PUSKESMAS : LANGKAPLANCAR SUB UNIT : PONED

KECAMATAN : LANGKAPLANCAR TANGGAL : 3 AGUSTUS 2022

KABUPATEN : PANGANDARAN PELAPORAN BULAN / PERIODE : JULI 2022
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : AGUSTUS 2

HARGA
NO NAMA OBAT SATUAN STOK AWAL PENERI MAAN PERSE DIAAN PEMA KAIAN STOK AKHIR PERMIN TAAN
KEMASAN

1 2 3 4 5 6 7 8 9 11
A. APBD / DAK
OBAT
1 Amoksisilin kaplet 500 mg Kaplet 249.00 ###

Antasida DOEN I tablet kunyah, kombinasi : Aluminium

2 Tablet 58.00 ###
Hidroksida 200 mg + Magnesium Hidroksida 200 mg

Antasida DOEN II suspensi, kombinasi : Aluminium

3 Btl 60 ml 1,679.00 ###
Hidroksida 200 mg + Magnesium Hidroksida 200 mg

4 Asam Folat Tablet 0,4 mg Tablet 55.00 ###

5 Asering Infus bag 9,646.00 ###
6 Asetosal 80 mg (Miniaspi) Tablet 89.00 ###
7 Bisakodil Tablet 5 mg Tablet 216.00 ###
8 Diazepam enema 5 mg/2,5ml tube 12,573.00 ###
9 Digoksin tablet 0,25 mg Tablet 104.00 ###
10 Dimenhidrinat tablet 50 mg Tablet 99.00 ###
11 Domperidon Suspensi Btl 2,700.00 ###
12 Epinefrin Cairan Injeksi 0,1 % Ampul 1,515.00 ###
13 Fitomenadion Injeksi 2 mg/ ml Ampul 1,386.00 ###
14 Fitomenadion Tablet Salut Gula 10 mg Tablet 748.00 ###
15 Furosemid tablet 40 mg Tablet 82.00 ###
Gemfibrozil capsul 300 mg kapsul 371.00 ###
16 Gentamisin Sulfat Tetes Mata 0,3 % pcs 10,054.00 ###
17 Glibenklamida tablet 5 mg Tablet 119.00 ###
18 Glimepiride 2 mg Tablet 207.00 ###
19 Glimepiride 2 mg Tablet 93.00 ###
20 Glukosa Larutan Infus 10%, (D10%) btl 500 ml 8,003.00 ###
21 Glukosa Larutan Infus 5% (Otsu-D5%) btl 500 ml 7,363.00 ###
22 Hidroklortiazid tab 25 mg tablet 155.00 ###
23 Hidrokortison krim 2,5% Tube 2,475.00 ###
24 Hidrokortison krim 2,5% tube 2,325.00 ###
25 Ibuprofen Tablet 400 mg Tablet 363.00 ###
26 Ibuprofen Tablet 400 mg Tablet 330.00 ###
27 Ibuprofen sirup 100 mg/ 5 ml Botol 6,600.00 ###
28 KA EN 3B - Larutan Karbohidrat + elektrolit kantong 10,696.00 ###
29 Kalsium Laktat 500 mg (KALK) Tablet 60.00 ###
30 Klindamisin 150 mg Kapsul 715.00 ###
31 Ketokonazol Krim Tube 2,518.00 ###

32 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml Ampul 803.00 ###

33 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml Ampul 1,229.00 ###

34 Loratadin tablet 10 mg Tablet 131.00 ###

35 L-BIO Prebiotik sachet 7,700.00 ###
36 Laktulosa sirup 3,335 g/5 ml botol 29,700.00 ###
37 LODECON (Obat batu flu) tablet 902.00 ###
38 Magnesium Sulfat (MgSO4) vial 3,580.00 ###
39 Molakrim Analgesik krim tube 13,640.00 ###
40 Metilergometrin Maleat injeksi 0,200 mg -1 ml Ampul 1,023.00 ###
41 Metoklopramid tablet 10 mg Tablet 87.00 ###
42 Metoklopramid tablet 10 mg Tablet 85.00 ###
43 Metronidazol Sirup Botol 3,950.00 ###
44 Mikonazole krim / salep 2% (nitrat) tube 1,900.00 ###
45 Mikonazole krim / salep 2% (nitrat) tube 3,414.00 ###
46 Natrium Diklofenak 25 mg Tablet 114.00 ###

47 Natrium Klorida larutan infus 0,9 % (Otsu-NS 0,9%) Botol 6,410.00 ###

48 Natrium Klorida larutan infus 0,9 % (Otsu-NS 0,9%) Botol 6,840.00 ###

49 Natrium Klorida larutan infus 0,9 % (Otsu-NS 0,9%) Botol 6,800.00 ###

50 Nistatin Tablet salut 500.000 IU/g Tablet 843.00 ###

51 Nistatitn Tablet salut 500.000 IU/g Tablet 825.00 ###
52 Nistatin Vaginal tablet salut 100.000 IU/g Ovula 550.00 ###
53 Nistatin Vaginal tablet salut 100.000 IU/g Ovula 598.00 ###
54 Oksitosin injeksi 10 UI/ml-1 ml Ampul 1,126.00 ###
55 Oksitetrasiklin salep mata 1% tube 3,500.00 ###
56 Omeprazole Injeksi 40 mg/vial Ampul 5,093.00 ###
57 Parasetamol drop 100 mg/5 ml Btl 4,976.00 ###
58 Parasetamol sirup 120 mg/ 5 ml Botol 1,181.00 ###
59 Perak Sulfadiazine 1% tube 18,557.00 ###
60 Permetrin krim 50 mg/5% tube 11,466.00 ###
61 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 123.00 ###
62 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet 67.00 ###
63 Prednison tablet 5 mg Tablet 73.00 ###
64 Prednison tablet 5 mg Tablet 68.00 ###
65 Propanolol tablet 10 mg (HCL) tablet 58.00 ###
66 Ringer Laktat larutan infus Botol 500 ml 7,150.00 ###
67 Ringer Laktat larutan infus Botol 500 ml 7,630.00 ###
68 Salbutamol Inhaler (Fartolin) vial 4,800.00 ###
69 Salbutamol Tablet 2 mg Tablet 48.00 ###
70 Salbutamol Tablet 2 mg tablet 121.00 ###
71 Salbutamol sirup botol 4,446.00 ###
72 Salisil bedak 2% Botol 5,390.00 ###
73 Sefadroksil Sirup 125 mg /5 ml Botol 3,800.00 ###
74 SOLVITRAL Multivitamin Tablet 1,595.00 ###
75 SOLAFLUZ Botol 13,530.00 ###
Setirizin Tablet 10 mg Tablet 49.00 ###
76 Setirizin tablet Tablet 90.00 ###
77 Setirizin Sirup 5 mg/5 ml Botol 2,915.00 ###

78 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) Vial 517,132.00 ###

79 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Vial 146,800.00 ###

80 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Vial 188,663.00 ###

81 Siprofloksasin Tablet salut selaput 500 mg Tablet 572.00 ###

82 Tetrasiklin 500 mg tablet 715.00 ###
83 TRUVIT Multivitamin Botol 17,050.00 ###
84 Yekaneuron Neurotropik Tablet 704.00 ###
85 Zink Tablet Dispersible 20mg Tablet 524.00 ###
86 Zink Sirup 20 mg/ml Btl 60 ml 2,489.00 ###
ALAT KESEHATAN ###
87 Aqua Pro Injeksi Steril, bebas pirogen vial @20ml 2,295.00 ###
88 Aqua Pro Injeksi Steril, bebas pirogen vial @20ml 2,449.00 ###
89 Aqua Pro Injeksi Steril, bebas pirogen vial @20ml 2,650.00 ###

90 Celemek Lengan Panjang (Apron non Steril waterproff) bag 25,256.00 ###

91 MMP Chroma Balloon Catheter 2 Way FR 16 Kotak 96,800.00 ###

92 MMP Chroma Balloon Catheter 2 Way FR 18 Kotak 96,800.00 ###
93 Gluco Protein (One Med) pcs 1,045.00 ###
94 Handscoon Maxter Exam Glove S Kotak 148,916.00 ###
95 Handscoon Maxter Exam Glove M Kotak 148,916.00 ###
96 IV Catheter No. 18 G (Aximed) 50 buah / kotak 7,000.00 ###
97 IV Catheter No. 18 G 50 buah / kotak 8,700.00 ###
98 Kasa Pembalut 2 m x 80 cm Rol 9,740.00 ###
Kasa Hidrofil 40 yard x 80 cm Rol 135,000.00 ###
99 Kasa Kompres 40x40 steril Pcs 1,600.00 ###
100 Kasa Hidrofil Steril 16 X 16 (Onemed) Pcs 8,000.00 ###
101 Kasa Pembalut Hidrofil 4M X15 cm Pcs 2,657.00 ###
102 Leukomed IV Film 6cm x 8cm streil pcs 2,461.12 ###
103 Leukomed IV Film 6cm x 8cm streil pcs 123.056 ###
104 Masker Earloop Kotak 35,000.00 ###
 Masker Ties On Kotak 42,000.00 ###
105 Masker N95 Kotak 250,000.00 ###
106 Masker Nebulizer set Anak pcs 19,470.00 ###
107 Masker Nebulizer Set Dewasa pcs 19,470.00 ###
108 Pro Crepe Pembalut Elastis Ukuran 10 cm X 4,55 M roll 33,000.00 ###

109 Pro Crepe Pembalut Elastis Ukuran 15 cm X 4,55 M roll 41,910.00 ###

110 Plester bulat Kotak 35,000.00 ###

111 Plester 7,5 x 4,5cm (Leukoplast) roll 43,300.00 ###
112 Sarung Tangan Obgyn Steril pasang 19,000.00 ###
113 Selang Oksigen Anak (Canula Nasal O2 Anak) Pcs 5,500.00 ###

114 Selang Oksigen Anak (Besmed Oxyflow Nasal O2) Pcs 6,930.00 ###

115 Selang Oksigen Dewasa (Besmed Oxyflow Nasal O2) Pcs 5,500.00 ###

116 Ultra one Test Hamil (Onemed) pcs 1,900.00 ###

117 Umbilical Cord Klem (onemedical) Kotak 65,000.00 ###
118 Umbilical Cord Klem (onemedical) Kotak 90,000.00 ###
119 Urine Bag Steril (Onemed) Pcs 5,100.00 ###
120 USG GEL 250 ml Botol 16,000.00 ###
121 DENGUE COMBO TES NS ONE Kotak 1,194,485.00 ###
Jumlah Rp. (A) ###
B. PROGRAM ###
I. TB PARU (OAT FDC) ###
1 Paduan OAT kategori 2 Paket 1,384,977.00 ###
2 Pewarna Ziehl Neelsen Kit 214,500.00 ###
3 Pot Dahak (Pot Sputum) Pcs 3,000.00 ###
4 Pot Dahak (Pot Sputum) Pcs 2,139.00 ###
5 Objek Glass box 22,000.00 ###
6 Box Objek Glass box 72,500.00 ###
7 OAT KDT Dosis Harian Paket 414,310.00 ###
8 OAT KDT Dosis Harian Paket 409,461.00 ###
9 OAT KDT Dosis Harian Paket 411,998.00 ###
II. DIARE ###
III. KECACINGAN ###
1 Albendazol tablet kunyah 400 mg Tablet 403.00 ###
2 Albendazol suspensi 200mg/5 mL Botol 4,300.00 ###
IV. GIZI ###
1 Tablet Fe (Ferro Fumarat) 200mg Tablet 353.00 ###
2 Tablet Fe (Ferro Fumarat) 200mg Tablet 226.00 ###
V. IMUNISASI ###
1 Safety Box pcs 22,433.00 ###
2 Vaksin Polio IPV 5 ds Vial 144,540.00 ###
VI. MALARIA ###
1 RDT buah 24,400.00 ###
2 Giemsa 100 ml Botol 358,706.67 ###
3 Immersion Oil 100 ml Botol 370,106.67 ###
4 Objek Glass Box 24,200.00 ###
5 Alkohol botol 7,700.00 ###
6 Larvasida Malaria IGR Kg 1,430,000.00 ###
VII. HIV/AIDS ###
1 VIROCHEK HIV 1/2 Ampul 7,978.00 ###
2 FOKUS SYPHILIS CASSETTE pcs 8,870.00 ###
VIII. KEJIWAAN ###
1 Amitriptillin tablet salut 25 mg tablet 167.00 ###
IX. RABIES ###
1 Vaksin Anti Rabies (Verorab) kuur 153,000.00 ###
X. KUSTA ###
XI. VAKSIN HAJI ###
Jumlah Rp. (B) ###
C. OBAT TAMBAHAN DILUAR JKN ###
OBAT ###
1 Allopurinol tablet 100 mg tablet 105.00 ###
2 Amlodipin tablet 5 mg Tablet 75.00 ###
3 Amlodipin tablet 10 mg Tablet 99.00 ###
4 Aminofillin injeksi 25 mg/ml Ampul 2,976.00 ###
5 Amoksisilin sirup kering 125 mg/ 5 mg Btl 60 ml 2,050.00 ###
6 Asam Askorbat (vitamin C) tablet 50 mg tablet 105.00 ###
7 Asam Mefenamat 500mg Tablet 103.00 ###
8 Asam Mefenamat 500mg Tablet 286.00 ###
 9 Difenhidramin injeksi I.M. 10 mg/ml (HCL) Ampul 1,095.00 ###
10 Domperidon tablet 10 mg Tablet 91.00 ###
Domperidon tablet 10 mg Tablet 71.00 ###
11 Garam Oralit Serbuk Kombinasi (Sacet-Ktk@100) sachet 274.00 ###
12 Griseofulvin tablet 125 mg, micronized Tablet 224.00 ###
13 Griseofulvin tablet 125 mg, micronized Tablet 210.00 ###
14 Isosorbid Dinitrat tablet Sublingual 5 mg tablet 118.80 ###
15 Kaptopril 12,5 mg Tablet 66.00 ###
16 Kloramfenikol Salep Kulit 1% (Bufacetin SK) tube 3,038.00 ###
17 Kloramfenikol 250 mg Kapsul 880.00 ###
18 Kloramfenikol Salep Mata 1% Tube 8,140.00 ###
19 Kloramfenikol Sirup 125 mg/ 5 ml botol 5,047.00 ###
20 Klorfeniramina Mealeat (CTM) tablet 4 mg tablet 23.00 ###
Kotrimoksakzol Suspensi Sulfametoksazol 200 mg,
21 Botol 2,100.00 ###
Trimetoprim 40 mg
Kotrimoksakzol DOEN I (dewasa) Kombinasi :
22 tablet 126.00 ###
Sulfametaksazol 400 mg, Trimetoprim 80 mg
23 Metilergometrin Maleat tablet salut 0,125 mg tablet 210.00 ###
24 N-asetil sistein 100 mg nebules inj (Fluimucil) ampul 12,535.00 ###
25 Paracetamol tablet 500 mg Tablet 159.50 ###
26 Paracetamol tablet 500 mg tablet 165.00 ###
27 Salbutamol Tablet 2 mg tablet 67.00 ###
28 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) tablet 91.00 ###
29 Vitamin B Kompleks tablet tablet 89.00 ###
30 Vitamin B Kompleks tablet tablet 57.00 ###
ALAT KESEHATAN DAN BMHP ###
Alat Suntik sekali pakai 1 cc pcs 689.96 ###
31 Alat Suntik Sekali Pakai 3 cc pcs 669.80 ###
32 Alat Suntik Sekali Pakai 5 cc pcs 804.07 ###
33 Alkohol 70% Botol 57,200.00 ###
34 Alkohol RUB 500 ml Kotak 340,918.00 ###
35 Alkohol swab Kotak 12,000.00 ###
36 Bisturi buah 3,150.00 ###
37 Bisturi (Surgical Blade N0 11) Kotak 48,739.00 ###
38 Catgut Chromic Onemed (2/0) Kotak 120,000.00 ###
39 Catgut Chromic Onemed (3/0) Kotak 120,000.00 ###
40 Catgut Plain Onemed (2/0) Kotak 120,000.00 ###
41 Catgut Plain Onemed (3/0) Kotak 120,000.00 ###
Catgut Plain Onemed (2/0) Kotak 90,500.00 ###
Catgut Plain Onemed (3/0) Kotak 90,500.00 ###

42 Onemed SILK BLACK SUTURE WITH NEEDLE (2/0) Kotak 96,700.00 ###

43 Onemed SILK BLACK SUTURE WITH NEEDLE (3/0) Kotak 96,700.00 ###

44 Infusion set anak (Aximed) set/kantong 5,415.00 ###

45 infusion set Y (Dewasa) set/kantong 8,061.00 ###
46 infusion set Dewasa set/kantong 5,096.00 ###
47 IV Catheter No. 18 G (Otsucath) pcs 6,277.00 ###
48 IV Catheter No. 20 G (Otsucath) pcs 6,277.00 ###
49 IV Catheter No. 22 G (Otsucath) pcs 6,239.00 ###
50 IV Catheter No. 22 G (Otsucath) pcs 3,800.00 ###
51 IV Catheter No. 24 G (Otsucath) pcs 6,239.00 ###
52 IV Catheter No. 26 G (Steracath) Pcs 8,055.00 ###
53 Masker Oksigen Dewasa (Besmed Maxiflow) pcs 13,552.00 ###
54 Mucus Extractor (Onemed) pcs 5,390.00 ###
55 Sabun Antiseptik botol 38,500.00 ###
56 Antiseptik Hand Scrub 500 ml Kotak 793,155.00 ###
57 Slide ( Objek Glass ) buah 34,000.00 ###
HIBAH ###
1 Uniflex 10 cm x 4.5 cm suc 21,406.00 ###
2 Uniflex 15 cm x 4.5 cm suc 29,189.00 ###
3 Uniflex 7.5 cm x 4.5 cm suc 17,515.00 ###
PROGRAM ###
I. TB PARU (OAT FDC) ###
1 Paduan OAT anak Bag 248,120.00 ###
2 Kaca Slide kotak 19,700.00 ###
3 Masker Bedah Ekomed Kotak 34,650.00 ###
II. GIZI ###
1 Vitamin A Kapsul lunak 100.000 IU Kapsul 307.00 ###
2 Vitamin A Kapsul lunak 200.000 IU Kapsul 552.00 ###
3 Vitamin A Kapsul lunak 200.000 IU Kapsul 553.00 ###
III. KECACINGAN ###
IV. KESEHATAN JIWA ###
1 Clozapine tablet 25 mg tablet 473.00 ###
2 Haloperidol tablet 5 mg tablet 60.00 ###
3 Haloperidol cairan injeksi 5 mg/ml ampul 109,000.00 ###
4 Klorpromazine tablet salut 100 mg tablet 157.00 ###
5 Klorpromazine tablet salut 100 mg tablet 302.50 ###
6 Risperidon tablet 2 mg tablet 123.00 ###
7 Risperidon tablet 2 mg tablet 287.00 ###
8 Triheksifenidil tablet 2 mg tablet 63.00 ###
9 Diazepam 5 mg Tablet tablet 108.00 ###
10 Diazepam 5 mg Tablet tablet 114.00 ###
11 Klobazam 10 mg tablet 776.00 ###
12 Trifluoperazine HCL 5 mg tablet 287.00 ###
13 Kodein tablet 571.00 ###
14 Ergotamine caffein 1 mg + 50 mg tablet 185.00 ###
V. DBD ###
VI. IMUNISASI ###
1 ADS 0,05 ml Oneject buah 1,590.00 ###
2 ADS 0,05 ml Oneject buah 1,518.00 ###
3 ADS 0,5 ml Oneject buah 1,190.00 ###
4 ADS 0,5 ml Oneject buah 1,210.00 ###
5 ADS 5 ml Oneject buah 1,640.00 ###
6 ADS 5 ml Oneject buah 1,583.00 ###
7 Safety box pcs 14,545.00 ###
8 Vaksin bOPV (Polio Oral) Vial 21,285.00 ###
9 Vaksin bOPV (Polio Oral) Vial 21,494.00 ###
10 Vaksin BCG SSI serbuk Injeksi 0,75 Mg/mL Vial 66,154.00 ###
11 Vaksin Hepatitis B Rekombinan Cairan Injeksi Vial 25,597.00 ###
12 Pentabio DTP-HB-HIB Cairan injeksi 2,5 ml Vial 85,103.00 ###
13 Pentabio DTP-HB-HIB Cairan injeksi 2,5 ml vial 25,597.00 ###
14 Vaksin MMR II serbuk Injeksi ampul 166,265.00 ###
15 Vaksin Jerap Td Cairan Injeksi Vial 18,128.00 ###
16 Vaksin DT BIAS Vial 19,195.00 ###
VII. HIV/AIDS ###
VIII. KB ###
1 Suntik KB I Komb. Harsen vial 5,435.00 ###
2 Suntik KB I Komb. Harsen vial 6,080.00 ###
3 Suntik KB I Komb. Harsen vial 4,800.00 ###
4 Pil KB I Komb. KF strip 1,350.00 ###
5 Auto Disable buah 1,212.00 ###
6 Auto Disable buah 1,138.00 ###
7 Susuk KB II + Ins Catur set 175,100.00 ###
8 Ads 3 ml buah 1,330.00 ###
9 Asam Mefenamat 500mg strip 2,822.60 ###
10 Povidon Iodin botol 2,750.00 ###
11 Povidon Iodin botol 3,200.00 ###
12 Handscoon no.7 steril pasang 9,900.00 ###
13 Face Mask / Masker buah 1,342.00 ###
14 Lidocain inj ampul 1,221.00 ###
15 Plester Antiseptik pcs 917.28 ###
16 Duk Lubang Steril buah 6,863.00 ###
17 Duk Lubang Steril buah 6,856.30 ###
18 Kondom gross 124,800.00 ###
19 IUD Coper T set 11,800.00 ###
20 Safety box pcs 20,680.00 ###
21 Face Shield pcs 14,150.00 ###
IX. VAKSIN HAJI ###
X. HEPATITIS ###
1 Reagen Rapid Tes HBsAG Kit 7,851.00 ###
XI. ZOONOSIS ###
XII. PROGRAM ISPA ###
XIII. PROGRAM BUFFER ###
1 VITAMIN C 500 mg tablet 198.00 ###
2 Multivitamin SIVIT-ZINC tablet 585.00 ###
Jumlah Rp. (C) ###
D. JKN/BPJS ###
OBAT ###
1 Tiamin (vitamin B1) tablet 50 mg tablet 85.00 ###
2 Ranitidine Hydrochloride ampul 1,188.00 ###
3 Metylergometrin 0,125 mg tablet 224.00 ###
4 Generik Ondansetron HCL Injeksi 2 mg/ml ampul 1,124.00 ###
5 Generik Ceftriaxone injeksi 1000 mg Vial 4,708.00 ###
6 Generik Amlodipine Besilate 10 mg Tablet 99.00 ###
7 generik Betahistine mesilate tablet 6mg Tablet 110.00 ###
8 Methylprednisolone tablet 16 mg Tablet 551.00 ###
9 Attapulgite 600 mg, Pectin 50 mg (Akita) box 44,000.00 ###
10 Ethyl Chloride sppray Botol 214,500.00 ###
11 Benzocaine, Zincoxyde, Alucol (Superhoid) box (6 supp) 38,280.00 ###
12 Cloramfenicol basse (Tetes Telinga Reco) Botol 8,085.00 ###
13 Parasetamol SUPPO 80 MG (Pyrexin 80 mg) box 111,000.00 ###

14 1% Chloramphenicol base (Erlamicetyn tts telinga) botol 12,870.00 ###

15 Neomisin dan hidro krim (Bufacort- N) tube 9,350.00 ###

16 GOM botol 4,620.00 ###
17 Neomisin dan plasenta (Neocenta gel) tube 17,380.00 ###
Chloramphenicol base 5 mg (Erlamicetyn tts Mata
18 Plus ) botol 18,700.00 ###
Dexamethasone sodium phosphate 1 mg
19 Gentamicin SK (Gentalex) tube 3,630.00 ###
Deksametason 0,5 mg tablet (Deksametason 0,5 mg
20 box 18,150.00 ###
tablet)

Rice Starch Maltodextrin 7 Strain bakteri :

Lactobacillus acidophilus Lactobacillus casei
21 Lactobacillus salivarius Lactococcus lactis box 363,000.00 ###
Bifidobacterium infantis Bifidobacterium lactis
Bifidobacterium longum (Lacidofil Sachet)

Vit A 2000 iu, Vitamin D 400 iu, Vit B1 3,2424 mg,

Vitamin B12 1,25 mg, Vitamin B6 HCL 1,25 mg, Vitamin
22 botol 16,940.00 ###
B12 2,5 mcg, Nikotinamida 16 mg, L-Lysin HCL 100
mg, Calsium Panthotenate 3 mg (Samcovit)

23 Asyclovir Salep Kulit tube 4,235.00 ###

Paracetamol 500 mg, guaiphenesin 50 mg, dan

24 Box 52,800.00 ###
phenylpropanolamine hcl 15 mg (Flutamol Kaplet)

Tiap 5 ml mengandung :Paracetamol 120 mg Glyseril

25 guaiakolate 25 mg CTM 1 mg Phenylephrine HCl 5 botol 9,460.00 ###
(Flutamol sirup)

26 Vitamin D3 1000 IU (DAILY D3 1000 / Prove D 1000) botol 121,000.00 ###

Vitamin A 4000 iu, vitamin D 400 iu, vitamin B1 3 mg,

vitamin B2 4 mg, vitamin B6 4 mg, vitamin B12 12 mcg,
vitamin C 75 mg, nikotinamid 20 mg, Ca pantotenat 5
27 mg, Vitamin E 10 mg, Biotin 0,1 mg, Acid Folic 1 mg, Fe box 84,150.00 ###
Fumarat 135 mg, Acid Glutamic 50 mg, Ca 100 mg, Mg
karbonat 87.5 mg, Zn 15 mg, Cu 0.5 mg, Mn 0.5 mg,
Fluor 0.5 mg, Iodium 0.15 mg (Biopradin)

Ac. Salycilicum 20 mg, Sulfur praecipitatum 40 mg

28 Pot 5,500.00 ###
(Salep 24)
Metamizole Na 500 mg, belladonna extr 10 mg,
29 box 89,925.00 ###
papaverine HCl 25 mg (Spasminal)

Tiap 3 sendok takar (15ml) mengandung : Vitex trifolia

folium 1 g, zingiber officinale rhizome 0,25 g, abrus
30 botol 14,850.00 ###
precatorius folium 0,25 g, phaleria macrocarpa fructus
0,20 g. (Herbacof)

31 Nifedipine/ Nifedipin tablet/kaplet 30 mg box 24,200.00 ###

32 Generix Asiklovir Tablet 407.00 ###
33 Gerik Ranitidine Hydrochliride (HCI) Ampul 814.00 ###
BAHAN MEDIS HABIS PAKAI ###
34 Alkohol 70% 1 lt botol 21,500.00 ###
35 Aximed Suction no 10 pcs 7,370.00 ###
36 Aximed Suction no 12 pcs 7,370.00 ###
37 Aximed Suction no 6 pcs 7,370.00 ###
38 Besmed Oxyflow Nasal Oxygen Anak pcs 5,500.00 ###
39 Jayamas Onemed Safety Box dus 15,708.00 ###
40 Mediplus Win Flon 18 G (IV catether) pcs 5,372.40 ###
41 Microspore 1/2 inchi box 268,374.00 ###
42 Oneject Auto Disable Syringe 0,5 ml pcs 1,195.00 ###
43 Sterecath IV Catheter 24G pcs 3,800.00 ###
44 Surya husada kapas pembalut @250gr pcs 12,400.00 ###
45 Win Syringe 2,5 cc pcs 713.90 ###
46 Wing Needle 19G pcs 1,400.00 ###
47 Wing Needle 21G pcs 1,400.00 ###
48 Wing Needle 27G pcs 1,400.00 ###
49 Polywin Safety IV Canual 24 G pcs 12,826.00 ###
50 Polywin Safety IV Canual 26 G pcs 13,750.00 ###
51 Kanjin Win Syringe 1 cc pcs 713.90 ###
52 Conavatec Duoderm Extra Thin 4x4 Inch pcs 29,826.50 ###
53 Conavatect Doederm Control Gel Formula Dessing 4x4 in pcs 64,517.20 ###
54 Sabun anti bakteri 500ml+dispenser botol 26,400 ###
55 Povidon lodine larutan antiseptik 300cc botol 21,000 ###
56 Catgut chormic 2/0+jarum 1/2 Gt 35mm box 120,000 ###
57 Syringe 3 cc (3ml) box 77,900 ###
58 Ecodin 1 Liter botol 79,650 ###
59 Soft pad (underpad) 60x90 bag 41,624 ###
60 Onescrub 4%, 500cc+ dispenser botol 62,500 ###
61 Syringe 5cc box 96,800 ###
62 Plasterin non woven roll 10 cmx 5m roll 41,360 ###
63 Minray Diluent 20L galon 1,815,000 ###
64 Minray Rinse 20L galon 1,815,000 ###
65 Minray Lise 500Ml botol 2,035,000 ###
66 Uric Acid Test Strip (Autocheck) Pot 240,000 ###
67 EXAMINATION GLOVE S BOX 120,000 ###
68 EXAMINATION GLOVE M BOX 120,000 ###
69 EXAMINATION GLOVE L BOX 148,916 ###
Jumlah Rp. (D) - ###
JUMLAH TOTAL (A+B+C+D) ###
 PUSKESMAS : LANGKAPLANCAR Sub Unit………………
KECAMATAN : LANGKAPLANCAR Tanggal……………
KABUPATEN : PANGANDARAN PELAPORAN BULAN / PERIODE ……………
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE……….

STOK PENERI PERSE PEMA STOK

NO NAMA OBAT SATUAN permintaan
AWAL MAAN DIAAN KAIAN AKHIR

1 2 3 4 5 6 7 8
A. APBD / DAK
OBAT
1 Amoksisilin kaplet 500 mg Kaplet
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200
3 Tablet
mg + Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg
4 Btl 60 ml
+ Magnesium Hidroksida 200 mg
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200
5 Tablet
mg + Magnesium Hidroksida 200 mg
6 Asam Folat Tablet 0,4 mg Tablet
9 Asering Infus bag
10 Asiklovir 400 mg Tablet
11 Asetilsistein Capsul 200 mg Capsul
12 Asetosal 80 mg (Miniaspi) Tablet
13 Antihemoroid Supp 2 gram suppo
14 Bisakodil Tablet 5 mg Tablet
15 Betahistin tablet 6 mg Tablet
16 Betametason Cream 0,1% Tablet
17 Deksametason 0,5 mg Tablet
18 Diazepam enema 5 mg/2,5ml tube
20 Digoksin tablet 0,25 mg Tablet
21 Dimenhidrinat tablet 50 mg Tablet
22 Dimenhidrinat tablet 50 mg Tablet
23 Domperidon Suspensi Btl
24 Domperidon Suspensi Btl
25 Epinefrin Cairan Injeksi 0,1 % Ampul
26 FENOBARBITAL Injeksi 50 mg/ml Ampul
27 Fitomenadion Injeksi 2 mg/ ml Ampul
29 Fitomenadion Tablet Salut Gula 10 mg Tablet
30 Furosemid tablet 40 mg Tablet
31 Furosemid tablet 40 mg Tablet
32 Gemfibrozil capsul 300 mg kapsul
33 Gentamisin Sulfat Tetes Mata 0,3 % pcs
34 Gentamisin Sulfat Tetes Mata 0,3 % pcs
35 Glibenklamida tablet 5 mg Tablet
36 Glimepiride 2 mg Tablet
38 Glukosa Larutan Infus 10%, (D10%) btl 500 ml
39 Glukosa Larutan Infus 5% (Otsu-D5%) btl 500 ml
40 Hidroklortiazid tab 25 mg tablet
42 Hidrokortison krim 2,5% Tube
43 Hidrokortison krim 2,5% tube
44 Obat Batuk Siruo (Herbakof) Sirup
47 Ibuprofen Tablet 400 mg (Etafen)
49 Ibuprofen sirup 100 mg/ 5 ml Botol
50 KA EN 3B - Larutan Karbohidrat + elektrolit Botol
51 KA EN 3B - Larutan Karbohidrat + elektrolit kantong
52 Kalsium Laktat 500 mg (KALK) Tablet
53 Klindamisin 150 mg Kapsul
54 Ketokonazol Krim
55 Ketokonazol Krim Tube
56 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml Ampul
57 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml Ampul
58 Loratadin tablet 10 mg Tablet
59 Loratadin tablet 10 mg Tablet
60 L-BIO Prebiotik sachet
61 Laktulosa sirup 3,335 g/5 ml botol
62 LODECON (Obat batu flu) tablet
63 Magnesium Sulfat (MgSO4) 20% vial
64 Magnesium Sulfat (MgSO4) 40% vial
65 Molakrim Analgesik krim tube
66 Metilergometrin Maleat injeksi 0,200 mg -1 ml Ampul
68 Metoklopramid tablet 10 mg Tablet
69 Metoklopramid tablet 10 mg Tablet
70 Metronidazol Sirup Botol
71 Metformin 500 mg Tablet
72 Metilprednisolon 4 mg Tablet
73 Mikonazole krim / salep 2% (nitrat) tube
75 Natrium Diklofenak 25 mg Tablet
76 Natrium Klorida larutan infus 0,9 % (Otsu-NS 0,9%) Botol
79 New Antides Atapulgit Tablet 600 mg Tablet
80 Nistatin Tablet salut 500.000 IU/g Tablet
82 Nistatin Vaginal tablet salut 100.000 IU/g Ovula
84 Oksitosin injeksi 10 UI/ml-1 ml Ampul
85 Oksitetrasiklin salep mata 1% tube
86 Omeprazole Injeksi 40 mg/vial Ampul
87 Omeprazole Tablet 20 mg Tablet
88 Parasetamol drop 100 mg/5 ml Btl
90 Parasetamol sirup 120 mg/ 5 ml Botol
91 Perak Sulfadiazine 1% tube
92 Permetrin krim 50 mg/5% tube
96 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tablet
97 Pirantel Pamoat Suspensi 125/5ml Botol
98 Prednison tablet 5 mg Tablet
100 Propanolol tablet 10 mg (HCL) tablet
101 Ringer Laktat larutan infus Botol 500 ml
103 Ranitidine tablet
104 Salep 24 tube
105 Salbutamol Inhaler (Fartolin) vial
106 Salbutamol Tablet 4 mg Tablet
107 Salbutamol Tablet 2 mg Tablet
109 Salbutamol sirup botol
110 Salisil bedak 2% Botol
111 Sefadroksil Sirup 125 mg /5 ml Botol
112 SOLVITRAL Multivitamin Tablet
SOLAFLUZ Botol
STIMUNO Botol
STIMUNO FORTE Kapsul
Setirizin Tablet 10 mg Tablet
76 Setirizin tablet Tablet
Setirizin Sirup 5 mg/5 ml Botol
78 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) Vial
79 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Vial
80 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Vial
Simvastatin 10 mg Tablet
81 Siprofloksasin Tablet salut selaput 500 mg Tablet
82 Tetrasiklin 500 mg tablet
83 TRUVIT Multivitamin Botol
84 Yekaneuron Neurotropik Tablet
85 Zink Tablet Dispersible 20mg Tablet
86 Zink Sirup 20 mg/ml Btl 60 ml
ALAT KESEHATAN
89 Aqua Pro Injeksi Steril, bebas pirogen vial @20ml
90 Celemek Lengan Panjang (Apron non Steril waterproff) bag
91 MMP Chroma Balloon Catheter 2 Way FR 16 Kotak
 92 MMP Chroma Balloon Catheter 2 Way FR 18 Kotak
93 Gluco Protein (One Med) pcs
94 Handscoon Maxter Exam Glove S Kotak
Handscoon Maxter Exam Glove M Kotak
96 IV Catheter No. 18 G (Aximed) pcs
97 IV Catheter No. 18 G pcs
98 Kasa Pembalut 2 m x 80 cm Rol
Kasa Hidrofil 40 yard x 80 cm Rol
99 Kasa Kompres 40x40 steril Pcs
100 Kasa Hidrofil Steril 16 X 16 (Onemed) Kotak
101 Kasa Pembalut Hidrofil 4M X15 cm Pcs
103 Leukomed IV Film 6cm x 8cm streil pcs
104 Masker Earloop Kotak
Masker Ties On Kotak
105 Masker N95 Kotak
106 Masker Nebulizer set Anak pcs
107 Masker Nebulizer Set Dewasa pcs
108 Pro Crepe Pembalut Elastis Ukuran 10 cm X 4,55 M roll
109 Pro Crepe Pembalut Elastis Ukuran 15 cm X 4,55 M roll
110 Plester bulat Kotak
111 Plester 7,5 x 4,5cm (Leukoplast) roll
112 Sarung Tangan Obgyn Steril pasang
113 Selang Oksigen Anak (Canula Nasal O2 Anak) Pcs
114 Selang Oksigen Anak (Besmed Oxyflow Nasal O2) Pcs
115 Selang Oksigen Dewasa (Besmed Oxyflow Nasal O2) Pcs
116 Ultra one Test Hamil (Onemed) pcs
117 Umbilical Cord Klem (onemedical) Kotak
Urine Bag Steril (Onemed) Pcs
120 USG GEL 250 ml Botol
121 DENGUE COMBO TES NS ONE Kotak
Jumlah Rp. (A)
B. PROGRAM
I. TB PARU (OAT FDC)
1 Paduan OAT kategori 2 Paket
2 Pewarna Ziehl Neelsen Kit
Pot Dahak (Pot Sputum) Pcs
5 Objek Glass box
6 Box Objek Glass box
7 OAT KDT Dosis Harian Paket
8 OAT KDT Dosis Harian Paket
9 OAT KDT Dosis Harian Paket
Kaca Mata Google PIECES
OAT KDT Dosis Harian ( Kategori anak ) Paket
OAT KDT Dosis Harian ( Kategori 1 ) Paket
Isoniazid 300 mg / Rifapentin 300 mg (TBC) Kotak
Isoniazid tablet 100 mg Tablet
Rifampicin/Isoniazid tablet dispersible 75 mg/50mg Tablet
Indo reagen pewarna ziehl neelsen botol
Kaca Preparat (Slide Kaca) Kotak
Masker Bedah Kotak
Masker N95 (Aero Pro) Kotak
Masker N95 (Dream Can) Kotak
Pot Sputum PIECES
Tuberkulin vial
GENEXPERT MTB/ RIF CATRIDGE Paket
II. DIARE
Garam Oralit Serbuk Kombinasi (Sacet-Ktk@100) Sachet
Zink Tablet Dispersible 20mg Tablet
III. KECACINGAN
Albendazol tablet kunyah 400 mg Tablet
2 Albendazol suspensi 200mg/5 mL Botol
IV.
GIZI
2 Tablet Fe (Ferro Fumarat) 200mg Tablet
V. IMUNISASI
1 Safety Box pcs
2 Vaksin Polio IPV 5 ds Vial
VI. MALARIA
1 RDT buah
2 Giemsa 100 ml Botol
3 Immersion Oil 100 ml Botol
4 Objek Glass Box
5 Alkohol botol
6 Larvasida Malaria IGR Kg
BACTIVEC BOTOL
Primakuin Tablet 15 mg Tablet
Dehidro Artemisin + Piperaquin ( DHP) 40 + 320 mg Tablet
RDT Leptospira Kit
RDT Carestart Malaria Test - (Box,25 Pieces) Kit
KIT Malaria Paket
VII. HIV/AIDS
1 VIROCHEK HIV 1/2 Ampul
2 VIROCHEK HIV 1/2 (SD HIV 1 ) Test
3 FOKUS SYPHILIS CASSETTE pcs
VIII. KEJIWAAN
1 Amitriptillin tablet salut 25 mg tablet
IX. RABIES
1 Vaksin Anti Rabies (Verorab) Ampul
X. KUSTA
XI. VAKSIN HAJI
XII. PROGRAM (P2P)
1 Alcohol Swab Kotak
2 Blood Lancet Kotak
3 Super Sensor Test Strip test
Jumlah Rp. (B)
C. OBAT TAMBAHAN DILUAR JKN
OBAT
1 Allopurinol tablet 100 mg tablet
2 Amlodipin tablet 5 mg Tablet
3 Amlodipin tablet 10 mg Tablet
4 Aminofillin injeksi 25 mg/ml Ampul
5 Amoksisilin sirup kering 125 mg/ 5 mg Btl 60 ml
6 Asam Askorbat (vitamin C) tablet 50 mg tablet
Asam Mefenamat 500mg tablet
9 Difenhidramin injeksi I.M. 10 mg/ml (HCL) Ampul
10 Domperidon tablet 10 mg Tablet
Domperidon tablet 10 mg Tablet
11 Garam Oralit Serbuk Kombinasi (Sacet-Ktk@100) sachet
12 Griseofulvin tablet 125 mg, micronized Tablet
14 Isosorbid Dinitrat tablet Sublingual 5 mg tablet
15 Kaptopril 12,5 mg Tablet
Kloramfenikol Tetes Telinga ( RECO TT)
Kloramfenikol Tetes Telinga tube
Kloramfenikol Salep 2% (Bufacetin SK) tube
16 Kloramfenikol Salep Kulit 1% (Bufacetin SK) tube
17 Kloramfenikol 250 mg Kapsul
18 Kloramfenikol Salep Mata 1% Tube
19 Kloramfenikol Sirup 125 mg/ 5 ml botol
Klorfeniramina Mealeat (CTM) tablet 4 mg tablet
21 Kotrimoksakzol Suspensi Sulfametoksazol 200 mg, Trimetoprim 40 mg Botol
Kotrimoksakzol DOEN I (dewasa) Kombinasi : Sulfametaksazol 400
22 tablet
mg, Trimetoprim 80 mg
23 Metilergometrin Maleat tablet salut 0,125 mg tablet
24 N-asetil sistein 100 mg nebules inj (Fluimucil) ampul
Paracetamol tablet 500 mg tablet
27 Salbutamol Tablet 2 mg tablet
28 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) tablet
 29 Vitamin B Kompleks tablet tablet
ALAT KESEHATAN DAN BMHP
Alat Suntik sekali pakai 1 cc pcs
Alat Suntik Sekali Pakai 3 cc pcs
32 Alat Suntik Sekali Pakai 5 cc pcs
33 Alkohol 70% Botol
34 Alkohol RUB 500 ml Kotak
35 Alkohol swab Kotak
36 Bisturi buah
37 Bisturi (Surgical Blade N0 11) Kotak
38 Catgut Chromic Onemed (2/0) Kotak
39 Catgut Chromic Onemed (3/0) Kotak
40 Catgut Plain Onemed (2/0) Kotak
41 Catgut Plain Onemed (3/0) Kotak
42 Onemed SILK BLACK SUTURE WITH NEEDLE (2/0) Kotak
43 Onemed SILK BLACK SUTURE WITH NEEDLE (3/0) Kotak
44 Infusion set anak (Aximed) set/kantong
45 infusion set Y (Dewasa) set/kantong
46 infusion set Dewasa set/kantong
infusion set Dewasa set/kantong
47 IV Catheter No. 18 G (Otsucath) pcs
IV Catheter No. 20 G (Otsucath) pcs
49 IV Catheter No. 22 G (Otsucath) pcs
50 IV Catheter No. 22 G (Otsucath) pcs
51 IV Catheter No. 24 G (Otsucath) pcs
52 IV Catheter No. 26 G (Steracath) Pcs
53 Masker Oksigen Dewasa (Besmed Maxiflow) pcs
54 Mucus Extractor (Onemed) pcs
Nasal Oxygen Dewasa ( Besmed Oxyflow )
55 Sabun Antiseptik botol
56 Antiseptik Hand Scrub 500 ml Kotak
57 Slide ( Objek Glass ) buah
HIBAH
1 Uniflex 10 cm x 4.5 cm suc
2 Uniflex 15 cm x 4.5 cm suc
3 Uniflex 7.5 cm x 4.5 cm suc
PROGRAM
I. TB PARU (OAT FDC)
1 Paduan OAT anak Bag
Paduan OAT anak Bag
2 Kaca Slide kotak
3 Masker Bedah Ekomed Kotak
II.
GIZI
1 Vitamin A Kapsul lunak 100.000 IU Kapsul
2 Vitamin A Kapsul lunak 200.000 IU Kapsul
3 Vitamin A Kapsul lunak 200.000 IU Kapsul
III. KECACINGAN
IV. KESEHATAN JIWA
Clozapine tablet 25 mg tablet
3 Haloperidol tablet 5 mg tablet
4 Haloperidol cairan injeksi 5 mg/ml ampul
5 Klorpromazine tablet salut 100 mg tablet
6 Klorpromazine tablet salut 100 mg tablet
8 Risperidon tablet 2 mg tablet
9 Triheksifenidil tablet 2 mg tablet
Diazepam 5 mg Tablet tablet
Diazepam 2 mg Tablet tablet
Diazepam Cairan Injeksi 5 mg/ml ampul
12 Klobazam 10 mg tablet
13 Trifluoperazine HCL 5 mg tablet
14 Kodein tablet
15 Ergotamine caffein 1 mg + 50 mg tablet
V.
DBD

RDT DBD COMBO (IGG,NSI) NS ONE test

VI. IMUNISASI
1 ADS 0,05 ml Oneject buah
4 ADS 0,5 ml Oneject buah
5 ADS 5 ml Oneject buah
6 ADS 5 ml Oneject buah
7 Safety box pcs
8 Vaksin bOPV (Polio Oral) Vial
Vaksin BCG BP (Intradermal) Cairan Injeksi 1mgx50vials 0,05 ml ampul
10 Vaksin BCG SSI serbuk Injeksi 0,75 Mg/mL Vial
Vaksin Hepatitis B rekombinan cairan Injeksi 20 mcg/ml ampul
11 Vaksin Hepatitis B Rekombinan Cairan Injeksi Vial
12 Pentabio DPT-HB-HIB Cairan injeksi 2,5 ml Vial
15 Vaksin MMR II serbuk Injeksi ampul
16 Vaksin Jerap Td Cairan Injeksi Vial
17 Vaksin DT BIAS Vial
VII. HIV/AIDS
VIII.
KB
1 Suntik KB I Komb. Harsen vial
4 Suntik KB I Komb. Gestin F3 vial
5 Pil KB I Komb. KF vial
7 Pil KB I Kombi Lynestrenol strip
8 Auto Disable buah
Susuk KB II + Ins Catur set
Syringe 3 cc (3ml) buah
11 Ads 3 ml buah
12 Asam Mefenamat 500mg strip
14 Povidon Iodin botol
15 Handscoon no.7 steril pasang
16 Face Mask / Masker buah
Lidocain inj ampul
18 Plester Antiseptik pcs
19 Duk Lubang Steril buah
21 Kondom gross
22 IUD Coper T set
23 Safety box pcs
24 Face Shield pcs
IX. VAKSIN HAJI
X. HEPATITIS
1 Hepatitis B Immunoglobin ( Hyperhep B )
2 Reagen Rapid Tes HBsAG Kit
3 Reagen Rapid Tes HBsAG Kit
XI. ZOONOSIS
XII. PROGRAM ISPA
XIII. PROGRAM BUFFER
1 VITAMIN C 500 mg tablet
2 Multivitamin SIVIT-ZINC tablet
Jumlah Rp. (C)
D. JKN/BPJS
OBAT
1 Tiamin (vitamin B1) tablet 50 mg tablet
2 Ranitidine Hydrochloride ampul
3 Metylergometrin 0,125 mg tablet
4 Generik Ondansetron HCL Injeksi 2 mg/ml ampul
5 Generik Ceftriaxone injeksi 1000 mg Vial
6 Generik Amlodipine Besilate 10 mg Tablet
 7 generik Betahistine mesilate tablet 6mg Tablet
8 Methylprednisolone tablet 16 mg Tablet
9 Attapulgite 600 mg, Pectin 50 mg (Akita) box
10 Ethyl Chloride sppray Botol
11 Benzocaine, Zincoxyde, Alucol (Superhoid) box (6 supp)
12 Cloramfenicol basse (Tetes Telinga Reco) Botol
13 Parasetamol SUPPO 80 MG (Pyrexin 80 mg) box
14 1% Chloramphenicol base (Erlamicetyn tts telinga) botol
15 Neomisin dan hidro krim (Bufacort- N) tube
16 GOM botol
17 Neomisin dan plasenta (Neocenta gel) tube
Chloramphenicol base 5 mg (Erlamicetyn tts Mata Plus )
18 botol
Dexamethasone sodium phosphate 1 mg
19 Gentamicin SK (Gentalex) tube
20 Deksametason 0,5 mg tablet (Deksametason 0,5 mg tablet) box

Rice Starch Maltodextrin 7 Strain bakteri : Lactobacillus acidophilus

Lactobacillus casei Lactobacillus salivarius Lactococcus lactis
21 box
Bifidobacterium infantis Bifidobacterium lactis Bifidobacterium longum
(Lacidofil Sachet)

Vit A 2000 iu, Vitamin D 400 iu, Vit B1 3,2424 mg, Vitamin B12 1,25
22 mg, Vitamin B6 HCL 1,25 mg, Vitamin B12 2,5 mcg, Nikotinamida 16 botol
mg, L-Lysin HCL 100 mg, Calsium Panthotenate 3 mg (Samcovit)

23 Asyclovir Salep Kulit tube

Paracetamol 500 mg, guaiphenesin 50 mg, dan phenylpropanolamine
24 Box
hcl 15 mg (Flutamol Kaplet)

Tiap 5 ml mengandung :Paracetamol 120 mg Glyseril guaiakolate 25

25 botol
mg CTM 1 mg Phenylephrine HCl 5 (Flutamol sirup)

26 Vitamin D3 1000 IU (DAILY D3 1000 / Prove D 1000) botol

Vitamin A 4000 iu, vitamin D 400 iu, vitamin B1 3 mg, vitamin B2 4 mg,
vitamin B6 4 mg, vitamin B12 12 mcg, vitamin C 75 mg, nikotinamid 20
mg, Ca pantotenat 5 mg, Vitamin E 10 mg, Biotin 0,1 mg, Acid Folic 1
27 box
mg, Fe Fumarat 135 mg, Acid Glutamic 50 mg, Ca 100 mg, Mg
karbonat 87.5 mg, Zn 15 mg, Cu 0.5 mg, Mn 0.5 mg, Fluor 0.5 mg,
Iodium 0.15 mg (Biopradin)

28 Ac. Salycilicum 20 mg, Sulfur praecipitatum 40 mg (Salep 24) Pot

Metamizole Na 500 mg, belladonna extr 10 mg, papaverine HCl 25 mg
29 box
(Spasminal)

Tiap 3 sendok takar (15ml) mengandung : Vitex trifolia folium 1 g,

30 zingiber officinale rhizome 0,25 g, abrus precatorius folium 0,25 g, botol
phaleria macrocarpa fructus 0,20 g. (Herbacof)

31 Nifedipine/ Nifedipin tablet/kaplet 30 mg box

32 Generix Asiklovir Tablet
33 Generik Ranitidine Hydrochliride (HCI) Ampul
34 Amoxicilin 500 mg box
35 Ondansentron inj box
36 ASAM TRANEKSAMAT INJEKSI Box
37 CEFTRIAXONE 1 gr Injeksi @ 2 Vial Box
38 CIPROFLOXACIN HYDROCHLORIDE 500 MG Box
39 METFORMIN HYDROCHLORIDE 500 MG @ 200 Tablet Box
40 METILPREDNISOLONE 4 MG Box
41 OMEPRAZOLE 30 MG @ 20 Strip Box
42 RANITIDINE HYDROCHLORIDE (HCL) 150 MG Box
43 MEPROVENT (Ipratropium Bromide, Salbutamol Sulfate) Box
44 PHYTOMENADION INJ 2 MG/ML (PEHA) Isi Kemasan: 30 AMP Box
RANITIDINE HCL 25 MG/ML INJ@25AMP(PEHA). Isi Kemasan: 25
45 Box
AMP
46 KETOROLAK 3% INJEKSI (Box/ 10 Amp) Box
47 ONDANSETRON 4 MG/2 ML INJEKSI (Box/ 25 Amp) Box
48 HERBACOF SYRUP 100 ml Botol
49 LYTACUR SYRUP 60 ml Botol
Asam Traneksamat
50 500 mg Box

51 PARACETAMOL SUPPO 80 MG (PYREXIN 80 MG) Box, 10 supp

52 Sukfacetamid Tetes mata (Cendocetamid tetes mata) botol
53 Neomycin sulfate dan hydrocortisone acetate (Bufacort- N) Tube
54 1% Chloramphenicol base (Erlamicetyn Tetes telinga) Botol 10 ml
55 Chloramphenicol base 1% (Erlamycetin TM) Botol 10 ml
56 Gentamycin Salep 0,1% (Gentalex) Tube 15 gr
57 Ambroxol 30 mg Tablet
Paracetamol 500 mg, guaiphenesin 50 mg, dan phenylpropanolamine
58 Tablet
hcl 15 mg (FLUTAMOL Kaplet)

Vitamin A 4000 iu, vitamin D 400 iu, vitamin B1 3 mg, vitamin B2 4 mg,
vitamin B6 4 mg, vitamin B12 12 mcg, vitamin C 75 mg, nikotinamid 20
mg, Capantotenat 5 mg, Vitamin E 10 mg, Biotin 0,1 mg, Acid Folic 1
59 Tablet
mg, Fe Fumarat 135 mg, Acid Glutamic 50 mg, Ca 100 mg, Mg
karbonat 87.5 mg, Zn 15 mg, Cu 0.5 mg, Mn 0.5 mg, Fluor 0.5 mg,
Iodium 0.15 mg (Solvitral)

Metamizole Na 500 mg, belladonna extr 10 mg, papaverineHCl 25 mg

60 Tablet
(Spasminal)
61 EtilKlorida Spray Botol 100 ml
62 Cefadroxil 500 mg Tab
63 ASIKLOVIR SALEP KULIT Tube
64 METRONIDAZOLE 500 mg Tablet
BAHAN MEDIS HABIS PAKAI
34 Alkohol 70% 1 lt botol
35 Aximed Suction no 10 pcs
36 Aximed Suction no 12 pcs
37 Aximed Suction no 6 pcs
38 Besmed Oxyflow Nasal Oxygen Anak pcs
39 Jayamas Onemed Safety Box dus
40 Mediplus Win Flon 18 G (IV catether) pcs
41 Microspore 1/2 inchi box
42 Oneject Auto Disable Syringe 0,5 ml pcs
43 Sterecath IV Catheter 24G pcs
44 Surya husada kapas pembalut @250gr pcs
45 Win Syringe 2,5 cc pcs
46 Wing Needle 19G pcs
48 Wing Needle 27G pcs
49 Polywin Safety IV Canual 24 G pcs
50 Polywin Safety IV Canual 26 G pcs
51 Kanjin Win Syringe 1 cc pcs
52 Conavatec Duoderm Extra Thin 4x4 Inch pcs
53 Conavatect Doederm Control Gel Formula Dessing 4x4 inchi pcs
54 Sabun anti bakteri 500ml+dispenser botol
55 Povidon lodine larutan antiseptik 300cc botol
56 Catgut chormic 2/0+jarum 1/2 Gt 35mm box
57 Syringe 3 cc (3ml) box
58 Ecodin 1 Liter botol
59 Soft pad (underpad) 60x90 bag
60 Onescrub 4%, 500cc+ dispenser botol
61 Syringe 5cc box
62 Plasterin non woven roll 10 cmx 5m roll
63 Minray Diluent 20L galon
64 Minray Rinse 20L galon
65 Minray Lise 500Ml botol
66 Uric Acid Test Strip (Autocheck) Pot
67 EXAMINATION GLOVE S BOX
68 EXAMINATION GLOVE M BOX
69 EXAMINATION GLOVE L BOX
70 Rinse M-30R 20L
71 DILUEN M-30D MINDRAY 20L
72 Reagent Widal (O,AO,BO,CO,H,AH,BH,CH) Set
73 Stik Hemoglobin Easy Touch Box
74 Urine Urit G11 Box
75 Stik Cholesterol Autocheck Box
76 Stik Glukosa Autocheck Box
77 Stik Asam Urat Autocheck Box
78 Reagent Golongan darah (A, B, AB, D) Set
79 Kartu Golongan Darah Pack
80 Gluco protein Test Box
81 Tabung Vacutainer EDTA Box
82 Spirtus/metanol Liter
83 Tissue Lensa Box -
84 Sarung Tangan ukuran M Box
85 Sarung Tangan ukuran S Box
86 Urine Bag Box
87 Spuit 3 cc Box
88 Urine Bag Steril 2 Lt (Onemed) Pcs
89 Uro One Foley Catheter 2 Way, FR 16 (Onemed) Box
90 Kasa Hydrofil 4 m x 3 cm (Onemed) Box
91 Kasa Steril 5 cm x 5 cm, 8 ply, isi 5 (Onemed) Box
92 3 Ply Earloop Medical Surgical (EKOMED) Box
93 Nasal Cannula Anak (EKOMED) Pcs
94 Nasal Cannula Dewasa (EKOMED) Pcs
95 Examination Gloves Lightly Powdered, Size S (MEDDIS) Box
96 Examination Gloves Lightly Powdered, Size M (MEDDIS) Box
97 Examination Gloves Lightly Powdered, Size L (MEDDIS) Box
98 SYRINGE WITH NEEDLE 3 ML Buah
99 SYRINGE WITH NEEDLE 5 ML Buah
100 IV CATETER GEA 22 G BOX @ 50 PCS Pcs
101 IV CATETER GEA 24 G BOX @ 50 PCS Pcs
102 UNDERPAD ONEMED 60 X 90 PACK @ 10 PCS pack
103 URINE BAG MEDDIS Pcs
104 FOLLEY CATHETER ONEHEALTH 2 WAY 16 BOX @ 10 PCS Pcs
105 SARUNG TANGAN NON STERIL SAFEGLOVE M Box
106 SARUNG TANGAN NON STERIL SAFEGLOVE S Box
107 DISPOSABLE SYRINGE ONEMED 3 ML Pcs
108 DISPOSABLE SYRINGE ONEMED 1 ML Pcs
109 KASA EVOMED 40 X 80 YARD Roll
110 KASA MEDLINE 16 X16 PACK @ 10 KOTAK Box
111 LEUKOPLAST 7,5 CM X 4,5 CM Roll
112 SARUNG TANGAN STERIL MAXTER NO 7 Pasang
113
MASKER OKSIGEN REBREATHING MEDDIS ANAK @ 50 PCS pcs
114
MASKER OKSIGEN REBREATHING MEDDIS DEWASA @ 50 PCS pcs
115 BISTURI AESCULAP NO 10 pcs
116 RESUCITATOR PVC MPM CHILD Unit
117 RESUCITATOR PVC MPM ADULT Unit

Petugas Sub Unit Langkaplancar, ……………………. 2023

Yang Menerima
Pengelola Obat Puskesmas

_____________________________ apt. Deni Tri Hartanto, S.Farm

NIP. 19941228 202203 1 008