NERACA BAHAN MEDIS HABIS PAKAI PUSKESMAS RAAS

PER 31 OKTOBER 2020

DINAS KESEHATAN KABUPATEN SUMENEP

NO NAMA OBAT KEMASAN Harga Satuan JKN

Jml
Gudang

1 Alkohol 70 % 1 liter BOTOL 25,000.00 -

2 Alkohol 70 persen 100 ml BOTOL 2,790.00 -
3 Alkohol Swab box isi 100 11,604.00 -
4 Antiseptik Sabun tangan/Onescrub 2% 500 ml botol 55,020.00 -
Antiseptik tangan tanpa bilas /Alkohol
5 BOTOL 38,640.00 -
Perokside 500 ml
6 Apron 75 x 130/025 lembar -
7 Benang Catgut Plain 2/0 + jarum pcs -
8 Benang Catgut Plain 3/0 tanpa jarum pcs 35,067.00 -
9 Benang Catgut Plain 3/0+jarum pcs 2,922.25 -
10 Benang Catgut Chromic 2/0+jarum pcs 34,300.00 -
11 Benang Catgut Chromic 3/0+jarum pcs 33,538.00 -
12 Benang Silk 3/0+jarum pcs 3,055.00 -
13 Blood transfusion set pcs 8,140.00 30 30
14 Dental Needle 30 G x 13 mm box isi 30 box isi 30 -
15 Dental Needle 30 G x 21 mm box isi 30 box isi 30 -
16 Foley Catheter (16 fr) pcs 18,450.00 -
17 Foley Catheter (18 fr) pcs 18,450.00 -
Gantungan Handwash / Bracket Hand Wash
18 pcs 17,600.00 -
Plastik
19 Hidrogen Peroxide 3% botol 100ml BOTOL 3,360.00 -
20 Infusion set anak pcs 3,500.00 550 550
21 Infusion set dewasa pcs 3,200.00 -
22 Infusion Set type Y Dewasa pcs -
23 Infusion Type Y Anak pcs -
24 IV catheter 18 G port side pcs -
25 IV Catheter 18G pcs 5,500.00 300 300
26 IV catheter 20 G port side pcs -
27 IV Catheter 20G pcs 5,500.00 600 600
28 IV catheter 22 G port side pcs 5500 -
29 IV Catheter 22G pcs 5,500.00 400 400
30 IV catheter 24 G port side pcs -
31 IV Catheter 24G pcs 5,500.00 100 100
32 IV catheter 26 G pcs -
33 IV catheter 26 G port side pcs -
34 Kapas Pembalut 250 gram bungkus 12,250.00 -
35 Kasa Kompres Steril 16 x 16cm box isi 5,950.00 103 103
36 Kasa Kompres Steril 40cm x 40cm box isi 1,600.00 40 40
37 Kasa Pembalut Hidrofil 40y x 80cm rol -
38 Kasa Pembalut Hidrofil 4y x 15cm rol 2,100.00 -
39 Kasa Pembalut Hidrofil 4y x 3cm rol -
40 Kasa Pembalut Hidrofil 4y x 5cm rol -
41 Lancet, Ukuran 28 G box isi 100 -
42 Masker box isi 50 165,000.00 20 20
43 Masker Nebulizer Adult pcs 16,000.00 -
44 Masker Nebulizer Pediatric /maxiflow pcs 13,552.00 -
45 Masker Oxygen Adult pcs 11,200.00 -
46 Masker Oxygen Pediatric pcs 11,200.00 -
47 Mucus Extractor pcs 5,000.00 -
48 Nasal Oxygen Canula Adult pcs 5,600.00 20 20
49 Nasal Oxygen Canula Child pcs 5,600.00 64 64
50 Plester Dermafix (10 x 20cm) pcs -
51 Plester Dermafix (10 x 25cm) pcs -

52 Plester Non Woven 5 x 10 cm (pharmafix) pcs 27,000.00 -

53 Plester Paper tape 2,5 x 9,14 pcs -

54 Plester Surgical tape pcs -
55 Pot Sputum pcs -

56 POVIDONE IODINE LARUTAN 10% 300 ml BOTOL 17,550.00 -

57 Sarung Tangan Examination size L pcs 47,600.00 -

58 Sarung Tangan Examination Size M pcs -
59 Sarung Tangan Obgyn pasang 19,360.00 -
60 Sarung tangan steril no. 7 pasang 4,980.00 -
61 Sarung tangan steril no. 7,5 pasang 4,980.00 -
62 Sarung tangan steril no.8 pasang -
63 Spuit /Alat Suntik 1ml pcs 1,023.00 400 400
64 Spuit 20 ml tanpa jarum pcs 2,090.00 -
65 Spuit/Alat Suntik 3 ml pcs 779.00 -
66 Spuit/Alat Suntik 5 ml pcs 968.00 -
67 Steril Pouch With Indicator 9 x26cm pcs -
68 Stomach Tube 16FR 125 cm pcs -
69 Stomach Tube 18FR 125 cm pcs -
70 Underpad pcs 2,895.00 300 300
71 Urine bag 2L pcs 4,590.00 -
72 Wing needle 21 G pcs -
73 Wing needle 23 G pcs -
74 Rivanol 300ml BOTOL -
Antiseptik betadin 60ml botol 23,890.00 -
Infusion set dewasa pcs 5,445.00 -
Kasa pembalut 4x 10 cm roll 1,500.00 -
Plester fixomul 37,440.00 -
Endofrost botol 418,176.00 -
-
-
-
-
-
-

JUMLAH

Mengetahui, Sumenep, 31 Desember

Kepala Puskesmas Raas Pengelola Obat

H.HERMANTO apt. R. AYU RIFQA Z. H, S.

NIP. 19690717 199003 1 007 NIP. 19951031 202012 2
TOTAL HARGA

-
-
-
-

-
-
-
-
-
-
-
244,200.00
-
-
-
-

-
1,925,000.00
-
-
-
-
1,650,000.00
-
3,300,000.00
-
2,200,000.00
-
550,000.00
-
-
-
 612,850.00
64,000.00
-
-
-
-
-
3,300,000.00
-
-
-
-
-
112,000.00
358,400.00
-
-

-
-
-

-
-
-
-
-
-
409,200.00
-
-
-
-
-
-
868,500.00
-
-
-
-
-
-
 -
-
-
-
-
-
-
-
-

15,594,150.00

Sumenep, 31 Desember 2020

Pengelola Obat

apt. R. AYU RIFQA Z. H, S.Farm

NIP. 19951031 202012 2 001
 NERACA OBAT PUSKESMAS RAAS
PER 31 DESEMBER 2020
DINAS KESEHATAN KABUPATEN SUMENEP

NO NAMA OBAT KEMASAN Harga Satuan JKN

Jml
Gudang

1 Albendazol susp 200 mg/5 ml botol -

2 Albendazol tab 400 mg tablet - -
3 Allopurinol 300 mg tab 419.98 -
4 Alprazolam 0.25 mg tab -
5 Alprazolam 0.5 mg tab -
6 Aminofilin tab tab -
7 Aminophilin inj 24 mg / ml ampul 2,976.00 -
8 Amitriptilin 25 mg tab 167.00 -
9 Amlodipin 10 mg tab 70.00 -
10 Amlodipin 5 mg tab 99.00 -
11 Amoksisilin 250 mg kapsul 196.00 -
12 Amoksisilin 500 mg tablet 249.00 -
Amoksisilin sir ker Forte 250
13 botol 3,628.00 -
mg/5 ml
14 Ampisilin injeksi 1000 mg vial -
15 Antasida DOEN suspensi tab 1,995.00 -
16 Antasida DOEN tablet kunyah tab -
Antibakteri DOEN salep kulit :
17 Basitrasin 500 IU/g + Polimiksin tube -
10000 IU/g

18 Antihemoroid doen kombinasi supp -

Aqua Pro injeksi steril bebas

19 vial 2,860.00 -
pirogen (OTSU - WI)
Asam Askorbat (Vitamin C) tab50
20 tablet -
mg
21 Asam Folat tab 1 mg tab 75.00 -
22 Asam Mefenamat 500 mg tablet -

23 Asam Traneksamat 500 mg tab tab -

24 Asam Traneksamat inj 50 mg/ml vial 1,748.00 -

25 Asetosal 80 mg (Miniaspi) tab 99.00 -

26 Asiklovir 200 mg tablet -
27 Asiklovir 400 mg tablet 405.00 -
28 Asiklovir krim 5 % tube 5 gram 3,080.00 -
Atropin inj i.m/i.v/s.k/ 0.25 mg/ml
29 amp -
(sulfat)
30 Attapulgit tab 162.00 -
31 Betahistine mesilate 6 mg tab -

32 Betametason krim 0.1 % 5 gram tube 1,340.00 -

33 Bisakodil tab 5 mg tab 319.00 -

34 Bisoprolol 2,5 mg (Concor) -
35 Bisoprolol 5 mg tab -
Cairan inhalasi Budesonid
36 0,25mg/mL, respoules 2 mL can 9,725.00 35
(Pulmicort Respules) 35
Cairan Inhalasi Ipratropium 0,5
37 mg + Salbutamol 2,5 mg / vial 4,550.00 -
Combivent UDV
38 Cairan inhalasi Terbutalin / Bric nebules 11,960.00 -
Chlorfeniramina Maleat 4 mg
39 tab -
(CTM)
40 Deksametason injeksi i.v 5 mg / m ampul 1,097.00 -
41 Deksametason tab 0.5 mg tab 89.10 -
Diazepam Enema 10 mg/2,5 ml /
42 tube -
Stesolid Enema 10
Diazepam Enema 5 mg/2,5 ml /
43 -
Stesolid Enema 5
44 Diazepam injeksi 5 mg / ml amp 1,735.00 -

45 Difenhidramin injeksi 10 mg / ml ampul 1,095.00 -

46 Digoksin tab 0,25 mg tab -

47 Diklofenak Kalium 50 mg tablet 115.00 -
48 Diklofenak Natrium 25 mg tab -
49 Diklofenak Natrium 50 mg tab -
50 Diltiazem 30mg tab 142.00 200 200
51 Dimenhidrinat tab 50 mg tab 112.00 -
52 Domperidon 10 mg tab 91.00 -

53 Domperidon susp 5 mg / 5 ml botol 2,700.00 -

54 Dopamin inj 40 mg/ml amp -

55 Dulcolax supp adult 10 mg supp 5,900.00 -
56 Dulcolax supp infant 5 mg supp -
Epinefrin / Adrenalin inj 0.1 ml
57 amp 1,408.00 -
(sebagai Hcl)

58 Ergotamin 1mg + kafein 50 mg tab 185.00 -

59 Eritromisin 250 mg kapsul 546.00 -

60 Eritromisin 500 mg tablet 770.00 -
Eritromisin syr kering 200 mg/5
61 botol -
ml
62 Etil Klorida Spray via/can/100ml 165,000.00 -
63 Fenitoin inj 50 mg/ml amp -
64 Fenobarbital tab 30 mg tab 171.00 100 100
65 Fenofibrat kaps 300 mg kap -

66 Fenol Gliserol tetes telinga 10 % btl 2,590.00 -

Fitomenadion (vitamin K1) inj 2

67 amp 3,682.00 -
mg/ml
Fitomenadion tab salut gula10
68 tab 3,682.00 -
mg (Vit. K1)
Furamin inj (Vit. B1 +
69 ampul -
Fursultiamin 2,5 mg/ml)
70 Furosemide injeksi 10 mg/ml amp 1,333.00 -
71 Furosemide tab 40 mg tab 77.00 -
72 Garam Oralit sachet 257.00 -
73 Gemfibrozil 300 mg kapsul 372.00 -
74 Gentamicin sulfat tetes mata 0,3 botol 4,232.00 -
75 Gentamisin sulfat salep mata tube 3,5 gr 2,675.00 -
gigi 3M 44030 CAVIT RF 28G
76 -
BOTTLE

gigi 3M 4862A2 BULK FLOW

77 -
REST 2G SYR 2/BG CEEMEA

gigi 3M 4862A3 BULK FLOW

78 -
REST 2G SYR 2/BG CEEMEA

gigi 3M 7018D Z350 XT UR SYR

79 -
DUAL KIT LA/APAC
gigi A2 Z250 XT/FILTEX Z250
80 -
XT WARNA A2
gigi A3 P60 posterior /FILTEX
81 -
P60 WARNA A3
 gigi ARTICULATING PAPER
82 -
SVENSKA

gigi Biodinamica Clorexoral 2%

83 (Chlorheksidin Diglukonat) botol -
200ml

84 gigi Biodinamica Frutti Flour Gel -

gigi Bonding / cairan dasar

85 -
tumpatan
86 gigi CAL LC -
gigi Caviton (Tambalan cavitas
87 -
sementara)
88 gigi Celluloid strip -

gigi Creshopen (Bahan sterilisasi

89 -
lengkap pada saluran akar gigi)

90 gigi Cresotin Liquid No. 2 -

gigi Denpro - Liquid Prevest
91 -
Denpro Hyposol
92 gigi Denpro Cal LC -
93 gigi Denpro Camphenol -
94 gigi Denpro Pulp-X -
95 gigi Denpro Zinc F -
gigi Edenta Composit Finishing
96 -
Kit
97 gigi Etchant gel vial -
98 gigi Eugenol -
99 gigi Fuji 1-1 Gold Label -
gigi Glass ionomer fuji IX ART
100 (Atraumatic Restorative -
Treatment)
101 gigi Hemostal -
102 gigi MICRON SUPERIOR -
gigi Surgical ginggival pack pasta
103 -
( coepack)

gigi Svenska Dentorama

104 -
Cellulose Matrix Strip box isi 100

gigi Svenska Dentorama Saliva

105 -
Ejector pack isi 100
 gigi Technew HYDCAL - PASTE,
106 -
BASE DAN CATALYST

gigi TehnoDent Calcetin Calcium

107 -
Hydroxide Paste
gigi TehnoDent POLIREN No.1
108 -
Polishing Paste
109 Glibenklamid tab 5 mg tablet 119.00 -
110 Glimepiride 1 mg tab -
111 Glimepiride 2 mg tablet 207.00 -
Glipizid tablet 5
112 tablet 3,090.00 300
mg(GLUCOTROL XL) 300
113 Gliseril Guaiakolat 100 mg tablet 121.00 -
114 Griseofulvin tab 125 mg tablet 245.00 -
115 Haloperidol 1,5 mg tab 59.00 -
116 Hidroklortiazida tab 25 mg tab 155.00 -
117 Hidrokortison krim 2.5 % tube -
118 Hiosin Butilbromid tab tablet -

Human Tetanus Imunoglobulin

119 prefilled syringe 176,800.00 -
i.m 250 IU (Tetagam)

120 Ibuprofen 400 mg tab tab 248.60 -

121 Ibuprofen suspensi 100 mg / ml btl 60 ml 372.00 -

Insulin analog fast acting inj 100

122 IU/mL, penfill cartridge pen 87,000.00 -
(NOVORAPID)

Insulin analog intermediate

acting combine with short or long
123 pen -
acting inj 100 IU/mL, penfill
cartridge (NOVOMIX 30)

Insulin human fast acting inj 100

124 vial -
IU/mL, vial 10 mL (Actrapid HM)

Isosorbid Dinitrat sublingual 5 mg

125 tab 165.00 -
(ISDN)
126 Kalsium Glukonas inj 10% amp 10,351.00 -
127 Kalsium Laktat tab 500 mg tab 63.00 -
128 Kaptopril 25 mg tab 116.40 -
129 Karbamazepin tab 200 mg tab -
130 Ketoconazole krim 2 % tube 15 gr 2,518.00 -
131 Ketokonazole tab 200 mg tab 288.00 -
132 Klindamisin 150 mg kap 715.00 -
133 Klindamisin 300 mg kapsul tab 1,599.95 950 950
134 Kloramfenicol 250 mg kapsul kap 310.00 1,000 1,000

135 Kloramfenicol Salep Mata 1 % tube 2,007.00 -

Kloramfenicol suspensi 125 mg/5

136 btl 60 ml 5,015.00 -
ml

137 Kloramfenicol Tetes Mata 0.5 % btl 5 ml -

Kloramfenicol tetes telinga 3 % 5

138 botol -
ml
139 Kloramfenikol Salep Kulit 2% 3,242.00 -
140 Klorfeniramin Maleat (CTM) tablet 22.00 -
141 Klozapin 25 mg tab 1,121.00 600 600
142 Kodein 10 mg tablet 571.00 3,600 3,600
143 Kodein 15 mg tab 987.00 4,000 4,000
144 Kodein 20 mg tab -
145 Kolkisin tab -

Kotrimoksasol suspensi
kombinasi suffametoksasol
146 botol 5,015.00 -
200mg dan trimetoprim 40 mg / 5
ml

147 Kotrimoksasol tab 480 mg tab 125.00 -

148 Kotrimoksazol Forte 960 mg tab 319.00 -
149 Laktulosa sir. 3,3335 gr/5 ml botol -
Larutan infus Asering / WIDA
150 softbag -
BES
151 Larutan Infus Asering 5 botol 500 ml -

152 Larutan infus D10 / Glukosa 10% btl 500 ml 8,003.00 -

Larutan infus D40 /Glukosa 40

153 ampul -
%
154 Larutan Infus D5 - ¼ NS botol 9,724.00 200 200
155 Larutan Infus D5 - ½ NS botol 9,776.00 300 300
156 Larutan Infus D5 - NS botol 8,346.00 -

157 Larutan infus D5 / Glukosa 5% btl 500 ml 7,363.00 200

200
158 Larutan infus Ka En 1B botol -
159 Larutan infus Ka En 3A btl / 500 ml -
160 Larutan infus Ka En 3B botol -
161 Larutan infus Ka En Mg3 softbag -
Larutan Infus Natrium Klorida
162 btl 500 ml 6,840.00 -
0.9 %
Larutan Infus Ringer D5 / WIDA
163 botol -
RD
164 Larutan infus Ringer Laktat btl 500 ml 7,630.00 300 300
165 Lidokain inj 2% amp 1,226.00 -

Lidokain injeksi 2 %
166 vial -
(Hcl+epinefrin) 1 : 80.000 - 2 ml

Lidokain jel 2% (Xylocain JELLY

167 syringe -
2%)
Lidokain spray oral 10%
168 botol -
(Xylocain SPRAY)
169 Loratadin 10 mg tab 131.00 -
170 Lorazepam 0,5 mg tab 379.00 -
Magnesium Sulfat inj 20 % - 25
171 vial -
ml
Magnesium Sulfat inj 40 % - 25
172 vial 3,796.00 -
ml
173 Metamizol inj amp 3,500.00 -
174 Metampiron tablet 500 mg tab -
175 Metformin 850 mg tablet 150.00 -

176 Metildopa tab 250 mg / Dopamet tab 946.00 -

Metilergometrin Maleat inj 0.200

177 amp 2,959.00 -
mg-1 ml
Metilergometrin Maleat tab salut
178 tablet 210.00 -
0,125 mg
179 Metilprednisolon 4 mg tab 134.00 -
180 Metoklopramid 10 mg tab 85.00 -
181 Metoklopramide inj 5 mg/ml ampul -
Metronidasol infus 500 mg /
182 botol -
100ml
183 Metronidasole tab 250 mg tab -
184 Metronidasole tab 500 mg tab 180.00 -

185 Metronidazol susp 125 mg/5 ml botol 3,950.00 -

186 N-asetil sistein tab 350.00 -

187 Nistatin tablet salut 500.000 IU/g tab -

188 Nistatin suspensi 100.000 IU/mL botol 20,570.00 -

Nistatin vaginal tablet 100.000

189 tab -
IU/g
190 Oksigen 1 m ³ tabung 44,000.00 -
191 Oksigen 6 m ³ tabung 77,000.00 -

192 Oksitosin injeksi 10 IU/ml - 1 ml amp 1,199.00 -

193 Omeprazol serb inj 40 mg vial 10,393.00 -

194 Omeprazole 20 mg kap 139.00 -

195 Ondansetron injeksi 4 mg/2 ml ampul 1,070.00 -

Oxymetazolin tts hidung 0,025%

196 botol -
(Iliadin)
Oxymetazolin tts hidung 0,05%
197 botol -
(Iliadin)
Parasetamol 1000 mg/100 ml
198 btl 100 ml -
infus

199 Parasetamol srp 125 mg/ 5 ml botol 1,107.00 -

200 Parasetamol tab 500 mg tab 53.00 -

201 Permetrin krim 5% (Scabimite) tube 11,825.00 -

Piridoksin (Vitamin B6) tab 10

202 tab 131.00 -
mg (Hcl)
203 Prednison 5 mg tablet 73.00 -
204 Propanolol 10 mg tab 58.00 -
205 Propiltiourasil 100 mg tab -
206 Ranitidin inj 25 mg/ml amp -
207 Risperidon 2 mg tab 273.00 -
208 Risperidone 1 mg tab 240.00 -
209 Salbutamol 4 mg tab 67.00 -

Salep 2-4 kombinasi asam

210 pot 2,796.00 -
salisilat 2 % belerang endap 4 %

211 Salisil Bedak 2% box 50 gr -

212 Sefadroksil 500 mg kap 478.00 -
Sefadroksil syrup kering 125 mg /
213 botol -
5 ml
 Sefadroksil syrup kering 250 mg /
214 botol 5,549.00 -
5 ml
215 Sefotaksim injeksi 1 gram vial 6,367.00 -
216 Seftriakson injeksi ampul 4,483.00 -
217 Serum Anti Bisa Ular / SABU vial 5 ml -
Serum Anti Tetanus /ATS 1500
218 ampul 1 ml -
IU

219 Sianokobalamin inj 500 mcg/ml amp -

220 Sianokobalamin tablet 50 mcg tab -

221 Simvastatin 10 mg tablet 117.00 -

222 Simvastatin 20 mg tab 217.00 -
223 Siprofloksasin 500 mg tab tab -
224 Spironolakton 25 mg tab tablet -
225 Sulfadiazin Silver Krim 1% tube 35 gr 20,700.00 -
Terbutalin inj 0,5 mg/ml
226 amp 11,960.00 -
(Bricasma inj sk/iv 0,5 mg/ml)
227 Thiamin Hcl tab 50 mg tab -

228 Tiamazol 5 mg (THYROZOL 5) tablet -

229 Topiramat 25 mg (Topamax) tab -

230 Triheksifenidil tablet 2 mg tab 91.00 1,000 1,000
231 Vitamin B Kompleks tablet 89.00 -
Zinc elemental 10 mg/ml (Zincpro
232 botol 6,281.00 62
drops) 62
233 Zinc tab dispersible 20 mg tab 524.00 -
234 Ringer lactat (rl infus) botol 7,150.00 2,200 2,200
-
TAMBAHAN -
-
-
235 Becefort syrup botol 17,365.00 17 17
236 Becefort tablet 1,548.00 -
237 Pehacain injeksi ampul 3,919.00 -
238 Bioron tablet 979.00 -
239 Lanzoprazol kap 303.00 30 30
240 Chloramex 500mg tablet 1,090.00 -
241 Ofloxacin 400 tablet 553.00 2,700 2,700
242 Geriavita tablet 2,180.00 1,080 1,080
243 Dermasolon tube 5,408.00 -
244 Fucilex tube 4,699.00 -
245 Optiflox tts mata botol 18,000.00 -

JUMLAH

Mengetahui, Sumenep, 31 Desember 2020

Kepala Puskesmas Raas Pengelola Obat

H.HERMANTO apt. R. AYU RIFQA Z. H, S.Farm

NIP. 19690717 199003 1 007 NIP. 19951031 202012 2 001
TOTAL HARGA

-
-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
 -
-
-

-
-

-
-
-

340,375.00

-
-

-
-
-
-
28,400.00
-
-

-
-
 -

-
-

-
-
17,100.00
-

-
-
-
-
-
-

-
-

-
-
-
-

-
-
-

-
-

-
 -

-
-
-

927,000.00

-
-
-
-
-
-

-
-
-
-
 -
-
-
1,519,952.50
310,000.00

-
-
672,600.00
2,055,600.00
3,948,000.00
-
-

-
-
-

1,944,800.00
2,932,800.00
-

1,472,600.00

-
-
 -
-

2,289,000.00
-

-
-

-
-
-

-
-
-

-
-

-
-

-
-

-
-

-
-
-
-
-
-
-

-
-

-
 -

-
-
-

-
-
-
-
-

-
91,000.00
-

389,422.00

-
15,730,000.00
-
-
-
-
295,205.00
-
-
-
9,090.00
-
1,493,100.00
2,354,400.00
-
 -
-

38,820,444.50

Sumenep, 31 Desember 2020

Pengelola Obat

pt. R. AYU RIFQA Z. H, S.Farm

NIP. 19951031 202012 2 001