Lplpo Jaringan Dak, Apbd & Kapitasi 2019

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
SUMBER ANGGARAN DAK

UNIT : RUANG FARMASI Bulan :
Tahun :
SATU STOK PENERI PERSE PENGE SISA PERMIN
No NAMA OBAT
AN AWAL MAAN DIAAN LUARAN STOK TAAN
1 2 3 4 5 6 7 8 9
1 Acetylsistein tablet - - - - -
2 Akarbose tablet 300 - 300 - 300
3 Alinamin F inj amp - - - - -
4 Allopurinol 100 mg tablet - - - - -
5 Allopurinol 300 tablet 170 150 320 85 235 60
6 Alprazolam 0,5 tablet - - - - -
7 Alprazolam 1 tablet - - - - -
8 Ambroxol suspensi 15mg/5ml botol - - - - -
9 Ambroxol tablet 30mg tablet - - - - -
10 Aminophillin tablet - - - - -
11 Amitriptilin 25mg tablet - - - - -
12 Amlodipin 10 mg tablet 840 - 840 270 570 600
13 Amlodipin 5 tablet 2,176 - 2,176 1,060 1,116 1,200
14 Amoxicillin 250 mg tablet 286 - 286 44 242 300
15 Amoxicillin 500 mg tablet 1,014 1,000 2,014 290 1,724
16 Amoxicillin sir ker 125mg/5ml botol - 60 60 2 58
17 Amoxicillin sir ker forte 250mg/5ml botol 41 - 41 24 17
18 Antasida DOEN tablet 562 - 562 12 550
19 Antasida Syrup botol 46 50 96 34 62 10
20 Anti hemorroid DOEN suppo - 5 5 5 - 11
21 Asam Askorbat 50 mg kotak 696 500 1,196 394 802
22 Asam folat (PROFOLAT) tablet 305 - 305 - 305
No NAMA OBAT
1 2 3 4 5 6 7 8 9
23 Asam Mefenamat 500mg tablet 428 500 928 340 588 1,000
24 Asam Traneksamat Inj amp - - - - -
25 Asering infus botol - - - - -
26 Asering 5 infus botol - - - - -
27 Asiklovir 200 mg tablet - - - - -
28 Asiklovir 400 mg tablet 494 - 494 68 426
29 Asiklovir krim 5% tube - - - - -
30 Ativan Lorasepam 2 Mg tablet - - - - -
31 Atorvastatin 10 tablet 10 - 10 - 10
32 Atorvastatin 20 tablet - - - - -
33 Atropin inj im,iv,sk 0,25mg/ml amp - - - - -
34 Azitromicin 250 mg tablet - - - - -
35 Azitromicin syrup botol - - - - -
36 Bacitracin S.K. tube - - - - -
37 Becefort syrup botol - - - - -
38 Becefort tablet tablet - - - - -
39 Berotec spray - - - - -
40 Betahistin Mesilat 6 mg tab tablet 767 - 767 80 687
41 Betametason krim tube 17 - 17 2 15
42 Bio ATP tablet tablet - - - - -
43 Bioron tablet - - - - -
44 Bisacodil tab tablet 50 - 50 - 50
45 Bisoprolol 2,5 mg (CONCOR) tablet 75 - 75 - 75 200
46 Bricasma inj ampul - - - - -
47 Bricasma nebuleizer pcs - - - - -
48 Bricasma turboheler pcs - - - - -
49 Calcium Gluconas ampul - - - - -
50 Carbamazepin 200 mg tablet - - - - -
51 Cefexime tablet 236 500 736 380 356 300
52 Ceterizine 10mg capsul 626 620 1,246 611 635 520
No NAMA OBAT
1 2 3 4 5 6 7 8 9
53 Ceterizine syr botol 25 - 25 12 13
54 Citicholin injeksi amp - - - - -
55 Clobazam 10 mg tablet - - - - -
56 Co-Amoksiklav tablet tablet - - - - -
57 Codein 10 mg tablet - - - - -
60 Combivenc hebulazer inj ampul - - - - -
61 Decamidon injeksi vial - - - - -
62 Deksametason Injk amp - - - - -
63 Desoximethason 0,25% crim tube 5 - 5 - 5
64 Dexametason 0,5 tablet 542 500 1,042 273 769
65 Dextral sirup botol - - - - -
66 Diamicron tablet 150 - 150 - 150
67 Diazepam 2mg tablet - - - - -
68 Diazepam 5mg tablet - - - - -
69 Diazepam injk amp - - - - -
70 Difenhidramin Inj ampul - - - - -
71 Digoxin 0,25 mg tablet - - - - -
72 Diltiazem 30 mg tablet - - - - -
73 Dimenhidrinat tablet 85 - 85 - 85
74 Domperidon 10 mg tablet 261 - 261 31 230 200
75 Domperidon Syrup botol 36 - 36 15 21 50
76 Dulcolax Suppo Adult 10 mg suppo - 9 9 9 - 17
77 Dulcolax Suppo Invan 5mg suppo - - - - -
78 Epinefrin Injeksi amp - - - - -
79 Erithromicin 500 mg kaplet - - - - -
80 Eritromicin syr botol - - - - -
81 Esomeprazole injk ampul - - - - -
82 Famotidin 40mg tablet Tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
83 Fenolglicerol T.Telinga botol 23 - 23 - 23
84 Fitomenadion tablet 186 - 186 3 183
85 Fitomenadion inj im 2mg/ml amp - - - - -
86 Fungasol SS botol - - - - -
87 Furosemid inj ampul - - - - -
88 Furosemid40 mg tablet 228 - 228 20 208 200
89 Garam oralit sachet - - - - -
90 Gemfibrozil 300 mg tablet 762 - 762 116 646
91 Gentamisin Injeksi amp - - - - -
92 Gentamisin salep kulit 0,1% tube - 16 16 3 13
93 Gentamisin salep Mata 0,3% tube 22 - 22 - 22
94 Gentamisin tetes Mata 0.3% botol 16 - 16 - 16
95 Geriavita tablet 60 - 60 - 60
96 Glibenclamid 5 mg tablet - - - - -
97 Glikasid tablet - - - - -
98 Glimepiride 1 mg tablet 260 - 260 - 260
99 Glimepiride 2 mg tablet 45 - 45 - 45
100 Glimepiride 3 mg tablet 524 - 524 100 424
101 Glimepiride 4 mg tablet 415 - 415 110 305 500
102 Gliseril Guaiakolat 100 mg tab tablet - - - - -
103 Glucodex/GORED tablet 310 - 310 20 290
104 Glucotrol XL 10 tablet - - - - -
105 Glukosa 5 % Infus botol - - - - -
106 Griceofulvin 500 tablet - - - - -
107 Griseofulvin tab 125mg tablet 150 - 150 - 150
108 Haloperidol 0,5 tablet - - - - -
109 Haloperidol 1,5 tablet - - - - -
110 Haloperidol 5 tablet - - - - -
111 Harnal tablet 57 - 57 - 57
112 Herbesser CD 100 (DiltiazemSR 100) tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
113 Herbesser CD 200 (DiltiazemSR 200) tablet - - - - -
114 Hidroklortiazid (HCT 25 mg) tablet 111 - 111 - 111
115 Hidrokortison salep kulit tube 33 6 39 20 19
116 Hiosin Butil Bromida Injk (Spashi plus injk) amp - - - - -
117 Humidefier Adapter Injk botol - - - - -
118 Hustab kaplet 175 - 175 - 175
119 Ibuprofen 200mg tablet 534 1,500 2,034 1,095 939 500
120 Ibuprofen 400mg tablet 490 - 490 30 460
121 Ibuprofen suspensi 200mg/5ml botol 15 20 35 4 31
122 Iliadin spray (dws) botol 1 4 5 - 5
123 Iliadin tts (ank) botol 1 6 7 - 7
124 Irbestan 150 mg tablet 150 - 150 - 150
125 Irbestan 300 mg tablet - - - - -
126 Isosorbit 5 tablet - 100 100 3 97
127 KAEN 1B infus botol - - - - -
128 KAEN 3A infus botol - - - - -
129 KAEN 3B infus botol - - - - -
130 Kalium Diklofenak 50mg tablet tablet - - - - -
131 Kalsium Laktat(novakal) tablet 433 500 933 420 513 1,000
132 Kandesartan 8 tablet 235 - 235 30 205
133 Kaominal syr botol - - - - -
134 Kaptopril 12,5 mg tablet 373 - 373 60 313
135 Kaptopril 25 mg tablet 227 - 227 - 227 300
136 Kaptopril 50 mg tablet - - - - -
137 Karbamazepin 200 tablet - - - - -
138 Ketoconazol salep tube 21 - 21 6 15 25
139 Ketokonazol 200 mg tablet 332 - 332 20 312
140 Ketoprofen 100 mg tablet - - - - -
141 Ketoprofen injeksi 100mg amp - - - - -
142 Ketorolak Injk amp - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
143 Klindamisin 150 mg tablet 250 - 250 40 210
144 Klindamisin 300 mg tablet - - - - -
145 Kloramfenikol salep mata tube - - - - -
146 Kloramfenikol Syrup botol - - - - -
147 Kloramfenikol tetes mata botol 14 - 14 6 8
148 Klorfeniramin Maleat/CTM 4mg tablet - - - - -
149 Klorpromasin 100 mg tablet - - - - -
150 Klozapin tablet - - - - -
151 Kotrimoksazol 480 mg tablet 131 - 131 - 131
152 Lactodia sachet - - - - -
153 Lambucid tablet tablet - - - - -
154 Lansoprasol tablet 153 400 553 190 363
155 Lapifed tablet tablet - - - - -
156 Levofloxacin 500 mg tablet 90 - 90 - 90
157 Levopar tablet - - - - -
158 Lexacrol sirup botol - - - - -
159 Lexapram syrup botol - - - - -
160 Lidocain Injeksi amp - - - - -
161 Lidocain Jelly tube - - - - -
162 Lisinopril 10 mg tablet - - - - -
163 Loperamid 2 mg (trifadium) tablet 252 - 252 - 252
164 Loratadin 10 mg tablet - - - - -
165 Meloxicam 15mg tablet tablet - - - - -
166 Metampiron injeksi (Antalgin) amp - - - - -
167 Metampiron tablet 500mg tablet 4 - 4 - 4
168 Metformin 500mg tablet - - - - -
169 Metformin 850mg tablet 500 - 500 - 500
170 Metilergometrin tablet - - - - -
171 Metilergometrin inj amp - - - - -
172 Metilprednisolon 4mg tablet 270 300 570 203 367 1,500
No NAMA OBAT
1 2 3 4 5 6 7 8 9
173 Metilprednisolon 8mg tablet - - - - -
174 Metoklorpromid injk amp - - - - -
175 Metoklorpromid 5 mg tablet - - - - -
176 Metronidazol 500 mg tablet 500 - 500 130 370 500
177 MgSO4 20% inj Amp - - - - -
178 Mineral Mix sachet - - - - -
179 Miniaspi tablet - - - - -
180 Molagit tablet - - - - -
181 Molasma tablet 200 - 200 - 200
182 Molexflu sirup botol - - - - -
183 Molexflu tablet tablet - - - - -
184 Nacl Infus botol - - - - -
185 Natrium Diklofenac 25 mg tablet 575 500 1,075 475 600 500
186 Natrium Diklofenac 50 mg tablet 444 - 444 - 444
187 Nebacetin powder botol 5 grm - - - - -
188 Nebacetin salep tube - - - - -
189 Neo Diagon (attapulgit) tablet - - - - -
190 Neurobion 5000 injeksi amp - - - - -
191 New Antides (attapulgit) tablet 406 500 906 160 746
192 Nifedipin 10 mg tablet 234 - 234 1 233
193 Nistatin 500.000 tablet 257 - 257 - 257
194 Nistatin vag 100.000 IV/ gram tablet 10 - 10 - 10
195 Norages inj 500mg amp - - - - -
196 Novacobalamin 50mg tablet 472 - 472 - 472
197 OBH sirup botol - - - - -
198 Oksitetrasiklin salep kulit 3 % tube 1 - 1 - 1
199 Oksitetrasiklin salep mata 1 % tube - - - - -
200 Omeprazol 20mg tablet 585 300 885 310 575 300
201 Ondansentron 4 Mg tablet 145 - 145 10 135
202 Ondansentron 8 Mg tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
203 Ondansentron Injk amp - - - - -
204 Osteotin capsul - - - - -
205 Ostovel (kalsitriol) tablet 150 - 150 70 80
206 Otsu D40 amp - - - - -
207 Otsu MgSO4 40% amp - - - - -
208 Paracetamol Infus botol - - - - -
209 Paracetamol syr 125 botol 60ml 61 100 161 74 87 60
210 Parasetamol drop botol - - - - -
211 Parasetamol tablet 100mg tablet - - - - -
212 Parasetamol tablet 500mg tablet 1,430 1,500 2,930 1,217 1,713 1,000
213 Permetrin cream (Scabimite) tube - - - - -
214 Permetrin tablet tube - - - - -
215 Piralen injeksi amp - - - - -
216 Pirasetam 800mg tablet tablet - - - - -
217 Piridoksin 10 mg tablet - - - - -
218 Piridoksin 25 mg tablet - - - - -
219 Piroxicam 20mg/licofel kapsul 248 200 448 - 448
220 Pitogin injeksi amp - - - - -
221 Pravastatin 20 tablet - - - - -
222 Prednison tablet 5mg tablet 422 - 422 47 375
223 Primpen syr (metoklopramid) botol - - - - -
224 Propanolol tablet - - - - -
225 Ranitidin 150 mg tablet 797 - 797 354 443 1,000
226 Ranitidin Injeksi amp - - - - -
227 Reco Kloramfenikol tetes telinga botol 10ml - - - - -
228 Ringer Laktat Infus botol - - - - -
229 Risperidon 1 tablet - - - - -
230 Risperidon 2 tablet - - - - -
231 Salbutamol 4mg tablet 329 - 329 30 299
232 Salbutamol syr botol 10 - 10 - 10
No NAMA OBAT
1 2 3 4 5 6 7 8 9
233 Salep 2-4 tablet 20 - 20 - 20
234 Sanmol infus botol 100 ml - - - - -
235 Sefadroxil 250 mg capsul 300 - 300 - 300
236 Sefadroxil 500 mg tablet 880 - 880 30 850 500
237 Sefadroxil Syrup 125 Mg botol 44 - 44 - 44
238 Sefadroxil Syrup 250 Mg botol - - - - -
239 Sefalexim 500 mg tablet 180 - 180 - 180
240 Sefepim serbuk Injk 1000 mg vial 5 ml - - - - -
241 Sefexim Syrup botol 19 - 19 - 19
242 Sefotaxim Injk vial 5 ml - - - - -
243 Seftriakson Injk vial - - - - -
244 Seledoxyn 10mg tablet tablet - - - - -
245 Serum Anti Bisa Ular I vial 5 ml - - - - -
246 Serum Anti Diftery 20,000 IU vial 5 ml - - - - -
247 Serum Anti Tetanus 1500 iu amp - 1 1 1 - 7
248 Sianokobalamin injk amp - - - - -
249 Simetidin 200 mg tablet 64 - 64 10 54
250 Simvastatin 10 mg tablet 385 - 385 65 320 600
251 Simvastatin 20 mg tablet 240 500 740 150 590
252 Siprofloxacim 500mg tablet 67 300 367 40 327
253 Skincol gel tube - - - - -
254 Spashi Plus tablet tablet - - - - -
255 Spirinolakton 100mg tablet - - - - -
256 Stabimit cair botol - - - - -
257 Stesolid Diasepam rectal 10 mg suppo - - - - -
258 Stesolid Diasepam rectal 5 mg suppo - - - - -
259 Stimuno syr botol 6 10 16 1 15 20
260 Sukralfat syr botol - - - - -
261 Suprafenid Suppo (Ketoprofen) suppo - - - - -
262 Tablet tambah darah tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
263 Taburia sachet - - - - -
264 Tetagram Injeksi amp - - - - -
265 Tetrasiklin 250 mg capsul - - - - -
267 Thiamfilex suspensi botol 60 ml - - - - -
268 Thyrozol 5 tablet - - - - -
269 Tiamfenikol 500mg kapsul capsul 50 - 50 20 30 100
270 Tiamfenikol 500mg kapsul / SOLATHIM capsul - - - - -
271 Tiamin injeksi 100mg/ml amp - - - - -
272 Tiamin/Vit. B1tab50mg (HCl/Nitrat) tablet 270 - 270 - 270
273 Topamax 25 mg tablet - - - - -
274 Topamax 50 mg tablet - - - - -
275 Tramadol tablet - - - - -
276 Trihaxiphenidil 25 mg tablet - - - - -
277 Tyrosol 10 mg tablet 170 - 170 - 170
278 Urinter tablet 100 - 100 10 90
279 Vagizol Ovula suppo - - - - -
280 Valdimex 10 inj amp - - - - -
281 Valproit syr botol 4 - 4 - 4
282 Valsartan 8 tablet 150 - 150 - 150
283 Ventolin tablet - - - - -
284 Ventolin Nebulaser nebul - - - - -
285 Vit B Komplek tablet 1,076 - 1,076 549 527 2,000
286 Water for Injecktion 25 ml (Aqua pro injk) amp - - - - -
287 Wida D5 1/2Ns Infus botol - - - - -
288 Wida D5 1/4Ns Infus botol - - - - -
289 Wida D5.Ns Infus botol - - - - -
290 Zinc tablet 640 - 640 38 602
291 Zinc Pro Drops Syrup botol - - - - -
292 Zinnat 500mg (Sefuroksim) tablet 50 - 50 - 50
No NAMA OBAT
1 2 3 4 5 6 7 8 9
293 Zink syrup botol 27 36 63 11 52
- - - - -
INSULIN - - - - -
294 Humalog 1unit/ kotak - - - - -
295 Lantus 1unit/ kotak - 1 1 1 - 1
296 Levemir Flexpen Analog 1unit/ kotak - 3 3 3 -
297 Novo Twist 326 pcs - - - - - 1
298 Novomix Flexpen 1unit/ kotak - 8 8 8 - 2
299 Novorapid flexpen 1unit/ kotak - - - - -
- - - - -
BAHAN MEDIS HABIS PAKAI - - - - -
300 Alat Suntik 1ml pcs - - - - -
301 Alat Suntik 2,5 ml pcs - - - - -
302 Alat Suntik 3 ml pcs - - - - -
303 Alat Suntik 5 ml pcs - - - - -
304 Alkohol Swab pcs - - - - -
305 Antiseptik Hand Rub 5 liter galon - - - - -
306 Antiseptik Hand Rub 500 ml botol - - - - -
307 Aseptic gel botol - - - - -
308 Bedak Salicyl dos 10 10 20 8 12 10
309 Blood transfusion set pcs - - - - -
310 Bracket buah - - - - -
311 Catgut Chromic 3/0 pcs - - - - -
312 Catgut Plaint 2/0 pcs - - - - -
313 Catgut Plaint 3/0 sct - - - - -
314 Catgut Cromic 2/0 pcs - - - - -
315 Etanol 70 % 1 liter botol 1 liter - - - - -
316 Eugenol botol - - - - -
317 Examinasi Glove sixe M (Sarung Tangan) pcs - - - - -
318 Examinasi Glove sixe S (Sarung Tangan) pcs - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
319 Film IV dressing kotak - - - - -
320 Folly Catheter 2 way no 16 pcs - - - - -
321 Folly Catheter 2 way no 18 pcs - - - - -
322 Gips 10 cm x 2,7 m rol - - - - -
323 Gips 7,5 cm x 2,7 m rol - - - - -
324 Infusion set anak pcs - - - - -
325 Infusion set dewasa pcs - - - - -
326 IV catheter 18 G pcs - - - - -
331 Kantung urine Pee & Pee pack - - - - -
332 Kapas berlemak 250 gram bungkus - - - - -
333 Kapas berlemak 500 gram bungkus - - - - -
334 Kasa hidrophil 40 x 40 cm pack - - - - -
335 Kasa hidrophil 40 x 80 cm pack - - - - -
336 Kasa hidrophil steril 16x16cm pcs - - - - -
337 Kasa pembalut hydrophil 18 x 22cm rol - - - - -
338 Kasa pembalut hydrophil 4 x10cm pack - - - - -
339 Kasa pembalut hydrophil 4 x15cm pack - - - - -
340 Kasa pembalut hydrophil 4 x3cm rol - - - - -
341 Kasa pembalut hydrophil 4 x5cm rol - - - - -
342 Lisol botol - - - - -
343 Masker pcs - - - - -
344 Nasal oxygen Cannula Size L pcs - - - - -
345 Nasal oxygen Cannula Size M pcs - - - - -
346 Nasal oxygen Cannula Size S pcs - - - - -
347 Plester Dermafix (10 x 15cm) rol - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
351 Plester Dermafix (10 x12cm) rol - - - - -
353 Plester fixomul rol - - - - -
354 Plester Pharmafix (10 x 500cm) rol - - - - -
357 Plester pharmafix (5 x 5cm) rol - - - - -
358 Povidon 10% 1Lt botol - - - - -
359 Povidon 10% 300ml botol - - - - -
360 Povidon 10% 60ml botol - - - - -
361 Rivanol botol - - - - -
362 Sarung tangan no.6 (Safe Glove) pasang - - - - -
365 Sarung tangan obgyn pasang - - - - -
366 Silk pcs - - - - -
367 Steril phouch pcs - - - - -
368 Surgical tape box - - - - -
369 Urine bag 2L pcs - - - - -
370 Ventolin rotahaler pcs - - - - -
371 Wing needle 21 G box - - - - -
372 Wing needle 23 G pcs - - - - -
373 Wing needle 25 G pcs - - - - -
374 Wing needle 27 G box - - - - -
- - - - -
OBAT GIGI - - - - -
375 Alvogyl pot - - - - -
376 Articulating Paper dus - - - - -
377 Bonding dasar tambalan botol - - - - -
378 Bur diamond set 6FG Edenta pcs - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
379 Bor Polishing Kit sach - - - - -
380 Cal LC dus - - - - -
381 Cavitol syringe - - - - -
382 Caustinerf Rapid botol 4.5 gram - - - - -
383 CHKM/camphenol dus - - - - -
384 Citodur Soft botol 30 gr - - - - -
385 Dentin Conditioner dus - - - - -
386 Elite cement MP bh - - - - -
387 Email preparator Bh - - - - -
388 Endoseptone botol - - - - -
389 Etsa Scocthbond cement botol - - - - -
390 Ethyl Chloride Semprot botol spray - - - - -
391 Exterpasie Jarum tabung - - - - -
392 Glass Ionomer Fuji IX ART botol - - - - -
393 Hydcal dus - - - - -
394 Hemospon/curaspon spon - - - - -
395 Kemdent matrix strip strip - - - - -
396 Kendo K-file Jarum file - - - - -
397 Kendo K-reamer kotak - - - - -
398 Mata bur high speed Edenta sct - - - - -
399 Mata bur high speed SS White sct - - - - -
400 Metapex pcs - - - - -
401 Mummifying Pasta antiseptik botol - - - - -
402 Pulperyl dus - - - - -
403 Reamers box - - - - -
404 Solare A2 dus - - - - -
405 Solare X dus - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
406 Stae Bond botol - - - - -
407 TKF dus - - - - -
408 Topicaina/prime gel pot - - - - -
Wedges 4953/ Transparan Strip Matrix Strip poly pack
409 strip - - - - -
Sumenep,
Mengetahui Yang Menyerahkan Penanggung Ja
Kepala Puskesmas Pamolokan Petugas Gudang Puskesmas Pamolokan RUANG FA
Kecamatan Kota Sumenep Kecamatan Kota Sumenep
dr. RIFMI UTAMI, M.Kes VERA YUNITA

Nip. 19760826 200501 2 008 Nip . 19810621 200901 2 005
LEMBAR PERMINTAAN OBAT (LPLPO)
NGGARAN DAK
JANUARI
2019
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
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10 11 ###
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JANUARI 2019
Penanggung Jawab Obat
RUANG FARMASI
REGISTER BULANAN
SUMBER ANGGARAN APBD
Unit : RUANG FARMASI
SATU STOK PENERI PERSE

No NAMA OBAT
AN AWAL MAAN DIAAN 1 2 3 4 5 6 7 8 9 10
1 Albendazol Syrup botol -
2 Alinamin F injk amp -
3 Allopurinol tab 100mg tablet -
4 Alprazolam 1mg tablet -
5 Altera syrup botol 18 18
6 Amaropo Plus tablet 700 500 1,200 78 20 85 50 30
7 Ambroxol 30 mg tablet 1,099 1,000 2,099 10 20 10 20 34
8 Ambroxol Syrup botol 47 47 2 1 2
9 Aminofilin 200mg tablet 15 15
10 Aminofilin inj 24mg/ml amp -
12 Amitriptilin tab 25mg tablet -
13 Amlodipin tab 10mg tablet -
14 Amlodipin tab 5mg tablet -
15 Amoksisilin kap 250mg tablet -
16 Amoksisilin kaps 500mg tablet -
17 Amoksisilin syr 125mg/5ml botol 60 ml -
18 Amoksisilin syr forte 250mg/5ml botol 60 ml -
20 Antalgidon Injeksi vial -
21 Antalpugit (PULAREX) tablet -
22 Antasida DOEN I tab kunyah tablet -
23 Antasida DOEN syrup tablet -
24 Antibakteri DOEN salep(basitrasin500 I tube -
25 Antihemorroid kotak -
No NAMA OBAT
27 Antimigren:ergotamin tartrat 1mg+ kofe tablet -
28 Antimo Herbal Syrup sacht -
29 Antiparkinson DOEN (benserazid 25m tablet -
30 Antitusif Syr botol
31 Antrain Injeksi amp -
32 Aqua Pro Injeksi vial -
33 Asam askorbat/Vit.C tab 50mg tablet -
34 Asam Folat kap 1mg tablet -
35 Asam mefenamat kap 500mg tablet -
36 Asam traneksamat injk amp -
37 Asering 5 Infus botol -
38 Asering Infus botol -
39 Asetosal 80 mg (Miniaspi) tablet 123 123
40 Asiklovir kap 200mg tablet -
41 Asiklovir kap 400mg tablet -
42 Asiklovir krim kotak 25 25 2 1
43 Atropin Injk amp -
44 Azitrimisin 250 mg tablet -
45 Becefort caplet -
46 Becefort Syrup Botol 60 ml -
47 Betahistine 6 mg tablet -
48 Betametason krim 0,1% tube -
49 Bio ATP tablet 500 500 1,000 40 50 10 10 20
50 Bioneuron tablet -
51 Bioneuron Injk amp -
52 Bioron tablet 260 500 760 80 10 10 10 20 30 40 10
53 Bioron injk amp -
54 Bisoprolol 5 mg tablet -
55 Bromhexin tablet -
56 Cardismo 20 Mg tablet -
57 Cartogen tablet 60 60
58 Citicholin Injk amp -
No NAMA OBAT
59 Clobazam 10 mg tablet -
60 Codein 10 mg tablet -
63 Cystone tablet 100 100
64 Deksametason inj iv/im 5mg/ml amp -
65 Deksametason tab 0,5mg tablet -
66 Desoximethason krim 0,25% tube -
67 Dextamin tablet 500 500
68 Dextamin Syrup botol -
69 Dextral tablet -
70 Dextral F tablet 620 500 1,120 60 10 40 50 10 50 60
71 Dextral Syrup botol 60ml 10 10
72 Dextrofen syrup botol 9 9
73 Diazepam 5 mg/ml Injeksi amp -
74 Diazepam lart.rektal tube -
75 Difenhidramin tablet -
76 Difenhidramin inj iv/im 10mg/ml (HCl) amp -
77 Digoksin tab 0,25mg tablet -
78 Diltiazem 30 mg tablet -
79 Dimenhidrinat tab 50mg tablet -
80 DIOS tablet 150 150 10
81 Domperidon susp 5mg/5ml botol -
82 Domperidon tab tablet -
84 Dormi Compositum tablet 379 379
85 Epinefrin/Adrenalin inj iv/sk/im 1mg/ml amp -
86 Eritromisin kap 250mg tablet -
87 Eritromisin kap 500mg kapsul -
88 Eritromisin sir.kering 200mg/5ml botol -
89 Erlamycetin tetes telinga (khlorampenico botol 23 23 1
90 Etambutol 500mg (HCl) tablet -
91 Etambutol tab 250mg tablet -
No NAMA OBAT
93 Famotidin 40mg tablet -
94 Fenitoin inj 100mg/ml amp -
95 Fenitoin inj 50mg/ml amp -
96 Fenitoin kap 100mg tablet -
97 Fenoksimetil penisilin (penisilin V)tab tablet -
98 Fenoksimetil penisilin (penisilin V)tab tablet -
99 Fenolgliserol Tetes Telinga flas -
100 Fitomenadion/Vit K Injeksi amp -
101 Fitomenadion/Vit K tab salut gula 10mg tablet -
102 Flucort N Zalp Tube 5 gram -
103 Furosemid 40mg tab tablet -
104 Furosemid inj iv/im 10mg/ml vial -
105 Garam Oralit I sacht -
106 Gemfibrozil 300 mg capsul -
107 Gentamicyn Injeksi amp -
108 Gentamicyn salep mata tube -
109 Gentamycin salep kulit kotak 16 16 2 2 1 1 2 2 2
110 Gentamycin tetes mata botol -
111 Glibenklamid tab 5 mg tablet 195 195
112 Glikuidon 30 mg tablet -
113 Glimepirid 1 mg tablet -
114 Gliseril Guaiyacolat100 mg tablet 597 597 10 10 20 2 12 2
115 Gliserin lar 50% botol -
116 Glukodex 80 mg tablet -
117 Glukosa lar.infus 10% (dextrose 10%) botol -
118 Glukosa lar.infus 5% (Dextrose 5%) botol -
119 Griseofulvin tab 125mg tablet -
120 Haloperidol tab 0,5mg tablet -
121 Haloperidol tab 1,5mg tablet -
122 Haloperidol tab 2mg tablet -
123 Haloperidol tab 5mg tablet -
124 Hemafort tablet 665 665 10 10 30
No NAMA OBAT
125 Hemogard Capsul capsul -
126 Hepagard Tablet tablet 190 190 10
127 Hidrokortison krim 2,5% tube -
128 Hiosin Butil Promida Injk amp -
129 Hustab tablet 730 730
130 Ibuprofen 200mg tablet -
131 Ibuprofen 400mg tablet -
132 Ibuprofen Syrup tablet -
133 IKADRIL injk amp -
134 Isosorbid Dinitrat tab sublingual 5mg tablet -
135 KA EN 1B Infus botol -
136 KA EN 3A Infus botol -
137 KA EN 3B Infus botol -
138 Kalium Diklofenat 50 mg tablet -
139 Kaloba tablet -
140 Kaloba Syrup Syrup -
141 Kalsium Laktat 500mg tablet -
142 Kaptopril 12,5mg tablet -
143 Kaptopril tab 25mg tablet -
144 Kaptopril tab 50mg tablet -
145 Karbamazepin 200 mg tablet -
146 Karbogliserin tts telinga 10% botol -
147 Ketokonazol 200mg tablet -
148 Ketokonazol krim 2% tube -
149 Ketoprofen Injeksi amp -
150 Ketorolac inj 30mg/ml amp -
151 Klindamisin kaps 300mg tablet -
152 Kloramfenikol kap 250mg capsul 86 86
153 Kloramfenikol salep mata 1 % tube 40 40
154 Kloramfenikol Syrup botol 34 34
155 Klorpheniramin Maleat (CTM) tablet 784 784 2 2 2 12 6
156 Klorpromazin 100 mg tablet -
No NAMA OBAT
157 Klorpromazin 25 mg tablet -
158 Klorpromazin Injeksi 25 mg amp -
159 Klorpromazin Injeksi 5 mg amp -
160 Kolkatriol tablet
161 Kotrimoksazol DOEN I (dewasa):Sulfa tablet -
162 Kotrimoksazol susp(sulfametoksazol 2 botol 18 18
163 Lactodia polybag/ 10 mg -
164 Lansoprazol 30 mg tablet -
165 Lapifed tablet -
166 Levofloxasin 500 mg tablet -
167 Lexacrol tablet 370 370
168 Lexacrol Syrup botol 100 ml -
169 Lidokain inj 2%+epinefrin 1:80.000-2ml amp -
170 Lidokain Jelly tube -
171 Lisinopril tablet -
172 Loperamid tab 2mg tablet -
173 Loratadin 10 mg tablet -
174 Lorazepam 2 mg/ Merlopan tablet -
175 Lytacur syr botol 6 58 64 1
176 Mebendazole 500mg kotak/24 cath -
177 Meloxicam 15 mg tablet 510 510 10 10
178 Mersibion 5000 injk amp -
179 Mertigo SR tablet -
180 Metamphiron 500mg/Metamizol 500mg tablet 885 500 1,385 30 20 10 20 40 30 30
181 Metaneuron tablet tablet -
182 Metformin 500 mg tablet -
185 MethylPrednisolon 4 mg tablet -
186 Metilergometrin maleat injk 0,25mg amp -
187 Metilergometrin maleat tab salut 0,25m tablet 134 134
188 Metoklopramid 5mg/ 60 ml syrup (Lexa botol 5 5
189 Metoklopramid tab 5mg tablet -
190 Metronidasol 250mg tab tablet -
No NAMA OBAT
191 Metronidasol 500mg tab tablet -
192 Metronidazol infus 500mg/100ml botol -
193 MgSo4 20% vial -
194 MgSo4 40% vial -
195 Molexdinde Gargle botol -
196 Molexflu tablet 481 481 10 10 20
197 Molexflu Syrup botol 60 botol 10 45 55 1
198 NaCl 0,9% Infus botol -
200 Natrium Diklofenat 50 mg tablet -
201 NB Top Salep tube -
202 Nebacetin Powder botol 5 gram -
203 Nebacetin Zalp tube -
204 Neo Kaominanl Syrup botol 29 29 1 1
205 Neomycin Basitrasin Salep Kulit (Topica tube 14 14 1 1 2
206 Neumed tablet tablet -
207 Neurobion inj 5000 ampul -
208 Nifedipin 10mg tablet -
209 Nifedipin slow rease oros 20 mg tablet -
210 Nistatin tab salut 500,000 IU/g tablet -
211 Nistatin Vag.tab 100.000 IU/g tablet 16 16
212 Norages Injeksi amp -
213 Noza tablet 500 500
214 Ocugard tablet -
215 Oksitetrasiklin injk 10 ml amp -
216 Oksitetrasiklin salep mata tube -
217 Oksitetrasiklin Zalp kulit kotak 25 25
218 Oksitosin injk amp -
219 Omeprasol injk 40ml / 10 ml vial -
220 Omeprasol kap 20mg tablet -
221 Ondansetron 4mg tablet -
222 Ondansetron inj 4mg/2ml amp -
No NAMA OBAT
223 Osteotin 125 mg tablet 531 531
224 Parasetamol 500mg tab tablet -
225 Parasetamol Infus botol/ 100 ml -
226 Parasetamol sirup 120mg/5ml botol -
227 Parasetamol sirup Drop 100mg/ 15ml botol -
228 Pehacain Injk amp -
229 Phetidin HCL 50mg/ml amp -
230 Piracetam 800mg tablet 300 300
232 Pirantel susp 125mg/5ml botol -
233 Pirantel tab 125mg tablet -
234 Pirazinamid tab 500mg tablet -
235 Piroxicam 20mg kapsul 200 200
236 Prednison tablet -
237 Profika (Ketoprofen Suppo) suppo -
238 Propanolol 10 mg tablet 160 160
239 Propanolol tab 40mg tablet 100 100
240 Ranitidin 150mg tablet -
241 Ranitidin inj 25mg/2ml amp -
244 RL infus botol -
245 Salbutamol 2mg tablet -
246 Salbutamol 4 mg (sulfat) tablet 67 67
247 Saldona Forte tablet -
249 Salep 2-4,kombinasi:asam salisilat 2% pot -
250 Sanbe Kids Syrup botol -
251 Sefadroksil kap 500mg kapsul -
252 Sefadroksil sir.kering 125mg/5ml botol -
253 Sefadroksil sir.kering 250mg/5ml botol -
254 Sefotaxim injk vial -
255 Seftriakson serbuk inj 1g/vial vial -
256 Serum Anti Bisa Ular (SABU) vial -
257 Serum Anti Difteri 20.000 UI vial -
No NAMA OBAT
258 Serum Anti Tetanus 1.500 IU (ATS) amp -
259 Setirizin 10 mg capsul -
260 Sianokobalamin tablet -
261 Sianokobalamin inj 500mcg amp -
262 Simvastatin tab 10mg tablet -
263 Simvastatin tab 20mg tablet -
264 Siprofloksasin infus 2% botol -
265 Siprofloksasin tab 500mg kaplet -
266 Sotatic Injk amp -
267 Spironolakton 100 mg tablet -
268 Stimuno syr botol
269 Syntocinon amp -
270 Tablet tambah darah (Fe So4 + Asam Fo tablet -
271 Taburia sacth -
272 Tebokan tablet 100 100
273 Tensigard tablet 220 220
274 Tetagram/ Human tetanus (munoglobulikotak/ 1pcs -
275 Tetrakain HCl tts mata 0,5% botol -
276 Tetrasiklin 250 mg capsul -
277 Tetrasiklin 500 mg capsul 147 147
278 Thiamfilex syrup botol 7 7 1
279 Thiamin Injeksi amp -
280 Thiamphenikol 500mg capsul 250 250
281 Thyrosol 10 mg tablet -
282 Tramadol tablet -
283 Tramadol Injeksi 50 mg/ ml amp -
284 Trampara tablet
285 Unthecol tablet -
286 Ventolin inhaler botol 200 dosis -
287 Vermox 500 mg tablet 20 20
288 Vit. B Kompleks tab tablet -
289 Vitamin neurotopik tablet
No NAMA OBAT
290 Vitamin neurotopik inj ampul
291 WIDA D5-1/2NS (Dextrase) botol -
292 WIDA D5-1/4NS (Dextrose) botol -
293 WIDA D5-NS (Dextrose) botol -
295 Zentra tablet -
296 Zinc tab dispersible 20mg tablet -
297 Zircum Kid Syr botol -
BAHAN MEDIS HABIS PAKAI

298 Catgut chromic 2/0+jarum 1/2GT 35mm pcs -
299 Catgut chromic 3/0+jarum 1/2GT 35mm pcs -
300 Catgut plain 2/0+jarum 1/2GT 35mm pcs -
301 Catgut plain 3/0+jarum 1/2GT 35mm pcs -
302 Etanol 70% botol 100ml -
303 Ethil Chlorida spray botol -
304 Eugenol botol -
305 Folley catheter 2 way no 18 pcs -
306 Infusion set pediatric (anak) pcs -
307 Kasa 4 x 10 cm rol -
308 Kasa 4 x 5 cm rol -
309 Lisol 1 L botol -
310 Plester ultrafix rol -
311 Povidon Iodida 10% 300ml botol -
312 Povidon Iodida 10% 30ml botol -
313 Rivanol 300cc botol -
314 Salicyl bedak kotak -
315 Sarung Tangan / Examination Glove pcs -
316 Sarung Tangan No. 7 pasang -
317 Silk 3/0+jarum 1/2GT 35mm pcs -
318 Spuit 1 cc pcs -
321 Yodium 1 liter botol -
No NAMA OBAT
Mengetahui Yang Me
Kepala Puskesmas Pamolokan Petugas Gudang P
Kecamatan Kota Sumenep Kecamatan
dr. RIFMI UTAMI, M.Kes VERA

Nip. 19760826 200501 2 008 Nip . 198106
LANAN
N APBD
Bulan : JANUARI Unit

Tahun : 2019
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 1 Albendazol Syrup
- - 2 Alinamin F injk
- - 3 Allopurinol tab 100mg
- - 4 Alprazolam 1mg
- 18 5 Altera syrup
20 70 50 10 20 10 70 30 10 553 647 6 Amaropo Plus
75 10 40 20 20 26 50 10 20 20 10 395 1,704 7 Ambroxol 30 mg
2 2 1 2 1 13 34 8 Ambroxol Syrup
- 15 9 Aminofilin 200mg
- - 10 Aminofilin inj 24mg/ml
- - 12 Amitriptilin tab 25mg
- - 13 Amlodipin tab 10mg
- - 14 Amlodipin tab 5mg
- - 15 Amoksisilin kap 250mg
- - 16 Amoksisilin kaps 500mg
- - 17 Amoksisilin syr 125mg/5m
- - 18 Amoksisilin syr forte 250m
- - 20 Antalgidon Injeksi
- - 21 Antalpugit (PULAREX)
- - 22 Antasida DOEN I tab kun
- - 23 Antasida DOEN syrup
- - 24 Antibakteri DOEN salep(b
- - 25 Antihemorroid
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 27 Antimigren:ergotamin tart
- - 28 Antimo Herbal Syrup
- - 29 Antiparkinson DOEN (ben
- - 30 Antitusif Syr
- - 31 Antrain Injeksi
- - 32 Aqua Pro Injeksi
- - 33 Asam askorbat/Vit.C tab 5
- - 34 Asam Folat kap 1mg
- - 35 Asam mefenamat kap 50
- - 36 Asam traneksamat injk
- - 37 Asering 5 Infus
- - 38 Asering Infus
- 123 39 Asetosal 80 mg (Miniaspi
- - 40 Asiklovir kap 200mg
- - 41 Asiklovir kap 400mg
3 22 42 Asiklovir krim
- - 43 Atropin Injk
- - 44 Azitrimisin 250 mg
- - 45 Becefort
- - 46 Becefort Syrup
- - 47 Betahistine 6 mg
- - 48 Betametason krim 0,1%
40 10 180 820 49 Bio ATP
- - 50 Bioneuron
- - 51 Bioneuron Injk
50 40 10 10 10 20 350 410 52 Bioron
- - 53 Bioron injk
- - 54 Bisoprolol 5 mg
- - 55 Bromhexin
- - 56 Cardismo 20 Mg
- 60 57 Cartogen
- - 58 Citicholin Injk
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 59 Clobazam 10 mg
- - 60 Codein 10 mg
- - 61 Codein 15 mg
- - 62 Codein 20 mg
- 100 63 Cystone
- - 64 Deksametason inj iv/im 5
- - 65 Deksametason tab 0,5mg
- - 66 Desoximethason krim 0,2
10 20 10 30 10 10 90 410 67 Dextamin
- - 68 Dextamin Syrup
- - 69 Dextral
50 20 10 30 10 10 10 90 10 10 530 590 70 Dextral F
1 1 2 8 71 Dextral Syrup
- 9 72 Dextrofen syrup
- - 73 Diazepam 5 mg/ml Injeks
- - 74 Diazepam lart.rektal
- - 75 Difenhidramin
- - 76 Difenhidramin inj iv/im 10
- - 77 Digoksin tab 0,25mg
- - 78 Diltiazem 30 mg
- - 79 Dimenhidrinat tab 50mg
10 140 80 DIOS
- - 81 Domperidon susp 5mg/5m
- - 82 Domperidon tab
- 379 84 Dormi Compositum
- - 85 Epinefrin/Adrenalin inj iv/s
- - 86 Eritromisin kap 250mg
- - 87 Eritromisin kap 500mg
- - 88 Eritromisin sir.kering 200m
1 1 3 20 89 Erlamycetin tetes telinga
- - 90 Etambutol 500mg (HCl)
- - 91 Etambutol tab 250mg
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 93 Famotidin 40mg
- - 94 Fenitoin inj 100mg/ml
- - 95 Fenitoin inj 50mg/ml
- - 96 Fenitoin kap 100mg
- - 97 Fenoksimetil penisilin (pe
- - 98 Fenoksimetil penisilin (pe
- - 99 Fenolgliserol Tetes Teling
- - 100 Fitomenadion/Vit K Injeks
- - 101 Fitomenadion/Vit K tab sa
- - 102 Flucort N Zalp
- - 103 Furosemid 40mg tab
- - 104 Furosemid inj iv/im 10mg
- - 105 Garam Oralit I
- - 106 Gemfibrozil 300 mg
- - 107 Gentamicyn Injeksi
- - 108 Gentamicyn salep mata
2 1 1 16 - 109 Gentamycin salep kulit
- - 110 Gentamycin tetes mata
- 195 111 Glibenklamid tab 5 mg
- - 112 Glikuidon 30 mg
- - 113 Glimepirid 1 mg
4 4 7 5 4 11 9 4 2 4 110 487 114 Gliseril Guaiyacolat100 m
- - 115 Gliserin lar 50%
- - 116 Glukodex 80 mg
- - 117 Glukosa lar.infus 10% (de
- - 118 Glukosa lar.infus 5% (Dex
- - 119 Griseofulvin tab 125mg
- - 120 Haloperidol tab 0,5mg
- - 121 Haloperidol tab 1,5mg
- - 122 Haloperidol tab 2mg
- - 123 Haloperidol tab 5mg
30 10 90 575 124 Hemafort
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 125 Hemogard Capsul
10 10 10 40 150 126 Hepagard Tablet
- - 127 Hidrokortison krim 2,5%
- - 128 Hiosin Butil Promida Injk
20 20 710 129 Hustab
- - 130 Ibuprofen 200mg
- - 131 Ibuprofen 400mg
- - 132 Ibuprofen Syrup
- - 133 IKADRIL injk
- - 134 Isosorbid Dinitrat tab sub
- - 135 KA EN 1B Infus
- - 136 KA EN 3A Infus
- - 137 KA EN 3B Infus
- - 138 Kalium Diklofenat 50 mg
- - 139 Kaloba
- - 140 Kaloba Syrup
- - 141 Kalsium Laktat 500mg
- - 142 Kaptopril 12,5mg
- - 143 Kaptopril tab 25mg
- - 144 Kaptopril tab 50mg
- - 145 Karbamazepin 200 mg
- - 146 Karbogliserin tts telinga 1
- - 147 Ketokonazol 200mg
- - 148 Ketokonazol krim 2%
- - 149 Ketoprofen Injeksi
- - 150 Ketorolac inj 30mg/ml
- - 151 Klindamisin kaps 300mg
- 86 152 Kloramfenikol kap 250mg
1 1 2 38 153 Kloramfenikol salep mata
- 34 154 Kloramfenikol Syrup
2 3 10 2 2 5 7 5 1 61 723 155 Klorpheniramin Maleat (C
- - 156 Klorpromazin 100 mg
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 157 Klorpromazin 25 mg
- - 158 Klorpromazin Injeksi 25 m
- - 159 Klorpromazin Injeksi 5 mg
- - 160 Kolkatriol
- - 161 Kotrimoksazol DOEN I (d
- 18 162 Kotrimoksazol susp(sulfa
- - 163 Lactodia
- - 164 Lansoprazol 30 mg
- - 165 Lapifed
- - 166 Levofloxasin 500 mg
30 10 10 10 10 40 10 40 160 210 167 Lexacrol
- - 168 Lexacrol Syrup
- - 169 Lidokain inj 2%+epinefrin
- - 170 Lidokain Jelly
- - 171 Lisinopril
- - 172 Loperamid tab 2mg
- - 173 Loratadin 10 mg
- - 174 Lorazepam 2 mg/ Merlop
2 1 1 1 1 6 4 7 3 4 4 35 29 175 Lytacur syr
- - 176 Mebendazole 500mg
10 10 10 10 20 10 90 420 177 Meloxicam 15 mg
- - 178 Mersibion 5000 injk
- - 179 Mertigo SR
10 20 30 30 10 10 20 30 50 390 995 180 Metamphiron 500mg/Met
- - 181 Metaneuron tablet
- - 182 Metformin 500 mg
- - 185 MethylPrednisolon 4 mg
- - 186 Metilergometrin maleat in
- 134 187 Metilergometrin maleat ta
- 5 188 Metoklopramid 5mg/ 60 m
- - 189 Metoklopramid tab 5mg
- - 190 Metronidasol 250mg tab
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 191 Metronidasol 500mg tab
- - 192 Metronidazol infus 500mg
- - 193 MgSo4 20%
- - 194 MgSo4 40%
- - 195 Molexdinde Gargle
45 30 3 20 5 143 338 196 Molexflu
1 2 1 1 1 3 10 45 197 Molexflu Syrup
- - 198 NaCl 0,9% Infus
- - 200 Natrium Diklofenat 50 mg
- - 201 NB Top Salep
- - 202 Nebacetin Powder
- - 203 Nebacetin Zalp
1 1 4 25 204 Neo Kaominanl Syrup
1 1 4 10 4 205 Neomycin Basitrasin Sale
- - 206 Neumed tablet
- - 207 Neurobion inj 5000
- - 208 Nifedipin 10mg
- - 209 Nifedipin slow rease oros
- - 210 Nistatin tab salut 500,000
- 16 211 Nistatin Vag.tab 100.000
- - 212 Norages Injeksi
- 500 213 Noza
- - 214 Ocugard
- - 215 Oksitetrasiklin injk 10 ml
- - 216 Oksitetrasiklin salep mata
- 25 217 Oksitetrasiklin Zalp kulit
- - 218 Oksitosin injk
- - 219 Omeprasol injk 40ml / 10
- - 220 Omeprasol kap 20mg
- - 221 Ondansetron 4mg
- - 222 Ondansetron inj 4mg/2ml
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
10 10 521 223 Osteotin 125 mg
- - 224 Parasetamol 500mg tab
- - 225 Parasetamol Infus
- - 226 Parasetamol sirup 120mg
- - 227 Parasetamol sirup Drop 1
- - 228 Pehacain Injk
- - 229 Phetidin HCL 50mg/ml
- 300 230 Piracetam 800mg
- - 232 Pirantel susp 125mg/5ml
- - 233 Pirantel tab 125mg
- - 234 Pirazinamid tab 500mg
- 200 235 Piroxicam 20mg
- - 236 Prednison
- - 237 Profika (Ketoprofen Supp
- 160 238 Propanolol 10 mg
- 100 239 Propanolol tab 40mg
- - 240 Ranitidin 150mg
- - 241 Ranitidin inj 25mg/2ml
- - 244 RL infus
- - 245 Salbutamol 2mg
- 67 246 Salbutamol 4 mg (sulfat)
- - 247 Saldona Forte
- - 249 Salep 2-4,kombinasi:asam
- - 250 Sanbe Kids Syrup
- - 251 Sefadroksil kap 500mg
- - 252 Sefadroksil sir.kering 125
- - 253 Sefadroksil sir.kering 250
- - 254 Sefotaxim injk
- - 255 Seftriakson serbuk inj 1g/
- - 256 Serum Anti Bisa Ular (SA
- - 257 Serum Anti Difteri 20.000
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 258 Serum Anti Tetanus 1.500
- - 259 Setirizin 10 mg
- - 260 Sianokobalamin
- - 261 Sianokobalamin inj 500m
- - 262 Simvastatin tab 10mg
- - 263 Simvastatin tab 20mg
- - 264 Siprofloksasin infus 2%
- - 265 Siprofloksasin tab 500mg
- - 266 Sotatic Injk
- - 267 Spironolakton 100 mg
- - 268 Stimuno syr
- - 269 Syntocinon
- - 270 Tablet tambah darah (Fe
- - 271 Taburia
- 100 272 Tebokan
- 220 273 Tensigard
- - 274 Tetagram/ Human tetanus
- - 275 Tetrakain HCl tts mata 0,5
- - 276 Tetrasiklin 250 mg
- 147 277 Tetrasiklin 500 mg
1 6 278 Thiamfilex syrup
- - 279 Thiamin Injeksi
- 250 280 Thiamphenikol 500mg
- - 281 Thyrosol 10 mg
- - 282 Tramadol
- - 283 Tramadol Injeksi 50 mg/ m
- - 284 Trampara
- - 285 Unthecol
- - 286 Ventolin inhaler
- 20 287 Vermox 500 mg
- - 288 Vit. B Kompleks tab
- - 289 Vitamin neurotopik
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- - 290 Vitamin neurotopik inj
- - 291 WIDA D5-1/2NS (Dextras
- - 292 WIDA D5-1/4NS (Dextros
- - 293 WIDA D5-NS (Dextrose)
- - 295 Zentra
- - 296 Zinc tab dispersible 20mg
- - 297 Zircum Kid Syr
- -
- - BAHAN MEDIS HABIS P
- - 298 Catgut chromic 2/0+jarum
- - 299 Catgut chromic 3/0+jarum
- - 300 Catgut plain 2/0+jarum 1/
- - 301 Catgut plain 3/0+jarum 1/
- - 302 Etanol 70%
- - 303 Ethil Chlorida spray
- - 304 Eugenol
- - 305 Folley catheter 2 way no
- - 306 Infusion set pediatric (ana
- - 307 Kasa 4 x 10 cm
- - 308 Kasa 4 x 5 cm
- - 309 Lisol 1 L
- - 310 Plester ultrafix
- - 311 Povidon Iodida 10% 300m
- - 312 Povidon Iodida 10% 30m
- - 313 Rivanol 300cc
- - 314 Salicyl bedak
- - 315 Sarung Tangan / Examina
- - 316 Sarung Tangan No. 7
- - 317 Silk 3/0+jarum 1/2GT 35m
- - 318 Spuit 1 cc
- - 319 Spuit 3 cc
- - 320 Spuit 5 cc
- - 321 Yodium 1 liter
PENGE SISA
No NAMA OBAT
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
Yang Menyerahkan Mengetahui

Petugas Gudang Puskesmas Pamolokan Kepala Puskesmas Pamo
Kecamatan Kota Sumenep Kecamatan Kota Sume
VERA YUNITA dr. RIFMI UTAMI, M.

Nip . 19810621 200901 2 005 Nip. 19760826 200501 2
REGISTER BULANAN
: RUANG FARMASI

NAMA OBAT
AN AWAL MAAN DIAAN 26 27 28 29 30 31 1 2 3 4 5 6 7
dazol Syrup botol - -
min F injk amp - -
rinol tab 100mg tablet - -
olam 1mg tablet - -
botol 18 18
po Plus tablet 647 300 947 58 100 72 10 10 36 20 10
xol 30 mg tablet 1,704 1,704 90 29 72 31 5 40 25 35 3
xol Syrup botol 34 34 2 1 1 4 5 1 1
filin 200mg tablet 15 15
filin inj 24mg/ml amp - -
ptilin tab 25mg tablet - -
ipin tab 10mg tablet - -
ipin tab 5mg tablet - -
sisilin kap 250mg tablet - -
sisilin kaps 500mg tablet - -
sisilin syr 125mg/5ml botol 60 ml - -
sisilin syr forte 250mg/5ml botol 60 ml - -
idon Injeksi vial - -
ugit (PULAREX) tablet - -
da DOEN I tab kunyah tablet - -
da DOEN syrup tablet - -
kteri DOEN salep(basitrasin500 I tube - -
morroid kotak - -
NAMA OBAT
gren:ergotamin tartrat 1mg+ kofe tablet - -
o Herbal Syrup sacht - -
rkinson DOEN (benserazid 25m tablet - -
botol -
n Injeksi amp - -
Pro Injeksi vial - -
askorbat/Vit.C tab 50mg tablet - -
Folat kap 1mg tablet - -
mefenamat kap 500mg tablet - -
traneksamat injk amp - -
g 5 Infus botol - -
g Infus botol - -
sal 80 mg (Miniaspi) tablet 123 123
vir kap 200mg tablet - -
vir kap 400mg tablet - -
vir krim kotak 22 22 1
amp - -
misin 250 mg tablet - -
caplet - -
ort Syrup Botol 60 ml - -
stine 6 mg tablet - -
etason krim 0,1% tube - -
tablet 820 500 1,320 20 60 30 50 50 40 10 10
tablet - -
uron Injk amp - -
tablet 410 410 10 20 20 20 20
amp - -
olol 5 mg tablet - -
tablet - -
mo 20 Mg tablet - -
tablet 60 60
olin Injk amp - -
NAMA OBAT
zam 10 mg tablet - -
n 10 mg tablet - -
n 15 mg tablet - -
n 20 mg tablet - -
tablet 100 100
metason inj iv/im 5mg/ml amp - -
metason tab 0,5mg tablet - -
imethason krim 0,25% tube - -
tablet 410 410 80 10 5 20 10
min Syrup botol - -
tablet - -
tablet 590 1,000 1,590 10 10 10 20 30 10 20 95
l Syrup botol 60ml 8 20 28 1 1 2
fen syrup botol 9 9
pam 5 mg/ml Injeksi amp - -
pam lart.rektal tube - -
idramin tablet - -
idramin inj iv/im 10mg/ml (HCl) amp - -
sin tab 0,25mg tablet - -
em 30 mg tablet - -
hidrinat tab 50mg tablet - -
tablet 140 140
eridon susp 5mg/5ml botol - -
eridon tab tablet - -
Compositum tablet 379 379
rin/Adrenalin inj iv/sk/im 1mg/ml amp - -
misin kap 250mg tablet - -
misin kap 500mg kapsul - -
misin sir.kering 200mg/5ml botol - -
ycetin tetes telinga (khlorampenico botol 20 20 1 1
utol 500mg (HCl) tablet - -
utol tab 250mg tablet - -
NAMA OBAT
idin 40mg tablet - -
in inj 100mg/ml amp - -
in inj 50mg/ml amp - -
in kap 100mg tablet - -
simetil penisilin (penisilin V)tab tablet - -
simetil penisilin (penisilin V)tab tablet - -
gliserol Tetes Telinga flas - -
enadion/Vit K Injeksi amp - -
enadion/Vit K tab salut gula 10mg tablet - -
t N Zalp Tube 5 gram - -
emid 40mg tab tablet - -
emid inj iv/im 10mg/ml vial - -
m Oralit I sacht - -
brozil 300 mg capsul - -
micyn Injeksi amp - -
micyn salep mata tube - -
mycin salep kulit kotak - -
mycin tetes mata botol - -
klamid tab 5 mg tablet 195 195
don 30 mg tablet - -
pirid 1 mg tablet - -
l Guaiyacolat100 mg tablet 487 500 987 6 10 4 53 18 20 30 15 14 9
n lar 50% botol - -
dex 80 mg tablet - -
sa lar.infus 10% (dextrose 10%) botol - -
sa lar.infus 5% (Dextrose 5%) botol - -
fulvin tab 125mg tablet - -
eridol tab 0,5mg tablet - -
eridol tab 1,5mg tablet - -
eridol tab 2mg tablet - -
eridol tab 5mg tablet - -
tablet 575 500 1,075 60 10 60 10 40
NAMA OBAT
gard Capsul capsul - -
ard Tablet tablet 150 150 10
ortison krim 2,5% tube - -
Butil Promida Injk amp - -
tablet 710 710 10
fen 200mg tablet - -
fen 400mg tablet - -
fen Syrup tablet - -
amp - -
bid Dinitrat tab sublingual 5mg tablet - -
1B Infus botol - -
3A Infus botol - -
3B Infus botol - -
m Diklofenat 50 mg tablet - -
tablet - -
a Syrup Syrup - -
m Laktat 500mg tablet - -
pril 12,5mg tablet - -
pril tab 25mg tablet - -
pril tab 50mg tablet - -
mazepin 200 mg tablet - -
gliserin tts telinga 10% botol - -
onazol 200mg tablet - -
onazol krim 2% tube - -
ofen Injeksi amp - -
lac inj 30mg/ml amp - -
misin kaps 300mg tablet - -
mfenikol kap 250mg capsul 86 86
mfenikol salep mata 1 % tube 38 38
mfenikol Syrup botol 34 34
eniramin Maleat (CTM) tablet 723 723 13 20 12 5 3 7
omazin 100 mg tablet - -
NAMA OBAT
omazin 25 mg tablet - -
omazin Injeksi 25 mg amp - -
omazin Injeksi 5 mg amp - -
tablet -
oksazol DOEN I (dewasa):Sulfa tablet - -
oksazol susp(sulfametoksazol 2 botol 18 18 1
polybag/ 10 mg - -
prazol 30 mg tablet - -
tablet - -
oxasin 500 mg tablet - -
tablet 210 750 960 10 30 10 20 30 10
rol Syrup botol 100 ml - -
in inj 2%+epinefrin 1:80.000-2ml amp - -
in Jelly tube - -
tablet - -
amid tab 2mg tablet - -
din 10 mg tablet - -
epam 2 mg/ Merlopan tablet - -
botol 29 15 44 2 1 5 1 1 1 2 1
ndazole 500mg kotak/24 cath - -
cam 15 mg tablet 420 500 920 10 10 10 20 25 80
bion 5000 injk amp - -
tablet - -
mphiron 500mg/Metamizol 500mg tablet 995 1,000 1,995 10 20 10 20 20 20 10
euron tablet tablet - -
min 500 mg tablet - -
Prednisolon 4 mg tablet - -
rgometrin maleat injk 0,25mg amp - -
rgometrin maleat tab salut 0,25m tablet 134 134
opramid 5mg/ 60 ml syrup (Lexa botol 5 5
opramid tab 5mg tablet - -
nidasol 250mg tab tablet - -
NAMA OBAT
nidasol 500mg tab tablet - -
nidazol infus 500mg/100ml botol - -
vial - -
vial - -
dinde Gargle botol - -
tablet 338 300 638 3 35 12 20 14 13 30
lu Syrup botol 60 botol 45 55 100 2 1 1 2 5 1 6 2
0,9% Infus botol - -
m Diklofenat 50 mg tablet - -
p Salep tube - -
etin Powder botol 5 gram - -
etin Zalp tube - -
aominanl Syrup botol 25 25 2 1 1
ycin Basitrasin Salep Kulit (Topica tube 4 4 2 2
ed tablet tablet - -
bion inj 5000 ampul - -
pin 10mg tablet - -
pin slow rease oros 20 mg tablet - -
n tab salut 500,000 IU/g tablet - -
n Vag.tab 100.000 IU/g tablet 16 16
es Injeksi amp - -
tablet 500 500
tablet - -
trasiklin injk 10 ml amp - -
trasiklin salep mata tube - -
trasiklin Zalp kulit kotak 25 25
sin injk amp - -
rasol injk 40ml / 10 ml vial - -
rasol kap 20mg tablet - -
nsetron 4mg tablet - -
nsetron inj 4mg/2ml amp - -
NAMA OBAT
in 125 mg tablet 521 300 821 40 10 20 50
etamol 500mg tab tablet - -
etamol Infus botol/ 100 ml - -
etamol sirup 120mg/5ml botol - -
etamol sirup Drop 100mg/ 15ml botol - -
ain Injk amp - -
in HCL 50mg/ml amp - -
tam 800mg tablet 300 300
el susp 125mg/5ml botol - -
el tab 125mg tablet - -
namid tab 500mg tablet - -
cam 20mg kapsul 200 200
tablet - -
a (Ketoprofen Suppo) suppo - -
nolol 10 mg tablet 160 160
nolol tab 40mg tablet 100 100
din 150mg tablet - -
din inj 25mg/2ml amp - -
botol - -
amol 2mg tablet - -
amol 4 mg (sulfat) tablet 67 67
na Forte tablet - -
2-4,kombinasi:asam salisilat 2% pot - -
Kids Syrup botol - -
oksil kap 500mg kapsul - -
oksil sir.kering 125mg/5ml botol - -
oksil sir.kering 250mg/5ml botol - -
xim injk vial - -
kson serbuk inj 1g/vial vial - -
Anti Bisa Ular (SABU) vial - -
Anti Difteri 20.000 UI vial - -
NAMA OBAT
Anti Tetanus 1.500 IU (ATS) amp - -
in 10 mg capsul - -
kobalamin tablet - -
kobalamin inj 500mcg amp - -
statin tab 10mg tablet - -
statin tab 20mg tablet - -
oksasin infus 2% botol - -
oksasin tab 500mg kaplet - -
amp - -
olakton 100 mg tablet - -
botol -
amp - -
tambah darah (Fe So4 + Asam Fo tablet - -
sacth - -
tablet 100 100
tablet 220 220
am/ Human tetanus (munoglobulikotak/ 1pcs - -
ain HCl tts mata 0,5% botol - -
klin 250 mg capsul - -
klin 500 mg capsul 147 147 60
filex syrup botol 6 6 1 1 1
in Injeksi amp - -
phenikol 500mg capsul 250 100 350 10 10
sol 10 mg tablet - -
tablet - -
dol Injeksi 50 mg/ ml amp - -
ara tablet -
tablet - -
in inhaler botol 200 dosis - -
x 500 mg tablet 20 20
Kompleks tab tablet - -
n neurotopik tablet -
NAMA OBAT
n neurotopik inj ampul -
D5-1/2NS (Dextrase) botol - -
D5-1/4NS (Dextrose) botol - -
D5-NS (Dextrose) botol - -
tablet - -
ab dispersible 20mg tablet - -
m Kid Syr botol - -
-
N MEDIS HABIS PAKAI -
chromic 2/0+jarum 1/2GT 35mm pcs - -
chromic 3/0+jarum 1/2GT 35mm pcs - -
plain 2/0+jarum 1/2GT 35mm pcs - -
plain 3/0+jarum 1/2GT 35mm pcs - -
botol 100ml - -
hlorida spray botol - -
botol - -
catheter 2 way no 18 pcs - -
n set pediatric (anak) pcs - -
4 x 10 cm rol - -
4 x 5 cm rol - -
botol - -
r ultrafix rol - -
on Iodida 10% 300ml botol - -
on Iodida 10% 30ml botol - -
ol 300cc botol - -
bedak kotak - -
g Tangan / Examination Glove pcs - -
g Tangan No. 7 pasang - -
0+jarum 1/2GT 35mm pcs - -
pcs - -
pcs - -
pcs - -
m 1 liter botol -
NAMA OBAT
Mengetahui Yang M
a Puskesmas Pamolokan Petugas Gudang
amatan Kota Sumenep Kecamata
RIFMI UTAMI, M.Kes VER

. 19760826 200501 2 008 Nip . 1981
ULANAN
AN APBD
Bulan : FEBRUARI
Tahun : 2019
PENGELUARAN PENGE SISA
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- 18
10 38 14 54 10 20 10 32 10 35 22 571 376
12 22 12 10 23 30 22 16 35 40 40 75 667 1,037
1 1 1 2 20 14
- 15
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 123
- -
- -
1 3 5 17
- -
- -
- -
- -
- -
- -
130 10 30 10 20 40 510 810
- -
- -
10 20 40 10 20 20 210 200
- -
- -
- -
- -
- 60
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- 100
- -
- -
- -
125 285
- -
- -
30 92 10 120 60 43 90 40 60 40 40 30 80 940 650
1 1 1 1 1 1 1 1 4 16 12
1 1 8
- -
- -
- -
- -
- -
- -
- -
- 140
- -
- -
- 379
- -
- -
- -
- -
1 1 4 16
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 195
- -
- -
12 33 14 10 5 12 10 7 31 16 12 20 361 626
- -
- -
- -
- -
- -
- -
- -
- -
- -
10 40 10 20 20 10 10 10 10 10 20 350 725
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
10 30 30 40 120 30
- -
- -
10 700
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 86
1 1 37
- 34
12 15 16 10 16 2 12 16 3 20 9 11 15 217 506
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
1 2 1 5 13
- -
- -
- -
- -
10 10 10 10 10 10 170 790
- -
- -
- -
- -
- -
- -
- -
1 2 6 1 5 1 1 1 2 5 2 1 42 2
- -
10 10 10 10 40 100 60 10 50 455 465
- -
- -
10 20 10 30 20 20 20 20 10 35 10 10 10 20 355 1,640
- -
- -
- -
- -
10 10 20 114
- 5
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
5 10 10 30 30 10 10 30 262 376
2 2 2 2 2 1 4 4 1 40 60
- -
- -
- -
- -
- -
1 1 6 19
4 -
- -
- -
- -
- -
- -
- 16
- -
- 500
- -
- -
- -
- 25
- -
- -
- -
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
10 10 20 10 10 10 30 10 230 591
- -
- -
- -
- -
- -
- -
- 300
- -
- -
- -
- 200
- -
- -
- 160
- 100
- -
- -
- -
- -
10 11 20 20 61 6
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 100
- 220
- -
- -
- -
60 87
3 3
- -
10 10 15 55 295
- -
- -
- -
- -
- -
- -
- 20
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LUARAN STOK
Yang Menyerahkan
Petugas Gudang Puskesmas Pamolokan
Kecamatan Kota Sumenep
VERA YUNITA
Nip . 19810621 200901 2 005
REGIS
SUMBER AN
RUARI Unit : RUANG FARMASI

No NAMA OBAT
AN AWAL MAAN DIAAN 26 27 28 29 30 31 1 2 3
1 Albendazol Syrup botol - -
2 Alinamin F injk amp - -
3 Allopurinol tab 100mg tablet - -
4 Alprazolam 1mg tablet - -
5 Altera syrup botol 18 18
6 Amaropo Plus tablet 376 376 70 10 10 10
7 Ambroxol 30 mg tablet 1,037 1,500 2,537 69 14 12 17 43
8 Ambroxol Syrup botol 14 30 44 1 1
9 Aminofilin 200mg tablet 15 15
10 Aminofilin inj 24mg/ml amp - -
12 Amitriptilin tab 25mg tablet - -
13 Amlodipin tab 10mg tablet - -
14 Amlodipin tab 5mg tablet - -
15 Amoksisilin kap 250mg tablet - -
16 Amoksisilin kaps 500mg tablet - -
17 Amoksisilin syr 125mg/5ml botol 60 ml - -
18 Amoksisilin syr forte 250mg/5ml botol 60 ml - -
20 Antalgidon Injeksi vial - -
21 Antalpugit (PULAREX) tablet - -
22 Antasida DOEN I tab kunyah tablet - -
23 Antasida DOEN syrup tablet - -
24 Antibakteri DOEN salep(basitrasin500 I tube - -
25 Antihemorroid kotak - -
No NAMA OBAT
27 Antimigren:ergotamin tartrat 1mg+ kofe tablet - -
28 Antimo Herbal Syrup sacht - -
29 Antiparkinson DOEN (benserazid 25m tablet - -
30 Antitusif Syr botol -
31 Antrain Injeksi amp - -
32 Aqua Pro Injeksi vial - -
33 Asam askorbat/Vit.C tab 50mg tablet - -
34 Asam Folat kap 1mg tablet - -
35 Asam mefenamat kap 500mg tablet - -
36 Asam traneksamat injk amp - -
37 Asering 5 Infus botol - -
38 Asering Infus botol - -
39 Asetosal 80 mg (Miniaspi) tablet 123 123
40 Asiklovir kap 200mg tablet - -
41 Asiklovir kap 400mg tablet - -
42 Asiklovir krim kotak 17 17 2
43 Atropin Injk amp - -
44 Azitrimisin 250 mg tablet - -
45 Becefort caplet - -
46 Becefort Syrup Botol 60 ml - -
47 Betahistine 6 mg tablet - -
48 Betametason krim 0,1% tube - -
49 Bio ATP tablet 810 810 45 20 30 10
50 Bioneuron tablet - -
51 Bioneuron Injk amp - -
52 Bioron tablet 200 200 400 10 30 10
53 Bioron injk amp - -
54 Bisoprolol 5 mg tablet - -
55 Bromhexin tablet - 300 300
56 Cardismo 20 Mg tablet - -
57 Cartogen tablet 60 60
58 Citicholin Injk amp - -
No NAMA OBAT
59 Clobazam 10 mg tablet - -
60 Codein 10 mg tablet - -
63 Cystone tablet 100 100
64 Deksametason inj iv/im 5mg/ml amp - -
65 Deksametason tab 0,5mg tablet - -
66 Desoximethason krim 0,25% tube - -
67 Dextamin tablet 285 285
68 Dextamin Syrup botol - -
69 Dextral tablet - -
70 Dextral F tablet 650 800 1,450 50 30 33 10 10
71 Dextral Syrup botol 60ml 12 20 32 3 3 1
72 Dextrofen syrup botol 8 10 18 4
73 Diazepam 5 mg/ml Injeksi amp - -
74 Diazepam lart.rektal tube - -
75 Difenhidramin tablet - -
76 Difenhidramin inj iv/im 10mg/ml (HCl) amp - -
77 Digoksin tab 0,25mg tablet - -
78 Diltiazem 30 mg tablet - -
79 Dimenhidrinat tab 50mg tablet - -
80 DIOS tablet 140 140
81 Domperidon susp 5mg/5ml botol - -
82 Domperidon tab tablet - -
84 Dormi Compositum tablet 379 379
85 Epinefrin/Adrenalin inj iv/sk/im 1mg/ml amp - -
86 Eritromisin kap 250mg tablet - -
87 Eritromisin kap 500mg kapsul - -
88 Eritromisin sir.kering 200mg/5ml botol - -
89 Erlamycetin tetes telinga (khlorampenico botol 16 16
90 Etambutol 500mg (HCl) tablet - -
91 Etambutol tab 250mg tablet - -
No NAMA OBAT
93 Famotidin 40mg tablet - -
94 Fenitoin inj 100mg/ml amp - -
95 Fenitoin inj 50mg/ml amp - -
96 Fenitoin kap 100mg tablet - -
97 Fenoksimetil penisilin (penisilin V)tab tablet - -
98 Fenoksimetil penisilin (penisilin V)tab tablet - -
99 Fenolgliserol Tetes Telinga flas - -
100 Fitomenadion/Vit K Injeksi amp - -
101 Fitomenadion/Vit K tab salut gula 10mg tablet - -
102 Flucort N Zalp Tube 5 gram - -
103 Furosemid 40mg tab tablet - -
104 Furosemid inj iv/im 10mg/ml vial - -
105 Garam Oralit I sacht - -
106 Gemfibrozil 300 mg capsul - -
107 Gentamicyn Injeksi amp - -
108 Gentamicyn salep mata tube - -
109 Gentamycin salep kulit kotak - -
110 Gentamycin tetes mata botol - -
111 Glibenklamid tab 5 mg tablet 195 195
112 Glikuidon 30 mg tablet - -
113 Glimepirid 1 mg tablet - -
114 Gliseril Guaiyacolat100 mg tablet 626 626 35 4 2 10
115 Gliserin lar 50% botol - -
116 Glukodex 80 mg tablet - -
117 Glukosa lar.infus 10% (dextrose 10%) botol - -
118 Glukosa lar.infus 5% (Dextrose 5%) botol - -
119 Griseofulvin tab 125mg tablet - -
120 Haloperidol tab 0,5mg tablet - -
121 Haloperidol tab 1,5mg tablet - -
122 Haloperidol tab 2mg tablet - -
123 Haloperidol tab 5mg tablet - -
124 Hemafort tablet 725 725 10
No NAMA OBAT
125 Hemogard Capsul capsul - -
126 Hepagard Tablet tablet 30 30 30
127 Hidrokortison krim 2,5% tube - -
128 Hiosin Butil Promida Injk amp - -
129 Hustab tablet 700 700
130 Ibuprofen 200mg tablet - -
131 Ibuprofen 400mg tablet - -
132 Ibuprofen Syrup tablet - -
133 IKADRIL injk amp - -
134 Isosorbid Dinitrat tab sublingual 5mg tablet - -
135 KA EN 1B Infus botol - -
136 KA EN 3A Infus botol - -
137 KA EN 3B Infus botol - -
138 Kalium Diklofenat 50 mg tablet - -
139 Kaloba tablet - -
140 Kaloba Syrup Syrup - -
141 Kalsium Laktat 500mg tablet - -
142 Kaptopril 12,5mg tablet - -
143 Kaptopril tab 25mg tablet - -
144 Kaptopril tab 50mg tablet - -
145 Karbamazepin 200 mg tablet - -
146 Karbogliserin tts telinga 10% botol - -
147 Ketokonazol 200mg tablet - -
148 Ketokonazol krim 2% tube - -
149 Ketoprofen Injeksi amp - -
150 Ketorolac inj 30mg/ml amp - -
151 Klindamisin kaps 300mg tablet - -
152 Kloramfenikol kap 250mg capsul 86 86
153 Kloramfenikol salep mata 1 % tube 37 37
154 Kloramfenikol Syrup botol 34 34
155 Klorpheniramin Maleat (CTM) tablet 506 200 706 40 23 13
156 Klorpromazin 100 mg tablet - -
No NAMA OBAT
157 Klorpromazin 25 mg tablet - -
158 Klorpromazin Injeksi 25 mg amp - -
159 Klorpromazin Injeksi 5 mg amp - -
160 Kolkatriol tablet -
161 Kotrimoksazol DOEN I (dewasa):Sulfa tablet - -
162 Kotrimoksazol susp(sulfametoksazol 2 botol 13 13
163 Lactodia polybag/ 10 mg - -
164 Lansoprazol 30 mg tablet - -
165 Lapifed tablet - -
166 Levofloxasin 500 mg tablet - -
167 Lexacrol tablet 790 790 10
168 Lexacrol Syrup botol 100 ml - -
169 Lidokain inj 2%+epinefrin 1:80.000-2ml amp - -
170 Lidokain Jelly tube - -
171 Lisinopril tablet - -
172 Loperamid tab 2mg tablet - -
173 Loratadin 10 mg tablet - -
174 Lorazepam 2 mg/ Merlopan tablet - -
175 Lytacur syr botol 2 2
176 Mebendazole 500mg kotak/24 cath - -
177 Meloxicam 15 mg tablet 465 465 10 30 10 40
178 Mersibion 5000 injk amp - -
179 Mertigo SR tablet - -
180 Metamphiron 500mg/Metamizol 500mg tablet 1,640 1,640 20 20 30 80
181 Metaneuron tablet tablet - -
182 Metformin 500 mg tablet - -
185 MethylPrednisolon 4 mg tablet - -
186 Metilergometrin maleat injk 0,25mg amp - -
187 Metilergometrin maleat tab salut 0,25m tablet 114 114
188 Metoklopramid 5mg/ 60 ml syrup (Lexa botol 5 5
189 Metoklopramid tab 5mg tablet - -
190 Metronidasol 250mg tab tablet - -
No NAMA OBAT
191 Metronidasol 500mg tab tablet - -
192 Metronidazol infus 500mg/100ml botol - -
193 MgSo4 20% vial - -
194 MgSo4 40% vial - -
195 Molexdinde Gargle botol - -
196 Molexflu tablet 376 376 15 3 16 3 10
197 Molexflu Syrup botol 60 botol 60 60 1 1 2
198 NaCl 0,9% Infus botol - -
200 Natrium Diklofenat 50 mg tablet - -
201 NB Top Salep tube - -
202 Nebacetin Powder botol 5 gram - -
203 Nebacetin Zalp tube - -
204 Neo Kaominanl Syrup botol 19 19
205 Neomycin Basitrasin Salep Kulit (Topica tube - -
206 Neumed tablet tablet - -
207 Neurobion inj 5000 ampul - -
208 Nifedipin 10mg tablet - -
209 Nifedipin slow rease oros 20 mg tablet - -
210 Nistatin tab salut 500,000 IU/g tablet - -
211 Nistatin Vag.tab 100.000 IU/g tablet 16 16
212 Norages Injeksi amp - -
213 Noza tablet 500 500
214 Ocugard tablet - -
215 Oksitetrasiklin injk 10 ml amp - -
216 Oksitetrasiklin salep mata tube - -
217 Oksitetrasiklin Zalp kulit kotak 25 25
218 Oksitosin injk amp - -
219 Omeprasol injk 40ml / 10 ml vial - -
220 Omeprasol kap 20mg tablet - -
221 Ondansetron 4mg tablet - -
222 Ondansetron inj 4mg/2ml amp - -
No NAMA OBAT
223 Osteotin 125 mg tablet 591 591 10
224 Parasetamol 500mg tab tablet - -
225 Parasetamol Infus botol/ 100 ml - -
226 Parasetamol sirup 120mg/5ml botol - -
227 Parasetamol sirup Drop 100mg/ 15ml botol - -
228 Pehacain Injk amp - -
229 Phetidin HCL 50mg/ml amp - -
230 Piracetam 800mg tablet 300 300
232 Pirantel susp 125mg/5ml botol - -
233 Pirantel tab 125mg tablet - -
234 Pirazinamid tab 500mg tablet - -
235 Piroxicam 20mg kapsul 200 200 400
236 Prednison tablet - -
237 Profika (Ketoprofen Suppo) suppo - -
238 Propanolol 10 mg tablet 160 160
239 Propanolol tab 40mg tablet 100 100
240 Ranitidin 150mg tablet - -
241 Ranitidin inj 25mg/2ml amp - -
244 RL infus botol - -
245 Salbutamol 2mg tablet - -
246 Salbutamol 4 mg (sulfat) tablet 6 6
247 Saldona Forte tablet - -
249 Salep 2-4,kombinasi:asam salisilat 2% pot - -
250 Sanbe Kids Syrup botol - -
251 Sefadroksil kap 500mg kapsul - -
252 Sefadroksil sir.kering 125mg/5ml botol - -
253 Sefadroksil sir.kering 250mg/5ml botol - -
254 Sefotaxim injk vial - -
255 Seftriakson serbuk inj 1g/vial vial - -
256 Serum Anti Bisa Ular (SABU) vial - -
257 Serum Anti Difteri 20.000 UI vial - -
No NAMA OBAT
258 Serum Anti Tetanus 1.500 IU (ATS) amp - -
259 Setirizin 10 mg capsul - -
260 Sianokobalamin tablet - -
261 Sianokobalamin inj 500mcg amp - -
262 Simvastatin tab 10mg tablet - -
263 Simvastatin tab 20mg tablet - -
264 Siprofloksasin infus 2% botol - -
265 Siprofloksasin tab 500mg kaplet - -
266 Sotatic Injk amp - -
267 Spironolakton 100 mg tablet - -
268 Stimuno syr botol -
269 Syntocinon amp - -
270 Tablet tambah darah (Fe So4 + Asam Fo tablet - -
271 Taburia sacth - -
272 Tebokan tablet 100 100
273 Tensigard tablet 220 220
274 Tetagram/ Human tetanus (munoglobulikotak/ 1pcs - -
275 Tetrakain HCl tts mata 0,5% botol - -
276 Tetrasiklin 250 mg capsul - -
277 Tetrasiklin 500 mg capsul 87 87
278 Thiamfilex syrup botol 3 3
279 Thiamin Injeksi amp - -
280 Thiamphenikol 500mg capsul 295 295 10
281 Thyrosol 10 mg tablet - -
282 Tramadol tablet - -
283 Tramadol Injeksi 50 mg/ ml amp - -
284 Trampara tablet -
285 Unthecol tablet - -
286 Ventolin inhaler botol 200 dosis - -
287 Vermox 500 mg tablet 20 20
288 Vit. B Kompleks tab tablet - -
289 Vitamin neurotopik tablet -
No NAMA OBAT
290 Vitamin neurotopik inj ampul -
291 WIDA D5-1/2NS (Dextrase) botol - -
292 WIDA D5-1/4NS (Dextrose) botol - -
293 WIDA D5-NS (Dextrose) botol - -
295 Zentra tablet - -
296 Zinc tab dispersible 20mg tablet - -
297 Zircum Kid Syr botol - -
-
BAHAN MEDIS HABIS PAKAI -
298 Catgut chromic 2/0+jarum 1/2GT 35mm pcs - -
299 Catgut chromic 3/0+jarum 1/2GT 35mm pcs - -
300 Catgut plain 2/0+jarum 1/2GT 35mm pcs - -
301 Catgut plain 3/0+jarum 1/2GT 35mm pcs - -
302 Etanol 70% botol 100ml - -
303 Ethil Chlorida spray botol - -
304 Eugenol botol - -
305 Folley catheter 2 way no 18 pcs - -
306 Infusion set pediatric (anak) pcs - -
307 Kasa 4 x 10 cm rol - -
308 Kasa 4 x 5 cm rol - -
309 Lisol 1 L botol - -
310 Plester ultrafix rol - -
311 Povidon Iodida 10% 300ml botol - -
312 Povidon Iodida 10% 30ml botol - -
313 Rivanol 300cc botol - -
314 Salicyl bedak kotak - -
315 Sarung Tangan / Examination Glove pcs - -
316 Sarung Tangan No. 7 pasang - -
317 Silk 3/0+jarum 1/2GT 35mm pcs - -
318 Spuit 1 cc pcs - -
321 Yodium 1 liter botol -
No NAMA OBAT
Mengetahui
Kepala Puskesmas Pamolokan
dr. RIFMI UTAMI, M.Kes

Nip. 19760826 200501 2 008
REGISTER BULANAN
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
56 42 30 15 54 47 10 12 24 12 24 32
60 30 30 30 12 28 63 44 33 57 42 20 58 24 20 17 28 50
1 2 2 4
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
40 10 20 10 10 10 40 30 10 10
30 20 10 10 20 30
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
10 30 10 70 30 120 60 10 10 30 50 70 10 10 20 20
1 2 1
10
2
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
17 29 11 16 4 5 16 12 7 16 4 10 8
20 10 20 10 10 30 20
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
17 10 16 18 20 25 36 15 5 32 12 25 15 5 10 10 6
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
10 10 20 10 30
50 60 72 40 60 55 10 20 8
20 10 30 60 30 30 10 10 20 20 10 30
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
10 3 6 10 13 2 10 10 10
1 1 2
12
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
10 20 20 10
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
PENGELUARAN
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Yang Menyerahkan
VERA YUNITA
Nip . 19810621 200901 2 005
Bulan : MARET Unit : RUANG FARMASI
Tahun : 2019
PENGE SISA SATU STOK PENERI PERSE
No NAMA OBAT
LUARAN STOK AN AWAL MAAN DIAAN 26 27 28 29 30 31 1
- - 1 Albendazol Syrup botol - -
- - 2 Alinamin F injk amp - -
- - 3 Allopurinol tab 100mg tablet - -
- - 4 Alprazolam 1mg tablet - -
- 18 5 Altera syrup botol 18 18
458 (82) 6 Amaropo Plus tablet (82) (82)
801 1,736 7 Ambroxol 30 mg tablet 1,736 1,000 2,736 29 65 52 72 53 98
11 33 8 Ambroxol Syrup botol 33 33 1 1
- 15 9 Aminofilin 200mg tablet 15 15
- - 10 Aminofilin inj 24mg/ml amp - -
- - 12 Amitriptilin tab 25mg tablet - -
- - 13 Amlodipin tab 10mg tablet - -
- - 14 Amlodipin tab 5mg tablet - -
- - 15 Amoksisilin kap 250mg tablet - -
- - 16 Amoksisilin kaps 500mg tablet - -
- - 17 Amoksisilin syr 125mg/5ml botol 60 ml - -
- - 18 Amoksisilin syr forte 250mg/botol 60 ml - -
- - 20 Antalgidon Injeksi vial - -
- - 21 Antalpugit (PULAREX) tablet - -
- - 22 Antasida DOEN I tab kunyah tablet - -
- - 23 Antasida DOEN syrup tablet - -
- - 24 Antibakteri DOEN salep(basit tube - -
- - 25 Antihemorroid kotak - -
No NAMA OBAT
- - 27 Antimigren:ergotamin tartra tablet - -
- - 28 Antimo Herbal Syrup sacht - -
- - 29 Antiparkinson DOEN (bense tablet - -
- - 30 Antitusif Syr botol -
- - 31 Antrain Injeksi amp - -
- - 32 Aqua Pro Injeksi vial - -
- - 33 Asam askorbat/Vit.C tab 50 tablet - -
- - 34 Asam Folat kap 1mg tablet - -
- - 35 Asam mefenamat kap 500m tablet - -
- - 36 Asam traneksamat injk amp - -
- - 37 Asering 5 Infus botol - -
- - 38 Asering Infus botol - -
- 123 39 Asetosal 80 mg (Miniaspi) tablet 123 123
- - 40 Asiklovir kap 200mg tablet - -
- - 41 Asiklovir kap 400mg tablet - -
3 14 42 Asiklovir krim kotak 14 25 39 1
- - 43 Atropin Injk amp - -
- - 44 Azitrimisin 250 mg tablet - -
- - 45 Becefort caplet - -
- - 46 Becefort Syrup Botol 60 ml - -
- - 47 Betahistine 6 mg tablet - -
- - 48 Betametason krim 0,1% tube - -
295 515 49 Bio ATP tablet 515 500 1,015 10 10 20 55
- - 50 Bioneuron tablet - -
- - 51 Bioneuron Injk amp - -
170 230 52 Bioron tablet 230 1,000 1,230 10
- - 53 Bioron injk amp - -
- - 54 Bisoprolol 5 mg tablet - -
- 300 55 Bromhexin tablet 300 300
- - 56 Cardismo 20 Mg tablet - -
- 60 57 Cartogen tablet 60 60
- - 58 Citicholin Injk amp - -
No NAMA OBAT
- - 59 Clobazam 10 mg tablet - -
- - 60 Codein 10 mg tablet - -
- 100 63 Cystone tablet 100 100
- - 64 Deksametason inj iv/im 5mg amp - -
- - 65 Deksametason tab 0,5mg tablet - -
- - 66 Desoximethason krim 0,25% tube - -
- 285 67 Dextamin tablet 285 285
- - 68 Dextamin Syrup botol - -
- - 69 Dextral tablet - -
693 757 70 Dextral F tablet 757 500 1,257 10 40
11 21 71 Dextral Syrup botol 60ml 21 21
4 14 72 Dextrofen syrup botol 14 14 1
- - 73 Diazepam 5 mg/ml Injeksi amp - -
- - 74 Diazepam lart.rektal tube - -
- - 75 Difenhidramin tablet - -
- - 76 Difenhidramin inj iv/im 10mg amp - -
- - 77 Digoksin tab 0,25mg tablet - -
- - 78 Diltiazem 30 mg tablet - -
- - 79 Dimenhidrinat tab 50mg tablet - -
- 140 80 DIOS tablet 140 140
- - 81 Domperidon susp 5mg/5ml botol - -
- - 82 Domperidon tab tablet - -
10 369 84 Dormi Compositum tablet 369 369
- - 85 Epinefrin/Adrenalin inj iv/sk amp - -
- - 86 Eritromisin kap 250mg tablet - -
- - 87 Eritromisin kap 500mg kapsul - -
- - 88 Eritromisin sir.kering 200mg botol - -
2 14 89 Erlamycetin tetes telinga (kh botol 14 14 1
- - 90 Etambutol 500mg (HCl) tablet - 200 200
- - 91 Etambutol tab 250mg tablet - -
No NAMA OBAT
- - 93 Famotidin 40mg tablet - -
- - 94 Fenitoin inj 100mg/ml amp - -
- - 95 Fenitoin inj 50mg/ml amp - -
- - 96 Fenitoin kap 100mg tablet - -
- - 97 Fenoksimetil penisilin (penis tablet - -
- - 98 Fenoksimetil penisilin (penis tablet - -
- - 99 Fenolgliserol Tetes Telinga flas - -
- - 100 Fitomenadion/Vit K Injeksi amp - -
- - 101 Fitomenadion/Vit K tab salu tablet - -
- - 102 Flucort N Zalp Tube 5 gram - -
- - 103 Furosemid 40mg tab tablet - -
- - 104 Furosemid inj iv/im 10mg/ml vial - -
- - 105 Garam Oralit I sacht - -
- - 106 Gemfibrozil 300 mg capsul - -
- - 107 Gentamicyn Injeksi amp - -
- - 108 Gentamicyn salep mata tube - -
- - 109 Gentamycin salep kulit kotak - -
- - 110 Gentamycin tetes mata botol - -
- 195 111 Glibenklamid tab 5 mg tablet 195 195 10
- - 112 Glikuidon 30 mg tablet - -
- - 113 Glimepirid 1 mg tablet - -
206 420 114 Gliseril Guaiyacolat100 mg tablet 420 420 10 7
- - 115 Gliserin lar 50% botol - -
- - 116 Glukodex 80 mg tablet - -
- - 117 Glukosa lar.infus 10% (dext botol - -
- - 118 Glukosa lar.infus 5% (Dextr botol - -
- - 119 Griseofulvin tab 125mg tablet - -
- - 120 Haloperidol tab 0,5mg tablet - -
- - 121 Haloperidol tab 1,5mg tablet - -
- - 122 Haloperidol tab 2mg tablet - -
- - 123 Haloperidol tab 5mg tablet - -
130 595 124 Hemafort tablet 595 595
No NAMA OBAT
- - 125 Hemogard Capsul capsul - -
30 - 126 Hepagard Tablet tablet - -
- - 127 Hidrokortison krim 2,5% tube - -
- - 128 Hiosin Butil Promida Injk amp - -
- 700 129 Hustab tablet 700 700
- - 130 Ibuprofen 200mg tablet - -
- - 131 Ibuprofen 400mg tablet - -
- - 132 Ibuprofen Syrup tablet - -
- - 133 IKADRIL injk amp - -
- - 134 Isosorbid Dinitrat tab sublin tablet - -
- - 135 KA EN 1B Infus botol - -
- - 136 KA EN 3A Infus botol - -
- - 137 KA EN 3B Infus botol - -
- - 138 Kalium Diklofenat 50 mg tablet - -
- - 139 Kaloba tablet - -
- - 140 Kaloba Syrup Syrup - -
- - 141 Kalsium Laktat 500mg tablet - -
- - 142 Kaptopril 12,5mg tablet - -
- - 143 Kaptopril tab 25mg tablet - -
- - 144 Kaptopril tab 50mg tablet - -
- - 145 Karbamazepin 200 mg tablet - -
- - 146 Karbogliserin tts telinga 10% botol - -
- - 147 Ketokonazol 200mg tablet - -
- - 148 Ketokonazol krim 2% tube - -
- - 149 Ketoprofen Injeksi amp - -
- - 150 Ketorolac inj 30mg/ml amp - -
- - 151 Klindamisin kaps 300mg tablet - -
- 86 152 Kloramfenikol kap 250mg capsul 86 86 10
1 36 153 Kloramfenikol salep mata 1 tube 36 36 1
- 34 154 Kloramfenikol Syrup botol 34 34
353 353 155 Klorpheniramin Maleat (CTM tablet 353 1,000 1,353 28 42 20 27 10 15
- - 156 Klorpromazin 100 mg tablet - -
No NAMA OBAT
- - 157 Klorpromazin 25 mg tablet - -
- - 158 Klorpromazin Injeksi 25 mg amp - -
- - 159 Klorpromazin Injeksi 5 mg amp - -
- - 160 Kolkatriol tablet -
- - 161 Kotrimoksazol DOEN I (dewa tablet - -
1 12 162 Kotrimoksazol susp(sulfame botol 12 12
- - 163 Lactodia polybag/ 10 mg - -
- - 164 Lansoprazol 30 mg tablet - -
- - 165 Lapifed tablet - -
- - 166 Levofloxasin 500 mg tablet - -
90 700 167 Lexacrol tablet 700 700 10
- - 168 Lexacrol Syrup botol 100 ml - -
- - 169 Lidokain inj 2%+epinefrin 1: amp - -
- - 170 Lidokain Jelly tube - -
- - 171 Lisinopril tablet - -
- - 172 Loperamid tab 2mg tablet - -
- - 173 Loratadin 10 mg tablet - -
- - 174 Lorazepam 2 mg/ Merlopan tablet - -
- 2 175 Lytacur syr botol 2 2
- - 176 Mebendazole 500mg kotak/24 cath - -
465 - 177 Meloxicam 15 mg tablet - -
- - 178 Mersibion 5000 injk amp - -
- - 179 Mertigo SR tablet - -
430 1,210 180 Metamphiron 500mg/Metami tablet 1,210 1,210 20 10 10 10 10
- - 181 Metaneuron tablet tablet - -
- - 182 Metformin 500 mg tablet - -
- - 185 MethylPrednisolon 4 mg tablet - -
- - 186 Metilergometrin maleat injk amp - -
- 114 187 Metilergometrin maleat tab s tablet 114 114
- 5 188 Metoklopramid 5mg/ 60 ml botol 5 5
- - 189 Metoklopramid tab 5mg tablet - -
- - 190 Metronidasol 250mg tab tablet - -
No NAMA OBAT
- - 191 Metronidasol 500mg tab tablet - -
- - 192 Metronidazol infus 500mg/1 botol - -
- - 193 MgSo4 20% vial - -
- - 194 MgSo4 40% vial - -
- - 195 Molexdinde Gargle botol - -
121 255 196 Molexflu tablet 255 300 555 10
8 52 197 Molexflu Syrup botol 60 botol 52 52 1 1
- - 198 NaCl 0,9% Infus botol - -
- - 200 Natrium Diklofenat 50 mg tablet - -
- - 201 NB Top Salep tube - -
- - 202 Nebacetin Powder botol 5 gram - -
- - 203 Nebacetin Zalp tube - -
- 19 204 Neo Kaominanl Syrup botol 19 19
- - 205 Neomycin Basitrasin Salep Ku tube - -
- - 206 Neumed tablet tablet - -
- - 207 Neurobion inj 5000 ampul - -
- - 208 Nifedipin 10mg tablet - -
- - 209 Nifedipin slow rease oros 2 tablet - -
- - 210 Nistatin tab salut 500,000 IU tablet - -
- 16 211 Nistatin Vag.tab 100.000 IU/ tablet 16 16
- - 212 Norages Injeksi amp - -
12 488 213 Noza tablet 488 488
- - 214 Ocugard tablet - -
- - 215 Oksitetrasiklin injk 10 ml amp - -
- - 216 Oksitetrasiklin salep mata tube - -
- 25 217 Oksitetrasiklin Zalp kulit kotak 25 25
- - 218 Oksitosin injk amp - -
- - 219 Omeprasol injk 40ml / 10 ml vial - -
- - 220 Omeprasol kap 20mg tablet - -
- - 221 Ondansetron 4mg tablet - -
- - 222 Ondansetron inj 4mg/2ml amp - -
No NAMA OBAT
70 521 223 Osteotin 125 mg tablet 521 521 10 10 15
- - 224 Parasetamol 500mg tab tablet - -
- - 225 Parasetamol Infus botol/ 100 ml - -
- - 226 Parasetamol sirup 120mg/5m botol - -
- - 227 Parasetamol sirup Drop 100 botol - -
- - 228 Pehacain Injk amp - -
- - 229 Phetidin HCL 50mg/ml amp - -
- 300 230 Piracetam 800mg tablet 300 300
- - 232 Pirantel susp 125mg/5ml botol - -
- - 233 Pirantel tab 125mg tablet - -
- - 234 Pirazinamid tab 500mg tablet - -
- 400 235 Piroxicam 20mg kapsul 400 400
- - 236 Prednison tablet - -
- - 237 Profika (Ketoprofen Suppo) suppo - -
- 160 238 Propanolol 10 mg tablet 160 160
- 100 239 Propanolol tab 40mg tablet 100 100
- - 240 Ranitidin 150mg tablet - -
- - 241 Ranitidin inj 25mg/2ml amp - -
- - 244 RL infus botol - -
- - 245 Salbutamol 2mg tablet - -
- 6 246 Salbutamol 4 mg (sulfat) tablet 6 6
- - 247 Saldona Forte tablet - -
- - 249 Salep 2-4,kombinasi:asam sa pot - -
- - 250 Sanbe Kids Syrup botol - -
- - 251 Sefadroksil kap 500mg kapsul - -
- - 252 Sefadroksil sir.kering 125mg botol - -
- - 253 Sefadroksil sir.kering 250mg botol - -
- - 254 Sefotaxim injk vial - -
- - 255 Seftriakson serbuk inj 1g/vial vial - -
- - 256 Serum Anti Bisa Ular (SABU vial - -
- - 257 Serum Anti Difteri 20.000 UI vial - -
No NAMA OBAT
- - 258 Serum Anti Tetanus 1.500 IU amp - -
- - 259 Setirizin 10 mg capsul - -
- - 260 Sianokobalamin tablet - -
- - 261 Sianokobalamin inj 500mcg amp - -
- - 262 Simvastatin tab 10mg tablet - -
- - 263 Simvastatin tab 20mg tablet - -
- - 264 Siprofloksasin infus 2% botol - -
- - 265 Siprofloksasin tab 500mg kaplet - -
- - 266 Sotatic Injk amp - -
- - 267 Spironolakton 100 mg tablet - -
- - 268 Stimuno syr botol -
- - 269 Syntocinon amp - -
- - 270 Tablet tambah darah (Fe So4 tablet - -
- - 271 Taburia sacth - -
- 100 272 Tebokan tablet 100 100
- 220 273 Tensigard tablet 220 220
- - 274 Tetagram/ Human tetanus (m kotak/ 1pcs - -
- - 275 Tetrakain HCl tts mata 0,5% botol - -
- - 276 Tetrasiklin 250 mg capsul - -
- 87 277 Tetrasiklin 500 mg capsul 87 87
- 3 278 Thiamfilex syrup botol 3 3
- - 279 Thiamin Injeksi amp - -
10 285 280 Thiamphenikol 500mg capsul 285 285
- - 281 Thyrosol 10 mg tablet - -
- - 282 Tramadol tablet - -
- - 283 Tramadol Injeksi 50 mg/ ml amp - -
- - 284 Trampara tablet -
- - 285 Unthecol tablet - -
- - 286 Ventolin inhaler botol 200 dosis - -
- 20 287 Vermox 500 mg tablet 20 20
- - 288 Vit. B Kompleks tab tablet - -
- - 289 Vitamin neurotopik tablet -
No NAMA OBAT
- - 290 Vitamin neurotopik inj ampul -
- - 291 WIDA D5-1/2NS (Dextrase) botol - -
- - 292 WIDA D5-1/4NS (Dextrose) botol - -
- - 293 WIDA D5-NS (Dextrose) botol - -
- - 295 Zentra tablet - -
- - 296 Zinc tab dispersible 20mg tablet - -
- - 297 Zircum Kid Syr botol - -
- - -
- - BAHAN MEDIS HABIS PAKAI -
- - 298 Catgut chromic 2/0+jarum pcs - -
- - 299 Catgut chromic 3/0+jarum pcs - -
- - 300 Catgut plain 2/0+jarum 1/2 pcs - -
- - 301 Catgut plain 3/0+jarum 1/2 pcs - -
- - 302 Etanol 70% botol 100ml - -
- - 303 Ethil Chlorida spray botol - -
- - 304 Eugenol botol - -
- - 305 Folley catheter 2 way no 18 pcs - -
- - 306 Infusion set pediatric (anak) pcs - -
- - 307 Kasa 4 x 10 cm rol - -
- - 308 Kasa 4 x 5 cm rol - -
- - 309 Lisol 1 L botol - -
- - 310 Plester ultrafix rol - -
- - 311 Povidon Iodida 10% 300ml botol - -
- - 312 Povidon Iodida 10% 30ml botol - -
- - 313 Rivanol 300cc botol - -
- - 314 Salicyl bedak kotak - -
- - 315 Sarung Tangan / Examinatio pcs - -
- - 316 Sarung Tangan No. 7 pasang - -
- - 317 Silk 3/0+jarum 1/2GT 35mm pcs - -
- - 318 Spuit 1 cc pcs - -
- - 319 Spuit 3 cc pcs - -
- - 320 Spuit 5 cc pcs - -
- - 321 Yodium 1 liter botol -
No NAMA OBAT
Mengetahui

Nip. 19760826 200501 2 008
REGISTER BULANAN
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
105 49 36 74 63 37 22 37 21 72 34 12 40
1 1
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
1 1
20 30 20 20 20 30 30
55 30 65 40 20 25 30
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
10 20 30 10 10 30 30 40 50 10
1 2 2 1
1
20 10 10 10 10
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
10 10 3 24 20
50 10 30
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
30
10 42 13 25 10 20 50 45 40 8 24 34
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
10 5 10 10 10 20
10 30 30
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
50 10 10 11 43 13 43 10 10 20 30
2 2
40 20
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
35 35 10 10 10 45
10
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
PENGELUARAN
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Yang Menyerahkan
VERA YUNITA
Nip . 19810621 200901 2 005
Bulan : APRIL
Tahun : 2019
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- 18
- (82)
30 113 139 64 47 1,364 1,372
1 1 6 27
- 15
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 123
- -
- -
4 1 8 31
- -
- -
- -
- -
- -
- -
10 10 285 730
- -
- -
15 10 10 310 920
- -
- -
- 300
- -
- 60
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- 100
- -
- -
- -
- 285
- -
- -
30 20 17 357 900
1 1 8 13
2 12
- -
- -
- -
- -
- -
- -
- -
- 140
- -
- -
25 85 284
- -
- -
- -
- -
1 2 12
9 9 191
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
10 185
- -
- -
84 336
- -
- -
- -
- -
- -
- -
- -
- -
- -
20 10 20 140 455
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
30 670
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
10 76
1 35
- 34
30 30 33 28 584 769
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- 12
- -
- -
- -
- -
75 625
- -
- -
- -
- -
- -
- -
- -
- 2
- -
- -
- -
- -
10 10 150 1,060
- -
- -
- -
- -
- 114
- 5
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
10 33 7 4 30 344 211
1 1 8 44
- -
- -
- -
- -
- -
- 19
- -
- -
- -
- -
- -
- -
- 16
- -
10 40 12 122 366
- -
- -
- -
- 25
- -
- -
- -
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
10 190 331
- -
- -
- -
- -
- -
- -
- 300
- -
- -
- -
- 400
- -
- -
10 150
- 100
- -
- -
- -
- -
- 6
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 100
- 220
- -
- -
- -
- 87
- 3
- -
- 285
- -
- -
- -
- -
- -
- -
- 20
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
PENGE SISA
20 21 22 23 24 25 LUARAN STOK
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
Unit : RUANG FARMASI Bulan :

Tahun :

No NAMA OBAT
1 2 3 4 5 6 7 8 9
1 Albendazol Syrup botol - - - - -
2 Alinamin F injk amp - - - - -
3 Allopurinol tab 100mg tablet - - - - -
4 Alprazolam 1mg tablet - - - - -
5 Altera syrup botol 18 - 18 - 18
6 Amaropo Plus tablet 700 500 1,200 553 647
7 Ambroxol 30 mg tablet 1,099 1,000 2,099 395 1,704
8 Ambroxol Syrup botol 47 - 47 13 34
9 Aminofilin 200mg tablet 15 - 15 - 15
10 Aminofilin inj 24mg/ml amp - - - - -
12 Amitriptilin tab 25mg tablet - - - - -
13 Amlodipin tab 10mg tablet - - - - -
14 Amlodipin tab 5mg tablet - - - - - 600
15 Amoksisilin kap 250mg tablet - - - - -
16 Amoksisilin kaps 500mg tablet - - - - -
17 Amoksisilin syr 125mg/5ml botol 60 ml - - - - -
18 Amoksisilin syr forte 250mg/5ml botol 60 ml - - - - -
20 Antalgidon Injeksi vial - - - - -
21 Antalpugit (PULAREX) tablet - - - - -
22 Antasida DOEN I tab kunyah tablet - - - - -
23 Antasida DOEN syrup tablet - - - - - 10
No NAMA OBAT
1 2 3 4 5 6 7 8 9
24 Antibakteri DOEN salep(basitrasin500 IU/g Polimiksin 10,000 tube - - - - -
25 Antihemorroid kotak - - - - -
27 Antimigren:ergotamin tartrat 1mg+ kofein 50mg tablet - - - - -
28 Antimo Herbal Syrup sacht - - - - -
29 Antiparkinson DOEN (benserazid 25mg Levodopa 100mg) tablet - - - - -
30 Antitusif Syr botol - - - - -
31 Antrain Injeksi amp - - - - -
32 Aqua Pro Injeksi vial - - - - -
33 Asam askorbat/Vit.C tab 50mg tablet - - - - -
34 Asam Folat kap 1mg tablet - - - - -
35 Asam mefenamat kap 500mg tablet - - - - - 1,000
36 Asam traneksamat injk amp - - - - -
37 Asering 5 Infus botol - - - - -
38 Asering Infus botol - - - - -
39 Asetosal 80 mg (Miniaspi) tablet 123 - 123 - 123
40 Asiklovir kap 200mg tablet - - - - -
41 Asiklovir kap 400mg tablet - - - - -
42 Asiklovir krim kotak 25 - 25 3 22
43 Atropin Injk amp - - - - -
44 Azitrimisin 250 mg tablet - - - - -
45 Becefort caplet - - - - -
46 Becefort Syrup Botol 60 ml - - - - -
47 Betahistine 6 mg tablet - - - - -
48 Betametason krim 0,1% tube - - - - -
49 Bio ATP tablet 500 500 1,000 180 820
50 Bioneuron tablet - - - - -
51 Bioneuron Injk amp - - - - -
52 Bioron tablet 260 500 760 350 410
53 Bioron injk amp - - - - -
54 Bisoprolol 5 mg tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
55 Bromhexin tablet - - - - -
56 Cardismo 20 Mg tablet - - - - -
57 Cartogen tablet 60 - 60 - 60
58 Citicholin Injk amp - - - - -
59 Clobazam 10 mg tablet - - - - -
63 Cystone tablet 100 - 100 - 100
64 Deksametason inj iv/im 5mg/ml amp - - - - -
65 Deksametason tab 0,5mg tablet - - - - -
66 Desoximethason krim 0,25% tube - - - - -
67 Dextamin tablet 500 - 500 90 410
68 Dextamin Syrup botol - - - - -
69 Dextral tablet - - - - -
70 Dextral F tablet 620 500 1,120 530 590 500
71 Dextral Syrup botol 60ml 10 - 10 2 8 20
72 Dextrofen syrup botol 9 - 9 - 9
73 Diazepam 5 mg/ml Injeksi amp - - - - -
74 Diazepam lart.rektal tube - - - - -
75 Difenhidramin tablet - - - - -
76 Difenhidramin inj iv/im 10mg/ml (HCl) amp - - - - -
77 Digoksin tab 0,25mg tablet - - - - -
78 Diltiazem 30 mg tablet - - - - -
79 Dimenhidrinat tab 50mg tablet - - - - -
80 DIOS tablet 150 - 150 10 140
81 Domperidon susp 5mg/5ml botol - - - - -
82 Domperidon tab tablet - - - - -
84 Dormi Compositum tablet 379 - 379 - 379
85 Epinefrin/Adrenalin inj iv/sk/im 1mg/ml amp - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
86 Eritromisin kap 250mg tablet - - - - -
87 Eritromisin kap 500mg kapsul - - - - -
88 Eritromisin sir.kering 200mg/5ml botol - - - - -
89 Erlamycetin tetes telinga (khlorampenicol Tts telinga) botol 23 - 23 3 20
90 Etambutol 500mg (HCl) tablet - - - - -
91 Etambutol tab 250mg tablet - - - - -
93 Famotidin 40mg tablet - - - - -
94 Fenitoin inj 100mg/ml amp - - - - -
95 Fenitoin inj 50mg/ml amp - - - - -
96 Fenitoin kap 100mg tablet - - - - -
97 Fenoksimetil penisilin (penisilin V)tab 250mg tablet - - - - -
98 Fenoksimetil penisilin (penisilin V)tab 500mg tablet - - - - -
99 Fenolgliserol Tetes Telinga flas - - - - -
100 Fitomenadion/Vit K Injeksi amp - - - - -
101 Fitomenadion/Vit K tab salut gula 10mg tablet - - - - -
102 Flucort N Zalp Tube 5 gram - - - - -
103 Furosemid 40mg tab tablet - - - - -
104 Furosemid inj iv/im 10mg/ml vial - - - - -
105 Garam Oralit I sacht - - - - -
106 Gemfibrozil 300 mg capsul - - - - -
107 Gentamicyn Injeksi amp - - - - -
108 Gentamicyn salep mata tube - - - - -
109 Gentamycin salep kulit kotak 16 - 16 16 -
110 Gentamycin tetes mata botol - - - - -
111 Glibenklamid tab 5 mg tablet 195 - 195 - 195
112 Glikuidon 30 mg tablet - - - - -
113 Glimepirid 1 mg tablet - - - - -
114 Gliseril Guaiyacolat100 mg tablet 597 - 597 110 487
115 Gliserin lar 50% botol - - - - -
116 Glukodex 80 mg tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
117 Glukosa lar.infus 10% (dextrose 10%) botol - - - - -
118 Glukosa lar.infus 5% (Dextrose 5%) botol - - - - -
119 Griseofulvin tab 125mg tablet - - - - -
120 Haloperidol tab 0,5mg tablet - - - - -
121 Haloperidol tab 1,5mg tablet - - - - -
122 Haloperidol tab 2mg tablet - - - - -
123 Haloperidol tab 5mg tablet - - - - -
124 Hemafort tablet 665 - 665 90 575
125 Hemogard Capsul capsul - - - - -
126 Hepagard Tablet tablet 190 - 190 40 150
127 Hidrokortison krim 2,5% tube - - - - -
128 Hiosin Butil Promida Injk amp - - - - -
129 Hustab tablet 730 - 730 20 710
130 Ibuprofen 200mg tablet - - - - -
131 Ibuprofen 400mg tablet - - - - -
132 Ibuprofen Syrup tablet - - - - -
133 IKADRIL injk amp - - - - -
134 Isosorbid Dinitrat tab sublingual 5mg tablet - - - - -
135 KA EN 1B Infus botol - - - - -
136 KA EN 3A Infus botol - - - - -
137 KA EN 3B Infus botol - - - - -
138 Kalium Diklofenat 50 mg tablet - - - - -
139 Kaloba tablet - - - - -
140 Kaloba Syrup Syrup - - - - -
141 Kalsium Laktat 500mg tablet - - - - -
142 Kaptopril 12,5mg tablet - - - - -
143 Kaptopril tab 25mg tablet - - - - -
144 Kaptopril tab 50mg tablet - - - - -
145 Karbamazepin 200 mg tablet - - - - -
146 Karbogliserin tts telinga 10% botol - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
147 Ketokonazol 200mg tablet - - - - -
148 Ketokonazol krim 2% tube - - - - -
149 Ketoprofen Injeksi amp - - - - -
150 Ketorolac inj 30mg/ml amp - - - - -
151 Klindamisin kaps 300mg tablet - - - - -
152 Kloramfenikol kap 250mg capsul 86 - 86 - 86
153 Kloramfenikol salep mata 1 % tube 40 - 40 2 38
154 Kloramfenikol Syrup botol 34 - 34 - 34
155 Klorpheniramin Maleat (CTM) tablet 784 - 784 61 723
156 Klorpromazin 100 mg tablet - - - - -
157 Klorpromazin 25 mg tablet - - - - -
158 Klorpromazin Injeksi 25 mg amp - - - - -
159 Klorpromazin Injeksi 5 mg amp - - - - -
160 Kolkatriol tablet - - - - -
161 Kotrimoksazol DOEN I (dewasa):Sulfametoksazol400mg trim tablet - - - - -
162 Kotrimoksazol susp(sulfametoksazol 200mg+trimetoprim40mg botol 18 - 18 - 18
163 Lactodia polybag/ 10 mg - - - - -
164 Lansoprazol 30 mg tablet - - - - -
165 Lapifed tablet - - - - -
166 Levofloxasin 500 mg tablet - - - - -
167 Lexacrol tablet 370 - 370 160 210 750
168 Lexacrol Syrup botol 100 ml - - - - -
169 Lidokain inj 2%+epinefrin 1:80.000-2ml amp - - - - -
170 Lidokain Jelly tube - - - - -
171 Lisinopril tablet - - - - -
172 Loperamid tab 2mg tablet - - - - -
173 Loratadin 10 mg tablet - - - - -
174 Lorazepam 2 mg/ Merlopan tablet - - - - -
175 Lytacur syr botol 6 58 64 35 29 15
176 Mebendazole 500mg kotak/24 cath - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
177 Meloxicam 15 mg tablet 510 - 510 90 420
178 Mersibion 5000 injk amp - - - - -
179 Mertigo SR tablet - - - - -
180 Metamphiron 500mg/Metamizol 500mg tablet 885 500 1,385 390 995 1,000
181 Metaneuron tablet tablet - - - - -
182 Metformin 500 mg tablet - - - - -
185 MethylPrednisolon 4 mg tablet - - - - -
186 Metilergometrin maleat injk 0,25mg amp - - - - -
187 Metilergometrin maleat tab salut 0,25mg tablet 134 - 134 - 134
188 Metoklopramid 5mg/ 60 ml syrup (Lexapram Syr) botol 5 - 5 - 5
189 Metoklopramid tab 5mg tablet - - - - -
190 Metronidasol 250mg tab tablet - - - - -
191 Metronidasol 500mg tab tablet - - - - -
192 Metronidazol infus 500mg/100ml botol - - - - -
193 MgSo4 20% vial - - - - -
194 MgSo4 40% vial - - - - -
195 Molexdinde Gargle botol - - - - -
196 Molexflu tablet 481 - 481 143 338
197 Molexflu Syrup botol 60 botol 10 45 55 10 45 55
198 NaCl 0,9% Infus botol - - - - -
200 Natrium Diklofenat 50 mg tablet - - - - -
201 NB Top Salep tube - - - - -
202 Nebacetin Powder botol 5 gram - - - - -
203 Nebacetin Zalp tube - - - - -
204 Neo Kaominanl Syrup botol 29 - 29 4 25
205 Neomycin Basitrasin Salep Kulit (Topical ointment) tube 14 - 14 10 4
206 Neumed tablet tablet - - - - -
207 Neurobion inj 5000 ampul - - - - -
208 Nifedipin 10mg tablet - - - - -
209 Nifedipin slow rease oros 20 mg tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
210 Nistatin tab salut 500,000 IU/g tablet - - - - -
211 Nistatin Vag.tab 100.000 IU/g tablet 16 - 16 - 16
212 Norages Injeksi amp - - - - -
213 Noza tablet 500 - 500 - 500
214 Ocugard tablet - - - - -
215 Oksitetrasiklin injk 10 ml amp - - - - -
216 Oksitetrasiklin salep mata tube - - - - -
217 Oksitetrasiklin Zalp kulit kotak 25 - 25 - 25
218 Oksitosin injk amp - - - - -
219 Omeprasol injk 40ml / 10 ml vial - - - - -
220 Omeprasol kap 20mg tablet - - - - -
221 Ondansetron 4mg tablet - - - - -
222 Ondansetron inj 4mg/2ml amp - - - - -
223 Osteotin 125 mg tablet 531 - 531 10 521
224 Parasetamol 500mg tab tablet - - - - -
225 Parasetamol Infus botol/ 100 ml - - - - -
226 Parasetamol sirup 120mg/5ml botol - - - - -
227 Parasetamol sirup Drop 100mg/ 15ml botol - - - - -
228 Pehacain Injk amp - - - - -
229 Phetidin HCL 50mg/ml amp - - - - -
230 Piracetam 800mg tablet 300 - 300 - 300
232 Pirantel susp 125mg/5ml botol - - - - -
233 Pirantel tab 125mg tablet - - - - -
234 Pirazinamid tab 500mg tablet - - - - -
235 Piroxicam 20mg kapsul - 200 200 - 200
236 Prednison tablet - - - - -
237 Profika (Ketoprofen Suppo) suppo - - - - -
238 Propanolol 10 mg tablet 160 - 160 - 160
239 Propanolol tab 40mg tablet 100 - 100 - 100
240 Ranitidin 150mg tablet - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
241 Ranitidin inj 25mg/2ml amp - - - - -
244 RL infus botol - - - - -
245 Salbutamol 2mg tablet - - - - -
246 Salbutamol 4 mg (sulfat) tablet 67 - 67 - 67
247 Saldona Forte tablet - - - - -
249 Salep 2-4,kombinasi:asam salisilat 2%+belerang endap 4% pot - - - - -
250 Sanbe Kids Syrup botol - - - - -
251 Sefadroksil kap 500mg kapsul - - - - -
252 Sefadroksil sir.kering 125mg/5ml botol - - - - -
253 Sefadroksil sir.kering 250mg/5ml botol - - - - -
254 Sefotaxim injk vial - - - - -
255 Seftriakson serbuk inj 1g/vial vial - - - - -
256 Serum Anti Bisa Ular (SABU) vial - - - - -
257 Serum Anti Difteri 20.000 UI vial - - - - -
258 Serum Anti Tetanus 1.500 IU (ATS) amp - - - - -
259 Setirizin 10 mg capsul - - - - -
260 Sianokobalamin tablet - - - - -
261 Sianokobalamin inj 500mcg amp - - - - -
262 Simvastatin tab 10mg tablet - - - - -
263 Simvastatin tab 20mg tablet - - - - -
264 Siprofloksasin infus 2% botol - - - - -
265 Siprofloksasin tab 500mg kaplet - - - - -
266 Sotatic Injk amp - - - - -
267 Spironolakton 100 mg tablet - - - - -
268 Stimuno syr botol - - - - - 20
269 Syntocinon amp - - - - -
270 Tablet tambah darah (Fe So4 + Asam Folat) tablet - - - - -
271 Taburia sacth - - - - -
272 Tebokan tablet 100 - 100 - 100
273 Tensigard tablet 220 - 220 - 220
No NAMA OBAT
1 2 3 4 5 6 7 8 9
274 Tetagram/ Human tetanus (munoglobulin Im 250IU) kotak/ 1pcs - - - - -
275 Tetrakain HCl tts mata 0,5% botol - - - - -
277 Tetrasiklin 500 mg capsul 147 - 147 - 147
278 Thiamfilex syrup botol 7 - 7 1 6
279 Thiamin Injeksi amp - - - - -
280 Thiamphenikol 500mg capsul 250 - 250 - 250
281 Thyrosol 10 mg tablet - - - - -
282 Tramadol tablet - - - - -
283 Tramadol Injeksi 50 mg/ ml amp - - - - -
284 Trampara tablet - - - - -
285 Unthecol tablet - - - - -
286 Ventolin inhaler botol 200 dosis - - - - -
287 Vermox 500 mg tablet 20 - 20 - 20
288 Vit. B Kompleks tab tablet - - - - -
289 Vitamin neurotopik tablet - - - - -
290 Vitamin neurotopik inj ampul - - - - -
291 WIDA D5-1/2NS (Dextrase) botol - - - - -
292 WIDA D5-1/4NS (Dextrose) botol - - - - -
293 WIDA D5-NS (Dextrose) botol - - - - -
295 Zentra tablet - - - - -
296 Zinc tab dispersible 20mg tablet - - - - -
297 Zircum Kid Syr botol - - - - -
- - - - -
BAHAN MEDIS HABIS PAKAI - - - - -
298 Catgut chromic 2/0+jarum 1/2GT 35mm pcs - - - - -
299 Catgut chromic 3/0+jarum 1/2GT 35mm pcs - - - - -
300 Catgut plain 2/0+jarum 1/2GT 35mm pcs - - - - -
301 Catgut plain 3/0+jarum 1/2GT 35mm pcs - - - - -
302 Etanol 70% botol 100ml - - - - -
303 Ethil Chlorida spray botol - - - - -
304 Eugenol botol - - - - -
No NAMA OBAT
1 2 3 4 5 6 7 8 9
305 Folley catheter 2 way no 18 pcs - - - - -
306 Infusion set pediatric (anak) pcs - - - - -
307 Kasa 4 x 10 cm rol - - - - -
308 Kasa 4 x 5 cm rol - - - - -
309 Lisol 1 L botol - - - - -
310 Plester ultrafix rol - - - - -
311 Povidon Iodida 10% 300ml botol - - - - -
312 Povidon Iodida 10% 30ml botol - - - - -
313 Rivanol 300cc botol - - - - -
314 Salicyl bedak kotak - - - - -
315 Sarung Tangan / Examination Glove pcs - - - - -
316 Sarung Tangan No. 7 pasang - - - - -
317 Silk 3/0+jarum 1/2GT 35mm pcs - - - - -
318 Spuit 1 cc pcs - - - - -
319 Spuit 3 cc pcs - - - - -
320 Spuit 5 cc pcs - - - - -
321 Yodium 1 liter botol - - - - -
Sumenep,
Mengetahui Yang Menyerahkan Penanggung Jaw
Kepala Puskesmas Pamolokan Petugas Gudang Puskesmas Pamolokan

Nip. 19760826 200501 2 008 Nip . 19810621 200901 2 005
LEMBAR PERMINTAAN OBAT (LPLPO)
GGARAN APBD
JANUARI
2019
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
PEMBERIAN
KET
10 11 ###
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PEMBERIAN
KET
10 11 ###
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PEMBERIAN
KET
10 11 ###
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PEMBERIAN
KET
10 11 ###
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JANUARI 2019
Penanggung Jawab Obat
-
SATU
No NAMA OBAT
AN
1 ACTRAPID HM PENFILL Human insulin Short penvil/catridge 100 pcs
2 UI
ADALAT OROS 20 Nifedipin tab 20 mg, slow release; oros tablet
3 BECEFORT Kaplet
4 BECEFORT SYRUP botol
5 BIORON INJEKSI/NEUROBION INJ ampul
6 BIORON tablet tablet
7 CERCUL Injeksi ( Citicoline 250 mg injeksi) Ampul
8 DARYANT TULLE Framisetin sulfat tulle 1% pcs
9 DECACETIN TETES MATA 0.5% Kloramfenikol tetes mata 0,5 % botol
10 DEXOCORT Desoksimetason salep 0,25% tube
11 DEXTAMIN Tab (Deksammetason 0,5 mg, Dexchlorpheniramine Tablet
12 maleate
DIFLUCAN2 mg)50MG Flukonazol kaps 50 mg capsul
13 DULCOLAX SUPP ADULT Bisakodil suppositoria 10 mg supp
14 DULCOLAX SUPP INFANT Bisakodil suppositoria 5 mg supp
15 FARGOXIN Digoksin injeksi 0,25 mg/ml ampul
16 FARSORBID 10 Isosorbid dinitrat tablet/kapsul/kaplet 10 mg tablet
17 FARSORBID Isosorbid Dinitrat injeksi i.v 10 mg/10 ml ampul
18 FLUCORT N CREAM 5 mg ( Fluosinolon aesitonida 0,25 mg, Tube
19 Neomisina
GENERIKSulfat 5 mg)
Air untuk injeksi 20 ml botol
20 GENERIK Alopurinol tablet/kapsul/kaplet 100 mg tablet
21 GENERIK Alopurinol tablet/kapsul/kaplet 300 mg tablet
22 GENERIK Amlodipin tablet/kapsul/kaplet 10 mg tablet
23 GENERIK Amlodipin tablet/kapsul/kaplet 5 mg tablet
24 GENERIK Amoksisilin kapsul/kaplet/tablet scored 250 mg capsul
25 GENERIK Amoksisilin kapsul/kaplet/tablet scored 500 mg kaplet
26 GENERIK Amoksisilin sirup kering 125 mg/ 5 ml botol
27 GENERIK Amoksisilin sirup kering forte 250 mg/5 ml botol
28 GENERIK Antasida DOEN I tablet kunyah, kombinasi: Aluminium tablet
29 Hidroksida
GENERIK 200Asammgaskorbat
+ Magnesium Hidroksida
(vitamin C) tab 50 200
mg mg tablet
30 GENERIK Asam Mefenamat tablet/kapsul/kaplet 500 mg kaplet
31 GENERIK Acyclovir 200 tablet
32 GENERIK Asiklovir tablet/kapsul/kaplet 400 mg tablet
33 GENERIK Bedak salisil serbuk 2% dos
34 GENERIK Betahistin tablet/kapsul/kaplet 6 mg tablet
35 GENERIK Betametason krim 0,1% (sebagai Valerat) tube
36 GENERIK Bisakodil tablet/kapsul/kaplet 5 mg tablet
37 GENERIK Deksametason tablet/kapsul/kaplet 0,5 mg tablet
38 GENERIK Desoksimetason krim 0,25% tube
39 GENERIK Dietilkarbamazin tablet scored 100 mg tablet
40 GENERIK Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) ampul
41 GENERIK Desoksimetason krim 0,25% tube
42 GENERIK Dietilkarbamazin tablet scored 100 mg tablet
43 GENERIK Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) ampul
44 GENERIK Dimenhidrinat tablet/kapsul/kaplet 50 mg tablet
45 GENERIK Domperidon syrup botol
46 GENERIK Domperidon tablet/kapsul/kaplet 10 mg tablet
47 GENERIK Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) ampul
48 GENERIK Fitomenadion (Vit.K1) tablet/kaplet salut gula 10 mg tablet
49 GENERIK Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) ampul
50 GENERIK Furosemid tablet/kapsul/kaplet 40 mg tablet
51 GENERIK Garam Oralit I serbuk, kombinasi: Natrium klorida 0,52 g + sachet
52 kalium klorida
GENERIK 0,30 g + Trinatrium
Gemfibrozil sitrat dihidrat
tablet/kapsul/kaplet 300 0,58
mg g + Glukosa capsul
53 Anhidrat 2,70 g
GENERIK Gemfibrozil tablet/kapsul/kaplet 600 mg capsul
54 GENERIK Gentamisin injeksi 40 mg/ ml ampul
55 GENERIK Gentamisin tetes mata 0,3% Botol
56 GENERIK Glimepiride tablet/kapsul/kaplet 1 mg tablet
57 GENERIK Glimepiride tablet/kapsul/kaplet 2 mg Tablet
60 GENERIK Griseofulvin (micronized) tablet/kapsul/kaplet 125 mg tablet
61 GENERIK Haloperidol tablet/kapsul/kaplet 0,5 mg tablet
62 GENERIK Haloperidol tablet/kapsul/kaplet 5 mg tablet
63 GENERIK Hidroklorotiazid tab 25 mg tablet
64 GENERIK Hidrokortison krim 2,5% Tube
65 GENERIK Ibuprofen susp 100 mg/5 ml botol
66 GENERIK Ibuprofen susp 200 mg/5 ml botol
67 GENERIK Ibuprofen tablet/kapsul/kaplet 200 mg tablet
68 GENERIK Ibuprofen tablet/kapsul/kaplet 400 mg tablet
69 GENERIK Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg tablet
70 GENERIK Kaptopril tablet/kaplet scored 12,5 mg tablet
71 GENERIK Kaptopril tablet/kaplet scored 25 mg tablet
72 GENERIK Kaptopril tablet/kaplet scored 50 mg tablet
73 GENERIK Karbogliserin tetes telinga 10% botol
74 GENERIK Ketokonazol krim 2% tube
75 GENERIK Ketokonazol tablet/kapsul/kaplet 200 mg tablet
76 GENERIK Ketorolak inj 30 mg/ml ampul
77 GENERIK Klindamisin tablet/kapsul/kaplet 300 mg tablet
78 GENERIK Klopidogrel tablet/kapsul/kaplet 75 mg tablet
79 GENERIK Kloramfenikol salep mata 1 % Tube
80 GENERIK Klorfeniramina Maleat (CTM) tablet/kapsul/kaplet 4 mg tablet
81 GENERIK Klorpromazin tablet/kaplet salut 100 mg (HCl) tablet
82 GENERIK Klozapin 100 mg tablet
84 GENERIK Kloramfenikol salep mata 1 % tube
85 GENERIK Klorfeniramina Maleat (CTM) tablet/kapsul/kaplet 4 mg tablet
86 GENERIK Klorpromazin tablet/kaplet salut 100 mg (HCl) tablet
89 GENERIK Kodein tablet/kapsul/kaplet 10 mg tablet
90 GENERIK kombinasi: ergotamin 1 mg + kafein 50 mg tablet
91 GENERIK kombinasi: ferro fumarat 60 mg + as. Folat 0,4 mg tablet tablet
92 salut gula (tablet
GENERIK tambah darah)
Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: Botol
93 sulfametoksazol 200 mg + trimetoprim 40 mg
GENERIK Kotrimoksazol (dewasa) kombinasi: sulfametoksazol 400 tablet
94 mg + trimetoprim 80 mg
GENERIK Kotrimoksazol forte kombinasi: sulfametoksazol 800 mg + tablet
95 trimetoprim 160 mg
GENERIK Lidokain injeksi 2% (HCL) ampul
96 GENERIK Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol
botol 200 mg + trimetoprim
97 GENERIK Kotrimoksazol (dewasa) kombinasi: sulfametoksazol 400 mg + trimetoprim
tablet 80 mg
98 GENERIK Kotrimoksazol forte kombinasi: sulfametoksazol 800 mg + trimetoprim
Tablet 160 mg
99 GENERIK Lansoprazol tablet/kapsul/kaplet 30 mg capsul
100 GENERIK Lidokain injeksi 2% (HCL) ampul
101 GENERIK Loperamid tablet/kapsul/kaplet 2 mg Tablet
102 GENERIK Loratadin tablet/kapsul/kaplet 10 mg Tablet
103 GENERIK Metformin HCl tablet/kapsul/kaplet 500 mg Tablet
104 GENERIK Metformin HCl tablet/kapsul/kaplet 850 mg tablet
105 GENERIK Metilprednisolon inj 125 mg/mL ampul
106 GENERIK Metilprednisolon inj 500 mg/vial ampul
107 GENERIK Metilprednisolon tablet/kapsul/kaplet 16 mg tablet
110 GENERIK Metilprednisolon inj 500 mg/vial ampul
114 GENERIK Metoklopramide inj 5 mg/mL ampul
115 GENERIK Metoklopramide tablet/kapsul/kaplet 5 mg tablet
116 GENERIK Metronidazol infus 5 mg/ ml botol
117 GENERIK Metronidazol sirup 125 mg/5 ml Botol
118 GENERIK Metronidazol tablet/kapsul/kaplet 500 mg tablet
119 GENERIK Mometason furoat krim 0,1% tube
120 GENERIK Nacl 0,9% botol
121 GENERIK Natrium diklofenak tablet/kapsul/kaplet 25 mg tablet
122 GENERIK Natrium diklofenak tablet/kapsul/kaplet 50 mg tablet
123 GENERIK Nifedipin tablet/kapsul/kaplet 10 mg tablet
124 GENERIK Nistatin tablet/kaplet salut 500.000 IU/ g tablet
125 GENERIK Nistatin vaginal tablet 100.000 IU/ g tablet vaginal
126 GENERIK Ofloxacin 400 tablet
127 GENERIK Omeprazol injeksi 40 mg/ 10 ml ampul
128 GENERIK Omeprazol tablet/kapsul/kaplet 20 mg capsul
129 GENERIK Ondansetron inj 2 mg/ml (4 mg/ 2 mL) ampul
130 GENERIK Ondansetron tablet/kapsul/kaplet 4 mg tablet
131 GENERIK Ondansetron tablet/kapsul/kaplet 8 mg tablet
132 GENERIK Parasetamol drips (infus) 1000 mg/100 mL botol
133 GENERIK Parasetamol sirup 120 mg / 5 ml botol
134 GENERIK Parasetamol tablet/kapsul/kaplet 500 mg tablet
135 GENERIK Piridoxin (vitamin B6) 10mg tablet
136 GENERIK Piridoxin (vitamin B6) 25mg tablet
137 GENERIK Prednison tablet/kapsul/kaplet 5 mg tablet
138 GENERIK Propranolol tab 40 mg tablet
139 GENERIK Propranolol tablet/kapsul/kaplet 10 mg tablet
140 GENERIK Ranitidin injeksi 25 mg/ml ampul
141 GENERIK Ranitidin tablet/kapsul/kaplet 150 mg tablet
142 GENERIK Ringer Laktat botol
143 GENERIK Risperidon tablet/kapsul/kaplet 1 mg tablet
144 GENERIK Risperidon tablet/kapsul/kaplet 2 mg tablet
145 GENERIK Salbutamol tablet/kapsul/kaplet 2 mg (sebagai Sulfat) tablet
146 GENERIK Salbutamol tablet/kapsul/kaplet 4 mg (sebagai Sulfat) tablet
147 GENERIK Sefadroksil sir kering 250 mg/5 ml botol
148 GENERIK Sefadroksil sirup kering 125 mg/5ml botol
149 GENERIK Sefadroksil tablet/kapsul/kaplet 500 mg tablet
150 GENERIK Sefiksim sirup kering 100 mg/ 5 ml botol
151 GENERIK Sefiksim tablet/kapsul/kaplet 100 mg tablet
152 GENERIK Sefiksim tablet/kapsul/kaplet 200 mg tablet
153 GENERIK Sefotaksim serb inj 1.000 mg vial
154 GENERIK Sefotaksim serb inj 500 mg vial
155 GENERIK Seftriaxon serb inj 1000 mg vial
156 GENERIK Setirizin sirup 5 mg/5 ml Botol
157 GENERIK Setirizin tablet/kapsul/kaplet 10 mg tablet
158 GENERIK Sianokobalamin (vitamin B12) injeksi 500 mcg ampul
159 GENERIK Sianokobalamin (vitamin B12) tablet tablet
160 GENERIK Simvastatin tablet/kaplet/salut 10 mg tablet
161 GENERIK Simvastatin tablet/kaplet/salut 20 mg tablet
162 GENERIK Siprofloksasin inf 2 mg/ml (2%) botol
163 GENERIK Sukralfat susp 500 mg/5 mL, 100 ml Botol 100ml
164 GENERIK Tiamin (Vitamin B1) tablet/kapsul/kaplet 50 mg (HCl/ tablet
165 Nitrat)
GENERIK Triheksifenidil tablet/kapsul/kaplet 2 mg tablet
166 GENERIK Vitamin B Kompleks tablet tablet
167 GENERIK Zinc sir 20 mg/5 ml Botol
168 GENERIK Zinc tablet dispersible 20 mg tablet
169 GENOINT SALEP MATA Gentamisin salep mata 0,3% Tube
170 GERIAVITA / Multivitamin (Beta-Carotene 6 mg, Vit E 30 mg, Vit C tablet
171 500 mg, Asam
Glucotrol Folat 0,4 mg)
XL 10mg tablet
172 HUSTAB Kaplet
173 INFUSAN D5 (100 ML) Larutan mengandung Karbohidrat (Glukosa botol
174 5g/100 ml) D5 (250 ML) Larutan mengandung Karbohidrat (Glukosa
INFUSAN botol
175 12,5 g/250 ml)
INTERZOL SS 2% Ketokonazol scalp sol 2% botol
176 KETEROLAC INJ ampul
177 LEVEMIR INSULIN Pen
178 MERSIBION INJ ampul
179 MOLEXFLU KAPLET kaplet
180 (PARACETAMOL,PHENYLPROPANOLAMIN
MOLEXFLU SYRUP HCL, botol
181 KLORFENIRAMINA MALEAT)
(PARACETAMOL,PHENYLPROPANOLAMIN
MYCORINE POWDER Mikonazol serbuk 2% HCL, botol
MYCOSTOP TAB. 250 Griseofulvin tablet/kapsul/kaplet 250 mg tablet
183 NEO DIAGON Attapulgit tab 650 mg (Omegdiar) tablet
184 NEW ANTIDES Atapulgit tablet/kapsul/kaplet 600 mg tablet
185 NORAGES INJ Ampul
186 NOVOMIX 30 FLEXPEN Mix Insulin flexpen/catridge pcs
187 NOVORAPID FLEXPEN Rapid insulin pen/flexpen/catridge pcs
188 OSTEOTIN capsul
189 OSTOVEL capsul
190 Otsuka KA-EN 3B Softbag 500ml
191 PRIMPEN SYR botol
192 PROFOLAT Asam Folat tablet/kapsul/kaplet 0,4 mg tablet
193 PROSOGAN INJ 30MG Lansoprazol inj 30 mg/ml ampul
194 PULAREX Attapulgit tab 630 mg tablet
195 SCABIMITE CREAM 10 Permetrin Krim 5% tube
196 SKIZON Betametason krim 0,5 mg/g tube
197 TETAGAM Human tetanus imunoglobulin inj 250 IU (i.m.) pcs
198 THYROZOL 10 Tiamazol tab 10 mg tablet
199 ULSIDEX TABLET 500 MG Sukralfat tablet/kapsul/kaplet 500 mg tablet
200 VAGIZOL Metronidazol ovula 500 mg ovula
201 VENTOLIN ROTAHALER Ventolin Rotahaler (Alat Hirup Salbutamol pcs
200 mcg/kapsul)
202 STIMUNO SYR botol
203 TETAGAM Human tetanus imunoglobulin inj 250 IU (i.m.) pcs
204 THYROZOL 10 Tiamazol tab 10 mg tablet
205 ULSIDEX TABLET 500 MG Sukralfat tablet/kapsul/kaplet 500 mg tablet
206 VAGIZOL Metronidazol ovula 500 mg ovula
207 VENTOLIN ROTAHALER Ventolin Rotahaler (Alat Hirup Salbutamol pcs
208 200
WIDAmcg/kapsul)
BES botol
209 WIDA D5-1/2NS Larutan mengandung Karbohidrat + Elektrolit (D5- botol
210 1/2NS)
WIDA D5-1/4NS Larutan mengandung Karbohidrat + Elektrolit (D5- botol
211 1/4NS)
WIDA D5NS Larutan mengandung Karbohidrat + Elektrolit (D5NS) botol
212 WIDA HSD Larutan mengandung Karbohidrat + Elektrolit (HSD) botol
213 WIDA KDN1 Larutan mengandung Karbohidrat + Elektrolit (D2,5 %+ botol
214 KCl 0,15KDN2
WIDA %+ NaCl 0,45mengandung
Larutan %) 500 ml Karbohidrat + Elektrolit (D2,5 %+ botol
215 KCl 0,3KN1
WIDA %+ NaCl 0,45mengandung
Larutan %) 500 ml Elektrolit (KCl 0,15% + NaCl 0,9%) botol
216 WIDA KN2 Larutan mengandung elektrolit (KCl 0,3% + NaCl 0,9%) botol
217 WIDA RD Larutan mengandung Karbohidrat + Elektrolit (RD) botol
218 WIDA 0,9 % SOD.CHLOR botol
219 Pehacain inj 2ml ampul
220 Cavit G pcs
221 Endo-Frost roeko botol
222 Fuji IX art botol
223 Etcha (Scothbond Etchant liq) botol
224 Komposit/Lighcure (filtek Z 250 kit) pcs
225 Bonding single bond universal pcs
226 Cal lc denpro box
227 Cresotin liquid II pcs
228 Dentin Conditioner 6 Gr botol
229 Hemospon box
230 K File sendoline L25 15-40 pcs
231 K reamers L25 15-40 pcs
232 Seluloid strip box
233 Softlex mini kit pcs
234 NaOcl botol
235 Sponge dental pcs
236 Solare A2 pcs
237 Solare A3 pcs
BAHAN MEDIS HABIS PAKAI

238 Alat Suntik 3 ml pcs
239 Alat Suntik 5 ml pcs
240 Alkohol 70% 1 L botol
241 Alkohol Swab pcs
242 Antiseptik Gel@500 ml botol
243 Bracket Hand Wash pcs
244 Odex 500 ml botol
245 Dermafix T 10 x 12 cm pcs
248 Infus set dewasa pcs
249 Kasa Hidrofil uk. 40 x 80 cm rol
250 Kasa Hidrofil Steril uk. 16 x 16 dos
251 Kasa pembalut 4 x 15 cm elastic rol
252 Kasa pembalut 4 x 3 cm elastic rol
253 Kasa pembalut hydrofil 4 x 10 cm rol
254 Kasa pembalut hydrofil 4 x 5 cm rol
255 My Jelly pcs
256 Lisol 1 L botol
257 Pot Sputum pcs
258 Safeglove PP no. 7 pasang
259 Catgut plain / Benang bedah No. 2/0 dengan jarum pcs
260 Catgut plain / Benang bedah No. 3/0 dengan jarum pcs
261 Examination Glove size L pcs
262 Examination Gloves size M pcs
263 Examination Gloves size S pcs
264 Folley Catheter 2 way No. 16 pcs
265 Folley Catheter 2 way No. 18 pcs
266 IV Catheter NP pen type no. 18 pcs
267 IV Catheter NP pen type no. 20 pcs
268 Kapas Pembalut / Absorben 250 gram rol
269 Masker pcs
270 Nasal oxygen cannula size L pcs
271 Nasal oxygen cannula size M pcs
272 Nasal oxygen cannula size S pcs
273 Examination Gloves size L pcs
274 Paper tape 2.5 cm x 9.14 m pcs
275 Novo Twist 32 G x 5 mm pcs
276 Blood Transfusion set pcs
277 IV Catheter trovensite 20 G pcs
278 IV Catheter trovensite 22 G pcs
279 Onesept sol botol
280 Pharmafix 10 x 500 cm Rol
283 Povidon 10% 60ml botol
284 Povidon 10% 300ml botol
285 Rivanol 0,1 % 300ml botol
286 Soft pad 60x90 pcs
287 Suction catheter, 14 pcs
291 Urine Bag pcs
Mengetahui

Nip. 19760826 200501 2 008
LAPORAN PEMAKAIAN DAN LEMBAR PERMINT
SUMBER ANGGARAN KAPITA
STOK PENERI PERSE

AWAL MAAN DIAAN 1 2 3 4 5 6 7
-
75 75
1,899 1,899 270 20 60
70 70 3 4 3 3 4
-
519 1,000 1,519 70 50 20 10 30
-
-
15 15 1
-
-
50 50
-
-
-
100 100
-
60 60 2 1 2 1
-
-
300 300
606 606 80 60
-
158 158 14
746 746 40 10 30 10
-
26 26 1 4 1
-
-
-
200 200 15 14 5
522 522
-
120 120
-
-
699 699 20 13 34
-
-
-
10 10 1
-
-
-
3 20 23 1
152 152
-
123 123
-
-
-
387 387
-
-
18 18
335 335 20 30 30
795 795 180 30 20 120
785 785 10 30
330 330
-
-
-
-
-
- 20 20
-
-
-
-
-
629 629
285 285
-
-
-
-
-
-
-
370 370 2 2
-
-
-
-
-
-
-
-
-
-
-
11 11
-
-
-
-
-
-
290 200 490
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7 7
-
-
-
-
280 280 10
235 235
42 42
99 99
169 169
-
410 410 70 20 10 20
-
-
-
-
-
-
604 604 10
141 141
380 380 56
100 100
50 50
-
230 230 20
-
-
-
-
-
8 8
10 10 1
691 691 10
6 6
-
50 50
-
-
-
8 8 1 1
-
-
200 200
-
-
-
otol 100ml -
450 450
-
-
17 17 1
455 455 10 20
40 40 1
90 90
90 90
713 713
-
-
-
-
-
-
358 358 10 10 20
49 49
-
-
180 180
-
-
-
-
898 898 80 20 50 60
140 140 20
ftbag 500ml -
50 50
290 290
-
-
-
-
1 1
185 185
-
-
-
13 13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
18 18
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
EMBAR PERMINTAAN OBAT (LPLPO)
GGARAN KAPITASI
8 9 10 11 12 13 14 15 16 17 18
50 90 60 60 10 30 30 30 30 30
3 5 3 2 2 1 3 2
100 20 20 60 50 10 10
4 1 1 2 2 1 1
30 30 10
10
30 10 20 10 20 10
1 1 1 1
15
10 10
20 40 20 2 10 5 10 10 10
4 1 2
10
12 10
1
30 20 30
40 30 60 40 10 30 20
30 60 90 20 10 20 20
20 20 10
10 3 3
60 60 30 50
20 20 30 20 30 20 30 20
56 56
20 20 20 60 20
2
10 10 10
1 1 2
10 10
20
10 20 20 40 20 10
30 10
10 20 10 20
10 30 10 20
1
7
Yang Menyerahkan
VERA YUNITA
Nip . 19810621 200901 2 005
Bulan : JANUARI
Tahun : 2019
PENGE SISA
19 20 21 22 23 24 25 LUARAN STOK
- -
- 75
20 110 30 50 10 80 1,070 829
3 2 1 44 26
- -
10 10 30 30 40 570 949
- -
- -
2 13
- -
- -
- 50
- -
- -
- -
- 100
- -
1 2 2 3 26 34
- -
- -
- 300
30 20 10 20 290 316
- -
20 44 114
10 30 20 10 20 20 300 446
- -
1 1 2 1 15 11
- -
- -
- -
34 166
15 507
- -
10 10 40 80
- -
- -
10 60 10 1 10 285 414
- -
- -
- -
2 8
- -
- -
- -
2 1 1 12 11
10 10 30 122
- -
- 123
- -
- -
- -
22 365
- -
- -
1 17
10 10 180 155
30 30 640 155
20 30 20 40 400 385
10 60 270
- -
- -
- -
- -
- -
3 3 17
- -
- -
- -
- -
- -
- 629
- 285
- -
- -
- -
- -
- -
- -
- -
1 1 2 1 25 345
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 11
- -
- -
- -
- -
- -
- -
10 80 30 30 350 140
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 7
- -
- -
- -
- -
10 270
- 235
- 42
- 99
- 169
- -
10 10 60 20 410 -
- -
- -
- -
- -
- -
- -
10 594
- 141
84 32 284 96
- 100
- 50
- -
20 4 46 230 -
- -
- -
- -
- -
- -
- 8
3 7
20 20 80 611
- 6
- -
- 50
- -
- -
- -
2 6
- -
- -
- 200
- -
- -
- -
- -
- 450
- -
- -
1 6 11
10 60 395
1 39
- 90
- 90
20 693
- -
- -
- -
- -
- -
- -
20 20 200 158
1 3 1 5 44
- -
- -
8 48 132
- -
- -
- -
- -
10 20 20 10 40 10 380 518
90 50
- -
- 50
- 290
- -
- -
- -
- -
1 -
- 185
- -
- -
- -
- 13
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
5 12 6
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
SATU STOK
No NAMA OBAT
AN AWAL
1 ACTRAPID HM PENFILL Human insulin Short pcs -
2 penvil/catridge
ADALAT OROS 10020UINifedipin tab 20 mg, slow tablet 75
3 release;
BECEFORToros Kaplet 829
4 BECEFORT SYRUP botol 26
5 BIORON INJEKSI/NEUROBION INJ ampul -
6 BIORON tablet tablet 949
7 CERCUL Injeksi ( Citicoline 250 mg injeksi) Ampul -
8 DARYANT TULLE Framisetin sulfat tulle 1% pcs -
9 DECACETIN TETES MATA botol 13
10 0.5% Kloramfenikol
DEXOCORT tetes mata salep
Desoksimetason 0,5 %0,25% tube -
11 DEXTAMIN Tab (Deksammetason 0,5 mg, Tablet -
12 Dexchlorpheniramine maleate 2 mg)
DIFLUCAN 50MG Flukonazol kaps 50 mg capsul 50
13 DULCOLAX SUPP ADULT Bisakodil supp -
14 suppositoria
DULCOLAX 10SUPP
mg INFANT Bisakodil supp -
15 suppositoria
FARGOXIN5Digoksin
mg injeksi 0,25 mg/ml ampul -
16 FARSORBID 10 Isosorbid dinitrat tablet 100
17 tablet/kapsul/kaplet
FARSORBID Isosorbid 10 mg Dinitrat injeksi i.v 10 ampul -
18 mg/10
FLUCORTml N CREAM 5 mg ( Fluosinolon Tube 34
19 aesitonida
GENERIK0,25Air mg,
untukNeomisina
injeksi 20Sulfat
ml 5 mg) botol -
20 GENERIK Alopurinol tablet/kapsul/kaplet 100 tablet -
21 mg
GENERIK Alopurinol tablet/kapsul/kaplet 300 tablet 300
22 mg
GENERIK Amlodipin tablet/kapsul/kaplet 10 mg tablet 316
23 GENERIK Amlodipin tablet/kapsul/kaplet 5 mg tablet -
24 GENERIK Amoksisilin kapsul/kaplet/tablet capsul 114
25 scored
GENERIK250 mg
Amoksisilin kapsul/kaplet/tablet kaplet 446
26 scored 500 mg
GENERIK Amoksisilin sirup kering 125 mg/ 5 botol -
27 ml
GENERIK Amoksisilin sirup kering forte 250 botol 11
28 mg/5 ml Antasida DOEN I tablet kunyah,
GENERIK tablet -
29 kombinasi:
GENERIKAluminium
Asam askorbatHidroksida
(vitamin200C) mg + mg
tab 50 tablet -
30 Magnesium Hidroksida 200 mg
GENERIK Asam Mefenamat tablet/kapsul/kaplet kaplet -
31 500 mg
GENERIK Acyclovir 200 tablet 166
32 GENERIK Asiklovir tablet/kapsul/kaplet 400 mg tablet 507
33 GENERIK Bedak salisil serbuk 2% dos -
34 GENERIK Betahistin tablet/kapsul/kaplet 6 mg tablet 80
35 GENERIK Betametason krim 0,1% (sebagai tube -
36 Valerat)
GENERIK Bisakodil tablet/kapsul/kaplet 5 mg tablet -
37 GENERIK Deksametason tablet/kapsul/kaplet 0,5 tablet 414
38 mg
GENERIK Desoksimetason krim 0,25% tube -
39 GENERIK Dietilkarbamazin tablet scored 100 tablet -
mg
40 GENERIK Difenhidramin injeksi i.v./i.m. 10 ampul -
mg/ml (HCl)
41 GENERIK Desoksimetason krim 0,25% tube 8
42 GENERIK Dietilkarbamazin tablet scored 100 tablet -
43 mg
GENERIK Difenhidramin injeksi i.v./i.m. 10 ampul -
44 mg/ml
GENERIK (HCl)Dimenhidrinat tablet/kapsul/kaplet 50 tablet -
45 mg
GENERIK Domperidon syrup botol 11
46 GENERIK Domperidon tablet/kapsul/kaplet 10 tablet 122
47 mg
GENERIK Epinefrin (Adrenalin) injeksi ampul -
48 i.v/s.k./i.m
GENERIK1Fitomenadion
mg/ml (0,1%)(Vit.K1) tablet/kaplet tablet 123
49 salut gula 10Fitomenadion
GENERIK mg (vitamin K1) inj 10 ampul -
50 mg/ml
GENERIK (i.m) Furosemid tablet/kapsul/kaplet 40 mg tablet -
51 GENERIK Garam Oralit I serbuk, kombinasi: sachet -
52 Natrium
GENERIK klorida 0,52 g + tablet/kapsul/kaplet
Gemfibrozil kalium klorida 0,30300
g+ capsul 365
53 Trinatrium
mg sitrat dihidrat 0,58 g + Glukosa
GENERIK Gemfibrozil tablet/kapsul/kaplet 600 capsul -
Anhidrat
mg 2,70 g
54 GENERIK Gentamisin injeksi 40 mg/ ml ampul -
55 GENERIK Gentamisin tetes mata 0,3% Botol 17
56 GENERIK Glimepiride tablet/kapsul/kaplet 1 mg tablet 155
57 GENERIK Glimepiride tablet/kapsul/kaplet 2 mg Tablet 155
60 GENERIK Griseofulvin (micronized) tablet -
GENERIK Haloperidol 125 mg
tablet/kapsul/kaplet 0,5 tablet -
62 mg
GENERIK Haloperidol tablet/kapsul/kaplet 5 mg tablet -
63 GENERIK Hidroklorotiazid tab 25 mg tablet -
64 GENERIK Hidrokortison krim 2,5% Tube -
65 GENERIK Ibuprofen susp 100 mg/5 ml botol 17
66 GENERIK Ibuprofen susp 200 mg/5 ml botol -
67 GENERIK Ibuprofen tablet/kapsul/kaplet 200 mg tablet -
68 GENERIK Ibuprofen tablet/kapsul/kaplet 400 mg tablet -
69 GENERIK Kalsium Laktat (Kalk) tablet -
GENERIK Kaptopril 500 mg
tablet/kaplet scored 12,5 mg tablet -
71 GENERIK Kaptopril tablet/kaplet scored 25 mg tablet 629
72 GENERIK Kaptopril tablet/kaplet scored 50 mg tablet 285
73 GENERIK Karbogliserin tetes telinga 10% botol -
74 GENERIK Ketokonazol krim 2% tube -
75 GENERIK Ketokonazol tablet/kapsul/kaplet 200 tablet -
76 mg
GENERIK Ketorolak inj 30 mg/ml ampul -
77 GENERIK Klindamisin tablet/kapsul/kaplet 300 tablet -
78 mg
GENERIK Klopidogrel tablet/kapsul/kaplet 75 tablet -
79 mg
GENERIK Kloramfenikol salep mata 1 % Tube -
80 GENERIK Klorfeniramina Maleat (CTM) tablet 345
tablet/kapsul/kaplet 4 mg
81 GENERIK Klorpromazin tablet/kaplet salut 100 tablet -
mg (HCl)
82 GENERIK Klozapin 100 mg tablet -
84 GENERIK Kloramfenikol salep mata 1 % tube -
85 GENERIK Klorfeniramina Maleat (CTM) tablet/kapsul/kaplet
tablet 4 mg -
86 GENERIK Klorpromazin tablet/kaplet salut 100 mg (HCl)
tablet -
89 GENERIK Kodein tablet/kapsul/kaplet 10 mg tablet -
90 GENERIK kombinasi: ergotamin 1 mg + kafein tablet -
91 50 mg
GENERIK kombinasi: ferro fumarat 60 mg + as. tablet -
92 Folat 0,4 mgKotrimoksazol
GENERIK tablet salut gula (tablet
(anak) tambah tiap
kombinasi Botol 11
darah)
5GENERIK
ml suspensi: sulfametoksazol 200 mg +
93 Kotrimoksazol (dewasa) kombinasi: tablet -
trimetoprim 40 mg
sulfametoksazol 400 mg + trimetoprim 80 mg
94 GENERIK Kotrimoksazol forte kombinasi: tablet -
95 sulfametoksazol 800 mg + trimetoprim
GENERIK Lidokain injeksi 2% (HCL) 160 mg ampul -
96 GENERIK Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi:
botol sulfametoksazol -200 mg + trimetoprim
97 GENERIK Kotrimoksazol (dewasa) kombinasi: sulfametoksazol
tablet 400 mg + trimetoprim
- 80 mg
98 GENERIK Kotrimoksazol forte kombinasi: sulfametoksazol
Tablet800 mg + trimetoprim
- 160 mg
99 GENERIK Lansoprazol tablet/kapsul/kaplet 30 mg capsul 140
100 GENERIK Lidokain injeksi 2% (HCL) ampul -
101 GENERIK Loperamid tablet/kapsul/kaplet 2 mg Tablet -
102 GENERIK Loratadin tablet/kapsul/kaplet 10 mg Tablet -
103 GENERIK Metformin HCl tablet/kapsul/kaplet Tablet -
104 500 mg
GENERIK Metformin HCl tablet/kapsul/kaplet tablet -
105 850 mg
GENERIK Metilprednisolon inj 125 mg/mL ampul -
106 GENERIK Metilprednisolon inj 500 mg/vial ampul -
107 GENERIK Metilprednisolon tablet/kapsul/kaplet tablet -
16 mg
109 4GENERIK
mg Metilprednisolon tablet/kapsul/kaplet tablet -
110 8GENERIK
mg Metilprednisolon inj 500 mg/vial ampul -
112 16 mg
GENERIK Metilprednisolon tablet/kapsul/kaplet tablet -
113 4GENERIK
mg Metilprednisolon tablet/kapsul/kaplet tablet -
114 8GENERIK
mg Metoklopramide inj 5 mg/mL ampul -
115 GENERIK Metoklopramide tablet/kapsul/kaplet tablet -
116 5GENERIK
mg Metronidazol infus 5 mg/ ml botol -
117 GENERIK Metronidazol sirup 125 mg/5 ml Botol 7
118 GENERIK Metronidazol tablet/kapsul/kaplet 500 tablet -
119 mg
GENERIK Mometason furoat krim 0,1% tube -
120 GENERIK Nacl 0,9% botol -
121 GENERIK Natrium diklofenak tablet -
GENERIK Natrium25 mg
diklofenak tablet 270
GENERIK Nifedipin 50tablet/kapsul/kaplet
mg 10 mg tablet 235
124 GENERIK Nistatin tablet/kaplet salut 500.000 tablet 42
125 IU/ g
GENERIK Nistatin vaginal tablet 100.000 IU/ g tablet vaginal 99
126 GENERIK Ofloxacin 400 tablet 169
127 GENERIK Omeprazol injeksi 40 mg/ 10 ml ampul -
128 GENERIK Omeprazol tablet/kapsul/kaplet 20 mg capsul -
129 GENERIK Ondansetron inj 2 mg/ml (4 mg/ 2 ampul -
130 mL)
GENERIK Ondansetron tablet/kapsul/kaplet 4 mg tablet -
131 GENERIK Ondansetron tablet/kapsul/kaplet 8 mg tablet -
132 GENERIK Parasetamol drips (infus) 1000 botol -
133 mg/100 mL
GENERIK Parasetamol sirup 120 mg / 5 ml botol -
134 GENERIK Parasetamol tablet/kapsul/kaplet 500 tablet -
135 mg
GENERIK Piridoxin (vitamin B6) 10mg tablet 594
136 GENERIK Piridoxin (vitamin B6) 25mg tablet 141
137 GENERIK Prednison tablet/kapsul/kaplet 5 mg tablet 96
138 GENERIK Propranolol tab 40 mg tablet 100
139 GENERIK Propranolol tablet/kapsul/kaplet 10 tablet 50
140 mg
GENERIK Ranitidin injeksi 25 mg/ml ampul -
141 GENERIK Ranitidin tablet/kapsul/kaplet 150 mg tablet -
142 GENERIK Ringer Laktat botol -
143 GENERIK Risperidon tablet/kapsul/kaplet 1 mg tablet -
144 GENERIK Risperidon tablet/kapsul/kaplet 2 mg tablet -
145 GENERIK Salbutamol tablet/kapsul/kaplet 2 mg tablet -
146 (sebagai Sulfat)
GENERIK Salbutamol tablet/kapsul/kaplet 4 mg tablet -
147 (sebagai Sulfat)
GENERIK Sefadroksil sir kering 250 mg/5 ml botol 8
148 GENERIK Sefadroksil sirup kering 125 mg/5ml botol 7
149 GENERIK Sefadroksil tablet/kapsul/kaplet 500 tablet 611
150 mg
GENERIK Sefiksim sirup kering 100 mg/ 5 ml botol 6
151 GENERIK Sefiksim tablet/kapsul/kaplet 100 mg tablet -
152 GENERIK Sefiksim tablet/kapsul/kaplet 200 mg tablet 50
153 GENERIK Sefotaksim serb inj 1.000 mg vial -
154 GENERIK Sefotaksim serb inj 500 mg vial -
155 GENERIK Seftriaxon serb inj 1000 mg vial -
156 GENERIK Setirizin sirup 5 mg/5 ml Botol 6
157 GENERIK Setirizin tablet/kapsul/kaplet 10 mg tablet -
158 GENERIK Sianokobalamin (vitamin B12) injeksi ampul -
159 500 mcg
GENERIK Sianokobalamin (vitamin B12) tablet tablet 200
160 GENERIK Simvastatin tablet/kaplet/salut 10 mg tablet -
161 GENERIK Simvastatin tablet/kaplet/salut 20 mg tablet -
162 GENERIK Siprofloksasin inf 2 mg/ml (2%) botol -
163 GENERIK Sukralfat susp 500 mg/5 mL, 100 ml Botol 100ml -
164 GENERIK Tiamin (Vitamin B1) tablet 450
165 tablet/kapsul/kaplet 50 mg (HCl/
GENERIK Triheksifenidil Nitrat)
tablet/kapsul/kaplet 2 tablet -
166 mg
GENERIK Vitamin B Kompleks tablet tablet -
167 GENERIK Zinc sir 20 mg/5 ml Botol 11
168 GENERIK Zinc tablet dispersible 20 mg tablet 395
169 GENOINT SALEP MATA Gentamisin salep mata Tube 39
170 0,3%
GERIAVITA / Multivitamin (Beta-Carotene 6 mg, tablet 90
171 Vit E 30 mg, Vit
Glucotrol XL 10mgC 500 mg, Asam Folat 0,4 mg) tablet 90
172 HUSTAB Kaplet 693
173 INFUSAN D5 (100 ML) Larutan mengandung botol -
174 Karbohidrat
INFUSAN D5 (Glukosa 5g/100
(250 ML) ml) mengandung
Larutan botol -
175 Karbohidrat
INTERZOL(Glukosa 12,5 g/250 ml)
SS 2% Ketokonazol scalp sol 2% botol -
176 KETEROLAC INJ ampul -
177 LEVEMIR INSULIN Pen -
178 MERSIBION INJ ampul -
179 MOLEXFLU KAPLET kaplet 158
MOLEXFLU SYRUP botol 44
181 HCL, KLORFENIRAMINA
MYCORINE POWDER MikonazolMALEAT)
serbuk 2% botol -
182 HCL, KLORFENIRAMINA
MYCOSTOP MALEAT)
TAB. 250 Griseofulvin tablet -
NEO DIAGON Attapulgit250 mgtab 650 mg (Omegdiar) tablet 132
184 NEW ANTIDES Atapulgit tablet/kapsul/kaplet tablet -
185 600 mg
NORAGES INJ Ampul -
186 NOVOMIX 30 FLEXPEN Mix Insulin pcs -
187 flexpen/catridge
NOVORAPID FLEXPEN Rapid insulin pcs -
188 pen/flexpen/catridge
OSTEOTIN capsul 518
189 OSTOVEL capsul 50
190 Otsuka KA-EN 3B Softbag 500ml -
191 PRIMPEN SYR botol 50
192 PROFOLAT Asam Folat tablet/kapsul/kaplet 0,4 tablet 290
193 mg
PROSOGAN INJ 30MG Lansoprazol inj 30 ampul -
194 mg/ml
PULAREX Attapulgit tab 630 mg tablet -
195 SCABIMITE CREAM 10 Permetrin Krim 5% tube -
196 SKIZON Betametason krim 0,5 mg/g tube -
197 TETAGAM Human tetanus imunoglobulin inj pcs -
198 250 IU (i.m.)
THYROZOL 10 Tiamazol tab 10 mg tablet 185
199 ULSIDEX TABLET 500 MG Sukralfat tablet -
200 VAGIZOL Metronidazol ovula 500 mg ovula -
201 VENTOLIN ROTAHALER Ventolin Rotahaler pcs -
(Alat Hirup Salbutamol 200 mcg/kapsul)
202 STIMUNO SYR botol 13
203 TETAGAM Human tetanus imunoglobulin inj pcs -
204 250 IU (i.m.) 10 Tiamazol tab 10 mg
THYROZOL tablet -
205 ULSIDEX TABLET 500 MG Sukralfat tablet -
VAGIZOL Metronidazol 500 mg ovula 500 mg ovula -
207 VENTOLIN ROTAHALER Ventolin Rotahaler pcs -
208 (Alat Hirup
WIDA BES Salbutamol 200 mcg/kapsul) botol -
209 WIDA D5-1/2NS Larutan mengandung botol -
210 Karbohidrat + Elektrolit (D5-1/2NS)
WIDA D5-1/4NS Larutan mengandung botol -
211 Karbohidrat + Elektrolit (D5-1/4NS)
WIDA D5NS Larutan mengandung Karbohidrat + botol -
212 Elektrolit (D5NS)
WIDA HSD Larutan mengandung Karbohidrat + botol -
213 Elektrolit (HSD)
WIDA KDN1 Larutan mengandung Karbohidrat botol -
214 +WIDA
Elektrolit (D2,5 %+ KCl 0,15 %+ NaCl
KDN2 Larutan mengandung Karbohidrat 0,45 %) botol -
215 500
+WIDAml KN1(D2,5
Elektrolit %+ KCl 0,3 %+ NaCl 0,45 %)
Larutan mengandung Elektrolit (KCl botol -
216 500
0,15%
WIDAml +KN2
NaClLarutan
0,9%) mengandung elektrolit (KCl botol -
217 0,3%
WIDA + NaCl 0,9%) mengandung Karbohidrat +
RD Larutan botol -
Elektrolit (RD)
218 WIDA 0,9 % SOD.CHLOR botol -
219 Pehacain inj 2ml ampul -
220 Cavit G pcs -
221 Endo-Frost roeko botol -
222 Fuji IX art botol -
223 Etcha (Scothbond Etchant liq) botol -
224 Komposit/Lighcure (filtek Z 250 kit) pcs -
225 Bonding single bond universal pcs -
226 Cal lc denpro box -
227 Cresotin liquid II pcs -
228 Dentin Conditioner 6 Gr botol -
229 Hemospon box -
230 K File sendoline L25 15-40 pcs -
231 K reamers L25 15-40 pcs -
232 Seluloid strip box -
233 Softlex mini kit pcs -
234 NaOcl botol -
235 Sponge dental pcs -
236 Solare A2 pcs -
237 Solare A3 pcs -
-
238 Alat Suntik 3 ml pcs -
239 Alat Suntik 5 ml pcs -
240 Alkohol 70% 1 L botol -
241 Alkohol Swab pcs -
242 Antiseptik Gel@500 ml botol -
243 Bracket Hand Wash pcs -
244 Odex 500 ml botol -
245 Dermafix T 10 x 12 cm pcs -
248 Infus set dewasa pcs -
249 Kasa Hidrofil uk. 40 x 80 cm rol -
250 Kasa Hidrofil Steril uk. 16 x 16 dos -
251 Kasa pembalut 4 x 15 cm elastic rol -
252 Kasa pembalut 4 x 3 cm elastic rol -
253 Kasa pembalut hydrofil 4 x 10 cm rol -
254 Kasa pembalut hydrofil 4 x 5 cm rol -
255 My Jelly pcs -
256 Lisol 1 L botol -
257 Pot Sputum pcs -
258 Safeglove PP no. 7 pasang -
259 Catgut plain / Benang bedah No. 2/0 dengan jarum pcs -
260 Catgut plain / Benang bedah No. 3/0 dengan jarum pcs -
261 Examination Glove size L pcs -
262 Examination Gloves size M pcs -
263 Examination Gloves size S pcs -
264 Folley Catheter 2 way No. 16 pcs -
265 Folley Catheter 2 way No. 18 pcs -
266 IV Catheter NP pen type no. 18 pcs -
267 IV Catheter NP pen type no. 20 pcs -
268 Kapas Pembalut / Absorben 250 gram rol -
269 Masker pcs -
270 Nasal oxygen cannula size L pcs -
271 Nasal oxygen cannula size M pcs -
272 Nasal oxygen cannula size S pcs -
273 Examination Gloves size L pcs -
274 Paper tape 2.5 cm x 9.14 m pcs -
275 Novo Twist 32 G x 5 mm pcs 6
276 Blood Transfusion set pcs -
277 IV Catheter trovensite 20 G pcs -
278 IV Catheter trovensite 22 G pcs -
279 Onesept sol botol -
280 Pharmafix 10 x 500 cm Rol -
283 Povidon 10% 60ml botol -
284 Povidon 10% 300ml botol -
285 Rivanol 0,1 % 300ml botol -
286 Soft pad 60x90 pcs -
287 Suction catheter, 14 pcs -
291 Urine Bag pcs -
Mengetahui

Nip. 19760826 200501 2 008
LAPORAN PEMAKAIAN DAN L
SUMBER ANG
PENERI PERSE
MAAN DIAAN 26 27 28 29 30 31 1
-
75
1,500 2,329 110 30 100 100 60 70
26 1 5 2 7 4
-
949 30 20 40
-
-
13 1
-
-
50
-
-
-
100
-
34 3 2
-
-
300 10
1,200 1,516 10 10 20 20 30
-
300 414
300 746 10 20 30 30
-
11 3 1 1 1
-
-
-
166
507
-
500 580 20
-
-
414 20 10 5
-
-
-
8 1
-
-
-
10 21 2
200 322 10 10 20
-
123
-
-
-
365 12
-
-
17
155 30
155 20 20 60 55
500 885 30 40
500 770 60 45
-
-
-
-
-
20 37 1 1 2 3 1
-
-
-
-
-
629
285
-
-
-
-
-
-
-
345 15 10 5
-
-
-
-
-
-
-
-
-
-
-
11 1 1
-
-
-
-
-
-
220 360 50 20 20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7 1
-
-
-
-
270
235
42 10
99
169
-
-
-
-
-
-
-
-
594 10 30
141
300 396
100
50
-
-
-
-
-
-
-
8
10 17 1
300 911 20 20 10 20 20 10
6
-
50
-
-
-
6
-
-
200
-
-
-
-
450
-
-
11 1 1
395 10
39 1
90
90
693 10
-
-
-
-
3 3
-
600 758 10 55 14
44 1 1
-
-
132
-
-
-
-
900 1,418 10 40 10 30
90 140
-
50
290
-
-
-
-
-
185 30
-
-
-
50 63 1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
SUMBER ANGGARAN KAPITASI
2 3 4 5 6 7 8 9 10 11 12
89 120 100 70 20 60
1
10 20 10 10 20
6 35 5 20
30 30 15 70 15 45 25 10
10 5 10 20 10
35 20 20 20
1 1
25
10 10 50 10 10 10
6 20 10 11 26
2 1
20 10 20 10 10
10
30
60 10 20 25 80
25 5 31 15 10 15 8
1 1
10
18 15 28 10
20
10 20
20 20
54 38
1 1 1
10 10 40 18 10 20
10 10
3
30 16 100 10 10 5
1 1
20 90 95 40 10
20
1 3 2
3 2
Yang Menyerahkan
VERA YUNITA
Nip . 19810621 200901 2 005
13 14 15 16 17 18 19 20 21 22 23
40 30 20 10 20 20 20 20 70
10 10 50 10 40 30 10 50
1 1 1 1
10 20 10 20 20 10
75 35 40 25 10 10 50
10
10 10 10 10 30 30 20 20
1 1 1
20 20 10 10
15 5 10 30
1 1
10 10 6 6
10
15 12 24 12
1 1
15
10 35 20 30 30 30
5 24 8 36 23 8 13 10
1 1
20 15
5 8 13 3
20 10 20 10
20 10 10 10 10
40 3
42 14 10
1 1 1
20 20 10 10 20 30
1
10 10
10 10 10 10 20 10 10
2 1 1 1 1 1
40 10 40 75 40 50 60 20 30
30 30
1 1 1 2 1 3
Bulan : FEBRUARI Unit :
Tahun : 2019
PENGE SISA
No NAMA OBAT
24 25 LUARAN STOK
- - 1 ACTRAPID HM PENFILL Human
- 75 2 insulin
ADALAT Short penvil/catridge
OROS 100tab
20 Nifedipin UI20 m
20 1,199 1,130 3 slow release; oros
BECEFORT
20 6 4 BECEFORT SYRUP
- - 5 BIORON INJEKSI/NEUROBION INJ
370 579 6 BIORON tablet
- - 7 CERCUL Injeksi ( Citicoline 250 mg
- - 8 injeksi)
DARYANT TULLE Framisetin sulfat
1 12 9 tulle 1%
DECACETIN TETES MATA
- - 10 0.5% Kloramfenikol tetes mata salep
DEXOCORT Desoksimetason 0,5 %
- - 11 0,25%
DEXTAMIN Tab (Deksammetason 0,5
- 50 12 mg, Dexchlorpheniramine
DIFLUCAN maleate
50MG Flukonazol 2 mg
kaps 50
- - 13 mg
DULCOLAX SUPP ADULT Bisakodil
- - 14 suppositoria
DULCOLAX 10SUPP
mg INFANT Bisakodi
- - 15 suppositoria
FARGOXIN5Digoksin
mg injeksi 0,25 mg/
- 100 16 FARSORBID 10 Isosorbid dinitrat
- - 17 tablet/kapsul/kaplet
FARSORBID Isosorbid 10 mgDinitrat injeksi
1 11 23 18 i.v 10 mg/10NmlCREAM 5 mg
FLUCORT
- - 19 (GENERIK
Fluosinolon aesitonida
Air 0,25 20
untuk injeksi mg,ml
- - 20 Neomisina
GENERIKSulfat 5 mg)
Alopurinol
10 176 124 21 tablet/kapsul/kaplet
GENERIK Alopurinol 100 300
mg mg
40 615 901 22 GENERIK Amlodipin tablet 10 mg
- - 23 GENERIK Amlodipin tablet/kapsul/kap
20 85 329 24 5GENERIK
mg Amoksisilin kapsul 250 mg
10 335 411 25 GENERIK Amoksisilin kaplet 500 mg
- - 26 GENERIK Amoksisilin sirup kering 12
11 - 27 mg/ 5 ml Amoksisilin sirup kering for
GENERIK
- - 28 250 mg/5 mlAntasida DOEN I tablet
GENERIK
- - 29 kunyah,
GENERIK kombinasi: Aluminium
Asam askorbat (vitamin C) t
- - 30 Hidroksida
50 mg
GENERIK 200 mg + Magnesium
Asam Mefenamat
Hidroksida 200 mg 500 mg
tablet/kapsul/kaplet
- 166 31 GENERIK Acyclovir 200
25 482 32 GENERIK Asiklovir tablet 400 mg
- - 33 GENERIK Bedak salisil serbuk 2%
180 400 34 GENERIK Betahistin tablet/kapsul/kap
- - 35 6GENERIK
mg Betametason krim 0,1%
- - 36 (sebagai Valerat)
GENERIK Bisakodil tablet/kapsul/kapl
5 mg
20 188 226 37 GENERIK Deksametason
GENERIK Desoksimetason0,5 mg krim 0,25%
- - 39 GENERIK Dietilkarbamazin tablet scor

100 mg
- - 40 GENERIK Difenhidramin injeksi i.v./i.m
10 mg/ml (HCl)
1 7 41 GENERIK Desoksimetason krim 0,25%
- - 42 GENERIK Dietilkarbamazin tablet scor
- - 43 100 mg
GENERIK Difenhidramin injeksi i.v./i.m
- - 44 10 mg/ml (HCl)
GENERIK Dimenhidrinat
7 14 45 tablet/kapsul/kaplet
GENERIK Domperidon 50 mgsyrup
142 180 46 GENERIK Domperidon
GENERIK Epinefrin 10(Adrenalin)
mg injeks
10 113 48 i.v/s.k./i.m 1 mg/ml (0,1%)
GENERIK Fitomenadion (Vit.K1)
- - 49 tablet/kaplet salut gula 10 mg
GENERIK Fitomenadion (vitamin K1)
- - 50 10 mg/ml (i.m)
GENERIK Furosemid tablet/kapsul/kap
- - 51 40 mg
GENERIK Garam Oralit I serbuk,
12 97 268 52 kombinasi:
GENERIK Natrium klorida 0,52 g +
Gemfibrozil
- - 53 kalium klorida 0,30
GENERIK Gemfibrozil g + Trinatrium
300 mg sitrat
dihidrat 0,58 g +
tablet/kapsul/kapletGlukosa Anhidrat
600 injeksi
mg 2,70
- - 54 GENERIK Gentamisin 40 mg/ m
2 15 55 GENERIK Gentamisin tetes mata 0,3%
75 80 56 GENERIK Glimepiride tablet 1 mg
155 - 57 GENERIK Glimepiride tablet 2 mg
35 455 430 58 GENERIK Glimepiride tablet 3 mg
341 429 59 GENERIK Glimepiride tablet 4 mg
- - 60 GENERIK Griseofulvin (micronized)
GENERIK Haloperidol 0,5 mg
- - 63 tablet/kapsul/kaplet 5 mg
GENERIK Hidroklorotiazid tab 25 mg
- - 64 GENERIK Hidrokortison krim 2,5%
12 25 65 GENERIK Ibuprofen susp 100 mg/5 m
- - 66 GENERIK Ibuprofen susp 200 mg/5 m
- - 67 GENERIK Ibuprofen tablet/kapsul/kapl
- - 68 200 mg
GENERIK Ibuprofen tablet/kapsul/kapl
- - 69 400 mg
GENERIK Kalsium Laktat (Kalk)
tablet/kaplet score
30 65 564 71 12,5 mg
GENERIK Kaptopril tablet 25 mg
10 275 72 GENERIK Kaptopril tablet 50 mg
- - 73 GENERIK Karbogliserin tetes telinga
- - 74 10%
GENERIK Ketokonazol krim 2%
- - 75 GENERIK Ketokonazol
GENERIK Ketorolak 200injmg
30 mg/ml
- - 77 GENERIK Klindamisin
GENERIK Klopidogrel 300 mg
79 tablet/kapsul/kaplet 75 mg salep mata 1
GENERIK Kloramfenikol
- -
10 140 205 80 GENERIK Klorfeniramina Maleat (CTM
- - 81 GENERIK Klorpromazin tablet/kaplet
salut 100 mg (HCl)
- - 82 GENERIK Klozapin 100 mg
- - 84 GENERIK Kloramfenikol salep mata 1
- - 85 GENERIK Klorfeniramina Maleat (CTM
- - 86 GENERIK Klorpromazin tablet/kaplet s
- - 89 GENERIK Kodein tablet/kapsul/kaplet
- - 90 mg
GENERIK kombinasi: ergotamin 1 mg
- - 91 kafein
GENERIK50 mgkombinasi: ferro fumarat 60
2 9 92 mg + as. Folat
GENERIK 0,4 mg tablet(anak)
Kotrimoksazol salut gula
(tablet tambah
kombinasi darah)
- - 93 GENERIKtiap 5 ml suspensi:
Kotrimoksazol (dewasa)
sulfametoksazol
kombinasi: 200 mg + trimetoprim
sulfametoksazol 400 mg + 4
- - 94 GENERIK Kotrimoksazol forte
mg
trimetoprim
kombinasi: 80 mg
- - 95 GENERIK sulfametoksazol
Lidokain injeksi800
2% mg +
(HCL)
trimetoprim 160 mg
- - 96 GENERIK Kotrimoksazol (anak) komb
- - 97 GENERIK Kotrimoksazol (dewasa) kom
- - 98 GENERIK Kotrimoksazol forte kombin
170 190 99 GENERIK Lansoprazol tablet/kapsul/k
- - 100 GENERIK Lidokain injeksi 2% (HCL)
- - 101 GENERIK Loperamid
GENERIK Loratadin 2 mg
tablet/kapsul/kapl
- - 103 10 mg
GENERIK Metformin HCl
GENERIK Metformin 500HCl
mg
- - 105 tablet/kapsul/kaplet 850 mg inj 125
GENERIK Metilprednisolon
106 mg/mL
GENERIK Metilprednisolon inj 500
- -
mg/vial
- - 107 GENERIK Metilprednisolon
- - 108 GENERIK Metilprednisolon
GENERIK Metilprednisolon inj 500
- - 111 mg/vial
GENERIK Metoklopramide inj 5 mg/m
- - 115 GENERIK Metoklopramide
GENERIK Metronidazol 5 mg infus 5 mg/ m
2 5 117 GENERIK Metronidazol sirup 125 mg/
- - 118 ml
GENERIK Metronidazol
GENERIK Mometason 500 mg
furoat krim 0,1%
- - 120 GENERIK Nacl 0,9%
- - 121 GENERIK Natrium diklofenak
GENERIK Natrium25 mg
diklofenak tablet 5
- 235 123 mg
GENERIK Nifedipin tablet/kapsul/kapl
10 32 124 10 mg
GENERIK Nistatin tablet/kaplet salut
- 99 125 500.000
GENERIK IU/ Nistatin
g vaginal tablet 100.0
- 169 126 IU/ g
GENERIK Ofloxacin 400
- - 127 GENERIK Omeprazol injeksi 40 mg/ 1
- - 128 ml
GENERIK Omeprazol
GENERIK Ondansetron 20 mginj 2 mg/ml (4
- - 130 mg/ 2 mL) Ondansetron
GENERIK
GENERIK Ondansetron 4 mg
GENERIK Parasetamol 8 mgdrips (infus) 10
- - 133 mg/100
GENERIK mL Parasetamol sirup 120 mg /
- - 134 ml
GENERIK Parasetamol
GENERIK Piridoxin 50010mg
mg
- 141 136 GENERIK Piridoxin 25mg
158 238 137 GENERIK Prednison tablet/kapsul/kap
- 100 138 5GENERIK
mg Propranolol tab 40 mg
- 50 139 GENERIK Propranolol tablet 10 mg
- - 140 GENERIK Ranitidin injeksi 25 mg/ml
- - 141 GENERIK Ranitidin tablet/kapsul/kaple
- - 142 150 mg
GENERIK Ringer Laktat
- - 143 GENERIK Risperidon
GENERIK Risperidon 1 mg
GENERIK Salbutamol 2 mg
GENERIK Salbutamol 2 mg (sebagai Sulfa
- 8 147 tablet/kapsul/kaplet
GENERIK Sefadroksil 4 mgsir(sebagai Sulfa
kering 250
7 10 148 mg/5 ml
GENERIK Sefadroksil sirup kering 125
10 328 583 149 mg/5ml
GENERIK Sefadroksil kapsul 500 mg
- 6 150 GENERIK Sefiksim sirup kering 100 m
- - 151 5GENERIK
ml Sefiksim tablet/kapsul/kaple
- 50 152 100 mg
GENERIK Sefiksim tablet/kapsul/kaple
- - 153 200 mg
GENERIK Sefotaksim serb inj 1.000 m
- - 154 GENERIK Sefotaksim serb inj 500 mg
- - 155 GENERIK Seftriaxon serb inj 1000 mg
- 6 156 GENERIK Setirizin sirup 5 mg/5 ml
- - 157 GENERIK Setirizin tablet/kapsul/kaple
- - 158 10 mg
GENERIK Sianokobalamin (vitamin B1
- 200 159 injeksi 500 mcg
GENERIK Sianokobalamin (vitamin B1
- - 160 tablet
GENERIK Simvastatin tablet/kaplet/sal
- - 161 10 mg
GENERIK Simvastatin tablet/kaplet/sal
- - 162 20 mg
GENERIK Siprofloksasin inf 2 mg/ml
- - 163 (2%)
GENERIK Sukralfat susp 500 mg/5 mL
- 450 164 100 ml
GENERIK Tiamin (Vitamin B1)
- - 165 tablet/kapsul/kaplet 50 mg (HCl/ Nitrat)
GENERIK Triheksifenidil
GENERIK Vitamin2Bmg Kompleks tablet
3 8 167 GENERIK Zinc sir 20 mg/5 ml
50 345 168 GENERIK Zinc tablet dispersible 20 m
1 38 169 GENOINT SALEP MATA Gentamisin
- 90 170 salep mata 0,3%
GERIAVITA / Multivitamin (Beta-
- 90 171 Carotene 6 mg, Vit E 30 mg, Vit C 500
Glucotrol XL 10mg
10 683 172 mg, Asam Folat 0,4 mg)
HUSTAB
- - 173 INFUSAN D5 (100 ML) Larutan
- - 174 mengandung
INFUSAN D5Karbohidrat (Glukosa 5g/1
(250 ML) Larutan
- - 175 ml)
mengandung Karbohidrat
INTERZOL SS (Glukosa
2% Ketokonazol 12,5
scalp
- - 176 g/250
2% ml)
KETEROLAC INJ
3 - 177 LEVEMIR INSULIN
- - 178 MERSIBION INJ
330 428 179 MOLEXFLU KAPLET
11 33 180 (PARACETAMOL,PHENYLPROPANO
MOLEXFLU SYRUP
- - 181 AMIN HCL, KLORFENIRAMINA
(PARACETAMOL,PHENYLPROPANO
MYCORINE POWDER Mikonazol
MALEAT)
AMIN
serbuk HCL,
2% KLORFENIRAMINA
- - 182 MYCOSTOP TAB. 250 Griseofulvin
MALEAT)
tablet/kapsul/kaplet 250 mgtab 650 mg (
- 132 183 NEO DIAGON Attapulgit
- - 184 NEW ANTIDES Atapulgit
NORAGES INJ 600 mg
- - 186 NOVOMIX 30 FLEXPEN Mix Insulin
- - 187 flexpen/catridge
NOVORAPID FLEXPEN Rapid insulin
20 730 688 188 pen/flexpen/catridge
OSTEOTIN
10 70 70 189 OSTOVEL
- - 190 Otsuka KA-EN 3B
- 50 191 PRIMPEN SYR
20 270 192 PROFOLAT Asam Folat
PROSOGAN INJ 30MG 0,4 mgLansoprazol in
- - 194 30 mg/ml Attapulgit tab 630 mg
PULAREX
- - 195 SCABIMITE CREAM 10 Permetrin Kr
- - 196 5%
SKIZON Betametason krim 0,5 mg/g
- - 197 TETAGAM Human tetanus
30 155 198 imunoglobulin
THYROZOL 10 injTiamazol
250 IU (i.m.)
tab 10 mg
- - 199 ULSIDEX TABLET 500 MG Sukralfat
- - 200 VAGIZOL Metronidazol ovula 500 mg
- - 201 VENTOLIN ROTAHALER Ventolin
Rotahaler (Alat Hirup Salbutamol 200
16 47 202 STIMUNO SYR
mcg/kapsul)
- - 203 TETAGAM Human tetanus
- - 204 imunoglobulin
250 IU (i.m.)
tab 10 mg
- - 205 ULSIDEX TABLET 500 MG Sukralfat
VAGIZOL Metronidazol 500 mgovula 500 mg
- - 207 VENTOLIN ROTAHALER Ventolin
- - 208 Rotahaler
WIDA BES (Alat Hirup Salbutamol 200
- - 209 mcg/kapsul)
WIDA D5-1/2NS Larutan mengandung
- - 210 Karbohidrat
WIDA D5-1/4NS+ Elektrolit (D5-1/2NS)
Larutan mengandung
- - 211 Karbohidrat + Elektrolit (D5-1/4NS)
WIDA D5NS Larutan mengandung
- - 212 Karbohidrat
WIDA HSD+Larutan
Elektrolit (D5NS)
mengandung
- - 213 Karbohidrat
WIDA KDN1 + Elektrolit (HSD)
Larutan mengandung
- - 214 Karbohidrat
WIDA KDN2 + Elektrolit (D2,5 %+ KCl
Larutan mengandung
- - 215 0,15 %+
KarbohidratNaCl 0,45
WIDA KN1+Larutan %)
Elektrolit500 ml %+ KCl
(D2,5
mengandung
- - 216 0,3 %+ NaCl
Elektrolit
WIDA KN2(KCl0,45 %) mengandung
0,15%
Larutan 500 ml 0,9%)
+ NaCl
- - 217 elektrolit
WIDA RD (KCl 0,3%mengandung
Larutan + NaCl 0,9%)
Karbohidrat + Elektrolit (RD)
- - 218 WIDA 0,9 % SOD.CHLOR
- - 219 Pehacain inj 2ml
- - 220 Cavit G
- - 221 Endo-Frost roeko
- - 222 Fuji IX art
- - 223 Etcha (Scothbond Etchant liq)
- - 224 Komposit/Lighcure (filtek Z 250 kit)
- - 225 Bonding single bond universal
- - 226 Cal lc denpro
- - 227 Cresotin liquid II
- - 228 Dentin Conditioner 6 Gr
- - 229 Hemospon
- - 230 K File sendoline L25 15-40
- - 231 K reamers L25 15-40
- - 232 Seluloid strip
- - 233 Softlex mini kit
- - 234 NaOcl
- - 235 Sponge dental
- - 236 Solare A2
- - 237 Solare A3
- -
- - BAHAN MEDIS HABIS PAKAI
- - 238 Alat Suntik 3 ml
- - 240 Alkohol 70% 1 L
- - 241 Alkohol Swab
- - 242 Antiseptik Gel@500 ml
- - 243 Bracket Hand Wash
- - 244 Odex 500 ml
- - 245 Dermafix T 10 x 12 cm
- - 248 Infus set dewasa
- - 249 Kasa Hidrofil uk. 40 x 80 cm
- - 250 Kasa Hidrofil Steril uk. 16 x 16
- - 251 Kasa pembalut 4 x 15 cm elastic
- - 252 Kasa pembalut 4 x 3 cm elastic
- - 253 Kasa pembalut hydrofil 4 x 10 cm
- - 254 Kasa pembalut hydrofil 4 x 5 cm
- - 255 My Jelly
- - 256 Lisol 1 L
- - 257 Pot Sputum
- - 258 Safeglove PP no. 7
- - 259 Catgut plain / Benang bedah No. 2/0 de
- - 260 Catgut plain / Benang bedah No. 3/0 de
- - 261 Examination Glove size L
- - 262 Examination Gloves size M
- - 263 Examination Gloves size S
- - 264 Folley Catheter 2 way No. 16
- - 265 Folley Catheter 2 way No. 18
- - 266 IV Catheter NP pen type no. 18
- - 267 IV Catheter NP pen type no. 20
- - 268 Kapas Pembalut / Absorben 250 gram
- - 269 Masker
- - 270 Nasal oxygen cannula size L
- - 271 Nasal oxygen cannula size M
- - 272 Nasal oxygen cannula size S
- - 273 Examination Gloves size L
- - 274 Paper tape 2.5 cm x 9.14 m
5 1 275 Novo Twist 32 G x 5 mm
- - 276 Blood Transfusion set
- - 277 IV Catheter trovensite 20 G
- - 278 IV Catheter trovensite 22 G
- - 279 Onesept sol
- - 280 Pharmafix 10 x 500 cm
- - 283 Povidon 10% 60ml
- - 284 Povidon 10% 300ml
- - 285 Rivanol 0,1 % 300ml
- - 286 Soft pad 60x90
- - 287 Suction catheter, 14
- - 291 Urine Bag
Mengetahui

Nip. 19760826 200501 2 008
LAP
RUANG FARMASI

MA OBAT
AN AWAL MAAN DIAAN 26 27 28 29
PENFILL Human pcs - -
il/catridge
20 Nifedipin100tab
UI20 mg, tablet 75 75
Kaplet 1,130 500 1,630 20 40 90
RUP botol 6 6 1
SI/NEUROBION INJ ampul - -
tablet 579 900 1,479 10
( Citicoline 250 mg Ampul - -
LE Framisetin sulfat pcs - -
ETES MATA botol 12 12
kol tetes mata salep
soksimetason 0,5 % tube - -
(Deksammetason 0,5 Tablet - -
niramine
MG Flukonazol maleate 2 mg)
kaps 50 capsul 50 50
PP ADULT Bisakodil supp - -
gPP INFANT Bisakodil supp - -
oksin injeksi 0,25 mg/ml ampul - -
Isosorbid dinitrat tablet 100 100
et 10 mg
sorbid Dinitrat injeksi ampul - -
EAM 5 mg Tube 23 23
tonida
ntuk injeksi0,25 20
mg,ml botol - -
5rinol
mg) tablet - -
etrinol
100 300
mg mg tablet 124 124 13
dipin tablet 10 mg tablet 901 600 1,501 25 15 65
dipin tablet/kapsul/kaplet tablet - -
sisilin kapsul 250 mg capsul 329 329
sisilin kaplet 500 mg kaplet 411 500 911 10 20 40
sisilin sirup kering 125 botol - -
sisilin sirup kering forte botol - -
ida DOEN I tablet tablet - -
i:askorbat
Aluminium
(vitamin C) tab tablet - -
gMefenamat
+ Magnesium kaplet - -
g 500 mg
et
ovir 200 tablet 166 166
ovir tablet 400 mg tablet 482 482
k salisil serbuk 2% dos - -
istin tablet/kapsul/kaplet tablet 400 300 700 10 10
metason krim 0,1% tube - -
odil tablet/kapsul/kaplet tablet - -
ametason tablet 226 300 526 19 20
et 0,5 mg krim 0,25%
ksimetason tube - -
karbamazin tablet scored tablet - -
hidramin injeksi i.v./i.m. ampul - -
ksimetason krim 0,25% tube 7 7
karbamazin tablet scored tablet - -
hidramin injeksi i.v./i.m. ampul - -
nhidrinat tablet - -
et 50 mgsyrup
peridon botol 14 14 1
peridon tablet 180 400 580 30
et 10(Adrenalin)
frin mg injeksi ampul - -
ml (0,1%)
enadion (Vit.K1) tablet 113 113
gula 10 mg
enadion (vitamin K1) inj ampul - -
emid tablet/kapsul/kaplet tablet - -
m Oralit I serbuk, sachet - -
m klorida 0,52 g +
ibrozil capsul 268 268 15
30
et g + Trinatrium
300
ibrozil mg sitrat capsul - -
Glukosa
et Anhidrat
600 injeksi
mg 2,70 g
misin 40 mg/ ml ampul - -
misin tetes mata 0,3% Botol 15 15
epiride tablet 1 mg tablet 80 80
epiride tablet 2 mg Tablet - -
epiride tablet 3 mg tablet 430 300 730
epiride tablet 4 mg tablet 429 500 929 55 45
ofulvin (micronized) tablet - -
eteridol
125 mg tablet - -
eteridol
0,5 mg tablet - -
et 5 mg
klorotiazid tab 25 mg tablet - -
kortison krim 2,5% Tube - -
ofen susp 100 mg/5 ml botol 25 25
ofen susp 200 mg/5 ml botol - -
ofen tablet/kapsul/kaplet tablet - -
ofen tablet/kapsul/kaplet tablet - -
um Laktat (Kalk) tablet - -
etpril
500 mg
tablet/kaplet scored tablet - -
pril tablet 25 mg tablet 564 500 1,064 10 70
pril tablet 50 mg tablet 275 275
ogliserin tetes telinga botol - -
onazol krim 2% tube - -
onazol tablet - -
et 200injmg
olak 30 mg/ml ampul - -
amisin tablet - -
et 300 mg
dogrel tablet - -
et 75 mg salep mata 1 %
mfenikol Tube - -
eniramina Maleat (CTM) tablet 205 200 405 15 10 10
et 4 mg
romazin tablet/kaplet tablet - -
l)
pin 100 mg tablet - -
mfenikol salep mata 1 % tube - -
eniramina Maleat (CTM) tablet/kapsul/kaplet
tablet 4 mg
- -
romazin tablet/kaplet salut 100
tablet
mg (HCl) - -
n tablet/kapsul/kaplet 10 tablet - -
inasi: ergotamin 1 mg + tablet - -
inasi: ferro fumarat 60 tablet - -
mg tablet(anak)
moksazol salut gula Botol 9 9
ah)
ml suspensi:
moksazol (dewasa) tablet - -
00 mg + trimetoprim
metoksazol 400 mg + 40
moksazol forte tablet - -
g
metoksazol 800 mg +
ain injeksi 2% (HCL) ampul - -
mg
moksazol (anak) kombinasi tiap botol
5 ml suspensi: sulfametoksazol
- 200 mg +- trimetoprim 40 mg
moksazol (dewasa) kombinasi: tablet
sulfametoksazol 400
- mg + trimetoprim 80- mg
moksazol forte kombinasi: sulfametoksazol
Tablet 800 mg
- + trimetoprim 160 mg -
prazol tablet/kapsul/kaplet 30
capsul
mg 190 190
ain injeksi 2% (HCL) ampul - -
amid Tablet - -
et 2 mg
adin tablet/kapsul/kaplet Tablet - -
rmin HCl Tablet - -
etrmin
500HCl
mg tablet - -
et 850 mg
prednisolon inj 125 ampul - -
prednisolon tablet - -
et 16 mg
et 4 mg
et 8 mg
et 16 mg
et 4 mg
et 8 mg
klopramide inj 5 mg/mL ampul - -
klopramide tablet - -
etnidazol
5 mg infus 5 mg/ ml botol - -
nidazol sirup 125 mg/5 Botol 5 5
nidazol tablet - -
et 500 mg
etason furoat krim 0,1% tube - -
0,9% botol - -
um diklofenak tablet - -
et 25 mg
um diklofenak tablet 50 tablet 160 100 260 20 10
ipin tablet/kapsul/kaplet tablet 235 235
in tablet/kaplet salut tablet 32 32
in vaginal tablet 100.000tablet vaginal 99 99
acin 400 tablet 169 169
razol injeksi 40 mg/ 10 ampul - -
razol capsul - -
et 20 mginj 2 mg/ml (4
nsetron ampul - -
nsetron tablet - -
et 4 mg
nsetron tablet - -
et 8 mgdrips (infus) 1000
etamol botol - -
etamol sirup 120 mg / 5 botol - -
etamol tablet - -
etxin
50010mg
mg tablet 471 200 671 20
xin 25mg tablet 141 141
ison tablet/kapsul/kaplet tablet 238 200 438
anolol tab 40 mg tablet 100 100
anolol tablet 10 mg tablet 50 50
din injeksi 25 mg/ml ampul - -
din tablet/kapsul/kaplet tablet - -
botol - -
ridon tablet - -
et 1
ridonmg tablet - -
et 2
tamolmg tablet - -
et 2
tamolmg (sebagai Sulfat) tablet - -
et 4 mg (sebagai Sulfat)
roksil sir kering 250 botol 8 8
roksil sirup kering 125 botol 10 10
roksil kapsul 500 mg tablet 583 583 9 10
sim sirup kering 100 mg/ botol 6 6
sim tablet/kapsul/kaplet tablet - -
sim tablet/kapsul/kaplet tablet 50 50
aksim serb inj 1.000 mg vial - -
aksim serb inj 500 mg vial - -
axon serb inj 1000 mg vial - -
zin sirup 5 mg/5 ml Botol 6 6
zin tablet/kapsul/kaplet tablet - -
kobalamin (vitamin B12) ampul - -
kobalamin (vitamin B12) tablet 200 200
astatin tablet/kaplet/salut tablet - -
astatin tablet/kaplet/salut tablet - -
floksasin inf 2 mg/ml botol - -
lfat susp 500 mg/5 mL, Botol 100ml - -
n (Vitamin B1) tablet 450 450
et 50 mg (HCl/ Nitrat)
ksifenidil tablet - -
et
in2BmgKompleks tablet tablet - -
sir 20 mg/5 ml Botol 8 8 1
ablet dispersible 20 mg tablet 345 345
EP MATA Gentamisin Tube 38 38
ultivitamin (Beta- tablet 90 90
t
mg E 30 mg, Vit C 500 tablet 90 90
,4 mg) Kaplet 683 683
00 ML) Larutan botol - -
bohidrat (Glukosa 5g/100
50 ML) Larutan botol - -
bohidrat (Glukosa
% Ketokonazol 12,5sol
scalp botol - -
NJ ampul - -
LIN Pen - 1 1
J ampul - -
APLET kaplet 428 428
L,PHENYLPROPANOL
RUP botol 33 33
ORFENIRAMINA
L,PHENYLPROPANOL
WDER Mikonazol botol - -
ORFENIRAMINA
B. 250 Griseofulvin tablet - -
et 250 mgtab 650 mg (Omegdiar)
Attapulgit tablet 132 132
Atapulgit tablet - -
et 600 mg Ampul - -
LEXPEN Mix Insulin pcs - -
LEXPEN Rapid insulin pcs - -
ge capsul 688 300 988 20 40 20
capsul 70 70
Softbag 500ml - -
botol 50 50
m Folat tablet 270 270
et 0,4 mg
J 30MG Lansoprazol inj ampul - -
ulgit tab 630 mg tablet - -
EAM 10 Permetrin Krim tube - -
tason krim 0,5 mg/g tube - -
an tetanus pcs - -
250 IU (i.m.)
Tiamazol tab 10 mg tablet 155 155
ET 500 MG Sukralfat tablet - -
et 500 mg
nidazol ovula 500 mg ovula - -
TAHALER Ventolin pcs - -
irup Salbutamol 200
botol 47 10 57
an tetanus pcs - -
250 IU (i.m.)
Tiamazol tab 10 mg tablet - -
ET 500 MG Sukralfat tablet - -
et 500 mg
nidazol ovula 500 mg ovula - -
TAHALER Ventolin pcs - -
irup Salbutamol 200 botol - -
Larutan mengandung botol - -
ktrolit (D5-1/2NS)
Larutan mengandung botol - -
ktrolit (D5-1/4NS)
utan mengandung botol - -
ktrolit (D5NS)
tan mengandung botol - -
ktrolit (HSD)
rutan mengandung botol - -
ktrolit (D2,5
rutan mengandung%+ KCl botol - -
5 %)
ktrolit500 ml
(D2,5
tan mengandung %+ KCl botol - -
15%%) mengandung
tan 500 ml 0,9%)
+ NaCl botol - -
an%mengandung
+ NaCl 0,9%) botol - -
ktrolit (RD)
D.CHLOR botol - -
ampul - -
pcs - -
botol - -
botol - -
d Etchant liq) botol - -
re (filtek Z 250 kit) pcs - -
ond universal pcs - -
box - -
pcs - -
er 6 Gr botol - -
box - -
L25 15-40 pcs - -
5-40 pcs - -
box - -
pcs - -
botol - -
pcs - -
pcs - -
pcs - -
-
DIS HABIS PAKAI -
pcs - -
pcs - -
botol - -
pcs - -
botol - -
pcs - -
botol - -
pcs - -
pcs - -
pcs - -
pcs - -
. 40 x 80 cm rol - -
ril uk. 16 x 16 dos - -
x 15 cm elastic rol - -
x 3 cm elastic rol - -
ydrofil 4 x 10 cm rol - -
ydrofil 4 x 5 cm rol - -
pcs - -
botol - -
pcs - -
pasang - -
nang bedah No. 2/0 denga pcs - -
nang bedah No. 3/0 denga pcs - -
pcs - -
ves size M pcs - -
pcs - -
way No. 16 pcs - -
way No. 18 pcs - -
en type no. 18 pcs - -
en type no. 20 pcs - -
Absorben 250 gram rol - -
pcs - -
nnula size L pcs - -
nnula size M pcs - -
nnula size S pcs - -
pcs - -
m x 9.14 m pcs - -
pcs 1 100 101 1 1
pcs - -
nsite 20 G pcs - -
nsite 22 G pcs - -
botol - -
Rol - -
Rol - -
Rol - -
botol - -
botol - -
botol - -
pcs - -
pcs - -
pcs - -
pcs - -
pcs - -
pcs - -
tahui
mas Pamolokan
ota Sumenep
TAMI, M.Kes
200501 2 008
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO
30 31 1 2 3 4 5 6 7 8 9
20 40 90 60 20 30
30 50 20 50 100 60
2 1
10 20 30
20 30 30 15 15 20 30
10
20 40 40 40 10
20
10 15 10 20
20 13 10 30 10 10
1
3 20 20
40
15 8 70
20 16 23 20 15
10
3 10 3 18
10 10 10
10
60
28 10
1 1 1
10 10 10 20 40
20
23 20 50 40 10
10 30 40 30 40
10 10
1 3 1 1 1
2 5
Yang Menyerahkan
Petugas Gudang Puskesmas Pamoloka
VERA YUNITA
Nip . 19810621 200901 2 005
AAN OBAT (LPLPO)
ASI
10 11 12 13 14 15 16 17 18 19 20
30 30 20 10 20 50 72 90 10
30 10 10 50 20 60
25 26
35 55 15 45 85 15 35
10 30 10 20 10
30
30 50 52
3 15 10 30 20
1
15 10 10
15 30
55 40 15 15 15
10 15 10 30 25 33 15
15
15 5 22 18 10
20
10 20
60 50
10 15 20
8 4 15 30 20 10
10
10
6 3 10 10 10 30
1
10 40 10 30 10 10 20
50
4 3 2 2 1
1
Yang Menyerahkan
dang Puskesmas Pamolokan
matan Kota Sumenep
VERA YUNITA
19810621 200901 2 005
Bulan : MARET Unit
Tahun : 2019
PENGE SISA
No NAMA O
21 22 23 24 25 LUARAN STOK
- - 1 ACTRAPID HM PEN
- 75 2 insulin
ADALAT Short penvil/cat
OROS 20 N
10 10 762 868 3 mg, slow release; oros
BECEFORT
1 5 4 BECEFORT SYRUP
- - 5 BIORON INJEKSI/NE
80 55 70 20 725 754 6 BIORON tablet
- - 7 CERCUL Injeksi ( Citi
- - 8 injeksi)
DARYANT TULLE Fr
- 12 9 tulle 1%
DECACETIN TETES
- - 10 0.5% Kloramfenikol
DEXOCORT Desoksim tet
- - 11 0,25%
DEXTAMIN Tab (Dek
- 50 12 mg, Dexchlorphenirami
DIFLUCAN 50MG Fl
- - 13 mg
DULCOLAX SUPP A
- - 14 suppositoria
DULCOLAX 10SUPP
mg IN
- - 15 suppositoria
FARGOXIN5Digoksin
mg
- 100 16 mg/ml
FARSORBID 10 Isoso
FARSORBID Isosorbi 10
2 1 6 17 18 i.v 10 mg/10NmlCREAM
FLUCORT
- - 19 (GENERIK
Fluosinolon aesitonida
Air untuk in
- - 20 Neomisina Sulfat
GENERIK Alopurinol5 mg)
124 - 21 tablet/kapsul/kaplet
GENERIK Alopurinol 100
20 15 10 10 605 896 22 GENERIK Amlodipin
- - 23 GENERIK Amlodipin
10 319 24 GENERIK Amoksisilin
10 10 320 591 25 GENERIK Amoksisilin
- - 26 GENERIK Amoksisilin
- - 27 mg/ 5 ml Amoksisilin
GENERIK
- - 28 forte 250 mg/5
GENERIK ml D
Antasida
- - 29 kunyah,
GENERIK kombinasi: Alu
Asam askor
- - 30 Hidroksida
tab 200 mg
50 mg Asam Mefe
GENERIK + M
Hidroksida 200 mg
tablet/kapsul/kaplet 5002
30 136 31 GENERIK Acyclovir
20 462 32 GENERIK Asiklovir ta
- - 33 GENERIK Bedak salis
15 10 25 257 443 34 GENERIK Betahistin
GENERIK Betametaso 6m
- - 36 (sebagai
GENERIK Valerat)
Bisakodil
tablet/kapsul/kaplet 5 m
30 240 286 37 GENERIK Deksameta
GENERIK Desoksime 0,5
- - 39 GENERIK Dietilkarba
scored 100 mg
- - 40 GENERIK Difenhidram
i.v./i.m. 10 mg/ml (HCl
1 1 6 41 GENERIK Desoksime
- - 42 GENERIK Dietilkarba
- - 43 scored
GENERIK 100 mg
Difenhidram
- - 44 i.v./i.m. 10 mg/ml
GENERIK Dimenhidri (HCl
GENERIK Domperido 50
10 10 128 452 46 GENERIK Domperido
GENERIK Epinefrin 10(A
- 113 48 i.v/s.k./i.m
GENERIK1Fitomenadi
mg/ml (0,1
- - 49 tablet/kaplet salut gula
GENERIK Fitomenadi
- - 50 inj 10 mg/mlFurosemid
GENERIK (i.m)
GENERIK Garam Ora 40
12 20 132 136 52 kombinasi:
GENERIK Natrium
Gemfibroziklo
- - 53 kalium klorida 0,30
GENERIK Gemfibrozi g
300+
dihidrat 0,58 g +
tablet/kapsul/kapletGluko
600
- - 54 GENERIK Gentamisin
1 14 55 GENERIK Gentamisin
- 80 56 GENERIK Glimepirid
- - 57 GENERIK Glimepirid
30 263 467 58 GENERIK Glimepirid
20 40 63 10 465 464 59 GENERIK Glimepirid
- - 60 GENERIK Griseofulvi
GENERIK Haloperido 125
GENERIK Haloperido 0,5
GENERIK Hidrokloro 5m
- - 64 GENERIK Hidrokortis
1 2 23 65 GENERIK Ibuprofen s
- - 66 GENERIK Ibuprofen s
- - 67 GENERIK Ibuprofen
GENERIK Ibuprofen 200
GENERIK Kalsium400 La
GENERIK Kaptopril 500
ta
105 959 71 12,5 mg
GENERIK Kaptopril ta
- 275 72 GENERIK Kaptopril ta
- - 73 GENERIK Karboglise
- - 74 10%
GENERIK Ketokonazo
- - 75 GENERIK Ketokonazo
GENERIK Ketorolak 200i
- - 77 GENERIK Klindamisi
GENERIK Klopidogre 300
GENERIK Kloramfeni 75
- -
%
10 149 256 80 GENERIK Klorfeniram
(CTM) tablet/kapsul/ka
- - 81 GENERIK Klorproma
salut 100 mg (HCl)
- - 82 GENERIK Klozapin 1
- - 84 GENERIK Kloramfeni
- - 85 GENERIK Klorfeniram
- - 86 GENERIK Klorproma
- - 89 GENERIK Kodein tab
- - 90 10 mg
GENERIK kombinasi:
- - 91 kafein
GENERIK50 mgkombinasi:
- 9 92 mg + as. Folat
GENERIK 0,4 mg t
Kotrimoksa
(tablet tambah
kombinasi darah)
- - 93 GENERIKtiap 5 ml sus
Kotrimoksa
sulfametoksazol
kombinasi: 200 mg
sulfametoks
- - 94 GENERIK
40 mg Kotrimoksa
trimetoprim
kombinasi: 80 mg
- - 95 GENERIK sulfametoks
Lidokain in
trimetoprim 160 mg
- - 96 GENERIK Kotrimoksa
20 10 10 90 100 99 GENERIK Lansoprazo
- - 100 GENERIK Lidokain in
- - 101 GENERIK Loperamid
GENERIK Loratadin 2m
GENERIK Metformin 10
GENERIK Metformin 500
GENERIK Metilpredn 850
106 mg/mL
GENERIK Metilpredn
- -
mg/vial
- - 107 GENERIK Metilpredn
- - 108 GENERIK Metilpredn
GENERIK Metilpredn 4m
- -
- - 111 mg/vial
GENERIK Metilpredn
GENERIK Metilpredn 16
GENERIK Metoklopra 8m
- - 115 GENERIK Metoklopra
GENERIK Metronidaz 5m
2 3 117 GENERIK Metronidaz
- - 118 ml
GENERIK Metronidaz
GENERIK Mometason 500
- - 120 GENERIK Nacl 0,9%
- - 121 GENERIK Natrium dik
10 10 90 170 122 tablet/kapsul/kaplet
GENERIK Natrium25 dik
- 235 123 mg
GENERIK Nifedipin
GENERIK Nistatin10 tab
- 99 125 500.000
g vag
- 169 126 100.000
GENERIK IU/ Ofloxacin
g 4
- - 127 GENERIK Omeprazol
- - 128 ml
GENERIK Omeprazol
GENERIK Ondansetro 20
- - 130 mg/ 2 mL) Ondansetro
GENERIK
GENERIK Ondansetro 4m
GENERIK Parasetamo 8m
- - 133 1000 mg/100Parasetamo
GENERIK mL
- - 134 ml
GENERIK Parasetamo
15 20 20 245 426 135 tablet/kapsul/kaplet
GENERIK Piridoxin 5001
- 141 136 GENERIK Piridoxin 2
20 20 30 153 285 137 GENERIK Prednison
GENERIK Propranolo 5m
- 50 139 GENERIK Propranolo
- - 140 GENERIK Ranitidin in
- - 141 GENERIK Ranitidin ta
- - 142 150 mg
GENERIK Ringer Lak
- - 143 GENERIK Risperidon
GENERIK Risperidon 1m
GENERIK Salbutamol 2m
GENERIK Salbutamol 2m
GENERIK Sefadroksil 4m
1 4 6 148 mg/5 ml
GENERIK Sefadroksil
30 10 20 256 327 149 mg/5ml
GENERIK Sefadroksil
1 1 5 150 GENERIK Sefiksim si
- - 151 mg/ 5 ml Sefiksim ta
GENERIK
- 50 152 100 mg
GENERIK Sefiksim ta
- - 153 200 mg
GENERIK Sefotaksim
- - 154 GENERIK Sefotaksim
- - 155 GENERIK Seftriaxon
- 6 156 GENERIK Setirizin sir
- - 157 GENERIK Setirizin tab
- - 158 10 mg
GENERIK Sianokobal
- 200 159 B12) injeksi 500 mcg
GENERIK Sianokobal
- - 160 B12) tablet Simvastatin
GENERIK
- - 161 tablet/kaplet/salut
GENERIK Simvastatin10 m
- - 162 tablet/kaplet/salut
GENERIK Siprofloksa20 m
- - 163 (2%)
GENERIK Sukralfat su
- 450 164 100 ml
GENERIK Tiamin (Vit
GENERIK Triheksifen 50
GENERIK Vitamin2BmK
1 7 167 GENERIK Zinc sir 20
15 330 168 GENERIK Zinc tablet
- 38 169 GENOINT SALEP MA
20 70 170 salep mata 0,3%
GERIAVITA / Multivit
- 90 171 Carotene 6 mg, Vit E 30
Glucotrol XL 10mg
10 673 172 mg, Asam Folat 0,4 mg
HUSTAB
- - 173 INFUSAN D5 (100 M
- - 174 mengandung
INFUSAN D5Karbohidr
(250 M
- - 175 5g/100 ml)
mengandung Karbohidr
INTERZOL SS 2% Ke
- - 176 g/250
sol 2%ml)
KETEROLAC INJ
1 1 - 177 LEVEMIR INSULIN
- - 178 MERSIBION INJ
10 20 20 10 272 156 179 MOLEXFLU KAPLET
1 2 31 180 (PARACETAMOL,PHE
MOLEXFLU SYRUP
- - 181 LAMIN
MYCORINEHCL, POWDE
KLORF
(PARACETAMOL,PHE
MALEAT)
LAMIN
serbuk HCL, TAB.
2% KLORF
- - 182 MYCOSTOP 25
MALEAT)
- 132 183 NEO DIAGON Attapu
- - 184 NEW ANTIDES Atapu
NORAGES INJ 600
- - 186 NOVOMIX 30 FLEXP
- - 187 flexpen/catridge
NOVORAPID FLEXP
20 10 390 598 188 pen/flexpen/catridge
OSTEOTIN
70 - 189 OSTOVEL
- - 190 Otsuka KA-EN 3B
- 50 191 PRIMPEN SYR
- 270 192 PROFOLAT Asam Fol
PROSOGAN INJ 30M 0,4
- - 194 30 mg/ml Attapulgit
PULAREX
- - 195 SCABIMITE CREAM
- - 196 Krim
SKIZON5% Betametason
- - 197 TETAGAM Human tet
- 155 198 imunoglobulin
THYROZOL 10 injTiama
250 I
- - 199 ULSIDEX TABLET 50

- - 200 VAGIZOL Metronidaz
- - 201 VENTOLIN ROTAHA
Rotahaler (Alat Hirup S
2 2 4 27 30 202 STIMUNO SYR
mcg/kapsul)
- - 203 TETAGAM Human tet
- - 204 imunoglobulin
THYROZOL 10 injTiama
250 I
- - 205 ULSIDEX TABLET 50
VAGIZOL Metronidaz 500
- - 207 VENTOLIN ROTAHA
- - 208 Rotahaler
WIDA BES (Alat Hirup S
- - 209 mcg/kapsul)
WIDA D5-1/2NS Laru
- - 210 Karbohidrat
WIDA D5-1/4NS+ Elektroli
Laru
- - 211 Karbohidrat + Elektroli
WIDA D5NS Larutan
- - 212 Karbohidrat
WIDA HSD+Larutan
Elektroli
m
- - 213 Karbohidrat + Elektroli
WIDA KDN1 Larutan
- - 214 Karbohidrat
WIDA KDN2 + Elektroli
Larutan
- - 215 0,15
WIDA KN1 Larutan%)m
%+
KarbohidratNaCl
+ 0,45
Elektroli
- - 216 0,3 %+ NaCl
Elektrolit
WIDA KN2 0,45
(KCl %) m
0,15%
Larutan 5+
- - 217 elektrolit
WIDA RD (KCl 0,3%me
Larutan +N
Karbohidrat + Elektroli
- - 218 WIDA 0,9 % SOD.CH
- - 219 Pehacain inj 2ml
- - 220 Cavit G
- - 221 Endo-Frost roeko
- - 222 Fuji IX art
- - 223 Etcha (Scothbond Etch
- - 224 Komposit/Lighcure (fi
- - 225 Bonding single bond u
- - 226 Cal lc denpro
- - 227 Cresotin liquid II
- - 228 Dentin Conditioner 6 G
- - 229 Hemospon
- - 230 K File sendoline L25 1
- - 231 K reamers L25 15-40
- - 232 Seluloid strip
- - 233 Softlex mini kit
- - 234 NaOcl
- - 235 Sponge dental
- - 236 Solare A2
- - 237 Solare A3
- -
- - BAHAN MEDIS H
- - 240 Alkohol 70% 1 L
- - 241 Alkohol Swab
- - 242 Antiseptik Gel@500 m
- - 243 Bracket Hand Wash
- - 244 Odex 500 ml
- - 248 Infus set dewasa
- - 249 Kasa Hidrofil uk. 40 x
- - 250 Kasa Hidrofil Steril uk
- - 251 Kasa pembalut 4 x 15 c
- - 252 Kasa pembalut 4 x 3 cm
- - 253 Kasa pembalut hydrofi
- - 254 Kasa pembalut hydrofi
- - 255 My Jelly
- - 256 Lisol 1 L
- - 257 Pot Sputum
- - 258 Safeglove PP no. 7
- - 259 Catgut plain / Benang b
- - 260 Catgut plain / Benang b
- - 261 Examination Glove siz
- - 262 Examination Gloves si
- - 264 Folley Catheter 2 way
- - 265 Folley Catheter 2 way
- - 266 IV Catheter NP pen typ
- - 267 IV Catheter NP pen typ
- - 268 Kapas Pembalut / Abso
- - 269 Masker
- - 270 Nasal oxygen cannula
- - 274 Paper tape 2.5 cm x 9.
3 13 88 275 Novo Twist 32 G x 5 m
- - 276 Blood Transfusion set
- - 277 IV Catheter trovensite
- - 278 IV Catheter trovensite
- - 279 Onesept sol
- - 283 Povidon 10% 60ml
- - 284 Povidon 10% 300ml
- - 285 Rivanol 0,1 % 300ml
- - 286 Soft pad 60x90
- - 291 Urine Bag
Mengetahui
Kepala Puskesmas Pam
Kecamatan Kota Su
dr. RIFMI UTAMI,

Nip. 19760826 20050
: RUANG FARMASI

NAMA OBAT
AN AWAL MAAN DIAAN 26 27 28
ACTRAPID HM PENFILL Human pcs - -
insulin Short penvil/catridge 100
ADALAT OROS 20 Nifedipin tab 20 UI tablet 75 75
mg, slow release; oros
BECEFORT Kaplet 868 900 1,768 20 10 30
BECEFORT SYRUP botol 5 5
BIORON INJEKSI/NEUROBION INJ ampul - -
BIORON tablet tablet 754 500 1,254 20 10
CERCUL Injeksi ( Citicoline 250 mg Ampul - -
injeksi)
DARYANT TULLE Framisetin sulfat pcs - -
tulle 1%
DECACETIN TETES MATA botol 12 10 22 1
0.5% Kloramfenikol tetes mata
DEXOCORT Desoksimetason salep 0,5 % tube - -
0,25%
DEXTAMIN Tab (Deksammetason 0,5 Tablet - -
mg, Dexchlorpheniramine maleate 2
DIFLUCAN 50MG Flukonazol kaps 50 capsul mg) 50 50
mg
DULCOLAX SUPP ADULT Bisakodil supp - -
suppositoria
DULCOLAX 10SUPP
mg INFANT Bisakodil supp - -
suppositoria
FARGOXIN5Digoksin
mg injeksi 0,25 ampul - -
mg/ml
FARSORBID 10 Isosorbid dinitrat tablet 100 100
FARSORBID Isosorbid 10 mgDinitrat injeksi ampul - -
i.v 10 mg/10NmlCREAM 5 mg
FLUCORT Tube 17 17
(GENERIK
Fluosinolon aesitonida 0,25 mg,
Air untuk injeksi 20 ml botol - -
Neomisina Sulfat
GENERIK Alopurinol 5 mg) tablet - -
GENERIK Alopurinol 300 mg mg tablet - -
GENERIK Amlodipin tablet 10 mg tablet 896 1,500 2,396 15 75 40
GENERIK Amlodipin tablet 5 mg tablet - -
GENERIK Amoksisilin kapsul 250 mg capsul 319 319
GENERIK Amoksisilin kaplet 500 mg kaplet 591 591 10
GENERIK Amoksisilin sirup kering 125 botol - -
mg/ 5 ml Amoksisilin sirup kering
GENERIK botol - -
forte 250 mg/5
GENERIK ml DOEN I tablet
Antasida tablet - -
kunyah,
GENERIK kombinasi: Aluminium
Asam askorbat (vitamin C) tablet - -
Hidroksida
tab 50 mg 200
GENERIK AsammgMefenamat
+ Magnesium kaplet - -
Hidroksida 200 mg 500 mg
GENERIK Acyclovir 200 tablet 136 136
GENERIK Asiklovir tablet 400 mg tablet 462 462 10
GENERIK Bedak salisil serbuk 2% dos - -
GENERIK Betahistin tablet 443 443 25 25 35
GENERIK Betametason krim 0,1% tube - -
(sebagai Valerat)
GENERIK Bisakodil tablet - -
GENERIK Deksametason tablet 286 286 10
GENERIK Desoksimetason0,5 mg krim 0,25% tube - -
GENERIK Dietilkarbamazin tablet tablet - -
scored 100 mg
GENERIK Difenhidramin injeksi ampul - -
i.v./i.m. 10 mg/ml (HCl)
GENERIK Desoksimetason krim 0,25% tube 6 6 1
GENERIK Dietilkarbamazin tablet tablet - -
scored
GENERIK 100 mg
Difenhidramin injeksi ampul - -
i.v./i.m. 10 mg/ml
GENERIK Dimenhidrinat(HCl) tablet - -
GENERIK Domperidon 50 mgsyrup botol 11 11
GENERIK Domperidon tablet 452 452
GENERIK Epinefrin 10(Adrenalin)
mg injeksi
ampul - -
i.v/s.k./i.m 1 mg/ml (0,1%)
GENERIK Fitomenadion (Vit.K1) tablet 113 113
tablet/kaplet salut gula 10 mg
GENERIK Fitomenadion (vitamin K1) ampul - -
inj 10 mg/mlFurosemid
GENERIK (i.m) tablet - -
GENERIK Garam Oralit 40 mgI serbuk, sachet - -
kombinasi:
GENERIK Natrium klorida 0,52 g +
Gemfibrozil capsul 136 136
kalium klorida 0,30
GENERIK Gemfibrozil g
300+ Trinatrium
mg sitrat
capsul - -
dihidrat 0,58 g +
tablet/kapsul/kapletGlukosa Anhidrat
600 injeksi
mg 2,70 g
GENERIK Gentamisin 40 mg/ ml
ampul - -
GENERIK Gentamisin tetes mata 0,3% Botol 14 14
GENERIK Glimepiride tablet 1 mg tablet 80 80
GENERIK Glimepiride tablet 2 mg Tablet - -
GENERIK Glimepiride tablet 3 mg tablet 467 700 1,167 10
GENERIK Glimepiride tablet 4 mg tablet 464 1,000 1,464 20 45 30
GENERIK Griseofulvin (micronized) tablet - -
GENERIK Haloperidol 125 mg tablet - -
GENERIK Haloperidol 0,5 mg tablet - -
GENERIK Hidroklorotiazid tab 25 mg tablet - -
GENERIK Hidrokortison krim 2,5% Tube - -
GENERIK Ibuprofen susp 100 mg/5 ml botol 23 23
GENERIK Ibuprofen susp 200 mg/5 ml botol - -
GENERIK Ibuprofen tablet - -
GENERIK Ibuprofen 200 mg tablet - -
GENERIK Kalsium400 mg (Kalk)
Laktat tablet - -
tablet/kaplet scored tablet - -
12,5 mg
GENERIK Kaptopril tablet 25 mg tablet 959 500 1,459 80
GENERIK Kaptopril tablet 50 mg tablet 275 275
GENERIK Karbogliserin tetes telinga botol - -
10%
GENERIK Ketokonazol krim 2% tube - -
GENERIK Ketokonazol tablet - -
GENERIK Ketorolak inj 30 mg/ml ampul - -
GENERIK Klindamisin tablet - -
GENERIK Klopidogrel 300 mg tablet - -
GENERIK Kloramfenikol salep mata 1 Tube - -
%
GENERIK Klorfeniramina Maleat tablet 256 900 1,156 10 35 13
(CTM) tablet/kapsul/kaplet 4 mg
GENERIK Klorpromazin tablet/kaplet tablet - -
salut 100 mg (HCl)
GENERIK Klozapin 100 mg tablet - -
GENERIK Kloramfenikol salep mata 1 % tube - -
GENERIK Klorfeniramina Maleat (CTM) tablet/kapsul/kaplet
tablet - 4 mg -
GENERIK Klorpromazin tablet/kaplet saluttablet 100 mg (HCl) - -
GENERIK Kodein tablet/kapsul/kaplet tablet - -
10 mg
GENERIK kombinasi: ergotamin 1 mg + tablet - -
kafein
GENERIK50 mgkombinasi: ferro fumarat 60 tablet - -
mg + as. Folat
GENERIK 0,4 mg tablet(anak)
Kotrimoksazol salut gula Botol 9 9
(tablet tambah
kombinasi tiap darah)
5 ml suspensi:
GENERIK Kotrimoksazol (dewasa) tablet - -
sulfametoksazol
kombinasi: 200 mg + trimetoprim
sulfametoksazol 400 mg +
GENERIK
40 mg Kotrimoksazol forte tablet - -
trimetoprim
kombinasi: 80 mg
sulfametoksazol 800 mg +
GENERIK Lidokain injeksi 2% (HCL) ampul - -
trimetoprim 160 mg
GENERIK Kotrimoksazol (anak) kombinasibotol tiap 5 ml suspensi:
- sulfametoksazol
- 200 mg + trimetoprim 40 mg
GENERIK Kotrimoksazol (dewasa) kombinasi: tabletsulfametoksazol
- 400 mg + trimetoprim
- 80 mg
GENERIK Kotrimoksazol forte kombinasi:Tablet sulfametoksazol- 800 mg + trimetoprim
- 160 mg
GENERIK Lansoprazol tablet/kapsul/kapletcapsul 30 mg 100 100 10 10
GENERIK Lidokain injeksi 2% (HCL) ampul - -
GENERIK Loperamid Tablet - -
GENERIK Loratadin 2 mg Tablet - -
GENERIK Metformin HCl 10 mg Tablet - -
GENERIK Metformin HCl 500 mg tablet - -
GENERIK Metilprednisolon inj 125 ampul - -
mg/mL
mg/vial
GENERIK Metilprednisolon tablet - -
GENERIK Metilprednisolonmg
tablet - -
mg/vial
GENERIK Metoklopramide8 mg inj 5 mg/mL ampul - -
GENERIK Metoklopramide tablet - -
GENERIK Metronidazol infus 5 mg/ ml botol - -
GENERIK Metronidazol sirup 125 mg/5 Botol 3 3
ml
GENERIK Metronidazol tablet - -
GENERIK Mometason furoat krim 0,1% tube - -
GENERIK Nacl 0,9% botol - -
GENERIK Natrium diklofenak tablet - -
GENERIK Natrium diklofenak tablet 50 tablet 170 170
mg
GENERIK Nifedipin tablet 235 235
GENERIK Nistatin10 mg
tablet/kaplet salut tablet 32 32
500.000
g vaginal tablet tablet vaginal 99 99
100.000
GENERIK IU/ Ofloxacin
g 400 tablet 169 169
GENERIK Omeprazol injeksi 40 mg/ 10 ampul - -
ml
GENERIK Omeprazol capsul - -
GENERIK Ondansetron inj 2 mg/ml (4 ampul - -
mg/ 2 mL)
GENERIK Ondansetron tablet - -
GENERIK Ondansetron 4 mg tablet - -
GENERIK Parasetamol drips (infus) botol - -
1000 mg/100 mL
GENERIK Parasetamol sirup 120 mg / 5 botol - -
ml
GENERIK Parasetamol tablet - -
GENERIK Piridoxin 50010mg
mg tablet 426 426
GENERIK Piridoxin 25mg tablet 141 141
GENERIK Prednison tablet 285 400 685
GENERIK Propranolol 5 mgtab 40 mg tablet 100 100
GENERIK Propranolol tablet 10 mg tablet 50 50
GENERIK Ranitidin injeksi 25 mg/ml ampul - -
GENERIK Ranitidin tablet/kapsul/kaplet tablet - -
150 mg
GENERIK Ringer Laktat botol - -
GENERIK Risperidon tablet - -
GENERIK Risperidon 1 mg tablet - -
GENERIK Salbutamol 2 mg tablet - -
GENERIK Salbutamol 2 mg (sebagai Sulfat) tablet - -
tablet/kapsul/kaplet 4 mg (sebagai
GENERIK Sefadroksil sir kering 250 Sulfat) botol 7 7
mg/5 ml
GENERIK Sefadroksil sirup kering 125 botol 6 6 1
mg/5ml
GENERIK Sefadroksil kapsul 500 mg tablet 327 300 627 10 20
GENERIK Sefiksim sirup kering 100 botol 5 5
mg/ 5 ml Sefiksim tablet/kapsul/kaplet tablet
GENERIK - -
100 mg
GENERIK Sefiksim tablet/kapsul/kaplet tablet 50 50
200 mg
GENERIK Sefotaksim serb inj 1.000 mg vial - -
GENERIK Sefotaksim serb inj 500 mg vial - -
GENERIK Seftriaxon serb inj 1000 mg vial - -
GENERIK Setirizin sirup 5 mg/5 ml Botol 6 6
GENERIK Setirizin tablet/kapsul/kaplet tablet - -
10 mg
GENERIK Sianokobalamin (vitamin ampul - -
B12) injeksi 500 mcg
GENERIK Sianokobalamin (vitamin tablet 200 200
B12) tablet
GENERIK Simvastatin tablet - -
tablet/kaplet/salut
GENERIK Simvastatin10 mg tablet - -
tablet/kaplet/salut 20 mg
GENERIK Siprofloksasin inf 2 mg/ml botol - -
(2%)
GENERIK Sukralfat susp 500 mg/5 mL,Botol 100ml - -
100 ml
GENERIK Tiamin (Vitamin B1) tablet 450 450
tablet/kapsul/kaplet 50 mg (HCl/ Nitrat)
GENERIK Triheksifenidil tablet - -
GENERIK Vitamin2Bmg Kompleks tablet tablet - -
GENERIK Zinc sir 20 mg/5 ml Botol 7 7
GENERIK Zinc tablet dispersible 20 mg tablet 330 330 10
GENOINT SALEP MATA Gentamisin Tube 38 38
salep mata 0,3%
GERIAVITA / Multivitamin (Beta- tablet 70 70
Carotene 6 mg, Vit
Glucotrol XL 10mg E 30 mg, Vit C 500 tablet 90 90
mg, Asam
HUSTAB Folat 0,4 mg) Kaplet 673 673
INFUSAN D5 (100 ML) Larutan botol - -
mengandung
INFUSAN D5Karbohidrat (Glukosa
(250 ML) Larutan botol - -
5g/100 ml) SS
mengandung
INTERZOL Karbohidrat (Glukosa
2% Ketokonazol 12,5
scalp botol - -
g/250
sol 2%ml)
KETEROLAC INJ ampul - -
LEVEMIR INSULIN Pen - -
MERSIBION INJ ampul - -
MOLEXFLU KAPLET kaplet 156 156 10 25 20
(PARACETAMOL,PHENYLPROPANO
MOLEXFLU SYRUP botol 31 31
LAMIN
MYCORINE HCL, POWDER
KLORFENIRAMINA
(PARACETAMOL,PHENYLPROPANO Mikonazol botol - -
MALEAT)
LAMIN
serbuk 2%HCL, TAB.
KLORFENIRAMINA
MYCOSTOP 250 Griseofulvin tablet - -
MALEAT)
tablet/kapsul/kaplet 250 mgtab 650 mg (Omegdiar)
NEO DIAGON Attapulgit tablet 132 132
NEW ANTIDES Atapulgit tablet - -
NORAGES INJ 600 mg Ampul - -
NOVOMIX 30 FLEXPEN Mix Insulin pcs - -
flexpen/catridge
NOVORAPID FLEXPEN Rapid insulin pcs - -
pen/flexpen/catridge
OSTEOTIN capsul 598 598 10 10
OSTOVEL capsul - -
Otsuka KA-EN 3B Softbag 500ml - -
PRIMPEN SYR botol 50 50
PROFOLAT Asam Folat tablet 270 270
tablet/kapsul/kaplet 0,4 mg
PROSOGAN INJ 30MG Lansoprazol inj ampul - -
30 mg/ml Attapulgit tab 630 mg
PULAREX tablet - -
SCABIMITE CREAM 10 Permetrin tube - -
Krim 5%
SKIZON Betametason krim 0,5 mg/g tube - -
TETAGAM Human tetanus pcs - -
imunoglobulin inj 250 IU (i.m.)
THYROZOL 10 Tiamazol tab 10 mg tablet 155 155
ULSIDEX TABLET 500 MG Sukralfat tablet - -
VAGIZOL Metronidazol ovula 500 mg ovula - -
VENTOLIN ROTAHALER Ventolin pcs - -
Rotahaler (Alat Hirup Salbutamol 200
STIMUNO SYR botol 30 48 78 3 1
mcg/kapsul)
TETAGAM Human tetanus pcs - -
imunoglobulin
250 IU (i.m.)
tab 10 mg tablet - -
ULSIDEX TABLET 500 MG Sukralfat tablet - -
VAGIZOL Metronidazol 500 mgovula 500 mg ovula - -
VENTOLIN ROTAHALER Ventolin pcs - -
Rotahaler
WIDA BES (Alat Hirup Salbutamol 200 botol - -
mcg/kapsul)
WIDA D5-1/2NS Larutan mengandung botol - -
Karbohidrat + Elektrolit (D5-1/2NS)
WIDA D5-1/4NS Larutan mengandung botol - -
Karbohidrat + Elektrolit (D5-1/4NS)
WIDA D5NS Larutan mengandung botol - -
Karbohidrat + Elektrolit (D5NS)
WIDA HSD Larutan mengandung botol - -
Karbohidrat + Elektrolit (HSD)
WIDA KDN1 Larutan mengandung botol - -
Karbohidrat + Elektrolit (D2,5
WIDA KDN2 Larutan mengandung %+ KCl botol - -
0,15 %+
KarbohidratNaCl
+ 0,45 %)
Elektrolit500 ml
(D2,5
WIDA KN1 Larutan mengandung %+ KCl botol - -
0,3 %+ NaCl
Elektrolit
WIDA (KCl
KN2 0,45 %) mengandung
0,15%
Larutan 500 ml 0,9%)
+ NaCl botol - -
elektrolit
WIDA RD (KCl 0,3%mengandung
Larutan + NaCl 0,9%) botol - -
Karbohidrat + Elektrolit (RD)
WIDA 0,9 % SOD.CHLOR botol - -
Pehacain inj 2ml ampul - -
Cavit G pcs - -
Endo-Frost roeko botol - -
Fuji IX art botol - -
Etcha (Scothbond Etchant liq) botol - -
Komposit/Lighcure (filtek Z 250 kit) pcs - -
Bonding single bond universal pcs - -
Cal lc denpro box - -
Cresotin liquid II pcs - -
Dentin Conditioner 6 Gr botol - -
Hemospon box - -
K File sendoline L25 15-40 pcs - -
K reamers L25 15-40 pcs - -
Seluloid strip box - -
Softlex mini kit pcs - -
botol - -
Sponge dental pcs - -
Solare A2 pcs - -
Solare A3 pcs - -
-
Alat Suntik 3 ml pcs - -
Alat Suntik 5 ml pcs - -
Alkohol 70% 1 L botol - -
Alkohol Swab pcs - -
Antiseptik Gel@500 ml botol - -
Bracket Hand Wash pcs - -
Odex 500 ml botol - -
Dermafix T 10 x 12 cm pcs - -
Infus set dewasa pcs - -
Kasa Hidrofil uk. 40 x 80 cm rol - -
Kasa Hidrofil Steril uk. 16 x 16 dos - -
Kasa pembalut 4 x 15 cm elastic rol - -
Kasa pembalut 4 x 3 cm elastic rol - -
Kasa pembalut hydrofil 4 x 10 cm rol - -
Kasa pembalut hydrofil 4 x 5 cm rol - -
My Jelly pcs - -
Lisol 1 L botol - -
Pot Sputum pcs - -
Safeglove PP no. 7 pasang - -
Catgut plain / Benang bedah No. 2/0 deng pcs - -
Catgut plain / Benang bedah No. 3/0 deng pcs - -
Examination Glove size L pcs - -
Examination Gloves size M pcs - -
Examination Gloves size S pcs - -
Folley Catheter 2 way No. 16 pcs - -
Folley Catheter 2 way No. 18 pcs - -
IV Catheter NP pen type no. 18 pcs - -
IV Catheter NP pen type no. 20 pcs - -
Kapas Pembalut / Absorben 250 gram rol - -
pcs - -
Nasal oxygen cannula size L pcs - -
Nasal oxygen cannula size M pcs - -
Nasal oxygen cannula size S pcs - -
Examination Gloves size L pcs - -
Paper tape 2.5 cm x 9.14 m pcs - -
Novo Twist 32 G x 5 mm pcs 88 88
Blood Transfusion set pcs - -
IV Catheter trovensite 20 G pcs - -
IV Catheter trovensite 22 G pcs - -
Onesept sol botol - -
Pharmafix 10 x 500 cm Rol - -
Povidon 10% 60ml botol - -
Povidon 10% 300ml botol - -
Rivanol 0,1 % 300ml botol - -
Soft pad 60x90 pcs - -
Suction catheter, 14 pcs - -
Urine Bag pcs - -
Mengetahui

Nip. 19760826 200501 2 008
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
29 30 31 1 2 3 4 5 6 7
40 30 10 60 30 10 30
25 90 95 40 35
1 2 1
2 2
30 35 55 85 140 25
10
20 40 20 10
10 20 30 40
10 30
10 10 10
10
15 45 70 20 10
15 30 30 30 30 20
1 1
15 30 35
20
50 11 39 29 9
20 10
1 1
30
10 10 30 20
1
12 30 10 20
20 20 40 20
1
40 20 35 10
3 1 1 1
Yang
Petugas Gudang
Kecamata
VER
Nip . 1981
BAR PERMINTAAN OBAT (LPLPO)
RAN KAPITASI
8 9 10 11 12 13 14 15 16 17
75 40 20 20 50 65
10 90 10 70 95
40 95 30 65 50 20 50
10 10 15 11 10
16
10 30 45 20 20
10 10
10 30
20
30 15 65 50 20
15 25 30 10 78 40
15 120 30 45 20 20
45
40 22 20 20 14 11
15 20 15
10
30 20
45
30
10 33 20
1
1 1 1 1
10 10 40 30 15
1 2 2 1 3 3 1 1
Yang Menyerahkan
VERA YUNITA
Nip . 19810621 200901 2 005
Bulan : APRIL
Tahun : 2019
PENGE SISA
18 19 20 21 22 23 24 25 LUARAN STOK
- -
- 75
50 100 130 190 90 60 1,160 608
- 5
- -
30 20 10 650 604
- -
- -
1 7 15
- -
- -
- 50
- -
- -
- -
- 100
- -
1 6 11
- -
- -
- -
50 15 80 20 35 50 1,100 1,296
- -
10 20 299
10 40 40 246 345
- -
- -
- -
- -
- -
20 20 116
21 47 415
- -
40 15 365 78
- -
- -
5 10 10 30 125 161
- -
- -
- -
1 5
- -
- -
- -
- 11
7 77 375
- -
10 103
- -
- -
- -
20 116
- -
- -
- 14
- 80
- -
30 45 30 50 505 662
60 30 20 40 598 866
- -
- -
- -
- -
- -
1 5 18
- -
- -
- -
- -
- -
75 45 530 929
65 210
- -
- -
- -
- -
- -
- -
- -
30 50 30 20 13 466 690
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 9
- -
- -
- -
- -
- -
- -
100 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 3 -
- -
- -
- -
- -
50 10 70 100
- 235
- 32
- 99
- 169
- -
- -
- -
- -
- -
- -
- -
- -
50 130 296
- 141
10 10 10 145 540
- 100
30 20
- -
- -
- -
- -
- -
- -
- -
- 7
2 4
2 2 10 179 448
- 5
- -
- 50
- -
- -
- -
- 6
- -
- -
- 200
- -
- -
- -
- -
- 450
- -
- -
1 1 6
10 320
- 38
- 70
- 90
30 30 643
- -
- -
- -
- -
- -
- -
156 -
1 1 7 24
- -
- -
- 132
- -
- -
- -
- -
40 10 20 300 298
- -
- -
- 50
- 270
- -
- -
- -
- -
- -
- 155
- -
- -
- -
1 4 2 1 2 34 44
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 88
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO

No NAMA OBAT
AN AWAL MAAN DIAAN
1 2 3 4 5 6
1 ACTRAPID HM PENFILL Human insulin Short pcs - - -
2 penvil/catridge
ADALAT OROS 10020UINifedipin tab 20 mg, slow release; tablet 75 - 75
3 oros
BECEFORT Kaplet 1,899 - 1,899
4 BECEFORT SYRUP botol 70 - 70
5 BIORON INJEKSI/NEUROBION INJ ampul - - -
6 BIORON tablet tablet 519 1,000 1,519
7 CERCUL Injeksi ( Citicoline 250 mg injeksi) Ampul - - -
8 DARYANT TULLE Framisetin sulfat tulle 1% pcs - - -
9 DECACETIN TETES MATA 0.5% Kloramfenikol botol 15 - 15
10 tetes mata 0,5 %
DEXOCORT Desoksimetason salep 0,25% tube - - -
11 DEXTAMIN Tab (Deksammetason 0,5 mg, Tablet - - -
12 Dexchlorpheniramine maleate 2 mg)
DIFLUCAN 50MG Flukonazol kaps 50 mg capsul 50 - 50
13 DULCOLAX SUPP ADULT Bisakodil suppositoria 10 supp - - -
14 mg
DULCOLAX SUPP INFANT Bisakodil suppositoria 5 supp - - -
15 mg
FARGOXIN Digoksin injeksi 0,25 mg/ml ampul - - -
16 FARSORBID 10 Isosorbid dinitrat tablet/kapsul/kaplet tablet 100 - 100
17 10 mg
FARSORBID Isosorbid Dinitrat injeksi i.v 10 mg/10 ampul - - -
18 ml
FLUCORT N CREAM 5 mg ( Fluosinolon aesitonida Tube 60 - 60
19 0,25 mg, Neomisina
GENERIK Air untukSulfat 5 mg)
injeksi 20 ml botol - - -
20 GENERIK Alopurinol tablet/kapsul/kaplet 100 mg tablet - - -
21 GENERIK Alopurinol tablet/kapsul/kaplet 300 mg tablet - 300 300
22 GENERIK Amlodipin tablet/kapsul/kaplet 10 mg tablet 606 - 606
23 GENERIK Amlodipin tablet/kapsul/kaplet 5 mg tablet - - -
24 GENERIK Amoksisilin kapsul/kaplet/tablet scored 250 capsul 158 - 158
25 mg
GENERIK Amoksisilin kapsul/kaplet/tablet scored 500 kaplet 746 - 746
26 mg
GENERIK Amoksisilin sirup kering 125 mg/ 5 ml botol - - -
27 GENERIK Amoksisilin sirup kering forte 250 mg/5 ml botol 26 - 26
28 GENERIK Antasida DOEN I tablet kunyah, tablet - - -
29 kombinasi:
GENERIKAluminium Hidroksida
Asam askorbat (vitamin200
C) mg + mg
tab 50 tablet - - -
30 Magnesium Hidroksida 200 mg
GENERIK Asam Mefenamat tablet/kapsul/kaplet 500 kaplet - - -
31 mg
GENERIK Acyclovir 200 tablet 200 - 200
32 GENERIK Asiklovir tablet/kapsul/kaplet 400 mg tablet 522 - 522
33 GENERIK Bedak salisil serbuk 2% dos - - -
34 GENERIK Betahistin tablet/kapsul/kaplet 6 mg tablet 120 - 120
35 GENERIK Betametason krim 0,1% (sebagai Valerat) tube - - -
36 GENERIK Bisakodil tablet/kapsul/kaplet 5 mg tablet - - -
37 GENERIK Deksametason tablet/kapsul/kaplet 0,5 mg tablet 699 - 699
38 GENERIK Desoksimetason krim 0,25% tube - - -
39 GENERIK Dietilkarbamazin tablet scored 100 mg tablet - - -
40 GENERIK Difenhidramin injeksi i.v./i.m. 10 mg/ml ampul - - -
(HCl)
41 GENERIK Desoksimetason krim 0,25% tube 10 - 10
42 GENERIK Dietilkarbamazin tablet scored 100 mg tablet - - -
43 GENERIK Difenhidramin injeksi i.v./i.m. 10 mg/ml ampul - - -
44 (HCl)
GENERIK Dimenhidrinat tablet/kapsul/kaplet 50 mg tablet - - -
45 GENERIK Domperidon syrup botol 3 20 23
46 GENERIK Domperidon tablet/kapsul/kaplet 10 mg tablet 152 - 152
47 GENERIK Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 ampul - - -
48 mg/ml
GENERIK(0,1%)
Fitomenadion (Vit.K1) tablet/kaplet salut tablet 123 - 123
49 gula 10 mg Fitomenadion (vitamin K1) inj 10 mg/ml
GENERIK ampul - - -
(i.m)
50 GENERIK Furosemid tablet/kapsul/kaplet 40 mg tablet - - -
51 GENERIK Garam Oralit I serbuk, kombinasi: Natrium sachet - - -
52 klorida
GENERIK 0,52 Gemfibrozil
g + kalium klorida 0,30 g + Trinatrium
tablet/kapsul/kaplet 300 mg capsul 387 - 387
53 sitrat dihidrat 0,58 g + Glukosa Anhidrat 2,70
GENERIK Gemfibrozil tablet/kapsul/kaplet 600 g mg capsul - - -
54 GENERIK Gentamisin injeksi 40 mg/ ml ampul - - -
55 GENERIK Gentamisin tetes mata 0,3% Botol 18 - 18
56 GENERIK Glimepiride tablet/kapsul/kaplet 1 mg tablet 335 - 335
57 GENERIK Glimepiride tablet/kapsul/kaplet 2 mg Tablet 795 - 795
60 GENERIK Griseofulvin (micronized) tablet - - -
tablet/kapsul/kaplet 0,5 mg tablet - - -
62 GENERIK Haloperidol tablet/kapsul/kaplet 5 mg tablet - - -
63 GENERIK Hidroklorotiazid tab 25 mg tablet - - -
64 GENERIK Hidrokortison krim 2,5% Tube - - -
65 GENERIK Ibuprofen susp 100 mg/5 ml botol - 20 20
66 GENERIK Ibuprofen susp 200 mg/5 ml botol - - -
67 GENERIK Ibuprofen tablet/kapsul/kaplet 200 mg tablet - - -
68 GENERIK Ibuprofen tablet/kapsul/kaplet 400 mg tablet - - -
69 GENERIK Kalsium Laktat (Kalk) tablet/kapsul/kaplet tablet - - -
70 500 mg
GENERIK Kaptopril tablet/kaplet scored 12,5 mg tablet - - -
71 GENERIK Kaptopril tablet/kaplet scored 25 mg tablet 629 - 629
72 GENERIK Kaptopril tablet/kaplet scored 50 mg tablet 285 - 285
73 GENERIK Karbogliserin tetes telinga 10% botol - - -
74 GENERIK Ketokonazol krim 2% tube - - -
75 GENERIK Ketokonazol tablet/kapsul/kaplet 200 mg tablet - - -
76 GENERIK Ketorolak inj 30 mg/ml ampul - - -
77 GENERIK Klindamisin tablet/kapsul/kaplet 300 mg tablet - - -
78 GENERIK Klopidogrel tablet/kapsul/kaplet 75 mg tablet - - -
79 GENERIK Kloramfenikol salep mata 1 % Tube - - -
80 GENERIK Klorfeniramina Maleat (CTM) tablet 370 - 370
81 GENERIK Klorpromazin tablet/kaplet salut 100 mg tablet - - -
82 (HCl)
GENERIK Klozapin 100 mg tablet - - -
83 GENERIK Klozapin 25 mg tablet - - -
84 GENERIK Kloramfenikol salep mata 1 % tube - - -
85 GENERIK Klorfeniramina Maleat (CTM) tablet/kapsul/kaplettablet
4 mg - - -
86 GENERIK Klorpromazin tablet/kaplet salut 100 mg (HCl) tablet - - -
89 GENERIK Kodein tablet/kapsul/kaplet 10 mg tablet - - -
90 GENERIK kombinasi: ergotamin 1 mg + kafein 50 mg tablet - - -
91 GENERIK kombinasi: ferro fumarat 60 mg + as. Folat tablet - - -
92 0,4 mg tablet salut gula (tablet tambah darah)
GENERIK Kotrimoksazol (anak) kombinasi tiap 5 ml Botol 11 - 11
93 suspensi: sulfametoksazol 200 mg + trimetoprim
GENERIK Kotrimoksazol (dewasa) kombinasi: 40 mg
tablet - - -
GENERIK Kotrimoksazol forte kombinasi: 80 mg
tablet - - -
GENERIK Lidokain injeksi 2% (HCL) 160 mg ampul - - -
96 GENERIK Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi:
botol
sulfametoksazol 200 mg -+ trimetoprim 40 -mg -
97 GENERIK Kotrimoksazol (dewasa) kombinasi: sulfametoksazol
tablet
400 mg + trimetoprim 80
- mg - -
98 GENERIK Kotrimoksazol forte kombinasi: sulfametoksazol 800
Tablet
mg + trimetoprim 160 mg
- - -
99 GENERIK Lansoprazol tablet/kapsul/kaplet 30 mg capsul 290 200 490
100 GENERIK Lidokain injeksi 2% (HCL) ampul - - -
101 GENERIK Loperamid tablet/kapsul/kaplet 2 mg Tablet - - -
102 GENERIK Loratadin tablet/kapsul/kaplet 10 mg Tablet - - -
103 GENERIK Metformin HCl tablet/kapsul/kaplet 500 mg Tablet - - -
104 GENERIK Metformin HCl tablet/kapsul/kaplet 850 mg tablet - - -
105 GENERIK Metilprednisolon inj 125 mg/mL ampul - - -
106 GENERIK Metilprednisolon inj 500 mg/vial ampul - - -
107 GENERIK Metilprednisolon tablet/kapsul/kaplet 16 tablet - - -
mg
108 GENERIK Metilprednisolon tablet/kapsul/kaplet 4 mg tablet - - -
110 GENERIK Metilprednisolon inj 500 mg/vial ampul - - -
111 GENERIK Metilprednisolon tablet/kapsul/kaplet 16 tablet - - -
112 mg
GENERIK Metilprednisolon tablet/kapsul/kaplet 4 mg tablet - - -
114 GENERIK Metoklopramide inj 5 mg/mL ampul - - -
115 GENERIK Metoklopramide tablet/kapsul/kaplet 5 mg tablet - - -
116 GENERIK Metronidazol infus 5 mg/ ml botol - - -
117 GENERIK Metronidazol sirup 125 mg/5 ml Botol 7 - 7
118 GENERIK Metronidazol tablet/kapsul/kaplet 500 mg tablet - - -
119 GENERIK Mometason furoat krim 0,1% tube - - -
120 GENERIK Nacl 0,9% botol - - -
121 GENERIK Natrium diklofenak tablet/kapsul/kaplet 25 tablet - - -
122 mg
GENERIK Natrium diklofenak tablet/kapsul/kaplet 50 tablet 280 - 280
123 mg
GENERIK Nifedipin tablet/kapsul/kaplet 10 mg tablet 235 - 235
124 GENERIK Nistatin tablet/kaplet salut 500.000 IU/ g tablet 42 - 42
125 GENERIK Nistatin vaginal tablet 100.000 IU/ g tablet vaginal 99 - 99
126 GENERIK Ofloxacin 400 tablet 169 - 169
127 GENERIK Omeprazol injeksi 40 mg/ 10 ml ampul - - -
128 GENERIK Omeprazol tablet/kapsul/kaplet 20 mg capsul 410 - 410
129 GENERIK Ondansetron inj 2 mg/ml (4 mg/ 2 mL) ampul - - -
130 GENERIK Ondansetron tablet/kapsul/kaplet 4 mg tablet - - -
131 GENERIK Ondansetron tablet/kapsul/kaplet 8 mg tablet - - -
132 GENERIK Parasetamol drips (infus) 1000 mg/100 mL botol - - -
133 GENERIK Parasetamol sirup 120 mg / 5 ml botol - - -
134 GENERIK Parasetamol tablet/kapsul/kaplet 500 mg tablet - - -
135 GENERIK Piridoxin (vitamin B6) 10mg tablet 604 - 604
136 GENERIK Piridoxin (vitamin B6) 25mg tablet 141 - 141
137 GENERIK Prednison tablet/kapsul/kaplet 5 mg tablet 380 - 380
138 GENERIK Propranolol tab 40 mg tablet 100 - 100
139 GENERIK Propranolol tablet/kapsul/kaplet 10 mg tablet 50 - 50
140 GENERIK Ranitidin injeksi 25 mg/ml ampul - - -
141 GENERIK Ranitidin tablet/kapsul/kaplet 150 mg tablet 230 - 230
142 GENERIK Ringer Laktat botol - - -
143 GENERIK Risperidon tablet/kapsul/kaplet 1 mg tablet - - -
144 GENERIK Risperidon tablet/kapsul/kaplet 2 mg tablet - - -
145 GENERIK Salbutamol tablet/kapsul/kaplet 2 mg tablet - - -
146 (sebagai
GENERIK Sulfat)
Salbutamol tablet/kapsul/kaplet 4 mg tablet - - -
147 (sebagai
GENERIK Sulfat)
Sefadroksil sir kering 250 mg/5 ml botol 8 - 8
148 GENERIK Sefadroksil sirup kering 125 mg/5ml botol 10 - 10
149 GENERIK Sefadroksil tablet/kapsul/kaplet 500 mg tablet 691 - 691
150 GENERIK Sefiksim sirup kering 100 mg/ 5 ml botol 6 - 6
151 GENERIK Sefiksim tablet/kapsul/kaplet 100 mg tablet - - -
152 GENERIK Sefiksim tablet/kapsul/kaplet 200 mg tablet 50 - 50
153 GENERIK Sefotaksim serb inj 1.000 mg vial - - -
154 GENERIK Sefotaksim serb inj 500 mg vial - - -
155 GENERIK Seftriaxon serb inj 1000 mg vial - - -
156 GENERIK Setirizin sirup 5 mg/5 ml Botol 8 - 8
157 GENERIK Setirizin tablet/kapsul/kaplet 10 mg tablet - - -
158 GENERIK Sianokobalamin (vitamin B12) injeksi 500 ampul - - -
159 mcg
GENERIK Sianokobalamin (vitamin B12) tablet tablet 200 - 200
160 GENERIK Simvastatin tablet/kaplet/salut 10 mg tablet - - -
161 GENERIK Simvastatin tablet/kaplet/salut 20 mg tablet - - -
162 GENERIK Siprofloksasin inf 2 mg/ml (2%) botol - - -
163 GENERIK Sukralfat susp 500 mg/5 mL, 100 ml Botol 100ml - - -
164 GENERIK Tiamin (Vitamin B1) tablet/kapsul/kaplet tablet 450 - 450
165 50 mg (HCl/Triheksifenidil
GENERIK Nitrat) tablet/kapsul/kaplet 2 mg tablet - - -
166 GENERIK Vitamin B Kompleks tablet tablet - - -
167 GENERIK Zinc sir 20 mg/5 ml Botol 17 - 17
168 GENERIK Zinc tablet dispersible 20 mg tablet 455 - 455
169 GENOINT SALEP MATA Gentamisin salep mata Tube 40 - 40
170 0,3%
GERIAVITA / Multivitamin (Beta-Carotene 6 mg, Vit tablet 90 - 90
171 EGlucotrol
30 mg, Vit
XLC10mg
500 mg, Asam Folat 0,4 mg) tablet 90 - 90
172 HUSTAB Kaplet 713 - 713
173 INFUSAN D5 (100 ML) Larutan mengandung botol - - -
174 Karbohidrat (Glukosa 5g/100 ml)
INFUSAN D5 (250 ML) Larutan mengandung botol - - -
175 Karbohidrat (Glukosa 12,5 g/250 ml)
INTERZOL SS 2% Ketokonazol scalp sol 2% botol - - -
176 KETEROLAC INJ ampul - - -
177 LEVEMIR INSULIN Pen - - -
178 MERSIBION INJ ampul - - -
179 MOLEXFLU KAPLET kaplet 358 - 358
MOLEXFLU SYRUP HCL, botol 49 - 49
MYCORINE POWDER Mikonazol serbuk 2% HCL, botol - - -
MYCOSTOP TAB. 250 Griseofulvin tablet - - -
183 tablet/kapsul/kaplet 250 mg
NEO DIAGON Attapulgit tab 650 mg tablet 180 - 180
184 NEW ANTIDES Atapulgit tablet/kapsul/kaplet 600 mg tablet - - -
185 NORAGES INJ Ampul - - -
186 NOVOMIX 30 FLEXPEN Mix Insulin pcs - - -
187 flexpen/catridge
NOVORAPID FLEXPEN Rapid insulin pcs - - -
188 pen/flexpen/catridge
OSTEOTIN capsul 898 - 898
189 OSTOVEL capsul 140 - 140
190 Otsuka KA-EN 3B Softbag 500ml - - -
191 PRIMPEN SYR botol 50 - 50
192 PROFOLAT Asam Folat tablet/kapsul/kaplet 0,4 mg tablet 290 - 290
193 PROSOGAN INJ 30MG Lansoprazol inj 30 mg/ml ampul - - -
194 PULAREX Attapulgit tab 630 mg tablet - - -
195 SCABIMITE CREAM 10 Permetrin Krim 5% tube - - -
196 SKIZON Betametason krim 0,5 mg/g tube - - -
197 TETAGAM Human tetanus imunoglobulin inj 250 IU pcs - 1 1
198 (i.m.)
THYROZOL 10 Tiamazol tab 10 mg tablet 185 - 185
199 ULSIDEX TABLET 500 MG Sukralfat tablet - - -
200 VAGIZOL Metronidazol ovula 500 mg ovula - - -
201 VENTOLIN ROTAHALER Ventolin Rotahaler (Alat pcs - - -
Hirup Salbutamol 200 mcg/kapsul)
202 STIMUNO SYR botol - 13 13
203 TETAGAM Human tetanus imunoglobulin inj 250 IU pcs - - -
204 (i.m.)
THYROZOL 10 Tiamazol tab 10 mg tablet - - -
205 ULSIDEX TABLET 500 MG Sukralfat tablet - - -
VAGIZOL Metronidazol500 mg
ovula 500 mg ovula - - -
207 VENTOLIN ROTAHALER Ventolin Rotahaler (Alat pcs - - -
208 Hirup
WIDASalbutamol
BES 200 mcg/kapsul) botol - - -
209 WIDA D5-1/2NS Larutan mengandung Karbohidrat + botol - - -
210 Elektrolit (D5-1/2NS)
WIDA D5-1/4NS Larutan mengandung Karbohidrat + botol - - -
211 Elektrolit (D5-1/4NS)
WIDA D5NS Larutan mengandung Karbohidrat + botol - - -
212 Elektrolit
WIDA HSD (D5NS)
Larutan mengandung Karbohidrat + botol - - -
213 Elektrolit (HSD)
WIDA KDN1 Larutan mengandung Karbohidrat + botol - - -
214 Elektrolit
WIDA KDN2 (D2,5Larutan
%+ KClmengandung
0,15 %+ NaCl 0,45 %) 500
Karbohidrat + ml botol - - -
215 Elektrolit
WIDA KN1 (D2,5 %+ KCl
Larutan 0,3 %+ NaCl
mengandung 0,45 %)
Elektrolit 500 ml
(KCl botol - - -
216 0,15%
WIDA+KN2 NaClLarutan
0,9%) mengandung elektrolit (KCl 0,3% botol - - -
217 +WIDA
NaCl RD
0,9%)Larutan mengandung Karbohidrat + botol - - -
218 Elektrolit (RD)
WIDA 0,9 % SOD.CHLOR botol - - -
219 Pehacain inj 2ml ampul - - -
220 Cavit G pcs - - -
221 Endo-Frost roeko botol - - -
222 Fuji IX art botol - - -
223 Etcha (Scothbond Etchant liq) botol - - -
224 Komposit/Lighcure (filtek Z 250 kit) pcs - - -
225 Bonding single bond universal pcs - - -
226 Cal lc denpro box - - -
227 Cresotin liquid II pcs - - -
228 Dentin Conditioner 6 Gr botol - - -
229 Hemospon box - - -
230 K File sendoline L25 15-40 pcs - - -
231 K reamers L25 15-40 pcs - - -
232 Seluloid strip box - - -
233 Softlex mini kit pcs - - -
234 NaOcl botol - - -
235 Sponge dental pcs - - -
236 Solare A2 pcs - - -
237 Solare A3 pcs - - -
- - -
BAHAN MEDIS HABIS PAKAI - - -
238 Alat Suntik 3 ml pcs - - -
239 Alat Suntik 5 ml pcs - - -
240 Alkohol 70% 1 L botol - - -
241 Alkohol Swab pcs - - -
242 Antiseptik Gel@500 ml botol - - -
243 Bracket Hand Wash pcs - - -
244 Odex 500 ml botol - - -
245 Dermafix T 10 x 12 cm pcs - - -
248 Infus set dewasa pcs - - -
249 Kasa Hidrofil uk. 40 x 80 cm rol - - -
250 Kasa Hidrofil Steril uk. 16 x 16 dos - - -
251 Kasa pembalut 4 x 15 cm elastic rol - - -
252 Kasa pembalut 4 x 3 cm elastic rol - - -
253 Kasa pembalut hydrofil 4 x 10 cm rol - - -
254 Kasa pembalut hydrofil 4 x 5 cm rol - - -
255 My Jelly pcs - - -
256 Lisol 1 L botol - - -
257 Pot Sputum pcs - - -
258 Safeglove PP no. 7 pasang - - -
259 Catgut plain / Benang bedah No. 2/0 dengan jarum pcs - - -
260 Catgut plain / Benang bedah No. 3/0 dengan jarum pcs - - -
261 Examination Glove size L pcs - - -
262 Examination Gloves size M pcs - - -
263 Examination Gloves size S pcs - - -
264 Folley Catheter 2 way No. 16 pcs - - -
265 Folley Catheter 2 way No. 18 pcs - - -
266 IV Catheter NP pen type no. 18 pcs - - -
267 IV Catheter NP pen type no. 20 pcs - - -
268 Kapas Pembalut / Absorben 250 gram rol - - -
269 Masker pcs - - -
270 Nasal oxygen cannula size L pcs - - -
271 Nasal oxygen cannula size M pcs - - -
272 Nasal oxygen cannula size S pcs - - -
273 Examination Gloves size L pcs - - -
274 Paper tape 2.5 cm x 9.14 m pcs - - -
275 Novo Twist 32 G x 5 mm pcs 18 - 18
276 Blood Transfusion set pcs - - -
277 IV Catheter trovensite 20 G pcs - - -
278 IV Catheter trovensite 22 G pcs - - -
279 Onesept sol botol - - -
280 Pharmafix 10 x 500 cm Rol - - -
283 Povidon 10% 60ml botol - - -
284 Povidon 10% 300ml botol - - -
285 Rivanol 0,1 % 300ml botol - - -
286 Soft pad 60x90 pcs - - -
287 Suction catheter, 14 pcs - - -
291 Urine Bag pcs - - -
Mengetahui Yang Menyerahkan

Kepala Puskesmas Pamolokan Petugas Gudang Puskesmas Pamolokan

Nip. 19760826 200501 2 008 Nip . 19810621 200901 2 005
RMINTAAN OBAT (LPLPO)
APITASI
Bulan : JANUARI
Tahun : 2019
PENGE SISA PERMIN PEMBERIAN KETR

LUARAN STOK TAAN
7 8 9 10 11
- -
- 75
1,070 829 500
44 26
- -
570 949
- -
- -
2 13
- -
- -
- 50
- -
- -
- -
- 100
- -
26 34
- -
- -
- 300
290 316 600
- -
44 114
300 446
- -
15 11
- -
- -
- -
34 166
15 507 50
- -
40 80
- -
- -
285 414
- -
- -
- -
2 8
- -
- -
- -
12 11
30 122
- -
- 123
- -
- -
- -
22 365
- -
- -
1 17
180 155
640 155
400 385
60 270
- -
- -
- -
- -
- -
3 17
- -
- -
- -
- -
- -
- 629
- 285
- -
- -
- -
- -
- -
- -
- -
25 345
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 11
- -
- -
- -
- -
- -
- -
350 140
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 7
- -
- -
- -
- -
10 270
- 235
- 42
- 99
- 169
- -
410 -
- -
- -
- -
- -
- -
- -
10 594
- 141
284 96
- 100
- 50
- -
230 -
- -
- -
- -
- -
- -
- 8
3 7
80 611
- 6
- -
- 50
- -
- -
- -
2 6
- -
- -
- 200
- -
- -
- -
- -
- 450
- -
- -
6 11
60 395
1 39
- 90
- 90
20 693
- -
- -
- -
- -
- -
- -
200 158
5 44
- -
- -
48 132
- -
- -
- -
- -
380 518
90 50
- -
- 50
- 290
- -
- -
- -
- -
1 -
- 185
- -
- -
- -
- 13
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
12 6
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Sumenep, JANUARI 2019

enyerahkan Penanggung Jawab Obat
uskesmas Pamolokan RUANG FARMASI
Kota Sumenep
A YUNITA
21 200901 2 005

Lplpo Jaringan Dak, Apbd & Kapitasi 2019

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

SUMBER ANGGARAN DAK

dr. RIFMI UTAMI, M.Kes VERA YUNITA

Unit : RUANG FARMASI

SATU STOK PENERI PERSE

BAHAN MEDIS HABIS PAKAI

dr. RIFMI UTAMI, M.Kes VERA

Bulan : JANUARI Unit

Yang Menyerahkan Mengetahui

VERA YUNITA dr. RIFMI UTAMI, M.

SATU STOK PENERI PERSE

RIFMI UTAMI, M.Kes VER

RUARI Unit : RUANG FARMASI

SATU STOK PENERI PERSE

dr. RIFMI UTAMI, M.Kes

dr. RIFMI UTAMI, M.Kes

Unit : RUANG FARMASI Bulan :

SATU STOK PENERI PERSE PENGE SISA PERMIN

dr. RIFMI UTAMI, M.Kes VERA YUNITA

BAHAN MEDIS HABIS PAKAI

dr. RIFMI UTAMI, M.Kes

STOK PENERI PERSE

dr. RIFMI UTAMI, M.Kes

- - 39 GENERIK Dietilkarbamazin tablet scor

dr. RIFMI UTAMI, M.Kes

SATU STOK PENERI PERSE

- - 199 ULSIDEX TABLET 50

dr. RIFMI UTAMI,

SATU STOK PENERI PERSE

dr. RIFMI UTAMI, M.Kes

SUMBER ANGGARAN KAPITASI

Unit : RUANG FARMASI

SATU STOK PENERI PERSE

Mengetahui Yang Menyerahkan

dr. RIFMI UTAMI, M.Kes VERA YUNITA

PENGE SISA PERMIN PEMBERIAN KETR

Sumenep, JANUARI 2019

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