LAPORAN PEMAKAIAN OBAT JAMINAN KESEHATAN NASIONAL

PUSKESMAS CIAMIS
PERIODE / BULAN :

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR HARGA KEMASAN JUMLAH HARGA RP (8x9) KET

1 2 3 4 5 6 7 8 9 10 11
►JKN
1 Alletrol Tetes Mata Botol 19,030.00 Rp - Rp -
Alletrol Tetes Mata Botol 18,700.00 Rp - Rp -
2 Alopurinol 100 mg Tablet 231.00 Rp - Rp -
3 Antihemoroid kombinasi DOEN supp Supp 3,167.00 Rp - Rp -
4 Antihemoroid kombinasi (SUPERHOID) supp Supp 3,089.17 Rp - Rp -
Antihemoroid oral (Disosmin 450 mg, Hisperidin 50 mg )
5 DIOS Tablet 1,395.00 Rp - Rp -

6 Ambroksol 30 mg Tablet 181.50 Rp - Rp -

7 Ambroksol 30 mg Tablet 162.00 Rp - Rp -
8 Ambroxol syrup 15mg botol 3,608.00 Rp - Rp -
9 Amlodipin 5 mg Tablet 85.00 Rp - Rp -
Amlodipin 10 mg Tablet 1,980.00 Rp - Rp -
10 Amlodipin 10 mg Tablet 104.00 Rp - Rp -
11 Amlodipin 10 mg Tablet 104.00 Rp - Rp -
Anti Spasmodik Analgetik tablet, mengandung
12 Methampiron 500 mg, Papaverin HCl 25 mg, Ektrak Tablet 575.00 Rp - Rp -
Belladon 10 mg (SPASMINAL)
Anti Spasmodik Analgetik tablet, mengandung
Methampiron 500 mg, Papaverin HCl 25 mg, Ektrak Tablet 605.00 Rp - Rp -
Belladon 10 mg (SPASMINAL)
13 Asetil sistein 200 mg tablet 387.27 Rp - Rp -
14 Amitriptilin 25 mg Tablet 130.00 Rp - Rp -
15 Amoksisilin 250 mg Kapsul 195.00 Rp - Rp -
16 Amoksisilin 500 mg Tablet 370.00 Rp - Rp -
17 Amoksisilin syrup 125 mg / 5 ml botol 1,881.00 Rp - Rp -
Amoksisilin syrup 125 mg / 5 ml botol 4,246.00 Rp - Rp -
18 Amoksisilin forte syrup 250 mg / 5 ml botol 3,400.10 Rp - Rp -
19 Amoksisilin forte Syrup 250 mg / 5 ml Botol 3,473.00 Rp - Rp -
20 Amoksisilin Drop (SUPRAMOX) Botol 22,440.00 Rp - Rp -

Antasida DOEN I tablet kunyah, kombinasi :Aluminium

21 Hidroksida 200 mg + Magnesium Hidroksida 200 mg Tablet 75.00 Rp - Rp -
1 2 3 4 5 6 7 8 9 10 11
Antasida DOEN II suspensi, kombinasi :Aluminium
22 Hidroksida 200 mg + Magnesium Hidroksida 200 mg Btl 60 ml 1,923.00 Rp - Rp -

Aluminium (OH)3 300 mg Mg (OH)2 300 mg Simethicon

23 25 mg (TRIANTA) Tablet 323.00 Rp - Rp -

Antifungi DOEN Salep, Kombinasi : Asam Benzoat 6 %

24 Asam salisilat 3 % (Whitfield) unit 4,158.00 Rp - Rp -

25 Asam Mefenamat 500 mg Tablet 260.00 Rp - Rp -

26 Asiklovir tablet 400 mg Tablet 417.27 Rp - Rp -
27 Asiklovir tablet 400 mg Tablet 380.00 Rp - Rp -
28 Asiklovir Salep Kulit 3% tube 8,200.00 Rp - Rp -
29 Berotec 0,1 mg MDI HFA AS box 83,190.00 Rp - Rp -
30 Betametason krim 0,1 % Tube 1,339.00 Rp - Rp -
31 Betametason + Neomicin Sulfat Krim (BERLOSON-N) Tube 8,000.00 Rp - Rp -
Betametason + Neomicin Sulfat Krim (NISAGON) Tube 9,240.00 Rp - Rp -
Betametason + Neomicin Sulfat Krim (NISAGON) Tube 9,097.00 Rp - Rp -
32 Betametason + Neomicin Sulfat Krim (NISAGON) Tube 8,400.00 Rp - Rp -
33 Betahistin Mesilat 6 mg Tablet 149.00 Rp - Rp -
Betahistin Mesilat 6 mg (HISTIGO) Tablet 660.00 Rp - Rp -
34 Borax Glycerin (GOM) Botol 2,750.00 Rp - Rp -
35 Cetirizin HCl 10 mg Kapsul 96.00 Rp - Rp -
36 Cetirizin HCl 10 mg Tablet 89.98 Rp - Rp -
37 Cetirizin syr 5 mg botol 3,150.00 Rp - Rp -
Cetirizin syr 5 mg botol 10,340.00 Rp - Rp -
38 Cetirizin syr 5 mg botol 2,850.10 Rp - Rp -

Chloramfenicol 2% + Hydrocortison 2,5% (ARMACORT) Tube 8,030.00 Rp - Rp -

39 Combivent UDV Botol 3,150.00 Rp - Rp -

40 Caviplex Botol 4,550.00 Rp - Rp -
41 Curcuma xanthorriza extract 20 mg (CAVICUR) Tablet 408.00 Rp - Rp -
Curcuma xanthorriza extract 20 mg (CAVICUR) Tablet 550.00 Rp - Rp -
42 Dexamethason 0,5 mg Tablet 79.09 Rp - Rp -
Deksametason 0,5 mg + Deksklorfeniramin maleat 2 mg
43 (DEXTACO) syrup Botol 9,449.00 Rp - Rp -

Deksametason 0,5 mg + Deksklorfeniramin maleat 2 mg

(DEXTACO) syrup Botol 12,760.00 Rp - Rp -

Deksametason 0,5 mg + Deksklorfeniramin maleat 2 mg Botol 12,980.00 Rp - Rp -

(DEXTACO) syrup

44 Deksametason 0,5 mg + Deksklorfeniramin maleat 2 mg Botol 10,450.00 Rp - Rp -

(DEXTACO) syrup
Deksametason 0,5 mg + Deksklorfeniramin maleat 2 mg
45 Botol 9,400.00 Rp - Rp -
(DEXTACO) syrup
46 Deksklorfeniramin maleat 2 mg (GRAFACHLOR) Tablet 136.36 Rp - Rp -
47 Dexocort Salep Kulit Tube 7,250.10 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
48 Desoximetason 0,25 cream 15 G Tube 10,400.00 Rp - Rp -
49 Diazepam tablet 2 mg botol 100 Tablet 28.00 Rp - Rp -
50 Digoxin 0,25 mg Tablet 170.00 Rp - Rp -
51 Dimenhidrinat tablet 50 mg Tablet 104.00 Rp - Rp -
52 Domperidon syrup (VESPERUM) Botol 9,500.00 Rp - Rp -
53 Dulcolax Supp (TRIOLAX) supp 3,545.46 Rp - Rp -
Ektrak Plasenta dari sapi 10 % Neomisin sulfat 0,5 %,
54 Jelly base (BIOPLACENTON GEL) Tube 15,862.00 Rp - Rp -

Ektrak Plasenta dari sapi 10 % Neomisin sulfat 0,5 %,

55 Jelly base (NEOCENTA GEL) Tube 17,954.55 Rp - Rp -

56 Fenol Gliserol Tetes Telinga Botol 2,042.00 Rp - Rp -

57 Fenol Gliserol Tetes Telinga 10 % Botol 2,500.00 Rp - Rp -
58 Fitomenadion injek 2 mg/ml (Vitka Infant)/Neo K ampul 5,909.09 Rp - Rp -
59 Gentamicin Salep Kulit 1 mg (GENTALEX) Tube 3,220.00 Rp - Rp -
60 Gentian Violet Botol 1,700.00 Rp - Rp -
61 Glibenklamide 5 mg Tablet 200.97 Rp - Rp -
62 Glimepirid tablet 1 mg tablet 194.00 Rp - Rp -
63 Glimepirid tablet 1 mg tablet 174.00 Rp - Rp -
Glimepirid tablet 1 mg tablet 528.00 Rp - Rp -
64 Gom botol 2,500.00 Rp - Rp -
65 Gliseril guayacolat 100 mg tablet 87.56 Rp - Rp -
66 Haloperidol 1,5 mg tablet 66.00 Rp - Rp -
67 Hidrokortison krim 1 % Tube 2,787.00 Rp - Rp -
68 Hidrokortison krim 2,5% Tube 2,475.00 Rp - Rp -
69 Hyosine N butilbromida 20 mg/ml Ampul 8,900.00 Rp - Rp -
70 Ibuprofen tablet 400 mg Tablet 272.00 Rp - Rp -
71 Ibuprofen syrup 100 mg / 5 ml (ETAFEN) Botol 10,670.00 Rp - Rp -
71 Ibuprofen syrup 100 mg / 5 ml (FARSIFEN) Botol 9,636.36 Rp - Rp -
72 Kaptopril 25 mg Tablet 80.00 Rp - Rp -
73 Karbamazepin 200 mg Tablet 228.00 Rp - Rp -
74 Kemiderm Krim Tube 10,727.27 Rp - Rp -
75 Ketokonazole krim 2 % Tube 5 gr 2,595.00 Rp - Rp -
76 Kotrimoxsazol tablet 363.64 Rp - Rp -
77 Ketokonazole tablet 200 mg tablet 270.01 Rp - Rp -
78 Klindamisin Gel (CLINICA Gel) Pot 22,935.00 Rp - Rp -
79 Klindamisin Gel (CLINICA Gel) Pot 20,727.27 Rp - Rp -
80 Klindamisin Gel (MEDIKLIN GEL) Pot 20,600.00 Rp - Rp -
Klindamisin Kapsul 300 mg Kapsul 1,430.00 Rp - Rp -
81 Klindamisin Kapsul 300 mg Kapsul 2,150.00 Rp - Rp -
82 Kloramfenikol kapsul 250 mg Kapsul 310.40 Rp - Rp -
83 Kloramfenikol Suspensi Botol 4,725.45 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
Kombinasi Methampiron 500 mg, Vit B1 50 mg, Vit B6
84 100 mg Vit B12 100 mcg (ETANEURAL) Tablet 384.00 Rp - Rp -

Kombinasi Terbutalin sulfat 1,5 mg, Guaifenesin 50 mg

(NEOSMA) Botol 9,460.00 Rp - Rp -

Kombinasi Terbutalin sulfat 1,5 mg, Guaifenesin 50 mg

85 (NEOSMA) Botol 8,700.00 Rp - Rp -

86 Lansoprazol 30 mg Kapsul 1,181.82 Rp - Rp -

87 Lansoprazol 30 mg Kapsul 303.00 Rp - Rp -
88 Lisinopril 5 mg Tablet 269.00 Rp - Rp -
L-Lysin hydrokloride 200 mg, beta caroten 1000UI, Vit
B1 3 mg, Vit B2 2 mg, Vit B6 1 mg, Vit B12 10 mcg, Vit C
89 50 mg, nikotinamide 20 mg, D-pantothenol 3 mg Botol 11,900.00 Rp - Rp -
(LYTACUR)

L-Lysin hydrokloride 200 mg, beta caroten 1000UI, Vit

B1 3 mg, Vit B2 2 mg, Vit B6 1 mg, Vit B12 10 mcg, Vit C Botol 12,980.00 Rp - Rp -
50 mg, nikotinamide 20 mg, D-pantothenol 3 mg
(LYTACUR)
90 Loratadin HCL 10 mg Tablet 123.00 Rp - Rp -
91 Mecobalamin 500 mg (OXYCOBAL) Kapsul 790.91 Rp - Rp -
92 Mecobalamin 500 mg (OXYCOBAL) Kapsul 790.00 Rp - Rp -
93 Metil prednisolon 4 mg tablet 463.64 Rp - Rp -
94 Metil prednisolon 4 mg tablet 134.00 Rp - Rp -
95 Metoklopramid syrup 5 mg / 5 mL (PRIMPEN) Botol 2,530.00 Rp - Rp -
96 Meloksikam 7,5 mg Tablet 628.36 Rp - Rp -
97 Meloksikam 15 mg Tablet 1,000.00 Rp - Rp -
98 Metformin 500 mg Tablet 94.00 Rp - Rp -
99 Metilergometrin 0,125 mg / Oxitocin Tablet 210.00 Rp - Rp -
100 Metoklopramid tablet 5 mg tablet 108.00 Rp - Rp -
Metoklopramid tablet 5 mg tablet 385.00 Rp - Rp -
Metoklopramid Syrup 5 mg / 5 mL (NORVOM) botol 7,150.00 Rp - Rp -
101 Metoklopramid Syrup 5 mg / 5 mL (LEXAPRAM) botol 2,684.00 Rp - Rp -
102 Metronidazol tablet 500 mg Tablet 12,000.91 Rp - Rp -
103 Metronidazol tablet 500 mg Tablet 112.99 Rp - Rp -
104 Metronidazol suspensi (FARIZOL) Botol 4,100.00 Rp - Rp -
Metronidazol suspensi 125 mg / 5 ml Botol 14,080.00 Rp - Rp -
105 Metronidazol suspensi 125 mg / 5 ml Botol 3,950.10 Rp - Rp -
106 Mikonazole krim / salep 2% (nitrat) tube 3,234.00 Rp - Rp -
107 Mikonazole krim / salep 2% (nitrat) tube 3,414.00 Rp - Rp -
Molakrim tube 13,750.00 Rp - Rp -
108 Molakrim Tube 12,545.45 Rp - Rp -
Momethason (ELMOX) Tube 19,800.00 Rp - Rp -
Methyl salisilat 102 mg, eugenol 13,6 mg, menthol 53,4
109 mg, vanishing cream ad 1 gr (MOLAKRIM) Tube 12,600.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
Multivitamin kombinasi mengandung Echinaceae250
110 mg Black elderberry 400 mg Zn pikolinat 5 mg Vit C 100 Kapsul 1,820.00 Rp - Rp -
mg (STIMUNO)

Multivitamin kombinasi mengandung Fe fumarat, Ca

pnthethonat, Vit B1, Vit B2, Vit B 6, Vit B12, Vit C, Vit D,
111 Mn sulfat, cupri sulfat, nicotinamide, Zn sulfat, Ca, Tablet 840.00 Rp - Rp -
iodine, Mg (SOLVITRAL)

Natrium lauril sulfoasetat 0,045 g, Na sitrat 0,450 g, PEG

112 400 0,625 g, Sorbitol 4,465 g, Asam sorbat 0,005 g, dan Tube 18,600.00 Rp - Rp -
air murni 6,250 g (MICROLAX)
Nystatin drop 100.000 IU Botol 13,500.00 Rp - Rp -
Obat Tetes Mata Neomisin sulfat + deksametason +
113 polimiksin (ALLETROL TETES MATA) Botol 16,412.00 Rp - Rp -

Obat pencernaan setiap 1 gr mengandung rice starch

maltodextrin lactobacillus acidophilus W 55 Tablet 7,150.00 Rp - Rp -
Lactobacillus (L-BIO)
Obat Pelindung Fungsi Hati (hepatoprotektor)
114 mengandung sylimarin 70 mg, Cynarin 1,2 mg, Tablet 2,500.00 Rp - Rp -
Curcumin 5 mg, Lycopene 5 mg (HEPAGARD)
115 Obat Batuk Hitam (HERBAKOF) syrup Botol 11,090.91 Rp - Rp -
Obat Batuk Hitam (HERBAKOF) syrup Botol 11,550.00 Rp - Rp -
Obat Batuk Hitam (HERBAKOF) syrup Botol 11,858.00 Rp - Rp -
116 Obat Batuk Hitam (HERBAKOF) syrup Botol 10,900.00 Rp - Rp -
117 Obat Fllu Kombinasi (ANACETIN) syrup Botol 8,818.18 Rp - Rp -
Obat Fllu Kombinasi (ANACETIN) syrup Botol 14,025.00 Rp - Rp -
118 Obat Fllu Kombinasi (ANACETIN) syrup Botol 9,800.00 Rp - Rp -
119 Obat Flu Syrup Kombinasi (COLFIN) Botol 6,765.00 Rp - Rp -
120 Obat Flu Syrup Kombinasi (COLFIN) Botol 9,818.18 Rp - Rp -
Obat Flu Syrup Kombinasi (SOLAFLUZ) Botol 13,585.00 Rp - Rp -
Obat Flu Syrup Kombinasi (SOLAFLUZ) Botol 13,750.00 Rp - Rp -
121 Obat Flu Syrup Kombinasi (SOLAFLUZ) Botol 10,909.09 Rp - Rp -
122 Obat Flu Syrup Kombinasi (LODECON) TABLET Botol 772.73 Rp - Rp -
123 Obat kombinasi Hyosiamin + PCT (SCOPMA PLUS) tablet 1,590.91 Rp - Rp -
Obat kombinasi Hyosiamin + PCT (SCOPMA PLUS) tablet 1,650.00 Rp - Rp -
Pancreatin 170mg eqiv to amylase 5500u,lipase
124 6500u,protease 400u,dimetilpolisiloksan80 mg Tablet 2,735.70 Rp - Rp -
(XEPAZYM)
Pancreatin 170mg eqiv to amylase 5500u,lipase
125 6500u,protease 400u,dimetilpolisiloksan80 mg Tablet 2,475.00 Rp - Rp -
(XEPAZYM)
126 Paracetamol 500 mg Tablet 89.00 Rp - Rp -
127 Paracetamol drop 100 mg / 5 ml botol 15,909.09 Rp - Rp -
128 Paracetamol drop 100 mg / 5 ml botol 5,192 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
129 Paracetamol syrup 120 mg / 5 Ml (FASIDOL) Botol 6,136.36 Rp - Rp -
130 Paracetamol syrup FORTE 250 mg / 5 Ml (FASIDOL) Botol 7,272.73 Rp - Rp -
131 Paracetamol Forte 650 mg (FASIDOL FORTE) Tablet 214.50 Rp - Rp -
Paracetamol Forte 650 mg (FASIDOL FORTE) Tablet 352.00 Rp - Rp -
132 Paracetamol Forte 650 mg (FASIDOL FORTE) Tablet 190.00 Rp - Rp -
Paracetamol 650mg + Phenylpropanolamin 15mg +
Gliseril guayakolat 50mg + Chloramfeniramin maleat Tablet 440.00 Rp - Rp -
2mg (ELSIRON)
133 Pehacain Injeksi ampul 3,113.00 Rp - Rp -
134 Permetrin 5 % (SCACID) Tube 34,750.00 Rp - Rp -
Permetrin 5 % (SCACID) Tube 41,800.00 Rp - Rp -
135 Pirantel tablet 125 mg Tablet 269.00 Rp - Rp -
136 Prednison 5 mg Tablet 76.00 Rp - Rp -
137 Propanolol 40 mg Tablet 65.00 Rp - Rp -
138 Ranitidin 150 mg Tablet 300.00 Rp - Rp -
139 Ranitidin 150 mg Tablet 105.00 Rp - Rp -
140 Ringer Laktat 500 ml Botol 5,200.00 Rp - Rp -
141 Salbutamol 2 mg Tablet 490.00 Rp - Rp -
142 Salep 2 - 4 pot 2,621.00 Rp - Rp -
143 Sefadroksil 500 mg Kapsul 450.00 Rp - Rp -
144 Sefadroksil 500 mg (LOSTACEF) Kapsul 1,120.00 Rp - Rp -
145 Sefadroksil tablet 250 mg Botol 690.00 Rp - Rp -
146 Sefadroksil syrup botol 60 mL 3,980.00 Rp - Rp -
147 Sefadroksil syrup 125 mg / 5 ml botol 60 mL 3,921.50 Rp - Rp -
Sefadroksil FORTE syrup 250 mg / 5 ml (LOSTACEF
FORTE) Botol 35,750.00 Rp - Rp -

148 Sefadroksil FORTE syrup 250 mg / 5 ml Botol 5,199.70 Rp - Rp -

149 Sefiksim syrup 100 mg / 5 ml Botol 6,150.00 Rp - Rp -
150 Sefiksim tablet 100 mg Tablet 750.00 Rp - Rp -
151 Sefiksim tablet 100 mg Tablet 2,800.00 Rp - Rp -
152 Simvastatin 10 mg Tablet 111.00 Rp - Rp -
153 Siprofloxacin 500 mg Tablet 545.45 Rp - Rp -
154 Sukralfat tablet 500 mg (ULSIDEX) Tablet 296.00 Rp - Rp -
Sukralfat tablet 500 mg (ULSIDEX) Tablet 1,100.00 Rp - Rp -
155 Sukralfat Suspensi 100 ml Botol 6,789.20 Rp - Rp -
Triheksifenidil tablet 2 mg (AKRINE) Tablet 715.00 Rp - Rp -
156 Terbutalin HCl 2,5 mg (MOLASMA) Tablet 305.80 Rp - Rp -
157 Terikortin Krim Tube 8,090.91 Rp - Rp -
Tramadol 37,5mg + Paracetamol 325mg (TRAMOFAL) Tablet 5,170.00 Rp - Rp -
158 Vitamin kombinasi syrup (SOLVITA) Botol 9,405.00 Rp - Rp -
159 Vitamin kombinasi syrup (SOLVITA) Botol 8,545.45 Rp - Rp -
160 Vitamin kombinasi syrup (TRUVIT) Botol 11,814.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
161 Vitamin kombinasi syrup (TRUVIT) Botol 10,727.27 Rp - Rp -
Vitamin kombinasi syrup (CAVICUR) Botol 11,550.00 Rp - Rp -
Vitamin B1 + vit B6 + vit B12 (NEUCOMPLI) Tablet 725.00 Rp - Rp -
162 Zink Syrup 20 mg botol 60 mL 4,789.00 Rp - Rp -
163 Zink Syrup 20 mg botol 60 mL 4,789.00 Rp - Rp -
SUB TOTAL OBAT Rp - Rp -

ALAT KESEHATAN & BMHP

1 Alat suntik 3 cc Set 1,375.00 Rp - Rp -
2 Alkazid 1 L pcs 2,702,700.00 Rp - Rp -
3 Alkzym 25 (Alkazym Sachet) Sachet 800,883.60 Rp - Rp -
4 Alkohol Swab Dus 10,300.00 Rp - Rp -
5 Alkohol Swab pcs 103.00 Rp - Rp -
6 Alkohol Swab (Jayamas Onemed) pcs 103.00 Rp - Rp -
7 Alkohol 70 % Botol 100 ml 2,500.00 Rp - Rp -
8 Alkohol 70 % Botol 1000 ml 21,500.00 Rp - Rp -
9 Aquagel Tube 49,528.00 Rp - Rp -
10 Bein buah 98,500.00 Rp - Rp -
11 Brush pcs 10,500.00 Rp - Rp -
12 B Braun Bisturi No 11 buah 2,915.00 Rp - Rp -
13 B Braun Bisturi No 11 buah 5,780.06 Rp - Rp -
14 Chromic C 3/0 75C 22 M R pcs 275,500.50 Rp - Rp -
15 Catgut Plain pcs 134,000.00 Rp - Rp -
16 Chlorin 1000 mL Botol 19,000.00 Rp - Rp -
17 Coverplast Tansparent (OK Plast) Dus 31,250.00 Rp - Rp -
18 E Care Hand Rub Antiseptik 500 ml botol 500 ml 28,772.70 Rp - Rp -
19 E Care Hand Rub Antiseptik 5 Lt Galon 5 Lt 275,454.50 Rp - Rp -
20 E Care Hand Rub Antiseptik 5 Lt Galon 5 Lt 605,000.00 Rp - Rp -
21 E Care Hand Scrub 500 ml Botol 500 mL 34,727.15 Rp - Rp -
22 E Care Hand Scrub 5 Lt Galon 5 Lt 304,909.00 Rp - Rp -
23 E Care Hand Scrub 5 Lt Galon 5 Lt 640,800.00 Rp - Rp -
24 E Care Sarung tangan No 6,5 Buah 5,055.00 Rp - Rp -
25 E Care Sarung tangan No 7 Buah 5,055.00 Rp - Rp -
26 E Care Mask 3 ply TIE ON pcs 468.90 Rp - Rp -
27 Gunting Perban 14 cm Buah 35,000.00 Rp - Rp -
28 Handpiece Highspeed 2 Hole set 2,690,000.00 Rp - Rp -
29 Handpiece Highspeed 4 Hole set 2,690,000.00 Rp - Rp -
30 Handpiece Lowspeed set 3,060,000.00 Rp - Rp -
31 HCG Tes Kehamilan Dus 60,000.00 Rp - Rp -
32 HCG Tes Kehamilan (Onemed Ultra one) pcs 1,997.17 Rp - Rp -
33 IV Catheter no 20 pcs 60,000.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
34 IV Catheter no 18 pcs 60,001.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
35 Masker (MMP Mas Face Mask 3-Ply / Tie On) pcs 740.52 Rp - Rp -
36 Masker Plus Earloop (Hijab) pcs 453.20 Rp - Rp -
37 Masker N 95 pcs 6,707.35 Rp - Rp -
38 Mata bor round Highspeed pcs 30,500.00 Rp - Rp -
39 Mata bor round Lowspeed pcs 36,500.00 Rp - Rp -
40 Mata bor Visure Highspeed pcs 30,500.00 Rp - Rp -
41 Mata bor Visure Lowspeed pcs 36,500.00 Rp - Rp -
42 Mata bor Inverted Highspeed pcs 30,500.00 Rp - Rp -
43 Mata bor Inverted Lowspeed pcs 36,500.00 Rp - Rp -
44 Micropipettes MT-1 200 µl (yellow tip) pcs 180.70 Rp - Rp -
45 Micropipettes MT-II-up to 1ml (blue tip) pcs 232.10 Rp - Rp -
46 One Clean 1 L Botol 17,424.00 Rp - Rp -
47 Pen Lancet AccuCheck buah 305,000.00 Rp - Rp -
48 Pincet buah 24,000.00 Rp - Rp -
49 Polishing Bor pcs 42,500.00 Rp - Rp -
50 Sarung Tangan Latex Powder free Uk S pcs 535.00 Rp - Rp -
51 Sarung Tangan Latex Powder free Uk M pcs 535.00 Rp - Rp -
52 Sarung Tangan Latex Powder free Uk L pcs 535.00 Rp - Rp -
53 Sarung Tangan Nitrile Uk S pcs 589.16 Rp - Rp -
54 Sarung Tangan Nitrile Uk M pcs 589.16 Rp - Rp -
55 Sarung Tangan Nitrile Uk L pcs 589.16 Rp - Rp -
56 Sarung Tangan Nitrile Uk L pcs 589.16 Rp - Rp -
57 Silk (Benag Bedah) Box 14,032.67 Rp - Rp -
58 Sonde buah 24,000.00 Rp - Rp -
59 Umbilical Cord Klem Steril Nylon pcs 1,339.00 Rp - Rp -
60 Under Pad Steril 60 X 90 cm Bister 7,855.00 Rp - Rp -
61 Under Pad Steril 60 X 90 cm Bister 6,930.00 Rp - Rp -
62 USG Gel 250 ml Botol 250 ml 13,213.20 Rp - -
63 Tensi Aneroid Transpr, GC unit 200,000.00 Rp - Rp -
64 Timer pcs 200,000.00 Rp - Rp -
65 Thermometer Kulkas pcs 165,000.00 Rp - Rp -
66 Tabung LED Westergreen pcs 40,000.40 Rp - Rp -
67 Bunsen Lampu Spiritus pcs 82,500.00 Rp - Rp -
68 Torniquet pcs 38,500.00 Rp - Rp -
69 Penjepit kayu pcs 30,000.30 Rp - Rp -
70 Ose pcs 16,500.00 Rp - Rp -
71 Pensil kaca pcs 26,400.00 Rp - Rp -
72 Tabung Ungu EDTA Box 247,500.00 Rp - Rp -
73 Tabung Merah Plain Box 247,500.00 Rp - Rp -
74 Micropipet Adjust Vol 10 100 uL Dumo pcs 1,925,000.00 Rp - Rp -
75 Korentang set pcs 275,000.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
76 Tabung reaksi 12 x 75 pcs 5,500.00 Rp - Rp -
77 Tabung reaksi tutup karet 12 x 75 pcs 16,500.00 Rp - Rp -
78 Tissue lensa buku 27,500.00 Rp - Rp -
79 Kertas saring lembar 16,500.00 Rp - Rp -
80 Blood lancet Onemed box 35,200.00 Rp - Rp -
81 Hb Hemoglobin Strip 50 test Mission ACON box 415,000.00 Rp - Rp -
82 ABN BPM UPPER Arm Digital Sphy (Tensi Digital) unit 401,000.00 Rp - Rp -
83 ABN Nylon Cuff, Black Adult unit 70,455.00 Rp - Rp -
84 ABN Latex Bulb Print Deluxe unit 41,113.00 Rp - Rp -
85 Micripippet Adjust 100 - 1000 mikron unit 541,862.00 Rp - Rp -
86 Dermafix T 5x7cm New pcs 1,677.87 Rp - Rp -
87 Dermafix T 10x12cm New pcs 6,514.45 Rp - Rp -
88 Safety Box 5 Lt Onemed Kuning pcs 16,186.80 Rp - Rp -
89 Autoclick Device Onemed pcs 17,938.25 Rp - Rp -
90 Object Glass 72 pcs 251.84 Rp - Rp -
91 Rak Tabung Reaksi Multipurpose pcs 780,626.00 Rp - Rp -
92 Standar Infus SS Deluxe Indomed pcs 457,380.00 Rp - Rp -
93 Kantong obat K pak 13,380.00 Rp - Rp -
94 Kertas puyer pcs 153.40 Rp - Rp -
95 Hygrometer pcs 275,000.00 Rp - Rp -
96 Hand Rub Anti Septik 5 lt Galon 1,045,000.00 Rp - Rp -
97 Hand Scrub 5 lt Galon 1,100,000.00 Rp - Rp -
98 Timbangan injak Digital pcs 385,000.00 Rp - Rp -
99 Metlin pcs 27,500.00 Rp - Rp -
100 Pita Lila pcs 22,000.00 Rp - Rp -
101 Silk No.3/0 pcs 22,000.00 Rp - Rp -
102 Cat Gut 3/0 pcs 38,500.00 Rp - Rp -
103 Umbilical Cord Klem Steril Nylon pcs 3,300.00 Rp - Rp -
104 UnderPad Steril 60 X 90 cm Bister 22,000.00 Rp - Rp -
105 USG Gel 250 ml Botol 27,500.00 Rp - Rp -
106 Microtoa Alat ukur TB pcs 72,050.00 Rp - Rp -
107 Sungkup O2 anak pcs 30,250.00 Rp - Rp -
108 Thermometer pcs 49,500.00 Rp - Rp -
109 Sungkup O2 Dewasa pcs 30,250.00 Rp - Rp -
110 Infuse set dewasa pcs 11,000.00 Rp - Rp -
111 Infuse set anak pcs 11,000.00 Rp - Rp -
112 Douwer Cateter No 16 pcs 143,000.00 Rp - Rp -
113 Douwer Cateter No 18 pcs 143,000.00 Rp - Rp -
114 Douwer Cateter No 12 pcs 143,000.00 Rp - Rp -
115 Kondom Chateter pcs 16,500.00 Rp - Rp -
116 Cathejell pcs 99,000.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
117 Spuit 50cc (NGT) pcs 24,750.00 Rp - Rp -
118 Spuit 10cc pcs 3,850.00 Rp - Rp -
119 Aquadest Box 990,000.00 Rp - Rp -
120 Duk Bolong pcs 38,500.00 Rp - Rp -
121 Masker Nebulizer Anak pcs 44,000.00 Rp - Rp -
122 Masker Nebulizer Dewasa pcs 44,000.00 Rp - Rp -
123 Nasal canule Anak pcs 19,250.00 Rp - Rp -
124 Nasal canule dewasa pcs 19,250.00 Rp - Rp -
125 Mayo anak pcs 38,500.00 Rp - Rp -
126 Mayo Dewasa pcs 38,500.00 Rp - Rp -
127 Buli-buli Panas pcs 55,000.00 Rp - Rp -
128 Gunting up hecting 14cm pcs 71,500.00 Rp - Rp -
129 Penlight pcs 82,500.00 Rp - Rp -
130 Pinset anatomis 14cm pcs 38,500.00 Rp - Rp -
131 Pinset telinga pcs 60,500.00 Rp - Rp -
132 Arteri klem bengkok 14cm pcs 55,000.00 Rp - Rp -
133 Arteri klem lurus 14cm pcs 55,000.00 Rp - Rp -
134 Urine bag 2 lt pcs 11,000.00 Rp - Rp -
135 IV cath no 20 pcs 27,500.00 Rp - Rp -
136 IV cath no 22 pcs 27,500.00 Rp - Rp -
137 IV cath no 24 pcs 27,500.00 Rp - Rp -
138 IV cath no 26 pcs 27,500.00 Rp - Rp -
139 NGT no 16 pcs 71,500.00 Rp - Rp -
140 NGT no 12 pcs 71,500.00 Rp - Rp -
141 NGT no 5 pcs 79,750.00 Rp - Rp -
142 Google (Kaca Mata) pcs 55,000.00 Rp - Rp -
143 Jas periksa pcs 217,800.00 Rp - Rp -
144 Ambu bag dewasa pcs 495,000.00 Rp - Rp -
Rp -
BMHP OBAT GIGI
1 Devitalisasi Pasta (Non Arsen) ktk 269,000.00 Rp - Rp -
2 Etil Klorida spray Botol 157,344.00 Rp - Rp -
3 Cevitron buah 116,000.00 Rp - Rp -
4 Fuji IX mini buah 410,000.00 Rp - Rp -
5 Glass Ionomer Cement ART ktk 2 tube set @30 1,125,000.00 Rp - Rp -
6 Klorfenol kamfer Menthol ( CHKM ) gram/btl 67,000.00 Rp - Rp -
7 Cresotin II botol 550,000.00 Rp - Rp -
8 GC, Elite Semen set 700,000.00 Rp - Rp -
9 Minosept gargle buah 48,500.00 Rp - Rp -
10 Spongostan box 103,000.00 Rp - Rp -
11 Triklorofenol buah 80,700.00 Rp - Rp -
1 2 3 4 5 6 7 8 9 10 11
SUB TOTAL BMHP OBAT GIGI Rp - Rp -
1 2 3 4 5 6 7 8 9 10 11

REAGENT

1 Golongan Darah Anti A vial 78,000.00 Rp - Rp -

2 Golongan Darah Anti B vial 78,000.00 Rp - Rp -
3 Golongan Darah Rhesus vial Rp - Rp -
4 Benecheck Kolesterol pcs 25,410.00 Rp - Rp -
5 Benecheck Glucose pcs 3,019.76 Rp - Rp -
6 Benecheck Glucose pcs 3,045.37 Rp - Rp -
7 Benecheck Glucose pcs 3,291.20 Rp - Rp -
8 Benecheck Uric Acid pcs 5,566.00 Rp - Rp -
9 SD Bioline HBsAg pcs 9,878.00 Rp - Rp -
10 SD Bioline HIV 1/23.0 pcs 14,344.00 Rp - Rp -
11 Widal Test set 1,500,220.00 Rp - Rp -
12 Exatrol - N 10x5 mL kit 5,415,960.00 Rp - Rp -
13 Uric Acid (URIASE) 2x100 ml kit 1,461,680.00 Rp - Rp -
14 Trigliserida GPO 2x50 ml kit 1,415,700.00 Rp - Rp -
15 Glukosa GOD PAP 2x200 ml kit 1,118,040.00 Rp - Rp -
16 Cholesterol CHOD PAP 2x100 ml kit 1,461,680.00 Rp - Rp -
17 ALT/GPT (IFCC) 8x30 ml kit 2,357,080.00 Rp - Rp -
18 AST/GOT (IFCC) 8x30 ml kit 2,357,080.00 Rp - Rp -
19 HDL Cholesterol PTA 300 test 1x30 ml kit 1,340,680.00 Rp - Rp -
20 HDL/LDL/CKMB Control Lev 1 2x2 ml kit 2,388,540.00 Rp - Rp -
21 Urea UV Kinetic High Linerity 8x30 ml kit 2,461,140.00 Rp - Rp -
22 Creatinin Kinetic 2x125 ml kit 1,161,600.00 Rp - Rp -
23 Golongan Darah Set 605,000.00 Rp - Rp -
24 SYSMEX Stromatolyser WH, 500 ml Botol 1,171,500.00 Rp - Rp -
25 SYSMEX Cellpack (PK 301), 20 liter Box 1,768,800.00 Rp - Rp -
26 SYSMEX Cell Clean, (CL 50), 50 ml Botol 1,197,900.00 Rp - Rp -
27 SYSMEX Thermal Paper Roll 38,500.00 Rp - Rp -
28 SYSMEX Coatle Stik 11M Box 446,160.00 Rp - Rp -
29 SYSMEX Lightcheck - 3 WP (LOW) vial 316,066.00 Rp - Rp -
30 SYSMEX Lightcheck - 3 WP (NORMAL) vial 316,066.00 Rp - Rp -
31 SYSMEX Lightcheck - 3 WP (HIGH) vial 316,066.00 Rp - Rp -
Accu Check instant glucosa 25 strip Box 137,500.00 Rp - Rp -
32 Accu Check Performa pcs 4,200.00 Rp - Rp -
33 Stik Urine (URIT 11P) Box 3,500.00 Rp - Rp -
34 Stik Lipid Pro Box 1,262,500.00 Rp - Rp -
34 Stik Lipid Pro Box 125,000.00 Rp - Rp -
 1 2 3 4 5 6 7 8 9 10 11
35 Nesco stick Cholesterol isi 10 Box 401,500.00 Rp - Rp -
36 Nesco stick Asam Urat isi 25 Box 209,000.00 Rp - Rp -
37 Nesco stick Gula darah isi 25 Box 181,500.00 Rp - Rp -
38 HB Mission strip isi 50 Box 1,045,000.00 Rp - Rp -
39 HCG test strip isi 50 Box 203,500.00 Rp 1,831,500.00 Rp -
SUB TOTAL REAGEN Rp 1,831,500.00 Rp -
JUMLAH TOTAL Rp Rp 1,831,500.00 Rp -

ASKES JPS MANDIRI KIS WALUYA JUMLAH

JUMLAH KUNJUNGAN RESEP
-

Ciamis
Mengetahui / Menyetujui Yang Menyerahkan : Yang menerima :
Kepala Dinas Kesehatan Kabupaten Ciamis Kepala Pkm Ciamis Petugas Gudang Farmasi Pkm Ciamis Petugas Pustu/Poskesdes

……………………………………... ………………………… EVIE TRIYANTI,drg.,MM IRMA SANDRA

NIP. 198110182010012001 NIP. 19640323 198501 2 001