Form Laporan Obat SubUnit

DINAS KESEHATAN KABUPATEN SUM
UPTD PUSKESMAS RAWAT INAP W

Jl. RAYA WADO
LAPORAN OBAT TERPADU
Nama SubUnit : polindes wado

Nomor :
Tanggal : 27 nov 2020
Bulan : November
Stok Awal Penambahan

No Nama Obat Satuan Harga Satuan
Jumlah Σ Harga Jumlah
1 2 3 4 5 6(5x4) 7
1 Acetyl Cysteine 200 mg Kapsul 382.00 -
2 Alat Suntik 0,05ml Buah 1,379.80 -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs 1,249.45 -
4 Alat Suntik Sekali Pakai 1 ml Pcs 1,034.88 -
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah 946.14 -
6 Alat Suntik Sekali Pakai 10 ml (Top Poin Buah 946.16 -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs 662.29 - - 30
8 Alat Suntik Sekali Pakai 20 ml Buah 1,525.12 -

9 Alat Suntik Sekali Pakai 3 ml Pcs 950.40 - 40
10 Alat Suntik Sekali Pakai 3 ml Pcs 662.00 -

12 Alat Suntik Sekali Pakai 5 ml Pcs 787.97 - 40
13 Albendazol 400 mg Tablet 430.00 -

14 Alkohol Swab ( PT. Bio Axion Healthind Sase 116.04 - 40
15 Alkohol Swab CHG + 0,5 % (e-care) Pcs 200.00 -

16 Alopurinol tablet 100 mg Tablet 99.00 100.00 9,900.00
17 Alopurinol tablet 300 mg Tablet 210.00 -
18 Ambroxol Sirup Botol 3,970.00 -
19 Ambroxol Tablet 30 mg Tablet 148.50 -
20 Aminofilin Inj 24 mg/ml-10 ml Ampul 2,789.00 -
21 Aminofilin Tablet 200 mg Tablet 89.00 -
22 Amitriptilina HCl tablet salut 25 mg Tablet 167.00 -
23 Amlodipin tablet 10 mg Tablet 99.00 -
25 Amoksilin 500 mg Kaplet 233.00 210.00 48,930.00 1,000
26 Amoksilin Kapsul 250 mg Kapsul 184.00 -

27 Amoksilin sirup kering 125 mg/5ml Botol 2,500.00 16.00 40,000.00 10
28 Amoksilin sirup kering 125 mg/5ml Botol 2,050.00 -

29 Amoksilin sirup kering forte 250 mg/5ml Botol 3,628.00 18.00 65,304.00 10
30 Ampisilin 1 gr inj Ampul 8,237.00 -

31 Ampisilin Kaplet 500 mg Kaplet 521,4 #VALUE!
32 Ampisilin Serbuk Injeksi Vial 8,237.00 -
33 Antalgin(Metampiron) Tablet 500 mg Tablet 268.00 140.00 37,520.00
34 Antalgin(Metampiron) Tablet 500 mg Tablet 268.07 -
35 Antasida DOEN I tablet kombinasi Tablet 54.00 1,540.00 83,160.00 500
36 Antasida DOEN II suspensi kombinasi Botol 1,995.00 -

37 Anti hemoroid suppositorida Supp 3,167.00 -
38 Antifungi DOEN kombinasi : Pot 4,496.00 -
39 Antimigren DOEN/Ergotamin kafein Tablet 173.00 -
40 Antiseptik Hand Rub 5 lt Galon 145,000.00 -
41 Antiseptik Hand Rub 500 ml Botol 60,800.00 -
42 Antiseptik Surgical Hand Scrub 5 lt Galon 160,200.00 -
43 Antiseptik Surgical Hand Scrub 500 ml Botol 74,000.00 -
44 Aqua Pro Injeksi steril bebas pirogen- 20 Ampul 2,295.00 -
45 Aquadest steril -500 ml Botol 25,949.00 -
46 Asam Askorbat (VIT C) Tablet 50 mg (K Tablet 105.00 430.00 45,150.00 300
47 Asam folat tablet 0,4 mg Tablet 55.00 70.00 3,850.00 100
48 Asam Mefenamat 500 mg Tablet 103.00 - - 300
49 Asering Botol 9,646.00 -

50 Asetosal tablet 80 mg Tablet 92.00 -
52 Asiklovir cr Tube 4,180.00 -
53 Asiklovir tab 200 mg Tablet 236.00 - 100
54 Asiklovir tab 400 mg Tablet 405.00 -

55 Atapulgit Tablet 136.00 -
56 Atorvastatin 10 mg Tablet 1,100.00 -
57 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 1,595.00 -
59 Azitromisin 500 mg Kaplet 1,888.00 -
60 Bedak Salisil serbuk 2 % Buah 2,585.00 - 10
61 Benzatin benzil penisilin 1,2 juta IU/Vial Vial 14,500.00 -

62 Betametason Krim 0.1 % Tube 1,430.00 7.00 10,010.00
63 Bisakodil Supp (Dulcolax) Supp 6,000.00 -
64 Bisturi no 10 Buah 767.00 -
65 Bloodseet Buah 11,550.00 -
66 Carpul (Articain & Adrenalin) Ampul 10,914.00 -
67 Catgut Chromic 2/0 100 m Roll 940,554.00 -
68 Catgut Chromic 2/0 75C + Jarum 1/2 30 Roll 61,800.00 -
69 Catgut Chromic 3/0 75C + Jarum 1/2 22 Roll 22,500.00 -
70 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll 30,500.00 -
71 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll 29,583.33 -
72 Catgut/Benang Bedah No.2/0-3/0 dg jaru Roll 24,500.00 -
73 Cefiksim 100 mg Kapsul 803.00 -
74 Cetirizine Kapsul 90.00 - 100
75 Citoject Pcs 909,900.00 -

76 Clorofenol (CHKM) Ples 115,700.00 -
77 Deksametason inj 5 mg/ml-1 ml Ampul 1,097.00 -
78 Deksametason Tablet 0,5 mg Tablet 77.00 - 200
79 Devitalisasi Pasta (Non arsen) Botol 385,000.00 -

80 Dextaco Tablet 394.00 -
81 Dextrofen Syrup 60 ml Botol 11,500.00 -
82 Difenhidramin inj 10 mg/ml Ampul 1,095.00 -
83 Digoksin tablet 0,25 mg Tablet 104.00 -
84 Dimenhidrinat tablet 50 mg Tablet 99.00 -
85 Doksisiklin 100 mg Kapsul 264.00 -
86 Domperidon Syrup Botol 2,700.00 8.00 21,600.00 10
87 Domperidon tablet 10 mg Tablet 85.00 -

88 Ekstrak Belladona tablet 10 mg Tablet 38.00 -
89 Eosin 2% 1x100 ml Botol 179,595.00 -
90 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 m Ampul 1,408.00 -
91 Eritromisin 250 mg Tablet 546.00 -
93 Eritromisin sirup kering 200 mg/5 ml Botol 6,090.00 -
94 Etambutol Hcl tablet 250 mg Tablet 366.00 -
95 Etambutol Hcl Tablet 500 mg Tablet 451.00 -
97 Etanol 70 %- 100 ml Botol 2,500.00 -
98 Etanol 70% - 1 L Botol 18,700.00 - 1
99 Etil Klorida semprot-100 ml Botol 124,900.00 -

100 Eugenol Cairan Botol 18,824.00 -
101 Female Catheter no 16 Pcs 5,720.00 -
103 Fenitoin Kapsul100 mg Kapsul 152.00 -
104 Fenoksimetil Penisilin tablet 250 mg Tablet 350.00 -
106 Fenol Gliserol Tetes telinga 10 % Botol 1,008.33 -
107 Film IV Dressing 6x7 P Pcs 2,200.00 -
108 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul 1,566.00 -
109 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 3,682.00 10.00 36,820.00 15
110 Fitomenadion(Vit K1) tablet salut gula 1 Tablet 710.00 -

111 Fluconazol 150 mg kapsul 18,720.00 -
112 Folley Cathether 2 way no 20 Pcs 8,000.00 -
113 Folley Cathether no 16 Pcs 10,340.00 -
116 Furosemid tablet 40 mg Tablet 77.00 -
117 Garam Oralit 200 ml air Sachet 257.00 46.00 11,822.00
118 Garam Oralit 200 ml air Sachet 274.00 -
119 Gentamisin Inj 40 mg/ml Vial 5,900.00 -
120 Gentamycin Salep Kulit Tube 3,550.00 -
121 Gentamycin Salep Mata Tube 2,675.00 3.00 8,025.00 8
122 Gentamycin Tetes Mata Tube 4,232.00 -

123 Gentian violet larutan 1 %-10 ml Botol 3,000.00 -
124 Glas Lonomer Cement Set 275,924.71 -
125 Glas Lonomer Cement Liquid Set 151,242.86 -
126 Glibenklamid tablet 5 mg Tablet 119.00 -
127 Glimepiride tablet 1 mg Tablet 174.00 -
128 Gliseril Gyayakolat tablet 100 mg Tablet 128,81 #VALUE!
129 Glukosa Larutan infus 10% steril-500 ml Botol 5,700.00 -
130 Glukosa Larutan infus 5% steril-500 ml Botol 7,363.00 3.00 22,089.00 2
131 Griseofulvin tablet 125 mg micronized Tablet 210.00 -
132 Haloperidol Injeksi (Lodomer) Ampul 6,250.00 -
134 Haloperidol tablet 0,5 mg Tablet 55.00 -
136 Haloperidol tablet 2 mg Tablet 84.00 -
138 Hansaplast 2,5 cm x 4,5 m Roll 11,334.00 -
140 Hemafort Tablet 834.00 -
141 Hidrogen Peroksida 3% (H2O2) Botol 23,931.00 -
142 Hidroklortiazid (HCT) tablet 25 mg Tablet 155.00 -
143 Hidrokortison krim 2,5 % Tube 2,475.00 4.00 9,900.00 15
144 Ibuprofen sirup 100 mg/5 ml Botol 2,365.00 -

145 Ibuprofen tablet 200 mg Tablet 105.00 -
146 Ibuprofen tablet 400 mg Tablet 330.00 - 100
147 Infusion set anak Set 6,150.00 -

149 Infusion set dewasa Set 2,880.00 4.00 11,520.00 10
150 Infusion Set Dewasa Set 5,887.00 -

151 Isoniazida ( INH ) tablet 100 mg Tablet 72.00 -
154 Isosorbit 5 mg Tablet 89.00 -
155 IV Cateter 18 Buah 11,110.00 - 20
156 IV Cateter 20 Buah 11,110.00 - 10
157 IV Cateter 22 Buah 11,110.00 -

158 IV Cateter 24 Buah 11,110.00 -
159 IV Cateter no 26 wings & port Buah 6,600.00 -
160 IV Cateter with injection port 26 G Buah 13,332.00 -
161 Jarum Citojek No 16 Pcs 2,093.00 -
162 Jarum Jahit kulit No.12 Pcs 2,283.33 -
163 Jarum Jahit Otot No.12 Pcs 2,283.33 -
164 Kalium Permanganat Pot 8,700.00 -
165 Kalsium Glukonat injeksi i.v 10 % Ampul 10,351.00 - 5
166 Kalsium Hidroksida Pasta Set 290,000.00 -

167 Kalsium laktat (Kalk) tablet 500 mg Tablet 59.00 - 1,000
168 Kapas pembalut/absorben 250 mg Buah 12,500.00 -

169 Kaptropil 12,5 mg Tablet 62.00 390.00 24,180.00 100
170 Kaptropil 25 mg Tablet 75.00 -

171 Karbamazepin tablet 200 mg Tablet 230.00 -
172 Karbogliserin Tetes Telinga Botol 2,590.00 10.00 25,900.00
173 Kasa hidrofil 36 m x 80 cm Roll 123,000.00 -
174 Kasa hidrofile 3 yard x 10 cm/2,7 yardx Buah 1,380.00 -
175 Kasa hidrofile 40 yard x 80 cm/36mx80c Roll 123,000.00 -
176 Kasa kompres 16x16 steril Buah 291,67 #VALUE!
177 Kasa pembalut hidrofil 4 m x 10 cm Roll 1,493.50 5.00 7,467.50
178 Ketokonazol 200 mg Tablet 270.00 -
179 Ketokonazol Krim 2% Tube 2,518.00 -
180 Klindamisin 150 mg Tablet 759.00 -
182 Kloramfenikol kapsul 250 mg Kapsul 310.00 -
184 Kloramfenikol salep kulit 2 % Tube 3,038.00 -
185 Kloramfenikol salep mata 1 % Tube 1,881.00 - 10
186 Kloramfenikol susp 125 ml Botol 5,015.00 -

187 Kloramfenikol tetes telinga 3 % Ples 11,044.00 -
188 Klorfenariamin maleat (CTM) tablet 4 m Tablet 22.00 150.00 3,300.00 300
189 Klorine Botol 24,000.00 -

190 Klorpromazin 100 MG Tablet 147.00 -
191 Klorpromazin 25 mg Tablet 148.00 -
192 Klorpromazin injeksi 5 mg/ml-2ml Ampul 1,050.00 -
193 Kotrimoksazol anak Tablet 76.00 -
194 Kotrimoksazol Susp Botol 2,052.00 19.00 38,988.00 5
195 Kotrimoksazol Tablet 480 mg Tablet 133.00 -

196 Leucoplast 2,50 cm x 4,5 m Roll 12,675.00 -
197 Leucoplast 7,50 cm x 4,5 m Roll 37,371.00 - 1
198 Lidocain compositum inj kombinasi Ampul 1,152.00 -

199 Lidocain Injeksi 2% Ampul 1,144.00 -
200 Lidocain Jeli 2% Syringe 41,600.00 6.00 249,600.00 20
201 Lidokain Spray Oral 10%(Xylocaine spra Botol 177,216.00 -

202 Lisol Botol 41,000.00 -
203 Lodecon Forte Tablet 1,110.00 -
204 Loratadine 10 mg Tablet 131.00 -
205 Magnesium Sulfat Inj 20% Vial 3,200.00 -
206 Magnesium Sulfat Inj 40% Ampul 3,796.00 -
207 Masker Karet Buah 314.00 -
209 Masker Tali Buah 762.00 -
210 Metformin Tablet 96.00 -
211 Metildopa 250 mg / Dopamet Tablet 946.00 -
212 Metilergometrin Maleat Inj Ampul 2,959.00 1.00 2,959.00 20
213 Metilergometrin Maleat tab Tablet 210.00 40.00 8,400.00 100
214 Metilprednisolone 4 mg Tablet 143.00 -

215 Metoklopramide Inj Ampul 3,960.00 - 10
216 Metoklopramide Inj Ampul 3,395.00 -

217 Metronidazol Syrup Botol 3,950.00 -
218 Metronidazol tablet 250 mg Tablet 89.00 230.00 20,470.00
220 Mikonazol krim 2% Tube 3,414.00 -
221 Mummying Pasta Botol 285,000.00 -
222 Nasal Oxygen, O2 cannula size L/adult Pcs 4,000.00 - 1
223 Nasal Oxygen, O2 cannula size M Pcs 5,082.00 -

224 Nasal Oxygen, O2 cannula size S/infant Pcs 5,500.00 - 2
225 Nasal Oxygen, O2 cannula size XS Pcs 6,930.00 -

226 Natrium Bikarbonat tablet 500 mg Tablet 66.00 -
227 Natrium Diklofenak Tablet 137.00 -
228 Natrium Klorida Lar.infus 0,9 % steril Botol 6,840.00 7.00 47,880.00 2
229 Natrium Tiroksin Tablet 3,100.00 -

230 Nifedipin 10 mg Tablet 104.00 -
231 Nistatin Suspensi 100.000 IU/ml Botol 13,500.00 -
232 Nistatin tablet vaginal 100.000 IU/g Tablet 560.00 - 20
233 Nistatin tablet vaginal 500.000 IU/g Tablet 640.00 -

234 Norit Tablet 250.00 -
235 OAT Sisipan/FDC Sisipan Paket 160,000.00 -
236 Obat antituberkolosis Kombipak Kat.I D Paket 316,635.00 -
237 Obat antituberkulosis anak/FDC Anak Paket 248,120.00 -
239 Obat antituberkulosis kategori 1/FDC 1 Paket 415,469.00 -
241 Obat antituberkulosis kategori 2/FDC 2 Paket 1,297,889.00 -
243 Obat Batuk Hitam (OBH) Cairan -100 ml Botol 2,800.00 -
244 OBH Nusantara Menthol Botol 9,647.00 -
245 OBH Plus Botol 10,600.00 -
246 Oksitetrasiklin HCl 1 % Salep mata Tube 2,500.00 - 10
247 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 Vial 7,700.00 -

248 Oksitetrasiklin HCl Salep Kulit 3 % Tube 4,884.00 -
249 Oksitoksin inj 10 IU/ml- 1 ml Ampul 1,785.00 -
251 Omeprazol Kapsul 139.00 -
252 Omeprazol Injeksi Vial 9,898.00 -
253 Papaverin tab Tablet 640.00 -
254 Paraformaldehid Tablet 660.00 -
255 Parasetamol drop Botol 6,649.00 -
256 Parasetamol sirup 120 mg / 5ml Botol 1,107.00 - 30
257 Parasetamol tablet 500 mg Tablet 53.00 - 1,000
258 Parasetamol tablet 100 mg Tablet 92.00 -

259 Pehakain Ampul 3,000.00 -
260 Permetrin Krim 5% (Scabimite) Tube 7,200.00 -
262 PGA 2 75 C + Jarum 1/2 40 M Pcs 58,333.33 -
263 Piralent Inj Ampul 7,240.00 -
264 Pirantel Pamoat 125 mg Tablet 269.00 -
265 Pirazinamid 500 mg Tablet 237.00 -
266 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 123.00 460.00 56,580.00
267 Piroxicam 10 mg Tablet 160.60 -
268 Plester 5 yard x 2 inch Roll 23,600.00 -
269 Plester 7,5 cm x 5 m Buah 30,000.00 -
270 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs 24,500.00 -
271 Povidon Iodiada 10 %-30 ml Botol 2,900.00 -
273 Povidon Iodiada 10 %-60 ml Botol 4,620.00 - 1
274 Prednison tablet 5 mg Tablet 73.00 -

275 Probenesid 500 mg Tablet 1,755.00 -
276 Propanolol HCl tablet 10 mg Tablet 60.00 -
278 Propiltiourasil tablet 100 mg Tablet 279.00 -
279 Ranitidin inj Ampul 1,155.00 -
280 Ranitidine 150 mg Tablet 112.00 220.00 24,640.00 100
281 Retinol (VIT A) Kapsul 100.000 IU Kapsul 288.00 -

283 Rifampisin kapsul 300 mg Kapsul 725.00 -
285 Ringer Laktat Larutan Infus Steril Botol 7,150.00 - 30
286 Rivanol 300 ml Botol 3,400.00 -

287 Salbutamol tablet 2 mg Tablet 63.00 -
288 Salep 2-4 kombinasi : as.asal 2 % + Bel. Pot 2,621.00 3.00 7,863.00 10
289 Salisil Spiritus Botol 32,299.00 -

290 Sarung Tangan non steril no 6,5 Pasang 7,700.00 -
291 Sarung Tangan non steril no 7 Pasang 8,701.00 -
292 Sarung Tangan non steril no 7,5 Pasang 8,701.00 - 10
293 Sarung Tangan Obgyn steril Pasang 19,360.00 -

294 Sarung tangan steril no 6,5 Pasang 7,865.00 -
295 Sarung tangan steril no 7 Pasang 8,987.00 -
297 Scandonest Ampul 13,612.00 -
298 Seledril Tablet Tablet 823.33 -
299 Semen Seng Fosfat Serbuk Cairan Set 238,200.00 -
300 Semillas non Woven Medical Tape Pcs 21,753.00 -
301 Sepadroxil 500 mg Tablet 478.00 -
302 Sepadroxil Syrup Kering 125 mg/5 ml Botol 4,185.00 -
303 Serum anti tetanus (ATS) / Biosat Ampul 130,999.00 -
304 Serum anti tetanus (ATS) / Tetagam Ampul 176,800.00 -
305 Serum antibisa ular Polivalen inj 5 ml ( Ampul 512,204.00 -
306 Silk 2/0 75 C + Jarum 1/2 30M R Sase 20,833.33 -
308 Silk 3/0 75 C + Jarum 3/8 26M C Sase 37,100.00 -
309 Silk Black 2/0 DS 24 MM Sase 23,300.00 -
310 Silk Black 2/0 HR 26 MM Sase 20,300.00 -
313 Silk Black PFM 2/0 100 m Roll 425,066.00 -
314 Simvastatin tablet 10 mg Tablet 110.00 -
316 Siprofloksasin 500 mg Tablet 500.00 -
318 Softanol antimicrobial 500 ml Botol 55,000.00 -
319 Softanol antimicrobial galon 5 liter Galon 550,000.00 -
321 Solacort krim /Armacort Tube 8,200.00 -
322 Solafluz Botol 13,700.00 -
323 Soldextam Tablet 566.00 -
324 Solvitral Tablet 913.00 -
325 Spironolakton 25 mg Tablet 208.00 -
326 Streptomisin Inj Vial 5,200.00 -
327 Sulfasetamid Natrium Tetes mata 15 % Ples 15,180.00 -
328 Tablet Tambah darah kombinasi : Besi II Tablet 353.00 -
329 Tablet Tambah darah kombinasi : Besi II Tablet 350.00 - 990
330 Temporary Filling Material (Fermin) Botol 250,900.00 -

331 Temporary Stopping Fletcher serbuk &ca Set 37,000.00 -
332 Tetrakain HCl tetes mata 0,5 % Botol 11,500.00 -
333 Tetrasiklin Kapsul 250 mg Kapsul 166.00 -
335 Tiamin HCL (Vit B1) tablet 50 mg Tablet 85.00 180 15,300.00 300
336 Transfusion Set Set 7,860.00 -
337 Triheksifenidil HCl tablet 2 mg Tablet 85.00 -
338 Trikesol Formalin (TKF) Botol 110,000.00 -
340 Truvit Syr Botol 12,221.00 5 61,105.00
341 Umbilical cord klem steril Pcs 1,000.00 -
342 Urine Bag Pcs 4,202.00 3 12,606.00
343 Ventolin nebules Nebule 4,000.00 -
344 Viorex no rinse antimicrobial Galon 649,990.00 -
345 Viorex no rinse antimicrobial Botol 65,340.00 -
346 Vitamin B 12 Injeksi Ampul 520.00 -
347 Vitamin B 12 tab Tablet 46.00 320 14,720.00 100
348 Vitamin B Kompleks tablet Tablet 89.00 -
349 Widabest Botol 10,293.00 - 10
350 Wing Nedle no 25 Tablet 5,749.00 -
351 transfusion Set Tablet 524.00 - 15
352 Zink Tablet 508.00 120 60,960.00
-
OBAT PREKURSOR DAN PSIKOTROPIKA -
1 Diazepam inj 5 mg/ml-2 ml Ampul 1,735.00 -
2 Diazepam tablet 2 mg Tablet 86.00 -
4 Fenobarbital inj 50 mg/ml-2ml Ampul 1,300.00 -
5 Fenobarbital tablet 30 mg Tablet 165.00 -
6 Stesolid (Diazepam Rectal) Tube 12,573.00 -
Total (Rp) ### Total (Rp)

Cat : Format/nama-nama obat jangan dirubah, Bila ada obat-obat yang tidak ada di format (obat lama) mohon d
MENGETAHUI
KEPALA UPTD PUSKESMAS WADO PETUGAS OBAT PUSKESMAS
dr. Eka. Damayanti
NIP. 197509122005012008 Apt. Nurelawati, S.Si
NIP. 19841109 201903 2 006
SEHATAN KABUPATEN SUMEDANG
USKESMAS RAWAT INAP WADO
Jl. RAYA WADO
APORAN OBAT TERPADU
Penambahan Persediaan Pengeluaran ED Sisa Stok

Ket
Σ Harga Jumlah Σ Harga Jumlah Σ Harga Jumlah Σ Harga Jumlah Σ Harga
8(7x4) 9(5+7) 10(9x4) 11 12(11x4) 13 14(13x4) 15 16(15x4)
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
19,868.70 30.00 19,868.70 - - - 30 19,868.70
- - - - - - -
38,016.00 40.00 38,016.00 - - - 40 38,016.00
- - - - - - -
- - - - - - -
31,518.80 40.00 31,518.80 - - - 40 31,518.80
- - - - - - -
4,641.60 40.00 4,641.60 - - - 40 4,641.60
- - - - - - -
- 100.00 9,900.00 - - - 100 9,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
233,000.00 1,210.00 281,930.00 210 48,930.00 - 1,000 233,000.00
- - - - - - -
25,000.00 26.00 65,000.00 4 10,000.00 - 22 55,000.00
- - - - - - -
36,280.00 28.00 101,584.00 - - - 28 101,584.00
- - - - - - -
#VALUE! - #VALUE! - #VALUE! #VALUE! #VALUE!
- - - - - - -
- 140.00 37,520.00 140 37,520.00 - -
- - - - - - -
27,000.00 2,040.00 110,160.00 220 11,880.00 - 1,820 98,280.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
31,500.00 730.00 76,650.00 100 10,500.00 - 630 66,150.00
5,500.00 170.00 9,350.00 - - - 170 9,350.00
30,900.00 300.00 30,900.00 - - - 300 30,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
23,600.00 100.00 23,600.00 - - - 100 23,600.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
25,850.00 10.00 25,850.00 - - - 10 25,850.00
- - - - - - -
- 7.00 10,010.00 - - - 7 10,010.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
9,000.00 100.00 9,000.00 - - - 100 9,000.00
- - - - - - -
- - - - - - -
- - - - - - -
15,400.00 200.00 15,400.00 - - - 200 15,400.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
27,000.00 18.00 48,600.00 1 2,700.00 - 17 45,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
18,700.00 1.00 18,700.00 - - - 1 18,700.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
55,230.00 25.00 92,050.00 3 11,046.00 - 22 81,004.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 46.00 11,822.00 - - - 46 11,822.00
- - - - - - -
- - - - - - -
- - - - - - -
21,400.00 11.00 29,425.00 2 5,350.00 - 9 24,075.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
14,726.00 5.00 36,815.00 - - - 5 36,815.00

- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
37,125.00 19.00 47,025.00 5 12,375.00 - 14 34,650.00
- - - - - - -
- - - - - - -
33,000.00 100.00 33,000.00 - - - 100 33,000.00
- - - - - - -
- - - - - - -
28,800.00 14.00 40,320.00 4 11,520.00 - 10 28,800.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
222,200.00 20.00 222,200.00 - - - 20 222,200.00
111,100.00 10.00 111,100.00 - - - 10 111,100.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
51,755.00 5.00 51,755.00 - - - 5 51,755.00
- - - - - - -
59,000.00 1,000.00 59,000.00 - - - 1,000 59,000.00
- - - - - - -
6,200.00 490.00 30,380.00 110 6,820.00 - 380 23,560.00
- - - - - - -
- - - - - - -
- 10.00 25,900.00 - - - 10 25,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 7,467.50 - - - 5 7,467.50
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
18,810.00 10.00 18,810.00 - - - 10 18,810.00
- - - - - - -
- - - - - - -
6,600.00 450.00 9,900.00 160 3,520.00 - 300 6,600.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
10,260.00 24.00 49,248.00 2 4,104.00 - 22 45,144.00
- - - - - - -
- - - - - - -
37,371.00 1.00 37,371.00 - - - 1 37,371.00
- - - - - - -
- - - - - - -
832,000.00 26.00 1,081,600.00 6 249,600.00 - 20 832,000.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
59,180.00 21.00 62,139.00 1 2,959.00 - 20 59,180.00
21,000.00 140.00 29,400.00 40 8,400.00 - 100 21,000.00
- - - - - - -
39,600.00 10.00 39,600.00 - - - 10 39,600.00
- - - - - - -
- - - - - - -
- 230.00 20,470.00 20 1,780.00 - 210 18,690.00
- 130.00 16,120.00 20 2,480.00 - 110 13,640.00
- - - - - - -
- - - - - - -
4,000.00 1.00 4,000.00 - - - 1 4,000.00
- - - - - - -
11,000.00 2.00 11,000.00 - - - 2 11,000.00
- - - - - - -
- - - - - - -
- - - - - - -
13,680.00 9.00 61,560.00 - - - 9 61,560.00
- - - - - - -
- - - - - - -
- - - - - - -
11,200.00 20.00 11,200.00 - - - 20 11,200.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
25,000.00 10.00 25,000.00 - - - 10 25,000.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
33,210.00 30.00 33,210.00 - - - 30 33,210.00
53,000.00 1,000.00 53,000.00 - - - 1,000 53,000.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 460.00 56,580.00 10 1,230.00 - 450 55,350.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
4,620.00 1.00 4,620.00 1 4,620.00 - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
11,200.00 320.00 35,840.00 30 3,360.00 - 190 21,280.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
214,500.00 30.00 214,500.00 5 35,750.00 - 25 178,750.00
- - - - - - -
- - - - - - -
26,210.00 13.00 34,073.00 5 13,105.00 - 8 20,968.00
- - - - - - -
- - - - - - -
- - - - - - -
87,010.00 10.00 87,010.00 4 34,804.00 - 6 52,206.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
346,500.00 990.00 346,500.00 - - - 990 346,500.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
25,500.00 480.00 40,800.00 120 10,200.00 - 360 30,600.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 61,105.00 - - - 5 61,105.00
- - - - - - -
- 3.00 12,606.00 - - - 3 12,606.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
4,600.00 420.00 19,320.00 80 3,680.00 - 340 15,640.00
- - - - - - -
102,930.00 10.00 102,930.00 - - - 10 102,930.00
- - - - - - -
7,860.00 15.00 7,860.00 - - - 15 7,860.00
- 120.00 60,960.00 30 15,240.00 - 90 45,720.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
### Total (Rp) ### Total (Rp) 563,473.00 Total (Rp) - Total (Rp) 3,840,338
format (obat lama) mohon dimasukan di kolom paling bawah sesudah nomor 352 (Zink)
S OBAT PUSKESMAS PETUGAS OBAT POL/PP

. Nurelawati, S.Si Yuli yulianti yuniar,Amd.Keb
841109 201903 2 006 NIP.
DINAS KESEHATAN KABUPATEN SU
UPTD PUSKESMAS RAWAT INAP
Jl. RAYA WADO
LAPORAN OBAT TERPADU
Nama SubUnit : polindes wado

Nomor :
Tanggal : 27 nov 2020
Bulan : November
Stok Awal Penambahan

No Nama Obat Satuan Harga Satuan
Jumlah Σ Harga Jumlah
1 2 3 4 5 6(5x4) 7
1 Acetyl Cysteine 200 mg Kapsul 382.00 -
2 Alat Suntik 0,05ml Buah 1,379.80 -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs 1,249.45 -
4 Alat Suntik Sekali Pakai 1 ml Pcs 1,034.88 -
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah 946.14 -
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah 946.16 -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs 662.29 30.00 19,868.70 -
8 Alat Suntik Sekali Pakai 20 ml Buah 1,525.12 -

9 Alat Suntik Sekali Pakai 3 ml Pcs 950.40 40.00 38,016.00 -

12 Alat Suntik Sekali Pakai 5 ml Pcs 787.97 40.00 31,518.80 -
13 Albendazol 400 mg Tablet 430.00 -

14 Alkohol Swab ( PT. Bio Axion Healthindo) Sase 116.04 40.00 4,641.60 -
15 Alkohol Swab CHG + 0,5 % (e-care) Pcs 200.00 -

16 Alopurinol tablet 100 mg Tablet 99.00 100.00 9,900.00
17 Alopurinol tablet 300 mg Tablet 210.00 -
18 Ambroxol Sirup Botol 3,970.00 -
19 Ambroxol Tablet 30 mg Tablet 148.50 -
20 Aminofilin Inj 24 mg/ml-10 ml Ampul 2,789.00 -
21 Aminofilin Tablet 200 mg Tablet 89.00 -
22 Amitriptilina HCl tablet salut 25 mg Tablet 167.00 -
25 Amoksilin 500 mg Kaplet 233.00 1,000.00 233,000.00 -
26 Amoksilin Kapsul 250 mg Kapsul 184.00 -

27 Amoksilin sirup kering 125 mg/5ml Botol 2,500.00 22.00 55,000.00 -
28 Amoksilin sirup kering 125 mg/5ml Botol 2,050.00 -

29 Amoksilin sirup kering forte 250 mg/5ml Botol 3,628.00 28.00 101,584.00 -
30 Ampisilin 1 gr inj Ampul 8,237.00 -

31 Ampisilin Kaplet 500 mg Kaplet 521,4 #VALUE!
32 Ampisilin Serbuk Injeksi Vial 8,237.00 -
33 Antalgin(Metampiron) Tablet 500 mg Tablet 268.00 140.00 37,520.00
34 Antalgin(Metampiron) Tablet 500 mg Tablet 268.07 -
35 Antasida DOEN I tablet kombinasi Tablet 54.00 1,820.00 98,280.00 -
36 Antasida DOEN II suspensi kombinasi Botol 1,995.00 -

37 Anti hemoroid suppositorida Supp 3,167.00 -
38 Antifungi DOEN kombinasi : Pot 4,496.00 -
39 Antimigren DOEN/Ergotamin kafein Tablet 173.00 -
40 Antiseptik Hand Rub 5 lt Galon 145,000.00 -
41 Antiseptik Hand Rub 500 ml Botol 60,800.00 -
42 Antiseptik Surgical Hand Scrub 5 lt Galon 160,200.00 -
43 Antiseptik Surgical Hand Scrub 500 ml Botol 74,000.00 -
44 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul 2,295.00 -
45 Aquadest steril -500 ml Botol 25,949.00 -
46 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 105.00 630.00 66,150.00 -
47 Asam folat tablet 0,4 mg Tablet 55.00 170.00 9,350.00 -
48 Asam Mefenamat 500 mg Tablet 103.00 300.00 30,900.00 -
49 Asering Botol 9,646.00 -

52 Asiklovir cr Tube 4,180.00 -
53 Asiklovir tab 200 mg Tablet 236.00 100.00 23,600.00 -
54 Asiklovir tab 400 mg Tablet 405.00 -

55 Atapulgit Tablet 136.00 -
56 Atorvastatin 10 mg Tablet 1,100.00 -
59 Azitromisin 500 mg Kaplet 1,888.00 -
60 Bedak Salisil serbuk 2 % Buah 2,585.00 10.00 25,850.00 -
61 Benzatin benzil penisilin 1,2 juta IU/Vial Vial 14,500.00 -

62 Betametason Krim 0.1 % Tube 1,430.00 7.00 10,010.00
63 Bisakodil Supp (Dulcolax) Supp 6,000.00 -
64 Bisturi no 10 Buah 767.00 -
65 Bloodseet Buah 11,550.00 -
66 Carpul (Articain & Adrenalin) Ampul 10,914.00 -
67 Catgut Chromic 2/0 100 m Roll 940,554.00 -
68 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Roll 61,800.00 -
69 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll 22,500.00 -
70 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll 30,500.00 -
71 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll 29,583.33 -
72 Catgut/Benang Bedah No.2/0-3/0 dg jarum Roll 24,500.00 -
73 Cefiksim 100 mg Kapsul 803.00 -
74 Cetirizine Kapsul 90.00 100.00 9,000.00 -
75 Citoject Pcs 909,900.00 -

76 Clorofenol (CHKM) Ples 115,700.00 -
77 Deksametason inj 5 mg/ml-1 ml Ampul 1,097.00 -
78 Deksametason Tablet 0,5 mg Tablet 77.00 200.00 15,400.00 -
79 Devitalisasi Pasta (Non arsen) Botol 385,000.00 -

80 Dextaco Tablet 394.00 -
81 Dextrofen Syrup 60 ml Botol 11,500.00 -
82 Difenhidramin inj 10 mg/ml Ampul 1,095.00 -
83 Digoksin tablet 0,25 mg Tablet 104.00 -
84 Dimenhidrinat tablet 50 mg Tablet 99.00 -
85 Doksisiklin 100 mg Kapsul 264.00 -
86 Domperidon Syrup Botol 2,700.00 17.00 45,900.00 -
87 Domperidon tablet 10 mg Tablet 85.00 -

88 Ekstrak Belladona tablet 10 mg Tablet 38.00 -
89 Eosin 2% 1x100 ml Botol 179,595.00 -
90 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/m Ampul 1,408.00 -
93 Eritromisin sirup kering 200 mg/5 ml Botol 6,090.00 -
94 Etambutol Hcl tablet 250 mg Tablet 366.00 -
97 Etanol 70 %- 100 ml Botol 2,500.00 -
98 Etanol 70% - 1 L Botol 18,700.00 1.00 18,700.00 -
99 Etil Klorida semprot-100 ml Botol 124,900.00 -

100 Eugenol Cairan Botol 18,824.00 -
103 Fenitoin Kapsul100 mg Kapsul 152.00 -
106 Fenol Gliserol Tetes telinga 10 % Botol 1,008.33 -
107 Film IV Dressing 6x7 P Pcs 2,200.00 -
108 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul 1,566.00 -
109 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 3,682.00 22.00 81,004.00 -
110 Fitomenadion(Vit K1) tablet salut gula 10 m Tablet 710.00 -

111 Fluconazol 150 mg kapsul 18,720.00 -
112 Folley Cathether 2 way no 20 Pcs 8,000.00 -
116 Furosemid tablet 40 mg Tablet 77.00 -
117 Garam Oralit 200 ml air Sachet 257.00 46.00 11,822.00
118 Garam Oralit 200 ml air Sachet 274.00 -
119 Gentamisin Inj 40 mg/ml Vial 5,900.00 -
120 Gentamycin Salep Kulit Tube 3,550.00 -
121 Gentamycin Salep Mata Tube 2,675.00 9.00 24,075.00 -
122 Gentamycin Tetes Mata Tube 4,232.00 -

123 Gentian violet larutan 1 %-10 ml Botol 3,000.00 -
124 Glas Lonomer Cement Set 275,924.71 -
125 Glas Lonomer Cement Liquid Set 151,242.86 -
126 Glibenklamid tablet 5 mg Tablet 119.00 -
127 Glimepiride tablet 1 mg Tablet 174.00 -
128 Gliseril Gyayakolat tablet 100 mg Tablet 128,81 #VALUE!
129 Glukosa Larutan infus 10% steril-500 ml Botol 5,700.00 -
130 Glukosa Larutan infus 5% steril-500 ml Botol 7,363.00 5.00 36,815.00 -
131 Griseofulvin tablet 125 mg micronized Tablet 210.00 -
140 Hemafort Tablet 834.00 -
141 Hidrogen Peroksida 3% (H2O2) Botol 23,931.00 -
142 Hidroklortiazid (HCT) tablet 25 mg Tablet 155.00 -
143 Hidrokortison krim 2,5 % Tube 2,475.00 14.00 34,650.00 -
144 Ibuprofen sirup 100 mg/5 ml Botol 2,365.00 -

145 Ibuprofen tablet 200 mg Tablet 105.00 -
146 Ibuprofen tablet 400 mg Tablet 330.00 100.00 33,000.00 -

149 Infusion set dewasa Set 2,880.00 10.00 28,800.00 -
150 Infusion Set Dewasa Set 5,887.00 -

154 Isosorbit 5 mg Tablet 89.00 -
155 IV Cateter 18 Buah 11,110.00 20.00 222,200.00 -
156 IV Cateter 20 Buah 11,110.00 10.00 111,100.00 -
157 IV Cateter 22 Buah 11,110.00 -

158 IV Cateter 24 Buah 11,110.00 -
159 IV Cateter no 26 wings & port Buah 6,600.00 -
160 IV Cateter with injection port 26 G Buah 13,332.00 -
161 Jarum Citojek No 16 Pcs 2,093.00 -
162 Jarum Jahit kulit No.12 Pcs 2,283.33 -
163 Jarum Jahit Otot No.12 Pcs 2,283.33 -
164 Kalium Permanganat Pot 8,700.00 -
165 Kalsium Glukonat injeksi i.v 10 % Ampul 10,351.00 5.00 51,755.00 -
166 Kalsium Hidroksida Pasta Set 290,000.00 -

167 Kalsium laktat (Kalk) tablet 500 mg Tablet 59.00 1,000.00 59,000.00 -
168 Kapas pembalut/absorben 250 mg Buah 12,500.00 -

169 Kaptropil 12,5 mg Tablet 62.00 380.00 23,560.00 -
170 Kaptropil 25 mg Tablet 75.00 -

171 Karbamazepin tablet 200 mg Tablet 230.00 -
172 Karbogliserin Tetes Telinga Botol 2,590.00 10.00 25,900.00
173 Kasa hidrofil 36 m x 80 cm Roll 123,000.00 -
174 Kasa hidrofile 3 yard x 10 cm/2,7 yardx10c Buah 1,380.00 -
175 Kasa hidrofile 40 yard x 80 cm/36mx80cm Roll 123,000.00 -
176 Kasa kompres 16x16 steril Buah 291,67 #VALUE!
177 Kasa pembalut hidrofil 4 m x 10 cm Roll 1,493.50 5.00 7,467.50
178 Ketokonazol 200 mg Tablet 270.00 -
179 Ketokonazol Krim 2% Tube 2,518.00 -
184 Kloramfenikol salep kulit 2 % Tube 3,038.00 -
185 Kloramfenikol salep mata 1 % Tube 1,881.00 10.00 18,810.00 -
186 Kloramfenikol susp 125 ml Botol 5,015.00 -

187 Kloramfenikol tetes telinga 3 % Ples 11,044.00 -
188 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 22.00 300.00 6,600.00 -
189 Klorine Botol 24,000.00 -

190 Klorpromazin 100 MG Tablet 147.00 -
191 Klorpromazin 25 mg Tablet 148.00 -
192 Klorpromazin injeksi 5 mg/ml-2ml Ampul 1,050.00 -
193 Kotrimoksazol anak Tablet 76.00 -
194 Kotrimoksazol Susp Botol 2,052.00 22.00 45,144.00 -
195 Kotrimoksazol Tablet 480 mg Tablet 133.00 -

196 Leucoplast 2,50 cm x 4,5 m Roll 12,675.00 -
197 Leucoplast 7,50 cm x 4,5 m Roll 37,371.00 1.00 37,371.00 -
198 Lidocain compositum inj kombinasi Ampul 1,152.00 -

199 Lidocain Injeksi 2% Ampul 1,144.00 -
200 Lidocain Jeli 2% Syringe 41,600.00 20.00 832,000.00 -
201 Lidokain Spray Oral 10%(Xylocaine spray) Botol 177,216.00 -

202 Lisol Botol 41,000.00 -
203 Lodecon Forte Tablet 1,110.00 -
204 Loratadine 10 mg Tablet 131.00 -
205 Magnesium Sulfat Inj 20% Vial 3,200.00 -
206 Magnesium Sulfat Inj 40% Ampul 3,796.00 -
209 Masker Tali Buah 762.00 -
210 Metformin Tablet 96.00 -
211 Metildopa 250 mg / Dopamet Tablet 946.00 -
212 Metilergometrin Maleat Inj Ampul 2,959.00 20.00 59,180.00 -
213 Metilergometrin Maleat tab Tablet 210.00 100.00 21,000.00 -
214 Metilprednisolone 4 mg Tablet 143.00 -

215 Metoklopramide Inj Ampul 3,960.00 10.00 -
39,600.00
216 Metoklopramide Inj Ampul 3,395.00 -
217 Metronidazol Syrup Botol 3,950.00 -
220 Mikonazol krim 2% Tube 3,414.00 -
221 Mummying Pasta Botol 285,000.00 -
222 Nasal Oxygen, O2 cannula size L/adult Pcs 4,000.00 1.00 4,000.00 -
223 Nasal Oxygen, O2 cannula size M Pcs 5,082.00 -

224 Nasal Oxygen, O2 cannula size S/infant Pcs 5,500.00 2.00 11,000.00 -
225 Nasal Oxygen, O2 cannula size XS Pcs 6,930.00 -

226 Natrium Bikarbonat tablet 500 mg Tablet 66.00 -
227 Natrium Diklofenak Tablet 137.00 -
228 Natrium Klorida Lar.infus 0,9 % steril Botol 6,840.00 9.00 61,560.00 -
229 Natrium Tiroksin Tablet 3,100.00 -

230 Nifedipin 10 mg Tablet 104.00 -
231 Nistatin Suspensi 100.000 IU/ml Botol 13,500.00 -
232 Nistatin tablet vaginal 100.000 IU/g Tablet 560.00 20.00 11,200.00
233 Nistatin tablet vaginal 500.000 IU/g Tablet 640.00 -
234 Norit Tablet 250.00 -
235 OAT Sisipan/FDC Sisipan Paket 160,000.00 -
236 Obat antituberkolosis Kombipak Kat.I Dewa Paket 316,635.00 -
243 Obat Batuk Hitam (OBH) Cairan -100 ml Botol 2,800.00 -
244 OBH Nusantara Menthol Botol 9,647.00 -
245 OBH Plus Botol 10,600.00 -
246 Oksitetrasiklin HCl 1 % Salep mata Tube 2,500.00 10.00 25,000.00 -
247 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial 7,700.00 -

248 Oksitetrasiklin HCl Salep Kulit 3 % Tube 4,884.00 -
251 Omeprazol Kapsul 139.00 -
252 Omeprazol Injeksi Vial 9,898.00 -
253 Papaverin tab Tablet 640.00 -
254 Paraformaldehid Tablet 660.00 -
255 Parasetamol drop Botol 6,649.00 -
256 Parasetamol sirup 120 mg / 5ml Botol 1,107.00 30.00 33,210.00 -
257 Parasetamol tablet 500 mg Tablet 53.00 1,000.00 53,000.00 -
258 Parasetamol tablet 100 mg Tablet 92.00 -

259 Pehakain Ampul 3,000.00 -
262 PGA 2 75 C + Jarum 1/2 40 M Pcs 58,333.33 -
263 Piralent Inj Ampul 7,240.00 -
264 Pirantel Pamoat 125 mg Tablet 269.00 -
265 Pirazinamid 500 mg Tablet 237.00 -
266 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 123.00 450.00 55,350.00
267 Piroxicam 10 mg Tablet 160.60 -
268 Plester 5 yard x 2 inch Roll 23,600.00 -
269 Plester 7,5 cm x 5 m Buah 30,000.00 -
270 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs 24,500.00 -
273 Povidon Iodiada 10 %-60 ml Botol 4,620.00 - - -
274 Prednison tablet 5 mg Tablet 73.00 -

275 Probenesid 500 mg Tablet 1,755.00 -
278 Propiltiourasil tablet 100 mg Tablet 279.00 -
279 Ranitidin inj Ampul 1,155.00 -
280 Ranitidine 150 mg Tablet 112.00 190.00 21,280.00 -

285 Ringer Laktat Larutan Infus Steril Botol 7,150.00 25.00 178,750.00 -
286 Rivanol 300 ml Botol 3,400.00 -

287 Salbutamol tablet 2 mg Tablet 63.00 -
288 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 2,621.00 8.00 20,968.00 -
289 Salisil Spiritus Botol 32,299.00 -

290 Sarung Tangan non steril no 6,5 Pasang 7,700.00 -
291 Sarung Tangan non steril no 7 Pasang 8,701.00 -
292 Sarung Tangan non steril no 7,5 Pasang 8,701.00 6.00 52,206.00 -
293 Sarung Tangan Obgyn steril Pasang 19,360.00 -

295 Sarung tangan steril no 7 Pasang 8,987.00 -
297 Scandonest Ampul 13,612.00 -
298 Seledril Tablet Tablet 823.33 -
299 Semen Seng Fosfat Serbuk Cairan Set 238,200.00 -
300 Semillas non Woven Medical Tape Pcs 21,753.00 -
301 Sepadroxil 500 mg Tablet 478.00 -
302 Sepadroxil Syrup Kering 125 mg/5 ml Botol 4,185.00 -
303 Serum anti tetanus (ATS) / Biosat Ampul 130,999.00 -
304 Serum anti tetanus (ATS) / Tetagam Ampul 176,800.00 -
305 Serum antibisa ular Polivalen inj 5 ml (SAB Ampul 512,204.00 -
308 Silk 3/0 75 C + Jarum 3/8 26M C Sase 37,100.00 -
313 Silk Black PFM 2/0 100 m Roll 425,066.00 -
318 Softanol antimicrobial 500 ml Botol 55,000.00 -
321 Solacort krim /Armacort Tube 8,200.00 -
322 Solafluz Botol 13,700.00 -
323 Soldextam Tablet 566.00 -
324 Solvitral Tablet 913.00 -
325 Spironolakton 25 mg Tablet 208.00 -
326 Streptomisin Inj Vial 5,200.00 -
327 Sulfasetamid Natrium Tetes mata 15 % Ples 15,180.00 -
328 Tablet Tambah darah kombinasi : Besi II Su Tablet 353.00 -
329 Tablet Tambah darah kombinasi : Besi II Su Tablet 350.00 990 346,500.00 0
330 Temporary Filling Material (Fermin) Botol 250,900.00 -

331 Temporary Stopping Fletcher serbuk &caira Set 37,000.00 -
332 Tetrakain HCl tetes mata 0,5 % Botol 11,500.00 -
335 Tiamin HCL (Vit B1) tablet 50 mg Tablet 85.00 360 30,600.00 0
336 Transfusion Set Set 7,860.00 -
337 Triheksifenidil HCl tablet 2 mg Tablet 85.00 -
340 Truvit Syr Botol 12,221.00 5 61,105.00
341 Umbilical cord klem steril Pcs 1,000.00 -
342 Urine Bag Pcs 4,202.00 3 12,606.00
343 Ventolin nebules Nebule 4,000.00 -
344 Viorex no rinse antimicrobial Galon 649,990.00 -
345 Viorex no rinse antimicrobial Botol 65,340.00 -
346 Vitamin B 12 Injeksi Ampul 520.00 -
347 Vitamin B 12 tab Tablet 46.00 0 - 0
348 Vitamin B Kompleks tablet Tablet 89.00 340 30,260.00
349 Widabest Botol 10,293.00 10 102,930.00 0
350 Wing Nedle no 25 Tablet 5,749.00 -
351 transfusion Set Tablet 524.00 15 7,860.00 0
352 Zink Tablet 508.00 90 45,720.00
-
OBAT PREKURSOR DAN PSIKOTROPIKA -
1 Diazepam inj 5 mg/ml-2 ml Ampul 1,735.00 -
4 Fenobarbital inj 50 mg/ml-2ml Ampul 1,300.00 -
5 Fenobarbital tablet 30 mg Tablet 165.00 -
6 Stesolid (Diazepam Rectal) Tube 12,573.00 -
Total (Rp) ### Total (Rp)

Cat : Format/nama-nama obat jangan dirubah, Bila ada obat-obat yang tidak ada di format (obat lama) mohon d
MENGETAHUI
KEPALA UPTD PUSKESMAS WADO PETUGAS OBAT PUSKESMAS
dr. Eka. Damayanti
NIP. 197509122005012008 Apt. Nurelawati, S.Si
NIP. 19841109 201903 2 006
HATAN KABUPATEN SUMEDANG
KESMAS RAWAT INAP WADO
Jl. RAYA WADO
ORAN OBAT TERPADU
Penambahan Persediaan Pengeluaran ED Sisa Stok

Ket
Σ Harga Jumlah Σ Harga Jumlah Σ Harga Jumlah Σ Harga Jumlah Σ Harga
8(7x4) 9(5+7) 10(9x4) 11 12(11x4) 13 14(13x4) 15 16(15x4)
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 30.00 19,868.70 10 6,622.90 - 20 13,245.80
- - - - - - -
- 40.00 38,016.00 40 38,016.00 - - -
- - - - - - -
- - - - - - -
- 40.00 31,518.80 5 3,939.85 - 35 27,578.95
- - - - - - -
- 40.00 4,641.60 20 2,320.80 - 20 2,320.80
- - - - - - -
- 100.00 9,900.00 - - - 100 9,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 1,000.00 233,000.00 60 13,980.00 - 940 219,020.00
- - - - - - -
- 22.00 55,000.00 3 7,500.00 - 19 47,500.00
- - - - - - -
- 28.00 101,584.00 - - - 28 101,584.00
- - - - - - -
- - - - - - -
- 140.00 37,520.00 140 37,520.00 - -
- - - - - - -
- 1,820.00 98,280.00 - - - 1,820 98,280.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 630.00 66,150.00 50 5,250.00 - 580 60,900.00
- 170.00 9,350.00 - - - 170 9,350.00
- 300.00 30,900.00 - - - 300 30,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 100.00 23,600.00 - - - 100 23,600.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 10.00 25,850.00 - - - 10 25,850.00
- - - - - - -
- 7.00 10,010.00 - - - 7 10,010.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 100.00 9,000.00 - - - 100 9,000.00
- - - - - - -
- - - - - - -
- - - - - - -
- 200.00 15,400.00 20 1,540.00 - 180 13,860.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 17.00 45,900.00 - - - 17 45,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 1.00 18,700.00 1 18,700.00 - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 22.00 81,004.00 1 3,682.00 - 21 77,322.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 46.00 11,822.00 - - - 46 11,822.00
- - - - - - -
- - - - - - -
- - - - - - -
- 9.00 24,075.00 - - - 9 24,075.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 36,815.00 - - - 5 36,815.00

- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 14.00 34,650.00 1 2,475.00 - 13 32,175.00
- - - - - - -
- - - - - - -
- 100.00 33,000.00 - - - 100 33,000.00
- - - - - - -
- - - - - - -
- 10.00 28,800.00 1 2,880.00 - 9 25,920.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 20.00 222,200.00 - - - 20 222,200.00
- 10.00 111,100.00 2 22,220.00 - 8 88,880.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 51,755.00 - - - 5 51,755.00
- - - - - - -
- 1,000.00 59,000.00 80 4,720.00 - 920 54,280.00
- - - - - - -
- 380.00 23,560.00 10 620.00 - 370 22,940.00
- - - - - - -
- - - - - - -
- 10.00 25,900.00 - - - 10 25,900.00
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 7,467.50 - - - 5 7,467.50
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 10.00 18,810.00 - - - 10 18,810.00
- - - - - - -
- - - - - - -
- 300.00 6,600.00 20 440.00 - 280 6,160.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 22.00 45,144.00 - - - 22 45,144.00
- - - - - - -
- - - - - - -
- 1.00 37,371.00 1 37,371.00 - - -
- - - - - - -
- - - - - - -
- 20.00 832,000.00 1 41,600.00 - 19 790,400.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 20.00 59,180.00 1 2,959.00 - 19 56,221.00
- 100.00 21,000.00 - - - 100 21,000.00
- - - - - - -
- 10.00 39,600.00 - - - 10 39,600.00
- - - - - - -
- - - - - - -
- 210.00 18,690.00 10 890.00 - 200 17,800.00
- 110.00 13,640.00 - - - 110 13,640.00
- - - - - - -
- - - - - - -
- 1.00 4,000.00 1 4,000.00 - - -
- - - - - - -
- 2.00 11,000.00 - - - 2 11,000.00
- - - - - - -
- - - - - - -
- - - - - - -
- 9.00 61,560.00 - - - 9 61,560.00
- - - - - - -
- - - - - - -
- - - - - - -
- 20.00 11,200.00 - - - 20 11,200.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 10.00 25,000.00 1 2,500.00 - 9 22,500.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 30.00 33,210.00 - - - 30 33,210.00
- 1,000.00 53,000.00 70 3,710.00 - 930 49,290.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 450.00 55,350.00 - - - 450 55,350.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 190.00 21,280.00 - - - 190 21,280.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 25.00 178,750.00 2 14,300.00 - 23 164,450.00
- - - - - - -
- - - - - - -
- 8.00 20,968.00 1 2,621.00 - 7 18,347.00
- - - - - - -
- - - - - - -
- - - - - - -
- 6.00 52,206.00 6 52,206.00 - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 990.00 346,500.00 160 56,000.00 - 830 290,500.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 360.00 30,600.00 40 3,400.00 - 320 27,200.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- 5.00 61,105.00 - - - 5 61,105.00
- - - - - - -
- 3.00 12,606.00 - - - 3 12,606.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - 0 -
- 340.00 30,260.00 10 890.00 - 330 29,370.00
- 10.00 102,930.00 - - - 10 102,930.00
- - - - - - -
- 15.00 7,860.00 - - - 15 7,860.00
- 90.00 45,720.00 - - - 90 45,720.00
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- Total (Rp) ### Total (Rp) 394,873.55 Total (Rp) - Total (Rp) 3,497,604
mat (obat lama) mohon dimasukan di kolom paling bawah sesudah nomor 352 (Zink)
S OBAT PUSKESMAS PETUGAS OBAT POL/PP

. Nurelawati, S.Si Yuli yulianti yuniar,Amd.Keb
841109 201903 2 006 NIP.

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DINAS KESEHATAN KABUPATEN SUM

UPTD PUSKESMAS RAWAT INAP W

LAPORAN OBAT TERPADU

Nama SubUnit : polindes wado

Stok Awal Penambahan

8 Alat Suntik Sekali Pakai 20 ml Buah 1,525.12 -

10 Alat Suntik Sekali Pakai 3 ml Pcs 662.00 -

13 Albendazol 400 mg Tablet 430.00 -

15 Alkohol Swab CHG + 0,5 % (e-care) Pcs 200.00 -

26 Amoksilin Kapsul 250 mg Kapsul 184.00 -

28 Amoksilin sirup kering 125 mg/5ml Botol 2,050.00 -

30 Ampisilin 1 gr inj Ampul 8,237.00 -

36 Antasida DOEN II suspensi kombinasi Botol 1,995.00 -

47 Asam folat tablet 0,4 mg Tablet 55.00 70.00 3,850.00 100

48 Asam Mefenamat 500 mg Tablet 103.00 - - 300

49 Asering Botol 9,646.00 -

54 Asiklovir tab 400 mg Tablet 405.00 -

61 Benzatin benzil penisilin 1,2 juta IU/Vial Vial 14,500.00 -

75 Citoject Pcs 909,900.00 -

79 Devitalisasi Pasta (Non arsen) Botol 385,000.00 -

87 Domperidon tablet 10 mg Tablet 85.00 -

99 Etil Klorida semprot-100 ml Botol 124,900.00 -

110 Fitomenadion(Vit K1) tablet salut gula 1 Tablet 710.00 -

122 Gentamycin Tetes Mata Tube 4,232.00 -

144 Ibuprofen sirup 100 mg/5 ml Botol 2,365.00 -

147 Infusion set anak Set 6,150.00 -

150 Infusion Set Dewasa Set 5,887.00 -

156 IV Cateter 20 Buah 11,110.00 - 10

157 IV Cateter 22 Buah 11,110.00 -

166 Kalsium Hidroksida Pasta Set 290,000.00 -

168 Kapas pembalut/absorben 250 mg Buah 12,500.00 -

170 Kaptropil 25 mg Tablet 75.00 -

186 Kloramfenikol susp 125 ml Botol 5,015.00 -

189 Klorine Botol 24,000.00 -

195 Kotrimoksazol Tablet 480 mg Tablet 133.00 -

198 Lidocain compositum inj kombinasi Ampul 1,152.00 -

201 Lidokain Spray Oral 10%(Xylocaine spra Botol 177,216.00 -

213 Metilergometrin Maleat tab Tablet 210.00 40.00 8,400.00 100

214 Metilprednisolone 4 mg Tablet 143.00 -

216 Metoklopramide Inj Ampul 3,395.00 -

223 Nasal Oxygen, O2 cannula size M Pcs 5,082.00 -

225 Nasal Oxygen, O2 cannula size XS Pcs 6,930.00 -

229 Natrium Tiroksin Tablet 3,100.00 -

233 Nistatin tablet vaginal 500.000 IU/g Tablet 640.00 -

247 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 Vial 7,700.00 -

257 Parasetamol tablet 500 mg Tablet 53.00 - 1,000

258 Parasetamol tablet 100 mg Tablet 92.00 -

274 Prednison tablet 5 mg Tablet 73.00 -

281 Retinol (VIT A) Kapsul 100.000 IU Kapsul 288.00 -

286 Rivanol 300 ml Botol 3,400.00 -

289 Salisil Spiritus Botol 32,299.00 -

293 Sarung Tangan Obgyn steril Pasang 19,360.00 -

330 Temporary Filling Material (Fermin) Botol 250,900.00 -

Total (Rp) ### Total (Rp)

APORAN OBAT TERPADU

Penambahan Persediaan Pengeluaran ED Sisa Stok

19,868.70 30.00 19,868.70 - - - 30 19,868.70

38,016.00 40.00 38,016.00 - - - 40 38,016.00

31,518.80 40.00 31,518.80 - - - 40 31,518.80

4,641.60 40.00 4,641.60 - - - 40 4,641.60

- 100.00 9,900.00 - - - 100 9,900.00

233,000.00 1,210.00 281,930.00 210 48,930.00 - 1,000 233,000.00

25,000.00 26.00 65,000.00 4 10,000.00 - 22 55,000.00