Apotek Pesanan Obat Farmasi

SURAT PESANAN
Nomor SP : / K-24 PBK / K / 09 / 2021
Yang bertanda tangan di bawah ini :

Nama : apt. Thryana Tunggal Dewi, S.Farm.
Jabatan : Apoteker Pengelola Apotek
Nomor SIPA : 19850914/SIPA_32.01/BPMPTSP/216/2-000192
Mengajukan pesanan Obat Farmasi kepada :

Nama PBF : PT. Tifany Usaha Mandiri
Alamat : Jl. Raya Pasar Minggu No. 15B RT 13 / RW 05, Pasar Minggu, Jakarta Selatan
Telp. : (021) 22793565
Jenis obat yang dipesan adalah :

NO NAMA BARANG QTY SATUAN
1 ALLOPURINOL HEXPHARM 100MG TAB 100S 1 DOS
2 AMLODIPINE HEXPHARM 10MG TAB 100S 5 DOS
3 AMLODIPINE HEXPHARM 5MG TAB 100S 5 DOS
4 AMOXSAN 125MG/5ML D SYR 60ML 3 BTL
5 ASAM MEFENAMAT HEXPHARM 500MG CAPL 100S 1 DOS
6 ASPILETS 80MG CHEW TAB 100S 2 DOS
7 ATORVASTATIN HEXPHARM 20MG TAB 30S 3 DOS
8 BAQUINOR F 500MG TAB 20S 1 DOS
9 BENOSON N CR 5G 2 TUBE
10 BETASON N CR 5G 10 TUBE
11 BIOPLACENTON GEL 15G 5 TUBE
12 BISOPROLOL FUMARATE NOVELL 5MG TAB 100S 1 DOS
13 BODREX FLU&BATUK TIDAK BERDAHAK SYR 60ML 3 BTL
14 C EYEFRESH MD 0.6ML 2 PCS
15 C FENICOL EYE OINT 3.5G 1 TUBE
16 C TOBRO EYE DROP 5ML 3 TUB
17 CANDESARTAN DEXA 8MG TAB 30S 2 DOS
18 CATAFLAM 50MG TAB 50S 3 DOS
19 CEFIXIME NOVELL 200MG CAP 50S 1 DOS
20 CEFSPAN 200MG FC CAPL 10S 1 BOX
21 CERINI 10MG TAB 20S 2 DOS
22 CETIRIZINE HEXPHARM 10MG FC TAB 100S 5 DOS
23 CINOLON N CR 5G 2 TUBE
24 CLANEKSI 125MG/5ML D SYR 60ML 1 BTL
25 CLONIDINE KF 0.15MG TAB 100S 2 DOS
26 COLSANCETINE 125MG/5ML SUSP 60ML 2 BTL
27 DEXAHARSEN 0.5MG CAPL 200S 1 DOS
28 DEXTEEM PLUS TAB 100S 3 DOS
29 DIAMICRON MR 60MG TAB 30S 2 DOS
30 DIPROSONE OV CR 10G 2 TUBE
31 EPEXOL 15MG/ML DROP 20ML 2 BTL
32 EPEXOL 30MG TAB 100S 1 DOS
33 EPISAN 500MG/5ML SUSP 100ML 3 BTL
34 EPISAN 500MG/5ML SUSP 200ML 3 BTL
35 FLUIMUCIL 200MG CAP 60S 3 DOS
36 FUKRICIN 5% EYE DROP 5ML 2 BTL
37 GLAUSETA 250MG TAB 100S 1 DOS
38 GLIBENCLAMIDE IF 5MG TAB 100S 1 DOS
39 GLUDEPATIC 500MG TAB 100S 1 DOS
40 GLYCERYL GUAIACOLATE TRIMAN 100MG TAB 100S 1 DOS
41 HCT KF 25MG TAB 100S 3 BOX
42 HERBESSER CD 200MG CAP 30S 1 DOS
43 HEXILON 8MG TAB 30S 1 DOS
44 HISTRINE 5MG/5ML SYR 60ML 3 BTL
45 HYPERIL 5MG TAB 60S 1 DOS
46 IBUPROFEN PROMED 400MG TAB 100S 1 DOS
47 INCIDAL OD 10MG CAP 50S 2 DOS
48 ISONIAZIDE/INH KF 300MG TAB 100S 1 DOS
49 ISOSORBIDE DINITRATE IF 5MG TAB 100S 2 BOX
50 KETOMED 2% GEL 15G 3 TUB
51 KETOMED SS 2% SHAMPO 60ML 1 BTL
52 LANSOPRAZOLE HEXPHARM 30MG CAP 50S 3 DOS
53 LERZIN 10MG CAPL 50S 1 DOS
54 LERZIN SYR 60ML 2 BTL
55 MEFINAL 500MG TAB 100S 1 DOS
56 MELOXICAM HEXPHARM 15MG TAB 50S 1 DOS
57 METFORMIN DEXA 850MG TAB 100S 2 DOS
58 METFORMIN HEXPHARM 500MG TAB 100S 4 DOS
59 METHYLPREDNISOLONE HEXPHARM 4MG TAB 100S 2 DOS
60 METHYLPREDNISOLONE NOVELL 8MG TAB 100S 1 DOS
61 MUCERA FORTE 30MG/5ML SYR 60ML 5 BTL
62 MUCOPECT 7.5MG/ML DROP 20ML 3 BTL
63 MUCOS 15MG/5ML SYR 60ML 6 BTL
64 NA DIKLOFENAK 50MG TAB 50S 1 DOS
65 NEURALGIN RX TAB 100S 2 DOS
66 OMEPRAZOLE HEXPHARM 20MG CAP 200S 1 DOS
67 OROXIN SYR 60ML 3 BTL
68 PANTOPRAZOLE MAHAKAM 40MG TAB 10S 1 DOS
69 PI KANG SHUANG HIJAU CR 5G 6 TUBE
70 PIROFEL 0.5% GEL 20G 2 TUBE
71 PIROXICAM KF 10MG TAB 100S 2 DOS
72 PULMICORT RESP 1MG/ML 2ML AMPUL 20S 1 BOX
73 RANITIDINE HEXPHARM 150MG TAB 100S 3 DOS
74 REFAQUIN CR 15G 1 TUBE
75 RHINATHIOL 100MG/5ML INFANT SYR 100ML 2 BTL
76 RHINOFED TAB 50S 1 DOS
77 RIFAMPICIN KF 450MG TAB 100S 1 DOS
78 SAGESTAM 0.1% OINT 10G 2 TUBE
79 SANPRIMA 240MG/5ML SUSP 60ML 2 BTL
80 SIMARC-2 2MG TAB 100S 1 DOS
81 SIMVASTATIN HEXPHARM 10MG TAB 100S 2 DOS
82 SIMVASTATIN HEXPHARM 20MG TAB 100S 2 DOS
83 TOSMA 1MG/5ML SYR 60ML 1 BTL
84 TRADOSIK 50MG CAP 100S 1 DOS
85 TRANEXAMIC ACID BERNOFARM 500MG FC TAB 100S 1 DOS
86 TRICHODAZOL 500MG TAB 100S 1 DOS
87 ULSAFATE SUSP 100ML 2 BTL
88 URISPAS 200MG TAB 30S 1 BOX
89 VENTOLIN INH 100MCG/PUFF 200 DOSE 3 PCS
90 VOLTADEX 1% GEL 20G 2 TUBE
91 VOLTADEX 50MG TAB 50S 2 DOS
92 VOLTAREN 1% GEL 10G 2 TUBE
Nama Apotek : K-24 Pemda Bambu Kuning

Alamat Lengkap : Jl. Pemda Bambu Kuning, Ruko Graha Kartika Pratama Blok C / 5
Surat Izin Apotek : 449.1/031/00045/DPMPTSP/2017
BOGOR, 20 SEPTEMBER 2021
apt. Thryana Tunggal Dewi, S.Farm.

No. SIPA : 19850914/SIPA_32.01/BPMPTSP/216/2-000192
SURAT PESANAN
Nomor SP : / K-24 PBK / B / 09 / 2021


Telp. : (021) 22793565

1 AL JAZIRA SARI KURMA 360G 3 BTL
2 ALBUSMIN CAP 30S 2 BOX
3 AMBEVEN CAP 10S STRIP 10S 1 DOS
4 ANGKAK 500G 3 BTL
5 ANTANGIN JUNIOR MADU + MENIRAN 10ML SACH 5S 2 DOS
6 ANTASIDA DOEN AFI SUSP 60ML 5 BTL
7 ANTASIDA PROMED 400MG TAB 100S 2 DOS
8 APIALYS DROP 10ML 5 BTL
9 APIALYS SYR 100ML 8 BTL
10 ASEPSO SOAP 80G 2 PCS
11 ASIFIT CAP 30S BTL 3 BTL
12 BECOM C TAB 100S 4 DOS
13 BECOM ZET TAB 100S 4 DOS
14 BEJO HERBAL JAHE MERAH 15ML SACH 12S 3 BOX
15 BENTRAP 3G SACH 2S 2 PCS
16 BERLOSID SUSP 60ML 2 BTL
17 BLACKMORES KOALAKIDS FRUITY FISHIES CAP 30S BTL 2 BTL
18 BLACKMORES MULTIVITAMIN&MINERAL TAB 30S BTL 1 BTL
19 BODREX TAB 20S 2 DOS
20 BODREXIN DEMAM SYR 60ML 2 BTL
21 BYE BYE FEVER ANAK 5 DOS
22 BYE BYE FEVER BAYI 3 DOS
23 CAVIPLEX CDEZ CAPL 60S BTL 1 BTL
24 CDR EFF 10S TUBE 5 PCS
25 CDR FORTOS EFF 10S TUBE 5 BTL
26 CDR FRUIT PUNCH EFF 10S TUBE 10 PCS
27 COMBANTRIN JERUK SUSP 10ML 5 BTL
28 CURCUMA PLUS GROW EMULSION STRAWBERRY 400ML 3 BTL
29 CURVIT CL EMULSION 175ML 2 BTL
30 DECUBAL CR 20G TUBE 2 BTL
31 DOLO NEUROBION TAB 100S 1 DOS
32 EAZYCAL TAB 30S 1 DOS
33 ENERVON ACTIVE FC TAB 30S BTL 5 BTL
34 ENERVON C TAB 30S BTL 5 BTL
35 ENERVON C TAB 4S STRIP 25S 1 DOS
36 ENTROSTOP HERBAL ANAK 10ML SACH 6S 2 DOS
37 ETHYLCHLORIDE DUTA KAISAR 100ML SPRAY 1 PCS
38 EVER E 250IU SOFTCAP 30S BTL 2 BTL
39 FERRIZ DROP 15ML 2 BTL
40 FOLAMIL GENIO SOFTCAP 30S BTL 3 BTL
41 FRESH CARE MINYAK ANGIN STRONG 10ML 5 PCS
42 GIOVAN ANTISEPTIK 100ML 2 BTL
43 GIOVAN SOAP FRESH 100ML 3 BTL
44 HAU FUNG SAN 1G 12 PCS
45 HI D 5000IU CHEW TAB 30S 6 DOS
46 HOLISTICARE SUPER ESTER C KIDS CHEW TAB 30S BTL 5 BTL
47 IBU DAN ANAK OBAT BATUK 150ML 2 BTL
48 IMBOOST FORCE TAB 30S 4 DOS
49 IMUNPED SYR 60ML 5 BTL
50 KANNA CR 30G 1 PCS
51 KAPAK MINYAK ANGIN 56ML 2 PCS
52 KASA STERIL HUSADA 16X16 15 PCS
53 KONILIFE VISION SOFTCAP 30S BTL 1 PCS
54 KOYO CABE 20S 1 DOS
55 LACTACYD ALL DAY CARE 150ML 2 BTL
56 LACTACYD BABY 230ML 2 BTL
57 LACTO B SACH 40S 1 DOS
58 LACTULAX SYR 120ML 2 BTL
59 LANAMOL 500MG TAB 100S 1 DOS
60 LANG INHALER 1.1G 1 DOS
61 LANG MKP 120ML 7 PCS
64 MADU SUPER NUSANTARA 100ML 3 BTL
65 MAPOH 5.5G BTL 3 PCS
66 MARIMER ISOTONIC NASAL SPRAY 100ML 2 PCS
67 MEDICATED OIL 12ML 2 BTL
68 MILO ACT-E 200ML 10 BTL
69 MIRASIC 500MG CAPL 100S 1 DOS
70 MYLANTA SUSP 50ML 10 BTL
71 NATUR E 100IU SOFTCAP 16S 6 DOS
72 NATUR E 100IU SOFTCAP 32S 3 DOS
73 NEO KAOLANA SUSP 120ML 3 BTL
74 NEO RHEUMACYL OTOT&SENDI HOT CR 30G 2 TUBE
75 NEO RHEUMACYL TAB 20S 1 DOS
76 NEPHRISOL VAN 201G 10 PCS
77 NEPHRISOL-D VANILA 210G 3 BOX
78 NEW DIATABS TAB 4S STRIP 25S 1 DOS
79 NICE FACIAL TISSUE 2PLY 180S 3 PCS
80 NOROID DERMA RASH CR 60ML TUBE 1 PCS
81 NUTRAHEALTH BETA CAROTENE 15MG SOFTCAP 30S BTL 2 BTL
82 NUTRINI DRINK VANILA 200ML BTL 5 BTL
83 NUTRINI DRINK VANILA 400G KALENG 4 KLG
84 OB HERBAL SYR 60ML 5 BTL
85 OBH COMBI MENTHOL SYR 100ML (GEPENG) 15 BTL
86 OBH COMBI PLUS BATUK FLU MENTHOL SYR 100ML 10 BTL
87 OBH ITRASAL SYR 100ML 3 BTL
88 OILUM SOAP BRIGHTENING SCRUB 85G 2 PCS
89 OLIGOCARE FOR MEN TAB 6S STRIP 5S 1 DOS
90 OREZINC 20MG/5ML SYR 60ML 1 BTL
91 OSTEOCAL TAB 72S 1 DOS
92 PANADOL BIRU TAB 100S 2 DOS
93 PARACETAMOL PROMED 500MG TAB 100S 2 DOS
94 PIGEON BOTOL PP PERISTALTIC NIPPLE 240ML 1 PCS
95 PIGEON BOTOL PP RP STD CHARACTER 240ML 2 BTL
96 PLOSSA BLUE MOUNTAIN ROLL ON 8ML & INHALER 2ML 1 BOX
97 PLOSSA RED HOT ROLL ON 8ML & INHALER 2ML 1 BOX
98 POLYSILANE SUSP 100ML 5 BTL
99 PRAXION FORTE 250MG/5ML SUSP 60ML 2 BTL
100 PROMAG CHEW TAB 10S STRIP 3S 3 DOS
101 PROMAG GAZERO 10ML SACH 6S 2 DOS
102 PRORIS 100MG/5ML SUSP 60ML 5 BTL
103 PROVE D3 1000IU FC TAB 30S 6 DOS
104 REDOXON ZINC EFF ORANGE 15S TUBE 20 PCS
105 RENU FRESH MULTI PURPOSE SOL 355ML 2 BTL
106 RILLUS TAB CHEW 30S 1 DOS
107 SAKATONIK ABC STRAW 30S BTL 10 BTL
108 SANBE TEARS EYE DROP 8ML 5 BTL
109 SANGOBION CAP 10S STRIP 25S 1 DOS
110 SANMOL 120MG/5ML SYR 60ML 48 BTL
111 SANMOL 60MG/0.6ML DROP 15ML 4 BTL
112 SARI KURMA MADINAH 3 BTL
113 SCOTTS EMULSION ORIG 200ML 3 BTL
114 SCOTTS EMULSION ORIG 400ML 3 BTL
115 SEBAMED BABY DIAPER RASH CR 100ML 2 TUB
116 SELSUN GOLD 120ML 2 PCS
117 SEVEN SEAS KIDS SYR 100ML 2 BTL
118 SGM ANANDA 6-12BLN 400G BOX 2 PCS
119 SHEN NONG SHI DIE DA YAO JING 30ML 2 PCS
120 SIDOMUNCUL VIT C 1000MG ORANGE SACH 6S 3 PCS
121 STIMUNO GRAPE SYR 100ML 3 BTL
122 STREPSILS COOL SACH 12S 1 DOS
123 TANTUM VERDE GARGLE 120ML 1 PCS
124 TEMPRA DROPS 15ML 5 BTL
125 TEMPRA SYR 60ML 10 BTL
126 THERAGRAN M TAB 4S STRIP 25S 1 DOS
127 THROMBOPHOB GEL 20G 3 TUBE
128 TOLAK ANGIN CAIR+MADU 15ML SACH 12S 1 KARTON
129 TOLAK ANGIN LOZ SACH 15S BOX 1 DOS
130 VENARON CAP 100S 1 DOS
131 VERMINT FORTE CAP 30S 3 BTL
132 VIDORAN SMART STRAW TAB 30S BTL 5 BTL
133 VITACIMIN LEMON TAB 2S STRIP 50S 2 DOS
134 VITALONG C CAP 4S STRIP 25S 1 DOS
135 VITAMIN B COMP IPI TAB 90S TUBE 12 BTL
136 VITAMIN C IPI TAB 50S TUBE 10 PCS
137 VOLTAREN 1% GEL 20G 2 TUBE
138 VOSEDON 5MG/5ML SUSP 60ML 3 BTL
139 XONCE TAB 2S STRIP 50S 1 DOS
140 YOU C 1000 ORANGE 140ML 15 BTL

SURAT PESANAN
Nomor SP : / K-24 PBK / ALK / 09 / 2021


Telp. : (021) 22793565

1 ABBOCATH 22 2 PCS
2 BD DISP SPUIT 10CC 10 PCS
3 BD DISP SPUIT 5CC 10 PCS
4 EASY TOUCH GLUCOSE STRIP 25S (PACK) 2 PCS
5 HANSAPLAST ROL 1.25CMX5M 15 PCS
6 HUSADA VERBAN 10CM 2 PCS
7 HUSADA VERBAN 7CM 2 PCS
8 LIFREE POPOK CELANA DEWASA L 1S 5 PCS
9 LIFREE POPOK CELANA DEWASA XL 3S 2 PCS
10 MAMY POKO NEW BORN 4S 3 PCS
11 ONE SWABS ALKOHOL SWAB 100S 2 PCS
12 OVUTEST STRIP 10S 2 PCS
13 RINGER LACTATE WIDA INFUS 500ML TUTUP KARET 5 KLB
14 SENSI GLOVES LATEX PWD M 100S 2 DOS
15 SUTRA KONDOM 12S 2 PCS
16 TEGADERM 1626 3 PCS
17 TENSOCREPE 7.5CM 1 PCS
18 TERUMO DISP SPUIT 10ML 10 PCS
19 URINAL PRIA 3 PCS


SURAT PESANAN OBAT MENGANDUNG PREKURSOR FARMASI
Nomor SP : / K-24 PBK / 09 / 2021

Mengajukan pesanan obat mengandung Prekursor Farmasi kepada :

Telp. : (021) 22793565
Jenis obat mengandung Prekursor Farmasi yang dipesan adalah :

NO NAMA BARANG
1 ALPARA SYR 60ML

2 BODREX FLU&BATUK BERDAHAK SYR 60ML
3 BODREXIN FLU&BATUK PE SYR 56ML
4 DEXTRAL SYR 100ML
5 DEXTRAL SYR 60ML
6 FLUCADEX TAB 100S
7 HUFAGRIP BP SYR 60ML
8 HUFAGRIP FLU&BATUK SYR 60ML
9 KOMIX JAHE 7ML SACH 30S
10 KOMIX OBH 7ML SACH 30S
13 OBH COMBI PLUS BATUK FLU JAHE SYR 100ML
14 PANADOL COLD&FLU REG TAB 100S
15 PARATUSIN SYR 60ML
16 RHINOS JUNIOR SYR 60ML
17 RHINOS NEO 7.5MG/0.8ML DROP 10ML
18 RHINOS SR CAP 50S
19 SANADRYL DMP SYR 120ML
20 SANADRYL DMP SYR 60ML
21 TREMENZA SYR 60ML
22 TRIAMINIC PILEK SYR 60ML


SURAT PESANAN OBAT MENGANDUNG PREKURSOR FARMASI
Nomor SP : / K-24 PBK / 09 / 2021
/216/2-000192
rmasi kepada :
13 / RW 05, Pasar Minggu, Jakarta Selatan
an adalah :
KEKUATAN DAN
ZAT AKTIF JUML SAT KET
BENTUK SEDIAAN
Phenylpropanolamine HCl 12.5mg, Dextromethorphan HBr 15mg SYRUP 3 BTL
Pseudoephedrine HCl 7,5mg SYRUP 2 BTL
Pseudoephedrine HCl 7,5mg SYRUP 3 BTL
Phenylpropanolamine HCl 12,5 mg, Dextromethorphan HBr 10 mg SYRUP 3 BTL
Phenylpropanolamine HCl 12,5 mg, Dextromethorphan HBr 10 mg SYRUP 3 BTL
Phenylpropanolamine HCl 15mg, Dextromethorphan HBr 15mg TABLET 1 DOS
Dextromethorphan hbr 7,5 mg, Pseudoephedrine hcl 15 mg SYRUP 10 BTL
Pseudoephedrine hcl 7,5 mg SYRUP 20 BTL
Dextromethorphan HBr 15mg SYRUP 1 DOS
Dextromethorphan HBr 15mg SYRUP 1 BOX
Ephedrine HCl 2,5 mg SYRUP 5 BTL
Phenylephrine hcl 5 mg, Dextromethorphan HBr 15 mg TABLET 1 DOS
PSEUDOEPHEDRINE HCl 30mg, DEXTROMETHORPAN HBr 15mg SYRUP 5 BTL
Pseudoephedrine HCl 15 mg SYRUP 15 BTL
Pseudoephedrine HCl 120mg TABLET 2 DOS
Pseudoephedrine HCl 120mg SYRUP 10 BTL
Pseudoephedrine HCl 120mg SYRUP 10 BTL
Pseudoephedrine HCl 60 mg, Triprolidine HCl 2.5 mg SYRUP 3 BTL
a Kartika Pratama Blok C / 5
16/2-000192

Apotek Pesanan Obat Farmasi

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Apotek Pesanan Obat Farmasi

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SURAT PESANAN

Nomor SP : / K-24 PBK / K / 09 / 2021

Yang bertanda tangan di bawah ini :

Mengajukan pesanan Obat Farmasi kepada :

Jenis obat yang dipesan adalah :

Nama Apotek : K-24 Pemda Bambu Kuning

BOGOR, 20 SEPTEMBER 2021

apt. Thryana Tunggal Dewi, S.Farm.

Yang bertanda tangan di bawah ini :

Mengajukan pesanan Obat Farmasi kepada :

Jenis obat yang dipesan adalah :

BOGOR, 20 SEPTEMBER 2021

apt. Thryana Tunggal Dewi, S.Farm.

Yang bertanda tangan di bawah ini :

Mengajukan pesanan Obat Farmasi kepada :

Jenis obat yang dipesan adalah :

Nama Apotek : K-24 Pemda Bambu Kuning

BOGOR, 20 SEPTEMBER 2021

apt. Thryana Tunggal Dewi, S.Farm.

Yang bertanda tangan di bawah ini :

Mengajukan pesanan obat mengandung Prekursor Farmasi kepada :

Jenis obat mengandung Prekursor Farmasi yang dipesan adalah :

1 ALPARA SYR 60ML

Nama Apotek : K-24 Pemda Bambu Kuning

BOGOR, 20 SEPTEMBER 2021

apt. Thryana Tunggal Dewi, S.Farm.

13 / RW 05, Pasar Minggu, Jakarta Selatan

a Kartika Pratama Blok C / 5

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