Nomor Dokumen

Unit Penerima

No Kode Obat
1 DRG000000591
2 DRG000000605
3 DRG000046861
4 MDVx041973
5 DRG000001895
6 DRG000047580
7 DRG000002883
8 DRG000003002
9 DRG000005108
10 DRG000006907
11 DRG000006949
12 DRG000008516
13 DRG000008574
14 DRG000047648
15 DRG000047558
16 DRG000012199
17 DRG000012728
18 DRG000015698
19 DRG000017167
20 DRG000017432
21 DRG000047563
22 DRG000047634
23 DRG000046832
24 MDVx001123
25 MDVx011826
26 DRG000047300
27 DRG000021382
28 MDVx041864
29 MDVx042578
30 MDVx042374
31 DRG000021673
32 DRG000047112
33 DRG000023416
34 DRG000047101
35 MDVx000818
36 DRG000025565
37 DRG000025979
38 DRG000027443
 39 DRG000047548
40 DRG000030251
41 DRG000046745
42 MDVx042192
43 DRG000031217
44 DRG000031603
45 DRG000047199
46 DRG000046859
47 DRG000033677
48 MDVx026976
49 DRG000034963
50 DRG000036603
51 DRG000047604
52 DRG000037725
53 MDVx042611
54 DRG000038684
55 DRG000038922
56 MDVx001726
57 MDVx001791
58 MDVx001793
59 DRG000040326
60 DRG000041068
61 DRG000046785
62 DRG000044395
63 DRG000047376
64 DRG000044426
65 DRG000044506
66 DRG000044754
67 DRG000046225

Yang menerima

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 SURAT BUKTI
INSTALASI
DINAS KESEHATAN KA

:
: PANGKALAN LAMPAM

Nama Obat/Barang
ACYCLOVIR CREAM 5 %(DUS, 25 TUBE @ 5 G)
ACYCLOVIR TABLET 400 MG(DUS, 10 STRIP @ 10 TABLET)
ALKOHOL LARUTAN \/ CAIRAN 70% 1000ML()
ALKOHOL SWAB LAIN-LAIN\n -(BOX, 50 PIECES)
AMOKSISILIN CAPTABS 500 MG(Dus, 10 strip a 10 kaplet)
ANTASIDA DOEN I KOMBINASI TABLET KUNYAH (ALUMUNIUM HIDROKSIDA 200 MG, MAGNESIUM HIDROKSIDA 200 MG)(BOX
ANTASIDA DOEN SUSPENSI (BOTOL @ 60 ML)
ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 2 GRAM(STRIP a 10 SUPPOSITORIA)
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)
CHLORPENIRAMINE Tablet 4 Mg(CHLORPHENIRAMINE MALEAS 4 MG 1000 TABLET)
CHLORPROMAZIN TABLET SALUT SELAPUT 100 MG(BOTOL PLASTIK 250 TABLET SLT SLP)
COTRIMOXAZOLE SUSPENSI KOMBINASI: SULFAMETOXAZOLE 200 MG + TRIMETROPIN 40 MG\/5 ML(BOX, 1 BOTOL 60 ML)
COTRIMOXAZOLE TABLET Sulfametoxazole 400 mg + Trimetoprim 80 mg(BOX, 10 BLISTERS @10 TABLETS)
DIAZEPAM TABLET 2 MG(BOTOL PLASTIK @ 250 TABLET)
DOMPERIDONE TABLET 10 MG(DUS, 10 BLISTER @ 10 TABLET)
FITOMENADION Tablet 10 Mg(FITOMENADION TABLET SALUT GULA 10 MG)
GENTAMICIN TETES MATA 0.3 %(DUS, BOTOL PLASTIK @ 5 ML)
GLIMEPIRIDE TABLET 1 MG(DUS, 5 STRIP @ 10 TABLET)
GUAIFENESIN TABLET 100 MG(BOX, 10 STRIPS @10 TABLETS)
HALOPERIDOL TABLET 5 MG(BOX, 100 TABLET)
HIDROKORTISON CREAM 2,5%(Ktk)
IV CATHY NO 20()
IV CATHY NO 22()
KALSIUM LAKTAT TABLET 500 MG(KOTAK 100 TABLET)
KAPAS ONEMED 250 Gram(KAPAS ONEMED 250 GRAM)
KASA KOMPRES LAIN-LAIN\n 40 CM X 40 CM(Bks@10)
KASA PEMBALUT HIDROFIL LAIN-LAIN UKURAN 2 M X 80 CM(1 ROLL)
KASA PEMBALUT HIDROFIL ONEMED LAIN-LAIN 4 M X 15 CM()
KETOCONAZOLE CREAM 2 %(DUS, TUBE @ 10 G)
LEUKOPLAST PLASTER 4,5 CM X 5 CM()
LIDOCAIN COMPOSITUM INJEKSI 2 Ml(LIDOCAIN COMPOSITUM INJEKSI)
LYSOL LIQUID 1 L()
MASKER HIJAU EAR LOP()
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)
OKSITOSIN CAIRAN INJEKSI 10 IU\/ML()
OMEPRAZOLE CAPSUL 20 MG(DUS, 3 STRIP @ 10 KAPSUL)
ONEMED ASEPTAN LARUTAN \/ CAIRAN 500 ML(BOTOL 500 ML)
ONEMED MY JELLY 80 GRAM()
OXYTETRACYCLINE SALEP MATA 1%(DUS, 25 TUBE @ 3.5 GRAM)
PARACETAMOL SIRUP 120 MG/5 ML(BOTOL PLASTIK @ 60 ML)
PARACETAMOL TABLET 500 MG(BOX, 10 STRIP @10 TABLET)
POVIDONE IODINE LARUTAN \/ CAIRAN 10 % 30 ML()
PREDNISON TABLET 5 MG(DUS,10 STRIP @ 10 TABLET)
PROSONIC USG Gel()
PYRANTEL TABLET 125 MG(DUS, 25 STRIP @ 4 TABLET)
RINGER LAKTAT INFUS 500 ML(BOTOL PLASTIK PE @ 500 ML)
RISPERIDONE TABLET 2 MG(BOX, 10 BLISTERS @10 TABLETS)
SCABIMITE CREAM 5 %(DUS,TUBE @ 10 G)
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)
SODIUM CHLORIDE 0,9 % BP INFUS 0,9 %(20 BOTOL PLASTIK @ 500 ML)
SPUIT 1 CC TUBERCULIN NIPRO()
SPUIT 3 CC TERUMO()
SPUIT 5 CC TERUMO()
TABLET TAMBAH DARAH TABLET SALUT SELAPUT (100 SACHET a 30 TABLET)
TETRACYCLINE CAPSUL 500 MG(DUS, 10 STRIP @ 10 KAPSUL)
TRIHEKSIFENIDIL TABLET 2 MG(Ktk@100)
VITAMIN A CAPSUL LUNAK 200.000 IU(BOTOL PLASTIK @ 50 KAPSUL LUNAK)
VITAMIN B 12 TABLET 50 MCG(BOX, 10 STRIP @10 TABLET)
VITAMIN B COMPLEX TABLET (DUS, 10 STRIP @ 10 TABLET)
VITAMIN B1 TABLET 100 MG/ML(DUS, 10 STRIP @ 10 TABLET)
VITAMIN C TABLET 50 MG(DUS, 10 STRIP @ 10 TABLET)
ZINK TABLET DISPERSIBLE 20 MG(DUS, 10 STRIP @ 10 TABLET DISPERSIBEL)

Yang menerima
No. Batch Jumlah Distribusi Expired Harga (Rp) Jumlah (Rp) Tahun Anggaran
20BC3030 50 2024-08-01 3220 161000 APBDII 2020
36304043 400 2022-07-01 426 170400 APBDII 2020
DS062088 6 2024-04-01 30250 181500 DAK 2020
4052088 500 2024-04-01 132 66000 DAK 2020
CAMXA01788 15000 2024-04-30 216 3240000 APBDII 2020
a06627 10000 2025-11-01 60 600000 DAK 2020
20SE085 100 2024-04-30 2189 218900 DAK 2020
K92033W 80 2024-04-30 3325 266000 DAK 2020
b00051t 150 2025-11-01 1430 214500 DAK 2020
K00599BJ 2000 2025-10-01 68 136000 APBDII 2020
a00027 600 2025-11-01 247 148200 DAK 2020
200902152 7500 2025-12-01 46 345000 APBDII 2020
2053500 2000 2023-01-01 105 210000 DAK 2020
a93367 100 2025-04-30 2190 219000 DAK 2020
a00356 2000 2022-02-01 319 638000 DAK 2020
A3106FX 500 2024-06-01 86 43000 APBDII 2020
51F0381 2100 2025-12-01 86 180600 DAK 2020
26381002 500 2025-11-01 797 398500 DAK 2020
d0254012 48 2025-11-01 2000 96000 DAK 2019
50l4227 500 2021-11-01 174 87000 DAK 2020
200908 5000 2023-09-01 119 595000 APBDII 2020
a00384 1000 2025-11-01 60 60000 DAK 2020
a80065t 72 2022-01-01 2476 178272 DAK 2018
18548 50 2025-04-01 6898.07 344903.5 DAK 2019
19333 50 2025-04-01 6739 336950 DAK 2019
a00575 5500 2023-02-01 63 346500 DAK 2020
1111a 5 2022-08-01 15000 75000 DAK 2019
15031888 100 2025-11-01 1760 176000 DAK 2018
052488mx 20 2025-11-01 8000 160000 DAK 2019
92288 50 2021-08-01 2310 115500 DAK 2018
a80118t 50 2022-01-01 297 14850 DAK 2018
94626110 30 2024-11-01 12675 380250 APBDII 2020
171b00621 150 2025-11-01 2037 305550 DAK 2018
15051988 3 2023-04-01 49200 147600 DAK 2019
13201036 500 2025-10-01 1490 745000 APBDII 2020
18cb008 400 2025-11-01 222 88800 DAK 2018
L92103W 72 2025-04-30 3585 258120 DAK 2020
1636405 3600 2021-04-01 132 475200 DAK 2019
961980020a 100 2025-05-01 1199 119900 DAK 2019
HLI091 900 2025-05-01 330 297000 APBDII 2020
22 10 2025-11-01 10000 100000 DAK 2018
17092088 2 2023-08-01 29550 59100 APBDII 2020
D90443W 25 2025-11-01 2774 69350 DAK 2020
A00941 300 2023-03-01 1181 354300 DAK 2020
A00985 14000 2023-04-01 89.1 1247400 DAK 2020
150719881 20 2022-06-01 3520 70400 DAK 2019
100461 5000 2022-04-01 77 385000 DAK 2020
29081988 3 2021-07-01 15100.8 45302.4 DAK 2019
c90491b 100 2024-02-01 322 32200 DAK 2019
300307 120 2025-05-01 7630 915600 DAK 2020
5IE0556 1000 2023-05-01 287 287000 DAK 2020
620002 10 2025-04-01 11825 118250 APBDII 2020
2002019 36 2025-03-01 3055.8 110008.8 DAK 2020
a8716dw 300 2021-04-01 117 35100 DAK 2019
400302 20 2025-02-01 6840 136800 DAK 2020
20170910 400 2025-11-01 907 362800 DAK 2018
18052088 400 2025-04-01 856.9 342760 APBDII 2020
40520881 200 2025-04-01 1064.8 212960 APBDII 2020
36818052 3000 2025-12-01 372 1116000 DAK 2020
D91056J 200 2022-04-01 323 64600 DAK 2020
a90807 1000 2025-11-01 87 87000 DAK 2019
F81655W 3000 2025-04-01 543 1629000 DAK 2018
20EA003 10000 2025-05-01 50 500000 DAK 2020
19TM010 1000 2022-12-01 131 131000 DAK 2020
H9223B 3000 2024-08-01 92 276000 DAK 2020
D00101BJ 2000 2023-03-01 112 224000 DAK 2020
36496045 500 2023-06-01 551 275500 APBDII 2020
22027426.7

OGAN KOMERING ILIR, 10 February 2021

Yang menyerahkan/memeriksa

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