Nomor :

Tanggal :
Bulan :

Harga Satuan Harga Satuan Stok Awal

No Nama Obat Satuan

2017 2018 Jumlah

1 2 3 4 5 6
1 Acetyl Cysteine 200 mg Kapsul - 358.00
2 Alat Suntik Sekali Pakai 0.5 ml Pcs 1,249.45 -
3 Alat Suntik Sekali Pakai 1 ml Pcs 990.00 653.41
4 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah - 1,382.37
5 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah 3,600.00 941.48
6 Alat Suntik Sekali Pakai 2,5 ml Pcs 652.51 -
7 Alat Suntik Sekali Pakai 20 ml Buah - 1,478.28
8 Alat Suntik Sekali Pakai 3 ml Pcs 792.00 792.00
9 Alat Suntik Sekali Pakai 5 ml Pcs 979.00 784.09
10 Albendazol 400 mg Tablet - 403.00
11 Alkohol Swab ( PT. Bio Axion Healthindo) Sase - 116.04
12 Alkohol Swab CHG + 0,5 % (e-care) Pcs 196.80 196.80
13 Alopurinol tablet 100 mg Tablet 89.00 99.00
14 Alopurinol tablet 300 mg Tablet 210.00 -
15 Ambroxol Sirup Botol 3,900.00 3,970.00
16 Ambroxol Tablet 30 mg Tablet 148.50 -
17 Aminofilin Inj 24 mg/ml-10 ml Ampul 3,345.00 2,789.00
18 Aminofilin Tablet 200 mg Tablet 91.00 89.00
19 Aminofluid Botol 64,990.00 -
20 Amitriptilina HCl tablet salut 25 mg Tablet 112.00 167.00
21 Amlodipin tablet 10 mg Tablet 104.00 93.00
22 Amlodipin tablet 5 mg Tablet 85.00 70.00
23 Amoksilin 500 mg Kaplet 190.00 233.00
24 Amoksilin Kapsul 250 mg Kapsul 195.00 184.00
25 Amoksilin sirup kering 125 mg/5ml Botol 1,881.00 -
26 Amoksilin sirup kering forte 250 mg/5ml Botol 3,984.00 3,400.00
27 Ampisilin 1 gr inj Ampul 9,176.00 8,237.00
28 Ampisilin Kaplet 500 mg Kaplet 362.00 570.00
29 Ampisilin Kaplet 500 mg Kaplet 597.00 570.00
30 Ampisilin Serbuk Injeksi Vial - 8,237.00
31 Antalgin(Metampiron) Tablet 500 mg Tablet 242.00 218.50
32 Antasida DOEN I tablet kombinasi Tablet 58.00 54.00
33 Antasida DOEN II suspensi kombinasi Botol 1,923.00 1,995.00
34 Anti hemoroid suppositorida Supp 4,950.00 3,167.00
35 Antifungi DOEN kombinasi : Pot 4,323.00 4,496.00
36 Antimigren DOEN/Ergotamin kafein Tablet 135.00 173.00
37 Antiseptik Hand Rub 5 lt Galon 145,000.00 -
38 Antiseptik Hand Rub 500 ml Botol 60,800.00 -
39 Antiseptik Surgical Hand Scrub 5 lt Galon 160,200.00 -
40 Antiseptik Surgical Hand Scrub 500 ml Botol 74,000.00 -
41 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul 2,302.00 2,295.00
42 Aquadest steril -500 ml Botol 24,000.00 24,200.00
43 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 104.00 105.00
44 Asam folat tablet 0,4 mg Tablet 55.00 52.00
45 Asam Mefenamat 500 mg Tablet 100.00 103.00
46 Asering Botol 9,275.00 9,646.00
47 Asetosal tablet 80 mg Tablet 92.00 -
48 Asiklovir cr Tube 3,110.00 3,140.00
49 Asiklovir tab 200 mg Tablet 240.00 -
50 Asiklovir tab 400 mg Tablet 365.00 380.00
51 Atapulgit Tablet 142.00 136.00
52 Atorvastatin 10 mg Tablet 10,890.00 1,100.00
53 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 1,672.00 -
54 Azitromisin 500 mg Kaplet 1,888.00 -
55 Bedak Salisil serbuk 2 % Buah 1,025.00 2,400.00
56 Benzatin benzil penisilin 1,2 juta IU/Vial Vial 14,500.00 -
57 Betametason Krim 0.1 % Tube 1,349.00 1,340.00
58 Bisturi no 10 Buah 767.00 -
59 Bloodseet Buah 13,420.00 -
60 Camabion Tablet 355.00 -
61 Carpul (Articain & Adrenalin) Ampul 10,914.00 -
62 Catgut Chromic 2/0 100 m Roll 940,554.00 -
63 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Roll 22,500.00 22,500.00
64 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll 22,500.00 22,500.00
65 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll 30,500.00 -
66 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll 29,583.33 -
Catgut/Benang Bedah No.2/0-3/0 dg jarum
67 Roll 24,500.00
bedah -
68 Cefiksim 100 mg Kapsul 750.00 803.00
69 Cetirizine Kapsul 96.00 90.00
70 Citoject Pcs 909,900.00 -
71 Clorofenol (CHKM) Ples 115,700.00 -
72 Deksametason inj 5 mg/ml-1 ml Ampul 1,500.00 1,097.00
73 Deksametason Tablet 0,5 mg Tablet 41.00 32.00
74 Devitalisasi Pasta (Non arsen) Botol 816,700.00 -
75 Difenhidramin inj 10 mg/ml Ampul 1,060.00 1,095.00
76 Digoksin tablet 0,25 mg Tablet 104.00 104.00
77 Dimenhidrinat tablet 50 mg Tablet 99.00 -
78 Doksisiklin 100 mg Kapsul 268.00 -
79 Domperidon Syrup Botol 3,000.00 2,700.00
80 Domperidon tablet 10 mg Tablet 95.00 85.00
81 Ekstrak Belladona tablet 10 mg Tablet 38.00 -
82 Eosin 2% 1x100 ml Botol - 179,595.00
83 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul 1,749.00 1,408.00
84 Eritromisin 250 mg Tablet 557.00 546.00
85 Eritromisin 500 mg Tablet 730.00 750.00
86 Eritromisin sirup kering 200 mg/5 ml Botol 6,700.00 6,090.00
87 Etambutol Hcl tablet 250 mg Tablet 314.00 366.00
88 Etambutol Hcl Tablet 500 mg Tablet 451.00 -
89 Etanol 70 %- 100 ml Botol 2,500.00 -
90 Etanol 70% - 1 L Botol 21,500.00 25,000.00
91 Etil Klorida semprot-100 ml Botol 124,900.00 -
92 Eugenol Cairan Botol 102,000.00 18,824.00
93 Female Catheter no 16 Pcs 5,720.00 -
94 Female Catheter no 18 Pcs 5,720.00 -
95 Fenitoin Kapsul100 mg Kapsul 152.00 -
96 Fenoksimetil Penisilin tablet 250 mg Tablet 350.00 -
97 Fenoksimetil Penisilin tablet 500 mg Tablet 605.00 -
98 Fenol Gliserol Tetes telinga 10 % Botol 1,008.33 -
99 Film IV Dressing 6x7 P Pcs 2,200.00 -
100 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul 1,566.00 -
101 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 3,550.00 3,682.00
102 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet 686.00 710.00
103 Fluconazol 150 mg kapsul 18,000.00 18,720.00
104 Folley Cathether 2 way no 20 Pcs 8,000.00 -
105 Folley Cathether no 16 Pcs 11,000.00 -
106 Folley Cathether no 18 Pcs 11,000.00 -
107 Furosemid tablet 40 mg Tablet 72.00 77.00
108 Garam Oralit 200 ml air Sachet 260.00 260.00
109 Gentamisin Inj 40 mg/ml Vial 3,386.00 3,509.00
110 Gentamycin Salep Kulit Tube 3,040.00 3,550.00
111 Gentamycin Salep Mata Tube 2,960.00 2,675.00
112 Gentamycin Tetes Mata Tube 4,170.00 4,232.00
113 Gentian violet larutan 1 %-10 ml Botol 3,000.00 -
114 Glas Lonomer Cement Set 480,840.00 -
115 Glibenklamid tablet 5 mg Tablet 100.00 119.00
116 Glimepiride tablet 1 mg Tablet 194.00 -
117 Gliseril Gyayakolat tablet 100 mg Tablet 118.80 118.00
118 Glukosa Larutan infus 10% steril-500 ml Botol 5,700.00 -
119 Glukosa Larutan infus 5% steril-500 ml Botol 5,200.00 -
120 Griseofulvin tablet 125 mg micronized Tablet 247.00 210.00
121 Haloperidol Injeksi (Lodomer) Ampul 6,250.00 -
122 Haloperidol tablet 0,5 mg Tablet 56.00 55.00
123 Haloperidol tablet 1,5 mg Tablet 61.00 59.00
124 Haloperidol tablet 2 mg Tablet 126.00 84.00
125 Haloperidol tablet 5 mg Tablet 69.00 56.00
126 Hansaplast 2,5 cm x 4,5 m Roll 11,334.00 -
127 Hansaplast 7,5 cm x 4,5 m Roll 31,265.00 -
128 Hidrogen Peroksida 3% (H2O2) Botol 23,931.00 -
129 Hidroklortiazid (HCT) tablet 25 mg Tablet 149.00 155.00
130 Hidrokortison krim 2,5 % Tube 2,639.00 2,475.00
131 Ibuprofen sirup 100 mg/5 ml Botol 2,475.00 2,365.00
132 Ibuprofen tablet 200 mg Tablet 102.00 105.00
133 Ibuprofen tablet 400 mg Tablet 111.00 -
134 Infusion set anak Set 4,000.00 6,273.00
135 Infusion set dewasa Set 6,435.00 6,435.00
136 Isoniazida ( INH ) tablet 300 mg Tablet 170.00 173.00
137 Isosorbit 5 mg Tablet 90.00 89.00
138 IV Cateter 18 Buah 10,494.00 10,494.00
139 IV Cateter 20 Buah 10,494.00 10,494.00
140 IV Cateter 22 Buah 10,494.00 10,494.00
141 IV Cateter 24 Buah 10,494.00 10,494.00
142 IV Cateter no 26 wings & port Buah 6,600.00 -
143 IV Cateter with injection port 26 G Buah 16,346.00 13,200.00
144 Jarum Citojek No 16 Pcs 2,093.00 -
145 Jarum Jahit kulit No.12 Pcs 2,283.33 -
146 Jarum Jahit Otot No.12 Pcs 2,283.33 -
147 Kalium Permanganat Pot 8,700.00 -
148 Kalsium Glukonat injeksi i.v 10 % Ampul 9,955.00 10,351.00
149 Kalsium Hidroksida Pasta Set 290,000.00 -
150 Kalsium laktat (Kalk) tablet 500 mg Tablet 56.00 59.00
151 Kapas pembalut/absorben 250 mg Buah 12,500.00 12,500.00
152 Kaptropil 12,5 mg Tablet 62.00 -
153 Kaptropil 25 mg Tablet 80.00 -
154 Karbamazepin tablet 200 mg Tablet 270.00 230.00
155 Karbogliserin Tetes Telinga Botol 2,500.00 2,590.00
156 Kasa hidrofil 36 m x 80 cm Roll 55,000.00 106,605.00
157 Kasa hidrofile 3 yard x 10 cm Buah - 1,380.00
158 Kasa hidrofile 40 yard x 80 cm Roll - 123,000.00
159 Kasa kompres 16x16 steril Buah 362.50 500.00
160 Kasa pembalut hidrofil 4 m x 10 cm Roll 606.00 1,493.50
161 Ketokonazol 200 mg Tablet 280.00 270.00
162 Ketokonazol Krim 2% Tube 2,595.00 2,518.00
163 Klindamisin 300 mg Tablet 578.00 -
164 Kloramfenikol kapsul 250 mg Kapsul 649.05 310.00
165 Kloramfenikol salep kulit 2 % Tube 3,091.00 3,038.00
166 Kloramfenikol salep mata 1 % Tube 1,810.00 1,881.00
167 Kloramfenikol susp 125 ml Botol 4,700.00 4,700.00
168 Kloramfenikol tetes telinga 3 % Ples 8,910.00 7,700.00
169 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 37.00 22.00
170 Klorine Botol 24,000.00 -
171 Klorpromazin 100 MG Tablet 144.00 147.00
172 Klorpromazin 25 mg Tablet 148.00 -
173 Klorpromazin injeksi 5 mg/ml-2ml Ampul 1,050.00 -
174 Kotrimoksazol anak Tablet 76.00 -
175 Kotrimoksazol Susp Botol 2,140.00 2,052.00
176 Kotrimoksazol Tablet 480 mg Tablet 129.00 -
177 Leucoplast 2,50 cm x 4,5 m Roll 12,076.00 12,076.00
178 Leucoplast 7,50 cm x 4,5 m Roll 35,532.00 35,532.00
179 Lidocain compositum inj kombinasi Ampul 1,937.00 1,152.00
180 Lidocain Injeksi 2% Ampul 1,111.00 1,144.00
181 Lidocain Jeli 2% Syringe 40,000.00 41,600.00
182 Lidokain Spray Oral 10%(Xylocaine spray) Botol - 177,216.00
183 Lisol Botol 41,000.00 41,000.00
184 Loratadine 10 mg Tablet 123.00 -
185 Magnesium Sulfat Inj 20% Vial 3,200.00 -
186 Magnesium Sulfat Inj 40% Ampul - 3,796.00
187 Masker Karet Buah 726.00 -
188 Masker Tali Buah 726.00 762.00
189 Metformin Tablet 94.00 96.00
190 Metildopa 250 mg / Dopamet Tablet 869.00 -
191 Metilergometrin Maleat Inj Ampul 2,849.00 2,959.00
192 Metilergometrin Maleat tab Tablet 267.86 210.00
193 Metoklopramide Inj Ampul 4,200.00 3,960.00
194 Metronidazol tablet 250 mg Tablet 90.00 89.00
195 Metronidazol tablet 500 mg Tablet 113.00 -
196 Mikonazol krim 2% Tube 3,250.00 3,414.00
197 Mummying Pasta Botol 285,000.00 -
198 Nasal Oxygen, O2 cannula size L Pcs 6,600.00 5,082.00
199 Nasal Oxygen, O2 cannula size M Pcs - 5,082.00
200 Nasal Oxygen, O2 cannula size S Pcs 6,600.00 -
201 Nasal Oxygen, O2 cannula size XS Pcs 6,600.00 -
202 Natrium Bikarbonat tablet 500 mg Tablet 544.00 60.00
203 Natrium Diklofenak Tablet 132.00 128.00
204 Natrium Klorida Lar.infus 0,9 % steril Botol 6,410.00 -
205 Natrium Tiroksin Tablet 3,100.00 -
206 Nifedipin 10 mg Tablet 104.00 -
207 Nistatin Suspensi 100.000 IU/ml Botol - 13,500.00
208 Nistatin tablet vaginal 100.000 IU/g Tablet 523.00 560.00
209 Nistatin tablet vaginal 500.000 IU/g Tablet 640.00 -
210 Norit Tablet 250.00 -
211 OAT Sisipan/FDC Sisipan Paket 160,000.00 -
Obat antituberkolosis Kombipak Kat.I
212 Paket 288,199.00
Dewasa 316,635.00
213 Obat antituberkulosis anak/FDC Anak Paket 214,900.00 232,518.00
214 Obat antituberkulosis kategori 1/FDC 1 Paket 359,900.00 389,344.00
215 Obat antituberkulosis kategori 2/FDC 2 Paket 1,247,984.00 1,297,889.00

216 Obat Batuk Hitam (OBH) Cairan -100 ml Botol 2,800.00 -

217 OBH Nusantara Menthol Botol - 7,950.00
218 OBH Plus Botol 10,600.00 -
219 Oksitetrasiklin HCl 1 % Salep mata Tube 1,600.00 2,500.00
220 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial 7,700.00 -
221 Oksitetrasiklin HCl Salep Kulit 3 % Tube 2,926.00 5,800.00
222 Oksitoksin inj 10 IU/ml- 1 ml Ampul 1,900.00 1,199.00
223 Omeprazol Kapsul 140.00 130.00
224 Omeprazol Injeksi Vial 11,868.00 9,898.00
225 Papaverin tab Tablet 297.00 640.00
226 Paraformaldehid Tablet 660.00 -
227 Parasetamol drop Botol 17,458.00 6,649.00
228 Parasetamol sirup 120 mg / 5ml Botol 1,010.00 1,107.00
229 Parasetamol tablet 500 mg Tablet 49.00 53.00
230 Parasetamol tablet 100 mg Tablet 92.00 -
231 Pehakain Ampul 3,000.00 -
232 Permetrin Krim 5% (Scabimite) Tube 12,155.00 -
233 PGA 2 75 C + Jarum 1/2 40 M Pcs 58,333.33 -
234 Piralent Inj Ampul 7,240.00 -
235 Pirazinamid 500 mg Tablet 237.00 222.00
236 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 45.00 123.00
237 Piroxicam 10 mg Tablet 118.80 195.00
238 Plester 5 yard x 2 inch Roll 23,600.00 -
239 Plester 7,5 cm x 5 m Buah 30,000.00 -
240 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs 24,500.00 -
241 Povidon Iodiada 10 %-30 ml Botol 2,900.00 2,900.00
242 Povidon Iodiada 10 %-300 ml Botol 18,000.00 18,000.00
243 Prednison tablet 5 mg Tablet 76.00 68.00
244 Probenesid 500 mg Tablet 1,755.00 -
245 Propanolol HCl tablet 10 mg Tablet 60.00 -
246 Propanolol HCl tablet 40 mg Tablet 74.00 76.00
247 Propiltiourasil tablet 100 mg Tablet 279.00 -
248 Ranitidin inj Ampul 1,458.00 -
249 Ranitidine 150 mg Tablet 98.00 105.00
250 Retinol (VIT A) Kapsul 100.000 IU Kapsul 284.00 288.00
251 Retinol (VIT A) Kapsul 200.000 IU Kapsul 459.00 517.00
252 Rifampisin kapsul 300 mg Kapsul 376.00 725.00
253 Rifampisin kapsul 450 mg Kapsul 897.00 -
254 Ringer Laktat Larutan Infus Steril Botol 7,150.00 7,150.00
255 Rivanol 300 ml Botol 2,550.00 3,000.00
256 Salbutamol tablet 2 mg Tablet 78.00 63.00
257 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 2,527.00 2,621.00
258 Salisil Spiritus Botol 32,299.00 -
259 Sarung Tangan non steril no 6,5 Pasang 7,700.00 7,700.00
260 Sarung Tangan non steril no 7 Pasang - 7,700.00
261 Sarung Tangan non steril no 7,5 Pasang - 7,700.00
262 Sarung Tangan Obgyn steril Pasang - 19,360.00
263 Sarung tangan steril no 6,5 Pasang 7,865.00 7,865.00
264 Sarung tangan steril no 7 Pasang 7,865.00 7,865.00
265 Sarung tangan steril no 7,5 Pasang 7,865.00 7,865.00
266 Semen Seng Fosfat Serbuk Cairan Set 238,200.00 -
267 Semillas non Woven Medical Tape Pcs 21,753.00 -
268 Serum anti tetanus (ATS) / Biosat Ampul - 130,999.00
269 Serum anti tetanus (ATS) / Tetagam Ampul 170,000.00 176,800.00
Serum antibisa ular Polivalen inj 5 ml
270 Ampul 462,000.00 479,996.00
(SABU) I
271 Silk 2/0 75 C + Jarum 1/2 30M R Sase 20,833.33 20,833.33
272 Silk 3/0 75 C + Jarum 1/2 17M R Sase - 20,833.33
273 Silk 3/0 75 C + Jarum 3/8 26M C Sase 15,000.00 -
274 Silk Black 2/0 DS 24 MM Sase 23,300.00 -
275 Silk Black 2/0 HR 26 MM Sase 20,300.00 -
276 Silk Black 3/0 DS 24 MM Sase 22,400.00 -
277 Silk Black 3/0 HR 26 MM Sase 19,700.00 -
278 Silk Black PFM 2/0 100 m Roll 425,066.00 -
279 Simvastatin tablet 10 mg Tablet 111.00 110.00
280 Simvastatin tablet 20 mg Tablet 229.00 205.00
281 Siprofloksasin 500 mg Tablet 281.00 265.00
282 Softanol antimicrobial 500 ml Botol - 56,925.00
283 Softanol antimicrobial galon 5 liter Galon - 569,250.00
284 Spironolakton 25 mg Tablet 244.00 195.00
285 Streptomisin Inj Vial 5,000.00 -
286 Sulfasetamid Natrium Tetes mata 15 % Ples 10,890.00 12,300.00
Tablet Tambah darah kombinasi : Besi II
287 Tablet 350.00
Sulfat 353.00
288 Temporary Filling Material (Fermin) Botol 158,000.00 -

289 Temporary Stopping Fletcher serbuk &cairan Set 37,000.00

-
290 Tetrakain HCl tetes mata 0,5 % Botol 11,500.00 -
291 Tetrasiklin Kapsul 250 mg Kapsul 166.00 -
292 Tetrasiklin Kapsul 500 mg Kapsul 310.00 303.00
293 Tiamin HCL (Vit B1) tablet 50 mg Tablet 82.00 85.00
294 Transfusion Set Set 7,860.00 -
295 Triheksifenidil HCl tablet 2 mg Tablet 80.00 85.00
296 Trikesol Formalin (TKF) Botol 110,000.00 -
297 Umbilical cord klem steril Pcs 1,000.00 -
298 Urine bag pcs 4,000.00 -
299 Urine Drainage Bag, T valve with hanger Pcs - 5,785.00
300 Ventolin nebules Nebule 4,000.00 -
301 Viorex no rinse antimicrobial Galon - 672,740.00
302 Viorex no rinse antimicrobial Botol - 67,626.66
303 Vitamin B 12 Injeksi Ampul 520.00 -
304 Vitamin B 12 tab Tablet 51.00 46.00
305 Vitamin B Kompleks tablet Tablet 115.00 83.00
306 Wing Nedle no 25 Tablet 5,749.00 -
307 Zink Tablet 514.00 524.00
308 Dextaco Tablet - 394.00
309 Dextrofen Syrup 60 ml Botol - 11,500.00
310 Hemafort Tablet 834.90 834.00
311 Lodecon Forte Tablet 958.30 1,110.00
312 Scandonest Ampul 13,612.00 -
313 Seledril Tablet Tablet 815.00 823.33
314 Solacort krim /Armacort Tube 8,150.00 8,200.00
315 Solafluz Botol 11,900.00 13,700.00
316 Soldextam Tablet 566.00 -
317 Solvitral Tablet 816.00 911.00
318 Truvit Syr Botol 10,700.00 12,400.00
319 Widabest Botol - 9,646.00

OBAT PREKURSOR DAN PSIKOTROPIKA

1 Diazepam inj 5 mg/ml-2 ml Ampul 4,180.00 1,735.00

2 Diazepam tablet 2 mg Tablet 35.00 -
3 Diazepam tablet 5 mg Tablet 117.00 109.00
4 Fenobarbital inj 50 mg/ml-2ml Ampul 1,300.00 -
5 Fenobarbital tablet 30 mg Tablet 165.00 -
6 Stesolid (Diazepam Rectal) Tube 11,517.00 12,573.00

APBN

1 MB Dewasa Blister - 31,570.00

2 MB Anak Blister - 20,554.00
3 PB Dewasa Blister - 12,569.00
4 PB Anak Blister - -
5 Clozapine 25 mg Tablet - 1,550.00
6 DHP Kotak - -
7 Doksisiklin Kapsul - -
8 Efavirenz 200 mg Botol - -
9 Efavirenz 600 mg Botol - 191,250.00
10 Lamivudine 150 mg Botol - 90,000.00
11 Malation 96 Drigen - -
12 Nepiraphine 200 mg Botol - 168,000.00
13 Primakuin Tablet - -
14 RDT Malaria Test - -
15 TDP (300)+3TC(300)+EFV(600) Botol - 356,829.00
16 Tenofovir 300 mg Botol - 243.00
17 Vaksin Anti Rabies Kuur - 164,030.00
18 Zdvdn(60)+Lmvdn(30)+Nvrpn(50) Botol - 41,532.00
19 Zidopudin(300)+lamivudin(150) Botol - 222,000.00
20 Zidovudin 100 mg Botol - 102,000.00
REAGEN

1 Kaca Slide Box - 21,347.00

2 Pot Dahak Buah - 5,800.00
3 Reagen Ziehl Neelsen Kit - -
4 Rapid Test HIV SD Kit - -
5 Hepatitis B IMM Kit - -
6 Rapid Test Syphilis Kit - -
Total (Rp)

Total (Rp)
Cat : Format/nama-nama obat jangan dirubah, Bila ada obat-obat yang tidak ada di format (obat lama) mohon dimasuka

Mengetahui,
Kepala UPT BLUD Puskesmas
 PEMERINTAH KABUPATEN SUMEDANG
DINAS KESEHATAN KABUPATEN SUMEDANG
UPT BLUD PUSKESMAS
Jl. RAYA

LAPORAN OBAT TERPADU

Muta
Stok Awal
Penambahan Persediaan
Σ Harga 2017 Jumlah Σ Harga 2018 Jumlah Σ Harga 2017 Jumlah Σ Harga 2018 Jumlah

7(6x4) 8 9(8x5) 10 11(10x4) 12 13(12x5) 14(6+10)

 0.00 Total (Rp) 0.00 Total (Rp) 0.00 Total (Rp) - Total (Rp)

0.00 Total (Rp) - Total (Rp)

rmat (obat lama) mohon dimasukan di kolom paling bawah sesudah nomor 319 (Widabest)
PATEN SUMEDANG
BUPATEN SUMEDANG
USKESMAS
YA

AT TERPADU

Mutasi 2018

Persediaan Pengeluaran ED
Σ Harga 2017 Jumlah Σ Harga 2018
Jumlah Σ Harga 2017 Jumlah Σ Harga 2018 Jumlah

15(14x4) 16(8+12) 17(16x5) 18 19(18x4) 20 21(20x5) 21

- Total (Rp) - Total (Rp) - Total (Rp) - Total (Rp)

- Total (Rp) - Total (Rp)

Sumedang, 2019

Petugas Obat Puskesmas

 Sisa Stok
ED Ket

Jumlah Harga Jumlah Σ Harga 2017 Jumlah Σ Harga 2018

22(21x4) 23 24(23x4) 25 26(25x5)

- Total (Rp) - Total (Rp) -

- Total (Rp) -