KESESUAIAN DENGAN FORNAS 2021

Dec-21
nama obat di puskesmas bentuk fornas non fornas
ALLOPURINOL TABLET 100 MG TABLET
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
1 AMLODIPINE TABLET 10 MG TABLET 1
2 AMLODIPINE TABLET 5 MG TABLET 1
3 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
4 AMOKSISILIN TABLET 500 MG KAPLET 1
5 AMOKSISILIN SERBUK INJEKSI VIAL 1
6 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
7 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
8 ANTASIDA SUSPENSI 60 ML BOTOL 1
ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
9 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
10 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
11 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
12 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
13 ASAM FOLAT 1MG TABLET TABLET 1
14 ASAM MEFENAMAT TABLET 500 MG TABLET 1
15 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
16 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
17 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
18 ASETOSAL TABLET 100 (80) MG TABLET 1
19 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
20 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 0
21 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
22 betametason tube 1
23 COMBIVENT UDV INHALASI VIAL 1
24 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
25 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
26 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
27 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
28 DIAZEPAM TABLET 5 MG TABLET 1
29 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
30 DIGOXIN TABLET 0,25 MG TABLET 1
31 DIMENHYDRINATE TABLET 50 MG TABLET 1
32 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
33 DOMPERIDON TABLET 10 MG TABLET 1
34 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
35 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0
36 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
37 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
38 FENOBARBITAL TABLET 30 MG TABLET 1
39 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
40 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
41 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
42 FUROSEMID TABLET 40 MG TABLET 1
43 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
44 GENTAMISIN SALEP MATA 0,3% TUBE 1
45 GLIBENCLAMIDE TABLET 5 MG TABLET 1
46 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 1
47 GLIMEPIRIDE 2 MG TABLET TABLET 1
GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 0
49 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
50 gentian violet botol 1
HALOPERIDOL DEKANOAT INJ 50 MG VIAL
HALOPERIDOL TABLET 1,5 MG TABLET
HALOPERIDOL TABLET 5 MG TABLET 1
51 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
52 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
53 IBUPROFEN TABLET 400 MG TABLET 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET
54 KAEN 3B BOTOL 1
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL
55 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL
56 KAPTOPRIL TABLET 25 MG TABLET 1
57 KARBAMAZEPIN TABLET 200 MG TABLET 1
KETOKONAZOLE TABLET 200 MG TABLET
59 KLOBAZAM 10 MG TABLET TABLET 1
60 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
61 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
62 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
63 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
64 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
65 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
66 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
67 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
68 KLOZAPIN 100 MG TABLET TABLET 1
KODEIN HCL TABLET 10 MG TABLET
69 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
70 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
71 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
72 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
73 METFORMIN TABLET 500 MG TABLET 1
METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL
74 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
75 METOKLOPRAMIDE 10 MG TABLET TABLET 1
76 METOKLOPRAMIDE 5 MG TABLET TABLET 1
77 METRONIDAZOL TABLET 500 MG TABLET 1
78 MIKONAZOL KREAM 10 GR TUBE 1
79 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
80 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
81 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
82 NIFEDIPINE TABLET 10 MG TABLET 1
83 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
84 NISTATTIN TAB TABLET 1
NOREPINEPHRINE CAIRAN INJEKSI AMPUL
OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL
OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE
86 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
87 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
88 OMEPRAZOLE TABLET 20 MG KAPSUL 1
89 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
90 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
91 PARACETAMOL TABLET 500 MG TABLET 1
92 PEHAVRAL TABLET TABLET 1
PIRACETAM TABLET 800 MG TABLET
93 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
94 PREDNISON TABLET 5 MG TABLET 1
95 PROPANOLOL HCL TABLET 40 MG TABLET 1
96 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
97 RESPERIDON 2 MG TABLET TABLET 1
98 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
99 SALBUTAMOL TABLET 4 MG TABLET 1
100 SALEP 2-4 KOMBINASI 30 GR POT 1
101 SEFADROKSIL KAPSUL 500 MG KAPSUL 1 0
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL
102 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
103 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
104 SIMVASTATIN TABLET 10 MG TABLET 1
105 SIPROFLOXACIN TABLET 500 MG TABLET 1
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
106 salisilk talk botol 1
107 TABLET TAMBAH DARAH (DAK) TABLET 1
108 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
109 TRIFLOUPERASIN TABLET 5 MG TABLET 0 1
110 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
111 VITAMIN B COMPLEX TABLET TABLET 1
ketoprofen supp 1
zink TABLET 1
89 22

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

total item obat

#REF! TOTAL 98 120

% KESESUAIAN = 0.816667
non fornas

nonfornas
 non fornas

non forns

111

NON FORNAS

120
120
 KESESUAIAN DENGAN FORNAS 2021
Nov-21
nama obat di puskesmas bentuk fornas non fornas
ALLOPURINOL TABLET 100 MG TABLET
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
1 AMLODIPINE TABLET 10 MG TABLET 1
2 AMLODIPINE TABLET 5 MG TABLET 1
3 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
4 AMOKSISILIN TABLET 500 MG KAPLET 1
5 AMOKSISILIN SERBUK INJEKSI VIAL 1
6 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
7 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
8 ANTASIDA SUSPENSI 60 ML BOTOL 1
ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
9 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
10 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
11 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
12 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
13 ASAM FOLAT 1MG TABLET TABLET 1
14 ASAM MEFENAMAT TABLET 500 MG TABLET 1
15 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
16 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
17 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
18 ASETOSAL TABLET 100 (80) MG TABLET 1
19 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
20 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 0
21 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
22 betametason tube 1
23 COMBIVENT UDV INHALASI VIAL 1
24 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
25 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
26 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
27 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
28 DIAZEPAM TABLET 5 MG TABLET 1
29 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
30 DIGOXIN TABLET 0,25 MG TABLET 1
31 DIMENHYDRINATE TABLET 50 MG TABLET 1
32 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
33 DOMPERIDON TABLET 10 MG TABLET 1
34 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
35 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
36 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
37 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
38 FENOBARBITAL TABLET 30 MG TABLET 1
39 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
40 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
41 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
42 FUROSEMID TABLET 40 MG TABLET 1
43 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
44 GENTAMISIN SALEP MATA 0,3% TUBE 1
45 GLIBENCLAMIDE TABLET 5 MG TABLET 1
46 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
47 GLIMEPIRIDE 2 MG TABLET TABLET 1
48 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
49 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
50 gentian violet botol 1
HALOPERIDOL DEKANOAT INJ 50 MG VIAL
HALOPERIDOL TABLET 1,5 MG TABLET 1
HALOPERIDOL TABLET 5 MG TABLET 1
51 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
52 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
53 IBUPROFEN TABLET 400 MG TABLET 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET
54 KAEN 3B BOTOL 1
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL
55 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL
56 KAPTOPRIL TABLET 25 MG TABLET 1
57 KARBAMAZEPIN TABLET 200 MG TABLET 1
58 KETOKONAZOLE TABLET 200 MG TABLET 1
59 KLOBAZAM 10 MG TABLET TABLET 1
60 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
61 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
62 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
63 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
64 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
65 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
66 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
67 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
68 KLOZAPIN 100 MG TABLET TABLET 1
KODEIN HCL TABLET 10 MG TABLET
69 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
70 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
71 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
72 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
73 METFORMIN TABLET 500 MG TABLET 1
METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL
74 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
75 METOKLOPRAMIDE 10 MG TABLET TABLET 1
76 METOKLOPRAMIDE 5 MG TABLET TABLET 1
77 METRONIDAZOL TABLET 500 MG TABLET 1
78 MIKONAZOL KREAM 10 GR TUBE 1
79 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
80 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
81 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
82 NIFEDIPINE TABLET 10 MG TABLET 1
83 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
84 NISTATTIN TAB TABLET 1
85 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL
OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE
86 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
87 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
88 OMEPRAZOLE TABLET 20 MG KAPSUL 1
89 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
90 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
91 PARACETAMOL TABLET 500 MG TABLET 1
92 PEHAVRAL TABLET TABLET 1
PIRACETAM TABLET 800 MG TABLET
93 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
94 PREDNISON TABLET 5 MG TABLET 1
95 PROPANOLOL HCL TABLET 40 MG TABLET 1
96 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
97 RESPERIDON 2 MG TABLET TABLET 1
98 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
99 SALBUTAMOL TABLET 4 MG TABLET 1
100 SALEP 2-4 KOMBINASI 30 GR POT 1
101 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL
102 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
103 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
104 SIMVASTATIN TABLET 10 MG TABLET 1
105 SIPROFLOXACIN TABLET 500 MG TABLET 1
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
106 salisilk talk botol 1
107 TABLET TAMBAH DARAH (DAK) TABLET 1
108 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
109 TRIFLOUPERASIN TABLET 5 MG TABLET 1
110 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
111 VITAMIN B COMPLEX TABLET TABLET 1
99 15

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

#REF! TOTAL 108 123

% KESESUAIAN = 0.878049
non fornas

nonfornas
 non fornas

non forns

114

NON FORNAS

123
 KESESUAIAN DENGAN FORNAS 2021
Oct-21
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
13 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
14 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
15 ASAM FOLAT 1MG TABLET TABLET 1
16 ASAM MEFENAMAT TABLET 500 MG TABLET 1
17 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
18 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
19 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
20 ASETOSAL TABLET 100 (80) MG TABLET 1
21 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
22 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 0
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET
59 KAEN 3B BOTOL 1
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL
60 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL
61 KAPTOPRIL TABLET 25 MG TABLET 1
62 KARBAMAZEPIN TABLET 200 MG TABLET 1
63 KETOKONAZOLE TABLET 200 MG TABLET 1
64 KLOBAZAM 10 MG TABLET TABLET 1
65 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
66 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
67 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
68 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
69 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
70 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
71 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
72 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
73 KLOZAPIN 100 MG TABLET TABLET 1
KODEIN HCL TABLET 10 MG TABLET
74 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
75 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
76 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
77 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
78 METFORMIN TABLET 500 MG TABLET 1
79 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
80 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
81 METOKLOPRAMIDE 10 MG TABLET TABLET 1
82 METOKLOPRAMIDE 5 MG TABLET TABLET 1
83 METRONIDAZOL TABLET 500 MG TABLET 1
84 MIKONAZOL KREAM 10 GR TUBE 1
85 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
86 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
87 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
88 NIFEDIPINE TABLET 10 MG TABLET 1
89 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
90 NISTATTIN TAB TABLET 1
91 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL
92 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
93 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
94 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
95 OMEPRAZOLE TABLET 20 MG KAPSUL 1
96 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
97 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
98 PARACETAMOL TABLET 500 MG TABLET 1
99 PEHAVRAL TABLET TABLET 1
PIRACETAM TABLET 800 MG TABLET
100 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
101 PREDNISON TABLET 5 MG TABLET 1
102 PROPANOLOL HCL TABLET 40 MG TABLET 1
103 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
104 RESPERIDON 2 MG TABLET TABLET 1
105 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
106 SALBUTAMOL TABLET 4 MG TABLET 1
107 SALEP 2-4 KOMBINASI 30 GR POT 1
108 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL
109 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
110 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
111 SIMVASTATIN TABLET 10 MG TABLET 1
112 SIPROFLOXACIN TABLET 500 MG TABLET 1
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
113 salisilk talk botol 1
114 TABLET TAMBAH DARAH (DAK) TABLET 1
115 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
116 TRIFLOUPERASIN TABLET 5 MG TABLET 1
117 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
118 VITAMIN B COMPLEX TABLET TABLET 1
103 15

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

#REF! TOTAL 112 127

% KESESUAIAN = 112/127*100% 0.88189

 118

NON FORNAS

127
 KESESUAIAN DENGAN FORNAS 2021
Sep-21
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
13 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
14 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
15 ASAM FOLAT 1MG TABLET TABLET 1
16 ASAM MEFENAMAT TABLET 500 MG TABLET 1
17 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
18 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
19 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
20 ASETOSAL TABLET 100 (80) MG TABLET 1
21 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
22 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 0
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET
59 KAEN 3B BOTOL 1
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL
60 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL
61 KAPTOPRIL TABLET 25 MG TABLET 1
62 KARBAMAZEPIN TABLET 200 MG TABLET 1
63 KETOKONAZOLE TABLET 200 MG TABLET 1
64 KLOBAZAM 10 MG TABLET TABLET 1
65 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
66 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
67 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
68 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
69 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
70 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
71 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
72 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
73 KLOZAPIN 100 MG TABLET TABLET 1
KODEIN HCL TABLET 10 MG TABLET
74 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
75 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
76 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
77 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
78 METFORMIN TABLET 500 MG TABLET 1
79 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
80 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
81 METOKLOPRAMIDE 10 MG TABLET TABLET 1
82 METOKLOPRAMIDE 5 MG TABLET TABLET 1
83 METRONIDAZOL TABLET 500 MG TABLET 1
84 MIKONAZOL KREAM 10 GR TUBE 1
85 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
86 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
87 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
88 NIFEDIPINE TABLET 10 MG TABLET 1
89 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
90 NISTATTIN TAB TABLET 1
91 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
92 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
93 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
94 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
95 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
96 OMEPRAZOLE TABLET 20 MG KAPSUL 1
97 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
98 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
99 PARACETAMOL TABLET 500 MG TABLET 1
100 PEHAVRAL TABLET TABLET 1
101 PIRACETAM TABLET 800 MG TABLET 1
102 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
103 PREDNISON TABLET 5 MG TABLET 1
104 PROPANOLOL HCL TABLET 40 MG TABLET 1
105 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
106 RESPERIDON 2 MG TABLET TABLET 1
107 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
108 SALBUTAMOL TABLET 4 MG TABLET 1
109 SALEP 2-4 KOMBINASI 30 GR POT 1
110 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
111 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
112 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
113 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
114 SIMVASTATIN TABLET 10 MG TABLET 1
115 SIPROFLOXACIN TABLET 500 MG TABLET 1
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
116 salisilk talk botol 1
117 TABLET TAMBAH DARAH (DAK) TABLET 1
118 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
119 TRIFLOUPERASIN TABLET 5 MG TABLET 1
120 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
121 VITAMIN B COMPLEX TABLET TABLET 1
104 17

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

#REF! TOTAL 113 130

% KESESUAIAN = 0.869231
 121

NON FORNAS

130
 KESESUAIAN DENGAN FORNAS 2021
AGUSTUS 2021
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
ANTI SPASMODIK TABLET (DORMICOMP) TABLET
13 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
14 ASAM FOLAT 1MG TABLET TABLET 1
15 ASAM MEFENAMAT TABLET 500 MG TABLET 1
16 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
17 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
18 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
19 ASETOSAL TABLET 100 (80) MG TABLET 1
20 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
21 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
22 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
59 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
60 KAEN 3B BOTOL 1
61 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
62 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
63 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
64 KAPTOPRIL TABLET 25 MG TABLET 1
65 KARBAMAZEPIN TABLET 200 MG TABLET 1
66 KETOKONAZOLE TABLET 200 MG TABLET 1
67 KLOBAZAM 10 MG TABLET TABLET 1
68 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
69 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
70 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
71 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
72 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
73 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
74 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
75 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
76 KLOZAPIN 100 MG TABLET TABLET 1
77 KODEIN HCL TABLET 10 MG TABLET 1
78 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
79 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
80 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
81 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
82 METFORMIN TABLET 500 MG TABLET 1
83 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
84 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
85 METOKLOPRAMIDE 10 MG TABLET TABLET 1
86 METOKLOPRAMIDE 5 MG TABLET TABLET 1
87 METRONIDAZOL TABLET 500 MG TABLET 1
88 MIKONAZOL KREAM 10 GR TUBE 1
89 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
90 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
91 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 1
92 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
93 NIFEDIPINE TABLET 10 MG TABLET 1
94 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
95 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
96 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
97 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
98 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
99 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
100 OMEPRAZOLE TABLET 20 MG KAPSUL 1
101 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
102 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
103 PARACETAMOL TABLET 500 MG TABLET 1
104 PEHAVRAL TABLET TABLET 1
105 PIRACETAM TABLET 800 MG TABLET 1
106 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
107 PREDNISON TABLET 5 MG TABLET 1
108 PROPANOLOL HCL TABLET 40 MG TABLET 1
109 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
110 RESPERIDON 2 MG TABLET TABLET 1
111 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
112 SALBUTAMOL TABLET 4 MG TABLET 1
113 SALEP 2-4 KOMBINASI 30 GR POT 1
114 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
115 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
116 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
117 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
118 SIMVASTATIN TABLET 10 MG TABLET 1
119 SIPROFLOXACIN TABLET 500 MG TABLET 1
120 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL 1
121 salisilk talk botol 1
122 TABLET TAMBAH DARAH (DAK) TABLET 1
123 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
124 TRIFLOUPERASIN TABLET 5 MG TABLET 1
125 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
126 VITAMIN B COMPLEX TABLET TABLET 1
107 19

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

#REF! TOTAL 116 135

% KESESUAIAN = 0.859259
 126

NON FORNAS

135
 KESESUAIAN DENGAN FORNAS 2021
Sep-21
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
13 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
14 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
15 ASAM FOLAT 1MG TABLET TABLET 1
16 ASAM MEFENAMAT TABLET 500 MG TABLET 1
17 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
18 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
19 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
20 ASETOSAL TABLET 100 (80) MG TABLET 1
21 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
22 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 0
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET
59 KAEN 3B BOTOL 1
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL
60 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL
61 KAPTOPRIL TABLET 25 MG TABLET 1
62 KARBAMAZEPIN TABLET 200 MG TABLET 1
63 KETOKONAZOLE TABLET 200 MG TABLET 1
64 KLOBAZAM 10 MG TABLET TABLET 1
65 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
66 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
67 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
68 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
69 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
70 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
71 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
72 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
73 KLOZAPIN 100 MG TABLET TABLET 1
KODEIN HCL TABLET 10 MG TABLET
74 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
75 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
76 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
77 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
78 METFORMIN TABLET 500 MG TABLET 1
79 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
80 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
81 METOKLOPRAMIDE 10 MG TABLET TABLET 1
82 METOKLOPRAMIDE 5 MG TABLET TABLET 1
83 METRONIDAZOL TABLET 500 MG TABLET 1
84 MIKONAZOL KREAM 10 GR TUBE 1
85 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
86 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
87 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
88 NIFEDIPINE TABLET 10 MG TABLET 1
89 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
90 NISTATTIN TAB TABLET 1
91 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
92 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
93 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
94 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
95 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
96 OMEPRAZOLE TABLET 20 MG KAPSUL 1
97 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
98 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
99 PARACETAMOL TABLET 500 MG TABLET 1
100 PEHAVRAL TABLET TABLET 1
101 PIRACETAM TABLET 800 MG TABLET 1
102 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
103 PREDNISON TABLET 5 MG TABLET 1
104 PROPANOLOL HCL TABLET 40 MG TABLET 1
105 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
106 RESPERIDON 2 MG TABLET TABLET 1
107 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
108 SALBUTAMOL TABLET 4 MG TABLET 1
109 SALEP 2-4 KOMBINASI 30 GR POT 1
110 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
111 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
112 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
113 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
114 SIMVASTATIN TABLET 10 MG TABLET 1
115 SIPROFLOXACIN TABLET 500 MG TABLET 1
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
116 salisilk talk botol 1
117 TABLET TAMBAH DARAH (DAK) TABLET 1
118 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
119 TRIFLOUPERASIN TABLET 5 MG TABLET 1
120 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
121 VITAMIN B COMPLEX TABLET TABLET 1
104 17

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
2 7

#REF! TOTAL 107 130

% KESESUAIAN = 0.823077
 121

NON FORNAS

130
 KESESUAIAN DENGAN FORNAS 2021
AGUSTUS 2021
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
ANTI SPASMODIK TABLET (DORMICOMP) TABLET
13 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
14 ASAM FOLAT 1MG TABLET TABLET 1
15 ASAM MEFENAMAT TABLET 500 MG TABLET 1
16 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
17 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
18 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
19 ASETOSAL TABLET 100 (80) MG TABLET 1
20 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
21 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
22 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
59 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
60 KAEN 3B BOTOL 1
61 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
62 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
63 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
64 KAPTOPRIL TABLET 25 MG TABLET 1
65 KARBAMAZEPIN TABLET 200 MG TABLET 1
66 KETOKONAZOLE TABLET 200 MG TABLET 1
67 KLOBAZAM 10 MG TABLET TABLET 1
68 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
69 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
70 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
71 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
72 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
73 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
74 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
75 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
76 KLOZAPIN 100 MG TABLET TABLET 1
77 KODEIN HCL TABLET 10 MG TABLET 1
78 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
79 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
80 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
81 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
82 METFORMIN TABLET 500 MG TABLET 1
83 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
84 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
85 METOKLOPRAMIDE 10 MG TABLET TABLET 1
86 METOKLOPRAMIDE 5 MG TABLET TABLET 1
87 METRONIDAZOL TABLET 500 MG TABLET 1
88 MIKONAZOL KREAM 10 GR TUBE 1
89 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
90 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
91 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 1
92 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
93 NIFEDIPINE TABLET 10 MG TABLET 1
94 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
95 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
96 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
97 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
98 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
99 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
100 OMEPRAZOLE TABLET 20 MG KAPSUL 1
101 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
102 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
103 PARACETAMOL TABLET 500 MG TABLET 1
104 PEHAVRAL TABLET TABLET 1
105 PIRACETAM TABLET 800 MG TABLET 1
106 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
107 PREDNISON TABLET 5 MG TABLET 1
108 PROPANOLOL HCL TABLET 40 MG TABLET 1
109 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
110 RESPERIDON 2 MG TABLET TABLET 1
111 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
112 SALBUTAMOL TABLET 4 MG TABLET 1
113 SALEP 2-4 KOMBINASI 30 GR POT 1
114 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
115 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
116 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
117 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
118 SIMVASTATIN TABLET 10 MG TABLET 1
119 SIPROFLOXACIN TABLET 500 MG TABLET 1
120 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL 1
121 salisilk talk botol 1
122 TABLET TAMBAH DARAH (DAK) TABLET 1
123 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
124 TRIFLOUPERASIN TABLET 5 MG TABLET 1
125 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
126 VITAMIN B COMPLEX TABLET TABLET 1
107 19

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
2 7

#REF! TOTAL 107 134

% KESESUAIAN = 0.798507
 126

NON FORNAS

128
 KESESUAIAN DENGAN FORNAS 2021
JULI 2021
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
AMBROXOL SIRUP 5MG/ML BOTOL
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL
AMINOPHYLLINE TABLET 200 MG TABLET
2 AMLODIPINE TABLET 10 MG TABLET 1
3 AMLODIPINE TABLET 5 MG TABLET 1
4 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
5 AMOKSISILIN TABLET 500 MG KAPLET 1
6 AMOKSISILIN SERBUK INJEKSI VIAL 1
7 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
9 ANTASIDA SUSPENSI 60 ML BOTOL 1
10 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
11 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
12 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
ANTI SPASMODIK TABLET (DORMICOMP) TABLET
13 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
14 ASAM FOLAT 1MG TABLET TABLET 1
15 ASAM MEFENAMAT TABLET 500 MG TABLET 1
16 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
17 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
18 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
19 ASETOSAL TABLET 100 (80) MG TABLET 1
20 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
21 ASIKLOVIR TABLET 400 MG TABLET 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
22 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
23 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
BROMHEXINE SIRUP (HUSTAB) BOTOL
24 betametason tube 1
25 COMBIVENT UDV INHALASI VIAL 1
26 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
27 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
28 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
29 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
30 DIAZEPAM TABLET 5 MG TABLET 1
31 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
32 DIGOXIN TABLET 0,25 MG TABLET 1
33 DIMENHYDRINATE TABLET 50 MG TABLET 1
34 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
35 DOMPERIDON TABLET 10 MG TABLET 1
36 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
37 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
38 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
39 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
40 FENOBARBITAL TABLET 30 MG TABLET 1
41 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
42 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
43 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
44 FUROSEMID TABLET 40 MG TABLET 1
45 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
46 GENTAMISIN SALEP MATA 0,3% TUBE 1
47 GLIBENCLAMIDE TABLET 5 MG TABLET 1
48 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
49 GLIMEPIRIDE 2 MG TABLET TABLET 1
50 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
51 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
52 gentian violet botol 1
53 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
54 HALOPERIDOL TABLET 1,5 MG TABLET 1
55 HALOPERIDOL TABLET 5 MG TABLET 1
56 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
57 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
58 IBUPROFEN TABLET 400 MG TABLET 1
59 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
60 KAEN 3B BOTOL 1
61 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
62 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
63 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
64 KAPTOPRIL TABLET 25 MG TABLET 1
65 KARBAMAZEPIN TABLET 200 MG TABLET 1
66 KETOKONAZOLE TABLET 200 MG TABLET 1
67 KLOBAZAM 10 MG TABLET TABLET 1
68 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
69 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
70 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
71 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
72 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
73 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
74 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
75 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
76 KLOZAPIN 100 MG TABLET TABLET 1
77 KODEIN HCL TABLET 10 MG TABLET 1
78 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
79 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
80 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
81 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
82 METFORMIN TABLET 500 MG TABLET 1
83 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
84 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
85 METOKLOPRAMIDE 10 MG TABLET TABLET 1
86 METOKLOPRAMIDE 5 MG TABLET TABLET 1
87 METRONIDAZOL TABLET 500 MG TABLET 1
88 MIKONAZOL KREAM 10 GR TUBE 1
89 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
90 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
91 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 1
92 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
93 NIFEDIPINE TABLET 10 MG TABLET 1
94 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
95 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
96 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
97 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
98 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
99 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
100 OMEPRAZOLE TABLET 20 MG KAPSUL 1
101 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
102 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
103 PARACETAMOL TABLET 500 MG TABLET 1
104 PEHAVRAL TABLET TABLET 1
105 PIRACETAM TABLET 800 MG TABLET 1
106 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
107 PREDNISON TABLET 5 MG TABLET 1
108 PROPANOLOL HCL TABLET 40 MG TABLET 1
109 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
110 RESPERIDON 2 MG TABLET TABLET 1
111 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
112 SALBUTAMOL TABLET 4 MG TABLET 1
113 SALEP 2-4 KOMBINASI 30 GR POT 1
114 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
115 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
116 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
117 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
118 SIMVASTATIN TABLET 10 MG TABLET 1
119 SIPROFLOXACIN TABLET 500 MG TABLET 1
120 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL 1
121 salisilk talk botol 1
122 TABLET TAMBAH DARAH (DAK) TABLET 1
123 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
124 TRIFLOUPERASIN TABLET 5 MG TABLET 1
125 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
126 VITAMIN B COMPLEX TABLET TABLET 1
107 19

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 0
8 0

#REF! TOTAL 107 134

% KESESUAIAN = 0.798507
 126

NON FORNAS
 KESESUAIAN DENGAN FORNAS 2021
JUNI 2021
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
2 AMBROXOL SIRUP 5MG/ML BOTOL 1
3 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 1
4 AMINOPHYLLINE TABLET 200 MG TABLET 1
5 AMLODIPINE TABLET 10 MG TABLET 1
6 AMLODIPINE TABLET 5 MG TABLET 1
7 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
8 AMOKSISILIN TABLET 500 MG KAPLET 1
9 AMOKSISILIN SERBUK INJEKSI VIAL 1
10 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
11 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
12 ANTASIDA SUSPENSI 60 ML BOTOL 1
13 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
14 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
15 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
16 ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET 1
17 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
18 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
19 ASAM FOLAT 1MG TABLET TABLET 1
20 ASAM MEFENAMAT TABLET 500 MG TABLET 1
21 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
22 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
23 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
24 ASETOSAL TABLET 100 (80) MG TABLET 1
25 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
26 ASIKLOVIR TABLET 400 MG TABLET 1
27 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
28 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
29 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
30 BROMHEXINE SIRUP (HUSTAB) BOTOL 1
31 betametason tube 1
32 COMBIVENT UDV INHALASI VIAL 1
33 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
34 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
35 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
36 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
37 DIAZEPAM TABLET 5 MG TABLET 1
38 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
39 DIGOXIN TABLET 0,25 MG TABLET 1
40 DIMENHYDRINATE TABLET 50 MG TABLET 1
41 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
42 DOMPERIDON TABLET 10 MG TABLET 1
43 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
44 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
45 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
46 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
47 FENOBARBITAL TABLET 30 MG TABLET 1
48 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
49 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
50 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
51 FUROSEMID TABLET 40 MG TABLET 1
52 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
53 GENTAMISIN SALEP MATA 0,3% TUBE 1
54 GLIBENCLAMIDE TABLET 5 MG TABLET 1
55 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
56 GLIMEPIRIDE 2 MG TABLET TABLET 1
57 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
58 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
59 gentian violet botol 1
60 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
61 HALOPERIDOL TABLET 1,5 MG TABLET 1
62 HALOPERIDOL TABLET 5 MG TABLET 1
63 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
64 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
65 IBUPROFEN TABLET 400 MG TABLET 1
66 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
67 KAEN 3B BOTOL 1
68 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
69 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
70 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
71 KAPTOPRIL TABLET 25 MG TABLET 1
72 KARBAMAZEPIN TABLET 200 MG TABLET 1
73 KETOKONAZOLE TABLET 200 MG TABLET 1
74 KLOBAZAM 10 MG TABLET TABLET 1
75 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
76 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
77 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
78 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
79 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
80 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
81 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
82 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
83 KLOZAPIN 100 MG TABLET TABLET 1
84 KODEIN HCL TABLET 10 MG TABLET 1
85 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
86 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
87 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
88 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
89 METFORMIN TABLET 500 MG TABLET 1
90 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
91 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
92 METOKLOPRAMIDE 10 MG TABLET TABLET 1
93 METOKLOPRAMIDE 5 MG TABLET TABLET 1
94 METRONIDAZOL TABLET 500 MG TABLET 1
95 MIKONAZOL KREAM 10 GR TUBE 1
96 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
97 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
98 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 1
99 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
100 NIFEDIPINE TABLET 10 MG TABLET 1
101 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
102 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
103 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
104 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
105 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
106 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
107 OMEPRAZOLE TABLET 20 MG KAPSUL 1
108 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
109 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
110 PARACETAMOL TABLET 500 MG TABLET 1
111 PEHAVRAL TABLET TABLET 1
112 PIRACETAM TABLET 800 MG TABLET 1
113 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
114 PREDNISON TABLET 5 MG TABLET 1
115 PROPANOLOL HCL TABLET 40 MG TABLET 1
116 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
117 RESPERIDON 2 MG TABLET TABLET 1
118 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
119 SALBUTAMOL TABLET 4 MG TABLET 1
120 SALEP 2-4 KOMBINASI 30 GR POT 1
121 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
122 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
123 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
124 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
125 SIMVASTATIN TABLET 10 MG TABLET 1
126 SIPROFLOXACIN TABLET 500 MG TABLET 1
127 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL 1
128 salisilk talk botol 1
129 TABLET TAMBAH DARAH (DAK) TABLET 1
130 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
131 TRIFLOUPERASIN TABLET 5 MG TABLET 1
132 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
133 VITAMIN B COMPLEX TABLET TABLET 1
111 21

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 0

#REF! TOTAL 120 141

% KESESUAIAN = 0.851064
 132

NON FORNAS
 KESESUAIAN DENGAN FORNAS 2021
MEI 2021
nama obat di puskesmas bentuk fornas non fornas
1 ALLOPURINOL TABLET 100 MG TABLET 1
2 AMBROXOL SIRUP 5MG/ML BOTOL 1
3 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 1
4 AMINOPHYLLINE TABLET 200 MG TABLET 1
5 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 1
6 AMLODIPINE TABLET 10 MG TABLET 1
7 AMLODIPINE TABLET 5 MG TABLET 1
8 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
9 AMOKSISILIN TABLET 500 MG KAPLET 1
10 AMOKSISILIN SERBUK INJEKSI VIAL 1
11 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL 1
12 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
13 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
14 ANTASIDA SUSPENSI 60 ML BOTOL 1
15 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
16 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
17 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
18 ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET 1
19 ANTI INFLUENZA (SOLAFLUZ) KOMBINASI SYRUP BOTOL 0
20 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 1
21 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
22 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
23 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 1
24 ASAM FOLAT 1MG TABLET TABLET 1
25 ASAM MEFENAMAT TABLET 500 MG TABLET 1
26 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 1
27 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0
28 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET 1
29 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
30 ASETOSAL TABLET 100 (80) MG TABLET 1
31 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
32 ASIKLOVIR TABLET 400 MG TABLET 1
33 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0
34 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
35 BETAHISTINMESILAT 6 MG TABLET TABLET 0
36 BISAKODIL SUPPOSITORIA 10 MG SUPP. 1
37 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 1
38 BROMHEXINE SIRUP (HUSTAB) BOTOL 1
39 COMBIVENT UDV INHALASI VIAL 1
40 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
41 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
42 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
43 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
44 DIAZEPAM TABLET 5 MG TABLET 1
45 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
46 DIGOXIN TABLET 0,25 MG TABLET 1
47 DIMENHYDRINATE TABLET 50 MG TABLET 1
48 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
49 DOMPERIDON TABLET 10 MG TABLET 1
50 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 1
51 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
52 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
53 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
54 FENOBARBITAL TABLET 30 MG TABLET 1
55 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
56 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
57 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
58 FUROSEMID TABLET 40 MG TABLET 1
59 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
60 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 1
61 GENTAMISIN SALEP MATA 0,3% TUBE 1
62 GLIBENCLAMIDE TABLET 5 MG TABLET 1
63 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
64 GLIMEPIRIDE 2 MG TABLET TABLET 1
65 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
66 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 1
67 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
68 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
69 HALOPERIDOL TABLET 1,5 MG TABLET 1
70 HALOPERIDOL TABLET 5 MG TABLET 1
71 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
72 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0
73 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 1
74 IBUPROFEN TABLET 400 MG TABLET 1
75 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
76 KAEN 3B BOTOL 1
77 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
78 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
79 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
80 KAPTOPRIL TABLET 25 MG TABLET 1
81 KARBAMAZEPIN TABLET 200 MG TABLET 1
82 KETOKONAZOLE TABLET 200 MG TABLET 1
83 KLOBAZAM 10 MG TABLET TABLET 1
84 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
85 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
86 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
87 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
88 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
89 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
90 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
91 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
92 KLOZAPIN 100 MG TABLET TABLET 1
93 KODEIN HCL TABLET 10 MG TABLET 1
94 KOTRIMOKSAZOL DEWASA TABLET TABLET 1
95 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
96 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
97 LORATADIN TABLET 10 MG TABLET 1
98 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
99 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 1
100 METFORMIN TABLET 500 MG TABLET 1
101 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
102 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
103 METOKLOPRAMIDE 10 MG TABLET TABLET 1
104 METOKLOPRAMIDE 5 MG TABLET TABLET 1
105 METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2 ML AMPUL 1
106 METRONIDAZOL + NYSTATIN VAG. (PROVAGIN) INJEKSI VIAL 1
107 METRONIDAZOL TABLET 500 MG TABLET 1
108 MIKONAZOL KREAM 10 GR TUBE 1
109 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL 1
110 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
111 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 1
112 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
113 NIFEDIPINE TABLET 10 MG TABLET 1
114 NISTATIN TABLET 500.000 UI TABLET 0
115 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
116 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
117 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
118 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
119 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
120 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
121 OMEPRAZOLE TABLET 20 MG KAPSUL 1
122 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 1
123 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
124 PARACETAMOL TABLET 500 MG TABLET 1
125 PEHAVRAL TABLET TABLET 1
126 PIRACETAM TABLET 800 MG TABLET 1
127 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
128 PREDNISON TABLET 5 MG TABLET 1
129 PROPANOLOL HCL TABLET 40 MG TABLET 1
130 RANITIDIN INJEKSI 25 MG/ ML AMPUL 1
131 RESPERIDON 2 MG TABLET TABLET 1
132 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
133 SALBUTAMOL TABLET 4 MG TABLET 1
134 SALEP 2-4 KOMBINASI 30 GR POT 1
135 SEFADROKSIL KAPSUL 500 MG KAPSUL 1
136 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
137 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
138 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1 ML AMPUL 0
139 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
140 SIMVASTATIN TABLET 10 MG TABLET 1
141 SIPROFLOXACIN TABLET 500 MG TABLET 1
142 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL 1
143 TABLET TAMBAH DARAH (DAK) TABLET 1
144 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0
145 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
146 TRIFLOUPERASIN TABLET 5 MG TABLET 1
147 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
148 VITAMIN B COMPLEX TABLET TABLET 1
149 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 1
150 ZINK SYRUP BOTOL 0
119 22

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS NON FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
3 LEVOTHYROXINE ACTAVIS TABLET 100 MCG (KESGA) TABLET 1
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9 1
TOTAL 128
0.847682
 141

N FORNAS
151
 KESESUAIAN DENGAN FORNAS 2021

nama obat di puskesmas bentuk fornas

1 ALLOPURINOL TABLET 100 MG TABLET 1
2 AMBROXOL SIRUP 5MG/ML BOTOL 1
3 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 1
4 AMINOPHYLLINE TABLET 200 MG TABLET 1
5 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 1
6 AMLODIPINE TABLET 10 MG TABLET 1
7 AMLODIPINE TABLET 5 MG TABLET 1
8 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 1
9 AMOKSISILIN TABLET 500 MG KAPLET 1
10 AMOKSISILIN SERBUK INJEKSI VIAL 1
11 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL 1
12 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 1
13 ANTASIDA DOEN TABLET KOMBINASI TABLET 1
14 ANTASIDA SUSPENSI 60 ML BOTOL 1
15 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 1
16 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 1
17 ANTI HAEMOROID DOEN KOMBINASI SUPP. 1
18 ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET
19 ANTI INFLUENZA (SOLAFLUZ) KOMBINASI SYRUP BOTOL
20 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 1
21 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 1
22 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL 1
23 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 1
24 ASAM FOLAT 1MG TABLET TABLET 1
25 ASAM MEFENAMAT TABLET 500 MG TABLET 1
26 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL
27 ASAM TRANEKSAMAT 500 MG TABLET TABLET
28 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET
29 ASERING (ASETAT RINGER) SOFT BAG BOTOL 1
30 ASETOSAL TABLET 100 (80) MG TABLET 1
31 ASIKLOVIR KREAM 5 % 5 GR TUBE 1
32 ASIKLOVIR TABLET 400 MG TABLET 1
33 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 1
34 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET 1
35 BETAHISTINMESILAT 6 MG TABLET TABLET
36 BISAKODIL SUPPOSITORIA 10 MG SUPP. 1
37 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET
38 BROMHEXINE SIRUP (HUSTAB) BOTOL
39 COMBIVENT UDV INHALASI VIAL 1
40 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 1
41 DEKSAMETHASONE TABLET 0,5 MG TABLET 1
42 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 1
43 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE 1
44 DIAZEPAM TABLET 5 MG TABLET 1
45 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 1
46 DIGOXIN TABLET 0,25 MG TABLET 1
47 DIMENHYDRINATE TABLET 50 MG TABLET 1
48 DOMPERIDON SUSPENSI 5MG/ML BOTOL 1
49 DOMPERIDON TABLET 10 MG TABLET 1
50 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE
51 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 1
52 ETIL KLORIDA SEMPROT 100 ML BOTOL 1
53 FENITOIN NATRIUM TABLET 100 MG KAPSUL 1
54 FENOBARBITAL TABLET 30 MG TABLET 1
55 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 1
56 FITOMENADION INFANT INJ. 2MG/ML AMPUL 1
57 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 1
58 FUROSEMID TABLET 40 MG TABLET 1
59 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE 1
60 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 1
61 GENTAMISIN SALEP MATA 0,3% TUBE 1
62 GLIBENCLAMIDE TABLET 5 MG TABLET 1
63 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 1
64 GLIMEPIRIDE 2 MG TABLET TABLET
65 GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI VIAL 1
66 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 1
67 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 1
68 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 1
69 HALOPERIDOL TABLET 1,5 MG TABLET 1
70 HALOPERIDOL TABLET 5 MG TABLET 1
71 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL 1
72 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 1
73 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 1
74 IBUPROFEN TABLET 400 MG TABLET 1
75 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 1
76 KAEN 3B BOTOL 1
77 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 1
78 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 1
79 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL 1
80 KAPTOPRIL TABLET 25 MG TABLET 1
81 KARBAMAZEPIN TABLET 200 MG TABLET 1
82 KETOKONAZOLE TABLET 200 MG TABLET 1
83 KLOBAZAM 10 MG TABLET TABLET 1
84 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 1
85 KLORAMFENIKOL SALEP KULIT 2 % TUBE 1
86 KLORAMFENIKOL SALEP MATA 1 % TUBE 1
87 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
88 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 1
89 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET 1
90 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 1
91 KLORPROMAZIN HCL TABLET 100 MG TABLET 1
92 KLOZAPIN 100 MG TABLET TABLET 1
93 KODEIN HCL TABLET 10 MG TABLET 1
94 KOTRIMOKSAZOL DEWASA TABLET TABLET 1
95 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 1
96 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 1
97 LORATADIN TABLET 10 MG TABLET
98 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 1
99 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL
100 METFORMIN TABLET 500 MG TABLET 1
101 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL 1
102 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 1
103 METOKLOPRAMIDE 10 MG TABLET TABLET
104 METOKLOPRAMIDE 5 MG TABLET TABLET
105 METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2 ML AMPUL
106 METRONIDAZOL + NYSTATIN VAG. (PROVAGIN) INJEKSI VIAL 1
107 METRONIDAZOL TABLET 500 MG TABLET 1
108 MIKONAZOL KREAM 10 GR TUBE 1
109 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL
110 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1
111 NATRIUM DIKLOFENAK TABLET 50 MG TABLET
112 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 1
113 NIFEDIPINE TABLET 10 MG TABLET 1
114 NISTATIN TABLET 500.000 UI TABLET 1
115 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 1
116 NOREPINEPHRINE CAIRAN INJEKSI AMPUL 1
117 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 1
118 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 1
119 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 1
120 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 1
121 OMEPRAZOLE TABLET 20 MG KAPSUL
122 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL
123 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 1
124 PARACETAMOL TABLET 500 MG TABLET 1
125 PEHAVRAL TABLET TABLET
126 PIRACETAM TABLET 800 MG TABLET
127 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 1
128 PREDNISON TABLET 5 MG TABLET 1
129 PROPANOLOL HCL TABLET 40 MG TABLET 1
130 RANITIDIN INJEKSI 25 MG/ ML AMPUL
131 RESPERIDON 2 MG TABLET TABLET 1
132 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 1
133 SALBUTAMOL TABLET 4 MG TABLET 1
134 SALEP 2-4 KOMBINASI 30 GR POT 1
135 SEFADROKSIL KAPSUL 500 MG KAPSUL
136 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL 1
137 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL 1
138 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1 ML AMPUL 1
139 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 1
140 SIMVASTATIN TABLET 10 MG TABLET 1
141 SIPROFLOXACIN TABLET 500 MG TABLET 1
142 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL
143 TABLET TAMBAH DARAH (DAK) TABLET 1
144 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 1
145 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET 1
146 TRIFLOUPERASIN TABLET 5 MG TABLET 1
147 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 1
148 VITAMIN B COMPLEX TABLET TABLET 1
149 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET
150 ZINK SYRUP BOTOL 1
125

JUMLAH OBAT PKD

NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH FORNAS
1 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S 1
2 ISONIAZID TABLET 300 MG TABLET 1
3 LEVOTHYROXINE ACTAVIS TABLET 100 MCG (KESGA) TABLET
4 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET 1
5 OBAT HIV EFAVIRENZ 600 MG TABLET BTL30'S 1
6 OBAT HIV LAMIVUDIN 150 MG TABLET BTL60'S 1
7 OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET BTL60'S 1
8 OBAT HIV TENOFOVIR 300 MG (TDF) BTL30'S 1
9 OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) BTL30'S 1
10 OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BTL60'S 1
9

NO DAFTAR OBAT TAMBAHAN SATUAN

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

160 TOTAL 134

% KESESUAIAN = 0.8375
non fornas

1
1

1
1
1

1
1
1

1
1

1
1
1

1
1

1
1

1
 1

25

NON FORNAS

26
TOTAL ITEM sesuai fornas
JAN 157 124
FEB 157 124
MARET 154 124
APRIL 150 123
MEI 151 128
JUNI 141 120
JULI 134 107
AGUST 135 116
SEPT 130 113
OKT 127 112
NOV 123 108
DES 120 98
1679 1397 0.832043

1343.2