RENCANA KEBUTUHAN OBAT TAHUN 2022

PUSKESMAS : BULUROKENG

NO NAMA OBAT SATUAN

1 2 3
SESUAI LAMPIRAN KEPUTUSAN MENKES RI N0. HK. 01.07/MENKES/813/2019 TTG FORNAS : FASKES TKT 1

1 Air Untuk Injeksi Botol

2 Albendazole 400 mg Tablet

3 Albendazole suspensi 200 mg/5 ml Botol

4 Allopurinol 300 mg Tablet

5 Allopurinol 100 mg* Tablet

6 Aminofilin 150 mg Tablet

7 Aminofilin 200 mg Tablet

8 Aminofilin injeksi 24 mg/ml ( PP) Ampul

9 Amitriptilin 25 mg Tablet

10 Amlodipin 10 mg * Tablet

11 Amlodipin 5 mg * Tablet

12 Amoksisilin sirup kering 125 mg/5 ml Botol

13 Amoksisilin sirup kering 250 mg/5 ml Botol

14 Amoksisilin 500 mg Tablet

15 Amoksisilin 250 mg Tablet

16 Amoksisilin drops 100 mg/ml Botol

17 Antasida supensi Botol

18 Antasida Tablet Kunyah

19 Antifungi Kombinasi Asam Benzoat 6 % dan Asam Salisilat 3 % Pot

20 Antihaemorroid Suppositoria

21 Asam asetat tetes telinga 2 % Botol

22 Asam Asetilsalisilat (Asetosal) 80 mg Tablet

23 Asam Askorbat (Vitamin C) 250 mg Tablet

24 Asam Askorbat (Vitamin C) 50 mg Tablet

25 Asam Mefenamat 500 mg Tablet

26 Asam Retinoat 0.05 % krim Tube

27 Asam Retinoat 0.1 % krim Tube

28 Asam Salisilat 2 % Salep Tube

29 Asam Salisilat 5 % Salep Tube

30 Asam Salisilat 10 % Salep Tube

31 Asam Salisilat Lar 0.1 % Botol

32 Asetazolamid 250 mg Tablet

33 Asiklovir 200 mg Tablet

34 Asiklovir 400 mg Tablet

35 Atapulgit Tablet

36 Atenolol 50 mg * Tablet

37 Atropin injeksi 0.25 mg /ml Ampul

38 Atropin 0,5 mg Tablet

39 Bedak Salisil serb 2 % Dos

40 Betahistin 6 mg Tablet

41 Betametason Krim 0.05 % Tube

42 Betametason Krim 0.1 % Tube

43 Betametason Salep 0.1 % Tube

44 Bisakodil 5 mg Tablet Salut

45 Bisakodil suppo 5 mg Suppositoria

46 Bisakodil suppo 10 mg Suppositoria

47 Budesonid serbuk ih 100 mcg/dosis* Botol

48 Budesonid serbuk ih 200 mcg/dosis* Botol

49 Budesonid cairan ih 0,25 mg/ml Botol

50 Budesonid cairan ih 0,5 mg/ml Botol

51 Deksametason 0,5 mg* Tablet

52 Deksametason injeksi 5 mg/ml Ampul

53 Diazepam injeksi 5 mg /ml Ampul

54 Diazepam 2 mg Tablet

55 Diazepam 5 mg Tablet

56 Diazepam enema 10 mg/2.5 ml Tube

57 Diazepam enema 5 mg/2.5 ml Tube

58 Dietilkarbamazin 100 mg Tablet

59 Dimenhidrinat 50 mg Tablet

60 Difenhidramin injeksi 10 mg/ml Ampul

61 Doksisiklin 100 mg Kapsul

62 Domperidon 10 mg Tablet

63 Domperidon sirup 5 mg/5 ml Botol

64 Ephinefrin (Adrenalin) inj 1 mg/ml Ampul

65 Eritromisin 500 mg Kapsul

66 Eritromisin 250 mg Kapsul

67 Eritromisin 200 mg/5 ml sirup kering Botol

68 Ergokalsiferol (Vitamin B2) 50.000 IU Kapsul

69 Ergokalsiferol (Vitamin B2) 10.000 IU/ml suspensi Botol

70 Ergotamin 1 mg Tablet

71 Fenitoin 30 mg * Kapsul

72 Fenitoin injeksi 50 mg/ml Ampul

73 Fenitoin 100 mg * Kapsul

74 Fenobarbital 30 mg* Tablet

75 Fenobarbital 100 mg* Tablet

76 Fenobarbital injeksi 50 mg/ml Ampul

77 Fenoksimetil Penisilin ( Penisilin V) 250 mg Tablet

78 Fenoksimetil Penisilin ( Penisilin V) 500 mg Tablet

 79 Fitomenadion (Vit K1) injeksi 2 mg/ml Ampul

80 Fitomenadion (Vit K1) 10 mg Tablet

81 Fitomenadion (Vit K1) injeksi 10 mg/ml Ampul

82 Fluoksetin 10 mg Kapsul

83 Fluoksetin 20 mg Kapsul

84 Fluor 1 mg Kaplet

85 Fluor sediaan topikal Tube

86 Furosemide 40 mg Tablet

87 Furosemide injeksi 10 mg/ml Ampul

88 Garam Oralit Sachet

89 Gentamisin Salep mata 0.3 % Tube

90 Gentamisin Tetes Mata 0.3 % Botol

91 Glibenklamid 5 mg * Tablet

92 Glibenklamid 2.5 mg * Tablet

93 Glimepiride 1 mg * Tablet

94 Glimepiride 2 mg * Tablet

95 Glimepiride 3 mg * Tablet

96 Glimepiride 4 mg * Tablet

97 Glipizide 5 mg * Tablet

98 Glipizide 10 mg * Tablet

99 Gliserin 100 mg/ml Botol

100 Gliseril Trinitrat 0.5 mg * Tablet

101 Griseofulvin 125 mg Tablet

102 Griseofulvin 250 mg Tablet

103 Griseofulvin 500 mg Tablet

104 Haloperidol 5 mg * Tablet

105 Haloperidol 1.5 mg * Tablet

106 Haloperidol 2 mg * Tablet

107 Haloperidol drops 2 mg/ml Botol

108 Haloperidol injeksi 5 mg/ml Ampul

109 HCT 25 mg Tablet

110 Hidrokortison Krim 2.5 % Tube

111 Hidrokortison injeksi 100 mg Vial

112 Hiosin Butilbromida 10 mg Tablet

113 Ibuprofen 200 mg* Tablet

114 Ibuprofen 400 mg * Tablet

115 Ibuprofen Suspensi 100 mg/5 ml* Botol

116 Ipratropium bromida aerosol 0.02 mg /dosis * Canister

117 Ipratropium bromida cairan ih 0.025 % (PP) Botol

118 Isosorbid Dinitrat 5 mg * Tablet

119 Kalamin Lotion Botol

120 Kalsium Karbonat 500 mg * Tablet

121 Kalsium Laktat 500 mg Tablet

122 Kaptopril 12.5 mg* Tablet

123 Kaptopril 25 mg* Tablet

124 Kaptopril 50 mg* Tablet

125 Karbamazepin 100 mg Tablet

126 Karbamazepin 200 mg * Tablet

127 Karbamazepin sirup 100 mg/5ml * Botol

128 Karbogliserin tetes telinga 10 % Botol

129 Ketokonazol 200 mg Tablet

130 Ketokonazole Krim 2% Tube

131 Ketokonazole Scalp Sol 2 % Botol

132 Klindamisin 150 mg Kapsul

133 Klindamisin 300 mg Kapsul

134 Klorheksidin Larutan 15 % Botol

135 Kloramfenikol 125 mg/5 ml suspensi Botol

136 Kloramfenikol 250 mg Kapsul

137 Kloramfenikol injeksi 1000 mg (PP) Vial

138 Kloramfenikol salep kulit 2 % Tube

139 Kloramfenikol Tetes Telinga Botol

140 Kloramfenikol Tetes Mata 0.5 % Botol

141 Kloramfenikol Tetes Mata 1 % Botol

142 Kloramfenikol salep mata 1 % Tube

143 Klorfeniramini 4 mg Tablet

144 Klorheksidin Larutan 0.2% Botol

145 Klorpromazin 25 mg Tablet

146 Klorpromazin injeksi 5 mg/ml Ampul

147 Klorpromazin injeksi 25 mg/ml Ampul

148 Klortalidon 50 mg Tablet

149 Kodein 10 mg Tablet

150 Kodein 15 mg Tablet

151 Kodein 20 mg Tablet

152 Kolkisin 500 mcg Tablet

Kombinasi Ipratropium Bromida 0.5 mg & Salbutamol 2.5 mg cairan
153 ih Vial

154 Kombinasi KDT/FDC (Ergotamin 1 mg Kafein 50 mg) Tablet

Kombinasi KDT/FDC (Fe Sulfat/Fe Fumarat/Fe Glukonat = 60 mg Fe
155 Elemental & Asam Folat 0.4 mg) Tablet Salut

156 Kombinasi Kaolin 550 mg dan Pektin 20 mg Tablet

157 Kotrimoksazol suspensi 200/40 mg per 5 ml Botol

158 Kotrimoksazol Dewasa 400/80 mg Tablet

159 Kotrimoksazol Forte Dewasa 800/160 mg Tablet

160 Laktulosa sirup 3.335 g/5 ml Botol

161 Larutan mengandung elektrolit RL Botol

162 Larutan mengandung karbohidrat (PP) Glukosa Botol

163 Larutan mengandung karbohidrat + elektrolit (PP) Botol

164 Lidokain Gel 2% PP Tube

165 Lidokain Spray oral 10 % Botol

166 Lidokain2 % injeksi Ampul

167 Lidokain 2 % + Ephinefrin 1 : 80.000 inj 2 ml Ampul

168 Lidokain salep 5 % Tube

169 Lidokain Spray Topikal 10 % Botol

170 Lisinopril 5 mg * Tablet

171 Lisinopril 10 mg * Tablet

172 Lisinopril 20 mg * Tablet

173 Loratadin 10 mg Tablet

174 Lorazepam 0.5 mg Tablet

175 Lorazepam 1 mg Tablet

176 Lorazepam 2 mg Tablet

177 Mannitol infus 20 % (PP) Botol

178 Mebendazole 100 mg Tablet

179 Mebendazole 500 mg Tablet

180 Mebendazole sirup 100 mg/5 ml Botol

181 Metenamin Mandelat (Heksamin Mandelat) 500 mg Tablet Salut Enterik

182 Metformin 500 mg * Tablet

183 Metformin 850 mg * Tablet

184 Metilergometrin injeksi 0,2 mg/ml Ampul

185 Metilergometrin 0.125 mg Tablet

186 Metilprednisolon injeksi 125 mg (PP) Vial

187 Metoklopramid 5 mg Tablet

188 Metoklopramid 10 mg Tablet

189 Metoklopramid injeksi 5 mg /ml Ampul

190 Metronidazol susp 125 mg /5 ml Botol

191 Metronidazol 500 mg Tablet

192 Metronidazol 250 mg Tablet

193 Mikonazole serbuk 2 % Pot

194 Mikonazole krim 2 % Tube

195 Mometason Furuoat Krim 0.1 % Tube

196 N - Asetil Sistein 200 mg * Kapsul

197 Natrium Diklofenak 50 mg* Tablet

198 Natium Diklofenak tetes mata 1 mg/ml Botol

199 Natrium Bikarbonat 500 mg Tablet

200 Natrium Fluoresein tetes mata 2 % Botol

201 Natrium Tiosulfat injeksi 25 % Vial

202 Nistatin 100.000 IU/ml suspensi Botol

203 Nistatin 500.000 IU Tablet

204 Nistatin 100.000 IU Tablet Vaginal

205 Nitrofurantoin 50 mg Tablet

206 Oksimetazolin tetes hidung 0.025 % Botol

207 Oksimetazolin tetes hidung 0.05% Botol

208 Oksitetrasiklin salep mata 1 % Tube

209 Oksitosin injeksi 10 IU/ml Ampul

210 Olopatadin tetes mata 0.1 % Botol

211 Omeprazole 20 mg Kapsul

212 Omeprazole injeksi 40 mg Ampul

213 Parasetamol 500 mg Tablet

214 Parasetamol Drops 100 mg/ml Botol

215 Parasetamol sir 120 mg/5 ml Botol

216 Perak Nitrat Lar 20 % Botol

217 Perak Sulfadiazin Krim 1 % Tube

218 Permetrin Krim 5 % Tube

219 Pilokarpin tetes mata 2 % Botol

220 Pirantel Pamoat 125 mg Tablet

221 Pirantel Pamoat 250 mg Tablet

222 Pirantel Pamoat suspensi 125 mg/5 ml Botol

223 Piridoksin 10 mg* Tablet

224 Piridoksin 25 mg* Tablet

225 Prazikuantel 600 mg Tablet

226 Prednison 5 mg * Tablet

227 Probenesid 500 mg Tablet

228 Propanolol 10 mg Tablet

229 Ranitidin 150 mg Tablet

230 Salbutamol 2 mg * Tablet

231 Salbutamol 4 mg * Tablet

232 Salbutamol cairan ih 1 mg/ml Vial

233 Salep 2-4 Pot

234 Sefadroksil sirup kering 125 mg/5 ml (PP) Botol

235 Sefadroksil sirup kering 250 mg/5 ml (PP) Botol

236 Sefadroksil 500 mg (PP) Kapsul

237 Sefadroksil 250 mg (PP) Kapsul

238 Setirizin tablet 10 mg Tablet

239 Setirizin sirup 5 mg/5 ml Botol

240 Sianokobalamin (Vitamin B12) 50 mcg Tablet

241 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml Ampul

242 Simvastatin 10 mg * Tablet

243 Simvastatin 20 mg * Tablet

244 Simvastatin 40 mg Tablet

245 Siprofloksasin 500 mg Tablet

246 Streptomisin serb inj 1000 mg Vial

247 Spironolakton 25 mg * Tablet

248 Spironolakton 100 mg Tablet

249 Terbutalin injeksi 0.5 mg/ml Ampul

250 Terbutalin cairan ih 2.5 mg/ml Vial

251 Tetrakain tetes mata 0.5 % Botol

252 Tetrasiklin 250 mg Kapsul

253 Tetrasiklin 500 mg Kapsul

254 Tetrasiklin salep mata 1 % Tube

255 Tiamin (Vitamin B1) 50 mg * Tablet

256 Timolol tetes mata 0.25 % Botol

257 Timolol tetes mata 0.5 % Botol

258 Tropikamid tetes mata 0.5 % Botol

259 Valproat sirup 250 mg/5 ml * Botol

260 Valproat 500 mg * Tablet Lepas Lambat

261 Valproat 250 mg * Tablet Lepas Lambat

262 Vitamin B kompeks Tablet

263 Zinc drops 10 mg/ml Botol

264 Zinc 20 mg Tablet Dispersible

265 Zinc serbuk 10 mg Sachet

266 Zinc sirup 20 mg/5 ml Botol

TAMBAHAN PUSKESMAS

1 kloramfenikol 500 Kapsul

2 klorpromazin hcl 100 mg Tab salut

3 Ambroksol 30 mg Tablet

4 Ambroksol syr Botol

5 Antibakteri Doen Salep (bacitracin - polimiksin) Tube

6 Atorvastatin 10 mg Tablet

7 Budesonid inhaler 160/4,5 mcg (symbicort) Botol

 8 Cefixime 200 mg Tablet

9 Clotrimazol cr Cream

10 Clozapin 25 mg Tablet

11 Gabapentin 100 mg Kapsul

12 Gentamisin Tetes Mata 0.2 % Botol

13 Gentamisin Salep Kulit Tube

14 Guaifenesin (GG) 100 mg Tablet

15 Kalium Diklofenak 50 mg Tablet

16 Lacto B Sachet

17 Lansoprazole 30 mg Kapsul

18 Levofloxacin 500 mg tablet

19 Loperamid 2 mg Tablet

20 Meloksikam 7.5 mg Tablet

21 Metilprednisolon 4 mg Tablet

22 Metoklorpramide sirup 5 mg/5 ml Botol

23 Multivitamin Anak syr Botol

24 Multivitamin Dewasa Tablet

25 Piroksikam 20 mg Kapsul

26 polikresulen cairan Botol

27 Risperidon 2 mg Tablet

28 Thiamfenicol 500 mg Kapsul

29 Natrium Dilkofenak 25 mg Tablet

30 Nifedipin 10 mg Tablet

31 Oksitetrasiklin Salep Kulit Tube

32 NaCl 0.9 % 500 ml Btol

33 Papaveri tab

34 pirasetam 400 mg

35 Glucosamin 500 mg Tablet

36 Pregabalin 75 mg Kapsul

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63
Mengetahui

Kepala Puskesmas Bulurokeng

dr. Andi Norman Hauritama

Nip. 19720901 201001 1 004

KETERANGAN
1 = Nomor Urut 13. MOHON DENGAN SANGAT TIDAK
2 = Nama Obat 14. MOHON DISERTAKAN SATUANNY
3 = Satuan 15. PP : PUSKESMAS PERAWATAN
4 = Harga Satuan (Rp) 16. * = RUJUK BALIK
5 = Pemakaian Rata-rata selama Tahun 2020
6 = Total Kebutuhan adalah Pemakaian Rata-rata selama Tahun 2020 x 12 Bulan
7 = Sisa Stok 28 Februari 2021
8 = Jumlah Yang Kadaluwarsa Tahun 2021 dan 2022
9 = Rencana Kebutuhan Obat Tahun 2022
10 = Total Harga (Rp) Obat Tahun 2022
11 = Fix Jumlah Obat yang dipesan dengan acuan tabel 9
12 = Fix Total Harga Obat yang dipesan
 PEMAKAIAN RATA-RATA PER TOTAL
HARGA SATUAN (Rp) BULAN SELAMA 2020 KEBUTUHAN 1 THN SISA STOK DES 2020
4 5 6 = 5 x 12 7
FORNAS : FASKES TKT 1

375 4,500 471

1 12 659

115 1,380 -

364 4,368 1,347

1 12 98

252 3,024 1,405

850 10,200 3,592

7 84 120

10 120 -

682 8,184 4,589

9 108 157

390 4,680 1,125

9 108 58

14 168
 -

2,500 30,000 18,474

740 8,880 6,841

40 480 447

12 144 1

- -

90 1,080 3,870

31 372 84

6 72 123

-
1,141 13,692 7,000

52 624 570

155 1,860 65

80 960 505

10 120

-
 -

25 300 275

15 180 241

28 336 1,047

2 24 41

2 24 51

390 4,680 -

20 240 880

143 1,716 -

28 336 200

-
 -

11 132 52

66 792 120

280 3,360 4,105

8 96 47

10 120 21

1,350 16,200 4,180

100 1,200 -

7 84 38

40 480 550

8 96 25

-
 1 12 42

22 264 90

4 48 56

5 60 48

1,014 12,168 7,647

30 360 236

12 144 440

3,200 38,400 5,400

1 12 46

21 252 154

162 1,944 986

-
 -

5 60

10 120 197

42 504 270

300 3,600 9,400

63 756 571

-
 60 720 225

8 96 187

3 36 34

12 144 87

185 2,220 1,310

1,253 15,036 1,459

13 156

26 312 149

-
 -

124 1,488 103

1 12 41

1,176 14,112 7,071

201 2,412 3,269

30 360 170

167 2,004 8,010

52 624 560

2 24 95

10 120 86

185 2,220 4,804

437 5,244 6,902

4 48 50

947 11,364 7,204

287 3,444 75

158 1,896 1,310

-
 -

1,062 12,744 4,984

2,450 29,400 4,809

55 660 2,615

8 96 6

25 300 170

40 480 1,410

450 5,400 6,513

6 72 30

8 96 9

162 1,944 -

1 12 6
 25 300 450

2 24 1

67 804 -

10 120 340

4 48 -

6 72 24

418 5,016 10,411

500

14 168 166

70 840 2,590

40 480 1,617

71 852 339

54 648 1,650

710 8,520 8,377

1 12 8

22 264 -

250 3,000 30

237 2,844 2,281

1 12 7

66 792 780

24 288 786

570 6,840 6,294

4 48 15

-
-

-
 TOTAL HARGA (Rp)

N DENGAN SANGAT TIDAK MENGUBAH FORMAT

N DISERTAKAN SATUANNYA UTK PKM YANG ADA TAMBAHAN OBAT
ESMAS PERAWATAN
 FIX
JUMLAH YG RENCANA KEBUTUHAN OBAT KEBUTUHAN OBAT YANG PESAN
ED 2021 DAN
2022 JUMLAH HARGA (Rp) JUMLAH HARGA (Rp)
8 9=6-7+8 10 = 9 x 4 11 12=11 x 4

- - -

4,029 - 4,100 -

(647) - -

1,380 - 2,000 -

3,021 - 4,000 -

- - -

- - -

- - -

98 12 - 100 -

1,405 3,024 - 4,000 -

6,608 - 8,000 -

(36) - -

120 - 200 -

3,595 - 5,000 -

- - -

- - -

107 58 - 100 -

3,555 - 5,000 -

- - -

50 - 50 -

- - -

168 - 200 -
 - - -

11,526 - 15,000 -

2,039 - 5,000 -

- - 256 -

- - 25 -

- - 25 -

- - 25 -

- - 25 -

- - 25 -

- - -

- - -

33 - 200 -

143 - 500 -

- - -

- - -

- - -

- - 150 -

3,870 1,080 - 1,500 -

- - -

84 372 - 400 -

- - -

- - 300 -

- - -

(51) - 50 -

- - -

- - -

- - -

- - 50 -
2,479 9,171 - 10,000 -

- - -

- - -

54 - -

- - -

- - 100 -

- - 100 -

- - -

- - 600 -

- - 50 -

1,795 - 1,500 -

455 - 600 -

120 - 120 -

- - 20 -

- - -

- - -

- - -

- - -

- - 200 -

- - -

- - 500 -

- - -

- - 500 -

- - -

- - -

- - -

- - -

- - -
 - - -

75 100 - 100 -

- - -

- - -

- - -

- - -

- - -

(61) - -

- - -

(711) - -

(17) - 25 -

51 24 - 25 -

- - -

- - -

4,680 - 5,000 -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

880 240 - 500 -

- - -

- - -

1,716 - 2,000 -

136 - -

- - -
 - - -

- - -

- - -

80 - 100 -

- - -

672 - 1,000 -

- - -

4,105 3,360 - 3,500 -

47 96 - 100 -

- - -

- - -

- - -

99 - 200 -

- - 50 -

12,020 - 20,000 -

- - -

- - -

1,200 - 1,500 -

- - -

- - -

- - -

46 - 50 -

550 480 - 600 -

25 96 - 200 -

- - -

- - -

- - 5,000 -

- - -
 42 12 - 25 -

- - -

- - -

174 - 300 -

(8) - 50 -

- - -

- - -

12 - 50 -

6,605 11,126 - 15,000 -

- - -

- - -

- - -

- - -

- - -

124 - 300 -

- - -

- - -

- - 1,000 -

- - 10 -

(296) - 300 -

33,000 - 40,000 -

46 12 - 20 -

98 - 300 -

986 1,944 - 2,000 -

- - 1,000 -

- - 20 -

- - -

- - -
 - - -

- - 24 -

- - 5 -

60 - 50 -

197 120 - 200 -

- - -

- - 5 -

- - -

234 - 1,000 -

- - -

- - 1,500 -

- - -

- - -

- - -

- - -

- - 300 -

- - 300 -

- - -

- - -

(5,800) - 5,000 -

- - -

- - -

- - -

- - -

- - -

185 - 500 -

- - -

- - 50 -
 495 - 1,000 -

- - -

- - -

(91) - 200 -

34 36 - 100 -

- - -

- - 1,000 -

- - -

- - -

- - -

- - -

- - -

- - -

57 - 150 -

- - -

- - 20 -

- - 20 -

- - 100 -

- - 20 -

- - -

1,310 2,220 - 3,000 -

- - -

13,577 - 15,000 -

156 - 200 -

163 - 300 -

- - -

- - -

- - -
 - - -

103 1,488 - 1,500 -

- - -

41 12 - 12 -

7,041 - 10,000 -

- - -

- - -

3,269 2,412 - 2,500 -

- - -

190 - 300 -

8,010 2,004 - 3,000 -

64 - 1,000 -

- - -

- - -

95 24 - 100 -

34 - 300 -

- - -

(2,584) - 5,000 -

- - -

9,902 8,244 - 5,000 -

(2) - -

4,160 - 10,000 -

- - -

3,369 - 5,000 -

586 - 5,000 -

- - -

- - -

- - 5 -
 - - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

7,760 - 10,000 -

- - -

- - -

- - -

- - -

- - -

- - -

24,591 - 35,000 -

- - -

2,615 660 - 500 -

- - -

6 96 - 200 -

- - -

130 - 200 -

(930) - 500 -

6,513 5,400 - 10,000 -

30 72 - 150 -

87 - 250 -

1,944 - 3,000 -

6 - 6 -
 (150) - 2,000 -

23 - 25 -

804 - 1,000 -

(220) - 500 -

48 - 48 -

48 - 48 -

10,411 5,016 - 10,000 -

- 1,000 -

166 168 - 200 -

2,590 840 - 1,500 -

1,617 480 - 600 -

513 - 2,000 -

1,650 648 - 1,500 -

8,377 8,520 - 10,000 -

8 12 - 12 -

264 - 500 -

2,970 - 10,000 -

2,281 2,844 - 3,500 -

7 12 - 12 -

780 792 - 1,000 -

786 288 - 300 -

546 - 5,000 -

- - 500 -

- - 200 -

15 48 - 48 -

- - 500 -

- - 1,000 -

- - 1,000 -
- - 1,000 -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -
 -

Makassar

Pengelola Obat Puskesmas Bulurokeng

Muthmainnah Nurdin, S.Farm., Apt

Nip. 19920604 201903 2 010
program
RENCANA KEBUTUHAN BMHP TAHUN 2022
PUSKESMAS BULU:

NO NAMA OBAT SATUAN

1 2 3

SESUAI LAMPIRAN KEPUTUSAN MENKES RI N0. HK.

01.07/MENKES/813/2019 TTG FORNAS : FASKES TKT 1

1 Articulating Paper Pcs

2 Aquadest 500 ml Botol

3 Bahan Tumpatan Sementara lar,serb Pcs

4 Chlorfenol Kamfer Mentol (CHKM) Botol

5 Etanol 70 % Botol

6 Etilklorida spray 100 ml Botol

7 Eugenol cairan Botol

8 Ferrakrilum cairan 1 % Pcs

9 Formokresol Cair Botol

10 Framisetin Sulfat 1 % Tube

Glass Ionomer ART (Atraumatic Restorative Treatment)
11 serb Pcs
Glass Ionomer ART (Atraumatic Restorative Treatment)
12 lar Pcs
Glass Ionomer ART (Atraumatic Restorative Treatment)
13 cocoa butter 5 g Pcs

14 Hidrogen Peroksida cairan 3 % Botol

15 Kalsium Hidroksida Pasta, Bubuk Pcs

 Kombinasi Deksametason Asetat 0.1 % Thymol 5 %
16 Paraklorphenol 30 % Champor 64 % Botol
Kombinasi Lidokain, medisinal, creosote phenol, eugenol,
17 benzil alkohol cairan Botol
Kombinasi Pasta Triamsinolon Asetonid & Dementil
18 Klortetrasiklin Pasta Pot

19 Komposit Resin Set

20 Natrium Hipoklorit cairan konsentrat 5 % Botol

21 Pasta Devitalisasi (Non Arsen) Botol

22 Pasta Pengisi Saluran Akar Pcs

23 Pasta Surgical Ginggival Pack Pack

24 Povidone Iodine Larutan 100 mg/ml Botol

TAMBAHAN (SESUAI FORMAT RKO 2020)

1 Alat Suntik 0,5 cc Pcs

2 Alat Suntik 1 cc Pcs

3 Alat Suntik 3 cc Pcs

4 Alat Suntik 5 cc Pcs

5 Alcohol Swab Pcs

6 Alkohol 70% 1 Liter Botol

7 Bahan Pengisi Untuk Gigi (Meta Biomed Metapex) Pcs

8 Bahan Pengobatan Untuk Pulpa Botol

9 Bahan Perawatan Akar Gigi Pack

10 Bahan Tambalan Tetap Tube

11 Bahan Tambalan Sementara (Dorident -Citodur) Pot 30 g

12 Benang Operasi Cromic Catgut with Needle 2.0 Pcs

13 Benang Operasi Cromic Catgut with Needle 3.0 Pcs

14 Blood Lancet Pcs

15 BRAUN INTROCAN G 18 Pcs

16 BRAUN INTROCAN G 20 x 1.25 Pcs

17 BRAUN INTROCAN G 22 Pcs

18 BRAUN INTROCAN G24 Pcs

19 CUTIMED GEL Pcs

20 Deck Glass (Sail Brand) Pcs

21 ECG Gel 1000 ml Dus

22 Face Mask with Ear-Loops (Jenis Karet) Pcs

23 Face Mask With Tie-On (Jenis Tali) Pcs

24 Gelang Nama Pasien Pcs

25 Handschoen 8 Pasang

26 Handschoen 7 Pasang

27 Handschoen 7.5 Pasang

28 Handschoen Gynecology Pasang

29 Handscoen Size L Pcs

30 Handscoen Size M Pcs

31 Human Hexagon Spilis Tes

32 Infusion Set (anak) Pcs

33 Infusion Set (Dewasa) Pcs

34 Jarum Injeksi Gigi Sekali Pakai (CK Jeet) Pcs

35 Kalsium Hidroksida Pasta Tube

36 Kapas Lidi IVA Pcs

37 Kapas Pembalut Roll

38 Kasa Hidrofil uk 4 cm x 10 cm Bungkus

39 Kasa pembalut steril 2 m X 80 cm Roll

40 Kertas ECG Roll

41 Larutan Ammonium Oxalat Botol

42 Larutan Asam Asetat 6% Botol 100 ml

43 Larutan Asam Sulfosalisilat Botol 100 ml

44 Larutan Barium Klorida 10 % Botol 100 ml

45 Larutan Benedict Botol 100 ml

46 Larutan EDTA Botol 100 ml

47 Larutan Eosin Botol 100 ml

48 Larutan Fauchet Botol 100 ml

49 Larutan HCl 0.1 N Botol 100 ml

50 Larutan Hayem Botol 100 ml

51 Larutan Injeksi Untuk Gigi (Inibsa/Artinibsa 4 %) Ampul

52 Larutan Metilen Blue Botol 100 ml

53 Larutan Natrium Citrat Botol

54 Larutan Rees Eckher Botol 100 ml

55 Larutan Rokles Botol 100 ml

56 Larutan Turk Botol 100 ml

57 Lubricating Gel 82 g Tube

58 Lysol 1 liter Botol

59 Masker N95 pcs

60 Natural Silk, 3/0 Black, 75,Taper, 1/2 26 mm Pcs

61 Object Glass (Sail Brand) Pcs

62 Penjepit Tali Pusat Pcs

63 Penutup Luka Lebar (Daryantulle) Pcs

64 Perfussor Line Black Pcs

65 Plaster Luka 2 x 5 Roll

66 Plester Non Woven ( Hypavix) Roll

67 Pot Dahak Pcs

68 Prontosan Wound Gel 30 ml Botol

69 Rapid Test Demam Berdarah(NS1) Panbio pcs

70 Reagensia LB Botol 500 g

71 Reagen Urinaria Test Pcs

72 Reagen Zn Paket

73 Rivanol 300 cc Botol

74 Speculum Disposable Ukuran L Pcs

75 Speculum Disposable Ukuran M PCS

76 Spon Dental Dos

77 Strip Asam Urat Pcs

78 Strip Cholesterol Stripe

79 Stripe Glucose Strip

80 Suction Catheter Anak No. 10 Pcs

81 Suction Catheter Anak No.8 Pcs

82 Suction Catheter dewasa No.12 Pcs

83 Surgical Blades Pcs

84 Tes Golongan Darah Set

85 Test Kehamilan Pcs

86 Vacuum Tube Steril EDTA GONGDONG Pcs

87 Widal Test Set

88 Wing Needle Pcs

89 Yodiform Pasta (bahan pengisi saluran akar) Botol

90 Zink Fosfat Set

TAMBAHAN PUSKESMAS

1 Konix Lubricating Gel 82 g Tube

2 Strip Shypilis Strip

3 Strip HBSAG Strip

4 Strip HIV Strip

9
10

Mengetahui

Kepala Puskesmas Bulurokeng

dr. Andi Norman Hauritama

Nip. 19720901 201001 1 004

KETERANGAN
1 = Nomor Urut 13. MOHON DENGAN SA
2 = Nama BMHP 14. MOHON DISERTAKAN
3 = Satuan 15. PP : PUSKESMAS PERAWA
4 = Harga Satuan (Rp) 16. * = RUJUK BALIK
5 = Pemakaian Rata-rata selama Tahun 2020
6 = Total Kebutuhan adalah Pemakaian Rata-rata selama Tahun 2020 x 12 Bulan
7 = Sisa Stok 28 Februari 2021
8 = Jumlah Yang Kadaluwarsa Tahun 2021 dan 2022
9 = Rencana Kebutuhan BMHP Tahun 2022
10 = Total Harga (Rp) BMHP Tahun 2022
11 = Fix Jumlah BMHP yang dipesan dengan acuan tabel 9
12 = Fix Total Harga BMHP yang dipesan
 PEMAKAIAN RATA-
HARGA SATUAN TOTAL KEBUTUHAN 1
(Rp) RATA PER BULAN THN SISA STOK DES 2021
SELAMA 2020

4 5 6 = 5 x 12 7

4 48 6

1 12 1

-
 -

2 24 6

1,472 312 3,744 590

955 50 600 -

909 36 432 2,100

936 66 792 370

110 103 1,236 336

25,800 4 48

572,000 -

485,485 -

335,720 -

617,045 1 12 1
199,210
-

9,850 -
 9,850 -
192
27 324 300

9,150 3 36 40

9,250 -

9,150 2 24 192

9,150 - - 200

84,000 -

135 -

26,000 -

536 590 7,080 476

622 -

1,186 -

11,775 -

25 300 400

13,750 -

490 -

490 479 5,748 5,900

26,774 -

5,104 -

4,756 2 24 53

1,892 11 132 220

463,100 -

1,232 18 216 195

13,750 1 12 10

1,367 15 180 405

10,340 2 24 4

46,500 1 12 2

49,665 -

75,000 -

265,100 -

22,000 -

81,400 -

130,000 -

187,000 -

178,200 -

12,100 -

25,300 -

6,853 -

37,400 -

22,715 -

56,100 -
56,100
-

35,200 -
 19,167 -

47,150 -

7,163 16 192 14

27,533 -

260 -

1,430 -

28,820 2 24 1

47,000 -

21,340 -

18,480 8 96 9

3,001 13 156 160

203,500 1 12 -

129,580 4 48 -

3,041,500 -

13,618 -

263,011 -

3,060 5 60 -

11,110 4 48 85

11,110 4 48 15

823,845 1 12 1

7,146 66 792 300

24,530 77 924 224

 6,116 40 480 400

8,844 -

8,844 -

8,844 -

783 2 24 122

1,567,500 1 12 1

1,380 27 324 40

1,125 -

1,991,000 -

12,067 -
630,000
-

373,945 -

3 36

- 25

- 200

- 150

-
 -

TOTAL HARGA (Rp)

MOHON DENGAN SANGAT TIDAK MENGUBAH FORMAT

MOHON DISERTAKAN SATUANNYA UTK PKM YANG ADA TAMBAHAN BMHP
P : PUSKESMAS PERAWATAN
= RUJUK BALIK

2020 x 12 Bulan
 RENCANA KEBUTUHAN BMHP KEBUTUHAN BMHP YANG PESAN
JUMLAH YG ED 2021
DAN 2022
JUMLAH HARGA (Rp) JUMLAH
8
9=6-7+8 10 = 9 x 4 11

- -

- - 24

- - 1

- - 1

- -

6 48 - 48

- -

- -

- -

- -

- - 2

- - 2

11 - 3

- -

- -
 - -

- -

- -

- -

- -

- -

- -

- -

6 24 - 30

- -

3,154 4,643,382 3,500

600 572,700 600

2,100 432 392,688 600

422 394,992 500

336 1,236 135,960

48 1,238,400

- -

- -

- -

1 12 7,404,540 2

- -

- -
 - -

300 324 62,208 600

40 36 329,400 36

- -

193 25 228,750 25

(200) (1,830,000)

- -

- -

- -

6,604 3,539,744 13,000

- -

- -

- -

- -

(100) - 500

- -

- -

(152) (74,478) 5,000

- -

- -

53 24 114,144 24

(88) (166,496) 100

 - -

21 25,872

2 27,500 10

(225) (307,575)

4 24 248,160 24

2 12 558,000 2

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -
 - -

- -

14 192 1,375,334 300

- -

- -

- -

1 24 691,680 24

- -

- -

87 1,607,760 100

(4) (12,004) 100

12 2,442,000 12

48 6,219,840 50

- -

- -

- -

60 183,600 20

(37) (411,070)

33 366,630 50

1 12 9,886,140 1

300 792 5,659,315 1,000

224 924 22,665,720 1,000

400 480 2,935,680 600

- -

- -

- -

(98) (76,754) 100

11 17,242,500 1

284 391,920 500

- -

- -

- -

- -

- -

- -

19 55 - 60

25 - - 100

200 - - 100

150 - - 100

- -

- -

- -

- -

- -
 - -

Makassar

Pengelola Obat Puskesmas Bulurokeng

Muthmainnah Nurdin, S.Farm., Apt

Nip. 19920604 201903 2 010
UTUHAN BMHP YANG PESAN

HARGA (Rp)

12=11 x 4

-
 -

5,152,770

572,700

545,400

468,000

1,234,090

-
 -

115,200

329,400

228,750

6,968,000

2,449,950

114,144

189,200
 -

137,500

248,160

93,000

-
 -

2,148,960

691,680

1,848,000

300,100

2,442,000

6,479,000

61,200

555,500

823,845

7,145,600

24,530,000
3,669,600

78,320

1,567,500

690,000

-
 -

71,877,569