Page 1

LAPORAN PERSEDIAAN OBAT PUSKESMAS PER 01 JANUARI S/D 31 DESEMBER 2018

UNIT PENERIMA : FKTP ASAM BARU

KECAMATAN : DANAU SELULUK
KABUPATEN : SERUYAN
PROVINSI : KALIMANTAN TENGAH

SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
10315 2 - 4 SALEP SALEP 0 48 48 24 24 3,149.00
238 2 - 4 SALEP SALEP 14 14 14 0 3,033.00
108 ACYCLOVIR SALEP 5 % SALEP 0 0 0 0 4,240.00
523 ACYCLOVIR TABLET 400 MG TABLET 250 1500 1750 850 900 354.00
175 ALBENDAZOLE TABLET 400 MG TABLET 4145 4145 4145 0 407.00
229 ALBENDAZOLE TABLET 400 MG TABLET 0 22400 22400 16400 6000 266.80
238 ALKOHOL LIQUID 70 % LIQUID 0 0 0 0 25,500.00
403 ALLOPURINOL TABLET 300 MG TABLET 0 300 300 0 300 222.00
3 ALLOPURINOL TABLET 100 MG TABLET 300 4600 4900 4100 800 96.00
377 AMBROXOL SIRUP 15 MG/5 ML SIRUP 0 0 0 0 3,626.00
368 AMBROXOL SIRUP 30 MG/5 ML SIRUP 0 0 0 0 -
379 AMBROXOL TABLET 30 MG TABLET 0 0 0 0 137.00
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 28 28 28 28 0 4,204.00
809 AMINOPHYLLINE TABLET 200 MG TABLET 100 100 100 0 99.00
444 AMITRIPTYLINE TABLET 25 MG TABLET 300 300 300 300 0 123.00
540 AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP 0 0 0 0 2,560.00
375 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 30 290 320 133 187 3,740.00
376 AMOXYCILLIN TABLET 250 MG TABLET 0 3000 3000 600 2400 203.00
511 AMOXYCILLIN TABLET 500 MG TABLET 2000 5500 7500 4900 2600 248.00
713 AMPICILLIN TABLET 500 MG TABLET 0 0 0 0 419.00
806 ANTALGIN INJEKSI INJEKSI 0 0 0 0 1,613.00
804 ANTACIDA SIRUP 400 MG/5 ML SIRUP 0 0 0 0 78.00
7 ANTACIDA TABLET 400 MG TABLET 1400 14000 15400 10200 5200 61.00
ANTIMALARIA KOMBINASI SULFADOKSIN 500 MG|PIRIMETAMIN 25 MG
829 TABLET 36 9 45 36 36 9 -
TABLET 525 MG
410 AQUA PRO INJEKSI INJEKSI INJEKSI 4 10 14 4 10 2,860.00
883 ARTEMISININ TABLET 40 & 320 MG TABLET 0 0 0 0 -
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SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
1599 ASAM MEFENAMAT TABLET 500 MG TABLET 1200 10000 11200 7600 3600 122.00
923 ASCORBIC
ASCORBIC ACID (VITAMIN C) TABLET 250 MG
ACID|CAFFEINE|PYRIDOXINE|BIOTIN|FOLIC ACID|THIAMINE| TABLET 1200 1200 1200 0 154.00
926 COLECALCIFEROL|CYANOCOBALAMIN|RETINOL
ASCORBIC ACID (VITAMIN C) TABLET 50 MG PALMITATE|
ASCORBIC ACID|CAFFEINE|PYRIDOXINE|BIOTIN|FOLIC ACID|THIAMINE| TABLET 800 800 800 0 125.00
NICOTINAMIDE|TAURINE|RIBOFLAVIN
COLECALCIFEROL|CYANOCOBALAMIN|RETINOLSODIUM PALMITATE|
PHOSPHATE|CALCIUM
1000 TABLET 0 1400 1400 1400 0 52.00
PANTOTHENATE|FERRIC AMMONIUM CITRATE|MAGNESIUM
NICOTINAMIDE|TAURINE|RIBOFLAVIN SODIUM PHOSPHATE|CALCIUM
GLYCEROPHOSPHATE|SODIUM MOLYBDATE|ZINC SULPHATE|COPPER TABLET 0 4000 4000 2500 1500 141.00
PANTOTHENATE|FERRIC AMMONIUM CITRATE|MAGNESIUM
SULPHATE|MANGANESE
ASPIRIN (ASETOSAL) SULPHATE|CALCIUM
TABLET 80 MG GLYCEROPHOSPHATE
GLYCEROPHOSPHATE|SODIUM MOLYBDATE|ZINC SULPHATE|COPPER TABLET TABLET 0 400 400 0 400 125.00
1274 SULPHATE|MANGANESE SULPHATE|CALCIUM
ATROPINE SULPHATE INJEKSI 0.25 MG/ML GLYCEROPHOSPHATE TABLET INJEKSI 8 8 0 8 951.80
1277 ATROPINE SULPHATE TABLET 0.5 MG TABLET 1600 1600 1600 1600 0 81.00
1288 ATTAPULGITE SIRUP 200 MG/5 ML SIRUP 0 0 0 0 -
1289 ATTAPULGITE TABLET 600 MG TABLET 500 1500 2000 1000 1000 199.00
1362 BACITRACIN|NEOMYCIN SULPHATE|POLYMYXIN B SULPHATE SALEP SALEP 0 0 0 0 2,767.00
1436 BEDAK SALISIL LIQUID 5 % LIQUID 0 8 8 8 0 1,350.00
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 -
BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE|HEXACHLOROPHENE
1702 SUPPO 0 0 0 0 -
SUPPOSITORIA 2 G
AK9001917BLOOD LANCET 0 0 0 0 0 -
AK9002009BOX SLIDE 0 0 0 0 0 -
1879 CAFFEINE|ERGOTAMINE TARTRATE TABLET 1 MG|50 MG TABLET 1100 300 1400 1400 0 149.00
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE|SODIUM
10160 INFUS 14 180 194 109 85 7,150.00
CHLORIDE|SODIUM LACTATE INFUS
1866 CALCIUM GLUCONATE INJEKSI 10 ML INJEKSI 24 24 0 24 -
407 CALCIUM LACTATE TABLET 500 MG TABLET 4000 3000 7000 5700 1300 60.00
2073 CAPTOPRIL TABLET 12.5 MG TABLET 4300 500 4800 700 4100 0 59.00
2075 CAPTOPRIL TABLET 25 MG TABLET 0 4000 4000 2900 1100 89.00
385 CAPTOPRIL TABLET 25 MG TABLET 0 2000 2000 0 2000 82.00
CEFADROXIL TABLET 500 MG TABLET 0 3500 3500 1100 2400 529.00
10435 CEFOTAXIME INJEKSI 1000 MG INJEKSI 4 4 4 0 2,426.00
2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 25 25 25 0 8,094.00
CHLORAMPHENICOL DROPS 0.5% DROPS 0 30 30 16 14 4,250.00
2571 CHLORAMPHENICOL DROPS 3 % DROPS 0 0 0 0 10,000.00
3756 CHLORAMPHENICOL SIRUP 60 ML SIRUP 35 100 135 35 100 5,170.00
381 CHLORAMPHENICOL TABLET 250 MG TABLET 0 1000 1000 0 1000 341.00
377 CHLORPHENIRAMINE TABLET 4 MG TABLET 2100 400 2500 2500 0 40.00
CHLORPHENIRAMINE TABLET 4 MG TABLET 0 3500 3500 1000 2500 25.00
2754 CHLORPROMAZINE INJEKSI 25 MG/ML INJEKSI 10 10 0 10 -
2763 CHLORPROMAZINE TABLET 25 MG TABLET 100 100 100 0 50.00
CIPROFLOXACIN TABLET 500 MG TABLET 0 1500 1500 1500 0 309.00
2988 CLINDAMYCIN TABLET 300 MG TABLET 0 0 0 0 -
3157 CODEINE TABLET 10 MG TABLET 0 0 0 0 550.00
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SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
408 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 0 200 200 100 100 2,115.00
COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 20 100 120 90 30 2,250.00
3206 COTRIMOXAZOLE TABLET 120 MG TABLET 0 0 0 0 83.00
409 COTRIMOXAZOLE TABLET 480 MG TABLET 1300 600 1900 1700 200 129.00
4458 COTRIMOXAZOLE TABLET 480 MG TABLET 1000 1000 2000 2000 0 158.00
5814 CYANOCOBALAMIN INJEKSI INJEKSI 65 230 295 145 150 1,187.00
5252 CYANOCOBALAMIN TABLET 50 MCG TABLET 1400 2000 3400 2400 1000 57.00
CYANOCOBALAMIN TABLET 50 MCG TABLET 0 1500 1500 1500 0 1,277.00
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 71 300 371 96 275 1,830.00
378 DEXAMETHASONE TABLET 0.5 MG TABLET 1400 5000 6400 3600 2800 35.00
3357 DEXTRAN DROPS 1.5 ML DROPS 0 0 0 0 -
3628 DIAZEPAM ENEMA 5 MG/2.5 ML ENEMA 0 0 0 0 29,520.00
DIAZEPAM ENEMA 5 MG/2.5 ML ENEMA 0 5 5 5 5 0 14,054.00
3631 DIAZEPAM LIQUID LIQUID 0 0 0 0 -
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 0 0 0 0 193.00
398 DIETHYLCARBAMAZINE TABLET 100 MG TABLET 11407 59800 71207 59800 11407 0 188.00
79 DIGOXIN TABLET 0.25 MG TABLET 1500 500 2000 100 1400 500 104.00
3794 DIMENHYDRINATE TABLET 50 MG TABLET 2500 2500 400 2100 107.00
78 DIPHENHYDRAMINE INJEKSI 10 MG/ML INJEKSI 24 30 54 24 30 1,316.00
DIPHENHYDRAMINE|AMMONIUM CHLORIDE|CODEIN PHO SIRUP 12.5
3857 SIRUP 0 0 0 0 -
MG|125 MG|10 MG /5ML
3888 DIPHENHYDRAMINE|GUAIFENESIN|MENTHOL TABLET TABLET 0 0 0 0 -
AK9003970DISPOSIBLE SYRINGE 27G MISAWA 0 0 0 0 0 -
379 DOMPERIDONE SIRUP 5 MG/5 ML SIRUP 15 150 165 36 129 2,970.00
374 DOMPERIDONE TABLET 10 MG TABLET 100 1000 1100 400 700 90.00
4286 EPHEDRINE|THEOPHYLLINE TABLET TABLET 0 0 0 0 56.00
4303 EPINEPHRINE INJEKSI 0.1 % INJEKSI 23 23 8 15 1,650.00
EPINEPHRINE INJEKSI 0.1 % INJEKSI 0 10 10 0 10 2,068.00
7491 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 10 10 10 0 7,391.00
4458 ERYTHROMYCIN TABLET 250 MG TABLET 300 1500 1800 700 1100 666.00
4551 ETAKRIDIN LIQUID 0.1 % LIQUID 14 14 6 8 0 5,124.00
4663 EUGENOL LIQUID LIQUID 0 0 0 0 50,416.67
4732 FENOL GLISEROL DROPS 10 % DROPS 6 48 54 14 40 2,590.00
4863 FLUCONAZOLE TABLET 150 MG TABLET 30 30 30 0 -
AK9004700FOLEY CATHETER 2 WAY NO 16 SET 27 27 27 27 0 -
AK9004701FOLEY CATHETER 2 WAY NO 18 SET 27 27 27 27 0 -
5071 FUROSEMIDE INJEKSI 10 MG/ML INJEKSI 8 8 0 8 2,012.00
82 FUROSEMIDE TABLET 40 MG TABLET 200 1000 1200 500 700 89.00
 Page 4

SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
5126 GARAM ORALIT SERBUK SERBUK 500 2000 2500 1300 500 1200 263.00
393 GEMFIBROZIL TABLET 300 MG TABLET 0 2760 2760 840 1920 447.00
58 GENTAMYCIN DROPS 0.3 % DROPS 0 48 48 30 18 5,098.00
5186 GENTAMYCIN INJEKSI 40 MG/ML INJEKSI 3 3 0 3 4,065.60
5225 GENTIAN VIOLET LIQUID 1 % LIQUID 60 48 108 35 73 0 2,684.00
5228 GENTIAN VIOLET LIQUID LIQUID 0 0 0 0 -
5252 GLIBENCLAMIDE TABLET 5 MG TABLET 1500 3500 5000 3600 1400 90.00
394 GLIBENCLAMIDE TABLET 5 MG TABLET 0 1000 1000 0 1000 143.00
5291 GLUCOSE INFUS 10 % INFUS 3 3 1 2 0 6,300.00
7695 GLUCOSE INFUS 5 % INFUS 43 60 103 36 67 6,900.00
AK0101069Glucose test system SET 0 0 0 0 -
5522 GRISEOFULVIN TABLET 125 MG TABLET 100 100 100 0 199.00
GRISEOFULVIN TABLET 125 MG TABLET 0 1500 1500 500 1000 263.00
5539 GUAIFENESIN TABLET 100 MG TABLET 850 850 850 0 31.00
5642 HALOPERIDOL TABLET 5 MG TABLET 0 300 300 0 300 119.00
AK9005157HCG ONE STEP PREGNANCY TEST STRIP ACON 0 0 0 0 0 -
AK1105006Hemorrhoid prevention pressure wedge 0 0 0 0 0 -
5736 HIDROKSI METIL SELOLOSA DROPS 3 ML DROPS 0 0 0 0 -
5788 HYDROCHLOROTHIAZIDE TABLET 25 MG TABLET 200 200 100 100 39.90
5814 HYDROCORTISONE SALEP 25 MG/G SALEP 0 0 0 0 2,712.00
5964 IBUPROFEN TABLET 200 MG TABLET 1000 1000 2000 2000 0 112.00
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 157.00
AK9005570INFUS SET SET 50 110 160 125 35 3,680.00
AK9005571INFUS SET PEDIATRIC SET 28 40 68 37 31 2,925.00
6179 IODIUM POVIDON LIQUID 10 % LIQUID 0 0 0 0 21,500.00
IODIUM POVIDON LIQUID 10 % LIQUID 0 5 5 5 0 21,600.00
AK9012183Iodoform (Mummifying Pasta) 0 0 0 0 0 -
6386 ISOSORBIDE DINITRATE TABLET 5 MG TABLET 4100 500 4600 4100 500 98.00
AK9005688IV CATHETER NO 20 0 115 115 115 115 0 8,480.00
AK9005689IV CATHETER NO 22 0 50 40 90 67 23 4,316.00
AK9005690IV CATHETER NO 24 0 41 40 81 53 28 4,630.00
AK9005695IV CATHY NO 20 0 0 0 0 0 -
AK9005696IV CATHY NO 24 0 0 0 0 0 -
3690 KAPAS PEMBALUT SET 250 G SET 3 11 14 11 3 14,375.00
AK9005961KASA 2Y X 80 CM 0 7 7 7 0 9,500.00
AK9012107KASA HYDROFIL 4 M X 15 CM 0 240 240 40 200 3,685.00
KASA HYDROFIL 4 M X 15 CM 0 0 50 50 0 50 2,380.00
 Page 5

SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
AK9012107KASA HYDROFIL 4 M X 3 CM 0 100 100 50 50 798.00
AK9005982KASA HYDROFIL 40 M X 80 CM 0 1 1 1 0 127,700.00
AK9006008KASA LIPAT STERIL 40 CM X 40 CM 0 25 100 125 36 89 1,681.00
8593 KETOCONAZOLE TABLET 200 MG TABLET 200 1250 1450 850 600 308.00
AK9012185Klorfenol Kamfer Menthol (CHKM) 0 0 0 0 0 60,500.00
381 LIDOCAINE INJEKSI 2% INJEKSI 54 100 154 54 100 1,382.00
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 0 0 0 0 1,250.33
LIQUORICE LIQUID EXTRACT|AMMONIUM CHLORIDE|ANISATED SPIRIT OF
6945 SIRUP 0 0 0 0 1,887.00
AMMONIA SIRUP
6959 LISIN, MULTIVITAMIN, MULTIMINERAL 0 0 0 0 9,500.00
LOPERAMIDE TABLET TABLET 200 1800 2000 1600 400 91.00
AK9008970LORATADINE TABLET 10 MG TABLET 300 2000 2300 1200 1100 150.00
7153 MAGNESIUM SULPHATE INJEKSI 20 % INJEKSI 0 20 20 6 14 3,328.00
7159 MAGNESIUM SULPHATE INJEKSI 40 % INJEKSI 10 20 30 14 16 3,796.00
AK9006974MASKER N95 0 0 20 20 20 0 7,400.00
AK9006983MASKER PAKAI TALI 0 1100 1100 50 1050 1,237.50
MASKER PAKAI TALI 0 0 3000 3000 2000 1000 630.00
799 METAMPIRON (ANTALGIN) INJEKSI 250 MG/ML INJEKSI 0 0 0 0 1,613.33
10482 METFORMIN TABLET 500 MG TABLET 300 1000 1300 800 500 110.00
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 35 20 55 20 35 17 2,684.00
METHYLERGOMETRINE MALEAT 0,125 mg TABLET 0 200 200 50 150 254.00
395 METOCLOPRAMIDE SIRUP 5 MG/5 ML SIRUP 0 150 150 28 122 2,870.00
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 0 2000 2000 1900 100 110.00
METOCLOPRAMIDE TABLET 10 MG TABLET 0 1000 1000 0 1000 93.00
7695 METRONIDAZOLE TABLET 250 MG TABLET 500 500 100 400 116.00
7697 METRONIDAZOLE TABLET 500 MG TABLET 0 500 500 100 400 169.00
7727 MICONAZOLE SALEP 2% SALEP 0 0 0 0 3,075.00
7747 MINERAL MIX SERBUK 8 G SERBUK 600 600 600 0 2,727.00
AK0303039Mycobacterium tuberculosisimmunofluorescent reagents 0 0 0 0 -
387 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 850 3500 4350 2900 1450 146.00
8160 NIFEDIPINE TABLET 10 MG TABLET 200 200 200 0 123.00
8268 NYSTATIN TABLET 10000 IU TABLET 0 300 300 100 200 654.00
388 NYSTATIN TABLET 50000 IU TABLET 0 300 300 100 200 950.00
384 OMEPRAZOLE TABLET 20 MG TABLET 0 810 810 510 300 143.00
397 PARACETAMOL DROPS 100 MG/ML DROPS 12 100 112 30 82 7,979.00
4767 PARACETAMOL SIRUP 120 MG/ML SIRUP 0 200 200 185 15 1,150.00
PARACETAMOL SIRUP 120 MG/ML SIRUP 145 400 545 145 400 1,190.00
MDVx00179PARACETAMOL TABLET 500 MG TABLET 1900 18000 19900 10200 9700 49.00
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SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
PARACETAMOL TABLET 500 MG TABLET 0 3000 3000 3000 0 60.00
9246 PHENYTOIN TABLET 100 MG TABLET 200 200 200 0 146.00
389 PHYTOMENADIONE (VITAMIN K) INJEKSI 2 MG/ML INJEKSI 4 330 334 156 150 28 4,420.00
9261 PHYTOMENADIONE (VITAMIN K) TABLET 10 MG TABLET 0 700 700 100 600 697.00
AK9008044PIPET WESTERGREEN 0 0 0 0 0 -
9345 PIRACETAM INJEKSI 200 MG/ML INJEKSI 6 6 6 6 0 22,750.00
9392 PIROXICAM TABLET 20 MG TABLET 0 0 0 0 90.00
AK0303045Plasmodium species antigen detection assays 0 0 0 0 0 -
AK9008129PLESTERKU 0 10 1 11 10 1 25,700.00
AK9008213POT 100 CC 0 0 0 0 0 5,890.00
9581 PREDNISONE DROPS 0.5 ML MG DROPS 0 0 0 0 -
PREDNISONE TABLET 5 MG TABLET 0 7000 7000 7000 0 85.00
9597 PRIMAQUINE TABLET 15 MG TABLET 100 100 100 0 -
9673 PROPANOL TABLET 10 MG TABLET 400 400 400 400 0 71.00
1684 PYRIDOXINE TABLET 10 MG TABLET 400 400 400 0 19.00
PYRIDOXINE TABLET 10 MG TABLET 0 1000 1000 900 100 52.00
9958 QUININE TABLET 222 MG TABLET 0 0 0 0 -
9998 RANITIDINE INJEKSI 25 MG/ML INJEKSI 0 40 40 9 31 1,320.00
10014 RANITIDINE TABLET 150 MG TABLET 3200 3200 2800 400 0 128.00
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 450 1000 1450 1300 150 341.00
11900 RETINOL PALMITATE TABLET 200000 IU TABLET 2300 4000 6300 5550 550 200 519.00
10108 RIFAMPACIN|ISONIAZID TABLET 60 MG|30 MG TABLET 0 0 0 0 -
12233 RIFAMPICINE|DAPSON 0 0 0 0 -
10125 RIFAMPICIN|ISONIAZID|ETHAMBUTOL TABLET 150 MG|75 MG|275 MG TABLET 5 10 15 7 8 431,978.00
10136 RIFAMPICIN|ISONIAZID|PYRAZINAMIDE TABLET 75 MG|50 MG|150 MG TABLET 0 0 0 0 247,238.00
11921 SAFE EX GLOVES POWDER S Pcs 200 600 800 800 0 512.00
23 SALBUTAMOL TABLET 2 MG TABLET 0 1000 1000 0 1000 64.00
23 SALBUTAMOL TABLET 2 MG TABLET 0 2000 2000 1800 200 85.00
10336 SALICYLIC ACID|BENZOIC ACID|SULFUR SALEP SALEP 0 24 24 24 0 5,395.00
AK9008968SARUNG TANGAN STERIL NO 6.5 0 37 100 137 37 100 9,025.00
AK9008970SARUNG TANGAN STERIL NO 7.5 0 43 50 93 15 78 9,025.00
44 SARUNG TANGAN STERIL NO 7.5 0 0 100 100 50 50 8,865.00
AK9008973SARUNG TANGAN SURGIPRO NO 7 0 8 8 8 0 4,665.64
SARUNG TANGAN SURGIPRO NO 7 0 0 150 150 50 100 8,646.00
AK9012192Semen Seng Fosfat Serbuk dan Cairan 0 0 0 0 0 235,950.00
AK9009378SILK 3 - 0 0 12 12 12 0 18,883.33
AK9009380SILK BLACK BRAIDED 2 - 0 0 60 60 24 36 0 14,416.67
 Page 7

SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
10515 SODIUM BICARBONATE TABLET 500 MG TABLET 0 0 0 0 -
10532 SODIUM CHLORIDE INFUS 0.9 % INFUS 16 16 16 0 5,170.00
SODIUM CHLORIDE INFUS 0.9 % INFUS 20 20 40 22 18 6,410.00
AK9009623SPUIT 1 CC TUBERCULIN 0 485 200 685 105 485 95 766.94
AK9009627SPUIT 2,5 CC 0 372 372 372 0 848.00
SPUIT 2,5 CC 0 0 1200 1200 710 490 770.00
SPUIT 3 CC 0 0 200 200 0 200 775.58
AK9009629SPUIT 3 CC 0 500 500 1000 800 200 842.00
AK9009632SPUIT 5 CC 0 157 100 257 238 19 943.00
10902 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 80 MG|16 MG/ML TABLET 0 0 0 0 -
11070 TERBUTALINE TABLET 0.25 MG/DOSE TABLET 0 0 0 0 -
11210 THIAMINE INJEKSI 100 MG/ML INJEKSI 0 0 0 0 1,149.50
11936 THIAMINE TABLET 25 MG TABLET 0 0 0 0 -
11328 THIAMINE (VITAMIN B1) TABLET 50 MG TABLET 200 200 200 0 41.58
11296 THIAMPHENICOL TABLET 500 MG TABLET 200 200 200 200 0 440.00
11480 TRAMADOL TABLET 50 MG TABLET 250 150 400 100 300 600.00
11636 TRIHEXYPHENIDYL TABLET 2 MG TABLET 0 800 800 0 800 106.00
AK9012057WING NEEDLE NO 27 0 0 15 15 0 15 1,610.00
12192 ZINC SULPHATE TABLET 20 MG TABLET 100 100 50 50 618.00
358 ZINC SULPHATE TABLET 20 MG TABLET 0 1000 1000 0 1000 631.00
CLINDAMYCIN TABLET 150 MG TABLET 0 0 0 0 -
PIRACETAM TABLET TABLET 100 100 100 100 0 3,680.00
BETAMETHASON KRIM 0,1% SALEP 12 12 12 0 1,444.00
CATGUT/BENANG BEDAH NO.2/0 DGN JARUM BEDAH SET 21 48 69 32 37 6,347.22
CATGUT/BENANG BEDAH NO.3/0 DGN JARUM BEDAH SET 7 48 55 16 39 6,347.22
KASA STERIL 16 X 16 CM KOTAK 0 45 45 16 29 9,200.00
KASA STERIL 18 X 22 CM KOTAK 0 45 45 19 26 8,382.35
PEMBALUT GIPS UK.3 ROLL 5 5 0 5 18,467.00
PEMBALUT GIPS UK.4 ROLL 5 5 0 5 25,742.00
PEMBALUT GIPS UK.6 ROLL 2 2 0 2 34,137.00
ASAM FOLAT TABLET 900 5000 5900 1200 4700 69.00
PIRANTEL 125 mg TABLET 35 35 35 0 333.00
VENTOLIN NEBULIZER AMPUL 0 0 0 0 11,440.00
ANTI A BOTOL 0 0 0 0 14,028.00
ANTI B BOTOL 0 0 0 0 14,028.00
ANTI AB BOTOL 0 0 0 0 14,028.00
FERROUS FUMARATE TABLET TABLET 2580 18000 20580 9330 11250 355.00
 Page 8

SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18
FERROUS FUMARATE TABLET TABLET 5200 5200 3900 1300 425.00
WIDAL TEST BOTOL 1 7 8 0 8 -
BISTURI NO.11 SET 90 90 90 0 -
CATGUT 3/0 CHROMIC SET 20 20 20 0 6,417.00
211 CATGUT 3/0 CHROMIC SET 0 72 72 1 71 6,347.22
OKSIMETHAZOLIN TTS HIDUNG 0,025 % BOTOL 0 5 5 1 4 39,050.00
DIAZEPAM INJEKSI 5MG/ML AMPUL 30 30 0 30 2,604.90
OXYTOCINE INJEKSI AMPUL 18 18 13 5 1,900.00
OXYTOCINE INJEKSI AMPUL 0 10 10 0 10 1,287.00
KASA PEMBALUT 4 m x 5 cm 0 50 50 50 0 333.85
OAT FDC KATEGORI 2 DEWASA PAKET 1 1 1 0 -
373 SIMVASTATIN TABLET 10 MG TABLET 0 2880 2880 1110 1770 110.00
ALBENDAZOLE TABLET 400 MG TABLET 3720 3720 630 3090 470.00
SAFE EX GLOVES POWDER M Pcs 0 100 100 0 100 512.00
CHLORAMPHENICOL SALEP KULIT TUBE 0 24 24 24 0 3,382.00
TETRACYCLINE 250 MG KAPSUL KAPSUL 0 2500 2500 500 2000 181.00
SERUM ANTI BISA ULAR AMPUL 0 2 2 0 2 462,000.00
DIAZEPAM 5 MG TABLET 0 100 100 0 100 109.00
RAPID TEST HIV STRIP 0 400 400 400 0 22,385.00
PHENYTOIN KAPSUL 30 MG KAPSUL 0 500 500 200 300 142.00
CHLORPROMAZINE TABLET 100 MG TABLET 0 50 50 10 40 144.00
SALMONELLA THYPI-H WIDAL TEST VIAL 0 2 2 0 2 77,771.11
SALMONELLA THYPI-O WIDAL TEST VIAL 0 2 2 0 2 77,771.11
SALMONELLA PARATHYPI-AO WIDAL TEST VIAL 0 2 2 0 2 77,771.11
SALMONELLA PARATHYPI-BO WIDAL TEST VIAL 0 2 2 0 2 77,771.11
SURGICAL TAPE 1,25 cm X 9,10 cm Pcs 0 24 24 1 23 4,857.60
104 SURGICAL TAPE 2,5 cm X 9,10 cm Pcs 0 12 12 0 12 8,596.25
392 BISAKODIL TAB 5 MG TABLET 0 600 600 60 540 330.00
396 N-ACETILCYSTEIN KAPS 200 MG KAPSUL 2000 540 2540 0 2000 540 431.00
401 AMLODIPNE 5 MG TABLET 0 600 600 300 300 80.00
383 LIDOCAINE INJ.2% + EPINEFRIN 1:80000 - 2 ML INJEKSI 60 30 90 60 30 1,380.00
REAGEN IODIUM BOTOL 0 6 6 6 0 -
Rp 40,916,456.62

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Kepala Dinas Kesehatan Kabupaten Seruyan Kepala UPTD Gudang Farmasi Ka Subbag TU UPTD Puskesmas
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SEDIAAN STOK 01 PENERIMAA PERSEDIAAN SISA STOK 31

KODE NAMA OBAT PEMAKAIAN RUSAK/ED HARGA SATUAN
JAN'18 N DES'18

Rabiatul Qamariah,A.Md.KL
NIP 19770406 200501 2 018
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Rp 75,576.00
Rp -
Rp -
Rp 318,600.00
Rp -
Rp 1,600,800.00
Rp -
Rp 66,600.00
Rp 76,800.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 699,380.00
Rp 487,200.00
Rp 644,800.00
Rp -
Rp -
Rp -
Rp 317,200.00
Rp -
Rp 28,600.00
Rp -
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Rp 439,200.00
Rp -
Rp -
Rp -
Rp 211,500.00
Rp 50,000.00
Rp 7,614.40
Rp -
Rp -
Rp 199,000.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 607,750.00
Rp -
Rp 78,000.00
Rp -
Rp 97,900.00
Rp 164,000.00
Rp 1,269,600.00
Rp -
Rp -
Rp 59,500.00
Rp -
Rp 517,000.00
Rp 341,000.00
Rp -
Rp 62,500.00
Rp -
Rp -
Rp -
Rp -
Rp -
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Rp 211,500.00
Rp 67,500.00
Rp -
Rp 25,800.00
Rp -
Rp 178,050.00
Rp 57,000.00
Rp -
Rp 503,250.00
Rp 98,000.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 52,000.00
Rp 224,700.00
Rp 39,480.00
Rp -
Rp -
Rp -
Rp 383,130.00
Rp 63,000.00
Rp -
Rp 24,750.00
Rp 20,680.00
Rp -
Rp 732,600.00
Rp -
Rp -
Rp 103,600.00
Rp -
Rp -
Rp -
Rp 16,096.00
Rp 62,300.00
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Rp 315,600.00
Rp 858,240.00
Rp 91,764.00
Rp 12,196.80
Rp -
Rp -
Rp 126,000.00
Rp 143,000.00
Rp -
Rp 462,300.00
Rp -
Rp -
Rp 263,000.00
Rp -
Rp 35,700.00
Rp -
Rp -
Rp -
Rp 3,990.00
Rp -
Rp -
Rp -
Rp 128,800.00
Rp 90,675.00
Rp -
Rp -
Rp -
Rp 49,000.00
Rp -
Rp 99,268.00
Rp 129,640.00
Rp -
Rp -
Rp 43,125.00
Rp -
Rp 737,000.00
Rp 119,000.00
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Rp 39,900.00
Rp -
Rp 149,609.00
Rp 184,800.00
Rp -
Rp 138,200.00
Rp -
Rp -
Rp -
Rp 36,400.00
Rp 165,000.00
Rp 46,592.00
Rp 60,736.00
Rp -
Rp 1,299,375.00
Rp 630,000.00
Rp -
Rp 55,000.00
Rp 45,628.00
Rp 38,100.00
Rp 350,140.00
Rp 11,000.00
Rp 93,000.00
Rp 46,400.00
Rp 67,600.00
Rp -
Rp -
Rp -
Rp 211,700.00
Rp -
Rp 130,800.00
Rp 190,000.00
Rp 42,900.00
Rp 654,278.00
Rp 17,250.00
Rp 476,000.00
Rp 475,300.00
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Rp -
Rp -
Rp 123,760.00
Rp 418,200.00
Rp -
Rp -
Rp -
Rp -
Rp 25,700.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 5,200.00
Rp -
Rp 40,920.00
Rp -
Rp 51,150.00
Rp 103,800.00
Rp -
Rp -
Rp 3,455,824.00
Rp -
Rp -
Rp 64,000.00
Rp 17,000.00
Rp -
Rp 902,500.00
Rp 703,950.00
Rp 443,250.00
Rp -
Rp 864,600.00
Rp -
Rp -
Rp -
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Rp -
Rp -
Rp 115,380.00
Rp 72,859.30
Rp -
Rp 377,300.00
Rp 155,116.00
Rp 168,400.00
Rp 17,917.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 180,000.00
Rp 84,800.00
Rp 24,150.00
Rp 30,900.00
Rp 631,000.00
Rp -
Rp -
Rp -
Rp 234,847.14
Rp 247,541.58
Rp 266,800.00
Rp 217,941.10
Rp 92,335.00
Rp 128,710.00
Rp 68,274.00
Rp 324,300.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 3,993,750.00
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Rp 552,500.00
Rp -
Rp -
Rp -
Rp 450,652.62
Rp 156,200.00
Rp 78,147.00
Rp 9,500.00
Rp 12,870.00
Rp -
Rp -
Rp 194,700.00
Rp 1,452,300.00
Rp 51,200.00
Rp -
Rp 362,000.00
Rp 924,000.00
Rp 10,900.00
Rp -
Rp 42,600.00
Rp 5,760.00
Rp 155,542.22
Rp 155,542.22
Rp 155,542.22
Rp 155,542.22
Rp 111,724.80
Rp 103,155.00
Rp 178,200.00
Rp 232,740.00
Rp 24,000.00
Rp 41,400.00
Rp -
40,916,456.62

Yang menerima
Petugas Puskesmas
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Hasminah, S.Farm.,Apt
NIP 19840728 201001 2 005