OH

Item Code Item Name 29.11.23 UOM

HIS

ACYC1002 ACYCLOVIR 400 MG TAB ::: - TAB

ACYC1001 ACYCLOVIR 5% 5G CRM 10 TUB
ALKO2001 ALKOHOL SWAB ::: 494 PIECE
ALLO1002 ALLOPURINOL 100 MG TAB ::: 395 TAB
ALPA1002 ALPARA TAB ///::::: 6,089 TAB
AMBR1002 AMBROXOL 30 MG TAB ::: 3,946 TAB
AMBR1001 AMBROXOL HCL 15 MG/5 ML, 60ML SIR 26 BT60
AMLO1002 AMLODIPINE BESYLATE 10 MG TAB ::: 1,330 TAB
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 1,880 TAB
AMOX1006 AMOXICILLIN 125 MG/5 ML 60ML SIR ::: 38 BT60
AMOX1010 amoxiCILLIN 500 MG TAB ::: 1,726 TAB
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: 11 AMP
MGOH1002 ANTASIDA DOEN 60ML SIR ::: 40 BT60
ASEP1001 ASEPTAN LIQUID 500 ML 8 BTL
BETA1022 BETADINE SOLUTION 1 LITER - BTL
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: 835 TAB
BEVA1001 BEVALEX CR 5 G 120 TUB
CAPT1002 CAPTOPRIL 12.5 MG TAB ::: 1,853 TAB
CAPT1003 CAPTOPRIL 25 MG TAB ::: 712 TAB
CEFA1009 CEFADROXIL MONOHYDRATE 500 MG CAP ::: 3,850 CAP
CEFT1002 cefTRIAXONE DISODIUM 1 G INJ ::: 10 VIAL
XITR1001 CENDO XITROL ED 5 ML 59 BTL
CERV2001 CERVICAL COLLAR (FOAM) S 1 PIECE
CERV2003 CERVICAL COLLAR (FOAM) L - PIECE
CETI1002 CETIRIZINE 5 MG/5 ML SYR 60 ML ::: 16 BT60
CETI1001 CETIRIZINE HCL 10MG TAB ::: 3,048 TAB
CHLO1007 CHLORAMPHENICOL 1% 3.5 G SALEP MATA 51 TUB
CHLO1005 CHLORPHENIRAMINE MALEAT 4 MG TAB ::: 108 TAB
CIPR1005 CIPROFLOXACIN 500 MG TAB ::: 2,149 TAB
CLIN1002 CLINDAMYCIN 300 MG CAP ::: 135 CAP
CLOP1001 CLOPIDOGREL 75 MG TAB ::: 17 TAB
COMB1003 COMBIVENT UDV NEB 2.5 ML ::: 44 NEB
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 2,637 TAB
DEXA1002 DEXAMETHASONE 5 MG INJ ::: 39 AMP
DEXT1006 DEXTROSE 5% INF 500 ML 1 BTL
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 7,280 TAB
DIPH1001 diphenhydrAMINE INJ ::: 83 AMP
DOMP1002 DOMPERIDON 10MG TAB ::: 2,343 TAB
DOMP1004 DOMPERIDONE SYR ::: 14 BTL
DULC1002 DULCOLAX 5 MG SUPP ::: 61 SUPP
DULC1003 DULCOLAX 5 MG TAB 94 TAB
EPER1002 EPERISONE 50 MG TAB ::: 2,050 TAB
FGTR1001 FG-TROCHES TAB 1,300 TAB
FORU1006 FORUMEN EAR DROPS 10 ML 9 BTL
GENT1012 GENTALEX 0.1% CR 5 G /// 107 TUB
GLIM1003 GLIMEPIRIDE 2 MG TAB ::: 940 TAB
HYDR1003 HYDROCORTISONE ACETATE 2.5% 5G CRM ::: 119 TUB
HYPA2003 HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) 294 UNIT
IBUP1001 IBUPROFEN 400 MG TAB ::: 2,717 TAB
INFU2001 INFUSION SAFETY SET MACRO ::: 75 PIECE
IODI2002 IODINE POVIDONE LAR 10% 30 ML ::: 10 BT30
ISOS1001 isoSORBIDE DINITRATE 5 MG TAB ::: 18 TAB
IVCA2002 IV CATH WITH PORT 22 G ::: 60 PIECE
IVCA2004 IV CATH WITH PORT 24 G ::: 107 PIECE
KALN1005 KALNEX 500 MG TAB 343 TAB
KASA2035 KASA ROLL 40 Y X 80 CM NON X RAY 1,164,800 CM
KETO1002 KETOCONAZOLE 2% 10 G CRM ::: 70 TUB
KETO1009 KETOCONAZOLE 200 MG TAB ::: 128 TAB
KETO1007 KETOPROFEN 50 MG TAB 809 TAB
KETO1005 KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: 92 AMP
LANS1001 LANSOprazole 30 MG CAP ::: 3,217 CAP
LIDO1003 LIDOCAINE HCL 2%/2 ML INJ ::: 95 AMP
LODI1001 LODIA 2 MG TAB /// 604 TAB
LOMA2001 LOMATULLE (SOFRATULLE)/// 40 LEM
R0103118 MASKER OKSIGEN DEWASA 7 PIECE
MECO1004 MECOBALAMIN 500 MCG CAP 1,040 CAP
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 1,420 TAB
MELO1003 MELOXICAM 15 MG 310 TAB
MELO1002 MELOXICAM 7,5 MG TAB ::: 300 TAB
METF1002 METFORMIN HCL 500 MG TAB ::: 1,145 TAB
R0103121 MICROMIST DEWASA SET INHALASI (1172) 40 PIECE
R0103120 MICROMIST ANAK SET INHALASI (1173) 8 PIECE
MUCO1011 MUCOHEXIN 8 MG TAB/// 626 TAB
MYGE2002 MY JELLY 80 G ::: 1 TUB
R0103091 NASAL CANULE DEWASA 11 PIECE
R0109027 NEEDLE NO. 27 76 PIECE
NEUR1012 NEURObion 5000 INJ 3 ML 95 AMP
OMEP1001 OMEprazol 20 MG CAP ::: 1,150 CAP
ONDA1004 ONDANSETRON HCL 4 MG/2 ML INJ ::: 69 AMP
OPTI2020 OPTIUM NEO H STRIP 51 TES
OTOP1001 OTOPAIN EAR DROPS 8 ML 15 BTL
PAMO1001 PAMOL 125 MG SUPP 161 SUPP
PANT1006 PANTOPRAZOL 40 MG INJ 80 VIAL
PARA1004 PARACETAMOL 120 MG/5 ML 60ML SIR ::: - BT60
RANI1002 RANITIDINE HCL 150 MG TAB ::: 597 TAB
RANI1001 RANITIDINE HCL 50MG/2 ML INJ ::: 47 AMP
RECO1008 RECO ED 10 ML ///::::: 38 BTL
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 119 BTL
SALB1001 SALBUTAMOL SULFATE 2 MG TAB ::: 334 TAB
SALB1002 SALBUTAMOL SULFATE 4 MG TAB ::: 137 TAB
SALI2001 SALICYL POWDER 80 G 27 PIECE
SCAB1001 scabiMITE CR 10 G ::: 22 TUB
SCOP1004 SCOPAMIN 10 MG TAB ///::: 390 TAB
SENS1001 SENSI WASH 250 ML 5 BTL
BURN1005 SILVER SULFADIAZIN 10% CR 500 GR 4 POT
SIMV1003 SIMVASTATIN 10 MG TAB ::: 368 TAB
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 36 TUB
SITE2006 STRIP ASAM URAT EASY TOUCH (SITE) 56 PIECE
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) 33 PIECE
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 3 BTL
R0109045 SYRINGE 10 ML TERUMO 137 PIECE
R0109058 SYRINGE 3 ML 410 PIECE
TETA1001 TETAGAM P 250 IU INJ 1 ML 10 SYRINGE
THRO1002 THROMBOPHOB GEL 20 G - TUB
TREM1001 TREMENZA TAB ///::::: 300 TAB
VENO1004 VENOSMIL 200 MG CAP 196 TAB
VENT1002 VENTOLIN 2.5 MG NEBULES ::: 18 NEB
VITA1004 VITAMIN B COMPLEX TAB ::: 3,530 TAB
VITA1007 VITAMIN C 50 MG TAB ::: 6,269 TAB
WATE1005 WATER FOR INJEKSI 25 ML ::: 101 AMP
ZINC1004 ZINC 20 MG TAB ::: 447 TAB
 Draft Pemesanan Obat dan Alkes KIM - (Maret- MEI 2023

PEMAKAIAN
Total
MIN (90
pemakaian (86
Non Racikan ISSUE hari)
hari)
DES'22 JAN'23 FEB'23 DES'22 JAN'23 FEB'23
30 70 90 - - - 190 194
8 2 1 - - - 11 11
247 245 190 - - - 682 698
130 140 80 - - - 350 358
1,460 1,366 892 - - - 3,718 3,803
787 695 370 - - - 1,852 1,894
- 8 6 - - - 14 14
210 400 190 - - - 800 818
910 780 430 - - - 2,120 2,168
- 3 9 - - - 12 12
486 715 337 - - - 1,538 1,573
3 5 2 - - - 10 10
- 3 17 - - - 20 20
- - - 6 4 - 10 10
- - - - 1 - 1 1
130 90 80 - - - 300 307
35 44 17 - - - 96 98
360 210 60 - - - 630 644
121 350 280 - - - 751 768
630 390 440 - - - 1,460 1,493
4 2 2 - - - 8 8
12 12 9 - - - 33 34
- 1 - - - - 1 1
- 1 - - - -
- 12 8 - - - 20 20
1,120 1,070 669 - - - 2,859 2,924
6 5 6 - - - 17 17
1 - - - - - 1 1
360 262 154 - - - 776 794
140 60 60 - - - 260 266
1 10 4 - - - 15 15
3 10 3 - - - 16 16
2,050 1,660 1,170 - - - 4,880 4,991
13 13 6 - - - 32 33
- - 1 - - - 1 1
791 1,130 528 - - - 2,449 2,505
12 17 7 - - - 36 37
365 460 110 - - - 935 956
- 1 5 - - - 6 6
10 1 24 - - - 35 36
70 22 - - - - 92 94
680 560 310 - - - 1,550 1,585
340 250 230 - - - 820 839
10 10 3 - - - 23 24
23 25 19 - - - 67 69
360 300 70 - - - 730 747
12 20 3 - - - 35 36
142 48 58 - - - 248 254
930 1,020 500 - - - 2,450 2,506
33 8 10 - - - 51 52
7 2 5 - - - 14 14
2 10 1 - - - 13 13
17 4 8 - - - 29 30
29 6 5 - - - 40 41
95 30 33 - - - 158 162
- - - 582,400 291,200 - 873,600 893,455
20 26 10 - - - 56 57
51 90 - - - - 141 144
160 140 60 - - - 360 368
26 31 16 - - - 73 75
980 880 500 - - - 2,360 2,414
20 25 20 - - - 65 66
156 182 124 - - - 462 473
15 18 11 - - - 44 45
2 - 1 - - - 3 3
370 260 140 - - - 770 788
750 790 720 - - - 2,260 2,311
30 90 10 - - - 130 133
340 380 140 - - - 860 880
810 660 230 - - - 1,700 1,739
5 10 5 - - - 20 20
7 2 1 - - - 10 10
170 62 30 - - - 262 268
- - - 1 - - 1 1
8 1 3 - - - 12 12
21 29 9 - - - 59 60
12 8 8 - - - 28 29
420 160 150 - - - 730 747
14 12 7 - - - 33 34
 18 17 17 - - - 52 53
11 4 2 - - - 17 17
23 40 15 - - - 78 80
11 12 10 - - - 33 34
- - - - - - - -
360 311 190 - - - 861 881
23 19 8 - - - 50 51
15 16 12 - - - 43 44
48 12 10 - - - 70 72
30 40 70 - - - 140 143
90 90 20 - - - 200 205
16 8 16 - - - 40 41
3 6 1 - - - 10 10
200 170 90 - - - 460 470
- - - 3 8 - 11 11
- 10 22 - - - 32 33
100 200 90 - - - 390 399
7 7 4 - - - 18 18
15 23 15 - - - 53 54
6 15 3 - - - 24 25
- 1 5 - - - 6 6
17 17 13 - - - 47 48
128 134 73 - - - 335 343
4 4 5 - - - 13 13
3 6 - - - - 9 9
780 490 330 - - - 1,600 1,636
110 70 50 - - - 230 235
13 1 2 - - - 16 16
1,280 1,119 775 - - - 3,174 3,246
1,300 725 596 - - - 2,621 2,681
22 16 12 - - - 50 51
180 90 90 - - - 360 368
M - (Maret- MEI 2023)

STOCK
Permintaa Permintaan
MAX (120 OBAT
n (OH- (OH- PO
hari) MENIPIS
Pemakaian Pemakaian
/CITO
90hari) 120 hari)

259 (194) (259) 500

15 (1) (5) 20
930 (204) (436) 1,200
477 37 (82) 400
5,070 2,287 1,019 1,500
2,525 2,052 1,421 300
19 12 7 50
1,091 512 239 700
2,891 (288) (1,011) 3,200
16 26 22 50
2,097 153 (371) 1,800
14 1 (3) 15
27 20 13 50
14 (2) (6) 20
1 (1) (1) 1
409 528 426 200
131 22 (11) 120
859 1,209 994 600
1,024 (56) (312) 1,000
1,991 2,357 1,859 500
11 2 (1) 10
45 25 14 50
1 (0) (0) 1
1
27 (4) (11) 50
3,899 124 (851) 3,000
23 34 28 20
1 107 107 100
1,058 1,355 1,091 1,000
355 (131) (220) 600
20 2 (3) 20
22 28 22 20
6,655 (2,354) (4,018) 8,000
44 6 (5) 75
1 (0) (0) 1
3,340 4,775 3,940 300
 49 46 34 20
1,275 1,387 1,068 700
8 8 6 50
48 25 13 60
125 (0) (31) 160
2,114 465 (64) 1,800
1,118 461 182 900
31 (15) (22) 50
91 38 16 60
995 193 (55) 1,600
48 83 71 60
338 40 (44) 10 kotak
3,341 211 (624) 3,000
70 23 5 77
19 (4) (9) 20
18 5 0 20
40 30 20 35
55 66 52 75
215 181 128 300
1,191,273 271,345 (26,473) 5 roll
76 13 (6) 72
192 (16) (64) 400
491 441 318 100
100 17 (8) 50
3,218 803 (1) 2,000
89 29 6 80
630 132 (26) 500
60 (5) (20) 60
4 4 3 5
1,050 253 (10) 1,000
3,082 (891) (1,662) 3,000
177 177 133 200
1,173 (580) (873) 2,000
2,318 (594) (1,173) 3,200
27 20 13 20
14 (2) (6) 20
357 358 269 400
1 (0) (0) 1
16 (1) (5) 15
80 16 (4) 1 kotak
38 66 57 20
995 403 155 900
45 35 24 40
 71 (2) (20) 50
23 (2) (8) 30
106 81 55 60
45 46 35 10
- - - 100
1,174 (284) (577) 2,000
68 (4) (21) 80
59 (6) (21) 80
95 47 24 80
191 191 143 200
273 (68) (136) 400
55 (14) (28) 48
14 12 8 10
627 (80) (237) 800
15 (6) (10) 25
44 (29) (40) 1 pot 500 g
532 (31) (164) 1,000
25 18 11 16
72 2 (16) 2 kotak
33 8 0 2 kotak
8 (3) (5) 10
64 89 73 100
457 67 (47) 270
18 (3) (8) 25
12 (9) (12) 20
2,182 (1,336) (1,882) 3,500
314 (39) (118) 340
22 2 (4) 10
4,328 284 (798) 3,000
3,574 3,588 2,695 1,000
68 50 33 12
491 79 (44) 700
 KETERANGAN

stock kosong, safety stock

safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock kosong, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock kosong, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock tipis, safety stock
cito
safety stock
safety stock
safety stock
safety stock
stock tipis, safety stock
safety stock
safety stock
safety stock
stock kosong safety stock
safety stock, cito
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
 OH PEMAK
Item Code Item Name 11.02.2 UOM
023 HIS Non Racikan

DES'22
ALLO1001 ALLOPURINOL 300 MG TAB ::: 90 TAB 10
ALPA1002 ALPARA TAB ///::::: 1,650 TAB 140
AMBR1002 AMBROXOL 30 MG TAB ::: 1,100 TAB 270
AMBR1001 AMBROXOL HCL 15 MG/5 ML, 60ML SIR 1 BT60 1
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 320 TAB 130
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: 4 AMP 1
ANTA1009 ANTASIDA DOEN TAB ::: 265 TAB 90
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: 270 TAB 50
R0117013 BISTURI NO.15 1 PIECE 2
BURN1004 BURNAZIN 10% CR 35 G (G) 3 TUB -
CETI1001 CETIRIZINE HCL 10MG TAB ::: 1,438 TAB 281
COUN1001 counterpain CREAM 15 G - TUB 5
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 3,033 TAB 801
DEXT1003 DEXTRAL SYR 60 ML - BTL 1
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 550 TAB 100
DOMP1002 DOMPERIDON 10MG TAB ::: 560 TAB 200
DULC1002 DULCOLAX 5 MG SUPP ::: 1 SUPP 2
ELKA1005 ELKANA FC TAB 730 TAB 220
EPER1002 EPERISONE 50 MG TAB ::: 280 TAB 20
FGTR1001 FG-TROCHES TAB 670 TAB 160
GENT1012 GENTALEX 0.1% CR 5 G /// 18 TUB 3
HYPA2003 HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) 1 UNIT 21
INFU2001 INFUSION SAFETY SET MACRO ::: 6 PIECE 3
IVCA2002 IV CATH WITH PORT 22 G ::: 1 PIECE 3
IVCA2004 IV CATH WITH PORT 24 G ::: 7 PIECE -
KASA2035 KASA ROLL 40 Y X 80 CM NON X RAY - roll -
KETO1007 KETOPROFEN 50 MG TAB 80 TAB 20
KETO1005 KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: 15 AMP 2
LANS1001 LANSOprazole 30 MG CAP ::: 650 CAP 150
LEXA1004 LEXACROL FORTE SUSP 100 ML ///::::: 4 BTL -
LODI1001 LODIA 2 MG TAB /// 115 TAB 45
RO115011 MASKER KERTAS KARET 120 TAB 5
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 2,409 TAB 590
METR1012 METRONIDAZOLE 500 MG TAB ::: 80 TAB -
R0103121 MICROMIST DEWASA SET INHALASI (1172) 3 TAB 1
MUCO1011 MUCOHEXIN 8 MG TAB/// 98 TAB 30
NACL1006 NACL 0.9% 500 ML (RUBBER) ::: 13 BTL 1
R0103091 NASAL CANULE DEWASA 1 PIECE 1
R0109023 NEEDLE NO. 23 5 PIECE 4
NEUR1012 NEURObion 5000 INJ 3 ML 20 AMP 14
OMEP1001 OMEprazol 20 MG CAP ::: 190 CAP 130
PARA1003 PARACETAMOL 500 MG TAB ::: 1,641 TAB 536
RANI1001 RANITIDINE HCL 50MG/2 ML INJ ::: 10 AMP 2
RECO1008 RECO ED 10 ML ///::::: 11 BTL 8
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 1 BTL 5
SALI2001 SALICYL POWDER 80 G 18 PIECE 4
SCOP1004 SCOPAMIN 10 MG TAB ///::: 80 TAB 65
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 16 TUB -
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) 6 PIECE 4
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 2 BTL 2
R0109058 SYRINGE 3 ML 160 PIECE 27
TREM1001 TREMENZA TAB ///::::: - TAB -
VENO1004 VENOSMIL 200 MG CAP 65 TAB 6
VELU1001 VELUTINE 2.5 MG NEBULES 4 ML 7 NEB 1
VITA1007 VITAMIN C 50 MG TAB ::: 1,000 TAB -
 Draft Pemesanan Obat dan Alkes LEBONG - (Maret-MEI 2023)

PEMAKAIAN Total
MAX Permintaan
pemakaia MIN (90
(120 hari) (OH-
Non Racikan ISSUE n (86 hari)
Pemakaian
hari)
90hari)
JAN'23 FEB'23 DES'22 JAN'23 FEB'23
30 40 - - - 80 95 126 (5)
410 180 - - - 730 864 1,153 786
140 30 - - - 440 521 695 579
- - - - - 1 1 2 (0)
50 30 - - - 210 249 332 71
1 3 - - - 5 6 8 (2)
120 10 - - - 220 261 347 4
60 10 - - - 120 142 189 128
- - - - - 2 2 3 (1)
1 - - - - 1 1 2 2
241 120 - - - 642 760 1,014 678
- - - - - 5 6 8 (6)
970 350 - - - 2,121 2,512 3,349 521
1 - - - - 2 2 3 (2)
70 50 - - - 220 261 347 289
190 60 - - - 450 533 711 27
- - - - - 2 2 3 (1)
360 180 - - - 760 900 1,200 (170)
60 - - - - 80 95 126 185
210 150 - - - 520 616 821 54
4 1 - - - 8 9 13 9
21 3 - - - 45 53 71 (52)
3 - - - - 6 7 9 (1)
- - - - - 3 4 5 (3)
2 - - - - 2 2 3 5
- - - - - - - - -
- - - - - 20 24 32 56
3 - - - - 5 6 8 9
260 40 - - - 450 533 711 117
1 - - - - 1 1 2 3
60 5 - - - 110 130 174 (15)
86 6 - - - 97 115 153 5
501 150 - - - 1,241 1,470 1,959 939
90 30 - - - 120 142 189 (62)
- - - - - 1 1 2 2
60 12 - - - 102 121 161 (23)
 3 - - - - 4 5 6 8
- - - - - 1 1 2 (0)
2 2 - - - 8 9 13 (4)
1 2 - - - 17 20 27 (0)
- - - - - 130 154 205 36
292 65 - - - 893 1,058 1,410 584
1 1 - - - 4 5 6 5
1 1 - - - 10 12 16 (1)
4 - - - - 9 11 14 (10)
4 1 - - - 9 11 14 7
60 20 - - - 145 172 229 (92)
4 3 - - - 7 8 11 8
1 - - - - 5 6 8 0
- - - - - 2 2 3 (0)
10 9 - - - 46 54 73 106
- - - - - - - - -
10 10 - - - 26 31 41 34
1 2 - - - 4 5 6 2
500 - - - - 500 592 789 408
et-MEI 2023)

STOCK
Permintaan
OBAT
(OH- PO KETERANGAN
MENIPIS/
Pemakaian
CITO
120 hari)

(36) 100 Safety stock

497 750 Safety stock
405 500 Safety stock
(1) 20 stock tipis,(+) Safety stock
(12) 300 Safety stock
(4) 10 Safety stock
(82) 300 Safety stock
81 90 Safety stock
(2) 5 ambil di KIM
1 5 Safety stock
424 100 Safety stock
(8) 20 Stock habis, Safety stock
(316) 1,600 Safety stock
(3) -
203 100 Safety stock
(151) 500 Safety stock
(2) 6 ambil di KIM
(470) 600 Safety stock
154 100 Safety stock
(151) 300 Safety stock
5 12 Safety stock
(70) 2 roll stock tipis,(+) Safety stock
(3) 15 Safety stock
(4) 15 Safety stock
4 15 Safety stock
- 1 roll Safety stock
48 100 Safety stock
7 10 Safety stock
(61) 900 Safety stock
2 3 Safety stock
(59) 200 Safety stock
(33) 2 kotak Safety stock
450 600 Safety stock
(109) 200 Safety stock
1 5 Safety stock
(63) 100 Safety stock
 7 5 Safety stock
(1) 5 Safety stock
(8) 15 Safety stock
(7) 10 Safety stock
(15) 210 Safety stock
231 500 ambil di KIM
4 10 Safety stock
(5) 10 Safety stock
(13) 20 stock tipis,(+) Safety stock
4 5 Safety stock
(149) 200 Safety stock
5 8 Safety stock
(2) 1 kotak
(1) 6 Safety stock
87 20 Safety stock
- 200 Stock habis, Safety stock
24 20 Safety stock
1 5 Safety stock
211 1,000 Safety stock
 PEM
OH
Item Code Item Name 11.02.202 UOM Non Racikan
3 HIS
DES'22
LABC029143 ACCU-CHEK SAFE-T-PRO UNO (39684) - PIECE -
ACYC1002 ACYCLOVIR 400 MG TAB ::: 250 TAB -
ACYC1001 ACYCLOVIR 5% 5G CRM 2 TUB 1
ALKO2001 ALKOHOL SWAB ::: 140 PIECE 24
ALLO1002 ALLOPURINOL 100 MG TAB ::: 180 TAB -
ALLO1001 ALLOPURINOL 300 MG TAB ::: 155 TAB 60
ALPA1002 ALPARA TAB ///::::: - TAB -
AMBR1002 AMBROXOL 30 MG TAB ::: 107 TAB 30
AMBR1001 AMBROXOL HCL 15 MG/5 ML, 60ML SIR 12 BT60 3
AMLO1002 AMLODIPINE BESYLATE 10 MG TAB ::: 380 TAB 30
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 420 TAB 60
AMOX1006 AMOXICILLIN 125 MG/5 ML 60ML SIR ::: 2 BT60 1
AMOX1010 amoxiCILLIN 500 MG TAB ::: 687 TAB 70
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: 7 AMP -
ANDA1006 ANDALAN PIL KB SC TAB (STRIP)///::::: 2 STRIP -
MGOH1002 ANTASIDA DOEN 60ML SIR ::: 6 BT60 1
ANTA1009 ANTASIDA DOEN TAB ::: 205 TAB 20
TRAN1022 ASAM TRANEKSAMAT 500 MG INJ ::: 2 AMP -
ATRO1003 ATROPINE SULFAT 0.25 MG/ML INJ ::: 3 AMP -
BABY1001 BABY COUGH SYRUP (BAKSOS) - BT60 -
BECO1010 BECOM C CAPL - TAB -
BENA2370 BENANG SILK 2/0 100 M (BIO SM) (ECER) - UNIT -
BENA2372 BENANG SILK 3/0 100 M (BIO SM) (ECER) - UNIT -
BETA1003 BETADINE 10% SOLUTION 30 ML - BT30 -
BETA1022 BETADINE SOLUTION 1 LITER 2 BTL -
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: 150 TAB 20
BEVA1001 BEVALEX CR 5 G 84 TUB 4
R0117011 BISTURI NO. 11 2 PIECE 1
R0117013 BISTURI NO.15 2 PIECE -
BURN1004 BURNAZIN 10% CR 35 G (G) 8 TUB -
BUSC1001 buscopan 10 MG TAB - TAB -
BUSC1002 BUSCOPAN 20 MG /ML INJ - AMP -
CAPT1002 CAPTOPRIL 12.5 MG TAB ::: - TAB -
CAPT1003 CAPTOPRIL 25 MG TAB ::: 150 TAB -
CEFA1009 CEFADROXIL MONOHYDRATE 500 MG CAP ::: 1,055 CAP 170
CEFT1002 cefTRIAXONE DISODIUM 1 G INJ ::: 12 VIAL -
XITR1001 CENDO XITROL ED 5 ML 24 BTL 1
CERV2006 CERVICAL COLLAR (HARD) M - PIECE -
CERV2001 CERVICAL COLLAR (FOAM) S 2 PIECE -
CETI1002 CETIRIZINE 5 MG/5 ML SYR 60 ML ::: - BT60 -
CETI1001 CETIRIZINE HCL 10MG TAB ::: 887 TAB 310
CHLO1007 CHLORAMPHENICOL 1% 3.5 G SALEP MATA 8 TUB -
CHLO1005 CHLORPHENIRAMINE MALEAT 4 MG TAB ::: - TAB -
CIPR1005 CIPROFLOXACIN 500 MG TAB ::: 340 TAB 50
CLIN1002 CLINDAMYCIN 300 MG CAP ::: 415 CAP 165
CLOP1001 CLOPIDOGREL 75 MG TAB ::: 10 TAB -
COMB1002 COMBANTRIN 250 MG TAB ::: 20 TAB -
COMB1003 COMBIVENT UDV NEB 2.5 ML ::: 8 NEB -
COTR1002 COTRIMOXAZOLE 240 MG/5 ML 60ML SIR ::: - BT60 -
COTR1003 COTRIMOXAZOLE 480 MG TAB ::: 355 TAB 10
COUN1001 counterpain CREAM 15 G - TUB -
R0102050 DARYANTULLE (PLESTER DENGAN ANTIBIOTIKA) ::: - PIECE -
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 152 TAB 220
DEXA1002 DEXAMETHASONE 5 MG INJ ::: 4 AMP 1
DEXT1003 DEXTRAL SYR 60 ML - BTL 8
DIAG1001 DIAGIT TAB - TAB -
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 790 TAB 130
DIPH1001 diphenhydrAMINE INJ ::: 23 AMP -
DOMP1002 DOMPERIDON 10MG TAB ::: 382 TAB 20
DOMP1004 DOMPERIDONE SYR ::: - BTL -
DULC1001 DULCOLAX 10 MG SUPP - SUPP -
DULC1002 DULCOLAX 5 MG SUPP ::: 5 SUPP -
DULC1003 DULCOLAX 5 MG TAB 20 TAB -
ECAR2001 E-CARE HANDRUB 500 ML 6 BTL -
ELKA1005 ELKANA FC TAB 560 TAB 170
EPER1002 EPERISONE 50 MG TAB ::: 730 TAB 80
EPIN1001 EPINEphrine 0.1%, 1ML INJ ::: 3 AMP -
ERLA1004 ERLAMYCETINE EYE OINT 1% 3.5 G - TUB -
FGTR1001 FG-TROCHES TAB 320 TAB 100
FORU1006 FORUMEN EAR DROPS 10 ML 3 BTL -
FURO1001 FUROSEMIDE 10 MG/ML INJ ::: - AMP -
FURO1002 FUROSEMIDE 40 MG TAB ::: - TAB -
GENT1012 GENTALEX 0.1% CR 5 G /// 10 TUB 13
GLIM1003 GLIMEPIRIDE 2 MG TAB ::: 120 TAB -
R0106012 GLOVES NON STERIL L - PIECE -
R0106011 GLOVES NON STERIL M 106 PIECE 40
R0106010 GLOVES NON STERIL S 18 PIECE -
HYDR1002 HYDROCHLOROTIAZIDE 25 MG TAB ::: - TAB -
HYDR1003 HYDROCORTISONE ACETATE 2.5% 5G CRM ::: 15 TUB 1
HYPA2003 HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) 49 UNIT -
IBUP1001 IBUPROFEN 400 MG TAB ::: 630 TAB 50
INFA1003 INFATRIM TAB ///::::: - TAB -
INFU2001 INFUSION SAFETY SET MACRO ::: 9 PIECE -
R0104050 INFUSION SAFETY SET MICRO 8 PIECE -
IODI2002 IODINE POVIDONE LAR 10% 30 ML ::: 12 BT30 -
ISOS1001 isoSORBIDE DINITRATE 5 MG TAB ::: 2 TAB -
IVCA2001 IV CATH WITH PORT 20 G ::: 17 PIECE -
IVCA2002 IV CATH WITH PORT 22 G ::: 9 PIECE -
IVCA2004 IV CATH WITH PORT 24 G ::: 9 PIECE -
JARU2065 JARUM KULIT HEACTING GT 10 9 PIECE -
JARU2066 JARUM KULIT HEACTING GT 11 24 PIECE -
JARU2077 JARUM KULIT HEACTING GT 12 24 PIECE 1
JARU2062 JARUM OTOT HEACTING GR 10 - PIECE -
JARU2063 JARUM OTOT HEACTING GR 11 18 PIECE -
JARU2064 JARUM OTOT HEACTING GR 12 16 PIECE -
KALN1005 KALNEX 500 MG TAB 100 TAB -
R0102029 KASA HIDROFIL STERIL 4X5 CM - PIECE -
KASA2035 KASA ROLL 40 Y X 80 CM NON X RAY - CM -
KERT2001 KERTAS PUYER/PERKAMEN - PIECE -
KETO1002 KETOCONAZOLE 2% 10 G CRM ::: 7 TUB 3
KETO1009 KETOCONAZOLE 200 MG TAB ::: 90 TAB 20
KETO1007 KETOPROFEN 50 MG TAB - TAB -
KETO1005 KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: - AMP -
SITE2002 LANCET (SITE) 97 PIECE 8
LANS1001 LANSOprazole 30 MG CAP ::: 410 CAP 40
R0101011 LEUKOCREPE / ELASTIS BANDAGE 4 INCH - PIECE -
R0101013 LEUKOCREPE / ELASTIS BANDAGE 6 INCH 1 PIECE -
LEXA1004 LEXACROL FORTE SUSP 100 ML ///::::: - BTL -
LEXA1021 LEXACROL - TAB -
LIDO1003 LIDOCAINE HCL 2%/2 ML INJ ::: 21 AMP 2
LODI1001 LODIA 2 MG TAB /// 150 TAB 10
LOMA2001 LOMATULLE (SOFRATULLE)/// 3 LEM -
RO115011 MASKER KERTAS KARET 114 PIECE -
R0103118 MASKER OKSIGEN DEWASA - PIECE -
MECO1004 MECOBALAMIN 500 MCG CAP - CAP -
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 10 TAB 240
MELO1003 MELOXICAM 15 MG - TAB -
MELO1002 MELOXICAM 7,5 MG TAB ::: - TAB -
METF1002 METFORMIN HCL 500 MG TAB ::: 160 TAB -
METH1012 METHYL PREDNISOLON 4 MG ::: 1,115 TAB 140
METR1012 METRONIDAZOLE 500 MG TAB ::: 160 TAB 10
R0103121 MICROMIST DEWASA SET INHALASI (1172) 1 PIECE -
R0103120 MICROMIST ANAK SET INHALASI (1173) - PIECE -
MOLA1004 MOLACORT 0.5 MG TAB ///::::: - TAB -
MOLA1010 MOLAKRIM CREAM 30 GR 1 TUB 2
MUCO1011 MUCOHEXIN 8 MG TAB/// - TAB -
MUCO1013 MUCOHEXIN 4 MG/5 ML ELIXIR 120 ML (PKU) - BT60 7
MYGE2002 MY JELLY 80 G ::: - TUB -
NACL1006 NACL 0.9% 500 ML (RUBBER) ::: 4 BTL -
R0103090 NASAL CANULE ANAK 3 PIECE -
R0103091 NASAL CANULE DEWASA 7 PIECE 1
R0109023 NEEDLE NO. 23 6 PIECE 1
R0109027 NEEDLE NO. 27 7 PIECE -
NEUR1012 NEURObion 5000 INJ 3 ML 11 AMP 4
NEWD1001 NEW DIATAB TAB ::: - TAB -
OMEP1001 OMEprazol 20 MG CAP ::: 195 CAP 30
ONDA1004 ONDANSETRON HCL 4 MG/2 ML INJ ::: 6 AMP -
OPTI2020 OPTIUM NEO H STRIP - TES -
ORAL1001 ORALIT SACH ::: 77 SACH 5
OTOP1001 OTOPAIN EAR DROPS 8 ML 12 BTL -
PAMO1001 PAMOL 125 MG SUPP 14 SUPP -
PANT1006 PANTOPRAZOL 40 MG INJ - VIAL -
PARA1017 PARACETAMOL 10 MG/1 ML INF 100 ML ::: - BTL -
PARA1004 PARACETAMOL 120 MG/5 ML 60ML SIR ::: 2 BT60 2
PARA1003 PARACETAMOL 500 MG TAB ::: 480 TAB 300
PIRO1002 PIROXICAM 20 MG TAB - TAB -
POTP1007 POT PLASTIK 10 CC - PIECE -
RANI1002 RANITIDINE HCL 150 MG TAB ::: - TAB -
RANI1001 RANITIDINE HCL 50MG/2 ML INJ ::: 6 AMP -
RECO1008 RECO ED 10 ML ///::::: 27 BTL -
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 8 BTL -
SAFE2005 SAFETY BOX 12.5 LITER - PIECE -
SAFE2004 SAFETY BOX 5 LITER 4 PIECE -
SALB1001 SALBUTAMOL SULFATE 2 MG TAB ::: - TAB -
SALB1002 SALBUTAMOL SULFATE 4 MG TAB ::: 190 TAB -
SALI2001 SALICYL POWDER 80 G 9 PIECE 2
SCAB1001 scabiMITE CR 10 G ::: 4 TUB -
SCOP1004 SCOPAMIN 10 MG TAB ///::: 90 TAB -
SCOP1005 SCOPAMIN 20 MG/ML INJ 1 ML ///::: - AMP -
SENS1001 SENSI WASH 250 ML - BTL -
SERU1003 SERUM ANTI BISA ULAR ::: 1 VIAL -
SIMV1003 SIMVASTATIN 10 MG TAB ::: 90 TAB 60
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 8 TUB 1
R0111263 SPALK KAKI BIASA SEI -IGD - SET -
R0111261 SPALK TANGAN SET - IGD 2 SET -
SPAS1006 SPASMOLIT 10 MG TAB/// - TAB -
SITE2006 STRIP ASAM URAT EASY TOUCH (SITE) 58 PIECE 2
SITE2003 STRIP GLUKOSA ONCALL PLUS (SITE) 69 PIECE 4
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) 13 PIECE 3
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 8 BTL 2
R0109045 SYRINGE 10 ML TERUMO 8 PIECE -
R0109058 SYRINGE 3 ML 32 PIECE 7
R0109044 SYRINGE 5 ML 21 PIECE 1
SYRI2003 SYRINGE TUBERKULIN 1 ML ::: - PIECE -
TEST2001 TEST SENSITIF STRIP 2 PIECE -
TETA1001 TETAGAM P 250 IU INJ 1 ML ::: 2 syringe 1
THRO1001 THROMBO ASPILET 80 MG EC TAB - TAB -
THRO1002 THROMBOPHOB GEL 20 G - TUB -
R0111270 TONGUE SPATEL - PIECE -
TREM1001 TREMENZA TAB ///::::: 2 TAB -
ULTR30003 ULTRAFIX 10X5 CM ECER 10 CM 74 UNIT 2
VENO1004 VENOSMIL 200 MG CAP 50 TAB -
VENT1002 VENTOLIN 2.5 MG NEBULES ::: 3 NEB -
VELU1001 VELUTINE 2.5 MG NEBULES 4 ML - NEB -
VITA1004 VITAMIN B COMPLEX TAB ::: 410 TAB 110
VITA1007 VITAMIN C 50 MG TAB ::: 597 TAB 10
WATE1005 WATER FOR INJEKSI 25 ML ::: 4 AMP -
ZINC1004 ZINC 20 MG TAB ::: 20 TAB -
 Draft Pemesanan Obat dan Alkes DBT - (Maret - MEI 2023)
PEMAKAIAN
Total MAX Permintaan
Non Racikan ISSUE MIN (90
pemakaian (120 hari) (OH-
hari)
(86 hari) Pemakaian
JAN'23 FEB'23 DES'22 JAN'23 FEB'23 90hari)
- - - - - - - - -
- 50 - - - 50 52 70 198
- 2 - - - 3 3 4 (1)
7 8 - - - 39 41 54 99
30 - - - - 30 31 42 149
10 - - - - 70 73 98 82
- - - - - - - - -
113 80 - - - 223 233 311 (126)
2 - - - - 5 5 7 7
- 60 - - - 90 94 126 286
30 - - - - 90 94 126 326
1 - - - - 2 2 3 (0)
73 60 - - - 203 212 283 475
- - - - - - - - 7
- - - - - - - - 2
- - - - - 1 1 1 5
10 30 - - - 60 63 84 142
- - - - - - - - 2
- - - - - - - - 3
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 2
60 10 - - - 90 94 126 56
5 2 - - - 11 12 15 72
1 - - - - 2 2 3 (0)
- - - - - - - - 2
2 - - - - 2 2 3 6
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 150
140 80 - - - 390 408 544 647
- - - - - - - - 12
2 1 - - - 4 4 6 20
- - - - - - - - -
 - - - - - - - - 2
- - - - - - - - -
283 150 - - - 743 778 1,037 109
3 - - - - 3 3 4 5
- - - - - - - - -
60 40 - - - 150 157 209 183
120 20 - - - 305 319 426 96
- - - - - - - - 10
- - - - - - - - 20
- - - - - - - - 8
- - - - - - - - -
- - - - - 10 10 14 345
- - - - - - - - -
- - - - - - - - -
277 60 - - - 557 583 777 (431)
- 1 - - - 2 2 3 2
- - - - - 8 8 11 (8)
- - - - - - - - -
20 50 - - - 200 209 279 581
- - - - - - - - 23
20 10 - - - 50 52 70 330
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 5
- - - - - - - - 20
- - - - - - - - 6
280 40 - - - 490 513 684 47
20 20 - - - 120 126 167 604
- - - - - - - - 3
- - - - - - - - -
40 10 - - - 150 157 209 163
1 - - - - 1 1 1 2
- - - - - - - - -
- - - - - - - - -
5 1 - - - 19 20 27 (10)
- 30 - - - 30 31 42 89
- - - - - - - - -
48 34 - - - 122 128 170 (22)
- - - - - - - - 18
- - - - - - - - -
7 - - - - 8 8 11 7
1 - - - - 1 1 1 48
80 - - - - 130 136 181 494
 - - - - - - - - -
- - - - - - - - 9
- - - - - - - - 8
- 1 - - - 1 1 1 11
- 3 - - - 3 3 4 (1)
- - - - - - - - 17
- - - - - - - - 9
- - - - - - - - 9
- - - - - - - - 9
- - - - - - - - 24
1 - - - - 2 2 3 22
- - - - - - - - -
- - - - - - - - 18
- - - - - - - - 16
- - - - - - - - 100
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
1 3 - - - 7 7 10 (0)
- 20 - - - 40 42 56 48
- - - - - - - - -
- - - - - - - - -
3 4 - - - 15 16 21 81
60 10 - - - 110 115 153 295
- - - - - - - - -
1 - - - - 1 1 1 (0)
- - - - - - - - -
- - - - - - - - -
3 5 - - - 10 10 14 11
- - - - - 10 10 14 140
- 1 - - - 1 1 1 2
21 34 - - - 55 58 77 56
- - - - - - - - -
- - - - - - - - -
350 90 - - - 680 712 949 (702)
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 160
50 170 - - - 360 377 502 738
80 40 - - - 130 136 181 24
- - - - - - - - 1
- - - - - - - - -
- - - - - - - - -
 6 - - - - 8 8 11 (7)
- - - - - - - - -
10 3 - - - 20 21 28 (21)
- - - - - - - - -
- 1 - - - 1 1 1 3
- - - - - - - - 3
- 1 - - - 2 2 3 5
- - - - - 1 1 1 5
- - - - - - - - 7
4 1 - - - 9 9 13 2
- - - - - - - - -
50 50 - - - 130 136 181 59
1 - - - - 1 1 1 5
- - - - - - - - -
3 - - - - 8 8 11 69
1 - - - - 1 1 1 11
- - - - - - - - 14
- - - - - - - - -
- - - - - - - - -
1 - - - - 3 3 4 (1)
420 140 - - - 860 900 1,200 (420)
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
1 - - - - 1 1 1 5
- - - - - - - - 27
- - - - - - - - 8
- - - - - - - - -
- - - - - - - - 4
- - - - - - - - -
20 - - - - 20 21 28 169
1 - - - - 3 3 4 6
- - - - - - - - 4
10 - - - - 10 10 14 80
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 1
10 20 - - - 90 94 126 (4)
- - - - - 1 1 1 7
- - - - - - - - -
- - - - - - - - 2
- - - - - - - - -
3 2 - - - 7 7 10 51
 1 2 - - - 7 7 10 62
2 1 - - - 6 6 8 7
10 5 - - - 17 18 24 (10)
- 2 - - - 2 2 3 6
7 5 - - - 19 20 27 12
- - - - - 1 1 1 20
- - - - - - - - -
- - - - - - - - 2
- 1 - - - 2 2 3 (0)
- 3 - - - 3 3 4 (3)
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 2
2 2 - - - 6 6 8 68
- - - - - - - - 50
- - - - - - - - 3
- - - - - - - - -
110 100 - - - 320 335 447 75
10 - - - - 20 21 28 576
- - - - - - - - 4
- 10 - - - 10 10 14 10
ret - MEI 2023)
STOCK
Permintaa
OBAT
n (OH- PO
MENIPIS/
Pemakaian
CITO
120 hari)
- -
180 -
(2) 5
86 -
138 -
57 100
- -
(204) 400
5 20
254 -
294 100
(1) 5
404 -
7 -
2 -
5 -
121 100
2 -
3 -
- -
- -
- -
- -
- -
2 -
24 90
69 -
(1) 5
2 -
5 -
- -
- -
- -
150 -
511 -
12 -
18 -
- -
 2 -
- -
(150) 800
4 -
- -
131 -
(11) 200
10 -
20 -
8 -
- -
341 -
- -
- -
(625) 1,000
1 5
(11) -
- -
511 -
23 -
312 -
- -
- -
5 -
20 -
6 -
(124) 1,000
563 -
3 -
- -
111 300
2 5
- -
- -
(17) 24
78 -
- -
(64) 1 kotak
18 -
- -
4 10
48 -
449 -
 - -
9 -
8 -
11 -
(2) -
17 -
9 -
9 -
9 -
24 -
21 -
- -
18 -
16 -
100 -
- -
- 1 roll
- -
(3) 10
34 100
- -
- -
76 -
257 100
- -
(0) -
- -
- -
7 10
136 -
2 -
37 1 kotak
- -
- -
(939) 1,500
- -
- -
160 -
613 -
(21) 100
1 1
- -
- -
 (10) 20
- -
(28) 40
- -
3 3
3 -
4 -
5 -
7 -
(2) 10
- -
14 90
5 5
- -
66 -
11 -
14 -
- -
- -
(2) 20
(720) 1,500
- -
- -
- -
5 5
27 -
8 -
- -
4 -
- -
162 -
5 -
4 -
76 -
- -
- -
1 -
(36) 100
7 -
- -
2 -
- -
48 -
59 -
5 -
(16) -
5 -
5 10
20 -
- -
2 -
(1)
(4) 5
- -
- -
2 300
66 -
50 -
3 -
- -
(37) 200
569 -
4 -
6 100
 KETERANGAN

safety stock

safety stock

safety stock
safety stock

safety stock
stock tipis, safety stock

safety stock

safety stock

ambil di KIM
safety stock

safety stock

safety stock
safety stock

safety stock

safety stock
safety stock

stock tipis, safety stock

safety stock

safety stock
safety stock

stock tipis, safety stock

safety stock

safety stock

safety stock

safety stock

stock tipis, safety stock

safety stock
safety stock
stock tipis, safety stock

stock habis, safety stock

safety stock

safety stock

safety stock
safety stock

safety stock
ambil di KIM

safety stock

safety stock
safety stock

ambil kim

stock tipis, safety stock

safety stock

stock tipis, safety stock

Item Code Item Name OH 7.02.2023 HIS UOM

ALKO2001 ALKOHOL SWAB ::: 186 PIECE

ALLO1001 ALLOPURINOL 300 MG TAB ::: 240 TAB
AMBR1002 AMBROXOL 30 MG TAB ::: 610 TAB
AMBR1001 AMBROXOL HCL 15 MG/5 ML, 60ML SIR BT60
-
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 80 TAB
AMOX1006 AMOXICILLIN 125 MG/5 ML 60ML SIR ::: - BT60
AMOX1010 amoxiCILLIN 500 MG TAB ::: 780 TAB
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: 1 AMP
ANDA1006 ANDALAN PIL KB SC TAB (STRIP)///::::: 2 STRIP
MGOH1002 ANTASIDA DOEN 60ML SIR ::: - BT60
ANTA1009 ANTASIDA DOEN TAB ::: 160 TAB
TRAN1022 ASAM TRANEKSAMAT 500 MG INJ ::: - AMP
BENA2276 BENANG CHROMIC 2/0 CUTGUT + JARUM GEA 10 PIECE
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: - TAB
BEVA1001 BEVALEX CR 5 G 25 TUB
CEFA1009 CEFADROXIL MONOHYDRATE 500 MG CAP ::: 500 CAP
XITR1001 CENDO XITROL ED 5 ML 37 BTL
CETI1002 CETIRIZINE 5 MG/5 ML SYR 60 ML ::: 1 BT60
CETI1001 CETIRIZINE HCL 10MG TAB ::: 520 TAB
CIPR1005 CIPROFLOXACIN 500 MG TAB ::: 110 TAB
COMB1002 COMBANTRIN 250 MG TAB ::: 6 TAB
COMB1003 COMBIVENT UDV NEB 2.5 ML ::: 3 NEB
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 480 TAB
DEXA1002 DEXAMETHASONE 5 MG INJ ::: 8 AMP
DIAG1001 DIAGIT TAB 40 TAB
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 780 TAB
DOMP1002 DOMPERIDON 10MG TAB ::: 250 TAB
DULC1002 DULCOLAX 5 MG SUPP ::: 1 SUPP
DULC1003 DULCOLAX 5 MG TAB 50 TAB
ELKA1005 ELKANA FC TAB 20 TAB
EPER1002 EPERISONE 50 MG TAB ::: 200 TAB
FGTR1001 FG-TROCHES TAB 190 TAB
FORU1006 FORUMEN EAR DROPS 10 ML 4 BTL
R0106011 GLOVES NON STERIL M 412 PIECE
IBUP1001 IBUPROFEN 400 MG TAB ::: 210 TAB
INFU2001 INFUSION SAFETY SET MACRO ::: 12 PIECE
IODI2002 IODINE POVIDONE LAR 10% 30 ML ::: 4 BT30
IVCA2004 IV CATH WITH PORT 24 G ::: 6 PIECE
KETO1002 KETOCONAZOLE 2% 10 G CRM ::: 29 TUB
KETO1009 KETOCONAZOLE 200 MG TAB ::: 10 TAB
LANS1001 LANSOprazole 30 MG CAP ::: 240 CAP
LIDO1003 LIDOCAINE HCL 2%/2 ML INJ ::: 31 AMP
LOMA2001 LOMATULLE (SOFRATULLE)/// 3 LEM
MECO1004 MECOBALAMIN 500 MCG CAP 140 CAP
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 150 TAB
METH1012 METHYL PREDNISOLON 4 MG ::: 30 TAB
MOLA1010 MOLAKRIM CREAM 30 GR 1 TUB
MUCO1011 MUCOHEXIN 8 MG TAB/// 8 TAB
NACL1006 NACL 0.9% 500 ML (RUBBER) ::: 14 BTL
NEUR1012 NEURObion 5000 INJ 3 ML 8 AMP
OMEP1001 OMEprazol 20 MG CAP ::: 40 CAP
ONDA1004 ONDANSETRON HCL 4 MG/2 ML INJ ::: 9 AMP
OTOP1001 OTOPAIN EAR DROPS 8 ML 5 BTL
PARA1017 PARACETAMOL 10 MG/1 ML INF 100 ML ::: 5 BTL
PARA1004 PARACETAMOL 120 MG/5 ML 60ML SIR ::: - BT60
PARA1003 PARACETAMOL 500 MG TAB ::: 404 TAB
PIRO1002 PIROXICAM 20 MG TAB 340 TAB
RECO1008 RECO ED 10 ML ///::::: 9 BTL
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 5 BTL
SALB1002 SALBUTAMOL SULFATE 4 MG TAB ::: 70 TAB
SCOP1004 SCOPAMIN 10 MG TAB ///::: - TAB
SIMV1003 SIMVASTATIN 10 MG TAB ::: 70 TAB
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 5 TUB
SITE2006 STRIP ASAM URAT EASY TOUCH (SITE) 16 PIECE
SITE2003 STRIP GLUKOSA ONCALL PLUS (SITE) 12 PIECE
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) 6 PIECE
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 7 BTL
TEST2001 TEST SENSITIF STRIP 1 PIECE
ULTR30003 ULTRAFIX 10 CM X 5 M ECER-10 CM (pku) 17 UNIT
VENO1004 VENOSMIL 200 MG CAP 50 TAB
VELU1001 VELUTINE 2.5 MG NEBULES 4 ML - NEB
VITA1004 VITAMIN B COMPLEX TAB ::: 880 TAB
VITA1007 VITAMIN C 50 MG TAB ::: 1,430 TAB
ZINC1004 ZINC 20 MG TAB ::: - TAB
 Draft Pemesanan Obat dan Alkes BEYUKU - (Maret-MEI 2023
PEMAKAIAN
Total
Non Racikan ISSUE MIN (90
pemakaian
hari)
(86 hari)
DES'22 JAN'23 FEB'23 DES'22 JAN'23 FEB'23
32 59 8 - - - 99 104
20 40 - - - -
440 650 - - - - 1,090 1,141
- - - - - - - -
150 190 10 - - - 350 366
1 2 - - - - 3 3
610 730 200 - - - 1,540 1,612
- 2 - - - - 2 2
3 1 2 - - - 6 6
4 - - - - - 4 4
40 30 - - - - 70 73
1 3 - - - - 4 4
- - - - - - - -
160 260 10 - - - 430 450
35 70 17 - - - 122 128
300 580 40 - - - 920 963
6 21 1 - - - 28 29
2 2 - - - - 4 4
800 1,250 250 - - - 2,300 2,407
40 220 10 - - - 270 283
- 2 - - - - 2 2
- 3 - - - - 3 3
500 610 130 - - - 1,240 1,298
5 5 1 - - - 11 12
40 30 - - - - 70 73
90 270 - - - - 360 377
160 180 70 - - - 410 429
- - - - - - - -
5 20 - - - - 25 26
550 740 - - - - 1,290 1,350
30 100 70 - - - 200 209
240 270 50 - - - 560 586
4 7 - - - - 11 12
110 126 40 - - - 276 289
190 40 30 - - - 260 272
2 5 1 - - - 8 8
5 3 - - - - 8 8
 1 2 1 - - - 4 4
4 4 - - - - 8 8
30 - - - - - 30 31
80 200 30 - - - 310 324
4 6 4 - - - 14 15
1 1 1 - - - 3 3
40 130 10 - - - 180 188
630 570 40 - - - 1,240 1,298
280 270 80 - - - 630 659
38 80 2 - - - 120 126
24 56 12 - - - 92 96
1 5 - - - - 6 6
3 13 2 - - - 18 19
180 60 - - - - 240 251
- 3 1 - - - 4 4
1 - 1 - - - 2 2
1 4 - - - - 5 5
- - - - - - - -
700 970 120 - - - 1,790 1,873
210 220 100 - - - 530 555
3 2 1 - - - 6 6
2 5 1 - - - 8 8
40 40 - - - - 80 84
50 70 - - - - 120 126
10 90 - - - - 100 105
1 4 - - - - 5 5
11 13 2 - - - 26 27
12 8 2 - - - 22 23
11 15 3 - - - 29 30
5 3 - - - - 8 8
7 4 - - - - 11 12
26 32 12 - - - 70 73
10 30 - - - - 40 42
1 - - - - - 1 1
360 840 260 - - - 1,460 1,528
150 300 40 - - - 490 513
- 6 - - - - 6 6
UKU - (Maret-MEI 2023)

STOCK
Permintaan (OH- Permintaan
MAX OBAT
Pemakaian 90hari) (OH-Pemakaian PO
(120 hari) MENIPIS
120 hari)
/CITO

138 82 48 1 kotak
100
1,521 (531) (911) 2,400
- - - 20
488 (286) (408) 1,200
4 (3) (4) 20
2,149 (832) (1,369) 2,800
3 (1) (2) 8
8 (4) (6) 6
6 (4) (6) 30
98 87 62 100
6 (4) (6) 6
- 10 10
600 (450) (600) 1,500
170 (103) (145) 300
1,284 (463) (784) 2,500
39 8 (2) 60
6 (3) (5) 20
3,209 (1,887) (2,689) 4,500
377 (173) (267) 900
3 4 3 10
4 (0) (1) 5
1,730 (818) (1,250) 2,500
15 (4) (7) 20
98 (33) (58) 100
502 403 278 500
572 (179) (322) 800
- 1 1 6
35 24 15 30
1,800 (1,330) (1,780) 3,000
279 (9) (79) 300
781 (396) (591) 1,200
15 (8) (11) 20
385 123 27 1 kotak
363 (62) (153) 800
11 4 1 8
11 (4) (7) 20
 6 2 0 10
11 21 18 10
42 (21) (32) 100
433 (84) (193) 900
20 16 11 10
4 (0) (1) 10
251 (48) (111) 400
1,730 (1,148) (1,580) 3,000
879 (629) (849) 1,500
167 (125) (166) 180
128 (88) (120) 200
8 8 6 5
25 (11) (17) 20
335 (211) (295) 700
6 5 3 10
3 3 2 3
7 (0) (2) 10
- - - 20
2,498 (1,469) (2,094) 3,500
740 (215) (400) 700
8 3 1 10
11 (3) (6) 10
112 (14) (42) 100
167 (126) (167) 300
140 (35) (70) 200
7 (0) (2) 10
36 (11) (20) 1 kotak
31 (11) (19) 2 kotak
40 (24) (34) 4 kotak
11 (1) (4) 10
15 (11) (14) 20
98 (56) (81) 2 roll
56 8 (6) 100
1 (1) (1) 5
2,037 (648) (1,157) 3,000
684 917 746 200
8 (6) (8) 100
 KETERANGAN

safety stock
safety stock
safety stock
stock habis, safety stock
safety stock
stock habis, safety stock
safety stock
stock tipis, safety stock
safety stock
stock habis, safety stock
safety stock
stock habis, safety stock

stock habis, safety stock

stock tipis, safety stock
stock tipis, safety stock
safety stock
stock tipis, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
ambil di KIM
safety stock
stock tipis, safety stock
safety stock
safety stock
stock tipis, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock tipis, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock habis, safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
safety stock
stock tipis, safety stock
safety stock
safety stock
stock habis, safety stock
safety stock
safety stock
stock habis, safety stock
Item Code Item Name KIM LEBONG

ACYC1001 ACYCLOVIR 5% 5G CRM 20 -

ACYC1002 ACYCLOVIR 400 MG TAB ::: 500 -
ALKO2001 ALKOHOL SWAB ::: 1,200 -
ALLO1002 ALLOPURINOL 100 MG TAB ::: 400 -
ALLO1001 ALLOPURINOL 300 MG TAB ::: - 100
ALPA1002 ALPARA TAB ///::::: 1,500 750
AMBR1002 AMBROXOL 30 MG TAB ::: 300 500
AMLO1002 AMLODIPINE BESYLATE 10 MG TAB ::: 700 -
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 3,200 300
AMOX1006 AMOXICILLIN 125 MG/5 ML 60ML SIR ::: 50 -
AMOX1010 amoxiCILLIN 500 MG TAB ::: 1,800 -
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: 15 10
ANDA1006 ANDALAN PIL KB SC TAB (STRIP)///::::: - -
MGOH1002 ANTASIDA DOEN 60ML SIR ::: 70 -
ANTA1009 ANTASIDA DOEN TAB ::: - 300
TRAN1022 ASAM TRANEKSAMAT 500 MG INJ ::: - -
ASEP1001 ASEPTAN LIQUID 500 ML 20 -
BETA1022 BETADINE SOLUTION 1 LITER 1 -
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: 200 90
BEVA1001 BEVALEX CR 5 G 120 -
BURN1004 BURNAZIN 10% CR 35 G (G) 5 5
CAPT1002 CAPTOPRIL 12.5 MG TAB ::: 600 -
CAPT1003 CAPTOPRIL 25 MG TAB ::: 1,000 -
CEFA1009 CEFADROXIL MONOHYDRATE 500 MG CAP ::: 500 -
CEFT1002 cefTRIAXONE DISODIUM 1 G INJ ::: 10 -
XITR1001 CENDO XITROL ED 5 ML 50 -
CERV2003 CERVICAL COLLAR (FOAM) L 1 -
CERV2001 CERVICAL COLLAR (FOAM) S 1 -
CETI1001 CETIRIZINE HCL 10MG TAB ::: 3,000 100
CETI1002 CETIRIZINE 5 MG/5 ML SYR 60 ML ::: 100 -
CHLO1007 CHLORAMPHENICOL 1% 3.5 G SALEP MATA 20 -
CHLO1005 CHLORPHENIRAMINE MALEAT 4 MG TAB ::: 100 -
CIPR1005 CIPROFLOXACIN 500 MG TAB ::: 1,000 -
CLIN1002 CLINDAMYCIN 300 MG CAP ::: 600 -
CLOP1001 CLOPIDOGREL 75 MG TAB ::: 20 -
COMB1002 COMBANTRIN 250 MG TAB ::: - -
COMB1003 COMBIVENT UDV NEB 2.5 ML ::: 15 -
COUN1001 counterpain CREAM 15 G - 20
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 8,000 1,600
DEXA1002 DEXAMETHASONE 5 MG INJ ::: 75 -
DEXT1006 Dextrose 5% INF 500 ML 1 -
DIAG1001 DIAGIT TAB - -
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 300 100
DIPH1001 diphenhydrAMINE INJ ::: 20 -
DOMP1002 DOMPERIDON 10MG TAB ::: 700 500
DOMP1004 DOMPERIDONE SYR ::: 50 -
DULC1002 DULCOLAX 5 MG SUPP ::: 60 -
DULC1003 DULCOLAX 5 MG TAB 160 -
ELKA1005 ELKANA FC TAB - 600
EPER1002 EPERISONE 50 MG TAB ::: 1,800 100
FGTR1001 FG-TROCHES TAB 900 300
FORU1006 FORUMEN EAR DROPS 10 ML 50 -
GENT1012 GENTALEX 0.1% CR 5 G /// 60 12
GLIM1003 GLIMEPIRIDE 2 MG TAB ::: 1,600 -
R0106011 GLOVES NON STERIL M 28 -
HYDR1003 HYDROCORTISONE ACETATE 2.5% 5G CRM ::: 60 -
HYPA2003 HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) 10 2
INFU2001 INFUSION SAFETY SET MACRO ::: 77 15
IODI2002 IODINE POVIDONE LAR 10% 30 ML ::: 20 -
ISOS1001 isoSORBIDE DINITRATE 5 MG TAB ::: 20 -
IBUP1001 IBUPROFEN 400 MG TAB ::: 3,000 -
IVCA2002 IV CATH WITH PORT 22 G ::: 35 15
IVCA2004 IV CATH WITH PORT 24 G ::: 75 15
KALN1005 KALNEX 500 MG TAB 300 -
KASA2035 KASA ROLL 40 Y X 80 CM NON X RAY 5 1
KETO1009 KETOCONAZOLE 200 MG TAB ::: 400 -
KETO1007 KETOPROFEN 50 MG TAB 100 100
KETO1002 KETOCONAZOLE 2% 10 G CRM ::: 72 -
KETO1005 KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: 50 10
LEXA1004 LEXACROL FORTE SUSP 100 ML ///::::: - 3
LANS1001 LANSOprazole 30 MG CAP ::: 2,000 900
LIDO1003 LIDOCAINE HCL 2%/2 ML INJ ::: 80 -
LODI1001 LODIA 2 MG TAB /// 500 200
LOMA2001 LOMATULLE (SOFRATULLE)/// 60 -
RO115011 MASKER KERTAS KARET 37 2
R0103118 MASKER OKSIGEN DEWASA 5 -
MECO1004 MECOBALAMIN 500 MCG CAP 1,000 -
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 3,000 600
MELO1003 MELOXICAM 15 MG 200 -
MELO1002 MELOXICAM 7,5 MG TAB ::: 2,000 -
METF1002 METFORMIN HCL 500 MG TAB ::: 3,200 -
METH1012 METHYL PREDNISOLON 4 MG ::: - -
METR1012 METRONIDAZOLE 500 MG TAB ::: - 200
R0103121 MICROMIST DEWASA SET INHALASI (1172) 20 5
R0103120 MICROMIST ANAK SET INHALASI (1173) 20 -
MOLA1010 MOLAKRIM CREAM 30 GR - -
MUCO1011 MUCOHEXIN 8 MG TAB/// 400 100
MUCO1013 MUCOHEXIN 4 MG/5 ML ELIXIR 120 ML (PKU) - -
MYGE2002 MY JELLY 80 G ::: 1 -
R0103091 NASAL CANULE DEWASA 15 5
R0109023 NEEDLE NO. 23 1 -
R0109027 NEEDLE NO. 27 1 -
NEUR1012 NEURObion 5000 INJ 3 ML 20 10
ONDA1004 ONDANSETRON HCL 4 MG/2 ML INJ ::: 40 -
OMEP1001 OMEprazol 20 MG CAP ::: 900 210
OTOP1001 OTOPAIN EAR DROPS 8 ML 30 -
PAMO1001 PAMOL 125 MG SUPP 60 -
PANT1006 PANTOPRAZOL 40 MG INJ 10 -
PARA1017 PARACETAMOL 10 MG/1 ML INF 100 ML ::: - -
PARA1004 PARACETAMOL 120 MG/5 ML 60ML SIR ::: 100 10
PIRO1002 PIROXICAM 20 MG TAB - -
RANI1002 RANITIDINE HCL 150 MG TAB ::: 2,000 -
RANI1001 RANITIDINE HCL 50MG/2 ML INJ ::: 80 10
RECO1008 RECO ED 10 ML ///::::: 80 10
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 80 20
SALB1001 SALBUTAMOL SULFATE 2 MG TAB ::: 200 -
SALB1002 SALBUTAMOL SULFATE 4 MG TAB ::: 400 -
SALI2001 SALICYL POWDER 80 G 48 5
SCAB1001 scabiMITE CR 10 G ::: 10 -
SCOP1004 SCOPAMIN 10 MG TAB ///::: 800 200
BURN1005 SILVER SULFADIAZIN 10% CR 500 GR 1 -
SIMV1003 SIMVASTATIN 10 MG TAB ::: 1,000 -
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 16 8
SENS1001 SENSI WASH 250 ML 25 -
SITE2006 STRIP ASAM URAT EASY TOUCH (SITE) 2 -
SITE2003 STRIP GLUKOSA ONCALL PLUS (SITE) 2 -
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) - 1
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 10 10
R0109045 SYRINGE 10 ML 1 -
R0109058 SYRINGE 3 ML - -
TEST2001 TEST SENSITIF STRIP - -
TETA1001 TETAGAM P 250 IU INJ 1 ML 25 -
TREM1001 TREMENZA TAB ///::::: 3,500 200
THRO1002 THROMBOPHOB GEL 20 G 20 -
ULTR30003 ULTRAFIX 10X5 CM ECER 10 CM - -
VENO1004 VENOSMIL 200 MG CAP 380 20
VENT1002 VENTOLIN 2.5 MG NEBULES ::: 10 -
VELU1001 VELUTINE 2.5 MG NEBULES 4 ML - 5
VITA1004 VITAMIN B COMPLEX TAB ::: 3,000 -
VITA1007 VITAMIN C 50 MG TAB ::: 1,000 1,000
WATE1005 WATER FOR INJEKSI 25 ML ::: 12 -
ZINC1004 ZINC 20 MG TAB ::: 700 -
BEYUKU DBT TOTAL

- 5 25
- - 500
1 - 1,201 ISI 100 PIECE
- - 400
100 100 300
- - 2,250
2,400 400 3,600
- - 700
1,200 100 4,800
20 5 75
2,800 - 4,600
8 - 33
6 - 6
30 - 100
100 100 500
6 - 6
- - 20
- - 1
1,500 90 1,880
300 - 420
- - 10
- - 600
- - 1,000
2,500 - 3,000
- - 10
60 - 110
- - 1
- - 1
4,500 800 8,400
20 - 120
- - 20
- - 100
900 - 1,900
- 200 800
- - 20
10 - 10
5 - 20
- - 20
2,500 1,000 13,100
20 5 100
- - 1
100 - 100
500 - 900
- - 20
800 - 2,000
- - 50
- - 60
30 - 190
3,000 1,000 4,600
300 - 2,200
1,200 300 2,700
20 5 75
- 24 96
- - 1,600
1 1 30 ISI 100 PIECES
- 10 70
- - 12 ROLL
8 - 100 ISI 50 PIECE
20 - 40
- - 20
800 - 3,800
- - 50 ISI 50 PIECE
10 - 100 ISI 50 PIECE
- - 300
- 1 7 ROLL
100 100 600
- - 200
10 10 92
- - 60
- - 3
900 100 3,900
10 10 100
- - 700
10 - 70
- 1 40 ISI 50 PIECE
- - 5
400 - 1,400
3,000 1,500 8,100
- - 200
- - 2,000
- - 3,200
1,500 - 1,500
- 100 300
- 1 26
- - 20
180 20 200
200 - 700
- 40 40
- - 1
- - 20
- - 1
- - 1 ISI 100 PIECES
20 10 60
- 5 45
720 90 1,920
3 - 33
- - 60
- - 10
10 - 10
20 20 150
700 - 700
- - 2,000
- 10 100
10 - 100
10 10 120
- - 200
100 - 500
- - 53
- - 10
300 - 1,300
- - 1
200 100 1,300
10 - 34
- - 25
1 - 3 ISI 25 PIECES
2 - 4 ISI 25 PIECES
4 - 5 ISI 10 PIECES
10 - 30
- - 1 ISI 100 PIECES
- - 3 ISI 100 PIECES
20 - 20
- - 25
- 300 4,000
- - 20
 2 - 2 ROLL
100 - 500
- - 10
5 - 10
3,000 200 6,200
200 - 2,200
- - 12
100 100 900
 APT
Item Code Item Name APT OGAN KETERANGA
GANDA
N
LABC029143 ACCU-CHEK SAFE-T-PRO UNO (39684) - 210000
ACYC1002 ACYCLOVIR 400 MG TAB ::: 735 740
ACYC1001 ACYCLOVIR 5% 5G CRM 4,500 4500
ALKO2001 ALKOHOL SWAB ::: 25,000 box/100 pcs 18000
ALLO1002 ALLOPURINOL 100 MG TAB ::: 200 198
ALLO1001 ALLOPURINOL 300 MG TAB ::: 500 504
ALPA1002 ALPARA TAB ///::::: 900 758
AMBR1002 AMBROXOL 30 MG TAB ::: 150 145
AMBR1001 AMBROXOL HCL 15 MG/5 ML, 60ML SIR 7,000 6300
AMLO1002 AMLODIPINE BESYLATE 10 MG TAB ::: 700 280
AMLO1001 AMLODIPINE BESYLATE 5 MG TAB ::: 400 180
AMOX1006 AMOXICILLIN 125 MG/5 ML 60ML SIR ::: 5,000 5500
AMOX1010 amoxiCILLIN 500 MG TAB ::: 550 450
ANDA1002 ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: - 7500
ANDA1006 ANDALAN PIL KB SC TAB (STRIP)///::::: 16,000 15500
MGOH1002 ANTASIDA DOEN 60ML SIR ::: 4,500 4600
ANTA1009 ANTASIDA DOEN TAB ::: 150 144
ARMS2002 ARMSLING M 32,000 27500
TRAN1022 ASAM TRANEKSAMAT 500 MG INJ ::: 6,500 6000
ASEP1001 ASEPTAN LIQUID 500 ML 40,000 39000
ATRO1003 ATROPINE SULFAT 0.25 MG/ML INJ ::: 4,200 5900
BECO1010 becom C CAPL 1,900 2090
BENA2045 BENANG SILK 2/0 100 M (BIO SM) - -
BENA2003 BENANG SILK 3/0 100 M (BIO SM) - -
BETA1003 BETADINE 10% SOLUTION 30 ML 25,000 24500
BETA1022 BETADINE SOLUTION 1 LITER 215,000 84000
BETA1007 BETAHISTINE MESYLATE 6 MG TAB ::: 1,000 850
BEVA1001 BEVALEX CR 5 G 13,000 12500
R0117011 BISTURI NO. 11 - 84000
R0117013 BISTURI NO.15 - 84000
BURN1004 BURNAZIN 10% CR 35 G (G) 72,000 79000
BUSC1001 buscopan 10 MG TAB 3,900 3730
BUSC1002 BUSCOPAN 20 MG /ML INJ 45,000 43000
CAPT1002 CAPTOPRIL 12.5 MG TAB ::: 137 135
CAPT1003 CAPTOPRIL 25 MG TAB ::: 160 148
CEFA1009 CEFADROXIL MONOHYDRATE 500 MG CAP ::: 775 770
CEFT1002 cefTRIAXONE DISODIUM 1 G INJ ::: 8,000 7800
XITR1001 CENDO XITROL ED 5 ML 31,750 34200
CERV2006 CERVICAL COLLAR (HARD) M 250,000 -
CERV2003 CERVICAL COLLAR (FOAM) L - 0
CERV2001 CERVICAL COLLAR (FOAM) S 250,000 250000
CETI1002 CETIRIZINE 5 MG/5 ML SYR 60 ML ::: 5,500 5400
CETI1001 CETIRIZINE HCL 10MG TAB ::: 150 120
CHLO1007 CHLORAMPHENICOL 1% 3.5 G SALEP MATA 8,500 8000
CHLO1005 CHLORPHENIRAMINE MALEAT 4 MG TAB ::: 60 145
CIPR1005 CIPROFLOXACIN 500 MG TAB ::: 500 540
CLIN1002 CLINDAMYCIN 300 MG CAP ::: 1,500 1310
CLOP1001 CLOPIDOGREL 75 MG TAB ::: 2,500 3960
COMB1002 COMBANTRIN 250 MG TAB ::: 8,500 tablet 17500
COMB1003 COMBIVENT UDV NEB 2.5 ML ::: 23,000 22500
COTR1002 COTRIMOXAZOLE 240 MG/5 ML 60ML SIR ::: 5,000 6000
COTR1003 COTRIMOXAZOLE 480 MG TAB ::: 300 350
COUN1001 counterpain CREAM 15 G 28,000 30500
R0102050 DARYANTULLE (PLESTER DENGAN ANTIBIOTIKA) ::: 25,000 28000
DEXA1001 DEXAMETHASONE 0.5 MG TAB ::: 100 98
DEXA1002 DEXAMETHASONE 5 MG INJ ::: 2,000 1800
DEXT1003 DEXTRAL SYR 60 ML 10,000 9800
DEXT1006 Dextrose 5% INF 500 ML - 13000
DIAG1001 DIAGIT TAB 3,150 3500
DICL1003 DICLOFENAC NATRIUM 50 MG TAB ::: 350 300
DIPH1001 diphenhydrAMINE INJ ::: 3,750 6500
DOMP1002 DOMPERIDON 10MG TAB ::: 200 190
DOMP1004 DOMPERIDONE SYR ::: 6,000 6500
DULC1001 DULCOLAX 10 MG SUPP 28,000 31900
DULC1002 DULCOLAX 5 MG SUPP ::: 21,500 22916
DULC1003 DULCOLAX 5 MG TAB 1,800 2050
ECAR2001 E-CARE HANDRUB 500 ML 250,000 33000
ELKA1005 ELKANA FC TAB 1,000 1050
EPER1002 EPERISONE 50 MG TAB ::: 1,300 1150
EPIN1001 EPINEphrine 0.1%, 1ML INJ ::: 3,500 9500
ERLA1004 ERLAMYCETINE EYE OINT 1% 3.5 G 10,000 10200
FGTR1001 FG-TROCHES TAB 1,650 1600
FORU1006 FORUMEN EAR DROPS 10 ML 32,500 34000
FOLLEY CATHETER 2 WAY NO 14 LATEX 25,000 -
FURO1001 FUROSEMIDE 10 MG/ML INJ ::: 3,500 4320
FURO1002 FUROSEMIDE 40 MG TAB ::: 240 255
GENT1012 GENTALEX 0.1% CR 5 G /// 4,500 4500
GLIM1003 GLIMEPIRIDE 2 MG TAB ::: 500 350
R0106012 GLOVES NON STERIL L - 55000
R0106011 GLOVES NON STERIL M - 55000
R0106010 GLOVES NON STERIL S - 55000
HYDR1002 HYDROCHLOROTIAZIDE 25 MG TAB ::: 325 265
HYDR1003 HYDROCORTISONE ACETATE 2.5% 5G CRM ::: 6,000 6500
HYPA2003 HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) 165,000 1 roll 155000
IBUP1001 IBUPROFEN 400 MG TAB ::: 350 320
INFA1003 INFATRIM TAB ///::::: 600 400
INFU2001 INFUSION SAFETY SET MACRO ::: 12,500 5000
R0104050 INFUSION SAFETY SET MICRO 12,500 5000
IODI2002 IODINE POVIDONE LAR 10% 30 ML ::: 8,000 5600
ISOS1001 isoSORBIDE DINITRATE 5 MG TAB ::: 200 170
IVCA2001 IV CATH WITH PORT 20 G ::: - 7500
IVCA2002 IV CATH WITH PORT 22 G ::: - 7500
IVCA2004 IV CATH WITH PORT 24 G ::: - 7500
R0104012 IV CATHETER SAFETY NO. 18 - 7500
JARU2065 JARUM KULIT HEACTING GT 10 22,000 1 pac -
JARU2066 JARUM KULIT HEACTING GT 11 22,000 1 pac -
JARU2077 JARUM KULIT HEACTING GT 12 22,000 1 pac -
JARU2062 JARUM OTOT HEACTING GR 10 22,000 1 pac -
JARU2063 JARUM OTOT HEACTING GR 11 22,000 1 pac -
JARU2064 JARUM OTOT HEACTING GR 12 22,000 1 pac -
R0102030 KAPAS 1 KG 55,000 1 roll 54000
KALN1005 KALNEX 500 MG TAB 4,750 3820
R0102029 KASA HIDROFIL STERIL 4X5 CM 1,300 verban 4 X 5 4000
KASA2035 KASA ROLL 40 Y X 80 CM NON X RAY 130,000 roll 85000
KASA2043 KASA PEMBALUT 10 CM - -
KERT2001 KERTAS PUYER / PERKAMEN 13500
KETO1002 KETOCONAZOLE 2% 10 G CRM ::: 7,000 6700
KETO1009 KETOCONAZOLE 200 MG TAB ::: 500 490
KETO1007 KETOPROFEN 50 MG TAB 750 935
KETO1005 KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: 3,000 2475
SITE2002 LANCET (SITE) 35,000 box 19000
LANS1001 LANSOprazole 30 MG CAP ::: 850 750
R0101010 LEUKOCREPE/ELASTIS BANDAGE 3 INCH 77,500 roll 18000
R0101011 LEUKOCREPE / ELASTIS BANDAGE 4 INCH 93,000 roll 21000
R0101013 LEUKOCREPE / ELASTIS BANDAGE 6 INCH 115,000 roll 25300
LEXA1004 LEXACROL FORTE SUSP 100 ML ///::::: 30,000 26000
LEXA1021 LEXACROL 1,000 550
LIDO1003 LIDOCAINE HCL 2%/2 ML INJ ::: 2,000 1900
LODI1001 LODIA 2 MG TAB /// 1,250 1350
LOMA2001 LOMATULLE (SOFRATULLE)/// 25,000 lembar 16800
RO115011 MASKER KERTAS KARET 20,000 ISI 50 PCS 24000
R0103118 MASKER OKSIGEN DEWASA 25,000 18000
R0103117 MASKER OKSIGEN ANAK - 0
R0103119 MASKER OKSIGEN UKURAN S - 0
MECO1004 MECOBALAMIN 500 MCG CAP 680 670
MEFE1001 MEFENAMIC ACID 500 MG TAB ::: 225 220
MELO1003 MELOXICAM 15 MG 600 380
MELO1002 MELOXICAM 7,5 MG TAB ::: 450 280
METF1002 METFORMIN HCL 500 MG TAB ::: 250 232
METH1012 METHYL PREDNISOLON 4 MG ::: 300 245
METR1012 METRONIDAZOLE 500 MG TAB ::: 250 240
R0103121 MICROMIST DEWASA SET INHALASI (1172) - 28000
R0103120 MICROMIST ANAK SET INHALASI (1173) - 28000
MOLA1004 MOLACORT 0.5 MG TAB ///::::: 160 190
MOLA1010 MOLAKRIM CREAM 30 GR 12,500 12300
MUCO1011 MUCOHEXIN 8 MG TAB/// 660 655
MUCO1013 MUCOHEXIN 4 MG/5 ML ELIXIR 120 ML (PKU) 22,500 22000
MYGE2002 MY JELLY 80 G ::: 82,500 46200
NACL1006 NACL 0.9% 500 ML (RUBBER) ::: 16,500 13000
R0103090 NASAL CANULE ANAK 15,000 15000
R0103091 NASAL CANULE DEWASA 15,000 15000
R0116006 NASAL CANULE BAYI 15,000 15000
R0109023 NEEDLE NO. 23 135,000 box 24000
R0109027 NEEDLE NO. 27 - 24000
NEUR1012 NEURObion 5000 INJ 3 ML 15,500 14500
NEWD1001 NEW DIATAB TAB ::: 660 688
OMEP1001 OMEprazol 20 MG CAP ::: 500 420
ONDA1004 ONDANSETRON HCL 4 MG/2 ML INJ ::: 3,000 2800
OPTI2020 OPTIUM NEO H STRIP - -
ORAL1001 ORALIT SACH ::: 500 455
OTOP1001 OTOPAIN EAR DROPS 8 ML 99,000 90000
PAMO1001 PAMOL 125 MG SUPP 16,500 16480
PANT1006 PANTOPRAZOL 40 MG INJ 27,500 24000
PAPE2021 PAPER EKG MINRAY 80 X 25 (PALEMBANG) - -
PARA1017 PARACETAMOL 10 MG/1 ML INF 100 ML ::: 22,000 20000
PARA1004 PARACETAMOL 120 MG/5 ML 60ML SIR ::: 4,500 5000
PARA1003 PARACETAMOL 500 MG TAB ::: 205 202
PIRO1002 PIROXICAM 20 MG TAB 150 240
POTP1007 POT PLASTIK 10 CC 1,300 850
RANI1002 RANITIDINE HCL 150 MG TAB ::: 225 220
RANI1001 RANITIDINE HCL 50MG/2 ML INJ ::: 2,000 2300
RECO1008 RECO ED 10 ML ///::::: 10,000 9500
RING1002 RINGER LACTATE 500 ML RUBBER CAP ::: 16,500 13000
SAFE2005 SAFETY BOX 12.5 LITER 35,000 34000
SAFE2004 SAFETY BOX 5 LITER 34,000 30000
SALB1001 SALBUTAMOL SULFATE 2 MG TAB ::: 140 125
SALB1002 SALBUTAMOL SULFATE 4 MG TAB ::: 220 200
SALI2001 SALICYL POWDER 80 G 7,250 8500
SCAB1001 scabiMITE CR 10 G ::: 54,000 53000
SCOP1004 SCOPAMIN 10 MG TAB ///::: - 1600
SCOP1005 SCOPAMIN 20 MG/ML INJ 1 ML ///::: - 12000
SENS1001 SENSI WASH 250 ML 27,500 42000
SERU1003 SERUM ANTI BISA ULAR ::: 1,100,000 1100000
SIMV1003 SIMVASTATIN 10 MG TAB ::: 175 245
SINO1001 SINOCORT 0.1% ORAL PASTE 5 G ///::::: 46,000 49000
R0111263 SPALK KAKI BIASA SEI -IGD 150,000 -
R0111261 SPALK TANGAN SET - IGD 150,000 -
R0111301 SPALK UK 11 X 90 CM - -
SPAS1006 SPASMOLIT 10 MG TAB/// - 2180
SITE2006 STRIP ASAM URAT EASY TOUCH (SITE) 130,000 100000
SITE2003 STRIP GLUKOSA ONCALL PLUS (SITE) 120,000 -
SITE2005 STRIP KOLESTEROL EASY TOUCH (SITE) 220,000 170000
R0108105 SUCTION CATHETER NO 12 27,000 12000
SUCR1001 SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: 15,000 14800
R0109045 SYRINGE 10 ML TERUMO 4,600 2500
R0109058 SYRINGE 3 ML 3,300 77000
R0109044 SYRINGE 5 ML 3,350 101400
BURN1005 SILVER SULFADIAZIN 10% CR 500 GR - 0
SYRI2003 SYRINGE TUBERKULIN 1 ML ::: 4,100 88000
TEST2001 TEST SENSITIF STRIP 23,000 23500
TETA1001 TETAGAM P 250 IU INJ 1 ML 235,000 286000
THRO1001 THROMBO ASPILET 80 MG EC TAB 1,100 1100
THRO1002 THROMBOPHOB GEL 20 G 60,000 58000
TREM1001 TREMENZA TAB ///::::: 1,900 1958
ULTR3003 ULTRAFIX 10X5CM ECER 10CM 30,000 roll 36000
URIN2002 URINE BAG (GEA) -
VENO1004 VENOSMIL 200 MG CAP 13,000 12900
VENT1002 VENTOLIN 2.5 MG NEBULES ::: 12,500 -
VELU1001 VELUTINE 2.5 MG NEBULES 4 ML 9,250 -
VITA1004 VITAMIN B COMPLEX TAB ::: 200 123
VITA1007 VITAMIN C 50 MG TAB ::: 170 168
WATE1005 WATER FOR INJEKSI 25 ML ::: 6,500 6000
ZINC1004 ZINC 20 MG TAB ::: 275 320
 CV
KETERANGAN KETERANGAN PROCUREMENT
SINERGI

isi 200 pcs -

box/100pcs 20,000 box

25,000

45,000

970,000
2,200,000 b braun cat gut
5,500
ecodin 85,000

box/100 pcs 85,000

box/100 pcs 85,000

243,000
275,000
 270,000

strip

10,000

42,000
42,000
42,000

160,000
 185,000 box/50 pcs
185,000 box/50 pcs
5,500

gea 300,000 box/ 50 pcs

gea 300,000 box/ 50 pcs
gea 300,000 box/ 50 pcs
gea 300,000 box/ 50 pcs
180,000 box/ 10 lusin merk remedi
180,000 box/ 10 lusin merk remedi
180,000 box/ 10 lusin merk remedi
180,000 box/ 10 lusin merk remedi
180,000 box/ 10 lusin merk remedi
180,000 box/ 10 lusin merk remedi
65,000

-
bidara 85,000
50,000 ISI 50 PCS
PACK/500 PCS 15,000 PACK

box 20,000

15,000
17,000
20,000

180,000 box/10 pcs

box/50 pcs onemed 25,000 box/50 pcs
15,000
15,000
15,000
gea 35,000
gea ukuran S -

onemed

8,500
8,500
8,500
box/100 pcs 45,000
box/100 pcs 45,000

95,000

1,000
-

33,000
20,000

kf

BIOSAVE
 15,000
47,500

86,000
81,000
160,000
GEA 10,000

115,000 box/100 pcs

cosmo/onehealth 70,000 box/100 pcs
Onemed 96,000 box/100 pcs
- 259000
Onemed 70,000 box/100 pcs

45,000
50,000 isi 10 pcs

10,000
 Requisition Form
PT HARSANA EKLINIKA REFORMA
FRM/PROC/001 Tanggal Terbit: 23 Juni 2022 Rev.0

Dept/Klinik: KSQ-OKI Requisition Form no: HER-PR-SS-02-2023-008-KSQ-OKI

Reason for Requisition: PEMBELIAN OBAT & BHP KIM FEBRUARI 2022 (3 BULAN) Date Procurement received:

No Item Code Goods/Services Required Description / Specification UOM Quantity Estimated Price Total Estimated Price Required Date Remarks
1 ACYC1001 DRUG ACYCLOVIR 5% 5G CRM TUBE 25 Rp 4,500 Rp 112,500
2 ACYC1002 DRUG ACYCLOVIR 400 MG TAB ::: TAB 500 Rp 735 Rp 367,500 CITO
3 ALKO2001 BHP ALKOHOL SWAB ::: KOTAK 12 Rp 18,000 Rp 216,000 ISI 100 PCS
4 ALLO1002 DRUG ALLOPURINOL 100 MG TAB ::: TAB 400 Rp 198 Rp 79,200
5 ALLO1001 DRUG ALLOPURINOL 300 MG TAB ::: TAB 300 Rp 500 Rp 150,000
6 ALPA1002 DRUG ALPARA TAB ///::::: TAB 2,400 Rp 758 Rp 1,819,200
7 AMBR1002 DRUG AMBROXOL 30 MG TAB ::: TAB 3,600 Rp 145 Rp 522,000
8 AMBR1001 DRUG AMBROXOL HCL 15 MG/5 ML, 60ML SIR BTL 160 Rp 6,300 Rp 1,008,000
9 AMLO1002 DRUG AMLODIPINE BESYLATE 10 MG TAB ::: TAB 700 Rp 280 Rp 196,000
10 AMLO1001 DRUG AMLODIPINE BESYLATE 5 MG TAB ::: TAB 4,800 Rp 180 Rp 864,000
11 AMOX1006 DRUG AMOXICILLIN 125 MG/5 ML 60ML SIR ::: BTL 80 Rp 5,000 Rp 400,000
12 AMOX1010 DRUG amoxiCILLIN 500 MG TAB ::: TAB 4,600 Rp 450 Rp 2,070,000
13 ANDA1002 DRUG ANDALAN 150 MG/3 ML INJ 3 ML (HIJAU) ///::::: VIAL 33 Rp 7,500 Rp 247,500
14 ANDA1006 DRUG ANDALAN PIL KB SC TAB (STRIP)///::::: STRIP 6 Rp 15,500 Rp 93,000
15 MGOH1002 DRUG ANTASIDA DOEN 60ML SIR ::: BTL 100 Rp 4,500 Rp 450,000
16 ANTA1009 DRUG ANTASIDA DOEN TAB ::: TAB 500 Rp 144 Rp 72,000
17 TRAN1022 DRUG ASAM TRANEKSAMAT 500 MG INJ ::: AMP 6 Rp 6,000 Rp 36,000
18 ASEP1001 BHP ASEPTAN LIQUID 500 ML BTL 20 Rp 39,000 Rp 780,000
19 BETA1022 DRUG BETADINE SOLUTION 1 LITER BTL 1 Rp 84,000 Rp 84,000
20 BETA1007 DRUG BETAHISTINE MESYLATE 6 MG TAB ::: TAB 1,880 Rp 850 Rp 1,598,000
21 BEVA1001 DRUG BEVALEX CR 5 G TUBE 420 Rp 12,500 Rp 5,250,000
22 BURN1004 DRUG BURNAZIN 10% CR 35 G (G) TUBE 10 Rp 72,000 Rp 720,000 CITO
23 CAPT1002 DRUG CAPTOPRIL 12.5 MG TAB ::: TAB 600 Rp 135 Rp 81,000
24 CAPT1003 DRUG CAPTOPRIL 25 MG TAB ::: TAB 1,000 Rp 148 Rp 148,000
25 CEFA1009 DRUG CEFADROXIL MONOHYDRATE 500 MG CAP ::: CAP 3,000 Rp 770 Rp 2,310,000
26 CEFT1002 DRUG cefTRIAXONE DISODIUM 1 G INJ ::: VIAL 10 Rp 7,800 Rp 78,000
27 XITR1001 DRUG CENDO XITROL ED 5 ML BTL 110 Rp 31,750 Rp 3,492,500
28 CERV2003 BHP CERVICAL COLLAR (FOAM) L PIECE 1 Rp 275,000 Rp 275,000
29 CERV2001 BHP CERVICAL COLLAR (FOAM) S PIECE 1 Rp 250,000 Rp 250,000
30 CETI1001 DRUG CETIRIZINE HCL 10MG TAB ::: TAB 8,400 Rp 120 Rp 1,008,000
31 CETI1002 DRUG CETIRIZINE 5 MG/5 ML SYR 60 ML ::: BTL 120 Rp 5,400 Rp 648,000
32 CHLO1007 DRUG CHLORAMPHENICOL 1% 3.5 G SALEP MATA TUBE 20 Rp 8,000 Rp 160,000
33 CHLO1005 DRUG CHLORPHENIRAMINE MALEAT 4 MG TAB ::: TAB 100 Rp 60 Rp 6,000
34 CIPR1005 DRUG CIPROFLOXACIN 500 MG TAB ::: TAB 1,900 Rp 500 Rp 950,000
35 CLIN1002 DRUG CLINDAMYCIN 300 MG CAP ::: CAP 800 Rp 1,310 Rp 1,048,000
36 CLOP1001 DRUG CLOPIDOGREL 75 MG TAB ::: TAB 20 Rp 2,500 Rp 50,000 CITO
37 COMB1002 DRUG COMBANTRIN 250 MG TAB ::: TAB 10 Rp 8,500 Rp 85,000
38 COMB1003 DRUG COMBIVENT UDV NEB 2.5 ML ::: NEBU 20 Rp 22,500 Rp 450,000
39 COUN1001 DRUG counterpain CREAM 15 G TUBE 20 Rp 28,000 Rp 560,000
40 DEXA1001 DRUG DEXAMETHASONE 0.5 MG TAB ::: TAB 13,100 Rp 98 Rp 1,283,800
41 DEXA1002 DRUG DEXAMETHASONE 5 MG INJ ::: AMP 100 Rp 1,800 Rp 180,000
42 DEXT1006 DRUG Dextrose 5% INF 500 ML BTL 1 Rp 13,000 Rp 13,000
43 DIAG1001 DRUG DIAGIT TAB TAB 100 Rp 3,150 Rp 315,000
44 DICL1003 DRUG DICLOFENAC NATRIUM 50 MG TAB ::: TAB 900 Rp 300 Rp 270,000
45 DIPH1001 DRUG diphenhydrAMINE INJ ::: AMP 20 Rp 3,750 Rp 75,000
46 DOMP1002 DRUG DOMPERIDON 10MG TAB ::: TAB 2,000 Rp 190 Rp 380,000
47 DOMP1004 DRUG DOMPERIDONE SYR ::: BTL 50 Rp 6,000 Rp 300,000
48 DULC1002 DRUG DULCOLAX 5 MG SUPP ::: SUPPOS 60 Rp 21,500 Rp 1,290,000
49 DULC1003 DRUG DULCOLAX 5 MG TAB TAB 190 Rp 1,800 Rp 342,000
50 ELKA1005 DRUG ELKANA FC TAB TAB 4,600 Rp 1,000 Rp 4,600,000
51 EPER1002 DRUG EPERISONE 50 MG TAB ::: TAB 2,200 Rp 1,150 Rp 2,530,000
Rp 1,600
52 FGTR1001 DRUG FG-TROCHES TAB TAB 2,700 Rp 4,320,000
53 FORU1006 DRUG FORUMEN EAR DROPS 10 ML BTL 75 Rp 32,500 Rp 2,437,500 CITO
54 GENT1012 DRUG GENTALEX 0.1% CR 5 G /// TUBE 96 Rp 4,500 Rp 432,000
55 GLIM1003 DRUG GLIMEPIRIDE 2 MG TAB ::: TAB 1,600 Rp 350 Rp 560,000
56 R0106011 BHP GLOVES NON STERIL M KOTAK 30 Rp 42,000 Rp 1,260,000
57 HYDR1003 DRUG HYDROCORTISONE ACETATE 2.5% 5G CRM ::: TUBE 70 Rp 6,000 Rp 420,000
58 HYPA2003 BHP HYPAFIX 10 CM X 5 M ECER -10 CM (PKU) KOTAK 12 Rp 155,000 Rp 1,860,000
59 INFU2001 BHP INFUSION SAFETY SET MACRO ::: KOTAK 2 Rp 185,000 Rp 370,000 ISI 50 PCS
60 IODI2002 DRUG IODINE POVIDONE LAR 10% 30 ML ::: BTL 40 Rp 5,500 Rp 220,000
61 ISOS1001 DRUG isoSORBIDE DINITRATE 5 MG TAB ::: TAB 20 Rp 170 Rp 3,400
62 IBUP1001 DRUG IBUPROFEN 400 MG TAB ::: TAB 3,800 Rp 320 Rp 1,216,000
63 IVCA2002 BHP IV CATH WITH PORT 22 G ::: KOTAK 1 Rp 300,000 Rp 300,000 ISI 50 PCS
64 IVCA2004 BHP IV CATH WITH PORT 24 G ::: KOTAK 2 Rp 300,000 Rp 600,000 ISI 50 PCS
65 KALN1005 DRUG KALNEX 500 MG TAB TAB 300 Rp 3,820 Rp 1,146,000
66 KASA2035 BHP KASA ROLL 40 Y X 80 CM NON X RAY ROLL 7 Rp 85,000 Rp 595,000
67 KETO1009 DRUG KETOCONAZOLE 200 MG TAB ::: TAB 600 Rp 490 Rp 294,000
68 KETO1007 DRUG KETOPROFEN 50 MG TAB TAB 200 Rp 750 Rp 150,000
69 KETO1002 DRUG KETOCONAZOLE 2% 10 G CRM ::: TUBE 92 Rp 6,700 Rp 616,400
70 KETO1005 DRUG KETOROLAC TROMETHAMINE 30 MG/ML 3% INJ ::: AMP 60 Rp 2,475 Rp 148,500
71 LEXA1004 DRUG LEXACROL FORTE SUSP 100 ML ///::::: BTL 3 Rp 26,000 Rp 78,000
72 LANS1001 DRUG LANSOprazole 30 MG CAP ::: CAP 3,900 Rp 750 Rp 2,925,000
73 LIDO1003 DRUG LIDOCAINE HCL 2%/2 ML INJ ::: AMP 100 Rp 1,900 Rp 190,000
74 LODI1001 DRUG LODIA 2 MG TAB /// TAB 700 Rp 1,250 Rp 875,000
75 LOMA2001 BHP LOMATULLE (SOFRATULLE)/// PIECE 70 Rp 16,800 Rp 1,176,000
76 RO115011 BHP MASKER KERTAS KARET KOTAK 40 Rp 20,000 Rp 800,000 ISI 50 PCS
77 R0103118 BHP MASKER OKSIGEN DEWASA PIECE 5 Rp 15,000 Rp 75,000
78 MECO1004 DRUG MECOBALAMIN 500 MCG CAP CAP 1,400 Rp 670 Rp 938,000
79 MEFE1001 DRUG MEFENAMIC ACID 500 MG TAB ::: TAB 8,100 Rp 220 Rp 1,782,000
80 MELO1003 DRUG MELOXICAM 15 MG TAB 200 Rp 380 Rp 76,000
81 MELO1002 DRUG MELOXICAM 7,5 MG TAB ::: TAB 2,000 Rp 280 Rp 560,000
82 METF1002 DRUG METFORMIN HCL 500 MG TAB ::: TAB 3,200 Rp 232 Rp 742,400
83 METH1012 DRUG METHYL PREDNISOLON 4 MG ::: TAB 1,500 Rp 245 Rp 367,500
84 METR1012 DRUG METRONIDAZOLE 500 MG TAB ::: TAB 300 Rp 240 Rp 72,000
85 R0103121 BHP MICROMIST DEWASA SET INHALASI (UKURAN L) PIECE 26 Rp 28,000 Rp 728,000
86 R0103120 BHP MICROMIST ANAK SET INHALASI (UKURAN S) PIECE 20 Rp 28,000 Rp 560,000
87 MOLA1010 DRUG MOLAKRIM CREAM 30 GR TUBE 200 Rp 12,300 Rp 2,460,000
88 MUCO1011 DRUG MUCOHEXIN 8 MG TAB/// TAB 700 Rp 655 Rp 458,500
89 MUCO1013 DRUG MUCOHEXIN 4 MG/5 ML ELIXIR 120 ML (PKU) BTL 40 Rp 22,000 Rp 880,000
90 MYGE2002 BHP MY JELLY 80 G ::: TUBE 1 Rp 46,200 Rp 46,200
91 NACL1006 DRUG NACL 0.9% 500 ML (RUBBER) ::: BTL 220 Rp 13,000 Rp 2,860,000
92 R0103091 BHP NASAL CANULE DEWASA PIECE 20 Rp 8,500 Rp 170,000
93 R0109027 BHP NEEDLE NO. 27 KOTAK 1 Rp 24,000 Rp 24,000 ISI 100
94 NEUR1012 DRUG NEURObion 5000 INJ 3 ML AMP 60 Rp 14,500 Rp 870,000
95 ONDA1004 DRUG ONDANSETRON HCL 4 MG/2 ML INJ ::: AMP 50 Rp 2,800 Rp 140,000
96 OMEP1001 DRUG OMEprazol 20 MG CAP ::: CAP 1,920 Rp 420 Rp 806,400
97 OTOP1001 DRUG OTOPAIN EAR DROPS 8 ML BTL 33 Rp 90,000 Rp 2,970,000
98 PAMO1001 DRUG PAMOL 125 MG SUPP SUPPOS 84 Rp 16,480 Rp 1,384,320
99 PANT1006 DRUG PANTOPRAZOL 40 MG INJ VIAL 10 Rp 24,000 Rp 240,000
100 PARA1017 DRUG PARACETAMOL 10 MG/1 ML INF 100 ML ::: BTL 10 Rp 20,000 Rp 200,000
101 PARA1004 DRUG PARACETAMOL 120 MG/5 ML 60ML SIR ::: BTL 150 Rp 4,500 Rp 675,000 CITO
102 PIRO1002 DRUG PIROXICAM 20 MG TAB TAB 700 Rp 150 Rp 105,000
103 RANI1002 DRUG RANITIDINE HCL 150 MG TAB ::: TAB 2,000 Rp 220 Rp 440,000
 104 RANI1001 DRUG RANITIDINE HCL 50MG/2 ML INJ ::: AMP 100 Rp 2,000 Rp 200,000
105 RECO1008 DRUG RECO ED 10 ML ///::::: BTL 100 Rp 9,500 Rp 950,000
106 RING1002 DRUG RINGER LACTATE 500 ML RUBBER CAP ::: BTL 120 Rp 13,000 Rp 1,560,000
107 SALB1001 DRUG SALBUTAMOL SULFATE 2 MG TAB ::: TAB 200 Rp 125 Rp 25,000
108 SALB1002 DRUG SALBUTAMOL SULFATE 4 MG TAB ::: TAB 500 Rp 200 Rp 100,000
109 SALI2001 DRUG SALICYL POWDER 80 G BTL 60 Rp 7,250 Rp 435,000
110 SCAB1001 DRUG scabiMITE CR 10 G ::: TUBE 10 Rp 53,000 Rp 530,000
111 SCOP1004 DRUG SCOPAMIN 10 MG TAB ///::: TAB 1,300 Rp 1,600 Rp 2,080,000
112 BURN1005 DRUG SILVER SULFADIAZIN 10% CR 500 GR POT 1 Rp 259,585 Rp 259,585 CITO
113 SIMV1003 DRUG SIMVASTATIN 10 MG TAB ::: TAB 1,300 Rp 175 Rp 227,500
114 SINO1001 DRUG SINOCORT 0.1% ORAL PASTE 5 G ///::::: TUBE 34 Rp 46,000 Rp 1,564,000
115 SENS1001 BHP SENSI WASH 250 ML BTL 25 Rp 27,500 Rp 687,500
116 SITE2006 BHP STRIP ASAM URAT EASY TOUCH (SITE) KOTAK 3 Rp 86,000 Rp 258,000 ISI 25 PCS
117 SITE2003 BHP STRIP GLUKOSA ONCALL PLUS (SITE) KOTAK 4 Rp 81,000 Rp 324,000 ISI 25 PCS
118 SITE2005 BHP STRIP KOLESTEROL EASY TOUCH (SITE) KOTAK 5 Rp 160,000 Rp 800,000 ISI 10 PCS
119 SUCR1001 DRUG SUCRALFATE 500 MG/5 ML SUSP 100 ML ::: BTL 30 Rp 14,800 Rp 444,000
120 R0109045 BHP SYRINGE 10 ML KOTAK 1 Rp 115,000 Rp 115,000 ISI 100 PCS
121 R0109058 BHP SYRINGE 3 ML KOTAK 3 Rp 70,000 Rp 210,000 ISI 100 PCS
122 TEST2001 BHP TEST SENSITIF STRIP PIECE 20 Rp 23,000 Rp 460,000
123 THRO1002 DRUG THROMBOPHOB GEL 20 G TUBE 20 Rp 58,000 Rp 1,160,000 CITO
124 TETA1001 DRUG TETAGAM P 250 IU INJ 1 ML SYRINGE 25 Rp 235,000 Rp 5,875,000
125 TREM1001 DRUG TREMENZA TAB ///::::: TAB 4,000 Rp 1,900 Rp 7,600,000 CITO
126 ULTR30003 BHP ULTRAFIX 10X5 CM ECER 10 CM KOTAK 2 Rp 30,000 Rp 60,000
127 VENO1004 DRUG VENOSMIL 200 MG CAP CAP 500 Rp 12,900 Rp 6,450,000
128 VENT1002 DRUG VENTOLIN 2.5 MG NEBULES ::: NEBU 10 Rp 12,500 Rp 125,000
129 VELU1001 DRUG VELUTINE 2.5 MG NEBULES 4 ML NEBU 10 Rp 9,250 Rp 92,500
130 VITA1004 DRUG VITAMIN B COMPLEX TAB ::: TAB 6,200 Rp 123 Rp 762,600
131 VITA1007 DRUG VITAMIN C 50 MG TAB ::: TAB 2,200 Rp 168 Rp 369,600
132 WATE1005 DRUG WATER FOR INJEKSI 25 ML ::: VIAL 12 Rp 6,000 Rp 72,000
133 ZINC1004 DRUG ZINC 20 MG TAB ::: TAB 900 Rp 275 Rp 247,500
TOTAL Rp 117,980,105

*Prepared by, Approved by, **Approved by, Received by,

Date: Date: Date:

apt. Kiky Susilo Anggara dr. Tria Jaya Budi Kusuma dr. Rowny Ginting,MM.,MARS.
Requester PJ Klinik SehatQ OKI Kepala Klinik/Head Of Departement CEO Procurement
*Khusus Obat: Apoteker & PJ Klinik
** Over Budget/Not Budgeted
Checklist for Submission: To be filled by Approver: Yes(Y) or No (No)
* Budget Is it budgeted and within budget? If no, please explain reason for overbudget/not budgeted
* Inventory report (for inventory) Is there an approved preferred vendor?