TT RH 2022

TANDA TERIMA BARANG
RSIA REFA HUSADA
NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

1 Adalat oros 5 Tab 4,494 22,471
2 Adona 5 3 Amp 14,775 44,324
3 Aminophylline 10 Amp 2,806 28,059
4 Amiodaron/ Tyarit 10 Amp 23,452 234,520
5 Asam tranexamat 10 Amp 5,308 53,077
6 Asering 2 Fls 9,020 18,040
7 Aspilet 30 Tab 501 15,018
8 Atropine Sulfas 35 Amp 1,759 61,562
10 Clopidogrel 30 Tab 1,040 31,185
12 Dextrose 40% 16 Fls 9,747 155,956
13 Dobutamin HCl 6 Vial 30,412 182,470
14 Dopamine 7 Amp 6,468 45,276
15 Ephinephrine 30 Amp 1,553 46,577
16 Fargoxin 2 Amp 45,100 90,200
17 Furosemide 16 Amp 3,320 53,128
18 Inviclot 1 Vial 52,599 52,599
20 Farsorbid inj 11 Vial 60,885 669,735
21 KCl 2 Fls 3,304 6,607
22 Ketoprofen 3 Amp 20,493 61,479
23 Ketorolac 5 Amp 6,876 34,381
24 Lidocain 20 Amp 1,353 27,060
25 Manitol 1 Fls 44,587 44,587
26 Dopamet 2 Tab 2,108 4,217
28 MgSO4 20% 5 Fls 3,670 18,350
29 MgSO4 40% 7 Fls 4,192 29,344
30 Nifedipin 10 tab 10 Tab 214 2,142
31 Nor Ephinephrine 6 Amp 24,016 144,095
32 Notrixum 3 Amp 64,041 192,122
33 Noveron 2 Amp 79,695 159,390
34 Oxytocin 10 Amp 2,255 22,550
35 Pehacain 10 Amp 2,712 27,122
36 Phenitoin 6 Amp 29,315 175,890
37 Piracetam 3 g 1 Amp 15,583 15,583
38 RD 1 Fls 9,819 9,819
39 Velutine 5 Amp 7,735 38,673
40 Widahes 5 Fls 166,416 832,080
41 Cat Gut Cromic No. 0. 1 Pcs 49,183 49,183
43 Condom cath 1 Pcs 6,540 6,540
44 Cromic Gut 1 (Blunt Point) 1 Pcs 67,627 67,627
45 Cromic Gut 1 (Taper) 1 Pcs 59,361 59,361
46 Curaspon/T -HEMOVIN 1 Pcs 100,150 100,150
47 Cuticell 2 Pcs 10,838 21,675
49 Dermalon/Monosorb 2/0. 4 Pcs 43,582 174,327
52 ECG paper 2 Pcs 68,817 137,633
53 Folley Cath. No. 8. 2 Pcs 55,811 111,623
61 Gypsona 3" 2 Pcs 35,178 70,356
62 Gypsona 4" 2 Pcs 25,121 50,241
63 Gypsona 6" 2 Pcs 46,137 92,275
65 Infuset dws 5 Pcs 5,778 28,889
66 Infuset paed 5 Pcs 15,142 75,710
67 Maag Slang No. 10. 2 Pcs 29,032 58,064
68 Maag Slang No. 12 2 Pcs 21,344 42,689
69 Maag Slang No. 14. 2 Pcs 22,952 45,904
70 Maag Slang No. 16. 2 Pcs 21,344 42,689
71 Maag Slang No. 18. 2 Pcs 21,344 42,689
72 Maag Slang No. 5 (100 cm) 2 Pcs 26,299 52,599
73 Maag Slang No. 8 (40 cm) 2 Pcs 26,299 52,599
74 Masker nebul anak 3 Pcs 22,550 67,650
75 masker nebul dws 3 Pcs 23,889 71,666
76 Masker NRM anak 3 Pcs 25,933 77,798
77 Masker NRM dws 4 Pcs 33,825 135,300
78 Masker O2 anak 3 Pcs 16,656 49,969
79 Nasal canul anak 5 Pcs 6,201 31,006
80 Nasal canul bayi 5 Pcs 6,105 30,526
81 Nasal canul dws 5 Pcs 9,922 49,610
82 Polisorb 1. 2 Pcs 69,130 138,259
83 Polisorb 2. 2 Pcs 82,655 165,310
84 Polisorb 0 2 Pcs 68,378 136,757
86 Polisorb 3 - 0 2 Pcs 63,870 127,740
87 Slym zuiker 5 Pcs 7,938 39,688
88 Sofband 3". 3 Pcs 26,176 78,528
89 Sofband 4". 3 Pcs 29,732 89,197
90 Sofband 6". 3 Pcs 44,704 134,113
93 Surgicel 2 Pcs 109,368 218,735
94 Tensocrep 3". 2 Pcs 45,664 91,328
95 Tensocrep 4". 2 Pcs 56,826 113,652
96 Tensocrep 6". 2 Pcs 79,151 158,301
97 Three way Cath No. 22 1 Pcs 81,462 81,462
98 Three way Cath No. 24 1 Pcs 81,462 81,462
99 Tranfusi set 5 Pcs 9,165 45,825
100 Urine bag 7 Pcs 6,774 47,419
101 Verban Besar 26 Pcs 2,217 57,633
102 Verban Kecil 10 Pcs 1,108 11,083 7,989,282
Jember 23 November 2021
apt. Alfasea R., S. Farm
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Diazepam/ Valisanbe 5 Amp 20,284 101,419
2 Midanest 5 10 Amp 24,805 248,050 349,469

TANDA TERIMA BARANG
RSIA REFA HUSADA

1 Fentanyl 2 Amp 49,610 99,220
2 Pethidine 3 Amp 19,968 59,904 159,124
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Acetylsistein 100 Tab 683 68,310
2 Ambroxol 100 Tab 179 17,860
3 Amoxiciillin 200 Tab 355 71,033
4 Asam mefenamat 300 Tab 282 84,647
5 Aspilet 20 Tab 501 10,012
6 Becom zet 50 Tab 2,249 112,468
7 Cefixim 200 100 Tab 2,464 246,359
8 Cetirizin 100 Tab 257 25,707
9 CTM 30 Tab 66 1,989
10 Domperidon 30 Tab 222 6,660
11 Becom C 100 Tab 1,687 168,702
12 Cefixim 100 100 Tab 947 94,723
13 Dulcolax 20 Tab 1,972 39,447
14 Folavit 30 Tab 959 28,760
15 Gitas plus 50 Tab 6,675 333,740
16 Hevit C 200 Tab 558 111,623
17 Ibuprofen 50 Tab 296 14,789
18 Lacto B 40 Tab 5,322 212,872
19 Lansoprazol 100 Tab 913 91,328
20 Methyl prednisolon 4 100 Tab 195 19,453
21 Metoclopramid 60 Tab 68 4,059
22 Na diklofenak 50 50 Tab 280 13,981
23 Molagit 100 Tab 396 39,643
24 Ravalgin 50 Tab 203 10,148
25 Oralit 20 Tab 395 7,893
26 Ranitidin 100 Tab 148 14,801
27 Sumagesic 100 Tab 559 55,924
28 Vitamin B comp 100 Tab 141 14,108
29 Vitamam 1 60 Tab 2,391 143,451
30 Vitamam 2 56 Tab 2,733 153,034
31 Vitamam 3 28 Tab 2,733 76,517
32 Imunos 20 Tab 8,660 173,201
33 Mefinal 100 Tab 1,473 147,280
34 Sanprima syr 1 Fls 28,117 28,117
35 Sucralfat 15 Fls 16,743 251,151
36 Zamel 3 Fls 33,825 101,475
37 Burnazin 1 Tube 69,829 69,829
38 Enystin 2 Tube 30,740 61,479
39 Desoximetason 1 Tube 17,443 17,443
40 Genoint SK 7 Tube 5,442 38,091
41 Lantus 1 Pen 91,225 91,225
42 Alkohol swab 500 Pcs 130 64,831
43 Transfusi set 10 Pcs 9,165 91,649
44 Cuticell 10 Pcs 10,838 108,375
45 Folley cath 16 10 Pcs 21,423 214,225
46 Handscoon Safe glove M 200 Pcs 798 159,549
47 Handscoon Altamed S 400 Pcs 1,015 405,900
48 Infuset dewasa 20 Pcs 5,778 115,558
49 Cefoperazon 5 Vial 40,986 204,930
50 Kasa steril 15 Box 6,991 104,858
51 Leukoplast 2 Pcs 42,633 85,266
52 Masker 300 Pcs 699 209,715
53 Masker Nebul Anak 5 Pcs 23,889 119,443
54 Masker Nebul Dewasa 5 Pcs 23,889 119,443
55 Masker NRM Anak 2 Pcs 25,933 51,865
56 Masker NRM Dewasa 3 Pcs 39,463 118,388
57 Maxiflow dewasa 3 Pcs 16,656 49,969
58 Mess 20 30 Pcs 2,858 85,746
59 Needle 23 50 Pcs 530 26,478
60 Nurse cap 50 Pcs 378 18,886
61 Opsite 25x10 20 Pcs 36,418 728,365
62 Oxyflow bayi 3 Pcs 6,201 18,604
63 Spinocan 26 10 Pcs 32,083 320,830
64 DS 3 cc terumo 100 Pcs 2,368 236,775
65 DS 3 cc GIDCARE 200 Pcs 789 157,850
66 Suction connect tube 3,6 1 Pcs 24,577 24,577
67 Surflo 20 5 Pcs 8,969 44,846
68 Surflo wing 20 15 Pcs 19,392 290,887
69 Asam traneksamat inj 5 Amp 5,308 26,538
70 Biocombin inj 20 Amp 6,201 124,025
71 Ceftriaxon 50 Vial 3,063 153,138
72 D5 1/4 NS 10 Fls 10,665 106,650
73 Ephedrin 2 Amp 28,188 56,375
74 Kaen 3B 10 Fls 11,788 117,880
75 ketorolac inj 40 Amp 7,017 280,665
76 Lidocain 10 Amp 1,195 11,954
77 Ondansetron 4 inj 30 Amp 4,447 133,403
79 Oxytocin 50 Amp 2,255 112,750
80 Paracetamol inf 10 Fls 35,322 353,220
81 Phenytoin inj 3 Amp 29,315 87,945
82 Ranitidin inj 70 Amp 3,125 218,780
83 Regivell inj 10 Amp 51,802 518,018
84 RL 60 Fls 7,820 469,220
85 Sagestam inj 20 Amp 10,433 208,655
86 Lasal Neb 20 Amp 8,569 171,380
87 Amoxan DS 2 Fls 24,100 48,201
88 Antasida syr 5 Fls 3,157 15,785
89 Apialys syr 5 Fls 35,347 176,736
90 Caviplex syr 5 Fls 9,563 47,817
91 Cefadroxyl syr 1 Fls 7,565 7,565
92 Cetirizin syr 1 Fls 10,165 10,165
93 Claneksi DS 1 Fls 56,770 56,770
94 Domperidon syr 3 Fls 9,820 29,459
95 Elkana syr 2 Fls 24,743 49,486
96 Ferriz syr 1 Fls 39,463 39,463
97 Novaxifen syr 3 Fls 4,848 14,545
98 Imunos syr 1 Fls 74,229 74,229
99 L zinc 3 Fls 35,347 106,041
100 Lapisiv syr 2 Fls 22,976 45,951
101 Lasal syr 2 Fls 27,849 55,699
102 Nucral syr 3 Fls 66,415 199,246
103 Paracetamol syr 6 Fls 3,326 19,957
104 Polysilane 3 Fls 20,746 62,238
105 Sanmol syr 10 Fls 12,532 125,322
106 Surflo wing 26 10 Pcs 27,993 279,929
107 Three way stopcock 30 Pcs 12,432 372,973
108 Umbilical klem 10 Pcs 2,030 20,295
109 Underpad NS 20 Pcs 3,722 74,438
110 Urine bag 5 Pcs 7,103 35,516
111 Aseptic gel 5 L 1 Galon 252,474 252,474
112 Gigasept 1 Galon 1,471,298 1,471,298
113 Gigazym 1 Galon 538,667 538,667
114 Terralin 1 Galon 1,046,364 1,046,364
115 Needle 18 100 Pcs 289 28,875
116 Picyn 1500 5 Vial 21,656 108,281
117 Chromic 2/0 3 Pcs 54,102 162,305
118 Brilon 4/0 3 Pcs 41,328 123,983
119 Farbivent 10 Amp 9,922 99,220
120 Sirplus 2 Fls 16,123 32,247
121 Caviplex 100 Tab 655 65,508
122 Infusan Ring as 5 Fls 9,021 45,106
123 Diphenhidramin inj 3 Amp 801 2,402
124 Lactrin 60 Tab 3,834 230,010 16,978,882
125 Atropine Sulfas 1 Amp 1,759 1,759
Jember 13 Januari 2022
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Tradosik 30 Tab 4,285 128,535
2 Tramadol inj 10 Amp 4,638 46,382 174,917
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Pethidin inj 2 Amp 19,968 39,936 39,936

TANDA TERIMA BARANG
RSIA REFA HUSADA

1 rapid test antigen 75 Pcs 21,423 1,606,688 1,606,688

TANDA TERIMA BARANG
RSIA REFA HUSADA

2 Infusan NS 500 48 Fls 6,969 334,516
3 Infusan NS 100 60 Fls 7,408 444,461
4 Kaen 3B 20 Fls 11,788 235,760 1,969,114
5 D 5 1/4 NS 10 Fls 10,665 106,650
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Asering 24 bag 9,020 216,480
2 Likurmin 3 Fls 38,424 115,273
3 Cefadroxyl syr NOVA 10 Fls 5,945 59,453
4 Amoxicillin syr 10 Fls 5,356 53,556
5 Sirplus 3 Fls 16,123 48,370
6 OBH itrasal 1 Fls 5,679 5,679
7 OBH Ika 2 Fls 5,705 11,410
8 Lasal syr 3 Fls 27,849 83,548
9 Ambroxol syr 3 Fls 3,680 11,040
10 Mefinal 100 Tab 1,473 147,280
11 Acetylsistein 100 Tab 683 68,310
12 Lactrin 60 Tab 4,552 273,137
13 Domperidon nulab 100 Tab 299 29,897
14 Pamol 125 supp 12 Supp 14,004 168,043
15 Betahistin 6 100 Tab 485 48,510
16 DS 3 cc 200 Pcs 789 157,850
17 DS 5 cc 200 Pcs 846 169,125
18 DS 10 cc 100 Pcs 1,297 129,663
19 Vitamin B comp 100 Tab 82 8,231
20 HC Altamed S 500 Pcs 846 422,813
21 DS 20 cc 10 Pcs 1,387 13,868
22 Fetik supp 10 Supp 17,208 172,085
23 Picyn 750 7 Vial 15,636 109,451
24 Povidon iodin 1 L 2 Fls 66,625 133,250
25 Pehacain inj 5 Amp 2,872 14,359
26 Cefixim syr 5 Fls 19,280 96,401
27 Bioplacenton 1 Tube 24,805 24,805
28 Apron 20 Pcs 2,108 42,169
29 Kasa gulung 3 Roll 178,348 535,044
30 Spalk 15 20 Pcs 4,059 81,180
31 Amoxan 200 Tab 3,535 706,943
32 Cataflam 50 20 Tab 9,258 185,158
33 Metronidazol 50 Tab 262 13,087
34 Becefort 100 Tab 1,199 119,938
35 Omeprazol HJ 100 Tab 376 37,647
36 Omeprazol 50 Tab 460 23,001 4,761,551
37 Chloretyhyl 1 Fls 225,500 225,500
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Demacolin 200 Tab 451 90,200
2 Tremenza 100 Tab 1,641 164,051 254,251
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Alpara 100 Tab 618 61,787 61,787
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Stesolid 5 supp 5 Supp 28,799 143,993 143,993
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Accu check performa 1 bx 451,000 451,000 451,000

TANDA TERIMA BARANG
RSIA REFA HUSADA

1 Sumagesic 100 Tab 559 55,924
2 Paracetamol 200 Tab 251 50,287
3 Vitamam 3 28 Tab 2,733 76,517
4 Vitamam 1 60 Tab 3,383 202,950
5 Amlodipin 5 100 Tab 153 15,334
6 Triamcort 100 Tab 3,942 394,174
7 Sanmol 200 Tab 321 64,268
8 Becom zet 100 Tab 2,249 224,936
9 Urinter 30 Tab 3,229 96,868
10 Amoxan syr 3 Fls 24,743 74,229
11 Amoxan drop 2 Fls 23,993 47,986
12 Apialys drop 3 Fls 42,845 128,535
13 Curcuma plus lysine syr 3 Fls 10,711 32,134
14 Betadin gargle 190 2 Fls 30,443 60,885
15 Surflo wing 24 20 Pcs 20,189 403,788
16 Underpad steril 30 Pcs 8,434 253,011
17 Masker nebul anak 10 Pcs 23,889 238,886
18 Aspilet 30 Tab 501 15,018
19 Masker nebul dewasa 5 Pcs 23,889 119,443
20 Atorvastatin 20 30 Tab 3,664 109,931
21 Surflo wing 26 20 Pcs 27,993 559,857
22 Underpad NS 50 Pcs 3,721 186,038
23 Injectomat line 5 Pcs 8,533 42,665
24 Teosal 50 Tab 214 10,711
25 Apialys syr 5 Fls 35,347 176,736
26 Pehacain inj 10 Amp 3,191 31,908
27 Lidocain inj 10 Amp 1,195 11,954
28 Metformin 50 Tab 164 8,188
29 Infuset buret 10 Pcs 51,500 515,003 4,274,038
Sanprima forte 30 Tab 2,196 65,874
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Codein 10 50 Tab 702 35,122 35,122
Jember 28 Januari 2022 39,249,153

TANDA TERIMA BARANG
RSIA REFA HUSADA

1 Amlodipin 10 30 Tab 328 9,840
2 Amlodipin 5 30 Tab 154 4,612
3 Amoxan 200 Tab 3,535 706,943
4 Amoxicillin 100 Tab 355 35,518
5 Antasida 50 Tab 188 9,393
6 Asam mefenamat 400 Tab 264 105,421
7 Cefadroxyl 200 Tab 635 126,933
8 Cetirizin 150 Tab 283 42,417
9 Curcuma 20 Tab 898 17,961
10 Dexametason 200 Tab 187 37,394
11 Dulcolax 30 Tab 1,973 59,187
12 Glimepirid 2 30 Tab 196 5,869
13 Ibuprofen 400 50 Tab 296 14,784
14 Imunos 20 Tab 8,660 173,201
15 Lactamor 30 Tab 1,921 57,637
16 Lansoprazol 100 Tab 913 91,328
17 Mefinal 300 Tab 1,473 441,839
18 Antalgin 100 Tab 282 28,188
19 Metoclopramid 100 Tab 68 6,765
20 Bledstop 50 Tab 648 32,416
21 Molagit 150 Tab 397 59,509
22 Paracetamol 200 Tab 265 52,934
23 Psidii 20 Tab 4,961 99,220
24 Vitamin D3 1000 IPI 75 Tab 133 9,945
25 Salbutamol 2 30 Tab 81 2,435
26 Santa E 52 Tab 1,028 53,471
27 Vitamam 2 28 Tab 2,732 76,507
28 Becom C 100 Tab 1,687 168,702
29 Spinocan 26 10 Pcs 37,208 372,075
30 DS 50 cc 5 Pcs 5,681 28,403
31 DS 5 cc 200 Pcs 846 169,125
32 Suction cath 10 3 Pcs 4,899 14,697
33 Surflo 20 20 Pcs 9,246 184,910
34 Double spike 10 Pcs 2,481 24,805
35 Umbilical Klem 3 Pcs 2,030 6,089
36 Underpad NS 30 Pcs 3,721 111,623
37 Underpad S 20 Pcs 8,434 168,674
38 Urine bag 10 Pcs 7,103 71,033
39 Plesterin bulat 200 Pcs 197 39,463
40 Alkohol 70% 5 Liter 35,875 179,375
41 Betadin 1 L 2 Liter 66,625 133,250
42 USG Jelly 1.5 Liter 38,572 57,859
43 Paracetamol syr 10 Fls 6,305 63,053
44 Polysilane 2 Fls 20,746 41,492
45 Pralax 5 Fls 63,140 315,700
46 Sanmag 2 Fls 27,448 54,895
47 Sanmol drop 5 Fls 16,817 84,083
48 Sanmol syr 2 Fls 12,532 25,064
49 Sanprima 2 Fls 28,117 56,234
50 Vometa drop 3 Fls 35,863 107,588
51 Betadin 60 ml 2 Fls 5,540 11,081
52 Betadin gargle 3 Fls 20,295 60,885
53 Genoint SK 4 Tube 5,414 21,655
54 Novorapid 1 Pen 91,737 91,737
55 Permethrin 2 Tube 12,128 24,255
56 Betadin 30 ml 3 Fls 3,927 11,782
57 Brilon 3-0 3 Pcs 42,830 128,491
58 Fixomull 2 Pcs 158,611 317,222
59 HC Altamed S 1800 Pcs 846 1,522,125
60 HC Altamed M 300 Pcs 846 253,688
61 HC steril 6.5 50 Pcs 12,177 608,850
62 HC steril 7.5 100 Pcs 12,177 1,217,700
63 Hansaplast 100 Pcs 276 27,624
64 Kasa steril 15 Pcs 6,991 104,858
65 Leukoplast 3 1 Pcs 42,633 42,633
66 Masker tali 200 Pcs 699 139,810
67 Slym suicker 10 Pcs 5,593 55,930
68 Opsite 25x10 10 Pcs 36,418 364,183
69 Oxyflow Dewasa 20 Pcs 9,922 198,440
70 Gabapentin 20 Tab 661 13,213
71 Glimepirid 1 30 Tab 184 5,507
72 Diadium 50 Tab 1,339 66,945
73 Ceftriaxon 50 Vial 2,814 140,681
74 Infusan D 5 1/2 NS 24 Bag 10,722 257,327
75 Dexametason inj 30 Amp 947 28,413
76 Furosemid inj 5 Amp 3,198 15,990
77 Ketorolac 60 Amp 6,876 412,578
78 PZ 1000 1 Fls 21,437 21,437
79 Omeprazol inj 50 Vial 6,283 314,160
81 Oxytocin inj 20 Amp 2,255 45,100
83 Ranitidin inj 40 Amp 3,125 125,017
84 Regivel inj 10 Amp 51,802 518,018
85 Infusan RL 48 Bag 7,821 375,420
86 Phytomenadion inj 10 Amp 3,536 35,363
87 Metronidazol inf 3 Fls 32,559 97,676
88 Ambroxol syr 3 Fls 3,680 11,040
89 Amoxicillin syr 4 Fls 5,638 22,550
90 Apialys drop 5 Fls 42,845 214,225
91 Caviplex 3 Fls 10,520 31,559
92 Cefixim syr 5 Fls 19,280 96,401
93 Cetirizin syr 4 Fls 14,460 57,841
94 Claneksi DS 1 Fls 58,189 58,189
95 Domperidon syr 5 Fls 9,820 49,098
96 Imunos syr 2 Fls 74,229 148,458
97 L zinc 3 Fls 35,347 106,041 13,970,841
98 Cefadroxyl syr 1 Fls 7,565 7,565
99 DS 1 cc Gidcare 100 Pcs 767 76,670
Jember 05 Februari 2022
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Lacoldin 100 Tab 1,944 194,409
2 Lapisiv syr 2 Fls 22,976 45,951
3 Sanadryl DM 2 Fls 12,854 25,707 266,067
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Rhinofed 50 Tab 2,034 101,701
2 Rhinos neo drop 2 Fls 54,526 109,052 210,752

TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Rapid test antigen clungene 100 Pcs 21,423 2,142,250 2,142,250
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 GD Purple EDTA 200 Pcs 1,030 206,025
2 Tabung Non EDTA 200 Pcs 1,105 220,990
3 Troponin 5 Pcs 67,199 335,995
4 Yellow tip 1000 Pcs 99 99,220 862,230
5 VTM 5 Pcs
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 Safety box 5 Pcs 16,349 81,744
2 Tes Kehamilan 50 Pcs 1,627 81,353
3 PD Infuset 50 Pcs 5,778 288,894
4 Ambroxol 100 Tab 169 16,907
5 Antasida syr 3 Fls 3,157 9,471
6 Neo Kaominal 2 Fls 5,164 10,328
7 OBH itrasal 5 Fls 5,679 28,396
8 Aseptic gel 2 Gal 252,474 504,948
9 Citicolin 500 inj 10 Amp 8,316 83,159 1,105,200
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 T suture 12 Pcs 119,126 1,429,512
2 Ibuprofen syr 5 Fls 4,369 21,845
3 Metronidazol 100 Tab 216 21,648
4 Goralgin 100 Tab 1,550 155,031
5 Alpara 150 Tab 618 92,626
6 Vitamin C 500 Promed 100 Tab 620 62,013
7 Viccilin 1 g 10 Vial - -
8 Viccilin SX 10 Vial - -
9 Brilon 4/0 2 Pcs 41,328 82,655
10 Ciprofloxacin 100 Tab 738 73,795
11 Prove D3 5000 90 Tab 4,134 372,075 2,311,201
TANDA TERIMA BARANG

RSIA REFA HUSADA

1 IgG/IgM Dengue 10 Pcs 65,215 652,146 652,146

290.9091 0% 291 320 328
136.3636 0% 136 150 154
3300 5% 3,135 3,449 3,535
315.015 0% 315 347 355
220 25% 165 182 188
275 15% 234 257 264
763.64 27% 557 613 635
313.5 20% 251 276 283
885 10% 797 876 898
165.825 0% 166 182 187
1767.475 1% 1,750 1,925 1,973
1302.98 87% 169 186 196
581.82 56% 256 282 296
8085 5% 7,681 8,449 8,660
2250 25% 1,688 1,856 1,921
900 10% 810 891 913
1375 5% 1,306 1,437 1,473
250 0% 250 275 282
60 0% 60 66 68
575 0% 575 633 648
437.333333 20% 348 383 397
242 3% 235 258 265
5500 20% 4,400 4,840 4,961
120 2% 118 129 133
80 10% 72 79 81
960 5% 912 1,003 1,028
3428.57143 30% 2,400 2,640 2,732
1575 5% 1,496 1,646 1,687
33000 0% 33,000 36,300 37,208
7128 30% 4,990 5,489 5,681
750 0% 750 825 846
4345 0% 4,345 4,780 4,899
8200 0% 8,200 9,020 9,246
2200 0% 2,200 2,420 2,481
1800 0% 1,800 1,980 2,030
3300 0% 3,300 3,630 3,721
7480 0% 7,480 8,228 8,434
6300 0% 6,300 6,930 7,103
175 0% 175 193 197
31818.1818 0% 31,818 35,000 35,875
83600 30% 58,520 64,372 66,625
48400 30% 33,880 37,268 38,572
7200 23% 5,538 6,092 6,305
20000 8% 18,400 20,240 20,746
70000 20% 56,000 61,600 63,140
25625 5% 24,344 26,778 27,448
15700 5% 14,915 16,407 16,817
11700 5% 11,115 12,227 12,532
26250 5% 24,938 27,431 28,117
45000 30% 31,500 34,650 35,863
6952 30% 4,866 5,353 5,540
18000 0% 18,000 19,800 20,295
4950 3% 4,802 5,282 5,414
81363.636 0% 81,364 89,500 91,737
25000 58% 10,500 11,550 12,128
4928 30% 3,450 3,795 3,927
62700 40% 37,620 41,382 42,830
165500 15% 140,675 154,743 158,611
750 0% 750 825 846
750 0% 750 825 846
10800 0% 10,800 11,880 12,177
10800 0% 10,800 11,880 12,177
250 2% 245 270 276
6200 0% 6,200 6,820 6,991
37812 0% 37,812 41,593 42,633
620 0% 620 682 699
7018 30% 4,913 5,404 5,593
38000 15% 32,300 35,530 36,418
8800 0% 8,800 9,680 9,922
5200 89% 572 629 661
690.98 77% 159 175 184
1250 5% 1,188 1,306 1,339
2495.455 0% 2,495 2,745 2,814
9509.5 0% 9,510 10,460 10,722
840 0% 840 924 947
2836.36 0% 2,836 3,120 3,198
12150 51% 5,954 6,549 6,876
25105 25% 18,829 20,712 21,437
68000 92% 5,440 5,984 6,283
7000 45% 3,850 4,235 4,447
2500 20% 2,000 2,200 2,255
42500 27% 31,025 34,128 35,322
3150 12% 2,772 3,049 3,125
70000 35% 45,500 50,050 51,802
6936.8 0% 6,937 7,630 7,821
3136.36667 0% 3,136 3,450 3,536
36200 21% 28,598 31,458 32,559
3264 0% 3,264 3,590 3,680
5000 0% 5,000 5,500 5,638
40000 5% 38,000 41,800 42,845
9330 0% 9,330 10,263 10,520
18000 5% 17,100 18,810 19,280
12825 0% 12,825 14,108 14,460
54325 5% 51,609 56,770 58,189
11500 25% 8,625 9,488 9,820
69300 5% 65,835 72,419 74,229
33000 5% 31,350 34,485 35,347
7455 10% 6,710 7,380 7,565
680 0% 680 748 767
1815 5% 1,724 1,897 1,944

21450 5% 20,378 22,415 22,976
12000 5% 11,400 12,540 12,854
2200 18% 1,804 1,984 2,034

52000 7% 48,360 53,196 54,526
19000 0% 19,000 20,900 21,423
913.6364 0% 914 1,005 1,030

980 0% 980 1,078 1,105
74500 20% 59,600 65,560 67,199
110 20% 88 97 99
14500 0% 14,500 15,950 16,349

2041.6 30% 1,429 1,572 1,627
7250 30% 5,075 5,583 5,778
198 25% 149 163 169
2800 0% 2,800 3,080 3,157
7200 37% 4,536 4,990 5,164
5037 0% 5,037 5,541 5,679
316800 30% 221,760 243,936 252,474
21818 67% 7,200 7,920 8,316
124300 15% 105,655 116,221 119,126
3875 0% 3,875 4,263 4,369
192 0% 192 211 216
1375 0% 1,375 1,513 1,550
547.68 0% 548 602 618
550 0% 550 605 620
0% - - -
0% - - -
60500 40% 36,300 39,930 41,328
770 15% 655 720 738
3666.66667 0% 3,667 4,033 4,134
72300 20% 57,840 63,624 65,215

PENGIRIM:
INSTALASI FARMASI RS BINA SEHAT
JL JAYANEGARA 7
JEMBER
KEPADA:
MELLY. APT (085749749013)
INSTALASI FARMASI RSIA REFA HUSADA
JL. MAYJEN SUNGKONO NO 9
TLOGOWARU KEDUNGKANDANG
MALANG
JANGAN DIBANTING/DITINDIH
BARANG PECAH BELAH
PENGIRIM:
INSTALASI FARMASI RS BINA SEHAT
JL JAYANEGARA 7
JEMBER
KEPADA:
MELLY. APT (085749749013)
INSTALASI FARMASI RSIA REFA HUSADA
JL. MAYJEN SUNGKONO NO 9
TLOGOWARU KEDUNGKANDANG
MALANG
JANGAN DIBANTING/DITINDIH
BARANG PECAH BELAH
Sanmag tab 40 tab 1,003 40,120
Notrixum inj 1 amp 64,041 64,041
Esola 3 amp 194,409 583,228
Candesartan 16 30 tab 990 29,707
Pyrazinamide 100 tab 379 37,884
Propanolol 40 60 tab 112 6,697
Ethambutol 100 tab 706 70,582
LMA 3 2 pcs 206,774 413,549
Suction cath 10 2 pcs 4,167 8,334
LMA 4 2 pcs 206,774 413,549
Suction cath 6 1 pcs 4,899 4,899
USG paper 2 roll 227,928 455,855
Widahes 9 Fls 68,200 613,800
T silk 1 3 Pcs 23,720 71,160
Piracetam 1 2 Amp 6,562 13,124
Proterin 5 amp 23,565 117,825
Folley cath 14 2 pcs 20,295 40,590
Folley cath 18 1 pcs 19,168 19,168
Folley cath 22 1 pcs 18,322 18,322
3,022,432

TT RH 2022

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TANDA TERIMA BARANG

RSIA REFA HUSADA

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 23 November 2021

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 23 November 2021

apt. Alfasea R., S. Farm

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 23 November 2021

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 13 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 13 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 13 Januari 2022

apt. Alfasea R., S. Farm

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 13 Januari 2022

apt. Alfasea R., S. Farm

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 17 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 20 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 20 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 20 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 20 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 20 Januari 2022

apt. Alfasea R., S. Farm

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 28 Januari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 28 Januari 2022 39,249,153

apt. Alfasea R., S. Farm

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 05 Februari 2022

apt. Alfasea R., S. Farm

TANDA TERIMA BARANG

NO NAMA BARANG JUMLAH SATUAN HARGA SATUAN TOTAL

Jember 05 Februari 2022