LAPORAN PEMAKAKAIAN OBAT BPJS

TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : JANUARI 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Metronidazol syrup Btl - - - 3,454.00 -
2 Methyl Ergometrin Injeksi Ampul 45 45 45 - 2,440.00 -
3 Haloperidol 5 mg Tablet - - - 96.00 -
4 Alkohol 70% BOTOL - - - 2,500.00 -
5 Domperidon suspensi BOTOL 107 107 18 89 3,333.00 296,637
6 Domperidon 10 mg Tablet 10 10 - 10 167.00 1,670
7 Kalsium glukonas Amp 26 26 - 26 7,090.88 184,362.75
8 Hexymer 2 mg (THF) Tablet - - - 270.00 -
9 Glimepirid Tablet - - - 263.00 -
10 Kloramfecort Cream Tube 52 52 5 47 11,285.00 530,395
11 Cendo Polydex str - - - 29,150.00 -
12 Enervon C 120 ml btl - - - 17,118.00 -
13 Cendo Genta str - - - 17,463.00 -
14 As. Tranex injek Amp 352 352 352 5,250.00 1,848,000
15 Seftriaxon ij box 449 449 0 449 20,000.00 8,980,000
16 Ketorolak ij Amp - - - 5,455.00 -
17 Allerin expext syr Btl - - - 9,750.00 -
18 Aspilet Tablet - - - 530.00 -
19 Betason n Cr Tube 134 134 34 100 1,061.00 106,100
20 Kloramfenikol tetes mata Btl - - - 3,250.01 -
21 Thiampenikol Tablet 199 199 49 150 1,210.00 181,500 -
22 Lidokain injek Amp - - - 1,222.10 - -
23 Neosenta Salep Tube 4 4 2 2 19,958.00 39,916 -
24 Ambroxol Tablet - - - 144.00 - -
25 Ketopropen injeksi Amp 7 7 0 7 28,249.00 197,743 -
26 Amlodipin Tablet - - - 176.00 - -
27 L BIO Saset 14 14 14 - 6,600.00 - -
28 Glibenklamid Tablet - - - 198.00 - -
29 Skopma Plus Tablet - - - 2,596.00 - -
30 Sotatik injeksi Amp 1,119 1,119 19 1,100 4,400.00 4,840,000 -

Page 1 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
31 Spashi injeksi Amp 6 6 2 4 9,900.00 39,600 -
32 Parasetamol infus Botol - - - 33,000.00 - -
33 Cedrox Kapsul - - - 1,170.00 - -
34 Sefadroxil syr botol - - - 13,000.00 - -
35 spaslic Tablet - - - 2,500.00 - -
36 Bupantasid syr botol - - - 8,800.00 - -
37 Skopma Tablet - - - 1,600.00 - -
38 neocenta jell Tube - - - 19,700.00 - -
39 kloram tetes mata botol - - - 27,300.00 - -
40 zenirex syr botol - - - 8,800.00 - -
41 Fasidol forte Tablet - - - 350.00 - -
42 kloram Tetes telinga botol 2 2 2 - 7,840.00 - -
43 As. Tranex tablet Tablet - - - 9,915.00 - -
44 Fit k infant amp - - - 6,300.00 - -
45 Dopamet Tablet 40 40 0 40 1,830.00 73,200 -
46 Klorampenikol syr botol 5 5 0 5 8,900.00 44,500 -
47 Ikaneuron injeksi amp - - - 5,350.00 - -
48 Farsipen syr Btl - - - 10,780.00 - -
49 Lexapram syr (2) btl - - - 7,260.00 - -
50 Lexigo Tablet - - - 660.00 - -
51 Zink syr Botol - - - 33,000.00 - -
52 Vitamin syr Btl 24 24 24 - 11,880.00 - -
53 Thiamfilex syr Btl 11 11 1 10 7,150.00 71,500 -
54 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
55 Aciblok Tablet - - - 550.00 - -
56 Zevask 10 mg Tablet - - - 746.00 - -
57 Bimaflock Tablet - - - 615.00 - -
58 Diazepam 2 mg Tablet 642 642 0 642 1,000.00 642,000 -
59 Terbutalin Tablet 460 460 0 460 89.012 40,945.52 -
60 Metergin Tablet 590 590 0 590 210.000 123,900 -
61 Ketokonazole Tablet 638 638 130 508 270.00 137,160.00 -
62 Metro syr Btl 75 75 2 73 3,950.10 288,357.30 -
63 Cefadroxil syr Btl 185 185 19 166 3,921.50 650,969.00 -
64 Profolat Tablet 600 600 0 600 51.997 31,198.20 -
65 Combiven nebu amp 376 376 17 359 4,550.000 1,633,450.00 -
66 Simvastatin Tablet 1,500 1,500 100 1,400 205.000 287,000.00 -
67 Ranitidin Tablet 2,000 2,000 0 2,000 104.995 209,990.00 -
68 Decafil (Aminophillin) Tablet 990 990 100 890 138.996 123,706.44 -
69 Scabimide pot 64 64 9 55 10,825.000 595,375.00 -
70 Amlodipin 10 mg Tablet 3,747 3,747 87 3,660 93.000 340,380.00 -
71 Domperidon 10 mg Tablet 600 600 300 300 84.996 25,498.80 -
72 Allupurinol Tablet 840 840 70 770 99.000 76,230.00 -
73 Miniaspi Tablet 790 790 130 660 99.000 65,340.00 -
74 Methilprednisolon Tablet 12,000 12,000 0 12,000 133.991 1,607,892.00 -

Page 2 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
75 Nistatin drop Btl 43 43 0 43 13,500.300 580,512.90 -
76 Amoxicillin 500 mg Tablet 4,990 4,990 4029 961 363.000 348,843.00 -
77 Bimaflok Tablet 432 432 316 116 670.000 77,720.00 -
78 Corsaneuron Tablet 410 410 160 250 690.000 172,500.00 -
79 Caviplex Tablet 900 900 0 900 422.000 379,800.00 -
80 Grantusip Tablet 2,380 2,380 544 1,836 483.000 886,788.00 -
81 Kloram Tetes mata Btl 164 164 19 145 9,350.000 1,355,750.00 -
82 Lostasef Kapsul 1,462 1,462 12 1,450 2,270.000 3,291,500.00 -
83 Novamagh syr Btl 248 248 1 247 6,000.000 1,482,000.00 -
84 Meloxicam 15 mg Tablet 1,000 1,000 0 1,000 1,089.000 1,089,000.00 -
85 Spasminal Tablet 500 500 83 417 638.000 266,046.00 -
86 Skopma Tablet 678 678 134 544 1,527.000 830,688.00 -
87 Superhoid suppo suppo 18 18 0 18 3,565.000 64,170.00 -
88 Cetirizin syr Btl 81 81 21 60 2,850.100 171,006.00 -
89 Baby cough Btl 200 200 0 200 6,823.000 1,364,600.00 -
90 Cefixim Kapsul 2,400 2,400 471 1,929 1,320.000 2,546,280.00 -
- JML 39,221,720 -

Page 3 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2   Spuit 10 cc ONIONEX PCS - - - 1,163 -
3 Foley cath 18 Pcs 93 93 4 89 8,000 712,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5 Foley cath 16 Pcs 63 63 2 61 8,000 488,000
6 Spuit 3 ml nipro - - - 792 -
7 Sarung tangan Gynecolog Pasang 400 400 0 400 12,000 4,800,000
8 Suction cath 16 Bh - - - 7,545 -
9 Warm water zak Bh 1 1 0 1 23,864 23,864 .
10 KTO B 1 kntong isi 10 pak - - - 11,000 -
11 KTO K Pak 204 204 29 175 8,800 1,540,000
12 Kertas puyer Pak - - - 10,000 -
13 Label Baru pak - - - 25,000 - -
14 Aximed Fixation nonwoven Roll 2 2 0 2 68,651 137,302 -
15 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
16 Masker Nebu anak Bh 4 4 0 4 22,660 90,640 -
17 Stikpan plastik deluxe Bh - - - 36,155 - -
18 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
19 Aximed papertape hivapik Roll - - - 21,849 - -
20 Silk BARU 3/0 - - - 3,900 - -
21 Syringe 1 cc 170 170 31 139 728.00 101,192.28 -
22 Catgut chromik 3/0 - - - 7,493.06 - -
23 Hcg test bh 68 68 22 46 1,800.00 82,800.00 -
24 Underpad bh - - - 4,100.00 - -
25 sarung tangan young psg 1 1 0 1 36,000.00 36,000.00 -
26 sarung tangan steril 7,5 psg 108 108 62 46 4,214.00 193,844.00 -
27 kasa hidrofil besar bh - - - 143,550.00 - -
28 kasa steril mini bh - - - 3,600.00 - -
29 exam glove M psg - - - 545.45 - -
30 eXAm glove S psg - - - 1,200.00 - -
31 Gatrix nasal Bayi bh - - - 8,800.00 - -
32 Gatrix nasal Anak bh - - - 8,800.00 - -
33 Jarum Bd no 23 bh - - - 4,000.04 - -
34 Umbilikal bh - - - 2,600.00 - -
35 Jarum hekting paket - - - 35,333.32 - -
36 Jely USG Botol - - - 30,800.00 - -
37 Aboket 26 bh - - - 12,000.00 - -
38 Aboket 24 bh - - - 8,000.00 - -
39 plester coklat besar bh - - - 60,000.00 - -
40 feeding no 5 bh - - - 38,500.00 - -
41 tisu besar bh - - - 17,000.00 - -
42 Hanrub (2) Bh - - - 62,050.00 - -
43 One clean (klorin) Btl 31 31 3 28 15,246.00 426,888.00 -
44 sabun anti bakteri Btl 13 13 4 9 27,720.00 249,480.00 -
45 Hcl 0,1 N 100 ml Btl 2 2 1 1 11,088.00 11,088.00 -
46 Catgut + jarum 3/0 Bh 121 121 19 102 5,750.80 586,581.60 -
47 Silk + jarum 2/0 Bh 142 142 13 129 3,147.20 405,988.80 -
48 Alkohol 1 L Btl 11 11 1 10 26,250.40 262,504.00 -

Page 4 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
49 Exam Glove M Pak - - - 366.88 - -
50 Exam Glove L Pak - - - 366.88 - -
51 Masker Ear Loop Bh 400 400 200 200 453.20 90,640.00 -
52 Umbilikal Cord Nylon Bh 62 62 17 45 1,338.70 60,241.50 -
53 Spuit 10 cc Sterra Set 94 94 0 94 952.75 89,558.50 -
54 Infusion set Dewasa Set 39 39 0 39 3,295.60 128,528.40 -
55 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
56 Oxyflow Anak transparan bh 50 50 0 50 5,150.00 257,500.00 -
57 Tes kehamilan ultra one bh 100 100 92 8 1,997.60 15,980.80 -
58 Safety box 5 Lt kuning bh 75 75 0 75 16,186.50 1,213,987.50 -
59 Aboket no 26 Sterra Set 78 78 11 67 4,222.90 282,934.30 -
60 Ultrasonik gell Btl 9 9 0 9 13,213.20 118,918.80 -
61 Oxyflow bayi transparan bh 50 50 0 50 5,665.00 283,250.00 -
62 Oxyflow Dewasa transparan bh 49 49 9 40 5,665.00 226,600.00 -
63 Suction cath 8 bh - - - 9,000.00 - -
64 Kantong obat Besar pak 2 2 2 - 11,000.00 - -
65 kresek pak 121 121 20 101 12,000.00 1,212,000.00 -
66 Etiket Putih pak 91 91 10 81 25,000.00 2,025,000.00 -
67 Edta ungu box - - - 190,000.00 - -
68 ubderpad pak 5 5 1 4 42,000.00 168,000.00 -
69 jarum no 8 set 2 2 0 2 17,500.00 35,000.00 -
70 jarum no 10 set 1 1 1 - 17,500.00 - -
71 Stik Glukosa Acucek box - - - 630,000.00 - -
72 Stik Hb family dr box - - - 370,000.00 - -
73 Stik urin 3 p box - - - 150,000.00 - -
74 Plester coklat besar roll - - - 85,000.00 - -
75 Bisturi bh - - - 10,000.00 - -
76 Stik gula benecheck box - - - 152,049.00 - -
77 Stik asam urat benecheck box - - - 131,398.00 - -
78 Stik Kolesterol benecheck box - - - 232,836.75 - -
Tranfusi set set 50 50 0 50 11,000.00 550,000.00 -
Kasa gulung besar baru bh 8 8 1 7 143,000.00 1,001,000.00 -
bisturi no 11 bh 100 100 9 91 1,320.00 120,120.00 -
Exam glove M box 5 5 2 3 55,000.00 165,000.00 -
Batang pengaduk bh 2 2 0 2 33,000.00 66,000.00 -
Termometer Ruangan bh 1 1 0 1 275,000.00 275,000.00 -
Catgut baru bh 120 120 0 120 11,229.16 1,347,499.20 -
Silk BARU 3/0 bh 180 180 0 180 7,486.11 1,347,499.80 -
Underpad Pads 30 30 0 30 55,000.00 1,650,000.00 -
Kantong obat Besar pak 100 100 12 88 12,100.00 1,064,800.00 -
Plester Hifavik box 18 18 0 18 22,000.00 396,000.00 -
Alkohol swab box 10 10 8 2 22,000.00 44,000.00 -
Jarum hekting no 8 bh 10 10 0 10 19,800.00 198,000.00 -
Jarum hekting no 10 bh 10 10 0 10 6,600.00 66,000.00 -
Feeding tube no 8 bh 10 10 2 8 66,000.00 528,000.00 -
Hanrub Btl 14 14 4 10 57,200.00 572,000.00 -
Gelly usg baru Btl 7 7 0 7 38,500.00 269,500.00 -
Umbilikal klem baru bh 90 90 0 90 2,640.00 237,600.00 -
Jarum Bd no 23 bh 168 168 68 100 605.00 60,500.00 -
Kasa steril box 500 500 0 500 1,650.00 825,000.00 -
Masker 02 Dewasa bh 3 3 0 3 24,750.00 74,250.00 -
Page 5 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
Masker 02 Anak bh 3 3 0 3 24,750.00 74,250.00 -
Tisu lensa box 1 1 1 - 132,000.00 - -
Termometer Tembak bh 1 1 1 - 275,000.00 - -
Bola bobat bh 1 1 0 1 550,000.00 550,000.00 -

REAGEN
Probe cleaner bh 4 4 0 4 618,182.00 2,472,728.00 -
Diluent bh 4 4 0 4 2,545,454.00 10,181,816.00 -
Lyse bh 4 4 0 4 2,545,454.00 10,181,816.00
50,782,421.08 -

Jumlah Total - 90,004,140.99 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,302

........................, ....................................20......
Yang Menerima : Diketahui /disetujui , Yang Menerima :
Mengetahui/Menyetujui : Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan : Pengelola Obat
Kepala UPTD Farmasi

Nolis Sukmayati N, Amd,Far

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr NR.PTT. 873.32.07.14.4.003
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 6 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
sisa lab 18

Page 7 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
SISA 100

Page 8 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
........................, ....................................20......
Yang Menerima :
Pengelola Obat

Nolis Sukmayati N, Amd,Far

NR.PTT. 873.32.07.14.4.003

Page 9 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : FEBRUARI 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Metronidazol syrup Btl - - - 3,454.00 -
2 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
3 Haloperidol 5 mg Tablet - - - 96.00 -
4 Alkohol 70% BOTOL - - - 2,500.00 -
5 Domperidon suspensi BOTOL 89 89 8 81 3,333.00 269,973
6 Domperidon 10 mg Tablet 10 10 - 10 167.00 1,670
7 Kalsium glukonas Amp 26 26 - 26 7,090.88 184,362.75
8 Hexymer 2 mg (THF) Tablet - - - 270.00 -
9 Glimepirid Tablet - - - 263.00 -
10 Kloramfecort Cream Tube 47 47 32 15 11,285.00 169,275
11 Cendo Polydex str - - - 29,150.00 -
12 Enervon C 120 ml btl - - - 17,118.00 -
13 Cendo Genta str - - - 17,463.00 -
14 As. Tranex injek Amp 352 352 0 352 5,250.00 1,848,000
15 Seftriaxon ij box 449 449 0 449 20,000.00 8,980,000
16 Ketorolak ij Amp - - - 5,455.00 -
17 Allerin expext syr Btl - - - 9,750.00 -
18 Aspilet Tablet - - - 530.00 -
19 Betason n Cr Tube 100 100 9 91 1,061.00 96,551
20 Kloramfenikol tetes mata Btl - - - 3,250.01 -
21 Thiampenikol Tablet 150 150 80 70 1,210.00 84,700 -
22 Lidokain injek Amp - - - 1,222.10 - -
23 Neosenta Salep Tube 2 2 2 - 19,958.00 - -
24 Ambroxol Tablet - - - 144.00 - -
25 Ketopropen injeksi Amp 7 7 0 7 28,249.00 197,743 -
26 Amlodipin Tablet - - - 176.00 - -
27 L BIO Saset - - - 6,600.00 - -
28 Glibenklamid Tablet - - - 198.00 - -
29 Skopma Plus Tablet - - - 2,596.00 - -
30 Sotatik injeksi Amp 1,100 1,100 21 1,079 4,400.00 4,747,600 -

Page 10 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
31 Spashi injeksi Amp 4 4 0 4 9,900.00 39,600 -
32 Parasetamol infus Botol - - - 33,000.00 - -
33 Cedrox Kapsul - - - 1,170.00 - -
34 Sefadroxil syr botol - - - 13,000.00 - -
35 spaslic Tablet - - - 2,500.00 - -
36 Bupantasid syr botol - - - 8,800.00 - -
37 Skopma Tablet - - - 1,600.00 - -
38 neocenta jell Tube - - - 19,700.00 - -
39 kloram tetes mata botol - - - 27,300.00 - -
40 zenirex syr botol - - - 8,800.00 - -
41 Fasidol forte Tablet - - - 350.00 - -
42 kloram Tetes telinga botol - - - 7,840.00 - -
43 As. Tranex tablet Tablet - - - 9,915.00 - -
44 Fit k infant amp - - - 6,300.00 - -
45 Dopamet Tablet 40 40 0 40 1,830.00 73,200 -
46 Klorampenikol syr botol 5 5 3 2 8,900.00 17,800 -
47 Ikaneuron injeksi amp - - - 5,350.00 - -
48 Farsipen syr Btl - - - 10,780.00 - -
49 Lexapram syr (2) btl - - - 7,260.00 - -
50 Lexigo Tablet - - - 660.00 - -
51 Zink syr Botol - - - 33,000.00 - -
52 Vitamin syr Btl - - - 11,880.00 - -
53 Thiamfilex syr Btl 10 10 0 10 7,150.00 71,500 -
54 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
55 Aciblok Tablet - - - 550.00 - -
56 Zevask 10 mg Tablet - - - 746.00 - -
57 Bimaflock Tablet - - - 615.00 - -
58 Diazepam 2 mg Tablet 642 642 0 642 1,000.00 642,000 -
59 Terbutalin Tablet 460 460 70 390 89.012 34,714.68 -
60 Metergin Tablet 590 590 0 590 210.000 123,900 -
61 Ketokonazole Tablet 508 508 42 466 270.00 125,820.00 -
62 Metro syr Btl 73 73 6 67 3,950.10 264,656.70 -
63 Cefadroxil syr Btl 166 166 39 127 3,921.50 498,030.50 -
64 Profolat Tablet 600 600 20 580 51.997 30,158.26 -
65 Combiven nebu amp 359 359 14 345 4,550.000 1,569,750.00 -
66 Simvastatin Tablet 1,400 1,400 0 1,400 205.000 287,000.00 -
67 Ranitidin Tablet 2,000 2,000 762 1,238 104.995 129,983.81 -
68 Decafil (Aminophillin) Tablet 890 890 0 890 138.996 123,706.44 -
69 Scabimide pot 55 55 27 28 10,825.000 303,100.00 -
70 Amlodipin 10 mg Tablet 3,660 3,660 240 3,420 93.000 318,060.00 -
71 Domperidon 10 mg Tablet 300 300 0 300 84.996 25,498.80 -
72 Allupurinol Tablet 770 770 160 610 99.000 60,390.00 -
73 Miniaspi Tablet 660 660 50 610 99.000 60,390.00 -
74 Methilprednisolon Tablet 12,000 12,000 0 12,000 133.991 1,607,892.00 -

Page 11 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
75 Nistatin drop Btl 43 43 1 42 13,500.300 567,012.60 -
76 Amoxicillin 500 mg Tablet 961 961 961 - 363.000 - -
77 Bimaflok Tablet 116 116 116 - 670.000 - -
78 Corsaneuron Tablet 250 250 210 40 690.000 27,600.00 -
79 Caviplex Tablet 900 900 265 635 422.000 267,970.00 -
80 Grantusip Tablet 1,836 1,836 509 1,327 483.000 640,941.00 -
81 Kloram Tetes mata Btl 145 145 14 131 9,350.000 1,224,850.00 -
82 Lostasef Kapsul 1,450 1,450 1076 374 2,270.000 848,980.00 -
83 Novamagh syr Btl 247 247 1 246 6,000.000 1,476,000.00 -
84 Meloxicam 15 mg Tablet 1,000 1,000 0 1,000 1,089.000 1,089,000.00 -
85 Spasminal Tablet 417 417 159 258 638.000 164,604.00 -
86 Skopma Tablet 544 544 164 380 1,527.000 580,260.00 -
87 Superhoid suppo suppo 18 18 0 18 3,565.000 64,170.00 -
88 Cetirizin syr Btl 60 60 24 36 2,850.100 102,603.60 -
89 Baby cough Btl 200 200 25 175 6,823.000 1,194,025.00 -
90 Cefixim Kapsul 1,929 1,929 935 994 1,320.000 1,312,080.00 -
- JML 32,547,122 -

Page 12 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2   Spuit 10 cc ONIONEX PCS - - - 1,163 -
3 Foley cath 18 Pcs 89 89 3 86 8,000 688,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5 Foley cath 16 Pcs 61 61 3 58 8,000 464,000
6 Spuit 3 ml nipro - - - 792 -
7 Sarung tangan Gynecolog Pasang 400 400 0 400 12,000 4,800,000
8 Suction cath 16 Bh - - - 7,545 -
9 Warm water zak Bh 1 1 0 1 23,864 23,864 .
10 KTO B 1 kntong isi 10 pak - - - 11,000 -
11 KTO K Pak 175 175 24 151 8,800 1,328,800
12 Kertas puyer Pak - - - 10,000 -
13 Label Baru pak - - - 25,000 - -
14 Aximed Fixation nonwoven Roll 2 2 0 2 68,651 137,302 -
15 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
16 Masker Nebu anak Bh 4 4 0 4 22,660 90,640 -
17 Stikpan plastik deluxe Bh - - - 36,155 - -
18 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
19 Aximed papertape hivapik Roll - - - 21,849 - -
20 Silk BARU 3/0 - - - 3,900 - -
21 Syringe 1 cc 139 139 14 125 728.00 91,000.25 -
22 Catgut chromik 3/0 - - - 7,493.06 - -
23 Hcg test bh 46 46 29 17 1,800.00 30,600.00 -
24 Underpad bh - - - 4,100.00 - -
25 sarung tangan young psg 1 1 0 1 36,000.00 36,000.00 -
26 sarung tangan steril 7,5 psg 46 46 20 26 4,214.00 109,564.00 -
27 kasa hidrofil besar bh - - - 143,550.00 - -
28 kasa steril mini bh - - - 3,600.00 - -
29 exam glove M psg - - - 545.45 - -
30 eXAm glove S psg - - - 1,200.00 - -
31 Gatrix nasal Bayi bh - - - 8,800.00 - -
32 Gatrix nasal Anak bh - - - 8,800.00 - -
33 Jarum Bd no 23 bh - - - 4,000.04 - -
34 Umbilikal bh - - - 2,600.00 - -
35 Jarum hekting paket - - - 35,333.32 - -
36 Jely USG Botol - - - 30,800.00 - -
37 Aboket 26 bh - - - 12,000.00 - -
38 Aboket 24 bh - - - 8,000.00 - -
39 plester coklat besar bh - - - 60,000.00 - -
40 feeding no 5 bh - - - 38,500.00 - -
41 tisu besar bh - - - 17,000.00 - -
42 Hanrub (2) Bh - - - 62,050.00 - -
43 One clean (klorin) Btl 28 28 0 28 15,246.00 426,888.00 -
44 sabun anti bakteri Btl 9 9 0 9 27,720.00 249,480.00 -
45 Hcl 0,1 N 100 ml Btl 1 1 1 - 11,088.00 - -
46 Catgut + jarum 3/0 Bh 102 102 8 94 5,750.80 540,575.20 -
47 Silk + jarum 2/0 Bh 129 129 11 118 3,147.20 371,369.60 -
48 Alkohol 1 L Btl 10 10 2 8 26,250.40 210,003.20 -

Page 13 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
49 Exam Glove M Pak - - - 366.88 - -
50 Exam Glove L Pak - - - 366.88 - -
51 Masker Ear Loop Bh 200 200 50 150 453.20 67,980.00 -
52 Umbilikal Cord Nylon Bh 45 45 26 19 1,338.70 25,435.30 -
53 Spuit 10 cc Sterra Set 94 94 0 94 952.75 89,558.50 -
54 Infusion set Dewasa Set 39 39 39 - 3,295.60 - -
55 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
56 Oxyflow Anak transparan bh 50 50 2 48 5,150.00 247,200.00 -
57 Tes kehamilan ultra one bh 8 8 8 - 1,997.60 - -
58 Safety box 5 Lt kuning bh 75 75 0 75 16,186.50 1,213,987.50 -
59 Aboket no 26 Sterra Set 67 67 10 57 4,222.90 240,705.30 -
60 Ultrasonik gell Btl 9 9 1 8 13,213.20 105,705.60 -
61 Oxyflow bayi transparan bh 50 50 6 44 5,665.00 249,260.00 -
62 Oxyflow Dewasa transparan bh 40 40 5 35 5,665.00 198,275.00 -
63 Suction cath 8 bh - - - 9,000.00 - -
64 Kantong obat Besar pak - - - 11,000.00 - -
65 kresek pak 101 101 44 57 12,000.00 684,000.00 -
66 Etiket Putih pak 81 81 8 73 25,000.00 1,825,000.00 -
67 Edta ungu box - - - 190,000.00 - -
68 ubderpad pak 4 4 3 1 42,000.00 42,000.00 -
69 jarum no 8 set 2 2 0 2 17,500.00 35,000.00 -
70 jarum no 10 set - - - 17,500.00 - -
71 Stik Glukosa Acucek box - - - 630,000.00 - -
72 Stik Hb family dr box - - - 370,000.00 - -
73 Stik urin 3 p box - - - 150,000.00 - -
74 Plester coklat besar roll - - - 85,000.00 - -
75 Bisturi bh - - - 10,000.00 - -
76 Stik gula benecheck box - - - 152,049.00 - -
77 Stik asam urat benecheck box - - - 131,398.00 - -
78 Stik Kolesterol benecheck box - - - 232,836.75 - -
79 Tranfusi set set 50 50 7 43 11,000.00 473,000.00 -
80 Kasa gulung besar baru bh 7 7 1 6 143,000.00 858,000.00 -
81 bisturi no 11 bh 91 91 2 89 1,320.00 117,480.00 -
82 Exam glove M box 3 3 3 - 55,000.00 - -
83 Batang pengaduk bh 2 2 0 2 33,000.00 66,000.00 -
84 Termometer Ruangan/KULKAS bh 1 1 0 1 275,000.00 275,000.00 -
85 Catgut baru bh 120 120 0 120 11,229.16 1,347,499.20 -
86 Silk BARU 3/0 bh 180 180 0 180 7,486.11 1,347,499.80 -
87 Underpad Pads 30 30 0 30 55,000.00 1,650,000.00 -
88 Kantong obat Besar pak 88 88 17 71 12,100.00 859,100.00 -
89 Plester Hifavik box 18 18 0 18 22,000.00 396,000.00 -
90 Alkohol swab box 2 2 2 - 22,000.00 - -
91 Jarum hekting no 8 bh 10 10 0 10 19,800.00 198,000.00 -
92 Jarum hekting no 10 bh 10 10 0 10 6,600.00 66,000.00 -
93 Feeding tube no 8 bh 8 8 0 8 66,000.00 528,000.00 -
94 Hanrub Btl 10 10 0 10 57,200.00 572,000.00 -
95 Gelly usg baru Btl 7 7 0 7 38,500.00 269,500.00 -
96 Umbilikal klem baru bh 90 90 0 90 2,640.00 237,600.00 -
97 Jarum Bd no 23 bh 100 100 5 95 605.00 57,475.00 -
98 Kasa steril box 500 500 0 500 1,650.00 825,000.00 -
99 Masker 02 Dewasa bh 3 3 0 3 24,750.00 74,250.00 -
Page 14 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
100 Masker 02 Anak bh 3 3 0 3 24,750.00 74,250.00 -
101 Tisu lensa box - - - 132,000.00 - -
102 Termometer Tembak bh - - - 275,000.00 - -
103 Bola bobat bh 1 1 1 - 550,000.00 - -

REAGEN
Probe cleaner bh 4 4 1 3 618,182.00 1,854,546.00 -
Diluent bh 4 4 1 3 2,545,454.00 7,636,362.00 -
Lyse bh 4 4 1 3 2,545,454.00 7,636,362.00
42,148,847.05 -

Jumlah Total - 74,695,969.19 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,061

........................, ....................................20......
Yang Menerima : Diketahui /disetujui , Yang Menerima :
Mengetahui/Menyetujui : Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan : Pengelola Obat
Kepala UPTD Farmasi

Nolis Sukmayati N, Amd,Far

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr NR.PTT. 873.32.07.14.4.003
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 15 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
sisa lab 18

Page 16 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
SISA 100

Page 17 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
........................, ....................................20......
Yang Menerima :
Pengelola Obat

Nolis Sukmayati N, Amd,Far

NR.PTT. 873.32.07.14.4.003

Page 18 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : MARET 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Metronidazol syrup Btl - - - 3,454.00 -
2 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
3 Haloperidol 5 mg Tablet - - - 96.00 -
4 Alkohol 70% BOTOL - - - 2,500.00 -
5 Domperidon suspensi BOTOL 81 81 26 55 3,333.00 183,315 -
6 Domperidon 10 mg Tablet 10 10 10 - 167.00 -
7 Kalsium glukonas Amp 26 26 - 26 7,090.88 184,362.75
8 Hexymer 2 mg (THF) Tablet - - - 270.00 -
9 Glimepirid Tablet - - - 263.00 -
10 Kloramfecort Cream Tube 15 15 15 - 11,285.00 -
11 Cendo Polydex str - - - 29,150.00 -
12 Enervon C 120 ml btl - - - 17,118.00 -
13 Cendo Genta str - - - 17,463.00 -
14 As. Tranex injek Amp 352 352 0 352 5,250.00 1,848,000
15 Seftriaxon ij box 449 449 0 449 20,000.00 8,980,000
16 Ketorolak ij Amp - - - 5,455.00 -
17 Allerin expext syr Btl - - - 9,750.00 -
18 Aspilet Tablet - - - 530.00 -
19 Betason n Cr Tube 91 91 46 45 1,061.00 47,745
20 Kloramfenikol tetes mata Btl - - - 3,250.01 -
21 Thiampenikol Tablet 70 70 40 30 1,210.00 36,300 -
22 Lidokain injek Amp - - - 1,222.10 - -
23 Neosenta Salep Tube - - - 19,958.00 - -
24 Ambroxol Tablet - - - 144.00 - -
25 Ketopropen injeksi Amp 7 7 0 7 28,249.00 197,743 -
26 Amlodipin Tablet - - - 176.00 - -
27 L BIO Saset - - - 6,600.00 - -
28 Glibenklamid Tablet - - - 198.00 - -
29 Skopma Plus Tablet - - - 2,596.00 - -
30 Sotatik injeksi Amp 1,079 1,079 47 1,032 4,400.00 4,540,800 -

Page 19 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
31 Spashi injeksi Amp 4 4 0 4 9,900.00 39,600 -
32 Parasetamol infus Botol - - - 33,000.00 - -
33 Cedrox Kapsul - - - 1,170.00 - -
34 Sefadroxil syr botol - - - 13,000.00 - -
35 spaslic Tablet - - - 2,500.00 - -
36 Bupantasid syr botol - - - 8,800.00 - -
37 Skopma Tablet - - - 1,600.00 - -
38 neocenta jell Tube - - - 19,700.00 - -
39 kloram tetes mata botol - - - 27,300.00 - -
40 zenirex syr botol - - - 8,800.00 - -
41 Fasidol forte Tablet - - - 350.00 - -
42 kloram Tetes telinga botol - - - 7,840.00 - -
43 As. Tranex tablet Tablet - - - 9,915.00 - -
44 Fit k infant amp - - - 6,300.00 - -
45 Dopamet Tablet 40 40 0 40 1,830.00 73,200 -
46 Klorampenikol syr botol 2 2 2 - 8,900.00 - -
47 Ikaneuron injeksi amp - - - 5,350.00 - -
48 Farsipen syr Btl - - - 10,780.00 - -
49 Lexapram syr (2) btl - - - 7,260.00 - -
50 Lexigo Tablet - - - 660.00 - -
51 Zink syr Botol - - - 33,000.00 - -
52 Vitamin syr Btl - - - 11,880.00 - -
53 Thiamfilex syr Btl 10 10 0 10 7,150.00 71,500 -
54 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
55 Aciblok Tablet - - - 550.00 - -
56 Zevask 10 mg Tablet - - - 746.00 - -
57 Bimaflock Tablet - - - 615.00 - -
58 Diazepam 2 mg Tablet 642 642 3 639 1,000.00 639,000 -
59 Terbutalin Tablet 390 390 80 310 89.012 27,593.72 -
60 Metergin Tablet 590 590 10 580 210.000 121,800 -
61 Ketokonazole Tablet 466 466 86 380 270.00 102,600.00 -
62 Metro syr Btl 67 67 1 66 3,950.10 260,706.60 -
63 Cefadroxil syr Btl 127 127 32 95 3,921.50 372,542.50 -
64 Profolat Tablet 580 580 20 560 51.997 29,118.32 -
65 Combiven nebu amp 345 345 14 331 4,550.000 1,506,050.00 -
66 Simvastatin Tablet 1,400 1,400 456 944 205.000 193,520.00 -
67 Ranitidin Tablet 1,238 1,238 694 544 104.995 57,117.28 -
68 Decafil (Aminophillin) Tablet 890 890 100 790 138.996 109,806.84 -
69 Scabimide pot 28 28 17 11 10,825.000 119,075.00 -
70 Amlodipin 10 mg Tablet 3,420 3,420 180 3,240 93.000 301,320.00 -
71 Domperidon 10 mg Tablet 300 300 200 100 84.996 8,499.60 -
72 Allupurinol Tablet 610 610 80 530 99.000 52,470.00 -
73 Miniaspi Tablet 610 610 20 590 99.000 58,410.00 -
74 Methilprednisolon Tablet 12,000 12,000 100 11,900 133.991 1,594,492.90 -

Page 20 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
75 Nistatin drop Btl 42 42 0 42 13,500.300 567,012.60 -
76 Amoxicillin 500 mg Tablet - - - 363.000 - -
77 Bimaflok Tablet - - - 670.000 - -
78 Corsaneuron Tablet 40 40 40 - 690.000 - -
79 Caviplex Tablet 635 635 85 550 422.000 232,100.00 -
80 Grantusip Tablet 1,327 1,327 512 815 483.000 393,645.00 -
81 Kloram Tetes mata Btl 131 131 41 90 9,350.000 841,500.00 -
82 Lostasef Kapsul 374 374 374 - 2,270.000 - -
83 Novamagh syr Btl 246 246 21 225 6,000.000 1,350,000.00 -
84 Meloxicam 15 mg Tablet 1,000 1,000 236 764 1,089.000 831,996.00 -
85 Spasminal Tablet 258 258 76 182 638.000 116,116.00 -
86 Skopma Tablet 380 380 126 254 1,527.000 387,858.00 -
87 Superhoid suppo suppo 18 18 3 15 3,565.000 53,475.00 -
88 Cetirizin syr Btl 36 36 14 22 2,850.100 62,702.20 -
89 Baby cough Btl 175 175 35 140 6,823.000 955,220.00 -
90 Cefixim Kapsul 994 994 994 - 1,320.000 - -
JML 27,548,313 -

Page 21 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2   Spuit 10 cc ONIONEX PCS - - - 1,163 -
3 Foley cath 18 Pcs 86 86 10 76 8,000 608,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5 Foley cath 16 Pcs 58 58 17 41 8,000 328,000
6 Spuit 3 ml nipro - - - 792 -
7 Sarung tangan Gynecolog Pasang 400 400 10 390 12,000 4,680,000
8 Suction cath 16 Bh - - - 7,545 -
9 Warm water zak Bh 1 1 0 1 23,864 23,864 .
10 KTO B 1 kntong isi 10 pak - - - 11,000 -
11 KTO K Pak 151 151 25 126 8,800 1,108,800
12 Kertas puyer Pak - - - 10,000 -
13 Label Baru pak - - - 25,000 - -
14 Aximed Fixation nonwoven Roll 2 2 0 2 68,651 137,302 -
15 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
16 Masker Nebu anak Bh 4 4 0 4 22,660 90,640 -
17 Stikpan plastik deluxe Bh - - - 36,155 - -
18 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
19 Aximed papertape hivapik Roll - - - 21,849 - -
20 Silk BARU 3/0 - - - 3,900 - -
21 Syringe 1 cc 125 125 125 - 728.00 - -
22 Catgut chromik 3/0 - - - 7,493.06 - -
23 Hcg test bh 17 17 17 - 1,800.00 - -
24 Underpad bh - - - 4,100.00 - -
25 sarung tangan young psg 1 1 0 1 36,000.00 36,000.00 -
26 sarung tangan steril 7,5 psg 26 26 26 - 4,214.00 - -
27 kasa hidrofil besar bh - - - 143,550.00 - -
28 kasa steril mini bh - - - 3,600.00 - -
29 exam glove M psg - - - 545.45 - -
30 eXAm glove S psg - - - 1,200.00 - -
31 Gatrix nasal Bayi bh - - - 8,800.00 - -
32 Gatrix nasal Anak bh - - - 8,800.00 - -
33 Jarum Bd no 23 bh - - - 4,000.04 - -
34 Umbilikal bh - - - 2,600.00 - -
35 Jarum hekting paket - - - 35,333.32 - -
36 Jely USG Botol - - - 30,800.00 - -
37 Aboket 26 bh - - - 12,000.00 - -
38 Aboket 24 bh - - - 8,000.00 - -
39 plester coklat besar bh - - - 60,000.00 - -
40 feeding no 5 bh - - - 38,500.00 - -
41 tisu besar bh - - - 17,000.00 - -
42 Hanrub (2) Bh - - - 62,050.00 - -
43 One clean (klorin) Btl 28 28 0 28 15,246.00 426,888.00 -
44 sabun anti bakteri Btl 9 9 1 8 27,720.00 221,760.00 -
45 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
46 Catgut + jarum 3/0 Bh 94 94 24 70 5,750.80 402,556.00 -
47 Silk + jarum 2/0 Bh 118 118 2 116 3,147.20 365,075.20 -
48 Alkohol 1 L Btl 8 8 5 3 26,250.40 78,751.20 -

Page 22 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
49 Exam Glove M Pak - - - 366.88 - -
50 Exam Glove L Pak - - - 366.88 - -
51 Masker Ear Loop Bh 150 150 0 150 453.20 67,980.00 -
52 Umbilikal Cord Nylon Bh 19 19 19 - 1,338.70 - -
53 Spuit 10 cc Sterra Set 94 94 19 75 952.75 71,456.25 -
54 Infusion set Dewasa Set - - - 3,295.60 - -
55 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
56 Oxyflow Anak transparan bh 48 48 0 48 5,150.00 247,200.00 -
57 Tes kehamilan ultra one bh - - - 1,997.60 - -
58 Safety box 5 Lt kuning bh 75 75 0 75 16,186.50 1,213,987.50 -
59 Aboket no 26 Sterra Set 57 57 16 41 4,222.90 173,138.90 -
60 Ultrasonik gell Btl 8 8 2 6 13,213.20 79,279.20 -
61 Oxyflow bayi transparan bh 44 44 12 32 5,665.00 181,280.00 -
62 Oxyflow Dewasa transparan bh 35 35 9 26 5,665.00 147,290.00 -
63 Suction cath 8 bh - - - 9,000.00 - -
64 Kantong obat Besar pak - - - 11,000.00 - -
65 kresek pak 57 57 38 19 12,000.00 228,000.00 -
66 Etiket Putih pak 73 73 5 68 25,000.00 1,700,000.00 -
67 Edta ungu box - - - 190,000.00 - -
68 ubderpad pak 1 1 1 - 42,000.00 - -
69 jarum no 8 set 2 2 0 2 17,500.00 35,000.00 -
70 jarum no 10 set - - - 17,500.00 - -
71 Stik Glukosa Acucek box - - - 630,000.00 - -
72 Stik Hb family dr box - - - 370,000.00 - -
73 Stik urin 3 p box - - - 150,000.00 - -
74 Plester coklat besar roll - - - 85,000.00 - -
75 Bisturi bh - - - 10,000.00 - -
76 Stik gula benecheck box - - - 152,049.00 - -
77 Stik asam urat benecheck box - - - 131,398.00 - -
78 Stik Kolesterol benecheck box - - - 232,836.75 - -
79 Tranfusi set set 43 43 43 - 11,000.00 - -
80 Kasa gulung besar baru bh 6 6 0 6 143,000.00 858,000.00 -
81 bisturi no 11 bh 89 89 13 76 1,320.00 100,320.00 -
82 Exam glove M box - - - 55,000.00 - -
83 Batang pengaduk bh 2 2 0 2 33,000.00 66,000.00 -
84 Termometer Ruangan/KULKAS bh 1 1 0 1 275,000.00 275,000.00 -
85 Catgut baru bh 120 120 0 120 11,229.16 1,347,499.20 -
86 Silk BARU 3/0 bh 180 180 0 180 7,486.11 1,347,499.80 -
87 Underpad Pads 30 30 0 30 55,000.00 1,650,000.00 -
88 Kantong obat Besar pak 71 71 18 53 12,100.00 641,300.00 -
89 Plester Hifavik box 18 18 1 17 22,000.00 374,000.00 -
90 Alkohol swab box - - - 22,000.00 - -
91 Jarum hekting no 8 bh 10 10 0 10 19,800.00 198,000.00 -
92 Jarum hekting no 10 bh 10 10 0 10 6,600.00 66,000.00 -
93 Feeding tube no 8 bh 8 8 0 8 66,000.00 528,000.00 -
94 Hanrub Btl 10 10 0 10 57,200.00 572,000.00 -
95 Gelly usg baru Btl 7 7 0 7 38,500.00 269,500.00 -
96 Umbilikal klem baru bh 90 90 15 75 2,640.00 198,000.00 -
97 Jarum Bd no 23 bh 95 95 95 - 605.00 - -
98 Kasa steril box 500 500 2 498 1,650.00 821,700.00 -
99 Masker 02 Dewasa bh 3 3 0 3 24,750.00 74,250.00 -
Page 23 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
100 Masker 02 Anak bh 3 3 0 3 24,750.00 74,250.00 -
101 Tisu lensa box - - - 132,000.00 - -
102 Termometer Tembak bh - - - 275,000.00 - -
103 Bola bobat bh - - - 550,000.00 - -

REAGEN
Probe cleaner bh 3 3 0 3 618,182.00 1,854,546.00 -
Diluent bh 3 3 0 3 2,545,454.00 7,636,362.00 -
Lyse bh 3 3 0 3 2,545,454.00 7,636,362.00
39,348,566.85 -

Jumlah Total - 66,896,880.16 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,109

........................, ....................................20......
Yang Menerima : Diketahui /disetujui , Yang Menerima :
Mengetahui/Menyetujui : Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan : Pengelola Obat
Kepala UPTD Farmasi

Nolis Sukmayati N, Amd,Far

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr NR.PTT. 873.32.07.14.4.003
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 24 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
........................, ....................................20......
Yang Menerima :
Pengelola Obat

Nolis Sukmayati N, Amd,Far

NR.PTT. 873.32.07.14.4.003

Page 25 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : MARET 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Metronidazol syrup Btl - - - 3,454.00 -
2 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
3 Haloperidol 5 mg Tablet - - - 96.00 -
4 Alkohol 70% BOTOL - - - 2,500.00 -
5 Domperidon suspensi BOTOL 55 55 10 45 3,333.00 149,985 -
6 Domperidon 10 mg Tablet - - - 167.00 -
7 Kalsium glukonas Amp 26 26 26 7,090.88 184,362.75
8 Hexymer 2 mg (THF) Tablet - - - 270.00 -
9 Glimepirid Tablet - - - 263.00 -
10 Kloramfecort Cream Tube - - - 11,285.00 -
11 Cendo Polydex str - - - 29,150.00 -
12 Enervon C 120 ml btl - - - 17,118.00 -
13 Cendo Genta str - - - 17,463.00 -
14 As. Tranex injek Amp 352 352 352 5,250.00 1,848,000
15 Seftriaxon ij box 449 449 449 20,000.00 8,980,000
16 Ketorolak ij Amp - - - 5,455.00 -
17 Allerin expext syr Btl - - - 9,750.00 -
18 Aspilet Tablet - - - 530.00 -
19 Betason n Cr Tube 45 45 30 15 1,061.00 15,915
20 Kloramfenikol tetes mata Btl - - - 3,250.01 -
21 Thiampenikol Tablet 30 30 20 10 1,210.00 12,100 -
22 Lidokain injek Amp - - - 1,222.10 - -
23 Neosenta Salep Tube - - - 19,958.00 - -
24 Ambroxol Tablet - - - 144.00 - -
25 Ketopropen injeksi Amp 7 7 7 28,249.00 197,743 -
26 Amlodipin Tablet - - - 176.00 - -
27 L BIO Saset - - - 6,600.00 - -
28 Glibenklamid Tablet - - - 198.00 - -
29 Skopma Plus Tablet - - - 2,596.00 - -
30 Sotatik injeksi Amp 1,032 1,032 21 1,011 4,400.00 4,448,400 -

Page 26 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
31 Spashi injeksi Amp 4 4 4 9,900.00 39,600 -
32 Parasetamol infus Botol - - - 33,000.00 - -
33 Cedrox Kapsul - - - 1,170.00 - -
34 Sefadroxil syr botol - - - 13,000.00 - -
35 spaslic Tablet - - - 2,500.00 - -
36 Bupantasid syr botol - - - 8,800.00 - -
37 Skopma Tablet - - - 1,600.00 - -
38 neocenta jell Tube - - - 19,700.00 - -
39 kloram tetes mata botol - - - 27,300.00 - -
40 zenirex syr botol - - - 8,800.00 - -
41 Fasidol forte Tablet - - - 350.00 - -
42 kloram Tetes telinga botol - - - 7,840.00 - -
43 As. Tranex tablet Tablet - - - 9,915.00 - -
44 Fit k infant amp - - - 6,300.00 - -
45 Dopamet Tablet 40 40 40 1,830.00 73,200 -
46 Klorampenikol syr botol - - - 8,900.00 - -
47 Ikaneuron injeksi amp - - - 5,350.00 - -
48 Farsipen syr Btl - - - 10,780.00 - -
49 Lexapram syr (2) btl - - - 7,260.00 - -
50 Lexigo Tablet - - - 660.00 - -
51 Zink syr Botol - - - 33,000.00 - -
52 Vitamin syr Btl - - - 11,880.00 - -
53 Thiamfilex syr Btl 10 10 1 9 7,150.00 64,350 -
54 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
55 Aciblok Tablet - - - 550.00 - -
56 Zevask 10 mg Tablet - - - 746.00 - -
57 Bimaflock Tablet - - - 615.00 - -
58 Diazepam 2 mg Tablet 639 639 639 1,000.00 639,000 -
59 Terbutalin Tablet 310 310 60 250 89.012 22,253.00 -
60 Metergin Tablet 580 580 110 470 210.000 98,700 -
61 Ketokonazole Tablet 380 380 80 300 270.00 81,000.00 -
62 Metro syr Btl 66 66 18 48 3,950.10 189,604.80 -
63 Cefadroxil syr Btl 95 95 95 3,921.50 372,542.50 -
64 Profolat Tablet 560 560 560 51.997 29,118.32 -
65 Combiven nebu amp 331 331 11 320 4,550.000 1,456,000.00 -
66 Simvastatin Tablet 944 944 166 778 205.000 159,490.00 -
67 Ranitidin Tablet 544 544 544 - 104.995 - -
68 Decafil (Aminophillin) Tablet 790 790 790 138.996 109,806.84 -
69 Scabimide pot 11 11 11 - 10,825.000 - -
70 Amlodipin 10 mg Tablet 3,240 3,240 215 3,025 93.000 281,325.00 -
71 Domperidon 10 mg Tablet 100 100 100 84.996 8,499.60 -
72 Allupurinol Tablet 530 530 80 450 99.000 44,550.00 -
73 Miniaspi Tablet 590 590 80 510 99.000 50,490.00 -
74 Methilprednisolon Tablet 11,900 11,900 100 11,800 133.991 1,581,093.80 -

Page 27 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
75 Nistatin drop Btl 42 42 1 41 13,500.300 553,512.30 -
76 Amoxicillin 500 mg Tablet - - - 363.000 - -
77 Bimaflok Tablet - - - 670.000 - -
78 Corsaneuron Tablet - - - 690.000 - -
79 Caviplex Tablet 550 550 135 415 422.000 175,130.00 -
80 Grantusip Tablet 815 815 815 - 483.000 - -
81 Kloram Tetes mata Btl 90 90 25 65 9,350.000 607,750.00 -
82 Lostasef Kapsul - - - 2,270.000 - -
83 Novamagh syr Btl 225 225 201 24 6,000.000 144,000.00 -
84 Meloxicam 15 mg Tablet 764 764 220 544 1,089.000 592,416.00 -
85 Spasminal Tablet 182 182 58 124 638.000 79,112.00 -
86 Skopma Tablet 254 254 186 68 1,527.000 103,836.00 -
87 Superhoid suppo suppo 15 15 15 3,565.000 53,475.00 -
88 Cetirizin syr Btl 22 22 22 - 2,850.100 - -
89 Baby cough Btl 140 140 31 109 6,823.000 743,707.00 -
90 Cefixim Kapsul - - - 1,320.000 - -
JML 24,190,068 -

Page 28 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2   Spuit 10 cc ONIONEX PCS - - - 1,163 -
3 Foley cath 18 Pcs 76 76 7 69 8,000 552,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5 Foley cath 16 Pcs 41 41 41 8,000 328,000
6 Spuit 3 ml nipro - - - 792 -
7 Sarung tangan Gynecolog Pasang 390 390 390 12,000 4,680,000
8 Suction cath 16 Bh - - - 7,545 -
9 Warm water zak Bh 1 1 0 1 23,864 23,864 .
10 KTO B 1 kntong isi 10 pak - - - 11,000 -
11 KTO K Pak 126 126 36 90 8,800 792,000
12 Kertas puyer Pak - - - 10,000 -
13 Label Baru pak - - - 25,000 - -
14 Aximed Fixation nonwoven Roll 2 2 0 2 68,651 137,302 -
15 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
16 Masker Nebu anak Bh 4 4 0 4 22,660 90,640 -
17 Stikpan plastik deluxe Bh - - - 36,155 - -
18 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
19 Aximed papertape hivapik Roll - - - 21,849 - -
20 Silk BARU 3/0 - - - 3,900 - -
21 Syringe 1 cc - - - 728.00 - -
22 Catgut chromik 3/0 - - - 7,493.06 - -
23 Hcg test bh - - - 1,800.00 - -
24 Underpad bh - - - 4,100.00 - -
25 sarung tangan young psg 1 1 1 36,000.00 36,000.00 -
26 sarung tangan steril 7,5 psg - - - 4,214.00 - -
27 kasa hidrofil besar bh - - - 143,550.00 - -
28 kasa steril mini bh - - - 3,600.00 - -
29 exam glove M psg - - - 545.45 - -
30 eXAm glove S psg - - - 1,200.00 - -
31 Gatrix nasal Bayi bh - - - 8,800.00 - -
32 Gatrix nasal Anak bh - - - 8,800.00 - -
33 Jarum Bd no 23 bh - - - 4,000.04 - -
34 Umbilikal bh - - - 2,600.00 - -
35 Jarum hekting paket - - - 35,333.32 - -
36 Jely USG Botol - - - 30,800.00 - -
37 Aboket 26 bh - - - 12,000.00 - -
38 Aboket 24 bh - - - 8,000.00 - -
39 plester coklat besar bh - - - 60,000.00 - -
40 feeding no 5 bh - - - 38,500.00 - -
41 tisu besar bh - - - 17,000.00 - -
42 Hanrub (2) Bh - - - 62,050.00 - -
43 One clean (klorin) Btl 28 28 1 27 15,246.00 411,642.00 -
44 sabun anti bakteri Btl 8 8 1 7 27,720.00 194,040.00 -
45 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
46 Catgut + jarum 3/0 Bh 70 70 10 60 5,750.80 345,048.00 -
47 Silk + jarum 2/0 Bh 116 116 30 86 3,147.20 270,659.20 -
48 Alkohol 1 L Btl 3 3 2 1 26,250.40 26,250.40 -

Page 29 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
49 Exam Glove M Pak - - - 366.88 - -
50 Exam Glove L Pak - - - 366.88 - -
51 Masker Ear Loop Bh 150 150 100 50 453.20 22,660.00 -
52 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
53 Spuit 10 cc Sterra Set 75 75 75 952.75 71,456.25 -
54 Infusion set Dewasa Set - - - 3,295.60 - -
55 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
56 Oxyflow Anak transparan bh 48 48 1 47 5,150.00 242,050.00 -
57 Tes kehamilan ultra one bh - - - 1,997.60 - -
58 Safety box 5 Lt kuning bh 75 75 25 50 16,186.50 809,325.00 -
59 Aboket no 26 Sterra Set 41 41 23 18 4,222.90 76,012.20 -
60 Ultrasonik gell (jelly usg putih) Btl 6 6 2 4 13,213.20 52,852.80 -
61 Oxyflow bayi transparan bh 32 32 32 5,665.00 181,280.00 -
62 Oxyflow Dewasa transparan bh 26 26 1 25 5,665.00 141,625.00 -
63 Suction cath 8 bh - - - 9,000.00 - -
64 Kantong obat Besar pak - - - 11,000.00 - -
65 kresek pak 19 19 19 - 12,000.00 - -
66 Etiket Putih pak 68 68 10 58 25,000.00 1,450,000.00 -
67 Edta ungu box - - - 190,000.00 - -
68 ubderpad pak - - - 42,000.00 - -
69 jarum no 8 set 2 2 2 - 17,500.00 - -
70 jarum no 10 set - - - 17,500.00 - -
71 Stik Glukosa Acucek box - - - 630,000.00 - -
72 Stik Hb family dr box - - - 370,000.00 - -
73 Stik urin 3 p box - - - 150,000.00 - -
74 Plester coklat besar roll - - - 85,000.00 - -
75 Bisturi bh - - - 10,000.00 - -
76 Stik gula benecheck box - - - 152,049.00 - -
77 Stik asam urat benecheck box - - - 131,398.00 - -
78 Stik Kolesterol benecheck box - - - 232,836.75 - -
79 Tranfusi set set - - - 11,000.00 - -
80 Kasa gulung besar baru bh 6 6 2 4 143,000.00 572,000.00 -
81 bisturi no 11 bh 76 76 14 62 1,320.00 81,840.00 -
82 Exam glove M box - - - 55,000.00 - -
83 Batang pengaduk bh 2 2 1 1 33,000.00 33,000.00 -
84 Termometer Ruangan/KULKAS bh 1 1 1 275,000.00 275,000.00 -
85 Catgut baru GEA bh 120 120 120 11,229.16 1,347,499.20 -
86 Silk BARU 3/0 GEA bh 180 180 180 7,486.11 1,347,499.80 -
87 Underpad Pads 30 30 1 29 55,000.00 1,595,000.00 -
88 Kantong obat Besar pak 53 53 31 22 12,100.00 266,200.00 -
89 Plester Hifavik box 17 17 17 22,000.00 374,000.00 -
90 Alkohol swab box - - - 22,000.00 - -
91 Jarum hekting no 8 bh 10 10 10 19,800.00 198,000.00 -
92 Jarum hekting no 10 bh 10 10 1 9 6,600.00 59,400.00 -
93 Feeding tube no 8 bh 8 8 8 66,000.00 528,000.00 -
94 Hanrub ASEPTIC Btl 10 10 2 8 57,200.00 457,600.00 -
95 Gelly usg baru KUNING Btl 7 7 7 38,500.00 269,500.00 -
96 Umbilikal klem baru bh 75 75 12 63 2,640.00 166,320.00 -
97 Jarum Bd no 23 bh - - - 605.00 - -
98 Kasa steril box 498 498 13 485 1,650.00 800,250.00 -
99 Masker 02 Dewasa bh 3 3 3 24,750.00 74,250.00 -
Page 30 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
100 Masker 02 Anak bh 3 3 3 24,750.00 74,250.00 -
101 Tisu lensa box - - - 132,000.00 - -
102 Termometer Tembak bh - - - 275,000.00 - -
103 Bola bobat bh - - - 550,000.00 - -

REAGEN
Probe cleaner bh 3 3 3 618,182.00 1,854,546.00 -
Diluent bh 3 3 3 2,545,454.00 7,636,362.00 -
Lyse bh 3 3 3 2,545,454.00 7,636,362.00
36,689,315.45 -

Jumlah Total - 60,879,383.36 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,702

........................, ....................................20......
Yang Menerima : Diketahui /disetujui , Yang Menerima :
Mengetahui/Menyetujui : Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan : Pengelola Obat
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 31 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
........................, ....................................20......
Yang Menerima :
Pengelola Obat

Irwan Hilmy S.Farm., Apt

Page 32 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : MARET 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Aciblok Tablet - - - 550.00 - -
2 Alkohol 70% BOTOL - - - 2,500.00 -
3 Allerin expext syr Btl - - - 9,750.00 -
4 Allupurinol Tablet 450 450 205 245 99.000 24,255.00 -
5 Ambroxol Tablet - - - 144.00 - -
6 Amlodipin Tablet - - - 176.00 - -
7 Amlodipin 10 mg Tablet 3,025 3,025 3,025 93.000 281,325.00 -
8 Amoxicillin 500 mg Tablet - - - 363.000 - -
9 As. Tranex injek Amp 352 352 2 350 5,250.00 1,837,500
10 As. Tranex tablet Tablet - - - 9,915.00 - -
11 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
12 Aspilet Tablet - - - 530.00 -
13 Baby cough Btl 109 109 6 103 6,823.000 702,769.00 -
14 Betason n Cr Tube 15 15 15 - 1,061.00 -
15 Bimaflock Tablet - - - 615.00 - -
16 Bimaflok Tablet - - - 670.000 - -
17 Bupantasid syr botol - - - 8,800.00 - -
18 Caviplex Tablet 415 415 115 300 422.000 126,600.00 -
19 Cedrox Kapsul - - - 1,170.00 - -
20 Cefadroxil syr Btl 95 95 0 95 3,921.50 372,542.50 -
21 Cefixim Kapsul - - - 1,320.000 - -
22 Cendo Genta str - - - 17,463.00 -
23 Cendo Polydex str - - - 29,150.00 -
24 Cetirizin syr Btl - - - 2,850.100 - -
25 Combiven nebu amp 320 320 11 309 4,550.000 1,405,950.00 -
26 Corsaneuron Tablet - - - 690.000 - -
27 Decafil (Aminophillin) Tablet 790 790 10 780 138.996 108,416.88 -
28 Diazepam 2 mg Tablet 639 639 4 635 1,000.00 635,000 -
29 Domperidon 10 mg Tablet 100 100 0 100 84.996 8,499.60 -
30 Domperidon 10 mg Tablet - - - 167.00 -
31 Domperidon suspensi BOTOL 45 45 2 43 3,333.00 143,319 -

Page 33 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
32 Dopamet Tablet 40 40 20 20 1,830.00 36,600 -
33 Enervon C 120 ml btl - - - 17,118.00 -
34 Farsipen syr Btl - - - 10,780.00 - -
35 Fasidol forte Tablet - - - 350.00 - -
36 Fit k infant amp - - - 6,300.00 - -
37 Glibenklamid Tablet - - - 198.00 - -
38 Glimepirid Tablet - - - 263.00 -
39 Grantusip Tablet - - - 483.000 - -
40 Haloperidol 5 mg Tablet - - - 96.00 -
41 Hexymer 2 mg (THF) Tablet - - - 270.00 -
42 Ikaneuron injeksi amp - - - 5,350.00 - -
43 Kalsium glukonas Amp 26 26 1 25 7,090.88 177,271.88
44 Ketokonazole Tablet 300 300 90 210 270.00 56,700.00 -
45 Ketopropen injeksi Amp 7 7 7 28,249.00 197,743 -
46 Ketorolak ij Amp - - - 5,455.00 -
47 kloram tetes mata botol - - - 27,300.00 - -
48 Kloram Tetes mata Btl 65 65 22 43 9,350.000 402,050.00 -
49 kloram Tetes telinga botol - - - 7,840.00 - -
50 Kloramfecort Cream Tube - - - 11,285.00 -
51 Kloramfenikol tetes mata Btl - - - 3,250.01 -
52 Klorampenikol syr botol - - - 8,900.00 - -
53 L BIO Saset - - - 6,600.00 - -
54 Lexapram syr (2) btl - - - 7,260.00 - -
55 Lexigo Tablet - - - 660.00 - -
56 Lidokain injek Amp - - - 1,222.10 - -
57 Lostasef Kapsul - - - 2,270.000 - -
58 Meloxicam 15 mg Tablet 544 544 479 65 1,089.000 70,785.00 -
59 Metergin Tablet 470 470 50 420 210.000 88,200 -
60 Methilprednisolon Tablet 11,800 11,800 1056 10,744 133.991 1,439,599.30 -
61 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
62 Metro syr Btl 48 48 25 23 3,950.10 90,852.30 -
63 Metronidazol syrup Btl - - 3,454.00 -
64 Miniaspi Tablet 510 510 120 390 99.000 38,610.00 -
65 neocenta jell Tube - - - 19,700.00 - -
66 Neosenta Salep Tube - - - 19,958.00 - -
67 Nistatin drop Btl 41 41 1 40 13,500.300 540,012.00 -
68 Novamagh syr Btl 24 24 6 18 6,000.000 108,000.00 -
69 Parasetamol infus Botol - - - 33,000.00 - -
70 Profolat Tablet 560 560 0 560 51.997 29,118.32 -
71 Ranitidin Tablet - - - 104.995 - -
72 Scabimide pot - - - 10,825.000 - -
73 Sefadroxil syr botol - - - 13,000.00 - -
74 Seftriaxon ij box 449 449 0 449 20,000.00 8,980,000
75 Simvastatin Tablet 778 778 30 748 205.000 153,340.00 -
76 Skopma Tablet 68 68 68 - 1,527.000 - -

Page 34 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
77 Skopma Tablet - - - 1,600.00 - -
78 Skopma Plus Tablet - - - 2,596.00 - -
79 Sotatik injeksi Amp 1,011 1,011 48 963 4,400.00 4,237,200 -
80 Spashi injeksi Amp 4 4 0 4 9,900.00 39,600 -
81 spaslic Tablet - - - 2,500.00 - -
82 Spasminal Tablet 124 124 124 - 638.000 - -
83 Superhoid suppo suppo 15 15 15 3,565.000 53,475.00 -
84 Terbutalin Tablet 250 250 90 160 89.012 14,241.92 -
85 Thiamfilex syr Btl 9 9 5 4 7,150.00 28,600 -
86 Thiampenikol Tablet 10 10 10 1,210.00 12,100 -
87 Vitamin syr Btl - - - 11,880.00 - -
88 zenirex syr botol - - - 8,800.00 - -
89 Zevask 10 mg Tablet - - - 746.00 - -
90 Zink syr Botol - - - 33,000.00 - -
JML 22,440,276 -

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2 Foley cath 16 Pcs 41 41 6 35 8,000 280,000
3 Foley cath 18 Pcs 69 69 7 62 8,000 496,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5   Spuit 10 cc ONIONEX PCS - - - 1,163 -
6 Aboket 24 bh - - - 8,000.00 - -
7 Aboket 26 bh - - - 12,000.00 - -
8 Aboket no 26 Sterra Set 18 18 18 4,222.90 76,012.20 -
9 Alkohol 1 L Btl 1 1 1 26,250.40 26,250.40 -
10 Alkohol swab box - - - 22,000.00 - -
11 Aximed Fixation nonwoven Roll 2 2 2 - 68,651 - -
12 Aximed papertape hivapik Roll - - - 21,849 - -
13 Batang pengaduk bh 1 1 1 33,000.00 33,000.00 -
14 Bisturi bh - - - 10,000.00 - -
15 bisturi no 11 bh 62 62 8 54 1,320.00 71,280.00 -
16 Bola bobat bh - - - 550,000.00 - -
17 Catgut + jarum 3/0 Bh 60 60 15 45 5,750.80 258,786.00 -
18 Catgut baru GEA bh 120 120 120 11,229.16 1,347,499.20 -
19 Catgut chromik 3/0 - - - 7,493.06 - -
20 Edta ungu box - - - 190,000.00 - -
21 Etiket Putih pak 58 58 9 49 25,000.00 1,225,000.00 -
22 Exam Glove L Pak - - - 366.88 - -

Page 35 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
23 exam glove M psg - - - 545.45 - -
24 Exam Glove M Pak - - - 366.88 - -
25 Exam glove M box - - - 55,000.00 - -
26 eXAm glove S psg - - - 1,200.00 - -
27 feeding no 5 bh - - - 38,500.00 - -
28 Feeding tube no 8 bh 8 8 8 66,000.00 528,000.00 -
29 Gatrix nasal Anak bh - - - 8,800.00 - -
30 Gatrix nasal Bayi bh - - - 8,800.00 - -
31 Gelly usg baru KUNING Btl 7 7 1 6 38,500.00 231,000.00 -
32 Hanrub (2) Bh - - - 62,050.00 - -
33 Hanrub ASEPTIC Btl 8 8 2 6 57,200.00 343,200.00 -
34 Hcg test bh - - - 1,800.00 - -
35 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
36 Infusion set Dewasa Set - - - 3,295.60 - -
37 Jarum Bd no 23 bh - - - 4,000.04 - -
38 Jarum Bd no 23 bh - - - 605.00 - -
39 Jarum hekting paket - - - 35,333.32 - -
40 Jarum hekting no 10 bh 9 9 9 6,600.00 59,400.00 -
41 Jarum hekting no 8 bh 10 10 10 19,800.00 198,000.00 -
42 jarum no 10 set - - - 17,500.00 - -
43 jarum no 8 set - - - 17,500.00 - -
44 Jely USG Botol - - - 30,800.00 - -
45 Kantong obat Besar pak - - - 11,000.00 - -
46 Kantong obat Besar pak 22 22 22 - 12,100.00 - -
47 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
48 Kasa gulung besar baru bh 4 4 4 143,000.00 572,000.00 -
49 kasa hidrofil besar bh - - - 143,550.00 - -
50 Kasa steril box 485 485 12 473 1,650.00 780,450.00 -
51 kasa steril mini bh - - - 3,600.00 - -
52 Kertas puyer Pak - - - 10,000 -
53 kresek pak - - - 12,000.00 - -
54 KTO B 1 kntong isi 10 pak - - - 11,000 -
55 KTO K Pak 90 90 10 80 8,800 704,000
56 Label Baru pak - - - 25,000 - -
57 Masker 02 Anak bh 3 3 3 24,750.00 74,250.00 -
58 Masker 02 Dewasa bh 3 3 3 24,750.00 74,250.00 -
59 Masker Ear Loop Bh 50 50 50 - 453.20 - -
60 Masker Nebu anak Bh 4 4 1 3 22,660 67,980 -
61 Masker Nebu Dewasa Bh 2 2 2 22,660 45,320 -
62 One clean (klorin) Btl 27 27 3 24 15,246.00 365,904.00 -
63 Oxyflow Anak transparan / NASAL bh 47 47 9 38 5,150.00 195,700.00 -
64 Oxyflow bayi transparan bh 32 32 7 25 5,665.00 141,625.00 -
65 Oxyflow Dewasa transparan bh 25 25 5 20 5,665.00 113,300.00 -
66 plester coklat besar bh - - - 60,000.00 - -
67 Plester coklat besar roll - - - 85,000.00 - -
68 Plester Hifavik box 17 17 17 22,000.00 374,000.00 -
69 sabun anti bakteri Btl 7 7 3 4 27,720.00 110,880.00 -
70 Safety box 5 Lt kuning bh 50 50 50 16,186.50 809,325.00 -
71 Sarung tangan Gynecolog Pasang 390 390 390 12,000 4,680,000
72 sarung tangan steril 7,5 psg - - - 4,214.00 - -
73 sarung tangan young psg 1 1 1 36,000.00 36,000.00 -

Page 36 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
74 Silk + jarum 2/0 Bh 86 86 33 53 3,147.20 166,801.60 -
75 Silk BARU 3/0 - - - 3,900 - -
76 Silk BARU 3/0 GEA bh 180 180 180 7,486.11 1,347,499.80 -
77 Spuit 10 cc Sterra Set 75 75 0 75 952.75 71,456.25 -
78 Spuit 3 ml nipro - - - 792 -
79 Stik asam urat benecheck box - - - 131,398.00 - -
80 Stik Glukosa Acucek box - - - 630,000.00 - -
81 Stik gula benecheck box - - - 152,049.00 - -
82 Stik Hb family dr box - - - 370,000.00 - -
83 Stik Kolesterol benecheck box - - - 232,836.75 - -
84 Stik urin 3 p box - - - 150,000.00 - -
85 Stikpan plastik deluxe Bh - - - 36,155 - -
86 Suction cath 16 Bh - - - 7,545 -
87 Suction cath 8 bh - - - 9,000.00 - -
88 Syringe 1 cc - - - 728.00 - -
89 Termometer Ruangan/KULKAS bh 1 1 1 275,000.00 275,000.00 -
90 Termometer Tembak bh - - - 275,000.00 - -
91 Tes kehamilan ultra one bh - - - 1,997.60 - -
92 tisu besar bh - - - 17,000.00 - -
93 Tisu lensa box - - - 132,000.00 - -
94 Tranfusi set set - - - 11,000.00 - -
95 ubderpad pak - - - 42,000.00 - -
96 Ultrasonik gell (jelly usg putih) Btl 4 4 4 13,213.20 52,852.80 -
97 Umbilikal bh - - - 2,600.00 - -
98 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
99 Umbilikal klem baru bh 63 63 5 58 2,640.00 153,120.00 -
100 Underpad bh - - - 4,100.00 - -
101 Underpad Pads 29 29 3 26 55,000.00 1,430,000.00 -
102 Urinal plastik + tutup Bh 2 2 2 31,205 62,410 -
103 Warm water zak Bh 1 1 1 23,864 23,864 .

REAGEN
1 Probe cleaner bh 3 3 3 618,182.00 1,854,546.00 -
2 Diluent bh 3 3 3 2,545,454.00 7,636,362.00 -
3 Lyse bh 3 3 3 2,545,454.00 7,636,362.00
35,028,685.85 -

Jumlah Total - 57,468,961.55 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,115

........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 37 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 ........................, ....................................20......
Yang Menerima :
Diketahui /disetujui , Pengelola Obat
Mengetahui/Menyetujui : dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

Riki Amardiansyah,dr
.......................................................... ............................................................ HARGA
NIP. 197511032006041001 JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

Page 38 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : juni 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Aciblok Tablet - - - 550.00 - -
2 Alkohol 70% BOTOL - - - 2,500.00 -
3 Allerin expext syr Btl - - - 9,750.00 -
4 Allupurinol Tablet 245 245 180 65 99.000 6,435.00 -
5 Ambroxol Tablet - - - 144.00 - -
6 Amlodipin Tablet - - - 176.00 - -
7 Amlodipin 10 mg Tablet 3,025 3,025 485 2,540 93.000 236,220.00 -
8 Amoxicillin 500 mg Tablet - - - 363.000 - -
9 As. Tranex injek Amp 350 350 0 350 5,250.00 1,837,500
10 As. Tranex tablet Tablet - - - 9,915.00 - -
11 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
12 Aspilet Tablet - - - 530.00 -
13 Baby cough Btl 103 103 8 95 6,823.000 648,185.00 -
14 Betason n Cr Tube - - - 1,061.00 -
15 Bimaflock Tablet - - - 615.00 - -
16 Bimaflok Tablet - - - 670.000 - -
17 Bupantasid syr botol - - - 8,800.00 - -
18 Caviplex Tablet 300 300 300 - 422.000 - -
19 Cedrox Kapsul - - - 1,170.00 - -
20 Cefadroxil syr Btl 95 95 74 21 3,921.50 82,351.50 -
21 Cefixim Kapsul - - - 1,320.000 - -
22 Cendo Genta str - - - 17,463.00 -
23 Cendo Polydex str - - - 29,150.00 -
24 Cetirizin syr Btl - - - 2,850.100 - -
25 Combiven nebu amp 309 309 6 303 4,550.000 1,378,650.00 -
26 Corsaneuron Tablet - - - 690.000 - -
27 Decafil (Aminophillin) Tablet 780 780 10 770 138.996 107,026.92 -
28 Diazepam 2 mg Tablet 635 635 15 620 1,000.00 620,000 -
29 Domperidon 10 mg Tablet 100 100 0 100 84.996 8,499.60 -
30 Domperidon 10 mg Tablet - - - 167.00 -
31 Domperidon suspensi BOTOL 43 43 11 32 3,333.00 106,656 -

Page 39 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
32 Dopamet Tablet 20 20 0 20 1,830.00 36,600 -
33 Enervon C 120 ml btl - - - 17,118.00 -
34 Farsipen syr Btl - - - 10,780.00 - -
35 Fasidol forte Tablet - - - 350.00 - -
36 Fit k infant amp - - - 6,300.00 - -
37 Glibenklamid Tablet - - - 198.00 - -
38 Glimepirid Tablet - - - 263.00 -
39 Grantusip Tablet - - - 483.000 - -
40 Haloperidol 5 mg Tablet - - - 96.00 -
41 Hexymer 2 mg (THF) Tablet - - - 270.00 -
42 Ikaneuron injeksi amp - - - 5,350.00 - -
43 Kalsium glukonas Amp 25 25 - 25 7,090.88 177,271.88
44 Ketokonazole Tablet 210 210 10 200 270.00 54,000.00 -
45 Ketopropen injeksi Amp 7 7 0 7 28,249.00 197,743 -
46 Ketorolak ij Amp - - - 5,455.00 -
47 kloram tetes mata botol - - - 27,300.00 - -
48 Kloram Tetes mata Btl 43 43 13 30 9,350.000 280,500.00 -
49 kloram Tetes telinga botol - - - 7,840.00 - -
50 Kloramfecort Cream Tube - - - 11,285.00 -
51 Kloramfenikol tetes mata Btl - - - 3,250.01 -
52 Klorampenikol syr botol - - - 8,900.00 - -
53 L BIO Saset - - - 6,600.00 - -
54 Lexapram syr (2) btl - - - 7,260.00 - -
55 Lexigo Tablet - - - 660.00 - -
56 Lidokain injek Amp - - - 1,222.10 - -
57 Lostasef Kapsul - - - 2,270.000 - -
58 Meloxicam 15 mg Tablet 65 65 65 - 1,089.000 - -
59 Metergin Tablet 420 420 0 420 210.000 88,200 -
60 Methilprednisolon Tablet 10,744 10,744 671 10,073 133.991 1,349,691.34 -
61 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
62 Metro syr Btl 23 23 9 14 3,950.10 55,301.40 -
63 Metronidazol syrup Btl - - 3,454.00 -
64 Miniaspi Tablet 390 390 30 360 99.000 35,640.00 -
65 neocenta jell Tube - - - 19,700.00 - -
66 Neosenta Salep Tube - - - 19,958.00 - -
67 Nistatin drop Btl 40 40 7 33 13,500.300 445,509.90 -
68 Novamagh syr Btl 18 18 18 - 6,000.000 - -
69 Parasetamol infus Botol - - - 33,000.00 - -
70 Profolat Tablet 560 560 0 560 51.997 29,118.32 -
71 Ranitidin Tablet - - - 104.995 - -
72 Scabimide pot - - - 10,825.000 - -
73 Sefadroxil syr botol - - - 13,000.00 - -
74 Seftriaxon ij box 449 449 0 449 20,000.00 8,980,000
75 Simvastatin Tablet 748 748 168 580 205.000 118,900.00 -
76 Skopma Tablet - - - 1,527.000 - -

Page 40 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
77 Skopma Tablet - - - 1,600.00 - -
78 Skopma Plus Tablet - - - 2,596.00 - -
79 Sotatik injeksi Amp 963 963 15 948 4,400.00 4,171,200 -
80 Spashi injeksi Amp 4 4 1 3 9,900.00 29,700 -
81 spaslic Tablet - - - 2,500.00 - -
82 Spasminal Tablet - - - 638.000 - -
83 Superhoid suppo suppo 15 15 0 15 3,565.000 53,475.00 -
84 Terbutalin Tablet 160 160 0 160 89.012 14,241.92 -
85 Thiamfilex syr Btl 4 4 1 3 7,150.00 21,450 -
86 Thiampenikol Tablet 10 10 0 10 1,210.00 12,100 -
87 Vitamin syr Btl - - - 11,880.00 - -
88 zenirex syr botol - - - 8,800.00 - -
89 Zevask 10 mg Tablet - - - 746.00 - -
90 Zink syr Botol - - - 33,000.00 - -
JML 21,182,167 -

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2 Foley cath 16 Pcs 35 35 6 29 8,000 232,000
3 Foley cath 18 Pcs 62 62 4 58 8,000 464,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5   Spuit 10 cc ONIONEX PCS - - - 1,163 -
6 Aboket 24 bh - - - 8,000.00 - -
7 Aboket 26 bh - - - 12,000.00 - -
8 Aboket no 26 Sterra Set 18 18 18 - 4,222.90 - -
9 Alkohol 1 L Btl 1 1 1 - 26,250.40 - -
10 Alkohol swab box - - - 22,000.00 - -
11 Aximed Fixation nonwoven Roll - - - 68,651 - -
12 Aximed papertape hivapik Roll - - - 21,849 - -
13 Batang pengaduk bh 1 1 0 1 33,000.00 33,000.00 -
14 Bisturi bh - - - 10,000.00 - -
15 bisturi no 11 bh 54 54 17 37 1,320.00 48,840.00 -
16 Bola bobat bh - - - 550,000.00 - -
17 Catgut + jarum 3/0 Bh 45 45 34 11 5,750.80 63,258.80 -
18 Catgut baru GEA bh 120 120 0 120 11,229.16 1,347,499.20 -
19 Catgut chromik 3/0 - - - 7,493.06 - -
20 Edta ungu box - - - 190,000.00 - -
21 Etiket Putih pak 49 49 10 39 25,000.00 975,000.00 -
22 Exam Glove L Pak - - - 366.88 - -

Page 41 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
23 exam glove M psg - - - 545.45 - -
24 Exam Glove M Pak - - - 366.88 - -
25 Exam glove M box - - - 55,000.00 - -
26 eXAm glove S psg - - - 1,200.00 - -
27 feeding no 5 bh - - - 38,500.00 - -
28 Feeding tube no 8 bh 8 8 0 8 66,000.00 528,000.00 -
29 Gatrix nasal Anak bh - - - 8,800.00 - -
30 Gatrix nasal Bayi bh - - 0 - 8,800.00 - -
31 Gelly usg baru KUNING Btl 6 6 6 38,500.00 231,000.00 -
32 Hanrub (2) Bh - - - 62,050.00 - -
33 Hanrub ASEPTIC Btl 6 6 1 5 57,200.00 286,000.00 -
34 Hcg test bh - - - 1,800.00 - -
35 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
36 Infusion set Dewasa Set - - - 3,295.60 - -
37 Jarum Bd no 23 bh - - - 4,000.04 - -
38 Jarum Bd no 23 bh - - - 605.00 - -
39 Jarum hekting paket - - - 35,333.32 - -
40 Jarum hekting no 10 bh 9 9 0 9 6,600.00 59,400.00 -
41 Jarum hekting no 8 bh 10 10 0 10 19,800.00 198,000.00 -
42 jarum no 10 set - - - 17,500.00 - -
43 jarum no 8 set - - - 17,500.00 - -
44 Jely USG Botol - - - 30,800.00 - -
45 Kantong obat Besar pak - - - 11,000.00 - -
46 Kantong obat Besar pak - - - 12,100.00 - -
47 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
48 Kasa gulung besar baru bh 4 4 2 2 143,000.00 286,000.00 -
49 kasa hidrofil besar bh - - - 143,550.00 - -
50 Kasa steril box 473 473 18 455 1,650.00 750,750.00 -
51 kasa steril mini bh - - - 3,600.00 - -
52 Kertas puyer Pak - - - 10,000 -
53 kresek pak - - - 12,000.00 - -
54 KTO B 1 kntong isi 10 pak - - - 11,000 -
55 KTO K Pak 80 80 22 58 8,800 510,400
56 Label Baru pak - - - 25,000 - -
57 Masker 02 Anak bh 3 3 0 3 24,750.00 74,250.00 -
58 Masker 02 Dewasa bh 3 3 0 3 24,750.00 74,250.00 -
59 Masker Ear Loop Bh - - - 453.20 - -
60 Masker Nebu anak Bh 3 3 0 3 22,660 67,980 -
61 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
62 One clean (klorin) Btl 24 24 1 23 15,246.00 350,658.00 -
63 Oxyflow Anak transparan / NASAL bh 38 38 3 35 5,150.00 180,250.00 -
64 Oxyflow bayi transparan bh 25 25 0 25 5,665.00 141,625.00 -
65 Oxyflow Dewasa transparan bh 20 20 3 17 5,665.00 96,305.00 -
66 plester coklat besar bh - - - 60,000.00 - -
67 Plester coklat besar roll - - - 85,000.00 - -
68 Plester Hifavik box 17 17 2 15 22,000.00 330,000.00 -
69 sabun anti bakteri Btl 4 4 2 2 27,720.00 55,440.00 -
70 Safety box 5 Lt kuning bh 50 50 0 50 16,186.50 809,325.00 -
71 Sarung tangan Gynecolog Pasang 390 390 0 390 12,000 4,680,000
72 sarung tangan steril 7,5 psg - - - 4,214.00 - -
73 sarung tangan young psg 1 1 0 1 36,000.00 36,000.00 -

Page 42 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
74 Silk + jarum 2/0 Bh 53 53 20 33 3,147.20 103,857.60 -
75 Silk BARU 3/0 - - - 3,900 - -
76 Silk BARU 3/0 GEA bh 180 180 0 180 7,486.11 1,347,499.80 -
77 Spuit 10 cc Sterra Set 75 75 0 75 952.75 71,456.25 -
78 Spuit 3 ml nipro - - - 792 -
79 Stik asam urat benecheck box - - - 131,398.00 - -
80 Stik Glukosa Acucek box - - - 630,000.00 - -
81 Stik gula benecheck box - - - 152,049.00 - -
82 Stik Hb family dr box - - - 370,000.00 - -
83 Stik Kolesterol benecheck box - - - 232,836.75 - -
84 Stik urin 3 p box - - - 150,000.00 - -
85 Stikpan plastik deluxe Bh - - - 36,155 - -
86 Suction cath 16 Bh - - - 7,545 -
87 Suction cath 8 bh - - - 9,000.00 - -
88 Syringe 1 cc - - - 728.00 - -
89 Termometer Ruangan/KULKAS bh 1 1 0 1 275,000.00 275,000.00 -
90 Termometer Tembak bh - - - 275,000.00 - -
91 Tes kehamilan ultra one bh - - - 1,997.60 - -
92 tisu besar bh - - - 17,000.00 - -
93 Tisu lensa box - - - 132,000.00 - -
94 Tranfusi set set - - - 11,000.00 - -
95 ubderpad pak - - - 42,000.00 - -
96 Ultrasonik gell (jelly usg putih) Btl 4 4 1 3 13,213.20 39,639.60 -
97 Umbilikal bh - - - 2,600.00 - -
98 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
99 Umbilikal klem baru bh 58 58 10 48 2,640.00 126,720.00 -
100 Underpad bh - - - 4,100.00 - -
101 Underpad Pads 26 26 0 26 55,000.00 1,430,000.00 -
102 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
103 Warm water zak Bh 1 1 0 1 23,864 23,864 .

REAGEN
1 Probe cleaner bh 3 3 0 3 618,182.00 1,854,546.00 -
2 Diluent bh 3 3 0 3 2,545,454.00 7,636,362.00 -
3 Lyse bh 3 3 0 3 2,545,454.00 7,636,362.00
33,562,267.85 -

Jumlah Total - 54,744,434.63 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,786

........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
Page
. 43 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 ........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) Irwan
JML Hilmy S.Farm., Apt
PENERIMAAN
..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 44 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : juni 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Aciblok Tablet - - - 550.00 - -
2 Alkohol 70% BOTOL - - - 2,500.00 -
3 Allerin expext syr Btl - - - 9,750.00 -
4 Allupurinol Tablet 65 65 65 - 99.000 - -
5 Ambroxol Tablet - - - 144.00 - -
6 Amlodipin Tablet - - - 176.00 - -
7 Amlodipin 10 mg Tablet 2,540 2,540 135 2,405 93.000 223,665.00 -
8 Amoxicillin 500 mg Tablet - - - 363.000 - -
9 As. Tranex injek Amp 350 350 0 350 5,250.00 1,837,500
10 As. Tranex tablet Tablet - - - 9,915.00 - -
11 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
12 Aspilet Tablet - - - 530.00 -
13 Baby cough Btl 95 95 29 66 6,823.000 450,318.00 -
14 Betason n Cr Tube - - - 1,061.00 -
15 Bimaflock Tablet - - - 615.00 - -
16 Bimaflok Tablet - - - 670.000 - -
17 Bupantasid syr botol - - - 8,800.00 - -
18 Caviplex Tablet - - - 422.000 - -
19 Cedrox Kapsul - - - 1,170.00 - -
20 Cefadroxil syr Btl 21 21 21 - 3,921.50 - -
21 Cefixim Kapsul - - - 1,320.000 - -
22 Cendo Genta str - - - 17,463.00 -
23 Cendo Polydex str - - - 29,150.00 -
24 Cetirizin syr Btl - - - 2,850.100 - -
25 Combiven nebu amp 303 303 23 280 4,550.000 1,274,000.00 -
26 Corsaneuron Tablet - - - 690.000 - -
27 Decafil (Aminophillin) Tablet 770 770 170 600 138.996 83,397.60 -
28 Diazepam 2 mg Tablet 620 620 2 618 1,000.00 618,000 -
29 Domperidon 10 mg Tablet 100 100 0 100 84.996 8,499.60 -
30 Domperidon 10 mg Tablet - - - 167.00 -
31 Domperidon suspensi BOTOL 32 32 11 21 3,333.00 69,993 -

Page 45 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
32 Dopamet Tablet 20 20 0 20 1,830.00 36,600 -
33 Enervon C 120 ml btl - - - 17,118.00 -
34 Farsipen syr Btl - - - 10,780.00 - -
35 Fasidol forte Tablet - - - 350.00 - -
36 Fit k infant amp - - - 6,300.00 - -
37 Glibenklamid Tablet - - - 198.00 - -
38 Glimepirid Tablet - - - 263.00 -
39 Grantusip Tablet - - - 483.000 - -
40 Haloperidol 5 mg Tablet - - - 96.00 -
41 Hexymer 2 mg (THF) Tablet - - - 270.00 -
42 Ikaneuron injeksi amp - - - 5,350.00 - -
43 Kalsium glukonas Amp 25 25 - 25 7,090.88 177,271.88
44 Ketokonazole Tablet 200 200 0 200 270.00 54,000.00 -
45 Ketopropen injeksi Amp 7 7 0 7 28,249.00 197,743 -
46 Ketorolak ij Amp - - - 5,455.00 -
47 kloram tetes mata botol - - - 27,300.00 - -
48 Kloram Tetes mata Btl 30 30 18 12 9,350.000 112,200.00 -
49 kloram Tetes telinga botol - - - 7,840.00 - -
50 Kloramfecort Cream Tube - - - 11,285.00 -
51 Kloramfenikol tetes mata Btl - - - 3,250.01 -
52 Klorampenikol syr botol - - - 8,900.00 - -
53 L BIO Saset - - - 6,600.00 - -
54 Lexapram syr (2) btl - - - 7,260.00 - -
55 Lexigo Tablet - - - 660.00 - -
56 Lidokain injek Amp - - - 1,222.10 - -
57 Lostasef Kapsul - - - 2,270.000 - -
58 Meloxicam 15 mg Tablet - - - 1,089.000 - -
59 Metergin Tablet 420 420 20 400 210.000 84,000 -
60 Methilprednisolon Tablet 10,073 10,073 1649 8,424 133.991 1,128,740.18 -
61 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
62 Metro syr Btl 14 14 10 4 3,950.10 15,800.40 -
63 Metronidazol syrup Btl - - 3,454.00 -
64 Miniaspi Tablet 360 360 70 290 99.000 28,710.00 -
65 neocenta jell Tube - - - 19,700.00 - -
66 Neosenta Salep Tube - - - 19,958.00 - -
67 Nistatin drop Btl 33 33 3 30 13,500.300 405,009.00 -
68 Novamagh syr Btl - - - 6,000.000 - -
69 Parasetamol infus Botol - - - 33,000.00 - -
70 Profolat Tablet 560 560 20 540 51.997 28,078.38 -
71 Ranitidin Tablet - - - 104.995 - -
72 Scabimide pot - - - 10,825.000 - -
73 Sefadroxil syr botol - - - 13,000.00 - -
74 Seftriaxon ij box 449 449 1 448 20,000.00 8,960,000
75 Simvastatin Tablet 580 580 0 580 205.000 118,900.00 -
76 Skopma Tablet - - - 1,527.000 - -

Page 46 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
77 Skopma Tablet - - - 1,600.00 - -
78 Skopma Plus Tablet - - - 2,596.00 - -
79 Sotatik injeksi Amp 948 948 25 923 4,400.00 4,061,200 -
80 Spashi injeksi Amp 3 3 0 3 9,900.00 29,700 -
81 spaslic Tablet - - - 2,500.00 - -
82 Spasminal Tablet - - - 638.000 - -
83 Superhoid suppo suppo 15 15 1 14 3,565.000 49,910.00 -
84 Terbutalin / MOLASMA Tablet 160 160 60 100 89.012 8,901.20 -
85 Thiamfilex syr Btl 3 3 0 3 7,150.00 21,450 -
86 Thiampenikol Tablet 10 10 0 10 1,210.00 12,100 -
87 Vitamin syr Btl - - - 11,880.00 - -
88 zenirex syr botol - - - 8,800.00 - -
89 Zevask 10 mg Tablet - - - 746.00 - -
90 Zink syr Botol - - - 33,000.00 - -
JML 20,095,687 -

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2 Foley cath 16 Pcs 29 29 0 29 8,000 232,000
3 Foley cath 18 Pcs 58 58 0 58 8,000 464,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5   Spuit 10 cc ONIONEX PCS - - - 1,163 -
6 Aboket 24 bh - - - 8,000.00 - -
7 Aboket 26 bh - - - 12,000.00 - -
8 Aboket no 26 Sterra Set - - - 4,222.90 - -
9 Alkohol 1 L Btl - - - 26,250.40 - -
10 Alkohol swab box - - - 22,000.00 - -
11 Aximed Fixation nonwoven Roll - - - 68,651 - -
12 Aximed papertape hivapik Roll - - - 21,849 - -
13 Batang pengaduk bh 1 1 0 1 33,000.00 33,000.00 -
14 Bisturi bh - - - 10,000.00 - -
15 bisturi no 11 bh 37 37 12 25 1,320.00 33,000.00 -
16 Bola bobat bh - - - 550,000.00 - -
17 Catgut + jarum 3/0 Bh 11 11 11 - 5,750.80 - -
18 Catgut baru GEA bh 120 120 24 96 11,229.16 1,077,999.36 -
19 Catgut chromik 3/0 - - - 7,493.06 - -
20 Edta ungu box - - - 190,000.00 - -
21 Etiket Putih pak 39 39 5 34 25,000.00 850,000.00 -
22 Exam Glove L Pak - - - 366.88 - -

Page 47 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
23 exam glove M psg - - - 545.45 - -
24 Exam Glove M Pak - - - 366.88 - -
25 Exam glove M box - - - 55,000.00 - -
26 eXAm glove S psg - - - 1,200.00 - -
27 feeding no 5 bh - - - 38,500.00 - -
28 Feeding tube no 8 bh 8 8 0 8 66,000.00 528,000.00 -
29 Gatrix nasal Anak bh - - - 8,800.00 - -
30 Gatrix nasal Bayi bh - - - 8,800.00 - -
31 Gelly usg baru KUNING Btl 6 6 1 5 38,500.00 192,500.00 -
32 Hanrub (2) Bh - - - 62,050.00 - -
33 Hanrub ASEPTIC Btl 5 5 1 4 57,200.00 228,800.00 -
34 Hcg test bh - - - 1,800.00 - -
35 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
36 Infusion set Dewasa Set - - - 3,295.60 - -
37 Jarum Bd no 23 bh - - - 4,000.04 - -
38 Jarum Bd no 23 bh - - - 605.00 - -
39 Jarum hekting paket - - - 35,333.32 - -
40 Jarum hekting no 10 bh 9 9 8 1 6,600.00 6,600.00 -
41 Jarum hekting no 8 bh 10 10 9 1 19,800.00 19,800.00 -
42 jarum no 10 set - - - 17,500.00 - -
43 jarum no 8 set - - - 17,500.00 - -
44 Jely USG Botol - - - 30,800.00 - -
45 Kantong obat Besar pak - - - 11,000.00 - -
46 Kantong obat Besar pak - - - 12,100.00 - -
47 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
48 Kasa gulung besar baru bh 2 2 1 1 143,000.00 143,000.00 -
49 kasa hidrofil besar bh - - - 143,550.00 - -
50 Kasa steril box 455 455 25 430 1,650.00 709,500.00 -
51 kasa steril mini bh - - - 3,600.00 - -
52 Kertas puyer Pak - - - 10,000 -
53 kresek pak - - - 12,000.00 - -
54 KTO B 1 kntong isi 10 pak - - - 11,000 -
55 KTO K Pak 58 58 38 20 8,800 176,000
56 Label Baru pak - - - 25,000 - -
57 Masker 02 Anak bh 3 3 0 3 24,750.00 74,250.00 -
58 Masker 02 Dewasa bh 3 3 0 3 24,750.00 74,250.00 -
59 Masker Ear Loop Bh - - - 453.20 - -
60 Masker Nebu anak Bh 3 3 0 3 22,660 67,980 -
61 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
62 One clean (klorin) Btl 23 23 8 15 15,246.00 228,690.00 -
63 Oxyflow Anak transparan / NASAL bh 35 35 35 5,150.00 180,250.00 -
64 Oxyflow bayi transparan bh 25 25 25 5,665.00 141,625.00 -
65 Oxyflow Dewasa transparan bh 17 17 17 5,665.00 96,305.00 -
66 plester coklat besar bh - - - 60,000.00 - -
67 Plester coklat besar roll - - - 85,000.00 - -
68 Plester Hifavik box 15 15 2 13 22,000.00 286,000.00 -
69 sabun anti bakteri Btl 2 2 0 2 27,720.00 55,440.00 -
70 Safety box 5 Lt kuning bh 50 50 0 50 16,186.50 809,325.00 -
71 Sarung tangan Gynecolog Pasang 390 390 0 390 12,000 4,680,000
72 sarung tangan steril 7,5 psg - - - 4,214.00 - -
73 sarung tangan young psg 1 1 0 1 36,000.00 36,000.00 -

Page 48 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
74 Silk + jarum 2/0 Bh 33 33 33 - 3,147.20 - -
75 Silk BARU 3/0 - - - 3,900 - -
76 Silk BARU 3/0 GEA bh 180 180 28 152 7,486.11 1,137,888.72 -
77 Spuit 10 cc Sterra Set 75 75 5 70 952.75 66,692.50 -
78 Spuit 3 ml nipro - - - 792 -
79 Stik asam urat benecheck box - - - 131,398.00 - -
80 Stik Glukosa Acucek box - - - 630,000.00 - -
81 Stik gula benecheck box - - - 152,049.00 - -
82 Stik Hb family dr box - - - 370,000.00 - -
83 Stik Kolesterol benecheck box - - - 232,836.75 - -
84 Stik urin 3 p box - - - 150,000.00 - -
85 Stikpan plastik deluxe Bh - - - 36,155 - -
86 Suction cath 16 Bh - - - 7,545 -
87 Suction cath 8 bh - - - 9,000.00 - -
88 Syringe 1 cc - - - 728.00 - -
89 Termometer Ruangan/KULKAS bh 1 1 0 1 275,000.00 275,000.00 -
90 Termometer Tembak bh - - - 275,000.00 - -
91 Tes kehamilan ultra one bh - - - 1,997.60 - -
92 tisu besar bh - - - 17,000.00 - -
93 Tisu lensa box - - - 132,000.00 - -
94 Tranfusi set set - - - 11,000.00 - -
95 ubderpad pak - - - 42,000.00 - -
96 Ultrasonik gell (jelly usg putih) Btl 3 3 2 1 13,213.20 13,213.20 -
97 Umbilikal bh - - - 2,600.00 - -
98 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
99 Umbilikal klem baru bh 48 48 26 22 2,640.00 58,080.00 -
100 Underpad bh - - - 4,100.00 - -
101 Underpad Pads 26 26 2 24 55,000.00 1,320,000.00 -
102 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
103 Warm water zak Bh 1 1 0 1 23,864 23,864 .

REAGEN
1 Probe cleaner bh 3 3 0 3 618,182.00 1,854,546.00 -
2 Diluent bh 3 3 0 3 2,545,454.00 7,636,362.00 -
3 Lyse bh 3 3 0 3 2,545,454.00 7,636,362.00
31,554,052.38 -

Jumlah Total - 51,649,739.62 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,815

........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
Page
. 49 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 ........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) Irwan
JML Hilmy S.Farm., Apt
PENERIMAAN
..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 50 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : juni 2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Aciblok Tablet - - - 550.00 - -
2 Alkohol 70% BOTOL - - - 2,500.00 -
3 Allerin expext syr Btl - - - 9,750.00 -
4 Allupurinol Tablet - - - 99.000 - -
5 Ambroxol Tablet - - - 144.00 - -
6 Amlodipin Tablet - - - 176.00 - -
7 Amlodipin 10 mg Tablet 2,405 2,405 2,405 93.000 223,665.00 -
8 Amoxicillin 500 mg Tablet - - - 363.000 - -
9 As. Tranex injek Amp 350 350 350 - 5,250.00 -
10 As. Tranex tablet Tablet - - - 9,915.00 - -
11 As. Tranex tablet (2) Tablet - - - 2,376.00 - -
12 Aspilet Tablet - - - 530.00 -
13 Baby cough Btl 66 66 66 6,823.000 450,318.00 -
14 Betason n Cr Tube - - - 1,061.00 -
15 Bimaflock Tablet - - - 615.00 - -
16 Bimaflok Tablet - - - 670.000 - -
17 Bupantasid syr botol - - - 8,800.00 - -
18 Caviplex Tablet - - - 422.000 - -
19 Cedrox Kapsul - - - 1,170.00 - -
20 Cefadroxil syr Btl - - - 3,921.50 - -
21 Cefixim Kapsul - - - 1,320.000 - -
22 Cendo Genta str - - - 17,463.00 -
23 Cendo Polydex str - - - 29,150.00 -
24 Cetirizin syr Btl - - - 2,850.100 - -
25 Combiven nebu amp 280 280 280 4,550.000 1,274,000.00 -
26 Corsaneuron Tablet - - - 690.000 - -
27 Decafil (Aminophillin) Tablet 600 600 600 138.996 83,397.60 -
28 Diazepam 2 mg Tablet 618 618 618 1,000.00 618,000 -
29 Domperidon 10 mg Tablet 100 100 100 84.996 8,499.60 -
30 Domperidon 10 mg Tablet - - - 167.00 -
31 Domperidon suspensi BOTOL 21 21 21 3,333.00 69,993 -

Page 51 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
32 Dopamet Tablet 20 20 20 - 1,830.00 - -
33 Enervon C 120 ml btl - - - 17,118.00 -
34 Farsipen syr Btl - - - 10,780.00 - -
35 Fasidol forte Tablet - - - 350.00 - -
36 Fit k infant amp - - - 6,300.00 - -
37 Glibenklamid Tablet - - - 198.00 - -
38 Glimepirid Tablet - - - 263.00 -
39 Grantusip Tablet - - - 483.000 - -
40 Haloperidol 5 mg Tablet - - - 96.00 -
41 Hexymer 2 mg (THF) Tablet - - - 270.00 -
42 Ikaneuron injeksi amp - - - 5,350.00 - -
43 Kalsium glukonas Amp 25 25 25 - 7,090.88 -
44 Ketokonazole Tablet 200 200 200 270.00 54,000.00 -
45 Ketopropen injeksi Amp 7 7 7 28,249.00 197,743 -
46 Ketorolak ij Amp - - - 5,455.00 -
47 kloram tetes mata botol - - - 27,300.00 - -
48 Kloram Tetes mata Btl 12 12 12 - 9,350.000 - -
49 kloram Tetes telinga botol - - - 7,840.00 - -
50 Kloramfecort Cream Tube - - - 11,285.00 -
51 Kloramfenikol tetes mata Btl - - - 3,250.01 -
52 Klorampenikol syr botol - - - 8,900.00 - -
53 L BIO Saset - - - 6,600.00 - -
54 Lexapram syr (2) btl - - - 7,260.00 - -
55 Lexigo Tablet - - - 660.00 - -
56 Lidokain injek Amp - - - 1,222.10 - -
57 Lostasef Kapsul - - - 2,270.000 - -
58 Meloxicam 15 mg Tablet - - - 1,089.000 - -
59 Metergin Tablet 400 400 400 210.000 84,000 -
60 Methilprednisolon Tablet 8,424 8,424 8,424 133.991 1,128,740.18 -
61 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 -
62 Metro syr Btl 4 4 4 - 3,950.10 - -
63 Metronidazol syrup Btl - - 3,454.00 -
64 Miniaspi Tablet 290 290 290 99.000 28,710.00 -
65 neocenta jell Tube - - - 19,700.00 - -
66 Neosenta Salep Tube - - - 19,958.00 - -
67 Nistatin drop Btl 30 30 30 13,500.300 405,009.00 -
68 Novamagh syr Btl - - - 6,000.000 - -
69 Parasetamol infus Botol - - - 33,000.00 - -
70 Profolat Tablet 540 540 540 51.997 28,078.38 -
71 Ranitidin Tablet - - - 104.995 - -
72 Scabimide pot - - - 10,825.000 - -
73 Sefadroxil syr botol - - - 13,000.00 - -
74 Seftriaxon ij box 448 448 448 20,000.00 8,960,000
75 Simvastatin Tablet 580 580 580 205.000 118,900.00 -
76 Skopma Tablet - - - 1,527.000 - -

Page 52 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
77 Skopma Tablet - - - 1,600.00 - -
78 Skopma Plus Tablet - - - 2,596.00 - -
79 Sotatik injeksi Amp 923 923 923 4,400.00 4,061,200 -
80 Spashi injeksi Amp 3 3 3 9,900.00 29,700 -
81 spaslic Tablet - - - 2,500.00 - -
82 Spasminal Tablet - - - 638.000 - -
83 Superhoid suppo suppo 14 14 2 12 3,565.000 42,780.00 -
84 Terbutalin / MOLASMA Tablet 100 100 100 89.012 8,901.20 -
85 Thiamfilex syr Btl 3 3 3 7,150.00 21,450 -
86 Thiampenikol Tablet 10 10 10 1,210.00 12,100 -
87 Vitamin syr Btl - - - 11,880.00 - -
88 zenirex syr botol - - - 8,800.00 - -
89 Zevask 10 mg Tablet - - - 746.00 - -
90 Zink syr Botol - - - 33,000.00 - -
JML 17,909,185 -

BMHP
1 E care ALC swab Ktk - - - 17,891 -
2 Foley cath 16 Pcs 29 29 29 8,000 232,000
3 Foley cath 18 Pcs 58 58 58 8,000 464,000
4 IV Catheter 18 ONIONEX Pcs - - - 4,770 -
5   Spuit 10 cc ONIONEX PCS - - - 1,163 -
6 Aboket 24 bh - - - 8,000.00 - -
7 Aboket 26 bh - - - 12,000.00 - -
8 Aboket no 26 Sterra Set - - - 4,222.90 - -
9 Alkohol 1 L Btl - - - 26,250.40 - -
10 Alkohol swab box - - - 22,000.00 - -
11 Aximed Fixation nonwoven Roll - - - 68,651 - -
12 Aximed papertape hivapik Roll - - - 21,849 - -
13 Batang pengaduk bh 1 1 1 33,000.00 33,000.00 -
14 Bisturi bh - - - 10,000.00 - -
15 bisturi no 11 bh 25 25 25 1,320.00 33,000.00 -
16 Bola bobat bh - - - 550,000.00 - -
17 Catgut + jarum 3/0 Bh - - - 5,750.80 - -
18 Catgut baru GEA bh 96 96 96 11,229.16 1,077,999.36 -
19 Catgut chromik 3/0 - - - 7,493.06 - -
20 Edta ungu box - - - 190,000.00 - -
21 Etiket Putih pak 34 34 34 25,000.00 850,000.00 -
22 Exam Glove L Pak - - - 366.88 - -

Page 53 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
23 exam glove M psg - - - 545.45 - -
24 Exam Glove M Pak - - - 366.88 - -
25 Exam glove M box - - - 55,000.00 - -
26 eXAm glove S psg - - - 1,200.00 - -
27 feeding no 5 bh - - - 38,500.00 - -
28 Feeding tube no 8 bh 8 8 8 66,000.00 528,000.00 -
29 Gatrix nasal Anak bh - - - 8,800.00 - -
30 Gatrix nasal Bayi bh - - - 8,800.00 - -
31 Gelly usg baru KUNING Btl 5 5 5 38,500.00 192,500.00 -
32 Hanrub (2) Bh - - - 62,050.00 - -
33 Hanrub ASEPTIC Btl 4 4 4 57,200.00 228,800.00 -
34 Hcg test bh - - - 1,800.00 - -
35 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
36 Infusion set Dewasa Set - - - 3,295.60 - -
37 Jarum Bd no 23 bh - - - 4,000.04 - -
38 Jarum Bd no 23 bh - - - 605.00 - -
39 Jarum hekting paket - - - 35,333.32 - -
40 Jarum hekting no 10 bh 1 1 1 6,600.00 6,600.00 -
41 Jarum hekting no 8 bh 1 1 1 19,800.00 19,800.00 -
42 jarum no 10 set - - - 17,500.00 - -
43 jarum no 8 set - - - 17,500.00 - -
44 Jely USG Botol - - - 30,800.00 - -
45 Kantong obat Besar pak - - - 11,000.00 - -
46 Kantong obat Besar pak - - - 12,100.00 - -
47 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
48 Kasa gulung besar baru bh 1 1 1 143,000.00 143,000.00 -
49 kasa hidrofil besar bh - - - 143,550.00 - -
50 Kasa steril box 430 430 430 1,650.00 709,500.00 -
51 kasa steril mini bh - - - 3,600.00 - -
52 Kertas puyer Pak - - - 10,000 -
53 kresek pak - - - 12,000.00 - -
54 KTO B 1 kntong isi 10 pak - - - 11,000 -
55 KTO K Pak 20 20 20 8,800 176,000
56 Label Baru pak - - - 25,000 - -
57 Masker 02 Anak bh 3 3 3 24,750.00 74,250.00 -
58 Masker 02 Dewasa bh 3 3 3 24,750.00 74,250.00 -
59 Masker Ear Loop Bh - - - 453.20 - -
60 Masker Nebu anak Bh 3 3 3 22,660 67,980 -
61 Masker Nebu Dewasa Bh 2 2 2 22,660 45,320 -
62 One clean (klorin) Btl 15 15 15 15,246.00 228,690.00 -
63 Oxyflow Anak transparan / NASAL bh 35 35 35 5,150.00 180,250.00 -
64 Oxyflow bayi transparan bh 25 25 25 5,665.00 141,625.00 -
65 Oxyflow Dewasa transparan bh 17 17 17 5,665.00 96,305.00 -
66 plester coklat besar bh - - - 60,000.00 - -
67 Plester coklat besar roll - - - 85,000.00 - -
68 Plester Hifavik box 13 13 13 22,000.00 286,000.00 -
69 sabun anti bakteri Btl 2 2 2 27,720.00 55,440.00 -
70 Safety box 5 Lt kuning bh 50 50 50 16,186.50 809,325.00 -
71 Sarung tangan Gynecolog Pasang 390 390 390 12,000 4,680,000
72 sarung tangan steril 7,5 psg - - - 4,214.00 - -
73 sarung tangan young psg 1 1 1 36,000.00 36,000.00 -

Page 54 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
74 Silk + jarum 2/0 Bh - - - 3,147.20 - -
75 Silk BARU 3/0 - - - 3,900 - -
76 Silk BARU 3/0 GEA bh 152 152 152 7,486.11 1,137,888.72 -
77 Spuit 10 cc Sterra Set 70 70 70 952.75 66,692.50 -
78 Spuit 3 ml nipro - - - 792 -
79 Stik asam urat benecheck box - - - 131,398.00 - -
80 Stik Glukosa Acucek box - - - 630,000.00 - -
81 Stik gula benecheck box - - - 152,049.00 - -
82 Stik Hb family dr box - - - 370,000.00 - -
83 Stik Kolesterol benecheck box - - - 232,836.75 - -
84 Stik urin 3 p box - - - 150,000.00 - -
85 Stikpan plastik deluxe Bh - - - 36,155 - -
86 Suction cath 16 Bh - - - 7,545 -
87 Suction cath 8 bh - - - 9,000.00 - -
88 Syringe 1 cc - - - 728.00 - -
89 Termometer Ruangan/KULKAS bh 1 1 1 275,000.00 275,000.00 -
90 Termometer Tembak bh - - - 275,000.00 - -
91 Tes kehamilan ultra one bh - - - 1,997.60 - -
92 tisu besar bh - - - 17,000.00 - -
93 Tisu lensa box - - - 132,000.00 - -
94 Tranfusi set set - - - 11,000.00 - -
95 ubderpad pak - - - 42,000.00 - -
96 Ultrasonik gell (jelly usg putih) Btl 1 1 1 13,213.20 13,213.20 -
97 Umbilikal bh - - - 2,600.00 - -
98 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
99 Umbilikal klem baru bh 22 22 22 2,640.00 58,080.00 -
100 Underpad bh - - - 4,100.00 - -
101 Underpad Pads 24 24 24 55,000.00 1,320,000.00 -
102 Urinal plastik + tutup Bh 2 2 2 31,205 62,410 -
103 Warm water zak Bh 1 1 1 23,864 23,864 .

REAGEN
1 Probe cleaner bh 3 3 1 2 618,182.00 1,236,364.00 -
2 Diluent bh 3 3 1 2 2,545,454.00 5,090,908.00 -
3 Lyse bh 3 3 1 2 2,545,454.00 5,090,908.00
25,844,962.38 -

Jumlah Total - 43,754,147.34 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

1,815

........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

Irwan Hilmy S.Farm., Apt

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
Page
. 55 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 ........................, ....................................20......
Yang Menerima :
Yang Menerima : Diketahui /disetujui ,
Mengetahui/Menyetujui : Pengelola Obat
Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan :
Kepala UPTD Farmasi

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) Irwan Hilmy S.Farm., Apt
JML PENERIMAAN
..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 56 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 LAPORAN PEMAKAKAIAN OBAT BPJS
TAHUN2018

PUSKESMAS : PANJALU
KECAMATAN : PANJALU .
KABUPATEN : CIAMIS
PROPINSI : JAWA BARAT Laporan bulan : MEI2019

HARGA JUMLAH HARGA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
1 2 3 4 5 6 7 8 9 10
A. APBD / DAK
1 Aciblok Tablet - - - 550.00 -
2 Alkohol 70% BOTOL - - - 2,500.00 -
3 Allerin expext syr Btl - - - 9,750.00 -
4 Allupurinol Tablet 530 530 530 99.000 52,470
5 Ambroxol Tablet - - - 144.00 - -
6 Amlodipin Tablet - - - 176.00 -
7 Amlodipin 10 mg Tablet 3,240 3,240 3,240 93.000 301,320.00
8 Amoxicillin 500 mg Tablet - - - 363.000 -
9 As. Tranex injek Amp 352 352 352 5,250.00 1,848,000
10 As. Tranex tablet Tablet - - - 9,915.00 -
11 As. Tranex tablet (2) Tablet - - - 2,376.00 -
12 Aspilet Tablet - - - 530.00 -
13 Baby cough Btl 140 140 140 6,823.000 955,220
14 Betason n Cr Tube 45 45 45 1,061.00 47,745
15 Bimaflock Tablet - - - 615.00 -
16 Bimaflok Tablet - - - 670.000 -
17 Bupantasid syr botol - - - 8,800.00 -
18 Caviplex Tablet 550 550 550 422.000 232,100
19 Cedrox Kapsul - - - 1,170.00 -
20 Cefadroxil syr Btl 95 95 95 3,921.50 372,542.50
21 Cefixim Kapsul - - - 1,320.000 - -
22 Cendo Genta str - - - 17,463.00 - -
23 Cendo Polydex str - - - 29,150.00 - -
24 Cetirizin syr Btl 22 22 22 2,850.100 62,702 -
25 Combiven nebu amp 331 331 331 4,550.000 1,506,050 -
26 Corsaneuron Tablet - - - 690.000 - -
27 Decafil (Aminophillin) Tablet 790 790 790 138.996 109,807 -
28 Diazepam 2 mg Tablet 639 639 639 1,000.00 639,000 -
29 Domperidon 10 mg Tablet 100 100 100 84.996 8,500 -
30 Domperidon 10 mg Tablet - - - 167.00 - -

Page 57 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
31 Domperidon suspensi BOTOL 55 55 55 3,333.00 183,315 -
32 Dopamet Tablet 40 40 40 1,830.00 73,200 -
33 Enervon C 120 ml btl - - - 17,118.00 - -
34 Farsipen syr Btl - - - 10,780.00 - -
35 Fasidol forte Tablet - - - 350.00 - -
36 Fit k infant amp - - - 6,300.00 - -
37 Glibenklamid Tablet - - - 198.00 - -
38 Glimepirid Tablet - - - 263.00 - -
39 Grantusip Tablet 815 815 815 483.000 393,645 -
40 Haloperidol 5 mg Tablet - - - 96.00 - -
41 Hexymer 2 mg (THF) Tablet - - - 270.00 - -
42 Ikaneuron injeksi amp - - - 5,350.00 - -
43 Kalsium glukonas Amp 26 26 26 7,090.88 184,363 -
44 Ketokonazole Tablet 380 380 380 270.00 102,600 -
45 Ketopropen injeksi Amp 7 7 7 28,249.00 197,743 -
46 Ketorolak ij Amp - - - 5,455.00 - -
47 Kloram Tetes mata Btl 90 90 90 9,350.000 841,500 -
48 kloram tetes mata botol - - - 27,300.00 - -
49 kloram Tetes telinga botol - - - 7,840.00 - -
50 Kloramfecort Cream Tube - - - 11,285.00 - -
51 Kloramfenikol tetes mata Btl - - - 3,250.01 - -
52 Klorampenikol syr botol - - - 8,900.00 - -
53 L BIO Saset - - - 6,600.00 - -
54 Lexapram syr (2) btl - - - 7,260.00 - -
55 Lexigo Tablet - - - 660.00 - -
56 Lidokain injek Amp - - - 1,222.10 - -
57 Lostasef Kapsul - - - 2,270.000 - -
58 Meloxicam 15 mg Tablet 764 764 764 1,089.000 831,996 -
59 Metergin Tablet 580 580 580 210.000 121,800.00 -
60 Methilprednisolon Tablet 11,900 11,900 11,900 133.991 1,594,493 -
61 Methyl Ergometrin Injeksi Ampul - - - 2,440.00 - -
62 Metro syr Btl 66 66 66 3,950.10 260,706.60 -
63 Metronidazol syrup Btl - - - 3,454.00 - -
64 Miniaspi Tablet 590 590 590 99.000 58,410.00 -
65 neocenta jell Tube - - - 19,700.00 - -
66 Neosenta Salep Tube - - - 19,958.00 - -
67 Nistatin drop Btl 42 42 42 13,500.300 567,012.60 -
68 Novamagh syr Btl 225 225 225 6,000.000 1,350,000.00 -
69 Parasetamol infus Botol - - - 33,000.00 - -
70 Profolat Tablet 560 560 560 51.997 29,118.32 -
71 Ranitidin Tablet 544 544 544 104.995 57,117.28 -
72 Scabimide pot 11 11 11 10,825.000 119,075.00 -
73 Sefadroxil syr botol - - - 13,000.00 - -
74 Seftriaxon ij box 449 449 449 20,000.00 8,980,000.00 -

Page 58 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
75 Simvastatin Tablet 944 944 944 205.000 193,520.00 -
76 Skopma Tablet 254 254 254 1,527.000 387,858.00 -
77 Skopma Tablet - - - 1,600.00 - -
78 Skopma Plus Tablet - - - 2,596.00 - -
79 Sotatik injeksi Amp 1,032 1,032 1,032 4,400.00 4,540,800.00 -
80 Spashi injeksi Amp 4 4 4 9,900.00 39,600.00 -
81 spaslic Tablet - - - 2,500.00 - -
82 Spasminal Tablet 182 182 182 638.000 116,116.00 -
83 Superhoid suppo suppo 15 15 15 3,565.000 53,475.00 -
84 Terbutalin Tablet 310 310 310 89.012 27,593.72 -
85 Thiamfilex syr Btl 10 10 10 7,150.00 71,500.00 -
86 Thiampenikol Tablet 30 30 30 1,210.00 36,300.00 -
87 Vitamin syr Btl - - - 11,880.00 - -
88 zenirex syr botol - - - 8,800.00 - -
89 Zevask 10 mg Tablet - - - 746.00 - -
90 Zink syr Botol - - - 33,000.00 - -
JML 27,548,313 -

Page 59 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN

BMHP

1 Aboket 24 bh - - - 8,000.00 -
2 Aboket 26 bh - - - 12,000.00 -
3 Aboket no 26 Sterra Set 41 41 23 18 4,222.90 76,012.20
4 Alkohol 1 L Btl 3 3 2 1 26,250.40 26,250.40
5 Alkohol swab box - - - 22,000.00 -
6 Aximed Fixation nonwoven Roll 2 2 0 2 68,651 137,302
7 Aximed papertape hivapik Roll - - - 21,849 -
8 Batang pengaduk bh 2 2 1 1 33,000.00 33,000.00
9 Bisturi bh - - - 10,000.00 - .
10 bisturi no 11 bh 76 76 14 62 1,320.00 81,840.00
11 Bola bobat bh - - - 550,000.00 -
12 Catgut + jarum 3/0 Bh 70 70 10 60 5,750.80 345,048.00
13 Catgut baru GEA bh 120 120 120 11,229.16 1,347,499.20 -
14 Catgut chromik 3/0 - - - 7,493.06 - -
15 E care ALC swab Ktk - - - 17,891 - -
16 Edta ungu box - - - 190,000.00 - -
17 Etiket Putih pak 68 68 10 58 25,000.00 1,450,000.00 -
18 Exam Glove L Pak - - - 366.88 - -
19 exam glove M psg - - - 545.45 - -
20 Exam Glove M Pak - - - 366.88 - -
21 Exam glove M box - - - 55,000.00 - -
22 eXAm glove S psg - - - 1,200.00 - -
23 feeding no 5 bh - - - 38,500.00 - -
24 Feeding tube no 8 bh 8 8 8 66,000.00 528,000.00 -
25 Foley cath 16 Pcs 41 41 41 8,000 328,000 -
26 Foley cath 18 Pcs 76 76 7 69 8,000 552,000 -
27 Gatrix nasal Anak bh - - - 8,800.00 - -
28 Gatrix nasal Bayi bh - - - 8,800.00 - -
29 Gelly usg baru KUNING Btl 7 7 7 38,500.00 269,500.00 -
30 Hanrub (2) Bh - - - 62,050.00 - -
31 Hanrub ASEPTIC Btl 10 10 2 8 57,200.00 457,600.00 -
32 Hcg test bh - - - 1,800.00 - -
33 Hcl 0,1 N 100 ml Btl - - - 11,088.00 - -
34 Infusion set Dewasa Set - - - 3,295.60 - -
35 IV Catheter 18 ONIONEX Pcs - - - 4,770 - -
36 Jarum Bd no 23 bh - - - 4,000.04 - -
37 Jarum Bd no 23 bh - - - 605.00 - -
38 Jarum hekting paket - - - 35,333.32 - -
39 Jarum hekting no 10 bh 10 10 1 9 6,600.00 59,400.00 -
40 Jarum hekting no 8 bh 10 10 10 19,800.00 198,000.00 -
41 jarum no 10 set - - - 17,500.00 - -
42 jarum no 8 set 2 2 2 - 17,500.00 - -
43 Jely USG Botol - - - 30,800.00 - -
44 Kantong obat Besar pak - - - 11,000.00 - -
45 Kantong obat Besar pak 53 53 31 22 12,100.00 266,200.00 -
46 Kasa gulung besar 40 x 80 Bh - - - 108,149.80 - -
47 Kasa gulung besar baru bh 6 6 2 4 143,000.00 572,000.00 -

Page 60 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
48 kasa hidrofil besar bh - - - 143,550.00 - -
49 Kasa steril box 498 498 13 485 1,650.00 800,250.00 -
50 kasa steril mini bh - - - 3,600.00 - -
51 Kertas puyer Pak - - - 10,000 - -
52 kresek pak 19 19 19 - 12,000.00 - -
53 KTO B 1 kntong isi 10 pak - - - 11,000 - -
54 KTO K Pak 126 126 36 90 8,800 792,000 -
55 Label Baru pak - - - 25,000 - -
56 Masker 02 Anak bh 3 3 3 24,750.00 74,250.00 -
57 Masker 02 Dewasa bh 3 3 3 24,750.00 74,250.00 -
58 Masker Ear Loop Bh 150 150 100 50 453.20 22,660.00 -
59 Masker Nebu anak Bh 4 4 0 4 22,660 90,640 -
60 Masker Nebu Dewasa Bh 2 2 0 2 22,660 45,320 -
61 One clean (klorin) Btl 28 28 1 27 15,246.00 411,642.00 -
62 Oxyflow Anak transparan bh 48 48 1 47 5,150.00 242,050.00 -
63 Oxyflow bayi transparan bh 32 32 32 5,665.00 181,280.00 -
64 Oxyflow Dewasa transparan bh 26 26 1 25 5,665.00 141,625.00 -
65 plester coklat besar bh - - - 60,000.00 - -
66 Plester coklat besar roll - - - 85,000.00 - -
67 Plester Hifavik box 17 17 17 22,000.00 374,000.00 -
68 sabun anti bakteri Btl 8 8 1 7 27,720.00 194,040.00 -
69 Safety box 5 Lt kuning bh 75 75 25 50 16,186.50 809,325.00 -
70 Sarung tangan Gynecolog Pasang 390 390 390 12,000 4,680,000 -
71 sarung tangan steril 7,5 psg - - - 4,214.00 - -
72 sarung tangan young psg 1 1 1 36,000.00 36,000.00 -
73 Silk + jarum 2/0 Bh 116 116 30 86 3,147.20 270,659.20 -
74 Silk BARU 3/0 - - - 3,900 - -
75 Silk BARU 3/0 GEA bh 180 180 180 7,486.11 1,347,499.80 -
76 Spuit 10 cc ONIONEX PCS - - - 1,163 - -
77 Spuit 10 cc Sterra Set 75 75 75 952.75 71,456.25 -
78 Spuit 3 ml nipro - - - 792 - -
79 Stik asam urat benecheck box - - - 131,398.00 - -
80 Stik Glukosa Acucek box - - - 630,000.00 - -
81 Stik gula benecheck box - - - 152,049.00 - -
82 Stik Hb family dr box - - - 370,000.00 - -
83 Stik Kolesterol benecheck box - - - 232,836.75 - -
84 Stik urin 3 p box - - - 150,000.00 - -
85 Stikpan plastik deluxe Bh - - - 36,155 - -
86 Suction cath 16 Bh - - - 7,545 - -
87 Suction cath 8 bh - - - 9,000.00 - -
88 Syringe 1 cc - - - 728.00 - -
89 Termometer Ruangan/KULKAS bh 1 1 1 275,000.00 275,000.00 -
90 Termometer Tembak bh - - - 275,000.00 - -
91 Tes kehamilan ultra one bh - - - 1,997.60 - -
92 tisu besar bh - - - 17,000.00 - -
93 Tisu lensa box - - - 132,000.00 - -
94 Tranfusi set set - - - 11,000.00 - -
95 ubderpad pak - - - 42,000.00 - -
96 Ultrasonik gell (jelly usg putih) Btl 6 6 2 4 13,213.20 52,852.80 -
97 Umbilikal bh - - - 2,600.00 - -
98 Umbilikal Cord Nylon Bh - - - 1,338.70 - -
Page 61 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
 HARGA JUMLAH HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
KEMASAN RP (8x9) JML PENERIMAAN
99 Umbilikal klem baru bh 75 75 12 63 2,640.00 166,320.00 -
100 Underpad bh - - - 4,100.00 - -
101 Underpad Pads 30 30 1 29 55,000.00 1,595,000.00 -
102 Urinal plastik + tutup Bh 2 2 0 2 31,205 62,410 -
Warm water zak Bh 1 1 0 1 23,864 23,864

REAGEN -
Diluent Pasang 3 3 3 2,545,454.00 7,636,362.00
Lyse Pasang 3 3 3 2,545,454.00 7,636,362.00 -
Probe cleaner bh 3 3 3 618,182.00 1,854,546.00 -
36,689,315.45 -

Jumlah Total - 64,237,628.76 -

JUMLAH
JUMLAH KUNJUNGAN RESEP

........................, ....................................20......
Yang Menerima : Diketahui /disetujui , Yang Menerima :
Mengetahui/Menyetujui : Kepala Puskesmas, dokter Puskesmas
Kepala Dinas Kesehatan Kabupaten Ciamis Yang Menyerahkan : Pengelola Obat
Kepala UPTD Farmasi

Nolis Sukmayati N, Amd,Far

..H. Usep Koswara,S.Kep.,Ners Riki Amardiansyah,dr NR.PTT. 873.32.07.14.4.003
.......................................................... ............................................................ NIP. 197207151992031007 NIP. 197511032006041001
.

Page 62 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........
........................, ....................................20......
Yang Menerima :
Pengelola Obat

Nolis Sukmayati N, Amd,Far

NR.PTT. 873.32.07.14.4.003

Page 63 ............ Laporan Pemakaian dan Lembar Permintaan Obat (LPLPO) Puskesmas ..........