LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS :
KECAMATAN : PELAPORAN BULAN :
KABUPATEN : PERMINTAAN BULAN :

PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
A. TABLET/KAPLET/KAPSUL
1 Albendazole 400 mg Tablet 0 0
2 Alprazolam 0,5 mg Tablet 0 0
3 Allopurinol 100 mg Tablet 0 0
4 Aminofilin 200 mg Tablet 0 0
5 Amitriptilin 25 mg Tablet 0 0
6 Amlodipin 5 mg Tablet 0 0
7 Amlodipin 10 mg Tablet 0 0
8 Amoksisilin 250 mg Kapsul 0 0
9 Amoksisilin 500 mg Tablet 0 0
10 Antasida Doen Tablet 0 0
11 Asam Folat 0,4 mg Tablet 0 0
12 Asam Folat 1 mg Tablet 0 0
13 Asam Mefenamat 500 mg Tablet 0 0
14 Asetyl Cystein 200 mg Kapsul 0 0
15 Asiklovir 200 mg Tablet 0 0
16 Asiklovir 400 mg Tablet 0 0
17 Azytromizin 500 mg Tablet 0 0
18 Betahistine 6 mg Tablet 0 0
19 Captopril 12,5 mg Tablet 0 0
20 Captopril 25 mg Tablet 0 0
21 Captopril 50 mg Tablet 0 0
22 Carbamazepin 200 mg Tablet 0 0
23 Cefadroxil 500 mg Kapsul 0 0
24 Cefixim 100 mg Tablet 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
25 Cetirizine 10 mg Tablet 0 0
26 Chlorfeniramina Maleat (CTM) 4 mg Tablet 0 0
27 Chlorpromazin 25 mg Tablet 0 0
28 Chlorpromazin 100 mg Tablet 0 0
29 Ciprofloxacin 500 mg Tablet 0 0
30 Clobazam 10 mg Tablet 0 0
31 Clozapine 25 mg Tablet 0 0
32 Cotrimoxazole 120 mg Tablet 0 0
33 Cotrimoxazole 480 mg Tablet 0 0
34 Cotrimoxazole Forte Kombinasi 960 mg Tablet 0 0
35 Codein Phospate 10 mg Tablet 0 0
36 Deksametason 0,5 mg Tablet 0 0
37 Diltiazem 30 mg Tablet 0 0
38 Diazepam 2 mg Tablet 0 0
39 Doksisiklin 100 mg Kapsul 0 0
40 Domperidon 10 mg Tablet 0 0
41 Ergotamin Caffein Tablet 0 0
42 Eritromisin 250 mg Tablet 0 0
43 Eritromisin 500 mg Tablet 0 0
44 FDC KAT Anak Paket 0 0
45 FDC KAT I Paket 0 0
46 FDC KAT II Paket 0 0
47 Fervital Tablet 0 0
48 Fitomenadion (Vit. K1) 10 mg Tablet 0 0
49 Furosemid 40 mg Tablet 0 0
50 Garam Oralit Sachet 0 0
51 Glibenklamid 5 mg Tablet 0 0
52 Griseofulvin 125 mg Tablet 0 0
53 Haloperidol 1,5 mg Tablet 0 0
54 Ibuprofen 200 mg Tablet 0 0
55 Ibuprofen 400 mg Tablet 0 0
56 Isoniasid (INH) 100 mg Tablet 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
57 Isoniasid (INH) 300 mg Tablet 0 0
58 Isosorbid Dinitrat 5 mg Tablet 0 0
59 Kalsium Laktat (Kalk) 500 mg Tablet 0 0
60 Ketokonazole 200 mg Tablet 0 0
61 Klindamisin 300 mg Kapsul 0 0
62 Klindamycin 150 mg Kapsul 0 0
63 Lanzoprazole 30 mg Kapsul 0 0
64 Loperamid 2 mg Tablet 0 0
65 Loratadin 10 mg Tablet 0 0
66 Metformin 500 mg Tablet 0 0
67 Metilergometrin 0,125 mg Tablet 0 0
68 Metilprednisolon 4 mg Tablet 0 0
69 Metilprednisolon 8 mg Tablet 0 0
70 Metoklopramide 5 mg Tablet 0 0
71 Metoklopramide 10 mg Tablet 0 0
72 Metrodinazole 500 mg Tablet 0 0
73 Mineral MIX, Kombinasi Sachet 0 0
74 Natrium diklofenak 25 mg Tablet 0 0
75 Nifedipin 10 mg Tablet 0 0
76 Nystatin 500.000 IU Tablet 0 0
77 Nystatin tablet vagina 100.000 IU Tablet 0 0
78 Omeprazole 20 mg Kapsul 0 0
79 Ondasetron 4 mg Tablet 0 0
80 Ondasetron 8 mg Tablet 0 0
81 Paracetamol 500 mg Tablet 0 0
82 Pil KB Oral kombinasi Tablet 0 0
83 Prednison 5 mg Tablet 0 0
 84 Propiltiourasil (PTU) 100 mg Tablet 0 0
85 Pyrantel 125 mg Tablet 0 0
86 Phenobarbital 30 mg Tablet 0 0
87 Ranitidin 150 mg Tablet 0 0
88 Resperidon 2 mg Tablet 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
89 Rifampicin 300 mg Kapsul 0 0
90 Salbutamol 2 mg Tablet 0 0
91 Salbutamol 4 mg Tablet 0 0
92 Simvastatin 10 mg Tablet 0 0
93 Simvastatin 20 mg Tablet 0 0
94 Spironolakton 100 mg Tablet 0 0
95 Tablet Tambah Darah Tablet 0 0
96 Tetrasiklin 250 mg Kapsul 0 0
97 Tetrasiklin 500 mg Kapsul 0 0
98 Triheksilfenidil 2 mg Tablet 0 0
99 Vitamin A (Retinol) 100.000 IU Kapsul 0 0
100 Vitamin A (Retinol) 200.000 IU Kapsul 0 0
101 Vitamin B Complex Tablet 0 0
102 Vitamin B1 (Thiamin) Tablet 0 0
103 Vitamin B12 (Sianokobalamin) Tablet 0 0
104 Vitamin B6 (Piridoksin) Tablet 0 0
105 Vitamin C 50 mg Tablet 0 0
106 Vitamin C 250 mg Tablet 0 0
107 Zinc 20 mg Tablet 0 0
B. SIRUP
108 Albendazole Sirup 200 mg Botol 0 0
109 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0
110 Amoxicillin syrup Kering 250 mg/5ml Botol 0 0
111 Antasida Suspensi Botol 0 0
112 Cefadroxil sirup Kering 125 mg/5ml Botol 0 0
113 Cefadroxil Sirup Kering 250 mg/5 ml Botol 0 0
114 Ceterizin Sirup Botol 0 0
115 Chloramfenikol suspensi 125 mg/5 ml Botol 0 0
116 Cotrimoksazole Sirup 60 ml Botol 0 0
117 Domperidon Suspensi / Sirup 5 mg/ml Botol 0 0
118 Eritromisin Sirup Botol 0 0
119 Ibuprofen Suspensi 100 mg/ 5 ml Botol 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
120 Multivitamin Syr (Supralysin Sirup) Botol 0 0
121 Parasetamol drops Botol 0 0
122 Parasetamol sirup 120 mg /5 ml Botol 0 0
123 Pyrantel Sirup Botol 0 0
124 Sefiksim Sirup kering 100 mg / 5 ml Botol 0 0
125 Zink Sulfate syr 20 mg/5ml Botol 0 0
C. INJEKSI & INFUS
126 Aminofilin inj 24 mg/ml Ampul 0 0
127 Amoksisilin Serbuk Injeksi 1000 mg Vial 0 0
128 Antalgin Ampul 0 0
129 Aqua Pro Injeksi Vial 0 0
130 Asam Traneksamat Ampul 0 0
131 Asering Infus Botol 0 0
132 Atropin Sulfat 0,25 mg Ampul 0 0
133 Calcii Gluconas Inj Ampul 0 0
134 Dexamethason Inj 5 mg/ml Ampul 0 0
135 Diazepam Injeksi 5 mg/ml Ampul 0 0
136 Difenhidramin Injeksi 10 mg/ml (HCl) Ampul 0 0
137 Epinefrin (Adrenalin) inj 0,1 % Ampul 0 0
138 Fenobarbital Inj. Ampul 0 0
139 Fitomenadion (Vit. K1) Injeksi 10 mg/ml Ampul 0 0
140 Furosemide Inj Ampul 0 0
141 Gentamicin Inj Ampul 0 0
142 Glukosa 5% Infus Botol 500 ml 0 0
143 Glukosa 10 % Infus Botol 500 ml 0 0
144 Glukosa 40 % Botol 0 0
145 Haloperidol 5 mg/ml (Lodomer Inj) Ampul 0 0
146 Haloperidol 50 mg (Haldol Inj) Ampul 0 0
147 hyocine N-buthylbromide inj Ampul 0 0
148 KA-EN 3B Botol 0 0
149 Lidocain inj 2 % Ampul 0 0
150 Lidocain injeksi 2 % + Epinefrin 1 : 80.000 Ampul 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
151 Metilergometrin inj Ampul 0 0
152 Metilprednisolon inj 125 mg/ml Vial 0 0
153 Metoklopramide inj 5 mg/ml Ampul 0 0
154 MGSO4 20 % Ampul 0 0
155 MGSO4 40 % Ampul 0 0
156 Metronidazol Infus Botol 0 0
157 NaCl 0,9 % Infus Botol 500 ml 0 0
158 Oksitocin inj 10 ui/ml Ampul 0 0
159 Ranitidine HCl inj. Ampul 0 0
160 Ringer Laktat Infus Botol 500 ml 0 0
161 Tramadol Injeksi Ampul 0 0
162 Vitamin B1 (Tiamin) inj. Ampul 0 0
163 Vitamin B12 (Sianokabalamin) Inj Ampul 0 0
164 Vitamin B6 (Piridoksin) inj Ampul 0 0
165 Xylestecin inj Ampul 0 0
D. OBAT LUAR
166 Antihemoroid Supp 0 0
167 As. Sal + Bel. Endap (2 - 4 Salep) Pot 0 0
168 Antifungi DOEN (ac.salicylicum+ac.Benzo Pot 0 0
169 Asiklovir Cr Tube 0 0
170 Betametason krim 0,1% Tube 0 0
171 Betamethason Dipropionate krim 0,05 % Tube 0 0
172 Ceivitron Pink 30 gr Pot 0 0
173 Ceivitron White 30 gr Pot 0 0
174 Dulcolax ( Bisacodil Supp) 10 mg Supp 0 0
175 Dulcolax ( Bisacodil Supp) 5 mg Supp 0 0
176 Eugenol Cairan Botol 0 0
177 Etakridine Larutan 0,1 % Botol 0 0
178 Fenol Gliserol TT Botol 0 0
179 Gentian Violet Botol 0 0
180 Gentamicin 0,3 % Salep Mata Tube 0 0
181 Gentamicin 0,3 % Salep Kulit Tube 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
182 Gentamisin Tetes Mata Botol 0 0
183 Glass Ionomer Pcs 0 0
184 Hydrocortison cream 1 % Tube 0 0
185 Hidrokortison krim 2,5% Tube 0 0
186 Ketokenazole Cr 2 % Tube 0 0
187 Kloramfenikol Salep Mata 1 % Tube 0 0
188 Kloramfenikol tetes telinga 3% Botol 0 0
189 Miconazole 2 % Tube 0 0
190 Oksitetrasiklin 1% SM Tube 0 0
191 Povidon Iodida larutan 10% 30 ml Botol 0 0
192 Povidon Iodida larutan 60 ml Botol 0 0
193 Povidon Iodida larutan 300 ml Botol 0 0
194 Povidon Iodida larutan 1000 ml Botol 0 0
195 Salisil bedak 2% Kotak 0 0
196 Xilocaine Jelly 2 % Syringe 0 0
197 Xilocaine Spray Botol 0 0
E. BAHAN MEDIS HABIS PAKAI
198 Alkohol 70% Botol 1 Liter 0 0
199 Alkohol Swab Kotak 0 0
200 ARM Sling M Pcs 0 0
201 ARM Sling L Pcs 0 0
202 Aseptan 500 cc + Pump Botol 0 0
203 Alkazime sachet 25 mg Sachet 0 0
204 Alkacide 1 L High Level Disinfectant botol 0 0
205 Bood Lancet Kotak 0 0
206 Bood Tranfusion Set Pcs 0 0
207 Blood Tranfusion Set (Troge ) Pcs 0 0
208 Bracket Hand Wash Plasik Pcs 0 0
209 Cannofix-PU Pcs 0 0
210 Cannula Oksigen Bayi Pcs 0 0
211 Cannula Oksigen Anak Pcs 0 0
212 Cannula Oksigen Dewasa Pcs 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
213 Catgut Crhomic No. 2/0 Pcs 0 0
214 Catgut Crhomic No. 3/0 Pcs 0 0
215 Crhomic No. 2/0 (Gabler) Pcs 0 0
216 Crhomic No. 3/0 (Gabler) Pcs 0 0
217 Crhomic No. 4/0 (Gabler) Pcs 0 0
218 Catgut Plain No. 2/0 Pcs 0 0
219 Catgut Plain No. 3/0 Pcs 0 0
220 Cavidagel 15g Tube 0 0
221 Dermafix 10 x 15 Pcs 0 0
222 Disposable (Spoit) 1 cc Pcs 0 0
223 Disposable (Spoit) 3 cc Pcs 0 0
224 Disposable (Spoit) 5 cc Pcs 0 0
225 Disposable (Spoit) 10 cc Pcs 0 0
226 Dental BIP Pack 0 0
227 Ethyl Chloride Botol 0 0
228 Foley Catheter No. 16 Pcs 0 0
229 Foley Catheter No. 18 Pcs 0 0
230 Foley Catheter No. 20 Pcs 0 0
231 Foley Catheter No. 22 Pcs 0 0
232 Foley Catheter No, 24 Pcs 0 0
233 Hanschoen Gynecolog Glove No. 6,5 Pasang 0 0
234 Hanschoen Gynecolog Glove No. 7 Pasang 0 0
235 Hanschoen Gynecolog Glove No. 7,5 Pasang 0 0
236 Hanschoen Gynecolog Glove No. 8 Pasang 0 0
237 Hanschoen Gynecolog Glove No. 8,5 Pasang 0 0
238 Handschoen Steril Free Powder No. 6,5 Pasang 0 0
239 Handschoen Steril Free Powder No. 7 Pasang 0 0
240 Handschoen Steril Free Powder No. 7,5 Pasang 0 0
241 Handschoen Steril Free Powder No. 8 Pasang 0 0
242 Handschoen Nitrile S (Golden Glove) Pasang 0 0
243 Handschoen Nitrile M (Golden Glove) Pasang 0 0
244 Handschoen Nitrile L (Golden Glove) Pasang 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
245 Handschoen Non Steril S Pcs 0 0
246 Handschoen Non Steril M Pcs 0 0
247 Handschoen Non Steril L Pcs 0 0
248 I.V. Catheter No. 18 Pcs 0 0
249 I.V. Catheter No. 20 Pcs 0 0
250 I.V. Catheter No. 22 Pcs 0 0
251 I.V. Catheter No. 24 Pcs 0 0
252 I.V. Catheter No. 18 (Troge Medical) Pcs 0 0
253 I.V. Catheter No. 20 (Troge Medical) Pcs 0 0
254 I.V. Catheter No. 22 (Troge Medical) Pcs 0 0
255 I.V. Catheter No. 24 (Troge Medical) Pcs 0 0
256 I.V. Catheter No. 26 (Troge Medical) Pcs 0 0
257 Infus Set Makro (Dewasa) Pcs 0 0
258 Infus Set Mikro (Anak) Pcs 0 0
259 Jelly Catheter Tube 0 0
260 Jelly USG Botol 0 0
261 Jarum Intraligamen Pcs 0 0
262 Kapas 250 g Roll 0 0
263 Kapas Berlemak 500 g Roll 0 0
264 Kapas 1000 g Roll 0 0
265 Kasa Hidrofil 40 m x 80 cm Roll 0 0
266 Kasa Kompres 40 x 40 cm Pcs 0 0
267 Kasa Steril 16 x 16 cm Ktk 0 0
268 Kasa Pembalut Hydrofil 4 x 5 cm Roll 0 0
269 Kasa Pembalut Hydrofil 4 x 10 cm Roll 0 0
270 Kasa Pembalut Hydrofil 4 x 15 cm Roll 0 0
271 Lysol larutan 1 liter Botol 0 0
272 Masker Earloop Pcs 0 0
273 Masker Headloop 3 Ply (Masker Hijab) Pcs 0 0
274 Masker Tali Pcs 0 0
275 Nasal Oxigen M Pcs 0 0
276 Nasal Oxigen L Pcs 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
277 Nylon Non Absorbable 5/0 Pcs 0 0
278 Optime 4/0 Pcs 0 0
279 Optime 5/0, 1/2 TP 18 mm, 75 cm Pcs 0 0
280 Optime 5/0, 3/8 TP 13 mm, 75 cm Pcs 0 0
281 One Scrub 5 Liter Botol 0 0
282 One Scrub 500 ml Botol 0 0
283 One Test Hamil Pcs 0 0
284 Plesterin 10 cm x 5 m Pcs 0 0
285 Plesterin 5 cm x 5 m Set 0 0
286 Pot Urine Pot 0 0
287 Pot Dahak Steril Pot 0 0
288 Paper Tape 2,5 cm x 9,14 m Roll 0 0
289 Paper Tape 5,0 cm x 9,14 m Roll 0 0
290 Pharmafix ( 5 cm x 500 cm ) Roll 0 0
291 Pharmafix ( 10 cm x 500 cm ) Roll 0 0
292 Pharmafix ( 15 cm x 500 cm ) Roll 0 0
293 Postofix-PU Pcs 0 0
294 Reagen Zn Paket 0 0
295 Sharp Container 1 Liter bh 0 0
296 Shoe cover Pasang 0 0
297 Silk No. 2/0 Pcs 0 0
298 Silk No. 3/0 Pcs 0 0
299 Silk No. 2/0 (Gabler) Pcs 0 0
300 Silk No. 3/0 (Gabler) Pcs 0 0
301 Silk No. 4/0 Pcs 0 0
302 Sungkup Oksigen Bayi Pcs 0 0
303 Sungkup Oksigen Anak Pcs 0 0
304 Sungkup Oksigen Dewasa Pcs 0 0
305 Tape Fescoplast 2.5 cm x 4,5 M Roll 0 0
306 Tape Fescoplast 5 cm x 4.5 M Roll 0 0
307 Tro-Venoflow 3-way Pcs 0 0
308 T-Silk/Sutra 3-0, 76 cm Pcs 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
309 T-Silk/Sutra 2-0, 76 cm Reverse Cutting, Pcs 0 0
310 T-Vio Episiotomy 2-0, 110 cm, TC, 1/2C, Pcs 0 0
311 T-Handrub Chlorhexidine 250 ml Botol 0 0
312 Umbilical Cord Klem Steril Nylon Pcs 0 0
313 Urine Bag Pcs 0 0
314 Water One 1 liter botol 0 0
315 Wing Needle 19 G Pcs 0 0
316 Wing Needle 21 G Pcs 0 0
F. VAKSIN DAN LAIN-LAIN
317 Vaksin HB.Pid Pouch 0 0
318 Vaksin BCG Vial 0 0
319 Vaksin Polio Oral Vial 0 0
320 Vaksin IPV Vial 0 0
321 Vaksin Campak Vial 0 0
322 Vaksin DPT-HB-Hib Vial 0 0
323 Vaksin TD Vial 0 0
324 Vaksin DT Vial 0 0
325 Vaksin MR Vial 0 0
326 Kombipak Kategori I Paket 0 0
327 ADS 0,05 ml Pcs 0 0
328 ADS 0,5 ml Pcs 0 0
329 ADS 5 ml Pcs 0 0
330 Safety Box Pcs 0 0
331 Vaksin Rabies Pcs 0 0
332 Box Slide Box 0 0
333 Masker N95 Box 0 0
334 MC Side (Slide Enforst) Pack 0 0
335 Pot Dahak Pot 0 0
336 Pot Urine Pot 0 0
337 Reagen DBD Botol 0 0
338 Reagen TB Botol 0 0
339 Rapid Test Syphilis Paket 0 0
PEMBERIAN
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
340 Styrofom Box Pcs 0 0
G. TAMBAHAN/LAIN-LAIN
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0

JUMLAH KUNJUNGAN RESEP UMUM

BPJS JAMKESDA JUMLAH
BAYAR TDK BAYAR

Bantaeng, 2020
Mengetahui/Menyetujui, Yang Menyerahkan Yang meminta,
Kepala Bidang Pelayanan dan Sumber Kasi Farmasi, Alkes dan PKRT Kepala Puskesmas Pengelola Obat
Daya Kesehatan Puskesmas …………….. Puskesmas ………………

M I R N A, S.Si, Apt. HABIBI, S.Farm, Apt.

NIP. 19780426 200502 2 002 NIP. 19840319 201001 1 019 NIP. NIP.
 KEADAAN FISIK KETERSEDIAAN OBAT DAN BAHAN MEDIS HA
(PENGADAAN MELALUI DANA KAPITASI JKN)
PER 31 DESEMBER 2019
PUSKESMAS BISSAPPU

STOK
NO NAMA BARANG SATUAN
GUDANG OBAT APOTEK
1 Cefixime 100 mg Kapsul 0
2 Ambroxol tablet 100 100
3 Allopurinol 100 mg tablet 100
4 Ciprofloksasin tablet 100
5 Metronidazole tablet 120
6 Ibuprofen 400 mg tablet 200
7 Guaifenesin tablet 1000 200
8 Kaolin-pektin tablet 85 0
9 Asam mefenamat tablet 200 40
10 Papaverin tablet 100 50
11 loperamid tablet 100 100
12 Cotrimoxazole Botol 20
13 Paracetamol drop Botol
14 Ondansetron Ampul 10
15 Hyoscine ampul 0
16 neurosanbe ampul 0
17 Oksitetrasiklin kulit Tube 10
18 Asiklovir krim tube 10
19 Blood lancet Pcs
20 Surgical blades Box 10
21 Strip kolesterol nesco Box 0
22 Strip gula nesco Box
23 Strip asam urat nesco box
T O T A L (Rp)

Mengetahui,
Kepala Puskesmas bissappu

dr.Nurfatmiyanti Gani., M.Kes

NIP. 19860130 201111 2 001130 201111 2 01
N BAHAN MEDIS HABIS PAKAI (BMHP)
ANA KAPITASI JKN)
BER 2019
ISSAPPU

STOK HARGA JUMLAH

KET
LAINNYA JUMLAH SATUAN (Rp) HARGA (Rp)
0 0
0 200 1,500 30,000
100 2,000 20,000
100 4,000 40,000
2,500 30,000
2,500 50,000
200 10,000 120,000
4,000 32,000
245 3,500 84,000
150 3,000 45,000
200 1,500 30,000
20 5,000 100,000
5 13,000 65,000
10 20 8,000 160,000

3,000 30,000
4,000 40,000
200 60,000
10 2000 20,000

1 110,000 110,000
1 110,000 110,000
1,176,000

Bantaeng, 31 Desember 2019

Pengelola Obat,

Qurratul Aeni, S.Farm., Apt.

NIP. 19920915 201903 2 023
 KEADAAN FISIK KETERSEDIAAN OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP)
PER TANGGAL 31 DESEMBER 2019
PUSKESMAS BISSAPPU

STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
A. TABLET/KAPLET/KAPSUL
1 Albendazole 400 mg Tablet 870 37 18 925
2 Alprazolam 0,5 mg Tablet
3 Allopurinol 100 mg Tablet 0 1 305 306
4 Aminofilin 200 mg Tablet 600 149 749
5 Amitriptilin 25 mg Tablet 100 100
6 Amlodipin 5 mg Tablet
7 Amlodipin 10 mg Tablet 1470 116 217 1803
8 Amoksisilin 250 mg Kapsul 700 78 778
9 Amoksisilin 500 mg Tablet 3300 91 150 3541
10 Antasida Doen Tablet 1600 111 330 2041
11 Asam Folat 0,4 mg Tablet 1400 74 425 1899
12 Asam Folat 1 mg Tablet 0 0
13 Asam Mefenamat 500 mg Tablet
14 Asetyl Cystein 200 mg Kapsul 100 6 106
15 Asiklovir 200 mg Tablet 400 300 700
16 Asiklovir 400 mg Tablet 600 70 16 686
17 Azytromizin 500 mg Tablet 80 80
18 Betahistine 6 mg Tablet
19 Captopril 12,5 mg Tablet 700 1 765 1466
20 Captopril 25 mg Tablet
21 Captopril 50 mg Tablet
22 Carbamazepin 200 mg Tablet
23 Cefadroxil 500 mg Kapsul 1000 59 1059
24 Cefixim 100 mg Tablet
25 Cetirizine 10 mg Tablet 1200 249 184 1633
26 Chlorfeniramina Maleat (CTM) 4 mg Tablet 2000 198 758 2956
27 Chlorpromazin 25 mg Tablet
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
28 Chlorpromazin 100 mg Tablet 170 170
29 Ciprofloxacin 500 mg Tablet
30 Clobazam 10 mg Tablet
31 Clozapine 25 mg Tablet
32 Cotrimoxazole 120 mg Tablet
33 Cotrimoxazole 480 mg Tablet
34 Cotrimoxazole Forte Kombinasi 960 mg Tablet 600 88 88 776
35 Codein Phospate 10 mg Tablet 100 100
36 Deksametason 0,5 mg Tablet 2100 47 545 2692
37 Diltiazem 30 mg Tablet 200 200
38 Diazepam 2 mg Tablet 90 90
39 Doksisiklin 100 mg Kapsul 600 50 650
40 Domperidon 10 mg Tablet 1200 59 567 1826
41 Ergotamin Caffein Tablet
42 Eritromisin 250 mg Tablet 300 32 332
43 Eritromisin 500 mg Tablet
44 FDC KAT Anak Paket
45 FDC KAT I Paket 6 6
46 FDC KAT II Paket 4 4
47 Fervital Tablet 2100 125 1642 3867
48 Fitomenadion (Vit. K1) 10 mg Tablet 700 80 780
49 Furosemid 40 mg Tablet
50 Garam Oralit Sachet 100 13 113
51 Glibenklamid 5 mg Tablet 700 21 100 821
52 Griseofulvin 500 mg Tablet 300 29 300 629
53 Haloperidol 1,5 mg Tablet
54 Ibuprofen 200 mg Tablet
55 Ibuprofen 400 mg Tablet
56 Isoniasid (INH) 100 mg Tablet
57 Isoniasid (INH) 300 mg Tablet 400 200 600
58 Isosorbid Dinitrat 5 mg Tablet 300 42 342
59 Kalsium Laktat (Kalk) 500 mg Tablet 200 54 512 766
60 Ketokonazole 200 mg Tablet 350 25 375
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
61 Klindamisin 300 mg Kapsul
62 Klindamycin 150 mg Kapsul 950 88 1038
63 Lanzoprazole 30 mg Kapsul 760 11 32 803
64 Loperamid 2 mg Tablet
65 Loratadin 10 mg Tablet 450 38 200 688
66 Metformin 500 mg Tablet 500 42 542
67 Metilergometrin 0,125 mg Tablet 400 90 490
68 Metilprednisolon 4 mg Tablet 2700 62 150 2912
69 Metilprednisolon 8 mg Tablet
70 Metoklopramide 5 mg Tablet
71 Metoklopramide 10 mg Tablet 100 53 1110 1263
72 Metrodinazole 500 mg Tablet
73 Mineral MIX, Kombinasi Sachet
74 Natrium diklofenak 25 mg Tablet 600 96 696
75 Nifedipin 10 mg Tablet 300 200 500
76 Nystatin 500.000 IU Tablet 200 28 228
77 Nystatin tablet vagina 100.000 IU Tablet 30 18 48
78 Omeprazole 20 mg Kapsul
79 Ondasetron 4 mg Tablet
80 Ondasetron 8 mg Tablet
81 Paracetamol 500 mg Tablet 5100 50 100 725 5975
82 Pil KB Oral kombinasi Tablet
83 Prednison 5 mg Tablet
84 Propiltiourasil (PTU) 100 mg Tablet 100 100
85 Pyrantel 125 mg Tablet
86 Phenobarbital 30 mg Tablet
87 Ranitidin 150 mg Tablet
 88 Resperidon 2 mg Tablet
89 Rifampicin 300 mg Kapsul 200 100 300
90 Salbutamol 2 mg Tablet 700 0 700 1400
91 Salbutamol 4 mg Tablet
92 Simvastatin 10 mg Tablet 90 9 199 298
93 Simvastatin 20 mg Tablet 70 19 89
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
94 Spironolakton 100 mg Tablet
95 Tablet Tambah Darah Tablet 2460 61 520 3041
96 Tetrasiklin 250 mg Kapsul
97 Tetrasiklin 500 mg Kapsul 100 44 144
98 Triheksilfenidil 2 mg Tablet 140 140
99 Vitamin A (Retinol) 100.000 IU Kapsul 0 0
100 Vitamin A (Retinol) 200.000 IU Kapsul 549 98 15 662
101 Vitamin B Complex Tablet 5300 193 524 6017
102 Vitamin B1 (Thiamin) Tablet 300 0 1727 2027
103 Vitamin B12 (Sianokobalamin) Tablet 1100 0 1522 2622
104 Vitamin B6 (Piridoksin) Tablet 900 118 775 1793
105 Vitamin C 50 mg Tablet 1700 59 148 1907
106 Vitamin C 250 mg Tablet 0 136 136
107 Zinc 20 mg Tablet 700 54 206 960
B. SIRUP
108 Albendazole Sirup 200 mg Botol
109 Amoksisilin sirup kering 125 mg/5 ml Botol
110 Amoxicillin syrup Kering 250 mg/5ml Botol 72 13 85
111 Antasida Suspensi Botol 80 2 49 131
112 Cefadroxil sirup Kering 125 mg/5ml Botol
113 Cefadroxil Sirup Kering 250 mg/5 ml Botol
114 Ceterizin Sirup Botol
115 Chloramfenikol suspensi 125 mg/5 ml Botol 19 19
116 Cotrimoksazole Sirup 60 ml Botol
117 Domperidon Suspensi / Sirup 5 mg/ml Botol
118 Eritromisin Sirup Botol
119 Ibuprofen Suspensi 100 mg/ 5 ml Botol 4 15 7 26
120 Multivitamin Syr (Supralysin Sirup) Botol 36 36
121 Parasetamol drops Botol
122 Parasetamol sirup 120 mg /5 ml Botol
123 Pyrantel Sirup Botol
124 Sefiksim Sirup kering 100 mg / 5 ml Botol
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
125 Zink Sulfate syr 20 mg/5ml Botol 0 0
C. INJEKSI & INFUS
126 Aminofilin inj 24 mg/ml Ampul 9 9
127 Amoksisilin Serbuk Injeksi 1000 mg Vial 10 10
128 Antalgin Ampul 1 50 51
129 Aqua Pro Injeksi Vial 48 15 7 70
130 Asam Traneksamat Ampul 4 10 14
131 Asering Infus Botol 0 15 15
132 Atropin Sulfat 0,25 mg Ampul 5 5
133 Calcii Gluconas Inj Ampul 10 10
134 Dexamethason Inj 5 mg/ml Ampul 37 10 47
135 Diazepam Injeksi 5 mg/ml Ampul 7 7
136 Difenhidramin Injeksi 10 mg/ml (HCl) Ampul
137 Epinefrin (Adrenalin) inj 0,1 % Ampul 13 13
138 Fenobarbital Inj. Ampul
139 Fitomenadion (Vit. K1) Injeksi 10 mg/ml Ampul 20 10 30
140 Furosemide Inj Ampul
141 Gentamicin Inj Ampul
142 Glukosa 5% Infus Botol 500 ml 21 21
143 Glukosa 10 % Infus Botol 500 ml 14 11 25
144 Glukosa 40 % Botol
145 Haloperidol 5 mg/ml (Lodomer Inj) Ampul
146 Haloperidol 50 mg (Haldol Inj) Ampul
147 hyocine N-buthylbromide inj Ampul
148 KA-EN 3B Botol 0 17 17
149 Lidocain inj 2 % Ampul
150 Lidocain injeksi 2 % + Epinefrin 1 : 80.000-inj Ampul 11 15 22 10 80 138
151 Metilergometrin inj Ampul 12 3 18 33
152 Metilprednisolon inj 125 mg/ml Vial
153 Metoklopramide inj 5 mg/ml Ampul
154 MGSO4 20 % Ampul 9 9
155 MGSO4 40 % Ampul 10 10
156 Metronidazol Infus Botol
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
157 NaCl 0,9 % Infus Botol 500 ml 33 10 5 48
158 Oksitocin inj 10 ui/ml Ampul 40 15 55 110
159 Ranitidine HCl inj. Ampul 23 50 73
160 Ringer Laktat Infus Botol 500 ml 26 44 10 36 116
161 Tramadol Injeksi Ampul
162 Vitamin B1 (Tiamin) inj. Ampul
163 Vitamin B12 (Sianokabalamin) Inj Ampul
164 Vitamin B6 (Piridoksin) inj Ampul
165 Xylestecin inj Ampul
D. OBAT LUAR
166 Antihemoroid Supp 39 39
167 As. Sal + Bel. Endap (2 - 4 Salep) Pot 7 3 10
168 Antifungi DOEN (ac.salicylicum+ac.Benzoicum Pot 42 4 46
169 Asiklovir Cr Tube
170 Betametason krim 0,1% Tube 20 6 14 40
171 Betamethason Dipropionate krim 0,05 % Tube
172 Ceivitron Pink 30 gr Pot
173 Ceivitron White 30 gr Pot
174 Dulcolax ( Bisacodil Supp) 10 mg Supp 9 9
175 Dulcolax ( Bisacodil Supp) 5 mg Supp
176 Eugenol Cairan Botol
177 Etakridine Larutan 0,1 % Botol 4 2 1 3 10
178 Fenol Gliserol TT Botol 4 4
179 Gentian Violet Botol
180 Gentamicin 0,3 % Salep Mata Tube 33 5 38
181 Gentamicin 0,3 % Salep Kulit Tube
182 Gentamisin Tetes Mata Botol
183 Glass Ionomer Pcs
184 Hydrocortison cream 1 % Tube
185 Hidrokortison krim 2,5% Tube 33 6 5 44
186 Ketokenazole Cr 2 % Tube 40 2 11 53
187 Kloramfenikol Salep Mata 1 % Tube
188 Kloramfenikol tetes telinga 3% Botol
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
189 Miconazole 2 % Tube 42 3 45
190 Oksitetrasiklin 1% SM Tube 34 6 9 49
191 Povidon Iodida larutan 10% 30 ml Botol
192 Povidon Iodida larutan 60 ml Botol 23 2 4 29
193 Povidon Iodida larutan 300 ml Botol
194 Povidon Iodida larutan 1000 ml Botol 2 1 1 4
195 Salisil bedak 2% Kotak
196 Xilocaine Jelly 2 % Syringe 2 2
197 Xilocaine Spray Botol 2 2
E. BAHAN MEDIS HABIS PAKAI
198 Alkohol 70% Botol 1 Liter
199 Alkohol Swab Kotak 25 25
200 ARM Sling M Pcs 4 4
201 ARM Sling L Pcs 1 1
202 Aseptan 500 cc + Pump Botol
203 Alkazime sachet 25 mg Sachet
204 Alkacide 1 L High Level Disinfectant botol
205 Bood Lancet Kotak
206 Bood Tranfusion Set Pcs 5 5
207 Blood Tranfusion Set (Troge ) Pcs
208 Bracket Hand Wash Plasik Pcs 6 6
209 Cannofix-PU Pcs
210 Cannula Oksigen Bayi Pcs 9 20 29
211 Cannula Oksigen Anak Pcs 6 7 13
212 Cannula Oksigen Dewasa Pcs 17 10 27
213 Catgut Crhomic No. 2/0 Pcs 85 10 5 100
214 Catgut Crhomic No. 3/0 Pcs 24 45 4 15 88
215 Crhomic No. 2/0 (Gabler) Pcs
216 Crhomic No. 3/0 (Gabler) Pcs
217 Crhomic No. 4/0 (Gabler) Pcs
218 Catgut Plain No. 2/0 Pcs
219 Catgut Plain No. 3/0 Pcs
220 Cavidagel 15g Tube 6 6
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
221 Dermafix 10 x 15 Pcs 30 10 40
222 Disposable (Spoit) 1 cc Pcs 174 93 40 307
223 Disposable (Spoit) 3 cc Pcs 132 40 60 318 550
224 Disposable (Spoit) 5 cc Pcs 48 20 25 93
225 Disposable (Spoit) 10 cc Pcs 95 20 10 125
226 Dental BIP Pack
227 Ethyl Chloride Botol 2 2
228 Foley Catheter No. 16 Pcs 12 10 7 29
229 Foley Catheter No. 18 Pcs 15 10 3 28
230 Foley Catheter No. 20 Pcs 10 10
231 Foley Catheter No. 22 Pcs
232 Foley Catheter No, 24 Pcs 5 5
233 Hanschoen Gynecolog Glove No. 6,5 Pasang
234 Hanschoen Gynecolog Glove No. 7 Pasang 4 6 10
235 Hanschoen Gynecolog Glove No. 7,5 Pasang 24 7 25 56
236 Hanschoen Gynecolog Glove No. 8 Pasang
237 Hanschoen Gynecolog Glove No. 8,5 Pasang
238 Handschoen Steril Free Powder No. 6,5 Pasang
239 Handschoen Steril Free Powder No. 7 Pasang 55 25 80
240 Handschoen Steril Free Powder No. 7,5 Pasang 105 105
241 Handschoen Steril Free Powder No. 8 Pasang
242 Handschoen Nitrile S (Golden Glove) Pasang
243 Handschoen Nitrile M (Golden Glove) Pasang
244 Handschoen Nitrile L (Golden Glove) Pasang
245 Handschoen Non Steril S Pcs 100 16 100 216
246 Handschoen Non Steril M Pcs 0 24 76 100
247 Handschoen Non Steril L Pcs 200 100 140 440
248 I.V. Catheter No. 18 Pcs 35 34 31 100
249 I.V. Catheter No. 20 Pcs 0 0
250 I.V. Catheter No. 22 Pcs 48 30 17 95
251 I.V. Catheter No. 24 Pcs 53 30 19 102
252 I.V. Catheter No. 18 (Troge Medical) Pcs
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
253 I.V. Catheter No. 20 (Troge Medical) Pcs
254 I.V. Catheter No. 22 (Troge Medical) Pcs
255 I.V. Catheter No. 24 (Troge Medical) Pcs
256 I.V. Catheter No. 26 (Troge Medical) Pcs
257 Infus Set Makro (Dewasa) Pcs 57 10 20 35 122
258 Infus Set Mikro (Anak) Pcs 73 5 23 101
259 Jelly Catheter Tube 2 2
260 Jelly USG Botol
261 Jarum Intraligamen Pcs
262 Kapas 250 g Roll 4 4
263 Kapas Berlemak 500 g Roll 4 4
264 Kapas 1000 g Roll 1 1
265 Kasa Hidrofil 40 m x 80 cm Roll 3 1 2 6
266 Kasa Kompres 40 x 40 cm Pcs 61 3 64
267 Kasa Steril 16 x 16 cm Ktk 4 2 6 1 13
268 Kasa Pembalut Hydrofil 4 x 5 cm Roll
269 Kasa Pembalut Hydrofil 4 x 10 cm Roll
270 Kasa Pembalut Hydrofil 4 x 15 cm Roll
271 Lysol larutan 1 liter Botol 5 1 6
272 Masker Earloop Pcs
273 Masker Headloop 3 Ply (Masker Hijab) Pcs 180 40 10 15 85 330
274 Masker Tali Pcs
275 Nasal Oxigen M Pcs
276 Nasal Oxigen L Pcs
277 Nylon Non Absorbable 5/0 Pcs
278 Optime 4/0 Pcs
279 Optime 5/0, 1/2 TP 18 mm, 75 cm Pcs
280 Optime 5/0, 3/8 TP 13 mm, 75 cm Pcs
281 One Scrub 5 Liter Botol
282 One Scrub 500 ml Botol
283 One Test Hamil Pcs
284 Plesterin 10 cm x 5 m Pcs
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
285 Plesterin 5 cm x 5 m Set
286 Pot Urine Pot
287 Pot Dahak Steril Pot
288 Paper Tape 2,5 cm x 9,14 m Roll
289 Paper Tape 5,0 cm x 9,14 m Roll
290 Pharmafix ( 5 cm x 500 cm ) Roll 6 1 7
291 Pharmafix ( 10 cm x 500 cm ) Roll 1 1 2
292 Pharmafix ( 15 cm x 500 cm ) Roll
293 Postofix-PU Pcs
294 Reagen Zn Paket 1 1
295 Sharp Container 1 Liter bh
296 Shoe cover Pasang 10 10
297 Silk No. 2/0 Pcs 32 32
298 Silk No. 3/0 Pcs 2 29 31
299 Silk No. 2/0 (Gabler) Pcs
300 Silk No. 3/0 (Gabler) Pcs
301 Silk No. 4/0 Pcs
302 Sungkup Oksigen Bayi Pcs
303 Sungkup Oksigen Anak Pcs 2 2
304 Sungkup Oksigen Dewasa Pcs 5 5 10
305 Tape Fescoplast 2.5 cm x 4,5 M Roll
306 Tape Fescoplast 5 cm x 4.5 M Roll
307 Tro-Venoflow 3-way Pcs 50 50
308 T-Silk/Sutra 3-0, 76 cm Pcs
309 T-Silk/Sutra 2-0, 76 cm Reverse Cutting, 3/8 c Pcs
310 T-Vio Episiotomy 2-0, 110 cm, TC, 1/2C, 35 Pcs
311 T-Handrub Chlorhexidine 250 ml Botol 4 4
312 Umbilical Cord Klem Steril Nylon Pcs 15 35 26 76
313 Urine Bag Pcs 0 10 3 13
314 Water One 1 liter botol 0 0
315 Wing Needle 19 G Pcs 9 9
316 Wing Needle 21 G Pcs 5 5
STOK
NO NAMA BARANG SATUAN KET
G. OBAT APOTEK IGD/RI LAB KIA P.GIGI GIZI PUSTU IMUNISASI JUMLAH
F. VAKSIN DAN LAIN-LAIN
317 Vaksin HB.Pid Pouch 0 0
318 Vaksin BCG Vial 13 13
319 Vaksin Polio Oral Vial 21 21
320 Vaksin IPV Vial 3 3
321 Vaksin Campak Vial 36 36
322 Vaksin DPT-HB-Hib Vial 4 4
323 Vaksin TD Vial 46 46
324 Vaksin DT Vial 30 30
325 Vaksin MR Vial 11 11
326 Kombipak Kategori I Paket
327 ADS 0,05 ml Pcs
328 ADS 0,5 ml Pcs
329 ADS 5 ml Pcs
330 Safety Box Pcs 10 2 12
331 Vaksin Rabies Pcs 5 5
332 Box Slide Box 1 1
333 Masker N95 Box
334 MC Side (Slide Enforst) Pack 72 72
335 Pot Dahak Pot 40 40
336 Pot Urine Pot 0 0
337 Reagen DBD Botol 10 10
338 Reagen TB Botol 6 6
339 Rapid Test Syphilis Paket 29 29
340 Styrofom Box Pcs 2 2
G. TAMBAHAN/LAIN-LAIN

Bantaeng, 31 Desember 2019

Mengetahui,
Kepala Puskesmas Bissappu Pengelola Obat,

dr. Nurfatmiyanti Gani., M.Kes Qurratul Aeni,S.Farm., Apt

NIP. 19860130 20111 2 001 NIP. 19920915 201903 2 023