Lampiran :

DAFTAR PENERIMAAN DAN PENGELUARAN BARANG PERSEDIAAN

PADA UPT PUSKESMAS PAKUWON JULI S/D 31 DESEMBER 2020
Penerimaan Barang Persediaan Pengeluaran Barang Persediaan
Saldo Per 31 Juni 2020 Saldo Per 31 Oktober 2020
Tahun 2020 Tahun 2020
No Nama Barang
Jml Jml Harga Nilai Jml Harga Nilai Jml Harga Nilai
Jml Harga satuan
Harga Barang Satuan Total Barang Satuan Total Barang Satuan Total
A Bahan Habis Pakai
1 Alat Tulis Kantor
AMPLOP 3/4 PLS PPL 0 11,875 - - 11,875 0 11,875 0 11,875 0
AMPLOP Kabinet (Pak) 0 25,000 - - 25,000 0 25,000 0 25,000 0
Amplop (Pak) 0 20,000 - 20,000 0 20,000 0 20,000 0
Ballpoint 0 4,000 - - 4,000 0 4,000 0 4,000 0
Ballpoint (Pak) 0 48,000 - - 48,000 0 48,000 0 48,000 0
Ballpoint Gel (Pak) 0 23,000 - - 23,000 0 23,000 0 23,000 0
Ballpoint Gel (Pak) 0 36,000 - - 2 36,000 72,000 2 36,000 72,000 15,000 0
Ballpoint Gel (Pak) 0 48,000 - - 1 48,000 48,000 1 48,000 48,000 48,000 0
Ballpoint Stopen XDM- 850 0 7,425 - - 1 7,425 7,425 1 7,425 7,425 0 7,425 0
Ballpoint Top Pic Segel BR/HT/MR 0 19,800 - - 19,800 0 19,800 0 0 19,800 0
Ballpoint SM Cefrek 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
Ballpoint SM Cefrek (Pak) 0 42,000 - - 4 42,000 168,000 4 42,000 168,000 0 42,000 0
Ballpoint Cair 2 6,000 12,000 4 6,000 24,000 6 6,000 36,000 0 6,000 0
Ballpoint Cair 1 5,000 5,000 13 5,000 65,000 14 5,000 70,000 0 5,000 0
Batu Batre ABC Kecil 0 2,250 - - 2,250 0 2,250 0 0 2,250 0
Batu Batre ABC Kecil 0 2,500 - - 2,500 0 2,500 0 0 2,500 0
Batu Batre ABC Besar 0 4,500 - - 4,500 0 4,500 0 0 4,500 0
Batre ABC Besar 0 7,500 - - 7,500 0 7,500 0 0 7,500 0
Bola Tensi ABN 0 65,000 - - 65,000 0 65,000 0 0 65,000 0
Buku Folio 1 107,000 107,000 107,000 1 107,000 107,000 0 107,000 0
Buku Folio 0 15,000 - - 15,000 0 15,000 0 0 15,000 0
BUKU Folio 100 L 0 17,500 - - 17,500 0 17,500 0 0 17,500 0
BUKU folio 200 L 0 36,000 - - 6 36,000 216,000 6 36,000 216,000 0 36,000 0
BUKU kwarto 100 0 18,500 - - 18,500 0 18,500 0 0 18,500 0
BUKU KWITANSI 100 VISION 0 8,500 - - 8 8,500 68,000 8 8,500 68,000 0 8,500 0
BUKU KWITANSI 0 3,000 - - 10 3,000 30,000 10 3,000 30,000 0 3,000 0
B campus 0 42,000 - - 3 42,000 126,000 3 42,000 126,000 0 42,000 0
Buku Campus 0 4,000 - 6 4,000 24,000 6 4,000 24,000 0 4,000 0
Buku Nota K2 NCR PPL 0 3,300 - - 3,300 0 3,300 0 0 3,300 0
Buku Nota kontan 2ply B 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
BK Nota 0 5,500 - - 5,500 0 5,500 0 0 5,500 0
BAK STEMPL JOYKO 1 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Box File 4ss Besi 0 117,000 - 117,000 0 117,000 0 0 117,000 0
CUTTER JY K200 (Kecil) 0 13,000 - 1 13,000 13,000 1 13,000 13,000 0 13,000 0
CUTTER JY K200 (Besar) 0 3,500 - - 3,500 0 3,500 3,500 0
Cover Glass 0 20,000 - - 20,000 0 20,000 0 0 20,000 0
Clip Joyko 0 33,000 - - 33,000 0 33,000 0 0 33,000 0
DESK PEN 0 11,000 - - 11,000 0 33,000 0 0 33,000 0
DESK SET 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
Eraser Whiteboard 0 28,000 - - 28,000 0 28,000 0 0 28,000 0
Flash D 16 GB Toshiba 0 70,000 - - 70,000 0 70,000 0 0 70,000 0
Flash D 16 GB Sandisk 0 80,000 - - 80,000 0 80,000 0 0 80,000 0
MMC Sandisk 64 gb 0 200,000 - 1 200,000 0 1 200,000 0 0 200,000 0
Gunting Kecil 0 5,000 5,000 0 5,000 0 0 5,000 0
Gunting Kecil 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
Gunting 0 6,500 - - 6,500 0 6,500 0 0 6,500 0
Gunting Besar 0 12,000 - - 4 12,000 48,000 3 12,000 36,000 1 12,000 12,000
HVS 75 GR F4 0 55,000 - - 6 55,000 330,000 6 55,000 330,000 0 55,000 0
HVS 75 GR F4 0 53,000 - - 53,000 0 53,000 0 0 53,000 0
HVS 75 GR F4 0 60,000 - - 3 60,000 180,000 3 60,000 180,000 0 60,000 0
HVS 70 GR A4 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
Kertas A4 70 grm 0 53,000 - - 53,000 0 53,000 0 0 53,000 0
HVS 75 GR F4 0 57,000 - - 57,000 0 57,000 0 0 57,000 0
HVS 75 GR A4 0 53,000 - - 53,000 0 53,000 0 0 53,000 0
HVS 75 GR A4 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
Isi Gel JY HTM 0 52,800 - - 52,800 0 52,800 0 0 52,800 0
Isi Gel JY HTM 0 28,000 - - 1 28,000 28,000 1 28,000 28,000 0 28,000 0
Isi Pulpen 0 9,000 - - 9,000 0 9,000 0 0 9,000 0
Isi Mst Jyk 0 5,400 - - 5,400 0 5,400 0 0 5,400 0
Isolasi GT 1/2 X 10 0 9,250 - - 9,250 0 9,250 0 0 9,250 0
Isolasi (s) 0 3,000 - - 1 3,000 3,000 1 3,000 3,000 0 3,000 0
Isolasi 0 2,500 - - 2,500 0 2,500 0 0 2,500 0
Isolasi 0 10,000 - - 3 10,000 30,000 3 10,000 30,000 0 10,000 0
Klip (k) 0 6,500 - - 6,500 0 6,500 0 0 6,500 0
klip (B) 0 24,000 - - 2 24,000 48,000 2 24,000 48,000 0 24,000 0
Klip Besar 0 18,800 - - 18,800 0 18,800 0 0 18,800 0
Kalkulator 0 92,000 - - 92,000 0 92,000 0 0 92,000 0
Kalkulator Citizen 0 90,000 - - 90,000 0 90,000 0 0 90,000 0
Kertas jilid (Lembar) 0 500 - - 500 0 500 0 0 500 0
Kertas Minyak 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Kertas Minyak 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
Lakban 0 15,000 - 2 15,000 30,000 2 15,000 30,000 0 15,000
Lem Permanen 0 70,000 - - 70,000 0 70,000 0 0 70,000 0
LEM Takol Kecil 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
Label Undangan Berlian 0 5,000 - - 2 5,000 10,000 2 5,000 10,000 0 4,950 0
Label Undangan Berlian 0 12,000 - - 1 12,000 12,000 1 12,000 12,000 0 4,950 0
Lakmus Nesko 0 65,000 - - 65,000 0 65,000 0 0 65,000 0
Magnet X 0 20,000 - - 40,000 2 40,000 0 0 40,000 0
Map Dokumen Bag KK 4 4,000 16,000 4,000 0 4 4,000 16,000 0 4,000 0
Map Kancing Cetet 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
Map SH Plastik 0 21,000 - - 42,000 0 42,000 0 0 42,000 0
Map SH Plastik 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
Map Plastik Kancing 1 35,650 35,650 1 35,650 35,650 2 35,650 71,300 0 35,650 0
Map Kancing 0 48,000 3 48,000 144,000 3 48,000 144,000 0 48,000
Map Biola 0 3,500 - - 50 3,000 150,000 45 3,000 135,000 5 3,000 15,000
Mouse Banda 0 52,500 - - 52,500 0 52,500 0 0 52,500 0
Mistar 30 cm Buter Fly 0 2,500 - - 1 2,500 2,500 1 2,500 2,500 0 2,500 0
Mistar 30 cm KK 3 7,500 22,500 7,500 0 3 7,500 22,500 0 7,500 0
Mistar 0 3,000 - - 5 3,000 15,000 5 3,000 15,000 0 3,000 0
Penghapus 0 2,000 - - 2,000 0 2,000 0 0 2,000 0
Pensil Joyko 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
Pensil Fancy 0 3,500 - 2 3,500 7,000 2 3,500 7,000 0 0
Paku ETONA 10 (Pak) 0 48,400 - - 48,400 0 48,400 0 0 48,400 0
Paku ETONA 10 (Pcs/ Buah) 3 2,500 7,500 7,500 2,500 0 3 2,500 7,500 0 2,500 0
Paku hekter 0 32,000 - - 32,000 0 32,000 0 0 32,000 0
Paku Hekter Kecil 0 3,000 - - 3,000 0 3,000 0 0 3,000 0
Panol Tape 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
Paku ETONA 24/6 0 79,200 - - 79,200 0 79,200 0 0 79,200 0
Paku ETONA 24/6 (lusin) 0 135,000 - - 135,000 0 135,000 0 0 135,000 0
Papan Whiteboard 0 230,000 - - 230,000 0 230,000 0 0 230,000 0
Perpulator no 30 0 13,000 - - 13,000 0 13,000 0 0 13,000 0
Penjepit Tali Pusat 0 2,500 - - 2,500 0 2,500 0 0 2,500 0
Pisau Kater 0 6,500 - - 6,500 0 6,500 0 0 6,500 0
Push Pin 0 8,500 - - 8,500 0 8,500 0 0 8,500 0
Stempel Otom 0 50,000 - - 1 50,000 50,000 1 50,000 50,000 0 50,000 0
Stempel Kayu 0 25,000 - - 25,000 0 25,000 0 0 25,000 0
Steempel Elektrik 0 75,000 - 4 75,000 300,000 4 75,000 300,000
STAPL.HD 10 JY 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
STAPL.HD 10 JY 0 20,000 - - 20,000 0 20,000 0 0 20,000 0
STAPL.HD 10 JY 0 2,500 - - 1 2,500 2,500 1 2,500 2,500 0 2,500 0
STAPL.HD 10 JY 0 13,000 - - 1 13,000 13,000 1 13,000 13,000 0 13,000 0
STAPL.HD 10 JY 0 18,000 - - 18,000 0 18,000 0 0 18,000 0
STAPL.SDI 1104 0 19,800 - - 19,800 0 19,800 0 0 19,800 0
STAPL.SDI 1123 0 38,000 - - 38,000 0 38,000 0 0 38,000 0
STAPL. Joyko 0 67,500 - - 1 67,500 67,500 1 67,500 67,500 0 67,500 0
 Stik Not 0 6,000 - - 1 6,000 6,000 1 6,000 6,000 0 7,000 0
Stik Not 0 8,000 - - 2 8,000 16,000 2 8,000 16,000 0 8,000 0
Stick Not 0 10,500 - - 10,500 0 10,500 0 0 10,500 0
Spidol Snowman Permanen 0 70,000 - - 3 70,000 210,000 3 70,000 210,000 0 70,000 0
Spidol Snowman Permanen 0 9,000 - - 5 9,000 45,000 5 9,000 45,000 0 9,000 0
Stabilo (2W) 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
Stabilo(Lw) 0 4,500 - - 4,500 0 4,500 0 0 4,500 0
TINTA STEMPEL 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
TINTA INO BROTHER (BH) 0 46,200 - - 46,200 0 46,200 0 0 46,200 0
TIPP EX JOYKO CF-P211PE 0 6,000 - - 6 6,000 36,000 6 6,000 36,000 0 6,000 0
TIPP EX JOYKO CF-P211PE 0 38,000 - - 38,000 0 38,000 0 0 38,000 0
TIPP EX RETYPE 7800 PEN 0 6,000 - - 6,000 0 6,000 0 0 6,000 0
Tinta SPID. SNM HT 0 10,125 - - 1 10,125 10,125 1 10,125 10,125 0 10,125 0
Tinta Botol Warna 0 83,500 - - 1 83,500 83,500 1 83,500 83,500 0 83,500 0
Tinta EPSON Hitam Putih 0 145,000 - - 2 145,000 290,000 2 145,000 290,000 0 145,000 0
Ultimate 0 245,000 - - 1 245,000 245,000 1 245,000 245,000 0 245,000 0
Jumlah 0 205,650 3,309,202 3,487,850 0 27,000
0 - - - 0 0 0
Alat listrik dan elektronik 0 - - - 0 0 0
Adaptor Monitor 0 150,000 1 150,000 150,000 1 150,000 150,000 0 150,000 0
2 Fiting 0 8,000 - - 8,000 0 8,000 0 0 8,000 0
HDD Ekternal A Data I TB 0 850,000 - - 850,000 0 850,000 0 0 850,000 0
IB Stop Metal 0 15,000 - 5 15,000 75,000 5 15,000 75,000 0 15,000 0
I Dus 0 8,000 - - 8,000 0 8,000 0 0 8,000 0
Kabel 0 100,000 - - 1 100,000 100,000 1 100,000 100,000 0 100,000 0
Kabel Besar 0 250,000 - - 1 250,000 250,000 1 250,000 250,000 0 250,000 0
Kleman Beton 0 10,000 - - 2 10,000 20,000 2 10,000 20,000 0 10,000 0
Kleman 0 2,000 - - 2,000 0 2,000 0 0 2,000 0
Kul 1/2 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Kul 3/4 0 4,500 - - 4,500 0 4,500 0 0 4,500 0
Lem 0 18,000 - - 18,000 0 18,000 0 0 18,000 0
Lampu Neon 0 65,000 - - 65,000 0 65,000 0 0 65,000 0
Lampu 10 W 0 13,000 - - 13,000 0 13,000 0 0 13,000 0
Lampu Pijar 25 W 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Paku 0 22,000 - - 2 22,000 44,000 2 22,000 44,000 0 22,000 0
Philip 24 w Urd 0 65,000 - - 65,000 0 65,000 0 0 65,000 0
Philip 15 w Urd 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
Ragaji Besi 0 25,000 - - 25,000 0 25,000 0 0 25,000 0
Sanyo 0 450,000 - - 450,000 0 450,000 0 0 450,000 0
SDI 3/4 x 11 m 0 27,000 - - 27,000 0 27,000 0 0 27,000 0
Sealtip 0 13,000 - - 6 13,000 78,000 6 13,000 78,000 0 13,000 0
Terminal Listrik Lbg 6 Kuningan 0 175,000 - - 175,000 0 175,000 0 0 175,000 0
 GRC highbor 0 50,000 - 15 50,000 750,000 15 50,000 750,000 0 50,000
Bahan Habis Pakai Bangunan Lainnya 0 626,000 - 1 626,000 626,000 1 626,000 626,000 0 626,000
Bahan Habis Pakai Elektronik Lainnya 0 2,545,000 - 1 2,545,000 2,545,000 1 2,545,000 2,545,000
Jumlah 0 - - - 4,638,000 4,638,000 0 0
Perangko/Materai/benda Pos Lainnya 0 - - - 0 0 0 0
Materai 6000 0 7,000 - - 7,000 0 7,000 0 0 7,000 0
materai 6000 0 6,000 - - 6,000 0 6,000 0 0 6,000 0
3 Materai 3000 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
Materai 3000 0 4,000 - - 4,000 0 4,000 0 0 4,000 0
materai 3000 0 3,000 - - 3,000 0 3,000 0 0 3,000 0
Jumlah 0 - - - 0 0 0 0
Peralatan Kebersihan dan Bahan Pembersi 0 - - - 0 0 0 0
Cairan Pembersih Lantai 0 11,900 - - 11,900 0 11,900 0 0 11,900 0
Ember 0 71,800 - - 71,800 0 71,800 0 0 71,800 0
4 Ember Besar 0 71,800 - - 71,800 0 71,800 0 0 71,800 0
Ember Besar 0 270,000 - - 270,000 0 270,000 0 0 270,000 0
Hit Extra 0 40,000 - - 40,000 0 40,000 0 0 40,000 0
Hand Soap 0 16,000 - - 16,000 0 16,000 0 0 16,000 0
Hand Soap 0 75,000 - - 5 75,000 375,000 5 75,000 375,000 0 25,300 0
Hand Soap 0 40,000 - 40,000 0 40,000 0 0 40,000 0
Hand Sanitizer 0 220,000 1 220,000 220,000 1 220,000 220,000 0 0
Kanebo 0 9,000 - - 9,000 0 9,000 0 0 9,000 0
Kanebo botol 0 25,000 - - 25,000 0 25,000 0 0 25,000 0
Kanebo Wiper 80,000 2 80,000 160,000 2 80,000 160,000
Kamper 0 18,000 - - 18,000 0 18,000 0 0 18,000 0
Kamper 0 27,000 - - 27,000 0 27,000 0 0 27,000 0
Kemoceng 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
Kemoceng 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Kesed 0 35,900 - - 35,900 0 35,900 0 0 35,900 0
Lap Pel Tangan 0 17,900 - - 17,900 0 17,900 0 0 17,900 0
Lap pel Besar 0 8,950 - - 8,950 0 8,950 0 0 8,950 0
lap Pel Tgn Gtg 0 17,950 - - 17,950 0 17,950 0 0 17,950 0
Lap Pel 0 7,000 - - 7,000 0 7,000 0 0 7,000 0
Lap Pel 1 12,000 12,000 12,000 12,000 0 1 12,000 12,000 0 12,000 0
Lap Pel Super Mop 0 180,000 - - 180,000 0 180,000 0 0 180,000 0
Nosy H Soap 420 apl 0 16,000 - - 16,000 0 16,000 0 0 16,000 0
Pengki 0 15,000 - - 2 15,000 30,000 2 15,000 30,000 0 15,000 0
Pewangi Ruangan 0 14,000 - - 14,000 0 14,000 0 0 14,000 0
Plastik Sampah 0 22,500 - - 22,500 0 22,500 0 0 22,500 0
Plastik Sampah Kuning 0 24,000 - 24,000 0 24,000 0 0 24,000 0
Proclyn 1lt 1 30,000 30,000 30,000 30,000 0 1 30,000 30,000 0 30,000 0
Sabun Giv Lia 0 10,700 - - 21,400 0 21,400 0 0 21,400 0
 Superpell Rf 800 0 11,000 - - 11,000 0 11,000 0 0 11,000 0
Sunlight 100 ml 0 4,800 - - 4,800 0 4,800 0 0 4,800 0
sabun Pencuci 0 6,500 - - 6,500 0 6,500 0 0 6,500 0
Sapu Injuk 0 11,900 - - 11,900 0 11,900 0 0 11,900 0
Sapu 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
Selang Air 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
Sikat 0 11,000 - - 11,000 0 11,000 0 0 11,000 0
Sikat 0 18,000 - - 18,000 0 18,000 0 0 18,000 0
Sikat Wc 0 19,500 - - 19,500 0 19,500 0 0 19,500 0
Sikat bak 0 23,000 - - 23,000 0 23,000 0 0 23,000 0
Sprayer 0 60,000 - - 60,000 0 60,000 0 0 60,000 0
Tissue Basah 0 19,500 - - 19,500 0 19,500 0 0 19,500 0
Tissue Nice 0 11,900 - - 11,900 0 11,900 0 0 11,900 0
Tissue 0 8,500 - - 8,500 0 8,500 0 0 8,500 0
Wiper 0 12,500 - - 2 12,500 25,000 2 12,500 25,000 0 12,500 0
Bahan Habis Pakai Kebersihan Lainnya 0 8,162,500 - 1 8,162,500 8,162,500 1 8,162,500 8,162,500 0 8,162,500 0
Jumlah 0 - - - 8,972,500 9,014,500 0 0
Barang Cetak 0 - - - 0 0 0 0
REKAM MEDIK KUNING UKURAN FOLIO 0 1,000 - - 2,500 1,000 2,500,000 1500 1,000 1,500,000 1,000 1,000 1,000,000
REKAM MEDIK MERAH UKURAN FOLIO 0 1,000 - - 1,000 0 0 1,000 0 0 1,000 0
5 REKAM MEDIK MERAH UKURAN FOLIO 0 1,130 - 1,130 0 0 1,130 0 0 1,130 0
RESEP UKURAN 1/4 FOLIO BULAK BALIK 4 7,910 31,640 31,640 4 7,910 31,640 8 7,910 63,280 0 7,910 0
RESEP UKURAN 3/4 FOLIO BIASA 0 10,000 - - 80 10,000 800,000 60 10,000 600,000 20 10,000 200,000
RESEP UKURAN 1/3 FOLIO 0 12,000 - - 12,000 0 0 12,000 0 0 12,000 0
RESEP UKURAN 1/3 FOLIO 3 13,560 40,680 40,680 13,560 0 3 13,560 40,680 0 13,560 0
RESEP UKURAN 1/2 FOLIO 0 15,000 - - 45 15,000 675,000 35 15,000 525,000 10 15,000 150,000
RETRIBUSI UKURAN 10.000 1/8 FOLIO 0 15,000 - - 15,000 0 0 15,000 0 0 15,000 0
RETRIBUSI UKURAN 8.000 1/8 FOLIO 0 15,000 - - 30 15,000 450,000 25 15,000 375,000 5 15,000 75,000
BUKU TB 01 0 - - - 0 0 0 0 0 0 0
KUITANSI RANGKAP DUA 0 10,000 - - 10,000 0 0 10,000 0 0 10,000 0
BLANGKO HASIL LAB 0 15,000 - - 15,000 0 0 15,000 0 0 15,000 0
Kartu 20 2,000 40,000 40,000 2,000 0 20 2,000 40,000 0 2,000 0
Kartu KB 0 500 - - 500 0 0 500 0 0 500 0
Pigura 0 250,000 - - 250,000 0 0 250,000 0 0 250,000 0
Kartu Medis KIA 0 50,000 - - 100 50,000 5,000,000 85 50,000 4,250,000 15 50,000 750,000
Format Isian Hasil Lab 0 15,000 - - 15,000 0 0 15,000 0 0 15,000 0
Resep Obat 1/4 0 8,000 - - 8,000 0 0 8,000 0 0 8,000 0
Resep Obat 1/3 0 12,000 - - 12,000 0 0 12,000 0 0 12,000 0
Retribusi 0 15,000 - 50 15,000 750,000 35 15,000 525,000 15 15,000 225,000
Jumlah 0 - 112,320 - 10,206,640 7,918,960 0 2,400,000
BMHP/ Beban Belanja Kantong Obat : 0 - - - 0 0 0 0
Kantong Plastik OBAT 0 30,000 - - 30,000 0 30,000 0 0 30,000 0
 Kantong Kresek Sedang 0 30,000 - - 30,000 0 30,000 0 0 30,000 0
6 Kantong Keresek Merek bebek No. 15 0 3,500 - - 3,500 0 3,500 0 0 3,500 0
Plastik Ukuran 9x15 No. 03 0 32,000 - - 32,000 0 32,000 0 0 32,000 0
Plastik Ukuran 9x15 No. 03 0 32,400 - - 32,400 0 32,400 0 0 32,400 0
Kantong (P) 0 15,000 - - 15,000 0 15,000 0 0 15,000 0
Kantong Plastik OBAT (Pak) 0 22,500 - - 22,500 0 22,500 0 0 22,500 0
Kantong Plastik OBAT (Pak) 0 340,000 - - 340,000 0 340,000 0 0 340,000 0
Plastik Obat G 0 32,400 - - 32,400 0 32,400 0 0 32,400 0
Plastik 8 x 15 0 99,100 - - 99,100 0 99,100 0 0 99,100 0
Kresek 15 0 4,000 - - 30 4,000 120,000 25 4,000 100,000 5 4,000 20,000
Plastik Uk 8x15-3 0 32,000 - - 32,000 0 32,000 0 0 32,000 0
Kantong Kresek Kecil 0 30,000 - - 30,000 0 30,000 0 0 30,000 0
Kresek K 0 10,000 - - 1 10,000 10,000 1 10,000 10,000 0 10,000 0
Kertas Puyer 0 13,750 - - 13,750 0 13,750 0 0 13,750 0
Seal ware jumbo 0 14,500 - - 14,500 0 14,500 0 0 14,500 0
15 kg Klip 8,7x13 0 592,500 - 592,500 0 592,500 0 0 592,500 0
Jumlah 0 - - - 130,000 110,000 0 0
Bahan bakar minyak/Gas : 0 - - - 0 0 0 0 0 0 0
Gas Elpiji 0 26,000 - - 26,000 0 26,000 0 0 26,000 0
Gas Elpiji 0 27,000 - - 27,000 0 27,000 0 0 27,000 0
7 Oli MesranSuper 4 liter 0 163,000 - - 163,000 0 163,000 0 0 163,000 0
Saringan Oli 0 35,000 - - 35,000 0 35,000 0 0 35,000 0
BBM SPBU (Pertalite 7.650 ; Pertamax 9.200 0 50,000 - - 1 50,000 50,000 1 50,000 50,000 0 50,000 0
BBM SPBU (Pertalite 7.650 ; Pertamax 9.200 0 30,000 - - 30,000 0 30,000 0 0 30,000 0
BBM SPBU (Pertalite 7.650 ; Pertamax 9.200 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
BBM SPBU (Pertalite 7.650 ; Pertamax 9.200 0 100,000 - - 100,000 0 100,000 0 0 100,000 0
BBM SPBU (Pertalite 7.650 ; Pertamax 9.200 0 125,000 - - 125,000 0 125,000 0 0 125,000 0
GSHY AKI 0 792,000 - - 792,000 0 792,000 0 0 792,000 0
Minyak Rem 0 55,000 - - 55,000 0 55,000 0 0 55,000 0
Shell Helix 0 87,500 - - 87,500 0 87,500 0 0 87,500 0
OLI Perseneleng Top 1 0 100,000 - - 100,000 0 100,000 0 0 100,000 0
OLI Gardan 0 100,000 - - 100,000 0 100,000 0 0 100,000 0
STP 0 75,000 - - 75,000 0 75,000 0 0 75,000 0
Slym Sacher 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Biaya Service Kendaraan dll 0 6,140,000 - 1 6,140,000 6,140,000 1 6,140,000 6,140,000
Jumlah 0 - - - 6,190,000 6,190,000 0 0
Bahan / Material 0 - - - 0 0 0 0 0 0 0
Bahan Obat-obatan 0 - - - 0 0 0 0 0 0 0
Tiacinon Inj 0 60,000 - - 60,000 0 60,000 0 0 60,000 0
Sintocinon 17,000 10 17,000 170,000 10 17,000 170,000 0 170,000
B Jumlah 0 - - - 0 0 0 0
Bahan baku Bangunan : 0 84,000 - - 84,000 0 84,000 0 0 84,000 0
1 Jumlah 0 - - - 0 0 0 0
Bahan Medis Habis Pakai 0 - - - 0 0 0 0
2 Abocat No 20 0 7,500 - - 7,500 0 7,500 0 0 7,500 0
Dower Cateter No 16 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Urin Bag 0 8,000 - - 2 8,000 16,000 2 8,000 16,000 0 8,000 0
Urin Bag 7,000 10 7,000 70,000 10 7,000 70,000
Umbilical 70 2,500 175,000 85 2,500 212,500 152 2,500 380,000 3 2,500 7,500
Pisau Bisturi 0 2,500 - - 2,500 0 2,500 0 0 2,500 0
Bisturi No. 4 0 12,000 - - 12,000 0 12,000 0 0 12,000 0
Cateter 0 12,000 - - 20 12,000 240,000 20 12,000 240,000 0 12,000 0
Cut gut 0 10,000 5 10,000 50,000 5 10,000 50,000
Cut gut 0 12,000 7 12,000 84,000 7 12,000 84,000
Kasa Steril 0 3,000 - - 3,000 0 3,000 0 0 3,000 0
Hand Scoond No 6,5 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Hand Scoond No 7 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Jelly 0 20,000 - - 4 20,000 80,000 4 20,000 80,000 0 20,000 0
Kassa Steril 0 3,500 - - 10 3,500 35,000 10 3,500 35,000 0 3,500 0
Kassa Hidrofil 0 121,500 - 3 121,500 364,500 1 121,500 121,500 2 121,500 243,000
Jepit Tali Pusar 0 2,500 - - 2,500 0 2,500 0 0 2,500 0
Dower Cateter no 16 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Urine Bag 8 7,000 56,000 56,000 7,000 0 8 7,000 56,000 0 7,000 0
Urine Bag 0 4,000 - 10 4,000 40,000 9 4,000 36,000 1 4,000 4,000
Folycateter 0 10,000 - - 11 10,000 110,000 10 10,000 100,000 1 10,000 10,000
Folycateter 18 0 90,000 - - 90,000 0 90,000 0 0 90,000 0
Folycateter 20 0 95,000 - - 95,000 0 95,000 0 0 95,000 0
Folycateter 20 0 19,500 - 5 19,500 97,500 5 19,500 97,500 9,500
Hans scoon Steril no 07 0 10,000 - - 10,000 0 10,000 0 0 10,000 0
Handscoon non steril S 0 95,000 - 10 95,000 950,000 8 95,000 760,000 2 95,000 190,000
Handscoon non steril M 0 95,000 - - 5 55,000 275,000 4 55,000 220,000 1 55,000 55,000
Hand Scoon uk M 3 120,000 360,000 360,000 120,000 0 3 120,000 360,000 0 0
Handscoon uk S 0 130,000 - - 130,000 0 130,000 0 0 130,000 0
Hand Scoon Obgyn 0 30,000 - - 30,000 0 30,000 0 0 30,000 0
Hand Scoon Obgyn 0 35,000 - - 30,000 0 30,000 0 0 30,000 0
Hand Scoon Obgyn 0 12,500 - - 12,500 0 12,500 0 0 12,500 0
Infus set 0 8,000 - 5 8,000 40,000 5 8,000 40,000
Gloves M 0 136,000 - 4 136,000 544,000 4 136,000 544,000 136,000 0
Gloves L 0 136,000 - 2 136,000 272,000 1 136,000 136,000 1 136,000 136,000
Masker surgical 0 150,000 - - 150,000 0 150,000 0 0 150,000 0
Masker Tie On 0 110,000 - 4 110,000 440,000 4 110,000 440,000 0 110,000 0
Masker Headloop 0 115,000 - 4 115,000 460,000 3 115,000 345,000 1 115,000 115,000
Masker Headloop 0 80,000 - 10 80,000 800,000 9 80,000 720,000 1 80,000 80,000
Masker N95 0 2,500,000 - - 2,500,000 0 2,500,000 0 0 2,500,000 0
 MGSO4 0 11,200 - 10 11,200 112,000 10 11,200 112,000 0 11,200 0
Nurse cup 4 120,000 480,000 480,000 120,000 0 4 120,000 480,000 0 120,000 0
Mukus 0 10,000 - - 30,000 0 30,000 0 0 30,000 0
Betadin 15 ml 0 10,000 - - 30,000 0 30,000 0 30,000 0
Sarung Tgn no 6,5 0 10,000 - - 30,000 0 30,000 0 0 30,000 0
Vaculab EDTA 3 ML 0 1,300 - - 30,000 0 30,000 0 0 30,000 0
IV canula 0 10,000 - 20 10,000 200,000 20 10,000 200,000 10,000 0
Jumlah 0 - 1,071,000 - 5,492,500 5,723,000 0 840,500
Bahan Laboratorium/Radiologi 0 - - - 0 0 0 0
Ziehl nelson 3x 100ml 0 389,000 - - 0 389,000 0 0 389,000 0
Emersi Oil 100 ml 0 785,000 - - 785,000 0 785,000 0 0 785,000 0
Emersi Oil 50 ml 0 239,000 - - 0 239,000 0 0 239,000 0
turk C 100 ml 0 67,000 - - 0 67,000 0 0 67,000 0
Ammonium QX 100ml 0 30,000 - - 0 30,000 0 0 30,000 0
3 Na Citrat 100ml 0 66,000 - - 0 66,000 0 0 66,000 0
EDTA 10% C 100 ml 0 192,000 - - 192,000 0 192,000 0 0 192,000 0
EDTA 10% C 100 ml 4 13,000 52,000 52,000 13,000 0 4 13,000 52,000 0 13,000 0
Widal 0 880,000 - - 0 880,000 0 0 880,000 0
Cholesterol 100 ml 0 433,000 - - 0 433,000 0 0 433,000 0
Cholesterol 100 ml 1 170,000 170,000 170,000 170,000 0 1 170,000 170,000 0 170,000 0
Spitrus 0 35,000 - - 0 35,000 0 0 35,000 0
Kontrol Kimia 0 750,000 - - 0 750,000 0 0 750,000 0
Tabung EDTA Lab 0 1,800 - - 1,800 0 1,800 0 0 1,800 0
Easy Touch Kolesterol Strip 0 170,000 - - 170,000 0 170,000 0 0 170,000 0
Plester Bulat 0 50,000 - - 50,000 0 50,000 0 0 50,000 0
Blood Lancet 0 23,000 - - 1 23,000 23,000 1 23,000 23,000 0 12,000 0
Alkohol Swab 4 20,000 80,000 80,000 20,000 0 4 20,000 80,000 0 20,000 0
Alkohol Swab 0 15,000 - - 5 15,000 75,000 5 15,000 75,000 0 18,000 0
Alkohol Swab 0 145 - 2,000 145 290,000 1000 145 145,000 1,000 145 145,000
One swab 0 25,000 - 1 25,000 25,000 1 25,000 25,000 0 25,000 0
Easy Touch Hb 0 325,000 - 1 325,000 325,000 1 325,000 325,000 0 325,000 0
Easy Touch Asam Urat Strip 0 110,000 - - 110,000 0 0 110,000 0
Easy Touch Kolesterol Strip 0 180,000 - - 180,000 0 180,000 0 0 180,000 0
Stik Kolesterol 0 178,000 - - 178,000 0 178,000 0 0 178,000 0
Stik Hemoglobin 0 155,000 - 1 155,000 155,000 1 155,000 155,000 0 0
Reagen trigleserida 0 1,100,000 275,000 275,000 1,100,000 0 1 1,100,000 275,000 0 0 0
Reagen Asam Urat 0 771,250 385,625 385,625 771,250 0 1 771,250 385,625 0 0 0
Reagen Cholesterol 0 880,000 880,000 0 - 880,000 0 0 880,000 0
Reagen Amonium Oksalat 1 69,200 69,200 69,200 69,200 0 1 69,200 69,200 0 69,200 0
Ragen Haemoglobin C 0 110,000 - 27,500 110,000 0 - 110,000 0 0 110,000 0
Strip Peri FY 0 362,500 - 362,500 0 - 362,500 0 0 362,500 0
 Ziehel Nelson 0 420,000 105,000 105,000 420,000 0 105,000 420,000 105,000 420,000 0
1,136,825 893,000 1,884,825 145,000
BARANG LAINNYA - 0
- 0
Peralatan Penunjang Lainnya - 0
- 0
JUMLAH 0
4 JUMLAH SELURUH
Garut, 31 Desember 2020

Yang melaksanakan Stock Opname

Mengetahui Pengurus Barang Pengguna/Pembantu
Pejabat Pelaksana Teknis Kegiatan

Hidayat, S.Kep.,Ners
(Wandy Firmansyah, S.KM) NIP. 19740609 199403 1 004
NIP. 19841225 201001 1 007

Pengguna Barang

H Wahyudin, S.Kep.,Ners
Nip : 19711104 199403 1 003
0
 PEMERINTAH KABUPATEN GARUT
DINAS KESEHATAN KABUPATEN
Jalan Proklamasi No 7 Telepon & Fax ( 0262 ) 232670 Trg 44151
Jalan Proklamasi No 7 Telepon & Fax ( 0262 ) 232670 Trg 44151

SALDO PERSEDIAAN PER 31 DESEMBER 2020

BERITA ACARA
STOCK OPNAME PERSEDIAAN BARANG

Pada hari ini, Kamis tanggal 31 Desember 2020, Kami yang bertanda tangan dibawah ini :

1 Nama : H. Wahyudin, S.Kep.,Ners

Jabatan : Kepala UPT Puskesmas Pakuwon Selaku Kuasa Pengguna Anggaran

2 Nama : Hidayat, S.Kep.,Ners

Jabatan : Pengurus Barang Pembantu

Sesuai dengan ketentuan Pasal 16 dan 17 Peraturan Bupati Garut No. 14 Tahun 2016 tentang Sistem dan
Prosedur Pengelolaan Barang Milik Daerah di lingkungan Pemerintah Kabupaten Garut, Kami telah melakukan
Stock Opname Persediaan per 31 Desember 2020 dengan hasil sebagai berikut:

MULAI TAHUN 2020 SALDO

NO NAMA BARANG SALDO PER
JUNI 2020 PENAMBAHAN PENGURANGAN 31-Dec-20
A PERSEDIAAN BAHAN HABIS PAKAI
1 Alat Tulis Kantor 205,650 3,309,202 3,487,850.00 27,002.00
Alat listrik dan Elektronik
2 (Lampu Pijar, battery - 4,638,000.00 4,638,000.00 -
kering)

Perangko, Materai &benda

3 -
pos lainnya

Peralatan kebersihan dan

4 42,000.00 8,972,500.00 9,014,500.00 -
bahan pembersih
5 Dst -
B BAHAN / MATERIAL -
1 Bahan Obat-obatan 170,000.00 170,000.00 -
2 Bahan Medis Habis pakai 1,071,000.00 5,492,500.00 5,723,000.00 840,500.00
3 Barang Cetak 112,320.00 10,206,640.00 7,918,960.00 2,400,000.00
4 Bahan Habis Pakai
5 Bahan Laboratorium 1,136,825.00 893,000.00 1,884,825.00 145,000.00
6 Bahan Belanja Kantong Obat 130,000.00 110,000.00 20,000.00
7 Bahan Bakar Minyak/Gas 6,190,000.00 6,190,000.00 -
C BARANG LAINNYA -
1 Barang untuk Pihak Ketiga -
2 Barang Penunjang Lainnya

J U M L A H 2,567,795 40,001,842 39,137,135 3,432,502.00

Demikian Berita acara ini kami buat, untuk dipergunakan seperlunya

Kepala UPT Puskesmas Pakuwon Pengurus Barang Pembantu

Selaku Kuasa Pengguna Barang

H Wahyudin, S.Kep.,Ners Hidayat, S.Kep.,Ners

NIP. 19711104 199403 1 003 NIP. 19740609 199403 1 004
 p.,Ners
99403 1 004
 DAFTA
PE

KODE MERK/TYPE/SPESIFIKASI/L
NO NAMA BARANG JML SATUAN
BARANG OKASI/JUDUL

1 Scaler Ultrasonic WOODPACKER 1 Unit

2 Tambal Gigi Set SCHEZER 1 Set
3 Set Tang Pencabut Gigi Dewasa 1 Set
YAMACO
4 Set Tang Pencabut Gigi Anak YAMACO 1 Set
5 Bur Intan (diamond bur assorted) DIAMOND 1 Set
6 Bur (round, fissuere dan inverted) DIAMOND 1 Set
7 Set Scaller Manual SCHEZER 1 Set
8 Set Alat Diagnostik Gigi dan Mulut YAMACO 1 Set
9 Spatula Pengaduk Semen SCHEZER 1 Unit
10 Partus Set MARWA 2 Set
11 Spekulum Medium Hidung YAMACO 2 Buah
12 Spekulum Telinga RENZ 2 Buah
13 Stetoskop Bayi ABN 1 Buah
14 Bak Instrumen ONEMED 2 Unit
15 Lampu Sorot IBS 1 Unit
16 Meja Resuitasi LOKAL 1 Unit
17 Tabung Oksigen dan Regulator PUREAIR 2 Unit
18 Stetoskop Anak ABN 1 Unit
19 Timbangan Injak ONEMED 1 Unit
20 Alat Ukur Panjang Bayi ONEMED 1 Unit
21 Pengukur Lingkar Kepala ONEMED 1 Unit
22 Pengukur Tinggi Badan Anak GEA 1 Unit
23 Baki Logam Tempat Alat Steril Bertutup ONEMED 1 Unit
24 IUD KIT YAMACO 1 Unit
25 PC A10 ASUS V222F ASUS 3 Unit
26 Printer EPSON L4150 EPSON 2 Unit
27 LED LG+Bracket LG 1 Unit

JUMLAH
JUMLAH TOTAL

Mengetahui
Kepala UPT Puskesmas Pakuwon

H Wahyudin, S.Kep.,Ners
Nip : 19711104 199403 1 003
 DAFTAR PENGADAAN BARANG SEMESETER 2
PERIODE : JULI SD DESEMBER 2020
UPT PUSKESMAS PAKUWON

HARGA PAJAK BIAYA UMUM HARGA JUMLAH

SATUAN (Rp) ( HARGA /JMLH SATUAN+ BIYAYA HARGA (Rp)
BRANG UMUM

3,509,091.00 - 3,509,091.00 3,509,091.00

1,181,818.00 - 1,181,818.00 1,181,818.00
1,363,636.00 - 1,363,636.00 1,363,636.00

1,000,000.00 - 1,000,000.00 1,000,000.00

263,636.00 - 263,636.00 263,636.00

147,273.00 - 147,273.00 147,273.00
545,455.00 - 545,455.00 545,455.00
354,545.00 - 354,545.00 354,545.00
45,455.00 - 45,455.00 45,455.00
490,909.00 - 490,909.00 981,818.00
142,727.00 - 142,727.00 285,454.00
104,545.00 104,545.00 209,091.00
290,909.00 290,909.00 290,909.00
100,000.00 100,000.00 200,000.00
1,090,900.00 1,090,900.00 1,090,909.00
2,363,636.00 2,363,636.00 2,363,636.00
1,045,455.00 1,045,455.00 2,090,909.00
290,909.00 290,909.00 290,909.00
180,000.00 180,000.00 180,000.00
254,545.00 254,545.00 254,545.00
45,455.00 45,455.00 45,455.00
45,455.00 45,455.00 45,455.00
245,455.00 245,455.00 245,455.00
709,091.00 709,091.00 709,091.00
8,249,885.00 8,249,885.00 24,749,655.00
4,225,850.00 4,225,850.00 8,451,700.00
1,625,000.00 1,625,000.00 1,625,000.00

1,769,455.00 52,520,900.00

54,290,355.00
NAMA PT/CV/TOKO DOKUMEN SUMBER KET
NOSPK/PERJA DPA/SPM/KWITANASI
NJIAN TANGGAL
KONTRAK
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
PT. FULKY HASYA 027/ /PKMPKW/XII/2020 04 Dec 2020
MALIBU COMPUTER 027/ /PKMPKW/XI/2020 25 Nov 2020
MALIBU COMPUTER 027/ /PKMPKW/XI/2020 25 Nov 2020
SEHATI 027/ /PKMPKW/IX/2020 15 Sep 2020

Garut, Desember 2020

Pengelola Barang

Hidayat, S.Kep.,Ners
NIP. 19740609 199403 1 004
 biaya umum:
DI ENTRI KE ATISIBADA
1.Ongkos kirim nama
harga satuan sdh dengan WARNA KUNING JANGAN perusahaan
2.honor barjas
DIRUbAH
pajak.apabila belum dokumen s
kolom pajak harus di isi wajib di isi
RI KE ATISIBADA nama
KUNING JANGAN perusahaan.dan
H dokumen sumber
wajib di isi