Laporan BHP Kaliasin Permintaan April 2021

BUKU BARANG PAKAI HABIS
NOMOR : 445/ / IV.03 / IV / 2021

PUSKESMAS : KALIASIN
KECAMATAN : Tanjung Bintang
KABUPATEN : LAMPUNG SELATAN
BARANG PERSEDIAAN : OBAT - OBATAN, VAKSIN/SERUM DAN BAHAN MEDIS HABIS PAKAI
BULAN : APRIL 2021
SALDO AWAL PENERIMAAN PENGELUARAN SALDO/SISA

SUMBER
NO JENIS BARANG HARGA SATUAN HARGA SATUAN HARGA SATUAN JUMLAH SATUAN HARGA SATUAN DANA / KET
JUMLAH SATUAN BARANG NILAI JUMLAH SATUAN BARANG NILAI JUMLAH SATUAN BARANG NILAI NILAI BARANG
BARANG BARANG BARANG BARANG BARANG
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
1 OBAT - OBATAN APBD II

SUB OBAT -OBATAN
ACT(Artesunate Tablet 50 mg + Amodiaquine
1 - Tablet 1,375.00 - Tablet 1,375.00 - Tablet 1,375.00 - - Tablet 1,375.00 -
anhydrida Tablet 200 mg)
2 Albendazol Tablet Kunyah 400 mg - Tablet 392.00 - Tablet 392.00 - Tablet 392.00 - - Tablet 392.00 -
3 Albendazol Tablet Kunyah 400 mg - Tablet 402.00 - Tablet 402.00 - Tablet 402.00 - - Tablet 402.00 -
4 Alkohol 70 % - 100 ml - Botol 100 ml 2,500.00 - Botol 100 ml 2,500.00 - Botol 100 ml 2,500.00 - - Botol 100 ml 2,500.00 -
5 Alkohol 70 % - 100 ml - Botol 100 ml 2,900.00 - Botol 100 ml 2,900.00 - Botol 100 ml 2,900.00 - - Botol 100 ml 2,900.00 -
6 Alkohol 70 % - 1 L - Botol 1 L 25,000.00 - Botol 1 L 25,000.00 - Botol 1 L 25,000.00 - - Botol 1 L 25,000.00 -
7 Alkohol 70 & - 1 L 8 Botol 1 L 18,700.00 149,600.00 Botol 1 L 18,700.00 - Botol 1 L 18,700.00 - 8 Botol 1 L 18,700.00 149,600.00
8 Alkohol 70 & - 1 L - Jrg 20 L 319,000.00 - Jrg 20 L 319,000.00 - Jrg 20 L 319,000.00 - - Jrg 20 L 319,000.00 -
9 Alopurinol Tablet 100 mg - Tablet 86.00 - Tablet 86.00 - Tablet 86.00 - - Tablet 86.00 -
11 Alopurinol Tablet 100 mg 490 Tablet 99.00 48,510.00 Tablet 99.00 - Tablet 99.00 - 490 Tablet 99.00 48,510.00
13 Alprazolam Tablet 1 mg - Tablet 233.00 - Tablet 233.00 - Tablet 233.00 - - Tablet 233.00 -
16 Alprazolam Tablet 0,25 mg - Tablet 380.00 - Tablet 380.00 - Tablet 380.00 - - Tablet 380.00 -
17 Alprazolam Tablet 0,5 mg - Tablet 88.00 - Tablet 88.00 - Tablet 88.00 - - Tablet 88.00 -
18 Ambroxol Tablet 30 mg (Mucos Tab) 400 Tablet 880.00 352,000.00 Tablet 880.00 - 100 Tablet 880.00 88,000.00 300 Tablet 880.00 264,000.00
19 Aminofilin Injeksi 24 mg/ml - Amp 10 ml 3,823.00 - Amp 10 ml 3,823.00 - Amp 10 ml 3,823.00 - - Amp 10 ml 3,823.00 -
20 Aminofilin Injeksi 24 mg/ml - Ampul 3,345.00 - Ampul 3,345.00 - Ampul 3,345.00 - - Ampul 3,345.00 -
21 Aminofilin Tablet 200 mg - Tablet 993.00 - Tablet 993.00 - Tablet 993.00 - - Tablet 993.00 -
22 Aminofilin Tablet 150 mg (Decafil) - Tablet 139.00 - Tablet 139.00 - Tablet 139.00 - - Tablet 139.00 -
23 Aminofilin Tablet 150 mg (Decafil) 100 Tablet 148.00 14,800.00 Tablet 148.00 - Tablet 148.00 - 100 Tablet 148.00 14,800.00
24 Amitriptilin Tablet Salut 25 mg (HCl) - Tablet 112.00 - Tablet 112.00 - Tablet 112.00 - - Tablet 112.00 -
27 Amlodipine Tablet 10 mg - Tablet 330.00 - Tablet 330.00 - Tablet 330.00 - - Tablet 330.00 -
30 Amlodipine Tablet 10 mg 900 Tablet 92.00 82,800.00 Tablet 92.00 - Tablet 92.00 - 900 Tablet 92.00 82,800.00
34 Amlodipine Tablet 5 mg 570 Tablet 78.00 44,460.00 Tablet 78.00 - 200 Tablet 78.00 15,600.00 370 Tablet 78.00 28,860.00
35 Amoksisilin Kaplet 500 mg - Tablet 272.00 - Tablet 272.00 - Tablet 272.00 - - Tablet 272.00 -
36 Amoksisilin Kaplet 500 mg - kaplet 232.00 - kaplet 232.00 - kaplet 232.00 - - kaplet 232.00 -
37 Amoksisilin Kaplet 500 mg - kaplet 233.00 - kaplet 233.00 - kaplet 233.00 - - kaplet 233.00 -
38 Amoksisilin Kaplet 500 mg 4,700 kaplet 249.00 1,170,300.00 kaplet 249.00 - 300 kaplet 249.00 74,700.00 4,400 kaplet 249.00 1,095,600.00
39 Amoksisilin Kapsul 250 mg - Kapsul 211.00 - Kapsul 211.00 - Kapsul 211.00 - - Kapsul 211.00 -
40 Amoksisilin Kapsul 250 mg - kapsul 195.00 - kapsul 195.00 - kapsul 195.00 - - kapsul 195.00 -
43 Amoksisilin Syrup Kering 125 mg/5ml - Botol 60 ml 2,445.00 - Botol 60 ml 2,445.00 - Botol 60 ml 2,445.00 - - Botol 60 ml 2,445.00 -
47 Amoksisilin Syrup Kering 250 mg/5ml 55 Botol 60 ml 2,050.00 112,750.00 Botol 60 ml 2,050.00 - 20 Botol 60 ml 2,050.00 41,000.00 35 Botol 60 ml 2,050.00 71,750.00
Kotak 10
48 Ampisilin Serbuk Injeksi im/iv. 1000 mg/vial - Kotak 10 Vial 51,000.00 - Kotak 10 Vial 51,000.00 - Kotak 10 Vial 51,000.00 - - 51,000.00 -
Vial
Antasida DOEN Tablet Kunyah, Kombinasi :
49 - Tablet 72.00 - Tablet 72.00 - Tablet 72.00 - - Tablet 72.00 -
AlOH 200 mg + MgOH 200 mg
BHP-02-2021 1
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17

52 990 Tablet 58.00 57,420.00 Tablet 58.00 - 190 Tablet 58.00 11,020.00 800 Tablet 58.00 46,400.00
53 Antasida DOEN II Suspensi Kombinasi - Botol 60 ml 2,025.00 - Botol 60 ml 2,025.00 - Botol 60 ml 2,025.00 - - Botol 60 ml 2,025.00 -
56 Antibakteri DOEN (Bacitracin Salep Kulit) - Tube 2,924.00 - Tube 2,924.00 - Tube 2,924.00 - - Tube 2,924.00 -
57 Antibakteri DOEN (Bacitracin Salep Kulit) - Tube 3,035.00 - Tube 3,035.00 - Tube 3,035.00 - - Tube 3,035.00 -
Antifungi DOEN Kombinasi:
58 - Pot 30 gr 1,719.00 - Pot 30 gr 1,719.00 - Pot 30 gr 1,719.00 - - Pot 30 gr 1,719.00 -
Asam Benzoat 6% + AsamSalisilat 3%
59 - Tube 4,158.00 - Tube 4,158.00 - Tablet 4,158.00 - - Tablet 4,158.00 -
60 - Pot 4,496.00 - Pot 4,496.00 - Pot 4,496.00 - - Pot 4,496.00 -

61 24 Pot 4,798.00 115,152.00 Pot 4,798.00 - Pot 4,798.00 - 24 Pot 4,798.00 115,152.00
62 Antihemoroid kombinasi - Suppositoria 3,045.00 - Suppositoria 3,045.00 - Suppositoria 3,045.00 - - Suppositoria 3,045.00 -
63 Antihemoroid kombinasi - Suppositoria 3,167.00 - Suppositoria 3,167.00 - Suppositoria 3,167.00 - - Suppositoria 3,167.00 -
Antimalaria DOEN Kombinasi:

Pirimetamin 25 mg + Sulfadoksin 500 mg
Antimigren Tablet :
Ergotamin Tartrat 1 mg + Kofein 50 mg
Antimigren Tablet : Ergotamin 1 mg + Kafein 50 mg

(Generik Kombinasi)
67 Artemether Injeksi 80 mg/ml - ampul 22,000.00 - ampul 22,000.00 - ampul 22,000.00 - - ampul 22,000.00 -
68 Artesunate Injeksi vial 60 mg - viaL 38,999.00 - viaL 38,999.00 - viaL 38,999.00 - - viaL 38,999.00 -
69 Asam Asetilsalisilat Tablet 100 mg (Asetosal) - Tablet 116.00 - Tablet 116.00 - Tablet 116.00 - - Tablet 116.00 -
70 Asam Askorbat (Vitamin C) Tablet 250mg - Tablet 125.00 - Tablet 125.00 - Tablet 125.00 - - Tablet 125.00 -
72 Asam Askorbat (Vitamin C) Tablet 50mg 700 Tablet 105.00 73,500.00 Tablet 105.00 - 100 Tablet 105.00 10,500.00 600 Tablet 105.00 63,000.00
73 Asam Folat Tablet 1 mg - Tablet 48.00 - Tablet 48.00 - Tablet 48.00 - - Tablet 48.00 -
76 Asam Folat Tablet 0,4 mg - Tablet 63.00 - Tablet 63.00 - Tablet 63.00 - - Tablet 63.00 -
77 Asam Folat Tablet 0,4 mg - Tablet 55.00 - Tablet 55.00 - Tablet 55.00 - - Tablet 55.00 -
78 Asam Mefenamat Kapsul 500 mg - Tablet 112.00 - Tablet 112.00 - Tablet 112.00 - - Tablet 112.00 -
80 Asam Mefenamat Kapsul 500 mg 1,500 Tablet 103.00 154,500.00 Tablet 103.00 - 500 Tablet 103.00 51,500.00 1,000 Tablet 103.00 103,000.00
81 Asiklovir krim 2,5 % - Tube 2,995.00 - Tube 2,995.00 - Tube 2,995.00 - - Tube 2,995.00 -
82 Asiklovir krim 5 % 25 Tube 3,850.00 96,250.00 Tube 3,850.00 - Tube 3,850.00 - 25 Tube 3,850.00 96,250.00
83 Asiklovir krim 5 % - Tube 3,146.00 - Tube 3,146.00 - Tube 3,146.00 - - Tube 3,146.00 -
84 Asiklovir Tablet 200 mg - Tablet 237.00 - Tablet 237.00 - Tablet 237.00 - - Tablet 237.00 -
87 Asiklovir Tablet 400 mg 500 Tablet 380.00 190,000.00 Tablet 380.00 - 100 Tablet 380.00 38,000.00 400 Tablet 380.00 152,000.00
88 Atropin Sulfat Injeksi. i.m./i.v./s.k. 0,25 mg/ml - Amp 1 ml 1,350.00 - Amp 1 ml 1,350.00 - Amp 1 ml 1,350.00 - - Amp 1 ml 1,350.00 -
89 Atropin Sulfat Tablet 0,5mg - Tablet 74.00 - Tablet 74.00 - Tablet 74.00 - - Tablet 74.00 -
90 Benzatin Benzil Penisilin 1,2 juta IU/ vial - vial 9,800.00 - vial 9,800.00 - vial 9,800.00 - - vial 9,800.00 -
Besi (II) Sulfat 200 mg + Asam Folat 0,25mg Tablet
(tablet tambah darah kombinasi)

93 Betahistin Tablet 6 mg - Tablet 149.00 - Tablet 149.00 - Tablet 149.00 - - Tablet 149.00 -
94 Betametason Krim 0,1% (sebagai valerat) - Tube 1,520.00 - Tube 1,520.00 - Tube 1,520.00 - - Tube 1,520.00 -
99 Bromheksin Tablet 8 mg - Tablet 39.00 - Tablet 39.00 - Tablet 39.00 - - Tablet 39.00 -
100 Cetrizin Syrup 5mg/5ml - Botol 2,915.00 - Botol 2,915.00 - Botol 2,915.00 - - Botol 2,915.00 -
101 Cetrizin Tablet 10 mg - Tablet 181.00 - Tablet 181.00 - Tablet 181.00 - - Tablet 181.00 -
103 Cimetidine 200 mg - Tablet 192.67 - Tablet 192.67 - Tablet 192.67 - - Tablet 192.67 -
BHP-02-2021 2
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
104 Deksametason 1nj 5 mg/ml - Vial 1,500.00 - Vial 1,500.00 - Vial 1,500.00 - - Vial 1,500.00 -
105 Deksametason 1nj 5 mg/ml 10 Ampul 1,097.00 10,970.00 Ampul 1,097.00 - Ampul 1,097.00 - 10 Ampul 1,097.00 10,970.00
106 Deksametason Tablet 0.5 mg 3,000 Tablet 77.00 231,000.00 Tablet 77.00 - 1,000 Tablet 77.00 77,000.00 2,000 Tablet 77.00 154,000.00
107 Deksametason Tablet 0.5 mg - Tablet 41.00 - Tablet 41.00 - Tablet 41.00 - - Tablet 41.00 -
109 Diazepam Injeksi 5 mg/ml - Ampul 4,180.00 - Ampul 4,180.00 - Ampul 4,180.00 - - Ampul 4,180.00 -
110 Diazepam Injeksi 5 mg/ml - Ampul 1,735.00 - Ampul 1,735.00 - Ampul 1,735.00 - - Ampul 1,735.00 -
111 Diazepam Tablet 2 mg - Tablet 45.00 - Tablet 45.00 - Tablet 45.00 - - Tablet 45.00 -
114 Diazepam Enema (Stesolid 5 mg/2,5 ml) - Tube 12,573.00 - Tube 12,573.00 - Tube 12,573.00 - - Tube 12,573.00 -
115 Dietilkarbamazin 100 mg - Tablet 158.00 - Tablet 158.00 - Tablet 158.00 - - Tablet 158.00 -
116 Difenhidramin Injeksi i.m.10 mg/ml (HCl) - Ampul 1,054.00 - Ampul 1,054.00 - Ampul 1,054.00 - - Ampul 1,054.00 -
117 Difenhidramin Injeksi i.m.10 mg/ml (HCl) - Ampul 1,176.00 - Ampul 1,176.00 - Ampul 1,176.00 - - Ampul 1,176.00 -
118 Difenhidramin Injeksi i.m.10 mg/ml (HCl) 30 Ampul 1,168.00 35,040.00 Ampul 1,168.00 - Ampul 1,168.00 - 30 Ampul 1,168.00 35,040.00
119 Digoksin Tablet 0,25 mg - Tablet 97.00 - Tablet 97.00 - Tablet 97.00 - - Tablet 97.00 -
120 Digoksin Tablet 0,25 mg - Tablet 105.00 - Tablet 105.00 - Tablet 105.00 - - Tablet 105.00 -
121 Dimenhidrinat Tablet 50 mg - Tablet 104.00 - Tablet 104.00 - Tablet 104.00 - - Tablet 104.00 -
122 Doksisiklin Kapsul 100 mg - Tablet 270.00 - Tablet 270.00 - Tablet 270.00 - - Tablet 270.00 -
123 Doksisiklin Kapsul 100 mg - Tablet 269.00 - Tablet 269.00 - Tablet 269.00 - - Tablet 269.00 -
124 Doksisiklin Kapsul 100 mg 500 Tablet 280.00 140,000.00 Tablet 280.00 - Tablet 280.00 - 500 Tablet 280.00 140,000.00
125 Domperidon Suspensi 5 mg/ml - Botol 60 ml 3,333.00 - Botol 60 ml 3,333.00 - Botol 60 ml 3,333.00 - - Botol 60 ml 3,333.00 -
126 Domperidon Suspensi 5 mg/ml - Botol 60 ml 2,700.00 - Botol 60 ml 2,700.00 - Botol 60 ml 2,700.00 - - Botol 60 ml 2,700.00 -
127 Domperidon Tablet 10 mg - Tablet 85.00 - Tablet 85.00 - Tablet 85.00 - - Tablet 85.00 -
128 Domperidon Tablet 10 mg 400 Tablet 91.00 36,400.00 Tablet 91.00 - 60 Tablet 91.00 5,460.00 340 Tablet 91.00 30,940.00
129 Epinefrin (Adrenalin) Injeksi 1mg/ml - ampul 8,100.00 - ampul 8,100.00 - ampul 8,100.00 - - ampul 8,100.00 -
131 Epinefrin (Adrenalin) Injeksi 1mg/ml 30 ampul 1,408.00 42,240.00 ampul 1,408.00 - ampul 1,408.00 - 30 ampul 1,408.00 42,240.00
133 Ekstarak Beladona Tab 250 mg - Tablet 235.00 - Tablet 235.00 - Tablet 235.00 - - Tablet 235.00 -
134 Eritromisin Kapsul 250 mg - Tablet 49.00 - Tablet 49.00 - Tablet 49.00 - - Tablet 49.00 -
135 Eritromisin Kapsul 250 mg - Tablet 566.00 - Tablet 566.00 - Tablet 566.00 - - Tablet 566.00 -
136 Eritromisin Kapsul 250 mg - Kapsul 546.00 - Kapsul 546.00 - Kapsul 546.00 - - Kapsul 546.00 -
137 Eritromisin Syrup 200 mg / 5ml - Botol 60 ml 7,700.00 - Botol 60 ml 7,700.00 - Botol 60 ml 7,700.00 - - Botol 60 ml 7,700.00 -
138 Eritromisin Syrup 200 mg / 5ml - Botol 60 ml 9,702.00 - Botol 60 ml 9,702.00 - Botol 60 ml 9,702.00 - - Botol 60 ml 9,702.00 -
139 Fenobarbital Injeksi i.m./i.v. 50 mg/ml - Amp 1ml 1,800.00 - Amp 1ml 1,800.00 - Amp 1ml 1,800.00 - - Amp 1ml 1,800.00 -
140 Fenobarbital 30 mg Tablet - Tablet 171.00 - Tablet 171.00 - Tablet 171.00 - - Tablet 171.00 -
141 Fenol Gliserol Tetes Telinga10% - Botol 5 ml 1,008.00 - Botol 5 ml 1,008.00 - Botol 5 ml 1,008.00 - - Botol 5 ml 1,008.00 -
Kotak 30 Amp Kotak 30 Amp Kotak 30 Amp Kotak 30
144 Fitomenadion (Vit-K1) Injeksi 10 mg/ml - 4,250.10 - 4,250.10 - 4,250.10 - - 4,250.10 -
1ml 1ml 1ml Amp 1ml
145 Fitomenadion (Vit-K1)Tab Salut Gula10 mg - Tablet 634.00 - Tablet 634.00 - Tablet 634.00 - - Tablet 634.00 -
149 Fitomenadion (Vit-K1) Injeksi 2 mg/ml - Amp 1ml 3,417.00 - Amp 1ml 3,417.00 - Amp 1ml 3,417.00 - - Amp 1ml 3,417.00 -
150 Fitomenadion (Vit-K1) Injeksi 2 mg/ml - Ampul 3,550.00 - Ampul 3,550.00 - Ampul 3,550.00 - - Ampul 3,550.00 -
151 Fitomenadion (Vit-K1) Injeksi 2 mg/ml 30 Ampul 3,682.00 110,460.00 Ampul 3,682.00 - Ampul 3,682.00 - 30 Ampul 3,682.00 110,460.00
152 Furosemid Injeksi i.v/i.m. 10 mg/ml - Amp 2ml 1,829.00 - Amp 2ml 1,829.00 - Amp 2ml 1,829.00 - - Amp 2ml 1,829.00 -
153 Furosemid Tablet 40 mg - Tablet 85.00 - Tablet 85.00 - Tablet 85.00 - - Tablet 85.00 -
154 Furosemid Tablet 40 mg 200 Tablet 77.00 15,400.00 Tablet 77.00 - 100 Tablet 77.00 7,700.00 100 Tablet 77.00 7,700.00
155 Gameksan Lotion 1% - Botol 3,000.00 - Botol 3,000.00 - Botol 3,000.00 - - Botol 3,000.00 -
156 Garam Oralit Serbuk - Sachet 28.00 - Sachet 28.00 - Sachet 28.00 - - Sachet 28.00 -
157 Garam Oralit Kombinasi - Sachet 264.00 - Sachet 264.00 - Sachet 264.00 - - Sachet 264.00 -
158 Gemfibrozil Kapsul 300 mg - Kapsul 289.00 - Kapsul 289.00 - Kapsul 289.00 - - Kapsul 289.00 -
159 Gentamisin Injeksi 40 mg/ml - Amp 2ml 3,399.00 - Amp 2ml 3,399.00 - Amp 2ml 3,399.00 - - Amp 2ml 3,399.00 -
160 Gentamisin Injeksi 40 mg/ml - Vial 2ml 15,450.00 - Vial 2ml 15,450.00 - Vial 2ml 15,450.00 - - Vial 2ml 15,450.00 -
161 Gentamisin Injeksi 40 mg/ml - Ampul 3,509.00 - Ampul 3,509.00 - Ampul 3,509.00 - - Ampul 3,509.00 -
162 Gentamisin salep Kulit 0,1 % - Tube 3,400.00 - Tube 3,400.00 - Tube 3,400.00 - - Tube 3,400.00 -
163 Gentamisin Sulfat Tetes Mata 0,3% - Botol 5 ml 3,194.00 - Botol 5 ml 3,194.00 - Botol 5 ml 3,194.00 - - Botol 5 ml 3,194.00 -
164 Gentamisin Sulfat Tetes Mata 0,3% 24 Botol 5 ml 4,232.00 101,568.00 Botol 5 ml 4,232.00 - 10 Botol 5 ml 4,232.00 42,320.00 14 Botol 5 ml 4,232.00 59,248.00
166 Gentamisin Salep mata( GENOINT) - Tube 2,830.00 - Tube 2,830.00 - Tube 2,830.00 - - Tube 2,830.00 -
167 Gentamisin Sulfat Salep mata 0,3 % 24 Tube 2,675.00 64,200.00 Tube 2,675.00 - Tube 2,675.00 - 24 Tube 2,675.00 64,200.00
168 Gentian Violet Larutan 1 % 24 Botol 10 ml 3,410.00 81,840.00 Botol 10 ml 3,410.00 - Botol 10 ml 3,410.00 - 24 Botol 10 ml 3,410.00 81,840.00
169 Gentian Violet Larutan 1 % - Botol 10 ml 3,320.00 - Botol 10 ml 3,320.00 - Botol 10 ml 3,320.00 - - Botol 10 ml 3,320.00 -
BHP-02-2021 3
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
170 Gentian Violet Larutan 1 % - Botol 10 ml 3,344.00 - Botol 10 ml 3,344.00 - Botol 10 ml 3,344.00 - - Botol 10 ml 3,344.00 -
171 Glibenklamida Tablet 5 mg - Tablet 56.00 - Tablet 56.00 - Tablet 56.00 - - Tablet 56.00 -
172 Glibenklamida Tablet 5 mg - Tablet 92.00 - Tablet 92.00 - Tablet 92.00 - - Tablet 92.00 -
173 Glibenklamida Tablet 5 mg 1,000 Tablet 119.00 119,000.00 Tablet 119.00 - 300 Tablet 119.00 35,700.00 700 Tablet 119.00 83,300.00
174 Gliserilguaiakolat Tablet 100 mg - Tablet 34.12 - Tablet 34.12 - Tablet 34.12 - - Tablet 34.12 -
175 Gliserin Liquid - Botol 100 ml 5,333.00 - Botol 100 ml 5,333.00 - Botol 100 ml 5,333.00 - - Botol 100 ml 5,333.00 -
176 Glukosa Larutan Infus 5% steril - Botol 500 ml 5,200.00 - Botol 500 ml 5,200.00 - Botol 500 ml 5,200.00 - - Botol 500 ml 5,200.00 -
179 Guaifenisin - Botol 178.00 - Botol 178.00 - Botol 178.00 - - Botol 178.00 -
180 Guaifenisin 100 mg 2,960 Tablet 88.00 260,480.00 Tablet 88.00 - 960 Tablet 88.00 84,480.00 2,000 Tablet 88.00 176,000.00
181 Guaifenisin 100 mg - Tablet 233.20 - Tablet 233.20 - Tablet 233.20 - - Tablet 233.20 -
182 Griseofulvin Tablet 125 mg - Tablet 209.00 - Tablet 209.00 - Tablet 209.00 - - Tablet 209.00 -
185 Haloperidol Injeksi 5% - Vial 4,000.00 - Vial 4,000.00 - Vial 4,000.00 - - Vial 4,000.00 -
186 Haloperidol Injeksi 50 mg/ml - Ampul 101,300.00 - Ampul 101,300.00 - Ampul 101,300.00 - - Ampul 101,300.00 -
187 Haloperidol Tablet 1,5 mg - Tablet 69.00 - Tablet 69.00 - Tablet 69.00 - - Tablet 69.00 -
188 Haloperidol Tablet 1,5 mg - Tablet 66.00 - Tablet 66.00 - Tablet 66.00 - - Tablet 66.00 -
189 Haloperidol Tablet 2 mg - Tablet 126.00 - Tablet 126.00 - Tablet 126.00 - - Tablet 126.00 -
191 Haloperidol Tablet 2 mg (lodomer) - Tablet 84.00 - Tablet 84.00 - Tablet 84.00 - - Tablet 84.00 -
192 Haloperidol Tablet 2 mg (lodomer) - Tablet 90.00 - Tablet 90.00 - Tablet 90.00 - - Tablet 90.00 -
Botol 1000
196 Hidrogen Peroksida (H2O2) Larutan 3% - Botol 1000 ml 18,700.00 - Botol 1000 ml 18,700.00 - Botol 1000 ml 18,700.00 - - 18,700.00 -
ml
197 Hidrogen Peroksida (H2O2) Larutan 3% - Botol 100 ml 4,780.00 - Botol 100 ml 4,780.00 - Botol 100 ml 4,780.00 - - Botol 100 ml 4,780.00 -
198 Hidroklorotiazida Tablet 25 mg - Tablet 149.00 - Tablet 149.00 - Tablet 149.00 - - Tablet 149.00 -
199 Hidroklorotiazida Tablet 25 mg - Tablet 155.00 - Tablet 155.00 - Tablet 155.00 - - Tablet 155.00 -
200 Hidrokortison krim 2,5% - Tube 5 gram 2,798.00 - Tube 5 gram 2,798.00 - Tube 5 gram 2,798.00 - - Tube 5 gram 2,798.00 -
201 Hidrokortison krim 2,5% - Tube 5 gram 2,650.00 - Tube 5 gram 2,650.00 - Tube 5 gram 2,650.00 - - Tube 5 gram 2,650.00 -
202 Hidrokortison krim 2,5% 11 Tube 5 gram 2,475.00 27,225.00 Tube 5 gram 2,475.00 - 11 Tube 5 gram 2,475.00 27,225.00 - Tube 5 gram 2,475.00 -
203 Hidrokortison krim1% - Tube 5 gram 2,570.00 - Tube 5 gram 2,570.00 - Tube 5 gram 2,570.00 - - Tube 5 gram 2,570.00 -
204 Ibuprofen Suspensi 100 mg/5ml - Botol 60 ml 3,499.00 - Botol 60 ml 3,499.00 - Botol 60 ml 3,499.00 - - Botol 60 ml 3,499.00 -
207 Ibuprofen Suspensi 100 mg/5ml 46 Botol 60 ml 2,721.00 125,166.00 Botol 60 ml 2,721.00 - Botol 60 ml 2,721.00 - 46 Botol 60 ml 2,721.00 125,166.00
208 Ibuprofen Tablet 400 mg - Tablet 150.00 - Tablet 150.00 - Tablet 150.00 - - Tablet 150.00 -
209 Ibuprofen Tablet 400 mg 400 Tablet 308.00 123,200.00 Tablet 308.00 - 100 Tablet 308.00 30,800.00 300 Tablet 308.00 92,400.00
212 Ichtiol Salep 48 Tube 6,820.00 327,360.00 Tube 6,820.00 - Tube 6,820.00 - 48 Tube 6,820.00 327,360.00
213 Ichtiol Salep - Tube 5,940.00 - Tube 5,940.00 - Tube 5,940.00 - - Tube 5,940.00 -
214 Isoniazid Tablet 300 mg - Tablet 158.00 - Tablet 158.00 - Tablet 158.00 - - Tablet 158.00 -
215 Isosorbid Dinitrat Tablet Sublingual 5 mg - Tablet 275.00 - Tablet 275.00 - Tablet 275.00 - - Tablet 275.00 -
216 Isosorbid Dinitrat Tablet Sublingual 5 mg - Tablet 89.00 - Tablet 89.00 - Tablet 89.00 - - Tablet 89.00 -
217 Kalsium Laktat (Kalk) Tablet 500 mg - Tablet 58.00 - Tablet 58.00 - Tablet 58.00 - - Tablet 58.00 -
220 Kalsium Laktat (Kalk) Tablet 5 mg 3,000 Tablet 59.00 177,000.00 Tablet 59.00 - 600 Tablet 59.00 35,400.00 2,400 Tablet 59.00 141,600.00
221 Kaptopril Tablet 12,5 mg - Tablet 62.00 - Tablet 62.00 - Tablet 62.00 - - Tablet 62.00 -
222 Kaptopril Tablet 12,5 mg - Tablet 59.00 - Tablet 59.00 - Tablet 59.00 - - Tablet 59.00 -
223 Kaptopril Tablet 12,5 mg 1,000 Tablet 66.00 66,000.00 Tablet 66.00 - 300 Tablet 66.00 19,800.00 700 Tablet 66.00 46,200.00
224 Kaptopril Tablet 25 mg - Tablet 84.00 - Tablet 84.00 - Tablet 84.00 - - Tablet 84.00 -
229 Karbamazepin Tablet 200 mg - Tablet 230.00 - Tablet 230.00 - Tablet 230.00 - - Tablet 230.00 -
230 Karbamazepin Tablet 200 mg - Tablet 245.00 - Tablet 245.00 - Tablet 245.00 - - Tablet 245.00 -
Tube 15
231 Ketokonazol Krim 2 % - Tube 15 gram 4,700.00 - Tube 15 gram 4,700.00 - Tube 15 gram 4,700.00 - - 4,700.00 -
gram
232 Ketokonazol Krim 2 % - Tube 2,545.00 - Tube 2,545.00 - Tube 2,545.00 - - Tube 2,545.00 -
233 Ketokonazol Krim 2 % 50 Tube 2,518.00 125,900.00 Tube 2,518.00 - Tube 2,518.00 - 50 Tube 2,518.00 125,900.00
234 Ketokonazol Tablet 200 mg - Tablet 300.00 - Tablet 300.00 - Tablet 300.00 - - Tablet 300.00 -
BHP-02-2021 4
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
237 Ketoprofen Tablet 100 mg - Tablet 608.00 - Tablet 608.00 - Tablet 608.00 - - Tablet 608.00 -
238 Klindamisin Kapsul 150 mg - Kapsul 361.00 - Kapsul 361.00 - Kapsul 361.00 - - Kapsul 361.00 -
239 Klindamisin Kapsul 150 mg - Kapsul 715.00 - Kapsul 715.00 - Kapsul 715.00 - - Kapsul 715.00 -
240 Kloramfenikol Kapsul 250 mg - Kapsul 594.00 - Kapsul 594.00 - Kapsul 594.00 - - Kapsul 594.00 -
241 Kloramfenikol Kapsul 250 mg - Kapsul 310.00 - Kapsul 310.00 - Kapsul 310.00 - - Kapsul 310.00 -
242 Kloramfenikol Salep Mata 1 % 5 gram - Tube 1,600.00 - Tube 1,600.00 - Tube 1,600.00 - - Tube 1,600.00 -
245 Kloramfenikol Salep Mata 1 % 5 gram 48 Tube 2,007.00 96,336.00 Tube 2,007.00 - Tube 2,007.00 - 48 Tube 2,007.00 96,336.00
246 Kloramfenikol salep kulit 2 % - Tube 3,091.00 - Tube 3,091.00 - Tube 3,091.00 - - Tube 3,091.00 -
247 Kloramfenikol salep kulit 2 % (Bufacetin) - Tube 3,008.00 - Tube 3,008.00 - Tube 3,008.00 - - Tube 3,008.00 -
248 Kloramfenikol salep kulit 2 % (Bufacetin) 24 Tube 3,242.00 77,808.00 Tube 3,242.00 - Tube 3,242.00 - 24 Tube 3,242.00 77,808.00
249 Kloramfenikol Suspensi 125mg/5ml - Botol 3,955.00 - Botol 3,955.00 - Botol 3,955.00 - - Botol 3,955.00 -
250 Kloramfenikol Suspensi 125mg/5ml 50 Botol 5,015.00 250,750.00 Botol 5,015.00 - Botol 5,015.00 - 50 Botol 5,015.00 250,750.00
251 Kloramfenikol Tetes Mata Komb. ( Erlamicetin Plus) 43 Botol 15,180.00 652,740.00 Botol 15,180.00 - 5 Botol 15,180.00 75,900.00 38 Botol 15,180.00 576,840.00
252 Kloramfenikol Tetes Telinga 3 % - 5ml - Botol 1,815.00 - Botol 1,815.00 - Botol 1,815.00 - - Botol 1,815.00 -
253 Kloramfenikol Tetes Telinga 1% (Reco) 39 Botol 8,360.00 326,040.00 Botol 8,360.00 - 9 Botol 8,360.00 75,240.00 30 Botol 8,360.00 250,800.00
254 Kloramfenikol Tetes Telinga 1% (Erlamycetin) - Botol 7,843.00 - Botol 7,843.00 - Botol 7,843.00 - - Botol 7,843.00 -
255 Klorfeniramina Maleat (CTM )Tablet 4 mg - Tablet 51.00 - Tablet 51.00 - Tablet 51.00 - - Tablet 51.00 -
257 Klorfeniramina Maleat (CTM )Tablet 4 mg 2,584 Tablet 66.00 170,544.00 Tablet 66.00 - 584 Tablet 66.00 38,544.00 2,000 Tablet 66.00 132,000.00
259 Klorokuin Tablet 150 mg - Tablet 107.00 - Tablet 107.00 - Tablet 107.00 - - Tablet 107.00 -
260 Klorpromazin Tablet Salut 100 mg (HCl) - Tablet 149.00 - Tablet 149.00 - Tablet 149.00 - - Tablet 149.00 -
266 Klorpromazin Injeksi i.m.25 mg/ml(HCl) - Ampul 2ml 1,100.00 - Ampul 2ml 1,100.00 - Ampul 2ml 1,100.00 - - Ampul 2ml 1,100.00 -
267 Klorpromazin Injeksi i.m.25 mg/ml(HCl) - Ampul 1,240.00 - Ampul 1,240.00 - Ampul 1,240.00 - - Ampul 1,240.00 -
268 Kodein Tablet 10 mg - Tablet 500.00 - Tablet 500.00 - Tablet 500.00 - - Tablet 500.00 -
269 Kodein Tablet 10 mg - Tablet 571.00 - Tablet 571.00 - Tablet 571.00 - - Tablet 571.00 -
270 Kodein Tablet 20 mg - Tablet 1,100.00 - Tablet 1,100.00 - Tablet 1,100.00 - - Tablet 1,100.00 -
Kotrimoksazol DOEN (dewasa) Kombinasi :
Sulfametoksazol 400mg
Kotrimoksazol DOEN +Trimetoprim
(dewasa) 80mg:
Kombinasi
(dewasa) 80mg:
Kombinasi
(dewasa) 80mg:
Kombinasi
274 1,200 Tablet 125.00 150,000.00 Tablet 125.00 - 400 Tablet 125.00 50,000.00 800 Tablet 125.00 100,000.00
(dewasa) 80mg:
Kombinasi
(pediatrik) 80mg:
Kombinasi
Sulmetoksazol 100 mg + Trimetoprim 20 mg
Kotrimoksazol Suspensi Kombi : Sulfame- toksazol
277 - Botol 60 ml 2,190.00 - Botol 60 ml 2,190.00 - Botol 60 ml 2,190.00 - - Botol 60 ml 2,190.00 -
20 mg + Trimetoprim 40mg/5ml

Kotrimoksazol Suspensi Kombi tiap 5ml :

279 Sulfematoksazol 200 mg + Trimetoprim 40mg (susp - Botol 60 ml 2,052.00 - Botol 60 ml 2,052.00 - Botol 60 ml 2,052.00 - - Botol 60 ml 2,052.00 -
240 mg)
280 Kuinin (Kina) Tablet 200 mg - Tablet 670.00 - Tablet 670.00 - Tablet 670.00 - - Tablet 670.00 -
281 Kuinin Injeksi i.v. 25% (sebagai 2HCl) - Amp 2 ml 6,200.00 - Amp 2 ml 6,200.00 - Amp 2 ml 6,200.00 - - Amp 2 ml 6,200.00 -
282 Kuinin Tablet 222 mg (H2SO4.7H2O) - Tablet 540.00 - Tablet 540.00 - Tablet 540.00 - - Tablet 540.00 -
283 Lansoprazol Kapsul 30 mg - Kapsul 473.00 - Kapsul 473.00 - Kapsul 473.00 - - Kapsul 473.00 -
284 Levertran Salep - pot 3,599.00 - pot 3,599.00 - pot 3,599.00 - - pot 3,599.00 -
285 Levertran Salep 24 Pot 4,268.00 102,432.00 Pot 4,268.00 - Pot 4,268.00 - 24 Pot 4,268.00 102,432.00
286 Levofloksasin Tablet 500 mg - Tablet 528.00 - Tablet 528.00 - Tablet 528.00 - - Tablet 528.00 -
287 Lidokain Injeksi 2% - Ampul 2 ml 839.00 - Ampul 2 ml 839.00 - Ampul 2 ml 839.00 - - Ampul 2 ml 839.00 -
288 Lidokain Injeksi 2% - Ampul 860.00 - Ampul 860.00 - Ampul 860.00 - - Ampul 860.00 -
289 Lidokain Injeksi 2% - Ampul 1,221.00 - Ampul 1,221.00 - Ampul 1,221.00 - - Ampul 1,221.00 -
290 Lidokain Injeksi 2% + Epinefrin 1:80.000 Injeksi 2 ml - Ampul 1,145.00 - Ampul 1,145.00 - Ampul 1,145.00 - - Ampul 1,145.00 -
291 Lidokain Injeksi 2% + Epinefrin 1:80.000 Injeksi 2 ml - Ampul 1,222.00 - Ampul 1,222.00 - Ampul 1,222.00 - - Ampul 1,222.00 -
292 Lidokain Spray (Xylocain Spray) - Botol 177,216.00 - Botol 177,216.00 - Botol 177,216.00 - - Botol 177,216.00 -
293 Linkomisin Kapsul 500 mg - Kapsul 650.00 - Kapsul 650.00 - Kapsul 650.00 - - Kapsul 650.00 -
Botol 1000
294 Lisol Larutan Antiseptik 2 Botol 1000 ml 41,000.00 82,000.00 Botol 1000 ml 41,000.00 - 1 Botol 1000 ml 41,000.00 41,000.00 1 41,000.00 41,000.00
ml
295 Loperamid tablet 2 mg 1,500 Tablet 187.00 280,500.00 Tablet 187.00 - 300 Tablet 187.00 56,100.00 1,200 Tablet 187.00 224,400.00
BHP-02-2021 5
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
296 Loperamid tablet 2 mg - Tablet 374.00 - Tablet 374.00 - Tablet 374.00 - - Tablet 374.00 -
297 Magnesium Sulfat Injeksi (IV)20%-25ml - Vial 2,800.00 - Vial 2,800.00 - Vial 2,800.00 - - Vial 2,800.00 -
298 Magnesium Sulfat Injeksi (IV)20%-25ml - Vial 3,200.00 - Vial 3,200.00 - Vial 3,200.00 - - Vial 3,200.00 -
299 Magnesium Sulfat Injeksi (IV)40% 10 Ampul 3,796.00 37,960.00 Ampul 3,796.00 - Ampul 3,796.00 - 10 Ampul 3,796.00 37,960.00
300 Mebendazol Syrup 100 mg/5ml - Botol 30 ml 3,400.00 - Botol 30 ml 3,400.00 - Botol 30 ml 3,400.00 - - Botol 30 ml 3,400.00 -
301 Metampiron Injeksi 250 mg - Amp 2 ml 1,333.00 - Amp 2 ml 1,333.00 - Amp 2 ml 1,333.00 - - Amp 2 ml 1,333.00 -
302 Metformin HCl Tablet 500 mg - Tablet 100.00 - Tablet 100.00 - Tablet 100.00 - - Tablet 100.00 -
303 Metformin HCl Tablet 500 mg 1,000 Tablet 102.00 102,000.00 Tablet 102.00 - 300 Tablet 102.00 30,600.00 700 Tablet 102.00 71,400.00
304 Metformin HCl Tablet 850 mg - Tablet 150.00 - Tablet 150.00 - Tablet 150.00 - - Tablet 150.00 -
305 Metilergometrin Maleat Injeksi 0,2 mg/ml - Ampul 2,684.00 - Ampul 2,684.00 - Ampul 2,684.00 - - Ampul 2,684.00 -
306 Metilergometrin Maleat Injeksi 0,2 mg/ml 100 Ampul 2,959.00 295,900.00 Ampul 2,959.00 - Ampul 2,959.00 - 100 Ampul 2,959.00 295,900.00
307 Metilergometrin Maleat Tab Salut 0,125 mg - Tablet 154.00 - Tablet 154.00 - Tablet 154.00 - - Tablet 154.00 -
308 Metilergometrin Maleat Tab Salut 0,125 mg 1,000 Tablet 210.00 210,000.00 Tablet 210.00 - Tablet 210.00 - 1,000 Tablet 210.00 210,000.00
309 Metilergometrin Maleat Tab Salut 0,125 mg - Tablet 224.00 - Tablet 224.00 - Tablet 224.00 - - Tablet 224.00 -
Kotak 1 Vial 8 Kotak 1 Vial
310 Metilprednisolon Injeksi 500 mg - Kotak 1 Vial 8 ml 93,393.00 - Kotak 1 Vial 8 ml 93,393.00 - 93,393.00 - - 93,393.00 -
ml 8 ml
311 Metilprednisolon kaplet 4 mg - Tablet 150.00 - Tablet 150.00 - Tablet 150.00 - - Tablet 150.00 -
312 Metilprednisolon kaplet 4 mg - Tablet 134.00 - Tablet 134.00 - Tablet 134.00 - - Tablet 134.00 -
313 Metilprednisolon kaplet 4 mg 1,500 Tablet 143.00 214,500.00 Tablet 143.00 - 300 Tablet 143.00 42,900.00 1,200 Tablet 143.00 171,600.00
314 Metilprednisolon kaplet 8 mg - Kaplet 309.00 - Kaplet 309.00 - Kaplet 309.00 - - Kaplet 309.00 -
315 Metoklorpramid syrup 5 mg/5 ml - Botol 2,530.00 - Botol 2,530.00 - Botol 2,530.00 - - Botol 2,530.00 -
316 Metoklorpramid 5 mg Tab - Tablet 121.00 - Tablet 121.00 - Tablet 121.00 - - Tablet 121.00 -
320 Metronidazol Tablet 250 mg - Tablet 110.00 - Tablet 110.00 - Tablet 110.00 - - Tablet 110.00 -
Tube 10
324 Mikonazol Krim/Salep 2 % (Nitrat) - Tube 10 gram 3,000.00 - Tube 10 gram 3,000.00 - Tube 10 gram 3,000.00 - - 3,000.00 -
gram
Tube 10
325 Mikonazol Krim/Salep 2 % (Nitrat) - Tube 10 gram 3,250.00 - Tube 10 gram 3,250.00 - Tube 10 gram 3,250.00 - - 3,250.00 -
gram
Tube 10
326 Mikonazol Krim/Salep 2 % (Nitrat) 35 Tube 10 gram 3,414.00 119,490.00 Tube 10 gram 3,414.00 - 5 Tube 10 gram 3,414.00 17,070.00 30 3,414.00 102,420.00
gram
327 Natrium Diklofenak Tablet 25 mg - Tablet 133.00 - Tablet 133.00 - Tablet 133.00 - - Tablet 133.00 -
330 Natrium Diklofenak Tablet 25 mg 90 Tablet 137.00 12,330.00 Tablet 137.00 - Tablet 137.00 - 90 Tablet 137.00 12,330.00
331 Natrium Klorida Larutan Infus 0,9% - Botol 500 ml 4,700.00 - Botol 500 ml 4,700.00 - Botol 500 ml 4,700.00 - - Botol 500 ml 4,700.00 -
332 Natrium Klorida Larutan Infus 0,9% 40 Botol 500 ml 6,410.00 256,400.00 Botol 500 ml 6,410.00 - Botol 500 ml 6,410.00 - 40 Botol 500 ml 6,410.00 256,400.00
333 Natrium Klorida Larutan Infus 0,9% - Botol 500 ml 6,840.00 - Botol 500 ml 6,840.00 - Botol 500 ml 6,840.00 - - Botol 500 ml 6,840.00 -
334 Natrium Tiroxin (Etyrox) - Tablet 850.00 - Tablet 850.00 - Tablet 850.00 - - Tablet 850.00 -
335 N-Asetil sistein - Kapsul 426.00 - Kapsul 426.00 - Kapsul 426.00 - - Kapsul 426.00 -
338 Nistatin Tablet Salut 500.000 IU/g - Tablet 640.00 - Tablet 640.00 - Tablet 640.00 - - Tablet 640.00 -
342 Nistatin vaginal Tablet 100.000 IU/g - Tablet 480.00 - Tablet 480.00 - Tablet 480.00 - - Tablet 480.00 -
345 Obat Anti Tuberkulosis FDC Kategori 1 - Paket 359,990.00 - Paket 359,990.00 - Paket 359,990.00 - - Paket 359,990.00 -
349 Obat Anti Tuberkulosis FDC Kategori 2 - Paket 1,199,985.00 - Paket 1,199,985.00 - Paket 1,199,985.00 - - Paket 1,199,985.00 -
351 Obat Anti Tuberkulosis FDC Kategori Anak - Paket 214,990.00 - Paket 214,990.00 - Paket 214,990.00 - - Paket 214,990.00 -
354 Obat Anti Tuberkulosis FDC sisipan - Paket 160,000.00 - Paket 160,000.00 - Paket 160,000.00 - - Paket 160,000.00 -
355 Obat Anti Tuberkulosis Kategori 1 - Paket 288,199.00 - Paket 288,199.00 - Paket 288,199.00 - - Paket 288,199.00 -
356 Obat Batuk Hitam(O.B.H.) cairan Molex 54 Botol 100 ml 4,840.00 261,360.00 Botol 100 ml 4,840.00 - 6 Botol 100 ml 4,840.00 29,040.00 48 Botol 100 ml 4,840.00 232,320.00
357 Obat Batuk Hitam(O.B.H.) cairan - Botol 120 ml 5,735.00 - Botol 120 ml 5,735.00 - Botol 120 ml 5,735.00 - - Botol 120 ml 5,735.00 -
358 Obat Batuk Hitam(O.B.H.) cairan Molex - Botol 120 ml 5,500.00 - Botol 120 ml 5,500.00 - Botol 120 ml 5,500.00 - - Botol 120 ml 5,500.00 -
359 Obat Batuk Kombinasi (Hustab) tablet - Tablet 434.00 - Tablet 434.00 - Tablet 434.00 - - Tablet 434.00 -
360 Obat Batuk Kombinasi (Hustab) tablet - Tablet 429.00 - Tablet 429.00 - Tablet 429.00 - - Tablet 429.00 -
361 Obat Batuk Pilek Kombinasi (Intunal Syrup) - Botol 16,500.00 - Botol 16,500.00 - Botol 16,500.00 - - Botol 16,500.00 -
BHP-02-2021 6
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
362 Ofloxacin Tablet 400 mg - Tablet 650.00 - Tablet 650.00 - Tablet 650.00 - - Tablet 650.00 -
363 Oksitetrasiklin HCl Salep Mata 1% - Tube 3,5 g 3,220.00 - Tube 3,5 g 3,220.00 - Tube 3,5 g 3,220.00 - - Tube 3,5 g 3,220.00 -
364 Oksitetrasiklin HCl Salep Mata 1% - Tube 3,5 g 2,668.00 - Tube 3,5 g 2,668.00 - Tube 3,5 g 2,668.00 - - Tube 3,5 g 2,668.00 -
365 Oksitosin Injeksi 10 IU/ml-1ml - ampul 2,200.00 - ampul 2,200.00 - ampul 2,200.00 - - ampul 2,200.00 -
366 Oksitosin Injeksi 10 IU/ml-1ml - Ampul 1,900.00 - Ampul 1,900.00 - Ampul 1,900.00 - - Ampul 1,900.00 -
367 Oksitosin Injeksi 10 IU/ml-1ml 100 Ampul 1,199.00 119,900.00 Ampul 1,199.00 - Ampul 1,199.00 - 100 Ampul 1,199.00 119,900.00
368 Omeprazol Kapsul 20 mg - Kapsul 211.00 - Kapsul 211.00 - Kapsul 211.00 - - Kapsul 211.00 -
370 Omeprazol Kapsul 20 mg 570 Kapsul 341.00 194,370.00 Kapsul 341.00 - 70 Kapsul 341.00 23,870.00 500 Kapsul 341.00 170,500.00
372 Papaverin Tablet 40 mg - Tablet 100.00 - Tablet 100.00 - Tablet 100.00 - - Tablet 100.00 -
373 Papaverin Tablet 40 mg - Tablet 298.00 - Tablet 298.00 - Tablet 298.00 - - Tablet 298.00 -
374 Parasetamol Drops - Botol 15 ml 5,200.00 - Botol 15 ml 5,200.00 - Botol 15 ml 5,200.00 - - Botol 15 ml 5,200.00 -
375 Parasetamol Drops - Botol 15 ml 6,649.00 - Botol 15 ml 6,649.00 - Botol 15 ml 6,649.00 - - Botol 15 ml 6,649.00 -
376 Parasetamol Syrup 120 mg/ 5ml - Botol 60 ml 1,438.00 - Botol 60 ml 1,438.00 - Botol 60 ml 1,438.00 - - Botol 60 ml 1,438.00 -
380 Parasetamol Syrup 120 mg/ 5ml 65 Botol 60 ml 1,181.00 76,765.00 Botol 60 ml 1,181.00 - 25 Botol 60 ml 1,181.00 29,525.00 40 Botol 60 ml 1,181.00 47,240.00
381 Parasetamol Tablet 500 mg - Tablet 79.00 - Tablet 79.00 - Tablet 79.00 - - Tablet 79.00 -
382 Parasetamol Tablet 500 mg - Tablet 56.00 - Tablet 56.00 - Tablet 56.00 - - Tablet 56.00 -
383 Parasetamol Tablet 500 mg 2,300 Tablet 53.00 121,900.00 Tablet 53.00 - 1,300 Tablet 53.00 68,900.00 1,000 Tablet 53.00 53,000.00
384 Piracetam Injeksi 3g/15ml - Amp 15ml 13,750.00 - Amp 15ml 13,750.00 - Amp 15ml 13,750.00 - - Amp 15ml 13,750.00 -
385 Piracetam Tablet 400 mg - Tablet 194.00 - Tablet 194.00 - Tablet 194.00 - - Tablet 194.00 -
386 Pirantel Syrup 125 mg/5ml - Botol 60 ml 8,360.00 - Botol 60 ml 8,360.00 - Botol 60 ml 8,360.00 - - Botol 60 ml 8,360.00 -
387 Pirantel Tablet score (base) 125 mg - Tablet 298.00 - Tablet 298.00 - Tablet 298.00 - - Tablet 298.00 -
388 Pirantel Tablet score (base) 125 mg - Tablet 291.00 - Tablet 291.00 - Tablet 291.00 - - Tablet 291.00 -
389 Pirazinamid Tablet 500 mg - Tablet 208.00 - Tablet 208.00 - Tablet 208.00 - - Tablet 208.00 -
390 Piridoksin (Vitamin B6) inj 100 mg/ml - ampul 1,008.00 - ampul 1,008.00 - ampul 1,008.00 - - ampul 1,008.00 -
Botol 100 Botol 100
391 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) - Botol 100 Tablet 11,000.00 - Botol 100 Tablet 11,000.00 - 11,000.00 - - 11,000.00 -
Tablet Tablet
392 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) - tablet 45.00 - tablet 45.00 - tablet 45.00 - - tablet 45.00 -
393 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) - Tablet 123.00 - Tablet 123.00 - Tablet 123.00 - - Tablet 123.00 -
394 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) 990 Tablet 131.00 129,690.00 Tablet 131.00 - 200 Tablet 131.00 26,200.00 790 Tablet 131.00 103,490.00
395 Piroxicam Tablet 10 mg - Tablet 84.00 - Tablet 84.00 - Tablet 84.00 - - Tablet 84.00 -
396 Piroxicam Tablet 10 mg - Tablet 130.00 - Tablet 130.00 - Tablet 130.00 - - Tablet 130.00 -
397 Povidon Iodida Larutan 10% - Botol 30 ml 2,163.00 - Botol 30 ml 2,163.00 - Botol 30 ml 2,163.00 - - Botol 30 ml 2,163.00 -
398 Povidon Iodida Larutan 10% - botol 60 ml 6,550.00 - botol 60 ml 6,550.00 - botol 60 ml 6,550.00 - - botol 60 ml 6,550.00 -
404 Prednison Tablet 5 mg - Tablet 114.00 - Tablet 114.00 - Tablet 114.00 - - Tablet 114.00 -
405 Prednison Tablet 5 mg - Kaplet 96.00 - Kaplet 96.00 - Kaplet 96.00 - - Kaplet 96.00 -
406 Prednison Tablet 5 mg - Tablet 68.00 - Tablet 68.00 - Tablet 68.00 - - Tablet 68.00 -
407 Prednison Tablet 5 mg 900 Tablet 73.00 65,700.00 Tablet 73.00 - 100 Tablet 73.00 7,300.00 800 Tablet 73.00 58,400.00
408 Primakuin Tablet - Tablet 224.00 - Tablet 224.00 - Tablet 224.00 - - Tablet 224.00 -
409 Prokain Benzil Penisilin G.Injeksi 3 jt IU/vial - Vial 7,190.00 - Vial 7,190.00 - Vial 7,190.00 - - Vial 7,190.00 -
410 Prokain Penisillin inj - Vial 6,017.00 - Vial 6,017.00 - Vial 6,017.00 - - Vial 6,017.00 -
411 Propanolol Tablet 10 mg (HCl) - Tablet 65.00 - Tablet 65.00 - Tablet 65.00 - - Tablet 65.00 -
412 Propanolol Tablet 10 mg (HCl) - Tablet 60.00 - Tablet 60.00 - Tablet 60.00 - - Tablet 60.00 -
413 Propiltiourasil Tablet 100 mg - Tablet 319.00 - Tablet 319.00 - Tablet 319.00 - - Tablet 319.00 -
414 RanitidinTablet 150 mg - Tablet 98.00 - Tablet 98.00 - Tablet 98.00 - - Tablet 98.00 -
Botol 50 Botol 50
415 Retinol (Vitamin A) 100.000 IU Kapsul Lunak - Botol 50 Kapsul 13,000.00 - Botol 50 Kapsul 13,000.00 - 13,000.00 - - 13,000.00 -
Kapsul
Botol 50 Kapsul
Botol 50
416 Retinol (Vitamin A) 100.000 IU Kapsul Lunak - Botol 50 Kapsul 14,200.00 - Botol 50 Kapsul 14,200.00 - 14,200.00 - - 14,200.00 -
Kapsul Kapsul
417 Retinol (Vitamin A) 200.000 IU Kapsul Lunak - Kapsul 519.20 - Kapsul 519.20 - Kapsul 519.20 - - Kapsul 519.20 -
419 Rifampisin Tablet Salut 450 mg - Tablet 789.00 - Tablet 789.00 - Tablet 789.00 - - Tablet 789.00 -
420 Ringer Laktat Larutan Infus - Botol 500 ml 5,200.00 - Botol 500 ml 5,200.00 - Botol 500 ml 5,200.00 - - Botol 500 ml 5,200.00 -
422 Ringer Laktat Larutan Infus 40 Botol 500 ml 7,630.00 305,200.00 Botol 500 ml 7,630.00 - Botol 500 ml 7,630.00 - 40 Botol 500 ml 7,630.00 305,200.00
423 Risperidon Tablet 1 mg - Kapsul 1,500.00 - Kapsul 1,500.00 - Kapsul 1,500.00 - - Kapsul 1,500.00 -
424 Risperidon Tablet 2 mg - Kapsul 1,008.00 - Kapsul 1,008.00 - Kapsul 1,008.00 - - Kapsul 1,008.00 -
425 Risperidon Tablet 2 mg - Tablet 495.00 - Tablet 495.00 - Tablet 495.00 - - Tablet 495.00 -
BHP-02-2021 7
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
428 Salbutamol Tablet 2 mg (sebagai Sulfat) - Tablet 59.00 - Tablet 59.00 - Tablet 59.00 - - Tablet 59.00 -
429 Salbutamol Tablet 2 mg (sebagai Sulfat) - tablet 66.00 - tablet 66.00 - tablet 66.00 - - tablet 66.00 -
430 Salbutamol Tablet 2 mg (sebagai Sulfat) 500 tablet 63.00 31,500.00 tablet 63.00 - 50 tablet 63.00 3,150.00 450 tablet 63.00 28,350.00
Salep 2-4 ,Kombinasi:
434 - Pot 30 gr 2,000.00 - Pot 30 gr 2,000.00 - Pot 30 gr 2,000.00 - - Pot 30 gr 2,000.00 -
Asam Salisilat 2% + Belerang endap 4%

435 - Tube 2,429.00 - Tube 2,429.00 - Tube 2,429.00 - - Tube 2,429.00 -

436 - Pot 2,621.00 - Pot 2,621.00 - Pot 2,621.00 - - Pot 2,621.00 -

437 24 Pot 2,797.00 67,128.00 Pot 2,797.00 - Pot 2,797.00 - 24 Pot 2,797.00 67,128.00
438 Salisil Bedak 2% - Ktk 50 gram 1,250.00 - Ktk 50 gram 1,250.00 - Ktk 50 gram 1,250.00 - - Ktk 50 gram 1,250.00 -
439 Salisil Bedak 2% - kotak 1,025.00 - kotak 1,025.00 - kotak 1,025.00 - - kotak 1,025.00 -
440 Salisil Bedak 2% - Kotak 1,020.00 - Kotak 1,020.00 - Kotak 1,020.00 - - Kotak 1,020.00 -
441 Salisil Bedak 2% - Botol 50 g 4,525.00 - Botol 50 g 4,525.00 - Botol 50 g 4,525.00 - - Botol 50 g 4,525.00 -
442 Salisil Bedak 2% 48 Botol 50 g 4,543.00 218,064.00 Botol 50 g 4,543.00 - Botol 50 g 4,543.00 - 48 Botol 50 g 4,543.00 218,064.00
443 Sefaleksin Kapsul 500 mg - Tablet 1,000.00 - Tablet 1,000.00 - Tablet 1,000.00 - - Tablet 1,000.00 -
444 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg 35 Ampul 1,104.00 38,640.00 Ampul 1,104.00 - Ampul 1,104.00 - 35 Ampul 1,104.00 38,640.00
445 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg - Ampul 1,098 - Ampul 1,098.00 - Ampul 1,098.00 - - Ampul 1,098.00 -
446 Sianokobalamin (Vit-B12) Tablet 50 mcg - Tablet 57 - Tablet 57.00 - Tablet 57.00 - - Tablet 57.00 -
448 Sianokobalamin (Vit-B12) Tablet 50 mcg 200 Tablet 46 9,200.00 Tablet 46.00 - Tablet 46.00 - 200 Tablet 46.00 9,200.00
450 Simvastatin Tablet 10 mg - tablet 131 - tablet 131.00 - tablet 131.00 - - tablet 131.00 -
451 Simvastatin Tablet 10 mg - Tablet 110 - Tablet 110.00 - Tablet 110.00 - - Tablet 110.00 -
452 Simvastatin Tablet 10 mg 300 Tablet 117 35,100.00 Tablet 117.00 - 50 Tablet 117.00 5,850.00 250 Tablet 117.00 29,250.00
453 Simvastatin Tablet 20 mg - Tablet 391 - Tablet 391.00 - Tablet 391.00 - - Tablet 391.00 -
454 Simvastatin Tablet 20 mg - tablet 252 - tablet 252.00 - tablet 252.00 - - tablet 252.00 -
455 Siprofloksasin Tablet 500 mg (sebagai HCl) - Tablet 255 - Tablet 255.00 - Tablet 255.00 - - Tablet 255.00 -
456 Siprofloksasin Tablet scored 500 mg - Tablet 281 - Tablet 281.00 - Tablet 281.00 - - Tablet 281.00 -
459 Siprofloksasin Tablet scored 500 mg 1,000 Tablet 1,188 1,188,000.00 Tablet 1,188.00 - 300 Tablet 1,188.00 356,400.00 700 Tablet 1,188.00 831,600.00
460 Sulfasetamida Natrium Tetes Mata 15% - Botol 5ml 1,428 - Botol 5ml 1,428.00 - Botol 5ml 1,428.00 - - Botol 5ml 1,428.00 -
461 Tetrakain HCl Tetes Mata 0,5% - Botol @ 5ml 11,500 - Botol @ 5ml 11,500.00 - Botol @ 5ml 11,500.00 - - Botol @ 5ml 11,500.00 -
462 Tetrasiklin Kapsul 250 mg - Kapsul 149 - Kapsul 149.00 - Kapsul 149.00 - - Kapsul 149.00 -
463 Tetrasiklin Kapsul 500 mg - Kapsul 300 - Kapsul 300.00 - Kapsul 300.00 - - Kapsul 300.00 -
464 Tetrasiklin Kapsul 500 mg - Tablet 310 - Tablet 310.00 - Tablet 310.00 - - Tablet 310.00 -
465 Tetrasiklin Kapsul 500 mg - Tablet 323 - Tablet 323.00 - Tablet 323.00 - - Tablet 323.00 -
466 Tiamin HCl (Vitamin B1) Tablet - Kapsul 380 - Kapsul 380.00 - Kapsul 380.00 - - Kapsul 380.00 -
467 Tiamin HCl (Vitamin B1) Tablet - Tablet 81 - Tablet 81.00 - Tablet 81.00 - - Tablet 81.00 -
470 Tramadol Injeksi 50 mg/ml - ampul 2,395 - ampul 2,395.00 - ampul 2,395.00 - - ampul 2,395.00 -
472 Tramadol Kapsul 50 mg - Kapsul 322 - Kapsul 322.00 - Kapsul 322.00 - - Kapsul 322.00 -
474 Triheksifenidil Tablet 2 mg - Tablet 80 - Tablet 80.00 - Tablet 80.00 - - Tablet 80.00 -
477 Ventolin nebulizer - Ampul 12,320 - Ampul 12,320.00 - Ampul 12,320.00 - - Ampul 12,320.00 -
478 Vitamin B Kompleks Tablet - Tablet 107 - Tablet 107.00 - Tablet 107.00 - - Tablet 107.00 -
482 Zinc Tablet 20 mg - Tablet 474 - Tablet 474.00 - Tablet 474.00 - - Tablet 474.00 -
483 Zinc Tablet dispersible 20 mg - Tablet 514 - Tablet 514.00 - Tablet 514.00 - - Tablet 514.00 -
484 Zinc Tablet dispersible 20 mg - Tablet 524 - Tablet 524.00 - Tablet 524.00 - - Tablet 524.00 -
485 Ongkir - - - - - - -
- - - - - - -
OBAT GIGI - - - - - -
BHP-02-2021 8
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
1 Calplus - Tube 333,830.00 - Tube 333,830.00 - Tube 333,830.00 - - Tube 333,830.00 -
2 Calsium Hidroksi Pasta ( Calplus) - Pack 330,491.70 - Pack 330,491.70 - Pack 330,491.70 - - Pack 330,491.70 -
3 Caviton (Temporary Stoping Fleker) - Pot 184,240.00 - Pot 184,240.00 - Pot 184,240.00 - - Pot 184,240.00 -
4 Caviton (Temporary Stoping Fleker) - Pot 182,397.60 - Pot 182,397.60 - Pot 182,397.60 - - Pot 182,397.60 -
5 CHKM (Monokloramkamfer Menthol Cairan) - Botol 77,030.00 - Botol 77,030.00 - Botol 77,030.00 - - Botol 77,030.00 -
6 CHKM (Monokloramkamfer Menthol Cairan) - Botol 76,259.70 - Botol 76,259.70 - Botol 76,259.70 - - Botol 76,259.70 -
7 Cold Spray - Botol 352,000.00 - Botol 352,000.00 - Botol 352,000.00 - - Botol 352,000.00 -
8 Devitalisasi Pasta (Pulp X) - Botol 256,790.00 - Botol 256,790.00 - Botol 256,790.00 - - Botol 256,790.00 -
9 Devitalisasi Pasta NON Arsen ( Devita) - Pot 259,996.00 - Pot 259,996.00 - Pot 259,996.00 - - Pot 259,996.00 -
10 Eugenol cairan - Botol 18,100.00 - Botol 18,100.00 - Botol 18,100.00 - - Botol 18,100.00 -
11 Glass Ionomer Cement - Set 395,000.00 - Set 395,000.00 - Set 395,000.00 - - Set 395,000.00 -
12 Glass Ionomer (Ketac Universal) - Botol 761,390.00 - Botol 761,390.00 - Botol 761,390.00 - - Botol 761,390.00 -
13 Glass Ionomer (Ketac Universal) - Botol 658,845.00 - Botol 658,845.00 - Botol 658,845.00 - - Botol 658,845.00 -
14 Mummipaying Pasta (Cresotin Pasta) - Tube 309,310.00 - Tube 309,310.00 - Tube 309,310.00 - - Tube 309,310.00 -
15 Mummipaying Pasta (Cresotin Pasta) - Pot 262,350.00 - Pot 262,350.00 - Pot 262,350.00 - - Pot 262,350.00 -
16 Semen Seng Posfat Sebuk / Cair - Botol 30gr 93,500.00 - Botol 30gr 93,500.00 - Botol 30gr 93,500.00 - - Botol 30gr 93,500.00 -
17 Zink Cement (Eliet Cement) - Botol 197,730.00 - Botol 197,730.00 - Botol 197,730.00 - - Botol 197,730.00 -
18 Zink Cement (Eliet Cement) - Botol 195,800.00 - Botol 195,800.00 - Botol 195,800.00 - - Botol 195,800.00 -
- - - - - -
PERBEKALAN KESEHATAN - - - - - -
1 Alat Suntik Sekali Pakai 0,05 ml - pieces 1,354.00 - pieces 1,354.00 - pieces 1,354.00 - - pieces 1,354.00 -
2 Alat Suntik Sekali Pakai 0,5 ml - pieces 1,175.00 - pieces 1,175.00 - pieces 1,175.00 - - pieces 1,175.00 -
3 Alat Suntik Sekali Pakai 1 ml - Pieces 762.00 - Pieces 762.00 - Pieces 762.00 - - Pieces 762.00 -
4 Alat Suntik Sekali Pakai 1 cc 60 Pieces 689.86 41,391.60 Pieces 689.86 - Pieces 689.86 - 60 Pieces 689.86 41,391.60
5 Alat Suntik Sekali Pakai 2,5 cc - Pieces 669.80 - Pieces 669.80 - Pieces 669.80 - - Pieces 669.80 -
6 Alat Suntik Sekali Pakai 3 ml - pcs 1,038.00 - pcs 1,038.00 - pcs 1,038.00 - - pcs 1,038.00 -
7 Alat Suntik Sekali Pakai 3 ml - pieces 916.00 - pieces 916.00 - pieces 916.00 - - pieces 916.00 -
8 Alat Suntik Sekali Pakai 3 ml - pieces 1,212.00 - pieces 1,212.00 - pieces 1,212.00 - - pieces 1,212.00 -
9 Alat Suntik Sekali Pakai 3 cc 200 pieces 669.80 133,960.00 pieces 669.80 - pieces 669.80 - 200 pieces 669.80 133,960.00
10 Alat Suntik Sekali Pakai 5 ml - pcs 1,038.00 - pcs 1,038.00 - pcs 1,038.00 - - pcs 1,038.00 -
11 Alat Suntik Sekali Pakai 5 ml - pieces 1,030.00 - pieces 1,030.00 - pieces 1,030.00 - - pieces 1,030.00 -
12 Alat Suntik Sekali Pakai 5 cc 60 pieces 804.07 48,244.20 pieces 804.07 - pieces 804.07 - 60 pieces 804.07 48,244.20
13 Aqua jely steril 5 gr - Sachet 2,566.00 - Sachet 2,566.00 - Sachet 2,566.00 - - Sachet 2,566.00 -
14 Bisturi (BBraun steril scalpel blades #18) - pcs 3,000.00 - pcs 3,000.00 - pcs 3,000.00 - - pcs 3,000.00 -
15 Catgut / Benang Bedah 2/0, 26 mm (Gabler Med) - pieces 64,595.67 - pieces 64,595.67 - pieces 64,595.67 - - pieces 64,595.67 -
16 Catgut / Benang Bedah 2/0, 24 mm (Gabler Med) - pcs 60,438.84 - pcs 60,438.84 - pcs 60,438.84 - - pcs 60,438.84 -
17 Catgut / Benang Bedah 2/0, 19 mm (Gabler Med) - pcs 50,063.09 - pcs 50,063.09 - pcs 50,063.09 - - pcs 50,063.09 -
Catgut / Benang Bedah 2/0, 1/2 taper 30 mm (Gabler
18 - pcs 58,839.90 - pcs 58,839.90 - pcs 58,839.90 - - pcs 58,839.90 -
Med)
19 Cutgut 2/0,90 cm.1/2TP ( Chromic 2/0) 24 pcs 49,619.29 1,190,862.96 pcs 49,619.29 - pcs 49,619.29 - 24 pcs 49,619.29 1,190,862.96
20 Catgut / Benang Bedah 3/0 - Rol 23,600.00 - Rol 23,600.00 - Rol 23,600.00 - - Rol 23,600.00 -
21 Catgut / Benang Bedah 3/0 - pcs 58,355.51 - pcs 58,355.51 - pcs 58,355.51 - - pcs 58,355.51 -
22 Catgut / Benang Bedah 3/0 - pieces 42,605.12 - pieces 42,605.12 - pieces 42,605.12 - - pieces 42,605.12 -
23 Cutgut 3/0 ,1/2 TP 22mm,75-2PTRO20EE 36 pieces 55,000.00 1,980,000.00 pieces 55,000.00 - pieces 55,000.00 - 36 pieces 55,000.00 1,980,000.00
24 Folley Catheter No. 18 - Pieces 8,495.00 - Pieces 8,495.00 - Pieces 8,495.00 - - Pieces 8,495.00 -
25 Folley Catheter No. 18 5 Pieces 11,000.00 55,000.00 Pieces 11,000.00 - Pieces 11,000.00 - 5 Pieces 11,000.00 55,000.00
26 Folley Catheter No. 18 - pieces 18,450.00 - pieces 18,450.00 - pieces 18,450.00 - - pieces 18,450.00 -
27 Folley Catheter 2- WAY No. 18 - pieces 11,565.00 - pieces 11,565.00 - pieces 11,565.00 - - pieces 11,565.00 -
28 Gel Catheter - Tube 82,500.00 - Tube 82,500.00 - Tube 82,500.00 - - Tube 82,500.00 -
29 Hand Scone Steril #7,0 (Aximed) 15 Pasang 7,872.00 118,080.00 Pasang 7,872.00 - 15 Pasang 7,872.00 118,080.00 - Pasang 7,872.00 -
30 Hand Scone Steril #7,0 (Aximed) - Pcs 6,595.00 - Pcs 6,595.00 - Pcs 6,595.00 - - Pcs 6,595.00 -
31 Hand Scone Steril #7,5 (Aximed) - Pieces 7,600.00 - Pieces 7,600.00 - Pieces 7,600.00 - - Pieces 7,600.00 -
32 Hand Scone Steril #7,5 (medict dent) - pasang 5,000.00 - pasang 5,000.00 - pasang 5,000.00 - - pasang 5,000.00 -
33 Handscone Steril ( Mas Surgical Gloves 7,5 steril) - pasang 8,888.00 - pasang 8,888.00 - pasang 8,888.00 - - pasang 8,888.00 -
34 Hand Scone Steril #7,5 (KISMED) - pcs 6,595.00 - pcs 6,595.00 - pcs 6,595.00 - - pcs 6,595.00 -
35 Hand Scone / Sarung Tangan Non Steril - pcs 69.85 - pcs 69.85 - pcs 69.85 - - pcs 69.85 -
36 Hand Scone Non Steril # L (Aximed) - pcs 462.00 - pcs 462.00 - pcs 462.00 - - pcs 462.00 -
37 Hand Scone Non Steril # L (LIGHTY mas latex) - pcs 462.00 - pcs 462.00 - pcs 462.00 - - pcs 462.00 -
Hand Scone Non Steril # L (pree powdered mas
38 - pcs 462.00 - pcs 462.00 - pcs 462.00 - - pcs 462.00 -
latex)
39 Handscone Non Steril (L ) (Mas pree powdered) - pcs 522.06 - pcs 522.06 - pcs 522.06 - - pcs 522.06 -
40 Hand Scone Non Steril # M (Aximed) - pcs 462.00 - pcs 462.00 - pcs 462.00 - - pcs 462.00 -
41 Hand Scone Non Steril # M (kismed mask latex) - pcs 462.00 - pcs 462.00 - pcs 462.00 - - pcs 462.00 -
42 Handscone Non Steril (M ) (Mas pree powdered) - pcs 522.06 - pcs 522.06 - pcs 522.06 - - pcs 522.06 -
43 Handscone Non Steril 7.5 ( Mask Surgical) - Pasang 8,701.00 - Pasang 8,701.00 - Pasang 8,701.00 - - Pasang 8,701.00 -
44 Infusion Set Anak (Aximed) - Set 5,100.00 - Set 5,100.00 - Set 5,100.00 - - Set 5,100.00 -
BHP-02-2021 9
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
45 Infusion Set Anak - set 4,884.00 - set 4,884.00 - set 4,884.00 - - set 4,884.00 -
46 Infusion Set Anak - pcs 5,661.00 - pcs 5,661.00 - pcs 5,661.00 - - pcs 5,661.00 -
48 Infusion Set Anak 5 pcs 5,415.00 27,075.00 pcs 5,415.00 - pcs 5,415.00 - 5 pcs 5,415.00 27,075.00
49 Infusion Set Dewasa - Set 3,500.00 - Set 3,500.00 - Set 3,500.00 - - Set 3,500.00 -
52 Infusion Set Dewasa - pcs 5,445.00 - pcs 5,445.00 - pcs 5,445.00 - - pcs 5,445.00 -
54 Infusion Set Dewasa (y - TYPE) 10 pcs 8,061.00 80,610.00 pcs 8,061.00 - pcs 8,061.00 - 10 pcs 8,061.00 80,610.00
55 IV Canula non inj & wing no 20 (Eskamed) - Pieces 10,386.21 - Pieces 10,386.21 - Pieces 10,386.21 - - Pieces 10,386.21 -
58 IV Catheter No. 20 G - pcs 7,787.50 - pcs 7,787.50 - pcs 7,787.50 - - pcs 7,787.50 -
59 IV Catheter NP No. 20 G - Pieces 6,105.00 - Pieces 6,105.00 - Pieces 6,105.00 - - Pieces 6,105.00 -
60 IV Catheter No. 20 G - Pieces 10,000.00 - Pieces 10,000.00 - Pieces 10,000.00 - - Pieces 10,000.00 -
62 IV Catheter No. 20 G - pieces 10,483.00 - pieces 10,483.00 - pieces 10,483.00 - - pieces 10,483.00 -
67 IV Catheter No. 22 G 20 pieces 12,100.00 242,000.00 pieces 12,100.00 - pieces 12,100.00 - 20 pieces 12,100.00 242,000.00
72 Kapas Berlemak 500 gram - Bungkus 17,250.00 - Bungkus 17,250.00 - Bungkus 17,250.00 - - Bungkus 17,250.00 -
73 Kapas Pembalut / Absorben 250 gram - Bungkus 7,475.00 - Bungkus 7,475.00 - Bungkus 7,475.00 - - Bungkus 7,475.00 -
74 Kapas Pembalut / Absorben 250 gram - Bungkus 12,400.00 - Bungkus 12,400.00 - Bungkus 12,400.00 - - Bungkus 12,400.00 -
75 Kapas Pembalut / Absorben 250 gram - Roll 12,500.00 - Roll 12,500.00 - Roll 12,500.00 - - Roll 12,500.00 -
76 Kapas Pembalut / Absorben 250 gram 4 Roll 24,000.00 96,000.00 Roll 24,000.00 - Roll 24,000.00 - 4 Roll 24,000.00 96,000.00
77 Kapas Pembalut / Absorben 250 gram - Roll 20,600.00 - Roll 20,600.00 - Roll 20,600.00 - - Roll 20,600.00 -
78 Kassa Hidrofil Steril Ukuran 16 x 16 cm - Bungkus 5,750.00 - Bungkus 5,750.00 - Bungkus 5,750.00 - - Bungkus 5,750.00 -
79 Kassa Hidrofil Steril Ukuran 16 x 16 cm - box 8,000.00 - box 8,000.00 - box 8,000.00 - - box 8,000.00 -
80 Kassa Hidrofil Steril Ukuran 16 x 16 cm - kotak 7,900.00 - kotak 7,900.00 - kotak 7,900.00 - - kotak 7,900.00 -
81 Kassa Hidrofil Steril Ukuran 16 x 16 cm 29 kotak 7,370.00 213,730.00 kotak 7,370.00 - kotak 7,370.00 - 29 kotak 7,370.00 213,730.00
82 Kassa Hidrofil Steril Ukuran 18 x 22 cm - Kotak 4,750.00 - Kotak 4,750.00 - Kotak 4,750.00 - - Kotak 4,750.00 -
83 Kassa Hidrofil Steril Ukuran 18 x 22 cm - box 5,900.00 - box 5,900.00 - box 5,900.00 - - box 5,900.00 -
84 Kassa Hidrofil Steril Ukuran 18 x 22 cm 30 Box 7,500.00 225,000.00 Box 7,500.00 - Box 7,500.00 - 30 Box 7,500.00 225,000.00
85 Kassa Hidrofil Ukuran 36 x 10 cm - Rol 2,415.00 - Rol 2,415.00 - Rol 2,415.00 - - Rol 2,415.00 -
88 Kassa Hidrofil Ukuran 40 yard x 80 cm - Rol 256,250.00 - Rol 256,250.00 - Rol 256,250.00 - - Rol 256,250.00 -
89 Kassa Hidrofil Ukuran 40 yard x 80 cm - Roll 250,250.00 - Roll 250,250.00 - Roll 250,250.00 - - Roll 250,250.00 -
90 Kassa Pembalut Hidrofil 4m x 10cm - Rol 607.00 - Rol 607.00 - Rol 607.00 - - Rol 607.00 -
91 Kassa Pembalut Hidrofil 4m x 10cm (SN Medika) - Rol 33,000.00 - Rol 33,000.00 - Rol 33,000.00 - - Rol 33,000.00 -
92 Kassa Pembalut Hidrofil 4m x 10cm - Rol 1,500.00 - Rol 1,500.00 - Rol 1,500.00 - - Rol 1,500.00 -
93 Kassa Pembalut Hidrofil 4m x 10cm - Rol 2,300.00 - Rol 2,300.00 - Rol 2,300.00 - - Rol 2,300.00 -
94 Kassa Pembalut Hidrofil 4m x 7,5cm (SN Medika) - Rol 27,830.00 - Rol 27,830.00 - Rol 27,830.00 - - Rol 27,830.00 -
95 Kassa Pembalut Hidrofil 4m x 5 cm 50 Rol 607.00 30,350.00 Rol 607.00 - Rol 607.00 - 50 Rol 607.00 30,350.00
96 Kassa Pembalut Hidrofil 4m x 5 cm - Rol 750.00 - Rol 750.00 - Rol 750.00 - - Rol 750.00 -
97 Kassa Pembalut Hidrofil 4m x 5 cm - Rol 1,100.00 - Rol 1,100.00 - Rol 1,100.00 - - Rol 1,100.00 -
100 Kassa Pembalut elastis 10 cmx4,55m - Rol 33,000.00 - Rol 33,000.00 - Rol 33,000.00 - - Rol 33,000.00 -
101 Kassa Pembalut elastis 7,5 cmx4,55m - Rol 27,830.00 - Rol 27,830.00 - Rol 27,830.00 - - Rol 27,830.00 -
102 Masker - pcs 1,125.00 - pcs 1,125.00 - pcs 1,125.00 - - pcs 1,125.00 -
103 Masker (Aximed Face Mask Ear Loop ) - pcs 396.00 - pcs 396.00 - pcs 396.00 - - pcs 396.00 -
104 Masker Face Mask -30ply / Ear Loop ) - pcs 726.00 - pcs 726.00 - pcs 726.00 - - pcs 726.00 -
105 Masker N95 - pcs 6,512.00 - pcs 6,512.00 - pcs 6,512.00 - - pcs 6,512.00 -
107 Masker Jilbab - pcs 396.00 - pcs 396.00 - pcs 396.00 - - pcs 396.00 -
108 Masker Jilbab (Mas surgical) - box 41,019.00 - box 41,019.00 - box 41,019.00 - - box 41,019.00 -
109 Masker Bedah - pcs 6,500.00 - pcs 6,500.00 - pcs 6,500.00 - - pcs 6,500.00 -
110 masker bioaxi face mask ear loop - pcs 4,800.00 - pcs 4,800.00 - pcs 4,800.00 - - pcs 4,800.00 -
BHP-02-2021 10
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
111 Pembalut Gips 3 inch - Rol 23,500.00 - Rol 23,500.00 - Rol 23,500.00 - - Rol 23,500.00 -
112 Pembalut Gips 6 inch - Rol 42,000.00 - Rol 42,000.00 - Rol 42,000.00 - - Rol 42,000.00 -
113 Plester 5 yard x 2 inch - Rol 23,618.00 - Rol 23,618.00 - Rol 23,618.00 - - Rol 23,618.00 -
114 Plester 5 yard x 2 inch - Roll 35,532.00 - Roll 35,532.00 - Roll 35,532.00 - - Roll 35,532.00 -
115 Plester Rol Kain 2.5 cm x 1 m ( Hansaplast) - Rol 5,017.00 - Rol 5,017.00 - Rol 5,017.00 - - Rol 5,017.00 -
116 Plester Leukoplast 7,5cm x 4,5 cm - Roll 35,532.00 - Roll 35,532.00 - Roll 35,532.00 - - Roll 35,532.00 -
117 Pharmaplast (pharmafix) - box 27,000.00 - box 27,000.00 - box 27,000.00 - - box 27,000.00 -
118 Plester Pharmaplast ( PHARMAFIX) 5 cm x 500 cm - Rol 16,500.00 - Rol 16,500.00 - Rol 16,500.00 - - Rol 16,500.00 -
119 Paper tape /2,5cm x 9,14m - Rol 11,583.00 - Rol 11,583.00 - Rol 11,583.00 - - Rol 11,583.00 -
120 Paper tape / 1,25cm x 9,14m - Rol 4,900.00 - Rol 4,900.00 - Rol 4,900.00 - - Rol 4,900.00 -
121 Paper tape / 1,25cm x 9,14m - Rol 7,029.00 - Rol 7,029.00 - Rol 7,029.00 - - Rol 7,029.00 -
122 Safety Box - pcs 15,708.00 - pcs 15,708.00 - pcs 15,708.00 - - pcs 15,708.00 -
123 Silk (Benang Bedah) 3/0 + Jarum - rol 705.55 - rol 705.55 - rol 705.55 - - rol 705.55 -
124 Silk (Benang Bedah) 3/0 + Jarum - pcs 48,240.17 - pcs 48,240.17 - pcs 48,240.17 - - pcs 48,240.17 -
125 Silk 3/0.1/2 18mm 75cm-2PTR5261E - pcs 39,481.00 - pcs 39,481.00 - pcs 39,481.00 - - pcs 39,481.00 -
126 Silk 3/0.1/2 18mm 75cm-2PTR5261E 24 pcs 34,607.26 830,574.24 pcs 34,607.26 - pcs 34,607.26 - 24 pcs 34,607.26 830,574.24
127 Urine Bag - Set 3,600.00 - Set 3,600.00 - Set 3,600.00 - - Set 3,600.00 -
128 Urine Bag ( Aximed TVW Hanger) - pcs 5,128.00 - pcs 5,128.00 - pcs 5,128.00 - - pcs 5,128.00 -
129 Urine Bag ( Aximed TVW Hanger) - pcs 5,500.00 - pcs 5,500.00 - pcs 5,500.00 - - pcs 5,500.00 -
130 Urine Bag ( trode medical trourocol plus) - pcs 8,070.00 - pcs 8,070.00 - pcs 8,070.00 - - pcs 8,070.00 -
131 Urine Bag ( AXIMED) - pcs 5,785.00 - pcs 5,785.00 - pcs 5,785.00 - - pcs 5,785.00 -
132 Wing Needle No. 21 G - pcs 1,400.00 - pcs 1,400.00 - pcs 1,400.00 - - pcs 1,400.00 -
135 Rapid Test Vikia HIV 1/2 - Kit 487,500.00 - Kit 487,500.00 - Kit 487,500.00 - - Kit 487,500.00 -
136 Larvasida - Galon 3,500,000.00 - Galon 3,500,000.00 - Galon 3,500,000.00 - - Galon 3,500,000.00 -
137 Larvasida (obat DBD / Abate) - kg 140,000.00 - kg 140,000.00 - kg 140,000.00 - - kg 140,000.00 -
138 Larvasida Sumilar - kg 1,500,000.00 - kg 1,500,000.00 - kg 1,500,000.00 - - kg 1,500,000.00 -
139 Accu-Chek Test Strip - kotak 420,000.00 - kotak 420,000.00 - kotak 420,000.00 - - kotak 420,000.00 -
140 KIT Emergensi P3K Posko Mudik - Paket 1,000,000.00 - Paket 1,000,000.00 - Paket 1,000,000.00 - - Paket 1,000,000.00 -
141 Ongkir - - - - - - - - - -
- - - - - -
OBAT - OBATAN LAIN - - - - - -
1 Antapulgit NEW ANTIDES - Tablet 136.00 - Tablet 136.00 - Tablet 136.00 - - Tablet 136.00 -
2 Aqua Pro Injection (OTSU SWI 25 Ml) - Ampul 2,750.00 - Ampul 2,750.00 - Ampul 2,750.00 - - Ampul 2,750.00 -
3 Aqua Pro Injection (OTSU SWI 25 Ml) - Ampul 2,860.00 - Ampul 2,860.00 - Ampul 2,860.00 - - Ampul 2,860.00 -
4 Betason N - Tube 9,182.00 - Tube 9,182.00 - Tube 9,182.00 - - Tube 9,182.00 -
5 Becefort Syrup , Multivitamin anak - Botol 60 ml 15,686.00 - Botol 60 ml 15,686.00 - Botol 60 ml 15,686.00 - - Botol 60 ml 15,686.00 -
6 Becefort Syrup , Multivitamin anak 37 Botol 60 ml 19,470.00 720,390.00 Botol 60 ml 19,470.00 - 13 Botol 60 ml 19,470.00 253,110.00 24 Botol 60 ml 19,470.00 467,280.00
7 Becefort Syrup , Multivitamin anak - Botol 60 ml 17,358.00 - Botol 60 ml 17,358.00 - Botol 60 ml 17,358.00 - - Botol 60 ml 17,358.00 -
8 Multivitamin Dewasa (BECEFORT TAB) 300 Tablet 1,743.50 523,050.00 Tablet 1,743.50 - 200 Tablet 1,743.50 348,700.00 100 Tablet 1,743.50 174,350.00
9 Multivitamin Dewasa (AMAROPO) - Tablet 2,277.00 - Tablet 2,277.00 - Tablet 2,277.00 - - Tablet 2,277.00 -
Kaptab Salut Kaptab Salut Kaptab Salut Kaptab Salut
10 Bisakodil 5 mg - 300.00 - 300.00 - 300.00 - - 300.00 -
Selaput Selaput Selaput Selaput
Botol 1000
11 Cairan Antiseptik 1000 ml (A. Class) - Botol 1000 ml 344,048.00 - Botol 1000 ml 344,048.00 - Botol 1000 ml 344,048.00 - - 344,048.00 -
ml
12 Cairan Antiseptik ( Hansanitizer 25 L) - Jerigen 25 L 3,663,000.00 - Jerigen 25 L 3,663,000.00 - Jerigen 25 L 3,663,000.00 - - Jerigen 25 L 3,663,000.00 -
13 Chloramex - kloramfenikol 500mg - Tablet 1,007.00 - Tablet 1,007.00 - Tablet 1,007.00 - - Tablet 1,007.00 -
14 Dehidro Artemisin + Piperazin (DHP) Tablet - Tablet 2,756.44 - Tablet 2,756.44 - Tablet 2,756.44 - - Tablet 2,756.44 -
15 Glimipiride Tablet 3 mg - tablet 319.18 - tablet 319.18 - tablet 319.18 - - tablet 319.18 -
16 Glukonas Kalsikus Inj 10% - Ampul 19,750.00 - Ampul 19,750.00 - Ampul 19,750.00 - - Ampul 19,750.00 -
17 Hemafort tab kombinasi - Tablet 757.00 - Tablet 757.00 - Tablet 757.00 - - Tablet 757.00 -
18 HIV Test - Box 487,500.00 - Box 487,500.00 - Box 487,500.00 - - Box 487,500.00 -
19 Insektisida Fogging - Liter 200,000.00 - Liter 200,000.00 - Liter 200,000.00 - - Liter 200,000.00 -
20 Mineral mix - sachet 68.00 - sachet 68.00 - sachet 68.00 - - sachet 68.00 -
21 Mineral mix - sachet 2,805.00 - sachet 2,805.00 - sachet 2,805.00 - - sachet 2,805.00 -
22 Mouthiece Smolkilizer - Box 1,050,000.00 - Box 1,050,000.00 - Box 1,050,000.00 - - Box 1,050,000.00 -
23 RDT Malaria - Box 476,372.60 - Box 476,372.60 - Box 476,372.60 - - Box 476,372.60 -
24 RDT COVID-19 - AntiBody - Pcs 245,000.00 - Pcs 245,000.00 - Pcs 245,000.00 - - Pcs 245,000.00 -
27 RDT COVID-19 - AntiGEN - Pcs 300,000.00 - Pcs 300,000.00 - Pcs 300,000.00 - - Pcs 300,000.00 -
28 Rivanol 0,1% 300 ml - Botol 3,000.00 - Botol 3,000.00 - Botol 3,000.00 - - Botol 3,000.00 -
29 Rivanol 0,1% 300 ml - Botol 3,400.00 - Botol 3,400.00 - Botol 3,400.00 - - Botol 3,400.00 -
30 Ventolin nebulizer - Botol 12,320.00 - Botol 12,320.00 - Botol 12,320.00 - - Botol 12,320.00 -
31 Ventolin nebulizer - Ampul 10,373.00 - Ampul 10,373.00 - Botol 10,373.00 - - Ampul 10,373.00 -
BHP-02-2021 11
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
32 Glucose - Botol 1,370,000.00 - Botol 1,370,000.00 - Botol 1,370,000.00 - - Botol 1,370,000.00 -

33 Glucose - Botol 880,674.30 - Botol 880,674.30 - Botol 880,674.30 - - Botol 880,674.30 -
34 Acid/Uric - Botol 1,860,000.00 - Botol 1,860,000.00 - Botol 1,860,000.00 - - Botol 1,860,000.00 -
35 Acid/Uric - Botol 1,851,894.00 - Botol 1,851,894.00 - Botol 1,851,894.00 - - Botol 1,851,894.00 -
36 HDL Cholesterol - Botol 4,440,000.00 - Botol 4,440,000.00 - Botol 4,440,000.00 - - Botol 4,440,000.00 -
37 LDL Cholesterol - Botol 5,160,000.00 - Botol 5,160,000.00 - Botol 5,160,000.00 - - Botol 5,160,000.00 -
38 Cholesterol - Botol 2,093,300.00 - Botol 2,093,300.00 - Botol 2,093,300.00 - - Botol 2,093,300.00 -
39 Ongkir - - - - - - - - - - - - - -
- - - - - -
VAKSIN - - - - - -
1 ADS 0,05 ML (Union) - Pcs 1,379.80 - Pcs 1,379.80 - Pcs 1,379.80 - - Pcs 1,379.80 -
2 ADS 0,5 ML (Union) - Pcs 1,249.45 - Pcs 1,249.45 - Pcs 1,249.45 - - Pcs 1,249.45 -
3 Anti Bisa Ular Serum - Vial 274,000.00 - Vial 274,000.00 - Vial 274,000.00 - - Vial 274,000.00 -
4 Anti Bisa Ular Serum (Biosave) - Vial 430,000.00 - Vial 430,000.00 - Vial 430,000.00 - - Vial 430,000.00 -
7 Anti Tetanus Serum 1500 IU - Ampul 59,004.00 - Ampul 59,004.00 - Ampul 59,004.00 - - Ampul 59,004.00 -
8 Anti Tetanus Serum 1500 UI (biosat-1,5) - Ampul 115,000.00 - Ampul 115,000.00 - Ampul 115,000.00 - - Ampul 115,000.00 -
11 Safety Box Stera Sharp 7 Ltr - Pcs 61,600.00 - Pcs 61,600.00 - Pcs 61,600.00 - - Pcs 61,600.00 -
12 Safety Box Stera Sharp 7 Ltr - Pcs 15,840.00 - Pcs 15,840.00 - Pcs 15,840.00 - - Pcs 15,840.00 -
13 Spuit 5 ML (aximed) - pcs 1,030.00 - pcs 1,030.00 - pcs 1,030.00 - - pcs 1,030.00 -
- -
SUB JUMLAH OBAT, BMHP, VAKSIN APBD II - 17,739,056.00 - 2,393,684.00 - 15,345,372.00 -
- -
2 OBAT - OBATAN APBD I - -

( PROPINSI )
SUB OBAT -OBATAN - -
1 Albendazol Tablet Kunyah 400 mg 100 Tablet 402.00 40,200.00 Tablet 402.00 - Tablet 402.00 - 100 Tablet 402.00 40,200.00
2 Alkohol 70 % - 100 ml - botol 300 ml 9,800.00 - botol 300 ml 9,800.00 - botol 300 ml 9,800.00 - - botol 300 ml 9,800.00 -
3 Alkohol 70 % - 100 ml - botol 300 ml 21,500.00 - botol 300 ml 21,500.00 - botol 300 ml 21,500.00 - - botol 300 ml 21,500.00 -
5 Aminofilin Tablet 200 mg - Tablet 91.00 - Tablet 91.00 - Tablet 91.00 - - Tablet 91.00 -
7 Artemether Injeksi 80 mg/ml - Ampul 25,490.00 - Ampul 25,490.00 - Ampul 25,490.00 - - Ampul 25,490.00 -
9 Artesunate Injeksi vial 60 mg - Vial 39,000.00 - Vial 39,000.00 - Vial 39,000.00 - - Vial 39,000.00 -
10 Artesunate Injeksi vial 60 mg - Vial 57,585.00 - Vial 57,585.00 - Vial 57,585.00 - - Vial 57,585.00 -
15 Azitromicin Tablet 500 mg - Tablet 380.00 - Tablet 380.00 - Tablet 380.00 - - Tablet 380.00 -
16 19,740 Tablet 354.00 6,987,960.00 Tablet 354.00 - Tablet 354.00 - 19,740 Tablet 354.00 6,987,960.00
20 Deksametason Tablet - Tablet 32.00 - Tablet 32.00 - Tablet 32.00 - - Tablet 32.00 -
24 Fenobarbital Injeksi i.m./i.v. 50 mg/ml - Amp 1ml 1,800.00 - Amp 1ml 1,800.00 - Amp 1ml 1,800.00 - - Amp 1ml 1,800.00 -
26 Garam Oralit 300 sachet 257.00 77,100.00 sachet 257.00 - 50 sachet 257.00 12,850.00 250 sachet 257.00 64,250.00
27 Gentamisin Injeksi 40 mg/ml - Ampul 617.00 - Ampul 617.00 - Ampul 617.00 - - Ampul 617.00 -
BHP-02-2021 12
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
32 Kaptopril tab 12,5 mg - Tablet 66.00 - Tablet 66.00 - Tablet 66.00 - - Tablet 66.00 -
33 Kloramfenikol Tetes Mata ( DECACETIN) - Botol 3,250.00 - Botol 3,250.00 - Botol 3,250.00 - - Botol 3,250.00 -
36 Klorokuin Tablet 150 mg - Tablet 15.06 - Tablet 15.06 - Tablet 15.06 - - Tablet 15.06 -
39 Loperamid tablet 2 mg - Tablet 80.00 - Tablet 80.00 - Tablet 80.00 - - Tablet 80.00 -
40 Magnesium Sulfat Injeksi (IV)40% - Ampul 3,650.00 - Ampul 3,650.00 - Ampul 3,650.00 - - Ampul 3,650.00 -
41 Magnesium Sulfat Injeksi (IV)40% - Ampul 3,796.00 - Ampul 3,796.00 - Ampul 3,796.00 - - Ampul 3,796.00 -
42 Nifedipin Tablet 10 mg - Tablet 110.00 - Tablet 110.00 - Tablet 110.00 - - Tablet 110.00 -
44 Nifedipin Tablet 10 mg - Tablet 108.00 - Tablet 108.00 - Tablet 108.00 - - Tablet 108.00 -
45 Obat Anti Tuberkulosis Kombipak Kategori 1 - Paket 317,018.00 - Paket 317,018.00 - Paket 317,018.00 - - Paket 317,018.00 -
55 Oksitosin Injeksi 10 IU/ml-1ml - Ampul 1,199.00 - Ampul 1,199.00 - Ampul 1,199.00 - - Ampul 1,199.00 -
57 Osetalmivir Kapsul 100 mg - Kapsul 129.69 - Kapsul 129.69 - Kapsul 129.69 - - Kapsul 129.69 -
58 Oxytetrasiklin salep mata 1 % - tube 2,500.00 - tube 2,500.00 - tube 2,500.00 - - tube 2,500.00 -
61 Primakuin Tablet - Tablet 224.00 - Tablet 224.00 - Tablet 224.00 - - Tablet 224.00 -
62 Ranitidin HCl Injeksi 25 mg/ml - Ampul 1,155.00 - Ampul 1,155.00 - Ampul 1,155.00 - - Ampul 1,155.00 -
70 WIDA KDNI ( D 2,5 % + KCl 0,15% + NaCl 0,45%) - Botol 11,435.00 - Botol 11,435.00 - Botol 11,435.00 - - Botol 11,435.00 -
71 WIDA KDN2 ( D 2,5 % + KCl 0,3% + NaCl 0,45%) - Botol 11,435.00 - Botol 11,435.00 - Botol 11,435.00 - - Botol 11,435.00 -
72 WIDA KNI ( KCl 0,15% + NaCl 0,9%) - Botol 11,011.00 - Botol 11,011.00 - Botol 11,011.00 - - Botol 11,011.00 -
74 WIDA KN2 ( KCl 0,3% + NaCl 09%) - Botol 11,011.00 - Botol 11,011.00 - Botol 11,011.00 - - Botol 11,011.00 -
75 Vitamin B Kompleks 1,500 Tablet 117.00 175,500.00 Tablet 117.00 - 300 Tablet 117.00 35,100.00 1,200 Tablet 117.00 140,400.00
76 Zinc Tablet 50 Tablet 524.00 26,200.00 Tablet 524.00 - Tablet 524.00 - 50 Tablet 524.00 26,200.00
- - - - - -
PERBEKALAN KESEHATAN - - - -
1 Alat Suntik Sekali Pakai 3 cc - pieces 835.00 - pieces 835.00 - pieces 835.00 - - pieces 835.00 -
2 Alat Suntik Sekali Pakai 5 cc - pieces 889.00 - pieces 889.00 - pieces 889.00 - - pieces 889.00 -
3 Alkohol Swab - pcs 169.88 - pcs 169.88 - pcs 169.88 - - pcs 169.88 -
4 Cutgut 2/0 - pcs 33,645.00 - pcs 33,645.00 - pcs 33,645.00 - - pcs 33,645.00 -
12 Kassa Hidrofil Ukuran 40 yard x 80 cm - Roll 255,750.00 - Roll 255,750.00 - Roll 255,750.00 - - Roll 255,750.00 -
13 Masker - pcs 761.64 - pcs 761.64 - pcs 761.64 - - pcs 761.64 -
14 Masker - pcs 339.90 - pcs 339.90 - pcs 339.90 - - pcs 339.90 -
15 Oxygen Nasal Cannula (Adult) - pcs 12,200.00 - pcs 12,200.00 - pcs 12,200.00 - - pcs 12,200.00 -
16 Oxygen Nasal Cannula (Child) - pcs 12,140.00 - pcs 12,140.00 - pcs 12,140.00 - - pcs 12,140.00 -
17 Virus Transport Media ( VTM) - pcs 39,000.00 - pcs 39,000.00 - pcs 39,000.00 - - pcs 39,000.00 -
BHP-02-2021 13
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
18 Under Pad - pcs 8,295.00 - pcs 8,295.00 - pcs 8,295.00 - - pcs 8,295.00 -
19 Urine Bag - pcs 6,036.00 - pcs 6,036.00 - pcs 6,036.00 - - pcs 6,036.00 -
- - - - - - - - - - -
OBAT - OBATAN LAIN - - - -
1 Cefotaksim Injeksi - Vial 4,500.00 - Vial 4,500.00 - Vial 4,500.00 - - Vial 4,500.00 -
2 Chloramex - kloramfenikol 500mg - Tablet 1,007.00 - Tablet 1,007.00 - Tablet 1,007.00 - - Tablet 1,007.00 -
3 Clorampecorth - Tube 9,085.00 - Tube 9,085.00 - Tube 9,085.00 - - Tube 9,085.00 -
4 Dehidro Artemisin + Piperazin (DHP) Tablet 27 Tablet 2,134.00 57,618.00 Tablet 2,134.00 - Tablet 2,134.00 - 27 Tablet 2,134.00 57,618.00
5 Dehidro Artemisin + Piperazin (DHP) Tablet - Tablet 2,000.00 - Tablet 2,000.00 - Tablet 2,000.00 - - Tablet 2,000.00 -
6 Glukonas Kalsikus Inj 10% - ampul 9,955.00 - ampul 9,955.00 - ampul 9,955.00 - - ampul 9,955.00 -
7 Glukonas Kalsikus Inj 10% - Ampul 10,351.00 - Ampul 10,351.00 - Ampul 10,351.00 - - Ampul 10,351.00 -
8 Mersibion inj - Ampul 4,400.00 - Ampul 4,400.00 - Ampul 4,400.00 - - Ampul 4,400.00 -
9 Mineral mix - sachet 2,920.00 - sachet 2,920.00 - sachet 2,920.00 - - sachet 2,920.00 -
10 Urea ( Soft U derm) Krim 10% - tube 3,941.00 - tube 3,941.00 - tube 3,941.00 - - tube 3,941.00 -
11 Spironolakton tab - Tablet 244.00 - Tablet 244.00 - Tablet 244.00 - - Tablet 244.00 -
- - - - - - - - - - -
VAKSIN - - - -
1 ADS 0,05 ML (Oneject) - Pcs 1,650.00 - Pcs 1,650.00 - Pcs 1,650.00 - - Pcs 1,650.00 -
4 ADS 0,05 ML (Skifa) - Pcs 1,354.00 - Pcs 1,354.00 - Pcs 1,354.00 - - Pcs 1,354.00 -
6 ADS 0,5 ML (Oneject) - pcs 1,210.00 - pcs 1,210.00 - pcs 1,210.00 - - pcs 1,210.00 -
10 ADS 0,5 ML - Pcs 1,185.00 - Pcs 1,185.00 - Pcs 1,185.00 - - Pcs 1,185.00 -
11 ADS 5 ML (Skifa) - Pcs 1,470.00 - Pcs 1,470.00 - Pcs 1,470.00 - - Pcs 1,470.00 -
12 ADS 5 ML (Skifa) - Pcs 1,580.00 - Pcs 1,580.00 - Pcs 1,580.00 - - Pcs 1,580.00 -
13 Alkohol Swab - Pcs 95.00 - Pcs 95.00 - Pcs 95.00 - - Pcs 95.00 -
14 BCG - Vial 59,590.00 - Pcs 59,590.00 - Pcs 59,590.00 - - Vial 59,590.00 -
15 BCG - Vial 56,360.00 - Vial 56,360.00 - Vial 56,360.00 - - Vial 56,360.00 -
16 BCG - Vial 60,140.00 - Vial 60,140.00 - Vial 60,140.00 - - Vial 60,140.00 -
17 Corona Vaccin - Vial 211,282.00 - Vial 211,282.00 - Vial 211,282.00 - - Vial 211,282.00 -
18 Campak Vaksin - Vial 28,204.00 - Vial 28,204.00 - Vial 28,204.00 - - Vial 28,204.00 -
19 DPT - HB -HiB - Vial 76,620.00 - Vial 76,620.00 - Vial 76,620.00 - - Vial 76,620.00 -
20 DPT - HB -HiB - Vial 71,810.00 - Vial 71,810.00 - Vial 71,810.00 - - Vial 71,810.00 -
21 DT - Vial 16,180.00 - Vial 16,180.00 - Vial 16,180.00 - - Vial 16,180.00 -
24 Hepatitis B - pcs 20,900.00 - pcs 20,900.00 - pcs 20,900.00 - - pcs 20,900.00 -
25 Hepatitis B - Pcs 23,270.00 - Pcs 23,270.00 - Pcs 23,270.00 - - Pcs 23,270.00 -
26 Polio Injeksi - Vial 34,815.00 - Vial 34,815.00 - Vial 34,815.00 - - Vial 34,815.00 -
29 Polio Vaksin - Vial 19,954.00 - Vial 19,954.00 - Vial 19,954.00 - - Vial 19,954.00 -
30 Polio Vaksin - Vial 18,140.00 - Vial 18,140.00 - Vial 18,140.00 - - Vial 18,140.00 -
31 Polio Oral + Droper - Vial 19,350.00 - Vial 19,350.00 - Vial 19,350.00 - - Vial 19,350.00 -
32 Safety Box - Pcs 15,708.00 - Pcs 15,708.00 - Pcs 15,708.00 - - Pcs 15,708.00 -
36 Spuit 5 ML (Oneject) - Pcs 1,705.00 - Pcs 1,705.00 - Pcs 1,705.00 - - Pcs 1,705.00 -
37 Td - Vial 16,500.00 - Pcs 16,500.00 - Pcs 16,500.00 - - Vial 16,500.00 -
38 Td - Vial 16,480.00 - Pcs 16,480.00 - Pcs 16,480.00 - - Vial 16,480.00 -
39 Tetanus Toksoid (TT) - Vial 14,498.00 - Pcs 14,498.00 - Pcs 14,498.00 - - Vial 14,498.00 -
40 Vaksin MR - Vial 141,648.00 - Pcs 141,648.00 - Pcs 141,648.00 - - Vial 141,648.00 -
41 Vaksin MR - Vial 151,150.00 - Vial 151,150.00 - Vial 151,150.00 - - Vial 151,150.00 -
BHP-02-2021 14
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
42 Vaksin Anti Rabies (VAR) - Vial 70,000.00 - Pcs 70,000.00 - Vial 70,000.00 - - Vial 70,000.00 -
43 Vaksin Anti Rabies (VAR) - Vial 78,500.00 - Pcs 78,500.00 - Vial 78,500.00 - - Vial 78,500.00 -
44 Vaksin Anti Rabies (VAR) - Vial 164,030.00 - Vial 164,030.00 - Vial 164,030.00 - - Vial 164,030.00 -
45 HB Uniject - Vial 23,270.00 - Vial 23,270.00 - Vial 23,270.00 - - Vial 23,270.00 -
46 HB Uniject - Vial 20,900.00 - Vial 20,900.00 - Vial 20,900.00 - - Vial 20,900.00 -
47 Vaksin Anti Rabies (VAR) - Vial 165,000.00 - Vial 165,000.00 - Vial 165,000.00 - - Vial 165,000.00 -
SUB JUMLAH OBAT-OBATAN,VAKSIN DAN
- 7,364,578.00 - 47,950.00 - 7,316,628.00
BMHP PROPINSI
- -
3 BOK - -
- -
1 Desinfektan - Botol - - Botol - - Botol - - - Botol - -
2 Handsanitizer 500 ml - Botol 500 ml 81,500.00 - Botol 500 ml 81,500.00 - Botol 500 ml 81,500.00 - - Botol 500 ml 81,500.00 -
3 Hand Scone Steril - Pasang 8,250.00 - Pasang 8,250.00 - Pasang 8,250.00 - - Pasang 8,250.00 -
4 Hand Scone Non Steril - Pcs 950.00 - Pcs 950.00 - Pcs 950.00 - - Pcs 950.00 -
5 Hazmat - Pcs 200,000.00 - Pcs 200,000.00 - Pcs 200,000.00 - - Pcs 200,000.00 -
6 Masker Bedah - Pcs 4,000.00 - Pcs 4,000.00 - Pcs 4,000.00 - - Pcs 4,000.00 -
7 Masker Bedah 3 ply (Hijab) - Pcs 1,860.00 - Pcs 1,860.00 - Pcs 1,860.00 - - Pcs 1,860.00 -
8 Masker Bedah 3 ply (ear loop) - Pcs 1,760.00 - Pcs 1,760.00 - Pcs 1,760.00 - - Pcs 1,760.00 -
9 Masker N-95 - Pcs 85,000.00 - Pcs 85,000.00 - Pcs 85,000.00 - - Pcs 85,000.00 -
- -
SUB JUMLAH BELANJA BOK - - - - - -

- -
BAHAN KEPERLUAN
4 - -
LABORATORIUM
- -
1 BHP HIV - paket 811,991,100.00 - paket 811,991,100.00 - paket 811,991,100.00 - - paket 811,991,100.00 -
2 BHP Malaria - paket 126,000,000.00 - paket 126,000,000.00 - paket 126,000,000.00 - - paket 126,000,000.00 -
3 Botol Sampel Keracunan - buah 20,000.00 - buah 20,000.00 - buah 20,000.00 - - buah 20,000.00 -
4 Catride TCM - paket 259,175.00 - paket 259,175.00 - paket 259,175.00 - - paket 259,175.00 -
5 Handscone - bok @ 50,000.00 - bok @ 50,000.00 - bok @ 50,000.00 - - bok @ 50,000.00 -
6 Holdel Vacuete - buah 1,000.00 - buah 1,000.00 - buah 1,000.00 - - buah 1,000.00 -
7 Jarum Vacutener - buah 2,000.00 - buah 2,000.00 - buah 2,000.00 - - buah 2,000.00 -
8 Mount piece - bok 2,250,000.00 - bok 2,250,000.00 - bok 2,250,000.00 - - bok 2,250,000.00 -
9 Paket Alat Pelindung Diri ( APD) - paket 1,500,000.00 - paket 1,500,000.00 - paket 1,500,000.00 - - paket 1,500,000.00 -
Paket Pemeriksaan SHK ( Kertas
10 - buah 65,000.00 - buah 65,000.00 - buah 65,000.00 - - buah 65,000.00 -
Saring,Lanset,Alkohol Swab )
11 Pipet test plastik - buah 3,000.00 - buah 3,000.00 - buah 3,000.00 - - buah 3,000.00 -
12 Pot Dahak - buah 3,000.00 - buah 3,000.00 - buah 3,000.00 - - buah 3,000.00 -
13 Pot Sampel AFP - buah 10,000.00 - buah 10,000.00 - buah 10,000.00 - - buah 10,000.00 -
14 Pot Urine - buah 5,000.00 - buah 5,000.00 - buah 5,000.00 - - buah 5,000.00 -
15 Rak Tabung Sampel - buah 25,000.00 - buah 25,000.00 - buah 25,000.00 - - buah 25,000.00 -
16 RDT DBD - bok 1,500,000.00 - bok 1,500,000.00 - bok 1,500,000.00 - - bok 1,500,000.00 -
17 RDT Hepatitis - buah 25,000.00 - buah 25,000.00 - buah 25,000.00 - - buah 25,000.00 -
18 Reagen TB - paket 500,000.00 - paket 500,000.00 - paket 500,000.00 - - paket 500,000.00 -
19 Safety Bok ADS - buah 25,000.00 - buah 25,000.00 - buah 25,000.00 - - buah 25,000.00 -
20 Sampel Cup - buah 500.00 - buah 500.00 - buah 500.00 - - buah 500.00 -
21 Slide - bok 30,000.00 - bok 30,000.00 - bok 30,000.00 - - bok 30,000.00 -
22 Stick Gula Darah - pak 160,000.00 - pak 160,000.00 - pak 160,000.00 - - pak 160,000.00 -
23 Tabung Vacuete - buah 3,000.00 - buah 3,000.00 - buah 3,000.00 - - buah 3,000.00 -
24 Alat Suntik 3 cc - pcs 920.00 - pcs 920.00 - pcs 920.00 - - pcs 920.00 -
25 Alkohol swab - pcs 354.00 - pcs 354.00 - pcs 354.00 - - pcs 354.00 -
26 Lancet (Sentry Lancet) - pcs 1,650.00 - pcs 1,650.00 - pcs 1,650.00 - - pcs 1,650.00 -
27 RDT HIV Test Kit - pcs 11,506.00 - pcs 11,506.00 - pcs 11,506.00 - - pcs 11,506.00 -
BHP-02-2021 15
SUMBER
1 2 3 4 5 6 8 9 10 11 12.00 13 14 15 16 17
28 RDT Malaria Test Kit - pcs 13,950.00 - pcs 13,950.00 - pcs 13,950.00 - - pcs 13,950.00 -
29 RDT Syphilis Test Kit - pcs 9,020.00 - pcs 9,020.00 - pcs 9,020.00 - - pcs 9,020.00 -
30 Tabung Vacuate (Vacum Tube Steril k3 EDTA) - buah 870.00 - buah 870.00 - buah 870.00 - - buah 870.00 -
31 RDT Covid-19 (Eco Test) - pcs 135,000.00 - pcs 135,000.00 - pcs 135,000.00 - - pcs 135,000.00 -
32 Virus Transport Media ( VTM) - pcs 80,000.00 - pcs 80,000.00 - pcs 80,000.00 - - pcs 80,000.00 -
33 Gown/Apron 10 pcs 70,000.00 700,000.00 pcs 70,000.00 - pcs 70,000.00 - 10 pcs 70,000.00 700,000.00
34 RDT Covid-19 Antibody - pcs 75,000.00 - pcs 75,000.00 - pcs 75,000.00 - - pcs 75,000.00 -
35 Face Shield - pcs 30,000.00 - pcs 30,000.00 - pcs 30,000.00 - - pcs 30,000.00 -
36 Handscone 4 box@ 120,000.00 480,000.00 box@ 120,000.00 - 1 box@ 120,000.00 120,000.00 3 box@ 120,000.00 360,000.00
37 Penutup Kepala - pcs 2,500.00 - pcs 2,500.00 - pcs 2,500.00 - - pcs 2,500.00 -
39 Cover All Suit - pcs 175,000.00 - pcs 175,000.00 - pcs 175,000.00 - - pcs 175,000.00
40 Face Shield - pcs 20,000.00 - pcs 20,000.00 - pcs 20,000.00 - - pcs 20,000.00
41 Gown/Apron - pcs 180,000.00 - pcs 180,000.00 - pcs 180,000.00 - - pcs 180,000.00
42 Under Pad - pcs 5,500.00 - pcs 5,500.00 - pcs 5,500.00 - - pcs 5,500.00 -
- - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
SUB JUMLAH BELANJA BAHAN KEPERLUAN

- 1,180,000.00 - 120,000.00 - 1,060,000.00
LABORATORIUM
- -
PERALATAN KEBERSIHAN DAN
5 - -
BAHAN PEMBERSIH
- -
1 Sanitarian Bag - Buah 3,000.00 - Buah 3,000.00 - Buah 3,000.00 - - Buah 3,000.00 -
2 Desinfektan 4 Dirigen 5 L 137,000.00 548,000.00 Dirigen 5 L 137,000.00 - Dirigen 5 L 137,000.00 - 4 Dirigen 5 L 137,000.00 548,000.00
- -
JUMLAH BELANJA PERALATAN KEBERSIHAN
- 548,000.00 - - - 548,000.00
DAN BAHAN PEMBERSIH
- -
6 APBN - -
- -
1 Masker polos / motif jenis earloop untuk Puskesmas - pcs 5,500.00 - pcs 5,500.00 - pcs 5,500.00 - - pcs 5,500.00 -
Masker polos / motif jenis headloop untuk

2 - pcs 5,500.00 - pcs 5,500.00 - pcs 5,500.00 - - pcs 5,500.00 -
Puskesmas
- -
JUMLAH BELANJA APBN - - - -
J U M L A H TOTAL 26,831,634.00 - 2,561,634.00 24,270,000.00
MENGETAHUI
Kepala UPT. Puskesmas Kaliasin Penyimpan Barang UPT Puskesmas Kaliasin Pengelola Obat UPT. Puskesmas Kaliasin
Kabupaten Lampung Selatan Dinas Kesehatan Kab. Lampung Selatan
apt.Ahmad Solich Annas M, S.Farm

SUHARTO Kristina Wulan Y Devi, A.Md,KG NIP . 19781002 201001 1 011
NIP. 19661013 198703 1 003 NIP. 19850731 200902 2 001
BHP-02-2021 16
PEMERINTAHAN KABUPATEN LAMPUNG SELATAN
UPT PUSKESMAS KALIASIN

DINAS KESEHATAN KABUPATEN LAMPUNG SELATAN
Kecamatan Tanjung Bintang
BERITA ACARA STOK OPNAME PERSEDIAAN OBAT

Nomor : 442/ /IV.03 / IV / 2021
Pada hari ini, Rabu tanggal Tiga Puluh Satu, bulan Maret, Tahun Dua Ribu Dua Puluh Satu, yang bertanda tangan dibawah ini Tim Stok
Opname Obat, Perbekalan Kesehatan dan Vaksin Puskesmas Kaliasin Kabupaten Lampung Selatan.
Telah melakukan pemeriksaan stok opname persediaan obat, perbekalan kesehatan dan vaksin sampai dengan hari ini 30 April 2021 di
Gudang Farmasi UPT. Puskesmas Kaliasin Kabupaten Lampung Selatan dengan keadaan sebagai berikut :
HASIL
HARGA
NO NAMA OBAT SATUAN STOK JUMLAH HARGA (Rp) KET
SATUAN (Rp)
OPNAME

SUB OBAT -OBATAN
1 Tablet 1,375.00 - -
anhydrida Tablet 200 mg)
2 Albendazol Tablet Kunyah 400 mg Tablet 392.00 - -
3 Albendazol Tablet Kunyah 400 mg Tablet 402.00 - -
4 Alkohol 70 % - 100 ml Botol 100 ml 2,500.00 - -
5 Alkohol 70 % - 100 ml Botol 100 ml 2,900.00 - -
6 Alkohol 70 % - 1 L Botol 1 L 25,000.00 - -
7 Alkohol 70 & - 1 L Botol 1 L 18,700.00 8 149,600.00
8 Alkohol 70 & - 1 L Jrg 20 L 319,000.00 - -
9 Alopurinol Tablet 100 mg Tablet 86.00 - -
11 Alopurinol Tablet 100 mg Tablet 99.00 490 48,510.00
13 Alprazolam Tablet 1 mg Tablet 233.00 - -
16 Alprazolam Tablet 0,25 mg Tablet 380.00 - -
17 Alprazolam Tablet 0,5 mg Tablet 88.00 - -
18 Ambroxol Tablet 30 mg (Mucos Tab) Tablet 880.00 300 264,000.00
19 Aminofilin Injeksi 24 mg/ml Amp 10 ml 3,823.00 - -
20 Aminofilin Injeksi 24 mg/ml Ampul 3,345.00 - -
21 Aminofilin Tablet 200 mg Tablet 993.00 - -
22 Aminofilin Tablet 150 mg (Decafil) Tablet 139.00 - -
23 Aminofilin Tablet 150 mg (Decafil) Tablet 148.00 100 14,800.00
24 Amitriptilin Tablet Salut 25 mg (HCl) Tablet 112.00 - -
27 Amlodipine Tablet 10 mg Tablet 330.00 - -
30 Amlodipine Tablet 10 mg Tablet 92.00 900 82,800.00
34 Amlodipine Tablet 5 mg Tablet 78.00 370 28,860.00
35 Amoksisilin Kaplet 500 mg Tablet 272.00 - -
36 Amoksisilin Kaplet 500 mg kaplet 232.00 - -
37 Amoksisilin Kaplet 500 mg kaplet 233.00 - -
38 Amoksisilin Kaplet 500 mg kaplet 249.00 4,400 1,095,600.00
39 Amoksisilin Kapsul 250 mg Kapsul 211.00 - -
40 Amoksisilin Kapsul 250 mg kapsul 195.00 - -
43 Amoksisilin Syrup Kering 125 mg/5ml Botol 60 ml 2,445.00 - -
47 Amoksisilin Syrup Kering 250 mg/5ml Botol 60 ml 2,050.00 35 71,750.00
48 Ampisilin Serbuk Injeksi im/iv. 1000 mg/vial Kotak 10 Vial 51,000.00 - -

49 Tablet 72.00 - -
17
HASIL
HARGA
SATUAN (Rp)
OPNAME
50 Tablet 62.00 - -
51 Tablet 54.00 - -
52 Tablet 58.00 800 46,400.00
53 Antasida DOEN II Suspensi Kombinasi Botol 60 ml 2,025.00 - -
56 Antibakteri DOEN (Bacitracin Salep Kulit) Tube 2,924.00 - -

57 Antibakteri DOEN (Bacitracin Salep Kulit) Tube 3,035.00 - -
58 Pot 30 gr 1,719.00 - -
59 Tube 4,158.00 - -
60 Pot 4,496.00 - -
61 Pot 4,798.00 24 115,152.00
62 Antihemoroid kombinasi Suppositoria 3,045.00 - -
63 Antihemoroid kombinasi Suppositoria 3,167.00 - -
64 Tablet 483.00 - -
Pirimetamin 25 mg + Sulfadoksin 500 mg
Antimigren Tablet :
65 Tablet 135.00 - -
Antimigren Tablet : Ergotamin 1 mg + Kafein 50
66 Tablet 173.00 - -
mg (Generik Kombinasi)
67 Artemether Injeksi 80 mg/ml ampul 22,000.00 - -
68 Artesunate Injeksi vial 60 mg viaL 38,999.00 - -
69 Asam Asetilsalisilat Tablet 100 mg (Asetosal) Tablet 116.00 - -
70 Asam Askorbat (Vitamin C) Tablet 250mg Tablet 125.00 - -
72 Asam Askorbat (Vitamin C) Tablet 50mg Tablet 105.00 600 63,000.00
73 Asam Folat Tablet 1 mg Tablet 48.00 - -
76 Asam Folat Tablet 0,4 mg Tablet 63.00 - -
77 Asam Folat Tablet 0,4 mg Tablet 55.00 - -
78 Asam Mefenamat Kapsul 500 mg Tablet 112.00 - -
80 Asam Mefenamat Kapsul 500 mg Tablet 103.00 1,000 103,000.00
81 Asiklovir krim 2,5 % Tube 2,995.00 - -
82 Asiklovir krim 5 % Tube 3,850.00 25 96,250.00
83 Asiklovir krim 5 % Tube 3,146.00 - -
84 Asiklovir Tablet 200 mg Tablet 237.00 - -
87 Asiklovir Tablet 400 mg Tablet 380.00 400 152,000.00
88 Atropin Sulfat Injeksi. i.m./i.v./s.k. 0,25 mg/ml Amp 1 ml 1,350.00 - -
89 Atropin Sulfat Tablet 0,5mg Tablet 74.00 - -
90 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial 9,800.00 - -
Besi (II) Sulfat 200 mg + Asam Folat 0,25mg
91 Tablet 367.00 - -
Tablet (tablet
Besi (II) Sulfattambah
200 mgdarah kombinasi)
+ Asam Folat 0,25mg
92 Tablet 352.00 - -
Tablet (tablet tambah darah kombinasi)
93 Betahistin Tablet 6 mg Tablet 149.00 - -
94 Betametason Krim 0,1% (sebagai valerat) Tube 1,520.00 - -

99 Bromheksin Tablet 8 mg Tablet 39.00 - -
100 Cetrizin Syrup 5mg/5ml Botol 2,915.00 - -
101 Cetrizin Tablet 10 mg Tablet 181.00 - -
103 Cimetidine 200 mg Tablet 192.67 - -
104 Deksametason 1nj 5 mg/ml Vial 1,500.00 - -
105 Deksametason 1nj 5 mg/ml Ampul 1,097.00 10 10,970.00
18
HASIL
HARGA
SATUAN (Rp)
OPNAME
106 Deksametason Tablet 0.5 mg Tablet 77.00 2,000 154,000.00
107 Deksametason Tablet 0.5 mg Tablet 41.00 - -
109 Diazepam Injeksi 5 mg/ml Ampul 4,180.00 - -
110 Diazepam Injeksi 5 mg/ml Ampul 1,735.00 - -
111 Diazepam Tablet 2 mg Tablet 45.00 - -
114 Diazepam Enema (Stesolid 5 mg/2,5 ml) Tube 12,573.00 - -
115 Dietilkarbamazin 100 mg Tablet 158.00 - -
116 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul 1,054.00 - -
117 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul 1,176.00 - -
118 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul 1,168.00 30 35,040.00
119 Digoksin Tablet 0,25 mg Tablet 97.00 - -
120 Digoksin Tablet 0,25 mg Tablet 105.00 - -
121 Dimenhidrinat Tablet 50 mg Tablet 104.00 - -
122 Doksisiklin Kapsul 100 mg Tablet 270.00 - -
123 Doksisiklin Kapsul 100 mg Tablet 269.00 - -
124 Doksisiklin Kapsul 100 mg Tablet 280.00 500 140,000.00
125 Domperidon Suspensi 5 mg/ml Botol 60 ml 3,333.00 - -
126 Domperidon Suspensi 5 mg/ml Botol 60 ml 2,700.00 - -
127 Domperidon Tablet 10 mg Tablet 85.00 - -
128 Domperidon Tablet 10 mg Tablet 91.00 340 30,940.00
129 Epinefrin (Adrenalin) Injeksi 1mg/ml ampul 8,100.00 - -
131 Epinefrin (Adrenalin) Injeksi 1mg/ml ampul 1,408.00 30 42,240.00
133 Ekstarak Beladona Tab 250 mg Tablet 235.00 - -
134 Eritromisin Kapsul 250 mg Tablet 49.00 - -
135 Eritromisin Kapsul 250 mg Tablet 566.00 - -
136 Eritromisin Kapsul 250 mg Kapsul 546.00 - -
137 Eritromisin Syrup 200 mg / 5ml Botol 60 ml 7,700.00 - -
138 Eritromisin Syrup 200 mg / 5ml Botol 60 ml 9,702.00 - -
139 Fenobarbital Injeksi i.m./i.v. 50 mg/ml Amp 1ml 1,800.00 - -
140 Fenobarbital 30 mg Tablet Tablet 171.00 - -
141 Fenol Gliserol Tetes Telinga10% Botol 5 ml 1,008.00 - -
Kotak 30 Amp
144 Fitomenadion (Vit-K1) Injeksi 10 mg/ml 4,250.10 - -
1ml
145 Fitomenadion (Vit-K1)Tab Salut Gula10 mg Tablet 634.00 - -
149 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Amp 1ml 3,417.00 - -
150 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Ampul 3,550.00 - -
151 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Ampul 3,682.00 30 110,460.00
152 Furosemid Injeksi i.v/i.m. 10 mg/ml Amp 2ml 1,829.00 - -
153 Furosemid Tablet 40 mg Tablet 85.00 - -
154 Furosemid Tablet 40 mg Tablet 77.00 100 7,700.00
155 Gameksan Lotion 1% Botol 3,000.00 - -
156 Garam Oralit Serbuk Sachet 28.00 - -
157 Garam Oralit Kombinasi Sachet 264.00 - -
158 Gemfibrozil Kapsul 300 mg Kapsul 289.00 - -
159 Gentamisin Injeksi 40 mg/ml Amp 2ml 3,399.00 - -
160 Gentamisin Injeksi 40 mg/ml Vial 2ml 15,450.00 - -
161 Gentamisin Injeksi 40 mg/ml Ampul 3,509.00 - -
162 Gentamisin salep Kulit 0,1 % Tube 3,400.00 - -
163 Gentamisin Sulfat Tetes Mata 0,3% Botol 5 ml 3,194.00 - -
164 Gentamisin Sulfat Tetes Mata 0,3% Botol 5 ml 4,232.00 14 59,248.00
166 Gentamisin Salep mata( GENOINT) Tube 2,830.00 - -
167 Gentamisin Sulfat Salep mata 0,3 % Tube 2,675.00 24 64,200.00
168 Gentian Violet Larutan 1 % Botol 10 ml 3,410.00 24 81,840.00
169 Gentian Violet Larutan 1 % Botol 10 ml 3,320.00 - -
170 Gentian Violet Larutan 1 % Botol 10 ml 3,344.00 - -
171 Glibenklamida Tablet 5 mg Tablet 56.00 - -
172 Glibenklamida Tablet 5 mg Tablet 92.00 - -
173 Glibenklamida Tablet 5 mg Tablet 119.00 700 83,300.00
174 Gliserilguaiakolat Tablet 100 mg Tablet 34.12 - -
175 Gliserin Liquid Botol 100 ml 5,333.00 - -
176 Glukosa Larutan Infus 5% steril Botol 500 ml 5,200.00 - -
19
HASIL
HARGA
SATUAN (Rp)
OPNAME
179 Guaifenisin Botol 178.00 - -
180 Guaifenisin 100 mg Tablet 88.00 2,000 176,000.00
181 Guaifenisin 100 mg Tablet 233.20 - -
182 Griseofulvin Tablet 125 mg Tablet 209.00 - -
185 Haloperidol Injeksi 5% Vial 4,000.00 - -
186 Haloperidol Injeksi 50 mg/ml Ampul 101,300.00 - -
187 Haloperidol Tablet 1,5 mg Tablet 69.00 - -
188 Haloperidol Tablet 1,5 mg Tablet 66.00 - -
189 Haloperidol Tablet 2 mg Tablet 126.00 - -
191 Haloperidol Tablet 2 mg (lodomer) Tablet 84.00 - -
192 Haloperidol Tablet 2 mg (lodomer) Tablet 90.00 - -
196 Hidrogen Peroksida (H2O2) Larutan 3% Botol 1000 ml 18,700.00 - -
197 Hidrogen Peroksida (H2O2) Larutan 3% Botol 100 ml 4,780.00 - -
198 Hidroklorotiazida Tablet 25 mg Tablet 149.00 - -
199 Hidroklorotiazida Tablet 25 mg Tablet 155.00 - -
200 Hidrokortison krim 2,5% Tube 5 gram 2,798.00 - -
203 Hidrokortison krim1% Tube 5 gram 2,570.00 - -
204 Ibuprofen Suspensi 100 mg/5ml Botol 60 ml 3,499.00 - -
207 Ibuprofen Suspensi 100 mg/5ml Botol 60 ml 2,721.00 46 125,166.00
208 Ibuprofen Tablet 400 mg Tablet 150.00 - -
209 Ibuprofen Tablet 400 mg Tablet 308.00 300 92,400.00
212 Ichtiol Salep Tube 6,820.00 48 327,360.00
213 Ichtiol Salep Tube 5,940.00 - -
214 Isoniazid Tablet 300 mg Tablet 158.00 - -
215 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 275.00 - -
216 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 89.00 - -
217 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 58.00 - -
220 Kalsium Laktat (Kalk) Tablet 5 mg Tablet 59.00 2,400 141,600.00
221 Kaptopril Tablet 12,5 mg Tablet 62.00 - -
222 Kaptopril Tablet 12,5 mg Tablet 59.00 - -
223 Kaptopril Tablet 12,5 mg Tablet 66.00 700 46,200.00
224 Kaptopril Tablet 25 mg Tablet 84.00 - -
229 Karbamazepin Tablet 200 mg Tablet 230.00 - -
230 Karbamazepin Tablet 200 mg Tablet 245.00 - -
231 Ketokonazol Krim 2 % Tube 15 gram 4,700.00 - -
232 Ketokonazol Krim 2 % Tube 2,545.00 - -
233 Ketokonazol Krim 2 % Tube 2,518.00 50 125,900.00
234 Ketokonazol Tablet 200 mg Tablet 300.00 - -

237 Ketoprofen Tablet 100 mg Tablet 608.00 - -
238 Klindamisin Kapsul 150 mg Kapsul 361.00 - -
239 Klindamisin Kapsul 150 mg Kapsul 715.00 - -
240 Kloramfenikol Kapsul 250 mg Kapsul 594.00 - -
241 Kloramfenikol Kapsul 250 mg Kapsul 310.00 - -
242 Kloramfenikol Salep Mata 1 % 5 gram Tube 1,600.00 - -
20
HASIL
HARGA
SATUAN (Rp)
OPNAME
245 Kloramfenikol Salep Mata 1 % 5 gram Tube 2,007.00 48 96,336.00
246 Kloramfenikol salep kulit 2 % Tube 3,091.00 - -
247 Kloramfenikol salep kulit 2 % (Bufacetin) Tube 3,008.00 - -
248 Kloramfenikol salep kulit 2 % (Bufacetin) Tube 3,242.00 24 77,808.00
249 Kloramfenikol Suspensi 125mg/5ml Botol 3,955.00 - -
250 Kloramfenikol Suspensi 125mg/5ml Botol 5,015.00 50 250,750.00
Kloramfenikol Tetes Mata Komb. ( Erlamicetin
251 Botol 15,180.00 38 576,840.00
Plus)
252 Kloramfenikol Tetes Telinga 3 % - 5ml Botol 1,815.00 - -
253 Kloramfenikol Tetes Telinga 1% (Reco) Botol 8,360.00 30 250,800.00
254 Kloramfenikol Tetes Telinga 1% (Erlamycetin) Botol 7,843.00 - -
255 Klorfeniramina Maleat (CTM )Tablet 4 mg Tablet 51.00 - -
257 Klorfeniramina Maleat (CTM )Tablet 4 mg Tablet 66.00 2,000 132,000.00
259 Klorokuin Tablet 150 mg Tablet 107.00 - -
260 Klorpromazin Tablet Salut 100 mg (HCl) Tablet 149.00 - -

266 Klorpromazin Injeksi i.m.25 mg/ml(HCl) Ampul 2ml 1,100.00 - -
267 Klorpromazin Injeksi i.m.25 mg/ml(HCl) Ampul 1,240.00 - -
268 Kodein Tablet 10 mg Tablet 500.00 - -
269 Kodein Tablet 10 mg Tablet 571.00 - -
270 Kodein Tablet 20 mg Tablet 1,100.00 - -
271 Tablet 138.00 - -
(dewasa) 80mg:
Kombinasi
272 Tablet 138.00 - -
Sulfametoksazol 400mg +Trimetoprim
Kotrimoksazol DOEN (dewasa) Kombinasi 80mg:
273 Tablet 151.00 - -
274 Tablet 125.00 800 100,000.00
(dewasa) 80mg:
Kombinasi
275 Tablet 133.00 - -
(pediatrik) 80mg:
Kombinasi
276 Tablet 76.00 - -
Sulmetoksazol
Kotrimoksazol 100 mg + Kombi
Suspensi Trimetoprim 20 mg
: Sulfame-
277 Botol 60 ml 2,190.00 - -
toksazol 20 mg + Trimetoprim 40mg/5ml
Kotrimoksazol Suspensi Kombi : Sulfame-
278 Botol 60 ml 2,140.00 - -
Kotrimoksazol Suspensi Kombi tiap 5ml :
279 Sulfematoksazol 200 mg + Trimetoprim 40mg Botol 60 ml 2,052.00 - -
(susp 240 mg)
280 Kuinin (Kina) Tablet 200 mg Tablet 670.00 - -
281 Kuinin Injeksi i.v. 25% (sebagai 2HCl) Amp 2 ml 6,200.00 - -
282 Kuinin Tablet 222 mg (H2SO4.7H2O) Tablet 540.00 - -
283 Lansoprazol Kapsul 30 mg Kapsul 473.00 - -
284 Levertran Salep pot 3,599.00 - -

285 Levertran Salep Pot 4,268.00 24 102,432.00
286 Levofloksasin Tablet 500 mg Tablet 528.00 - -
287 Lidokain Injeksi 2% Ampul 2 ml 839.00 - -
288 Lidokain Injeksi 2% Ampul 860.00 - -
289 Lidokain Injeksi 2% Ampul 1,221.00 - -
Lidokain Injeksi 2% + Epinefrin 1:80.000 Injeksi
290 Ampul 1,145.00 - -
2Lidokain
ml Injeksi 2% + Epinefrin 1:80.000 Injeksi
291 Ampul 1,222.00 - -
2 ml
292 Lidokain Spray (Xylocain Spray) Botol 177,216.00 - -
293 Linkomisin Kapsul 500 mg Kapsul 650.00 - -
294 Lisol Larutan Antiseptik Botol 1000 ml 41,000.00 1 41,000.00
295 Loperamid tablet 2 mg Tablet 187.00 1,200 224,400.00
296 Loperamid tablet 2 mg Tablet 374.00 - -
297 Magnesium Sulfat Injeksi (IV)20%-25ml Vial 2,800.00 - -
298 Magnesium Sulfat Injeksi (IV)20%-25ml Vial 3,200.00 - -
299 Magnesium Sulfat Injeksi (IV)40% Ampul 3,796.00 10 37,960.00
300 Mebendazol Syrup 100 mg/5ml Botol 30 ml 3,400.00 - -
301 Metampiron Injeksi 250 mg Amp 2 ml 1,333.00 - -
302 Metformin HCl Tablet 500 mg Tablet 100.00 - -
303 Metformin HCl Tablet 500 mg Tablet 102.00 700 71,400.00
304 Metformin HCl Tablet 850 mg Tablet 150.00 - -
305 Metilergometrin Maleat Injeksi 0,2 mg/ml Ampul 2,684.00 - -
21
HASIL
HARGA
SATUAN (Rp)
OPNAME
306 Metilergometrin Maleat Injeksi 0,2 mg/ml Ampul 2,959.00 100 295,900.00
307 Metilergometrin Maleat Tab Salut 0,125 mg Tablet 154.00 - -
308 Metilergometrin Maleat Tab Salut 0,125 mg Tablet 210.00 1,000 210,000.00
309 Metilergometrin Maleat Tab Salut 0,125 mg Tablet 224.00 - -
Kotak 1 Vial 8
310 Metilprednisolon Injeksi 500 mg 93,393.00 - -
ml
311 Metilprednisolon kaplet 4 mg Tablet 150.00 - -
312 Metilprednisolon kaplet 4 mg Tablet 134.00 - -
313 Metilprednisolon kaplet 4 mg Tablet 143.00 1,200 171,600.00
314 Metilprednisolon kaplet 8 mg Kaplet 309.00 - -
315 Metoklorpramid syrup 5 mg/5 ml Botol 2,530.00 - -
316 Metoklorpramid 5 mg Tab Tablet 121.00 - -
320 Metronidazol Tablet 250 mg Tablet 110.00 - -
324 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram 3,000.00 - -
325 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram 3,250.00 - -
326 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram 3,414.00 30 102,420.00
327 Natrium Diklofenak Tablet 25 mg Tablet 133.00 - -
330 Natrium Diklofenak Tablet 25 mg Tablet 137.00 90 12,330.00
331 Natrium Klorida Larutan Infus 0,9% Botol 500 ml 4,700.00 - -
332 Natrium Klorida Larutan Infus 0,9% Botol 500 ml 6,410.00 40 256,400.00
333 Natrium Klorida Larutan Infus 0,9% Botol 500 ml 6,840.00 - -
334 Natrium Tiroxin (Etyrox) Tablet 850.00 - -
335 N-Asetil sistein Kapsul 426.00 - -
338 Nistatin Tablet Salut 500.000 IU/g Tablet 640.00 - -
342 Nistatin vaginal Tablet 100.000 IU/g Tablet 480.00 - -
345 Obat Anti Tuberkulosis FDC Kategori 1 Paket 359,990.00 - -
349 Obat Anti Tuberkulosis FDC Kategori 2 Paket 1,199,985.00 - -
351 Obat Anti Tuberkulosis FDC Kategori Anak Paket 214,990.00 - -
354 Obat Anti Tuberkulosis FDC sisipan Paket 160,000.00 - -
355 Obat Anti Tuberkulosis Kategori 1 Paket 288,199.00 - -
356 Obat Batuk Hitam(O.B.H.) cairan Molex Botol 100 ml 4,840.00 48 232,320.00
357 Obat Batuk Hitam(O.B.H.) cairan Botol 120 ml 5,735.00 - -
358 Obat Batuk Hitam(O.B.H.) cairan Molex Botol 120 ml 5,500.00 - -
359 Obat Batuk Kombinasi (Hustab) tablet Tablet 434.00 - -
360 Obat Batuk Kombinasi (Hustab) tablet Tablet 429.00 - -
361 Obat Batuk Pilek Kombinasi (Intunal Syrup) Botol 16,500.00 - -
362 Ofloxacin Tablet 400 mg Tablet 650.00 - -
363 Oksitetrasiklin HCl Salep Mata 1% Tube 3,5 g 3,220.00 - -
364 Oksitetrasiklin HCl Salep Mata 1% Tube 3,5 g 2,668.00 - -
365 Oksitosin Injeksi 10 IU/ml-1ml ampul 2,200.00 - -
366 Oksitosin Injeksi 10 IU/ml-1ml Ampul 1,900.00 - -
367 Oksitosin Injeksi 10 IU/ml-1ml Ampul 1,199.00 100 119,900.00
368 Omeprazol Kapsul 20 mg Kapsul 211.00 - -
370 Omeprazol Kapsul 20 mg Kapsul 341.00 500 170,500.00
372 Papaverin Tablet 40 mg Tablet 100.00 - -
373 Papaverin Tablet 40 mg Tablet 298.00 - -
374 Parasetamol Drops Botol 15 ml 5,200.00 - -
375 Parasetamol Drops Botol 15 ml 6,649.00 - -
22
HASIL
HARGA
SATUAN (Rp)
OPNAME
376 Parasetamol Syrup 120 mg/ 5ml Botol 60 ml 1,438.00 - -
380 Parasetamol Syrup 120 mg/ 5ml Botol 60 ml 1,181.00 40 47,240.00
381 Parasetamol Tablet 500 mg Tablet 79.00 - -
382 Parasetamol Tablet 500 mg Tablet 56.00 - -

383 Parasetamol Tablet 500 mg Tablet 53.00 1,000 53,000.00
384 Piracetam Injeksi 3g/15ml Amp 15ml 13,750.00 - -
385 Piracetam Tablet 400 mg Tablet 194.00 - -
386 Pirantel Syrup 125 mg/5ml Botol 60 ml 8,360.00 - -
387 Pirantel Tablet score (base) 125 mg Tablet 298.00 - -
388 Pirantel Tablet score (base) 125 mg Tablet 291.00 - -
389 Pirazinamid Tablet 500 mg Tablet 208.00 - -
390 Piridoksin (Vitamin B6) inj 100 mg/ml ampul 1,008.00 - -
391 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Botol 100 Tablet 11,000.00 - -
392 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) tablet 45.00 - -
393 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Tablet 123.00 - -
394 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Tablet 131.00 790 103,490.00
395 Piroxicam Tablet 10 mg Tablet 84.00 - -
396 Piroxicam Tablet 10 mg Tablet 130.00 - -
397 Povidon Iodida Larutan 10% Botol 30 ml 2,163.00 - -
398 Povidon Iodida Larutan 10% botol 60 ml 6,550.00 - -
404 Prednison Tablet 5 mg Tablet 114.00 - -
405 Prednison Tablet 5 mg Kaplet 96.00 - -
406 Prednison Tablet 5 mg Tablet 68.00 - -
407 Prednison Tablet 5 mg Tablet 73.00 800 58,400.00
408 Primakuin Tablet Tablet 224.00 - -
409 Prokain Benzil Penisilin G.Injeksi 3 jt IU/vial Vial 7,190.00 - -
410 Prokain Penisillin inj Vial 6,017.00 - -
411 Propanolol Tablet 10 mg (HCl) Tablet 65.00 - -
412 Propanolol Tablet 10 mg (HCl) Tablet 60.00 - -
413 Propiltiourasil Tablet 100 mg Tablet 319.00 - -
414 RanitidinTablet 150 mg Tablet 98.00 - -
415 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 50 Kapsul 13,000.00 - -
416 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 50 Kapsul 14,200.00 - -
417 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Kapsul 519.20 - -

419 Rifampisin Tablet Salut 450 mg Tablet 789.00 - -
420 Ringer Laktat Larutan Infus Botol 500 ml 5,200.00 - -
422 Ringer Laktat Larutan Infus Botol 500 ml 7,630.00 40 305,200.00
423 Risperidon Tablet 1 mg Kapsul 1,500.00 - -
424 Risperidon Tablet 2 mg Kapsul 1,008.00 - -
425 Risperidon Tablet 2 mg Tablet 495.00 - -
428 Salbutamol Tablet 2 mg (sebagai Sulfat) Tablet 59.00 - -
429 Salbutamol Tablet 2 mg (sebagai Sulfat) tablet 66.00 - -
430 Salbutamol Tablet 2 mg (sebagai Sulfat) tablet 63.00 450 28,350.00
433 Salbutamol
Salep Tablet 4 mg (sebagai Sulfat)
2-4 ,Kombinasi: Tablet 70.00 - -
434 Asam Salisilat 2% + Belerang endap
Salep 2-4 ,Kombinasi: Pot 30 gr 2,000.00 - -
435 4% Asam Salisilat 2% + Belerang endap Tube 2,429.00 - -
436 4% Asam Salisilat 2% + Belerang endap Pot 2,621.00 - -
437 4% Asam Salisilat 2% + Belerang endap Pot 2,797.00 24 67,128.00
438 4%
Salisil Bedak 2% Ktk 50 gram 1,250.00 - -
439 Salisil Bedak 2% kotak 1,025.00 - -
440 Salisil Bedak 2% Kotak 1,020.00 - -
441 Salisil Bedak 2% Botol 50 g 4,525.00 - -
442 Salisil Bedak 2% Botol 50 g 4,543.00 48 218,064.00
443 Sefaleksin Kapsul 500 mg Tablet 1,000.00 - -
23
HASIL
HARGA
SATUAN (Rp)
OPNAME
444 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg Ampul 1,104.00 35 38,640.00
445 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg Ampul 1,098.00 - -
446 Sianokobalamin (Vit-B12) Tablet 50 mcg Tablet 57.00 - -
448 Sianokobalamin (Vit-B12) Tablet 50 mcg Tablet 46.00 200 9,200.00
450 Simvastatin Tablet 10 mg tablet 131.00 - -
451 Simvastatin Tablet 10 mg Tablet 110.00 - -
452 Simvastatin Tablet 10 mg Tablet 117.00 250 29,250.00
453 Simvastatin Tablet 20 mg Tablet 391.00 - -
454 Simvastatin Tablet 20 mg tablet 252.00 - -
455 Siprofloksasin Tablet 500 mg (sebagai HCl) Tablet 255.00 - -
456 Siprofloksasin Tablet scored 500 mg Tablet 281.00 - -
459 Siprofloksasin Tablet scored 500 mg Tablet 1,188.00 700 831,600.00
460 Sulfasetamida Natrium Tetes Mata 15% Botol 5ml 1,428.00 - -
461 Tetrakain HCl Tetes Mata 0,5% Botol @ 5ml 11,500.00 - -
462 Tetrasiklin Kapsul 250 mg Kapsul 149.00 - -
463 Tetrasiklin Kapsul 500 mg Kapsul 300.00 - -
464 Tetrasiklin Kapsul 500 mg Tablet 310.00 - -
465 Tetrasiklin Kapsul 500 mg Tablet 323.00 - -
466 Tiamin HCl (Vitamin B1) Tablet Kapsul 380.00 - -
467 Tiamin HCl (Vitamin B1) Tablet Tablet 81.00 - -
470 Tramadol Injeksi 50 mg/ml ampul 2,395.00 - -
472 Tramadol Kapsul 50 mg Kapsul 322.00 - -
474 Triheksifenidil Tablet 2 mg Tablet 80.00 - -
477 Ventolin nebulizer Ampul 12,320.00 - -
478 Vitamin B Kompleks Tablet Tablet 107.00 - -
482 Zinc Tablet 20 mg Tablet 474.00 - -
483 Zinc Tablet dispersible 20 mg Tablet 514.00 - -
484 Zinc Tablet dispersible 20 mg Tablet 524.00 - -
485 Ongkir - - - -
- - - -
OBAT GIGI - - - -
1 Calplus Tube 333,830.00 - -
2 Calsium Hidroksi Pasta ( Calplus) Pack 330,491.70 - -
3 Caviton (Temporary Stoping Fleker) Pot 184,240.00 - -
4 Caviton (Temporary Stoping Fleker) Pot 182,397.60 - -
5 CHKM (Monokloramkamfer Menthol Cairan) Botol 77,030.00 - -
6 CHKM (Monokloramkamfer Menthol Cairan) Botol 76,259.70 - -
7 Cold Spray Botol 352,000.00 - -
8 Devitalisasi Pasta (Pulp X) Botol 256,790.00 - -
9 Devitalisasi Pasta NON Arsen ( Devita) Pot 259,996.00 - -
10 Eugenol cairan Botol 18,100.00 - -
11 Glass Ionomer Cement Set 395,000.00 - -
12 Glass Ionomer (Ketac Universal) Botol 761,390.00 - -

13 Glass Ionomer (Ketac Universal) Botol 658,845.00 - -
14 Mummipaying Pasta (Cresotin Pasta) Tube 309,310.00 - -
15 Mummipaying Pasta (Cresotin Pasta) Pot 262,350.00 - -
16 Semen Seng Posfat Sebuk / Cair Botol 30gr 93,500.00 - -
17 Zink Cement (Eliet Cement) Botol 197,730.00 - -
18 Zink Cement (Eliet Cement) Botol 195,800.00 - -
- - - -
1 Alat Suntik Sekali Pakai 0,05 ml pieces 1,354.00 - -
2 Alat Suntik Sekali Pakai 0,5 ml pieces 1,175.00 - -
3 Alat Suntik Sekali Pakai 1 ml Pieces 762.00 - -
4 Alat Suntik Sekali Pakai 1 cc Pieces 689.86 60 41,391.60
5 Alat Suntik Sekali Pakai 2,5 cc Pieces 669.80 - -
24
HASIL
HARGA
SATUAN (Rp)
OPNAME
6 Alat Suntik Sekali Pakai 3 ml pcs 1,038.00 - -
7 Alat Suntik Sekali Pakai 3 ml pieces 916.00 - -
8 Alat Suntik Sekali Pakai 3 ml pieces 1,212.00 - -
9 Alat Suntik Sekali Pakai 3 cc pieces 669.80 200 133,960.00
10 Alat Suntik Sekali Pakai 5 ml pcs 1,038.00 - -
11 Alat Suntik Sekali Pakai 5 ml pieces 1,030.00 - -
12 Alat Suntik Sekali Pakai 5 cc pieces 804.07 60 48,244.20
13 Aqua jely steril 5 gr Sachet 2,566.00 - -
14 Bisturi (BBraun steril scalpel blades #18) pcs 3,000.00 - -
Catgut / Benang Bedah 2/0, 26 mm (Gabler
15 pieces 64,595.67 - -
Med)
16 pcs 60,438.84 - -
Med)
17 pcs 50,063.09 - -
Med)
Catgut / Benang Bedah 2/0, 1/2 taper 30 mm
18 pcs 58,839.90 - -
(Gabler Med)
19 Cutgut 2/0,90 cm.1/2TP ( Chromic 2/0) pcs 49,619.29 24 1,190,862.96
20 Catgut / Benang Bedah 3/0 Rol 23,600.00 - -
21 Catgut / Benang Bedah 3/0 pcs 58,355.51 - -
22 Catgut / Benang Bedah 3/0 pieces 42,605.12 - -
23 Cutgut 3/0 ,1/2 TP 22mm,75-2PTRO20EE pieces 55,000.00 36 1,980,000.00
24 Folley Catheter No. 18 Pieces 8,495.00 - -
25 Folley Catheter No. 18 Pieces 11,000.00 5 55,000.00
26 Folley Catheter No. 18 pieces 18,450.00 - -
27 Folley Catheter 2- WAY No. 18 pieces 11,565.00 - -
28 Gel Catheter Tube 82,500.00 - -
29 Hand Scone Steril #7,0 (Aximed) Pasang 7,872.00 - -
30 Hand Scone Steril #7,0 (Aximed) Pcs 6,595.00 - -
31 Hand Scone Steril #7,5 (Aximed) Pieces 7,600.00 - -
32 Hand Scone Steril #7,5 (medict dent) pasang 5,000.00 - -
Handscone Steril ( Mas Surgical Gloves 7,5
33 pasang 8,888.00 - -
steril)
34 Hand Scone Steril #7,5 (KISMED) pcs 6,595.00 - -
35 Hand Scone / Sarung Tangan Non Steril pcs 69.85 - -
36 Hand Scone Non Steril # L (Aximed) pcs 462.00 - -
37 Hand Scone Non Steril # L (LIGHTY mas latex) pcs 462.00 - -

38 pcs 462.00 - -
latex)
39 Handscone Non Steril (L ) (Mas pree powdered) pcs 522.06 - -
40 Hand Scone Non Steril # M (Aximed) pcs 462.00 - -
41 Hand Scone Non Steril # M (kismed mask latex) pcs 462.00 - -
42 Handscone Non Steril (M ) (Mas pree powdered) pcs 522.06 - -
43 Handscone Non Steril 7.5 ( Mask Surgical) Pasang 8,701.00 - -

44 Infusion Set Anak (Aximed) Set 5,100.00 - -
45 Infusion Set Anak set 4,884.00 - -
46 Infusion Set Anak pcs 5,661.00 - -
48 Infusion Set Anak pcs 5,415.00 5 27,075.00
49 Infusion Set Dewasa Set 3,500.00 - -
52 Infusion Set Dewasa pcs 5,445.00 - -
54 Infusion Set Dewasa (y - TYPE) pcs 8,061.00 10 80,610.00
55 IV Canula non inj & wing no 20 (Eskamed) Pieces 10,386.21 - -
58 IV Catheter No. 20 G pcs 7,787.50 - -
59 IV Catheter NP No. 20 G Pieces 6,105.00 - -
60 IV Catheter No. 20 G Pieces 10,000.00 - -
62 IV Catheter No. 20 G pieces 10,483.00 - -
25
HASIL
HARGA
SATUAN (Rp)
OPNAME
67 IV Catheter No. 22 G pieces 12,100.00 20 242,000.00
72 Kapas Berlemak 500 gram Bungkus 17,250.00 - -
73 Kapas Pembalut / Absorben 250 gram Bungkus 7,475.00 - -
74 Kapas Pembalut / Absorben 250 gram Bungkus 12,400.00 - -
75 Kapas Pembalut / Absorben 250 gram Roll 12,500.00 - -
76 Kapas Pembalut / Absorben 250 gram Roll 24,000.00 4 96,000.00
77 Kapas Pembalut / Absorben 250 gram Roll 20,600.00 - -
78 Kassa Hidrofil Steril Ukuran 16 x 16 cm Bungkus 5,750.00 - -
79 Kassa Hidrofil Steril Ukuran 16 x 16 cm box 8,000.00 - -
80 Kassa Hidrofil Steril Ukuran 16 x 16 cm kotak 7,900.00 - -
81 Kassa Hidrofil Steril Ukuran 16 x 16 cm kotak 7,370.00 29 213,730.00
82 Kassa Hidrofil Steril Ukuran 18 x 22 cm Kotak 4,750.00 - -
83 Kassa Hidrofil Steril Ukuran 18 x 22 cm box 5,900.00 - -
84 Kassa Hidrofil Steril Ukuran 18 x 22 cm Box 7,500.00 30 225,000.00
85 Kassa Hidrofil Ukuran 36 x 10 cm Rol 2,415.00 - -
88 Kassa Hidrofil Ukuran 40 yard x 80 cm Rol 256,250.00 - -
89 Kassa Hidrofil Ukuran 40 yard x 80 cm Roll 250,250.00 - -
90 Kassa Pembalut Hidrofil 4m x 10cm Rol 607.00 - -
Kassa Pembalut Hidrofil 4m x 10cm (SN
91 Rol 33,000.00 - -
Medika)
92 Kassa Pembalut Hidrofil 4m x 10cm Rol 1,500.00 - -
93 Kassa Pembalut Hidrofil 4m x 10cm Rol 2,300.00 - -
Kassa Pembalut Hidrofil 4m x 7,5cm (SN
94 Rol 27,830.00 - -
Medika)
95 Kassa Pembalut Hidrofil 4m x 5 cm Rol 607.00 50 30,350.00
96 Kassa Pembalut Hidrofil 4m x 5 cm Rol 750.00 - -
97 Kassa Pembalut Hidrofil 4m x 5 cm Rol 1,100.00 - -
100 Kassa Pembalut elastis 10 cmx4,55m Rol 33,000.00 - -
101 Kassa Pembalut elastis 7,5 cmx4,55m Rol 27,830.00 - -
102 Masker pcs 1,125.00 - -
103 Masker (Aximed Face Mask Ear Loop ) pcs 396.00 - -
104 Masker Face Mask -30ply / Ear Loop ) pcs 726.00 - -
105 Masker N95 pcs 6,512.00 - -
106 Masker N95 pcs 115,000.00 - -
107 Masker Jilbab pcs 396.00 - -
108 Masker Jilbab (Mas surgical) box 41,019.00 - -
109 Masker Bedah pcs 6,500.00 - -
110 masker bioaxi face mask ear loop pcs 4,800.00 - -
111 Pembalut Gips 3 inch Rol 23,500.00 - -
112 Pembalut Gips 6 inch Rol 42,000.00 - -
113 Plester 5 yard x 2 inch Rol 23,618.00 - -
114 Plester 5 yard x 2 inch Roll 35,532.00 - -
115 Plester Rol Kain 2.5 cm x 1 m ( Hansaplast) Rol 5,017.00 - -
116 Plester Leukoplast 7,5cm x 4,5 cm Roll 35,532.00 - -

117 Pharmaplast (pharmafix) box 27,000.00 - -
Plester Pharmaplast ( PHARMAFIX) 5 cm x 500
118 Rol 16,500.00 - -
cm
119 Paper tape /2,5cm x 9,14m Rol 11,583.00 - -
120 Paper tape / 1,25cm x 9,14m Rol 4,900.00 - -
121 Paper tape / 1,25cm x 9,14m Rol 7,029.00 - -
122 Safety Box pcs 15,708.00 - -
123 Silk (Benang Bedah) 3/0 + Jarum rol 705.55 - -
124 Silk (Benang Bedah) 3/0 + Jarum pcs 48,240.17 - -
125 Silk 3/0.1/2 18mm 75cm-2PTR5261E pcs 39,481.00 - -
126 Silk 3/0.1/2 18mm 75cm-2PTR5261E pcs 34,607.26 24 830,574.24
127 Urine Bag Set 3,600.00 - -
26
HASIL
HARGA
SATUAN (Rp)
OPNAME
128 Urine Bag ( Aximed TVW Hanger) pcs 5,128.00 - -
129 Urine Bag ( Aximed TVW Hanger) pcs 5,500.00 - -
130 Urine Bag ( trode medical trourocol plus) pcs 8,070.00 - -
131 Urine Bag ( AXIMED) pcs 5,785.00 - -
132 Wing Needle No. 21 G pcs 1,400.00 - -
135 Rapid Test Vikia HIV 1/2 Kit 487,500.00 - -
136 Larvasida Galon 3,500,000.00 - -
137 Larvasida (obat DBD / Abate) kg 140,000.00 - -
138 Larvasida Sumilar kg 1,500,000.00 - -
139 Accu-Chek Test Strip kotak 420,000.00 - -
140 KIT Emergensi P3K Posko Mudik Paket 1,000,000.00 - -
141 Ongkir - - - -
- - - -
1 Antapulgit NEW ANTIDES Tablet 136.00 - -
2 Aqua Pro Injection (OTSU SWI 25 Ml) Ampul 2,750.00 - -
3 Aqua Pro Injection (OTSU SWI 25 Ml) Ampul 2,860.00 - -
4 Betason N Tube 9,182.00 - -
5 Becefort Syrup , Multivitamin anak Botol 60 ml 15,686.00 - -
6 Becefort Syrup , Multivitamin anak Botol 60 ml 19,470.00 24 467,280.00
7 Becefort Syrup , Multivitamin anak Botol 60 ml 17,358.00 - -
8 Multivitamin Dewasa Tablet 1,743.50 100 174,350.00
9 Multivitamin Dewasa (AMAROPO) Tablet 2,277.00 - -
Kaptab Salut
10 Bisakodil 5 mg 300.00 - -
Selaput
11 Cairan Antiseptik 1000 ml (A. Class) Botol 1000 ml 344,048.00 - -
12 Cairan Antiseptik ( Hansanitizer 25 L) Jerigen 25 L 3,663,000.00 - -
13 Chloramex - kloramfenikol 500mg Tablet 1,007.00 - -
14 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet 2,756.44 - -
15 Glimipiride Tablet 3 mg tablet 319.18 - -

16 Glukonas Kalsikus Inj 10% Ampul 19,750.00 - -
17 Hemafort tab kombinasi Tablet 757.00 - -
18 HIV Test Box 487,500.00 - -
19 Insektisida Fogging Liter 200,000.00 - -
20 Mineral mix sachet 68.00 - -
21 Mineral mix sachet 2,805.00 - -
22 Mouthiece Smolkilizer Box 1,050,000.00 - -
23 RDT Malaria Box 476,372.60 - -
24 RDT COVID-19 - AntiBody Pcs 245,000.00 - -
27 RDT COVID-19 - AntiGEN Pcs 300,000.00 - -
28 Rivanol 0,1% 300 ml Botol 3,000.00 - -
29 Rivanol 0,1% 300 ml Botol 3,400.00 - -
30 Ventolin nebulizer Botol 12,320.00 - -
31 Ventolin nebulizer Ampul 10,373.00 - -
32 Glucose Botol 1,370,000.00 - -
33 Glucose Botol 880,674.30 - -
34 Acid/Uric Botol 1,860,000.00 - -
35 Acid/Uric Botol 1,851,894.00 - -
36 HDL Cholesterol Botol 4,440,000.00 - -
37 LDL Cholesterol Botol 5,160,000.00 - -
38 Cholesterol Botol 2,093,300.00 - -
39 Ongkir - - - -
- - - -
VAKSIN - - - -
1 ADS 0,05 ML (Union) Pcs 1,379.80 - -
2 ADS 0,5 ML (Union) Pcs 1,249.45 - -
3 Anti Bisa Ular Serum Vial 274,000.00 - -
4 Anti Bisa Ular Serum (Biosave) Vial 430,000.00 - -
7 Anti Tetanus Serum 1500 IU Ampul 59,004.00 - -
8 Anti Tetanus Serum 1500 UI (biosat-1,5) Ampul 115,000.00 - -
27
HASIL
HARGA
SATUAN (Rp)
OPNAME
11 Safety Box Stera Sharp 7 Ltr Pcs 61,600.00 - -
12 Safety Box Stera Sharp 7 Ltr Pcs 15,840.00 - -
13 Spuit 5 ML (aximed) pcs 1,030.00 - -
-
SUB JUMLAH OBAT, BMHP, VAKSIN
15,345,372.00
APBD II
2 OBAT - OBATAN APBD I

( PROPINSI )
SUB OBAT -OBATAN
1 Albendazol Tablet Kunyah 400 mg Tablet 402.00 100 40,200.00
2 Alkohol 70 % - 100 ml botol 300 ml 9,800.00 - -
3 Alkohol 70 % - 100 ml botol 300 ml 21,500.00 - -
5 Aminofilin Tablet 200 mg Tablet 91.00 - -
7 Artemether Injeksi 80 mg/ml Ampul 25,490.00 - -
9 Artesunate Injeksi vial 60 mg Vial 39,000.00 - -
10 Artesunate Injeksi vial 60 mg Vial 57,585.00 - -
15 Azitromicin Tablet 500 mg Tablet 380.00 - -
Besi (II) Sulfat 200 mg + Asam Folat 0,25mg

16 Tablet 354.00 19,740 6,987,960.00
Tablet (tablet tambah darah kombinasi)

20 Deksametason Tablet Tablet 32.00 - -
24 Fenobarbital Injeksi i.m./i.v. 50 mg/ml Amp 1ml 1,800.00 - -
26 Garam Oralit sachet 257.00 250 64,250.00
27 Gentamisin Injeksi 40 mg/ml Ampul 617.00 - -
32 Kaptopril tab 12,5 mg Tablet 66.00 - -
33 Kloramfenikol Tetes Mata ( DECACETIN) Botol 3,250.00 - -
36 Klorokuin Tablet 150 mg Tablet 15.06 - -
Kotrimoksazol Suspensi Kombi : Sulfame-
37 Botol 60 ml 2,286.00 - -
39 Loperamid tablet 2 mg Tablet 80.00 - -
40 Magnesium Sulfat Injeksi (IV)40% Ampul 3,650.00 - -
41 Magnesium Sulfat Injeksi (IV)40% Ampul 3,796.00 - -
42 Nifedipin Tablet 10 mg Tablet 110.00 - -
44 Nifedipin Tablet 10 mg Tablet 108.00 - -
45 Obat Anti Tuberkulosis Kombipak Kategori 1 Paket 317,018.00 - -

55 Oksitosin Injeksi 10 IU/ml-1ml Ampul 1,199.00 - -
57 Osetalmivir Kapsul 100 mg Kapsul 129.69 - -
58 Oxytetrasiklin salep mata 1 % tube 2,500.00 - -
61 Primakuin Tablet Tablet 224.00 - -
62 Ranitidin HCl Injeksi 25 mg/ml Ampul 1,155.00 - -

28
HASIL
HARGA
SATUAN (Rp)
OPNAME
WIDA KDNI ( D 2,5 % + KCl 0,15% + NaCl
70 Botol 11,435.00 - -
0,45%)
WIDA KDN2 ( D 2,5 % + KCl 0,3% + NaCl
71 Botol 11,435.00 - -
0,45%)
72 WIDA KNI ( KCl 0,15% + NaCl 0,9%) Botol 11,011.00 - -
74 WIDA KN2 ( KCl 0,3% + NaCl 09%) Botol 11,011.00 - -
75 Vitamin B Kompleks Tablet 117.00 1,200 140,400.00
76 Zinc Tablet Tablet 524.00 50 26,200.00
- - - -
1 Alat Suntik Sekali Pakai 3 cc pieces 835.00 - -
2 Alat Suntik Sekali Pakai 5 cc pieces 889.00 - -
3 Alkohol Swab pcs 169.88 - -
4 Cutgut 2/0 pcs 33,645.00 - -
12 Kassa Hidrofil Ukuran 40 yard x 80 cm Roll 255,750.00 - -
13 Masker pcs 761.64 - -
14 Masker pcs 339.90 - -
15 Oxygen Nasal Cannula (Adult) pcs 12,200.00 - -
16 Oxygen Nasal Cannula (Child) pcs 12,140.00 - -
17 Virus Transport Media ( VTM) pcs 39,000.00 -
18 Under Pad pcs 8,295.00 - -
19 Urine Bag pcs 6,036.00 - -
- - - -
1 Cefotaksim Injeksi Vial 4,500.00 - -
2 Chloramex - kloramfenikol 500mg Tablet 1,007.00 - -
3 Clorampecorth Tube 9,085.00 - -
4 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet 2,134.00 27 57,618.00
5 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet 2,000.00 - -
6 Glukonas Kalsikus Inj 10% ampul 9,955.00 - -
7 Glukonas Kalsikus Inj 10% Ampul 10,351.00 - -
8 Mersibion inj Ampul 4,400.00 - -
9 Mineral mix sachet 2,920.00 - -
10 Urea ( Soft U derm) Krim 10% tube 3,941.00 - -
11 Spironolakton tab Tablet 244.00 - -
- - - -
VAKSIN - - - -
1 ADS 0,05 ML (Oneject) Pcs 1,650.00 - -
4 ADS 0,05 ML (Skifa) Pcs 1,354.00 - -
6 ADS 0,5 ML (Oneject) pcs 1,210.00 - -
7 ADS 0,5 ML (Skifa) Pcs 1,175.00 - -
8 ADS 0,5 ML (Skifa) Pcs 1,118.18 - -
9 ADS 0,5 ML (Skifa) Pcs 1,240.00 - -
10 ADS 0,5 ML Pcs 1,185.00 - -
11 ADS 5 ML (Skifa) Pcs 1,470.00 - -
12 ADS 5 ML (Skifa) Pcs 1,580.00 - -
13 Alkohol Swab Pcs 95.00 - -
14 BCG Vial 59,590.00 - -
15 BCG Vial 56,360.00 - -
16 BCG Vial 60,140.00 - -
17 Corona Vaccin Vial 211,282.00 - -
18 Campak Vaksin Vial 28,204.00 - -
19 DPT - HB -HiB Vial 76,620.00 - -
20 DPT - HB -HiB Vial 71,810.00 - -
21 DT Vial 16,180.00 - -
22 DT Vial 16,360.00 - -
23 DT Vial 17,450.00 - -
24 Hepatitis B pcs 20,900.00 - -
29
HASIL
HARGA
SATUAN (Rp)
OPNAME
25 Hepatitis B Pcs 23,270.00 - -
26 Polio Injeksi Vial 34,815.00 - -
29 Polio Vaksin Vial 19,954.00 - -
30 Polio Vaksin Vial 18,140.00 - -
31 Polio Oral + Droper Vial 19,350.00 - -
32 Safety Box Pcs 15,708.00 - -
33 Safety Box Pcs 24,122.00 - -
34 Safety Box Pcs 21,929.00 - -
35 Safety Box Pcs 22,433.00 - -
36 Spuit 5 ML (Oneject) Pcs 1,705.00 - -
37 Td Vial 16,500.00 - -
38 Td Vial 16,480.00 - -
39 Tetanus Toksoid (TT) Vial 14,498.00 - -
40 Vaksin MR Vial 141,648.00 - -
41 Vaksin MR Vial 151,150.00 - -
42 Vaksin Anti Rabies (VAR) Vial 70,000.00 - -
45 HB Uniject Vial 23,270.00 - -
46 HB Uniject Vial 20,900.00 - -
SUB JUMLAH OBAT-OBATAN,VAKSIN

7,316,628.00
DAN BMHP APBD I (PROPINSI)
3 BOK
1 Desinfektan Botol - - -
2 Handsanitizer 500 ml Botol 500 ml 81,500.00 - -
3 Hand Scone Steril Pasang 8,250.00 - -
4 Hand Scone Non Steril Pcs 950.00 - -
5 Hazmat Pcs 200,000.00 - -
6 Masker Bedah Pcs 4,000.00 - -
7 Masker Bedah 3 ply (Hijab) Pcs 1,860.00 - -
8 Masker Bedah 3 ply (ear loop) Pcs 1,760.00 - -
9 Masker N-95 Pcs 85,000.00 - -
-
SUB JUMLAH BELANJA BOK -
BAHAN KEPERLUAN
4
LABORATORIUM
1 BHP HIV paket 811,991,100.00 - -

2 BHP Malaria paket 126,000,000.00 - -
3 Botol Sampel Keracunan buah 20,000.00 - -
4 Catride TCM paket 259,175.00 - -
5 Handscone bok @ 50,000.00 - -
6 Holdel Vacuete buah 1,000.00 - -
7 Jarum Vacutener buah 2,000.00 - -
8 Mount piece bok 2,250,000.00 - -
9 Paket Alat Pelindung Diri ( APD) paket 1,500,000.00 - -
10 buah 65,000.00 - -
Saring,Lanset,Alkohol Swab )
11 Pipet test plastik buah 3,000.00 - -
12 Pot Dahak buah 3,000.00 - -
13 Pot Sampel AFP buah 10,000.00 - -
14 Pot Urine buah 5,000.00 - -
15 Rak Tabung Sampel buah 25,000.00 - -
16 RDT DBD bok 1,500,000.00 - -
17 RDT Hepatitis buah 25,000.00 - -
18 Reagen TB paket 500,000.00 - -
19 Safety Bok ADS buah 25,000.00 - -
20 Sampel Cup buah 500.00 - -
21 Slide bok 30,000.00 - -
22 Stick Gula Darah pak 160,000.00 - -
30
HASIL
HARGA
SATUAN (Rp)
OPNAME
23 Tabung Vacuete buah 3,000.00 - -
24 Alat Suntik 3 cc pcs 920.00 - -
25 Alkohol swab pcs 354.00 - -
26 Lancet (Sentry Lancet) pcs 1,650.00 - -
27 RDT HIV Test Kit pcs 11,506.00 - -
28 RDT Malaria Test Kit pcs 13,950.00 - -
29 RDT Syphilis Test Kit pcs 9,020.00 - -
30 Tabung Vacuate (Vacum Tube Steril k3 EDTA) buah 870.00 - -
31 RDT Covid-19 (Eco Test) pcs 135,000.00 - -
32 Virus Transport Media ( VTM) pcs 80,000.00 - -
33 Gown/Apron pcs 70,000.00 10 700,000.00
34 RDT Covid-19 Antibody pcs 75,000.00 - -
35 Face Shield pcs 30,000.00 - -
36 Handscone box@ 120,000.00 3 360,000.00
37 Penutup Kepala pcs 2,500.00 - -
38 Masker N95 pcs 115,000.00 - -
39 Cover All Suit pcs 175,000.00 - -
40 Face Shield pcs 20,000.00 - -
41 Gown/Apron pcs 180,000.00 - -
42 Under Pad pcs 5,500.00 - -
-
-
-
SUB JUMLAH BELANJA BAHAN
1,060,000.00
KEPERLUAN LABORATORIUM
PERALATAN KEBERSIHAN
5
DAN BAHAN PEMBERSIH
1 Sanitarian Bag Buah 3,000 - -

2 Desinfektan Dirigen 5 L 137,000 4 548,000.00
JUMLAH BELANJA PERALATAN

548,000.00
KEBERSIHAN DAN BAHAN PEMBERSIH
6 APBN
Masker polos / motif jenis earloop untuk

1 pcs 5,500 -
Puskesmas
Masker polos / motif jenis headloop untuk

2 pcs 5,500 -
Puskesmas
JUMLAH BELANJA APBN -
J U M L A H TOTAL 24,270,000.00
Demikian Berita Acara Stok Opname ini dibuat, untuk dapat dipergunakan sebagaimana mestinya
MENGETAHUI Kaliasin, 30 April 2021

Kepala UPT. Pengelola Obat
Puskesmas Rawat Inap Tanjungbintang UPT Puskesmas Kaliasin
SUHARTO apt.Ahmad Solich Annas M, S.Farm

NIP. 19661013 198703 1 003 NIP . 19781002 201001 1 011
31
PEMERINTAH KABUPATEN LAMPUNG SELATAN
DAFTAR REALISASI PENAMBAHAN DAN PENGURANGAN BARANG PERSEDIAAN DAERAH
NOMOR : 445/ / IV.03 / IV / 2021

BULAN : APRIL 2021
MUTASI TAMBAH MUTASI KURANG
SALDO Penerimaan Puskesmas dari IFK SALDO Per

NO JENIS BARANG Penggunaan puskesmas KET
Per 1 April 2021 BELANJA Dinas Kabupaten BELANJA
BELANJA
LAIN- 30 April 2021
LAIN-LAIN JUMLAH BARANG RELOKAS JUMLAH
BARANG JASA RELOKASI MODAL LAIN
Barang Belanja Barang JASA Barang Belanja Barang I
Barang Hibah Barang Hibah
dan Jasa dan Jasa
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 OBAT, BMHP, VAKSIN APBD II 17,739,056.00 - - 2,393,684.00 2,393,684.00 15,345,372.00
OBAT, BMHP, VAKSIN APBD I

2 7,364,578.00 - - 47,950.00 47,950.00 7,316,628.00
(PROPINSI)
3 OBAT DAN BMHP BOK - - - - - -
BAHAN KEPERLUAN
4 1,180,000.00 - - 120,000.00 120,000.00 1,060,000.00
LABORATORIUM
5 548,000.00 - - - - 548,000.00
BAHAN PEMBERSIH
6 APBN - - - - - - -
- - -
JUMLAH 26,831,634.00 - - - - - - - - 2,513,684.00 47,950.00 - - 2,561,634.00 24,270,000.00 -
MENGETAHUI Kaliasin, 30 April 2021

NIP. 19720603 199302 1 001 NIP. 19830408 201101 1 003
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS :…................................
JUMLAH PUSTU : 5 (Lima)
BULAN : APRIL 2021
TINGKAT
NO. NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPTIMUM PERMINTAAN PEMBERIAN KET
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14

SUB OBAT -OBATAN

1 - - - - -
anhydrida Tablet 200 mg) Tablet
2 Albendazol Tablet Kunyah 400 mg Tablet - - - - -
3 Albendazol Tablet Kunyah 400 mg Tablet - - - - -
4 Alkohol 70 % - 100 ml Botol 100 ml - - - - -
5 Alkohol 70 % - 100 ml Botol 100 ml - - - - -
6 Alkohol 70 % - 1 L Botol 1 L - - - - -
7 Alkohol 70 & - 1 L Botol 1 L 8 - 8 - 8 10
8 Alkohol 70 & - 1 L Jrg 20 L - - - - -
9 Alopurinol Tablet 100 mg Tablet - - - - -
11 Alopurinol Tablet 100 mg Tablet 490 - 490 - 490 2,000
13 Alprazolam Tablet 1 mg Tablet - - - - -
16 Alprazolam Tablet 0,25 mg Tablet - - - - -
17 Alprazolam Tablet 0,5 mg Tablet - - - - -
18 Ambroxol Tablet 30 mg (Mucos Tab) Tablet 400 - 400 100 300 3,000
19 Aminofilin Injeksi 24 mg/ml Amp 10 ml - - - - -
20 Aminofilin Injeksi 24 mg/ml Ampul - - - - -
21 Aminofilin Tablet 200 mg Tablet - - - - -
22 Aminofilin Tablet 150 mg (Decafil) Tablet - - - - -
23 Aminofilin Tablet 150 mg (Decafil) Tablet 100 - 100 - 100 1,000
24 Amitriptilin Tablet Salut 25 mg (HCl) Tablet - - - - -
27 Amlodipine Tablet 10 mg Tablet - - - - -
LPLPO 33
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14

30 Amlodipine Tablet 10 mg Tablet 900 - 900 - 900 2,000
34 Amlodipine Tablet 5 mg Tablet 570 - 570 200 370 2,000
35 Amoksisilin Kaplet 500 mg Tablet - - - - -
36 Amoksisilin Kaplet 500 mg kaplet - - - - -
37 Amoksisilin Kaplet 500 mg kaplet - - - - -
38 Amoksisilin Kaplet 500 mg kaplet 4,700 - 4,700 300 4,400 2,000
39 Amoksisilin Kapsul 250 mg Kapsul - - - - -
40 Amoksisilin Kapsul 250 mg kapsul - - - - -
43 Amoksisilin Syrup Kering 125 mg/5ml Botol 60 ml - - - - -
47 Amoksisilin Syrup Kering 250 mg/5ml Botol 60 ml 55 - 55 20 35 100
48 Ampisilin Serbuk Injeksi im/iv. 1000 mg/vial Kotak 10 Vial - - - - -
49 Tablet - - - - -
AlOH 200 DOEN
Antasida mg + MgOH
Tablet200 mg Kombinasi :
Kunyah,
50 Tablet - - - - -
51 - - - - -
AlOH 200 mg + MgOH 200 mg Tablet
52 990 - 990 190 800 3,000
AlOH 200 mg + MgOH 200 mg Tablet
53 Antasida DOEN II Suspensi Kombinasi - - - - -

Botol 60 ml
54 Antasida DOEN II Suspensi Kombinasi - - - - -

Botol 60 ml
55 Antasida DOEN II Suspensi Kombinasi Botol 60 ml - - - - -
56 Antibakteri DOEN (Bacitracin Salep Kulit) Tube - - - - -
57 Antibakteri DOEN (Bacitracin Salep Kulit) Tube - - - - -
58 Pot 30 gr - - - - -
Asam Benzoat
Antifungi DOEN6% + AsamSalisilat 3%
Kombinasi:
59 Tablet - - - - -
60 - - - - -
Asam Benzoat 6% + AsamSalisilat 3% Pot
61 24 - 24 - 24 48
Asam Benzoat 6% + AsamSalisilat 3% Pot
62 Antihemoroid kombinasi - - - - -
Suppositoria
63 Antihemoroid kombinasi - - - - -
Suppositoria
LPLPO 34
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
64 Tablet - - - - -
Pirimetamin 25 mg +: Sulfadoksin 500 mg
Antimigren Tablet
65 Tablet - - - - -
Antimigren Tablet : Ergotamin 1 mg + Kafein 50 mg
66 - - - - -
(Generik Kombinasi)
Tablet
67 Artemether Injeksi 80 mg/ml - - - - -

ampul
68 Artesunate Injeksi vial 60 mg - - - - -

viaL
69 Asam Asetilsalisilat Tablet 100 mg (Asetosal) Tablet - - - - -
70 Asam Askorbat (Vitamin C) Tablet 250mg Tablet - - - - -
72 Asam Askorbat (Vitamin C) Tablet 50mg Tablet 700 - 700 100 600 3,000
73 Asam Folat Tablet 1 mg Tablet - - - - -
76 Asam Folat Tablet 0,4 mg Tablet - - - - -
77 Asam Folat Tablet 0,4 mg Tablet - - - - -
78 Asam Mefenamat Kapsul 500 mg Tablet - - - - -
80 Asam Mefenamat Kapsul 500 mg Tablet 1,500 - 1,500 500 1,000 3,000
81 Asiklovir krim 2,5 % Tube - - - - -
82 Asiklovir krim 5 % Tube 25 - 25 - 25 100
83 Asiklovir krim 5 % Tube - - - - -
84 Asiklovir Tablet 200 mg Tablet - - - - -
87 Asiklovir Tablet 400 mg Tablet 500 - 500 100 400 2,000
88 Atropin Sulfat Injeksi. i.m./i.v./s.k. 0,25 mg/ml Amp 1 ml - - - - -
89 Atropin Sulfat Tablet 0,5mg Tablet - - - - -
90 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - - -
91 Tablet - - - - -
(tablet tambah
Besi (II) Sulfat darah
200 mgkombinasi)
+ Asam Folat 0,25mg Tablet
92 Tablet - - - - -
93 Betahistin Tablet 6 mg - - - - -
Tablet
94 Betametason Krim 0,1% (sebagai valerat) - - - - -

Tube
95 Betametason Krim 0,1% (sebagai valerat) Tube - - - - -
LPLPO 35
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
96 Betametason Krim 0,1% (sebagai valerat) Tube - - - - - 100

99 Bromheksin Tablet 8 mg Tablet - - - - - 1,000
100 Cetrizin Syrup 5mg/5ml Botol - - - - - 50
101 Cetrizin Tablet 10 mg Tablet - - - - -
102 Cetrizin Tablet 10 mg Tablet - - - - - 2,000
103 Cimetidine 200 mg Tablet - - - - - 2,000
104 Deksametason 1nj 5 mg/ml Vial - - - - -
105 Deksametason 1nj 5 mg/ml Ampul 10 - 10 - 10
106 Deksametason Tablet 0.5 mg Tablet 3,000 - 3,000 1,000 2,000 3,000
107 Deksametason Tablet 0.5 mg Tablet - - - - -
109 Diazepam Injeksi 5 mg/ml Ampul - - - - -
110 Diazepam Injeksi 5 mg/ml Ampul - - - - -
111 Diazepam Tablet 2 mg Tablet - - - - - 100
112 Diazepam Tablet 2 mg Tablet - - - - -
113 Diazepam Tablet 5 mg Tablet - - - - -
114 Diazepam Enema (Stesolid 5 mg/2,5 ml) Tube - - - - - 10
115 Dietilkarbamazin 100 mg Tablet - - - - -
116 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul - - - - -
117 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul - - - - -
118 Difenhidramin Injeksi i.m.10 mg/ml (HCl) Ampul 30 - 30 - 30
119 Digoksin Tablet 0,25 mg Tablet - - - - -
120 Digoksin Tablet 0,25 mg Tablet - - - - -
121 Dimenhidrinat Tablet 50 mg Tablet - - - - -
122 Doksisiklin Kapsul 100 mg Tablet - - - - -
123 Doksisiklin Kapsul 100 mg Tablet - - - - -
124 Doksisiklin Kapsul 100 mg Tablet 500 - 500 - 500
125 Domperidon Suspensi 5 mg/ml Botol 60 ml - - - - -
126 Domperidon Suspensi 5 mg/ml Botol 60 ml - - - - -
127 Domperidon Tablet 10 mg Tablet - - - - -
128 Domperidon Tablet 10 mg Tablet 400 - 400 60 340 2,000
129 Epinefrin (Adrenalin) Injeksi 1mg/ml ampul - - - - -
131 Epinefrin (Adrenalin) Injeksi 1mg/ml ampul 30 - 30 - 30
133 Ekstarak Beladona Tab 250 mg Tablet - - - - -
134 Eritromisin Kapsul 250 mg Tablet - - - - -
135 Eritromisin Kapsul 250 mg Tablet - - - - -
136 Eritromisin Kapsul 250 mg Kapsul - - - - -
137 Eritromisin Syrup 200 mg / 5ml Botol 60 ml - - - - - 50
138 Eritromisin Syrup 200 mg / 5ml Botol 60 ml - - - - -
139 Fenobarbital Injeksi i.m./i.v. 50 mg/ml Amp 1ml - - - - -
LPLPO 36
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
140 Fenobarbital 30 mg Tablet Tablet - - - - -

141 Fenol Gliserol Tetes Telinga10% Botol 5 ml - - - - -
142 Fenol Gliserol Tetes Telinga10% Botol 5 ml - - - - -
143 Fenol Gliserol Tetes Telinga10% Botol305 ml
Kotak Amp - - - - -
144 Fitomenadion (Vit-K1) Injeksi 10 mg/ml 1ml - - - - -
145 Fitomenadion (Vit-K1)Tab Salut Gula10 mg Tablet - - - - -
148 Fitomenadion (Vit-K1)Tab Salut Gula10 mg Tablet - - - - - 1,000
149 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Amp 1ml - - - - -
150 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Ampul - - - - -
151 Fitomenadion (Vit-K1) Injeksi 2 mg/ml Ampul 30 - 30 - 30
152 Furosemid Injeksi i.v/i.m. 10 mg/ml Amp 2ml - - - - -
153 Furosemid Tablet 40 mg Tablet - - - - -
154 Furosemid Tablet 40 mg Tablet 200 - 200 100 100 1,000
155 Gameksan Lotion 1% Botol - - - - -
156 Garam Oralit Serbuk Sachet - - - - - 1,000
157 Garam Oralit Kombinasi Sachet - - - - -
158 Gemfibrozil Kapsul 300 mg Kapsul - - - - -
159 Gentamisin Injeksi 40 mg/ml Amp 2ml - - - - -
160 Gentamisin Injeksi 40 mg/ml Vial 2ml - - - - -
161 Gentamisin Injeksi 40 mg/ml Ampul - - - - -
162 Gentamisin salep Kulit 0,1 % Tube - - - - -
163 Gentamisin Sulfat Tetes Mata 0,3% Botol 5 ml - - - - -
164 Gentamisin Sulfat Tetes Mata 0,3% Botol 5 ml 24 - 24 10 14 48
166 Gentamisin Salep mata( GENOINT) Tube - - - - -
167 Gentamisin Sulfat Salep mata 0,3 % Tube 24 - 24 - 24 48
168 Gentian Violet Larutan 1 % Botol 10 ml 24 - 24 - 24 48
169 Gentian Violet Larutan 1 % Botol 10 ml - - - - -
170 Gentian Violet Larutan 1 % Botol 10 ml - - - - -
171 Glibenklamida Tablet 5 mg Tablet - - - - -
172 Glibenklamida Tablet 5 mg Tablet - - - - -
173 Glibenklamida Tablet 5 mg Tablet 1,000 - 1,000 300 700 3,000
174 Gliserilguaiakolat Tablet 100 mg Tablet - - - - -
175 Gliserin Liquid Botol 100 ml - - - - -
176 Glukosa Larutan Infus 5% steril Botol 500 ml - - - - -
177 Glukosa Larutan Infus 5% steril Botol 500 ml - - - - -
178 Glukosa Larutan Infus 5% steril Botol 500 ml - - - - - 60
179 Guaifenisin Botol - - - - -
180 Guaifenisin 100 mg Tablet 2,960 - 2,960 960 2,000 3,000
181 Guaifenisin 100 mg Tablet - - - - -
182 Griseofulvin Tablet 125 mg Tablet - - - - -
LPLPO 37
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14

185 Haloperidol Injeksi 5% Vial - - - - -
186 Haloperidol Injeksi 50 mg/ml Ampul - - - - -
187 Haloperidol Tablet 1,5 mg Tablet - - - - -
188 Haloperidol Tablet 1,5 mg Tablet - - - - -
189 Haloperidol Tablet 2 mg Tablet - - - - -
191 Haloperidol Tablet 2 mg (lodomer) Tablet - - - - -
192 Haloperidol Tablet 2 mg (lodomer) Tablet - - - - -
196 Hidrogen Peroksida (H2O2) Larutan 3% Botol 1000 ml - - - - -
197 Hidrogen Peroksida (H2O2) Larutan 3% Botol 100 ml - - - - - 2
198 Hidroklorotiazida Tablet 25 mg Tablet - - - - -
199 Hidroklorotiazida Tablet 25 mg Tablet - - - - -
200 Hidrokortison krim 2,5% Tube 5 gram - - - - -
201 Hidrokortison krim 2,5% Tube 5 gram - - - - -
202 Hidrokortison krim 2,5% Tube 5 gram 11 - 11 11 - 100
203 Hidrokortison krim1% Tube 5 gram - - - - -
204 Ibuprofen Suspensi 100 mg/5ml Botol 60 ml - - - - -
207 Ibuprofen Suspensi 100 mg/5ml Botol 60 ml 46 - 46 - 46 50
208 Ibuprofen Tablet 400 mg Tablet - - - - -
209 Ibuprofen Tablet 400 mg Tablet 400 - 400 100 300 2,000
212 Ichtiol Salep Tube 48 - 48 - 48 48
213 Ichtiol Salep Tube - - - - -
214 Isoniazid Tablet 300 mg Tablet - - - - -
215 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet - - - - -
216 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet - - - - - 1,000
217 Kalsium Laktat (Kalk) Tablet 500 mg Tablet - - - - -
220 Kalsium Laktat (Kalk) Tablet 5 mg Tablet 3,000 - 3,000 600 2,400 3,000
221 Kaptopril Tablet 12,5 mg Tablet - - - - -
222 Kaptopril Tablet 12,5 mg Tablet - - - - -
223 Kaptopril Tablet 12,5 mg Tablet 1,000 - 1,000 300 700 2,000
224 Kaptopril Tablet 25 mg Tablet - - - - -
226 Kaptopril Tablet 25 mg Tablet - - - - - 2,000
LPLPO 38
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14

229 Karbamazepin Tablet 200 mg Tablet - - - - -
230 Karbamazepin Tablet 200 mg Tablet - - - - -
231 Ketokonazol Krim 2 % Tube 15 gram - - - - -
232 Ketokonazol Krim 2 % Tube - - - - -
233 Ketokonazol Krim 2 % Tube 50 - 50 - 50 100
234 Ketokonazol Tablet 200 mg Tablet - - - - -
235 Ketokonazol Tablet 200 mg Tablet - - - - - 2,000
236 Ketokonazol Tablet 200 mg Tablet - - - - -
237 Ketoprofen Tablet 100 mg Tablet - - - - -
238 Klindamisin Kapsul 150 mg Kapsul - - - - -
239 Klindamisin Kapsul 150 mg Kapsul - - - - -
240 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
241 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
242 Kloramfenikol Salep Mata 1 % 5 gram Tube - - - - -
245 Kloramfenikol Salep Mata 1 % 5 gram Tube 48 - 48 - 48
246 Kloramfenikol salep kulit 2 % Tube - - - - -
247 Kloramfenikol salep kulit 2 % (Bufacetin) Tube - - - - -
248 Kloramfenikol salep kulit 2 % (Bufacetin) Tube 24 - 24 - 24 48
249 Kloramfenikol Suspensi 125mg/5ml Botol - - - - -
250 Kloramfenikol Suspensi 125mg/5ml Botol 50 - 50 - 50
251 Kloramfenikol Tetes Mata Komb. ( Erlamicetin Plus) Botol 43 - 43 5 38 48
252 Kloramfenikol Tetes Telinga 3 % - 5ml Botol - - - - -
253 Kloramfenikol Tetes Telinga 1% (Reco) Botol 39 - 39 9 30 48
254 Kloramfenikol Tetes Telinga 1% (Erlamycetin) Botol - - - - -
255 Klorfeniramina Maleat (CTM )Tablet 4 mg Tablet - - - - -
257 Klorfeniramina Maleat (CTM )Tablet 4 mg Tablet 2,584 - 2,584 584 2,000 4,000
259 Klorokuin Tablet 150 mg Tablet - - - - -
260 Klorpromazin Tablet Salut 100 mg (HCl) Tablet - - - - -
266 Klorpromazin Injeksi i.m.25 mg/ml(HCl) Ampul 2ml - - - - -
267 Klorpromazin Injeksi i.m.25 mg/ml(HCl) Ampul - - - - -
268 Kodein Tablet 10 mg Tablet - - - - -
271 Tablet - - - - -
Sulfametoksazol 400mg +Trimetoprim 80mg
LPLPO 39
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
272 Tablet - - - - -
Sulfametoksazol
Kotrimoksazol DOEN 400mg +Trimetoprim
(dewasa) 80mg:
Kombinasi
273 Tablet - - - - -
274 Tablet 1,200 - 1,200 400 800 3,000
Sulfametoksazol
(dewasa) 80mg:
Kombinasi
275 Tablet - - - - -
Sulfametoksazol
(pediatrik) 80mg:
Kombinasi
276 Tablet - - - - -
Sulmetoksazol
Kotrimoksazol 100 mg + Kombi
Suspensi Trimetoprim 20 mgtoksazol
: Sulfame-
277 Botol 60 ml - - - - -
20 mg + Trimetoprim
Kotrimoksazol 40mg/5ml
Suspensi Kombi : Sulfame- toksazol
278 Kotrimoksazol Suspensi Kombi tiap 5ml : Botol 60 ml - - - - - 100
279 Sulfematoksazol 200 mg + Trimetoprim 40mg (susp Botol 60 ml - - - - -
280 240 mg)(Kina) Tablet 200 mg
Kuinin Tablet - - - - -
281 Kuinin Injeksi i.v. 25% (sebagai 2HCl) Amp 2 ml - - - - -
282 Kuinin Tablet 222 mg (H2SO4.7H2O) Tablet - - - - -
283 Lansoprazol Kapsul 30 mg Kapsul - - - - -
284 Levertran Salep - - - - -

pot
285 Levertran Salep 24 - 24 - 24 48

Pot
286 Levofloksasin Tablet 500 mg - - - - -

Tablet
287 Lidokain Injeksi 2% Ampul 2 ml - - - - -
288 Lidokain Injeksi 2% Ampul - - - - - 20
289 Lidokain Injeksi 2% Ampul - - - - -
290 Lidokain Injeksi 2% + Epinefrin 1:80.000 Injeksi 2 ml Ampul - - - - - 50
291 Lidokain Injeksi 2% + Epinefrin 1:80.000 Injeksi 2 ml Ampul - - - - -
292 Lidokain Spray (Xylocain Spray) Botol - - - - -
293 Linkomisin Kapsul 500 mg Kapsul - - - - -
294 Lisol Larutan Antiseptik Botol 1000 ml 2 - 2 1 1 3
295 Loperamid tablet 2 mg Tablet 1,500 - 1,500 300 1,200 2,000
296 Loperamid tablet 2 mg Tablet - - - - -
297 Magnesium Sulfat Injeksi (IV)20%-25ml Vial - - - - -
298 Magnesium Sulfat Injeksi (IV)20%-25ml Vial - - - - -
299 Magnesium Sulfat Injeksi (IV)40% Ampul 10 - 10 - 10
300 Mebendazol Syrup 100 mg/5ml Botol 30 ml - - - - -
301 Metampiron Injeksi 250 mg Amp 2 ml - - - - -
302 Metformin HCl Tablet 500 mg Tablet - - - - -
303 Metformin HCl Tablet 500 mg Tablet 1,000 - 1,000 300 700 2,000
304 Metformin HCl Tablet 850 mg Tablet - - - - -
305 Metilergometrin Maleat Injeksi 0,2 mg/ml Ampul - - - - -
306 Metilergometrin Maleat Injeksi 0,2 mg/ml Ampul 100 - 100 - 100
307 Metilergometrin Maleat Tab Salut 0,125 mg Tablet - - - - -
308 Metilergometrin Maleat Tab Salut 0,125 mg Tablet 1,000 - 1,000 - 1,000
309 Metilergometrin Maleat Tab Salut 0,125 mg Tablet - - - - -
LPLPO 40
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
310 Metilprednisolon Injeksi 500 mg Kotak 1 Vial 8 ml - - - - -

311 Metilprednisolon kaplet 4 mg Tablet - - - - -
312 Metilprednisolon kaplet 4 mg Tablet - - - - -
313 Metilprednisolon kaplet 4 mg Tablet 1,500 - 1,500 300 1,200 2,000
314 Metilprednisolon kaplet 8 mg Kaplet - - - - -
315 Metoklorpramid syrup 5 mg/5 ml Botol - - - - -
316 Metoklorpramid 5 mg Tab Tablet - - - - -
320 Metronidazol Tablet 250 mg Tablet - - - - -
322 Metronidazol Tablet 500 mg Tablet - - - - - 3,000
324 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram - - - - -
325 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram - - - - -
326 Mikonazol Krim/Salep 2 % (Nitrat) Tube 10 gram 35 - 35 5 30 48
327 Natrium Diklofenak Tablet 25 mg Tablet - - - - -
330 Natrium Diklofenak Tablet 25 mg Tablet 90 - 90 - 90 3,000
331 Natrium Klorida Larutan Infus 0,9% Botol 500 ml - - - - -
332 Natrium Klorida Larutan Infus 0,9% Botol 500 ml 40 - 40 - 40 60
333 Natrium Klorida Larutan Infus 0,9% Botol 500 ml - - - - -
334 Natrium Tiroxin (Etyrox) Tablet - - - - -
335 N-Asetil sistein Kapsul - - - - -
336 N-Asetil sistein Kapsul - - - - -
337 N-Asetil sistein Kapsul - - - - - 3,000
338 Nistatin Tablet Salut 500.000 IU/g Tablet - - - - -
340 Nistatin Tablet Salut 500.000 IU/g Tablet - - - - - 1,000
342 Nistatin vaginal Tablet 100.000 IU/g Tablet - - - - -
343 Nistatin vaginal Tablet 100.000 IU/g Tablet - - - - - 1,000
344 Nistatin vaginal Tablet 100.000 IU/g Tablet - - - - -
345 Obat Anti Tuberkulosis FDC Kategori 1 Paket - - - - -
351 Obat Anti Tuberkulosis FDC Kategori Anak Paket - - - - -
LPLPO 41
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
354 Obat Anti Tuberkulosis FDC sisipan Paket - - - - -

355 Obat Anti Tuberkulosis Kategori 1 Paket - - - - -
356 Obat Batuk Hitam(O.B.H.) cairan Molex Botol 100 ml 54 - 54 6 48 100
357 Obat Batuk Hitam(O.B.H.) cairan Botol 120 ml - - - - -
358 Obat Batuk Hitam(O.B.H.) cairan Molex Botol 120 ml - - - - -
359 Obat Batuk Kombinasi (Hustab) tablet Tablet - - - - -
360 Obat Batuk Kombinasi (Hustab) tablet Tablet - - - - - 4,000
361 Obat Batuk Pilek Kombinasi (Intunal Syrup) Botol - - - - - 100
362 Ofloxacin Tablet 400 mg Tablet - - - - -
363 Oksitetrasiklin HCl Salep Mata 1% Tube 3,5 g - - - - -
364 Oksitetrasiklin HCl Salep Mata 1% Tube 3,5 g - - - - -
365 Oksitosin Injeksi 10 IU/ml-1ml ampul - - - - -
366 Oksitosin Injeksi 10 IU/ml-1ml Ampul - - - - -
367 Oksitosin Injeksi 10 IU/ml-1ml Ampul 100 - 100 - 100
368 Omeprazol Kapsul 20 mg Kapsul - - - - -
370 Omeprazol Kapsul 20 mg Kapsul 570 - 570 70 500 2,000
372 Papaverin Tablet 40 mg Tablet - - - - -
373 Papaverin Tablet 40 mg Tablet - - - - -
374 Parasetamol Drops Botol 15 ml - - - - -
375 Parasetamol Drops Botol 15 ml - - - - - 50
376 Parasetamol Syrup 120 mg/ 5ml Botol 60 ml - - - - -
380 Parasetamol Syrup 120 mg/ 5ml Botol 60 ml 65 - 65 25 40 100
381 Parasetamol Tablet 500 mg Tablet - - - - -
382 Parasetamol Tablet 500 mg Tablet - - - - -
383 Parasetamol Tablet 500 mg Tablet 2,300 - 2,300 1,300 1,000 5,000
384 Piracetam Injeksi 3g/15ml Amp 15ml - - - - -
385 Piracetam Tablet 400 mg Tablet - - - - -
386 Pirantel Syrup 125 mg/5ml Botol 60 ml - - - - -
387 Pirantel Tablet score (base) 125 mg Tablet - - - - -
388 Pirantel Tablet score (base) 125 mg Tablet - - - - -
389 Pirazinamid Tablet 500 mg Tablet - - - - -
390 Piridoksin (Vitamin B6) inj 100 mg/ml ampul - - - - -
391 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Botol 100 Tablet - - - - -
392 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) tablet - - - - -
393 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Tablet - - - - -
394 Piridoksin (Vitamin B6) Tablet 10 mg(HCl) Tablet 990 - 990 200 790 2,000
395 Piroxicam Tablet 10 mg Tablet - - - - -
396 Piroxicam Tablet 10 mg Tablet - - - - - 3,000
397 Povidon Iodida Larutan 10% Botol 30 ml - - - - -
LPLPO 42
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
398 Povidon Iodida Larutan 10% botol 60 ml - - - - -

400 Povidon Iodida Larutan 10% botol 60 ml - - - - - 10
401 Povidon Iodida Larutan 10% botol 60 ml - - - - -
402 Povidon Iodida Larutan 10% Botol 300 ml - - - - - 5
404 Prednison Tablet 5 mg Tablet - - - - -
405 Prednison Tablet 5 mg Kaplet - - - - -
406 Prednison Tablet 5 mg Tablet - - - - -
407 Prednison Tablet 5 mg Tablet 900 - 900 100 800 2,000
408 Primakuin Tablet Tablet - - - - -
409 Prokain Benzil Penisilin G.Injeksi 3 jt IU/vial Vial - - - - -
410 Prokain Penisillin inj Vial - - - - -
411 Propanolol Tablet 10 mg (HCl) Tablet - - - - -
412 Propanolol Tablet 10 mg (HCl) Tablet - - - - -
413 Propiltiourasil Tablet 100 mg Tablet - - - - -
414 RanitidinTablet 150 mg Tablet - - - - -
415 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 50 Kapsul - - - - -
416 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 50 Kapsul - - - - -
417 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Kapsul - - - - -
419 Rifampisin Tablet Salut 450 mg Tablet - - - - -
420 Ringer Laktat Larutan Infus Botol 500 ml - - - - -
422 Ringer Laktat Larutan Infus Botol 500 ml 40 - 40 - 40 60
423 Risperidon Tablet 1 mg Kapsul - - - - -
424 Risperidon Tablet 2 mg Kapsul - - - - -
425 Risperidon Tablet 2 mg Tablet - - - - -
428 Salbutamol Tablet 2 mg (sebagai Sulfat) Tablet - - - - -
429 Salbutamol Tablet 2 mg (sebagai Sulfat) tablet - - - - -
430 Salbutamol Tablet 2 mg (sebagai Sulfat) tablet 500 - 500 50 450 2,000
434 Pot 30 gr - - - - -
Asam
Salep 2-4 Salisilat 2% + Belerang endap 4%
,Kombinasi:
435 Tube - - - - -
Asam
Salep 2-4 Salisilat 2% + Belerang endap 4%
,Kombinasi:
436 Pot - - - - -
437 Pot 24 - 24 - 24
438 Salisil Bedak 2% Ktk 50 gram - - - - -
439 Salisil Bedak 2% kotak - - - - -
440 Salisil Bedak 2% Kotak - - - - -
441 Salisil Bedak 2% Botol 50 g - - - - -
LPLPO 43
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
442 Salisil Bedak 2% Botol 50 g 48 - 48 - 48 50

443 Sefaleksin Kapsul 500 mg Tablet - - - - -
444 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg Ampul 35 - 35 - 35
445 Sianokobalamin (Vit-B12 ) Injeksi 500 mcg - - - - -

Ampul
446 Sianokobalamin (Vit-B12) Tablet 50 mcg - - - - -

Tablet

Tablet
448 Sianokobalamin (Vit-B12) Tablet 50 mcg 200 - 200 - 200

Tablet

Tablet
450 Simvastatin Tablet 10 mg tablet - - - - -
451 Simvastatin Tablet 10 mg Tablet - - - - -
452 Simvastatin Tablet 10 mg Tablet 300 - 300 50 250 2,000
453 Simvastatin Tablet 20 mg Tablet - - - - -
454 Simvastatin Tablet 20 mg tablet - - - - -
455 Siprofloksasin Tablet 500 mg (sebagai HCl) Tablet - - - - -
456 Siprofloksasin Tablet scored 500 mg Tablet - - - - -
459 Siprofloksasin Tablet scored 500 mg Tablet 1,000 - 1,000 300 700 3,000
460 Sulfasetamida Natrium Tetes Mata 15% Botol 5ml - - - - -
461 Tetrakain HCl Tetes Mata 0,5% Botol @ 5ml - - - - -
462 Tetrasiklin Kapsul 250 mg Kapsul - - - - -
463 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
464 Tetrasiklin Kapsul 500 mg Tablet - - - - -
465 Tetrasiklin Kapsul 500 mg Tablet - - - - -
466 Tiamin HCl (Vitamin B1) Tablet Kapsul - - - - -
467 Tiamin HCl (Vitamin B1) Tablet Tablet - - - - -
468 Tiamin HCl (Vitamin B1) Tablet Tablet - - - - - 2,000
469 Tiamin HCl (Vitamin B1) Tablet Tablet - - - - -
470 Tramadol Injeksi 50 mg/ml ampul - - - - -
472 Tramadol Kapsul 50 mg Kapsul - - - - -
474 Triheksifenidil Tablet 2 mg Tablet - - - - -
477 Ventolin nebulizer Ampul - - - - -
LPLPO 44
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
478 Vitamin B Kompleks Tablet Tablet - - - - -

480 Vitamin B Kompleks Tablet Tablet - - - - - 4,000
482 Zinc Tablet 20 mg Tablet - - - - - 1,000
483 Zinc Tablet dispersible 20 mg Tablet - - - - -
484 Zinc Tablet dispersible 20 mg Tablet - - - - -
485 Ongkir - - - - - -
- - - - - -
OBAT GIGI - - - - - -
1 Calplus Tube - - - - -
2 Calsium Hidroksi Pasta ( Calplus) Pack - - - - -
3 Caviton (Temporary Stoping Fleker) Pot - - - - - 1
4 Caviton (Temporary Stoping Fleker) Pot - - - - -
5 CHKM (Monokloramkamfer Menthol Cairan) Botol - - - - - 1
6 CHKM (Monokloramkamfer Menthol Cairan) Botol - - - - -
7 Cold Spray Botol - - - - - 1
8 Devitalisasi Pasta (Pulp X) Botol - - - - -
Devitalisasi Pasta NON Arsen ( Devita) - - - - -

9 Pot
10 Eugenol cairan Botol - - - - -
11 Glass Ionomer Cement Set - - - - -
12 Glass Ionomer (Ketac Universal) Botol - - - - - 1
13 Glass Ionomer (Ketac Universal) Botol - - - - -
14 Mummipaying Pasta (Cresotin Pasta) Tube - - - - -
15 Mummipaying Pasta (Cresotin Pasta) Pot - - - - - 1
16 Semen Seng Posfat Sebuk / Cair Botol 30gr - - - - -
17 Zink Cement (Eliet Cement) Botol - - - - -
18 Zink Cement (Eliet Cement) Botol - - - - -
- - - - - -
1 Alat Suntik Sekali Pakai 0,05 ml pieces - - - - -
2 Alat Suntik Sekali Pakai 0,5 ml pieces - - - - -
3 Alat Suntik Sekali Pakai 1 ml Pieces - - - - -
4 Alat Suntik Sekali Pakai 1 cc Pieces 60 - 60 - 60 100
5 Alat Suntik Sekali Pakai 2,5 cc Pieces - - - - -
6 Alat Suntik Sekali Pakai 3 ml pcs - - - - -
7 Alat Suntik Sekali Pakai 3 ml pieces - - - - -
9 Alat Suntik Sekali Pakai 3 cc pieces 200 - 200 - 200
10 Alat Suntik Sekali Pakai 5 ml pcs - - - - -
12 Alat Suntik Sekali Pakai 5 cc pieces 60 - 60 - 60 100
13 Aqua jely steril 5 gr Sachet - - - - -
LPLPO 45
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
14 Bisturi (BBraun steril scalpel blades #18) pcs - - - - - 50

15 Catgut / Benang Bedah 2/0, 26 mm (Gabler Med) pieces - - - - -
16 Catgut / Benang Bedah 2/0, 24 mm (Gabler Med) pcs - - - - -
17 Catgut / Benang Bedah 2/0, 19 mm (Gabler Med) pcs - - - - -
Catgut / Benang Bedah 2/0, 1/2 taper 30 mm (Gabler
18 pcs - - - - -
Med)
19 Cutgut 2/0,90 cm.1/2TP ( Chromic 2/0) pcs 24 - 24 - 24
20 Catgut / Benang Bedah 3/0 Rol - - - - -
21 Catgut / Benang Bedah 3/0 pcs - - - - -
22 Catgut / Benang Bedah 3/0 pieces - - - - -
23 Cutgut 3/0 ,1/2 TP 22mm,75-2PTRO20EE pieces 36 - 36 - 36
24 Folley Catheter No. 18 Pieces - - - - -
25 Folley Catheter No. 18 Pieces 5 - 5 - 5
26 Folley Catheter No. 18 pieces - - - - -
27 Folley Catheter 2- WAY No. 18 pieces - - - - -
28 Gel Catheter Tube - - - - -
29 Hand Scone Steril #7,0 (Aximed) Pasang 15 - 15 15 - 200
30 Hand Scone Steril #7,0 (Aximed) Pcs - - - - -
31 Hand Scone Steril #7,5 (Aximed) Pieces - - - - -
32 Hand Scone Steril #7,5 (medict dent) pasang - - - - -
33 Handscone Steril ( Mas Surgical Gloves 7,5 steril) pasang - - - - -
34 Hand Scone Steril #7,5 (KISMED) - - - - - 100

pcs
35 Hand Scone / Sarung Tangan Non Steril pcs - - - - -
36 Hand Scone Non Steril # L (Aximed) pcs - - - - - 100
37 Hand Scone Non Steril # L (LIGHTY mas latex) pcs - - - - -
38 pcs - - - - -
latex)
39 Handscone Non Steril (L ) (Mas pree powdered) pcs - - - - -
40 Hand Scone Non Steril # M (Aximed) pcs - - - - - 200
41 Hand Scone Non Steril # M (kismed mask latex) pcs - - - - -
42 Handscone Non Steril (M ) (Mas pree powdered) pcs - - - - -
43 Handscone Non Steril 7.5 ( Mask Surgical) Pasang - - - - -
44 Infusion Set Anak (Aximed) Set - - - - -
45 Infusion Set Anak set - - - - -
46 Infusion Set Anak pcs - - - - -
48 Infusion Set Anak pcs 5 - 5 - 5 20
49 Infusion Set Dewasa Set - - - - -
52 Infusion Set Dewasa pcs - - - - -
54 Infusion Set Dewasa (y - TYPE) pcs 10 - 10 - 10 50
LPLPO 46
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
55 IV Canula non inj & wing no 20 (Eskamed) - - - - -

Pieces
56 IV Canula non inj & wing no 22 (Eskamed) Pieces - - - - -
57 IV Canula non inj & wing no 24 (Eskamed) Pieces - - - - -
58 IV Catheter No. 20 G pcs - - - - -
59 IV Catheter NP No. 20 G Pieces - - - - -
60 IV Catheter No. 20 G Pieces - - - - -
61 IV Catheter No. 20 G Pieces - - - - - 40
62 IV Catheter No. 20 G pieces - - - - -
67 IV Catheter No. 22 G pieces 20 - 20 - 20 20
69 IV Catheter No. 24 G Pieces - - - - - 40
72 Kapas Berlemak 500 gram Bungkus - - - - -
73 Kapas Pembalut / Absorben 250 gram Bungkus - - - - -
74 Kapas Pembalut / Absorben 250 gram Bungkus - - - - -
75 Kapas Pembalut / Absorben 250 gram Roll - - - - -
76 Kapas Pembalut / Absorben 250 gram Roll 4 - 4 - 4 5
77 Kapas Pembalut / Absorben 250 gram Roll - - - - -
78 Kassa Hidrofil Steril Ukuran 16 x 16 cm Bungkus - - - - -
79 Kassa Hidrofil Steril Ukuran 16 x 16 cm box - - - - -
80 Kassa Hidrofil Steril Ukuran 16 x 16 cm kotak - - - - -
81 Kassa Hidrofil Steril Ukuran 16 x 16 cm kotak 29 - 29 - 29 50
82 Kassa Hidrofil Steril Ukuran 18 x 22 cm Kotak - - - - -
83 Kassa Hidrofil Steril Ukuran 18 x 22 cm box - - - - -
84 Kassa Hidrofil Steril Ukuran 18 x 22 cm Box 30 - 30 - 30
85 Kassa Hidrofil Ukuran 36 x 10 cm Rol - - - - -
88 Kassa Hidrofil Ukuran 40 yard x 80 cm Rol - - - - -
89 Kassa Hidrofil Ukuran 40 yard x 80 cm Roll - - - - -
90 Kassa Pembalut Hidrofil 4m x 10cm Rol - - - - -
91 Kassa Pembalut Hidrofil 4m x 10cm (SN Medika) Rol - - - - -
94 Kassa Pembalut Hidrofil 4m x 7,5cm (SN Medika) Rol - - - - -
95 Kassa Pembalut Hidrofil 4m x 5 cm Rol 50 - 50 - 50 50
96 Kassa Pembalut Hidrofil 4m x 5 cm Rol - - - - -
LPLPO 47
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14

100 Kassa Pembalut elastis 10 cmx4,55m Rol - - - - -
101 Kassa Pembalut elastis 7,5 cmx4,55m Rol - - - - -
102 Masker pcs - - - - -
103 Masker (Aximed Face Mask Ear Loop ) pcs - - - - -
104 Masker Face Mask -30ply / Ear Loop ) pcs - - - - -
105 Masker N95 pcs - - - - -
106 Masker N95 pcs - - - - - 20
107 Masker Jilbab pcs - - - - -
108 Masker Jilbab (Mas surgical) box - - - - -
109 Masker Bedah pcs - - - - -
110 masker bioaxi face mask ear loop pcs - - - - - 600
111 Pembalut Gips 3 inch Rol - - - - -
112 Pembalut Gips 6 inch Rol - - - - -
113 Plester 5 yard x 2 inch Rol - - - - -
114 Plester 5 yard x 2 inch Roll - - - - -
115 Plester Rol Kain 2.5 cm x 1 m ( Hansaplast) Rol - - - - -
116 Plester Leukoplast 7,5cm x 4,5 cm Roll - - - - - 10
117 Pharmaplast (pharmafix) box - - - - - 5
118 Plester Pharmaplast ( PHARMAFIX) 5 cm x 500 cm Rol - - - - -
119 Paper tape /2,5cm x 9,14m Rol - - - - -
120 Paper tape / 1,25cm x 9,14m Rol - - - - -
121 Paper tape / 1,25cm x 9,14m Rol - - - - -
122 Safety Box pcs - - - - - 10
123 Silk (Benang Bedah) 3/0 + Jarum rol - - - - -
124 Silk (Benang Bedah) 3/0 + Jarum pcs - - - - -
125 Silk 3/0.1/2 18mm 75cm-2PTR5261E pcs - - - - -
126 Silk 3/0.1/2 18mm 75cm-2PTR5261E pcs 24 - 24 - 24
127 Urine Bag Set - - - - -
128 Urine Bag ( Aximed TVW Hanger) pcs - - - - -
129 Urine Bag ( Aximed TVW Hanger) pcs - - - - -
130 Urine Bag ( trode medical trourocol plus) pcs - - - - -
131 Urine Bag ( AXIMED) pcs - - - - -
132 Wing Needle No. 21 G pcs - - - - -
135 Rapid Test Vikia HIV 1/2 Kit - - - - -
136 Larvasida Galon - - - - -
137 Larvasida (obat DBD / Abate) kg - - - - -
138 Larvasida Sumilar kg - - - - -
139 Accu-Chek Test Strip kotak - - - - -
140 KIT Emergensi P3K Posko Mudik Paket - - - - -
141 Ongkir - - - - - -
LPLPO 48
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
- - - - - -
1 Antapulgit NEW ANTIDES Tablet - - - - - 1,000
2 Aqua Pro Injection (OTSU SWI 25 Ml) Ampul - - - - -
3 Aqua Pro Injection (OTSU SWI 25 Ml) Ampul - - - - - 10
4 Betason N Tube - - - - -
5 Becefort Syrup , Multivitamin anak Botol 60 ml - - - - -
6 Becefort Syrup , Multivitamin anak Botol 60 ml 37 - 37 13 24 100
7 Becefort Syrup , Multivitamin anak Botol 60 ml - - - - -
8 Multivitamin Dewasa Tablet 300 - 300 200 100 2,000
9 Multivitamin Dewasa (AMAROPO) Tablet
Kaptab Salut - - - - - 1,000
10 Bisakodil 5 mg Selaput - - - - -
11 Cairan Antiseptik 1000 ml (A. Class) Botol 1000 ml - - - - -
12 Cairan Antiseptik ( Hansanitizer 25 L) Jerigen 25 L - - - - -
13 Chloramex - kloramfenikol 500mg Tablet - - - - -
14 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet - - - - -
15 Glimipiride Tablet 3 mg tablet - - - - -
16 Glukonas Kalsikus Inj 10% Ampul - - - - - 10
17 Hemafort tab kombinasi Tablet - - - - -
18 HIV Test Box - - - - -
19 Insektisida Fogging Liter - - - - -
20 Mineral mix sachet - - - - -
22 Mouthiece Smolkilizer Box - - - - -
23 RDT Malaria Box - - - - -
24 RDT COVID-19 - AntiBody Pcs - - - - -
27 RDT COVID-19 - AntiGEN Pcs - - - - -
28 Rivanol 0,1% 300 ml Botol - - - - -
29 Rivanol 0,1% 300 ml Botol - - - - - 10
30 Ventolin nebulizer Botol - - - - -
31 Ventolin nebulizer Botol - - - - -
32 Glucose Botol - - - - -
33 Glucose Botol - - - - -
34 Acid/Uric Botol - - - - -
35 Acid/Uric Botol - - - - -
36 HDL Cholesterol Botol - - - - -
37 LDL Cholesterol Botol - - - - -
38 Cholesterol Botol - - - - -
39 Ongkir - - - - - -
- - - - - -
VAKSIN - - - - - -
LPLPO 49
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
1 ADS 0,05 ML (Union) Pcs - - - - -

2 ADS 0,5 ML (Union) Pcs - - - - -
3 Anti Bisa Ular Serum Vial - - - - -
4 Anti Bisa Ular Serum (Biosave) Vial - - - - -
7 Anti Tetanus Serum 1500 IU Ampul - - - - -
8 Anti Tetanus Serum 1500 UI (biosat-1,5) Ampul - - - - -
11 Safety Box Stera Sharp 7 Ltr Pcs - - - - -
12 Safety Box Stera Sharp 7 Ltr Pcs - - - - -
13 Spuit 5 ML (aximed) pcs - - - - -
- - - - - -
- - - - - -
- - - - - -
2 OBAT - OBATAN APBD I - - - - -

( PROPINSI ) -
SUB OBAT -OBATAN - - - - - -
1 Albendazol Tablet Kunyah 400 mg Tablet 100 - 100 - 100
2 Alkohol 70 % - 100 ml botol 300 ml - - - - -
3 Alkohol 70 % - 100 ml botol 300 ml - - - - -
5 Aminofilin Tablet 200 mg Tablet - - - - -
7 Artemether Injeksi 80 mg/ml Ampul - - - - -
9 Artesunate Injeksi vial 60 mg Vial - - - - -
10 Artesunate Injeksi vial 60 mg Vial - - - - -
15 Azitromicin Tablet 500 mg Tablet - - - - -
16 Tablet 19,740 - 19,740 - 19,740
18 Cetrizin Tablet 10 mg Tablet - - - - -
20 Deksametason Tablet Tablet - - - - -
24 Fenobarbital Injeksi i.m./i.v. 50 mg/ml Amp 1ml - - - - -
LPLPO 50
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
26 Garam Oralit 300 - 300 50 250

sachet
27 Gentamisin Injeksi 40 mg/ml Ampul - - - - -
32 Kaptopril tab 12,5 mg Tablet - - - - -
33 Kloramfenikol Tetes Mata ( DECACETIN) Botol - - - - -
36 Klorokuin Tablet 150 mg Tablet - - - - -
37 - - - - -
20 mg + Trimetoprim 40mg/5ml Botol 60 ml
39 Loperamid tablet 2 mg Tablet - - - - -
40 Magnesium Sulfat Injeksi (IV)40% Ampul - - - - -
41 Magnesium Sulfat Injeksi (IV)40% Ampul - - - - -
42 Nifedipin Tablet 10 mg Tablet - - - - -
44 Nifedipin Tablet 10 mg Tablet - - - - -
45 Obat Anti Tuberkulosis Kombipak Kategori 1 Paket - - - - -
55 Oksitosin Injeksi 10 IU/ml-1ml Ampul - - - - -
57 Osetalmivir Kapsul 100 mg Kapsul - - - - -
58 Oxytetrasiklin salep mata 1 % tube - - - - -
61 Primakuin Tablet Tablet - - - - -
62 Ranitidin HCl Injeksi 25 mg/ml Ampul - - - - -
70 WIDA KDNI ( D 2,5 % + KCl 0,15% + NaCl 0,45%) - - - - -

Botol
LPLPO 51
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
71 WIDA KDN2 ( D 2,5 % + KCl 0,3% + NaCl 0,45%) - - - - -

Botol
72 WIDA KNI ( KCl 0,15% + NaCl 0,9%) Botol - - - - -
74 WIDA KN2 ( KCl 0,3% + NaCl 09%) Botol - - - - -
75 Vitamin B Kompleks Tablet 1,500 - 1,500 300 1,200
76 Zinc Tablet Tablet 50 - 50 - 50
- - - - - -
1 Alat Suntik Sekali Pakai 3 cc pieces - - - - -
2 Alat Suntik Sekali Pakai 5 cc pieces - - - - -
3 Alkohol Swab pcs - - - - -
4 Cutgut 2/0 pcs - - - - -
12 Kassa Hidrofil Ukuran 40 yard x 80 cm Roll - - - - -
13 Masker pcs - - - - -
14 Masker pcs - - - - -
15 Oxygen Nasal Cannula (Adult) pcs - - - - -
16 Oxygen Nasal Cannula (Child) pcs - - - - -
17 Virus Transport Media ( VTM) pcs - - - - -
18 Under Pad pcs - - - - -
19 Urine Bag pcs - - - - -
- - - - - -
1 Cefotaksim Injeksi Vial - - - - -
2 Chloramex - kloramfenikol 500mg Tablet - - - - -
3 Clorampecorth Tube - - - - -
4 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet 27 - 27 - 27
5 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet - - - - -
6 Glukonas Kalsikus Inj 10% ampul - - - - -
7 Glukonas Kalsikus Inj 10% Ampul - - - - -
8 Mersibion inj Ampul - - - - -
LPLPO 52
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
10 Urea ( Soft U derm) Krim 10% tube - - - - -

11 Spironolakton tab Tablet - - - - -
- - - - - -
VAKSIN - - - - - -
1 ADS 0,05 ML (Oneject) Pcs - - - - -
4 ADS 0,05 ML (Skifa) Pcs - - - - -
6 ADS 0,5 ML (Oneject) pcs - - - - -
7 ADS 0,5 ML (Skifa) Pcs - - - - -
8 ADS 0,5 ML (Skifa) Pcs - - - - -
9 ADS 0,5 ML (Skifa) Pcs - - - - -
10 ADS 0,5 ML Pcs - - - - -
11 ADS 5 ML (Skifa) Pcs - - - - -
12 ADS 5 ML (Skifa) Pcs - - - - -
13 Alkohol Swab Pcs - - - - -
14 BCG Pcs - - - - -
15 BCG Vial - - - - -
16 BCG Vial - - - - -
17 Corona Vaccin Vial - - - - -
18 Campak Vaksin Vial - - - - -
19 DPT - HB -HiB Vial - - - - -
20 DPT - HB -HiB Vial - - - - -
21 DT Vial - - - - -
22 DT Vial - - - - -
23 DT Vial - - - - -
24 Hepatitis B pcs - - - - -
25 Hepatitis B Pcs - - - - -
26 Polio Injeksi Vial - - - - -
29 Polio Vaksin Vial - - - - -
30 Polio Vaksin Vial - - - - -
31 Polio Oral + Droper Vial - - - - -
32 Safety Box Pcs - - - - -
LPLPO 53
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
36 Spuit 5 ML (Oneject) - - - - -
Pcs
37 Td Pcs - - - - -
38 Td Pcs - - - - -
39 Tetanus Toksoid (TT) Pcs - - - - -
40 Vaksin MR Pcs - - - - -
41 Vaksin MR Vial - - - - -
42 Vaksin Anti Rabies (VAR) Vial - - - - -
45 HB Uniject Vial - - - - -
46 HB Uniject Vial - - - - -
- -
- - - - - -
- - - - - -
3 BOK - - - - - -
- - - - - -
1 Desinfektan Botol - - - - -
2 Handsanitizer 500 ml Botol 500 ml - - - - -
3 Hand Scone Steril Pasang - - - - -
4 Hand Scone Non Steril Pcs - - - - -
5 Hazmat Pcs - - - - -
6 Masker Bedah Pcs - - - - -
7 Masker Bedah 3 ply (Hijab) Pcs - - - - -
8 Masker Bedah 3 ply (ear loop) Pcs - - - - -
9 Masker N-95 Pcs - - - - -
- - - - - -
- - - - - -
- - - - - -
BAHAN KEPERLUAN
4 - - - - -
LABORATORIUM -
- - - - - -
1 BHP HIV paket - - - - -
2 BHP Malaria paket - - - - -
3 Botol Sampel Keracunan buah - - - - -
4 Catride TCM paket - - - - -
LPLPO 54
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
5 Handscone bok @ - - - - -
6 Holdel Vacuete buah - - - - -
7 Jarum Vacutener buah - - - - -
8 Mount piece bok - - - - -
9 Paket Alat Pelindung Diri ( APD) paket - - - - -
10 - - - - -
Saring,Lanset,Alkohol Swab ) buah
11 Pipet test plastik buah - - - - -
12 Pot Dahak buah - - - - -
13 Pot Sampel AFP buah - - - - -
14 Pot Urine buah - - - - -
15 Rak Tabung Sampel buah - - - - -
16 RDT DBD bok - - - - -
17 RDT Hepatitis buah - - - - -
18 Reagen TB paket - - - - -
19 Safety Bok ADS buah - - - - -
20 Sampel Cup buah - - - - -
21 Slide bok - - - - -
22 Stick Gula Darah pak - - - - -
23 Tabung Vacuete buah - - - - -
24 Alat Suntik 3 cc pcs - - - - -
25 Alkohol swab pcs - - - - -
26 Lancet (Sentry Lancet) pcs - - - - -
27 RDT HIV Test Kit pcs - - - - -
28 RDT Malaria Test Kit pcs - - - - -
29 RDT Syphilis Test Kit pcs - - - - -
30 Tabung Vacuate (Vacum Tube Steril k3 EDTA) - - - - -

buah
31 RDT Covid-19 (Eco Test) pcs - - - - -
32 Virus Transport Media ( VTM) pcs - - - - -
33 Gown/Apron pcs 10 - 10 - 10
34 RDT Covid-19 Antibody pcs - - - - -
35 Face Shield pcs - - - - -
36 Handscone box@ 4 - 4 1 3
37 Penutup Kepala pcs - - - - -
38 Masker N95 pcs - - - - -
39 Cover All Suit pcs - - - - -
40 Face Shield pcs - - - - -
LPLPO 55
TINGKAT
KECUKUPAN
1 2 4 5 6 7 8 9 10 11 12 13 14
41 Gown/Apron pcs - - - - -
42 Under Pad pcs - - - - -
- - - - - -

5 - - - - -
BAHAN PEMBERSIH -
- - - - - -
1 Sanitarian Bag Buah - - - - -
2 Desinfektan Dirigen 5 L 4 - 4 - 4
- - - - - -
MENGETAHUI

NIP. 19720603 199302 1 001 NIP. 19830408 201101 1 003
LPLPO 56

Laporan BHP Kaliasin Permintaan April 2021

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Laporan BHP Kaliasin Permintaan April 2021

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BUKU BARANG PAKAI HABIS

NOMOR : 445/ / IV.03 / IV / 2021

SALDO AWAL PENERIMAAN PENGELUARAN SALDO/SISA

1 OBAT - OBATAN APBD II

Antasida DOEN Tablet Kunyah, Kombinasi :

Antifungi DOEN Kombinasi:

Antimalaria DOEN Kombinasi:

Antimigren Tablet : Ergotamin 1 mg + Kafein 50 mg

Besi (II) Sulfat 200 mg + Asam Folat 0,25mg Tablet

Kotrimoksazol Suspensi Kombi : Sulfame- toksazol

Kotrimoksazol Suspensi Kombi tiap 5ml :

Salep 2-4 ,Kombinasi:

Salep 2-4 ,Kombinasi:

Salep 2-4 ,Kombinasi:

32 Glucose - Botol 1,370,000.00 - Botol 1,370,000.00 - Botol 1,370,000.00 - - Botol 1,370,000.00 -

SUB JUMLAH OBAT, BMHP, VAKSIN APBD II - 17,739,056.00 - 2,393,684.00 - 15,345,372.00 -

2 OBAT - OBATAN APBD I - -

SUB JUMLAH BELANJA BOK - - - - - -

SUB JUMLAH BELANJA BAHAN KEPERLUAN

Masker polos / motif jenis headloop untuk

J U M L A H TOTAL 26,831,634.00 - 2,561,634.00 24,270,000.00

apt.Ahmad Solich Annas M, S.Farm

UPT PUSKESMAS KALIASIN

Kecamatan Tanjung Bintang

BERITA ACARA STOK OPNAME PERSEDIAAN OBAT

1 OBAT - OBATAN APBD II

48 Ampisilin Serbuk Injeksi im/iv. 1000 mg/vial Kotak 10 Vial 51,000.00 - -

53 Antasida DOEN II Suspensi Kombinasi Botol 60 ml 2,025.00 - -

54 Antasida DOEN II Suspensi Kombinasi Botol 60 ml 1,995.00 - -

55 Antasida DOEN II Suspensi Kombinasi Botol 60 ml 2,129.00 - -

56 Antibakteri DOEN (Bacitracin Salep Kulit) Tube 2,924.00 - -

94 Betametason Krim 0,1% (sebagai valerat) Tube 1,520.00 - -

95 Betametason Krim 0,1% (sebagai valerat) Tube 1,380.00 - -

232 Ketokonazol Krim 2 % Tube 2,545.00 - -

233 Ketokonazol Krim 2 % Tube 2,518.00 50 125,900.00

234 Ketokonazol Tablet 200 mg Tablet 300.00 - -

235 Ketokonazol Tablet 200 mg Tablet 270.00 - -

236 Ketokonazol Tablet 200 mg Tablet 288.00 - -

262 Klorpromazin Tablet Salut 100 mg (HCl) Tablet 147.00 - -

263 Klorpromazin Tablet Salut 25 mg (HCl) Tablet 68.00 - -

281 Kuinin Injeksi i.v. 25% (sebagai 2HCl) Amp 2 ml 6,200.00 - -

282 Kuinin Tablet 222 mg (H2SO4.7H2O) Tablet 540.00 - -

283 Lansoprazol Kapsul 30 mg Kapsul 473.00 - -

284 Levertran Salep pot 3,599.00 - -

380 Parasetamol Syrup 120 mg/ 5ml Botol 60 ml 1,181.00 40 47,240.00

381 Parasetamol Tablet 500 mg Tablet 79.00 - -

382 Parasetamol Tablet 500 mg Tablet 56.00 - -

418 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Kapsul 508.00 - -

11 Glass Ionomer Cement Set 395,000.00 - -

12 Glass Ionomer (Ketac Universal) Botol 761,390.00 - -

37 Hand Scone Non Steril # L (LIGHTY mas latex) pcs 462.00 - -

Hand Scone Non Steril # L (pree powdered mas

39 Handscone Non Steril (L ) (Mas pree powdered) pcs 522.06 - -

40 Hand Scone Non Steril # M (Aximed) pcs 462.00 - -

41 Hand Scone Non Steril # M (kismed mask latex) pcs 462.00 - -

42 Handscone Non Steril (M ) (Mas pree powdered) pcs 522.06 - -

43 Handscone Non Steril 7.5 ( Mask Surgical) Pasang 8,701.00 - -

115 Plester Rol Kain 2.5 cm x 1 m ( Hansaplast) Rol 5,017.00 - -

116 Plester Leukoplast 7,5cm x 4,5 cm Roll 35,532.00 - -

14 Dehidro Artemisin + Piperazin (DHP) Tablet Tablet 2,756.44 - -

15 Glimipiride Tablet 3 mg tablet 319.18 - -

2 OBAT - OBATAN APBD I

Besi (II) Sulfat 200 mg + Asam Folat 0,25mg

18 Cetrizin Tablet 10 mg Tablet 90.00 - -