013/SMUOPS-Form/IX/2017 Color Code :

Return To Supplier
6 Month Before Expiry Date
Minimum stock
Site: Difference with Stock
Month: Borrowing
Site To Site Transfer
Rejected

IN OUT
NO VENDOR BRAND TYPE DESCRIPTION LOT NUMBER EXP DATE QTY BEGIN TOTAL IN TOTAL OUT QTY END
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31
1 PT REKAMILENIUMINDO SELARAS MERIT GUIDING CATHETER Concierge 6Fr JL 3.5 E1011444 01 AGT2019 2 0 0 2
Concierge 6Fr JL 4.0 E877181 01/09/2019 2 0 0 2
Concierge 6Fr JR 3.5 E1025564 01/09/2019 2 0 0 2
Concierge 6Fr SBS 3.5 E1041880 01/11/2019 3 0 0 3
Concierge 6Fr SBS 4.0 E812117 01/06/2018 2 0 0 2
Concierge 6Fr AL 1 E899581 01/12/2018 1 0 0 1
Concierge 6Fr AR 1 E825108 01/07/2018 1 0 0 1
0
ACCESSORIES BIPOLAR PACING LEAD 5861474 01/01/2020 5 0 0 5
PRELUDE SHEATH FEMORAL 6F 11CM 0.038" H985756 01/06//2019 10 0 1 1 1 2 5 5
PRELUDE SHEATH FEMORAL 7F 11CM 0.038" H937385 01/03/2019 5 0 0 5
PRELUDE TRANSRADIAL 6F 7CM 0.018" H957701 01/05/2019 10 0 0 10
H977138 01/06/2019 19 0 5 4 8 2 19 0
MANIFOLD 3PORT
H1146277 5/1/2020 20 20 0 20
GUIDEWIRE 0.035 150CM K925848 01/02/2019 19 0 5 4 7 2 18 1
H950368 01/02/2019 19 0 5 4 7 2 18 1
HIGH PRESSURE TUBING 20" (51CM)
H1124348 4/1/2020 20 20 0 20
H918405 01/02/2019 19 0 5 4 7 2 18 1
HIGH PRESSURE TUBING 48" (122CM)
H1153862 6/1/2020 20 20 0 20
ANGIOGRAPHIC ONE WALL NEEDLE H1069339 01/12/2019 10 0 1 1 3 5 5
MAP302 01/02/2019 20 0 3 2 6 1 12 8
AKSESORIS KIT / MAP 302
K1128835 3/1/2020 20 20 0 20
Finale Compression Regular I 1021870 01/09/2019 10 0 0 10
Basix compak K989284 6/30/2019 5 5 0 5
0
DIAGNOSTIC CATHETER Performa Catheter 5F ULTIMATE 1 I 1034710 01/10/2019 4 0 4 4 0
Performa Catheter 5F ULTIMATE 1 1130443 4/1/2020 5 5 4 4 1
Performa Catheter 5F ULTIMATE 1 1921325 4/30/2019 5 5 3 2 5 0
Performa Catheter 6F PIGTAIL I 987947 01/08/2019 1 0 0 1
Performa Catheter Head Hunter 5F 1061529 30/04/2019 5 0 0 5
Performa Catheter 6F MPA 2 I 1034710 01/10/2019 1 0 0 1
Performa Catheter 6F AL 1 I 1013666 9/1/2019 1 0 0 1
Performa Catheter 6F AL 2 I 829716 8/1/2018 1 0 0 1
I 984578 01/08/2019 5 0 1 4 5 0
Performa Catheter 6F JL 3.5
I1155372 6/1/2020 5 5 0 5
Performa Catheter 6F JL 4.0 I 883903 01/11/2018 4 0 0 4
Performa Catheter 6F JR 3.5 I 1025970 01/09/2019 5 0 0 5
Performa Catheter 6F JR 4.0 I 962002 01/05/2019 5 0 0 5
Performa Catheter 5F JL 3.5 I 1003527 01/09/2019 2 0 0 2
Performa Catheter 5F JL 4.0 I1012284 01/10/2019 2 0 0 2
Performa Catheter 5F JR 3.5 I 962016 01/05/2019 5 0 4 4 1
Performa Catheter 5F JR 4.0 I1012293 01/09/2019 5 0 1 1 4
0
2 PT NUGRA KARSERA BOSTON DES Promus Element 2.25x12mm 20014795 23/11/2018 1 0 0 1
Promus Element 2.25x16mm 20184784 16/01/2019 1 0 0 1
Promus Element 2.25x20mm 20192547 16/01/2019 1 0 0 1
Promus Element 2.25x24mm 20199147 16/01/2019 1 0 0 1
Promus Element 2.25x28mm 20291051 16/02/2019 1 0 0 1
Promus Element 2.25x32mm 20296113 06/02/2019 1 0 0 1
Promus Element 2.50x12mm 20312028 15/02/2019 1 0 0 1
Promus Element 2.50x16mm 20218718 24/01/2019 1 0 0 1
Promus Element 2.50x20mm 20319316 15/02/2019 1 0 0 1
Promus Element 2.50x24mm 20202512 18/01/2019 1 0 0 1
Promus Element 2.50x28mm 20209488 18/01/2019 1 0 0 1
Promus Element 2.50x32mm 20231440 24/01/2019 1 0 0 1
Promus Element 2.75x12mm 20436353 15/03/2019 1 0 0 1
Promus Element 2.75x16mm 20528584 06/04/2019 1 1 0 1
Promus Element 2.75x20mm 20689043 18/05/2019 1 1 0 1
Promus Element 2.75x24mm 20356273 22/02/2019 2 0 0 2
20411097 09/03/2019 1 0 1 1 0
Promus Element 2.75x28mm
20522964 03/04/2019 1 1
Promus Element 2.75x32mm 20445354 15/03/2019 1 1 1 1 0
20649125 08/05/2019 1 1 1 1 0
Promus Element 2.75x38mm
20649125 08/05/2019 1 1 0 1
Promus Element 3.00x12mm 20436469 13/03/2019 2 0 0 2
204280021 14/03/2019 1 0 1 1 0
Promus Element 3.00x20mm
20567584 19/04/2019 1 1 0 1
Promus Element 3.00x24mm 20659351 09/05/2019 1 1 0 1
Promus Element 3.00x28mm 20250042 27/01/2019 1 0 1 1 0
Promus Element 3.00x32mm 20407654 3/9/2018 1 0 0 1
20549107 13/04/2019 1 1 1 1 0
Promus Element 3.00x38mm
20549107 13/04/2019 1 1 0 1
Promus Element 3.50x12mm 20440399 13/01/2019 1 0 0 1
Promus Element 3.50x16mm 20392364 02/03/2019 2 0 0 2
Promus Element 3.50x20mm 20573314 19/04/2019 1 1 0 1
Promus Element 3.50x28mm 20441655 14/03/2019 1 0 1 1 0
Promus Element 3.50x32mm 20606326 25/04/2019 1 1 1 1 0
Promus Element 3.50x38mm 20369467 01/03/2019 1 0 1 1 0
BALLON MR FG EMERGE MR, OUS 1.50X12mm 19657747 30/04/2019 1 1 1 1 0
FG EMERGE MR, OUS 1.50X15mm 20447346 30/11/2019 1 1 0 1
FG EMERGE MR, OUS 1.20X15mm 20455816 30/11/2019 1 1 0 1
0 0 0
BALLOON Maverick 2 2.00x12mm 20271994 29/02/2020 3 0 0 3
Maverick 2 2.00x15mm 20454018 31/03/2020 3 3 0 3
Maverick 2 2.00x20mm 20499688 30/04/2020 3 3 0 3
Maverick 2 2.25x12mm 20408938 31/03/2020 1 0 0 1
Maverick 2 2.25x15mm 20501420 30/04/2020 3 0 0 3
Maverick 2 2.25x20mm 20496682 30/04/2020 2 0 0 2
Maverick 2 3.00x12mm 20425320 31/03/2020 1 0 0 1
Maverick 2 3.00x15mm 20068728 31/12/2019 1 0 0 1
Maverick 2 3.00x20mm 20346547 29/02/2020 1 0 0 1
Maverick 2 3.50x12mm 20070363 31/12/2019 1 0 0 1
Maverick 2 3.50x15mm 20368956 31/03/2020 1 0 0 1
0
NC BALOON NC Quantum Apex MR 2.00x12mm 19132612 30/04/2019 2 0 0 2
NC EMERGE MR, QUS 2.25X15 19992015 30/11/2018 2 0 0 2
NC EMERGE MR, QUS 3.00X15 19969668 30/11/2018 2 0 0 2
NC EMERGE MR, QUS 3.50X15 20300808 28/02/2019 1 0 0 1
0 0
GUIDING CATHETER Model-6F RunWay CLS 3.5 60061530 31/05/2020 2 2 1 1 2 0
Model-6F RunWay CLS 3.5 60064211 31/05/2020 2 2 0 2
Model-6F RunWay CLS 3.5 60060230 31/05/2020 1 1 0 1
Model-6F RunWay JR 4.0 60043058 31/01/2020 1 0 0 1
Model-6F RunWay JL 3.5 60022887 31/10/2019 3 0 1 1 2
0
3 PT. Anugrah Argon Medika MEDTRONIC DES ERES 2.50 X 12mm 7897675 01/01/2018 1 0 1 1 0
ERES 2.50 X 14mm 8659041 01/06/2019 1 0 0 1
ERES 2.50 X 18mm 8371171 NOV-18 1 0 0 1
ERES 2.50 X 24mm 8331880 OCT-18 1 0 0 1
ERES 2.50 X 30mm 8251604 OCT-18 1 0 0 1
ERES 2.75 X 14mm 8629713 01/05/2019 1 0 0 1
ERES 2.75 X 18mm 8377308 NOV-18 1 0 0 1
ERES 2.75 X 24mm 8400605 01/12/2018 1 0 0 1
ERES 2.75 X 30mm 8243805 OCT-18 1 0 0 1
ERES 3.00 X 12mm 8581623 01/04/2019 1 0 0 1
ERES 3.00 X 15mm 8571295 01/04/2019 1 0 0 1
ERES 3.00 X 18mm 8222867 01/09/2018 1 0 0 1
ERES 3.00 X 30mm 8392374 NOV-18 1 0 1 1 0
ERES 3.00 X 38mm 8382673 NOV-18 1 0 0 1
ERES 3.50 X 18mm 8639983 01/05/2019 1 0 0 1
ERES 3.50 X 30mm 8377309 NOV-18 1 0 1 1 0
ERES 3.50 X 38mm 8561201 01/03/2019 1 0 1 1 0
0
BALLOON 213250069 01/05/2020 1 0 1 1 0
SPRINTER LEGEND 1.25 X 10 213265814 03/05/2020 3 3 1 1 2
212489183 DEC-19 1 0 0 1
SPRINTER LEGEND 1.25 X 15
213325462 14/05/2020 3 3 0 3
212821760 01/02/2020 2 0 0 2
SPRINTER LEGEND 1.5 X 15 213195821 23/04/2020 3 3 0 3
212321488 NOV-19 1 0 0 1
SPRINTER LEGEND 2.0 X 12 213250078 01/05/2020 3 3 0 3
211951900 01/09/2019 1 0 1 1 0
SPRINTER LEGEND 2.0 X 15 213060207 29/03/2020 3 3 1 1 2
212015718 01/01/2020 1 0 1 1 0
SPRINTER LEGEND 2.0 X 20 212966860 15/03/2020 4 4 0 4
209922400 01/07/2018 1 0 0 1
SPRINTER LEGEND 2.5 X 12 210325531 22/10/2018 3 3 0 3
211951965 01/09/2019 1 0 0 1
SPRINTER LEGEND 2.5 X 15 21326595 30/04/2020 3 3 0 3
212015718 01/09/2018 1 0 1 1 0
212908526 02/03/2020 1 1 0 1
SPRINTER LEGEND 2.5 X 20 211754794 08/08/2019 2 2 1 1 1
SPRINTER LEGEND 2.75X 15 213040661 28/03/2020 1 1 0 1
SPRINTER LEGEND 3.0 X 15 21205997 OCT-18 1 1 0 1
213325464 01/05/2020 1 0 0 1
213055918 28/03/2020 1 1 0 1
SPRINTER LEGEND 3.0 X 20
212645464 19/01/2020 1 1 0 1
213325464 14/05/2020 1 1 0 1
0 0
NC BALLOON NCSP2512X-NC SPINTER-BALL RX 211913872 01/09/2018 1 0 0 1
213069827 01/03/2019 1 0 0 1
NCSP2515X-NC SPINTER-BALL RX 213405808 29/05/2019 3 3 0 3
212770687 01/02/2019 1 0 0 1
NCSP3012X-NC SPINTER-BALL RX 212770687 10/02/2019 3 3 0 3
212770689 01/02/2019 1 0 0 1
NCSP3015X-NC SPINTER-BALL RX 212770689 10/02/2019 3 3 0 3
212902597 01/03/2019 1 0 0 1
NCSP3512X-NC SPINTER-BALL RX 213025747 25/03/2019 2 2 0 2
213025757 01/03/2019 1 0 0 1
NCSP3515X-NC SPINTER-BALL RX 213333310 16/05/2019 2 2 0 2
213025757 25/03/2019 1 1 0 1
NCSP4009X-NC SPINTER-BALL RX 2122672996 NOV-18 1 0 0 1
0 0 0
ASPIRATION CATHETER OCT-17 5 0 3 1 1 5 0
50932553
EVEREST 10/3/2017 9 9 6 1 7 2
ACCESSORIES 50932554 10/4/2017 10 10 1 9 10 0
GUIDING CATHETER LA6JR35-LAUNCHER-CATH 6F 100CM JR3.5 8504716 2/1/2019 3 0 2 2 1
LA6JR40-LAUNCHER-CATH 6F 100CM JR4.0 8650279 5/1/2019 3 0 1 1 2
LA6JL35-LAUNCHER-CATH 6F 100CM JL3.5 8519433 3/1/2019 3 0 2 2 1
LA6AL35-LAUNCHER-CATH 6F 100CM AL 10 8655957 3/1/2019 2 0 0 2
8658989 6/1/2019 1 0 1 1 0
LA6JL40-LAUNCHER-CATH 6F 100CM JL4.0
8655957 5/1/2019 1 0 0 1
LA6EBU35-LAUNCHER-CATH 6F 100CM EB3.5 8504834 2/1/2019 3 0 1 2 3 0

TOTAL

PREPARED BY ACKNOWLEDGED BY APPROVED BY

014/SMUOPS-Form/IX/2017 Color Code :
Return to supplier
6 months before expiry date
Minimum stock
Site: Difference with stock
Month: Borrowing
Site to site transfer
Rejected

IN OUT
NO VENDOR BRAND TYPE DESCRIPTION LOT NUMBER EXP DATE UNIT QTY BEGIN TOTAL IN TOTAL OUT UNIT PRICE QTY END
1 2 3 4 5 6 7 22 23 9 10 23 24
1 Pharmacy Name : BAYER 710128 3/1/2020 19 0 8 5 6 19 Rp 151,384 0
CONTRAST Ultravist 300/50ml
71012F 3/1/2020 40 40 6 3 9 31

2 PT. Mensa Bina Sukses TERUMO 160730 12/31/2018 10 0 3 7 10 Rp 370,000 0

INTRODUCER KIT 6FR,7CM,STRAIGHT 25- E/40.00 160829 1/31/2019 9 0 4 4 5
161025V 3/31/2019 10 0 2 2 8
INTRODUCER KIT 6FR,10CM,STRAIGHT 35- E/40.00 161207V 5/31/2019 10 0 0 10
TR-BAND- E/40.00 160210 31/08/2018 4 0 4 4 Rp 350,000 0
0 0 ###
CORONARY
3 PT WEGO MEDIKA INDONESIA ASAHI 170120A091 31/12/2019 5 0 4 1 5 0
GUIDEWIRE
Sion Blue 170607A011 30/05/2020 5 5 2 3 5 0
170607A021 Mei 2020 10 10 2 1 3 7

4 Store Name : PHARMACY Spuit 1cc 95 0 4 3 7 2 16 Rp 2,600 79

Spuit 3cc 94 0 4 4 7 2 17 Rp 1,900 77
Spuit 5cc 95 0 4 4 7 2 17 Rp 2,500 78
Spuit 10cc 93 0 6 5 8 2 21 Rp 3,200 72
Abocath 20G 10 0 4 3 3 10 Rp 10,000 0
Abocath 22G 10 0 0 Rp 10,000 10
Needle Terumo 18G (1box 100pcs) 50 0 0 Rp 700 50
Infus Set 9 0 2 2 Rp 4,000 7
Blood Set 10 0 0 Rp 15,000 10
Jelly Doppler 6 1 1 Rp 20,000 5
Alkohol Swab 10 0 1 1 Rp 10,000 9
Alkohol 70% 5 0 1 1 Rp 12,000 4
Betadine 1lt 2 0 1 1 Rp 210,000 1
Kanul 02 24 0 1 1 Rp 8,000 23
Nurse Cap 2 0 0 Rp 40,000 2
Masker Hijab 3 0 0 Rp 22,000 3
Kassa Steril 5 0 0 Rp 23,000 5
Micropore 1 Inc (1box 12pcs) 6 0 0 Rp 18,700 6
Urine Bag 20 0 0 Rp 4,000 20
Underpads / 50 pcs 19 0 4 7 2 13 Rp 3,000 6
Hipafix 10X5 3 0 1 1 Rp 112,000 2
Perban Elastis 3" 10 0 0 Rp 12,000 10
Perban Elastis 6" 10 0 0 Rp 18,000 10
Kassa Gulung Gede 2 0 1 1 Rp 141,750 1
One Scrub 4 0 0 Rp 35,000 4
Aspilet 1 0 0 Rp 55,000 1
Clopidogrel 5 0 0 Rp 100,000 5
Epinephrine 5 0 0 Rp 13,000 5
Atropine 5 0 0 Rp 4,000 5
Inviclot 10 0 3 3 1 7 Rp 55,000 3
Lidocain 99 0 9 7 18 4 38 Rp 1,650 61
NACL 500 19 0 3 3 6 Rp 15,000 13
RL 500 20 0 1 1 Rp 15,000 19
Spuit 20cc 43 0 5 4 2 2 13 Rp 8,000 30
Spuit 50cc 50 0 0 Rp 6,400 50
38 0 13 10 15 38 Rp 8,000 0
Sarung Tangan Steril 7.0
20 20 8 8 Rp 5,600 12
1 0 1 Rp 38,000 0
Sarung Tangan non Steril
1 1 0 Rp 52,000 1
0 ###
ECG ELECT VICOM 30s 90 0 25 23 35 7 90 Rp 3,200 0
STOMACH TUBE/NGT 14 JMS 1 0 0 Rp 17,600 1
STOMACH TUBE/NGT 16 JMS 1 0 0 Rp 17,600 1
FOLLEY CATH 2 WAY/DC 14 WRP 1 0 0 Rp 15,000 1
FOLLEY CATH 2 WAY/DC 18 WRP 1 0 0 Rp 15,000 1
ETT CLEAR + BALON RUSCH NO. 7 2 0 0 Rp 65,000 2
ETT CLEAR + BALON RUSCH NO. 8 2 0 0 Rp 65,000 2
AMINOPHILIN 10 ML 10 0 0 Rp 7,000 10
CA GLUCONAS INJEK 10 0 0 Rp 20,000 10
CATAPRESS 150 Mg 10 0 0 Rp 5,520 10
FARGOXIN 10 0 0 Rp 300 10
CORDARONE 10 0 0 Rp 7,290 10
ISDN 10 0 0 Rp 150 10
LASIX INJEK 10 0 0 Rp 16,700 10
DS % 100 2 0 0 Rp 33,000 2
DS % 500 1 0 0 Rp 9,000 1
Herbeser cd 100 10 0 0 Rp 10,620 10
herbeser 30 mg 10 0 0 Rp 30,400 10
Blood set 49 0 5 4 7 2 18 Rp 5,600 31
Bisturi "10 10 0 0 Rp 4,000 10
Bisturi "11 10 0 2 2 4 Rp 4,000 6
NR. Udopa inj /dopamine 5 0 Rp 34,674 5
Cedocard 10 ml inj 9 0 0 Rp 112,612 9
Debutel/ dobutamine 5 0 0 Rp 205,562 5
NTG 10 ml 10 0 1 1 Rp 82,225 9
Fentanyl 0.05 ml inj 1 0 0 Rp 65,340 1
N-Epi 4 ml inj/vascon 10 0 0 Rp 128,700 10
safety box 2 0 0 Rp 20,000 2
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
0 ###
TOTAL ###

PREPARED
ACKNOWLEDGED
BY BY APPROVED BY
015/SMUOPS-Form/IX/2018 Color Code :
Return to supplier
6 months before expiry date
Minimum stock
Site: Difference with stock
Month: Borrowing
Site to site transfer
Rejected

IN OUT
NO VENDOR BRAND TYPE DESCRIPTION BARCODE EXP DATE QTY BEGIN TOTAL IN TOTAL OUT QTY END
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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###

PREPARED BY ACKNOWLEDGED BY APPROVED BY