Rancaseneng 2023

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUSKESMAS 2022
PUSKESMAS : CIKEUSIK/RANCASENENG
KECAMATAN : CIKEUSIK DOKUMEN NOMOR TANGGAL
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE mar DINKES KAB/KOTA
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE april GFK KAB/KOTA
PUSKESMAS
mar
Jumlah
Stok
Jumlah Permintaa PEMBERIAN JUMLAH
Optimum
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Persediaa Pemakaian Stok Akhir n
n BUFFER
APBD II JKN PROG LAIN LAIN
STOK
1 Alprazolam Tablet 0 0 0 0
2 Albendazol Tablet 400 mg Tablet 0 0 0 0
3 Allopurinol tablet 100 mg Tablet 0 0 0 0
Allopurinol tablet 100 mg Tablet 0 100 100 100 0
4 Ambroxol sirup Botol 0 0 0 0
5 Ambroxol tablet 30 mg Tablet 0 0 0 0
6 Aminofilin Tablet 200 mg Tablet 0 0 0 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 0 0 0
8 Amlodipin 10 mg Tablet 0 0 0 0
Amlodipin 10 mg Tablet 0 0 0 0
9 Amlodipin Besilate 5 mg Tablet 0 0 0 0
Amlodipin Besilate 5 mg Tablet 0 30 30 30 0
10 Amoksisilin Forte sirup kering 250mg Botol 0 0 0 0
11 Amoksisilin Injeksi 1 gr Vial 0 0 0 0
12 Amoksisilin Tablet 500 mg Tablet 0 0 0 0
Amoksisilin Tablet 500 mg kaplet 40 200 240 240 0
13 Amoksisillin kapsul 250 mg Kapsul 0 0 0 0
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 0 0 0 0
Amoksisillin Sirup Kering 125 mg/5 ml Botol 0 5 5 5 0
15 Ampisilin Injeksi 1 gr Vial 0 0 0 0
16 Analog insulin Long Acting Pen 0 0 0 0
17 Analog insulin Mix Acting Pen 0 0 0 0
18 Antalgin (Metampiron) tablet 500 mg Tablet 0 0 0 0
20 Antasida DOEN suspensi Botol 0 5 5 5 0
21 ANTASIDA DOEN Tablet Tablet 0 100 100 100 0
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 0 0 0 0
23 anti hemoroid doen kombinasi supp 0 0 0 0
24 Antifungi DOEN Tube 0 0 0 0
25 Antimigren DOEN Kombinasi : Tablet 0 0 0 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet 0 0 0 0
27 Antiparkinson Tablet ( Levopar ) Tablet 0 0 0 0
28 Aqua Pro Injeksi Vial 0 0 0 0
29 Artermeter injeksi Ampul 0 0 0 0
30 Artesunate injeksi 60 mg/ml vial 0 0 0 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 0 0 0 0
32 Asam Folat Botol 0 0 0 0
33 Asam Fusidat Cream Tube 0 0 0 0
34 Asam Klorida 0,1 N Botol 0 0 0 0
35 Asam Mefenamat 500 mg Tablet 0 0 0 0
Asam Mefenamat 500 mg Tablet 0 100 100 100 0
36 Asam Traneksamat Inj 5% Ampul 0 0 0 0
37 Asering Botol 0 0 0 0
38 Asetosal tablet 500 mg Tablet 0 0 0 0
39 Asetyl Cysteine Capsul 0 0 0 0
40 Asiklovir Cream 5% Tube 0 0 0 0
41 Asiklovir tablet 200 mg Tablet 0 0 0 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0 0 0 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0 0 0 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0 0 0 0
46 Berotec Metered Aerosol 100 mg Bok 0 0 0 0
47 Betadine Salep Antiseptik 5 mg Tube 0 0 0 0
48 Betametason krim 0,1 % Tube 2 3 5 5 0
49 Bisakodil Suppositoria supp 0 0 0 0
50 Bisoprolol 2,5 mg Tablet 0 0 0 0
51 Bisoprolol 5 mg Tablet 0 0 0 0
52 Cairan Infus KN-3B Botol 0 0 0 0
53 Cairan Infus Wida KDN 1 Botol 0 0 0 0
Cairan Infus Wida KDN 2 Botol 0 0 0 0
54 Cairan Pembersih ( Protektor ) Botol 0 0 0 0
55 Captopril Tablet 12,5 mg Tablet 0 0 0 0
56 Captopril Tablet 25 mg Tablet 0 100 100 100 0
57 Cefadroxil Capsul 500 mg Capsul 0 0 0 0
58 Cefixime Capsul 100 mg Capsul 0 0 0 0
59 Cefixime Sirup Botol 0 0 0 0
60 Cefotaksime 1 gr Injeksi Vial 0 0 0 0
61 Cetirizine Capsul 50 mg Capsul 0 0 0 0
62 Cetirizine sirup 5 mg/5 ml Botol 0 0 0 0
63 Ciprofloxcacin 500 mg tablet Tablet 0 0 0 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 0 0 0 0
65 D-Artepp tablet Tablet 0 0 0 0
66 deksametason tab Tablet 0 0 0 0
67 Dekstran 70 - larutan infus 6% steril Botol 0 0 0 0
68 Dekstrometorfan sirup Botol 0 0 0 0
69 Dekstrometorfan tablet 15 mg Tablet 0 0 0 0
70 Diazepam Rektal 0,5 mg / 2 ml supp 0 0 0 0
71 Diazepam tablet 2 mg Tablet 0 0 0 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1mlAmpul 0 0 0 0
74 Digoksin tablet 0,25 mg Tablet 0 0 0 0
75 Diltiazem Tablet 0 0 0 0
76 Doksisiklin Kapsul 100 mg Capsul 0 0 0 0
77 Domperidon 10mg Tablet Tablet 0 50 50 50 0
78 Domperidon Suspensi 5 mg/ 5 ml Botol 0 0 0 0
79 Doxicyclin 500mg capsul 0 0 0 0
80 Efedrin HCLTablet 25 mg Tablet 0 0 0 0
81 Epinefrina HCL/Bitartrat Injeksi/ EFINEF Ampul 0 0 0 0
82 Eritromicyn kapsul 250 mg capsul 0 0 0 0
83 Erytromicin kapsul 500 mg Kapsul 0 0 0 0
84 Erytromicin sirup 125 mg Botol 0 0 0 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol 0 0 0 0
86 Etambutol 500 mg Tablet 0 0 0 0
87 Etanol 70 % Botol 0 0 0 0
88 Etil Klorida Semprot Botol 0 0 0 0
89 Fenitoin Natrium kapsul 30 mg Kapsul 0 0 0 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0 0 0 0
91 Fenobarbital tablet 30 mg Tablet 0 0 0 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet 0 0 0 0
93 Fenol Gliserol tetes telinga 10 % Botol 4 4 4 0
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 Ampul 0 0 0 0
95 Fitomenadion (Vit.K1) tab salut gula 10 mTablet 0 0 0 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul 0 0 0 0
97 Furosemida tablet 40 mg Tablet 0 0 0 0
98 Furosemide Injeksi Ampul 0 0 0 0
99 Garam Oralit Sachet 0 0 0 0
100 Gemfibrozil 300 mg Tablet 0 0 0 0
101 Gentamicin Injeksi Ampul 0 0 0 0
102 Gentamicin Salep Kulit Tube 0 0 0 0
103 Gentamicin Salep mata Tube 0 0 0 0
104 Gentamicin Tetes Mata Botol 0 3 3 3 0
Gentamicin Tetes Mata Botol 0 0 0 0
105 Gentian Violet 1 % Botol 0 0 0 0
106 Glibenclamid tablet 5 mg Tablet 0 0 0 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0 0 0 0
108 Glikazid 80 mg Tablet Tablet 0 0 0 0
109 Glimepiride 2 mg Tablet 0 0 0 0
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 500 mg, Tablet 0 0 0 0
113 Guaiafenesin 100 mg Tablet 0 0 0 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 0 0 0 0
115 Hidrokortison krim 2,5% Tube 0 0 0 0
116 Ibuprofen Suspensi Tablet 0 0 0 0
117 Ibuprofen tablet 200 mg Tablet 0 0 0 0
119 Imunomodulator sirup( STIMUNO) Botol 0 0 0 0
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 0 0 0 0
121 Kalsium Glukonas Injeksi Ampul 0 0 0 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0 100 100 100 0
123 Kapas Berlemak 500 mg Bungkus 0 0 0 0
124 Ketokonazol Kream Tube 0 0 0 0
125 Ketokonazol Tablet 200 mg Tablet 0 0 0 0
126 Ketorolac inj Ampul 0 0 0 0
127 Kifadene tablet 20 mg Tablet 0 0 0 0
128 Kloramfenikol salep mata 1 % capsul 0 0 0 0
129 Kloramfenikol suspensi Botol 0 0 0 0
130 Kloramfenikol tetes telinga 3% Tube 0 0 0 0
131 Kloramphenicol 250 mg Capsul 0 0 0 0
132 Kloramphenicol 500 mg capsul 0 0 0 0
133 Kloramphenicol Tetes Mata Botol 0 0 0 0
134 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 0 0 0 0
135 Klorokuin tablet 150 mg Tablet 0 0 0 0
136 Klorpromazin HCL tablet salut 25 mg Tablet 0 0 0 0
137 Kombinasi (Pirimetamin 25 mg + SolfadoxTablet 0 0 0 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 0 0 0 0
139 Kotrimoksazol Sirup / Suspensi Botol 0 5 5 5 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0 0 0 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0 0 0 0
142 Lactobacilus serbuk Sachet 0 0 0 0
143 Lidocain 2%+efinefrin injeksi Ampul 0 0 0 0
144 Lidocain injeksi 2 ml Ampul 0 0 0 0
145 Lisinopril 10 mg tablet Tablet 0 0 0 0
147 Loperamid 4 mg tablet Tablet 40 40 40 0
148 Lytacur Sirup Botol 0 0 0 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 0 0 0 0
150 Metamizol 500 mg Tablet 0 0 0 0
151 Metformin 500 mg Tablet Tablet 0 0 0 0
152 Methilprednisolon tablet 8 mg Tablet 0 0 0 0
153 Metilergometrin Maleat injeksi 1 ml Ampul 0 0 0 0
154 Metilergometrin Maleat Tablet Tablet 0 0 0 0
155 Metoklopramid Suspensi Botol 0 0 0 0
156 Metoklopramid tablet Tablet 0 0 0 0
157 Metronidazol 500 mg Tablet 0 0 0 0
158 Metronidazol infus / injeksi Botol 0 0 0 0
159 Metronidazol Ovula supp 0 0 0 0
160 Metronidazol suspensi Botol 0 0 0 0
161 Mikonazol kream Tube 0 0 0 0
162 Multivitamin Anak Sirup Botol 0 0 0 0
163 Multivitamin Dewasa Antioksidan ( BecomTablet 0 0 0 0
164 Natrium Diklofenak 25 mg Tablet Tablet 0 0 0 0
165 Natrium Diklofenak 50 mg Tablet Tablet 0 100 100 100 0
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 0 0 0 0
167 Nifedipine Tablet 10 mg box 0 0 0 0
168 Nistatin tablet vaginal 100.000 IU/g Tube 0 0 0 0
169 Obat anti Diare suspensi Botol 0 0 0 0
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 0 0 0 0
171 Obat Batuk Flu ( Molexflu ) BOX 0 0 0 0
Obat Batuk Flu ( Molexflu ) BOX 0 0 0 0
172 Obat Batuk Hitam (OBH) Botol 0 0 0 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0 0 0
Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0 0 0
174 Ofloxsacin Tetes Telinga Tube 0 0 0 0
175 Oksitetrasiklin HCL salep mata 1% Botol 0 0 0 0
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 0 0 0 0
177 Omeprazol injeksi Ampul 0 0 0 0
178 Omeprazol Kapsul 20 mg capsul 0 0 0 0
179 Ondancentron injeksi 4 mg Ampul 0 0 0 0
180 Ondancentron Tablet4 mg Tablet 0 0 0 0
181 Paracetamol Drop 15 ml Botol 0 0 0 0
182 Paracetamol Sirup 120 mg/5 ml Botol 0 3 3 3 0
183 Parafin Dresing ( Bioplacenton Tull ) pcs 0 0 0 0
184 Parasetamol tablet 100 mg Tablet 0 0 0 0
186 Permetrin Krim 5 % Tube 0 0 0 0
187 Pirantel Sirup Botol 0 0 0 0
188 Pirantel tablet 125 mg Tablet 0 0 0 0
189 Pirazinamid Botol 0 0 0 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 0 0 0 0
191 Piroksikam tablet 20 mg Tablet 0 0 0 0
192 Polikresulen Tube 0 0 0 0
193 Povidon lodida 10% 300 ml 0 0 0 0
195 Prazikuantel tablet 600 mg Botol 0 0 0 0
196 Prednison Tablet 5 mg Tablet 0 0 0 0
197 Primakuin 15 mg Tablet 0 0 0 0
198 Probenesid 500 mg tablet Tablet 0 0 0 0
199 Prokain Benzil Penisilin 3 juta IU/vial injekAmpul 0 0 0 0
200 Propanolol HCL tablet 10 mg Tablet 0 0 0 0
201 Ranitidin injeksi Ampul 0 0 0 0
202 Ranitidin tablet Tablet 0 100 100 100 0
203 Resperidone 2 mg tablet Tablet 0 0 0 0
204 Ringer Laktat cairan infus (Otsuka) 0 0 0 0
205 Ringer Laktat cairan infus (Widatra) Botol 0 2 2 2 0
206 Rivanol 300 ml Botol 0 0 0 0
207 Salbutamol Tablet 2 mg Tablet 0 0 0 0
208 Salbutamol tablet 4mg Tablet 0 0 0 0
209 Salep 2-4 Tube 0 0 0 0
210 Salep kombinasi cream ( Berloson ) Tube 0 0 0 0
211 Salicil bedak Kotak 0 0 0 0
212 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 0 0 0 0
213 Serum Anti Tetanus inj 1500 IU ( TetagamVial 0 0 0 0
214 Sianokobalamin Injeksi Ampul 0 0 0 0
215 Simvastatin 10 mg tablet Tablet 0 0 0 0
217 Sukralfat Suspensi Botol 0 0 0 0
218 Sukralfat tablet 500 mg Tablet 0 0 0 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 mlTube 0 0 0 0
220 Temporary Stopping Fletcher serbuk & caTablet 0 0 0 0
221 Tetrakain HCL tetes mata 0,5% Tube 0 0 0 0
222 Tetrasiklin 250 mg capsul capsul 0 0 0 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0 0
Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0 0
225 Ventolin Nebulizer Ampul 0 0 0 0
226 vitamin b komplek Tablet 0 0 0 0
vitamin b komplek 0 200 200 200 0
227 Zink sirup Botol 0 2 2 2 0
228 Zink tablet 20 mg Tablet 0 0 0 0
229 Deksametason inj Ampul 0 0 0 0
230 Diazepam inj 5 mg/ml Ampul 0 0 0 0
231 Griseofulvin 125 mcg Tablet 0 0 0 0
232 Kloramfenikol SK/ BUFACETIN Tube 0 0 0 0
233 Nystatin tab 500.000 IU Tablet 0 0 0 0
234 magnesium Sulfat Inj. 25 ml 40% ampul 0 0 0 0
235 natrium bicarbonat tab 0 0 0 0
236 MULTIVITAMIN ANAK STIMUNO SYR BOTOL 0 0 0 0
237 tetagam set 0 0 0 0
238 vit c kemenkes tab 0 0 0 0
0 0 0 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 0 0 0 0
1 Alat suntik 1 ml Pcs 0 0 0 0
3 Alat suntik 2,5 ml Pcs 0 0 0 0
5 Alat suntik 3 cc (Remedi) 0 0 0 0
7 Alat suntik 5 ml pcs 0 0 0 0
8 Alkazide 1 L High Level Desinfectant Botol 0 0 0 0
9 Alkazyme Sachet 25 mg Pack 0 0 0 0
10 Alkohol 70 % 1 L Botol 0 0 0 0
11 Alkohol swab box 0 0 0 0
12 Anti Septik Hand Rub Botol 0 0 0 0
13 Anti Septik Surgikal Hand Scrub Botol 0 0 0 0
14 Cat Gut no 2/0 KOTAK 0 0 0 0
16 Cat Gut No 2/0 (24 mm) Sachet 0 0 0 0
18 Cathetter Jelly Biji 0 0 0 0
19 Demetech Silk 3/0 Set 0 0 0 0
20 E Care I.V Dresing Pcs 0 0 0 0
21 E-Care Surgical Mask Tie On Lembar 0 0 0 0
22 Folly No 14 Catether pcs 0 0 0 0
23 Folly No 16 Catether box 0 0 0 0
24 I.V Cathetter No. 20 Set 0 0 0 0
iv cathETER no 20 pcs 0 0 0 0
26 I.V Cathetter No. 24 pcs 0 0 0 0
28 Infuset Anak Set 0 0 0 0
Infuset Anak PCS 0 0 0 0
29 Infuset Dewasa pcs 0 0 0 0
30 Jarum Insulin Tablet 0 0 0 0
31 Kapas Berlemak 250 gr Bungkus 0 0 0 0
33 Kasa 4 m x 10 cm Rol 0 0 0 0
34 Kasa Hidrofil 36 x 80 cm Rol 0 0 0 0
35 Kasa Pembalut 2 x 80 cm Pack 0 0 0 0
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 0 0 0 0
37 Lisol 1 L Botol 0 0 0 0
38 Masker karet Ear Loop Lembar 0 0 0 0
39 Masker tali Tube 0 0 0 0
40 Nasal Canula Oksigen Set 0 0 0 0
41 Plester 1" Rol 0 0 0 0
42 Plester Kertas 2,5 cm Rol 0 0 0 0
43 Plester Non Woven 5cm x 5 cm Rol 0 0 0 0
44 Policlean Botol 0 0 0 0
45 Polifik Kotak 0 0 0 0
46 Saraya Alsof A 500 ml Botol 0 0 0 0
47 Saraya Alsof Pure 500 ml Botol 0 0 0 0
48 Sarung Tangan Gynecolog No 7 Pasang 0 0 0 0
49 Sarung tangan M (Non Steril) Pasang 0 0 0 0
50 Sarung tangan no 6,5 Pasang 0 0 0 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0 0 0 0
52 Sarung tangan no 7,0 Steril Pasang 0 0 0 0
53 Selang Section ( Surgikal Conection TubePcs 0 0 0 0
54 Underpad pack 0 0 0 0
55 Urine Bag Biji 3 3 3 0
56 safety blackblood BOX 0 0 0 0
57 safety box BOX 0 0 0 0
58 Tabung BD Vacutener pcs 0 0 0 0
59 masker n95 box 0 0 0 0
60 t silk black 3/0 26 mm pcs 0 0 0 0
64 Nasal Canula Oksigen anak nca pcs 0 0 0 0
65 nasal canula oksigen dewasa ncd pcs 0 0 0 0
66 silk 2-0 box 0 0 0 0
67 silk 3-0 box 0 0 0 0
0 0 0 0
OBAT JKN 0 0 0 0
1 etil klorida spray btl 0 0 0 0
2 Ketorolac inj box 0 0 0 0
3 parasetamol tab box 0 0 0 0
4 Acyclovir 400 mg box 0 0 0 0
5 GLUKOSA 5% BOTOL 0 0 0 0
6 glukosa 10% BOTOL 0 0 0 0
7 asam tranexamat inj box 0 0 0 0
8 IBUPROFEN 400 mg box 0 0 0 0
9 Mecobalamin 500 Mg Tab box 0 0 0 0
10 Metronidazole 500 mg box 0 0 0 0
11 d40 % botol 0 0 0 0
12 dulcolax anak suppo box 0 0 0 0
13 gom box 0 0 0 0
14 Lexigo box 0 0 0 0
15 METRONIDAZOL SYR/ farizol botol 0 0 0 0
16 mikrolax suppositoria Tube 0 0 0 0
17 natrium bicarbonat tab botol 0 0 0 0
18 nifedipin tab box 0 0 0 0
19 nacl botol 0 0 0 0
20 acylovir cream tube 0 0 0 0
21 Ciprofloxacin 500 mg box 0 0 0 0
22 Cetirizine syr BOTOL 0 0 0 0
23 Guanistrep syr BOTOL 0 0 0 0
24 nisagon krim tube 0 0 0 0
25 piroksikam 20 mg tab box 0 0 0 0
26 metilergo injek ampul 0 0 0 0
27 NILACELIN SIR botol 0 0 0 0
28 water for injeksi/ Aqua pro inj vial 0 0 0 0
29 mgso 40 vial 0 0 0 0
30 oksitosin inj box 0 0 0 0
31 asam traneksamat 500 mg tab box @50 tab 0 0 0 0
32 ctm 4 mg box @100 ta 0 0 0 0
33 domperidon syr botol 0 0 0 0
34 h202 3% 100 ML botol 0 0 0 0
HYOSCINE N BUTYLBROMIDE 10 box
35 MG/scopma 0 0 0 0
36 ketokonazol cr tube 0 0 0 0
37 ketokonazol tab box@50 tab 0 0 0 0
38 molexflu box@150 tab 0 0 0 0
BOTOL
PARACETAMOL 100MG/ML DROP 15 ML
39 0 0 0 0
PERMETHRIN CREAM 5% 30 GRAM/ TUBE
40 scabimite 30 gram 0 0 0 0
41 DIASTRIX(loperamid) box @100 ta 0 0 0 0
42 PARASETAMOL INFUS BOTOL 0 0 0 0
43 Salep 2-4 POT 0 0 0 0
44 ventolin nebu BOX 0 0 0 0
45 Ambroxol Syrup 15 mg/5 ml Botol 0 0 0 0
47 Akita Tablet 0 0 0 0
48 BEDAK SALICYL 2% 60 GRAM POT 0 0 0 0
49 BIOPLASENTON GEL 15 GRAM TUBE 0 0 0 0
50 Cefadroxil 500 mg Tablet 0 0 0 0
51 Dexamethasone Inj ampul 0 0 0 0
52 DOMPERIDON SYR BOTOL 0 0 0 0
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 0 100 100 100 0
54 Methylergometrin injeksi ampul 0 0 0 0
55 MgSO4 40% botol 0 0 0 0
56 Ondancetron 4 mg/2ml Injeksi Ampul 0 0 0 0
57 Ondansetron Tablet 4 mg Tablet 0 0 0 0
58 Oxytocin Injeksi Ampul 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0
60 PARACETAMOL SUPPOSITORIA 160MG SUPP 0 0 0 0
61 Ranitidin Injeksi Ampul 0 0 0 0
62 UNI BABY COUGH BOTOL 0 0 0 0
63 Vit K injeksi/ NEO K - 2 MG ampul 0 0 0 0
64 EFINEPRIN INJ AMPUL 0 0 0 0
65 SUKRALFAT SYR BOTOL 0 0 0 0
66 0 0 0 0
67 0 0 0 0
68 0 0 0 0
69 0 0 0 0
70 0 0 0 0
BMHP JKN Set 0 0 0 0
1 LANSET CENTURY pcs 0 0 0 0
2 BISTURI pcs 0 0 0 0
3 CHKM pcs 0 0 0 0
3 mukus ekstraktor pcs 0 0 0 0
4 pipet obat 1 ml pcs 0 0 0 0
5 kertas goldar pcs 0 0 0 0
6 Rebreathing mask O2 dewasa NRM pcs 0 0 0 0
7 vaselin pcs 0 0 0 0
8 rivanol botol 0 1 1 1 0
9 povidone/ betadine botol 0 0 0 0
10 alkohol botol 0 0 0 0
11 lancet media box 0 0 0 0
12 OKSIGEN MASKER STANDAR ANAK SUNGKUP pcs 0 0 0 0
13 OKSIGEN MASKER STANDAR DEWASA (SUNGKpcs 0 0 0 0
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack 0 0 0 0
15 IV CATHETER NO. 18 Box 0 0 0 0
16 KASA 40X80 pcs 0 0 0 0
17 PERBAN ELASTIS 10M Pcs 0 0 0 0
18 STRIP GULA DARAH GDS Box 0 0 0 0
19 SYRINGE 1ML/ SUNTIK 1 CC Box 0 0 0 0
20 UMBILICAL KLEM Box 0 0 0 0
21 URINE BAG Pcs 0 0 0 0
22 catheter jeli Pcs 0 0 0 0
23 nesco asam urat botol 0 0 0 0
24 usg jeli pouch 0 0 0 0
25 PLASTIK LIMBAH KUNING 80 x 60 (50 Buah) pack 0 0 0 0
26 PLASTIK LIMBAH KUNING 100 x 80 (50 Buah) pack 0 0 0 0
27 IV CATH 26 box 0 0 0 0
28 PLASTIK KRESEK BERLOGO PKM CETAK DEPA pack 0 0 0 0
29 SYRINGE 10ML Box 0 0 0 0
30 Infusion Set with Airvent Dewasa Pcs 0 0 0 0
Medical Catgut Plain Sterile Suture with
31 Needle 2/0 Box 0 0 0 0
32 Nasal Oxygen Cannula Anak nca Pcs 0 0 0 0
33 TES KEHAMILAN BOX 0 0 0 0
34 STRIP CHOLESTEROL KOLES botol 0 0 0 0
35 strip hb easy touc botol 0 0 0 0
36 urine gluco protein test box 0 0 0 0
37 HANDSABUTAZER PUMP+ BRACKET botol 0 0 0 0
38 HANDSANITAZER PUMP botol 0 0 0 0
39 NEBULIZER ANAK PCS 0 0 0 0
40 NEBULIZER BAYI PCS 0 0 0 0
41 NEBULIZER DEWASA PCS 0 0 0 0
42 JELLY USG 5 LITER Derigen 0 0 0 0
43 KERTAS LAKMUS PINK / BIRU Pack 0 0 0 0
44 OXYGEN NASAL CANNULA NEONATUS Pcs 0 0 0 0
45 PLASTIK LIMBAH HITAM (60x100) Pack 0 0 0 0
46 PLASTIK LIMBAH HITAM (90x120) Pack 0 0 0 0
47 PLASTIK LIMBAH KUNING 60x90 (20 buah) Pack 0 0 0 0
48 REAGEN GOLDAR Set 0 0 0 0
49 SENDOK OBAT 5ML (250 Pcs) Pack 0 0 0 0
50 SYRINGE 0,5ML Box 0 0 0 0
51 POVIDON IODIN 1LITER botol 0 0 0 0
52 SPALK BAYI pcs 0 0 0 0
53 SPALK TANGAN pcs 0 0 0 0
54 STRIP GULA DARAH box 0 0 0 0
55 SYRINGE 10ML box 0 0 0 0
56 SUFRATULLE box 0 0 0 0
57 NURSE CAPS box 0 0 0 0
58 KERTAS PUYER LIPAT pack 0 0 0 0
59 ALHOKOL 70% 1 LITER botol 0 0 0 0
60 RAPID TEST DENGUE IgG/IgM box 0 0 0 0
61 RAPID TEST DENGUE NS1 box 0 0 0 0
62 RAPID TEST TYPHOID box 0 0 0 0
63 RIVANOL 300ML botol 0 0 0 0
64 POVIDION IODINE 15ML botol 0 0 0 0
65 SUCTION NO 8 PCS 0 0 0 0
66 0 0 0 0
67 0 0 0 0
68 0 0 0 0
69 0 0 0 0
70 0 0 0 0
71 0 0 0 0
72 0 0 0 0
73 0 0 0 0
74 0 0 0 0
75 0 0 0 0
76 0 0 0 0
COVID GFK 0 0 0 0
1 KANTONG JENAZAH BJB PCS 0 0 0 0
2 SEPATU BOOTS BJB PASANG 0 0 0 0
3 APD MEDIS SET BANKEU SET 0 0 0 0
4 APD MEDIS SET BANKEU SET 0 0 0 0
5 APD MEDIS SET BANKEU 2 SET 0 0 0 0
6 KANTONG JENAZAH BANKEU PCS 0 0 0 0
7 good life kotak 0 0 0 0
8 handsanitazer galon 5L 0 0 0 0
9 MASKER MEDIS 3 PLAY (MASKER COVID) box 0 0 0 0
10 parafilm roll 0 0 0 0
11 antigen kotak 0 0 0 0
12 metisoprinol box 0 0 0 0
13 desinfektan 750 mg cletira botol 0 0 0 0
14 faceshield bankeu 2 pcs 0 0 0 0
15 n95 pcs 0 0 0 0
16 sarung tangan gynekolog pasang 0 0 0 0
17 APD HAZMAT PCS 0 0 0 0
18 RAPID ANTIGEN DAU PEL VAKSIN COVID KOTAK 0 0 0 0
19 masker yx135 pcs 0 0 0 0
20 rapid antigen sd biosensor test 0 0 0 0
21 vitamin c 500 mg kemenkes tab 0 0 0 0
22 desinfektan cletira botol 0 0 0 0
23 FOREHEAD TERMOMETER MICROLITE DID unit 0 0 0 0
24 masker earloop 3 play dau kotak 0 0 0 0
25 masker n 95 5 play dau box 0 0 0 0
26 nasal anak oksigen anak nca pcs 0 0 0 0
27 nasal anak oksigen dewasa ncd pcs 0 0 0 0
28 sarung tangan steril sz 6.5 did tambahan pasang 0 0 0 0
29 ADS 0,05 ml PCS 0 0 0 0
30 ALKOHOL SWAB PCS 0 0 0 0
31 SAFETY BOX PCS 0 0 0 0
32 VAKSIN COVID/202109199e VIAL 0 0 0 0
33 0 0 0 0
34 0 0 0 0
35 0 0 0 0
36 0 0 0 0
37 0 0 0 0
38 0 0 0 0
39 0 0 0 0
40 0 0 0 0
41 0 0 0 0
42 0 0 0 0
43 0 0 0 0
44 0 0 0 0
45 0 0 0 0
COVID SWASTA 0 0 0 0
2 JAS HUJAN PCS 0 0 0 0
YANG MENYERAHKAN MENGETAHUI YANG MEMINTA :

PENGELOLA OBAT KEPALA PUSKESMAS PENANGGUNG JAWAB PUSTU/POSKEDES
RENY WIGIAWATI, A.Pt ALIK WAHYUDI, S.Kep.Ners Elis Febriyani, Amd. Keb
NIP.198601142019 02 2 003 NIP.19850607 2010 01 1 014 NIP.198910042017042002
LAPORAN PERSEDIAAN PUSKESMAS CIKEUSIK
Nama Puskesmas : PKM CIKEUSIK/ rancaseneng

Bulan :maret
Saldo Awal 2022 Penerimaan T.A 2022 Pengeluaran TA. 2022 Saldo Akhir
N0 NAMA OBAT SATUAN Harga per Unit Harga per Unit Harga per Unit Harga per Unit
Jumlah satuan Jumlah (Rp) Jumlah satuan Jumlah (Rp) Jumlah satuan Jumlah (Rp) Jumlah satuan Jumlah (Rp)
(Rp) (Rp) (Rp) (Rp)
1 Alprazolam Tablet - - - - - - - - - -
2 Albendazol Tablet 400 mg Tablet - 407 - 407 - 407 - - 407 -
3 Allopurinol tablet 100 mg Tablet - 105 - 105 - 105 - - 105 -
Allopurinol tablet 100 mg Tablet - 87 - 100 87 8,700 100 87 8,700 - 87 -
4 Ambroxol sirup Botol - 3,300 - 3,300 - 3,300 - - 3,300 -
5 Ambroxol tablet 30 mg Tablet - - - - - - - - - -
6 Aminofilin Tablet 200 mg Tablet - 91 - 91 - 91 - - 91 -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - 3,345 - 3,345 - 3,345 - - 3,345 -
8 Amlodipin 10 mg Tablet - 93 - 93 - 93 - - 93 -
Amlodipin 10 mg Tablet - 99 - 99 - 99 - - 99 -
9 Amlodipin Besilate 5 mg Tablet - 75 - 75 - 75 - - 75 -
Amlodipin Besilate 5 mg Tablet - 53 - 30 53 1,590 30 53 1,590 - 53 -
10 Amoksisilin Forte sirup kering 250mg Botol - 3,050 - 3,050 - 3,050 - - 3,050 -
11 Amoksisilin Injeksi 1 gr Vial - 5,368 - 5,368 - 5,368 - - 5,368 -
12 Amoksisilin Tablet 500 mg Tablet - 249 - 249 - 249 - - 249 -
Amoksisilin Tablet 500 mg kaplet 40 201 8,040 200 201 40,200 200 201 40,200 - 201 -
13 Amoksisillin kapsul 250 mg Kapsul - - - - - - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - - - - - - - - -
Amoksisillin Sirup Kering 125 mg/5 ml Botol - 2,050 - 5 2,050 10,250 5 2,050 10,250 - 2,050 -
15 Ampisilin Injeksi 1 gr Vial - 10,300 - 10,300 - 10,300 - - 10,300 -
16 Analog insulin Long Acting Pen - - - - - - - - - -
17 Analog insulin Mix Acting Pen - - - - - - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - 305 - 305 - 305 - - 305 -
19 Antalgin (Metampiron) tablet 500 mg Tablet - 305 - 305 - 305 - - 305 -
20 Antasida DOEN suspensi Botol - 1,679 - 5 1,679 8,395 5 1,679 8,395 - 1,679 -
21 ANTASIDA DOEN Tablet Tablet - 54 - 100 54 5,400 100 54 5,400 - 54 -
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - 3,035 - 3,035 - 3,035 - - 3,035 -
23 anti hemoroid doen kombinasi supp - 3,167 - 3,167 - 3,167 - - 3,167 -
24 Antifungi DOEN Tube - - - - - - - - - -
25 Antimigren DOEN Kombinasi : Tablet - 173 - 173 - 173 - - 173 -
26 Antiparkinson DOEN tablet Kombinasi Tablet - - - - - - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - - - - - - -
28 Aqua Pro Injeksi Vial - 2,650 - 2,650 - 2,650 - - 2,650 -
29 Artermeter injeksi Ampul - 1,000 - 1,000 - 1,000 - - 1,000 -
30 Artesunate injeksi 60 mg/ml vial - - - - - - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet - 105 - 105 - 105 - - 105 -
32 Asam Folat Botol - 55 - 55 - 55 - - 55 -
33 Asam Fusidat Cream Tube - 5,506 - 5,506 - 5,506 - - 5,506 -
34 Asam Klorida 0,1 N Botol - - - - - - - - - -
35 Asam Mefenamat 500 mg Tablet - 200 - 200 - 200 - - 200 -
Asam Mefenamat 500 mg Tablet - 111 - 100 111 11,100 100 111 11,100 - 111 -
36 Asam Traneksamat Inj 5% Ampul - 1,748 - 1,748 - 1,748 - - 1,748 -
37 Asering Botol - 8,800 - 8,800 - 8,800 - - 8,800 -
38 Asetosal tablet 500 mg Tablet - - - - - - - - - -
39 Asetyl Cysteine Capsul - 301 - 301 - 301 - - 301 -
40 Asiklovir Cream 5% Tube - 8,800 - 8,800 - 8,800 - - 8,800 -
41 Asiklovir tablet 200 mg Tablet - 236 - 236 - 236 - - 236 -
42 Asiklovir tablet 400 mg Tablet - 405 - 405 - 405 - - 405 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - 1,639 - 1,639 - 1,639 - - 1,639 -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - - - - - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - - - - - - - - -
46 Berotec Metered Aerosol 100 mg Bok - 80,000 - 80,000 - 80,000 - - 80,000 -
47 Betadine Salep Antiseptik 5 mg Tube - 7,083 - 7,083 - 7,083 - - 7,083 -
48 Betametason krim 0,1 % Tube 2 1,540 3,080 3 1,540 4,620 5 1,540 7,700 - 1,540 -
49 Bisakodil Suppositoria supp - 5,800 - 5,800 - 5,800 - - 5,800 -
50 Bisoprolol 2,5 mg Tablet - 650 - 650 - 650 - - 650 -
51 Bisoprolol 5 mg Tablet - 263 - 263 - 263 - - 263 -
52 Cairan Infus KN-3B Botol - 10,696 - 10,696 - 10,696 - - 10,696 -
53 Cairan Infus Wida KDN 1 Botol - 1,007 - 1,007 - 1,007 - - 1,007 -
Cairan Infus Wida KDN 2 Botol - 11,435 - 11,435 - 11,435 - - 11,435 -
54 Cairan Pembersih ( Protektor ) Botol - 22,000 - 22,000 - 22,000 - - 22,000 -
55 Captopril Tablet 12,5 mg Tablet - 66 - 66 - 66 - - 66 -
56 Captopril Tablet 25 mg Tablet - 75 - 100 75 7,500 100 75 7,500 - 75 -
57 Cefadroxil Capsul 500 mg Capsul - 516 - 516 - 516 - - 516 -
58 Cefixime Capsul 100 mg Capsul - 590 - 590 - 590 - - 590 -
59 Cefixime Sirup Botol - 7,490 - 7,490 - 7,490 - - 7,490 -
60 Cefotaksime 1 gr Injeksi Vial - 4,200 - 4,200 - 4,200 - - 4,200 -
61 Cetirizine Capsul 50 mg Capsul - 49 - 49 - 49 - - 49 -
62 Cetirizine sirup 5 mg/5 ml Botol - 2,849 - 2,849 - 2,849 - - 2,849 -
63 Ciprofloxcacin 500 mg tablet Tablet - 265 - 265 - 265 - - 265 -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul - 4,550 - 4,550 - 4,550 - - 4,550 -
65 D-Artepp tablet Tablet - - - - - - - - - -
66 deksametason tab Tablet - 70 - 70 - 70 - - 70 -
67 Dekstran 70 - larutan infus 6% steril Botol - - - - - - - - - -
68 Dekstrometorfan sirup Botol - - - - - - - - - -
69 Dekstrometorfan tablet 15 mg Tablet - - - - - - - - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp - 12,573 - 12,573 - 12,573 - - 12,573 -
71 Diazepam tablet 2 mg Tablet - - - - - - - - - -
72 Diazepam tablet 5 mg Tablet - 109 - 109 - 109 - - 109 -
73 Difenhidramin HCL injeksi 10 mg/ml - Ampul - 1,168 - 1,168 - 1,168 - - 1,168 -
74 Digoksin tablet 0,25 mg Tablet - 105 - 105 - 105 - - 105 -
75 Diltiazem Tablet - - - - - - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - 264 - 264 - 264 - - 264 -
77 Domperidon 10mg Tablet Tablet - 71 - 50 71 3,550 50 71 3,550 - 71 -
78 Domperidon Suspensi 5 mg/ 5 ml Botol - 2,700 - 2,700 - 2,700 - - 2,700 -
79 Doxicyclin 500mg capsul - - - - - - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - - - - - - -
81 Epinefrina HCL/Bitartrat Injeksi/ EFI Ampul - 1,408 - 1,408 - 1,408 - - 1,408 -
82 Eritromicyn kapsul 250 mg capsul - 583 - 583 - 583 - - 583 -
83 Erytromicin kapsul 500 mg Kapsul - - - - - - - - - -
84 Erytromicin sirup 125 mg Botol - - - - - - - - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - 2,992 - 2,992 - 2,992 - - 2,992 -
86 Etambutol 500 mg Tablet - - - - - - - - - -
87 Etanol 70 % Botol - - - - - - - - - -
88 Etil Klorida Semprot Botol - 137,500 - 137,500 - 137,500 - - 137,500 -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - - - - - - - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - 1,740 - 1,740 - 1,740 - - 1,740 -
91 Fenobarbital tablet 30 mg Tablet - 171 - 171 - 171 - - 171 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - - - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol 4 3,300 13,200 3,300 - 4 3,300 13,200 - 3,300 -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml Ampul - 3,550 - 3,550 - 3,550 - - 3,550 -
95 Fitomenadion (Vit.K1) tab salut gula 1 Tablet - 710 - 710 - 710 - - 710 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul - 57,500 - 57,500 - 57,500 - - 57,500 -
97 Furosemida tablet 40 mg Tablet - 82 - 82 - 82 - - 82 -
98 Furosemide Injeksi Ampul - - - - - - - - - -
99 Garam Oralit Sachet - 274 - 274 - 274 - - 274 -
100 Gemfibrozil 300 mg Tablet - 380 - 380 - 380 - - 380 -
101 Gentamicin Injeksi Ampul - 1,010 - 1,010 - 1,010 - - 1,010 -
102 Gentamicin Salep Kulit Tube - 2,800 - 2,800 - 2,800 - - 2,800 -
103 Gentamicin Salep mata Tube - 4,232 - 4,232 - 4,232 - - 4,232 -
104 Gentamicin Tetes Mata Botol - 4,232 - 3 4,232 12,696 3 4,232 12,696 - 4,232 -
Gentamicin Tetes Mata Botol - 4,520 - 4,520 - 4,520 - - 4,520 -
105 Gentian Violet 1 % Botol - - - - - - - - - -
106 Glibenclamid tablet 5 mg Tablet - 119 - 119 - 119 - - 119 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - - - - - - -
108 Glikazid 80 mg Tablet Tablet - 235 - 235 - 235 - - 235 -
109 Glimepiride 2 mg Tablet - 207 - 207 - 207 - - 207 -
110 Glukosa larutan infus 10% steril Botol - - - - - - - - - -
111 Glukosa larutan infus 5 % steril Botol - 6,900 - 6,900 - 6,900 - - 6,900 -
112 Griseofulvin tablet 500 mg, Tablet - 906 - 906 - 906 - - 906 -
113 Guaiafenesin 100 mg Tablet - 132 - 132 - 132 - - 132 -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - 155 - 155 - 155 - - 155 -
115 Hidrokortison krim 2,5% Tube - 2,325 - 2,325 - 2,325 - - 2,325 -
116 Ibuprofen Suspensi Tablet - - - - - - - - - -
117 Ibuprofen tablet 200 mg Tablet - 105 - 105 - 105 - - 105 -
118 Ibuprofen tablet 400 mg Tablet - - - - - - - - - -
119 Imunomodulator sirup( STIMUNO) Botol - 25,548 - 25,548 - 25,548 - - 25,548 -
120 Isosorbid Dinitrat tablet sublingual 5 m Tablet - 89 - 89 - 89 - - 89 -
121 Kalsium Glukonas Injeksi Ampul - 4,800 - 4,800 - 4,800 - - 4,800 -
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet - 60 - 100 60 6,000 100 60 6,000 - 60 -
123 Kapas Berlemak 500 mg Bungkus - - - - - - - - - -
124 Ketokonazol Kream Tube - 2,518 - 2,518 - 2,518 - - 2,518 -
125 Ketokonazol Tablet 200 mg Tablet - 270 - 270 - 270 - - 270 -
126 Ketorolac inj Ampul - 1,045 - 1,045 - 1,045 - - 1,045 -
127 Kifadene tablet 20 mg Tablet - - - - - - - - - -
128 Kloramfenikol salep mata 1 % capsul - 1,881 - 1,881 - 1,881 - - 1,881 -
129 Kloramfenikol suspensi Botol - 5,015 - 5,015 - 5,015 - - 5,015 -
130 Kloramfenikol tetes telinga 3% Tube - - - - - - - - - -
131 Kloramphenicol 250 mg Capsul - 310 - 310 - 310 - - 310 -
132 Kloramphenicol 500 mg capsul - 1,163 - 1,163 - 1,163 - - 1,163 -
133 Kloramphenicol Tetes Mata Botol - - - - - - - - - -
134 Klorfeniramin Maleat (CTM) tablet 4 m Tablet - 24 - 24 - 24 - - 24 -
135 Klorokuin tablet 150 mg Tablet - - - - - - - - - -
136 Klorpromazin HCL tablet salut 25 mg Tablet - - - - - - - - - -
137 Kombinasi (Pirimetamin 25 mg + Solfa Tablet - - - - - - - - - -
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet - 133 - 133 - 133 - - 133 -
139 Kotrimoksazol Sirup / Suspensi Botol - 2,100 - 5 2,100 10,500 5 2,100 10,500 - 2,100 -
140 Kuinin Dihidroklorida injeksi 25% - 2 m Ampul - - - - - - - - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 m Botol - - - - - - - - - -
142 Lactobacilus serbuk Sachet - 14,707 - 14,707 - 14,707 - - 14,707 -
143 Lidocain 2%+efinefrin injeksi Ampul - 1,229 - 1,229 - 1,229 - - 1,229 -
144 Lidocain injeksi 2 ml Ampul - 1,152 - 1,152 - 1,152 - - 1,152 -
145 Lisinopril 10 mg tablet Tablet - 448 - 448 - 448 - - 448 -
146 Lisinopril 5 mg tablet Tablet - 375 - 375 - 375 - - 375 -
147 Loperamid 4 mg tablet Tablet 40 77 3,080 77 - 40 77 3,080 - 77 -
148 Lytacur Sirup Botol - - - - - - - - - -
149 Magnesium Sulfat Inj. 25 ml 20% Ampul - 3,328 - 3,328 - 3,328 - - 3,328 -
150 Metamizol 500 mg Tablet - 473 - 473 - 473 - - 473 -
151 Metformin 500 mg Tablet Tablet - 77 - 77 - 77 - - 77 -
152 Methilprednisolon tablet 4 mg Tablet - 102 - 102 - 102 - - 102 -
153 Metilergometrin Maleat injeksi 1 ml Ampul - 2,550 - 2,550 - 2,550 - - 2,550 -
154 Metilergometrin Maleat Tablet Tablet - 224 - 224 - 224 - - 224 -
155 Metoklopramid Suspensi Botol - 2,345 - 2,345 - 2,345 - - 2,345 -
156 Metoklopramid tablet Tablet - - - - - - - - - -
157 Metronidazol 500 mg Tablet - - - - - - - - - -
158 Metronidazol infus / injeksi Botol - - - - - - - - - -
159 Metronidazol Ovula supp - 4,100 - 4,100 - 4,100 - - 4,100 -
160 Metronidazol suspensi Botol - 3,799 - 3,799 - 3,799 - - 3,799 -
161 Mikonazol kream Tube - 1,900 - 1,900 - 1,900 - - 1,900 -
162 Multivitamin Anak Sirup Botol - 9,900 - 9,900 - 9,900 - - 9,900 -
163 Multivitamin Dewasa Antioksidan (HB VTablet - 95,063 - 95,063 - 95,063 - - 95,063 -
164 Natrium Diklofenak 25 mg Tablet Tablet - - - - - - - - - -
165 Natrium Diklofenak 50 mg Tablet Tablet - 99 - 100 99 9,900 100 99 9,900 - 99 -
166 Natrium Klorida Cairan Infus ( NaCL ) Botol - 6,840 - 6,840 - 6,840 - - 6,840 -
167 Nifedipine Tablet 10 mg box - - - - - - - - - -
168 Nistatin tablet vaginal 100.000 IU/g Tube - 598 - 598 - 598 - - 598 -
169 Obat anti Diare suspensi Botol - - - - - - - - - -
170 Obat Anti Diare Tablet (Akita / Molagit Tablet - 145 - 145 - 145 - - 145 -
171 Obat Batuk Flu ( Molexflu ) BOX - 54,870 - 54,870 - 54,870 - - 54,870 -
Obat Batuk Flu ( Molexflu ) BOX - 59,090 - 59,090 - 59,090 - - 59,090 -
172 Obat Batuk Hitam (OBH) Botol - - - - - - - - - -
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol - 11,363 - 11,363 - 11,363 - - 11,363 -
Obat Batuk Sirup Herbal ( Herbacop ) Botol - 14,273 - 14,273 - 14,273 - - 14,273 -
174 Ofloxsacin Tetes Telinga Tube - - - - - - - - - -
175 Oksitetrasiklin HCL salep mata 1% Botol - 12,700 - 12,700 - 12,700 - - 12,700 -
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - - - - - - -
177 Omeprazol injeksi Ampul - 9,898 - 9,898 - 9,898 - - 9,898 -
178 Omeprazol Kapsul 20 mg capsul - 129 - 129 - 129 - - 129 -
179 Ondancentron injeksi 4 mg Ampul - 1,070 - 1,070 - 1,070 - - 1,070 -
180 Ondancentron Tablet4 mg Tablet - 385 - 385 - 385 - - 385 -
181 Paracetamol Drop 15 ml Botol - 4,976 - 4,976 - 4,976 - - 4,976 -
182 Paracetamol Sirup 120 mg/5 ml Botol - 1,181 - 3 1,181 3,543 3 1,181 3,543 - 1,181 -
183 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - - - - - - -
184 Parasetamol tablet 100 mg Tablet - - - - - - - - - -
185 Parasetamol tablet 500 mg Tablet - 100 - 100 - 100 - - 100 -
186 Permetrin Krim 5 % Tube - 11,825 - 11,825 - 11,825 - - 11,825 -
187 Pirantel Sirup Botol - 9,700 - 9,700 - 9,700 - - 9,700 -
188 Pirantel tablet 125 mg Tablet - 291 - 291 - 291 - - 291 -
189 Pirazinamid Botol - - - - - - - - - -
190 Piridoksin HCL (VIT B6) tablet 10mg Botol - 131 - 131 - 131 - - 131 -
191 Piroksikam tablet 20 mg Tablet - - - - - - - - - -
192 Polikresulen Tube - - - - - - - - - -
193 Povidon lodida 10% 300 ml - 17,996 - 17,996 - 17,996 - - 17,996 -
194 Povidon lodida 10% 60 ml - 6,550 - 6,550 - 6,550 - - 6,550 -
195 Prazikuantel tablet 600 mg Botol - - - - - - - - - -
196 Prednison Tablet 5 mg Tablet - 73 - 73 - 73 - - 73 -
197 Primakuin 15 mg Tablet - 224 - 224 - 224 - - 224 -
198 Probenesid 500 mg tablet Tablet - - - - - - - - - -
199 Prokain Benzil Penisilin 3 juta IU/vial inAmpul - - - - - - - - - -
200 Propanolol HCL tablet 10 mg Tablet - 60 - 60 - 60 - - 60 -
201 Ranitidin injeksi Ampul - 1,188 - 1,188 - 1,188 - - 1,188 -
202 Ranitidin tablet Tablet - 85 - 100 85 8,500 100 85 8,500 - 85 -
203 Resperidone 2 mg tablet Tablet - 273 - 273 - 273 - - 273 -
204 Ringer Laktat cairan infus (Otsuka) - 7,150 - 7,150 - 7,150 - - 7,150 -
205 Ringer Laktat cairan infus (Widatra) Botol - 7,630 - 2 7,630 15,260 2 7,630 15,260 - 7,630 -
206 Rivanol 300 ml Botol - 2,992 - 2,992 - 2,992 - - 2,992 -
207 Salbutamol Tablet 2 mg Tablet - 48 - 48 - 48 - - 48 -
208 Salbutamol tablet 4mg Tablet - 70 - 70 - 70 - - 70 -
209 Salep 2-4 Tube - 1,410 - 1,410 - 1,410 - - 1,410 -
210 Salep kombinasi cream ( Berloson ) Tube - 11,000 - 11,000 - 11,000 - - 11,000 -
211 Salicil bedak Kotak - 1,025 - 1,025 - 1,025 - - 1,025 -
212 Serum Anti Bisa Ular Polivalen Inj 50 mVial - 517,132 - 517,132 - 517,132 - - 517,132 -
213 Serum Anti Tetanus inj 1500 IU ( Teta Vial - 130,999 - 130,999 - 130,999 - - 130,999 -
214 Sianokobalamin Injeksi Ampul - 1,035 - 1,035 - 1,035 - - 1,035 -
215 Simvastatin 10 mg tablet Tablet - 68 - 68 - 68 - - 68 -
216 Simvastatin 20 mg tablet Tablet - 205 - 205 - 205 - - 205 -
217 Sukralfat Suspensi Botol - 6,789 - 6,789 - 6,789 - - 6,789 -
218 Sukralfat tablet 500 mg Tablet - 368 - 368 - 368 - - 368 -
219 Suspensi Seng Insulin inj.40 IU/ml - 10Tube - - - - - - - - - -
220 Temporary Stopping Fletcher serbuk &Tablet - - - - - - - - - -
221 Tetrakain HCL tetes mata 0,5% Tube - - - - - - - - - -
222 Tetrasiklin 250 mg capsul capsul - 163 - 163 - 163 - - 163 -
223 Tetrasiklin 500 mg capsul capsul - - - - - - - - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet - 57 - 57 - 57 - - 57 -
Tiamin Tablet 50 mg ( B1 ) Tablet - 180 - 180 - 180 - - 180 -
225 Ventolin Nebulizer Ampul - - - - - - - - - -
226 vitamin b komplek Tablet - 118 - 118 - 118 - - 118 -
vitamin b komplek Tablet - 57 - 200 57 11,400 200 57 11,400 - 57 -
227 Zink sirup Botol - 3,171 - 2 3,171 6,342 2 3,171 6,342 - 3,171 -
228 Zink tablet 20 mg Tablet - 524 - 524 - 524 - - 524 -
229 Deksametason inj Ampul - 1,097 - 1,097 - 1,097 - - 1,097 -
230 Diazepam inj 5 mg/ml Ampul - 1,545 - 1,545 - 1,545 - - 1,545 -
231 Griseofulvin 125 mcg Tablet - 210 - 210 - 210 - - 210 -
232 Kloramfenikol SK/ BUFACETIN Tube - 3,266 - 3,266 - 3,266 - - 3,266 -
233 Nystatin tab 500.000 IU Tablet - 843 - 843 - 843 - - 843 -
234 magnesium Sulfat Inj. 25 ml 40% ampul - 11,100 - 11,100 - 11,100 - - 11,100 -
235 natrium bicarbonat tab - - - - - - - - - -
236 MULTIVITAMIN ANAK STIMUNO SYRBOTOL - - - - - - - - - -
237 tetagam set - 146,800 - 146,800 - 146,800 - - 146,800 -
238 vit c kemenkes tab - 198 - 198 - 198 - - 198 -
- - - - - - - -
- - - - - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) - - - - - - - -
1 Alat suntik 1 ml Pcs - 777 - 777 - 777 - 777 -
2 Alat suntik 10 ml Pcs - 1,067 - 1,067 - 1,067 - 1,067 -
3 Alat suntik 2,5 ml Pcs - 649 - 649 - 649 - 649 -
4 Alat suntik 20 ml Pcs - 2,650 - 2,650 - 2,650 - 2,650 -
5 Alat suntik 3 cc (Remedi) - 924 - 924 - 924 - 924 -
6 Alat suntik 3 ml Pcs - 880 - 880 - 880 - 880 -
7 Alat suntik 5 ml pcs - 968 - 968 - 968 - 968 -
8 Alkazide 1 L High Level Desinfectant Botol - 2,702,700 - 2,702,700 - 2,702,700 - 2,702,700 -
9 Alkazyme Sachet 25 mg Pack - 801,000 - 801,000 - 801,000 - 801,000 -
10 Alkohol 70 % 1 L Botol - 25,000 - 25,000 - 25,000 - 25,000 -
11 Alkohol swab box - 12,000 - 12,000 - 12,000 - 12,000 -
12 Anti Septik Hand Rub Botol - 26,500 - 26,500 - 26,500 - 26,500 -
13 Anti Septik Surgikal Hand Scrub Botol - - - - - - - - -
14 Cat Gut no 2/0 KOTAK - 270,000 - 270,000 - 270,000 - 270,000 -
15 Cat Gut no 3/0 KOTAK - 202,950 - 202,950 - 202,950 - 202,950 -
16 Cat Gut No 2/0 (24 mm) Sachet - 61,800 - 61,800 - 61,800 - 61,800 -
17 Cat Gut No 3/0 (26 mm) Sachet - 58,700 - 58,700 - 58,700 - 58,700 -
18 Cathetter Jelly Biji - 41,600 - 41,600 - 41,600 - 41,600 -
19 Demetech Silk 3/0 Set - 3,825 - 3,825 - 3,825 - 3,825 -
20 E Care I.V Dresing Pcs - 2,937 - 2,937 - 2,937 - 2,937 -
21 E-Care Surgical Mask Tie On Lembar - 520 - 520 - 520 - 520 -
22 Folly No 14 Catether pcs - 16,610 - 16,610 - 16,610 - 16,610 -
23 Folly No 16 Catether box - 96,800 - 96,800 - 96,800 - 96,800 -
24 I.V Cathetter No. 20 Set - 5,786 - 5,786 - 5,786 - 5,786 -
iv cathETER no 20 pcs - 6,277 - 6,277 - 6,277 - 6,277 -
26 I.V Cathetter No. 24 pcs - 5,786 - 5,786 - 5,786 - 5,786 -
28 Infuset Anak Set - 8,400 - 8,400 - 8,400 - 8,400 -
Infuset Anak PCS - 6,504 - 6,504 - 6,504 - 6,504 -
29 Infuset Dewasa pcs - 6,504 - 6,504 - 6,504 - 6,504 -
30 Jarum Insulin Tablet - 2,083 - 2,083 - 2,083 - 2,083 -
31 Kapas Berlemak 250 gr Bungkus - 20,600 - 20,600 - 20,600 - 20,600 -
32 Kapas Berlemak 500 gr Bungkus - - - - - - - - -
33 Kasa 4 m x 10 cm Rol - 1,440 - 1,440 - 1,440 - 1,440 -
34 Kasa Hidrofil 36 x 80 cm Rol - 127,600 - 127,600 - 127,600 - 127,600 -
35 Kasa Pembalut 2 x 80 cm Pack - 9,400 - 9,400 - 9,400 - 9,400 -
36 Kasa Steril / hidrofil 16 x 16 cm Kotak - 4,600 - 4,600 - 4,600 - 4,600 -
37 Lisol 1 L Botol - 40,997 - 40,997 - 40,997 - 40,997 -
38 Masker karet Ear Loop Lembar - 15,700 - 15,700 - 15,700 - 15,700 -
39 Masker tali Tube - 500 - 500 - 500 - 500 -
40 Nasal Canula Oksigen Set - - - - - - - - -
41 Plester 1" Rol - 9,750 - 9,750 - 9,750 - 9,750 -
42 Plester Kertas 2,5 cm Rol - 7,624 - 7,624 - 7,624 - 7,624 -
43 Plester Non Woven 5cm x 5 cm Rol - 23,760 - 23,760 - 23,760 - 23,760 -
44 Policlean Botol - 78,200 - 78,200 - 78,200 - 78,200 -
45 Polifik Kotak - 7,370 - 7,370 - 7,370 - 7,370 -
46 Saraya Alsof A 500 ml Botol - - - - - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang - 40,733 - 40,733 - 40,733 - 40,733 -
49 Sarung tangan M (Non Steril) KOTAK - 120,000 - 120,000 - 120,000 - 120,000 -
50 Sarung tangan no 6,5 Pasang - 13,178 - 13,178 - 13,178 - 13,178 -
51 Sarung tangan no 6,5 Steril Gloves Pasang - 8,635 - 8,635 - 8,635 - 8,635 -
52 Sarung tangan no 7,0 Steril Pasang - 8,635 - 8,635 - 8,635 - 8,635 -
53 Selang Section ( Surgikal Conection T Pcs - 30,003 - 30,003 - 30,003 - 30,003 -
54 Underpad pack - 33,000 - 33,000 - 33,000 - 33,000 -
55 Urine Bag Biji 3 5,782 17,346 5,782 - 3 5,782 17,346 5,782 -
56 safety blackblood BOX - 204,167 - 204,167 - 204,167 - 204,167 -
57 safety box BOX - 22,433 - 22,433 - 22,433 - 22,433 -
58 Tabung BD Vacutener pcs - 1,690 - 1,690 - 1,690 - 1,690 -
59 masker n95 box - 130,240 - 130,240 - 130,240 - 130,240 -
60 t silk black 3/0 26 mm pcs - 19,700 - 19,700 - 19,700 - 19,700 -
64 Nasal Canula Oksigen anak nca pcs - 6,504 - 6,504 - 6,504 - 6,504 -
65 nasal canula oksigen dewasa ncd pcs - 6,504 - 6,504 - 6,504 - 6,504 -
66 silk 2-0 box - 350,000 - 350,000 - 350,000 - 350,000 -
67 silk 3-0 box - 299,310 - 299,310 - 299,310 - 299,310 -
- - - - - - - -
OBAT JKN - - - - - - - -
1 etil klorida spray btl 352,000 - 352,000 - 352,000 - 352,000 -
2 Ketorolac inj box 20,010 - 20,010 - 20,010 - 20,010 -
3 parasetamol tab box 16,939 - 16,939 - 16,939 - 16,939 -
4 Acyclovir 400 mg box 37,829 - 37,829 - 37,829 - 37,829 -
5 GLUKOSA 5% BOTOL 7,363 - 7,363 - 7,363 - 7,363 -
6 glukosa 10% BOTOL 8,003 - 8,003 - 8,003 - 8,003 -
7 asam tranexamat inj box 110,000 - 110,000 - 110,000 - 110,000 -
8 IBUPROFEN 400 mg box 52,800 - 52,800 - 52,800 - 52,800 -
9 Mecobalamin 500 Mg Tab box 77,000 - 77,000 - 77,000 - 77,000 -
10 Metronidazole 500 mg box 26,400 - 26,400 - 26,400 - 26,400 -
11 d40 % botol 24,000 - 24,000 - 24,000 - 24,000 -
12 dulcolax anak suppo box 146,396 - 146,396 - 146,396 - 146,396 -
13 gom box 95,040 - 95,040 - 95,040 - 95,040 -
14 Lexigo box 27,500 - 27,500 - 27,500 - 27,500 -
15 METRONIDAZOL SYR/ farizol botol 6,600 - 6,600 - 6,600 - 6,600 -
16 mikrolax suppositoria Tube 20,625 - 20,625 - 20,625 - 20,625 -
17 natrium bicarbonat tab botol 15,000 - 15,000 - 15,000 - 15,000 -
18 nifedipin tab box 17,050 - 17,050 - 17,050 - 17,050 -
19 nacl botol 6,840 - 6,840 - 6,840 - 6,840 -
20 acylovir cream tube 5,500 - 5,500 - 5,500 - 5,500 -
21 Ciprofloxacin 500 mg box 66,000 - 66,000 - 66,000 - 66,000 -
22 Cetirizine syr BOTOL 7,700 - 7,700 - 7,700 - 7,700 -
23 Guanistrep syr BOTOL 7,700 - 7,700 - 7,700 - 7,700 -
24 nisagon krim tube 7,700 - 7,700 - 7,700 - 7,700 -
25 piroksikam 20 mg tab box 24,200 - 24,200 - 24,200 - 24,200 -
26 metilergo injek ampul 7,700 - 7,700 - 7,700 - 7,700 -
27 NILACELIN SIR botol 38,500 - 38,500 - 38,500 - 38,500 -
28 water for injeksi/ Aqua pro inj vial 8,800 - 8,800 - 8,800 - 8,800 -
29 mgso 40 vial 13,200 - 13,200 - 13,200 - 13,200 -
30 oksitosin inj box 88,000 - 88,000 - 88,000 - 88,000 -
31 asam traneksamat 500 mg tab box @50 tab 115,500 - 115,500 - 115,500 - 115,500 -
32 ctm 4 mg box @100 tab 11,000 - 11,000 - 11,000 - 11,000 -
33 domperidon syr botol 6,600 - 6,600 - 6,600 - 6,600 -
34 h202 3% 100 ML botol 22,000 - 22,000 - 22,000 - 22,000 -
35 MG/scopma 154,000 - 154,000 - 154,000 - 154,000 -
36 ketokonazol cr tube 7,700 - 7,700 - 7,700 - 7,700 -
37 ketokonazol tab box@50 tab 29,700 - 29,700 - 29,700 - 29,700 -
38 molexflu box@150 tab 64,900 - 64,900 - 64,900 - 64,900 -
PARACETAMOL 100MG/ML DROP 15 BOTOL
39 ML 13,750 - 13,750 - 13,750 - 13,750 -
40 scabimite 30 gram 82,500 - 82,500 - 82,500 - 82,500 -
41 DIASTRIX(loperamid) box @100 tab 24,200 - 24,200 - 24,200 - 24,200 -
42 PARASETAMOL INFUS BOTOL 33,000 - 33,000 - 33,000 - 33,000 -
43 Salep 2-4 POT 6,600 - 6,600 - 6,600 - 6,600 -
44 ventolin nebu BOX 330,000 - 330,000 - 330,000 - 330,000 -
45 Ambroxol Syrup 15 mg/5 ml Botol 4,400 - 4,400 - 4,400 - 4,400 -
46 Amlodipin 10 mg Tablet 275 - 275 - 275 - 275 -
47 Akita Tablet 440 - 440 - 440 - 440 -
48 BEDAK SALICYL 2% 60 GRAM POT 7,700 - 7,700 - 7,700 - 7,700 -
49 BIOPLASENTON GEL 15 GRAM TUBE 29,700 - 29,700 - 29,700 - 29,700 -
50 Cefadroxil 500 mg Tablet 968 - 968 - 968 - 968 -
51 Dexamethasone Inj ampul 3,300 - 3,300 - 3,300 - 3,300 -
52 DOMPERIDON SYR BOTOL 6,600 - 6,600 - 6,600 - 6,600 -
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 110 - 100 110 11,000 100 110 11,000 110 -
54 Methylergometrin injeksi ampul 7,700 - 7,700 - 7,700 - 7,700 -
55 MgSO4 40% botol 13,200 - 13,200 - 13,200 - 13,200 -
56 Ondancetron 4 mg/2ml Injeksi Ampul 9,900 - 9,900 - 9,900 - 9,900 -
57 Ondansetron Tablet 4 mg Tablet 1,210 - 1,210 - 1,210 - 1,210 -
58 Oxytocin Injeksi Ampul 8,800 - 8,800 - 8,800 - 8,800 -
59 Paracetamol 500 mg Tablet 220 - 220 - 220 - 220 -
60 PARACETAMOL SUPPOSITORIA 160MG SUPP 8,800 - 8,800 - 8,800 - 8,800 -
61 Ranitidin Injeksi Ampul 3,300 - 3,300 - 3,300 - 3,300 -
62 UNI BABY COUGH BOTOL 6,600 - 6,600 - 6,600 - 6,600 -
63 Vit K injeksi/ NEO K - 2 MG ampul 14,300 - 14,300 - 14,300 - 14,300 -
64 EFINEPRIN INJ AMPUL 11,000 - 11,000 - 11,000 - 11,000 -
65 SUKRALFAT SYR BOTOL 46,200 - 46,200 - 46,200 - 46,200 -
66 - - - - - - - -
67 - - - - - - - -
68 - - - - - - - -
69 - - - - - - - -
70 - - - - - - - -
BMHP JKN Set - - - - - - - -
1 LANSET CENTURY pcs 36,700 - 36,700 - 36,700 - 36,700 -
2 BISTURI pcs 438,750 - 438,750 - 438,750 - 438,750 -
3 CHKM pcs 96,200 - 96,200 - 96,200 - 96,200 -
3 mukus ekstraktor pcs 9,800 - 9,800 - 9,800 - 9,800 -
4 pipet obat 1 ml pcs 350,000 - 350,000 - 350,000 - 350,000 -
5 kertas goldar pcs 38,675 - 38,675 - 38,675 - 38,675 -
6 Rebreathing mask O2 dewasa NRM pcs 35,100 - 35,100 - 35,100 - 35,100 -
7 vaselin pcs 9,240 - 9,240 - 9,240 - 9,240 -
8 rivanol botol 8,500 - 1 8,500 8,500 1 8,500 8,500 - 8,500 -
9 povidone/ betadine botol 105,000 - 105,000 - 105,000 - 105,000 -
10 alkohol botol 75,250 - 75,250 - 75,250 - 75,250 -
11 lancet media box 20,909 - 20,909 - 20,909 - 20,909 -
12 OKSIGEN MASKER STANDAR ANAK SUNGKU pcs 19,400 - 19,400 - 19,400 - 19,400 -
13 OKSIGEN MASKER STANDAR DEWASA (SUNpcs 19,400 - 19,400 - 19,400 - 19,400 -
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack 95,000 - 95,000 - 95,000 - 95,000 -
15 IV CATHETER NO. 18 Box 214,100 - 214,100 - 214,100 - 214,100 -
16 KASA 40X80 pcs 108,400 - 108,400 - 108,400 - 108,400 -
17 PERBAN ELASTIS 10M Pcs 22,500 - 22,500 - 22,500 - 22,500 -
18 STRIP GULA DARAH GDS Box 99,450 - 99,450 - 99,450 - 99,450 -
19 SYRINGE 1ML/ SUNTIK 1 CC Box 150,525 - 150,525 - 150,525 - 150,525 -
20 UMBILICAL KLEM Box 88,275 - 88,275 - 88,275 - 88,275 -
21 URINE BAG Pcs 8,150 - 8,150 - 8,150 - 8,150 -
22 catheter jeli Pcs 58,973 - 58,973 - 58,973 - 58,973 -
23 nesco asam urat botol 121,550 - 121,550 - 121,550 - 121,550 -
24 usg jeli pouch 38,675 - 38,675 - 38,675 - 38,675 -
25 PLASTIK LIMBAH KUNING 80 x 60 (50 Buahpack 127,000 - 127,000 - 127,000 - 127,000 -
26 PLASTIK LIMBAH KUNING 100 x 80 (50 Buapack 203,250 - 203,250 - 203,250 - 203,250 -
27 IV CATH 26 box 355,700 - 355,700 - 355,700 - 355,700 -
28 PLASTIK KRESEK BERLOGO PKM CETAK DE pack 65,000 - 65,000 - 65,000 - 65,000 -
29 SYRINGE 10ML/SPUIT Box 301,050 - 301,050 - 301,050 - 301,050 -
30 Infusion Set with Airvent Dewasa Pcs 3,179 - 3,179 - 3,179 - 3,179 -
31 Needle 2/0 Box 39,677 - 39,677 - 39,677 - 39,677 -
32 Nasal Oxygen Cannula Anak nca Pcs 8,184 - 8,184 - 8,184 - 8,184 -
33 TES KEHAMILAN BOX 96,000 - 96,000 - 96,000 - 96,000 -
34 STRIP CHOLESTEROL KOLES botol 206,550 - 206,550 - 206,550 - 206,550 -
35 strip hb easy touc botol 165,675 - 165,675 - 165,675 - 165,675 -
36 urine gluco protein test box 47,450 - 47,450 - 47,450 - 47,450 -
37 HANDSABUTAZER PUMP+ BRACKET botol 93,000 - 93,000 - 93,000 - 93,000 -
38 HANDSANITAZER PUMP botol 61,400 - 61,400 - 61,400 - 61,400 -
39 NEBULIZER ANAK PCS 25,500 - 25,500 - 25,500 - 25,500 -
40 NEBULIZER BAYI PCS 25,500 - 25,500 - 25,500 - 25,500 -
41 NEBULIZER DEWASA PCS 25,500 - 25,500 - 25,500 - 25,500 -
42 JELLY USG 5 LITER Derigen 269,830 - 269,830 - 269,830 - 269,830 -
43 KERTAS LAKMUS PINK / BIRU Pack 57,300 - 57,300 - 57,300 - 57,300 -
44 OXYGEN NASAL CANNULA NEONATUS NCBPcs 8,450 - 8,450 - 8,450 - 8,450 -
45 PLASTIK LIMBAH HITAM (60x100) Pack 26,350 - 26,350 - 26,350 - 26,350 -
47 PLASTIK LIMBAH KUNING 60x90 (20 buah) Pack 81,800 - 81,800 - 81,800 - 81,800 -
48 REAGEN GOLDAR Set 355,750 - 355,750 - 355,750 - 355,750 -
49 SENDOK OBAT 5ML (250 Pcs) Pack 53,200 - 53,200 - 53,200 - 53,200 -
50 SYRINGE 0,5ML Box 165,550 - 165,550 - 165,550 - 165,550 -
51 POVIDON IODIN 1LITER botol 105,000 - 105,000 - 105,000 - 105,000 -
52 SPALK BAYI pcs 22,575 - 22,575 - 22,575 - 22,575 -
53 SPALK TANGAN pcs 106,092 - 106,092 - 106,092 - 106,092 -
54 STRIP GULA DARAH box 99,450 - 99,450 - 99,450 - 99,450 -
55 SYRINGE 10ML/SPUIT box 150,525 - 150,525 - 150,525 - 150,525 -
56 SUFRATULLE box 87,500 - 87,500 - 87,500 - 87,500 -
57 NURSE CAPS box 72,900 - 72,900 - 72,900 - 72,900 -
58 KERTAS PUYER LIPAT pack 14,365 - 14,365 - 14,365 - 14,365 -
59 alkohol 70% 1 LITER botol 45,000 - 45,000 - 45,000 - 45,000 -
60 RAPID TEST DENGUE IgG/IgM box 1,440,000 - 1,440,000 - 1,440,000 - 1,440,000 -
61 RAPID TEST DENGUE NS1 box 1,375,000 - 1,375,000 - 1,375,000 - 1,375,000 -
62 RAPID TEST TYPHOID box 1,091,188 - 1,091,188 - 1,091,188 - 1,091,188 -
63 RIVANOL 300ML botol 8,500 - 8,500 - 8,500 - 8,500 -
64 POVIDION IODINE 15ML botol 3,680 - 3,680 - 3,680 - 3,680 -
65 SUCTION NO 8 PCS 10,000 - 10,000 - 10,000 - 10,000 -
66 - - - - - - - -
67 - - - - - - - -
68 - - - - - - - -
69 - - - - - - - -
70 - - - - - - - -
71 - - - - - - - -
72 - - - - - - - -
73 - - - - - - - -
74 - - - - - - - -
75 - - - - - - - -
76 - - - - - - - -
total 44,746 204,946 241,652 -
Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

Kabupaten Pandeglang Puskesmas Cikeusik
1 Acep Surahman, S.Kep. Ners

NIP.19750506 199503 1002
ALIK WAHYUDI, S.Kep.Ners ELAH NURHAYATI. Amd. Keb
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
2 Reny Wigyawati. Apt
NIP. 19860114201902 2 003
3 Jujum Jumiati, Amd. Keb

NIP. 19780401 200604 2 020
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : UPT PUSKESMAS CIKEUSIK
PERHITUNGAN PERSEDIAAN
PER 31 Maret 2022
Harga Perhitungan Persediaan :

Penjelasan
No Uraian Satuan Satuan Reviu Mutasi Jumlah Nilai Selisih
(Rp) Administr Selisih
Fisik (+) (-) Fisik Persediaan
asi
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (4 x 10) 12
BMHP+OBAT+HIBAH
BAHAN HABIS PAKAI
GUDANG OBAT -
RANCASENENG (BOP)
-
RANCASENENG OBAT (JKN) -
RANCASENENG (BMHP) -
-
RANCASENENG OBAT (JKN) -


NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003
NIP. 19780401 200604 2 020
PUSKESMAS : CIKEUSIK/Pustu rancaseneng

KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE juni DINKES KAB/KOTA
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE juli GFK KAB/KOTA
PUSKESMAS
juni
Jumlah
Stok
Optimum
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Persediaa Pemakaian Stok Akhir n
n BUFFER
STOK
1 Alprazolam Tablet 0 0 0
2 Albendazol Tablet 400 mg Tablet 0 0 0
3 Allopurinol tablet 100 mg Tablet 0 0 0
Allopurinol tablet 100 mg Tablet 0 0 0
4 Ambroxol sirup Botol 0 0 0
5 Ambroxol tablet 30 mg Tablet 0 0 0
6 Aminofilin Tablet 200 mg Tablet 0 0 0
7 Aminofilina injeksi 24 mg/ml Ampul 0 0 0
8 Amlodipin 10 mg Tablet 0 0 0
Amlodipin 10 mg Tablet 0 0 0
9 Amlodipin Besilate 5 mg Tablet 0 0 0
Amlodipin Besilate 5 mg Tablet 0 0 0
10 Amoksisilin Forte sirup ker Botol 0 0 0
11 Amoksisilin Injeksi 1 gr Vial 0 0 0
12 Amoksisilin Tablet 500 mg Tablet 0 0 0
Amoksisilin Tablet 500 mg kaplet 0 200 200 200 0 200
13 Amoksisillin kapsul 250 mg Kapsul 0 0 0
14 Amoksisillin Sirup Kering 1 Botol 0 0 0
Amoksisillin Sirup Kering 1 Botol 0 10 10 10 0 10
15 Ampisilin Injeksi 1 gr Vial 0 0 0
16 Analog insulin Long Acting Pen 0 0 0
17 Analog insulin Mix Acting Pen 0 0 0
18 Antalgin (Metampiron) table Tablet 0 0 0
19 Antalgin (Metampiron) table Tablet 0 0 0
20 Antasida DOEN suspensi Botol 0 10 10 10 0 10
21 ANTASIDA DOEN Tablet Tablet 0 0 0
22 Anti Bakteri DOEN ( BacitrasTube 0 0 0
23 anti hemoroid doen kombinasupp 0 0 0
24 Antifungi DOEN Tube 0 0 0
25 Antimigren DOEN KombinasiTablet 0 0 0
26 Antiparkinson DOEN tablet Tablet 0 0 0
27 Antiparkinson Tablet ( LevopTablet 0 0 0
28 Aqua Pro Injeksi Vial 0 0 0
29 Artermeter injeksi Ampul 0 0 0
30 Artesunate injeksi 60 mg/ml vial 0 0 0
31 Asam Ascorbat ( Vit. C ) 50 Tablet 0 0 0
32 Asam Folat Botol 0 0 0
33 Asam Fusidat Cream Tube 0 0 0
34 Asam Klorida 0,1 N Botol 0 0 0
35 Asam Mefenamat 500 mg Tablet 0 0 0
Asam Mefenamat 500 mg Tablet 0 100 100 100 0 200
36 Asam Traneksamat Inj 5% Ampul 0 0 0
37 Asering Botol 0 0 0
38 Asetosal tablet 500 mg Tablet 0 0 0
39 Asetyl Cysteine Capsul 0 0 0
40 Asiklovir Cream 5% Tube 0 0 0
41 Asiklovir tablet 200 mg Tablet 0 0 0
42 Asiklovir tablet 400 mg Tablet 0 0 0
43 Atropin Sulfat injeksi 0,25 mAmpul 0 0 0
44 Atropin Sulfat injeksi 0,25 mVial 0 0 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0 0 0
46 Berotec Metered Aerosol 1 Bok 0 0 0
47 Betadine Salep Antiseptik 5 Tube 0 0 0
48 Betametason krim 0,1 % Tube 0 2 2 2 0 5
49 Bisakodil Suppositoria supp 0 0 0
50 Bisoprolol 2,5 mg Tablet 0 0 0
51 Bisoprolol 5 mg Tablet 0 0 0
52 Cairan Infus KN-3B Botol 0 0 0
53 Cairan Infus Wida KDN 1 Botol 0 0 0
Cairan Infus Wida KDN 2 Botol 0 0 0
54 Cairan Pembersih ( ProtektoBotol 0 0 0
55 Captopril Tablet 12,5 mg Tablet 0 0 0
56 Captopril Tablet 25 mg Tablet 100 100 200 200 0 100
57 Cefadroxil Capsul 500 mg Capsul 0 0 0
58 Cefixime Capsul 100 mg Capsul 0 0 0
59 Cefixime Sirup Botol 0 0 0
60 Cefotaksime 1 gr Injeksi Vial 0 0 0
61 Cetirizine Capsul 50 mg Capsul 0 0 0
62 Cetirizine sirup 5 mg/5 ml Botol 0 0 0
63 Ciprofloxcacin 500 mg tabletTablet 0 0 0
64 Combivent UDV 2,5 mg+0,5Ampul 0 0 0
65 D-Artepp tablet Tablet 0 0 0
66 deksametason tab Tablet 0 0 0
67 Dekstran 70 - larutan infus 6Botol 0 0 0
68 Dekstrometorfan sirup Botol 0 0 0
69 Dekstrometorfan tablet 15 Tablet 0 0 0
70 Diazepam Rektal 0,5 mg / 2supp 0 0 0
71 Diazepam tablet 2 mg Tablet 0 0 0
72 Diazepam tablet 5 mg Tablet 0 0 0
73 Difenhidramin HCL injeksi 1Ampul 0 0 0
74 Digoksin tablet 0,25 mg Tablet 0 0 0
75 Diltiazem Tablet 0 0 0
76 Doksisiklin Kapsul 100 mg Capsul 0 0 0
77 Domperidon 10mg Tablet Tablet 0 0 0
78 Domperidon Suspensi 5 mg/Botol 0 0 0 10
79 Doxicyclin 500mg capsul 0 0 0
80 Efedrin HCLTablet 25 mg Tablet 0 0 0
81 Epinefrina HCL/Bitartrat In Ampul 0 0 0
82 Eritromicyn kapsul 250 mg capsul 0 0 0
83 Erytromicin kapsul 500 mg Kapsul 0 0 0
84 Erytromicin sirup 125 mg Botol 0 0 0
85 Etakridin ( Rivanol ) larutan Botol 0 0 0
86 Etambutol 500 mg Tablet 0 0 0
87 Etanol 70 % Botol 0 0 0
88 Etil Klorida Semprot Botol 0 0 0
89 Fenitoin Natrium kapsul 30 Kapsul 0 0 0
90 Fenobarbital injeksi 50 mg/mAmpul 0 0 0
91 Fenobarbital tablet 30 mg Tablet 0 0 0
92 Fenoksimetil Penisilina tabl Tablet 0 0 0
93 Fenol Gliserol tetes telinga Botol 0 0 0
94 Fitomenadion (Vit.K1) InjeksAmpul 0 0 0
95 Fitomenadion (Vit.K1) tab saTablet 0 0 0
96 Flufenazine Deconat Inj 25 Ampul 0 0 0
97 Furosemida tablet 40 mg Tablet 0 0 0
98 Furosemide Injeksi Ampul 0 0 0
99 Garam Oralit Sachet 0 10 10 10 0 5
100 Gemfibrozil 300 mg Tablet 0 0 0
101 Gentamicin Injeksi Ampul 0 0 0
102 Gentamicin Salep Kulit Tube 0 0 0
103 Gentamicin Salep mata Tube 0 0 0
105 Gentian Violet 1 % Botol 0 0 0
106 Glibenclamid tablet 5 mg Tablet 0 0 0
107 Glicerin Guaiacolat ( GG ) Tablet 0 0 0
108 Glikazid 80 mg Tablet Tablet 0 0 0
109 Glimepiride 2 mg Tablet 0 0 0
110 Glukosa larutan infus 10% stBotol 0 0 0
111 Glukosa larutan infus 5 % ste Botol 0 0 0
112 Griseofulvin tablet 500 mg, Tablet 0 0 0
113 Guaiafenesin 100 mg Tablet 0 0 0
114 Hidroklortiniazid ( HCT )Ta Tablet 0 0 0
115 Hidrokortison krim 2,5% Tube 0 0 0
116 Ibuprofen Suspensi Tablet 0 0 0
117 Ibuprofen tablet 200 mg Tablet 0 0 0
118 Ibuprofen tablet 400 mg Tablet 0 0 0
119 Imunomodulator sirup( STI Botol 0 10 10 10 0 10
120 Isosorbid Dinitrat tablet sub Tablet 0 0 0
121 Kalsium Glukonas Injeksi Ampul 0 0 0
122 Kalsium Laktat (Kalk) tablet Tablet 0 0 0
123 Kapas Berlemak 500 mg Bungkus 0 0 0
124 Ketokonazol Kream Tube 0 0 0
125 Ketokonazol Tablet 200 mg Tablet 0 100 100 100 0 100
126 Ketorolac inj Ampul 0 0 0
127 Kifadene tablet 20 mg Tablet 0 0 0
128 Kloramfenikol salep mata 1 capsul 0 0 0
129 Kloramfenikol suspensi Botol 0 0 0
130 Kloramfenikol tetes telinga Tube 0 0 0
131 Kloramphenicol 250 mg Capsul 0 0 0
132 Kloramphenicol 500 mg capsul 0 0 0
133 Kloramphenicol Tetes Mata Botol 0 0 0
134 Klorfeniramin Maleat (CTM) Tablet 0 0 0
135 Klorokuin tablet 150 mg Tablet 0 0 0
136 Klorpromazin HCL tablet salTablet 0 0 0
137 Kombinasi (Pirimetamin 25 Tablet 0 0 0
138 Kotrimoksazol Dewasa TablTablet 0 0 0
139 Kotrimoksazol Sirup / SuspeBotol 0 5 5 5 0 10
140 Kuinin Dihidroklorida injeksi Ampul 0 0 0
141 Kuinin Dihidroklorida injeksi Botol 0 0 0
142 Lactobacilus serbuk Sachet 0 0 0
143 Lidocain 2%+efinefrin injeksAmpul 0 0 0
144 Lidocain injeksi 2 ml Ampul 0 0 0
145 Lisinopril 10 mg tablet Tablet 0 0 0
146 Lisinopril 5 mg tablet Tablet 0 0 0
147 Loperamid 4 mg tablet Tablet 0 0 0
148 Lytacur Sirup Botol 0 0 0
149 Magnesium Sulfat Inj. 25 m Ampul 0 0 0
150 Metamizol 500 mg Tablet 0 0 0
151 Metformin 500 mg Tablet Tablet 0 200 200 200 0 200
152 Methilprednisolon tablet 4 mTablet 0 100 100 100 0 100
153 Metilergometrin Maleat injekAmpul 0 0 0
154 Metilergometrin Maleat TablTablet 0 0 0
155 Metoklopramid Suspensi Botol 0 0 0
156 Metoklopramid tablet Tablet 0 0 0
157 Metronidazol 500 mg Tablet 0 0 0
158 Metronidazol infus / injeksi Botol 0 0 0
159 Metronidazol Ovula supp 0 0 0
160 Metronidazol suspensi Botol 0 0 0
161 Mikonazol kream Tube 0 0 0
162 Multivitamin Anak Sirup Botol 0 0 0
163 Multivitamin Dewasa AntioksTablet 0 5 5 5 0 5
164 Natrium Diklofenak 25 mg Ta Tablet 0 0 0
165 Natrium Diklofenak 50 mg Ta Tablet 0 100 100 100 0 200
166 Natrium Klorida Cairan InfusBotol 0 0 0
167 Nifedipine Tablet 10 mg box 0 0 0
168 Nistatin tablet vaginal 100.0 Tube 0 0 0
169 Obat anti Diare suspensi Botol 0 0 0
170 Obat Anti Diare Tablet (AkitaTablet 0 0 0
171 Obat Batuk Flu ( Molexflu ) BOX 0 1 1 1 0 2
Obat Batuk Flu ( Molexflu ) BOX 0 0 0
172 Obat Batuk Hitam (OBH) Botol 0 0 0
173 Obat Batuk Sirup Herbal ( HBotol 0 0 0
Obat Batuk Sirup Herbal ( HBotol 0 5 5 5 0 7
174 Ofloxsacin Tetes Telinga Tube 0 0 0
175 Oksitetrasiklin HCL salep m Botol 0 0 0
176 Oksitosin injeksi 10 IU/ml - Ampul 0 0 0
177 Omeprazol injeksi Ampul 0 0 0
178 Omeprazol Kapsul 20 mg capsul 0 200 200 200 0 150
179 Ondancentron injeksi 4 mg Ampul 0 0 0
180 Ondancentron Tablet4 mg Tablet 0 0 0
181 Paracetamol Drop 15 ml Botol 0 0 0
182 Paracetamol Sirup 120 mg/5Botol 0 0 0
183 Parafin Dresing ( Bioplacento pcs 0 0 0
184 Parasetamol tablet 100 mg Tablet 0 0 0
185 Parasetamol tablet 500 mg Tablet 0 0 0
186 Permetrin Krim 5 % Tube 0 0 0
187 Pirantel Sirup Botol 0 0 0
188 Pirantel tablet 125 mg Tablet 0 0 0
189 Pirazinamid Botol 0 0 0
190 Piridoksin HCL (VIT B6) tab Botol 0 0 0
191 Piroksikam tablet 20 mg Tablet 0 0 0
192 Polikresulen Tube 0 0 0
193 Povidon lodida 10% 300 ml 0 0 0
194 Povidon lodida 10% 60 ml 0 0 0
195 Prazikuantel tablet 600 mg Botol 0 0 0
196 Prednison Tablet 5 mg Tablet 0 0 0
197 Primakuin 15 mg Tablet 0 0 0
198 Probenesid 500 mg tablet Tablet 0 0 0
199 Prokain Benzil Penisilin 3 jutAmpul 0 0 0
200 Propanolol HCL tablet 10 m Tablet 0 0 0
201 Ranitidin injeksi Ampul 0 0 0
202 Ranitidin tablet Tablet 0 150 150 150 0 200
203 Resperidone 2 mg tablet Tablet 0 0 0
204 Ringer Laktat cairan infus (Otsuka) 0 0 0
205 Ringer Laktat cairan infus ( Botol 0 0 0
206 Rivanol 300 ml Botol 0 0 0
207 Salbutamol Tablet 2 mg Tablet 0 0 0
208 Salbutamol tablet 4mg Tablet 0 0 0
209 Salep 2-4 Tube 0 0 0
210 Salep kombinasi cream ( BeTube 0 0 0
211 Salicil bedak Kotak 0 0 0
212 Serum Anti Bisa Ular PolivalVial 0 0 0
213 Serum Anti Tetanus inj 1500Vial 0 0 0
214 Sianokobalamin Injeksi Ampul 0 0 0
215 Simvastatin 10 mg tablet Tablet 0 100 100 100 0 100
216 Simvastatin 20 mg tablet Tablet 0 0 0
217 Sukralfat Suspensi Botol 0 0 0
218 Sukralfat tablet 500 mg Tablet 0 0 0
219 Suspensi Seng Insulin inj.40Tube 0 0 0
220 Temporary Stopping FletcheTablet 0 0 0
221 Tetrakain HCL tetes mata Tube 0 0 0
222 Tetrasiklin 250 mg capsul capsul 0 0 0
223 Tetrasiklin 500 mg capsul capsul 0 0 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0
Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0
225 Ventolin Nebulizer Ampul 0 0 0
226 vitamin b komplek Tablet 0 0 0
vitamin b komplek Tablet 0 0 0
227 Zink sirup Botol 0 6 6 6 0 10
228 Zink tablet 20 mg Tablet 0 0 0
229 Deksametason inj Ampul 0 0 0
230 Diazepam inj 5 mg/ml Ampul 0 0 0
231 Griseofulvin 125 mcg Tablet 0 0 0
232 Kloramfenikol SK/ BUFACETIN Tube 0 0 0
233 Nystatin tab 500.000 IU Tablet 0 0 0
234 magnesium Sulfat Inj. 25 m ampul 0 0 0
235 natrium bicarbonat tab 0 0 0
236 MULTIVITAMIN ANAK STI BOTOL 0 0 0
237 tetagam set 0 0 0
238 vit c kemenkes tab 0 100 100 100 0 100
0 0 0
NAMA BAHAN MEDIS HABIS PAKAI ( 0 0 0
1 Alat suntik 1 ml Pcs 0 0 0
3 Alat suntik 2,5 ml Pcs 0 0 0
5 Alat suntik 3 cc (Remedi) 0 0 0
7 Alat suntik 5 ml pcs 0 0 0
8 Alkazide 1 L High Level DesBotol 0 0 0
9 Alkazyme Sachet 25 mg Pack 0 0 0
10 Alkohol 70 % 1 L Botol 0 0 0
12 Anti Septik Hand Rub Botol 0 0 0
13 Anti Septik Surgikal Hand S Botol 0 0 0
14 Cat Gut no 2/0 KOTAK 0 0 0
15 Cat Gut no 3/0 KOTAK 0 0 0
16 Cat Gut No 2/0 (24 mm) Sachet 0 0 0
17 Cat Gut No 3/0 (26 mm) Sachet 0 0 0
18 Cathetter Jelly Biji 0 0 0
19 Demetech Silk 3/0 Set 0 0 0
20 E Care I.V Dresing Pcs 0 0 0
21 E-Care Surgical Mask Tie OLembar 0 0 0
22 Folly No 14 Catether pcs 0 0 0
23 Folly No 16 Catether box 0 0 0
24 I.V Cathetter No. 20 Set 0 0 0
iv cathETER no 20 pcs 0 0 0
27 I.V Cathetter No. 26 Set 0 0 0
28 Infuset Anak Set 0 0 0
Infuset Anak PCS 0 0 0
30 Jarum Insulin Tablet 0 0 0
31 Kapas Berlemak 250 gr Bungkus 0 0 0
32 Kapas Berlemak 500 gr Bungkus 0 0 0
33 Kasa 4 m x 10 cm Rol 0 0 0
34 Kasa Hidrofil 36 x 80 cm Rol 0 0 0
35 Kasa Pembalut 2 x 80 cm Pack 0 0 0
36 Kasa Steril / hidrofil 16 x 16 Kotak 0 1 1 1 0 3
37 Lisol 1 L Botol 0 0 0
38 Masker karet Ear Loop Lembar 0 0 0
39 Masker tali Tube 0 0 0
40 Nasal Canula Oksigen Set 0 0 0
41 Plester 1" Rol 0 0 0
43 Plester Non Woven 5cm x 5Rol 0 0 0
44 Policlean Botol 0 0 0
45 Polifik Kotak 0 0 0
46 Saraya Alsof A 500 ml Botol 0 0 0
47 Saraya Alsof Pure 500 ml Botol 0 0 0

48 Sarung Tangan Gynecolog No 7Pasang 0 0 0
49 Sarung tangan M (Non Steril) KOTAK 0 0 0 1
50 Sarung tangan no 6,5 Pasang 0 0 0
51 Sarung tangan no 6,5 Steril Pasang 0 0 0
52 Sarung tangan no 7,0 Steril Pasang 0 0 0
53 Selang Section ( Surgikal C Pcs 0 0 0
55 Urine Bag Biji 0 0 0
56 safety blackblood BOX 0 0 0
57 safety box BOX 0 0 0
58 Tabung BD Vacutener pcs 0 0 0
59 masker n95 box 0 0 0
60 t silk black 3/0 26 mm pcs 0 0 0
64 Nasal Canula Oksigen anakpcs 0 0 0
65 nasal canula oksigen dewaspcs 0 0 0
66 silk 2-0 box 0 0 0
67 silk 3-0 box 0 0 0
0 0 0
OBAT JKN 0 0 0
1 etil klorida spray btl 0 0 0
2 Ketorolac inj box 0 0 0
3 parasetamol tab box 0 0 0
4 Acyclovir 400 mg box 0 0 0
5 GLUKOSA 5% BOTOL 0 0 0
6 glukosa 10% BOTOL 0 0 0
7 asam tranexamat inj box 0 0 0
8 IBUPROFEN 400 mg box 0 0 0
9 Mecobalamin 500 Mg Tab box 0 0 0
10 Metronidazole 500 mg box 0 0 0
11 d40 % botol 0 0 0
12 dulcolax anak suppo box 0 0 0
13 gom box 0 0 0
14 Lexigo box 0 0 0
15 METRONIDAZOL SYR/ farizol botol 0 0 0
16 mikrolax suppositoria Tube 0 0 0
17 natrium bicarbonat tab botol 0 0 0
18 nifedipin tab box 0 0 0
19 nacl botol 0 0 0
20 acylovir cream tube 0 0 0
21 Ciprofloxacin 500 mg box 0 0 0
22 Cetirizine syr BOTOL 0 0 0
23 Guanistrep syr BOTOL 0 0 0
24 nisagon krim tube 0 0 0
25 piroksikam 20 mg tab box 0 0 0
26 metilergo injek ampul 0 0 0
27 NILACELIN SIR botol 0 0 0
28 water for injeksi/ Aqua pro inj vial 0 0 0
29 mgso 40 vial 0 0 0
30 oksitosin inj box 0 0 0
31 asam traneksamat 500 mg tab box @50 tab 0 0 0
32 ctm 4 mg box @100 ta 0 0 0
33 domperidon syr botol 0 0 0
34 h202 3% 100 ML botol 0 0 0
HYOSCINE N box
BUTYLBROMIDE 10
35 MG/scopma 0 0 0
36 ketokonazol cr tube 0 0 0
37 ketokonazol tab box@50 tab 0 0 0
38 molexflu box@150 tab 0 0 0
PARACETAMOL 100MG/ML BOTOL
39 DROP 15 ML 0 0 0
TUBE
PERMETHRIN CREAM 5%
30 GRAM/ scabimite 30 gram
40 0 0 0
41 DIASTRIX(loperamid) box @100 ta 0 0 0
42 PARASETAMOL INFUS BOTOL 0 0 0
43 Salep 2-4 POT 0 0 0
44 ventolin nebu BOX 0 0 0
45 Ambroxol Syrup 15 mg/5 ml Botol 0 0 0
46 Amlodipin 10 mg Tablet 0 90 90 90 0 100
47 Akita Tablet 0 0 0
48 BEDAK SALICYL 2% 60 GRAM POT 0 0 0
49 BIOPLASENTON GEL 15 GRAM TUBE 0 0 0
50 Cefadroxil 500 mg Tablet 0 0 0
51 Dexamethasone Inj ampul 0 0 0
52 DOMPERIDON SYR BOTOL 0 0 0
53 Klorfeniramin Maleat (CTM) 4 MgTablet 0 300 300 300 0 200
54 Methylergometrin injeksi ampul 0 0 0
55 MgSO4 40% botol 0 0 0
56 Ondancetron 4 mg/2ml Injeksi Ampul 0 0 0
57 Ondansetron Tablet 4 mg Tablet 0 0 0
58 Oxytocin Injeksi Ampul 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0
60 PARACETAMOL SUPPOSITORIA 1 SUPP 0 0 0
61 Ranitidin Injeksi Ampul 0 0 0
62 UNI BABY COUGH BOTOL 0 0 0
63 Vit K injeksi/ NEO K - 2 MG ampul 0 0 0
64 EFINEPRIN INJ AMPUL 0 0 0
65 SUKRALFAT SYR BOTOL 0 0 0
66 Acyclovir Cream 5 gr Tube 0 0 0
67 Ambroxol Syrup 15 mg/5 ml Botol 0 0 0

68 ambroxol tablet tablet 0 200 200 200 0 300
69 Amlodipin 10 mg Tablet 0 0 0
70 Antihaemoroid Suppositoria Supp 0 0 0

71 BABY COUGH SYR BOTOL 0 0 0
BETAHISTIN MAESILAT 6
72 TABLET 0 0 0
MG
73 Biocombin/ Mersibion 5000 inj AMPUL 0 0 0

74 Cefadroxil 500 mg Tablet 0 0 0
75 CETIRIZINE 10 MG TABLET 0 100 100 100 0 200
76 CIPROFLOXACIN 500 MG TABLET 0 0 0
77 Dexamethasone Inj ampul 0 0 0
78 DOMPERIDON SYR BOTOL 0 0 0
79 FUROSEMIDE 40MG TABLET 0 0 0
GENTAMISIN SALEP KULIT
80 TUBE 0 0 0
0,1% 5 GRAM
GLUKOSA INFUS 10% 500ML
81 BOTOL 0 0 0
OTSUKA
GLUKOSA INFUS 5% 500ML
82 BOTOL 0 0 0
OTSUKA
83 Kloramfenichol salep mata tube 0 0 0

84 Lidocain + Ephineprin AMPUL 0 0 0
85 METRONIDAZOL 500 MG TABLET 0 0 0
86 METRONIDAZOL 500 MG TABLET 0 0 0
87 Metronidazol Sirup Botol 0 0 0
88 Ondancetron 4 mg/2ml Injeksi Ampul 0 0 0

89 Ondansetron Tablet 4 mg Tablet 0 0 0
90 Paracetamol Syrup Botol 0 10 10 10 0 15
91 PARASETAMOL INFUS BOTOL 0 0 0
92 Ranitidin Injeksi Ampul 0 0 0
Ventolin Nebu/ SALBUTAMOL
Vial
NEBULIZER 2,5MG
93 0 0 0
94 mecobalamin tab 500 mg tablet 0 0 0
95 sukralfat syr botol 0 0 0
96 ketokonazol tab tablet 0 0 0
1 Kg
(Bentuk
97 Kaporit tabet Tablet) 0 0 0
98 parasetamol tab 500 mg box 0 2 2 2 0 4
99 vit k inj box 0 0 0
100 0 0 0
BMHP JKN Set 0 0 0
1 LANSET CENTURY pcs 0 0 0
2 BISTURI pcs 0 0 0
3 CHKM pcs 0 0 0
3 mukus ekstraktor pcs 0 0 0
4 pipet obat 1 ml pcs 0 0 0
5 kertas goldar pcs 0 0 0
6 Rebreathing mask O2 dewasa pcs 0 0 0
7 vaselin pcs 0 0 0
8 rivanol botol 0 0 0
9 povidone/ betadine botol 0 0 0 5
10 alkohol botol 0 0 0
11 lancet media box 0 0 0
12 OKSIGEN MASKER STANDAR A pcs 0 0 0
13 OKSIGEN MASKER STANDAR D pcs 0 0 0
14 PLASTIK KLIP SEDANG 13x8,7 Pack 0 0 0
15 IV CATHETER NO. 18 Box 0 0 0
16 KASA 40X80 pcs 0 0 0
17 PERBAN ELASTIS 10M Pcs 0 0 0
18 STRIP GULA DARAH GDS Box 0 0 0
SYRINGE 1ML/ SUNTIK 1 CC
19 Box 0 0 0
20 UMBILICAL KLEM Box 0 0 0
21 URINE BAG Pcs 0 0 0
22 catheter jeli Pcs 0 0 0
23 nesco asam urat botol 0 0 0
24 usg jeli pouch 0 0 0
25 PLASTIK LIMBAH KUNING 80 x 6pack 0 0 0
26 PLASTIK LIMBAH KUNING 100 xpack 0 0 0
27 IV CATH 26 box 0 0 0
28 PLASTIK KRESEK BERLOGO PK pack 0 0 0
29 SYRINGE 10ML/SPUIT Box 0 0 0
Infusion Set with Airvent
Pcs
30 Dewasa 0 0 0
Medical Catgut Plain Sterile

Suture with Needle 2/0
31 Box 0 0 0
Nasal Oxygen Cannula Anak
32 nca Pcs 0 0 0
33 TES KEHAMILAN BOX 0 0 0
STRIP CHOLESTEROL KOLES botol
34 0 0 0
35 strip hb easy touc botol 0 0 0
36 urine gluco protein test box 0 0 0
37 HANDSABUTAZER PUMP+ BRAbotol 0 0 0
38 HANDSANITAZER PUMP botol 0 0 0
39 NEBULIZER ANAK PCS 0 0 0
40 NEBULIZER BAYI PCS 0 0 0
41 NEBULIZER DEWASA PCS 0 0 0
42 JELLY USG 5 LITER Derigen 0 0 0
43 KERTAS LAKMUS PINK / BIRU Pack 0 0 0
44 OXYGEN NASAL CANNULA NEOPcs 0 0 0
45 PLASTIK LIMBAH HITAM (60x10Pack 0 0 0
46 PLASTIK LIMBAH HITAM (90x12Pack 0 0 0
47 PLASTIK LIMBAH KUNING 60x90Pack 0 0 0
48 REAGEN GOLDAR Set 0 0 0
49 SENDOK OBAT 5ML (250 Pcs) Pack 0 0 0
50 SYRINGE 0,5ML Box 0 0 0
51 POVIDON IODIN 1LITER botol 0 1 1 1 0
52 SPALK BAYI pcs 0 0 0
53 SPALK TANGAN pcs 0 0 0
54 STRIP GULA DARAH box 0 0 0
55 SYRINGE 10ML/SPUIT box 0 0 0
56 SUFRATULLE/vaselin box 0 0 0
57 NURSE CAPS box 0 0 0
58 KERTAS PUYER LIPAT pack 0 0 0
59 alkohol 70% 1 LITER botol 0 0 0
60 RAPID TEST DENGUE IgG/IgM box 0 0 0
61 RAPID TEST DENGUE NS1 box 0 0 0
62 RAPID TEST TYPHOID box 0 0 0
63 RIVANOL 300ML botol 0 0 0
64 POVIDION IODINE 15ML botol 0 0 0
65 SUCTION NO 8 PCS 0 0 0
66 ALKOHOL SWAB BOX 0 0 0
BLOOD LANCET (1 Box = 100
BOX
67 Pcs) 0 0 0
EXAMINATION GLOVES uk. M BOX
68 0 0 0
69 FOLLEY CATHETER NO 14 PCS 0 0 0
PLASTIK KRESEK BERLOGO
PACK
70 PKM CETAK DEPAN 0 0 0
PLASTIK LIMBAH COKLAT 60 x
PACK
71 100 (50 Buah) 0 0 0
72 PLASTIK MERAH UK 40 PACK 0 0 0
PLESTER INCL DISPENSER 1
BOX
73 INCH 0 0 0
POT URINE NON STERILE 20
PACK
74 CC (1 Pack = 100 Pcs) 0 0 0
75 POVIDION IODINE 15ML BOTOL 0 0 0
76 STRIP CHOLESTEROL BOX 0 0 0
77 SUNGKUP NEBULIZER BAYI PCS 0 0 0
78 SYRINGE 1ML BOX 0 0 0
TABUNG VACUM TUBE EDTA
PACK
79 K3E 0 0 0
80 0 0 0

RENY WIGIAWATI, A.Pt ALIK WAHYUDI, S.Kep.Ners Rita Afriyani, Amd. Keb
NIP.198601142019 02 2 003 NIP.19850607 2010 01 1 014 NIP.
Nama Puskesmas : PKM CIKEUSIK/ Rancaseneng

Bulan : Juni
N0 NAMA OBAT SATUAN Harga per Unit
Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Jumlah (Rp) Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Harga per Unit (Rp) Jumlah (Rp)
(Rp)
1 Alprazolam Tablet - - - - - - - -
2 Albendazol Tablet 400 mg Tablet 407 - 407 - 407 - 407 -
3 Allopurinol tablet 100 mg Tablet 105 - 105 - 105 - 105 -
Allopurinol tablet 100 mg Tablet 87 - 87 - 87 - 87 -
4 Ambroxol sirup Botol 3,300 - 3,300 - 3,300 - 3,300 -
5 Ambroxol tablet 30 mg Tablet - - - - - - - -
6 Aminofilin Tablet 200 mg Tablet 91 - 91 - 91 - 91 -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 3,345 - 3,345 - 3,345 - 3,345 -
Amlodipin 10 mg Tablet 99 - 99 - 99 - 99 -
9 Amlodipin Besilate 5 mg Tablet 15,900 - 15,900 - 15,900 - 15,900 -
Amlodipin Besilate 5 mg Tablet 53 - 53 - 53 - 53 -
10 Amoksisilin Forte sirup kering 250mg Botol 3,050 - 3,050 - 3,050 - 3,050 -
11 Amoksisilin Injeksi 1 gr Vial 5,368 - 5,368 - 5,368 - 5,368 -
12 Amoksisilin Tablet 500 mg Tablet 249 - 249 - 249 - 249 -
Amoksisilin Tablet 500 mg kaplet 201 - 200 201 40,200 200 201 40,200 201 -
13 Amoksisillin kapsul 250 mg Kapsul - - - - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - - - - - - -
Amoksisillin Sirup Kering 125 mg/5 ml Botol 2,050 - 10 2,050 20,500 10 2,050 20,500 2,050 -
15 Ampisilin Injeksi 1 gr Vial 10,300 - 10,300 - 10,300 - 10,300 -
16 Analog insulin Long Acting Pen - - - - - - - -
17 Analog insulin Mix Acting Pen - - - - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet 305 - 305 - 305 - 305 -
20 Antasida DOEN suspensi Botol 1,679 - 10 1,679 16,790 10 1,679 16,790 1,679 -
21 ANTASIDA DOEN Tablet Tablet 54 - 54 - 54 - 54 -
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 3,035 - 3,035 - 3,035 - 3,035 -
23 anti hemoroid doen kombinasi supp 3,167 - 3,167 - 3,167 - 3,167 -
24 Antifungi DOEN Tube - - - - - - - -
25 Antimigren DOEN Kombinasi : Tablet 173 - 173 - 173 - 173 -
26 Antiparkinson DOEN tablet Kombinasi Tablet - - - - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - - - - -
28 Aqua Pro Injeksi Vial 2,650 - 2,650 - 2,650 - 2,650 -
29 Artermeter injeksi Ampul 1,000 - 1,000 - 1,000 - 1,000 -
30 Artesunate injeksi 60 mg/ml vial - - - - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 105 - 105 - 105 - 105 -
32 Asam Folat Botol 55 - 55 - 55 - 55 -
33 Asam Fusidat Cream Tube 5,506 - 5,506 - 5,506 - 5,506 -
34 Asam Klorida 0,1 N Botol - - - - - - - -
35 Asam Mefenamat 500 mg Tablet 200 - 200 - 200 - 200 -
Asam Mefenamat 500 mg Tablet 111 - 100 111 11,100 100 111 11,100 111 -
36 Asam Traneksamat Inj 5% Ampul 1,748 - 1,748 - 1,748 - 1,748 -
37 Asering Botol 8,800 - 8,800 - 8,800 - 8,800 -
38 Asetosal tablet 500 mg Tablet - - - - - - - -
39 Asetyl Cysteine Capsul 301 - 301 - 301 - 301 -
40 Asiklovir Cream 5% Tube 8,800 - 8,800 - 8,800 - 8,800 -
41 Asiklovir tablet 200 mg Tablet 236 - 236 - 236 - 236 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 1,639 - 1,639 - 1,639 - 1,639 -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - - - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - - - - - - -
46 Berotec Metered Aerosol 100 mg Bok 80,000 - 80,000 - 80,000 - 80,000 -
47 Betadine Salep Antiseptik 5 mg Tube 7,083 - 7,083 - 7,083 - 7,083 -
48 Betametason krim 0,1 % Tube 1,540 - 2 1,540 3,080 2 1,540 3,080 1,540 -
49 Bisakodil Suppositoria supp 5,800 - 5,800 - 5,800 - 5,800 -
50 Bisoprolol 2,5 mg Tablet 650 - 650 - 650 - 650 -
51 Bisoprolol 5 mg Tablet 263 - 263 - 263 - 263 -
52 Cairan Infus KN-3B Botol 10,696 - 10,696 - 10,696 - 10,696 -
53 Cairan Infus Wida KDN 1 Botol 1,007 - 1,007 - 1,007 - 1,007 -
Cairan Infus Wida KDN 2 Botol 11,435 - 11,435 - 11,435 - 11,435 -
54 Cairan Pembersih ( Protektor ) Botol 22,000 - 22,000 - 22,000 - 22,000 -
55 Captopril Tablet 12,5 mg Tablet 66 - 66 - 66 - 66 -
56 Captopril Tablet 25 mg Tablet 100 75 7,500 100 75 7,500 200 75 15,000 75 -
57 Cefadroxil Capsul 500 mg Capsul 516 - 516 - 516 - 516 -
58 Cefixime Capsul 100 mg Capsul 590 - 590 - 590 - 590 -
59 Cefixime Sirup Botol 7,490 - 7,490 - 7,490 - 7,490 -
60 Cefotaksime 1 gr Injeksi Vial 4,200 - 4,200 - 4,200 - 4,200 -
61 Cetirizine Capsul 50 mg Capsul 49 - 49 - 49 - 49 -
62 Cetirizine sirup 5 mg/5 ml Botol 2,849 - 2,849 - 2,849 - 2,849 -
63 Ciprofloxcacin 500 mg tablet Tablet 248 - 248 - 248 - 248 -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 4,550 - 4,550 - 4,550 - 4,550 -
65 D-Artepp tablet Tablet - - - - - - - -
66 deksametason tab Tablet 70 - 70 - 70 - 70 -
67 Dekstran 70 - larutan infus 6% steril Botol - - - - - - - -
68 Dekstrometorfan sirup Botol - - - - - - - -
69 Dekstrometorfan tablet 15 mg Tablet - - - - - - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp 12,573 - 12,573 - 12,573 - 12,573 -
71 Diazepam tablet 2 mg Tablet - - - - - - - -
72 Diazepam tablet 5 mg Tablet 109 - 109 - 109 - 109 -
73 Difenhidramin HCL injeksi 10 mg/ml - Ampul 1,168 - 1,168 - 1,168 - 1,168 -
74 Digoksin tablet 0,25 mg Tablet 105 - 105 - 105 - 105 -
75 Diltiazem Tablet - - - - - - - -
76 Doksisiklin Kapsul 100 mg Capsul 264 - 264 - 264 - 264 -
77 Domperidon 10mg Tablet Tablet 71 - 71 - 71 - 71 -
78 Domperidon Suspensi 5 mg/ 5 ml Botol 2,296 - 2,296 - 2,296 - 2,296 -
79 Doxicyclin 500mg capsul - - - - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - - - - -
81 Epinefrina HCL/Bitartrat Injeksi/ EFI Ampul 1,408 - 1,408 - 1,408 - 1,408 -
82 Eritromicyn kapsul 250 mg capsul 583 - 583 - 583 - 583 -
83 Erytromicin kapsul 500 mg Kapsul - - - - - - - -
84 Erytromicin sirup 125 mg Botol - - - - - - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol 2,992 - 2,992 - 2,992 - 2,992 -
86 Etambutol 500 mg Tablet - - - - - - - -
87 Etanol 70 % Botol - - - - - - - -
88 Etil Klorida Semprot Botol 137,500 - 137,500 - 137,500 - 137,500 -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - - - - - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 1,740 - 1,740 - 1,740 - 1,740 -
91 Fenobarbital tablet 30 mg Tablet 171 - 171 - 171 - 171 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol 3,300 - 3,300 - 3,300 - 3,300 -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml Ampul 1,386 - 1,386 - 1,386 - 1,386 -
95 Fitomenadion (Vit.K1) tab salut gula 1 Tablet 710 - 710 - 710 - 710 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul 57,500 - 57,500 - 57,500 - 57,500 -
97 Furosemida tablet 40 mg Tablet 82 - 82 - 82 - 82 -
98 Furosemide Injeksi Ampul - - - - - - - -
99 Garam Oralit Sachet 274 - 10 274 2,740 10 274 2,740 274 -
100 Gemfibrozil 300 mg Tablet 380 - 380 - 380 - 380 -
101 Gentamicin Injeksi Ampul 1,010 - 1,010 - 1,010 - 1,010 -
102 Gentamicin Salep Kulit Tube 2,800 - 2,800 - 2,800 - 2,800 -
103 Gentamicin Salep mata Tube 4,232 - 4,232 - 4,232 - 4,232 -
104 Gentamicin Tetes Mata Botol 4,520 - 4,520 - 4,520 - 4,520 -
Gentamicin Tetes Mata Botol 4,520 - 5 4,520 22,600 5 4,520 22,600 4,520 -
105 Gentian Violet 1 % Botol - - - - - - - -
106 Glibenclamid tablet 5 mg Tablet 119 - 119 - 119 - 119 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - - - - -
108 Glikazid 80 mg Tablet Tablet 235 - 235 - 235 - 235 -
109 Glimepiride 2 mg Tablet 207 - 207 - 207 - 207 -
110 Glukosa larutan infus 10% steril Botol - - - - - - - -
111 Glukosa larutan infus 5 % steril Botol 6,900 - 6,900 - 6,900 - 6,900 -
112 Griseofulvin tablet 500 mg, Tablet 906 - 906 - 906 - 906 -
113 Guaiafenesin 100 mg Tablet 132 - 132 - 132 - 132 -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 155 - 155 - 155 - 155 -
115 Hidrokortison krim 2,5% Tube 2,475 - 2,475 - 2,475 - 2,475 -
116 Ibuprofen Suspensi Tablet - - - - - - - -
117 Ibuprofen tablet 200 mg Tablet 105 - 105 - 105 - 105 -
118 Ibuprofen tablet 400 mg Tablet - - - - - - - -
119 Imunomodulator sirup( STIMUNO) Botol 28,118 - 10 28,118 281,180 10 28,118 281,180 28,118 -
120 Isosorbid Dinitrat tablet sublingual 5 m Tablet 89 - 89 - 89 - 89 -
121 Kalsium Glukonas Injeksi Ampul 4,800 - 4,800 - 4,800 - 4,800 -
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 60 - 60 - 60 - 60 -
123 Kapas Berlemak 500 mg Bungkus - - - - - - - -
124 Ketokonazol Kream Tube 2,518 - 2,518 - 2,518 - 2,518 -
125 Ketokonazol Tablet 200 mg Tablet 252 - 100 252 25,200 100 252 25,200 252 -
126 Ketorolac inj Ampul 1,045 - 1,045 - 1,045 - 1,045 -
127 Kifadene tablet 20 mg Tablet - - - - - - - -
128 Kloramfenikol salep mata 1 % capsul 1,881 - 1,881 - 1,881 - 1,881 -
129 Kloramfenikol suspensi Botol 5,015 - 5,015 - 5,015 - 5,015 -
130 Kloramfenikol tetes telinga 3% Tube - - - - - - - -
131 Kloramphenicol 250 mg Capsul 310 - 310 - 310 - 310 -
132 Kloramphenicol 500 mg capsul 1,163 - 1,163 - 1,163 - 1,163 -
133 Kloramphenicol Tetes Mata Botol - - - - - - - -
134 Klorfeniramin Maleat (CTM) tablet 4 m Tablet 2,300 - 2,300 - 2,300 - 2,300 -
135 Klorokuin tablet 150 mg Tablet - - - - - - - -
136 Klorpromazin HCL tablet salut 25 mg Tablet - - - - - - - -
137 Kombinasi (Pirimetamin 25 mg + Solfa Tablet - - - - - - - -
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 133 - 133 - 133 - 133 -
139 Kotrimoksazol Sirup / Suspensi Botol 2,100 - 5 2,100 10,500 5 2,100 10,500 2,100 -
140 Kuinin Dihidroklorida injeksi 25% - 2 m Ampul - - - - - - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 m Botol - - - - - - - -
142 Lactobacilus serbuk Sachet 14,707 - 14,707 - 14,707 - 14,707 -
143 Lidocain 2%+efinefrin injeksi Ampul 1,229 - 1,229 - 1,229 - 1,229 -
144 Lidocain injeksi 2 ml Ampul 1,152 - 1,152 - 1,152 - 1,152 -
145 Lisinopril 10 mg tablet Tablet 448 - 448 - 448 - 448 -
147 Loperamid 4 mg tablet Tablet 77 - 77 - 77 - 77 -
148 Lytacur Sirup Botol - - - - - - - -
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 3,328 - 3,328 - 3,328 - 3,328 -
150 Metamizol 500 mg Tablet 473 - 473 - 473 - 473 -
151 Metformin 500 mg Tablet Tablet 77 - 200 77 15,400 200 77 15,400 77 -
152 Methilprednisolon tablet 4 mg Tablet 102 - 100 102 10,200 100 102 10,200 102 -
153 Metilergometrin Maleat injeksi 1 ml Ampul 2,550 - 2,550 - 2,550 - 2,550 -
154 Metilergometrin Maleat Tablet Tablet 224 - 224 - 224 - 224 -
155 Metoklopramid Suspensi Botol 2,345 - 2,345 - 2,345 - 2,345 -
156 Metoklopramid tablet Tablet - - - - - - - -
157 Metronidazol 500 mg Tablet - - - - - - - -
158 Metronidazol infus / injeksi Botol - - - - - - - -
159 Metronidazol Ovula supp 4,100 - 4,100 - 4,100 - 4,100 -
160 Metronidazol suspensi Botol 3,799 - 3,799 - 3,799 - 3,799 -
161 Mikonazol kream Tube 1,900 - 1,900 - 1,900 - 1,900 -
162 Multivitamin Anak Sirup Botol 9,900 - 9,900 - 9,900 - 9,900 -
163 Multivitamin Dewasa Antioksidan (HB VTablet 95,063 - 5 95,063 475,315 5 95,063 475,315 95,063 -
164 Natrium Diklofenak 25 mg Tablet Tablet - - - - - - - -
165 Natrium Diklofenak 50 mg Tablet Tablet 99 - 100 99 9,900 100 99 9,900 99 -
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 6,840 - 6,840 - 6,840 - 6,840 -
167 Nifedipine Tablet 10 mg box - - - - - - - -
168 Nistatin tablet vaginal 100.000 IU/g Tube 598 - 598 - 598 - 598 -
169 Obat anti Diare suspensi Botol - - - - - - - -
170 Obat Anti Diare Tablet (Akita / Molagit Tablet 145 - 1 145 145 1 145 145 145 -
171 Obat Batuk Flu ( Molexflu ) BOX 54,870 - 54,870 - 54,870 - 54,870 -
Obat Batuk Flu ( Molexflu ) BOX 59,090 - 59,090 - 59,090 - 59,090 -
172 Obat Batuk Hitam (OBH) Botol - - - - - - - -
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 11,363 - 11,363 - 11,363 - 11,363 -
Obat Batuk Sirup Herbal ( Herbacop ) Botol 14,273 - 5 14,273 71,365 5 14,273 71,365 14,273 -
174 Ofloxsacin Tetes Telinga Tube - - - - - - - -
175 Oksitetrasiklin HCL salep mata 1% Botol 3,500 - 3,500 - 3,500 - 3,500 -
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 1,126 - 1,126 - 1,126 - 1,126 -
177 Omeprazol injeksi Ampul 9,898 - 9,898 - 9,898 - 9,898 -
178 Omeprazol Kapsul 20 mg capsul 129 - 200 129 25,800 200 129 25,800 129 -
179 Ondancentron injeksi 4 mg Ampul 1,070 - 1,070 - 1,070 - 1,070 -
180 Ondancentron Tablet4 mg Tablet 385 - 385 - 385 - 385 -
181 Paracetamol Drop 15 ml Botol 4,976 - 4,976 - 4,976 - 4,976 -
182 Paracetamol Sirup 120 mg/5 ml Botol 1,160 - 1,160 - 1,160 - 1,160 -
183 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - - - - -
184 Parasetamol tablet 100 mg Tablet - - - - - - - -
185 Parasetamol tablet 500 mg Tablet 100 - 100 - 100 - 100 -
186 Permetrin Krim 5 % Tube 11,825 - 11,825 - 11,825 - 11,825 -
187 Pirantel Sirup Botol 9,700 - 9,700 - 9,700 - 9,700 -
188 Pirantel tablet 125 mg Tablet 291 - 291 - 291 - 291 -
189 Pirazinamid Botol - - - - - - - -
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 131 - 131 - 131 - 131 -
191 Piroksikam tablet 20 mg Tablet - - - - - - - -
192 Polikresulen Tube - - - - - - - -
193 Povidon lodida 10% 300 ml 17,996 - 17,996 - 17,996 - 17,996 -
195 Prazikuantel tablet 600 mg Botol - - - - - - - -
196 Prednison Tablet 5 mg Tablet 68 - 68 - 68 - 68 -
197 Primakuin 15 mg Tablet 224 - 224 - 224 - 224 -
198 Probenesid 500 mg tablet Tablet - - - - - - - -
199 Prokain Benzil Penisilin 3 juta IU/vial inAmpul - - - - - - - -
200 Propanolol HCL tablet 10 mg Tablet 60 - 60 - 60 - 60 -
201 Ranitidin injeksi Ampul 1,188 - 1,188 - 1,188 - 1,188 -
202 Ranitidin tablet Tablet 85 - 150 85 12,750 150 85 12,750 85 -
203 Resperidone 2 mg tablet Tablet 273 - 273 - 273 - 273 -
204 Ringer Laktat cairan infus (Otsuka) 7,150 - 7,150 - 7,150 - 7,150 -
205 Ringer Laktat cairan infus (Widatra) Botol 7,630 - 7,630 - 7,630 - 7,630 -
206 Rivanol 300 ml Botol 2,992 - 2,992 - 2,992 - 2,992 -
207 Salbutamol Tablet 2 mg Tablet 48 - 48 - 48 - 48 -
208 Salbutamol tablet 4mg Tablet 70 - 70 - 70 - 70 -
209 Salep 2-4 Tube 2,333 - 2,333 - 2,333 - 2,333 -
210 Salep kombinasi cream ( Berloson ) Tube 11,000 - 11,000 - 11,000 - 11,000 -
211 Salicil bedak Kotak 1,025 - 1,025 - 1,025 - 1,025 -
212 Serum Anti Bisa Ular Polivalen Inj 50 mVial 517,132 - 517,132 - 517,132 - 517,132 -
213 Serum Anti Tetanus inj 1500 IU ( Teta Vial 130,999 - 130,999 - 130,999 - 130,999 -
214 Sianokobalamin Injeksi Ampul 1,035 - 1,035 - 1,035 - 1,035 -
215 Simvastatin 10 mg tablet Tablet 68 - 100 68 6,800 100 68 6,800 68 -
216 Simvastatin 20 mg tablet Tablet 205 - 205 - 205 - 205 -
217 Sukralfat Suspensi Botol 6,789 - 6,789 - 6,789 - 6,789 -
218 Sukralfat tablet 500 mg Tablet 368 - 368 - 368 - 368 -
219 Suspensi Seng Insulin inj.40 IU/ml - 10Tube - - - - - - - -
220 Temporary Stopping Fletcher serbuk &Tablet - - - - - - - -
221 Tetrakain HCL tetes mata 0,5% Tube - - - - - - - -
222 Tetrasiklin 250 mg capsul capsul 163 - 163 - 163 - 163 -
223 Tetrasiklin 500 mg capsul capsul - - - - - - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet 57 - 57 - 57 - 57 -
Tiamin Tablet 50 mg ( B1 ) Tablet 180 - 180 - 180 - 180 -
225 Ventolin Nebulizer Ampul - - - - - - - -
226 vitamin b komplek Tablet 57 - 57 - 57 - 57 -
vitamin b komplek Tablet 57 - 57 - 57 - 57 -
227 Zink sirup Botol 2,489 - 6 2,489 14,934 6 2,489 14,934 2,489 -
228 Zink tablet 20 mg Tablet 524 - 524 - 524 - 524 -
229 Deksametason inj Ampul 1,097 - 1,097 - 1,097 - 1,097 -
230 Diazepam inj 5 mg/ml Ampul 1,545 - 1,545 - 1,545 - 1,545 -
231 Griseofulvin 125 mcg Tablet 210 - 210 - 210 - 210 -
232 Kloramfenikol SK/ BUFACETIN Tube 3,266 - 3,266 - 3,266 - 3,266 -
233 Nystatin tab 500.000 IU Tablet 843 - 843 - 843 - 843 -
234 magnesium Sulfat Inj. 25 ml 40% ampul 11,100 - 11,100 - 11,100 - 11,100 -
235 natrium bicarbonat tab - - - - - - - -
236 MULTIVITAMIN ANAK STIMUNO SYRBOTOL 24,475 - 24,475 - 24,475 - 24,475 -
237 tetagam set 146,800 - 146,800 - 146,800 - 146,800 -
238 vit c kemenkes tab 198 - 100 198 19,800 100 198 19,800 198 -
- - - - - - - -
- - - - - - - -
1 Alat suntik 1 ml Pcs 777 - 777 - 777 - 777 -
2 Alat suntik 10 ml Pcs 1,067 - 1,067 - 1,067 - 1,067 -
3 Alat suntik 2,5 ml Pcs 649 - 649 - 649 - 649 -
5 Alat suntik 3 cc (Remedi) 924 - 924 - 924 - 924 -
7 Alat suntik 5 ml pcs 968 - 968 - 968 - 968 -
8 Alkazide 1 L High Level Desinfectant Botol 2,702,700 - 2,702,700 - 2,702,700 - 2,702,700 -
9 Alkazyme Sachet 25 mg Pack 801,000 - 801,000 - 801,000 - 801,000 -
10 Alkohol 70 % 1 L Botol 25,000 - 25,000 - 25,000 - 25,000 -
11 Alkohol swab box 12,000 - 12,000 - 12,000 - 12,000 -
12 Anti Septik Hand Rub Botol 26,500 - 26,500 - 26,500 - 26,500 -
13 Anti Septik Surgikal Hand Scrub Botol - - - - - - - -
14 Cat Gut no 2/0 KOTAK 270,000 - 270,000 - 270,000 - 270,000 -
15 Cat Gut no 3/0 KOTAK 202,950 - 202,950 - 202,950 - 202,950 -
16 Cat Gut No 2/0 (24 mm) Sachet 61,800 - 61,800 - 61,800 - 61,800 -
18 Cathetter Jelly Biji 41,600 - 41,600 - 41,600 - 41,600 -
19 Demetech Silk 3/0 Set 3,825 - 3,825 - 3,825 - 3,825 -
20 E Care I.V Dresing Pcs 2,937 - 2,937 - 2,937 - 2,937 -
21 E-Care Surgical Mask Tie On Lembar 520 - 520 - 520 - 520 -
22 Folly No 14 Catether pcs 16,610 - 16,610 - 16,610 - 16,610 -
23 Folly No 16 Catether box 96,800 - 96,800 - 96,800 - 96,800 -
24 I.V Cathetter No. 20 Set 5,786 - 5,786 - 5,786 - 5,786 -
iv cathETER no 20 pcs 6,277 - 6,277 - 6,277 - 6,277 -
26 I.V Cathetter No. 24 pcs 5,786 - 5,786 - 5,786 - 5,786 -
28 Infuset Anak Set 8,400 - 8,400 - 8,400 - 8,400 -
Infuset Anak PCS 6,504 - 6,504 - 6,504 - 6,504 -
29 Infuset Dewasa pcs 6,504 - 6,504 - 6,504 - 6,504 -
30 Jarum Insulin Tablet 2,083 - 2,083 - 2,083 - 2,083 -
31 Kapas Berlemak 250 gr Bungkus 20,600 - 20,600 - 20,600 - 20,600 -
32 Kapas Berlemak 500 gr Bungkus - - - - - - - -
33 Kasa 4 m x 10 cm Rol 1,440 - 1,440 - 1,440 - 1,440 -
34 Kasa Hidrofil 36 x 80 cm Rol 190,564 - 190,564 - 190,564 - 190,564 -
35 Kasa Pembalut 2 x 80 cm Pack 9,400 - 9,400 - 9,400 - 9,400 -
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 4,600 - 1 4,600 4,600 1 4,600 4,600 4,600 -
37 Lisol 1 L Botol 40,997 - 40,997 - 40,997 - 40,997 -
38 Masker karet Ear Loop Lembar 55,000 - 55,000 - 55,000 - 55,000 -
39 Masker tali Tube 500 - 500 - 500 - 500 -
40 Nasal Canula Oksigen Set - - - - - - - -
41 Plester 1" Rol 9,750 - 9,750 - 9,750 - 9,750 -
42 Plester Kertas 2,5 cm Rol 7,624 - 7,624 - 7,624 - 7,624 -
43 Plester Non Woven 5cm x 5 cm Rol 23,760 - 23,760 - 23,760 - 23,760 -
44 Policlean Botol 78,200 - 78,200 - 78,200 - 78,200 -
45 Polifik Kotak 7,370 - 7,370 - 7,370 - 7,370 -
46 Saraya Alsof A 500 ml Botol - - - - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang 40,733 - 40,733 - 40,733 - 40,733 -
49 Sarung tangan M (Non Steril) KOTAK 120,000 - 120,000 - 120,000 - 120,000 -
50 Sarung tangan no 6,5 Pasang 13,178 - 13,178 - 13,178 - 13,178 -
51 Sarung tangan no 6,5 Steril Gloves Pasang 8,635 - 8,635 - 8,635 - 8,635 -
52 Sarung tangan no 7,0 Steril Pasang 8,635 - 8,635 - 8,635 - 8,635 -
53 Selang Section ( Surgikal Conection T Pcs 30,003 - 30,003 - 30,003 - 30,003 -
54 Underpad pack 33,000 - 33,000 - 33,000 - 33,000 -
55 Urine Bag Biji 5,782 - 5,782 - 5,782 - 5,782 -
56 safety blackblood BOX 204,167 - 204,167 - 204,167 - 204,167 -
57 safety box BOX 22,433 - 22,433 - 22,433 - 22,433 -
58 Tabung BD Vacutener pcs 1,690 - 1,690 - 1,690 - 1,690 -
59 masker n95 box 130,240 - 130,240 - 130,240 - 130,240 -
60 t silk black 3/0 26 mm pcs 19,700 - 19,700 - 19,700 - 19,700 -
64 Nasal Canula Oksigen anak nca pcs 6,504 - 6,504 - 6,504 - 6,504 -
65 nasal canula oksigen dewasa ncd pcs 6,504 - 6,504 - 6,504 - 6,504 -
66 silk 2-0 box 350,000 - 350,000 - 350,000 - 350,000 -
67 silk 3-0 box 299,310 - 299,310 - 299,310 - 299,310 -
- - - - - - - -
OBAT JKN - - - - - - - -
4 Acyclovir 400 mg box 37,829 - 37,829 - 37,829 - 37,829 -
5 GLUKOSA 5% BOTOL 7,363 - 7,363 - 7,363 - 7,363 -
6 glukosa 10% BOTOL 8,003 - 8,003 - 8,003 - 8,003 -
8 IBUPROFEN 400 mg box 52,800 - 52,800 - 52,800 - 52,800 -
11 d40 % botol 24,000 - 24,000 - 24,000 - 24,000 -
13 gom box 95,040 - 95,040 - 95,040 - 95,040 -
14 Lexigo box 27,500 - 27,500 - 27,500 - 27,500 -
19 nacl botol 6,840 - 6,840 - 6,840 - 6,840 -
29 mgso 40 vial 13,200 - 13,200 - 13,200 - 13,200 -
32 ctm 4 mg box @100 tab 11,000 - 11,000 - 11,000 - 11,000 -
34 h202 3% 100 ML botol 22,000 - 22,000 - 22,000 - 22,000 -
35 MG/scopma 154,000 - 154,000 - 154,000 - 154,000 -
38 molexflu box@150 tab 64,900 - 64,900 - 64,900 - 64,900 -
PARACETAMOL 100MG/ML DROP 15 BOTOL
39 ML 13,750 - 13,750 - 13,750 - 13,750 -
40 scabimite 30 gram 82,500 - 82,500 - 82,500 - 82,500 -
43 Salep 2-4 POT 6,600 - 6,600 - 6,600 - 6,600 -
46 Amlodipin 10 mg Tablet 275 - 90 275 24,750 90 275 24,750 275 -
47 Akita Tablet 440 - 440 - 440 - 440 -
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 110 - 300 110 33,000 300 110 33,000 110 -
54 Methylergometrin injeksi ampul 7,700 - 7,700 - 7,700 - 7,700 -
55 MgSO4 40% botol 13,200 - 13,200 - 13,200 - 13,200 -
66 Acyclovir Cream 5 gr Tube 5,500 - 5,500 - 5,500 - 5,500 -
68 ambroxol tablet tablet 154 - 200 154 30,800 200 154 30,800 154 -
70 Antihaemoroid Suppositoria Supp 7,700 - 7,700 - 7,700 - 7,700 -
71 BABY COUGH SYR BOTOL 6,600 - 6,600 - 6,600 - 6,600 -
72 BETAHISTIN MAESILAT 6 MG TABLET 913 - 913 - 913 - 913 -
73 Biocombin/ Mersibion 5000 inj box 58,300 - 58,300 - 58,300 - 58,300 -
75 CETIRIZINE 10 MG TABLET 220 - 100 220 22,000 100 220 22,000 220 -
76 CIPROFLOXACIN 500 MG TABLET 880 - 880 - 880 - 880 -
79 FUROSEMIDE 40MG TABLET 275 - 275 - 275 - 275 -
80 GENTAMISIN SALEP KULIT 0,1% 5 GRAM TUBE 4,400 - 4,400 - 4,400 - 4,400 -
81 GLUKOSA INFUS 10% 500ML OTSUKA BOTOL 27,500 - 27,500 - 27,500 - 27,500 -
83 Kloramfenichol salep mata tube 6,600 - 6,600 - 6,600 - 6,600 -
84 Lidocain + Ephineprin AMPUL 4,400 - 4,400 - 4,400 - 4,400 -
85 METRONIDAZOL 500 MG TABLET 385 - 385 - 385 - 385 -
87 Metronidazol Sirup Botol 7,700 - 7,700 - 7,700 - 7,700 -
90 Paracetamol Syrup Botol 5,500 - 5,500 - 5,500 - 5,500 -
93 Ventolin Nebu/ SALBUTAMOL NEBULIZER 2,5 Vial 16,500 - 16,500 - 16,500 - 16,500 -
94 mecobalamin tab 500 mg tablet 990 - 990 - 990 - 990 -
95 sukralfat syr botol 46,200 - 46,200 - 46,200 - 46,200 -
96 ketokonazol tab tablet 880 - 880 - 880 - 880 -
97 Kaporit tabet 1 Kg (Bentuk Tablet) 77,000 - 77,000 - 77,000 - 77,000 -
98 parasetamol tab 500 mg box 22,000 - 2 22,000 44,000 2 22,000 44,000 22,000 -
99 vit k inj box 40,000 - 40,000 - 40,000 - 40,000 -
100 - - - - - - - -
BMHP JKN Set - - - - - - - -
1 LANSET CENTURY pcs 36,700 - 36,700 - 36,700 - 36,700 -
2 BISTURI pcs 438,750 - 438,750 - 438,750 - 438,750 -
3 CHKM pcs 96,200 - 96,200 - 96,200 - 96,200 -
3 mukus ekstraktor pcs 9,800 - 9,800 - 9,800 - 9,800 -
4 pipet obat 1 ml pcs 350,000 - 350,000 - 350,000 - 350,000 -
5 kertas goldar pcs 38,675 - 38,675 - 38,675 - 38,675 -
6 Rebreathing mask O2 dewasa NRM pcs 35,100 - 35,100 - 35,100 - 35,100 -
7 vaselin pcs 9,240 - 9,240 - 9,240 - 9,240 -
8 rivanol botol 8,500 - 8,500 - 8,500 - 8,500 -
9 povidone/ betadine botol 105,000 - 1 105,000 105,000 1 105,000 105,000 105,000 -
10 alkohol botol 75,250 - 75,250 - 75,250 - 75,250 -
11 lancet media box 20,909 - 20,909 - 20,909 - 20,909 -
12 OKSIGEN MASKER STANDAR ANAK SUNGKU pcs 19,400 - 19,400 - 19,400 - 19,400 -
13 OKSIGEN MASKER STANDAR DEWASA (SUNpcs 19,400 - 19,400 - 19,400 - 19,400 -
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack 95,000 - 95,000 - 95,000 - 95,000 -
15 IV CATHETER NO. 18 Box 214,100 - 214,100 - 214,100 - 214,100 -
16 KASA 40X80 pcs 108,400 - 108,400 - 108,400 - 108,400 -
17 PERBAN ELASTIS 10M Pcs 22,500 - 22,500 - 22,500 - 22,500 -
18 STRIP GULA DARAH GDS Box 99,450 - 99,450 - 99,450 - 99,450 -
19 SYRINGE 1ML/ SUNTIK 1 CC Box 150,525 - 150,525 - 150,525 - 150,525 -
20 UMBILICAL KLEM Box 88,275 - 88,275 - 88,275 - 88,275 -
21 URINE BAG Pcs 8,150 - 8,150 - 8,150 - 8,150 -
22 catheter jeli Pcs 58,973 - 58,973 - 58,973 - 58,973 -
23 nesco asam urat botol 121,550 - 121,550 - 121,550 - 121,550 -
24 usg jeli pouch 38,675 - 38,675 - 38,675 - 38,675 -
25 PLASTIK LIMBAH KUNING 80 x 60 (50 Buahpack 127,000 - 127,000 - 127,000 - 127,000 -
26 PLASTIK LIMBAH KUNING 100 x 80 (50 Buapack 203,250 - 203,250 - 203,250 - 203,250 -
27 IV CATH 26 box 355,700 - 355,700 - 355,700 - 355,700 -
28 PLASTIK KRESEK BERLOGO PKM CETAK DE pack 65,000 - 65,000 - 65,000 - 65,000 -
29 SYRINGE 10ML Box 301,050 - 301,050 - 301,050 - 301,050 -
30 Infusion Set with Airvent Dewasa Pcs 3,179 - 3,179 - 3,179 - 3,179 -
31 Needle 2/0 Box 39,677 - 39,677 - 39,677 - 39,677 -
32 Nasal Oxygen Cannula Anak nca Pcs 8,184 - 8,184 - 8,184 - 8,184 -
33 TES KEHAMILAN BOX 96,000 - 96,000 - 96,000 - 96,000 -
34 STRIP CHOLESTEROL KOLES botol 206,550 - 206,550 - 206,550 - 206,550 -
35 strip hb easy touc botol 165,675 - 165,675 - 165,675 - 165,675 -
36 urine gluco protein test box 47,450 - 47,450 - 47,450 - 47,450 -
37 HANDSABUTAZER PUMP+ BRACKET botol 93,000 - 93,000 - 93,000 - 93,000 -
38 HANDSANITAZER PUMP botol 61,400 - 61,400 - 61,400 - 61,400 -
39 NEBULIZER ANAK PCS 25,500 - 25,500 - 25,500 - 25,500 -
40 NEBULIZER BAYI PCS 25,500 - 25,500 - 25,500 - 25,500 -
41 NEBULIZER DEWASA PCS 25,500 - 25,500 - 25,500 - 25,500 -
42 JELLY USG 5 LITER Derigen 269,830 - 269,830 - 269,830 - 269,830 -
43 KERTAS LAKMUS PINK / BIRU Pack 57,300 - 57,300 - 57,300 - 57,300 -
44 OXYGEN NASAL CANNULA NEONATUS Pcs 8,450 - 8,450 - 8,450 - 8,450 -
47 PLASTIK LIMBAH KUNING 60x90 (20 buah) Pack 81,800 - 81,800 - 81,800 - 81,800 -
48 REAGEN GOLDAR Set 355,750 - 355,750 - 355,750 - 355,750 -
49 SENDOK OBAT 5ML (250 Pcs) Pack 53,200 - 53,200 - 53,200 - 53,200 -
50 SYRINGE 0,5ML Box 165,550 - 165,550 - 165,550 - 165,550 -
51 POVIDON IODIN 1LITER botol 105,000 - 105,000 - 105,000 - 105,000 -
52 SPALK BAYI pcs 22,575 - 22,575 - 22,575 - 22,575 -
53 SPALK TANGAN pcs 106,092 - 106,092 - 106,092 - 106,092 -
54 STRIP GULA DARAH box 99,450 - 99,450 - 99,450 - 99,450 -
55 SYRINGE 10ML box 150,525 - 150,525 - 150,525 - 150,525 -
56 SUFRATULLE box 87,500 - 87,500 - 87,500 - 87,500 -
57 NURSE CAPS box 72,900 - 72,900 - 72,900 - 72,900 -
58 KERTAS PUYER LIPAT pack 14,365 - 14,365 - 14,365 - 14,365 -
59 ALHOKOL 70% 1 LITER botol 45,000 - 45,000 - 45,000 - 45,000 -
60 RAPID TEST DENGUE IgG/IgM box 1,440,000 - 1,440,000 - 1,440,000 - 1,440,000 -
61 RAPID TEST DENGUE NS1 box 1,375,000 - 1,375,000 - 1,375,000 - 1,375,000 -
62 RAPID TEST TYPHOID box 1,091,188 - 1,091,188 - 1,091,188 - 1,091,188 -
63 RIVANOL 300ML botol 8,500 - 8,500 - 8,500 - 8,500 -
64 POVIDION IODINE 15ML botol 3,680 - 3,680 - 3,680 - 3,680 -
65 SUCTION NO 8 PCS 10,000 - 10,000 - 10,000 - 10,000 -
66 ALKOHOL SWAB BOX 24,850 - 24,850 - 24,850 - 24,850 -
67 BLOOD LANCET (1 Box = 100 Pcs) BOX 14,200 - 14,200 - 14,200 - 14,200 -
68 EXAMINATION GLOVES uk. M BOX 92,800 - 92,800 - 92,800 - 92,800 -
69 FOLLEY CATHETER NO 14 PCS 16,400 - 16,400 - 16,400 - 16,400 -
PLASTIK KRESEK BERLOGO PKM CETAK
PACK
70 DEPAN 65,000 - 65,000 - 65,000 - 65,000 -
PLASTIK LIMBAH COKLAT 60 x 100 (50
PACK
71 Buah) 141,600 - 141,600 - 141,600 - 141,600 -
72 PLASTIK MERAH UK 40 PACK 38,000 - 38,000 - 38,000 - 38,000 -
73 PLESTER INCL DISPENSER 1 INCH BOX 306,300 - 306,300 - 306,300 - 306,300 -
POT URINE NON STERILE 20 CC (1 Pack =
PACK
74 100 Pcs) 48,200 - 48,200 - 48,200 - 48,200 -
75 POVIDION IODINE 15ML BOTOL 3,680 - 3,680 - 3,680 - 3,680 -
76 STRIP CHOLESTEROL BOX 206,550 - 206,550 - 206,550 - 206,550 -
77 SUNGKUP NEBULIZER BAYI PCS 36,125 - 36,125 - 36,125 - 36,125 -
78 SYRINGE 1ML BOX 150,525 - 150,525 - 150,525 - 150,525 -
79 TABUNG VACUM TUBE EDTA K3E PACK 170,000 - 170,000 - 170,000 - 170,000 -
80 - - - -
total 7,500 1,367,949 1,375,449 -


NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003

NIP. 19780401 200604 2 020
PER 30 juni 2022

No Uraian Satuan Satuan Mutasi Nilai Penjelas
Reviu Jumlah
(Rp) Administ Fisik Selisih Persedia an
(+) (-) Fisik Selisih
rasi an
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9)11 (4 x 10) 12
BMHP+OBAT+HIBAH
BAHAN HABIS PAKAI
GUDANG OBAT - -
RANCASENENG (BOP) -
KOSONG
RANCASENENG (JKN) -
KOSONG
RANCASENENG (BOP) -
KOSONG
RANCASENENG (JKN) -
KOSONG
PUSKESMAS : CIKEUSIK/ PUSTU RANCASENENG

KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : juli DINKES KAB/KOTA PELAPORAN BULAN / PERIODE
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE agustus GFK KAB/KOTA PERMINTAAN BULAN / PERIODE
PUSKESMAS
juli agustus
Jumlah
Stok
Stok Optimum
N0 NAMA OBAT SATUAN Stok AwalPenerimaanPersediaa Pemakaian n Stok Awal
Akhir
n BUFFER
STOK
1 Alprazolam Tablet 0 0 0 0
2 Albendazol Tablet 400 mg Tablet 0 0 0 0
3 Allopurinol tablet 100 mg Tablet 0 0 0 0
Allopurinol tablet 100 mg Tablet 0 0 0 0
4 Ambroxol sirup Botol 0 0 0 0
5 Ambroxol tablet 30 mg Tablet 0 0 0 100 0
6 Aminofilin Tablet 200 mg Tablet 0 0 0 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 0 0 0
8 Amlodipin 10 mg Tablet 0 0 0 100 0
Amlodipin 10 mg Tablet 0 0 0 0
9 Amlodipin Besilate 5 mg Tablet 0 0 0 100 0
Amlodipin Besilate 5 mg Tablet 0 0 0 0
10 Amoksisilin Forte sirup kering 250mg Botol 0 0 0 0
11 Amoksisilin Injeksi 1 gr Vial 0 0 0 0
12 Amoksisilin Tablet 500 mg Tablet 0 0 0 0
Amoksisilin Tablet 500 mg kaplet 0 400 400 350 50 150 50
13 Amoksisillin kapsul 250 mg Kapsul 0 0 0 0
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 0 0 0 0
Amoksisillin Sirup Kering 125 mg/5 ml Botol 0 20 20 20 20 20
15 Ampisilin Injeksi 1 gr Vial 0 0 0 0
16 Analog insulin Long Acting Pen 0 0 0 0
17 Analog insulin Mix Acting Pen 0 0 0 0
20 Antasida DOEN suspensi Botol 0 0 0 0
21 ANTASIDA DOEN Tablet Tablet 0 200 200 200 0 200 0
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 0 0 0 0
23 anti hemoroid doen kombinasi supp 0 0 0 0
24 Antifungi DOEN Tube 0 0 0 0
25 Antimigren DOEN Kombinasi : Tablet 0 0 0 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet 0 0 0 0
27 Antiparkinson Tablet ( Levopar ) Tablet 0 0 0 0
28 Aqua Pro Injeksi Vial 0 0 0 0
29 Artermeter injeksi Ampul 0 0 0 0
30 Artesunate injeksi 60 mg/ml vial 0 0 0 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 0 0 0 0
32 Asam Folat Botol 0 0 0 0
33 Asam Fusidat Cream Tube 0 0 0 0
34 Asam Klorida 0,1 N Botol 0 0 0 0
35 Asam Mefenamat 500 mg Tablet 0 0 0 0
Asam Mefenamat 500 mg Tablet 0 100 100 100 0 100 0
36 Asam Traneksamat Inj 5% Ampul 0 0 0 0
37 Asering Botol 0 0 0 0
38 Asetosal tablet 500 mg Tablet 0 0 0 0
39 Asetyl Cysteine Capsul 0 120 120 120 0 200 0
40 Asiklovir Cream 5% Tube 0 0 0 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0 0 0 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0 0 0 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0 0 0 0
46 Berotec Metered Aerosol 100 mg Bok 0 0 0 0
47 Betadine Salep Antiseptik 5 mg Tube 0 0 0 0
48 Betametason krim 0,1 % Tube 0 3 3 3 0 5 0
49 Bisakodil Suppositoria supp 0 0 0 0
50 Bisoprolol 2,5 mg Tablet 0 0 0 0
51 Bisoprolol 5 mg Tablet 0 0 0 0
52 Cairan Infus KN-3B Botol 0 0 0 0
53 Cairan Infus Wida KDN 1 Botol 0 0 0 0
Cairan Infus Wida KDN 2 Botol 0 0 0 0
54 Cairan Pembersih ( Protektor ) Botol 0 0 0 0
55 Captopril Tablet 12,5 mg Tablet 0 0 0 0
56 Captopril Tablet 25 mg Tablet 0 100 100 100 0 100 0
57 Cefadroxil Capsul 500 mg Capsul 0 0 0 0
58 Cefixime Capsul 100 mg Capsul 0 0 0 0
59 Cefixime Sirup Botol 0 0 0 0
60 Cefotaksime 1 gr Injeksi Vial 0 0 0 0
61 Cetirizine Capsul 50 mg Capsul 0 0 0 100 0
62 Cetirizine sirup 5 mg/5 ml Botol 0 0 0 0
63 Ciprofloxcacin 500 mg tablet Tablet 0 0 0 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 0 0 0 0
65 D-Artepp tablet Tablet 0 0 0 0
66 deksametason tab Tablet 0 0 0 100 0
67 Dekstran 70 - larutan infus 6% steril Botol 0 0 0 0
68 Dekstrometorfan sirup Botol 0 0 0 0
69 Dekstrometorfan tablet 15 mg Tablet 0 0 0 0
70 Diazepam Rektal 0,5 mg / 2 ml supp 0 0 0 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1 Ampul 0 0 0 0
74 Digoksin tablet 0,25 mg Tablet 0 0 0 0
75 Diltiazem Tablet 0 0 0 0
76 Doksisiklin Kapsul 100 mg Capsul 0 0 0 0
77 Domperidon 10mg Tablet Tablet 0 0 0 0
78 Domperidon Suspensi 5 mg/ 5 ml Botol 0 0 0 0
79 Doxicyclin 500mg capsul 0 0 0 0
80 Efedrin HCLTablet 25 mg Tablet 0 0 0 0
81 Epinefrina HCL/Bitartrat Injeksi/ EFIN Ampul 0 0 0 0
82 Eritromicyn kapsul 250 mg capsul 0 0 0 0
83 Erytromicin kapsul 500 mg Kapsul 0 0 0 0
84 Erytromicin sirup 125 mg Botol 0 0 0 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol 0 0 0 0
86 Etambutol 500 mg Tablet 0 0 0 0
87 Etanol 70 % Botol 0 0 0 0
88 Etil Klorida Semprot Botol 0 0 0 0
89 Fenitoin Natrium kapsul 30 mg Kapsul 0 0 0 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0 0 0 0
91 Fenobarbital tablet 30 mg Tablet 0 0 0 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet 0 0 0 0
93 Fenol Gliserol tetes telinga 10 % Botol 0 0 0 0
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-Ampul 0 0 0 0
95 Fitomenadion (Vit.K1) tab salut gula 10 Tablet 0 0 0 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul 0 0 0 0
97 Furosemida tablet 40 mg Tablet 0 0 0 0
98 Furosemide Injeksi Ampul 0 0 0 0
99 Garam Oralit Sachet 0 0 0 0
100 Gemfibrozil 300 mg Tablet 0 0 0 0
101 Gentamicin Injeksi Ampul 0 0 0 0
102 Gentamicin Salep Kulit Tube 0 0 0 0
103 Gentamicin Salep mata Tube 0 0 0 0
105 Gentian Violet 1 % Botol 0 0 0 0
106 Glibenclamid tablet 5 mg Tablet 0 0 0 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0 0 0 0
108 Glikazid 80 mg Tablet Tablet 0 0 0 0
109 Glimepiride 2 mg Tablet 0 0 0 0
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 500 mg, Tablet 0 0 0 0
113 Guaiafenesin 100 mg Tablet 0 0 0 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 0 0 0 0
115 Hidrokortison krim 2,5% Tube 0 0 0 0
116 Ibuprofen Suspensi Tablet 0 0 0 0
119 Imunomodulator sirup( STIMUNO) Botol 0 10 10 10 0 10 0
120 Isosorbid Dinitrat tablet sublingual 5 mgTablet 0 0 0 0
121 Kalsium Glukonas Injeksi Ampul 0 0 0 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0 200 200 170 30 100 30
123 Kapas Berlemak 500 mg Bungkus 0 0 0 0
124 Ketokonazol Kream Tube 0 0 0 0
125 Ketokonazol Tablet 200 mg Tablet 0 0 0 0
126 Ketorolac inj Ampul 0 0 0 0
127 Kifadene tablet 20 mg Tablet 0 0 0 0
128 Kloramfenikol salep mata 1 % capsul 0 0 0 0
129 Kloramfenikol suspensi Botol 0 0 0 0
130 Kloramfenikol tetes telinga 3% Tube 0 0 0 0
131 Kloramphenicol 250 mg Capsul 0 0 0 0
132 Kloramphenicol 500 mg capsul 0 0 0 0
133 Kloramphenicol Tetes Mata Botol 0 0 0 0
134 Klorfeniramin Maleat (CTM) tablet 4 mgTablet 0 0 0 0
135 Klorokuin tablet 150 mg Tablet 0 0 0 0
136 Klorpromazin HCL tablet salut 25 mg Tablet 0 0 0 0
137 Kombinasi (Pirimetamin 25 mg + SolfadTablet 0 0 0 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 0 0 0 0
139 Kotrimoksazol Sirup / Suspensi Botol 0 0 0 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0 0 0 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0 0 0 0
142 Lactobacilus serbuk Sachet 0 0 0 0
143 Lidocain 2%+efinefrin injeksi Ampul 0 0 0 0
144 Lidocain injeksi 2 ml Ampul 0 0 0 0
147 Loperamid 4 mg tablet Tablet 0 0 0 0
148 Lytacur Sirup Botol 0 0 0 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 0 0 0 0
150 Metamizol 500 mg Tablet 0 0 0 0
151 Metformin 500 mg Tablet Tablet 0 200 200 200 0 100 0
152 Methilprednisolon tablet 4 mg Tablet 0 0 0 0
153 Metilergometrin Maleat injeksi 1 ml Ampul 0 0 0 0
154 Metilergometrin Maleat Tablet Tablet 0 0 0 0
155 Metoklopramid Suspensi Botol 0 0 0 0
156 Metoklopramid tablet Tablet 0 0 0 0
157 Metronidazol 500 mg Tablet 0 0 0 0
158 Metronidazol infus / injeksi Botol 0 0 0 0
159 Metronidazol Ovula supp 0 0 0 0
160 Metronidazol suspensi Botol 0 0 0 0
161 Mikonazol kream Tube 0 0 0 0
162 Multivitamin Anak Sirup Botol 0 0 0 0
163 Multivitamin Dewasa Antioksidan (HB VITablet 0 0 0 0
164 Natrium Diklofenak 25 mg Tablet Tablet 0 0 0 0
165 Natrium Diklofenak 50 mg Tablet Tablet 0 100 100 100 0 200 0
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 0 0 0 0
167 Nifedipine Tablet 10 mg box 0 0 0 0
168 Nistatin tablet vaginal 100.000 IU/g Tube 0 0 0 0
169 Obat anti Diare suspensi Botol 0 0 0 0
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 0 0 0 0
171 Obat Batuk Flu ( Molexflu ) BOX 0 1 1 1 0 2 0
Obat Batuk Flu ( Molexflu ) BOX 0 0 0 0
172 Obat Batuk Hitam (OBH) Botol 0 0 0 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0 0 0
Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0 0 0
174 Ofloxsacin Tetes Telinga Tube 0 0 0 0
175 Oksitetrasiklin HCL salep mata 1% Botol 0 0 0 0
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 0 0 0 0
177 Omeprazol injeksi Ampul 0 0 0 0
178 Omeprazol Kapsul 20 mg capsul 0 200 200 200 0 100 0
179 Ondancentron injeksi 4 mg Ampul 0 0 0 0
180 Ondancentron Tablet4 mg Tablet 0 0 0 0
181 Paracetamol Drop 15 ml Botol 0 5 5 5 0 10 0
182 Paracetamol Sirup 120 mg/5 ml Botol 0 15 15 15 0 20 0
183 Parafin Dresing ( Bioplacenton Tull ) pcs 0 0 0 0
186 Permetrin Krim 5 % Tube 0 0 0 0
187 Pirantel Sirup Botol 0 0 0 0
188 Pirantel tablet 125 mg Tablet 0 0 0 0
189 Pirazinamid Botol 0 0 0 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 0 0 0 0
191 Piroksikam tablet 20 mg Tablet 0 0 0 0
192 Polikresulen Tube 0 0 0 0
195 Prazikuantel tablet 600 mg Botol 0 0 0 0
196 Prednison Tablet 5 mg Tablet 0 100 100 100 0 200 0
197 Primakuin 15 mg Tablet 0 0 0 0
198 Probenesid 500 mg tablet Tablet 0 0 0 0
199 Prokain Benzil Penisilin 3 juta IU/vial inj Ampul 0 0 0 0
200 Propanolol HCL tablet 10 mg Tablet 0 0 0 0
201 Ranitidin injeksi Ampul 0 0 0 0
202 Ranitidin tablet Tablet 0 0 0 0
203 Resperidone 2 mg tablet Tablet 0 0 0 0
204 Ringer Laktat cairan infus (Otsuka) 0 0 0 0
205 Ringer Laktat cairan infus (Widatra) Botol 0 3 3 3 0 3 0
206 Rivanol 300 ml Botol 0 0 0 0
207 Salbutamol Tablet 2 mg Tablet 0 0 0 0
208 Salbutamol tablet 4mg Tablet 0 0 0 0
209 Salep 2-4 Tube 0 2 2 2 0 2 0
210 Salep kombinasi cream ( Berloson ) Tube 0 0 0 0
211 Salicil bedak Kotak 0 0 0 0
212 Serum Anti Bisa Ular Polivalen Inj 50 mlVial 0 0 0 0
213 Serum Anti Tetanus inj 1500 IU ( Tetag Vial 0 0 0 0
214 Sianokobalamin Injeksi Ampul 0 0 0 0
217 Sukralfat Suspensi Botol 0 0 0 0
218 Sukralfat tablet 500 mg Tablet 0 0 0 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 Tube 0 0 0 0
220 Temporary Stopping Fletcher serbuk & Tablet 0 0 0 0
221 Tetrakain HCL tetes mata 0,5% Tube 0 0 0 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0 0
Tiamin Tablet 50 mg ( B1 ) Tablet 0 0 0 0
225 Ventolin Nebulizer Ampul 0 0 0 0
226 vitamin b komplek Tablet 0 200 200 200 0 200 0
vitamin b komplek Tablet 0 0 0 0
227 Zink sirup Botol 0 0 0 0
228 Zink tablet 20 mg Tablet 0 0 0 0
229 Deksametason inj Ampul 0 0 0 0
230 Diazepam inj 5 mg/ml Ampul 0 0 0 0
231 Griseofulvin 125 mcg Tablet 0 0 0 0
232 Kloramfenikol SK/ BUFACETIN Tube 0 3 3 3 0 3 0
233 Nystatin tab 500.000 IU Tablet 0 0 0 0
234 magnesium Sulfat Inj. 25 ml 40% ampul 0 0 0 0
235 natrium bicarbonat tab 0 0 0 0
236 MULTIVITAMIN ANAK STIMUNO SYR BOTOL 0 0 0 0
237 tetagam set 0 0 0 0
238 vit c kemenkes tab 0 0 0 0
0 0 0 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 0 0 0 0
3 Alat suntik 2,5 ml Pcs 0 0 0 0
5 Alat suntik 3 cc (Remedi) 0 0 0 0
7 Alat suntik 5 ml pcs 0 0 0 0
8 Alkazide 1 L High Level Desinfectant Botol 0 0 0 0

9 Alkazyme Sachet 25 mg Pack 0 0 0 0
10 Alkohol 70 % 1 L Botol 0 0 0 0
12 Anti Septik Hand Rub Botol 0 0 0 0
13 Anti Septik Surgikal Hand Scrub Botol 0 0 0 0
18 Cathetter Jelly Biji 0 0 0 0
19 Demetech Silk 3/0 Set 0 0 0 0
20 E Care I.V Dresing Pcs 0 0 0 0
21 E-Care Surgical Mask Tie On Lembar 0 0 0 0
22 Folly No 14 Catether pcs 0 0 0 0
23 Folly No 16 Catether box 0 0 0 0
iv cathETER no 20 pcs 0 0 0 0
28 Infuset Anak Set 0 0 0 0
Infuset Anak PCS 0 0 0 0
30 Jarum Insulin Tablet 0 0 0 0
33 Kasa 4 m x 10 cm Rol 0 0 0 0
34 Kasa Hidrofil 36 x 80 cm Rol 0 0 0 0
35 Kasa Pembalut 2 x 80 cm Pack 0 0 0 0
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 0 0 0 0
kasa lembar
37 Lisol 1 L Botol 0 0 0 0
38 Masker karet Ear Loop Lembar 0 0 0 0
Masker karet Ear Loop Kotak
39 Masker tali Tube 0 0 0 0
40 Nasal Canula Oksigen Set 0 0 0 0
41 Plester 1" Rol 0 0 0 0
43 Plester Non Woven 5cm x 5 cm Rol 0 0 0 0
44 Policlean Botol 0 0 0 0
45 Polifik Kotak 0 0 0 0
46 Saraya Alsof A 500 ml Botol 0 0 0 0
47 Saraya Alsof Pure 500 ml Botol 0 0 0 0
48 Sarung Tangan Gynecolog No 7 Pasang 0 0 0 0
49 Sarung tangan M (Non Steril) KOTAK 0 0 0 0
50 Sarung tangan no 6,5 Pasang 0 0 0 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0 0 0 0
52 Sarung tangan no 7,0 Steril Pasang 0 0 0 0
53 Selang Section ( Surgikal Conection TuPcs 0 0 0 0
55 Urine Bag Biji 0 0 0 0
56 safety blackblood BOX 0 0 0 0
57 safety box BOX 0 0 0 0
58 Tabung BD Vacutener pcs 0 0 0 0
59 masker n95 box 0 0 0 0
60 t silk black 3/0 26 mm pcs 0 0 0 0
64 Nasal Canula Oksigen anak nca pcs 0 0 0 0
65 nasal canula oksigen dewasa ncd pcs 0 0 0 0
66 silk 2-0 box 0 0 0 0
67 silk 3-0 box 0 0 0 0
0 0 0 0
OBAT JKN 0 0 0 0
1 etil klorida spray btl 0 0 0 0
2 Ketorolac inj box 0 0 0 0
3 parasetamol tab box 0 0 0 0
4 Acyclovir 400 mg box 0 0 0 0
5 GLUKOSA 5% BOTOL 0 0 0 0
6 glukosa 10% BOTOL 0 0 0 0
7 asam tranexamat inj box 0 0 0 0
8 IBUPROFEN 400 mg box 0 0 0 0
9 Mecobalamin 500 Mg Tab box 0 0 0 0
10 Metronidazole 500 mg box 0 0 0 0
11 d40 % botol 0 0 0 0
12 dulcolax anak suppo box 0 0 0 0
13 gom box 0 0 0 0
14 Lexigo box 0 0 0 0
15 METRONIDAZOL SYR/ farizol botol 0 0 0 0
16 mikrolax suppositoria Tube 0 0 0 0
17 natrium bicarbonat tab botol 0 0 0 0
18 nifedipin tab box 0 0 0 0
19 nacl botol 0 0 0 0
20 acylovir cream tube 0 0 0 0
21 Ciprofloxacin 500 mg box 0 0 0 0
22 Cetirizine syr BOTOL 0 0 0 0
23 Guanistrep syr BOTOL 0 0 0 0
24 nisagon krim tube 0 0 0 0
25 piroksikam 20 mg tab box 0 0 0 0
26 metilergo injek ampul 0 0 0 0
27 NILACELIN SIR botol 0 0 0 0
28 water for injeksi/ Aqua pro inj vial 0 0 0 0
29 mgso 40 vial 0 0 0 0
30 oksitosin inj box 0 0 0 0
31 asam traneksamat 500 mg tab box @50 tab 0 0 0 0
32 ctm 4 mg box @100 ta 0 0 0 0
33 domperidon syr botol 0 0 0 0
34 h202 3% 100 ML botol 0 0 0 0
35 MG/scopma 0 0 0 0
36 ketokonazol cr tube 0 0 0 0
37 ketokonazol tab box@50 tab 0 0 0 0
38 molexflu box@150 ta 0 0 0 0
BOTOL
39 0 0 0 0
40 scabimite 30 gram 0 0 0 0
41 DIASTRIX(loperamid) box @100 ta 0 0 0 0
43 Salep 2-4 POT 0 0 0 0
44 ventolin nebu BOX 0 0 0 0
47 Akita Tablet 0 0 0 0
48 BEDAK SALICYL 2% 60 GRAM POT 0 0 0 0
49 BIOPLASENTON GEL 15 GRAM TUBE 0 0 0 0
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 0 200 200 200 0 100 0
54 Methylergometrin injeksi ampul 0 0 0 0
55 MgSO4 40% botol 0 0 0 0
58 Oxytocin Injeksi Ampul 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0
60 PARACETAMOL SUPPOSITORIA 160MG SUPP 0 0 0 0
62 UNI BABY COUGH BOTOL 0 0 0 0
63 Vit K injeksi/ NEO K - 2 MG ampul 0 0 0 0
64 EFINEPRIN INJ AMPUL 0 0 0 0
65 SUKRALFAT SYR BOTOL 0 0 0 0
66 Acyclovir Cream 5 gr Tube 0 0 0 0
68 ambroxol tablet tablet 0 0 0 0
70 Antihaemoroid Suppositoria Supp 0 0 0 0
71 BABY COUGH SYR BOTOL 0 0 0 0
72 BETAHISTIN MAESILAT 6 MG TABLET 0 0 0 0
73 Biocombin/ Mersibion 5000 inj AMPUL 0 0 0 0
75 CETIRIZINE 10 MG TABLET 0 0 0 0
76 CIPROFLOXACIN 500 MG TABLET 0 0 0 0
79 FUROSEMIDE 40MG TABLET 0 0 0 0
GENTAMISIN SALEP KULIT 0,1% 5
TUBE
80 GRAM 0 0 0 0
GLUKOSA INFUS 10% 500ML OTSUKA BOTOL
81 0 0 0 0
82 GLUKOSA INFUS 5% 500ML OTSUKA BOTOL 0 0 0 0
83 Kloramfenichol salep mata tube 0 0 0 0
84 Lidocain + Ephineprin AMPUL 0 0 0 0
85 METRONIDAZOL 500 MG TABLET 0 0 0 0
86 METRONIDAZOL 500 MG TABLET 0 0 0 0
87 Metronidazol Sirup Botol 0 0 0 0
90 Paracetamol Syrup Botol 0 0 0 0
Ventolin Nebu/ SALBUTAMOL NEBULIZER
Vial
93 2,5MG 0 0 0 0
94 mecobalamin tab 500 mg tablet 0 0 0 0
95 sukralfat syr botol 0 0 0 0
96 ketokonazol tab 1 Kg
tablet 0 0 0 0
(Bentuk
97 Kaporit tabet Tablet) 0 0 0 0
98 parasetamol tab 500 mg box 0 2 2 2 0 3 0
99 vit k inj box 0 0 0 0
100 Acyclovir Cream 5 gr Tube 0 0 0 0
101 Ambroxol Syrup 15 mg/5 ml Botol
102 Asam Tranexamat 500 Mg Box 50 tab
103 Bedak Salicyl 2 % 60 gram Pot
104 Betahistin Maesilat 6 Mg Box 50 tab
Box 10
Biocombine/ Mersibion
105 Ampul
Box 100
Bisacodil 5 mg
106 tab
Box 100
Ceterizin 10 mg
107 tab
108 Ceterizine syrup Botol
Furosemide 40 mg Box 100 tab

109
Box 100
Hyocine N Butylbromide 10 mg
110 tab
111 Ketorolac 30 Mg Inj Ampul
Box 100
Klorfeniramin Maleat (CTM) 4 Mg
112 tab
Box 10
Ranitidin Injeksi
113 Ampul
114 Uni baby Cough Syrup Botol
Ventolin Nebules / SALBUTAMOL Box 20
115 NEBULIZER 2,5MG nebu
116 Diazepam Suppo 5 mg Box 5 pcs
117 Clorpromazine 100 mg (OGB) 100/Box
118 Hexymer 2 mg tablet/trihexyfenidil 2 mg 100/Box
Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box

119
Sikzonoat injeksi/fluphenazine decanoate 25
5/Box
120 mg
121 Risperidone 2 mg 50/Box
YANG MENYERAHKAN MENGETAHUI YANG MEMINTA : YANG MENYERAHKAN

PENGELOLA OBAT KEPALA PUSKESMAS PENANGGUNG JAWAB PUSTU/POSKEDES PENGELOLA OBAT
RENY WIGIAWATI, A.Pt ALIK WAHYUDI, S.Kep.Ners Rita Afriyani, Amd. Keb RENY WIGIAWATI, A.Pt
NIP.198601142019 02 2 003 NIP.19850607 2010 01 1 014 NIP. NIP.198601142019 02 2 003
DOKUMEN NOMOR TANGGAL
PELAPORAN BULAN / PERIODE agst DINKES KAB/KOTA
PERMINTAAN BULAN / PERIODE sept GFK KAB/KOTA
PUSKESMAS
agustus
Jumlah
Stok
Stok Optimum
PenerimaanPersediaa Pemakaian n
Akhir
n BUFFER
STOK
0 0
0 0
0 0
100 100 100 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
300 300 250 50 100
0 0
0 0
0 0
400 450 450 0 200
0 0
0 0
20 40 40 0 10
0 0
0 0
0 0
0 0
0 0
0 0
200 200 200 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
200 200 200 0 100
0 0
0 0
0 0
240 240 240 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
100 100 100 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 3 3 0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 30 0 20
0 0
0 0
100 100 100 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
100 100 100 0 200
5 5 5 0 5
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 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100 0 100
0 0
0 0
0 0
0 0
0 0
2 2 2 0 2
0 0
0 0
0 0
3 3 3 0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 3 3 0 5
20 20 20 0 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200 200 0 100
0 0
0 0
0 0
0 0
0 0
200 200 200 0 200
0 0
0 0
0 0
0 0
0 0
200 200 200 0 100
0 0
0 0
3 3 3 0 5
0 0
100 100 100 0 100
0 0
5 5 5 0 3
0 0
0 0
0 0
0 0
0 0
100 100 100 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
400 400 400 0 300
0 0
2 2 2 0 5
0 0
0 0
0 0
0 0
3 3 3 0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5 5 0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5 5 0 5
0 0
5 5 5 0 5
0 0
5 5 5 0 5
0 0
3 3 3 0 3
5 5 5 0 5
0 0
0 0
0 0
0 0
0 0
0 0
1 1 1 0 3
0 0
0 0
1 1 1 0 1
0 0
0 0
1 1 1 0 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 1
0 0
10 10 10 0 5
0 0
0 0
0 0
2 2 2 0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6 6 6 0 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

RENY WIGIAWATI, A.Pt ALIK WAHYUDI, S.Kep.Ners Rita Afriyani, Amd. Keb
NIP.198601142019 02 2 003 NIP.19850607 2010 01 1 014 NIP.
Nama Puskesmas : PKM CIKEUSIK/ Pustu Rancaseneng

Bulan : Sept
N0 NAMA OBAT SATUAN Harga per Unit Harga per Unit Harga per Unit
Jumlah satuan Jumlah (Rp) Jumlah satuan Jumlah (Rp) Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Jumlah (Rp)
(Rp) (Rp) (Rp)
Allopurinol tablet 100 mg Tablet 87 - 100 87 8,700 100 87 8,700 87 -
9 Amlodipin Besilate 5 mg BOX 15,900 - 15,900 - 15,900 - 15,900 -
Amlodipin Besilate 5 mg Tablet 53 - 53 - 53 - 53 -
20 Antasida DOEN suspensi Botol 1,679 - 15 1,679 25,185 15 1,679 25,185 1,679 -
21 ANTASIDA DOEN Tablet Tablet 54 - 200 54 10,800 200 54 10,800 54 -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - - - - -
32 Asam Folat Botol 42 - 100 42 4,200 100 42 4,200 42 -
Asam Mefenamat 500 mg Tablet 111 - 111 - 111 - 111 -
37 Asering Botol 8,800 - 8,800 - 8,800 - 8,800 -
39 Asetyl Cysteine Capsul 301 - 180 301 54,180 180 301 54,180 301 -
48 Betametason krim 0,1 % Tube 1,540 - 1,540 - 1,540 - 1,540 -
56 Captopril Tablet 25 mg Tablet 75 - 100 75 7,500 100 75 7,500 75 -
66 deksametason tab Tablet 73 - 73 - 73 - 73 -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 1,168 - 1,168 - 1,168 - 1,168 -
78 Domperidon Suspensi 5 mg/ 5 ml Botol 2,296 - 10 2,296 22,960 10 2,296 22,960 2,296 -
81 Epinefrina HCL/Bitartrat Injeksi/ EFINEFRIN Ampul 1,408 - 1,408 - 1,408 - 1,408 -
87 Etanol 70 % Botol - - - - - - - -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul 1,386 - 1,386 - 1,386 - 1,386 -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 710 - 710 - 710 - 710 -
99 Garam Oralit Sachet 274 - 274 - 274 - 274 -
Gentamicin Tetes Mata Botol 4,520 - 4,520 - 4,520 - 4,520 -
106 Glibenclamid tablet 5 mg Tablet 82 - 100 82 8,200 100 82 8,200 82 -
115 Hidrokortison krim 2,5% Tube 2,325 - 2,325 - 2,325 - 2,325 -
119 Imunomodulator sirup( STIMUNO) Botol 28,118 - 5 28,118 140,590 5 28,118 140,590 28,118 -
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 89 - 89 - 89 - 89 -
124 Ketokonazol Kream Tube 2,349 - 5 2,349 11,745 5 2,349 11,745 2,349 -
125 Ketokonazol Tablet 200 mg Tablet 252 - 100 252 25,200 100 252 25,200 252 -
134 Klorfeniramin Maleat (CTM) tablet 4 mg BOX 2,300 - 2,300 - 2,300 - 2,300 -
137 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - - - - - - - -
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 126 - 126 - 126 - 126 -
139 Kotrimoksazol Sirup / Suspensi Botol 2,100 - 2,100 - 2,100 - 2,100 -
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - - - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - - - - -
144 Lidocain injeksi 2 ml Ampul 847 - 847 - 847 - 847 -
148 Lytacur Sirup Botol - - - - - - - -
151 Metformin 500 mg Tablet Tablet 77 - 77 - 77 - 77 -
152 Methilprednisolon tablet 4 mg Tablet 102 - 100 102 10,200 100 102 10,200 102 -
161 Mikonazol kream Tube 1,900 - 1,900 - 1,900 - 1,900 -
163 Multivitamin Dewasa Antioksidan (HB VIT ) Tablet 95,063 - 95,063 - 95,063 - 95,063 -
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 145 - 145 - 145 - 145 -
171 Obat Batuk Flu ( Molexflu ) BOX 54,870 - 1 54,870 54,870 1 54,870 54,870 54,870 -
Obat Batuk Sirup Herbal ( Herbacop ) Botol 14,273 - 5 14,273 71,365 5 14,273 71,365 14,273 -
178 Omeprazol Kapsul 20 mg capsul 129 - 129 - 129 - 129 -
181 Paracetamol Drop 15 ml Botol 4,976 - 5 4,976 24,880 5 4,976 24,880 4,976 -
182 Paracetamol Sirup 120 mg/5 ml Botol 1,160 - 15 1,160 17,400 15 1,160 17,400 1,160 -
185 Parasetamol tablet 500 mg Tablet 100 - 100 - 100 - 100 -
196 Prednison Tablet 5 mg Tablet 68 - 200 68 13,600 200 68 13,600 68 -
199 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - - - - -
205 Ringer Laktat cairan infus (Widatra) Botol 7,630 - 5 7,630 38,150 5 7,630 38,150 7,630 -
206 Rivanol 300 ml Botol 2,992 - 2,992 - 2,992 - 2,992 -
207 Salbutamol Tablet 2 mg Tablet 48 - 48 - 48 - 48 -
208 Salbutamol tablet 4mg Tablet 63 - 100 63 6,300 100 63 6,300 63 -
209 Salep 2-4 Tube 2,333 - 2,333 - 2,333 - 2,333 -
212 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 517,132 - 517,132 - 517,132 - 517,132 -
213 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 130,999 - 130,999 - 130,999 - 130,999 -
214 Sianokobalamin Injeksi Ampul 1,035 - 1,035 - 1,035 - 1,035 -
218 Sukralfat tablet 500 mg Tablet 368 - 368 - 368 - 368 -
219 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - - - - -
220 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - - - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet 57 - 200 57 11,400 200 57 11,400 57 -
226 vitamin b komplek Tablet 57 - 200 57 11,400 200 57 11,400 57 -
227 Zink sirup Botol 2,489 - 2,489 - 2,489 - 2,489 -
236 STIMUNO SYR PROV BOTOL 24,475 - 24,475 - 24,475 - 24,475 -
237 tetagam set 146,800 - 146,800 - 146,800 - 146,800 -
238 vit c kemenkes tab 198 - 198 - 198 - 198 -
- - - - - - - -
alat suntik 3 ml kotak 100,000 - 100,000 - 100,000 - 100,000 -
Alat suntik 5 ml box 110,000 - 110,000 - 110,000 - 110,000 -
10 Alkohol 70 % 1 L Botol 25,000 - 25,000 - 25,000 - 25,000 -
11 Alkohol swab box 12,000 - 12,000 - 12,000 - 12,000 -
12 Anti Septik Hand Rub/henclin Botol 99,000 - 99,000 - 99,000 - 99,000 -
14 Cat Gut no 2/0 KOTAK 270,000 - 270,000 - 270,000 - 270,000 -
15 Cat Gut no 3/0 KOTAK 202,950 - 202,950 - 202,950 - 202,950 -
25 I.V Cathetter No. 22 Set 5,786 - 5 5,786 28,930 5 5,786 28,930 5,786 -
26 I.V Cathetter No. 24 pcs 5,786 - 5,786 - 5,786 - 5,786 -
28 Infuset Anak Set 8,400 - 8,400 - 8,400 - 8,400 -
Infuset Anak PCS 6,504 - 6,504 - 6,504 - 6,504 -
29 Infuset Dewasa pcs 7,128 - 5 7,128 35,640 5 7,128 35,640 7,128 -
33 Kasa 4 m x 10 cm Rol 1,440 - 1,440 - 1,440 - 1,440 -
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 4,600 - 4,600 - 4,600 - 4,600 -
Kasa Steril / hidrofil 16 x 16 cm LEMBAR 602 - 36 602 21,672 36 602 21,672 602 -
37 Lisol 1 L Botol 40,997 - 40,997 - 40,997 - 40,997 -
38 Masker karet Ear Loop box 55,000 - 55,000 - 55,000 - 55,000 -
Masker karet Ear Loop box 49,500 - 49,500 - 49,500 - 49,500 -
39 Masker tali Tube 500 - 500 - 500 - 500 -
41 Plester 1" Rol 12,375 - 12,375 - 12,375 - 12,375 -
44 Policlean Botol 78,200 - 78,200 - 78,200 - 78,200 -
45 Polifik Kotak 7,370 - 7,370 - 7,370 - 7,370 -
49 Sarung tangan M (Non Steril) KOTAK 135,000 - 1 135,000 135,000 1 135,000 135,000 135,000 -
53 Selang Section ( Surgikal Conection Tube with yankauer) Pcs 30,003 - 30,003 - 30,003 - 30,003 -
54 Underpad pack 33,000 - 1 33,000 33,000 1 33,000 33,000 33,000 -
55 Urine Bag Biji 5,782 - 2 5,782 11,564 2 5,782 11,564 5,782 -
57 safety box BOX 22,433 - 22,433 - 22,433 - 22,433 -
59 masker n95 box 130,240 - 130,240 - 130,240 - 130,240 -
66 silk 2-0 box 350,000 - 350,000 - 350,000 - 350,000 -
67 silk 3-0 box 299,310 - 299,310 - 299,310 - 299,310 -
- - - - - - - -
OBAT JKN - - - - - - - -
4 Acyclovir 400 mg box 37,829 - 37,829 - 37,829 - 37,829 -
5 GLUKOSA 5% BOTOL 7,363 - 7,363 - 7,363 - 7,363 -
6 glukosa 10% BOTOL 8,003 - 8,003 - 8,003 - 8,003 -
8 IBUPROFEN 400 mg box 52,800 - 52,800 - 52,800 - 52,800 -
11 d40 % botol 24,000 - 24,000 - 24,000 - 24,000 -
13 gom box 95,040 - 95,040 - 95,040 - 95,040 -
14 Lexigo box 27,500 - 27,500 - 27,500 - 27,500 -
19 nacl botol 6,840 - 6,840 - 6,840 - 6,840 -
29 mgso 40 vial 13,200 - 13,200 - 13,200 - 13,200 -
32 ctm 4 mg box @100 tab 11,000 - 11,000 - 11,000 - 11,000 -
34 h202 3% 100 ML botol 22,000 - 22,000 - 22,000 - 22,000 -
35 HYOSCINE N BUTYLBROMIDE 10 MG/scopma box 154,000 - 154,000 - 154,000 - 154,000 -
38 molexflu box@150 tab 64,900 - 64,900 - 64,900 - 64,900 -
39 PARACETAMOL 100MG/ML DROP 15 ML BOTOL 13,750 - 13,750 - 13,750 - 13,750 -
40 PERMETHRIN CREAM 5% 30 GRAM/ scabimite 30 gram TUBE 82,500 - 82,500 - 82,500 - 82,500 -
43 Salep 2-4 POT 6,600 - 6,600 - 6,600 - 6,600 -
47 Akita Tablet 440 - 440 - 440 - 440 -
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 110 - 110 - 110 - 110 -
54 Methylergometrin injeksi/ metiler ampul 7,700 - 7,700 - 7,700 - 7,700 -
55 MgSO4 40% botol 13,200 - 13,200 - 13,200 - 13,200 -
68 ambroxol tablet tablet 154 - 154 - 154 - 154 -
70 Antihaemoroid Suppositoria/ superhoid Supp 7,700 - 7,700 - 7,700 - 7,700 -
71 BABY COUGH SYR BOTOL 6,600 - 6,600 - 6,600 - 6,600 -
72 BETAHISTIN MAESILAT 6 MG TABLET 913 - 913 - 913 - 913 -
73 Biocombin/ Mersibion 5000 inj box 58,300 - 58,300 - 58,300 - 58,300 -
75 CETIRIZINE 10 MG TABLET 220 - 220 - 220 - 220 -
76 CIPROFLOXACIN 500 MG TABLET 880 - 880 - 880 - 880 -
79 FUROSEMIDE 40MG TABLET 275 - 275 - 275 - 275 -
80 GENTAMISIN SALEP KULIT 0,1% 5 GRAM TUBE 4,400 - 4,400 - 4,400 - 4,400 -
83 Kloramfenichol salep mata tube 6,600 - 6,600 - 6,600 - 6,600 -
84 Lidocain + Ephineprin AMPUL 4,400 - 4,400 - 4,400 - 4,400 -
87 Metronidazol Sirup Botol 7,700 - 7,700 - 7,700 - 7,700 -
90 Paracetamol Syrup Botol 5,500 - 5,500 - 5,500 - 5,500 -
93 Ventolin Nebu/ SALBUTAMOL NEBULIZER 2,5MG Vial 16,500 - 16,500 - 16,500 - 16,500 -
94 mecobalamin tab 500 mg tablet 990 - 990 - 990 - 990 -
95 sukralfat syr botol 46,200 - 46,200 - 46,200 - 46,200 -
96 ketokonazol tab tablet 880 - 880 - 880 - 880 -
1 Kg
(Bentuk
97 Kaporit tabet Tablet) 77,000 - 77,000 - 77,000 - 77,000 -
98 parasetamol tab 500 mg box@100 tab 22,000 - 3 22,000 66,000 3 22,000 66,000 22,000 -
99 vit k inj box@5 ampul 40,000 - 40,000 - 40,000 - 40,000 -
102 Asam Tranexamat 500 Mg Box 50 tab 122,100 - 122,100 - 122,100 - 122,100 -
103 Bedak Salicyl 2 % 60 gram Pot 8,325 - 8,325 - 8,325 - 8,325 -
104 Betahistin Maesilat 6 Mg Box 50 tab 921 - 921 - 921 - 921 -
Box 10
105 Ampul 61,050 - 61,050 - 61,050 - 61,050 -
Box 100
Bisacodil 5 mg
106 tab 44,400 - 44,400 - 44,400 - 44,400 -
Box 100
Ceterizin 10 mg
107 tab 22,200 - 22,200 - 22,200 - 22,200 -
108 Ceterizine syrup Botol 7,770 - 7,770 - 7,770 - 7,770 -
Box 100
Furosemide 40 mg tab
109 33,300 - 33,300 - 33,300 - 33,300 -
Box 100
110 tab 166,500 - 166,500 - 166,500 - 166,500 -
111 Ketorolac 30 Mg Inj Ampul 12,210 - 12,210 - 12,210 - 12,210 -
Box 100
112 tab 13,320 - 13,320 - 13,320 - 13,320 -
Box 10
Ranitidin Injeksi
113 Ampul 38,850 - 38,850 - 38,850 - 38,850 -
114 Uni baby Cough Syrup Botol 7,215 - 7,215 - 7,215 - 7,215 -
Box 20
Ventolin Nebules / SALBUTAMOL NEBULIZER 2,5MG
115 nebu 333,000 - 333,000 - 333,000 - 333,000 -
116 Diazepam Suppo 5 mg Box 5 pcs 144,300 - 144,300 - 144,300 - 144,300 -
117 Clorpromazine 100 mg (OGB) 100/Box 25,228 - 25,228 - 25,228 - 25,228 -
118 Hexymer 2 mg tablet/trihexyfenidil 2 mg 100/Box 42,735 - 42,735 - 42,735 - 42,735 -
119 Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box 228,660 - 228,660 - 228,660 - 228,660 -
120 Sikzonoat injeksi/fluphenazine decanoate 25 mg 5/Box 443,223 - 443,223 - 443,223 - 443,223 -
121 Risperidone 2 mg 50/Box 129,416 - 129,416 - 129,416 - 129,416 -
122 - - - - - - - -
123 - - - - - - - -
124 - - - - - - - -
125 - - - - - - - -
total - 1,025,181 1,025,181 -


NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003
NIP. 19780401 200604 2 020
Lampiran
PER 30 September 2022

No Uraian Satuan Satuan Nilai Penjelasa
Reviu Mutasi Jumlah
(Rp) Administ Selisih Persediaa n Selisih
Fisik (+) (-) Fisik
rasi n
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9)11 (4 x 10) 12
BMHP+OBAT+HIBAH
BAHAN HABIS PAKAI
GUDANG OBAT - 25,760
RANCASENENG(BOP)
-
-
-
RANCASENENG( (JKN) -
-
-
RANCASENENG((BMHP) -
RANCASENENG((JKN) -


NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003

NIP. 19780401 200604 2 020
Nama Puskesmas : PKM CIKEUSIK/ Pustu rancaseneng

Bulan : Des
N0 NAMA OBAT SATUAN Harga per Unit Harga per Unit Harga per Unit
Jumlah satuan Jumlah (Rp) Jumlah satuan Jumlah (Rp) Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Jumlah (Rp)
(Rp) (Rp) (Rp)
Allopurinol tablet 100 mg Tablet 87 - 100 87 8,700 100 87 8,700 87 -
9 Amlodipin Besilate 5 mg BOX - - - - - - - -
Amlodipin Besilate 5 mg Tablet 53 - 150 53 7,950 150 53 7,950 53 -
20 Antasida DOEN suspensi Botol 1,679 - 1,679 - 1,679 - 1,679 -
21 ANTASIDA DOEN Tablet Tablet 54 - 200 54 10,800 200 54 10,800 54 -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - - - - -
32 Asam Folat Botol 42 - 42 - 42 - 42 -
Asam Mefenamat 500 mg Tablet 111 - 200 111 22,200 200 111 22,200 111 -
37 Asering Botol 8,800 - 8,800 - 8,800 - 8,800 -
39 Asetyl Cysteine Capsul 301 - 240 301 72,240 240 301 72,240 301 -
48 Betametason krim 0,1 % Tube 1,540 - 1,540 - 1,540 - 1,540 -
56 Captopril Tablet 25 mg Tablet 75 - 75 - 75 - 75 -
66 deksametason tab Tablet 73 - 300 73 21,900 300 73 21,900 73 -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 1,168 - 1,168 - 1,168 - 1,168 -
78 Domperidon Suspensi 5 mg/ 5 ml Botol 2,296 - 2,296 - 2,296 - 2,296 -
81 Epinefrina HCL/Bitartrat Injeksi/ EFINEFRIN Ampul 1,408 - 1,408 - 1,408 - 1,408 -
87 Etanol 70 % Botol - - - - - - - -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul 1,386 - 1,386 - 1,386 - 1,386 -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 710 - 710 - 710 - 710 -
99 Garam Oralit Sachet 274 - 274 - 274 - 274 -
Gentamicin Tetes Mata Botol 4,520 - 4,520 - 4,520 - 4,520 -
106 Glibenclamid tablet 5 mg Tablet 82 - 100 82 8,200 100 82 8,200 82 -
115 Hidrokortison krim 2,5% Tube 2,325 - 4 2,325 9,300 4 2,325 9,300 2,325 -
119 Imunomodulator sirup( STIMUNO) Botol 28,118 - 28,118 - 28,118 - 28,118 -
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 89 - 89 - 89 - 89 -
124 Ketokonazol Kream Tube 2,349 - 2,349 - 2,349 - 2,349 -
125 Ketokonazol Tablet 200 mg Tablet 252 - 252 - 252 - 252 -
134 Klorfeniramin Maleat (CTM) tablet 4 mg BOX 162 - 300 162 48,600 300 162 48,600 162 -
137 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - - - - - - - -
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 126 - 200 126 25,200 200 126 25,200 126 -
139 Kotrimoksazol Sirup / Suspensi Botol 2,100 - 2,100 - 2,100 - 2,100 -
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - - - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - - - - -
144 Lidocain injeksi 2 ml Ampul 847 - 847 - 847 - 847 -
148 Lytacur Sirup Botol 10,656 - 10,656 - 10,656 - 10,656 -
151 Metformin 500 mg Tablet Tablet 77 - 77 - 77 - 77 -
152 Methilprednisolon tablet 4 mg Tablet 102 - 102 - 102 - 102 -
161 Mikonazol kream Tube 1,900 - 6 1,900 11,400 6 1,900 11,400 1,900 -
163 Multivitamin Dewasa Antioksidan (HB VIT ) Tablet 95,063 - 95,063 - 95,063 - 95,063 -
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 145 - 145 - 145 - 145 -
171 Obat Batuk Flu ( Molexflu ) BOX 54,870 - 54,870 - 54,870 - 54,870 -
Obat Batuk Sirup Herbal ( Herbacop ) Botol 14,273 - 14,273 - 14,273 - 14,273 -
178 Omeprazol Kapsul 20 mg capsul 129 - 129 - 129 - 129 -
181 Paracetamol Drop 15 ml Botol 4,976 - 4,976 - 4,976 - 4,976 -
182 Paracetamol Sirup 120 mg/5 ml Botol 1,160 - 1,160 - 1,160 - 1,160 -
185 Parasetamol tablet 500 mg Tablet 182 - 400 182 72,800 400 182 72,800 182 -
196 Prednison Tablet 5 mg Tablet 68 - 68 - 68 - 68 -
199 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - - - - -
205 Ringer Laktat cairan infus (Widatra) Botol 7,630 - 10 7,630 76,300 10 7,630 76,300 7,630 -
206 Rivanol 300 ml Botol 2,992 - 2,992 - 2,992 - 2,992 -
207 Salbutamol Tablet 2 mg Tablet 48 - 100 48 4,800 100 48 4,800 48 -
208 Salbutamol tablet 4mg Tablet 63 - 63 - 63 - 63 -
209 Salep 2-4 Tube 2,333 - 2,333 - 2,333 - 2,333 -
212 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 517,132 - 517,132 - 517,132 - 517,132 -
213 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 146,800 - 146,800 - 146,800 - 146,800 -
214 Sianokobalamin Injeksi Ampul - - - - - - - -
218 Sukralfat tablet 500 mg Tablet - - - - - - - -
219 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - - - - -
220 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - - - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet 57 - 200 57 11,400 200 57 11,400 57 -
226 vitamin b komplek Tablet 57 - 400 57 22,800 400 57 22,800 57 -
227 Zink sirup Botol 2,489 - 2,489 - 2,489 - 2,489 -
236 STIMUNO SYR PROV BOTOL 24,475 - 24,475 - 24,475 - 24,475 -
237 tetagam set 146,800 - 146,800 - 146,800 - 146,800 -
238 vit c kemenkes tab 198 - 198 - 198 - 198 -
50,040 - 50,040 - 50,040 - 50,040 -
alat suntik 3 ml kotak 100,000 - 100,000 - 100,000 - 100,000 -
Alat suntik 5 ml box 110,000 - 110,000 - 110,000 - 110,000 -
10 Alkohol 70 % 1 L Botol 25,000 - 25,000 - 25,000 - 25,000 -
11 Alkohol swab box 12,000 - 12,000 - 12,000 - 12,000 -
12 Anti Septik Hand Rub/henclin Botol 99,000 - 99,000 - 99,000 - 99,000 -
14 Cat Gut no 2/0 KOTAK 270,000 - 270,000 - 270,000 - 270,000 -
15 Cat Gut no 3/0 KOTAK 202,950 - 202,950 - 202,950 - 202,950 -
26 I.V Cathetter No. 24 pcs 5,786 - 3 5,786 17,358 3 5,786 17,358 5,786 -
28 Infuset Anak Set 8,700 - 8,700 - 8,700 - 8,700 -
Infuset Anak PCS 6,504 - 6,504 - 6,504 - 6,504 -
29 Infuset Dewasa pcs 7,128 - 10 7,128 71,280 10 7,128 71,280 7,128 -
33 Kasa 4 m x 10 cm Rol 1,440 - 1,440 - 1,440 - 1,440 -
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 4,600 - 4,600 - 4,600 - 4,600 -
Kasa Steril / hidrofil 16 x 16 cm LEMBAR 602 - 24 602 14,448 24 602 14,448 602 -
37 Lisol 1 L Botol 40,997 - 40,997 - 40,997 - 40,997 -
38 Masker karet Ear Loop box 55,000 - 55,000 - 55,000 - 55,000 -
Masker karet Ear Loop box 49,500 - 49,500 - 49,500 - 49,500 -
39 Masker tali Tube 500 - 500 - 500 - 500 -
41 Plester 1" Rol 12,375 - 12,375 - 12,375 - 12,375 -
44 Policlean Botol 78,200 - 78,200 - 78,200 - 78,200 -
45 Polifik Kotak 7,370 - 7,370 - 7,370 - 7,370 -
49 Sarung tangan M (Non Steril) KOTAK 135,000 - 135,000 - 135,000 - 135,000 -
53 Selang Section ( Surgikal Conection Tube with yankauer) Pcs 8,635 - 8,635 - 8,635 - 8,635 -
54 Underpad pack 30,003 - 1 30,003 30,003 30,003 - 30,003 -
55 Urine Bag Biji 33,000 - 33,000 - 33,000 - 33,000 -
57 safety box BOX 204,167 - 204,167 - 204,167 - 204,167 -
59 masker n95 box 1,690 - 1,690 - 1,690 - 1,690 -
66 silk 2-0 box 6,504 - 6,504 - 6,504 - 6,504 -
67 silk 3-0 box 350,000 - 350,000 - 350,000 - 350,000 -
299,310 - 299,310 - 299,310 - 299,310 -
BMHP JKN Set - - - - - - - -
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack 95,000 - 1 95,000 95,000 1 95,000 95,000 95,000 -
total - - 1,002,569 - 972,566 - -


NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003

NIP. 19780401 200604 2 020
Lampiran
PER 31 Desember 2022
Perhitungan Persediaan :
Harga
No Uraian Satuan Reviu Mutasi Jumlah Nilai Penjelasan
Satuan (Rp)
Administ Selisih Selisih
Fisik (+) (-) Fisik Persediaan
rasi
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (4 x 10) 12
BMHP+OBAT+HIBAH
BAHAN HABIS PAKAI
OBAT
rancaseneng(BOP) - 757,188
rancaseneng(JKN)
BMHP
rancaseneng(BOP)
rancaseneng(JKN)
0
Kepala Puskesmas Cikeusik Pengurus Barang

NIP.19750506 199503 1002
NIP. 19850607 2010 01 1 014 NIP. 198301082017042001
NIP. 19860114201902 2 003
NIP. 19780401 200604 2 020
PUSKESMAS : CIKEUSIK/Pustu rancaseneng

KECAMATAN : CIKEUSIK
KAB / KOTA : PANDEGLANG
PROVINSI : BANTEN
N0 NAMA OBAT SATUAN
1 Alprazolam Tablet
2 Albendazol Tablet 400 mg Tablet
3 Allopurinol tablet 100 mg Tablet
Allopurinol tablet 100 mg Tablet
4 Ambroxol sirup Botol
5 Ambroxol tablet 30 mg Tablet
6 Aminofilin Tablet 200 mg Tablet
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul
8 Amlodipin 10 mg Tablet
Amlodipin 10 mg Tablet
9 Amlodipin Besilate 5 mg Tablet
Amlodipin Besilate 5 mg Tablet
10 Amoksisilin Forte sirup kering 250mg Botol
11 Amoksisilin Injeksi 1 gr Vial
12 Amoksisilin Tablet 500 mg Tablet
Amoksisilin Tablet 500 mg kaplet
13 Amoksisillin kapsul 250 mg Kapsul
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol
Amoksisillin Sirup Kering 125 mg/5 ml Botol
15 Ampisilin Injeksi 1 gr Vial
16 Analog insulin Long Acting Pen
17 Analog insulin Mix Acting Pen
18 Antalgin (Metampiron) tablet 500 mg Tablet
19 Antalgin (Metampiron) tablet 500 mg Tablet
20 Antasida DOEN suspensi Botol
21 ANTASIDA DOEN Tablet Tablet
22 Anti Bakteri DOEN ( Bacitrasin ) Tube
23 anti hemoroid doen kombinasi supp
24 Antifungi DOEN Tube
25 Antimigren DOEN Kombinasi : Tablet
26 Antiparkinson DOEN tablet Kombinasi : Tablet
27 Antiparkinson Tablet ( Levopar ) Tablet
28 Aqua Pro Injeksi Vial
29 Artermeter injeksi Ampul
30 Artesunate injeksi 60 mg/ml vial
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet
32 Asam Folat Botol
33 Asam Fusidat Cream Tube
34 Asam Klorida 0,1 N Botol
35 Asam Mefenamat 500 mg Tablet
Asam Mefenamat 500 mg Tablet
36 Asam Traneksamat Inj 5% Ampul
37 Asering Botol
38 Asetosal tablet 500 mg Tablet
39 Asetyl Cysteine Capsul
40 Asiklovir Cream 5% Tube
41 Asiklovir tablet 200 mg Tablet
42 Asiklovir tablet 400 mg Tablet
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial
45 Atropin Sulfat tablet 0,5 mg Tablet
46 Berotec Metered Aerosol 100 mg Bok
47 Betadine Salep Antiseptik 5 mg Tube
48 Betametason krim 0,1 % Tube
49 Bisakodil Suppositoria supp
50 Bisoprolol 2,5 mg Tablet
51 Bisoprolol 5 mg Tablet
52 Cairan Infus KN-3B Botol
53 Cairan Infus Wida KDN 1 Botol
Cairan Infus Wida KDN 2 Botol
54 Cairan Pembersih ( Protektor ) Botol
55 Captopril Tablet 12,5 mg Tablet
56 Captopril Tablet 25 mg Tablet
57 Cefadroxil Capsul 500 mg Capsul
58 Cefixime Capsul 100 mg Capsul
59 Cefixime Sirup Botol
60 Cefotaksime 1 gr Injeksi Vial
61 Cetirizine Capsul 50 mg Capsul
62 Cetirizine sirup 5 mg/5 ml Botol
63 Ciprofloxcacin 500 mg tablet Tablet
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul
65 D-Artepp tablet Tablet
66 deksametason tab Tablet
67 Dekstran 70 - larutan infus 6% steril Botol
68 Dekstrometorfan sirup Botol
69 Dekstrometorfan tablet 15 mg Tablet
70 Diazepam Rektal 0,5 mg / 2 ml supp
71 Diazepam tablet 2 mg Tablet
72 Diazepam tablet 5 mg Tablet
73 Difenhidramin HCL injeksi 10 mg/ml - 1mAmpul
74 Digoksin tablet 0,25 mg Tablet
75 Diltiazem Tablet
76 Doksisiklin Kapsul 100 mg Capsul
77 Domperidon 10mg Tablet Tablet
78 Domperidon Suspensi 5 mg/ 5 ml Botol
79 Doxicyclin 500mg capsul
80 Efedrin HCLTablet 25 mg Tablet
81 Epinefrina HCL/Bitartrat Injeksi/ EFIN Ampul
82 Eritromicyn kapsul 250 mg capsul
83 Erytromicin kapsul 500 mg Kapsul
84 Erytromicin sirup 125 mg Botol
85 Etakridin ( Rivanol ) larutan 0,1% Botol
86 Etambutol 500 mg Tablet
87 Etanol 70 % Botol
88 Etil Klorida Semprot Botol
89 Fenitoin Natrium kapsul 30 mg Kapsul
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul
91 Fenobarbital tablet 30 mg Tablet
92 Fenoksimetil Penisilina tablet 250 mg Tablet
93 Fenol Gliserol tetes telinga 10 % Botol
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml- Ampul
95 Fitomenadion (Vit.K1) tab salut gula 10 Tablet
96 Flufenazine Deconat Inj 25 mg/ml Ampul
97 Furosemida tablet 40 mg Tablet
98 Furosemide Injeksi Ampul
99 Garam Oralit Sachet
100 Gemfibrozil 300 mg Tablet
101 Gentamicin Injeksi Ampul
102 Gentamicin Salep Kulit Tube
103 Gentamicin Salep mata Tube
104 Gentamicin Tetes Mata Botol
Gentamicin Tetes Mata Botol
105 Gentian Violet 1 % Botol
106 Glibenclamid tablet 5 mg Tablet
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet
108 Glikazid 80 mg Tablet Tablet
109 Glimepiride 2 mg Tablet
110 Glukosa larutan infus 10% steril Botol
111 Glukosa larutan infus 5 % steril Botol
112 Griseofulvin tablet 500 mg, Tablet
113 Guaiafenesin 100 mg Tablet
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet
115 Hidrokortison krim 2,5% Tube
116 Ibuprofen Suspensi Tablet
117 Ibuprofen tablet 200 mg Tablet
118 Ibuprofen tablet 400 mg Tablet
119 Imunomodulator sirup( STIMUNO) Botol
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet
121 Kalsium Glukonas Injeksi Ampul
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet
123 Kapas Berlemak 500 mg Bungkus
124 Ketokonazol Kream Tube
125 Ketokonazol Tablet 200 mg Tablet
126 Ketorolac inj Ampul
127 Kifadene tablet 20 mg Tablet
128 Kloramfenikol salep mata 1 % capsul
129 Kloramfenikol suspensi Botol
130 Kloramfenikol tetes telinga 3% Tube
131 Kloramphenicol 250 mg Capsul
132 Kloramphenicol 500 mg capsul
133 Kloramphenicol Tetes Mata Botol
134 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet
135 Klorokuin tablet 150 mg Tablet
136 Klorpromazin HCL tablet salut 25 mg Tablet
137 Kombinasi (Pirimetamin 25 mg + Solfad Tablet
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet
139 Kotrimoksazol Sirup / Suspensi Botol
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol
142 Lactobacilus serbuk Sachet
143 Lidocain 2%+efinefrin injeksi Ampul
144 Lidocain injeksi 2 ml Ampul
145 Lisinopril 10 mg tablet Tablet
146 Lisinopril 5 mg tablet Tablet
147 Loperamid 4 mg tablet Tablet
148 Lytacur Sirup Botol
149 Magnesium Sulfat Inj. 25 ml 20% Ampul
150 Metamizol 500 mg Tablet
151 Metformin 500 mg Tablet Tablet
152 Methilprednisolon tablet 4 mg Tablet
153 Metilergometrin Maleat injeksi 1 ml Ampul
154 Metilergometrin Maleat Tablet Tablet
155 Metoklopramid Suspensi Botol
156 Metoklopramid tablet Tablet
157 Metronidazol 500 mg Tablet
158 Metronidazol infus / injeksi Botol
159 Metronidazol Ovula supp
160 Metronidazol suspensi Botol
161 Mikonazol kream Tube
162 Multivitamin Anak Sirup Botol
163 Multivitamin Dewasa Antioksidan (HB VITablet
164 Natrium Diklofenak 25 mg Tablet Tablet
165 Natrium Diklofenak 50 mg Tablet Tablet
166 Natrium Klorida Cairan Infus ( NaCL ) Botol
167 Nifedipine Tablet 10 mg box
168 Nistatin tablet vaginal 100.000 IU/g Tube
169 Obat anti Diare suspensi Botol
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet
171 Obat Batuk Flu ( Molexflu ) BOX
Obat Batuk Flu ( Molexflu ) BOX
172 Obat Batuk Hitam (OBH) Botol
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol
Obat Batuk Sirup Herbal ( Herbacop ) Botol
174 Ofloxsacin Tetes Telinga Tube
175 Oksitetrasiklin HCL salep mata 1% Botol
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul
177 Omeprazol injeksi Ampul
178 Omeprazol Kapsul 20 mg capsul
179 Ondancentron injeksi 4 mg Ampul
180 Ondancentron Tablet4 mg Tablet
181 Paracetamol Drop 15 ml Botol
182 Paracetamol Sirup 120 mg/5 ml Botol
183 Parafin Dresing ( Bioplacenton Tull ) pcs
184 Parasetamol tablet 100 mg Tablet
185 Parasetamol tablet 500 mg Tablet
186 Permetrin Krim 5 % Tube
187 Pirantel Sirup Botol
188 Pirantel tablet 125 mg Tablet
189 Pirazinamid Botol
190 Piridoksin HCL (VIT B6) tablet 10mg Botol
191 Piroksikam tablet 20 mg Tablet
192 Polikresulen Tube
193 Povidon lodida 10% 300 ml
194 Povidon lodida 10% 60 ml
195 Prazikuantel tablet 600 mg Botol
196 Prednison Tablet 5 mg Tablet
197 Primakuin 15 mg Tablet
198 Probenesid 500 mg tablet Tablet
199 Prokain Benzil Penisilin 3 juta IU/vial inj Ampul
200 Propanolol HCL tablet 10 mg Tablet
201 Ranitidin injeksi Ampul
202 Ranitidin tablet Tablet
203 Resperidone 2 mg tablet Tablet
204 Ringer Laktat cairan infus (Otsuka)
205 Ringer Laktat cairan infus (Widatra) Botol
206 Rivanol 300 ml Botol
207 Salbutamol Tablet 2 mg Tablet
208 Salbutamol tablet 4mg Tablet
209 Salep 2-4 Tube
210 Salep kombinasi cream ( Berloson ) Tube
211 Salicil bedak Kotak
212 Serum Anti Bisa Ular Polivalen Inj 50 mlVial
213 Serum Anti Tetanus inj 1500 IU ( TetagaVial
214 Sianokobalamin Injeksi Ampul
215 Simvastatin 10 mg tablet Tablet
216 Simvastatin 20 mg tablet Tablet
217 Sukralfat Suspensi Botol
218 Sukralfat tablet 500 mg Tablet
219 Suspensi Seng Insulin inj.40 IU/ml - 10 Tube
220 Temporary Stopping Fletcher serbuk & cTablet
221 Tetrakain HCL tetes mata 0,5% Tube
222 Tetrasiklin 250 mg capsul capsul
223 Tetrasiklin 500 mg capsul capsul
224 Tiamin Tablet 50 mg ( B1 ) Tablet
Tiamin Tablet 50 mg ( B1 ) Tablet
225 Ventolin Nebulizer Ampul
226 vitamin b komplek Tablet
vitamin b komplek Tablet
227 Zink sirup Botol
228 Zink tablet 20 mg Tablet
229 Deksametason inj Ampul
230 Diazepam inj 5 mg/ml Ampul
231 Griseofulvin 125 mcg Tablet
232 Kloramfenikol SK/ BUFACETIN Tube
233 Nystatin tab 500.000 IU Tablet
234 magnesium Sulfat Inj. 25 ml 40% ampul
235 natrium bicarbonat tab
236 MULTIVITAMIN ANAK STIMUNO SYR BOTOL
237 tetagam set
238 vit c kemenkes tab
239 goodlife box
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
1 Alat suntik 1 ml Pcs
3 Alat suntik 2,5 ml Pcs
5 Alat suntik 3 cc (Remedi)
Alat suntik 3 ml kotak
7 Alat suntik 5 ml pcs
alat suntik 5 ml box
8 Alkazide 1 L High Level Desinfectant Botol
9 Alkazyme Sachet 25 mg Pack
10 Alkohol 70 % 1 L Botol
11 Alkohol swab box
12 Anti Septik Hand Rub Botol
13 Anti Septik Surgikal Hand Scrub Botol
14 Cat Gut no 2/0 KOTAK
15 Cat Gut no 3/0 KOTAK
16 Cat Gut No 2/0 (24 mm) Sachet
17 Cat Gut No 3/0 (26 mm) Sachet
18 Cathetter Jelly Biji
19 Demetech Silk 3/0 Set
20 E Care I.V Dresing Pcs
21 E-Care Surgical Mask Tie On Lembar
22 Folly No 14 Catether pcs
23 Folly No 16 Catether box
24 I.V Cathetter No. 20 Set
iv cathETER no 20 pcs
26 I.V Cathetter No. 24 pcs
28 Infuset Anak Set
Infuset Anak PCS
29 Infuset Dewasa pcs
30 Jarum Insulin Tablet
31 Kapas Berlemak 250 gr Bungkus
32 Kapas Berlemak 500 gr Bungkus
33 Kasa 4 m x 10 cm Rol
34 Kasa Hidrofil 36 x 80 cm Rol
35 Kasa Pembalut 2 x 80 cm Pack
36 Kasa Steril / hidrofil 16 x 16 cm Kotak
Kasa Steril / hidrofil 16 x 16 cm lembar
37 Lisol 1 L lembar
38 Masker karet Ear Loop Lembar
masker kotak
39 Masker tali Tube
40 Nasal Canula Oksigen Set
41 Plester 1" Rol
42 Plester Kertas 2,5 cm Rol
43 Plester Non Woven 5cm x 5 cm Rol
44 Policlean Botol
45 Polifik Kotak
46 Saraya Alsof A 500 ml Botol
47 Saraya Alsof Pure 500 ml Botol
48 Sarung Tangan Gynecolog No 7 Pasang
49 Sarung tangan M (Non Steril) KOTAK
Sarung tangan M (Non Steril) KOTAK
50 Sarung tangan no 6,5 Pasang
51 Sarung tangan no 6,5 Steril Gloves Pasang
52 Sarung tangan no 7,0 Steril Pasang
53 Selang Section ( Surgikal Conection TubPcs
54 Underpad pack
55 Urine Bag Biji
56 safety blackblood BOX
57 safety box BOX
58 Tabung BD Vacutener pcs
59 masker n95 box
60 t silk black 3/0 26 mm pcs
64 Nasal Canula Oksigen anak nca pcs
65 nasal canula oksigen dewasa ncd pcs
66 silk 2-0 box
67 silk 3-0 box
OBAT JKN
1 etil klorida spray btl
2 Ketorolac inj box
3 parasetamol tab box
4 Acyclovir 400 mg box
5 GLUKOSA 5% BOTOL
6 glukosa 10% BOTOL
7 asam tranexamat inj box
8 IBUPROFEN 400 mg box
9 Mecobalamin 500 Mg Tab box
10 Metronidazole 500 mg box
11 d40 % botol
12 dulcolax anak suppo box
13 gom box
14 Lexigo box
15 METRONIDAZOL SYR/ farizol botol
16 mikrolax suppositoria Tube
17 natrium bicarbonat tab botol
18 nifedipin tab box
19 nacl botol
20 acylovir cream tube
21 Ciprofloxacin 500 mg box
22 Cetirizine syr BOTOL
23 Guanistrep syr BOTOL
24 nisagon krim tube
25 piroksikam 20 mg tab box
26 metilergo injek ampul
27 NILACELIN SIR botol
28 water for injeksi/ Aqua pro inj vial
29 mgso 40 vial
30 oksitosin inj box
31 asam traneksamat 500 mg tab box @50 ta
32 ctm 4 mg box @100 t
33 domperidon syr botol
34 h202 3% 100 ML botol
35 MG/scopma
36 ketokonazol cr tube
37 ketokonazol tab box@50 tab
38 molexflu box@150 ta
BOTOL
39
40 scabimite 30 gram
41 DIASTRIX(loperamid) box @100 t
42 PARASETAMOL INFUS BOTOL
43 Salep 2-4 POT
44 ventolin nebu BOX
47 Akita Tablet
48 BEDAK SALICYL 2% 60 GRAM POT
49 BIOPLASENTON GEL 15 GRAM TUBE
50 Cefadroxil 500 mg Tablet
51 Dexamethasone Inj ampul
52 DOMPERIDON SYR BOTOL
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet
54 Methylergometrin injeksi ampul
55 MgSO4 40% botol
56 Ondancetron 4 mg/2ml Injeksi Ampul
57 Ondansetron Tablet 4 mg Tablet
58 Oxytocin Injeksi Ampul
59 Paracetamol 500 mg Tablet
60 PARACETAMOL SUPPOSITORIA 160MG SUPP
61 Ranitidin Injeksi Ampul
62 UNI BABY COUGH BOTOL
63 Vit K injeksi/ NEO K - 2 MG ampul
64 EFINEPRIN INJ AMPUL
65 SUKRALFAT SYR BOTOL
66 Acyclovir Cream 5 gr Tube
68 ambroxol tablet tablet
70 Antihaemoroid Suppositoria Supp
71 BABY COUGH SYR BOTOL
72 BETAHISTIN MAESILAT 6 MG TABLET
73 Biocombin/ Mersibion 5000 inj AMPUL
74 Cefadroxil 500 mg Tablet
75 CETIRIZINE 10 MG TABLET
76 CIPROFLOXACIN 500 MG TABLET
77 Dexamethasone Inj ampul
78 DOMPERIDON SYR BOTOL
79 FUROSEMIDE 40MG TABLET
GENTAMISIN SALEP KULIT 0,1% 5
TUBE
80 GRAM
GLUKOSA INFUS 10% 500ML OTSUKA BOTOL

81
82 GLUKOSA INFUS 5% 500ML OTSUKA BOTOL
83 Kloramfenichol salep mata tube
84 Lidocain + Ephineprin AMPUL
85 METRONIDAZOL 500 MG TABLET
86 METRONIDAZOL 500 MG TABLET
87 Metronidazol Sirup Botol
88 Ondancetron 4 mg/2ml Injeksi Ampul
89 Ondansetron Tablet 4 mg Tablet
90 Paracetamol Syrup Botol
91 PARASETAMOL INFUS BOTOL
92 Ranitidin Injeksi Ampul
Ventolin Nebu/ SALBUTAMOL NEBULIZER
Vial
93 2,5MG
94 mecobalamin tab 500 mg tablet
95 sukralfat syr botol
96 ketokonazol tab tablet
1 Kg
(Bentuk
97 Kaporit tabet Tablet)
98 parasetamol tab 500 mg box
99 vit k inj box
100 Acyclovir Cream 5 gr Tube
102 Asam Tranexamat 500 Mg Box 50 tab
103 Bedak Salicyl 2 % 60 gram Pot
104 Betahistin Maesilat 6 Mg Box 50 tab
Box 10
105 Ampul
Box 100
Bisacodil 5 mg
106 tab
Box 100
Ceterizin 10 mg
107 tab
108 Ceterizine syrup Botol
Box 100
109
Box 100
110 tab
111 Ketorolac 30 Mg Inj Ampul
Box 100
112 tab
Box 10
Ranitidin Injeksi
113 Ampul
114 Uni baby Cough Syrup Botol
Ventolin Nebules / SALBUTAMOL Box 20
115 NEBULIZER 2,5MG nebu
116 Diazepam Suppo 5 mg Box 5 pcs
117 Clorpromazine 100 mg (OGB) 100/Box
118 Hexymer 2 mg tablet/trihexyfenidil 2 mg 100/Box
Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box

119
Sikzonoat injeksi/fluphenazine decanoate 25
5/Box
120 mg
121 Risperidone 2 mg 50/Box
122
123
124
125
BMHP JKN Set
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUS
PUSKESMAS : CIKEUSIK/RANCASENENG
KECAMATAN : CIKEUSIK
KAB / KOTA : PANDEGLANG
PROVINSI : BANTEN
STOK PENAMB
N0 NAMA OBAT SATUAN AWAL AHAN
1
1 Alprazolam Tablet 0
2 Albendazol Tablet 400 mg Tablet 0
3 Allopurinol tablet 100 mg Tablet 0
Allopurinol tablet 100 mg Tablet 0
4 Ambroxol sirup Botol 0
5 Ambroxol tablet 30 mg Tablet 0
6 Aminofilin Tablet 200 mg Tablet 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0
8 Amlodipin 10 mg Tablet 0
Amlodipin 10 mg Tablet 0
9 Amlodipin Besilate 5 mg Tablet 0
Amlodipin Besilate 5 mg Tablet 0 100
10 Amoksisilin Forte sirup kering 250mg Botol 0
11 Amoksisilin Injeksi 1 gr Vial 0
12 Amoksisilin Tablet 500 mg Tablet 0
Amoksisilin Tablet 500 mg kaplet 0 400
13 Amoksisillin kapsul 250 mg Kapsul 0
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 0
Amoksisillin Sirup Kering 125 mg/5 ml Botol 0
15 Ampisilin Injeksi 1 gr Vial 0
16 Analog insulin Long Acting Pen 0
17 Analog insulin Mix Acting Pen 0
18 Antalgin (Metampiron) tablet 500 mg Tablet 0
19 Antalgin (Metampiron) tablet 500 mg Tablet 0
20 Antasida DOEN suspensi Botol 0
21 ANTASIDA DOEN Tablet Tablet 0
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 0
23 anti hemoroid doen kombinasi supp 0
24 Antifungi DOEN Tube 0
25 Antimigren DOEN Kombinasi : Tablet 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet 0
27 Antiparkinson Tablet ( Levopar ) Tablet 0
28 Aqua Pro Injeksi Vial 0
29 Artermeter injeksi Ampul 0
30 Artesunate injeksi 60 mg/ml vial 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 0
32 Asam Folat Botol 0
33 Asam Fusidat Cream Tube 0
34 Asam Klorida 0,1 N Botol 0
35 Asam Mefenamat 500 mg Tablet 0
Asam Mefenamat 500 mg Tablet 0 300
36 Asam Traneksamat Inj 5% Ampul 0
37 Asering Botol 0
38 Asetosal tablet 500 mg Tablet 0
39 Asetyl Cysteine Capsul 0 180
40 Asiklovir Cream 5% Tube 0
41 Asiklovir tablet 200 mg Tablet 0
42 Asiklovir tablet 400 mg Tablet 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0
46 Berotec Metered Aerosol 100 mg Bok 0
47 Betadine Salep Antiseptik 5 mg Tube 0
48 Betametason krim 0,1 % Tube 0
49 Bisakodil Suppositoria supp 0
50 Bisoprolol 2,5 mg Tablet 0
51 Bisoprolol 5 mg Tablet 0
52 Cairan Infus KN-3B Botol 0
53 Cairan Infus Wida KDN 1 Botol 0
Cairan Infus Wida KDN 2 Botol 0
54 Cairan Pembersih ( Protektor ) Botol 0
55 Captopril Tablet 12,5 mg Tablet 0
56 Captopril Tablet 25 mg Tablet 0
57 Cefadroxil Capsul 500 mg Capsul 0
58 Cefixime Capsul 100 mg Capsul 0
59 Cefixime Sirup Botol 0
60 Cefotaksime 1 gr Injeksi Vial 0
61 Cetirizine Capsul 50 mg Capsul 0
62 Cetirizine sirup 5 mg/5 ml Botol 0
63 Ciprofloxcacin 500 mg tablet Tablet 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 0
65 D-Artepp tablet Tablet 0
66 deksametason tab Tablet 0 300
67 Dekstran 70 - larutan infus 6% steril Botol 0
68 Dekstrometorfan sirup Botol 0
69 Dekstrometorfan tablet 15 mg Tablet 0
70 Diazepam Rektal 0,5 mg / 2 ml supp 0
71 Diazepam tablet 2 mg Tablet 0
72 Diazepam tablet 5 mg Tablet 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 0
74 Digoksin tablet 0,25 mg Tablet 0
75 Diltiazem Tablet 0
76 Doksisiklin Kapsul 100 mg Capsul 0
77 Domperidon 10mg Tablet Tablet 0
78 Domperidon Suspensi 5 mg/ 5 ml Botol 0
79 Doxicyclin 500mg capsul 0
80 Efedrin HCLTablet 25 mg Tablet 0
81 Epinefrina HCL/Bitartrat Injeksi/ EFINEFRIN Ampul 0
82 Eritromicyn kapsul 250 mg capsul 0
83 Erytromicin kapsul 500 mg Kapsul 0
84 Erytromicin sirup 125 mg Botol 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol 0
86 Etambutol 500 mg Tablet 0
87 Etanol 70 % Botol 0
88 Etil Klorida Semprot Botol 0
89 Fenitoin Natrium kapsul 30 mg Kapsul 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0
91 Fenobarbital tablet 30 mg Tablet 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet 0
93 Fenol Gliserol tetes telinga 10 % Botol 0 4
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul 0
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul 0
97 Furosemida tablet 40 mg Tablet 0
98 Furosemide Injeksi Ampul 0
99 Garam Oralit Sachet 0
100 Gemfibrozil 300 mg Tablet 0
101 Gentamicin Injeksi Ampul 0
102 Gentamicin Salep Kulit Tube 0
103 Gentamicin Salep mata Tube 0
104 Gentamicin Tetes Mata Botol 0
Gentamicin Tetes Mata Botol 0
105 Gentian Violet 1 % Botol 0
106 Glibenclamid tablet 5 mg Tablet 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0
108 Glikazid 80 mg Tablet Tablet 0
109 Glimepiride 2 mg Tablet 0
110 Glukosa larutan infus 10% steril Botol 0
111 Glukosa larutan infus 5 % steril Botol 0
112 Griseofulvin tablet 500 mg, Tablet 0
113 Guaiafenesin 100 mg Tablet 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 0
115 Hidrokortison krim 2,5% Tube 0 3
116 Ibuprofen Suspensi Tablet 0
117 Ibuprofen tablet 200 mg Tablet 0
118 Ibuprofen tablet 400 mg Tablet 0
119 Imunomodulator sirup( STIMUNO) Botol 0
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 0
121 Kalsium Glukonas Injeksi Ampul 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0
123 Kapas Berlemak 500 mg Bungkus 0
124 Ketokonazol Kream Tube 0
125 Ketokonazol Tablet 200 mg Tablet 0
126 Ketorolac inj Ampul 0
127 Kifadene tablet 20 mg Tablet 0
128 Kloramfenikol salep mata 1 % capsul 0
129 Kloramfenikol suspensi Botol 0
130 Kloramfenikol tetes telinga 3% Tube 0
131 Kloramphenicol 250 mg Capsul 0
132 Kloramphenicol 500 mg capsul 0
133 Kloramphenicol Tetes Mata Botol 0
134 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 0 300
135 Klorokuin tablet 150 mg Tablet 0
136 Klorpromazin HCL tablet salut 25 mg Tablet 0
137 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 0 300
139 Kotrimoksazol Sirup / Suspensi Botol 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0
142 Lactobacilus serbuk Sachet 0
143 Lidocain 2%+efinefrin injeksi Ampul 0
144 Lidocain injeksi 2 ml Ampul 0 5
145 Lisinopril 10 mg tablet Tablet 0
146 Lisinopril 5 mg tablet Tablet 0
147 Loperamid 4 mg tablet Tablet 0
148 Lytacur Sirup Botol 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 0
150 Metamizol 500 mg Tablet 0
151 Metformin 500 mg Tablet Tablet 0
152 Methilprednisolon tablet 4 mg Tablet 0
153 Metilergometrin Maleat injeksi 1 ml Ampul 0
154 Metilergometrin Maleat Tablet Tablet 0
155 Metoklopramid Suspensi Botol 0
156 Metoklopramid tablet Tablet 0
157 Metronidazol 500 mg Tablet 0
158 Metronidazol infus / injeksi Botol 0
159 Metronidazol Ovula supp 0
160 Metronidazol suspensi Botol 0
161 Mikonazol kream Tube 0 5
162 Multivitamin Anak Sirup Botol 0
163 Multivitamin Dewasa Antioksidan (HB VIT ) Tablet 0 1
164 Natrium Diklofenak 25 mg Tablet Tablet 0
165 Natrium Diklofenak 50 mg Tablet Tablet 0 300
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 0
167 Nifedipine Tablet 10 mg box 0
168 Nistatin tablet vaginal 100.000 IU/g Tube 0
169 Obat anti Diare suspensi Botol 0
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 0
171 Obat Batuk Flu ( Molexflu ) BOX 0
Obat Batuk Flu ( Molexflu ) BOX 0
172 Obat Batuk Hitam (OBH) Botol 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0
Obat Batuk Sirup Herbal ( Herbacop ) Botol 0
174 Ofloxsacin Tetes Telinga Tube 0
175 Oksitetrasiklin HCL salep mata 1% Botol 0
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 0
177 Omeprazol injeksi Ampul 0
178 Omeprazol Kapsul 20 mg capsul 0
179 Ondancentron injeksi 4 mg Ampul 0
180 Ondancentron Tablet4 mg Tablet 0
181 Paracetamol Drop 15 ml Botol 0
182 Paracetamol Sirup 120 mg/5 ml Botol 0
183 Parafin Dresing ( Bioplacenton Tull ) pcs 0
184 Parasetamol tablet 100 mg Tablet 0
185 Parasetamol tablet 500 mg Tablet 0 300
186 Permetrin Krim 5 % Tube 0
187 Pirantel Sirup Botol 0
188 Pirantel tablet 125 mg Tablet 0
189 Pirazinamid Botol 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 0
191 Piroksikam tablet 20 mg Tablet 0
192 Polikresulen Tube 0
193 Povidon lodida 10% 300 ml 0
194 Povidon lodida 10% 60 ml 0
195 Prazikuantel tablet 600 mg Botol 0
196 Prednison Tablet 5 mg Tablet 0
197 Primakuin 15 mg Tablet 0
198 Probenesid 500 mg tablet Tablet 0
199 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul 0
200 Propanolol HCL tablet 10 mg Tablet 0
201 Ranitidin injeksi Ampul 0
202 Ranitidin tablet Tablet 0 100
203 Resperidone 2 mg tablet Tablet 0
204 Ringer Laktat cairan infus (Otsuka) 0
205 Ringer Laktat cairan infus (Widatra) Botol 0 5
206 Rivanol 300 ml Botol 0
207 Salbutamol Tablet 2 mg Tablet 0
208 Salbutamol tablet 4mg Tablet 0
209 Salep 2-4 Tube 0 4
210 Salep kombinasi cream ( Berloson ) Tube 0
211 Salicil bedak Kotak 0
212 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 0
213 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 0
214 Sianokobalamin Injeksi Ampul 0
215 Simvastatin 10 mg tablet Tablet 0 100
216 Simvastatin 20 mg tablet Tablet 0
217 Sukralfat Suspensi Botol 0
218 Sukralfat tablet 500 mg Tablet 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube 0
220 Temporary Stopping Fletcher serbuk & cairan Tablet 0
221 Tetrakain HCL tetes mata 0,5% Tube 0
222 Tetrasiklin 250 mg capsul capsul 0
223 Tetrasiklin 500 mg capsul capsul 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0
Tiamin Tablet 50 mg ( B1 ) Tablet 0
225 Ventolin Nebulizer Ampul 0
226 vitamin b komplek Tablet 0 400
vitamin b komplek Tablet 0
227 Zink sirup Botol 0
228 Zink tablet 20 mg Tablet 0
229 Deksametason inj Ampul 0
230 Diazepam inj 5 mg/ml Ampul 0
231 Griseofulvin 125 mcg Tablet 0
232 Kloramfenikol SK/ BUFACETIN Tube 0 4
233 Nystatin tab 500.000 IU Tablet 0
234 magnesium Sulfat Inj. 25 ml 40% ampul 0
235 natrium bicarbonat tab 0
236 MULTIVITAMIN ANAK STIMUNO SYR BOTOL 0
237 tetagam set 0
238 vit c kemenkes tab 0
239 goodlife box 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 0
1 Alat suntik 1 ml Pcs 0
3 Alat suntik 2,5 ml Pcs 0
5 Alat suntik 3 cc (Remedi) 0
Alat suntik 3 ml kotak 0
7 Alat suntik 5 ml pcs 0
alat suntik 5 ml box 0
8 Alkazide 1 L High Level Desinfectant Botol 0
9 Alkazyme Sachet 25 mg Pack 0
10 Alkohol 70 % 1 L Botol 0
11 Alkohol swab box 0
12 Anti Septik Hand Rub Botol 0
13 Anti Septik Surgikal Hand Scrub Botol 0
14 Cat Gut no 2/0 KOTAK 0
15 Cat Gut no 3/0 KOTAK 0
16 Cat Gut No 2/0 (24 mm) Sachet 0
17 Cat Gut No 3/0 (26 mm) Sachet 0
18 Cathetter Jelly Biji 0
19 Demetech Silk 3/0 Set 0
20 E Care I.V Dresing Pcs 0
21 E-Care Surgical Mask Tie On Lembar 0
22 Folly No 14 Catether pcs 0
23 Folly No 16 Catether box 0
24 I.V Cathetter No. 20 Set 0 5
iv cathETER no 20 pcs 0
25 I.V Cathetter No. 22 Set 0 5
26 I.V Cathetter No. 24 pcs 0
27 I.V Cathetter No. 26 Set 0
28 Infuset Anak Set 0 5
Infuset Anak PCS 0
29 Infuset Dewasa pcs 0
30 Jarum Insulin Tablet 0
31 Kapas Berlemak 250 gr Bungkus 0
32 Kapas Berlemak 500 gr Bungkus 0
33 Kasa 4 m x 10 cm Rol 0
34 Kasa Hidrofil 36 x 80 cm Rol 0
35 Kasa Pembalut 2 x 80 cm Pack 0
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 0
Kasa Steril / hidrofil 16 x 16 cm lembar 0 60
37 Lisol 1 L lembar 0
38 Masker karet Ear Loop Lembar 0
masker kotak 0 1
39 Masker tali Tube 0
40 Nasal Canula Oksigen Set 0
41 Plester 1" Rol 0
42 Plester Kertas 2,5 cm Rol 0
43 Plester Non Woven 5cm x 5 cm Rol 0
44 Policlean Botol 0
45 Polifik Kotak 0
46 Saraya Alsof A 500 ml Botol 0
47 Saraya Alsof Pure 500 ml Botol 0
48 Sarung Tangan Gynecolog No 7 Pasang 0
49 Sarung tangan M (Non Steril) KOTAK 0
Sarung tangan M (Non Steril) KOTAK 0
50 Sarung tangan no 6,5 Pasang 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0
52 Sarung tangan no 7,0 Steril Pasang 0
53 Selang Section ( Surgikal Conection Tube with Pcs 0
54 Underpad pack 0 1
55 Urine Bag Biji 0
56 safety blackblood BOX 0
57 safety box BOX 0
58 Tabung BD Vacutener pcs 0
59 masker n95 box 0
60 t silk black 3/0 26 mm pcs 0
64 Nasal Canula Oksigen anak nca pcs 0
65 nasal canula oksigen dewasa ncd pcs 0
66 silk 2-0 box 0
67 silk 3-0 box 0
0
OBAT JKN 0
1 etil klorida spray btl 0
2 Ketorolac inj box 0
3 parasetamol tab box 0
4 Acyclovir 400 mg box 0
5 GLUKOSA 5% BOTOL 0
6 glukosa 10% BOTOL 0
7 asam tranexamat inj box 0
8 IBUPROFEN 400 mg box 0
9 Mecobalamin 500 Mg Tab box 0
10 Metronidazole 500 mg box 0
11 d40 % botol 0
12 dulcolax anak suppo box 0
13 gom box 0
14 Lexigo box 0
15 METRONIDAZOL SYR/ farizol botol 0
16 mikrolax suppositoria Tube 0
17 natrium bicarbonat tab botol 0 1
18 nifedipin tab box 0
19 nacl botol 0
20 acylovir cream tube 0
21 Ciprofloxacin 500 mg box 0
22 Cetirizine syr BOTOL 0
23 Guanistrep syr BOTOL 0
24 nisagon krim tube 0
25 piroksikam 20 mg tab box 0
26 metilergo injek ampul 0
27 NILACELIN SIR botol 0
28 water for injeksi/ Aqua pro inj vial 0
29 mgso 40 vial 0
30 oksitosin inj box 0
31 asam traneksamat 500 mg tab box @50 ta 0
32 ctm 4 mg box @100 t 0
33 domperidon syr botol 0
34 h202 3% 100 ML botol 0
35 HYOSCINE N BUTYLBROMIDE 10 MG/scopma box 0
36 ketokonazol cr tube 0
37 ketokonazol tab box@50 tab 0
38 molexflu box@150 ta 0
39 PARACETAMOL 100MG/ML DROP 15 ML BOTOL 0
PERMETHRIN CREAM 5% 30 GRAM/ scabimite 30 TUBE
40 gram 0
41 DIASTRIX(loperamid) box @100 t 0
42 PARASETAMOL INFUS BOTOL 0
43 Salep 2-4 POT 0
44 ventolin nebu BOX 0
45 Ambroxol Syrup 15 mg/5 ml Botol 0
47 Akita Tablet 0
48 BEDAK SALICYL 2% 60 GRAM POT 0
49 BIOPLASENTON GEL 15 GRAM TUBE 0
50 Cefadroxil 500 mg Tablet 0
51 Dexamethasone Inj ampul 0
52 DOMPERIDON SYR BOTOL 0
53 Klorfeniramin Maleat (CTM) 4 Mg Tablet 0
54 Methylergometrin injeksi ampul 0
55 MgSO4 40% botol 0
56 Ondancetron 4 mg/2ml Injeksi Ampul 0
57 Ondansetron Tablet 4 mg Tablet 0
58 Oxytocin Injeksi Ampul 0
59 Paracetamol 500 mg Tablet 0
60 PARACETAMOL SUPPOSITORIA 160MG SUPP 0
61 Ranitidin Injeksi Ampul 0
62 UNI BABY COUGH BOTOL 0
63 Vit K injeksi/ NEO K - 2 MG ampul 0
64 EFINEPRIN INJ AMPUL 0
65 SUKRALFAT SYR BOTOL 0
66 Acyclovir Cream 5 gr Tube 0
68 ambroxol tablet tablet 0
70 Antihaemoroid Suppositoria Supp 0
71 BABY COUGH SYR BOTOL 0
72 BETAHISTIN MAESILAT 6 MG TABLET 0
73 Biocombin/ Mersibion 5000 inj AMPUL 0
74 Cefadroxil 500 mg Tablet 0
75 CETIRIZINE 10 MG TABLET 0
76 CIPROFLOXACIN 500 MG TABLET 0
77 Dexamethasone Inj ampul 0
78 DOMPERIDON SYR BOTOL 0
79 FUROSEMIDE 40MG TABLET 0
80 GENTAMISIN SALEP KULIT 0,1% 5 GRAM TUBE 0
81 GLUKOSA INFUS 10% 500ML OTSUKA BOTOL 0
82 GLUKOSA INFUS 5% 500ML OTSUKA BOTOL 0
83 Kloramfenichol salep mata tube 0
84 Lidocain + Ephineprin AMPUL 0
85 METRONIDAZOL 500 MG TABLET 0
86 METRONIDAZOL 500 MG TABLET 0
87 Metronidazol Sirup Botol 0
88 Ondancetron 4 mg/2ml Injeksi Ampul 0
89 Ondansetron Tablet 4 mg Tablet 0
90 Paracetamol Syrup Botol 0
91 PARASETAMOL INFUS BOTOL 0
92 Ranitidin Injeksi Ampul 0
Ventolin Nebu/ SALBUTAMOL NEBULIZER 2,5MG Vial
93 0
94 mecobalamin tab 500 mg tablet 0
95 sukralfat syr botol 0
96 ketokonazol tab tablet 0
1 Kg
(Bentuk
97 Kaporit tabet Tablet) 0
98 parasetamol tab 500 mg box 0
99 vit k inj box 0
100 Acyclovir Cream 5 gr Tube 0
102 Asam Tranexamat 500 Mg Box 50 tab 0
103 Bedak Salicyl 2 % 60 gram Pot 0
104 Betahistin Maesilat 6 Mg Box 50 tab 0
Box 10
105 Ampul 0
Box 100
Bisacodil 5 mg
106 tab 0
Box 100
Ceterizin 10 mg
107 tab 0
108 Ceterizine syrup Botol 0
Box 100
109 0
Box 100
110 tab 0
111 Ketorolac 30 Mg Inj Ampul 0
Box 100
112 tab 0
Box 10
Ranitidin Injeksi
113 Ampul 0
114 Uni baby Cough Syrup Botol 0
Ventolin Nebules / SALBUTAMOL NEBULIZER Box 20
115 2,5MG nebu 0
116 Diazepam Suppo 5 mg Box 5 pcs 0
117 Clorpromazine 100 mg (OGB) 100/Box 0
118 Hexymer 2 mg tablet/trihexyfenidil 2 mg 100/Box 0
119 Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box 0
120 Sikzonoat injeksi/fluphenazine decanoate 25 mg 5/Box 0
121 Risperidone 2 mg 50/Box 0
122 0
123 0
124 0
125 0
BMHP JKN Set 0
1 LANSET CENTURY pcs 0
2 BISTURI pcs 0
3 CHKM pcs 0
3 mukus ekstraktor pcs 0
4 pipet obat 1 ml pcs 0
5 kertas goldar pcs 0
6 Rebreathing mask O2 dewasa NRM pcs 0
7 vaselin pcs 0
8 rivanol botol 0
9 povidone/ betadine botol 0
10 alkohol botol 0
11 lancet media box 0
12 OKSIGEN MASKER STANDAR ANAK SUNGKUP (SUNGKpcs 0
13 OKSIGEN MASKER STANDAR DEWASA (SUNGKUP D) pcs 0
14 PLASTIK KLIP SEDANG 13x8,7 CM Pack 0 1
BAT ( LPLPO ) PUSKESMAS 2023
PENGELUARAN
2 3 4 5 6 7 8 9 10 11
10 10
10 20 20 20 20
10 20
20 10 10 20
10 20
1
1
10 10 10 20 10
30 20 10 20 10 10
1 1
20 20 10 10
30 20 10 20 30 10
10
2
1 1 1
10 10 10
20 20 30 20 20
1
1
1 1
1 1
1
1
1
PENGELUARAN
12 13 14 15 16 17 18 19 20 21
10 20 20 10 10
10 10 20 20 10 20
20 10
10
10 10 20
1 1
1
10 20 10 10
20 20 10 10 10
1 1
1
20 10 20
10 20 30 20 20 20
10
1
10 10
20 10 10 10 20 10
1
12
22 23 24 TOTAL PE SISA
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 100 0
0 0
0 0
0 0
20 200 200
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
20 80 220
0 0
0 0
0 0
10 80 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
70 230
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
110 190
0 0
0 0
0 0
170 130
0 0
0 0
0 0
0 0
0 0
2 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 2
0 0
1 0
0 0
110 190
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
40 280 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
20 80
0 0
0 0
2 3
0 0
0 0
0 0
4 0
0 0
0 0
0 0
0 0
0 0
20 70 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
20 20 20 250 150
0 0
0 0
0 0
0 0
0 0
0 0
1 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 3
0 0
2 3
0 0
0 0
1 3 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
12 48
0 0
0 0
1 0
0 0
0 0
0 0
0 0
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 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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 0

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUSKESMAS 2022

YANG MENYERAHKAN MENGETAHUI YANG MEMINTA :

Nama Puskesmas : PKM CIKEUSIK/ rancaseneng

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

3 Jujum Jumiati, Amd. Keb

Harga Perhitungan Persediaan :

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

PUSKESMAS : CIKEUSIK/Pustu rancaseneng

47 Saraya Alsof Pure 500 ml Botol 0 0 0

67 Ambroxol Syrup 15 mg/5 ml Botol 0 0 0

70 Antihaemoroid Suppositoria Supp 0 0 0

73 Biocombin/ Mersibion 5000 inj AMPUL 0 0 0

83 Kloramfenichol salep mata tube 0 0 0

88 Ondancetron 4 mg/2ml Injeksi Ampul 0 0 0

Medical Catgut Plain Sterile

YANG MENYERAHKAN MENGETAHUI YANG MEMINTA :

Nama Puskesmas : PKM CIKEUSIK/ Rancaseneng

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

3 Jujum Jumiati, Amd. Keb

Harga Perhitungan Persediaan :

PUSKESMAS : CIKEUSIK/ PUSTU RANCASENENG

7 Alat suntik 5 ml pcs 0 0 0 0

8 Alkazide 1 L High Level Desinfectant Botol 0 0 0 0

Furosemide 40 mg Box 100 tab

Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box

YANG MENYERAHKAN MENGETAHUI YANG MEMINTA : YANG MENYERAHKAN

YANG MENYERAHKAN MENGETAHUI YANG MEMINTA :

Nama Puskesmas : PKM CIKEUSIK/ Pustu Rancaseneng

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

Harga Perhitungan Persediaan :

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

3 Jujum Jumiati, Amd. Keb

Nama Puskesmas : PKM CIKEUSIK/ Pustu rancaseneng

Kepala Puskesmas Cikeusik Pengurus Barang Tim Pemeriksa,

1 Acep Surahman, S.Kep. Ners

3 Jujum Jumiati, Amd. Keb

1 Acep Surahman, S.Kep. Ners

PUSKESMAS : CIKEUSIK/Pustu rancaseneng

N0 NAMA OBAT SATUAN

GLUKOSA INFUS 10% 500ML OTSUKA BOTOL

Bamgetol 200 mg tablet/ carbamazepin 200 mg 100/Box

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