No Nama Barang Satuan Jumlah Harga

1 2 3 4 5
1 Asam Mefenamat Tab 600 800.00
2 Ambroxol Tab 600 300.00
3 Amlodipine 10 mg Tab 150 2,500.00
4 Amoxicillin 500 mg Tab 700 400.00
5 Antasida Tab 400 92.00
6 Calortusin Tab 1000 350.00
7 Cefadroxyl / Cefford F 500 mg Tab 300 750.00
8 CTM / Orphen Tab 200 70.00
9 Dexamethasone / Novadex Tab 300 100.00
10 Ibuprofen 400 mg Tab 200 243.00
11 Lansoprazole Tab 300 1,400.00
12 Metformin Tab 100 300.00
13 Natrium Diklofenak / Kemoren Tab 500 200.00
14 PCT Tab 600 200.00
15 Ranitidine Tab 200 158.00
16 Cloramphenicol 500 mg Tab 300 1,800.00
17 Meloxicam 15 mg Tab 300 800.00
18 MP 4 mg Tab 200 400.00
19 Domperidone / Vesperum Tab 300 200.00
20 Simvastatin 10 mg Tab 150 1,500.00
21 lacto-B Tab 20 9,000.00

SIRUP
22 Coparcetine Btl 10 6,000.00
23 Ibuprofen / Etafen Btl 10 7,000.00
24 PCT / Novagesic Btl 10 5,000.00
25 Zink Srup/Lecozink Btl 11 8,000.00
26 Multivitamin / Muliavit Btl 24 5,000.00
27 Nystatin Drop Btl 5 38,000.00

INJEKSI
28 Dexamethason Ampl 10 3,000.00
29 Ranitidin Ampl 10 3,000.00
30 Lidocaine Ampl 10 3,000.00

BHP
31 H2O2 3% 800 Ml Btl 3 35,000.00
32 Sofratulle Kotak 10 27,000.00
TOTAL
 Total
6 KETERANGAN
480,000.00
180,000.00 RILL YG DIBELANJAKAN/PESAN 5,089,000
375,000.00 YANG DI AJUKAN 18,438,000
280,000.00
36,800.00
350,000.00
225,000.00
14,000.00
30,000.00
48,600.00
420,000.00
30,000.00
100,000.00
120,000.00
31,600.00
540,000.00
240,000.00
80,000.00
60,000.00
225,000.00
180,000.00

60,000.00
70,000.00
50,000.00
88,000.00
120,000.00
190,000.00

30,000.00
30,000.00
30,000.00

105,000.00
270,000.00
5,089,000.00
 Daftar Pemesanan Barang Kegiatan FKTP Wilayah Singkawang

BULAN MEI 2019 18,438,000

N0 Nama Barang Satuan Banyaknya Biaya Per Satuan

1 2 3 4 5
1 Asam Mefenamat Tab 500 800
2 Acyclovir 400 mg Tab 400 300
3 Allupurinol 300 mg Tab 300 650
4 Ambroxol Tab 100 300
5 Amitriptilin Tab 30 2,500
6 Amlodipine 10 mg Tab 450 2,500
7 Amlodipine 5 mg Tab 300 1,400
8 Amoxicillin 500 mg Tab 500 400
9 Antasida Tab 100 90
10 Calortusin Tab 600 350
11 Cefadroxyl / Cefford F 500 mg Cap 500 750
12 Cetirizine 10 mg Tab 350 200
13 Ciprofloxacin 500 mg Tab 300 400
14 CTM / Orphen Tab 200 70
15 Dexamethasone / Novadex Tab 500 100
16 Domperidone / Vesperum Tab 300 200
17 Glimepiride 2 mg Tab 100 1,500
18 Glucosamine Tab 50 2,000
19 Histigo Tab 250 500
20 Ibuprofen 400 mg Tab 350 240
21 Lansoprazole Cap 200 1,400
22 Meloxicam 7,5 mg Tab 500 500
23 Metformin Tab 500 300
24 Molagit Tab 300 600
25 MP 4 mg / Rhemafar Tab 300 400
26 Natrium Diklofenak / Kemoren Tab 400 200
27 Omeprazole Cap 200 400
28 PCT Tab 600 200
29 Pyrantel 125 mg Tab 200 450
30 Ranitidine Tab 300 150
31 Scopma Tab 350 1,800
32 Simvastatin 10 mg Tab 300 1,500
33 Thiamphenicole 500 mg Cap 250 1,800
34 Vit B Complex Tab 300 300
35 Oralit Sachet 200 1,000
36 Multivitamin / Muliavit Tab 300 4,500
37 Zink Tab 300 700
 SIRUP
38 Ambroxol / Nuvopec Btl 30 4,500
39 Amoxicillin / Novamox Btl 50 4,500
40 Anacetine Btl 30 8,000
41 Antasida Btl 30 4,000
42 Cefadroxyl / Lostacef Btl 80 7,500
43 Cetirizine / Lerzine Btl 40 5,000
44 Coparcetine Btl 50 6,000
45 Domperidone / Hufadon Btl 30 5,000
46 Ibuprofen / Etafen Btl 40 7,000
47 Multivitamin / Muliavit Btl 40 5,000
48 Obat Sariawan GOM Btl 25 5,000
49 PCT / Novagesic Btl 120 5,000

LAIN LAIN
50 Antihemorroid supp Supp 30 6,000
51 L Bio Sachet 25 7,000
52 Salep Kulit Acyclovir Tube 30 5,000
53 Salep Kulit Armacort Tube 10 6,000
54 Salep Kulit Betamethason Tube 20 5,000
55 Salep Kulit Genalten Tube 20 4,500
56 Salep Kulit Ketokonazole Tube 25 6,400
57 Salep Scabicid Tube 15 65,000
58 Salep Pain Kila Tube 30 40,000
59 Salep Mata Reco Tube 20 35,000

BHP
61 Betadin 30 ml Btl 20 25,000
62 Chlorethyl Spray Btl 5 180,000
63 Hypafix 10x5m Box 2 165,000
64 Kasa Gulung 1 Meter Roll 3 115,000
65 Sensigloves Uk M Box 3 50,000
66 Sensigloves Uk S Box 3 50,000
67 Sofratulle Box 6 27,000
68 Spuit 1 cc Pcs 10 4,000
69 Spuit 3 cc Pcs 10 3,000
70 Surgical Face Mask Earloops Box 3 25,000
71 Surgical Mask Earloop 3Ply Box 3 28,000

TOTAL
gkawang

Jumlah

6
400,000
120,000
195,000
30,000
75,000
1,125,000
420,000
200,000
9,000
210,000
375,000
70,000
120,000
14,000
50,000
60,000
150,000
100,000
125,000
84,000
280,000
250,000
150,000
180,000
120,000
80,000
80,000
120,000
90,000
45,000
630,000
450,000
450,000
90,000
200,000
1,350,000
210,000
 135,000
225,000
240,000
120,000
600,000
200,000
300,000
150,000
280,000
200,000
125,000
600,000

180,000
175,000
150,000
60,000
100,000
90,000
160,000
975,000
1,200,000
700,000

500,000
900,000
330,000
345,000
150,000
150,000
162,000
40,000
 30,000
75,000
84,000

18,438,000
DETASEMEN KESEHATAN WILAYAH 12 04 01 Lampiran : Surat Ka FKTP Wil. Stg
FKTP WILAYAH SINTANG Nomor : B/ / V / 2019
Tanggal : Maret 2019

DAFTAR PEMESANAN OBAT OBATAN BPJS FKTP WILAYAH SINTANG

BULAN MARET 2019

No Nama Barang Satuan Jumlah Harga

1 2 3 4 5
1 Asam Mefenamat Tab 200 800.00
2 Ambroxol Tab 0 300.00
3 Amlodipine 10 mg Tab 30 2,500.00
4 Amoxicillin 500 mg Tab 0 400.00
5 Antasida Tab 0 92.00
6 Calortusin Tab 200 350.00
7 Cefadroxyl / Cefford F 500 mg Tab 200 750.00
8 CTM / Orphen Tab 0 70.00
9 Dexamethasone / Novadex Tab 110 100.00
10 Ibuprofen 400 mg Tab 200 243.00
11 Lansoprazole Tab 0 1,400.00
12 Metformin Tab 0 300.00
13 Natrium Diklofenak / Kemoren Tab 100 200.00
14 PCT Tab 100 200.00
15 Ranitidine Tab 0 158.00
16 Cloramphenicol 500 mg Tab 0 1,800.00
17 Meloxicam 15 mg Tab 25 800.00
18 MP 4 mg Tab 50 400.00
19 Domperidone / Vesperum Tab 100 200.00
20 Simvastatin 10 mg Tab 0 1,500.00
21 lacto-B Tab 11 9,000.00
s
SIRUP
22 Coparcetine Btl 20 6,000.00
23 Ibuprofen / Etafen Btl 20 7,000.00
24 PCT / Novagesic Btl 20 5,000.00
25 Zink Srup/Lecozink Btl 20 8,000.00
26 Multivitamin / Muliavit Btl 0 5,000.00
27 Nystatin Drop Btl 5 38,000.00

INJEKSI
28 Dexamethason Ampl 10 3,000.00
29 Ranitidin Ampl 0 3,000.00
30 Lidocaine Ampl 10 3,000.00

BHP
31 H2O2 3% 800 Ml Btl 2 35,000.00
32 Sofratulle Kotak 0 27,000.00
TOTAL
 Putussibau, 9 Juli 2019
 Dokter Yonif Raider Khusus
644 / Walet Sakti

 
dr. Setio Ari Bowo
Letnan Dua Ckm NRP 11160040270791
 Surat Ka FKTP Wil. Stg
B/ / V / 2019
Maret 2019

AYAH SINTANG

Total
6 KETERANGAN
160,000.00
- RILL YG DIBELANJAKAN/PESAN 1,553,600
75,000.00 YANG DI AJUKAN 18,438,000
-
-
70,000.00
150,000.00
-
11,000.00
48,600.00
-
-
20,000.00
20,000.00
-
-
20,000.00
20,000.00
20,000.00
-
99,000.00

120,000.00
140,000.00
100,000.00
160,000.00
-
190,000.00

30,000.00
-
30,000.00

70,000.00
-
1,553,600.00
bau, 9 Juli 2019
nif Raider Khusus
/ Walet Sakti

 
etio Ari Bowo
m NRP 11160040270791
DETASEMEN KESEHATAN WILAYAH 12 04 01 Lampiran : Surat Ka FKTP Wil. Stg
FKTP WILAYAH SINTANG Nomor : B/ / V / 2019
Tanggal : April 2019

DAFTAR PEMESANAN OBAT OBATAN BPJS FKTP WILAYAH SINTANG

BULAN APRIL 2019

No Nama Barang Satuan Jumlah Harga

1 2 3 4 5
1 Asam Mefenamat Tab 100 800.00
2 Ambroxol Tab 0 300.00
3 Amlodipine 10 mg Tab 30 2,500.00
4 Amoxicillin 500 mg Tab 0 400.00
5 Antasida Tab 0 92.00
6 Calortusin Tab 200 350.00
7 Cefadroxyl / Cefford F 500 mg Tab 200 750.00
8 CTM / Orphen Tab 0 70.00
9 Dexamethasone / Novadex Tab 100 100.00
10 Ibuprofen 400 mg Tab 100 243.00
11 Lansoprazole Tab 0 1,400.00
12 Metformin Tab 0 300.00
13 Natrium Diklofenak / Kemoren Tab 200 200.00
14 PCT Tab 200 200.00
15 Ranitidine Tab 0 158.00
16 Cloramphenicol 500 mg Tab 0 1,800.00
17 Meloxicam 15 mg Tab 50 800.00
18 MP 4 mg Tab 50 400.00
19 Domperidone / Vesperum Tab 100 200.00
20 Simvastatin 10 mg Tab 0 1,500.00
21 lacto-B Tab 6 9,000.00

SIRUP
22 Coparcetine Btl 20 6,000.00
23 Ibuprofen / Etafen Btl 20 7,000.00
24 PCT / Novagesic Btl 20 5,000.00
25 Zink Srup/Lecozink Btl 20 8,000.00
26 Multivitamin / Muliavit Btl 0 5,000.00
27 Nystatin Drop Btl 4 38,000.00

INJEKSI
28 Dexamethason Ampl 10 3,000.00
29 Ranitidin Ampl 0 3,000.00
30 Lidocaine Ampl 10 3,000.00

BHP
31 H2O2 3% 800 Ml Btl 5 35,000.00
32 Sofratulle Kotak 1 27,000.00
TOTAL
 Putussibau, 9 Juli 2019
 Dokter Yonif Raider Khusus
644 / Walet Sakti

 
dr. Setio Ari Bowo
Letnan Dua Ckm NRP 11160040270791
 Surat Ka FKTP Wil. Stg
B/ / V / 2019
April 2019

AYAH SINTANG

Total
6 KETERANGAN
80,000.00
- RILL YG DIBELANJAKAN/PESAN 1,557,300
75,000.00 YANG DI AJUKAN 18,438,000
-
-
70,000.00
150,000.00
-
10,000.00
24,300.00
-
-
40,000.00
40,000.00
-
-
40,000.00
20,000.00
20,000.00
-
54,000.00

120,000.00
140,000.00
100,000.00
160,000.00
-
152,000.00

30,000.00
-
30,000.00

175,000.00
27,000.00
1,557,300.00
bau, 9 Juli 2019
nif Raider Khusus
/ Walet Sakti

 
etio Ari Bowo
m NRP 11160040270791
DETASEMEN KESEHATAN WILAYAH 12 04 01 Lampiran : Surat Ka FKTP Wil. Stg
FKTP WILAYAH SINTANG Nomor : B/ / V / 2019
Tanggal : Mei 2019

DAFTAR PEMESANAN OBAT OBATAN BPJS FKTP WILAYAH SINTANG

BULAN MEI 2019

No Nama Barang Satuan Jumlah Harga

1 2 3 4 5
1 Asam Mefenamat Tab 200 800.00
2 Ambroxol Tab 0 300.00
3 Amlodipine 10 mg Tab 30 2,500.00
4 Amoxicillin 500 mg Tab 200 400.00
5 Antasida Tab 0 92.00
6 Calortusin Tab 200 350.00
7 Cefadroxyl / Cefford F 500 mg Tab 200 750.00
8 CTM / Orphen Tab 0 70.00
9 Dexamethasone / Novadex Tab 200 100.00
10 Ibuprofen 400 mg Tab 200 243.00
11 Lansoprazole Tab 0 1,400.00
12 Metformin Tab 0 300.00
13 Natrium Diklofenak / Kemoren Tab 200 200.00
14 PCT Tab 200 200.00
15 Ranitidine Tab 0 158.00
16 Cloramphenicol 500 mg Tab 0 1,800.00
17 Meloxicam 15 mg Tab 60 800.00
18 MP 4 mg Tab 50 400.00
19 Domperidone / Vesperum Tab 100 200.00
20 Simvastatin 10 mg Tab 0 1,500.00
21 lacto-B Tab 5 9,000.00

SIRUP
22 Coparcetine Btl 20 6,000.00
23 Ibuprofen / Etafen Btl 20 7,000.00
24 PCT / Novagesic Btl 20 5,000.00
25 Zink Srup/Lecozink Btl 10 8,000.00
26 Multivitamin / Muliavit Btl 0 5,000.00
27 Nystatin Drop Btl 2 38,000.00

INJEKSI
28 Dexamethason Ampl 10 3,000.00
29 Ranitidin Ampl 0 3,000.00
30 Lidocaine Ampl 10 3,000.00

BHP
31 H2O2 3% 800 Ml Btl 5 35,000.00
32 Sofratulle Kotak 0 27,000.00
TOTAL
 Putussibau, 9 Juli 2019
 Dokter Yonif Raider Khusus
644 / Walet Sakti

 
dr. Setio Ari Bowo
Letnan Dua Ckm NRP 11160040270791
 Surat Ka FKTP Wil. Stg
B/ / V / 2019
Mei 2019

AYAH SINTANG

Total
6 KETERANGAN
160,000.00
- RILL YG DIBELANJAKAN/PESAN 1,567,600
75,000.00 YANG DI AJUKAN 18,438,000
80,000.00
-
70,000.00
150,000.00
-
20,000.00
48,600.00
-
-
40,000.00
40,000.00
-
-
48,000.00
20,000.00
20,000.00
-
45,000.00

120,000.00
140,000.00
100,000.00
80,000.00
-
76,000.00

30,000.00
-
30,000.00

175,000.00
-
1,567,600.00
bau, 9 Juli 2019
nif Raider Khusus
/ Walet Sakti

 
etio Ari Bowo
m NRP 11160040270791
DETASEMEN KESEHATAN WILAYAH 12 04 01 Lampiran : Surat Ka FKTP Wil. Stg
FKTP WILAYAH SINTANG Nomor : B/ / V / 2019
Tanggal : Juni 2019

DAFTAR PEMESANAN OBAT OBATAN BPJS FKTP WILAYAH SINTANG

BULAN JUNI 2019

No Nama Barang Satuan Jumlah Harga

1 2 3 4 5
1 Asam Mefenamat Tab 200 800.00
2 Ambroxol Tab 0 300.00
3 Amlodipine 10 mg Tab 30 2,500.00
4 Amoxicillin 500 mg Tab 200 400.00
5 Antasida Tab 0 92.00
6 Calortusin Tab 200 350.00
7 Cefadroxyl / Cefford F 500 mg Tab 200 750.00
8 CTM / Orphen Tab 0 70.00
9 Dexamethasone / Novadex Tab 190 100.00
10 Ibuprofen 400 mg Tab 200 243.00
11 Lansoprazole Tab 0 1,400.00
12 Metformin Tab 0 300.00
13 Natrium Diklofenak / Kemoren Tab 200 200.00
14 PCT Tab 200 200.00
15 Ranitidine Tab 0 158.00
16 Cloramphenicol 500 mg Tab 0 1,800.00
17 Meloxicam 15 mg Tab 100 800.00
18 MP 4 mg Tab 50 400.00
19 Domperidone / Vesperum Tab 100 200.00
20 Simvastatin 10 mg Tab 0 1,500.00
21 lacto-B Tab 5 9,000.00

SIRUP
22 Coparcetine Btl 20 6,000.00
23 Ibuprofen / Etafen Btl 20 7,000.00
24 PCT / Novagesic Btl 20 5,000.00
25 Zink Srup/Lecozink Btl 5 8,000.00
26 Multivitamin / Muliavit Btl 0 5,000.00
27 Nystatin Drop Btl 2 38,000.00

INJEKSI
28 Dexamethason Ampl 10 3,000.00
29 Ranitidin Ampl 0 3,000.00
30 Lidocaine Ampl 10 3,000.00

BHP
31 H2O2 3% 800 Ml Btl 5 35,000.00
32 Sofratulle Kotak 0 27,000.00
TOTAL
 Putussibau, 9 Juli 2019
 Dokter Yonif Raider Khusus
644 / Walet Sakti

 
dr. Setio Ari Bowo
Letnan Dua Ckm NRP 11160040270791
 Surat Ka FKTP Wil. Stg
B/ / V / 2019
Juni 2019

AYAH SINTANG

Total
6 KETERANGAN
160,000.00
- RILL YG DIBELANJAKAN/PESAN 1,558,600
75,000.00 YANG DI AJUKAN 18,438,000
80,000.00
-
70,000.00
150,000.00
-
19,000.00
48,600.00
-
-
40,000.00
40,000.00
-
-
80,000.00
20,000.00
20,000.00
-
45,000.00

120,000.00
140,000.00
100,000.00
40,000.00
-
76,000.00

30,000.00
-
30,000.00

175,000.00
-
1,558,600.00
bau, 9 Juli 2019
nif Raider Khusus
/ Walet Sakti

 
etio Ari Bowo
m NRP 11160040270791