Form Perencanaan Pengadaan Obat dan Bahan Medis Habis Pakai 2023

NO KODE BARANG NAMA OBAT SATUAN

1 Acetylcysteine 200 mg Kapsul Kapsul
2 Acyclovir 400 mg Tablet Tablet
3 Acyclovir 5% SK Tube
4 Allopurinol 100 mg Tablet Tablet
5 Allopurinol 300 mg Tablet Tablet
6 Ambroxol 15 mg/5 ml Sirup Botol
7 Aminofilin 150 mg Tablet Tablet
8 Aminofilin 200 mg Tablet Tablet
9 Aminofilin 24 mg/ml injeksi Ampul
10 Amitriptillin 25 mg Tablet Tablet
11 Amlodipine 10 mg Tablet Tablet
12 Amlodipine 5 mg Tablet Tablet
13 Amoksisilin 125 mg/5 ml sirup kering Botol
14 Amoksisilin 250 mg tablet Tablet
15 Amoksisilin 250 mg/5 ml sirup kering Botol
16 Amoksisilin 500 mg tablet Tablet
17 Ampisilin 1 gram Injeksi Vial
18 Antasida DOEN 60 ml sirup Botol
19 Antasida DOEN tablet Tablet
20 Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 dan Tube
21 IU/g
Anti Bisa Ular Serum (SABU) 5 ml Injeksi Vial
22 Anti Fungi 3-6 DOEN Salep Kombinasi (Salep Whitfield) Pot
23 Anti Tetanus Serum (ATS) 1.500 UI Injeksi Ampul
24 Antihemoroid 2 gr Supp Supp
25 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet
26 Aqua pro injeksi Vial
27 Asam askorbat (vitamin C) 50 mg tablet Tablet
28 Asam Folat 1 mg Tablet Tablet
29 Asam Mefenamat 500 mg tablet Kaplet
30 Asam Traneksamat 500 mg tablet Tablet
31 Asam Tranexamat 500 mg/5 ml injeksi Ampul
32 Asering infus Botol
33 Asetosal 80 mg Tablet Tablet
34 Atapulgit Tablet Tablet
35 Atenolol 50 mg Tablet Tablet
36 Atropin sulfat injeksi Ampul
37 Bedak salisil serb 2% Dus
38 Betahistine 6 mg Tablet Tablet
39 Betametason 0,1 % krim SK Tube
40 Betametason 1 mg/ml tts mata Botol
41 Bisakodil 10 mg/gr Supp Suppositoria
42 Bisakodil 5 mg/gr Supp Suppositoria
43 Bisakodil tablet Tablet
44 Bromheksin 8 mg tablet Tablet
45 Candesartan cilexetil 8 mg Tablet Tablet
46 Captopril 12,5 mg tablet Tablet
47 Captopril 25 mg tablet Tablet
48 Carbamazepine 200 mg tablet Unit
49 Cefadroxil 125 mg/5 ml Sirup Botol
50 Cefadroxil 500 mg Kapsul Kapsul
51 Cefixim 100 mg kapsul Kapsul
52 Cefixim 100 mg/5 ml Sirup Botol
53 Cefotaxime 1 gr Injeksi Vial
54 Cetirizine 10 mg tablet Tablet
55 Cetirizine 5 mg/5 ml sirup Botol
56 Chloramphenicol 0,5% TM Botol
57 Chloramphenicol 1% krim Salep Mata Tube
58 Chloramphenicol 125 mg/5 ml susp Botol
59 Chloramphenicol 250 mg Kapsul Kapsul
60 Chloramphenicol 3% TT Tube
61 Chlorpromazine 100 mg Tablet Tablet
62 Chlorpromazine 25 mg Tablet Tablet
63 Ciprofloxacin 500 mg tablet Tablet
64 Clindamicin 150 mg Kapsul Tablet
65 Clindamycin 300 mg Kapsul Kapsul
66 Clobazam 10 mg Tablet Tablet
67 Clozapine 100 mg Tablet Tablet
68 Clozapine 25 mg Tablet Tablet
69 Codein 10 mg Tablet Tablet
70 Cotrimoxazole 240 mg/5 ml sirup Botol
71 Cotrimoxazole 480 mg Tablet Tablet
72 Cotrimoxazole 960 mg Tablet Kaptab
73 Curcuma sirup Botol
74 Curcuma tablet Box
75 Cyanocobalamin (Vitamin B12) 50 mg Tablet Tablet
76 Cyanocobalamine (Vitamin B12) 500 mcg/ml Injeksi Ampul
77 Deksametason i.v. 5 mg/ml injeksi Ampul
78 Dexamethasone 0,5 mg Tablet Kaptab
79 Dextrose 40% injeksi Ampul
80 Diazepam 10 mg/2,5 ml enema Tube
81 Diazepam 2 mg tablet Tablet
82 Diazepam 5 mg tablet Tablet
83 Diazepam 5 mg/2,5 ml enema Tube
84 Diazepam 5 mg/ml Injeksi Ampul
85 Difenhidramin 10 mg/ml (HCl) injeksi i.m. Ampul
86 Digoksin 0,25 mg tablet Tablet
87 Diltiazem HCl 30 mg tablet Tablet
88 Dimenhidrinat 50 mg tablet Tablet
 89 Doksisiklin 100 mg kapsul Kapsul
90 Domperidon 10 mg Tablet Tablet
91 Domperidon 5 mg/5 ml Sirup Botol
92 Domperidon 5 mg/ml Drop Botol
93 Dopamet (metildopa) 250 mg Tablet Tablet
94 Epinefrin (Adrenalin) 0,1 % (sebagai HCl) injeksi Ampul
95 Eritromisin 200 mg/5 ml sir kering Botol
96 Eritromisin 250 mg tab/kap Tablet
97 Eritromisin 500 mg tab/kap Tablet
98 Etil klorid Spray 100 ml Botol
99 Fenitoin 100 mg Kapsul Kapsul
100 Fenitoin 50 mg/ml injeksi Ampul
101 Fenobarbital 30 mg tablet Tablet
102 Fenoksimetil Penisilin 500 mg tablet Tablet
103 Fenol Gliserol 10% tetes telinga Botol
104 Fitomenadion (vitamin K1) 10 mg/ml inj (i.m.) Ampul
105 Fitomenadion (vitamin K1) 2 mg/ml (i.m.) inj Ampul
106 Fitomenadion 10 mg Tablet Ampul
107 Flufenazin 25 mg/ml inj Ampul
108 Fluoksetin 10 mg kaps Kapsul
109 Fluoksetin 20 mg kaps Kaplet
110 Furosemid 10 mg/ml Injeksi Ampul
111 Furosemid 40 mg Tablet Tablet
112 Garam Oralit Generik Sachet
113 Gentamicin 0,1% Krim SK Tube
114 Gentamisin 0,3% Krim SM Tube
115 Gentamisin 0,3% Tetes Mata Botol
116 Glibenclamide 5 mg tablet Tablet
117 Glimepiride 1 mg Tablet Tablet
118 Glimepiride 2 mg Tablet Tablet
119 Glimepiride 3 mg Tablet Tablet
120 Gliseril Guaiakolat 100 mg tablet Tablet
121 Glukosa 10% larutan infus Botol
122 Glukosa 5% larutan infus Botol
123 Griseofulvin 125 mg tablet Tablet
124 Haloperidol 1,5 mg tablet Tablet
125 Haloperidol 2 mg tablet Tablet
126 Haloperidol 2 mg/ml Drop Botol
127 Haloperidol 5 mg tablet Tablet
128 Haloperidol Decanoate 50 mg/ml Injeksi Ampul
129 Haloperidol HCl 5 mg/ml Injeksi Ampul
130 Hidroklorotiazid 25 mg Tablet Tablet
131 Hydrocortisone 2,5% Krim SK Tube
132 Hyoscine N Butilbromide 10 mg tablet Tablet
133 Hyoscine N Butylbromide 20 mg/ml Injeksi Ampul
134 Ibuprofen 100 mg/5 ml Sirup Botol
135 Ibuprofen 200 mg tablet Tablet
136 Ibuprofen 200 mg/5 ml Sirup Botol
137 Ibuprofen 400 mg tablet Tablet
138 Isosorbid Dinitrat 5 mg Tablet Tablet
139 KAEN - 3 A Botol
140 KAEN - 3 B Botol
141 Kalamin Lotio Botol
142 Kalsium glukonat injeksi Ampul
143 Kalsium laktat 500 mg Tablet Tablet
144 Ketokonazol 2% Krim SK Tube
145 Ketokonazol 200 mg tablet Tablet
146 Ketokonazol scalp sol 2% Botol
147 Klorfeniramin Maleat 4 mg (CTM) tablet Tablet
148 Kolkisin 500 mcg tablet Tablet
149 Kombinasi : kaolin pektin 550 mg 20 mg tablet Tablet
150 Kombinasi: Ipratropium bromida 0,5 mg + Salbutamol 2,5 mg inhalasi Ampul
151 Lactulose 3,335 g/5 ml Sirup Botol
152 Lidocain 2% 2 mg/ml Injeksi Ampul
153 Lidocain Comp 2 ml Injeksi Ampul
154 Lisinopril 10 mg tablet Tablet
155 Lisinopril 5 mg tablet Tablet
156 Loperamide 2 mg Tablet
157 Loratadine 10 mg Tablet Tablet
158 Lorazepam 2 mg Tablet Tablet
159 Magnesium Sulfat 20% Injeksi Ampul
160 Magnesium Sulfat 40% Injeksi Ampul
161 Metamizole 500 mg Tablet Tablet
162 Metamizole 500 mg/ml Injeksi Ampul
163 Metformin 500 mg Tablet Tablet
164 Metformin 850 mg Tablet Tablet
165 Metilergometrin Maleat 0,125 mg tablet salut Tablet
166 Metilergometrin Maleat 0,2 mg/ml Injeksi Ampul
167 Metilprednisolon 4 mg Tablet Tablet
168 Metoklopramid 10 mg tablet Tablet
169 Metoklopramid 5 mg tablet Tablet
170 Metoklopramid 5 mg/ml inj Ampul
171 Metronidazol 125 mg/5 ml Sirup Botol
172 Metronidazol 250 mg tablet Tablet
173 Metronidazol 500 mg tablet Tablet
174 Metronidazol 500 mg/100 ml Infus Botol
175 Miconazole 2% Krim SK Tube
176 Multivitamin sirup Botol
177 Natrium Bikarbonat 500 mg Tablet Tablet
178 Natrium Diklofenak 1 mg/ml TM Botol
179 Natrium Diklofenak 25 mg Tablet Tablet
180 Natrium Diklofenak 50 mg Tablet Tablet
181 Natrium Klorida 0,9 % larutan infus Botol
182 Neurotropik Tablet Tablet
183 Nifedipine 10 mg Tablet Tablet
184 Nistatin 100.000 IU Vaginal Tab Tablet
185 Nistatin 100.000 IU/ml suspensi Botol
186 Nistatin 500.000 IU Tablet Tablet
187 Oksimetazolin 0,025% Nasal Drop 10 m Tetes Hidung Botol
188 Oksimetazolin 0,05% Nasal Spray 10 ml Semprot Hidung Botol
189 Oksitetrasiklin HCl 1% 5gr SM Tube
190 Oksitosin 10 IU/ml Injeksi Ampul
191 Omeprazol 20 mg kapsul Kapsul
192 Omeprazol 40 mg/ml Injeksi Ampul
193 Parasetamol 120 mg/5 ml Sirup Botol
194 Parasetamol 500 mg Tablet Tablet
195 Perak Sulfadiazin Krim Tube
196 Permetrin 5% Krim SK Tube
197 Pirasetam 1200 mg Tablet Tablet
198 Pirasetam 1gr /5 ml Injeksi Ampul
199 Piridoksin (Vitamin B6) 25 mg tablet Tablet
200 piroksikam 10 mg Tablet Tablet
201 Piroksikam 20 mg Tablet Tablet
202 Prednison 5 mg Tablet Tablet
203 Propanolol 10 mg Tablet Tablet
204 Propiltiourasil 100 mg Tablet Tablet
205 Ranitidin 150 mg tablet Tablet
206 Ranitidin 25 mg/ml injeksi Ampul
207 Ringer Laktat 500 ml Infus Botol
208 Risperidone 2 mg Tablet Tablet
209 Salbutamol 1 mg/ml cairan ih Ampul
210 Salbutamol 2 mg Tablet Tablet
211 Salbutamol 4 mg Tablet Tablet
212 Salep 2-4 30 gr SK Pot
213 Simvastatin 10 mg tablet Tablet
214 Simvastatin 20 mg tablet Tablet
215 Spironolakton 25 mg tablet Tablet
216 Tetrakain 0,5% tetes mata Botol
217 Tetrasiklin 250 mg kapsul Kapsul
218 Tetrasiklin 500 mg kapsul Kapsul
219 Tiamfenikol 125 mg/5 ml sirup kering Botol
220 Tiamfenikol 500 mg Tablet Tablet
221 Tiamin (Vitamin B1) 50 mg Tablet Tablet
222 Trifluoperazin 5 mg Tablet Tablet
223 Triheksifenidil 2 mg tablet Tablet
224 Vitamin B Complex Tablet - Tablet
334 Tiamfenikol 125 mg/5 ml sirup kering Botol
337 Tiamfenikol 500 mg Tablet Tablet
338 Tiamin (Vitamin B1) 50 mg Tablet Tablet
339 Trifluoperazin 5 mg Tablet Tablet
341 Triheksifenidil 2 mg tablet Tablet
343 Vitamin B Complex Tablet - Tablet
ondan centron 4 mg injeksi Ampul
Ondan centron 4 mg (112 box @30 tablet) Tablet
Karbozokrom 10 mg /injeksi Ampul
BMHP
Alkohol 70% 1 liter -one med Botol
Aqua Pl 25 cc -otsuka Botol
Blod set Piece
Catgut silk Piece
Catgut silk 2/0 jarum 1/2 gt Piece
Kasa steril 16x 16 Kotak
Infuset dewasa Piece
Glove handscoon Box
Nasal O2 dewasa Piece
Malaria PF/PV Rapid tes box
LABORATORIUM
Golongan darah set
Golongan darah Ra Kit
Kertas Golongan Darah Box
 Diluent Minday Botol
Lyse 500 ml Minday Botol
Rinsey minday Botol
Stik Glukosa Box
Stik Asam Urat Box
Stik kolesterol Box
Reagen Wiadal tulip set
Control hematologi Vial
Urine 10 wp Tube
Vacum tube EDTA K3 3 ml Box
ReagenUrea LABKIT 2X 125
Creatinin 100 ml Glory Botol
SGOT Diasys Botol
SGPT Diasys Botol
EZ-Cleaner Mindray 100 ml
Probe Cleancer Midray Botol
Pot urine 60 ml Piece
Stik HB Kotak
Urine 3P Tube
TOTAL HARGA
 pagu versi puskesmas
pagu versi bu ephi 145,001,190
jumlah belanja 75,053,320
sisa mati 69,947,870

1.
KEBUTUHAN OBAT WONGSOREJO
HARGA TOTAL HARGA
Minta IFK RAB JKN
Rp 1,110.00 -
Rp 991.00 3,990 3,954,090
Rp 3,500.00 -
Rp 258.00 -
Rp 446.00 -
Rp 4,887.00 -
Rp 411.00 -
Rp 132.00 -
Rp 4,995.00 -
Rp 210.00 -
Rp 222.00 5,000 1,110,000
Rp 337.00 5,000 1,685,000
Rp 4,750.00 -
Rp 437.00 -
Rp 6,650.00 -
Rp 553.00 20,000 11,060,000
Rp 8,769.00 -
Rp 3,719.00 -
Rp 139.00 -
Rp 4,444.00 200 888,800
Rp 688,819.00 -
Rp 5,800.00 -
Rp 152,625.00 -
Rp 3,250.00 -
Rp 300.00 -
Rp 6,791.00 -
Rp 117.00 3,000 351,000
Rp 134.00 2,000 268,000
Rp 444.00 20,000 8,880,000
Rp 1,750.00 -
Rp 2,997.00 -
Rp 8,750.00 -
Rp 538.00 -
Rp 304.00 -
Rp 444.00 -
Rp 3,778.00 -
Rp 5,695.00 100 569,500
Rp 555.00 3,000 1,665,000
Rp 3,108.00 -
Rp 40,548.00 -
Rp 5,085.00 -
Rp 4,325.00 -
Rp 168.00 -
Rp 329.00 -
Rp 1,628.00 -
Rp 149.00 -
Rp 120.00 5,000 600,000
Rp 706.00 -
Rp 13,420.00 -
Rp 896.00 -
Rp 1,445.00 -
Rp 8,420.00 -
Rp 6,852.00 -
Rp 97.00 5,000 485,000
Rp 6,650.00 -
Rp 3,497.00 100 349,700
Rp 10,978.00 -
Rp 7,200.00 -
Rp 696.00 -
Rp 8,600.00 100 860,000
Rp 525.00 -
Rp 420.00 -
Rp 630.00 2,000 1,260,000
Rp 900.00 -
Rp 1,430.00 -
Rp 950.00 -
Rp 2,399.00 -
Rp 2,253.00 -
Rp 600.00 -
Rp 3,818.00 200 763,600
Rp 330.00 311 102,630
Rp 408.00 -
Rp 12,388.00 -
Rp 81,774.00 -
Rp 70.00 2,000 140,000
Rp 2,129.00 -
Rp 1,269.00 300 380,700
Rp 106.00 20,000 2,120,000
Rp 12,044.00 50 602,200
Rp 19,872.00 -
Rp 170.00 -
Rp 216.00 -
Rp 13,669.00 -
Rp 1,673.00 -
Rp 1,700.00 -
Rp 130.00 -
Rp 412.00 -
Rp 216.00 -
Rp 702.00 -
Rp 289.00 2,000 578,000
Rp 7,000.00 -
Rp 36,300.00 -
Rp 1,832.00 -
Rp 10,500.00 -
Rp 12,100.00 -
Rp 790.00 -
Rp 870.00 -
Rp 187,550.00 -
Rp 179.00 -
Rp 5,900.00 -
Rp 182.00 -
Rp 1,100.00 -
Rp 11,500.00 -
Rp 8,100.00 -
Rp 5,000.00 -
Rp 760.00 -
Rp 80,586.00 -
Rp 3,800.00 -
Rp 464.00 -
Rp 3,960.00 -
Rp 221.00 -
Rp 610.00 -
Rp 2,531.00 -
Rp 6,127.00 -
Rp 12,600.00 -
Rp 170.00 10,000 1,700,000
Rp 323.00 -
Rp 549.00 -
Rp 977.00 -
Rp 125.00 20,000 2,500,000
Rp 8,350.00 -
Rp 8,100.00 -
Rp 310.00 1,000 310,000
Rp 200.00 -
Rp 192.00 -
Rp 42,125.00 -
Rp 246.00 -
Rp 109,000.00 -
Rp 6,383.00 -
Rp 148.00 -
Rp 4,662.00 -
Rp 113.00 -
Rp 8,042.00 -
Rp 6,600.00 100 660,000
Rp 210.00 -
Rp 10,400.00 -
Rp 536.00 10,000 5,360,000
Rp 113.00 -
Rp 11,500.00 -
Rp 11,500.00 -
Rp 13,662.00 -
Rp 15,472.00 -
Rp 100.00 -
Rp 4,844.00 200 968,800
Rp 630.00 2,000 1,260,000
Rp 22,000.00 -
Rp 72.00 20,000 1,440,000
Rp 1,665.00 -
Rp 375.00 -
Rp 15,540.00 -
Rp 17,192.00 -
Rp 2,700.00 -
Rp 1,332.00 300 399,600
Rp 610.00 -
Rp 402.00 -
Rp 239.00 -
Rp 232.00 -
Rp 1,210.00 -
Rp 4,973.00 -
Rp 5,661.00 -
Rp 271.00 -
Rp 2,789.00 500 1,394,500
Rp 277.00 10,000 2,770,000
Rp 433.00 -
Rp 1,554.00 -
Rp 3,030.00 -
Rp 450.00 -
Rp 112.00 -
Rp 117.00 -
Rp 5,500.00 100 550,000
Rp 7,800.00 -
Rp 233.00 5,000 1,165,000
Rp 362.00 -
Rp 26,640.00 -
Rp 3,917.00 -
Rp 12,254.00 -
Rp 65.00 -
Rp 34,278.00 -
Rp 136.00 -
Rp 198.00 10,000 1,980,000
Rp 9,600.00 -
Rp 700.00 -
Rp 149.00 -
Rp 28,000.00 -
Rp 13,100.00 -
Rp 825.00 -
Rp 69,819.00 -
Rp 71,484.00 -
Rp 11,500.00 -
Rp 3,297.00 -
Rp 390.00 -
Rp 15,000.00 -
Rp 3,885.00 300 1,165,500
Rp 237.00 20,100 4,763,700
Rp 21,934.00 -
Rp 12,765.00 -
Rp 821.00 -
Rp 2,664.00 -
Rp 222.00 1,000 222,000
Rp 200.00 -
Rp 200.00 2,000 400,000
Rp 103.00 -
Rp 200.00 -
Rp 450.00 -
Rp 1,058.00 5,000 5,290,000
Rp 1,365.00 600 819,000
Rp 8,500.00 -
Rp 210.00 -
Rp 4,800.00 -
Rp 130.00 -
Rp 162.00 -
Rp 4,500.00 -
Rp 450.00 -
Rp 555.00 -
Rp 250.00 -
Rp 19,100.00 -
Rp 367.00 -
Rp 622.00 -
Rp 10,307.00 -
Rp 710.00 -
Rp 196.00 -
Rp 244.00 -
Rp 126.00 -
Rp 87.00 -
Rp 10,307.00 -
Rp 710.00 -
Rp 196.00 2,000 392,000
Rp 244.00 -
Rp 126.00 -
Rp 87.00 10,000 870,000
Rp 1,000.00 500 500,000
Rp 270.00 3,000 810,000
Rp 13,200.00 100 1,320,000

Rp 38,000.00 20 760,000
Rp 5,852.00 100 585,200
Rp 8,596.00 100 859,600
Rp 55,000.00 20 1,100,000
Rp 20,757.00 10 207,570
Rp 8,000.00 300 2,400,000
Rp 5,885.00 300 1,765,500
Rp 120,000.00 10 1,200,000
Rp 7,979.00 100 797,900
Rp 2.00 10 20

Rp 970,500.00 3 2,911,500
Rp 495,000.00 3 1,485,000
Rp 67,100.00 3 201,300
Rp 3,803,800.00 3 11,411,400
Rp 4,347,100.00 3 13,041,300
Rp 3,803,800.00 2 7,607,600
Rp 326,700.00 50 16,335,000
Rp 300,900.00 10 3,009,000
Rp 436,900.00 36 15,728,400
Rp 2,100,000.00 3 6,300,000
Rp 1,676,900.00 1 1,676,900
Rp 1,164,900.00 1 1,164,900
Rp 290,400.00 3 871,200
Rp 2,301,100.00 1 2,301,100
Rp 1,134,900.00 1 1,134,900
Rp 2,078,400.00 1 2,078,400
Rp 2,078,400.00 1 2,078,400
Rp 3,127,700.00 4 12,510,800
Rp 225,700.00 3 677,100
Rp 2,200.00 100 220,000
Rp 385,000.00 17 6,545,000
Rp 280,200.00 5 1,401,000