SBBK Surat Bukti Barang Keluar Table List

<table align="center" width="50%" border="0"cellpadding="1" cellspacing="0">
<tr>
<td align="center" colspan="9">
<big><big><big><span style="font-weight: bold;">
SBBK (SURAT BUKTI BARANG KELUAR)<br>
NO : .............................
</span></big></big></big>
</td>
</tr>
</table>
<table align="center" width="80%" border="0" cellpadding="0" cellspacing="0">
<tr align="left">
<td colspan="2">No Faktur</td>
<td >: 7025</td>
<td >Tanggal</td>
<td >: 12-04-2023</td>
<td >Menyerahkan</td>
<td >:
Nama : WIWIK SRI UTAMI, A.md.Far </td>
<td >
Nip : 196812301991032009 </td>
<td >
No Pesanan : LPLPO </td>
<td>
</td>
</tr>
<tr align="left">
<td colspan="2">PKM Tujuan</td>
<td >: PUSKESMAS TUGU</td>
<td >Nomor SBBK</td>
<td >: 442/ / 406.010.02/IV/2023 </td>
<td >Menerima</td>
<td >:
Nama : .................................... </td>
<td >
Nip :..................................... </td>
</tr>
</tr>
</table><br><table align="center" width="80%" style="border-collapse:collapse;"
border="1" cellpadding="2" cellspacing="2">
<tr class="row1" align="center">
<td class="garis">No</td>
<td class="garis">Kode </td>
<td class="garis">Nama </td>
<td class="garis">Batch</td>
<td class="garis">Ed</td>
<td class="garis">Jumlah</td>
<td class="garis">Sumber Dana</td>
<td class="garis">Harga (Rp.)</td>
<td class="garis">Total (Rp.)</td>
<td class="garis">Hapus</td>
</tr>
<tr class="font a-font" bgcolor='#efefef'>
<td class="garis" align="center">1 </td>
<td class="garis" align="left">Amlodipin 10 mg</td>
<td class="garis" align="left">2302-09-327/2302-07-327</td>
<td class="garis" align="center">28-02-2025</td>
<td class="garis" align="center">
5,010<font color="red"> TABLET</font>
</td>
<td class="garis" align="center">BELANJA OBAT OBATAN </td>
119 </td>
596,190 </td>
</td>
</tr>
<td class="garis" align="left">Antasida kombinasi tablet kunyah</td>
<td class="garis" align="left">T4558001</td>
</td>
139 </td>
278,000 </td>
</td>
</tr>
<td class="garis" align="left">Anti Flu / DEMACOLIN</td>
<td class="garis" align="left">22GA007</td>
100<font color="red"> TABLET</font>
</td>
840 </td>
84,000 </td>
</td>
</tr>
<td class="garis" align="left">Asam Askorbat 50 mg (Vitamin C)</td>
<td class="garis" align="left">C20079N / C20083N</td>
</td>
42 </td>
42,000 </td>
</td>
</tr>
<td class="garis" align="left">Asam Mefenamat 500 mg</td>
<td class="garis" align="left">HTMCA23410/23420</td>
</td>
111 </td>
111,000 </td>
</td>
</tr>
<td class="garis" align="left">Asiklovir 400 mg</td>
<td class="garis" align="left">2630408100</td>
</td>
<td class="garis" align="center">DAK </td>
405 </td>
40,500 </td>
</td>
</tr>
<td class="garis" align="left">Asiklovir krim</td>
19<font color="red"> TUBE</font>
</td>
3,543 </td>
67,314 </td>
</td>
</tr>
<td class="garis" align="left">Asiklovir krim</td>
<td class="garis" align="left">1628/1728</td>
</td>
3,543 </td>
38,971 </td>
</td>
</tr>
<td class="garis" align="left">Atropin injeksi 0,25mg/ml
(i.v./i.m./s.k.)</td>
<td class="garis" align="left">9621M0359A</td>
10<font color="red"> AMPUL</font>
</td>
1,718 </td>
17,180 </td>
</td>
</tr>
<td class="garis" align="left">Bedak Salicyl Serbuk 2%</td>
<td class="garis" align="left">K11393S/K11455S/K11454S/K11457S</td>
12<font color="red"> KOTAK</font>
</td>
6,670 </td>
80,037 </td>
</td>
</tr>
<td class="garis" align="left">Betamethasone krim 0,1%</td>
<td class="garis" align="left">K08007BB/K08006BB</td>
</td>
2,621 </td>
62,894 </td>
</td>
</tr>
<td class="garis" align="left">Clozapin 25 mg</td>
<td class="garis" align="left">53G1005/53F0803</td>
</td>
477 </td>
95,400 </td>
</td>
</tr>
<td class="garis" align="left">Deksamethasone 0,5 mg</td>
<td class="garis" align="left">2303-07-150</td>
</td>
66 </td>
66,000 </td>
</td>
</tr>
<td class="garis" align="left">Deksamethasone injeksi 5mg/ml
(i.v./i.m.)</td>
</td>
999 </td>
99,900 </td>
</td>
</tr>
<td class="garis" align="left">Domperidon 10 mg</td>
<td class="garis" align="left">54C0743</td>
</td>
230 </td>
115,000 </td>
</td>
</tr>
<td class="garis" align="left">Epinefrin (adrenalin) injeksi 0,1%
(i.v./s.k./i.m.)</td>
<td class="garis" align="left">9622B0025A</td>
</td>
1,515 </td>
45,450 </td>
</td>
</tr>
<td class="garis" align="left">Etanol 70% 1000 ml</td>
5<font color="red"> BOTOL</font>
</td>
<td class="garis" align="center">BELANJA BAHAN LAINNYA </td>
26,180 </td>
130,900 </td>
</td>
</tr>
<td class="garis" align="left">Flufenazin injeksi 25mg/ml
(i.m.)/SIKZONOATE</td>
<td class="garis" align="left">2EAD5244</td>
</td>
80,586 </td>
402,930 </td>
</td>
</tr>
<td class="garis" align="left">Gentamisin salep kulit 0,1%</td>
<td class="garis" align="left">G07EL015</td>
</td>
2,893 </td>
57,851 </td>
</td>
</tr>
<td class="garis" align="left">Gentian Violet 1%</td>
5<font color="red"> BOTOL</font>
</td>
<td class="garis" align="center">DAK </td>
2,310 </td>
11,550 </td>
</td>
</tr>
<td class="garis" align="left">Glibenklamid 5 mg</td>
<td class="garis" align="left">F12061J</td>
</td>
<td class="garis" align="center">BANTUAN PROPINSI </td>
82 </td>
82,000 </td>
</td>
</tr>
<td class="garis" align="left">Haloperidol 1,5 mg</td>
</td>
191 </td>
95,429 </td>
</td>
</tr>
<td class="garis" align="left">Hand Schoen non Steril Free Powder ukuran
M/L</td>
<td class="garis" align="left"></td>
1,000<font color="red"> PCS</font>
</td>
<td class="garis" align="center">DAU ASCOV </td>
1,250 </td>
1,250,000 </td>
</td>
</tr>
<td class="garis" align="left">Hidroklortiazid 25 mg (HCT)</td>
<td class="garis" align="left">C20111B</td>
</td>
148 </td>
44,400 </td>
</td>
</tr>
<td class="garis" align="left">Hidrokortison Krim 2,5%</td>
<td class="garis" align="left">K23703W</td>
</td>
1,272 </td>
19,085 </td>
</td>
</tr>
<td class="garis" align="left">Hidrokortison Krim 2,5%</td>
<td class="garis" align="left">A30285W/A30286W</td>
</td>
2,800 </td>
92,400 </td>
</td>
</tr>
<td class="garis" align="left">Ibuprofen 400 mg</td>
<td class="garis" align="left">1204213/1204212/1204216/120414/1204215</td>
</td>
190 </td>
190,000 </td>
</td>
</tr>
<td class="garis" align="left">Kalsium Laktat 500 mg (KALK)</td>
</td>
100 </td>
100,000 </td>
</td>
</tr>
<td class="garis" align="left">Klorfeniramin Maleat 4 mg (CTM)</td>
</td>
49 </td>
147,000 </td>
</td>
</tr>
<td class="garis" align="left">Klorpromazin 100 mg</td>
<td class="garis" align="left">A21451/A21574</td>
</td>
285 </td>
85,371 </td>
</td>
</tr>
<td class="garis" align="left">Lidokain 2%+Epinefrin 1:80.000 injeksi 2ml
(COMP.)</td>
<td class="garis" align="left">58815025/58815024/568125-1/568125-2</td>
</td>
1,332 </td>
119,880 </td>
</td>
</tr>
<td class="garis" align="left">Loratadin 10 mg</td>
</td>
123 </td>
123,000 </td>
</td>
</tr>
<td class="garis" align="left">Masker Medis 3 Ply </td>
<td class="garis" align="left">2468-1</td>
1,000<font color="red"> PCS</font>
</td>
<td class="garis" align="center">DAU ASCOV </td>
790 </td>
790,000 </td>
</td>
</tr>
<td class="garis" align="left">Metil Ergometrin 0,125 mg</td>
<td class="garis" align="left">D20788J</td>
</td>
214 </td>
21,400 </td>
</td>
</tr>
<td class="garis" align="left">Metronidazole 500 mg</td>
</td>
197 </td>
39,314 </td>
</td>
</tr>
<td class="garis" align="left">Parasetamol 500 mg</td>
<td class="garis" align="left">A3C114/A3C116</td>
</td>
185 </td>
370,000 </td>
</td>
</tr>
<td class="garis" align="left">Ranitidin 150 mg</td>
<td class="garis" align="left">HTRNTB22089</td>
</td>
85 </td>
42,500 </td>
</td>
</tr>
<td class="garis" align="left">Ringer Laktat larutan infus (RL)</td>
200<font color="red"> 500 ML</font>
</td>
7,860 </td>
1,572,000 </td>
</td>
</tr>
<td class="garis" align="left">Serum Anti Tetanus injeksi 1.500 IU
(A.T.S.)</td>
</td>
140,187 </td>
2,803,749 </td>
</td>
</tr>
<td class="garis" align="left">Thiamin 50 mg (Vitamin B1)</td>
<td class="garis" align="left">G20214/G20213/G20212</td>
</td>
131 </td>
65,490 </td>
</td>
</tr>
</table>
<br>
<br>
<table align="center" width="90%" border="0"cellpadding="2" cellspacing="2">
<tr valign="top">
<td colspan="2" >Mengetahui/Menyetujui<br>Kepala UPT Gudang
Farmasi</td>
<td></td>
<td >Yang Mengantar/Menyerahkan</td>
<td></td>
<td >Yang Menerima<br>Petugas Puskesmas</td>
</tr>
</table>

SBBK Surat Bukti Barang Keluar Table List

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