LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

PUSKESMAS : KASONAWEJA PELAPORAN BULAN : Januari 2022

KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : Februari 2022

SATUAN STOK PENERIMA PERSEDIA PEMAKAIA SISA STOK PERMINTA PEMBERI EXP NO.
NO NAMA OBAT KET.
KEMASAN AWAL AN AN N STOK OPNAME AN AN DATE BATCH
1 Acetylcysteine 200 mg Capsul 85 600 685 475 210 210 0
2 Acyclovir 200 mg Tablet 480 200 680 0 680 680 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 434 0 434 0 434 0 100 E.D
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 0 2 2 2 0 0 2
7 Allopurinol tab 100 mg Tablet 135 300 435 225 210 210 500
8 Ambroxol syrup 15mg/ml Botol 0 10 10 2 8 8 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 900 0 900 900 0 0 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 0 300 300 150 150 150 500
16 Amoksisilin syrup kering 125mg/5ml Botol 0 10 10 4 6 6 20
17 Amoksisilin tablet 500 mg Tablet 0 1600 1600 860 740 740 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 0 0 0 0 0 0 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 0 1310 1310 0
21 Antalgin (Metampyron) tab 500 mg Tablet 0 0 0 0 0 0 1000
22 Antalgin injeksi 250 mg/ml-2ml Ampul 0 0 0 0 0 0 10
23 Antasida Doen Tablet 0 0 0 0 0 0 1500
24 Antasida DOEN syrup Botol 0 10 10 2 8 8 20

Antasida DOEN tab kombinasi: Mg-hidroksida

25 Tablet 0 500 500 200 300 300 1500
200mg + Al-hidroksida 200mg

26 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0

Antibakteri DOEN salf kombinasi:Basitrasin 500

27 Tube 0 0 0 0 0 0 0
IU/g + Polimiksin 10000 IU/g

28 Aqua pro injection steril, bebas pyrogen Ampul 0 0 0 0 0 0 10

29 Aquadest steril Botol 11 0 11 4 7 7 6
30 Artem Vial 0 0 0 0 0 0 0
31 Artesunat injeksi vial 30 0 30 17 13 13 0
32 Asam askorbat (Vit.C)tab 50 mg Tablet 0 0 0 0 0 0 2000
33 Asam mefenamat 500 mg Tablet 0 900 900 530 370 370 1500
34 Baby Coug Syr Botol 42 72 114 14 100 100 0
35 Bekarbon Tablet 0 0 0 0 0 0 0
36 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
37 Betametason krim 0,1% Tube 24 0 24 4 20 20 25
38 Bionicim Zink Tablet 570 0 570 570 0 0 1000
39 Bioplacenton Slp Tube 6 6 12 1 11 11 0
40 Bioxon inj Vial 0 0 0 0 0 0 0
41 Bioxon injeksi Vial 0 0 0 0 0 0 0
42 Bisolvon Botol 0 0 0 0 0 0 0
43 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
44 Blangko laporan KIA Rim 0 0 0 0 0 0 0
45 Blestop Tablet 0 0 0 0 0 0 0
46 Bubur Sun Karton 0 0 0 0 0 0 0
47 Buku KIA PCS 0 0 0 0 0 0 0
48 Buku Lansia Pcs 0 0 0 0 0 0 0
49 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
50 Captopril 12,5 mg Tablet 220 0 220 20 200 200 0
51 Captopril 25 mg Tablet 400 0 400 40 360 360 200
52 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
53 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
54 Cefadroxil 500 mg Kapsul 520 1000 1520 270 1250 1250 0
55 Cefadroxil syrup Botol 0 10 10 2 8 8 5
56 Cefixime 200 mg Capsul 300 500 800 40 760 760 0
57 Cefixime kapsul 100 mg Kapsul 50 0 50 10 40 40 200
58 Cefixime syrup Botol 20 0 20 0 20 0 0 E.D
59 Cefotaxime inj 1 gr Vial 16 0 16 16 0 0 5
60 Ceftriaxon inj 1 gr Vial 18 0 18 16 2 2 5
61 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
62 Cimetidine 200 mg Tablet 0 0 0 0 0 0 0
63 Ciprofloksasin 500 mg Tablet 440 0 440 180 260 260 200
64 Clindamycin 150 mg Kapsul 1100 0 1100 0 1100 1100 0
65 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
66 Combantrin sirup orange Botol 2 20 22 3 19 19 20
67 Conterpain 30gr Tube 0 5 5 4 1 1 5
68 Cotrimoksasole syrup Botol 0 10 10 2 8 8 10
69 Cotrimoxazole 480 mg Tablet 1035 0 1035 134 901 901 0
70 Darplex Tablet 801 900 1701 1442 259 259 1350
71 Deksametason injeksi 5 mg/ml -1 ml Ampul 84 0 84 44 40 40 20
72 Deksametason tablet 0,5 mg Tablet 110 2000 2110 1080 1030 1030 1000
73 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
74 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
75 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
76 Diazepam inj Ampul 0 0 0 0 0 0 0
77 Diclovenac Sidium 50 mg Tablet 0 0 0 0 0 0 500
78 DietilCarbamazine Tablet 0 0 0 0 0 0 500
79 Difenhidramin HCL inj 10 mg/ml-1 ml Ampul 0 0 0 0 0 0 10
80 Digoxin 0.25 mg Tablet 0 0 0 0 0 0 0
81 Doksisiklin 100 mg kapsul Kapsul 0 1000 1000 0 1000 1000 200
82 Domperidone 10 mg Tablet 140 0 140 110 30 30 300
83 Domperidone syr Botol 0 0 0 0 0 0 10
84 Dumin 125mg/ml supp 33 5 38 0 38 38 0
85 Dumin 250mg/ml Supp 35 0 35 0 35 35 0
86 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
87 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
88 Emibion Capsul 260 0 260 260 0 0 500

89 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 130 0 130 0 130 0 10 E.D

90 Eritromisin 500 mg kap Kapsul 100 300 400 240 160 160 500
91 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
92 Eritromisin sirup 200 mg/5 ml Botol 6 0 6 0 6 6 10
93 Etabion Botol 0 0 0 0 0 0 500
94 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
95 Ethyl chloride Botol 0 0 0 0 0 0 2
96 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
97 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
98 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
99 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
100 Fermia Tablet 0 0 0 0 0 0 0
101 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
102 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0

103 Fitometandione (Vit K1) tablet salut gula 10 mg Tablet 0 0 0 0 0 0 0

104 Fludane Tablet 0 0 0 0 0 0 500

105 Fludane plus Tablet 0 0 0 0 0 0 500
106 Folamil Tablet 0 0 0 0 0 0 500
107 Folavit Tablet 0 0 0 0 0 0 500
108 Folic acid Tablet 0 0 0 0 0 0 1000
109 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
110 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl 0,30g,
111 .Sachet 569 0 569 42 527 0 200 E.D
trinatrium sachet
112 Gentamicin inj. Ampul 0 0 0 0 0 0 10
113 Gentian violet larutan 1%= 299 botol/10ml Botol 0 0 0 0 0 0 10
114 Glibenclamide 5 mg tablet Tablet 280 0 280 0 280 280 200
115 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
116 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
117 Glukosa larutan infus 5% Botol 4 0 4 4 0 0 10
118 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
119 Griseovulfin 125 mg Tablet 530 500 1030 110 920 920 0
120 Guaiefenesin Tablet 0 2000 2000 1300 700 700 2000
121 hepaQ Tablet 0 0 0 0 0 0 0
122 Hidrokortison krim 2,5% Tube 124 0 124 12 112 112 0
123 Ibuprofen tablet 200 mg Tablet 0 100 100 100 0 0 500
124 Ibuprofen tablet 400mg Tablet 0 200 200 200 0 0 1000
125 Ictiol salf Pot 0 9 9 2 7 7 10
126 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
127 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
128 Kalsium laktat (kalk) Tablet 840 0 840 90 750 750 0
129 Kalsium laktat (kalk) Tablet 420 0 420 200 220 220 0 BPJS
130 Kamulvit syrup Botol 0 0 0 0 0 0 24
131 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
132 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
133 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
134 Ketoconazole 200 mg Tablet 950 0 950 65 885 885 0
135 Ketoconazole krim 5 mg Tube 0 0 0 0 0 0 20
136 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
137 Kina Sulphate Tablet 0 0 0 0 0 0 0
138 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
139 Kloramfenikol tetes mata (Erlamycetin) Tube 0 0 0 0 0 0 12
140 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 12
141 Kloramphenicol suspensi Botol 0 60 60 0 60 60 0
142 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
143 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
144 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 293 1152 1445 1145 300 300 1440
145 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
146 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
147 Kohort bayi Pcs 0 0 0 0 0 0 0
148 Kohort Ibu Pcs 0 0 0 0 0 0 0

Kotrimoksazole DOEN I (dewasa)kombinasi :

149 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 400 mg, trimetoprim 25mg)

Kotrimoksazole DOEN II (dewasa)kombinasi :

150 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 100 mg, trimetoprim 20mg)

151 Lansoprazole kaps 30 mg Kapsul 0 0 0 0 0 0 100

152 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
153 Lexapram Tablet 0 0 0 0 0 0 0

154 Lidokain injeksi 2% (HCl) + Epinefrine 1:80.000 Ampul 18 0 18 7 11 11 10

155 Loperamide tab 2 mg Tablet 0 0 0 0 0 0 200

156 Loratadin 10 mg Tablet 0 0 0 0 0 0 500
157 Lysol (kresol tersaponifikasi 50%) Botol 0 2 2 0 2 2 0
158 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 0 0 0 0 0 0 6
159 MDT MB Anak Blister 0 0 0 0 0 0 6
160 MDT MB Dewasa Blister 5 9 14 8 6 6 6
161 MDT PB Anak Blister 0 3 3 3 0 0 6
162 MDT PB Dewasa Blister 3 0 3 1 2 2 3
163 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
164 Meloxicam 7,5 Tablet 0 250 250 180 70 70 500
165 Metamizole 500 mg Tablet 0 0 0 0 0 0 1000
166 Metformin 500 mg Tablet 1280 0 1280 60 1220 1220 0
167 Methergin injeksi ampul 0 0 0 0 0 0 0
168 Methylprednisolone 4 mg Tablet 0 0 0 0 0 0 500
169 Methylprednisolone 8 mg Tablet 90 0 90 0 90 90 500
170 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 50 0 50 0 50 50 0
171 Metilergometrin tablet Tablet 100 0 100 0 100 100 0
172 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
173 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
174 Metrodinazole tab 500 mg Tablet 1010 0 1010 0 1010 1010 0
175 Miconazole 2 % krim Tube 30 0 30 13 17 17 24
176 Natrium diklofenak 25 mg tab Tablet 0 0 0 0 0 0 500
177 Natrium diklofenak 50 mg Tablet 0 0 0 0 0 0 500
178 Natrium klorida larutan infus 0,9 % Botol 11 20 31 19 12 12 20
179 Neurobion injeksi Ampul 0 0 0 0 0 0 8
180 Neurosanbe injeksi Ampul 0 0 0 0 0 0 4
181 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0 E.D
182 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
183 Norit Tablet 0 0 0 0 0 0 0
184 Novadium Tablet 0 0 0 0 0 0 0
185 OAT Anak PAKET 0 0 0 0 0 0 2
186 OAT Dewasa PAKET 0 0 0 0 0 0 2
187 Obat batuk hitam (O.B.H.) Botol 30 20 50 4 46 46 0
188 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
189 Oksitetrasiklin HCL 3% Salep kulit Tube 0 15 15 9 6 6 48
190 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
191 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
192 Oksitosin injeksi 10 UI/ml-1 ml Ampul 9 0 9 0 9 9 0
193 Omeprasole Kapsul 0 0 0 0 0 0 150
194 Ondancentron Syrup Botol 0 0 0 0 0 0 0
195 Ondancentron tablet Tablet 0 0 0 0 0 0 500
196 Ondancetron inj Ampul 10 0 10 10 0 0 10
197 Osutran 70 Botol 0 0 0 0 0 0 0
198 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
199 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
200 Paracetamol drop Botol 12 10 22 0 22 22 0
201 Paracetamol infus Botol 2 5 7 2 5 5 0
202 Parasetamol sirup 120 mg/5 ml Botol 0 30 30 18 12 12 30
203 Parasetamol Tablet 500 gm Tablet 110 2500 2610 2594 16 16 3000
204 Penicilin injeksi Vial 8 0 8 2 6 6 0
205 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
206 phytomenadione Tablet 200 0 200 0 200 200 0
207 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
208 Piracetam tablet Tablet 0 0 0 0 0 0 0
209 Pirantel pamoat 125 mg Tablet 538 0 538 4 534 534 0
210 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 110 300 410 165 245 245 500
211 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
212 Pirosikam 10 mg Kapsul 70 0 70 70 0 0 500
213 Pitogin inj Ampul 0 0 0 0 0 0 0
214 Prednison tablet 5 mg Tablet 80 0 80 0 80 80 0
215 Primakuin 15 mg Tablet 3255 500 3755 1632 2123 0 1500 E.D
216 Promanolol 10 mg Tablet 0 0 0 0 0 0 0
217 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
218 Pyrazinamide Tablet 0 0 0 0 0 0 0
219 Quinine 222mg Tablet 0 0 0 0 0 0 0
220 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
221 Quinine inj ampul Ampul 0 0 0 0 0 0 0
222 Ranitidine 150 mg Tablet 290 300 590 420 170 170 1000
223 Ranitidine injeksi 25 mg/2ml Ampul 20 20 40 0 40 40 0
224 Rapid HIV 1 Pcs 0 4 4 2 2 2 0
225 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
226 Rapid Sifilis Pcs 0 0 0 0 0 0 0
227 Remolit Sachet 0 0 0 0 0 0 0
228 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
229 Ringer laktat larutan infus Botol 13 20 33 7 26 26 10
230 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 295 0 295 221 74 74 500
231 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 0 0 0 0 0 0 500
232 Salep 2-4 Pot 0 0 0 0 0 0 24
233 Salisil bedak 2% Pot 10 6 16 0 16 16 0
234 Scoott's Emultion Botol 0 0 0 0 0 0 24
235 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
236 Sianokobalamin ( vitamin B12) injeksi 50 mcg Vial 6 20 26 22 4 4 30
237 sianokobalamin (vitamin B12) Tabet 115 1000 1115 70 1045 1045 0
238 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
239 Simvastatine 20 mg Tablet 0 0 0 0 0 0 300
240 Stesolit Tablet 0 0 0 0 0 0 0
241 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
242 Susu ibu Hamil Karton 0 0 0 0 0 0 0
243 Susu ibu menyusui Karton 0 0 0 0 0 0 0
244 Susu lactogen 1 Karton 0 0 0 0 0 0 0
245 Susu sgm 1 Karton 0 0 0 0 0 0 0
246 Susu sgm 2 Karton 0 0 0 0 0 0 0
247 Tablet tambah darah pcs 790 300 1090 580 510 510 500
248 Test malaria pf= pv combo /parascreen (RDT) pcs 25 125 150 50 100 100 50
249 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 0
250 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
251 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
252 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0
253 Thiamin (vitamin B1) tablet 100 mg (HCL/nitrat) Tablet 0 0 0 0 0 0 0
254 Trampara Tablet 0 0 0 0 0 0 0
255 Trombhop gel Tube 0 3 3 0 3 3 3
256 Vi B Com Tablet 200 0 200 200 0 0 1500
257 Vit. A 200.000 IU merah Capsul 40 0 40 0 40 40 350 E.D
258 Vit. B1 ampul 130 0 130 0 130 130 0
259 Vit. K4 Tablet 1200 0 1200 0 1200 1200 0
260 Vit.A 100.000 IU biru Cap 60 0 60 12 48 48 250
261 Vit.B comp injeksi Vial 3 0 3 3 0 0 20
262 Vitamin C 500mg Tablet 150 500 650 500 150 150 1000
263 Zinc dispersible tab 20 mg Tablet 20 300 320 95 225 225 500

1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 19 20 39 4 35 35 5
3 Abucat No 20 (abbot) Pcs 9 3 12 5 7 7 10
4 Abucat No 22 (abbot) Pcs 7 0 7 2 5 5 20
5 Abucat No 24 (abbot) Pcs 0 5 5 1 4 4 20
6 Abucat No 26 (abbot) Pcs 4 2 6 2 4 4 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 680 0 680 100 580 580 100
10 Alat suntik sekali pakai 1 ml Pcs 0 30 30 13 17 17 100
11 Alat suntik sekali pakai 10 ml Pcs 0 50 50 8 42 42 50
12 Alat suntik sekali pakai 3 ml Pcs 72 30 102 50 52 52 100
13 Alat suntik sekali pakai 5 ml Pcs 82 0 82 25 57 57 100
14 Alcohol swab BD Pcs 300 0 300 300 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 2 0 2 2 0 0 3
20 Bethadine 30ml Botol 0 5 5 2 3 3 20
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 103 0 103 33 70 70 200
23 Blood lanced ktk 2 0 2 2 0 0 3
24 Brankar Pcs 0 0 0 0 0 0 0
25 BTA Botol 0 0 0 0 0 0 0
26 Buku resep Pcs 0 0 0 0 0 0 0
27 Bunsen Buah 0 0 0 0 0 0 0

28 Catgut / benang bedah no. 2/0 dengan jarum bedah Box 0 0 0 0 0 0 3

29 Catgut /benang bedah no. 3/0 dengan jarum bedah Box 0 0 0 0 0 0 3

30 Catgut chromic 3/10 Pcs 5 5 10 4 6 6 3

31 Celemek Kebidanan Pcs 0 50 50 0 50 50 0
32 Chateter 18 PCS 9 5 14 0 14 14 2
33 Chateter 20 Pcs 0 5 5 0 5 5 2
34 Chateter 22 Pcs 0 0 0 0 0 0 2
35 Daryant tulle Pcs 0 10 10 0 10 10 3
36 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
37 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
38 Dopler Pcs 0 0 0 0 0 0 1
39 Easy Ttocti Pcs 0 1 1 1 0 0 0
40 Gelas Ukur Pcs 0 0 0 0 0 0 0
41 Golf Hidung Pcs 0 0 0 0 0 0 0
42 Gunting epis Pcs 0 0 0 0 0 0 0
43 Gunting tajam Pcs 0 0 0 0 0 0 0
44 H2O2 3% Botol 0 0 0 0 0 0 2
45 Handscon bersih Pcs 0 0 0 0 0 0 0
46 Handscon non steril uk. L Box 0 2 2 1 1 1 2
47 Handscon non steril uk. M Box 1 0 1 1 0 0 3
48 Handscon non steril uk. S Box 2 2 4 1 3 3 2
49 Handscon non steril uk. XL Box 0 2 2 1 1 1 0
50 Hansaplast Box 100 0 100 0 100 100 2
51 HB sahli set 0 0 0 0 0 0 1
52 Hepavix Buah 0 1 1 0 1 1 2
53 Improvet Neubawer Pcs 0 0 0 0 0 0 0
54 Infusion set anak Pcs 0 10 10 3 7 7 10
55 Infusion set dewasa Pcs 0 20 20 5 15 15 20
56 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
57 Jarum Otot no. 6 Lsn 3 1 4 0 4 4 0
58 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
59 kapas 250gr Buah 0 1 1 1 0 0 3
60 Kasa gulung besar Roll 1 1 2 1 1 1 2
61 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
62 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
63 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
64 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
65 Kasa steril 16 x 16 (isi 16 lembar) Ktk 0 5 5 2 3 3 20
66 Kertas puyer klip pack 0 1 1 0 1 1 1 BOK
67 Kertas Puyer Perkamen Ikat 0 1 1 1 0 0 3
68 Kertas Puyer Perkamen Ikat 0 1 0 1 0 0 0 BOK
69 Kertas Saring Pack 0 0 0 0 0 0 0
70 Korentang Pcs 0 0 0 0 0 0 0
71 Kursi roda Buah 0 0 0 0 0 0 0
72 Labu Spirtus Pcs 0 0 0 0 0 0 0
73 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
74 Lampu Tindakan Pcs 0 0 0 0 0 0 0
75 Larutan Ziehl Neelsen Pcs 0 1 1 0 1 1 0
76 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
77 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
78 Masker Bedah tali karet Ktk 1 2 3 1 2 2 5
79 Masker kain 3 lapis me4ah putih pcs 0 0 0 0 0 0 400
80 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
81 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
82 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
83 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
84 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
85 Nebulizer Pcs 0 0 0 0 0 0 0
86 Needle 18 Pcs 0 0 0 0 0 0 0
87 Needle 21 Pcs 0 0 0 0 0 0 0
88 Needle 22 Pcs 0 0 0 0 0 0 0
89 Needle 23 Pcs 0 30 30 0 30 30 2
90 Needle 25 Pcs 0 30 30 0 30 30 0
91 Needle holder Pcs 0 0 0 0 0 0 0
92 NGT Pcs 0 0 0 0 0 0 0
93 Oil immersion Botol 0 1 1 0 1 1 0
94 Orofaring Pcs 0 0 0 0 0 0 0
95 Pengukur Lila Pcs 0 0 0 0 0 0 0
96 Pinset anatomis Pcs 0 0 0 0 0 0 0
97 Pipet Tetes Buah 0 0 0 0 0 0 0
98 Pipet tetes Pcs 0 0 0 0 0 0 0
99 Plastik klip Obat 12 x 8 cm pack 0 10 10 2 8 8 3 BOK
100 Plastik klip obat 7 x 10 cm Pack 2 0 2 1 1 1 3
101 Plastik klip obat 7x10 cm pack 1 10 11 3 8 8 3 BOK
102 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
103 Plastik Kresek (semangka) ikat 3 10 13 1 12 12 0 BPJS
104 Plester R0ll sedang Pcs 0 5 5 2 3 3 20
105 Poly gyps Pcs 0 0 0 0 0 0 10
106 Pot Dahak Pcs 5 25 30 5 25 25 10
107 Preparat Buah 0 0 0 0 0 0 0
108 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
109 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
110 Reagen giemzah Botol 1 1 2 1 1 1 1
111 Regulator O2 Pcs 0 0 0 0 0 0 0
112 Rivanol 300 ml Botol 1 0 1 0 1 1 0
113 Sabun Asepso Pcs 0 15 15 2 13 13 20
114 Sarung tangan no 7,5 steril Pcs 50 0 50 5 45 45 50
115 Sarung tangan no 8 steril Pcs 82 50 132 0 132 132 0
116 Sarung tangan no. 7 steril Pcs 112 50 162 7 155 155 100
117 Sarung Tangan Obgyn Pcs 0 5 5 0 5 5 0
118 Sarung tangan steril no. 6,5 Pcs 50 0 50 1 49 49 50
119 Scalpel Pcs 0 0 0 0 0 0 0
120 seide 2/0 roll 0 0 0 0 0 0 0
121 Selang nebulezer Pcs 0 0 0 0 0 0 0
122 Selang oksigen PCS 0 0 0 0 0 0 0
123 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
124 Silk black Braided 3/10 Box 0 0 0 0 0 0 3
125 silk Braided USP 3/0 150 cm Pcs 5 0 5 2 3 3 3
126 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
127 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
128 Sinurgis Pcs 0 0 0 0 0 0 0
129 Slide Pcs 72 0 72 0 72 72 72
130 Slide Pcs 72 0 72 72 0 0 0 BPJS
131 Spatle tongue Pcs 0 0 0 0 0 0 0
132 Spekulum Huding Pcs 0 0 0 0 0 0 0
133 Spekulum Vagina Pcs 0 0 0 0 0 0 0
134 Spigmomanometer Buah 0 0 0 0 0 0 0
135 Spirtus Botol 0 0 0 0 0 0 0
136 Standart Infus Pcs 0 0 0 0 0 0 0
137 Stick Asam Urat Box 0 1 1 0 1 1 1
138 Stick Cholesterol Box 0 2 2 1 1 1 1
139 Stick Gula Darah Box 0 1 1 0 1 1 1
140 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
141 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
142 Tabung EDTA pcs 0 0 0 0 0 0 0
143 Tabung HB Pcs 0 0 0 0 0 0 0
144 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
145 Tenscoprap Pcs 0 0 0 0 0 0 0
146 Tensi Raksa Set 0 0 0 0 0 0 1
147 Termometer Digital Pcs 0 2 2 0 2 2 0
148 Test Pack - HCG Pcs 0 50 50 11 39 39 20
149 Thorniquet Pcs 0 1 1 1 0 0 0
150 Timbangan Bayi Pcs 0 0 0 0 0 0 1
151 Timbangan dewasa set 0 0 0 0 0 0 1
152 Umbilical cord klem Pcs 0 0 0 0 0 0 10
153 Underpad Pcs 0 30 30 5 25 25 20
154 Urine bag Pcs 3 5 8 0 8 8 2
155 Verban elastis Roll 0 5 5 0 5 5 0
156 Wing Needle 21 Pcs 0 20 20 0 20 20 0
157 Wing Needle 25 Pcs 0 30 30 0 30 30 0

Kasonaweja, 04 Februari 2022

Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab
 LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : KASONAWEJA PELAPORAN BULAN : Februari 2022

KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : Maret 2022

SATUAN STOK PENERIMA PERSEDIA PEMAKAIA SISA STOK PERMINTA PEMBERI

NO NAMA OBAT EXP DATE NO. BATCH KET.
KEMASAN AWAL AN AN N STOK OPNAME AN AN
1 Acetylcysteine 200 mg Capsul 210 600 810 528 282 282 1200
2 Acyclovir 200 mg Tablet 680 0 680 40 640 640 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 0 200 200 0 200 200 0
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 0 5 5 4 1 1 5
7 Allopurinol tab 100 mg Tablet 210 300 510 260 250 250 500
8 Ambroxol syrup 15mg/ml Botol 8 10 18 7 11 11 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 0 1500 1500 170 1330 1330 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 150 500 650 340 310 310 500
16 Amoksisilin syrup kering 125mg/5ml Botol 6 10 16 2 14 14 10
17 Amoksisilin tablet 500 mg Tablet 740 0 740 740 0 0 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 0 0 0 0 0 0 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 0 1310 1310 0
21 Antalgin (Metampyron) tab 500 mg Tablet 0 0 0 0 0 0 1000
22 Antalgin injeksi 250 mg/ml-2ml Ampul 0 0 0 0 0 0 10
23 Antasida Doen Tablet 0 0 0 0 0 0 1500
24 Antasida DOEN syrup Botol 8 10 18 0 18 18 20
 Antasida DOEN tab kombinasi: Mg-hidroksida
25 Tablet 300 500 800 300 500 500 1500
200mg + Al-hidroksida 200mg

26 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0

Antibakteri DOEN salf kombinasi:Basitrasin 500
27 Tube 0 0 0 0 0 0 0
IU/g + Polimiksin 10000 IU/g
28 Aqua pro injection steril, bebas pyrogen Ampul 0 0 0 0 0 0 10
29 Aquadest steril Botol 7 0 7 4 3 3 6
30 Artem Vial 0 0 0 0 0 0 0
31 Artesunat injeksi vial 13 0 13 7 6 6 10
32 Asam askorbat (Vit.C)tab 50 mg Tablet 0 0 0 0 0 0 2000
33 Asam mefenamat 500 mg Tablet 370 1100 1470 1150 320 320 1500
34 Asam mefenamat 500 mg Tablet 0 500 500 0 500 500 0 BOK
35 Baby Coug Syr Botol 100 0 100 57 43 43 0
36 Bekarbon Tablet 0 0 0 0 0 0 0
37 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
38 Betametason krim 0,1% Tube 20 0 20 6 14 14 25
39 Bionicim Zink Tablet 0 200 200 0 200 200 500
40 Bioplacenton Slp Tube 11 0 11 1 10 10 0
41 Bioxon inj Vial 0 0 0 0 0 0 0
42 Bioxon injeksi Vial 0 0 0 0 0 0 0
43 Bisolvon Botol 0 0 0 0 0 0 0
44 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
45 Blangko laporan KIA Rim 0 0 0 0 0 0 0
46 Blestop Tablet 0 0 0 0 0 0 0
47 Bubur Sun Karton 0 0 0 0 0 0 0
48 Buku KIA PCS 0 0 0 0 0 0 0
49 Buku Lansia Pcs 0 0 0 0 0 0 0
50 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
51 Captopril 12,5 mg Tablet 200 0 200 30 170 170 0
52 Captopril 25 mg Tablet 360 500 860 50 810 810 0
53 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
54 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
55 Cefadroxil 500 mg Kapsul 1250 0 1250 520 730 730 0
56 Cefadroxil syrup Botol 8 15 23 3 20 20 0
57 Cefixime 200 mg Capsul 760 0 760 0 760 760 0
58 Cefixime kapsul 100 mg Kapsul 40 0 40 40 0 0 0
59 Cefixime syrup Botol 0 10 10 0 10 10 0
60 Cefotaxime inj 1 gr Vial 0 10 10 0 10 10 5
61 Ceftriaxon inj 1 gr Vial 2 10 12 8 4 4 5
62 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
63 Cetirizine hydrochloride 10 mg Tablet 0 500 500 0 500 500 0 BOK
64 Cimetidine 200 mg Tablet 0 400 400 0 400 400 0
65 Ciprofloksasin 500 mg Tablet 260 300 560 290 270 270 300
66 Clindamycin 150 mg Kapsul 1100 0 1100 0 1100 1100 0
67 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
68 Combantrin sirup orange Botol 19 15 34 5 29 29 0
69 Conterpain 30gr Tube 1 5 6 4 2 2 5
70 Cotrimoksasole syrup Botol 8 10 18 8 10 10 10
71 Cotrimoxazole 480 mg Tablet 901 0 901 70 831 831 0
72 Darplex Tablet 259 1800 2059 1924 135 135 2250
73 Deksametason injeksi 5 mg/ml -1 ml Ampul 40 200 240 26 214 214 0
74 Deksametason tablet 0,5 mg Tablet 1030 1000 2030 1950 80 80 1500
75 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
76 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
77 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
78 Diazepam inj Ampul 0 0 0 0 0 0 0
79 Diclovenac Sidium 50 mg Tablet 0 0 0 0 0 0 500
80 DietilCarbamazine Tablet 0 0 0 0 0 0 500
81 Difenhidramin HCL inj 10 mg/ml-1 ml Ampul 0 0 0 0 0 0 10
82 Digoxin 0.25 mg Tablet 0 100 100 0 100 100 0
83 Doksisiklin 100 mg kapsul Kapsul 1000 0 1000 0 1000 1000 0
84 Domperidone 10 mg Tablet 30 200 230 110 120 120 300
85 Domperidone syr Botol 0 0 0 0 0 0 10
86 Dumin 125mg/ml supp 38 0 38 2 36 36 0
87 Dumin 250mg/ml Supp 35 0 35 0 35 35 0
88 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
89 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
90 Emibion Capsul 0 0 0 0 0 0 500

91 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 0 20 20 0 20 20 0

92 Eritromisin 500 mg kap Kapsul 160 200 360 30 330 330 0

93 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
94 Eritromisin sirup 200 mg/5 ml Botol 6 8 14 0 14 14 0
95 Etabion Botol 0 0 0 0 0 0 500
96 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
97 Ethyl chloride Botol 0 0 0 0 0 0 2
98 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
99 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
100 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
101 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
102 Fermia Tablet 0 0 0 0 0 0 0
103 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
104 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0
105 Fitometandione (Vit K1) tablet salut gula 10 mg Tablet 0 0 0 0 0 0 0
106 Fludane Tablet 0 0 0 0 0 0 500
107 Fludane plus Tablet 0 0 0 0 0 0 500
108 Folamil Tablet 0 0 0 0 0 0 500
109 Folavit Tablet 0 0 0 0 0 0 500
110 Folic acid Tablet 0 0 0 0 0 0 1000
111 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
112 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl
113 .Sachet 0 100 100 72 28 28 200
0,30g, trinatrium sachet
114 Gentamicin inj. Ampul 0 0 0 0 0 0 10
115 Gentian violet larutan 1%= 299 botol/10ml Botol 0 10 10 0 10 10 10
116 Glibenclamide 5 mg tablet Tablet 280 0 280 0 280 280 200
117 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
118 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
119 Glukosa larutan infus 5% Botol 0 20 20 12 8 8 10
120 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
121 Griseovulfin 125 mg Tablet 920 0 920 165 755 755 0
122 Guaiefenesin Tablet 700 1500 2200 2200 0 0 2000
123 hepaQ Tablet 0 0 0 0 0 0 0
124 Hidrokortison krim 2,5% Tube 112 0 112 5 107 107 0
125 Ibuprofen tablet 200 mg Tablet 0 300 300 300 0 0 500
126 Ibuprofen tablet 400mg Tablet 0 400 400 400 0 0 1000
127 Ictiol salf Pot 7 6 13 1 12 12 10
128 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
129 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
130 Kalsium laktat (kalk) Tablet 750 0 750 0 750 750 0
131 Kalsium laktat (kalk) Tablet 220 0 220 220 0 0 0
132 Kamulvit syrup Botol 0 0 0 0 0 0 24
133 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
134 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
135 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
136 Ketoconazole 200 mg Tablet 885 0 885 80 805 805 0
137 Ketoconazole krim 5 mg Tube 0 0 0 0 0 0 20
138 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
139 Kina Sulphate Tablet 0 0 0 0 0 0 0
140 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
141 Kloramfenikol tetes mata (Erlamycetin) Tube 0 10 10 8 2 2 12
142 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 12
143 Kloramphenicol suspensi Botol 60 0 60 0 60 60 0
144 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
145 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
146 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 300 516 816 792 24 24 1440
147 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 0 288 288 125 163 163 0 BOK
148 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
149 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
150 Kohort bayi Pcs 0 0 0 0 0 0 0
151 Kohort Ibu Pcs 0 0 0 0 0 0 0
Kotrimoksazole DOEN I (dewasa)kombinasi :
152 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 400 mg, trimetoprim 25mg)

Kotrimoksazole DOEN II (dewasa)kombinasi :

153 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 100 mg, trimetoprim 20mg)
154 Lansoprazole kaps 30 mg Kapsul 0 60 60 0 60 60 100
155 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
156 Lexapram Tablet 0 0 0 0 0 0 0
157 Lidokain injeksi 2% (HCl) + Epinefrine 1:80.000 Ampul 11 20 31 16 15 15 10
158 Loperamide tab 2 mg Tablet 0 300 300 0 300 300 0
159 Loratadin 10 mg Tablet 0 100 100 100 0 0 500
160 Loratadin 10 mg Tablet 0 500 500 60 440 440 0 BOK
161 Lysol (kresol tersaponifikasi 50%) Botol 2 0 2 0 2 2 0
162 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 0 1 1 1 0 0 6
163 MDT MB Anak Blister 0 0 0 0 0 0 6
164 MDT MB Dewasa Blister 6 12 18 13 5 5 12
165 MDT PB Anak Blister 0 0 0 0 0 0 6
166 MDT PB Dewasa Blister 2 2 4 2 2 2 3
167 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
168 Meloxicam 7,5 Tablet 70 150 220 170 50 50 500
169 Metamizole 500 mg Tablet 0 0 0 0 0 0 1000
170 Metformin 500 mg Tablet 1220 0 1220 120 1100 1100 0
171 Methergin injeksi ampul 0 0 0 0 0 0 0
172 Methylprednisolone 4 mg Tablet 0 0 0 0 0 0 500
173 Methylprednisolone 8 mg Tablet 90 200 290 80 210 210 500
174 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 50 0 50 0 50 50 0
175 Metilergometrin tablet Tablet 100 0 100 0 100 100 0
176 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
177 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
178 Metrodinazole tab 500 mg Tablet 1010 0 1010 70 940 940 0
179 Miconazole 2 % krim Tube 17 24 41 39 2 2 24
180 Natrium diklofenak 25 mg tab Tablet 0 0 0 0 0 0 500
181 Natrium diklofenak 50 mg Tablet 0 0 0 0 0 0 500
182 Natrium diklofenak 50 mg Tablet 0 500 500 20 480 480 0 BOK
183 Natrium klorida larutan infus 0,9 % Botol 12 20 32 15 17 17 20
184 Neurobion injeksi Ampul 0 4 4 4 0 0 8
185 Neurosanbe injeksi Ampul 0 0 0 0 0 0 4
186 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0
187 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
188 Norit Tablet 0 80 80 0 80 80 0
189 Novadium Tablet 0 0 0 0 0 0 0
190 OAT Anak PAKET 0 0 0 0 0 0 2
191 OAT Dewasa PAKET 0 3 3 0 3 3 2
192 Obat batuk hitam (O.B.H.) Botol 46 0 46 5 41 41 0
193 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
194 Oksitetrasiklin HCL 3% Salep kulit Tube 6 25 31 18 13 13 48
195 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
196 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
197 Oksitosin injeksi 10 UI/ml-1 ml Ampul 9 0 9 3 6 6 0
198 Omeprasole Kapsul 0 90 90 20 70 70 150
199 Ondancentron Syrup Botol 0 0 0 0 0 0 0
200 Ondancentron tablet Tablet 0 0 0 0 0 0 500
201 Ondancetron inj Ampul 0 0 0 0 0 0 10
202 Osutran 70 Botol 0 0 0 0 0 0 0
203 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
204 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
205 Paracetamol drop Botol 22 0 22 3 19 19 0
206 Paracetamol infus Botol 5 0 5 2 3 3 2
207 Parasetamol sirup 120 mg/5 ml Botol 12 20 32 28 4 4 30
208 Parasetamol Tablet 500 gm Tablet 16 4000 4016 3942 74 24 4500
209 Penicilin injeksi Vial 6 0 6 4 2 2 0
210 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
211 phytomenadione Tablet 200 0 200 0 200 200 0
212 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
213 Piracetam tablet Tablet 0 0 0 0 0 0 0
214 Pirantel pamoat 125 mg Tablet 534 0 534 6 528 528 0
215 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 245 300 545 235 310 310 500
216 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
217 Pirosikam 10 mg Kapsul 0 0 0 0 0 0 500
218 Pitogin inj Ampul 0 0 0 0 0 0 0
219 Prednison tablet 5 mg Tablet 80 0 80 0 80 80 0
220 Primakuin 15 mg Tablet 0 3000 3000 2342 658 658 3000
221 Promanolol 10 mg Tablet 0 0 0 0 0 0 0
222 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
223 Pyrazinamide Tablet 0 0 0 0 0 0 0
224 Quinine 222mg Tablet 0 780 780 0 780 780 0
225 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
226 Quinine inj ampul Ampul 0 0 0 0 0 0 0
227 Ranitidine 150 mg Tablet 170 300 470 220 250 250 1000
228 Ranitidine injeksi 25 mg/2ml Ampul 40 0 40 5 35 35 0
229 Rapid HIV 1 Pcs 2 0 2 2 0 0 0
230 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
231 Rapid Sifilis Pcs 0 0 0 0 0 0 0
232 Remolit Sachet 0 0 0 0 0 0 0
233 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
234 Ringer laktat larutan infus Botol 26 0 26 18 8 8 10
235 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 74 200 274 200 74 74 500
236 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 0 0 0 0 0 0 500
237 Salep 2-4 Pot 0 0 0 0 0 0 24
238 Salisil bedak 2% Pot 16 0 16 3 13 13 0
239 Scoott's Emultion Botol 0 0 0 0 0 0 24
240 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
241 Sianokobalamin ( vitamin B12) injeksi 50 mcg Vial 4 10 14 11 3 3 30
242 sianokobalamin (vitamin B12) Tabet 1045 0 1045 400 645 645 1000
243 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
244 Simvastatine 20 mg Tablet 0 0 0 0 0 0 300
245 Stesolit Tablet 0 0 0 0 0 0 0
246 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
247 Susu ibu Hamil Karton 0 0 0 0 0 0 0
248 Susu ibu menyusui Karton 0 0 0 0 0 0 0
249 Susu lactogen 1 Karton 0 0 0 0 0 0 0
250 Susu sgm 1 Karton 0 0 0 0 0 0 0
251 Susu sgm 2 Karton 0 0 0 0 0 0 0
252 Tablet tambah darah pcs 510 300 810 710 100 100 1000
253 Test malaria pf= pv combo /parascreen (RDT) pcs 100 100 200 200 0 0 150
254 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 0
255 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
256 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
257 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0
258 Thiamin (vitamin B1) tablet 100 mg (HCL/nitrat) Tablet 0 0 0 0 0 0 0
259 Trampara Tablet 0 0 0 0 0 0 0
260 Trombhop gel Tube 3 0 3 0 3 3 3
261 Vi B Com Tablet 0 1500 1500 1400 100 100 1500
262 Vi B Com Tablet 0 1000 1000 200 800 800 0 BOK
263 Vit. A 200.000 IU merah Capsul 40 200 240 220 20 20 0
264 Vit. B1 ampul 130 0 130 0 130 130 0
265 Vit. K4 Tablet 1200 0 1200 0 1200 1200 0
266 Vit.A 100.000 IU biru Cap 48 150 198 110 88 88 0
267 Vit.B comp injeksi Vial 0 0 0 0 0 0 20
268 Vitamin C 500mg Tablet 150 200 350 350 0 0 1000
269 Zinc dispersible tab 20 mg Tablet 225 0 225 200 25 25 500

1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 35 0 35 2 33 33 5
3 Abucat No 20 (abbot) Pcs 7 0 7 5 2 2 10
4 Abucat No 22 (abbot) Pcs 5 0 5 2 3 3 20
5 Abucat No 24 (abbot) Pcs 4 0 4 3 1 1 20
6 Abucat No 26 (abbot) Pcs 4 0 4 0 4 4 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 580 0 580 580 580 0
10 Alat suntik sekali pakai 1 ml Pcs 17 0 17 15 2 2 100
11 Alat suntik sekali pakai 10 ml Pcs 42 0 42 20 22 22 50
12 Alat suntik sekali pakai 3 ml Pcs 52 100 152 152 0 0 100
13 Alat suntik sekali pakai 5 ml Pcs 57 0 57 10 47 47 100
14 Alcohol swab BD Pcs 0 100 100 100 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 0 0 0 0 0 0 3
20 Bethadine 30ml Botol 3 10 13 2 11 11 20
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 70 0 70 70 0 0 200
23 Blood lanced ktk 0 2 2 2 0 0 5
24 Blood lanced ktk 0 2 2 1 1 1 0 BOK
25 Brankar Pcs 0 0 0 0 0 0 0
26 BTA Botol 0 0 0 0 0 0 0
27 Buku resep Pcs 0 0 0 0 0 0 0
28 Bunsen Buah 0 0 0 0 0 0 0
Catgut / benang bedah no. 2/0 dengan jarum
29 Box 0 0 0 0 0 0 3
bedah
Catgut /benang bedah no. 3/0 dengan jarum
30 Box 0 0 0 0 0 0 3
bedah
31 Catgut chromic 3/0 Pcs 6 5 11 3 8 8 3
32 Celemek Kebidanan Pcs 50 0 50 0 50 50 0
33 Chateter 18 PCS 14 0 14 0 14 14 2
34 Chateter 20 Pcs 5 0 5 0 5 5 2
35 Chateter 22 Pcs 0 0 0 0 0 0 2
36 Daryant tulle Pcs 10 0 10 2 8 8 3
37 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
38 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
39 Dopler Pcs 0 0 0 0 0 0 1
40 Easy Ttocti Pcs 0 0 0 0 0 0 0
41 Gelas Ukur Pcs 0 0 0 0 0 0 0
42 Golf Hidung Pcs 0 0 0 0 0 0 0
43 Gunting epis Pcs 0 0 0 0 0 0 0
44 Gunting tajam Pcs 0 0 0 0 0 0 0
45 H2O2 3% Botol 0 0 0 0 0 0 2
46 Handscon bersih Pcs 0 0 0 0 0 0 0
47 Handscon non steril uk. L Box 1 2 3 1 2 0 2
48 Handscon non steril uk. M Box 0 1 1 1 0 0 3
49 Handscon non steril uk. S Box 3 2 5 2 3 3 2
50 Handscon non steril uk. XL Box 1 0 1 1 0 0 0
51 Hansaplast Box 100 0 100 0 100 100 2
52 HB sahli set 0 0 0 0 0 0 1
53 Hepavix Buah 1 0 1 0 1 1 2
54 Improvet Neubawer Pcs 0 0 0 0 0 0 0
55 Infusion set anak Pcs 7 0 7 3 4 4 10
56 Infusion set dewasa Pcs 15 0 15 8 7 7 20
57 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
58 Jarum Otot no. 6 Lsn 4 0 4 0 4 4 0
59 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
60 kapas 250gr Buah 0 0 0 0 0 0 3
61 Kapas 50gr Buah 0 2 2 1 1 1 2
62 Kasa gulung besar Roll 1 1 2 1 1 1 2
63 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
64 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
65 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
66 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
67 Kasa steril 16 x 16 (isi 16 lembar) Ktk 3 10 13 7 6 6 20
68 Kertas puyer klip pack 1 0 1 1 0 0 1 BOK
69 Kertas Puyer Perkamen Ikat 0 1 1 1 0 0 3
70 Kertas Puyer Perkamen Ikat 0 0 0 0 0 0 0 BOK
71 Kertas Saring Pack 0 0 0 0 0 0 0
72 Korentang Pcs 0 0 0 0 0 0 0
73 Kursi roda Buah 0 0 0 0 0 0 0
74 Labu Spirtus Pcs 0 0 0 0 0 0 0
75 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
76 Lampu Tindakan Pcs 0 0 0 0 0 0 0
77 Larutan Ziehl Neelsen Pcs 1 0 1 0 1 1 0
78 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
79 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
80 Masker Bedah tali karet Ktk 2 1 3 2 1 1 5
81 Masker kain 3 lapis me4ah putih pcs 0 0 0 0 0 0 400
82 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
83 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
84 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
85 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
86 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
87 Nebulizer Pcs 0 0 0 0 0 0 0
88 Needle 18 Pcs 0 0 0 0 0 0 0
89 Needle 21 Pcs 0 0 0 0 0 0 0
90 Needle 22 Pcs 0 0 0 0 0 0 0
91 Needle 23 Pcs 30 0 30 5 25 25 2
92 Needle 25 Pcs 30 0 30 0 30 30 0
93 Needle holder Pcs 0 0 0 0 0 0 0
94 NGT Pcs 0 0 0 0 0 0 0
95 Oil immersion Botol 1 0 1 0 1 1 0
96 Orofaring Pcs 0 0 0 0 0 0 0
97 Pengukur Lila Pcs 0 0 0 0 0 0 0
98 Pinset anatomis Pcs 0 0 0 0 0 0 0
99 Pipet Tetes Buah 0 0 0 0 0 0 0
100 Pipet tetes Pcs 0 0 0 0 0 0 0
101 Plastik klip Obat 12 x 8 cm pack 8 0 8 4 4 4 3 BOK
102 Plastik klip obat 7 x 10 cm Pack 1 2 3 3 0 0 3
103 Plastik klip obat 7x10 cm pack 8 0 8 2 6 6 3 BOK
104 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
105 Plastik Kresek (semangka) ikat 12 0 12 3 9 9 0 BPJS
106 Plester R0ll sedang Pcs 3 3 6 4 2 2 20
107 Poly gyps Pcs 0 0 0 0 0 0 10
108 Pot Dahak Pcs 25 0 25 4 21 21 10
109 Preparat Buah 0 0 0 0 0 0 0
110 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
111 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
112 Reagen giemzah Botol 1 0 1 0 1 1 1
113 Regulator O2 Pcs 0 0 0 0 0 0 0
114 Rivanol 300 ml Botol 1 0 1 0 1 1 0
115 Sabun Asepso Pcs 13 0 13 7 6 6 20
116 Sarung tangan no 7,5 steril Pcs 45 50 95 35 60 60 50
117 Sarung tangan no 8 steril Pcs 132 0 132 0 132 132 0
118 Sarung tangan no. 7 steril Pcs 155 0 155 55 100 100 100
119 Sarung Tangan Obgyn Pcs 5 0 5 0 5 5 0
120 Sarung tangan steril no. 6,5 Pcs 49 0 49 8 41 41 50
121 Scalpel Pcs 0 0 0 0 0 0 0
122 seide 2/0 roll 0 0 0 0 0 0 0
123 Selang nebulezer Pcs 0 0 0 0 0 0 0
124 Selang oksigen PCS 0 0 0 0 0 0 0
125 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
126 Silk black Braided 3/10 Box 0 0 0 0 0 0 3
127 silk Braided USP 3/0 150 cm Pcs 3 0 3 0 3 3 3
128 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
129 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
130 Sinurgis Pcs 0 0 0 0 0 0 0
131 Slide Pcs 72 144 216 216 0 0 216
132 Slide Pcs 0 0 0 0 0 0 0
133 Spatle tongue Pcs 0 0 0 0 0 0 0
134 Spekulum Huding Pcs 0 0 0 0 0 0 0
135 Spekulum Vagina Pcs 0 0 0 0 0 0 0
136 Spigmomanometer Buah 0 0 0 0 0 0 0
137 Spirtus Botol 0 0 0 0 0 0 0
138 Standart Infus Pcs 0 0 0 0 0 0 0
139 Stick Asam Urat Box 1 1 2 2 0 0 1
140 Stick Cholesterol Box 1 1 2 2 0 0 1
141 Stick Gula Darah Box 1 1 2 2 0 0 1
142 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
143 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
144 Tabung EDTA pcs 0 0 0 0 0 0 0
145 Tabung HB Pcs 0 0 0 0 0 0 0
146 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
147 Tenscoprap Pcs 0 0 0 0 0 0 0
148 Tensi Raksa Set 0 0 0 0 0 0 1
149 Termometer Digital Pcs 2 0 2 0 2 2 0
150 Test Pack - HCG Pcs 39 0 39 39 0 0 100
151 Thorniquet Pcs 0 0 0 0 0 0 0
152 Timbangan Bayi Pcs 0 0 0 0 0 0 1
153 Timbangan dewasa set 0 0 0 0 0 0 1
154 Ultasonic gell Botol 0 1 1 1 0 0 1 BOK
155 Umbilical cord klem Pcs 0 0 0 0 0 0 10
156 Underpad Pcs 25 0 25 10 15 15 20
157 Urine bag Pcs 8 0 8 0 8 8 2
158 Verban elastis Roll 5 0 5 0 5 5 0
159 Wing Needle 21 Pcs 20 0 20 0 20 20 0
160 Wing Needle 25 Pcs 30 0 30 0 30 30 0

Kasonaweja, 07 Maret 2022

Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab

LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002
 PUSKESMAS : KASONAWEJA PELAPORAN BULAN : Maret 2022
KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : APRIL 2022

SATUAN STOK PENERIM PERSEDI PEMAKAIA SISA STOK PERMINTA PEMBERI

NO NAMA OBAT EXP DATE NO. BATCH KET.
KEMASAN AWAL AAN AAN N STOK OPNAME AN AN
1 Acetylcysteine 200 mg Capsul 282 900 1182 462 720 720 1200
2 Acyclovir 200 mg Tablet 640 0 640 0 640 640 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 200 0 200 2 198 198 0
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 1 4 5 3 2 2 5
7 Allopurinol tab 100 mg Tablet 250 1000 1250 0 1250 1250 500
8 Ambroxol syrup 15mg/ml Botol 11 10 21 21 0 0 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 1330 0 1330 1185 145 145 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 310 500 810 210 600 600 500
16 Amoksisilin syrup kering 125mg/5ml Botol 14 10 24 24 0 0 10
17 Amoksisilin tablet 500 mg Tablet 0 1400 1400 1400 0 0 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 0 0 0 0 0 0 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 0 1310 1310 0
21 Antalgin (Metampyron) tab 500 mg Tablet 0 0 0 0 0 0 1000
22 Antalgin injeksi 250 mg/ml-2ml Ampul 0 10 10 0 10 10 10
23 Antasida Doen Tablet 0 0 0 0 0 0 1500
24 Antasida DOEN syrup Botol 18 10 28 13 15 15 20
 Antasida DOEN tab kombinasi: Mg-
25 Tablet 500 700 1200 190 1010 1010 1500
hidroksida 200mg + Al-hidroksida 200mg

26 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0

Antibakteri DOEN salf kombinasi:Basitrasin

27 Tube 0 0 0 0 0 0 0
500 IU/g + Polimiksin 10000 IU/g

28 Aqua pro injection steril, bebas pyrogen Ampul 0 0 0 0 0 0 10

29 Aquadest steril Botol 3 6 9 5 4 4 6
30 Artem Vial 0 0 0 0 0 0 0
31 Artesunat injeksi vial 6 10 16 4 12 12 10
32 Asam askorbat (Vit.C)tab 50 mg Tablet 0 0 0 0 0 0 2000
33 Asam mefenamat 500 mg Tablet 320 700 1020 900 120 120 1500
34 Asam mefenamat 500 mg Tablet 500 0 500 100 400 400 0 BOK
35 Baby Coug Syr Botol 43 0 43 19 24 24 0
36 Bekarbon Tablet 0 0 0 0 0 0 0
37 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
38 Betametason krim 0,1% Tube 14 0 14 14 0 0 50
39 Bionicim Zink Tablet 200 500 700 265 435 435 500
40 Bioplacenton Slp Tube 10 0 10 2 8 8 0
41 Bioxon inj Vial 0 0 0 0 0 0 0
42 Bioxon injeksi Vial 0 0 0 0 0 0 0
43 Bisolvon Botol 0 0 0 0 0 0 0
44 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
45 Blangko laporan KIA Rim 0 0 0 0 0 0 0
46 Blestop Tablet 0 0 0 0 0 0 0
47 Bubur Sun Karton 0 0 0 0 0 0 0
48 Buku KIA PCS 0 0 0 0 0 0 0
49 Buku Lansia Pcs 0 0 0 0 0 0 0
50 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
51 Captopril 12,5 mg Tablet 170 0 170 0 170 170 0
52 Captopril 25 mg Tablet 810 0 810 20 790 790 0
53 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
54 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
55 Cefadroxil 500 mg Kapsul 730 0 730 570 160 160 0
56 Cefadroxil syrup Botol 20 0 20 3 17 17 0
57 Cefixime 200 mg Capsul 760 0 760 0 760 760 0
58 Cefixime kapsul 100 mg Kapsul 0 0 0 0 0 0 0
59 Cefixime syrup Botol 10 0 10 10 0 0 0
60 Cefotaxime inj 1 gr Vial 10 0 10 2 8 8 5
61 Ceftriaxon inj 1 gr Vial 4 10 14 0 14 14 5
62 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
63 Cetirizine hydrochloride 10 mg Tablet 500 0 500 60 440 440 0 BOK
64 Cimetidine 200 mg Tablet 400 0 400 0 400 400 0
65 Ciprofloksasin 500 mg Tablet 270 300 570 220 350 350 300
66 Clindamycin 150 mg Kapsul 1100 0 1100 70 1030 1030 0
67 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
68 Combantrin sirup orange Botol 29 0 29 2 27 27 0
69 Conterpain 30gr Tube 2 5 7 4 3 3 5
70 Cotrimoksasole syrup Botol 10 10 20 19 1 1 10
71 Cotrimoxazole 480 mg Tablet 831 0 831 370 461 461 0
72 Darplex Tablet 135 1350 1485 1411 74 74 2250
73 Deksametason injeksi 5 mg/ml -1 ml Ampul 214 0 214 34 180 180 0
74 Deksametason tablet 0,5 mg Tablet 80 2000 2080 1820 260 260 2000
75 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
76 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
77 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
78 Diazepam inj Ampul 0 0 0 0 0 0 0
79 Diclovenac Sidium 50 mg Tablet 0 0 0 0 0 0 500
80 DietilCarbamazine Tablet 0 0 0 0 0 0 500
81 Difenhidramin HCL inj 10 mg/ml-1 ml Vial 0 5 5 0 5 5 10
82 Digoxin 0.25 mg Tablet 100 0 100 0 100 100 0
83 Doksisiklin 100 mg kapsul Kapsul 1000 0 1000 0 1000 1000 0
84 Domperidone 10 mg Tablet 120 300 420 70 350 350 300
85 Domperidone syr Botol 0 0 0 0 0 0 10
86 Dumin 125mg/ml supp 36 0 36 0 36 36 0
87 Dumin 250mg/ml Supp 35 0 35 0 35 35 0
88 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
89 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
90 Emibion Capsul 0 0 0 0 0 0 500

91 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 20 0 20 0 20 20 0

92 Eritromisin 500 mg kap Kapsul 330 0 330 60 270 270 0

93 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
94 Eritromisin sirup 200 mg/5 ml Botol 14 0 14 0 14 14 0
95 Etabion Botol 0 0 0 0 0 0 500
96 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
97 Ethyl chloride Botol 0 0 0 0 0 0 2
98 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
99 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
100 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
101 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
102 Fermia Tablet 0 0 0 0 0 0 0
103 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
104 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0
Fitometandione (Vit K1) tablet salut gula 10
105 Tablet 0 0 0 0 0 0 0
mg
106 Fludane Tablet 0 0 0 0 0 0 500
107 Fludane plus Tablet 0 0 0 0 0 0 500
108 Folamil Tablet 0 0 0 0 0 0 500
109 Folavit Tablet 0 0 0 0 0 0 500
110 Folic acid Tablet 0 0 0 0 0 0 1000
111 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
112 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl
113 .Sachet 28 100 128 73 55 55 200
0,30g, trinatrium sachet
114 Gentamicin inj. Ampul 0 0 0 0 0 0 10
115 Gentian violet larutan 1%= 299 botol/10ml Botol 10 0 10 2 8 8 10
116 Glibenclamide 5 mg tablet Tablet 280 0 280 0 280 280 200
117 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
118 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
119 Glukosa larutan infus 5% Botol 8 10 18 2 16 16 10
120 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
121 Griseovulfin 125 mg Tablet 755 0 755 210 545 545 0
122 Guaiefenesin Tablet 0 1000 1000 1000 0 0 2000
123 hepaQ Tablet 0 0 0 0 0 0 0
124 Hidrokortison krim 2,5% Tube 107 0 107 13 94 94 0
125 Ibuprofen tablet 200 mg Tablet 0 500 500 500 0 0 500
126 Ibuprofen tablet 400mg Tablet 0 500 500 500 0 0 1000
127 Ictiol salf Pot 12 0 12 2 10 10 10
128 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
129 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
130 Kalsium laktat (kalk) Tablet 750 0 750 80 670 670 0
131 Kalsium laktat (kalk) Tablet 0 0 0 0 0 0 0
132 Kamulvit syrup Botol 0 0 0 0 0 0 24
133 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
134 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
135 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
136 Ketoconazole 200 mg Tablet 805 0 805 70 735 735 0
137 Ketoconazole krim 5 mg Tube 0 5 5 5 0 0 20
138 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
139 Kina Sulphate Tablet 0 0 0 0 0 0 0
140 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
141 Kloramfenikol tetes mata (Erlamycetin) Tube 2 10 12 6 6 6 12
142 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 12
143 Kloramphenicol suspensi Botol 60 0 60 0 60 60 0
144 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
145 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
146 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 24 864 888 888 0 0 1440
147 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 163 0 163 76 87 87 0 BOK
148 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
149 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
150 Kohort bayi Pcs 0 0 0 0 0 0 0
151 Kohort Ibu Pcs 0 0 0 0 0 0 0

Kotrimoksazole DOEN I (dewasa)kombinasi

152 : (sulfametoksazole 400 mg, trimetoprim Tablet 0 0 0 0 0 0 0
25mg)

Kotrimoksazole DOEN II
153 (dewasa)kombinasi : (sulfametoksazole 100 Tablet 0 0 0 0 0 0 0
mg, trimetoprim 20mg)

154 Lansoprazole kaps 30 mg Kapsul 60 100 160 0 160 160 100

155 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
156 Lexapram Tablet 0 0 0 0 0 0 0
Lidokain injeksi 2% (HCl) + Epinefrine
157 Ampul 15 24 39 12 27 27 10
1:80.000
158 Loperamide tab 2 mg Tablet 300 0 300 30 270 270 0
159 Loratadin 10 mg Tablet 0 500 500 340 160 160 500
160 Loratadin 10 mg Tablet 440 0 440 0 440 440 0 BOK
161 Lysol (kresol tersaponifikasi 50%) Botol 2 0 2 0 2 2 0
162 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 0 0 0 0 0 0 6
163 MDT MB Anak Blister 0 0 0 0 0 0 6
164 MDT MB Dewasa Blister 5 0 5 4 1 1 12
165 MDT PB Anak Blister 0 0 0 0 0 0 6
166 MDT PB Dewasa Blister 2 0 2 2 0 0 3
167 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
168 Meloxicam 7,5 Tablet 50 150 200 140 60 60 500
169 Metamizole 500 mg Tablet 0 0 0 0 0 0 1000
170 Metformin 500 mg Tablet 1100 0 1100 60 1040 1040 0
171 Methergin injeksi ampul 0 0 0 0 0 0 0
172 Methylprednisolone 4 mg Tablet 0 0 0 0 0 0 500
173 Methylprednisolone 8 mg Tablet 210 300 510 0 510 510 500
174 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 50 0 50 2 48 48 0
175 Metilergometrin tablet Tablet 100 0 100 0 100 100 0
176 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
177 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
178 Metrodinazole tab 500 mg Tablet 940 0 940 70 870 870 0
179 Miconazole 2 % krim Tube 2 24 26 26 0 0 24
180 Natrium diklofenak 25 mg tab Tablet 0 0 0 0 0 0 500
181 Natrium diklofenak 50 mg Tablet 0 0 0 0 0 0 500
182 Natrium diklofenak 50 mg Tablet 480 0 480 30 450 450 0 BOK
183 Natrium klorida larutan infus 0,9 % Botol 17 20 37 7 30 30 20
184 Neurobion injeksi Ampul 0 4 4 4 0 0 8
185 Neurosanbe injeksi Ampul 0 0 0 0 0 0 4
186 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0
187 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
188 Norit Tablet 80 0 80 0 80 80 0
189 Novadium Tablet 0 0 0 0 0 0 0
190 OAT Anak PAKET 0 0 0 0 0 0 2
191 OAT Dewasa PAKET 3 0 3 3 0 0 2
192 Obat batuk hitam (O.B.H.) Botol 41 0 41 7 34 34 0
193 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
194 Oksitetrasiklin HCL 3% Salep kulit Tube 13 25 38 9 29 29 48
195 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
196 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
197 Oksitosin injeksi 10 UI/ml-1 ml Ampul 6 0 6 1 5 5 0
198 Omeprasole Kapsul 70 0 70 20 50 50 150
199 Ondancentron Syrup Botol 0 0 0 0 0 0 0
200 Ondancentron tablet Tablet 0 0 0 0 0 0 500
201 Ondancetron inj Ampul 0 10 10 0 10 10 10
202 Osutran 70 Botol 0 0 0 0 0 0 0
203 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
204 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
205 Paracetamol drop Botol 19 0 19 3 16 16 0
206 Paracetamol infus Botol 3 0 3 0 3 3 2
207 Parasetamol sirup 120 mg/5 ml Botol 4 20 24 24 0 0 30
208 Parasetamol Tablet 500 gm Tablet 24 3100 3124 2876 248 248 3000
209 Penicilin injeksi Vial 2 0 2 2 0 0 0
210 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
211 phytomenadione Tablet 200 0 200 0 200 200 0
212 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
213 Piracetam tablet Tablet 0 0 0 0 0 0 0
214 Pirantel pamoat 125 mg Tablet 528 0 528 8 520 520 0
215 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 310 500 810 275 535 535 500
216 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
217 Pirosikam 10 mg Kapsul 0 0 0 0 0 0 500
218 Pitogin inj Ampul 0 0 0 0 0 0 0
219 Prednison tablet 5 mg Tablet 80 0 80 0 80 80 0
220 Primakuin 15 mg Tablet 658 1500 2158 828 1330 1330 3000
221 Promanolol 10 mg Tablet 0 0 0 0 0 0 0
222 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
223 Pyrazinamide Tablet 0 0 0 0 0 0 0
224 Quinine 222mg Tablet 780 0 780 0 780 780 0
225 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
226 Quinine inj ampul Ampul 0 0 0 0 0 0 0
227 Ranitidine 150 mg Tablet 250 500 750 160 590 590 1000
228 Ranitidine injeksi 25 mg/2ml Ampul 35 0 35 6 29 29 0
229 Rapid HIV 1 Pcs 0 0 0 0 0 0 0
230 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
231 Rapid Sifilis Pcs 0 0 0 0 0 0 0
232 Remolit Sachet 0 0 0 0 0 0 0
233 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
234 Ringer laktat larutan infus Botol 8 10 18 14 4 4 10
235 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 74 200 274 112 162 162 500
236 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 0 200 200 200 0 0 500
237 Salep 2-4 Pot 0 10 10 2 8 8 24
238 Salisil bedak 2% Pot 13 0 13 9 4 4 0
239 Scoott's Emultion Botol 0 0 0 0 0 0 24
240 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
241 Sianokobalamin ( vitamin B12) injeksi 50 mc Vial 3 10 13 4 9 9 30
242 sianokobalamin (vitamin B12) Tabet 645 500 1145 80 1065 1065 1000
243 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
244 Simvastatine 20 mg Tablet 0 0 0 0 0 0 300
245 Stesolit Tablet 0 0 0 0 0 0 0
246 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
247 Susu ibu Hamil Karton 0 0 0 0 0 0 0
248 Susu ibu menyusui Karton 0 0 0 0 0 0 0
249 Susu lactogen 1 Karton 0 0 0 0 0 0 0
250 Susu sgm 1 Karton 0 0 0 0 0 0 0
251 Susu sgm 2 Karton 0 0 0 0 0 0 0
252 Tablet tambah darah pcs 100 9500 9600 1770 7830 7830 1000
253 Test malaria pf= pv combo /parascreen (RDT pcs 0 125 125 125 0 0 150
254 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 0
255 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
256 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
Propiretic 160 mg suppo Suppo 0 36 36 0 36 36 0
257 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0
258 Thiamin (vitamin B1) tablet 100 mg (HCL/nitra Tablet 0 0 0 0 0 0 0
259 Trampara Tablet 0 0 0 0 0 0 0
260 Trombhop gel Tube 3 0 3 0 3 3 3
261 Vi B Com Tablet 100 1000 1100 1100 0 0 1500
262 Vi B Com Tablet 800 0 800 340 460 460 0 BOK
263 Vit. A 200.000 IU merah Capsul 20 0 20 0 20 20 0
264 Vit. B1 ampul 130 0 130 0 130 130 0
265 Vit. K4 Tablet 1200 0 1200 40 1160 1160 0
266 Vit.A 100.000 IU biru Cap 88 0 88 2 86 86 0
267 Vit.B comp injeksi Vial 0 0 0 0 0 0 20
268 Vitamin C 500mg Tablet 0 500 500 500 0 0 1000
269 Zinc dispersible tab 20 mg Tablet 25 200 225 95 130 130 500
1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 33 0 33 2 31 31 5
3 Abucat No 20 (abbot) Pcs 2 10 12 6 6 6 10
4 Abucat No 22 (abbot) Pcs 3 9 12 5 7 7 20
5 Abucat No 24 (abbot) Pcs 1 10 11 3 8 8 20
6 Abucat No 26 (abbot) Pcs 4 0 4 0 4 4 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 580 0 580 15 565 565 0
10 Alat suntik sekali pakai 1 ml Pcs 2 30 32 19 13 13 100
11 Alat suntik sekali pakai 10 ml Pcs 22 20 42 17 25 25 50
12 Alat suntik sekali pakai 3 ml Pcs 0 100 100 85 15 15 200
13 Alat suntik sekali pakai 5 ml Pcs 47 100 147 50 97 97 100
14 Alcohol swab BD Pcs 0 0 0 0 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 0 0 0 0 0 0 3
20 Bethadine 30ml Botol 11 15 26 3 23 23 20
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 0 20 20 5 15 15 200
23 Blood lanced ktk 0 1 1 1 0 0 5
24 Blood lanced ktk 1 0 1 0 1 1 0 BOK
25 Brankar Pcs 0 0 0 0 0 0 0
26 BTA Botol 0 0 0 0 0 0 0
27 Buku resep Pcs 0 0 0 0 0 0 0
28 Bunsen Buah 0 0 0 0 0 0 0
Catgut / benang bedah no. 2/0 dengan
29 Box 0 0 0 0 0 0 3
jarum bedah
 Catgut /benang bedah no. 3/0 dengan jarum
30 Box 0 0 0 0 0 0 3
bedah
31 Catgut chromic 3/0 Pcs 8 0 8 0 8 8 3
32 Celemek Kebidanan Pcs 50 0 50 0 50 50 0
33 Chateter 18 PCS 14 0 14 0 14 14 2
34 Chateter 20 Pcs 5 0 5 0 5 5 2
35 Chateter 22 Pcs 0 10 10 0 10 10 2
36 Daryant tulle Pcs 8 0 8 0 8 8 3
37 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
38 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
39 Dopler Pcs 0 0 0 0 0 0 1
40 Easy Ttocti Pcs 0 0 0 0 0 0 0
41 Gelas Ukur Pcs 0 0 0 0 0 0 0
42 Golf Hidung Pcs 0 0 0 0 0 0 0
43 Gunting epis Pcs 0 0 0 0 0 0 0
44 Gunting tajam Pcs 0 0 0 0 0 0 0
45 H2O2 3% Botol 0 0 0 0 0 0 2
46 Handscon bersih Pcs 0 0 0 0 0 0 0
47 Handscon non steril uk. L Box 0 0 0 0 0 0 2
48 Handscon non steril uk. M Box 0 2 2 0 2 2 3
49 Handscon non steril uk. S Box 3 0 3 1 2 2 2
50 Handscon non steril uk. XL Box 0 2 2 2 0 0 3
51 Hansaplast Box 100 0 100 0 100 100 2
52 HB sahli set 0 0 0 0 0 0 1
53 Hepavix Buah 1 1 2 0 2 2 2
54 Improvet Neubawer Pcs 0 0 0 0 0 0 0
55 Infusion set anak Pcs 4 10 14 5 9 9 10
56 Infusion set dewasa Pcs 7 20 27 6 21 21 20
57 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
58 Jarum Otot no. 6 Lsn 4 0 4 0 4 4 0
59 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
60 kapas 250gr Buah 0 0 0 0 0 0 3
61 Kapas 50gr Buah 1 1 2 0 2 2 2
62 Kasa gulung besar Roll 1 1 2 1 1 1 2
63 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
64 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
65 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
66 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
67 Kasa steril 16 x 16 (isi 16 lembar) Ktk 6 0 6 3 3 3 20
68 Kertas puyer klip pack 0 0 0 0 0 0 1 BOK
69 Kertas Puyer Perkamen Ikat 0 2 2 0 2 2 3
70 Kertas Puyer Perkamen Ikat 0 0 0 0 0 0 0 BOK
71 Kertas Saring Pack 0 0 0 0 0 0 0
72 Korentang Pcs 0 0 0 0 0 0 0
73 Kursi roda Buah 0 0 0 0 0 0 0
74 Labu Spirtus Pcs 0 0 0 0 0 0 0
75 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
76 Lampu Tindakan Pcs 0 0 0 0 0 0 0
77 Larutan Ziehl Neelsen Pcs 1 0 1 0 1 1 0
78 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
79 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
80 Masker Bedah tali karet Ktk 1 4 5 4 1 1 5
81 Masker kain 3 lapis me4ah putih pcs 0 0 0 0 0 0 400
82 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
83 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
84 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
85 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
86 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
87 Nebulizer Pcs 0 0 0 0 0 0 0
88 Needle 18 Pcs 0 0 0 0 0 0 0
89 Needle 21 Pcs 0 0 0 0 0 0 0
90 Needle 22 Pcs 0 0 0 0 0 0 0
91 Needle 23 Pcs 25 20 45 7 38 38 2
92 Needle 25 Pcs 30 0 30 0 30 30 0
93 Needle holder Pcs 0 0 0 0 0 0 0
94 NGT Pcs 0 0 0 0 0 0 0
95 Oil immersion Botol 1 0 1 0 1 1 0
96 Orofaring Pcs 0 0 0 0 0 0 0
97 Pengukur Lila Pcs 0 0 0 0 0 0 0
98 Pinset anatomis Pcs 0 0 0 0 0 0 0
99 Pipet Tetes Buah 0 0 0 0 0 0 0
100 Pipet tetes Pcs 0 0 0 0 0 0 0
101 Plastik klip Obat 12 x 8 cm pack 4 0 4 3 1 1 3 BOK
102 Plastik klip obat 7 x 10 cm Pack 0 3 3 3 0 0 3
103 Plastik klip obat 7x10 cm pack 6 0 6 3 3 3 3 BOK
104 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
105 Plastik Kresek (semangka) ikat 9 0 9 2 7 7 0 BPJS
106 Plester R0ll sedang Pcs 2 5 7 6 1 1 20
107 Poly gyps Pcs 0 0 0 0 0 0 10
108 Pot Dahak Pcs 21 0 21 9 12 12 10
109 Preparat Buah 0 0 0 0 0 0 0
110 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
111 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
112 Reagen giemzah Botol 1 0 1 0 1 1 1
113 Regulator O2 Pcs 0 0 0 0 0 0 0
114 Rivanol 300 ml Botol 1 0 1 0 1 1 0
115 Sabun Asepso Pcs 6 15 21 21 0 0 20
116 Sarung tangan no 7,5 steril Pcs 60 50 110 110 0 0 50
117 Sarung tangan no 8 steril Pcs 132 0 132 0 132 132 0
118 Sarung tangan no. 7 steril Pcs 100 0 100 26 74 74 100
119 Sarung Tangan Obgyn Pcs 5 0 5 0 5 5 0
120 Sarung tangan steril no. 6,5 Pcs 41 0 41 5 36 36 50
121 Scalpel Pcs 0 0 0 0 0 0 0
122 seide 2/0 roll 0 0 0 0 0 0 0
123 Selang nebulezer Pcs 0 0 0 0 0 0 0
124 Selang oksigen PCS 0 0 0 0 0 0 0
125 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
126 Silk black Braided 2/0 Box 0 5 5 0 5 5 3
127 silk Braided USP 3/0 150 cm Pcs 3 0 3 0 3 3 3
128 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
129 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
130 Sinurgis Pcs 0 0 0 0 0 0 0
131 Slide Pcs 0 144 144 144 0 0 360
132 Slide Pcs 0 0 0 0 0 0 0
133 Spatle tongue Pcs 0 0 0 0 0 0 0
134 Spekulum Huding Pcs 0 0 0 0 0 0 0
135 Spekulum Vagina Pcs 0 0 0 0 0 0 0
136 Spigmomanometer Buah 0 0 0 0 0 0 0
137 Spirtus Botol 0 0 0 0 0 0 0
138 Standart Infus Pcs 0 0 0 0 0 0 0
139 Stick Asam Urat Box 0 4 4 4 0 0 5
140 Stick Cholesterol Box 0 4 4 4 0 0 5
141 Stick Gula Darah Box 0 4 4 4 0 0 5
142 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
143 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
144 Tabung EDTA pcs 0 0 0 0 0 0 0
145 Tabung HB Pcs 0 0 0 0 0 0 0
146 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
147 Tenscoprap Pcs 0 0 0 0 0 0 0
148 Tensi Raksa Set 0 0 0 0 0 0 1
149 Termometer Digital Pcs 2 0 2 1 1 1 0
150 Test Pack - HCG Pcs 0 50 50 29 21 21 100
151 Thorniquet Pcs 0 0 0 0 0 0 0
152 Timbangan Bayi Pcs 0 0 0 0 0 0 1
153 Timbangan dewasa set 0 0 0 0 0 0 1
154 Ultasonic gell Botol 0 0 0 0 0 0 1 BOK
155 Umbilical cord klem Pcs 0 0 0 0 0 0 10
156 Underpad Pcs 15 0 15 3 12 12 20
157 Urine bag Pcs 8 0 8 0 8 8 2
158 Verban elastis Roll 5 0 5 0 5 5 0
159 Wing Needle 21 Pcs 20 0 20 0 20 20 0
160 Wing Needle 25 Pcs 30 0 30 0 30 30 0

Kasonaweja, 04 April 2022

Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab

LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : KASONAWEJA PELAPORAN BULAN : APRIL 2022

KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : MEI 2022

SATUAN STOK PENERIM PERSEDIA PEMAKAIA SISA STOK PERMINTA PEMBERI EXP
NO NAMA OBAT NO. BATCH KET.
KEMASAN AWAL AAN AN N STOK OPNAME AN AN DATE
1 Acetylcysteine 200 mg Capsul 720 600 1320 380 940 940 1200
2 Acyclovir 200 mg Tablet 640 0 640 0 640 640 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 198 0 198 2 196 196 0
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 2 4 6 3 3 3 5
7 Allopurinol tab 100 mg Tablet 1250 500 1750 620 1130 1130 500
8 Ambroxol syrup 15mg/ml Botol 0 0 0 0 0 0 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 145 0 145 145 0 0 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 600 500 1100 220 880 880 500
16 Amoksisilin syrup kering 125mg/5ml Botol 0 20 20 0 20 20 10
17 Amoksisilin tablet 500 mg Tablet 0 1600 1600 1600 0 0 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 0 20 20 0 20 20 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 0 1310 1310 0
21 Antalgin tab 500 mg Tablet 0 0 0 0 0 0 1000
22 Antalgin injeksi 250 mg/ml-2ml (metamizole inj) Ampul 10 20 30 0 30 30 10
23 Antasida Doen Tablet 0 0 0 0 0 0 1500
24 Antasida DOEN syrup Botol 15 20 35 0 35 35 20
Antasida DOEN tab kombinasi: Mg-hidroksida
25 Tablet 1010 500 1510 215 1295 1295 1500
200mg + Al-hidroksida 200mg
26 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0
Antibakteri DOEN salf kombinasi:Basitrasin 500
27 Tube 0 0 0 0 0 0 0
IU/g + Polimiksin 10000 IU/g
28 Aqua pro injection steril, bebas pyrogen Vial 0 0 0 0 0 0 10
29 Aquadest steril Botol 4 5 9 4 5 5 6
30 Artem Vial 0 0 0 0 0 0 0
31 Artesunat injeksi vial 12 0 12 0 12 12 10
32 Asam askorbat (Vit.C)tab 50 mg Tablet 0 0 0 0 0 0 2000
33 Asam mefenamat 500 mg Tablet 120 1000 1120 1120 0 0 1500
34 Asam mefenamat 500 mg Tablet 400 0 400 200 200 200 0 BOK
35 Baby Coug Syr Botol 24 0 24 24 0 0 0
36 Bekarbon Tablet 0 0 0 0 0 0 0
37 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
38 Betametason krim 0,1% Tube 0 25 25 23 2 2 50
39 Bionicom Zink Tablet 435 500 935 700 235 235 500
40 Bioplacenton Slp Tube 8 0 8 0 8 8 0
41 Bioxon inj Vial 0 0 0 0 0 0 0
42 Bioxon injeksi Vial 0 0 0 0 0 0 0
43 Bisolvon Botol 0 0 0 0 0 0 0
44 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
45 Blangko laporan KIA Rim 0 0 0 0 0 0 0
46 Blestop Tablet 0 0 0 0 0 0 0
47 Bubur Sun Karton 0 0 0 0 0 0 0
48 Buku KIA PCS 0 0 0 0 0 0 0
49 Buku Lansia Pcs 0 0 0 0 0 0 0
50 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
51 Captopril 12,5 mg Tablet 170 0 170 10 160 160 0
52 Captopril 25 mg Tablet 790 0 790 20 770 770 0
53 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
54 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
55 Cefadroxil 500 mg Kapsul 160 0 160 160 0 0 0
56 Cefadroxil syrup Botol 17 0 17 5 12 12 0
57 Cefixime 200 mg Capsul 760 0 760 350 410 410 0
58 Cefixime kapsul 100 mg Kapsul 0 0 0 0 0 0 0
59 Cefixime syrup Botol 0 0 0 0 0 0 0
60 Cefotaxime inj 1 gr Vial 8 0 8 0 8 8 5
61 Ceftriaxon inj 1 gr Vial 14 0 14 0 14 14 5
62 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
63 Cetirizine hydrochloride 10 mg Tablet 440 0 440 110 330 330 0 BOK
64 Cimetidine 200 mg Tablet 400 0 400 0 400 400 0
65 Ciprofloksasin 500 mg Tablet 350 300 650 380 270 270 300
66 Clindamycin 150 mg Kapsul 1030 0 1030 0 1030 1030 0
67 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
68 Combantrin sirup orange Botol 27 0 27 5 22 22 0
69 Conterpain 30gr Tube 3 0 3 3 0 0 5
70 Cotrimoksasole syrup Botol 1 10 11 10 1 1 10
71 Cotrimoxazole 480 mg Tablet 461 0 461 289 172 172 0
72 Darplex Tablet 74 1350 1424 1356 68 68 2250
73 Deksametason injeksi 5 mg/ml -1 ml Ampul 180 0 180 6 174 174 0
74 Deksametason tablet 0,5 mg Tablet 260 2000 2260 2200 60 60 2000
75 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
76 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
77 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
78 Diazepam inj Ampul 0 0 0 0 0 0 0
79 Diclovenac Sidium 50 mg Tablet 0 500 500 200 300 300 500
80 DietilCarbamazine Tablet 0 0 0 0 0 0 500
81 Difenhidramin HCL inj 10 mg/ml-1 ml Vial 5 5 10 0 10 10 10
82 Digoxin 0.25 mg Tablet 100 0 100 0 100 100 0
83 Doksisiklin 100 mg kapsul Kapsul 1000 0 1000 0 1000 1000 0
84 Domperidone 10 mg Tablet 350 200 550 300 250 250 300
85 Domperidone syr Botol 0 0 0 0 0 0 10
86 Dumin 125mg/ml supp 36 0 36 0 36 36 0
87 Dumin 250mg/ml Supp 35 0 35 0 35 35 0
88 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
89 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
90 Emibion Capsul 0 0 0 0 0 0 500
91 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 20 0 20 0 20 20 0
92 Eritromisin 500 mg kap Kapsul 270 0 270 40 230 230 0
93 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
94 Eritromisin sirup 200 mg/5 ml Botol 14 0 14 4 10 10 0
95 Etabion Botol 0 0 0 0 0 0 500
96 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
97 Ethyl chloride Botol 0 1 1 1 0 0 2
98 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
99 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
100 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
101 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
102 Fermia Tablet 0 0 0 0 0 0 0
103 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
104 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0
105 Fitometandione (Vit K1) tablet salut gula 10 mg Tablet 0 0 0 0 0 0 0
106 Fludane Tablet 0 0 0 0 0 0 500
107 Fludane plus Tablet 0 0 0 0 0 0 500
108 Folamil Tablet 0 0 0 0 0 0 500
109 Folavit Tablet 0 0 0 0 0 0 500
110 Folic acid Tablet 0 0 0 0 0 0 1000
111 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
112 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl 0,30g,
113 .Sachet 55 100 155 45 110 110 200
trinatrium sachet
114 Gentamicin inj. Ampul 0 0 0 0 0 0 10
115 Gentian violet larutan 1%= 299 botol/10ml Botol 8 10 18 4 14 14 10
116 Glibenclamide 5 mg tablet Tablet 280 0 280 30 250 250 200
117 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
118 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
119 Glukosa larutan infus 5% Botol 16 0 16 6 10 10 10
120 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
121 Griseovulfin 125 mg Tablet 545 0 545 330 215 215 0
122 Guaiefenesin Tablet 0 1500 1500 1250 250 250 2000
123 hepaQ Tablet 0 0 0 0 0 0 0
124 Hidrokortison krim 2,5% Tube 94 72 166 14 152 152 0
125 Ibuprofen tablet 200 mg Tablet 0 300 300 300 0 0 500
126 Ibuprofen tablet 400mg Tablet 0 500 500 500 0 0 1000
127 Ictiol salf Pot 10 0 10 1 9 9 10
128 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
129 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
130 Kalsium laktat (kalk) Tablet 670 0 670 220 450 450 0
131 Kalsium laktat (kalk) Tablet 0 0 0 0 0 0 0
132 Kamulvit syrup Botol 0 0 0 0 0 0 24
133 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
134 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
135 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
136 Ketoconazole 200 mg Tablet 735 0 735 210 525 525 0
137 Ketoconazole krim 5 mg Tube 0 10 10 6 4 4 20
138 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
139 Kina Sulphate Tablet 0 0 0 0 0 0 0
140 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
141 Kloramfenikol tetes mata (Erlamycetin) Tube 6 14 20 9 11 11 12
142 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 12
143 Kloramphenicol suspensi Botol 60 0 60 0 60 60 0
144 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
145 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
146 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 0 864 864 812 52 52 1440
147 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 87 0 87 0 87 87 0 BOK
148 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
149 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
150 Kohort bayi Pcs 0 0 0 0 0 0 0
151 Kohort Ibu Pcs 0 0 0 0 0 0 0
Kotrimoksazole DOEN I (dewasa)kombinasi :
152 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 400 mg, trimetoprim 25mg)
Kotrimoksazole DOEN II (dewasa)kombinasi :
153 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 100 mg, trimetoprim 20mg)
154 Lansoprazole kaps 30 mg Kapsul 160 0 160 30 130 130 100
155 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
156 Lexapram Tablet 0 0 0 0 0 0 0

157 Lidokain injeksi 2% (HCl) + Epinefrine 1:80.000 Ampul 27 60 87 14 73 73 10

158 Loperamide tab 2 mg Tablet 270 0 270 85 185 185 0

159 Loratadin 10 mg Tablet 160 500 660 320 340 340 500
160 Loratadin 10 mg Tablet 440 0 440 200 240 240 0 BOK
161 Lysol (kresol tersaponifikasi 50%) Botol 2 0 2 0 2 2 0
162 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 0 0 0 0 0 0 6
163 MDT MB Anak Blister 0 0 0 0 0 0 6
164 MDT MB Dewasa Blister 1 6 7 7 0 0 12
165 MDT PB Anak Blister 0 0 0 0 0 0 6
166 MDT PB Dewasa Blister 0 0 0 0 0 0 3
167 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
168 Meloxicam 7,5 Tablet 60 250 310 150 160 160 500
169 Metamizole 500 mg Tablet 0 0 0 0 0 0 1000
170 Metformin 500 mg Tablet 1040 0 1040 470 570 570 0
171 Methergin injeksi ampul 0 0 0 0 0 0 0
172 Methylprednisolone 4 mg Tablet 0 200 200 100 100 100 500
173 Methylprednisolone 8 mg Tablet 510 200 710 200 510 510 500
174 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 48 0 48 0 48 48 0
175 Metilergometrin tablet Tablet 100 0 100 0 100 100 0
176 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
177 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
178 Metrodinazole tab 500 mg Tablet 870 0 870 60 810 810 0
179 Miconazole 2 % krim Tube 0 24 24 23 1 1 24
180 Natrium diklofenak 25 mg tab Tablet 0 0 0 0 0 0 500
181 Natrium diklofenak 50 mg Tablet 0 0 0 0 0 0 500
182 Natrium diklofenak 50 mg Tablet 450 0 450 200 250 250 0 BOK
183 Natrium klorida larutan infus 0,9 % Botol 30 0 30 14 16 16 20
184 Neurobion injeksi Ampul 0 3 3 3 0 0 8
185 Neurosanbe injeksi Ampul 0 0 0 0 0 0 4
186 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0
187 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
188 Norit Tablet 80 0 80 0 80 80 0
189 Novadium Tablet 0 0 0 0 0 0 0
190 OAT Anak PAKET 0 3 3 0 3 3 2
191 OAT Dewasa PAKET 0 0 0 0 0 0 2
192 Obat batuk hitam (O.B.H.) Botol 34 0 34 22 12 12 0
193 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
194 Oksitetrasiklin HCL 3% Salep kulit Tube 29 0 29 25 4 4 48
195 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
196 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
197 Oksitosin injeksi 10 UI/ml-1 ml Ampul 5 0 5 3 2 2 0
198 Omeprasole Kapsul 50 0 50 0 50 50 150
199 Ondancentron Syrup Botol 0 0 0 0 0 0 0
200 Ondancentron tablet Tablet 0 0 0 0 0 0 500
201 Ondancetron inj Ampul 10 0 10 2 8 8 10
202 Osutran 70 Botol 0 0 0 0 0 0 0
203 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
204 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
205 Paracetamol drop Botol 16 0 16 5 11 11 0
206 Paracetamol infus Botol 3 0 3 0 3 3 2
207 Parasetamol sirup 120 mg/5 ml Botol 0 20 20 20 0 0 30
208 Parasetamol Tablet 500 gm Tablet 248 3500 3748 3465 283 283 3000
209 Penicilin injeksi Vial 0 0 0 0 0 0 0
210 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
211 phytomenadione Tablet 200 0 200 0 200 200 0
212 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
213 Piracetam tablet Tablet 0 0 0 0 0 0 0
214 Pirantel pamoat 125 mg Tablet 520 0 520 24 496 496 0
215 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 535 300 835 240 595 595 500
216 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
217 Pirosikam 10 mg Kapsul 0 0 0 0 0 0 500
218 Pitogin inj Ampul 0 0 0 0 0 0 0
219 Prednison tablet 5 mg Tablet 80 0 80 0 80 80 0
220 Primakuin 15 mg Tablet 1330 1000 2330 522 1808 1808 3000
221 Promanolol 10 mg Tablet 0 0 0 0 0 0
222 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
223 Pyrazinamide Tablet 0 0 0 0 0 0 0
224 Quinine 222mg Tablet 780 0 780 0 780 780 0
225 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
226 Quinine inj ampul Ampul 0 0 0 0 0 0 0
227 Ranitidine 150 mg Tablet 590 300 890 330 560 560 1000
228 Ranitidine injeksi 25 mg/2ml Ampul 29 0 29 4 25 25 0
229 Rapid HIV 1 Pcs 0 0 0 0 0 0 0
230 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
231 Rapid Sifilis Pcs 0 0 0 0 0 0 0
232 Remolit Sachet 0 0 0 0 0 0 0
233 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
234 Ringer laktat larutan infus Botol 4 10 14 3 11 11 10
235 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 162 0 162 90 72 72 500
236 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 0 200 200 170 30 30 500
237 Salep 2-4 Pot 8 10 18 3 15 15 24
238 Salisil bedak 2% Pot 4 0 4 4 0 0 0
239 Scoott's Emultion Botol 0 0 0 0 0 0 24
240 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
241 Sianokobalamin ( vitamin B12) injeksi 50 mcg Vial 9 0 9 8 1 1 30
242 sianokobalamin (vitamin B12) Tabet 1065 0 1065 200 865 865 1000
243 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
244 Simvastatine 20 mg Tablet 0 100 100 40 60 60 300
245 Stesolit Tablet 0 0 0 0 0 0 0
246 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
247 Susu ibu Hamil Karton 0 0 0 0 0 0 0
248 Susu ibu menyusui Karton 0 0 0 0 0 0 0
249 Susu lactogen 1 Karton 0 0 0 0 0 0 0
250 Susu sgm 1 Karton 0 0 0 0 0 0 0
251 Susu sgm 2 Karton 0 0 0 0 0 0 0
252 Tablet tambah darah pcs 7830 0 7830 1900 5930 5930 1000
253 Test malaria pf= pv combo /parascreen (RDT) pcs 0 125 125 125 0 0 150
254 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 0
255 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
256 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
257 Propiretic 160 mg suppo Suppo 36 0 36 0 36 36 0
258 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0
259 Thiamin (vitamin B1) tablet 100 mg (HCL/nitrat) Tablet 0 0 0 0 0 0 0
260 Trampara Tablet 0 0 0 0 0 0 0
261 Trombhop gel Tube 3 0 3 2 1 1 3
262 Vi B Com Tablet 0 1000 1000 1000 0 0 1500
263 Vi B Com Tablet 460 0 460 460 0 0 0 BOK
264 Vit. A 200.000 IU merah Capsul 20 0 20 3 17 17 0
265 Vit. B1 ampul 130 0 130 0 130 130 0
266 Vit. K4 Tablet 1160 0 1160 50 1110 1110 0
267 Vit.A 100.000 IU biru Cap 86 0 86 6 80 80 0
268 Vit.B comp injeksi Vial 0 0 0 0 0 0 20
269 Vitamin C 500mg Tablet 0 300 300 300 0 0 1000
270 Zinc dispersible tab 20 mg Tablet 130 200 330 100 230 230 500

1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 31 0 31 15 16 16 5
3 Abucat No 20 (abbot) Pcs 6 0 6 2 4 4 10
4 Abucat No 22 (abbot) Pcs 7 0 7 0 7 7 20
5 Abucat No 24 (abbot) Pcs 8 0 8 2 6 6 20
6 Abucat No 26 (abbot) Pcs 4 0 4 0 4 4 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 565 0 565 0 565 565 0
10 Alat suntik sekali pakai 1 ml Pcs 13 30 43 43 0 0 100
11 Alat suntik sekali pakai 10 ml Pcs 25 10 35 13 22 22 50
12 Alat suntik sekali pakai 3 ml Pcs 15 100 115 115 0 0 200
13 Alat suntik sekali pakai 5 ml Pcs 97 100 197 5 192 192 100
14 Alcohol swab BD Pcs 0 100 100 100 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 0 0 0 0 0 0 3
20 Bethadine 30ml Botol 23 32 55 10 45 45 20
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 15 0 15 6 9 9 200
23 Blood lanced ktk 0 100 100 100 0 0 5
24 Blood lanced ktk 1 0 1 1 0 0 0 BOK
25 Brankar Pcs 0 0 0 0 0 0 0
26 BTA Botol 0 0 0 0 0 0 0
27 Buku resep Pcs 0 0 0 0 0 0 0
28 Bunsen Buah 0 0 0 0 0 0 0
Catgut / benang bedah no. 2/0 dengan jarum
29 Box 0 0 0 0 0 0 3
bedah
Catgut /benang bedah no. 3/0 dengan jarum
30 Box 0 0 0 0 0 0 3
bedah
31 Catgut chromic 3/0 Pcs 8 0 8 3 5 5 3
32 Celemek Kebidanan Pcs 50 0 50 0 50 50 0
33 Chateter 18 PCS 14 0 14 0 14 14 2
34 Chateter 20 Pcs 5 0 5 0 5 5 2
35 Chateter 22 Pcs 10 0 10 0 10 10 2
36 Daryant tulle Pcs 8 0 8 0 8 8 3
37 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
38 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
39 Dopler Pcs 0 0 0 0 0 0 1
40 Easy Ttocti Pcs 0 0 0 0 0 0 0
41 Gelas Ukur Pcs 0 0 0 0 0 0 0
42 Golf Hidung Pcs 0 0 0 0 0 0 0
43 Gunting epis Pcs 0 0 0 0 0 0 0
44 Gunting tajam Pcs 0 0 0 0 0 0 0
45 H2O2 3% Botol 0 1 1 0 1 1 2
46 Handscon bersih Pcs 0 0 0 0 0 0 0
47 Handscon non steril uk. L Box 0 200 200 100 100 100 2
48 Handscon non steril uk. M Box 2 200 202 0 202 202 3
49 Handscon non steril uk. S Box 2 0 2 0 2 2 2
50 Handscon non steril uk. XL Box 0 200 200 100 100 100 3
51 Hansaplast Box 100 0 100 100 0 0 2
52 HB sahli set 0 0 0 0 0 0 1
53 Hepavix Buah 2 0 2 0 2 2 2
54 Improvet Neubawer Pcs 0 0 0 0 0 0 0
55 Infusion set anak Pcs 9 0 9 2 7 7 10
56 Infusion set dewasa Pcs 21 0 21 11 10 10 20
57 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
58 Jarum Otot no. 6 Lsn 4 0 4 0 4 4 0
59 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
60 kapas 250gr Buah 0 0 0 0 0 0 3
61 Kapas 50gr Buah 2 0 2 2 0 0 2
62 Kapas 100 gr buah 0 1 1 1 0 0 2
63 Kasa gulung besar Roll 1 0 1 0 1 1 2
64 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
65 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
66 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
67 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
68 Kasa steril 16 x 16 (isi 16 lembar) Ktk 3 10 13 3 10 10 20
69 Kertas puyer klip pack 0 0 0 0 0 0 1 BOK
70 Kertas Puyer Perkamen Ikat 2 2 4 2 2 2 3
71 Kertas Puyer Perkamen Ikat 0 0 0 0 0 0 0 BOK
72 Kertas Saring Pack 0 0 0 0 0 0 0
73 Korentang Pcs 0 0 0 0 0 0 0
74 Kursi roda Buah 0 0 0 0 0 0 0
75 Labu Spirtus Pcs 0 0 0 0 0 0 0
76 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
77 Lampu Tindakan Pcs 0 0 0 0 0 0 0
78 Larutan Ziehl Neelsen Pcs 1 0 1 0 1 1 0
79 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
80 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
81 Masker Bedah tali karet Ktk 1 3 4 3 1 1 5
82 Masker kain 3 lapis pcs 0 200 200 58 142 142 400
83 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
84 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
85 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
86 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
87 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
88 Nebulizer Pcs 0 0 0 0 0 0 0
89 Needle 18 Pcs 0 0 0 0 0 0 0
90 Needle 21 Pcs 0 0 0 0 0 0 0
91 Needle 22 Pcs 0 0 0 0 0 0 0
92 Needle 23 Pcs 38 0 38 5 33 33 2
93 Needle 25 Pcs 30 0 30 0 30 30 0
94 Needle holder Pcs 0 0 0 0 0 0 0
95 NGT Pcs 0 0 0 0 0 0 0
96 Oil immersion Botol 1 0 1 0 1 1 0
97 Orofaring Pcs 0 0 0 0 0 0 0
98 Pengukur Lila Pcs 0 0 0 0 0 0 0
99 Pinset anatomis Pcs 0 0 0 0 0 0 0
100 Pipet Tetes Buah 0 0 0 0 0 0 0
101 Pipet tetes Pcs 0 0 0 0 0 0 0
102 Plastik klip Obat 12 x 8 cm pack 1 0 1 1 0 0 3 BOK
103 Plastik klip obat 7 x 10 cm Pack 0 3 3 3 0 0 3
104 Plastik klip obat 7x10 cm pack 3 0 3 1 2 2 3 BOK
105 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
106 Plastik Kresek (semangka) ikat 7 0 7 2 5 5 0 BPJS
107 Plester R0ll sedang Pcs 1 3 4 3 1 1 20
108 Polygyps Pcs 0 1 1 0 1 1 10
109 Pot Dahak Pcs 12 0 12 3 9 9 10
110 Preparat Buah 0 0 0 0 0 0 0
111 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
112 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
113 Reagen giemzah Botol 1 2 3 1 2 2 1
114 Regulator O2 Pcs 0 0 0 0 0 0 0
115 Rivanol 300 ml Botol 1 0 1 0 1 1 0
116 Sabun Asepso Pcs 0 10 10 10 0 0 20
117 Sarung tangan no 7,5 steril Pcs 0 50 50 50 0 0 50
118 Sarung tangan no 8 steril Pcs 132 0 132 4 128 128 0
119 Sarung tangan no. 7 steril Pcs 74 0 74 12 62 62 100
120 Sarung Tangan Obgyn Pcs 5 0 5 0 5 5 0
121 Sarung tangan steril no. 6,5 Pcs 36 50 86 12 74 74 50
122 Scalpel Pcs 0 0 0 0 0 0 0
123 seide 2/0 roll 0 0 0 0 0 0 0
124 Selang nebulezer Pcs 0 0 0 0 0 0 0
125 Selang oksigen PCS 0 0 0 0 0 0 0
126 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
127 Silk black Braided 2/0 Box 5 12 17 2 15 15 3
128 silk Braided USP 3/0 150 cm Pcs 3 0 3 0 3 3 3
129 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
130 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
131 Sinurgis Pcs 0 0 0 0 0 0 0
132 Slide Pcs 0 72 72 72 0 0 360
133 Spatle tongue Pcs 0 0 0 0 0 0 0
134 Spekulum Huding Pcs 0 0 0 0 0 0 0
135 Spekulum Vagina Pcs 0 0 0 0 0 0 0
136 Spigmomanometer Buah 0 0 0 0 0 0 0
137 Spirtus Botol 0 0 0 0 0 0 0
138 Standart Infus Pcs 0 0 0 0 0 0 0
139 Stick Asam Urat PCS 0 125 125 125 0 0 5
140 Stick Cholesterol PCS 0 50 50 50 0 0 5
141 Stick Gula Darah PCS 0 150 150 125 25 25 5
142 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
143 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
144 Tabung EDTA pcs 0 0 0 0 0 0 0
145 Tabung HB Pcs 0 0 0 0 0 0 0
146 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
147 Tenscoprap Pcs 0 0 0 0 0 0 0
148 Tensi Raksa Set 0 0 0 0 0 0 1
149 Termometer Digital Pcs 1 0 1 1 0 0 0
150 Test Pack - HCG Pcs 21 50 71 13 58 58 100
151 Thorniquet Pcs 0 0 0 0 0 0 0
152 Timbangan Bayi Pcs 0 0 0 0 0 0 1
153 Timbangan dewasa set 0 0 0 0 0 0 1
154 Ultasonic gell Botol 0 0 0 0 0 0 1 BOK
155 Umbilical cord klem Pcs 0 0 0 0 0 0 10
156 Underpad Pcs 12 0 12 0 12 12 20
157 Urine bag Pcs 8 0 8 0 8 8 2
158 Verban elastis Roll 5 0 5 1 4 4 0
159 Wing Needle 21 Pcs 20 0 20 0 20 20 0
160 Wing Needle 25 Pcs 30 0 30 0 30 30 0

Kasonaweja, 9 Mei 2022

 Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab

LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : KASONAWEJA PELAPORAN BULAN : MEI 2022

KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : JUNI 2022

SATUAN STOK PENERIMA PERSEDIA PEMAKAIA SISA STOK PERMINTA PEMBERI EXP
NO NAMA OBAT NO. BATCH KET.
KEMASAN AWAL AN AN N STOK OPNAME AN AN DATE
1 Acetylcysteine 200 mg Capsul 940 600 1540 710 830 830 1200
2 Acyclovir 200 mg Tablet 640 0 640 30 610 610 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 196 0 196 4 192 192 0
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 3 3 6 6 0 0 5
7 Allopurinol tab 100 mg Tablet 1130 500 1630 640 990 990 500
8 Ambroxol syrup 15mg/ml Botol 0 0 0 0 0 0 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 880 500 1380 760 620 620 500
16 Amoksisilin syrup kering 125mg/5ml Botol 20 20 40 29 11 11 10
17 Amoksisilin tablet 500 mg Tablet 0 1600 1600 1600 0 0 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 20 0 20 0 20 20 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 0 1310 1310 0
21 Antalgin tab 500 mg Tablet 0 0 0 0 0 0 1000
22 Antalgin injeksi 250 mg/ml-2ml (metamizole inj) Ampul 30 0 30 21 9 9 10

23 Antasida Doen Tablet 0 0 0 0 0 0 1500

24 Antasida DOEN syrup Botol 35 20 55 6 49 49 20
Antasida DOEN tab kombinasi: Mg-hidroksida
25 Tablet 1295 500 1795 445 1350 1350 1500
200mg + Al-hidroksida 200mg
26 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0
Antibakteri DOEN salf kombinasi:Basitrasin 500
27 Tube 0 0 0 0 0 0 0
IU/g + Polimiksin 10000 IU/g
28 Aqua pro injection steril, bebas pyrogen Vial 0 0 0 0 0 0 10
29 Aquadest steril Botol 5 4 9 4 5 5 6
30 Artem Vial 0 0 0 0 0 0 0
31 Artesunat injeksi vial 12 6 18 0 18 18 10
32 Asam askorbat (Vit.C)tab 50 mg Tablet 0 500 500 500 0 0 2000
33 Asam mefenamat 500 mg Tablet 0 500 500 500 0 0 1500
34 Asam mefenamat 500 mg Tablet 200 0 200 200 0 0 0 BOK
35 Baby Coug Syr Botol 0 72 72 18 54 54 24
36 Bekarbon Tablet 0 0 0 0 0 0 0
37 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
38 Betametason krim 0,1% Tube 2 13 15 11 4 4 50
39 Bionicom Zink Tablet 235 500 735 700 35 35 500
40 Bioplacenton Slp Tube 8 0 8 2 6 6 0
41 Bioxon inj Vial 0 0 0 0 0 0 0
42 Bioxon injeksi Vial 0 0 0 0 0 0 0
43 Bisolvon Botol 0 0 0 0 0 0 0
44 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
45 Blangko laporan KIA Rim 0 0 0 0 0 0 0
46 Blestop Tablet 0 0 0 0 0 0 0
47 Bubur Sun Karton 0 0 0 0 0 0 0
48 Buku KIA PCS 0 0 0 0 0 0 0
49 Buku Lansia Pcs 0 0 0 0 0 0 0
50 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
51 Captopril 12,5 mg Tablet 160 0 160 10 150 150 0
52 Captopril 25 mg Tablet 770 0 770 20 750 750 0
53 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
54 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
55 Cefadroxil 500 mg Kapsul 0 0 0 0 0 0 1000
56 Cefadroxil syrup Botol 12 0 12 4 8 8 5
57 Cefixime 200 mg Capsul 410 0 410 330 80 80 500
58 Cefixime kapsul 100 mg Kapsul 0 0 0 0 0 0 0
59 Cefixime syrup Botol 0 0 0 0 0 0 0
60 Cefotaxime inj 1 gr Vial 8 0 8 0 8 8 5
61 Ceftriaxon inj 1 gr Vial 14 0 14 0 14 14 5
62 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
63 Cetirizine hydrochloride 10 mg Tablet 330 0 330 60 270 270 0 BOK
64 Cimetidine 200 mg Tablet 400 0 400 0 400 400 0
65 Ciprofloksasin 500 mg Tablet 270 0 270 240 30 30 300
66 Clindamycin 150 mg Kapsul 1030 0 1030 20 1010 1010 0
67 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
68 Combantrin sirup orange Botol 22 0 22 5 17 17 0
69 Conterpain 30gr Tube 0 5 5 3 2 2 5
70 Cotrimoksasole syrup Botol 1 10 11 10 1 1 20
71 Cotrimoxazole 480 mg Tablet 172 0 172 170 2 2 0
72 Darplex Tablet 68 630 698 689 9 9 2250
73 Deksametason injeksi 5 mg/ml -1 ml Ampul 174 0 174 12 162 162 0
74 Deksametason tablet 0,5 mg Tablet 60 1000 1060 1060 0 0 2000
75 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
76 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
77 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
78 Diazepam inj Ampul 0 0 0 0 0 0 0
79 Diclovenac Sidium 50 mg Tablet 300 0 300 170 130 130 500
80 DietilCarbamazine Tablet 0 0 0 0 0 0 500
81 Difenhidramin HCL inj 10 mg/ml-1 ml Vial 10 0 10 2 8 8 10
82 Digoxin 0.25 mg Tablet 100 0 100 0 100 100 0
83 Doksisiklin 100 mg kapsul Kapsul 1000 0 1000 110 890 890 0
84 Domperidone 10 mg Tablet 250 300 550 175 375 375 300
85 Domperidone syr Botol 0 0 0 0 0 0 10
86 Dumin 125mg/ml supp 36 0 36 1 35 35 0
87 Dumin 250mg/ml Supp 35 0 35 2 33 33 0
88 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
89 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
90 Emibion Capsul 0 0 0 0 0 0 500
91 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 20 0 20 0 20 20 0
92 Eritromisin 500 mg kap Kapsul 230 0 230 170 60 60 0
93 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
94 Eritromisin sirup 200 mg/5 ml Botol 10 0 10 4 6 6 0
95 Etabion Botol 0 0 0 0 0 0 500
96 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
97 Ethyl chloride Botol 0 1 1 1 0 0 2
98 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
99 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
100 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
101 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
102 Fermia Tablet 0 0 0 0 0 0 0
103 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
104 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0
105 Fitometandione (Vit K1) tablet salut gula 10 mg Tablet 0 0 0 0 0 0 0
106 Fludane Tablet 0 0 0 0 0 0 500
107 Fludane plus Tablet 0 0 0 0 0 0 500
108 Folamil Tablet 0 0 0 0 0 0 500
109 Folavit Tablet 0 0 0 0 0 0 500
110 Folic acid Tablet 0 0 0 0 0 0 1000
111 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
112 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl 0,30g,
113 .Sachet 110 100 210 45 165 165 200
trinatrium sachet
114 Gentamicin inj. Ampul 0 0 0 0 0 0 10
115 Gentian violet larutan 1%= 299 botol/10ml Botol 14 10 24 1 23 23 10
116 Glibenclamide 5 mg tablet Tablet 250 200 450 30 420 420 0
117 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
118 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
119 Glukosa larutan infus 5% Botol 10 10 20 6 14 14 10
120 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
121 Griseovulfin 125 mg Tablet 215 0 215 215 0 0 1000
122 Guaiefenesin Tablet 250 2000 2250 1895 355 355 2000
123 hepaQ Tablet 0 0 0 0 0 0 0
124 Hidrokortison krim 2,5% Tube 152 48 200 14 186 186 0
125 Ibuprofen tablet 200 mg Tablet 0 200 200 200 0 0 500
126 Ibuprofen tablet 400mg Tablet 0 500 500 500 0 0 1000
127 Ictiol salf Pot 9 12 21 3 18 18 10
128 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
129 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
130 Kalsium laktat (kalk) Tablet 450 0 450 220 230 230 0
131 Kalsium laktat (kalk) Tablet 0 0 0 0 0 0 0
132 Kamulvit syrup Botol 0 0 0 0 0 0 24
133 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
134 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
135 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
136 Ketoconazole 200 mg Tablet 525 0 525 150 375 375 0
137 Ketoconazole krim 5 mg Tube 4 0 4 4 0 0 20
138 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
139 Kina Sulphate Tablet 0 0 0 0 0 0 0
140 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
141 Kloramfenikol tetes mata (Erlamycetin) Tube 11 12 23 4 19 19 12
142 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 12
143 Kloramphenicol suspensi Botol 60 0 60 0 60 60 0
144 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
145 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
146 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 52 876 928 812 116 116 1440
147 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 87 0 87 87 0 0 0 BOK
148 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
149 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
150 Kohort bayi Pcs 0 0 0 0 0 0 0
151 Kohort Ibu Pcs 0 0 0 0 0 0 0
Kotrimoksazole DOEN I (dewasa)kombinasi :
152 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 400 mg, trimetoprim 25mg)
Kotrimoksazole DOEN II (dewasa)kombinasi :
153 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 100 mg, trimetoprim 20mg)
154 Lansoprazole kaps 30 mg Kapsul 130 0 130 30 100 100 100
155 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
156 Lexapram Tablet 0 0 0 0 0 0 0
157 Lidokain injeksi 2% (HCl) + Epinefrine 1:80.000 Ampul 73 0 73 14 59 59 10
158 Loperamide tab 2 mg Tablet 185 0 185 50 135 135 0
159 Loratadin 10 mg Tablet 340 500 840 320 520 520 500
160 Loratadin 10 mg Tablet 240 0 240 100 140 140 0 BOK
161 Lysol (kresol tersaponifikasi 50%) Botol 2 2 4 0 4 4 0
162 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 0 3 3 0 3 3 6
163 MDT MB Anak Blister 0 0 0 0 0 0 6
164 MDT MB Dewasa Blister 0 6 6 5 1 1 12
165 MDT PB Anak Blister 0 0 0 0 0 0 6
166 MDT PB Dewasa Blister 0 0 0 0 0 0 3
167 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
168 Meloxicam 7,5 Tablet 160 250 410 150 260 260 500
169 Metamizole 500 mg Tablet 0 500 500 0 500 500 1000
170 Metformin 500 mg Tablet 570 200 770 330 440 440 0
171 Methergin injeksi ampul 0 0 0 0 0 0 0
172 Methylprednisolone 4 mg Tablet 100 0 100 0 100 100 500
173 Methylprednisolone 8 mg Tablet 510 0 510 200 310 310 500
174 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 48 0 48 0 48 48 0
175 Metilergometrin tablet Tablet 100 0 100 0 100 100 0
176 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
177 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
178 Metrodinazole tab 500 mg Tablet 810 0 810 60 750 750 0
179 Miconazole 2 % krim Tube 1 24 25 23 2 2 24
180 Natrium diklofenak 25 mg tab Tablet 0 150 150 150 0 0 500
181 Natrium diklofenak 50 mg Tablet 0 150 150 100 50 50 500
182 Natrium diklofenak 50 mg Tablet 250 0 250 200 50 50 0 BOK
183 Natrium klorida larutan infus 0,9 % Botol 16 10 26 14 12 12 20
184 Neurobion injeksi Ampul 0 0 0 0 0 0 8
185 Neurosanbe injeksi Ampul 0 10 10 10 0 0 4
186 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0
187 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
188 Norit Tablet 80 0 80 0 80 80 0
189 Novadium Tablet 0 0 0 0 0 0 0
190 OAT Anak PAKET 3 0 3 0 3 3 2
191 OAT Dewasa PAKET 0 0 0 0 0 0 2
192 Obat batuk hitam (O.B.H.) Botol 12 0 12 12 0 0 0
193 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
194 Oksitetrasiklin HCL 3% Salep kulit Tube 4 15 19 19 0 0 48
195 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
196 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
197 Oksitosin injeksi 10 UI/ml-1 ml Ampul 2 0 2 2 0 0 20
198 Omeprasole Kapsul 50 30 80 30 50 50 150
199 Ondancentron Syrup Botol 0 0 0 0 0 0 0
200 Ondancentron tablet Tablet 0 0 0 0 0 0 500
201 Ondancetron inj Ampul 8 10 18 2 16 16 10
202 Osutran 70 Botol 0 0 0 0 0 0 0
203 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
204 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
205 Paracetamol drop Botol 11 15 26 11 15 15 0
206 Paracetamol infus Botol 3 2 5 0 5 5 2
207 Parasetamol sirup 120 mg/5 ml Botol 0 0 0 0 0 0 30
208 Parasetamol Tablet 500 gm Tablet 283 2200 2483 2386 97 97 3000
209 Penicilin injeksi Vial 0 0 0 0 0 0 0
210 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
211 phytomenadione Tablet 200 0 200 0 200 200 0
212 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
213 Piracetam tablet Tablet 0 0 0 0 0 0 0
214 Pirantel pamoat 125 mg Tablet 496 0 496 24 472 472 0
215 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 595 0 595 595 0 0 500
216 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
217 Pirosikam 10 mg Kapsul 0 0 0 0 0 0 500
218 Pitogin inj Ampul 0 0 0 0 0 0 0
219 Prednison tablet 5 mg Tablet 80 0 80 0 80 80 0
220 Primakuin 15 mg Tablet 1808 300 2108 722 1386 1386 3000
221 Promanolol 10 mg Tablet 0 0 0 0 0 0 0
222 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
223 Pyrazinamide Tablet 0 0 0 0 0 0 0
224 Quinine 222mg Tablet 780 0 780 388 392 392 0
225 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
226 Quinine inj ampul Ampul 0 0 0 0 0 0 0
227 Ranitidine 150 mg Tablet 560 300 860 140 720 720 1000
228 Ranitidine injeksi 25 mg/2ml Ampul 25 0 25 4 21 21 0
229 Rapid HIV 1 Pcs 0 0 0 0 0 0 0
230 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
231 Rapid Sifilis Pcs 0 0 0 0 0 0 0
232 Remolit Sachet 0 0 0 0 0 0 0
233 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
234 Ringer laktat larutan infus Botol 11 10 21 17 4 4 10
235 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 72 200 272 90 182 182 500
236 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 30 200 230 170 60 60 500
237 Salep 2-4 Pot 15 5 20 3 17 17 24
238 Salisil bedak 2% Pot 0 12 12 4 8 8 0
239 Scoott's Emultion Botol 0 0 0 0 0 0 24
240 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
241 Sianokobalamin ( vitamin B12) injeksi 50 mcg Vial 1 0 1 1 0 0 30
242 sianokobalamin (vitamin B12) Tabet 865 0 865 200 665 665 1000
243 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
244 Simvastatine 20 mg Tablet 60 100 160 40 120 120 300
245 Stesolit Tablet 0 0 0 0 0 0 0
246 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
247 Susu ibu Hamil Karton 0 0 0 0 0 0 0
248 Susu ibu menyusui Karton 0 0 0 0 0 0 0
249 Susu lactogen 1 Karton 0 0 0 0 0 0 0
250 Susu sgm 1 Karton 0 0 0 0 0 0 0
251 Susu sgm 2 Karton 0 0 0 0 0 0 0
252 Tablet tambah darah pcs 5930 0 5930 2100 3830 3830 1000
253 Test malaria pf= pv combo /parascreen (RDT) pcs 0 225 225 225 0 0 150
254 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 0
255 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
256 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
257 Propiretic 160 mg suppo Suppo 36 0 36 0 36 36 0
258 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0
259 Thiamin (vitamin B1) tablet 100 mg (HCL/nitrat) Tablet 0 0 0 0 0 0 0
260 Trampara Tablet 0 0 0 0 0 0 0
261 Trombhop gel Tube 1 3 4 2 2 2 3
262 Vi B Com Tablet 0 1000 1000 1000 0 0 1500
263 Vi B Com Tablet 0 0 0 0 0 0 0 BOK
264 Vit. A 200.000 IU merah Capsul 17 0 17 3 14 14 0
265 Vit. B1 ampul 130 0 130 0 130 130 0
266 Vit. K4 Tablet 1110 0 1110 50 1060 1060 0
267 Vit.A 100.000 IU biru Cap 80 0 80 6 74 74 0
268 Vit.B comp injeksi Vial 0 10 10 0 10 10 20
269 Vitamin C 500mg Tablet 0 0 0 0 0 0 1000
270 Zinc dispersible tab 20 mg Tablet 230 200 430 280 150 150 500

1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 16 0 16 15 1 1 5
3 Abucat No 20 (abbot) Pcs 4 0 4 2 2 2 10
4 Abucat No 22 (abbot) Pcs 7 0 7 0 7 7 20
5 Abucat No 24 (abbot) Pcs 6 0 6 2 4 4 20
6 Abucat No 26 (abbot) Pcs 4 0 4 0 4 4 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 565 0 565 0 565 565 0
10 Alat suntik sekali pakai 1 ml Pcs 0 10 10 10 0 0 100
11 Alat suntik sekali pakai 10 ml Pcs 22 5 27 13 14 14 50
12 Alat suntik sekali pakai 3 ml Pcs 0 100 100 100 0 0 200
13 Alat suntik sekali pakai 5 ml Pcs 192 100 50 5 45 45 0
14 Alcohol swab BD Pcs 0 100 100 100 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 0 0 0 0 0 0 3
20 Bethadine 30ml Botol 45 25 70 3 67 67 20
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 9 7 16 6 10 10 200
23 Blood lanced ktk 0 200 200 100 100 100 5
24 Blood lanced ktk 0 0 0 0 0 0 0 BOK
25 Brankar Pcs 0 0 0 0 0 0 0
26 BTA Botol 0 0 0 0 0 0 0
27 Buku resep Pcs 0 0 0 0 0 0 0
28 Bunsen Buah 0 0 0 0 0 0 0
Catgut / benang bedah no. 2/0 dengan jarum
29 Box 0 0 0 0 0 0 3
bedah
Catgut /benang bedah no. 3/0 dengan jarum
30 Box 0 0 0 0 0 0 3
bedah
31 Catgut chromic 3/0 Pcs 5 0 5 3 2 2 3
32 Celemek Kebidanan Pcs 50 0 50 0 50 50 0
33 Chateter 18 PCS 14 0 14 0 14 14 2
34 Chateter 20 Pcs 5 0 5 0 5 5 2
35 Chateter 22 Pcs 10 0 10 0 10 10 2
36 Daryant tulle Pcs 8 0 8 0 8 8 3
37 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
38 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
39 Dopler Pcs 0 0 0 0 0 0 1
40 Easy Ttocti Pcs 0 0 0 0 0 0 0
41 Gelas Ukur Pcs 0 0 0 0 0 0 0
42 Golf Hidung Pcs 0 0 0 0 0 0 0
43 Gunting epis Pcs 0 0 0 0 0 0 0
44 Gunting tajam Pcs 0 0 0 0 0 0 0
45 H2O2 3% Botol 1 0 1 0 1 1 2
46 Handscon bersih Pcs 0 0 0 0 0 0 0
47 Handscon non steril uk. L Box 100 100 200 100 100 100 1
48 Handscon non steril uk. M Box 202 200 402 102 300 300 0
49 Handscon non steril uk. S Box 2 200 202 0 202 202 0
50 Handscon non steril uk. XL Box 100 200 300 200 100 100 2
51 Hansaplast Box 0 0 0 0 0 0 0
52 HB sahli set 0 0 0 0 0 0 1
53 Hepavix Buah 2 0 2 0 2 2 2
54 Improvet Neubawer Pcs 0 0 0 0 0 0 0
55 Infusion set anak Pcs 7 10 17 6 11 11 10
56 Infusion set dewasa Pcs 10 10 20 11 9 9 20
57 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
58 Jarum Otot no. 6 Lsn 4 0 4 0 4 4 0
59 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
60 kapas 250gr Buah 0 0 0 0 0 0 3
61 Kapas 50gr Buah 0 0 0 0 0 0 2
62 Kapas 100 gr buah 0 1 1 1 0 0 2
63 Kasa gulung besar Roll 1 1 2 0 2 2 2
64 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
65 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
66 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
67 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
68 Kasa steril 16 x 16 (isi 16 lembar) Ktk 10 0 10 3 7 7 20
69 Kertas puyer klip pack 0 0 0 0 0 0 1 BOK
70 Kertas Puyer Perkamen Ikat 2 1 3 2 1 1 3
71 Kertas Puyer Perkamen Ikat 0 0 0 0 0 0 0 BOK
72 Kertas Saring Pack 0 0 0 0 0 0 0
73 Korentang Pcs 0 0 0 0 0 0 0
74 Kursi roda Buah 0 0 0 0 0 0 0
75 Labu Spirtus Pcs 0 0 0 0 0 0 0
76 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
77 Lampu Tindakan Pcs 0 0 0 0 0 0 0
78 Larutan Ziehl Neelsen Pcs 1 0 1 0 1 1 0
79 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
80 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
81 Masker Bedah tali karet Ktk 1 2 3 3 0 0 5
82 Masker kain 3 lapis pcs 142 0 142 58 84 84 400
83 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
84 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
85 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
86 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
87 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
88 Nebulizer Pcs 0 0 0 0 0 0 0
89 Needle 18 Pcs 0 0 0 0 0 0 0
90 Needle 21 Pcs 0 0 0 0 0 0 0
91 Needle 22 Pcs 0 0 0 0 0 0 0
92 Needle 23 Pcs 33 0 33 5 28 28 2
93 Needle 25 Pcs 30 0 30 0 30 30 0
94 Needle holder Pcs 0 0 0 0 0 0 0
95 NGT Pcs 0 0 0 0 0 0 0
96 Oil immersion Botol 1 0 1 0 1 1 0
97 Orofaring Pcs 0 0 0 0 0 0 0
98 Pengukur Lila Pcs 0 0 0 0 0 0 0
99 Pinset anatomis Pcs 0 0 0 0 0 0 0
100 Pipet Tetes Buah 0 0 0 0 0 0 0
101 Pipet tetes Pcs 0 0 0 0 0 0 0
102 Plastik klip Obat 12 x 8 cm pack 0 0 0 0 0 0 0 BOK
103 Plastik klip obat 7 x 10 cm Pack 0 3 3 3 0 0 3
104 Plastik klip obat 7x10 cm pack 2 0 2 1 1 1 3 BOK
105 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
106 Plastik Kresek (semangka) ikat 5 0 5 2 3 3 0 BPJS
107 Plester R0ll sedang Pcs 1 5 6 3 3 3 20
108 Polygyps Pcs 1 0 1 0 1 1 10
109 Pot Dahak Pcs 9 0 9 3 6 6 10
110 Preparat Buah 0 0 0 0 0 0 0
111 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
112 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
113 Reagen giemzah Botol 2 1 3 1 2 2 0
114 Regulator O2 Pcs 0 0 0 0 0 0 0
115 Rivanol 300 ml Botol 1 0 1 0 1 1 0
116 Sabun Asepso Pcs 0 10 10 10 0 0 20
117 Sarung tangan no 7,5 steril Pcs 0 50 50 50 0 0 100
118 Sarung tangan no 8 steril Pcs 128 50 178 4 174 174 0
119 Sarung tangan no. 7 steril Pcs 62 50 112 12 100 100 50
120 Sarung Tangan Obgyn Pcs 5 50 55 0 55 55 0
121 Sarung tangan steril no. 6,5 Pcs 74 0 74 12 62 62 50
122 Scalpel Pcs 0 0 0 0 0 0 0
123 seide 2/0 roll 0 0 0 0 0 0 0
124 Selang nebulezer Pcs 0 0 0 0 0 0 0
125 Selang oksigen PCS 0 0 0 0 0 0 0
126 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
127 Silk black Braided 2/0 Box 15 0 15 2 13 13 3
128 silk Braided USP 3/0 150 cm Pcs 3 0 3 0 3 3 3
129 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
130 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
131 Sinurgis Pcs 0 0 0 0 0 0 0
132 Slide Pcs 0 216 216 72 144 144 360
133 Spatle tongue Pcs 0 0 0 0 0 0 0
134 Spekulum Huding Pcs 0 0 0 0 0 0 0
135 Spekulum Vagina Pcs 0 0 0 0 0 0 0
136 Spigmomanometer Buah 0 0 0 0 0 0 0
137 Spirtus Botol 0 0 0 0 0 0 0
138 Standart Infus Pcs 0 0 0 0 0 0 0
139 Stick Asam Urat PCS 0 50 50 50 0 0 5
140 Stick Cholesterol PCS 0 20 20 20 0 0 5
141 Stick Gula Darah PCS 25 50 75 50 25 25 5
142 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
143 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
144 Tabung EDTA pcs 0 0 0 0 0 0 0
145 Tabung HB Pcs 0 0 0 0 0 0 0
146 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
147 Tenscoprap Pcs 0 0 0 0 0 0 0
148 Tensi Raksa Set 0 0 0 0 0 0 1
149 Termometer Digital Pcs 0 0 0 0 0 0 0
150 Test Pack - HCG Pcs 58 50 108 13 95 95 100
151 Thorniquet Pcs 0 0 0 0 0 0 0
152 Timbangan Bayi Pcs 0 0 0 0 0 0 1
153 Timbangan dewasa set 0 0 0 0 0 0 1
154 Ultasonic gell Botol 0 0 0 0 0 0 1 BOK
155 Umbilical cord klem Pcs 0 0 0 0 0 0 10
156 Underpad Pcs 12 0 12 0 12 12 20
157 Urine bag Pcs 8 0 8 0 8 8 2
158 Verban elastis Roll 4 0 4 1 3 3 0
159 Wing Needle 21 Pcs 20 0 20 0 20 20 0
160 Wing Needle 25 Pcs 30 0 30 0 30 30 0

Kasonaweja, 3 Juni 2022

 Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab

LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : KASONAWEJA PELAPORAN BULAN : JUNI 2022

KABUPATEN : MAMBERAMO RAYA PERMINTAAN BULAN : JULI 2022

SATUAN STOK PENERIMA PERSEDIA PEMAKAIA SISA STOK PERMINTA PEMBERI

NO NAMA OBAT EXP DATE NO. BATCH KET.
KEMASAN AWAL AN AN N STOK OPNAME AN AN
1 Acetylcysteine 200 mg Capsul 830 900 1730 950 780 780 600
2 Acyclovir 200 mg Tablet 610 0 610 20 590 590 0
3 Acyclovir 5% krim Tube 0 0 0 0 0 0 10
4 Albendazole tab Tablet 192 1000 1192 2 1190 1190 0
5 Albothyl 10ml Botol 0 0 0 0 0 0 0
6 Alkohol 70% 100 ml Botol 0 7 7 7 0 0 8
7 Allopurinol tab 100 mg Tablet 990 300 1290 610 680 680 300
8 Ambroxol syrup 15mg/ml Botol 0 0 0 0 0 0 20
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 2000
10 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 0 BOK
11 Aminofilin 200 mg Tablet 500 0 500 0 500 500 0 e.d
12 Aminophylin 24mg/ml iv (injeksi) Ampul 60 0 60 0 60 60 0
13 Amlodipine Besilate 10 mg Tablet 0 0 0 0 0 0 500
14 Amlodipine Besilate 5 mg Tablet 0 0 0 0 0 0 500
15 Amoksisilin kapsul 250 mg Kapsul 620 1000 1620 1120 500 500 500
16 Amoksisilin syrup kering 125mg/5ml Botol 11 20 31 26 5 5 30
17 Amoksisilin tablet 500 mg Tablet 0 2000 2000 2000 0 0 2000
18 Ampicillin sebuk injeksi 1000 mg/ml Vial 20 0 20 0 20 20 0
19 Ampicillin syrup kering 125mg/5ml Botol 0 0 0 0 0 0 10
20 Ampicillin tablet 500 mg Tablet 1310 0 1310 20 1290 1290 0
21 Antalgin tab 500 mg Tablet 0 0 0 0 0 0 1000

22 Antalgin injeksi 250 mg/ml-2ml (metamizole inj) Ampul 9 0 9 9 0 0 10

23 Antasida DOEN syrup Botol 49 0 49 17 32 32 0
Antasida DOEN tab kombinasi: Mg-hidroksida
24 Tablet 1350 0 1350 450 900 900 300
200mg + Al-hidroksida 200mg
25 Anti hemorrhoid DOEN kombinasi Box 0 0 0 0 0 0 0
Antibakteri DOEN salf kombinasi:Basitrasin
26 Tube 0 0 0 0 0 0 0
500 IU/g + Polimiksin 10000 IU/g
27 Aqua pro injection steril, bebas pyrogen Vial 0 0 0 0 0 0 10
28 Aquadest steril Botol 5 11 16 6 10 10 0
29 Artem Vial 0 0 0 0 0 0 0
30 Artesunat injeksi vial 18 0 18 18 0 0 10
31 Asam askorbat (Vit.C)tab 50 mg Tablet 0 1000 1000 500 500 500 2000
32 Asam mefenamat 500 mg Tablet 0 1100 1100 1100 0 0 1500
33 Asam mefenamat 500 mg Tablet 0 0 0 0 0 0 0 BOK
34 Baby Coug Syr Botol 54 44 98 91 7 7 72
35 Bekarbon Tablet 0 0 0 0 0 0 0
36 Benzatin benzil penisillin 2,4 juta IU Vial 0 0 0 0 0 0 0
37 Betametason krim 0,1% Tube 4 40 44 12 32 32 25
38 Bionicom Zink Tablet 35 1100 1135 1135 0 0 1000
39 Bioplacenton Slp Tube 6 6 12 4 8 8 0
40 Bioxon inj Vial 0 0 0 0 0 0 0
41 Bioxon injeksi Vial 0 0 0 0 0 0 0
42 Bisolvon Botol 0 0 0 0 0 0 0
43 Bisoprplol 50 mg Tablet 0 0 0 0 0 0 0
44 Blangko laporan KIA Rim 0 0 0 0 0 0 0
45 Blestop Tablet 0 0 0 0 0 0 0
46 Bubur Sun Karton 0 0 0 0 0 0 0
47 Buku KIA PCS 0 0 0 0 0 0 0
48 Buku Lansia Pcs 0 0 0 0 0 0 0
49 Calsidol B12 + DHA Botol 0 0 0 0 0 0 24
50 Captopril 12,5 mg Tablet 150 0 150 50 100 100 0
51 Captopril 25 mg Tablet 750 0 750 10 740 740 0
52 Carbamasepin 200 mg Tablet 0 0 0 0 0 0 0
53 Cefadroxil 250 mg Capsul 0 0 0 0 0 0 0
54 Cefadroxil 500 mg Kapsul 0 1000 1000 920 80 80 1000
55 Cefadroxil syrup Botol 8 18 26 26 0 0 20
56 Cefixime 200 mg Capsul 80 600 680 150 530 530 200
57 Cefixime kapsul 100 mg Kapsul 0 0 0 0 0 0 0
58 Cefixime syrup Botol 0 5 5 5 0 0 10
59 Cefotaxime inj 1 gr Vial 8 0 8 0 8 8 5
60 Ceftriaxon inj 1 gr Vial 14 0 14 0 14 14 5
61 Cetirizine hydrochloride 10 mg Tablet 0 0 0 0 0 0 1000
62 Cetirizine hydrochloride 10 mg Tablet 270 0 270 250 20 20 0 BOK
63 Cimetidine 200 mg Tablet 400 0 400 0 400 400 0
64 Ciprofloksasin 500 mg Tablet 30 600 630 600 30 30 500
65 Clindamycin 150 mg Kapsul 1010 0 1010 0 1010 1010 0
66 Clindamycin 300 mg Kapsul 0 0 0 0 0 0 0
67 Combantrin sirup orange Botol 17 0 17 5 12 12 0
68 Conterpain 30gr Tube 2 3 5 4 1 1 5
69 Cotrimoksasole syrup Botol 1 28 29 24 5 5 30
70 Cotrimoxazole 480 mg Tablet 2 500 502 300 202 202 500
71 Darplex Tablet 9 270 279 279 0 0 360
72 Deksametason injeksi 5 mg/ml -1 ml Ampul 162 100 262 11 251 251 0
73 Deksametason tablet 0,5 mg Tablet 0 1500 1500 1365 135 135 2000
74 Dekstormethorpan tablet 15 mg Tablet 0 0 0 0 0 0 0
75 Dekstromethorpan sirup 10 mg/5 ml Botol 0 0 0 0 0 0 0
76 Diazepam 2 mg Tablet 0 0 0 0 0 0 0
77 Diazepam inj Ampul 0 0 0 0 0 0 0
78 Diclovenac Sidium 50 mg Tablet 130 500 630 110 520 520 500
79 DietilCarbamazine Tablet 0 0 0 0 0 0 500
80 Difenhidramin HCL inj 10 mg/ml-1 ml Vial 8 10 18 5 13 13 10
81 Digoxin 0.25 mg Tablet 100 0 100 3 97 97 0
82 Doksisiklin 100 mg kapsul Kapsul 890 300 1190 730 460 460 500
83 Domperidone 10 mg Tablet 375 200 575 420 155 155 500
84 Domperidone syr Botol 0 0 0 0 0 0 10
85 Dumin 125mg/ml supp 35 0 35 2 33 33 0
86 Dumin 250mg/ml Supp 33 0 33 3 30 30 0
87 Efedrin 25 mg Tablet 0 0 0 0 0 0 0
88 Ekstrak belladona 10 mg tab Tablet 0 0 0 0 0 0 0
89 Emibion Capsul 0 0 0 0 0 0 500
90 Epinefrin HCL /bitartar (epinefrin/adrenalin) Ampul 20 20 40 0 40 40 0
91 Eritromisin 500 mg kap Kapsul 60 0 60 60 0 0 500
92 Eritromisin 250 mg kap Kapsul 0 0 0 0 0 0 200
93 Eritromisin sirup 200 mg/5 ml Botol 6 10 16 0 16 16 0
94 Etabion Botol 0 0 0 0 0 0 500
95 Etakridin (rivanol)larutan 0,1% Botol 0 0 0 0 0 0 0
96 Ethyl chloride Botol 0 0 0 0 0 0 2
97 Famotidin 20 mg Tablet 0 0 0 0 0 0 0
98 Farmalat 10 mg Tablet 0 0 0 0 0 0 0
99 Fenilbutasol tablet 200 mg Tablet 0 0 0 0 0 0 0
100 Fenobarbital 30 mg Tablet 100 0 100 0 100 100 0
101 Fermia Tablet 0 0 0 0 0 0 0
102 Ferosus sulfat 300 mg Tablet 0 0 0 0 0 0 1000
103 Fitometandione (vit K1) inj 10mg/ml Ampul 0 0 0 0 0 0 0

104 Fitometandione (Vit K1) tablet salut gula 10 mg Tablet 0 0 0 0 0 0 0

105 Fludane Tablet 0 0 0 0 0 0 500

106 Fludane plus Tablet 0 0 0 0 0 0 500
107 Folamil Tablet 0 0 0 0 0 0 500
108 Folavit Tablet 0 0 0 0 0 0 500
109 Folic acid Tablet 0 0 0 0 0 0 1000
110 Furosemide 40 mg tablet Tablet 350 0 350 0 350 350 0
111 Furosemide inj IV/IM 10 mg/ml Ampul 0 0 0 0 0 0 0
Garam oralit kombinasi:Natrium 0,70g, KCl
112 .Sachet 165 100 265 49 216 216 100
0,30g, trinatrium sachet
113 Gentamicin inj. Ampul 0 0 0 0 0 0 10
114 Gentian violet larutan 1%= 299 botol/10ml Botol 23 0 23 2 21 21 0
115 Glibenclamide 5 mg tablet Tablet 420 0 420 220 200 200 200
116 Glukosa larutan infus 10% Botol 0 0 0 0 0 0 0
117 Glukosa larutan infus 40% Botol 0 0 0 0 0 0 0
118 Glukosa larutan infus 5% Botol 14 0 14 5 9 9 10
119 Glyceril Guaiacolat 100mg (GG) Tablet 0 0 0 0 0 0 2000
120 Griseovulfin 125 mg Tablet 0 1000 1000 0 1000 1000 0
121 Guaiefenesin Tablet 355 2000 2355 2155 200 200 2500
122 hepaQ Tablet 0 0 0 0 0 0 0
123 Hidrokortison krim 2,5% Tube 186 0 186 16 170 170 0
124 Ibuprofen tablet 200 mg Tablet 0 900 900 900 0 0 500
125 Ibuprofen tablet 400mg Tablet 0 0 0 0 0 0 1000
126 Ictiol salf Pot 18 0 18 3 15 15 10
127 Isoniazide 100 mg Tablet 300 0 300 0 300 300 0
128 Isosorbide dinitrate 5mg Tablet 0 0 0 0 0 0 0
129 Kalsium laktat (kalk) Tablet 230 0 230 50 180 180 0
130 Kalsium laktat (kalk) Tablet 0 0 0 0 0 0 0
131 Kamulvit syrup Botol 0 0 0 0 0 0 24
132 Kanamycin 1 gr Vial 0 0 0 0 0 0 0
133 KB suntik 1 Bulan Vial 0 0 0 0 0 0 20
134 KB suntik 3 bulan Vial 0 0 0 0 0 0 20
135 Ketoconazole 200 mg Tablet 375 0 375 75 300 300 300
136 Ketoconazole krim 5 mg Tube 0 5 5 5 0 0 20
137 Ketorolac inj 10mg/ml Ampul 0 0 0 0 0 0 0
138 Kina Sulphate Tablet 0 0 0 0 0 0 0
139 Kloramfenikol 250 mg Kapsul 0 0 0 0 0 0 0
140 Kloramfenikol tetes mata (Erlamycetin) Tube 19 10 29 7 22 22 10
141 Kloramfenikol tetes telinga (Erlamycetin) Botol 0 0 0 0 0 0 10
142 Kloramphenicol suspensi Botol 60 0 60 0 60 60 0
143 Kloreamfenikol salf mata 1% Tube 0 0 0 0 0 0 10
144 Klorokuin 100mg Tablet 0 0 0 0 0 0 0
145 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 116 2300 2416 1700 716 716 1000
146 Klorpheniramine mealeat (CTM) tab 4 mg Tablet 0 0 0 0 0 0 0 BOK
147 Klorpromazine inj IM 25mg/ml (HCL) Ampul 0 0 0 0 0 0 0
148 Klorpromazine tablet salut100 mg (HCl) Tablet 0 0 0 0 0 0 0
149 Kohort bayi Pcs 0 0 0 0 0 0 0
150 Kohort Ibu Pcs 0 0 0 0 0 0 0

Kotrimoksazole DOEN I (dewasa)kombinasi :

151 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 400 mg, trimetoprim 25mg)

Kotrimoksazole DOEN II (dewasa)kombinasi :

152 Tablet 0 0 0 0 0 0 0
(sulfametoksazole 100 mg, trimetoprim 20mg)

153 Lansoprazole kaps 30 mg Kapsul 100 100 200 140 60 60 100

154 Levofloxacin tab 500 mg Tablet 0 0 0 0 0 0 0
155 Lexapram Tablet 0 0 0 0 0 0 0

156 Lidokain injeksi 2% (HCl) + Epinefrine 1:80.000 Ampul 59 0 59 22 37 37 0

157 Loperamide tab 2 mg Tablet 135 0 135 75 60 60 200

158 Loratadin 10 mg Tablet 520 0 520 120 400 400 500
159 Loratadin 10 mg Tablet 140 0 140 0 140 140 0 BOK
160 Lysol (kresol tersaponifikasi 50%) Botol 4 0 4 0 4 4 0
161 Magnesium sulfat injeksi (IV) 40%-25 ml Ampul 3 3 6 2 4 4 3
162 MDT MB Anak Blister 0 0 0 0 0 0 6
163 MDT MB Dewasa Blister 1 12 13 10 3 3 12
164 MDT PB Anak Blister 0 0 0 0 0 0 6
165 MDT PB Dewasa Blister 0 0 0 0 0 0 3
166 Mebendazole sirup 100 mg/ 5 ml Botol 0 0 0 0 0 0 0
167 Meloxicam 7,5 Tablet 260 300 560 330 230 230 500
168 Metamizole 500 mg Tablet 500 200 700 510 190 190 1000
169 Metformin 500 mg Tablet 440 200 640 190 450 450 0
170 Methergin injeksi ampul 0 0 0 0 0 0 0
171 Methylprednisolone 4 mg Tablet 100 300 400 50 350 350 500
172 Methylprednisolone 8 mg Tablet 310 0 310 0 310 310 500

173 Metilergometrin maleat injeksi 0,200 mg-1 ml Ampul 48 25 73 0 73 73 0

174 Metilergometrin tablet Tablet 100 0 100 0 100 100 0

175 Metoclopramide HCl Tablet 450 0 450 0 450 450 0
176 Metrodinazole 250 mg Tablet 0 0 0 0 0 0 0
177 Metrodinazole tab 500 mg Tablet 750 0 750 30 720 720 0
178 Miconazole 2 % krim Tube 2 72 74 22 52 52 24
179 Natrium diklofenak 25 mg tab Tablet 0 0 0 0 0 0 500
180 Natrium diklofenak 50 mg Tablet 50 0 50 50 0 0 500
181 Natrium diklofenak 50 mg Tablet 50 0 50 0 50 50 0 BOK
182 Natrium klorida larutan infus 0,9 % Botol 12 20 32 12 20 20 20
183 Neurobion injeksi Ampul 0 0 0 0 0 0 8
184 Neurosanbe injeksi Ampul 0 20 20 20 0 0 20
185 Nifedipine 10 mg Tablet 0 0 0 0 0 0 0
186 Nistatin vaginal tablet 100.000 IV Tablet 0 0 0 0 0 0 0
187 Norit Tablet 80 0 80 0 80 80 0
188 Novadium Tablet 0 0 0 0 0 0 0
189 OAT Anak PAKET 3 0 3 0 3 3 2
190 OAT Dewasa PAKET 0 2 2 2 0 0 2
191 Obat batuk hitam (O.B.H.) Botol 0 20 20 20 0 0 30
192 Ofloxacin tab 200mg Tablet 0 0 0 0 0 0 0
193 Oksitetrasiklin HCL 3% Salep kulit Tube 0 35 35 25 10 10 48
194 Oksitetrasiklin HCL injeksi Vial 0 0 0 0 0 0 0
195 Oksitetrasiklin HCL salep mata 1% Tube 0 0 0 0 0 0 24
196 Oksitosin injeksi 10 UI/ml-1 ml Ampul 0 20 20 4 16 16 20
197 Omeprasole Kapsul 50 90 140 20 120 120 150
198 Ondancentron Syrup Botol 0 0 0 0 0 0 0
199 Ondancentron tablet Tablet 0 0 0 0 0 0 500
200 Ondancetron inj Ampul 16 10 26 5 21 21 10
201 Osutran 70 Botol 0 0 0 0 0 0 0
202 Papaverin inj 40 mg Ampul 0 0 0 0 0 0 0
203 Papaverin tab 40 mg Tablet 0 0 0 0 0 0 0
204 Paracetamol drop Botol 15 0 15 15 0 0 20
205 Paracetamol infus Botol 5 10 15 2 13 13 2
206 Parasetamol sirup 120 mg/5 ml Botol 0 0 0 0 0 0 50
207 Parasetamol Tablet 500 gm Tablet 97 4500 4597 4597 0 0 4000
208 Penicilin injeksi Vial 0 0 0 0 0 0 0
209 Phenol Glycerol 10% Botol 0 0 0 0 0 0 0
210 phytomenadione Tablet 200 0 200 0 200 200 0
211 Piracetam injeksi 200 mg/ml Ampul 0 0 0 0 0 0 0
212 Piracetam tablet Tablet 0 0 0 0 0 0 0
213 Pirantel pamoat 125 mg Tablet 472 0 472 8 464 464 0
214 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 0 800 800 200 600 600 500
215 Piroksikam 20 mg Kapsul 0 0 0 0 0 0 500
216 Pirosikam 10 mg Kapsul 0 100 100 60 40 40 500
217 Pitogin inj Ampul 0 0 0 0 0 0 0
218 Prednison tablet 5 mg Tablet 80 200 280 0 280 280 0
219 Primakuin 15 mg Tablet 1386 200 1586 1206 380 380 1000
220 Promanolol 10 mg Tablet 0 0 0 0 0 0 0
221 Propiretic 160 mg suppo Suppo 36 0 36 0 36 36 0
222 Propyltiouracil tablet Tablet 0 0 0 0 0 0 0
223 Pyrazinamide Tablet 0 0 0 0 0 0 0
224 Quinine 222mg Tablet 392 2400 2792 1592 1200 1200 0
225 Quinine antypirin inj Ampul 0 0 0 0 0 0 0
226 Quinine inj ampul Ampul 0 0 0 0 0 0 0
227 Ranitidine 150 mg Tablet 720 200 920 60 860 860 1000
228 Ranitidine injeksi 25 mg/2ml Ampul 21 20 41 15 26 26 0
229 Rapid HIV 1 Pcs 0 0 0 0 0 0 0
230 Rapid HIV 1/2 30 Pcs 0 0 0 0 0 0 0
231 Rapid Sifilis Pcs 0 0 0 0 0 0 0
232 Remolit Sachet 0 0 0 0 0 0 0
233 Rifampisin tablet salut 450 mg Tablet 0 0 0 0 0 0 0
234 Ringer laktat larutan infus Botol 4 30 34 6 28 28 10
235 Salbutamol tablet 2 mg ( sebagai sulfat) Tablet 182 200 382 80 302 302 500
236 Salbutamol tablet 4 mg ( sebagai sulfat) Tablet 60 200 260 200 60 60 500
237 Salep 2-4 Pot 17 10 27 3 24 24 0
238 Salisil bedak 2% Pot 8 6 14 11 3 3 12
239 Scoott's Emultion Botol 0 0 0 0 0 0 24
240 Serum antitetatus (ATS) 1500 IU/ampl Ampul 0 0 0 0 0 0 0
241 Sianokobalamin ( vitamin B12) injeksi 50 mcg Vial 0 0 0 0 0 0 30

242 sianokobalamin (vitamin B12) Tabet 665 500 1165 735 430 430 1000
243 Simvastatin tablet 10 mg Tablet 0 0 0 0 0 0 300
244 Simvastatine 20 mg Tablet 120 100 220 215 5 5 500
245 Stesolit Tablet 0 0 0 0 0 0 0
246 Sulfadoxine 525 mg Tablet 0 0 0 0 0 0 0
247 Susu ibu Hamil Karton 0 0 0 0 0 0 0
248 Susu ibu menyusui Karton 0 0 0 0 0 0 0
249 Susu lactogen 1 Karton 0 0 0 0 0 0 0
250 Susu sgm 1 Karton 0 0 0 0 0 0 0
251 Susu sgm 2 Karton 0 0 0 0 0 0 0
252 Tablet tambah darah pcs 3830 0 3830 0 3830 3830 1000

253 Test malaria pf= pv combo /parascreen (RDT) pcs 0 200 200 200 0 0 150

254 Tetrasiklin kapsul 250 mg Kapsul 0 0 0 0 0 0 100

255 Tetrasiklin kapsul 500 mg Kapsul 0 0 0 0 0 0 500
256 Thiamfenikol 500 Kapsul 0 0 0 0 0 0 0
257 Thiamin (vitamin B1) injeksi 100 mg/ml Ampul 0 0 0 0 0 0 0

258 Thiamin (vitamin B1) tablet 100 mg (HCL/nitrat) Tablet 0 0 0 0 0 0 0

259 Trampara Tablet 0 0 0 0 0 0 0

260 Trombhop gel Tube 2 10 12 2 10 10 3
261 Venolin Inhaler Botol 0 20 20 0 20 20 0
262 Ventolin Nebbulizer Pcs 0 40 40 0 40 40 0
263 Vi B Com Tablet 0 1500 1500 1380 120 120 1500
264 Vi B Com Tablet 0 0 0 0 0 0 0 BOK
265 Vit. A 200.000 IU merah Capsul 14 0 14 0 14 14 0
266 Vit. B1 ampul 130 0 130 0 130 130 0
267 Vit. K4 Tablet 1060 0 1060 0 1060 1060 0
268 Vit.A 100.000 IU biru Cap 74 0 74 0 74 74 0
269 Vit.B comp injeksi Vial 10 10 20 12 8 8 20
270 Vitamin C 500mg Tablet 0 0 0 0 0 0 1000
271 Zinc dispersible tab 20 mg Tablet 150 500 650 190 460 460 300

1 02 contentrator Pcs 0 0 0 0 0 0 0
2 Abucat No 18 (abbot) Pcs 1 20 21 4 17 17 5
3 Abucat No 20 (abbot) Pcs 2 20 22 4 18 18 10
4 Abucat No 22 (abbot) Pcs 7 0 7 1 6 6 20
5 Abucat No 24 (abbot) Pcs 4 15 19 4 15 15 20
6 Abucat No 26 (abbot) Pcs 4 5 9 3 6 6 10
7 Alat Suction Pcs 0 0 0 0 0 0 0
8 Alat suntik sekali pakai 0,05 ml pcs 0 0 0 0 0 0 0
9 Alat suntik sekali pakai 0,5 ml Pcs 565 0 565 0 565 565 0
10 Alat suntik sekali pakai 1 ml Pcs 0 10 10 5 5 5 100
11 Alat suntik sekali pakai 10 ml Pcs 14 0 14 0 14 14 50
12 Alat suntik sekali pakai 3 ml Pcs 0 200 200 140 60 60 200
13 Alat suntik sekali pakai 5 ml Pcs 45 0 50 4 46 46 0
14 Alcohol swab BD Pcs 0 100 100 100 0 0 300
15 Aligator Pcs 0 0 0 0 0 0 0
16 Auto klaf Pcs 0 0 0 0 0 0 0
17 Baby Scale Pcs 0 0 0 0 0 0 1
18 Berotec Botol 0 0 0 0 0 0 0
19 Betadin 300 ml/ Povidion iodine Botol 0 0 0 0 0 0 3
20 Bethadine 30ml Botol 67 0 67 6 61 61 0
21 Bidan kit Buah 0 0 0 0 0 0 0
22 Bistury/ Surgical bladesno Pcs 10 20 30 5 25 25 200
23 Blood lanced ktk 100 200 300 200 100 100 5
24 Blood lanced ktk 0 0 0 0 0 0 0 BOK
25 Brankar Pcs 0 0 0 0 0 0 0
26 BTA Botol 0 0 0 0 0 0 0
27 Buku resep Pcs 0 0 0 0 0 0 0
28 Bunsen Buah 0 0 0 0 0 0 0
 Catgut / benang bedah no. 2/0 dengan jarum
29 Box 0 0 0 0 0 0 3
bedah
Catgut /benang bedah no. 3/0 dengan jarum
30 Box 0 0 0 0 0 0 3
bedah
31 Catgut chromic 3/0 Pcs 2 10 12 4 8 8 3
32 Celemek Kebidanan Pcs 50 0 50 0 50 50 0
33 Chateter 18 PCS 14 0 14 0 14 14 2
34 Chateter 20 Pcs 5 0 5 0 5 5 2
35 Chateter 22 Pcs 10 0 10 0 10 10 2
36 Daryant tulle Pcs 8 0 8 2 6 6 3
37 DC (foley catheter)14 Buah 0 0 0 0 0 0 0
38 DC (foley catheter)16 Buah 0 0 0 0 0 0 0
39 Dopler Pcs 0 0 0 0 0 0 1
40 Easy Ttocti Pcs 0 0 0 0 0 0 0
41 Gelas Ukur Pcs 0 0 0 0 0 0 0
42 Golf Hidung Pcs 0 0 0 0 0 0 0
43 Gunting epis Pcs 0 0 0 0 0 0 0
44 Gunting tajam Pcs 0 0 0 0 0 0 0
45 H2O2 3% Botol 1 1 2 0 2 2 2
46 Handscon bersih Pcs 0 0 0 0 0 0 0
47 Handscon non steril uk. L Pcs 100 200 300 100 200 200 1
48 Handscon non steril uk. M Pcs 300 0 300 100 200 200 0
49 Handscon non steril uk. S Pcs 202 0 202 0 202 202 0
50 Handscon non steril uk. XL Pcs 100 200 300 100 200 200 2
51 Hansaplast Box 0 0 0 0 0 0 0
52 HB sahli set 0 0 0 0 0 0 1
53 Hepavix Buah 2 0 2 0 2 2 2
54 Improvet Neubawer Pcs 0 0 0 0 0 0 0
55 Infusion set anak Pcs 11 10 21 3 18 18 10
56 Infusion set dewasa Pcs 9 20 29 6 23 23 20
57 Jarum kulit no. 8 Lsn 0 0 0 0 0 0 0
58 Jarum Otot no. 6 Lsn 4 0 4 0 4 4 0
59 Jarum Otot no.9 Lsn 1 0 1 0 1 1 0
60 Kapas 100 gr buah 0 1 1 1 0 0 2
61 kapas 250gr Buah 0 0 0 0 0 0 3
62 Kapas 50gr Buah 0 1 1 1 0 0 2
63 Kasa gulung besar Roll 2 0 2 1 1 1 2
64 Kasa kompres 40 x 40 steril Pcs 0 0 0 0 0 0 10
65 Kasa pembalut 10 cm Roll 0 0 0 0 0 0 10
66 Kasa pembalut 15 cm elastis Roll 0 0 0 0 0 0 10
67 Kasa pembalut 5 cm Pcs 0 0 0 0 0 0 10
68 Kasa steril 16 x 16 (isi 16 lembar) Ktk 7 10 17 7 10 10 20
69 Kertas puyer klip pack 0 0 0 0 0 0 1 BOK
70 Kertas Puyer Perkamen Ikat 1 3 4 3 1 1 3
71 Kertas Puyer Perkamen Ikat 0 0 0 0 0 0 0 BOK
72 Kertas Saring Pack 0 0 0 0 0 0 0
73 Korentang Pcs 0 0 0 0 0 0 0
74 Kursi roda Buah 0 0 0 0 0 0 0
75 Labu Spirtus Pcs 0 0 0 0 0 0 0
76 Labu ukur 100 ml Pcs 0 0 0 0 0 0 0
77 Lampu Tindakan Pcs 0 0 0 0 0 0 0
78 Larutan Ziehl Neelsen Pcs 1 0 1 0 1 1 0
79 Lemari Narkotik-Spikotropik Pcs 0 0 0 0 0 0 0
80 Lidi/ Ose jarum Buah 0 0 0 0 0 0 0
81 Masker anak Box 0 2 2 0 2 2
82 Masker Bedah tali karet Ktk 0 4 4 2 2 2 5
83 Masker kain 3 lapis pcs 84 0 84 17 67 67 400
84 Metlin (Pengukur tinggi perut) Pcs 0 0 0 0 0 0 0
85 Mikroskoip Olympus C x 21 Buah 0 0 0 0 0 0 0
86 Naasal Kanul Adult Pcs 0 0 0 0 0 0 0
87 Naasal Kanul Pediatrik Pcs 0 0 0 0 0 0 0
88 Nasopharyngeal airway (goodle atau OPA) Pcs 0 0 0 0 0 0 0
89 Nebulizer Pcs 0 0 0 0 0 0 0
90 Needle 18 Pcs 0 0 0 0 0 0 0
91 Needle 21 Pcs 0 0 0 0 0 0 0
92 Needle 22 Pcs 0 0 0 0 0 0 0
93 Needle 23 Pcs 28 0 28 0 28 28 2
94 Needle 25 Pcs 30 0 30 0 30 30 0
95 Needle holder Pcs 0 0 0 0 0 0 0
96 NGT Pcs 0 0 0 0 0 0 0
97 Oil immersion Botol 1 0 1 0 1 1 0
98 Orofaring Pcs 0 0 0 0 0 0 0
99 Pengukur Lila Pcs 0 0 0 0 0 0 0
100 Pinset anatomis Pcs 0 0 0 0 0 0 0
101 Pipet Tetes Buah 0 0 0 0 0 0 0
102 Pipet tetes Pcs 0 0 0 0 0 0 0
103 Plastik klip Obat 12 x 8 cm pack 0 0 0 0 0 0 3 BOK
104 Plastik klip obat 7 x 10 cm Pack 0 6 6 4 2 2 3
105 Plastik klip obat 7x10 cm pack 1 0 1 1 0 0 3 BOK
106 plastik klip obat 8 x 5 cm pack 0 0 0 0 0 0 3
107 Plastik Kresek (semangka) ikat 3 0 3 3 0 0 0 BPJS
108 Plester R0ll sedang Pcs 3 5 8 4 4 4 20
109 Polygyps Pcs 1 0 1 0 1 1 10
110 Pot Dahak Pcs 6 0 6 0 6 6 10
111 Preparat Buah 0 0 0 0 0 0 0
112 Rak Pengering/Pewarnaan Pcs 0 0 0 0 0 0 0
113 RDT Prambusia / Syphilis Pcs 0 0 0 0 0 0 0
114 Reagen giemzah Botol 2 0 2 0 2 2 0
115 Regulator O2 Pcs 0 0 0 0 0 0 0
116 Rivanol 300 ml Botol 1 0 1 0 1 1 0
117 Sabun Asepso Pcs 0 `15 15 7 8 8 20
118 Sarung tangan no 7,5 steril Pcs 0 100 100 55 45 45 100
119 Sarung tangan no 8 steril Pcs 174 50 224 5 219 219 0
120 Sarung tangan no. 7 steril Pcs 100 0 100 24 76 76 50
121 Sarung Tangan Obgyn Pcs 55 0 55 0 55 55 0
122 Sarung tangan steril no. 6,5 Pcs 62 0 62 5 57 57 50
123 Scalpel Pcs 0 0 0 0 0 0 0
124 seide 2/0 roll 0 0 0 0 0 0 0
125 Selang nebulezer Pcs 0 0 0 0 0 0 0
126 Selang oksigen PCS 0 0 0 0 0 0 0
127 Silk ( benang bedah sutera ) no.3/0 Box 0 0 0 0 0 0 3
128 Silk black Braided 2/0 Box 13 0 13 0 13 13 3
129 silk Braided USP 3/0 150 cm Pcs 3 0 3 0 3 3 3
130 Silk USP 3/10 500 cm Box 0 0 0 0 0 0 3
131 Simple Mask Anak & Dewasa Pcs 0 0 0 0 0 0 0
132 Sinurgis Pcs 0 0 0 0 0 0 0
133 Slide Pcs 144 144 288 288 0 0 360
134 Spatle tongue Pcs 0 0 0 0 0 0 0
135 Spekulum Huding Pcs 0 0 0 0 0 0 0
136 Spekulum Vagina Pcs 0 0 0 0 0 0 0
137 Spigmomanometer Buah 0 0 0 0 0 0 0
138 Spirtus Botol 0 0 0 0 0 0 0
139 Standart Infus Pcs 0 0 0 0 0 0 0
140 Stick Asam Urat Box 0 3 3 3 0 0 5
141 Stick Cholesterol Box 0 3 3 3 0 0 5
142 Stick Gula Darah Box 1 3 4 2 2 2 5
143 Suture Needle heating no 10 Pcs 0 0 0 0 0 0 0
144 Suture Needle heating no 8 Pcs 0 0 0 0 0 0 0
145 Tabung EDTA pcs 0 0 0 0 0 0 0
146 Tabung HB Pcs 0 0 0 0 0 0 0
147 Tabung reaksi (Rak tabung) Buah 0 0 0 0 0 0 0
148 Tenscoprap Pcs 0 0 0 0 0 0 0
149 Tensi Raksa Set 0 0 0 0 0 0 1
150 Termometer Digital Pcs 0 0 0 0 0 0 0
151 Test Pack - HCG Pcs 95 50 145 52 93 93 100
152 Thorniquet Pcs 0 0 0 0 0 0 0
153 Timbangan Bayi Pcs 0 0 0 0 0 0 1
154 Timbangan dewasa set 0 0 0 0 0 0 1
155 Ultasonic gell Gen 0 1 1 0 1 1 1
156 Umbilical cord klem Pcs 0 0 0 0 0 0 10
157 Underpad Pcs 12 50 62 12 50 50 20
158 Urine bag Pcs 8 5 13 2 11 11 2
159 Verban elastis Roll 3 0 3 2 1 1 0
160 Wing Needle 21 Pcs 20 0 20 0 20 20 0
161 Wing Needle 25 Pcs 30 0 30 0 30 30 0

Kasonaweja, 03 Juli 2022

Mengetahui ,
Kepala Dinas Kesehatan Yang Menyerahkan Kepala Puskesmas Yang Menerima
Kab.Mamberamo Raya Kepala Instansi Farmasi Penanggung Jawab

LEVINA KREY, S. SiT., MPH AHMAD MAARIF,S. Farm.,Apt dr. Mario Korwa Nurmina Mile, A.md
NIP. 19650811 198801 2 003 NIP. 19891001 201505 1 001 NIP.19870530 201505 1 001 NIP. 19870104 201505 2 002