Stavudin tablet 30 mg tab - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - -
361 Sulfasalazin tablet 500 mg tab - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl - - - -
363 Syntosinon inj amp - - - -
364 Tamoksifen tablet 20 mg tab - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps - - - -
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 170 - - 170
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 14 - 14 -
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 720 - 240 480
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp - - - -
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - -
374 Tramadol injeksi 50 mg/ml amp - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - -
377 Transamin tab tab - - - -
378 Trifluoperazin tablet 5 mg tab - - - -
379 Triheksifenidil tablet 2 mg Tab - - - -
380 Ulsikur inj amp - - - -
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - -
382 Valdimex tablet 5 mg tab - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - -
384 Vicillin 1gr inj vial - - - -
385 Vitamin B Kompleks tablet Tab 1,353 - 308 1,045
386 Zidovudin tablet 100 mg tab - - - -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

388 Zinc drop 10 mg/mL btl 5 - - 5
389 Zinc tablet 20 mg tab 255 - 50 205
- - -
B PERBEKALAN KESEHATAN - - -
1 Alat suntik sekali pakai 1 ml set - - - -
2 Alat suntik sekali pakai 2,5 ml set - - - -
5 Catgut/benang bedah no.2/0 dengan jarum bedah set - - - -
7 Infusion set anak Set - - - -
8 Infusion set dewasa Set - - - -
9 IV Catheter No. 20 G Set - - - -
12 Kapas Berlemak 500 gram Bks - - - -
13 Kapas Pembalut / Absorben 250 gram Bks - - - -
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk - - - -
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - - - -
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol - - - -
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol - - - -
20 Kasa Pembalut Elastic 4 inchi rol - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol - - - -
22 Kasa Pembalut Elastic 10 cm x 4,5m rol - - - -
23 Pembalut Gips 3 ichi Rol - - - -
24 Plester 5 yards x 2 inch Rol - - - -
25 bedah Sac - - - -
26 Ultrafix 5x5 rol - - - -
27 Urine Bag Set - - - -
28 Foley Catheter set - - - -
29 Handscoon (Sarung Tangan Steril) Set - - - -
30 Masker set - - - -
- - -
C OBAT GIGI - - -
1 Etil Klorida spray btl - - - -
2 Eugenol cairan btl - - - -
3 Formokresol cairan btl - - - -
4 Glass Ionomer Cement ART btl - - - -
5 Gutta Percha dan Paper points 15-40 mm btl - - - -
7 Kalsium Hidroksida Pasta btl - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - -
9 Komposit resin btl - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - -
11 Mummifying Pasta btl - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - -
13 cairan btl - - - -
- - -
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN - - -
1 Alinamin F tablet tab - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - -
3 Combifen syr btl - - - -
4 Coparcetin tab - - - -
5 Dexanta tablet tab - - - -
6 Etafen syr btl - - - -
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl - - - -
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl - - - -
8 Farizol tablet tab - - - -
9 Fe Sirup btl - - - -
Gastrusid sirup btl - -
10 Grafadon tab - - - -
11 H2O2 3% 800 cc btl - - - -
12 Helixim syr btl - - - -
13 Histigo tablet tab - - - -
15 Kalium Permanganat Serbuk Pot - - - -
16 Lexapram tablet tab - - - -
Lostacef tab - - - -
17 Mes / Pisau bh - - - -
18 Mirasic syr btl - - - -
19 Molacort tab - - - -
20 Neurosanbe inj. amp - - - -
Novabion tab - - - -
21 Novaflox tab - - - -
22 Novalgin injeksi amp - - - -
23 Novamog tab - - - -
24 Novaxifen tab - - - -
25 Pimtracol syr btl - - - -
26 Sarung Tangan Obgyn set - - - -
27 Scopamin Inj box - - - -
28 Stesolid supp. tube - - - -
29 Sufratul lbr - - - -
30 Tidifar tab - - - -
31 Transamin inj. amp - - - -
Trifaneuro tab - - - -
32 Trolit sase - - - -
33 Urocare Set - - - -
34 Vixal syr btl - - - -
13,771
Penanggung Jawab Apotek
______________________
embar R/ :
enerik :
LPLPO UGD & PERAWATAN Lembar R/ :
31 Oktober 2015 Generik :

A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl - 12 9 3
2 Albendazol suspensi 200 mg/5 ml btl - - - -
3 Albendazol tablet 400 mg Tab 30 - - 30
4 Alopurinol tablet 100 mg Tab 60 - - 60
5 Alopurinol tablet 300 mg tab - - - -
8 Alprazolam tablet 1 mg tab - - - -
9 Ambroxol sirup 15 mg/ml btl 3 - - 3
11 Ambroxol tablet 30 mg Tab 90 - 8 82
12 Aminofilin injeksi 24 mg/ml Amp 21 - 2 19
13 Aminofilin tablet 150 mg tab - - - -
14 Aminofilin tablet 200 mg Tab 85 100 41 144
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps 80 - - 80
20 Amoksisilin kapsul/kaplet 500 mg Tab 162 - 104 58
21 Amoksisilin serbuk injeksi 1000 mg vial - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 8 - 1 7
23 Amoxsan tab 500 mg tab 200 - 40 160

27 Hidroksida 200 mg Magnesium Hidroksida 200 mg Tab 289 100 114 275
28 mg/5 ml Btl 2 5 4 3
29 IU/g + Polimiksin 10.000 IU/g Tube - - - -
30 Salisilat 3% pot - - - -
31 mg Heksaklorofen 2,5 mg Supp - - - -
32 mg Sulfadoksin tablet 500 mg tab - - - -
33 mg Tab - - - -
34 Antrain inj amp - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp 7 - 7 -
36 Artemether injeksi 80 mg/ml amp - - - -
37 Artesunate injeksi, vial 60 mg vial - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 360 - - 360
43 Asam Folat tablet 1 mg tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 20 300 74 246
47 Asiklovir krim 5% Tube 3 - 3 -
48 Asiklovir tablet 200 mg Tab 50 - - 50
49 Asiklovir tablet 400 mg tab - - - -
51 Atapulgit tablet 600 mg tab - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - -
58 (tablet tambah darah kombinasi ) tab - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 6 - 5 1
61 Bioplacenton tube - - - -
62 Bisakodil suppositoria 10 mg supp - - - -
63 Bisoprolol tablet 5 mg tab - - - -
64 Bromheksin tablet 8 mg tab - - - -
65 Buscopan inj amp - - - -
66 Cetirizin sirup 5 mg/5 ml btl - - - -
67 Cetirizine tablet 10 mg tab - - - -
68 Clobazam tablet 10 mg tab - - - -
69 Clobetasol krim 0,05% tube - - - -
70 Dapson tablet 100 mg tab - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 41 - 3 38
72 Deksametason injeksi i.v. 5 mg/ml amp - - - -
73 Deksametason tablet 0,5 mg Tab 197 200 323 74
74 Dekstran 70 - larutan infus 6% steril btl - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - -
78 Diazepam injeksi 5 mg/ml Amp - 3 - 3
79 Diazepam tablet 2 mg Tab 7 - 1 6
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 7 30 32 5
83 Digoksin tablet 0,25 mg Tab 80 - 5 75
84 Diltiazem HCl tablet 30 mg tab - - - -
85 Dimenhidrinat tablet 50 mg tab - - - -
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - -
87 Domperidon suspensi 5 mg/5 ml btl 3 - - 3
88 Domperidon tablet 10 mg Tab 74 - 33 41
89 Efedrin tablet 25 mg (HCl) tab - - - -
90 Ekstraks Belladona tablet 10 mg Tab - - - -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp - - - -
94 Eritromisin sirup 200 mg/ 5 ml Btl - - - -
95 Etakridin larutan 0,1% (Rivanol) Btl 2 - 1 1
96 Etambutol tablet 250 mg (HCl) tab - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - -
101 Fenilbutason tablet 200 mg tab - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp - - - -
110 Fenol Gliserol tetes telinga 10% Btl - - - -
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab - - - -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 13 - 1 12
113 Flukonazol tablet 150 mg tab - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - -
115 Furosemid tablet 40 mg Tab 260 - 60 200
116 Garam Oralit I serbuk Sac 75 - - 75
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - -
118 Gemfibrozil tablet 600 mg tab - - - -
119 Gentamisin injeksi 40 mg/ ml amp - - - -
120 Gentamisin salep kulit 0.1% tube 8 - 3 5
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - -
122 Gentian Violet larutan 1 % Btl 3 - - 3
123 Glibenklamida tablet 5 mg Tab 180 - - 180
129 Gliquidon tablet 30 mg tab - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 1,500 - 3 1,497
131 Gliserin btl - - - -
134 Glukosa larutan infus 5 % steril Btl 97 - 48 49
135 Griseofulvin tablet 125 mg Tab - - - -
136 Haloperidol inj 50 mg/mL amp - - - -
139 Haloperidol tablet 5 mg tab - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 896 - - 896
141 Hidrokortison krim 1% tube - - - -
142 Hidrokortison krim 2,5 % Tube - 5 - 5
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl 1 - - 1
145 Ibuprofen suspensi 200 mg/5 ml btl - - - -
146 Ibuprofen tablet 200 mg Tab - - - -
148 Ibuprofen tablet 400 mg Tab 259 - 89 170
150 Iodiol kapsul lunak kaps - - - -
151 Isoniazid tablet 100 mg Tab 100 - - 100
152 Isoniazid tablet 300 mg tab - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab - - - -
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab - - - -
158 Kaptopril tablet 12,5 mg Tab 150 - - 150
159 Kaptopril tablet 25 mg Tab 560 - 9 551
160 Kaptopril tablet 50 mg tab - - - -
161 Karbamazepin tablet 200 mg Tab - - - -
162 Ketokonazol krim 2% tube - - - -
163 Ketokonazol tablet 200 mg Tab 50 - - 50
164 Ketoprofen injeksi 100 mg amp - - - -
165 Ketoprofen tablet 100 mg tab - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 20 - - 20
170 Klomifen tablet 50 mg tab - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 493 - 11 482
174 Kloramfenikol salep mata 1 % Tube - - - -
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 5 - 5 -
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - -
178 Kloramfenikol tetes telinga 3 % btl - - - -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab - - - -
180 Klorokuin tablet 250 mg tab - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab - - - -
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 404 - - 404
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab - - - -
190 mg + Trimetoprim 40 mg / 5 ml Btl 1 - 1 -
191 Kuinin (Kina) tablet 200 mg tab - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - -
194 Lacto B sase - - - -
195 Lamivudine tablet 150 mg tab - - - -
196 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) btl - - - -
197 Dekstrosa 18.75 gr) (KAEN 1B) btl - - - -
198 (KAEN 3B) btl - - - -

2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr)
199 (KAEN 3A) btl - - - -
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - -
203 Lidokain injeksi 2% amp 34 - 18 16
205 ( Lidokain Comp. Inj ) Amp 20 - - 20
206 Lidokain jeli 2% pot - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - -
210 Loperamid tablet 2 mg tab 186 - - 186
211 Loratadin tablet 10 mg tab - - - -
212 Lorazepam tablet 2 mg tab - - - -
213 Lytacur btl - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial - - - -
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - -
217 Mebendazol tablet 100 mg tab - - - -
218 Meloksikam suppositoria supp - - - -
219 Meloksikam tablet 15 mg tab - - - -
220 Meloksikam tablet 7,5 mg tab - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp 14 - 7 7
223 Metampiron injeksi 250 mg amp - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 192 200 97 295
225 Metampiron tablet 500 mg tab - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 2 2 - 4
Tab
229 0,125 mg 100 - - 100
230 Metilprednisolon injeksi 500 mg amp - - - -
234 Metoklopramide injeksi 5 mg/ml amp 10 - - 10
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - -
236 Metoklopramide tablet 10 mg Tab - - - -
237 Metoklopramide tablet 5 mg tab - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - -
239 Metronidazol tablet 250 mg Tab - - - -
240 Metronidazol tablet 500 mg Tab 213 100 33 280
241 Metronidazol tablet 500 mg tab - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 3 - - 3
243 Mineral Mix, kombinasi sase - - - -
246 Morfin injeksi 10 mg/ml amp - - - -
247 Morfin tablet 10 mg tab - - - -
248 Natrium Diklofenak tablet 25 mg Tab - - - -
249 Natrium Diklofenak tablet 50 mg Tab 160 - 2 158
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 16 - 3 13
251 Neurobion 5000 injeksi amp - - - -
252 Nevirapin tablet 200 mg tab - - - -
253 Nifedipin tablet 10 mg tab 70 - 41 29
254 Nistatin tablet salut 500.000 IU/ g Tab - - - -
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - -
256 Norages inj amp - 30 - 30
259 Obat Antituberkulosis FDC Kategori Anak pak - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - -
262 Obat Antituberkulosis Kategori anak pak - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 3 - - 3
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube - 5 - 5
269 Oksitetrasiklin salep kulit 3% Tube - - - -
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 5 - 1 4
271 Omeprazol kapsul/kaplet 20 mg kaps - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - -
273 Papaverin injeksi 40 mg/ml amp - - - -
274 Papaverin tablet 40 mg Tab 430 - - 430
275 Parasetamol drops btl - - - -
276 Parasetamol sirup 120 mg / 5 ml Btl 2 - - 2
277 Parasetamol tablet 100 mg Tab 30 - - 30
278 Parasetamol tablet 500 mg Tab 466 - 103 363
279 Perfenazin tablet 4 mg (HCl) tab - - - -
280 Permetrin krim 5% tube - - - -
281 Petidin injeksi 50 mg/ml amp - - - -
283 Piracetam injeksi 3 g/15 ml amp 6 - 2 4
288 Pirantel sirup 125 mg/5 ml btl - - - -
289 Pirantel tablet score (base) 125 mg Tab - - - -
290 Pirazinamid tablet 500 mg tab - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 67 - - 67
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 340 - - 340
295 Povidon Iodida larutan 10% 30mL Btl 1 - - 1
296 Povidon Iodida larutan 10% 300 mL Btl - - - -
298 Pravastatin tablet 20 mg tab - - - -
299 Prednison tablet 5 mg Tab 960 - 40 920
300 Primakuin tablet 15 mg tab - - - -
301 Primperan inj amp 46 - 6 40
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab - - - -
306 Ramipril tablet 2,5 mg tab - - - -
307 Ramipril tablet 5 mg tab - - - -
308 Ranitidin injeksi 25 mg/2 ml amp 10 25 35 -
309 Ranitidin tablet 150 mg Tab 194 - 75 119
310 Ranitidin tablet 150 mg tab - - - -
317 Rifampisin tablet salut 450 mg kapl - - - -
318 Ringer Laktat larutan infus (RL) Btl 455 - 75 380
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab - - - -
325 endap 4% Pot 2 - - 2
326 Salisil Bedak 2 % Ktk 10 - - 10
327 Salisil Bedak 2 % ktk - - - -
328 Sanmol syr btl - - - -
329 Sanmol tab tab - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 34 100 25 109
333 Sefadroksil sirup kering 125 mg/5ml btl - - - -
336 Sefazolin injeksi 1 g amp - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - -
340 Sefotaksim injeksi 0,5 g amp - - - -
341 Sefotaksim injeksi 1 g vial 90 - 48 42
342 Seftazidim injeksi 1 g amp - - - -
343 Seftriakson injeksi 1 g vial 11 - - 11
344 Seftriakson injeksi 1 g amp - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp - - - -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 110 - 12 98
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - -
348 Simetidin tablet 200 mg Tab 490 - - 490
349 Simvastatin tablet 10 mg Tab 70 30 13 87
352 Siprofloksasin infus 2% btl - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 167 - 58 109
355 Spasminal tab tab 60 - 10 50
356 Spiramisin tablet 500 mg tab - - - -
359 Stavudin tablet 30 mg tab - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - -
361 Sulfasalazin tablet 500 mg tab - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl - - - -
363 Syntosinon inj amp - - - -
364 Tamoksifen tablet 20 mg tab - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps - - - -
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 80 - - 80
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 660 - 83 577
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 1,000 - - 1,000
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 17 - 17 -
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - -
374 Tramadol injeksi 50 mg/ml amp - - - -
377 Transamin tab tab - - - -
378 Trifluoperazin tablet 5 mg tab - - - -
379 Triheksifenidil tablet 2 mg Tab - - - -
380 Ulsikur inj amp 22 - 1 21
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - -
382 Valdimex tablet 5 mg tab - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - -
384 Vicillin 1gr inj vial - 20 15 5
385 Vitamin B Kompleks tablet Tab 1,385 - 363 1,022
386 Zidovudin tablet 100 mg tab - - - -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

388 Zinc drop 10 mg/mL btl 10 - - 10
389 Zinc tablet 20 mg tab 300 - - 300
-
2 Alat suntik sekali pakai 2,5 ml set 100 200 288 12
5 Catgut/benang bedah no.2/0 dengan jarum bedah set 20 - 5 15
7 Infusion set anak Set 12 45 12 45
8 Infusion set dewasa Set 23 50 38 35
9 IV Catheter No. 20 G Set 42 - 15 27
10 IV Catheter No. 22 G Set 47 50 18 79
11 IV Catheter No. 24 G Set 62 - 14 48
12 Kapas Berlemak 500 gram Bks - - - -
13 Kapas Pembalut / Absorben 250 gram Bks - 1 1 -
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 10 - 10 -
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 70 50 60 60
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol 3 - - 3
20 Kasa Pembalut Elastic 4 inchi rol - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol - - - -
22 Kasa Pembalut Elastic 10 cm x 4,5m rol - - - -
23 Pembalut Gips 3 ichi Rol - - - -
24 Plester 5 yards x 2 inch Rol 2 2 4 -
25 bedah Sac 15 - 2 13
26 Ultrafix 5x5 rol - - - -
27 Urine Bag Set 8 - 3 5
28 Foley Catheter set - - - -
29 Handscoon (Sarung Tangan Steril) Set 25 300 225 100
30 Masker set 20 50 40 30
-
C OBAT GIGI -
1 Etil Klorida spray btl - - - -
2 Eugenol cairan btl - - - -
3 Formokresol cairan btl - - - -
4 Glass Ionomer Cement ART btl - - - -
7 Kalsium Hidroksida Pasta btl - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - -
9 Komposit resin btl - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - -
11 Mummifying Pasta btl - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - -
13 cairan btl - - - -
-
1 Alinamin F tablet tab - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - -
3 Combifen syr btl - - - -
4 Coparcetin tab - 200 10 190
5 Dexanta tablet tab 110 - 50 60
6 Etafen syr btl 3 - - 3
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl - - - -
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl 3 - 1 2
8 Farizol tablet tab 100 - - 100
9 Fe Sirup btl - - - -
Gastrusid sirup btl -
10 Grafadon tab - - - -
11 H2O2 3% 800 cc btl - 1 1 -
12 Helixim syr btl 3 - - 3
13 Histigo tablet tab - - - -
15 Kalium Permanganat Serbuk Pot - - - -
16 Lexapram tablet tab 100 - - 100
Lostacef tab - - - -
17 Mes / Pisau bh 15 - 2 13
18 Mirasic syr btl 1 - - 1
19 Molacort tab - 200 - 200
20 Neurosanbe inj. amp 2 20 10 12
Novabion tab - 100 - 100
21 Novaflox tab - - - -
22 Novalgin injeksi amp - - - -
23 Novamog tab - - - -
24 Novaxifen tab - - - -
25 Pimtracol syr btl - - - -
26 Sarung Tangan Obgyn set - - - -
27 Scopamin Inj box - - - -
28 Stesolid supp. tube - - - -
29 Sufratul lbr - - - -
30 Tidifar tab - - -
31 Transamin inj. amp - - - -
Trifaneuro tab - 100 - 100
32 Trolit sase 6 - 3 3
33 Urocare Set 12 - 2 10
34 Vixal syr btl 3 - - 3
Penanggung Jawab UGD & Rawat Inap
PURWANTO S.Kep
bar R/ :
erik :
16,159
SISA OBAT DI PUSTU PONKESDES
31 Oktober 2015
B
a
d
NO Nama Obat SAT e TOTAL Semua
r
a
A OBAT - OBATAN n
1 Air untuk injeksi ampul 25 ml btl -
2 Albendazol suspensi 200 mg/5 ml btl -
3 Albendazol tablet 400 mg Tab 24
4 Alopurinol tablet 100 mg Tab 99
5 Alopurinol tablet 300 mg tab -
8 Alprazolam tablet 1 mg tab -
11 Ambroxol tablet 30 mg Tab 424
12 Aminofilin injeksi 24 mg/ml Amp 4
13 Aminofilin tablet 150 mg tab -
14 Aminofilin tablet 200 mg Tab 322
15 Amitriptilin tablet salut 25 mg (HCl) Tab -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab -
19 Amoksisilin kapsul/kaplet 250 mg Kaps -
20 Amoksisilin kapsul/kaplet 500 mg Tab 1,158
21 Amoksisilin serbuk injeksi 1000 mg vial -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 129
23 Amoxsan tab 500 mg tab -
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg
27 Magnesium Hidroksida 200 mg Tab 562
Antasida DOEN II suspensi, kombi : Aluminium Hidroksida 200 mg/5 ml
28 Magnesium Hidroksida 200 mg/5 ml Btl 69
Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g + Polimiksin 10.000
29 IU/g Tube 11
30 Antifungi DOEN Kombinasi: Asam Benzoat 6% + Asam Salisilat 3% pot 27
Antihemoroid DOEN kombinasi : Bismut subgalat 150 mg Heksaklorofen 2,5 mg
31 Supp 10
Antimalaria DOEN kombinasi : Pirimetamin tablet 25 mg Sulfadoksin tablet 500
32 mg tab -
33 Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50 mg Tab 100
34 Antrain inj amp -
35 Aqua pro Injeksi steril, bebas pirogen Amp -
36 Artemether injeksi 80 mg/ml amp -
37 Artesunate injeksi, vial 60 mg vial -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab 100
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 2,130
43 Asam Folat tablet 1 mg tab -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 130
B
a
d
r
47 a 33
Asiklovir krim 5% Tube
n
48 Asiklovir tablet 200 mg Tab 228
49 Asiklovir tablet 400 mg tab 10
51 Atapulgit tablet 600 mg tab -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp -
55 Atropin Sulfat tablet 0,5 mg tab -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial -
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet (tablet tambah darah
58 kombinasi ) tab -
59 Betahistin Mesilat tablet 6 mg tab -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 25
61 Bioplacenton tube -
62 Bisakodil suppositoria 10 mg supp -
63 Bisoprolol tablet 5 mg tab -
64 Bromheksin tablet 8 mg tab -
65 Buscopan inj amp -
66 Cetirizin sirup 5 mg/5 ml btl -
67 Cetirizine tablet 10 mg tab -
68 Clobazam tablet 10 mg tab -
69 Clobetasol krim 0,05% tube -
70 Dapson tablet 100 mg tab -
71 Deksametason injeksi i.v. 5 mg/ml Amp 41
72 Deksametason injeksi i.v. 5 mg/ml amp -
73 Deksametason tablet 0,5 mg Tab 1,539
74 Dekstran 70 - larutan infus 6% steril btl -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl -
78 Diazepam injeksi 5 mg/ml Amp -
81 Dietilkarbamazin Sitrat tablet 100 mg tab -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 550
83 Digoksin tablet 0,25 mg Tab 70
84 Diltiazem HCl tablet 30 mg tab -
85 Dimenhidrinat tablet 50 mg tab -
86 Doksisiklin kapsul/kaplet 100 mg kaps -
87 Domperidon suspensi 5 mg/5 ml btl -
88 Domperidon tablet 10 mg Tab -
89 Efedrin tablet 25 mg (HCl) tab -
90 Ekstraks Belladona tablet 10 mg Tab -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp -
94 Eritromisin sirup 200 mg/ 5 ml Btl -
95 Etakridin larutan 0,1% (Rivanol) Btl 6
96 Etambutol tablet 250 mg (HCl) tab -
97 Etambutol tablet salut 500 mg (HCl) tab -
98 Etanol 70% cairan ( 30 ml ) btl -
101 Fenilbutason tablet 200 mg tab -
B
a
d
r
102 a -
Fenitoin kapsul/kaplet 100 mg kaps
n
103 Fenitoin Natrium injeksi 50 mg/ml amp -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp -
110 Fenol Gliserol tetes telinga 10% Btl 24
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 481
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 270
113 Flukonazol tablet 150 mg tab -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp -
115 Furosemid tablet 40 mg Tab 151
116 Garam Oralit I serbuk Sac 357
117 Gemfibrozil kapsul/kaplet 300 mg kaps -
118 Gemfibrozil tablet 600 mg tab -
119 Gentamisin injeksi 40 mg/ ml amp -
120 Gentamisin salep kulit 0.1% tube 9
121 Gentamisin Sulfat tetes mata 0,3 % btl -
122 Gentian Violet larutan 1 % Btl 24
123 Glibenklamida tablet 5 mg Tab -
129 Gliquidon tablet 30 mg tab -
130 Gliseril Gualakolat tablet 100 mg Tab 8,724
131 Gliserin btl -
134 Glukosa larutan infus 5 % steril Btl 16
135 Griseofulvin tablet 125 mg Tab 220
136 Haloperidol inj 50 mg/mL amp -
139 Haloperidol tablet 5 mg tab -
140 HCT 25 mg (Hidroklortiazid) Tab 1,290
141 Hidrokortison krim 1% tube -
142 Hidrokortison krim 2,5 % Tube 66
143 Hyoscine -N-Butilbromide tablet 10 mg tab -
146 Ibuprofen tablet 200 mg Tab 80
148 Ibuprofen tablet 400 mg Tab 266
150 Iodiol kapsul lunak kaps -
151 Isoniazid tablet 100 mg Tab -
152 Isoniazid tablet 300 mg tab -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab -
154 Itrakonazol kapsul/kaplet 100 mg kaps -
B
a
d
r
157 Tab a 4,650
Kalsium Laktat (Kalk) tablet 500 mg
n
158 Kaptopril tablet 12,5 mg Tab -
159 Kaptopril tablet 25 mg Tab 988
160 Kaptopril tablet 50 mg tab -
161 Karbamazepin tablet 200 mg Tab -
162 Ketokonazol krim 2% tube -
163 Ketokonazol tablet 200 mg Tab 80
164 Ketoprofen injeksi 100 mg amp -
165 Ketoprofen tablet 100 mg tab -
168 Klindamisin kapsul/kaplet 150 mg kaps -
169 Klindamisin kapsul/kaplet 300 mg kaps 30
170 Klomifen tablet 50 mg tab -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 592
174 Kloramfenikol salep mata 1 % Tube -
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 8
176 Kloramfenikol suspensi 125 mg/ 5 ml btl -
177 Kloramfenicol tetes mata 0,5% Btl -
178 Kloramfenikol tetes telinga 3 % btl -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 3,812
180 Klorokuin tablet 250 mg tab -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp -
183 Klorpromazin tablet salut 100 mg (HCl) tab -
184 Klorpromazin tablet salut 25 mg (HCl) Tab -
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg ,
188 Trimetoprim 80 mg Tab 260
Kotrimoksazol DOEN II (pediatrik) kombinasi : Sulfametoksazol 100 mg
189 Trimetoprim 20 mg Tab 850
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg /
190 5 ml Btl 146
191 Kuinin (Kina) tablet 200 mg tab -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp -
194 Lacto B sase -
195 Lamivudine tablet 150 mg tab -
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28
196 mEq) (ASERING) btl -
197 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KAEN 1B) btl -
Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na
198 Lactat 2.24 gr, Dekstrosa 27 gr) (KAEN 3B) btl -
Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 gr,
199 KCL 0.75 gr Dekstrosa 27 gr) (KAEN 3A) btl -
200 Lanzoprazol kapsul/kaplet 30 mg tab -
203 Lidokain injeksi 2% amp 33
205 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml ( Lidokain Comp. Inj ) Amp 123
B
a
d
r
206 a -
Lidokain jeli 2% pot
n
207 Linkomisin kapsul/kaplet 500 mg kaps -
210 Loperamid tablet 2 mg tab 20
211 Loratadin tablet 10 mg tab -
212 Lorazepam tablet 2 mg tab -
213 Lytacur btl -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 5
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp -
216 Mebendazol sirup 100 mg / 5 ml btl -
217 Mebendazol tablet 100 mg tab -
218 Meloksikam suppositoria supp -
219 Meloksikam tablet 15 mg tab -
220 Meloksikam tablet 7,5 mg tab -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp -
222 Metampiron injeksi 250 mg (Antalgin) Amp -
223 Metampiron injeksi 250 mg amp -
224 Metampiron tablet 500 mg (Antalgin) Tab 745
225 Metampiron tablet 500 mg tab -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 6
229 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tab 240
230 Metilprednisolon injeksi 500 mg amp -
234 Metoklopramide injeksi 5 mg/ml amp -
235 Metoklopramide sirup 5 mg/ 5 ml btl -
236 Metoklopramide tablet 10 mg Tab 180
237 Metoklopramide tablet 5 mg tab -
238 Metronidazol infus 500 mg/100 ml btl -
239 Metronidazol tablet 250 mg Tab -
240 Metronidazol tablet 500 mg Tab 714
241 Metronidazol tablet 500 mg tab -
242 Mikonazol krim/salep 2 % (Nitrat) tube -
243 Mineral Mix, kombinasi sase -
246 Morfin injeksi 10 mg/ml amp -
247 Morfin tablet 10 mg tab -
248 Natrium Diklofenak tablet 25 mg Tab -
249 Natrium Diklofenak tablet 50 mg Tab 386
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 39
251 Neurobion 5000 injeksi amp -
252 Nevirapin tablet 200 mg tab -
253 Nifedipin tablet 10 mg tab 340
254 Nistatin tablet salut 500.000 IU/ g Tab 80
255 Nistatin vaginal tablet 100.000 IU/ g supp -
256 Norages inj amp -
259 Obat Antituberkulosis FDC Kategori Anak pak -
260 Obat Antituberkulosis FDC Sisipan pak -
B
a
d
r
261 a -
Obat Antituberkulosis Kategori 1 dewasa pak
n
262 Obat Antituberkulosis Kategori anak pak -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 25
264 Obat Batuk Hitam ( O.B.H. ) cairan btl -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp -
268 Oksitetrasiklin HCl salep mata 1 % Tube 104
269 Oksitetrasiklin salep kulit 3% Tube 63
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 364
271 Omeprazol kapsul/kaplet 20 mg kaps -
272 Oseltamivir kapsul/kaplet 75 mg kaps -
273 Papaverin injeksi 40 mg/ml amp -
274 Papaverin tablet 40 mg Tab 500
275 Parasetamol drops btl 3
276 Parasetamol sirup 120 mg / 5 ml Btl 279
277 Parasetamol tablet 100 mg Tab 80
278 Parasetamol tablet 500 mg Tab 1,206
279 Perfenazin tablet 4 mg (HCl) tab -
280 Permetrin krim 5% tube -
281 Petidin injeksi 50 mg/ml amp -
288 Pirantel sirup 125 mg/5 ml btl -
289 Pirantel tablet score (base) 125 mg Tab 91
290 Pirazinamid tablet 500 mg tab -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 3,016
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 80
295 Povidon Iodida larutan 10% 30mL Btl 10
296 Povidon Iodida larutan 10% 300 mL Btl 2
298 Pravastatin tablet 20 mg tab -
299 Prednison tablet 5 mg Tab 1,510
300 Primakuin tablet 15 mg tab -
301 Primperan inj amp -
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial -
303 Propanolol tablet 10 mg ( HCl ) tab -
304 Propanolol tablet 40 mg (HCl) tab -
305 Propiltiourasil tablet 100 mg (PTU) Tab -
306 Ramipril tablet 2,5 mg tab -
307 Ramipril tablet 5 mg tab -
308 Ranitidin injeksi 25 mg/2 ml amp -
309 Ranitidin tablet 150 mg Tab 458
310 Ranitidin tablet 150 mg tab -
B
a
d
r
316 a -
Rifampisin kapsul/kaplet 600 mg kapl
n
317 Rifampisin tablet salut 450 mg kapl -
318 Ringer Laktat larutan infus (RL) Btl -
322 SABU I Vial -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 230
325 Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang endap 4% Pot 26
326 Salisil Bedak 2 % Ktk 27
327 Salisil Bedak 2 % ktk -
328 Sanmol syr btl -
329 Sanmol tab tab -
331 Sefadroksil kapsul/kaplet 500 mg tab -
333 Sefadroksil sirup kering 125 mg/5ml btl -
336 Sefazolin injeksi 1 g amp -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab -
338 Sefiksim kapsul/kaplet 100 mg kaps -
339 Sefiksim sirup kering 100 mg/ 5 ml btl -
340 Sefotaksim injeksi 0,5 g amp -
341 Sefotaksim injeksi 1 g vial -
342 Seftazidim injeksi 1 g amp -
343 Seftriakson injeksi 1 g vial -
344 Seftriakson injeksi 1 g amp -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 263
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab -
348 Simetidin tablet 200 mg Tab 160
349 Simvastatin tablet 10 mg Tab -
352 Siprofloksasin infus 2% btl -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 424
355 Spasminal tab tab -
356 Spiramisin tablet 500 mg tab -
359 Stavudin tablet 30 mg tab -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl -
361 Sulfasalazin tablet 500 mg tab -
362 Sulfasetamida Natrium tetes mata 15 % Btl 3
363 Syntosinon inj amp -
364 Tamoksifen tablet 20 mg tab -
365 Tetrakain HCl tetes mata 0,5% btl -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 1,000
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 20
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 3,095
B
a
d
r
371 a -
Tiamin (Vitamin B1) 100 mg tablet tab
n
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 349
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp -
374 Tramadol injeksi 50 mg/ml amp -
377 Transamin tab tab -
378 Trifluoperazin tablet 5 mg tab -
379 Triheksifenidil tablet 2 mg Tab -
380 Ulsikur inj amp -
381 Valdimex Injeksi 5mg/ml (i.v.) amp -
382 Valdimex tablet 5 mg tab -
383 Verapamil tablet 80 mg (HCl) tab -
384 Vicillin 1gr inj vial -
385 Vitamin B Kompleks tablet Tab 6,540
386 Zidovudin tablet 100 mg tab -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab -
388 Zinc drop 10 mg/mL btl -
389 Zinc tablet 20 mg tab 432
-
1 Alat suntik sekali pakai 1 ml set 15
2 Alat suntik sekali pakai 2,5 ml set 1,033
5 Catgut/benang bedah no.2/0 dengan jarum bedah set 17
7 Infusion set anak Set -
8 Infusion set dewasa Set 15
12 Kapas Berlemak 500 gram Bks -
13 Kapas Pembalut / Absorben 250 gram Bks 5
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 40
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 79
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol -
20 Kasa Pembalut Elastic 4 inchi rol -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol -
22 Kasa Pembalut Elastic 10 cm x 4,5m rol -
23 Pembalut Gips 3 ichi Rol -
24 Plester 5 yards x 2 inch Rol 1
25 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum bedah Sac 94
26 Ultrafix 5x5 rol -
27 Urine Bag Set -
28 Foley Catheter set -
29 Handscoon (Sarung Tangan Steril) Set 50
30 Masker set 51
-
C OBAT GIGI -
1 Etil Klorida spray btl -
2 Eugenol cairan btl -
B
a
d
r
3 btl a -
Formokresol cairan
n
4 Glass Ionomer Cement ART btl -
7 Kalsium Hidroksida Pasta btl -
8 Klorfenol kamfer Menthol ( CHKM ) btl -
9 Komposit resin btl -
10 Devitalisasi Pasta (Non Arsen) btl -
11 Mummifying Pasta btl -
12 Semen Seng Fosfat serbuk dan cairan btl -
13 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan btl -

1 Alinamin F tablet tab -
2 Antiparkinson DOEN Tab Komb Tab -
3 Combifen syr btl -
4 Coparcetin tab -
5 Dexanta tablet tab -
6 Etafen syr btl -
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl -
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl 7
8 Farizol tablet tab -
9 Fe Sirup btl -
Gastrusid sirup btl -
10 Grafadon tab -
11 H2O2 3% 800 cc btl 1
12 Helixim syr btl -
13 Histigo tablet tab -
15 Kalium Permanganat Serbuk Pot -
16 Lexapram tablet tab -
Lostacef tab -
17 Mes / Pisau bh -
18 Mirasic syr btl -
19 Molacort tab -
20 Neurosanbe inj. amp -
Novabion tab -
21 Novaflox tab -
22 Novalgin injeksi amp -
23 Novamog tab -
24 Novaxifen tab -
25 Pimtracol syr btl -
26 Sarung Tangan Obgyn set -
27 Scopamin Inj box -
28 Stesolid supp. tube -
29 Sufratul lbr -
30 Tidifar tab -
31 Transamin inj. amp -
Trifaneuro tab -
32 Trolit sase -
33 Urocare Set -
34 Vixal syr btl -
55,874
SISA OBAT DI PUSTU PONKESDES
31 Oktober 2015
Alas Sumb Tama

Bade Plala Tama Tama Kalire Tlogo TOTAL
NO Nama Obat SAT Teng er- n-
ran ngan n n-sari jo sari Semua
ah argo kursi
1 Abbocath no 24 set -
2 Acyclovir 200 mg tab 8 60 50 100 10 228
3 Acyclovir 400 mg tab 10 10
4 Acyclovir oint tube 3 5 6 0 6 7 6 33
5 Alat Suntik sekali pakai 1 ml set 3 12 15
6 Alat Suntik sekali pakai 2,5 ml set 48 50 140 66 100 155 390 50 34 1,033
7 Alat Suntik sekali pakai 3 ml set -
8 Alat Suntik sekali pakai 5 ml set -
9 Albendazole tab 400 mg tab 9 15 24
10 Alkohol 70% 1000 ml btl 0 1 1 1 2 0 1 1 7
11 Alopurinol 100 tab 4 30 5 60 99
12 Ambroxol 30 mg tab 0 124 250 10 40 424
13 Ambroxol syr 15 mg/ml btl -
14 Aminophylline 200 tab 30 12 80 200 322
15 Aminophylline inj. amp 4 4
16 Amitriptillin 25 mg tab -
17 Amoxicillin 250 kaps 0 -
18 Amoxicillin 500 tab 40 100 108 100 110 400 100 200 1,158
19 Amoxicillin serbuk inj. vial -
20 Amoxicillin syr btl 20 10 11 0 13 20 30 25 129
21 Ampisillin 500 mg tab -
22 Ampisillin serbuk inj. vial -
23 Ampisillin syr btl -
24 Antalgin 500 tab 0 0 100 115 100 160 150 120 745
25 Antalgin inj. amp -
26 Antasida tab 0 10 100 166 100 36 100 50 562
27 Antasida syr btl 5 0 4 16 10 10 24 69
28 Anti Malaria tab -
29 Anti Parkinson DOEN komb tab -
30 Antibakteri DOEN salep tube 11 11

31 Antifungi DOEN salep tube 11 0 8 8 0 27
32 Antihemorrhoid supp. supp

10 10
33 Antimigren (ergotamin-kofein) tab

100 0 100
34 Aqua Pro inj. vial -
35 Asam Mefenamat 500 tab 50 0 50 30 0 130
36 Asetosal 100 mg tab -
37 Asetosal 500 tab 100 100
38 Atropin Sulfat inj. amp -
39 Atropin Sulfat tetes mata btl -
40 Benzatin Benzil Penisilin 1,2 amp -
41 Benzatin Benzil Penisilin 2,4 amp -
42 Betahistin Mesilat -
43 Betametasone oint tube 4 0 5 0 16 25
44 Bisoprolol 5 mg tab -
45 Captopril 12,5 tab -
46 Captopril 25 tab 0 0 130 88 120 0 520 100 30 988
47 Captopril 50 mg tab -
Alas Sumb Tama
ah argo kursi
48 Carbamazepin 200 mg tab -
49 Catgut set 3 12 0 2 17
50 Cetirizine 10 mg tab -
51 Chloramphenicole 250 kaps 440 142 0 10 592
52 Chloramphenikol Salep Mata tube -
53 Chloramphenikol syr btl 8 0 0 8
-
Alas Sumb Tama
ah argo kursi
54 Chloramphenikol Tetes mata btl -
55 Chlorin (1,5 l) btl -

56 Chlorpheniramine (CTM) tab 400 450 316 200 966 1100 0 380 3,812
57 Chlorpromazine 25mg (CPZ) tab -
58 Chlorpromazine 100mg (CPZ) tab -
59 Chlorpromazine inj. 25mg/ml amp -
60 Cimetidine tab 80 80 0 160
61 Ciprofloxacin 500 mg tab 60 90 30 104 50 90 424
62 Cotrimoxazole paed 120mg tab 850 850
63 Cotrimoxazole syr btl 0 0 15 9 30 22 60 10 146
64 Cotrimoxazole 480mg tab 100 70 0 90 260
65 Dexamethasone tab 100 200 104 120 165 300 400 150 1,539
66 Dexamethasone inj. amp 0 19 15 7 41
67 Dextromethorpan syr btl -
68 Dextromethorpan tab tab -
69 Diaform tab -
70 Digoxin 0,25 mg tab 70 70
71 Diltiazem HCl 30 mg tab 0 -
72 Dimenhydrinat 50 mg tab -
73 Diphenhydramine inj. amp 30 90 15 0 50 310 55 550
74 Doksisiklin 100 mg tab -
75 Domperidon 10 mg tab -
76 Ekstrak Belladonna tab -
77 Ephedrine 25 mg tab -
78 Epinefrin inj. amp -
79 Erythromycine 250 kaps -
80 Erythromycine 500 tab -
81 Erythromycine syr btl -
82 Ethyl Chloride spray btl -
83 Eugenol Cairan gigi btl -
84 Famotidin 20 mg tab -
85 Famotidin 40 mg tab -
86 Fenilbutason 200 mg tab -
87 Fenitoin Na 30 mg tab -
88 Fenitoin Na inj. amp -
89 Fenol Glycerol tetes telinga btl 15 9 24
90 Fenoxymethyl Penn. 250 tab -
91 Fenoxymethyl Penn. 500 tab -
92 Ferro Sulfat 300 mg tab -
93 Fluor tab 0,5 mg tab -
94 Furosemide 40 mg tab 1 150 151
95 Furosemide inj. amp -
96 Gameksan emulsi btl -
97 Garam Oralit sase 60 10 10 62 75 50 90 357
98 Gemfibrozil 300 mg tab -
Alas Sumb Tama
ah argo kursi
99 Gentamisin inj amp -
100 Gentamisin salep kulit tube 0 9 0 9
101 Gentamisin Sulfat tetes mata btl -
102 Gentian Violet btl 3 6 5 3 7 24
103 GG (gliseril guaiacolat) tab 370 400 1234 150 500 750 910 4410 8,724
104 Glimepiride 2 mg tab -
105 Glipizid 5 mg tab -
106 Gliquidon 30 mg tab -
107 Gliserin btl -
108 Glukosa 10 % btl -
109 Glukosa 40 % btl -
110 Glukosa 5 % btl 11 0 5 16
111 Griseofulvin tab 100 120 220
112 Haloperidol 1,5 mg tab -
113 HCT (hidrochlortiazid) tab 960 0 330 1,290
114 Hibiscrub btl -
-
Alas Sumb Tama
ah argo kursi
115 Hydrocortisone oint tube 0 9 0 5 16 36 66
116 Hyoscene-N- Butilbromide tab -
117 Ibuprofen 200 tab 80 0 80
118 Ibuprofen 400 tab 96 50 0 60 30 30 266
119 Infus Set Anak (Paed) set -
120 Infus Set Dewasa (Adult) set 15 15
121 Isoniazide 100 mg tab -
122 Isosorbid dinitrat (ISDN) tab -
123 Kalium Diklofenak 25 mg tab -
124 Kalium Diklofenak 50 mg tab -
125 Kalium Permanganat serbuk btl -
126 Kalk (calcium laktat) tab 1060 450 0 150 990 1300 700 0 4,650
127 Kapas Berlemak rol 0 -
128 Kapas Pembalut 250 gr rol 1 1 1 1 0 1 5
129 Kasa Kompres 40/40 rol -
130 Kasa Pembalut 2 x 80 rol -
131 Kasa Pembalut 4 x 15 / 4 x 10 rol 10 2 5 10 28 15 9 79
132 Kasa Pembalut 4m x 3cm / 4 x 5 rol 13 20 3 4 40
133 Kasa Steril Kotak ktk -
134 Ketokonazol krim tube 0 0 -
135 Ketokonazol tab 200 mg tab 80 80
136 Ketoprofen 100 mg tab -
137 Ketoprofen inj. amp -
138 Ketorolac inj. 10 mg amp -
139 Kina (kuinin) 200 mg tab -
140 Klindamisin 150 mg kaps -
141 Klindamisin 300 mg kaps 30 30
142 Klonidin 0,15 mg tab -
143 Kreolin btl -
144 Lidocaine Comp. Inj. amp 0 80 28 15 123
145 Lidocaine Inj. 2% amp 30 3 33
146 Linkomisin 500 mg tab -
147 Lisol btl -
148 Loperamid 2 mg tab 0 0 0 20 20
149 Magnesium Sulfat Inj. 20% amp 5 5
150 Magnesium Sulfat serbuk inj. vial -
Alas Sumb Tama
ah argo kursi
151 Masker set 41 10 51
152 Mebendazole syr btl -
153 Mebendazole tab 100mg tab -
154 Meloksikam 15 mg tab -
155 Metanol btl -
156 Metformin 500 mg tab -
157 Methylergometrin 0,125 mg tab 100 50 0 90 0 240
158 Methylergometrin inj. amp 6 6
159 Metilprednisolon 8 mg tab -
160 Metoklopramid 10 mg tab 0 30 0 100 10 40 180
161 Metilprednisolon 16 mg tab -
162 Metoklopramid inj. amp -
163 Metronidazole 250 tab 0 -
164 Metronidazole 500 tab 0 10 60 64 30 200 200 150 714
165 Na Diklofenak 25 mg tab 0 -
166 Na Diklofenak 50 mg tab 0 40 26 10 100 60 150 386
167 Na Fluorosein Tetes Mata btl -
168 Na Thiosulfat inj. amp -
169 NaCl infus btl 11 3 25 0 39
170 Natrium Bikarbonat 500 tab -
171 Nifedipin 10 mg tab 100 240 0 340
172 Nilatika tab tab -
173 Nistatin tab vaginal 100.000 IU tab -
174 Nistatin tab salut tab 80 80
-
Alas Sumb Tama
ah argo kursi
175 Novalgin inj amp -
176 OBH syr 100 ml btl 10 15 25
177 OBH syr 200 ml btl -
178 Ofloxacin 200 mg tab -
179 Ofloxacin 400 mg tab -
Oksitosin inj. amp 40 49 47 79 30 20 76 364

180 23
181 Omeprazol 20 mg tab -

182 Oxytetracycline inj. vial -
183 Oxytetracycline salep kulit tube 24 39 63
184 Oxytetracycline Salep Mata tube 10 4 0 58 3 29 104
185 Papaverin 40 mg tab 120 300 30 50 500
186 Papaverin inj. amp -
Paracetamol syr btl 50 20 30 15 40 3 53 279

187 68
188 Paracetamol 100 mg tab 30 50 80
189 Paracetamol 500 tab 30 50 150 138 100 138 500 100 0 1,206
190 Pembalut Gips rol -

191 Pilokarpin HCL tetes mata btl -
192 Piracetam 400 mg tab -
195 Piracetam inj. amp -
196 Pirazinamid tab -

Alas Sumb Tama
ah argo kursi
197 Piroksikam 20 mg tab 40 20 10 10 80
198 Plester 5cm x 4,5m (isoplast) rol 0 1 1
199 Polikresulen (Albothyl conc.) btl -
200 Prednisone tab 290 50 150 70 0 300 650 1,510
201 Primperan inj. amp -
202 Prokain Benzil Penisilin G. 3 jt vial -
203 Propanolol 40 tab -
204 Propiltiourasil 100 mg (PTU) tab -
205 Pyrantel 125 tab 89 2 91
206 Ranitidine 150 mg tab 110 0 20 40 10 30 248 458
207 Ranitidine inj. amp -
208 Reserpin 0,1 tab -
209 Reserpin 0,25 tab -
210 Rivanol btl 1 1 3 1 6
211 RL infus btl -
212 Salbutamol 2 mg tab -
213 Salbutamol 4 mg tab 0 50 80 100 0 230
214 Salep 2-4 btl 18 8 0 26
215 Salycil Bedak 2% ktk 0 2 6 8 3 8 27
216 Sanmol drop btl -
217 Sarung Tangan Steril set 50 50
218 Sefadroksil 500 mg tab -
219 Sefadroksil syr. btl -
220 Serum ABU I (anti bisa ular ) amp -
221 Serum ATS inj. 1500 IU/amp amp -
222 Silk (Benang Bedah sutera) set 35 20 33 6 94
223 Simvastatin tab 0 -
224 Spironolakton 100 mg tab -
225 Spironolakton 25 mg tab -
226 Streptomisin inj. Serbuk 1000mg/vial vial -
227 Sulfadimidin 500 mg tab -
228 Sulfasetamid Na Tetes Mata btl 3 3
229 Surflo IV Catheter set -
230 Terbutalin 2,5 mg tab -
231 Tetracyclin salep kulit (Erla) tube -
232 Tetracycline 250 kaps 1000 1,000
233 Tetracycline 500 kaps 20 20
234 Tetrakain tetes mata btl -
-
Alas Sumb Tama
ah argo kursi
235 Tramadol 50 mg tab -
236 Triheksifenidil 2 mg tab -
237 Urine Bag set -
238 Urocare / Foley Catheter set -
239 Viccilin inj. vial -
240 Vit.B Complex tab 400 1100 100 100 1350 1370 2000 120 6,540
241 Vit.B1 inj. amp 47 70 17 30 185 349
242 Vit.B1 50 mg (Thiamin) tab 400 960 400 185 400 150 600 0 3,095
243 Vit.B12 inj. (cyanocobalamin) amp 0 70 94 89 10 0 263
244 Vit.B12 tab. (cyanocobalamin) tab -
245 Vit.B6 (pyridoxine) tab 1000 0 766 0 550 700 3,016
246 Vit.C 100 mg tab -
247 Vit.C 250 mg tab -
248 Vit.C 50 mg tab 510 200 0 20 700 700 0 2,130
Alas Sumb Tama
ah argo kursi
249 Vit.K (phytomenadione) tab 109 22 350 481
250 Vit.K inj. amp 8 29 60 140 23 10 270
251 Wing Needle set -
252 Yodium Povidon 30 ml btl 2 7 1 0 10
253 Yodium Povidon 60 ml btl -
254 Yodium Povidon 300 ml btl 1 0 1 2
255 Yodium Povidon 1000 ml btl -
256 Zinc Tablet Diare tab 40 100 100 190 2 432
257 Thiampenicol 500 mg kaps 0 -
258 Domperidon syr btl -
259 Lytacur syr btl -
260 Zinc drop btl 0 -
257 Loratadine tab 0 -
258 Paracetamol drop btl 3 3
259 H2O2 800 ml btl 1 1
260 -
261 -
262 -
263 -
264 -
265 -
266 -
267 -
268 -
269 -
270 -
DAK = PKD
DAU / BUFFER = PKPS
Lainnya = dulu Jamkesda
JKN = Dulu Jamkesmas
REKAPITULASI SISA OBAT DI UNIT PELAYANAN
31 Oktober 2015
TOTAL TOTAL
No Nama Obat SAT GUDANG APOTEK UGD PUSPON
INDUK SEMUA
1 2 3 4 5 6 7(=4+5+6) 8 9(=7+8)
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl 42 - 3 45 - 45
2 Albendazol suspensi 200 mg/5 ml btl - - - - - -
3 Albendazol tablet 400 mg Tab 628 30 30 688 24 712
4 Alopurinol tablet 100 mg Tab 3,363 108 60 3,531 99 3,630
5 Alopurinol tablet 300 mg tab - - - - - -
6 Alprazolam tablet 0,25 mg tab - - - - - -
7 Alprazolam tablet 0,5 mg tab - - - - - -
8 Alprazolam tablet 1 mg tab - - - - - -
9 Ambroxol sirup 15 mg/ml btl - - 3 3 - 3
10 Ambroxol sirup 15 mg/ml btl - - - - - -
11 Ambroxol tablet 30 mg Tab 3,416 250 82 3,748 424 4,172
12 Aminofilin injeksi 24 mg/ml Amp 420 - 19 439 4 443
13 Aminofilin tablet 150 mg tab - - - - - -
14 Aminofilin tablet 200 mg Tab 3,175 331 144 3,650 322 3,972
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - - - -
16 Amlodipin tablet 10 mg tab - - - - - -
17 Amlodipin tablet 5 mg tab - - - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps - 229 80 309 - 309
20 Amoksisilin kapsul/kaplet 500 mg Tab 14,647 390 58 15,095 1,158 16,253
21 Amoksisilin serbuk injeksi 1000 mg vial - - - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 712 5 7 724 129 853
23 Amoxsan tab 500 mg tab 400 - 160 560 - 560
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - - - -
25 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - - - -
26 Ampisilin serbuk
Aluminium injeksi
Hidroksida i.m./i.v.
200 500 mg/vial
mgkombi
Magnesium vial - - - - - -
Antasida DOEN II suspensi, :
27 Hidroksida 200 mg
Aluminium Hidroksida 200 mg/5 ml Tab 5,986 170 275 6,431 562 6,993
28 Magnesium
Anti Bakteri Hidroksida
DOEN salep 200 mg/5 ml
kombinasi: Btl 378 13 3 394 69 463
29 Basitrasin 500 IU/g + Polimiksin
Antifungi DOEN Kombinasi: Asam 10.000 IU/g
Benzoat Tube 539 24 - 563 11 574
30 6% + Asam Salisilat 3% pot 141 6 - 147 27 174
31 Antihemoroid DOEN kombinasi : Bismut 50 - - 50 10 60
Antimalaria Supp
subgalat 150DOEN kombinasi : Pirimetamin
mg Heksaklorofen 2,5 mg
32 tablet 25 mgtablet:
Antimigren Sulfadoksin tablet
Ergotamin 500 mg
Tartrat 1 mg + tab - - - - - -
33 Kofein 50 mg Tab 2,100 100 - 2,200 100 2,300
34 Antrain inj amp - - - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp - - - - - -
36 Artemether injeksi 80 mg/ml amp - - - - - -
37 Artesunate injeksi, vial 60 mg vial - - - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab - - - - 100 100
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab - - 360 360 2,130 2,490
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - - - -
42 Asam Askorbat (Vitamin C) tablet 250 mg tab - - - - - -
43 Asam Folat tablet 1 mg tab - - - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 1,184 170 246 1,600 130 1,730
46 Asam Mefenamat kapsul/kaplet 500 mg tab - - - - - -
47 Asiklovir krim 5% Tube 152 22 - 174 33 207
48 Asiklovir tablet 200 mg Tab 50 30 50 130 228 358
49 Asiklovir tablet 400 mg tab 1,050 160 - 1,210 10 1,220
51 Atapulgit tablet 600 mg tab - - - - - -
52 Atenolol tablet 100 mg tab - - - - - -
53 Atenolol tablet 50 mg tab - - - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - - - -
57 Benzatin Benzil200
Besi (II) Sulfat Penisilin 2,4 juta
mg + Asam IU/vial
Folat 0,25 mg vial - - - - - -
58 tablet (tablet tambah darah kombinasi ) tab - - - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 51 20 1 72 25 97
61 Bioplacenton tube 1 - - 1 - 1
62 Bisakodil suppositoria 10 mg supp - - - - - -
63 Bisoprolol tablet 5 mg tab - - - - - -
64 Bromheksin tablet 8 mg tab - - - - - -
65 Buscopan inj amp 18 - - 18 - 18
66 Cetirizin sirup 5 mg/5 ml btl - - - - - -
67 Cetirizine tablet 10 mg tab 50 - - 50 - 50
68 Clobazam tablet 10 mg tab - - - - - -
69 Clobetasol krim 0,05% tube - - - - - -
70 Dapson tablet 100 mg tab - - - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 1,300 - 38 1,338 41 1,379
72 Deksametason injeksi i.v. 5 mg/ml amp - - - - - -
73 Deksametason tablet 0,5 mg Tab 3,358 457 74 3,889 1,539 5,428
74 Dekstran 70 - larutan infus 6% steril btl - - - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - -
77 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - -
78 Diazepam injeksi 5 mg/ml Amp 238 - 3 241 - 241
79 Diazepam tablet 2 mg Tab 1,152 - 6 1,158 - 1,158
80 Diazepam tablet 5 mg Tab 250 - - 250 - 250
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 911 - 5 916 550 1,466
83 Digoksin tablet 0,25 mg Tab 200 - 75 275 70 345
84 Diltiazem HCl tablet 30 mg tab - - - - - -
85 Dimenhidrinat tablet 50 mg tab 500 - - 500 - 500
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - - - -
87 Domperidon suspensi 5 mg/5 ml btl 7 5 3 15 - 15
88 Domperidon tablet 10 mg Tab - 106 41 147 - 147
89 Efedrin tablet 25 mg (HCl) tab - - - - - -
90 Ekstraks
Epinefrin Belladona
(Adrenalin)tablet 100,1
injeksi mg% (sebagai Tab 300 - - 300 - 300
91 HCl) Amp 88 - - 88 - 88
92 Eritromisin kapsul/kaplet 250 mg kaps 180 - - 180 - 180
93 Eritromisin kapsul/kaplet 500 mg kaps 1,376 124 - 1,500 - 1,500
94 Eritromisin sirup 200 mg/ 5 ml Btl 36 7 - 43 - 43
95 Etakridin larutan 0,1% (Rivanol) Btl 8 - 1 9 6 15
96 Etambutol tablet 250 mg (HCl) tab - - - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - - - -
99 Famotidine tablet 20 mg tab - - - - - -
100 Famotidine tablet 40 mg tab - - - - - -
101 Fenilbutason tablet 200 mg tab - - - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp 94 - - 94 - 94
106 Fenobarbital tablet 100 mg tab - - - - - -
107 Fenobarbital tablet 30 mg tab - - - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - - - -
109 Fenoksimetil Penisilin tablet 500 mg tab - - - - - -
110 Fenol Gliserol tetes telinga 10% Btl - 10 - 10 24 34
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 1,400 - - 1,400 481 1,881
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 507 - 12 519 270 789
113 Flukonazol tablet 150 mg tab - - - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - - - -
115 Furosemid tablet 40 mg Tab 2,000 95 200 2,295 151 2,446
116 Garam Oralit I serbuk Sac 5,700 100 75 5,875 357 6,232
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - - - -
118 Gemfibrozil tablet 600 mg tab - - - - - -
119 Gentamisin injeksi 40 mg/ ml amp 75 - - 75 - 75
120 Gentamisin salep kulit 0.1% tube 125 10 5 140 9 149
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - - - -
122 Gentian Violet larutan 1 % Btl 32 11 3 46 24 70
123 Glibenklamida tablet 5 mg Tab 3,090 46 180 3,316 - 3,316
124 Glimepiride tablet 1 mg tab - - - - - -
129 Gliquidon tablet 30 mg tab - - - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 16,876 625 1,497 18,998 8,724 27,722
131 Gliserin btl - - - - - -
132 Glukosa larutan infus 10 % steril Btl 4 - - 4 - 4
133 Glukosa larutan infus 40 % steril Btl - - - - - -
134 Glukosa larutan infus 5 % steril Btl 353 - 49 402 16 418
135 Griseofulvin tablet 125 mg Tab 2,085 280 - 2,365 220 2,585
136 Haloperidol inj 50 mg/mL amp - - - - - -
137 Haloperidol tablet 0,5 mg tab - - - - - -
138 Haloperidol tablet 1,5 mg tab - - - - - -
139 Haloperidol tablet 5 mg tab - - - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 3,727 536 896 5,159 1,290 6,449
141 Hidrokortison krim 1% tube - - - - - -
142 Hidrokortison krim 2,5 % Tube 550 7 5 562 66 628
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl - 1 1 2 - 2
145 Ibuprofen suspensi 200 mg/5 ml btl - - - - - -
146 Ibuprofen tablet 200 mg Tab 900 100 - 1,000 80 1,080
147 Ibuprofen tablet 200 mg tab - - - - - -
148 Ibuprofen tablet 400 mg Tab 4,681 375 170 5,226 266 5,492
149 Ibuprofen tablet 400 mg tab - - - - - -
150 Iodiol kapsul lunak kaps - - - - - -
151 Isoniazid tablet 100 mg Tab 1,800 - 100 1,900 - 1,900
152 Isoniazid tablet 300 mg tab - - - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab 500 - - 500 - 500
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - - - -
156 Kalium Diklofenak tablet 50 mg tab - - - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 24,078 762 - 24,840 4,650 29,490
158 Kaptopril tablet 12,5 mg Tab - - 150 150 - 150
159 Kaptopril tablet 25 mg Tab 5,857 229 551 6,637 988 7,625
160 Kaptopril tablet 50 mg tab - - - - - -
161 Karbamazepin tablet 200 mg Tab 200 90 - 290 - 290
162 Ketokonazol krim 2% tube 205 3 - 208 - 208
163 Ketokonazol tablet 200 mg Tab 1,450 75 50 1,575 80 1,655
164 Ketoprofen injeksi 100 mg amp - - - - - -
165 Ketoprofen tablet 100 mg tab - - - - - -
166 Ketorolac injeksi 10 mg amp - - - - - -
167 Ketorolac injeksi 30 mg amp - - - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 50 70 20 140 30 170
170 Klomifen tablet 50 mg tab - - - - - -
171 Klonidin tablet 0,15 mg tab - - - - - -
172 Klonidin tablet 0,15 mg tab - - - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 1,150 210 482 1,842 592 2,434
174 Kloramfenikol salep mata 1 % Tube - 1 - 1 - 1
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 42 9 - 51 8 59
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - - - -
178 Kloramfenikol tetes telinga 3 % btl 19 5 - 24 - 24
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 58,186 3 - 58,189 3,812 62,001
180 Klorokuin tablet 250 mg tab - - - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab 170 - - 170 - 170
185 Kodein tablet 10 mg tab - - - - - -
188 Kotrimoksazol DOEN I (dewasa) kombinasi : Tab 7,573 115 404 8,092 260 8,352
Kotrimoksazol
Kotrimoksazol DOEN
Sulfametoksazol II (pediatrik)
400 mg
Suspensi kombinasi
, Trimetoprim
komb: 80 mg :
189 Sulfametoksazol
Sulfametoksazol 100200 mg
mg Trimetoprim
+ Trimetoprim2040
mgmg Tab 9,632 170 - 9,802 850 10,652
190 / 5 ml Btl 680 9 - 689 146 835
191 Kuinin (Kina) tablet 200 mg tab - - - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - - - -
194 Lacto B sase - - - - - -
Larutan mengandung Elektrolit (Na 130 mEq,
195 Lamivudine
Cl 109 mEq, tablet 150 mg
Ca 3 mEq, Asetat 28 mEq) tab - - - - - -
196 (ASERING)
Larutan btl 500 - - 500 - 500
Larutan mengandung
mengandung Elektrolit (NaCl
Karbohidrat 1.125
+ Elektrolit
197 gr, Dekstrosa
(Nacl 1.75 18.75 gr)
gr, KCl 1.5 gr,(KAEN 1B)
Na Lactat +2.24 gr, btl 30 - - 30 - 30
Larutan mengandung Karbohidrat Elektrolit
198 Dekstrosa 27 gr) (KAEN 3B)
(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr btl 500 - - 500 - 500
199 Dekstrosa 27 gr) (KAEN 3A) btl 325 - - 325 - 325
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - - - -
201 Levofloksasin tablet 500 mg tab - - - - - -
202 Levofloksasin tablet 500 mg tab - - - - - -
203 Lidokain injeksi 2% amp 534 - 16 550 33 583
204 Lidokain
Lidokain injeksi
injeksi 2%
2% (HCl) + Epinefrin 1 : amp - - - - - -
205 80.000 - 2ml ( Lidokain Comp. Inj ) Amp 807 - 20 827 123 950
206 Lidokain jeli 2% pot - - - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - - - -
208 Lisinopril tablet 10 mg tab - - - - - -
209 Lisinopril tablet 5 mg tab - - - - - -
210 Loperamid tablet 2 mg tab 231 232 186 649 20 669
211 Loratadin tablet 10 mg tab 900 - - 900 - 900
212 Lorazepam tablet 2 mg tab - - - - - -
213 Lytacur btl - - - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 21 - - 21 5 26
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - - - -
217 Mebendazol tablet 100 mg tab - - - - - -
218 Meloksikam suppositoria supp - - - - - -
219 Meloksikam tablet 15 mg tab - - - - - -
220 Meloksikam tablet 7,5 mg tab - - - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp - - 7 7 - 7
223 Metampiron injeksi 250 mg amp - - - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 36,650 290 295 37,235 745 37,980
225 Metampiron tablet 500 mg tab - - - - - -
226 Metformin HCl tablet 500 mg tab - - - - - -
227 Metformin HCl tablet 850 mg tab - - - - - -
228 Metilergometrin
Metilergometrin Maleat
Maleat injeksi 0,200 mg -1 ml
(Metilergometrin) Amp 202 - 4 206 6 212
229 tablet salut 0,125 mg Tab 500 120 100 720 240 960
230 Metilprednisolon injeksi 500 mg amp - - - - - -
231 Metilprednisolon tablet 16 mg tab - - - - - -
232 Metilprednisolon tablet 4 mg tab - - - - - -
233 Metilprednisolon tablet 8 mg tab 30 - - 30 - 30
234 Metoklopramide injeksi 5 mg/ml amp - - 10 10 - 10
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - - - -
236 Metoklopramide tablet 10 mg Tab 1,100 219 - 1,319 180 1,499
237 Metoklopramide tablet 5 mg tab - - - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - - - -
239 Metronidazol tablet 250 mg Tab - 3 - 3 - 3
240 Metronidazol tablet 500 mg Tab 6,973 223 280 7,476 714 8,190
241 Metronidazol tablet 500 mg tab - - - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 4 4 3 11 - 11
243 Mineral Mix, kombinasi sase - - - - - -
244 Momethason krim 0,1 % tube - - - - - -
245 Momethason krim 0,1 % tube - - - - - -
246 Morfin injeksi 10 mg/ml amp - - - - - -
247 Morfin tablet 10 mg tab - - - - - -
248 Natrium Diklofenak tablet 25 mg Tab - - - - - -
249 Natrium Diklofenak tablet 50 mg Tab 2,738 140 158 3,036 386 3,422
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 1,089 - 13 1,102 39 1,141
251 Neurobion 5000 injeksi amp - - - - - -
252 Nevirapin tablet 200 mg tab - - - - - -
253 Nifedipin tablet 10 mg tab 2,200 - 29 2,229 340 2,569
254 Nistatin tablet salut 500.000 IU/ g Tab 700 - - 700 80 780
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - - - -
256 Norages inj amp 35 - 30 65 - 65
257 Obat Antituberkulosis FDC Kategori 1 pak - - - - - -
258 Obat Antituberkulosis FDC Kategori 2 pak - - - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - - - -
262 Obat Antituberkulosis Kategori anak pak - - - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 428 10 3 441 25 466
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - - - -
265 Ofloxacin tablet 200 mg tab - - - - - -
266 Ofloxacin tablet 400 mg tab - - - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube 26 7 5 38 104 142
269 Oksitetrasiklin salep kulit 3% Tube 364 24 - 388 63 451
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 137 - 4 141 364 505
271 Omeprazol kapsul/kaplet 20 mg kaps - - - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - - - -
273 Papaverin injeksi 40 mg/ml amp - - - - - -
274 Papaverin tablet 40 mg Tab 7,800 990 430 9,220 500 9,720
275 Parasetamol drops btl 182 8 - 190 3 193
276 Parasetamol sirup 120 mg / 5 ml Btl 506 8 2 516 279 795
277 Parasetamol tablet 100 mg Tab 760 - 30 790 80 870
278 Parasetamol tablet 500 mg Tab 33,408 190 363 33,961 1,206 35,167
279 Perfenazin tablet 4 mg (HCl) tab - - - - - -
280 Permetrin krim 5% tube - - - - - -
281 Petidin injeksi 50 mg/ml amp - - - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - - - -
283 Piracetam injeksi 3 g/15 ml amp 480 - 4 484 - 484
284 Piracetam injeksi 3 g/15 ml amp - - - - - -
285 Piracetam tablet 1200 mg tab - - - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - - - -
289 Pirantel tablet score (base) 125 mg Tab - 84 - 84 91 175
290 Pirazinamid tablet 500 mg tab - - - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 1,100 985 67 2,152 3,016 5,168
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 1,800 180 340 2,320 80 2,400
294 Povidon Iodida larutan 10% btl - - - - - -
295 Povidon Iodida larutan 10% 30mL Btl 11 - 1 12 10 22
296 Povidon Iodida larutan 10% 300 mL Btl - - - - 2 2
297 Povidon Iodida larutan 10% btl - - - - - -
298 Pravastatin tablet 20 mg tab - - - - - -
299 Prednison tablet 5 mg Tab 28,164 685 920 29,769 1,510 31,279
300 Primakuin tablet 15 mg tab - - - - - -
301 Primperan inj amp 165 - 40 205 - 205
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab 200 - - 200 - 200
306 Ramipril tablet 2,5 mg tab - - - - - -
307 Ramipril tablet 5 mg tab - - - - - -
308 Ranitidin injeksi 25 mg/2 ml amp - - - - - -
309 Ranitidin tablet 150 mg Tab 2,800 250 119 3,169 458 3,627
310 Ranitidin tablet 150 mg tab - - - - - -
311 Reserpin tablet 0,10 mg tab - - - - - -
312 Reserpin tablet 0,25 mg tab - - - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - - - -
314 Retinol (Vitamin A) 200.000 IU kapsul lunak kaps - - - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - - - -
316 Rifampisin kapsul/kaplet 600 mg kapl - - - - - -
317 Rifampisin tablet salut 450 mg kapl - - - - - -
318 Ringer Laktat larutan infus (RL) Btl - - 380 380 - 380
319 Risperidon tablet 1 mg tab - - - - - -
322 SABU I Vial - - - - - -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab - 144 228 372 - 372
324 Salbutamol tablet 4 mg Asam
Salep 2-4 , Kombinasi: (sebagai Sulfat)
Salisilat 2% + Tab 3,864 30 - 3,894 230 4,124
325 Belerang endap 4% Pot 54 8 2 64 26 90
326 Salisil Bedak 2 % Ktk 317 8 10 335 27 362
327 Salisil Bedak 2 % ktk - - - - - -
328 Sanmol syr btl 23 - - 23 - 23
329 Sanmol tab tab - - - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 900 6 109 1,015 - 1,015
333 Sefadroksil sirup kering 125 mg/5ml btl - - - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - - - -
335 Sefaleksin kapsul/kaplet 500 mg kaps - - - - - -
336 Sefazolin injeksi 1 g amp - - - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - - - -
340 Sefotaksim injeksi 0,5 g amp - - - - - -
341 Sefotaksim injeksi 1 g vial 560 - 42 602 - 602
342 Seftazidim injeksi 1 g amp - - - - - -
343 Seftriakson injeksi 1 g vial 128 - 11 139 - 139
344 Seftriakson injeksi 1 g amp - - - - - -
345 Serum A.T.S injeksi
Sianokobalamin 1.500B12)
(vitamin UI/amp (i.m.)
injeksi 500 Amp - - - - - -
346 mcg Amp 3,391 - 98 3,489 263 3,752
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - - - -
348 Simetidin tablet 200 mg Tab 4,510 - 490 5,000 160 5,160
349 Simvastatin tablet 10 mg Tab - 20 87 107 - 107
350 Simvastatin tablet 20 mg tab - - - - - -
351 Simvastatin tablet 5 mg tab - - - - - -
352 Siprofloksasin infus 2% btl - - - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 3,826 294 109 4,229 424 4,653
355 Spasminal tab tab - - 50 50 - 50
356 Spiramisin tablet 500 mg tab - - - - - -
357 Spironolakton tablet 100 mg tab - - - - - -
358 Spironolakton tablet 25 mg tab - - - - - -
359 Stavudin tablet 30 mg tab - - - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - - - -
361 Sulfasalazin tablet 500 mg tab - - - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl - - - - 3 3
363 Syntosinon inj amp 19 - - 19 - 19
364 Tamoksifen tablet 20 mg tab - - - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 7,900 - - 7,900 1,000 8,900
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 2,521 170 80 2,771 20 2,791
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 600 - 577 1,177 - 1,177
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 25,960 480 1,000 27,440 3,095 30,535
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 268 - - 268 349 617
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - - - -
374 Tramadol injeksi 50 mg/ml amp - - - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - -
376 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - -
377 Transamin tab tab - - - - - -
378 Trifluoperazin tablet 5 mg tab - - - - - -
379 Triheksifenidil tablet 2 mg Tab 100 - - 100 - 100
380 Ulsikur inj amp 34 - 21 55 - 55
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - - - -
382 Valdimex tablet 5 mg tab - - - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - - - -
384 Vicillin 1gr inj vial - - 5 5 - 5
385 Vitamin B Kompleks tablet Tab 50,313 1,045 1,022 52,380 6,540 58,920
386 Zidovudin
Zidovudin tablet
tablet 100
300 mg
mg + Lamivudine tablet tab - - - - - -
387 150 mg tab - - - - - -
388 Zinc drop 10 mg/mL btl 53 5 10 68 - 68
389 Zinc tablet 20 mg tab 5,538 205 300 6,043 432 6,475
- - - - - -
B PERBEKALAN KESEHATAN - - - - - -
1 Alat suntik sekali pakai 1 ml set 200 - - 200 15 215
2 Alat suntik sekali pakai 2,5 ml set 13,885 - 12 13,897 1,033 14,930
3 Alat suntik sekali pakai 3 ml set - - - - - -
4 Alat suntik sekali
Catgut/benang pakaino.2/0
bedah 5 ml dengan jarum set - - - - - -
5 bedah
Catgut/benang bedah no.3/0 dengan jarum set 197 - 15 212 17 229
6 bedah set - - - - - -
7 Infusion set anak Set 579 - 45 624 - 624
8 Infusion set dewasa Set 428 - 35 463 15 478
9 IV Catheter No. 20 G Set 514 - 27 541 - 541
12 Kapas Berlemak 500 gram Bks - - - - - -
13 Kapas Pembalut
Kasa Hidrofil / Absorben
uk. 16 250lembar)
x 16 (isi 16 gram / Bks 106 - - 106 5 111
14 kotak ktk 54 - - 54 - 54
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - - - -
16 Kasa Hidrofil uk. 40 m x 80 cm rol - - - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 2,729 - - 2,729 40 2,769
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 1,173 - 60 1,233 79 1,312
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol 71 - 3 74 - 74
20 Kasa Pembalut Elastic 4 inchi rol - - - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol 52 - - 52 - 52
22 Kasa Pembalut Elastic 10 cm x 4,5m rol 60 - - 60 - 60
23 Pembalut Gips 3 ichi Rol 10 - - 10 - 10
24 Plester 5 yards
Silk (Benang x 2 inch
Bedah Sutera) No. 3/0 dengan Rol 23 - - 23 1 24
25 jarum bedah Sac 137 - 13 150 94 244
26 Ultrafix 5x5 rol - - - - - -
27 Urine Bag Set 20 - 5 25 - 25
28 Foley Catheter set 10 - - 10 - 10
29 Handscoon (Sarung Tangan Steril) Set 760 - 100 860 50 910
30 Masker set 152 - 30 182 51 233
- - - - - -
C OBAT GIGI - - - - - -
1 Etil Klorida spray btl - - - - - -
2 Eugenol cairan btl - - - - - -
3 Formokresol cairan btl - - - - - -
4 Glass Ionomer Cement ART btl - - - - - -
5 Gutta Percha dan Paper points 15-40 mm btl - - - - - -
6 Gutta Percha dan Paper points 45-80 mm btl - - - - - -
7 Kalsium Hidroksida Pasta btl - - - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - - - -
9 Komposit resin btl - - - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - - - -
11 Mummifying Pasta btl - - - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - - - -
Temporary Stopping Fletcher (Fletcher)
13 serbuk dan cairan btl - - - - - -
- - - - - -
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN - - - - - -
1 Alinamin F tablet tab - - - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - - - -
3 Combifen syr btl 5 - - 5 - 5
4 Coparcetin tab 100 - 190 290 - 290
5 Dexanta tablet tab - - 60 60 - 60
6 Etafen syr btl 5 - 3 8 - 8
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl 14 - - 14 - 14
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl 12 - 2 14 7 21
8 Farizol tablet tab - - 100 100 - 100
9 Fe Sirup btl - - - - - -
Gastrusid sirup btl 20 - - 20 - 20
10 Grafadon tab 200 - - 200 - 200
11 H2O2 3% 800 cc btl 3 - - 3 1 4
12 Helixim syr btl 5 - 3 8 - 8
13 Histigo tablet tab - - - - - -
14 IV Catheter No. 18 G Set 100 - - 100 - 100
15 Kalium Permanganat Serbuk Pot 5 - - 5 - 5
16 Lexapram tablet tab - - 100 100 - 100
Lostacef tab 50 - - 50 - 50
17 Mes / Pisau bh - - 13 13 - 13
18 Mirasic syr btl 5 - 1 6 - 6
19 Molacort tab - - 200 200 - 200
20 Neurosanbe inj. amp 40 - 12 52 - 52
Novabion tab - - 100 100 - 100
21 Novaflox tab 300 - - 300 - 300
22 Novalgin injeksi amp - - - - - -
23 Novamog tab 200 - - 200 - 200
24 Novaxifen tab 200 - - 200 - 200
25 Pimtracol syr btl - - - - - -
26 Sarung Tangan Obgyn set 50 - - 50 - 50
27 Scopamin Inj box - - - - - -
28 Stesolid supp. tube - - - - - -
29 Sufratul lbr - - - - - -
30 Tidifar tab 200 - - 200 - 200
31 Transamin inj. amp - - - - - -
Trifaneuro tab - - 100 100 - 100
32 Trolit sase 6 - 3 9 - 9
33 Urocare Set - - 10 10 - 10
34 Vixal syr btl - - 3 3 - 3
Total 470,783 13,771 16,159 500,713 55,874 556,587

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT INPRES
( LPLPO )
KODE PUSKESMAS : 35120161 PEMAKAIAN BULAN : Oktober

KECAMATAN : SUMBERMALANG NO.(GFK) :
KABUPATEN : SITUBONDO
PROPINSI : JAWA TIMUR
STOK PENERI- PERSE- PEMAKAIAN SISA STOK PEMBER

NAMA OBAT PERMIN-
KODE SATUAN AWAL MAAN DIAAN DALAM LUAR TOTAL AKHIR OPT. INP/DAU PDPSEBK
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl 60 - 60 15 - 15 45
2 Albendazol suspensi 200 mg/5 ml btl - - - - - - -
3 Albendazol tablet 400 mg Tab 722 - 722 10 - 10 712
4 Alopurinol tablet 100 mg Tab 3,767 - 3,767 137 - 137 3,630
5 Alopurinol tablet 300 mg tab - - - - - - -
6 Alprazolam tablet 0,25 mg tab - - - - - - -
7 Alprazolam tablet 0,5 mg tab - - - - - - -
8 Alprazolam tablet 1 mg tab - - - - - - -
9 Ambroxol sirup 15 mg/ml btl 3 - 3 - - - 3
10 Ambroxol sirup 15 mg/ml btl - - - - - - -
11 Ambroxol tablet 30 mg Tab 4,411 - 4,411 239 - 239 4,172
12 Aminofilin injeksi 24 mg/ml Amp 477 - 477 34 - 34 443
13 Aminofilin tablet 150 mg tab - - - - - - -
14 Aminofilin tablet 200 mg Tab 4,262 - 4,262 290 - 290 3,972
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - - - - -
16 Amlodipin tablet 10 mg tab - - - - - - -
17 Amlodipin tablet 5 mg tab - - - - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps 319 - 319 10 - 10 309
20 Amoksisilin kapsul/kaplet 500 mg Tab 17,965 - 17,965 1,712 - 1,712 16,253
21 Amoksisilin serbuk injeksi 1000 mg vial - - - - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 981 - 981 128 - 128 853
23 Amoxsan tab 500 mg tab 600 - 600 40 - 40 560
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14

Aluminium Hidroksida 200 mg Magnesium
27 Hidroksida 200 mg Tab 8,187 - 8,187 1,194 - 1,194 6,993

Hidroksida 200 mg/5 ml Magnesium Hidroksida Btl
28 200 mg/5 ml 508 - 508 45 - 45 463
Anti Bakteri DOEN salep kombinasi: Basitrasin
29 500 IU/g + Polimiksin 10.000 IU/g Tube 575 - 575 1 - 1 574
Antifungi DOEN Kombinasi: Asam Benzoat 6% +

30 Asam Salisilat 3% pot 178 - 178 4 - 4 174
Antihemoroid DOEN kombinasi : Bismut subgalat
31 150 mg Heksaklorofen 2,5 mg Supp 60 - 60 - - - 60
Antimalaria DOEN kombinasi : Pirimetamin tablet
32 25 mg Sulfadoksin tablet 500 mg
tab - - - - - - -
33 Kofein 50 mg Tab 2,304 - 2,304 4 - 4 2,300
34 Antrain inj amp - - - - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp 7 - 7 7 - 7 -
36 Artemether injeksi 80 mg/ml amp - - - - - - -
37 Artesunate injeksi, vial 60 mg vial - - - - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab 160 - 160 60 - 60 100
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 4,320 - 4,320 1,830 - 1,830 2,490
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - - - - -
42 Asam Askorbat (Vitamin C) tablet 250 mg tab - - - - - - -
43 Asam Folat tablet 1 mg tab - - - - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 2,237 - 2,237 507 - 507 1,730
46 Asam Mefenamat kapsul/kaplet 500 mg tab - - - - - - -
47 Asiklovir krim 5% Tube 231 - 231 24 - 24 207
48 Asiklovir tablet 200 mg Tab 398 - 398 40 - 40 358
49 Asiklovir tablet 400 mg tab 1,220 - 1,220 - - - 1,220
51 Atapulgit tablet 600 mg tab - - - - - - -
52 Atenolol tablet 100 mg tab - - - - - - -
53 Atenolol tablet 50 mg tab - - - - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg
58 tablet (tablet tambah darah kombinasi )
tab - - - - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 115 - 115 18 - 18 97
61 Bioplacenton tube 1 - 1 - - - 1
62 Bisakodil suppositoria 10 mg supp - - - - - - -
63 Bisoprolol tablet 5 mg tab - - - - - - -
64 Bromheksin tablet 8 mg tab - - - - - - -
65 Buscopan inj amp 18 - 18 - - - 18
66 Cetirizin sirup 5 mg/5 ml btl - - - - - - -
67 Cetirizine tablet 10 mg tab 50 - 50 - - - 50
68 Clobazam tablet 10 mg tab - - - - - - -
69 Clobetasol krim 0,05% tube - - - - - - -
70 Dapson tablet 100 mg tab - - - - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 1,405 - 1,405 26 - 26 1,379
72 Deksametason injeksi i.v. 5 mg/ml amp - - - - - - -
73 Deksametason tablet 0,5 mg Tab 6,756 - 6,756 1,328 - 1,328 5,428
74 Dekstran 70 - larutan infus 6% steril btl - - - - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - - -
77 Dekstrometorfan tablet 15 mg (HBr) tab - - - - - - -
78 Diazepam injeksi 5 mg/ml Amp 241 - 241 - - - 241
79 Diazepam tablet 2 mg Tab 1,159 - 1,159 1 - 1 1,158
80 Diazepam tablet 5 mg Tab 250 - 250 - - - 250
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 1,601 - 1,601 135 - 135 1,466
83 Digoksin tablet 0,25 mg Tab 350 - 350 5 - 5 345
84 Diltiazem HCl tablet 30 mg tab - - - - - - -
85 Dimenhidrinat tablet 50 mg tab 500 - 500 - - - 500
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - - - - -
87 Domperidon suspensi 5 mg/5 ml btl 15 - 15 - - - 15
88 Domperidon tablet 10 mg Tab 184 - 184 37 - 37 147
89 Efedrin tablet 25 mg (HCl) tab - - - - - - -
90 Ekstraks Belladona tablet 10 mg Tab 300 - 300 - - - 300
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp 88 - 88 - - - 88

92 Eritromisin kapsul/kaplet 250 mg kaps 180 - 180 - - - 180
93 Eritromisin kapsul/kaplet 500 mg kaps 1,500 - 1,500 - - - 1,500
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
94 Eritromisin sirup 200 mg/ 5 ml Btl 44 - 44 1 - 1 43
95 Etakridin larutan 0,1% (Rivanol) Btl 16 - 16 1 - 1 15
96 Etambutol tablet 250 mg (HCl) tab - - - - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - - - - -
99 Famotidine tablet 20 mg tab - - - - - - -
100 Famotidine tablet 40 mg tab - - - - - - -
101 Fenilbutason tablet 200 mg tab - - - - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp 94 - 94 - - - 94
106 Fenobarbital tablet 100 mg tab - - - - - - -
107 Fenobarbital tablet 30 mg tab - - - - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - - - - -
109 Fenoksimetil Penisilin tablet 500 mg tab - - - - - - -
110 Fenol Gliserol tetes telinga 10% Btl 39 - 39 5 - 5 34
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 1,965 - 1,965 84 - 84 1,881
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 797 - 797 8 - 8 789
113 Flukonazol tablet 150 mg tab - - - - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - - - - -
115 Furosemid tablet 40 mg Tab 2,514 - 2,514 68 - 68 2,446
116 Garam Oralit I serbuk Sac 6,392 - 6,392 160 - 160 6,232
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - - - - -
118 Gemfibrozil tablet 600 mg tab - - - - - - -
119 Gentamisin injeksi 40 mg/ ml amp 75 - 75 - - - 75
120 Gentamisin salep kulit 0.1% tube 162 - 162 13 - 13 149
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - - - - -
122 Gentian Violet larutan 1 % Btl 95 - 95 25 - 25 70
123 Glibenklamida tablet 5 mg Tab 3,333 - 3,333 17 - 17 3,316
124 Glimepiride tablet 1 mg tab - - - - - - -
129 Gliquidon tablet 30 mg tab - - - - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 29,058 - 29,058 1,336 - 1,336 27,722
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
131 Gliserin btl - - - - - - -
132 Glukosa larutan infus 10 % steril Btl 4 - 4 - - - 4
133 Glukosa larutan infus 40 % steril Btl - - - - - - -
134 Glukosa larutan infus 5 % steril Btl 476 - 476 58 - 58 418
135 Griseofulvin tablet 125 mg Tab 2,615 - 2,615 30 - 30 2,585
136 Haloperidol inj 50 mg/mL amp - - - - - - -
137 Haloperidol tablet 0,5 mg tab - - - - - - -
138 Haloperidol tablet 1,5 mg tab - - - - - - -
139 Haloperidol tablet 5 mg tab - - - - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 6,513 - 6,513 64 - 64 6,449
141 Hidrokortison krim 1% tube - - - - - - -
142 Hidrokortison krim 2,5 % Tube 659 - 659 31 - 31 628
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl 2 - 2 - - - 2
145 Ibuprofen suspensi 200 mg/5 ml btl - - - - - - -
146 Ibuprofen tablet 200 mg Tab 1,120 - 1,120 40 - 40 1,080
147 Ibuprofen tablet 200 mg tab - - - - - - -
148 Ibuprofen tablet 400 mg Tab 6,445 - 6,445 953 - 953 5,492
149 Ibuprofen tablet 400 mg tab - - - - - - -
150 Iodiol kapsul lunak kaps - - - - - - -
151 Isoniazid tablet 100 mg Tab 1,900 - 1,900 - - - 1,900
152 Isoniazid tablet 300 mg tab - - - - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab 500 - 500 - - - 500
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - - - - -
156 Kalium Diklofenak tablet 50 mg tab - - - - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 29,990 - 29,990 500 - 500 29,490
158 Kaptopril tablet 12,5 mg Tab 170 - 170 20 - 20 150
159 Kaptopril tablet 25 mg Tab 8,459 - 8,459 834 - 834 7,625
160 Kaptopril tablet 50 mg tab - - - - - - -
161 Karbamazepin tablet 200 mg Tab 290 - 290 - - - 290
162 Ketokonazol krim 2% tube 208 - 208 - - - 208
163 Ketokonazol tablet 200 mg Tab 1,685 - 1,685 30 - 30 1,655
164 Ketoprofen injeksi 100 mg amp - - - - - - -
165 Ketoprofen tablet 100 mg tab - - - - - - -
166 Ketorolac injeksi 10 mg amp - - - - - - -
167 Ketorolac injeksi 30 mg amp - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
168 Klindamisin kapsul/kaplet 150 mg kaps - - - - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 180 - 180 10 - 10 170
170 Klomifen tablet 50 mg tab - - - - - - -
171 Klonidin tablet 0,15 mg tab - - - - - - -
172 Klonidin tablet 0,15 mg tab - - - - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 2,565 - 2,565 131 - 131 2,434
174 Kloramfenikol salep mata 1 % Tube 2 - 2 1 - 1 1
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 65 - 65 6 - 6 59
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - - - - -
178 Kloramfenikol tetes telinga 3 % btl 24 - 24 - - - 24
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 63,527 - 63,527 1,526 - 1,526 62,001
180 Klorokuin tablet 250 mg tab - - - - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab 200 - 200 30 - 30 170
185 Kodein tablet 10 mg tab - - - - - - -
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 8,612 - 8,612 260 - 260 8,352
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 10,802 - 10,802 150 - 150 10,652
Kotrimoksazol Suspensi komb: Sulfametoksazol

190 200 mg + Trimetoprim 40 mg / 5 ml Btl 1,083 - 1,083 248 - 248 835
191 Kuinin (Kina) tablet 200 mg tab - - - - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - - - - -
194 Lacto B sase - - - - - - -
195 Lamivudine tablet 150 mg tab - - - - - - -
Larutan mengandung Elektrolit (Na 130 mEq, Cl btl

196 109 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) 500 - 500 - - - 500
197 Dekstrosa 18.75 gr) (KAEN 1B)
btl 30 - 30 - - - 30
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
Larutan mengandung Karbohidrat + Elektrolit

(Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, btl
198 Dekstrosa 27 gr) (KAEN 3B) 500 - 500 - - - 500
Larutan mengandung Karbohidrat + Elektrolit

(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr btl 325
199 Dekstrosa 27 gr) (KAEN 3A) - 325 - - - 325
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - - - - -
201 Levofloksasin tablet 500 mg tab - - - - - - -
202 Levofloksasin tablet 500 mg tab - - - - - - -
203 Lidokain injeksi 2% amp 618 - 618 35 - 35 583
204 Lidokain injeksi 2% amp - - - - - - -
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 -
205 2ml ( Lidokain Comp. Inj ) Amp 974 - 974 24 - 24 950
206 Lidokain jeli 2% pot - - - - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - - - - -
208 Lisinopril tablet 10 mg tab - - - - - - -
209 Lisinopril tablet 5 mg tab - - - - - - -
210 Loperamid tablet 2 mg tab 755 - 755 86 - 86 669
211 Loratadin tablet 10 mg tab 920 - 920 20 - 20 900
212 Lorazepam tablet 2 mg tab - - - - - - -
213 Lytacur btl - - - - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 26 - 26 - - - 26
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - - - - -
217 Mebendazol tablet 100 mg tab - - - - - - -
218 Meloksikam suppositoria supp - - - - - - -
219 Meloksikam tablet 15 mg tab - - - - - - -
220 Meloksikam tablet 7,5 mg tab - - - - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp 14 - 14 7 - 7 7
223 Metampiron injeksi 250 mg amp - - - - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 39,632 - 39,632 1,652 - 1,652 37,980
225 Metampiron tablet 500 mg tab - - - - - - -
226 Metformin HCl tablet 500 mg tab - - - - - - -
227 Metformin HCl tablet 850 mg tab - - - - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 212 - 212 - - - 212
Metilergometrin Maleat (Metilergometrin) tablet
229 salut 0,125 mg Tab 1,020 - 1,020 60 - 60 960
230 Metilprednisolon injeksi 500 mg amp - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
231 Metilprednisolon tablet 16 mg tab - - - - - - -
232 Metilprednisolon tablet 4 mg tab - - - - - - -
233 Metilprednisolon tablet 8 mg tab 30 - 30 - - - 30
234 Metoklopramide injeksi 5 mg/ml amp 10 - 10 - - - 10
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - - - - -
236 Metoklopramide tablet 10 mg Tab 1,625 - 1,625 126 - 126 1,499
237 Metoklopramide tablet 5 mg tab - - - - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - - - - -
239 Metronidazol tablet 250 mg Tab 23 - 23 20 - 20 3
240 Metronidazol tablet 500 mg Tab 8,690 - 8,690 500 - 500 8,190
241 Metronidazol tablet 500 mg tab - - - - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 11 - 11 - - - 11
243 Mineral Mix, kombinasi sase - - - - - - -
244 Momethason krim 0,1 % tube - - - - - - -
245 Momethason krim 0,1 % tube - - - - - - -
246 Morfin injeksi 10 mg/ml amp - - - - - - -
247 Morfin tablet 10 mg tab - - - - - - -
248 Natrium Diklofenak tablet 25 mg Tab 80 - 80 80 - 80 -
249 Natrium Diklofenak tablet 50 mg Tab 3,924 - 3,924 502 - 502 3,422
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 1,154 - 1,154 13 - 13 1,141
251 Neurobion 5000 injeksi amp - - - - - - -
252 Nevirapin tablet 200 mg tab - - - - - - -
253 Nifedipin tablet 10 mg tab 2,620 - 2,620 51 - 51 2,569
254 Nistatin tablet salut 500.000 IU/ g Tab 800 - 800 20 - 20 780
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - - - - -
256 Norages inj amp 65 - 65 - - - 65
257 Obat Antituberkulosis FDC Kategori 1 pak - - - - - - -
258 Obat Antituberkulosis FDC Kategori 2 pak - - - - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - - - - -
262 Obat Antituberkulosis Kategori anak pak - - - - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 479 - 479 13 - 13 466
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - - - - -
265 Ofloxacin tablet 200 mg tab - - - - - - -
266 Ofloxacin tablet 400 mg tab - - - - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
268 Oksitetrasiklin HCl salep mata 1 % Tube 165 - 165 23 - 23 142
269 Oksitetrasiklin salep kulit 3% Tube 458 - 458 7 - 7 451
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 549 - 549 44 - 44 505
271 Omeprazol kapsul/kaplet 20 mg kaps - - - - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - - - - -
273 Papaverin injeksi 40 mg/ml amp - - - - - - -
274 Papaverin tablet 40 mg Tab 9,910 - 9,910 190 - 190 9,720
275 Parasetamol drops btl 195 - 195 2 - 2 193
276 Parasetamol sirup 120 mg / 5 ml Btl 952 - 952 157 - 157 795
277 Parasetamol tablet 100 mg Tab 1,120 - 1,120 250 - 250 870
278 Parasetamol tablet 500 mg Tab 36,768 - 36,768 1,601 - 1,601 35,167
279 Perfenazin tablet 4 mg (HCl) tab - - - - - - -
280 Permetrin krim 5% tube - - - - - - -
281 Petidin injeksi 50 mg/ml amp - - - - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - - - - -
283 Piracetam injeksi 3 g/15 ml amp 486 - 486 2 - 2 484
284 Piracetam injeksi 3 g/15 ml amp - - - - - - -
285 Piracetam tablet 1200 mg tab - - - - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - - - - -
289 Pirantel tablet score (base) 125 mg Tab 176 - 176 1 - 1 175
290 Pirazinamid tablet 500 mg tab - - - - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 5,343 - 5,343 175 - 175 5,168
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 2,510 - 2,510 110 - 110 2,400
294 Povidon Iodida larutan 10% btl - - - - - - -
295 Povidon Iodida larutan 10% 30mL Btl 23 - 23 1 - 1 22
296 Povidon Iodida larutan 10% 300 mL Btl 2 - 2 - - - 2
297 Povidon Iodida larutan 10% btl - - - - - - -
298 Pravastatin tablet 20 mg tab - - - - - - -
299 Prednison tablet 5 mg Tab 31,705 - 31,705 426 - 426 31,279
300 Primakuin tablet 15 mg tab - - - - - - -
301 Primperan inj amp 211 - 211 6 - 6 205
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
305 Propiltiourasil tablet 100 mg (PTU) Tab 200 - 200 - - - 200
306 Ramipril tablet 2,5 mg tab - - - - - - -
307 Ramipril tablet 5 mg tab - - - - - - -
308 Ranitidin injeksi 25 mg/2 ml amp 35 - 35 35 - 35 -
309 Ranitidin tablet 150 mg Tab 4,018 - 4,018 391 - 391 3,627
310 Ranitidin tablet 150 mg tab - - - - - - -
311 Reserpin tablet 0,10 mg tab - - - - - - -
312 Reserpin tablet 0,25 mg tab - - - - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - - - - -
314 Retinol (Vitamin A) 200.000 IU kapsul lunak kaps - - - - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - - - - -
316 Rifampisin kapsul/kaplet 600 mg kapl - - - - - - -
317 Rifampisin tablet salut 450 mg kapl - - - - - - -
318 Ringer Laktat larutan infus (RL) Btl 455 - 455 75 - 75 380
319 Risperidon tablet 1 mg tab - - - - - - -
322 SABU I Vial 1 - 1 1 - 1 -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab 372 - 372 - - - 372
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 4,334 - 4,334 210 - 210 4,124
325 Belerang endap 4% Pot 90 - 90 - - - 90
326 Salisil Bedak 2 % Ktk 382 - 382 20 - 20 362
327 Salisil Bedak 2 % ktk - - - - - - -
328 Sanmol syr btl 23 - 23 - - - 23
329 Sanmol tab tab - - - - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 1,040 - 1,040 25 - 25 1,015
333 Sefadroksil sirup kering 125 mg/5ml btl - - - - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - - - - -
335 Sefaleksin kapsul/kaplet 500 mg kaps - - - - - - -
336 Sefazolin injeksi 1 g amp - - - - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - - - - -
340 Sefotaksim injeksi 0,5 g amp - - - - - - -
341 Sefotaksim injeksi 1 g vial 650 - 650 48 - 48 602
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
342 Seftazidim injeksi 1 g amp - - - - - - -
343 Seftriakson injeksi 1 g vial 139 - 139 - - - 139
344 Seftriakson injeksi 1 g amp - - - - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp 3 - 3 3 - 3 -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 3,850 - 3,850 98 - 98 3,752
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - - - - -
348 Simetidin tablet 200 mg Tab 5,220 - 5,220 60 - 60 5,160
349 Simvastatin tablet 10 mg Tab 130 - 130 23 - 23 107
350 Simvastatin tablet 20 mg tab - - - - - - -
351 Simvastatin tablet 5 mg tab - - - - - - -
352 Siprofloksasin infus 2% btl - - - - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 5,017 - 5,017 364 - 364 4,653
355 Spasminal tab tab 60 - 60 10 - 10 50
356 Spiramisin tablet 500 mg tab - - - - - - -
357 Spironolakton tablet 100 mg tab - - - - - - -
358 Spironolakton tablet 25 mg tab - - - - - - -
359 Stavudin tablet 30 mg tab - - - - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - - - - -
361 Sulfasalazin tablet 500 mg tab - - - - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl 3 - 3 - - - 3
363 Syntosinon inj amp 19 - 19 - - - 19
364 Tamoksifen tablet 20 mg tab - - - - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 8,900 - 8,900 - - - 8,900
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 2,791 - 2,791 - - - 2,791
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 1,274 - 1,274 97 - 97 1,177
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 32,615 - 32,615 2,080 - 2,080 30,535
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 720 - 720 103 - 103 617
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - - - - -
374 Tramadol injeksi 50 mg/ml amp - - - - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - - -
376 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - - - -
377 Transamin tab tab - - - - - - -
378 Trifluoperazin tablet 5 mg tab - - - - - - -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
379 Triheksifenidil tablet 2 mg Tab 100 - 100 - - - 100
380 Ulsikur inj amp 56 - 56 1 - 1 55
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - - - - -
382 Valdimex tablet 5 mg tab - - - - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - - - - -
384 Vicillin 1gr inj vial 20 - 20 15 - 15 5
385 Vitamin B Kompleks tablet Tab 60,756 - 60,756 1,836 - 1,836 58,920
386 Zidovudin tablet 100 mg tab - - - - - - -
Zidovudin tablet 300 mg + Lamivudine tablet 150
387 mg
tab - - - - - - -
388 Zinc drop 10 mg/mL btl 68 - 68 - - - 68
389 Zinc tablet 20 mg tab 6,945 - 6,945 470 - 470 6,475
B PERBEKALAN KESEHATAN
1 Alat suntik sekali pakai 1 ml set 224 - 224 9 - 9 215
2 Alat suntik sekali pakai 2,5 ml set 15,635 - 15,635 705 - 705 14,930
3 Alat suntik sekali pakai 3 ml set - - - - - - -
4 Alat suntik sekali pakai 5 ml set - - - - - - -
5 bedah
set 241 - 241 12 - 12 229
6 bedah
set - - - - - - -
7 Infusion set anak Set 636 - 636 12 - 12 624
8 Infusion set dewasa Set 516 - 516 38 - 38 478
9 IV Catheter No. 20 G Set 556 - 556 15 - 15 541
12 Kapas Berlemak 500 gram Bks - - - - - - -
13 Kapas Pembalut / Absorben 250 gram Bks 114 - 114 3 - 3 111
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak

ktk 54 - 54 - - - 54
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - - - - -
16 Kasa Hidrofil uk. 40 m x 80 cm rol - - - - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 2,784 - 2,784 15 - 15 2,769
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 1,394 - 1,394 82 - 82 1,312
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol 74 - 74 - - - 74
20 Kasa Pembalut Elastic 4 inchi rol - - - - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol 52 - 52 - - - 52
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
22 Kasa Pembalut Elastic 10 cm x 4,5m rol 60 - 60 - - - 60
23 Pembalut Gips 3 ichi Rol 10 - 10 - - - 10
24 Plester 5 yards x 2 inch Rol 29 - 29 5 - 5 24
25 jarum bedah Sac 295 - 295 51 - 51 244
26 Ultrafix 5x5 rol - - - - - - -
27 Urine Bag Set 28 - 28 3 - 3 25
28 Foley Catheter set 10 - 10 - - - 10
29 Handscoon (Sarung Tangan Steril) Set 1,155 - 1,155 245 - 245 910
30 Masker set 275 - 275 42 - 42 233
C OBAT GIGI
1 Etil Klorida spray btl - - - - - - -
2 Eugenol cairan btl - - - - - - -
3 Formokresol cairan btl - - - - - - -
4 Glass Ionomer Cement ART btl - - - - - - -
5 Gutta Percha dan Paper points 15-40 mm btl - - - - - - -
6 Gutta Percha dan Paper points 45-80 mm btl - - - - - - -
7 Kalsium Hidroksida Pasta btl - - - - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - - - - -
9 Komposit resin btl - - - - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - - - - -
11 Mummifying Pasta btl - - - - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - - - - -
Temporary Stopping Fletcher (Fletcher) serbuk
13 dan cairan btl - - - - - - -
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN

1 Alinamin F tablet tab - - - - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - - - - -
3 Combifen syr btl 5 - 5 - - - 5
4 Coparcetin tab 300 - 300 10 - 10 290
5 Dexanta tablet tab 110 - 110 50 - 50 60
6 Etafen syr btl 8 - 8 - - - 8
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl 14 - 14 - - - 14
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl 25 - 25 4 - 4 21
8 Farizol tablet tab 100 - 100 - - - 100
9 Fe Sirup btl 1 - 1 1 - 1 -
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
Gastrusid sirup btl 20 - 20 - - - 20
10 Grafadon tab 200 - 200 - - - 200
11 H2O2 3% 800 cc btl 5 - 5 1 - 1 4
12 Helixim syr btl 8 - 8 - - - 8
13 Histigo tablet tab - - - - - - -
14 IV Catheter No. 18 G Set 100 - 100 - - - 100
15 Kalium Permanganat Serbuk Pot 5 - 5 - - - 5
16 Lexapram tablet tab 100 - 100 - - - 100
Lostacef tab 50 - 50 - - - 50
17 Mes / Pisau bh 15 - 15 2 - 2 13
18 Mirasic syr btl 6 - 6 - - - 6
19 Molacort tab 200 - 200 - - - 200
20 Neurosanbe inj. amp 62 - 62 10 - 10 52
Novabion tab 100 - 100 - - - 100
21 Novaflox tab 300 - 300 - - - 300
22 Novalgin injeksi amp - - - - - - -
23 Novamog tab 200 - 200 - - - 200
24 Novaxifen tab 200 - 200 - - - 200
25 Pimtracol syr btl - - - - - - -
26 Sarung Tangan Obgyn set 50 - 50 - - - 50
27 Scopamin Inj box - - - - - - -
28 Stesolid supp. tube - - - - - - -
29 Sufratul lbr - - - - - - -
30 Tidifar tab 200 - 200 - - - 200
31 Transamin inj. amp - - - - - - -
Trifaneuro tab 100 - 100 - - - 100
32 Trolit sase 12 - 12 3 - 3 9
33 Urocare Set 12 - 12 2 - 2 10
34 Vixal syr btl 3 - 3 - - - 3
UMUM
JUMLAH KUNJUNGAN ASKES JUMLAH
BAYAR GRATIS
RESEP
590 7 1,877 2,474
NAMA OBAT PERMIN-
TAAN
1 2 3 4 5 6 (=4+5) 7 8 9 (=7+8) 10 (=6-9) 11 12 13 14
MENGETAHUI/MENYETUJUI YANG MENYERAHKAN YANG MEMINTA / MELAPOR YANG

KADINKES KABUPATEN SITUBONDO KEPALA GFK KEPALA PUSKESMAS PENGELOLA
Drs. H. ABU BAKAR ABDI, Apt, Msi LIANA PUSPITANINGRUM, Apt. A M R O Z I, S.Kep.Ns JONI H
NIP. 19650525 199403 1 009 NIP: 19800614 200501 2 019 NIP. 19641008 198503 1 004 NIP. 198206
tober TAHUN : 2015
TANGGAL :
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YANG MENERIMA
PENGELOLA OBAT PUSKESMAS
JONI HARDIANTO
NIP. 19820610 200604 1 016
LAPORAN BULANAN PEMAKAIAN dan LEMBAR PERMINTAAN OBAT (LPLPO)
Kode Puskesmas : 3512010201 BULAN / TAHUN : Oktober : 2015

Puskesmas : SUMBERMALANG Pelaporan :
Permintaan :
DOKUMEN
DINKES KAB/KOTA
IF KAB/KOTA
Puskesmas Pembantu yang ada : 9 yang lapor 9 PUSKESMAS
STOK PENERI- PERSE- STOK PERMIN- PEMBE

NO KODE NAMA OBAT SATUAN SISA AKHIR
AWAL MAAN DIAAN PEMAKAIAN OPT. TAAN APBD I APBD II
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl 60 - 60 15 45
2 Albendazol suspensi 200 mg/5 ml btl - - - - -
3 Albendazol tablet 400 mg Tab 722 - 722 10 712
4 Alopurinol tablet 100 mg Tab 3,767 - 3,767 137 3,630
5 Alopurinol tablet 300 mg tab - - - - -
6 Alprazolam tablet 0,25 mg tab - - - - -
7 Alprazolam tablet 0,5 mg tab - - - - -
8 Alprazolam tablet 1 mg tab - - - - -
9 Ambroxol sirup 15 mg/ml btl 3 - 3 - 3
10 Ambroxol sirup 15 mg/ml btl - - - - -
11 Ambroxol tablet 30 mg Tab 4,411 - 4,411 239 4,172
12 Aminofilin injeksi 24 mg/ml Amp 477 - 477 34 443
13 Aminofilin tablet 150 mg tab - - - - -
14 Aminofilin tablet 200 mg Tab 4,262 - 4,262 290 3,972
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - - -
16 Amlodipin tablet 10 mg tab - - - - -
17 Amlodipin tablet 5 mg tab - - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps 319 - 319 10 309
20 Amoksisilin kapsul/kaplet 500 mg Tab 17,965 - 17,965 1,712 16,253
21 Amoksisilin serbuk injeksi 1000 mg vial - - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 981 - 981 128 853
23 Amoxsan tab 500 mg tab 600 - 600 40 560
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - - -
27 Antasida DOEN I tablet kunyah, kombinasi : Alu Tab 8,187 - 8,187 1,194 6,993
28 Antasida DOEN II suspensi, kombi : Aluminium H Btl 508 - 508 45 463
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
29 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 Tube 575 - 575 1 574
30 Antifungi DOEN Kombinasi: Asam Benzoat 6% + As pot 178 - 178 4 174
31 Antihemoroid DOEN kombinasi : Bismut subgalat Supp 60 - 60 - 60
32 Antimalaria DOEN kombinasi : Pirimetamin tablet tab - - - - -
33 Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein Tab 2,304 - 2,304 4 2,300
34 Antrain inj amp - - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp 7 - 7 7 -
36 Artemether injeksi 80 mg/ml amp - - - - -
37 Artesunate injeksi, vial 60 mg vial - - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab 160 - 160 60 100
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 4,320 - 4,320 1,830 2,490
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - - -
42 Asam Askorbat (Vitamin C) tablet 250 mg tab - - - - -
43 Asam Folat tablet 1 mg tab - - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 2,237 - 2,237 507 1,730
46 Asam Mefenamat kapsul/kaplet 500 mg tab - - - - -
47 Asiklovir krim 5% Tube 231 - 231 24 207
48 Asiklovir tablet 200 mg Tab 398 - 398 40 358
49 Asiklovir tablet 400 mg tab 1,220 - 1,220 - 1,220
51 Atapulgit tablet 600 mg tab - - - - -
52 Atenolol tablet 100 mg tab - - - - -
53 Atenolol tablet 50 mg tab - - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - - -
58 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg table tab - - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube 115 - 115 18 97
61 Bioplacenton tube 1 - 1 - 1
62 Bisakodil suppositoria 10 mg supp - - - - -
63 Bisoprolol tablet 5 mg tab - - - - -
64 Bromheksin tablet 8 mg tab - - - - -
65 Buscopan inj amp 18 - 18 - 18
66 Cetirizin sirup 5 mg/5 ml btl - - - - -
67 Cetirizine tablet 10 mg tab 50 - 50 - 50
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
68 Clobazam tablet 10 mg tab - - - - -
69 Clobetasol krim 0,05% tube - - - - -
70 Dapson tablet 100 mg tab - - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 1,405 - 1,405 26 1,379
72 Deksametason injeksi i.v. 5 mg/ml amp - - - - -
73 Deksametason tablet 0,5 mg Tab 6,756 - 6,756 1,328 5,428
74 Dekstran 70 - larutan infus 6% steril btl - - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - - -
77 Dekstrometorfan tablet 15 mg (HBr) tab - - - - -
78 Diazepam injeksi 5 mg/ml Amp 241 - 241 - 241
79 Diazepam tablet 2 mg Tab 1,159 - 1,159 1 1,158
80 Diazepam tablet 5 mg Tab 250 - 250 - 250
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 1,601 - 1,601 135 1,466
83 Digoksin tablet 0,25 mg Tab 350 - 350 5 345
84 Diltiazem HCl tablet 30 mg tab - - - - -
85 Dimenhidrinat tablet 50 mg tab 500 - 500 - 500
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - - -
87 Domperidon suspensi 5 mg/5 ml btl 15 - 15 - 15
88 Domperidon tablet 10 mg Tab 184 - 184 37 147
89 Efedrin tablet 25 mg (HCl) tab - - - - -
90 Ekstraks Belladona tablet 10 mg Tab 300 - 300 - 300
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp 88 - 88 - 88
92 Eritromisin kapsul/kaplet 250 mg kaps 180 - 180 - 180
93 Eritromisin kapsul/kaplet 500 mg kaps 1,500 - 1,500 - 1,500
94 Eritromisin sirup 200 mg/ 5 ml Btl 44 - 44 1 43
95 Etakridin larutan 0,1% (Rivanol) Btl 16 - 16 1 15
96 Etambutol tablet 250 mg (HCl) tab - - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - - -
99 Famotidine tablet 20 mg tab - - - - -
100 Famotidine tablet 40 mg tab - - - - -
101 Fenilbutason tablet 200 mg tab - - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - - -
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp 94 - 94 - 94
106 Fenobarbital tablet 100 mg tab - - - - -
107 Fenobarbital tablet 30 mg tab - - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - - -
109 Fenoksimetil Penisilin tablet 500 mg tab - - - - -
110 Fenol Gliserol tetes telinga 10% Btl 39 - 39 5 34
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 1,965 - 1,965 84 1,881
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 797 - 797 8 789
113 Flukonazol tablet 150 mg tab - - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - - -
115 Furosemid tablet 40 mg Tab 2,514 - 2,514 68 2,446
116 Garam Oralit I serbuk Sac 6,392 - 6,392 160 6,232
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - - -
118 Gemfibrozil tablet 600 mg tab - - - - -
119 Gentamisin injeksi 40 mg/ ml amp 75 - 75 - 75
120 Gentamisin salep kulit 0.1% tube 162 - 162 13 149
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - - -
122 Gentian Violet larutan 1 % Btl 95 - 95 25 70
123 Glibenklamida tablet 5 mg Tab 3,333 - 3,333 17 3,316
124 Glimepiride tablet 1 mg tab - - - - -
129 Gliquidon tablet 30 mg tab - - - - -
130 Gliseril Gualakolat tablet 100 mg Tab 29,058 - 29,058 1,336 27,722
131 Gliserin btl - - - - -
132 Glukosa larutan infus 10 % steril Btl 4 - 4 - 4
133 Glukosa larutan infus 40 % steril Btl - - - - -
134 Glukosa larutan infus 5 % steril Btl 476 - 476 58 418
135 Griseofulvin tablet 125 mg Tab 2,615 - 2,615 30 2,585
136 Haloperidol inj 50 mg/mL amp - - - - -
137 Haloperidol tablet 0,5 mg tab - - - - -
138 Haloperidol tablet 1,5 mg tab - - - - -
139 Haloperidol tablet 5 mg tab - - - - -
140 HCT 25 mg (Hidroklortiazid) Tab 6,513 - 6,513 64 6,449
141 Hidrokortison krim 1% tube - - - - -
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
142 Hidrokortison krim 2,5 % Tube 659 - 659 31 628
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl 2 - 2 - 2
145 Ibuprofen suspensi 200 mg/5 ml btl - - - - -
146 Ibuprofen tablet 200 mg Tab 1,120 - 1,120 40 1,080
147 Ibuprofen tablet 200 mg tab - - - - -
148 Ibuprofen tablet 400 mg Tab 6,445 - 6,445 953 5,492
149 Ibuprofen tablet 400 mg tab - - - - -
150 Iodiol kapsul lunak kaps - - - - -
151 Isoniazid tablet 100 mg Tab 1,900 - 1,900 - 1,900
152 Isoniazid tablet 300 mg tab - - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab 500 - 500 - 500
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - - -
156 Kalium Diklofenak tablet 50 mg tab - - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 29,990 - 29,990 500 29,490
158 Kaptopril tablet 12,5 mg Tab 170 - 170 20 150
159 Kaptopril tablet 25 mg Tab 8,459 - 8,459 834 7,625
160 Kaptopril tablet 50 mg tab - - - - -
161 Karbamazepin tablet 200 mg Tab 290 - 290 - 290
162 Ketokonazol krim 2% tube 208 - 208 - 208
163 Ketokonazol tablet 200 mg Tab 1,685 - 1,685 30 1,655
164 Ketoprofen injeksi 100 mg amp - - - - -
165 Ketoprofen tablet 100 mg tab - - - - -
166 Ketorolac injeksi 10 mg amp - - - - -
167 Ketorolac injeksi 30 mg amp - - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - - -
169 Klindamisin kapsul/kaplet 300 mg kaps 180 - 180 10 170
170 Klomifen tablet 50 mg tab - - - - -
171 Klonidin tablet 0,15 mg tab - - - - -
172 Klonidin tablet 0,15 mg tab - - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps 2,565 - 2,565 131 2,434
174 Kloramfenikol salep mata 1 % Tube 2 - 2 1 1
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl 65 - 65 6 59
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - - -
178 Kloramfenikol tetes telinga 3 % btl 24 - 24 - 24
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 63,527 - 63,527 1,526 62,001
180 Klorokuin tablet 250 mg tab - - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab 200 - 200 30 170
185 Kodein tablet 10 mg tab - - - - -
188 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulf Tab 8,612 - 8,612 260 8,352
189 Kotrimoksazol DOEN II (pediatrik) kombinasi : Su Tab 10,802 - 10,802 150 10,652
190 Kotrimoksazol Suspensi komb: Sulfametoksazol 20 Btl 1,083 - 1,083 248 835
191 Kuinin (Kina) tablet 200 mg tab - - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - - -
194 Lacto B sase - - - - -
195 Lamivudine tablet 150 mg tab - - - - -
196 Larutan mengandung Elektrolit (Na 130 mEq, Cl btl 500 - 500 - 500
197 Larutan mengandung Elektrolit (NaCl 1.125 gr, De btl 30 - 30 - 30
198 Larutan mengandung Karbohidrat + Elektrolit (Nacl btl 500 - 500 - 500
199 Larutan mengandung Karbohidrat + Elektrolit (Nacl btl 325 - 325 - 325
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - - -
201 Levofloksasin tablet 500 mg tab - - - - -
202 Levofloksasin tablet 500 mg tab - - - - -
203 Lidokain injeksi 2% amp 618 - 618 35 583
204 Lidokain injeksi 2% amp - - - - -
205 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - Amp 974 - 974 24 950
206 Lidokain jeli 2% pot - - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - - -
208 Lisinopril tablet 10 mg tab - - - - -
209 Lisinopril tablet 5 mg tab - - - - -
210 Loperamid tablet 2 mg tab 755 - 755 86 669
211 Loratadin tablet 10 mg tab 920 - 920 20 900
212 Lorazepam tablet 2 mg tab - - - - -
213 Lytacur btl - - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 26 - 26 - 26
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - - -
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
216 Mebendazol sirup 100 mg / 5 ml btl - - - - -
217 Mebendazol tablet 100 mg tab - - - - -
218 Meloksikam suppositoria supp - - - - -
219 Meloksikam tablet 15 mg tab - - - - -
220 Meloksikam tablet 7,5 mg tab - - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp 14 - 14 7 7
223 Metampiron injeksi 250 mg amp - - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab 39,632 - 39,632 1,652 37,980
225 Metampiron tablet 500 mg tab - - - - -
226 Metformin HCl tablet 500 mg tab - - - - -
227 Metformin HCl tablet 850 mg tab - - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp 212 - 212 - 212
229 Metilergometrin Maleat (Metilergometrin) tablet sa Tab 1,020 - 1,020 60 960
230 Metilprednisolon injeksi 500 mg amp - - - - -
231 Metilprednisolon tablet 16 mg tab - - - - -
232 Metilprednisolon tablet 4 mg tab - - - - -
233 Metilprednisolon tablet 8 mg tab 30 - 30 - 30
234 Metoklopramide injeksi 5 mg/ml amp 10 - 10 - 10
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - - -
236 Metoklopramide tablet 10 mg Tab 1,625 - 1,625 126 1,499
237 Metoklopramide tablet 5 mg tab - - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - - -
239 Metronidazol tablet 250 mg Tab 23 - 23 20 3
240 Metronidazol tablet 500 mg Tab 8,690 - 8,690 500 8,190
241 Metronidazol tablet 500 mg tab - - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube 11 - 11 - 11
243 Mineral Mix, kombinasi sase - - - - -
244 Momethason krim 0,1 % tube - - - - -
245 Momethason krim 0,1 % tube - - - - -
246 Morfin injeksi 10 mg/ml amp - - - - -
247 Morfin tablet 10 mg tab - - - - -
248 Natrium Diklofenak tablet 25 mg Tab 80 - 80 80 -
249 Natrium Diklofenak tablet 50 mg Tab 3,924 - 3,924 502 3,422
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 1,154 - 1,154 13 1,141
251 Neurobion 5000 injeksi amp - - - - -
252 Nevirapin tablet 200 mg tab - - - - -
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
253 Nifedipin tablet 10 mg tab 2,620 - 2,620 51 2,569
254 Nistatin tablet salut 500.000 IU/ g Tab 800 - 800 20 780
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - - -
256 Norages inj amp 65 - 65 - 65
257 Obat Antituberkulosis FDC Kategori 1 pak - - - - -
258 Obat Antituberkulosis FDC Kategori 2 pak - - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - - -
262 Obat Antituberkulosis Kategori anak pak - - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 479 - 479 13 466
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - - -
265 Ofloxacin tablet 200 mg tab - - - - -
266 Ofloxacin tablet 400 mg tab - - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube 165 - 165 23 142
269 Oksitetrasiklin salep kulit 3% Tube 458 - 458 7 451
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 549 - 549 44 505
271 Omeprazol kapsul/kaplet 20 mg kaps - - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - - -
273 Papaverin injeksi 40 mg/ml amp - - - - -
274 Papaverin tablet 40 mg Tab 9,910 - 9,910 190 9,720
275 Parasetamol drops btl 195 - 195 2 193
276 Parasetamol sirup 120 mg / 5 ml Btl 952 - 952 157 795
277 Parasetamol tablet 100 mg Tab 1,120 - 1,120 250 870
278 Parasetamol tablet 500 mg Tab 36,768 - 36,768 1,601 35,167
279 Perfenazin tablet 4 mg (HCl) tab - - - - -
280 Permetrin krim 5% tube - - - - -
281 Petidin injeksi 50 mg/ml amp - - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - - -
283 Piracetam injeksi 3 g/15 ml amp 486 - 486 2 484
284 Piracetam injeksi 3 g/15 ml amp - - - - -
285 Piracetam tablet 1200 mg tab - - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - - -
289 Pirantel tablet score (base) 125 mg Tab 176 - 176 1 175
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
290 Pirazinamid tablet 500 mg tab - - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab 5,343 - 5,343 175 5,168
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 2,510 - 2,510 110 2,400
294 Povidon Iodida larutan 10% btl - - - - -
295 Povidon Iodida larutan 10% 30mL Btl 23 - 23 1 22
296 Povidon Iodida larutan 10% 300 mL Btl 2 - 2 - 2
297 Povidon Iodida larutan 10% btl - - - - -
298 Pravastatin tablet 20 mg tab - - - - -
299 Prednison tablet 5 mg Tab 31,705 - 31,705 426 31,279
300 Primakuin tablet 15 mg tab - - - - -
301 Primperan inj amp 211 - 211 6 205
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab 200 - 200 - 200
306 Ramipril tablet 2,5 mg tab - - - - -
307 Ramipril tablet 5 mg tab - - - - -
308 Ranitidin injeksi 25 mg/2 ml amp 35 - 35 35 -
309 Ranitidin tablet 150 mg Tab 4,018 - 4,018 391 3,627
310 Ranitidin tablet 150 mg tab - - - - -
311 Reserpin tablet 0,10 mg tab - - - - -
312 Reserpin tablet 0,25 mg tab - - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - - -
314 Retinol (Vitamin A) 200.000 IU kapsul lunak kaps - - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - - -
316 Rifampisin kapsul/kaplet 600 mg kapl - - - - -
317 Rifampisin tablet salut 450 mg kapl - - - - -
318 Ringer Laktat larutan infus (RL) Btl 455 - 455 75 380
319 Risperidon tablet 1 mg tab - - - - -
322 SABU I Vial 1 - 1 1 -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab 372 - 372 - 372
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 4,334 - 4,334 210 4,124
325 Salep 2-4 , Kombinasi: Asam Salisilat 2% + Bele Pot 90 - 90 - 90
326 Salisil Bedak 2 % Ktk 382 - 382 20 362
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
327 Salisil Bedak 2 % ktk - - - - -
328 Sanmol syr btl 23 - 23 - 23
329 Sanmol tab tab - - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - - -
332 Sefadroksil kapsul/kaplet 500 mg kaps 1,040 - 1,040 25 1,015
333 Sefadroksil sirup kering 125 mg/5ml btl - - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - - -
335 Sefaleksin kapsul/kaplet 500 mg kaps - - - - -
336 Sefazolin injeksi 1 g amp - - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - - -
340 Sefotaksim injeksi 0,5 g amp - - - - -
341 Sefotaksim injeksi 1 g vial 650 - 650 48 602
342 Seftazidim injeksi 1 g amp - - - - -
343 Seftriakson injeksi 1 g vial 139 - 139 - 139
344 Seftriakson injeksi 1 g amp - - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp 3 - 3 3 -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 3,850 - 3,850 98 3,752
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - - -
348 Simetidin tablet 200 mg Tab 5,220 - 5,220 60 5,160
349 Simvastatin tablet 10 mg Tab 130 - 130 23 107
350 Simvastatin tablet 20 mg tab - - - - -
351 Simvastatin tablet 5 mg tab - - - - -
352 Siprofloksasin infus 2% btl - - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 5,017 - 5,017 364 4,653
355 Spasminal tab tab 60 - 60 10 50
356 Spiramisin tablet 500 mg tab - - - - -
357 Spironolakton tablet 100 mg tab - - - - -
358 Spironolakton tablet 25 mg tab - - - - -
359 Stavudin tablet 30 mg tab - - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - - -
361 Sulfasalazin tablet 500 mg tab - - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl 3 - 3 - 3
363 Syntosinon inj amp 19 - 19 - 19
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
364 Tamoksifen tablet 20 mg tab - - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 8,900 - 8,900 - 8,900
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 2,791 - 2,791 - 2,791
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - - -
369 Tiamfenikol kapsul/kaplet 500 mg kaps 1,274 - 1,274 97 1,177
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 32,615 - 32,615 2,080 30,535
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp 720 - 720 103 617
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - - -
374 Tramadol injeksi 50 mg/ml amp - - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - -
376 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - - -
377 Transamin tab tab - - - - -
378 Trifluoperazin tablet 5 mg tab - - - - -
379 Triheksifenidil tablet 2 mg Tab 100 - 100 - 100
380 Ulsikur inj amp 56 - 56 1 55
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - - -
382 Valdimex tablet 5 mg tab - - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - - -
384 Vicillin 1gr inj vial 20 - 20 15 5
385 Vitamin B Kompleks tablet Tab 60,756 - 60,756 1,836 58,920
386 Zidovudin tablet 100 mg tab - - - - -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 tab - - - - -
388 Zinc drop 10 mg/mL btl 68 - 68 - 68
389 Zinc tablet 20 mg tab 6,945 - 6,945 470 6,475
- - - - -
B PERBEKALAN KESEHATAN - - - - -
1 Alat suntik sekali pakai 1 ml set 224 - 224 9 215
2 Alat suntik sekali pakai 2,5 ml set 15,635 - 15,635 705 14,930
3 Alat suntik sekali pakai 3 ml set - - - - -
4 Alat suntik sekali pakai 5 ml set - - - - -
5 Catgut/benang bedah no.2/0 dengan jarum bedah set 241 - 241 12 229
6 Catgut/benang bedah no.3/0 dengan jarum bedah set - - - - -
7 Infusion set anak Set 636 - 636 12 624
8 Infusion set dewasa Set 516 - 516 38 478
9 IV Catheter No. 20 G Set 556 - 556 15 541
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
12 Kapas Berlemak 500 gram Bks - - - - -
13 Kapas Pembalut / Absorben 250 gram Bks 114 - 114 3 111
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk 54 - 54 - 54
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - - -
16 Kasa Hidrofil uk. 40 m x 80 cm rol - - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 2,784 - 2,784 15 2,769
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 1,394 - 1,394 82 1,312
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol 74 - 74 - 74
20 Kasa Pembalut Elastic 4 inchi rol - - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol 52 - 52 - 52
22 Kasa Pembalut Elastic 10 cm x 4,5m rol 60 - 60 - 60
23 Pembalut Gips 3 ichi Rol 10 - 10 - 10
24 Plester 5 yards x 2 inch Rol 29 - 29 5 24
25 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum Sac 295 - 295 51 244
26 Ultrafix 5x5 rol - - - - -
27 Urine Bag Set 28 - 28 3 25
28 Foley Catheter set 10 - 10 - 10
29 Handscoon (Sarung Tangan Steril) Set 1,155 - 1,155 245 910
30 Masker set 275 - 275 42 233
- - - - -
C OBAT GIGI - - - - -
1 Etil Klorida spray btl - - - - -
2 Eugenol cairan btl - - - - -
3 Formokresol cairan btl - - - - -
4 Glass Ionomer Cement ART btl - - - - -
5 Gutta Percha dan Paper points 15-40 mm btl - - - - -
6 Gutta Percha dan Paper points 45-80 mm btl - - - - -
7 Kalsium Hidroksida Pasta btl - - - - -
8 Klorfenol kamfer Menthol ( CHKM ) btl - - - - -
9 Komposit resin btl - - - - -
10 Devitalisasi Pasta (Non Arsen) btl - - - - -
11 Mummifying Pasta btl - - - - -
12 Semen Seng Fosfat serbuk dan cairan btl - - - - -
13 Temporary Stopping Fletcher (Fletcher) serbuk dan btl - - - - -
- - - - -
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN - - - - -
1 Alinamin F tablet tab - - - - -
2 Antiparkinson DOEN Tab Komb Tab - - - - -
3 Combifen syr btl 5 - 5 - 5
4 Coparcetin tab 300 - 300 10 290
5 Dexanta tablet tab 110 - 110 50 60
6 Etafen syr btl 8 - 8 - 8
Etanol 70% cairan ( 100 ml ) (Alkohol) Btl 14 - 14 - 14
7 Etanol 70% cairan ( 1 liter ) (Alkohol) Btl 25 - 25 4 21
8 Farizol tablet tab 100 - 100 - 100
9 Fe Sirup btl 1 - 1 1 -
Gastrusid sirup btl 20 - 20 - 20
10 Grafadon tab 200 - 200 - 200
11 H2O2 3% 800 cc btl 5 - 5 1 4
12 Helixim syr btl 8 - 8 - 8
13 Histigo tablet tab - - - - -
14 IV Catheter No. 18 G Set 100 - 100 - 100
15 Kalium Permanganat Serbuk Pot 5 - 5 - 5
16 Lexapram tablet tab 100 - 100 - 100
Lostacef tab 50 - 50 - 50
17 Mes / Pisau bh 15 - 15 2 13
18 Mirasic syr btl 6 - 6 - 6
19 Molacort tab 200 - 200 - 200
20 Neurosanbe inj. amp 62 - 62 10 52
Novabion tab 100 - 100 - 100
21 Novaflox tab 300 - 300 - 300
22 Novalgin injeksi amp - - - - -
23 Novamog tab 200 - 200 - 200
24 Novaxifen tab 200 - 200 - 200
25 Pimtracol syr btl - - - - -
26 Sarung Tangan Obgyn set 50 - 50 - 50
27 Scopamin Inj box - - - - -
28 Stesolid supp. tube - - - - -
29 Sufratul lbr - - - - -
30 Tidifar tab 200 - 200 - 200
31 Transamin inj. amp - - - - -
Trifaneuro tab 100 - 100 - 100
1 2 3 4 5 6 7 (=5+6) 8 9 (=7-8) 10 11 12 13
32 Trolit sase 12 - 12 3 9
33 Urocare Set 12 - 12 2 10
34 Vixal syr btl 3 - 3 - 3
UMUM
JUMLAH KUNJUNGAN JKN JUMLAH
BAYAR TIDAK
RESEP
576 1,228 12 1,816
MENGETAHUI/MENYETUJUI YANG MENYERAHKAN YANG MEMINTA / MELAPOR

KADINKES KABUPATEN SITUBONDO KEPALA GFK KEPALA PUSKESMAS PENGELOLA
Drs. H. ABU BAKAR ABDI, Apt, Msi LIANA PUSPITANINGRUM, Apt. A M R O Z I, S.Kep.Ns
NIP. 19650525 199403 1 009 NIP: 19800614 200501 2 019 NIP. 19641008 198503 1 004 NIP. 198206
EN NOMOR TGL
KOTA
PEMBERIAN
PROGRA
DAK LAIN-LAIN JUMLAH
M
14 15 16 17
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PEMBERIAN
PROGRA
M
14 15 16 17
-
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
PEMBERIAN
PROGRA
M
14 15 16 17
YANG MENERIMA
PENGELOLA OBAT PUSKESMAS
JONI HARDIANTO
NIP. 19820610 200604 1 016
LAPORAN MUTASI BARANG PERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS
KABUPATEN SITUBONDO
TAHUN 2015
BULAN : OKTOBER
SALDO AWAL MUTASI MASUK MUTASI KELUAR SALD

NO NAMA BARANG
Harga Harga Harga
unit/bh/set Jumlah unit/bh/set Jumlah unit/bh/set Jumlah unit/bh/set
Satuan (Rp) Satuan (Rp) Satuan (Rp)
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml 60 btl 3,509.00 210,540 - btl - 15 btl 3,509 52,635 45 btl
2 Albendazol suspensi 200 mg/5 ml - btl - - btl - 0 btl - - 0 btl
3 Albendazol tablet 400 mg 722 Tab 344.00 248,368 - tab - 10 tab 344.00 3,440 712 tab
4 Alopurinol tablet 100 mg 3,767 Tab 86.00 323,962 - tab - 137 tab 86.00 11,782 3,630 tab
5 Alopurinol tablet 300 mg - tab - - tab - 0 tab - - - tab
6 Alprazolam tablet 0,25 mg - tab - - tab - 0 tab - - - tab
7 Alprazolam tablet 0,5 mg - tab - - tab - 0 tab - - - tab
8 Alprazolam tablet 1 mg - tab - - tab - 0 tab - - - tab
9 Ambroxol sirup 15 mg/ml 3 btl 4,455.00 13,365 - btl - 0 btl 4,455.00 - 3 btl
10 Ambroxol sirup 15 mg/ml - btl - - btl - 0 btl - - - btl
11 Ambroxol tablet 30 mg 4,411 Tab 126.50 557,992 - tab - 239 tab 126.50 30,234 4,172 tab
12 Aminofilin injeksi 24 mg/ml 477 Amp 3,822.00 1,823,094 - amp - 34 amp 3,822.00 129,948 443 amp
13 Aminofilin tablet 150 mg - tab - - tab - 0 tab - - - tab
14 Aminofilin tablet 200 mg 4,262 Tab 80.00 340,960 - tab - 290 tab 80.00 23,200 3,972 tab
15 Amitriptilin tablet salut 25 mg (HCl) - Tab 112.00 - - tab - 0 tab 112.00 - - tab
16 Amlodipin tablet 10 mg - tab - - tab - 0 tab - - - tab
17 Amlodipin tablet 5 mg - tab - - tab - 0 tab - - - tab
-
18 Amoksisilin + As. Klavulanat 625 mg tablet - tab - - tab - 0 tab - - tab
19 Amoksisilin kapsul/kaplet 250 mg 319 Kaps 190.00 60,610 - kaps - 10 kaps 190.00 1,900 309 kaps
20 Amoksisilin kapsul/kaplet 500 mg 17,965 Tab 261.00 4,688,865 - kapl - 1,712 kapl 261.00 446,832 16,253 kapl
21 Amoksisilin serbuk injeksi 1000 mg - vial - - vial - 0 vial - - - vial
22 Amoksisilin sirup kering 125 mg/ 5 ml 981 Btl 2,445.00 2,398,545 - btl - 128 btl 2,445.00 312,960 853 btl
23 Amoxsan tab 500 mg 600 tab 3,161.00 1,896,600 - kaps - 40 kaps 3,161.00 126,440 560 kaps
vial vial -
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial - - - - 0 vial - - vial
vial vial -
vial vial -
Antasida DOEN I tablet kunyah, kombinasi : 72.00
Aluminium Hidroksida 200 mg Magnesium tab tab tab
27 Hidroksida 200 mg 8,187 Tab 72.00 589,464 - - 1194 85,968 6,993
NO NAMA BARANG
Harga Harga Harga
Antasida DOEN II suspensi, kombi : 2,160.00
Aluminium Hidroksida 200 mg/5 ml Btl btl btl btl
28 Magnesium Hidroksida 200 mg/5 ml 508 2,160.00 1,097,280 - - 45 97,200 463
2,516.00
Anti Bakteri DOEN salep kombinasi: tube tube tube
29 Basitrasin 500 IU/g + Polimiksin 10.000 IU/g 575 Tube 2,516.00 1,446,700 - - 1 2,516 574
Antifungi DOEN Kombinasi: Asam Benzoat
pot 1,904.00
30 6% + Asam Salisilat 3% 178 pot 1,904.00 338,912 - - 4 pot 7,616 174 pot
Antihemoroid DOEN kombinasi : Bismut
supp 2,450.00
31 subgalat 150 mg Heksaklorofen 2,5 mg 60 Supp 2,450.00 147,000 - - - supp - 60 supp
Antimalaria DOEN kombinasi : Pirimetamin
tab tab -
32 tablet 25 mg Sulfadoksin tablet 500 mg - - - - 0 tab - - tab
tab tab 123.00 tab
33 Kofein 50 mg 2,304 Tab 123.00 283,392 - - 4 492 2,300
34 Antrain inj - amp 11,000.00 - - amp - 0 amp 11,000.00 - - amp
35 Aqua pro Injeksi steril, bebas pirogen 7 Amp 5,000.00 35,000 - btl - 7 btl 5,000.00 35,000 - btl
36 Artemether injeksi 80 mg/ml - amp - - amp - 0 amp - - - amp
37 Artesunate injeksi, vial 60 mg - vial - - vial - 0 vial - - - vial
tab tab tab - tab
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) - - - - - - -
tab tab 162.00 tab
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) 160 Tab 162.00 25,920 - - 60 9,720 100
40 Asam Askorbat (Vitamin C) tablet 50 mg 4,320 Tab 32.00 138,240 - tab - 1830 tab 32.00 58,560 2,490 tab
41 Asam Askorbat (Vitamin C) tablet 100 mg - tab - - tab - 0 tab - - - tab
42 Asam Askorbat (Vitamin C) tablet 250 mg - tab - - tab - - tab - - - tab
43 Asam Folat tablet 1 mg - tab - - tab - 0 tab - - - tab
44 Asam Mefenamat kapsul/kaplet 250 mg - tab - - tab - 0 tab - - - tab
45 Asam Mefenamat kapsul/kaplet 500 mg 2,237 Tab 112.00 250,544 - tab - 507 tab 112.00 56,784 1,730 tab
46 Asam Mefenamat kapsul/kaplet 500 mg - tab - - tab - 0 tab - - - tab
47 Asiklovir krim 5% 231 Tube 3,150.00 727,650 - tube - 24 tube 3,150.00 75,600 207 tube
48 Asiklovir tablet 200 mg 398 Tab 237.00 94,326 - tab - 40 tab 237.00 9,480 358 tab
49 Asiklovir tablet 400 mg 1,220 tab 589 & 336 465,580 - tab - - tab 589 & 336 - 1,220 tab
51 Atapulgit tablet 600 mg - tab 190.00 - - tab - - tab 190.00 - - tab
52 Atenolol tablet 100 mg - tab - - tab - 0 tab - - - tab
53 Atenolol tablet 50 mg - tab - - tab - 0 tab - - - tab
amp amp amp 1,230.00 amp
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) - 1,230.00 - - - 0 - -
55 Atropin Sulfat tablet 0,5 mg - tab - - tab - 0 tab - - - tab
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial - vial - - vial - 0 vial - - - vial
57 Benzatin Benzil Penisilin 2,4 juta IU/vial - vial 12,185.00 - - vial - 0 vial 12,185.00 - - vial
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg
tab tab -
58 tablet (tablet tambah darah kombinasi ) - - - - 0 tab - - tab
59 Betahistin Mesilat tablet 6 mg - tab - - tab - 0 tab - - - tab
tube 1,520.00
60 Betametason krim 0,1 % (sebagai Valerat) 115 Tube 1,520.00 174,800 - - 18 tube 27,360 97 tube
61 Bioplacenton 1 tube 12,650.00 12,650 - tube - 0 tube 12,650.00 - 1 tube
NO NAMA BARANG
Harga Harga Harga
62 Bisakodil suppositoria 10 mg - supp - - supp - 0 supp - - - supp
63 Bisoprolol tablet 5 mg - tab - - tab - 0 tab - - - tab
64 Bromheksin tablet 8 mg - tab - - tab - 0 tab - - - tab
65 Buscopan inj 18 amp 21,758.00 391,644 - amp - 0 amp 21,758.00 - 18 amp
66 Cetirizin sirup 5 mg/5 ml - btl - - btl - 0 btl - - - btl
67 Cetirizine tablet 10 mg 50 tab 313.50 15,675 - tab - - tab 313.50 - 50 tab
68 Clobazam tablet 10 mg - tab - - tab - 0 tab - - - tab
69 Clobetasol krim 0,05% - tube - - tube - 0 tube - - - tube
70 Dapson tablet 100 mg - tab - - tab - 0 tab - - - tab
71 Deksametason injeksi i.v. 5 mg/ml 1,405 Amp 1,580.00 2,219,900 - amp - 26 amp 1,580.00 41,080 1,379 amp
72 Deksametason injeksi i.v. 5 mg/ml - amp - - amp - 0 amp - - - amp
73 Deksametason tablet 0,5 mg 6,756 Tab 62.00 418,872 - tab - 1328 tab 62.00 82,336 5,428 tab
74 Dekstran 70 - larutan infus 6% steril - btl - - btl - 0 btl - - - btl
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) - btl - - btl - 0 btl - - - btl
76 Dekstrometorfan tablet 15 mg (HBr) - tab - - tab - 0 tab - - - tab
77 Dekstrometorfan tablet 15 mg (HBr) - tab - - tab - 0 tab - - - tab
amp amp 2344 & amp
78 Diazepam injeksi 5 mg/ml 241 Amp 2344 & 12100 857,584 - - 0 12100 - 241
79 Diazepam tablet 2 mg 1,159 Tab 35.00 40,565 - tab - 1 tab 35.00 35 1,158 tab
80 Diazepam tablet 5 mg 250 Tab 56.00 14,000 - tab - 0 tab 56.00 - 250 tab
81 Dietilkarbamazin Sitrat tablet 100 mg - tab 93.00 - - tab - 0 tab 93.00 - - tab
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) 1,601 Amp 1,050.00 1,681,050 - amp - 135 amp 1,050.00 141,750 1,466 amp
83 Digoksin tablet 0,25 mg 350 Tab 97.00 33,950 - tab - 5 tab 97.00 485 345 tab
84 Diltiazem HCl tablet 30 mg - tab - - tab - 0 tab - - - tab
85 Dimenhidrinat tablet 50 mg 500 tab 104.00 52,000 - tab - 0 tab 104.00 - 500 tab
86 Doksisiklin kapsul/kaplet 100 mg - kaps - - kaps - 0 kaps - - - kaps
87 Domperidon suspensi 5 mg/5 ml 15 btl 3,624.00 54,360 - btl - 0 btl 3,624.00 - 15 btl
88 Domperidon tablet 10 mg 184 Tab 167.00 30,728 - tab - 37 tab 167.00 6,179 147 tab
89 Efedrin tablet 25 mg (HCl) - tab - - tab - 0 tab - - - tab
90 Ekstraks Belladona tablet 10 mg 300 Tab 38.00 11,400 - tab - 0 tab 38.00 - 300 tab
Epinefrin (Adrenalin) injeksi 0,1 % (sebagai
amp amp 8,100.00 amp
91 HCl) 88 Amp 8,100.00 712,800 - - 0 - 88
92 Eritromisin kapsul/kaplet 250 mg 180 kaps 337.04 60,667 - kaps - 0 kaps 337.04 - 180 kaps
93 Eritromisin kapsul/kaplet 500 mg 1,500 kaps 864.25 1,296,375 - kaps - - kaps 864.25 - 1,500 kaps
94 Eritromisin sirup 200 mg/ 5 ml 44 Btl 7,700.00 338,800 - btl - 1 btl 7,700.00 7,700 43 btl
95 Etakridin larutan 0,1% (Rivanol) 16 Btl 3,223.00 51,568 - btl - 1 btl 3,223.00 3,223 15 btl
96 Etambutol tablet 250 mg (HCl) - tab - - tab - 0 tab - - - tab
97 Etambutol tablet salut 500 mg (HCl) - tab - - tab - 0 tab - - - tab
98 Etanol 70% cairan ( 30 ml ) - btl - - btl - - btl - - - btl
99 Famotidine tablet 20 mg - tab - - tab - 0 tab - - - tab
100 Famotidine tablet 40 mg - tab - - tab - 0 tab - - - tab
101 Fenilbutason tablet 200 mg - tab - - tab - 0 tab - - - tab
102 Fenitoin kapsul/kaplet 100 mg - kaps - - kaps - 0 kaps - - - kaps
103 Fenitoin Natrium injeksi 50 mg/ml - amp - - amp - 0 amp - - - amp
NO NAMA BARANG
Harga Harga Harga
104 Fenitoin Natrium kapsul/kaplet 30 mg - kaps - - kaps - 0 kaps - - - kaps
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml 94 Amp 1,716.00 161,304 - amp - 0 amp 1,716.00 - 94 amp
106 Fenobarbital tablet 100 mg - tab - - tab - 0 tab - - - tab
107 Fenobarbital tablet 30 mg - tab - - tab - 0 tab - - - tab
108 Fenoksimetil Penisilin tablet 250 mg - tab - - tab - 0 tab - - - tab
109 Fenoksimetil Penisilin tablet 500 mg - tab - - tab - 0 tab - - - tab
110 Fenol Gliserol tetes telinga 10% 39 Btl 1,008.00 39,312 - btl - 5 btl 1,008.00 5,040 34 btl
tab tab 630.00 tab
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg 1,965 Tab 630.00 1,237,950 - - 84 52,920 1,881
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml 797 Amp 3,417.00 2,723,349 - - 8 27,336 789
113 Flukonazol tablet 150 mg - tab - - tab - 0 tab - - - tab
114 Furosemid injeksi i.v./i.m. 10 mg/ml - amp - - amp - 0 amp - - - amp
115 Furosemid tablet 40 mg 2,514 Tab 85.00 213,690 - tab - 68 tab 85.00 5,780 2,446 tab
116 Garam Oralit I serbuk 6,392 Sac 288.00 1,840,896 - sase - 160 sase 288.00 46,080 6,232 sase
117 Gemfibrozil kapsul/kaplet 300 mg - kaps - - kaps - 0 kaps - - - kaps
118 Gemfibrozil tablet 600 mg - tab - - tab - 0 tab - - - tab
119 Gentamisin injeksi 40 mg/ ml 75 amp 3,399.00 254,925 - amp - 0 amp 3,399.00 - 75 amp
120 Gentamisin salep kulit 0.1% 162 tube 1,650.00 267,300 - tube - 13 tube 1,650.00 21,450 149 tube
121 Gentamisin Sulfat tetes mata 0,3 % - btl 2,973.00 - - btl - - btl 2,973.00 - - btl
122 Gentian Violet larutan 1 % 95 Btl 900.00 85,500 - btl - 25 btl 900.00 22,500 70 btl
123 Glibenklamida tablet 5 mg 3,333 Tab 56.00 186,648 - tab - 17 tab 56.00 952 3,316 tab
124 Glimepiride tablet 1 mg - tab - - tab - 0 tab - - - tab
129 Gliquidon tablet 30 mg - tab - - tab - 0 tab - - - tab
130 Gliseril Gualakolat tablet 100 mg 29,058 Tab 44.00 1,278,552 - tab - 1,336 tab 44.00 58,784 27,722 tab
131 Gliserin - btl - - btl - 0 btl - - - btl
132 Glukosa larutan infus 10 % steril 4 Btl 5,727.00 22,908 - btl - - btl 5,727.00 - 4 btl
133 Glukosa larutan infus 40 % steril - Btl 1,960.00 - - btl - 0 btl 1,960.00 - - btl
134 Glukosa larutan infus 5 % steril 476 Btl 5,200.00 2,475,200 - btl - 58 btl 5,200.00 301,600 418 btl
135 Griseofulvin tablet 125 mg 2,615 Tab 209.00 546,535 - tab - 30 tab 209.00 6,270 2,585 tab
136 Haloperidol inj 50 mg/mL - amp - - amp - 0 amp - - - amp
137 Haloperidol tablet 0,5 mg - tab - - tab - 0 tab - - - tab
138 Haloperidol tablet 1,5 mg - tab - - tab - 0 tab - - - tab
139 Haloperidol tablet 5 mg - tab - - tab - 0 tab - - - tab
140 HCT 25 mg (Hidroklortiazid) 6,513 Tab 36.00 234,468 - tab - 64 tab 36.00 2,304 6,449 tab
141 Hidrokortison krim 1% - tube - - tube - 0 tube - - - tube
142 Hidrokortison krim 2,5 % 659 Tube 2,798.00 1,843,882 - tube - 31 tube 2,798.00 86,738 628 tube
143 Hyoscine -N-Butilbromide tablet 10 mg - tab - - tab - 0 tab - - - tab
144 Ibuprofen suspensi 100 mg/5 ml 2 btl 3,499.00 6,998 - btl - 0 btl 3,499.00 - 2 btl
145 Ibuprofen suspensi 200 mg/5 ml - btl - - btl - 0 btl - - - btl
NO NAMA BARANG
Harga Harga Harga
146 Ibuprofen tablet 200 mg 1,120 Tab 110.00 123,200 - tab - 40 tab 110.00 4,400 1,080 tab
147 Ibuprofen tablet 200 mg - tab - - tab - 0 tab - - - tab
148 Ibuprofen tablet 400 mg 6,445 Tab 150.00 966,750 - tab - 953 tab 150.00 142,950 5,492 tab
149 Ibuprofen tablet 400 mg - tab - - tab - 0 tab - - - tab
150 Iodiol kapsul lunak - kaps - - kaps - 0 kaps - - - kaps
151 Isoniazid tablet 100 mg 1,900 Tab 44.00 83,600 - tab - 0 tab 44.00 - 1,900 tab
152 Isoniazid tablet 300 mg - tab - - tab - 0 tab - - - tab
153 Isosorbid Dinitrat tablet sublingual 5 mg 500 Tab 88.00 44,000 - tab - 0 tab 88.00 - 500 tab
154 Itrakonazol kapsul/kaplet 100 mg - kaps - - kaps - 0 kaps - - - kaps
155 Kalium Diklofenak tablet 25 mg - tab - - - tab - 0 tab - - - tab
156 Kalium Diklofenak tablet 50 mg - tab 425.00 - - tab - 0 tab 425.00 - - tab
157 Kalsium Laktat (Kalk) tablet 500 mg 29,990 Tab 81.40 2,441,186 - tab - 500 tab 81.40 40,700 29,490 tab
158 Kaptopril tablet 12,5 mg 170 Tab 62.00 10,540 - tab - 20 tab 62.00 1,240 150 tab
159 Kaptopril tablet 25 mg 8,459 Tab 84.00 710,556 - tab - 834 tab 84.00 70,056 7,625 tab
160 Kaptopril tablet 50 mg - tab - - tab - 0 tab - - - tab
161 Karbamazepin tablet 200 mg 290 Tab 243.00 70,470 - tab - - tab 243.00 - 290 tab
162 Ketokonazol krim 2% 208 tube 2,569.00 534,352 - tube - 0 tube 2,569.00 - 208 tube
163 Ketokonazol tablet 200 mg 1,685 Tab 300.00 505,500 - tab - 30 tab 300.00 9,000 1,655 tab
164 Ketoprofen injeksi 100 mg - amp - - amp - 0 amp - - - amp
165 Ketoprofen tablet 100 mg - tab - - tab - 0 tab - - - tab
166 Ketorolac injeksi 10 mg - amp - - amp - 0 amp - - - amp
167 Ketorolac injeksi 30 mg - amp - - amp - 0 amp - - - amp
168 Klindamisin kapsul/kaplet 150 mg - kaps - - kaps - 0 kaps - - - kaps
169 Klindamisin kapsul/kaplet 300 mg 180 kaps 205.00 36,900 - kaps - 10 kaps 205.00 2,050 170 kaps
170 Klomifen tablet 50 mg - tab - - tab - 0 tab - - - tab
171 Klonidin tablet 0,15 mg - tab - - tab - 0 tab - - - tab
172 Klonidin tablet 0,15 mg - tab - - tab - 0 tab - - - tab
173 Kloramfenikol kapsul/kaplet 250 mg 2,565 Kaps 356.40 914,166 - kaps - 131 kaps 356.40 46,688 2,434 kaps
174 Kloramfenikol salep mata 1 % 2 Tube 1,562.00 3,124 - tube - 1 tube 1,562.00 1,562 1 tube
175 Kloramfenikol suspensi 125 mg/ 5 ml 65 Btl 3,700.00 240,500 - btl - 6 btl 3,700.00 22,200 59 btl
176 Kloramfenikol suspensi 125 mg/ 5 ml - btl - - btl - 0 btl - - - btl
177 Kloramfenicol tetes mata 0,5% - Btl 4,950.00 - - btl - - btl 4,950.00 - - btl
178 Kloramfenikol tetes telinga 3 % 24 btl 2,200.00 52,800 - btl - 0 btl 2,200.00 - 24 btl
179 Klorfeniramina Maleat (CTM) tablet 4 mg 63,527 Tab 91.30 5,800,015 - tab - 1,526 tab 91.30 139,324 62,001 tab
180 Klorokuin tablet 250 mg - tab - - tab - 0 tab - - - tab
-
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) - amp - - amp - 0 amp - - amp
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) - amp - - amp - 0 amp - - - amp
183 Klorpromazin tablet salut 100 mg (HCl) - tab - - tab - 0 tab - - - tab
184 Klorpromazin tablet salut 25 mg (HCl) 200 Tab 168.00 33,600 - tab - 30 tab 168.00 5,040 170 tab
185 Kodein tablet 10 mg - tab - - tab - 0 tab - - - tab
NO NAMA BARANG
Harga Harga Harga
Kotrimoksazol DOEN I (dewasa) kombinasi : 138.00

Sulfametoksazol 400 mg , Trimetoprim 80 mg tab tab tab
188 8,612 Tab 138.00 1,188,456 - - 260 35,880 8,352
Kotrimoksazol DOEN II (pediatrik) 72.00
kombinasi : Sulfametoksazol 100 mg tab tab tab
189 Trimetoprim 20 mg 10,802 Tab 72.00 777,744 - - 150 10,800 10,652
Kotrimoksazol Suspensi komb: 2,167.00
Sulfametoksazol 200 mg + Trimetoprim 40 mg btl btl btl
190 / 5 ml 1,083 Btl 2,167.00 2,346,861 - - 248 537,416 835
191 Kuinin (Kina) tablet 200 mg - tab - - tab - 0 tab - - - tab
192 Kuinin Dihidroklorida injeksi 25% - 2 ml - amp - - amp - 0 amp - - - amp
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) - amp - - amp - 0 amp - - - amp
194 Lacto B - sase 3,850.00 - - sase - 0 sase 3,850.00 - - sase
195 Lamivudine tablet 150 mg - tab - - tab - 0 tab - - - tab
Larutan mengandung Elektrolit (Na 130 mEq, 9,000.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) btl btl btl btl
196 (ASERING) 500 9,000.00 4,500,000 - - 0 - 500
Larutan mengandung Elektrolit (NaCl 1.125
btl 9,000.00 btl 9,000.00
197 gr, Dekstrosa 18.75 gr) (KAEN 1B) 30 270,000 - - 0 btl - 30 btl
10,000.00 10,000.00
Larutan mengandung Karbohidrat + Elektrolit btl btl btl btl
(Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr,
198 Dekstrosa 27 gr) (KAEN 3B) 500 5,000,000 - - 0 - 500
Larutan mengandung Karbohidrat + Elektrolit 10,000.00 10,000.00
(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr btl btl btl btl
199 Dekstrosa 27 gr) (KAEN 3A) 325 3,250,000 - - 0 - 325
200 Lanzoprazol kapsul/kaplet 30 mg - tab - - tab - 0 tab - - - tab
201 Levofloksasin tablet 500 mg - tab - - tab - 0 tab - - - tab
202 Levofloksasin tablet 500 mg - tab - - tab - 0 tab - - - tab
203 Lidokain injeksi 2% 618 amp 573.00 354,114 - amp - 35 amp 573.00 20,055 583 amp
204 Lidokain injeksi 2% - amp - - amp - - amp - - - amp
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
205 80.000 - 2ml ( Lidokain Comp. Inj ) 974 Amp 1,363.00 1,327,562 - - 24 32,712 950
206 Lidokain jeli 2% - pot - - pot - 0 pot - - - pot
207 Linkomisin kapsul/kaplet 500 mg - kaps - - kaps - 0 kaps - - - kaps
208 Lisinopril tablet 10 mg - tab - - tab - 0 tab - - - tab
209 Lisinopril tablet 5 mg - tab - - tab - 0 tab - - - tab
210 Loperamid tablet 2 mg 755 tab 91.55 69,120 - tab - 86 tab 91.55 7,873 669 tab
211 Loratadin tablet 10 mg 920 tab 154.00 141,680 - tab - 20 tab 154.00 3,080 900 tab
212 Lorazepam tablet 2 mg - tab - - tab - 0 tab - - - tab
213 Lytacur - btl 11,000.00 - - btl - - btl 11,000.00 - - btl
214 Magnesium Sulfat inj (IV) 20% - 25 ml 26 Vial 6,600.00 171,600 - amp - 0 amp 6,600.00 - 26 amp
215 Magnesium Sulfat inj (IV) 40% - 25 ml - amp - - amp - 0 amp - - - amp
216 Mebendazol sirup 100 mg / 5 ml - btl - - btl - 0 btl - - - btl
217 Mebendazol tablet 100 mg - tab - - tab - 0 tab - - - tab
218 Meloksikam suppositoria - supp - - supp - 0 supp - - - supp
NO NAMA BARANG
Harga Harga Harga
219 Meloksikam tablet 15 mg - tab - - tab - - tab - - - tab
220 Meloksikam tablet 7,5 mg - tab - - tab - 0 tab - - - tab
221 Menadion (Vitamin K3) injeksi 10 mg/ml - amp - - amp - 0 amp - - - amp
222 Metampiron injeksi 250 mg (Antalgin) 14 Amp 1,200.00 16,800 - amp - 7 amp 1,200.00 8,400 7 amp
223 Metampiron injeksi 250 mg - amp - - amp - 0 amp - - - amp
220 & 126,5
tab tab tab
224 Metampiron tablet 500 mg (Antalgin) 39,632 Tab 220 & 126,5 6,883,448 - - 1,652 208,978 37,980
225 Metampiron tablet 500 mg - tab - - tab - 0 tab - - - tab
226 Metformin HCl tablet 500 mg - tab - - tab - 0 tab - - - tab
227 Metformin HCl tablet 850 mg - tab - - tab - 0 tab - - - tab
amp 3,499.00
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml 212 Amp 3,499.00 741,788 - - 0 amp - 212 amp
Metilergometrin Maleat (Metilergometrin)
tab tab 140.00 tab
229 tablet salut 0,125 mg 1,020 Tab 140.00 142,800 - - 60 8,400 960
230 Metilprednisolon injeksi 500 mg - amp - - amp - 0 amp - - - amp
231 Metilprednisolon tablet 16 mg - tab - - tab - 0 tab - - - tab
232 Metilprednisolon tablet 4 mg - tab - - tab - 0 tab - - - tab
233 Metilprednisolon tablet 8 mg 30 tab 300.00 9,000 - tab - 0 tab 300.00 - 30 tab
234 Metoklopramide injeksi 5 mg/ml 10 amp - - amp - 0 amp - - 10 amp
235 Metoklopramide sirup 5 mg/ 5 ml - btl - - btl - 0 btl - - - btl
236 Metoklopramide tablet 10 mg 1,625 Tab 110.00 178,750 - tab - 126 tab 110.00 13,860 1,499 tab
237 Metoklopramide tablet 5 mg - tab - - tab - 0 tab - - - tab
238 Metronidazol infus 500 mg/100 ml - btl - - btl - - btl - - - btl
239 Metronidazol tablet 250 mg 23 Tab 110.00 2,530 - tab - 20 tab 110.00 2,200 3 tab
240 Metronidazol tablet 500 mg 8,690 Tab 160.00 1,390,400 - tab - 500 tab 160.00 80,000 8,190 tab
241 Metronidazol tablet 500 mg - tab - - tab - 0 tab - - - tab
242 Mikonazol krim/salep 2 % (Nitrat) 11 tube 3,000.00 33,000 - tube - 0 tube 3,000.00 - 11 tube
243 Mineral Mix, kombinasi - sase - - sase - - sase - - - sase
244 Momethason krim 0,1 % - tube - - tube - 0 tube - - - tube
245 Momethason krim 0,1 % - tube - - tube - 0 tube - - - tube
246 Morfin injeksi 10 mg/ml - amp - - amp - 0 amp - - - amp
247 Morfin tablet 10 mg - tab - - tab - 0 tab - - - tab
248 Natrium Diklofenak tablet 25 mg 80 Tab - - - tab - 80 tab - - - tab
249 Natrium Diklofenak tablet 50 mg 3,924 Tab 176.00 690,624 - tab - 502 tab 176.00 88,352 3,422 tab
250 Natrium Klorida larutan infus 0,9 % (NaCl) 1,154 Btl 4,700.00 5,423,800 - btl - 13 btl 4,700.00 61,100 1,141 btl
251 Neurobion 5000 injeksi - amp 6,006.00 - - amp - - amp 6,006.00 - - amp
252 Nevirapin tablet 200 mg - tab - - tab - 0 tab - - - tab
253 Nifedipin tablet 10 mg 2,620 tab 107,85 & 110 286,437 - tab - 51 tab 107.85 5,500 2,569 tab
254 Nistatin tablet salut 500.000 IU/ g 800 Tab 640.00 512,000 - tab - 20 tab 640.00 12,800 780 tab
255 Nistatin vaginal tablet 100.000 IU/ g - supp - - supp - 0 supp - - - supp
256 Norages inj 65 amp 7,000.00 455,000 - amp - 0 amp 7,000.00 - 65 amp
257 Obat Antituberkulosis FDC Kategori 1 - pak - - pak - 0 pak - - - pak
258 Obat Antituberkulosis FDC Kategori 2 - pak - - pak - 0 pak - - - pak
259 Obat Antituberkulosis FDC Kategori Anak - pak - - pak - 0 pak - - - pak
NO NAMA BARANG
Harga Harga Harga
260 Obat Antituberkulosis FDC Sisipan - pak - - pak - 0 pak - - - pak
261 Obat Antituberkulosis Kategori 1 dewasa - pak - - pak - 0 pak - - - pak
262 Obat Antituberkulosis Kategori anak - pak - - pak - 0 pak - - - pak
263 Obat Batuk Hitam ( O.B.H. ) cairan 479 Btl 5,940.00 2,845,260 - btl - 13 btl 5,940.00 77,220 466 btl
264 Obat Batuk Hitam ( O.B.H. ) cairan - btl - - btl - 0 btl - - - btl
265 Ofloxacin tablet 200 mg - tab - - tab - 0 tab - - - tab
266 Ofloxacin tablet 400 mg - tab - - tab - 0 tab - - - tab
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml - amp - - amp - 0 amp - - - amp
268 Oksitetrasiklin HCl salep mata 1 % 165 Tube 2,772.00 457,380 - tube - 23 tube 2,772.00 63,756 142 tube
269 Oksitetrasiklin salep kulit 3% 458 Tube 2,010.00 920,580 - tube - 7 tube 2,010.00 14,070 451 tube
270 Oksitosin injeksi 10 IU/ml - 1 ml 549 Amp 2,200.00 1,207,800 - amp - 44 amp 2,200.00 96,800 505 amp
271 Omeprazol kapsul/kaplet 20 mg - kaps - - kaps - - kaps - - - kaps
272 Oseltamivir kapsul/kaplet 75 mg - kaps - - kaps - 0 kaps - - - kaps
273 Papaverin injeksi 40 mg/ml - amp - - amp - 0 amp - - - amp
274 Papaverin tablet 40 mg 9,910 Tab 119.00 1,179,290 - tab - 190 tab 119.00 22,610 9,720 tab
275 Parasetamol drops 195 btl 5,200.00 1,014,000 - btl - 2 btl 5,200.00 10,400 193 btl
276 Parasetamol sirup 120 mg / 5 ml 952 Btl 1,438.00 1,368,976 - btl - 157 btl 1,438.00 225,766 795 btl
277 Parasetamol tablet 100 mg 1,120 Tab 32.00 35,840 - tab - 250 tab 32.00 8,000 870 tab
278 Parasetamol tablet 500 mg 36,768 Tab 79.00 2,904,672 - tab - 1,601 tab 79.00 126,479 35,167 tab
279 Perfenazin tablet 4 mg (HCl) - tab - - tab - 0 tab - - - tab
280 Permetrin krim 5% - tube - - tube - 0 tube - - - tube
281 Petidin injeksi 50 mg/ml - amp - - amp - 0 amp - - - amp
282 Piracetam injeksi 1 g/5 ml - amp - - amp - - amp - - - amp
283 Piracetam injeksi 3 g/15 ml 486 amp 6,270.00 3,047,220 - amp - 2 amp 6,270.00 12,540 484 amp
284 Piracetam injeksi 3 g/15 ml - amp - - amp - 0 amp - - - amp
285 Piracetam tablet 1200 mg - tab - - tab - 0 tab - - - tab
288 Pirantel sirup 125 mg/5 ml - btl - - btl - 0 btl - - - btl
289 Pirantel tablet score (base) 125 mg 176 Tab 298.00 52,448 - tab - 1 tab 298.00 298 175 tab
290 Pirazinamid tablet 500 mg - tab - - tab - 0 tab - - - tab
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) 5,343 Tab 17.39 92,915 - tab - 175 tab 17.39 3,043 5,168 tab
292 Piroksikam kapsul/kaplet/tablet 10 mg - kaps - - kaps - 0 kaps - - - kaps
293 Piroksikam kapsul/kaplet/tablet 20 mg 2,510 kaps 100.10 251,251 - kaps - 110 kaps 100.10 11,011 2,400 kaps
294 Povidon Iodida larutan 10% - btl - - btl - 0 btl - - - btl
295 Povidon Iodida larutan 10% 30mL 23 Btl 2,163.00 49,749 - btl - 1 btl 2,163.00 2,163 22 btl
296 Povidon Iodida larutan 10% 300 mL 2 Btl 14,203.00 28,406 - btl - 0 btl 14,203.00 - 2 btl
297 Povidon Iodida larutan 10% - btl - - btl - 0 btl - - - btl
298 Pravastatin tablet 20 mg - tab - - tab - 0 tab - - - tab
299 Prednison tablet 5 mg 31,705 Tab 151.80 4,812,819 - tab - 426 tab 151.80 64,667 31,279 tab
300 Primakuin tablet 15 mg - tab - - tab - 0 tab - - - tab
301 Primperan inj 211 amp 5,500.00 1,160,500 - amp - 6 amp 5,500.00 33,000 205 amp
NO NAMA BARANG
Harga Harga Harga
vial vial vial - vial

302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial - - - - 0 - -
303 Propanolol tablet 10 mg ( HCl ) - tab - - tab - 0 tab - - - tab
304 Propanolol tablet 40 mg (HCl) - tab - - tab - 0 tab - - - tab
305 Propiltiourasil tablet 100 mg (PTU) 200 Tab 284.00 56,800 - tab - 0 tab 284.00 - 200 tab
306 Ramipril tablet 2,5 mg - tab - - tab - 0 tab - - - tab
307 Ramipril tablet 5 mg - tab - - tab - 0 tab - - - tab
308 Ranitidin injeksi 25 mg/2 ml 35 amp 1,500.00 52,500 - amp - 35 amp 1,500.00 52,500 - amp
309 Ranitidin tablet 150 mg 4,018 Tab 120.00 482,160 - tab - 391 tab 120.00 46,920 3,627 tab
310 Ranitidin tablet 150 mg - tab - - tab - 0 tab - - - tab
311 Reserpin tablet 0,10 mg - tab - - tab - 0 tab - - - tab
312 Reserpin tablet 0,25 mg - tab - - tab - 0 tab - - - tab
kaps kaps -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak - - - - 0 kaps - - kaps
-
314 Retinol (Vitamin A) 200.000 IU kapsul lunak - kaps - - kaps - 0 kaps - - kaps
315 Rifampisin kapsul/kaplet 300 mg - kapl - - kapl - 0 kapl - - - kapl
316 Rifampisin kapsul/kaplet 600 mg - kapl - - kapl - 0 kapl - - - kapl
317 Rifampisin tablet salut 450 mg - kapl - - kapl - 0 kapl - - - kapl
318 Ringer Laktat larutan infus (RL) 455 Btl 5,200.00 2,366,000 - btl - 75 btl 5,200.00 390,000 380 btl
319 Risperidon tablet 1 mg - tab - - tab - 0 tab - - - tab
322 SABU I 1 Vial 398,420.00 398,420 - amp - 1 amp 398,420.00 398,420 - amp
323 Salbutamol tablet 2 mg (sebagai Sulfat) 372 Tab 59.00 21,948 - tab - 0 tab 59.00 - 372 tab
324 Salbutamol tablet 4 mg (sebagai Sulfat) 4,334 Tab 97.00 420,398 - tab - 210 tab 97.00 20,370 4,124 tab
pot pot 1,800.00 pot
325 Belerang endap 4% 90 Pot 1,800.00 162,000 - - 0 - 90
326 Salisil Bedak 2 % 382 Ktk 1,250.00 477,500 - ktk - 20 ktk 1,250.00 25,000 362 ktk
327 Salisil Bedak 2 % - ktk - - ktk - 0 ktk - - - ktk
328 Sanmol syr 23 btl 10,384.00 238,832 - btl - 0 btl 10,384.00 - 23 btl
329 Sanmol tab - tab 242.00 - - tab - 0 tab 242.00 - - tab
330 Sefadroksil kapsul/kaplet 250 mg - kaps - - kaps - 0 kaps - - - kaps
331 Sefadroksil kapsul/kaplet 500 mg - tab - - kaps - 0 kaps - - - kaps
332 Sefadroksil kapsul/kaplet 500 mg 1,040 kaps 509.00 529,360 - kaps - 25 kaps 509.00 12,725 1,015 kaps
333 Sefadroksil sirup kering 125 mg/5ml - btl - - btl - 0 btl - - - btl
334 Sefaleksin kapsul/kaplet 250 mg - kaps - - kaps - 0 kaps - - - kaps
335 Sefaleksin kapsul/kaplet 500 mg - kaps - - kaps - 0 kaps - - - kaps
336 Sefazolin injeksi 1 g - amp - - amp - 0 amp - - - amp
337 Sefiksim 400 mg + Azitromisin 1000 mg - tab - - tab - 0 tab - - - tab
338 Sefiksim kapsul/kaplet 100 mg - kaps - - kaps - 0 kaps - - - kaps
339 Sefiksim sirup kering 100 mg/ 5 ml - btl - - btl - 0 btl - - - btl
340 Sefotaksim injeksi 0,5 g - amp - - amp - - amp - - - amp
341 Sefotaksim injeksi 1 g 650 vial 2,950.00 1,917,500 - amp - 48 amp 2,950.00 141,600 602 amp
NO NAMA BARANG
Harga Harga Harga
342 Seftazidim injeksi 1 g - amp - - amp - 0 amp - - - amp
343 Seftriakson injeksi 1 g 139 vial 3,300.00 458,700 - amp - 0 amp 3,300.00 - 139 amp
344 Seftriakson injeksi 1 g - amp - - amp - - amp - - - amp
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) 3 Amp 137,500.00 412,500 - amp - 3 amp 137,500.00 412,500 - amp
Sianokobalamin (vitamin B12) injeksi 500
amp 1,078.00
346 mcg 3,850 Amp 1,078.00 4,150,300 - - 98 amp 105,644 3,752 amp
tab tab tab - tab

347 Sianokobalamin (vitamin B12) tablet 50 mcg - - - - - - -
348 Simetidin tablet 200 mg 5,220 Tab 110.84 578,585 - tab - 60 tab 110.84 6,650 5,160 tab
349 Simvastatin tablet 10 mg 130 Tab 169.00 21,970 - tab - 23 tab 169.00 3,887 107 tab
350 Simvastatin tablet 20 mg - tab - - tab - 0 tab - - - tab
351 Simvastatin tablet 5 mg - tab - - tab - 0 tab - - - tab
352 Siprofloksasin infus 2% - btl - - btl - 0 btl - - - btl
tab tab -
353 Siprofloksasin tablet 250 mg (sebagai HCl) - - - - 0 tab - - tab
255.00
354 Siprofloksasin tablet 500 mg (sebagai HCl) 5,017 Tab 255.00 1,279,335 - tab - 364 tab 92,820 4,653 tab
355 Spasminal tab 60 tab 517.00 31,020 - tab - 10 tab 517.00 5,170 50 tab
356 Spiramisin tablet 500 mg - tab - - tab - 0 tab - - - tab
357 Spironolakton tablet 100 mg - tab - - tab - 0 tab - - - tab
358 Spironolakton tablet 25 mg - tab - - tab - 0 tab - - - tab
359 Stavudin tablet 30 mg - tab - - tab - 0 tab - - - tab
360 Streptomisin serbuk injeksi i.v 1000 mg/ml - btl - - btl - 0 btl - - - btl
361 Sulfasalazin tablet 500 mg - tab - - tab - 0 tab - - - tab
362 Sulfasetamida Natrium tetes mata 15 % 3 Btl 3,226.00 9,678 - btl - 0 btl 3,226.00 - 3 btl
363 Syntosinon inj 19 amp 12,045.00 228,855 - amp - 0 amp 12,045.00 - 19 amp
364 Tamoksifen tablet 20 mg - tab - - tab - 0 tab - - - tab
365 Tetrakain HCl tetes mata 0,5% - btl - - btl - 0 btl - - - btl
366 Tetrasiklin kapsul/kaplet 250 mg 8,900 Kaps 149.00 1,326,100 - kaps - - kaps 149.00 - 8,900 kaps
367 Tetrasiklin kapsul/kaplet 500 mg 2,791 Kaps 300.30 838,137 - kaps - - kaps 300.30 - 2,791 kaps
368 Tiamfenikol kapsul/kaplet 250 mg - kaps - - kaps - 0 kaps - - - kaps
369 Tiamfenikol kapsul/kaplet 500 mg 1,274 kaps 616.00 784,784 - kaps - 97 kaps 616.00 59,752 1,177 kaps
tab tab 38 & 69,3 tab
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) 32,615 Tab 38 & 69,3 2,178,370 - - 2,080 79,040 30,535
371 Tiamin (Vitamin B1) 100 mg tablet - tab - - tab - 0 tab - - - tab
372 Tiamin (Vitamin B1) injeksi 100 mg/ml 720 Amp 680.00 489,600 - amp - 103 amp 680.00 70,040 617 amp
373 Tiamin (Vitamin B1) injeksi 100 mg/ml - amp - - amp - 0 amp - - - amp
374 Tramadol injeksi 50 mg/ml - amp - - amp - 0 amp - - - amp
375 Tramadol kapsul/kaplet/tablet 50 mg - kaps - - kaps - 0 kaps - - - kaps
376 Tramadol kapsul/kaplet/tablet 50 mg - kaps - - kaps - 0 kaps - - - kaps
377 Transamin tab - tab 290.00 - - tab - 0 tab 290.00 - - tab
378 Trifluoperazin tablet 5 mg - tab - - tab - 0 tab - - - tab
379 Triheksifenidil tablet 2 mg 100 Tab 40.00 4,000 - tab - 0 tab 40.00 - 100 tab
380 Ulsikur inj 56 amp 7,480.00 418,880 - amp - 1 amp 7,480.00 7,480 55 amp
NO NAMA BARANG
Harga Harga Harga
381 Valdimex Injeksi 5mg/ml (i.v.) - amp - - amp - 0 amp - - - amp
382 Valdimex tablet 5 mg - tab - - tab - 0 tab - - - tab
383 Verapamil tablet 80 mg (HCl) - tab - - tab - 0 tab - - - tab
384 Vicillin 1gr inj 20 vial 8,500.00 170,000 - vial - 15 vial 8,500.00 127,500 5 vial
385 Vitamin B Kompleks tablet 60,756 Tab 107 & 34,1 3,584,892 - tab - 1,836 tab 107.00 196,452 58,920 tab
386 Zidovudin tablet 100 mg - tab - - tab - 0 tab - - - tab
Zidovudin tablet 300 mg + Lamivudine tablet
tab tab -
387 150 mg - - - - 0 tab - - tab
388 Zinc drop 10 mg/mL 68 btl 12,840.00 873,120 - btl - 0 btl 12,840.00 - 68 btl
389 Zinc tablet 20 mg 6,945 tab 474.00 3,291,930 - tab - 470 tab 474.00 222,780 6,475 tab
J U M LAH 138,509,767 - 7,397,899
B PERBEKALAN KESEHATAN
1 Alat suntik sekali pakai 1 ml 224 set 625.00 140,000 - set - 9 set 625.00 5,625 215 set
2 Alat suntik sekali pakai 2,5 ml 15,635 set 1038 & 1089 16,739,130 - set - 705 set 1,038.00 731,790 14,930 set
3 Alat suntik sekali pakai 3 ml - set - - set - 0 set - - - set
4 Alat suntik sekali pakai 5 ml - set 750.00 - - set - 0 set 750.00 - - set
set set 5,583.33
5 bedah 241 5,583.33 1,345,583 - - 12 set 67,000 229 set
set set set - set
6 bedah - - - - 0 - -
7 Infusion set anak 636 Set 3,500.00 2,226,000 - set - 12 set 3,500.00 42,000 624 set
8 Infusion set dewasa 516 Set 3,509.00 1,810,644 - set - 38 set 3,509.00 133,342 478 set
9 IV Catheter No. 20 G 556 Set 9,185.00 5,106,860 - set - 15 set 9,185.00 137,775 541 set
12 Kapas Berlemak 500 gram - Bks 16,500.00 - - rol - 0 rol 16,500.00 - - rol
13 Kapas Pembalut / Absorben 250 gram 114 Bks 12,500.00 1,425,000 - rol - 3 rol 12,500.00 37,500 111 rol
Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / 5,800.00
14 kotak 54 ktk 5,800.00 313,200 - rol - - rol - 54 rol
15 Kasa Hidrofil uk. 36 m x 80 cm - rol - - rol - 0 rol - - - rol
16 Kasa Hidrofil uk. 40 m x 80 cm - rol 105,000.00 - - rol - 0 rol 105,000.00 - - rol
17 Kasa Pembalut Hidrofil 4 m x 5 2,784 Rol 750.00 2,088,000 - rol - 15 rol 750.00 11,250 2,769 rol
18 Kasa Pembalut Hidrofil 4 m x 10 cm 1,394 Rol 1,500.00 2,091,000 - rol - 82 rol 1,500.00 123,000 1,312 rol
rol rol rol 33,000.00 rol
19 Kasa Pembalut Elastic 3 inchi (medicrepe) 74 33,000.00 2,442,000 - - 0 - 74
20 Kasa Pembalut Elastic 4 inchi - rol - - rol - 0 rol - - - rol
21 Kasa Pembalut Elastic 7,5 cm x 4,5m 52 rol 33,000.00 1,716,000 - rol - 0 rol 33,000.00 - 52 rol
22 Kasa Pembalut Elastic 10 cm x 4,5m 60 rol 41,800.00 2,508,000 - rol - 0 rol 41,800.00 - 60 rol
23 Pembalut Gips 3 ichi 10 Rol 23,485.00 234,850 - rol - 0 rol 23,485.00 - 10 rol
23,624.70
rol 5 rol rol
24 Plester 5 yards x 2 inch 29 Rol 23,624.70 685,116 - - 118,124 24
bh 3,055.56
25 jarum bedah 295 Sac 3,055.56 901,390 - - 51 bh 155,834 244 bh
26 Ultrafix 5x5 - rol 42,250.00 - - rol - 0 rol 42,250.00 - - rol
NO NAMA BARANG
Harga Harga Harga
27 Urine Bag 28 Set 3,000.00 84,000 - set - 3 set 3,000.00 9,000 25 set
28 Foley Catheter 10 set 8,000.00 80,000 - set - 0 set 8,000.00 - 10 set
4249,3 &
Set set set set
29 Handscoon (Sarung Tangan Steril) 1,155 4249,3 & 4249,96 4,908,074 - - 245 4249,96 1,041,211 910
30 Masker 275 set 440 & 1100 137,500 - set - 42 set 440 & 1100 34,980 233 set
J U M LAH 53,733,322 - 2,942,350
C OBAT GIGI
1 Etil Klorida spray - btl - - btl - - btl - - - btl
2 Eugenol cairan - btl - - btl - 0 btl - - - btl
3 Formokresol cairan - btl - - btl - 0 btl - - - btl
4 Glass Ionomer Cement ART - btl - - btl - - btl - - - btl
5 Gutta Percha dan Paper points 15-40 mm - btl - - btl - 0 btl - - 0 btl
6 Gutta Percha dan Paper points 45-80 mm - btl - - btl - 0 btl - - 0 btl
7 Kalsium Hidroksida Pasta - btl - - btl - 0 btl - - 0 btl
8 Klorfenol kamfer Menthol ( CHKM ) - btl - - btl - 0 btl - - 0 btl
9 Komposit resin - btl - - btl - 0 btl - - 0 btl
10 Devitalisasi Pasta (Non Arsen) - btl - - btl - 0 btl - - 0 btl
11 Mummifying Pasta - btl - - btl - 0 btl - - 0 btl
12 Semen Seng Fosfat serbuk dan cairan - btl - - btl - 0 btl - - 0 btl
Temporary Stopping Fletcher (Fletcher)
btl btl -
13 serbuk dan cairan - - - - 0 btl - 0 btl
J U M LAH - - -
D OBAT & PERBEKALAN KESEHATAN TAMBAHAN
1 Alinamin F tablet - tab 1,100.00 - - tab - 0 tab 1,100.00 - 0 tab

2 Antiparkinson DOEN Tab Komb - Tab - - - Tab - 0 Tab - - 0 Tab
3 Combifen syr 5 btl 11,000.00 55,000 - btl - 0 btl 11,000.00 - 5 btl
4 Coparcetin 300 tab 350.00 105,000 - tab - 10 tab 350.00 3,500 290 tab
5 Dexanta tablet 110 tab 160.00 17,600 - tab - 50 tab 160.00 8,000 60 tab
6 Etafen syr 8 btl 7,000.00 56,000 - btl - 0 btl 7,000.00 - 8 btl
Etanol 70% cairan ( 100 ml ) (Alkohol) 14 Btl 2,500.00 35,000 - Btl - 0 Btl 2,500.00 - 14 Btl
7 Etanol 70% cairan ( 1 liter ) (Alkohol) 25 Btl 2,500.00 62,500 - Btl - 4 Btl 2,500.00 10,000 21 Btl
8 Farizol tablet 100 tab 200.00 20,000 - tab - 0 tab 200.00 - 100 tab
9 Fe Sirup 1 btl - - - btl - 1 btl - - 0 btl
Gastrusid sirup 20 btl 4,500.00 90,000 - btl - 0 btl 4,500.00 - 20 btl
10 Grafadon 200 tab 155.00 31,000 - tab - 0 tab 155.00 - 200 tab
11 H2O2 3% 800 cc 5 btl - - - btl - 1 btl - - 4 btl
12 Helixim syr 8 btl 10,000.00 80,000 - btl - 0 btl 10,000.00 - 8 btl
13 Histigo tablet - tab 2,500.00 - - tab - 0 tab 2,500.00 - 0 tab
14 IV Catheter No. 18 G 100 Set 9,185.00 918,500 - Set - - Set 9,185.00 - 100 Set
15 Kalium Permanganat Serbuk 5 Pot - - - Pot - 0 Pot - - 5 Pot
NO NAMA BARANG
Harga Harga Harga
16 Lexapram tablet 100 tab 160.00 16,000 - tab - 0 tab 160.00 - 100 tab
Lostacef 50 tab 660.00 33,000 - tab - 0 tab 660.00 - 50 tab
17 Mes / Pisau 15 bh 2,800.00 42,000 - bh - 2 bh 2,800.00 5,600 13 bh
18 Mirasic syr 6 btl 5,000.00 30,000 - btl - 0 btl 5,000.00 - 6 btl
19 Molacort 200 tab 265.00 53,000 - tab - 0 tab 265.00 - 200 tab
20 Neurosanbe inj. 62 amp 5000 & 7500 340,000 - amp - 10 amp 7,500.00 75,000 52 amp
Novabion 100 tab 260.00 26,000 - tab - 0 tab 260.00 - 100 tab
21 Novaflox 300 tab 450.00 135,000 - tab - 0 tab 450.00 - 300 tab
22 Novalgin injeksi - amp 11,500.00 - - amp - 0 amp 11,500.00 - 0 amp
23 Novamog 200 tab 400.00 80,000 - tab - 0 tab 400.00 - 200 tab
24 Novaxifen 200 tab 250.00 50,000 - tab - 0 tab 250.00 - 200 tab
25 Pimtracol syr - btl 8,000.00 - - btl - 0 btl 8,000.00 - 0 btl
26 Sarung Tangan Obgyn 50 set 4,249.00 212,450 - set - 0 set 4,249.00 - 50 set
27 Scopamin Inj - box - - - box - 0 box - - 0 box
28 Stesolid supp. - tube - - - tube - 0 tube - - 0 tube
29 Sufratul - lbr 26,000.00 - - lbr - 0 lbr 26,000.00 - 0 lbr
30 Tidifar 200 tab 260.00 52,000 - tab - 0 tab 260.00 - 200 tab
31 Transamin inj. - amp 15,000.00 - - amp - 0 amp 15,000.00 - 0 amp
Trifaneuro 100 tab 300.00 30,000 - sase - 0 sase 300.00 - 100 sase
32 Trolit 12 sase 13,333.33 160,000 - sase - 3 sase 13,333.33 40,000 9 sase
33 Urocare 12 Set - - - Set - 2 Set - - 10 Set
34 Vixal syr 3 btl 13,500.00 40,500 - btl - 0 btl 13,500.00 - 3 btl
dst
J U M LAH 2,770,550 - 142,100
J U M LAH TOTAL (A+B+C+D) 195,013,638.45 - 10,482,348.32
MENGETAHUI Sumbermalang, 31 Oktober 2015

KEPALA UPTD PUSKESMAS SUMBERMALANG PENGELOLA OBAT

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
NO NAMA BARANG
Harga Harga Harga
NB :
1.Tidak diperkenankan merubah format
( Menambah / mengurangi kolom ), kecuali kolom obat tambahan
2. Pelaporan mutasi persediaan diserahkan ke dinkes

dalam bentuk print out yg telah ditandatangani oleh Ka.Pusk
dan Pengelola Obat sebanyak 2 rangkap dan juga soft copy
dikirim ke email : farkalkessitbon@gmail.com
3. Terima kasih atas perhatian dan kerjasamanya……

SALDO SALDO AKHIR GUDANG OBAT SALDO AWAL GUDANG OBAT SALDO
Ket
Harga Harga Satuan Harga Satuan
Jumlah unit/bh/set Jumlah unit/bh/set Jumlah unit/bh/set
Satuan (Rp) (Rp) (Rp)
3,509.00 157,905 (63,162) 42 btl 3,509.00 147,378.00 60 btl 3,509.00 210,540.00 3

- - - btl - - - btl - - -
344.00 244,928 - 628 Tab 344.00 216,032.00 628 Tab 344.00 216,032.00 84
86.00 312,180 (8,600) 3,363 Tab 86.00 289,218.00 3,463 Tab 86.00 297,818.00 267
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
4,455.00 13,365 - - btl 4,455.00 - - btl 4,455.00 - 3
- - - btl - - - btl - - -
126.50 527,758 (63,250) 3,416 Tab 126.50 432,124.00 3,916 Tab 126.50 495,374.00 756
3,822.00 1,693,146 (114,660) 420 Amp 3,822.00 1,605,240.00 450 Amp 3,822.00 1,719,900.00 23
- - - tab - - - tab - - -
80.00 317,760 (56,800) 3,175 Tab 80.00 254,000.00 3,885 Tab 80.00 310,800.00 797
112.00 - - - Tab 112.00 - - Tab 112.00 - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
190.00 58,710 - - Kaps 190.00 - - Kaps 190.00 - 309
261.00 4,242,033 (522,000) 14,647 Tab 261.00 3,822,867.00 16,647 Tab 261.00 4,344,867.00 1,606
- - - vial - - - vial - - -
2,445.00 2,085,585 (195,600) 712 Btl 2,445.00 1,740,840.00 792 Btl 2,445.00 1,936,440.00 141
3,161.00 1,770,160 - 400 tab 3,161.00 1,264,400.00 400 tab 3,161.00 1,264,400.00 160
- - - vial - - - vial - - -
- - - vial - - - vial - - -
- - - vial - - - vial - - -
72.00 503,496 (91,152) 5,986 Tab 72.00 430,992.00 7,252 Tab 72.00 522,144.00 1,007
Ket
2,160.00 1,000,080 (97,200) 378 Btl 2,160.00 816,480.00 423 Btl 2,160.00 913,680.00 85
2,516.00 1,444,184 - 539 Tube 2,516.00 1,356,124.00 539 Tube 2,516.00 1,356,124.00 35
1,904.00 331,296 (19,040) 141 pot 1,904.00 268,464.00 151 pot 1,904.00 287,504.00 33
2,450.00 147,000 (24,500) 50 Supp 2,450.00 122,500.00 60 Supp 2,450.00 147,000.00 10
- - - tab - - - tab - - -
123.00 282,900 (12,300) 2,100 Tab 123.00 258,300.00 2,200 Tab 123.00 270,600.00 200
11,000.00 - - - amp 11,000.00 - - amp 11,000.00 - -
5,000.00 - - - Amp 5,000.00 - - Amp 5,000.00 - -
- - - amp - - - amp - - -
- - - vial - - - vial - - -
- - - tab - - - tab - - -
162.00 16,200 - - Tab 162.00 - - Tab 162.00 - 100

32.00 79,680 - - Tab 32.00 - - Tab 32.00 - 2,490
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
112.00 193,760 (71,456) 1,184 Tab 112.00 132,608.00 1,822 Tab 112.00 204,064.00 546
- - - tab - - - tab - - -
3,150.00 652,050 (31,500) 152 Tube 3,150.00 478,800.00 162 Tube 3,150.00 510,300.00 55
237.00 84,846 - 50 Tab 237.00 11,850.00 50 Tab 237.00 11,850.00 308
589 & 336 465,580 - 1,050 tab 336.00 352,800.00 1,050 tab 336.00 352,800.00 170
190.00 - - - tab 190.00 - - tab 190.00 - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
1,230.00 - - - amp 1,230.00 - - amp 1,230.00 - -

- - - tab - - - tab - - -
- - - vial - - - vial - - -
12,185.00 - - - vial 12,185.00 - - vial 12,185.00 - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
1,520.00 147,440 - 51 Tube 1,520.00 77,520.00 51 Tube 1,520.00 77,520.00 46

12,650.00 12,650 - 1 tube 12,650.00 12,650.00 1 tube 12,650.00 12,650.00 -
Ket
- - - supp - - - supp - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
21,758.00 391,644 - 18 amp 21,758.00 391,644.00 18 amp 21,758.00 391,644.00 -
- - - btl - - - btl - - -
313.50 15,675 - 50 tab 313.50 15,675.00 50 tab 313.50 15,675.00 -
- - - tab - - - tab - - -
- - - tube - - - tube - - -
- - - tab - - - tab - - -
1,580.00 2,178,820 - 1,300 Amp 1,580.00 2,054,000.00 1,300 Amp 1,580.00 2,054,000.00 79
- - - amp - - - amp - - -
62.00 336,536 (99,200) 3,358 Tab 62.00 208,196.00 4,958 Tab 62.00 307,396.00 2,070
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
2344 &
12100 857,584 (7,032) 238 Amp 2,344.00 557,872.00 241 Amp 2,344.00 564,904.00 3
35.00 40,530 - 1,152 Tab 35.00 40,320.00 1,152 Tab 35.00 40,320.00 6
56.00 14,000 - 250 Tab 56.00 14,000.00 250 Tab 56.00 14,000.00 -
93.00 - - - tab 93.00 - - tab 93.00 - -
1,050.00 1,539,300 (189,000) 911 Amp 1,050.00 956,550.00 1,091 Amp 1,050.00 1,145,550.00 555
97.00 33,465 - 200 Tab 97.00 19,400.00 200 Tab 97.00 19,400.00 145
- - - tab - - - tab - - -
104.00 52,000 - 500 tab 104.00 52,000.00 500 tab 104.00 52,000.00 -
- - - kaps - - - kaps - - -
3,624.00 54,360 - 7 btl 3,624.00 25,368.00 7 btl 3,624.00 25,368.00 8
167.00 24,549 - - Tab 167.00 - - Tab 167.00 - 147
- - - tab - - - tab - - -
38.00 11,400 - 300 Tab 38.00 11,400.00 300 Tab 38.00 11,400.00 -
8,100.00 712,800 - 88 Amp 8,100.00 712,800.00 88 Amp 8,100.00 712,800.00 -

337.04 60,667 - 180 kaps 337.04 60,667.20 180 kaps 337.04 60,667.20 -
864.25 1,296,375 - 1,376 kaps 864.25 1,189,208.00 1,376 kaps 864.25 1,189,208.00 124
7,700.00 331,100 - 36 Btl 7,700.00 277,200.00 36 Btl 7,700.00 277,200.00 7
3,223.00 48,345 - 8 Btl 3,223.00 25,784.00 8 Btl 3,223.00 25,784.00 7
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - btl - - - btl - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - kaps - - - kaps - - -
- - - amp - - - amp - - -
Ket
- - - kaps - - - kaps - - -
1,716.00 161,304 - 94 Amp 1,716.00 161,304.00 94 Amp 1,716.00 161,304.00 -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
1,008.00 34,272 - - Btl 1,008.00 - - Btl 1,008.00 - 34
630.00 1,185,030 (63,000) 1,400 Tab 630.00 882,000.00 1,500 Tab 630.00 945,000.00 481
3,417.00 2,696,013 - 507 Amp 3,417.00 1,732,419.00 507 Amp 3,417.00 1,732,419.00 282
- - - tab - - - tab - - -
- - - amp - - - amp - - -
85.00 207,910 - 2,000 Tab 85.00 170,000.00 2,000 Tab 85.00 170,000.00 446
288.00 1,794,816 (86,400) 5,700 Sac 288.00 1,641,600.00 6,000 Sac 288.00 1,728,000.00 532
- - - kaps - - - kaps - - -
- - - tab - - - tab - - -
3,399.00 254,925 - 75 amp 3,399.00 254,925.00 75 amp 3,399.00 254,925.00 -
1,650.00 245,850 (33,000) 125 tube 1,650.00 206,250.00 145 tube 1,650.00 239,250.00 24
2,973.00 - - - btl 2,973.00 - - btl 2,973.00 - -
900.00 63,000 (24,300) 32 Btl 900.00 28,800.00 59 Btl 900.00 53,100.00 38
56.00 185,696 (560) 3,090 Tab 56.00 173,040.00 3,100 Tab 56.00 173,600.00 226
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
44.00 1,219,768 (44,880) 16,876 Tab 44.00 742,544.00 17,896 Tab 44.00 787,424.00 10,846
- - - btl - - - btl - - -
5,727.00 22,908 - 4 Btl 5,727.00 22,908.00 4 Btl 5,727.00 22,908.00 -
1,960.00 - - - Btl 1,960.00 - - Btl 1,960.00 - -
5,200.00 2,173,600 (26,000) 353 Btl 5,200.00 1,835,600.00 358 Btl 5,200.00 1,861,600.00 65
209.00 540,265 (20,900) 2,085 Tab 209.00 435,765.00 2,185 Tab 209.00 456,665.00 500
- - - amp 83,333.00 - - amp 83,333.00 - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab 96.00 - - tab 96.00 - -
36.00 232,164 - 3,727 Tab 36.00 134,172.00 3,727 Tab 36.00 134,172.00 2,722
- - - tube - - - tube - - -
2,798.00 1,757,144 (179,072) 550 Tube 2,798.00 1,538,900.00 614 Tube 2,798.00 1,717,972.00 78
- - - tab - - - tab - - -
3,499.00 6,998 - - btl 3,499.00 - - btl 3,499.00 - 2
- - - btl - - - btl - - -
Ket
110.00 118,800 (11,000) 900 Tab 110.00 99,000.00 1,000 Tab 110.00 110,000.00 180
- - - tab - - - tab - - -
150.00 823,800 (125,850) 4,681 Tab 150.00 702,150.00 5,520 Tab 150.00 828,000.00 811
- - - tab - - - tab - - -
- - - kaps - - - kaps - - -
44.00 83,600 - 1,800 Tab 44.00 79,200.00 1,800 Tab 44.00 79,200.00 100
- - - tab - - - tab - - -
88.00 44,000 - 500 Tab 88.00 44,000.00 500 Tab 88.00 44,000.00 -
- - - kaps - - - kaps - - -
- - - - tab - - - tab - - -
425.00 - - - tab 425.00 - - tab 425.00 - -
81.40 2,400,486 - 24,078 Tab 81.40 1,959,949.20 24,078 Tab 81.40 1,959,949.20 5,412
62.00 9,300 (1,240) - Tab 62.00 - 20 Tab 62.00 1,240.00 150
84.00 640,500 (55,860) 5,857 Tab 84.00 491,988.00 6,522 Tab 84.00 547,848.00 1,768
- - - tab - - - tab - - -
243.00 70,470 - 200 Tab 243.00 48,600.00 200 Tab 243.00 48,600.00 90
2,569.00 534,352 - 205 tube 2,569.00 526,645.00 205 tube 2,569.00 526,645.00 3
300.00 496,500 (30,000) 1,450 Tab 300.00 435,000.00 1,550 Tab 300.00 465,000.00 205
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - amp - - - amp - - -
- - - amp - - - amp - - -
- - - kaps - - - kaps - - -
205.00 34,850 (10,250) 50 kaps 205.00 10,250.00 100 kaps 205.00 20,500.00 120
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
356.40 867,478 - 1,150 Kaps 356.40 409,860.00 1,150 Kaps 356.40 409,860.00 1,284
1,562.00 1,562 - - Tube 1,562.00 - - Tube 1,562.00 - 1
3,700.00 218,300 (18,500) 42 Btl 3,700.00 155,400.00 47 Btl 3,700.00 173,900.00 17
- - - btl - - - btl - - -
4,950.00 - - - Btl 4,950.00 - - Btl 4,950.00 - -
2,200.00 52,800 (11,000) 19 btl 2,200.00 41,800.00 24 btl 2,200.00 52,800.00 5
91.30 5,660,691 (237,380) 58,186 Tab 91.30 5,312,381.80 60,786 Tab 91.30 5,549,761.80 3,815
- - - tab - - - tab - - -
- - - amp - - - amp - - -
- - - amp - - - amp - - -
- - - tab 245.30 - - tab 245.30 - -
168.00 28,560 (5,040) 170 Tab 168.00 28,560.00 200 Tab 168.00 33,600.00 -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
Ket
138.00 1,152,576 (41,400) 7,573 Tab 138.00 1,045,074.00 7,873 Tab 138.00 1,086,474.00 779
72.00 766,944 (72,000) 9,632 Tab 72.00 693,504.00 10,632 Tab 72.00 765,504.00 1,020
2,167.00 1,809,445 (387,893) 680 Btl 2,167.00 1,473,560.00 859 Btl 2,167.00 1,861,453.00 155
- - - tab - - - tab - - -
- - - amp - - - amp - - -
- - - amp - - - amp - - -
3,850.00 - - - sase 3,850.00 - - sase 3,850.00 - -
- - - tab - - - tab - - -
9,000.00 4,500,000 - 500 btl 9,000.00 4,500,000.00 500 btl 9,000.00 4,500,000.00 -
9,000.00
270,000 - 30 btl 9,000.00 270,000.00 30 btl 9,000.00 270,000.00 -
10,000.00
5,000,000 - 500 btl 10,000.00 5,000,000.00 500 btl 10,000.00 5,000,000.00 -

10,000.00
3,250,000 - 325 btl 10,000.00 3,250,000.00 325 btl 10,000.00 3,250,000.00 -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
573.00 334,059 - 534 amp 573.00 305,982.00 534 amp 573.00 305,982.00 49
- - - amp - - - amp - - -
1,363.00 1,294,850 (122,670) 807 Amp 1,363.00 1,099,941.00 897 Amp 1,363.00 1,222,611.00 143
- - - pot - - - pot - - -
- - - kaps - - - kaps - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
91.55 61,247 (9,704) 231 tab 91.55 21,148.05 337 tab 91.55 30,852.35 438
154.00 138,600 - 900 tab 154.00 138,600.00 900 tab 154.00 138,600.00 -
- - - tab - - - tab - - -
11,000.00 - - - btl 11,000.00 - - btl 11,000.00 - -
6,600.00 171,600 - 21 Vial 6,600.00 138,600.00 21 Vial 6,600.00 138,600.00 5
- - - amp - - - amp - - -
- - - btl - - - btl - - -
- - - tab - - - tab - - -
- - - supp - - - supp - - -
Ket
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - amp - - - amp - - -
1,200.00 8,400 - - Amp 1,200.00 - - Amp 1,200.00 - 7
- - - amp - - - amp - - -
220 & 126,5 6,674,470 (263,120) 36,650 Tab 220 & 126,5 6,506,225 38,730 Tab 220 & 126,5 6,769,345 1,330
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
3,499.00 741,788 (6,998) 202 Amp 3,499.00 706,798.00 204 Amp 3,499.00 713,796.00 10
140.00 134,400 (14,000) 500 Tab 140.00 70,000.00 600 Tab 140.00 84,000.00 460
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
300.00 9,000 - 30 tab 300.00 9,000.00 30 tab 300.00 9,000.00 -
- - - amp - - - amp - - 10
- - - btl - - - btl - - -
110.00 164,890 (11,000) 1,100 Tab 110.00 121,000.00 1,200 Tab 110.00 132,000.00 399
- - - tab - - - tab - - -
- - - btl - - - btl - - -
110.00 330 - - Tab 110.00 - - Tab 110.00 - 3
160.00 1,310,400 (112,000) 6,973 Tab 160.00 1,115,680.00 7,673 Tab 160.00 1,227,680.00 1,217
- - - tab - - - tab - - -
3,000.00 33,000 - 4 tube 3,000.00 12,000.00 4 tube 3,000.00 12,000.00 7
- - - sase - - - sase - - -
- - - tube - - - tube - - -
- - - tube - - - tube - - -
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - - Tab - - - Tab - - -
176.00 602,272 (96,800) 2,738 Tab 176.00 481,888.00 3,288 Tab 176.00 578,688.00 684
4,700.00 5,362,700 - 1,089 Btl 4,700.00 5,118,300.00 1,089 Btl 4,700.00 5,118,300.00 52
6,006.00 - - - amp 6,006.00 - - amp 6,006.00 - -
- - - tab - - - tab - - -
107,85 & 110 280,937 (11,000) 2,200 tab 110.00 242,000.00 2,300 tab 110.00 253,000.00 369
640.00 499,200 (64,000) 700 Tab 640.00 448,000.00 800 Tab 640.00 512,000.00 80
- - - supp - - - supp - - -
7,000.00 455,000 (210,000) 35 amp 7,000.00 245,000.00 65 amp 7,000.00 455,000.00 30
- - - pak - - - pak - - -
- - - pak - - - pak - - -
- - - pak - - - pak - - -
Ket
- - - pak - - - pak - - -
- - - pak - - - pak - - -
- - - pak - - - pak - - -
5,940.00 2,768,040 (65,340) 428 Btl 5,940.00 2,542,320.00 439 Btl 5,940.00 2,607,660.00 38
- - - btl - - - btl - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - amp - - - amp - - -
2,772.00 393,624 (60,984) 26 Tube 2,772.00 72,072.00 48 Tube 2,772.00 133,056.00 116
2,010.00 906,510 (104,520) 364 Tube 2,010.00 731,640.00 416 Tube 2,010.00 836,160.00 87
2,200.00 1,111,000 - 137 Amp 2,200.00 301,400.00 137 Amp 2,200.00 301,400.00 368
- - - kaps - - - kaps - - -
- - - kaps - - - kaps - - -
- - - amp - - - amp - - -
119.00 1,156,680 - 7,800 Tab 119.00 928,200.00 7,800 Tab 119.00 928,200.00 1,920
5,200.00 1,003,600 (15,600) 182 btl 5,200.00 946,400.00 185 btl 5,200.00 962,000.00 11
1,438.00 1,143,210 (189,816) 506 Btl 1,438.00 727,628.00 638 Btl 1,438.00 917,444.00 289
32.00 27,840 (3,200) 760 Tab 32.00 24,320.00 860 Tab 32.00 27,520.00 110
79.00 2,778,193 (129,244) 33,408 Tab 79.00 2,639,232.00 35,044 Tab 79.00 2,768,476.00 1,759
- - - tab - - - tab - - -
- - - tube - - - tube - - -
- - - amp - - - amp - - -
- - - amp - - - amp - - -
6,270.00 3,034,680 - 480 amp 6,270.00 3,009,600.00 480 amp 6,270.00 3,009,600.00 4
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - btl - - - btl - - -
298.00 52,150 - - Tab 298.00 - - Tab 298.00 - 175
- - - tab - - - tab - - -
17.39 89,872 - 1,100 Tab 17.39 19,129.00 1,100 Tab 17.39 19,129.00 4,068
- - - kaps - - - kaps - - -
100.10 240,240 (10,010) 1,800 kaps 100.10 180,180.00 1,900 kaps 100.10 190,190.00 600
- - - btl - - - btl - - -
2,163.00 47,586 (2,163) 11 Btl 2,163.00 23,793.00 12 Btl 2,163.00 25,956.00 11
14,203.00 28,406 - - Btl 20,000.00 - - Btl 20,000.00 - 2
- - - btl - - - btl - - -
- - - tab - - - tab - - -
151.80 4,748,152 (15,180) 28,164 Tab 151.80 4,275,295.20 28,264 Tab 151.80 4,290,475.20 3,115
- - - tab - - - tab - - -
5,500.00 1,127,500 - 165 amp 5,500.00 907,500.00 165 amp 5,500.00 907,500.00 40
Ket
- - - vial - - - vial - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
284.00 56,800 - 200 Tab 284.00 56,800.00 200 Tab 284.00 56,800.00 -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
1,500.00 - (37,500) - amp 1,500.00 - 25 amp 1,500.00 37,500.00 -
120.00 435,240 (70,560) 2,800 Tab 120.00 336,000.00 3,388 Tab 120.00 406,560.00 827
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - kaps - - - kaps - - -
- - - kaps - - - kaps - - -
- - - kapl - - - kapl - - -
- - - kapl - - - kapl - - -
- - - kapl - - - kapl - - -
5,200.00 1,976,000 - - Btl 5,200.00 - - Btl 5,200.00 - 380
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
398,420.00 - (398,420) - Vial 398,420.00 - 1 Vial 398,420.00 398,420.00 -
59.00 21,948 - - Tab 59.00 - - Tab 59.00 - 372
97.00 400,028 (29,040) 3,864 Tab 96.80 374,035.20 4,164 Tab 96.80 403,075.20 260
1,800.00 162,000 - 54 Pot 1,800.00 97,200.00 54 Pot 1,800.00 97,200.00 36

1,250.00 452,500 (12,500) 317 Ktk 1,250.00 396,250.00 327 Ktk 1,250.00 408,750.00 45
- - - ktk - - - ktk - - -
10,384.00 238,832 - 23 btl 10,384.00 238,832.00 23 btl 10,384.00 238,832.00 -
242.00 - - - tab 242.00 - - tab 242.00 - -
- - - kaps - - - kaps - - -
- - - tab - - - tab - - -
509.00 516,635 (50,900) 900 kaps 509.00 458,100.00 1,000 kaps 509.00 509,000.00 115
- - - btl 4,896.00 - - btl 4,896.00 - -
- - - kaps - - - kaps - - -
- - - kaps - - - kaps - - -
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - kaps - - - kaps - - -
- - - btl - - - btl - - -
- - - amp - - - amp - - -
2,950.00 1,775,900 - 560 vial 2,950.00 1,652,000.00 560 vial 2,950.00 1,652,000.00 42
Ket
- - - amp - - - amp - - -
3,300.00 458,700 - 128 vial 3,300.00 422,400.00 128 vial 3,300.00 422,400.00 11
- - - amp - - - amp - - -
137,500.00 - (412,500) - Amp 137,500.00 - 3 Amp 137,500.00 412,500.00 -
1,078.00 4,044,656 (107,800) 3,391 Amp 1,078.00 3,655,498.00 3,491 Amp 1,078.00 3,763,298.00 361
- - - tab - - - tab - - -
110.84 571,934 (11,084) 4,510 Tab 110.84 499,888.40 4,610 Tab 110.84 510,972.40 650
169.00 18,083 (5,070) - Tab 400.00 - 30 Tab 169.00 5,070.00 107
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - btl - - - btl - - -
- - - tab - - - tab - - -
255.00 1,186,515 (155,550) 3,826 Tab 255.00 975,630.00 4,436 Tab 255.00 1,131,180.00 827
517.00 25,850 - - tab 517.00 - - tab 517.00 - 50
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
- - - btl - - - btl - - -
- - - tab - - - tab - - -
3,226.00 9,678 - - Btl 3,226.00 - - Btl 3,226.00 - 3
12,045.00 228,855 - 19 amp 12,045.00 228,855.00 19 amp 12,045.00 228,855.00 -
- - - tab - - - tab - - -
- - - btl - - - btl - - -
149.00 1,326,100 - 7,900 Kaps 149.00 1,177,100.00 7,900 Kaps 149.00 1,177,100.00 1,000
300.30 838,137 - 2,521 Kaps 300.30 757,056.30 2,521 Kaps 300.30 757,056.30 270
- - - kaps - - - kaps - - -
616.00 725,032 - 600 kaps 616.00 369,600.00 600 kaps 616.00 369,600.00 577
38 & 69,3 2,099,330 (145,530) 25,960 Tab 69.30 1,799,028.00 28,060 Tab 69.30 1,944,558.00 4,575
- - - tab - - - tab - - -
680.00 419,560 (40,800) 268 Amp 680.00 182,240.00 328 Amp 680.00 223,040.00 349
- - - amp - - - amp - - -
- - - amp - - - amp - - -
- - - kaps - - - kaps - - -
- - - kaps - - - kaps - - -
290.00 - - - tab 290.00 - - tab 290.00 - -
- - - tab - - - tab - - -
40.00 4,000 - 100 Tab 40.00 4,000.00 100 Tab 40.00 4,000.00 -
7,480.00 411,400 - 34 amp 7,480.00 254,320.00 34 amp 7,480.00 254,320.00 21
Ket
- - - amp - - - amp - - -
- - - tab - - - tab - - -
- - - tab - - - tab - - -
8,500.00 42,500 (170,000) - vial 8,500.00 - 20 vial 8,500.00 170,000.00 5
107 & 34,1 3,388,440 (217,210) 50,313 Tab 107 & 34,1 2,467,491 52,343 Tab 107 & 34,1 2,684,701 8,607
- - - tab - - - tab - - -
- - - tab - - - tab - - -
12,840.00 873,120 - 53 btl 12,840.00 680,520.00 53 btl 12,840.00 680,520.00 15
474.00 3,069,150 (237,000) 5,538 tab 474.00 2,625,012.00 6,038 tab 474.00 2,862,012.00 937
131,111,868 (6,770,790) - - - 111,057,147.35 - - - 117,827,938 -
- - - - - - - - - -
625.00 134,375 - 200 set 625 125,000.00 200 set 625.00 125,000.00 15
1038 & 1089 16,007,340 (934,200) 13,885 set 1038 & 1089 14,922,630 14,785 set 1038 & 1089 15,856,830 1,045
- - - set - - - set - - -
750.00 - - - set 750.00 - - set 750.00 - -
5,583.33 1,278,583 - 197 set 5,583.33 1,099,916.01 197 set 5,583.33 1,099,916.01 32
- - - set - - - set - - -
3,500.00 2,184,000 (157,500) 579 Set 3,500.00 2,026,500.00 624 Set 3,500.00 2,184,000.00 45
3,509.00 1,677,302 (175,450) 428 Set 3,509.00 1,501,852.00 478 Set 3,509.00 1,677,302.00 50
9,185.00 4,969,085 - 514 Set 9,185.00 4,721,090.00 514 Set 9,185.00 4,721,090.00 27
9,185.00 2,094,180 (459,250) 149 Set 9,185.00 1,368,565.00 199 Set 9,185.00 1,827,815.00 79
9,185.00 4,362,875 - 427 Set 9,185.00 3,921,995.00 427 Set 9,185.00 3,921,995.00 48
16,500.00 - - - Bks 16,500.00 - - Bks 16,500.00 - -
12,500.00 1,387,500 (50,000) 106 Bks 12,500.00 1,325,000.00 110 Bks 12,500.00 1,375,000.00 5
5,800.00 313,200 - 54 ktk 5,800.00 313,200.00 54 ktk 5,800.00 313,200.00 -

- - - rol - - - rol - - -
105,000.00 - - - rol 105,000.00 - - rol 105,000.00 - -
750.00 2,076,750 (15,000) 2,729 Rol 750.00 2,046,750.00 2,749 Rol 750.00 2,061,750.00 40
1,500.00 1,968,000 (120,000) 1,173 Rol 1,500.00 1,759,500.00 1,253 Rol 1,500.00 1,879,500.00 139
33,000.00 2,442,000 - 71 rol 33,000.00 2,343,000.00 71 rol 33,000.00 2,343,000.00 3

- - - rol - - - rol - - -
33,000.00 1,716,000 - 52 rol 33,000.00 1,716,000.00 52 rol 33,000.00 1,716,000.00 -
41,800.00 2,508,000 - 60 rol 41,800.00 2,508,000.00 60 rol 41,800.00 2,508,000.00 -
23,485.00 234,850 - 10 Rol 23,485.00 234,850.00 10 Rol 23,485.00 234,850.00 -
23,624.70 566,993 (47,249) 23 Rol 23,624.70 543,368.10 25 Rol 23,624.70 590,617.50 1
3,055.56 745,557 (110,000) 137 Sac 3,055.56 418,611.72 173 Sac 3,055.56 528,611.88 107
42,250.00 - - - rol 42,250.00 - - rol 42,250.00 - -
Ket
3,000.00 75,000 - 20 Set 3,000.00 60,000.00 20 Set 3,000.00 60,000.00 5
8,000.00 80,000 - 10 set 8,000.00 80,000.00 10 set 8,000.00 80,000.00 -
4,249.30 3,866,863 (1,274,790) 760 Set 4249.3 3,229,468.00 1,060 Set 4,249.30 4,504,258.00 150
440.00 102,520 (22,000) 152 set 440.00 66,880.00 202 set 440.00 88,880.00 81
50,790,972 (3,365,440) - - - 46,332,175.83 - - - 49,697,615 -
- - - - - - - - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - btl - - - btl - - -
- - - - - - - - - - -
- - - - - - - - - -
1,100.00 - - - tab 1,100.00 - - tab 1,100.00 - -
- - - - Tab 75.00 - - Tab 75.00 - -
11,000.00 55,000 - 5 btl 11,000.00 55,000.00 5 btl 11,000.00 55,000.00 -
350.00 101,500 (70,000) 100 tab 350.00 35,000.00 300 tab 350.00 105,000.00 190
160.00 9,600 - - tab 15,000.00 - - tab 15,000.00 - 60
7,000.00 56,000 - 5 btl 7,000.00 35,000.00 5 btl 7,000.00 35,000.00 3
2,500.00 35,000 - 14 Btl 2,500.00 35,000.00 14 Btl 2,500.00 35,000.00 -
2,500.00 52,500 (7,500) 12 Btl 2,500.00 30,000.00 15 Btl 2,500.00 37,500.00 9
200.00 20,000 - - tab 200.00 - - tab 200.00 - 100
- - - - btl - - 1 btl - - -
4,500.00 90,000 - 20 btl 4,500.00 90,000.00 20 btl 4,500.00 90,000.00 -
155.00 31,000 - 200 tab 155.00 31,000.00 200 tab 155.00 31,000.00 -
- - - 3 btl - - 4 btl - - 1
10,000.00 80,000 - 5 btl 10,000.00 50,000.00 5 btl 10,000.00 50,000.00 3
2,500.00 - - - tab 2,500.00 - - tab 2,500.00 - -
9,185.00 918,500 - 100 Set 9,185.00 918,500.00 100 Set 9,185.00 918,500.00 -
- - - 5 Pot - - 5 Pot - - -
Ket
160.00 16,000 - - tab 160.00 - - tab 160.00 - 100
660.00 33,000 - 50 tab 660.00 33,000.00 50 tab 660.00 33,000.00 -
2,800.00 36,400 - - bh 2,800.00 - - bh 2,800.00 - 13
5,000.00 30,000 - 5 btl 5,000.00 25,000.00 5 btl 5,000.00 25,000.00 1
265.00 53,000 (53,000) - tab 700.00 - 200 tab 265.00 53,000.00 200
5000 & 7500 265,000 (125,000) 40 amp 5,000.00 200,000.00 60 amp 5000 & 7500 325,000.00 12
260.00 26,000 (26,000) - tab 290.00 - 100 tab 260.00 26,000.00 100
450.00 135,000 - 300 tab 450.00 135,000.00 300 tab 450.00 135,000.00 -
11,500.00 - - - amp 11,500.00 - - amp 11,500.00 - -
400.00 80,000 - 200 tab 400.00 80,000.00 200 tab 400.00 80,000.00 -
250.00 50,000 - 200 tab 250.00 50,000.00 200 tab 250.00 50,000.00 -
8,000.00 - - - btl 8,000.00 - - btl 8,000.00 - -
4,249.00 212,450 - 50 set 4,249.00 212,450.00 50 set 4,249.00 212,450.00 -
- - - - box - - - box - - -
- - - - tube - - - tube - - -
26,000.00 - - - lbr 5,000.00 - - lbr 5,000.00 - -
260.00 52,000 - 200 tab 260.00 52,000.00 200 tab 260.00 52,000.00 -
15,000.00 - - - amp 15,000.00 - - amp 15,000.00 - -
300.00 30,000 (30,000) - tab 7,000.00 - 100 tab 300.00 30,000.00 100
13,333.33 120,000 - 6 sase 13,333.33 80,000.00 6 sase 13,333.33 80,000.00 3
- - - - Set - - - Set - - 10
13,500.00 40,500 - - btl 350.00 - - btl 350.00 - 3
- - - - - - - - -
- - - - - -
2,628,450 - - 2,146,950.00 - - - 2,458,450
- - - - - - -
184,531,290.13 - - 159,536,273.18 - - - 169,984,003.04
184,531,290.13 159,536,273.18
r 2015 Generik =
130,023,719
non Generik
54,507,571
1 016
Ket
81,222,279.75 70,774,549.89
470,783 240,758,552.93 500,476 240,758,552.93 85,804
SALDO AKHIR UNIT PELAYANAN
Harga Satuan
nit/bh/set Jumlah
(Rp)
btl 3,509.00 10,527.00

btl - -
Tab 344.00 28,896.00
Tab 86.00 22,962.00
tab - -
tab - -
tab - -
tab - -
btl 4,455.00 13,365.00
btl - -
Tab 126.50 95,634.00
Amp 3,822.00 87,906.00
tab - -
Tab 80.00 63,760.00
Tab 112.00 -
tab - -
tab - -
tab - -
Kaps 190.00 58,710.00
Tab 261.00 419,166.00
vial - -
Btl 2,445.00 344,745.00
tab 3,161.00 505,760.00
vial - -
vial - -
vial - -
Tab 72.00 72,504.00

Harga Satuan
nit/bh/set Jumlah
(Rp)
Btl 2,160.00 183,600.00
Tube 2,516.00 88,060.00
pot 1,904.00 62,832.00
Supp 2,450.00 24,500.00
tab - -
Tab 123.00 24,600.00

amp 11,000.00 -
Amp 5,000.00 -
amp - -
vial - -
tab - -
Tab 162.00 16,200.00

Tab 32.00 79,680.00
tab - -
tab - -
tab - -
tab - -
Tab 112.00 61,152.00
tab - -
Tube 3,150.00 173,250.00
Tab 237.00 72,996.00
tab 589 & 336 112,780.00
tab 190.00 -
tab - -
tab - -
amp 1,230.00 -
tab - -
vial - -
vial 12,185.00 -
tab - -
tab - -
Tube 1,520.00 69,920.00

tube 12,650.00 -
Harga Satuan
nit/bh/set Jumlah
(Rp)
supp - -
tab - -
tab - -
amp 21,758.00 -
btl - -
tab 313.50 -
tab - -
tube - -
tab - -
Amp 1,580.00 124,820.00
amp - -
Tab 62.00 128,340.00
btl - -
btl - -
tab - -
tab - -
Amp 2,344.00 299,712.00

Tab 35.00 210.00
Tab 56.00 -
tab 93.00 -
Amp 1,050.00 582,750.00
Tab 97.00 14,065.00
tab - -
tab 104.00 -
kaps - -
btl 3,624.00 28,992.00
Tab 167.00 24,549.00
tab - -
Tab 38.00 -
Amp 8,100.00 -
kaps 337.04 -
kaps 864.25 107,167.00
Btl 7,700.00 53,900.00
Btl 3,223.00 22,561.00
tab - -
tab - -
btl - -
tab - -
tab - -
tab - -
kaps - -
amp - -
Harga Satuan
nit/bh/set Jumlah
(Rp)
kaps - -
Amp 1,716.00 -
tab - -
tab - -
tab - -
tab - -
Btl 1,008.00 34,272.00
Tab 630.00 303,030.00
Amp 3,417.00 963,594.00

tab - -
amp - -
Tab 85.00 37,910.00
Sac 288.00 153,216.00
kaps - -
tab - -
amp 3,399.00 -
tube 1,650.00 39,600.00
btl 2,973.00 -
Btl 900.00 34,200.00
Tab 56.00 12,656.00
tab - -
tab - -
tab - -
tab - -
tab - -
tab - -
Tab 44.00 477,224.00
btl - -
Btl 5,727.00 -
Btl 1,960.00 -
Btl 5,200.00 338,000.00
Tab 209.00 104,500.00
amp 83,333.00 -
tab - -
tab - -
tab 96.00 -
Tab 36.00 97,992.00
tube - -
Tube 2,798.00 218,244.00
tab - -
btl 3,499.00 6,998.00
btl - -
Harga Satuan
nit/bh/set Jumlah
(Rp)
Tab 110.00 19,800.00
tab - -
Tab 150.00 121,650.00
tab - -
kaps - -
Tab 44.00 4,400.00
tab - -
Tab 88.00 -
kaps - -
tab - -
tab 425.00 -
Tab 81.40 440,536.80
Tab 62.00 9,300.00
Tab 84.00 148,512.00
tab - -
Tab 243.00 21,870.00
tube 2,569.00 7,707.00
Tab 300.00 61,500.00
amp - -
tab - -
amp - -
amp - -
kaps - -
kaps 205.00 24,600.00
tab - -
tab - -
tab - -
Kaps 356.40 457,617.60
Tube 1,562.00 1,562.00
Btl 3,700.00 62,900.00
btl - -
Btl 4,950.00 -
btl 2,200.00 11,000.00
Tab 91.30 348,309.50
tab - -
amp - -
amp - -
tab 245.30 -
Tab 168.00 -
tab - -
tab - -
tab - -
Harga Satuan
nit/bh/set Jumlah
(Rp)
Tab 138.00 107,502.00
Tab 72.00 73,440.00
Btl 2,167.00 335,885.00

tab - -
amp - -
amp - -
sase 3,850.00 -
tab - -
btl 9,000.00 -
btl 9,000.00 -
btl 10,000.00 -
btl 10,000.00 -
tab - -
tab - -
tab - -
amp 573.00 28,077.00
amp - -
Amp 1,363.00 194,909.00

pot - -
kaps - -
tab - -
tab - -
tab 91.55 40,098.90
tab 154.00 -
tab - -
btl 11,000.00 -
Vial 6,600.00 33,000.00
amp - -
btl - -
tab - -
supp - -
Harga Satuan
nit/bh/set Jumlah
(Rp)
tab - -
tab - -
amp - -
Amp 1,200.00 8,400.00
amp - -
Tab 126.50 168,245.00

tab - -
tab - -
tab - -
Amp 3,499.00 34,990.00
Tab 140.00 64,400.00

amp - -
tab - -
tab - -
tab 300.00 -
amp - -
btl - -
Tab 110.00 43,890.00
tab - -
btl - -
Tab 110.00 330.00
Tab 160.00 194,720.00
tab - -
tube 3,000.00 21,000.00
sase - -
tube - -
tube - -
amp - -
tab - -
Tab - -
Tab 176.00 120,384.00
Btl 4,700.00 244,400.00
amp 6,006.00 -
tab - -
tab 110.00 38,936.65
Tab 640.00 51,200.00
supp - -
amp 7,000.00 210,000.00
pak - -
pak - -
pak - -
Harga Satuan
nit/bh/set Jumlah
(Rp)
pak - -
pak - -
pak - -
Btl 5,940.00 225,720.00
btl - -
tab - -
tab - -
amp - -
Tube 2,772.00 321,552.00
Tube 2,010.00 174,870.00
Amp 2,200.00 809,600.00
kaps - -
kaps - -
amp - -
Tab 119.00 228,480.00
btl 5,200.00 57,200.00
Btl 1,438.00 415,582.00
Tab 32.00 3,520.00
Tab 79.00 138,961.00
tab - -
tube - -
amp - -
amp - -
amp 6,270.00 25,080.00
amp - -
tab - -
tab - -
tab - -
btl - -
Tab 298.00 52,150.00
tab - -
Tab 17.39 70,742.52
kaps - -
kaps 100.10 60,060.00
btl - -
Btl 2,163.00 23,793.00
Btl 20,000.00 28,406.00
btl - -
tab - -
Tab 151.80 472,857.00
tab - -
amp 5,500.00 220,000.00
Harga Satuan
nit/bh/set Jumlah
(Rp)
vial - -
tab - -
tab - -
Tab 284.00 -
tab - -
tab - -
amp 1,500.00 -
Tab 120.00 99,240.00
tab - -
tab - -
tab - -
kaps - -
kaps - -
kapl - -
kapl - -
kapl - -
Btl 5,200.00 1,976,000.00
tab - -
tab - -
tab - -
Vial 398,420.00 -
Tab 59.00 21,948.00
Tab 96.80 25,992.80
Pot 1,800.00 64,800.00

Ktk 1,250.00 56,250.00
ktk - -
btl 10,384.00 -
tab 242.00 -
kaps - -
tab - -
kaps 509.00 58,535.00
btl 4,896.00 -
kaps - -
kaps - -
amp - -
tab - -
kaps - -
btl - -
amp - -
vial 2,950.00 123,900.00
Harga Satuan
nit/bh/set Jumlah
(Rp)
amp - -
vial 3,300.00 36,300.00
amp - -
Amp 137,500.00 -
Amp 1,078.00 389,158.00
tab - -
Tab 110.84 72,046.00
Tab 400.00 18,083.00
tab - -
tab - -
btl - -
tab - -
Tab 255.00 210,885.00

tab 517.00 25,850.00
tab - -
tab - -
tab - -
tab - -
btl - -
tab - -
Btl 3,226.00 9,678.00
amp 12,045.00 -
tab - -
btl - -
Kaps 149.00 149,000.00
Kaps 300.30 81,081.00
kaps - -
kaps 616.00 355,432.00
Tab 69.30 300,302.00

tab - -
Amp 680.00 237,320.00
amp - -
amp - -
kaps - -
kaps - -
tab 290.00 -
tab - -
Tab 40.00 -
amp 7,480.00 157,080.00
Harga Satuan
nit/bh/set Jumlah
(Rp)
amp - -
tab - -
tab - -
vial 8,500.00 42,500.00
Tab 107.00 920,949.00
tab - -
tab - -
btl 12,840.00 192,600.00
tab 474.00 444,138.00
- - 20,054,720.77
- - -
set 625.00 9,375.00
set 1,038.00 1,084,710.00
set - -
set 750.00 -
set 5,583.33 178,666.56
set - -
Set 3,500.00 157,500.00
Set 3,509.00 175,450.00
Set 9,185.00 247,995.00
Set 9,185.00 725,615.00
Set 9,185.00 440,880.00
Bks 16,500.00 -
Bks 12,500.00 62,500.00
ktk 5,800.00 -
rol - -
rol 105,000.00 -
Rol 750.00 30,000.00
Rol 1,500.00 208,500.00
rol 33,000.00 99,000.00

rol - -
rol 33,000.00 -
rol 41,800.00 -
Rol 23,485.00 -
Rol 23624,7 & 18000 23,624.70
Sac 3,055.56 326,944.92

rol 42,250.00 -
Harga Satuan
nit/bh/set Jumlah
(Rp)
Set 3,000.00 15,000.00
set 10,000.00 -
Set 4,249.30 637,395.00

set 440.00 35,640.00
- - 4,458,796.18
- - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
btl - -
- - -
- - -
set 1,100.00 -
tab 75.00 -
tab 11,000.00 -
Tab 350.00 66,500.00
amp 15,000.00 9,600.00
tab 7,000.00 21,000.00
tab 2,500.00 -
btl 2,500.00 22,500.00
tab 200.00 20,000.00
tab - -
tab 4,500.00 -
btl 7,000.00 -
Btl - -
Btl 10,000.00 30,000.00
tab 2,500.00 -
btl 9,185.00 -
btl 4,500.00 -
Harga Satuan
nit/bh/set Jumlah
(Rp)
tab 160.00 16,000.00
btl 660.00 -
btl 2,800.00 36,400.00
btl 5,000.00 5,000.00
tab 700.00 53,000.00
tab 5,000.00 65,000.00
Tab 290.00 26,000.00
Set 450.00 -
Pot 11,500.00 -
tab 400.00 -
tab 250.00 -
tab 8,000.00 -
bh 4,249.00 -
btl - -
tab - -
amp 5,000.00 -
set 260.00 -
tab 15,000.00 -
btl 7,000.00 30,000.00
tab 13,333.33 40,000.00
amp - -
tab 400.00 40,500.00
tab - -
- -
- 481,500.00
- -
- 24,995,016.95
Harga Satuan
nit/bh/set Jumlah
(Rp)
24,995,016.95
LAPORAN KETERSEDIAAN OBAT
BULAN : Oktober 2015
,
MUTASI OBAT Tingkat
No Nama Obat Sat Pemakaia
Stok Awal Terima Keluar Stok Akhir Kecukupan
n rata-rata
1 Adrenalin Inj. Ampul 90 - - 90 ###
3 30
2 Amoxycillin 250 mg Kapsul 1,722 - 52 1,670 100
### 17
3 Amoxycillin 500 mg Kaplet 16,172 - 2,252
### ### 1,500 9
Amoxycillin Syr. Kering
4 Botol 1,283 - 187 1,096 100 11
125 mg/5 ml
5 Ampisillin 500 mg Kaplet - - - - - -
Ampisillin Syr. Kering
6 Botol - - - -
125 mg/5 ml - -
7 Antasida DOEN komp. Tablet 7,660 - 1,369 6,291 1,500 4
8 Asam Askorbat 50 mg Tablet 14,162 - 3,450 ### 1,500 7
9 Deksamethason Inj. 5 mg/ml Ampul 1,196 - 2 1,194 100 12
10 Deksamethason 0,5 mg Tablet 2,758 - 536 2,222 1,000 2
11 Dextromethorpan 15 mg Tablet - - - - 30 -
12 Garam Oralit 200 ml Sase 3,275 - 487 2,788 300 9
13 Glibenklamide 5 mg Tablet 2,400 - - 2,400 30 80
14 Gliseryl Guaiacolat 100 mg Tablet 8,582 - 4,007 4,575 2,000 2
15 Hidrocortison Krim 2,5 mg Tube 38 - - 38 10 4
16 Ibuprofen 200 mg Tablet - - - - 100 -
17 Infus Ringer Lactat Botol 1,102 - 555 547 125 4
18 Infus Dextrose 5% Botol 343 - 36 307 5 61
19 Iodiol Kapsul Kapsul - - - - - -
20 Kloramphenicol 250 mg Kapsul 3,500 - 185 3,315 200 17
21 Kloramphenicol Salep Mata Tube 17 - - 17 30 1
22 Klorfeniramin Maleat 4 mg Tablet 3,080 - 2,078 1,002 1,000 1
23 Kloroquin 150 mg Tablet - - - - - -
Kotrimoksasol Suspensi
24 Botol 1,176 - 4 1,172 50 23
komb. 240 mg / 5ml
25 Kotrimoksasol 480 mg Tablet 5,984 - 1,065 4,919 500 10
26 Kotrimoksasol 120 mg Tablet 6,532 - 100 6,432 100 64
27 Metronidazol 250 mg Tablet 13 - - 13 100 0
28 Obat Anti TBC kat. 1 Paket - - - - - -
31 Obat Anti TBC sisipan Paket - - - - - -
32 Oksitetrasiklin salp. 3 % Tube 523 - 25 498 50 10
33 Parasetamol Syr. 120 mg/5 ml Botol 1,097 - 118 979 100 10
34 Parasetamol 500 mg Tablet 9,392 - 1,469 7,923 1,000 8
35 Parasetamol 100 mg Tablet 2,030 - 100 1,930 100 19
36 Prednison 5 mg Tablet 15,695 - 3,000 ### 1,000 13
37 Retinol 200.000 IU (vit A) Kapsul - - - - - -
38 Tablet Tambah Darah Tablet - - - - - -
39 Tetrasiklin 250 mg Kapsul 5,000 - - 5,000 100 50
Mengetahui,
Kepala Puskesmas Sumbermalang Pengelola Obat

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
421
26
53
179
140
70
70
459
LAPORAN PEMANTAUAN PENULISAN RESEP OBAT GENERIK DI PUSKESMAS DAN JARINGANNYA
R / OBAT
NO DOKTER JUMLAH LEMBAR RESEP KETERANGAN
TOTAL R/ TOTAL R/ OBAT GENERIK % R/ GENERIK THD TOTAL R/
1 2 3 4 5 6 = 5/4 7
1 dr. Indah Ayuning Wulan 305 1117 1117 100%
Mengetahui,
Kepala UPTD Puskesmas Sumbermalang
NIP. 19641008 198503 1 004
mbermalang
Ns
1 004
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKESMAS DAN JARINGANNYA
PERSEDIAAN OBAT PERSEDIAAN ITEM OBAT

NO PUSKESMAS TOTAL PERSEDIAAN PERSEDIAAN OBAT GENERIK TOTAL ITEM / PERSEDIAAN OBAT
(Rp) JENIS
Rp % THD TOTAL JUMLAH ITEM
1 2 4 5 = 4/3 6 7
1 Sumbermalang Rp 184,531,290.13 Rp 130,023,719.12 70.46% 207 155
Sumbermalang,
Mengetahui,
Kepala UPTD Puskesmas Sumbermala
NIP. 19641008 198503 1 004
ANNYA
IAAN ITEM OBAT

PERSEDIAAN OBAT GENERIK
MLAH ITEM % THD TOTAL
7 8 = 7/6
155 74.88%
31 Oktober 2015
Mengetahui,
uskesmas Sumbermalang
O Z I, S.Kep.Ns
41008 198503 1 004
Laporan Narkotika Bulan Oktober 2015
Unit Layanan: PKM SUMBERMALANG
Data ini sudah diverifikasi oleh Kepala Puskesmas Sumbermalang : AMROZI, S.Kep.Ns.
Tanggal: 31 Oktober 2015
Saldo PEMASUKAN PENGGUNAAN

Nama Satuan Saldo Akhir
Count of Nama Awal Dari Jumlah Untuk Jumlah
Nama Satuan Saldo AwaPEMASUKANPEMASUKAN
PENGGUNAAN
PENGGUNAAN
Saldo Akhir
Codein 10 mg Tablet Tablet 0 (empty) 0 (empty) 0 0

Codein Pulvis mg 0 (empty) 0 (empty) 0 0
Codipront Capsul Kapsul 0 (empty) 0 (empty) 0 0
Codipront Cum Exp Kapsu Kapsul 0 (empty) 0 (empty) 0 0
Codipront Cum Exp Syrup Botol 0 (empty) 0 (empty) 0 0
Codipront Syrup Botol 0 (empty) 0 (empty) 0 0
Doveri 100 mg Tablet Tablet 0 (empty) 0 (empty) 0 0
Doveri Pulvis mg 0 (empty) 0 (empty) 0 0
Durogesic 25 MU Ampul 0 (empty) 0 (empty) 0 0
Durogesic 50 MU Ampul 0 (empty) 0 (empty) 0 0
Fentanyl 0.05 mg/ml Inj Ampul 0 (empty) 0 (empty) 0 0
Fentanyl 0.5 mg/ml 2 ml In Ampul 0 (empty) 0 (empty) 0 0
Morphine HCl 10 mg/ml In Ampul 0 (empty) 0 (empty) 0 0
Morphine Syrup Botol 0 (empty) 0 (empty) 0 0
Pethidine HCl 50 mg/ml In Ampul 0 (empty) 0 (empty) 0 0
Sufenta 0.005 mg Inj Ampul 0 (empty) 0 (empty) 0 0
MST Continous 10 mg Tablet 0 (empty) 0 (empty) 0 0
Coditam 30 mg Tab Tablet 0 (empty) 0 (empty) 0 0
Coditam Tab. (Askes) Tablet 0 (empty) 0 (empty) 0 0
Durogesic Matrix 12,5 MU Ampul 0 (empty) 0 (empty) 0 0
Fentanyl Inj (Abbot) Vial 0 (empty) 0 (empty) 0 0
Morphin 20 mg Tablet 0 (empty) 0 (empty) 0 0
Sufenta 0.005 mg Inj (fort Ampul 0 (empty) 0 (empty) 0 0
Laporan Psikotropika Bulan Oktober 2015
Unit Layanan : PKM SUMBERMALANG
Data ini sudah diverifikasi oleh Kepala Puskesmas Sumbermalang : AMROZI, S.Kep.Ns.
Tanggal: 31 Oktober 2015
PEMASUKAN PENGGUNAAN
Saldo
Nama Satuan Saldo Akhir
Awal
Dari Jumlah Untuk Jumlah
Diazepam 10 ml Inj Ampul 241 - - 241
Diazepam 2 mg Tablet 1,159 0 1 1,158
Diazepam 5 mg Tablet 250 0 0 250
Luminal 60 mg/ml Inj Ampul 94 - - 94

gudang + UGD
DAFTAR OBAT YANG ADA
MARET 2009
I. TABLET / KAPSUL
No Nama Obat No Nama Obat No Nama Obat No
1 Acyclovir 200 mg 37 Doksisiklin 100 mg 73 Chloramphenicole 250 109

2 Acyclovir 400 mg 38 Domperidon 10 mg 74 Chlorpheniramine (CTM) 110
3 Albendazole tab 400 mg 39 Ekstrak Belladonna 75 Chlorpromazine 100mg (CPZ) 111
4 Alopurinol 100 40 Ephedrine 25 mg 76 Chlorpromazine 25mg (CPZ) 112
5 Alprazolam tab 0,5 mg 41 Erythromycine 250 77 Cotrimoxazole 480 113
6 Ambroxol 30 mg 42 Erythromycine 500 78 Cotrimoxazole paed 114
7 Aminophylline 200 43 Famotidin 20 mg 79 Linkomisin 500 mg 115
8 Amitriptillin 25 mg 44 Famotidin 40 mg 80 Loperamid 2 mg 116
9 Amoxicillin 250 45 Fenilbutason 200 mg 81 Mebendazole 100 117
10 Amoxicillin 500 46 Fenitoin Na 30 mg 82 Meloksikam 15 mg 118
11 Ampisillin 500 mg 47 Fenobarbital 30 83 Metformin 500 mg 119
12 Antalgin 500 48 Fenoxymethyl Penn. 250 84 Methylergometrin 0,125 mg 120
13 Antasida 49 Fenoxymethyl Penn. 500 85 Metilprednisolon 16 mg 121
14 Anti Malaria 50 Ferro Sulfat 300 mg 86 Metilprednisolon 8 mg 122
15 Anti Parkinson DOEN komb 51 Fluor tab 0,5 mg 87 Metoklopramid 10 mg 123
16 Antimigren (ergotamin-kofein) 52 Furosemide 40 mg 88 Metronidazole 250 124
17 Asam Mefenamat 500 53 Garam Oralit 89 Metronidazole 500 125
18 Asetosal 100 mg 54 GG (gliseril guaiacolat) 90 Na Diklofenak 25 mg 126
19 Asetosal 500 55 Glibenklamide 5 mg 91 Na Diklofenak 50 mg 127
20 Betahistin Mesilat 6 mg 56 Glimepiride 2 mg 92 Natrium Bikarbonat 500 128
21 Bisoprolol 5 mg 57 Griseofulvin 93 Nifedipin 10 mg
22 Captopril 12,5 58 Haloperidol 1,5 mg 94 Nilatika tab
23 Captopril 25 59 HCT (hidrochlortiazid) 95 Nistatin tab salut
24 Captopril 50 mg 60 Hyoscene-N- Butilbromide 96 Ofloxacin 200 mg
25 Cetirizine 10 mg 61 Ibuprofen 200 97 Ofloxacin 400 mg
26 Cimetidine 62 Ibuprofen 400 98 Omeprazol 20 mg
27 Ciprofloxacin 500 mg 63 Isoniazide 100 mg 99 Papaverin 40 mg
28 Clobazam 10 mg 64 Isosorbid dinitrat (ISDN) 100 Paracetamol 100 mg
29 Dexamethasone 65 Kalium Diklofenak 25 mg 101 Paracetamol 500
30 Dextromethorpan tab 66 Kalium Diklofenak 50 mg 102 Pirazinamid
31 Diaform 67 Kalk (calcium laktat) 103 Piroksikam 20 mg
32 Diazepam 2 68 Carbamazepin 200 mg 104 Prednisone
33 Diazepam 5 69 Ketokonazol tab 200 mg 105 Propanolol 40
34 Digoxin 0,25 mg 70 Kina (kuinin) 200 mg 106 Propiltiourasil 100 mg (PTU)
35 Diltiazem HCl 30 mg 71 Klindamisin 150 mg 107 Pyrantel 125
36 Dimenhydrinat 50 mg 72 Klindamisin 300 mg 108 Ranitidine 150 mg
II. SIRUP III. SALEP / TETES IV. INJEKSI / SUPPO
No Nama Obat No Nama Obat No Nama Obat
1 Ambroxol syr 15 mg/ml OBAT KULIT 1 Antihemorrhoid supp.

2 Amoxicillin syr 1 Acyclovir oint 2 Atropin Sulfat inj.
3 Ampisillin syr 2 Antibakteri DOEN salep 3 Benzatin Benzil Penisilin 1,2
4 Antasida syr 3 Antifungi DOEN salep 4 Benzatin Benzil Penisilin 2,4
5 Chloramphenikol syr 4 Betametasone oint 5 Chlorpromazine inj.
6 Cotrimoxazole syr 5 Gameksan emulsi 6 Dexamethasone inj.
7 Dextromethorpan syr 6 Gentamisin salep kulit 7 Diphenhydramine inj.
8 Erythromycine syr 7 Gentian Violet 8 Epinefrin inj.
9 Mebendazole syr 8 Gliserin 9 Fenitoin Na inj.
10 OBH syr 100 ml 9 Hydrocortisone oint 10 Fenobarbital inj.
11 Paracetamol syr 10 Ketokonazol krim 11 Lidocaine Comp. Inj.
12 Sanmol drop 11 Oxytetracycline salep kulit 12 Lidocaine Inj. 2%
13 Sefadroksil syr. 12 Polikresulen (Albothyl conc.) 13 Magnesium Sulfat Inj. 20%
13 Rivanol 14 Magnesium Sulfat serbuk inj.
14 Salep 2-4 15 Methylergometrin inj.
15 Salycil Bedak 2% 16 Metoklopramid inj.
16 Tetracyclin salep kulit (Erla) 17 Nistatin tab vaginal 100.000 IU
18 Novalgin inj
TETES / SALEP MATA 19 Oksitosin inj.
1 Atropin Sulfat tetes mata 20 Oxytetracycline inj.
2 Chloramphenikol Salep Mata 21 Papaverin inj.
3 Chloramphenikol Tetes mata 22 Primperan inj.
4 Gentamisin Sulfat tetes mata 23 Prokain Benzil Penisilin G. 3 jt
5 Na Fluorosein Tetes Mata 24 Ranitidine inj.
6 Oxytetracycline Salep Mata 25 Viccilin inj.
7 Pilokarpin HCL tetes mata 26 Vit.B1 inj.
9 Sulfasetamid Na Tetes Mata 27 Vit.B12 inj. (cyanocobalamin)
10 Tetrakain tetes mata 28 Vit.K inj.
TETES TELINGA
1 Chloramphenicole 3% ear drop
2 Fenol Glycerol tetes telinga
Nama Obat
Reserpin 0,1
Reserpin 0,25
Salbutamol 2 mg
Salbutamol 4 mg
Sefadroksil 500 mg
Simvastatin
Sulfadimidin 500 mg
Terbutalin 2,5 mg
Tetracycline 250
Tetracycline 500
Tramadol 50 mg
Triheksifenidil 2 mg
Vit. C 100 mg
Vit. C 250 mg
Vit.B Complex
Vit.B1 50 mg
Vit.B12 tab. (cyanocobalamin)
Vit.B6 (pyridoxine)
Vit.C 50 mg
Vit.K (phytomenadione)
DAFTAR EXPIRED DATE
TGL
No SAT KET
BLN THN
1 Abbocath no 18 set
5 Acyclovir 200 mg tab SEP 20 16
6 Acyclovir 400 mg tab 20
7 Acyclovir oint tube 20
8 Alat Suntik sekali pakai 1 ml set 20
9 Alat Suntik sekali pakai 2,5 ml set MEI 20 16
12 Albendazole tab 400 mg tab 20
13 Alkohol 70% 1000 ml btl 20
14 Alkohol 95% 300 ml btl 20
15 Alopurinol 100 tab 20
16 Alprazolam tab 0,5 mg tab 20
17 Ambroxol 30 mg tab 20
18 Ambroxol syr 15 mg/ml btl 20
19 Aminophylline 200 tab 4 20 14
20 Aminophylline inj. amp 20
21 Amitriptillin 25 mg tab 20
22 Amoxicillin 250 kaps 7 20 15
23 Amoxicillin 500 tab 7 20 15
24 Amoxicillin serbuk inj. vial 20
25 Amoxicillin syr btl 10 20 15
26 Ampisillin 500 mg tab 20
27 Ampisillin serbuk inj. vial 20
28 Ampisillin syr btl 20
29 Antalgin 500 tab 12 20 16
30 Antalgin inj. amp 20
31 Antasida tab 11 20 15
32 Antasida syr btl 20
33 Anti Malaria tab 20
34 Anti Parkinson DOEN komb tab 20
35 Antibakteri DOEN salep tube 12 20 15
36 Antifungi DOEN salep tube 11 20 15
37 Antihemorrhoid supp. supp 11 20 15
38 Antimigren (ergotamin-kofein) tab 20
39 Aqua Pro inj. vial 6 20 16
40 AS infus btl 20
41 Asam Mefenamat 500 tab 9 20 16
42 Asetosal 100 mg tab 20
43 Asetosal 500 tab 20
44 Atropin Sulfat inj. amp 20
45 Atropin Sulfat tetes mata btl 20
46 Benzatin Benzil Penisilin 1,2 amp 20
47 Benzatin Benzil Penisilin 2,4 amp 20
48 Betahistin Mesilat 6 mg tab 20
49 Betametasone oint tube 10 20 14
50 Bisoprolol 5 mg tab 20
51 Captopril 12,5 tab 11 20 16
52 Captopril 25 tab 7 20 16
53 Captopril 50 mg tab 20
54 Carbamazepin 200 mg tab 20
55 Catgut set 20
56 Cetirizine 10 mg tab 20
57 Chloramphenicole 250 kaps 8 20 16
58 Chloramphenikol Salep Mata tube 20
59 Chloramphenikol Tetes Telinga btl 5 20 13
60 Chloramphenikol syr btl 20
61 Chloramphenikol Tetes mata btl 4 20 13
62 Chlorin (1,5 l) btl 20
63 Chlorpheniramine (CTM) tab 12 20 15
64 Chlorpromazine 25mg (CPZ) tab 20
65 Chlorpromazine 100mg (CPZ) tab 20
66 Chlorpromazine inj. amp 20
67 Cimetidine tab 7 20 15
20
20
No Nama Obat SAT
20
68 Ciprofloxacin 500 mg tab 9 20 15
69 Clobazam 10 mg tab 20
70 Cotrimoxazole paed 120mg tab 20
71 Cotrimoxazole syr btl 11 20 15
72 Cotrimoxazole 480mg tab 8 20 16
73 Dekstran 70 lar.infus 6% btl 20
74 Devitalisasi Pasta (NonArsen) btl 20
75 Dexamethasone tab 12 20 14
76 Dexamethasone inj. amp 5 20 14
77 Dextromethorpan syr btl 11 20 15
78 Dextromethorpan tab tab 20
79 Diaform tab 20
80 Diazepam 2 tab 20
81 Diazepam 5 tab 20
82 Diazepam inj. amp 20
83 Digoxin 0,25 mg tab 20
84 Diltiazem HCl 30 mg tab 20
85 Dimenhydrinat 50 mg tab 20
86 Diphenhydramine inj. amp 7 20 15
87 Doksisiklin 100 mg tab 20
88 Domperidon 10 mg tab 20
89 Ekstrak Belladonna tab 20
90 Ephedrine 25 mg tab 20
91 Epinefrin inj. amp 20
92 Erythromycine 250 kaps 20
93 Erythromycine 500 tab 20
94 Erythromycine syr btl 20
95 Ethyl Chloride spray btl 20
96 Eugenol Cairan gigi btl 20
97 Famotidin 20 mg tab 20
98 Famotidin 40 mg tab 20
99 Fenilbutason 200 mg tab 20
100 Fenitoin Na 30 mg tab 20
101 Fenitoin Na inj. amp 20
102 Fenobarbital 30 tab 20
103 Fenobarbital inj. amp 20
104 Fenol Glycerol tetes telinga btl 9 20 14
105 Fenoxymethyl Penn. 250 tab 20
106 Fenoxymethyl Penn. 500 tab 20
107 Ferro Sulfat 300 mg tab 20
108 Fluor tab 0,5 mg tab 20
109 Furosemide 40 mg tab 10 20 15
110 Furosemide inj. amp 20
111 Gameksan emulsi btl 20
112 Garam Oralit sase 8 20 14
113 Gemfibrozil 300 mg tab 20
114 Gentamisin inj amp 20
115 Gentamisin salep kulit tube 2 20 15
116 Gentamisin Sulfat tetes mata btl 20
117 Gentian Violet btl 9 20 15
118 GG (gliseril guaiacolat) tab 11 20 15
119 Glass Ionomer Cement (GC IX) btl 20
120 Glibenklamide 5 mg tab 8 20 14
121 Glimepiride 2 mg tab 20
122 Glipizid 5 mg tab 20
123 Gliquidon 30 mg tab 20
124 Gliserin btl 20
125 Glukosa 10 % btl 20
126 Glukosa 40 % btl 20
127 Glukosa 5 % btl 7 20 16
128 Griseofulvin tab 12 20 16
129 Haloperidol 1,5 mg tab 20
130 HCT (hidrochlortiazid) tab 7 20 16
131 Hibiscrub btl 20
132 Hydrocortisone oint tube 8 20 13
133 Hyoscene-N- Butilbromide tab 20
136 Infus Set Anak (Paed) set 20
137 Infus Set Dewasa (Adult) set 20
138 Isoniazide 300 mg tab 20
139 Isosorbid dinitrat (ISDN) tab 1 20 15
140 Kalium Diklofenak 25 mg tab 20
141 Kalium Diklofenak 50 mg tab 20
20
20
No Nama Obat SAT
20
142 Kalium Permanganat serbuk btl 20
143 Kalk (calcium laktat) tab 6 20 16
144 Kapas Berlemak rol 20
145 Kapas Pembalut 250 gr rol 8 20 15
146 Kasa Kompres 40/40 rol 20
147 Kasa Pembalut 2 x 80 rol 20
148 Kasa Pembalut 4m x 15cm rol 20
149 Kasa Pembalut 4m x 3cm rol 20
150 Kasa Steril Kotak ktk 20
151 Ketokonazol krim tube 20
152 Ketokonazol tab 200 mg tab 20
153 Ketoprofen 100 mg tab 20
154 Ketoprofen inj. amp 20
155 Ketorolac inj. 10 mg amp 20
156 Kina (kuinin) 200 mg tab 20
157 Klindamisin 150 mg kaps 20
158 Klindamisin 300 mg kaps 20
159 Klonidin 0,15 mg tab 20
160 Kreolin btl 20
161 Lidocaine Comp. Inj. amp 20
162 Lidocaine Inj. 2% amp 7 20 15
163 Linkomisin 500 mg tab 20
164 Lisol btl 20
165 Loperamid 2 mg tab 20
166 Magnesium Sulfat Inj. 20% amp 9 20 16
167 Magnesium Sulfat serbuk inj. vial 20
168 Masker set 20
169 Mebendazole syr btl 20
170 Mebendazole tab 100mg tab 20
171 Meloksikam 15 mg tab 20
172 Metanol btl 20
173 Metformin 500 mg tab 20
174 Methylergometrin 0,125 mg tab 20
175 Methylergometrin inj. amp 2 20 15
176 Metilprednisolon 8 mg tab 20
177 Metoklopramid 10 mg tab 20
178 Metilprednisolon 16 mg tab 20
179 Metoklopramid inj. amp 20
180 Metronidazole 250 tab 7 20 15
181 Metronidazole 500 tab 11 20 15
182 Monoklorkamfer Mentol Cairan btl 20
183 Na Diklofenak 25 mg tab 20
184 Na Diklofenak 50 mg tab 9 20 16
185 Na Fluorosein Tetes Mata btl 20
186 Na Thiosulfat inj. amp 20
187 NaCl infus btl 6 20 16
188 Natrium Bikarbonat 500 tab 20
189 Nifedipin 10 mg tab 20
190 Nilatika tab tab 20
191 Nistatin tab vaginal 100.000 IU tab 20
192 Nistatin tab salut tab 20
193 Novalgin inj amp 20
194 OBH syr 100 ml btl 4 20 15
195 OBH syr 200 ml btl 20
196 Ofloxacin 200 mg tab 20
197 Ofloxacin 400 mg tab 20
198 Oksitosin inj. amp 20
199 Omeprazol 20 mg tab 20
200 Oxytetracycline inj. vial 20
201 Oxytetracycline salep kulit tube 20
202 Oxytetracycline Salep Mata tube 11 20 15
203 Papaverin 40 mg tab 10 20 15
204 Papaverin inj. amp 20
205 Paracetamol syr btl 11 20 15
206 Paracetamol 100 mg tab 10 20 15
207 Paracetamol 500 tab 10 20 15
208 Pembalut Gips (Medicrepe) rol 20
209 Pilokarpin HCL tetes mata btl 20
210 Piracetam 400 mg tab 20
213 Piracetam inj. amp 20
20
20
No Nama Obat SAT
20
214 Pirazinamid tab 20
215 Piroksikam 20 mg tab 10 20 15
216 Plester 5cm x 4,5m (isoplast) rol 7 20 14
217 Polikresulen (Albothyl conc.) btl 20
218 Prednisone tab 11 20 15
219 Primperan inj. amp 20
220 Prokain Benzil Penisilin G. 3 jt vial 20
221 Propanolol 40 tab 20
222 Propiltiourasil 100 mg (PTU) tab 20
223 Pyrantel 125 tab 20
224 Ranitidine 150 mg tab 2 20 14
225 Ranitidine inj. amp 20
226 Reserpin 0,1 tab 20
227 Reserpin 0,25 tab 20
228 Rivanol btl 9 20 14
229 RL infus btl 8 20 16
230 Salbutamol 2 mg tab 20
231 Salbutamol 4 mg tab 20
232 Salep 2-4 btl 11 20 16
233 Salycil Bedak 2% ktk 10 20 16
234 Sanmol drop btl 20
235 Sarung Tangan Steril set 20
236 Sefadroksil 500 mg tab 20
237 Sefadroksil syr. btl 20
238 Semen seng Fosfat btl 20
239 Serum ABU I (anti bisa ular ) amp 20
240 Serum ATS inj. 1500 IU/amp amp 20
241 Silk (Benang Bedah sutera) set 9 20 15
242 Simvastatin tab 20
243 Spironolakton 100 mg tab 20
244 Spironolakton 25 mg tab 20
245 Spons Gelatin Cubicles 1x1x1 cm ktk 20
246 Streptomisin inj. Serbuk vial 20
247 Sulfadimidin 500 mg tab 20
248 Sulfasetamid Na Tetes Mata btl 20
249 Surflo IV Catheter set 20
250 Temporary Stopping Fletcher btl 20
251 Terbutalin 2,5 mg tab 20
252 Tetracyclin salep kulit (Erla) tube 20
253 Tetracycline 250 kaps 11 20 15
254 Tetracycline 500 kaps 11 20 15
255 Tetrakain tetes mata btl 20
256 Tramadol 50 mg tab 20
257 Triheksifenidil 2 mg tab 20
258 Urine Bag set 20
259 Urocare set 20
260 Viccilin inj. vial 20
261 Vit.B Complex tab 10 20 14
262 Vit.B1 inj. amp 20
263 Vit.B1 50 mg tab 10 20 15
264 Vit.B12 inj. (cyanocobalamin) amp 9 20 16
265 Vit.B12 tab. (cyanocobalamin) tab 20
266 Vit.B6 (pyridoxine) tab 9 20 16
267 Vit.C 100 mg tab 20
268 Vit.C 250 mg tab 20
269 Vit.C 50 mg tab 10 20 14
270 Vit.K (phytomenadione) tab 10 20 15
271 Vit.K inj. amp 7 20 14
272 Wing Needle set 20
273 Yodium Povidon 30 ml btl 10 20 14
274 Yodium Povidon 60 ml btl 20
275 Yodium Povidon 300 ml btl 11 20 14
276 Yodium Povidon 1000 ml btl 20
277 Zinc Tablet Diare tab 12 20 13
278 Pamol 500 mg tab (box) tab 20
279 Bioplacenton tube 20
280 New Diatabs ktk 20
281 Balsem pot 20
282 Obat Sakit Kepala strip 20
283 Obat Flu strip 20
284 Obat Penurun Panas strip 20
285 Obat Batuk Cair strip 20
286 Obat Asma strip 20
20
20
No Nama Obat SAT
20
287 Obat Batuk dan Flu strip 20
288 Obat Cacing strip 20
289 Obat Penurun Panas Anak strip 20
290 Obat Cacing Anak sase 20
291 Obat Batuk Berdahak strip 20
292 Obat Tab. Tambah Darah strip 20
293 Obat Maag strip 20
294 Loratadin tab 20
295 Rifampisin 600 mg kaps 20
296 Cefriaxone inj. 1 g vial 20
297 Cefotaxime inj. 1 g vial 20
298 Clarithromicin 500 mg tab 20
299 Haloperidol 1,5 mg tab 20
300 Tetrasiklin Salep Mata Tube 20
301 Kalsium Hidroksida Pasta ktk 20
302 Mummifying Pasta btl 20
303 Tiamfenicol 500mg tab 20
304 Kasa Pembalut elastis 3in/4in rol 20
DPCache_Psikotropika
Nama Satuan Saldo Awal PEMASUKAN PEMASUKAN PENGGUNAAN
PENGGUNAAN
Alganax 0.2 Tablet 0 0 0
Alganax 0.5 Tablet 0 0 0
Alganax 1 m Tablet 0 0 0
Alprazolam Tablet 0 0 0
Alviz 0.25 m Tablet 0 0 0
Alviz 0.5 mg Tablet 0 0 0
Alviz 1 mg Tablet 0 0 0
Analsik Tab Tablet 0 0 0
Apisate Tab Tablet 0 0 0
Asabium 10 Tablet 0 0 0
Atarax 0.25 Tablet 0 0 0
Atarax 0.5 m Tablet 0 0 0
Ativan 0.5 m Tablet 0 0 0
Ativan 1 mg Tablet 0 0 0
Ativan 2 mg Tablet 0 0 0
Bellaphen Ta Tablet 0 0 0
Braxidin Tab Tablet 0 0 0
Calmlet 0.2 Tablet 0 0 0
Calmlet 0.5 Tablet 0 0 0
Calmlet 1 m Tablet 0 0 0
Calmlet 2 m Tablet 0 0 0
CeTabrium 1 Tablet 0 0 0
CeTabrium 5 Tablet 0 0 0
Cetalgin Tablet 0 0 0
Cliad Tablet 0 0 0
Clobazam 1 Tablet 0 0 0
Danalgin Tab Tablet 0 0 0
Decazepam Tablet 0 0 0
Diazepam 10 Ampul 303 GFK 28 0
Diazepam 2 Tablet 1994 GFK 100 0
Diazepam 5 Tablet 500 s 0 0
Diobrium 10 Kapsul 0 0 0
Diobrium 5 Kapsul 0 0 0
Ditalin Tab Tablet 0 0 0
Dormicum 15 Ampul 0 0 0
Dormicum 5 Ampul 0 0 0
Dumolid 5 m Tablet 0 0 0
Esilgan 1 mg Tablet 0 0 0
Esligan 2 mg Tablet 0 0 0
Fortanest 1 Ampul 0 0 0
Fortanest 5 Ampul 0 0 0
Frisium 10 m Tablet 0 0 0
Frixitas 0.25 Tablet 0 0 0
Frixitas 0.5 Tablet 0 0 0
Frixitas 1 mg Ampul 0 0 0
Hedix Tablet 0 0 0
Page 253
Klidibrax Tablet 0 0 0
Lexotan 1.5 Tablet 0 0 0
Lexotan 3 m Tablet 0 0 0
Librax Tablet 0 0 0
Luminal 100 Tablet 0 0 0
Melidox Tablet 0 0 0
Mentalium 1 Tablet 0 0 0
Merlopam 0. Tablet 0 0 0
Merlopam 2 Tablet 0 0 0
Metaneuron Tablet 0 0 0
Midazolam 1 Ampul 0 0 0
Midazolam 5 Ampul 0 0 0
Miloz 15 mg/ Ampul 0 0 0
Miloz 5 mg/ 5 Ampul 0 0 0
Neo Protal T Tablet 0 0 0
Neoroval Tablet 0 0 0
Neurodial 5 Tablet 0 0 0
Neurogen Ta Tablet 0 0 0
Neuropyron Tablet 0 0 0
Luminal 30 Tablet 4000 s 0 0
Luminal 50 Tablet 0 0 0
Luminal 60 m Ampul 90 s 0 0
Piptal Pet dr Botol 0 0 0
Proclozam 1 Tablet 0 0 0
Proneuron Tablet 0 0 0
Prozepam 2 Tablet 0 0 0
Prozepam 5 Tablet 0 0 0
Renagas 6 m Tablet 0 0 0
Renaquil 1 Tablet 0 0 0
Ritalin 10 mg Tablet 0 0 0
Ritalin LA 2 Tablet 0 0 0
Rivotril 2 mg Tablet 0 0 0
Sedacum inj Ampul 0 0 0
Sibital Inj Ampul 0 0 0
Spasmium 5 Tablet 0 0 0
Stesolid 2 m Tablet 0 0 0
Stesolid 5 m Tablet 0 0 0
Stesolid Inj. Ampul 0 0 0
Stesolid rec Tube 0 0 0
Stesolid rec Tube 0 0 0
Stesolid Syr Botol 0 0 0
Teronac Tab Tablet 0 0 0
Trazep Rect Tube 0 0 0
Valdimex 10 Ampul 0 0 0
Valdimex 5 Tablet 0 0 0
Valium 10 m Tablet 0 0 0
Valium 10 mgAmpul 0 0 0
Page 254
Valium 2 mg Tablet 0 0 0
Valium 5 mg Tablet 0 0 0
Valizanbe 2 Tablet 0 0 0
Valizanbe 5 Tablet 0 0 0
Xanax 0.25 Tablet 0 0 0
Xanax 0.5 m Tablet 0 0 0
Xanax 1 mg Tablet 0 0 0
Yekalgin Kap Kaplet 0 0 0
Zolastin 1 m Tablet 0 0 0
Zolmia 10 m Tablet 0 0 0
Zyparon Tablet 0 0 0
Zypraz 0.25 Tablet 0 0 0
Zypraz 0.5 Tablet 0 0 0
Zypraz 1 mg Tablet 0 0 0
Hufralgin Tablet 0 0 0
Lexotan 6 m Tablet 0 0 0
Librium 5mg Tablet 0 0 0
Librium 10 mTablet 0 0 0
Limbritol Tablet 0 0 0
Omegastri Tablet 0 0 0
Pehaspas Tablet 0 0 0
Ritalin 30 m Tablet 0 0 0
Ritalin 40 m Tablet 0 0 0
Ritalin SR 2 Tablet 0 0 0
Riklona 2 mgTablet 0 0 0
Soxietas 0.5 Tablet 0 0 0
Stilnox Tablet 0 0 0
Tranquam 5 Tablet 0 0 0
Unagen wit Tablet 0 0 0
Page 255
Saldo Akhir
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
331
2094
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 256
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4000
0
90
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
Page 257
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
Page 258
DPCache_Narkotika
Nama Satuan Saldo Awal PEMASUKAN PEMASUKAN PENGGUNAAN
PENGGUNAAN
Codein 10 m Tablet 0 0 0
Codein Pulvi mg 0 0 0
Codipront C Kapsul 0 0 0
Codipront C Kapsul 0 0 0
Codipront C Botol 0 0 0
Codipront Sy Botol 0 0 0
Doveri 100 m Tablet 0 0 0
Doveri Pulvis mg 0 0 0
Durogesic 2 Ampul 0 0 0
Durogesic 5 Ampul 0 0 0
Fentanyl 0.0 Ampul 0 0 0
Fentanyl 0.5 Ampul 0 0 0
Morphine HClAmpul 0 0 0
Morphine Sy Botol 0 0 0
MST Contin Tablet 0 0 0
Pethidine HC Ampul 0 0 0
Sufenta 0.00 Ampul 0 0 0
Coditam 30 Tablet 0 0 0
Coditam Tab.Tablet 0 0 0
Durogesic M Ampul 0 0 0
Fentanyl Inj Vial 0 0 0
Morphin 20 Tablet 0 0 0
Sufenta 0.005Ampul 0 0 0
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DPCache_Narkotika
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Oktober - Betul

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Laporan Obat Kegiatan Ambugelu

Nopember 2015 di Alun-alun Besuki

Penanggung Jawab Ambugelu

1 Alat Suntik sekali pakai 2,5 ml set 370 #VALUE! 170

42 Lidocaine Comp. Inj. amp 29 #VALUE! 29

Sumbermalang, 21 Oktober 2015

Kepala UPTD Puskesmas Sumbermalang

1 Acyclovir 400 tab 100 100

2 Allopurinol 400 tab 100 100

3 Ambroxol tab 100 100

5 Amoxicillin 500 mg tab 163 163

6 Antalgin 500 tab 200 200

7 Antasida tab 186 186

8 Asam Mefenamat 500 tab 200 200

10 Captopril 25 tab 165 165

11 Cimetidin tab 120 120

12 CTM tab 200 200

13 Diphenhydramin inj amp 30 30

14 Epinefrin inj. amp - -

15 GG (gliseril guaiacolat) tab 450 450

Penanggung Jawab Kegiatan

Keterangan : '- Kegiatan dilaksanakan pada :

Ke BP/ KIA / BPG / Laborat / Expired / Kembali ke

27 Antasida DOEN I tablet kunyah, kombinasi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab -

900 66 66 1,266 - - - - 1,266

100 - 100 - - - - 100

300 - 300 - - - - 300

1,000 - 320 680 - - - 1,000

100 - 100 - - - - 100

SALDO AWAL MUTASI MASUK MUTASI KELUAR SALDO

4,164 Tab 96.80 403,075 - tab - 4,164 tab

MENGETAHUI Sumbermalang, 31 Oktober 2015

A M R O Z I, S.Kep.Ns JONI HARDIANTO

2,516.00 1,356,124 - 1,356,124 1 1 2

1,904.00 287,504 - 287,504 1 1 2

2,450.00 147,000 - 147,000 1 1 2

4,700.00 5,118,300 - 5,118,300 1 1 2

17.39 19,129 - 19,129 1 1 2

17.39 19,129 - 19,129 1 1 2

96.80 403,075 - 403,075 1 1 2

137,500.00 412,500 - 412,500 1 1 2

255.00 1,131,180 - 1,131,180 1 1 2

5,800.00 313,200 - 313,200 1 1 2

33,000.00 2,343,000 - 2,343,000 1 1 2

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - - - - - - - - - - - - - - - - -

Stok Peneri Pema Stok

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

Antasida DOEN II suspensi, kombi : Aluminium

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

Penanggung Jawab Apotek

Stok Peneri Pema Stok

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

Penanggung Jawab UGD & Rawat Inap

D OBAT & PERBEKALAN KESEHATAN TAMBAHAN -

Alas Sumb Tama

28 Anti Malaria tab -

29 Anti Parkinson DOEN komb tab -

30 Antibakteri DOEN salep tube 11 11