PEMERINTAH KABUPATEN SAMPANG

DINAS KESEHATAN DAN KELUARGA BERENCANA

UPTD PUSKESMAS BRINGKONING
Jl. R. Praseno No. 53 Tlagah-Banyuates, Sampang Kode Pos 69263
Email : Puskesmas.bringkoning@gmail.com
Blog : puskesmas-bringkoning.com

DAFTAR RENCANA PEMBELIAN OBAT JKN TAHUN 2021

PUSKESMAS BRINGKONING

NO. NAMA OBAT SATUAN PEMBELIAN

1 Acyclovir Krim 5% Tube 300
2 Allopurinol Tablet 100 mg Tablet 10000
3 Ambroxol Tablet 30 mg Tablet 15000
4 Amoxicillin Sirup Kering 125 mg/5 ml Botol 1000
5 Amoxicillin 500 mg Kaplet 5000
Analgesik Kaplet Dismenorhea Kombinasi
6 Kaplet 300
(Procolic)
7 Anti Influenza Kombinasi (Demacolin) Tablet 10000
8 Asam Askorbat / Vitamin C Tablet 250 mg Tablet 10000
9 Asam Asetilsalisilat Tablet 80 mg (Miniaspi) Tablet 400
10 Asam Traneksamat Injeksi 50 mg/ml Ampul 200
11 Asam Traneksamat Tablet 500 mg Tablet 500
12 Betahistine Mesylate Tablet 6 mg Tablet 2000
13 Bioplacenton Tube 30
14 Calcium Lactate Tablet 500 mg (Novakal) Tablet 3000
15 Captopril Tablet 25 mg Tablet 10000
16 Cefadroxil Kapsul 500 mg Kapsul 5000
17 Cefotaxime Injeksi 1 g Vial 300
18 Cetirizin Tablet 10 mg Tablet 10000
19 Chloramphenicol Tetes Mata Botol 100
20 Ciprofloxacin Tablet 500 mg Tablet 3000
21 Dexamethasone Tablet 0,5 mg Tablet 15000
22 Epinephrine Injeksi Ampul 100
23 Gentamicin Salep Kulit 0.1% Tube 100
24 Gentamicin Tetes Mata 0,3% Botol 100
25 Glimepiride Tablet 4 mg Tablet 1500
26 Glukosa Larutan Infus 40 % Steril Botol 20
27 Glyceryl Guaiacolate Tablet 100 mg Tablet 10000
28 Ibuprofen Tablet 400 mg Tablet 3000
29 Ketoconazole Tablet 200 mg Tablet 3000
30 Lansoprazole Kapsul 30 mg Kapsul 3000
31 Levofloxacin Tablet 500 mg Tablet 2000
32 Loperamide Tablet 2 mg Tablet 5000
Ampul 25
33 Magnesium Sulfate Injeksi 40% 50
ml
34 Metamizole Tablet 500 mg Tablet 10000
35 Metamizole Injeksi 1g/2ml Ampul 500
36 Methylergometrine Maleat Injeksi 0,2 mg/ml Ampul 100
37 Metoclopramide HCl Drop Botol 10 ml 100
38 Metronidazole Tablet 500 mg Tablet 2000
39 Multivitamin dan Mineral (Becefort) Tablet 7000
40 Nifedipine Tablet 10 mg Tablet 10000
41 Obat Batuk Hitam ( O.B.H ) Sirup Botol 100 ml 100
42 Oxytetracycline HCl Salep Kulit 3% Tube 100
43 Oxytocin Injeksi 10 IU/ml Ampul 100
44 Permethrin Krim 5% (Scabimite) Tube 50
45 Piracetam Injeksi 1 g/5 ml Ampul 100
46 Piroxicam Tablet 20 mg Tablet 7000
47 Prednisone Tablet 5 mg Tablet 10000
48 Procurma Plus Sirup Botol 200
49 Ranitidine Injeksi 25 mg/ml Ampul 700
50 Salbutamol 2,5 mg (Ventolin Nebules) Ampul 200
Tambah Darah + Multivitamin Mineral
51 Tablet 5000
(Hemafort)
52 Thiamine / Vitamin B1 Tablet 50 mg Tablet 5000
53 Vitamin B Kompleks Injeksi (Biocombin) Ampul 500
54 Vitamin B Kompleks Tablet (Neurodex) Tablet 10000
55 Zinc Sulphate Sirup 20 mg/5 ml (Zircum Kid) Botol 60 ml 400
BELANJA OBAT-OBATAN

NO. NAMA OBAT SATUAN PEMBELIAN

56 Alat Suntik Sekali Pakai 2,5 ml Pcs 5000
57 Aseptic Gel + Dispenser Botol 500 ml
100
58 Bayclin Botol 10
59 Catgut Chromic 2/0 + Jarum Set 48
60 Catgut Chromic 3/0 + Jarum Set 48
61 Catgut Plain 3/0 + Jarum Set 48
62 Catgut Plain2/0 + Jarum Set 48
63 Foley Catheter 16 Pcs 80
64 Foley Catheter 18 Pcs 80
65 Larutan Klorin (One Clean) Botol 1 L 20
66 Larutan Lysol Botol 1 L 50
67 Masker Medis Box 180
68 Masker N95 Pcs 100
69 Mucus Extractor / Slem Secker Pcs 50
70 My Jelly Tube 82 gr 20
71 Nasal Oxygen Size L Pcs 300
72 Needle 23 (One Med/Terumo) Pcs 100
73 Needle 25 (One Med/Terumo) Pcs 100
74 Sarung Tangan Non Steril (M) Pcs 6000
75 Underpad Pcs 500
76 Surgical Gown Steril Non Woven Pcs 100
BELANJA OBAT-OBATAN LAINNYA

Menyetujui, Yang mengusulkan

Plt. Kepala Puskesmas Bringkoning Pj. Obat Puskesmas Bringkoning

Eka Agus Indriyati, Amd. Kep. SKM. Ach. Khairul Hidayat, S. Farm., A
NIP. 19790103 200501 2 011 NIP. 19940707 202012 1 005
TEN SAMPANG
UARGA BERENCANA
BRINGKONING
s, Sampang Kode Pos 69263
ning@gmail.com
koning.com

BAT JKN TAHUN 2021

ONING

HARGA TOTAL
3,740 1,122,000 (3,400)
209 2,090,000 (190)
132 1,980,000 (120)
3,850 3,850,000 (3,500)
396 1,980,000 (360)

2,970 891,000
(2,700)
550 5,500,000 (500)
462 4,620,000 (420)
759 303,600 (690)
4,620 924,000 (4,200)
2,090 1,045,000 (1,900)
396 792,000 (360)
24,420 732,600 (22,200)
176 528,000 (160)
132 1,320,000 (120)
847 4,235,000 (770)
7,480 2,244,000 (6,800)
132 1,320,000 (120)
9,240 924,000 (8,400)
506 1,518,000 (460)
154 2,310,000 (140)
8,030 803,000 (7,300)
10,120 1,012,000 (9,200)
11,880 1,188,000 (10,800)
1,353 2,029,500 (1,230)
12,430 248,600 (11,300)
99 990,000 (90)
385 1,155,000 (350)
1,177 3,531,000 (1,070)
891 2,673,000 (810)
660 1,320,000 (600)
 154 770,000 (140)

12,507 625,350
(11,370)
264 2,640,000 (240)
2,090 1,045,000 (1,900)
7,260 726,000 (6,600)
16,170 1,617,000 (14,700)
264 528,000 (240)
1,870 13,090,000 (1,700)
253 2,530,000 (230)

6,050 605,000
(5,500)
2,915 291,500 (2,650)
3,905 390,500 (3,550)
46,750 2,337,500 (42,500)
5,940 594,000 (5,400)
176 1,232,000 (160)
110 1,100,000 (100)
11,550 2,310,000 (10,500)
2,574 1,801,800 (2,340)
13,750 2,750,000 (12,500)

1,034 5,170,000
(940)
176 880,000 (160)
5,500 2,750,000 (5,000)
770 7,700,000 (700)
6,050 2,420,000 (5,500)
109,960,950

HARGA TOTAL
748 3,740,000 (680)

49,500
4,950,000 (45,000)
69,190 691,900 (62,900)
13,090 628,320 (11,900)
13,090 628,320 (11,900)
13,090 628,320 (11,900)
13,090 628,320 (11,900)
16,456 1,316,480 (14,960)
16,456 1,316,480 (14,960)
13,750 275,000 (12,500)
27,500 1,375,000 (25,000)
46,750 8,415,000 (42,500)
40,150 4,015,000 (36,500)
 7,480 374,000 (6,800)
35,200 704,000 (32,000)
8,470 2,541,000 (7,700)
2,805 280,500 (2,550)
2,805 280,500 (2,550)
2,002 12,012,000 (1,820)
4,114 2,057,000 (3,740)
146,410 14,641,000 (133,100)
61,498,140

Yang mengusulkan
Pj. Obat Puskesmas Bringkoning

ch. Khairul Hidayat, S. Farm., Apt.

NIP. 19940707 202012 1 005