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SISA STOK 2021

LIST OBAT 2021 (PASTE DI SINI) STOK AWAL 2022


2 WAY FOLEY CATHETER NO.16 0 0
2 WAY FOLEY CATHETER NO.18 0 0
2 WAY FOLEY CATHETER NO.20 0 0
ACETYLCYSTEINE CAPSULE 200 MG 0 0
ALABETIK TABLET 0 0
ALAT SUNTIK SEKALI PAKAI 1 ML 0 0
ALAT SUNTIK SEKALI PAKAI 10 ML 0 0
ALAT SUNTIK SEKALI PAKAI 20 ML 0 0
ALAT SUNTIK SEKALI PAKAI 3 ML 0 0
ALAT SUNTIK SEKALI PAKAI 5 ML 0
ALLOPURINOL TABLET 100 MG 0 0
ALPRAZOLAM 1 MG TABLET 0 0
AMBROXOL SIRUP 5MG/ML 0 0
AMBROXOL TABLET 30 MG 0 0
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML 0 0
AMINOPHYLLINE TABLET 200 MG 0 0
AMITRIPTYLLINE HCL TABLET 25 MG 0 0
AMLODIPINE TABLET 10 MG 0 0
AMLODIPINE TABLET 5 MG 0 0
AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML 0 0
AMOKSISILIN TABLET 500 MG 0 0
AMOKSISILIN SERBUK INJEKSI 0 0
AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL 0
ANTALGIN 500 MG TABLET (METAMIZOL) 0 0
ANTASIDA DOEN TABLET KOMBINASI 0 0
ANTASIDA SUSPENSI 60 ML 0 0
ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR 0 0
ANTI FUNGI DOEN SALEP KOMBINASI 30 GR 0 0
ANTI HAEMOROID DOEN KOMBINASI 0 0
ANTI INFLUENZA (EMFLU) KOMBINASI TAB 0 0
ANTI INFLUENZA (SOLAFLUZ) KOMBINASI SYRUP 0 0
ANTI MIGRAIN DOEN TABLET KOMBINASI 0 0
ANTI SPASMODIK INJEKSI (SPASHI) 0 0
ANTI SPASMODIK TABLET (DORMICOMP) 0 0
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML 0 0
ASAM ASKORBAT ( VIT C ) TABLET 250 MG 0 0
ASAM ASKORBAT ( VIT C ) TABLET 50 MG 0 0
ASAM FOLAT 1MG TABLET 0 0
ASAM MEFENAMAT TABLET 500 MG 0 0
ASAM TRANEKSAMAT 100 MG/ML INJEKSI 0 0
ASAM TRANEKSAMAT 500 MG TABLET 0 0
ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER 0 0
ASEPTAN 500CC + PUMP 0 0
ASEPTIC GEL 500CC + DISPENSER 0 0
ASERING (ASETAT RINGER) SOFT BAG 0 0
ASETOSAL TABLET 100 (80) MG 0 0
ASIKLOVIR KREAM 5 % 5 GR 0 0
ASIKLOVIR TABLET 400 MG 0 0
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML 0 0
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET 0
BETAHISTINMESILAT 6 MG TABLET 0 0
BETAMETHASONE CREAM 0,1 % 5 GR 0
BISAKODIL ( BICOLAX ) TABLET 5 MG 0 0
BISAKODIL SUPPOSITORIA 10 MG 0
BISAKODIL SUPPOSITORIA 5 MG 0 0
BISOPROLOL 2,5 MG TABLET (CONCOR) 0 0
BISOPROLOL 5 MG TABLET 0 0
BROMHEXINE SIRUP (HUSTAB) 0 0
CAT GUT NO.2/0 CHROMIC 0 0
CAT GUT NO.2/0-3/0 PLAIN 0 0
CITICHOLIN 250 MG/ML-2ML INJEKSI 0 0
COMBIVENT UDV INHALASI 0
DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML 0
DEKSAMETHASONE TABLET 0,5 MG 0 0
DEVITALISASI PASTA ( NON ARSEN ) 0 0
DIAZEPAM INJEKSI 5 MG/ML 2 ML 0 0
DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID 0 0
DIAZEPAM TABLET 2 MG 0 0
DIAZEPAM TABLET 5 MG 0 0
DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML 0 0
DIGOXIN TABLET 0,25 MG 0 0
DIMENHYDRINATE TABLET 50 MG 0 0
DOKSISIKLIN TABLET 100 MG 0 0
DOMPERIDON SUSPENSI 5MG/ML 0 0
DOMPERIDON TABLET 10 MG 0 0
EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR 0 0
EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML 0 0
ERITROMISIN KAPSUL 250 MG 0 0
ERITROMISIN SIRUP KERING 200 MG/5ML 0 0
ERITROMISIN TABLET 500 MG 0 0
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 ML 0 0
ETANOL [ ALKOHOL ] 70 % 1000 ML 0 0
ETIL KLORIDA SEMPROT 100 ML 0 0
EUGENOL CAIRAN 10 ML 0 0
FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML 0 0
FENITOIN NATRIUM TABLET 100 MG 0 0
FENOBARBITAL INJEKSI 50 MG/ML 2 ML 0 0
FENOBARBITAL TABLET 30 MG 0 0
FENOL GLISEROL TETES TELINGA 10 % 5 ML 0 0
FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1 ML 0 0
FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG 0 0
FITOMENADION INFANT INJ. 2MG/ML 0 0
FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML 0 0
FUROSEMID INJEKSI 0 0
FUROSEMID TABLET 40 MG 0 0
GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR 0 0
GEMFIBROZIL 300 MG KAPSUL 0 0
GENTAMISIN SALEP KULIT 0,1 % 5 GR 0 0
GENTAMISIN SALEP MATA 0,3% 0
GENTAMISIN TETES MATA 0,3% 0 0
GLASS IONOMER CEMENT ( GC IX ) 0 0
GLIBENCLAMIDE TABLET 5 MG 0 0
GLICERIL GUAIACOLAT TABLET 100 MG 0 0
GLIMEPIRIDE 2 MG TABLET 0 0
GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI 0 0
GLUKOSA LARUTAN INFUS 10 % STERIL 0 0
GLUKOSA LARUTAN INFUS 5 % STERIL 0
GRISEOFULVIN TABLET 125 MG 0 0
HALOPERIDOL DEKANOAT INJ 50 MG 0 0
HALOPERIDOL INJ. 5 MG/ML (LODOMER) 0 0
HALOPERIDOL TABLET 1,5 MG 0 0
HALOPERIDOL 2 MG 0 0
HALOPERIDOL TABLET 5 MG 0 0
HEPARIN SODIUM 200 UI (THROMBOFLASH) 0 0
HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML 0 0
HIDROCORTISONE CREAM 2,5 % 5 GR 0 0
I.V CATHETER NO.16 WITH INJECTION PORT 0 0
I.V CATHETER NO.18 WITH INJECTION PORT 0
I.V CATHETER NO.20 WITH INJECTION PORT 0 0
I.V CATHETER NO.22 WITH INJECTION PORT 0
I.V CATHETER NO.24 WITH INJECTION PORT 0 0
I.V CATHETER NO.26 WITH INJECTION PORT 0
IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML 0 0
IBUPROFEN TABLET 400 MG 0 0
INFUSION SET ANAK 0 0
INFUSION SET DEWASA 0 0
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG 0 0
KAEN 3B 0 0
KALIUM DIKLOFENAK 50 MG TABLET 0
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML 0 0
KALSIUM LAKTAT (KALK) TABLET 500 MG 0 0
KANTONG URINE DEWASA 0 0
KAOLIN PEKTIN (NOVADIAR) SUSPENSI 0 0
KAPAS PEMBALUT/ABSORBEN 250 GR 0 0
KAPTOPRIL TABLET 25 MG 0 0
KARBAMAZEPIN TABLET 200 MG 0 0
KARBAZOKHROME SODIUM SULFONATE INJEKSI 5 MG/ML 10 ML (SALDONA) 0 0
KASA KOMPRES 40/40 STERIL 0 0
KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL 0 0
KASA PEMBALUT HIDROFIL 2 M X 80 CM 0 0
KASA PEMBALUT HIDROFIL 4 M X 10 CM 0 0
KASA PEMBALUT HIDROFIL 4 M X 5 CM 0 0
KASA STERIL (DARYAN TOLLE)YG DIRESAPI FRAMISETIN 0 0
KETOKONAZOLE TABLET 200 MG 0 0
KETOPROFEN 100 MG SUPPOSITORIA 0 0
KLINDAMISIN KAPSUL 150 MG 0 0
KLINDAMISIN KAPSUL 300 MG 0 0
KLOBAZAM 10 MG TABLET 0 0
KLORAMFENIKOL KAPSUL 500 MG 0 0
KLORAMFENIKOL SALEP KULIT 2 % 0 0
KLORAMFENIKOL SALEP MATA 1 % 0 0
KLORAMFENIKOL SUSPENSI 125 MG/5 ML 0 0
KLORAMFENIKOL TETES TELINGA 3 % 0 0
KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG 0 0
KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML 0 0
KLORPROMAZIN HCL TABLET 100 MG 0 0
KLOZAPIN 100 MG TABLET 0 0
KLOZAPIN 25 MG TABLET 0 0
KODEIN HCL TABLET 10 MG 0 0
KOTRIMOKSAZOL DEWASA TABLET 0 0
KOTRIMOKSAZOL SUSPENSI 60 ML 0
LEVOFLOXACIN TABLET 500 MG 0 0
LIDOCAIN 2% INJ 0 0
LIDOCAIN COMPOSITUM INJEKSI 2 ML 0 0
LISOL CONCENTRATE 1000 ML 0 0
LOPERAMIDE TABLET 2 MG 0 0
LORATADIN TABLET 10 MG 0 0
MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML 0 0
MASKER KERTAS 3 PLY EAR LOOP 0 0
MASKER KERTAS 3 PLY TIE ON 0 0
MELOKSIKAM TABLET 7,5 MG 0 0
METAMIZOL (NORAGES) INJEKSI 500 MG/2ML 0 0
METFORMIN TABLET 500 MG 0 0
METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML 0
METILERGOMETRIN MALEAT TABLET 0,125 MG 0 0
METILPREDNISOLON TABLET 4 MG 0
METOKLOPRAMIDE 10 MG TABLET 0 0
METOKLOPRAMIDE 5 MG TABLET 0 0
METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2 ML 0
METOKLOPROMIDE SIRUP 0 0
METRONIDAZOL + NYSTATIN VAG. (PROVAGIN) INJEKSI 0 0
METRONIDAZOL TABLET 250 MG 0 0
METRONIDAZOL TABLET 500 MG 0 0
METRONIDAZOLE INFUS 5 MG/ML 100 ML 0 0
MIKONAZOL KREAM 10 GR 0 0
MINERAL MIX 0 0
MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML 0 0
MULTIVITAMIN (MALTIRON PLUS) KOMBINASI TABLET 0 0
NATRIUM DIKLOFENAK TABLET 25 MG 0 0
NATRIUM DIKLOFENAK TABLET 50 MG 0 0
NATRIUM KLORIDA INFUS 0,9 % STERIL 0 0
NEUROTROPIK (IKANEURON) INJEKSI 0 0
NEUROTROPIK KOMBINASI (IKANEURON) TABLET 0 0
NIFEDIPINE TABLET 10 MG 0 0
NISTATIN TABLET 500.000 UI 0 0
NISTATIN VAGINAL TABLET 100.000 UI 0 0
NOREPINEPHRINE CAIRAN INJEKSI 0 0
OBAT BATUK HITAM (OBH) CAIRAN 100 ML 0 0
OKSIGEN NASAL CANNULA ADULT 0 0
OKSIGEN NASAL CANNULA INFANT 0 0
OKSITETRACYCLIN SALEP KULIT 3 % 5 GR 0 0
OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR 0 0
OKSITOSIN INJEKSI 10 IU/ML 1 ML 0 0
OMEPRAZOLE TABLET 20 MG 0 0
ONDANSENTRON 4 MG/2 ML INJEKSI 0 0
PARACETAMOL SYRUP 120 MG/5 ML 60 ML 0 0
PARACETAMOL TABLET 500 MG 0 0
PARACETAMOL TETES 100 MG/ML 15 ML 0 0
PEHAVRAL TABLET 0 0
PERAK SULFADIAZIN KRIM 1 % 0 0
PERHYDROL [ H2O2 ] 3 % 800 ML 0 0
PIRACETAM TABLET 800 MG 0 0
PIRANTEL PAMOAT TABLET 0 0
PIRIDOKSIN HCL (VIT B6) TABLET 10 MG 0 0
PIROKSIKAM KAPSUL 10 MG 0 0
PLESTER 5 YARD X 2 INCI (LEUKOPLAST) 0
PREDNISON TABLET 5 MG 0 0
PROPANOLOL HCL TABLET 40 MG 0 0
PROPILTHIOURACIL TABLET 100 MG 0 0
RANITIDIN INJEKSI 25 MG/ ML 0 0
RESPERIDON 2 MG TABLET 0 0
RINGER LAKTATE LARUTAN INFUS STERIL 0 0
SALBUTAMOL TABLET 2 MG 0 0
SALBUTAMOL TABLET 4 MG 0 0
SALEP 2-4 KOMBINASI 30 GR 0 0
SALICYL BEDAK 2 % 0 0
SARUNG TANGAM NON STERIL L 0 0
SARUNG TANGAN NON STERIL M 0 0
SARUNG TANGAN NON STERIL S 0 0
SARUNG TANGAN STERIL NO 6 0 0
SARUNG TANGAN STERIL NO. 7,5 0 0
SARUNG TANGAN STERILE NO.6,5 0 0
SARUNG TANGAN STERILE NO.7 0 0
SEFADROKSIL KAPSUL 500 MG 0 0
SEFIKSIM KAPSUL 100 MG 0 0
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) 0 0
SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) 0 0
SETIRIZINE TABLET 10 MG 0 0
SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1 ML 0 0
SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG 0 0
SILK (BENANG BEDAH SUTERA) NO.3/0 0 0
SIMETIDINE TABLET 200 MG 0 0
SIMVASTATIN TABLET 10 MG 0 0
SIPROFLOXACIN INFUS 2% 0 0
SIPROFLOXACIN TABLET 500 MG 0 0
SIPROHEPTADINE 4 MG TABLET (PRONICY) 0 0
SPONS GELATIN CUBICLES 1x1x1 CM 0 0
SULFADOKSIN TABLET 0 0
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML 0 0
STIMUNO TAB (100) 0 0
STIMUNO TAB (30) 0 0
STIMUNO SYR 0 0
TABLET TAMBAH DARAH (DAK) 0 0
TEMPORARY CAVITY SEALER [TUMPATAN SEMENTARA] (CAVIT G) 0 0
TETRAKAIN HCL TETES MATA 5 ML 0 0
TETRASIKLIN HCL TABLET 500 MG 0 0
THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML 0 0
THIAMIN HCL MONONITRAT (VIT B1) TABLET 100 MG 0 0
THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG 0
TRAMADOL INJEKSI 50 MG/ML 0 0
TRANFUSION SET ADULT WITH Y INJECTION 0 0
TRIAMSINOLON ACETONIDE (BUFACOMB) 1MG/GR SALEP 0 0
TRIFLOUPERASIN TABLET 5 MG 0 0
TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG 0 0
VITAMIN B COMPLEX TABLET 0 0
YODIUM POVIDON LARUTAN 10 % 30 ML 0 0
YODIUM POVIDON LARUTAN 10% 60 ML 0 0
ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) 0 0
ZINK 20 MG TABLET 0 0
ZINK SYRUP 0 0
0
0
0

LIST OBAT PROGAM 2021 SISA STOK 2021 STOK AWAL 2022
(PASTE DI SINI)

ALAT SUNTIK 0,05 ML (PROGRAM) 0


ALAT SUNTIK 0,5 ML (PROGRAM) 0
ALAT SUNTIK 5 ML (PROGRAM) 0
ALBENDAZOL TABLET 400 MG 0
AMPICILLIN SERBUK INJEKSI 1 G (KESGA) 0
CA GLUCONAS INJEKSI 10 Ml (KESGA) 0
DIAZEPAM CAIRAN INJEKSI 5 MG\/2ML (KESGA) 0
FITOMENADION INJECTION 2 MG\/ ML (KESGA) 0 0
GARAM ORALIT UNTUK 200 ML AIR 0 0
GENTAMICIN CAIRAN INJEKSI 40 MG/ML (KESGA) 0 0
IODINE TES 0 0
ISONIAZID TABLET 100 MG 0
ISONIAZID TABLET 300 MG 0 0
KOMBIPAK AZITHROMYCIN - CEFIXIME KOMBINASI 0
KOTRIMOKSASOL 480 TABLET KOMBINASI 0 0
KOTRIMOKSASOL 960 TABLET KOMBINASI 0
LEVOTHYROXINE ACTAVIS TABLET 100 MCG (KESGA) 0
LODOMER CAIRAN INJEKSI 5 MG/ML (HALOPERIDOL) 0
MDT COMBI - MB ADULT (RED) 0 0
MDT COMBI - MB CHILD (ORANGE) 0 0
MDT COMBI - PB ADULT (GREEN) 0 0
METILERGOMETRIN MALEAT INJECTION 0,200 MG (KESGA) 0 0
OBAT ANTI TUBERKULOSIS ANAK 0 0
OBAT ANTI TUBERKULOSIS KATAGORI 1 0 0
OBAT ANTI TUBERKULOSIS KATAGORI 2 0 0
OBAT ANTI TUBERKULOSIS KOMBIPAK KATEGORI I 0 0
OBAT HIV EFAVIRENZ 200 MG TABLET 0 0
OBAT HIV EFAVIRENZ 600 MG TABLET 0
OBAT HIV LAMIVUDIN 150 MG TABLET 0 0
OBAT HIV NEVIRAPINE (NVP) 200 MG TABLET 0 0
OBAT HIV TENOFOVIR 300 MG (TDF) 0 0
OBAT HIV TRIPLE FDC ANAK ZDV+3TC+NVP (60+30+50) 0 0
OBAT HIV TRIPLE FDC DEWASA TDC+3TC+EFV (300/300/600) 0 0
OBAT HIV ZIDOVUDINE 100 MG TABLET 0 0
OBAT HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG 0 0
OKSITETRASIKLIN SALEP MATA 1% (KESGA) 0 0
PIRIDOKSIN 25 MG TABLET (VIT B6) 0
REAGEN HIV (FOKUS) 0 0
REAGEN HIV (STANDART DIAGNOSTIC/SD) 0 0
REAGEN HIV (VIKIA) 0 0
REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP RAPID TEST 0
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2) ANTIBODY (COLLOIDAL GOLD) 0 0
REAGEN SYPHILIS (TREPOCHECK) 0
REAGEN SYPHILIS RDT (FOKUS) 0 0
RETINOL ( VIT A ) KAPSUL 100.000 IU 0 0
RETINOL ( VIT A ) KAPSUL 200.000 IU 0 0
SAFETY BOX 0 0
SERUM ANTI DIFTERI CAIRAN INJEKSI 125 MG/ML 0 0
TABLET TAMBAH DARAH (PROGRAM) 0 0
ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) 0 0
0
0
0
0
0
0
LIST OBAT 2022
2 WAY FOLEY CATHETER NO.16
2 WAY FOLEY CATHETER NO.18
2 WAY FOLEY CATHETER NO.20
ACETYLCYSTEINE CAPSULE 200 MG
ALAT SUNTIK SEKALI PAKAI 1 ML
ALAT SUNTIK SEKALI PAKAI 10 ML
ALAT SUNTIK SEKALI PAKAI 20 ML
ALAT SUNTIK SEKALI PAKAI 3 ML
ALAT SUNTIK SEKALI PAKAI 5 ML
ALKOHOL SWAB
ALLOPURINOL TABLET 100 MG
ALPRAZOLAM 1 MG TABLET
AMBROXOL SIRUP 5MG/ML
AMBROXOL TABLET 30 MG
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML
AMINOPHYLLINE TABLET 200 MG
AMITRIPTYLLINE HCL TABLET 25 MG
AMLODIPINE TABLET 10 MG
AMLODIPINE TABLET 5 MG
AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML
AMOKSISILIN SERBUK INJEKSI 1000 MG
AMOKSISILIN TABLET 500 MG
AMOXCICILIN FORTE SYRUP KERING 250MG/5ML
AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL
ANTALGIN 500 MG TABLET (METAMIZOL)
ANTASIDA DOEN TABLET KOMBINASI
ANTASIDA SUSPENSI 60 ML
ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR
ANTI FUNGI DOEN SALEP KOMBINASI 30 GR
ANTI HAEMOROID DOEN KOMBINASI
ANTI MIGRAIN DOEN TABLET KOMBINASI
ANTI SPASMODIK INJEKSI (SPASHI)
ANTI SPASMODIK TABLET (DORMICOMP)
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML
ASAM ASKORBAT ( VIT C ) TABLET 250 MG
ASAM ASKORBAT ( VIT C ) TABLET 50 MG
ASAM FOLAT 1MG TABLET
ASAM MEFENAMAT TABLET 500 MG
ASAM TRANEKSAMAT 100 MG/ML INJEKSI
ASAM TRANEKSAMAT 500 MG TABLET
ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER
ASEPTAN 500CC + PUMP
ASEPTIC GEL 500CC + DISPENSER
ASERING (ASETAT RINGER) SOFT BAG
ASETOSAL TABLET 100 (80) MG
ASIKLOVIR KREAM 5 % 5 GR
ASIKLOVIR TABLET 400 MG
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML
ATTAPULGIT + PECTIN TABLET
BETAHISTINE MESILAT 24 MG TABLET
BETAHISTINMESILAT 6 MG TABLET
BETAMETHASON CR 0.05% 20 GR
BETAMETHASONE CREAM 0,1 % 5 GR
BIONICOM ZINC TABLET
BISAKODIL SUPPOSITORIA 10 MG
BISAKODIL SUPPOSITORIA 5 MG
BISOPROLOL 2,5 MG TABLET (CONCOR)
BISOPROLOL 5 MG TABLET
CAT GUT NO. 3/0 CHROMIC
CAT GUT NO. 3/0 PLAIN
CITICHOLIN 250 MG/ML-2ML INJEKSI
CLONIDINE 0.15 MG TABLET
CLOPIDOGREL 75 MG
COMBIVENT UDV INHALASI
DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML
DEKSAMETHASONE TABLET 0,5 MG
DEVITALISASI PASTA ( NON ARSEN )
DIAZEPAM INJEKSI 5 MG/ML 2 ML
DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID
DIAZEPAM TABLET 2 MG
DIAZEPAM TABLET 5 MG
DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML
DIGOXIN TABLET 0,25 MG
DIMENHYDRINATE TABLET 50 MG
DOKSISIKLIN TABLET 100 MG
DOMPERIDON SUSPENSI 5MG/ML
DOMPERIDON TABLET 10 MG
EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR
EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML
ERITROMISIN KAPSUL 250 MG
ERITROMISIN SIRUP KERING 200 MG/5ML
ERITROMISIN TABLET 500 MG
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 ML
ETANOL [ ALKOHOL ] 70 % 1000 ML
ETIL KLORIDA SEMPROT 100 ML
EUGENOL CAIRAN 10 ML
FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML
FENITOIN NATRIUM TABLET 100 MG
FENOBARBITAL INJEKSI 50 MG/ML 2 ML
FENOBARBITAL TABLET 30 MG
FENOL GLISEROL TETES TELINGA 10 % 5 ML
FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1 ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG
FITOMENADION INFANT INJ. 2MG/ML
FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML
FUROSEMID INJEKSI 10 mg
FUROSEMID TABLET 40 MG
GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR
GARAM ORALIT
GEMFIBROZIL 300 MG KAPSUL
GENTAMISIN SALEP KULIT 0,1 % 5 GR
GENTAMISIN SALEP MATA 0,3%
GENTAMISIN TETES MATA 0,3%
GLASS IONOMER CEMENT ( GC IX )
GLIBENCLAMIDE TABLET 5 MG
GLICERIL GUAIACOLAT TABLET 100 MG
GLIMEPIRIDE 1 MG TABLET
GLIMEPIRIDE 2 MG TABLET
GLUKOSA 40% DEXTROSE INJECTION U.S.P CAIRAN INJEKSI
GLUKOSA LARUTAN INFUS 10 % STERIL
GLUKOSA LARUTAN INFUS 5 % STERIL
GRISEOFULVIN TABLET 125 MG
HALOPERIDOL 2 MG
HALOPERIDOL DEKANOAT INJ 50 MG
HALOPERIDOL INJ. 5 MG/ML (LODOMER)
HALOPERIDOL TABLET 1,5 MG
HALOPERIDOL TABLET 5 MG
HERBAKOF SYRUP 60ML
HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML
HIDROCORTISON CR 1%
HIDROCORTISONE CREAM 2,5 % 5 GR
HYDROCHLORTHIAZIDE 25 MG
I.V CATHETER NO.16 WITH INJECTION PORT
I.V CATHETER NO.18 WITH INJECTION PORT
I.V CATHETER NO.20 WITH INJECTION PORT
I.V CATHETER NO.22 WITH INJECTION PORT
I.V CATHETER NO.24 WITH INJECTION PORT
I.V CATHETER NO.26 WITH INJECTION PORT
IBUPROFEN FORTE SYRUP 200MG/5ML
IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML
IBUPROFEN TABLET 400 MG
INFUSION SET ANAK
INFUSION SET DEWASA
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG
KAEN 3B
KALIUM DIKLOFENAK 50 MG TABLET
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML
KALSIUM LAKTAT (KALK) TABLET 500 MG
KANTONG URINE DEWASA
KAPAS PEMBALUT/ABSORBEN 250 GR
KAPTOPRIL TABLET 25 MG
KARBAMAZEPIN TABLET 200 MG
KASA KOMPRES 40/40 STERIL
KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL
KASA PEMBALUT HIDROFIL 2 M X 80 CM
KASA PEMBALUT HIDROFIL 4 M X 10 CM
KASA PEMBALUT HIDROFIL 4 M X 5 CM
KASA STERIL (DARYAN TOLLE)YG DIRESAPI FRAMISETIN
KETOKONAZOLE TABLET 200 MG
KETOPROFEN 100 MG SUPPOSITORIA
KLINDAMISIN KAPSUL 150 MG
KLINDAMISIN KAPSUL 300 MG
KLOBAZAM 10 MG TABLET
KLORAMFENIKOL KAPSUL 500 MG
KLORAMFENIKOL SALEP KULIT 2 %
KLORAMFENIKOL SALEP MATA 1 %
KLORAMFENIKOL SUSPENSI 125 MG/5 ML
KLORAMFENIKOL TETES TELINGA 3 %
KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG
KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML
KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML
KLORPROMAZIN HCL TABLET 100 MG
KLOZAPIN 100 MG TABLET
KLOZAPIN 25 MG TABLET
KODEIN HCL TABLET 10 MG
KOTRIMOKSAZOL DEWASA TABLET
KOTRIMOKSAZOL SUSPENSI 60 ML
LEVOFLOXACIN TABLET 500 MG
LIDOCAIN 2% INJ
LIDOCAIN COMPOSITUM INJEKSI 2 ML
LISOL CONCENTRATE 1000 ML
LOPERAMIDE TABLET 2 MG
LORATADIN TABLET 10 MG
LORAZEPAM 2 MG
MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML
MASKER EARLOOP PLUS
MASKER KERTAS 3 PLY EAR LOOP
MASKER KERTAS 3 PLY TIE ON
MASKER N95
MELOKSIKAM TABLET 7,5 MG
METAMIZOL (NORAGES) INJEKSI 500 MG/2ML
METFORMIN TABLET 500 MG
METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML
METILERGOMETRIN MALEAT TABLET 0,125 MG
METILPREDNISOLON TABLET 4 MG
METOKLOPRAMIDE 10 MG TABLET
METOKLOPRAMIDE 5 MG TABLET
METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2 ML
METOKLOPROMIDE SIRUP
METRONIDAZOL + NYSTATIN VAG. (PROVAGIN) INJEKSI
METRONIDAZOL TABLET 250 MG
METRONIDAZOL TABLET 500 MG
METRONIDAZOLE INFUS 5 MG/ML 100 ML
MIKONAZOL KREAM 10 GR
MINERAL MIX
NATRIUM DIKLOFENAK TABLET 25 MG
NATRIUM DIKLOFENAK TABLET 50 MG
NATRIUM KLORIDA INFUS 0,9 % STERIL
NIFEDIPINE TABLET 10 MG
NISTATIN TABLET 500.000 UI
NISTATIN VAGINAL TABLET 100.000 UI
OBAT BATUK HITAM (OBH) CAIRAN 100 ML
OKSIGEN NASAL CANNULA ADULT
OKSIGEN NASAL CANNULA INFANT
OKSITETRACYCLIN SALEP KULIT 3 % 5 GR
OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR
OKSITOSIN INJEKSI 10 IU/ML 1 ML
OMEPRAZOLE TABLET 20 MG
ONDANSENTRON 4 MG/2 ML INJEKSI
PARACETAMOL SYRUP 120 MG/5 ML 60 ML
PARACETAMOL TABLET 500 MG
PARACETAMOL TETES 100 MG/ML 15 ML
PEHAVRAL TABLET
PERAK SULFADIAZIN KRIM 1 %
PERHYDROL [ H2O2 ] 3 % 800 ML
PERMETHRINE 5% CR 15 GRAM
PIRACETAM TABLET 800 MG
PIRANTEL PAMOAT TABLET
PIRIDOKSIN HCL (VIT B6) TABLET 10 MG
PIROKSIKAM KAPSUL 10 MG
PLESTER 10 CM X 2 M
PREDNISON TABLET 5 MG
PROPRANOLOL HCL TABLET 40 MG
PROPILTHIOURACIL TABLET 100 MG
RANITIDIN INJEKSI 25 MG/ ML
RESPERIDON 2 MG TABLET
RINGER LAKTATE LARUTAN INFUS STERIL
SALBUTAMOL TABLET 2 MG
SALBUTAMOL TABLET 4 MG
SALEP 2-4 KOMBINASI 30 GR
SALICYL BEDAK 2 %
SARUNG TANGAM NON STERIL L
SARUNG TANGAN NON STERIL M
SARUNG TANGAN NON STERIL S
SARUNG TANGAN STERIL NO 6
SARUNG TANGAN STERIL NO. 7,5
SARUNG TANGAN STERILE NO.6,5
SARUNG TANGAN STERILE NO.7
SEFADROKSIL KAPSUL 500 MG
SEFIKSIM KAPSUL 100 MG
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I)
SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS)
SETIRIZINE TABLET 10 MG
SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1 ML
SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG
SILK (BENANG BEDAH SUTERA) NO.3/0
SIMETIDINE TABLET 200 MG
SIMVASTATIN TABLET 10 MG
SIPROFLOXACIN INFUS 2%
SIPROFLOXACIN TABLET 500 MG
SPONS GELATIN CUBICLES 1x1x1 CM
STIMUNO SYR
STIMUNO TAB (100)
STIMUNO TAB (30)
SULFADOKSIN TABLET
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML
TABLET TAMBAH DARAH (DAK)
TEMPORARY CAVITY SEALER [TUMPATAN SEMENTARA] (CAVIT G)
TETAGRAM 150 IU
TETRAKAIN HCL TETES MATA 5 ML
TETRASIKLIN HCL TABLET 500 MG
THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML
THIAMIN HCL MONONITRAT (VIT B1) TABLET 100 MG
THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG
TRAMADOL INJEKSI 50 MG/ML
TRANFUSION SET ADULT WITH Y INJECTION
TRIFLOUPERASIN TABLET 5 MG
TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG
VITAMIN B COMPLEX TABLET
YODIUM POVIDON LARUTAN 10 % 30 ML
YODIUM POVIDON LARUTAN 10% 60 ML
ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE)
ZINK 20 MG TABLET

LIST OBAT PROGRAM 2022

AMITRIPTYLINE 25 MG
HALOPERIDOLE INJEKSI
HALOPERIDOLE 1,5 MG
HALOPERIDOLE 5 MG
LODOMER 2 MG
LODOMER 5 MG
TRIHEXYPHENIDYL 2 MG
ALAT SUNTIK 0,05 ML (PROGRAM)
ALAT SUNTIK 0,5 ML (PROGRAM)
ALAT SUNTIK 5 ML (PROGRAM)
ALBENDAZOL TABLET 400 MG
BENZATINE BENZYLPENICILLIN 2.400.000 IU
COTRIMOXAZOLE 800/160
DIETHYLCARBAMAZINE 100 MG
GARAM ORALIT UNTUK 200 ML AIR
HIV ABACAVIR TABLET 300 MG
HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50)
HIV DOLUTEGRAFIR 50 MG
HIV EFAFIRENZ 200 MG TABLET
HIV EFAFIRENZ 600 MG TABLET
HIV LAMIVUDIN 150 MG TABLET
HIV NEVIRAPINE 200 MG TABLET
HIV TENOFOVIR 300 MG
HIV TRIPLE FDC ANAK (ZIDOVUDIN 60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV (300/300/600))
HIV ZIDOVUDINE 100 MG @60 KAPSUL
HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG
HIV ZIDOVUDINE SYRUP 240 ML
IODINE TES
ISONIAZID TABLET 100 MG
ISONIAZID TABLET 300 MG
KOMBIPAK AZITHROMYCIN - CEFIXIME KOMBINASI
MDT COMBI - MB ADULT (RED)
MDT COMBI - MB CHILD (ORANGE)
MDT COMBI - PB ADULT (GREEN)
OBAT ANTI TUBERKULOSIS ANAK
OBAT ANTI TUBERKULOSIS DOSIS HARIAN STOP TB KIT
OBAT ANTI TUBERKULOSIS KATEGORI 1
OBAT ANTI TUBERKULOSIS KATEGORI 2
OBAT ANTI TUBERKULOSIS KOMBIPAK KATEGORI I
PARACETAMOL 500 MG (P2)
PIRIDOKSIN 25 MG TABLET (VIT B6)
PYRIMETAMINE
REAGEN HIV (FOKUS)
REAGEN HIV (STANDART DIAGNOSTIC/SD)
REAGEN HIV (VIKIA)
REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2) ANTIBODY (COLLOIDAL GOLD) V2 PAKET
REAGEN SYPHILIS (TREPOCHECK)
REAGEN SYPHILIS RDT (FOKUS)
RETINOL ( VIT A ) KAPSUL 100.000 IU
RETINOL ( VIT A ) KAPSUL 200.000 IU
SAFETY BOX
SERUM ANTI DIFTERI CAIRAN INJEKSI 125 MG/ML
TABLET TAMBAH DARAH (PROGRAM)
ZINK TABLET DISPERSIBLE 20 MG (PROGRAM)
SD BIOLINE Syphilis 3.0 One Step Syphilis Antibody Test
KEPALA PUSKESMAS :
PENGELOLA OBAT WILAYAH :
ENDAH ROSITANINGSIH, SE, MM NIP :
APRILLIA YUDHA A.S. NIP :
196912302010012002
199104082015022002
LPLPO Sumberingin Jan22

DINAS KESEHATAN KABUPATEN BLITAR


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BUL : JANUARI
PUSKESMAS : SANANKULON PERMINTAAN BU : FEBRUARI
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH OBAT


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0

10 ALKOHOL SWAB PCS 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL 0 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0

34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 BOTOL 0


ML 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0

Page 16 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0

41 ASAM VALPROAT 250 MG TABLET / DEPAKOTE TABLET 0


ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0

54 BIONICOM ZINC TABLET TABLET 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 STESOLID TUBE 0 0

70 DIAZEPAM TABLET 2 MG TABLET 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE 0 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0

Page 17 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 ML BOTOL 0 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 ML AMPUL 0 0

93 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET 0 0

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL 0 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 0

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 TUBE 0


GR 0

99 GARAM ORALIT SACHET 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0

113 HALOPERIDOL 2 MG TABLET 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0

Page 18 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0

132 INFUSION SET ANAK PCS 0 0

133 INFUSION SET DEWASA PCS 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0

135 KAEN 3B BOTOL 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL 0 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0

139 KANTONG URINE DEWASA PCS 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0

148 KASA STERIL (DARYAN TOLLE)YG DIRESAPI PCS 0


FRAMISETIN 0

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0

165 KODEIN HCL TABLET 10 MG TABLET 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0

Page 19 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

169 LIDOCAIN 2% INJ AMPUL 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0

174 LORAZEPAM 2 MG TABLET 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0

176 MASKER EARLOOP PLUS PCS 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0

179 MASKER N95 PCS 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 MG AMPUL 0


1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET 0 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0

188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 AMPUL 0


MG/ML 2 ML 0

189 METOKLOPROMIDE SIRUP BOTOL 0 0

190 METRONIDAZOL + NYSTATIN VAG. (PROVAGIN) VIAL 0


INJEKSI 0

191 METRONIDAZOL TABLET 250 MG TABLET 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0

195 MINERAL MIX SACHET 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0

Page 20 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0

213 PEHAVRAL TABLET TABLET 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0

221 PLESTER 10 CM X 2 M ROL 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0

SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML


241 (ABU I) VIAL 0 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500


244 MCG/ML 1 ML AMPUL 0 0

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0

252 STIMUNO SYR BOTOL 0 0

253 STIMUNO TAB (100) TABLET 0 0

254 STIMUNO TAB (30) BOTOL 0 0

Page 21 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

255 SULFADOKSIN TABLET TABLET 0 0

256 SULFASETAMID NATRIUM TETES MATA 15 % 5 BOTOL 0


ML 0

257 TABLET TAMBAH DARAH TABLET 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET 100 TABLET 0


MG 0

THIAMIN HCL MONONITRAT (VIT B1) TABLET 50


264 MG TABLET 0 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET 0 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0

273 ZINK 20 MG TABLET TABLET 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0

5 LODOMER 2 MG TABLET 0 0

6 LODOMER 5 MG TABLET 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0

Page 22 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

23 HIV TENOFOVIR 300 MG BOTOL 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0

29 IODINE TES PCS 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN STOP PAKET 0 0


TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0

40 OBAT ANTI TUBERKULOSIS KOMBIPAK PAKET 0 0


KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0

43 PYRIMETAMINE TABLET 0 0

44 REAGEN HIV (FOKUS) PCS 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0

46 REAGEN HIV (VIKIA) PCS 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 RAPID TEST PCS 0 0
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0

53 SAFETY BOX PCS 0 0

SERUM ANTI DIFTERI CAIRAN INJEKSI 125


54 VIAL 0 0
MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0

59 MINERAL MIX SACHET 0 0

SD BIOLINE Syphilis 3.0 One Step Syphilis


60 PCS 0 0
Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0

2 ALLOPURINOL 0 0

3 AMLODIPINE 5MG (BLUD) 0 0

4 ANTISEPTIK GEL (DINKES) 0 0

5 APD VAKSIN 0 0

Page 23 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

6 APRON (DINKES) 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0

9 ASIKLOVIR TABLET 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0

11 BIOPLACENTON (BLUD) 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0

13 CIPROFLOXACIN (BLUD) 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0

DEKSAMETHASONE HARSEN TABLET 0,5 MG


15 ((BLUD) ) 0 0

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0

18 FENITOIN KAPS (BLUD) 0 0

19 FITOMENADION INJ (BLUD) 0 0

20 FITOMENADION TABLET (BLUD) 0 0

21 FUROSEMIDE TABLET 0 0

22 GEMFIBROZIL (BLUD) 0 0

23 GENOINT (BLUD) 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0

28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK 0 0


BLUD)

29 HYPAFIX (BLUD) 0 0

30 INFUSET (BLUD) 0 0

31 IV CATHETER (BLUD) 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0

33 KLORAMFENIKOL SIRUP (BLUD) 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0

37 MASKER (DINKES) 0 0

38 MASKER N9 0 0

39 METFORMIN (BLUD) 0 0

40 METILERGOMETRINE INJ (BLUD) 0 0

41 MULTIVITAMIN KOMB 0 0

42 NEW DIATABS (BLUD) 0 0

43 NIFEDIPINE TAB (BLUD) 0 0

44 NURSE CAP 0 0

45 OMEPRAZOLE 20MG 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0

48 PEHAVRAL 0 0

Page 24 of 217
LPLPO Sumberingin Jan22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0

50 PIROXICAM 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0

52 SARUNG TANGAN OBGYN 0 0

53 SARUNG TANGAN OBGYN 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0

55 VGEL (BLUD) 0 0

56 VITAMIN C 50 MG (BLUD) 0 0

57 ZIVIT ZINC 0 0

58 ASETIL (DINKES) 0 0

59 DEXAMETHASONE (DINKES) 0 0

60 OBH (DINKES) 0 0

PARACETAMOL (DINKES)

Blitar , 02 February 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002

Page 25 of 217
LPLPO Feb22

DINAS KESEHATAN KABUPATEN BLITAR


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN : FEBRUARI
PUSKESMAS : SANANKULON PERMINTAAN: MARET
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH OBAT


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

AMPICILLIN SERBUK INJEKSI 1.000 MG


24 VIAL 0 0 0
MG/VIAL

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0 0

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 BOTOL 0 0


ML 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

Page 26 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 STESOLID TUBE 0 0 0

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

Page 27 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300
83 BOTOL 0 0 0
ML

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 ML AMPUL 0 0 0

93 FITOMENADION ( VIT K1 ) TABLET SALUT 10 TABLET 0 0


MG 0

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

FLUPHENASINE DEKANOAT INJEKSI 25 MG 1


95 ML AMPUL 0 0 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 0 0

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

Page 28 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

148 KASA STERIL (DARYAN TOLLE)YG DIRESAPI PCS 0 0


FRAMISETIN 0

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

Page 29 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

METAMIZOL (NORAGES) INJEKSI 500


181 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 AMPUL 0 0


MG/ML 2 ML 0

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

190 METRONIDAZOL + NYSTATIN VAG. VIAL 0 0


(PROVAGIN) INJEKSI 0

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0

Page 30 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML


241 (ABU I) VIAL 0 0 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500


244 MCG/ML 1 ML AMPUL 0 0 0

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

Page 31 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

255 SULFADOKSIN TABLET TABLET 0 0 0

256 SULFASETAMID NATRIUM TETES MATA 15 % BOTOL 0 0


5 ML 0

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

THIAMIN HCL MONONITRAT (VIT B1) TABLET


264 50 MG TABLET 0 0 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

Page 32 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

40 OBAT ANTI TUBERKULOSIS KOMBIPAK PAKET 0 0 0


KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 RAPID TEST PCS 0 0 0
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

SERUM ANTI DIFTERI CAIRAN INJEKSI 125


54 VIAL 0 0 0
MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0

59 MINERAL MIX SACHET 0 0 0

SD BIOLINE Syphilis 3.0 One Step Syphilis


60 PCS 0 0 0
Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 0 0 0

4 ANTISEPTIK GEL (DINKES) 0 0 0 0

5 APD VAKSIN 0 0 0 0

Page 33 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

DEKSAMETHASONE HARSEN TABLET 0,5 MG


15 ((BLUD) ) 0 0 0

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK 0 0 0


BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0 0

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 0 0

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

Page 34 of 217
LPLPO Feb22
SISA STOK JUMLAH OBAT
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 0 0 0 0

59 0 0 0 0

60 0 0 0 0

Blitar , 01 March 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002

Page 35 of 217
LPLPO Sumberingin Mar22

DINAS KESEHATAN KABUPATEN BLITAR


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BU: MARET
PUSKESMAS : SANANKULON PERMINTAAN : APRIL
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH OBAT


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

AMOXCICILIN FORTE SYRUP KERING


23 BOTOL 0 0 0
250MG/5ML
AMPICILLIN SERBUK INJEKSI 1.000 MG
24 VIAL 0 0 0
MG/VIAL

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0 0

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 BOTOL 0 0


ML 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

Page 36 of 217
LPLPO Sumberingin Mar22

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

ASAM VALPROAT 250 MG TABLET /


41 TABLET 0 0 0
DEPAKOTE ER

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 STESOLID TUBE 0 0 0

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

EKSTRACT PLASENTA + NEOMYSIN SALEP 15


78 TUBE 0 0 0
GR

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300


83 BOTOL 0 0 0
ML

Page 37 of 217
LPLPO Sumberingin Mar22

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 0 0

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

Page 38 of 217
LPLPO Sumberingin Mar22

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

KALSIUM GLUCONAS INJEKSI 100 MG/ML 10


137 AMPUL 0 0 0
ML

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

Page 39 of 217
LPLPO Sumberingin Mar22

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 AMPUL 0 0


MG/ML 2 ML 0

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

190 METRONIDAZOL + NYSTATIN VAG. VIAL 0 0


(PROVAGIN) INJEKSI 0

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

Page 40 of 217
LPLPO Sumberingin Mar22

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML


241 VIAL 0 0 0
(ABU I)
SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP
242 VIAL 0 0 0
(ATS)

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500


244 AMPUL 0 0 0
MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

Page 41 of 217
LPLPO Sumberingin Mar22

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

THIAMIN HCL MONONITRAT (VIT B1) TABLET


263 TABLET 0 0 0
100 MG
THIAMIN HCL MONONITRAT (VIT B1) TABLET
264 TABLET 0 0 0
50 MG

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2


268 TABLET 0 0 0
MG

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0


HIV TRIPLE FDC ANAK (ZIDOVUDIN
24 BOTOL 0 0 0
60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

Page 42 of 217
LPLPO Sumberingin Mar22

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

KOMBIPAK AZITHROMYCIN - CEFIXIME


32 TABLET 0 0 0
KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

OBAT ANTI TUBERKULOSIS DOSIS HARIAN


37 PAKET 0 0 0
STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 KATEGORI I PAKET 0 0 0

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

47 REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP PCS 0 0 0


RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

SERUM ANTI DIFTERI CAIRAN INJEKSI 125


54 VIAL 0 0 0
MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0

59 MINERAL MIX SACHET 0 0 0

SD BIOLINE Syphilis 3.0 One Step Syphilis


60 Antibody Test PCS 0 0 0

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 0 0

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

Page 43 of 217
LPLPO Sumberingin Mar22

14 CLINDAMISIN KAPS (BLUD) 0 0 0

DEKSAMETHASONE HARSEN TABLET 0,5 MG


15 0 0 0
((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK 0 0 0


BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0 0

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 0 0

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

Page 44 of 217
LPLPO Sumberingin Mar22

58 0 0 0 0

59 0 0 0 0

60 0 0 0 0

Blitar , 01 April 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002

Page 45 of 217
Page 46 of 217

DINAS KESEHATAN KABUPATEN BLITAR


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BULAN : APRIL
PUSKESMAS : SANANKULON PERMINTAAN BULAN : MEI
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

AMPICILLIN SERBUK INJEKSI 1.000 MG


24 VIAL 0 0 0
MG/VIAL

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0 0

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 BOTOL 0 0


ML 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

LPLPO SUMBERINGIN APR222


Page 47 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 STESOLID TUBE 0 0 0

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

LPLPO SUMBERINGIN APR222


Page 48 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300
83 BOTOL 0 0 0
ML

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 ML AMPUL 0 0 0

93 FITOMENADION ( VIT K1 ) TABLET SALUT 10 TABLET 0 0


MG 0

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

FLUPHENASINE DEKANOAT INJEKSI 25 MG 1


95 ML AMPUL 0 0 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 0 0

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

LPLPO SUMBERINGIN APR222


Page 49 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

148 KASA STERIL (DARYAN TOLLE)YG DIRESAPI PCS 0 0


FRAMISETIN 0

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

LPLPO SUMBERINGIN APR222


Page 50 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

METAMIZOL (NORAGES) INJEKSI 500


181 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 AMPUL 0 0


MG/ML 2 ML 0

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

190 METRONIDAZOL + NYSTATIN VAG. VIAL 0 0


(PROVAGIN) INJEKSI 0

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0

LPLPO SUMBERINGIN APR222


Page 51 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML


241 (ABU I) VIAL 0 0 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500


244 MCG/ML 1 ML AMPUL 0 0 0

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

LPLPO SUMBERINGIN APR222


Page 52 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

255 SULFADOKSIN TABLET TABLET 0 0 0

256 SULFASETAMID NATRIUM TETES MATA 15 % BOTOL 0 0


5 ML 0

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

THIAMIN HCL MONONITRAT (VIT B1) TABLET


264 50 MG TABLET 0 0 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

LPLPO SUMBERINGIN APR222


Page 53 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

40 OBAT ANTI TUBERKULOSIS KOMBIPAK PAKET 0 0 0


KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 RAPID TEST PCS 0 0 0
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

SERUM ANTI DIFTERI CAIRAN INJEKSI 125


54 VIAL 0 0 0
MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0

59 MINERAL MIX SACHET 0 0 0

SD BIOLINE Syphilis 3.0 One Step Syphilis


60 PCS 0 0 0
Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 0 0

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

LPLPO SUMBERINGIN APR222


Page 54 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

DEKSAMETHASONE HARSEN TABLET 0,5 MG


15 ((BLUD) ) 0 0 0

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK 0 0 0


BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0 0

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 0 0

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

LPLPO SUMBERINGIN APR222


Page 55 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 0 0 0 0

59 0 0 0 0

60 0 0 0 0

Blitar , 04 May 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002

LPLPO SUMBERINGIN APR222


Page 56 of 217

DINAS KESEHATAN KABUPATEN BLITAR


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BULAN : MEI
PUSKESMAS : SANANKULON PERMINTAAN BULAN : JUNI
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

AMPICILLIN SERBUK INJEKSI 1.000 MG


24 VIAL 0 0 0
MG/VIAL

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0 0

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 BOTOL 0 0


ML 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

LPLPO SUMBERINGIN MEI22


Page 57 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 STESOLID TUBE 0 0 0

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

LPLPO SUMBERINGIN MEI22


Page 58 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300
83 BOTOL 0 0 0
ML

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 ML AMPUL 0 0 0

93 FITOMENADION ( VIT K1 ) TABLET SALUT 10 TABLET 0 0


MG 0

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

FLUPHENASINE DEKANOAT INJEKSI 25 MG 1


95 ML AMPUL 0 0 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 0 0

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

LPLPO SUMBERINGIN MEI22


Page 59 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

148 KASA STERIL (DARYAN TOLLE)YG DIRESAPI PCS 0 0


FRAMISETIN 0

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

LPLPO SUMBERINGIN MEI22


Page 60 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

METAMIZOL (NORAGES) INJEKSI 500


181 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 AMPUL 0 0


MG/ML 2 ML 0

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

190 METRONIDAZOL + NYSTATIN VAG. VIAL 0 0


(PROVAGIN) INJEKSI 0

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0

LPLPO SUMBERINGIN MEI22


Page 61 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML


241 (ABU I) VIAL 0 0 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500


244 MCG/ML 1 ML AMPUL 0 0 0

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

LPLPO SUMBERINGIN MEI22


Page 62 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

255 SULFADOKSIN TABLET TABLET 0 0 0

256 SULFASETAMID NATRIUM TETES MATA 15 % BOTOL 0 0


5 ML 0

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

THIAMIN HCL MONONITRAT (VIT B1) TABLET


264 50 MG TABLET 0 0 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0 0

5 LODOMER 2 MG TABLET 0 0 0 0

6 LODOMER 5 MG TABLET 0 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0 0

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0 0

LPLPO SUMBERINGIN MEI22


Page 63 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0 0

29 IODINE TES PCS 0 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0 0

40 OBAT ANTI TUBERKULOSIS KOMBIPAK PAKET 0 0 0 0


KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0 0

43 PYRIMETAMINE TABLET 0 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 RAPID TEST PCS 0 0 0 0
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0 0

53 SAFETY BOX PCS 0 0 0 0

SERUM ANTI DIFTERI CAIRAN INJEKSI 125


54 VIAL 0 0 0 0
MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0 0

59 MINERAL MIX SACHET 0 0 0 0

SD BIOLINE Syphilis 3.0 One Step Syphilis


60 PCS 0 0 0 0
Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 0 0

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

LPLPO SUMBERINGIN MEI22


Page 64 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

DEKSAMETHASONE HARSEN TABLET 0,5 MG


15 ((BLUD) ) 0 0 0

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK 0 0 0


BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0 0

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 0 0

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

LPLPO SUMBERINGIN MEI22


Page 65 of 217
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 0 0 0 0

59 0 0 0 0

60 0 0 0 0

Blitar , 02 June 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002

LPLPO SUMBERINGIN MEI22


DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BULAN : JUNI
PUSKESMAS : SANANKULON PERMINTAAN BULAN : JULI
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0 0

10 ALKOHOL SWAB PCS 0 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 200 200 10 190

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 0 200 200 10 190

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 200 200 200 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0

132 INFUSION SET ANAK PCS 0 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0 0

135 KAEN 3B BOTOL 0 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0 0

179 MASKER N95 PCS 0 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 400 400 240 160

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0 0

195 MINERAL MIX SACHET 0 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0 0

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0 0

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0 0

252 STIMUNO SYR BOTOL 0 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0 0

2 ALLOPURINOL 0 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 1,800 1,800 330 1,470

4 ANTISEPTIK GEL (DINKES) 0 0 0 0

5 APD VAKSIN 0 0 0 0

6 APRON (DINKES) 0 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0 0

9 ASIKLOVIR TABLET 0 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0 0

21 FUROSEMIDE TABLET 0 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0 0

23 GENOINT (BLUD) 0 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0 0

30 INFUSET (BLUD) 0 0 0 0

31 IV CATHETER (BLUD) 0 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 500 500 500

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0 0

37 MASKER (DINKES) 0 0 0 0

38 MASKER N9 0 0 0 0

39 METFORMIN (BLUD) 0 0 0 0
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0 0

41 MULTIVITAMIN KOMB 0 0 0 0

42 NEW DIATABS (BLUD) 0 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0 0

44 NURSE CAP 0 0 0 0

45 OMEPRAZOLE 20MG 0 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0 0

50 PIROXICAM 0 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0 0

55 VGEL (BLUD) 0 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 0 0 0
ASETIL (DINKES)

59 0 0 0
DEXAMETHASONE (DINKES)

60 0 0 0
OBH (DINKES)
61 AMBROXOL 0 0 0
62 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
63 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
64 BETADINE GARGLE (BLUD) 0 0 0
65 BUFACOMB SALEP (BLUD) 0 0 0
66 BUFACORT - N (BLUD) 0 0 0
67 DARYANTULLE (BLUD) 0 0 0
68 ETIL KLORIDA SPRAY (BLUD) 0 0 0
69 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
70 GLIMEPIRIDE 2 MG TABLET (BLUD) 0 0 0
71 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
72 PIRACETAM KAPSUL (BLUD) 0 0 0
73 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
74 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
75 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
76 ASAM TRANEKSAMAT (BLUD) 0 0 0
77 ASETILSISTEIN (BLUD) 0 0 0
78 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
79 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
80 BEDAK SALISIL (BLUD) 0 0 0
81 BETAHISTIN TABLET (BLUD) 0 0 0
82 CTM (BLUD) 0 0 0
83 GLIMEPIRID 1 MG (BLUD) 0 0 0
84 GLUKOSA INFUS (BLUD) 0 0 0
85 ISDN (BLUD) 0 0 0
86 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
87 METRONIDAZOL (BLUD) 0 0 0
88 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
89 POVIDONE IODINE 60ML (BLUD) 0 0 0
90 RANITIDIN TABLET (BLUD) 0 0 0
91 SETERIZIN TABLET (BLUD) 0 0 0
92 VITAMIN B KOMPLEKS (BLUD) 0 0 0
93 VITAMIN B1 (BLUD) 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002
ALKOHOL SWAB

ALLOPURINOL

AMLODIPINE 5MG (BLUD)

ANTISEPTIK GEL (DINKES)

APD VAKSIN

APRON (DINKES)

AQUA PRO INJEKSI (BLUD)

ASAM MEFENAMAT TABLET 500 MG (BLUD)

ASIKLOVIR TABLET

BETAMETHASONE SALEP KULIT (BLUD)

BIOPLACENTON (BLUD)

BISAKODIL TABLET 5 MG (BLUD)

CIPROFLOXACIN (BLUD)

CLINDAMISIN KAPS (BLUD)

DEKSAMETHASONE HARSEN TABLET 0,5 MG ((BLUD) )

DOMPERIDONE TABLET 10 MG ( (BLUD))

EPINEFRIN INJEKSI (BLUD)

FENITOIN KAPS (BLUD)

FITOMENADION INJ (BLUD)

FITOMENADION TABLET (BLUD)

FUROSEMIDE TABLET

GEMFIBROZIL (BLUD)

GENTAMISIN SALEP KULIT /GENOINT (BLUD)

GENTAMICIN TETES MATA (BLUD)

GENTIAN VIOLET LARUTAN 1 % (BLUD)

GLISERIL GUAIKOLAT/GUAIFENESIN BLUD

HIDROKORTISON CREAM KULIT (BLUD)

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK BLUD)

HYPAFIX (BLUD)

INFUSET (BLUD)

IV CATHETER (BLUD)

KAPTOPRIL TABLET 12,5 MG (BLUD)

KLORAMFENIKOL SIRUP (BLUD)

KLORAMFENIKOL TETES TELINGA (BLUD)

KOTRIMOKSAZOL TAB (BLUD)

LOPERAMIDE TABLET 2 MG (BLUD)

MASKER (DINKES)

MASKER N9

METFORMIN (BLUD)
METILERGOMETRINE INJ (BLUD)

MULTIVITAMIN KOMB

NEW DIATABS (BLUD)

NIFEDIPINE TAB (BLUD)

NURSE CAP

OMEPRAZOLE 20MG

ONDANSETRONE INJEKSI (BLUD)

PARACETAMOL TABLET 500 MG (BLUD)

PEHAVRAL

PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD)

PIROXICAM

SALBUTAMOL TABLET 2 MG (BLUD)

SARUNG TANGAN OBGYN

SARUNG TANGAN OBGYN

SEFADROKSIL KAPSUL 500 MG (BLUD)

VGEL (BLUD)

VITAMIN C 50 MG (BLUD)

ZIVIT ZINC

ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : PELAPORAN BULAN : JULI
PUSKESMAS : SANANKULON PERMINTAAN BULAN : AGUSTUS
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0 0

10 ALKOHOL SWAB PCS 0 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 190 0 190 10 180

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 190 200 390 10 380

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 500 500 360 140

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0

132 INFUSION SET ANAK PCS 0 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0 0

135 KAEN 3B BOTOL 0 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0 0

179 MASKER N95 PCS 0 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0 0

182 METFORMIN TABLET 500 MG TABLET 160 0 160 160 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0 0

195 MINERAL MIX SACHET 0 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0 0

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0 0

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0 0

252 STIMUNO SYR BOTOL 0 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 1,470 1,470 320 1,150

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 500 100 600 600

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 0 0
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 0 0 0
ASETIL (DINKES)

59 0 0 0
DEXAMETHASONE (DINKES)

60 0 0 0
OBH (DINKES)
61 AMBROXOL 0 0 0
62 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
63 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
64 BETADINE GARGLE (BLUD) 0 0 0
65 BUFACOMB SALEP (BLUD) 0 0 0
66 BUFACORT - N (BLUD) 0 0 0
67 DARYANTULLE (BLUD) 0 0 0
68 ETIL KLORIDA SPRAY (BLUD) 0 0 0
69 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
70 GLIMEPIRIDE 2 MG TABLET (BLUD) 0 0 0
71 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
72 PIRACETAM KAPSUL (BLUD) 0 0 0
73 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
74 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
75 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
76 ASAM TRANEKSAMAT (BLUD) 0 0 0
77 ASETILSISTEIN (BLUD) 0 0 0
78 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
79 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
80 BEDAK SALISIL (BLUD) 0 0 0
81 BETAHISTIN TABLET (BLUD) 0 0 0
82 CTM (BLUD) 0 0 0
83 GLIMEPIRID 1 MG (BLUD) 0 0 0
84 GLUKOSA INFUS (BLUD) 0 0 0
85 ISDN (BLUD) 0 0 0
86 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
87 METRONIDAZOL (BLUD) 0 0 0
88 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
89 POVIDONE IODINE 60ML (BLUD) 0 0 0
90 RANITIDIN TABLET (BLUD) 0 0 0
91 SETERIZIN TABLET (BLUD) 0 0 0
92 VITAMIN B KOMPLEKS (BLUD) 0 0 0
93 VITAMIN B1 (BLUD) 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

ENDAH ROSITANINGSIH, SE, MM Apt. AINA MUJTAHIDA A, S.Farm. APRILLIA YUDHA A.S.
NIP. 196912302010012002 NIP : 198612188 11033 2 0004 NIP. 199104082015022002
Amlo 5 mg 3 3 3 3 2 2 2 2 2 1 2 3 3 31

Glime 2 3 1 2 2 2 1 2 1 1 1 18

Metformin 3 3 3 2 3 2 2 3 3 2 26
1150
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : SUMBERINGIN PELAPORAN BULAN : AGUSTUS
PUSKESMAS : SANANKULON PERMINTAAN BULAN : SEPTEMBER
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 180 180 20 160

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 380 380 380

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 140 140 140 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 0 0

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 0 0

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 1,150 1,150 400 750

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 600 600 600

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 0 1,000 1,000 510 490


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 0 0

58 ASETIL (DINKES) 0 0 0

59 DEXAMETHASONE (DINKES) 0 0 0

61 OBH (DINKES) 0 0 0
62 AMBROXOL 0 0 0
63 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
64 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
65 BETADINE GARGLE (BLUD) 0 0 0
66 BUFACOMB SALEP (BLUD) 0 0 0
67 BUFACORT - N (BLUD) 0 0 0
68 DARYANTULLE (BLUD) 0 0 0
69 ETIL KLORIDA SPRAY (BLUD) 0 0 0
70 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
71 GLIMEPIRIDE 2 MG TABLET (BLUD) 0 0 0
72 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
73 PIRACETAM KAPSUL (BLUD) 0 0 0
74 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
75 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
76 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
77 ASAM TRANEKSAMAT (BLUD) 0 0 0
78 ASETILSISTEIN (BLUD) 0 0 0
79 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
80 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
81 BEDAK SALISIL (BLUD) 0 0 0
82 BETAHISTIN TABLET (BLUD) 0 0 0
83 CTM (BLUD) 0 0 0
84 GLIMEPIRID 1 MG (BLUD) 0 0 0
85 GLUKOSA INFUS (BLUD) 0 0 0
86 ISDN (BLUD) 0 0 0
87 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
88 METRONIDAZOL (BLUD) 0 0 0
89 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
90 POVIDONE IODINE 60ML (BLUD) 0 0 0
91 RANITIDIN TABLET (BLUD) 0 0 0
92 SETERIZIN TABLET (BLUD) 0 0 0
93 VITAMIN B KOMPLEKS (BLUD) 0 0 0
94 VITAMIN B1 (BLUD) 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SUMBERINGIN Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

0 Apt. AINA MUJTAHIDA A, S.Farm. ENDAH ROSITANINGSIH, SE, MM


NIP. 0 NIP : 198612188 11033 2 0004 NIP. 196912302010012002
700
900
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : SUMBERINGEN PELAPORAN BULAN : SEPTEMBER
PUSKESMAS : SANANKULON PERMINTAAN BULAN : OKTOBER
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 160 160 160

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 380 380 380

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 0 300 300 300

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 0 300 300 300

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 0 0

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 750 750 750

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 100 100 100

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 200 200 200

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 600 600 600

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 490 490 490


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 0 150 150 150

58 ASETIL (DINKES) 0 0 0

59 DEXAMETHASONE (DINKES) 0 0 0

61 OBH (DINKES) 0 0 0
62 AMBROXOL 0 0 0
63 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
64 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
65 BETADINE GARGLE (BLUD) 0 0 0
66 BUFACOMB SALEP (BLUD) 0 0 0
67 BUFACORT - N (BLUD) 0 0 0
68 DARYANTULLE (BLUD) 0 0 0
69 ETIL KLORIDA SPRAY (BLUD) 0 0 0
70 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
71 GLIMEPIRIDE 2 MG TABLET (BLUD) 0 0 0
72 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
73 PIRACETAM KAPSUL (BLUD) 0 0 0
74 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
75 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
76 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
77 ASAM TRANEKSAMAT (BLUD) 0 0 0
78 ASETILSISTEIN (BLUD) 0 0 0
79 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
80 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
81 BEDAK SALISIL (BLUD) 0 0 0
82 BETAHISTIN TABLET (BLUD) 0 0 0
83 CTM (BLUD) 0 0 0
84 GLIMEPIRID 1 MG (BLUD) 0 0 0
85 GLUKOSA INFUS (BLUD) 0 0 0
86 ISDN (BLUD) 0 0 0
87 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
88 METRONIDAZOL (BLUD) 0 0 0
89 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
90 POVIDONE IODINE 60ML (BLUD) 0 0 0
91 RANITIDIN TABLET (BLUD) 0 0 0
92 SETERIZIN TABLET (BLUD) 0 0 0
93 VITAMIN B KOMPLEKS (BLUD) 0 0 0
94 VITAMIN B1 (BLUD) 0 0 0
95
96
97
98
99 Blitar , 01 July 2022
100 Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
101 Kepala Puskesmas Petugas Petugas Pengelola Obat
SUMBERINGEN Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

0 Apt. AINA MUJTAHIDA A, S.Farm. ENDAH ROSITANINGSIH, SE, MM


NIP. 0 NIP : 198612188 11033 2 0004 NIP. 196912302010012002
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : SUMBERINGIN PELAPORAN BULAN : OKTOBER
PUSKESMAS : SANANKULON PERMINTAAN BULAN : NOVEMBER
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 160 160 58 102

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 380 380 25 355

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0 1,000

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 300 300 300

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 300 300 46 254

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 0 50 50 45 5 OK 200

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 750 750 330 420 20 900

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 100 100 92 8

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 200 200 400 20 380 180

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 600 600 30 570 570 OK

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 490 400 890 300 590 760


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 150 150 150

58 ASETIL (DINKES) 0 0 0

59 DEXAMETHASONE (DINKES) 0 0 0

61 OBH (DINKES) 0 0 0
62 AMBROXOL 0 0 0
63 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
64 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
65 BETADINE GARGLE (BLUD) 0 0 0
66 BUFACOMB SALEP (BLUD) 0 0 0
67 BUFACORT - N (BLUD) 0 0 0
68 DARYANTULLE (BLUD) 0 0 0
69 ETIL KLORIDA SPRAY (BLUD) 0 0 0
70 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
71 GLIMEPIRIDE 2 MG TABLET (BLUD) 0 500 500 250 250
72 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
73 PIRACETAM KAPSUL (BLUD) 0 0 0
74 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
75 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
76 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
77 ASAM TRANEKSAMAT (BLUD) 0 0 0
78 ASETILSISTEIN (BLUD) 0 0 0
79 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
80 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
81 BEDAK SALISIL (BLUD) 0 0 0
82 BETAHISTIN TABLET (BLUD) 0 0 0
83 CTM (BLUD) 0 0 0
84 GLIMEPIRID 1 MG (BLUD) 0 0 0
85 GLUKOSA INFUS (BLUD) 0 0 0
86 ISDN (BLUD) 0 0 0
87 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
88 METRONIDAZOL (BLUD) 0 0 0
89 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
90 POVIDONE IODINE 60ML (BLUD) 0 0 0
91 RANITIDIN TABLET (BLUD) 0 0 0
92 SETERIZIN TABLET (BLUD) 0 0 0
93 VITAMIN B KOMPLEKS (BLUD) 0 0 0
94 VITAMIN B1 (BLUD) 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SUMBERINGIN Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

0 Apt. AINA MUJTAHIDA A, S.Farm. ENDAH ROSITANINGSIH, SE, MM


NIP. 0 NIP : 198612188 11033 2 0004 NIP. 196912302010012002
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : SUMBERINGIN PELAPORAN BULAN : NOVEMBER
PUSKESMAS : SANANKULON PERMINTAAN BULAN : DESEMBER
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 102 102 102

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 355 355 355

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 300 300 300

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 254 254 254

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 5 5 5

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0 0

2 ALLOPURINOL 0 0 0 0

3 AMLODIPINE 5MG (BLUD) 420 900 0

4 ANTISEPTIK GEL (DINKES) 0 0 0 0

5 APD VAKSIN 0 0 0 0

6 APRON (DINKES) 0 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 8 100 108 108

9 ASIKLOVIR TABLET 0 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0 0

21 FUROSEMIDE TABLET 0 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0 0

23 GENOINT (BLUD) 0 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 380 200 580 580

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0 0

30 INFUSET (BLUD) 0 0 0 0

31 IV CATHETER (BLUD) 0 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 570 0 570 570

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0 0

37 MASKER (DINKES) 0 0 0 0

38 MASKER N9 0 0 0 0

39 METFORMIN (BLUD) 590 0 590 590


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0 0

41 MULTIVITAMIN KOMB 0 0 0 0

42 NEW DIATABS (BLUD) 0 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0 0

44 NURSE CAP 0 0 0 0

45 OMEPRAZOLE 20MG 0 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0 0

48 PEHAVRAL 0 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0 0

50 PIROXICAM 0 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0 0

55 VGEL (BLUD) 0 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0 0

57 ZIVIT ZINC 150 150 150

58 ASETIL (DINKES) 0 0 0

59 DEXAMETHASONE (DINKES) 0 0 0

61 OBH (DINKES) 0 0 0
62 AMBROXOL 0 0 0
63 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
64 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
65 BETADINE GARGLE (BLUD) 0 0 0
66 BUFACOMB SALEP (BLUD) 0 0 0
67 BUFACORT - N (BLUD) 0 0 0
68 DARYANTULLE (BLUD) 0 0 0
69 ETIL KLORIDA SPRAY (BLUD) 0 0 0
70 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
71 GLIMEPIRIDE 2 MG TABLET (BLUD) 250 250 250
72 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
73 PIRACETAM KAPSUL (BLUD) 0 0 0
74 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
75 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
76 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
77 ASAM TRANEKSAMAT (BLUD) 0 0 0
78 ASETILSISTEIN (BLUD) 0 0 0
79 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
80 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
81 BEDAK SALISIL (BLUD) 0 0 0
82 BETAHISTIN TABLET (BLUD) 0 0 0
83 CTM (BLUD) 0 0 0
84 GLIMEPIRID 1 MG (BLUD) 0 1,000 1,000 1,000
85 GLUKOSA INFUS (BLUD) 0 0 0
86 ISDN (BLUD) 0 0 0
87 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
88 METRONIDAZOL (BLUD) 0 0 0
89 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
90 POVIDONE IODINE 60ML (BLUD) 0 0 0
91 RANITIDIN TABLET (BLUD) 0 0 0
92 SETERIZIN TABLET (BLUD) 0 200 200 200
93 VITAMIN B KOMPLEKS (BLUD) 0 0 0
94 VITAMIN B1 (BLUD) 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SUMBERINGIN Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

0 Apt. AINA MUJTAHIDA A, S.Farm. ENDAH ROSITANINGSIH, SE, MM


NIP. 0 NIP : 198612188 11033 2 0004 NIP. 196912302010012002
1,000
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
WILAYAH : SUMBERINGIN PELAPORAN BULAN : DESEMBER
PUSKESMAS : SANANKULON PERMINTAAN BULAN : JANUARI
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PROVINSI : JAWA TIMUR

SISA STOK JUMLAH


NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0

10 ALKOHOL SWAB PCS 0 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL 0 0 0

16 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0

17 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

18 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19 AMLODIPINE TABLET 5 MG TABLET 0 0 0

20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL 0 0 0

21 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL 0 0 0

22 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

23 AMOXCICILIN FORTE SYRUP KERING BOTOL 0 0


250MG/5ML 0

24 AMPICILLIN SERBUK INJEKSI 1.000 MG VIAL 0 0


MG/VIAL 0

25 ANTALGIN 500 MG TABLET (METAMIZOL) TABLET 0 0 0

26 ANTASIDA DOEN TABLET KOMBINASI TABLET 102 102 102

27 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT 0 0 0

29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT 0 0 0

30 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

31 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET 0 0 0

32 ANTI SPASMODIK INJEKSI (SPASHI) AMPUL 0 0 0

33 ANTI SPASMODIK TABLET (DORMICOMP) TABLET 0 0 0

AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20


34 ML BOTOL 0 0 0

35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 0 0 0

36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 0 0 0

37 ASAM FOLAT 1MG TABLET TABLET 0 0 0

38 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL 0 0 0

40 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

41 ASAM VALPROAT 250 MG TABLET / TABLET 0 0


DEPAKOTE ER 0

42 ASEPTAN 500CC + PUMP BOTOL 0 0 0

43 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0

44 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0

45 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0

46 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0

47 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL 0 0 0

49 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0

50 BETAHISTINE MESILAT 24 MG TABLET TABLET 0 0 0

51 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0

52 BETAMETHASON CR 0.05% 20 GR TUBE 0 0 0

53 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0

54 BIONICOM ZINC TABLET TABLET 0 0 0

55 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

56 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0 0

57 BISOPROLOL 2,5 MG TABLET (CONCOR) TABLET 0 0 0

58 BISOPROLOL 5 MG TABLET TABLET 0 0 0

59 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0

60 CAT GUT NO. 3/0 PLAIN PCS 0 0 0

61 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0

62 CLONIDINE 0.15 MG TABLET TABLET 0 0 0

63 CLOPIDOGREL 75 MG TABLET 0 0 0

64 COMBIVENT UDV INHALASI VIAL 0 0 0

65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL 0 0 0

66 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

67 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0

68 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-


69 TUBE 0 0 0
STESOLID

70 DIAZEPAM TABLET 2 MG TABLET 0 0 0

71 DIAZEPAM TABLET 5 MG TABLET 0 0 0

72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL 0 0 0

73 DIGOXIN TABLET 0,25 MG TABLET 0 0 0

74 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0

75 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0

76 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0

77 DOMPERIDON TABLET 10 MG TABLET 0 0 0

78 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 TUBE 0 0


GR 0

79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL 0 0 0

80 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

81 ERITROMISIN SIRUP KERING 200 MG/5ML BOTOL 0 0 0

82 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 BOTOL 0 0


ML 0

84 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0

85 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0

86 EUGENOL CAIRAN 10 ML BOTOL 0 0 0

87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

88 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL 0 0 0

90 FENOBARBITAL TABLET 30 MG TABLET 0 0 0

91 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL 0 0 0

FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1


92 AMPUL 0 0 0
ML
FITOMENADION ( VIT K1 ) TABLET SALUT 10
93 TABLET 0 0 0
MG

94 FITOMENADION INFANT INJ. 2MG/ML AMPUL 0 0 0

95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 AMPUL 0 0


ML 0

96 FUROSEMID INJEKSI 10 mg VIAL 0 0 0

97 FUROSEMID TABLET 40 MG TABLET 355 355 355

98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % TUBE 0 0


10 GR 0

99 GARAM ORALIT SACHET 0 0 0

100 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0

101 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0

102 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0

103 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0

104 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0

105 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

106 GLICERIL GUAIACOLAT TABLET 100 MG TABLET 0 0 0

107 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

108 GLIMEPIRIDE 2 MG TABLET TABLET 0 0 0

GLUKOSA 40% DEXTROSE INJECTION U.S.P


109 VIAL 0 0 0
CAIRAN INJEKSI

110 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL 0 0 0

111 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL 0 0 0

112 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0

113 HALOPERIDOL 2 MG TABLET 0 0 0

114 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0

115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL 0 0 0

116 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0

117 HALOPERIDOL TABLET 5 MG TABLET 0 0 0

118 HERBAKOF SYRUP 60ML BOTOL 0 0 0

119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN BOTOL 0 0


INFUS 500 ML 0

120 HIDROCORTISON CR 1% TUBE 0 0 0

121 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0

122 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

123 I.V CATHETER NO.16 WITH INJECTION PORT PCS 0 0 0

124 I.V CATHETER NO.18 WITH INJECTION PORT PCS 0 0 0

125 I.V CATHETER NO.20 WITH INJECTION PORT PCS 0 0 0

126 I.V CATHETER NO.22 WITH INJECTION PORT PCS 0 0 0

127 I.V CATHETER NO.24 WITH INJECTION PORT PCS 0 0 0

128 I.V CATHETER NO.26 WITH INJECTION PORT PCS 0 0 0

129 IBUPROFEN FORTE SYRUP 200MG/5ML BOTOL 0 0 0

130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL 0 0 0

131 IBUPROFEN TABLET 400 MG TABLET 0 0 0

132 INFUSION SET ANAK PCS 0 0 0

133 INFUSION SET DEWASA PCS 0 0 0

134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET 0 0 0

135 KAEN 3B BOTOL 0 0 0

136 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0

137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 AMPUL 0 0


ML 0

138 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET 300 300 300

139 KANTONG URINE DEWASA PCS 0 0 0

140 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0

141 KAPTOPRIL TABLET 25 MG TABLET 0 0 0

142 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0

143 KASA KOMPRES 40/40 STERIL BKS 0 0 0

144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL 0 0 0

145 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL 0 0 0

146 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL 0 0 0

147 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL 0 0 0

KASA STERIL (DARYAN TOLLE)YG DIRESAPI


148 PCS 0 0 0
FRAMISETIN

149 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0

150 KETOPROFEN 100 MG SUPPOSITORIA SUPP. 0 0 0

151 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0

152 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0

153 KLOBAZAM 10 MG TABLET TABLET 0 0 0

154 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0

155 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0

156 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 0 0 0

158 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

159 KLORFENIRAMINE MALEAT (CTM) TABLET 4 TABLET 0 0


MG 0

160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL 0 0 0

161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 ML AMPUL 0 0 0

162 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0

163 KLOZAPIN 100 MG TABLET TABLET 0 0 0

164 KLOZAPIN 25 MG TABLET TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

165 KODEIN HCL TABLET 10 MG TABLET 0 0 0

166 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0

167 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0

168 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0

169 LIDOCAIN 2% INJ AMPUL 0 0 0

170 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL 0 0 0

171 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0

172 LOPERAMIDE TABLET 2 MG TABLET 0 0 0

173 LORATADIN TABLET 10 MG TABLET 0 0 0

174 LORAZEPAM 2 MG TABLET 0 0 0

175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL 0 0 0

176 MASKER EARLOOP PLUS PCS 0 0 0

177 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0

178 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0

179 MASKER N95 PCS 0 0 0

180 MELOKSIKAM TABLET 7,5 MG TABLET 0 0 0

181 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL 0 0 0

182 METFORMIN TABLET 500 MG TABLET 0 0 0

183 METILERGOMETRIN MALEAT INJEKSI 0,200 AMPUL 0 0


MG 1 ML 0

184 METILERGOMETRIN MALEAT TABLET 0,125 TABLET 0 0


MG 0

185 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0

186 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

187 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0 0

METOKLOPROMIDE (SOTATIC) INJEKSI 5


188 AMPUL 0 0 0
MG/ML 2 ML

189 METOKLOPROMIDE SIRUP BOTOL 0 0 0

METRONIDAZOL + NYSTATIN VAG.


190 VIAL 0 0 0
(PROVAGIN) INJEKSI

191 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

192 METRONIDAZOL TABLET 500 MG TABLET 0 0 0

193 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL 0 0 0

194 MIKONAZOL KREAM 10 GR TUBE 0 0 0

195 MINERAL MIX SACHET 0 0 0

196 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0 0

197 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0

198 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL 0 0 0

199 NIFEDIPINE TABLET 10 MG TABLET 0 0 0

200 NISTATIN TABLET 500.000 UI TABLET 0 0 0

201 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL 0 0 0

203 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0

204 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE 0 0 0

206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

207 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0

208 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0

209 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL 0 0 0

211 PARACETAMOL TABLET 500 MG TABLET 254 254 254

212 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL 0 0 0

213 PEHAVRAL TABLET TABLET 0 0 0

214 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0

215 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0

216 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0

217 PIRACETAM TABLET 800 MG TABLET 0 0 0

218 PIRANTEL PAMOAT TABLET TABLET 0 0 0

219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET 0 0 0

220 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0

221 PLESTER 10 CM X 2 M ROL 0 0 0

222 PREDNISON TABLET 5 MG TABLET 0 0 0

223 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0

224 PROPILTHIOURACIL TABLET 100 MG TABLET 0 0 0

225 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0

226 RESPERIDON 2 MG TABLET TABLET 0 0 0

227 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL 0 0 0

228 SALBUTAMOL TABLET 2 MG TABLET 0 0 0

229 SALBUTAMOL TABLET 4 MG TABLET 0 0 0

230 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0

231 SALICYL BEDAK 2 % KOTAK 0 0 0

232 SARUNG TANGAM NON STERIL L PCS 0 0 0

233 SARUNG TANGAN NON STERIL M PCS 0 0 0

234 SARUNG TANGAN NON STERIL S PCS 0 0 0

235 SARUNG TANGAN STERIL NO 6 PSG 0 0 0

236 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0

237 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0

238 SARUNG TANGAN STERILE NO.7 PSG 0 0 0

239 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

240 SEFIKSIM KAPSUL 100 MG KAPSUL 0 0 0

241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML VIAL 0 0


(ABU I) 0

242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP VIAL 0 0


(ATS) 0

243 SETIRIZINE TABLET 10 MG TABLET 5 5 5

244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 AMPUL 0 0 0


MCG/ML 1 ML

245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET 0 0 0

246 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS 0 0 0

247 SIMETIDINE TABLET 200 MG TABLET 0 0 0

248 SIMVASTATIN TABLET 10 MG TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

249 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0

250 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0

251 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

252 STIMUNO SYR BOTOL 0 0 0

253 STIMUNO TAB (100) TABLET 0 0 0

254 STIMUNO TAB (30) BOTOL 0 0 0

255 SULFADOKSIN TABLET TABLET 0 0 0

SULFASETAMID NATRIUM TETES MATA 15 %


256 BOTOL 0 0 0
5 ML

257 TABLET TAMBAH DARAH TABLET 0 0 0

TEMPORARY CAVITY SEALER [TUMPATAN


258 PCS 0 0 0
SEMENTARA] (CAVIT G)

259 TETAGRAM 150 IU AMPUL 0 0 0

260 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0

261 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL 0 0 0

263 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


100 MG 0

264 THIAMIN HCL MONONITRAT (VIT B1) TABLET TABLET 0 0


50 MG 0

265 TRAMADOL INJEKSI 50 MG/ML AMPUL 0 0 0

266 TRANFUSION SET ADULT WITH Y INJECTION PCS 0 0 0

267 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 TABLET 0 0


MG 0

269 VITAMIN B COMPLEX TABLET TABLET 0 0 0

270 YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL 0 0 0

271 YODIUM POVIDON LARUTAN 10% 60 ML BOTOL 0 0 0

272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) TABLET 0 0 0

273 ZINK 20 MG TABLET TABLET 0 0 0

274 Hi-D 1000 CHOLECALCIFEROL TABLET 0 0 0

OBAT PROGRAM / HIBAH

1 AMITRIPTYLINE 25 MG TABLET 0 0 0

2 HALOPERIDOLE INJEKSI AMPUL 0 0 0

3 HALOPERIDOLE 1,5 MG TABLET 0 0 0

4 HALOPERIDOLE 5 MG TABLET 0 0 0

5 LODOMER 2 MG TABLET 0 0 0

6 LODOMER 5 MG TABLET 0 0 0

7 TRIHEXYPHENIDYL 2 MG TABLET 0 0 0

8 ALAT SUNTIK 0,05 ML (PROGRAM) PCS 0 0 0

9 ALAT SUNTIK 0,5 ML (PROGRAM) PCS 0 0 0

10 ALAT SUNTIK 5 ML (PROGRAM) PCS 0 0 0

11 ALBENDAZOL TABLET 400 MG TABLET 0 0 0

12 BENZATINE BENZYLPENICILLIN 2.400.000 IU VIAL 0 0 0

13 COTRIMOXAZOLE 800/160 TABLET 0 0 0

14 DIETHYLCARBAMAZINE 100 MG TABLET 0 0 0

15 GARAM ORALIT UNTUK 200 ML AIR SACHET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

16 HIV ABACAVIR TABLET 300 MG BOTOL 0 0 0

17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 50) BOTOL 0 0 0

18 HIV DOLUTEGRAFIR 50 MG BOTOL 0 0 0

19 HIV EFAFIRENZ 200 MG TABLET BOTOL 0 0 0

20 HIV EFAFIRENZ 600 MG TABLET BOTOL 0 0 0

21 HIV LAMIVUDIN 150 MG TABLET BOTOL 0 0 0

22 HIV NEVIRAPINE 200 MG TABLET BOTOL 0 0 0

23 HIV TENOFOVIR 300 MG BOTOL 0 0 0

24 HIV TRIPLE FDC ANAK (ZIDOVUDIN BOTOL 0 0 0


60MG+LAMIVUDIN 30MG+NEVIRAPINE 50MG)
HIV TRIPLE FDC DEWASA (TDC+3TC+EFV
25 BOTOL 0 0 0
(300/300/600))

26 HIV ZIDOVUDINE 100 MG @60 KAPSUL BOTOL 0 0 0

27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 MG BOTOL 0 0 0

28 HIV ZIDOVUDINE SYRUP 240 ML BOTOL 0 0 0

29 IODINE TES PCS 0 0 0

30 ISONIAZID TABLET 100 MG TABLET 0 0 0

31 ISONIAZID TABLET 300 MG TABLET 0 0 0

32 KOMBIPAK AZITHROMYCIN - CEFIXIME TABLET 0 0 0


KOMBINASI

33 MDT COMBI - MB ADULT (RED) BLISTER 0 0 0

34 MDT COMBI - MB CHILD (ORANGE) BLISTER 0 0 0

35 MDT COMBI - PB ADULT (GREEN) BLISTER 0 0 0

36 OBAT ANTI TUBERKULOSIS ANAK PAKET 0 0 0

37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN PAKET 0 0 0


STOP TB KIT

38 OBAT ANTI TUBERKULOSIS KATEGORI 1 PAKET 0 0 0

39 OBAT ANTI TUBERKULOSIS KATEGORI 2 PAKET 0 0 0

OBAT ANTI TUBERKULOSIS KOMBIPAK


40 PAKET 0 0 0
KATEGORI I

41 PARACETAMOL 500 MG (P2) TABLET 0 0 0

42 PIRIDOKSIN 25 MG TABLET (VIT B6) TABLET 0 0 0

43 PYRIMETAMINE TABLET 0 0 0

44 REAGEN HIV (FOKUS) PCS 0 0 0

45 REAGEN HIV (STANDART DIAGNOSTIC/SD) PCS 0 0 0

46 REAGEN HIV (VIKIA) PCS 0 0 0

REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STEP


47 PCS 0 0 0
RAPID TEST
REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2)
48 PCS 0 0 0
ANTIBODY (COLLOIDAL GOLD) V2 PAKET
49 REAGEN SYPHILIS (TREPOCHECK) PCS 0 0 0

50 REAGEN SYPHILIS RDT (FOKUS) PCS 0 0 0

51 RETINOL ( VIT A ) KAPSUL 100.000 IU KAPSUL 0 0 0

52 RETINOL ( VIT A ) KAPSUL 200.000 IU KAPSUL 0 0 0

53 SAFETY BOX PCS 0 0 0

54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 VIAL 0 0 0


MG/ML

55 TABLET TAMBAH DARAH (PROGRAM) TABLET 0 0 0

56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM) TABLET 0 0 0

57 ALBENDAZOLE SIRUP BOTOL 0 0 0

58 COTRIMOXAZOLE 400/80 TABLET 0 0 0


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

59 MINERAL MIX SACHET 0 0 0

60 SD BIOLINE Syphilis 3.0 One Step Syphilis PCS 0 0 0


Antibody Test

OBAT TAMBAHAN

1 ALKOHOL SWAB 0 0 0 0

2 ALLOPURINOL 0 0 0

3 AMLODIPINE 5MG (BLUD) 0 0 0

4 ANTISEPTIK GEL (DINKES) 0 0 0

5 APD VAKSIN 0 0 0

6 APRON (DINKES) 0 0 0

7 AQUA PRO INJEKSI (BLUD) 0 0 0

8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 108 108 108

9 ASIKLOVIR TABLET 0 0 0

10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0

11 BIOPLACENTON (BLUD) 0 0 0

12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0

13 CIPROFLOXACIN (BLUD) 0 0 0

14 CLINDAMISIN KAPS (BLUD) 0 0 0

15 DEKSAMETHASONE HARSEN TABLET 0,5 MG 0 0 0


((BLUD) )

16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0

17 EPINEFRIN INJEKSI (BLUD) 0 0 0

18 FENITOIN KAPS (BLUD) 0 0 0

19 FITOMENADION INJ (BLUD) 0 0 0

20 FITOMENADION TABLET (BLUD) 0 0 0

21 FUROSEMIDE TABLET 0 0 0

22 GEMFIBROZIL (BLUD) 0 0 0

23 GENOINT (BLUD) 0 0 0

24 GENTAMICIN TETES MATA (BLUD) 0 0 0

25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0

26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 580 580 580

27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0

HYOSCINE BUTYLBROMIDE (ANTI SPASMODIK


28 0 0 0
BLUD)

29 HYPAFIX (BLUD) 0 0 0

30 INFUSET (BLUD) 0 0 0

31 IV CATHETER (BLUD) 0 0 0

32 KAPTOPRIL TABLET 12,5 MG (BLUD) 570 570 570

33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0

34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0

35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0

36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0

37 MASKER (DINKES) 0 0 0

38 MASKER N9 0 0 0

39 METFORMIN (BLUD) 590 590 590


SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

40 METILERGOMETRINE INJ (BLUD) 0 0 0

41 MULTIVITAMIN KOMB 0 0 0

42 NEW DIATABS (BLUD) 0 0 0

43 NIFEDIPINE TAB (BLUD) 0 0 0

44 NURSE CAP 0 0 0

45 OMEPRAZOLE 20MG 0 0 0

46 ONDANSETRONE INJEKSI (BLUD) 0 0 0

47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0

48 PEHAVRAL 0 0 0

49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLUD) 0 0 0

50 PIROXICAM 0 0 0

51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0

52 SARUNG TANGAN OBGYN 0 0 0

53 SARUNG TANGAN OBGYN 0 0 0

54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0

55 VGEL (BLUD) 0 0 0

56 VITAMIN C 50 MG (BLUD) 0 0 0

57 ZIVIT ZINC 150 150 150

58 ASETIL (DINKES) 0 0 0

59 DEXAMETHASONE (DINKES) 0 0 0

61 OBH (DINKES) 0 0 0
62 AMBROXOL 0 0 0
63 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0 0 0
64 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0 0 0
65 BETADINE GARGLE (BLUD) 0 0 0
66 BUFACOMB SALEP (BLUD) 0 0 0
67 BUFACORT - N (BLUD) 0 0 0
68 DARYANTULLE (BLUD) 0 0 0
69 ETIL KLORIDA SPRAY (BLUD) 0 0 0
70 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0 0 0
71 GLIMEPIRIDE 2 MG TABLET (BLUD) 250 250 250
72 KAOLIN PEKTIN SIRUP (NOVADIAR) 0 0 0
73 PIRACETAM KAPSUL (BLUD) 0 0 0
74 TIAMFENIKOL KAPSUL (BLUD) 0 0 0
75 VITAMIN ANAK SIRUP (SAMCOVIT) 0 0 0
76 ANTIHEMOROID/BORRAGINOL (BLUD) 0 0 0
77 ASAM TRANEKSAMAT (BLUD) 0 0 0
78 ASETILSISTEIN (BLUD) 0 0 0
79 ASETOSAL TABLET 100 (80) MG (BLUD) 0 0 0
80 ASIKLOVIR SALEP KULIT (BLUD) 0 0 0
81 BEDAK SALISIL (BLUD) 0 0 0
82 BETAHISTIN TABLET (BLUD) 0 0 0
83 CTM (BLUD) 0 0 0
84 GLIMEPIRID 1 MG (BLUD) 1,000 1,000 1,000
85 GLUKOSA INFUS (BLUD) 0 0 0
86 ISDN (BLUD) 0 0 0
87 METILPREDNISOLON TABLET 4 MG (BLUD) 0 0 0
88 METRONIDAZOL (BLUD) 0 0 0
89 OKSITETRASIKLIN SALEP KULIT (BLUD) 0 0 0
90 POVIDONE IODINE 60ML (BLUD) 0 0 0
91 RANITIDIN TABLET (BLUD) 0 0 0
92 SETERIZIN TABLET (BLUD) 200 200 200
93 VITAMIN B KOMPLEKS (BLUD) 0 0 0
94 VITAMIN B1 (BLUD) 0 0 0
95 0 0 0 0
96 0 0 0 0

Blitar , 01 July 2022


Mengetahui / Menyetujui
Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Petugas Petugas Pengelola Obat
SUMBERINGIN Instalasi Farmasi Kabupaten Pustu/Polindes/Ponkesdes
SISA STOK JUMLAH
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN STOK IFK
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12

0 Apt. AINA MUJTAHIDA A, S.Farm. ENDAH ROSITANINGSIH, SE, MM


NIP. 0 NIP : 198612188 11033 2 0004 NIP. 196912302010012002
ASETIL (DINKES)

DEXAMETHASONE (DINKES)

OBH (DINKES)
AMBROXOL
BATUK FLU SIRUP/ ETAFLUSIN (BLUD)
BATUK FLU TABLET/ETAFLUSIN (BLUD)
BETADINE GARGLE (BLUD)
BUFACOMB SALEP (BLUD)
BUFACORT - N (BLUD)
DARYANTULLE (BLUD)
ETIL KLORIDA SPRAY (BLUD)
GLIBENCLAMIDE TABLET 5 MG (BLUD)
GLIMEPIRIDE 2 MG TABLET (BLUD)
KAOLIN PEKTIN SIRUP (NOVADIAR)
PIRACETAM KAPSUL (BLUD)
TIAMFENIKOL KAPSUL (BLUD)
VITAMIN ANAK SIRUP (SAMCOVIT)
ANTIHEMOROID/BORRAGINOL (BLUD)
ASAM TRANEKSAMAT (BLUD)
ASETILSISTEIN (BLUD)
ASETOSAL TABLET 100 (80) MG (BLUD)
ASIKLOVIR SALEP KULIT (BLUD)
BEDAK SALISIL (BLUD)
BETAHISTIN TABLET (BLUD)
CTM (BLUD)
GLIMEPIRID 1 MG (BLUD)
GLUKOSA INFUS (BLUD)
ISDN (BLUD)
METILPREDNISOLON TABLET 4 MG (BLUD)
METRONIDAZOL (BLUD)
OKSITETRASIKLIN SALEP KULIT (BLUD)
POVIDONE IODINE 60ML (BLUD)
RANITIDIN TABLET (BLUD)
SETERIZIN TABLET (BLUD)
VITAMIN B KOMPLEKS (BLUD)
VITAMIN B1 (BLUD)
DINAS KESEHATAN KABUPATEN BLITAR
PROLANIS 2022
PEMASUKAN
STOK
JAN FEB MAR APR MEI JUNI
NO NAMA OBAT AWA
L

1 2 WAY FOLEY CATHETER NO.16 0 0 0 0 0 0 0


2 2 WAY FOLEY CATHETER NO.18 0 0 0 0 0 0 0
3 2 WAY FOLEY CATHETER NO.20 0 0 0 0 0 0 0
4 ACETYLCYSTEINE CAPSULE 200 MG 0 0 0 0 0 0 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML 0 0 0 0 0 0 0
6 ALAT SUNTIK SEKALI PAKAI 10 ML 0 0 0 0 0 0 0
7 ALAT SUNTIK SEKALI PAKAI 20 ML 0 0 0 0 0 0 0
8 ALAT SUNTIK SEKALI PAKAI 3 ML 0 0 0 0 0 0 0
9 ALAT SUNTIK SEKALI PAKAI 5 ML 0 0 0 0 0 0 0
10 ALKOHOL SWAB 0 0 0 0 0 0 0
11 ALLOPURINOL TABLET 100 MG 0 0 0 0 0 0 0
12 ALPRAZOLAM 1 MG TABLET 0 0 0 0 0 0 0
13 AMBROXOL SIRUP 5MG/ML 0 0 0 0 0 0 0
14 AMBROXOL TABLET 30 MG 0 0 0 0 0 0 0
15 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML 0 0 0 0 0 0 0
16 AMINOPHYLLINE TABLET 200 MG 0 0 0 0 0 0 0
17 AMITRIPTYLLINE HCL TABLET 25 MG 0 0 0 0 0 0 0
18 AMLODIPINE TABLET 10 MG 0 0 0 0 0 0 0
19 AMLODIPINE TABLET 5 MG 0 0 0 0 0 0 0
20 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 M 0 0 0 0 0 0 0
21 AMOKSISILIN SERBUK INJEKSI 1000 MG 0 0 0 0 0 0 0
22 AMOKSISILIN TABLET 500 MG 0 0 0 0 0 0 0
23 AMOXCICILIN FORTE SYRUP KERING 250M 0 0 0 0 0 0 0
24 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VI 0 0 0 0 0 0 0
25 ANTALGIN 500 MG TABLET (METAMIZOL) 0 0 0 0 0 0 0
26 ANTASIDA DOEN TABLET KOMBINASI 0 0 0 0 0 0 200
27 ANTASIDA SUSPENSI 60 ML 0 0 0 0 0 0 0
28 ANTI BAKTERI DOEN SALEP KOMBINASI 5 G 0 0 0 0 0 0 0
29 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR 0 0 0 0 0 0 0
30 ANTI HAEMOROID DOEN KOMBINASI 0 0 0 0 0 0 0
31 ANTI MIGRAIN DOEN TABLET KOMBINASI 0 0 0 0 0 0 0
32 ANTI SPASMODIK INJEKSI (SPASHI) 0 0 0 0 0 0 0
33 ANTI SPASMODIK TABLET (DORMICOMP) 0 0 0 0 0 0 0
34 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 0 0 0 0 0 0 0
35 ASAM ASKORBAT ( VIT C ) TABLET 250 MG 0 0 0 0 0 0 0
36 ASAM ASKORBAT ( VIT C ) TABLET 50 MG 0 0 0 0 0 0 0
37 ASAM FOLAT 1MG TABLET 0 0 0 0 0 0 0
38 ASAM MEFENAMAT TABLET 500 MG 0 0 0 0 0 0 0
39 ASAM TRANEKSAMAT 100 MG/ML INJEKSI 0 0 0 0 0 0 0
40 ASAM TRANEKSAMAT 500 MG TABLET 0 0 0 0 0 0 0
41 ASAM VALPROAT 250 MG TABLET / DEPAK 0 0 0 0 0 0 0
42 ASEPTAN 500CC + PUMP 0 0 0 0 0 0 0
43 ASEPTIC GEL 500CC + DISPENSER 0 0 0 0 0 0 0
44 ASERING (ASETAT RINGER) SOFT BAG 0 0 0 0 0 0 0
45 ASETOSAL TABLET 100 (80) MG 0 0 0 0 0 0 0
46 ASIKLOVIR KREAM 5 % 5 GR 0 0 0 0 0 0 0
47 ASIKLOVIR TABLET 400 MG 0 0 0 0 0 0 0
48 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML 0 0 0 0 0 0 0
49 ATTAPULGIT + PECTIN TABLET 0 0 0 0 0 0 0
50 BETAHISTINE MESILAT 24 MG TABLET 0 0 0 0 0 0 0
51 BETAHISTINMESILAT 6 MG TABLET 0 0 0 0 0 0 0
52 BETAMETHASON CR 0.05% 20 GR 0 0 0 0 0 0 0
53 BETAMETHASONE CREAM 0,1 % 5 GR 0 0 0 0 0 0 0
54 BIONICOM ZINC TABLET 0 0 0 0 0 0 0
55 BISAKODIL SUPPOSITORIA 10 MG 0 0 0 0 0 0 0
56 BISAKODIL SUPPOSITORIA 5 MG 0 0 0 0 0 0 0
57 BISOPROLOL 2,5 MG TABLET (CONCOR) 0 0 0 0 0 0 0
58 BISOPROLOL 5 MG TABLET 0 0 0 0 0 0 0
59 CAT GUT NO. 3/0 CHROMIC 0 0 0 0 0 0 0
60 CAT GUT NO. 3/0 PLAIN 0 0 0 0 0 0 0
61 CITICHOLIN 250 MG/ML-2ML INJEKSI 0 0 0 0 0 0 0
62 CLONIDINE 0.15 MG TABLET 0 0 0 0 0 0 0
63 CLOPIDOGREL 75 MG 0 0 0 0 0 0 0
64 COMBIVENT UDV INHALASI 0 0 0 0 0 0 0
65 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML 0 0 0 0 0 0 0
66 DEKSAMETHASONE TABLET 0,5 MG 0 0 0 0 0 0 0
67 DEVITALISASI PASTA ( NON ARSEN ) 0 0 0 0 0 0 0
68 DIAZEPAM INJEKSI 5 MG/ML 2 ML 0 0 0 0 0 0 0
69 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML- 0 0 0 0 0 0 0
70 DIAZEPAM TABLET 2 MG 0 0 0 0 0 0 0
71 DIAZEPAM TABLET 5 MG 0 0 0 0 0 0 0
72 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 M 0 0 0 0 0 0 0
73 DIGOXIN TABLET 0,25 MG 0 0 0 0 0 0 0
74 DIMENHYDRINATE TABLET 50 MG 0 0 0 0 0 0 0
75 DOKSISIKLIN TABLET 100 MG 0 0 0 0 0 0 0
76 DOMPERIDON SUSPENSI 5MG/ML 0 0 0 0 0 0 0
77 DOMPERIDON TABLET 10 MG 0 0 0 0 0 0 0
78 EKSTRACT PLASENTA + NEOMYSIN SALEP 1 0 0 0 0 0 0 0
79 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML 0 0 0 0 0 0 0
80 ERITROMISIN KAPSUL 250 MG 0 0 0 0 0 0 0
81 ERITROMISIN SIRUP KERING 200 MG/5ML 0 0 0 0 0 0 0
82 ERITROMISIN TABLET 500 MG 0 0 0 0 0 0 0
83 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 0 0 0 0 0 0 0
84 ETANOL [ ALKOHOL ] 70 % 1000 ML 0 0 0 0 0 0 0
85 ETIL KLORIDA SEMPROT 100 ML 0 0 0 0 0 0 0
86 EUGENOL CAIRAN 10 ML 0 0 0 0 0 0 0
87 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 M 0 0 0 0 0 0 0
88 FENITOIN NATRIUM TABLET 100 MG 0 0 0 0 0 0 0
89 FENOBARBITAL INJEKSI 50 MG/ML 2 ML 0 0 0 0 0 0 0
90 FENOBARBITAL TABLET 30 MG 0 0 0 0 0 0 0
91 FENOL GLISEROL TETES TELINGA 10 % 5 M 0 0 0 0 0 0 0
92 FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 0 0 0 0 0 0 0
93 FITOMENADION ( VIT K1 ) TABLET SALUT 10 0 0 0 0 0 0 0
94 FITOMENADION INFANT INJ. 2MG/ML 0 0 0 0 0 0 0
95 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 0 0 0 0 0 0 0
96 FUROSEMID INJEKSI 10 mg 0 0 0 0 0 0 0
97 FUROSEMID TABLET 40 MG 0 0 0 0 0 0 200
98 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 0 0 0 0 0 0 0
99 GARAM ORALIT 0 0 0 0 0 0 0
100 GEMFIBROZIL 300 MG KAPSUL 0 0 0 0 0 0 0
101 GENTAMISIN SALEP KULIT 0,1 % 5 GR 0 0 0 0 0 0 0
102 GENTAMISIN SALEP MATA 0,3% 0 0 0 0 0 0 0
103 GENTAMISIN TETES MATA 0,3% 0 0 0 0 0 0 0
104 GLASS IONOMER CEMENT ( GC IX ) 0 0 0 0 0 0 0
105 GLIBENCLAMIDE TABLET 5 MG 0 0 0 0 0 0 0
106 GLICERIL GUAIACOLAT TABLET 100 MG 0 0 0 0 0 0 0
107 GLIMEPIRIDE 1 MG TABLET 0 0 0 0 0 0 0
108 GLIMEPIRIDE 2 MG TABLET 0 0 0 0 0 0 200
109 GLUKOSA 40% DEXTROSE INJECTION U.S.P 0 0 0 0 0 0 0
110 GLUKOSA LARUTAN INFUS 10 % STERIL 0 0 0 0 0 0 0
111 GLUKOSA LARUTAN INFUS 5 % STERIL 0 0 0 0 0 0 0
112 GRISEOFULVIN TABLET 125 MG 0 0 0 0 0 0 0
113 HALOPERIDOL 2 MG 0 0 0 0 0 0 0
114 HALOPERIDOL DEKANOAT INJ 50 MG 0 0 0 0 0 0 0
115 HALOPERIDOL INJ. 5 MG/ML (LODOMER) 0 0 0 0 0 0 0
116 HALOPERIDOL TABLET 1,5 MG 0 0 0 0 0 0 0
117 HALOPERIDOL TABLET 5 MG 0 0 0 0 0 0 0
118 HERBAKOF SYRUP 60ML 0 0 0 0 0 0 0
119 HES-HYDROXYETHYL STARCH 6 %/VOLUVEN 0 0 0 0 0 0 0
120 HIDROCORTISON CR 1% 0 0 0 0 0 0 0
121 HIDROCORTISONE CREAM 2,5 % 5 GR 0 0 0 0 0 0 0
122 HYDROCHLORTHIAZIDE 25 MG 0 0 0 0 0 0 0
123 I.V CATHETER NO.16 WITH INJECTION PORT 0 0 0 0 0 0 0
124 I.V CATHETER NO.18 WITH INJECTION PORT 0 0 0 0 0 0 0
125 I.V CATHETER NO.20 WITH INJECTION POR 0 0 0 0 0 0 0
126 I.V CATHETER NO.22 WITH INJECTION POR 0 0 0 0 0 0 0
127 I.V CATHETER NO.24 WITH INJECTION POR 0 0 0 0 0 0 0
128 I.V CATHETER NO.26 WITH INJECTION POR 0 0 0 0 0 0 0
129 IBUPROFEN FORTE SYRUP 200MG/5ML 0 0 0 0 0 0 0
130 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML 0 0 0 0 0 0 0
131 IBUPROFEN TABLET 400 MG 0 0 0 0 0 0 0
132 INFUSION SET ANAK 0 0 0 0 0 0 0
133 INFUSION SET DEWASA 0 0 0 0 0 0 0
134 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG 0 0 0 0 0 0 0
135 KAEN 3B 0 0 0 0 0 0 0
136 KALIUM DIKLOFENAK 50 MG TABLET 0 0 0 0 0 0 0
137 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 0 0 0 0 0 0 0
138 KALSIUM LAKTAT (KALK) TABLET 500 MG 0 0 0 0 0 0 0
139 KANTONG URINE DEWASA 0 0 0 0 0 0 0
140 KAPAS PEMBALUT/ABSORBEN 250 GR 0 0 0 0 0 0 0
141 KAPTOPRIL TABLET 25 MG 0 0 0 0 0 0 0
142 KARBAMAZEPIN TABLET 200 MG 0 0 0 0 0 0 0
143 KASA KOMPRES 40/40 STERIL 0 0 0 0 0 0 0
144 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL 0 0 0 0 0 0 0
145 KASA PEMBALUT HIDROFIL 2 M X 80 CM 0 0 0 0 0 0 0
146 KASA PEMBALUT HIDROFIL 4 M X 10 CM 0 0 0 0 0 0 0
147 KASA PEMBALUT HIDROFIL 4 M X 5 CM 0 0 0 0 0 0 0
148 KASA STERIL (DARYAN TOLLE)YG DIRESAPI 0 0 0 0 0 0 0
149 KETOKONAZOLE TABLET 200 MG 0 0 0 0 0 0 0
150 KETOPROFEN 100 MG SUPPOSITORIA 0 0 0 0 0 0 0
151 KLINDAMISIN KAPSUL 150 MG 0 0 0 0 0 0 0
152 KLINDAMISIN KAPSUL 300 MG 0 0 0 0 0 0 0
153 KLOBAZAM 10 MG TABLET 0 0 0 0 0 0 0
154 KLORAMFENIKOL KAPSUL 500 MG 0 0 0 0 0 0 0
155 KLORAMFENIKOL SALEP KULIT 2 % 0 0 0 0 0 0 0
156 KLORAMFENIKOL SALEP MATA 1 % 0 0 0 0 0 0 0
157 KLORAMFENIKOL SUSPENSI 125 MG/5 ML 0 0 0 0 0 0 0
158 KLORAMFENIKOL TETES TELINGA 3 % 0 0 0 0 0 0 0
159 KLORFENIRAMINE MALEAT (CTM) TABLET 0 0 0 0 0 0 0
160 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 M 0 0 0 0 0 0 0
161 KLORPROMAZIN HCL INJEKSI 50 MG/ML 1 M 0 0 0 0 0 0 0
162 KLORPROMAZIN HCL TABLET 100 MG 0 0 0 0 0 0 0
163 KLOZAPIN 100 MG TABLET 0 0 0 0 0 0 0
164 KLOZAPIN 25 MG TABLET 0 0 0 0 0 0 0
165 KODEIN HCL TABLET 10 MG 0 0 0 0 0 0 0
166 KOTRIMOKSAZOL DEWASA TABLET 0 0 0 0 0 0 0
167 KOTRIMOKSAZOL SUSPENSI 60 ML 0 0 0 0 0 0 0
168 LEVOFLOXACIN TABLET 500 MG 0 0 0 0 0 0 0
169 LIDOCAIN 2% INJ 0 0 0 0 0 0 0
170 LIDOCAIN COMPOSITUM INJEKSI 2 ML 0 0 0 0 0 0 0
171 LISOL CONCENTRATE 1000 ML 0 0 0 0 0 0 0
172 LOPERAMIDE TABLET 2 MG 0 0 0 0 0 0 0
173 LORATADIN TABLET 10 MG 0 0 0 0 0 0 0
174 LORAZEPAM 2 MG 0 0 0 0 0 0 0
175 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 M 0 0 0 0 0 0 0
176 MASKER EARLOOP PLUS 0 0 0 0 0 0 0
177 MASKER KERTAS 3 PLY EAR LOOP 0 0 0 0 0 0 0
178 MASKER KERTAS 3 PLY TIE ON 0 0 0 0 0 0 0
179 MASKER N95 0 0 0 0 0 0 0
180 MELOKSIKAM TABLET 7,5 MG 0 0 0 0 0 0 0
181 METAMIZOL (NORAGES) INJEKSI 500 MG/2 0 0 0 0 0 0 0
182 METFORMIN TABLET 500 MG 0 0 0 0 0 0 400
183 METILERGOMETRIN MALEAT INJEKSI 0,200 0 0 0 0 0 0 0
184 METILERGOMETRIN MALEAT TABLET 0,125 0 0 0 0 0 0 0
185 METILPREDNISOLON TABLET 4 MG 0 0 0 0 0 0 0
186 METOKLOPRAMIDE 10 MG TABLET 0 0 0 0 0 0 0
187 METOKLOPRAMIDE 5 MG TABLET 0 0 0 0 0 0 0
188 METOKLOPROMIDE (SOTATIC) INJEKSI 5 M 0 0 0 0 0 0 0
189 METOKLOPROMIDE SIRUP 0 0 0 0 0 0 0
190 METRONIDAZOL + NYSTATIN VAG. (PROVAGI 0 0 0 0 0 0 0
191 METRONIDAZOL TABLET 250 MG 0 0 0 0 0 0 0
192 METRONIDAZOL TABLET 500 MG 0 0 0 0 0 0 0
193 METRONIDAZOLE INFUS 5 MG/ML 100 ML 0 0 0 0 0 0 0
194 MIKONAZOL KREAM 10 GR 0 0 0 0 0 0 0
195 MINERAL MIX 0 0 0 0 0 0 0
196 NATRIUM DIKLOFENAK TABLET 25 MG 0 0 0 0 0 0 0
197 NATRIUM DIKLOFENAK TABLET 50 MG 0 0 0 0 0 0 0
198 NATRIUM KLORIDA INFUS 0,9 % STERIL 0 0 0 0 0 0 0
199 NIFEDIPINE TABLET 10 MG 0 0 0 0 0 0 0
200 NISTATIN TABLET 500.000 UI 0 0 0 0 0 0 0
201 NISTATIN VAGINAL TABLET 100.000 UI 0 0 0 0 0 0 0
202 OBAT BATUK HITAM (OBH) CAIRAN 100 ML 0 0 0 0 0 0 0
203 OKSIGEN NASAL CANNULA ADULT 0 0 0 0 0 0 0
204 OKSIGEN NASAL CANNULA INFANT 0 0 0 0 0 0 0
205 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR 0 0 0 0 0 0 0
206 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR 0 0 0 0 0 0 0
207 OKSITOSIN INJEKSI 10 IU/ML 1 ML 0 0 0 0 0 0 0
208 OMEPRAZOLE TABLET 20 MG 0 0 0 0 0 0 0
209 ONDANSENTRON 4 MG/2 ML INJEKSI 0 0 0 0 0 0 0
210 PARACETAMOL SYRUP 120 MG/5 ML 60 ML 0 0 0 0 0 0 0
211 PARACETAMOL TABLET 500 MG 0 0 0 0 0 0 0
212 PARACETAMOL TETES 100 MG/ML 15 ML 0 0 0 0 0 0 0
213 PEHAVRAL TABLET 0 0 0 0 0 0 0
214 PERAK SULFADIAZIN KRIM 1 % 0 0 0 0 0 0 0
215 PERHYDROL [ H2O2 ] 3 % 800 ML 0 0 0 0 0 0 0
216 PERMETHRINE 5% CR 15 GRAM 0 0 0 0 0 0 0
217 PIRACETAM TABLET 800 MG 0 0 0 0 0 0 0
218 PIRANTEL PAMOAT TABLET 0 0 0 0 0 0 0
219 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG 0 0 0 0 0 0 0
220 PIROKSIKAM KAPSUL 10 MG 0 0 0 0 0 0 0
221 PLESTER 10 CM X 2 M 0 0 0 0 0 0 0
222 PREDNISON TABLET 5 MG 0 0 0 0 0 0 0
223 PROPRANOLOL HCL TABLET 40 MG 0 0 0 0 0 0 0
224 PROPILTHIOURACIL TABLET 100 MG 0 0 0 0 0 0 0
225 RANITIDIN INJEKSI 25 MG/ ML 0 0 0 0 0 0 0
226 RESPERIDON 2 MG TABLET 0 0 0 0 0 0 0
227 RINGER LAKTATE LARUTAN INFUS STERIL 0 0 0 0 0 0 0
228 SALBUTAMOL TABLET 2 MG 0 0 0 0 0 0 0
229 SALBUTAMOL TABLET 4 MG 0 0 0 0 0 0 0
230 SALEP 2-4 KOMBINASI 30 GR 0 0 0 0 0 0 0
231 SALICYL BEDAK 2 % 0 0 0 0 0 0 0
232 SARUNG TANGAM NON STERIL L 0 0 0 0 0 0 0
233 SARUNG TANGAN NON STERIL M 0 0 0 0 0 0 0
234 SARUNG TANGAN NON STERIL S 0 0 0 0 0 0 0
235 SARUNG TANGAN STERIL NO 6 0 0 0 0 0 0 0
236 SARUNG TANGAN STERIL NO. 7,5 0 0 0 0 0 0 0
237 SARUNG TANGAN STERILE NO.6,5 0 0 0 0 0 0 0
238 SARUNG TANGAN STERILE NO.7 0 0 0 0 0 0 0
239 SEFADROKSIL KAPSUL 500 MG 0 0 0 0 0 0 0
240 SEFIKSIM KAPSUL 100 MG 0 0 0 0 0 0 0
241 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML 0 0 0 0 0 0 0
242 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP 0 0 0 0 0 0 0
243 SETIRIZINE TABLET 10 MG 0 0 0 0 0 0 0
244 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 0 0 0 0 0 0 0
245 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 M 0 0 0 0 0 0 0
246 SILK (BENANG BEDAH SUTERA) NO.3/0 0 0 0 0 0 0 0
247 SIMETIDINE TABLET 200 MG 0 0 0 0 0 0 0
248 SIMVASTATIN TABLET 10 MG 0 0 0 0 0 0 0
249 SIPROFLOXACIN INFUS 2% 0 0 0 0 0 0 0
250 SIPROFLOXACIN TABLET 500 MG 0 0 0 0 0 0 0
251 SPONS GELATIN CUBICLES 1x1x1 CM 0 0 0 0 0 0 0
252 STIMUNO SYR 0 0 0 0 0 0 0
253 STIMUNO TAB (100) 0 0 0 0 0 0 0
254 STIMUNO TAB (30) 0 0 0 0 0 0 0
255 SULFADOKSIN TABLET 0 0 0 0 0 0 0
256 SULFASETAMID NATRIUM TETES MATA 15 % 0 0 0 0 0 0 0
257 TABLET TAMBAH DARAH 0 0 0 0 0 0 0
258 TEMPORARY CAVITY SEALER [TUMPATAN S 0 0 0 0 0 0 0
259 TETAGRAM 150 IU 0 0 0 0 0 0 0
260 TETRAKAIN HCL TETES MATA 5 ML 0 0 0 0 0 0 0
261 TETRASIKLIN HCL TABLET 500 MG 0 0 0 0 0 0 0
262 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 0 0 0 0 0 0 0
263 THIAMIN HCL MONONITRAT (VIT B1) TABLET 0 0 0 0 0 0 0
264 THIAMIN HCL MONONITRAT (VIT B1) TABLE 0 0 0 0 0 0 0
265 TRAMADOL INJEKSI 50 MG/ML 0 0 0 0 0 0 0
266 TRANFUSION SET ADULT WITH Y INJECTIO 0 0 0 0 0 0 0
267 TRIFLOUPERASIN TABLET 5 MG 0 0 0 0 0 0 0
268 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 0 0 0 0 0 0 0
269 VITAMIN B COMPLEX TABLET 0 0 0 0 0 0 0
270 YODIUM POVIDON LARUTAN 10 % 30 ML 0 0 0 0 0 0 0
271 YODIUM POVIDON LARUTAN 10% 60 ML 0 0 0 0 0 0 0
272 ZENTRA (TRIPROLIDINE|PSEUDOEPHEDRINE) 0 0 0 0 0 0 0
273 ZINK 20 MG TABLET 0 0 0 0 0 0 0
274 Hi-D 1000 CHOLECALCIFEROL 0 0 0 0 0 0 0
OBAT PROGRAM / HIBAH
1 AMITRIPTYLINE 25 MG 0 0 0 0 0 0 0
2 HALOPERIDOLE INJEKSI 0 0 0 0 0 0 0
3 HALOPERIDOLE 1,5 MG 0 0 0 0 0 0 0
4 HALOPERIDOLE 5 MG 0 0 0 0 0 0 0
5 LODOMER 2 MG 0 0 0 0 0 0 0
6 LODOMER 5 MG 0 0 0 0 0 0 0
7 TRIHEXYPHENIDYL 2 MG 0 0 0 0 0 0 0
8 ALAT SUNTIK 0,05 ML (PROGRAM) 0 0 0 0 0 0 0
9 ALAT SUNTIK 0,5 ML (PROGRAM) 0 0 0 0 0 0 0
10 ALAT SUNTIK 5 ML (PROGRAM) 0 0 0 0 0 0 0
11 ALBENDAZOL TABLET 400 MG 0 0 0 0 0 0 0
12 BENZATINE BENZYLPENICILLIN 2.400.000 IU 0 0 0 0 0 0 0
13 COTRIMOXAZOLE 800/160 0 0 0 0 0 0 0
14 DIETHYLCARBAMAZINE 100 MG 0 0 0 0 0 0 0
15 GARAM ORALIT UNTUK 200 ML AIR 0 0 0 0 0 0 0
16 HIV ABACAVIR TABLET 300 MG 0 0 0 0 0 0 0
17 HIV ACRIPTEGA (TDF 300 + 3TC 300 + DTG 5 0 0 0 0 0 0 0
18 HIV DOLUTEGRAFIR 50 MG 0 0 0 0 0 0 0
19 HIV EFAFIRENZ 200 MG TABLET 0 0 0 0 0 0 0
20 HIV EFAFIRENZ 600 MG TABLET 0 0 0 0 0 0 0
21 HIV LAMIVUDIN 150 MG TABLET 0 0 0 0 0 0 0
22 HIV NEVIRAPINE 200 MG TABLET 0 0 0 0 0 0 0
23 HIV TENOFOVIR 300 MG 0 0 0 0 0 0 0
24 HIV TRIPLE FDC ANAK (ZIDOVUDIN 60MG+L 0 0 0 0 0 0 0
25 HIV TRIPLE FDC DEWASA (TDC+3TC+EFV (30 0 0 0 0 0 0 0
26 HIV ZIDOVUDINE 100 MG @60 KAPSUL 0 0 0 0 0 0 0
27 HIV ZIDOVUDINE 300 MG + LAMIVUDIN 150 0 0 0 0 0 0 0
28 HIV ZIDOVUDINE SYRUP 240 ML 0 0 0 0 0 0 0
29 IODINE TES 0 0 0 0 0 0 0
30 ISONIAZID TABLET 100 MG 0 0 0 0 0 0 0
31 ISONIAZID TABLET 300 MG 0 0 0 0 0 0 0
32 KOMBIPAK AZITHROMYCIN - CEFIXIME KOM 0 0 0 0 0 0 0
33 MDT COMBI - MB ADULT (RED) 0 0 0 0 0 0 0
34 MDT COMBI - MB CHILD (ORANGE) 0 0 0 0 0 0 0
35 MDT COMBI - PB ADULT (GREEN) 0 0 0 0 0 0 0
36 OBAT ANTI TUBERKULOSIS ANAK 0 0 0 0 0 0 0
37 OBAT ANTI TUBERKULOSIS DOSIS HARIAN ST 0 0 0 0 0 0 0
38 OBAT ANTI TUBERKULOSIS KATEGORI 1 0 0 0 0 0 0 0
39 OBAT ANTI TUBERKULOSIS KATEGORI 2 0 0 0 0 0 0 0
40 OBAT ANTI TUBERKULOSIS KOMBIPAK KATEG 0 0 0 0 0 0 0
41 PARACETAMOL 500 MG (P2) 0 0 0 0 0 0 0
42 PIRIDOKSIN 25 MG TABLET (VIT B6) 0 0 0 0 0 0 0
43 PYRIMETAMINE 0 0 0 0 0 0 0
44 REAGEN HIV (FOKUS) 0 0 0 0 0 0 0
45 REAGEN HIV (STANDART DIAGNOSTIC/SD) 0 0 0 0 0 0 0
46 REAGEN HIV (VIKIA) 0 0 0 0 0 0 0
47 REAGEN HIV DIAGNOSTAR HIV 1\/2 ONE STE 0 0 0 0 0 0 0
48 REAGEN HIV DIAGNOSTIC KIT FOR HIV (1+2 0 0 0 0 0 0 0
49 REAGEN SYPHILIS (TREPOCHECK) 0 0 0 0 0 0 0
50 REAGEN SYPHILIS RDT (FOKUS) 0 0 0 0 0 0 0
51 RETINOL ( VIT A ) KAPSUL 100.000 IU 0 0 0 0 0 0 0
52 RETINOL ( VIT A ) KAPSUL 200.000 IU 0 0 0 0 0 0 0
53 SAFETY BOX 0 0 0 0 0 0 0
54 SERUM ANTI DIFTERI CAIRAN INJEKSI 125 M 0 0 0 0 0 0 0
55 TABLET TAMBAH DARAH (PROGRAM) 0 0 0 0 0 0 0
56 ZINK TABLET DISPERSIBLE 20 MG (PROGRAM 0 0 0 0 0 0 0
57 ALBENDAZOLE SIRUP 0 0 0 0 0 0 0
58 COTRIMOXAZOLE 400/80 0 0 0 0 0 0 0
59 MINERAL MIX 0 0 0 0 0 0 0
60 SD BIOLINE Syphilis 3.0 One Step Syphilis A 0 0 0 0 0 0 0
OBAT TAMBAHAN
1 ALKOHOL SWAB 0 0 0 0
2 ALLOPURINOL 0 0 0 0
3 AMLODIPINE 5MG (BLUD) 0 0 0 1,800
4 ANTISEPTIK GEL (DINKES) 0 0 0 0
5 APD VAKSIN 0 0 0 0
6 APRON (DINKES) 0 0 0 0
7 AQUA PRO INJEKSI (BLUD) 0 0 0 0
8 ASAM MEFENAMAT TABLET 500 MG (BLUD) 0 0 0 0
9 ASIKLOVIR TABLET 0 0 0 0
10 BETAMETHASONE SALEP KULIT (BLUD) 0 0 0 0
11 BIOPLACENTON (BLUD) 0 0 0 0
12 BISAKODIL TABLET 5 MG (BLUD) 0 0 0 0
13 CIPROFLOXACIN (BLUD) 0 0 0 0
14 CLINDAMISIN KAPS (BLUD) 0 0 0 0
15 DEKSAMETHASONE HARSEN TABLET 0,5 MG ( 0 0 0 0
16 DOMPERIDONE TABLET 10 MG ( (BLUD)) 0 0 0 0
17 EPINEFRIN INJEKSI (BLUD) 0 0 0 0
18 FENITOIN KAPS (BLUD) 0 0 0 0
19 FITOMENADION INJ (BLUD) 0 0 0 0
20 FITOMENADION TABLET (BLUD) 0 0 0 0
21 FUROSEMIDE TABLET 0 0 0 0
22 GEMFIBROZIL (BLUD) 0 0 0 0
23 GENOINT (BLUD) 0 0 0 0
24 GENTAMICIN TETES MATA (BLUD) 0 0 0 0
25 GENTIAN VIOLET LARUTAN 1 % (BLUD) 0 0 0 0
26 GLISERIL GUAIKOLAT/GUAIFENESIN BLUD 0 0 0 0
27 HIDROKORTISON CREAM KULIT (BLUD) 0 0 0 0
28 HYOSCINE BUTYLBROMIDE (ANTI SPASMODI 0 0 0 0
29 HYPAFIX (BLUD) 0 0 0 0
30 INFUSET (BLUD) 0 0 0 0
31 IV CATHETER (BLUD) 0 0 0 0
32 KAPTOPRIL TABLET 12,5 MG (BLUD) 0 0 0 500
33 KLORAMFENIKOL SIRUP (BLUD) 0 0 0 0
34 KLORAMFENIKOL TETES TELINGA (BLUD) 0 0 0 0
35 KOTRIMOKSAZOL TAB (BLUD) 0 0 0 0
36 LOPERAMIDE TABLET 2 MG (BLUD) 0 0 0 0
37 MASKER (DINKES) 0 0 0 0
38 MASKER N9 0 0 0 0
39 METFORMIN (BLUD) 0 0 0 0
40 METILERGOMETRINE INJ (BLUD) 0 0 0 0
41 MULTIVITAMIN KOMB 0 0 0 0
42 NEW DIATABS (BLUD) 0 0 0 0
43 NIFEDIPINE TAB (BLUD) 0 0 0 0
44 NURSE CAP 0 0 0 0
45 OMEPRAZOLE 20MG 0 0 0 0
46 ONDANSETRONE INJEKSI (BLUD) 0 0 0 0
47 PARACETAMOL TABLET 500 MG (BLUD) 0 0 0 0
48 PEHAVRAL 0 0 0 0
49 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG (BLU 0 0 0 0
50 PIROXICAM 0 0 0 0
51 SALBUTAMOL TABLET 2 MG (BLUD) 0 0 0 0
52 SARUNG TANGAN OBGYN 0 0 0 0
53 SARUNG TANGAN OBGYN 0 0 0 0
54 SEFADROKSIL KAPSUL 500 MG (BLUD) 0 0 0 0
55 VGEL (BLUD) 0 0 0 0
56 VITAMIN C 50 MG (BLUD) 0 0 0 0
57 ZIVIT ZINC 0 0 0 0
58 ASETIL (DINKES) 0 0 0 0
59 DEXAMETHASONE (DINKES) 0 0 0 0
60 OBH (DINKES) 0 0 0 0
61 AMBROXOL 0
62 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) 0
63 BATUK FLU TABLET/ETAFLUSIN (BLUD) 0
64 BETADINE GARGLE (BLUD) 0
65 BUFACOMB SALEP (BLUD) 0
66 BUFACORT - N (BLUD) 0
67 DARYANTULLE (BLUD) 0
68 ETIL KLORIDA SPRAY (BLUD) 0
69 GLIBENCLAMIDE TABLET 5 MG (BLUD) 0
70 GLIMEPIRIDE 2 MG TABLET (BLUD) 0
71 KAOLIN PEKTIN SIRUP (NOVADIAR) 0
72 PIRACETAM KAPSUL (BLUD) 0
73 TIAMFENIKOL KAPSUL (BLUD) 0
74 VITAMIN ANAK SIRUP (SAMCOVIT) 0
75 ANTIHEMOROID/BORRAGINOL (BLUD) 0
76 ASAM TRANEKSAMAT (BLUD) 0
77 ASETILSISTEIN (BLUD) 0
78 ASETOSAL TABLET 100 (80) MG (BLUD) 0
79 ASIKLOVIR SALEP KULIT (BLUD) 0
80 BEDAK SALISIL (BLUD) 0
81 BETAHISTIN TABLET (BLUD) 0
82 CTM (BLUD) 0
83 GLIMEPIRID 1 MG (BLUD) 0
84 GLUKOSA INFUS (BLUD) 0
85 ISDN (BLUD) 0
86 METILPREDNISOLON TABLET 4 MG (BLUD) 0
87 METRONIDAZOL (BLUD) 0
88 OKSITETRASIKLIN SALEP KULIT (BLUD) 0
89 POVIDONE IODINE 60ML (BLUD) 0
90 RANITIDIN TABLET (BLUD) 0
91 SETERIZIN TABLET (BLUD) 0
92 VITAMIN B KOMPLEKS (BLUD) 0
93 VITAMIN B1 (BLUD) 0
94 0
95
kartu stok
JULI AGUST SEPT OKT NOV DES TOTAL JAN FEB MAR APR MEI JUNI

0 0 0 0 0 22 JUNI 22
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 200 0 0 0 0 0 200
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
200 0 0 0 0 0 400 0 0 0 0 0 200
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
500 0 0 0 0 0 500 0 0 0 0 0 0
0 0 0 0 0 0 200 0 0 0 0 0 200
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 300 0 0 0 300 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 400 0 0 0 0 0 400
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 300 0 0 0 300 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 50 0 0 50 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 900 0 2,700 0 0 0 0 0 1,800
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 100 0 100 0 200 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 200 200 200 0 600 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
100 0 0 0 0 0 600 0 0 0 0 0 500
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 1,000 0 400 0 0 1,400 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 150 0 0 0 150 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 500 0 0 500 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1,000 0 1,000 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 200 0 200 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0
PAKAI
JULI AGUST SEPT OKT NOV DES TOTAL B/S JAN FEB

11 JULI 22 0 22/09/2022
21 OKTOBER 22
NOV 222 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 200 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
200 0 0 0 0 0 400 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
500 0 0 0 0 0 500 1 0 0
0 0 0 0 0 0 200 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 300 0 0 0 300 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 400 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 300 0 0 0 300 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 50 0 0 50 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 900 0 2,700 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 200 200 0 0 400 0 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
100 0 0 0 0 0 600 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 1,000 0 400 0 0 1,400 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 150 0 0 0 150 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
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0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 500 0 0 500 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 1,000 0 1,000 1
0 0 0 0 0 0 0 1
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0 0 0 0 0 0 0 1
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0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 200 0 200 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 1
0 0 0 0 1
SISA
MAR APR MEI JUNI JULI AGUST SEPT OKT NOV DES TOTAL JAN FEB

0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 10 10 0 0 25 0 0 45 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 360 140 0 0 0 0 500 0 0
0 0 0 200 0 0 0 0 0 0 200 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Yang MYang MYang MYang MYang MYang M 0 0 0 0 0 0 0
PetugasPetugasPetugasPetugasPetugasPetugas 0 0 0 0 0 0 0
Pustu/PPustu/PPustu/PPustu/PPustu/PPustu/P 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
APRILLI APRILLI APRILLI APRILLI APRILLI APRILLI 0 0 0 0 0 0 0
NIP. NIP. NIP. NIP. NIP. NIP. 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL REAL PAKCEK

0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
98 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
45 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
500 1
200 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
400 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
46 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
45 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
2,700 0
0 1
0 1
0 1
0 1
92 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
20 1
0 1
0 1
0 1
0 1
0 1
30 1
0 1
0 1
0 1
0 1
0 1
0 1
810 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1

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