Lplpo Bulanan Pustu Ciherang 2020 Fixss

LAPORAN PERSEDIAAN DAN BEBAN PERSEDIAAN OBAT DAN BAHAN MEDIS HABIS PAKAI
UPTD PUSKESMAS KEDALOMAN DINAS KESEHATAN KABUPATEN TANGGAMUS

TAHUN 2020
Pustu : CIHERANG
Bulan : JANUARI
NO. NAMA OBAT SATUAN HARGA SATUAN STOCK NILAI (Rp.) PENERIMAAN PERSEDIAAN PEMAKAIAN HARGA SATUAN SISA STOCK NILAI BEBAN Ket
(Rp.) AWAL (Rp.) PERSEDIAAN
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

1 Air untuk Injeksi 25 ml/Otsu Water 25 ml Ampul 2,860.00 - - - 2,750.00 - - - -
2 Albendazol tab 400 mg Tab 392.00 - - - 392.00 - - - -
3 Albendazole susp 200mg/5ml Botol@60ml 3,849.00 - - - 3,849.00 - - - -
4 Alopurinol tab 100 mg Tab 110.00 - - - 110.00 - - - -
6 Ambroksol Tab 30 mg Tab 140.00 - - - - - - - -
8 Ambroksol Syr 30mg/5 ml Btl 3,750.00 - - - - - - - -
9 Aminofilin injeksi 24 mg/ml Ampul 3,823.00 - - - - - - - -
10 Aminofilin injeksi 24 mg/ml Ampul 2,998.00 - - - 2,998.00 - - - -
11 Aminofilin tablet scored 200 mg Tab 91.00 - - - 91.00 - - - -
12 Amlodipin tablet 10 mg Tab 94.00 - - - - - - - -
14 Amoksisilin kap 250 mg Kaps 211.00 - - - 180.00 - - - -
15 Amoksisilin kap 250 mg Kaps 180.00 - - - - - - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 100 27,200.00 100 100 233.00 - - 23,300.00 -
18 Amoksisilin kap scored 500 mg Kaptab 232.00 - - - - - - - -
19 Amoksisilin sirup kering forte 250 mg/5 ml Btl@ 60 ml 3,400.00 - - - - - - - ED 330
20 Amoksisilin sirup kering 125 mg/ 5 ml Btl @ 60 ml 1,881.00 - - - 1,881.00 - - - -
21 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 4,200.00 - - - 4,200.00 - - - -
22 Ampisilin Tab 500 mg Tab 477.00 - - - - - - - -
23 Ampisillin syr kering 125 mg / 5 ml 8,155.00 - - - - - - - -
24 Antalgin Tab 500mg Tab 191.00 - - - - - - - -
25 Antalgin Inj 250mg/2ml Ampul 2,900.00 - - - 2,900.00 - - - -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 - - - 62.00 - - - -
27 Antasida DOEN I tablet kunyah, komb Tab 62.00 - - - - - - - -
29 Antasida DOEN II suspensi, komb Btl @ 60 ml 1,995.00 - - - 1,995.00 - - - -
30 Anti Bakteri DOEN salep kombi Tube @ 5g 3,035.00 - - - 2,924.00 - - - -
31 Anti Diare/ Diapecta tab Tab 145.00 - - - - - - - -
32 Anti Konstipasi / Laxadin Emulsion Btl 7,700.00 - - - 7,700.00 - - - -
33 Antihemoroid komb Supp 3,045.00 - - - - - - - -
34 Antifungi Doen Kombinasi Pot @ 30 g 4,496.00 - - - 4,323.00 - - - -
35 Antimigren tab Komb Tab 135.00 - - - - - - - -
36 As. Asetilsalisilat (asetosal) tablet 100 mg Tab 116.00 - - - - - - - -
37 As. Asetilsalisilat (asetosal) 80 mg/Miniaspi 80 Tab 99.00 - - - 92.00 - - - -
38 As. Asetilsalisilat (asetosal) tab 500 mg Tab 162.00 - - - - - - - -
39 Asam Askorbat (Vitamin C) tablet 250 mg Tab 159.00 - - - - - - - -
43 Asam Folat/Profolat 0,4 mg Tab 55.00 - - - 55.00 - - - -
44 Asam Mefenamat kaps 250 mg Kap 158.00 - - - - - - - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 200 20,000.00 200 200 100.00 - - 20,000.00 -
46 Asam pipemidat kap 400 mg/Urotractin tab Tab 1,815.00 - - - 1,815.00 - - - -
47 Asam traneksamat injeksi 50 mg/ml Ampul 1,956.00 - - - 1,956.00 - - - ED 1325
48 Asifit Tab Tab 1,818.00 - - - - - - - -
49 Asiklovir Krim Tube @ 5g 2,861.00 - - - - - - - -
51 Asiklovir salep mata 3%/Temiral Eye Oint Tube 3,5 g 24,750.00 - - - - - - - -
52 Asiklovir tab 200 mg Tab 240.00 - - - 240.00 - - - ED 300
53 Asiklovir tab 200 mg Tab 249.00 - - - 249.00 - - - -
54 Asiklovir tab 400 mg Tab 226.08 - - - - - - - -
55 Atapulgit tab 600 mg/Pularex Tab 140.00 - - - 140.00 - - - -
56 Atropin Sulfat Inj 0,25mg/1ml Ampul 1,230.00 - - - - - - - -
58 Atropin Sulfat Inj 0,25mg/1ml Ampul 1,595.00 - - - 1,595.00 - - - -
59 Bricasma respules inh 2,5mg/1ml Ampul 1,691.00 - - - 1,020.00 - - - -
60 Bedak salisil serbuk 2% Ktk @ 50 g 1,020.00 - - - 1,691.00 - - - -
61 Betahistine Maleat 6 mg Tablet 149.00 - - - - - - - -
62 Betametason krim 0,1% Tube 5 gr 1,349.00 - - - - - - - -
64 Betason N Krim Tube 5 gr 9,182.00 - - - - - - - ED 6
65 Bioneuron Inj Ampul 4,341.00 - - - - - - - -
66 Bisakodil suppositoria 10 mg/Stolax Supp Supp 6,045.00 - - - - - - - -
67 Bisoprolol tablet 2,5 mg/Concor 2,5 mg Tab 597.00 - - - 597.00 - - - -
68 Chloramfecort H Cream Tube @ 5g 9,085.00 - - - - - - - -
69 Deksametason inj 5 mg/ml Ampul 1,580.00 - - - - - - - -
70 Deksametason inj 5 mg/ml Ampul 1,097.00 - - - 1,097.00 - - - -
71 Deksametason tablet 0,5 mg Tab 62.00 - - - 41.00 - - - ED 58
72 Deksametason tablet 0,5 mg Tab 41.00 - - - - - - - ED 58
74 Dekstran 70-larutan infus 6% steril Botol 40,100.00 - - - - - - - ED 530
75 Diazepam larutan rektal 5 mg/2,5 mL/Stesolid Tube @ 2,5 ml 12,573.00 - - - 12,573.00 - - - ED 104.000
76 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 2,344.00 - - - - - - - -
78 Diazepam tablet 2 mg Tab 86.00 - - - 86.00 - - - -
79 Diazepam tablet 5 mg Tab 117.00 - - - 109.00 - - - Pecah 5
80 Dietilkarbamazin tablet scored 100 mg Tab 119.00 - - - 119.00 - - - -
81 Difenhidramin inj 10 mg/ml (HCl) Ampul 1,054.00 - - - 1,062.00 - - - -
82 Difenhidramin inj 10 mg/ml (HCl) Ampul 1,062.00 - - - - - - - -
84 Digoksin tablet 0,25 mg Tab 91.00 - - - - - - - -
86 Diltiazem HCl tablet 30 mg Tab 134.00 - - - - - - - -
87 Doksisiklin Kap 100 mg Kapsul 268.00 - - - 268.00 - - - -
88 Domperidon susp/sirup 5 mg/5 ml btl @ 60 ml 2,700.00 - - - - - - - -
89 Domperidon tablet 10 mg Tab 176.00 - - - - - - - -
90 Domperidon tablet 10 mg Tab 95.00 - - - 95.00 - - - -
91 Efedrin tab 25 mg Tab 176.00 - - - - - - - ED 210
92 Ekstrak Beladona tab 10 mg Tab 38.00 - - - - - - - -
93 Epinefrin (Adrenalin) inj 1 mg/ml Ampul 8,100.00 - - - - - - - -
96 Eritromisin kaps 250 mg Kapsul 557.00 - - - 557.00 - - - -
97 Eritromisin kaplet 500 mg Kaplet 557.00 - - - 557.00 - - - -
98 Eritromisin sirup kering 200 mg/ 5 ml Botol @60 ml 6,150.00 - - - 6,150.00 - - - -
99 Etakridina (Rivanol) Lar 0,1 % 300 ml Botol 3,568.00 - - - - - - - -
101 Etanol 70% cairan btl @ 100 ml 255.00 - - - - - - - -
102 Etanol 70% cairan Btl @ 1000 ml 4,700.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
105 Febrinex Syr Btl @ 60 ml 15,830.00 - - - - - - - ED 29160
106
Fenoterol HBr aerosol 100mcg/dosis/Berotec MDI Vial
80,000.00 - - - - - - - -
107 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 1,800.00 - - - 1,800.00 - - - -
108 Fenol gliserol TT 10 % Btl @ 5ml 2,590.00 - - - 2,500.00 - - - -
109 Finasterid tab 5 mg/Prostacom Tab Tab 634.00 - - - - - - - -
110 Fitomenadion (Vit.K1) tab salut gula 10 mg Tab 634.00 - - - 634.00 - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
113 Flusinolon asetonid krim 0,025%/Synarcus Tube 5 g 2,400.00 - - - - - - - -
114 Furosemid inj 10 mg/ml Ampul 1,829.00 - - - - - - - -
115 Furosemid tablet 40 mg Tab 80.00 - - - 80.00 - - - ED 634
116 Gentamisin injeksi 40 mg/ ml Ampul 3,399.00 - - - - - - - -
117 Gentamisin injeksi 40 mg/ ml Ampul 3,386.00 - - - 3,386.00 - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 - - - - - - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 - - - 2,960.00 - - - -
120 Gentamisin tetes mata 0,3% Btl @ 5 ml 3,194.00 - - - - - - - -
122 Gentian Violet 1% Btl 900.00 - - - - - - - -
123 Glibenklamid tablet 5 mg Tab 119.00 - - - 56.00 - - - -
124 Gliklazid tab 80 mg/Glicab Tab Tab 248.00 - - - - - - - -
125 Glimepiride tablet 2 mg Tab 436.00 - - - - - - - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 - - - - - - - -
129 Glukosa larutan infus 10 % steril Btl @ 500 ml 7,500.00 - - - - - - - -
130 Glukosa larutan infus 5 % steril Btl @ 500 ml 5,200.00 - - - - - - - ED 4700
131 Glukosa larutan infus 5 % steril Btl @ 500 ml 6,900.00 - - - 6,900.00 - - - ED 4700
132 Glukosa Larutan Infus 40 % btl @ 100 ml 1,960.00 - - - - - - - -
133 Griseofulvin tablet 125 mg Tab 249.00 - - - 249.00 - - - -
135 Hidroklorotiazid (HCt ) Tab 25 mg Tab 155.00 - - - 149.00 - - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 - - - 2,399.00 - - - -
137 Hidrokortison krim 2,5 % Tube 5 gr 2,475.00 - - - - - - - -
138 Ibuprofen sirup 100 mg/5 ml btl @ 60 ml 2,475.00 - - - - - - - -
139 Ibuprofen tablet 200 mg Tab 110.00 - - - - - - - -
140 Ibuprofen tablet 200 mg Tab 105.00 - - - 105.00 - - - -
141 Ibuprofen tablet 400 mg Tab 111.00 - - - - - - - ED 900
142 Ichtyol Salep Pot @ 30 gram 4,420.00 - - - - - - - -
143 Isosorbid Dinitrat tablet sublingual 5 mg Tab 88.00 - - - - - - - -
144 Isosorbid Dinitrat 10 mg/Fasorbid 10 mg Tab 198.00 - - - 198.00 - - - -
145 Kalium Diklofenak tab 25 mg Tab 332.00 - - - - - - - BPOM 9200
146 Kalium Diklofenak tab 50 mg Tab 425.00 - - - - - - - -
147 Kalsium Laktat (Kalk) tab 500 mg Tab 56.00 - - - 56.00 - - - -
148 Kaptopril tablet scored 25 mg Tab 80.00 200 16,000.00 200 100 80.00 100 8,000.00 8,000.00 -
149 Kaptopril tablet scored 25 mg Tab 75.00 - - - 75.00 - - - -
150 Kaptopril tablet scored12,5 mg Tab 62.00 - - - 62.00 - - - -
152 Ketokonazol krim 2% Tube @ 15 g 4,700.00 - - - 4,700.00 - - - -
154 Ketokonazol tablet 200 mg Tab 280.00 - - - 280.00 - - - ED 150
155 Ketorolac injeksi 30 mg/ml Ampul 2,300.00 - - - 2,300.00 - - - -
157 Klindamisin kapsul/kaplet 150 mg Kapsul 715.00 - - - 382.00 - - - -
159 Klonidin tablet 0,15 mg Tab 170.00 - - - 170.00 - - - -
162 Kloramfenikol kap 250 mg Kapsul 310.00 - - - 310.00 - - - -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 - - - 3,008.00 - - - ED 595
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 - - - 1,881.00 - - - -
165 Kloramfenikol inj 1000 mg/Chloramex inj vial 7,954.00 - - - 7,954.00 - - - -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 - - - 4,700.00 - - - -
167 Kloramfenikol Tetes Mata/Decacetin OTM Btl @ 5 ml 3,250.00 - - - 3,250.00 - - - -
168 Kloramfenikol Tetes Telinga Btl @ 5 ml 5,940.00 - - - 5,940.00 - - - -
169 Klorfeniramina Maleat (CTM) tab 4 mg Tab 51.00 - - - 51.00 - - - -
172 Kodein tablet 10 mg Tab 500.00 - - - 500.00 - - - -
173 Komb Amoks + As. Klavulanat/Co-Amoxiclav 625mg Tab 4,550.00 - - - 4,550.00 - - - -
174 Kombinasi tablet salut : Besi (II) sulfat Tab
tab+as.folat/Tab. Tambah Darah 352.00 - - - 352.00 - - - -
176 Kombinasi tetes mata /Cendo Lyteers Btl @ 15 ml 15,750.00 - - - 15,750.00 - - - -
178 Kotrimoksazol DOEN I (dewasa) komb Tab 138.00 - - - 138.00 - - - -
180 Kotrimoksazol Pediatrik Tab Tab 75.00 - - - 75.00 - - - -
181 Kotrimoksazol Suspensi komb Btl @ 60 ml 2,190.00 - - - 2,190.00 - - - -
183 Lanzoprazol kapsul/kaplet 30 mg Kapsul 473.00 - - - 473.00 - - - ED 10630
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
185 Lidokain injeksi 2% (HCl) Ampul 1,937.00 - - - 1,937.00 - - - -
187 Lidokain jeli 2%/Xylocaine Jelly 2% syringe @ 10 g 40,000.00 - - - 40,000.00 - - - -
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
190 Loperamid tablet 2 mg Tab 89.00 - - - 89.00 - - - -
192 Loratadin tablet 10 mg Tab 125.00 100 12,500.00 100 100 125.00 - - 12,500.00 -
193 Mebendazol tablet 500 mg/Vermox tab Tab 7,140.00 - - - 7,140.00 - - - -
194 Mebendazol Sirup 50 mg/ml btl 3,534.00 - - - 3,534.00 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
196 Meloxicam 15 mg tab 1,199.00 - - - 1,199.00 - - - ED 700
197 Metformin HCl tablet 500 mg Tab 112.50 - - - 112.50 - - - -
199 Metilergometrin Maleat tab salut 0,125 mg Tab 153.00 - - - 153.00 - - - ED 150
200 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 8,935.00 - - - 8,935.00 - - - -
202 Metilprednisolon tablet 16 mg Tab 1,076.00 - - - 1,076.00 - - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 100 20,500.00 100 100 205.00 - - 20,500.00 -
204 Metilprednisolon tablet 4 mg Tab 194.00 - - - 194.00 - - - -
207 Metoklopramide injeksi 5 mg/ ml Ampul 3,395.00 - - - 3,395.00 - - - -
208 Metoklopramide sirup 5 mg/ 5 ml/Lexapram syr Btl @ 60 ML 2,600.00 - - - 2,600.00 - - - -
209 Metoklopramide tablet 10 mg Tab 91.00 - - - 91.00 - - - -
211 Metronidazol infus 500 mg/100 ml Btl @ 100 ml 9,950.00 - - - 9,950.00 - - - -
212 Metronidazol ovula 500 mg/Vagizol Tab Vag 3,850.00 - - - 3,850.00 - - - -
213 Metronidazol sirup 125 mg/5 Ml Btl @ 60ml 3,950.00 - - - 3,950.00 - - - -
214 Metronidazol supositoria 500 mg/Flagyl Supp 3,220.00 - - - 3,220.00 - - - -
215 Metronidazol tablet 250 mg Tab 110.00 100 11,000.00 100 100 110.00 - - 11,000.00 -
216 Metronidazol tablet 250 mg Tab 90.00 - - - 90.00 - - - -
220 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,000.00 - - - 3,000.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
223 Miraneuron kap Kap 598.00 - - - 598.00 - - - -
224 Multivitamin Kom Dewasa/Ramaton Tab Tab 698.00 - - - 698.00 - - - -
225 Multivitamin Anak+DHA Syr/Bionick DHA Milk Syr Btl @ 60 ml 16,000.00 - - - 16,000.00 - - - -
226 Multivitamin Anak Syr/Bionick Syr Btl @ 60 ml 18,700.00 - - - 18,700.00 - - - -
227 Multivitamin Bayi Drop/Bionick Drop Btl @ 30 ml 22,500.00 - - - 22,500.00 - - - Rusak 5000
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
230 Natrium Bikarbonat Tab 500mg Tab 24.00 - - - 24.00 - - - -
231 Natrium Diklofenak tablet 50 mg Tab 200.00 - - - 200.00 - - - ED 12
232 Natrium Diklofenak tablet 25 mg Tab 132.00 500 66,000.00 500 200 132.00 300 39,600.00 26,400.00 -
233 Natrium Tiosulfat Inj 25%-10 ml Ampul 3,000.00 - - - 3,000.00 - - - -
234 Neurovit E tab Tab 818.00 - - - 818.00 - - - -
235 Nifedipin tab 10 mg Tab 110.00 - - - 110.00 - - - -
237 Nistatin tablet salut 500.000 IU/ g Tab 640.00 - - - 640.00 - - - -
239 Nistatin vaginal tablet 100.000 IU/ g Tab Vag 480.00 - - - 480.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
242 Obat Batuk Hitam (OBH) Syrup Btl @ 100 ml 4,230.00 - - - 4,230.00 - - - -
244 Obat Batuk pilek Komb (Hustab tab) Tab 284.00 - - - 284.00 - - - -
245 Obat Flu Anak komb (Flutamol Syr) Btl @ 100 ml 13,500.00 - - - 13,500.00 - - - -
246 Ofloxacin tablet 200 mg Tab 400.00 - - - 400.00 - - - -
248 Ofloksasin tetes telinga 3%/Tarivid Otic Solution Botol 45,089.00 - - - 45,089.00 - - - -
249 Oksimetazolin tts hidung 0,025%/Ilaidin Drop botol @ 10 ml 27,550.00 - - - 27,550.00 - - - ED 280
250 Oksimetazolin tts hidung 0,025%/Ilaidin Drop botol @ 10 ml 30,000.00 - - - 30,000.00 - - - -
251 Oksitetrasiklin HCl inj 50 mg/ ml Vial 3,100.00 - - - 3,100.00 - - - ED 1204
252 Oksitetrasiklin HCl Salep 3 % Tube 2,514.00 - - - 2,514.00 - - - -
254 Omeprazol injeksi 40 mg/ 10 ml Vial 36,000.00 - - - 36,000.00 - - - -
256 Omeprazol kaps 20 mg Kaps 211.00 - - - 211.00 - - - -
259 ondansetron inj 4 mg/ 2 mL Ampul 2,400.00 - - - 2,400.00 - - - -
261 Ondansetron tab 4 mg Tab 716.00 - - - 716.00 - - - -
262 Ondansetron tablet 8 mg Tab 1,189.00 - - - 1,189.00 - - - -
263 Papaverin Tab Tab 112.00 - - - 112.00 - - - -
264 Papaverin Inj Ampul 1,150.00 - - - 1,150.00 - - - -
265 Parasetamol drop ( Generik) Botol @ 15 Ml 5,200.00 - - - 5,200.00 - - - ED 280
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 - - - 1,438.00 - - - ED 199
268 Parasetamol tablet 500 mg Tab 79.00 200 15,800.00 200 200 79.00 - - 15,800.00 -
269 Parasetamol Drop /Fasidol Drop Btl @ 15 ml 6,450.00 - - - 6,450.00 - - - -
270 Perak sulfadiazin krim 1%/Burnazine cr tube @ 35 gram 20,700.00 - - - 20,700.00 - - - -
271 Permetrin krim 5%/Scabimite Cream Tube @ 10 g 10,430.00 - - - 10,430.00 - - - -
273 Petidin inj 50 mg/ml (HCl) Ampul 14,500.00 - - - 14,500.00 - - - ED 2800
274 Pirantel suspensi 125 mg/5 ml Btl @ 60 ml 8,360.00 - - - 8,360.00 - - - Rusak 14000
275 Pirantel tablet score (base) 125 mg Tab 277.00 - - - 277.00 - - - -
276 Piridoksin (vitamin B6) 10 mg Tab 27.00 - - - 27.00 - - - -
277 Piridoksin (vitamin B6) 10 mg Tab 118.00 100 11,800.00 100 118.00 100 11,800.00 - -
278 Piroxicam tab 10mg Tab 86.00 - - - 86.00 - - - -
280 Povidon Iodida larutan 10% 1000 ml Btl @ 1000 ml 87,604.00 - - - 87,604.00 - - - -
281 Povidon Iodida larutan 10% 30 ml Bt l@ 30 ml 2,000.00 - - - 2,000.00 - - - -
284 Povidon Iodida larutan 10% 60 ml btl 60 ml 3,500.00 - - - 3,500.00 - - - -
285 Prednison tablet 5 mg Tab 98.00 - - - 98.00 - - - -
287 Progastric tab Tab 303.00 - - - 303.00 - - - -
288 Propanolol tablet 10 mg ( HCl ) Tab 65.00 - - - 65.00 - - - -
290 Propranolol tablet 40 mg (HCl) Tab 107.00 - - - 107.00 - - - -
291 Propiltiourasil tab 100 mg Tab 264.00 - - - 264.00 - - - -
292 Ranitidin injeksi 25 mg/ml Ampul 1,140.00 - - - 1,140.00 - - - -
293 Ranitidin tablet 150 mg Tab 98.00 - - - 98.00 - - - -
294 Ringer Laktat larutan infus Btl @ 500 ml 5,200.00 - - - 5,200.00 - - - -
296 Risperidon tablet 2 mg Tab 347.00 - - - 347.00 - - - -
297 Salbutamol tab 2mg Tab 71.00 - - - 71.00 - - - ED 1285
299 Salbutamol Tab 4 mg Tab 141.00 - - - 141.00 - - - -
301 Salbutamol cairan ih 0,1%/Ventolin Nebules Btl 16,445.00 - - - 16,445.00 - - - -
302 Salbutamol inh 100 mcg/dosis/Ventolin Inhaler Btl 63,750.00 - - - 63,750.00 - - - -
303 Salbutamol Syr Btl 4,750.00 - - - 4,750.00 - - - -
304 Salep 2-4 , Komb Pot @ 30 gram 2,000.00 - - - 2,000.00 - - - -
307 Sefadroksil sirup kering 125 mg/5ml Btl @ 60 ml 3,984.00 - - - 3,984.00 - - - -
308 Sefadroksil kapsul 500 mg Kapsl 509.00 - - - 509.00 - - - -
309 Sefaleksin kapsul 500 mg Kapsul 516.00 - - - 516.00 - - - -
310 Sefaleksin kapsul 500 mg Kapsul 1,000.00 - - - 1,000.00 - - - -
311 Sefiksim kapsul 100 mg Kapsul 859.00 - - - 859.00 - - - -
312 Sefiksim sirup kering 100 mg/ 5 ml Btl @ 30 ml 7,490.00 - - - 7,490.00 - - - -
313 Sefotaksim injeksi 1 g Vial 2,950.00 - - - 2,950.00 - - - -
315 Seftriakson serbuk injeksi 1 g/vial Vial 3,300.00 - - - 3,300.00 - - - -
316 Serum ABU Polivalen inj 5 ml Vial 589,900.00 - - - 589,900.00 - - - -
318 Serum ATS 1500 IU/ml Ampul 157,000.00 - - - 157,000.00 - - - -
320 Serum ATS 20.000 mcg.ml Vial 523,300.00 - - - 523,300.00 - - - -
321 Setirizin sirup 5 mg/5 ml Btl @ 60 ml 2,850.00 - - - 2,850.00 - - - -
322 Setirizin tablet 10 mg Kapsul 181.00 - - - 181.00 - - - -
325 Sianokobalamin (vitamin B12) inj 500 mcg Ampul 1,077.00 - - - 1,077.00 - - - -
327 Sianokobalamin (vitamin B12) tab 50 mcg Tab 46.00 100 4,600.00 100 100 46.00 - - 4,600.00 -
328 Simetidine Tab 10 mg Tab 160.00 - - - 160.00 - - - -
329 Simvastatin scored tablet 10 mg Kap 169.00 - - - 169.00 - - - -
331 Simvastatin tab 20 mg Tab 229.00 - - - 229.00 - - - ED 400
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 200 51,000.00 200 200 255.00 - - 51,000.00 -
333 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 240.00 - - - 240.00 - - - -
334 Spiramisin tablet 500 mg Tab 1,499.00 - - - 1,499.00 - - - -
335 Spironolakton tablet 100 mg Tab 900.00 - - - 900.00 - - - ED 148
336 Spironolakton tablet 25 mg Tab 294.00 - - - 294.00 - - - -
337 Stimuno Syr Btl @ 60 ml 25,420.00 - - - 25,420.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
339 Sukralfat susp 500 mg/5 mL/Ulsafate Btl @ 100 ml 13,425.00 - - - 13,425.00 - - - -
340 Sukralfat tab 500 mg/Ulsidex Tab 296.00 - - - 296.00 - - - -
341 Tab Tambah darah/Hemafort Tab 834.90 - - - 834.90 - - - -
342 Terbutalin tablet 2,5 mg/Molasma Tab 99.00 - - - 99.00 - - - -
343 Tetrasiklin kapsul 250 mg Kapsul 149.00 - - - 149.00 - - - -
345 Tetrasiklin Kapsul 500 mg Kapsul 300.00 - - - 300.00 - - - -
347 Thiamin HCl inj 100mg/ml Ampul 690.00 - - - 690.00 - - - -
348 Thiamin Mononitrat Tab 50 mg Tab 376.00 100 37,600.00 100 100 376.00 - - 37,600.00 -
349 Thiamin Mononitrat Tab 50 mg Tab 82.00 - - - 82.00 - - - -
350 Thiamfenikol Kap 500 mg Kapsul 900.00 - - - 900.00 - - - -
351 Tramadol injeksi 50 mg/ml Ampul 2,395.00 - - - 2,395.00 - - - -
353 Tramadol Tab 50 mg Tab 387.00 - - - 387.00 - - - -
354 Urea krim 10%/Soft U Derm tube 6,809.00 - - - 6,809.00 - - - -
355 Videne Povidone Iodine 500 ml Btl 27,500.00 - - - 27,500.00 - - - -
356 Vitamin Tab/Becefort Tab Tab 1,545.43 - - - 1,545.43 - - - -
357 Vitamin Syr/Becefort Syr Btl 17,365.00 - - - 17,365.00 - - -
358 Vitamin B Kompleks tablet Tab 22.00 - - - 22.00 - - - -
359 Vitamin B Kompleks tablet Tab 115.00 100 11,500.00 100 100 115.00 - - 11,500.00 -
OBAT ASKES - - - - ED 1700
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
361 Cargesik tab 500 mg Tab 448.00 - - - 448.00 - - - -
362 Farmoten tab 12,5 mg Tab 270.00 - - - 270.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
365 Levertraan Zalf Pot 4,091.00 - - - 4,091.00 - - - -
366 Mirasic tab 500 mg Tab 248.00 - - - 248.00 - - -
367 Miraneuro Tab tab 891.00 - - - 891.00 - - -
- - -
OBAT PROGRAM GIGI - - -
368 Air Raksa DentalUse Botol 103,536.00 - - - 103,536.00 - - - -
369 Devitalisasi Pasta (Non Arsen) Pot 382,000.00 - - - 382,000.00 - - - -
370 Etil Klorida Semprot Botol 107,000.00 - - - 107,000.00 - - - -
371 Eugenol cairan Botol 18,100.00 - - - 18,100.00 - - - -
372 Glass Ionomer Cement (gc IX) Btl 858,000.00 - - - 858,000.00 - - - -
373 Kalsium hidroksida Pasta Set 23,850.00 - - - 23,850.00 - - - -
375 Monoklor Mentol Cairan/CHKM Btl 55,000.00 - - - 55,000.00 - - - -
376 Mummfying Pasta Btl 172,250.00 - - - 172,250.00 - - - -
378 Semen Seng Fosfat Serbuk Btl 93,500.00 - - - 93,500.00 - - - -
380 Silver Amalgam Btl 227,311.00 - - - 227,311.00 - - - -
381 Spon Gelatin Cubicles 1x1x1 cm Buah 9,471.00 - - - 9,471.00 - - - -
382 Temporary Stopp. F. srb & Cair Btl 34,000.00 - - - 34,000.00 - - - -
383 Trikresol Formalin Btl 40,330.00 - - - 40,330.00 - - - -
384 GC Fuji Varnish (Butter Coconut/Varnish) Btl 230,000.00 - - - 230,000.00 - - -
385 Articulation Paper Red GC Kotak 145,000.00 - - - 145,000.00 - - -
- - -
OBAT PROGRAM JIWA - - -
386 Amitriptilin tablet salut 25 mg (HCl) Tab 112.00 - - - 112.00 - - - -
389 Fenitoin injeksi 50mg/ml Ampul 20,250.00 - - - 20,250.00 - - - -
390 Fenitoin kap 100mg kaplet 152.00 - - - 152.00 - - - -
391 Fenobarbital tab 100 mg Tab 220.00 - - - 220.00 - - - -
393 Haloperidol tablet 0,5 mg Tab 56.00 - - - 56.00 - - - -
394 Haloperidol tablet 1,5 mg Tab 61.00 - - - 61.00 - - - ED 1.700
395 Haloperidol tablet 5 mg Tab 96.00 - - - 96.00 - - - -
397 Karbamazepin sir 100 mg/5 ml/Tegretol Syr Btl @ 120 ml 44,770.00 - - - 44,770.00 - - - -
398 Karbamazepin tablet 200 mg Tab 228.00 - - - 228.00 - - - ED 30
399 Klorpromazin tablet salut 100 mg (HCl) Tab 149.00 - - - 149.00 - - - -
400 Klorpromazin injeksi i.m. 25 mg/ml (HCl) Ampul 1,021.00 - - - 1,021.00 - - - -
402 Trifluoferazin tab 5 mg Tab 274.00 - - - 274.00 - - -
403 Triheksifenidil HCl tab 2 mg Tab 80.00 - - - 80.00 - - -
- - - - -
OBAT PROGRAM FARMASI - - - - ED 1
404 Alu +Mortir 10 Cm Buah 65,738.00 - - - 65,738.00 - - - ED 1
405 Boraks Test Set 1,642,000.00 - - - 1,642,000.00 - - - ED 3
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
407 Formalin Test Set 1,641,500.00 - - - 1,641,500.00 - - - -
408 Formalin Test Set 1,264,850.00 - - - 1,264,850.00 - - - ED 2
409 Rhodamin Test Set 1,642,000.00 - - - 1,642,000.00 - - - -
410 Rhodamin Test Set 1,402,250.00 - - - 1,402,250.00 - - -
411 Methanyl Yellow Test Unit 1,248,400.00 - - - 1,248,400.00 - - -
- - - - ED 302
OBAT PROGRAM MALARIA - - - - ED 400
412 ACT Tab Blister 1,375.00 - - - 1,375.00 - - - ED 24+152
413 Antimalaria DOEN kombinasi /suldox tab Tab 478.00 - - - 478.00 - - - ED 666
414 Artemether injeksi 80 mg/ml/Artem Ampul 25,490.00 - - - 25,490.00 - - - ED 192
415 Arterakin/Darplex/DHP Tab Tab 3,567.00 - - - 3,567.00 - - - -
416 Artesunate inj 60 mg/ml/Artesunate Vial 39,000.00 - - - 39,000.00 - - - -
417 Fokus Malaria PF&PV Casette Unit 53,110.00 - - - 53,110.00 - - - -
418 Kuinin (Kina) tablet 200 mg Tab 670.00 - - - 670.00 - - - ED 360
419 Kuinin injeksi i.v. 25% (sebagai 2 HCl) Ampul 6,200.00 - - - 6,200.00 - - - -
420 Kuinin tablet 222 mg (H2SO4.7H2O) Tab 400.00 - - - 400.00 - - - -
421 Larvasida Malaria Galon 11,200,000.00 - - - 11,200,000.00 - - - ED 40
422 Primakuin tablet 15 mg Tab 224.00 - - - 224.00 - - - -
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
424 RDT Malaria Piece 12,950.30 - - - 12,950.30 - - -
- - - - ED 51100
OBAT PROGRAM DIARE - - - - ED 32
426 Garam Oralit I serbuk, kombi Sacchet 264.00 - - - 264.00 - - - -
427 Zinc drop 10 mg/mL/Zincpro Drops Btl @15 ml 6,281.00 - - - 6,281.00 - - - -
428 Zinc sir 10 mg/mL/Zinc Kid Btl @ 100 ml 14,980.00 - - - 14,980.00 - - - ED 1100
429 Zinc sir 20 mg/5 ml Btl @ 60 ml 4,789.00 - - - 4,789.00 - - -
430 Zinc tablet dispersible20 mg Tab 474.00 - - - 474.00 - - -
- - - - -
OBAT PROGRAM TB - - - - ED 16
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
432 Obat Antituberkulosis FDC Kategori 1 Paket 374,384.00 - - - 374,384.00 - - - -
433 Obat Antituberkulosis FDC Kategori 2 Paket 1,247,980.00 - - - 1,247,980.00 - - - ED 1
434 Obat Antituberkulosis Kategori 3 Paket 154,000.00 - - - 154,000.00 - - - -
435 Obat Antituberkulosis FDC Kategori Anak Paket 214,990.00 - - - 214,990.00 - - - -
437 Obat Antituberkulosis FDC Sisipan Paket 160,000.00 - - - 160,000.00 - - - -
438 Obat Antituberkulosis Kategori 1 dewasa combipac Paket 288,199.00 - - - 288,199.00 - - - ED 300
439 Obat Antituberkulosis Kategori anak combipac Paket 171,195.00 - - - 171,195.00 - - - ED 200
440 Pyrazinamid Tab 500 mg Tab 234.00 - - - 234.00 - - - ED300
441 Rifampisin tab 300 mg Kapsul 376.00 - - - 376.00 - - -
442 Rifampisin tab 600 mg Kaplet 830.00 - - - 830.00 - - -
- - - - -
OBAT PROGRAM P2 - - - - -
443 Insektisida Botol@1ltr 200,000.00 - - - 200,000.00 - - - -
444 Insektisida Cynof Botol 198,000.00 - - - 198,000.00 - - - -
445 Insektisida Zetta 15 UL Liter 74,470.00 - - - 74,470.00 - - - -
446 Insektisida DBD/Mustang TC 95% Fogging Galon @ 5 Liter 968,000.00 - - - 968,000.00 - - - -
447 Larvasida Botol@1kg 110,000.00 - - - 110,000.00 - - - -
448 Larvasida DBD Jentika Botol @ 1 Kg kg 115,500.00 - - - 115,500.00 - - - -
449 Larvasida DBD Bentuk Cair/ Bactivec SL @ 30 ml ml 537.13 - - - 537.13 - - - -
450 Larvasida Malaria/Bactivel SL @ 20 Liter Galon 14,464,450.00 - - - 14,464,450.00 - - - ED 700
451 MDT Combi Adult Paket 30,595.00 - - - 30,595.00 - - - -
452 Oseltamivir tab Tab 13,000.00 - - - 13,000.00 - - - -
453 Obat Fogging/Alfa Cypermetrin 30 EC @ 5 liter Liter 480,150.00 - - - 480,150.00 - - -
454 Vaksin rabies/Rabipur Vial 78,500.00 - - - 78,500.00 - - -
- - - - -
OBAT PROGRAM KELING - - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
457 Kaporit Bubuk 60% Galon @ 15Kg 493,050.00 - - - 493,050.00 - - -
- - - - -
OBAT PROGRAM GIZI - - - - ED 858
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
459 Mineral Mix Sacchet 2,805.00 - - - 2,805.00 - - - ED 14450
460 Retinol (Vitamin A) 100.000 IU Kapsul 260.00 - - - 260.00 - - - -
461 Retinol (Vitamin A) 100.000 IU Kapsul 284.00 - - - 284.00 - - - ED 2880
463 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 460.00 - - - 460.00 - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
OBAT PROGRAM KESEHATAN IBU DAN ANAK - - - - ED 140
465 Alat HB Hemoglobin Starter Kit Mission Unit 762,000.00 - - - 762,000.00 - - - ED 29+50
466 Alat tes Hb Hemoglobin Unit 416,666.67 - - - 416,666.67 - - - ED 29+50
467 Benzatin Benzil Penisilin 1,2 juta IU/ vial Vial 8,935.00 - - - 8,935.00 - - - ED 3870
468 Benzatin Benzil Penisilin 2,4 juta IU/vial Vial 12,185.00 - - - 12,185.00 - - - -
469 Fitomenadion (Vitamin K1) inj 2 mg/ml Ampul 1,566.00 - - - 1,566.00 - - - -
471 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 1,800.00 - - - 1,800.00 - - - ED 65
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
473 Hb Hemoglobin Strip Test Kotak 403,750.00 - - - 403,750.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
476 Kaporit Tablet Kg 35,990.16 - - - 35,990.16 - - - -
477 Kalsium Glukonat inj i.v 10% (100 mg/ml) Ampul 7,800.00 - - - 7,800.00 - - - ED 100
478 Kondom Kotak - - - - - - - - ED 241
479 Levotiroksin tab 100 mcg/Euthyrox 100 Tab 1,694.00 - - - 1,694.00 - - - ED 60
480 Magnesium sulfat injeksi 20% Vial 5,500.00 - - - 5,500.00 - - - ED 635+647
481 Magnesium sulfat injeksi 20% Vial 3,200.00 - - - 3,200.00 - - - Rusak 128
482 Magnesium sulfat injeksi 40% Vial 2,629.00 - - - 2,629.00 - - - -
484 Oksitosin injeksi 10 IU/ml Ampul 1,900.00 - - - 1,900.00 - - - -
485 Paket KIA Paket - - - - - - - - ED 360+400
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
487 Prokain Benzilpenisilin serbuk inj 3 juta IU/vial Vial 10,780.00 - - - 10,780.00 - - - -
488 Suntik KB 3 Bln @ 1 ml Vial - - - - - - - - -
490 Test Kehamilan Strip 1,460.00 - - - 1,460.00 - - - -
492 Urin strip(tes protein &gula) Strip 1,100.00 - - - 1,100.00 - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
BAHAN HABIS PAKAI - - - - -
495 Alat Suntik 0,05 ml Buah 2,134.00 - - - 2,134.00 - - - -
498 Alat Suntik 0,5 ml Buah 1,656.00 - - - 1,656.00 - - - ED 6150
499 Alat Suntik 1 ml. Buah 650.00 - - - 650.00 - - - ED 5670
502 Alat Suntik 2,5 ml. Buah 650.00 - - - 650.00 - - - ed 2494
503 Alat Suntik 2,5 ml. Buah 1,253.00 10 12,530.00 10 5 1,253.00 5 6,265.00 6,265.00 -
504 Alat Suntik 2,5 ml. Buah 827.00 - - - 827.00 - - - -
505 Alat Suntik 5 ml. Buah 1,000.00 - - - 1,000.00 - - - -
507 Alat Suntik 10 ml Buah 1,406.00 12 16,872.00 12 2 1,406.00 10 14,060.00 2,812.00 -
508 Blood Lancet Kotak 725.00 - - - 725.00 - - - -
509 Blood Lancet Kotak 15,191.00 - - - 15,191.00 - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
511 Cat Gut/ Benang Bedah no. 2/0 Set 5,583.00 - - - 5,583.00 - - - -
515 Folley Cathether No. 14 Buah 8,475.00 - - - 8,475.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
526 Infusion Set anak Set 3,500.00 - - - 3,500.00 - - - -
529 Infusion Set dewasa/NIPRO Set 5,935.00 - - - 5,935.00 - - - -
530 Infusion Set dewasa Set 3,200.00 - - - 3,200.00 - - - ED 24
532 IV catheter no 18 Buah 3,800.00 - - - 3,800.00 - - - -
542 Kasa Pembalut Hidrofil 4m x 10cm Roll 1,083.00 - - - 1,083.00 - - - -
543 Kapas Berlemak 500 mg. Roll 16,500.00 - - - 16,500.00 - - - -
544 Kapas Pembalut/Adsorben 250 mg. Roll 27,349.28 - - - 27,349.28 - - - -
545 Kasa Elastis Roll 23,200.00 - - - 23,200.00 - - - -
546 Kasa Meteran 36m x 80cm Roll 150,300.00 - - - 150,300.00 - - - -
547 Kasa Pembalut Hidrofil 40Cm x 40cm. Roll 1,928.00 - - - 1,928.00 - - - ED 100
548 Kasa Pembalut 2m x 80cm. Roll 9,900.00 - - - 9,900.00 - - - -
549 Kasa Pembalut Hidrofil 4m x 15cm. Roll 3,988.00 - - - 3,988.00 - - - -
550 Kasa Pembalut Hidrofil 4m x 3cm. Roll 607.00 - - - 607.00 - - - ED 297
552 Kasa Pembalut Hidrofil 4m x 5cm. Roll 1,163.00 - - - 1,163.00 - - - ED 338
553 Kasa Steril Kotak 4,300.00 - - - 4,300.00 - - - -
555 Kasa Steril Kotak 8,651.00 5 43,255.00 5 2 8,651.00 3 25,953.00 17,302.00 -
556 Leucoplast 7,50cm x 4,5m Roll 35,532.00 - - - 35,532.00 - - - -
557 Masker Buah 532.80 1 532.80 1 532.80 1 532.80 - -
558 Masker Buah 491.00 - - - 491.00 - - - -
559 Pembalut Gips Roll 32,200.00 - - - 32,200.00 - - - -
560 Plastik Besar Pak 10,000.00 - - - 10,000.00 - - - -
561 Plastik Kecil Pak 7,000.00 - - - 7,000.00 - - - -
562 Plester 5 Yard x 2 Inc. Roll 23,510.24 - - - 23,510.24 - - - -
563 Silk (benang bedah sutra) no 3/0 Set 3,056.00 - - - 3,056.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
566 Transfussion set Set - - - - - - - - -
567 Kantong Urin Dewasa Buah 3,000.00 - - - 3,000.00 - - -
- - - - -
BAHAN LABORATORIUM - - - - -
567 Autocliclik Lancing Device Piece 17,938.00 - - - 17,938.00 - - - -
568 Alat Hitung bakteri Buah 2,910,000.00 - - - 2,910,000.00 - - - -
569 Alat Test Easy Touch Buah 695,000.00 - - - 695,000.00 - - - -
570 Alat Benecheck Plus Monitoring Unit 199,855.00 - - - 199,855.00 - - - -
571 Alkohol Swab Buah 10,100.00 - - - 10,100.00 - - - ED 2
572 Asam Klorida 0,1 N Botol 2,386,304.00 - - - 2,386,304.00 - - - ED 622
573 Asam Sulfosalisilat 20% Botol 31,300.00 - - - 31,300.00 - - - ED 421
574 Bennecheck Urid Acid Test Strip Kotak 130,269.13 - - - 130,269.13 - - - -
575 Bennecheck Total Cholesterol Test Strip Kotak 234,958.14 - - - 234,958.14 - - - -
576 Bennecheck Blood Glukosa Test Strip Kotak 157,821.58 - - - 157,821.58 - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
578 Batang Pengaduk 25 cm Buah 6,120.00 - - - 6,120.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
580 Erlenmeyer 50 ml Buah 21,500.00 - - - 21,500.00 - - - -
581 Golongan Darah Anti-A Monoclonal Reagnt Btl@ 10 ml 69,450.00 - - - 69,450.00 - - - -
582 Golongan Darah Anti-B Monoclonal Reagent Btl@ 10 ml 69,450.00 - - - 69,450.00 - - - -
583 Golongan Darah Anti-A,B Monoclonal Reagent Btl@ 10 ml 93,760.00 - - - 93,760.00 - - - -
584 Golongan Darah Anti-D Duoclone Reagent Btl@ 10 ml 115,320.00 - - - 115,320.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
586 Kertas Lakmus Buah 49,435.00 - - - 49,435.00 - - - -
587 Kertas Golongan darah Lembar 230.00 - - - 230.00 - - - -
588 Lampu Spiritus Buah 69,000.00 - - - 69,000.00 - - - ED 6
589 Larutan Anisol Btl 1,415,994.00 - - - 1,415,994.00 - - - ED 5
590 Larutan Asam Asetat Btl 58,400.00 - - - 58,400.00 - - - -
591 Larutan Bennedict Btl 68,000.00 - - - 68,000.00 - - - -
592 Larutan Emersi Btl@50ml 203,413.04 - - - 203,413.04 - - - -
593 Larutan Eosin 2 % Btl 143,750.00 - - - 143,750.00 - - - -
594 Larutan Etanol Asam Btl 28,000.00 - - - 28,000.00 - - - -
595 Larutan Gebbet Btl 424,000.00 - - - 424,000.00 - - - -
596 Larutan Giemsa Stain Btl@100ml 493,115.00 - - - 493,115.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
598 Larutan Karbol Fuksin Btl 74,000.00 - - - 74,000.00 - - - -
599 Larutan Kinyoun Btl 785,000.00 - - - 785,000.00 - - - ED 4
600 Larutan Metilen Blue Btl 32,600.00 - - - 32,600.00 - - - -
601 Larutan Ress Eccer Btl 97,000.00 - - - 97,000.00 - - - ED 6
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
603 Larutan Xylol Btl 31,000.00 - - - 31,000.00 - - - -
604 Larutan Ziehl Nielson Paket - - - - - - - - -
605 Malaria test Buah 35,035.00 - - - 35,035.00 - - - -
606 Pipet Eritrosit Buah 1,716.00 - - - 1,716.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
611 Test Golongan Darah Paket 603,300.00 - - - 603,300.00 - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
613 ABN Calibra Aneroid Sphygmomanometer Unit 158,701.00 - - - 158,701.00 - - - -
614 ABN Classic Stethoscope Black Adult Unit 223,710.00 - - - 223,710.00 - - -
615 ABN Digital Spygmomanometer With Inflamation Syst Unit 1,247,035.00 - - - 1,247,035.00 - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
617 DPT-HB.HIB/pentabio Buah 69,350.00 - - - 69,350.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
620 Hepatitis B/uniject Vial 20,900.00 - - - 20,900.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
628 DPT-HB.HIB/pentabio Buah 69,350.00 - - - 69,350.00 - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
631 Hepatitis B/uniject Vial 20,900.00 - - - 20,900.00 - - -
632 Reagen SD HIV Test 21,815.00 - - - 21,815.00 - - -
633 Reagen Oncoprobe Test 21,818.00 - - - 21,818.00 - - -
634 Reagen Intec Test 21,818.00 - - - 21,818.00 - - -
635 Reagen SD Sifilis Test 27,900.00 - - - 27,900.00 - - -
636 Antimalaria DOEN kombinasi /suldox tab tab 478.00 - - - 478.00 - - -
637 Asam folat tab 1 mh Tab 45.00 - - - 45.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
639 Bedak Salisil serbuk 2% ktk@50gr 1,200.00 - - - 1,200.00 - - -
640 Doksisiklin Kap 100 mg kapsul 220.00 - - - 220.00 - - -
641 Fenol gliserol TT 10 % btl@5ml 2,500.00 - - - 2,500.00 - - -
642 Haloperidol tablet 1,5mg tab 61.00 - - - 61.00 - - -
643 Hidroklorotiazid (HCt) Tab 25mg tab 36.00 - - - 36.00 - - -
644 Ibuprofen tablet 200mg tab 93.00 - - - 93.00 - - -
646 Karbamazepin 200mg tab 243.00 - - - 243.00 - - -
647 Klorpromazin tablet salut 25 mg (HCl) tab 45.00 - - - 45.00 - - -
648 Metoklopramide sirup 5 mg/ 5 ml/Lexapram syr btl@60ml 2,830.00 - - - 2,830.00 - - -
649 Natrium Bikarbonat Tab 500mg tab 93.00 - - - 93.00 - - -
650 Nifedipin tab 10 mg tab 112.00 - - - 112.00 - - -
651 Nistatin vaginal tablet 100.000 IU/ g tab vag 407.00 - - - 407.00 - - -
652 Parasetamol drop/fasidol drop btl@15ml 5,200.00 - - - 5,200.00 - - -
653 Etil Klorida Semprot botol 104,030.00 - - - 104,030.00 - - -
654 Cat Gut/Benang bedah no.3/0 set 24,450.00 - - 24,450.00 - - -
655 handscond 7/M paket 498.96 - - - 498.96 - - -
656 plaster 5 yard x 2 inch roll 23,500.00 - - - 23,500.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
659 Glimepiride tablet 3 mg tablet 289.00 - - - 289.00 - - -
660 miconazole serbuk 2% / Mycorin powder btl@5ml 26,950.00 - - 26,950.00 - - -
661 Bisakodil 10 mg supp/Dulcolak supp adult 10mg supp 5,800.00 - - - 5,800.00 - - -
662 Bisakodil 5 mg supp/Dulcolak supp adult 5 mg supp 5,800.00 - - - 5,800.00 - - -
663 bisakodil tab salut 5mg tab 300.00 - - - 300.00 - - -
664 allopurinol tab 300 mg tab 222.00 - - - 222.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
667 Hansaplast plester roll roll 11,964.00 - - - 11,964.00 - - -
668 infuset dewasa/grahaloka set 8,610.00 - - 8,610.00 - - -
669 kalsium karbonat 500 mg/calporosis Tablet 430.00 - - - 430.00 - - -
670 fenitoin 30mg/decatona 30mg kaplet 142.00 - - - 142.00 - - -
671 asetil systein kapsul 104.00 - - - 104.00 - - -
672 microlit tips for micropipet vial 181,469.00 - - - 181,469.00 - - -
- - - - - -
ITEM BARU JKN - - - - - -
673 Acyclovir Cream 5% (5Gram) Tube 3,948 - - - 3,948 - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
675 Ambroxol Sirup 60ml Btl 4,556 - - - 4,556 - - -
676 Betametason 0,1% 5gram Tube 1,300 - - - 1,300 - - -
677 Cefadroxil 500mg Kaps 1,432 - - - 1,432 - - -
678 Chloramphenicol Susp 60ml Btl 8,135 - - - 8,135 - - -
679 Dexamethasone 0,5mg Tab 107 - - - 107 - - -
680 Gentamycin 0,1% 5gram Tube 3,319 - - - 3,319 - - -
681 Glyceril Guaiacolat 100mg Tab 214 - - - 214 - - -
682 Ibuprofen Susp 100mg/5ml Btl 2,474 - - - 2,474 - - -
683 Methyl Prednisolone 4mg Tab 130 - - - 130 - - -
684 Metronidazole 500mg Tab 260 - - - 260 - - -
685 Paracetamol Sirup 60ml Btl 4,605 - - - 4,605 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
687 Bedak Salicyl 2% 60gr Pcs 5,460 - - - 5,460 - - -
688 Vitamin B Kompleks Tab 131 - - - 131 - - -
689 Fituno Kaplet Blister Kaps 3,785 - - - 3,785 - - -
690 Silk 3/0 Without Needle Box 150,545 - - - 150,545 - - -
691 Skifa Examination Glove L Box 53,182 - - - 53,182 - - -
692 Infusion Set Troge Pcs 5,445 - - - 5,445 - - -
693 IV Cath Troge 22G Pcs 12,631 - - - 12,631 - - -
697 Urine Bag Troge Pcs 8,070 - - - 8,070 - - -
698 Postofix-PU 10 x 25 cm Pcs 29,379 - - - 29,379 - - -
699 Strip Autocheck Gula Pcs 2,636 - - - 2,636 - - -
700 Strip Autocheck Urid Acid Pcs 3,386 - - - 3,386 - - -
701 Strip Autocheck Cholesterol Pcs 13,536 - - - 13,536 - - -
702 Kasa Hidro 38 m x 80 cm Rol 124,091 - - - 124,091 - - -
703 Kasa Steril DRC 16cm x 16cm 16 Box 6,700 - - - 6,700 - - -
704 Selang O2 Dewasa Pcs 6,586 - - - 6,586 - - -
705 Masker Karet GP Care Box 22,843 - - - 22,843 - - -
JUMLAH 2,128.00 378,689.80 - 2,128.00 1,609.00 519.00 106,210.80 268,579.00
UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP
69 59 128
Kedaloman, Januari 2020

Mengetahui Yang Membuat Laporan
Ka. UPTD Puskesmas Kedaloman
Dedy Heriyanto, SKM Nama

NIP.19730716 199302 1 001
TAHUN 2020
Pustu : CIHRANG
Bulan : FEBRUARI
NO. NAMA OBAT SATUAN HARGA SATUAN STOCK NILAI (Rp.) PENERIMAAN PERSEDIAAN PEMAKAIAN HARGA SATUAN SISA STOCK NILAI BEBAN
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12)

1 Air untuk Injeksi 25 ml/Otsu Water 25 ml Ampul 2,860.00 - - - 2,750.00 - - -
2 Albendazol tab 400 mg Tab 392.00 - - - 392.00 - - -
3 Albendazole susp 200mg/5ml Botol@60ml 3,849.00 - - - 3,849.00 - - -
4 Alopurinol tab 100 mg Tab 110.00 - - - 110.00 - - -
5 Alopurinol tab 100 mg Tab 99.00 - - - 99.00 - - -
6 Ambroksol Tab 30 mg Tab 140.00 - - - - - - -
7 Ambroksol Tab 30 mg Tab 123.00 - - - - - - -
8 Ambroksol Syr 30mg/5 ml Btl 3,750.00 - - - - - - -
9 Aminofilin injeksi 24 mg/ml Ampul 3,823.00 - - - - - - -
10 Aminofilin injeksi 24 mg/ml Ampul 2,998.00 - - - 2,998.00 - - -
11 Aminofilin tablet scored 200 mg Tab 91.00 - - - 91.00 - - -
12 Amlodipin tablet 10 mg Tab 94.00 - - 90 90 - 90 - -
13 Amlodipin tablet 5 mg Tab 187.00 - - - - - - -
14 Amoksisilin kap 250 mg Kaps 211.00 - - - 180.00 - - -
15 Amoksisilin kap 250 mg Kaps 180.00 - - - - - - -
16 Amoksisilin kap 250 mg Kaps 184.00 - - - 184.00 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 - - 500 500 100 233.00 400 93,200.00 23,300.00
18 Amoksisilin kap scored 500 mg Kaptab 232.00 - - - - - - -
19 Amoksisilin sirup kering forte 250 mg/5 ml Btl@ 60 ml 3,400.00 - - - - - - -
20 Amoksisilin sirup kering 125 mg/ 5 ml Btl @ 60 ml 1,881.00 - - - 1,881.00 - - -
21 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 4,200.00 - - - 4,200.00 - - -
22 Ampisilin Tab 500 mg Tab 477.00 - - - - - - -
23 Ampisillin syr kering 125 mg / 5 ml 8,155.00 - - - - - - -
24 Antalgin Tab 500mg Tab 191.00 - - - - - - -
25 Antalgin Inj 250mg/2ml Ampul 2,900.00 - - - 2,900.00 - - -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 - - 500 500 200 62.00 300 18,600.00 12,400.00
27 Antasida DOEN I tablet kunyah, komb Tab 62.00 - - - - - - -
28 Antasida DOEN I tablet kunyah, komb Tab 54.00 - - - 54.00 - - -
29 Antasida DOEN II suspensi, komb Btl @ 60 ml 1,995.00 - - 10 10 1,995.00 10 19,950.00 -
30 Anti Bakteri DOEN salep kombi Tube @ 5g 3,035.00 - - - 2,924.00 - - -
31 Anti Diare/ Diapecta tab Tab 145.00 - - - - - - -
32 Anti Konstipasi / Laxadin Emulsion Btl 7,700.00 - - - 7,700.00 - - -
33 Antihemoroid komb Supp 3,045.00 - - - - - - -
34 Antifungi Doen Kombinasi Pot @ 30 g 4,496.00 - - - 4,323.00 - - -
35 Antimigren tab Komb Tab 135.00 - - - - - - -
36 As. Asetilsalisilat (asetosal) tablet 100 mg Tab 116.00 - - - - - - -
37 As. Asetilsalisilat (asetosal) 80 mg/Miniaspi 80 Tab 99.00 - - - 92.00 - - -
38 As. Asetilsalisilat (asetosal) tab 500 mg Tab 162.00 - - - - - - -
39 Asam Askorbat (Vitamin C) tablet 250 mg Tab 159.00 - - - - - - -
43 Asam Folat/Profolat 0,4 mg Tab 55.00 - - - 55.00 - - -
44 Asam Mefenamat kaps 250 mg Kap 158.00 - - - - - - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 - - 200 200 200 100.00 - - 20,000.00
46 Asam pipemidat kap 400 mg/Urotractin tab Tab 1,815.00 - - - 1,815.00 - - -
47 Asam traneksamat injeksi 50 mg/ml Ampul 1,956.00 - - - 1,956.00 - - -
48 Asifit Tab Tab 1,818.00 - - - - - - -
49 Asiklovir Krim Tube @ 5g 2,861.00 - - - - - - -
50 Asiklovir Krim Tube @ 5g 3,138.00 - - - - - - -
51 Asiklovir salep mata 3%/Temiral Eye Oint Tube 3,5 g 24,750.00 - - - - - - -
52 Asiklovir tab 200 mg Tab 240.00 - - - 240.00 - - -
53 Asiklovir tab 200 mg Tab 249.00 - - - 249.00 - - -
54 Asiklovir tab 400 mg Tab 226.08 - - - - - - -
55 Atapulgit tab 600 mg/Pularex Tab 140.00 - - - 140.00 - - -
56 Atropin Sulfat Inj 0,25mg/1ml Ampul 1,230.00 - - - - - - -
57 Atropin Sulfat Inj 0,25mg/1ml Ampul 1,540.00 - - - - - - -
58 Atropin Sulfat Inj 0,25mg/1ml Ampul 1,595.00 - - - 1,595.00 - - -
59 Bricasma respules inh 2,5mg/1ml Ampul 1,691.00 - - - 1,020.00 - - -
60 Bedak salisil serbuk 2% Ktk @ 50 g 1,020.00 - - - 1,691.00 - - -
61 Betahistine Maleat 6 mg Tablet 149.00 - - - - - - -
62 Betametason krim 0,1% Tube 5 gr 1,349.00 - - - - - - -
63 Betametason krim 0,1% Tube 5 gr 1,340.00 - - - - - - -
64 Betason N Krim Tube 5 gr 9,182.00 - - - - - - -
65 Bioneuron Inj Ampul 4,341.00 - - - - - - -
66 Bisakodil suppositoria 10 mg/Stolax Supp Supp 6,045.00 - - - - - - -
67 Bisoprolol tablet 2,5 mg/Concor 2,5 mg Tab 597.00 - - - 597.00 - - -
68 Chloramfecort H Cream Tube @ 5g 9,085.00 - - - - - - -
69 Deksametason inj 5 mg/ml Ampul 1,580.00 - - - - - - -
70 Deksametason inj 5 mg/ml Ampul 1,097.00 - - - 1,097.00 - - -
71 Deksametason tablet 0,5 mg Tab 62.00 - - - 41.00 - - -
72 Deksametason tablet 0,5 mg Tab 41.00 - - - - - - -
73 Deksametason tablet 0,5 mg Tab 32.00 - - - 32.00 - - -
74 Dekstran 70-larutan infus 6% steril Botol 40,100.00 - - - - - - -
75 Diazepam larutan rektal 5 mg/2,5 mL/Stesolid Tube @ 2,5 ml 12,573.00 - - - 12,573.00 - - -
76 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 2,344.00 - - - - - - -
77 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 1,735.00 - - - - - - -
78 Diazepam tablet 2 mg Tab 86.00 - - - 86.00 - - -
79 Diazepam tablet 5 mg Tab 117.00 - - - 109.00 - - -
80 Dietilkarbamazin tablet scored 100 mg Tab 119.00 - - - 119.00 - - -
81 Difenhidramin inj 10 mg/ml (HCl) Ampul 1,054.00 - - - 1,062.00 - - -
82 Difenhidramin inj 10 mg/ml (HCl) Ampul 1,062.00 - - - - - - -
83 Difenhidramin inj 10 mg/ml (HCl) Ampul 1,095.00 - - - 1,095.00 - - -
84 Digoksin tablet 0,25 mg Tab 91.00 - - - - - - -
85 Digoksin tablet 0,25 mg Tab 105.00 - - - - - - -
86 Diltiazem HCl tablet 30 mg Tab 134.00 - - - - - - -
87 Doksisiklin Kap 100 mg Kapsul 268.00 - - - 268.00 - - -
88 Domperidon susp/sirup 5 mg/5 ml btl @ 60 ml 2,700.00 - - - - - - -
89 Domperidon tablet 10 mg Tab 176.00 - - - - - - -
90 Domperidon tablet 10 mg Tab 95.00 - - - 95.00 - - -
91 Efedrin tab 25 mg Tab 176.00 - - - - - - -
92 Ekstrak Beladona tab 10 mg Tab 38.00 - - - - - - -
93 Epinefrin (Adrenalin) inj 1 mg/ml Ampul 8,100.00 - - - - - - -
96 Eritromisin kaps 250 mg Kapsul 557.00 - - - 557.00 - - -
97 Eritromisin kaplet 500 mg Kaplet 557.00 - - - 557.00 - - -
98 Eritromisin sirup kering 200 mg/ 5 ml Botol @60 ml 6,150.00 - - - 6,150.00 - - -
99 Etakridina (Rivanol) Lar 0,1 % 300 ml Botol 3,568.00 - - - - - - -
100 Etakridina (Rivanol) Lar 0,1 % 300 ml Botol 3,289.00 - - - - - - -
101 Etanol 70% cairan btl @ 100 ml 255.00 - - - - - - -
102 Etanol 70% cairan Btl @ 1000 ml 4,700.00 - - - - - - -
103 Etanol 70% cairan Btl @ 1000 ml 18,600.00 - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - -
105 Febrinex Syr Btl @ 60 ml 15,830.00 - - - - - - -
106
80,000.00 - - - - - - -
107 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 1,800.00 - - - 1,800.00 - - -
108 Fenol gliserol TT 10 % Btl @ 5ml 2,590.00 - - - 2,500.00 - - -
109 Finasterid tab 5 mg/Prostacom Tab Tab 634.00 - - - - - - -
110 Fitomenadion (Vit.K1) tab salut gula 10 mg Tab 634.00 - - - 634.00 - - -
111 Fitomenadion (Vit.K1) tab salut gula 10 mg Tab 710.00 - - - 710.00 - - -
112 Fituno Tab Tab 3,014.00 - - - - - - -
113 Flusinolon asetonid krim 0,025%/Synarcus Tube 5 g 2,400.00 - - - - - - -
114 Furosemid inj 10 mg/ml Ampul 1,829.00 - - - - - - -
115 Furosemid tablet 40 mg Tab 80.00 - - - 80.00 - - -
116 Gentamisin injeksi 40 mg/ ml Ampul 3,399.00 - - - - - - -
117 Gentamisin injeksi 40 mg/ ml Ampul 3,386.00 - - - 3,386.00 - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 - - - - - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 - - - 2,960.00 - - -
120 Gentamisin tetes mata 0,3% Btl @ 5 ml 3,194.00 - - - - - - -
121 Gentamisin tetes mata 0,3% Btl @ 5 ml 4,170.00 - - - - - - -
122 Gentian Violet 1% Btl 900.00 - - - - - - -
123 Glibenklamid tablet 5 mg Tab 119.00 - - - 56.00 - - -
124 Gliklazid tab 80 mg/Glicab Tab Tab 248.00 - - - - - - -
125 Glimepiride tablet 2 mg Tab 436.00 - - - - - - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 - - - - - - -
129 Glukosa larutan infus 10 % steril Btl @ 500 ml 7,500.00 - - - - - - -
130 Glukosa larutan infus 5 % steril Btl @ 500 ml 5,200.00 - - - - - - -
131 Glukosa larutan infus 5 % steril Btl @ 500 ml 6,900.00 - - - 6,900.00 - - -
132 Glukosa Larutan Infus 40 % btl @ 100 ml 1,960.00 - - - - - - -
133 Griseofulvin tablet 125 mg Tab 249.00 - - - 1.00 - - -
134 Griseofulvin tablet 125 mg Tab 210.00 - - - 210.00 - - -
135 Hidroklorotiazid (HCt ) Tab 25 mg Tab 155.00 - - - 149.00 - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 - - - 2,399.00 - - -
137 Hidrokortison krim 2,5 % Tube 5 gr 2,475.00 - - - - - - -
138 Ibuprofen sirup 100 mg/5 ml btl @ 60 ml 2,475.00 - - - - - - -
139 Ibuprofen tablet 200 mg Tab 110.00 - - - - - - -
140 Ibuprofen tablet 200 mg Tab 105.00 - - - 105.00 - - -
141 Ibuprofen tablet 400 mg Tab 111.00 - - - - - - -
142 Ichtyol Salep Pot @ 30 gram 4,420.00 - - - - - - -
143 Isosorbid Dinitrat tablet sublingual 5 mg Tab 88.00 - - - - - - -
144 Isosorbid Dinitrat 10 mg/Fasorbid 10 mg Tab 198.00 - - - 198.00 - - -
145 Kalium Diklofenak tab 25 mg Tab 332.00 - - - - - - -
146 Kalium Diklofenak tab 50 mg Tab 425.00 - - - - - - -
147 Kalsium Laktat (Kalk) tab 500 mg Tab 56.00 - - - 56.00 - - -
148 Kaptopril tablet scored 25 mg Tab 80.00 100 8,000.00 100 100 80.00 - - 8,000.00
149 Kaptopril tablet scored 25 mg Tab 75.00 - - - 75.00 - - -
150 Kaptopril tablet scored12,5 mg Tab 62.00 - - - 62.00 - - -
151 Kaptopril tablet scored12,5 mg Tab 59.00 - - - 59.00 - - -
152 Ketokonazol krim 2% Tube @ 15 g 4,700.00 - - - 4,700.00 - - -
153 Ketokonazol krim 2% Tube @ 15 g 2,599.00 - - - 2,599.00 - - -
154 Ketokonazol tablet 200 mg Tab 280.00 - - - 280.00 - - -
155 Ketorolac injeksi 30 mg/ml Ampul 2,300.00 - - - 2,300.00 - - -
156 Ketorolac injeksi 30 mg/ml Ampul 1,045.00 - - - 1,045.00 - - -
157 Klindamisin kapsul/kaplet 150 mg Kapsul 715.00 - - - 382.00 - - -
158 Klindamisin kapsul/kaplet 300 mg Kapsul 553.00 - - - 553.00 - - -
159 Klonidin tablet 0,15 mg Tab 170.00 - - - 170.00 - - -
162 Kloramfenikol kap 250 mg Kapsul 310.00 - - - 310.00 - - -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 - - - 3,008.00 - - -
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 - - - 1,881.00 - - -
165 Kloramfenikol inj 1000 mg/Chloramex inj vial 7,954.00 - - - 7,954.00 - - -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 - - - 4,700.00 - - -
167 Kloramfenikol Tetes Mata/Decacetin OTM Btl @ 5 ml 3,250.00 - - - 3,250.00 - - -
168 Kloramfenikol Tetes Telinga Btl @ 5 ml 5,940.00 - - - 5,940.00 - - -
169 Klorfeniramina Maleat (CTM) tab 4 mg Tab 51.00 - - 300 300 200 51.00 100 5,100.00 10,200.00
170 Klorfeniramina Maleat (CTM) tab 4 mg Tab 42.00 - - - 42.00 - - -
171 Klorfeniramina Maleat (CTM) tab 4 mg Tab 22.00 - - - 22.00 - - -
172 Kodein tablet 10 mg Tab 500.00 - - - 500.00 - - -
173 Komb Amoks + As. Klavulanat/Co-Amoxiclav 625mg Tab 4,550.00 - - - 4,550.00 - - -
tab+as.folat/Tab. Tambah Darah 352.00 - - - 352.00 - - -
tab+as.folat/Tab. Tambah Darah 354.00 - - - 354.00 - - -
176 Kombinasi tetes mata /Cendo Lyteers Btl @ 15 ml 15,750.00 - - - 15,750.00 - - -
177 Kombinasi tetes mata /Cendo Lyteers Btl @ 15 ml 19,125.00 - - - 19,125.00 - - -
178 Kotrimoksazol DOEN I (dewasa) komb Tab 138.00 - - - 138.00 - - -
179 Kotrimoksazol DOEN I (dewasa) komb Tab 129.00 - - - 129.00 - - -
180 Kotrimoksazol Pediatrik Tab Tab 75.00 - - - 75.00 - - -
181 Kotrimoksazol Suspensi komb Btl @ 60 ml 2,190.00 - - - 2,190.00 - - -
182 Kotrimoksazol Suspensi komb Btl @ 60 ml 2,286.00 - - - 2,286.00 - - -
183 Lanzoprazol kapsul/kaplet 30 mg Kapsul 473.00 - - - 473.00 - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - -
185 Lidokain injeksi 2% (HCl) Ampul 1,937.00 - - - 1,937.00 - - -
186 Lidokain injeksi 2% (HCl) Ampul 1,145.00 - - - 1,145.00 - - -
187 Lidokain jeli 2%/Xylocaine Jelly 2% syringe @ 10 g 40,000.00 - - - 40,000.00 - - -
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - -
190 Loperamid tablet 2 mg Tab 89.00 - - - 89.00 - - -
191 Loperamid tablet 2 mg Tab 85.00 - - - 85.00 - - -
192 Loratadin tablet 10 mg Tab 125.00 - - - 125.00 - - -
193 Mebendazol tablet 500 mg/Vermox tab Tab 7,140.00 - - - 7,140.00 - - -
194 Mebendazol Sirup 50 mg/ml btl 3,534.00 - - - 3,534.00 - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - -
196 Meloxicam 15 mg tab 1,199.00 - - - 1,199.00 - - -
197 Metformin HCl tablet 500 mg Tab 112.50 - - - 112.50 - - -
198 Metformin HCl tablet 500 mg Tab 94.00 - - - 94.00 - - -
199 Metilergometrin Maleat tab salut 0,125 mg Tab 153.00 - - - 153.00 - - -
200 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 8,935.00 - - - 8,935.00 - - -
201 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 2,959.00 - - - 2,959.00 - - -
202 Metilprednisolon tablet 16 mg Tab 1,076.00 - - - 1,076.00 - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 - - - 205.00 - - -
207 Metoklopramide injeksi 5 mg/ ml Ampul 3,395.00 - - - 3,395.00 - - -
208 Metoklopramide sirup 5 mg/ 5 ml/Lexapram syr Btl @ 60 ML 2,600.00 - - - 2,600.00 - - -
209 Metoklopramide tablet 10 mg Tab 91.00 - - - 91.00 - - -
210 Metoklopramide tablet 10 mg Tab 80.00 - - - 80.00 - - -
211 Metronidazol infus 500 mg/100 ml Btl @ 100 ml 9,950.00 - - - 9,950.00 - - -
212 Metronidazol ovula 500 mg/Vagizol Tab Vag 3,850.00 - - - 3,850.00 - - -
213 Metronidazol sirup 125 mg/5 Ml Btl @ 60ml 3,950.00 - - - 3,950.00 - - -
214 Metronidazol supositoria 500 mg/Flagyl Supp 3,220.00 - - - 3,220.00 - - -
215 Metronidazol tablet 250 mg Tab 110.00 - - - 110.00 - - -
220 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,000.00 - - - 3,000.00 - - -
221 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,250.00 - - - 3,250.00 - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - -
223 Miraneuron kap Kap 598.00 - - - 598.00 - - -
224 Multivitamin Kom Dewasa/Ramaton Tab Tab 698.00 - - - 698.00 - - -
225 Multivitamin Anak+DHA Syr/Bionick DHA Milk Syr Btl @ 60 ml 16,000.00 - - - 16,000.00 - - -
226 Multivitamin Anak Syr/Bionick Syr Btl @ 60 ml 18,700.00 - - - 18,700.00 - - -
227 Multivitamin Bayi Drop/Bionick Drop Btl @ 30 ml 22,500.00 - - - 22,500.00 - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - -
230 Natrium Bikarbonat Tab 500mg Tab 24.00 - - - 24.00 - - -
231 Natrium Diklofenak tablet 50 mg Tab 200.00 - - - 200.00 - - -
231 Natrium Diklofenak tablet 50 mg Tab 122.00 - - - 200.00 - - -
232 Natrium Diklofenak tablet 25 mg Tab 132.00 300 39,600.00 300 100 132.00 200 26,400.00 13,200.00
233 Natrium Tiosulfat Inj 25%-10 ml Ampul 3,000.00 - - - 3,000.00 - - -
234 Neurovit E tab Tab 818.00 - - - 818.00 - - -
235 Nifedipin tab 10 mg Tab 110.00 - - - 110.00 - - -
236 Nifedipin tab 10 mg Tab 110.00 - - - 110.00 - - -
237 Nistatin tablet salut 500.000 IU/ g Tab 640.00 - - - 640.00 - - -
238 Nistatin tablet salut 500.000 IU/ g Tab 765.00 - - - 765.00 - - -
239 Nistatin vaginal tablet 100.000 IU/ g Tab Vag 480.00 - - - 480.00 - - -
240 Nistatin vaginal tablet 100.000 IU/ g Tab Vag 560.00 - - - 560.00 - - -
241 Noza tab Tab 399.00 - - - 399.00 - - -
242 Obat Batuk Hitam (OBH) Syrup Btl @ 100 ml 4,230.00 - - - 4,230.00 - - -
243 Obat Batuk Hitam (OBH) Syrup Btl @ 100 ml 6,600.00 - - - 6,600.00 - - -
244 Obat Batuk pilek Komb (Hustab tab) Tab 284.00 - - - 284.00 - - -
245 Obat Flu Anak komb (Flutamol Syr) Btl @ 100 ml 13,500.00 - - - 13,500.00 - - -
246 Ofloxacin tablet 200 mg Tab 400.00 - - - 400.00 - - -
247 Ofloxacin tablet 400 mg Tab 650.00 - - - 650.00 - - -
248 Ofloksasin tetes telinga 3%/Tarivid Otic Solution Botol 45,089.00 - - - 45,089.00 - - -
249 Oksimetazolin tts hidung 0,025%/Ilaidin Drop botol @ 10 ml 27,550.00 - - - 27,550.00 - - -
250 Oksimetazolin tts hidung 0,025%/Ilaidin Drop botol @ 10 ml 30,000.00 - - - 30,000.00 - - -
251 Oksitetrasiklin HCl inj 50 mg/ ml Vial 3,100.00 - - - 3,100.00 - - -
252 Oksitetrasiklin HCl Salep 3 % Tube 2,514.00 - - - 2,514.00 - - -
253 Oksitetrasiklin HCl Salep 1 % Tube 1,824.00 - - - 1,824.00 - - -
254 Omeprazol injeksi 40 mg/ 10 ml Vial 36,000.00 - - - 36,000.00 - - -
255 Omeprazol injeksi 40 mg/ 10 ml Vial 9,898.00 - - - 9,898.00 - - -
256 Omeprazol kaps 20 mg Kaps 211.00 - - - 211.00 - - -
259 ondansetron inj 4 mg/ 2 mL Ampul 2,400.00 - - - 2,400.00 - - -
260 ondansetron inj 4 mg/ 2 mL Ampul 1,254.00 - - - 1,254.00 - - -
261 Ondansetron tab 4 mg Tab 716.00 - - - 716.00 - - -
262 Ondansetron tablet 8 mg Tab 1,189.00 - - - 1,189.00 - - -
263 Papaverin Tab Tab 112.00 - - - 112.00 - - -
264 Papaverin Inj Ampul 1,150.00 - - - 1,150.00 - - -
265 Parasetamol drop ( Generik) Botol @ 15 Ml 5,200.00 - - - 5,200.00 - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 - - 15 15 10 1,438.00 5 7,190.00 14,380.00
267 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,107.00 - - - 1,107.00 - - -
268 Parasetamol tablet 500 mg Tab 79.00 - - 500 500 300 79.00 200 15,800.00 23,700.00
269 Parasetamol Drop /Fasidol Drop Btl @ 15 ml 6,450.00 - - - 6,450.00 - - -
270 Perak sulfadiazin krim 1%/Burnazine cr tube @ 35 gram 20,700.00 - - - 20,700.00 - - -
271 Permetrin krim 5%/Scabimite Cream Tube @ 10 g 10,430.00 - - - 10,430.00 - - -
272 Permetrin krim 5%/Scabimite Cream Tube @ 10 g 12,155.00 - - - 12,155.00 - - -
273 Petidin inj 50 mg/ml (HCl) Ampul 14,500.00 - - - 14,500.00 - - -
274 Pirantel suspensi 125 mg/5 ml Btl @ 60 ml 8,360.00 - - - 8,360.00 - - -
275 Pirantel tablet score (base) 125 mg Tab 277.00 - - - 277.00 - - -
276 Piridoksin (vitamin B6) 10 mg Tab 27.00 - - - 27.00 - - -
277 Piridoksin (vitamin B6) 10 mg Tab 118.00 100 11,800.00 100 118.00 100 11,800.00 -
278 Piroxicam tab 10mg Tab 86.00 - - - 86.00 - - -
279 Piroxicam tab 20mg Tab 105.00 - - - 105.00 - - -
280 Povidon Iodida larutan 10% 1000 ml Btl @ 1000 ml 87,604.00 - - - 87,604.00 - - -
281 Povidon Iodida larutan 10% 30 ml Bt l@ 30 ml 2,000.00 - - - 2,000.00 - - -
282 Povidon Iodida larutan 10% 30 ml Bt l@ 30 ml 3,190.00 - - - 3,190.00 - - -
283 Povidon Iodida larutan 10% 300 ml Btl @ 300 ml 14,203.00 - - - 14,203.00 - - -
284 Povidon Iodida larutan 10% 60 ml btl 60 ml 3,500.00 - - - 3,500.00 - - -
285 Prednison tablet 5 mg Tab 98.00 - - - 98.00 - - -
286 Prednison tablet 5 mg Tab 76.00 - - - 76.00 - - -
287 Progastric tab Tab 303.00 - - - 303.00 - - -
288 Propanolol tablet 10 mg ( HCl ) Tab 65.00 - - - 65.00 - - -
289 Propanolol tablet 10 mg ( HCl ) Tab 54.00 - - - 54.00 - - -
290 Propranolol tablet 40 mg (HCl) Tab 107.00 - - - 107.00 - - -
291 Propiltiourasil tab 100 mg Tab 264.00 - - - 264.00 - - -
292 Ranitidin injeksi 25 mg/ml Ampul 1,140.00 - - - 1,140.00 - - -
293 Ranitidin tablet 150 mg Tab 98.00 - - - 98.00 - - -
294 Ringer Laktat larutan infus Btl @ 500 ml 5,200.00 - - - 5,200.00 - - -
295 Ringer Laktat larutan infus Btl @ 500 ml 7,150.00 - - - 7,150.00 - - -
296 Risperidon tablet 2 mg Tab 347.00 - - - 347.00 - - -
297 Salbutamol tab 2mg Tab 71.00 - - - 71.00 - - -
298 Salbutamol tab 2mg Tab 66.00 - - - 66.00 - - -
299 Salbutamol Tab 4 mg Tab 141.00 - - - 141.00 - - -
300 Salbutamol Tab 4 mg Tab 83.00 - - - 83.00 - - -
301 Salbutamol cairan ih 0,1%/Ventolin Nebules Btl 16,445.00 - - - 16,445.00 - - -
302 Salbutamol inh 100 mcg/dosis/Ventolin Inhaler Btl 63,750.00 - - - 63,750.00 - - -
303 Salbutamol Syr Btl 4,750.00 - - - 4,750.00 - - -
304 Salep 2-4 , Komb Pot @ 30 gram 2,000.00 - - - 2,000.00 - - -
307 Sefadroksil sirup kering 125 mg/5ml Btl @ 60 ml 3,984.00 - - - 3,984.00 - - -
308 Sefadroksil kapsul 500 mg Kapsl 509.00 - - - 509.00 - - -
309 Sefaleksin kapsul 500 mg Kapsul 516.00 - - - 516.00 - - -
310 Sefaleksin kapsul 500 mg Kapsul 1,000.00 - - - 1,000.00 - - -
311 Sefiksim kapsul 100 mg Kapsul 859.00 - - - 859.00 - - -
312 Sefiksim sirup kering 100 mg/ 5 ml Btl @ 30 ml 7,490.00 - - - 7,490.00 - - -
313 Sefotaksim injeksi 1 g Vial 2,950.00 - - - 2,950.00 - - -
314 Sefotaksim injeksi 1 g Vial 6,325.00 - - - 6,325.00 - - -
315 Seftriakson serbuk injeksi 1 g/vial Vial 3,300.00 - - - 3,300.00 - - -
316 Serum ABU Polivalen inj 5 ml Vial 589,900.00 - - - 589,900.00 - - -
317 Serum ABU Polivalen inj 5 ml Vial 473,000.00 - - - 473,000.00 - - -
318 Serum ATS 1500 IU/ml Ampul 157,000.00 - - - 157,000.00 - - -
319 Serum ATS 1500 IU/ml Ampul 130,999.00 - - - 130,999.00 - - -
320 Serum ATS 20.000 mcg.ml Vial 523,300.00 - - - 523,300.00 - - -
321 Setirizin sirup 5 mg/5 ml Btl @ 60 ml 2,850.00 - - - 2,850.00 - - -
322 Setirizin tablet 10 mg Kapsul 181.00 - - - 181.00 - - -
325 Sianokobalamin (vitamin B12) inj 500 mcg Ampul 1,077.00 - - - 1,077.00 - - -
326 Sianokobalamin (vitamin B12) inj 500 mcg Ampul 1,035.00 - - - 1,035.00 - - -
327 Sianokobalamin (vitamin B12) tab 50 mcg Tab 46.00 - - - 46.00 - - -
328 Simetidine Tab 10 mg Tab 160.00 - - - 160.00 - - -
329 Simvastatin scored tablet 10 mg Kap 169.00 - - - 169.00 - - -
330 Simvastatin scored tablet 10 mg Kap 110.00 - - - 110.00 - - -
331 Simvastatin tab 20 mg Tab 229.00 - - - 229.00 - - -
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 - - - 255.00 - - -
333 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 240.00 - - - 240.00 - - -
334 Spiramisin tablet 500 mg Tab 1,499.00 - - - 1,499.00 - - -
335 Spironolakton tablet 100 mg Tab 900.00 - - - 900.00 - - -
336 Spironolakton tablet 25 mg Tab 294.00 - - - 294.00 - - -
337 Stimuno Syr Btl @ 60 ml 25,420.00 - - - 25,420.00 - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - -
339 Sukralfat susp 500 mg/5 mL/Ulsafate Btl @ 100 ml 13,425.00 - - - 13,425.00 - - -
340 Sukralfat tab 500 mg/Ulsidex Tab 296.00 - - - 296.00 - - -
341 Tab Tambah darah/Hemafort Tab 834.90 - - - 834.90 - - -
342 Terbutalin tablet 2,5 mg/Molasma Tab 99.00 - - - 99.00 - - -
343 Tetrasiklin kapsul 250 mg Kapsul 149.00 - - - 149.00 - - -
344 Tetrasiklin kapsul 250 mg Kapsul 168.00 - - - 168.00 - - -
345 Tetrasiklin Kapsul 500 mg Kapsul 300.00 - - - 300.00 - - -
346 Tetrasiklin Kapsul 500 mg Kapsul 310.00 - - - 310.00 - - -
347 Thiamin HCl inj 100mg/ml Ampul 690.00 - - - 690.00 - - -
348 Thiamin Mononitrat Tab 50 mg Tab 376.00 - - 300 300 100 376.00 200 75,200.00 37,600.00
349 Thiamin Mononitrat Tab 50 mg Tab 82.00 - - - 82.00 - - -
350 Thiamfenikol Kap 500 mg Kapsul 900.00 - - - 900.00 - - -
351 Tramadol injeksi 50 mg/ml Ampul 2,395.00 - - - 2,395.00 - - -
352 Tramadol injeksi 50 mg/ml Ampul 1,800.00 - - - 1,800.00 - - -
353 Tramadol Tab 50 mg Tab 387.00 - - - 387.00 - - -
354 Urea krim 10%/Soft U Derm tube 6,809.00 - - - 6,809.00 - - -
355 Videne Povidone Iodine 500 ml Btl 27,500.00 - - - 27,500.00 - - -
356 Vitamin Tab/Becefort Tab Tab 1,545.43 - - - 1,545.43 - - -
358 Vitamin B Kompleks tablet Tab 22.00 - - - 22.00 - - -
359 Vitamin B Kompleks tablet Tab 115.00 - - - 115.00 - - -
OBAT ASKES - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - -
361 Cargesik tab 500 mg Tab 448.00 - - - 448.00 - - -
362 Farmoten tab 12,5 mg Tab 270.00 - - - 270.00 - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - -
365 Levertraan Zalf Pot 4,091.00 - - - 4,091.00 - - -
- -
OBAT PROGRAM GIGI - -
368 Air Raksa DentalUse Botol 103,536.00 - - - 103,536.00 - - -
369 Devitalisasi Pasta (Non Arsen) Pot 382,000.00 - - - 382,000.00 - - -
370 Etil Klorida Semprot Botol 107,000.00 - - - 107,000.00 - - -
371 Eugenol cairan Botol 18,100.00 - - - 18,100.00 - - -
372 Glass Ionomer Cement (gc IX) Btl 858,000.00 - - - 858,000.00 - - -
373 Kalsium hidroksida Pasta Set 23,850.00 - - - 23,850.00 - - -
374 Kalsium hidroksida Pasta Set 23,000.00 - - - 23,000.00 - - -
375 Monoklor Mentol Cairan/CHKM Btl 55,000.00 - - - 55,000.00 - - -
376 Mummfying Pasta Btl 172,250.00 - - - 172,250.00 - - -
377 Mummfying Pasta Btl 172,000.00 - - - 172,000.00 - - -
378 Semen Seng Fosfat Serbuk Btl 93,500.00 - - - 93,500.00 - - -
379 Semen Seng Fosfat Serbuk Btl 93,000.00 - - - 93,000.00 - - -
380 Silver Amalgam Btl 227,311.00 - - - 227,311.00 - - -
381 Spon Gelatin Cubicles 1x1x1 cm Buah 9,471.00 - - - 9,471.00 - - -
382 Temporary Stopp. F. srb & Cair Btl 34,000.00 - - - 34,000.00 - - -
383 Trikresol Formalin Btl 40,330.00 - - - 40,330.00 - - -
- -
OBAT PROGRAM JIWA - -
386 Amitriptilin tablet salut 25 mg (HCl) Tab 112.00 - - - 112.00 - - -
387 Amitriptilin tablet salut 25 mg (HCl) Tab 143.00 - - - 143.00 - - -
388 Risperidon tablet 2 mg Tab 347.00 - - - 347.00 - - -
389 Fenitoin injeksi 50mg/ml Ampul 20,250.00 - - - 20,250.00 - - -
390 Fenitoin kap 100mg kaplet 152.00 - - - 152.00 - - -
391 Fenobarbital tab 100 mg Tab 220.00 - - - 220.00 - - -
392 Fenobarbital tab 30 mg Tab 64.00 - - - 64.00 - - -
393 Haloperidol tablet 0,5 mg Tab 56.00 - - - 56.00 - - -
394 Haloperidol tablet 1,5 mg Tab 61.00 - - - 61.00 - - -
395 Haloperidol tablet 5 mg Tab 96.00 - - - 96.00 - - -
396 Haloperidol tablet 5 mg Tab 75.00 - - - 75.00 - - -
397 Karbamazepin sir 100 mg/5 ml/Tegretol Syr Btl @ 120 ml 44,770.00 - - - 44,770.00 - - -
398 Karbamazepin tablet 200 mg Tab 228.00 - - - 228.00 - - -
399 Klorpromazin tablet salut 100 mg (HCl) Tab 149.00 - - - 149.00 - - -
400 Klorpromazin injeksi i.m. 25 mg/ml (HCl) Ampul 1,021.00 - - - 1,021.00 - - -
401 Klorpromazin tablet salut 25 mg (HCl) Tab 68.00 - - - 68.00 - - -
- - - -
OBAT PROGRAM FARMASI - - - -
404 Alu +Mortir 10 Cm Buah 65,738.00 - - - 65,738.00 - - -
405 Boraks Test Set 1,642,000.00 - - - 1,642,000.00 - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - -
407 Formalin Test Set 1,641,500.00 - - - 1,641,500.00 - - -
408 Formalin Test Set 1,264,850.00 - - - 1,264,850.00 - - -
- - - -
OBAT PROGRAM MALARIA - - - -
412 ACT Tab Blister 1,375.00 - - - 1,375.00 - - -
413 Antimalaria DOEN kombinasi /suldox tab Tab 478.00 - - - 478.00 - - -
414 Artemether injeksi 80 mg/ml/Artem Ampul 25,490.00 - - - 25,490.00 - - -
415 Arterakin/Darplex/DHP Tab Tab 3,567.00 - - - 3,567.00 - - -
416 Artesunate inj 60 mg/ml/Artesunate Vial 39,000.00 - - - 39,000.00 - - -
417 Fokus Malaria PF&PV Casette Unit 53,110.00 - - - 53,110.00 - - -
418 Kuinin (Kina) tablet 200 mg Tab 670.00 - - - 670.00 - - -
419 Kuinin injeksi i.v. 25% (sebagai 2 HCl) Ampul 6,200.00 - - - 6,200.00 - - -
420 Kuinin tablet 222 mg (H2SO4.7H2O) Tab 400.00 - - - 400.00 - - -
421 Larvasida Malaria Galon 11,200,000.00 - - - 11,200,000.00 - - -
422 Primakuin tablet 15 mg Tab 224.00 - - - 224.00 - - -
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - -
OBAT PROGRAM DIARE - - - -
426 Garam Oralit I serbuk, kombi Sacchet 264.00 - - - 264.00 - - -
427 Zinc drop 10 mg/mL/Zincpro Drops Btl @15 ml 6,281.00 - - - 6,281.00 - - -
428 Zinc sir 10 mg/mL/Zinc Kid Btl @ 100 ml 14,980.00 - - - 14,980.00 - - -
- - - -
OBAT PROGRAM TB - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - -
432 Obat Antituberkulosis FDC Kategori 1 Paket 374,384.00 - - - 374,384.00 - - -
433 Obat Antituberkulosis FDC Kategori 2 Paket 1,247,980.00 - - - 1,247,980.00 - - -
434 Obat Antituberkulosis Kategori 3 Paket 154,000.00 - - - 154,000.00 - - -
435 Obat Antituberkulosis FDC Kategori Anak Paket 214,990.00 - - - 214,990.00 - - -
436 Obat Antituberkulosis FDC Kategori Anak Paket 223,585.00 - - - 223,585.00 - - -
437 Obat Antituberkulosis FDC Sisipan Paket 160,000.00 - - - 160,000.00 - - -
438 Obat Antituberkulosis Kategori 1 dewasa combipac Paket 288,199.00 - - - 288,199.00 - - -
439 Obat Antituberkulosis Kategori anak combipac Paket 171,195.00 - - - 171,195.00 - - -
440 Pyrazinamid Tab 500 mg Tab 234.00 - - - 234.00 - - -
- - - -
OBAT PROGRAM P2 - - - -
443 Insektisida Botol@1ltr 200,000.00 - - - 200,000.00 - - -
444 Insektisida Cynof Botol 198,000.00 - - - 198,000.00 - - -
445 Insektisida Zetta 15 UL Liter 74,470.00 - - - 74,470.00 - - -
446 Insektisida DBD/Mustang TC 95% Fogging Galon @ 5 Liter 968,000.00 - - - 968,000.00 - - -
447 Larvasida Botol@1kg 110,000.00 - - - 110,000.00 - - -
448 Larvasida DBD Jentika Botol @ 1 Kg kg 115,500.00 - - - 115,500.00 - - -
449 Larvasida DBD Bentuk Cair/ Bactivec SL @ 30 ml ml 537.13 - - - 537.13 - - -
450 Larvasida Malaria/Bactivel SL @ 20 Liter Galon 14,464,450.00 - - - 14,464,450.00 - - -
451 MDT Combi Adult Paket 30,595.00 - - - 30,595.00 - - -
452 Oseltamivir tab Tab 13,000.00 - - - 13,000.00 - - -
- - - -
OBAT PROGRAM KELING - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - -
OBAT PROGRAM GIZI - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - -
459 Mineral Mix Sacchet 2,805.00 - - - 2,805.00 - - -
460 Retinol (Vitamin A) 100.000 IU Kapsul 260.00 - - - 260.00 - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - -
OBAT PROGRAM KESEHATAN IBU DAN ANAK - - - -
465 Alat HB Hemoglobin Starter Kit Mission Unit 762,000.00 - - - 762,000.00 - - -
466 Alat tes Hb Hemoglobin Unit 416,666.67 - - - 416,666.67 - - -
467 Benzatin Benzil Penisilin 1,2 juta IU/ vial Vial 8,935.00 - - - 8,935.00 - - -
468 Benzatin Benzil Penisilin 2,4 juta IU/vial Vial 12,185.00 - - - 12,185.00 - - -
469 Fitomenadion (Vitamin K1) inj 2 mg/ml Ampul 1,566.00 - - - 1,566.00 - - -
470 Fitomenadion (Vitamin K1) inj 2 mg/ml Ampul 3,550.00 - - - 3,550.00 - - -
471 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 1,800.00 - - - 1,800.00 - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - -
473 Hb Hemoglobin Strip Test Kotak 403,750.00 - - - 403,750.00 - - -
474 Implant Paket - - - - - - - -
475 IUD Pcs - - - - - - - -
476 Kaporit Tablet Kg 35,990.16 - - - 35,990.16 - - -
477 Kalsium Glukonat inj i.v 10% (100 mg/ml) Ampul 7,800.00 - - - 7,800.00 - - -
478 Kondom Kotak - - - - - - - -
479 Levotiroksin tab 100 mcg/Euthyrox 100 Tab 1,694.00 - - - 1,694.00 - - -
480 Magnesium sulfat injeksi 20% Vial 5,500.00 - - - 5,500.00 - - -
484 Oksitosin injeksi 10 IU/ml Ampul 1,900.00 - - - 1,900.00 - - -
485 Paket KIA Paket - - - - - - - -
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - -
487 Prokain Benzilpenisilin serbuk inj 3 juta IU/vial Vial 10,780.00 - - - 10,780.00 - - -
488 Suntik KB 3 Bln @ 1 ml Vial - - - - - - - -
489 Suntik KB 3 Bln @ 3 ml Vial - - - - - - - -
490 Test Kehamilan Strip 1,460.00 - - - 1,460.00 - - -
491 Test Kehamilan Strip 2,084.00 - - - 2,084.00 - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - -
BAHAN HABIS PAKAI - - - -
495 Alat Suntik 0,05 ml Buah 2,134.00 - - - 2,134.00 - - -
499 Alat Suntik 1 ml. Buah 650.00 - - - 650.00 - - -
502 Alat Suntik 2,5 ml. Buah 650.00 - - - 650.00 - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 5 6,265.00 5 1,253.00 5 6,265.00 -
504 Alat Suntik 2,5 ml. Buah 827.00 - - - 827.00 - - -
505 Alat Suntik 5 ml. Buah 1,000.00 - - - 1,000.00 - - -
506 Alat Suntik 5 ml. Buah 1,624.00 - - - 1,624.00 - - -
507 Alat Suntik 10 ml Buah 1,406.00 10 14,060.00 10 1,406.00 10 14,060.00 -
508 Blood Lancet Kotak 725.00 - - - 725.00 - - -
509 Blood Lancet Kotak 15,191.00 - - - 15,191.00 - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - -
511 Cat Gut/ Benang Bedah no. 2/0 Set 5,583.00 - - - 5,583.00 - - -
515 Folley Cathether No. 14 Buah 8,475.00 - - - 8,475.00 - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - -
526 Infusion Set anak Set 3,500.00 - - - 3,500.00 - - -
529 Infusion Set dewasa/NIPRO Set 5,935.00 - - - 5,935.00 - - -
530 Infusion Set dewasa Set 3,200.00 - - - 3,200.00 - - -
531 Infusion Set dewasa Set 5,184.00 - - - 5,184.00 - - -
532 IV catheter no 18 Buah 3,800.00 - - - 3,800.00 - - -
542 Kasa Pembalut Hidrofil 4m x 10cm Roll 1,083.00 - - - 1,083.00 - - -
543 Kapas Berlemak 500 mg. Roll 16,500.00 - - - 16,500.00 - - -
544 Kapas Pembalut/Adsorben 250 mg. Roll 27,349.28 - - - 27,349.28 - - -
545 Kasa Elastis Roll 23,200.00 - - - 23,200.00 - - -
546 Kasa Meteran 36m x 80cm Roll 150,300.00 - - - 150,300.00 - - -
547 Kasa Pembalut Hidrofil 40Cm x 40cm. Roll 1,928.00 - - - 1,928.00 - - -
548 Kasa Pembalut 2m x 80cm. Roll 9,900.00 - - - 9,900.00 - - -
549 Kasa Pembalut Hidrofil 4m x 15cm. Roll 3,988.00 - - - 3,988.00 - - -
550 Kasa Pembalut Hidrofil 4m x 3cm. Roll 607.00 - - - 607.00 - - -
551 Kasa Pembalut Hidrofil 4m x 5cm. Roll 750.00 - - - 750.00 - - -
552 Kasa Pembalut Hidrofil 4m x 5cm. Roll 1,163.00 - - - 1,163.00 - - -
553 Kasa Steril Kotak 4,300.00 - - - 4,300.00 - - -
554 Kasa Steril Kotak 8,243.00 - - - 8,243.00 - - -
555 Kasa Steril Kotak 8,651.00 3 25,953.00 3 8,651.00 3 25,953.00 -
556 Leucoplast 7,50cm x 4,5m Roll 35,532.00 - - - 35,532.00 - - -
557 Masker Buah 532.80 1 532.80 1 532.80 1 532.80 -
558 Masker Buah 491.00 - - - 491.00 - - -
559 Pembalut Gips Roll 32,200.00 - - - 32,200.00 - - -
560 Plastik Besar Pak 10,000.00 - - - 10,000.00 - - -
561 Plastik Kecil Pak 7,000.00 - - - 7,000.00 - - -
562 Plester 5 Yard x 2 Inc. Roll 23,510.24 - - - 23,510.24 - - -
563 Silk (benang bedah sutra) no 3/0 Set 3,056.00 - - - 3,056.00 - - -
564 Silk (benang bedah sutra) no 3/0 Set 21,455.00 - - - 3,056.00 - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - -
566 Transfussion set Set - - - - - - - -
- - - -
BAHAN LABORATORIUM - - - -
567 Autocliclik Lancing Device Piece 17,938.00 - - - 17,938.00 - - -
568 Alat Hitung bakteri Buah 2,910,000.00 - - - 2,910,000.00 - - -
569 Alat Test Easy Touch Buah 695,000.00 - - - 695,000.00 - - -
570 Alat Benecheck Plus Monitoring Unit 199,855.00 - - - 199,855.00 - - -
571 Alkohol Swab Buah 10,100.00 - - - 10,100.00 - - -
572 Asam Klorida 0,1 N Botol 2,386,304.00 - - - 2,386,304.00 - - -
573 Asam Sulfosalisilat 20% Botol 31,300.00 - - - 31,300.00 - - -
574 Bennecheck Urid Acid Test Strip Kotak 130,269.13 - - - 130,269.13 - - -
575 Bennecheck Total Cholesterol Test Strip Kotak 234,958.14 - - - 234,958.14 - - -
576 Bennecheck Blood Glukosa Test Strip Kotak 157,821.58 - - - 157,821.58 - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - -
578 Batang Pengaduk 25 cm Buah 6,120.00 - - - 6,120.00 - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - -
580 Erlenmeyer 50 ml Buah 21,500.00 - - - 21,500.00 - - -
581 Golongan Darah Anti-A Monoclonal Reagnt Btl@ 10 ml 69,450.00 - - - 69,450.00 - - -
582 Golongan Darah Anti-B Monoclonal Reagent Btl@ 10 ml 69,450.00 - - - 69,450.00 - - -
583 Golongan Darah Anti-A,B Monoclonal Reagent Btl@ 10 ml 93,760.00 - - - 93,760.00 - - -
584 Golongan Darah Anti-D Duoclone Reagent Btl@ 10 ml 115,320.00 - - - 115,320.00 - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - -
586 Kertas Lakmus Buah 49,435.00 - - - 49,435.00 - - -
587 Kertas Golongan darah Lembar 230.00 - - - 230.00 - - -
588 Lampu Spiritus Buah 69,000.00 - - - 69,000.00 - - -
589 Larutan Anisol Btl 1,415,994.00 - - - 1,415,994.00 - - -
590 Larutan Asam Asetat Btl 58,400.00 - - - 58,400.00 - - -
591 Larutan Bennedict Btl 68,000.00 - - - 68,000.00 - - -
592 Larutan Emersi Btl@50ml 203,413.04 - - - 203,413.04 - - -
593 Larutan Eosin 2 % Btl 143,750.00 - - - 143,750.00 - - -
594 Larutan Etanol Asam Btl 28,000.00 - - - 28,000.00 - - -
595 Larutan Gebbet Btl 424,000.00 - - - 424,000.00 - - -
596 Larutan Giemsa Stain Btl@100ml 493,115.00 - - - 493,115.00 - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - -
598 Larutan Karbol Fuksin Btl 74,000.00 - - - 74,000.00 - - -
599 Larutan Kinyoun Btl 785,000.00 - - - 785,000.00 - - -
600 Larutan Metilen Blue Btl 32,600.00 - - - 32,600.00 - - -
601 Larutan Ress Eccer Btl 97,000.00 - - - 97,000.00 - - -
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - -
603 Larutan Xylol Btl 31,000.00 - - - 31,000.00 - - -
604 Larutan Ziehl Nielson Paket - - - - - - - -
605 Malaria test Buah 35,035.00 - - - 35,035.00 - - -
606 Pipet Eritrosit Buah 1,716.00 - - - 1,716.00 - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - -
ALKES - - - -
613 ABN Calibra Aneroid Sphygmomanometer Unit 158,701.00 - - - 158,701.00 - - -
- - - -
VAKSIN - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - -
ITEM BARU - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
676 Betametason 0,1% 5gram Tube 1,300 - - 15 15 9 1,300 6 7,800.00 11,700.00
679 Dexamethasone 0,5mg Tab 107 - - 500 500 200 107 300 32,031.00 21,354.00
681 Glyceril Guaiacolat 100mg Tab 214 - - 500 500 200 214 300 64,059.00 42,706.00
686 Piroxicam 20mg Tab 142 - - - 142 - - -
688 Vitamin B Kompleks Tab 131 - - 300 300 - 131 300 39,270.00 -
JUMLAH 519.00 106,210.80 2,415.00 2,934.00 1,310.00 1,624.00 320,050.80 162,780.00
UMUM BPJS JUMLAH

54 64 118
Kedaloman, 02 februari 2020

Dedy Heriyanto, SKM Airaswati, Amd. Keb

NIP.19730716 199302 1 001
Ket
14
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 330
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 1325
-
-
-
-
ED 300
-
-
-
-
-
-
-
-
-
JKN
-
ED 6
-
-
-
-
-
-
ED 58
ED 58
ED 58
ED 530
ED 104.000
-
-
-
Pecah 5
-
-
-
-
-
-
-
-
-
-
-
ED 210
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 29160
-
-
-
-
-
-
-
-
-
ED 634
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 4700
ED 4700
-
-
-
-
-
-
-
-
-
ED 900
-
-
-
BPOM 9200
-
-
-
-
-
-
-
-
ED 150
-
-
-
-
-
-
-
-
ED 595
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 10630
ED 90
-
-
-
-
-
-
-
-
-
-
-
ED 700
-
-
ED 150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Rusak 5000
-
-
-
ED 12
ED 12
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 280
-
ED 1204
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 280
ED 199
ED 199
-
-
-
-
-
ED 2800
Rusak 14000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 1285
ED 1285
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 400
-
-
-
ED 148
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 1700
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 1.700
-
-
-
ED 30
-
-
-
-
ED 1
ED 1
ED 3
-
-
ED 2
-
ED 302
ED 400
ED 24+152
ED 666
ED 192
-
-
-
ED 360
-
-
ED 40
-
ED 51100
ED 32
-
-
ED 1100
-
ED 16
-
-
ED 1
-
-
-
-
ED 300
ED 200
ED300
-
-
-
-
-
-
-
-
-
ED 700
-
-
-
-
-
-
ED 858
-
ED 14450
-
ED 2880
ED 2880
-
ED 140
ED 29+50
ED 29+50
ED 3870
-
-
-
ED 65
-
-
-
-
-
ED 100
ED 241
ED 60
ED 635+647
Rusak 128
-
-
-
ED 360+400
-
-
-
-
-
-
-
-
-
-
-
ED 6150
ED 5670
ED 5670
ED 5670
ed 2494
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 24
ED 24
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 100
-
-
ED 297
ED 338
ED 338
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 2
ED 622
ED 421
-
-
-
-
-
-
-
-
-
-
-
-
-
-
ED 6
ED 5
-
-
-
-
-
-
-
ED 8
-
ED 4
-
ED 6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
TAHUN 2020
Pustu : CIHERANG
Bulan : MARET
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

12 Amlodipin tablet 10 mg Tab 94.00 90 8,460.00 90 30 - 60 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 400 108,800.00 400 200 233.00 200 46,600.00 46,600.00 -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 300 21,600.00 300 200 62.00 100 6,200.00 12,400.00 -
29 Antasida DOEN II suspensi, komb Btl @ 60 ml 1,995.00 10 19,950.00 10 4 1,995.00 6 11,970.00 7,980.00 -
34 Antifungi Doen Kombinasi Pot @ 30 g 4,496.00 - - - 4,323.00 - - - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 - - - 100.00 - - - -
48 Asifit Tab Tab 1,818.00 - - - - - - - -
52 Asiklovir tab 200 mg Tab 240.00 - - - 240.00 - - - ED 300
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 - - - - - - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 - - - 2,960.00 - - - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 - - - - - - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 - - - 2,399.00 - - - -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 - - - 3,008.00 - - - ED 595
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 - - - 1,881.00 - - - -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 - - - 4,700.00 - - - -
169 Klorfeniramina Maleat (CTM) tab 4 mg Tab 51.00 100 5,100.00 100 100 51.00 - - 5,100.00 -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
192 Loratadin tablet 10 mg Tab 125.00 - - - 125.00 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
232 Natrium Diklofenak tablet 25 mg Tab 132.00 200 26,400.00 200 200 132.00 - - 26,400.00 -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 5 7,190.00 5 5 1,438.00 - - 7,190.00 ED 199
268 Parasetamol tablet 500 mg Tab 79.00 200 15,800.00 200 200 79.00 - - 15,800.00 -
275 Pirantel tablet score (base) 125 mg Tab 277.00 - - - 277.00 - - - -
277 Piridoksin (vitamin B6) 10 mg Tab 118.00 100 11,800.00 100 100 118.00 - - 11,800.00 -
327 Sianokobalamin (vitamin B12) tab 50 mcg Tab 46.00 - - - 46.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
348 Thiamin Mononitrat Tab 50 mg Tab 376.00 200 75,200.00 200 200 376.00 - - 75,200.00 -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 5 6,265.00 5 1,253.00 5 6,265.00 - -
507 Alat Suntik 10 ml Buah 1,406.00 10 14,060.00 10 1,406.00 10 14,060.00 - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 1 532.80 1 1 532.80 - - 532.80 -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
676 Betametason 0,1% 5gram Tube 1,300 6 7,800.00 6 4 1,300 2 2,600.00 5,200.00
679 Dexamethasone 0,5mg Tab 107 300 32,031.00 300 200 107 100 10,677.00 21,354.00
681 Glyceril Guaiacolat 100mg Tab 214 300 64,059.00 300 200 214 100 21,353.00 42,706.00
686 Piroxicam 20mg Tab 142 - - - 142 - - -
688 Vitamin B Kompleks Tab 131 300 39,270.00 300 200 131 100 13,090.00 26,180.00
JUMLAH 1,624.00 347,110.80 - 1,624.00 1,241.00 383.00 102,397.00 217,653.80
UMUM BPJS JUMLAH

72 49 121
Kedaloman, Maret 2020

HASANUDDIN, SKM., M.M AIRASWATI, Amd. Keb

NIP.196608051988031004
TAHUN 2020
Pustu : CIHERANG
Bulan : APRIL
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

6 Ambroksol Tab 30 mg Tab 140.00 - - 500 500 100 - 400 - - -
8 Ambroksol Syr 30mg/5 ml Btl 3,750.00 - - 10 10 3 - 7 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 200 54,400.00 500 700 300 233.00 400 93,200.00 69,900.00 -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 100 7,200.00 - 100 100 62.00 - - 6,200.00 -
34 Antifungi Doen Kombinasi Pot @ 30 g 4,496.00 - - 4 4 4,323.00 4 17,292.00 - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 - - 100 100 100.00 100 10,000.00 - -
48 Asifit Tab Tab 1,818.00 - - - - - - - -
49 Asiklovir Krim Tube @ 5g 2,861.00 - - 5 5 2 - 3 - - -
52 Asiklovir tab 200 mg Tab 240.00 - - 200 200 20 240.00 180 43,200.00 4,800.00 ED 300
62 Betametason krim 0,1% Tube 5 gr 1,349.00 - - 5 5 1 - 4 - - -
71 Deksametason tablet 0,5 mg Tab 62.00 - - 500 500 200 41.00 300 12,300.00 8,200.00 ED 58
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 - - 5 5 - 5 - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 - - 5 5 1 2,960.00 4 11,840.00 2,960.00 -
120 Gentamisin tetes mata 0,3% Btl @ 5 ml 3,194.00 - - 5 5 - 5 - - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 - - 500 500 200 - 300 - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 - - 5 5 1 2,399.00 4 9,596.00 2,399.00 -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 - - 2 2 3,008.00 2 6,016.00 - ED 595
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 - - 5 5 1 1,881.00 4 7,524.00 1,881.00 -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 - - 5 5 4,700.00 5 23,500.00 - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 - - 500 500 200 205.00 300 61,500.00 41,000.00 -
220 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,000.00 - - 5 5 2 3,000.00 3 9,000.00 6,000.00 -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
232 Natrium Diklofenak tablet 25 mg Tab 132.00 - - - 132.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 - - 10 10 1,438.00 10 14,380.00 - ED 199
268 Parasetamol tablet 500 mg Tab 79.00 - - 500 500 200 79.00 300 23,700.00 15,800.00 -
275 Pirantel tablet score (base) 125 mg Tab 277.00 - - 200 200 277.00 200 55,400.00 - -
279 Piroxicam tab 20mg Tab 105.00 - - 500 500 105.00 500 52,500.00 - -
304 Salep 2-4 , Komb Pot @ 30 gram 2,000.00 - - 5 5 2,000.00 5 10,000.00 - -
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 - - 500 500 200 255.00 300 76,500.00 51,000.00 -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 5 6,265.00 5 1,253.00 5 6,265.00 - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
555 Kasa Steril Kotak 8,651.00 2 17,302.00 2 8,651.00 2 17,302.00 - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
676 Betametason 0,1% 5gram Tube 1,300 2 2,600.00 2 1,300 2 2,600.00 -
679 Dexamethasone 0,5mg Tab 107 100 10,677.00 100 107 100 10,677.00 -
681 Glyceril Guaiacolat 100mg Tab 214 100 21,353.00 100 214 100 21,353.00 -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
688 Vitamin B Kompleks Tab 131 100 13,090.00 100 131 100 13,090.00 -
JUMLAH 383.00 116,837.00 4,576.00 4,959.00 1,543.00 3,416.00 583,055.00 214,130.00
UMUM BPJS JUMLAH

57 64 121
Kedaloman, April 2020


NIP.196608051988031004
TAHUN 2020
Pustu : CIHERANG
Bulan : MEI
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

6 Ambroksol Tab 30 mg Tab 140.00 400 56,000.00 400 200 - 200 - - -
8 Ambroksol Syr 30mg/5 ml Btl 3,750.00 7 26,250.00 7 4 - 3 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 400 108,800.00 400 200 233.00 200 46,600.00 46,600.00 -
34 Antifungi Doen Kombinasi Pot @ 30 g 4,496.00 4 17,984.00 4 4,323.00 4 17,292.00 - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 100 10,000.00 100 100 100.00 - - 10,000.00 -
48 Asifit Tab Tab 1,818.00 - - - - - - - -
49 Asiklovir Krim Tube @ 5g 2,861.00 3 8,583.00 3 1 - 2 - - -
52 Asiklovir tab 200 mg Tab 240.00 180 43,200.00 180 20 240.00 160 38,400.00 4,800.00 ED 300
62 Betametason krim 0,1% Tube 5 gr 1,349.00 4 5,396.00 4 2 - 2 - - -
71 Deksametason tablet 0,5 mg Tab 62.00 300 18,600.00 300 100 41.00 200 8,200.00 4,100.00 ED 58
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 5 6,750.00 5 1 - 4 - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 4 11,840.00 4 1 2,960.00 3 8,880.00 2,960.00 -
120 Gentamisin tetes mata 0,3% Btl @ 5 ml 3,194.00 5 15,970.00 5 - 5 - - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 300 34,200.00 300 100 - 200 - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 4 9,596.00 4 1 2,399.00 3 7,197.00 2,399.00 -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 2 6,016.00 2 1 3,008.00 1 3,008.00 3,008.00 ED 595
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 4 7,524.00 4 1 1,881.00 3 5,643.00 1,881.00 -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 5 23,500.00 5 4,700.00 5 23,500.00 - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 300 61,500.00 300 100 205.00 200 41,000.00 20,500.00 -
220 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,000.00 3 9,000.00 3 1 3,000.00 2 6,000.00 3,000.00 -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 10 14,380.00 10 4 1,438.00 6 8,628.00 5,752.00 ED 199
268 Parasetamol tablet 500 mg Tab 79.00 300 23,700.00 300 200 79.00 100 7,900.00 15,800.00 -
275 Pirantel tablet score (base) 125 mg Tab 277.00 200 55,400.00 200 277.00 200 55,400.00 - -
279 Piroxicam tab 20mg Tab 105.00 500 52,500.00 500 200 105.00 300 31,500.00 21,000.00 -
304 Salep 2-4 , Komb Pot @ 30 gram 2,000.00 5 10,000.00 5 2,000.00 5 10,000.00 - -
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 300 76,500.00 300 100 255.00 200 51,000.00 25,500.00 -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 5 6,265.00 5 2 1,253.00 3 3,759.00 2,506.00 -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
676 Betametason 0,1% 5gram Tube 1,300 2 2,600.00 2 2 1,300 - - 2,600.00
679 Dexamethasone 0,5mg Tab 107 100 10,677.00 100 100 107 - - 10,677.00
681 Glyceril Guaiacolat 100mg Tab 214 100 21,353.00 100 100 214 - - 21,353.00
686 Piroxicam 20mg Tab 142 - - - 142 - - -
688 Vitamin B Kompleks Tab 131 100 13,090.00 100 100 131 - - 13,090.00
JUMLAH 3,416.00 763,496.00 - 3,416.00 1,354.00 2,062.00 397,796.00 185,259.00
UMUM BPJS JUMLAH

34 48 82
Kedaloman, 30-May-20
HASANUDDIN, SKM., M.M Nama

NIP.196608051988031004
TAHUN 2020
Pustu : CIHERANG
Bulan : JUNI
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

6 Ambroksol Tab 30 mg Tab 140.00 200 28,000.00 100 300 200 - 100 - - -
8 Ambroksol Syr 30mg/5 ml Btl 3,750.00 3 11,250.00 3 3 - - - - -
12 Amlodipin tablet 10 mg Tab 94.00 40 3,760.00 40 - 40 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 200 54,400.00 500 700 200 233.00 500 116,500.00 46,600.00 -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 - - 500 500 200 62.00 300 18,600.00 12,400.00 -
29 Antasida DOEN II suspensi, komb Btl @ 60 ml 1,995.00 2 3,990.00 2 1,995.00 2 3,990.00 - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 - - 300 300 200 100.00 100 10,000.00 20,000.00 -
48 Asifit Tab Tab 1,818.00 - - - - - - - -
49 Asiklovir Krim Tube @ 5g 2,861.00 2 5,722.00 2 - 2 - - -
52 Asiklovir tab 200 mg Tab 240.00 160 38,400.00 160 240.00 160 38,400.00 - ED 300
62 Betametason krim 0,1% Tube 5 gr 1,349.00 2 2,698.00 2 - 2 - - -
71 Deksametason tablet 0,5 mg Tab 62.00 200 12,400.00 200 100 41.00 100 4,100.00 4,100.00 ED 58
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 4 5,400.00 4 1 - 3 - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 3 8,880.00 3 1 2,960.00 2 5,920.00 2,960.00 -
128 Gliseril Guayakolat tab 100mg Tab 114.00 200 22,800.00 200 100 - 100 - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 3 7,197.00 3 1 2,399.00 2 4,798.00 2,399.00 -
163 Kloramfenikol salep kulit 2%/Bufacetin Tube @ 15g 3,008.00 1 3,008.00 1 3,008.00 1 3,008.00 - ED 595
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 3 5,643.00 3 1 1,881.00 2 3,762.00 1,881.00 -
166 Kloramfenikol suspensi 125 mg/ 5 ml Btl @ 60 ml 4,700.00 5 23,500.00 5 1 4,700.00 4 18,800.00 4,700.00 -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 200 41,000.00 500 700 200 205.00 500 102,500.00 41,000.00 -
220 Mikonazol krim/salep 2 % (Nitrat) Tube 10 gram 3,000.00 2 6,000.00 2 3,000.00 2 6,000.00 - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 6 8,628.00 6 4 1,438.00 2 2,876.00 5,752.00 ED 199
268 Parasetamol tablet 500 mg Tab 79.00 100 7,900.00 500 600 200 79.00 400 31,600.00 15,800.00 -
279 Piroxicam tab 20mg Tab 105.00 300 31,500.00 300 100 105.00 200 21,000.00 10,500.00 -
304 Salep 2-4 , Komb Pot @ 30 gram 2,000.00 5 10,000.00 10 15 2 2,000.00 13 26,000.00 4,000.00 -
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 200 51,000.00 300 500 200 255.00 300 76,500.00 51,000.00 -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 3 3,759.00 3 3 1,253.00 - - 3,759.00 -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
555 Kasa Steril Kotak 8,651.00 1 8,651.00 1 1 8,651.00 - - 8,651.00 -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 2,062.00 506,088.00 2,710.00 4,772.00 1,720.00 3,052.00 575,482.00 238,314.00
UMUM BPJS JUMLAH

53 57 110
Kedaloman, 30-Jun-20

NIP.196608051988031004
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

6 Ambroksol Tab 30 mg Tab 140.00 100 14,000.00 100 - 100 - - -
17 Amoksisilin kap scored 500 mg Kaptab 272.00 500 136,000.00 500 233.00 500 116,500.00 - -
26 Antasida DOEN I tablet kunyah, komb Tab 72.00 300 21,600.00 300 62.00 300 18,600.00 - -
45 Asam Mefenamat kaps 500 mg Kaptab 100.00 100 10,000.00 100 100.00 100 10,000.00 - -
48 Asifit Tab Tab 1,818.00 - - - - - - - -
71 Deksametason tablet 0,5 mg Tab 62.00 100 6,200.00 100 41.00 100 4,100.00 - ED 58
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
118 Gentamisin salep Kulit Tube @ 5 g 1,350.00 3 4,050.00 3 - 3 - - -
119 Gentamisin salep mata 0,3%/Genoint SM Tube @ 3,5 gr 2,960.00 2 5,920.00 2 2,960.00 2 5,920.00 - -
128 Gliseril Guayakolat tab 100mg Tab 114.00 100 11,400.00 100 - 100 - - -
136 Hidrokortison krim 2,5 % Tube 5 gr 2,399.00 2 4,798.00 2 2,399.00 2 4,798.00 - -
164 Kloramfenikol salep mata 1 % Tube 5 gr 1,881.00 2 3,762.00 2 1,881.00 2 3,762.00 - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
203 Metilprednisolon tablet 4 mg Tab 205.00 500 102,500.00 500 205.00 500 102,500.00 - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
266 Parasetamol sirup 120 mg / 5 ml Btl @ 60 ml 1,438.00 2 2,876.00 2 1,438.00 2 2,876.00 - ED 199
268 Parasetamol tablet 500 mg Tab 79.00 400 31,600.00 400 79.00 400 31,600.00 - -
279 Piroxicam tab 20mg Tab 105.00 200 21,000.00 200 105.00 200 21,000.00 - -
332 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 255.00 300 76,500.00 300 255.00 300 76,500.00 - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
503 Alat Suntik 2,5 ml. Buah 1,253.00 - - - 1,253.00 - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

48 Asifit Tab Tab 1,818.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

48 Asifit Tab Tab 1,818.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

48 Asifit Tab Tab 1,818.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

48 Asifit Tab Tab 1,818.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001
TAHUN 2020
Pustu :
Bulan :
1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

48 Asifit Tab Tab 1,818.00 - - - - - - - -
104 Etanol 96% Btl @ 300 ml 25,000.00 - - - - - - - -
106
80,000.00 - - - - - - - -
112 Fituno Tab Tab 3,014.00 - - - - - - - -
184 Levertan Pot 4,780.00 - - - 4,780.00 - - - ED 90
188 Lisol Btl @ 300 ml 21,700.00 - - - 21,700.00 - - - -
189 Lisol Btl @ 300 ml 45,096.70 - - - 45,096.70 - - - -
195 Meloxicam 7,5 mg tab 297.00 - - - 297.00 - - - -
222 Miraclav tab Tab 13,200.00 - - - 13,200.00 - - - -
228 Nacl 0,9% Btl 500 ml 4,700.00 - - - 4,700.00 - - - -
229 Nacl 0,9% Btl 500 ml 6,410.00 - - - 6,410.00 - - - -
241 Noza tab Tab 399.00 - - - 399.00 - - - -
338 Stimuno Tab Tab 2,430.00 - - - 2,430.00 - - - -
360 Broadamox 500 mg Tab 1,100.00 - - - 1,100.00 - - - -
363 Hufadin tab Tab 565.00 - - - 565.00 - - - -
364 Icthyol Zalf Pot 5,455.00 - - - 5,455.00 - - - -
- - -
- - -
- - - - -
406 Boraks Test Set 1,182,000.00 - - - 1,182,000.00 - - - -
- - - - ED 302
423 RDT Malaria Test 5,400.00 - - - 5,400.00 - - -
- - - - ED 51100
- - - - -
431 Isoniazid 100 mg Tab 71.00 - - - 71.00 - - - -
- - - - -
- - - - -
455 Abate Kg 68,500.00 - - - 68,500.00 - - - -
456 Abate Galon @ 25 Kg 2,499,250.00 - - - 2,499,250.00 - - -
- - - - -
458 Iodin Test Btl 19,250.00 - - - 19,250.00 - - - -
464 Taburia Sacchet 457.00 - - - 457.00 - - -
- - - - -
472 HB Sahli Buah 94,600.00 - - - 94,600.00 - - - -
474 Implant Paket - - - - - - - - -
475 IUD Pcs - - - - - - - - -
478 Kondom Kotak - - - - - - - - ED 241
486 Pita Lila Buah 2,145.00 - - - 2,145.00 - - - -
494 Underpad Pcs 4,320.00 - - - 4,320.00 - - -
- - - - -
510 Bisturi No. 11 Buah 3,000.00 - - - 3,000.00 - - - -
520 Hanscond 6,5 Paket 325.00 - - - 325.00 - - - -
521 Hanscond 7 / M Paket 325.00 - - - 325.00 - - - -
522 Hanscond 7 / M Paket 8,436.00 - - - 8,436.00 - - - -
523 Hanscond 7,5/L Paket 325.00 - - - 325.00 - - - -
524 Hanscond 7,5/L Paket 4,625.00 - - - 4,625.00 - - - -
525 Hanscond 8 Paket 325.00 - - - 325.00 - - - -
557 Masker Buah 532.80 - - - 532.80 - - - -
558 Masker Buah 491.00 - - - 491.00 - - - -
565 Sofratull Buah 5,198.00 - - - 21,455.00 - - - -
- - - - -
577 Botol 100 ml Buah 1,650.00 - - - 1,650.00 - - - -
579 Centrifuse Buah 4,900,000.00 - - - 4,900,000.00 - - - -
585 Kawat Ose Buah 13,001.00 - - - 13,001.00 - - - -
597 Larutan H2O2 50 % Btl 14,804.00 - - - 14,804.00 - - - ED 8
602 Larutan Turk Btl 27,500.00 - - - 27,500.00 - - - -
607 Pot Dahak Buah 2,933.00 - - - 2,932.60 - - - -
608 Respirator Buah 410,000.00 - - - 410,000.00 - - - -
609 Slide Buah 2,608.33 - - - 2,608.33 - - - -
610 Slide Boks Buah 190,000.00 - - - 190,000.00 - - - -
612 Tissu Lensa Buah 54,000.00 - - - 54,000.00 - - -
- - - - -
ALKES - - - - -
- - - - -
VAKSIN - - - - -
616 BCG Vial 59,590.00 - - - 59,590.00 - - - -
618 POLIO Vial 18,140.00 - - - 18,140.00 - - - -
619 CAMPAK Vial 28,204.00 - - - 28,204.00 - - - -
621 TT Vial 14,201.00 - - - 14,201.00 - - - -
622 DT Vial 16,180.00 - - - 16,180.00 - - - -
623 TD Vial 16,500.00 - - - 16,500.00 - - - -
624 ADS 0,05 ml Ampul 1,650.00 - - - 1,650.00 - - - -
625 ADS 0,5 ml Buah 1,240.00 - - - 1,240.00 - - - -
626 ADS 5 ml Buah 1,705.00 - - - 1,705.00 - - -
627 Safety Box Buah 16,886.10 - - - 16,886.10 - - -
- - - - -
ITEM BARU - - - - -
629 CAMPAK Vial 28,204.00 - - - 28,204.00 - - -
630 td Vial 16,500.00 - - - 16,500.00 - - -
638 RDT HIV AIDS Test 45.00 - - - 45.00 - - -
657 Taburia sachet 475.00 - - - 475.00 - - -
658 td vial 19,404.00 - - - 19,404.00 - - -
666 klobazam 10 mg tab 967.00 - - 967.00 - - -
- - - - - -
674 Ambroxol 30mg Tab 141 - - - 141 - - -
686 Piroxicam 20mg Tab 142 - - - 142 - - -
JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -
UMUM BPJS JUMLAH

-
Kedaloman, Mei 2020


NIP.19730716 199302 1 001

Lplpo Bulanan Pustu Ciherang 2020 Fixss

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LAPORAN PERSEDIAAN DAN BEBAN PERSEDIAAN OBAT DAN BAHAN MEDIS HABIS PAKAI

UPTD PUSKESMAS KEDALOMAN DINAS KESEHATAN KABUPATEN TANGGAMUS

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 2,128.00 378,689.80 - 2,128.00 1,609.00 519.00 106,210.80 268,579.00

UMUM BPJS JUMLAH

Kedaloman, Januari 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12)

JUMLAH 519.00 106,210.80 2,415.00 2,934.00 1,310.00 1,624.00 320,050.80 162,780.00

UMUM BPJS JUMLAH

Kedaloman, 02 februari 2020

Dedy Heriyanto, SKM Airaswati, Amd. Keb

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 1,624.00 347,110.80 - 1,624.00 1,241.00 383.00 102,397.00 217,653.80

UMUM BPJS JUMLAH

Kedaloman, Maret 2020

HASANUDDIN, SKM., M.M AIRASWATI, Amd. Keb

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 383.00 116,837.00 4,576.00 4,959.00 1,543.00 3,416.00 583,055.00 214,130.00

UMUM BPJS JUMLAH

Kedaloman, April 2020

HASANUDDIN, SKM., M.M AIRASWATI, Amd. Keb

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,416.00 763,496.00 - 3,416.00 1,354.00 2,062.00 397,796.00 185,259.00

UMUM BPJS JUMLAH

HASANUDDIN, SKM., M.M Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 2,062.00 506,088.00 2,710.00 4,772.00 1,720.00 3,052.00 575,482.00 238,314.00

UMUM BPJS JUMLAH

HASANUDDIN, SKM., M.M AIRASWATI, Amd. Keb

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

1 2 3 4 5 5b=(4x5) 6 7=(5+6) 8 9 10=(7-8) 12 =(7 X 11) 13=(6+9-12) 14

JUMLAH 3,052.00 658,374.00 - 3,052.00 - 3,052.00 575,482.00 -

UMUM BPJS JUMLAH

Kedaloman, Mei 2020

Dedy Heriyanto, SKM Nama

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