NO Nama Barang/Jenis Barang Satuan Barang

1 2 3
POLI GIGI
1 Endoseal Pack
2 GIC Type 2 ART Set
3 GIC Type 2 Restorasi Set
4 Microbrush Pack
5 Cresotin No. 1 Set
6 Cresotin No. 2 Set
7 Eugenol Cair Botol
8 Tooth Strain Remover Botol
9 Bonding Botol
10 Composite A2 Buah
11 Composit A3 Buah
12 Tumpatan Sementara Buah
13 Topikal Anestesi Buah
14 Matrik Seluloit Strip Pack
15 Povidon iodida 10% larutan - 30 ml botol
16 Povidon iodida 10% larutan - 300 ml botol
17 Lidocain komp. injeksi 2 % - ml ampul
18 Chloretyl Spray Botol
19 Bendchek Botol
JUMLAH GIGI
TINDAKAN
1 Aquabidest (Aqua Pro Inject) 20 ml ampul
2 Povidon iodida 10% larutan - 300 ml botol
3 Ranitidine Inj ampul
4 Lidocain komp. injeksi 2 % - ml ampul
5 Poro Supositoria 125 mg Suppositoria
6 Natrium Klorida larutan infus 0,9% - 500 ml botol
7 Alat Suntik sekali pakai 3 ml pcs
8 Alat Suntik sekali pakai 5 ml pcs
9 Alat Suntik sekali pakai 1 ml (Tuberkulin) pcs
10 Alat Suntik 0,5 ml (Vaksinasi) Pcs
11 Urine bag steril 2 L pcs
12 Alkohol Swab (Vaksinasi) Pcs
13 Blood Lancet pcs
14 Fixomull Stretch 5cm x 5m roll
15 Ok Plast Spot (Plesterin Bulat) Pcs
16 Jarum Suntik / Needle No. 25 BD Pcs
17 Nasal Aspirator ( Penguin ) ERN Pak
18 Bactigras 10 x 10 Lembar
19 Silk 3/0 pcs
20 Surgical Blade No. 10 Onemed Pcs
21 Catgut 3/0 pcs
22 Kasa 16 x 16 cm kotak
23 I.V CHAT 26 G pcs
24 I.V CHAT 24G X 3/4 pcs
25 I.V CHAT 22G X 1 pcs
26 Infus Set Dewasa Onemed Box
27 Alkohol 1 Liter Medika Liter
28 Sarung Tangan Steril No. 8 Maxter Pasang
29 I.V CHAT 18GX2 pcs
30 Kasa Pembalut Hidrofil 4 m x 5 cm bks
31 Kasa Pembalut Hidrofil 4 m x 10 cm bks
32 Nasal Oksigen Canula Dewasa Buah
33 Nasal Oksigen Canula Bayi Buah
34 Masker Nebulizer Set Anak Set
35 Maxiflow Dewasa / Masker Oksigen Dewasa Besmed Set
JUMLAH TINDAKAN
LABOLATORIUM
1 HIV Test 2 (FOKUS) tes/ kit
2 Reagen Rapid Test HBsAg Test/kit
3 Vacutainer Edta GP, kaca 3 ml B/100 Pcs
4 Kartu Gol. Darah 100 Pak
5 Test Kehamilan Strips Package
6 Sarung Tangan Non Steril Uk. S SuperGard Pasang
7 Sarung Tangan Non Steril Uk. L SuperGard Pasang
8 Plester Bulat Non Moven OK Plas Botol
9 Objek Glass 72/box Box
10 Alat Suntik sekali pakai 3 ml pcs
11 Blood Lancet pcs
12 Urine Test 3 P Tube
13 Urine Strip 11 Tube
14 M 30 D Diluent, 20 L Galon
15 M 30 CFL Lyse, 500 ml Botol
16 M 30 Probe Cleanser Mindray Kit
17 Blood Glucose On Call Srtip Test Acon Strip
18 Humasens Cholesterol Test Strip Strip
19 Reagen Widal Set Set
20 Gol. Darah Set Botol
21 Alkohol 1 Liter Medika Liter
22 Pot dahak pot
JUMLAH LABOLATORIUM
PONED
1 Amoksisilin kaplet 500 mg tablet
2 Etafen ( Ibuprofen 400 mg ) Tablet
3 Metronidazole Tablet 500 mg Tablet
4 Asam Mefenamat tablet 500 mg tablet
5 Metildopa (Dopamet) 250mg tablet
6 Carbidu 0.5 mg (1) Tablet
7 Antasida DOEN tablet tablet
8 Zendalat Tablet
 9 Kalsium lactat 500 mg tablet
10 Parcetamol Triman (1) Tablet
11 Domperidon Tablet 10 mg Tablet
12 Ranitidine tablet 150 mg tablet
13 Sagestam Inj (1) Vial
14 Dexametason inj ampul
15 Ondansetron 8 mg Inj (2) Ampul
16 Metilergometrin maleat (Metergin) tablet salut 0,125 mg tablet
17 Retinol kapsul lunak 200.000 IU kapsul
18 Magnesium sulfat injeksi 20% - 25 ml vial
19 Magnesium sulfat injeksi 40% - 25 ml vial
20 Lidocain komp. injeksi 2 % - ml ampul
21 Aquabidest (Aqua Pro Inject) 20 ml ampul
22 Gentamisin salep mata tube
23 Kloramfenikol 1% Salep Mata tube
24 Povidon iodida 10% larutan - 300 ml botol
25 Metilergometrin maleat injeksi 0,2 mg/ml ampul
26 Oksitosin injeksi 10 IU/ml tablet
27 Ringer Laktat larutan infus - 500 ml botol
28 Natrium Klorida larutan infus 0,9% - 500 ml botol
29 Plester Roll Uk. 5 x 4,5 Cm ROLL
30 Masker N95 Pcs
31 Umbilical Cord Klem Cosa Pcs
32 Alkohol 1 Liter Medika Liter
33 Masker KN95 Pcs
34 Urine Bag Onemed Botol
35 Kasa 16 x 16 cm kotak
36 Nasal Oksigen Canula Dewasa Buah
37 Sarung Tangan Obgyn psg
38 Folley Catheter 2 Way No. 20 GC Vial
39 Sarung Tangan Steril No. 8 Maxter Pasang
40 Alat Suntik sekali pakai 1 ml (Tuberkulin) pcs
41 Alat Suntik sekali pakai 3 ml pcs
JUMLAH PONED
TB
1 Obat antituberkulosa FDC kat. 1 (OAT KDT Dosis Harian) paket
2 Obat antituberkulosa FDC kat. Anak Paket
3 Obat antituberkulosa FDC kat. 2 paket
4 Masker N95 Pcs
JUMLAH TB
GIZI
1 PMT BALITA karton
JUMLAH GIZI
JUMLAH TOTAL PERSEDIAAN
 Stok Akhir Per 05 April 2023 Ket
Sumber Anggaran Jumlah
Harga Barang Jumlah Harga
Barang
4 5 6 7 8

BLUD2022 1 298,736.49 298,736.49 BMHP

BLUD2022 1 898,990.99 898,990.99 BMHP
BLUD2022 1 898,990.99 898,990.99 BMHP
BLUD2022 3 54,518.02 163,554.05 BMHP
BLUD2022 1 261,463.96 261,463.96 BMHP
BLUD2022 1 261,463.96 261,463.96 BMHP
BLUD 2020 1 121,000.00 121,000.00 BMHP
BLUD2022 1 149,646.40 149,646.40 BMHP
BLUD2022 3 99,022.52 297,067.57 BMHP
BLUD2022 2 898,990.99 1,797,981.98 BMHP
BLUD2022 1 898,990.99 898,990.99 BMHP
BLUD2022 1 84,002.25 84,002.25 BMHP
BLUD2022 1 149,646.40 149,646.40 BMHP
BLUD2022 1 69,538.29 69,538.29 BMHP
APBD (DAK) 2020 3 2,862.50 8,587.50 BMHP
APBD (DAK) 2022 5 25,530.00 127,650.00 BMHP
APBD (DAK) 2022 30 803.00 24,090.00 BMHP
BLUD2022 2 99,022.52 198,045.05 BMHP
BLUD2022 2 149,646.40 299,292.79 BMHP
7,008,739.66

APBD (DAK) 2020 20 2,449.00 48,980.00 OBAT

APBD (DAK) 2022 6 25,530.00 153,180.00 OBAT
BLUD 2022 3 2,142.30 6,426.90 OBAT
APBD (DAK) 2022 29 803.00 23,287.00 OBAT
BLUD 2022 10 14,208.00 142,080.00 OBAT
APBD (DAK) 2021 10 6,800.00 68,000.00 OBAT 441,953.90 OBAT
APBD (DAK) 2021 106 880.00 93,280.00 BMHP
APBN 2020 20 1,583.00 31,660.00 BMHP
APBN 2021 100 1,668.00 166,800.00 BMHP
APBD PROVINSI 2021 60 1,185.00 71,100.00 BMHP
APBD 2020 28 3,000.00 84,000.00 BMHP
APBD PROVINSI 2022 100 79.00 7,900.00 BMHP
APBD (DAK) 2021 100 92.00 9,200.00 BMHP
APBD (DAK) 2021 19 49,500.00 940,500.00 BMHP
APBD (BTT I) 2021 5 300.00 1,500.00 BMHP
BLUD 2020 200 770.00 154,000.00 BMHP
BLUD 2020 1 99,000.00 99,000.00 BMHP
BLUD 2020 7 16,700.00 116,900.00 BMHP
APBD (DAK) 2021 14 45,100.00 631,400.00 BMHP
BLUD 2020 50 880.00 44,000.00 BMHP
APBD (DAK) 2021 19 42,690.00 811,110.00 BMHP
APBD (DAK) 2021 48 8,000.00 384,000.00 BMHP
APBD (DAK) 2021 1 4,200.00 4,200.00 BMHP
APBD (DAK) 2021 2 4,818.00 9,636.00 BMHP
APBD (DAK) 2021 1 4,818.00 4,818.00 BMHP
BLUD 2020 16 4,478.57 71,657.14 BMHP
BLUD 2020 2 121,000.00 242,000.00 BMHP
BLUD 2021 2 9,900.00 19,800.00 BMHP
APBD (DAK) 2021 1 3,800.00 3,800.00 BMHP
APBD 2013 30 550.00 16,500.00 BMHP
APBD 2013 6 1,100.00 6,600.00 BMHP
BLUD 2021 1 5,500.00 5,500.00 BMHP
BLUD 2021 1 6,490.00 6,490.00 BMHP
BLUD 2020 6 35,750.00 214,500.00 BMHP
BLUD 2020 4 27,500.00 110,000.00 BMHP 4,361,851.14 BMHP
4,803,805.04

APBN 2020 250 12,500.00 3,125,000.00 BMHP

APBN 2022 - 7,369.00 - BMHP
BLUD 2020 290 693.00 200,970.00 BMHP
BLUD 2021 600 58,850.00 35,310,000.00 BMHP
BLUD 2020 65 82,500.00 5,362,500.00 BMHP
BLUD 2021 300 3,960.00 1,188,000.00 BMHP
BLUD 2021 50 3,960.00 198,000.00 BMHP
BLUD 2020 8 22,000.00 176,000.00 BMHP
BLUD 2021 72 39,050.00 2,811,600.00 BMHP
APBD (DAK) 2021 200 880.00 176,000.00 BMHP
APBD (DAK) 2021 1,600 92.00 147,200.00 BMHP
BLUD 2021 130 130,900.00 17,017,000.00 BMHP
BLUD 2021 100 130,900.00 13,090,000.00 BMHP
BLUD 2021 1 2,343,000.00 2,343,000.00 BMHP
BLUD 2021 3 3,349,500.00 10,048,500.00 BMHP
BLUD 2021 2 627,000.00 1,254,000.00 BMHP
APBD (DAK) 2022 1,203 8,575.76 10,316,639.78 BMHP
APBD 2022 55 27,000.00 1,485,000.00 BMHP
BLUD 2021 1 1,260,600.00 1,260,600.00 BMHP
BLUD 2021 1 92,950.00 92,950.00 BMHP
BLUD 2020 2 121,000.00 242,000.00 BMHP
APBN 2022 320 2,624.00 839,680.00 BMHP
106,684,639.78

APBD (DAK) 2022 140 202.83 28,395.81 OBAT

BLUD 2020 200 227.13 45,425.60 OBAT
BLUD 2020 180 286.00 51,480.00 OBAT
APBD (DAK) 2022 390 112.01 43,683.94 OBAT
APBD (DAK) 2022 260 994.56 258,585.60 OBAT
BLUD 2021 - 195.00 - OBAT
APBD (DAK) 2020 259 58.00 15,022.00 OBAT
BLUD 2022 640 586.08 375,091.20 OBAT
APBD (DAK) 2021 380 60.00 22,800.00 OBAT
BLUD 2021 480 199.00 95,520.48 OBAT
APBD (DAK) 2022 200 71.00 14,200.00 OBAT
APBD (DAK) 2022 64 85.77 5,489.26 OBAT
BLUD 2021 29 15,799.96 458,198.84 OBAT
BLUD 2022 78 2,197.80 171,428.40 OBAT
BLUD 2021 25 17,160.00 429,000.00 OBAT
APBD (DAK) 2022 180 214.00 38,520.00 OBAT
APBN 2022 180 553.00 99,540.00 OBAT
APBD (DAK) 2021 13 3,580.00 46,540.00 OBAT
APBD (DAK) 2021 12 4,090.00 49,080.00 OBAT
APBD (DAK) 2022 150 803.00 120,450.00 OBAT
APBD (DAK) 2020 88 2,449.00 215,512.00 OBAT
APBD (DAK) 2020 16 2,675.00 42,800.00 OBAT
APBD (DAK) 2020 2 2,007.00 4,014.00 OBAT
APBD (DAK) 2022 3 25,530.00 76,590.00 OBAT
APBD (DAK) 2021 100 1,023.00 102,300.00 OBAT
APBN 2022 2 1,126.00 2,252.00 OBAT
APBD (DAK) 2021 23 7,630.00 175,490.00 OBAT
APBD (DAK) 2021 1 6,800.00 6,800.00 OBAT 2,994,209.13 0BAT
BLUD 2020 18 12,834.00 231,012.00 BMHP
APBD PROVINSI 2021 46 12,500.00 575,000.00 BMHP
BLUD 2020 100 1,496.00 149,600.00 BMHP
BLUD 2020 10 121,000.00 1,210,000.00 BMHP
APBD PROVINSI 2020 30 20,700.00 621,000.00 BMHP
BLUD 2020 38 5,280.00 200,640.00 BMHP
APBD (DAK) 2021 80 8,000.00 640,000.00 BMHP
BLUD 2021 3 5,500.00 16,500.00 BMHP
APBD (BTT I) 2021 75 17,272.73 1,295,454.60 BMHP
BLUD 2020 10 9,350.00 93,500.00 BMHP
BLUD 2021 100 9,900.00 990,000.00 BMHP
APBN 2021 200 1,668.00 333,600.00 BMHP
APBD (DAK) 2021 300 880.00 264,000.00 BMHP 6,620,306.60 BMHP
9,614,515.73

APBD PROVINSI 2022 26 511,609.00 13,301,834.00 OBAT

APBN 2022 3 246,010.00 738,030.00 OBAT
APBN 2021 3 1,384,977.00 4,154,931.00 OBAT 18,194,795.00 OBAT
APBD PROVINSI 2021 62 12,500.00 775,000.00 BMHP 775,000.00 BMHP
18,969,795.00

APBN 2 30,250.00 60,500.00

60,500.00
147,141,995.22
REKAP PENGELUARAN HARIAN TB PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Satuan Jumlah permintaan
NO Nama Barang/Jenis Barang HARGA Pemakaian Akhir
Barang Awal Penerimaan Jumlah Bulan bulan
1 2 3 4 5 6 7
TB
Obat antituberkulosa FDC kat. 1
1 (OAT KDT Dosis Harian) paket 511,609.00 26
Obat antituberkulosa FDC kat.
2 Anak Paket 246,010.00 3
3 Obat antituberkulosa FDC kat. 2 paket 1,384,977.00 3
4 Masker N95 Pcs 12,500.00 62

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN PONED PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Satuan Jumlah
NO Nama Barang/Jenis Barang HARGA Pemakaian Akhir
Barang Awal Penerimaan Jumlah Bulan permintaan bulan
1 2 3 4 5 6 7
PONED
1 Amoksisilin kaplet 500 mg tablet 202.83 140
2 Etafen ( Ibuprofen 400 mg ) Tablet 227.13 200
3 Metronidazole Tablet 500 mg Tablet 286.00 180
4 Asam Mefenamat tablet 500 mg tablet 112.01 390
5 Metildopa (Dopamet) 250mg tablet 994.56 260
6 Carbidu 0.5 mg (1) Tablet 195.00 -
7 Antasida DOEN tablet tablet 58.00 259
8 Zendalat Tablet 586.08 640
9 Kalsium lactat 500 mg tablet 60.00 380
10 Parcetamol Triman (1) Tablet 199.00 480
11 Domperidon Tablet 10 mg Tablet 71.00 200
12 Ranitidine tablet 150 mg tablet 85.77 64
13 Sagestam Inj (1) Vial 15,799.96 29
14 Dexametason inj ampul 2,197.80 78
15 Ondansetron 8 mg Inj (2) Ampul 17,160.00 25
Metilergometrin maleat (Metergin)
tablet 214.00 180
16 tablet salut 0,125 mg
17 Retinol kapsul lunak 200.000 IU kapsul 553.00 180

Magnesium sulfat injeksi 20% - 25 ml vial 3,580.00 13

18
Magnesium sulfat injeksi 40% - 25 ml vial 4,090.00 12
19
20 Lidocain komp. injeksi 2 % - ml ampul 803.00 150

Aquabidest (Aqua Pro Inject) 20 ml ampul 2,449.00 88

21
22 Gentamisin salep mata tube 2,675.00 16
23 Kloramfenikol 1% Salep Mata tube 2,007.00 2

Povidon iodida 10% larutan - 300 ml botol 25,530.00 3

24
Metilergometrin maleat injeksi 0,2
ampul 1,023.00 100
25 mg/ml
26 Oksitosin injeksi 10 IU/ml tablet 1,126.00 2

Ringer Laktat larutan infus - 500 ml botol 7,630.00 23

27
Natrium Klorida larutan infus 0,9% -
botol 6,800.00 1
28 500 ml
29 Plester Roll Uk. 5 x 4,5 Cm ROLL 12,834.00 18

30 Masker N95 Pcs 12,500.00 46

31 Umbilical Cord Klem Cosa Pcs 1,496.00 100
32 Alkohol 1 Liter Medika Liter 121,000.00 10

33 Masker KN95 Pcs 20,700.00 30

34 Urine Bag Onemed Botol 5,280.00 38
35 Kasa 16 x 16 cm kotak 8,000.00 80
36 Nasal Oksigen Canula Dewasa Buah 5,500.00 3
37 Sarung Tangan Obgyn psg 17,272.73 75
38 Folley Catheter 2 Way No. 20 GC Vial 9,350.00 10

Sarung Tangan Steril No. 8 Maxter Pasang 9,900.00 100

39
Alat Suntik sekali pakai 1 ml
pcs 1,668.00 200
40 (Tuberkulin)
41 Alat Suntik sekali pakai 3 ml pcs 880.00 300

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN LAB PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Satuan Jumlah
NO Nama Barang/Jenis Barang HARGA Pemakaian Akhir
Barang Awal Penerimaan Jumlah Bulan permintaan bulan
1 2 3 4 5 6 7
LABOLATORIUM
1 HIV Test 2 (FOKUS) tes/ kit 12,500.00 250
2 Reagen Rapid Test HBsAg Test/kit 7,369.00 -

Vacutainer Edta GP, kaca 3 ml B/100 Pcs 693.00 290

3
4 Kartu Gol. Darah 100 Pak 58,850.00 600
5 Test Kehamilan Strips Package 82,500.00 65
Sarung Tangan Non Steril Uk. S
Pasang 3,960.00 300
6 SuperGard
Sarung Tangan Non Steril Uk. L
Pasang 3,960.00 50
7 SuperGard
8 Plester Bulat Non Moven OK Plas Botol 22,000.00 8
9 Objek Glass 72/box Box 39,050.00 72
10 Alat Suntik sekali pakai 3 ml pcs 880.00 200
11 Blood Lancet pcs 92.00 1,600
12 Urine Test 3 P Tube 130,900.00 130
13 Urine Strip 11 Tube 130,900.00 100
14 M 30 D Diluent, 20 L Galon 2,343,000.00 1
15 M 30 CFL Lyse, 500 ml Botol 3,349,500.00 3
16 M 30 Probe Cleanser Mindray Kit 627,000.00 2

Blood Glucose On Call Srtip Test Acon Strip 8,575.76 1,203

17
18 Humasens Cholesterol Test Strip Strip 27,000.00 55
19 Reagen Widal Set Set 1,260,600.00 1
20 Gol. Darah Set Botol 92,950.00 1
21 Alkohol 1 Liter Medika Liter 121,000.00 2
22 Pot dahak pot 2,624.00 320

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN TINDAKAN PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Jumlah
NO Nama Barang/Jenis Barang Satuan Barang HARGA Pemakaian Akhir permintaan
Awal Penerimaan Jumlah Bulan bulan
1 2 3 4 5 6 7
POLI GIGI
1 Aquabidest (Aqua Pro Inject) 20 ml ampul 2,449.00 20
2 Povidon iodida 10% larutan - 300 ml botol 25,530.00 6
3 Ranitidine Inj ampul 2,142.30 3
4 Lidocain komp. injeksi 2 % - ml ampul 803.00 29
5 Poro Supositoria 125 mg Suppositoria 14,208.00 10
Natrium Klorida larutan infus 0,9% - 500
botol 6,800.00 10
6 ml
7 Alat Suntik sekali pakai 3 ml pcs 880.00 106
8 Alat Suntik sekali pakai 5 ml pcs 1,583.00 20

Alat Suntik sekali pakai 1 ml (Tuberkulin) pcs 1,668.00 100

9
10 Alat Suntik 0,5 ml (Vaksinasi) Pcs 1,185.00 60
11 Urine bag steril 2 L pcs 3,000.00 28
12 Alkohol Swab (Vaksinasi) Pcs 79.00 100
13 Blood Lancet pcs 92.00 100
14 Fixomull Stretch 5cm x 5m roll 49,500.00 19
15 Ok Plast Spot (Plesterin Bulat) Pcs 300.00 5
16 Jarum Suntik / Needle No. 25 BD Pcs 770.00 200
17 Nasal Aspirator ( Penguin ) ERN Pak 99,000.00 1
18 Bactigras 10 x 10 Lembar 16,700.00 7
19 Silk 3/0 pcs 45,100.00 14
20 Surgical Blade No. 10 Onemed Pcs 880.00 50
21 Catgut 3/0 pcs 42,690.00 19
22 Kasa 16 x 16 cm kotak 8,000.00 48
23 I.V CHAT 26 G pcs 4,200.00 1
24 I.V CHAT 24G X 3/4 pcs 4,818.00 2
25 I.V CHAT 22G X 1 pcs 4,818.00 1
26 Infus Set Dewasa Onemed Box 4,478.57 16
27 Alkohol 1 Liter Medika Liter 121,000.00 2
28 Sarung Tangan Steril No. 8 Maxter Pasang 9,900.00 2
29 I.V CHAT 18GX2 pcs 3,800.00 1
30 Kasa Pembalut Hidrofil 4 m x 5 cm bks 550.00 30
31 Kasa Pembalut Hidrofil 4 m x 10 cm bks 1,100.00 6
32 Nasal Oksigen Canula Dewasa Buah 5,500.00 1
33 Nasal Oksigen Canula Bayi Buah 6,490.00 1
34 Masker Nebulizer Set Anak Set 35,750.00 6
Maxiflow Dewasa / Masker Oksigen
Set 27,500.00 4
35 Dewasa Besmed

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN GIGI PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Jumlah
NO Nama Barang/Jenis Barang Satuan Barang HARGA Pemakaian Akhir
Awal Penerimaan Jumlah Bulan permintaan bulan
1 2 3 4 5 6 7
POLI GIGI
1 Endoseal Pack 298,736.49 1
2 GIC Type 2 ART Set 898,990.99 1
3 GIC Type 2 Restorasi Set 898,990.99 1
4 Microbrush Pack 54,518.02 3
5 Cresotin No. 1 Set 261,463.96 1
6 Cresotin No. 2 Set 261,463.96 1
7 Eugenol Cair Botol 121,000.00 1
8 Tooth Strain Remover Botol 149,646.40 1
9 Bonding Botol 99,022.52 3
10 Composite A2 Buah 898,990.99 2
11 Composit A3 Buah 898,990.99 1
12 Tumpatan Sementara Buah 84,002.25 1
13 Topikal Anestesi Buah 149,646.40 1
14 Matrik Seluloit Strip Pack 69,538.29 1
Povidon iodida 10% larutan -
botol 2,862.50 3
15 30 ml
Povidon iodida 10% larutan -
botol 25,530.00 5
16 300 ml
Lidocain komp. injeksi 2 % - ml ampul 803.00 30
17
18 Chloretyl Spray Botol 99,022.52 2
19 Bendchek Botol 149,646.40 2
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN KB PUSKESMAS CIKANCUNG
BULAN 2023

PERSEDIAAN Sisa
Nama Barang/Jenis Satuan Sumber Jumlah
NO Pemakaian Akhir permintaan bulan
Barang Barang Anggaran Penerimaan Bulan
Awal Jumlah
1 2 3 4 5 6 7
1 Pil KB buah APBN 100

Povidon Iodine 30 ml buah APBN 3

2
3 Lidocain buah APBN 15
4 Mini Pil siklus APBN 150
5 Implan set APBN 15
6 IUD Cover T buah APBN 71
7 Suntikan 1 cc buah APBN 94
8 Syiring 3 ml buah APBN 94
9 Masker face mark buah APBN 15
10 Doek Steril Buah APBN 15
11 Sarung Tangan pasang APBN 84
12
13
14
15
16
17
18
19
20

Penanggung Jawab Ruangan

NIP/NRP
REKAP PENGELUARAN HARIAN KB PUSKESMAS CIKANCUNG
BULAN 2023

Nama
PERSEDIAAN Sisa
Satuan Sumber Jumlah permintaan
NO Barang/Jenis
Barang Anggaran Pemakaian Akhir bulan
Barang Penerimaan Bulan
Awal Jumlah
1 2 3 4 5 6 7
1 PMT Balita Dus APBN 2
2 PMT Ibu Dus APBN
3 Taburia Dus APBN

Penanggung Jawab Ruangan

NIP/NRP
Lembar Penerimaan dan Laporan Pemakaian (LPLPO)
BULAN 2023

PERSEDIAAN
Satuan
NO Nama Barang/Jenis Barang HARGA
Barang Awal Penerimaan
1 2 3 4 5 6
1 Acetylcystein 200 mg tablet 304.00
2 Alopurinol tablet 100 mg tablet 87.79
3 Amlodipine Tab 10 mg tablet 70.00
4 Amlodipine Tab 5 mg tablet 53.48
5 Amoksisilin kaplet 500 mg tablet 202.83
6 Amoksisilin Sirup 125 mg / 5 ml botol 3,330.00
7 Asam Askorbat (Vit. C) tablet 50 mg tablet 42.00
8 Asam Folat 1 mg tablet tablet 56.00
9 Asam Mefenamat tablet 500 mg tablet 112.01
10 Betametason krim 0.1 % tube 1,540.00
11 Domperidon tablet 10 mg tablet 71.00
12 Dopamet 250 mg Tablet 994.56
13 Fenol Gliserol 10% Tetes Telinga botol 3,300.00
14 Fitomenadion (Vit. K) tablet 10 mg tablet 748.00
15 Gentamisin salep mata tube 2,675.00
16 Glimepirid 2 mg tablet 124.12
17 Hidrokortison krim 2,5% tube 2,475.00
18 Ibuprofen Suspensi 200 mg/ 5 ml 60 ml botol 3,200.00
19 Kalsium lactat 500 mg tablet 60.00
20 Kaptopril tablet 25 mg tablet 75.00
21 Ketokonazol krim 2% tube 2,370.00
22 Magnesium sulfat injeksi 20% - 25 ml vial 3,580.00
23 Magnesium sulfat injeksi 40% - 25 ml vial 4,090.00
24 Metformin Tablet 500 mg Tablet 77.70
25 Metildopa (Dopamet) 250mg tablet 994.56
26 Metilergometrin maleat (Metergin) tablet salut 0 tablet 214.00
27 Mikonazol krim 2 % tube 1,900.00
28 Multivitamin Syrup (Procurma Suspensi 60 ml) Tablet ###
29 Natrium Diklofenak 50 mg tablet 99.90
30 Natrium Klorida larutan infus 0,9% - 500 ml botol 6,800.00
31 Nistatin tablet 500.000 IU tablet 843.00
32 Nistatin tablet vaginal 100.000 IU tablet vagi 598.00
33 Oksitosin injeksi 10 IU/ml tablet 1,126.00
34 Parasetamol sirup 120 mg/ 5 ml botol 1,160.00
35 Parasetamol tablet 500 mg tablet 209.00
36 Permetrin 5% krim tube ###
37 Ranitidine tablet 150 mg tablet 85.77
38 Salbutamol 2 mg tablet tablet 67.00
39 Salbutamol 4 mg tablet tablet 63.00
40 Salep 2-4 kombinasi : Asam Salisilat 2% + Beleran pot 2,333.00
41 Simvastatin tablet 10 mg tablet 128.00
42 Thiamin Hcl (Vit B1) tablet 165.07
43 Vitamin B Kompleks tablet tablet 57.00
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Penanggung Jawab Ruangan

NIP/NRP
SEDIAAN Sisa
Jumlah
Pemakaian Akhir permintaan
bulan
Jumlah Bulan
7