Kartu Stock

LAPORAN PERSEDIAAN OBAT & BAHAN HABIS PAKAI PER 31 Desember 2015
RUMAH SAKIT UMUM DAERAH KELAS - D

KABUPATEN RAJA AMPAT
Sisa Obat Obat masuk Tahun 2015 Total Sisa Obat Stock
Harga Satuan
No. JENIS PERSEDIAAN Sat Per Pengadaan Pengadaan Bantuan Bantuan Obat Per Per Total Harga Satuan
Terkecil
25 Mar '15 TA. 2015 Tambahan Provinsi Lain-Lain Keluar 31 Des '15 1 Jan 16
A TABLET KEMASAN BOX
1 Acarbose/Glucobay tablet 50 mg Tablet 450 0 450 Rp 2,520.00 Rp 1,134,000.00
2 Acetosal 500 mg Tablet 2,900 0 2,900 Rp 218.00 Rp 632,200.00
3 Acyclovir tablet score 200 mg Tablet 900 500 400 Rp 1,411.00 Rp 564,400.00
4 Acyclovir Tablet score 400 mg Tablet 7,000 0 7,000 Rp 2,077.56 Rp 14,542,920.00
Alopurinol tablet 100 mg
5 Tablet 1,380 1,380 0 Rp 178.20 Rp -
6 Ambroxol 30 mg Tab Tablet 1,300 20,000 5,400 15,900 Rp 243.41 Rp 3,870,219.00
7 Amlodipin Tab 5 mg Tablet 300 300 0 Rp 1,152.00 Rp -
8 Amlodipin Tab. 10 mg Tablet 720 900 1,110 510 Rp 439.57 Rp 224,180.70
9 Amoksisilin kaplet 500 mg Tablet 5,400 75,000 17,900 62,500 Rp 607.73 Rp 37,983,125.00
10 Ampisillin kaplet 500mg Kaplet 24,100 7,800 16,300 Rp 514.35 Rp 8,383,905.00
11 Antasida Doen Tablet kunyah Tablet 100 10,000 100 10,000 Rp 85.00 Rp 850,000.00
12 Asam Mefenamat kaplet 500 mg Kaplet 8,000 100,000 50,000 16,800 141,200 Rp 139.00 Rp 19,626,800.00
13 Asam Traneksamat tablet 500 mg Tablet 1,800 1,000 800 Rp 1,254.00 Rp 1,003,200.00
14 Captopril Tab. 12,5 mg Tablet 1,900 200 1,700 Rp 121.50 Rp 206,550.00
15 Captopril Tab.25 mg Tablet 1,800 200 1,600 Rp 185.96 Rp 297,536.00
16 Captopril tablet 50 mg Tablet 4,800 0 4,800 Rp 302.91 Rp 1,453,968.00
17 Cefadroksil kaps 500 mg Kapsul 24,300 13,800 10,500 Rp 1,832.72 Rp 19,243,560.00
18 Cefiksim Kaplet 100 mg Kaplet 0 2,450 2,500 1,590 3,360 Rp 2,155.04 Rp 7,240,934.40
Cetirizine tablet 10 mg
19 Tablet 0 3,000 3,000 6,000 Rp 362.75 Rp 2,176,500.00
20 Chloramfenikol kapsul 250 mg Kapsul 1,700 300 1,400 Rp 359.78 Rp 503,692.00
21 Ciprofloxacin 500 mg Tablet 9,800 5,100 4,700 Rp 277.00 Rp 1,301,900.00
22 Clindamisin Kapsul 150 mg Kapsul 3,750 950 2,800 Rp 1,377.00 Rp 3,855,600.00
23 Clobazam Tablet Tablet 300 300 Rp 1,420.73 Rp 426,219.00
24 Cotrimosasol tablet 480mg Tablet 500 2,000 5,000 2,700 4,800 Rp 166.00 Rp 796,800.00
Deksametason tablet 0,5 mg
25 Tablet 100 100 0 Rp 117.45 Rp -
26 Digoksin Tab. 0,25 mg Tablet 200 0 200 Rp 193.05 Rp 38,610.00
27 Diltiazem HCL TABLET 30 MG Tablet 700 0 700 Rp 204.70 Rp 143,290.00
28 Doksisiklin kapsul 100mg Kapsul 2,500 1,800 700 Rp 300.00 Rp 210,000.00
29 Domperidone Tablet 10mg (20) Tablet 5,450 3,900 1,550 Rp 1,089.96 Rp 1,689,438.00
30 Duvadilan Tablet Tablet 250 0 250 Rp 2,472.50 Rp 618,125.00
31 Erysanbe Chweable 200 mg Tab Tablet 1,000 800 200 Rp 1,987.77 Rp 397,554.00
32 Eritromisin kapsul 250 mg Kapsul 3,960 3,960 500 Rp 680.40 Rp 340,200.00
33 Eritromisin Tablet 500 mg Tablet 4,600 200 4,400 Rp 1,116.00 Rp 4,910,400.00
34 Etambutol tablet 500 mg Tablet 2,400 400 2,000 Rp 774.36 Rp 1,548,720.00
35 Furosemide Tablet 40mg Tablet 2,000 1,400 600 Rp 137.81 Rp 82,686.00
36 Glibenklamid Tablet 5mg Tablet 2,600 500 2,100 Rp 97.20 Rp 204,120.00
37 Glimepirid Tablet 2 mg Tablet 1,000 1,000 Rp 523.00 Rp 523,000.00
38 Griseofulfin Tablet 125mg Tablet 6,400 800 5,600 Rp 324.00 Rp 1,814,400.00
Ibuprofen tablet 400 mg
39 Tablet 600 5,000 4,200 1,400 Rp 171.00 Rp 239,400.00
40 Isosorbit dinitrat Tablet sublingual 5 mg Tablet 200 0 200 Rp 131.42 Rp 26,284.00
Kalium Diklofenak tablet 50 mg
41 Tablet 2,100 900 1,200 Rp 955.82 Rp 1,146,984.00
42 Klopidogrel Tablet 75 mg Tablet 480 180 300 Rp 3,990.00 Rp 1,197,000.00
43 Levofloksasina tablet 500 mg Tablet 300 300 0 Rp 1,557.46 Rp -
44 Loperamid Tab. 2mg Tablet 7,900 1,400 6,500 Rp 123.59 Rp 803,335.00
Loratadin tablet 10 mg
45 Tablet 700 700 0 Rp 449.66 Rp -
46 Mebendazol tablet 100 mg Tablet 360 0 360 Rp 292.50 Rp 105,300.00
47 Meloksikam tablet 7,5 mg Tablet 650 650 0 Rp 934.06 Rp -
48 Metformin tablet 500mg Tablet 1,000 500 500 Rp 245.03 Rp 122,515.00
49 Methilprednisolon 4 mg Tablet 0 5,000 1,400 3,600 Rp 444.18 Rp 1,599,048.00
50 Metilegometrin Tablet 0,125mg Tablet 0 5,000 800 4,200 Rp 185.00 Rp 777,000.00
51 Metoclopramide tablet 10mg Tablet 2,700 2,000 0 4,700 Rp 130.94 Rp 615,418.00
52 Metronidasol Tablet 500mg Tablet 600 2,000 5,000 200 7,400 Rp 176.00 Rp 1,302,400.00
53 Molaneuron Tab Tablet 500 500 Rp 2,488.14 Rp 1,244,070.00
54 Natrium Diklofenak tablet 50mg Tablet 17,200 4,600 12,600 Rp 293.86 Rp 3,702,636.00
55 Nifedipin Tab. 10mg Tablet 4,100 1,300 2,800 Rp 174.15 Rp 487,620.00
56 Ofloksasin tablet 200mg Tablet 6,200 6,000 200 Rp 796.64 Rp 159,328.00
57 Ofloksasin tablet 400mg Tablet 1,350 250 1,100 Rp 1,178.56 Rp 1,296,416.00
58 Obat Anti Malaria Tablet 327 327 0 Rp -
60 Omeprazole Kapsul 20mg Kapsul 28,860 12,000 16,860 Rp 490.00 Rp 8,261,400.00
61 Ondansentron 4 mg Tablet 84 4,980 1,074 3,990 Rp 1,090.00 Rp 4,349,100.00
62 Oralit Sachet 100gr Sachet 1,250 5,000 1,250 5,000 Rp 346.00 Rp 1,730,000.00
63 Parasetamol tablet 500 mg Tablet 24,000 100,000 100,000 18,300 205,700 Rp 96.00 Rp 19,747,200.00
64 Pirantel Pamoat tablet 125 mg Tablet 1,400 1,200 200 Rp 432.00 Rp 86,400.00
65 Piroksikam tablet 10 mg (10) Tablet 1,800 700 1,100 Rp 113.40 Rp 124,740.00
66 Piroksikam 20 mg Tablet 1,000 500 500 Rp 97.00 Rp 48,500.00
67 Propanolol Tab. 10 mg Tablet 800 0 800 Rp 103.95 Rp 83,160.00
68 Pyrazinamide tablet 500 mg Tablet 4,600 2,600 2,000 Rp 315.90 Rp 631,800.00
69 Quinine Tablet 222mg Tablet 6,000 240 5,760 Rp 804.00 Rp 4,631,040.00
70 Ranitidine Tablet 150mg Tablet 13,400 5,800 7,600 Rp 297.00 Rp 2,257,200.00
71 Rifampisin kapsul 300 mg Kapsul 4,600 900 3,700 Rp 648.00 Rp 2,397,600.00
72 Salbutamol Tab 2mg Tablet 1,800 1,100 700 Rp 113.44 Rp 79,408.00
73 Salbutamol Tab 4mg Tablet 2,800 1,700 1,100 Rp 113.44 Rp 124,784.00
74 Scopma (Hyoscine-N-Butilbromide) 10 mg Tablet 3,100 1,800 1,300 Rp 450.83 Rp 586,079.00
75 Simvastatin Tab 10mg Tablet 90 2,600 90 2,600 Rp 624.00 Rp 1,622,400.00
76 Spironolakton 25 mg Tablet 0 0 0 Rp -
77 Tetrasiklin 250 mg Tablet 400 200 200 Rp -
78 Tetrasiklin 500 mg Kapsul 3,000 0 3,000 Rp 346.95 Rp 1,040,850.00
80 Vitamin B Complex (Dus) Tablet 42,700 16,600 26,100 Rp 122.00 Rp 3,184,200.00
81 Vitamin C 50 mg (Dus) Tablet 50,000 25,900 24,100 Rp 114.00 Rp 2,747,400.00
82 Zink Tablet 20mg Tablet 0 3,000 5,000 2,200 5,800 Rp 569.00 Rp 3,300,200.00
B TABLET KEMASAN BOTOL
83 Aminophillin Tablet 200mg Tablet 400 100 300 Rp 152.96 Rp 45,888.00
84 Antalgin (metampiron) tablet 500 mg Tablet 14,000 6,000 8,000 Rp 116.64 Rp 933,120.00
85 Bekarbon Tablet Tablet 1,000 0 1,000 Rp 84.04 Rp 84,040.00
86 Besi (II) Sulfat/ Sulfaferosus Tablet 200mg Tablet 44,000 2,000 42,000 Rp 35.41 Rp 1,487,220.00
87 Bikarbonat Na. tablet 500 mg Tablet 1,000 0 1,000 Rp 19.30 Rp 19,300.00
88 Calsium laktat (Kalk) tablet 500 mg Tablet 30,000 0 30,000 Rp 70.20 Rp 2,106,000.00
89 Chloramfenikol kapsul 250 mg Kapsul 250 0 250 Rp 359.78 Rp 89,945.00
91 Cloroquin Tablet 250 mg Tablet 1,000 0 1,000 Rp 102.00 Rp 102,000.00
93 Cotrimoksazol tablet Pediatrik Tablet 5,400 1,200 4,200 Rp 91.08 Rp 382,536.00
94 CTM Tablet 39,000 9,000 30,000 Rp 28.80 Rp 864,000.00
95 Tablet 109,000 24,000 85,000 Rp 117.45 Rp 9,983,250.00
96 Diazepam 2 MG Tablet 6,100 600 5,500 Rp 30.00 Rp 165,000.00
Fenilbutason tablet 200 mg
97 Tablet 9,000 0 9,000 Rp 109.35 Rp 984,150.00
98 Folic Acid Tablet 1mg Tablet 8,400 400 8,000 Rp 91.80 Rp 734,400.00
99 Gliseril Guaiakolat tablet 100 mg Tablet 26,000 6,000 20,000 Rp 37.66 Rp 753,200.00
100 HCT (Hidro Cloro Tiazid) Tablet 25mg Tablet 1,000 0 1,000 Rp 49.00 Rp 49,000.00
102 Isoniazid tablet 300 mg Tablet 2,000 0 2,000 Rp 130.95 Rp 261,900.00
103 Natrium Fenitoin kapsul 100 mg Kapsul 1,900 400 1,500 Rp 324.80 Rp 487,200.00
104 Papaverin tablet 40 mg Tablet 6,000 2,000 4,000 Rp 134.42 Rp 537,680.00
106 Phenobarbital 30mg Tablet 6,000 0 6,000 Rp 5,580.00 Rp 33,480,000.00
107 Piridoksin (vitamin B6) tablet 10 mg Tablet 6,000 2,000 4,000 Rp 23.49 Rp 93,960.00
Prednison tablet 5 mg
108 Tablet 23,000 14,000 9,000 Rp 84.37 Rp 759,330.00
110 Propiltiourasil (PTU) Tablet 100mg Tablet 800 0 800 Rp 404.42 Rp 323,536.00
111 Quinine Tablet 222mg Tablet 7,000 3,000 4,000 Rp 610.29 Rp 2,441,160.00
112 Sianokobalamin (B12) Tablet 50 mcg Tablet 7,000 1,000 6,000 Rp 17.68 Rp 106,080.00
C SYRUP KEMASAN BOTOL
114 Amoksisilin sirup kering 125 mg/ 5 ml Botol 904 724 180 Rp 4,995.00 Rp 899,100.00
115 Ampisillin sirup 125mg /5ml Botol 312 132 180 Rp 5,940.00 Rp 1,069,200.00
116 Ambroxol Syrup 60 ml Botol 0 500 0 500 Rp 7,480.00 Rp 3,740,000.00
117 Antasida Suspensi Botol 60ml Botol 69 2,000 319 1,750 Rp 2,409.00 Rp 4,215,750.00
118 Cefadroksil sirup kering 125 mg/5 ml Botol 4 300 104 200 Rp 18,000.00 Rp 3,600,000.00
119 Cotrimoksazol Suspensi 240 mg Botol 1,000 100 900 Rp 2,590.00 Rp 2,331,000.00
120 Domperidone Suspensi 5mg/5ml Botol 350 250 100 Rp 17,078.00 Rp 1,707,800.00
121 Erysanbe Syrup 60 ml 120 40 80 Rp 27,280.00 Rp 2,182,400.00
123 Parasetamol drops 15 ml Botol 206 500 301 405 Rp 6,240.00 Rp 2,527,200.00
124 Paracetamol syrup 60 ml Botol 908 808 100 Rp 2,474.00 Rp 247,400.00
D SALEP / OBAT LUAR
125 Acyclovir Cream 5% Tube 5 Gr Tube 120 20 100 Rp 4,253.00 Rp 425,300.00
127 Alkohol 70% 1000 ml Botol 240 132 108 Rp 75,000.00 Rp 8,100,000.00
128 Antihemoroid suppo sitoria Supp 78 30 48 Rp 2,700.00 Rp 129,600.00
129 Bedak Salisil Serbuk 2% kotak 50gr Kotak 5 5 0 Rp 1,931.00 Rp -
130 Betametason Cream 0,1% Tube 500 225 275 Rp 2,519.12 Rp 692,758.00
131 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 18 18 0 Rp 2,110.00 Rp -
132 Chloramfenikol TT 3% 5 ml Botol 84 120 108 96 Rp 2,111.00 Rp 202,656.00
133 Dulcolax Suppo 10 mg Supp 45 15 30 Rp 22,000.00 Rp 660,000.00
134 Dulcolax Suppo 5 mg Supp 48 18 30 Rp 16,416.66 Rp 492,499.80
137 Gentian Violet Pot 20 5 15 Rp 776.00 Rp 11,640.00
140 Ketokonasol Cream 2% 15 gram Tube 97 77 20 Rp 9,450.00 Rp 189,000.00
141 Levertraan Zalf Pot 206 26 180 Rp 150.00 Rp 27,000.00
142 Miconazole Krim/Salep 2% Tube 10gr 34 1,200 34 1,200 Rp 3,600.00 Rp 4,320,000.00
144 Povidon Iodida (yodium) 10% 1000 m Botol 240 130 110 Rp 110,000.00 Rp 12,100,000.00
E INJEKSI
145 Aminophillin Injeksi 24mg/ml Ampul 330 100 230 Rp 4,050.00 Rp 931,500.00
146 Ampisilin inj i.m./i.v.1000 mg Vial 0 200 80 120 Rp 9,266.40 Rp 1,111,968.00
147 Anesfar Inj 1 mg/ml (Midazolam) Ampul 100 100 Rp 21,248.60 Rp 2,124,860.00
148 Anti Bisa Ular (Polyvalent) Vial 7 0 7 Rp - Rp -
149 Anti Tetanus Serum Ampul 34 50 34 50 Rp 127,409.00 Rp 6,370,450.00
150 Antrain Injeksi Ampul 20 10 10 Rp 11,515.40 Rp 115,154.00
151 Artemeter Inj 80 mg/ml Ampul 2,544 1,662 882 Rp 23,666.67 Rp 20,874,002.94
152 Artesunat injeksi Vial 288 288 0 Rp 30,076.00 Rp -
154 Asam Traneksamat injeksi 500 mg/ml Ampul 0 0 0 Rp 6,400.00 Rp -
155 Atropin sulphat injeksi 0,25mg/ml Ampul 85 85 0 Rp 1,707.76 Rp -
156 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 0 50 0 50 Rp 79,510.80 Rp 3,975,540.00
157 Citicolin Injeksi Ampul 0 0 0 Rp - Rp -
158 Chinin Antipyrin Injeksi Ampul 0 0 0 Rp - Rp -
159 Chlorpromazin Injeksi 25mg/ml Ampul 0 0 0 Rp - Rp -
160 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 455 455 0 Rp 1,399.95 Rp -
161 Diazepam Injeksi Ampul 239 119 120 Rp 2,583.34 Rp 310,000.80
162 Deksametason injeksi i.v. 5 mg/ml Ampul 1,300 1,300 0 Rp 2,700.00 Rp -
163 Dellamidon injeksi (Benodon) Vial 10 0 10 Rp 175,000.00 Rp 1,750,000.00
164 Dellladryl injeksi (Recodryl) Vial 14 4 10 Rp 160,000.00 Rp 1,600,000.00
165 Diphenhydramine injeksi Ampul 150 120 30 Rp - Rp -
166 Dobutamin Giulini Ampul 31 6 25 Rp - Rp -
167 Dopamin Injeksi Ampul 5 5 Rp 99,328.60 Rp 496,643.00
168 Duvadilan injeksi Ampul 12 0 12 Rp 25,083.33 Rp 300,999.96
169 Epinefrin (Adrenalin) inj 0,1 % (sebagai HCl) Ampul 706 286 420 Rp 1,674.00 Rp 703,080.00
170 Farbion 5000 injeksi Ampul 50 50 Rp 7,087.40 Rp 354,370.00
171 Fenitoin Injeksi Ampul 10 10 Rp 42,223.00 Rp 422,230.00
172 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 0 0 0 Rp 2,349.00 Rp -
173 Furosemide Injeksi10 mg/ml Ampul 75 75 0 Rp 2,781.12 Rp -
174 Gentamisin Injeksi 80mg/2ml Ampul 85 85 0 Rp 4,989.60 Rp -
175 Hyoscine-N-Butilbromide Injeksi Ampul 20 20 0 Rp 62,700.00 Rp -
177 Kalsium Glukonat Injeksi 10% Ampul 24 0 24 Rp 15,625.00 Rp 375,000.00
179 Ketamine-Hameln injeksi 50 mg/ml Vial 0 0 0 Rp 125,898.00 Rp -
180 Ketoprofen Injeksi 100 mg Ampul 0 0 0 Rp - Rp -
Ketorolac injeksi 30 mg
181 Ampul 462 2,400 1,062 1,800 Rp 2,799.00 Rp 5,038,200.00
182 Lidokain injeksi 2% 2 ml Ampul 3,200 600 2,600 Rp 1,363.50 Rp 3,545,100.00
183 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 210 210 0 Rp 1,800.00 Rp -
184 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 80 80 0 Rp 2,092.50 Rp -
185 Meropenem Inj 1 gr Vial 10 10 Rp 329,010.00 Rp 3,290,100.00
186 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0 0 0 Rp 15,577.20 Rp -
187 Oksitosin Injeksi 10 IU/ml Ampul 0 0 0 Rp 3,338.11 Rp -
188 Omeprazole Injeksi 40mg/10ml Vial 0 0 0 Rp 70,000.00 Rp -
189 Ondansentron Injeksi 2mg/2 ml Ampul 0 100 2,000 500 1,600 Rp 2,700.00 Rp 4,320,000.00
190 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 60 0 60 Rp 17,400.00 Rp 1,044,000.00
191 Papaverin injeksi 40 mg/ml Ampul 0 0 0 Rp 1,595.00 Rp -
192 Pehacain Injeksi Ampul 100 200 240 60 Rp 3,113.05 Rp 186,783.00
194 Propofol Injeksi Ampul 100 100 Rp 97,743.40 Rp 9,774,340.00
195 Quinin HCL Injeksi IV 25% Ampul 246 246 0 Rp 4,853.52 Rp -
196 Ranitidine Injeksi 25mg/2ml (10) Ampul 7,175 2,375 4,800 Rp 8,673.80 Rp 41,634,240.00
197 Roculax 10 mg/ml Ampul 25 25 Rp 281,029.40 Rp 7,025,735.00
198 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0 0 0 Rp 12,400.00 Rp -
Sefotaksim injeksi 1 gram
199 Vial 1,234 200 1,434 0 Rp 10,364.00 Rp -
200 Seftazidim injeksi 1000 mg/vial Vial 0 100 0 100 Rp 50,634.50 Rp 5,063,450.00
201 Seftriakson injeksi 1 gram Vial 1,462 496 966 Rp 11,602.00 Rp 11,207,532.00
202 Streptomisin Serbuk injeksi 1500mg/vial Vial 500 0 500 Rp 5,175.00 Rp 2,587,500.00
203 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 79 1,500 469 1,110 Rp 1,376.97 Rp 1,528,436.70
204 Tramadol Injeksi 50 mg/ml Ampul 0 0 0 Rp 8,642.80 Rp -
205 Vitamin C Injeksi Ampul 60 60 Rp 27,805.83 Rp 1,668,349.80
F CAIRAN DAN INFUS
206 Aqua Pro Injeksi Botol 560 3,000 1,100 680 3,980 Rp 6,937.00 Rp 27,609,260.00
207 Glukosa 10% larutan infus 500 ml Botol 38 40 38 40 Rp 21,111.00 Rp 844,440.00
208 Glukosa 10%-1/5 NS Botol 81 41 40 Rp 9,240.00 Rp 369,600.00
209 Glukosa 40% Botol 25ml Botol 30 30 6 54 Rp 10,857.00 Rp 586,278.00
210 Glukosa 5% larutan infus 500 ml Botol 3,857 1,057 2,800 Rp 8,273.00 Rp 23,164,400.00
211 Glukosa 5%-NS 500 ml Botol 100 60 40 Rp 9,240.00 Rp 369,600.00
212 Glukosa 5% - 1/2 NS 500 ml Botol 0 400 100 300 Rp 22,619.00 Rp 6,785,700.00
213 Glukosa 5% - 1/4 NS 500 ml Botol 0 400 100 300 Rp 22,482.00 Rp 6,744,600.00
214 KAEN 1 B Larutan Infus 500 ml Botol 19 100 59 60 Rp 24,196.00 Rp 1,451,760.00
215 KAEN 3 B Larutan Infus 500 ml Botol 0 100 60 40 Rp 27,897.00 Rp 1,115,880.00
216 Kaen 3A cairan infus 500 ml Botol 0 100 60 40 Rp 26,047.00 Rp 1,041,880.00
217 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 18 0 18 Rp 45,000.00 Rp 810,000.00
218 Lartan infus asering 500 ml Botol 0 0 0 Rp 22,000.00 Rp -
219 Larutan Infus Manitol 20%, 500 ml Botol 40 0 40 Rp 125,000.00 Rp 5,000,000.00
220 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 268 640 444 464 Rp 44,117.00 Rp 20,470,288.00
221 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 0 10 0 10 Rp 10,857.00 Rp 108,570.00
222 NaCl 0,9% cairan infus 500 ml Botol 3,289 1,189 2,100 Rp 8,273.00 Rp 17,373,300.00
223 Ringer Laktat larutan infus 500 ml Botol 4,199 3,399 800 Rp 9,900.00 Rp 7,920,000.00
224 Sanbehest 500 ml Botol 20 20 Rp 254,160.00 Rp 5,083,200.00
225 Sanmol Infus (Paracetamol) Botol 200 40 160 Rp 75,672.00 Rp 12,107,520.00
226 Sifrofloksasin infus 2mg/ml, 100 ml Botol 0 20 0 20 Rp 85,244.00 Rp 1,704,880.00
227 Sevoflurane Liquid Botol 2 2 0 Rp 3,684,260.00 Rp -
228 Larutan Martos 10% 500 ml Botol 35 0 35 Rp 9,246.00 Rp 323,610.00
229 BAHAN HABIS PAKAI 0
230 Abbocath No 16 Picis 57 27 30 Rp 35,000.00 Rp 1,050,000.00
231 Abbocath No 18 Picis 148 100 248 0 Rp 13,750.00 Rp -
232 Abbocath No 20 Picis 0 150 100 50 Rp 13,750.00 Rp 687,500.00
233 Abbocath No 22 Picis 37 150 0 187 Rp 13,750.00 Rp 2,571,250.00
234 Abbocath No 24 Picis 0 150 0 150 Rp 13,750.00 Rp 2,062,500.00
235 Abbocath no. 26 Merk Venysistem Picis 200 200 Rp 25,361.00 Rp 5,072,200.00
236 Abbocath no. 18 Merk Terumo Picis 100 100 0 Rp 25,361.00 Rp -
237 Abbocath no. 20 Merk Terumo Picis 500 500 Rp 25,361.00 Rp 12,680,500.00
240 Spinocan injeksi No. 26 Picis 75 0 75 Rp 50,000.00 Rp 3,750,000.00
241 Spinocan injeksi No. 27 Picis 0 100 0 100 Rp 60,319.00 Rp 6,031,900.00
242 Needle No. 22 Picis 0 0 0 Rp -
245 Guedel Airway 40 mm Picis 2 0 2 Rp -
246 Guedel Airway 50 mm Picis 1 0 1 Rp -
247 3 Way Stopcock Picis 1 100 0 101 Rp 9,347.00 Rp 944,047.00
248 Cord Clamps (Penjepit Tali Pusar) Picis 0 3,500 300 3,200 Rp 1,682.55 Rp 5,384,160.00
249 Collor Neck Picis 10 10 Rp 218,904.00 Rp 2,189,040.00
250 Disposible Syringes 1 CC Merk Skifa Picis 29 1,500 29 1,500 Rp 2,376.00 Rp 3,564,000.00
251 Disposible Syringes 3 CC Merk Skifa Picis 1,987 2,500 3,487 1,000 Rp 2,266.00 Rp 2,266,000.00
252 Disposible Syringes 5 CC Merk Skifa Picis 3,159 2,000 4,159 1,000 Rp 2,618.00 Rp 2,618,000.00
253 Disposible Syringes 10 CC Merk Skifa Picis 18 1,000 618 400 Rp 3,058.00 Rp 1,223,200.00
254 Disposible Syringes 20 CC Merk Skifa Picis 30 450 30 450 Rp 10,208.00 Rp 4,593,600.00
256 Disposible Syringes 1 CC Merk Terumo Picis 15,000 15,000 Rp 7,265.64 Rp 108,984,600.00
261 Disposible Syringes 50 CC Merk Terumo Picis 300 300 Rp 29,062.55 Rp 8,718,765.00
262 Masker Picis 0 0 0 Rp 1,650.00 Rp -
263 Handscoon Steril No. 6,5 Merk Gammex Pasang 0 480 80 400 Rp 21,934.00 Rp 8,773,600.00
264 Handscoon Steril No. 7 Merk Gammex Pasang 0 500 800 580 720 Rp 16,500.00 Rp 11,880,000.00
265 Handscoon Steril No. 7,5 Merk Gammex Pasang 0 500 800 580 720 Rp 16,500.00 Rp 11,880,000.00
266 Handscoon Steril No. 8 Pasang 427 427 0 Rp 4,830.00 Rp -
267 Handscoon Sensigloves M Pasang 0 1,000 5,000 1,000 5,000 Rp 1,804.00 Rp 9,020,000.00
268 Handscoon Sensigloves L Pasang 0 1,000 5,000 1,000 5,000 Rp 1,804.00 Rp 9,020,000.00
269 Handscoon Panjang (Obgyn) Pasang 0 0 0 Rp 55,000.00 Rp -
270 Underpad Picis 110 110 Rp 5,745.00 Rp 631,950.00
276 Endotracheal Tube ( ETT ) No. 2,5 Tube 10 5 5 10 Rp 104,954.19 Rp 1,049,541.90
277 Endotracheal Tube ( ETT ) No. 3 tube 10 5 5 10 Rp 104,954.19 Rp 1,049,541.90
279 Endotracheal Tube ( ETT ) No. 4 Tube 17 5 5 17 Rp 104,954.19 Rp 1,784,221.23
281 Endotracheal Tube ( ETT ) No. 5 Tube 12 5 5 12 Rp 104,954.19 Rp 1,259,450.28
282 Endotracheal Tube ( ETT ) No. 5,5 Tube 1 5 5 1 Rp 104,954.19 Rp 104,954.19
283 Endotracheal Tube ( ETT ) No. 6 tube 2 5 5 2 Rp 104,954.19 Rp 209,908.38
284 Endotracheal Tube ( ETT ) No. 6,5 tube 3 5 5 3 Rp 104,954.19 Rp 314,862.57
285 Endotracheal Tube ( ETT ) No. 7 tube 2 5 5 2 Rp 104,954.19 Rp 209,908.38
286 Endotracheal Tube ( ETT ) No.7,5 tube 2 5 5 2 Rp 104,954.19 Rp 209,908.38
287 Endotracheal Tube ( ETT ) No.8 Tube 0 5 5 0 Rp 104,954.19 Rp -
288 ETT Tanpa Cup No. 2,5 tube 16 0 16 Rp 22,500.00 Rp 360,000.00
289 ETT Tanpa Cup No. 3 tube 10 0 10 Rp 22,500.00 Rp 225,000.00
290 ETT Tanpa Cup No. 3,5 tube 5 0 5 Rp 22,500.00 Rp 112,500.00
291 ETT Tanpa Cup No. 4 Tube 10 0 10 Rp 22,500.00 Rp 225,000.00
292 Rectal Tube No. 30 Picis 16 0 16 Rp 20,000.00 Rp 320,000.00
293 NGT (Maag Slang) No. 3 Picis 0 0 0 Rp 29,500.00 Rp -
294 NGT (Maag Slang) No. 3,5 Picis 10 10 0 Rp 29,500.00 Rp -
297 NGT (Maag Slang) No. 14 Picis 16 0 16 Rp 29,500.00 Rp 472,000.00
300 Selang Oksigen Anak Picis 0 0 0 Rp 27,500.00 Rp -
301 Selang Oksigen Dewasa Picis 0 0 0 Rp 27,500.00 Rp -
302 Folley cateter (2 way) No. 3 Picis 0 0 0 Rp 27,500.00 Rp -
303 Folley cateter (2 way) No. 3,5 Picis 0 0 0 Rp 27,500.00 Rp -
306 Folley cateter (2 way) No. 10 Picis 34 20 4 50 Rp 74,775.00 Rp 3,738,750.00
307 Folley cateter (2 way) No. 12 Picis 45 20 15 50 Rp 28,041.00 Rp 1,402,050.00
308 Folley cateter (2 way) No. 14 Picis 0 20 0 20 Rp 28,041.00 Rp 560,820.00
309 Folley cateter (2 way) No.16 Picis 0 20 20 0 Rp 28,041.00 Rp -
310 Folley cateter (2 way) No. 18 Picis 0 20 50 50 20 Rp 24,200.00 Rp 484,000.00
311 Folley cateter (2 way) No. 20 Picis 0 20 20 10 30 Rp 24,200.00 Rp 726,000.00
312 Folley cateter (2 way) No. 22 Picis 10 20 0 30 Rp 28,041.00 Rp 841,230.00
313 Folley cateter (2 way) No. 24 Picis 12 0 12 Rp 27,500.00 Rp 330,000.00
314 Suction Catheter No. 8 Picis 0 0 0 Rp 15,000.00 Rp -
315 Suction Catheter No. 10 Picis 0 0 0 Rp 15,000.00 Rp -
316 Suction Catheter No. 12 Picis 9 0 9 Rp 15,000.00 Rp 135,000.00
317 Suction Catheter No. 14 Picis 10 0 10 Rp 15,000.00 Rp 150,000.00
318 Urine Bag 2000 ml Bag 0 50 200 60 190 Rp 74,800.00 Rp 14,212,000.00
319 Infuset Mikro Picis 0 200 200 0 Rp 26,400.00 Rp -
320 Infuset Makro Set 0 200 200 390 10 Rp 22,000.00 Rp 220,000.00
321 Transfusi Darah Set Picis 0 200 100 100 Rp 26,400.00 Rp 2,640,000.00
322 Etil Clorida Spray Botol 8 4 4 Rp 127,000.00 Rp 508,000.00
323 Gliserin botol 100ml Botol 18 1 17 Rp 6,386.00 Rp 108,562.00
324 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 0 0 0 Rp 2,630.00 Rp -
325 Plester Luka Steril ( Chloro Tulle) Lembar 0 0 0 Rp 34,400.00 Rp -
326 Hipafix 10 cm x 5 M Roll 0 0 0 Rp 350,000.00 Rp -
327 Kapas Pembalut 100 g Roll 0 0 0 Rp - Rp -
328 Kapas Pembalut 250 g Roll 1 1 0 Rp -
329 Kapas Pembalut 1000 g Roll 10 10 0 Rp 22,700.00 Rp -
330 Kasa Hidrofil 16 x 16 cm Bks 0 0 0 Rp 7,727.00 Rp -
331 Kasa Hidrofil 40 x 80 cm Rol 0 0 0 Rp 130,000.00 Rp -
332 Kasa Hidrofil 40 x 40 cm Bungkus 10 10 0 Rp 500.00 Rp -
333 Plester Luka (Leukoplas 1621) Roll 0 113 73 40 Rp 11,550.00 Rp 462,000.00
334 Leukoplas 1624 (2x5) Roll 0 0 0 Rp - Rp -
335 Elastis Perban Putih 6" Roll 10 10 0 Rp 65,428.00 Rp -
336 Elastis Perban 10 cm x 4,5 m Roll 0 0 0 Rp - Rp -
337 Gypsona 6" Roll 5 5 0 Rp 62,320.00 Rp -
338 Poli Creepe 4" Roll 5 5 0 Rp 129,922.00 Rp -
339 Poli Creepe 6 " Roll 5 5 0 Rp 171,084.00 Rp -
340 Softband 3" Pcs 0 0 0 Rp 75,000.00 Rp -
341 Softband 6" Roll 20 20 0 Rp 56,081.00 Rp -
342 Kertas Puyer (kertas perkamen) Bks 18 20 18 20 Rp 27,500.00 Rp 550,000.00
343 Kertas USG Picis 6 0 6 Rp 320,000.00 Rp 1,920,000.00
344 Kertas EKG Picis 3 0 3 Rp 24,000.00 Rp 72,000.00
H PISAU,BENANG & JARUM 0
348 Surgical Blades (Bisturi) No. 10 Picis 95 95 0 Rp 1,100.00 Rp -
349 Surgical Blades (Bisturi) No. 11 Picis 8 0 8 Rp 1,100.00 Rp 8,800.00
350 Jarum Hecting Kulit No.10 Lusin 0 0 0 Rp 175,000.00 Rp -
353 Jarum Hecting Otot No.7 Lusin 5 0 5 Rp 175,000.00 Rp 875,000.00
354 Jarum Hecting Otot No.10 Lusin 3 0 3 Rp 175,000.00 Rp 525,000.00
355 Jarum Hecting Otot No.11 Lusin 0 0 0 Rp 175,000.00 Rp -
356 Silk Black 2/0 100 Meter Roll 0 0 0 Rp - Rp -
357 Silk Black 3/0 100 Meter Roll 0 0 0 Rp - Rp -
358 SoftSilk No. 2/0 Bks 0 0 0 Rp 3,250,000.00 Rp -
359 SoftSilk No. 3/0 Bks 0 0 0 Rp 3,350,000.00 Rp -
360 Catgut Chromic No. 1/0 Bks 0 0 0 Rp 1,600,000.00 Rp -
361 Catgut Chromic No. 2/0 Bks 0 0 0 Rp 750,000.00 Rp -
362 Catgut Chromic No. 3/0 Bks 0 0 0 Rp 1,600,000.00 Rp -
363 Catgut Plain No. 0 Roll 0 0 0 Rp - Rp -
364 Catgut Plain No. 2/0 (3,5) 100 M Roll 0 0 0 Rp - Rp -
365 Jarum Prolene No. 1/0 Bks 0 0 0 Rp 2,100,000.00 Rp -
I LAB, UTDRS, RADIOLOGY DAN LAIN-LAIN 0
379 Hidrogen Peroksida 3% 800 ml Botol 13 1 12 Rp -
380 Halothane Liquid 250 ml Botol 0 0 0 Rp - Rp -
382 Jelly ECG Tube 35 10 25 Rp 120,000.00 Rp 3,000,000.00
390 RDT Malaria Box 0 0 0 Rp 650,000.00 Rp -
391 Sodalime 1 1 0 Rp 832,495.00
392 Test Golongan darah Set 0 0 0 Rp - Rp -
393 Test Amphetamine Box 1 0 1 Rp -
394 Test Malaria (Fast/Rapid Test) Box 4 0 4 Rp 750,000.00 Rp 3,000,000.00
395 Test Syphilis Box 2 0 2 Rp 880,000.00 Rp 1,760,000.00
396 Test HbsAg Box 0 0 0 Rp - Rp -
397 Test HCV Box 0 0 0 Rp - Rp -
398 Test HIV Box 2 0 2 Rp 2,000,000.00 Rp 4,000,000.00
399 Test Urine Botol 2 0 2 Rp 1,700,000.00 Rp 3,400,000.00
403 Xylocain jelly Tube 0 0 0 Rp - Rp -
Rp 1,221,567,664.01
Waisai, 31 Desember 2015
Mengetahui
Direktur RSUD Kelas - D Penanggungjawab Farmasi
Kab. Raja Ampat
dr. Engelbert Wader Nahruddin Abbas, S.Si., Apt

NIP. 19710703 200212 1 006 NIP. 19800427 200801 2 025
LAPORAN PERSEDIAAN OBAT & BAHAN HABIS PAKAI PER 31 Desember 2015
RUMAH SAKIT UMUM DAERAH KELAS - D
KABUPATEN RAJA AMPAT
Sisa Obat Obat masuk Tahun 2015

No. JENIS PERSEDIAAN Sat Per Pengadaan Pengadaan Bantuan
25 Mar '15 TA. 2015 Tambahan Provinsi
1 Acarbose/Glucobay tablet 50 mg Tablet 450
2 Acetosal 500 mg Tablet 2,900
3 Acyclovir tablet score 200 mg Tablet 900
4 Acyclovir Tablet score 400 mg Tablet 7,000
5 Tablet 1,380
6 Ambroxol 30 mg Tab Tablet 1,300 20,000
7 Amlodipin Tab 5 mg Tablet 300
8 Amlodipin Tab. 10 mg Tablet 720 900
9 Amoksisilin kaplet 500 mg Tablet 5,400 75,000
10 Ampisillin kaplet 500mg Kaplet 24,100
11 Antasida Doen Tablet kunyah Tablet 100 10,000
12 Asam Mefenamat kaplet 500 mg Kaplet 8,000 100,000 50,000
13 Asam Traneksamat tablet 500 mg Tablet 1,800
14 Captopril Tab. 12,5 mg Tablet 1,900
15 Captopril Tab.25 mg Tablet 1,800
16 Captopril tablet 50 mg Tablet 4,800
17 Cefadroksil kaps 500 mg Kapsul 24,300
18 Cefiksim Kaplet 100 mg Kaplet 0 2,450 2,500
19 Tablet 0 3,000 3,000
20 Chloramfenikol kapsul 250 mg Kapsul 1,700
21 Ciprofloxacin 500 mg Tablet 9,800
22 Clindamisin Kapsul 150 mg Kapsul 3,750
23 Clobazam Tablet Tablet 300
24 Cotrimosasol tablet 480mg Tablet 500 2,000 5,000
25 Tablet 100
26 Digoksin Tab. 0,25 mg Tablet 200
27 Diltiazem HCL TABLET 30 MG Tablet 700
28 Doksisiklin kapsul 100mg Kapsul 2,500
29 Domperidone Tablet 10mg (20) Tablet 5,450
30 Duvadilan Tablet Tablet 250
31 Erysanbe Chweable 200 mg Tab Tablet 1,000
32 Eritromisin kapsul 250 mg Kapsul 3,960
33 Eritromisin Tablet 500 mg Tablet 4,600
34 Etambutol tablet 500 mg Tablet 2,400
35 Furosemide Tablet 40mg Tablet 2,000
36 Glibenklamid Tablet 5mg Tablet 2,600
37 Glimepirid Tablet 2 mg Tablet 1,000
38 Griseofulfin Tablet 125mg Tablet 6,400
39 Tablet 600 5,000
40 Isosorbit dinitrat Tablet sublingual 5 mg Tablet 200
41 Tablet 2,100
42 Klopidogrel Tablet 75 mg Tablet 480
43 Levofloksasina tablet 500 mg Tablet 300
44 Loperamid Tab. 2mg Tablet 7,900
Loratadin tablet 10 mg
45 Tablet 700
46 Mebendazol tablet 100 mg Tablet 360
47 Meloksikam tablet 7,5 mg Tablet 650
48 Metformin tablet 500mg Tablet 1,000
49 Methilprednisolon 4 mg Tablet 0 5,000
50 Metilegometrin Tablet 0,125mg Tablet 0 5,000
51 Metoclopramide tablet 10mg Tablet 2,700 2,000
52 Metronidasol Tablet 500mg Tablet 600 2,000 5,000
53 Molaneuron Tab Tablet 500
54 Natrium Diklofenak tablet 50mg Tablet 17,200
55 Nifedipin Tab. 10mg Tablet 4,100
56 Ofloksasin tablet 200mg Tablet 6,200
57 Ofloksasin tablet 400mg Tablet 1,350
58 Obat Anti Malaria Tablet 327
59 Obat Anti TB Anak Paket 1
60 Omeprazole Kapsul 20mg Kapsul 28,860
61 Ondansentron 4 mg Tablet 84 4,980
62 Oralit Sachet 100gr Sachet 1,250 5,000
63 Parasetamol tablet 500 mg Tablet 24,000 100,000 100,000
64 Pirantel Pamoat tablet 125 mg Tablet 1,400
65 Piroksikam tablet 10 mg (10) Tablet 1,800
66 Piroksikam 20 mg Tablet 1,000
67 Propanolol Tab. 10 mg Tablet 800
68 Pyrazinamide tablet 500 mg Tablet 4,600
69 Quinine Tablet 222mg Tablet 6,000
70 Ranitidine Tablet 150mg Tablet 13,400
71 Rifampisin kapsul 300 mg Kapsul 4,600
72 Salbutamol Tab 2mg Tablet 1,800
73 Salbutamol Tab 4mg Tablet 2,800
74 Scopma (Hyoscine-N-Butilbromide) 10 mg Tablet 3,100
75 Simvastatin Tab 10mg Tablet 90 2,600
76 Spironolakton 25 mg Tablet 0
77 Tetrasiklin 250 mg Tablet 400
78 Tetrasiklin 500 mg Kapsul 3,000
79 Tramadol tablet 50 mg Tablet 0
80 Vitamin B Complex (Dus) Tablet 42,700
81 Vitamin C 50 mg (Dus) Tablet 50,000
82 Zink Tablet 20mg Tablet 0 3,000 5,000
83 Aminophillin Tablet 200mg Tablet 400
84 Antalgin (metampiron) tablet 500 mg Tablet 14,000
85 Bekarbon Tablet Tablet 1,000
86 Besi (II) Sulfat/ Sulfaferosus Tablet 200mg Tablet 44,000
87 Bikarbonat Na. tablet 500 mg Tablet 1,000
88 Calsium laktat (Kalk) tablet 500 mg Tablet 30,000
89 Chloramfenikol kapsul 250 mg Kapsul 250
90 Cloroquin Tablet 150 mg Tablet 0
91 Cloroquin Tablet 250 mg Tablet 1,000
92 Chlorpromazin Tablet 25 mg Tablet 0
93 Cotrimoksazol tablet Pediatrik Tablet 5,400
94 CTM Tablet 39,000
95 Tablet 109,000
96 Diazepam 2 MG Tablet 6,100
97 Tablet 9,000
98 Folic Acid Tablet 1mg Tablet 8,400
99 Gliseril Guaiakolat tablet 100 mg Tablet 26,000
100 HCT (Hidro Cloro Tiazid) Tablet 25mg Tablet 1,000
101 Isoniazid tablet 100 mg Tablet 0
102 Isoniazid tablet 300 mg Tablet 2,000
103 Natrium Fenitoin kapsul 100 mg Kapsul 1,900
104 Papaverin tablet 40 mg Tablet 6,000
105 Parasetamol 500 mg tablet lepas Tablet 8,000
106 Phenobarbital 30mg Tablet 6,000
107 Piridoksin (vitamin B6) tablet 10 mg Tablet 6,000
108 Tablet 23,000
109 Primaquin Tablet 15mg Tablet 5,000
110 Propiltiourasil (PTU) Tablet 100mg Tablet 800
111 Quinine Tablet 222mg Tablet 7,000
112 Sianokobalamin (B12) Tablet 50 mcg Tablet 7,000
113 Tiamin HCl (Vitamin B1) tablet 50 mg Tablet 0
114 Amoksisilin sirup kering 125 mg/ 5 ml Botol 904
115 Ampisillin sirup 125mg /5ml Botol 312
116 Ambroxol Syrup 60 ml Botol 0 500
117 Antasida Suspensi Botol 60ml Botol 69 2,000
118 Cefadroksil sirup kering 125 mg/5 ml Botol 4 300
119 Cotrimoksazol Suspensi 240 mg Botol 1,000
120 Domperidone Suspensi 5mg/5ml Botol 350
121 Erysanbe Syrup 60 ml 120
122 Obat Batuk Hitam (OBH) sirup 100 ml Botol 365
123 Parasetamol drops 15 ml Botol 206 500
124 Paracetamol syrup 60 ml Botol 908
125 Salbutamol Sirup 100ml (Salbron) Botol 9
D SALEP / OBAT LUAR
125 Acyclovir Cream 5% Tube 5 Gr Tube 120
126 Albothyl konsentrat Botol 14
127 Alkohol 70% 1000 ml Botol 240
128 Antihemoroid suppo sitoria Supp 78
129 Bedak Salisil Serbuk 2% kotak 50gr Kotak 5
130 Betametason Cream 0,1% Tube 500
131 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 18
132 Chloramfenikol TT 3% 5 ml Botol 84 120
133 Dulcolax Suppo 10 mg Supp 45
134 Dulcolax Suppo 5 mg Supp 48
135 Dumin rectal Tube 0
136 Gentamicin Salep Kulit 0,1% Tube 0
137 Gentian Violet Pot 20
138 Hidrocortison Cream 2,5% Tube 71
139 Kalium permanganat (pk serbuk 5 gram) Pot 20
140 Ketokonasol Cream 2% 15 gram Tube 97
141 Levertraan Zalf Pot 206
142 Miconazole Krim/Salep 2% Tube 10gr 34 1,200
143 Oksitetrasiklin Salep mata 0,1%, 5 gr Tube 19
144 Povidon Iodida (yodium) 10% 1000 m Botol 240
E INJEKSI
145 Aminophillin Injeksi 24mg/ml Ampul 330
146 Ampisilin inj i.m./i.v.1000 mg Vial 0 200
147 Anesfar Inj 1 mg/ml (Midazolam) Ampul 100
148 Anti Bisa Ular (Polyvalent) Vial 7
149 Anti Tetanus Serum Ampul 34 50
150 Antrain Injeksi Ampul 20
151 Artemeter Inj 80 mg/ml Ampul 2,544
152 Artesunat injeksi Vial 288
153 Asam Traneksamat injeksi 250 mg/ml Ampul 0
154 Asam Traneksamat injeksi 500 mg/ml Ampul 0
155 Atropin sulphat injeksi 0,25mg/ml Ampul 85
156 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 0 50
157 Citicolin Injeksi Ampul 0
158 Chinin Antipyrin Injeksi Ampul 0
159 Chlorpromazin Injeksi 25mg/ml Ampul 0
160 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 455
161 Diazepam Injeksi Ampul 239
162 Deksametason injeksi i.v. 5 mg/ml Ampul 1,300
163 Dellamidon injeksi (Benodon) Vial 10
164 Dellladryl injeksi (Recodryl) Vial 14
165 Diphenhydramine injeksi Ampul 150
166 Dobutamin Giulini Ampul 31
167 Dopamin Injeksi Ampul 5
168 Duvadilan injeksi Ampul 12
169 Epinefrin (Adrenalin) inj 0,1 % (sebagai HCl) Ampul 706
170 Farbion 5000 injeksi Ampul 50
171 Fenitoin Injeksi Ampul 10
172 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 0
173 Furosemide Injeksi10 mg/ml Ampul 75
174 Gentamisin Injeksi 80mg/2ml Ampul 85
175 Hyoscine-N-Butilbromide Injeksi Ampul 20
176 Inviclot Heparin Sodium Vial 3
177 Kalsium Glukonat Injeksi 10% Ampul 24
178 Kanamisin injeksi 1gr Vial 0
179 Ketamine-Hameln injeksi 50 mg/ml Vial 0
180 Ketoprofen Injeksi 100 mg Ampul 0
181 Ampul 462 2,400
182 Lidokain injeksi 2% 2 ml Ampul 3,200
183 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 210
184 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 80
185 Meropenem Inj 1 gr Vial 10
186 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0
187 Oksitosin Injeksi 10 IU/ml Ampul 0
188 Omeprazole Injeksi 40mg/10ml Vial 0
189 Ondansentron Injeksi 2mg/2 ml Ampul 0 100 2,000
190 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 60
191 Papaverin injeksi 40 mg/ml Ampul 0
192 Pehacain Injeksi Ampul 100 200
193 Prokain benzil penisillin g inj 3 juta IU/vial Vial 272
194 Propofol Injeksi Ampul 100
195 Quinin HCL Injeksi IV 25% Ampul 246
196 Ranitidine Injeksi 25mg/2ml (10) Ampul 7,175
197 Roculax 10 mg/ml Ampul 25
198 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0
199 Vial 1,234 200
200 Seftazidim injeksi 1000 mg/vial Vial 0 100
201 Seftriakson injeksi 1 gram Vial 1,462
202 Streptomisin Serbuk injeksi 1500mg/vial Vial 500
203 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 79 1,500
204 Tramadol Injeksi 50 mg/ml Ampul 0
205 Vitamin C Injeksi Ampul 60
F CAIRAN DAN INFUS
206 Aqua Pro Injeksi Botol 560 3,000 1,100
207 Glukosa 10% larutan infus 500 ml Botol 38 40
208 Glukosa 10%-1/5 NS Botol 81
209 Glukosa 40% Botol 25ml Botol 30 30
210 Glukosa 5% larutan infus 500 ml Botol 3,857
211 Glukosa 5%-NS 500 ml Botol 100
212 Glukosa 5% - 1/2 NS 500 ml Botol 0 400
213 Glukosa 5% - 1/4 NS 500 ml Botol 0 400
214 KAEN 1 B Larutan Infus 500 ml Botol 19 100
215 KAEN 3 B Larutan Infus 500 ml Botol 0 100
216 Kaen 3A cairan infus 500 ml Botol 0 100
217 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 18
218 Lartan infus asering 500 ml Botol 0
219 Larutan Infus Manitol 20%, 500 ml Botol 40
220 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 268 640
221 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 0 10
222 NaCl 0,9% cairan infus 500 ml Botol 3,289
223 Ringer Laktat larutan infus 500 ml Botol 4,199
224 Sanbehest 500 ml Botol 20
225 Sanmol Infus (Paracetamol) Botol 200
226 Sifrofloksasin infus 2mg/ml, 100 ml Botol 0 20
227 Sevoflurane Liquid Botol 2
228 Larutan Martos 10% 500 ml Botol 35
229 BAHAN HABIS PAKAI
230 Abbocath No 16 Picis 57
231 Abbocath No 18 Picis 148 100
235 Abbocath no. 26 Merk Venysistem Picis 200
236 Abbocath no. 18 Merk Terumo Picis 100
240 Spinocan injeksi No. 26 Picis 75
241 Spinocan injeksi No. 27 Picis 0 100
242 Needle No. 22 Picis 0
245 Guedel Airway 40 mm Picis 2
246 Guedel Airway 50 mm Picis 1
247 3 Way Stopcock Picis 1 100
248 Cord Clamps (Penjepit Tali Pusar) Picis 0 3,500
249 Collor Neck Picis 10
250 Disposible Syringes 1 CC Merk Skifa Picis 29 1,500
251 Disposible Syringes 3 CC Merk Skifa Picis 1,987 2,500
252 Disposible Syringes 5 CC Merk Skifa Picis 3,159 2,000
253 Disposible Syringes 10 CC Merk Skifa Picis 18 1,000
254 Disposible Syringes 20 CC Merk Skifa Picis 30 450
255 Disposible Syringes 50 CC Picis 0
256 Disposible Syringes 1 CC Merk Terumo Picis 15,000
261 Disposible Syringes 50 CC Merk Terumo Picis 300
262 Masker Picis 0
263 Handscoon Steril No. 6,5 Merk Gammex Pasang 0 480
264 Handscoon Steril No. 7 Merk Gammex Pasang 0 500 800
265 Handscoon Steril No. 7,5 Merk Gammex Pasang 0 500 800
266 Handscoon Steril No. 8 Pasang 427
267 Handscoon Sensigloves M Pasang 0 1,000 5,000
268 Handscoon Sensigloves L Pasang 0 1,000 5,000
269 Handscoon Panjang (Obgyn) Pasang 0
270 Underpad Picis 110
271 ETT Non Pyrogenik/Non King-King No. 6,0 Tube 0
276 Endotracheal Tube ( ETT ) No. 2,5 Tube 10 5
277 Endotracheal Tube ( ETT ) No. 3 tube 10 5
279 Endotracheal Tube ( ETT ) No. 4 Tube 17 5
281 Endotracheal Tube ( ETT ) No. 5 Tube 12 5
284 Endotracheal Tube ( ETT ) No. 6,5 tube 3 5
286 Endotracheal Tube ( ETT ) No.7,5 tube 2 5
287 Endotracheal Tube ( ETT ) No.8 Tube 0 5
288 ETT Tanpa Cup No. 2,5 tube 16
289 ETT Tanpa Cup No. 3 tube 10
290 ETT Tanpa Cup No. 3,5 tube 5
291 ETT Tanpa Cup No. 4 Tube 10
292 Rectal Tube No. 30 Picis 16
293 NGT (Maag Slang) No. 3 Picis 0
294 NGT (Maag Slang) No. 3,5 Picis 10
300 Selang Oksigen Anak Picis 0
301 Selang Oksigen Dewasa Picis 0
302 Folley cateter (2 way) No. 3 Picis 0
303 Folley cateter (2 way) No. 3,5 Picis 0
306 Folley cateter (2 way) No. 10 Picis 34 20
309 Folley cateter (2 way) No.16 Picis 0 20
310 Folley cateter (2 way) No. 18 Picis 0 20 50
311 Folley cateter (2 way) No. 20 Picis 0 20 20
314 Suction Catheter No. 8 Picis 0
318 Urine Bag 2000 ml Bag 0 50 200
319 Infuset Mikro Picis 0 200
320 Infuset Makro Set 0 200 200
321 Transfusi Darah Set Picis 0 200
322 Etil Clorida Spray Botol 8
323 Gliserin botol 100ml Botol 18
324 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 0
325 Plester Luka Steril ( Chloro Tulle) Lembar 0
326 Hipafix 10 cm x 5 M Roll 0
327 Kapas Pembalut 100 g Roll 0
330 Kasa Hidrofil 16 x 16 cm Bks 0
331 Kasa Hidrofil 40 x 80 cm Rol 0
332 Kasa Hidrofil 40 x 40 cm Bungkus 10
333 Plester Luka (Leukoplas 1621) Roll 0 113
334 Leukoplas 1624 (2x5) Roll 0
335 Elastis Perban Putih 6" Roll 10
336 Elastis Perban 10 cm x 4,5 m Roll 0
337 Gypsona 6" Roll 5
338 Poli Creepe 4" Roll 5
339 Poli Creepe 6 " Roll 5
340 Softband 3" Pcs 0
341 Softband 6" Roll 20
342 Kertas Puyer (kertas perkamen) Bks 18 20
343 Kertas USG Picis 6
344 Kertas EKG Picis 3
345 Kertas Film Ukr 24 x 30 Picis 0
H PISAU,BENANG & JARUM
348 Surgical Blades (Bisturi) No. 10 Picis 95
349 Surgical Blades (Bisturi) No. 11 Picis 8
350 Jarum Hecting Kulit No.10 Lusin 0
353 Jarum Hecting Otot No.7 Lusin 5
356 Silk Black 2/0 100 Meter Roll 0
357 Silk Black 3/0 100 Meter Roll 0
358 SoftSilk No. 2/0 Bks 0
359 SoftSilk No. 3/0 Bks 0
360 Catgut Chromic No. 1/0 Bks 0
363 Catgut Plain No. 0 Roll 0
364 Catgut Plain No. 2/0 (3,5) 100 M Roll 0
365 Jarum Prolene No. 1/0 Bks 0
I LAB, UTDRS, RADIOLOGY DAN LAIN-LAIN
369 Alkaline Phospatase (5x24 ml) Kit 0
370 Albumin Kit 0
371 Blood bag Merk Terumo Bag 0
372 Blood Lancet Dus 0
373 Comb. Serum Box 0
374 Cholesterol Liquid (6x30 ml) Kit 0
375 Creatinin (5x24 ml) Kit 0
376 Formalin 1 Liter Botol 0
377 Glucose Liquid (6x30 ml) Kit 0
378 GOT IFCC (5x24 ml) Kit 0
379 Hidrogen Peroksida 3% 800 ml Botol 13
380 Halothane Liquid 250 ml Botol 0
381 HDL Cholesterol (2x25 ml) Kit 0
382 Jelly ECG Tube 35
383 Jelly Libricating/My Jelly Tube 0
384 Jelly USG Botol 46
385 One Scrub 5 Liter Gen 0
386 One Scrub 500 ml Botol 0
387 Rapid 1 Test 0
388 Rapid 2 Test 0
389 Rapid 3 Test 0
390 RDT Malaria Box 0
391 Sodalime 1
392 Test Golongan darah Set 0
393 Test Amphetamine Box 1
394 Test Malaria (Fast/Rapid Test) Box 4
395 Test Syphilis Box 2
396 Test HbsAg Box 0
397 Test HCV Box 0
398 Test HIV Box 2
399 Test Urine Botol 2
400 Triglycerida (5x24 ml) Kit 0
401 UREA (5x24 ml) Kit 0
402 URIC ACID (5x24 ml) Kit 0
403 Xylocain jelly Tube 0
Mengetahui
Direktur RSUD Kelas - D
Kab. Raja Ampat
dr. Engelbert Wader

NIP. 19710703 200212 1 006
PER 31 Desember 2015
S-D
Tahun 2015
Bantuan Qty Harga SatNILAI (Rp)
Lain-Lain
450 ### ###

2,900 ### ###
900 ### ###
7,000 ### ###
1,380 ### ###
21,300 ### ###
300 ### ###
1,620 ### ###
80,400 ### ###
24,100 ### ###
10,100 ### ###
158,000 ### ###
1,800 ### ###
1,900 ### ###
1,800 ### ###
4,800 ### ###
24,300 ### ###
6,000 ### ###

1,700 ### ###
9,800 ### ###
3,750 ### ###
7,500 ### ###

100 ### ###
200 ### ###
700 ### ###
2,500 ### ###
5,450 ### ###
250 ### ###
3,960 ### ###

4,600 ### ###
2,400 ### ###
2,000 ### ###
2,600 ### ###
6,400 ### ###

5,600 ### ###
200 ### ###
2,100 ### ###
300 ### ###

7,900 ### ###
700 ### ###
360 ### ###
650 ### ###
1,000 ### ###
5,000 Rp -
5,000 ### ###
4,700 ### ###
7,600 ### ###
17,200 ### ###

4,100 ### ###
6,200 ### ###
1,350 ### ###
327 Rp -
1 ### ###
28,860 ### ###
5,064 Rp -
6,250 ### ###
224,000 ### ###
1,400 ### ###
1,800 ### ###
1,000 ### ###
800 ### ###
4,600 ### ###
13,400 ### ###

4,600 ### ###
1,800 ### ###
2,800 ### ###
3,100 ### ###
2,690 ### ###
0 Rp -
400 Rp -
3,000 ### ###
0 ### Rp -
8,000 ### ###

0
400 ### ###
14,000 ### ###
1,000 ### ###
44,000 ### ###
1,000 ### ###
30,000 ### ###
250 ### ###
0 ### Rp -
1,000 ### ###
5,400 ### ###

39,000 ### ###
109,000 ### ###
6,100 ### ###
9,000 ### ###
8,400 ### ###
26,000 ### ###
1,000 ### ###
0 Rp - Rp -
2,000 ### ###
1,900 ### ###
6,000 ### ###
8,000 ### ###
6,000 ### ###

23,000 ### ###
5,000 ### ###
800 ### ###
7,000 ### ###
7,000 ### ###
0 ### Rp -
904 ### ###

312 ### ###
500 ### ###
2,069 ### ###
304 ### ###
350 ### ###
365 ### ###

706 ### ###
908 ### ###
9 ### ###
0
120 ### ###
14 ### ###
78 ### ###
5 ### ###
500 ### ###
18 ### ###
204 ### ###
45 ### ###
48 ### ###
0
0 ### Rp -
20 Rp -
71 ### ###
20 ### ###
97 ### ###
206 Rp -
19 ### ###
0
330 ### ###
200 ### ###
7 Rp -
84 Rp -
2,544 ### ###

288 ### ###
0 ### Rp -
0 ### Rp -
85 ### ###
50 Rp -
0 Rp -
455 ### ###
239 ### ###
1,300 ### ###
10 ### ###
14 ### ###
150 Rp -
31 Rp -
12 ### ###
706 ### ###
0 ### Rp -
75 ### ###
85 ### ###
20 ### ###
3 Rp -
24 ### ###
0 ### Rp -
0 ### Rp -
2,862 ### ###

3,200 ### ###
210 ### ###
80 ### ###
0 ### Rp -
0 ### Rp -
0 ### Rp -
2,100 Rp -
0 ### Rp -
300 ### ###
272 ### ###
246 ### ###

7,175 ### ###
0 ### Rp -
1,434 ### ###
100 ### ###
1,462 ### ###
500 ### ###
1,579 ### ###
0 ### Rp -
0
4,660 ### ###
78 ### ###
60 ### ###
3,857 ### ###
100 ### ###
400 ### ###
400 ### ###
119 ### ###
100 ### ###
100 ### ###
18 ### ###
0 ### Rp -
40 ### ###
908 ### ###
10 ### ###
3,289 ### ###
4,199 ### ###
20 ### ###
35 Rp -
0
57 ### ###
248 ### ###
150 ### ###
187 ### ###
150 ### ###
#REF! ### #REF!
75 ### ###
100 ### ###
0 Rp -
0 Rp -
0 Rp -
2 Rp -
1 Rp -
101 Rp -
3,500 ### ###
1,529 ### ###

4,487 ### ###
5,159 ### ###
1,018 ### ###
480 ### ###
0 ### Rp -
0 ### Rp -
480 ### ###
1,300 ### ###
1,300 ### ###
427 ### ###
6,000 ### ###
6,000 ### ###
0 ### Rp -
0
0
0
0
0
15 ### ###
15 ### ###
24 ### ###
22 ### ###
16 ### ###
17 ### ###
6 ### ###
7 ### ###
8 ### ###
7 ### ###
7 ### ###
5
16 ### ###
10 ### ###
5 ### ###
10 ### ###
16 Rp -
0 ### Rp -
10 ### ###
0 ### Rp -
0 ### Rp -
16 ### ###
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
54 ### ###
65 ### ###
20 ### ###
20 ### ###
70 ### ###
40 ### ###
30 ### ###
12 ### ###
0 ### Rp -
0 ### Rp -
9 ### ###
10 ### ###
250 Rp -
200 ### ###
400 ### ###
200 ### ###
8 ### ###
18 ### ###
0 ### Rp -
0 ### Rp -
0 ### Rp -
1 Rp -
10 ### ###
0 ### Rp -
0 ### Rp -
113 ### ###
0 ### Rp -
38 ### ###
6 ### ###
3 ### ###
0 ### Rp -
0 ### Rp -
0 ### Rp -
0
95 ### ###
8 ### ###
0 ### Rp -
0 ### Rp -
0 ### Rp -
5 ### ###
3 ### ###
0 ### Rp -
0
0
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
0 Rp -
0 ### Rp -
0 ### Rp -
0 ### Rp -
RUMAH SAKIT UMUM DAERAH KAB. RAJA AMPAT
Alamat : Waisai, Disrtik Waisai Kota Kab.Raja Ampat
Laporan Persediaan Obat dan Bahan Medis Habis Pakai di Rumah Sakit Umum Daerah Kelas-D Kabupaten Raja Ampat
Periode 30 April 2016
Sisa Obat Obat masuk per Jan s/d Apr 2016 Obat Sisa Obat
Harga Satuan Total Harga
No. JENIS PERSEDIAAN Satuan Per Pengadaan Sisa Bantuan Bantuan Keluar Per
(RP) Satuan (Rp)
1 jan '16 TA. 2016 TA 2015 Provinsi Dinkes R4 Per Jan-Apr 30 Apr '16
1 Acarbose/Glucobay tablet 50 mg Box, 50 Tab 9 1 8 126,000 1,008,000
2 Acetosal 500 mg Box, 100 Tab 18 2 16 21,800 348,800
3 Acyclovir tablet score 200 mg Box, 100 Tab 4 2 2 141,100 282,200
4 Acyclovir Tablet score 400 mg Box, 100 Tab 66 4 62 207,756 12,880,872
5 Box, 100 Tab 0 500 500 0 17,820 0
6 Ambroxol 30 mg Tab Box, 100 Tab 166 67 99 24,341 2,409,759
7 Amlodipin Tab 5 mg Box 30 Tab 0 0 0 34,560 0
8 Amlodipin Tab. 10 mg Box 30 Tab 18 18 0 13,200 0
9 Amoksisilin kaplet 500 mg Box, 100 Tab 688 200 101 787 28,800 22,665,600
10 Ampisillin kaplet 500mg Box, 100 Tab 147 25 122 51,435 6,275,070
11 Antasida Doen Tablet kunyah Box, 100 Tab 129 27 102 8,500 867,000
12 Asam Mefenamat kaplet 500 mg Box, 100 Tab 1,420 98 1,322 25,344 33,504,768
13 Asam Traneksamat tablet 500 mg Box, 100 Tab 7 7 0 125,400 0
14 Captopril Tab. 12,5 mg Box, 100 Tab 17 17 0 12,150 0
15 Captopril Tab.25 mg Box, 100 Tab 76 37 39 18,596 725,244
16 Captopril tablet 50 mg Box, 100 Tab 43 2 41 30,291 1,241,931
17 Cefadroksil kaps 500 mg Box, 100 Cap 111 69 42 183,272 7,697,424
18 Cefiksim Kaplet 100 mg Box 50 tab 66 40 26 107,752 2,801,552
19 Box 30 Tab 130 88 42 10,882 457,044
20 Chloramfenikol kapsul 250 mg Box 100 Tab 0 0 0 35,978 0
21 Ciprofloxacin 500 mg Box, 100 Tab 49 16 33 27,700 914,100
22 Clindamisin Kapsul 150 mg Box 50 tab 56 7 49 68,850 3,373,650
23 Clobazam Tablet Box 50 tab 6 6 0 71,036 0
24 Cotrimosasol tablet 480mg Box, 100 Tab 48 24 24 16,600 398,400
(RP) Satuan (Rp)
25 Box, 100 Tab 0 0 0 11,745 0
26 Digoksin Tab. 0,25 mg Box, 100 Tab 2 0 2 19,305 38,610
27 Diltiazem HCL TABLET 30 MG Box, 100 Tab 7 2 5 20,470 102,350
28 Doksisiklin kapsul 100mg Box, 100 Tab 7 2 5 30,000 150,000
29 Domperidone Tablet 10mg (20) Box, 100 Tab 30 17 13 108,996 1,416,948
30 Duvadilan Tablet Box 50 tab 5 0 5 123,625 618,125
31 Erysanbe Chweable 200 mg Tab Box, 100 Tab 7 6 1 198,777 198,777
32 Eritromisin kapsul 250 mg Box, 100 Tab 3 3 0 68,040 0
33 Eritromisin Tablet 500 mg Box, 100 Tab 42 9 33 111,600 3,682,800
34 Etambutol tablet 500 mg Box, 100 Tab 20 2 18 77,436 1,393,848
35 Furosemide Tablet 40mg Box, 100 Tab 6 6 0 13,781 0
36 Glibenklamid Tablet 5mg Box, 100 Tab 21 5 16 9,720 155,520
37 Glimepirid Tablet 2 mg Box 50 tab 20 4 16 26,150 418,400
38 Griseofulfin Tablet 125mg Box, 100 Tab 54 11 43 32,400 1,393,200
39 Box, 100 Tab 14 14 0 17,100 0
40 Isosorbit dinitrat Tablet sublingual 5 mg Box, 100 Tab 2 2 0 13,142 0
41 Box 50 tab 28 28 0 47,791 0
42 Clopidogrel Tablet 75 mg Box 30 Tab 11 3 8 119,700 957,600
43 Levofloksasina tablet 500 mg Box 50 tab 0 0 0 77,873 0
44 Loperamid Tab. 2mg Box, 100 Tab 62 4 58 12,359 716,822
45 Mebendazol tablet 100 mg Box 30 Tab 9 1 8 8,775 70,200
46 Meloksikam tablet 7,5 mg Box 50 tab 0 0 0 46,703 0
47 Metformin tablet 500mg Box, 100 Tab 5 5 0 24,503 0
48 Methilprednisolon 4 mg Box, 100 Tab 39 35 4 44,418 177,672
49 Metilegometrin Tablet 0,125mg Box, 100 Tab 42 7 35 18,500 647,500
50 Metoclopramide tablet 10mg Box, 100 Tab 68 4 64 13,094 838,016
51 Metronidasol Tablet 500mg Box, 100 Tab 74 12 62 17,600 1,091,200
52 Molaneuron Tab Box 50 tab 10 10 0 124,407 0
53 Natrium Diklofenak tablet 50mg Box 50 tab 250 68 182 14,693 2,674,126
54 Nifedipin Tab. 10mg Box, 100 Tab 28 11 17 17,415 296,055
55 Ofloksasin tablet 200mg Box 50 tab 17 7 10 39,832 398,320
56 Ofloksasin tablet 400mg Box 50 tab 22 5 17 58,928 1,001,776
57 Obat Anti Malaria Box 9 tab 0 111 111 0 34,497 0
(RP) Satuan (Rp)
58 Omeprazole Kapsul 20mg Box 30 Cap 884 49 835 14,700 12,274,500
59 Ondansentron 4 mg Box 30 Tab 133 27 106 32,700 3,466,200
60 Oralit Sachet 100gr Box 100 Sach 52 5 47 34,600 1,626,200
61 Parasetamol tablet 500 mg Box, 100 Tab 2,060 113 1,947 9,600 18,691,200
62 Pirantel Pamoat tablet 125 mg Box, 100 Tab 2 2 0 43,200 0
63 Piroksikam tablet 10 mg (10) Box, 100 Tab 11 3 8 11,340 90,720
64 Piroksikam 20 mg Box, 100 Tab 5 2 3 9,700 29,100
65 Primaquin Tablet 15 mg Box, 100 Tab 0 72 27 45 21,000
66 Propanolol Tab. 10 mg Box, 100 Tab 8 0 8 10,395 83,160
67 Pyrazinamide tablet 500 mg Box, 100 Tab 20 2 18 31,590 568,620
68 Quinine Tablet 222mg Box 60 tab 114 22 92 48,240 4,438,080
69 Ranitidine Tablet 150mg Box, 100 Tab 77 24 53 29,700 1,574,100
70 Rifampisin kapsul 300 mg Box, 100 Tab 37 9 28 64,800 1,814,400
71 Salbutamol Tab 2mg Box, 100 Tab 7 7 0 11,344 0
72 Salbutamol Tab 4mg Box, 100 Tab 11 9 2 11,344 22,688
73 Scopma (Hyoscine-N-Butilbromide) 10 mg Box, 100 Tab 13 2 11 45,083 495,913
74 Simvastatin Tab 10mg Box 50 tab 52 33 19 31,200 592,800
75 Tetrasiklin 250 mg Box, 100 Tab 2 0 2 2,835 5,670
76 Tetrasiklin 500 mg Box, 100 Tab 30 15 15 34,695 520,425
77 Vitamin B Complex (Dus) Box, 100 Tab 261 77 184 12,200 2,244,800
78 Vitamin C 50 mg (Dus) Box, 100 Tab 244 64 180 11,400 2,052,000
79 Zink Tablet 20mg Box, 100 Tab 58 25 33 56,900 1,877,700
80 Aminophillin Tablet 200mg Botol 100 Tab 3 1 2 15,296 30,592
81 Antalgin (metampiron) tablet 500 mg Botol 1000 Tab 8 5 3 116,640 349,920
82 Bekarbon Tablet Botol 1000 Tab 1 1 0 84,040 0
83 Besi (II) Sulfat/ Sulfaferosus Tablet 200mg Botol 1000 Tab 42 2 40 35,410 1,416,400
84 Bikarbonat Na. tablet 500 mg Botol 1000 Tab 1 0 1 19,300 19,300
85 Calsium laktat (Kalk) tablet 500 mg Botol 1000 Tab 30 3 27 70,200 1,895,400
86 Chloramfenikol kapsul 250 mg Botol 250 Cap 1 1 0 89,945 0
87 Cloroquin Tablet 250 mg Botol 1000 Tab 1 1 0 102,000 0
88 Cotrimoksazol tablet Pediatrik Botol 100 Tab 42 2 40 9,108 364,320
89 CTM Botol 1000 Tab 30 13 17 28,800 489,600
(RP) Satuan (Rp)
90 Botol 1000 Tab 86 10 76 117,450 8,926,200
91 Diazepam 2 MG Botol 100 Tab 45 2 43 3,000 129,000
92 Botol 1000 Tab 9 1 8 109,350 874,800
93 Folic Acid Tablet 1mg Botol 100 Tab 80 2 78 9,180 716,040
94 Gliseril Guaiakolat tablet 100 mg Botol 1000 Tab 20 11 9 37,660 338,940
95 HCT (Hidro Cloro Tiazid) Tablet 25mg Botol 1000 Tab 1 0 1 49,000 49,000
96 Isoniazid tablet 300 mg Botol 1000 Tab 2 2 0 130,950 0
97 Natrium Fenitoin kapsul 100 mg Botol 100 Tab 15 0 15 32,480 487,200
98 Papaverin tablet 40 mg Botol 1000 Tab 5 2 3 134,420 403,260
99 Phenobarbital 30mg Botol 100 Tab 59 1 58 5,580 323,640
100 Piridoksin (vitamin B6) tablet 10 mg Botol 1000 Tab 4 3 1 23,490 23,490
101 Botol 1000 Tab 9 100 6 103 84,370 8,690,110
102 Propiltiourasil (PTU) Tablet 100mg Botol 100 Tab 8 0 8 40,442 323,536
103 Quinine Tablet 222mg Botol 1000 Tab 2 0 2 610,290 1,220,580
104 Sianokobalamin (B12) Tablet 50 mcg Botol 1000 Tab 6 0 6 17,680 106,080
105 Vitamin A 200.000 UI Botol 50 Caap 5 5 0 34,000 0
106 Amoksisilin sirup kering 125 mg/ 5 ml Botol 274 54 220 4,995 1,098,900
107 Ampisillin sirup 125mg /5ml Botol 180 60 120 5,940 712,800
108 Ambroxol Syrup 60 ml Botol 5 500 5 500 7,480 3,740,000
109 Antasida Suspensi Botol 60ml Botol 1,774 268 1,506 2,409 3,627,954
110 Cefadroksil sirup kering 125 mg/5 ml Botol 200 100 100 18,000 1,800,000
111 Cotrimoksazol Suspensi 240 mg Botol 900 147 753 2,590 1,950,270
112 Domperidone Suspensi 5mg/5ml Botol 111 111 0 17,078 0
113 Erysanbe Syrup 60 ml Botol 80 80 0 27,280 0
114 Parasetamol drops 15 ml Botol 420 72 348 6,240 2,171,520
115 Paracetamol syrup 60 ml Botol 157 1,000 227 930 2,474 2,300,820
D SALEP / OBAT LUAR
116 Acyclovir Cream 5% Tube 5 Gr Tube 70 58 12 4,253 51,036
117 Alkohol 70% 1000 ml Botol 108 70 38 75,000 2,850,000
118 Antihemoroid suppo sitoria Supp 48 6 42 2,700 113,400
119 Bedak Salisil Serbuk 2% kotak 50gr Kotak 0 0 0 1,931 0
120 Betametason Cream 0,1% Tube 250 101 149 2,520 375,480
(RP) Satuan (Rp)
121 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 240 53 187 2,110 394,570
122 Chloramfenikol TT 3% 5 ml Botol 96 39 57 2,111 120,327
123 Dulcolax Suppo 10 mg Supp 30 30 0 22,000 0
124 Dulcolax Suppo 5 mg Supp 30 30 0 16,417 0
125 Gentian Violet Pot 0 0 0 776 0
126 Ketokonasol Cream 2% 15 gram Tube 0 0 0 9,450 0
127 Levertraan Zalf Pot 156 0 156 150 23,400
128 Miconazole Krim/Salep 2% Tube 10gr 1,272 107 1,165 3,600 4,194,000
129 Povidon Iodida (yodium) 10% 1000 m Botol 108 54 54 110,000 5,940,000
E INJEKSI
130 Aminophillin Injeksi 24mg/ml Ampul 201 30 171 4,050 692,550
131 Ampisilin inj i.m./i.v.1000 mg Vial 120 120 0 9,267 0
132 Anesfar Inj 1 mg/ml (Midazolam) Ampul 100 25 75 21,249 1,593,675
133 Anti Bisa Ular (Polyvalent) Vial 0 0 0 30,000 0
134 Anti Tetanus Serum Ampul 50 20 30 127,409 3,822,270
135 Antrain Injeksi Ampul 0 0 0 11,515 0
136 Artemeter Inj 80 mg/ml Ampul 882 90 0 972 26,600 25,855,200
137 Artesunat injeksi Vial 0 400 352 48 30,720 1,474,560
138 Asam Traneksamat injeksi 500 mg/ml Ampul 0 0 0 6,400 0
139 Atropin sulphat injeksi 0,25mg/ml Ampul 0 0 0 1,708 0
140 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 50 50 0 79,510 0
141 Citicolin Injeksi Ampul 0 0 0 25,000 0
142 Chinin Antipyrin Injeksi Ampul 0 0 0 1,000 0
143 Chlorpromazin Injeksi 25mg/ml Ampul 0 0 0 2,590 0
144 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 0 0 0 1,400 0
145 Diazepam Injeksi Ampul 102 12 90 2,584 232,560
146 Deksametason injeksi i.v. 5 mg/ml Ampul 0 4,800 400 4,400 2,700 11,880,000
147 Dellamidon injeksi (Benodon) Vial 15 0 15 17,500 262,500
148 Dellladryl injeksi (Recodryl) Vial 10 3 7 16,000 112,000
149 Diphenhydramine injeksi Ampul 0 150 150 0 1,296 0
150 Dobutamin Giulini Ampul 25 0 25 344,000 8,600,000
151 Dopamin Injeksi Ampul 0 0 0 99,329 0
152 Duvadilan injeksi Ampul 0 0 0 25,084 0
(RP) Satuan (Rp)
153 Epinefrin (Adrenalin) inj 0,1 % (sebagai HCl) Ampul 131 30 101 1,674 169,074
154 Farbion 5000 injeksi Ampul 5 5 0 7,088 0
155 Fenitoin Injeksi Ampul 12 4 8 42,223 337,784
156 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 0 300 90 210 4,100 861,000
157 Furosemide Injeksi10 mg/ml Ampul 0 0 0 2,782 0
158 Gentamisin Injeksi 80mg/2ml Ampul 0 0 0 4,990 0
159 Hyoscine-N-Butilbromide Injeksi Ampul 0 0 0 62,700 0
160 Kalsium Glukonat Injeksi 10% Ampul 24 0 24 15,625 375,000
161 Ketamine-Hameln injeksi 50 mg/ml Vial 0 0 0 125,898 0
162 Ketoprofen Injeksi 100 mg Ampul 0 0 0 1,254 0
163 Ampul 1,680 488 1,192 2,799 3,336,408
164 Lidokain injeksi 2% 2 ml Ampul 2,600 1,100 1,500 1,364 2,046,000
165 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 0 0 0 1,800 0
166 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 0 0 0 2,093 0
167 Meropenem Inj 1 gr Vial 10 4 6 329,010 1,974,060
168 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0 0 0 15,578 0
169 Oksitosin Injeksi 10 IU/ml Ampul 0 0 0 3,338 0
170 Omeprazole Injeksi 40mg/10ml Vial 0 0 0 70,000 0
171 Ondansentron Injeksi 2mg/2 ml Ampul 1,600 400 1,200 2,700 3,240,000
172 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 60 10 50 17,400 870,000
173 Papaverin injeksi 40 mg/ml Ampul 0 0 0 1,595 0
174 Pehacain Injeksi Ampul 60 60 0 3,114 0
175 Propofol/Proanes Injeksi Ampul 0 0 0 97,743 0
176 Quinin HCL Injeksi IV 25% Ampul 0 0 0 4,854 0
177 Ranitidine Injeksi 25mg/2ml (10) Ampul 3,775 425 3,350 8,674 29,057,900
178 Roculax 10 mg/ml Ampul 0 0 0 281,030 0
179 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0 0 0 12,400 0
180 Vial 0 0 0 10,364 0
181 Seftazidim injeksi 1000 mg/vial Vial 100 100 0 50,634 0
182 Seftriakson injeksi 1 gram Vial 966 371 595 11,602 6,903,190
183 Streptomisin Serbuk injeksi 1500mg/vial Vial 500 0 500 5,175 2,587,500
184 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 1,110 480 630 1,377 867,510
185 Tramadol Injeksi 50 mg/ml Ampul 0 0 0 8,643 0
(RP) Satuan (Rp)
186 Vitamin C Injeksi Ampul 0 0 0 27,806 0
F CAIRAN DAN INFUS
187 Aqua Pro Injeksi Botol 2,914 608 2,306 6,937 15,996,722
188 Glukosa 10% larutan infus 500 ml Botol 40 0 40 2,110 84,400
189 Glukosa 10%-1/5 NS Botol 40 0 40 9,240 369,600
190 Glukosa 40% Botol 25ml Botol 53 53 0 10,857 0
191 Glukosa 5% larutan infus 500 ml Botol 2,793 740 2,053 8,273 16,984,469
192 Glukosa 5%-NS 500 ml Botol 40 0 40 9,240 369,600
193 Glukosa 5% - 1/2 NS 500 ml Botol 18 2,000 77 1,941 9,240 17,934,840
194 Glukosa 5% - 1/4 NS 500 ml Botol 0 2,000 100 1,900 9,240 17,556,000
195 KAEN 1 B Larutan Infus 500 ml Botol 57 20 37 24,196 895,252
196 KAEN 3 B Larutan Infus 500 ml Botol 23 23 0 27,897 0
197 Kaen 3A cairan infus 500 ml Botol 38 38 0 26,047 0
198 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 25 0 25 45,000 1,125,000
199 Lartan infus asering 500 ml Botol 0 0 0 22,000 0
200 Larutan Infus Manitol 20%, 500 ml Botol 40 0 40 125,000 5,000,000
201 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 448 208 240 44,117 10,588,080
202 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 21 0 21 10,857 227,997
203 MgSO4 ( Magesium sulfat 40% - 25 ml ) Botol 0 0 0 0 0
204 NaCl 0,9% cairan infus 500 ml Botol 1,981 620 1,361 8,273 11,259,553
205 Ringer Laktat larutan infus 500 ml Botol 786 1,500 2,160 126 6,240 786,240
206 Sanbehest 500 ml Botol 20 0 20 254,160 5,083,200
207 Sanmol Infus (Paracetamol) Botol 0 0 0 75,672 0
208 Sifrofloksasin infus 2mg/ml, 100 ml Botol 0 0 0 85,244 0
209 Sevoflurane Liquid Botol 0 0 0 3,684,260 0
210 Larutan Martos 10% 500 ml Botol 46 0 46 9,246 425,316
BAHAN HABIS PAKAI
211 Abbocath No 16 Picis 26 20 6 35,000 210,000
212 Abbocath No 18 Picis 50 1,000 185 865 25,361 21,937,265
213 Abbocath No 20 Picis 499 499 0 25,361 0
214 Abbocath No 22 Picis 659 150 329 480 25,361 12,173,280
215 Abbocath No 24 Picis 797 270 527 25,361 13,365,247
216 Abbocath no. 26 Merk Venysistem Picis 285 125 160 25,361 4,057,760
(RP) Satuan (Rp)
217 Spinocan injeksi No. 26 Picis 75 50 25 50,000 1,250,000
218 Spinocan injeksi No. 27 Picis 100 0 100 60,319 6,031,900
219 Needle No. 22 Picis 0 0 0 200 0
220 Needle No. 24 Picis 0 0 0 200 0
221 Needle No. 26 Picis 0 0 0 200 0
222 Guedel Airway 40 mm Picis 0 0 0 10,000 0
223 Guedel Airway 50 mm Picis 0 0 0 10,000 0
224 3 Way Stopcock Picis 0 0 0 9,347 0
225 Cord Clamps (Penjepit Tali Pusar) Picis 3,400 400 3,000 1,683 5,049,000
226 Collor Neck Picis 10 6 4 218,904 875,616
227 Disposible Syringes 1 CC Picis 14,133 1,500 1,963 13,670 7,266 99,326,220
228 Disposible Syringes 3 CC Picis 18,647 5,153 13,494 5,895 79,547,130
230 Disposible Syringes 10 CC Picis 5,400 380 5,020 4,798 24,085,960
232 Disposible Syringes 50 CC Picis 302 25 277 29,062 8,050,174
233 Masker Picis 0 0 0 1,650 0
234 Handscoon Steril No. 6,5 Merk Gammex Pasang 509 309 200 21,934 4,386,800
235 Handscoon Steril No. 7 Merk Gammex Pasang 704 694 10 16,500 165,000
236 Handscoon Steril No. 7,5 Merk Gammex Pasang 700 500 200 16,500 3,300,000
237 Handscoon Steril No. 8 Pasang 0 0 0 4,830 0
238 Handscoon Sensigloves M Pasang 4,100 3,100 1,000 1,804 1,804,000
239 Handscoon Sensigloves L Pasang 5,350 1,350 4,000 1,804 7,216,000
240 Handscoon Panjang (Obgyn) Pasang 0 0 0 55,000 0
241 Underpad Picis 110 90 20 5,745 114,900
242 Endotracheal Tube ( ETT ) No. 2,5 Tube 5 5 0 10 104,954 1,049,540
243 Endotracheal Tube ( ETT ) No. 3 tube 10 0 10 104,954 1,049,540
244 Endotracheal Tube ( ETT ) No. 3,5 Tube 19 0 19 104,954 1,994,126
245 Endotracheal Tube ( ETT ) No. 4 Tube 17 0 17 104,954 1,784,218
246 Endotracheal Tube ( ETT ) No. 4,5 Tube 10 0 10 104,954 1,049,540
247 Endotracheal Tube ( ETT ) No. 5 Tube 12 0 12 104,954 1,259,448
248 Endotracheal Tube ( ETT ) No. 5,5 Tube 1 0 1 104,954 104,954
249 Endotracheal Tube ( ETT ) No. 6 tube 2 0 2 104,954 209,908
250 Endotracheal Tube ( ETT ) No. 6,5 tube 3 0 3 104,954 314,862
(RP) Satuan (Rp)
252 Endotracheal Tube ( ETT ) No.7,5 tube 2 0 2 104,954 209,908
253 Endotracheal Tube ( ETT ) No.8 Tube 0 0 0 104,954 0
254 ETT Tanpa Cup No. 2,5 tube 16 0 16 22,500 360,000
255 ETT Tanpa Cup No. 3 tube 10 0 10 22,500 225,000
256 ETT Tanpa Cup No. 3,5 tube 5 0 5 22,500 112,500
257 ETT Tanpa Cup No. 4 Tube 10 0 10 22,500 225,000
258 Rectal Tube No. 30 Picis 10 0 10 20,000 200,000
259 NGT (Maag Slang) No. 3 Picis 0 0 0 29,500 0
260 NGT (Maag Slang) No. 3,5 Picis 0 0 0 29,500 0
263 NGT (Maag Slang) No. 14 Picis 11 0 11 29,500 324,500
264 NGT (Maag Slang) No. 16 Picis 45 0 45 29,500 1,327,500
265 NGT (Maag Slang) No. 18 Picis 44 0 44 29,500 1,298,000
266 Selang Oksigen Anak Picis 0 0 0 27,500 0
267 Selang Oksigen Dewasa Picis 17 0 17 27,500 467,500
268 Folley cateter (2 way) No. 3 Picis 0 0 0 27,500 0
269 Folley cateter (2 way) No. 3,5 Picis 0 0 0 27,500 0
272 Folley cateter (2 way) No. 10 Picis 50 0 50 74,775 3,738,750
274 Folley cateter (2 way) No. 14 Picis 30 0 30 28,041 841,230
275 Folley cateter (2 way) No.16 Picis 0 0 0 28,041 0
276 Folley cateter (2 way) No. 18 Picis 20 10 30 0 19,800 0
280 Suction Catheter No. 8 Picis 5 5 0 15,000 0
(RP) Satuan (Rp)
284 Urine Bag 2000 ml Bag 200 65 135 74,800 10,098,000
285 Infuset Mikro Picis 0 1,500 251 1,249 4,830 6,032,670
286 Infuset Makro Set 10 1,500 376 1,134 4,416 5,007,744
287 Transfusi Darah Set Picis 88 88 0 26,400 0
288 Etil Clorida Spray Botol 0 20 4 16 127,000 2,032,000
289 Gliserin botol 100ml Botol 16 0 16 6,386 102,176
290 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 0 0 0 2,630 0
291 Plester Luka Steril ( Chloro Tulle) Lembar 0 0 0 34,400 0
292 Hipafix 10 cm x 5 M Roll 0 0 0 350,000 0
293 Kapas Pembalut 100 g Roll 0 0 0 7,000 0
294 Kapas Pembalut 250 g Roll 9 100 13 96 15,000 1,440,000
295 Kapas Pembalut 1000 g Roll 0 0 0 22,700 0
296 Kasa Hidrofil 16 x 16 cm Bks 0 0 0 7,727 0
297 Kasa Hidrofil 40 Yard x 80 cm Rol 0 100 53 47 144,900 6,810,300
298 Kasa Hidrofil 40 x 40 cm Bungkus 0 0 0 500 0
299 Plester 5 Yard x 2 Inci Roll 24 120 120 24 28,000 672,000
300 Elastis Perban Putih 6" Roll 0 0 0 65,428 0
301 Elastis Perban 10 cm x 4,5 m Roll 0 0 0 45,000 0
302 Gypsona 6" Roll 0 0 0 62,320 0
303 Poli Creepe 4" Roll 0 0 0 129,992 0
304 Poli Creepe 6 " Roll 0 0 0 171,084 0
305 Softband 3" Pcs 0 0 0 75,000 0
306 Softband 6" Roll 0 0 0 56,081 0
307 Kertas Puyer (kertas perkamen) Bks 40 9 31 27,500 852,500
308 Kertas USG Picis 0 0 0 320,000 0
309 Kertas EKG Picis 0 0 0 24,000 0
310 Surgical Blades (Bisturi) Picis 0 1,000 55 945 1,100 1,039,500
311 Jarum Hecting Kulit No.10 Lusin 0 0 0 175,000 0
314 Jarum Hecting Otot No.7 Lusin 5 0 5 175,000 875,000
316 Jarum Hecting Otot No.11 Lusin 0 0 0 175,000 0
(RP) Satuan (Rp)
317 Silk Black 2/0 100 Meter Roll 0 0 0 175,000 0
318 Silk Black 3/0 100 Meter Roll 0 180 108 72 4,217 303,624
319 SoftSilk No. 2/0 Bks 0 0 0 0 3,250,000 0
320 SoftSilk No. 3/0 Bks 0 0 0 0 3,350,000 0
321 Catgut Chromic No. 1/0 Bks 0 0 0 0 1,600,000 0
322 Catgut Chromic No. 2/0 Bks 0 0 0 0 750,000 0
323 Catgut Chromic No. 3/0 Bks 0 120 72 48 7,705 369,840
324 Catgut Plain No. 0 Roll 0 0 0 1,600,000 0
325 Catgut Plain No. 2/0 (3,5) 100 M Roll 0 0 0 1,600,000 0
326 Catgut Plain No. 3/0 Roll 0 120 72 48 7,705 369,840
327 Jarum Prolene No. 1/0 Bks 0 0 0 2,100,000 0
331 Hidrogen Peroksida 3% 800 ml Botol 9 0 9 110,000 990,000
332 Halothane Liquid 250 ml Botol 0 0 0 2,500,000 0
333 Jelly ECG Tube 25 5 20 120,000 2,400,000
334 RDT Malaria Box 0 0 0 650,000 0
335 Sodalime 0 0 0 832,495 0
336 Test Golongan darah Set 0 0 0 0 0
337 Test Amphetamine Box 1 1 0 750,000 0
338 Test Malaria (Fast/Rapid Test) Box 3 0 3 750,000 2,250,000
339 Test Syphilis Box 16 4 12 880,000 10,560,000
340 Test HbsAg Box 0 0 0 0 0
341 Test HCV Box 0 0 0 0 0
342 Test HIV Box 5 1 4 2,000,000 8,000,000
343 Test Urine Botol 2 2 0 1,700,000 0
344 Xylocain jelly Tube 0 0 0 0
889,829,006
Waisai, 30 April 2016
Mengetahui
Direktur RSUD Kelas - D Penanggungjawab Farmasi
Kab. Raja Ampat
(RP) Satuan (Rp)
dr. Engelbert Wader Nahruddin Abbas, S.Si., Apt

NIP. 19710703 200212 1 006 NIP. 19800427 200801 2 025
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Pengadaan 2016 (Dinkes R4)

31 Agust '16 Page 48

Alamat : Jl. Jend. Basuki Rahmat, Disrtik Waisai Kota Kab.Raja Ampat
Laporan Persediaan Obat dan Bahan Medis Habis Pakai di Rumah Sakit Umum Daerah Kelas-D Kabupaten Raja Ampat
Periode 31 Agustus 2016
Sisa Obat Obat masuk per Mei s/d Agust 16 Obat Sisa Obat
No. JENIS PERSEDIAAN Satuan Per Pengadaan Bantuan Bantuan Bantuan Keluar Per
(RP) Satuan (Rp)
30 Apr '16 TA. 2016 30% BPJS Provinsi Dinkes R4 Per Mei - Agust 31 Agust '16
1 Acarbose/Glucobay tablet 50 mg Box, 50 Tab 8 8 0 126,000 0
2 Acetosal 500 mg Box, 100 Tab 16 16 0 21,800 0
3 Acyclovir tablet score 200 mg Box, 100 Tab 2 2 0 141,100 0
4 Acyclovir Tablet score 400 mg Box, 100 Tab 62 62 0 207,756 0
5 Box, 100 Tab 0 0 17,820 0
6 Ambroxol 30 mg Tab Box, 100 Tab 99 59 40 17,900 716,000
7 Amlodipin Tab 5 mg Box 30 Tab 0 0 34,560 0
8 Amlodipin Tab. 10 mg Box 30 Tab 0 0 13,200 0
9 Amlodipine Besylate 10 mg Box, 30 Tab 9 6 3 63,500 190,500
10 Amlodipine Besylate 10 mg Box, 50 Tab 1 1 114,264 114,264
11 Amoksisilin kaplet 500 mg Box, 100 Tab 787 302 485 28,800 13,968,000
13 Antasida Doen Tablet kunyah Box, 100 Tab 102 26 76 8,500 646,000
14 Asam Mefenamat kaplet 500 mg Box, 100 Tab 1,322 202 1,120 25,344 28,385,280
15 Asam Traneksamat tablet 500 mg Box, 100 Tab 0 0 125,400 0
16 Aspilet Box, 30 Tab 1 1 0 0
17 Bisoprolol Fumarate Box 2 2 0 0
18 Captopril Tab. 12,5 mg Box, 100 Tab 0 0 12,150 0
19 Captopril Tab.25 mg Box, 100 Tab 39 21 18 18,596 334,728
(RP) Satuan (Rp)
20 Captopril tablet 50 mg Box, 100 Tab 41 7 34 30,291 1,029,894
21 Cedocard (ISDN) Box, 60 Tab 2 2 0 0
22 Cefadroksil kaps 500 mg Box, 100 Cap 42 42 0 183,272 0
23 Cefiksim Kaplet 100 mg Box 50 tab 26 26 0 107,752 0
24 Box 30 Tab 42 42 0 10,882 0
25 Chloramfenikol kapsul 250 mg Box 100 Tab 0 0 35,978 0
26 Ciprofloxacin 500 mg Box, 100 Tab 33 23 10 27,700 277,000
27 Clindamisin Kapsul 150 mg Box 50 tab 49 8 41 68,850 2,822,850
28 Clobazam Tablet Box 50 tab 0 0 71,036 0
29 Clopidogrel Tablet 75 mg Box 30 Tab 8 8 0 119,700 0
30 Cotrimosasol tablet 480mg Box, 100 Tab 24 22 2 16,600 33,200
31 Box, 100 Tab 0 0 11,745 0
32 Digoksin Tab. 0,25 mg Box, 100 Tab 2 2 19,305 38,610
33 Diltiazem HCL TABLET 30 MG Box, 100 Tab 5 5 20,470 102,350
34 Doksisiklin kapsul 100mg Box, 100 Tab 5 5 30,000 150,000
35 Domperidone Tablet 10mg (20) Box, 100 Tab 13 13 0 108,996 0
36 Duvadilan Tablet Box 50 tab 5 5 123,625 618,125
37 Eritromisin kapsul 250 mg Box, 100 Tab 0 0 68,040 0
39 Erysanbe Chweable 200 mg Tab Box, 100 Tab 1 1 0 198,777 0
40 Etambutol tablet 500 mg Box, 100 Tab 18 5 13 77,436 1,006,668
41 Fasorbid (ISDN) Box, 100 Tab 8 8 0 0
42 Furosemide Tablet 40mg Box, 100 Tab 0 0 13,781 0
43 Glibenklamid Tablet 5mg Box, 100 Tab 16 3 13 9,720 126,360
44 Glimepirid Tablet 2 mg Box 50 tab 16 16 26,150 418,400
45 Griseofulfin Tablet 125mg Box, 100 Tab 43 3 40 32,400 1,296,000
46 Box, 100 Tab 0 0 17,100 0
(RP) Satuan (Rp)
47 Isosorbit dinitrat Tablet sublingual 5 mg Box, 100 Tab 0 0 13,142 0
48 Box 50 tab 0 0 47,791 0
49 Levofloksasina tablet 500 mg Box 50 tab 0 5 3 2 77,873 155,746
50 Loperamid Tab. 2mg Box, 100 Tab 58 8 50 12,359 617,950
51 Lovofloksasin HCL 500 mg Box, 50 Tab 5 3 2 0
52 Mebendazol tablet 100 mg Box 30 Tab 8 8 8,775 70,200
53 Meloksikam tablet 7,5 mg Box 50 tab 0 0 46,703 0
54 Metformin tablet 500mg Box, 100 Tab 0 0 24,503 0
55 Methilprednisolon 4 mg Box, 100 Tab 4 4 0 44,418 0
56 Methilprednisolone 4 mg Box, 100 Tab 5 4 1 55,069 55,069
57 Methilprednisolone 8 mg Box, 100 Tab 2 2 0 0
60 Metronidasol Tablet 500mg Box, 100 Tab 62 5 57 17,600 1,003,200
61 Molaneuron Tab Box 50 tab 0 0 124,407 0
62 Natrium Diklofenak tablet 50mg Box 50 tab 182 126 56 14,693 822,808
63 Nifedipin Tab. 10mg Box, 100 Tab 17 4 13 17,415 226,395
64 Obat Anti Malaria Box 9 tab 0 0 34,497 0
67 Omeprazole Kapsul 20mg Box 30 Cap 835 111 724 14,700 10,642,800
71 Pirantel Pamoat tablet 125 mg Box, 100 Tab 0 0 43,200 0
72 Piroksikam 20 mg Box, 100 Tab 3 3 0 9,700 0
73 Piroksikam tablet 10 mg (10) Box, 100 Tab 8 8 0 11,340 0
(RP) Satuan (Rp)
74 Primaquin Tablet 15 mg Box, 100 Tab 45 35 10 21,000
75 Propanolol Tab. 10 mg Box, 100 Tab 8 8 10,395 83,160
76 Pyrazinamide tablet 500 mg Box, 100 Tab 18 18 0 31,590 0
78 Ranitidine Tablet 150mg Box, 100 Tab 53 33 20 29,700 594,000
79 Rifampisin kapsul 300 mg Box, 100 Tab 28 5 23 64,800 1,490,400
80 Salbutamol Tab 2mg Box, 100 Tab 0 0 11,344 0
82 Scopma (Hyoscine-N-Butilbromide) 10 mg Box, 100 Tab 11 10 1 45,083 45,083
83 Simvastatin Tab 10mg Box 50 tab 19 17 2 31,200 62,400
84 Spinorolakton Box, 100 Tab 1 1 0 0
85 Tetrasiklin 250 mg Box, 100 Tab 2 2 0 2,835 0
87 Vitamin B Complex (Dus) Box, 100 Tab 184 87 97 12,200 1,183,400
89 Zink Tablet 20mg Box, 100 Tab 33 20 13 56,900 739,700
90 Aminophillin Tablet 200mg Botol 100 Tab 2 2 15,296 30,592
91 Antalgin (metampiron) tablet 500 mg Botol 1000 Tab 5 3 2 116,640 233,280
92 Bekarbon Tablet Botol 1000 Tab 0 0 84,040 0
93 Besi (II) Sulfat/ Sulfaferosus Tablet 200mg Botol 1000 Tab 40 0 40 35,410 1,416,400
94 Bikarbonat Na. tablet 500 mg Botol 1000 Tab 1 1 0 19,300 0
95 Calsium laktat (Kalk) tablet 500 mg Botol 1000 Tab 27 27 62,000 1,674,000
96 Chloramfenikol kapsul 250 mg Botol 250 Cap 0 0 89,945 0
97 Cloroquin Tablet 250 mg Botol 1000 Tab 0 0 102,000 0
98 Cotrimoksazol tablet Pediatrik Botol 100 Tab 40 40 0 9,108 0
99 CTM Botol 1000 Tab 17 7 10 28,000 280,000
(RP) Satuan (Rp)
100 Botol 1000 Tab 76 9 67 117,450 7,869,150
101 Diazepam 2 MG Botol 100 Tab 41 16 25 3,000 75,000
102 Botol 1000 Tab 8 8 109,350 874,800
103 Folic Acid Tablet 1mg Botol 100 Tab 78 2 76 9,180 697,680
104 Gliseril Guaiakolat tablet 100 mg Botol 1000 Tab 9 2 7 37,660 263,620
105 HCT (Hidro Cloro Tiazid) Tablet 25mg Botol 1000 Tab 1 1 0 49,000 0
106 Isoniazid tablet 300 mg Botol 1000 Tab 0 0 130,950 0
107 Natrium Fenitoin kapsul 100 mg Botol 100 Tab 15 15 0 32,480 0
108 Papaverin tablet 40 mg Botol 1000 Tab 3 3 134,420 403,260
109 Phenobarbital 30mg Botol 100 Tab 58 58 5,580 323,640
110 Piridoksin (vitamin B6) tablet 10 mg Botol 1000 Tab 1 1 0 23,490 0
111 Botol 1000 Tab 103 8 95 84,370 8,015,150
112 Propiltiourasil (PTU) Tablet 100mg Botol 100 Tab 8 8 40,442 323,536
113 Quinine Tablet 222mg Botol 1000 Tab 2 2 610,290 1,220,580
114 Sianokobalamin (B12) Tablet 50 mcg Botol 1000 Tab 6 6 0 17,680 0
115 Vitamin A 200.000 UI Botol 50 Caap 0 34,000 0
116 Amoksisilin sirup kering 125 mg/ 5 ml Botol 220 216 4 4,995 19,980
117 Ampisillin sirup 125mg /5ml Botol 120 120 0 5,940 0
118 Ambroxol Syrup 60 ml Botol 500 95 405 7,480 3,029,400
120 Cefadroksil sirup kering 125 mg/5 ml Botol 100 250 175 175 18,000 3,150,000
122 Domperidone Suspensi 5mg/5ml Botol 0 0 17,078 0
123 Erysanbe Syrup 60 ml Botol 0 0 27,280 0
124 Parasetamol drops 15 ml Botol 348 85 263 6,240 1,641,120
125 Paracetamol syrup 60 ml Botol 930 373 557 2,474 1,378,018
(RP) Satuan (Rp)
D SALEP / OBAT LUAR
126 Acyclovir Cream 5% Tube 5 Gr Tube 12 12 0 4,253 0
127 Alkohol 70% 1000 ml Botol 38 27 11 75,000 825,000
128 Antihemoroid suppo sitoria Supp 42 24 18 2,700 48,600
129 Bedak Salisil Serbuk 2% kotak 50gr Kotak 0 0 1,931 0
130 Betametason Cream 0,1% Tube 149 149 0 2,520 0
131 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 187 104 83 2,110 175,130
132 Chloramfenikol TT 3% 5 ml Botol 57 57 0 2,111 0
133 Dulcolax Suppo 10 mg Supp 0 0 22,000 0
135 Gentian Violet Pot 0 0 776 0
136 Ketokonasol Cream 2% 15 gram Tube 0 0 9,450 0
137 Levertraan Zalf Pot 156 156 0 150 0
139 Povidon Iodida (yodium) 10% 1000 m Botol 54 96 59 91 110,000 10,010,000
E INJEKSI
140 Aminophillin Injeksi 24mg/ml Ampul 171 171 4,050 692,550
141 Ampisilin inj i.m./i.v.1000 mg Vial 0 0 9,267 0
142 Anesfar Inj 1 mg/ml (Midazolam) Ampul 75 45 30 21,249 637,470
143 Anti Bisa Ular (Polyvalent) Vial 0 0 30,000 0
144 Anti Tetanus Serum Ampul 30 1 29 127,409 3,694,861
145 Antrain Injeksi Ampul 0 0 11,515 0
146 Artemeter Inj 80 mg/ml Ampul 972 90 492 570 26,600 15,162,000
147 Artesunat injeksi Vial 48 888 664 272 30,720 8,355,840
148 Asam Traneksamat injeksi 500 mg/ml Ampul 0 0 6,400 0
149 Atropin sulphat injeksi 0,25mg/ml Ampul 0 0 1,708 0
150 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 0 0 79,510 0
(RP) Satuan (Rp)
151 Cedocard Injeksi 5 5 0 0
152 Chinin Antipyrin Injeksi Ampul 0 0 1,000 0
153 Chlorpromazin Injeksi 25mg/ml Ampul 0 0 2,590 0
154 Citicolin Injeksi Ampul 0 0 25,000 0
155 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 0 0 1,400 0
156 Deksametason injeksi i.v. 5 mg/ml Ampul 4,400 800 3,600 2,700 9,720,000
157 Dellamidon injeksi (Benodon) Vial 15 15 0 17,500 0
158 Dellladryl injeksi (Recodryl) Vial 7 7 0 16,000 0
160 Digoksin Injeksi Ampul 15 5 10 256,700 2,567,000
161 Diphenhydramine injeksi Ampul 0 0 1,296 0
162 Dobutamin Giulini Ampul 25 10 4 31 344,000 10,664,000
163 Dopamin Injeksi Ampul 0 0 99,329 0
164 Duvadilan injeksi Ampul 0 0 25,084 0
166 Farbion 5000 injeksi Ampul 0 0 7,088 0
167 Fenitoin Injeksi Ampul 8 8 42,223 337,784
168 Fentanil Injeksi Ampul 37 13 24 254,355 6,104,520
169 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 210 210 0 4,100 0
170 Furosemide Injeksi10 mg/ml Ampul 0 0 2,782 0
171 Gentamisin Injeksi 80mg/2ml Ampul 0 0 4,990 0
172 Hyoscine-N-Butilbromide Injeksi Ampul 0 0 62,700 0
173 Kalsium Glukonat Injeksi 10% Ampul 24 24 15,625 375,000
174 Ketamine-Hameln injeksi 50 mg/ml Vial 0 0 125,898 0
175 Ketoprofen Injeksi 100 mg Ampul 0 0 1,254 0
176 Ampul 1,680 1,584 96 2,799 268,704
177 Lidokain injeksi 2% 2 ml Ampul 1,192 392 800 1,364 1,091,200
(RP) Satuan (Rp)
178 Meropenem Inj 1 gr Vial 6 6 0 329,010 0
179 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 0 0 1,800 0
180 Methilprednisolon Injeksi Ampul 30 30 0
181 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 0 0 2,093 0
182 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0 0 15,578 0
183 Nicardipine Hcl Ampul 10 1 9 1,001,000 9,009,000
184 Nourobion Injeksi Pasang 40 20 20 0
185 Oksitosin Injeksi 10 IU/ml Ampul 0 600 100 500 3,338 1,669,000
186 Omeprazole Injeksi 40mg/10ml Vial 0 20 5 15 110,000 1,650,000
187 Ondansentron Injeksi 2mg/2 ml Ampul 1,200 590 610 2,700 1,647,000
188 Papaverin injeksi 40 mg/ml Ampul 0 0 1,595 0
189 Pehacain Injeksi Ampul 0 0 3,114 0
190 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 50 50 17,400 870,000
191 Propofol/Proanes Injeksi Ampul 0 0 97,743 0
192 Quinin HCL Injeksi IV 25% Ampul 0 0 4,854 0
193 Ranitidine Injeksi 25mg/2ml (10) Ampul 3,350 2,200 1,150 8,674 9,975,100
194 Roculax 10 mg/ml Ampul 0 0 281,030 0
195 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0 0 12,400 0
196 Vial 0 8 1,520 1,058 470 10,364 4,871,080
197 Seftazidim injeksi 1000 mg/vial Vial 100 100 0 50,634 0
198 Seftriakson injeksi 1 gram Vial 595 595 0 11,602 0
199 Streptomisin Serbuk injeksi 1500mg/vial Vial 500 100 400 5,175 2,070,000
200 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 630 480 150 1,377 206,550
201 Tramadol Injeksi 50 mg/ml Ampul 0 0 8,643 0
202 Vascom Injeksi Ampul 10 9 1 623,350 623,350
203 Vitamin C Injeksi Ampul 0 0 27,806 0
F CAIRAN DAN INFUS
(RP) Satuan (Rp)
204 Aqua Pro Injeksi Botol 2,306 1,100 16 907 2,515 6,937 17,446,555
205 Glukosa 10% larutan infus 500 ml Botol 40 40 0 2,110 0
206 Glukosa 10%-1/5 NS Botol 40 40 0 9,240 0
207 Glukosa 40% Botol 25ml Botol 0 0 10,857 0
209 Glukosa 5%-NS 500 ml Botol 40 40 9,240 369,600
210 Glukosa 5% - 1/2 NS 500 ml Botol 1,981 342 167 2,156 9,240 19,921,440
211 Glukosa 5% - 1/4 NS 500 ml Botol 1,900 376 159 2,117 9,240 19,561,080
212 KAEN 1 B Larutan Infus 500 ml Botol 57 62 54 65 24,196 1,572,740
213 KAEN 3 B Larutan Infus 500 ml Botol 0 0 27,897 0
214 Kaen 3A cairan infus 500 ml Botol 0 0 26,047 0
215 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 25 25 45,000 1,125,000
216 Lartan infus asering 500 ml Botol 0 0 22,000 0
217 Larutan Infus Manitol 20%, 500 ml Botol 40 40 0 125,000 0
218 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 208 208 0 44,117 0
219 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 21 21 10,857 227,997
220 MgSO4 ( Magesium sulfat 40% - 25 ml ) Botol 0 0 0 0
221 NaCl 0,9% cairan infus 500 ml Botol 1,361 1,001 360 8,273 2,978,280
222 Ringer Laktat larutan infus 500 ml Botol 126 126 0 6,240 0
223 Sanbehest 500 ml Botol 20 20 254,160 5,083,200
224 Sanmol Infus (Paracetamol) Botol 0 185 185 0 75,672 0
225 Sifrofloksasin infus 2mg/ml, 100 ml Botol 0 10 4 6 85,244 511,464
226 Sevoflurane Liquid Botol 0 0 3,684,260 0
227 Larutan Martos 10% 500 ml Botol 46 46 0 9,246 0
G BAHAN HABIS PAKAI
228 3 Way Stopcock Picis 0 13,803 0
(RP) Satuan (Rp)
230 Abbocath No 18 Picis 865 100 715 250 25,361 6,340,250
231 Abbocath No 20 Picis 0 500 500 0 25,361 0
234 Abbocath no. 26 Merk Venysistem Picis 160 108 52 25,361 1,318,772
235 Collor Neck Picis 4 3 3 4 218,904 875,616
236 Cord Clamps (Penjepit Tali Pusar) Picis 3,000 3,000 1,683 5,049,000
241 Disposible Syringes 5 CC Picis 7,270 12,300 2,370 17,200 7,677 132,044,400
243 Elastis Perban 10 cm x 4,5 m Roll 0 0 45,000 0
244 Elastis Perban Putih 6" Roll 0 0 65,428 0
245 Endotracheal Tube ( ETT ) No. 2,5 Tube 10 10 104,954 1,049,540
246 Endotracheal Tube ( ETT ) No. 3 tube 10 10 104,954 1,049,540
248 Endotracheal Tube ( ETT ) No. 4 Tube 17 17 104,954 1,784,218
251 Endotracheal Tube ( ETT ) No. 5,5 Tube 1 5 6 104,954 629,724
253 Endotracheal Tube ( ETT ) No. 6,5 tube 3 5 8 104,954 839,632
255 Endotracheal Tube ( ETT ) No.7,5 tube 2 5 7 104,954 734,678
256 Endotracheal Tube ( ETT ) No.8 Tube 0 5 5 104,954 524,770
257 Etil Clorida Spray Botol 20 18 2 127,000 254,000
(RP) Satuan (Rp)
258 ETT Non King No. 5 Tube 1 1 0
259 ETT Non King No. 6,5 Tube 1 1 0
260 ETT Non King No. 7 1 1 0
261 ETT Non King No. 7,5 Tube 1 1 0
262 ETT Tanpa Cup No. 2,5 tube 16 16 22,500 360,000
263 ETT Tanpa Cup No. 3 tube 10 10 22,500 225,000
265 ETT Tanpa Cup No. 4 Tube 10 10 22,500 225,000
267 Folley cateter (2 way) No. 12 Picis 48 48 28,041 1,345,968
268 Folley cateter (2 way) No. 14 Picis 30 30 28,041 841,230
269 Folley cateter (2 way) No. 18 Picis 70 50 70 50 12,500 625,000
273 Folley cateter (2 way) No. 3 Picis 0 0 27,500 0
274 Folley cateter (2 way) No. 3,5 Picis 0 0 27,500 0
277 Folley cateter (2 way) No.16 Picis 0 30 30 12,000 360,000
280 Gliserin botol 100ml Botol 16 16 0 6,386 0
281 Guedel Airway 40 mm Picis 0 0 10,000 0
283 Gypsona 6" Roll 0 0 62,320 0
284 Handscoon Panjang (Obgyn) Pasang 0 0 55,000 0
285 Handscoon Sensigloves L Pasang 4,000 4,000 0 1,804 0
(RP) Satuan (Rp)
286 Handscoon Sensigloves M Pasang 1,000 1,000 2,000 0 1,804 0
287 Handscoon Sensigloves S Pasang 0 250 250 0 0
288 Handscoon Steril No. 6,5 Pasang 200 100 250 50 7,000 350,000
289 Handscoon Steril No. 7 Pasang 10 500 360 150 7,000 1,050,000
290 Handscoon Steril No. 7,5 Pasang 200 500 400 300 7,000 2,100,000
291 Handscoon Steril No. 8 Pasang 0 200 200 7,000 1,400,000
292 Hipafix 10 cm x 5 M Roll 0 0 350,000 0
293 Infuset Makro Set 1,134 619 515 4,416 2,274,240
294 Infuset Mikro Picis 1,249 509 740 4,830 3,574,200
295 Kapas Pembalut 100 g Roll 0 0 7,000 0
297 Kapas Pembalut 250 g Roll 96 68 28 15,000 420,000
298 Kasa Hidrofil 16 x 16 cm Bks 0 0 7,727 0
299 Kasa Hidrofil 40 x 40 cm Bungkus 0 0 500 0
300 Kasa Hidrofil 40 Yard x 80 cm Rol 47 5 10 60 2 144,900 289,800
301 Kertas EKG Picis 0 0 24,000 0
303 Kertas USG Picis 0 0 320,000 0
304 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 0 0 2,630 0
305 LMA Supreme No. 3 Pcs 1 1 477,972 477,972
308 LMA Unique No. 1 Pcs 1 1 275,876 275,876
309 LMA Unique No. 1,5 Pcs 1 1 275,876 275,876
310 LMA Unique No. 2 Pcs 1 1 275,876 275,876
311 LMA Unique No. 2,5 Pcs 1 1 275,876 275,876
312 Masker ear loop box (50 picis) 200 21 179 22,000 3,938,000
(RP) Satuan (Rp)
313 Masker tie on box (50 picis) 200 38 69 169 22,500 3,802,500
314 Needle No. 22 Picis 0 0 200 0
315 Needle No. 24 Picis 0 0 200 0
316 Needle No. 26 Picis 0 0 200 0
318 NGT (Maag Slang) No. 16 Picis 45 40 5 29,500 147,500
320 NGT (Maag Slang) No. 3 Picis 0 0 29,500 0
321 NGT (Maag Slang) No. 3,5 Picis 0 0 29,500 0
324 Penflon No. 18 Picis 500 500 12,078 6,039,000
325 Penflon No. 20 Picis 500 500 12,078 6,039,000
326 Penflon No. 22 Picis 1,000 1,000 12,078 12,078,000
327 Penflon No. 24 Picis 1,000 1,000 12,078 12,078,000
328 Penflon No. 26 Picis 200 200 13,458 2,691,600
329 Plester 5 Yard x 2 Inci Roll 24 95 96 23 28,000 644,000
330 Plester Luka Steril ( Chloro Tulle) Lembar 0 0 34,400 0
331 Poli Creepe 4" Roll 0 0 129,992 0
332 Poli Creepe 6 " Roll 0 0 171,084 0
333 Rectal Tube No. 30 Picis 10 10 20,000 200,000
334 Selang Oksigen Anak Picis 0 100 8 92 12,000 1,104,000
335 Selang Oksigen Bayi Picis 0 100 27 73 13,200 963,600
336 Selang Oksigen Dewasa Picis 17 100 67 50 12,000 600,000
337 Sofratulle Box 2 2 0 0
338 Softband 3" Pcs 0 0 75,000 0
339 Softband 6" Roll 0 0 56,081 0
(RP) Satuan (Rp)
340 Spinocan injeksi No. 26 Picis 25 10 15 50,000 750,000
341 Spinocan injeksi No. 27 Picis 100 100 60,319 6,031,900
342 Suction Catheter No. 10 Picis 0 0 15,000 0
346 Transfusi Darah Set Picis 0 500 224 175 549 13,000 7,137,000
347 Underpad Picis 20 10 30 0 5,745 0
348 Urine Bag 2000 ml Bag 135 80 55 74,800 4,114,000
349 Surgical Blades (Bisturi) Picis 945 185 760 1,100 836,000
350 Jarum Hecting Kulit No.10 Lusin 0 0 175,000 0
355 Jarum Hecting Otot No.11 Lusin 0 0 175,000 0
356 Silk Black 2/0 100 Meter Roll 0 0 175,000 0
357 Silk Black 3/0 100 Meter Roll 72 72 0 4,217 0
358 SoftSilk No. 2/0 Bks 0 0 3,250,000 0
359 SoftSilk No. 3/0 Bks 0 180 180 0 3,350,000 0
360 Catgut Chromic No. 1/0 Bks 0 0 1,600,000 0
361 Catgut Chromic No. 2/0 Bks 0 0 750,000 0
362 Catgut Chromic No. 3/0 Bks 48 120 168 0 7,705 0
363 Catgut Plain No. 0 Roll 0 0 1,600,000 0
364 Catgut Plain No. 2/0 (3,5) 100 M Roll 0 0 1,600,000 0
365 Catgut Plain No. 3/0 Roll 48 48 0 7,705 0
(RP) Satuan (Rp)
366 Jarum Prolene No. 1/0 Bks 0 0 2,100,000 0
370 Hidrogen Peroksida 3% 800 ml Botol 9 9 0 110,000 0
371 Halothane Liquid 250 ml Botol 0 0 2,500,000 0
372 Jelly ECG Tube 20 20 0 120,000 0
373 RDT Malaria Box 0 0 650,000 0
374 Sodalime 0 0 832,495 0
375 Test Golongan darah Set 0 0 0 0
376 Test Amphetamine Box 0 0 750,000 0
377 Test Malaria (Fast/Rapid Test) Box 3 3 0 750,000 0
378 Test Syphilis Box 12 12 0 880,000 0
379 Test HbsAg Box 0 0 0 0
380 Test HCV Box 0 0 0 0
381 Test HIV Box 4 4 0 2,000,000 0
382 Test Urine Botol 0 0 1,700,000 0
758,537,196
Waisai, 31 Agustus 2016

Mengetahui
Direktur RSUD Kelas - D Penanggungjawab Gudang Obat
Kab. Raja Ampat
(RP) Satuan (Rp)
Ferdinand Rumsowek, SKM. M.Kes Nahruddin Abbas, S.Si., Apt

NIP. 19700204 1993021 002 NIP. 19800427 200801 2 025
Pada hari ini, Tanggal 31 bulan Desember tahun Dua ribu enam belas, kami melakukan stock opname Obat dan Bahan Medis habis pakai di Rumah Sakit Umum Daerah Raja Ampat,
dengan rincian sebagai berikut :
Obat masuk per Agust s/d Des 16

Sisa Obat Obat Keluar Sisa Obat
Harga Satuan
No. JENIS PERSEDIAAN Satuan per 31 Pengadaan Bantuan Bantuan Bantuan Per Agust- Per 31 des
Agust '16 (RP)
Des '16 '16
TA. 2016 30% BPJS green komodo Dinkes R4
1 Acarbose/Glucobay tablet 50 mg Box, 50 Tab 0 0 126,000
2 Acetosal 500 mg Box, 100 Tab 0 0 21,800
3 Acyclovir tablet score 200 mg Box, 100 Tab 0 0 141,100
4 Allopurinol tablet 300 mg Box, 100 Tab 0 6 5 1 207,756
5 Box, 100 Tab 0 46 24 22 17,820
6 Ambroxol 30 mg Tab Box, 100 Tab 40 40 0 17,900
7 Amlodipin Tab 5 mg Box 30 Tab 0 0 34,560
8 Amlodipin Tab. 10 mg Box 30 Tab 0 10 10 0 13,200
9 Amoksisilin kaplet 500 mg Box, 100 Tab 485 2,000 143 2,342 28,800
10 Ampisillin kaplet 500mg Box, 100 Tab 81 30 51 51,435
11 Antasida Doen Tablet kunyah Box, 100 Tab 76 500 31 545 8,500
12 Asam Mefenamat kaplet 500 mg Box, 100 Tab 1,120 50 171 999 25,344
13 Asam Traneksamat tablet 500 mg Box, 100 Tab 0 0 125,400
14 Aspilet Box, 30 Tab 0 7 6 1 72,875
15 Bisoprolol Fumarate Box 0 0
16 Captopril Tab. 12,5 mg Box, 100 Tab 0 120 17 103 12,150
17 Captopril Tab.25 mg Box, 100 Tab 0 0 18,596
18 Captopril tablet 50 mg Box, 100 Tab 34 20 14 30,291
19 Cedocard (ISDN) Box, 60 Tab 0 0
20 Cefadroksil kaps 500 mg Box, 100 Cap 0 25 25 0 183,272
01+02431 Desember 2016 64

Harga Satuan
Agust '16 (RP)
Des '16 '16
21 Cefiksim Kaplet 100 mg Box 50 tab 0 10 10 0 107,752
22 Box 30 Tab 0 30 30 0 10,882
23 Chloramfenikol kapsul 250 mg Box 100 Tab 0 0 35,978
24 Ciprofloxacin 500 mg Box, 100 Tab 10 10 500 136 384 27,700
25 Clindamisin Kapsul 150 mg Box 50 tab 41 41 0 68,850
26 Clobazam Tablet Box 50 tab 0 0 71,036
27 Clopidogrel Tablet 75 mg Box 30 Tab 8 5 3 119,700
28 Cotrimosasol tablet 480mg Box, 100 Tab 2 400 22 380 16,600
29 Box, 100 Tab 0 100 23 77 11,745
30 Digoksin Tab. 0,25 mg Box, 100 Tab 2 2 0 19,305
31 Diltiazem HCL TABLET 30 MG Box, 100 Tab 5 5 20,470
32 Doksisiklin kapsul 100mg Box, 100 Tab 5 100 5 100 30,000
33 Domperidone Tablet 10mg (20) Box, 100 Tab 0 100 100 108,996
34 Duvadilan Tablet Box 50 tab 5 5 123,625
35 Eritromisin kapsul 250 mg Box, 100 Tab 0 0 68,040
36 Eritromisin Tablet 500 mg Box, 100 Tab 21 7 14 111,600
37 Erysanbe Chweable 200 mg Tab Box, 100 Tab 0 0 198,777
38 Etambutol tablet 500 mg Box, 100 Tab 13 2 11 77,436
39 Farsiven Box, 100 Tab 50 38 12 77,436
40 Fasorbid (ISDN) Box, 100 Tab 0 10 2 8 58,400
41 Furosemide Tablet 40mg Box, 100 Tab 0 0 13,781
42 Glibenklamid Tablet 5mg Box, 100 Tab 13 2 11 9,720
43 Glimepirid Tablet 2 mg Box 50 tab 16 16 26,150
44 Griseofulfin Tablet 125mg Box, 100 Tab 40 3 37 32,400
45 Box, 100 Tab 0 396 396 17,100
46 Isosorbit dinitrat Tablet sublingual 5 mg Box, 100 Tab 0 0 13,142
47 Box 50 tab 0 0 47,791
48 Levofloksasina tablet 500 mg Box 50 tab 2 63 2 63 77,873
01+02431 Desember 2016 65

Harga Satuan
Agust '16 (RP)
Des '16 '16
49 Loperamid Tab. 2mg Box, 100 Tab 50 1 49 12,359
50 Mebendazol tablet 100 mg Box 30 Tab 8 8 8,775
51 Meloksikam tablet 7,5 mg Box 50 tab 0 0 46,703
52 Metformin tablet 500mg Box, 100 Tab 2 1 1 24,503
53 Methilprednisolone 4 mg Box, 100 Tab 1 7 40 35 13 55,069
54 Methilprednisolone 8 mg Box, 100 Tab 0 0
55 Metilegometrin Tablet 0,125mg Box, 100 Tab 34 8 26 18,500
56 Metoclopramide tablet 10mg Box, 100 Tab 59 28 31 13,094
57 Metronidasol Tablet 500mg Box, 100 Tab 57 200 5 252 17,600
58 Molaneuron Tab Box 50 tab 0 0 124,407
59 Natrium Diklofenak tablet 50mg Box 50 tab 56 56 0 14,693
60 Nifedipin Tab. 10mg Box, 100 Tab 13 10 3 17,415
61 Obat Anti Malaria Box 9 tab 0 2,000 137 1,863 34,497
62 Ofloksasin tablet 200mg Box 50 tab 4 4 0 39,832
63 Ofloksasin tablet 400mg Box 50 tab 7 7 0 58,928
64 Omeprazole Kapsul 20mg Box 30 Cap 724 388 11 1,101 14,700
65 Ondansentron 4 mg Box 30 Tab 68 12 56 32,700
66 Oralit Sachet 100gr Box 100 Sach 39 60 11 88 34,600
67 Parasetamol tablet 500 mg Box, 100 Tab 1,796 1,000 153 2,643 9,600
68 Pirantel Pamoat tablet 125 mg Box, 100 Tab 0 0 43,200
69 Piroksikam 20 mg Box, 100 Tab 0 0 9,700
70 Piroksikam tablet 10 mg (10) Box, 100 Tab 0 0 11,340
71 Primaquin Tablet 15 mg Box, 100 Tab 10 972 35 947 21,000
72 Propanolol Tab. 10 mg Box, 100 Tab 8 8 10,395
73 Pyrazinamide tablet 500 mg Box, 100 Tab 0 0 31,590
74 Quinine Tablet 222mg Box 60 tab 64 26 38 48,240
75 Ranitidine Tablet 150mg Box, 100 Tab 20 200 54 166 29,700
76 Rifampisin kapsul 300 mg Box, 100 Tab 23 23 64,800
01+02431 Desember 2016 66

Harga Satuan
Agust '16 (RP)
Des '16 '16
77 Salbutamol Tab 2mg Box, 100 Tab 0 23 100 24 99 11,344
78 Salbutamol Tab 4mg Box, 100 Tab 0 7 6 1 11,344
79 Scopma (Hyoscine-N-Butilbromide) 10 mg Box, 100 Tab 1 1 0 45,083
80 Simvastatin Tab 10mg Box 50 tab 2 2 31,200
81 Spinorolakton Box, 100 Tab 0 2 1 1 46,760
82 Tetrasiklin 250 mg Box, 100 Tab 0 0 2,835
83 Tetrasiklin 500 mg Box, 100 Tab 15 2 13 34,695
84 Vitamin B Complex (Dus) Box, 100 Tab 97 78 19 12,200
85 Vitamin B12 Box, 100 Tab 0 500 20 480 1,900
86 Vitamin B6 Box, 100 Tab 0 500 500 18,500
87 Vitamin C 50 mg (Dus) Box, 100 Tab 113 91 500 13 691 11,400
88 Zink Tablet 20mg Box, 100 Tab 13 13 0 56,900
89 Aminophillin Tablet 200mg Botol 100 Tab 2 200 3 199 15,296
90 Antalgin (metampiron) tablet 500 mg Botol 1000 Tab 2 1 1 116,640
91 Bekarbon Tablet Botol 1000 Tab 0 0 84,040
92 Besi (II) Sulfat/ Sulfaferosus Tablet 200mg Botol 1000 Tab 40 0 40 35,410
93 Bikarbonat Na. tablet 500 mg Botol 1000 Tab 0 0 19,300
94 Calsium laktat (Kalk) tablet 500 mg Botol 1000 Tab 27 27 62,000
95 Chloramfenikol kapsul 250 mg Botol 250 Cap 0 0 89,945
96 Cloroquin Tablet 250 mg Botol 1000 Tab 0 0 102,000
97 Cotrimoksazol tablet Pediatrik Botol 100 Tab 0 0 9,108
98 CTM Botol 1000 Tab 10 50 9 51 28,000
99 Botol 1000 Tab 8 1 7 117,450
100 Diazepam 2 MG Botol 100 Tab 25 9 16 3,000
101 Botol 1000 Tab 8 1 7 109,350
102 Folic Acid Tablet 1mg Botol 100 Tab 76 76 9,180
103 Gliseril Guaiakolat tablet 100 mg Botol 1000 Tab 7 7 0 37,660
01+02431 Desember 2016 67

Harga Satuan
Agust '16 (RP)
Des '16 '16
104 HCT (Hidro Cloro Tiazid) Tablet 25mg Botol 1000 Tab 1 1 49,000
105 Isoniazid tablet 300 mg Botol 1000 Tab 0 0 130,950
106 Natrium Fenitoin kapsul 100 mg Botol 100 Tab 0 0 32,480
107 Papaverin tablet 40 mg Botol 1000 Tab 3 1 2 134,420
108 Phenobarbital 30mg Botol 100 Tab 58 3 55 5,580
109 Phytomenadion Tablet Botol 100 Tab 20 20 91,884
110 Piridoksin (vitamin B6) tablet 10 mg Botol 1000 Tab 0 0 23,490
111 Botol 1000 Tab 95 50 6 139 84,370
112 Propiltiourasil (PTU) Tablet 100mg Botol 100 Tab 8 8 40,442
113 Quinine Tablet 222mg Botol 1000 Tab 2 2 610,290
114 Sianokobalamin (B12) Tablet 50 mcg Botol 1000 Tab 0 0 17,680
115 Vitamin A 200.000 UI Botol 50 Caap 0 0 34,000
116 Ambroxol Syrup 60 ml Botol 405 205 200 7,480
117 Amoksisilin sirup kering 125 mg/ 5 ml Botol 4 5,100 104 5,000 4,995
118 Ampisillin sirup 125mg /5ml Botol 0 0 5,940
119 Antasida Suspensi Botol 60ml Botol 1,213 1,000 281 1,932 2,409
120 Cefadroksil sirup kering 125 mg/5 ml Botol 175 110 245 40 18,000
121 Cotrimoksazol Suspensi 240 mg Botol 683 162 521 2,590
122 Domperidone Suspensi 5mg/5ml Botol 0 1,000 1,000 17,078
123 Eritromisin suspensi 200 mg Botol 600 61 539 10,935
124 Erysanbe Syrup 60 ml Botol 0 0 27,280
125 Molapect Syrup (Ambroxol) 0 60 13 47 16,638
126 Paracetamol syrup 60 ml Botol 557 3,000 457 3,100 2,474
127 Parasetamol drops 15 ml Botol 263 108 155 6,240
128 Zink Syrup Botol 240 58 182 40,333
D SALEP / OBAT LUAR
126 Acyclovir Cream 5% Tube 5 Gr Tube 0 0 4,253
01+02431 Desember 2016 68

Harga Satuan
Agust '16 (RP)
Des '16 '16
127 Alkohol 70% 1000 ml Botol 11 400 25 386 75,000
128 Antihemoroid suppo sitoria Supp 18 6 12 2,700
129 Bedak Salisil Serbuk 2% Kotak 0 100 100 1,931
130 Betametason Cream 0,1% Tube 0 0 2,520
131 Burnazin Salf Tube 25 25 56,250
132 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 83 83 0 2,110
133 Chloramfenikol TT 3% 5 ml Botol 57 27 30 2,111
134 Dulcolax Suppo 10 mg Supp 0 0 22,000
135 Dulcolax Suppo 5 mg Supp 0 0 16,417
136 Gentian Violet Pot 0 0 776
137 Hidrocortison salf Tube 528 528 4,050
138 Ketokonasol Cream 2% 15 gram Tube 0 0 9,450
139 Levertraan Zalf Pot 0 0 150
140 Miconazole Krim/Salep 2% Tube 10gr 1,272 1,272 3,600
141 One Scrub Botol 500 ml 504 39 465 126,750
142 Povidon Iodida (yodium) 10% 1000 m Botol 91 57 34 110,000
143 Suprafenid supp 100 mg ( Ketoprofen ) Suppositoria 0 15 4,000 540 3,475 12,500
E INJEKSI
144 Aminophillin Injeksi 24mg/ml Ampul 171 48 3,142 201 3,160 4,050
145 Amiodaron HCL 50mg/ml Ampul 12 8 4 20,077
146 Ampisilin inj i.m./i.v.1000 mg Vial 0 1,000 60 940 9,267
147 Anesfar Inj 1 mg/ml (Midazolam) Ampul 30 10 20 21,249
148 Anti Bisa Ular (Polyvalent) Vial 0 0 30,000
149 Anti Tetanus Serum Ampul 29 2 27 127,409
150 Antrain Injeksi Ampul 0 0 11,515
151 Artemeter Inj 80 mg/ml Ampul 570 360 210 26,600
152 Artesunat injeksi Vial 272 2,000 432 1,840 30,720
153 Asam Traneksamat injeksi 500 mg/ml Ampul 0 1,200 740 460 10,000
01+02431 Desember 2016 69

Harga Satuan
Agust '16 (RP)
Des '16 '16
154 Atropin sulphat injeksi 0,25mg/ml Ampul 0 400 300 100 3,750
155 Bricasma Ampul 10 10 32,058
156 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 0 28 8 20 79,510
157 Cedocard Injeksi Ampul 0 0
158 Chinin Antipyrin Injeksi Ampul 0 0 1,000
159 Chlorpromazin Injeksi 25mg/ml Ampul 0 0 2,590
160 Citicolin Injeksi Ampul 0 0 25,000
161 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 0 9,600 9,600 1,400
162 Deksametason injeksi i.v. 5 mg/ml Ampul 3,600 1,500 2,100 2,700
163 Dellamidon injeksi (Benodon) Vial 0 0 17,500
164 Dellladryl injeksi (Recodryl) Vial 0 0 16,000
165 Diazepam Injeksi Ampul 60 10 50 2,584
166 Digoksin Injeksi Ampul 10 5 5 256,700
167 Diphenhydramine injeksi Ampul 0 1,200 1,200 1,296
168 Dobutamin Giulini Ampul 31 25 10 46 344,000
169 Dopamin Injeksi Ampul 5 10 15 75,000
170 Duvadilan injeksi Ampul 0 0 25,084
171 Epedrin Ampul 100 60 40 34,375
Epinefrin (Adrenalin) inj 0,1 % (sebagai HCl) Ampul 111 100 39 70 180 13,750
172
173 Farbion 5000 injeksi Ampul 0 0 7,088
174 Fenitoin Injeksi Ampul 8 200 8 200 42,223
175 Fentanil Injeksi Ampul 24 200 90 134 81,250
176 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 0 100 300 300 100 3,750
177 Furosemide Injeksi10 mg/ml Ampul 0 0 2,782
178 Gentamisin Injeksi 80mg/2ml Ampul 0 0 4,990
179 Hyoscine-N-Butilbromide Injeksi Ampul 0 0 62,700
180 Isofluran 250 ml Ampul 2 2 875,000
181 Kalsium Glukonat Injeksi 10% Ampul 24 24 15,625
01+02431 Desember 2016 70

Harga Satuan
Agust '16 (RP)
Des '16 '16
182 Ketamine-Hameln injeksi 50 mg/ml Vial 0 0 125,898
183 Ketoprofen Injeksi 100 mg Ampul 0 0 1,254
184 Ampul 96 180 36 312 0 2,799
185 Lasix Inj Ampul 25 25 23,750
186 Lidokain injeksi 2% 2 ml Ampul 800 5,000 1,005 4,795 1,364
187 Meropenem Inj 1 gr Vial 0 0 329,010
188 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 0 0 1,800
189 Methilergometrin Ampul 5,000 5,000 5,687
191 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 0 0 2,093
192 Myomergin (Methylergometrin) 200 9,375 2,094
193 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0 0 15,578
194 Nicardipine Hcl Ampul 9 9 0 1,001,000
195 Nokoba Ampul 5 5 0
196 Nourobion Injeksi Pasang 20 20 0
197 Oksitosin Injeksi 10 IU/ml Ampul 500 10,000 700 9,800 3,338
198 Omeprazole Injeksi 40mg/10ml Vial 15 15 0 47,500
199 Ondansentron Injeksi 2mg/2 ml Ampul 610 610 0 2,700
200 Papaverin injeksi 40 mg/ml Ampul 0 0 1,595
201 Pehacain Injeksi Ampul 0 0 3,114
202 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 50 10 40 17,400
203 Propofol/Proanes Injeksi Ampul 100 65 35 97,743
204 Prostigmin Ampul 250 50 200 25,820
205 Quinin HCL Injeksi IV 25% Ampul 0 0 4,854
206 Ranitidine Injeksi 25mg/2ml (10) Ampul 1,150 1,150 0 8,674
207 Recofol Ampul 80 80 89,375
208 Roculax 10 mg/ml Ampul 0 0 281,030
209 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0 0 12,400
01+02431 Desember 2016 71

Harga Satuan
Agust '16 (RP)
Des '16 '16
210 Vial 470 450 920 0 10,364
211 Sefoulurane 250 ml Ampul 2 2 1,125,000
212 Seftazidim injeksi 1000 mg/vial Vial 0 0 50,634
213 Seftriakson injeksi 1 gram Vial 0 1,300 660 640 11,602
214 Streptomisin Serbuk injeksi 1500mg/vial Vial 400 300 100 5,175
215 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 150 150 0 1,377
216 Tramadol Injeksi 50 mg/ml Ampul 0 0 6,875
217 Vascom Injeksi (Norephinefrin) Ampul 1 1 623,350
218 Vitamin C Injeksi Ampul 0 0 10,625
F CAIRAN DAN INFUS
219 Aqua Pro Injeksi Botol 2,515 6,000 2,221 6,294 2,750
220 Glukosa 10% larutan infus 500 ml Botol 0 1,020 60 960 12,000
221 Glukosa 10%-1/5 NS Botol 0 0 9,240
222 Glukosa 40% Botol 25ml Botol 0 0 10,857
223 Glukosa 5% - 1/2 NS 500 ml Botol 2,156 8,000 166 9,990 14,000
224 Glukosa 5% - 1/4 NS 500 ml Botol 2,117 8,000 159 9,958 14,000
225 Glukosa 5% larutan infus 500 ml Botol 1,153 8,000 763 8,390 8,273
226 Glukosa 5%-NS 500 ml Botol 40 40 0 9,240
227 KAEN 1 B Larutan Infus 500 ml Botol 65 1,500 65 1,500 9,273
228 KAEN 3 B Larutan Infus 500 ml Botol 0 4,500 320 4,180 10,050
229 Kaen 3A cairan infus 500 ml Botol 0 4,500 4,500 10,050
230 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 25 25 45,000
231 Lartan infus asering 500 ml Botol 0 200 200 9,275
232 Larutan Infus Manitol 20%, 500 ml Botol 0 0 125,000
233 Larutan Martos 10% 500 ml Botol 0 0 9,246
234 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 0 300 300 0 44,117
235 Meylon Vial 500 500 6,200
236 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 21 21 3,200
01+02431 Desember 2016 72

Harga Satuan
Agust '16 (RP)
Des '16 '16
237 MgSO4 ( Magesium sulfat 40% - 25 ml ) Vial 0 600 600 3,650
238 NaCl 0,9% cairan infus 500 ml Botol 360 8,000 640 7,720 11,000
239 Ringer Laktat larutan infus 500 ml Botol 0 1,820 15,000 2,400 14,420 13,000
240 Sanbehest 500 ml Botol 20 20 254,160
241 Sanmol Infus (Paracetamol) Botol 0 130 130 0 75,672
242 Sevoflurane Liquid Botol 0 0 3,684,260
243 Sifrofloksasin infus 2mg/ml, 100 ml Botol 6 122 64 64 85,244
G BAHAN HABIS PAKAI
245 3 Way Stopcock Picis 0 100 350 1,000 400 1,050 13,803
246 Abbocath No 16 Picis 0 0 35,000
247 Abbocath No 18 Picis 250 500 270 480 25,361
248 Abbocath No 20 Picis 0 500 450 50 25,361
249 Abbocath No 22 Picis 0 1,000 250 750 25,361
250 Abbocath No 24 Picis 207 210 500 417 500 25,361
251 Abbocath no. 26 Picis 52 100 102 50 25,361
252 Collor Neck Picis 4 4 218,904
253 Cord Clamps (Penjepit Tali Pusar) Picis 3,000 500 2,500 1,683
254 Dermafix 10 x 15 Box (10 lembar) 100 14 86 143,000
255 Dermafix 10 x 25 Box (10 lembar) 100 14 86 169,000
256 Dermafix 10 x 8 Box (10 lembar) 100 100 72,800
257 Disposible Syringes 1 CC Picis 11,495 30,000 2,795 38,700 7,266
259 Disposible Syringes 20 CC Picis 1,460 1,200 110 2,550 13,297
262 Disposible Syringes 50 CC Picis 265 400 6 659 29,062
263 Elastis Perban 10 cm x 4,5 m Roll 0 0 45,000
264 Elastis Perban Putih 6" Roll 0 0 65,428
01+02431 Desember 2016 73

Harga Satuan
Agust '16 (RP)
Des '16 '16
265 Endotracheal Tube ( ETT ) No. 2,5 Tube 10 10 93,005
266 Endotracheal Tube ( ETT ) No. 3 tube 10 10 93,005
268 Endotracheal Tube ( ETT ) No. 4 Tube 17 17 93,005
270 Endotracheal Tube ( ETT ) No. 5 Tube 12 12 93,005
272 Endotracheal Tube ( ETT ) No. 6 tube 7 7 93,005
273 Endotracheal Tube ( ETT ) No. 6,5 tube 8 8 0 93,005
274 Endotracheal Tube ( ETT ) No. 7 tube 7 7 0 93,005
275 Endotracheal Tube ( ETT ) No.7,5 tube 7 5 2 93,005
276 Endotracheal Tube ( ETT ) No.8 Tube 5 5 93,005
277 Etil Clorida Spray Botol 2 1 1 127,000
278 ETT Non King No. 5 Tube 1 1 479,504
279 ETT Non King No. 6,5 Tube 1 1 479,504
280 ETT Non King No. 7 1 1 479,504
281 ETT Non King No. 7,5 Tube 1 1 456,549
282 ETT Tanpa Cup No. 2,5 tube 16 16 22,500
283 ETT Tanpa Cup No. 3 tube 10 10 22,500
284 ETT Tanpa Cup No. 3,5 tube 5 5 22,500
285 ETT Tanpa Cup No. 4 Tube 10 10 22,500
286 Feeding Tube 5 100 cm Picis 51 51 26,000
290 Folley cateter (2 way) No. 10 Picis 0 0 74,775
291 Folley cateter (2 way) No. 12 Picis 48 10 38 28,041
293 Folley cateter (2 way) No. 18 Picis 50 200 50 200 12,500
01+02431 Desember 2016 74

Harga Satuan
Agust '16 (RP)
Des '16 '16
298 Folley cateter (2 way) No. 3,5 Picis 0 0 27,500
301 Folley cateter (2 way) No.16 Picis 30 100 50 80 12,000
304 Gliserin botol 100ml Botol 0 0 6,386
305 Guedel Airway 40 mm Picis 0 0 10,000
306 Guedel Airway 50 mm Picis 0 0 10,000
307 Gypsona 6" Roll 0 0 62,320
308 Handscoon Panjang (Obgyn) Pasang 0 0 55,000
309 Handscoon Sensigloves L Ktk (100 lbr ) 0 205 21 184 69,960
310 Handscoon Sensigloves M Ktk (100 lbr ) 0 205 57 148 69,960
311 Handscoon Sensigloves S Ktk (100 lbr ) 0 0
312 Handscoon Steril No. 6,5 Pasang 50 50 0 7,000
313 Handscoon Steril No. 7 Pasang 150 400 2,000 1,210 1,340 7,000
314 Handscoon Steril No. 7,5 Pasang 300 300 0 7,000
315 Handscoon Steril No. 8 Pasang 200 200 0 7,000
316 Hipafix 10 cm x 5 M Roll 0 0 350,000
317 Infuset Makro Set 515 5,000 605 4,910 4,416
318 Infuset Mikro Picis 740 5,500 990 5,250 4,830
319 Kapas Pembalut 100 g Roll 0 0 7,000
320 Kapas Pembalut 1000 g Roll 0 0 22,700
321 Kapas Pembalut 250 g Roll 40 800 4 836 15,000
01+02431 Desember 2016 75

Harga Satuan
Agust '16 (RP)
Des '16 '16
322 Kasa Hidrofil 16 x 16 cm Bks 0 50 5,000 20 5,030 8,004
323 Kasa Hidrofil 2m x 80 cm Bungkus 50 2,000 21 2,029 10,624
324 Kasa Hidrofil 40 Yard x 80 cm Rol 2 100 300 69 333 144,900
325 Kertas EKG Picis 0 0 24,000
326 Kertas Puyer (kertas perkamen) Bks 29 3 26 27,500
327 Kertas USG Picis 0 0 320,000
328 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 0 240 240 2,630
329 LMA Supreme No. 3 Pcs 1 1 477,972
332 LMA Unique No. 1 Pcs 1 1 274,227
333 LMA Unique No. 1,5 Pcs 1 1 275,876
334 LMA Unique No. 2 Pcs 1 1 275,876
335 LMA Unique No. 2,5 Pcs 1 1 275,876
336 Masker ear loop box (50 picis) 179 200 51 328 22,000
337 Masker tie on box (50 picis) 169 200 28 341 22,500
338 Needle No. 22 Picis 0 0 200
341 NGT (Maag Slang) No. 14 Picis 0 0 29,500
345 NGT (Maag Slang) No. 3,5 Picis 0 0 29,500
348 Penflon No. 18 Picis 500 215 285 12,078
349 Penflon No. 20 Picis 500 500 200 800 12,078
01+02431 Desember 2016 76

Harga Satuan
Agust '16 (RP)
Des '16 '16
350 Penflon No. 22 Picis 1,000 1,000 50 1,950 12,078
351 Penflon No. 24 Picis 1,000 2,850 3,850 12,078
352 Penflon No. 26 Picis 200 1,000 1,455 205 2,450 13,458
353 Plester 5 Yard x 2 Inci Roll 23 23 0 28,000
354 Plester 7.5 x 4.5 Roll 30 21 9 67,600
355 Plester Luka Steril ( Chloro Tulle) Lembar 0 0 34,400
356 Poli Creepe 4" Roll 0 0 129,992
357 Poli Creepe 6 " Roll 0 0 171,084
358 Rectal Tube No. 30 Picis 10 10 0 20,000
359 Selang Oksigen Anak Picis 92 16 76 12,000
360 Selang Oksigen Bayi Picis 73 50 35 88 13,200
361 Selang Oksigen Dewasa Picis 50 200 50 200 12,000
362 Selang Oksigen Masker 21 21 15,000
363 Sofratulle Box 6 6 0
364 Softband 3" Pcs 0 0 75,000
365 Softband 6" Roll 0 0 56,081
366 Spinocan injeksi No. 26 Picis 15 15 50,000
367 Spinocan injeksi No. 27 Picis 100 50 100 50 60,319
368 Stomach Tube 12 Picis 50 50 23,683
373 Suction Catheter No. 10 Picis 0 0 15,000
377 Transfusi Darah Set Picis 549 40 900 219 1,270 13,000
01+02431 Desember 2016 77

Harga Satuan
Agust '16 (RP)
Des '16 '16
378 Ultra One Box (50 test ) 50 50 150,000
379 Underpad Picis 0 0 5,745
380 Urine Bag 2000 ml Bag 55 400 105 350 74,800
381 Catgut Chromic No. 1/0 Bks 0 0
382 Catgut Chromic No. 3/0 Bks 48 2,400 408 2,040 7,705
383 Catgut Chromic No. 2/0 Bks 0 2,400 72 2,328 67,714
384 Catgut Plain No. 0 Roll 0 0
385 Catgut Plain No. 2/0 (3,5) 100 M Roll 0 2,400 168 2,232 19,500
386 Catgut Plain No. 3/0 Roll 48 48 0 7,705
387 Jarum Hecting Kulit No.10 Lusin 0 0 175,000
390 Jarum Hecting Otot No.10 Lusin 3 3 175,000
393 Jarum Prolene No. 1/0 Bks 0 0
394 Jarum Prolene No. 2/0 Bks 0 0 1,900,000
397 Silk Black 2/0 100 Meter Roll 0 0 175,000
398 Silk Black 3/0 100 Meter Roll 0 0 4,217
399 SoftSilk No. 2/0 Bks 0 0
400 SoftSilk No. 3/0 Bks 0 3,600 216 3,384 35,209
401 Surgical Blades (Bisturi) Picis 760 285 475 1,100
402 Cairan Developer 5 5 1,250,000
403 Blood Lancets Box 15 13 2 26,000
01+02431 Desember 2016 78

Harga Satuan
Agust '16 (RP)
Des '16 '16
404 Cairan Fixer 1 1 0 1,100,000
405 Formalin 37 % Botol 1 ltr 0 116 20 96
406 Film 24 x 30 10 10 2,200,000
407 Film 30 x 40 Box 10 10 3,674,000
408 Film 35 x 35 12 1 11 3,916,000
409 Halothane Liquid 250 ml Botol 0 0 2,500,000
410 Hidrogen Peroksida 3% 800 ml Botol 0 0 110,000
411 Jelly ECG Tube 10 10 26,000
412 Jelly M-Y Botol 20 600 620 30,750
413 Jelly USG Botol 300 15 285 31,250
414 RDT Malaria Box 0 0 650,000
415 Sodalime 0 0 832,495
416 Test Amphetamine Box 0 0 750,000
417 Test Golongan darah Set 0 0 0
418 Test HbsAg Box 0 0 0
419 Test HCV Box 0 0 0
420 Test HIV Box 0 0 0 2,000,000
421 Test Malaria (Fast/Rapid Test) Box 0 0 750,000
422 Test Syphilis Box 0 0 0 880,000
423 Test Urine Botol 0 0 1,700,000
424 Xylocain jelly Tube 0 0 0

Mengetahui
Kab. Raja Ampat
01+02431 Desember 2016 79

Harga Satuan
Agust '16 (RP)
Des '16 '16

NIP. 19700204 1993021 002 NIP. 19800427 200801 2 025
01+02431 Desember 2016 80

mum Daerah Raja Ampat,
Total Harga Satuan

(Rp)
0
0
0
207,756
392,040
0
0
0
67,449,600
2,623,185
4,632,500
25,318,656
0
72,875
0
1,251,450
0
424,074
0
0
01+02431 Desember 2016 81

Total Harga Satuan
(Rp)
0
0
0
10,636,800
0
0
359,100
6,308,000
904,365
0
102,350
3,000,000
10,899,600
618,125
0
1,562,400
0
851,796
467,200
0
106,920
418,400
1,198,800
6,771,600
0
0
4,905,999
01+02431 Desember 2016 82

Total Harga Satuan
(Rp)
605,591
70,200
0
24,503
715,897
0
481,000
405,914
4,435,200
0
0
52,245
64,267,911
0
0
16,184,700
1,831,200
3,044,800
25,372,800
0
0
0
83,160
0
1,833,120
4,930,200
1,490,400
01+02431 Desember 2016 83

Total Harga Satuan
(Rp)
1,123,056
11,344
0
62,400
46,760
0
451,035
231,800
912,000
9,250,000
7,877,400
0
3,043,904
116,640
0
1,416,400
0
1,674,000
0
0
0
1,428,000
822,150
48,000
765,450
697,680
0
01+02431 Desember 2016 84

Total Harga Satuan
(Rp)
49,000
0
0
268,840
306,900
1,837,680
0
11,727,430
323,536
1,220,580
0
0
1,496,000
24,975,000
0
4,654,188
720,000
1,349,390
17,078,000
5,893,965
0
781,986
7,669,400
967,200
7,340,606
01+02431 Desember 2016 85

Total Harga Satuan
(Rp)
28,950,000
32,400
193,100
0
1,406,250
0
63,330
0
0
0
2,138,400
0
0
4,579,200
58,938,750
3,740,000
43,437,500
12,798,000
80,308
8,710,980
424,980
0
3,440,043
0
5,586,000
56,524,800
4,600,000
01+02431 Desember 2016 86

Total Harga Satuan
(Rp)
375,000
320,580
1,590,200
0
0
0
0
13,440,000
5,670,000
0
0
129,200
1,283,500
1,555,200
15,824,000
1,125,000
0
1,375,000
2,475,000
0
8,444,600
10,887,500
375,000
0
0
0
1,750,000
375,000
01+02431 Desember 2016 87

Total Harga Satuan
(Rp)
0
0
0
593,750
6,540,380
0
0
28,435,000
0
0
19,631,250
0
0
0
32,712,400
0
0
0
0
696,000
3,421,005
5,164,000
0
0
7,150,000
0
0
01+02431 Desember 2016 88

Total Harga Satuan
(Rp)
0
2,250,000
0
7,425,280
517,500
0
0
623,350
0
17,308,500
11,520,000
0
0
139,860,000
139,412,000
69,410,470
0
13,909,500
42,009,000
45,225,000
1,125,000
1,855,000
0
0
0
3,100,000
67,200
01+02431 Desember 2016 89

Total Harga Satuan
(Rp)
2,190,000
84,920,000
187,460,000
5,083,200
0
0
5,455,616
14,493,150
0
12,173,280
1,268,050
19,020,750
12,680,500
1,268,050
875,616
4,207,500
12,298,000
14,534,000
7,280,000
281,194,200
67,172,000
33,907,350
252,895,500
319,424,616
19,151,858
0
0
01+02431 Desember 2016 90

Total Harga Satuan
(Rp)
930,050
930,050
1,767,095
1,581,085
930,050
1,116,060
558,030
651,035
0
0
186,010
465,025
127,000
479,504
479,504
479,504
456,549
360,000
225,000
112,500
225,000
1,326,000
1,170,000
1,196,000
1,170,000
0
1,065,558
841,230
2,500,000
01+02431 Desember 2016 91

Total Harga Satuan
(Rp)
312,500
580,800
440,000
0
0
0
0
960,000
0
0
0
0
0
0
0
12,872,640
10,354,080
0
0
9,380,000
0
0
0
21,682,560
25,357,500
0
0
12,540,000
01+02431 Desember 2016 92

Total Harga Satuan
(Rp)
40,260,120
21,556,096
48,251,700
0
715,000
0
631,200
477,972
477,972
477,972
274,227
275,876
275,876
275,876
7,216,000
7,672,500
0
0
0
0
147,500
0
0
0
0
0
3,442,230
9,662,400
01+02431 Desember 2016 93

Total Harga Satuan
(Rp)
23,552,100
46,500,300
32,972,100
0
608,400
0
0
0
0
912,000
1,161,600
2,400,000
315,000
0
0
0
750,000
3,015,950
1,184,150
473,660
390,000
975,000
23,683
0
0
0
0
16,510,000
01+02431 Desember 2016 94

Total Harga Satuan
(Rp)
7,500,000
0
26,180,000
0
15,718,200
157,638,192
0
43,524,000
0
0
0
0
525,000
0
875,000
0
0
0
0
0
0
0
119,147,256
522,500
6,250,000
52,000
01+02431 Desember 2016 95

Total Harga Satuan
(Rp)
22,000,000
36,740,000
43,076,000
0
0
260,000
19,065,000
8,906,250
0
0
0
0
0
0
0
0
0
0
0
3,555,125,571
enanggungjawab Gudang Obat
01+02431 Desember 2016 96

Total Harga Satuan
(Rp)
Nahruddin Abbas, S.Si., Apt

NIP. 19800427 200801 2 025
01+02431 Desember 2016 97

Pada hari ini : Minggu, Tanggal 30 bulan April tahun Dua ribu Tujuh belas, kami melakukan stock opname Obat dan Bahan Medis habis pakai di Rumah Sakit Umum Daerah Raja Ampat,
dengan rincian sebagai berikut :
Obat masuk per Januari s/d April 17

Sisa Obat Pengadaan Bantuan Pengadaan Bantuan Obat keluar Sisa Obat
Harga
No. JENIS PERSEDIAAN Satuan per 31 per 1 jan s/d 30 Per 30 April Total Harga Satuan (Rp)
Des'16 Satuan (RP)
April '17 '17
TA. 2016 30% BPJS TA.2017 Dinkes R4

1 Acarbose/Glucobay tablet 50 mg Box, 50 Tab 0 0 126,000 0
2 Acetosal 500 mg Box, 100 Tab 0 0 21,800 0
3 Acyclovir tablet score 200 mg Box, 100 Tab 0 0 141,100 0
4 Allopurinol tablet 300 mg Box, 100 Tab 1 1 0 207,756 0
5 Box, 100 Tab 22 18 4 17,820 71,280
6 Ambroxol 30 mg Tab Box, 100 Tab 0 40 40 0 17,900 0
7 Amlodipin Tab 5 mg Box 30 Tab 0 0 34,560 0
8 Amlodipin Tab. 10 mg Box 30 Tab 0 0 13,200 0
9 Amoksisilin kaplet 500 mg Box, 100 Tab 2,342 200 92 2,450 28,800 70,560,000
11 Antasida Doen Tablet kunyah Box, 100 Tab 545 6 539 8,500 4,581,500
12 Asam Mefenamat kaplet 500 mg Box, 100 Tab 999 20 979 25,344 24,811,776
13 Asam Traneksamat tablet 500 mg Box, 100 Tab 0 0 125,400 0
14 Aspilet Box, 30 Tab 1 1 72,875 72,875
15 Bisoprolol Fumarate Box 0 0 0
16 Captopril Tab. 12,5 mg Box, 100 Tab 103 103 12,150 1,251,450
17 Captopril Tab.25 mg Box, 100 Tab 0 0 18,596 0
18 Captopril tablet 50 mg Box, 100 Tab 14 14 30,291 424,074
19 Cedocard (ISDN) Box, 60 Tab 0 0 0
20 Cefadroksil kaps 500 mg Box, 100 Cap 0 0 183,272 0
21 Cefiksim Kaplet 100 mg Box 50 tab 0 22 21 1 107,752 107,752
22 Box 30 Tab 0 20 16 4 10,882 43,528
23 Chloramfenikol kapsul 250 mg Box 100 Tab 0 0 35,978 0
Stock opname 30 April 2017 98]

Harga
Des'16 Satuan (RP)
April '17 '17
24 Ciprofloxacin 500 mg Box, 100 Tab 384 36 420 27,700 11,634,000

25 Clindamisin Kapsul 150 mg Box 50 tab 0 0 68,850 0
26 Clobazam Tablet Box 50 tab 0 0 71,036 0
27 Clopidogrel Tablet 75 mg Box 30 Tab 3 3 119,700 359,100
28 Cotrimosasol tablet 480mg Box, 100 Tab 380 40 340 16,600 5,644,000
29 Box, 100 Tab 77 44 33 11,745 387,585
30 Digoksin Tab. 0,25 mg Box, 100 Tab 0 0 19,305 0
31 Diltiazem HCL TABLET 30 MG Box, 100 Tab 5 5 20,470 102,350
32 Doksisiklin kapsul 100mg Box, 100 Tab 100 100 30,000 3,000,000
33 Domperidone Tablet 10mg (20) Box, 100 Tab 100 11 89 108,996 9,700,644
34 Duvadilan Tablet Box 50 tab 5 5 123,625 618,125
35 Eritromisin kapsul 250 mg Box, 100 Tab 0 0 68,040 0
37 Erysanbe Chweable 200 mg Tab Box, 100 Tab 0 0 198,777 0
38 Etambutol tablet 500 mg Box, 100 Tab 11 11 77,436 851,796
39 Farsiven Box, 100 Tab 12 12 0 77,436
40 Fasorbid (ISDN) Box, 100 Tab 8 1 7 58,400 408,800
41 Furosemide Tablet 40mg Box, 100 Tab 0 0 13,781 0
42 Glibenklamid Tablet 5mg Box, 100 Tab 11 11 9,720 106,920
43 Glimepirid Tablet 2 mg Box 50 tab 16 16 26,150 418,400
44 Griseofulfin Tablet 125mg Box, 100 Tab 37 7 30 32,400 972,000
45 Box, 100 Tab 396 8 388 17,100 6,634,800
46 Isosorbit dinitrat sublingual 5 mg Box, 100 Tab 0 0 13,142 0
47 Box 50 tab 0 0 47,791 0
48 Levofloksasina tablet 500 mg Box 50 tab 63 63 77,873 4,905,999
49 Loperamid Tab. 2mg Box, 100 Tab 49 49 12,359 605,591
50 Mebendazol tablet 100 mg Box 30 Tab 8 8 8,775 70,200
51 Meloksikam tablet 7,5 mg Box 50 tab 0 0 46,703 0
52 Metformin tablet 500mg Box, 100 Tab 1 1 0 24,503 0
53 Methilprednisolone 4 mg Box, 100 Tab 13 4 9 55,069 495,621
54 Methilprednisolone 8 mg Box, 100 Tab 0 0 0

Harga
Des'16 Satuan (RP)
April '17 '17

57 Metronidasol Tablet 500mg Box, 100 Tab 252 252 17,600 4,435,200
58 Molaneuron Tab Box 50 tab 0 0 124,407 0
59 Natrium Diklofenak tablet 50mg Box 50 tab 0 0 14,693 0
60 Nifedipin Tab. 10mg Box, 100 Tab 3 3 17,415 52,245
61 Obat Anti Malaria Box 9 tab 1,863 114 1,749 34,497 60,335,253
62 Ofloksasin tablet 200mg Box 50 tab 0 0 39,832 0
63 Ofloksasin tablet 400mg Box 50 tab 0 0 58,928 0
64 Omeprazole Kapsul 20mg Box 30 Cap 1,101 41 1,060 14,700 15,582,000
68 Pirantel Pamoat tablet 125 mg Box, 100 Tab 0 0 43,200 0
69 Piroksikam 20 mg Box, 100 Tab 0 0 9,700 0
70 Piroksikam tablet 10 mg (10) Box, 100 Tab 0 0 11,340 0
71 Primaquin Tablet 15 mg Box, 100 Tab 947 48 899 21,000
72 Propanolol Tab. 10 mg Box, 100 Tab 8 8 10,395 83,160
73 Pyrazinamide tablet 500 mg Box, 100 Tab 0 0 31,590 0
75 Ranitidine Tablet 150mg Box, 100 Tab 166 29 137 29,700 4,068,900
76 Rifampisin kapsul 300 mg Box, 100 Tab 23 23 64,800 1,490,400
77 Salbutamol Tab 2mg Box, 100 Tab 99 9 90 11,344 1,020,960
79 Scopma (Hyoscine-N-Butilbromide) 10 mg Box, 100 Tab 0 0 45,083 0
80 Simvastatin Tab 10mg Box 50 tab 2 2 0 31,200 0
81 Spinorolakton Box, 100 Tab 1 1 0 46,760 0
82 Tetrasiklin 250 mg Box, 100 Tab 0 0 2,835 0
84 Vitamin B Complex (Dus) Box, 100 Tab 19 19 0 12,200 0
85 Vitamin B12 Box, 100 Tab 480 18 462 1,900 877,800

Harga
Des'16 Satuan (RP)
April '17 '17
86 Vitamin B6 Box, 100 Tab 500 2 498 18,500 9,213,000

88 Zink Tablet 20mg Box, 100 Tab 0 0 56,900 0
89 Aminophillin Tablet 200mg Botol 100 Tab 199 199 15,296 3,043,904
90 Antalgin (metampiron) 500 mg Botol 1000 Tab 1 1 0 116,640 0
91 Bekarbon Tablet Botol 1000 Tab 0 0 84,040 0
92 Besi (II) Sulfat/ Sulfaferosus 200mg Botol 1000 Tab 40 3 37 35,410 1,310,170
93 Bikarbonat Na. tablet 500 mg Botol 1000 Tab 0 0 19,300 0
94 Calsium laktat (Kalk) tablet 500 mg Botol 1000 Tab 27 2 25 62,000 1,550,000
95 Chloramfenikol kapsul 250 mg Botol 250 Cap 0 0 89,945 0
96 Cloroquin Tablet 250 mg Botol 1000 Tab 0 0 102,000 0
97 Cotrimoksazol tablet Pediatrik Botol 100 Tab 0 0 9,108 0
98 CTM Botol 1000 Tab 51 11 40 28,000 1,120,000
99 Botol 1000 Tab 7 46 53 117,450 6,224,850
100 Diazepam 2 MG Botol 100 Tab 16 16 0 3,000 0
101 Botol 1000 Tab 7 7 109,350 765,450
102 Folic Acid Tablet 1mg Botol 100 Tab 76 76 9,180 697,680
103 Gliseril Guaiakolat tablet 100 mg Botol 1000 Tab 0 5 2 3 37,660 112,980
104 HCT (Hidro Cloro Tiazid) 25mg Botol 1000 Tab 1 1 49,000 49,000
105 Isoniazid tablet 300 mg Botol 1000 Tab 0 0 130,950 0
106 Natrium Fenitoin kapsul 100 mg Botol 100 Tab 0 0 32,480 0
107 Papaverin tablet 40 mg Botol 1000 Tab 2 1 1 134,420 134,420
108 Phenobarbital 30mg Botol 100 Tab 55 2 53 5,580 295,740
109 Phytomenadion Tablet Botol 100 Tab 20 20 91,884 1,837,680
110 Piridoksin (vitamin B6) 10 mg Botol 1000 Tab 0 0 23,490 0
111 Botol 1000 Tab 139 5 134 84,370 11,305,580
112 Propiltiourasil (PTU) 100mg Botol 100 Tab 8 8 40,442 323,536
113 Quinine Tablet 222mg Botol 1000 Tab 2 2 610,290 1,220,580
114 Sianokobalamin (B12) 50 mcg Botol 1000 Tab 0 0 17,680 0
115 Vitamin A 200.000 UI Botol 50 Caap 0 0 34,000 0

Harga
Des'16 Satuan (RP)
April '17 '17

116 Ambroxol Syrup 60 ml Botol 200 65 135 7,480 1,009,800
117 Amoksisilin sirup kering 125 mg/ 5 ml Botol 5,000 135 4,865 4,995 24,300,675
118 Ampisillin sirup 125mg /5ml Botol 0 0 5,940 0
120 Cefadroksil sirup kering 125 mg/5 ml Botol 40 40 0 18,000 0
122 Domperidone Suspensi 5mg/5ml Botol 1,000 500 60 1,440 17,078 24,592,320
123 Eritromisin suspensi 200 mg Botol 539 130 409 10,935 4,472,415
124 Erysanbe Syrup 60 ml Botol 0 0 27,280 0
125 Molapect Syrup (Ambroxol) 47 12 35 16,638 582,330
126 Paracetamol syrup 60 ml Botol 3,100 335 2,765 2,474 6,840,610
127 Parasetamol drops 15 ml Botol 155 155 0 6,240 0
128 Zink Syrup Botol 182 46 136 40,333 5,485,288
D SALEP / OBAT LUAR
126 Acyclovir Cream 5% Tube 5 Gr Tube 0 0 4,253 0
127 Alkohol 70% 1000 ml Botol 386 47 339 75,000 25,425,000
128 Antihemoroid suppo sitoria Supp 12 12 2,700 32,400
129 Bedak Salisil Serbuk 2% Kotak 100 11 89 1,931 171,859
130 Betametason Cream 0,1% Tube 0 0 2,520 0
131 Burnazin Salf Tube 25 24 1 56,250 56,250
132 Chloramfenikol SM 1 % 5 gr (Erlamycetin) Tube 0 0 2,110 0
133 Chloramfenikol TT 3% 5 ml Botol 30 30 0 2,111 0
136 Gentian Violet Pot 0 0 776 0
137 Hidrocortison salf Tube 528 72 456 4,050 1,846,800
138 Ketokonasol Cream 2% 15 gram Tube 0 0 9,450 0
139 Levertraan Zalf Pot 0 0 150 0
141 One Scrub Botol 500 ml 465 58 407 126,750 51,587,250

Harga
Des'16 Satuan (RP)
April '17 '17
142 Povidon Iodida (yodium) 10% 1000 m Botol 34 12 22 110,000 2,420,000

143 Suprafenid supp 100 mg ( Ketoprofen ) Suppositoria 3,475 665 2,810 12,500 35,125,000
E INJEKSI
144 Aminophillin Injeksi 24mg/ml Ampul 3,160 22 3,138 4,050 12,708,900
145 Amiodaron HCL 50mg/ml Ampul 4 4 20,077 80,308
146 Ampisilin inj i.m./i.v.1000 mg Vial 940 70 870 9,267 8,062,290
147 Anesfar Inj 1 mg/ml (Midazolam) Ampul 20 20 0 21,249 0
148 Anti Bisa Ular (Polyvalent) Vial 0 0 30,000 0
149 Anti Tetanus Serum Ampul 27 27 0 127,409 0
150 Antrain Injeksi Ampul 0 0 11,515 0
151 Artemeter Inj 80 mg/ml Ampul 210 90 120 26,600 3,192,000
152 Artesunat injeksi Vial 1,840 712 1,128 30,720 34,652,160
153 Asam Traneksamat injeksi 500 mg/ml Ampul 460 180 280 10,000 2,800,000
154 Atropin sulphat injeksi 0,25mg/ml Ampul 100 100 3,750 375,000
155 Bricasma Ampul 10 10 32,058 320,580
156 Bunascan Spinal 0,5% inj (Bupivacain) Ampul 20 20 0 79,510 0
157 Cedocard Injeksi Ampul 0 0 0
158 Chinin Antipyrin Injeksi Ampul 0 0 1,000 0
159 Chlorpromazin Injeksi 25mg/ml Ampul 0 0 2,590 0
160 Citicolin Injeksi Ampul 0 0 25,000 0
161 Cyanokobalamin Injeksi 500 mcg/ml 1 ml Ampul 9,600 1,000 8,600 1,400 12,040,000
162 Deksametason injeksi i.v. 5 mg/ml Ampul 2,100 200 1,900 2,700 5,130,000
163 Dellamidon injeksi (Benodon) Vial 0 0 17,500 0
164 Dellladryl injeksi (Recodryl) Vial 0 0 16,000 0
166 Digoksin Injeksi Ampul 5 5 256,700 1,283,500
167 Diphenhydramine injeksi Ampul 1,200 60 1,140 1,296 1,477,440
168 Dobutamin Giulini Ampul 46 36 10 344,000 3,440,000
169 Dopamin Injeksi Ampul 15 15 75,000 1,125,000
170 Duvadilan injeksi Ampul 0 0 25,084 0
171 Epedrin Ampul 40 40 34,375 1,375,000

Harga
Des'16 Satuan (RP)
April '17 '17
173 Farbion 5000 injeksi Ampul 0 0 7,088 0

174 Fenitoin Injeksi Ampul 200 30 170 42,223 7,177,910
175 Fentanil Injeksi Ampul 134 134 0 81,250 0
176 Fitomenadion ( Vit. k1) Injeksi 10mg/ml 1ml Ampul 100 30 70 3,750 262,500
177 Furosemide Injeksi10 mg/ml Ampul 0 0 2,782 0
178 Gentamisin Injeksi 80mg/2ml Ampul 0 0 4,990 0
179 Hyoscine-N-Butilbromide Injeksi Ampul 0 0 62,700 0
180 Isofluran 250 ml Ampul 2 2 0 875,000 0
181 Kalsium Glukonat Injeksi 10% Ampul 24 24 15,625 375,000
182 Ketamine-Hameln injeksi 50 mg/ml Vial 0 0 125,898 0
183 Ketoprofen Injeksi 100 mg Ampul 0 0 1,254 0
184 Ampul 0 0 2,799 0
185 Lasix Inj Ampul 25 5 20 23,750 475,000
186 Lidokain injeksi 2% 2 ml Ampul 4,795 195 4,600 1,364 6,274,400
187 Meropenem Inj 1 gr Vial 0 0 329,010 0
188 Metampiron inj 250 mg/2 ml (Antalgin injeksi) Ampul 0 0 1,800 0
189 Methilergometrin Ampul 5,000 5,000 5,687 28,435,000
191 Metoclopramide Injeksi 5mg/ 2 ml (Sotatic) Ampul 0 0 2,093 0
192 Myomergin (Methylergometrin) 9,375 9,175 200 2,094 418,800
193 Neostigmin-Hameln injeksi 0,5 mg/ml Ampul 0 0 15,578 0
194 Nicardipine Hcl Ampul 0 0 1,001,000 0
195 Nokoba Ampul 0 0
196 Nourobion Injeksi Pasang 0 0 0
197 Oksitosin Injeksi 10 IU/ml Ampul 9,800 100 9,700 3,338 32,378,600
198 Omeprazole Injeksi 40mg/10ml Vial 0 0 47,500 0
199 Ondansentron Injeksi 2mg/2 ml Ampul 0 0 2,700 0
200 Papaverin injeksi 40 mg/ml Ampul 0 0 1,595 0
201 Pehacain Injeksi Ampul 0 0 3,114 0
202 Petidin Inj i.m/s.k/i.v lambat 50 mg/ml Ampul 40 40 17,400 696,000

Harga
Des'16 Satuan (RP)
April '17 '17
203 Propofol/Proanes Injeksi Ampul 35 35 97,743 3,421,005

204 Prostigmin Ampul 200 200 25,820 5,164,000
205 Quinin HCL Injeksi IV 25% Ampul 0 0 4,854 0
206 Ranitidine Injeksi 25mg/2ml (10) Ampul 0 0 8,674 0
207 Recofol Ampul 80 20 60 89,375 5,362,500
208 Roculax 10 mg/ml Ampul 0 0 281,030 0
209 Salbutamol Nebules 2,5mg ( Ventolin ) Ampul 0 0 12,400 0
210 Vial 0 0 10,364 0
211 Sefoulurane 250 ml Ampul 2 2 0 1,125,000 0
212 Seftazidim injeksi 1000 mg/vial Vial 0 0 50,634 0
213 Seftriakson injeksi 1 gram Vial 640 240 400 11,602 4,640,800
214 Streptomisin Serbuk injeksi 1500mg/vial Vial 100 100 5,175 517,500
215 Tiamin HCl (Vit. B1) inji 100 mg/ml @ 1 ml Ampul 0 0 1,377 0
216 Tramadol Injeksi 50 mg/ml Ampul 0 0 6,875 0
217 Vascom Injeksi (Norephinefrin) Ampul 1 1 623,350 623,350
218 Vitamin C Injeksi Ampul 0 0 10,625 0
F CAIRAN DAN INFUS
219 Aqua Pro Injeksi Botol 6,294 624 5,670 2,750 15,592,500
220 Glukosa 10% larutan infus 500 ml Botol 960 20 940 12,000 11,280,000
221 Glukosa 10%-1/5 NS Botol 0 0 9,240 0
222 Glukosa 40% Botol 25ml Botol 0 0 10,857 0
223 Glukosa 5% - 1/2 NS 500 ml Botol 9,990 20 9,970 14,000 139,580,000
224 Glukosa 5% - 1/4 NS 500 ml Botol 9,958 24 9,934 14,000 139,076,000
226 Glukosa 5%-NS 500 ml Botol 0 0 9,240 0
227 KAEN 1 B Larutan Infus 500 ml Botol 1,500 1,500 9,273 13,909,500
228 KAEN 3 B Larutan Infus 500 ml Botol 4,180 100 4,080 10,050 41,004,000
229 Kaen 3A cairan infus 500 ml Botol 4,500 4,500 10,050 45,225,000
230 Kalium Klorida ( KCL ) Injeksi 7,46% 25 ml Vial 25 25 45,000 1,125,000
231 Lartan infus asering 500 ml Botol 200 200 9,275 1,855,000
232 Larutan Infus Manitol 20%, 500 ml Botol 0 0 125,000 0

Harga
Des'16 Satuan (RP)
April '17 '17
233 Larutan Martos 10% 500 ml Botol 0 0 9,246 0

234 Metronidasol Larutan infus 5mg/ml, 100 ml Botol 0 0 44,117 0
235 Meylon Vial 500 500 6,200 3,100,000
236 MgSO4 ( Magesium sulfat 20% - 25 ml ) Vial 21 600 621 3,200 1,987,200
237 MgSO4 ( Magesium sulfat 40% - 25 ml ) Vial 600 20 580 3,650 2,117,000
238 NaCl 0,9% cairan infus 500 ml Botol 7,720 6,619 1,101 11,000 12,111,000
239 Ringer Laktat larutan infus 500 ml Botol 14,420 1,600 12,820 13,000 166,660,000
240 Sanbehest 500 ml Botol 20 20 254,160 5,083,200
241 Sanmol Infus (Paracetamol) Botol 0 0 75,672 0
242 Sevoflurane Liquid Botol 0 0 3,684,260 0
243 Sifrofloksasin infus 2mg/ml, 100 ml Botol 64 64 0 85,244 0
G BAHAN HABIS PAKAI
245 3 Way Stopcock Picis 1,050 100 950 13,803 13,112,850
246 Abbocath No 16 Picis 0 0 35,000 0
251 Abbocath no. 26 Picis 50 10 40 25,361 1,014,440
252 Collor Neck Picis 4 1 3 218,904 656,712
253 Cord Clamps (Penjepit Tali Pusar) Picis 2,500 100 2,400 1,683 4,039,200
254 Dermafix 10 x 15 Box (10 lembar) 86 5 81 143,000 11,583,000
263 Elastis Perban 10 cm x 4,5 m Roll 0 0 45,000 0

Harga
Des'16 Satuan (RP)
April '17 '17
264 Elastis Perban Putih 6" Roll 0 0 65,428 0

265 Endotracheal Tube ( ETT ) No. 2,5 Tube 10 10 93,005 930,050
266 Endotracheal Tube ( ETT ) No. 3 tube 10 10 93,005 930,050
272 Endotracheal Tube ( ETT ) No. 6 tube 7 7 93,005 651,035
273 Endotracheal Tube ( ETT ) No. 6,5 tube 0 0 93,005 0
274 Endotracheal Tube ( ETT ) No. 7 tube 0 0 93,005 0
275 Endotracheal Tube ( ETT ) No.7,5 tube 2 2 93,005 186,010
276 Endotracheal Tube ( ETT ) No.8 Tube 5 5 93,005 465,025
277 Etil Clorida Spray Botol 1 1 127,000 127,000
278 ETT Non King No. 5 Tube 1 1 0 479,504 0
279 ETT Non King No. 6,5 Tube 1 1 0 479,504 0
280 ETT Non King No. 7 1 1 0 479,504 0
281 ETT Non King No. 7,5 Tube 1 1 0 456,549 0
283 ETT Tanpa Cup No. 3 tube 10 10 22,500 225,000
285 ETT Tanpa Cup No. 4 Tube 10 10 22,500 225,000
286 Feeding Tube 5 100 cm Picis 51 51 26,000 1,326,000
291 Folley cateter (2 way) No. 12 Picis 38 38 28,041 1,065,558

Harga
Des'16 Satuan (RP)
April '17 '17

298 Folley cateter (2 way) No. 3,5 Picis 0 0 27,500 0
301 Folley cateter (2 way) No.16 Picis 80 10 70 12,000 840,000
304 Gliserin botol 100ml Botol 0 0 6,386 0
307 Gypsona 6" Roll 0 0 62,320 0
308 Handscoon Panjang (Obgyn) Pasang 0 0 55,000 0
309 Handscoon Sensigloves L Ktk (100 lbr ) 184 20 164 69,960 11,473,440
310 Handscoon Sensigloves M Ktk (100 lbr ) 148 67 81 69,960 5,666,760
311 Handscoon Sensigloves S Ktk (100 lbr ) 0 0 0
312 Handscoon Steril No. 6,5 Pasang 0 0 7,000 0
313 Handscoon Steril No. 7 Pasang 1,340 752 588 7,000 4,116,000
314 Handscoon Steril No. 7,5 Pasang 0 0 7,000 0
315 Handscoon Steril No. 8 Pasang 0 0 7,000 0
316 Hipafix 10 cm x 5 M Roll 0 0 350,000 0
317 Infuset Makro Set 4,910 4,515 395 4,416 1,744,320
318 Infuset Mikro Picis 5,250 140 5,110 4,830 24,681,300
321 Kapas Pembalut 250 g Roll 836 12 824 15,000 12,360,000
322 Kasa Hidrofil 16 x 16 cm Bks 5,030 141 4,889 8,004 39,131,556
323 Kasa Hidrofil 2m x 80 cm Bungkus 2,029 29 2,000 10,624 21,248,000
324 Kasa Hidrofil 40 Yard x 80 cm Rol 333 31 302 144,900 43,759,800
325 Kertas EKG Picis 0 0 24,000 0

Harga
Des'16 Satuan (RP)
April '17 '17
327 Kertas USG Picis 0 0 320,000 0

328 Larutan Rivanol 0,1% 300 ml (Etakridin) Botol 240 11 229 2,630 602,270
329 LMA Supreme No. 3 Pcs 1 1 0 477,972 0
332 LMA Unique No. 1 Pcs 1 1 0 274,227 0
333 LMA Unique No. 1,5 Pcs 1 1 0 275,876 0
334 LMA Unique No. 2 Pcs 1 1 0 275,876 0
335 LMA Unique No. 2,5 Pcs 1 1 0 275,876 0
336 Masker ear loop box (50 picis) 328 48 280 22,000 6,160,000
337 Masker tie on box (50 picis) 341 32 309 22,500 6,952,500
338 Needle No. 22 Picis 0 0 200 0
339 Needle No. 24 Picis 0 0 200 0
340 Needle No. 26 Picis 0 0 200 0
342 NGT (Maag Slang) No. 16 Picis 5 5 29,500 147,500
345 NGT (Maag Slang) No. 3,5 Picis 0 0 29,500 0
348 Penflon No. 18 Picis 285 37 248 12,078 2,995,344
349 Penflon No. 20 Picis 800 280 520 12,078 6,280,560
350 Penflon No. 22 Picis 1,950 1,840 3,790 12,078 45,775,620
351 Penflon No. 24 Picis 3,850 1,500 2,350 12,078 28,383,300
352 Penflon No. 26 Picis 2,450 520 1,930 13,458 25,973,940
353 Plester 5 Yard x 2 Inci Roll 0 0 28,000 0
354 Plester 7.5 x 4.5 Roll 9 50 36 23 67,600 1,554,800
355 Plester Luka Steril ( Chloro Tulle) Lembar 0 0 34,400 0
356 Poli Creepe 4" Roll 0 0 129,992 0
357 Poli Creepe 6 " Roll 0 0 171,084 0

Harga
Des'16 Satuan (RP)
April '17 '17
358 Rectal Tube No. 30 Picis 0 10 10 20,000 200,000

359 Selang Oksigen Anak Picis 76 5 71 12,000 852,000
360 Selang Oksigen Bayi Picis 88 5 83 13,200 1,095,600
361 Selang Oksigen Dewasa Picis 200 55 145 12,000 1,740,000
362 Selang Oksigen Masker 21 4 17 15,000 255,000
363 Sofratulle Box 0 0 0
364 Softband 3" Pcs 0 0 75,000 0
365 Softband 6" Roll 0 0 56,081 0
366 Spinocan injeksi No. 26 Picis 15 15 0 50,000 0
367 Spinocan injeksi No. 27 Picis 50 50 60,319 3,015,950
368 Stomach Tube 12 Picis 50 50 23,683 1,184,150
369 Stomach Tube 14 Picis 20 20 23,683 473,660
377 Transfusi Darah Set Picis 1,270 140 1,130 13,000 14,690,000
378 Ultra One Box (50 test ) 50 4 46 150,000 6,900,000
379 Underpad Picis 0 0 5,745 0
380 Urine Bag 2000 ml Bag 350 20 330 74,800 24,684,000
381 Catgut Chromic No. 1/0 Bks 0 0 0
382 Catgut Chromic No. 3/0 Bks 2,040 24 2,016 7,705 15,533,280
383 Catgut Chromic No. 2/0 Bks 2,328 58 2,270 67,714 153,710,780
384 Catgut Plain No. 0 Roll 0 0 0
385 Catgut Plain No. 2/0 (3,5) 100 M Roll 2,232 96 2,136 19,500 41,652,000
386 Catgut Plain No. 3/0 Roll 0 0 7,705 0

Harga
Des'16 Satuan (RP)
April '17 '17

391 Jarum Hecting Otot No.11 Lusin 0 0 175,000 0
393 Jarum Prolene No. 1/0 Bks 0 0 0
399 SoftSilk No. 2/0 Bks 0 0 0
400 SoftSilk No. 3/0 Bks 3,384 252 3,132 35,209 110,274,588
401 Surgical Blades (Bisturi) Picis 475 460 15 1,100 16,500
402 Cairan Developer 5 5 1,250,000 6,250,000
403 Blood Lancets Box 2 2 26,000 52,000
404 Cairan Fixer 0 0 1,100,000 0
405 Formalin 37 % Botol 1 ltr 96 9 87 169,000 14,703,000
406 Film 24 x 30 10 1 9 2,200,000 19,800,000
407 Film 30 x 40 Box 10 10 3,674,000 36,740,000
408 Film 35 x 35 11 1 10 3,916,000 39,160,000
409 Halothane Liquid 250 ml Botol 0 0 2,500,000 0
410 Hidrogen Peroksida 3% 800 ml Botol 0 0 110,000 0
411 Jelly ECG Tube 10 10 0 26,000 0
412 Jelly M-Y Botol 620 17 603 30,750 18,542,250
413 Jelly USG Botol 285 35 7 313 31,250 9,781,250
414 RDT Malaria Box 0 0 650,000 0
415 Sodalime 0 0 832,495 0
416 Test Amphetamine Box 0 0 750,000 0
417 Test Golongan darah Set 0 0 0 0

Harga
Des'16 Satuan (RP)
April '17 '17
418 Test HbsAg Box 0 0 0 0

419 Test HCV Box 0 0 0 0
420 Test HIV Box 0 0 2,000,000 0
421 Test Malaria (Fast/Rapid Test) Box 0 0 750,000 0
422 Test Syphilis Box 0 0 880,000 0
423 Test Urine Botol 0 0 1,700,000 0
2,935,021,933
Waisai, 30 April 2017

Mengetahui
Kab. Raja Ampat

NIP. 19700204 1993021 002 NIP. 19800427 200801 2 025

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LAPORAN PERSEDIAAN OBAT & BAHAN HABIS PAKAI PER 31 Desember 2015

RUMAH SAKIT UMUM DAERAH KELAS - D

dr. Engelbert Wader Nahruddin Abbas, S.Si., Apt

Sisa Obat Obat masuk Tahun 2015

dr. Engelbert Wader

450 ### ###

6,000 ### ###

7,500 ### ###

3,960 ### ###

6,400 ### ###

300 ### ###

17,200 ### ###

13,400 ### ###

8,000 ### ###

5,400 ### ###

6,000 ### ###

904 ### ###

365 ### ###

2,544 ### ###

2,862 ### ###

246 ### ###

1,529 ### ###

113 ### ###

dr. Engelbert Wader Nahruddin Abbas, S.Si., Apt

Pengadaan 2015 (ABT)

Pengadaan 2016 (Dinkes R4)

Pengadaan 2016 (Dinkes R4)

Pengadaan 2016 (Dinkes R4)

RUMAH SAKIT UMUM DAERAH KAB. RAJA AMPAT

Waisai, 31 Agustus 2016

Ferdinand Rumsowek, SKM. M.Kes Nahruddin Abbas, S.Si., Apt

Obat masuk per Agust s/d Des 16

01+02431 Desember 2016 64

01+02431 Desember 2016 65

01+02431 Desember 2016 66

01+02431 Desember 2016 67

01+02431 Desember 2016 68

01+02431 Desember 2016 69

01+02431 Desember 2016 70

01+02431 Desember 2016 71

01+02431 Desember 2016 72

01+02431 Desember 2016 73

01+02431 Desember 2016 74

01+02431 Desember 2016 75

01+02431 Desember 2016 76

01+02431 Desember 2016 77

01+02431 Desember 2016 78

Waisai, 31 Desember 2016

01+02431 Desember 2016 79

Ferdinand Rumsowek, SKM. M.Kes Nahruddin Abbas, S.Si., Apt

01+02431 Desember 2016 80

Total Harga Satuan

01+02431 Desember 2016 81

01+02431 Desember 2016 82

01+02431 Desember 2016 83

01+02431 Desember 2016 84

01+02431 Desember 2016 85

01+02431 Desember 2016 86

01+02431 Desember 2016 87

01+02431 Desember 2016 88

01+02431 Desember 2016 89

01+02431 Desember 2016 90

01+02431 Desember 2016 91

01+02431 Desember 2016 92