PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn :

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Allylestrenol 5 Mg /
1 2017 Tablet 5,144.70 -
Prestrenol
2 2019 Alopurinol 100 mg Tablet 99.00 -
3 2019 Tablet 574.75 -
Alprazolam 0,5 mg
2017 Tablet 214.50 -
4 2019 Ambroxol tablet 30 mg/Brox Tablet 207.90 -
Ambroxol sirup 15 mg/mL/
5 2019 Botol 22,374.00 -
Mucos Syr
6 2018 Tablet 248.00 -
Amoxicillin 500 mg
2019 Tablet 248.00 -
Amoksisillin sirup kering
7 2019 Tablet 4,121.70 -
125 mg/ 5 ml
Ampicillin 500
8 2018 Tablet 2,250.00 -
mg/Sanpicillin 500 mg
Aminofilin Tablet scored
9 2018 Tab 95.00 -
200 mg
Aminofilin injeksi 24
10 2018 Amp 2,878.00 -
mg/mL
11 2019 Amlodipin 10 mg Tablet Tablet 1,188.00 -
12 2018 Antrain Tab/ Revalgin Tablet 2,388.00 -

Antihemoroid, kombinasi :
bismut subgalat 150 mg
13 2018 heksaklorofen 2,5 mg Supp 3,642.00 -
lidokain 10 mg seng
oksida 120 mg

Antasida DOEN I tablet

14 2019 Tablet 120.84 -
kunyah
15 2018 suspensi, kombinasi : Botol@ 60 mL 2,098.00 -
Aluminium Hidroksida 200
2019 mg/ 5 ml Magnesium Botol 2,098.00 -
Anti Tetanus Serum ( ATS
16 2016 VIAL 139,000.00 -
) 1500 I U
17 2019 Asam Askorbat (Vit C) 50 Tablet 120.00 -
18 2019 Asam Mefenamat 500 mg Kaplet 404.00 -
Asam Tranexamat 500
19 2018 Tablet 3,600.00 -
mg/Tranec 500 mg
Asam Traneksamat Injeksi
20 2018 Ampl 2,217.00 -
100 mg/ml
21 2018 Tablet 81.00 -
Asam Folat tablet 1 mg
2019 Tab 60.00 -
22 2018 Asam Asetilsalisilat Tablet 99.00 -
2016 (Asetosal) 80 mg/ miniaspi Tablet 163.00 -
23 2018 Asiklovir 200 mg Tablet 236.00 -
24 2018 Asiklovir 400 mg Tablet 425.00 -
25 2019 Acyclovir Cream 5% Tube 16,830.00 -
2018 Acyclovir Cream 5% Tube 17,080.00 -
Aqua Pro Injeksi Steril,
27 2019 Vlf 2,860.00 -
Bebas Pirogen/Otsu
28 2018 Azitromycin tab 500 mg Tablet 1,778.00 -
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6

Baby Cough syr/ Pecdin

(Obat batuk anak dan
bayi yang mengandung
29 2019 17,820.00 -
Paracetamol , Guaifenesin
, Chlorpheniramine
Maleate )

30 2018 Betahistine 6 mg Tablet 119.00 -

31 2018 Tube 1,420.00 -
Betametason krim 0,1%
2019 Tube 1,420.00 -
Bisacodil Tab 10 mg/
32 2018 Tablet 410.00 -
Laxana
33 2018 Bisoprolol tablet 5 mg Tablet 248.00 -
34 2018 Bio ATP/Neuro ATP Tablet 2,975.00 -
35 2019 Bromhexin 4 mg 60 ml Botol 21,780.00 -
2018 Syrup/ Miravon syr Botol 17,000.00 -
36 2019 Bromhexin 8 mg/ Bromifar Tablet 495.00 -
2018 Tab Tablet 250.00 -
37 2019 Captopril 12,5 mg Tablet 68.00 -
Captopril 25 mg /
38 2019 Tablet 855.36 -
Farmoten
39 2019 Cefadroxil Sirup Botol 7,425.00 -
40 2019 Cefadroxil 500 mg Capsul 803.00 -
Cendo xytrol TM 5 ml /
41 2019 Botol 38,610.00 -
Nlydex TM
42 2018 Colistin 1500000 I U BTL 7,500.00 -
43 2019 Tablet 623.70 -
Cetirizine HCl 10 mg
2018 Tablet 97.00 -
Citicolin Injeksi /Incelin Inj/
44 2019 Ampul 53,757.00 -
Cercul Inj
45 2017 Cimetidin Tablet 200 mg Tablet 165.00 -
46 2019 Curcuma Plus Botol 10,950.01 -
Cefotaksim injeksi 0,5
47 2019 Vial 7,920.00 -
gram
Ceftriaxone serb. Inj 1.000
48 2018 Vial 4,822.00 -
mg
49 2019 Tablet 762.30 -
Ciprofloxacin 500 mg Tab
2017 Tab 254.00 -
Cotrimoksazol 480 mg
(Dewasa) kombinasi :
50 2019 Tablet 969.21 -
Sulfametoksazol 400 mL
trimetoprim 80 mg

Cotrimoksazole 240
mgKombinasi tiap 5 ml
suspensi
51 2019 Botol 2,052.00 -
Sulfammetoksazol 200 mg
+ trimetoprim 40 mg /
Omegtrim

Chloramphenicol Tetes
52 2019 Botol 10,890.00 -
Telinga/ Erlamicetin TT

53 2018 Cloramphenicol Salep Tube 2,013.00 -

2019 Mata Tube 2,013.00 -
54 2017 Chloramphenicol 250 mg Capsul 550.00 -
55 2019 Clorpromazin HCl 100 mg Tablet 170.00 -
56 2019 Diazepam inj Ampul 8,761.50 -
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
57 2019 Tablet 155.00 -
Diazepam 2 mg
2017 Tablet 99.00 -
58 2018 Difenhidramin injeksi i.v/ Ampl 1,262.00 -
2019 i.m 10 mg/mL (HCl) Ampul 1,262.00 -
59 2018 Domperidon 10 mg Tablet 90.00 -
60 2019 Domperidon 10 mg Tablet 90.00 -
Domperidon suspensi/
61 2019 Botol 19,800.00 -
sirup 5 mg/5 mL
62 2018 Tablet 264.00 -
Doksisiklin 100 mg
2017 Caps 299.00 -
63 2018 Dimenhidrinat tablet 50 Tablet 121.00 -
2017 mg Tab 114.00 -
Dumin Rectal 125 Mg
64 2019 (Paracetamol 125 mg Supp 14,949.00 -
Rectal)
Deksametason injeksi i.v/
65 2019 Ampul 1,210.00 -
i.m 5 mg/ mL
66 2019 Dexamethason 0,5 mg Tablet 183.15 -
67 2018 Dulcolax 10 mg Supp Supp 20,250.00 -
68 2019 Capsul 2,029.50 -
Elkana / Lycalvit
2018 Tablet 1,490.00 -
Epinefrin HCl (Adrenalin)
69 2019 Ampul 1,518.00 -
injeksi 0,1 %
70 2018 Eritromisin 500 mg Tablet 781.00 -
71 2019 Fenitoin 100 Mg Capsul 180 -
72 2019 Fenobarbital 30 mg Tablet 272.50 -
Fenobarbital 50 mg / ml
73 2019 Ampul 2,135.00 -
Injeksi
Fitomenadion (Vit. K) 10
74 2019 Tablet 818.00 -
mg
Fitomenadion (Vit. K)
75 2019 injeksi 10 mg ( K1) 2 Ampul 4,236.00 -
mg/ml
76 2018 Tablet 82.00 -
Furosemid 40 mg
2019 Tablet 82.00 -
Furosemid injeksi i.v/i.m
77 2019 Ampul 1,555 -
10 mg/ml
78 2019 Garam Oralit Sct 509.85 -
79 2018 Gemfibrosil 300 mg Tablet 428.00 -
80 2019 Gentian Violet Botol 2,722.50 -
Gentamicin Inj 40 mg/
81 2019 Ampul 19,602.00 -
Salticin Inj
82 2019 Botol 9,438.00 -
Gentamisin tetes mata 0,3
2017 Btl 4,800.00 -
Gentamisin salep kulit 0,1
83 2019 Tube 15,840.00 -
%/Dermabiotik
Gentamisin (Genoin) zalf
84 2019 Tube 3,075.00 -
Mata 0,3 %
85 2018 Gliquidon tab 30 mg Tablet 1,135.00 -
86 2018 Glimepirid 2mg Tablet 207.00 -
87 2019 Tablet 128.70 -
Gliseril Guaiakolat 100 mg
2018 Tablet 207 -
88 2018 Glibenklamida 5 mg Tablet 137.00 -
89 2018 Haloperidol 0.5 mg Tablet 55.00 -
90 2018 Tube 2,648.00 -
Hidrocortison krim 2,5 %
2019 Tube 2,648.00 -
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Hydroclorotiazid 25 mg
91 2018 Tablet 178.00 -
Tab

Hyoscine N Butilbromide
92 2019 Tablet 3,019.50 -
tab 10 mg/ Prolic Tab

93 2019 Botol 79,695.00 -

Hyalub TM
2017 Botol 72,600.00 -
94 2019 Ibuprofen Sirup 100 mg/5 m Botol 5,342.70 -
95 2019 Ibuprofen 400 mg Tablet 257.00 -
Ibuprofen 200 mg/ Iremax
96 2019 Tablet 1,455.30 -
Tab
97 2019 Pot 6,534.00 -
Ichityol SK
2018 Pot 5,950.00 -
98 2018 Isosorbid Dinitrat 5 mg Tablet 89.00 -
99 2019 Inerson Salep Kulit Tube 88,481.25 -
100 2018 Tablet 985.00 -
Interhistin (Mebhydroline
2017 Tablet 583.00 -
Napadisilat 50 mg)
2016 kotak 10x10 75,375.00 -
101 2019 Kalium Diklofenac 50 Tablet 3,435.30 -
2018 mg/Fenaren Tablet 860.00 -
Kalsium Laktat tablet 500
102 2019 Tablet 59.00 -
mg
103 2019 Klorfeniramina Maleat Tablet 242.55 -
2017 (CTM) 4 mg Tablet 37.00 -
104 2018 Tube 2,694.00 -
Ketokonazol krim 2 %
2019 Tube 2,694.00 -
105 2017 Ketokonazol 200 mg Tab 297.00 -
106 2019 ketorolac injeksi 30 mg/ml Ampul 1,045.00 -

Karbamazepin tablet 200

107 2019 Tablet 234.00 -
mg
Lanzoprazol kapsul/kapsul
108 2018 Tablet 330.00 -
30 mg
109 2017 Levofloxacin 500 mg Tab 686.00 -
110 2018 Lidokain injeksi HCL 2% Ampl 1,319 -
111 2019 Ampul 1,317.00 -
Lidokain injeksi 2% +
2018 Ampl 1,317.00 -
Epinefrin 2 mL
2017 Ampl 2,227.00 -
112 2018 Capsul 4,361.00 -
Linkomisin 500 mg/Biolinco
2017 Capsul 2,640.00 -
113 2019 Loratadin tablet/Kaplet 10 Tablet 127.00 -
2018 mg Tablet 127.00 -
114 2019 Loperamid 2 mg Tablet 712.80 -
115 2019 LFX Minidose Botol 98,010.00 -
116 2019 Tablet 256.25 -
Metformin 500 mg
2018 Tablet 102.00 -
Methyldopa 250 mg
117 2018 Tablet 1,088.00 -
(Dopamet Tablet)
Metilprednisolon 4 mg/
118 2019 Tablet 139.00 -
Ometilson/
Metoklopramide Tablet
119 2018 Tablet 87.00 -
mg
120 2019 Metronidazol 500 Mg Tablet 325.00 -
121 2018 Metronidazol 250 mg Tablet 93.00 -
122 2019 Mikonazol krim/salep 2% Tube 3,926.00 -
2018 (Nitrat) Tube 3,926.00 -
123 2017 Mydriatil 1 % TM Botol 48,400.00 -
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
MGSO4 40%/ OTSU
124 2019 Vlf 3,796.00 -
MGSO4 40%
125 2018 Tablet 451.00 -
Metampiron 500 mg/
2017 Tablet 242.00 -
Antalgin 500 mg
2016 Tablet 225 -
126 2018 Meloksikam 15 mg Tablet 1,238.00 -
127 2018 Mediamer B6 Tablet 3,236 -
128 2019 Botol 6,410.00 -
2018 NaCl 0,9 % Btl 6,410.00 -
2017 Btl 6,410.00 -
129 2019 Natrium Diclofenak 25 mg Tablet 142.00 -
2018 (Renadinak 25 mg) Tablet 142.00 -
130 2019 Natrium Diclofenak 50 mg Tablet 136.00 -
2018 (Grathzon 50 mg) Tablet 136.00 -
131 2019 Nifedipin 10 mg Tablet 3,350.00 -
2018 (Farmalat10 mg) Tablet 600.00 -
132 2019 Botol 54,450.00 -
Nistatin Drop
2018 Botol 47,025.00 -
133 2019 Tablet 910.00 -
Nistatin tablet 500.000 IU/ g
2018 Tablet 910.00 -
Neurobion 5000 mcg Inj /
134 2019 Ampul 6,782 -
Biocombin 500 mcg inj
Obat Batuk Hitam (OBH)
135 2019 Botol 12,870.00 -
Indo Plus
136 2019 Omeprazol 20 mg Capsul 633.60 -
137 2018 Omecal D/ Hi Cal Tablet 1,920.00 -
138 2019 Ondansentron inj Ampul 7,700.00 -
139 2019 Ondansentron Tablet 1,540.00 -
140 2018 Oksitetrasiklin salep mata Tube 2,600.00 -
141 2019 Oxytocin Inj Ampul 1,232.00 -
142 2018 Prednison tablet 5 mg Tablet 74.00 -
143 2019 Propilitiourasil 50 mg Tablet 601.92 -
Piracetam 400
144 2018 Tablet 525.00 -
mg/pirabrain 400 mg
145 2019 Capsul 2,851.20 -
Piroksikam 20 mg/ Yasiden
2018 Tablet 355.00 -
Piridoksin HCl (Vitamin
146 2018 Tablet 141.00 -
B6) 10 mg
147 2019 Botol 11,610.00 -
Paracetamol Infus 10 mg/m
2018 Btl 11,610.00 -
148 2019 Parasetamol Drops Botol 15,125 -
Parasetamol sirup 120
149 2019 Botol 7,920.00 -
mg/ 5 mL
150 2019 Paracetamol 500 mg tablet 60.00 -
Pirantel tablet Score
151 2018 Tablet 331.00 -
(Base) 125 mg
152 2018 Propanolol HCl 40 mg Tablet 59.00 -
153 2018 Tablet 297.00 -
Papaverin 40 mg tab
2017 Tablet 374.00 -
154 2019 Panvit C / Bexicom C/ Kaplet 1,930.50 -
2018 meviton Tablet 1,700.00 -
155 2018 Pantocain 0,5 % Btl 15,840.00 -
156 2019 Progenta TM Botol 49,500.00 -
157 2019 Ranitidin Tab 150 mg Tablet 207.90 -
158 2019 Botol 7,150 -
Ringer Laktat
2018 Btl 7,150 -
159 2019 Tablet 64.00 -
Salbutamol Sulfat 2 mg
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Salbutamol Sulfat 2 mg
2018 Tablet 64.00 -
160 2019 Tablet 77.00 -
Salbutamol Sulfat 4 mg
2018 Tablet 77.00 -
161 2019 Salep 2-4 Pot 3,011.00 -
162 2019 Salicil Bedak serbuk 2% Box 11,880.00 -
163 2019 Tablet 110.00 -
Simvastatin 10 mg
2018 Tablet 110.00 -
164 2019
Simvastatin 20 Mg Tablet 407.00 -
Sefadroksil Sirup kering
165 2018 Btl 4,086.00 -
125 mg/ml
Sianokobalamin (vitamin
166 2018 Ampl 1,087.00 -
B12) inj 500 mcg
Sianokobalamin (vitamin
167 2018 Tablet 48.00 -
B12) 50 mcg

Tablet Tambah Darah

168 2018 (Kombinasi: Ferro fumarat Tablet 409 -
60 mg + as. Folat 0,4 mg

169 2019 Ampul 176,800.00 -

Tetagam
2018 Ampl 176,800.00 -
170 2019 Tramadol Inj 50 mg/ml Ampul 1,764.00 -
171 2019 Trihexyphenidil 2 mg Tab Tablet 95.00 -
172 2019 Botol 47,520.00 -
2018 Tobroson TM Botol 47,000.00 -
2016 BTL 49,600.00 -
Ventolin Nebule/
173 2019 Nebu 4,550.00 -
COMBIVENT
174 2019 Tablet 135.00 -
Vitamin B Kompleks
2018 Tablet 135.00 -
175 2018 Zink Sulfat Dispersibel 20 Tablet 604.00 -
OBAT GIGI -
1 2018 Absorbent paper Point Kotak 180,000.00 -
2017 10mg Kemasan 204,050.00 -
2 2017 Alpin Meisinger Kemasan 104,500.00 -
Articulating Paper Full dc
3 2018 Box 420,000 -
Swedish
4 2017 Artinipsa 4 % Kemasan 770,000.00 -
5 2018 Kemasan 770,000.00 -
Bahan Tambal sementara
2016 Kemasan 320,000.00 -
6 2018 Bonding Light Cure T-Bond Kemasan 750,000.00 -
7 2018 Kemasan 698,000.00 -
Bur Diamond Set Meisinger
2017 Kemasan 374,000.00 -
8 2018 Kemasan 1,020,000.00 -
Cresotin Liquid II
2017 Kemasan 709,830.00 -
9 2018 Pak 95,000.00 -
Cotton Roll
2017 Kemasan 132,000.00 -
10 2017 Endoscal Kemasan 275,000.00 -
11 2018 Etilklorid spray Botol 200,000.00 -
12 2018 Eugenol 10 ml Btl 21,468.00 -
13 2018 Endoseal Denpro Kemasan 598,000.00 -
14 2018 Kemasan 200,000.00 -
Gulta Perca Poin 15 - 40
2016 Kemasan 95,000.00 -
15 2018 Micro Brush Aplication Kemasan 220,000.00 -
16 2017 Micro Aplicator Kemasan 176,000.00 -
17 2018 Tube 450,000.00 -
Master Fill A3
2017 Kemasan 290,400.00 -
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
18 2018 Needle Olyco (16 mm) Kemasan 795,000.00 -
19 2017 Paramonoclorafenol / CHK Kemasan 143,000.00 -
Solare A 2 Light Cured
20 2018 Buah 450,000.00 -
Composit Anterior
21 2017 Saliva Enjektor Defend Kemasan 192,500.00 -
22 2018 Scotchbond Etchant Kemasan 450,000.00 -
Solare Anterior A2
23 2018 Buah 775,000.00 -
(Komposit) GC
Solare X-A2 Light curet
24 2017 Kemasan 605,275.00 -
Composit Restorative
25 2018 Tip Scaller GT Pcs 620,000.00 -
26 2017 Wodpecker Kemasan 269,500.00 -
27 2018 Kemasan 475,000.00 -
Tricesolformalin/ TKF
2017 Kemasan 214,500.00 -
28 2018 Kemasan 910,000.00 -
Vitapex/metapex 2,5 mg
2016 Kemasan 1,125,000.00 -

PENANGGUNG JAWAB INSTALASI YANG MENYERAHKAN MENERIMA

FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR ( CITO )
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 24 Januari 2020

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6

1 2019 Asam Mefenamat 500 mg Kaplet 404.00 1000 403,997.00

2 2019 Asam Askorbat (Vit C) 50 mg Tablet 120.00 1000 120,000.00

3 2018 Cloramphenicol Salep Mata Tube 2,013.00 96 193,248.00

4 2018 Vitamin B Kompleks Tablet 135.00 3000 405,000.00

1,122,245.00

31,102,680.38
31,102,680.38
-
PENANGGUNG JAWAB INSTALASI YANG MENYERAHKAN MENERIMA
FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 18 Maret 2020

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6

1 2019 Alopurinol 100 mg Tablet 99.00 1000 99,000.00

Ambroxol tablet 30
2 2019 Tablet 207.90 2000 415,800.00
mg/Broxal 30 mg

Ambroxol sirup 15 mg/mL/

3 2019 Botol 22,374.00 25 559,350.00
Mucos Syr

4 2018 Amoxicillin 500 mg Tablet 248.00 12000 2,976,000.00

Amoksisillin sirup kering

5 2019 Tablet 4,121.70 50 206,085.00
125 mg/ 5 ml

Aminofilin Tablet scored

6 2018 Tab 95.00 1000 95,000.00
200 mg

7 2019 Amlodipin 10 mg Tablet Tablet 1,188.00 900 1,069,200.00

Antasida DOEN I tablet

8 2019 Tablet 120.84 1300 157,085.50
kunyah

Asam Askorbat (Vit C) 50

9 2019 Tablet 120.00 1000 120,000.00
mg

10 2019 Asam Mefenamat 500 mg Kaplet 404.00 1500 605,995.50

11 2019 Asam Folat tablet 1 mg Tab 60.00 1500 90,000.00

12 2018 Acyclovir Cream 5% Tube 17,080.00 48 819,840.00

Aqua Pro Injeksi Steril,

13 2019 Vlf 2,860.00 30 85,800.00
Bebas Pirogen/Otsu

14 2018 Azitromycin tab 500 mg Tablet 1,778.00 600 1,066,800.00

Baby Cough syr/ Pecdin
(Obat batuk anak dan
bayi yang mengandung
15 2019 17,820.00 48 855,360.00
Paracetamol , Guaifenesin
, Chlorpheniramine
Maleate )
16 2018 Betahistine 6 mg Tablet 119.00 3000 357,000.00

17 2018 Betametason krim 0,1% Tube 1,420.00 50 71,000.00

18 2019 Captopril 12,5 mg Tablet 68.00 500 34,000.00

Captopril 25 mg /
19 2019 Tablet 855.36 1000 855,360.00
Farmoten
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN

20 2019 Cefadroxil Sirup Botol 7,425.00 50 371,250.00

21 2018 Cetirizine HCl 10 mg Tablet 97.00 2000 194,000.00

Citicolin Injeksi /Incelin Inj/

22 2019 Ampul 53,757.00 5 268,785.00
Cercul Inj

23 2017 Cimetidin Tablet 200 mg Tablet 165.00 1000 165,000.00

24 2019 Curcuma Plus Botol 10,950.01 25 273,750.13

Cotrimoksazol 480 mg
(Dewasa) kombinasi :
25 2019 Tablet 969.21 1000 969,210.00
Sulfametoksazol240
Cotrimoksazole 400 mL
trimetoprim 80tiap
mgKombinasi mg 5 ml
suspensi
26 2019 Botol 2,052.00 100 205,200.00
Sulfammetoksazol 200 mg
+ trimetoprim 40 mg /
Omegtrim
Cloramphenicol Salep
27 2018 Tube 2,013.00 96 193,248.00
Mata

28 2017 Chloramphenicol 250 mg Capsul 550.00 1000 550,000.00

Difenhidramin injeksi i.v/

29 2019 Ampul 1,262.00 60 75,720.00
i.m 10 mg/mL (HCl)

Domperidon suspensi/
30 2019 Botol 19,800.00 50 990,000.00
sirup 5 mg/5 mL

31 2018 Doksisiklin 100 mg Tablet 264.00 3000 792,000.00

Dimenhidrinat tablet 50
32 2018 Tablet 121.00 1000 121,000.00
mg

Deksametason injeksi i.v/

33 2019 Ampul 1,210.00 50 60,500.00
i.m 5 mg/ mL

34 2019 Dexamethason 0,5 mg Tablet 183.15 3000 549,450.00

35 2019 Elkana / Lycalvit Capsul 2,029.50 1500 3,044,250.00

Gentamisin tetes mata

36 2019 Botol 9,438.00 24 226,512.00
0,3%

Gentamisin (Genoin) zalf

37 2019 Tube 3,075.00 96 295,200.00
Mata 0,3 %

38 2018 Glimepirid 2mg Tablet 207.00 1000 207,000.00

39 2018 Gliseril Guaiakolat 100 mg Tablet 207 5000 1,035,000.00

40 2018 Glibenklamida 5 mg Tablet 137.00 2000 274,000.00

41 2018 Hidrocortison krim 2,5 % Tube 2,648.00 96 254,208.00

 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN

Hydroclorotiazid 25 mg
42 2018 Tablet 178.00 2000 356,000.00
Tab

Hyoscine N Butilbromide
43 2019 Tablet 3,019.50 1000 3,019,500.00
tab 10 mg/ Prolic Tab

Ibuprofen Sirup 100 mg/5

44 2019 Botol 5,342.70 50 267,135.00
ml

Interhistin (Mebhydroline
45 2017 Tablet 583.00 5000 2,915,000.00
Napadisilat 50 mg)

Kalsium Laktat tablet 500

46 2019 Tablet 59.00 2000 118,000.00
mg

Klorfeniramina Maleat
47 2017 Tablet 37.00 10000 370,000.00
(CTM) 4 mg

48 2018 Lidokain injeksi HCL 2% Ampl 1,319 100 131,900.00

Lidokain injeksi 2% +
49 2018 Ampl 1,317.00 90 118,530.00
Epinefrin 2 mL

Loratadin tablet/Kaplet 10
50 2018 Tablet 127.00 6000 762,000.00
mg

51 2019 Loperamid 2 mg Tablet 712.80 1500 1,069,200.00

52 2019 Metformin 500 mg Tablet 256.25 1000 256,245.00

Methyldopa 250 mg
53 2018 Tablet 1,088.00 3000 3,264,000.00
(Dopamet Tablet)

Metilprednisolon 4 mg/
54 2019 Tablet 139.00 1000 139,000.00
Ometilson/

Metoklopramide Tablet
55 2018 Tablet 87.00 1000 87,000.00
mg

56 2018 Metronidazol 250 mg Tablet 93.00 3000 279,000.00

MGSO4 40%/ OTSU

57 2019 Vlf 3,796.00 30 113,880.00
MGSO4 40%

58 2018 NaCl 0,9 % Btl 6,410.00 80 512,800.00

Neurobion 5000 mcg Inj /

59 2019 Ampul 6,782 20 135,630.00
Biocombin 500 mcg inj

Obat Batuk Hitam (OBH)

60 2019 Botol 12,870.00 48 617,760.00
Indo Plus

61 2019 Omeprazol 20 mg Capsul 633.60 1800 1,140,480.00

62 2019 Oxytocin Inj Ampul 1,232.00 100 123,200.00

63 2019 Propilitiourasil 50 mg Tablet 601.92 500 300,960.00

 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN

Piroksikam 20 mg/
64 2019 Capsul 2,851.20 2000 5,702,400.00
Yasiden

Paracetamol Infus 10
65 2019 Botol 11,610.00 10 116,100.00
mg/mL

Parasetamol sirup 120

66 2019 Botol 7,920.00 144 1,140,480.00
mg/ 5 mL

67 2019 Paracetamol 500 mg tablet 60.00 8000 480,000.00

Pirantel tablet Score

68 2018 Tablet 331.00 1000 331,000.00
(Base) 125 mg

Panvit C / Bexicom C/
69 2019 Kaplet 1,930.50 1000 1,930,500.00
meviton

70 2019 Ranitidin Tab 150 mg Tablet 207.90 3000 623,700.00

71 2019 Ringer Laktat Botol 7,150 100 715,000.00

72 2019 Salep 2-4 Pot 3,011.00 24 72,264.00

73 2019 Salicil Bedak serbuk 2% Box 11,880.00 36 427,680.00

Sianokobalamin (vitamin
74 2018 Ampl 1,087.00 100 108,700.00
B12) inj 500 mcg

Ventolin Nebule/
75 2019 Nebu 4,550.00 20 91,000.00
COMBIVENT

49,987,038.13
60,070,508.13
- 10,083,470.00

PENANGGUNG JAWAB INSTALASI YANG MENYERAHKAN MENERIMA

FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 21 April 2020

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
1 2019 Alopurinol 100 mg Tablet 99.00 1000 99,000.00

2 2019 Ambroxol tablet 30 mg/Brox Tablet 207.90 2000 415,800.00

Ambroxol sirup 15 mg/mL/
3 2019 Botol 22,374.00 50 1,118,700.00
Mucos Syr
Aminofilin Tablet scored
4 2018 Tab 95.00 1000 95,000.00
200 mg
5 2019 Amlodipin 10 mg Tablet Tablet 1,188.00 900 1,069,200.00

Antasida DOEN I tablet

6 2019 Tablet 120.84 2000 241,670.00
kunyah
Antasida DOEN II
suspensi, kombinasi :
7 2018 Aluminium Hidroksida 200Botol@ 60 mL 2,098.00 300 629,400.00
mg/ 5 ml Magnesium
8 2019 Hidroksida 200 mg/
Asam Mefenamat 5 mL
500 mg Kaplet 404.00 2000 807,994.00

9 2019 Asam Folat tablet 1 mg Tab 60.00 2000 120,000.00

Baby Cough syr/ Pecdin

(Obat batuk anak dan
bayi yang mengandung
10 2019 17,820.00 12 213,840.00
Paracetamol , Guaifenesin
, Chlorpheniramine
Maleate )

11 2018 Betahistine 6 mg Tablet 119.00 3000 357,000.00

12 2018 Betametason krim 0,1% Tube 1,420.00 100 142,000.00

Bromhexin 4 mg 60 ml
13 2018 Botol 17,000.00 100 1,700,000.00
Syrup/ Miravon syr
Bromhexin 8 mg/ Bromifar
14 2018 Tablet 250.00 2000 500,000.00
Tab
Cloramphenicol Salep
15 2018 Tube 2,013.00 96 193,248.00
Mata
Deksametason injeksi i.v/
16 2019 Ampul 1,210.00 50 60,500.00
i.m 5 mg/ mL
17 2018 Furosemid 40 mg Tablet 82.00 2000 164,000.00
Furosemid injeksi i.v/i.m
18 2019 Ampul 1,555 50 77,750.00
10 mg/ml
Hydroclorotiazid 25 mg
19 2018 Tablet 178.00 200 35,600.00
Tab
Kalsium Laktat tablet 500
20 2019 Tablet 59.00 1000 59,000.00
mg
21 2017 Ketokonazol 200 mg Tab 297.00 3000 891,000.00
Loratadin tablet/Kaplet 10
22 2018 Tablet 127.00 5000 635,000.00
mg
23 2019 Loperamid 2 mg Tablet 712.80 1000 712,800.00
MGSO4 40%/ OTSU
24 2019 Vlf 3,796.00 60 227,760.00
MGSO4 40%
 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Metampiron 500 mg/
25 2017 Tablet 242.00 2000 484,000.00
Antalgin 500 mg
Natrium Diclofenak 25 mg
26 2018 Tablet 142.00 3000 426,000.00
(Renadinak 25 mg)
Natrium Diclofenak 50 mg
27 2018 Tablet 136.00 5600 761,600.00
(Grathzon 50 mg)
Nifedipin 10 mg
28 2018 Tablet 600.00 2000 1,200,000.00
(Farmalat10 mg)
29 2019 Omeprazol 20 mg Capsul 633.60 500 316,800.00
30 2018 Omecal D/ Hi Cal Tablet 1,920.00 210 403,200.00
Piracetam 400
31 2018 Tablet 525.00 1500 787,500.00
mg/pirabrain 400 mg
Parasetamol sirup 120
32 2019 Botol 7,920.00 144 1,140,480.00
mg/ 5 mL
33 2019 Paracetamol 500 mg tablet 60.00 5000 300,000.00
Panvit C / Bexicom C/
34 2019 Kaplet 1,930.50 840 1,621,620.00
meviton

18,007,462.00
-
18,007,462.00

PENANGGUNG JAWAB INSTALASI YANG MENYERAHKAN MENERIMA

FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 28 Mei 2020

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
1 2019 Alopurinol 100 mg Tablet 99.00 1000 99,000.00
Ambroxol sirup 15 mg/mL/
2 2019 Botol 22,374.00 25 559,350.00
Mucos Syr
3 2019 Amoxicillin 500 mg Tablet 248.00 10000 2,480,000.00

Amoksisillin sirup kering

4 2019 Tablet 4,121.70 50 206,085.00
125 mg/ 5 ml
Aminofilin Tablet scored
5 2018 Tab 95.00 900 85,500.00
200 mg
Antasida DOEN I tablet
6 2019 Tablet 120.84 3000 362,505.00
kunyah
Antasida DOEN II
suspensi, kombinasi :
7 2018 Aluminium Hidroksida 200Botol@ 60 mL 2,098.00 400 839,200.00
mg/ 5 ml Magnesium
8 2019 Hidroksida
Asam Folat200 mg/
tablet 15
mgmL Tab 60.00 2000 120,000.00

9 2018 Betahistine 6 mg Tablet 119.00 2000 238,000.00

10 2019 Betametason krim 0,1% Tube 1,420.00 125 177,500.00

Bromhexin 8 mg/ Bromifar

11 2018 Tablet 250.00 5000 1,250,000.00
Tab

12 2019 Cotrimoksazole
Cefadroxil Sirup 240 Botol 7,425.00 50 371,250.00
mgKombinasi tiap 5 ml
suspensi
13 2019 Botol 2,052.00 100 205,200.00
Sulfammetoksazol 200 mg
+ trimetoprim 40 mg /
Chloramphenicol Tetes
14 2019 Omegtrim Botol 10,890.00 10 108,900.00
Telinga/ Erlamicetin TT

15 2017 Chloramphenicol 250 mg Capsul 550.00 2000 1,100,000.00

16 2018 Doksisiklin 100 mg Tablet 264.00 500 132,000.00

17 2019 Dexamethason 0,5 mg Tablet 183.15 2000 366,300.00

18 2019 Elkana / Lycalvit Capsul 2,029.50 420 852,390.00

19 2018 Furosemid 40 mg Tablet 82.00 2000 164,000.00

Furosemid injeksi i.v/i.m

20 2019 Ampul 1,555 25 38,875.00
10 mg/ml

21 2018 Gemfibrosil 300 mg Tablet 428.00 600 256,800.00

22 2018 Gliseril Guaiakolat 100 mg Tablet 207 1000 207,000.00

Klorfeniramina Maleat
2019 Tablet 37.00 10000 370,000.00
(CTM) 4 mg
Kalsium Laktat tablet 500
23 2019 Tablet 59.00 1000 59,000.00
mg

24 2019 ketorolac injeksi 30 mg/ml Ampul 1,045.00 100 104,500.00

 Tahu NAMA OBAT /
NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Metilprednisolon 4 mg/
25 2019 Tablet 139.00 1000 139,000.00
Ometilson/
Neurobion 5000 mcg Inj /
26 2019 Ampul 6,782 20 135,630.00
Biocombin 500 mcg inj
Parasetamol sirup 120
27 2019 Botol 7,920.00 144 1,140,480.00
mg/ 5 mL
Panvit C / Bexicom C/
28 2019 Kaplet 1,930.50 840 1,621,620.00
meviton
29 2019 Salicil Bedak serbuk 2% Box 11,880.00 36 427,680.00

30 2019 Simvastatin 10 mg Tablet 110.00 900 99,000.00

14,316,765.00
-
14,316,765.00

PENANGGUNG JAWAB INSTALASI YANG MENYERAHKAN MENERIMA

FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn :

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2017 Allylestrenol 5 Mg / Prestrenol Tablet 5,144.70
2 2019 Alopurinol 100 mg Tablet 99.00
3 2019 Tablet 574.75
Alprazolam 0,5 mg
2017 Tablet 214.50
4 2019 Ambroxol tablet 30 mg/Broxal 30 Tablet 207.90
Ambroxol sirup 15 mg/mL/ Mucos
5 2019 Botol 22,374.00
Syr
6 2018 Tablet 248.00
Amoxicillin 500 mg
2019 Tablet 248.00
Amoksisillin sirup kering 125 mg/
7 2019 Tablet 4,121.70
5 ml
Ampicillin 500 mg/Sanpicillin 500
8 2018 Tablet 2,250.00
mg

9 2018 Aminofilin Tablet scored 200 mg Tab 95.00

10 2018 Aminofilin injeksi 24 mg/mL Amp 2,878.00
11 2019 Amlodipin 10 mg Tablet Tablet 1,188.00
12 2018 Antrain Tab/ Revalgin Tablet 2,388.00
Antihemoroid, kombinasi : bismut
subgalat 150 mg heksaklorofen
13 2018 Supp 3,642.00
2,5 mg lidokain 10 mg seng
oksida 120 mg
14 2019 Antasida
Antasida DOEN
DOEN II suspensi,
I tablet kunyah Tablet 120.84
kombinasi : Aluminium Hidroksida
15 2018 Botol@ 60 mL 2,098.00
200 mg/ 5 ml Magnesium
2019 Hidroksida 200 mg/ 5 mL Botol 2,098.00
Anti Tetanus Serum ( ATS ) 1500
16 2016 VIAL 139,000.00
IU
17 2019 Asam Askorbat (Vit C) 50 mg Tablet 120.00
18 2019 Asam Mefenamat 500 mg Kaplet 404.00
Asam Tranexamat 500
19 2018 Tablet 3,600.00
mg/Tranec 500 mg
Asam Traneksamat Injeksi 100
20 2018 Ampl 2,217.00
mg/ml
21 2018 Tablet 81.00
Asam Folat tablet 1 mg
2019 Tab 60.00
22 2018 Asam Asetilsalisilat (Asetosal) 80 Tablet 99.00
mg/ miniaspi
 Asam Asetilsalisilat (Asetosal) 80
2016 mg/ miniaspi Tablet 163.00
23 2018 Asiklovir 200 mg Tablet 236.00
24 2018 Asiklovir 400 mg Tablet 425.00
25 2019 Tube 16,830.00
Acyclovir Cream 5%
2018 Tube 17,080.00
Aqua Pro Injeksi Steril, Bebas
27 2019 Vlf 2,860.00
Pirogen/Otsu
28 2018 Azitromycin tab 500 mg Tablet 1,778.00
Baby Cough syr/ Pecdin (Obat
batuk anak dan bayi yang
29 2019 mengandung Paracetamol , 17,820.00
Guaifenesin , Chlorpheniramine
Maleate )
30 2018 Betahistine 6 mg Tablet 119.00
31 2018 Tube 1,420.00
Betametason krim 0,1%
2019 Tube 1,420.00
32 2018 Bisacodil Tab 10 mg/ Laxana Tablet 410.00
33 2018 Bisoprolol tablet 5 mg Tablet 248.00
34 2018 Bio ATP/Neuro ATP Tablet 2,975.00
35 2019 Bromhexin 4 mg 60 ml Syrup/ Botol 21,780.00
2018 Miravon syr Botol 17,000.00
36 2019 Tablet 495.00
Bromhexin 8 mg/ Bromifar Tab
2018 Tablet 250.00
37 2019 Captopril 12,5 mg Tablet 68.00
38 2019 Captopril 25 mg / Farmoten Tablet 855.36
39 2019 Cefadroxil Sirup Botol 7,425.00
40 2019 Cefadroxil 500 mg Capsul 803.00
Cendo xytrol TM 5 ml / Nlydex
41 2019 Botol 38,610.00
TM
42 2018 Colistin 1500000 I U BTL 7,500.00
43 2019 Tablet 623.70
Cetirizine HCl 10 mg
2018 Tablet 97.00
Citicolin Injeksi /Incelin Inj/ Cercul
44 2019 Ampul 53,757.00
Inj
45 2017 Cimetidin Tablet 200 mg Tablet 165.00
46 2019 Curcuma Plus Botol 10,950.01
47 2019 Cefotaksim injeksi 0,5 gram Vial 7,920.00
48 2018 Ceftriaxone serb. Inj 1.000 mg Vial 4,822.00
49 2019 Tablet 762.30
Ciprofloxacin 500 mg Tab
2017 Tab 254.00

Cotrimoksazol 480 mg (Dewasa)

50 2019 kombinasi : Sulfametoksazol 400 Tablet 969.21
mL trimetoprim 80 mg
 Cotrimoksazole 240
mgKombinasi tiap 5 ml suspensi
51 2019 Botol 2,052.00
Sulfammetoksazol 200 mg +
trimetoprim 40 mg / Omegtrim

Chloramphenicol Tetes Telinga/

52 2019 Botol 10,890.00
Erlamicetin TT
53 2018 Tube 2,013.00
Cloramphenicol Salep Mata
2019 Tube 2,013.00
54 2017 Chloramphenicol 250 mg Capsul 550.00
55 2019 Clorpromazin HCl 100 mg Tablet 170.00
56 2019 Diazepam inj Ampul 8,761.50
57 2019 Tablet 155.00
Diazepam 2 mg
2017 Tablet 99.00
58 2018 Difenhidramin injeksi i.v/ i.m 10 Ampl 1,262.00
2019 mg/mL (HCl) Ampul 1,262.00
59 2018 Domperidon 10 mg Tablet 90.00
60 2019 Domperidon 10 mg Tablet 90.00
Domperidon suspensi/ sirup 5
61 2019 Botol 19,800.00
mg/5 mL
62 2018 Tablet 264.00
Doksisiklin 100 mg
2017 Caps 299.00
63 2018 Tablet 121.00
Dimenhidrinat tablet 50 mg
2017 Tab 114.00
Dumin Rectal 125 Mg
64 2019 Supp 14,949.00
(Paracetamol 125 mg Rectal)
Deksametason injeksi i.v/ i.m 5
65 2019 Ampul 1,210.00
mg/ mL
66 2019 Dexamethason 0,5 mg Tablet 183.15
67 2018 Dulcolax 10 mg Supp Supp 20,250.00
68 2019 Elkana / Lycalvit Capsul 2,029.50
2018 Tablet 1,490.00
Epinefrin HCl (Adrenalin) injeksi
69 2019 Ampul 1,518.00
0,1 %
70 2018 Eritromisin 500 mg Tablet 781.00
71 2019 Fenitoin 100 Mg Capsul 180
72 2019 Fenobarbital 30 mg Tablet 272.50
73 2019 Fenobarbital 50 mg / ml Injeksi Ampul 2,135.00
74 2019 Fitomenadion (Vit. K) 10 mg Tablet 818.00
Fitomenadion (Vit. K) injeksi 10
75 2019 Ampul 4,236.00
mg ( K1) 2 mg/ml
76 2018 Tablet 82.00
Furosemid 40 mg
2019 Tablet 82.00
Furosemid injeksi i.v/i.m 10
77 2019 Ampul 1,555
mg/ml
78 2019 Garam Oralit Sct 509.85
79 2018 Gemfibrosil 300 mg Tablet 428.00
80 2019 Gentian Violet Botol 2,722.50
81 2019 Gentamicin Inj 40 mg/ Salticin Inj Ampul 19,602.00
82 2019 Botol 9,438.00
Gentamisin tetes mata 0,3%
2017 Btl 4,800.00
Gentamisin salep kulit 0,1
83 2019 Tube 15,840.00
%/Dermabiotik
Gentamisin (Genoin) zalf Mata
84 2019 Tube 3,075.00
0,3 %
85 2018 Gliquidon tab 30 mg Tablet 1,135.00
86 2018 Glimepirid 2mg Tablet 207.00
87 2019 Tablet 128.70
Gliseril Guaiakolat 100 mg
2018 Tablet 207
88 2018 Glibenklamida 5 mg Tablet 137.00
89 2018 Haloperidol 0.5 mg Tablet 55.00
90 2018 Tube 2,648.00
Hidrocortison krim 2,5 %
2019 Tube 2,648.00
91 2018 Hydroclorotiazid 25 mg Tab Tablet 178.00
Hyoscine N Butilbromide tab 10
92 2019 Tablet 3,019.50
mg/ Prolic Tab
93 2019 Botol 79,695.00
Hyalub TM
2017 Botol 72,600.00
94 2019 Ibuprofen Sirup 100 mg/5 ml Botol 5,342.70
95 2019 Ibuprofen 400 mg Tablet 257.00
96 2019 Ibuprofen 200 mg/ Iremax Tab Tablet 1,455.30
97 2019 Pot 6,534.00
Ichityol SK
2018 Pot 5,950.00
98 2018 Isosorbid Dinitrat 5 mg Tablet 89.00
99 2019 Inerson Salep Kulit Tube 88,481.25
100 2018 Tablet 985.00
Interhistin (Mebhydroline
2017 Tablet 583.00
Napadisilat 50 mg)
2016 kotak 10x10 75,375.00
101 2019 Kalium Diklofenac 50 Tablet 3,435.30
2018 mg/Fenaren Tablet 860.00
102 2019 Kalsium Laktat tablet 500 mg Tablet 59.00
103 2019 Klorfeniramina Maleat (CTM) 4 Tablet 242.55
2017 mg Tablet 37.00
104 2018 Tube 2,694.00
Ketokonazol krim 2 %
2019 Tube 2,694.00
105 2017 Ketokonazol 200 mg Tab 297.00
106 2019 ketorolac injeksi 30 mg/ml Ampul 1,045.00
107 2019 Karbamazepin tablet 200 mg Tablet 234.00
108 2018 Lanzoprazol kapsul/kapsul 30 mg Tablet 330.00
109 2017 Levofloxacin 500 mg Tab 686.00
110 2018 Lidokain injeksi HCL 2% Ampl 1,319
111 2019 Ampul 1,317.00
Lidokain injeksi 2% + Epinefrin 2
2018 Ampl 1,317.00
mL
 Lidokain injeksi 2% + Epinefrin 2
mL
2017 Ampl 2,227.00
112 2018 Capsul 4,361.00
Linkomisin 500 mg/Biolincom
2017 Capsul 2,640.00
113 2019 Tablet 127.00
Loratadin tablet/Kaplet 10 mg
2018 Tablet 127.00
114 2019 Loperamid 2 mg Tablet 712.80
115 2019 LFX Minidose Botol 98,010.00
116 2019 Metformin 500 mg Tablet 256.25
2018 Tablet 102.00
Methyldopa 250 mg (Dopamet
117 2018 Tablet 1,088.00
Tablet)
Metilprednisolon 4 mg/
118 2019 Tablet 139.00
Ometilson/
119 2018 Metoklopramide Tablet mg Tablet 87.00
120 2019 Metronidazol 500 Mg Tablet 325.00
121 2018 Metronidazol 250 mg Tablet 93.00
122 2019 Tube 3,926.00
Mikonazol krim/salep 2% (Nitrat)
2018 Tube 3,926.00
123 2017 Mydriatil 1 % TM Botol 48,400.00
MGSO4 40%/ OTSU MGSO4
124 2019 Vlf 3,796.00
40%
125 2018 Tablet 451.00
Metampiron 500 mg/ Antalgin 500
2017 Tablet 242.00
mg
2016 Tablet 225
126 2018 Meloksikam 15 mg Tablet 1,238.00
127 2018 Mediamer B6 Tablet 3,236
128 2019 Botol 6,410.00
2018 NaCl 0,9 % Btl 6,410.00
2017 Btl 6,410.00
129 2019 Natrium Diclofenak 25 mg Tablet 142.00
2018 (Renadinak 25 mg) Tablet 142.00
130 2019 Natrium Diclofenak 50 mg Tablet 136.00
2018 (Grathzon 50 mg) Tablet 136.00
131 2019 Tablet 3,350.00
Nifedipin 10 mg (Farmalat10 mg)
2018 Tablet 600.00
132 2019 Botol 54,450.00
Nistatin Drop
2018 Botol 47,025.00
133 2019 Tablet 910.00
Nistatin tablet 500.000 IU/ g
2018 Tablet 910.00
Neurobion 5000 mcg Inj /
134 2019 Ampul 6,782
Biocombin 500 mcg inj
Obat Batuk Hitam (OBH) Indo
135 2019 Botol 12,870.00
Plus
136 2019 Omeprazol 20 mg Capsul 633.60
137 2018 Omecal D/ Hi Cal Tablet 1,920.00
138 2019 Ondansentron inj Ampul 7,700.00
139 2019 Ondansentron Tablet 1,540.00
140 2018 Oksitetrasiklin salep mata 1 % Tube 2,600.00
141 2019 Oxytocin Inj Ampul 1,232.00
142 2018 Prednison tablet 5 mg Tablet 74.00
143 2019 Propilitiourasil 50 mg Tablet 601.92
Piracetam 400 mg/pirabrain 400
144 2018 Tablet 525.00
mg
145 2019 Piroksikam 20 mg/ Yasiden Capsul 2,851.20
2018 Tablet 355.00
Piridoksin HCl (Vitamin B6) 10
146 2018 Tablet 141.00
mg
147 2019 Botol 11,610.00
Paracetamol Infus 10 mg/mL
2018 Btl 11,610.00
148 2019 Parasetamol Drops Botol 15,125
149 2019 Parasetamol sirup 120 mg/ 5 mL Botol 7,920.00
150 2019 Paracetamol 500 mg tablet 60.00
Pirantel tablet Score (Base) 125
151 2018 Tablet 331.00
mg
152 2018 Propanolol HCl 40 mg Tablet 59.00
153 2018 Tablet 297.00
Papaverin 40 mg tab
2017 Tablet 374.00
154 2019 Kaplet 1,930.50
Panvit C / Bexicom C/ meviton
2018 Tablet 1,700.00
155 2018 Pantocain 0,5 % Btl 15,840.00
156 2019 Progenta TM Botol 49,500.00
157 2019 Ranitidin Tab 150 mg Tablet 207.90
158 2019 Botol 7,150
Ringer Laktat
2018 Btl 7,150
159 2019 Tablet 64.00
Salbutamol Sulfat 2 mg
2018 Tablet 64.00
160 2019 Tablet 77.00
Salbutamol Sulfat 4 mg
2018 Tablet 77.00
161 2019 Salep 2-4 Pot 3,011.00
162 2019 Salicil Bedak serbuk 2% Box 11,880.00
163 2019 Tablet 110.00
Simvastatin 10 mg
2018 Tablet 110.00
164 2019 Simvastatin 20 Mg Tablet 407.00
Sefadroksil Sirup kering 125
165 2018 Btl 4,086.00
mg/ml
Sianokobalamin (vitamin B12) inj
166 2018 Ampl 1,087.00
500 mcg
Sianokobalamin (vitamin B12) 50
167 2018 Tablet 48.00
mcg
Tablet Tambah Darah
168 2018 (Kombinasi: Ferro fumarat 60 mg Tablet 409
+ as. Folat 0,4 mg
169 2019 Ampul 176,800.00
Tetagam
2018 Ampl 176,800.00
170 2019 Tramadol Inj 50 mg/ml Ampul 1,764.00
171 2019 Trihexyphenidil 2 mg Tab Tablet 95.00
172 2019 Botol 47,520.00
2018 Tobroson TM Botol 47,000.00
2016 BTL 49,600.00
173 2019 Ventolin Nebule/ COMBIVENT Nebu 4,550.00
174 2019 Tablet 135.00
Vitamin B Kompleks
2018 Tablet 135.00
175 2018 Zink Sulfat Dispersibel 20 mg Tablet 604.00
OBAT GIGI
1 2018 Kotak 180,000.00
Absorbent paper Point 10mg
2017 Kemasan 204,050.00
2 2017 Alpin Meisinger Kemasan 104,500.00
Articulating Paper Full dc
3 2018 Box 420,000
Swedish
4 2017 Artinipsa 4 % Kemasan 770,000.00
5 2018 Kemasan 770,000.00
Bahan Tambal sementara
2016 Kemasan 320,000.00
6 2018 Bonding Light Cure T-Bond Kemasan 750,000.00
7 2018 Kemasan 698,000.00
Bur Diamond Set Meisinger
2017 Kemasan 374,000.00
8 2018 Kemasan 1,020,000.00
Cresotin Liquid II
2017 Kemasan 709,830.00
9 2018 Pak 95,000.00
Cotton Roll
2017 Kemasan 132,000.00
10 2017 Endoscal Kemasan 275,000.00
11 2018 Etilklorid spray Botol 200,000.00
12 2018 Eugenol 10 ml Btl 21,468.00
13 2018 Endoseal Denpro Kemasan 598,000.00
14 2018 Kemasan 200,000.00
Gulta Perca Poin 15 - 40
2016 Kemasan 95,000.00
15 2018 Micro Brush Aplication Kemasan 220,000.00
16 2017 Micro Aplicator Kemasan 176,000.00
17 2018 Tube 450,000.00
Master Fill A3
2017 Kemasan 290,400.00
18 2018 Needle Olyco (16 mm) Kemasan 795,000.00
19 2017 Paramonoclorafenol / CHKM Kemasan 143,000.00
Solare A 2 Light Cured Composit
20 2018 Buah 450,000.00
Anterior
21 2017 Saliva Enjektor Defend Kemasan 192,500.00
22 2018 Scotchbond Etchant Kemasan 450,000.00
Solare Anterior A2 (Komposit)
23 2018 Buah 775,000.00
GC
Solare X-A2 Light curet Composit
24 2017 Kemasan 605,275.00
Restorative
25 2018 Pcs 620,000.00
Tip Scaller GT Wodpecker
26 2017 Kemasan 269,500.00
27 2018 Kemasan 475,000.00
Tricesolformalin/ TKF
2017 Kemasan 214,500.00
 28 2018 Kemasan 910,000.00
Vitapex/metapex 2,5 mg
2016 Kemasan 1,125,000.00

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (E-CATALOG)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn :

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2020 Alluporinol 100 mg Tablet Tablet 105
2 2020 Amoxicillin 500 mg Tablet 265
Amoksisillin sirup kering 250 mg/
3 2020
5 ml Btl 3,846
4 2020 Amlodipin 5 mg Tablet Tablet 80
5 2020 Antasida DOEN I tablet kunyah Tab 60
6 2020 Asam Askorbat (Vit C) 50 mg Tablet 120
7 2020 Asam Folat tablet 1 mg Tablet 64
Aqua Pro Injeksi Steril, Bebas
8 2020 Ampul
Pirogen/Otsu 2,860
9 2020 Betametason krim 0,1% Tube 1,515
Cefotaxime sodium serb inj 1.000
10 2020 Vial
mg 4,706
11 2020 Cloramphenicol Salep Mata Tube 2,148
 Diazepam enema 10 mg/2.5 mL/
12 2020 Suppo
Stesolid 21,021
Difenhidramin injeksi i.v/ i.m 10
13 2020
mg/mL (HCl) Ampl 1,347
14 2020 Domperidon 10 mg Tablet 96.00
Domperidon suspensi/ sirup 5
15 2020 Botol
mg/5 mL 2,862
Deksametason injeksi i.v/ i.m 5
16 2020 Ampl
mg/ mL 1,210
17 2020 Furosemid 40 mg Tablet 88
18 2020 Garam Oralt Sacchet 293
19 2020 Gentamisin tetes mata 0,3% Btl 4,885
20 2020 Griseofulvin 125 mg Tablet 238
21 2020 Hidrocortison krim 2,5 % Tube 2,648
22 2020 Ibuprofen Sirup 200 mg/5 ml Btl 2,858
Klorfeniramina Maleat (CTM) 4
23 2020 Tablet
mg 26
24 2020 Ketokonazol krim 2 % Tube 2,694
25 2020 Karbamazepin tablet 200 mg Tablet 250
26 2020 Lanzoprazol kapsul/kapsul 30 mg Tablet
352
27 2020 Loratadin tablet/Kaplet 10 mg Tablet 136
28 2020 Metformin 500 mg Tablet 109
29 2020 MGSO4 40% Ampl 3,796
30 2020 Oksitetrasiklin salep mata 1 % Tube 2,774
Piridoksin HCl (Vitamin B6) 10
31 2020 Tablet
mg 150
32 2020 Ringer Laktat Btl 7,630
33 2020 Salep 2-4 Tube 3,213
Sianokobalamin (vitamin B12) 50
34 2020 Tablet
mcg 51
35 2020 Tiamin (Vitamin B1) 50 mg Tab 96
36 2020 Zink Sulfat Dispersibel 20 mg Tablet 604

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (PL)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn :

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
Ambroxol tablet 30 mg/Broxal 30 140
1 2020 Tablet
mg
Ambroxol sirup 15 mg/mL/ Mucos
2 2020 Botol 6,600
Syr
3 2020 Asam Mefenamat 500 mg Kaplet 276
4 2020 Betahistine 6 mg Tablet 119
5 2020 Bisoprolol tablet 5 mg Tablet 1,485
6 2020 Captopril 12,5 mg Tablet 85
7 2020 Cefadroxil Sirup Botol 7,425
8 2020 Cefadroxil 500 mg Capsul 803
9 2020 Cefixim 200 mg Capsul 4,950

Cotrimoksazol 480 mg (Dewasa)

10 2020 kombinasi : Sulfametoksazol 400 Tablet 264
mL trimetoprim 80 mg

11 2020 Dexamethason 0,5 mg Tab 154

Furosemid injeksi i.v/i.m 10
12 2020
mg/ml Ampl 1,556
13 2020 Fitomenadion inj Ampul 5000
14 2020 Glukosa larutan infus 5% steril Btl 7,363
15 2020 Ibuprofen 400 mg Tablet 510
16 2020 Ibuprofen 200 mg Tab Tablet 440
17 2020 Kalsium Laktat tablet 500 mg Tablet 135
18 2020 Lidokain injeksi HCL 2% Ampl 1,650
19 2020 Loperamid 2 mg Tab 1,210

20 2020 Metamizol/ Norages Liquid injeksi Ampul 9,185

Metampiron 500 mg/ Antalgin 500

21 2020 Tablet
mg 295
22 2020 Metilprednisolon 4 mg/
Ometilson/ Tablet 529
Metilergomettrin inj 0,2 mg/mL/
23 2020 Ampul 8,250
Myotonic inj
24 2020 Metronidazol 500 mg Tablet 264
 25 2020 Meloksikam 15 mg Tablet 1,439
Natrium Diclofenak 50 mg
26 2020 Tablet
(Grathzon 50 mg) 242
27 2020 Omeprazol 20 mg Tab 583
Paracetamol 125 mg Rectal/
28 2020 Suppo 16,208
Dumin Rectal 125 Mg
Paracetamol 250 mg Rectal/
29 2020 Suppo 22,645
Dumin Rectal 250 Mg
30 2020 Parasetamol Drops/ Xepamol Botol 15,125

31 2020 Parasetamol sirup 120 mg/ 5 mL Botol

3,850
32 2020 Paracetamol 500 mg Tablet 165
33 2020 Paracetamol Infus 10 mg/mL Botol 66,000
34 2020 Propilitiourasil 50 mg Tablet 546
35 2020 Simvastatin 10 mg Tablet 616

Tablet Tambah Darah

36 2020 (Kombinasi: Ferro fumarat 60 mg Tablet 1,650
+ as. Folat 0,4 mg/ Maltiron

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (DAK-TAMBAHAN)
PUSKESMAS : MOOAT

Tgl/Bln/Thn :

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2020 EMINETON Tablet 1,870
 YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (DID)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 26 Oktober 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5

Antasida DOEN II suspensi,

kombinasi : Aluminium Hidroksida
1 2020 Botol 60 ml 4,630
200 mg/ 5 ml Magnesium
Hidroksida 200 mg/ 5 mL

3 2020 Amlodipin 10 mg Tablet Tablet 715

4 2020 Asam askorbat inj Ampul 8,000
5 2020 Bio ATP/ Neuro ATP Tablet 2,550
6 2020 Biocombin inj Ampul 5,500
2020 Bisacodil/ Dulcolax 10 mg Supp Supp 6,875
2020 Bromhexin 8 mg/ Solvinex Tab Tablet 440
8 2020 Cendo Citrol 5 ml boltol 5 ml 29,975
Cetirizine hydrochlorida (Hcl)
9 2020 Tablet 374
tablet 10 mg
Cetirizine hydrochlorida (Hcl)
10 2020 Botol 20 ml 57,200
tablet 10 mg/ Rinosep drop
11 2020 Ceftriaxone serb inj 1.000 mg Vial 8,250
12 2020 Chloramfenicol HCl 250 mg Capsul 811
13 2020 Chloramfenicol TT Bool 5 ml 6,105
 Citicolin Injeksi /Incelin Inj/ Cercul
14 2020 Ampul 29,480
Inj
Eflin tab (pseudoefedrin +
16 2020 Tablet 1,375
tripolidin)

Etaflusin (Obat batuk anak dan

bayi yang mengandung
17 2020 Paracetamol , Gliseril Guaikolat , Botol 6,695
Chlorpheniramine Maleate,
Efedrin, Nat.Sitrat, Etanol )

18 2020 Etacurvita (Curcumin, Vit.1,B6,B12 Botol 8,022

Gentamisin salep kulit 0,1
20 2020 Tube 5,390
%/Dermabiotik
Hyoscine N Butilbromide tab 10
21 2020 Tablet 1,317
mg Tab/
2020 Kalium Diklofenac 50 mg/ Tablet 708
22 2020 Ketorolac 10 mg/ml Ampul 1 ml 1,364
24 2020 Metronidazol inf Botol 55,000
26 2020 Meviton Tab tablet 1,650
27 2020 Nystatin 100.000 IU/ml Botol 12 ml 41,250
2020 Oxytocin 10 IU/ ml Ampul 7,920
2020 Ondansentron inj Ampul 7,700
2020 Ondansentron Tablet 2,530
28 2020 Prednison tablet 5 mg Tablet 354
2020 Ranitidin (HCl) 25 mg/ml Inj Ampul 1,507
29 2020 Voltaren SK/ Megatic SK Tube 25,000
30 2020 Asam Folat + DHA + VitB 12 Capsul 4,565

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013
ONDOW TIMUR

JUMLAH HARGA

6
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MENERIMA

………………

ONDOW TIMUR

ATALOG)

JUMLAH HARGA

6
-
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MENERIMA

………………
ONDOW TIMUR

(PL)

JUMLAH HARGA

6
-
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MENERIMA

………………

AMBAHAN)

JUMLAH HARGA

6
-
 -

MENERIMA

………………

ONDOW TIMUR

DID)

JUMLAH HARGA

-
-
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MENERIMA

………………
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 26 Agustus 2020

NAMA OBAT /
NO Tahun HARGA
PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
1 2019 Amlodipin 10 mg Tablet Tablet 1,188.00 1500 1,782,000.00
Antasida DOEN I tablet
2 2019 Tablet 120.84 2000 241,670.00
kunyah

Antasida DOEN II
suspensi, kombinasi :
3 2019 Aluminium Hidroksida 200 Botol 2,098.00 400 839,200.00
mg/ 5 ml Magnesium
Hidroksida 200 mg/ 5 mL

4 2019 Asam Mefenamat 500 mg Kaplet 404.00 2000 807,994.00

Asam Tranexamat 500
5 2018 Tablet 3,600.00 1000 3,600,000.00
mg/Tranec 500 mg

6 2018 Acyclovir Cream 5% Tube 17,080.00 98 1,673,840.00

7 2019 Betametason krim 0,1% Tube 1,420.00 100 142,000.00

8 2019 Cefadroxil Sirup Botol 7,425.00 50 371,250.00

9 2019 Cetirizine HCl 10 mg Tablet 623.70 900 561,330.00

10 2019 Curcuma Plus Botol 10,950.01 50 547,500.25

11 2019 Ciprofloxacin 500 mg Tab Tablet 762.30 1000 762,300.00

Cotrimoksazol 480 mg
(Dewasa) kombinasi :
12 2019 Tablet 969.21 500 484,605.00
Sulfametoksazol 400 mL
trimetoprim 80 mg
Cotrimoksazole 240
mgKombinasi tiap 5 ml
suspensi
13 2019 Botol 2,052.00 100 205,200.00
Sulfammetoksazol 200 mg
+ trimetoprim 40 mg /
Omegtrim

14 2018 Domperidon 10 mg Tablet 90.00 5000 450,000.00

Domperidon suspensi/
15 2019 Botol 19,800.00 50 990,000.00
sirup 5 mg/5 mL
Deksametason injeksi i.v/
16 2019 Ampul 1,210.00 50 60,500.00
i.m 5 mg/ mL
17 2019 Dexamethason 0,5 mg Tablet 183.15 5000 915,750.00

18 2019 Furosemid 40 mg Tablet 82.00 5000 410,000.00

19 2019 Garam Oralit Sct 509.85 100 50,985.00

20 2018 Gemfibrosil 300 mg Tablet 428.00 1200 513,600.00

21 2019 Gentamisin tetes mata 0,3 Botol 9,438.00 24 226,512.00

Gentamisin salep kulit 0,1
22 2019 Tube 15,840.00 48 760,320.00
%/Dermabiotik

23 2018 Gliseril Guaiakolat 100 mg Tablet 207 5000 1,035,000.00

 NAMA OBAT /
NO Tahun HARGA
PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6

24 2018 Hidrocortison krim 2,5 % Tube 2,648.00 96 254,208.00

25 2019 Ibuprofen Sirup 100 mg/5 m Botol 5,342.70 50 267,135.00

26 2019 Ketokonazol krim 2 % Tube 2,694.00 100 269,400.00

Lidokain injeksi 2% +
27 2018 Ampl 1,317.00 90 118,530.00
Epinefrin 2 mL
Methyldopa 250 mg
28 2018 Tablet 1,088.00 1000 1,088,000.00
(Dopamet Tablet)
Metilprednisolon 4 mg/
29 2019 Tablet 139.00 1000 139,000.00
Ometilson/
Metoklopramide Tablet
30 2018 Tablet 87.00 1000 87,000.00
mg
Mikonazol krim/salep 2%
31 2019 Tube 3,926.00 96 376,896.00
(Nitrat)
32 2018 Meloksikam 15 mg Tablet 1,238.00 1000 1,238,000.00

33 2018 NaCl 0,9 % Btl 6,410.00 200 1,282,000.00

Natrium Diclofenak 25 mg
34 2018 Tablet 142.00 1000 142,000.00
(Renadinak 25 mg)
Natrium Diclofenak 50 mg
35 2019 Tablet 136.00 2800 380,800.00
(Grathzon 50 mg)

36 2019 Nistatin Drop Botol 54,450.00 20 1,089,000.00

Neurobion 5000 mcg Inj /
37 2019 Ampul 6,782 20 135,630.00
Biocombin 500 mcg inj
Obat Batuk Hitam (OBH)
38 2019 Botol 12,870.00 48 617,760.00
Indo Plus
39 2019 Omeprazol 20 mg Capsul 633.60 600 380,160.00

40 2018 Oksitetrasiklin salep mata Tube 2,600.00 50 130,000.00

41 2019 Oxytocin Inj Ampul 1,232.00 100 123,200.00

42 2019 Piroksikam 20 mg/ Yasiden Capsul 2,851.20 500 1,425,600.00

Parasetamol sirup 120
43 2019 Botol 7,920.00 144 1,140,480.00
mg/ 5 mL
44 2019 Paracetamol 500 mg tablet 60.00 5000 300,000.00

45 2019 Ranitidin Tab 150 mg Tablet 207.90 4000 831,600.00

46 2018 Salbutamol Sulfat 2 mg Tablet 64.00 3000 192,000.00

47 2018 Salbutamol Sulfat 4 mg Tablet 77.00 3000 231,000.00

48 2019 Salep 2-4 Pot 3,011.00 24 72,264.00

Sianokobalamin (vitamin
49 2018 Tablet 48.00 100 4,800.00
B12) 50 mcg
Ventolin Nebule/
50 2019 Nebu 4,550.00 60 273,000.00
COMBIVENT

30,021,019.25
-
30,021,019.25

YANG MENYERAHKAN MENERIMA

KEPALA SEKSI FARMASI
 NAMA OBAT /
NO Tahun HARGA
PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (PL)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 14 September 2020

Tahu NAMA OBAT /

NO HARGA
n PERBELKES SATUAN UNIT JUMLAH HARGA
SATUAN
0 1 2 3 4 5 6
Ambroxol sirup 15 mg/mL/
1 2020 Botol 6,600 200 1,320,000.00
Mucos Syr
2 2020 Bisoprolol tablet 5 mg Tablet 1,485 900 1,336,500.00

3 2020 Cefadroxil 500 mg Capsul 803 500 401,500.00

4 2020 Cefixim 200 mg Capsul 4,950 150 742,500.00

5 2020 Fitomenadion inj Ampul 5000 100 500,000.00

6 2020 Lidokain injeksi HCL 2% Ampl 1,650 100 165,000.00
Metamizol/ Norages Liquid
7 2020 Ampul 9,185 20 183,700.00
injeksi
27 2020 Omeprazol 20 mg Tab 583 900 525,006.91
Paracetamol 125 mg
8 2020 Rectal/ Dumin Rectal 125 Suppo 16,208 5 81,039.75
Mg
Paracetamol 250 mg
9 2020 Rectal/ Dumin Rectal 250 Suppo 22,645 5 113,225.75
Mg
10 2020 Simvastatin 10 mg Tablet 616 1000 616,000.00

5,984,472.41
5,984,472.41
-

YANG MENYERAHKAN MENERIMA

KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si …………… ………………

Nip. 19860510 201001 2 013
 PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR
DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 22 November 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2019 Amlodipin 10 mg Tablet Tablet 1,188.00 1200

Antasida DOEN II suspensi,

kombinasi : Aluminium Hidroksida
2 2019 Botol 2,098.00 400
200 mg/ 5 ml Magnesium
Hidroksida 200 mg/ 5 mL

3 2019 Cefadroxil Sirup Botol 7,425.00 50

Difenhidramin injeksi i.v/ i.m 10
4 2019 Ampul 1,262.00 90
mg/mL (HCl)
5 2019 Garam Oralit Sct 509.85 100
Gentamisin (Genoin) zalf Mata
6 2019 Tube 3,075.00 144
0,3 %
Metilprednisolon 4 mg/
7 2019 Tablet 139.00 2000
Ometilson/
Metampiron 500 mg/ Antalgin 500
8 2018 Tablet 451.00 1000
mg
9 2018 NaCl 0,9 % Btl 6,410.00 100
Natrium Diclofenak 25 mg
10 2018 Tablet 142.00 2250
(Renadinak 25 mg)
Obat Batuk Hitam (OBH) Indo
11 2019 Botol 12,870.00 48
Plus
12 2018 Oksitetrasiklin salep mata 1 % Tube 2,600.00 50
13 2019 Parasetamol sirup 120 mg/ 5 mL Botol 7,920.00 144
14 2019 Salicil Bedak serbuk 2% Box 11,880.00 36
15 2019 Simvastatin 20 Mg Tablet 407.00 1000

YANG MENYERAHKAN
KEPALA SEKSI FARMASI
 Ramlah Hanaping, S.Si ……………
Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (E-CATALOG)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 22 November 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2020 Alluporinol 100 mg Tablet Tablet 105 5000
2 2020 Amoxicillin 500 mg Tablet 265 3000
3 2020 Amlodipin 5 mg Tablet Tablet 80 1500
4 2020 Antasida DOEN I tablet kunyah Tab 60 5000
5 2020 Asam Askorbat (Vit C) 50 mg Tablet 120 2000
6 2020 Ibuprofen Sirup 200 mg/5 ml Btl 2,858 50

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (PL)
PUSKESMAS : MOTONGKAD
Tgl/Bln/Thn : 22 November 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
Ambroxol sirup 15 mg/mL/ Mucos
1 2020 100
Syr Botol 6,600
2 2020 Asam Mefenamat 500 mg Kaplet 276 1500
3 2020 Betahistine 6 mg Tablet 119 500
4 2020 Cefadroxil 500 mg Capsul 803 500
5 2020 Dexamethason 0,5 mg Tab 154 3000
6 2020 Omeprazol 20 mg Tab 583 1000
Paracetamol 125 mg Rectal/
7 2020 Suppo 16,208 5
Dumin Rectal 125 Mg
Paracetamol 250 mg Rectal/
8 2020 Suppo 22,645 5
Dumin Rectal 250 Mg
9 2020 Simvastatin 10 mg Tablet 616 500

Tablet Tambah Darah

10 2020 (Kombinasi: Ferro fumarat 60 mg Tablet 1,650 500
+ as. Folat 0,4 mg/ Maltiron

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (BANTUAN)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 22 November 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
NO Tahun NAMA OBAT / PERBELKES HARGA
SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 Tablet Tambah Darah Tablet 3780
2 Captopril 12,5 mg Tablet 1000

YANG MENYERAHKAN
KEPALA SEKSI FARMASI

Ramlah Hanaping, S.Si ……………

Nip. 19860510 201001 2 013

PEMERINTAH KABUPATEN BOLAANG MONGONDOW TIMUR

DINAS KESEHATAN
SURAT BUKTI BARANG KELUAR (DID)
PUSKESMAS : MOTONGKAD

Tgl/Bln/Thn : 22 November 2020

NO Tahun NAMA OBAT / PERBELKES HARGA

SATUAN UNIT
SATUAN
0 1 2 3 4 5
1 2020 Chloramfenicol TT Bool 5 ml 6,105 10

Etaflusin (Obat batuk anak dan

bayi yang mengandung
2 2020 Paracetamol , Gliseril Guaikolat , Botol 6,695 100
Chlorpheniramine Maleate,
Efedrin, Nat.Sitrat, Etanol )

3 2020 Etacurvita (Curcumin, Vit.1,B6,B12 Botol 8,022 100

YANG MENYERAHKAN
KEPALA SEKSI FARMASI
 Ramlah Hanaping, S.Si ……………
Nip. 19860510 201001 2 013
ONDOW TIMUR

JUMLAH HARGA

6
1,425,600.00

839,200.00

371,250.00
113,580.00
50,985.00
442,800.00

278,000.00
451,000.00
641,000.00
319,500.00

617,760.00
130,000.00
1,140,480.00
427,680.00
407,000.00

7,655,835.00
-
7,655,835.00

MENERIMA
 ………………

ONDOW TIMUR

ATALOG)

JUMLAH HARGA

6
525,000.00
795,000.00
120,000.00
300,000.00
240,000.00
142,900.00

2,122,900.00
-
2,122,900.00

MENERIMA

………………

ONDOW TIMUR

(PL)
 JUMLAH HARGA

6
660,000.00
413,275.50
59,500.20
401,500.00
462,000.00
583,341.02
81,039.75

113,225.75

308,000.00

825,000.00

3,906,882.22
(85,001.40)
3,991,883.62

MENERIMA

………………

ONDOW TIMUR

NTUAN)

JUMLAH HARGA
 JUMLAH HARGA

6
-

MENERIMA

………………

ONDOW TIMUR

DID)

JUMLAH HARGA

6
61,050.00

669,500.00

802,200.00

1,532,750.00
-
1,532,750.00

MENERIMA
………………