SURAT

INSTALASI FARMASI DINA

Nomor Dokumen
Unit Penerima

No Kode
1 DRG000000082
2 DRG000046774
3 DRG000046775
4 DRG000000385
5 DRG000000591
6 DRG000000597
7 DRG000000987
8 MDVx041973
9 DRG000047576
10 DRG000047416
11 DRG000001895
12 DRG000002881
13 DRG000002883
14 DRG000003949
15 DRG000005086
16 DRG000005108
17 DRG000006907
18 DRG000006949
19 DRG000008166
20 DRG000008516
21 DRG000008574
22 DRG000012208
23 DRG000012199
24 DRG000012728
25 DRG000014235
26 DRG000015694
27 DRG000015698
28 DRG000047563
29 DRG000047634
30 DRG000046832
31 MDVx001136
32 DRG000021227
33 MDVx041854
34 DRG000047002
35 DRG000021673
36 DRG000047112
37 DRG000023445
38 DRG000047068
39 MDVx000818
40 DRG000025567
41 DRG000025565
42 DRG000025979
43 DRG000027442
44 DRG000029468
 45 DRG000030251
46 MDVx042157
47 MDVx042192
48 DRG000031234
49 DRG000047199
50 DRG000046875
51 DRG000046839
52 MDVx026976
53 DRG000036603
54 DRG000036695
55 DRG000037221
56 MDVx042611
57 DRG000038684
58 DRG000047540
59 DRG000038922
60 DRG000041068
61 DRG000047376
62 DRG000044506

Total Berat:
Total Koli:

Yang menerima

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 SURAT BUKTI BARANG KELUAR (SBB
INSTALASI FARMASI DINAS KESEHATAN KABUPATEN O

: 22/PKD/II/2021
: penanggoan duren

Nama Obat/Perbekkes
2-4 KOMBINASI SALEP (POT 30 GRAM)
ABBOCATH (IV CATHETER) NO. 20 LAIN-LAIN -(Pieces)
ABBOCATH (IV CATHETER) NO. 22 LAIN-LAIN -(Pieces)
ACETYLCYSTEINE CAPSUL 200 MG(DUS, 10 STRIP @ 10 KAPSUL)
ACYCLOVIR CREAM 5 %(DUS, 25 TUBE @ 5 G)
ACYCLOVIR TABLET 200 MG(DUS, 10 STRIP @ 10 TABLET)
ALBENDAZOLE TABLET 400 MG(5 STRIP @ 6 TABLET)
ALKOHOL SWAB LAIN-LAIN\n -(BOX, 50 PIECES)
ALLOPURINOL TABLET 100 MG(BOX, 100 TABLET)
AMLODIPIN TABLET 5 MG(BOX, 3 BLISTER @10 TABLET)
AMOKSISILIN CAPTABS 500 MG(Dus, 10 strip a 10 kaplet)
ANTASID DOEN TABLET KUNYAH (10 STRIP a 10 TABLET)
ANTASIDA DOEN SUSPENSI (BOTOL @ 60 ML)
ATROPINE CAIRAN INJEKSI 0,25 MG/ML(DUS, 30 AMPUL @ 1 ML)
BETAHISTIN TABLET 6 MG(10 STR @ 10 TAB)
BETAMETASON CREAM 0,1 %(DUS, 25 TUBE @ 5 GRAM)
CAPTOPRIL TABLET 12,5 MG(DUS, 10 STRIP @ 10 TABLET)
CARBAMAZEPINE CAPTABS SALUT SELAPUT 200 MG(BOX, 10 STRIP @ 10 KAPLET SALUT SELAPUT)
CETIRIZINE SIRUP 5 MG/5 ML(DUS, BOTOL @ 60 ML)
CHLORPENIRAMINE Tablet 4 Mg(CHLORPHENIRAMINE MALEAS 4 MG 1000 TABLET)
CHLORPROMAZIN TABLET SALUT SELAPUT 100 MG(BOTOL PLASTIK 250 TABLET SLT SLP)
DIAZEPAM LARUTAN / CAIRAN 5 MG / 2,5 ML(DUS, 4 TUBE @ 2,5 ML)
DIAZEPAM TABLET 2 MG(BOTOL PLASTIK @ 250 TABLET)
DOMPERIDONE TABLET 10 MG(DUS, 10 BLISTER @ 10 TABLET)
ERYTHROMYCIN CAPTABS 500 MG(10 STRIP a 10 CAPTABS)
FITOMENADION INJEKSI 1 Ml(FITOMENADION (VITAMIN K) INJ 10MG/ML - 1ML)
FITOMENADION Tablet 10 Mg(FITOMENADION TABLET SALUT GULA 10 MG)
GUAIFENESIN TABLET 100 MG(BOX, 10 STRIPS @10 TABLETS)
HALOPERIDOL TABLET 5 MG(BOX, 100 TABLET)
HIDROKORTISON CREAM 2,5%(Ktk)
IV CATHETER NO 24 TERUMO()
KALSIUM LACTAS Tablet 500 Mg(KALSIUM LACTAS TABLET 4 MG)
KASA HIDROFIL 2m x 80cm LAIN-LAIN -(Pieces@2mx80cm)
KASA HIDROFIL LAIN-LAIN\n 4 M X 3 CM()
KETOCONAZOLE CREAM 2 %(DUS, TUBE @ 10 G)
LEUKOPLAST PLASTER 4,5 CM X 5 CM()
LIDOKAIN CAIRAN INJEKSI 1 %(100 AMP a 2)
LORATADINE TABLET 10 MG()
MASKER HIJAU EAR LOP()
METHYLERGOMETRINE CAIRAN INJEKSI 0.2 MG/ML(DUS, 100 AMPUL @ 1 ML)
METHYLERGOMETRINE TABLET SALUT SELAPUT 0,125 MG(DUS, BOTOL @ 100 TABLET SALUT SELAPUT)
MICONAZOLE CREAM 2 %(DUS, 24 TUBE @ 10 G)
NATRIUM DIKLOFENAK TABLET SALUT ENTERIK 25 MG(DUS, 5 STRIP @ 10 TABLET SALUT ENTERIK)
NYSTATIN TABLET VAGINAL 100.000 IU(10 STRIP a 10 TABLET)
OMEPRAZOLE CAPSUL 20 MG(DUS, 3 STRIP @ 10 KAPSUL)
ONEMED DISPOSABLE INFUSET ANAK LAIN-LAIN\n -()
ONEMED MY JELLY 80 GRAM()
OXYTOCIN CAIRAN INJEKSI 10 MCG/ML(10 AMP a 1)
PARACETAMOL TABLET 500 MG(BOX, 10 STRIP @10 TABLET)
POLIWASH 500 ML LAIN-LAIN\n Chlorhexidine Gluconate 4% W\/V(BOTOL, 500 ML)
Povidon Iodida 10% CAIRAN OBAT LUAR\n 300 ml()
PROSONIC USG Gel()
RINGER LAKTAT INFUS 500 ML(BOTOL PLASTIK PE @ 500 ML)
RISPERIDONE TABLET SALUT SELAPUT 2 MG(DUS, 5 STRIP @ 10 TABLET SALUT SELAPUT)
SALBUTAMOL TABLET 2 MG(DUS, 10 STRIP @ 10 TABLET)
SILK BENANG NO. 3 DENGAN JARUM BEDAH LAIN-LAIN -(KOTAK, 36 SET\/PIECES)
SIMVASTATIN TABLET SALUT SELAPUT 10 MG(DUS, 3 STRIP @ 10 TABLET SALUT SELAPUT)
SNA MEDIKA POLICLEAN HANDRUB CAIRAN STERIL 500 ML(BOTTLE)
SODIUM CHLORIDE 0,9 % BP INFUS 0,9 %(20 BOTOL PLASTIK @ 500 ML)
TETRACYCLINE CAPSUL 500 MG(DUS, 10 STRIP @ 10 KAPSUL)
VITAMIN B 12 TABLET 50 MCG(BOX, 10 STRIP @10 TABLET)
VITAMIN B1 TABLET 100 MG/ML(DUS, 10 STRIP @ 10 TABLET)

Yang menerima

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LUAR (SBBK)
UPATEN OGAN KOMERING ILIR

Satuan Jumlah Distribusi No. Batch Expired Harga (Rp) Jumlah (Rp)
POT 48 205B005 2024-04-01 2938 141024
PIECES 50 191139 2025-04-01 5869 293450
PIECES 50 191140 2025-02-01 5869 293450
CAPSULE 5000 EDH112 2022-08-01 381 1905000
TUBE 150 20BC3030 2024-08-01 3220 483000
TABLET 3000 1811006 2024-02-01 720 2160000
TABLET 1200 1111 2023-01-01 452 542400
PIECES 400 4052088 2024-04-01 132 52800
TABLET 2100 A015901 2023-07-31 105 220500
TABLET 300 102009 2025-11-01 78 23400
TABLET 4000 CAMXA01846 2023-04-30 216 864000
TABLET 3800 A01590 2023-08-01 60 228000
BOTTLE 50 20SE085 2024-04-30 2189 109450
AMPULE 10 9620B0061A 2023-03-01 1694 16940
TABLET 200 51do597 2022-03-01 110 22000
TUBE 100 b00051t 2025-11-01 1430 143000
TABLET 3000 K00599BJ 2025-10-01 68 204000
TABLET 400 a00027 2025-11-01 247 98800
BOTTLE 50 509015BK 2025-04-30 2973 148650
TABLET 8400 200902152 2025-12-01 46 386400
TABLET 400 2053500 2023-01-01 105 42000
AMPULE 10 450 2023-08-01 1822 18220
TABLET 500 A3106FX 2024-06-01 86 43000
TABLET 800 51F0381 2025-12-01 86 68800
TABLET 1500 T05157AJ 2024-11-01 785 1177500
AMPULE 30 36478010 2025-11-01 3867 116010
TABLET 800 26381002 2025-11-01 797 637600
TABLET 8400 200908 2023-09-01 119 999600
TABLET 400 a00384 2025-11-01 60 24000
TUBE 24 a80065t 2022-01-01 2476 59424
PIECES 50 191141 2025-02-02 5896 294800
TABLET 700 A01484 2025-04-01 63 44100
ROLL 25 082488MX 2024-05-01 8470 211750
PIECES 25 11101988 2025-04-01 649 16225
TUBE 50 k9168t 2023-11-01 2518 125900
PIECES 50 94626110 2024-11-01 12675 633750
AMPULE 150 768150127 2023-02-01 1286 192900
TABLET 3000 TLRTA00370 2024-06-01 133 399000
PIECES 1000 13201036 2025-10-01 1490 1490000
AMPULE 30 1114 2023-01-01 3102 93060
TABLET 600 18cb008 2025-11-01 222 133200
TUBE 48 L92103W 2025-04-30 3585 172080
TABLET 8400 36364005 2024-12-01 136 1142400
TABLET 100 26372010 2025-11-01 630 63000
CAPSULE 3000 HLI091 2025-05-01 330 990000
PIECES 50 23072088 2025-06-01 3850 192500
TUBE 2 17092088 2023-08-01 29550 59100
AMPULE 100 96201025A 2023-09-01 1199 119900
TABLET 6000 A00985 2023-04-01 89.1 534600
BOTTLE 4 206118 2022-06-01 58300 233200
BOTTLE 7 7072088 2023-06-01 23100 161700
BOTTLE 2 29081988 2021-07-01 15100.8 30201.6
BOTTLE 40 500201 2025-05-01 6936 277440
TABLET 400 51d0752 2021-03-01 287 114800
TABLET 800 H92224B 2026-04-01 67 53600
PIECES 36 2002019 2025-03-01 3055.8 110008.8
TABLET 810 A8776IW 2024-07-01 117 94770
BOTTLE 6 2002018 2022-04-01 78200 469200
BOTTLE 20 400302 2025-02-01 6840 136800
CAPSULE 900 D91057 2025-11-01 323 290700
TABLET 1400 20EA003 2025-05-01 50 70000
TABLET 3000 H9223B 2024-08-01 92 276000
20749103.4

OGAN KOMERING ILIR, 2021-02-09

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Mengetahui,

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Keterangan
DAK 2020
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 APBDII 2020
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R, 2021-02-09
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