DAFTAR AMPRAHAN RENCANA KEBUTUHAN REAGEN TES / STIK TEST CEPAT

BOK DAK NON FISIK UPT. PUSKESMAS BENAO TAHUN 2018

Nama Puskesmas : UPT. Puskesmas Benao

Kecamatan : Lahei Barat
Kabupaten/Kota : Barito Utara

A. DAFTAR ALAT KESEHATAN & REAGEN / STIK TEST CEPAT

No. Nama Alat Harga (Rp) Kuantitas Satuan Nama Penyedia Jumlah (Rp)
1
FOKUS Anti HIV 1/2 Cassette 14,877 6 Box PT. Fokus Diagnostic Indonesia 89,262
2
FOKUS Anti Malaria Pan/Pf Cassette 46,897 15 Box PT. Fokus Diagnostic Indonesia 703,455
3
FOKUS Anti Malaria Pf & Pv Cassette 52,760 15 Box PT. Fokus Diagnostic Indonesia 791,400
4
FOKUS HBsAG Strip 10,547 7 Box PT. Fokus Diagnostic Indonesia 73,829
5
UJI Dengue IgG/IgM 39,915 16 Box PT. Pakar Biomedika Indonesa 638,640
6
HUMAN HUMASENS Plus Glucose Test Strips 249,800 7 Box PT. Rajawali Nusindo 1,748,600
7
HUMAN HUMASENS Plus Total Cholesterol Test Strips 541,900 7 Box PT. Rajawali Nusindo 3,793,300
8
HUMAN HUMASENS Plus Uric Acid Test Strips 548,300 7 Box PT. Rajawali Nusindo 3,838,100
9 LORNE Laboratories Anti-B Monoclonal Gol. Darah
(Vial 10 ml) 68,200 6 Vial PT. Rafa Topaz Utama 409,200
10 LORNE Laboratories Anti-A, B Monoclonal Gol. Darah
(Vial 10 ml) 92,510 5 Vial PT. Rafa Topaz Utama 462,550
11 LORNE Laboratories Anti-D Duoclonal Gol. Darah (Vial
10 ml) 114,070 5 Vial PT. Rafa Topaz Utama 570,350
12 GENERAL LIFE BIOTECHNOLOGY CO. LTD
231,000 5 Box PT. Mitra Asa Pratama 1,155,000
BeneCheck Plus Total Cholesterol Test Strip 10'
13 GENERAL LIFE BIOTECHNOLOGY CO. LTD
126,500 5 Box PT. Mitra Asa Pratama 632,500
BeneCheck Plus Uric Acid Test Strip 25'
14 GENERAL LIFE BIOTECHNOLOGY CO. LTD 149,600 5 Box PT. Mitra Asa Pratama
BeneCheck Plus Glucose Test Strip 25' 748,000
15 LORNE Laboratories Salmonella Typhi H Widal Test
(Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
16 LORNE Laboratories Salmonella Typhi O Widal Test
(Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
17 LORNE Laboratories Salmonella ParaTyphi AO Widal
Test (Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
18 LORNE Laboratories Salmonella ParaTyphi BO Widal
Test (Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
19 LORNE Laboratories Salmonella ParaTyphi CO Widal
Test (Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
20 LORNE Laboratories Salmonella ParaTyphi BH Widal
Test (Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300
21 LORNE Laboratories Salmonella ParaTyphi CH Widal
Test (Vial 5 ml) 66,660 5 Vial PT. Rafa Topaz Utama 333,300

22 ACON Hb Haemoglobin Strip 50 Test Mission 400,000 5 Box PT. Mitra Bahagia Citra Medika 2,000,000

TOTAL 19,987,286

Mengetahui, Benao Hulu, Oktober 2018

Kepala UPT Puskesmas Benao Pengelola Keuangan BOK UPT Puskesmas Benao

Usman Alipandi, S.Sos Halim Pranata, SKM

NIP. 19620615 198803 1 011 NIP. 19910815 201503 1 008

Tanda Terima :
Nama :
Jabatan :
Tanggal :
Tanda Tangan :

(......................................................)
 PEMERINTAH KABUPATEN BARITO UTARA
DINAS KESEHATAN
PUSKESMAS KANDUI KEC.GUNUNG TIMA
Jln A. Yani No.175 RT.04 Desa Kandui Kecamatan Gunung Timang Kode Pos. 7386

DAFTAR AMPRAHAN RENCANA KEBUTUHAN REAGEN TES / STI

BOK DAK NON FISIK PUSKESMAS KANDUI TAHUN 2

Nama Puskesmas : PUSKESMAS KANDUI

Kecamatan : GUNUNG TIMANG
Kabupaten/Kota : BARITO UTARA

A. DAFTAR ALAT KESEHATAN & REAGEN / STIK TEST CEPAT

No. Nama Alat Harga (Rp) Kuantitas Satuan

1 FOKUS Anti HIV 1/2 Cassette 14,877 10 Box

2 FOKUS Anti Malaria Pan/Pf Cassette 46,897 10 Box

3 FOKUS Anti Malaria Pf & Pv Cassette 52,760 10 Box

4 FOKUS HBsAG Strip 10,547 10 Box

5 UJI Dengue IgG/IgM 39,915 10 Box

9 LORNE Laboratories Anti-B Monoclonal Gol. Darah (Vial 10 ml) 68,200 5 Vial

10 LORNE Laboratories Anti-A, B Monoclonal Gol. Darah (Vial 10 ml) 92,510 7 Vial

11 LORNE Laboratories Anti-D Duoclonal Gol. Darah (Vial 10 ml) 114,070 5 Vial
GENERAL LIFE BIOTECHNOLOGY CO. LTD BeneCheck Plus Total
12 231,000 60 Box
Cholesterol Test Strip 10'
GENERAL LIFE BIOTECHNOLOGY CO. LTD BeneCheck Plus Uric
13 126,500 50 Box
Acid Test Strip 25'
GENERAL LIFE BIOTECHNOLOGY CO. LTD BeneCheck Plus Glucose
14 149,600 50 Box
Test Strip 25'
15 LORNE Laboratories Salmonella Typhi H Widal Test (Vial 5 ml) 66,660 10 Vial

16 LORNE Laboratories Salmonella Typhi O Widal Test (Vial 5 ml) 66,660 10 Vial

17 LORNE Laboratories Salmonella ParaTyphi AO Widal Test (Vial 5 ml) 66,660 10 Vial

18 LORNE Laboratories Salmonella ParaTyphi BO Widal Test (Vial 5 ml) 66,660 10 Vial

19 LORNE Laboratories Salmonella ParaTyphi CO Widal Test (Vial 5 ml) 66,660 10 Vial

20 LORNE Laboratories Salmonella ParaTyphi BH Widal Test (Vial 5 ml) 66,660 10 Vial

21 LORNE Laboratories Salmonella ParaTyphi CH Widal Test (Vial 5 ml) 66,660 10 Vial

22 ACON Hb Haemoglobin Strip 50 Test Mission 400,000 11 Box

No. Nama Alat Harga (Rp) Kuantitas Satuan

TOTAL

Mengetahui,
Kepala Puskesmas Benao

FRIT TARONG, SKM

NIP. 19750527 199603 1 006

Tanda Terima :
Nama :
Jabatan :
Tanggal :
Tanda Tangan :

(......................................................)
ARITO UTARA
N
UNUNG TIMANG
ng Timang Kode Pos. 73862

EAGEN TES / STIK TEST CEPAT

ANDUI TAHUN 2019

Nama Penyedia Jumlah (Rp)

PT. Fokus Diagnostic Indonesia 148,770

PT. Fokus Diagnostic Indonesia 468,970

PT. Fokus Diagnostic Indonesia 527,600

PT. Fokus Diagnostic Indonesia 105,470

PT. Pakar Biomedika Indonesa 399,150

PT. Rafa Topaz Utama 341,000

PT. Rafa Topaz Utama 647,570

PT. Rafa Topaz Utama 570,350

PT. Mitra Asa Pratama 13,860,000

PT. Mitra Asa Pratama 6,325,000

PT. Mitra Asa Pratama 7,480,000

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Rafa Topaz Utama 666,600

PT. Mitra Bahagia Citra Medika 4,400,000

 Nama Penyedia Jumlah (Rp)

39,940,080

Kandui, Oktober 2019

Pengelola Keuangan BOK Puskesmas Kandui

TADIUS RENE Y.M, A.Md.AK

NIP. 19900716 201503 1 001
No. Nama Obat Generik Harga (Rp.) Nama Penyedia Urutan
2 Aminofilin inj 24 mg/ml 3.349 PT. Phapros Tbk 1
PT. Mersifarma Tirmaku
10 As. Mefenamat 500mg 117
Mercusana 1
As. Traneksamat inj.
11 2.999 PT. Dexa Medica
100mg/ml 1
PT. Mersifarma Tirmaku
15 Betahistin 6mg 177
Mercusana 1
17 Cendo Mydriatil 1% 36.47 PT. Cendo 1
Domperidon
19 3.3 PT. Novapharin
suspense/sirup 5mg/5ml 1

Dulcolax supp adult 10mg

22 5.8 PT. Boehringer Ingelheim
-Bisakodil supp 10mg
1
Dulcolax supp infant
23 5.67 PT. Boehringer Ingelheim
-Bisakodil supp 5mg 1
PT Kimia Farma (Persero)
28 Glimepiride tablet 2mg 296
Tbk 1
31 Isosorbid Dinitrat 5mg 96 PT. Yarindo Farmatama 1
Kloramfenikol susp
35 5.17 PT. Novapharin
125mg/5ml 1
49 Nifedipin 10mg 123 PT. Dexa Medica 1
Nistatin vaginal tablet
51 628 PT. Phapros Tbk
100.000 IU/g 1

54 Oxytocin inj 10 IU/ml 1.9 PT. Ethica Industri Farmasi

1

55 PCT drop 100mg/ml 6.24 PT. Indofarma (Persero) Tbk

1

57 Salbutamol sirup 5.7 PT. Indofarma (Persero) Tbk

1

62 Setrizin sirup 5mg/5ml 8.094 PT. Indofarma (Persero) Tbk

1
Sucralfate tablet 500mg / PT. Combined Imperial
65 470
5ml Pharmaceuticals 1

69 Zinc sirup 10mg/ml 16.478 PT. Indofarma (Persero) Tbk

1
Zinc Pro Drops – Zinc PT. Combined Imperial
71 12.1
elemental 10mg/ml Pharmaceuticals 1
12 Asiklovir 200mg 276 PT. Yarindo Farmatama
PT Kimia Farma (Persero)
13 Asiklovir 400mg 368
Tbk
BEROTEC MDI –
14 Fenoterol HBr aerosol 100 80 PT. Boehringer Ingelheim
mcg/dosis
16 Bisoprolol 5mg 425 PT. Dexa Medica
Deksametason inj. 5
18 1.83 PT. Bernofarm
mg/ml
20 Domperidon tablet 10mg 136 PT. Dexa Medica

21 Domperidon tetes 5mg/ml 18.719 PT. Bernofarm

Fitomenadion (Vit K1)

24 835 PT. Phapros Tbk
tablet 10mg
PT Kimia Farma (Persero)
25 Furosemid 40mg 86
Tbk
Generik INN – Ringer
26 7.15 PT. Widatra Bhakti
Laktat
Gentamisin tetes mata
27 4.8 PT. Erela
0,3%
Glukosa larutan infuse 5%
29 6.9 PT. Widatra Bhakti
steril
PT. Mersifarma Tirmaku
30 Haloperidol tablet 2mg 118
Mercusana

KA EN 3B – Larutan
Karbohidrat+elektrolit(Na
32 Cl) 1,75, KCL 1,5, Na 10.05 PT. Otsuka Indonesia
Laktat 2,24, Desktrosa
27gram

PT Kimia Farma (Persero)

33 Kalk 500mg 71
Tbk
34 Ketorolak inj. 30 mg/ml 1.45 PT. Phapros Tbk
Klorpromazin tablet salut PT. Mersifarma Tirmaku
36 181
100mg (HCl) Mercusana

37 Lansoprazole 30mg 341 PT. Soho Industri Pharmasi

PT. Ifars Pharmaceutical

38 Loperamid 2mg 97
Laboratories
39 Loratadin 10mg 159 PT. Bernofarm
40 MetforminHCl 500mg 119 PT. Dexa Medica
Metilprednisolon inj 125
41 15.09 PT. Phapros Tbk
mg/ml

42 Metilprednisolon 4mg 214 PT. Natura Laboratoria Prima

43 Metoklopramid 10mg 110 PT. Graha Farma

44 Metronidazol 500mg 143 PT. Erela
Metronidazole sirup
45 3.8 PT. Meprofarm
125mg/ml
46 NaCl 0,9% 6.41 PT. Widatra Bhakti
47 Nat Diklofenak 25mg 178 PT. Phapros Tbk
48 Nat Diklofenak 50mg 162 PT. Phapros Tbk
Nistatin tablet salut
50 895 PT. Phapros Tbk
500.000 IU/g

52 Ofloksasin tablet 400mg 663 PT. Indofarma (Persero) Tbk

Omeprazole inj PT. Otto Pharmaceutical

53 20.737
40mg/10ml Industries
Phitomenadion (Vit K) inj
56 4.28 PT. Phapros Tbk
i.m 2mg/ml
58 Salep 2-4 2.917 PT. Marin Liza Farmasi

Salep mata – Gentamisin

59 3 PT. Erela
salep mata 0,3%

60 Sefadroksil kaplet 500mg 557 PT. Holi Pharma

61 Setrizin kapsul 10mg 156 PT. Pertiwi Agung

Sianokobalamin (Vit B12)
63 1.283 PT. Lucas Djaja
inj 500 mcg
Stesolid-Diazepam larutan
64 12.749 PT. Actavis Indonesia
rectal 5mg/2,5ml
Vagizol-Metronidazol PT Kimia Farma (Persero)
66 4.92
Ovula 500mg Tbk

Ventolin Nebules-
67 4 PT. Glaxo Wellcome Indonesia
Salbutamol cairan ih 0,1%

68 Zinc Cair 20mg/5ml 6.6 PT. Interbat

Zinc tablet dispersible PT Kimia Farma (Persero)
70 618
20mg Tbk