PEMERINTAH PROVINSI SULAWESI TENGGA

BADAN LAYANAN UMUM DAERAH (BLUD

RUMAH SAKIT UMUM BAHTERAM
Jl. Pierre Tandean No. 50 Baruga-Kendari Telpon (0401) 31
KENDARI

LAMPIRAN BERITA ACARA OBAT RETUR

NO NAMA BARANG PABRIK SATUAN BATCH JUMLAH EXPIRE DATE

1 Vitamin B6 Kimia Farma box @100 tab C70175B 70 Feb-20
2 Vitamin B6 Kimia Farma box @100 tab B70111BB 6 Jan-20
3 Duragesic patch Janssen box @5 patch IBBOW00.A 2 Jan-20
4 Rifampicin 300 Indofarma box @100 kaps 1512047 3 Dec-19
5 Vancep Inj TL0153 box @2 vial TL0153 5 Dec-19
6 Spironolacton 100 Dexa Medica box @100 tab 49D0937 8 Mar-20
7 Diazepam Inj Mepro box @10 ampul F8G477 68 Jul-20
8 T. Tube 5 mm Rusch pcs 15191 37 Apr-20
9 T. Tube 4 mm Rusch pcs 15201 5 Apr-20
10 Catgut plain 1 BBraun box @ 1 roll F1144073 3 Oct-19
11 Catgut plain 0 BBraun box @ 1 roll F1144065 2 Oct-19
12 Catgut plain 2 BBraun box @ 24 pcs B0560596 1 Oct-19
13 Test Hamil Onemed Onemed box @100 strip 10121688 2 Nov-19
14 Wing Neddle 27 Terumo pcs 104987 2 Dec-19
15 Feeding tube 6 JMS pcs 805-0601 20 Dec-19
16 Asering Otsuka box @24 bag SB93E47A 26 May-20
17 Asering Otsuka box @24 bag 1 Jun-20
18
19

TOTAL H
ULAWESI TENGGARA
M DAERAH (BLUD)
M BAHTERAMAS
endari Telpon (0401) 3195611

OBAT RETUR

HARGA SATUAN JUMLAH HARGA KETERANGAN/ALASAN

TOTAL HARGA

Kendari, dd/mm/yy
Ka. Ruangan Farmasi Depo.......

Nama/nip