File Puskesmas Lplpo Baru 2

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) FORM : LPLPO
PUSKESMAS
PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

KECAMATAN :………………….. DINKES KABUPATEN
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : ………………… UPTD GFK
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : ……………….. UPTD PUSKESMAS
STOK STOK STOK PEMBERIAN

NO NAMA OBAT SATUAN
AWAL
PENERIMAAN PERSEDIAAN PEMAKAIAN
AKHIR OPT.
PERMINTAAN Jumlah
PKD ASKES APBD I APBD II PROGRAM LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Air Raksa Dental Use Botol - - - -
2 Albendazole Tablet 400 mg Set 1,260 - 1,260 - 1,260 - (1,260)
3 Alopurinol Tablet 100 mg Set 269 300 569 175 394 350 (44)
4 Ambroksol Tablet 30 mg Set 4,840 3,000 7,840 143 7,697 286 (7,411)
5 Ambroksol sirup 15 mg/5 ml Tablet 273 300 573 32 541 64 (477)
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - 3 3 - (3)
7 Aminofillin Tablet 200 mg Tablet 105 - 105 81 24 162 138
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 600 - 600 600 - (600)
9 Amlodipin Tablet 5 mg Tablet 254 - 254 120 134 240 106
10 Amlodipin Tablet 10 mg Kapsul 260 - 260 260 - (260)
11 Amoksisillin Kapsul 250 mg Kaplet 18,644 4,100 22,744 930 21,814 1,860 (19,954)
12 Amoksisillin Kaplet 500 mg Botol 9,010 10,900 19,910 3,764 16,146 7,528 (8,618)
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 240 240 - (240)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 233 390 623 137 486 274 (212)
15 Amoksisillin Double Strengh Sirup Kering 2 Tablet 465 - 465 10 455 20 (435)
16 Ampisilin Kapsul 250 mg Tube - - - - - -

17 Ampisillin Kaplet 500 mg Supp - 2,400 2,400 110 2,290 220 (2,070)
18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - -
19 Ampisillin Injeksi 1000 mg Tablet 30 120 150 - 150 - (150)
20 Analgetik Plus Tablet - - - - - - -

21 Antasida Doen Suspensi Kombinasi : MagnVial 262 150 412 17 395 34 (361)
22 Antasida Doen Tablet, Kombinasi : Magn Botol 33,515 33,515 6,744 26,771 13,488 (13,283)
23 Antasida Plus Tablet Tablet 60 200 260 - 260 - (260)
24 Antalgin (Metampiron) Tablet 500 mg Tablet 1,819 2,900 4,719 3,066 1,653 6,132 4,479
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 - 60 - 60 - (60)
26 Anti Bakteri DOEN Salep Kombinasi : Botol - 50 50 9 41 18 (23)
27 Anti Hemoroid Doen komb Tablet - 10 10 - 10 - (10)
28 Anti Fungi DOEN Kombinasi : Tablet 194 200 394 - 394 - (394)
29 Antimigren DOEN Kombinasi : Ergotamin Tar Ampul 225 500 725 10 715 20 (695)
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 35 - 35 9 26 18 (8)
31 Anti Diare Tablet ( Neo Diaform) Vial 1,902 2,000 3,902 467 3,435 934 (2,501)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 583 1,500 2,083 - 2,083 - (2,083)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 500 500 - 500 - (500)
34 Antihistamin Tablet kombinasi (Soldextam) Ampul 1,887 1,887 708 1,179 1,416 237
35 Antispasmodik Tablet (Spasminal) Tablet - - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 83 20 103 47 56 94 38
37 Antitusiva Tablet (Dekorin) Tablet - - - - - - -
38 Asam Folat Tablet 1 mg Botol - - - - - - -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 18,228 7,000 25,228 2,421 22,807 4,842 (17,965)
40 Asam Mefenamat Kapsul 500 mg Tablet 323 500 823 370 453 740 287
41 Asetosal Tablet 80 mg Tablet - 100 100 100 - (100)
42 Asetosal Tablet 100 mg Tablet - 200 200 200 - (200)
43 Asetosal Tablet 500 mg Ampul - - - - - -
44 Asiklovir Krim 5 % Tablet 188 - 188 32 156 64 (92)
45 Asiklovir Tablet 200 mg Tablet 180 - 180 180 - (180)
46 Asiklovir Tablet 400 mg Tablet 240 - 240 60 180 120 (60)
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - - - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mlBotol 190 - 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,000 300 1,300 10 1,290 20 (1,270)
50 Betametason Krim 0,1 %- 5g Botol 268 125 393 62 331 124 (207)
51 Bisakodil suppositoria 10 mg Botol 30 - 30 3 27 6 (21)
52 Bisoprolol Tablet 5 mg Kapsul - - - - - - -
53 Bromheksin 8 mg Kapsul 4,875 2,500 7,375 225 7,150 450 (6,700)
54 Deksametason Injeksi 5mg/ml-1ml Ampul 58 70 128 - 128 - (128)
55 Deksametason Tablet 0,5 mg Tablet - - - - - - -
56 Devitalisasi Pasta (Non Arsen) Tablet - 1 1 1 - 2 2
57 Diazepam tablet 2 mg Tablet 212 - 212 13 199 26 (173)
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - - - - - -
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 - 10 - 10 - (10)
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - - - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 345 120 465 - 465 - (465)
62 Digoksin Tablet 0,25 mg Tablet - - - - - - -
63 Dimenhidrinat Tablet 50 mg Botol 1,300 - 1,300 100 1,200 200 (1,000)
64 Domperidon Tablet 10 mg Tablet 2,005 - 2,005 230 1,775 460 (1,315)
65 Donperidon Suspensi 5 mg/5ml Botol - - - - - - -
66 Efedrin Hcl Tablet 25 mg Kantong 35 100 135 - 135 - (135)
67 Ekstrak Belladone Tablet 10 mg Kantong - - - - -
68 Epinefrin HCl / Bitartrat Botol 15 10 25 - 25 - (25)
69 Eritromisin Kapsul 250 mg Set - - - - -
70 Eritromisin Kapsul 500 mg Tablet 400 400 400 - (400)
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - - - -
72 Etambutol Tablet 500 mg Botol - - - - -
73 Etanol 70 % 100 ml Botol - 16 16 16 - (16)
74 Etil Klorida Semprot -100 ml Botol 13 13 2 11 4 (7)
75 Eugenol Cairan -10 ml Tablet - 1 1 1 - 2 2
76 Fenitoin Natrium Kapsul 100 mg Stick 190 190 190 - (190)
77 Fenobarbital tablet 30 mg Tablet 50 200 250 60 190 120 (70)
78 Fenobarbital injeksi 50 mg / ml Tablet - - - - -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 830 500 1,330 1,330 - (1,330)
80 Fenoksimeti Penisilin 500 mg tablet Tube 700 700 80 620 160 (460)
81 Fitomenadion tablet 10 mg Tablet 130 130 130 - (130)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Tablet - - - - -
83 Furosemid Tablet 40 mg Set 145 2,000 2,145 120 2,025 240 (1,785)
84 Garam Oralit I serbuk, kombinasi : Set 1,113 1,113 210 903 420 (483)
85 Gemfibrozil Tablet 600 mg Vial - - - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul - - - - -
87 Gentamisin Salep Kulit 0,1 % Botol 180 200 380 76 304 152 (152)
88 Glibenklamid Tablet 5 mg Biji 2,069 2,069 442 1,627 884 (743)
89 Glimepiride 2 mg Pot 349 349 165 184 330 146
90 Gliseril Guayakolat Tablet 100 mg Tube 9,223 10,000 19,223 5,188 14,035 10,376 (3,659)
91 Gliseril Guayakolat sirup Tablet 234 200 434 23 411 46 (365)
92 Glukonas Kalsikus injeksi Bungkus - - - - -
93 Glukosa Larutan Infus 5 % Bungkus - 10 10 - 10 - (10)
94 Glukosa Larutan Infus10 % Tablet - 24 24 - 24 - (24)
95 Griseofulvin Tablet 125 mg,micronized Bungkus 1,368 1,368 210 1,158 420 (738)
96 Haloperidol Tablet 0,5 mg Rol 115 100 215 - 215 - (215)
97 Haloperidol Tablet 1,5 mg Rol 10 100 110 20 90 40 (50)
98 Haloperidol Tablet 5 mg Rol - 500 500 - 500 - (500)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 5,514 - 5,514 - 5,514 - (5,514)
100 Hidrokortison Krim 2,5 % Tube 201 200 401 38 363 76 (287)
101 Ibuprofen Tablet 200 mg Botol - 2,400 2,400 335 2,065 670 (1,395)
102 Ibuprofen Tablet 400 mg Tablet 1,118 - 1,118 966 152 1,932 1,780
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 40 - 40 - 40 - (40)
104 Ichtyol salep Kulit Ampul 5 13 18 4 14 8 (6)
105 Ipatropium Bromide + Salbutamol Ampul - 20 20 - 20 - (20)
106 Isoniazid tablet 100 mg Tablet - - - - -
107 Isosorbid Dinitrat 5 mg Tablet 300 - 300 - 300 - (300)
108 Kalium Diklofenak Tablet 25 mg Tablet - - - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 1,000 2,000 3,000 120 2,880 240 (2,640)
110 Kalsium Hidroksida Pasta Botol - 1 1 1 - 2 2
111 Kalsium Laktat Tablet 500 mg Tablet 19,754 4,200 23,954 2,245 21,709 4,490 (17,219)
112 Kaptopril 12,5 mg Ampul 2,085 - 2,085 1,170 915 2,340 1,425
113 Kaptopril 25 mg Botol - - - - - - -
114 Karbamazepin Tablet 200 mg Botol 160 - 160 - 160 - (160)
115 Ketokonazole Krim 2 % - 15 gr Botol 19 21 40 19 21 38 17
116 Ketokonazole Tablet 200 mg Botol 799 - 799 120 679 240 (439)
117 Ketoprofen Tablet 100 mg Botol - - - - - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - - - - - -
119 Ketorolac 10 mg injeksi Botol - - - - - - -
120 Ketorolac 30 mg injeksi Botol - 30 30 10 20 20 -
121 Klindamisin Kapsul 150 mg Botol - - - - - - -
122 Klindamisin Kapsul 300 mg Tablet - - - - - - -
123 Kloramfenikol Kapsul 250 mg Ampul 1,040 1,400 2,440 100 2,340 200 (2,140)
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -

125 Kloramfenikol Tetes Mata -5 ml Ampul 93 150 243 36 207 72 (135)
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 87 100 187 24 163 48 (115)
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 28,581 10,000 38,581 5,989 32,592 11,978 (20,614)
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 610 1,000 1,610 340 1,270 680 (590)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 820 - 820 500 320 1,000 680
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi Tablet 595 400 995 236 759 472 (287)
132 Kotrimoksazol Tablet, Kombinasi : Ampul 185 - 185 155 30 310 280
133 Kotrimoksazol Suspensi Kombinasi : Tablet 414 200 614 96 518 192 (326)
134 Lansoprazole 30 mg Kapsul Botol 140 - 140 100 40 200 160
135 Larutan mengandung Elektrolit Kaen 1b Botol - 20 20 - 20 - (20)
136 Larutan mengadung Elektrolit Tablet - 20 20 5 15 10 (5)
137 Larutan mengadung Karbohidrat + Elektrolit Botol - - - - -
138 Lidokain injeksi 2 % Botol - - - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - - - -
140 Loperamid Tablet 2 mg Tablet 145 200 345 345 - (345)
141 Loratadin tablet 10 mg Tablet 889 - 889 - 889 - (889)
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - - - -
143 Meloksikam tablet 15 mg Paket 1,105 1,400 2,505 160 2,345 320 (2,025)
144 Meloksikam Suppositoria Paket - - - - - - -
145 Metformin Hcl Tablet 500 mg Paket - 1,500 1,500 10 1,490 20 (1,470)
146 Methisoprinol 500 mg Paket 200 150 350 - 350 - (350)
147 Metilergometrin Maleat (Metergin) Tablet Botol 84 100 184 - 184 - (184)
148 Metilergometrin Maleat Injeksi 0,200 mg-1mVial - 200 200 - 200 - (200)
149 Metilprednisolon tablet 4 mg Tube 2,000 1,400 3,400 210 3,190 420 (2,770)
150 Metoklopramid 10 mg Tube 1,000 400 1,400 - 1,400 - (1,400)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - 200 200 - 200 - (200)
152 Metronidazol Tablet 250 mg Tablet 210 - 210 210 - 420 420
153 Metronidazole Tablet 500 mg Botol 418 418 275 143 550 407
154 Metronidazole Infus 500 mg /100 ml Tablet - - - - - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet 21 5 26 7 19 14 (5)
156 Multivitamin + Mineral tablet Tablet 620 - 620 620 - 1,240 1,240
157 Multivitamin sirup Tablet 22 30 52 42 10 84 74
158 Natrium Bikarbonat Tablet 500 mg Tablet 4,093 3,000 7,093 10 7,083 20 (7,063)
159 Natrum Diklofenak Tablet 25 mg Tablet 100 100 100 - 200 200
160 Natrium Diklofenak Tablet 50 mg Rol 3,000 3,200 6,200 80 6,120 160 (5,960)
161 Natrium Klorida Larutan infus 0,9%-Steril 5 Botol 13 8 21 4 17 8 (9)
162 Nipedifin Tablet 10 mg Botol 1,247 400 1,647 20 1,627 40 (1,587)

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 200 - 200 - 200 - (200)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 107 - 107 - 107 - (107)
165 Obat Antitiuberkolosis Kategori Anak Botol - - - - -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Tablet - - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan Dewas Tablet - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 294 200 494 44 450 88 (362)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 17 50 67 23 44 46 2
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol - - - - -
176 Obat Flu Sirup Tablet - - - - -
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 m Pot 50 - 50 - 50 - (50)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 181 - 181 31 150 62 (88)
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 38 130 168 50 118 100 (18)
181 Omeprazole injeksi 40mg/10ml Vial - 30 30 - 30 - (30)
182 Omeprazole Kapsul 20 mg Vial - - - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul - 145 145 - 145 - (145)
184 Parasetamol drop 100 mg/ml btl @15ml (60 Vial 144 - 144 45 99 90 (9)
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 429 300 729 172 557 344 (213)
186 Parasetamol Tablet 100 mg Sachet - - - - -
187 Parasetamol Tablet 500 mg Botol 37,501 20,000 57,501 10,913 46,588 21,826 (24,762)
188 Pehacain injeksi Buah 40 100 140 90 50 180 130
189 Perak Sulfadiazin krim 1 % 35 gr (Burnazin) Botol 32 27 59 8 51 16 (35)
190 Piracetam 400 mg Tablet 100 200 300 50 250 100 (150)
191 Piracetam Tablet 800 mg Botol - 200 200 - 200 - (200)
192 Piroksikam Tablet 20 mg Vial 699 400 1,099 270 829 540 (289)
193 Pirantel Pamoat Tablet 365 mg (Setara dng Set 196 200 396 - 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 17,061 7,000 24,061 4,261 19,800 8,522 (11,278)
195 Polikresulen (Kondensasi Metakresol Sulfo Set 12 - 12 2 10 4 (6)

196 Povidon Iodida 10% 30 ml Kapsul 2 - 2 2 - 4 4
197 Povidon Iodida 10% 300 ml Ampul 1 - 1 1 - 2 2
198 Predison Tablet - - - - - - -
199 Primakuin tablet 15 mg Tablet - - - - -
200 Propanolol Hcl Tablet 40 mg Botol 197 - 197 - 197 - (197)
201 Propilturasil Tablet 100 mg Kuur 130 - 130 - 130 - (130)
202 Ranitidin Injeksi 25 mg / ml Set - 300 300 - 300 - (300)
203 Ranitidin Tablet 150 mg Tablet 4,380 - 4,380 220 4,160 440 (3,720)
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - - - -
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - - - - -
206 Reserpin Tablet 0, 25 mg Buah 2,692 - 2,692 12 2,680 24 (2,656)
207 Rifampisin Tablet 450 mg Buah - - - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 4 - 4 4 - 8 8
209 Salbutamol Tablet 2 mg Tablet - - - - -
210 Salbutamol Tablet 4 mg Botol 990 1,000 1,990 - 1,990 - (1,990)
211 Salbutamol solution for Inhalation single dosTablet - 20 20 - 20 - (20)
212 Salep 2-4 Kombinasi : Asam Salisilat 2 % Tablet 14 25 39 6 33 12 (21)
213 Salisil bedak 2% -50 gr Botol 167 100 267 62 205 124 (81)
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml siru Botol 147 - 147 13 134 26 (108)
216 Sefadroksil Tablet 500 mg Kapsul - 1,500 1,500 150 1,350 300 (1,050)
217 Sefiksim Kapsul 100 mg Vial - - - - -
218 Sefotaksim Injeksi 1 gr Tablet - - - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - - - -
221 Setirizin Tablet 10 mg Botol 116 - 116 116 - 232 232
222 Setirizin Sirup 5 mg / 5 ml Tablet 51 - 51 10 41 20 (21)
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 200 50 250 - 250 - (250)
224 Sianokobalamin Tablet 50 mcg Tablet - - - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - - - -
226 Simetidin 200 mg Tablet Tablet 2,000 400 2,400 300 2,100 600 (1,500)
227 Simvastatin Tablet 10 mg Tablet 990 1,000 1,990 160 1,830 320 (1,510)
228 Siprofloksasin 500mg Tablet - - - - -
229 Spironolakton Tablet 25 mg Botol 90 - 90 - 90 - (90)
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet 20 - 20 20 - 40 40
231 Tablet Tambah Darah Kombinasi: Besi II SuTablet - - - - -
232 Temporary Stopping Fletcher (Fletcher) Ser Kapsul - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - - -
234 Tetrasiklin Kapsul 250 mg Tube 3,464 - 3,464 500 2,964 1,000 (1,964)
235 Tetrasiklin Kapsul 500 mg Tablet 2,058 1,000 3,058 790 2,268 1,580 (688)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Tablet 120 90 210 - 210 - (210)
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 m set 13,603 10,000 23,603 4,356 19,247 8,712 (10,535)
238 Thiamfenikol Kapsul 500 mg set 500 400 900 - 900 - (900)
239 Tramadol Injeksi 50 mg/ ml Botol - - - - -
240 Tramadol Tablet 50 mg Tablet - - - - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 10 100 110 - 110 - (110)
242 Vitamin B .Komplek Tablet Tablet 17,920 2,200 20,120 1,923 18,197 3,846 (14,351)
243 Vitamin Neurotropik Tablet Botol 3,280 2,000 5,280 660 4,620 1,320 (3,300)
244 Zinc Tablet 20 mg Tablet 608 - 608 390 218 780 562
245 Prednison tab 5 mg Tablet 4,321 5,000 9,321 2,467 6,854 4,934 (1,920)
246 Gentian Violet Tablet - - - - -
247 Furosemid injek 10mg/ml Tablet - 24 24 - 24 - (24)
248 Glass Ionoer semen Botol - 1 1 1 - 2 2
249 Bahan Tambal Sementara Kapsul - 1 1 1 - 2 2
250 MgSO4-40% Kapsul 37 - 37 13 24 26 2
251
252
253
254
255 Abbocath No 18 ( IV Chateter 18 ) Tablet 60 50 110 - 110 - (110)
256 Abbocath No 20 ( IV Chateter 20 ) Botol 58 50 108 - 108 - (108)
257 Abbocath No 22 ( IV Chateter 22 ) Pot 100 100 200 - 200 - (200)
258 Abbocath No 24 ( IV Chateter 24 ) Tablet 59 50 109 - 109 - (109)
259 Alat Suntik Sekali Pakai 10 ml Tablet - - - - - - -
260 Alat Suntik Sekali Pakai 1 ml Tablet 100 - 100 - 100 - (100)
261 Alat Suntik Sekali Pakai 2,5 ml Tablet 50 200 250 220 30 440 410
262 Alat Suntik Sekali Pakai 5 ml Tablet 200 - 200 100 100 200 100
263 Alat Suntik Sekali Pakai 10 ml Kotak - - - - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & CTube 44 15 59 20 39 40 1
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml Tablet 39 - 39 19 20 38 18
266 Etanol 70 % 1.000 ml Tablet 14 - 14 14 - (14)
267 Folley Catheter no 18 Pcs 5 5 3 2 6 4
268 Folley Catheter no 20 Pcs - - - - - -
269 Folley Catheter no 22 Pcs - - - - - -
270 Infus set Anak Set 53 22 75 - 75 - (75)
271 Infus set Dewasa Set 115 100 215 - 215 - (215)
272 Iodina Test Botol - - - - -
273 Kassa Hidrofil Steril 16 x 16 Botol 20 - 20 - 20 - (20)
274 Kapas Berlemak 500 gram Tablet - - - - -
275 Kapas Pembalut / Adsorbens 250 gram Tablet 18 10 28 4 24 8 (16)
276 Kassa Kompres 40 x 40 steril Kapsul 50 - 50 - 50 - (50)
277 Kassa Pembalut 2 m x 80 cm Tablet 16 26 42 13 29 26 (3)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet 40 25 65 45 20 90 70
279 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 64 10 74 - 74 - (74)
280 Kertas Puyer Tablet - - - - -
281 Lysol 1,000 ml Supp 6 - 6 1 5 2 (3)
282 Masker Tablet 80 - 80 20 60 40 (20)
283 Plester 5 yard x 2 inchi Tablet 3 - 3 3 - 6 6
284 Silk( Benang Bedah Sutra ) No 3/0 Tablet 82 15 97 10 87 20 (67)
285 Safety Box Ampul - - - - - - -
286 Sarung tangan Steril No 6 Ampul - - - - -
287 Sarung tangan Steril No 7 Tablet 25 30 55 25 30 50 20
288 Sarung tangan Steril No 7,5 Tube 26 30 56 30 26 60 34
289 Sarung tangan Non Steril S Sashet 100 - 100 - 100 - (100)
290 Sarung tangan Non Steril M Tablet 100 - 100 - 100 - (100)
291 Sarung tangan Non Steril L Botol 100 - 100 - 100 - (100)
292 Urine Bag Tablet - - - - -
293 Wing Neddle No 23 Tablet 30 - 30 - 30 - (30)
294
295
296
297
298
299
300
301 C. SERUM DAN VAKSIN
302 Serum Anti Bisa Ular Polivalen Injeksi 5 ml Tablet 2 7 9 - 9 - (9)
303 Serum Anti Rabies untuk manusia Botol 2 - 2 - 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 IU Tablet 3 24 27 - 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000 IUAmpul - - - - -
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
JUMLAH KUNJUNGAN RESEP
0
Mengetahui / Menyetujui: Yang Menyerahkan

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi & Perbekalan Yang Meminta Yang Menerima
Kuningan Kuningan Kabupaten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
Lembar Putih : Gudang Farmasi & Perbekalan
Lembar Biru : Dinas Kesehatan Kabupaten
Lembar Kuning : UPTD Puskesmas
PUSKESMAS


NO NAMA OBAT SATUAN
AWAL
AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Air Raksa Dental Use Botol - - - - -
2 Albendazole Tablet 400 mg Set 1,260 1,260 1,260 - (1,260)
3 Alopurinol Tablet 100 mg Set 394 - 394 394 - 788 788
4 Ambroksol Tablet 30 mg Set 7,697 - 7,697 332 7,365 664 (6,701)
5 Ambroksol sirup 15 mg/5 ml Tablet 541 - 541 48 493 96 (397)
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - 3 - 3 - (3)
7 Aminofillin Tablet 200 mg Tablet 24 100 124 70 54 140 86
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 600 - 600 10 590 20 (570)
9 Amlodipin Tablet 5 mg Tablet 134 - 134 40 94 80 (14)
10 Amlodipin Tablet 10 mg Kapsul 260 - 260 10 250 20 (230)
11 Amoksisillin Kapsul 250 mg Kaplet 21,814 - 21,814 2,270 19,544 4,540 (15,004)
12 Amoksisillin Kaplet 500 mg Botol 16,146 - 16,146 6,766 9,380 13,532 4,152
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 - 240 - 240 - (240)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 486 - 486 150 336 300 (36)
15 Amoksisillin Double Strengh Sirup Kerin Tablet 455 - 455 3 452 6 (446)
16 Ampisilin Kapsul 250 mg Tube - - - - -

17 Ampisillin Kaplet 500 mg Supp 2,290 - 2,290 290 2,000 580 (1,420)
18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - -
19 Ampisillin Injeksi 1000 mg Tablet 150 - 150 - 150 - (150)
20 Analgetik Plus Tablet - - - - -

21 Antasida Doen Suspensi Kombinasi : M Vial 395 - 395 6 389 12 (377)
22 Antasida Doen Tablet, Kombinasi : Ma Botol 26,771 - 26,771 5,715 21,056 11,430 (9,626)
23 Antasida Plus Tablet Tablet 260 - 260 60 200 120 (80)
24 Antalgin (Metampiron) Tablet 500 mg Tablet 1,653 4,000 5,653 3,635 2,018 7,270 5,252
26 Anti Bakteri DOEN Salep Kombinasi : Botol 41 - 41 - 41 - (41)
27 Anti Hemoroid Doen komb Tablet 10 - 10 - 10 - (10)
28 Anti Fungi DOEN Kombinasi : Tablet 394 - 394 37 357 74 (283)
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 715 - 715 - 715 - (715)
31 Anti Diare Tablet ( Neo Diaform) Vial 3,435 - 3,435 396 3,039 792 (2,247)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 2,083 - 2,083 - 2,083 - (2,083)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 500 - 500 30 470 60 (410)
34 Antihistamin Tablet kombinasi (Soldext Ampul 1,179 - 1,179 991 188 1,982 1,794
36 Antitusiva Sirup (Dexophan) Botol 56 - 56 41 15 82 67
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 22,807 - 22,807 1,586 21,221 3,172 (18,049)
40 Asam Mefenamat Kapsul 500 mg Tablet 453 - 453 453 - 906 906
41 Asetosal Tablet 80 mg Tablet 100 - 100 - 100 - (100)
43 Asetosal Tablet 500 mg Ampul - - - - - - -
45 Asiklovir Tablet 200 mg Tablet 180 - 180 150 30 300 270
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - - - - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20Botol 190 - 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,290 - 1,290 60 1,230 120 (1,110)
50 Betametason Krim 0,1 %- 5g Botol 331 - 331 48 283 96 (187)
51 Bisakodil suppositoria 10 mg Botol 27 - 27 2 25 4 (21)
53 Bromheksin 8 mg Kapsul 7,150 - 7,150 100 7,050 200 (6,850)
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 - 128 - 128 - (128)
55 Deksametason Tablet 0,5 mg Tablet - - - - - - -
56 Devitalisasi Pasta (Non Arsen) Tablet - - - - - - -
57 Diazepam tablet 2 mg Tablet 199 - 199 86 113 172 59
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 465 - 465 5 460 10 (450)
63 Dimenhidrinat Tablet 50 mg Botol 1,200 - 1,200 100 1,100 200 (900)
66 Efedrin Hcl Tablet 25 mg Kantong 135 - 135 - 135 - (135)
67 Ekstrak Belladone Tablet 10 mg Kantong - - - - - - -
68 Epinefrin HCl / Bitartrat Botol 25 - 25 - 25 - (25)
69 Eritromisin Kapsul 250 mg Set - - - - - - -
70 Eritromisin Kapsul 500 mg Tablet 400 - 400 - 400 - (400)
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - - - - - -
72 Etambutol Tablet 500 mg Botol - - - - - - -
73 Etanol 70 % 100 ml Botol 16 - 16 2 14 4 (10)
74 Etil Klorida Semprot -100 ml Botol 11 - 11 2 9 4 (5)
75 Eugenol Cairan -10 ml Tablet - - - - - - -
76 Fenitoin Natrium Kapsul 100 mg Stick 190 - 190 - 190 - (190)
77 Fenobarbital tablet 30 mg Tablet 190 - 190 70 120 140 20
78 Fenobarbital injeksi 50 mg / ml Tablet - 30 30 - 30 - (30)
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,330 - 1,330 - 1,330 - (1,330)
80 Fenoksimeti Penisilin 500 mg tablet Tube 620 - 620 - 620 - (620)
81 Fitomenadion tablet 10 mg Tablet 130 - 130 30 100 60 (40)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet - - - - - - -
83 Furosemid Tablet 40 mg Set 2,025 - 2,025 110 1,915 220 (1,695)
84 Garam Oralit I serbuk, kombinasi : Set 903 - 903 173 730 346 (384)
85 Gemfibrozil Tablet 600 mg Vial - - - - - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul - 20 20 - 20 - (20)
87 Gentamisin Salep Kulit 0,1 % Botol 304 - 304 62 242 124 (118)
88 Glibenklamid Tablet 5 mg Biji 1,627 - 1,627 885 742 1,770 1,028
89 Glimepiride 2 mg Pot 184 300 484 50 434 100 (334)
90 Gliseril Guayakolat Tablet 100 mg Tube 14,035 - 14,035 4,829 9,206 9,658 452
91 Gliseril Guayakolat sirup Tablet 411 - 411 34 377 68 (309)
92 Glukonas Kalsikus injeksi Bungkus - - - - - - -
93 Glukosa Larutan Infus 5 % Bungkus 10 - 10 - 10 - (10)
94 Glukosa Larutan Infus10 % Tablet 24 - 24 2 22 4 (18)
95 Griseofulvin Tablet 125 mg,micronized Bungkus 1,158 - 1,158 540 618 1,080 462
96 Haloperidol Tablet 0,5 mg Rol 215 - 215 - 215 - (215)
97 Haloperidol Tablet 1,5 mg Rol 90 - 90 20 70 40 (30)
98 Haloperidol Tablet 5 mg Rol 500 - 500 - 500 - (500)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 5,514 - 5,514 400 5,114 800 (4,314)
100 Hidrokortison Krim 2,5 % Tube 363 - 363 56 307 112 (195)
101 Ibuprofen Tablet 200 mg Botol 2,065 2,000 4,065 640 3,425 1,280 (2,145)
102 Ibuprofen Tablet 400 mg Tablet 152 1,000 1,152 556 596 1,112 516
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 40 - 40 15 25 30 5
104 Ichtyol salep Kulit Ampul 14 - 14 5 9 10 1

105 Ipatropium Bromide + Salbutamol Ampul 20 - 20 - 20 - (20)
106 Isoniazid tablet 100 mg Tablet - - - - - - -
108 Kalium Diklofenak Tablet 25 mg Tablet - - - - - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 2,880 - 2,880 100 2,780 200 (2,580)
110 Kalsium Hidroksida Pasta Botol - - - - - - -
111 Kalsium Laktat Tablet 500 mg Tablet 21,709 - 21,709 2,530 19,179 5,060 (14,119)
112 Kaptopril 12,5 mg Ampul 915 1,000 1,915 1,191 724 2,382 1,658
115 Ketokonazole Krim 2 % - 15 gr Botol 21 - 21 14 7 28 21
116 Ketokonazole Tablet 200 mg Botol 679 - 679 460 219 920 701
117 Ketoprofen Tablet 100 mg Botol - - - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - - - -
119 Ketorolac 10 mg injeksi Botol - - - - -
120 Ketorolac 30 mg injeksi Botol 20 - 20 - 20 - (20)
123 Kloramfenikol Kapsul 250 mg Ampul 2,340 - 2,340 - 2,340 - (2,340)

125 Kloramfenikol Tetes Mata -5 ml Ampul 207 - 207 25 182 50 (132)
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 163 - 163 23 140 46 (94)
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 32,592 - 32,592 9,374 23,218 18,748 (4,470)
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,270 - 1,270 270 1,000 540 (460)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 320 - 320 320 - 640 640
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 759 - 759 200 559 400 (159)
132 Kotrimoksazol Tablet, Kombinasi : Ampul 30 - 30 30 - 60 60
133 Kotrimoksazol Suspensi Kombinasi : Tablet 518 - 518 81 437 162 (275)
134 Lansoprazole 30 mg Kapsul Botol 40 100 140 60 80 120 40
135 Larutan mengadung Elektrolit Botol 20 - 20 - 20 - (20)
136 Larutan mengadung Elektrolit Tablet 15 - 15 - 15 - (15)
137 Larutan mengadung Karbohidrat + Elektrolit
Botol - - - - - - -
138 Lidokain injeksi 2 % Botol - - - - - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - - - - - -
140 Loperamid Tablet 2 mg Tablet 345 - 345 50 295 100 (195)
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - - - - - -
143 Meloksikam tablet 15 mg Paket 2,345 - 2,345 200 2,145 400 (1,745)
144 Meloksikam Suppositoria Paket - - - - - -
145 Metformin Hcl Tablet 500 mg Paket 1,490 - 1,490 230 1,260 460 (800)
146 Methisoprinol 500 mg Paket 350 - 350 - 350 - (350)
147 Metilergometrin Maleat (Metergin) Table Botol 184 - 184 120 64 240 176
148 Metilergometrin Maleat Injeksi 0,200 mg Vial 200 - 200 - 200 - (200)
149 Metilprednisolon tablet 4 mg Tube 3,190 - 3,190 490 2,700 980 (1,720)
150 Metoklopramid 10 mg Tube 1,400 - 1,400 - 1,400 - (1,400)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 200 - 200 20 180 40 (140)
152 Metronidazol Tablet 250 mg Tablet - 200 200 150 50 300 250
153 Metronidazole Tablet 500 mg Botol 143 - 143 85 58 170 112
155 Mikonazole KrIm 2 % - 10 gr Tablet 19 - 19 3 16 6 (10)
156 Multivitamin + Mineral tablet Tablet - 300 300 100 200 200 -
157 Multivitamin sirup Tablet 10 50 60 39 21 78 57
158 Natrium Bikarbonat Tablet 500 mg Tablet 7,083 - 7,083 21 7,062 42 (7,020)
159 Natrum Diklofenak Tablet 25 mg Tablet - - - - - - -
160 Natrium Diklofenak Tablet 50 mg Rol 6,120 - 6,120 150 5,970 300 (5,670)
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 17 - 17 3 14 6 (8)
162 Nipedifin Tablet 10 mg Botol 1,627 - 1,627 150 1,477 300 (1,177)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 107 - 107 10 97 20 (77)
165 Obat Antitiuberkolosis Kategori Anak Botol - - - - - - -
166 Obat Antitiuberkolosis Kategori 1 Dewas Tablet - - - - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet - - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 450 - 450 42 408 84 (324)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 44 - 44 31 13 62 49
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol - - - - - - -
176 Obat Flu Sirup Tablet - - - - - - -
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10Pot 50 - 50 - 50 - (50)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 150 - 150 25 125 50 (75)
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 118 - 118 10 108 20 (88)
181 Omeprazole injeksi 40mg/10ml Vial 30 - 30 - 30 - (30)
182 Omeprazole Kapsul 20 mg Vial - - - - - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul 145 - 145 5 140 10 (130)
184 Parasetamol drop 100 mg/ml btl @15ml Vial 99 - 99 40 59 80 21
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 557 - 557 207 350 414 64
186 Parasetamol Tablet 100 mg Sachet - - - - - - -
187 Parasetamol Tablet 500 mg Botol 46,588 - 46,588 9,660 36,928 19,320 (17,608)
188 Pehacain injeksi Buah 50 100 150 50 100 100 -
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 51 - 51 9 42 18 (24)
190 Piracetam 400 mg Tablet 250 - 250 100 150 200 50
191 Piracetam Tablet 800 mg Botol 200 - 200 - 200 - (200)
192 Piroksikam Tablet 20 mg Vial 829 - 829 170 659 340 (319)
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 - 396 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 19,800 - 19,800 4,387 15,413 8,774 (6,639)
195 Polikresulen (Kondensasi Metakresol SulSet 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul - 4 4 - 4 - (4)
197 Povidon Iodida 10% 300 ml Ampul - 1 1 - 1 - (1)
199 Primakuin tablet 15 mg Tablet - - - - - - -
202 Ranitidin Injeksi 25 mg / ml Set 300 - 300 - 300 - (300)
203 Ranitidin Tablet 150 mg Tablet 4,160 - 4,160 1,271 2,889 2,542 (347)
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - - - - - -
206 Reserpin Tablet 0, 25 mg Buah 2,680 - 2,680 2,680 - 5,360 5,360 EXP.DATE
207 Rifampisin Tablet 450 mg Buah - - - - - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set - 20 20 - 20 - (20)
209 Salbutamol Tablet 2 mg Tablet - - - - - -
210 Salbutamol Tablet 4 mg Botol 1,990 - 1,990 240 1,750 480 (1,270)
211 Salbutamol solution for Inhalation single Tablet 20 - 20 - 20 - (20)
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 33 - 33 6 27 12 (15)
213 Salisil bedak 2% -50 gr Botol 205 - 205 56 149 112 (37)
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml s Botol 134 - 134 15 119 30 (89)
216 Sefadroksil Tablet 500 mg Kapsul 1,350 - 1,350 460 890 920 30
217 Sefiksim Kapsul 100 mg Vial - - - - - - -
218 Sefotaksim Injeksi 1 gr Tablet - - - - - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - - - - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - - - - - -
221 Setirizin Tablet 10 mg Botol - - - - - - -
222 Setirizin Sirup 5 mg / 5 ml Tablet 41 - 41 - 41 - (41)
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 250 - 250 15 235 30 (205)
224 Sianokobalamin Tablet 50 mcg Tablet - - - - - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - - - - - -
226 Simetidin 200 mg Tablet Tablet 2,100 - 2,100 200 1,900 400 (1,500)
227 Simvastatin Tablet 10 mg Tablet 1,830 - 1,830 316 1,514 632 (882)
228 Siprofloksasin 500mg Tablet - - - - - - -
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - - - - - - -
231 Tablet Tambah Darah Kombinasi: Besi II Tablet - - - - - - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - - - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - - - - -
234 Tetrasiklin Kapsul 250 mg Tube 2,964 - 2,964 410 2,554 820 (1,734)
235 Tetrasiklin Kapsul 500 mg Tablet 2,268 - 2,268 490 1,778 980 (798)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet 210 - 210 - 210 - (210)
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 19,247 - 19,247 4,872 14,375 9,744 (4,631)
238 Thiamfenikol Kapsul 500 mg set 900 - 900 10 890 20 (870)
239 Tramadol Injeksi 50 mg/ ml Botol - - - - - - -
240 Tramadol Tablet 50 mg Tablet - - - - - - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 110 - 110 20 90 40 (50)
242 Vitamin B .Komplek Tablet Tablet 18,197 - 18,197 1,649 16,548 3,298 (13,250)
243 Vitamin Neurotropik Tablet Botol 4,620 - 4,620 430 4,190 860 (3,330)
244 Zinc Tablet 20 mg Tablet 218 200 418 220 198 440 242
245 Prednison tab 5 mg Tablet 6,854 - 6,854 2,253 4,601 4,506 (95)
246 Gentian Violet Tablet - - - - - - -
247 Furosemid injek 10mg/ml Tablet 24 - 24 - 24 - (24)
248 Glass Ionoer semen Botol - - - - - - -
249 Bahan Tambal Sementara Kapsul - - - - - - -
250 MgSO4-40% Kapsul 24 - 24 24 - (24)
251 - -
252 - -
253 - -
254 - -
255 Abbocath No 18 ( IV Chateter 18 ) Tablet 110 - 110 2 108 4 (104)
256 Abbocath No 20 ( IV Chateter 20 ) Botol 108 - 108 - 108 - (108)
257 Abbocath No 22 ( IV Chateter 22 ) Pot 200 - 200 - 200 - (200)
258 Abbocath No 24 ( IV Chateter 24 ) Tablet 109 - 109 - 109 - (109)
261 Alat Suntik Sekali Pakai 2,5 ml Tablet 30 300 330 20 310 40 (270)
263 Alat Suntik Sekali Pakai 10 ml Kotak - - - - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Tube 39 - 39 - 39 - (39)
265 Etakridin Larutan (Rivanol) 0,1% - 300 m Tablet 20 - 20 6 14 12 (2)
266 Etanol 70 % 1.000 ml Tablet 14 - 14 - 14 - (14)
267 Folley Catheter no 14 Ampul 2 - 2 - 2 - (2)
268 Folley Catheter no 16 Ampul - - - - - - -
270 Infus set Anak Kapsul 75 - 75 - 75 - (75)
271 Infus set Dewasa Kapsul 215 - 215 15 200 30 (170)
272 Iodina Test Botol - - - - - - -
273 Kassa Hidrofil Steril 16 x 16 Botol 20 - 20 - 20 - (20)
274 Kapas Berlemak 500 gram Tablet - - - - - - -
275 Kapas Pembalut / Adsorbens 250 gram Tablet 24 - 24 1 23 2 (21)
276 Kassa Kompres 40 x 40 steril Kapsul 50 - 50 3 47 6 (41)
277 Kassa Pembalut 2 m x 80 cm Tablet 29 - 29 6 23 12 (11)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet 20 50 70 - 70 - (70)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 74 - 74 10 64 20 (44)
280 Kertas Puyer Tablet - - - - - - -
281 Lysol 1,000 ml Supp 5 - 5 - 5 - (5)
282 Masker Tablet 60 - 60 - 60 - (60)
283 Plester 5 yard x 2 inchi Tablet - - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Tablet 87 - 87 5 82 10 (72)
286 Sarung tangan Steril No 6 Ampul - - - - - - -
287 Sarung tangan Steril No 7 Tablet 30 50 80 5 75 10 (65)
288 Sarung tangan Steril No 7,5 Tube 26 50 76 26 50 52 2
289 Sarung tangan Non Steril S Sashet 100 - 100 - 100 - (100)
290 Sarung tangan Non Steril M Tablet 100 - 100 - 100 - (100)
291 Sarung tangan Non Steril L Botol 100 - 100 - 100 - (100)
292 Urine Bag Tablet - - - - - - -
294 -
295 -
296 -
297 -
298 -
299 -
300 -
301 C. SERUM DAN VAKSIN -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Tablet 9 - 9 - 9 - (9)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Tablet 27 - 27 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000Ampul - - - - - - -
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

Kabupaten Kuningan Kabupaten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
PUSKESMAS


NO NAMA OBAT SATUAN
AWAL
AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2 Albendazole Tablet 400 mg Set 1,260 1,260 - 1,260 - (1,260)
3 Alopurinol Tablet 100 mg Set - 600 600 260 340 520 180
4 Ambroksol Tablet 30 mg Set 7,365 6,500 13,865 116 13,749 232 (13,517)
5 Ambroksol sirup 15 mg/5 ml Tablet 493 350 843 101 742 202 (540)
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 590 - 590 - 590 - (590)
9 Amlodipin Tablet 5 mg Tablet 94 - 94 90 4 180 176
10 Amlodipin Tablet 10 mg Kapsul 250 - 250 - 250 - (250)
11 Amoksisillin Kapsul 250 mg Kaplet 19,544 400 19,944 2,860 17,084 5,720 (11,364)
12 Amoksisillin Kaplet 500 mg Botol 9,380 73,500 82,880 4,532 78,348 9,064 (69,284)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 336 350 686 201 485 402 (83)
16 Ampisilin Kapsul 250 mg Tube - - - - - - -

17 Ampisillin Kaplet 500 mg Supp 2,000 - 2,000 570 1,430 1,140 (290)

22 Antasida Doen Tablet, Kombinasi : Ma Botol 21,056 - 21,056 6,483 14,573 12,966 (1,607)
23 Antasida Plus Tablet Tablet 200 2,400 2,600 500 2,100 1,000 (1,100)
24 Antalgin (Metampiron) Tablet 500 mg Tablet 2,018 3,000 5,018 5,018 - 10,036 10,036
26 Anti Bakteri DOEN Salep Kombinasi : Botol 41 - 41 1 40 2 (38)
27 Anti Hemoroid Doen komb Tablet 10 - 10 10 - 20 20
28 Anti Fungi DOEN Kombinasi : Tablet 357 325 682 20 662 40 (622)
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 715 - 715 100 615 200 (415)
31 Anti Diare Tablet ( Neo Diaform) Vial 3,039 3,300 6,339 721 5,618 1,442 (4,176)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 2,083 - 2,083 500 1,583 1,000 (583)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 470 - 470 80 390 160 (230)
34 Antihistamin Tablet kombinasi (Soldext Ampul 188 188 188 - 376 376
36 Antitusiva Sirup (Dexophan) Botol 15 500 515 45 470 90 (380)
40 Asam Mefenamat Kapsul 500 mg Tablet - 500 500 480 20 960 940
44 Asiklovir Krim 5 % Tablet 129 275 404 19 385 38 (347)
45 Asiklovir Tablet 200 mg Tablet 30 200 230 - 230 - (230)
46 Asiklovir Tablet 400 mg Tablet 70 200 270 200 70 400 330
48 Aqua Pro Injeksi Steril, bebas Pirogen 20Botol 190 - 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,230 140 1,370 30 1,340 60 (1,280)
50 Betametason Krim 0,1 %- 5g Botol 283 - 283 73 210 146 (64)
51 Bisakodil suppositoria 10 mg Botol 25 - 25 - 25 - (25)
53 Bromheksin 8 mg Kapsul 7,050 2,100 9,150 260 8,890 520 (8,370)
55 Deksametason Tablet 0,5 mg Tablet - 124,000 124,000 2,764 121,236 5,528 (115,708)
57 Diazepam tablet 2 mg Tablet 113 100 213 31 182 62 (120)
63 Dimenhidrinat Tablet 50 mg Botol 1,100 - 1,100 100 1,000 200 (800)
64 Domperidon Tablet 10 mg Tablet 1,675 - 1,675 340 1,335 680 (655)
66 Efedrin Hcl Tablet 25 mg Kantong 135 - 135 1 134 2 (132)
68 Epinefrin HCl / Bitartrat Botol 25 - 25 1 24 2 (22)
73 Etanol 70 % 100 ml Botol 14 - 14 3 11 6 (5)
76 Fenitoin Natrium Kapsul 100 mg Stick 190 - 190 40 150 80 (70)
77 Fenobarbital tablet 30 mg Tablet 120 - 120 50 70 100 30
78 Fenobarbital injeksi 50 mg / ml Tablet 30 - 30 - 30 - (30)
80 Fenoksimeti Penisilin 500 mg tablet Tube 620 - 620 100 520 200 (320)
81 Fitomenadion tablet 10 mg Tablet 100 - 100 100 - 200 200
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet - - - - - - -
83 Furosemid Tablet 40 mg Set 1,915 400 2,315 100 2,215 200 (2,015)
84 Garam Oralit I serbuk, kombinasi : Set 730 - 730 457 273 914 641
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 - 20 - 20 - (20)
87 Gentamisin Salep Kulit 0,1 % Botol 242 325 567 170 397 340 (57)
88 Glibenklamid Tablet 5 mg Biji 742 800 1,542 450 1,092 900 (192)
89 Glimepiride 2 mg Pot 434 - 434 - 434 - (434)
90 Gliseril Guayakolat Tablet 100 mg Tube 9,206 30,000 39,206 7,151 32,055 14,302 (17,753)
91 Gliseril Guayakolat sirup Tablet 377 50 427 44 383 88 (295)
93 Glukosa Larutan Infus 5 % Bungkus 10 - 10 2 8 4 (4)
94 Glukosa Larutan Infus10 % Tablet 22 - 22 - 22 - (22)
95 Griseofulvin Tablet 125 mg,micronized Bungkus 618 - 618 230 388 460 72
101 Ibuprofen Tablet 200 mg Botol 3,425 - 3,425 840 2,585 1,680 (905)
102 Ibuprofen Tablet 400 mg Tablet 596 23,000 23,596 510 23,086 1,020 (22,066)
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 25 - 25 5 20 10 (10)
104 Ichtyol salep Kulit Ampul 9 20 29 5 24 10 (14)

109 Kalium Diklofenak Tablet 50 mg Tablet 2,780 1,800 4,580 50 4,530 100 (4,430)
112 Kaptopril 12,5 mg Ampul 724 1,000 1,724 1,025 699 2,050 1,351
115 Ketokonazole Krim 2 % - 15 gr Botol 7 25 32 13 19 26 7
116 Ketokonazole Tablet 200 mg Botol 219 - 219 160 59 320 261
123 Kloramfenikol Kapsul 250 mg Ampul 2,340 - 2,340 480 1,860 960 (900)

126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 140 160 300 50 250 100 (150)
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,000 500 1,500 - 1,500 - (1,500)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 559 - 559 12 547 24 (523)
132 Kotrimoksazol Tablet, Kombinasi : Ampul - - - - - - -
133 Kotrimoksazol Suspensi Kombinasi : Tablet 437 1,600 2,037 87 1,950 174 (1,776)
134 Lansoprazole 30 mg Kapsul Botol 80 - 80 20 60 40 (20)
Botol - - - - - - -
140 Loperamid Tablet 2 mg Tablet 295 - 295 - 295 - (295)
145 Metformin Hcl Tablet 500 mg Paket 1,260 700 1,960 370 1,590 740 (850)
147 Metilergometrin Maleat (Metergin) Table Botol 64 - 64 50 14 100 86
149 Metilprednisolon tablet 4 mg Tube 2,700 - 2,700 400 2,300 800 (1,500)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 180 - 180 - 180 - (180)
152 Metronidazol Tablet 250 mg Tablet 50 - 50 50 - 100 100
153 Metronidazole Tablet 500 mg Botol 58 - 58 58 - 116 116
155 Mikonazole KrIm 2 % - 10 gr Tablet 16 - 16 6 10 12 2
156 Multivitamin + Mineral tablet Tablet 200 10,000 10,200 760 9,440 1,520 (7,920)
157 Multivitamin sirup Tablet 21 680 701 73 628 146 (482)
158 Natrium Bikarbonat Tablet 500 mg Tablet 7,062 3,000 10,062 1,203 8,859 2,406 (6,453)
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 14 - 14 - 14 - (14)
162 Nipedifin Tablet 10 mg Botol 1,477 - 1,477 106 1,371 212 (1,159)
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 408 1,100 1,508 117 1,391 234 (1,157)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 13 400 413 20 393 40 (353)
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol - 500 500 3 497 6 (491)
176 Obat Flu Sirup Tablet - 20 20 4 16 8 (8)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 125 - 125 61 64 122 58

183 Ondansetron inj 4 mg/ 2 mL Ampul 140 - 140 - 140 - (140)
184 Parasetamol drop 100 mg/ml btl @15ml Vial 59 30 89 36 53 72 19
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 350 1,800 2,150 242 1,908 484 (1,424)
187 Parasetamol Tablet 500 mg Botol 36,928 130,000 166,928 11,251 155,677 22,502 (133,175)
190 Piracetam 400 mg Tablet 150 - 150 - 150 - (150)
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 - 396 - 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 15,413 - 15,413 4,789 10,624 9,578 (1,046)
195 Polikresulen (Kondensasi Metakresol SulSet 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 4 - 4 - 4 - (4)
197 Povidon Iodida 10% 300 ml Ampul 1 - 1 - 1 - (1)
202 Ranitidin Injeksi 25 mg / ml Set 300 - 300 20 280 40 (240)
203 Ranitidin Tablet 150 mg Tablet 2,889 - 2,889 1,085 1,804 2,170 366
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - - - - - -
206 Reserpin Tablet 0, 25 mg Buah - - - - - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 20 - 20 5 15 10 (5)
209 Salbutamol Tablet 2 mg Tablet - - - - - - -
210 Salbutamol Tablet 4 mg Botol 1,750 - 1,750 10 1,740 20 (1,720)
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 27 - 27 16 11 32 21
213 Salisil bedak 2% -50 gr Botol 149 - 149 72 77 144 67
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 119 - 119 7 112 14 (98)
216 Sefadroksil Tablet 500 mg Kapsul 890 - 890 190 700 380 (320)
222 Setirizin Sirup 5 mg / 5 ml Tablet 41 - 41 14 27 28 1
226 Simetidin 200 mg Tablet Tablet 1,900 - 1,900 - 1,900 - (1,900)
227 Simvastatin Tablet 10 mg Tablet 1,514 - 1,514 140 1,374 280 (1,094)
228 Siprofloksasin 500mg Tablet - - - - - -
229 Spironolakton Tablet 25 mg Botol 90 300 390 - 390 - (390)
234 Tetrasiklin Kapsul 250 mg Tube 2,554 - 2,554 326 2,228 652 (1,576)
235 Tetrasiklin Kapsul 500 mg Tablet 1,778 - 1,778 610 1,168 1,220 52
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 14,375 4,000 18,375 5,735 12,640 11,470 (1,170)
238 Thiamfenikol Kapsul 500 mg set 890 - 890 - 890 - (890)
243 Vitamin Neurotropik Tablet Botol 4,190 2,300 6,490 666 5,824 1,332 (4,492)
244 Zinc Tablet 20 mg Tablet 198 - 198 198 - 396 396
245 Prednison tab 5 mg Tablet 4,601 4,500 9,101 2,947 6,154 5,894 (260)
248 Glass Ionoer semen Botol - - - - - -
250 MgSO4-40% Kapsul 24 - 24 6 18 12 (6)
251 Botol - - - - -
252 Tablet - - - - -
253 Tablet - - - - -
254 Tablet - - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set 108 - 108 5 103 10 (93)
256 Abbocath No 20 ( IV Chateter 20 ) Set 108 - 108 5 103 10 (93)
257 Abbocath No 22 ( IV Chateter 22 ) Set 200 100 300 15 285 30 (255)
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 109 - 109 5 104 10 (94)
260 Alat Suntik Sekali Pakai 1 ml Vial 100 - 100 - 100 - (100)
261 Alat Suntik Sekali Pakai 2,5 ml Tube 310 200 510 315 195 630 435
262 Alat Suntik Sekali Pakai 5 ml Botol 100 - 100 5 95 10 (85)
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Botol 39 - 39 12 27 24 (3)
265 Etakridin Larutan (Rivanol) 0,1% - 300 m Pot 14 - 14 4 10 8 (2)
266 Etanol 70 % 1.000 ml Tablet 14 - 14 2 12 4 (8)
267 F0lley Chateter no 14 Tablet 2 - 2 - 2 - (2)
268 Folley Catheter no 16 Tablet - - - - - - -
270 Infus set Anak Tablet 75 - 75 - 75 - (75)
271 Infus set Dewasa Kotak 200 - 200 - 200 - (200)
272 Iodina Test Tube - - - - - - -
273 Kassa Hidrofil Steril 16 x 16 Tablet 20 - 20 - 20 - (20)
275 Kapas Pembalut / Adsorbens 250 gram Ampul 23 20 43 2 41 4 (37)
276 Kassa Kompres 40 x 40 steril Ampul 47 - 47 - 47 - (47)
277 Kassa Pembalut 2 m x 80 cm Ampul 23 - 23 19 4 38 34
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 70 70 2 68 4 (64)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 64 - 64 4 60 8 (52)
280 Kertas Puyer Botol - - - - - - -
281 Lysol 1,000 ml Botol 5 - 5 1 4 2 (2)
282 Masker Tablet 60 - 60 60 - 120 120
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 82 82 10 72 20 (52)
285 Safety Box Tablet - - - - - - -
286 Sarung tangan Steril No 6 Tablet - - - - - - -
287 Sarung tangan Steril No 7 Buah 75 - 75 15 60 30 (30)
288 Sarung tangan Steril No 7,5 Tablet 50 - 50 - 50 - (50)
289 Sarung tangan Non Steril S Supp 100 - 100 1 99 2 (97)
290 Sarung tangan Non Steril M Tablet 100 - 100 60 40 120 80
291 Sarung tangan Non Steril L Tablet 100 - 100 - 100 - (100)
293 Wing Neddle No 23 Ampul 30 - 30 - 30 - (30)
294 Soun Timer Ampul - 13 13 - 26 26
295 Tablet - - - - -
296 Tube - - - - - -
297 Sashet - - - - - -
298 Tablet - - - - - - -
299 Botol - - - - - - -
300 Tablet - - - - - - -
301 C. SERUM DAN VAKSIN Tablet - - - - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Set 9 9 9 - (9)
303 Serum Anti Rabies untuk manusia Tablet 2 2 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Botol 27 27 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000Paket - - - - -
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
PUSKESMAS

STOK STOK PEMBERIAN

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2 Albendazole Tablet 400 mg Set 1,260 1,260 1,260 - (1,260)
3 Alopurinol Tablet 100 mg Set 340 300 640 230 410 460 50
4 Ambroksol Tablet 30 mg Set 13,749 - 13,749 956 12,793 1,912 (10,881)
9 Amlodipin Tablet 5 mg Tablet 4 500 504 354 150 708 558
10 Amlodipin Tablet 10 mg Kapsul 250 - 250 250 - 500 500
12 Amoksisillin Kaplet 500 mg Botol 78,348 - 78,348 3,040 75,308 6,080 (69,228)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 485 - 485 125 360 250 (110)


22 Antasida Doen Tablet, Kombinasi : Ma Botol 14,573 - 14,573 6,655 7,918 13,310 5,392
23 Antasida Plus Tablet Tablet 2,100 - 2,100 1,250 850 2,500 1,650
24 Antalgin (Metampiron) Tablet 500 mg Tablet - 5,000 5,000 2,634 2,366 5,268 2,902
27 Anti Hemoroid Doen komb Tablet - - - - - - -
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 18 - 18 11 7 22 15
31 Anti Diare Tablet ( Neo Diaform) Vial 5,618 - 5,618 1,050 4,568 2,100 (2,468)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit)Botol 1,583 - 1,583 500 1,083 1,000 (83)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 390 - 390 240 150 480 330
34 Antihistamin Tablet kombinasi (Soldext Ampul - - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 470 - 470 61 409 122 (287)
40 Asam Mefenamat Kapsul 500 mg Tablet 20 1,000 1,020 656 364 1,312 948
46 Asiklovir Tablet 400 mg Tablet 70 400 470 170 300 340 40
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 - 190 - 190 - (190)
50 Betametason Krim 0,1 %- 5g Botol 210 - 210 71 139 142 3
53 Bromheksin 8 mg Kapsul 8,890 - 8,890 640 8,250 1,280 (6,970)
55 Deksametason Tablet 0,5 mg Tablet 121,236 - 121,236 6,871 114,365 13,742 (100,623)
62 Digoksin Tablet 0,25 mg Tablet - 200 200 - 200 - (200)
63 Dimenhidrinat Tablet 50 mg Botol 1,000 - 1,000 - 1,000 - (1,000)
67 Ekstrak Belladone Tablet 10 mg Kantong - - - - - -
73 Etanol 70 % 100 ml Botol 11 20 31 10 21 20 (1)
76 Fenitoin Natrium Kapsul 100 mg Stick 150 - 150 50 100 100 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,330 - 1,330 100 1,230 200 (1,030)
80 Fenoksimeti Penisilin 500 mg tablet Tube 520 - 520 200 320 400 80
81 Fitomenadion tablet 10 mg Tablet - 100 100 - 100 - (100)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet - 100 100 - 100 - (100)
84 Garam Oralit I serbuk, kombinasi : Set 273 500 773 311 462 622 160
87 Gentamisin Salep Kulit 0,1 % Botol 397 - 397 88 309 176 (133)
88 Glibenklamid Tablet 5 mg Biji 1,092 1,092 350 742 700 (42)
90 Gliseril Guayakolat Tablet 100 mg Tube 32,055 - 32,055 4,398 27,657 8,796 (18,861)
95 Griseofulvin Tablet 125 mg,micronized Bungkus 388 200 588 110 478 220 (258)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 4,839 - 4,839 641 4,198 1,282 (2,916)
102 Ibuprofen Tablet 400 mg Tablet 23,086 - 23,086 920 22,166 1,840 (20,326)
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 20 - 20 10 10 20 10
104 Ichtyol salep Kulit Ampul 24 - 24 5 19 10 (9)

112 Kaptopril 12,5 mg Ampul 699 - 699 679 20 1,358 1,338

116 Ketokonazole Tablet 200 mg Botol 59 - 59 59 - 118 118
123 Kloramfenikol Kapsul 250 mg Ampul 1,860 - 1,860 610 1,250 1,220 (30)

128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,500 - 1,500 7 1,493 14 (1,479)
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 547 - 547 400 147 800 653
133 Kotrimoksazol Suspensi Kombinasi : Tablet 1,950 1,950 90 1,860 180 (1,680)
134 Lansoprazole 30 mg Kapsul Botol 60 - 60 55 5 110 105
Botol - - - - - - -
146 Methisoprinol 500 mg Paket 350 - 350 350 - (350)
147 Metilergometrin Maleat (Metergin) Tabl Botol 14 100 114 - 114 - (114)
148 Metilergometrin Maleat Injeksi 0,200 mg Vial 200 200 - 200 - (200)
149 Metilprednisolon tablet 4 mg Tube 2,300 - 2,300 1,700 600 3,400 2,800
152 Metronidazol Tablet 250 mg Tablet - - - - - - -
153 Metronidazole Tablet 500 mg Botol - 500 500 410 90 820 730
155 Mikonazole KrIm 2 % - 10 gr Tablet 10 - 10 10 - 20 20
156 Multivitamin + Mineral tablet Tablet 9,440 - 9,440 1,256 8,184 2,512 (5,672)
157 Multivitamin sirup Tablet 628 - 628 52 576 104 (472)
158 Natrium Bikarbonat Tablet 500 mg Tablet 8,859 - 8,859 1,337 7,522 2,674 (4,848)
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 14 - 14 10 4 20 16
162 Nipedifin Tablet 10 mg Botol 1,371 - 1,371 435 936 870 (66)
163 Nistatin 100.000 IU/gram Tablet Vagina Botol 200 - 200 5 195 10 (185)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 97 100 197 - 197 - (197)
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 1,391 - 1,391 116 1,275 232 (1,043)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 393 - 393 39 354 78 (276)
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 497 - 497 45 452 90 (362)
176 Obat Flu Sirup Tablet 16 25 41 10 31 20 (11)
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-1 Pot 50 - 50 - 50 - (50)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 64 - 64 37 27 74 47

180 Oksitosin Injeksi 10 IU/ml-1ml Botol 118 - 118 50 68 100 32
184 Parasetamol drop 100 mg/ml btl @15ml Vial 53 50 103 47 56 94 38
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 1,908 - 1,908 221 1,687 442 (1,245)
188 Pehacain injeksi Buah 75 70 145 25 120 50 (70)
190 Piracetam 400 mg Tablet 150 - 150 100 50 200 150
191 Piracetam Tablet 800 mg Botol 200 - 200 50 150 100 (50)
192 Piroksikam Tablet 20 mg Vial 449 900 1,349 380 969 760 (209)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 10,624 - 10,624 3,723 6,901 7,446 545
195 Polikresulen (Kondensasi Metakresol Su Set 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 4 - 4 3 1 6 5
197 Povidon Iodida 10% 300 ml Ampul 1 - 1 1 - 2 2
201 Propilturasil Tablet 100 mg Kuur 130 - 130 10 120 20 (100)
203 Ranitidin Tablet 150 mg Tablet 1,804 - 1,804 852 952 1,704 752
208 Ringer Laktat Larutan Infus Steril 500 ml Set 15 15 11 4 22 18
210 Salbutamol Tablet 4 mg Botol 1,740 - 1,740 560 1,180 1,120 (60)
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 11 50 61 8 53 16 (37)
213 Salisil bedak 2% -50 gr Botol 77 - 77 41 36 82 46
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 112 100 212 5 207 10 (197)
216 Sefadroksil Tablet 500 mg Kapsul 700 - 700 239 461 478 17
226 Simetidin 200 mg Tablet Tablet 1,900 - 1,900 500 1,400 1,000 (400)
227 Simvastatin Tablet 10 mg Tablet 1,374 - 1,374 110 1,264 220 (1,044)
229 Spironolakton Tablet 25 mg Botol 390 300 690 - 690 - (690)
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - - - - - -
234 Tetrasiklin Kapsul 250 mg Tube 2,228 - 2,228 940 1,288 1,880 592
235 Tetrasiklin Kapsul 500 mg Tablet 1,168 - 1,168 630 538 1,260 722
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 12,640 - 12,640 4,715 7,925 9,430 1,505
238 Thiamfenikol Kapsul 500 mg set 890 - 890 200 690 400 (290)
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 70 - 70 - 70 - (70)
243 Vitamin Neurotropik Tablet Botol 5,824 - 5,824 700 5,124 1,400 (3,724)
244 Zinc Tablet 20 mg Tablet - 2,000 2,000 950 1,050 1,900 850
245 Prednison tab 5 mg Tablet 6,154 - 6,154 4,000 2,154 8,000 5,846
250 MgSO4-40% Kapsul 18 - 18 - 18 - (18)
251 Botol - - - - -
252 Tablet - - - - -
253 Tablet - - - - -
254 Tablet - - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set 103 - 103 - 103 - (103)
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 104 - 104 5 99 10 (89)
260 Alat Suntik Sekali Pakai 1 ml Vial 100 - 100 - 100 - (100)
261 Alat Suntik Sekali Pakai 2,5 ml Tube 195 200 395 115 280 230 (50)
262 Alat Suntik Sekali Pakai 5 ml Botol 95 - 95 - 95 - (95)
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Botol 27 - 27 12 15 24 9
265 Etakridin Larutan (Rivanol) 0,1% - 300 mPot 10 20 30 5 25 10 (15)
266 Etanol 70 % 1.000 ml Tablet 12 - 12 5 7 10 3
267 Folley Catheter no 14 Tablet 2 - 2 - 2 - (2)
275 Kapas Pembalut / Adsorbens 250 gram Ampul 41 - 41 2 39 4 (35)
276 Kassa Kompres 40 x 40 steril Ampul 47 - 47 16 31 32 1
277 Kassa Pembalut 2 m x 80 cm Ampul 4 - 4 4 - 8 8
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 68 - 68 65 3 130 127
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 60 - 60 5 55 10 (45)
281 Lysol 1,000 ml Botol 4 - 4 - 4 - (4)
282 Masker Tablet - - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 72 - 72 - 72 - (72)
287 Sarung tangan Steril No 7 Buah 60 - 60 60 - 120 120
288 Sarung tangan Steril No 7,5 Tablet 50 - 50 50 - 100 100
289 Sarung tangan Non Steril S Supp 99 - 99 99 - 198 198
290 Sarung tangan Non Steril M Tablet 40 - 40 40 - 80 80
291 Sarung tangan Non Steril L Tablet 100 - 100 100 - 200 200
294 Ampul - - - - -
295 Tablet - - - - -
296 Tube - - - - -
297 Sashet - - - - -
298 Tablet - - - - -
299 Botol - - - - -
300 Tablet - - - - -
301 C. SERUM DAN VAKSIN Tablet - - - - -
303 Serum Anti Rabies untuk manusia Tablet 2 - 2 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Botol 27 - 27 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000Paket - - - - -
306 Paket - - - - -
307 Paket - - - - -
308 Botol - - - - -
309 Kapsul - - - - -
310 Tablet - - - - - - -
311 Botol - - - - - - -
312 Tablet - - - - - - -
313 Ampul - - - - - - -
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
GAL
PUSKESMAS

STOK STOK PEMBERIAN

AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
4 Ambroksol Tablet 30 mg Set 12,793 - 12,793 1,495 11,298 2,990 (8,308)
7 Aminofillin Tablet 200 mg Tablet 93 - 93 30 63 60 (3)
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 580 - 580 - 580 - (580)
9 Amlodipin Tablet 5 mg Tablet 150 150 150 - 300 300
10 Amlodipin Tablet 10 mg Kapsul - - - - - - -
11 Amoksisillin Kapsul 250 mg Kaplet 16,054 - 16,054 770 15,284 1,540 (13,744)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 360 - 360 132 228 264 36


22 Antasida Doen Tablet, Kombinasi : Ma Botol 7,918 7,918 4,797 3,121 9,594 6,473
23 Antasida Plus Tablet Tablet 850 - 850 500 350 1,000 650
24 Antalgin (Metampiron) Tablet 500 mg Tablet 2,366 2,366 2,366 - 4,732 4,732
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 7 - 7 3 4 6 2
31 Anti Diare Tablet ( Neo Diaform) Vial 4,568 - 4,568 490 4,078 980 (3,098)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit)Botol 1,083 - 1,083 310 773 620 (153)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 150 150 150 - 300 300
40 Asam Mefenamat Kapsul 500 mg Tablet 364 - 364 360 4 720 716
46 Asiklovir Tablet 400 mg Tablet 300 - 300 - 300 - (300)
50 Betametason Krim 0,1 %- 5g Botol 139 139 51 88 102 14
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 415 - 415 - 415 - (415)
62 Digoksin Tablet 0,25 mg Tablet 200 - 200 10 190 20 (170)
64 Domperidon Tablet 10 mg Tablet 1,225 - 1,225 160 1,065 320 (745)
73 Etanol 70 % 100 ml Botol 21 20 41 5 36 10 (26)
74 Etil Klorida Semprot -100 ml Botol 6 - 6 - 6 - (6)
76 Fenitoin Natrium Kapsul 100 mg Stick 100 - 100 40 60 80 20
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,230 - 1,230 100 1,130 200 (930)
80 Fenoksimeti Penisilin 500 mg tablet Tube 320 - 320 100 220 200 (20)
81 Fitomenadion tablet 10 mg Tablet 100 100 200 - 200 - (200)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 100 - 100 - 100 - (100)
84 Garam Oralit I serbuk, kombinasi : Set 462 - 462 174 288 348 60
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 - 20 20 - (20)
87 Gentamisin Salep Kulit 0,1 % Botol 309 309 97 212 194 (18)
88 Glibenklamid Tablet 5 mg Biji 742 500 1,242 60 1,182 120 (1,062)
89 Glimepiride 2 mg Pot 434 - 434 110 324 220 (104)
90 Gliseril Guayakolat Tablet 100 mg Tube 27,657 - 27,657 4,320 23,337 8,640 (14,697)
95 Griseofulvin Tablet 125 mg,micronized Bungkus 478 200 678 230 448 460 12
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 4,198 - 4,198 619 3,579 1,238 (2,341)
100 Hidrokortison Krim 2,5 % Tube 158 - 158 55 103 110 7
102 Ibuprofen Tablet 400 mg Tablet 22,166 - 22,166 1,223 20,943 2,446 (18,497)
104 Ichtyol salep Kulit Ampul 19 - 19 10 9 20 11

112 Kaptopril 12,5 mg Ampul 20 20 20 - 40 40

113 Kaptopril 25 mg Botol - - - - - -
114 Karbamazepin Tablet 200 mg Botol 160 - 160 10 150 20 (130)
115 Ketokonazole Krim 2 % - 15 gr Botol 7 7 7 - 14 14
116 Ketokonazole Tablet 200 mg Botol - - - - - - -
123 Kloramfenikol Kapsul 250 mg Ampul 1,250 - 1,250 480 770 960 190

128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,493 - 1,493 - 1,493 - (1,493)
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 147 - 147 - 147 - (147)
133 Kotrimoksazol Suspensi Kombinasi : Tablet 1,860 - 1,860 90 1,770 180 (1,590)
134 Lansoprazole 30 mg Kapsul Botol 5 5 5 - 10 10
136 Larutan mengadung Elektrolit Tablet 15 - 15 4 11 8 (3)
Botol - - - - - -
141 Loratadin tablet 10 mg Tablet 889 - 889 100 789 200 (589)
146 Methisoprinol 500 mg Paket 350 - 350 10 340 20 (320)
147 Metilergometrin Maleat (Metergin) Tabl Botol 114 200 314 - 314 - (314)
149 Metilprednisolon tablet 4 mg Tube 600 - 600 - 600 - (600)
153 Metronidazole Tablet 500 mg Botol 90 90 90 - 180 180
155 Mikonazole KrIm 2 % - 10 gr Tablet - - - - - - -
162 Nipedifin Tablet 10 mg Botol 936 - 936 236 700 472 (228)
167 Obat Antitiuberkolosis Kategori 2 Dewas Tablet - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 1,275 1,275 74 1,201 148 (1,053)
176 Obat Flu Sirup Tablet 31 - 31 6 25 12 (13)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 27 - 27 27 - 54 54

180 Oksitosin Injeksi 10 IU/ml-1ml Botol 68 - 68 40 28 80 52
184 Parasetamol drop 100 mg/ml btl @15ml Vial 56 56 9 47 18 (29)
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 1,687 1,687 121 1,566 242 (1,324)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 6,901 6,901 4,305 2,596 8,610 6,014
195 Polikresulen (Kondensasi Metakresol Su Set 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 1 1 - 1 - (1)
197 Povidon Iodida 10% 300 ml Ampul - - - - - -
203 Ranitidin Tablet 150 mg Tablet 952 952 600 352 1,200 848
208 Ringer Laktat Larutan Infus Steril 500 ml Set 4 10 14 5 9 10 1
210 Salbutamol Tablet 4 mg Botol 1,180 - 1,180 410 770 820 50
213 Salisil bedak 2% -50 gr Botol 36 50 86 40 46 80 34
216 Sefadroksil Tablet 500 mg Kapsul 461 - 461 350 111 700 589
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 195 - 195 - 195 - (195)
226 Simetidin 200 mg Tablet Tablet 1,400 - 1,400 400 1,000 800 (200)
227 Simvastatin Tablet 10 mg Tablet 1,264 - 1,264 220 1,044 440 (604)
234 Tetrasiklin Kapsul 250 mg Tube 1,288 - 1,288 365 923 730 (193)
235 Tetrasiklin Kapsul 500 mg Tablet 538 - 538 180 358 360 2
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 7,925 - 7,925 4,281 3,644 8,562 4,918
239 Tramadol Injeksi 50 mg/ ml Botol - - - - - -
240 Tramadol Tablet 50 mg Tablet - - - - - -
243 Vitamin Neurotropik Tablet Botol 5,124 - 5,124 430 4,694 860 (3,834)
244 Zinc Tablet 20 mg Tablet 1,050 - 1,050 355 695 710 15
245 Prednison tab 5 mg Tablet 2,154 - 2,154 1,863 291 3,726 3,435
250 MgSO4-40% Kapsul 18 - 18 - 18 - (18)
251 Botol - - - - -
252 Tablet - - - - -
253 Tablet - - - - -
254 Tablet - - - - - - -
260 Alat Suntik Sekali Pakai 1 ml Tablet 100 200 300 300 - 600 600
261 Alat Suntik Sekali Pakai 2,5 ml Tablet 280 - 280 - 280 - (280)
262 Alat Suntik Sekali Pakai 5 ml Kotak 95 - 95 - 95 - (95)
263 Alat Suntik Sekali Pakai 10 ml Tube - - - - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Tablet 15 20 35 - 35 - (35)
265 Etakridin Larutan (Rivanol) 0,1% - 300 mTablet 25 - 25 - 25 - (25)
266 Etanol 70 % 1.000 ml Ampul 7 - 7 - 7 - (7)
269 Folley Catheter no 18 Kapsul - - - - - - -
270 Infus set Anak Kapsul 75 - 75 - 75 - (75)
271 Infus set Dewasa Botol 200 - 200 - 200 - (200)
273 Kassa Hidrofil Steril 16 x 16 Tablet 20 - 20 20 - 40 40
275 Kapas Pembalut / Adsorbens 250 gram Kapsul 39 - 39 20 19 40 21
276 Kassa Kompres 40 x 40 steril Tablet 31 - 31 - 31 - (31)
277 Kassa Pembalut 2 m x 80 cm Tablet - - - - - - -
278 Kassa Pembalut Hidrofil 4 m x 3 cm Buah 3 - 3 - 3 - (3)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Tablet 55 - 55 - 55 - (55)
280 Kertas Puyer Supp - - - - - - -
281 Lysol 1,000 ml Tablet 4 - 4 - 4 - (4)
282 Masker Tablet - - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Ampul 72 - 72 - 72 - (72)
287 Sarung tangan Steril No 7 Tube - - - - - - -
288 Sarung tangan Steril No 7,5 Sashet - - - - - - -
289 Sarung tangan Non Steril S Tablet - - - - - - -
290 Sarung tangan Non Steril M Botol - - - - - - -
291 Sarung tangan Non Steril L Tablet - - - - - - -
293 Wing Neddle No 23 Tablet 30 30 - 30 - (30)
294 Tablet - - - - -
295 Botol - - - - -
296 Paket - - - - -
297 Paket - - - - -
298 Paket - - - - -
299 Botol - - - - -
300 Kapsul - - - - -
301 C. SERUM DAN VAKSIN Tablet - - - - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Botol 9 - 9 - 9 - (9)
303 Serum Anti Rabies untuk manusia Tablet 2 - 2 - 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Botol 27 27 27 - (27)
305 Paket - - - - -
306 Paket - - - - -
307 Paket - - - - -
308 Botol - - - - -
309
310
311
312
313
314 - - - - -
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
GAL
LAPORAN PEMAKAIAN DAN LEMBAR
PUSKESMA
PUSKESMAS :…………………..
KECAMATAN :…………………..
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : …………………
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : ………………..
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
1 2 3 4 5 6
1 Air Raksa Dental Use Botol - - -
2 Albendazole Tablet 400 mg Set 1,260 - 1,260
3 Alopurinol Tablet 100 mg Set 520 200 720
4 Ambroksol Tablet 30 mg Set 11,298 - 11,298
5 Ambroksol sirup 15 mg/5 ml Tablet 577 - 577
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - 3
7 Aminofillin Tablet 200 mg Tablet 63 63
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 580 - 580
9 Amlodipin Tablet 5 mg Tablet - 700 700
10 Amlodipin Tablet 10 mg Kapsul - - -
11 Amoksisillin Kapsul 250 mg Kaplet 15,284 - 15,284
12 Amoksisillin Kaplet 500 mg Botol 72,106 - 72,106
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 - 240
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 228 228
15 Amoksisillin Double Strengh Sirup Kerin Tablet 424 - 424
16 Ampisilin Kapsul 250 mg Tube - - -

17 Ampisillin Kaplet 500 mg Supp 1,230 - 1,230
18 Ampisilin Sirup 125 mg / 5 ml Pot - - -
19 Ampisillin Injeksi 1000 mg Tablet 150 - 150
20 Analgetik Plus Tablet - -

21 Antasida Doen Suspensi Kombinasi : M Vial 233 - 233
22 Antasida Doen Tablet, Kombinasi : Ma Botol 3,121 8,000 11,121
23 Antasida Plus Tablet Tablet 350 350
24 Antalgin (Metampiron) Tablet 500 mg Tablet - 4,000 4,000
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 - 60
26 Anti Bakteri DOEN Salep Kombinasi : Botol 25 - 25
27 Anti Hemoroid Doen komb Tablet - - -
28 Anti Fungi DOEN Kombinasi : Tablet 606 - 606
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 415 - 415
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 4 - 4
31 Anti Diare Tablet ( Neo Diaform) Vial 4,078 - 4,078
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 773 773
33 Anti Hipertensi Kapsul (Tensigard) Sachet - 300 300
34 Antihistamin Tablet kombinasi (Soldext Ampul - - -
35 Antispasmodik Tablet (Spasminal) Tablet - - -
36 Antitusiva Sirup (Dexophan) Botol 338 - 338
37 Antitusiva Tablet (Dekorin) Tablet - - -
38 Asam Folat Tablet 1 mg Botol - - -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 15,070 - 15,070
40 Asam Mefenamat Kapsul 500 mg Tablet 4 - 4
41 Asetosal Tablet 80 mg Tablet 100 - 100
42 Asetosal Tablet 100 mg Tablet 200 - 200
43 Asetosal Tablet 500 mg Ampul - - -
44 Asiklovir Krim 5 % Tablet 286 - 286
45 Asiklovir Tablet 200 mg Tablet 30 30
46 Asiklovir Tablet 400 mg Tablet 300 - 300
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 - 190

49 Betahistin Mesilat 6 mg Botol 1,180 - 1,180
50 Betametason Krim 0,1 %- 5g Botol 88 50 138
51 Bisakodil suppositoria 10 mg Botol 25 - 25
52 Bisoprolol Tablet 5 mg Kapsul - - -
53 Bromheksin 8 mg Kapsul 7,980 - 7,980
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 - 128
55 Deksametason Tablet 0,5 mg Tablet 110,175 - 110,175
56 Devitalisasi Pasta (Non Arsen) Tablet - - -
57 Diazepam tablet 2 mg Tablet 166 - 166
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - -
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 - 10
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 415 - 415
62 Digoksin Tablet 0,25 mg Tablet 190 - 190
63 Dimenhidrinat Tablet 50 mg Botol 1,000 - 1,000
64 Domperidon Tablet 10 mg Tablet 1,065 - 1,065
65 Donperidon Suspensi 5 mg/5ml Botol - - -
66 Efedrin Hcl Tablet 25 mg Kantong 134 134
67 Ekstrak Belladone Tablet 10 mg Kantong - - -
68 Epinefrin HCl / Bitartrat Botol 24 - 24
69 Eritromisin Kapsul 250 mg Set - - -
70 Eritromisin Kapsul 500 mg Tablet 400 - 400
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - -
72 Etambutol Tablet 500 mg Botol - - -
73 Etanol 70 % 100 ml Botol 36 - 36
74 Etil Klorida Semprot -100 ml Botol 6 - 6
75 Eugenol Cairan -10 ml Tablet - - -
76 Fenitoin Natrium Kapsul 100 mg Stick 60 - 60
77 Fenobarbital tablet 30 mg Tablet 210 - 210
78 Fenobarbital injeksi 50 mg / ml Tablet 30 - 30
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,130 - 1,130
80 Fenoksimeti Penisilin 500 mg tablet Tube 220 - 220
81 Fitomenadion tablet 10 mg Tablet 200 - 200
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 100 - 100
83 Furosemid Tablet 40 mg Set 2,095 - 2,095
84 Garam Oralit I serbuk, kombinasi : Set 288 - 288
85 Gemfibrozil Tablet 600 mg Vial - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 - 20
87 Gentamisin Salep Kulit 0,1 % Botol 212 - 212
88 Glibenklamid Tablet 5 mg Biji 1,182 - 1,182
89 Glimepiride 2 mg Pot 324 - 324
90 Gliseril Guayakolat Tablet 100 mg Tube 23,337 - 23,337
91 Gliseril Guayakolat sirup Tablet 302 - 302
92 Glukonas Kalsikus injeksi Bungkus - - -
93 Glukosa Larutan Infus 5 % Bungkus 8 - 8
94 Glukosa Larutan Infus10 % Tablet 22 - 22
95 Griseofulvin Tablet 125 mg,micronized Bungkus 448 - 448
96 Haloperidol Tablet 0,5 mg Rol 175 - 175
97 Haloperidol Tablet 1,5 mg Rol 60 - 60
98 Haloperidol Tablet 5 mg Rol 500 - 500
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 3,579 - 3,579
100 Hidrokortison Krim 2,5 % Tube 103 - 103
101 Ibuprofen Tablet 200 mg Botol 1,384 - 1,384
102 Ibuprofen Tablet 400 mg Tablet 20,943 - 20,943
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 10 - 10
104 Ichtyol salep Kulit Ampul 9 - 9

105 Ipatropium Bromide + Salbutamol Ampul 20 - 20
106 Isoniazid tablet 100 mg Tablet - - -
107 Isosorbid Dinitrat 5 mg Tablet 300 - 300
108 Kalium Diklofenak Tablet 25 mg Tablet - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 4,030 - 4,030
110 Kalsium Hidroksida Pasta Botol - - -
111 Kalsium Laktat Tablet 500 mg Tablet 11,647 - 11,647

112 Kaptopril 12,5 mg Ampul - 500 500
113 Kaptopril 25 mg Botol - - -
114 Karbamazepin Tablet 200 mg Botol 150 - 150
115 Ketokonazole Krim 2 % - 15 gr Botol - 25 25
116 Ketokonazole Tablet 200 mg Botol - - -
117 Ketoprofen Tablet 100 mg Botol - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - -
119 Ketorolac 10 mg injeksi Botol - - -
120 Ketorolac 30 mg injeksi Botol 20 - 20
121 Klindamisin Kapsul 150 mg Botol - - -
122 Klindamisin Kapsul 300 mg Tablet - - -
123 Kloramfenikol Kapsul 250 mg Ampul 770 - 770
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - -

125 Kloramfenikol Tetes Mata -5 ml Ampul 540 - 540
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 196 - 196
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 39,458 - 39,458
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,493 - 1,493
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - -
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 147 - 147
132 Kotrimoksazol Tablet, Kombinasi : Ampul - - -
133 Kotrimoksazol Suspensi Kombinasi : Tablet 1,770 - 1,770
134 Lansoprazole 30 mg Kapsul Botol - 100 100
135 Larutan mengadung Elektrolit Botol 20 - 20
136 Larutan mengadung Elektrolit Tablet 11 - 11
Botol - - -
138 Lidokain injeksi 2 % Botol - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - -
140 Loperamid Tablet 2 mg Tablet 295 - 295
141 Loratadin tablet 10 mg Tablet 789 - 789
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - -
143 Meloksikam tablet 15 mg Paket 1,615 - 1,615
144 Meloksikam Suppositoria Paket - - -
145 Metformin Hcl Tablet 500 mg Paket 1,042 - 1,042
146 Methisoprinol 500 mg Paket 340 - 340
147 Metilergometrin Maleat (Metergin) Table Botol 314 - 314
148 Metilergometrin Maleat Injeksi 0,200 mg Vial 200 200
149 Metilprednisolon tablet 4 mg Tube 600 - 600
150 Metoklopramid 10 mg Tube 1,400 - 1,400
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 180 - 180
152 Metronidazol Tablet 250 mg Tablet - - -
153 Metronidazole Tablet 500 mg Botol - 800 800
154 Metronidazole Infus 500 mg /100 ml Tablet - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet - - -
156 Multivitamin + Mineral tablet Tablet 7,184 - 7,184
157 Multivitamin sirup Tablet 524 - 524
158 Natrium Bikarbonat Tablet 500 mg Tablet 7,299 - 7,299
159 Natrum Diklofenak Tablet 25 mg Tablet - - -
160 Natrium Diklofenak Tablet 50 mg Rol 5,170 - 5,170
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 4 - 4
162 Nipedifin Tablet 10 mg Botol 700 - 700

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 195 - 195
164 Nistatin 500.000 IU/gram Tablet Salut Botol 197 197
165 Obat Antitiuberkolosis Kategori Anak Botol - - -
166 Obat Antitiuberkolosis Kategori 1 Dewas Tablet - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 1,201 - 1,201
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 314 - 314
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 425 - 425
176 Obat Flu Sirup Tablet 25 - 25
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10Pot 50 - 50
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - - -

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 28 - 28
181 Omeprazole injeksi 40mg/10ml Vial 30 - 30
182 Omeprazole Kapsul 20 mg Vial - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul 140 - 140
184 Parasetamol drop 100 mg/ml btl @15ml Vial 47 - 47
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 1,566 - 1,566
186 Parasetamol Tablet 100 mg Sachet - - -
187 Parasetamol Tablet 500 mg Botol 134,860 - 134,860
188 Pehacain injeksi Buah 115 115
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 27 - 27
190 Piracetam 400 mg Tablet 50 - 50
191 Piracetam Tablet 800 mg Botol 150 - 150
192 Piroksikam Tablet 20 mg Vial 739 - 739
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 - 396
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 2,596 5,000 7,596
195 Polikresulen (Kondensasi Metakresol Su Set 10 - 10

196 Povidon Iodida 10% 30 ml Kapsul 1 10 11
197 Povidon Iodida 10% 300 ml Ampul - 2 2
198 Predison Tablet - - -
199 Primakuin tablet 15 mg Tablet - - -
200 Propanolol Hcl Tablet 40 mg Botol 197 - 197
201 Propilturasil Tablet 100 mg Kuur 120 - 120
202 Ranitidin Injeksi 25 mg / ml Set 280 - 280
203 Ranitidin Tablet 150 mg Tablet 352 1,500 1,852
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - -
206 Reserpin Tablet 0, 25 mg Buah - - -
207 Rifampisin Tablet 450 mg Buah - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 9 - 9
209 Salbutamol Tablet 2 mg Tablet - - -
210 Salbutamol Tablet 4 mg Botol 770 - 770
211 Salbutamol solution for Inhalation single Tablet 20 - 20
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 36 - 36
213 Salisil bedak 2% -50 gr Botol 46 100 146
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 201 - 201
216 Sefadroksil Tablet 500 mg Kapsul 111 - 111
217 Sefiksim Kapsul 100 mg Vial - - -
218 Sefotaksim Injeksi 1 gr Tablet - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - -
221 Setirizin Tablet 10 mg Botol - - -
222 Setirizin Sirup 5 mg / 5 ml Tablet 3 - 3
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 195 - 195

224 Sianokobalamin Tablet 50 mcg Tablet - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - -
226 Simetidin 200 mg Tablet Tablet 1,000 - 1,000
227 Simvastatin Tablet 10 mg Tablet 1,044 - 1,044
228 Siprofloksasin 500mg Tablet - - -
229 Spironolakton Tablet 25 mg Botol 690 - 690
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - - -
231 Tablet Tambah Darah Kombinasi: Besi II Tablet - - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - -
234 Tetrasiklin Kapsul 250 mg Tube 923 - 923
235 Tetrasiklin Kapsul 500 mg Tablet 358 - 358
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet 210 - 210
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 3,644 10,000 13,644
238 Thiamfenikol Kapsul 500 mg set 690 - 690
239 Tramadol Injeksi 50 mg/ ml Botol - - -
240 Tramadol Tablet 50 mg Tablet - - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 50 - 50
242 Vitamin B .Komplek Tablet Tablet 7,790 - 7,790
243 Vitamin Neurotropik Tablet Botol 4,694 - 4,694
244 Zinc Tablet 20 mg Tablet 695 - 695
245 Prednison tab 5 mg Tablet 291 - 291
246 Gentian Violet Tablet - - -
247 Furosemid injek 10mg/ml Tablet 24 - 24
248 Glass Ionoer semen Botol - - -
249 Bahan Tambal Sementara Kapsul - - -
250 MgSO4-40% Kapsul 18 - 18
251 - -
252 - -
253 - -
254 - -
255 Abbocath No 18 ( IV Chateter 18 ) 103 - 103
258 Abbocath No 24 ( IV Chateter 24 ) 99 99
259 Alat Suntik Sekali Pakai 10 ml - - -
260 Alat Suntik Sekali Pakai 1 ml - - -
261 Alat Suntik Sekali Pakai 2,5 ml 280 280
262 Alat Suntik Sekali Pakai 5 ml 95 95
263 Alat Suntik Sekali Pakai 10 ml - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) 35 -
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml 25 -
266 Etanol 70 % 1.000 ml Tablet 7 - 7
267 Folley Catheter no 14 Botol 2 2
268 Folley Catheter no 16 Pot - - -
269 Folley Catheter no 18 Tablet - - -
270 Infus set Anak Tablet 75 - 75
271 Infus set Dewasa Tablet 200 - 200
272 Iodina Test Tablet - -
273 Kassa Hidrofil Steril 16 x 16 Tablet - -
274 Kapas Berlemak 500 gram Kotak - - -
275 Kapas Pembalut / Adsorbens 250 gram Tube 19 19
276 Kassa Kompres 40 x 40 steril Tablet 31 - 31
277 Kassa Pembalut 2 m x 80 cm Tablet - - -
278 Kassa Pembalut Hidrofil 4 m x 3 cm Ampul 3 - 3
279 Kassa Pembalut Hidrofil 4 m x 15 cm Ampul 55 55
280 Kertas Puyer Ampul - - -
281 Lysol 1,000 ml Kapsul 4 - 4
282 Masker Kapsul - - -
283 Plester 5 yard x 2 inchi Botol - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Botol 72 72
285 Safety Box Tablet - -
286 Sarung tangan Steril No 6 Tablet - - -
287 Sarung tangan Steril No 7 Kapsul - - -
288 Sarung tangan Steril No 7,5 Tablet - - -
289 Sarung tangan Non Steril S Tablet - - -
290 Sarung tangan Non Steril M Buah - - -
291 Sarung tangan Non Steril L Tablet - -
292 Urine Bag Supp - -
293 Wing Neddle No 23 Tablet 30 30
294 Tablet - - -
295 Tablet - - -
296 Ampul - - -
297 Ampul - - -
298 Tablet - -
299 Tube - -
300 Sashet - - -
301 C. SERUM DAN VAKSIN Tablet - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Botol 9 - 9
303 Serum Anti Rabies untuk manusia 2 - 2
304 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul 27 - 27
305 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul - -
306 - -
307 - -
308 - -
309 - -
310 - - -
311 - - -
312 - - -
313 - - -
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi & Perbekalan
Kuningan Kabupaten Kuningan
………………………………….. ..........................………………………
NIP NIP.
KETERANGAN:
MAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS
DOKUMEN NOMOR
DINKES KABUPATEN
PERIODE : ………………… UPTD GFK
/ PERIODE : ……………….. UPTD PUSKESMAS
STOK STOK PEMBERIAN

PEMAKAIAN PERMINTAAN
AKHIR OPT. PKD ASKES APBD I APBD II PROGRAM
7 8 9 10 11 12 13 14 15
- - - -
- 1,260 - (1,260)
340 380 680 300
770 10,528 1,540 (8,988)
98 479 196 (283)
- 3 - (3)
63 - 126 126
- 580 - (580)
260 440 520 80
- - - -
930 14,354 1,860 (12,494)
3,846 68,260 7,692 (60,568)
- 240 - (240)
163 65 326 261
- 424 - (424)
- - - -
100 1,130 200 (930)
- - - -
- 150 - (150)
- - - -
47 186 94 (92)
7,199 3,922 14,398 10,476
210 140 420 280
3,440 560 6,880 6,320
- 60 - (60)
4 21 8 (13)
- - - -
25 581 50 (531)
10 405 20 (385)
4 - 8 8
849 3,229 1,698 (1,531)
190 583 380 (203)
180 120 360 240
- - -
- - - -
71 267 142 (125)
- - - -
- - - -
2,814 12,256 5,628 (6,628)
4 - 8 8
- 100 - (100)
- 200 - (200)
- - - -
22 264 44 (220)
30 - 60 60
- 300 - (300)
- - - -
- 190 - (190)
- 1,180 - (1,180)
47 91 94 3
- 25 - (25)
- - - -
440 7,540 880 (6,660)
- 128 - (128)
6,134 104,041 12,268 (91,773)
- - - -
36 130 72 (58)
- - - -
- 10 - (10)
- - - -
5 410 10 (400)
- 190 - (190)
- 1,000 - (1,000)
400 665 800 135
- - - -
- 134 - (134)
- - - -
- 24 - (24)
- - - -
- 400 - (400)
- - - -
- - - -
4 32 8 (24)
2 4 4 -
- - - -
- 60 - (60)
- 210 - (210)
- 30 - (30)
- 1,130 - (1,130)
- 220 - (220)
- 200 - (200)
- 100 - (100)
210 1,885 420 (1,465)
254 34 508 474
- - - -
- 20 - (20)
133 79 266 187
250 932 500 (432)
60 264 120 (144)
7,057 16,280 14,114 (2,166)
43 259 86 (173)
- - - -
- 8 - (8)
- 22 - (22)
200 248 400 152
- 175 - (175)
- 60 - (60)
- 500 - (500)
300 3,279 600 (2,679)
34 69 68 (1)
700 684 1,400 716
560 20,383 1,120 (19,263)
10 - 20 20
- 9 - (9)
- 20 - (20)
- - - -
- 300 - (300)
- - - -
250 3,780 500 (3,280)
- - - -
3,272 8,375 6,544 (1,831)

500 - 1,000 1,000
- - - -
- 150 - (150)
3 22 6 (16)
- - - -
- - - -
- - - -
- - - -
- 20 - (20)
- - - -
- - - -
770 - (770)
- - - -
61 479 122 (357)
35 161 70 (91)
10,000 29,458 20,000 (9,458)
- 1,493 - (1,493)
- - - -
- - - -
133 14 266 252
- - - -
121 1,649 242 (1,407)
30 70 60 (10)
- 20 - (20)
- 11 - (11)
- - - -
- - - -
- - - -
30 265 60 (205)
100 689 200 (489)
- - - -
150 1,465 300 (1,165)
- - - -
215 827 430 (397)
- 340 - (340)
50 264 100 (164)
- 200 - (200)
- 600 - (600)
110 1,290 220 (1,070)
- 180 - (180)
- - - -
340 460 680 220
- - - -
- - - -
1,250 5,934 2,500 (3,434)
54 470 108 (362)
1,026 6,273 2,052 (4,221)
- - - -
- 5,170 - (5,170)
- 4 - (4)
20 680 40 (640)
- 195 - (195)
- 197 - (197)
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
126 1,075 252 (823)
37 277 74 (203)
44 381 88 (293)
8 17 16 (1)
- 50 - (50)
- - - -
- - - -
13 15 26 11
- 30 - (30)
- - - -
- 140 - (140)
20 27 40 13
246 1,320 492 (828)
- - - -
11,431 123,429 22,862 (100,567)
115 - 230 230
- 27 - (27)
- 50 - (50)
100 50 200 150
180 559 360 (199)
- 396 - (396)
3,593 4,003 7,186 3,183
- 10 - (10)
- 11 - (11)
- 2 - (2)
- - - -
- - - -
- 197 - (197)
- 120 - (120)
- 280 - (280)
380 1,472 760 (712)
- - - -
- - - -
- - - -
- - - -
- 9 - (9)
- - - -
380 390 760 370
- 20 - (20)
14 22 28 6
30 116 60 (56)
- - - -
8 193 16 (177)
- 111 - (111)
- - - -
- - - -
- - - -
- - - -
- - - -
- 3 - (3)
- 195 - (195)
- - - -
- - - -
400 600 800 200
186 858 372 (486)
- - - -
- 690 - (690)
- - - -
- - -
- - - -
- - - -
923 - 1,846 1,846
- 358 - (358)
- 210 - (210)
2,953 10,691 5,906 (4,785)
100 590 200 (390)
- - - -
- - - -
- 50 - (50)
2,600 5,190 5,200 10
580 4,114 1,160 (2,954)
695 - 1,390 1,390
- 291 - (291)
- - - -
- 24 - (24)
- - - -
- - - -
- 18 - (18)
- - -
- - -
- - -
- - -
- 103 - (103)
- 103 - (103)
- 285 - (285)
- 99 - (99)
- - - -
- - - -
180 100 360 260
- 95 - (95)
-
-
15
- 7 - (7)
- 2 - (2)
- - -
- - -
2 73 4 (69)
- 200 - (200)
- - - -
- - - -
- - - -
3 16 6 (10)
- 31 - (31)
- - - -
3 - 6 6
20 35 40 5
- - - -
1 3 2 (1)
- - -
- - - -
20 52 40 (12)
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 30 - (30)
- - -
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 9 - (9)
- 2 - (2)
- 27 - (27)
- - -
- - -
- - -
- - -
- - -
- - - -
- - - -
- - - -
- - - -
Menyerahkan
ang Farmasi & Perbekalan Yang Meminta Yang Menerima
aten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
..……………………… …………………………. …………………………..

NIP. NIP
FORM : LPLPO
NOMOR TANGGAL
Jumlah
LAIN-LAIN
16 17
Yang Menerima
Petugas UPTD Puskesmas
…………………………..
NIP
PUSKESMAS

STOK STOK PEMBERIAN

AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
3 Alopurinol Tablet 100 mg Set 380 - 380 240 140 480 340
7 Aminofillin Tablet 200 mg Tablet - 200 200 200 - 400 400
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 580 580 50 530 100 (430)
9 Amlodipin Tablet 5 mg Tablet 440 440 210 230 420 190
10 Amlodipin Tablet 10 mg Kapsul - - - - - -
11 Amoksisillin Kapsul 250 mg Kaplet 14,354 14,354 930 13,424 1,860 (11,564)
12 Amoksisillin Kaplet 500 mg Botol 68,260 68,260 3,846 64,414 7,692 (56,722)
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 240 - 240 - (240)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 65 200 265 163 102 326 224
15 Amoksisillin Double Strengh Sirup Kerin Tablet 424 424 10 414 20 (394)

17 Ampisillin Kaplet 500 mg Supp 1,130 1,130 100 1,030 200 (830)
19 Ampisillin Injeksi 1000 mg Tablet 150 150 - 150 - (150)
20 Analgetik Plus Tablet - 100 100 - 100 - (100)

21 Antasida Doen Suspensi Kombinasi : Vial 186 - 186 47 139 94 (45)
22 Antasida Doen Tablet, Kombinasi : M Botol 3,922 5,000 8,922 7,399 1,523 14,798 13,275
23 Antasida Plus Tablet Tablet 140 140 10 130 20 (110)
24 Antalgin (Metampiron) Tablet 500 mg Tablet 560 5,600 6,160 3,440 2,720 6,880 4,160
28 Anti Fungi DOEN Kombinasi : Tablet 581 581 10 571 20 (551)
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - - - - - - -
31 Anti Diare Tablet ( Neo Diaform) Vial 3,229 - 3,229 849 2,380 1,698 (682)
32 Anti Dotum Oral Tablet ( Bekarbon/Norit Botol 583 1,500 2,083 - 2,083 - (2,083)
33 Anti Hipertensi Kapsul (Tensigard) Sachet 120 - 120 120 - 240 240
40 Asam Mefenamat Kapsul 500 mg Tablet - - - - - - -
45 Asiklovir Tablet 200 mg Tablet - 200 200 105 95 210 115
46 Asiklovir Tablet 400 mg Tablet 300 - 300 - 300 - (300)
49 Betahistin Mesilat 6 mg Botol 1,180 - 1,180 - 1,180 - (1,180)
50 Betametason Krim 0,1 %- 5g Botol 91 - 91 47 44 94 50
62 Digoksin Tablet 0,25 mg Tablet 190 - 190 - 190 - (190)
64 Domperidon Tablet 10 mg Tablet 665 665 - 665 - (665)
65 Donperidon Suspensi 5 mg/5ml Botol - - - - - -
73 Etanol 70 % 100 ml Botol 32 8 40 4 36 8 (28)
74 Etil Klorida Semprot -100 ml Botol 4 - 4 2 2 4 2
76 Fenitoin Natrium Kapsul 100 mg Stick 60 - 60 - 60 - (60)
77 Fenobarbital tablet 30 mg Tablet 210 - 210 - 210 - (210)
81 Fitomenadion tablet 10 mg Tablet 200 - 200 - 200 - (200)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1 Tablet 100 - 100 - 100 - (100)
84 Garam Oralit I serbuk, kombinasi : Set 34 - 34 34 - 68 68
87 Gentamisin Salep Kulit 0,1 % Botol 79 - 79 79 - 158 158
88 Glibenklamid Tablet 5 mg Biji 932 - 932 450 482 900 418
89 Glimepiride 2 mg Pot 264 - 264 90 174 180 6
90 Gliseril Guayakolat Tablet 100 mg Tube 16,280 - 16,280 7,057 9,223 14,114 4,891
95 Griseofulvin Tablet 125 mg,micronized Bungkus 248 - 248 200 48 400 352
100 Hidrokortison Krim 2,5 % Tube 69 - 69 34 35 68 33
101 Ibuprofen Tablet 200 mg Botol 684 - 684 684 - 1,368 1,368
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - - - - - - -
104 Ichtyol salep Kulit Ampul 9 - 9 - 9 - (9)
111 Kalsium Laktat Tablet 500 mg Tablet 8,375 - 8,375 715 7,660 1,430 (6,230)
112 Kaptopril 12,5 mg Ampul - 600 600 - 600 - (600)

114 Karbamazepin Tablet 200 mg Botol 150 - 150 3 147 6 (141)
123 Kloramfenikol Kapsul 250 mg Ampul 770 - 770 680 90 1,360 1,270

127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 29,458 - 29,458 10,000 19,458 20,000 542
131 Kotrimoksazol Pedriatik Tablet, KombinaTablet 14 - 14 14 - 28 28
134 Lansoprazole 30 mg Kapsul Botol 70 180 250 30 220 60 (160)
Botol - - - - - -
140 Loperamid Tablet 2 mg Tablet 265 - 265 30 235 60 (175)
141 Loratadin tablet 10 mg Tablet 689 - 689 100 589 200 (389)
145 Metformin Hcl Tablet 500 mg Paket 827 - 827 215 612 430 (182)
146 Methisoprinol 500 mg Paket 340 - 340 340 - (340)
147 Metilergometrin Maleat (Metergin) Tabl Botol 264 - 264 - - -
148 Metilergometrin Maleat Injeksi 0,200 mg Vial 200 - 200 200 - (200)
149 Metilprednisolon tablet 4 mg Tube 600 - 600 600 - (600)
150 Metoklopramid 10 mg Tube 1,290 - 1,290 1,290 - (1,290)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 180 - 180 180 - (180)
152 Metronidazol Tablet 250 mg Tablet - - - - - -
153 Metronidazole Tablet 500 mg Botol 460 300 760 340 420 680 260
155 Mikonazole KrIm 2 % - 10 gr Tablet - - - - - - -
158 Natrium Bikarbonat Tablet 500 mg Tablet 6,273 - 6,273 1,026 5,247 2,052 (3,195)
160 Natrium Diklofenak Tablet 50 mg Rol 5,170 - 5,170 - 5,170 - (5,170)
162 Nipedifin Tablet 10 mg Botol 680 - 680 20 660 40 (620)

164 Nistatin 500.000 IU/gram Tablet Salut Botol 197 200 397 - 397 - (397)
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 1,075 - 1,075 126 949 252 (697)
176 Obat Flu Sirup Tablet 17 - 17 8 9 16 7
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - - - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 15 - 15 - 15 - (15)
184 Parasetamol drop 100 mg/ml btl @15ml Vial 27 - 27 20 7 40 33
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 1,320 - 1,320 156 1,164 312 (852)
188 Pehacain injeksi Buah - 120 120 120 - 240 240
189 Perak Sulfadiazin krim 1 % 35 gr (Burna Botol 27 - 27 - 27 - (27)
191 Piracetam Tablet 800 mg Botol 50 - 50 50 - 100 100
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 4,003 - 4,003 3,593 410 7,186 6,776
195 Polikresulen (Kondensasi Metakresol SuSet 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 11 - 11 - 11 - (11)
197 Povidon Iodida 10% 300 ml Ampul 2 2 - 2 - (2)
203 Ranitidin Tablet 150 mg Tablet 1,472 - 1,472 380 1,092 760 (332)
208 Ringer Laktat Larutan Infus Steril 500 ml Set 9 16 25 - 25 - (25)
210 Salbutamol Tablet 4 mg Botol 390 - 390 380 10 760 750
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 22 - 22 14 8 28 20
213 Salisil bedak 2% -50 gr Botol 116 - 116 30 86 60 (26)
216 Sefadroksil Tablet 500 mg Kapsul 111 - 111 - 111 - (111)
222 Setirizin Sirup 5 mg / 5 ml Tablet 3 - 3 - 3 - (3)
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 195 - 195 - 195 - (195)
226 Simetidin 200 mg Tablet Tablet 600 - 600 400 200 800 600
227 Simvastatin Tablet 10 mg Tablet 858 - 858 186 672 372 (300)
231 Tablet Tambah Darah Kombinasi: Besi IITablet - - - - - - -
234 Tetrasiklin Kapsul 250 mg Tube - - - - - - -
235 Tetrasiklin Kapsul 500 mg Tablet 358 - 358 - 358 - (358)
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 10,691 - 10,691 1,953 8,738 3,906 (4,832)
242 Vitamin B .Komplek Tablet Tablet 5,190 - 5,190 2,600 2,590 5,200 2,610
243 Vitamin Neurotropik Tablet Botol 4,114 - 4,114 580 3,534 1,160 (2,374)
244 Zinc Tablet 20 mg Tablet - - - - - - -
245 Prednison tab 5 mg Tablet 291 - 291 291 - 582 582
250 MgSO4-40% Kapsul 18 - 18 - 18 - (18)
251
252
253
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

259 Alat Suntik Sekali Pakai 1 ml Tablet - - - - - -
260 Alat Suntik Sekali Pakai 2,5 ml Tablet 100 200 300 200 100 400 300
262 Alat Suntik Sekali Pakai 10 ml Kotak - - - - - -
263 Catgut/Benang Bedah No.2/0-3/0 (Plain Tube - 48 48 - 48 - (48)
264 Etakridin Larutan (Rivanol) 0,1% - 300 mTablet - 3 3 - 3 - (3)
265 Etanol 70 % 1.000 ml Tablet 7 - 7 - 7 - (7)
269 Infus set Anak Kapsul 73 20 93 2 91 4 (87)
270 Infus set Dewasa Kapsul 200 - 200 - 200 - (200)
281 Kassa Hidrofil Steril 16 x 16 Botol - - - - - - -
283 Kapas Pembalut / Adsorbens 250 gram Tablet 16 5 21 3 18 6 (12)
284 Kassa Kompres 40 x 40 steril Kapsul 31 50 81 10 71 20 (51)
285 Kassa Pembalut 2 m x 80 cm Tablet - - - - - - -
286 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet - 40 40 3 37 6 (31)
287 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 35 15 50 20 30 40 10
288 Kertas Puyer Tablet - - - - - - -
289 Lysol 1,000 ml Supp 3 3 - 3 - (3)
290 Masker Tablet - 100 100 - 100 - (100)
292 Silk( Benang Bedah Sutra ) No 3/0 Tablet 52 - 52 - 52 - (52)
294 Sarung tangan Steril No 6 Ampul - - - - - - -
295 Sarung tangan Steril No 7 Tablet - 40 40 30 10 60 50
296 Sarung tangan Steril No 7,5 Tube - 45 45 40 5 80 75
297 Sarung tangan Non Steril S Sashet - - - - - - -
298 Sarung tangan Non Steril M Tablet - - - - - - -
299 Sarung tangan Non Steril L Botol - - - - - - -
302 POLIFIX KTK - 5 5 2 3 4 1
303 - - - - -
304 - - - - -
305 - - - - -
306 - - - - -
307 - - - - -
308 - - - - -
309 C. SERUM DAN VAKSIN - - - - -
310 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I ) 9 9 9 - (9)
311 Serum Anti Rabies untuk manusia 2 2 2 - (2)
312 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul 27 27 27 - (27)
313 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul - - - - -
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

Kepala Dinas Kesehatan Kabupaten Kepala UPTD Gudang Farmasi & Perbekalan Yang Meminta Yang Menerima
Kuningan Kabupaten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
PUSKESMAS

STOK PEMBERIAN
STOK PENERIM PERSEDI PEMAKAI STOK PERMINT
NO NAMA OBAT SATUAN Jumlah
AWAL AAN AAN AN AKHIR AAN PKD ASKES APBD I APBD II PROGRAMLAIN-LAIN
OPT.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
3 Alopurinol Tablet 100 mg Set 140 300 440 190 250 380 130
4 Ambroksol Tablet 30 mg Set 9,758 9,758 1,068 8,690 2,136 (6,554)
5 Ambroksol sirup 15 mg/5 ml Tablet 381 381 91 290 182 (108)
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 3 - 3 - (3)
7 Aminofillin Tablet 200 mg Tablet - - - - - -
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 530 530 - 530 - (530)
9 Amlodipin Tablet 5 mg Tablet 230 230 - 230 - (230)
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 240 10 230 20 (210)
14 Amoksisillin Sirup Kering 125 mg/5mlAmpul 102 102 102 - 204 204
15 Amoksisillin Double Strengh Sirup KeTablet 414 414 205 209 410 201

17 Ampisillin Kaplet 500 mg Supp 1,030 1,030 - 1,030 - (1,030)
18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - -
20 Analgetik Plus Tablet 100 100 - 100 - (100)

21 Antasida Doen Suspensi Kombinasi Vial 139 139 37 102 74 (28)
22 Antasida Doen Tablet, Kombinasi : Botol 1,523 8,000 9,523 4,722 4,801 9,444 4,643
23 Antasida Plus Tablet Tablet 130 130 20 110 40 (70)
24 Antalgin (Metampiron) Tablet 500 mgTablet 2,720 2,720 2,720 - 5,440 5,440
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 60 - 60 - (60)
26 Anti Bakteri DOEN Salep Kombinasi :Botol 17 17 5 12 10 (2)
27 Anti Hemoroid Doen komb Tablet - - - - -
29 Antimigren DOEN Kombinasi : ErgotaAmpul 395 395 - 395 - (395)
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - - - - - -
31 Anti Diare Tablet ( Neo Diaform) Vial 2,380 2,380 1,099 1,281 2,198 917
32 Anti Dotum Oral Tablet ( Bekarbon/NoBotol 2,083 750 2,833 1,000 1,833 2,000 167
33 Anti Hipertensi Kapsul (Tensigard) Sachet - - - - - -
34 Antihistamin Tablet kombinasi (Sold Ampul - - - - - -
35 Antispasmodik Tablet (Spasminal) Tablet - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 185 185 63 122 126 4
37 Antitusiva Tablet (Dekorin) Tablet - - - - - -
38 Asam Folat Tablet 1 mg Botol - - - - - -
39 Asam Askorbat (Vit. C) Tablet 50 mgAmpul 9,442 9,442 3,265 6,177 6,530 353
40 Asam Mefenamat Kapsul 500 mg Tablet - - - - - -
41 Asetosal Tablet 80 mg Tablet 100 100 20 80 40 (40)
42 Asetosal Tablet 100 mg Tablet 200 200 - 200 - (200)
44 Asiklovir Krim 5 % Tablet 242 242 36 206 72 (134)
45 Asiklovir Tablet 200 mg Tablet 95 95 95 - 190 190
46 Asiklovir Tablet 400 mg Tablet 300 300 100 200 200 -
48 Aqua Pro Injeksi Steril, bebas Piroge Botol 190 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,180 1,180 30 1,150 60 (1,090)
50 Betametason Krim 0,1 %- 5g Botol 44 44 44 - 88 88
51 Bisakodil suppositoria 10 mg Botol 25 25 - 25 - (25)
52 Bisoprolol Tablet 5 mg Kapsul - - - - - -
53 Bromheksin 8 mg Kapsul 7,100 7,100 610 6,490 1,220 (5,270)
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 128 - 128 - (128)
55 Deksametason Tablet 0,5 mg Tablet 97,907 97,907 7,697 90,210 15,394 (74,816)
56 Devitalisasi Pasta (Non Arsen) Tablet - - - - - -
57 Diazepam tablet 2 mg Tablet 94 94 - 94 - (94)
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - - - - -
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 10 - 10 - (10)
60 Dietilkarbamazin Sitrat Tablet 100 m Ampul - - - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1Tablet 405 405 - 405 - (405)
62 Digoksin Tablet 0,25 mg Tablet 190 190 - 190 - (190)
63 Dimenhidrinat Tablet 50 mg Botol 1,000 1,000 - 1,000 - (1,000)
64 Domperidon Tablet 10 mg Tablet 665 665 130 535 260 (275)
66 Efedrin Hcl Tablet 25 mg Kantong 334 334 - 334 - (334)
68 Epinefrin HCl / Bitartrat Botol 24 24 - 24 - (24)
69 Eritromisin Kapsul 250 mg Set - - - - - -
70 Eritromisin Kapsul 500 mg Tablet 400 400 - 400 - (400)
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - - - - -
72 Etambutol Tablet 500 mg Botol - - - - - -
73 Etanol 70 % 100 ml Botol 36 36 - 36 - (36)
74 Etil Klorida Semprot -100 ml Botol 2 2 2 - 4 4
75 Eugenol Cairan -10 ml Tablet - - - - - -
76 Fenitoin Natrium Kapsul 100 mg Stick 60 60 - 60 - (60)
77 Fenobarbital tablet 30 mg Tablet 210 210 - 210 - (210)
78 Fenobarbital injeksi 50 mg / ml Tablet 30 30 - 30 - (30)
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,130 1,130 100 1,030 200 (830)
80 Fenoksimeti Penisilin 500 mg tablet Tube 220 220 - 220 - (220)
81 Fitomenadion tablet 10 mg Tablet 200 200 25 175 50 (125)
82 Fitomenadion (Vit K1) Injeksi 2 mg/m Tablet 100 100 - 100 - (100)
83 Furosemid Tablet 40 mg Set 1,675 1,675 - 1,675 - (1,675)
84 Garam Oralit I serbuk, kombinasi : Set - - - - - -

85 Gemfibrozil Tablet 600 mg Vial - - - - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 20 - 20 - (20)
87 Gentamisin Salep Kulit 0,1 % Botol - - - - - -
88 Glibenklamid Tablet 5 mg Biji 482 500 982 165 817 330 (487)
89 Glimepiride 2 mg Pot 174 174 - 174 - (174)
90 Gliseril Guayakolat Tablet 100 mg Tube 9,223 9,223 5,402 3,821 10,804 6,983
91 Gliseril Guayakolat sirup Tablet 216 216 18 198 36 (162)
92 Glukonas Kalsikus injeksi Bungkus - - - - - -
93 Glukosa Larutan Infus 5 % Bungkus 8 8 - 8 - (8)
94 Glukosa Larutan Infus10 % Tablet 22 22 - 22 - (22)
95 Griseofulvin Tablet 125 mg,micronizeBungkus 48 48 48 - 96 96
96 Haloperidol Tablet 0,5 mg Rol 175 175 - 175 - (175)
98 Haloperidol Tablet 5 mg Rol 500 500 - 500 - (500)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 2,979 2,979 500 2,479 1,000 (1,479)
100 Hidrokortison Krim 2,5 % Tube 35 35 - 35 - (35)
101 Ibuprofen Tablet 200 mg Botol - - - - - -
102 Ibuprofen Tablet 400 mg Tablet 14,423 14,423 1,120 13,303 2,240 (11,063)
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - - - - - -
104 Ichtyol salep Kulit Ampul 9 9 1 8 2 (6)

105 Ipatropium Bromide + Salbutamol Ampul 20 20 - 20 - (20)
106 Isoniazid tablet 100 mg Tablet - - - - - -
107 Isosorbid Dinitrat 5 mg Tablet 300 300 - 300 - (300)
108 Kalium Diklofenak Tablet 25 mg Tablet - - - - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 3,580 3,580 100 3,480 200 (3,280)
110 Kalsium Hidroksida Pasta Botol - - - - - -
111 Kalsium Laktat Tablet 500 mg Tablet 7,660 7,660 2,699 4,961 5,398 437
112 Kaptopril 12,5 mg Ampul 600 600 295 305 590 285
114 Karbamazepin Tablet 200 mg Botol 147 147 - 147 - (147)
115 Ketokonazole Krim 2 % - 15 gr Botol 12 12 10 2 20 18
116 Ketokonazole Tablet 200 mg Botol - - - - - -
117 Ketoprofen Tablet 100 mg Botol - - - - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - - - - -
119 Ketorolac 10 mg injeksi Botol - - - - - -
120 Ketorolac 30 mg injeksi Botol 20 20 - 20 - (20)
121 Klindamisin Kapsul 150 mg Botol - - - - - -
122 Klindamisin Kapsul 300 mg Tablet - - - - - -
123 Kloramfenikol Kapsul 250 mg Ampul 90 90 90 - 180 180
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - -

125 Kloramfenikol Tetes Mata -5 ml Ampul 418 418 52 366 104 (262)
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 126 126 24 102 48 (54)
127 Klorfeniramin Maleat (CTM) Tablet 4 Bungkus 19,458 19,458 8,813 10,645 17,626 6,981
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,493 1,493 - 1,493 - (1,493)
129 Klorpromazin Hcl Tablet Salut 100 mTablet - - - - - -
130 Klorpromazin Hcl Injeksi 5 mg/ml-2mlTablet - - - - - -
131 Kotrimoksazol Pedriatik Tablet, KombTablet - - - - - -
132 Kotrimoksazol Tablet, Kombinasi : Ampul - - - - - -
134 Lansoprazole 30 mg Kapsul Botol 220 220 26 194 52 (142)
135 Larutan mengadung Elektrolit Botol 20 20 - 20 - (20)
136 Larutan mengadung Elektrolit Tablet 11 11 - 11 - (11)
137 Larutan mengadung Karbohidrat + Elektroli
Botol - - - - - -
138 Lidokain injeksi 2 % Botol - - - - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - - - - -
140 Loperamid Tablet 2 mg Tablet 235 235 10 225 20 (205)
141 Loratadin tablet 10 mg Tablet 589 589 - 589 - (589)
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - - - - -
143 Meloksikam tablet 15 mg Paket 1,315 1,315 170 1,145 340 (805)
145 Metformin Hcl Tablet 500 mg Paket 612 612 210 402 420 18
146 Methisoprinol 500 mg Paket 340 340 - 340 - (340)
147 Metilergometrin Maleat (Metergin) T Botol - - - - - -
148 Metilergometrin Maleat Injeksi 0,200 Vial 200 200 - 200 - (200)
149 Metilprednisolon tablet 4 mg Tube 600 600 600 - (600)
150 Metoklopramid 10 mg Tube 1,290 1,290 20 1,270 40 (1,230)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 180 180 - 180 - (180)
154 Metronidazole Infus 500 mg /100 ml Tablet - - - - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet - - - - - -
156 Multivitamin + Mineral tablet Tablet 4,684 4,684 895 3,789 1,790 (1,999)
157 Multivitamin sirup Tablet 416 416 66 350 132 (218)
158 Natrium Bikarbonat Tablet 500 mg Tablet 5,247 5,247 783 4,464 1,566 (2,898)
159 Natrum Diklofenak Tablet 25 mg Tablet - - - - - -
160 Natrium Diklofenak Tablet 50 mg Rol 5,170 5,170 50 5,120 100 (5,020)
161 Natrium Klorida Larutan infus 0,9%-StBotol 4 4 - 4 - (4)
162 Nipedifin Tablet 10 mg Botol 660 660 20 640 40 (600)

163 Nistatin 100.000 IU/gram Tablet Vagi Botol 195 195 - 195 - (195)
164 Nistatin 500.000 IU/gram Tablet Salu Botol 397 397 - 397 - (397)
165 Obat Antitiuberkolosis Kategori AnakBotol - - - - - -
166 Obat Antitiuberkolosis Kategori 1 De Tablet - - - - - -
169 Obat Anti Tuberkulosis FDC Kat An Tablet - - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & ITablet - - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & ITablet - - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan Tablet - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 Kapsul 949 949 146 803 292 (511)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 240 240 41 199 82 (117)
175 Obat Batuk Hitam Plus Sirup (ExcosBotol 337 337 34 303 68 (235)
176 Obat Flu Sirup Tablet 9 9 5 4 10 6
177 Oksiterasiklin Hcl injeksi i.m.50 mg/mPot 50 50 - 50 - (50)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - - - - - -

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 15 15 10 5 20 15
181 Omeprazole injeksi 40mg/10ml Vial 30 30 - 30 - (30)
182 Omeprazole Kapsul 20 mg Vial - - - - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul 140 140 - 140 - (140)
184 Parasetamol drop 100 mg/ml btl @15Vial 7 7 7 - 14 14
185 Parasetamol Sirup 120 mg/5ml-60 mlAmpul 1,164 1,164 256 908 512 (396)
186 Parasetamol Tablet 100 mg Sachet - - - - - -
187 Parasetamol Tablet 500 mg Botol 111,998 111,998 10,304 101,694 20,608 (81,086)
188 Pehacain injeksi Buah - 120 120 5 115 10 (105)
189 Perak Sulfadiazin krim 1 % 35 gr (Bu Botol 27 27 4 23 8 (15)
190 Piracetam 400 mg Tablet 50 50 - 50 - (50)
191 Piracetam Tablet 800 mg Botol - - - - - -
192 Piroksikam Tablet 20 mg Vial 379 379 150 229 300 71
193 Pirantel Pamoat Tablet 365 mg (Set Set 396 396 - 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 410 410 410 - 820 820
195 Polikresulen (Kondensasi MetakresolSet 10 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 11 11 2 9 4 (5)
198 Predison Tablet - - - - - -
199 Primakuin tablet 15 mg Tablet - - - - - -
200 Propanolol Hcl Tablet 40 mg Botol 197 197 - 197 - (197)
201 Propilturasil Tablet 100 mg Kuur 120 120 - 120 - (120)
202 Ranitidin Injeksi 25 mg / ml Set 280 280 - 280 - (280)
203 Ranitidin Tablet 150 mg Tablet 1,092 1,092 456 636 912 276
206 Reserpin Tablet 0, 25 mg Buah - - - - - -
207 Rifampisin Tablet 450 mg Buah - - - - - -
208 Ringer Laktat Larutan Infus Steril 500Set 25 20 45 5 40 10 (30)
210 Salbutamol Tablet 4 mg Botol 10 10 - 10 - (10)
211 Salbutamol solution for Inhalation sin Tablet 20 20 - 20 - (20)
212 Salep 2-4 Kombinasi : Asam Salisila Tablet 8 25 33 30 3 60 57
213 Salisil bedak 2% -50 gr Botol 86 30 116 72 44 144 100
214 Salep Luka Bakar (Neocenta/Bioplant vial - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 Botol 185 185 15 170 30 (140)
216 Sefadroksil Tablet 500 mg Kapsul 111 300 411 210 201 420 219
217 Sefiksim Kapsul 100 mg Vial - - - - - -
218 Sefotaksim Injeksi 1 gr Tablet - - - - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - - - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - - - - -
221 Setirizin Tablet 10 mg Botol - - - - - -
222 Setirizin Sirup 5 mg / 5 ml Tablet 3 3 - 3 - (3)
223 Sianokobalamin Injeksi 500 mcg/ml-1Botol 195 195 - 195 - (195)

224 Sianokobalamin Tablet 50 mcg Tablet - - - - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - - - - -
226 Simetidin 200 mg Tablet Tablet 200 200 200 - 400 400
227 Simvastatin Tablet 10 mg Tablet 672 672 40 632 80 (552)
228 Siprofloksasin 500mg Tablet - 300 300 - 300 - (300)
229 Spironolakton Tablet 25 mg Botol 690 690 - 690 - (690)
231 Tablet Tambah Darah Kombinasi: Besi Tablet - - - - - -
232 Temporary Stopping Fletcher (Fletch Kapsul - - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 Kapsul - - - - - -
234 Tetrasiklin Kapsul 250 mg Tube - - - - - -
235 Tetrasiklin Kapsul 500 mg Tablet 358 1,000 1,358 10 1,348 20 (1,328)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/mTablet 210 210 210 - 420 420
237 Tiamin Hcl /Mononitrat (Vit.B1) Table set 8,738 3,000 11,738 3,402 8,336 6,804 (1,532)
238 Thiamfenikol Kapsul 500 mg set 590 590 100 490 200 (290)
241 Triheksifenidil Hidroklorida Tablet 2 Tablet 50 50 - 50 - (50)
242 Vitamin B .Komplek Tablet Tablet 2,590 2,590 1,500 1,090 3,000 1,910
243 Vitamin Neurotropik Tablet Botol 3,534 3,534 600 2,934 1,200 (1,734)
244 Zinc Tablet 20 mg Tablet - - - - - -
245 Prednison tab 5 mg Tablet - - - - - -
246 Gentian Violet Tablet - - - - - -
247 Furosemid injek 10mg/ml Tablet 24 24 - 24 - (24)
249 Bahan Tambal Sementara Kapsul - - - - - -
250 MgSO4-40% Kapsul 18 18 - 18 - (18)
251 polifix5 - - - - -
252 - - - - -
253 - - - - -
254 B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES
- - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Tablet 103 103 3 100 6 (94)
256 Abbocath No 20 ( IV Chateter 20 ) Botol 103 103 - 103 - (103)
257 Abbocath No 22 ( IV Chateter 22 ) Pot 285 285 5 280 10 (270)
258 Abbocath No 24 ( IV Chateter 24 ) Tablet 99 99 - 99 - (99)
261 Alat Suntik Sekali Pakai 2,5 ml Tablet 100 200 300 - 300 - (300)
262 Alat Suntik Sekali Pakai 5 ml Tablet 95 95 - 95 - (95)
264 Catgut/Benang Bedah No.2/0-3/0 (PlaTube 48 48 12 36 24 (12)
265 Etakridin Larutan (Rivanol) 0,1% - 30 Tablet 3 3 - 3 - (3)
266 Etanol 70 % 1.000 ml Tablet 7 7 1 6 2 (4)
267 Folley Catheter no 14 Ampul 2 2 - 2 - (2)
268 Folley Catheter no 16 Ampul - - - - - -
270 Infus set Anak Kapsul 91 91 - 91 - (91)
271 Infus set Dewasa Kapsul 200 200 10 190 20 (170)
272 Iodina Test Botol - - - - - -
273 Kassa Hidrofil Steril 16 x 16 Botol - - - - - -
274 Kapas Berlemak 500 gram Tablet - - - - - -
275 Kapas Pembalut / Adsorbens 250 gr Tablet 18 10 28 - 28 - (28)
276 Kassa Kompres 40 x 40 steril Kapsul 71 71 - 71 - (71)
277 Kassa Pembalut 2 m x 80 cm Tablet - 20 20 - 20 - (20)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet 37 37 - 37 - (37)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 30 30 - 30 - (30)
280 Kertas Puyer Tablet - - - - - -
281 Lysol 1,000 ml Supp 3 3 - 3 - (3)
282 Masker Tablet 100 100 - 100 - (100)
283 Plester 5 yard x 2 inchi Tablet - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Tablet 52 52 - 52 - (52)
285 Safety Box Ampul - - - - - -
286 Sarung tangan Steril No 6 Ampul - - - - - -
287 Sarung tangan Steril No 7 Tablet 10 50 60 13 47 26 (21)
288 Sarung tangan Steril No 7,5 Tube 5 50 55 10 45 20 (25)
289 Sarung tangan Non Steril S Sashet - - - - - -
290 Sarung tangan Non Steril M Tablet - - - - - -
291 Sarung tangan Non Steril L Botol - - - - - -
292 Urine Bag Tablet - - - - - -
294 POLIFIX KTK 3 4 7 - 7 - (7)
- - -
- - -
- - - - -
- - - - - -
- - - - - -
- - - - - -
295 C. SERUM DAN VAKSIN Kapsul - - - - - -
296 Serum Anti Bisa Ular Polivalen InjeksiTablet 9 9 9 - (9)
297 Serum Anti Rabies untuk manusia Botol 2 2 2 (2)
298 Serum Anti Tetanus (ATS) Injeksi 1. Tablet 27 27 27 (27)
299 Serum Anti Tetanus (ATS) Injeksi 20 Ampul - - - -
300 Tablet
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0
Kbupaten Kuningan Kabupaten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
TANGGAL
PUSKESMAS

STOK STOK PEMBERIAN

AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Air Raksa Dental Use Botol - - - - - -
4 Ambroksol Tablet 30 mg Set 8,690 8,690 345 8,345 690 (7,655)
5 Ambroksol sirup 15 mg/5 ml Tablet 290 290 187 103 374 271
9 Amlodipin Tablet 5 mg Tablet 230 200 430 61 369 122 (247)
13 Amoksisillin Serbuk Injeksi 1000 mg ampul 230 230 150 80 300 220
14 Amoksisillin Sirup Kering 125 mg/5ml Tablet - 200 200 113 87 226 139

17 Ampisillin Kaplet 500 mg Supp 1,030 1,030 100 930 200 (730)
19 Ampisillin Injeksi 1000 mg Tablet 150 150 1 149 2 (147)
20 Analgetik Plus Tablet 100 - 100 10 90 20 (70)

21 Antasida Doen Suspensi Kombinasi : M Vial 102 102 36 66 72 6
22 Antasida Doen Tablet, Kombinasi : Ma Botol 4,801 4,801 1,523 3,278 3,046 (232)
23 Antasida Plus Tablet Tablet 110 500 610 200 410 400 (10)
24 Antalgin (Metampiron) Tablet 500 mg Tablet - 1,000 1,000 880 120 1,760 1,640
26 Anti Bakteri DOEN Salep Kombinasi : Botol 12 12 4 8 8 -
27 Anti Hemoroid Doen komb Tablet - - - - - -
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 395 395 120 275 240 (35)
31 Anti Diare Tablet ( Neo Diaform) Vial 1,281 1,281 486 795 972 177
32 Anti Dotum Oral Tablet ( Bekarbon/Norit)Botol 1,833 1,833 - 1,833 - (1,833)
34 Antihistamin Tablet kombinasi (Soldext Ampul - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 122 122 35 87 70 (17)
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 6,177 6,177 504 5,673 1,008 (4,665)
45 Asiklovir Tablet 200 mg Tablet - 200 200 1 199 2 (197)
46 Asiklovir Tablet 400 mg Tablet 200 200 63 137 126 (11)
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,150 1,150 60 1,090 120 (970)
50 Betametason Krim 0,1 %- 5g Botol - 75 75 15 60 30 (30)
51 Bisakodil suppositoria 10 mg Botol 25 25 5 20 10 (10)
53 Bromheksin 8 mg Kapsul 6,490 6,490 360 6,130 720 (5,410)
57 Diazepam tablet 2 mg Tablet 94 100 194 50 144 100 (44)
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 405 405 - 405 - (405)
73 Etanol 70 % 100 ml Botol 36 36 - 36 - (36)
74 Etil Klorida Semprot -100 ml Botol - - - - -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,030 1,030 - 1,030 - (1,030)
81 Fitomenadion tablet 10 mg Tablet 175 175 - 175 - (175)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 100 100 10 90 20 (70)
88 Glibenklamid Tablet 5 mg Biji 817 817 232 585 464 (121)
89 Glimepiride 2 mg Pot 174 174 80 94 160 66
90 Gliseril Guayakolat Tablet 100 mg Tube 3,821 5,000 8,821 3,445 5,376 6,890 1,514
94 Glukosa Larutan Infus10 % Tablet 22 22 3 19 6 (13)
95 Griseofulvin Tablet 125 mg,micronized Bungkus - - - - - -
98 Haloperidol Tablet 5 mg Rol 500 500 21 479 42 (437)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 2,479 2,479 203 2,276 406 (1,870)
100 Hidrokortison Krim 2,5 % Tube 35 75 110 9 101 18 (83)
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - - - - - -
104 Ichtyol salep Kulit Ampul 8 8 5 3 10 7

111 Kalsium Laktat Tablet 500 mg Tablet 4,961 4,961 1,300 3,661 2,600 (1,061)
112 Kaptopril 12,5 mg Ampul 305 305 45 260 90 (170)

114 Karbamazepin Tablet 200 mg Botol 147 147 100 47 200 153
115 Ketokonazole Krim 2 % - 15 gr Botol 2 2 - 2 - (2)
123 Kloramfenikol Kapsul 250 mg Ampul - - - - -

126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 102 102 20 82 40 (42)
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,493 1,493 200 1,293 400 (893)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - - - - -
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet - - - - - -
134 Lansoprazole 30 mg Kapsul Botol 194 150 344 65 279 130 (149)
Botol - - - - - -
138 Lidokain injeksi 2 % Botol - - - - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - - - - -
140 Loperamid Tablet 2 mg Tablet 225 225 - 225 - (225)
141 Loratadin tablet 10 mg Tablet 589 589 50 539 100 (439)
143 Meloksikam tablet 15 mg Paket 1,145 1,145 330 815 660 (155)
145 Metformin Hcl Tablet 500 mg Paket 402 200 602 20 582 40 (542)
147 Metilergometrin Maleat (Metergin) Tabl Botol - - - - - -
149 Metilprednisolon tablet 4 mg Tube 600 600 - 600 - (600)
150 Metoklopramid 10 mg Tube 1,270 1,270 660 610 1,320 710
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 180 180 50 130 100 (30)
155 Mikonazole KrIm 2 % - 10 gr Tablet - - - - - -
156 Multivitamin + Mineral tablet Tablet 3,789 3,789 892 2,897 1,784 (1,113)
158 Natrium Bikarbonat Tablet 500 mg Tablet 4,464 4,464 51 4,413 102 (4,311)
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 4 4 - 4 - (4)

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 195 195 - 195 - (195)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 397 397 - 397 - (397)
165 Obat Antitiuberkolosis Kategori Anak Botol - - - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 803 803 64 739 128 (611)
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 303 303 2 301 4 (297)
176 Obat Flu Sirup Tablet 4 4 4 - 8 8
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-1 Pot 50 50 - 50 - (50)

181 Omeprazole injeksi 40mg/10ml Vial 30 30 - 30 - (30)
184 Parasetamol drop 100 mg/ml btl @15ml Vial - 20 20 1 19 2 (17)
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 908 908 242 666 484 (182)
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 23 23 2 21 4 (17)
192 Piroksikam Tablet 20 mg Vial 229 229 10 219 20 (199)
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 396 - 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - - - - -
195 Polikresulen (Kondensasi Metakresol Su Set 10 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 9 9 - 9 - (9)
202 Ranitidin Injeksi 25 mg / ml Set 280 280 - 280 - (280)
203 Ranitidin Tablet 150 mg Tablet 636 636 200 436 400 (36)
208 Ringer Laktat Larutan Infus Steril 500 ml Set 40 40 10 30 20 (10)
210 Salbutamol Tablet 4 mg Botol 10 10 10 - 20 20
211 Salbutamol solution for Inhalation single Tablet 20 20 20 - 40 40
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 3 50 53 15 38 30 (8)
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 170 170 6 164 12 (152)
216 Sefadroksil Tablet 500 mg Kapsul 201 300 501 190 311 380 69
221 Setirizin Tablet 10 mg Botol - - - - - -
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 195 195 10 185 20 (165)
226 Simetidin 200 mg Tablet Tablet - - - - -
227 Simvastatin Tablet 10 mg Tablet 632 632 352 280 704 424
228 Siprofloksasin 500mg Tablet 300 300 - 300 - (300)
231 Tablet Tambah Darah Kombinasi: Besi II Tablet - - - - - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - - - -
235 Tetrasiklin Kapsul 500 mg Tablet 1,348 1,348 110 1,238 220 (1,018)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet - - - - - -
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 8,336 8,336 2,656 5,680 5,312 (368)
238 Thiamfenikol Kapsul 500 mg set 490 490 250 240 500 260
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 50 50 10 40 20 (20)
242 Vitamin B .Komplek Tablet Tablet 1,090 1,090 1,090 - 2,180 2,180
243 Vitamin Neurotropik Tablet Botol 2,934 2,934 836 2,098 1,672 (426)
250 MgSO4-40% Kapsul 18 18 18 - 36 36
251 Botol - - - - - -
252 Tablet - - - - - -
253 Tablet - - - - - -
254 B. BAHAN MEDIS HABIS PAKAI (BMHP) - - - - - -
255 Abbocath No 18 ( IV Chateter 18 ) 100 100 3 97 6 (91)
256 Abbocath No 20 ( IV Chateter 20 ) 103 103 - 103 - (103)
259 Alat Suntik Sekali Pakai 10 ml - - - - - -
260 Alat Suntik Sekali Pakai 1 ml - - - - -
261 Alat Suntik Sekali Pakai 2,5 ml 300 300 200 100 400 300
262 Alat Suntik Sekali Pakai 5 ml 95 95 - 95 - (95)
263 Alat Suntik Sekali Pakai 10 ml - - - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) 36 36 3 33 6 (27)
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml 3 3 - 3 - (3)
266 Etanol 70 % 1.000 ml 6 6 6 - 12 12
267 Folley Catheter no 14 2 2 2 - 4 4
268 Folley Catheter no 16 - - - - - -
269 Folley Catheter no 18 - - - - - -
270 Infus set Anak 91 91 - 91 - (91)
271 Infus set Dewasa 190 190 2 188 4 (184)
272 Iodina Test - - - - -
273 Kassa Hidrofil Steril 16 x 16 - - - - -
274 Kapas Berlemak 500 gram - - - - - -
275 Kapas Pembalut / Adsorbens 250 gram 28 28 4 24 8 (16)
276 Kassa Kompres 40 x 40 steril 71 71 - 71 - (71)
277 Kassa Pembalut 2 m x 80 cm 20 20 - 20 - (20)
278 Kassa Pembalut Hidrofil 4 m x 3 cm 37 37 - 37 - (37)
279 Kassa Pembalut Hidrofil 4 m x 15 cm 30 30 10 20 20 -
280 Kertas Puyer - - - - - -
281 Lysol 1,000 ml 3 3 3 - (3)
282 Masker 100 100 10 90 20 (70)
283 Plester 5 yard x 2 inchi - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 52 52 - 52 - (52)
285 Safety Box - - - - - -
286 Sarung tangan Steril No 6 - - - - - -
287 Sarung tangan Steril No 7 47 47 10 37 20 (17)
288 Sarung tangan Steril No 7,5 45 45 - 45 - (45)
289 Sarung tangan Non Steril S - - - - - -
290 Sarung tangan Non Steril M - - - - - -
291 Sarung tangan Non Steril L - - - - - -
292 Urine Bag - - - - - -
293 Wing Neddle No 23 30 30 - 30 - (30)
294 POLIFIX 7 7 - 7 - (7)
295 - - - - -
296 - - - - -
297 - - - - - -
298 - - - - - -
299 - - - - - -
300 - - - - - -
301 C. SERUM DAN VAKSIN - - - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I ) 9 9 - 9 - (9)
303 Serum Anti Rabies untuk manusia 2 2 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul 27 27 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul - - - - -
306 -
307 -
308 -
309 -
310 -
311 -
312 -
313 -
314 -
315 -
316 -
317 -
318 -
319 -
320 -
321 -
322 -
323 -
324 -
325 -
326 -
327 -
328 -
329 -
330 -
331 -
332 -
333 -
334 -
335 -
336 -
337 -
338 -
339 -
340 -
341 -
342 -
343 -
344 -
345 -
346 -
347 -
348 -
349 -
350 -
-
-
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
GAL
PUSKESMAS


NO NAMA OBAT SATUAN
AWAL
AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Air Raksa Dental Use Botol - - - - - -
3 Alopurinol Tablet 100 mg Set 440 440 440 - 880 880
4 Ambroksol Tablet 30 mg Set 8,345 8,345 510 7,835 1,020 (6,815)
5 Ambroksol sirup 15 mg/5 ml Tablet 103 60 163 75 88 150 62
11 Amoksisillin Kapsul 250 mg Kaplet 11,783 11,783 1,050 10,733 2,100 (8,633)
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 80 80 - 80 - (80)
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 87 87 87 - 174 174

17 Ampisillin Kaplet 500 mg Supp 930 930 100 830 200 (630)
20 Analgetik Plus Tablet 90 90 - 90 - (90)

21 Antasida Doen Suspensi Kombinasi : M Vial 66 66 52 14 104 90
22 Antasida Doen Tablet, Kombinasi : Ma Botol 3,278 3,500 6,778 3,725 3,053 7,450 4,397
23 Antasida Plus Tablet Tablet 410 410 370 40 740 700
24 Antalgin (Metampiron) Tablet 500 mg Tablet 120 2,000 2,120 1,116 1,004 2,232 1,228
26 Anti Bakteri DOEN Salep Kombinasi : Botol 8 8 - 8 - (8)
27 Anti Hemoroid Doen komb Tablet - - - - - -
28 Anti Fungi DOEN Kombinasi : Tablet 506 500 1,006 33 973 66 (907)
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 275 275 30 245 60 (185)
31 Anti Diare Tablet ( Neo Diaform) Vial 795 795 450 345 900 555
32 Anti Dotum Oral Tablet ( Bekarbon/Norit)Botol 1,833 1,833 1,833 - 3,666 3,666
34 Antihistamin Tablet kombinasi (Soldext Ampul - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 87 87 60 27 120 93
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 5,673 5,673 1,607 4,066 3,214 (852)
41 Asetosal Tablet 80 mg Tablet 80 80 10 70 20 (50)
45 Asiklovir Tablet 200 mg Tablet 199 199 199 - 398 398
46 Asiklovir Tablet 400 mg Tablet 137 137 80 57 160 103
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 190 - 190 - (190)
49 Betahistin Mesilat 6 mg Botol 1,090 1,090 120 970 240 (730)
50 Betametason Krim 0,1 %- 5g Botol 60 60 59 1 118 117
51 Bisakodil suppositoria 10 mg Botol 20 50 70 - 70 - (70)
53 Bromheksin 8 mg Kapsul 6,130 6,130 630 5,500 1,260 (4,240)
57 Diazepam tablet 2 mg Tablet 144 144 28 116 56 (60)
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 405 510 915 - 915 - (915)
66 Efedrin Hcl Tablet 25 mg Kantong 634 634 1 633 2 (631)
73 Etanol 70 % 100 ml Botol 36 36 5 31 10 (21)
74 Etil Klorida Semprot -100 ml Botol - 3 3 3 - 6 6
79 Fenoksimeti Penisilin 250 mg tablet Tablet 1,030 1,030 100 930 200 (730)
81 Fitomenadion tablet 10 mg Tablet 175 175 20 155 40 (115)
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 90 90 - 90 - (90)
88 Glibenklamid Tablet 5 mg Biji 585 585 290 295 580 285
89 Glimepiride 2 mg Pot 94 94 - 94 - (94)
90 Gliseril Guayakolat Tablet 100 mg Tube 5,376 5,376 4,828 548 9,656 9,108
94 Glukosa Larutan Infus10 % Tablet 19 19 - 19 - (19)
95 Griseofulvin Tablet 125 mg,micronized Bungkus - - - - - -
97 Haloperidol Tablet 1,5 mg Rol 60 60 10 50 20 (30)
98 Haloperidol Tablet 5 mg Rol 479 479 30 449 60 (389)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 2,276 2,276 630 1,646 1,260 (386)
100 Hidrokortison Krim 2,5 % Tube 101 101 44 57 88 31
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - 10 10 - 10 - (10)
104 Ichtyol salep Kulit Ampul 3 3 3 - 6 6

111 Kalsium Laktat Tablet 500 mg Tablet 3,661 2,000 5,661 2,180 3,481 4,360 879
112 Kaptopril 12,5 mg Ampul 260 260 135 125 270 145
114 Karbamazepin Tablet 200 mg Botol 47 47 47 - 94 94
115 Ketokonazole Krim 2 % - 15 gr Botol 2 2 2 - 4 4
123 Kloramfenikol Kapsul 250 mg Ampul - - - - - -

126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 82 82 32 50 64 14
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 12,710 12,710 7,348 5,362 14,696 9,334
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,293 1,293 - 1,293 - (1,293)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet - 300 300 10 290 20 (270)
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet - - - - - -
134 Lansoprazole 30 mg Kapsul Botol 279 3,000 3,279 130 3,149 260 (2,889)
Botol - - - - -
138 Lidokain injeksi 2 % Botol - 2,000 2,000 - 2,000 - (2,000)
139 Lidokain Komp Injeksi, Kombinasi : Botol - 2,000 2,000 - 2,000 - (2,000)
140 Loperamid Tablet 2 mg Tablet 225 225 40 185 80 (105)
141 Loratadin tablet 10 mg Tablet 539 539 160 379 320 (59)
143 Meloksikam tablet 15 mg Paket 815 815 100 715 200 (515)
144 Meloksikam Suppositoria Paket - - - - -
145 Metformin Hcl Tablet 500 mg Paket 582 12,000 12,582 120 12,462 240 (12,222)
147 Metilergometrin Maleat (Metergin) Tabl Botol - - - - - -
149 Metilprednisolon tablet 4 mg Tube 600 600 - 600 - (600)
150 Metoklopramid 10 mg Tube 610 610 73 537 146 (391)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 130 130 - 130 - (130)
153 Metronidazole Tablet 500 mg Botol 150 150 30 120 60 (60)
155 Mikonazole KrIm 2 % - 10 gr Tablet - 25 25 1 24 2 (22)
156 Multivitamin + Mineral tablet Tablet 2,897 2,897 1,713 1,184 3,426 2,242
158 Natrium Bikarbonat Tablet 500 mg Tablet 4,413 4,413 1,119 3,294 2,238 (1,056)
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 4 4 - 4 - (4)
163 Nistatin 100.000 IU/gram Tablet Vagina Botol 195 195 - 195 - (195)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 397 397 110 287 220 (67)
165 Obat Antitiuberkolosis Kategori Anak Botol - - - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 739 739 111 628 222 (406)
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 301 301 33 268 66 (202)
176 Obat Flu Sirup Tablet - - - - - -
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-1 Pot 50 50 - 50 - (50)

180 Oksitosin Injeksi 10 IU/ml-1ml Botol 85 85 20 65 40 (25)
181 Omeprazole injeksi 40mg/10ml Vial 30 30 1 29 2 (27)
184 Parasetamol drop 100 mg/ml btl @15ml Vial 19 19 17 2 34 32
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 666 666 292 374 584 210
188 Pehacain injeksi Buah 115 60 175 50 125 100 (25)
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 21 21 - 21 - (21)
192 Piroksikam Tablet 20 mg Vial 219 219 100 119 200 81
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 396 - 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - - - - - -
195 Polikresulen (Kondensasi Metakresol Su Set 10 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 9 9 8 1 16 15
202 Ranitidin Injeksi 25 mg / ml Set 280 280 20 260 40 (220)
203 Ranitidin Tablet 150 mg Tablet 436 300 736 250 486 500 14
208 Ringer Laktat Larutan Infus Steril 500 ml Set 30 30 13 17 26 9
210 Salbutamol Tablet 4 mg Botol - - - - - -
211 Salbutamol solution for Inhalation single Tablet - - - - - -
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 38 1,000 1,038 42 996 84 (912)
213 Salisil bedak 2% -50 gr Botol 99 99 47 52 94 42
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 164 164 11 153 22 (131)
216 Sefadroksil Tablet 500 mg Kapsul 311 311 120 191 240 49
221 Setirizin Tablet 10 mg Botol - 300 300 100 200 200 -

226 Simetidin 200 mg Tablet Tablet - - - - - -
227 Simvastatin Tablet 10 mg Tablet 280 300 580 160 420 320 (100)
228 Siprofloksasin 500mg Tablet 300 300 110 190 220 30
231 Tablet Tambah Darah Kombinasi: Besi II Tablet - - - - - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - - - -
235 Tetrasiklin Kapsul 500 mg Tablet 1,238 1,238 450 788 900 112
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet - - - - - -
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 5,680 3,000 8,680 4,958 3,722 9,916 6,194
238 Thiamfenikol Kapsul 500 mg set 240 240 - 240 - (240)
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 40 40 - 40 - (40)
242 Vitamin B .Komplek Tablet Tablet - 3,000 3,000 655 2,345 1,310 (1,035)
243 Vitamin Neurotropik Tablet Botol 2,098 700 2,798 1,102 1,696 2,204 508
250 MgSO4-40% Kapsul - - - - - -
251 Bisakodil suppositoria 5 mg Botol - 198 198 - 198 - (198)
252 Tablet - - - - -
253 Tablet - - - - - -
254 Tablet - - - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Tablet 97 97 - 97 - (97)
256 Abbocath No 20 ( IV Chateter 20 ) Botol 103 103 - 103 - (103)
257 Abbocath No 22 ( IV Chateter 22 ) Pot 280 280 - 280 - (280)
258 Abbocath No 24 ( IV Chateter 24 ) Tablet 99 99 99 - (99)
259 Alat Suntik Sekali Pakai 10 ml Tablet - - - - -
260 Alat Suntik Sekali Pakai 1 ml Tablet - - - - -
261 Alat Suntik Sekali Pakai 2,5 ml Tablet 100 200 300 - 300 - (300)
262 Alat Suntik Sekali Pakai 5 ml Tablet 95 95 - 95 - (95)
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Tube 33 33 - 33 - (33)
265 Etakridin Larutan (Rivanol) 0,1% - 300 mTablet 3 3 3 - 6 6
266 Etanol 70 % 1.000 ml Tablet - - - - - -
267 Folley Catheter no 14 Ampul - - - - -
269 Folley Catheter no 18 Ampul - 2 2 - 2 - (2)
270 Infus set Anak Kapsul 91 91 - 91 - (91)
271 Infus set Dewasa Kapsul 188 188 - 188 - (188)
272 Iodina Test Botol - - - - - -
273 Kassa Hidrofil Steril 16 x 16 Botol - 50 50 3 47 6 (41)
274 Kapas Berlemak 500 gram Tablet - - - - - -
275 Kapas Pembalut / Adsorbens 250 gram Tablet 24 24 - 24 - (24)
276 Kassa Kompres 40 x 40 steril Kapsul 71 100 171 15 156 30 (126)
277 Kassa Pembalut 2 m x 80 cm Tablet 20 220 240 3 237 6 (231)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet 37 230 267 - 267 - (267)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 20 150 170 35 135 70 (65)
280 Kertas Puyer Tablet - - - - - -
281 Lysol 1,000 ml Supp 3 3 - 3 - (3)
282 Masker Tablet 90 90 - 90 - (90)
283 Plester 5 yard x 2 inchi Tablet - - - - - -
284 Silk( Benang Bedah Sutra ) No 3/0 Tablet 52 52 - 52 - (52)
285 Safety Box Ampul - - - - - -
286 Sarung tangan Steril No 6 Ampul - 45 45 5 40 10 (30)
287 Sarung tangan Steril No 7 Tablet 37 37 10 27 20 (7)
288 Sarung tangan Steril No 7,5 Tube 45 45 10 35 20 (15)
289 Sarung tangan Non Steril S Sashet - - - - - -
291 Sarung tangan Non Steril L Botol - - - - - -
292 Urine Bag Tablet - - - - - -
294 POLIFIX Tablet 7 65 72 - 72 - (72)
295 Tablet - - - - - -
296 - - - - - -
297 - - - - - - -
298 - - - - - - -
299 - - - - - - -
300 - - - - - - -
301 C. SERUM DAN VAKSIN - - - - - - -
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Tablet 27 - 27 - 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000Ampul - - - - - - -
306 - - - - - - -
307 - - - - - - -
308 - - - - - - -
309 - - - - - - -
310 - - - - - - -
311 - - - - - - -
312 - - - - - -
313 - - - - - -
314 - - - - - -
315 - - - - -
316 - - - - -
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
NGGAL
PUSKESMAS


NO NAMA OBAT SATUAN
AWAL
AKHIR OPT.
PERMINTAAN Jumlah
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Air Raksa Dental Use Botol - - - - - - -
3 Alopurinol Tablet 100 mg Set - 15,500 15,500 140 15,360 280 (15,080)
5 Ambroksol sirup 15 mg/5 ml Tablet 88 - 88 76 12 152 140
7 Aminofillin Tablet 200 mg Tablet - - - - - - -
10 Amlodipin Tablet 10 mg Kapsul - - - - - - -
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul - - - - - - -
15 Amoksisillin Double Strengh Sirup KeringTablet 174 - 174 33 141 66 (75)

17 Ampisillin Kaplet 500 mg Supp 830 - 830 300 530 600 70
20 Analgetik Plus Tablet 90 - 90 - 90 - (90)

21 Antasida Doen Suspensi Kombinasi : M Vial 14 100 114 78 36 156 120
22 Antasida Doen Tablet, Kombinasi : Ma Botol 3,053 5,000 8,053 4,525 3,528 9,050 5,522
23 Antasida Plus Tablet Tablet 40 - 40 40 - 80 80
24 Antalgin (Metampiron) Tablet 500 mg Tablet 1,004 - 1,004 1,004 - 2,008 2,008
26 Anti Bakteri DOEN Salep Kombinasi : Botol 8 - 8 3 5 6 1
27 Anti Hemoroid Doen komb Tablet 10 - 10 - 10 - (10)
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - - - - - - -
31 Anti Diare Tablet ( Neo Diaform) Vial 345 - 345 326 19 652 633
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol - - - - - - -
33 Anti Hipertensi Kapsul (Tensigard) Sachet - - - - - - -
34 Antihistamin Tablet kombinasi (Soldexta Ampul - - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 27 - 27 25 2 50 48
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 4,066 - 4,066 2,303 1,763 4,606 2,843
40 Asam Mefenamat Kapsul 500 mg Tablet - - - - - - -
41 Asetosal Tablet 80 mg Tablet 70 - 70 30 40 60 20
45 Asiklovir Tablet 200 mg Tablet - 3,200 3,200 - 3,200 - (3,200)
46 Asiklovir Tablet 400 mg Tablet 57 3,200 3,257 - 3,257 - (3,257)
49 Betahistin Mesilat 6 mg Botol 970 - 970 - 970 - (970)
50 Betametason Krim 0,1 %- 5g Botol 1 - 1 1 - 2 2
53 Bromheksin 8 mg Kapsul 5,500 - 5,500 590 4,910 1,180 (3,730)
57 Diazepam tablet 2 mg Tablet 116 - 116 50 66 100 34
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 50 60 - 60 - (60)
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 915 - 915 - 915 - (915)
62 Digoksin Tablet 0,25 mg Tablet 190 - 190 30 160 60 (100)
63 Dimenhidrinat Tablet 50 mg Botol 1,000 - 1,000 100 900 200 (700)
64 Domperidon Tablet 10 mg Tablet 293 - 293 13 280 26 (254)
65 Donperidon Suspensi 5 mg/5ml Botol - 300 300 12 288 24 (264)
66 Efedrin Hcl Tablet 25 mg Kantong 633 - 633 100 533 200 (333)
73 Etanol 70 % 100 ml Botol 31 - 31 3 28 6 (22)
74 Etil Klorida Semprot -100 ml Botol - - - - - - -
75 Eugenol Cairan -10 ml Tablet - 12 12 - 12 - (12)
76 Fenitoin Natrium Kapsul 100 mg Stick 60 1,000 1,060 - 1,060 - (1,060)
77 Fenobarbital tablet 30 mg Tablet 210 - 210 - 210 - (210)
79 Fenoksimeti Penisilin 250 mg tablet Tablet 930 - 930 - 930 - (930)
81 Fitomenadion tablet 10 mg Tablet 155 - 155 70 85 140 55
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 90 - 90 - 90 - (90)
83 Furosemid Tablet 40 mg Set 1,675 - 1,675 - 1,675 - (1,675)
84 Garam Oralit I serbuk, kombinasi : Set - - - - - - -
87 Gentamisin Salep Kulit 0,1 % Botol - - - - - - -
88 Glibenklamid Tablet 5 mg Biji 295 300 595 420 175 840 665
90 Gliseril Guayakolat Tablet 100 mg Tube 548 8,000 8,548 4,895 3,653 9,790 6,137
91 Gliseril Guayakolat sirup Tablet 125 - 125 60 65 120 55
93 Glukosa Larutan Infus 5 % Bungkus 8 40 48 - 48 - (48)
95 Griseofulvin Tablet 125 mg,micronized Bungkus - - - - - - -
97 Haloperidol Tablet 1,5 mg Rol 50 - 50 30 20 60 40
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 1,646 50 1,696 218 1,478 436 (1,042)
100 Hidrokortison Krim 2,5 % Tube 57 1,200 1,257 31 1,226 62 (1,164)
101 Ibuprofen Tablet 200 mg Botol - 6,000 6,000 100 5,900 200 (5,700)
104 Ichtyol salep Kulit Ampul - - - 1 (1) 2 3
111 Kalsium Laktat Tablet 500 mg Tablet 3,481 1,000 4,481 1,320 3,161 2,640 (521)
112 Kaptopril 12,5 mg Ampul 125 - 125 215 (90) 430 520
113 Kaptopril 25 mg Botol - 200 200 - 200 - (200)
114 Karbamazepin Tablet 200 mg Botol - - - - - - -
115 Ketokonazole Krim 2 % - 15 gr Botol - - - 5 (5) 10 15
123 Kloramfenikol Kapsul 250 mg Ampul - - - 12 (12) 24 36
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - 8 (8) 16 24

126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 50 - 50 28 22 56 34
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 5,362 5,000 10,362 6,876 3,486 13,752 10,266
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 290 - 290 30 260 60 (200)
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet - - - - - - -
134 Lansoprazole 30 mg Kapsul Botol 3,149 3,000 6,149 270 5,879 540 (5,339)
Botol - - - - - - -
138 Lidokain injeksi 2 % Botol 2,000 - 2,000 - 2,000 - (2,000)
139 Lidokain Komp Injeksi, Kombinasi : Botol 2,000 - 2,000 20 1,980 40 (1,940)
140 Loperamid Tablet 2 mg Tablet 185 2,000 2,185 373 1,812 746 (1,066)
143 Meloksikam tablet 15 mg Paket 715 - 715 40 675 80 (595)
145 Metformin Hcl Tablet 500 mg Paket 12,462 - 12,462 550 11,912 1,100 (10,812)
147 Metilergometrin Maleat (Metergin) Table Botol - 200 200 - 200 - (200)
148 Metilergometrin Maleat Injeksi 0,200 mg- Vial 200 500 700 - 700 - (700)
149 Metilprednisolon tablet 4 mg Tube 600 - 600 - 600 - (600)
150 Metoklopramid 10 mg Tube 537 1,000 1,537 70 1,467 140 (1,327)
153 Metronidazole Tablet 500 mg Botol 120 - 120 220 (100) 440 540
155 Mikonazole KrIm 2 % - 10 gr Tablet 24 600 624 11 613 22 (591)
156 Multivitamin + Mineral tablet Tablet 1,184 - 1,184 1,575 (391) 3,150 3,541
157 Multivitamin sirup Tablet 203 - 203 93 110 186 76
159 Natrum Diklofenak Tablet 25 mg Tablet - - - 150 (150) 300 450
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 4 210 214 1 213 2 (211)
162 Nipedifin Tablet 10 mg Botol 370 5,000 5,370 862 4,508 1,724 (2,784)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 287 - 287 10 277 20 (257)
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 628 - 628 66 562 132 (430)
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 120 - 120 48 72 96 24
176 Obat Flu Sirup Tablet - - - - - - -
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - - - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 65 - 65 - 65 - (65)
182 Omeprazole Kapsul 20 mg Vial - 510 510 - 510 - (510)
184 Parasetamol drop 100 mg/ml btl @15ml Vial 2 - 2 - 2 - (2)
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 374 200 574 235 339 470 131
188 Pehacain injeksi Buah 125 - 125 - 125 - (125)
191 Piracetam Tablet 800 mg Botol - - - - - - -
192 Piroksikam Tablet 20 mg Vial 119 - 119 50 69 100 31
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - - - - - - -
195 Polikresulen (Kondensasi Metakresol Sul Set 10 - 10 - 10 - (10)

196 Povidon Iodida 10% 30 ml Kapsul 1 5 6 - 6 - (6)
197 Povidon Iodida 10% 300 ml Ampul 2 2 4 - 4 - (4)
203 Ranitidin Tablet 150 mg Tablet 486 15,000 15,486 1,520 13,966 3,040 (10,926)
208 Ringer Laktat Larutan Infus Steril 500 ml Set 17 400 417 - 417 - (417)
210 Salbutamol Tablet 4 mg Botol - - - 10 (10) 20 30
211 Salbutamol solution for Inhalation single Tablet - - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml s Botol 153 - 153 47 106 94 (12)
216 Sefadroksil Tablet 500 mg Kapsul 191 9,000 9,191 260 8,931 520 (8,411)
217 Sefiksim Kapsul 100 mg Vial - 1,000 1,000 - 1,000 - (1,000)
221 Setirizin Tablet 10 mg Botol 200 200 400 30 370 60 (310)
222 Setirizin Sirup 5 mg / 5 ml Tablet 3 - 3 5 (2) 10 12
226 Simetidin 200 mg Tablet Tablet - - - 100 (100) 200 300
227 Simvastatin Tablet 10 mg Tablet 420 - 420 280 140 560 420
228 Siprofloksasin 500mg Tablet 190 9,000 9,190 40 9,150 80 (9,070)
229 Spironolakton Tablet 25 mg Botol 690 - 690 140 550 280 (270)
234 Tetrasiklin Kapsul 250 mg Tube - - - - - - -
235 Tetrasiklin Kapsul 500 mg Tablet 788 15,000 15,788 230 15,558 460 (15,098)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet - - - - - - -
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 3,722 6,000 9,722 2,746 6,976 5,492 (1,484)
242 Vitamin B .Komplek Tablet Tablet 2,345 - 2,345 1,885 460 3,770 3,310
243 Vitamin Neurotropik Tablet Botol 1,696 - 1,696 900 796 1,800 1,004
244 Zinc Tablet 20 mg Tablet - - - 70 (70) 140 210
245 Prednison tab 5 mg Tablet - - - - - - -
250 MgSO4-40% Kapsul - - - - - -
251 Botol 198 198 198 - (198)
252 Tablet - - - - -
253 Tablet - - - - -
254 Tablet - - - - -
257 Abbocath No 22 ( IV Chateter 22 ) Set 280 280 - 280 - (280)
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 99 - 99 - 99 - (99)
260 Alat Suntik Sekali Pakai 1 ml Vial - - - - - - -
261 Alat Suntik Sekali Pakai 2,5 ml Tube 300 - 300 - 300 - (300)
262 Alat Suntik Sekali Pakai 5 ml Botol 95 - 95 - 95 - (95)
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Botol 33 - 33 1 32 2 (30)
265 Etakridin Larutan (Rivanol) 0,1% - 300 mlPot - - - - - - -
266 Etanol 70 % 1.000 ml Tablet - - - - - - -
268 Folley Catheter no 16 Tablet - - - - - -
269 Folley Catheter no 18 Tablet 2 - 2 - 2 - (2)
275 Kapas Pembalut / Adsorbens 250 gram Ampul 24 - 24 2 22 4 (18)
276 Kassa Kompres 40 x 40 steril Ampul 156 156 3 153 6 (147)
277 Kassa Pembalut 2 m x 80 cm Ampul 237 - 237 36 201 72 (129)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 267 - 267 - 267 - (267)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 135 135 - 135 - (135)
281 Lysol 1,000 ml Botol 3 - 3 - 3 - (3)
282 Masker Tablet 90 90 - 90 - (90)
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 52 - 52 12 40 24 (16)
286 Sarung tangan Steril No 6 Tablet 40 - 40 3 37 6 (31)
287 Sarung tangan Steril No 7 Buah 27 - 27 11 16 22 6
288 Sarung tangan Steril No 7,5 Tablet 35 35 - 35 - (35)
289 Sarung tangan Non Steril S Supp - - - - - - -
291 Sarung tangan Non Steril L Tablet - - - - - - -
294 Polifix Ampul 72 - 72 72 - (72)
295 Tablet - - - - - -
296 Tube - - - - -
297 Sashet - - - - -
298 Tablet - - - - -
299 Botol - - - - -
300 Tablet - - - - -
301 C. SERUM DAN VAKSIN Tablet - - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Tablet 9 - 9 9 - (9)
303 Serum Anti Rabies untuk manusia Tablet 2 - 2 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Botol 27 - 27 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000 Paket - - - - - -
306 - - - - -
307 - - - - -
308 - - - - -
309 - - - - -
310 - - - - -
311 - - - - -
312 - - - - -
313 - - - - -
314 - - - - -
315 - - - - -
316 - - - - -
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

………………………………….. ..........................……………………… …………………………. …………………………..

NIP NIP. NIP. NIP
KETERANGAN:
LAPORAN PEMAKAIAN DAN LEMBAR P
PUSKESMA
PUSKESMAS :…………………..
KECAMATAN :…………………..
KABUPATEN : KUNINGAN PELAPORAN BULAN/PERIODE : …………………
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : ………………..
STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL
1 2 3 4 5 6
1 Air Raksa Dental Use Botol - -
2 Albendazole Tablet 400 mg Set 1,260 1,260
3 Alopurinol Tablet 100 mg Set - -
4 Ambroksol Tablet 30 mg Set 7,835 7,835
5 Ambroksol sirup 15 mg/5 ml Tablet 88 88
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 3
7 Aminofillin Tablet 200 mg Tablet - -
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 510 510
9 Amlodipin Tablet 5 mg Tablet 217 217
10 Amlodipin Tablet 10 mg Kapsul - -
11 Amoksisillin Kapsul 250 mg Kaplet 10,733 10,733
12 Amoksisillin Kaplet 500 mg Botol 52,677 52,677
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 80 80
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul - -
15 Amoksisillin Double Strengh Sirup Kerin Tablet 174 174
16 Ampisilin Kapsul 250 mg Tube - -

17 Ampisillin Kaplet 500 mg Supp 830 830
18 Ampisilin Sirup 125 mg / 5 ml Pot - -
19 Ampisillin Injeksi 1000 mg Tablet 149 149
20 Analgetik Plus Tablet 90 90

21 Antasida Doen Suspensi Kombinasi : M Vial 14 14
22 Antasida Doen Tablet, Kombinasi : Ma Botol 3,053 3,053
23 Antasida Plus Tablet Tablet 40 40
24 Antalgin (Metampiron) Tablet 500 mg Tablet 1,004 1,004
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 60
26 Anti Bakteri DOEN Salep Kombinasi : Botol 8 8
27 Anti Hemoroid Doen komb Tablet 10 10
28 Anti Fungi DOEN Kombinasi : Tablet 973 973
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 245 245
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - -
31 Anti Diare Tablet ( Neo Diaform) Vial 345 345
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol - -
33 Anti Hipertensi Kapsul (Tensigard) Sachet - -
34 Antihistamin Tablet kombinasi (Soldext Ampul - -
35 Antispasmodik Tablet (Spasminal) Tablet - -
36 Antitusiva Sirup (Dexophan) Botol 27 27
37 Antitusiva Tablet (Dekorin) Tablet - -
38 Asam Folat Tablet 1 mg Botol - -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 4,066 4,066
40 Asam Mefenamat Kapsul 500 mg Tablet - -
41 Asetosal Tablet 80 mg Tablet 70 70
42 Asetosal Tablet 100 mg Tablet 200 200
43 Asetosal Tablet 500 mg Ampul - -
44 Asiklovir Krim 5 % Tablet 140 140
45 Asiklovir Tablet 200 mg Tablet - -
46 Asiklovir Tablet 400 mg Tablet 57 57
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 190

49 Betahistin Mesilat 6 mg Botol 970 970
50 Betametason Krim 0,1 %- 5g Botol 1 1
51 Bisakodil suppositoria 10 mg Botol 70 70
52 Bisoprolol Tablet 5 mg Kapsul - -
53 Bromheksin 8 mg Kapsul 5,500 5,500
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 128
55 Deksametason Tablet 0,5 mg Tablet 77,151 77,151
56 Devitalisasi Pasta (Non Arsen) Tablet - -
57 Diazepam tablet 2 mg Tablet 116 116
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - -
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 10
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 915 915
62 Digoksin Tablet 0,25 mg Tablet 190 190
63 Dimenhidrinat Tablet 50 mg Botol 1,000 1,000
64 Domperidon Tablet 10 mg Tablet 293 293
65 Donperidon Suspensi 5 mg/5ml Botol - -
66 Efedrin Hcl Tablet 25 mg Kantong 633 633
67 Ekstrak Belladone Tablet 10 mg Kantong - -
68 Epinefrin HCl / Bitartrat Botol 24 24
69 Eritromisin Kapsul 250 mg Set - -
70 Eritromisin Kapsul 500 mg Tablet 400 400
71 Eritromisin Sirup 200 mg / 5 ml Tablet - -
72 Etambutol Tablet 500 mg Botol - -
73 Etanol 70 % 100 ml Botol 31 31
74 Etil Klorida Semprot -100 ml Botol - -
75 Eugenol Cairan -10 ml Tablet - -
76 Fenitoin Natrium Kapsul 100 mg Stick 60 60
77 Fenobarbital tablet 30 mg Tablet 210 210
78 Fenobarbital injeksi 50 mg / ml Tablet 30 30
79 Fenoksimeti Penisilin 250 mg tablet Tablet 930 930
80 Fenoksimeti Penisilin 500 mg tablet Tube 220 220
81 Fitomenadion tablet 10 mg Tablet 155 155
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 90 90
83 Furosemid Tablet 40 mg Set 1,675 1,675
84 Garam Oralit I serbuk, kombinasi : Set - -
85 Gemfibrozil Tablet 600 mg Vial - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 20
87 Gentamisin Salep Kulit 0,1 % Botol - -
88 Glibenklamid Tablet 5 mg Biji 295 295
89 Glimepiride 2 mg Pot 94 94
90 Gliseril Guayakolat Tablet 100 mg Tube 548 548
91 Gliseril Guayakolat sirup Tablet 125 125
92 Glukonas Kalsikus injeksi Bungkus - -
93 Glukosa Larutan Infus 5 % Bungkus 8 8
94 Glukosa Larutan Infus10 % Tablet 19 19
95 Griseofulvin Tablet 125 mg,micronized Bungkus - -
96 Haloperidol Tablet 0,5 mg Rol 175 175
97 Haloperidol Tablet 1,5 mg Rol 50 50
98 Haloperidol Tablet 5 mg Rol 449 449
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 1,646 1,646
100 Hidrokortison Krim 2,5 % Tube 57 57
101 Ibuprofen Tablet 200 mg Botol - -
102 Ibuprofen Tablet 400 mg Tablet 9,718 9,718
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 10 10
104 Ichtyol salep Kulit Ampul - -

105 Ipatropium Bromide + Salbutamol Ampul 20 20
106 Isoniazid tablet 100 mg Tablet - -
107 Isosorbid Dinitrat 5 mg Tablet 300 300
108 Kalium Diklofenak Tablet 25 mg Tablet - -
109 Kalium Diklofenak Tablet 50 mg Tablet 3,080 3,080
110 Kalsium Hidroksida Pasta Botol - -
111 Kalsium Laktat Tablet 500 mg Tablet 3,481 3,481

112 Kaptopril 12,5 mg Ampul 125 125
113 Kaptopril 25 mg Botol - -
114 Karbamazepin Tablet 200 mg Botol - -
115 Ketokonazole Krim 2 % - 15 gr Botol - -
116 Ketokonazole Tablet 200 mg Botol - -
117 Ketoprofen Tablet 100 mg Botol - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - -
119 Ketorolac 10 mg injeksi Botol - -
120 Ketorolac 30 mg injeksi Botol 20 20
121 Klindamisin Kapsul 150 mg Botol - -
122 Klindamisin Kapsul 300 mg Tablet - -
123 Kloramfenikol Kapsul 250 mg Ampul - -
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - -

125 Kloramfenikol Tetes Mata -5 ml Ampul 305 305
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 50 50
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 5,362 5,362
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,293 1,293
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 290 290
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet - -
132 Kotrimoksazol Tablet, Kombinasi : Ampul - -
133 Kotrimoksazol Suspensi Kombinasi : Tablet 1,277 1,277
134 Lansoprazole 30 mg Kapsul Botol 3,149 3,149
135 Larutan mengadung Elektrolit Botol 20 20
136 Larutan mengadung Elektrolit Tablet 11 11
Botol - -
138 Lidokain injeksi 2 % Botol 2,000 2,000
139 Lidokain Komp Injeksi, Kombinasi : Botol 2,000 2,000
140 Loperamid Tablet 2 mg Tablet 185 185
141 Loratadin tablet 10 mg Tablet 379 379
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - -
143 Meloksikam tablet 15 mg Paket 715 715
144 Meloksikam Suppositoria Paket - -
145 Metformin Hcl Tablet 500 mg Paket 12,462 12,462
146 Methisoprinol 500 mg Paket 340 340
147 Metilergometrin Maleat (Metergin) Table Botol - -
148 Metilergometrin Maleat Injeksi 0,200 mg Vial 200 200
149 Metilprednisolon tablet 4 mg Tube 600 600
150 Metoklopramid 10 mg Tube 537 537
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 130 130
152 Metronidazol Tablet 250 mg Tablet - -
153 Metronidazole Tablet 500 mg Botol 120 120
154 Metronidazole Infus 500 mg /100 ml Tablet - -
155 Mikonazole KrIm 2 % - 10 gr Tablet 24 24
156 Multivitamin + Mineral tablet Tablet 1,184 1,184
157 Multivitamin sirup Tablet 203 203
158 Natrium Bikarbonat Tablet 500 mg Tablet 3,294 3,294
159 Natrum Diklofenak Tablet 25 mg Tablet - -
160 Natrium Diklofenak Tablet 50 mg Rol 4,710 4,710
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 4 4
162 Nipedifin Tablet 10 mg Botol 370 370

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 195 195
164 Nistatin 500.000 IU/gram Tablet Salut Botol 287 287
165 Obat Antitiuberkolosis Kategori Anak Botol - -
166 Obat Antitiuberkolosis Kategori 1 Dewas Tablet - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 628 628
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 120 120
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 268 268
176 Obat Flu Sirup Tablet - -
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10Pot 50 50
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - -

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 65 65
181 Omeprazole injeksi 40mg/10ml Vial 29 29
182 Omeprazole Kapsul 20 mg Vial - -
183 Ondansetron inj 4 mg/ 2 mL Ampul 140 140
184 Parasetamol drop 100 mg/ml btl @15ml Vial 2 2
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 374 374
186 Parasetamol Tablet 100 mg Sachet - -
187 Parasetamol Tablet 500 mg Botol 78,018 78,018
188 Pehacain injeksi Buah 125 125
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 21 21
190 Piracetam 400 mg Tablet 50 50
191 Piracetam Tablet 800 mg Botol - -
192 Piroksikam Tablet 20 mg Vial 119 119
193 Pirantel Pamoat Tablet 365 mg (Setara Set 396 396
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - -
195 Polikresulen (Kondensasi Metakresol Su Set 10 10

196 Povidon Iodida 10% 30 ml Kapsul 1 1
197 Povidon Iodida 10% 300 ml Ampul 2 2
198 Predison Tablet - -
199 Primakuin tablet 15 mg Tablet - -
200 Propanolol Hcl Tablet 40 mg Botol 197 197
201 Propilturasil Tablet 100 mg Kuur 120 120
202 Ranitidin Injeksi 25 mg / ml Set 260 260
203 Ranitidin Tablet 150 mg Tablet 486 486
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - -
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - -
206 Reserpin Tablet 0, 25 mg Buah - -
207 Rifampisin Tablet 450 mg Buah - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 17 17
209 Salbutamol Tablet 2 mg Tablet - -
210 Salbutamol Tablet 4 mg Botol - -
211 Salbutamol solution for Inhalation single Tablet - -
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 996 996
213 Salisil bedak 2% -50 gr Botol 52 52
214 Salep Luka Bakar (Neocenta/Bioplant) vial - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 153 153
216 Sefadroksil Tablet 500 mg Kapsul 191 191
217 Sefiksim Kapsul 100 mg Vial - -
218 Sefotaksim Injeksi 1 gr Tablet - -
219 Seftriakson Injeksi 1 gr / vial Tablet - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - -
221 Setirizin Tablet 10 mg Botol 200 200
222 Setirizin Sirup 5 mg / 5 ml Tablet 3 3
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 485 485

224 Sianokobalamin Tablet 50 mcg Tablet - -
225 Silver Amalgam Serbuk 65-75% Tablet - -
226 Simetidin 200 mg Tablet Tablet - -
227 Simvastatin Tablet 10 mg Tablet 420 420
228 Siprofloksasin 500mg Tablet 190 190
229 Spironolakton Tablet 25 mg Botol 690 690
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - -
231 Tablet Tambah Darah Kombinasi: Besi II Tablet - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - -
234 Tetrasiklin Kapsul 250 mg Tube - -
235 Tetrasiklin Kapsul 500 mg Tablet 788 788
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet - -
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 3,722 3,722
238 Thiamfenikol Kapsul 500 mg set 240 240
239 Tramadol Injeksi 50 mg/ ml Botol - -
240 Tramadol Tablet 50 mg Tablet - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 40 40
242 Vitamin B .Komplek Tablet Tablet 2,345 2,345
243 Vitamin Neurotropik Tablet Botol 1,696 1,696
244 Zinc Tablet 20 mg Tablet - -
245 Prednison tab 5 mg Tablet - -
246 Gentian Violet Tablet - -
247 Furosemid injek 10mg/ml Tablet 24 24
248 Glass Ionoer semen Botol - -
249 Bahan Tambal Sementara Kapsul - -
250 MgSO4-40% Kapsul - -
251 Botol 198 198
252 Tablet - -
253 Tablet - -
254 Tablet - -
255 Set 97 97
256 Set 103 103
257 Set 280 280
258 Ampul 99 99
259 Tablet - -
260 Vial - -
261 Tube 300 300
262 Botol 95 95
263 Abbocath No 18 ( IV Chateter 18 ) Tablet - -
264 Abbocath No 20 ( IV Chateter 20 ) Botol 33 33
265 Abbocath No 22 ( IV Chateter 22 ) Pot - -
266 Abbocath No 24 ( IV Chateter 24 ) Tablet - -
267 Alat Suntik Sekali Pakai 10 ml Tablet - -
268 Alat Suntik Sekali Pakai 1 ml Tablet - -
269 Alat Suntik Sekali Pakai 2,5 ml Tablet 2 2
270 Alat Suntik Sekali Pakai 5 ml Tablet 91 91
271 Alat Suntik Sekali Pakai 10 ml Kotak 188 188
272 Catgut/Benang Bedah No.2/0-3/0 (Plain Tube - -
273 Etakridin Larutan (Rivanol) 0,1% - 300 m Tablet 47 47
274 Etanol 70 % 1.000 ml Tablet - -
275 Folley Catheter no 14 Ampul 24 24
278 Infus set Anak Kapsul 267 267
279 Infus set Dewasa Kapsul 135 135
280 Iodina Test Botol - -
281 Kassa Hidrofil Steril 16 x 16 Botol 3 3
282 Kapas Berlemak 500 gram Tablet 90 90
283 Kapas Pembalut / Adsorbens 250 gram Tablet - -
284 Kassa Kompres 40 x 40 steril Kapsul 52 52
285 Kassa Pembalut 2 m x 80 cm Tablet - -
286 Kassa Pembalut Hidrofil 4 m x 3 cm Tablet 40 40
287 Kassa Pembalut Hidrofil 4 m x 15 cm Buah 27 27
288 Kertas Puyer Tablet 35 35
289 Lysol 1,000 ml Supp - -
290 Masker Tablet - -
291 Plester 5 yard x 2 inchi Tablet - -
292 Silk( Benang Bedah Sutra ) No 3/0 Tablet - -
293 Safety Box Ampul 30 30
294 Sarung tangan Steril No 6 Ampul 72 72
295 Sarung tangan Steril No 7 Tablet - -
296 Sarung tangan Steril No 7,5 Tube - -
297 Sarung tangan Non Steril S Sashet - -
298 Sarung tangan Non Steril M Tablet - -
299 Sarung tangan Non Steril L Botol - -
300 Urine Bag Tablet - -
301 Wing Neddle No 23 Tablet - -
302 Tablet 9 9
303 Tablet 2 2
304 Botol 27 27
305 Paket - -
306 Paket - -
307 Paket - -
308 Botol - -
309 C. SERUM DAN VAKSIN Kapsul - -
310 Serum Anti Bisa Ular Polivalen Injeksi 5 Tablet - -
311 Serum Anti Rabies untuk manusia Botol - -
312 Serum Anti Tetanus (ATS) Injeksi 1.500 Tablet - -
313 Serum Anti Tetanus (ATS) Injeksi 20.000Ampul - -
314 Piracetam Injeksi 3 g / 15 ml Ampul - -
315 Piracetam Tablet 400 mg Tablet - -
316 Piracetam Tablet 800 mg Tablet - -
317 Piroksikam Tablet 20 mg Tablet - -
318 Ranitidin Injeksi 25 mg / ml Ampul - -
319 Ranitidin Tablet 150 mg Tablet - -
320 Rifampisin Tablet 450 mg Tablet - -
321 Salbutamol Tablet 4 mg Tablet - -
322 Salep Luka Bakar Tube - -
323 Sarung tangan no 6 Pcs - -
324 Sarung tangan no 7 Pcs - -
325 Sarung tangan no 7,5 Pcs - -
326 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol - -
327 Sefadroksil Tablet 500 mg Tablet - -
328 Sefiksim Kapsul 100 mg Kapsul - -
329 Sefotaksim Injeksi 1 gr Ampul - -
330 Seftriakson Injeksi 1 gr / vial Ampul - -
331 Sianokobalamin Tablet 50 mcg Tablet - -
332 Simetidin Tablet 200 mg Tablet - -
333 Simvastatin Tablet 10 mg Tablet - -
334 Siprofloksasin Tablet 500 mg Tablet - -
335 Spironolakton Tablet 25 mg Tablet - -
336 Tetrasiklin Kapsul 500 mg Kapsul - -
337 Thiamfenikol Kapsul 500 mg Kapsul - -
338 Tramadol Injeksi 50 mg/ ml Ampul - -
339 Tramadol Tablet 50 mg Tablet - -
340 Urine Bag set - -
341 Wing Neddle No 23 Set - -
342 Zinc Tablet 20 mg Tablet - -
343 - -
344 - -
345 - -
346 - -
347 - -
348 - -
349 - -
350 - -
- -
- -
UMUM BPJS
JUMLAH
BAYAR JAMKES ASKES
0

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi & Perbekalan
Kabupaten Kuningan Kabupaten Kuningan
………………………………….. ..........................………………………
NIP NIP.
KETERANGAN:
MAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS
DOKUMEN NOMOR
DINKES KABUPATEN
N/PERIODE : ………………… UPTD GFK
AN / PERIODE : ……………….. UPTD PUSKESMAS
STOK STOK PEMBERIAN

PEMAKAIAN PERMINTAAN
AKHIR OPT. PKD ASKES APBD I APBD II PROGRAM
7 8 9 10 11 12 13 14 15
- - -
1,260 - (1,260)
- - -
7,835 - (7,835)
88 - (88)
3 - (3)
- - -
510 - (510)
217 - (217)
- - -
10,733 - (10,733)
52,677 - (52,677)
80 - (80)
- - -
174 - (174)
- - -
830 - (830)
- - -
149 - (149)
90 - (90)
14 - (14)
3,053 - (3,053)
40 - (40)
1,004 - (1,004)
60 - (60)
8 - (8)
10 - (10)
973 - (973)
245 - (245)
- - -
345 - (345)
- - -
- - -
- - -
- - -
27 - (27)
- - -
- - -
4,066 - (4,066)
- - -
70 - (70)
200 - (200)
- - -
140 - (140)
- - -
57 - (57)
- - -
190 - (190)
970 - (970)
1 - (1)
70 - (70)
- - -
5,500 - (5,500)
128 - (128)
77,151 - (77,151)
- - -
116 - (116)
- - -
10 - (10)
- - -
915 - (915)
190 - (190)
1,000 - (1,000)
293 - (293)
- - -
633 - (633)
- - -
24 - (24)
- - -
400 - (400)
- - -
- - -
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930 - (930)
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155 - (155)
90 - (90)
1,675 - (1,675)
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295 - (295)
94 - (94)
548 - (548)
125 - (125)
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125 - (125)
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3,149 - (3,149)
20 - (20)
11 - (11)
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2,000 - (2,000)
2,000 - (2,000)
185 - (185)
379 - (379)
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715 - (715)
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12,462 - (12,462)
340 - (340)
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600 - (600)
537 - (537)
130 - (130)
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120 - (120)
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24 - (24)
1,184 - (1,184)
203 - (203)
3,294 - (3,294)
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4,710 - (4,710)
4 - (4)
370 - (370)
195 - (195)
287 - (287)
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65 - (65)
29 - (29)
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140 - (140)
2 - (2)
374 - (374)
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78,018 - (78,018)
125 - (125)
21 - (21)
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396 - (396)
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10 - (10)
1 - (1)
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690 - (690)
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788 - (788)
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3,722 - (3,722)
240 - (240)
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40 - (40)
2,345 - (2,345)
1,696 - (1,696)
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24 - (24)
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95 - (95)
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135 - (135)
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Menyerahkan
dang Farmasi & Perbekalan Yang Meminta Yang Menerima
paten Kuningan Kepala UPTD Puskesmas Petugas UPTD Puskesmas
....……………………… …………………………. …………………………..

NIP. NIP
FORM : LPLPO
NOMOR TANGGAL
Jumlah
LAIN-LAIN
16 17
Yang Menerima
Petugas UPTD Puskesmas
…………………………..
NIP
REKAPITULASI PENERIMAAN OBAT DAN PERBEKA
TAHUN 2014
PUSKESMAS :........................................
KECAMATAN :........................................
KABUPATEN :.........................................
NO NAMA OBAT SATUAN

Jan Feb Mar
1 2 3 4 5 6
2 Albendazole Tablet 400 mg Set - - 1,260
3 Alopurinol Tablet 100 mg Set 300 - 600
4 Ambroksol Tablet 30 mg Set 3,000 - 6,500
5 Ambroksol sirup 15 mg/5 ml Tablet 300 - 350
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet - - -
7 Aminofillin Tablet 200 mg Tablet - 100 100
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul - - -
9 Amlodipin Tablet 5 mg Tablet - - -
10 Amlodipin Tablet 10 mg Kapsul - - -
11 Amoksisillin Kapsul 250 mg Kaplet 4,100 - 400
12 Amoksisillin Kaplet 500 mg Botol 10,900 - 73,500
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet - - -
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 390 - 350
15 Amoksisillin Double Strengh Sirup Kering 250 mg/5 ml Tablet - - -

17 Ampisillin Kaplet 500 mg Supp 2,400 - -
19 Ampisillin Injeksi 1000 mg Tablet 120 - -
20 Analgetik Plus Tablet - - -

21 Antasida Doen Suspensi Kombinasi : Magnesium Hid Vial 150 - -
22 Antasida Doen Tablet, Kombinasi : Magnesium Hidr Botol - - -
23 Antasida Plus Tablet Tablet 200 - 2,400
24 Antalgin (Metampiron) Tablet 500 mg Tablet 2,900 4,000 3,000
25 Antalgin Injeksi 250 mg/ml-2ml Botol - - -
26 Anti Bakteri DOEN Salep Kombinasi : Botol 50 - -
27 Anti Hemoroid Doen komb Tablet 10 - -
28 Anti Fungi DOEN Kombinasi : Tablet 200 - 325
29 Antimigren DOEN Kombinasi : Ergotamin Tartrat 1 mg Ampul 500 - -
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - - -
31 Anti Diare Tablet ( Neo Diaform) Vial 2,000 - 3,300
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 1,500 - -
33 Anti Hipertensi Kapsul (Tensigard) Sachet 500 - -
34 Antihistamin Tablet kombinasi (Soldextam) Ampul - - -
36 Antitusiva Sirup (Dexophan) Botol 20 - 500
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 7,000 - -
40 Asam Mefenamat Kapsul 500 mg Tablet 500 - 500
41 Asetosal Tablet 80 mg Tablet 100 - -
42 Asetosal Tablet 100 mg Tablet 200 - -
44 Asiklovir Krim 5 % Tablet - - 275
45 Asiklovir Tablet 200 mg Tablet - - 200
46 Asiklovir Tablet 400 mg Tablet - - 200
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Botol - - -

49 Betahistin Mesilat 6 mg Botol 300 - 140
50 Betametason Krim 0,1 %- 5g Botol 125 - -
51 Bisakodil suppositoria 10 mg Botol - - -
53 Bromheksin 8 mg Kapsul 2,500 - 2,100
54 Deksametason Injeksi 5mg/ml-1ml Ampul 70 - -
55 Deksametason Tablet 0,5 mg Tablet - - 124,000
56 Devitalisasi Pasta (Non Arsen) Tablet 1 - -
57 Diazepam tablet 2 mg Tablet - - 100
59 Diazepam Larutan Rektal 5 mg/ml Botol - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 120 - -
62 Digoksin Tablet 0,25 mg Tablet - - -
63 Dimenhidrinat Tablet 50 mg Botol - - -
64 Domperidon Tablet 10 mg Tablet - - -
65 Donperidon Suspensi 5 mg/5ml Botol - - -
66 Efedrin Hcl Tablet 25 mg Kantong 100 - -
68 Epinefrin HCl / Bitartrat Botol 10 - -
70 Eritromisin Kapsul 500 mg Tablet - - -
73 Etanol 70 % 100 ml Botol 16 - -
74 Etil Klorida Semprot -100 ml Botol - - -
75 Eugenol Cairan -10 ml Tablet 1 - -
76 Fenitoin Natrium Kapsul 100 mg Stick - - -
77 Fenobarbital tablet 30 mg Tablet 200 - -
78 Fenobarbital injeksi 50 mg / ml Tablet - 30 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 500 - -
80 Fenoksimeti Penisilin 500 mg tablet Tube - - -
81 Fitomenadion tablet 10 mg Tablet - - -
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Tablet - - -
83 Furosemid Tablet 40 mg Set 2,000 - 400
84 Garam Oralit I serbuk, kombinasi : Set - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul - 20 -
87 Gentamisin Salep Kulit 0,1 % Botol 200 - 325
88 Glibenklamid Tablet 5 mg Biji - - 800
89 Glimepiride 2 mg Pot - 300 -
90 Gliseril Guayakolat Tablet 100 mg Tube 10,000 - 30,000
91 Gliseril Guayakolat sirup Tablet 200 - 50
93 Glukosa Larutan Infus 5 % Bungkus 10 - -
94 Glukosa Larutan Infus10 % Tablet 24 - -
95 Griseofulvin Tablet 125 mg,micronized Bungkus - - -
96 Haloperidol Tablet 0,5 mg Rol 100 - -
97 Haloperidol Tablet 1,5 mg Rol 100 - -
98 Haloperidol Tablet 5 mg Rol 500 - -
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul - - -
100 Hidrokortison Krim 2,5 % Tube 200 - -
101 Ibuprofen Tablet 200 mg Botol 2,400 2,000 -
102 Ibuprofen Tablet 400 mg Tablet - 1,000 23,000
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - - -
104 Ichtyol salep Kulit Ampul 13 - 20

105 Ipatropium Bromide + Salbutamol Ampul 20 - -
107 Isosorbid Dinitrat 5 mg Tablet - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 2,000 - 1,800
110 Kalsium Hidroksida Pasta Botol 1 - -

111 Kalsium Laktat Tablet 500 mg Tablet 4,200 - -
112 Kaptopril 12,5 mg Ampul - 1,000 1,000

113 Kaptopril 25 mg Botol - - -
114 Karbamazepin Tablet 200 mg Botol - - -
115 Ketokonazole Krim 2 % - 15 gr Botol 21 - 25
116 Ketokonazole Tablet 200 mg Botol - - -
120 Ketorolac 30 mg injeksi Botol 30 - -
123 Kloramfenikol Kapsul 250 mg Ampul 1,400 - -
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - -

125 Kloramfenikol Tetes Mata -5 ml Ampul 150 - 475
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 100 - 160
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 10,000 - 46,600
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,000 - 500
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet - - -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi : Sulfame Tablet 400 - -
132 Kotrimoksazol Tablet, Kombinasi : Ampul - - -
133 Kotrimoksazol Suspensi Kombinasi : Tablet 200 - 1,600
134 Lansoprazole 30 mg Kapsul Botol - 100 -
135 Larutan mengadung Elektrolit Botol 20 - -
136 Larutan mengadung Elektrolit Tablet 20 - -
137 Larutan mengadung Karbohidrat + Elektrolit Botol - - -
138 Lidokain injeksi 2 % Botol - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - -
140 Loperamid Tablet 2 mg Tablet 200 - -
141 Loratadin tablet 10 mg Tablet - - -
143 Meloksikam tablet 15 mg Paket 1,400 - -
145 Metformin Hcl Tablet 500 mg Paket 1,500 - 700
146 Methisoprinol 500 mg Paket 150 - -
147 Metilergometrin Maleat (Metergin) Tablet 0,125 mg Botol 100 - -
148 Metilergometrin Maleat Injeksi 0,200 mg-1ml Vial 200 - -
149 Metilprednisolon tablet 4 mg Tube 1,400 - -
150 Metoklopramid 10 mg Tube 400 - -
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 200 - -
152 Metronidazol Tablet 250 mg Tablet - 200 -
153 Metronidazole Tablet 500 mg Botol - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet 5 - -
156 Multivitamin + Mineral tablet Tablet - 300 10,000
157 Multivitamin sirup Tablet 30 50 680
158 Natrium Bikarbonat Tablet 500 mg Tablet 3,000 - 3,000
159 Natrum Diklofenak Tablet 25 mg Tablet - - -
160 Natrium Diklofenak Tablet 50 mg Rol 3,200 - -
161 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol 8 - -
162 Nipedifin Tablet 10 mg Botol 400 - -

163 Nistatin 100.000 IU/gram Tablet Vagina Botol - - -
164 Nistatin 500.000 IU/gram Tablet Salut Botol - - -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Tablet - - -
172 Obat Anti Tuberkolosis FDC Sisipan Dewasa Tablet - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 200 - 1,100
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 50 - 400
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol - - 500
176 Obat Flu Sirup Tablet - - 20
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Pot - - -
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - - -

180 Oksitosin Injeksi 10 IU/ml-1ml Botol 130 - 30
181 Omeprazole injeksi 40mg/10ml Vial 30 - -
182 Omeprazole Kapsul 20 mg Vial - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul 145 - -
184 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Vial - - 30
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 300 - 1,800
187 Parasetamol Tablet 500 mg Botol 20,000 - 130,000
188 Pehacain injeksi Buah 100 100 100
189 Perak Sulfadiazin krim 1 % 35 gr (Burnazin) Botol 27 - -
190 Piracetam 400 mg Tablet 200 - -
191 Piracetam Tablet 800 mg Botol 200 - -
192 Piroksikam Tablet 20 mg Vial 400 - -
193 Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg B Set 200 - -
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 7,000 - -
195 Polikresulen (Kondensasi Metakresol Sulfonat dan Me Set - - -

196 Povidon Iodida 10% 30 ml Kapsul - 4 -
197 Povidon Iodida 10% 300 ml Ampul - 1 -
200 Propanolol Hcl Tablet 40 mg Botol - - -
201 Propilturasil Tablet 100 mg Kuur - - -
202 Ranitidin Injeksi 25 mg / ml Set 300 - -
203 Ranitidin Tablet 150 mg Tablet - - -
206 Reserpin Tablet 0, 25 mg Buah - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set - 20 -
210 Salbutamol Tablet 4 mg Botol 1,000 - -
211 Salbutamol solution for Inhalation single dose units 2,5Tablet 20 - -
212 Salep 2-4 Kombinasi : Asam Salisilat 2 % + Belerang Tablet 25 - -
213 Salisil bedak 2% -50 gr Botol 100 - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol - - -
216 Sefadroksil Tablet 500 mg Kapsul 1,500 - -
217 Sefiksim Kapsul 100 mg Vial - - -
221 Setirizin Tablet 10 mg Botol - - -
222 Setirizin Sirup 5 mg / 5 ml Tablet - - -
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 50 - -

226 Simetidin 200 mg Tablet Tablet 400 - -
227 Simvastatin Tablet 10 mg Tablet 1,000 - -
228 Siprofloksasin 500mg Tablet - - -
229 Spironolakton Tablet 25 mg Botol - - 300
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - - -
231 Tablet Tambah Darah Kombinasi: Besi II Sulfat 200 m Tablet - - -
232 Temporary Stopping Fletcher (Fletcher) Serbuk & Cair Kapsul - - -
234 Tetrasiklin Kapsul 250 mg Tube - - -
235 Tetrasiklin Kapsul 500 mg Tablet 1,000 - -
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Tablet 90 - -
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg set 10,000 - 4,000
238 Thiamfenikol Kapsul 500 mg set 400 - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 100 - -
242 Vitamin B .Komplek Tablet Tablet 2,200 - -
243 Vitamin Neurotropik Tablet Botol 2,000 - 2,300
244 Zinc Tablet 20 mg Tablet - 200 -
245 Prednison tab 5 mg Tablet 5,000 - 4,500
247 Furosemid injek 10mg/ml Tablet 24 - -
248 Glass Ionoer semen Botol 1 - -
249 Bahan Tambal Sementara Kapsul 1 - -
250 MgSO4-40% Kapsul - - -
251 polifix Botol - - -
252 Tablet - - -
253 Tablet - - -
254 Tablet - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set 50 - -
256 Abbocath No 20 ( IV Chateter 20 ) Set 50 - -
257 Abbocath No 22 ( IV Chateter 22 ) Set 100 - 100
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 50 - -
259 Alat Suntik Sekali Pakai 10 ml Tablet - - -
260 Alat Suntik Sekali Pakai 1 ml Vial - - -
261 Alat Suntik Sekali Pakai 2,5 ml Tube 200 300 200
262 Alat Suntik Sekali Pakai 5 ml Botol - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) Botol 15 - -
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml Pot - - -
266 Etanol 70 % 1.000 ml Tablet - - -
270 Infus set Anak Tablet 22 - -
271 Infus set Dewasa Kotak 100 - -
272 Iodina Test Tube - - -
273 Kassa Hidrofil Steril 16 x 16 Tablet - - -
274 Kapas Berlemak 500 gram Tablet - - -
275 Kapas Pembalut / Adsorbens 250 gram Ampul 10 - 20
276 Kassa Kompres 40 x 40 steril Ampul - - -
277 Kassa Pembalut 2 m x 80 cm Ampul 25 - -
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 10 50 -
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul - - -
280 Kertas Puyer Botol - - -
281 Lysol 1,000 ml Botol - - -
282 Masker Tablet - - -
283 Plester 5 yard x 2 inchi Tablet 15 - -
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul - - -
285 Safety Box Tablet - - -
286 Sarung tangan Steril No 6 Tablet 30 - -
287 Sarung tangan Steril No 7 Buah 30 50 -
288 Sarung tangan Steril No 7,5 Tablet - 50 -
289 Sarung tangan Non Steril S Supp - - -
290 Sarung tangan Non Steril M Tablet - - -
291 Sarung tangan Non Steril L Tablet - - -
292 Urine Bag Tablet - - -
293 Wing Neddle No 23 Ampul - - -
294 Ampul - - -
295 Tablet - - -
296 Tube - - -
297 Sashet - - -
298 Tablet - - -
299 Botol - - -
301 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I ) Tablet 7 - -
302 Serum Anti Rabies untuk manusia Tablet - - -
303 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul Tablet 24 - -
304 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul Botol - - -
305 Paket - - -
306 Paket - - -
307 Paket - - -
308 Botol - - -
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
Mengetahui
Kepala UPTD Puskesmas
...............................................................
NIP
OBAT DAN PERBEKALAN KESEHATAN (PERBEKKES)
TAHUN 2014
BULAN
Apr Mei Jun Jul Agst Sept Okt Nov Des
7 8 9 10 11 12 13 14 15
- - - - - - - - -
- - - - - - - - -
300 200 200 - 300 300 - 15,500 -
- - - - - - - - -
- - - - - - 60 - -
- - - - - - - - -
200 - - 200 - - - - -
- - - - - - - - -
500 - 700 - - 200 80 300 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - 200 - 200 - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - 100 - - - - -
- - - - - - - 100 -
- - 8,000 5,000 8,000 - 3,500 5,000 -
- - - - - 500 - - -
5,000 - 4,000 5,600 - 1,000 2,000 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 500 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - 1,500 750 - - - -
- - 300 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
1,000 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - 200 - 200 - 3,200 -
400 - - - - - - 3,200 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 50 - - 75 - - -
- - - - - - 50 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - 100 - - -
- - - - - - - - -
- - - - - - - 50 -
- - - - - - - - -
- - - - - - 510 - -
200 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - 300 -
- - - 200 - 300 - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
20 20 - 8 - - - - -
- - - - - - 3 - -
- - - - - - - 12 -
- - - - - - - 1,000 -
100 100 - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
100 100 - - - - - - -
100 - - - - - - - -
- - - - - - - - -
500 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- 500 - - 500 - - 300 -
- - - - - - - - -
- - - - - 5,000 - 8,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - 40 -
- - - - - - - - -
200 200 - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - 50 -
- - - - - 75 - 1,200 -
- - - - - - - 6,000 -
- - - - - - - - -
- - - - - - 10 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 2,000 1,000 -
- - 500 600 - - - - -
- - - - - - - 200 -
- - - - - - - - -
- - 25 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - 50 -
- - - - - - - - -
- - - - - 7,000 - 5,000 -
- - - - - - - - -
- - - - - - 300 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 100 180 - 150 3,000 3,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 2,000 - -
- - - - - - 2,000 - -
- - - - - - - 2,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - 200 12,000 - -
- - - - - - - - -
100 200 - - - - - 200 -
- - - - - - - 500 -
- - - - - - - - -
- - - - - - - 1,000 -
- - - - - - - - -
- - - - - - - - -
500 - 800 300 - - - - -
- - - - - - - - -
- - - - - - 25 600 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - 210 -
- - - - - - - 5,000 -
- - - - - - - - -
100 - - 200 - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
25 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - 100 - - -
- - - - - - - - -
- - - - - - - 510 -
- - - - - - - - -
50 - - - - 20 - - -
- - - - - - - 200 -
- - - - - - - - -
- - - - - - - - -
70 120 - 120 120 100 60 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
900 - - - - - - - -
- - - - - - - - -
- - 5,000 - - - - - -
- - - - - - - - -
- - 10 - - - - 5 -
- - 2 - - - - 2 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 1,500 - - - 300 15,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- 10 - 16 20 - - 400 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
50 - - - 25 50 1,000 - -
- 50 100 - 30 100 - 100 -
- - - - - - - - -
100 - - - - - - - -
- - - - 300 300 - 9,000 -
- - - - - - - 1,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 300 200 -
- - - - - - - - -
- - - - - - 300 300 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 300 - -
- - - - 300 - - 9,000 -
300 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - 1,000 - - 15,000 -
- - - - - - - - -
- - 10,000 - 3,000 - 3,000 6,000 -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 3,000 - -
- - - - - - 700 - -
2,000 - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 198 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- 200 - - - - - - -
200 - - 200 200 - 200 - -
- - - - - - - - -
- - - - - - - - -
- 20 - 48 - - - - -
20 - - 3 - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 2 - -
- - - 20 - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 50 - -
- - - - - - - - -
- - - 5 10 - - - -
- - - 50 - - 100 - -
- - - - 20 - 220 - -
- - - 40 - - 230 - -
- - - 15 - - 150 - -
- - - - - - - - -
- - - - - - - - -
- - - 100 - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - 45 - -
- - - 40 50 - - - -
- - - 45 50 - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - 5 4 - 65 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
Kuningan,.............
Pengelola Obat Puskesmas
....................................................
NIP
JUMLAH
TOTAL
16
-
1,260
17,700
9,500
710
-
600
-
1,780
-
4,500
84,400
-
1,140
-
2,400
120
100
250
29,500
3,100
27,500
-
50
10
1,025
500
-
5,300
3,750
800
-
-
520
-
-
7,000
2,000
100
200
-
275
3,800
3,800
-
-
440
250
50
-
4,600
70
124,000
1
200
-
50
-
630
200
-
-
300
600
-
10
-
-
-
-
64
3
13
1,000
400
30
500
-
200
100
2,400
500
-
20
525
2,100
300
53,000
250
-
50
24
400
100
100
500
50
1,475
10,400
24,000
10
33
20
-
-
-
3,800
1
7,200
3,100
200
-
71
-
-
-
-
30
-
-
1,400
-
675
260
68,600
1,500
300
-
400
-
1,800
6,530
20
20
-
2,000
2,000
2,200
-
-
1,400
-
14,400
150
600
700
1,400
1,400
200
200
1,600
-
630
10,300
760
6,000
-
3,200
218
5,400
-
300
-
-
-
-
-
-
-
-
1,300
450
500
45
-
-
-
260
30
510
145
100
2,300
-
150,000
890
27
200
200
1,300
200
12,000
-
19
5
-
-
-
-
300
16,800
-
-
-
-
466
-
1,000
20
1,150
480
-
100
11,100
1,000
-
-
-
500
650
-
-
400
1,300
9,300
600
-
-
-
-
-
17,000
90
36,000
400
-
-
100
5,200
5,000
2,200
9,500
-
24
1
1
-
198
-
-
-
50
50
200
50
-
200
1,500
-
-
83
23
-
-
-
2
42
100
-
50
-
45
150
265
330
165
-
-
100
15
-
-
75
170
145
-
-
-
-
-
74
-
-
-
-
-
-
7
-
24
-
-
-
-
-
REKAPITULASI PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN (PERBEKKES)
TAHUN 2014
PUSKESMAS :........................................
KECAMATAN :........................................
KABUPATEN :.........................................
BULAN JUMLAH
NO NAMA OBAT SATUAN
Jan Feb Mar Apr Mei Jun Jul Agst Sept Okt Nov Des TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Air Raksa Dental Use Botol - - - - - - - - - - - - -
2 Albendazole Tablet 400 mg Set - - - - - - - - - - - - -
3 Alopurinol Tablet 100 mg Set 175 394 260 230 90 340 240 190 110 440 140 - 2,609
4 Ambroksol Tablet 30 mg Set 143 332 116 956 1,495 770 770 1,068 345 510 500 - 7,005
5 Ambroksol sirup 15 mg/5 ml Tablet 32 48 101 88 77 98 98 91 187 75 76 - 971
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet - - - - - - - - - - - - -
7 Aminofillin Tablet 200 mg Tablet 81 70 130 131 30 63 200 - - - - - 705
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul - 10 - 10 - - 50 - 10 10 100 - 190
9 Amlodipin Tablet 5 mg Tablet 120 40 90 354 150 260 210 - 61 232 467 - 1,984
10 Amlodipin Tablet 10 mg Kapsul - 10 - 250 - - - - - - - - 260
11 Amoksisillin Kapsul 250 mg Kaplet 930 2,270 2,860 1,030 770 930 930 921 720 1,050 1,165 - 13,576
12 Amoksisillin Kaplet 500 mg Botol 3,764 6,766 4,532 3,040 3,202 3,846 3,846 4,102 3,470 4,165 3,955 - 44,688
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet - - - - - - - 10 150 - - - 160
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 137 150 201 125 132 163 163 102 113 87 - - 1,373
15 Amoksisillin Double Strengh Sirup Kering 250 mg/5 ml Tablet 10 3 17 1 10 - 10 205 15 20 33 - 324
16 Ampisilin Kapsul 250 mg Tube - - - - - - - - - - - - -

17 Ampisillin Kaplet 500 mg Supp 110 290 570 100 100 100 100 - 100 100 300 - 1,870
18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - - - - - - - -

19 Ampisillin Injeksi 1000 mg Tablet - - - - - - - - 1 - - - 1
20 Analgetik Plus Tablet - - - - - - - - 10 - - - 10

21 Antasida Doen Suspensi Kombinasi : Magnesium Hid Vial 17 6 71 53 32 47 47 37 36 52 78 - 476
22 Antasida Doen Tablet, Kombinasi : Magnesium Hidr Botol 6,744 5,715 6,483 6,655 4,797 7,199 7,399 4,722 1,523 3,725 4,525 - 59,487
23 Antasida Plus Tablet Tablet - 60 500 1,250 500 210 10 20 200 370 40 - 3,160
24 Antalgin (Metampiron) Tablet 500 mg Tablet 3,066 3,635 5,018 2,634 2,366 3,440 3,440 2,720 880 1,116 1,004 - 29,319
25 Antalgin Injeksi 250 mg/ml-2ml Botol - - - - - - - - - - - - -
26 Anti Bakteri DOEN Salep Kombinasi : Botol 9 - 1 5 10 4 4 5 4 - 3 - 45
27 Anti Hemoroid Doen komb Tablet - - 10 - - - - - - - - - 10
28 Anti Fungi DOEN Kombinasi : Tablet - 37 20 22 34 25 10 29 36 33 56 - 302
29 Antimigren DOEN Kombinasi : Ergotamin Tartrat 1 mg Ampul 10 - 100 100 100 10 10 - 120 30 30 - 510
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 9 5 3 11 3 4 - - - - - - 35
31 Anti Diare Tablet ( Neo Diaform) Vial 467 396 721 1,050 490 849 849 1,099 486 450 326 - 7,183
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol - - 500 500 310 190 - 1,000 - 1,833 - - 4,333
33 Anti Hipertensi Kapsul (Tensigard) Sachet - 30 80 240 150 180 120 - - - - - 800
34 Antihistamin Tablet kombinasi (Soldextam) Ampul 708 991 188 - - - - - - - - - 1,887
35 Antispasmodik Tablet (Spasminal) Tablet - - - - - - - - - - - - -
36 Antitusiva Sirup (Dexophan) Botol 47 41 45 61 71 71 82 63 35 60 25 - 601
37 Antitusiva Tablet (Dekorin) Tablet - - - - - - - - - - - - -
38 Asam Folat Tablet 1 mg Botol - - - - - - - - - - - - -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 2,421 1,586 2,566 2,008 1,577 2,814 2,814 3,265 504 1,607 2,303 - 23,465
40 Asam Mefenamat Kapsul 500 mg Tablet 370 453 480 656 360 4 - - - - - - 2,323
41 Asetosal Tablet 80 mg Tablet - - - - - - - 20 - 10 30 - 60
42 Asetosal Tablet 100 mg Tablet - - - - - - - - - - - - -
43 Asetosal Tablet 500 mg Ampul - - - - - - - - - - - - -
44 Asiklovir Krim 5 % Tablet 32 27 19 59 40 22 22 36 40 26 24 - 347
45 Asiklovir Tablet 200 mg Tablet - 150 - 100 100 30 105 95 1 199 - - 780
46 Asiklovir Tablet 400 mg Tablet 60 110 200 170 - - - 100 60 80 - - 780
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - - - - - - - - - - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Botol - - - - - - - - - - - - -

49 Betahistin Mesilat 6 mg Botol 10 60 30 100 60 - - 30 60 120 - - 470
50 Betametason Krim 0,1 %- 5g Botol 62 48 73 71 51 47 47 44 15 59 1 - 518
51 Bisakodil suppositoria 10 mg Botol 3 2 - - - - - - 5 - - - 10
52 Bisoprolol Tablet 5 mg Kapsul - - - - - - - - - - - - -
53 Bromheksin 8 mg Kapsul 225 100 260 640 270 440 440 610 360 630 590 - 4,565
54 Deksametason Injeksi 5mg/ml-1ml Ampul - - - - - - - - - - - - -
55 Deksametason Tablet 0,5 mg Tablet - - 2,764 6,871 4,190 6,134 6,134 7,697 6,559 6,500 8,826 - 55,675
56 Devitalisasi Pasta (Non Arsen) Tablet 1 - - - - - - - - - - - 1
57 Diazepam tablet 2 mg Tablet 13 86 31 6 10 36 36 - 50 28 50 - 346
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - - - - - - - - - - - -
59 Diazepam Larutan Rektal 5 mg/ml Botol - - - - - - - - - - - - -
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - - - - - - - - - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet - 5 10 35 - 5 5 - - - - - 60
62 Digoksin Tablet 0,25 mg Tablet - - - - 10 - - - - - 30 - 40
63 Dimenhidrinat Tablet 50 mg Botol 100 100 100 - - - - - - - 100 - 400
64 Domperidon Tablet 10 mg Tablet 230 100 340 110 160 400 - 130 165 77 13 - 1,725
65 Donperidon Suspensi 5 mg/5ml Botol - - - - - - - - - - 12 - 12
66 Efedrin Hcl Tablet 25 mg Kantong - - 1 - - - - - - 1 100 - 102
67 Ekstrak Belladone Tablet 10 mg Kantong - - - - - - - - - - - - -
68 Epinefrin HCl / Bitartrat Botol - - 1 - - - - - - - - - 1
69 Eritromisin Kapsul 250 mg Set - - - - - - - - - - - - -
70 Eritromisin Kapsul 500 mg Tablet - - - - - - - - - - - - -
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - - - - - - - - - - - -
72 Etambutol Tablet 500 mg Botol - - - - - - - - - - - - -
73 Etanol 70 % 100 ml Botol - 2 3 10 5 4 4 - - 5 3 - 36
74 Etil Klorida Semprot -100 ml Botol 2 2 1 2 - 2 2 2 - 3 - - 16
75 Eugenol Cairan -10 ml Tablet 1 - - - - - - - - - - - 1
76 Fenitoin Natrium Kapsul 100 mg Stick - - 40 50 40 - - - - - - - 130
77 Fenobarbital tablet 30 mg Tablet 60 70 50 20 40 - - - - - - - 240
78 Fenobarbital injeksi 50 mg / ml Tablet - - - - - - - - - - - - -
79 Fenoksimeti Penisilin 250 mg tablet Tablet - - - 100 100 - - 100 - 100 - - 400
80 Fenoksimeti Penisilin 500 mg tablet Tube 80 - 100 200 100 - - - - - - - 480
81 Fitomenadion tablet 10 mg Tablet - 30 100 - - - - 25 - 20 70 - 245
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Tablet - - - - - - - - 10 - - - 10
83 Furosemid Tablet 40 mg Set 120 110 100 100 20 210 210 - - - - - 870
84 Garam Oralit I serbuk, kombinasi : Set 210 173 457 311 174 254 34 - - - - - 1,613
85 Gemfibrozil Tablet 600 mg Vial - - - - - - - - - - - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul - - - - - - - - - - - - -
87 Gentamisin Salep Kulit 0,1 % Botol 76 62 170 88 97 133 79 - - - - - 705
88 Glibenklamid Tablet 5 mg Biji 442 885 450 350 60 250 450 165 232 290 420 - 3,994
89 Glimepiride 2 mg Pot 165 50 - - 110 60 90 - 80 - - - 555
90 Gliseril Guayakolat Tablet 100 mg Tube 5,188 4,829 7,151 4,398 4,320 7,057 7,057 5,402 3,445 4,828 4,895 - 58,570
91 Gliseril Guayakolat sirup Tablet 23 34 44 44 37 43 43 18 22 51 60 - 419
92 Glukonas Kalsikus injeksi Bungkus - - - - - - - - - - - - -
93 Glukosa Larutan Infus 5 % Bungkus - - 2 - - - - - - - - - 2
94 Glukosa Larutan Infus10 % Tablet - 2 - - - - - - 3 - - - 5
95 Griseofulvin Tablet 125 mg,micronized Bungkus 210 540 230 110 230 200 200 48 - - - - 1,768
96 Haloperidol Tablet 0,5 mg Rol - - - 20 20 - - - - - - - 40
97 Haloperidol Tablet 1,5 mg Rol 20 20 10 - - - - - - 10 30 - 90
98 Haloperidol Tablet 5 mg Rol - - - - - - - - 21 30 - - 51
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul - 400 275 641 619 300 300 500 203 630 218 - 4,086
100 Hidrokortison Krim 2,5 % Tube 38 56 78 71 55 34 34 - 9 44 31 - 450
101 Ibuprofen Tablet 200 mg Botol 335 640 840 690 511 700 684 - - - 100 - 4,500
102 Ibuprofen Tablet 400 mg Tablet 966 556 510 920 1,223 560 5,960 1,120 1,400 2,185 1,900 - 17,300
103 Ibuprofen Suspensi 100 mg/5 ml Tablet - 15 5 10 - 10 - - - - - - 40
104 Ichtyol salep Kulit Ampul 4 5 5 5 10 - - 1 5 3 1 - 39

105 Ipatropium Bromide + Salbutamol Ampul - - - - - - - - - - - - -
106 Isoniazid tablet 100 mg Tablet - - - - - - - - - - - - -
107 Isosorbid Dinitrat 5 mg Tablet - - - - - - - - - - - - -
108 Kalium Diklofenak Tablet 25 mg Tablet - - - - - - - - - - - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 120 100 50 300 200 250 200 100 100 300 200 - 1,920
110 Kalsium Hidroksida Pasta Botol 1 - - - - - - - - - - - 1
111 Kalsium Laktat Tablet 500 mg Tablet 2,245 2,530 2,533 3,163 1,836 3,272 715 2,699 1,300 2,180 1,320 - 23,793
112 Kaptopril 12,5 mg Ampul 1,170 1,191 1,025 679 20 500 - 295 45 135 215 - 5,275
113 Kaptopril 25 mg Botol - - - - - - - - - - - - -
114 Karbamazepin Tablet 200 mg Botol - - - - 10 - 3 - 100 47 - - 160
115 Ketokonazole Krim 2 % - 15 gr Botol 19 14 13 12 7 3 10 10 - 2 5 - 95
116 Ketokonazole Tablet 200 mg Botol 120 460 160 59 - - - - - - - - 799
117 Ketoprofen Tablet 100 mg Botol - - - - - - - - - - - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - - - - - - - - - - - -
119 Ketorolac 10 mg injeksi Botol - - - - - - - - - - - - -
120 Ketorolac 30 mg injeksi Botol 10 - - - - - - - - - - - 10
121 Klindamisin Kapsul 150 mg Botol - - - - - - - - - - - - -
122 Klindamisin Kapsul 300 mg Tablet - - - - - - - - - - - - -
123 Kloramfenikol Kapsul 250 mg Ampul 100 - 480 610 480 - 680 90 - - 12 - 2,452
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - - - - - 8 - 8

125 Kloramfenikol Tetes Mata -5 ml Ampul 36 25 27 57 33 61 61 52 29 32 59 - 472
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 24 23 50 21 33 35 35 24 20 32 28 - 325
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 5,989 9,374 10,360 11,000 9,000 10,000 10,000 8,813 4,935 7,348 6,876 - 93,695
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 340 270 - 7 - - - - 200 - - - 817
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 500 320 - - - - - - - 10 30 - 860
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - - - - - - - - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi : Sulfame Tablet 236 200 12 400 - 133 14 - - - - - 995
132 Kotrimoksazol Tablet, Kombinasi : Ampul 155 30 - - - - - - - - - - 185
133 Kotrimoksazol Suspensi Kombinasi : Tablet 96 81 87 90 90 121 121 86 64 101 56 - 993
134 Lansoprazole 30 mg Kapsul Botol 100 60 20 55 5 30 30 26 65 130 270 - 791
135 Larutan mengadung Elektrolit Botol - - - - - - - - - - - - -
136 Larutan mengadung Elektrolit Tablet 5 - - - 4 - - - - - - - 9
137 Larutan mengadung Karbohidrat + Elektrolit Botol - - - - - - - - - - - - -
138 Lidokain injeksi 2 % Botol - - - - - - - - - - - - -
139 Lidokain Komp Injeksi, Kombinasi : Botol - - - - - - - - - - 20 - 20
140 Loperamid Tablet 2 mg Tablet - 50 - - - 30 30 10 - 40 373 - 533
141 Loratadin tablet 10 mg Tablet - - - - 100 100 100 - 50 160 - - 510
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - - - - - - - - - - - -
143 Meloksikam tablet 15 mg Paket 160 200 10 220 300 150 150 170 330 100 40 - 1,830
144 Meloksikam Suppositoria Paket - - - - - - - - - - - - -
145 Metformin Hcl Tablet 500 mg Paket 10 230 370 320 228 215 215 210 20 120 550 - 2,488
146 Methisoprinol 500 mg Paket - - - - 10 - - - - - - - 10
147 Metilergometrin Maleat (Metergin) Tablet 0,125 mg Botol - 120 50 - - 50 - - - - - - 220
148 Metilergometrin Maleat Injeksi 0,200 mg-1ml Vial - - - - - - - - - - - - -
149 Metilprednisolon tablet 4 mg Tube 210 490 400 1,700 - - - - - - - - 2,800
150 Metoklopramid 10 mg Tube - - - - - 110 - 20 660 73 70 - 933
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - 20 - - - - - - 50 - - - 70
152 Metronidazol Tablet 250 mg Tablet 210 150 50 - - - - - - - - - 410
153 Metronidazole Tablet 500 mg Botol 275 85 58 410 90 340 340 150 120 30 220 - 2,118
154 Metronidazole Infus 500 mg /100 ml Tablet - - - - - - - - - - - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet 7 3 6 10 - - - - - 1 11 - 38
156 Multivitamin + Mineral tablet Tablet 620 100 760 1,256 1,000 1,250 1,250 895 892 1,713 1,575 - 11,311
157 Multivitamin sirup Tablet 42 39 73 52 52 54 54 66 65 82 93 - 672
158 Natrium Bikarbonat Tablet 500 mg Tablet 10 21 1,203 1,337 223 1,026 1,026 783 51 1,119 286 - 7,085
159 Natrum Diklofenak Tablet 25 mg Tablet 100 - - - - - - - - - 150 - 250
160 Natrium Diklofenak Tablet 50 mg Rol 80 150 140 360 300 - - 50 200 210 100 - 1,590
161 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol 4 3 - 10 - - - - - - 1 - 18
162 Nipedifin Tablet 10 mg Botol 20 150 106 435 236 20 20 20 90 180 862 - 2,139
163 Nistatin 100.000 IU/gram Tablet Vagina Botol - - - 5 - - - - - - - - 5
164 Nistatin 500.000 IU/gram Tablet Salut Botol - 10 - - - - - - - 110 10 - 130
165 Obat Antitiuberkolosis Kategori Anak Botol - - - - - - - - - - - - -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Tablet - - - - - - - - - - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - - - - - - - - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - - - - - - - - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - - - - - - - - - - -
172 Obat Anti Tuberkolosis FDC Sisipan Dewasa Tablet - - - - - - - - - - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 44 42 117 116 74 126 126 146 64 111 66 - 1,032
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 23 31 20 39 40 37 37 41 31 48 48 - 395
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol - - 3 45 27 44 44 34 2 33 23 - 255
176 Obat Flu Sirup Tablet - - 4 10 6 8 8 5 4 - - - 45
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Pot - - - - - - - - - - - - -
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 31 25 61 37 27 - - - - - - - 181

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - - - - - - - - - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 50 10 20 50 40 13 - 10 20 20 - - 233
181 Omeprazole injeksi 40mg/10ml Vial - - - - - - - - - 1 - - 1
182 Omeprazole Kapsul 20 mg Vial - - - - - - - - - - - - -
183 Ondansetron inj 4 mg/ 2 mL Ampul - 5 - - - - - - - - - - 5
184 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Vial 45 40 36 47 9 20 20 7 1 17 - - 242
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 172 207 242 221 121 246 156 256 242 292 235 - 2,390
186 Parasetamol Tablet 100 mg Sachet - - - - - - - - - - - - -
187 Parasetamol Tablet 500 mg Botol 10,913 9,660 11,251 11,419 9,398 11,431 11,431 10,304 10,350 13,326 13,250 - 122,733
188 Pehacain injeksi Buah 90 50 125 25 125 115 120 5 100 50 - - 805
189 Perak Sulfadiazin krim 1 % 35 gr (Burnazin) Botol 8 9 2 8 5 - - 4 2 - 6 - 44
190 Piracetam 400 mg Tablet 50 100 - 100 - - - - - - - - 250
191 Piracetam Tablet 800 mg Botol - - - 50 - 100 50 - - - - - 200
192 Piroksikam Tablet 20 mg Vial 270 170 210 380 230 180 180 150 10 100 50 - 1,930
193 Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg B Set - - - - - - - - - - - - -
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 4,261 4,387 4,789 3,723 4,305 3,593 3,593 410 - - - - 29,061
195 Polikresulen (Kondensasi Metakresol Sulfonat dan Me Set 2 - - - - - - - - - - - 2

196 Povidon Iodida 10% 30 ml Kapsul 2 - - 3 - - - 2 - 8 - - 15
197 Povidon Iodida 10% 300 ml Ampul 1 - - 1 - - - - - - - - 2
198 Predison Tablet - - - - - - - - - - - - -
199 Primakuin tablet 15 mg Tablet - - - - - - - - - - - - -
200 Propanolol Hcl Tablet 40 mg Botol - - - - - - - - - - - - -
201 Propilturasil Tablet 100 mg Kuur - - - 10 - - - - - - - - 10
202 Ranitidin Injeksi 25 mg / ml Set - - 20 - - - - - - 20 - - 40
203 Ranitidin Tablet 150 mg Tablet 220 1,271 1,085 852 600 380 380 456 200 250 1,520 - 7,214
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - - - - - - - - - - - -
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - - - - - - - - - - - - -
206 Reserpin Tablet 0, 25 mg Buah 12 2,680 - - - - - - - - - - 2,692
207 Rifampisin Tablet 450 mg Buah - - - - - - - - - - - - -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 4 - 5 11 5 - - 5 10 13 - - 53
209 Salbutamol Tablet 2 mg Tablet - - - - - - - - - - - - -
210 Salbutamol Tablet 4 mg Botol - 240 10 560 410 380 380 - 10 - 10 - 2,000
211 Salbutamol solution for Inhalation single dose units 2,5Tablet - - - - - - - - 20 - - - 20
212 Salep 2-4 Kombinasi : Asam Salisilat 2 % + Belerang Tablet 6 6 16 8 17 14 14 30 15 42 56 - 224
213 Salisil bedak 2% -50 gr Botol 62 56 72 41 40 30 30 72 45 47 50 - 545
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - - - - - - - - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 13 15 7 5 6 8 8 15 6 11 47 - 141
216 Sefadroksil Tablet 500 mg Kapsul 150 460 190 239 350 - - 210 190 120 260 - 2,169
217 Sefiksim Kapsul 100 mg Vial - - - - - - - - - - - - -
218 Sefotaksim Injeksi 1 gr Tablet - - - - - - - - - - - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - - - - - - - - - - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - - - - - - - - - - - -
221 Setirizin Tablet 10 mg Botol 116 - - - - - - - - 100 30 - 246
222 Setirizin Sirup 5 mg / 5 ml Tablet 10 - 14 14 10 - - - - - 5 - 53
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol - 15 25 15 - - - - 10 - - - 65

224 Sianokobalamin Tablet 50 mcg Tablet - - - - - - - - - - - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - - - - - - - - - - - -
226 Simetidin 200 mg Tablet Tablet 300 200 - 500 400 400 400 200 - - 100 - 2,500
227 Simvastatin Tablet 10 mg Tablet 160 316 140 110 220 186 186 40 352 160 280 - 2,150
228 Siprofloksasin 500mg Tablet - - - - - - - - - 110 40 - 150
229 Spironolakton Tablet 25 mg Botol - - - - - - - - - - 140 - 140
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet 20 - - - - - - - - - - - 20
231 Tablet Tambah Darah Kombinasi: Besi II Sulfat 200 m Tablet - - - - - - - - - - - - -
232 Temporary Stopping Fletcher (Fletcher) Serbuk & Cair Kapsul - - - - - - - - - - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - - - - - - - - - - -
234 Tetrasiklin Kapsul 250 mg Tube 500 410 326 940 365 923 - - - - - - 3,464
235 Tetrasiklin Kapsul 500 mg Tablet 790 490 610 630 180 - - 10 110 450 230 - 3,500
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Tablet - - - - - - - 210 - - - - 210
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg set 4,356 4,872 5,735 4,715 4,281 2,953 1,953 3,402 2,656 4,958 2,746 - 42,627
238 Thiamfenikol Kapsul 500 mg set - 10 - 200 - 100 - 100 250 - - - 660
239 Tramadol Injeksi 50 mg/ ml Botol - - - - - - - - - - - - -
240 Tramadol Tablet 50 mg Tablet - - - - - - - - - - - - -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet - 20 20 - 20 - - - 10 - - - 70
242 Vitamin B .Komplek Tablet Tablet 1,923 1,649 3,068 3,146 2,544 2,600 2,600 1,500 1,090 655 1,885 - 22,660
243 Vitamin Neurotropik Tablet Botol 660 430 666 700 430 580 580 600 836 1,102 900 - 7,484
244 Zinc Tablet 20 mg Tablet 390 220 198 950 355 695 - - - - 70 - 2,878
245 Prednison tab 5 mg Tablet 2,467 2,253 2,947 4,000 1,863 - 291 - - - - - 13,821
246 Gentian Violet Tablet - - - - - - - - - - - - -
247 Furosemid injek 10mg/ml Tablet - - - - - - - - - - - - -
248 Glass Ionoer semen Botol 1 - - - - - - - - - - - 1
249 Bahan Tambal Sementara Kapsul 1 - - - - - - - - - - - 1
250 MgSO4-40% Kapsul 13 - 6 - - - - - 18 - - - 37
251 Botol - - - - - - - - - - - - -
252 Tablet - - - - - - - - - - - - -
253 Tablet - - - - - - - - - - - - -
254 Tablet - - - - - - - - - - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set - 2 5 - - - - 3 3 - - - 13
256 Abbocath No 20 ( IV Chateter 20 ) Set - - 5 - - - - - - - - - 5
257 Abbocath No 22 ( IV Chateter 22 ) Set - - 15 - - - - 5 - - - - 20
258 Abbocath No 24 ( IV Chateter 24 ) Ampul - - 5 5 - - - - - - - - 10
259 Alat Suntik Sekali Pakai 10 ml Tablet - - - - - - - - - - - - -
260 Alat Suntik Sekali Pakai 1 ml Vial - - - - 300 - - - - - - - 300
261 Alat Suntik Sekali Pakai 2,5 ml Tube 220 20 315 115 - 180 200 - 200 - - - 1,250
262 Alat Suntik Sekali Pakai 5 ml Botol 100 - 5 - - - - - - - - - 105
263 Alat Suntik Sekali Pakai 10 ml Tablet - - - - - - - - - - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) Botol 20 - 12 12 - - - 12 3 - 1 - 60
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml Pot 19 6 4 5 - 15 - - - 3 - - 52
266 Etanol 70 % 1.000 ml Tablet - - 2 5 - - - 1 6 - - - 14
267 Folley Catheter no 14 Tablet 3 - - - - - - - 2 - - - 5
268 Folley Catheter no 16 Tablet - - - - - - - - - - - - -
269 Folley Catheter no 18 Tablet - - - - - - - - - - - - -
270 Infus set Anak Tablet - - - - - 2 2 - - - - - 4
271 Infus set Dewasa Kotak - 15 - - - - - 10 2 - - - 27
272 Iodina Test Tube - - - - - - - - - - - - -
273 Kassa Hidrofil Steril 16 x 16 Tablet - - - - 20 - - - - 3 - - 23
274 Kapas Berlemak 500 gram Tablet - - - - - - - - - - - - -
275 Kapas Pembalut / Adsorbens 250 gram Ampul 4 1 2 2 20 3 3 - 4 - 2 - 41
276 Kassa Kompres 40 x 40 steril Ampul - 3 - 16 - - 10 - - 15 3 - 47
277 Kassa Pembalut 2 m x 80 cm Ampul 13 6 19 4 - - - - - 3 36 - 81
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 45 - 2 65 - 3 3 - - - - - 118
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul - 10 4 5 - 20 20 - 10 35 - - 104
280 Kertas Puyer Botol - - - - - - - - - - - - -
281 Lysol 1,000 ml Botol 1 - 1 - - 1 - - - - - - 3
282 Masker Tablet 20 - 60 - - - - - 10 - - - 90
283 Plester 5 yard x 2 inchi Tablet 3 - - - - - - - - - - - 3
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 10 5 10 - - 20 - - - - 12 - 57
285 Safety Box Tablet - - - - - - - - - - - - -
286 Sarung tangan Steril No 6 Tablet - - - - - - - - - 5 3 - 8
287 Sarung tangan Steril No 7 Buah 25 5 15 60 - - 30 13 10 10 11 - 179
288 Sarung tangan Steril No 7,5 Tablet 30 26 - 50 - - 40 10 - 10 - - 166
289 Sarung tangan Non Steril S Supp - - 1 99 - - - - - - - - 100
290 Sarung tangan Non Steril M Tablet - - 60 40 - - - - - - - - 100
291 Sarung tangan Non Steril L Tablet - - - 100 - - - - - - - - 100
292 Urine Bag Tablet - - - - - - - - - - - - -
293 Wing Neddle No 23 Ampul - - - - - - - - - - - - -
294 Polifix Ampul - - 13 - - - 2 - - - - - 15
295 Tablet - - - - - - - - - - - - -
296 Tube - - - - - - - - - - - - -
297 Sashet - - - - - - - - - - - - -
298 Tablet - - - - - - - - - - - - -
299 Botol - - - - - - - - - - - - -
300 Tablet - - - - - - - - - - - - -
301 C. SERUM DAN VAKSIN Tablet - - - - - - - - - - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I ) Tablet - - - - - - - - - - - - -
303 Serum Anti Rabies untuk manusia Tablet - - - - - - - - - - - - -
304 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul Botol - - - - - - - - - - - - -
305 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ampul Paket - - - - - - - - - - - - -
306 Paket - - - - - - - - - - - - -
307 Paket - - - - - - - - - - - - -
308 Botol - - - - - - - - - - - - -
309 Kapsul - - - - - - - - - - - - -
310 Tablet - - - - - - - - - - - - -
311 Botol - - - - - - - - - - - - -
312 Tablet - - - - - - - - - - - - -
313 Ampul - - - - - - - - - - - - -
314 - -
315 - -
316 - -
317 - -
318 - -
319 -
320 -
321 -
322 -
323 -
324 -
325 -
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
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Mengetahui Kuningan,.............
Kepala UPTD Puskesmas Pengelola Obat Puskesmas
............................................................... ....................................................
NIP NIP
NERACA PERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN
TAHUN 2014
PUSKESMAS :........................................
KECAMATAN :........................................
KABUPATEN :.........................................
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN

NO NAMA OBAT SATUAN
THN 2014 THN 2014 THN 2014 THN 2014
1 2 3 4 5 6=4+5 7
2 Albendazole Tablet 400 mg Set 1,260 1,260 2,520 -
3 Alopurinol Tablet 100 mg Set 269 17,700 17,969 2,609
4 Ambroksol Tablet 30 mg Set 4,840 9,500 14,340 7,005
5 Ambroksol sirup 15 mg/5 ml Tablet 273 710 983 971
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - 3 -
7 Aminofillin Tablet 200 mg Tablet 105 600 705 705
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 600 - 600 190
9 Amlodipin Tablet 5 mg Tablet 254 1,780 2,034 1,984
10 Amlodipin Tablet 10 mg Kapsul 260 - 260 260
11 Amoksisillin Kapsul 250 mg Kaplet 18,644 4,500 23,144 13,576
12 Amoksisillin Kaplet 500 mg Botol 9,010 84,400 93,410 44,688
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 240 - 240 160
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 233 1,140 1,373 1,373
15 Amoksisillin Double Strengh Sirup Keri Tablet 465 - 465 324
16 Ampisilin Kapsul 250 mg Tube - - - -

17 Ampisillin Kaplet 500 mg Supp - 2,400 2,400 1,870
18 Ampisilin Sirup 125 mg / 5 ml Pot - - - -
19 Ampisillin Injeksi 1000 mg Tablet 30 120 150 1
20 Analgetik Plus Tablet - 100 100 10

21 Antasida Doen Suspensi Kombinasi : Vial 262 250 512 476
22 Antasida Doen Tablet, Kombinasi : M Botol 33,515 29,500 63,015 59,487
23 Antasida Plus Tablet Tablet 60 3,100 3,160 3,160
24 Antalgin (Metampiron) Tablet 500 mg Tablet 1,819 27,500 29,319 29,319
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 - 60 -
26 Anti Bakteri DOEN Salep Kombinasi : Botol - 50 50 45
27 Anti Hemoroid Doen komb Tablet - 10 10 10
28 Anti Fungi DOEN Kombinasi : Tablet 194 1,025 1,219 302
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 225 500 725 510
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 35 - 35 35
31 Anti Diare Tablet ( Neo Diaform) Vial 1,902 5,300 7,202 7,183
32 Anti Dotum Oral Tablet ( Bekarbon/NoritBotol 583 3,750 4,333 4,333
33 Anti Hipertensi Kapsul (Tensigard) Sachet - 800 800 800
34 Antihistamin Tablet kombinasi (Soldex Ampul 1,887 - 1,887 1,887
35 Antispasmodik Tablet (Spasminal) Tablet - - - -
36 Antitusiva Sirup (Dexophan) Botol 83 520 603 601
37 Antitusiva Tablet (Dekorin) Tablet - - - -
38 Asam Folat Tablet 1 mg Botol - - - -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 18,228 7,000 25,228 23,465
40 Asam Mefenamat Kapsul 500 mg Tablet 323 2,000 2,323 2,323
41 Asetosal Tablet 80 mg Tablet - 100 100 60
42 Asetosal Tablet 100 mg Tablet - 200 200 -
43 Asetosal Tablet 500 mg Ampul - - - -
44 Asiklovir Krim 5 % Tablet 188 275 463 347
45 Asiklovir Tablet 200 mg Tablet 180 3,800 3,980 780
46 Asiklovir Tablet 400 mg Tablet 240 3,800 4,040 783
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - - -
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol 190 - 190 -

49 Betahistin Mesilat 6 mg Botol 1,000 440 1,440 470
50 Betametason Krim 0,1 %- 5g Botol 268 250 518 518
51 Bisakodil suppositoria 10 mg Botol 30 50 80 10
52 Bisoprolol Tablet 5 mg Kapsul - - - -
53 Bromheksin 8 mg Kapsul 4,875 4,600 9,475 4,565
54 Deksametason Injeksi 5mg/ml-1ml Ampul 58 70 128 -
55 Deksametason Tablet 0,5 mg Tablet - 124,000 124,000 55,675
56 Devitalisasi Pasta (Non Arsen) Tablet - 1 1 1
57 Diazepam tablet 2 mg Tablet 212 200 412 346
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - - -
59 Diazepam Larutan Rektal 5 mg/ml Botol 10 50 60 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul - - - -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 345 630 975 60
62 Digoksin Tablet 0,25 mg Tablet - 200 200 40
63 Dimenhidrinat Tablet 50 mg Botol 1,300 - 1,300 400
64 Domperidon Tablet 10 mg Tablet 2,005 - 2,005 1,725
65 Donperidon Suspensi 5 mg/5ml Botol - 300 300 12
66 Efedrin Hcl Tablet 25 mg Kantong 35 600 635 102
67 Ekstrak Belladone Tablet 10 mg Kantong - - - -
68 Epinefrin HCl / Bitartrat Botol 15 10 25 1
69 Eritromisin Kapsul 250 mg Set - - - -
70 Eritromisin Kapsul 500 mg Tablet 400 - 400 -
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - - -
72 Etambutol Tablet 500 mg Botol - - - -
73 Etanol 70 % 100 ml Botol - 64 64 36
74 Etil Klorida Semprot -100 ml Botol 13 3 16 16
75 Eugenol Cairan -10 ml Tablet - 13 13 1
76 Fenitoin Natrium Kapsul 100 mg Stick 190 1,000 1,190 130
77 Fenobarbital tablet 30 mg Tablet 50 400 450 240
78 Fenobarbital injeksi 50 mg / ml Tablet - 30 30 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 830 500 1,330 400
80 Fenoksimeti Penisilin 500 mg tablet Tube 700 - 700 480
81 Fitomenadion tablet 10 mg Tablet 130 200 330 245
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1 Tablet - 100 100 10
83 Furosemid Tablet 40 mg Set 145 2,400 2,545 870
84 Garam Oralit I serbuk, kombinasi : Set 1,113 500 1,613 1,613
85 Gemfibrozil Tablet 600 mg Vial - - - -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul - 20 20 -
87 Gentamisin Salep Kulit 0,1 % Botol 180 525 705 705
88 Glibenklamid Tablet 5 mg Biji 2,069 2,100 4,169 3,994
89 Glimepiride 2 mg Pot 349 300 649 555
90 Gliseril Guayakolat Tablet 100 mg Tube 9,223 53,000 62,223 58,570
91 Gliseril Guayakolat sirup Tablet 234 250 484 419
92 Glukonas Kalsikus injeksi Bungkus - - - -
93 Glukosa Larutan Infus 5 % Bungkus - 50 50 2
94 Glukosa Larutan Infus10 % Tablet - 24 24 5
95 Griseofulvin Tablet 125 mg,micronized Bungkus 1,368 400 1,768 1,768
96 Haloperidol Tablet 0,5 mg Rol 115 100 215 40
97 Haloperidol Tablet 1,5 mg Rol 10 100 110 90
98 Haloperidol Tablet 5 mg Rol - 500 500 51
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 5,514 50 5,564 4,086
100 Hidrokortison Krim 2,5 % Tube 201 1,475 1,676 450
101 Ibuprofen Tablet 200 mg Botol - 10,400 10,400 4,500
102 Ibuprofen Tablet 400 mg Tablet 1,118 24,000 25,118 17,300
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 40 10 50 40
104 Ichtyol salep Kulit Ampul 5 33 38 39

105 Ipatropium Bromide + Salbutamol Ampul - 20 20 -
106 Isoniazid tablet 100 mg Tablet - - - -
107 Isosorbid Dinitrat 5 mg Tablet 300 - 300 -
108 Kalium Diklofenak Tablet 25 mg Tablet - - - -
109 Kalium Diklofenak Tablet 50 mg Tablet 1,000 3,800 4,800 1,920
110 Kalsium Hidroksida Pasta Botol - 1 1 1
111 Kalsium Laktat Tablet 500 mg Tablet 19,754 7,200 26,954 23,793
112 Kaptopril 12,5 mg Ampul 2,085 3,100 5,185 5,275
113 Kaptopril 25 mg Botol - 200 200 -
114 Karbamazepin Tablet 200 mg Botol 160 - 160 160
115 Ketokonazole Krim 2 % - 15 gr Botol 19 71 90 95
116 Ketokonazole Tablet 200 mg Botol 799 - 799 799
117 Ketoprofen Tablet 100 mg Botol - - - -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - - -
119 Ketorolac 10 mg injeksi Botol - - - -
120 Ketorolac 30 mg injeksi Botol - 30 30 10
121 Klindamisin Kapsul 150 mg Botol - - - -
122 Klindamisin Kapsul 300 mg Tablet - - - -
123 Kloramfenikol Kapsul 250 mg Ampul 1,040 1,400 2,440 2,452
124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - 8

125 Kloramfenikol Tetes Mata -5 ml Ampul 93 675 768 472
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 87 260 347 325
127 Klorfeniramin Maleat (CTM) Tablet 4 mgBungkus 28,581 68,600 97,181 93,695
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 610 1,500 2,110 817
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 820 300 1,120 860
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet - - - -
131 Kotrimoksazol Pedriatik Tablet, Kombin Tablet 595 400 995 995
132 Kotrimoksazol Tablet, Kombinasi : Ampul 185 - 185 185
133 Kotrimoksazol Suspensi Kombinasi : Tablet 414 1,800 2,214 993
134 Lansoprazole 30 mg Kapsul Botol 140 6,530 6,670 791
135 Larutan mengadung Elektrolit Botol - 20 20 -
136 Larutan mengadung Elektrolit Tablet - 20 20 9
Botol - - - -
138 Lidokain injeksi 2 % Botol - 2,000 2,000 -
139 Lidokain Komp Injeksi, Kombinasi : Botol - 2,000 2,000 20
140 Loperamid Tablet 2 mg Tablet 145 2,200 2,345 533
141 Loratadin tablet 10 mg Tablet 889 - 889 510
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - - -
143 Meloksikam tablet 15 mg Paket 1,105 1,400 2,505 1,830
144 Meloksikam Suppositoria Paket - - - -
145 Metformin Hcl Tablet 500 mg Paket - 14,400 14,400 2,488
146 Methisoprinol 500 mg Paket 200 150 350 10
147 Metilergometrin Maleat (Metergin) Tabl Botol 84 600 684 220
148 Metilergometrin Maleat Injeksi 0,200 mgVial - 700 700 -
149 Metilprednisolon tablet 4 mg Tube 2,000 1,400 3,400 2,800
150 Metoklopramid 10 mg Tube 1,000 1,400 2,400 933
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - 200 200 70
152 Metronidazol Tablet 250 mg Tablet 210 200 410 410
153 Metronidazole Tablet 500 mg Botol 418 1,600 2,018 2,118
154 Metronidazole Infus 500 mg /100 ml Tablet - - - -
155 Mikonazole KrIm 2 % - 10 gr Tablet 21 630 651 38
156 Multivitamin + Mineral tablet Tablet 620 10,300 10,920 11,311
157 Multivitamin sirup Tablet 22 760 782 672
158 Natrium Bikarbonat Tablet 500 mg Tablet 4,093 6,000 10,093 7,085
159 Natrum Diklofenak Tablet 25 mg Tablet 100 - 100 250
160 Natrium Diklofenak Tablet 50 mg Rol 3,000 3,200 6,200 1,590
161 Natrium Klorida Larutan infus 0,9%-Ster Botol 13 218 231 18
162 Nipedifin Tablet 10 mg Botol 1,247 5,400 6,647 2,139

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 200 - 200 5
164 Nistatin 500.000 IU/gram Tablet Salut Botol 107 300 407 130
165 Obat Antitiuberkolosis Kategori Anak Botol - - - -
166 Obat Antitiuberkolosis Kategori 1 Dewa Tablet - - - -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet - - - -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet - - - -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet - - - -
172 Obat Anti Tuberkolosis FDC Sisipan D Tablet - - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 294 1,300 1,594 1,032
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 17 450 467 395
175 Obat Batuk Hitam Plus Sirup (Excosin)Botol - 500 500 255
176 Obat Flu Sirup Tablet - 45 45 45
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-1 Pot 50 - 50 -
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 181 - 181 181

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol - - - -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 38 260 298 233
181 Omeprazole injeksi 40mg/10ml Vial - 30 30 1
182 Omeprazole Kapsul 20 mg Vial - 510 510 -
183 Ondansetron inj 4 mg/ 2 mL Ampul - 145 145 5
184 Parasetamol drop 100 mg/ml btl @15ml Vial 144 100 244 242
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 429 2,300 2,729 2,390
186 Parasetamol Tablet 100 mg Sachet - - - -
187 Parasetamol Tablet 500 mg Botol 37,501 150,000 187,501 122,733
188 Pehacain injeksi Buah 40 890 930 805
189 Perak Sulfadiazin krim 1 % 35 gr (BurnaBotol 32 27 59 44
190 Piracetam 400 mg Tablet 100 200 300 250
191 Piracetam Tablet 800 mg Botol - 200 200 200
192 Piroksikam Tablet 20 mg Vial 699 1,300 1,999 1,930
193 Pirantel Pamoat Tablet 365 mg (Setara Set 196 200 396 -
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 17,061 12,000 29,061 29,061
195 Polikresulen (Kondensasi Metakresol SuSet 12 - 12 2

196 Povidon Iodida 10% 30 ml Kapsul 2 19 21 15
197 Povidon Iodida 10% 300 ml Ampul 1 5 6 2
198 Predison Tablet - - - -
199 Primakuin tablet 15 mg Tablet - - - -
200 Propanolol Hcl Tablet 40 mg Botol 197 - 197 -
201 Propilturasil Tablet 100 mg Kuur 130 - 130 10
202 Ranitidin Injeksi 25 mg / ml Set - 300 300 40
203 Ranitidin Tablet 150 mg Tablet 4,380 16,800 21,180 7,214
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - - -
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - - - -
206 Reserpin Tablet 0, 25 mg Buah 2,692 - 2,692 2,692
207 Rifampisin Tablet 450 mg Buah - - - -
208 Ringer Laktat Larutan Infus Steril 500 mSet 4 466 470 53
209 Salbutamol Tablet 2 mg Tablet - - - -
210 Salbutamol Tablet 4 mg Botol 990 1,000 1,990 2,000
211 Salbutamol solution for Inhalation single Tablet - 20 20 20
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 14 1,150 1,164 224
213 Salisil bedak 2% -50 gr Botol 167 480 647 545
214 Salep Luka Bakar (Neocenta/Bioplant) vial - - - -
215 Sefadroksil Sirup Kering 125 mg / 5 ml Botol 147 100 247 141
216 Sefadroksil Tablet 500 mg Kapsul - 11,100 11,100 2,169
217 Sefiksim Kapsul 100 mg Vial - 1,000 1,000 -
218 Sefotaksim Injeksi 1 gr Tablet - - - -
219 Seftriakson Injeksi 1 gr / vial Tablet - - - -
220 Semen Seng Fosfat Serbuk & Cairan Tablet - - - -
221 Setirizin Tablet 10 mg Botol 116 500 616 246
222 Setirizin Sirup 5 mg / 5 ml Tablet 51 - 51 53
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 200 650 850 65

224 Sianokobalamin Tablet 50 mcg Tablet - - - -
225 Silver Amalgam Serbuk 65-75% Tablet - - - -
226 Simetidin 200 mg Tablet Tablet 2,000 400 2,400 2,500
227 Simvastatin Tablet 10 mg Tablet 990 1,300 2,290 2,150
228 Siprofloksasin 500mg Tablet - 9,300 9,300 150
229 Spironolakton Tablet 25 mg Botol 90 600 690 140
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet 20 - 20 20
231 Tablet Tambah Darah Kombinasi: Besi ITablet - - - -
232 Temporary Stopping Fletcher (Fletcher) Kapsul - - - -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul - - - -
234 Tetrasiklin Kapsul 250 mg Tube 3,464 - 3,464 3,464
235 Tetrasiklin Kapsul 500 mg Tablet 2,058 17,000 19,058 3,500
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml- Tablet 120 90 210 210
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet set 13,603 36,000 49,603 42,627
238 Thiamfenikol Kapsul 500 mg set 500 400 900 660
239 Tramadol Injeksi 50 mg/ ml Botol - - - -
240 Tramadol Tablet 50 mg Tablet - - - -
241 Triheksifenidil Hidroklorida Tablet 2 mg
Tablet 10 100 110 70
242 Vitamin B .Komplek Tablet Tablet 17,920 5,200 23,120 22,660
243 Vitamin Neurotropik Tablet Botol 3,280 5,000 8,280 7,484
244 Zinc Tablet 20 mg Tablet 608 2,200 2,808 2,878
245 Prednison tab 5 mg Tablet 4,321 9,500 13,821 13,821
246 Gentian Violet Tablet - - - -
247 Furosemid injek 10mg/ml Tablet - 24 24 -
248 Glass Ionoer semen Botol - 1 1 1
249 Bahan Tambal Sementara Kapsul - 1 1 1
250 MgSO4-40% Kapsul 37 - 37 37
251 Botol - 198 198 -
252 Tablet - - - -
253 Tablet - - - -
254 Tablet - - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set 60 50 110 13
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 59 50 109 10
259 Alat Suntik Sekali Pakai 10 ml Tablet - - - -
260 Alat Suntik Sekali Pakai 1 ml Vial 100 200 300 300
261 Alat Suntik Sekali Pakai 2,5 ml Tube 50 1,500 1,550 1,250
262 Alat Suntik Sekali Pakai 5 ml Botol 200 - 200 105
263 Alat Suntik Sekali Pakai 10 ml Tablet - - - -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Botol 44 83 127 60
265 Etakridin Larutan (Rivanol) 0,1% - 300 Pot 39 23 62 52
266 Etanol 70 % 1.000 ml Tablet 14 - 14 14
267 Folley Catheter no 14 Tablet 5 - 5 5
268 Folley Catheter no 16 Tablet - - - -
269 Folley Catheter no 18 Tablet - 2 2 -
270 Infus set Anak Tablet 53 42 95 4
271 Infus set Dewasa Kotak 115 100 215 27
272 Iodina Test Tube - - - -
273 Kassa Hidrofil Steril 16 x 16 Tablet 20 50 70 23
274 Kapas Berlemak 500 gram Tablet - - - -
275 Kapas Pembalut / Adsorbens 250 gram Ampul 18 45 63 41
276 Kassa Kompres 40 x 40 steril Ampul 50 150 200 47
277 Kassa Pembalut 2 m x 80 cm Ampul 16 266 282 81
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 40 345 385 118
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 64 175 239 104
280 Kertas Puyer Botol - - - -
281 Lysol 1,000 ml Botol 6 - 6 3
282 Masker Tablet 80 100 180 90
283 Plester 5 yard x 2 inchi Tablet 3 - 3 3
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 82 15 97 57
285 Safety Box Tablet - - - -
286 Sarung tangan Steril No 6 Tablet - 45 45 8
287 Sarung tangan Steril No 7 Buah 25 170 195 179
288 Sarung tangan Steril No 7,5 Tablet 26 175 201 166
289 Sarung tangan Non Steril S Supp 100 - 100 100
290 Sarung tangan Non Steril M Tablet 100 - 100 100
291 Sarung tangan Non Steril L Tablet 100 - 100 100
292 Urine Bag Tablet - - - -
293 Wing Neddle No 23 Ampul 30 - 30 -
294 Polifix Ampul - 74 74 15
295 Tablet - - - -
296 Tube - - - -
297 Sashet - - - -
298 Tablet - - - -
299 Botol - - - -
300 Tablet - - - -
301 C. SERUM DAN VAKSIN Tablet - - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Tablet 2 7 9 -
303 Serum Anti Rabies untuk manusia Tablet 2 - 2 -
304 Serum Anti Tetanus (ATS) Injeksi 1.50 Botol 3 24 27 -
305 Serum Anti Tetanus (ATS) Injeksi 20.00 Paket - - - -
306 Paket
307 Paket
308 Botol
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
Mengetahui Kuningan,.............
Kepala UPTD Puskesmas Pengelola Obat Puskesmas
............................................................... ....................................................
NIP NIP
N
STOK AKHIR
THN 2014
8= 6 -7
-
2,520
15,360
7,335
12
3
-
410
50
-
9,568
48,722
80
-
141
-
530
149
90
36
3,528
-
-
60
5
-
917
215
-
19
-
-
-
-
2
-
-
1,763
-
40
200
-
116
3,200
3,257
-
190
970
-
70
-
4,910
128
68,325
-
66
-
60
-
915
160
900
280
288
533
-
24
-
400
-
-
28
-
12
1,060
210
30
930
220
85
90
1,675
-
-
20
-
175
94
3,653
65
-
48
19
-
175
20
449
1,478
1,226
5,900
7,818
10
(1)
20
-
300
-
2,880
3,161
(90)
200
-
(5)
-
-
-
-
20
-
-
(12)
(8)
296
22
3,486
1,293
260
-
-
-
1,221
5,879
20
11
-
2,000
1,980
1,812
379
-
675
-
11,912
340
464
700
600
1,467
130
-
(100)
-
613
(391)
110
3,008
(150)
4,610
213
4,508
195
277
-
-
-
-
-
-
-
-
562
72
245
-
50
-
-
65
29
510
140
2
339
-
64,768
125
15
50
-
69
396
-
10
6
4
-
-
197
120
260
13,966
-
-
-
-
417
-
(10)
-
940
102
-
106
8,931
1,000
-
-
-
370
(2)
785
-
-
(100)
140
9,150
550
-
-
-
-
-
15,558
-
6,976
240
-
-
40
460
796
(70)
-
-
24
-
-
-
198
-
-
-
97
103
280
99
-
-
300
95
-
67
10
-
-
-
2
91
188
-
47
-
22
153
201
267
135
-
3
90
-
40
-
37
16
35
-
-
-
-
30
59
-
-
-
-
-
-
-
9
2
27
-
ingan,.............
at Puskesmas
..................................
RATA -RATA PEMAKAIAN OBAT DAN PERBEKKES PER BULAN
PUSKESMAS ...................................
TAHUN 2014
RATA2
NO NAMA OBAT SATUAN
PEMAKAIAN
1 2 3 4
1 Air Raksa Dental Use Botol -
2 Albendazole Tablet 400 mg Set -
3 Alopurinol Tablet 100 mg Set 217.4
4 Ambroksol Tablet 30 mg Set 583.8
5 Ambroksol sirup 15 mg/5 ml Tablet 80.9
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet -
7 Aminofillin Tablet 200 mg Tablet 58.8
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 15.8
9 Amlodipin Tablet 5 mg Tablet 165.3
10 Amlodipin Tablet 10 mg Kapsul 21.7
11 Amoksisillin Kapsul 250 mg Kaplet 1,131.3
12 Amoksisillin Kaplet 500 mg Botol 3,724.0
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 13.3
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul 114.4
15 Amoksisillin Double Strengh Sirup Kerin Tablet 27.0
16 Ampisilin Kapsul 250 mg Tube -

17 Ampisillin Kaplet 500 mg Supp 155.8
18 Ampisilin Sirup 125 mg / 5 ml Pot -
19 Ampisillin Injeksi 1000 mg Tablet 0.1
20 Analgetik Plus Tablet 0.8

21 Antasida Doen Suspensi Kombinasi : M Vial 39.7
22 Antasida Doen Tablet, Kombinasi : Ma Botol 4,957.3
23 Antasida Plus Tablet Tablet 263.3
24 Antalgin (Metampiron) Tablet 500 mg Tablet 2,443.3
25 Antalgin Injeksi 250 mg/ml-2ml Botol -
26 Anti Bakteri DOEN Salep Kombinasi : Botol 3.8
27 Anti Hemoroid Doen komb Tablet 0.8
28 Anti Fungi DOEN Kombinasi : Tablet 25.2
29 Antimigren DOEN Kombinasi : ErgotaminAmpul 42.5
30 Anti Diare Suspensi ( Neo Kaolimec) Vial 2.9
31 Anti Diare Tablet ( Neo Diaform) Vial 598.6
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol 361.1
33 Anti Hipertensi Kapsul (Tensigard) Sachet 66.7
34 Antihistamin Tablet kombinasi (Soldext Ampul 157.3
35 Antispasmodik Tablet (Spasminal) Tablet -
36 Antitusiva Sirup (Dexophan) Botol 50.1
37 Antitusiva Tablet (Dekorin) Tablet -
38 Asam Folat Tablet 1 mg Botol -
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 1,955.4
40 Asam Mefenamat Kapsul 500 mg Tablet 193.6
41 Asetosal Tablet 80 mg Tablet 5.0
42 Asetosal Tablet 100 mg Tablet -
43 Asetosal Tablet 500 mg Ampul -
44 Asiklovir Krim 5 % Tablet 28.9
45 Asiklovir Tablet 200 mg Tablet 65.0
46 Asiklovir Tablet 400 mg Tablet 65.3
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul -
48 Aqua Pro Injeksi Steril, bebas Pirogen 2 Botol -

49 Betahistin Mesilat 6 mg Botol 39.2
50 Betametason Krim 0,1 %- 5g Botol 43.2
51 Bisakodil suppositoria 10 mg Botol 0.8
52 Bisoprolol Tablet 5 mg Kapsul -
53 Bromheksin 8 mg Kapsul 380.4
54 Deksametason Injeksi 5mg/ml-1ml Ampul -
55 Deksametason Tablet 0,5 mg Tablet 4,639.6
56 Devitalisasi Pasta (Non Arsen) Tablet 0.1
57 Diazepam tablet 2 mg Tablet 28.8
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet -
59 Diazepam Larutan Rektal 5 mg/ml Botol -
60 Dietilkarbamazin Sitrat Tablet 100 mg Ampul -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 5.0
62 Digoksin Tablet 0,25 mg Tablet 3.3
63 Dimenhidrinat Tablet 50 mg Botol 33.3
64 Domperidon Tablet 10 mg Tablet 143.8
65 Donperidon Suspensi 5 mg/5ml Botol 1.0
66 Efedrin Hcl Tablet 25 mg Kantong 8.5
67 Ekstrak Belladone Tablet 10 mg Kantong -
68 Epinefrin HCl / Bitartrat Botol 0.1
69 Eritromisin Kapsul 250 mg Set -
70 Eritromisin Kapsul 500 mg Tablet -
71 Eritromisin Sirup 200 mg / 5 ml Tablet -
72 Etambutol Tablet 500 mg Botol -
73 Etanol 70 % 100 ml Botol 3.0
74 Etil Klorida Semprot -100 ml Botol 1.3
75 Eugenol Cairan -10 ml Tablet 0.1
76 Fenitoin Natrium Kapsul 100 mg Stick 10.8
77 Fenobarbital tablet 30 mg Tablet 20.0
78 Fenobarbital injeksi 50 mg / ml Tablet -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 33.3
80 Fenoksimeti Penisilin 500 mg tablet Tube 40.0
81 Fitomenadion tablet 10 mg Tablet 20.4
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mTablet 0.8
83 Furosemid Tablet 40 mg Set 72.5
84 Garam Oralit I serbuk, kombinasi : Set 134.4
85 Gemfibrozil Tablet 600 mg Vial -
86 Gentamisin injeksi 80 mg / 2 ml Kapsul -
87 Gentamisin Salep Kulit 0,1 % Botol 58.8
88 Glibenklamid Tablet 5 mg Biji 332.8
89 Glimepiride 2 mg Pot 46.3
90 Gliseril Guayakolat Tablet 100 mg Tube 4,880.8
91 Gliseril Guayakolat sirup Tablet 34.9
92 Glukonas Kalsikus injeksi Bungkus -
93 Glukosa Larutan Infus 5 % Bungkus 0.2
94 Glukosa Larutan Infus10 % Tablet 0.4
95 Griseofulvin Tablet 125 mg,micronized Bungkus 147.3
96 Haloperidol Tablet 0,5 mg Rol 3.3
97 Haloperidol Tablet 1,5 mg Rol 7.5
98 Haloperidol Tablet 5 mg Rol 4.3
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 340.5
100 Hidrokortison Krim 2,5 % Tube 37.5
101 Ibuprofen Tablet 200 mg Botol 375.0
102 Ibuprofen Tablet 400 mg Tablet 1,441.7
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 3.3
104 Ichtyol salep Kulit Ampul 3.3

105 Ipatropium Bromide + Salbutamol Ampul -
106 Isoniazid tablet 100 mg Tablet -
107 Isosorbid Dinitrat 5 mg Tablet -
108 Kalium Diklofenak Tablet 25 mg Tablet -
109 Kalium Diklofenak Tablet 50 mg Tablet 160.0
110 Kalsium Hidroksida Pasta Botol 0.1
111 Kalsium Laktat Tablet 500 mg Tablet 1,982.8
112 Kaptopril 12,5 mg Ampul 439.6

113 Kaptopril 25 mg Botol -
114 Karbamazepin Tablet 200 mg Botol 13.3
115 Ketokonazole Krim 2 % - 15 gr Botol 7.9
116 Ketokonazole Tablet 200 mg Botol 66.6
117 Ketoprofen Tablet 100 mg Botol -
118 Ketoprofen Injeksi 100 mg / 1 ml Botol -
119 Ketorolac 10 mg injeksi Botol -
120 Ketorolac 30 mg injeksi Botol 0.8
121 Klindamisin Kapsul 150 mg Botol -
122 Klindamisin Kapsul 300 mg Tablet -
123 Kloramfenikol Kapsul 250 mg Ampul 204.3
124 Kloramfenikol Salep Mata 1%-3,5 g Botol 0.7
125 Kloramfenikol Tetes Mata -5 ml Ampul 39.3
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 27.1
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 7,807.9
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 68.1
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 71.7
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Tablet -
131 Kotrimoksazol Pedriatik Tablet, Kombina Tablet 82.9
132 Kotrimoksazol Tablet, Kombinasi : Ampul 15.4
133 Kotrimoksazol Suspensi Kombinasi : Tablet 82.8
134 Lansoprazole 30 mg Kapsul Botol 65.9
135 Larutan mengadung Elektrolit Botol -
136 Larutan mengadung Elektrolit Tablet 0.8
Botol -
138 Lidokain injeksi 2 % Botol -
139 Lidokain Komp Injeksi, Kombinasi : Botol 1.7
140 Loperamid Tablet 2 mg Tablet 44.4
141 Loratadin tablet 10 mg Tablet 42.5
142 Magnesium Sulfat (IV) 20 %-25 ml Paket -
143 Meloksikam tablet 15 mg Paket 152.5
144 Meloksikam Suppositoria Paket -
145 Metformin Hcl Tablet 500 mg Paket 207.3
146 Methisoprinol 500 mg Paket 0.8
147 Metilergometrin Maleat (Metergin) Table Botol 18.3
148 Metilergometrin Maleat Injeksi 0,200 mg Vial -
149 Metilprednisolon tablet 4 mg Tube 233.3
150 Metoklopramid 10 mg Tube 77.8
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 5.8
152 Metronidazol Tablet 250 mg Tablet 34.2
153 Metronidazole Tablet 500 mg Botol 176.5
154 Metronidazole Infus 500 mg /100 ml Tablet -
155 Mikonazole KrIm 2 % - 10 gr Tablet 3.2
156 Multivitamin + Mineral tablet Tablet 942.6
157 Multivitamin sirup Tablet 56.0
158 Natrium Bikarbonat Tablet 500 mg Tablet 590.4
159 Natrum Diklofenak Tablet 25 mg Tablet 20.8
160 Natrium Diklofenak Tablet 50 mg Rol 132.5
161 Natrium Klorida Larutan infus 0,9%-Steri Botol 1.5
162 Nipedifin Tablet 10 mg Botol 178.3

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 0.4
164 Nistatin 500.000 IU/gram Tablet Salut Botol 10.8
165 Obat Antitiuberkolosis Kategori Anak Botol -
166 Obat Antitiuberkolosis Kategori 1 Dewas Tablet -
169 Obat Anti Tuberkulosis FDC Kat Anak Tablet -
170 Obat Anti Tuberkulosis FDC Kat I & II Tablet -
171 Obat Anti Tuberkulosis FDC Kat I & III Tablet -
172 Obat Anti Tuberkolosis FDC Sisipan De Tablet -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 86.0
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 32.9
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 21.3
176 Obat Flu Sirup Tablet 3.8
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10Pot -
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 15.1

179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Botol -
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 19.4
181 Omeprazole injeksi 40mg/10ml Vial 0.1
182 Omeprazole Kapsul 20 mg Vial -
183 Ondansetron inj 4 mg/ 2 mL Ampul 0.4
184 Parasetamol drop 100 mg/ml btl @15ml Vial 20.2
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 199.2
186 Parasetamol Tablet 100 mg Sachet -
187 Parasetamol Tablet 500 mg Botol 10,227.8
188 Pehacain injeksi Buah 67.1
189 Perak Sulfadiazin krim 1 % 35 gr (BurnazBotol 3.7
190 Piracetam 400 mg Tablet 20.8
191 Piracetam Tablet 800 mg Botol 16.7
192 Piroksikam Tablet 20 mg Vial 160.8
193 Pirantel Pamoat Tablet 365 mg (Setara Set -
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 2,421.8
195 Polikresulen (Kondensasi Metakresol Su Set 0.2

196 Povidon Iodida 10% 30 ml Kapsul 1.3
197 Povidon Iodida 10% 300 ml Ampul 0.2
198 Predison Tablet -
199 Primakuin tablet 15 mg Tablet -
200 Propanolol Hcl Tablet 40 mg Botol -
201 Propilturasil Tablet 100 mg Kuur 0.8
202 Ranitidin Injeksi 25 mg / ml Set 3.3
203 Ranitidin Tablet 150 mg Tablet 601.2
204 Retinol (Vit. A) 100.000 IU Kapsul Buah -
205 Retinol (Vit. A) 200.000 IU Kapsul Buah -
206 Reserpin Tablet 0, 25 mg Buah 224.3
207 Rifampisin Tablet 450 mg Buah -
208 Ringer Laktat Larutan Infus Steril 500 ml Set 4.4
209 Salbutamol Tablet 2 mg Tablet -
210 Salbutamol Tablet 4 mg Botol 166.7
211 Salbutamol solution for Inhalation single Tablet 1.7
212 Salep 2-4 Kombinasi : Asam Salisilat 2 Tablet 18.7
213 Salisil bedak 2% -50 gr Botol 45.4
214 Salep Luka Bakar (Neocenta/Bioplant) vial -
215 Sefadroksil Sirup Kering 125 mg / 5 ml sBotol 11.8
216 Sefadroksil Tablet 500 mg Kapsul 180.8
217 Sefiksim Kapsul 100 mg Vial -
218 Sefotaksim Injeksi 1 gr Tablet -
219 Seftriakson Injeksi 1 gr / vial Tablet -
220 Semen Seng Fosfat Serbuk & Cairan Tablet -
221 Setirizin Tablet 10 mg Botol 20.5
222 Setirizin Sirup 5 mg / 5 ml Tablet 4.4
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 5.4

224 Sianokobalamin Tablet 50 mcg Tablet -
225 Silver Amalgam Serbuk 65-75% Tablet -
226 Simetidin 200 mg Tablet Tablet 208.3
227 Simvastatin Tablet 10 mg Tablet 179.2
228 Siprofloksasin 500mg Tablet 12.5
229 Spironolakton Tablet 25 mg Botol 11.7
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet 1.7
231 Tablet Tambah Darah Kombinasi: Besi II Tablet -
232 Temporary Stopping Fletcher (Fletcher) Kapsul -
233 Trikesol formalin ( T K F ) Cairan 10 ml Kapsul -
234 Tetrasiklin Kapsul 250 mg Tube 288.7
235 Tetrasiklin Kapsul 500 mg Tablet 291.7
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1 Tablet 17.5
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 5 set 3,552.3
238 Thiamfenikol Kapsul 500 mg set 55.0
239 Tramadol Injeksi 50 mg/ ml Botol -
240 Tramadol Tablet 50 mg Tablet -
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 5.8
242 Vitamin B .Komplek Tablet Tablet 1,888.3
243 Vitamin Neurotropik Tablet Botol 623.7
244 Zinc Tablet 20 mg Tablet 239.8
245 Prednison tab 5 mg Tablet 1,151.8
246 Gentian Violet Tablet -
247 Furosemid injek 10mg/ml Tablet -
248 Glass Ionoer semen Botol 0.1
249 Bahan Tambal Sementara Kapsul 0.1
250 MgSO4-40% Kapsul 3.1
251 Botol -
252 Tablet -
253 Tablet -
254 Tablet -
255 Abbocath No 18 ( IV Chateter 18 ) Set 1.1
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 0.8
259 Alat Suntik Sekali Pakai 10 ml Tablet -
260 Alat Suntik Sekali Pakai 1 ml Vial 25.0
261 Alat Suntik Sekali Pakai 2,5 ml Tube 104.2
262 Alat Suntik Sekali Pakai 5 ml Botol 8.8
263 Alat Suntik Sekali Pakai 10 ml Tablet -
264 Catgut/Benang Bedah No.2/0-3/0 (Plain Botol 5.0
265 Etakridin Larutan (Rivanol) 0,1% - 300 m Pot 4.3
266 Etanol 70 % 1.000 ml Tablet 1.2
267 Folley Catheter no 14 Tablet 0.4
268 Folley Catheter no 16 Tablet -
269 Folley Catheter no 18 Tablet -
270 Infus set Anak Tablet 0.3
271 Infus set Dewasa Kotak 2.3
272 Iodina Test Tube -
273 Kassa Hidrofil Steril 16 x 16 Tablet 1.9
274 Kapas Berlemak 500 gram Tablet -
275 Kapas Pembalut / Adsorbens 250 gram Ampul 3.4
276 Kassa Kompres 40 x 40 steril Ampul 3.9
277 Kassa Pembalut 2 m x 80 cm Ampul 6.8
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 9.8
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 8.7
280 Kertas Puyer Botol -
281 Lysol 1,000 ml Botol 0.3
282 Masker Tablet 7.5
283 Plester 5 yard x 2 inchi Tablet 0.3
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 4.8
285 Safety Box Tablet -
286 Sarung tangan Steril No 6 Tablet 0.7
287 Sarung tangan Steril No 7 Buah 14.9
288 Sarung tangan Steril No 7,5 Tablet 13.8
289 Sarung tangan Non Steril S Supp 8.3
290 Sarung tangan Non Steril M Tablet 8.3
291 Sarung tangan Non Steril L Tablet 8.3
292 Urine Bag Tablet -
293 Wing Neddle No 23 Ampul -
294 Ampul 1.3
295 Tablet -
296 Tube -
297 Sashet -
298 Tablet -
299 Botol -
300 Tablet -
301 C. SERUM DAN VAKSIN Tablet -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 Tablet -
303 Serum Anti Rabies untuk manusia Tablet -
304 Serum Anti Tetanus (ATS) Injeksi 1.500 Botol -
305 Serum Anti Tetanus (ATS) Injeksi 20.000Paket -
306 Paket -
307 Paket -
308 Botol -
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN
TAHUN 2015
PUSKESMAS ........................................................
SISA STOK PEMAKAIAN KEBUTUHAN

NO NAMA OBAT SATUAN
2014 RATA-RATA 2015
1 2 3 4 5 6
2 Albendazole Tablet 400 mg Set 2,520 - (2,520)
3 Alopurinol Tablet 100 mg Set 15,360 217.4 (11,447)
4 Ambroksol Tablet 30 mg Set 7,335 583.8 3,173
5 Ambroksol sirup 15 mg/5 ml Tablet 12 80.9 1,445
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - (3)
7 Aminofillin Tablet 200 mg Tablet - 58.8 1,058
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 410 15.8 (125)
9 Amlodipin Tablet 5 mg Tablet 50 165.3 2,926
10 Amlodipin Tablet 10 mg Kapsul - 21.7 390
11 Amoksisillin Kapsul 250 mg Kaplet 9,568 1,131.3 10,796
12 Amoksisillin Kaplet 500 mg Botol 48,722 3,724.0 18,310
13 Amoksisillin Serbuk Injeksi 1000 mg Tablet 80 13.3 160
14 Amoksisillin Sirup Kering 125 mg/5ml Ampul - 114.4 2,060
15 Amoksisillin Double Strengh Sirup Kering 250Tablet 141 27.0 345

17 Ampisillin Kaplet 500 mg Supp 530 155.8 2,275
19 Ampisillin Injeksi 1000 mg Tablet 149 0.1 (148)
20 Analgetik Plus Tablet 90 0.8 (75)

21 Antasida Doen Suspensi Kombinasi : Magne Vial 36 39.7 678
22 Antasida Doen Tablet, Kombinasi : Magnes Botol 3,528 4,957.3 85,703
23 Antasida Plus Tablet Tablet - 263.3 4,740
24 Antalgin (Metampiron) Tablet 500 mg Tablet - 2,443.3 43,979
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 - (60)
26 Anti Bakteri DOEN Salep Kombinasi : Botol 5 3.8 63
27 Anti Hemoroid Doen komb Tablet - 0.8 15
28 Anti Fungi DOEN Kombinasi : Tablet 917 25.2 (464)
29 Antimigren DOEN Kombinasi : Ergotamin TartAmpul 215 42.5 550
30 Anti Diare Suspensi ( Neo Kaolimec) Vial - 2.9 53
31 Anti Diare Tablet ( Neo Diaform) Vial 19 598.6 10,756
32 Anti Dotum Oral Tablet ( Bekarbon/Norit) Botol - 361.1 6,500
33 Anti Hipertensi Kapsul (Tensigard) Sachet - 66.7 1,200
34 Antihistamin Tablet kombinasi (Soldextam) Ampul - 157.3 2,831
36 Antitusiva Sirup (Dexophan) Botol 2 50.1 900
39 Asam Askorbat (Vit. C) Tablet 50 mg Ampul 1,763 1,955.4 33,435
40 Asam Mefenamat Kapsul 500 mg Tablet - 193.6 3,485
41 Asetosal Tablet 80 mg Tablet 40 5.0 50
42 Asetosal Tablet 100 mg Tablet 200 - (200)
44 Asiklovir Krim 5 % Tablet 116 28.9 405
45 Asiklovir Tablet 200 mg Tablet 3,200 65.0 (2,030)
46 Asiklovir Tablet 400 mg Tablet 3,257 65.3 (2,083)
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Botol 190 - (190)

49 Betahistin Mesilat 6 mg Botol 970 39.2 (265)
50 Betametason Krim 0,1 %- 5g Botol - 43.2 777
51 Bisakodil suppositoria 10 mg Botol 70 0.8 (55)
53 Bromheksin 8 mg Kapsul 4,910 380.4 1,938
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 - (128)
55 Deksametason Tablet 0,5 mg Tablet 68,325 4,639.6 15,188
56 Devitalisasi Pasta (Non Arsen) Tablet - 0.1 2
57 Diazepam tablet 2 mg Tablet 66 28.8 453
59 Diazepam Larutan Rektal 5 mg/ml Botol 60 - (60)
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Tablet 915 5.0 (825)
62 Digoksin Tablet 0,25 mg Tablet 160 3.3 (100)
63 Dimenhidrinat Tablet 50 mg Botol 900 33.3 (300)
64 Domperidon Tablet 10 mg Tablet 280 143.8 2,308
65 Donperidon Suspensi 5 mg/5ml Botol 288 1.0 (270)
66 Efedrin Hcl Tablet 25 mg Kantong 533 8.5 (380)
68 Epinefrin HCl / Bitartrat Botol 24 0.1 (23)
70 Eritromisin Kapsul 500 mg Tablet 400 - (400)
73 Etanol 70 % 100 ml Botol 28 3.0 26
74 Etil Klorida Semprot -100 ml Botol - 1.3 24
75 Eugenol Cairan -10 ml Tablet 12 0.1 (11)
76 Fenitoin Natrium Kapsul 100 mg Stick 1,060 10.8 (865)
77 Fenobarbital tablet 30 mg Tablet 210 20.0 150
78 Fenobarbital injeksi 50 mg / ml Tablet 30 - (30)
79 Fenoksimeti Penisilin 250 mg tablet Tablet 930 33.3 (330)
80 Fenoksimeti Penisilin 500 mg tablet Tube 220 40.0 500
81 Fitomenadion tablet 10 mg Tablet 85 20.4 283
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Tablet 90 0.8 (75)
83 Furosemid Tablet 40 mg Set 1,675 72.5 (370)
84 Garam Oralit I serbuk, kombinasi : Set - 134.4 2,420
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 - (20)
87 Gentamisin Salep Kulit 0,1 % Botol - 58.8 1,058
88 Glibenklamid Tablet 5 mg Biji 175 332.8 5,816
89 Glimepiride 2 mg Pot 94 46.3 739
90 Gliseril Guayakolat Tablet 100 mg Tube 3,653 4,880.8 84,202
91 Gliseril Guayakolat sirup Tablet 65 34.9 564
93 Glukosa Larutan Infus 5 % Bungkus 48 0.2 (45)
94 Glukosa Larutan Infus10 % Tablet 19 0.4 (12)
95 Griseofulvin Tablet 125 mg,micronized Bungkus - 147.3 2,652
96 Haloperidol Tablet 0,5 mg Rol 175 3.3 (115)
97 Haloperidol Tablet 1,5 mg Rol 20 7.5 115
98 Haloperidol Tablet 5 mg Rol 449 4.3 (373)
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 1,478 340.5 4,651
100 Hidrokortison Krim 2,5 % Tube 1,226 37.5 (551)
101 Ibuprofen Tablet 200 mg Botol 5,900 375.0 850
102 Ibuprofen Tablet 400 mg Tablet 7,818 1,441.7 18,132
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 10 3.3 50
104 Ichtyol salep Kulit Ampul (1) 3.3 60

105 Ipatropium Bromide + Salbutamol Ampul 20 - (20)
107 Isosorbid Dinitrat 5 mg Tablet 300 - (300)
109 Kalium Diklofenak Tablet 50 mg Tablet 2,880 160.0 -
110 Kalsium Hidroksida Pasta Botol - 0.1 2
111 Kalsium Laktat Tablet 500 mg Tablet 3,161 1,982.8 32,529
112 Kaptopril 12,5 mg Ampul (90) 439.6 8,003

113 Kaptopril 25 mg Botol 200 - (200)
114 Karbamazepin Tablet 200 mg Botol - 13.3 240
115 Ketokonazole Krim 2 % - 15 gr Botol (5) 7.9 148
116 Ketokonazole Tablet 200 mg Botol - 66.6 1,199
120 Ketorolac 30 mg injeksi Botol 20 0.8 (5)
123 Kloramfenikol Kapsul 250 mg Ampul (12) 204.3 3,690
124 Kloramfenikol Salep Mata 1%-3,5 g Botol (8) 0.7 20
125 Kloramfenikol Tetes Mata -5 ml Ampul 296 39.3 412
126 Kloramfenikol Tetes Telinga 3%-5 ml Ampul 22 27.1 466
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Bungkus 3,486 7,807.9 137,057
128 Klorpromazin Hcl Tablet Salut 25 mg Botol 1,293 68.1 (68)
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 260 71.7 1,030
131 Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet - 82.9 1,493
132 Kotrimoksazol Tablet, Kombinasi : Ampul - 15.4 278
133 Kotrimoksazol Suspensi Kombinasi : Tablet 1,221 82.8 269
134 Lansoprazole 30 mg Kapsul Botol 5,879 65.9 (4,693)
135 Larutan mengadung Elektrolit Botol 20 - (20)
136 Larutan mengadung Elektrolit Tablet 11 0.8 3
137 Larutan mengadung Karbohidrat + Elektrolit Botol - - -
138 Lidokain injeksi 2 % Botol 2,000 - (2,000)
139 Lidokain Komp Injeksi, Kombinasi : Botol 1,980 1.7 (1,950)
140 Loperamid Tablet 2 mg Tablet 1,812 44.4 (1,013)
141 Loratadin tablet 10 mg Tablet 379 42.5 386
143 Meloksikam tablet 15 mg Paket 675 152.5 2,070
145 Metformin Hcl Tablet 500 mg Paket 11,912 207.3 (8,180)
146 Methisoprinol 500 mg Paket 340 0.8 (325)
147 Metilergometrin Maleat (Metergin) Tablet 0, Botol 464 18.3 (134)
148 Metilergometrin Maleat Injeksi 0,200 mg-1ml Vial 700 - (700)
149 Metilprednisolon tablet 4 mg Tube 600 233.3 3,600
150 Metoklopramid 10 mg Tube 1,467 77.8 (68)
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 130 5.8 (25)
152 Metronidazol Tablet 250 mg Tablet - 34.2 615
153 Metronidazole Tablet 500 mg Botol (100) 176.5 3,277
155 Mikonazole KrIm 2 % - 10 gr Tablet 613 3.2 (556)
156 Multivitamin + Mineral tablet Tablet (391) 942.6 17,358
157 Multivitamin sirup Tablet 110 56.0 898
158 Natrium Bikarbonat Tablet 500 mg Tablet 3,008 590.4 7,620
159 Natrum Diklofenak Tablet 25 mg Tablet (150) 20.8 525
160 Natrium Diklofenak Tablet 50 mg Rol 4,610 132.5 (2,225)
161 Natrium Klorida Larutan infus 0,9%-Steril 500 Botol 213 1.5 (186)
162 Nipedifin Tablet 10 mg Botol 4,508 178.3 (1,300)

163 Nistatin 100.000 IU/gram Tablet Vagina Botol 195 0.4 (188)
164 Nistatin 500.000 IU/gram Tablet Salut Botol 277 10.8 (82)
172 Obat Anti Tuberkolosis FDC Sisipan Dewasa Tablet - - -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Kapsul 562 86.0 986
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 72 32.9 521
175 Obat Batuk Hitam Plus Sirup (Excosin) Botol 245 21.3 138
176 Obat Flu Sirup Tablet - 3.8 68
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Pot 50 - (50)
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak - 15.1 272

180 Oksitosin Injeksi 10 IU/ml-1ml Botol 65 19.4 285
181 Omeprazole injeksi 40mg/10ml Vial 29 0.1 (28)
182 Omeprazole Kapsul 20 mg Vial 510 - (510)
183 Ondansetron inj 4 mg/ 2 mL Ampul 140 0.4 (133)
184 Parasetamol drop 100 mg/ml btl @15ml (60mVial 2 20.2 361
185 Parasetamol Sirup 120 mg/5ml-60 ml Ampul 339 199.2 3,246
187 Parasetamol Tablet 500 mg Botol 64,768 10,227.8 119,332
188 Pehacain injeksi Buah 125 67.1 1,083
189 Perak Sulfadiazin krim 1 % 35 gr (Burnazin) Botol 15 3.7 51
190 Piracetam 400 mg Tablet 50 20.8 325
191 Piracetam Tablet 800 mg Botol - 16.7 300
192 Piroksikam Tablet 20 mg Vial 69 160.8 2,826
193 Pirantel Pamoat Tablet 365 mg (Setara dng Set 396 - (396)
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet - 2,421.8 43,592
195 Polikresulen (Kondensasi Metakresol Sulfona Set 10 0.2 (7)

196 Povidon Iodida 10% 30 ml Kapsul 6 1.3 17
197 Povidon Iodida 10% 300 ml Ampul 4 0.2 (1)
200 Propanolol Hcl Tablet 40 mg Botol 197 - (197)
201 Propilturasil Tablet 100 mg Kuur 120 0.8 (105)
202 Ranitidin Injeksi 25 mg / ml Set 260 3.3 (200)
203 Ranitidin Tablet 150 mg Tablet 13,966 601.2 (3,145)
206 Reserpin Tablet 0, 25 mg Buah - 224.3 4,038
208 Ringer Laktat Larutan Infus Steril 500 ml Set 417 4.4 (338)
210 Salbutamol Tablet 4 mg Botol (10) 166.7 3,010
211 Salbutamol solution for Inhalation single dose Tablet - 1.7 30
212 Salep 2-4 Kombinasi : Asam Salisilat 2 % + Tablet 940 18.7 (604)
213 Salisil bedak 2% -50 gr Botol 102 45.4 716
215 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 106 11.8 106
216 Sefadroksil Tablet 500 mg Kapsul 8,931 180.8 (5,678)
217 Sefiksim Kapsul 100 mg Vial 1,000 - (1,000)
221 Setirizin Tablet 10 mg Botol 370 20.5 (1)
222 Setirizin Sirup 5 mg / 5 ml Tablet (2) 4.4 82
223 Sianokobalamin Injeksi 500 mcg/ml-1ml Botol 785 5.4 (688)

226 Simetidin 200 mg Tablet Tablet (100) 208.3 3,850
227 Simvastatin Tablet 10 mg Tablet 140 179.2 3,085
228 Siprofloksasin 500mg Tablet 9,150 12.5 (8,925)
229 Spironolakton Tablet 25 mg Botol 550 11.7 (340)
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet - 1.7 30
231 Tablet Tambah Darah Kombinasi: Besi II Sul Tablet - - -
232 Temporary Stopping Fletcher (Fletcher) SerbKapsul - - -
234 Tetrasiklin Kapsul 250 mg Tube - 288.7 5,196
235 Tetrasiklin Kapsul 500 mg Tablet 15,558 291.7 (10,308)
236 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Tablet - 17.5 315
237 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg
set 6,976 3,552.3 56,965
238 Thiamfenikol Kapsul 500 mg set 240 55.0 750
241 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 40 5.8 65
242 Vitamin B .Komplek Tablet Tablet 460 1,888.3 33,530
243 Vitamin Neurotropik Tablet Botol 796 623.7 10,430
244 Zinc Tablet 20 mg Tablet (70) 239.8 4,387
245 Prednison tab 5 mg Tablet - 1,151.8 20,732
247 Furosemid injek 10mg/ml Tablet 24 - (24)
248 Glass Ionoer semen Botol - 0.1 2
249 Bahan Tambal Sementara Kapsul - 0.1 2
250 MgSO4-40% Kapsul - 3.1 56
251 Botol 198 - (198)
252 Tablet - - -
253 Tablet - - -
254 Tablet - - -
255 Abbocath No 18 ( IV Chateter 18 ) Set 97 1.1 (78)
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 99 0.8 (84)
260 Alat Suntik Sekali Pakai 1 ml Vial - 25.0 450
261 Alat Suntik Sekali Pakai 2,5 ml Tube 300 104.2 1,575
262 Alat Suntik Sekali Pakai 5 ml Botol 95 8.8 63
264 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cr Botol 67 5.0 23
265 Etakridin Larutan (Rivanol) 0,1% - 300 ml Pot 10 4.3 68
266 Etanol 70 % 1.000 ml Tablet - 1.2 21
267 Folley Catheter no 14 Tablet - 0.4 8
269 Folley Catheter no 18 Tablet 2 - (2)
270 Infus set Anak Tablet 91 0.3 (85)
271 Infus set Dewasa Kotak 188 2.3 (148)
272 Iodina Test Tube - - -
273 Kassa Hidrofil Steril 16 x 16 Tablet 47 1.9 (13)
274 Kapas Berlemak 500 gram Tablet - - -
275 Kapas Pembalut / Adsorbens 250 gram Ampul 22 3.4 40
276 Kassa Kompres 40 x 40 steril Ampul 153 3.9 (83)
277 Kassa Pembalut 2 m x 80 cm Ampul 201 6.8 (80)
278 Kassa Pembalut Hidrofil 4 m x 3 cm Kapsul 267 9.8 (90)
279 Kassa Pembalut Hidrofil 4 m x 15 cm Kapsul 135 8.7 21
280 Kertas Puyer Botol - - -
281 Lysol 1,000 ml Botol 3 0.3 2
282 Masker Tablet 90 7.5 45
283 Plester 5 yard x 2 inchi Tablet - 0.3 5
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 40 4.8 46
285 Safety Box Tablet - - -
286 Sarung tangan Steril No 6 Tablet 37 0.7 (25)
287 Sarung tangan Steril No 7 Buah 16 14.9 253
288 Sarung tangan Steril No 7,5 Tablet 35 13.8 214
289 Sarung tangan Non Steril S Supp - 8.3 150
290 Sarung tangan Non Steril M Tablet - 8.3 150
291 Sarung tangan Non Steril L Tablet - 8.3 150
292 Urine Bag Tablet - - -
293 Wing Neddle No 23 Ampul 30 - (30)
294 Polifix Ampul 59 1.3 (37)
295 Tablet - - -
296 Tube - - -
297 Sashet - - -
298 Tablet - - -
299 Botol - - -
300 Tablet - - -
302 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ATablet 9 - (9)
303 Serum Anti Rabies untuk manusia Tablet 2 - (2)
304 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/a Botol 27 - (27)
305 Serum Anti Tetanus (ATS) Injeksi 20.000 IU/ Paket - - -
306 Paket - - -
307 Paket - - -
308 Botol - - -
309 Kapsul - - -
310 Tablet - - -
311 Botol - - -
312 Tablet - - -
313 Ampul - - -
314 Ampul - - -
315 Tablet - - -
316 Tablet - - -
317 Tablet - - -
318 Ampul - - -
319 Tablet - - -
320 Tablet - - -
321 Tablet - - -
322 Tube - - -
323 Pcs - - -
324 Pcs - - -
325 Pcs - - -
326 Botol - - -
327 Tablet - - -
328 Kapsul - - -
329 Ampul - - -
330 Ampul - - -
331 Tablet - - -
332 Tablet - - -
333 Tablet - - -
334 Tablet - - -
335 Tablet - - -
336 Kapsul - - -
337 Kapsul - - -
338 Ampul - - -
339 Tablet - - -
340 set - - -
341 Set - - -
342 Tablet - - -
343 - - -
344 - - -
345 - - -
346 - - -
347 - - -
348 - - -
349 - - -
350 - - -
- - -
- - -
Mengetahui Kuningan,....................................
Kepala UPTD Puskesmas Petugas Pengelola Obat Puskesmas
............................................................... ................................................
NIP NIP
PERSENTASE KETERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN
TAHUN 2014
PUSKESMAS : .................................
KECAMATAN :..................................
KABUPATEN :..................................
PERSEDIAAN PEMAKAIAN TINGKAT PERSENTASE

NO NAMA OBAT SATUAN STOCK OBAT RATA-RATA KECUKUPAN (%) TINGKAT
2014 PER BULAN (BULAN) KECUKUPAN
1 2 3 4 5 6 6
1 Air Raksa Dental Use Botol - - #DIV/0! #DIV/0!
2 Albendazole Tablet 400 mg Set 2,520 - #DIV/0! #DIV/0!
3 Alopurinol Tablet 100 mg Set 17,969 217.4 83 459%
4 Ambroksol Tablet 30 mg Set 14,340 583.8 25 136%
5 Ambroksol sirup 15 mg/5 ml Tablet 983 80.9 12 67%
6 Aminofillin Injeksi 24 mg/ml-10 ml Tablet 3 - #DIV/0! #DIV/0!
7 Aminofillin Tablet 200 mg Tablet 705 58.8 12 67%
8 Amitriptillin Hcl Tablet Salut 25 mg Ampul 600 15.8 38 211%
9 Amlodipin Tablet 5 mg Tablet 2,034 165.3 12 68%
10 Amlodipin Tablet 10 mg Kapsul 260 21.7 12 67%
11 Amoksisillin Kapsul 250 mg Kaplet 23,144 1,131.3 20 114%
12 Amoksisillin Kaplet 500 mg Botol 93,410 3,724.0 25 139%
13 Amoksisillin Serbuk Injeksi 1000 m Tablet 240 13.3 18 100%
14 Amoksisillin Sirup Kering 125 mg/5 Ampul 1,373 114.4 12 67%
15 Amoksisillin Double Strengh Sirup Tablet 465 27.0 17 96%
16 Ampisilin Kapsul 250 mg Tube - - #DIV/0! #DIV/0!

17 Ampisillin Kaplet 500 mg Supp 2,400 155.8 15 86%
18 Ampisilin Sirup 125 mg / 5 ml Pot - - #DIV/0! #DIV/0!
19 Ampisillin Injeksi 1000 mg Tablet 150 0.1 1,800 10000%
20 Analgetik Plus Tablet 100 0.8 120 667%

21 Antasida Doen Suspensi KombinasVial 512 39.7 13 72%
22 Antasida Doen Tablet, Kombinasi Botol 63,015 4,957.3 13 71%
23 Antasida Plus Tablet Tablet 3,160 263.3 12 67%
24 Antalgin (Metampiron) Tablet 500 Tablet 29,319 2,443.3 12 67%
25 Antalgin Injeksi 250 mg/ml-2ml Botol 60 - #DIV/0! #DIV/0!
26 Anti Bakteri DOEN Salep KombinasiBotol
: 50 3.8 13 74%
27 Anti Hemoroid Doen komb Tablet 10 0.8 12 67%
28 Anti Fungi DOEN Kombinasi : Tablet 1,219 25.2 48 269%
29 Antimigren DOEN Kombinasi : ErgotAmpul 725 42.5 17 95%
30 Anti Diare Suspensi ( Neo KaolimecVial 35 2.9 12 67%
31 Anti Diare Tablet ( Neo Diaform) Vial 7,202 598.6 12 67%
32 Anti Dotum Oral Tablet ( Bekarbon/ Botol 4,333 361.1 12 67%
33 Anti Hipertensi Kapsul (Tensigard) Sachet 800 66.7 12 67%
34 Antihistamin Tablet kombinasi (So Ampul 1,887 157.3 12 67%
35 Antispasmodik Tablet (Spasminal) Tablet - - #DIV/0! #DIV/0!
36 Antitusiva Sirup (Dexophan) Botol 603 50.1 12 67%
37 Antitusiva Tablet (Dekorin) Tablet - - #DIV/0! #DIV/0!
38 Asam Folat Tablet 1 mg Botol - - #DIV/0! #DIV/0!
39 Asam Askorbat (Vit. C) Tablet 50 Ampul 25,228 1,955.4 13 72%
40 Asam Mefenamat Kapsul 500 mg Tablet 2,323 193.6 12 67%
41 Asetosal Tablet 80 mg Tablet 100 5.0 20 111%
42 Asetosal Tablet 100 mg Tablet 200 - #DIV/0! #DIV/0!
43 Asetosal Tablet 500 mg Ampul - - #DIV/0! #DIV/0!
44 Asiklovir Krim 5 % Tablet 463 28.9 16 89%
45 Asiklovir Tablet 200 mg Tablet 3,980 65.0 61 340%
46 Asiklovir Tablet 400 mg Tablet 4,040 65.3 62 344%
47 Atropin Sulfat Injeksi 0,25 mg/ml-1 Ampul - - #DIV/0! #DIV/0!
48 Aqua Pro Injeksi Steril, bebas Piro Botol 190 - #DIV/0! #DIV/0!
49 Betahistin Mesilat 6 mg Botol 1,440 39.2 37 204%
50 Betametason Krim 0,1 %- 5g Botol 518 43.2 12 67%
51 Bisakodil suppositoria 10 mg Botol 80 0.8 96 533%
52 Bisoprolol Tablet 5 mg Kapsul - - #DIV/0! #DIV/0!
53 Bromheksin 8 mg Kapsul 9,475 380.4 25 138%
54 Deksametason Injeksi 5mg/ml-1ml Ampul 128 - #DIV/0! #DIV/0!
55 Deksametason Tablet 0,5 mg Tablet 124,000 4,639.6 27 148%
56 Devitalisasi Pasta (Non Arsen) Tablet 1 0.1 12 67%
57 Diazepam tablet 2 mg Tablet 412 28.8 14 79%
58 Diazepam Injeksi i.v/i.m 5 mg/ml Tablet - - #DIV/0! #DIV/0!
59 Diazepam Larutan Rektal 5 mg/ml Botol 60 - #DIV/0! #DIV/0!
60 Dietilkarbamazin Sitrat Tablet 100 Ampul - - #DIV/0! #DIV/0!
61 Difenhidramin HCl Injeksi 10 mg/ml Tablet 975 5.0 195 1083%
62 Digoksin Tablet 0,25 mg Tablet 200 3.3 60 333%
63 Dimenhidrinat Tablet 50 mg Botol 1,300 33.3 39 217%
64 Domperidon Tablet 10 mg Tablet 2,005 143.8 14 77%
65 Donperidon Suspensi 5 mg/5ml Botol 300 1.0 300 1667%
66 Efedrin Hcl Tablet 25 mg Kantong 635 8.5 75 415%
67 Ekstrak Belladone Tablet 10 mg Kantong - - #DIV/0! #DIV/0!
68 Epinefrin HCl / Bitartrat Botol 25 0.1 300 1667%
69 Eritromisin Kapsul 250 mg Set - - #DIV/0! #DIV/0!
70 Eritromisin Kapsul 500 mg Tablet 400 - #DIV/0! #DIV/0!
71 Eritromisin Sirup 200 mg / 5 ml Tablet - - #DIV/0! #DIV/0!
72 Etambutol Tablet 500 mg Botol - - #DIV/0! #DIV/0!
73 Etanol 70 % 100 ml Botol 64 3.0 21 119%
74 Etil Klorida Semprot -100 ml Botol 16 1.3 12 67%
75 Eugenol Cairan -10 ml Tablet 13 0.1 156 867%
76 Fenitoin Natrium Kapsul 100 mg Stick 1,190 10.8 110 610%
77 Fenobarbital tablet 30 mg Tablet 450 20.0 23 125%
78 Fenobarbital injeksi 50 mg / ml Tablet 30 - #DIV/0! #DIV/0!
79 Fenoksimeti Penisilin 250 mg tabletTablet 1,330 33.3 40 222%
80 Fenoksimeti Penisilin 500 mg tableTube 700 40.0 18 97%
81 Fitomenadion tablet 10 mg Tablet 330 20.4 16 90%
82 Fitomenadion (Vit K1) Injeksi 2 mg Tablet 100 0.8 120 667%
83 Furosemid Tablet 40 mg Set 2,545 72.5 35 195%
84 Garam Oralit I serbuk, kombinasi : Set 1,613 134.4 12 67%
85 Gemfibrozil Tablet 600 mg Vial - - #DIV/0! #DIV/0!
86 Gentamisin injeksi 80 mg / 2 ml Kapsul 20 - #DIV/0! #DIV/0!
87 Gentamisin Salep Kulit 0,1 % Botol 705 58.8 12 67%
88 Glibenklamid Tablet 5 mg Biji 4,169 332.8 13 70%
89 Glimepiride 2 mg Pot 649 46.3 14 78%
90 Gliseril Guayakolat Tablet 100 mg Tube 62,223 4,880.8 13 71%
91 Gliseril Guayakolat sirup Tablet 484 34.9 14 77%
92 Glukonas Kalsikus injeksi Bungkus - - #DIV/0! #DIV/0!
93 Glukosa Larutan Infus 5 % Bungkus 50 0.2 300 1667%
94 Glukosa Larutan Infus10 % Tablet 24 0.4 58 320%
95 Griseofulvin Tablet 125 mg,microni Bungkus 1,768 147.3 12 67%
96 Haloperidol Tablet 0,5 mg Rol 215 3.3 65 358%
97 Haloperidol Tablet 1,5 mg Rol 110 7.5 15 81%
98 Haloperidol Tablet 5 mg Rol 500 4.3 118 654%
99 Hidroklortiazid (HCT) Tablet 25 mg Kapsul 5,564 340.5 16 91%
100 Hidrokortison Krim 2,5 % Tube 1,676 37.5 45 248%
101 Ibuprofen Tablet 200 mg Botol 10,400 375.0 28 154%
102 Ibuprofen Tablet 400 mg Tablet 25,118 1,441.7 17 97%
103 Ibuprofen Suspensi 100 mg/5 ml Tablet 50 3.3 15 83%
104 Ichtyol salep Kulit Ampul 38 3.3 12 65%

105 Ipatropium Bromide + Salbutamol Ampul 20 - #DIV/0! #DIV/0!
106 Isoniazid tablet 100 mg Tablet - - #DIV/0! #DIV/0!
107 Isosorbid Dinitrat 5 mg Tablet 300 - #DIV/0! #DIV/0!
108 Kalium Diklofenak Tablet 25 mg Tablet - - #DIV/0! #DIV/0!
109 Kalium Diklofenak Tablet 50 mg Tablet 4,800 160.0 30 167%
110 Kalsium Hidroksida Pasta Botol 1 0.1 12 67%
111 Kalsium Laktat Tablet 500 mg Tablet 26,954 1,982.8 14 76%
112 Kaptopril 12,5 mg Ampul 5,185 439.6 12 66%

113 Kaptopril 25 mg Botol 200 - #DIV/0! #DIV/0!
114 Karbamazepin Tablet 200 mg Botol 160 13.3 12 67%
115 Ketokonazole Krim 2 % - 15 gr Botol 90 7.9 11 63%
116 Ketokonazole Tablet 200 mg Botol 799 66.6 12 67%
117 Ketoprofen Tablet 100 mg Botol - - #DIV/0! #DIV/0!
118 Ketoprofen Injeksi 100 mg / 1 ml Botol - - #DIV/0! #DIV/0!
119 Ketorolac 10 mg injeksi Botol - - #DIV/0! #DIV/0!
120 Ketorolac 30 mg injeksi Botol 30 0.8 36 200%
121 Klindamisin Kapsul 150 mg Botol - - #DIV/0! #DIV/0!
122 Klindamisin Kapsul 300 mg Tablet - - #DIV/0! #DIV/0!
123 Kloramfenikol Kapsul 250 mg Ampul 2,440 204.3 12 66%
124 Kloramfenikol Salep Mata 1%-3,5 gBotol - 0.7 - 0%
125 Kloramfenikol Tetes Mata -5 ml Ampul 768 39.3 20 108%
126 Kloramfenikol Tetes Telinga 3%-5 Ampul 347 27.1 13 71%
127 Klorfeniramin Maleat (CTM) Tablet Bungkus 97,181 7,807.9 12 69%
128 Klorpromazin Hcl Tablet Salut 25 Botol 2,110 68.1 31 172%
129 Klorpromazin Hcl Tablet Salut 100 Tablet 1,120 71.7 16 87%
130 Klorpromazin Hcl Injeksi 5 mg/ml-2 Tablet - - #DIV/0! #DIV/0!
131 Kotrimoksazol Pedriatik Tablet, Ko Tablet 995 82.9 12 67%
132 Kotrimoksazol Tablet, Kombinasi : Ampul 185 15.4 12 67%
133 Kotrimoksazol Suspensi Kombinasi Tablet
: 2,214 82.8 27 149%
134 Lansoprazole 30 mg Kapsul Botol 6,670 65.9 101 562%
135 Larutan mengadung Elektrolit Botol 20 - #DIV/0! #DIV/0!
136 Larutan mengadung Elektrolit Tablet 20 0.8 27 148%
137 Larutan mengadung Karbohidrat + Elektro
Botol - - #DIV/0! #DIV/0!
138 Lidokain injeksi 2 % Botol 2,000 - #DIV/0! #DIV/0!
139 Lidokain Komp Injeksi, Kombinasi : Botol 2,000 1.7 1,200 6667%
140 Loperamid Tablet 2 mg Tablet 2,345 44.4 53 293%
141 Loratadin tablet 10 mg Tablet 889 42.5 21 116%
142 Magnesium Sulfat (IV) 20 %-25 ml Paket - - #DIV/0! #DIV/0!
143 Meloksikam tablet 15 mg Paket 2,505 152.5 16 91%
144 Meloksikam Suppositoria Paket - - #DIV/0! #DIV/0!
145 Metformin Hcl Tablet 500 mg Paket 14,400 207.3 69 386%
146 Methisoprinol 500 mg Paket 350 0.8 420 2333%
147 Metilergometrin Maleat (Metergin) Botol 684 18.3 37 207%
148 Metilergometrin Maleat Injeksi 0,2 Vial 700 - #DIV/0! #DIV/0!
149 Metilprednisolon tablet 4 mg Tube 3,400 233.3 15 81%
150 Metoklopramid 10 mg Tube 2,400 77.8 31 171%
151 Metoklorpropamid Injeksi 5 mg/ 5 Ampul 200 5.8 34 190%
152 Metronidazol Tablet 250 mg Tablet 410 34.2 12 67%
153 Metronidazole Tablet 500 mg Botol 2,018 176.5 11 64%
154 Metronidazole Infus 500 mg /100 mTablet - - #DIV/0! #DIV/0!
155 Mikonazole KrIm 2 % - 10 gr Tablet 651 3.2 206 1142%
156 Multivitamin + Mineral tablet Tablet 10,920 942.6 12 64%
157 Multivitamin sirup Tablet 782 56.0 14 78%
158 Natrium Bikarbonat Tablet 500 mg Tablet 10,093 590.4 17 95%
159 Natrum Diklofenak Tablet 25 mg Tablet 100 20.8 5 27%
160 Natrium Diklofenak Tablet 50 mg Rol 6,200 132.5 47 260%
161 Natrium Klorida Larutan infus 0,9%-Botol 231 1.5 154 856%
162 Nipedifin Tablet 10 mg Botol 6,647 178.3 37 207%

163 Nistatin 100.000 IU/gram Tablet Va Botol 200 0.4 480 2667%
164 Nistatin 500.000 IU/gram Tablet Sa Botol 407 10.8 38 209%
165 Obat Antitiuberkolosis Kategori An Botol - - #DIV/0! #DIV/0!
166 Obat Antitiuberkolosis Kategori 1 Tablet - - #DIV/0! #DIV/0!
169 Obat Anti Tuberkulosis FDC Kat Tablet - - #DIV/0! #DIV/0!
170 Obat Anti Tuberkulosis FDC Kat I Tablet - - #DIV/0! #DIV/0!
171 Obat Anti Tuberkulosis FDC Kat I & Tablet - - #DIV/0! #DIV/0!
172 Obat Anti Tuberkolosis FDC Sisip Tablet - - #DIV/0! #DIV/0!
173 Obat Batuk Hitam (OBH) Cairan 10 Kapsul 1,594 86.0 19 103%
174 Obat Batuk Cair Sirup (Coredryl) Kapsul 467 32.9 14 79%
175 Obat Batuk Hitam Plus Sirup (Exc Botol 500 21.3 24 131%
176 Obat Flu Sirup Tablet 45 3.8 12 67%
177 Oksiterasiklin Hcl injeksi i.m.50 mg Pot 50 - #DIV/0! #DIV/0!
178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 181 15.1 12 67%

179 Oksitetrasiklin Hcl Salep Kulit 3%-5 Botol - - #DIV/0! #DIV/0!
180 Oksitosin Injeksi 10 IU/ml-1ml Botol 298 19.4 15 85%
181 Omeprazole injeksi 40mg/10ml Vial 30 0.1 360 2000%
182 Omeprazole Kapsul 20 mg Vial 510 - #DIV/0! #DIV/0!
183 Ondansetron inj 4 mg/ 2 mL Ampul 145 0.4 348 1933%
184 Parasetamol drop 100 mg/ml btl @ Vial 244 20.2 12 67%
185 Parasetamol Sirup 120 mg/5ml-60 Ampul 2,729 199.2 14 76%
186 Parasetamol Tablet 100 mg Sachet - - #DIV/0! #DIV/0!
187 Parasetamol Tablet 500 mg Botol 187,501 10,227.8 18 102%
188 Pehacain injeksi Buah 930 67.1 14 77%
189 Perak Sulfadiazin krim 1 % 35 gr ( Botol 59 3.7 16 89%
190 Piracetam 400 mg Tablet 300 20.8 14 80%
191 Piracetam Tablet 800 mg Botol 200 16.7 12 67%
192 Piroksikam Tablet 20 mg Vial 1,999 160.8 12 69%
193 Pirantel Pamoat Tablet 365 mg (Se Set 396 - #DIV/0! #DIV/0!
194 Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet 29,061 2,421.8 12 67%
195 Polikresulen (Kondensasi MetakresSet 12 0.2 72 400%

196 Povidon Iodida 10% 30 ml Kapsul 21 1.3 17 93%
197 Povidon Iodida 10% 300 ml Ampul 6 0.2 36 200%
198 Predison Tablet - - #DIV/0! #DIV/0!
199 Primakuin tablet 15 mg Tablet - - #DIV/0! #DIV/0!
200 Propanolol Hcl Tablet 40 mg Botol 197 - #DIV/0! #DIV/0!
201 Propilturasil Tablet 100 mg Kuur 130 0.8 156 867%
202 Ranitidin Injeksi 25 mg / ml Set 300 3.3 90 500%
203 Ranitidin Tablet 150 mg Tablet 21,180 601.2 35 196%
204 Retinol (Vit. A) 100.000 IU Kapsul Buah - - #DIV/0! #DIV/0!
205 Retinol (Vit. A) 200.000 IU Kapsul Buah - - #DIV/0! #DIV/0!
206 Reserpin Tablet 0, 25 mg Buah 2,692 224.3 12 67%
207 Rifampisin Tablet 450 mg Buah - - #DIV/0! #DIV/0!
208 Ringer Laktat Larutan Infus Steril 5 Set 470 4.4 106 591%
209 Salbutamol Tablet 2 mg Tablet - - #DIV/0! #DIV/0!
210 Salbutamol Tablet 4 mg Botol 1,990 166.7 12 66%
211 Salbutamol solution for Inhalation s Tablet 20 1.7 12 67%
212 Salep 2-4 Kombinasi : Asam Salisi Tablet 1,164 18.7 62 346%
213 Salisil bedak 2% -50 gr Botol 647 45.4 14 79%
214 Salep Luka Bakar (Neocenta/Biopla vial - - #DIV/0! #DIV/0!
215 Sefadroksil Sirup Kering 125 mg / Botol 247 11.8 21 117%
216 Sefadroksil Tablet 500 mg Kapsul 11,100 180.8 61 341%
217 Sefiksim Kapsul 100 mg Vial 1,000 - #DIV/0! #DIV/0!
218 Sefotaksim Injeksi 1 gr Tablet - - #DIV/0! #DIV/0!
219 Seftriakson Injeksi 1 gr / vial Tablet - - #DIV/0! #DIV/0!
220 Semen Seng Fosfat Serbuk & Cair Tablet - - #DIV/0! #DIV/0!
221 Setirizin Tablet 10 mg Botol 616 20.5 30 167%
222 Setirizin Sirup 5 mg / 5 ml Tablet 51 4.4 12 64%
223 Sianokobalamin Injeksi 500 mcg/mlBotol 850 5.4 157 872%

224 Sianokobalamin Tablet 50 mcg Tablet - - #DIV/0! #DIV/0!
225 Silver Amalgam Serbuk 65-75% Tablet - - #DIV/0! #DIV/0!
226 Simetidin 200 mg Tablet Tablet 2,400 208.3 12 64%
227 Simvastatin Tablet 10 mg Tablet 2,290 179.2 13 71%
228 Siprofloksasin 500mg Tablet 9,300 12.5 744 4133%
229 Spironolakton Tablet 25 mg Botol 690 11.7 59 329%
230 Sulfacetamid Tetes Mata 15 %-5ml Tablet 20 1.7 12 67%
231 Tablet Tambah Darah Kombinasi: Be Tablet - - #DIV/0! #DIV/0!
232 Temporary Stopping Fletcher (Flet Kapsul - - #DIV/0! #DIV/0!
233 Trikesol formalin ( T K F ) Cairan 1 Kapsul - - #DIV/0! #DIV/0!
234 Tetrasiklin Kapsul 250 mg Tube 3,464 288.7 12 67%
235 Tetrasiklin Kapsul 500 mg Tablet 19,058 291.7 65 363%
236 Thiamin Hcl (Vit B1) Injeksi 100 mg Tablet 210 17.5 12 67%
237 Tiamin Hcl /Mononitrat (Vit.B1) Tab set 49,603 3,552.3 14 78%
238 Thiamfenikol Kapsul 500 mg set 900 55.0 16 91%
239 Tramadol Injeksi 50 mg/ ml Botol - - #DIV/0! #DIV/0!
240 Tramadol Tablet 50 mg Tablet - - #DIV/0! #DIV/0!
241 Triheksifenidil Hidroklorida Tablet Tablet 110 5.8 19 105%
242 Vitamin B .Komplek Tablet Tablet 23,120 1,888.3 12 68%
243 Vitamin Neurotropik Tablet Botol 8,280 623.7 13 74%
244 Zinc Tablet 20 mg Tablet 2,808 239.8 12 65%
245 Prednison tab 5 mg Tablet 13,821 1,151.8 12 67%
246 Gentian Violet Tablet - - #DIV/0! #DIV/0!
247 Furosemid injek 10mg/ml Tablet 24 - #DIV/0! #DIV/0!
248 Glass Ionoer semen Botol 1 0.1 12 67%
249 Bahan Tambal Sementara Kapsul 1 0.1 12 67%
250 MgSO4-40% Kapsul 37 3.1 12 67%
251 Botol 198 - #DIV/0! #DIV/0!
252 Tablet - - #DIV/0! #DIV/0!
255 Abbocath No 18 ( IV Chateter 18 ) Set 110 1.1 102 564%
256 Abbocath No 20 ( IV Chateter 20 ) Set 108 0.4 259 1440%
257 Abbocath No 22 ( IV Chateter 22 )Set 300 1.7 180 1000%
258 Abbocath No 24 ( IV Chateter 24 ) Ampul 109 0.8 131 727%
259 Alat Suntik Sekali Pakai 10 ml Tablet - - #DIV/0! #DIV/0!
260 Alat Suntik Sekali Pakai 1 ml Vial 300 25.0 12 67%
261 Alat Suntik Sekali Pakai 2,5 ml Tube 1,550 104.2 15 83%
262 Alat Suntik Sekali Pakai 5 ml Botol 200 8.8 23 127%
263 Alat Suntik Sekali Pakai 10 ml Tablet - - #DIV/0! #DIV/0!
264 Catgut/Benang Bedah No.2/0-3/0 (PBotol 127 5.0 25 141%
265 Etakridin Larutan (Rivanol) 0,1% - Pot 62 4.3 14 79%
266 Etanol 70 % 1.000 ml Tablet 14 1.2 12 67%
267 Folley Catheter no 14 Tablet 5 0.4 12 67%
268 Folley Catheter no 16 Tablet - - #DIV/0! #DIV/0!
269 Folley Catheter no 18 Tablet 2 - #DIV/0! #DIV/0!
270 Infus set Anak Tablet 95 0.3 285 1583%
271 Infus set Dewasa Kotak 215 2.3 96 531%
272 Iodina Test Tube - - #DIV/0! #DIV/0!
273 Kassa Hidrofil Steril 16 x 16 Tablet 70 1.9 37 203%
274 Kapas Berlemak 500 gram Tablet - - #DIV/0! #DIV/0!
275 Kapas Pembalut / Adsorbens 250 Ampul 63 3.4 18 102%
276 Kassa Kompres 40 x 40 steril Ampul 200 3.9 51 284%
277 Kassa Pembalut 2 m x 80 cm Ampul 282 6.8 42 232%
278 Kassa Pembalut Hidrofil 4 m x 3 c Kapsul 385 9.8 39 218%
279 Kassa Pembalut Hidrofil 4 m x 15 Kapsul 239 8.7 28 153%
280 Kertas Puyer Botol - - #DIV/0! #DIV/0!
281 Lysol 1,000 ml Botol 6 0.3 24 133%
282 Masker Tablet 180 7.5 24 133%
283 Plester 5 yard x 2 inchi Tablet 3 0.3 12 67%
284 Silk( Benang Bedah Sutra ) No 3/0 Kapsul 97 4.8 20 113%
285 Safety Box Tablet - - #DIV/0! #DIV/0!
286 Sarung tangan Steril No 6 Tablet 45 0.7 68 375%
287 Sarung tangan Steril No 7 Buah 195 14.9 13 73%
288 Sarung tangan Steril No 7,5 Tablet 201 13.8 15 81%
289 Sarung tangan Non Steril S Supp 100 8.3 12 67%
290 Sarung tangan Non Steril M Tablet 100 8.3 12 67%
291 Sarung tangan Non Steril L Tablet 100 8.3 12 67%
292 Urine Bag Tablet - - #DIV/0! #DIV/0!
293 Wing Neddle No 23 Ampul 30 - #DIV/0! #DIV/0!
294 Ampul 74 1.3 59 329%
296 Tube - - #DIV/0! #DIV/0!
297 Sashet - - #DIV/0! #DIV/0!
299 Botol - - #DIV/0! #DIV/0!
301 C. SERUM DAN VAKSIN Tablet - - #DIV/0! #DIV/0!
302 Serum Anti Bisa Ular Polivalen InjekTablet 9 - #DIV/0! #DIV/0!
303 Serum Anti Rabies untuk manusia Tablet 2 - #DIV/0! #DIV/0!
304 Serum Anti Tetanus (ATS) Injeksi Botol 27 - #DIV/0! #DIV/0!
305 Serum Anti Tetanus (ATS) Injeksi 2Paket - - #DIV/0! #DIV/0!
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Mengetahui Kuningan,....................................
Kepala UPTD Puskesmas Petugas Pengelola Obat Puskesmas
................................................ ................................................
NIP NIP

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) FORM : LPLPO

PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

STOK STOK STOK PEMBERIAN

16 Ampisilin Kapsul 250 mg Tube - - - - - -

18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - -

19 Ampisillin Injeksi 1000 mg Tablet 30 120 150 - 150 - (150)

20 Analgetik Plus Tablet - - - - - - -

110 Kalsium Hidroksida Pasta Botol - 1 1 1 - 2 2

124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -

162 Nipedifin Tablet 10 mg Botol 1,247 400 1,647 20 1,627 40 (1,587)

195 Polikresulen (Kondensasi Metakresol Sulfo Set 12 - 12 2 10 4 (6)

222 Setirizin Sirup 5 mg / 5 ml Tablet 51 - 51 10 41 20 (21)

Mengetahui / Menyetujui: Yang Menyerahkan

………………………………….. ..........................……………………… …………………………. …………………………..

PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

STOK STOK STOK PEMBERIAN

16 Ampisilin Kapsul 250 mg Tube - - - - -

18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - -

19 Ampisillin Injeksi 1000 mg Tablet 150 - 150 - 150 - (150)

20 Analgetik Plus Tablet - - - - -

104 Ichtyol salep Kulit Ampul 14 - 14 5 9 10 1

124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -

195 Polikresulen (Kondensasi Metakresol SulSet 10 - 10 - 10 - (10)

222 Setirizin Sirup 5 mg / 5 ml Tablet 41 - 41 - 41 - (41)

Mengetahui / Menyetujui: Yang Menyerahkan

………………………………….. ..........................……………………… …………………………. …………………………..

PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

STOK STOK STOK PEMBERIAN

16 Ampisilin Kapsul 250 mg Tube - - - - - - -

18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - -

19 Ampisillin Injeksi 1000 mg Tablet 150 - 150 - 150 - (150)

20 Analgetik Plus Tablet - - - - - - -

104 Ichtyol salep Kulit Ampul 9 20 29 5 24 10 (14)

124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -

178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 125 - 125 61 64 122 58

195 Polikresulen (Kondensasi Metakresol SulSet 10 - 10 - 10 - (10)

222 Setirizin Sirup 5 mg / 5 ml Tablet 41 - 41 14 27 28 1

Mengetahui / Menyetujui: Yang Menyerahkan

………………………………….. ..........................……………………… …………………………. …………………………..

PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

STOK STOK PEMBERIAN

16 Ampisilin Kapsul 250 mg Tube - - - - - - -

18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - -

19 Ampisillin Injeksi 1000 mg Tablet 150 - 150 - 150 - (150)

20 Analgetik Plus Tablet - - - - - - -

104 Ichtyol salep Kulit Ampul 24 - 24 5 19 10 (9)

110 Kalsium Hidroksida Pasta Botol - - - - - - -

112 Kaptopril 12,5 mg Ampul 699 - 699 679 20 1,358 1,338

124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -

178 Oksiterasiklin Salep Mata 1%-3,5g Kotak 64 - 64 37 27 74 47

195 Polikresulen (Kondensasi Metakresol Su Set 10 - 10 - 10 - (10)

222 Setirizin Sirup 5 mg / 5 ml Tablet 27 - 27 14 13 28 15

Mengetahui / Menyetujui: Yang Menyerahkan

………………………………….. ..........................……………………… …………………………. …………………………..

PUSKESMAS :………………….. DOKUMEN NOMOR TANGGAL

STOK STOK PEMBERIAN

16 Ampisilin Kapsul 250 mg Tube - - - - - - -

18 Ampisilin Sirup 125 mg / 5 ml Pot - - - - - - -

19 Ampisillin Injeksi 1000 mg Tablet 150 - 150 - 150 - (150)

20 Analgetik Plus Tablet - - - - - - -

104 Ichtyol salep Kulit Ampul 19 - 19 10 9 20 11

110 Kalsium Hidroksida Pasta Botol - - - - - - -

112 Kaptopril 12,5 mg Ampul 20 20 20 - 40 40

124 Kloramfenikol Salep Mata 1%-3,5 g Botol - - - - - - -