LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO

TAHUN 2017

Bulan D
: esember

SATUAN/KEM HARGA PENERIMAA PERSEDIAA

NO NAMA OBAT STOK AWAL
ASAN SATUAN N N

1 2 3 4 5 6 7=(5+6)

1 ACT Tablet 2,750 -

2 Acetosal (Asam asetil salisilat) Tablet 110 -
3 Acyclovir 200 mg Tablet 276 -
4 Acyclovir 400 mg Tablet 387 -
5 Acyclovir cream Tube 3,150 -
6 Albendazole tab 400 mg Tablet 363 -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 -
8 Allupurinol tab 100 mg Tablet 96 -
9 Ambroxol tablet 30 mg Tablet 176 -
10 Ambroxol sirup 15 mg/ml Botol 4,250 -
11 Aminophilin tab 200 mg Tablet 86 -
12 Aminophilin Injeksi Amp 4,204 -
13 Amlodipin tab 5 mg Tablet 110 -
14 Amlodipin tab 10 mg Tablet 168 -
15 Amoxicillin kapsul 500 mg Tablet 239 -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 -
19 Ampicillin 500 mg Tablet 381 -
20 Antalgin tab Tablet 155 -
21 Antalgin injeksi Amp 1,501 -
22 Antasida DOEN tab kunyah Tablet 72 -
23 Antasida sirup Botol 2,213 -
24 Anti bakteri DOEN salep komb. Tube 2,767 -
25 Anti fungi DOEN komb. Pot 2,530 -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 -
27 Anti Migren Tablet 149 -
28 Anti Hemoroid suppo 3,654 -
29 Asam folat tab 1 mg Tablet 69 -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 -
32 Asam Mefenamat 500 mg Tablet 127 -
33 Atropin injeksi Ampul 1,353 -
34 Aqua Pro Injeksi steril Vial 5,900 -
35 Betametason krim 0.1 % Tube 1,596 -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 -
37 Calsium Laktat Tablet 142 -
38 Captopril tablet 12.5 mg Tablet 69 -
39 Captopril tablet 25 mg Tablet 82 -
40 Captopril tablet 50 mg Tablet 141 -
41 Carbamasepin 200 mg Tablet 269 -
42 Cetrizine tablet 10 mg Tablet 156 -
43 Cetrizine syrup 5 mg / ml Botol 8,094 -
44 Cifroploxacin Tablet 500 mg Tablet 309 -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 -
46 Cotrimoksazole Pediatrik Tablet 90 -
47 Cotrimoksazole Suspensi Botol 2,298 -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 -
49 Chlorpromazin tablet salut 25 mg Tablet 178 -
50 Chlorpromazin tablet salut 100 mg Tablet 146 -
51 Chloramfenicol Kapsul 250 Kapsul 275 -
52 Chloramfenicol suspensi Botol 5,170 -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 -
54 Chloramfenicol Salep mata 1 % Tube 1,900 -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 -
56 Deksametason Tablet 0.5 mg Tablet 52 -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 -
58 Dekstrometorfan Tablet 15 mg Tablet 102 -
59 Diazepam Tablet 2 mg Tablet 47 -
60 Diazepam Tablet 5 mg Tablet 65 -
61 Diazepam Injeksi Tablet 2,578 -
62 Digoksin Tablet 0.25 mg Tablet 103 -
63 Difenhidramin injeksi Ampul 1,415 -
64 Doksisiklin Kapsul 100 mg Kapsul 320 -
65 Domperidon Tablet 10 mg Tablet 138 -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 -
67 Efedrin HCl Tablet Tablet 83 -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 -
70 Erytromicin Tablet 250mg Tablet 679 -
71 Erytromicin Tablet 500 mg Tablet 771 -
72 Erytromicin Sirup Kering Botol 7,391 -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 -
74 Etanol 70 % 100 ml Botol 2,625 -
75 Etanol 70 % 1000 ml Botol 21,500 -
76 Fenobarbital Tablet 30 mg Tablet 124 -
77 Fenobarbital Injeksi Ampul 2,363 -
78 Fenol Gliserol Tetes telinga Botol 2,654 -
79 Ferro Sulfat Tablet 22 -
80 Fhenilbutason Tablet 200 mg Tablet 107 -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 -
83 Furosemid tablet 40 mg Tablet 84 -
84 Formalin 1000 ml Botol 58,100 -
85 Garam Oralit Untuk 200 ml air Kantong 278 -
86 Gentian Violet larutan 1 % Botol 985 -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 -
88 Glibenklamid tablet 5 mg Tablet 61 -
89 Glukosa larutan Infus 5% Steril Botol 5,720 -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 -
91 Glyseril Guaiakolat Tablet 41 -
92 Griseofulvin Tablet 125 mg Tablet 230 -
93 Haloperidol Tablet 0.5 mg Tablet 62 -
94 Haloperidol Tablet 1.5 mg Tablet 78 -
95 Haloperidol Tablet 5 mg Tablet 94 -
96 Hidrokortison Krim 2.5 % Tube 2,938 -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 -
98 Ibuprofen tablet 200 mg Tablet 116 -
99 Ibuprofen tablet 400 mg Tablet 139 -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 -
102 Ketokonazole Krim 2 % Tube 2,740 -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 -
104 Ketokonazole Tablet 200 mg Tablet 320 -
105 Klindamicin Kaplet 150 mg Kaplet 405 -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 -
107 Lidocain Injeksi Ampul 2,215 -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 -
109 Lisol Botol 53,505 -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 -
111 Loratadin Tablet 170 -
112 Metylergometrin Maleat Tablet Tablet 169 -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 -
114 Metylprednisolon Tablet 4 mg Tablet 230 -
115 Metylprednisolon Tablet 8 mg Tablet 390 -
116 Metronidazol tablet 250 mg Tablet 103 -
117 Metronidazol tablet 500 mg Tablet 143 -
118 Metronidazol tablet Vaginal suppo 3,665 -
119 Metoklorpropamid 5 mg Tablet Tablet 113 -
120 Metoklorpropamid 10 mg Tablet Tablet 100 -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 -
122 Miconazole Krim 2% Tube 3,150 -
123 Mineral Mix Bungkus 2,453 -
124 Natrium diklofenak 25 mg Tablet 178 -
125 Natrium diklofenak 50 mg Tablet 162 -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 -
127 Nifedipin tablet Tablet 129 -
128 Nistatin tablet salut 500.000 IU Tablet 895 -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 -
131 OAT Kategori FDC Anak PAKET 236,480 -
132 OAT Kategori FDC I PAKET 395,020 -
133 OAT Kategori FDC II PAKET 1,319,898 -
134 OAT Kategori FDC Sisipan PAKET 175,899 -
135 Ofloxacin Tablet 200 mg Tablet 440 -
136 Ofloxacin Tablet 400 mg Tablet 700 -
137 Oksitetrasiklin HCL injeksi Vial 3,100 -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 -
140 Oksitosin Injeksi Pytogin Ampul 1,900 -
141 Omeprasol Tab 20 mg Tablet 176 -
142 Papaverin Tablet 40 mg Tablet 128 -
143 Paracetamol 100 mg Tablet 49 -
144 Paracetamol 500 mg Tablet 88 -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 -
147 Piridoksin (Vit-B6) Tablet 31 -
148 Pirantel Pamoat tablet 125 mg Tablet 333 -
149 Pirantel suspensi Botol 9,100 -
150 Piroxicam 10 mg Tablet 131 -
151 PiroXicam 20 mg Tablet 164 -
152 Povidon iodida 10 % 30 ml 2,344 -
153 Povidon iodida 10 % 60 ml 4,829 -
154 Povidon iodida 10 % 300 ml 15,386 -
155 Prednison Tablet 5 mg Tablet 125 -
156 Propiltiorasil Tablet 100 mg Tablet 351 -
157 Ranitidin Tablet 150 mg Tablet 119 -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 -
159 Ramipril 5 mg Tablet 635 -
160 Ringer Laktat larutan infus steril Botol 7,150 -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 -
163 Salbutamol Tablet 2 mg Tablet 65 -
164 Salbutamol Tablet 4 mg Tablet 89 -
165 Salep 2-4, Kombinasi Pot 2,200 -
166 Salisil Bedak 2 % Kotak 1,080 -
167 Sefadroksil 500 mg Tablet 557 -
168 Sefadroksil sirup Botol 5,286 -
169 Sefotaksim Injeksi Vial 6,785 -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 -
172 Simvastatin 10 mg Tablet Tablet 136 -
173 Simvastatin 20 mg Tablet Tablet 480 -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 -
176 Tetracain Tetes Mata Botol 3,396 -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 -
181 Thiamfenicol kapsul 500 mg Tablet 616 -
182 Triheksilfenidil tab 2 mg Tablet 49 -
183 Vitamin B Plex Tablet 138 -
184 Vaksin Rabies Vero Kuur / flakon 450,000 -
185 Zink Tablet Tablet 618 -
186 PERBEKALAN KESEHATAN -
187 Alat suntik sekali pakai 1 ml Pcs 748 -
188 Alat suntik 2,5 ml pcs 848 -
189 Alat suntik sekali pakai 3 ml Pcs 748 -
190 Alat suntik sekali pakai 5 ml pcs 863 -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 -
195 Folley Cateter no. 18 Pcs 10,440 -
196 Folley Cateter no. 20 Pcs 10,440 -
197 Handscoon No. 7 Pcs 7,683 -
198 Handscoon No. 7,5 Pcs 7,683 -
199 Handscoon No. 8 Pcs 7,683 -
200 Handscoon S Pcs 848 -
201 Handscoon M Pcs 848 -
202 Handscoon L Pcs 848 -
203 Infuset Anak Pcs 4,025 -
204 Infuset Dewasa Pcs 3,680 -
205 IV. Cateter no. 18 G Pcs 7,334 -
206 IV. Cateter no. 20 G Pcs 7,334 -
207 IV. Cateter no. 22 G Pcs 7,334 -
208 IV. Cateter no. 24 G Pcs 7,334 -
209 Kapas Berlemak 500 g Roll 21,532 -
210 Kapas Berlemak 250 g Roll 14,376 -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 -
 218 Masker Pcs 1,077 -
219 Masker plus 3 ply earloop pcs 506 -
220 Masker plus earloop pcs 380 -
221 Pembalut Gips 6 inchi Roll 38,182 -
222 Plester 5 yard x 2 inchi Roll 23,630 -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 -
227 Urine Bag Pcs 3,915 -
228 Wing needle no. 23 Pcs 5,193 -
229 Wing needle no. 25 Pcs 6,347 -
230 Wing needle no. 27 Pcs 6,347 -
OBAT GIGI -
231 Albothil Concentrat btl 19,800 -
232 Devitalisasi Pasta Kotak 429,000 -
233 Etil Klorida Spray Botol 120,000 -
234 Eugenol Cairan Botol 18,333 -
235 Glas ionomer Cement ART Set 862,000 -
236 Kalcium Hidroksida Pasta Tube 276,298 -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 -
238 Mummifiying Pasta Botol 265,467 -
239 Polikresulen Cairan 10 ml Botol 31,200 -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 -
-
-
-
-
-
-
-
-

TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUAR SISA STOK EXPIRED

JUMLAH HARGA
AN PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
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- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
- -
- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
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- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
- -
- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
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- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
- -
- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
- -
- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
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- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
- -
- -
- -
- -
- -
- -
- -
- -
-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
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-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 LAPORAN PERSEDIAAN OBAT DAK PUSKESMAS WAWO
TAHUN 2017

Bulan D
: esember
SATUAN/KEM HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN
ASAN SATUAN

1 2 3 4 5 6 7=(5+6)
1 ACT Tablet 2,750 - -
2 Acetosal (Asam asetil salisilat) Tablet 110 - -
3 Acyclovir 200 mg Tablet 276 - -
4 Acyclovir 400 mg Tablet 387 - -
5 Acyclovir cream Tube 3,150 - -
6 Albendazole tab 400 mg Tablet 363 - -
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 - -
8 Allupurinol tab 100 mg Tablet 96 - -
9 Ambroxol tablet 30 mg Tablet 176 - -
10 Ambroxol sirup 15 mg/ml Botol 4,250 - -
11 Aminophilin tab 200 mg Tablet 86 - -
12 Aminophilin Injeksi Amp 4,204 - -
13 Amlodipin tab 5 mg Tablet 110 - -
14 Amlodipin tab 10 mg Tablet 168 - -
15 Amoxicillin kapsul 500 mg Tablet 239 - -
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 - -
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 - -
18 Amitriptilin tab salut 25 mg HCL Tablet 172 - -
19 Ampicillin 500 mg Tablet 381 - -
20 Antalgin tab Tablet 155 - -
21 Antalgin injeksi Amp 1,501 - -
22 Antasida DOEN tab kunyah Tablet 72 - -
23 Antasida sirup Botol 2,213 - -
24 Anti bakteri DOEN salep komb. Tube 2,767 - -
25 Anti fungi DOEN komb. Pot 2,530 - -
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 - -
27 Anti Migren Tablet 149 - -
28 Anti Hemoroid suppo 3,654 - -
29 Asam folat tab 1 mg Tablet 69 - -
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 - -
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 - -
32 Asam Mefenamat 500 mg Tablet 127 - -
33 Atropin injeksi Ampul 1,353 - -
34 Aqua Pro Injeksi steril Vial 5,900 - -
35 Betametason krim 0.1 % Tube 1,596 - -
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 - -
37 Calsium Laktat Tablet 142 - -
38 Captopril tablet 12.5 mg Tablet 69 - -
39 Captopril tablet 25 mg Tablet 82 - -
40 Captopril tablet 50 mg Tablet 141 - -
41 Carbamasepin 200 mg Tablet 269 - -
42 Cetrizine tablet 10 mg Tablet 156 - -
43 Cetrizine syrup 5 mg / ml Botol 8,094 - -
44 Cifroploxacin Tablet 500 mg Tablet 309 - -
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 - -
46 Cotrimoksazole Pediatrik Tablet 90 - -
47 Cotrimoksazole Suspensi Botol 2,298 - -
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 - -
49 Chlorpromazin tablet salut 25 mg Tablet 178 - -
50 Chlorpromazin tablet salut 100 mg Tablet 146 - -
51 Chloramfenicol Kapsul 250 Kapsul 275 - -
52 Chloramfenicol suspensi Botol 5,170 - -
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 - -
54 Chloramfenicol Salep mata 1 % Tube 1,900 - -
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 - -
56 Deksametason Tablet 0.5 mg Tablet 52 - -
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 - -
58 Dekstrometorfan Tablet 15 mg Tablet 102 - -
59 Diazepam Tablet 2 mg Tablet 47 - -
60 Diazepam Tablet 5 mg Tablet 65 - -
61 Diazepam Injeksi Tablet 2,578 - -
62 Digoksin Tablet 0.25 mg Tablet 103 - -
63 Difenhidramin injeksi Ampul 1,415 - -
64 Doksisiklin Kapsul 100 mg Kapsul 320 - -
65 Domperidon Tablet 10 mg Tablet 138 - -
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 - -
67 Efedrin HCl Tablet Tablet 83 - -
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 - -
69 Ekstrak Belladona Tablet 10 mg Tablet 106 - -
70 Erytromicin Tablet 250mg Tablet 679 - -
71 Erytromicin Tablet 500 mg Tablet 771 - -
72 Erytromicin Sirup Kering Botol 7,391 - -
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 - -
74 Etanol 70 % 100 ml Botol 2,625 - -
75 Etanol 70 % 1000 ml Botol 21,500 - -
76 Fenobarbital Tablet 30 mg Tablet 124 - -
77 Fenobarbital Injeksi Ampul 2,363 - -
78 Fenol Gliserol Tetes telinga Botol 2,654 - -
79 Ferro Sulfat Tablet 22 - -
80 Fhenilbutason Tablet 200 mg Tablet 107 - -
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 - -
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 - -
83 Furosemid tablet 40 mg Tablet 84 - -
84 Formalin 1000 ml Botol 58,100 - -
85 Garam Oralit Untuk 200 ml air Kantong 278 - -
86 Gentian Violet larutan 1 % Botol 985 - -
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 - -
88 Glibenklamid tablet 5 mg Tablet 61 - -
89 Glukosa larutan Infus 5% Steril Botol 5,720 - -
90 Glukosa larutan Infus 10 % Steril Botol 6,270 - -
91 Glyseril Guaiakolat Tablet 41 - -
92 Griseofulvin Tablet 125 mg Tablet 230 - -
93 Haloperidol Tablet 0.5 mg Tablet 62 - -
94 Haloperidol Tablet 1.5 mg Tablet 78 - -
95 Haloperidol Tablet 5 mg Tablet 94 - -
96 Hidrokortison Krim 2.5 % Tube 2,938 - -
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 - -
98 Ibuprofen tablet 200 mg Tablet 116 - -
99 Ibuprofen tablet 400 mg Tablet 139 - -
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 - -
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 - -
102 Ketokonazole Krim 2 % Tube 2,740 - -
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 - -
104 Ketokonazole Tablet 200 mg Tablet 320 - -
105 Klindamicin Kaplet 150 mg Kaplet 405 - -
106 Lanzoprasol Tablet 30 mg Tablet 1,200 - -
107 Lidocain Injeksi Ampul 2,215 - -
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 - -
109 Lisol Botol 53,505 - -
110 Loperamid Tablet 2 mg / Novadium Tablet 97 - -
111 Loratadin Tablet 170 - -
112 Metylergometrin Maleat Tablet Tablet 169 - -
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 - -
114 Metylprednisolon Tablet 4 mg Tablet 230 - -
115 Metylprednisolon Tablet 8 mg Tablet 390 - -
116 Metronidazol tablet 250 mg Tablet 103 - -
117 Metronidazol tablet 500 mg Tablet 143 - -
118 Metronidazol tablet Vaginal suppo 3,665 - -
119 Metoklorpropamid 5 mg Tablet Tablet 113 - -
120 Metoklorpropamid 10 mg Tablet Tablet 100 - -
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 - -
122 Miconazole Krim 2% Tube 3,150 - -
123 Mineral Mix Bungkus 2,453 - -
124 Natrium diklofenak 25 mg Tablet 178 - -
125 Natrium diklofenak 50 mg Tablet 162 - -
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 - -
127 Nifedipin tablet Tablet 129 - -
128 Nistatin tablet salut 500.000 IU Tablet 895 - -
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 - -
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 - -
131 OAT Kategori FDC Anak PAKET 236,480 - -
132 OAT Kategori FDC I PAKET 395,020 - -
133 OAT Kategori FDC II PAKET 1,319,898 - -
134 OAT Kategori FDC Sisipan PAKET 175,899 - -
135 Ofloxacin Tablet 200 mg Tablet 440 - -
136 Ofloxacin Tablet 400 mg Tablet 700 - -
137 Oksitetrasiklin HCL injeksi Vial 3,100 - -
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 - -
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 - -
140 Oksitosin Injeksi Pytogin Ampul 1,900 - -
141 Omeprasol Tab 20 mg Tablet 176 - -
142 Papaverin Tablet 40 mg Tablet 128 - -
143 Paracetamol 100 mg Tablet 49 - -
144 Paracetamol 500 mg Tablet 88 - -
145 Paracetamol Sirup 120 mg / ml Botol 1,338 - -
146 Paracetamol Drops 100 mg/ ml Botol 6,240 - -
147 Piridoksin (Vit-B6) Tablet 31 - -
148 Pirantel Pamoat tablet 125 mg Tablet 333 - -
149 Pirantel suspensi Botol 9,100 - -
150 Piroxicam 10 mg Tablet 131 - -
151 PiroXicam 20 mg Tablet 164 - -
152 Povidon iodida 10 % 30 ml 2,344 - -
153 Povidon iodida 10 % 60 ml 4,829 - -
154 Povidon iodida 10 % 300 ml 15,386 - -
155 Prednison Tablet 5 mg Tablet 125 - -
156 Propiltiorasil Tablet 100 mg Tablet 351 - -
157 Ranitidin Tablet 150 mg Tablet 119 - -
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 - -
159 Ramipril 5 mg Tablet 635 - -
160 Ringer Laktat larutan infus steril Botol 7,150 - -
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 - -
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah Kapsul 505 - -
163 Salbutamol Tablet 2 mg Tablet 65 - -
164 Salbutamol Tablet 4 mg Tablet 89 - -
165 Salep 2-4, Kombinasi Pot 2,200 - -
166 Salisil Bedak 2 % Kotak 1,080 - -
167 Sefadroksil 500 mg Tablet 557 - -
168 Sefadroksil sirup Botol 5,286 - -
169 Sefotaksim Injeksi Vial 6,785 - -
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 - -
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 - -
172 Simvastatin 10 mg Tablet Tablet 136 - -
173 Simvastatin 20 mg Tablet Tablet 480 - -
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 - -
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 - -
176 Tetracain Tetes Mata Botol 3,396 - -
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 - -
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 - -
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 - -
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 - -
181 Thiamfenicol kapsul 500 mg Tablet 616 - -
182 Triheksilfenidil tab 2 mg Tablet 49 - -
183 Vitamin B Plex Tablet 138 - -
184 Vaksin Rabies Vero Kuur / flakon 450,000 - -
185 Zink Tablet Tablet 618 - -
186 PERBEKALAN KESEHATAN - -
187 Alat suntik sekali pakai 1 ml Pcs 748 - -
188 Alat suntik 2,5 ml pcs 848 - -
189 Alat suntik sekali pakai 3 ml Pcs 748 - -
190 Alat suntik sekali pakai 5 ml pcs 863 - -
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 - -
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 - -
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 - -
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 - -
195 Folley Cateter no. 18 Pcs 10,440 - -
196 Folley Cateter no. 20 Pcs 10,440 - -
197 Handscoon No. 7 Pcs 7,683 - -
198 Handscoon No. 7,5 Pcs 7,683 - -
199 Handscoon No. 8 Pcs 7,683 - -
200 Handscoon S Pcs 848 - -
201 Handscoon M Pcs 848 - -
202 Handscoon L Pcs 848 - -
203 Infuset Anak Pcs 4,025 - -
204 Infuset Dewasa Pcs 3,680 - -
205 IV. Cateter no. 18 G Pcs 7,334 - -
206 IV. Cateter no. 20 G Pcs 7,334 - -
207 IV. Cateter no. 22 G Pcs 7,334 - -
208 IV. Cateter no. 24 G Pcs 7,334 - -
209 Kapas Berlemak 500 g Roll 21,532 - -
210 Kapas Berlemak 250 g Roll 14,376 - -
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 - -
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 - -
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 - -
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 - -
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 - -
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 - -
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 - -
218 Masker Pcs 1,077 - -
 219 Masker plus 3 ply earloop pcs 506 - -
220 Masker plus earloop pcs 380 - -
221 Pembalut Gips 6 inchi Roll 38,182 - -
222 Plester 5 yard x 2 inchi Roll 23,630 - -
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 - -
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 - -
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 - -
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 - -
227 Urine Bag Pcs 3,915 - -
228 Wing needle no. 23 Pcs 5,193 - -
229 Wing needle no. 25 Pcs 6,347 - -
230 Wing needle no. 27 Pcs 6,347 - -
OBAT GIGI - -
231 Albothil Concentrat btl 19,800 - -
232 Devitalisasi Pasta Kotak 429,000 - -
233 Etil Klorida Spray Botol 120,000 - -
234 Eugenol Cairan Botol 18,333 - -
235 Glas ionomer Cement ART Set 862,000 - -
236 Kalcium Hidroksida Pasta Tube 276,298 - -
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 - -
238 Mummifiying Pasta Botol 265,467 - -
239 Polikresulen Cairan 10 ml Botol 31,200 - -
240 Semen Seng Fospat serbuk + Cairan Set 156,200 - -
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 - -
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-
TOTAL

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
WAWO

PENGELUARA SISA STOK EXPIRED

JUMLAH HARGA
N PUSKESMAS DATE

8 9=(7 - 8 - 11) 10=(4x9) 11

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Lasusua, Desember 2017
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009
 DAFTAR OBAT EXPAIRED DAT

SATUAN/KEM HARGA
NO NAMA OBAT
ASAN SATUAN

1 2 3 4 1 2 3 4
1 ACT Tablet 2,750 0 0 0 0
2 Acetosal (Asam asetil salisilat) Tablet 110 0 0 0 0
3 Acyclovir 200 mg Tablet 276 0 0 0 0
4 Acyclovir 400 mg Tablet 387 0 0 0 0
5 Acyclovir cream Tube 3,150 0 0 0 0
6 Albendazole tab 400 mg Tablet 363 0 0 0 0
7 Albendazole Susp 200 mg / 5 ml Botol 4,619 0 0 0 0
8 Allupurinol tab 100 mg Tablet 96 0 0 0 0
9 Ambroxol tablet 30 mg Tablet 176 0 0 0 0
10 Ambroxol sirup 15 mg/ml Botol 4,250 0 0 0 0
11 Aminophilin tab 200 mg Tablet 86 0 0 0 0
12 Aminophilin Injeksi Amp 4,204 0 0 0 0
13 Amlodipin tab 5 mg Tablet 110 0 0 0 0
14 Amlodipin tab 10 mg Tablet 168 0 0 0 0
15 Amoxicillin kapsul 500 mg Tablet 239 0 0 0 0
16 Amoxicillin syrup kering 125 mg/ml Botol 2,560 0 0 0 0
17 Amoxicillin serbuk injeksi 1000 mg Vial 7,500 0 0 0 0
18 Amitriptilin tab salut 25 mg HCL Tablet 172 0 0 0 0
19 Ampicillin 500 mg Tablet 381 0 0 0 0
20 Antalgin tab Tablet 155 0 0 0 0
21 Antalgin injeksi Amp 1,501 0 0 0 0
22 Antasida DOEN tab kunyah Tablet 72 0 0 0 0
23 Antasida sirup Botol 2,213 0 0 0 0
24 Anti bakteri DOEN salep komb. Tube 2,767 0 0 0 0
25 Anti fungi DOEN komb. Pot 2,530 0 0 0 0
26 Anti malaria komb. Pirimetamin+Sulfadoxin Tablet 572 0 0 0 0
27 Anti Migren Tablet 149 0 0 0 0
28 Anti Hemoroid suppo 3,654 0 0 0 0
29 Asam folat tab 1 mg Tablet 69 0 0 0 0
30 Asam Askorbat ( Vit C ) tab 50 mg Tablet 125 0 0 0 0
31 Asam Askorbat ( Vit C ) tab 250 mg Tablet 139 0 0 0 0
32 Asam Mefenamat 500 mg Tablet 127 0 0 0 0
33 Atropin injeksi Ampul 1,353 0 0 0 0
34 Aqua Pro Injeksi steril Vial 5,900 0 0 0 0
35 Betametason krim 0.1 % Tube 1,596 0 0 0 0
36 Besi II sulfat+Asam folat ( Tablet + darah ) saset 45 0 0 0 0
37 Calsium Laktat Tablet 142 0 0 0 0
38 Captopril tablet 12.5 mg Tablet 69 0 0 0 0
39 Captopril tablet 25 mg Tablet 82 0 0 0 0
40 Captopril tablet 50 mg Tablet 141 0 0 0 0
41 Carbamasepin 200 mg Tablet 269 0 0 0 0
42 Cetrizine tablet 10 mg Tablet 156 0 0 0 0
43 Cetrizine syrup 5 mg / ml Botol 8,094 0 0 0 0
44 Cifroploxacin Tablet 500 mg Tablet 309 0 0 0 0
45 Cotrimoksazole Dewasa tablet 480 mg Tablet 158 0 0 0 0
46 Cotrimoksazole Pediatrik Tablet 90 0 0 0 0
47 Cotrimoksazole Suspensi Botol 2,298 0 0 0 0
48 Chlorfeniramin maleat ( CTM ) Tablet 4 mg Tablet 46 0 0 0 0
49 Chlorpromazin tablet salut 25 mg Tablet 178 0 0 0 0
50 Chlorpromazin tablet salut 100 mg Tablet 146 0 0 0 0
51 Chloramfenicol Kapsul 250 Kapsul 275 0 0 0 0
52 Chloramfenicol suspensi Botol 5,170 0 0 0 0
53 Chloramfenicol Tetes telinga 3 % Botol 2,150 0 0 0 0
54 Chloramfenicol Salep mata 1 % Tube 1,900 0 0 0 0
55 Deksametason injeksi 5 mg / - 1 ml Ampul 1,738 0 0 0 0
56 Deksametason Tablet 0.5 mg Tablet 52 0 0 0 0
57 Dekstrometorfan Sirup 10 mg / 5 ml Tablet 1,467 0 0 0 0
58 Dekstrometorfan Tablet 15 mg Tablet 102 0 0 0 0
59 Diazepam Tablet 2 mg Tablet 47 0 0 0 0
60 Diazepam Tablet 5 mg Tablet 65 0 0 0 0
61 Diazepam Injeksi Tablet 2,578 0 0 0 0
62 Digoksin Tablet 0.25 mg Tablet 103 0 0 0 0
63 Difenhidramin injeksi Ampul 1,415 0 0 0 0
64 Doksisiklin Kapsul 100 mg Kapsul 320 0 0 0 0
65 Domperidon Tablet 10 mg Tablet 138 0 0 0 0
66 Domperidon Sirup 5 mg/ 5 ml Botol 3,300 0 0 0 0
67 Efedrin HCl Tablet Tablet 83 0 0 0 0
68 Efinefrin HCl ( efinefrin/Adrenalin ) injeksi Injeksi 8,910 0 0 0 0
69 Ekstrak Belladona Tablet 10 mg Tablet 106 0 0 0 0
70 Erytromicin Tablet 250mg Tablet 679 0 0 0 0
71 Erytromicin Tablet 500 mg Tablet 771 0 0 0 0
72 Erytromicin Sirup Kering Botol 7,391 0 0 0 0
73 Etakridin ( Rivanol ) Larutan 0.1 % Botol 2,550 0 0 0 0
74 Etanol 70 % 100 ml Botol 2,625 0 0 0 0
75 Etanol 70 % 1000 ml Botol 21,500 0 0 0 0
76 Fenobarbital Tablet 30 mg Tablet 124 0 0 0 0
77 Fenobarbital Injeksi Ampul 2,363 0 0 0 0
78 Fenol Gliserol Tetes telinga Botol 2,654 0 0 0 0
79 Ferro Sulfat Tablet 22 0 0 0 0
80 Fhenilbutason Tablet 200 mg Tablet 107 0 0 0 0
81 Fitomenadion ( Vit. K ) Injeksi 10 mg/ml - 1 ml Ampul 4,260 0 0 0 0
82 Fitomenadion ( Vit. K ) Tablet 10 mg Tablet 835 0 0 0 0
83 Furosemid tablet 40 mg Tablet 84 0 0 0 0
84 Formalin 1000 ml Botol 58,100 0 0 0 0
85 Garam Oralit Untuk 200 ml air Kantong 278 0 0 0 0
86 Gentian Violet larutan 1 % Botol 985 0 0 0 0
87 Gentamisin Sulfat tetes mata 0,3 % Botol 4,800 0 0 0 0
88 Glibenklamid tablet 5 mg Tablet 61 0 0 0 0
89 Glukosa larutan Infus 5% Steril Botol 5,720 0 0 0 0
90 Glukosa larutan Infus 10 % Steril Botol 6,270 0 0 0 0
91 Glyseril Guaiakolat Tablet 41 0 0 0 0
92 Griseofulvin Tablet 125 mg Tablet 230 0 0 0 0
93 Haloperidol Tablet 0.5 mg Tablet 62 0 0 0 0
94 Haloperidol Tablet 1.5 mg Tablet 78 0 0 0 0
95 Haloperidol Tablet 5 mg Tablet 94 0 0 0 0
96 Hidrokortison Krim 2.5 % Tube 2,938 0 0 0 0
97 Hidroklorotiazide ( HCT ) Tablet 25 mg Tablet 36 0 0 0 0
98 Ibuprofen tablet 200 mg Tablet 116 0 0 0 0
99 Ibuprofen tablet 400 mg Tablet 139 0 0 0 0
100 Ibuprofen Suspensi 100 mg / 5 ml Botol 2,620 0 0 0 0
101 Isosorbit Dinitrat Tablet 5 mg Tablet 96 0 0 0 0
102 Ketokonazole Krim 2 % Tube 2,740 0 0 0 0
103 KA EN 3A (larutan karbohidrat dan elektrolit) 500 ml Botol 10,000 0 0 0 0
104 Ketokonazole Tablet 200 mg Tablet 320 0 0 0 0
105 Klindamicin Kaplet 150 mg Kaplet 405 0 0 0 0
106 Lanzoprasol Tablet 30 mg Tablet 1,200 0 0 0 0
107 Lidocain Injeksi Ampul 2,215 0 0 0 0
108 Lidocain Injeksi 2 % (HCl) + Efinefrin Ampul 1,485 0 0 0 0
109 Lisol Botol 53,505 0 0 0 0
110 Loperamid Tablet 2 mg / Novadium Tablet 97 0 0 0 0
111 Loratadin Tablet 170 0 0 0 0
112 Metylergometrin Maleat Tablet Tablet 169 0 0 0 0
113 Metylergometrin Maleat Injeksi ( Myomergin ) Ampul 3,210 0 0 0 0
114 Metylprednisolon Tablet 4 mg Tablet 230 0 0 0 0
115 Metylprednisolon Tablet 8 mg Tablet 390 0 0 0 0
116 Metronidazol tablet 250 mg Tablet 103 0 0 0 0
117 Metronidazol tablet 500 mg Tablet 143 0 0 0 0
118 Metronidazol tablet Vaginal suppo 3,665 0 0 0 0
119 Metoklorpropamid 5 mg Tablet Tablet 113 0 0 0 0
120 Metoklorpropamid 10 mg Tablet Tablet 100 0 0 0 0
121 Metoklorpropamid syr 5 mg/ml Botol 2,900 0 0 0 0
122 Miconazole Krim 2% Tube 3,150 0 0 0 0
123 Mineral Mix Bungkus 2,453 0 0 0 0
124 Natrium diklofenak 25 mg Tablet 178 0 0 0 0
125 Natrium diklofenak 50 mg Tablet 162 0 0 0 0
126 Natrium klorida Lar. Infus 0,9 % steril Botol 6,410 0 0 0 0
127 Nifedipin tablet Tablet 129 0 0 0 0
128 Nistatin tablet salut 500.000 IU Tablet 895 0 0 0 0
129 Nistatin tablet salut 100.000 IU Vaginal Tablet 628 0 0 0 0
130 Obat Batuk Hitam ( OBH ) sirup Botol 2,360 0 0 0 0
131 OAT Kategori FDC Anak PAKET 236,480 0 0 0 0
132 OAT Kategori FDC I PAKET 395,020 0 0 0 0
133 OAT Kategori FDC II PAKET 1,319,898 0 0 0 0
134 OAT Kategori FDC Sisipan PAKET 175,899 0 0 0 0
135 Ofloxacin Tablet 200 mg Tablet 440 0 0 0 0
136 Ofloxacin Tablet 400 mg Tablet 700 0 0 0 0
137 Oksitetrasiklin HCL injeksi Vial 3,100 0 0 0 0
138 Oksitetrasiklin Salep Kulit 3 % Tube 2,030 0 0 0 0
139 Oksitetrasiklin Salep Mata 1 % Tube 3,110 0 0 0 0
140 Oksitosin Injeksi PytoginAmpul 1,900 0 0 0 0
141 Omeprasol Tab 20 mg Tablet 176 0 0 0 0
142 Papaverin Tablet 40 mg Tablet 128 0 0 0 0
143 Paracetamol 100 mg Tablet 49 0 0 0 0
144 Paracetamol 500 mg Tablet 88 0 0 0 0
145 Paracetamol Sirup 120 mg / ml Botol 1,338 0 0 0 0
146 Paracetamol Drops 100 mg/ ml Botol 6,240 0 0 0 0
147 Piridoksin (Vit-B6) Tablet 31 0 0 0 0
148 Pirantel Pamoat tablet 125 mg Tablet 333 0 0 0 0
149 Pirantel suspensi Botol 9,100 0 0 0 0
150 Piroxicam 10 mg Tablet 131 0 0 0 0
151 PiroXicam 20 mg Tablet 164 0 0 0 0
152 Povidon iodida 10 % 30 ml 2,344 0 0 0 0
153 Povidon iodida 10 % 60 ml 4,829 0 0 0 0
154 Povidon iodida 10 % 300 ml 15,386 0 0 0 0
155 Prednison Tablet 5 mg Tablet 125 0 0 0 0
156 Propiltiorasil Tablet 100 mg Tablet 351 0 0 0 0
157 Ranitidin Tablet 150 mg Tablet 119 0 0 0 0
158 Ranitidin injeksi 25 mg/2ml Ampul 2,122 0 0 0 0
159 Ramipril 5 mg Tablet 635 0 0 0 0
160 Ringer Laktat larutan infus steril Botol 7,150 0 0 0 0
161 Retinol (Vit.A) 100.000 IU Kaps Lunak Biru Kapsil 341 0 0 0 0
162 Retinol (Vit.A) 200.000 IU Kaps Lunak Merah
Kapsul 505 0 0 0 0
163 Salbutamol Tablet 2 mg Tablet 65 0 0 0 0
164 Salbutamol Tablet 4 mg Tablet 89 0 0 0 0
165 Salep 2-4, Kombinasi Pot 2,200 0 0 0 0
166 Salisil Bedak 2 % Kotak 1,080 0 0 0 0
167 Sefadroksil 500 mg Tablet 557 0 0 0 0
168 Sefadroksil sirup Botol 5,286 0 0 0 0
169 Sefotaksim Injeksi Vial 6,785 0 0 0 0
170 Sianocobalamin (Vit.B12) Tablet Tablet 63 0 0 0 0
171 Sianocobalamin (Vit.B12) Injeksi 500 mg/mlAmpul Tablet 1,150 0 0 0 0
172 Simvastatin 10 mg Tablet Tablet 136 0 0 0 0
173 Simvastatin 20 mg Tablet Tablet 480 0 0 0 0
174 Sulfasetamida Natrium tetes mata 15 % Botol 4,500 0 0 0 0
175 Sucralfat Susp 500 mg/5 ml Botol 10,100 0 0 0 0
176 Tetracain Tetes Mata Botol 3,396 0 0 0 0
177 Tetrasiklin HCL Kapsul 250 mg Tablet 162 0 0 0 0
178 Tetrasiklin HCL Kapsul 500 mg Tablet 341 0 0 0 0
179 Tiamin HCL (Vit. B1) Tablet 100 mg Tablet 95 0 0 0 0
180 Tiamin HCL (Vit. B1) injeksi Ampul 950 0 0 0 0
181 Thiamfenicol kapsul 500 mg Tablet 616 0 0 0 0
182 Triheksilfenidil tab 2 mg Tablet 49 0 0 0 0
183 Vitamin B Plex Tablet 138 0 0 0 0
184 Vaksin Rabies Vero Kuur / flakon 450,000 0 0 0 0
185 Zink Tablet Tablet 618 0 0 0 0
186 PERBEKALAN KESEHATAN 0 0 0 0
187 Alat suntik sekali pakai 1 ml Pcs 748 0 0 0 0
188 Alat suntik 2,5 ml pcs 848 0 0 0 0
189 Alat suntik sekali pakai 3 ml Pcs 748 0 0 0 0
190 Alat suntik sekali pakai 5 ml pcs 863 0 0 0 0
191 Catgut/Benang bedah no.2/0 + Jarum bedah Pcs 7,286 0 0 0 0
192 Catgut/Benang bedah no.2/0 + Jarum bedah 24 MM Pcs 28,998 0 0 0 0
193 Catgut/Benang bedah no.2/0 + Jarum bedah 37 MM Pcs 23,839 0 0 0 0
194 Catgut/Benang bedah no.3/0 + Jarum bedah pcs 7,286 0 0 0 0
195 Folley Cateter no. 18 Pcs 10,440 0 0 0 0
196 Folley Cateter no. 20 Pcs 10,440 0 0 0 0
197 Handscoon No. 7 Pcs 7,683 0 0 0 0
198 Handscoon No. 7,5 Pcs 7,683 0 0 0 0
199 Handscoon No. 8 Pcs 7,683 0 0 0 0
200 Handscoon S Pcs 848 0 0 0 0
201 Handscoon M Pcs 848 0 0 0 0
202 Handscoon L Pcs 848 0 0 0 0
203 Infuset Anak Pcs 4,025 0 0 0 0
204 Infuset Dewasa Pcs 3,680 0 0 0 0
205 IV. Cateter no. 18 G Pcs 7,334 0 0 0 0
206 IV. Cateter no. 20 G Pcs 7,334 0 0 0 0
207 IV. Cateter no. 22 G Pcs 7,334 0 0 0 0
208 IV. Cateter no. 24 G Pcs 7,334 0 0 0 0
209 Kapas Berlemak 500 g Roll 21,532 0 0 0 0
210 Kapas Berlemak 250 g Roll 14,376 0 0 0 0
211 Kasa Hidrofil Steril 16 x 16 Pcs 9,350 0 0 0 0
212 Kasa Hidrofil Steril 4 x 5 cm Roll 334 0 0 0 0
213 Kasa Hidrofil Steril 4 x 10 cm Roll 668 0 0 0 0
214 Kasa Hidrofil Steril 4 x 15 cm Roll 2,415 0 0 0 0
215 Kasa Hidrofil Steril 38 x 60 cm Roll 60,720 0 0 0 0
216 Kasa Hidrofil Steril 40 x 80 cm Roll 120,750 0 0 0 0
217 Kasa Hidrofil Steril 16 x 16 cm Roll 7,570 0 0 0 0
218 Masker Pcs 1,077 0 0 0 0
219 Masker plus 3 ply earloop pcs 506 0 0 0 0
220 Masker plus earloop pcs 380 0 0 0 0
221 Pembalut Gips 6 inchi Roll 38,182 0 0 0 0
222 Plester 5 yard x 2 inchi Roll 23,630 0 0 0 0
223 Silk Benang bedah Sutra + Jarum bedah 2/0 Pcs 3,988 0 0 0 0
224 Silk Benang bedah Sutra + Jarum bedah 2/0 26 MM Pcs 15,240 0 0 0 0
225 Silk Benang bedah Sutra + Jarum bedah 3/0 Pcs 3,988 0 0 0 0
226 Silk Benang bedah Sutra + Jarum bedah 3/0 26 MM Pcs 14,856 0 0 0 0
227 Urine Bag Pcs 3,915 0 0 0 0
228 Wing needle no. 23 Pcs 5,193 0 0 0 0
229 Wing needle no. 25 Pcs 6,347 0 0 0 0
230 Wing needle no. 27 Pcs 6,347 0 0 0 0
OBAT GIGI 0 0 0 0
231 Albothil Concentrat btl 19,800 0 0 0 0
232 Devitalisasi Pasta Kotak 429,000 0 0 0 0
233 Etil Klorida Spray Botol 120,000 0 0 0 0
234 Eugenol Cairan Botol 18,333 0 0 0 0
235 Glas ionomer Cement ART Set 862,000 0 0 0 0
236 Kalcium Hidroksida Pasta Tube 276,298 0 0 0 0
237 Klorfenol Kamfer Menthol (CHKM) Botol 60,500 0 0 0 0
238 Mummifiying Pasta Botol 265,467 0 0 0 0
239 Polikresulen Cairan 10 ml Botol 31,200 0 0 0 0
240 Semen Seng Fospat serbuk + Cairan Set 156,200 0 0 0 0
241 Temportary Stopping Fletcher serbuk + Cairan Set 100,000 0 0 0 0

Ka.Bidang Jaminan dan Sarana Kesehatan

MAKBUL, SKM
NIP. 19780213 200604 1 011

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Kolaka Utara

ALIAS, SKM, M.Kes

NIP. 19690817 199501 1 002
OBAT EXPAIRED DATE

BULAN JUMLAH
TOTAL HARGA
5 6 7 8 9 10 11 12
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Lasusua, 2016
Pembuat Laporan

Yenni Heryani Syam,S.Farm

NIP. 19870213 201001 2 009

inas Kesehatan
n Kolaka Utara

0817 199501 1 002