Lplpo PKM Rasabou

LAPORAN PEM
PUSKESMAS : RASABOU
KECAMATAN : HU`U
KABUPATEN : DOMPU
PROPINSI : NUSA TENGGARA BARAT
STOCK
NO NAMA OBAT / ALKES SATUAN NO. BACTH
AWAL
1 2 3 4 5
APBD 1 / APBN
Alat Kesehatan
1 Alat Suntik sekali pakai 0,05 ml Pcs
2 Alat Suntik sekali pakai 1 ml Pcs
3 Alat Suntik sekali pakai 3 ml Pcs
4 Apron Biru malaria Pcs
5 Alkohol Swabs 100's Pcs GM2011244
6 APD IMUNISASI COVID PAKET
7 Gips 4 Inch Rol
8 BAJU (Cover All Suit /Hazmat Suit) baju BOHO Pcs
9 Masker Bedah 3 Ply (TB) Pcs
10 Kaca Mata Google TB Pcs 2
11 Masker Bedah 3 Ply (HIV) Pcs
12 Masker TB N95 Pcs
13 Masker N95 (Sure And Me) Pcs
14 Masker Bedah Anak Pcs
15 APD Lengkap Foging Set
16 Masker Las (Foging) Pcs
17 Masker Malaria Pcs
18 Sarung Tangan Non Steril S Pcs
19 Sarung Tangan Non Steril M Pcs
20 Kelambu Roll
21 Plester Bulat @200pcs Pcs
22 Sarung Tangan Steril 7 Pcs
OBAT-OBATAN
1 Albendazole 400 mg Tablet 465 1107273
2 Asam Ascorbat 500 mg Tablet
3 Bedaquiline Tablet
4 Closerin 250 mg Tablet
5 Clofazimin Tablet
6 DHP Frimal (Kotak @9 Tablet) ktk 1
7 Ethionamide Tablet
8 Linezolid 600 mg Tablet
9 Garam Oralit Sachet 253
10 Glibenclamide 5 mg Tablet
11 INH(Ishonizide) Tablet 700
12 Lompren ( Clofazimine) Tablet
13 MDT Combi Dewasa MB (Merah) Blister 5
14 MDT Combi Dewasa PB (Hijau) Blister
15 MDT Combi Anak MB ( ORANGE) Blister
16 Mineral Mix Sachet 30
17 Moxifloxacin ( moximed) Tablet
18 Metoclopramid 10 mg Tablet
19 OAT Kat. 1,3 Paket 3 46461012
20 OAT Kat. II Paket
21 OAT Kat Anak Paket 2
22 OAT Kat kombipak Paket
23 Primaquin 15 mg Tablet 86
24 Rifampicin Tablet
25 Retinol 200.000 IU (Merah) Kapsul lunak 200 F21209W
26 Retinol 100.000 IU (Biru) Kapsul lunak 200 E20910W
27 Sivit Zinc Tablet
28 Tablet Tambah Darah Tablet 18660
29 Zinc 20 mg Tablet
SIRUP, SUSPENSI DAN DROP
1 Albendazole sirup Botol
INJEKSI DAN PELARUT
1 Artesunat Injeksi 60 mg/ml Vial
2 Dextrose 40% Vial
3 Ephedrin HCL Inj 1% Ampul
4 Ephinefrine Ampul
5 Metoclopramid inj 5 mg/ml Ampul
6 MgSO4 40% Ampul
7 Phytomenadion inj 2 mg/ml Ampul
VAKSIN DAN SERUM
1 Alat Suntik sekali pakai 0,3 ml Pcs 2110125
2 Vaksin BCG Vial
3 Vaksin Td Vial
4 Vaksin HB0 Vial
5 Vaksin IPV Vial
6 Vaksin Polio (POLIO) Vial
7 Vaksin MR (1-2) ( Rubela/Campak)/Bian Vial
8 Vaksin MR (1-2) ( Rubela/Campak) Vial
9 Vaksin DT Vial
10 Vaksin PCV Vial
11 Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4) Vial
12 Tinta Vaksin Bian Pcs
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 6
14 RABIES VACCINE INACTIVATED Vial
15 RABIES IMMUNE GLOBULIN (HUMAN) 1 ML Vial
16 Vaksin Covid-19 (Sinovac) Vial
17 Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis) Vial
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial
19 Vaksin Covid-19 Pfizer (@ 6 Dosis) Vial
20 Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA Vial
21 Vaksin Covid-19 @14 (Moderna) Vial
22 Vaksin Sinopharm @ 2 dosis Vial
23 Vaksin Covid-19 (Moderna) @10 DOSIS Vial
24 Vaksin Covid-19 (@ 2 Dosis) CORONAVAC Vial
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial FX2761
26 Vaksin Covid-19 (@10 Dosis) ASTRAZENECA Vial
27 Cadox (Konecavax)@10 dosis Vial
28 Safety Box 5 Liter Pcs
29 Pelarut MR Bian Ampul
30 Pelarut BCG Ampul
31 Pelarut MR Ampul
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul B832
33 Pipet Tetes (Polio/BOPV)
34 Pelarut NaCl 0,9% 10 ml Flash
TETES MATA, TETES TELINGA, SALEP DAN
SEDIAAN TOPIKAL
1 Chloramphenicol SM 1% Tube
2 Hidrocortison salep Tube
3 Oxytetrasiklin Salep Mata 0,1% Tube
4 Salep 2-4 Pot
LABORATORIUM
1 Box Slide ( Warna Hijau )(malaria) 72'S ktk/72 pcs
2 Blood Lancet 100 'S Pcs
3 Fesco Blood Lancet 200 'S Pcs
4 Catride TCM TB Pcs
Malaria Ag. pLDH/HRP2 (COMBO Card Test)
5 (Whole Blood) (Warna PEACH)(AG PCDH) 25 kit/box
(MALARIA)
6 Handsanitizer 50 ml Botol
7 Handsanitizer 100 ml Botol
8 Giemsa 100 ml Botol
9 Oil Emersi 100 ml Botol
10 Oil Emersi 500 ml Botol 1
11 Giemsa 500 ml Botol
12 Kartu Golongan Darah pak
13 Lab. Kit Malaria kotak
14 Oil Emersi botol
15 Paket KIT TB kotak
16 Pot Dahak / Pot Sputum Buah
17 Reagen ZN 10 ktk/Dus
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak H22019
RDT Malaria ( Carestart Malaria PT/PAN HRP 2/PL
19 Test 25
DN Ag Combo RDT) (Warna KUNING)
20 RDT DBD SD BIOLINE 25 kit/box
Rapid antigen Abbot Panbio Covid (Ag) Rapid Test
21 Pcs
Divice (Nasopharyngeal)
22 Rapid Antigen (Whole Power) Pcs 100
23 Rapid Antigen Entram Pcs
24 Reagen Golda A vial
25 Reagen Golda B vial
26 Reagen Golda AB vial
27 Anti Resus D vial
28 SD HIV-1/2 3,0 25/kotak 0
29 TRIPOCHECK SYPHILIS 25/kotak 8
30 Tuberkulin Vial
31 VTM + Stik Steril Swab (CITO) Pcs
32 BETAFOG Botol
33 Insektisida DBD (GOKILATH)
34 Human Colesterol Liquid Botol
35 Human Glucose liquid Botol
36 Human Hemoglobine liquid Botol
37 Human Tryglyceride liquid Botol
38 Providen
39 Sars Cov-2 Anti Bodi Test BOX/20
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 5352AF1AC
39 Virotec Dengue Kombo (P2M) Pcs H22023
DAK
BAHAN MEDIS HABIS PAKAI (BMHP)
1 Alat Suntik sekali pakai 0,5 ml Pcs
2 Alat Suntik sekali pakai 1 ml Pcs 200
3 Alat Suntik sekali pakai 3 ml Pcs 218 2/13/1901
4 Alat Suntik sekali pakai 5 ml Pcs 148 710
5 Alkohol Swabs 100's Pcs 800
6 Blade Sterile (Mess) Pcs 109
7 Blood Lancet Pcs 200
8 Blod TransfusiSet Stera Pcs 14 280320088
9 Catgut Chromic (Absorbable Suture Sterile) Pcs 11
10 Catgut Plain 3/0 HR 37 mm Pcs 113
11 Dermatix Pcs
12 Female Catheter no. 16 Pcs
13 Female Catheter no. 18 Pcs
14 Foley Catheter no. 18 Pcs 12 20191017
15 Foley Catheter no. 20 Pcs
16 Infus Set Anak Pcs 217
17 Infus Set Dewasa Pcs 52
18 IV Catheter No. 16 Pcs
19 IV Catheter no. 18 Pcs 252
20 IV Catheter no. 20 Pcs 407
21 IV Catheter no. 22 Pcs 206 21L2506J
22 IV Catheter no. 24 Pcs 108 20108D003
23 Jarum Kulit GT 14 Pcs
24 Jarum Otot GR 14 Pcs
25 Kapas Pembalut 500 gr Bungkus 7
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 1
27 Kassa Steril kotak
28 Masker Nebul Anak Pcs
29 Masker Nebul Dewasa Pcs
30 Nasal Canula Bayi (Oxyflow) Pcs 9
31 Nasal Canula Anak (Oxyflow) Pcs 18
32 Nasal Canula Dewasa (Oxyflow) Pcs 18
33 Needle No. 25G x 25 mm Pcs
34 Polifix / Hipavix 5mx5cm Roll 0
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 800
36 Sarung Tangan Non Steril M Pcs
37 Sarung Tangan Non Steril L Pcs 100 7117306137
38 Sarung Tangan Steril 7,5 Pcs
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile) Pcs
40 Stomach tube no. 18 Pcs
41 Tes kehamilan Pcs 200
42 Under Pad (Soft Pad 60 x 90 cm) Pcs 115
43 Urine Bag Pcs 17
44 Sarung Tangan Steril 7 Pcs 12 SH2202032
OBAT-OBATAN
1 Acetylcystein 200 mg Tablet 940 22AS1211
Asam Asetil Salisilat/Asetosal tablet 80 mg ( Miniaspi
2 Tablet
)
3 acyclovir 400 mg Tablet
4 Allopurinol 100 mg Tablet 1690
5 Amlodipin 5 mg Tablet
6 Amlodipin 10 mg Tablet 3270
7 Amoxicillin 500 mg Tablet 5070
8 Antasida DOEN Tablet Tablet 4930
9 Asam Ascorbat 50 mg Tablet 2550
10 Asam Mefenamat 500 mg Tablet
11 Attapulgit 600 mg (pularex) Tablet 1400
12 Betahistine tablet 150
13 Captopril 12,5 mg Tablet 3400
14 Captopril 25 mg Tablet 1100
15 Calcium Lactate Tablet 1420
16 Cavicur Tablet 1470
17 Ciprofloxacin 500mg Tablet 690
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 3460 2207099
19 Cotrimoxazol 480 mg Tablet 3260
20 Cetirizin HCL Tablet 1745
21 Chlorampenicol 250 mg Tablet
22 Chlorampenicol 500 mg (Cloramex 500) Tablet 1545
23 Dexamethasone 0,5 mg Tablet 2140
24 Digoxin 0,25 mg Tablet
25 Dimenhydrinat 50 mg Tablet 90
26 Domperidon 10 mg Tablet 2430
27 Ergotamin Tablet
28 Erytromycin 250 mg Tablet
29 Erytromycin 500 mg Tablet
30 Folic Acid 1mg Tablet 140 2110-050365
31 Furosemide 40 mg Tablet
32 Glibenclamide 5 mg Tablet 3400
33 Glimepiride 1 mg Tablet
34 Glimepiride 2 mg Tablet 200
35 Glimepiride 13mg Tablet
36 Griseovulfin 125 mg Tablet 230
37 Griseovulfin 500 mg Tablet
38 Hydrochlorthiazide 25 mg Tablet 100
39 Ibuprofen 200 mg Tablet
40 Ibuprofen 400 mg Tablet 0
41 Ketokonazole 200 mg Tablet 1300
42 Loperamide Tablet 440
43 Loratadine 10 mg Tablet
44 Metyl Ergometrin 0,125 MG Tablet
45 Methyl Prednisolon 4 mg Tablet
46 Metformin 500 mg Tablet 2360
47 Metoclopramid 10 mg Tablet
48 Metronidazole 250 mg Tablet
49 Metronidazole 500 mg Tablet 580
50 Nifedipin 10 mg Tablet
51 Nifedipin 20 mg (Adalat Oros ) Tablet 60
52 Nystatin 100.000 IU Tablet Vaginal Tablet 10
53 Nystatin 500.000 IU Tablet Tablet 80 46371001
54 Natrium Diklofenak 25 mg Tablet 3670 G12162J
55 Natrium Diklofenak 50 mg Tablet 560
56 Omeprazole Cap Tablet 1230
57 Paracetamol 500 mg Tablet 2045
58 Phytomenadion 10 mg Tablet 100
59 Propranolol Tablet
60 Prednisone 5 mg Tablet
61 Propylthiouracil 100 mg Tablet
62 Pyrantel Pamoate 125 mg Tablet 200
63 Ranitidine 150 mg Tablet 3900
64 Salbutamol 4 mg Tablet 610
65 Simvastatin 10 mg Tablet 90
66 Simvastatin 20 mg Tablet
67 Vitamin B Kompleks Tablet 4590
68 Zinc 20 mg Tablet 1480
68 Cefadroksil Monohidrat 500 mg Tablet 0 2210-12-57
1 Amoxicillin Syr 125 mg/5ml Botol
2 Amoxicillin Syr 250 mg/5ml Botol 0 B10223
3 Antasida DOEN Suspensi Botol
4 Cotrimoxazol Suspensi 240 mg/5ml Botol 6
5 Domperidon suspensi Botol
6 Ibuprofen 200 mg/5ml suspensi Botol
7 Metronidazole Sirup Botol
8 Paracetamol Sirup 120 mg/5ml Botol 5
INJEKSI DAN PELARUT
1 Ampicillin Injeksi 1000 mg Vial
2 Aqua Pro Injeksi 25 ml Flush
3 Aqua DM 1000 ml Botol 1
Kombinasi Ipratropium Bromida 0,5 mg + Salbutamol

4 Ampul
2,5 mg nebule (Farbivent/Combivent)
5 Dexamethasone Injeksi Ampul
6 Diphenhydramin inj Ampul 19
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 23
8 Gluconat Calcicum Inj 100 mg/ml Ampul 5
9 Lidocain HCl 2% Ampul 85 56362059-3
Lidokain komp. injeksi, Kombinasi: Lidokain HCl 2%
10 Ampul 0
+ Epinefrin 1:80.000 - 2 ml
11 Meprovent Inhaler Ampul 7 N2D028
12 Methyl Ergometrin Inj 0,2 mg/ml Ampul 15
13 MgSO4 20% Vial 6 B771451B
14 MgSO4 40% Vial 5
15 Oxytocin Injeksi Ampul 31 9622C0076A
16 Omeprazole Inj 40 mg/ml Ampul 18
17 Phytomenadion Inj 2 mg/ml Vial 81
SEDIAAN TOPIKAL
1 Aciclovir salep kulit Tube
Anti Bakteri DOEN salep kombinasi: Basitrasin 500
2 Tube
IU/g + Polimiksin 10.000 IU/g
Antifungi DOEN Kombinasi: Asam Benzoat 6% +
3 Tube
Asam Salisilat 3%
4 Betamethasone cream Tube
5 Chloramphenicol 1% Salep Mata Tube 48
6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 4
7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol

8 Hydrocortison 2,5% Tube 24 F21197W
9 Ketokonazole Cream Tube
10 Miconazole 2% Tube 42
11 Oxytetrasiklin Salep Mata Tube
12 Phenol Glyserol (Tetes Telinga) Botol
13 perak sulfaduazine Tube
Salep 2-4 , Kombinasi: Asam Salisilat 2% +
14 Tube
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 4 21J101
16 Bedak Salisyl 2% Tube 27
SUPPOSITORIA DAN LARUTAN REKTAL
1 Antihemoroid Suppo Supp 6
2 Bisacodyl / Dulcolax 5 mg Supp 6
3 Bisacodyl / Dulcolax 10 mg Supp
ANTISEPTIK DAN DESINFEKTAN
1 Antiseptik Kumur Botol
2 E-Care Hand Sanitizer 500 ml Botol
3 E care hand Wash (Sabun Cair 500 mL) Botol
4 Povidon 300 ml Botol 11
5 Povidon 60 ml Botol
6 Lisol 1 L Botol
VAKSIN DAN SERUM
1 Serum Anti Bisa Ular /Biosave SABU Vial
Serum Anti Tetanus injeksi 25 IU/ampul (ATS)
2 Vial 2
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS
1 Glucosa 5% (D5%) 500 ml Botol 20
2 Glucosa 10% (D10%) 500 ml Botol 8
3 Natrium Chlorida (NaCl) 0,9% Botol 180
4 Ringer Laktat Botol 0 F222L10
5 Ringer Asering Botol
OBAT GIGI
1 Ethyl Chloride Kaleng
2 Fuji IX GP Besar pcs
3 Fuji IX GP Kecil pcs
4 Hydcal (Calsidol) pcs
5 Iodotin/ Iodoform pcs
6 Composit Pcs
7 Sponestan / Surgipson pcs
8 Cavit G pcs
9 Tri Kresol Formalin (TKF) Set
10 Klorfenol Kamfer Mentol pcs
11 Devitalisasi Pasta Ion Arsen pcs
12 Pulp - X Botol PK21222108
12 Eugenol Botol
LABORATORIUM
1 Golda A Vial
2 Golda B Vial
3 Golda AB Vial
4 Golda Resus D Vial
5 HB Mission 50's Acon pcs
6 Kertas Lensa Buah
7 Kartu Golongan Darah Lembar
8 Micropipet MT.II 1000 µl Pak
9 Micropipet MT.I 200 µl Pak
10 Object Glass Frosted (Slide) Box
11 Rak Tabung Reaksi 50 Lubang Multipurpose Pcs
RIGHT SIGN Malaria P.f/Pan Rapid Test Cassette

12 25 kit/box
(Whole Blood) (Warna PUTIH) (MALARIA)
13 Standbio Glucose 1 x 250 ml Kit

14 Standbio Uric Acid 4 x 30 ml Kit
15 Standbio Cholesterol 4 x 30 ml Kit
16 Stik Nesco Cholestrol Box
17 Stik Nesco Asam Urat Box
18 Stik Nesco Gula Box
19 Stik Easy Touch Asam Urat Box
20 Stik Easy Touch Gula Box
21 Stik Easy Touch Cholestrol Box
22 Stik Benecek Asam Urat Box 3
23 Stik Benecek Gula Box
24 Stik Benecek Cholestrol Box C22128080
25 Mindray U-II Urin Tes Botol
26 Stik Urin 3 Parameter 100'S pcs
27 Stik Urin 10 Parameter 100'S pcs
28 Stik Gluko Protein Tes 10'S pcs 1
Virotec Dengue Combo (IgG/IgM & NS 1) (Box@10
29 Box H22023
test) ( RDT Demam Berdarah)
30 Widal kotak
31 DILUENT GALON
32 RINSE GALON
33 LYSE Botol
34 Probe Cleanser Botol
35 EZ Cleanser Botol
36 Giemsa Botol
37 Oil Emersi 100 ml Botol
38 Blue Tip Botol 500
BAHAN KIMIA
1 Cynolf Botol
2 Kaporit Galon
3 ABATE 1 Kg/ Botol 224R070007
DANA DID, BTT & DBHCHT COVID
BMHP
1 Alat Suntik sekali pakai 3 ml pcs
2 Alat Suntik sekali pakai 5 ml pcs
3 APRON White pcs 30
4 APD LENGKAP pcs 15
5 Cover All Suit pcs 20
6 Faceshield pcs
7 Faceshield kacamata pcs
Flocked Sampling Swab ( Nasopharyngeal)
8 pcs
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 1000
10 Masker Tis On 3Ply pcs
11 Masker Kain Scuba (Anak) pcs 50
12 Masker Kain Scuba (dewasa) pcs
13 3M Particulate N95-8210 pcs
14 Masker KN95 (Protective Mask) pcs
15 Masker N95 (mask 5 play) smiles pcs
16 Sarung Tangan Non Steril S pcs
17 Sarung Tangan Non Steril M pcs
18 Sarung Tangan Non Steril L pcs
19 Sarung Tangan Steril 7 pcs
20 Sarung Tangan Steril 7.5 pcs
21 Sarung Tangan Obgyn pcs
22 Surgical Gown Water Proff pcs
23 Termometer & Hemidity meter pcs
24 Tensi ( Blood Pressure Monitor ) pcs
25 Termogun HTI pcs
26 Termogun ( OMRON Digital Forehead Termometer) pcs
TAMBAHAN
1 Kasa panjang 42y x 110 cm Poli Kassa Rol
LABORATORRIUM
1 Stik Cholesterol Easy Touch Box
2 Stik Asam Urat Easy Touch Box
3 Stik Glucose Easy Touch Box
4 Stik Glucose Nesco Box
5 Stik Cholestrol Nesco Box
6 Stik Uri Acid Nesco Box
7 Stik Uri Acid Nesco Box
8 Stik Cholestrol Bhenecek Box
9 Stik Uri Acid Bhenecek Box
10 Stik Uri Acid Bhenecek Box
11 Tabung EDTA Tutup ungu pcs
12 VTM + Stik Steril Swab pcs
13 VTM pcs
14 Rapid Antigen (Clungene Taishan) pcs
15 Rapid Test Indec pcs
16 Standar Q Covid-19 Ag pcs
17 VTM + Stik Steril Swab Dacron
OBAT-OBATAN
1 Asam Ascorbat (Vitamin C) 250 mg Tablet
2 Azithromycin 500 mg 20/ktk
3 Allopurinol 100 mg Tablet
4 Allopurinol 300 mg Tablet 1000
5 Cavicur Tablet
6 Chlorpromazine 100 mg Tablet
7 Ciprofloxacin 500 mg Tablet 0
8 Chloroquin Phospat 150 mg 100/ktk
9 Chloroquin Phospat 150 mg 100/ktk
10 Domperidon 10 mg Tablet
11 Farbion Tablet
12 Favipiravir 200 mg Tablet
13 Gold Trion Tablet
14 Ibuprofen 400 mg Tablet
15 Levofloxacin 500 mg 50/ktk
16 N-acetylcystein 30/box Tablet
17 Oseltamivir Capsules 75 mg Kapsul
18 Paracetamol 500 mg Tablet
19 Piroxicam 20 mg Tablet
20 Piridoxin Tablet 800
21 Seloxy Tablet
22 Kolkisin Tablet 580
INJEKSI DAN PELARUT
1 Phytominadion inj Ampul
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot
Anti Fungi Doen salep kombinasi : Asam Benzoat
2 Pot
6% + Asam Salisilat 3%
ANTISEPTIK DAN DESINFECTAN
1 Alkacide ( DESINFEKTAN) Botol
2 T. Handrub 100 ml botol
3 E-Care Handrub 500 ml Botol
4 Alkohol 70% Botol 2022033065
5 Kaporit 60% 15 Kg Galon
HIBAH
1 Jas Hujan (TorchMed-Guard) pcs
2 Kacamata pcs
3 Nurse Cap ONE MED / penutup kepala pcs
4 Sepatu Boot pcs
JKN
1 Salbutamol 2 mg Tablet
2 Ethyl Chloride Botol
3 Povidone 60 ml Botol
UMUM GRATIS
JUMLAH KUNJUNGAN
JUMLAH RESEP
MENGETAHUI, YANG MENYERAHKAN,

KEPALA DINAS KESEHATAN KAB. DOMPU KEPALA UPTD IFP DOMPU
Maman .SKM,M.Mkes Indi Hartini, A.Md.,Farm

NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PELAPORAN B
PERMINTAAN
TANGGAL HARGA PENERIM PERSEDI JUMLAH TOTAL SUB

SUMBER DANA PEMAKAIAN
KADALUARSA SATUAN AAN AAN EXPIRED UNIT
6 7 8 9 10=9+4 11 12 = (10-11-13) 13
0 0
0 0
5 5 5
0 0
11/30/2025 Rp70 30 30 30
0 0
0 0
0 0
0 0
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
7/1/2023 465 185 80
0 0
0 0
0 0
0 0
1 0
0 0
0 0
253 214 39
0 0
700 400 0
0 0
5 0
0 0
0 0
30 17
0 0
0 0
APBD I 2021 2/29/2024 Rp436,445 5 8 2
0 0
2 0
0 0
86 0
0 0
APBD I 6/30/2025 Rp586 2200 2400 2050
APBD I 5/30/2025 Rp324 550 750 350
0 0
18660 3360
100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10/17/2026 Rp1,185 30 30 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5 5
0 0
0 0
Rp14,000 1 1 1
0 0
0 0
0 0
8/31/2023 Rp3,280 5 5 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
APBN I 2023 7/31/2024 10 10 10
25 0
0 0
0 0
100 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
APBD I 10/14/2023 50 50 50
APBD I 8/31/2024 50 50 50
0 0
0 0
0 0
200 133 67
DAK 2022 4/9/2027 Rp979 400 618 456 62
DAK 2021 7/9/2026 Rp1,056 100 248 96 52
800 500
109 109
200 0
DAK 2021 2/1/2025 Rp3,600 10 24 9
11 11
113 65
0 0
0 0
0 0
DAK 2021 10/16/2024 Rp14,341 20 32 13
0 0
217 106 11
52 52
0 0
252 25 7
407 38 19
DAK 2022 11/30/2026 Rp4,862 300 506 173 33
DAK 2022 8/30/2027 Rp12,804 300 408 67 1
0 0
0 0
7 0
0 0
0 0
0 0
9 1
18 3
18 3
0 0
0 0
800 0
0 0
DAK 2022 4/30/2027 Rp546 3000 3100 1150
0 0
0 0
0 0
200 121
115 45
17 11
DAK 2022 3/30/2027 300 312 32
0 0
DAK 2022 9/30/2024 Rp307 5100 6040 2640 20
0 0
0 0
70
0 0
3270 2161 109
5070 3840 30
4930 3150 80
2550 2390 60
0 0
1400 120 80
150 0 50
3400 760 140
1100 700
1420 890 130
1470 920 150
690 290
DAK 2022 7/30/2024 Rp70 5000 8460 5610 450
3260 620 240
1745 660 285
0 0
1545 255 90
2140 2127 13
0 0
90 90
2430 60 270
0 0
0 0
0 0
DAK 2021 10/1/2023 Rp43 500 640 70 370
0 0
3400 1240 660 100
0 0
200 40 160
0 0
230 30 200
0 0 0
100 0
0 0
1300 910
440 220 220
0 0
0 0
0 0
2360 1850
0 0
0 0
580 245 35
0 0
60 0
10 10
DAK 2022 3/30/2024 Rp0 170 250 0 250
DAK 2021 7/1/2026 Rp114 1000 4670 3760
560 560
1230 810
5000 7045 5845
100 0 100
0 0
0 0
0 0
200 8
3900 2270 30
610 110
90 90
0 0
4590 3930 60
1480 1480
DAK 2022 10/30/2026 Rp1,100 500 500 20
0 0
0 0
DAK 2022 12/31/2024 Rp3,510 200 200 67
0 0
6 6
0 0
0 0
0 0
5 5
0 0
0 0
0 0
1 0
0 0
0 0
19 0
23 3
5 0
DAK 2022 6/30/2026 Rp847 100 185 121
0 0
DAK 2022 4/1/2028 Rp3,677 30 37 29
15 0
DAK 2022 11/8/2023 Rp3,760 5 11 6 0
5 0
DAK 2022 3/31/2025 Rp1,298 100 131 26
18 1
0 0
0 0
0 0
0 0
0 0
48 48 0
4 4
0 0
DAK 2022 6/30/2024 Rp2,325 48 72 20 28
0 0
42 42
0 0
0 0
0 0
0 0
DAK 2022 9/30/2024 Rp6,578 10 14 3
27 22
0 0
6 6
6 5
0 0
0 0
0 0
0 0
0 0
11 1
0 0
0 0
0 0
0 0
2 0
0 0
20 12
8 8
180 0
12/4/2025 100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
DAK 2022 1/7/2025 Rp210,500 2 2 0 0
2 2 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 0
0 0
DAK 2022 12/31/2023 Rp25,723 10 10 10
0 0
0 0
0 0
1 0
8/31/2024 10 10 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
500 0
0 0
0 0
0 0
APBN 6/8/2024 Rp0 1 1 1
0 0
0 0
0 0
0 0
30 30
15 15
20 20
0 0
0 0
0 0
DID 2021 2000 3000 1250
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1000 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
800 440 60
0 0
580 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
DAK 2022 11/30/2023 Rp58,000 5 5 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1000 1000 550 150
0 0
0 0
GRATIS JKN TOTAL

0
0
YANG MENYERAHKAN, YANG MEMINTA, YANG
PALA UPTD IFP DOMPU KEPALA UPTD PUSKESMAS PENGELOLA
ndi Hartini, A.Md.,Farm Joharis, AMG

P. 19690307 198903 2 013 NIP. 19660219 199401 1 002
PELAPORAN BULAN : JANUARI
PERMINTAAN BULAN : FEBRUARI
TAHUN : 2023
STOCK STOCK PERMINTAA

TOTAL HARGA STOK OPTIMUM PEMBERIA
GUDANG AKHIR N
N
14 15 16 17= 12+(9*50%) 18 19
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 7.5 8
0 Rp0 0 -
0 Rp0 45 45
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
2 2 Rp0 0 - 2
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
200 280 Rp0 277.5 - 3
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
1 1 Rp0 0 - 1
0 Rp0 0 -
0 Rp0 0 -
39 Rp0 321 282
0 Rp0 0 -
300 300 Rp0 0 - 300
0 Rp0 0 -
5 5 Rp0 0 - 5
0 Rp0 0 -
0 Rp0 0 -
13 13 Rp0 25.5 13
0 Rp0 0 -
0 Rp0 0 -
6 6 Rp30 3 4 - 3
0 Rp0 0 -
2 2 Rp0 0 - 2
0 Rp0 0 -
86 86 Rp0 0 - 86
0 Rp0 0 -
350 350 Rp770,000 3075 2,725
400 400 Rp220,000 525 125
0 Rp0 0 -
15300 15300 Rp0 5040 - 10,260
800 900 Rp0 0 - 900
Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 45 45
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
6 6 Rp0 0 - 6
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 7.5 8
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 1.5 2
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 7.5 8
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
1 1 Rp0 0 - 1
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 15 15
25 25 Rp0 0 - 25
0 Rp0 0 -
0 Rp0 0 -
80 80 Rp0 30 - 50
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 75 75
0 Rp0 75 75
Rp0 0 -
Rp0 0 -
0 Rp0 0 -
67 Rp0 199.5 133
100 162 Rp64,800 684 522
100 152 Rp15,200 144 100 - 8
300 300 Rp0 750 450
0 Rp0 163.5 300 164
200 200 Rp0 0 - 200
15 15 Rp150 13.5 - 2
0 0 Rp0 16.5 17
48 48 Rp0 97.5 50
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
19 19 Rp380 19.5 1
0 Rp0 0 -
100 111 Rp0 159 48
0 Rp0 78 78
0 Rp0 0 -
220 227 Rp0 37.5 - 190
350 369 Rp0 57 - 312
300 333 Rp99,900 259.5 - 74
340 341 Rp102,300 100.5 - 241
0 Rp0 0 -
0 Rp0 0 -
7 7 Rp0 0 - 7
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
8 8 Rp0 1.5 - 7
15 15 Rp0 4.5 - 11
15 15 Rp0 4.5 - 11
0 Rp0 0 -
0 Rp0 0 -
800 800 Rp0 0 - 800
0 Rp0 0 -
1950 1950 Rp5,850,000 1725 - 225
0 0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
79 79 Rp0 181.5 103
70 70 Rp0 67.5 - 3
6 6 Rp0 16.5 20 11
280 280 Rp84,000 48 - 232
Rp0 0 -
3380 3400 Rp17,340,000 3960 5000 560
0 Rp0 0 200 -
0 Rp0 0 -
800 870 Rp0 0 - 870
0 Rp0 0 -
1000 1109 Rp0 3241.5 5000 2,133
1200 1230 Rp0 5760 4,530
1700 1780 Rp0 4725 2,945
100 160 Rp0 3585 3500 3,425
0 Rp0 0 -
1200 1280 Rp0 180 - 1,100
100 150 Rp0 0 - 150
2500 2640 Rp0 1140 - 1,500
400 400 Rp0 1050 650
400 530 Rp0 1335 2000 805
400 550 Rp0 1380 830
400 400 Rp0 435 35
2400 2850 Rp14,250,000 8415 5000 5,565
2400 2640 Rp0 930 - 1,710
800 1085 Rp0 990 - 95
0 Rp0 0 -
1200 1290 Rp0 382.5 - 908
13 Rp0 3190.5 3,178
0 Rp0 0 -
0 Rp0 135 135
2100 2370 Rp0 90 - 2,280
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
200 570 Rp285,000 105 - 465
0 Rp0 0 -
1400 1500 Rp0 990 2000 - 510
0 Rp0 0 -
160 Rp0 60 - 100
0 Rp0 0 -
200 Rp0 45 - 155
0 Rp0 0 -
100 100 Rp0 0 - 100
0 Rp0 0 -
0 Rp0 0 -
390 390 Rp0 1365 975
220 Rp0 330 1000 110
0 Rp0 0 -
0 Rp0 0 100 -
0 Rp0 0 -
510 510 Rp0 2775 3000 2,265
0 Rp0 0 -
0 Rp0 0 -
300 335 Rp0 367.5 33
0 Rp0 0 -
60 60 Rp0 0 - 60
0 Rp0 15 15
250 Rp42,500 0 - 250
910 910 Rp910,000 5640 3000 4,730
0 Rp0 840 840
420 420 Rp0 1215 2000 795
1200 1200 Rp6,000,000 8767.5 5000 7,568
100 Rp0 0 - 100
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 100 -
192 192 Rp0 12 - 180
1600 1630 Rp0 3405 1,775
500 500 Rp0 165 - 335
0 Rp0 135 135
0 Rp0 0 -
600 660 Rp0 5895 5000 5,235
0 Rp0 2220 2,220
480 480 Rp240,000 30 - 450
Rp0 0 -
0 Rp0 0 -
133 133 Rp26,600 100.5 - 33
0 Rp0 0 -
0 Rp0 9 9
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 7.5 8
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
1 1 Rp0 0 - 1
0 Rp0 0 -
0 Rp0 0 -
19 19 Rp0 0 - 19
20 20 Rp0 4.5 - 16
5 5 Rp0 0 - 5
64 64 Rp6,400 181.5 100 118
0 Rp0 0 -
8 8 Rp240 43.5 30 36
15 15 Rp0 0 - 15
5 5 Rp25 0 - 5
5 5 Rp0 0 - 5
105 105 Rp10,500 39 - 66
17 17 Rp0 1.5 - 16
81 81 Rp0 0 - 81
Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 6 6
0 Rp0 0 -
24 52 Rp2,496 30 - 22
0 Rp0 0 -
0 Rp0 63 50 63
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
11 11 Rp110 4.5 - 7
5 5 Rp0 33 28
Rp0 0 -
0 Rp0 9 9
1 1 Rp0 7.5 7
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
10 10 Rp0 1.5 - 9
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
2 2 Rp0 0 - 2
Rp0 0 -
8 8 Rp0 18 10
0 Rp0 12 12
180 180 Rp0 0 - 180
0 Rp0 150 300 150
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
2 2 Rp4 0 - 2
2 2 Rp4 0 - 2
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
3 3 Rp0 0 - 3
0 Rp0 0 -
0 Rp0 15 15
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
1 1 Rp0 0 - 1
0 Rp0 15 15
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
500 500 Rp0 0 - 500
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 1.5 2
Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 45 45
0 Rp0 22.5 23
0 Rp0 30 30
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
1750 1750 Rp3,500,000 1875 125
0 Rp0 0 -
0 Rp0 75 75
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
800 800 Rp0 300 - 500
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
300 360 Rp0 660 300
0 Rp0 0 -
530 530 Rp0 75 - 455
Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
3 3 Rp15 3 2 -
0 Rp0 0 -
Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
0 Rp0 0 -
Rp0 0 -
300 450 Rp450,000 825 375
0 Rp0 0 -
0 Rp0 0 -
YANG MENERIMA,
PENGELOLA OBAT PUSKESMAS
apt. Ajhar, S.Farm

NIP. 19910201 202203 1 007
PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
NO NAMA OBAT / ALKES
1 2
APBD 1 / APBN
Alat Kesehatan
1 Alat Suntik sekali pakai 0,05 ml
2 Alat Suntik sekali pakai 1 ml
4 Apron Biru malaria
5 Alkohol Swabs 100's
6 APD IMUNISASI COVID
7 Gips 4 Inch
8 BAJU (Cover All Suit /Hazmat Suit) baju BOHO
9 Masker Bedah 3 Ply (TB)
10 Kaca Mata Google TB
11 Masker Bedah 3 Ply (HIV)
12 Masker TB N95
13 Masker N95 (Sure And Me)
14 Masker Bedah Anak
15 APD Lengkap Foging
16 Masker Las (Foging)
17 Masker Malaria
18 Sarung Tangan Non Steril S
19 Sarung Tangan Non Steril M
20 Kelambu
21 Plester Bulat @200pcs
22 Sarung Tangan Steril 7
OBAT-OBATAN
1 Albendazole 400 mg
2 Asam Ascorbat 500 mg
3 Bedaquiline
4 Closerin 250 mg
5 Clofazimin
6 DHP Frimal (Kotak @9 Tablet)
7 Ethionamide
8 Linezolid 600 mg
9 Garam Oralit
10 Glibenclamide 5 mg
11 INH(Ishonizide)
12 Lompren ( Clofazimine)
13 MDT Combi Dewasa MB (Merah)
14 MDT Combi Dewasa PB (Hijau)
15 MDT Combi Anak MB ( ORANGE)
16 Mineral Mix
17 Moxifloxacin ( moximed)
18 Metoclopramid 10 mg
19 OAT Kat. 1,3
20 OAT Kat. II
21 OAT Kat Anak
22 OAT Kat kombipak
23 Primaquin 15 mg
24 Rifampicin
25 Retinol 200.000 IU (Merah)
26 Retinol 100.000 IU (Biru)
27 Sivit Zinc
28 Tablet Tambah Darah
29 Zinc 20 mg
1 Albendazole sirup
INJEKSI DAN PELARUT
1 Artesunat Injeksi 60 mg/ml
2 Dextrose 40%
3 Ephedrin HCL Inj 1%
4 Ephinefrine
5 Metoclopramid inj 5 mg/ml
6 MgSO4 40%
7 Phytomenadion inj 2 mg/ml
VAKSIN DAN SERUM
2 Vaksin BCG
3 Vaksin Td
4 Vaksin HB0
5 Vaksin IPV
6 Vaksin Polio (POLIO)
7 Vaksin MR (1-2) ( Rubela/Campak)/Bian
8 Vaksin MR (1-2) ( Rubela/Campak)
9 Vaksin DT
10 Vaksin PCV
11 Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4)
12 Tinta Vaksin Bian
13 Hepatitis B Imunoglobin (HbIg) Bayi
14 RABIES VACCINE INACTIVATED
15 RABIES IMMUNE GLOBULIN (HUMAN) 1 ML
16 Vaksin Covid-19 (Sinovac)
17 Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis)
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC
19 Vaksin Covid-19 Pfizer (@ 6 Dosis)
20 Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA
21 Vaksin Covid-19 @14 (Moderna)
22 Vaksin Sinopharm @ 2 dosis
23 Vaksin Covid-19 (Moderna) @10 DOSIS
24 Vaksin Covid-19 (@ 2 Dosis) CORONAVAC
25 Vaksin Covid -19 Pfizer (@ 6 Dosis)
26 Vaksin Covid-19 (@10 Dosis) ASTRAZENECA
27 Cadox (Konecavax)@10 dosis
28 Safety Box 5 Liter
29 Pelarut MR Bian
30 Pelarut BCG
31 Pelarut MR
32 Pelarut Pfizer NaCl 0,9% 10 ml
34 Pelarut NaCl 0,9% 10 ml

SEDIAAN TOPIKAL
1 Chloramphenicol SM 1%
2 Hidrocortison salep
3 Oxytetrasiklin Salep Mata 0,1%
4 Salep 2-4
LABORATORIUM
1 Box Slide ( Warna Hijau )(malaria) 72'S
2 Blood Lancet 100 'S
3 Fesco Blood Lancet 200 'S
4 Catride TCM TB
5 (Whole Blood) (Warna PEACH)(AG PCDH)
(MALARIA)
6 Handsanitizer 50 ml
8 Giemsa 100 ml
9 Oil Emersi 100 ml
10 Oil Emersi 500 ml
11 Giemsa 500 ml
12 Kartu Golongan Darah
13 Lab. Kit Malaria
14 Oil Emersi
15 Paket KIT TB
16 Pot Dahak / Pot Sputum
17 Reagen ZN
18 Rapid Test HBsAg/ Virocheck
19
20 RDT DBD SD BIOLINE
21
22 Rapid Antigen (Whole Power)
23 Rapid Antigen Entram
24 Reagen Golda A
25 Reagen Golda B
26 Reagen Golda AB
27 Anti Resus D
28 SD HIV-1/2 3,0
29 TRIPOCHECK SYPHILIS
30 Tuberkulin
31 VTM + Stik Steril Swab (CITO)
32 BETAFOG
34 Human Colesterol Liquid
35 Human Glucose liquid
36 Human Hemoglobine liquid
37 Human Tryglyceride liquid
38 Providen
39 Sars Cov-2 Anti Bodi Test
40 Standar Q HIV 1/2 Ab 3 Line R3
39 Virotec Dengue Kombo (P2M)
DAK
6 Blade Sterile (Mess)
7 Blood Lancet
8 Blod TransfusiSet Stera
9 Catgut Chromic (Absorbable Suture Sterile)
10 Catgut Plain 3/0 HR 37 mm
11 Dermatix
12 Female Catheter no. 16
14 Foley Catheter no. 18
16 Infus Set Anak
17 Infus Set Dewasa
18 IV Catheter No. 16
19 IV Catheter no. 18
23 Jarum Kulit GT 14
24 Jarum Otot GR 14
25 Kapas Pembalut 500 gr
26 Kasa panjang 42y x 110 cm Poli Kassa
27 Kassa Steril
28 Masker Nebul Anak
29 Masker Nebul Dewasa
30 Nasal Canula Bayi (Oxyflow)
31 Nasal Canula Anak (Oxyflow)
32 Nasal Canula Dewasa (Oxyflow)
33 Needle No. 25G x 25 mm
34 Polifix / Hipavix 5mx5cm
35 Plesterin Bulat Soft (Box @200 Pcs)
37 Sarung Tangan Non Steril L
38 Sarung Tangan Steril 7,5
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile)
40 Stomach tube no. 18
41 Tes kehamilan
42 Under Pad (Soft Pad 60 x 90 cm)
43 Urine Bag
OBAT-OBATAN
1 Acetylcystein 200 mg
2
)
3 acyclovir 400 mg
4 Allopurinol 100 mg
5 Amlodipin 5 mg
6 Amlodipin 10 mg
7 Amoxicillin 500 mg
8 Antasida DOEN Tablet
10 Asam Mefenamat 500 mg
11 Attapulgit 600 mg (pularex)
12 Betahistine
13 Captopril 12,5 mg
14 Captopril 25 mg
15 Calcium Lactate
16 Cavicur
17 Ciprofloxacin 500mg
18 Chlorpheniramin Maleat (CTM) 4 mg
19 Cotrimoxazol 480 mg
20 Cetirizin HCL
21 Chlorampenicol 250 mg
22 Chlorampenicol 500 mg (Cloramex 500)
23 Dexamethasone 0,5 mg
24 Digoxin 0,25 mg
25 Dimenhydrinat 50 mg
26 Domperidon 10 mg
27 Ergotamin
28 Erytromycin 250 mg
30 Folic Acid 1mg
31 Furosemide 40 mg
33 Glimepiride 1 mg
34 Glimepiride 2 mg
35 Glimepiride 13mg
36 Griseovulfin 125 mg
38 Hydrochlorthiazide 25 mg
39 Ibuprofen 200 mg
40 Ibuprofen 400 mg
41 Ketokonazole 200 mg
42 Loperamide
43 Loratadine 10 mg
44 Metyl Ergometrin 0,125 MG
45 Methyl Prednisolon 4 mg
46 Metformin 500 mg
48 Metronidazole 250 mg
50 Nifedipin 10 mg
51 Nifedipin 20 mg (Adalat Oros )
52 Nystatin 100.000 IU Tablet Vaginal
53 Nystatin 500.000 IU Tablet
54 Natrium Diklofenak 25 mg
56 Omeprazole Cap
57 Paracetamol 500 mg
58 Phytomenadion 10 mg
59 Propranolol
60 Prednisone 5 mg
61 Propylthiouracil 100 mg
62 Pyrantel Pamoate 125 mg
63 Ranitidine 150 mg
64 Salbutamol 4 mg
65 Simvastatin 10 mg
67 Vitamin B Kompleks
68 Zinc 20 mg
68 Cefadroksil Monohidrat 500 mg
1 Amoxicillin Syr 125 mg/5ml
3 Antasida DOEN Suspensi
4 Cotrimoxazol Suspensi 240 mg/5ml
5 Domperidon suspensi
6 Ibuprofen 200 mg/5ml suspensi
7 Metronidazole Sirup
8 Paracetamol Sirup 120 mg/5ml
INJEKSI DAN PELARUT
1 Ampicillin Injeksi 1000 mg
2 Aqua Pro Injeksi 25 ml
3 Aqua DM 1000 ml
4
5 Dexamethasone Injeksi
6 Diphenhydramin inj
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml
8 Gluconat Calcicum Inj 100 mg/ml
9 Lidocain HCl 2%
10
11 Meprovent Inhaler
12 Methyl Ergometrin Inj 0,2 mg/ml
13 MgSO4 20%
14 MgSO4 40%
15 Oxytocin Injeksi
16 Omeprazole Inj 40 mg/ml
17 Phytomenadion Inj 2 mg/ml
SEDIAAN TOPIKAL
1 Aciclovir salep kulit
2
3
Asam Salisilat 3%
4 Betamethasone cream
5 Chloramphenicol 1% Salep Mata
6 Chloramphenicol 2% Salep Kulit (Bufacetin)
7 Chloramphenicol Tetes Telinga (Erlamycetin)

8 Hydrocortison 2,5%
9 Ketokonazole Cream
10 Miconazole 2%
11 Oxytetrasiklin Salep Mata
12 Phenol Glyserol (Tetes Telinga)
13 perak sulfaduazine
14
Belerang Endap 4%
15 Scabimite/ Scabisite
16 Bedak Salisyl 2%
1 Antihemoroid Suppo
2 Bisacodyl / Dulcolax 5 mg
1 Antiseptik Kumur
2 E-Care Hand Sanitizer 500 ml
3 E care hand Wash (Sabun Cair 500 mL)
4 Povidon 300 ml
5 Povidon 60 ml
6 Lisol 1 L
VAKSIN DAN SERUM
1 Serum Anti Bisa Ular /Biosave SABU
2
(Tetagram)
1 Glucosa 5% (D5%) 500 ml
2 Glucosa 10% (D10%) 500 ml
3 Natrium Chlorida (NaCl) 0,9%
4 Ringer Laktat
5 Ringer Asering
OBAT GIGI
1 Ethyl Chloride
2 Fuji IX GP Besar
3 Fuji IX GP Kecil
4 Hydcal (Calsidol)
5 Iodotin/ Iodoform
6 Composit
7 Sponestan / Surgipson
8 Cavit G
9 Tri Kresol Formalin (TKF)
10 Klorfenol Kamfer Mentol
11 Devitalisasi Pasta Ion Arsen
12 Pulp - X
12 Eugenol
LABORATORIUM
1 Golda A
2 Golda B
3 Golda AB
4 Golda Resus D
5 HB Mission 50's Acon
6 Kertas Lensa
8 Micropipet MT.II 1000 µl
9 Micropipet MT.I 200 µl
10 Object Glass Frosted (Slide)
11 Rak Tabung Reaksi 50 Lubang Multipurpose
12
13 Standbio Glucose 1 x 250 ml

14 Standbio Uric Acid 4 x 30 ml
15 Standbio Cholesterol 4 x 30 ml
16 Stik Nesco Cholestrol
17 Stik Nesco Asam Urat
18 Stik Nesco Gula
19 Stik Easy Touch Asam Urat
20 Stik Easy Touch Gula
21 Stik Easy Touch Cholestrol
22 Stik Benecek Asam Urat
23 Stik Benecek Gula
24 Stik Benecek Cholestrol
25 Mindray U-II Urin Tes
26 Stik Urin 3 Parameter 100'S
28 Stik Gluko Protein Tes 10'S
29
30 Widal
31 DILUENT
32 RINSE
33 LYSE
34 Probe Cleanser
35 EZ Cleanser
36 Giemsa
38 Blue Tip
BAHAN KIMIA
1 Cynolf
2 Kaporit
3 ABATE
BMHP
3 APRON White
4 APD LENGKAP
5 Cover All Suit
6 Faceshield
7 Faceshield kacamata
8
Nasofaring Kecil
9 Masker Ear loop 3 ply
10 Masker Tis On 3Ply
11 Masker Kain Scuba (Anak)
12 Masker Kain Scuba (dewasa)
13 3M Particulate N95-8210
14 Masker KN95 (Protective Mask)
15 Masker N95 (mask 5 play) smiles
20 Sarung Tangan Steril 7.5
21 Sarung Tangan Obgyn
22 Surgical Gown Water Proff
23 Termometer & Hemidity meter
24 Tensi ( Blood Pressure Monitor )
25 Termogun HTI
26 Termogun ( OMRON Digital Forehead Termometer)
TAMBAHAN
LABORATORRIUM
1 Stik Cholesterol Easy Touch
2 Stik Asam Urat Easy Touch
3 Stik Glucose Easy Touch
4 Stik Glucose Nesco
5 Stik Cholestrol Nesco
6 Stik Uri Acid Nesco
8 Stik Cholestrol Bhenecek
9 Stik Uri Acid Bhenecek
11 Tabung EDTA Tutup ungu
12 VTM + Stik Steril Swab
13 VTM
14 Rapid Antigen (Clungene Taishan)
15 Rapid Test Indec
16 Standar Q Covid-19 Ag
OBAT-OBATAN
1 Asam Ascorbat (Vitamin C) 250 mg
2 Azithromycin 500 mg
5 Cavicur
6 Chlorpromazine 100 mg
7 Ciprofloxacin 500 mg
8 Chloroquin Phospat 150 mg
10 Domperidon 10 mg
11 Farbion
12 Favipiravir 200 mg
13 Gold Trion
14 Ibuprofen 400 mg
15 Levofloxacin 500 mg
16 N-acetylcystein 30/box
17 Oseltamivir Capsules 75 mg
19 Piroxicam 20 mg
20 Piridoxin
21 Seloxy
22 Kolkisin
INJEKSI DAN PELARUT
1 Phytominadion inj
SEDIAAN TOPIKAL
1 Salep 2 - 4
2
1 Alkacide ( DESINFEKTAN)
2 T. Handrub 100 ml
3 E-Care Handrub 500 ml
4 Alkohol 70%
5 Kaporit 60% 15 Kg
HIBAH
1 Jas Hujan (TorchMed-Guard)
2 Kacamata
3 Nurse Cap ONE MED / penutup kepala
4 Sepatu Boot
JKN
1 Salbutamol 2 mg
2 Ethyl Chloride
3 Povidone 60 ml
JUMLAH KUNJUNGAN
JUMLAH RESEP
MENGETAHUI,
KEPALA DINAS KESEHATAN KAB. DOMPU
Maman .SKM,M.Mkes
NIP. 19651231 198603 1 221
LAPORAN PEMAKAIAN DAN LEMBAR P
: RASABOU
: HU'U
: DOMPU
: NUSA TENGGARA BARAT
STOCK TANGGAL HARGA

SATUAN SUMBER DANA
AWAL KADALUARSA SATUAN
3 4 6 7 8
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0 11/30/2025 Rp70
PAKET 0
Rol 0
Pcs 0
Pcs 0
Pcs 2
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Set 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Roll 0
Pcs 0
Pcs 0
Tablet 280 7/1/2023

Tablet 0
Tablet 0
Tablet 0
Tablet 0
ktk 1
Tablet 0
Tablet 0
Sachet 39
Tablet 0
Tablet 300
Tablet 0
Blister 5
Blister 0
Blister 0
Sachet 13
Tablet 0
Tablet 0
Paket 6 APBD I 2021 2/29/2024 Rp436,445
Paket 0
Paket 2
Paket 0
Tablet 86
Tablet 0
Kapsul lunak 350 APBD I 6/30/2025 Rp586
Tablet 0
Tablet 15300
Tablet 900
Botol 0
Vial 0
Vial 0
Ampul 0
Ampul 0
Ampul 0
Ampul 0
Ampul 0
Pcs 0 10/17/2026 Rp1,185

Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0
Vial 6
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0 Rp14,000
Ampul 0
Ampul 0
Ampul 0
Ampul 0 8/31/2023 Rp3,280
0
Flash 0
Tube 0
Tube 0
Tube 0
Pot 0
ktk/72 pcs 0
Pcs 0
Pcs 0
Pcs 0
25 kit/box 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 1
Botol 0
pak 0
kotak 0
botol 0
kotak 0
Buah 0
10 ktk/Dus 0
25 pcs/kotak 0 APBN I 2023 7/31/2024
Test 25
25 kit/box 0
Pcs 0
Pcs 80
Pcs 0
vial 0
vial 0
vial 0
vial 0
25/kotak 0
25/kotak 8
Vial 0
Pcs 0
Botol 0
0
Botol 0
Botol 0
Botol 0
Botol 0
0
BOX/20 0
Pcs 0 APBD I 10/14/2023
Pcs 0 APBD I 8/31/2024
Pcs 0
Pcs 67
Pcs 162 DAK 2022 4/9/2027 Rp979
Pcs 152 DAK 2021 7/9/2026 Rp1,056
Pcs 300
Pcs 0
Pcs 200
Pcs 15 DAK 2021 2/1/2025 Rp3,600
Pcs 0
Pcs 48
Pcs 0
Pcs 0
Pcs 0
Pcs 19 DAK 2021 10/16/2024 Rp14,341
Pcs 0
Pcs 111
Pcs 0
Pcs 0
Pcs 227
Pcs 369
Pcs 333 DAK 2022 11/30/2026 Rp4,862
Pcs 341 DAK 2022 8/30/2027 Rp12,804
Pcs 0
Pcs 0
Bungkus 7
Rol 0
kotak 0
Pcs 0
Pcs 0
Pcs 8
Pcs 15
Pcs 15
Pcs 0
Roll 0
200/box 800
Pcs 0
Pcs 1950 DAK 2022 4/30/2027 Rp546
Pcs 0
Pcs 0
Pcs 0
Pcs 79
Pcs 70
Pcs 6
Pcs 280 DAK 2022 3/30/2027
Tablet 3400 DAK 2022 9/30/2024 Rp307

Tablet 0
Tablet 0
Tablet 870
Tablet 0
Tablet 1109
Tablet 1230
Tablet 1780
Tablet 160
Tablet 0
Tablet 1280
tablet 150
Tablet 2640
Tablet 400
Tablet 530
Tablet 550
Tablet 400
Tablet 2850 DAK 2022 7/30/2024 Rp70
Tablet 2640
Tablet 1085
Tablet 0
Tablet 1290
Tablet 13
Tablet 0
Tablet 0
Tablet 2370
Tablet 0
Tablet 0
Tablet 0
Tablet 570 DAK 2021 10/1/2023 Rp43
Tablet 0
Tablet 1500
Tablet 0
Tablet 160
Tablet 0
Tablet 200
Tablet 0
Tablet 100
Tablet 0
Tablet 0
Tablet 390
Tablet 220
Tablet 0
Tablet 0
Tablet 0
Tablet 510
Tablet 0
Tablet 0
Tablet 335
Tablet 0
Tablet 60
Tablet 0
Tablet 250 DAK 2022 3/30/2024 Rp0
Tablet 910 DAK 2021 7/1/2026 Rp114
Tablet 0
Tablet 420
Tablet 1200
Tablet 100
Tablet 0
Tablet 0
Tablet 0
Tablet 192
Tablet 1630
Tablet 500
Tablet 0
Tablet 0
Tablet 660
Tablet 0
Tablet 480 DAK 2022 10/30/2026 Rp1,100
Botol 0
Botol 133 DAK 2022 12/31/2024 Rp3,510
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Vial 0
Flush 0
Botol 1
Ampul 0
Ampul 0
Ampul 19
Ampul 20
Ampul 5
Ampul 64 DAK 2022 6/30/2026 Rp847
Ampul 0
Ampul 8 DAK 2022 4/1/2028 Rp3,677

Ampul 15
Vial 5 DAK 2022 11/8/2023 Rp3,760
Vial 5
Ampul 105 DAK 2022 3/31/2025 Rp1,298
Ampul 17
Vial 81
Tube 0
Tube 0
Tube 0
Tube 0
Tube 0
Tube 0
Botol 0
Tube 52 DAK 2022 6/30/2024 Rp2,325
Tube 0
Tube 0
Tube 0
Botol 0
Tube 0
Tube 0
Tube 11 DAK 2022 9/30/2024 Rp6,578
Tube 5
Supp 0
Supp 1
Supp 0
Botol 0
Botol 0
Botol 0
Botol 10
Botol 0
Botol 0
Vial 0
Vial 2
Botol 8
Botol 0
Botol 180
Botol 0 12/4/2025
Botol 0
Kaleng 0
pcs 0
pcs 0
pcs 0
pcs 0
Pcs 0
pcs 0
pcs 0
Set 0
pcs 0
pcs 0
Botol 2 DAK 2022 1/7/2025 Rp210,500
Botol 2
Vial 0
Vial 0
Vial 0
Vial 0
pcs 0
Buah 0
Lembar 0
Pak 0
Pak 0
Box 0
Pcs 0
25 kit/box 0
Kit 0
Kit 0
Kit 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 3
Box 0
Box 0 DAK 2022 12/31/2023 Rp25,723
Botol 0
pcs 0
pcs 0
pcs 1
Box 0 8/31/2024
kotak 0
GALON 0
GALON 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 500
Botol 0
Galon 0
1 Kg/ Botol 0 APBN 6/8/2024 Rp0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 1750 DID 2021
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
Rol 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
0
Tablet 0
20/ktk 0
Tablet 0
Tablet 800
Tablet 0
Tablet 0
Tablet 0
100/ktk 0
100/ktk 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
50/ktk 0
Tablet 0
Kapsul 0
Tablet 0
Tablet 0
Tablet 360
Tablet 0
Tablet 530
Ampul 0
pot 0
Pot 0
Botol 0
botol 0
Botol 0
Botol 3 DAK 2022 11/30/2023 Rp58,000
Galon 0
pcs 0
pcs 0
pcs 0
pcs 0
Tablet 450
Botol 0
Botol 0
UMUM GRATIS JKN
YANG MENYERAHKAN,
KEPALA UPTD IFP DOMPU
Indi Hartini, A.Md.,Farm

NIP. 19690307 198903 2 013 NIP.
N LEMBAR PERMINTAAN OBAT (LPLPO)
PELAPORAN BULA
PERMINTAAN BULA
TAHUN
PENERIM PERSEDI JUMLAH TOTAL SUB STOCK

PEMAKAIAN
AAN AAN EXPIRED UNIT GUDANG
9 10=9+4 11 12 = (10-11-13) 13 14
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 0 0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
4000 4280 4114 166 0

0 0
0 0
0 0
0 0
1 0 0 1
0 0
0 0
300 339 124 15 200
0 0
300 0 0 300
0 0
5 0 0 5
0 0
0 0
13 0 0 13
0 0
0 0
2 8 1 0 7
0 0
2 1 0 1
0 0
86 0 0 86
0 0
350 28 72 250
400 0 50 350
0 0
8600 23900 9931 369 13600
900 350 50 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6 -3 0 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 0 0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
25 0 0 25
0 0
0 0
80 40 0 40
0 0
0 0
0 0
0 0
0 0
2 2 2 0 0
8 1 0 7
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
67 56 11 0
162 162 0 0
200 352 192 60 100
300 300 0 0
200 200 20 80 100
200 0 0 200
73 88 41 0 47
0 0
48 25 6 17
0 0
0 0
20 20 0 0 20
19 13 0 6
0 0
111 111 0 0
0 0
0 0
227 18 9 200
369 29 40 300
333 137 46 150
341 158 33 150
0 0
0 0
7 2 0 5
5 5 3 0 2
0 0
0 0
0 0
8 1 0 7
15 0 0 15
15 4 0 11
0 0
20 20 3 0 17
800 0 0 800
0 0
500 2450 1950 0 500
0 0
72 72 18 2 52
0 0
79 29 0 50
70 49 0 21
20 26 8 0 18
280 72 0 208
0 0
3000 6400 3490 210 2700
200 200 0 200
0 0
870 630 140 100
0 0
3000 4109 2019 490 1600
5000 6230 3400 130 2700
1780 1780 0 0
3000 3160 2045 115 1000
0 0
1280 0 180 1100
150 20 30 100
2640 1320 420 900
400 0 0 400
1000 1530 930 300 300
550 550 0 0
400 346 54 0
5000 7850 3524 426 3900
2640 630 110 1900
2000 3085 1165 120 1800
0 0
1290 25 65 1200
5000 5013 4373 440 200
0 0
0 0
2370 72 198 2100
0 0
0 0
0 0
570 130 240 200
0 0
1500 1090 110 300
0 0
160 40 120 0
0 0
200 110 90 0
0 0
100 0 0 100
0 0
390 270 120 0 0

1000 1220 140 180 900
0 0
100 100 0 100
0 0
2600 3110 2010 300 800
0 0
0 0
335 120 15 200
0 0
60 0 0 60
0 0
100 350 80 70 200
910 910 0 0
0 0
2000 2420 1150 70 1200
10000 11200 9055 145 2000
100 100 0 0
0 0
0 0
100 100 0 100
192 0 192
1630 1393 37 200
500 200 300
0 0
0 0
5000 5660 3480 180 2000
0 0
480 480 0 0
0 0
0 0
133 79 0 54
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 0
0 0
0 0
19 7 12
18 38 36 2
5 0 5
100 164 104 60
0 0
30 38 24 14
15 15 0
5 1 4
5 0 5
105 36 69
17 0 17
81 0 81
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
24 76 47 5 24
0 0
120 120 40 8 72
0 0
0 0
0 0
0 0
11 7 4
5 5 0
0 0
0 0
1 1 0
0 0
0 0
0 0
0 0
0 0
10 1 9
0 0
0 0
0 0
0 0
2 0 2
0 0
8 5 3
0 0
200 380 165 2 213
400 400 335 5 60
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 0 2
2 0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 0 3
0 0
0 0
0 0
0 0
0 0
1 0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
500 0 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1750 750 1000
0 0
0 0
0 0
0 0
0 0
0 0
20 20 2 18
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
800 0 800
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
360 239 121 0
0 0
530 60 110 360
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 5 5 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
450 270 80 100
0 0
0 0
TOTAL
0
0
YANG MEMINTA, YANG MENE

KEPALA UPTD PUSKESMAS PENGELOLA OBAT
Joharis, AMG apt. Ajhar, S

NIP. 19660219 199401 1 002 NIP. 19910201 20
APORAN BULAN : FEBRUARI
MINTAAN BULAN : MARET
: 2023
STOCK PERMINTAA PEMBERIA

TOTAL HARGA STOK OPTIMUM
AKHIR N N
15 16 17= 12+(9*50%) 18 19
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
2 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
166 Rp664,000 6114
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
1 Rp0 0
0 Rp0 0
0 Rp0 0
215 Rp64,500 274
0 Rp0 0
300 Rp0 0
0 Rp0 0
5 Rp0 0
0 Rp0 0
0 Rp0 0
13 Rp0 0
0 Rp0 0
0 Rp0 0
7 Rp14 2 4
0 Rp0 0
1 Rp0 1
0 Rp0 0
86 Rp0 0
0 Rp0 0
322 Rp0 28
400 Rp0 0
0 Rp0 0
13969 ### 14231
550 Rp0
Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
9 Rp0 -3
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
1 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
25 Rp0 0
0 Rp0 0
0 Rp0 0
40 Rp0 40
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 3
7 Rp0 1
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
Rp0 0
0 Rp0 0
11 Rp0 56
0 Rp0 162
160 Rp32,000 292
0 Rp0 300 500
180 Rp36,000 120
200 Rp0 0
47 Rp3,431 77.5
0 Rp0 0
23 Rp0 25 48
0 Rp0 0
0 Rp0 0
20 Rp400 10
6 Rp0 13
0 Rp0 0
0 Rp0 111
0 Rp0 0
0 Rp0 0
209 Rp0 18
340 Rp0 29
196 Rp0 137 100
183 Rp0 158 100
0 Rp0 0
0 Rp0 0
5 Rp0 2
2 Rp10 5.5 5
0 Rp0 0
0 Rp0 0
0 Rp0 0
7 Rp0 1
15 Rp0 0
11 Rp0 4
0 Rp0 0
17 Rp340 13
800 Rp0 0
0 Rp0 0
500 Rp250,000 2200 1000
0 Rp0 0
54 Rp3,888 54
0 Rp0 0
50 Rp0 29
21 Rp0 49 100
18 Rp360 18
208 Rp0 72
Rp0 0
2910 Rp8,730,000 4990 5000
200 Rp40,000 100
0 Rp0 0
240 Rp0 630
0 Rp0 0
2090 Rp6,270,000 3519 5000
2830 Rp14,150,000 5900 5000
0 Rp0 1780
1115 Rp3,345,000 3545 2000
0 Rp0 0
1280 Rp0 0
130 Rp0 20
1320 Rp0 1320 1000
400 Rp0 0 1000
600 Rp600,000 1430 2000
0 Rp0
54 Rp0 346
4326 Rp21,630,000 6024 3000
2010 Rp0 630
1920 Rp3,840,000 2165
0 Rp0 0
1265 Rp0 25
640 Rp3,200,000 6873 5000
0 Rp0 0
0 Rp0 0
2298 Rp0 72
0 Rp0 0
0 Rp0 0
0 Rp0 0
440 Rp0 130 1000
0 Rp0 0
410 Rp0 1090
0 Rp0 0
120 Rp0 40
0 Rp0 0
90 Rp0 110 500
0 Rp0 0
100 Rp0 0
0 Rp0 0
0 Rp0
0 Rp0 120 200
1080 Rp1,080,000 640
0 Rp0 0
100 Rp10,000 50
0 Rp0 0
1100 Rp2,860,000 3310 3000
0 Rp0 0
0 Rp0 0
215 Rp0 120 200
0 Rp0 0
60 Rp0 0
0 Rp0 0
270 Rp27,000 130
0 Rp0 910
0 Rp0 0
1270 Rp2,540,000 2150 2000
2145 Rp21,450,000 14055 10000
0 Rp0 0 100
0 Rp0 0
0 Rp0 0
100 Rp10,000 50
192 Rp0 0
237 Rp0 1393
300 Rp0 200
0 Rp0 0
0 Rp0 0
2180 Rp10,900,000 5980 3500
0 Rp0 0
0 Rp0 480
Rp0 0
0 Rp0 0
54 Rp0 79 100
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 1
0 Rp0 0
0 Rp0 0
12 Rp0 7
2 Rp36 45
5 Rp0 0
60 Rp6,000 154 100
0 Rp0 0
14 Rp420 39 30
0 Rp0 0
4 Rp0 1
5 Rp0 0
69 Rp0 36
17 Rp0 0
81 Rp0
Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
29 Rp696 59
0 Rp0 0
80 Rp9,600 100 50
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
4 Rp0 7
0 Rp0 5
Rp0 0
0 Rp0 0
0 Rp0 1
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
9 Rp0 1
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
2 Rp0 0
Rp0 0
3 Rp0 5 20
0 Rp0 0 10
215 Rp43,000 265
65 Rp26,000 535 300
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
2 Rp0 0
2 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
3 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
1 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
500 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
1000 Rp0 750 2000
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
18 Rp360 12
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
800 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
121 Rp0 239
0 Rp0 0
470 Rp0 60
Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 6 6
0 Rp0 0
Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
0 Rp0 0
Rp0 0
180 Rp0 270 1200
0 Rp0 0
0 Rp0 0
YANG MENERIMA,
GELOLA OBAT PUSKESMAS
apt. Ajhar, S.Farm

IP. 19910201 202203 1 007
PUSKESMAS : RASABOU PELAPORAN BULAN : MARET

KECAMATAN : HU'U PERMINTAAN BULAN : APRIL
KABUPATEN : DOMPU TAHUN : 2023
STOCK TANGGAL HARGA PENERIM PERSEDI JUMLAH TOTAL SUB STOCK STOCK PERMINTAA PEMBERIA
NO NAMA OBAT / ALKES SATUAN SUMBER DANA PEMAKAIAN TOTAL HARGA STOK OPTIMUM
AWAL KADALUARSA SATUAN AAN AAN EXPIRED UNIT GUDANG AKHIR N N
1 2 3 4 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19

APBD 1 / APBN
Alat Kesehatan
1 Alat Suntik sekali pakai 0,05 ml Pcs 0 0 0 0 Rp0 0
2 Alat Suntik sekali pakai 1 ml Pcs 0 0 0 0 Rp0 0
4 Apron Biru malaria Pcs 0 0 0 0 Rp0 0
5 Alkohol Swabs 100's Pcs 0 11/30/2025 Rp70 0 0 0 Rp0 0
6 APD IMUNISASI COVID PAKET 0 0 0 0 Rp0 0
7 Gips 4 Inch Rol 0 0 0 0 Rp0 0
8 BAJU (Cover All Suit /Hazmat Suit) baju BOHO Pcs 0 0 0 0 Rp0 0
9 Masker Bedah 3 Ply (TB) Pcs 0 0 0 0 Rp0 0
10 Kaca Mata Google TB Pcs 2 2 0 2 2 Rp0 0
11 Masker Bedah 3 Ply (HIV) Pcs 0 0 0 0 Rp0 0
12 Masker TB N95 Pcs 0 0 0 0 Rp0 0
13 Masker N95 (Sure And Me) Pcs 0 0 0 0 Rp0 0
14 Masker Bedah Anak Pcs 0 0 0 0 Rp0 0
15 APD Lengkap Foging Set 0 0 0 0 Rp0 0
16 Masker Las (Foging) Pcs 0 0 0 0 Rp0 0
17 Masker Malaria Pcs 0 0 0 0 Rp0 0
18 Sarung Tangan Non Steril S Pcs 0 0 0 0 Rp0 0
19 Sarung Tangan Non Steril M Pcs 0 0 0 0 Rp0 0
20 Kelambu Roll 0 0 0 0 Rp0 0
21 Plester Bulat @200pcs Pcs 0 0 0 0 Rp0 0
22 Sarung Tangan Steril 7 Pcs 0 0 Rp0 0
OBAT-OBATAN Rp0 0
1 Albendazole 400 mg Tablet 166 7/1/2023 166 3 163 163 Rp0 3
2 Asam Ascorbat 500 mg Tablet 0 0 0 0 Rp0 0
3 Bedaquiline Tablet 0 0 0 0 Rp0 0
4 Closerin 250 mg Tablet 0 0 0 0 Rp0 0
5 Clofazimin Tablet 0 0 0 0 Rp0 0
6 DHP Frimal (Kotak @9 Tablet) ktk 1 1 0 1 1 Rp0 0
7 Ethionamide Tablet 0 0 0 0 Rp0 0
8 Linezolid 600 mg Tablet 0 0 0 0 Rp0 0
9 Garam Oralit Sachet 215 200 415 212 3 200 203 Rp40,600 312
10 Glibenclamide 5 mg Tablet 0 0 0 0 Rp0 0
11 INH(Ishonizide) Tablet 300 300 200 0 100 100 Rp0 0
12 Lompren ( Clofazimine) Tablet 0 0 0 0 Rp0 0
13 MDT Combi Dewasa MB (Merah) Blister 5 5 0 5 5 Rp0 0
14 MDT Combi Dewasa PB (Hijau) Blister 0 0 0 0 Rp0 0
15 MDT Combi Anak MB ( ORANGE) Blister 0 0 0 0 Rp0 0
16 Mineral Mix Sachet 13 13 0 13 13 Rp0 0
17 Moxifloxacin ( moximed) Tablet 0 0 0 0 Rp0 0
18 Metoclopramid 10 mg Tablet 0 0 0 0 Rp0 0
19 OAT Kat. 1,3 Paket 7 APBD I 2021 2/29/2024 Rp436,445 1 8 4 4 4 Rp4 4.5
20 OAT Kat. II Paket 0 0 0 0 Rp0 0
21 OAT Kat Anak Paket 1 1 0 1 1 Rp0 0
22 OAT Kat kombipak Paket 0 0 0 0 Rp0 0
23 Primaquin 15 mg Tablet 86 86 0 86 86 Rp0 0
24 Rifampicin Tablet 0 0 0 0 Rp0 0
25 Retinol 200.000 IU (Merah) Kapsul lunak 322 APBD I 6/30/2025 Rp586 322 15 57 250 307 Rp0 15
26 Retinol 100.000 IU (Biru) Kapsul lunak 400 APBD I 5/30/2025 Rp324 400 0 50 350 400 Rp0 0
27 Sivit Zinc Tablet 0 0 0 0 Rp0 0
28 Tablet Tambah Darah Tablet 13969 17600 31569 12409 60 19100 19160 ### 21209
29 Zinc 20 mg Tablet 550 550 365 85 100 185 Rp0
SIRUP, SUSPENSI DAN DROP 0 0 Rp0 0
1 Albendazole sirup Botol 0 0 0 0 Rp0 0
INJEKSI DAN PELARUT 0 0 Rp0 0
1 Artesunat Injeksi 60 mg/ml Vial 0 0 0 0 Rp0 0
2 Dextrose 40% Vial 0 0 0 0 Rp0 0
3 Ephedrin HCL Inj 1% Ampul 0 0 0 0 Rp0 0
4 Ephinefrine Ampul 0 0 0 0 Rp0 0
5 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 Rp0 0
6 MgSO4 40% Ampul 0 0 0 0 Rp0 0
7 Phytomenadion inj 2 mg/ml Ampul 0 0 0 0 Rp0 0
VAKSIN DAN SERUM 0 0 Rp0 0
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 10/17/2026 Rp1,185 0 0 0 Rp0 0
2 Vaksin BCG Vial 0 0 0 0 Rp0 0
3 Vaksin Td Vial 0 0 0 0 Rp0 0
4 Vaksin HB0 Vial 0 0 0 0 Rp0 0
5 Vaksin IPV Vial 0 0 0 0 Rp0 0
6 Vaksin Polio (POLIO) Vial 0 0 0 0 Rp0 0
7 Vaksin MR (1-2) ( Rubela/Campak)/Bian Vial 0 0 0 0 Rp0 0
8 Vaksin MR (1-2) ( Rubela/Campak) Vial 0 0 0 0 Rp0 0
9 Vaksin DT Vial 0 0 0 0 Rp0 0
10 Vaksin PCV Vial 0 0 0 0 Rp0 0
11 Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4) Vial 0 0 0 0 Rp0 0
12 Tinta Vaksin Bian Pcs 0 0 0 0 Rp0 0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 9 9 0 9 9 Rp0 0
14 RABIES VACCINE INACTIVATED Vial 0 0 0 0 Rp0 0
15 RABIES IMMUNE GLOBULIN (HUMAN) 1 ML Vial 0 0 0 0 Rp0 0
16 Vaksin Covid-19 (Sinovac) Vial 0 0 0 0 Rp0 0
17 Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis) Vial 0 0 0 0 Rp0 0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 Rp0 0
19 Vaksin Covid-19 Pfizer (@ 6 Dosis) Vial 0 0 0 0 Rp0 0
20 Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA Vial 0 0 0 0 Rp0 0
21 Vaksin Covid-19 @14 (Moderna) Vial 0 0 0 0 Rp0 0
22 Vaksin Sinopharm @ 2 dosis Vial 0 0 0 0 Rp0 0
23 Vaksin Covid-19 (Moderna) @10 DOSIS Vial 0 0 0 0 Rp0 0
24 Vaksin Covid-19 (@ 2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0 0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 0 0 0 Rp0 0
26 Vaksin Covid-19 (@10 Dosis) ASTRAZENECA Vial 0 0 0 0 Rp0 0
27 Cadox (Konecavax)@10 dosis Vial 0 0 0 0 Rp0 0
28 Safety Box 5 Liter Pcs 0 Rp14,000 0 0 0 Rp0 0
29 Pelarut MR Bian Ampul 0 0 0 0 Rp0 0
30 Pelarut BCG Ampul 0 0 0 0 Rp0 0
31 Pelarut MR Ampul 0 0 0 0 Rp0 0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 8/31/2023 Rp3,280 0 0 0 Rp0 0
33 Pipet Tetes (Polio/BOPV) 0 0 0 0 Rp0 0
34 Pelarut NaCl 0,9% 10 ml Flash 0 0 0 0 Rp0 0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 Rp0 0
SEDIAAN TOPIKAL 0 0 Rp0 0
1 Chloramphenicol SM 1% Tube 0 0 0 0 Rp0 0
2 Hidrocortison salep Tube 0 0 Rp0 0
3 Oxytetrasiklin Salep Mata 0,1% Tube 0 0 0 0 Rp0 0
4 Salep 2-4 Pot 0 0 0 0 Rp0 0
LABORATORIUM 0 0 Rp0 0
1 Box Slide ( Warna Hijau )(malaria) 72'S ktk/72 pcs 0 0 0 0 Rp0 0
2 Blood Lancet 100 'S Pcs 0 0 0 0 Rp0 0
3 Fesco Blood Lancet 200 'S Pcs 0 0 0 0 Rp0 0
4 Catride TCM TB Pcs 0 0 0 0 Rp0 0
5 (Whole Blood) (Warna PEACH)(AG PCDH) 25 kit/box 0 0 0 0 Rp0 0
(MALARIA)
6 Handsanitizer 50 ml Botol 0 0 0 0 Rp0 0
8 Giemsa 100 ml Botol 0 0 0 0 Rp0 0
9 Oil Emersi 100 ml Botol 0 0 0 0 Rp0 0
10 Oil Emersi 500 ml Botol 1 1 0 1 1 Rp0 0
12 Kartu Golongan Darah pak 0 0 0 0 Rp0 0
13 Lab. Kit Malaria kotak 0 0 0 0 Rp0 0
14 Oil Emersi botol 0 0 0 0 Rp0 0
15 Paket KIT TB kotak 0 0 0 0 Rp0 0
16 Pot Dahak / Pot Sputum Buah 0 0 0 0 Rp0 0
17 Reagen ZN 10 ktk/Dus 0 0 0 0 Rp0 0 1
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 0 APBN I 2023 7/31/2024 0 0 0 Rp0 0 2
19 Test 25 25 0 25 25 Rp0 0
20 RDT DBD SD BIOLINE 25 kit/box 0 0 0 0 Rp0 0
21 Pcs 0 0 0 0 Rp0 0
22 Rapid Antigen (Whole Power) Pcs 40 20 60 40 20 20 Rp400 50
23 Rapid Antigen Entram Pcs 0 0 0 0 Rp0 0
24 Reagen Golda A vial 0 0 0 0 Rp0 0
25 Reagen Golda B vial 0 0 0 0 Rp0 0
26 Reagen Golda AB vial 0 0 0 0 Rp0 0
27 Anti Resus D vial 0 0 0 0 Rp0 0
28 SD HIV-1/2 3,0 25/kotak 0 75 75 50 25 25 Rp1,875 87.5
29 TRIPOCHECK SYPHILIS 25/kotak 7 7 0 7 7 Rp0 0
30 Tuberkulin Vial 0 0 0 0 Rp0 0
31 VTM + Stik Steril Swab (CITO) Pcs 0 0 0 0 Rp0 0
32 BETAFOG Botol 0 0 0 0 Rp0 0
33 Insektisida DBD (GOKILATH) 0 0 0 0 Rp0 0
34 Human Colesterol Liquid Botol 0 0 0 0 Rp0 0 1
35 Human Glucose liquid Botol 0 0 0 0 Rp0 0 1
36 Human Hemoglobine liquid Botol 0 0 0 0 Rp0 0
37 Human Tryglyceride liquid Botol 0 0 0 0 Rp0 0
38 Providen 0 0 0 0 Rp0 0
39 Sars Cov-2 Anti Bodi Test BOX/20 0 0 0 0 Rp0 0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 APBD I 10/14/2023 0 0 0 Rp0 0
39 Virotec Dengue Kombo (P2M) Pcs 0 APBD I 8/31/2024 0 0 0 Rp0 0
DAK 0 0 Rp0 0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 Rp0 0
2 Alat Suntik sekali pakai 1 ml Pcs 11 11 11 0 0 Rp0 11
3 Alat Suntik sekali pakai 3 ml Pcs 0 DAK 2022 4/9/2027 Rp979 0 0 0 Rp0 0
4 Alat Suntik sekali pakai 5 ml Pcs 160 DAK 2021 7/9/2026 Rp1,056 160 129 31 0 31 Rp0 129
5 Alkohol Swabs 100's Pcs 0 0 0 0 Rp0 0
6 Blade Sterile (Mess) Pcs 180 100 280 160 20 100 120 Rp12,000 210
7 Blood Lancet Pcs 200 200 0 200 200 Rp0 0
8 Blod TransfusiSet Stera Pcs 47 DAK 2021 2/1/2025 Rp3,600 100 147 92 5 50 55 Rp5,500 142 100
9 Catgut Chromic (Absorbable Suture Sterile) Pcs 0 0 0 0 Rp0 0
10 Catgut Plain 3/0 HR 37 mm Pcs 23 48 71 46 1 24 25 Rp1,200 70 24
11 Dermatix Pcs 0 0 0 0 Rp0 0
12 Female Catheter no. 16 Pcs 0 0 0 0 Rp0 0
13 Female Catheter no. 18 Pcs 20 20 0 20 20 Rp0 0
14 Foley Catheter no. 18 Pcs 6 DAK 2021 10/16/2024 Rp14,341 6 5 1 1 Rp0 5
15 Foley Catheter no. 20 Pcs 0 0 0 0 Rp0 0
16 Infus Set Anak Pcs 0 0 0 0 Rp0 0
17 Infus Set Dewasa Pcs 0 0 0 0 Rp0 0
18 IV Catheter No. 16 Pcs 0 0 0 0 Rp0 0
19 IV Catheter no. 18 Pcs 209 209 16 43 150 193 Rp0 16
20 IV Catheter no. 20 Pcs 340 340 40 300 300 Rp0 40
21 IV Catheter no. 22 Pcs 196 DAK 2022 11/30/2026 Rp4,862 50 246 168 28 50 78 Rp3,900 193
22 IV Catheter no. 24 Pcs 183 DAK 2022 8/30/2027 Rp12,804 183 73 10 100 110 Rp0 73
23 Jarum Kulit GT 14 Pcs 0 0 0 0 Rp0 0
24 Jarum Otot GR 14 Pcs 0 0 0 0 Rp0 0
25 Kapas Pembalut 500 gr Bungkus 5 5 2 1 2 3 Rp0 2 5
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 2 5 7 3 4 4 Rp20 5.5 3
27 Kassa Steril kotak 0 0 0 0 Rp0 0
28 Masker Nebul Anak Pcs 0 0 0 0 Rp0 0
29 Masker Nebul Dewasa Pcs 0 0 0 0 Rp0 0
30 Nasal Canula Bayi (Oxyflow) Pcs 7 7 1 6 6 Rp0 1
31 Nasal Canula Anak (Oxyflow) Pcs 15 15 0 15 15 Rp0 0
32 Nasal Canula Dewasa (Oxyflow) Pcs 11 11 4 7 7 Rp0 4
33 Needle No. 25G x 25 mm Pcs 0 0 0 0 Rp0 0
34 Polifix / Hipavix 5mx5cm Roll 17 5 22 14 1 7 8 Rp40 16.5
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 800 800 0 800 800 Rp0 0
37 Sarung Tangan Non Steril L Pcs 500 DAK 2022 4/30/2027 Rp546 2000 2500 1100 1400 1400 Rp2,800,000 2100
38 Sarung Tangan Steril 7,5 Pcs 0 0 0 0 Rp0 0
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile) Pcs 54 36 90 47 7 36 43 Rp1,548 65
40 Stomach tube no. 18 Pcs 0 0 0 0 Rp0 0
41 Tes kehamilan Pcs 50 50 100 0 100 100 Rp5,000 25
42 Under Pad (Soft Pad 60 x 90 cm) Pcs 21 21 21 0 0 Rp0 21
43 Urine Bag Pcs 18 9 27 2 25 25 Rp225 6.5
44 Sarung Tangan Steril 7 Pcs 208 DAK 2022 3/30/2027 208 79 129 129 Rp0 79
OBAT-OBATAN 0 0 Rp0 0
1 Acetylcystein 200 mg Tablet 2910 DAK 2022 9/30/2024 Rp307 3600 6510 5885 115 510 625 Rp2,250,000 7685 6000
2 Tablet 200 200 0 200 200 Rp0 0
)
3 acyclovir 400 mg Tablet 0 0 0 0 Rp0 0
4 Allopurinol 100 mg Tablet 240 240 240 0 0 Rp0 240
5 Amlodipin 5 mg Tablet 0 0 0 0 Rp0 0
6 Amlodipin 10 mg Tablet 2090 2500 4590 1285 105 3200 3305 Rp8,262,500 2535
7 Amoxicillin 500 mg Tablet 2830 4500 7330 3490 40 3800 3840 Rp17,280,000 5740 3000
8 Antasida DOEN Tablet Tablet 0 0 0 0 Rp0 0
9 Asam Ascorbat 50 mg Tablet 1115 3000 4115 2091 24 2000 2024 Rp6,072,000 3591 1000
10 Asam Mefenamat 500 mg Tablet 0 0 0 0 Rp0 0
11 Attapulgit 600 mg (pularex) Tablet 1280 1280 30 250 1000 1250 Rp0 30
12 Betahistine tablet 130 130 0 30 100 130 Rp0 0
13 Captopril 12,5 mg Tablet 1320 1000 2320 400 320 1600 1920 Rp1,920,000 900
14 Captopril 25 mg Tablet 400 400 30 170 200 370 Rp0 30
15 Calcium Lactate Tablet 600 1500 2100 480 320 1300 1620 Rp2,430,000 1230
16 Cavicur Tablet 0 0 0 0 Rp0
17 Ciprofloxacin 500mg Tablet 54 54 54 0 0 Rp0 54
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 4326 DAK 2022 7/30/2024 Rp70 4000 8326 3201 225 4900 5125 Rp20,500,000 5201
19 Cotrimoxazol 480 mg Tablet 2010 2010 440 170 1400 1570 Rp0 440
20 Cetirizin HCL Tablet 1920 1500 3420 400 120 2900 3020 Rp4,530,000 1150
21 Chlorampenicol 250 mg Tablet 0 0 0 0 Rp0 0
22 Chlorampenicol 500 mg (Cloramex 500) Tablet 1265 1265 20 45 1200 1245 Rp0 20
23 Dexamethasone 0,5 mg Tablet 640 6500 7140 180 60 6900 6960 Rp45,240,000 3430
24 Digoxin 0,25 mg Tablet 0 0 0 0 Rp0 0
25 Dimenhydrinat 50 mg Tablet 0 0 0 0 Rp0 0
26 Domperidon 10 mg Tablet 2298 2298 28 170 2100 2270 Rp0 28
27 Ergotamin Tablet 0 0 0 0 Rp0 0
28 Erytromycin 250 mg Tablet 0 0 0 0 Rp0 0
30 Folic Acid 1mg Tablet 440 DAK 2021 10/1/2023 Rp43 440 90 150 200 350 Rp0 90
31 Furosemide 40 mg Tablet 0 0 0 0 Rp0 0
32 Glibenclamide 5 mg Tablet 410 410 350 60 0 60 Rp0 350
33 Glimepiride 1 mg Tablet 0 0 0 0 Rp0 0
34 Glimepiride 2 mg Tablet 120 120 80 40 0 40 Rp0 80
35 Glimepiride 13mg Tablet 0 0 0 0 Rp0 0
36 Griseovulfin 125 mg Tablet 90 500 590 50 40 500 540 Rp270,000 300
37 Griseovulfin 500 mg Tablet 0 0 0 0 Rp0 0
38 Hydrochlorthiazide 25 mg Tablet 100 100 0 100 100 Rp0 0
39 Ibuprofen 200 mg Tablet 0 0 0 0 Rp0 0
40 Ibuprofen 400 mg Tablet 0 0 Rp0
41 Ketokonazole 200 mg Tablet 0 200 200 50 50 100 150 Rp30,000 150
42 Loperamide Tablet 1080 1080 370 110 600 710 Rp0 370
43 Loratadine 10 mg Tablet 0 0 0 0 Rp0 0
44 Metyl Ergometrin 0,125 MG Tablet 100 100 0 100 100 Rp0 0
45 Methyl Prednisolon 4 mg Tablet 0 0 0 0 Rp0 0
46 Metformin 500 mg Tablet 1100 3000 4100 980 120 3000 3120 Rp9,360,000 2480
48 Metronidazole 250 mg Tablet 0 0 0 0 Rp0 0
49 Metronidazole 500 mg Tablet 215 500 715 70 45 600 645 Rp322,500 320
50 Nifedipin 10 mg Tablet 0 0 0 0 Rp0 0
51 Nifedipin 20 mg (Adalat Oros ) Tablet 60 60 0 60 60 Rp0 0
52 Nystatin 100.000 IU Tablet Vaginal Tablet 0 0 0 0 Rp0 0
53 Nystatin 500.000 IU Tablet Tablet 270 DAK 2022 3/30/2024 Rp0 270 60 40 170 210 Rp0 60
54 Natrium Diklofenak 25 mg Tablet 0 DAK 2021 7/1/2026 Rp114 0 0 0 Rp0 0
55 Natrium Diklofenak 50 mg Tablet 0 0 0 0 Rp0 0
56 Omeprazole Cap Tablet 1270 1600 2870 900 170 1800 1970 Rp3,152,000 1700
57 Paracetamol 500 mg Tablet 2145 13000 15145 6605 40 8500 8540 ### 13105 5000
58 Phytomenadion 10 mg Tablet 0 0 0 0 Rp0 0 100
59 Propranolol Tablet 0 0 0 0 Rp0 0
60 Prednisone 5 mg Tablet 0 0 0 0 Rp0 0
61 Propylthiouracil 100 mg Tablet 100 100 0 100 100 Rp0 0
62 Pyrantel Pamoate 125 mg Tablet 192 192 1 191 191 Rp0 1
63 Ranitidine 150 mg Tablet 237 237 237 0 0 Rp0 237
64 Salbutamol 4 mg Tablet 300 300 260 40 0 40 Rp0 260 1000
65 Simvastatin 10 mg Tablet 0 0 0 0 Rp0 0
67 Vitamin B Kompleks Tablet 2180 5000 7180 2880 300 4000 4300 Rp21,500,000 5380
68 Zinc 20 mg Tablet 0 0 0 0 Rp0 0
68 Cefadroksil Monohidrat 500 mg Tablet 0 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0 0
SIRUP, SUSPENSI DAN DROP 0 0 Rp0 0
1 Amoxicillin Syr 125 mg/5ml Botol 0 0 0 0 Rp0 0
2 Amoxicillin Syr 250 mg/5ml Botol 54 DAK 2022 12/31/2024 Rp3,510 54 45 6 3 9 Rp0 45 150
3 Antasida DOEN Suspensi Botol 0 0 0 0 Rp0 0
4 Cotrimoxazol Suspensi 240 mg/5ml Botol 0 0 0 0 Rp0 0
5 Domperidon suspensi Botol 0 0 0 0 Rp0 0
6 Ibuprofen 200 mg/5ml suspensi Botol 0 0 0 0 Rp0 0
7 Metronidazole Sirup Botol 0 0 0 0 Rp0 0
8 Paracetamol Sirup 120 mg/5ml Botol 0 0 0 0 Rp0 0
1 Ampicillin Injeksi 1000 mg Vial 0 0 0 0 Rp0 0
2 Aqua Pro Injeksi 25 ml Flush 0 0 0 0 Rp0 0
3 Aqua DM 1000 ml Botol 0 0 0 0 Rp0 0

4 Ampul 0 0 0 0 Rp0 0
5 Dexamethasone Injeksi Ampul 0 0 0 0 Rp0 0

6 Diphenhydramin inj Ampul 12 12 0 12 12 Rp0 0
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 2 2 2 0 0 Rp0 2
8 Gluconat Calcicum Inj 100 mg/ml Ampul 5 5 0 5 5 Rp0 0
9 Lidocain HCl 2% Ampul 60 DAK 2022 6/30/2026 Rp847 100 160 102 13 45 58 Rp5,800 152 200
10 Ampul 0 0 0 0 Rp0 0
11 Meprovent Inhaler Ampul 14 DAK 2022 4/1/2028 Rp3,677 40 54 38 1 15 16 Rp640 58 50
12 Methyl Ergometrin Inj 0,2 mg/ml Ampul 0 0 0 0 Rp0 0
13 MgSO4 20% Vial 4 DAK 2022 11/8/2023 Rp3,760 4 0 4 4 Rp0 0
14 MgSO4 40% Vial 5 5 0 5 5 Rp0 0
15 Oxytocin Injeksi Ampul 69 DAK 2022 3/31/2025 Rp1,298 69 42 27 27 Rp0 42 100
16 Omeprazole Inj 40 mg/ml Ampul 17 17 0 17 17 Rp0 0
17 Phytomenadion Inj 2 mg/ml Vial 81 81 81 0 0 0 Rp0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 Rp0 0
SEDIAAN TOPIKAL 0 0 Rp0 0
1 Aciclovir salep kulit Tube 0 0 0 0 Rp0 0
2 Tube 0 0 0 0 Rp0 0
3 Tube 0 0 Rp0 0
Asam Salisilat 3%
4 Betamethasone cream Tube 0 0 0 0 Rp0 0
5 Chloramphenicol 1% Salep Mata Tube 0 0 0 0 Rp0 0
6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 0 Rp0 0
7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol 0 0 0 0 Rp0 0

8 Hydrocortison 2,5% Tube 29 DAK 2022 6/30/2024 Rp2,325 48 77 25 4 48 52 Rp2,496 49
9 Ketokonazole Cream Tube 0 0 0 0 Rp0 0
10 Miconazole 2% Tube 80 DAK 2022 3/31/2025 Rp1,900 72 152 27 5 120 125 Rp9,000 63
11 Oxytetrasiklin Salep Mata Tube 0 0 0 0 Rp0 0
12 Phenol Glyserol (Tetes Telinga) Botol 0 0 0 0 Rp0 0
13 perak sulfaduazine Tube 0 0 0 0 Rp0 0
14 Tube 0 0 0 0 Rp0 0
Belerang Endap 4%
15 Scabimite/ Scabisite Tube 4 DAK 2022 9/30/2024 Rp6,578 20 24 15 9 9 Rp180 25 30
16 Bedak Salisyl 2% Tube 0 0 0 0 Rp0 0
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 Rp0 0
1 Antihemoroid Suppo Supp 0 0 0 0 Rp0 0
2 Bisacodyl / Dulcolax 5 mg Supp 0 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFEKTAN 0 0 Rp0 0
1 Antiseptik Kumur Botol 0 0 0 0 Rp0 0
2 E-Care Hand Sanitizer 500 ml Botol 0 0 0 0 Rp0 0
3 E care hand Wash (Sabun Cair 500 mL) Botol 0 0 0 0 Rp0 0
4 Povidon 300 ml Botol 9 9 6 3 3 Rp0 6
5 Povidon 60 ml Botol 0 0 0 0 Rp0 0
6 Lisol 1 L Botol 0 0 0 0 Rp0 0
VAKSIN DAN SERUM 0 0 Rp0 0
1 Serum Anti Bisa Ular /Biosave SABU Vial 0 0 0 0 Rp0 0 1
2 Vial 2 2 0 2 2 Rp0 0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 Rp0 0
1 Glucosa 5% (D5%) 500 ml Botol 3 20 23 6 17 17 Rp340 16
3 Natrium Chlorida (NaCl) 0,9% Botol 215 100 315 120 195 195 Rp19,500 170
4 Ringer Laktat Botol 65 12/4/2025 340 405 265 140 140 Rp47,600 435 200
5 Ringer Asering Botol 0 0 0 0 Rp0 0
OBAT GIGI 0 0 Rp0 0
1 Ethyl Chloride Kaleng 0 0 0 0 Rp0 0
2 Fuji IX GP Besar pcs 0 0 0 0 Rp0 0
3 Fuji IX GP Kecil pcs 0 0 0 0 Rp0 0
4 Hydcal (Calsidol) pcs 0 0 0 0 Rp0 0
5 Iodotin/ Iodoform pcs 0 0 0 0 Rp0 0
6 Composit Pcs 0 0 0 0 Rp0 0
7 Sponestan / Surgipson pcs 0 0 0 0 Rp0 0 2
8 Cavit G pcs 0 0 0 0 Rp0 0
9 Tri Kresol Formalin (TKF) Set 0 0 0 0 Rp0 0
10 Klorfenol Kamfer Mentol pcs 0 0 0 0 Rp0 0
11 Devitalisasi Pasta Ion Arsen pcs 0 0 0 0 Rp0 0
12 Pulp - X Botol 2 DAK 2022 1/7/2025 Rp210,500 2 1 1 1 Rp0 1
12 Eugenol Botol 2 2 0 2 2 Rp0 0
LABORATORIUM 0 0 Rp0 0
1 Golda A Vial 0 0 0 0 Rp0 0
2 Golda B Vial 0 0 0 0 Rp0 0
3 Golda AB Vial 0 0 0 0 Rp0 0
4 Golda Resus D Vial 0 0 0 0 Rp0 0
5 HB Mission 50's Acon pcs 0 0 0 0 Rp0 0
6 Kertas Lensa Buah 0 0 0 0 Rp0 0
7 Kartu Golongan Darah Lembar 0 0 0 0 Rp0 0
8 Micropipet MT.II 1000 µl Pak 0 0 0 0 Rp0 0
9 Micropipet MT.I 200 µl Pak 0 0 0 0 Rp0 0
10 Object Glass Frosted (Slide) Box 0 0 0 0 Rp0 0
11 Rak Tabung Reaksi 50 Lubang Multipurpose Pcs 0 0 0 0 Rp0 0

12 25 kit/box 0 0 0 0 Rp0 0
13 Standbio Glucose 1 x 250 ml Kit 0 0 0 0 Rp0 0

14 Standbio Uric Acid 4 x 30 ml Kit 0 0 0 0 Rp0 0
15 Standbio Cholesterol 4 x 30 ml Kit 0 0 0 0 Rp0 0
16 Stik Nesco Cholestrol Box 0 0 0 0 Rp0 0
17 Stik Nesco Asam Urat Box 0 0 0 0 Rp0 0
18 Stik Nesco Gula Box 0 0 0 0 Rp0 0
19 Stik Easy Touch Asam Urat Box 0 0 0 0 Rp0 0
20 Stik Easy Touch Gula Box 0 0 0 0 Rp0 0
21 Stik Easy Touch Cholestrol Box 0 0 0 0 Rp0 0
22 Stik Benecek Asam Urat Box 3 3 2 1 1 Rp0 2
23 Stik Benecek Gula Box 0 0 0 0 Rp0 0
24 Stik Benecek Cholestrol Box 0 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0 0
25 Mindray U-II Urin Tes Botol 0 0 0 0 Rp0 0
26 Stik Urin 3 Parameter 100'S pcs 0 0 0 0 Rp0 0
28 Stik Gluko Protein Tes 10'S pcs 1 1 1 0 0 Rp0 1
29 Box 0 8/31/2024 0 0 0 Rp0 0
30 Widal kotak 0 0 0 0 Rp0 0
31 DILUENT GALON 0 0 0 0 Rp0 0
32 RINSE GALON 0 0 0 0 Rp0 0
33 LYSE Botol 0 0 0 0 Rp0 0
34 Probe Cleanser Botol 0 0 0 0 Rp0 0
35 EZ Cleanser Botol 0 0 0 0 Rp0 0
36 Giemsa Botol 0 0 0 0 Rp0 0
38 Blue Tip Botol 500 500 0 500 500 Rp0 0
BAHAN KIMIA 0 0 Rp0 0
1 Cynolf Botol 0 0 0 0 Rp0 0
2 Kaporit Galon 0 0 0 0 Rp0 0
3 ABATE 1 Kg/ Botol 0 APBN 6/8/2024 Rp0 0 0 0 Rp0 0
DANA DID, BTT & DBHCHT COVID 0 0 Rp0 0
BMHP 0 0 Rp0 0
1 Alat Suntik sekali pakai 3 ml pcs 0 0 0 0 Rp0 0
3 APRON White pcs 0 0 0 0 Rp0 0
4 APD LENGKAP pcs 0 0 0 0 Rp0 0
5 Cover All Suit pcs 0 0 0 0 Rp0 0
6 Faceshield pcs 0 0 0 0 Rp0 0
7 Faceshield kacamata pcs 0 0 0 0 Rp0 0
8 pcs 0 0 0 0 Rp0 0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 1000 DID 2021 1000 1000 0 0 Rp0 1000
10 Masker Tis On 3Ply pcs 0 0 0 0 Rp0 0
11 Masker Kain Scuba (Anak) pcs 0 0 0 0 Rp0 0
12 Masker Kain Scuba (dewasa) pcs 0 0 0 0 Rp0 0
13 3M Particulate N95-8210 pcs 0 0 Rp0 0
14 Masker KN95 (Protective Mask) pcs 0 0 0 0 Rp0 0
15 Masker N95 (mask 5 play) smiles pcs 0 0 0 0 Rp0 0
16 Sarung Tangan Non Steril S pcs 0 0 0 0 Rp0 0
17 Sarung Tangan Non Steril M pcs 0 0 Rp0 0
18 Sarung Tangan Non Steril L pcs 0 0 Rp0 0
19 Sarung Tangan Steril 7 pcs 0 0 Rp0 0
20 Sarung Tangan Steril 7.5 pcs 0 0 Rp0 0
21 Sarung Tangan Obgyn pcs 18 18 3 15 15 Rp0 3
22 Surgical Gown Water Proff pcs 0 0 0 0 Rp0 0
23 Termometer & Hemidity meter pcs 0 0 0 0 Rp0 0
24 Tensi ( Blood Pressure Monitor ) pcs 0 0 0 0 Rp0 0
25 Termogun HTI pcs 0 0 0 0 Rp0 0
26 Termogun ( OMRON Digital Forehead Termometer) pcs 0 0 0 0 Rp0 0
TAMBAHAN 0 0 Rp0 0
1 Kasa panjang 42y x 110 cm Poli Kassa Rol 0 0 0 0 Rp0 0
LABORATORRIUM 0 0 Rp0 0
1 Stik Cholesterol Easy Touch Box 0 0 0 0 Rp0 0
2 Stik Asam Urat Easy Touch Box 0 0 0 0 Rp0 0
3 Stik Glucose Easy Touch Box 0 0 0 0 Rp0 0
4 Stik Glucose Nesco Box 0 0 0 0 Rp0 0
5 Stik Cholestrol Nesco Box 0 0 0 0 Rp0 0
6 Stik Uri Acid Nesco Box 0 0 0 0 Rp0 0
8 Stik Cholestrol Bhenecek Box 0 0 0 0 Rp0 0
9 Stik Uri Acid Bhenecek Box 0 0 0 0 Rp0 0
11 Tabung EDTA Tutup ungu pcs 0 0 0 0 Rp0 0
12 VTM + Stik Steril Swab pcs 0 0 0 0 Rp0 0
13 VTM pcs 0 0 0 0 Rp0 0
14 Rapid Antigen (Clungene Taishan) pcs 0 0 0 0 Rp0 0
15 Rapid Test Indec pcs 0 0 0 0 Rp0 0
16 Standar Q Covid-19 Ag pcs 0 0 0 0 Rp0 0
17 VTM + Stik Steril Swab Dacron pcs 0 0 0 0 Rp0 0
OBAT-OBATAN 0 0 Rp0 0
1 Asam Ascorbat (Vitamin C) 250 mg Tablet 0 0 0 0 Rp0 0
2 Azithromycin 500 mg 20/ktk 0 0 0 0 Rp0 0
3 Allopurinol 100 mg Tablet 0 0 0 0 Rp0 0
4 Allopurinol 300 mg Tablet 800 800 430 70 300 370 Rp0 430 500
5 Cavicur Tablet 0 0 0 0 Rp0 0
6 Chlorpromazine 100 mg Tablet 0 0 0 0 Rp0 0
7 Ciprofloxacin 500 mg Tablet 0 0 0 0 Rp0 0
8 Chloroquin Phospat 150 mg 100/ktk 0 0 0 0 Rp0 0
10 Domperidon 10 mg Tablet 0 0 0 0 Rp0 0
11 Farbion Tablet 0 0 0 0 Rp0 0
12 Favipiravir 200 mg Tablet 0 0 0 0 Rp0 0
13 Gold Trion Tablet 0 0 0 0 Rp0 0
15 Levofloxacin 500 mg 50/ktk 0 0 0 0 Rp0 0
16 N-acetylcystein 30/box Tablet 0 0 0 0 Rp0 0
17 Oseltamivir Capsules 75 mg Kapsul 0 0 0 0 Rp0 0
18 Paracetamol 500 mg Tablet 0 0 0 0 Rp0 0
19 Piroxicam 20 mg Tablet 0 0 0 0 Rp0 0
20 Piridoxin Tablet 121 121 121 0 0 0 Rp0 121
21 Seloxy Tablet 0 0 0 0 Rp0 0
22 Kolkisin Tablet 470 470 297 140 33 173 Rp0 297 500
1 Phytominadion inj Ampul 0 0 0 0 Rp0 0
0 0 Rp0 0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0 0
2 Pot 0 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFECTAN 0 0 Rp0 0
1 Alkacide ( DESINFEKTAN) Botol 0 0 0 0 Rp0 0
2 T. Handrub 100 ml botol 0 0 0 0 Rp0 0
3 E-Care Handrub 500 ml Botol 0 0 0 0 Rp0 0
4 Alkohol 70% Botol 3 DAK 2022 11/30/2023 Rp58,000 6 9 4 5 5 Rp30 7
5 Kaporit 60% 15 Kg Galon 0 0 0 0 Rp0 0
HIBAH 0 0 Rp0 0
1 Jas Hujan (TorchMed-Guard) pcs 0 0 0 0 Rp0 0
2 Kacamata pcs 0 0 0 0 Rp0 0
3 Nurse Cap ONE MED / penutup kepala pcs 0 0 0 0 Rp0 0
4 Sepatu Boot pcs 0 0 0 0 Rp0 0
JKN 0 0 Rp0 0
1 Salbutamol 2 mg Tablet 180 500 680 400 80 200 280 Rp140,000 650 1000
2 Ethyl Chloride Botol 0 0 0 0 Rp0 0
3 Povidone 60 ml Botol 0 0 0 0 Rp0 0
1 Masker Hijab Pcs 0 2000 2000 720 30 1250 1280 1720
2 Vitamin B12 Tablet 1000 1000 10 90 900 990 10
3 Bionicom Zinc Tablet 0 1000 1000 95 5 900 905 595
UMUM GRATIS JKN TOTAL

JUMLAH KUNJUNGAN 203 17 422 642
JUMLAH RESEP 366 0 689 1055
MENGETAHUI, YANG MENYERAHKAN, YANG MEMINTA, YANG MENERIMA,

KEPALA DINAS KESEHATAN KAB. DOMPU KEPALA UPTD IFP DOMPU KEPALA UPTD PUSKESMAS PENGELOLA OBAT PUSKESMAS
Maman .SKM,M.Mkes Indi Hartini, A.Md.,Farm Joharis, AMG apt. Ajhar, S.Farm
NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007
PUSKESMAS : RASABOU PELAPORAN BULAN : APRIL

KECAMATAN : HU'U PERMINTAAN BULAN : MEI
1 2 3 4 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19

APBD 1 / APBN
Alat Kesehatan
1 Alat Suntik sekali pakai 0,05 ml Pcs 0 0 0 0 Rp0
2 Alat Suntik sekali pakai 1 ml Pcs 0 0 0 0 Rp0
4 Apron Biru malaria Pcs 0 0 0 0 Rp0
5 Alkohol Swabs 100's Pcs 0 11/30/2025 Rp70 0 0 0 Rp0
6 APD IMUNISASI COVID PAKET 0 0 0 0 Rp0
7 Gips 4 Inch Rol 0 0 0 0 Rp0
8 BAJU (Cover All Suit /Hazmat Suit) baju BOHO Pcs 0 0 0 0 Rp0
9 Masker Bedah 3 Ply (TB) Pcs 0 0 0 0 Rp0
10 Kaca Mata Google TB Pcs 2 2 0 2 2 Rp0
11 Masker Bedah 3 Ply (HIV) Pcs 0 0 0 0 Rp0
12 Masker TB N95 Pcs 0 0 0 0 Rp0
13 Masker N95 (Sure And Me) Pcs 0 0 0 0 Rp0
14 Masker Bedah Anak Pcs 0 0 0 0 Rp0
15 APD Lengkap Foging Set 0 0 0 0 Rp0
16 Masker Las (Foging) Pcs 0 0 0 0 Rp0
17 Masker Malaria Pcs 0 0 0 0 Rp0
18 Sarung Tangan Non Steril S Pcs 0 0 0 0 Rp0
19 Sarung Tangan Non Steril M Pcs 0 0 0 0 Rp0
20 Kelambu Roll 0 0 0 0 Rp0
21 Plester Bulat @200pcs Pcs 0 0 0 0 Rp0
22 Sarung Tangan Steril 7 Pcs 0 0 Rp0
OBAT-OBATAN Rp0
1 Albendazole 400 mg Tablet 163 7/1/2023 163 7 156 0 156 Rp0
2 Asam Ascorbat 500 mg Tablet 0 0 0 0 Rp0
3 Bedaquiline Tablet 0 0 0 0 Rp0
4 Closerin 250 mg Tablet 0 0 0 0 Rp0
5 Clofazimin Tablet 0 0 0 0 Rp0
6 DHP Frimal (Kotak @9 Tablet) ktk 1 1 0 1 1 Rp0 2
7 Ethionamide Tablet 0 0 0 0 Rp0
8 Linezolid 600 mg Tablet 0 0 0 0 Rp0
10 Glibenclamide 5 mg Tablet 0 0 0 0 Rp0
11 INH(Ishonizide) Tablet 100 100 0 100 100 Rp0
12 Lompren ( Clofazimine) Tablet 0 0 0 0 Rp0
13 MDT Combi Dewasa MB (Merah) Blister 5 5 0 5 5 Rp0
14 MDT Combi Dewasa PB (Hijau) Blister 0 0 0 0 Rp0
15 MDT Combi Anak MB ( ORANGE) Blister 0 0 0 0 Rp0
16 Mineral Mix Sachet 13 13 0 13 13 Rp0
17 Moxifloxacin ( moximed) Tablet 0 0 0 0 Rp0
18 Metoclopramid 10 mg Tablet 0 0 0 0 Rp0
19 OAT Kat. 1,3 Paket 4 APBD I 2021 2/29/2024 Rp436,445 6 10 5 5 5 Rp30 5
20 OAT Kat. II Paket 0 0 0 0 Rp0
21 OAT Kat Anak Paket 1 1 0 1 1 Rp0
22 OAT Kat kombipak Paket 0 0 0 0 Rp0
23 Primaquin 15 mg Tablet 86 86 0 86 86 Rp0
24 Rifampicin Tablet 0 0 0 0 Rp0
25 Retinol 200.000 IU (Merah) Kapsul lunak 307 APBD I 6/30/2025 Rp586 307 74 33 200 233 Rp0
26 Retinol 100.000 IU (Biru) Kapsul lunak 400 APBD I 5/30/2025 Rp324 400 3 47 350 397 Rp0
27 Sivit Zinc Tablet 0 0 0 0 Rp0
28 Tablet Tambah Darah Tablet 19160 8200 27360 8700 60 18600 18660 ###
29 Zinc 20 mg Tablet 185 185 185 0 0 0 Rp0 1500
SIRUP, SUSPENSI DAN DROP 0 0 Rp0
1 Albendazole sirup Botol 0 0 0 0 Rp0
INJEKSI DAN PELARUT 0 0 Rp0
1 Artesunat Injeksi 60 mg/ml Vial 0 0 0 0 Rp0
2 Dextrose 40% Vial 0 0 0 0 Rp0
3 Ephedrin HCL Inj 1% Ampul 0 0 0 0 Rp0
4 Ephinefrine Ampul 0 0 0 0 Rp0
5 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 Rp0
6 MgSO4 40% Ampul 0 0 0 0 Rp0
7 Phytomenadion inj 2 mg/ml Ampul 0 0 0 0 Rp0
VAKSIN DAN SERUM 0 0 Rp0
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 10/17/2026 Rp1,185 0 0 0 Rp0
2 Vaksin BCG Vial 0 0 0 0 Rp0
3 Vaksin Td Vial 0 0 0 0 Rp0
4 Vaksin HB0 Vial 0 0 0 0 Rp0
5 Vaksin IPV Vial 0 0 0 0 Rp0
6 Vaksin Polio (POLIO) Vial 0 0 0 0 Rp0
7 Vaksin MR (1-2) ( Rubela/Campak)/Bian Vial 0 0 0 0 Rp0
8 Vaksin MR (1-2) ( Rubela/Campak) Vial 0 0 0 0 Rp0
9 Vaksin DT Vial 0 0 0 0 Rp0
10 Vaksin PCV Vial 0 0 0 0 Rp0
11 Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4) Vial 0 0 0 0 Rp0
12 Tinta Vaksin Bian Pcs 0 0 0 0 Rp0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 9 9 1 8 8 Rp0
14 RABIES VACCINE INACTIVATED Vial 0 0 0 0 Rp0
15 RABIES IMMUNE GLOBULIN (HUMAN) 1 ML Vial 0 0 0 0 Rp0
16 Vaksin Covid-19 (Sinovac) Vial 0 0 0 0 Rp0
17 Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis) Vial 0 0 0 0 Rp0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 Rp0
19 Vaksin Covid-19 Pfizer (@ 6 Dosis) Vial 0 0 0 0 Rp0
20 Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA Vial 0 0 0 0 Rp0
21 Vaksin Covid-19 @14 (Moderna) Vial 0 0 0 0 Rp0
22 Vaksin Sinopharm @ 2 dosis Vial 0 0 0 0 Rp0
23 Vaksin Covid-19 (Moderna) @10 DOSIS Vial 0 0 0 0 Rp0
24 Vaksin Covid-19 (@ 2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 0 0 0 Rp0
26 Vaksin Covid-19 (@10 Dosis) ASTRAZENECA Vial 0 0 0 0 Rp0
27 Cadox (Konecavax)@10 dosis Vial 0 0 0 0 Rp0
28 Safety Box 5 Liter Pcs 0 Rp14,000 0 0 0 Rp0
29 Pelarut MR Bian Ampul 0 0 0 0 Rp0
30 Pelarut BCG Ampul 0 0 0 0 Rp0
31 Pelarut MR Ampul 0 0 0 0 Rp0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 8/31/2023 Rp3,280 0 0 0 Rp0
33 Pipet Tetes (Polio/BOPV) 0 0 0 0 Rp0
34 Pelarut NaCl 0,9% 10 ml Flash 0 0 0 0 Rp0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 Rp0
SEDIAAN TOPIKAL 0 0 Rp0
1 Chloramphenicol SM 1% Tube 0 0 0 0 Rp0
2 Hidrocortison salep Tube 0 0 Rp0
3 Oxytetrasiklin Salep Mata 0,1% Tube 0 0 0 0 Rp0
4 Salep 2-4 Pot 0 0 0 0 Rp0
LABORATORIUM 0 0 Rp0
1 Box Slide ( Warna Hijau )(malaria) 72'S ktk/72 pcs 0 0 0 0 Rp0
2 Blood Lancet 100 'S Pcs 0 0 0 0 Rp0
3 Fesco Blood Lancet 200 'S Pcs 0 0 0 0 Rp0
4 Catride TCM TB Pcs 0 0 0 0 Rp0
5 (Whole Blood) (Warna PEACH)(AG PCDH) 25 kit/box 0 0 0 0 Rp0
(MALARIA)
6 Handsanitizer 50 ml Botol 0 0 0 0 Rp0
8 Giemsa 100 ml Botol 0 0 0 0 Rp0
9 Oil Emersi 100 ml Botol 0 0 0 0 Rp0
10 Oil Emersi 500 ml Botol 1 1 0 1 1 Rp0
12 Kartu Golongan Darah pak 0 0 0 0 Rp0
13 Lab. Kit Malaria kotak 0 0 0 0 Rp0
14 Oil Emersi botol 0 0 0 0 Rp0
15 Paket KIT TB kotak 0 0 0 0 Rp0
16 Pot Dahak / Pot Sputum Buah 0 0 0 0 Rp0
17 Reagen ZN 10 ktk/Dus 0 1 1 1 0 0 Rp0
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 0 APBN I 2023 7/31/2024 50 50 0 50 50 Rp2,500
19 Test 25 25 25 0 0 Rp0
20 RDT DBD SD BIOLINE 25 kit/box 0 0 0 0 Rp0
21 Pcs 0 0 0 0 Rp0
22 Rapid Antigen (Whole Power) Pcs 20 60 80 40 40 40 Rp2,400
23 Rapid Antigen Entram Pcs 0 0 0 0 Rp0
24 Reagen Golda A vial 0 0 0 0 Rp0
25 Reagen Golda B vial 0 0 0 0 Rp0
26 Reagen Golda AB vial 0 0 0 0 Rp0
27 Anti Resus D vial 0 0 0 0 Rp0
28 SD HIV-1/2 3,0 25/kotak 25 100 125 0 125 125 Rp12,500
29 TRIPOCHECK SYPHILIS 25/kotak 7 7 0 7 7 Rp0
30 Tuberkulin Vial 0 0 0 0 Rp0
31 VTM + Stik Steril Swab (CITO) Pcs 0 0 0 0 Rp0
32 BETAFOG Botol 0 0 0 0 Rp0
33 Insektisida DBD (GOKILATH) 0 0 0 0 Rp0
34 Human Colesterol Liquid Botol 0 0 0 0 Rp0
35 Human Glucose liquid Botol 0 0 0 0 Rp0
36 Human Hemoglobine liquid Botol 0 0 0 0 Rp0
37 Human Tryglyceride liquid Botol 0 0 0 0 Rp0
38 Providen 0 0 0 0 Rp0
39 Sars Cov-2 Anti Bodi Test BOX/20 0 0 0 0 Rp0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 APBD I 10/14/2023 0 0 0 Rp0
39 Virotec Dengue Kombo (P2M) Pcs 0 APBD I 8/31/2024 0 0 0 Rp0
DAK 0 0 Rp0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 Rp0
3 Alat Suntik sekali pakai 3 ml Pcs 0 DAK 2022 4/9/2027 Rp979 0 0 0 0 Rp0 1000
4 Alat Suntik sekali pakai 5 ml Pcs 31 DAK 2021 7/9/2026 Rp1,056 31 31 0 0 Rp0 500
5 Alkohol Swabs 100's Pcs 0 0 0 0 Rp0
6 Blade Sterile (Mess) Pcs 120 300 420 39 81 300 381 Rp114,300
7 Blood Lancet Pcs 200 200 0 200 200 Rp0
8 Blod TransfusiSet Stera Pcs 55 DAK 2021 2/1/2025 Rp3,600 100 155 101 7 47 54 Rp5,400 50
9 Catgut Chromic (Absorbable Suture Sterile) Pcs 0 0 0 0 Rp0
10 Catgut Plain 3/0 HR 37 mm Pcs 25 72 97 54 1 42 43 Rp3,096 24
11 Dermatix Pcs 0 0 0 0 Rp0
12 Female Catheter no. 16 Pcs 0 0 0 0 Rp0
13 Female Catheter no. 18 Pcs 20 20 1 19 19 Rp0
14 Foley Catheter no. 18 Pcs 1 DAK 2021 10/16/2024 Rp14,341 1 1 0 0 Rp0 20
15 Foley Catheter no. 20 Pcs 0 0 0 0 Rp0
17 Infus Set Dewasa Pcs 0 100 100 100 0 0 Rp0 300
18 IV Catheter No. 16 Pcs 0 0 0 0 Rp0
19 IV Catheter no. 18 Pcs 193 50 243 34 9 200 209 Rp10,450
20 IV Catheter no. 20 Pcs 300 300 107 23 170 193 Rp0 50
21 IV Catheter no. 22 Pcs 78 DAK 2022 11/30/2026 Rp4,862 250 328 237 41 50 91 Rp22,750 250
22 IV Catheter no. 24 Pcs 110 DAK 2022 8/30/2027 Rp12,804 110 108 2 0 2 Rp0 250
23 Jarum Kulit GT 14 Pcs 0 0 0 0 Rp0
24 Jarum Otot GR 14 Pcs 0 0 0 0 Rp0
25 Kapas Pembalut 500 gr Bungkus 3 3 6 3 3 3 Rp9 5
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 4 5 9 5 4 4 Rp20 3
27 Kassa Steril kotak 0 0 0 0 Rp0 50
28 Masker Nebul Anak Pcs 0 0 0 0 Rp0
29 Masker Nebul Dewasa Pcs 0 6 6 1 5 5 Rp30
30 Nasal Canula Bayi (Oxyflow) Pcs 6 6 0 6 6 Rp0
31 Nasal Canula Anak (Oxyflow) Pcs 15 15 1 14 14 Rp0
32 Nasal Canula Dewasa (Oxyflow) Pcs 7 7 3 4 4 Rp0 15
33 Needle No. 25G x 25 mm Pcs 0 0 0 0 Rp0
34 Polifix / Hipavix 5mx5cm Roll 8 21 29 22 7 7 Rp147 20
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 800 800 100 700 700 Rp0
37 Sarung Tangan Non Steril L Pcs 1400 DAK 2022 4/30/2027 Rp546 200 1600 1300 300 300 Rp60,000 1000
38 Sarung Tangan Steril 7,5 Pcs 0 0 0 0 Rp0
40 Stomach tube no. 18 Pcs 0 0 0 0 Rp0
41 Tes kehamilan Pcs 100 100 30 70 70 Rp0
42 Under Pad (Soft Pad 60 x 90 cm) Pcs 0 0 0 0 Rp0 100
43 Urine Bag Pcs 25 3 28 5 23 23 Rp69
44 Sarung Tangan Steril 7 Pcs 129 DAK 2022 3/30/2027 150 279 29 250 250 Rp37,500
OBAT-OBATAN 0 0 Rp0
1 Acetylcystein 200 mg Tablet 625 DAK 2022 9/30/2024 Rp307 8700 9325 2573 54 6698 6752 Rp58,742,400
2 Tablet 200 200 0 0 200 200 Rp0
)
3 acyclovir 400 mg Tablet 0 0 0 0 Rp0
6 Amlodipin 10 mg Tablet 3305 3305 1715 190 1400 1590 Rp0 2000
7 Amoxicillin 500 mg Tablet 3840 3840 3840 0 0 0 Rp0 5000
8 Antasida DOEN Tablet Tablet 0 0 0 0 Rp0 6000
9 Asam Ascorbat 50 mg Tablet 2024 3500 5524 620 204 4700 4904 Rp17,164,000
10 Asam Mefenamat 500 mg Tablet 0 5000 5000 3450 150 1400 1550 Rp7,750,000 5000
11 Attapulgit 600 mg (pularex) Tablet 1250 1250 480 70 700 770 Rp0
12 Betahistine tablet 130 130 0 30 100 130 Rp0
13 Captopril 12,5 mg Tablet 1920 1920 830 90 1000 1090 Rp0 1000
15 Calcium Lactate Tablet 1620 1620 960 160 500 660 Rp0 1000
17 Ciprofloxacin 500mg Tablet 0 0 0 0 Rp0 500
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 5125 DAK 2022 7/30/2024 Rp70 5000 10125 4975 150 5000 5150 Rp25,750,000 3000
19 Cotrimoxazol 480 mg Tablet 1570 1570 1030 240 300 540 Rp0 1000
20 Cetirizin HCL Tablet 3020 3020 990 30 2000 2030 Rp0
21 Chlorampenicol 250 mg Tablet 0 0 0 0 Rp0
22 Chlorampenicol 500 mg (Cloramex 500) Tablet 1245 1245 410 35 800 835 Rp0
23 Dexamethasone 0,5 mg Tablet 6960 6960 1715 145 5100 5245 Rp0
24 Digoxin 0,25 mg Tablet 0 0 0 0 Rp0
25 Dimenhydrinat 50 mg Tablet 0 0 0 0 Rp0
26 Domperidon 10 mg Tablet 2270 2270 530 40 1700 1740 Rp0
27 Ergotamin Tablet 0 0 0 0 Rp0
28 Erytromycin 250 mg Tablet 0 0 0 0 Rp0
30 Folic Acid 1mg Tablet 350 DAK 2021 10/1/2023 Rp43 200 550 100 50 400 450 Rp90,000
31 Furosemide 40 mg Tablet 0 0 0 0 Rp0
32 Glibenclamide 5 mg Tablet 60 60 60 0 0 0 Rp0 5000
33 Glimepiride 1 mg Tablet 0 0 0 0 Rp0
35 Glimepiride 3mg Tablet 0 0 0 0 Rp0
36 Griseovulfin 125 mg Tablet 540 100 640 330 10 300 310 Rp31,000 500
37 Griseovulfin 500 mg Tablet 0 0 0 0 Rp0
38 Hydrochlorthiazide 25 mg Tablet 100 100 0 100 100 Rp0
39 Ibuprofen 200 mg Tablet 0 0 0 0 Rp0
40 Ibuprofen 400 mg Tablet 0 0 Rp0 3500
41 Ketokonazole 200 mg Tablet 150 150 50 100 100 Rp0
42 Loperamide Tablet 710 600 1310 580 230 500 730 Rp438,000
43 Loratadine 10 mg Tablet 0 0 0 0 Rp0
44 Metyl Ergometrin 0,125 MG Tablet 100 100 100 0 0 Rp0
45 Methyl Prednisolon 4 mg Tablet 0 0 0 0 Rp0
46 Metformin 500 mg Tablet 3120 3120 2000 120 1000 1120 Rp0 2000
48 Metronidazole 250 mg Tablet 0 0 0 0 Rp0
49 Metronidazole 500 mg Tablet 645 645 10 90 545 635 Rp0
50 Nifedipin 10 mg Tablet 0 0 0 0 Rp0
51 Nifedipin 20 mg (Adalat Oros ) Tablet 60 60 0 60 60 Rp0
52 Nystatin 100.000 IU Tablet Vaginal Tablet 0 0 0 0 Rp0
53 Nystatin 500.000 IU Tablet Tablet 210 DAK 2022 3/30/2024 Rp0 210 0 40 170 210 Rp0
54 Natrium Diklofenak 25 mg Tablet 0 DAK 2021 7/1/2026 Rp114 0 0 0 Rp0 4000
55 Natrium Diklofenak 50 mg Tablet 0 0 0 0 Rp0
56 Omeprazole Cap Tablet 1970 1400 3370 1611 159 1600 1759 Rp2,462,600 800
57 Paracetamol 500 mg Tablet 8540 10000 18540 9490 50 9000 9050 Rp90,500,000 5000
58 Phytomenadion 10 mg Tablet 0 100 100 20 80 0 80 Rp8,000
59 Propranolol Tablet 0 0 0 0 Rp0
61 Propylthiouracil 100 mg Tablet 100 100 0 100 100 Rp0
62 Pyrantel Pamoate 125 mg Tablet 191 191 0 191 191 Rp0
63 Ranitidine 150 mg Tablet 0 0 0 0 Rp0 3000
64 Salbutamol 4 mg Tablet 40 500 540 50 90 400 490 Rp245,000
67 Vitamin B Kompleks Tablet 4300 4300 3610 190 500 690 Rp0 5000
68 Zinc 20 mg Tablet 0 0 0 0 Rp0
68 Cefadroksil Monohidrat 500 mg Tablet 0 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0 1000
1 Amoxicillin Syr 125 mg/5ml Botol 0 0 0 0 Rp0
2 Amoxicillin Syr 250 mg/5ml Botol 9 DAK 2022 12/31/2024 Rp3,510 100 109 74 5 30 35 Rp3,500 100
4 Cotrimoxazol Suspensi 240 mg/5ml Botol 0 0 0 0 Rp0
5 Domperidon suspensi Botol 0 0 0 0 Rp0
6 Ibuprofen 200 mg/5ml suspensi Botol 0 0 0 0 Rp0
7 Metronidazole Sirup Botol 0 0 0 0 Rp0
1 Ampicillin Injeksi 1000 mg Vial 0 0 0 0 Rp0
2 Aqua Pro Injeksi 25 ml Flush 0 0 0 0 Rp0
3 Aqua DM 1000 ml Botol 0 0 0 0 Rp0

4 Ampul 0 0 0 0 Rp0
5 Dexamethasone Injeksi Ampul 0 0 0 0 Rp0

6 Diphenhydramin inj Ampul 12 12 0 12 12 Rp0
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 0 0 0 0 Rp0 10
8 Gluconat Calcicum Inj 100 mg/ml Ampul 5 5 0 5 5 Rp0
9 Lidocain HCl 2% Ampul 58 DAK 2022 6/30/2026 Rp847 200 258 158 0 100 100 Rp20,000 100
10 Ampul 0 30 30 0 30 30 Rp900
11 Meprovent Inhaler Ampul 16 DAK 2022 4/1/2028 Rp3,677 60 76 16 60 60 Rp3,600
12 Methyl Ergometrin Inj 0,2 mg/ml Ampul 0 0 0 0 Rp0
13 MgSO4 20% Vial 4 DAK 2022 11/8/2023 Rp3,760 4 0 4 4 Rp0
14 MgSO4 40% Vial 5 5 1 4 4 Rp0
15 Oxytocin Injeksi Ampul 27 DAK 2022 3/31/2025 Rp1,298 100 127 44 83 83 Rp8,300
16 Omeprazole Inj 40 mg/ml Ampul 17 17 0 17 17 Rp0
17 Phytomenadion Inj 2 mg/ml Vial 0 0 0 0 Rp0 30
1 Aciclovir salep kulit Tube 0 0 0 0 Rp0
2 Tube 0 0 0 0 Rp0 50
3 Tube 0 0 Rp0 50
Asam Salisilat 3%
4 Betamethasone cream Tube 0 0 0 0 Rp0
5 Chloramphenicol 1% Salep Mata Tube 0 0 0 0 Rp0 20
7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol 0 0 0 0 Rp0

8 Hydrocortison 2,5% Tube 52 DAK 2022 6/30/2024 Rp2,325 24 76 48 4 24 28 Rp672 48
9 Ketokonazole Cream Tube 0 0 0 0 Rp0
10 Miconazole 2% Tube 125 DAK 2022 3/31/2025 Rp1,900 48 173 78 23 72 95 Rp4,560
11 Oxytetrasiklin Salep Mata Tube 0 0 0 0 Rp0
12 Phenol Glyserol (Tetes Telinga) Botol 0 0 0 0 Rp0
13 perak sulfaduazine Tube 0 0 0 0 Rp0
14 Tube 0 0 0 0 Rp0 30
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 9 DAK 2022 9/30/2024 Rp6,578 23 32 10 22 22 Rp506
16 Bedak Salisyl 2% Tube 0 0 0 0 Rp0 30
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 Rp0
1 Antihemoroid Suppo Supp 0 0 0 0 Rp0
2 Bisacodyl / Dulcolax 5 mg Supp 0 0 0 0 Rp0
ANTISEPTIK DAN DESINFEKTAN 0 0 Rp0
1 Antiseptik Kumur Botol 0 0 0 0 Rp0
2 E-Care Hand Sanitizer 500 ml Botol 0 0 0 0 Rp0
3 E care hand Wash (Sabun Cair 500 mL) Botol 0 0 0 0 Rp0
4 Povidon 300 ml Botol 3 9 12 3 9 9 Rp81
5 Povidon 60 ml Botol 0 0 0 0 Rp0
6 Lisol 1 L Botol 0 0 0 0 Rp0
1 Serum Anti Bisa Ular /Biosave SABU Vial 0 0 0 0 Rp0 1
2 Vial 2 2 0 2 2 Rp0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 Rp0
1 Glucosa 5% (D5%) 500 ml Botol 17 17 5 2 10 12 Rp0
2 Glucosa 10% (D10%) 500 ml Botol 20 20 0 20 20 Rp0
3 Natrium Chlorida (NaCl) 0,9% Botol 195 180 375 94 1 280 281 Rp50,580
4 Ringer Laktat Botol 140 12/4/2025 400 540 455 5 80 85 Rp34,000 500
5 Ringer Asering Botol 0 0 0 0 Rp0
OBAT GIGI 0 0 Rp0
1 Ethyl Chloride Kaleng 0 0 0 0 Rp0
2 Fuji IX GP Besar pcs 0 0 0 0 Rp0
3 Fuji IX GP Kecil pcs 0 0 0 0 Rp0
4 Hydcal (Calsidol) pcs 0 0 0 0 Rp0
5 Iodotin/ Iodoform pcs 0 0 0 0 Rp0
6 Composit Pcs 0 0 0 0 Rp0
7 Sponestan / Surgipson pcs 0 24 24 0 24 24 Rp576
8 Cavit G pcs 0 0 0 0 Rp0
9 Tri Kresol Formalin (TKF) Set 0 0 0 0 Rp0
10 Klorfenol Kamfer Mentol pcs 0 0 0 0 Rp0
11 Devitalisasi Pasta Ion Arsen pcs 0 0 0 0 Rp0
12 Pulp - X Botol 1 DAK 2022 1/7/2025 Rp210,500 2 3 0 3 3 Rp6
12 Eugenol Botol 2 2 0 2 2 Rp0
1 Golda A Vial 0 0 0 0 Rp0
2 Golda B Vial 0 0 0 0 Rp0
3 Golda AB Vial 0 0 0 0 Rp0
4 Golda Resus D Vial 0 0 0 0 Rp0
5 HB Mission 50's Acon pcs 0 0 0 0 Rp0
6 Kertas Lensa Buah 0 0 0 0 Rp0
7 Kartu Golongan Darah Lembar 0 0 0 0 Rp0
8 Micropipet MT.II 1000 µl Pak 0 0 0 0 Rp0
9 Micropipet MT.I 200 µl Pak 0 0 0 0 Rp0
10 Object Glass Frosted (Slide) Box 0 0 0 0 Rp0
11 Rak Tabung Reaksi 50 Lubang Multipurpose Pcs 0 0 0 0 Rp0

12 25 kit/box 0 0 0 0 Rp0
13 Standbio Glucose 1 x 250 ml Kit 0 0 0 0 Rp0

14 Standbio Uric Acid 4 x 30 ml Kit 0 0 0 0 Rp0
15 Standbio Cholesterol 4 x 30 ml Kit 0 0 0 0 Rp0
22 Stik Benecek Asam Urat Box 1 1 1 0 0 Rp0 3
24 Stik Benecek Cholestrol Box 0 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0 3
25 Mindray U-II Urin Tes Botol 0 0 0 0 Rp0
26 Stik Urin 3 Parameter 100'S pcs 0 0 0 0 Rp0
28 Stik Gluko Protein Tes 10'S pcs 0 10 10 10 0 0 Rp0
29 Box 0 8/31/2024 0 0 0 Rp0
33 LYSE Botol 0 0 0 0 Rp0
34 Probe Cleanser Botol 0 0 0 0 Rp0
35 EZ Cleanser Botol 0 0 0 0 Rp0
36 Giemsa Botol 0 0 0 0 Rp0
38 Blue Tip Botol 500 500 0 500 500 Rp0
BAHAN KIMIA 0 0 Rp0
1 Cynolf Botol 0 0 0 0 Rp0
2 Kaporit Galon 0 0 0 0 Rp0
3 ABATE 1 Kg/ Botol 0 APBN 6/8/2024 Rp0 0 0 0 Rp0
DANA DID, BTT & DBHCHT COVID 0 0 Rp0
BMHP 0 0 Rp0
1 Alat Suntik sekali pakai 3 ml pcs 0 0 0 0 Rp0
3 APRON White pcs 0 0 0 0 Rp0
4 APD LENGKAP pcs 0 0 0 0 Rp0
5 Cover All Suit pcs 0 0 0 0 Rp0
6 Faceshield pcs 0 0 0 0 Rp0
7 Faceshield kacamata pcs 0 0 0 0 Rp0
8 pcs 0 0 0 0 Rp0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 0 DID 2021 2000 2000 0 2000 2000 Rp4,000,000
10 Masker Tis On 3Ply pcs 0 0 0 0 Rp0
11 Masker Kain Scuba (Anak) pcs 0 0 0 0 Rp0
12 Masker Kain Scuba (dewasa) pcs 0 0 0 0 Rp0
13 3M Particulate N95-8210 pcs 0 0 Rp0
14 Masker KN95 (Protective Mask) pcs 0 0 0 0 Rp0
15 Masker N95 (mask 5 play) smiles pcs 0 0 0 0 Rp0
16 Sarung Tangan Non Steril S pcs 0 0 0 0 Rp0
17 Sarung Tangan Non Steril M pcs 0 0 Rp0
18 Sarung Tangan Non Steril L pcs 0 0 Rp0
19 Sarung Tangan Steril 7 pcs 0 0 Rp0
20 Sarung Tangan Steril 7.5 pcs 0 0 Rp0
21 Sarung Tangan Obgyn pcs 15 15 1 1 13 14 Rp0
22 Surgical Gown Water Proff pcs 0 0 0 0 Rp0
23 Termometer & Hemidity meter pcs 0 0 0 0 Rp0
24 Tensi ( Blood Pressure Monitor ) pcs 0 0 0 0 Rp0
25 Termogun HTI pcs 0 0 0 0 Rp0
26 Termogun ( OMRON Digital Forehead Termometer) pcs 0 0 0 0 Rp0
TAMBAHAN 0 0 Rp0
1 Kasa panjang 42y x 110 cm Poli Kassa Rol 0 0 0 0 Rp0
LABORATORRIUM 0 0 Rp0
1 Stik Cholesterol Easy Touch Box 0 0 0 0 Rp0
2 Stik Asam Urat Easy Touch Box 0 0 0 0 Rp0
3 Stik Glucose Easy Touch Box 0 0 0 0 Rp0
4 Stik Glucose Nesco Box 0 0 0 0 Rp0
5 Stik Cholestrol Nesco Box 0 0 0 0 Rp0
6 Stik Uri Acid Nesco Box 0 0 0 0 Rp0
8 Stik Cholestrol Bhenecek Box 0 0 0 0 Rp0
9 Stik Uri Acid Bhenecek Box 0 0 0 0 Rp0
12 VTM + Stik Steril Swab pcs 0 0 0 0 Rp0
13 VTM pcs 0 0 0 0 Rp0
14 Rapid Antigen (Clungene Taishan) pcs 0 0 0 0 Rp0
15 Rapid Test Indec pcs 0 0 0 0 Rp0
16 Standar Q Covid-19 Ag pcs 0 0 0 0 Rp0
17 VTM + Stik Steril Swab Dacron pcs 0 0 0 0 Rp0
OBAT-OBATAN 0 0 Rp0
1 Asam Ascorbat (Vitamin C) 250 mg Tablet 0 0 0 0 Rp0
2 Azithromycin 500 mg 20/ktk 0 0 0 0 Rp0
3 Allopurinol 100 mg Tablet 0 0 0 0 Rp0
4 Allopurinol 300 mg Tablet 370 700 1070 620 150 300 450 Rp315,000 500
6 Chlorpromazine 100 mg Tablet 0 0 0 0 Rp0
7 Ciprofloxacin 500 mg Tablet 0 0 0 0 Rp0
8 Chloroquin Phospat 150 mg 100/ktk 0 0 0 0 Rp0
10 Domperidon 10 mg Tablet 0 0 0 0 Rp0
11 Farbion Tablet 0 0 0 0 Rp0
12 Favipiravir 200 mg Tablet 0 0 0 0 Rp0
13 Gold Trion Tablet 0 0 0 0 Rp0
15 Levofloxacin 500 mg 50/ktk 0 0 0 0 Rp0
16 N-acetylcystein 30/box Tablet 0 0 0 0 Rp0
17 Oseltamivir Capsules 75 mg Kapsul 0 0 0 0 Rp0
18 Paracetamol 500 mg Tablet 0 0 0 0 Rp0
19 Piroxicam 20 mg Tablet 0 0 0 0 Rp0
20 Piridoxin Tablet 0 0 0 0 Rp0
21 Seloxy Tablet 0 0 0 0 Rp0
22 Kolkisin Tablet 173 600 773 540 140 93 233 Rp139,800 500
1 Phytominadion inj Ampul 0 0 0 0 Rp0
0 0 Rp0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0
2 Pot 0 0 0 0 Rp0
ANTISEPTIK DAN DESINFECTAN 0 0 Rp0
1 Alkacide ( DESINFEKTAN) Botol 0 0 0 0 Rp0
2 T. Handrub 100 ml botol 0 0 0 0 Rp0
3 E-Care Handrub 500 ml Botol 0 0 0 0 Rp0
4 Alkohol 70% Botol 5 DAK 2022 11/30/2023 Rp58,000 6 11 3 1 7 8 Rp48
5 Kaporit 60% 15 Kg Galon 0 0 0 0 Rp0
HIBAH 0 0 Rp0
1 Jas Hujan (TorchMed-Guard) pcs 0 0 0 0 Rp0
2 Kacamata pcs 0 0 0 0 Rp0
3 Nurse Cap ONE MED / penutup kepala pcs 0 0 0 0 Rp0
4 Sepatu Boot pcs 0 0 0 0 Rp0
JKN 0 0 Rp0
1 Salbutamol 2 mg Tablet 280 1000 1280 810 170 300 470 Rp470,000 500
2 Ethyl Chloride Botol 0 0 0 0 Rp0
3 Povidone 60 ml Botol 0 0 0 0 Rp0
0
1 Masker Hijab Pcs 1280 1280 780 500 500
2 Vitamin B12 Tablet 990 990 100 90 800 890
3 Bionicom Zinc Tablet 905 905 5 900 900
4 Masker Oksigen Non Rebriting Bayi Pcs 0 DAK 2023 2 2 0 2 2


NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007
PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
1
2
3
4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
39
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
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
64
65
66
67
68
68
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
1
2
3
1
2
3
4
5
6
1
2
1
2
3
4
5
1
2
3
4
5
6
7
8
9
10
11
12
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
1
2
3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
1
1
2
1
2
3
4
5
1
2
3
4
1
2
3
1
2
3
4
5
PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
NAMA OBAT / ALKES
2
APBD 1 / APBN
Alat Kesehatan
Alat Suntik sekali pakai 0,05 ml
Alat Suntik sekali pakai 1 ml
Apron Biru malaria
Alkohol Swabs 100's
APD IMUNISASI COVID
Gips 4 Inch
BAJU (Cover All Suit /Hazmat Suit) baju BOHO
Masker Bedah 3 Ply (TB)
Kaca Mata Google TB
Masker Bedah 3 Ply (HIV)
Masker TB N95
Masker N95 (Sure And Me)
Masker Bedah Anak
APD Lengkap Foging
Masker Las (Foging)
Masker Malaria
Sarung Tangan Non Steril S
Sarung Tangan Non Steril M
Kelambu
Plester Bulat @200pcs
Sarung Tangan Steril 7
OBAT-OBATAN
Albendazole 400 mg
Asam Ascorbat 500 mg
Bedaquiline
Closerin 250 mg
Clofazimin
DHP Frimal (Kotak @9 Tablet)
Ethionamide
Linezolid 600 mg
Garam Oralit
Glibenclamide 5 mg
INH(Ishonizide)
Lompren ( Clofazimine)
MDT Combi Dewasa MB (Merah)
MDT Combi Dewasa PB (Hijau)
MDT Combi Anak MB ( ORANGE)
Mineral Mix
Moxifloxacin ( moximed)
Metoclopramid 10 mg
OAT Kat. 1,3
OAT Kat. II
OAT Kat Anak
OAT Kat kombipak
Primaquin 15 mg
Rifampicin
Retinol 200.000 IU (Merah)
Retinol 100.000 IU (Biru)
Sivit Zinc
Tablet Tambah Darah
Zinc 20 mg
Albendazole sirup
INJEKSI DAN PELARUT
Artesunat Injeksi 60 mg/ml
Dextrose 40%
Ephedrin HCL Inj 1%
Ephinefrine
Metoclopramid inj 5 mg/ml
MgSO4 40%
Phytomenadion inj 2 mg/ml
VAKSIN DAN SERUM
Vaksin BCG
Vaksin Td
Vaksin HB0
Vaksin IPV
Vaksin Polio (POLIO)
Vaksin MR (1-2) ( Rubela/Campak)/Bian
Vaksin MR (1-2) ( Rubela/Campak)
Vaksin DT
Vaksin PCV
Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4)
Tinta Vaksin Bian
Hepatitis B Imunoglobin (HbIg) Bayi
RABIES VACCINE INACTIVATED
RABIES IMMUNE GLOBULIN (HUMAN) 1 ML
Vaksin Covid-19 (Sinovac)
Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis)
Vaksin Covid-19 (@2 Dosis) CORONAVAC
Vaksin Covid-19 Pfizer (@ 6 Dosis)
Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA
Vaksin Covid-19 @14 (Moderna)
Vaksin Sinopharm @ 2 dosis
Vaksin Covid-19 (Moderna) @10 DOSIS
Vaksin Covid-19 (@ 2 Dosis) CORONAVAC
Vaksin Covid -19 Pfizer (@ 6 Dosis)
Vaksin Covid-19 (@10 Dosis) ASTRAZENECA
Cadox (Konecavax)@10 dosis
Safety Box 5 Liter
Pelarut MR Bian
Pelarut BCG
Pelarut MR
Pelarut Pfizer NaCl 0,9% 10 ml
Pipet Tetes (Polio/BOPV)
Pelarut NaCl 0,9% 10 ml
SEDIAAN TOPIKAL
Chloramphenicol SM 1%
Hidrocortison salep
Oxytetrasiklin Salep Mata 0,1%
Salep 2-4
LABORATORIUM
Box Slide ( Warna Hijau )(malaria) 72'S
Blood Lancet 100 'S
Fesco Blood Lancet 200 'S
Catride
Malaria TCM TB
Ag. pLDH/HRP2 (COMBO Card Test)
(Whole Blood) (Warna PEACH)(AG PCDH)
(MALARIA)
Handsanitizer 50 ml
Handsanitizer 100 ml
Giemsa 100 ml
Oil Emersi 100 ml
Oil Emersi 500 ml
Giemsa 500 ml
Kartu Golongan Darah
Lab. Kit Malaria
Oil Emersi
Paket KIT TB
Pot Dahak / Pot Sputum
Reagen ZN
Rapid Test HBsAg/ Virocheck
RDT DBD SD BIOLINE
Rapid Antigen (Whole Power)
Rapid Antigen Entram
Reagen Golda A
Reagen Golda B
Reagen Golda AB
Anti Resus D
SD HIV-1/2 3,0
TRIPOCHECK SYPHILIS
Tuberkulin
VTM + Stik Steril Swab (CITO)
BETAFOG
Insektisida DBD (GOKILATH)
Human Colesterol Liquid
Human Glucose liquid
Human Hemoglobine liquid
Human Tryglyceride liquid
Providen
Sars Cov-2 Anti Bodi Test
Standar Q HIV 1/2 Ab 3 Line R3
Virotec Dengue Kombo (P2M)
DAK
Alkohol Swabs 100's
Blade Sterile (Mess)
Blood Lancet
Blod TransfusiSet Stera
Catgut Chromic (Absorbable Suture Sterile)
Catgut Plain 3/0 HR 37 mm
Dermatix
Female Catheter no. 16
Female Catheter no. 18
Foley Catheter no. 18
Foley Catheter no. 20
Infus Set Anak
Infus Set Dewasa
IV Catheter No. 16
IV Catheter no. 18
IV Catheter no. 20
IV Catheter no. 22
IV Catheter no. 24
Jarum Kulit GT 14
Jarum Otot GR 14
Kapas Pembalut 500 gr
Kasa panjang 42y x 110 cm Poli Kassa
Kassa Steril
Masker Nebul Anak
Masker Nebul Dewasa
Nasal Canula Bayi (Oxyflow)
Nasal Canula Anak (Oxyflow)
Nasal Canula Dewasa (Oxyflow)
Needle No. 25G x 25 mm
Polifix / Hipavix 5mx5cm
Plesterin Bulat Soft (Box @200 Pcs)
Sarung Tangan Non Steril L
Sarung Tangan Steril 7,5
Silk 3/0 (Silk Braided Non Absorbable Suture Sterile)
Stomach tube no. 18
Tes kehamilan
Under Pad (Soft Pad 60 x 90 cm)
Urine Bag
Stik Benecheck Glukosa PTM
Benecheck Plus Monitoring PTM
OBAT-OBATAN
Acetylcystein 200 mg
)
acyclovir 400 mg
Allopurinol 100 mg
Amlodipin 5 mg
Amlodipin 10 mg
Amoxicillin 500 mg
Antasida DOEN Tablet
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Attapulgit 600 mg (pularex)
Betahistine
Captopril 12,5 mg
Captopril 25 mg
Calcium Lactate
Cavicur
Ciprofloxacin 500mg
Chlorpheniramin Maleat (CTM) 4 mg
Cotrimoxazol 480 mg
Cetirizin HCL
Chlorampenicol 250 mg
Chlorampenicol 500 mg (Cloramex 500)
Dexamethasone 0,5 mg
Digoxin 0,25 mg
Dimenhydrinat 50 mg
Domperidon 10 mg
Ergotamin
Erytromycin 250 mg
Erytromycin 500 mg
Folic Acid 1mg
Furosemide 40 mg
Glibenclamide 5 mg
Glimepiride 1 mg
Glimepiride 2 mg
Glimepiride 3mg
Griseovulfin 125 mg
Griseovulfin 500 mg
Hydrochlorthiazide 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ketokonazole 200 mg
Loperamide
Loratadine 10 mg
Metyl Ergometrin 0,125 MG
Methyl Prednisolon 4 mg
Metformin 500 mg
Metoclopramid 10 mg
Metronidazole 250 mg
Metronidazole 500 mg
Nifedipin 10 mg
Nifedipin 20 mg (Adalat Oros )
Nystatin 100.000 IU Tablet Vaginal
Nystatin 500.000 IU Tablet
Natrium Diklofenak 25 mg
Natrium Diklofenak 50 mg
Omeprazole Cap
Paracetamol 500 mg
Phytomenadion 10 mg
Propranolol
Prednisone 5 mg
Propylthiouracil 100 mg
Pyrantel Pamoate 125 mg
Ranitidine 150 mg
Salbutamol 4 mg
Simvastatin 10 mg
Simvastatin 20 mg
Vitamin B Kompleks
Zinc 20 mg
Cefadroksil Monohidrat 500 mg
Amoxicillin Syr 125 mg/5ml
Amoxicillin Syr 250 mg/5ml
Antasida DOEN Suspensi
Cotrimoxazol Suspensi 240 mg/5ml
Domperidon suspensi
Ibuprofen 200 mg/5ml suspensi
Metronidazole Sirup
Paracetamol Sirup 120 mg/5ml
INJEKSI DAN PELARUT
Ampicillin Injeksi 1000 mg
Aqua Pro Injeksi 25 ml
Aqua DM 1000 ml
Dexamethasone Injeksi
Diphenhydramin inj
Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml
Gluconat Calcicum Inj 100 mg/ml
Lidocain HCl 2%
Meprovent Inhaler
Methyl Ergometrin Inj 0,2 mg/ml
MgSO4 20%
MgSO4 40%
Oxytocin Injeksi
Omeprazole Inj 40 mg/ml
Phytomenadion Inj 2 mg/ml
SEDIAAN TOPIKAL
Aciclovir salep kulit
IU/g + Polimiksin
Antifungi 10.000 IU/gAsam Benzoat 6% +
DOEN Kombinasi:
Asam Salisilat 3%
Betamethasone cream
Chloramphenicol 1% Salep Mata
Chloramphenicol 2% Salep Kulit (Bufacetin)
Chloramphenicol Tetes Telinga (Erlamycetin)
Hydrocortison 2,5%
Ketokonazole Cream
Miconazole 2%
Oxytetrasiklin Salep Mata
Phenol Glyserol (Tetes Telinga)
perak sulfaduazine
Belerang Endap 4%
Permetrin/ Scabisite
Bedak Salisyl 2%
Antihemoroid Suppo
Bisacodyl / Dulcolax 5 mg
Bisacodyl / Dulcolax 10 mg
Antiseptik Kumur
E-Care Hand Sanitizer 500 ml
E care hand Wash (Sabun Cair 500 mL)
Povidon 300 ml
Povidon 60 ml
Lisol 1 L
VAKSIN DAN SERUM
Serum Anti Bisa Ular /Biosave SABU
(Tetagram)
Glucosa 5% (D5%) 500 ml
Glucosa 10% (D10%) 500 ml
Natrium Chlorida (NaCl) 0,9%
Ringer Laktat
Ringer Asering
OBAT GIGI
Ethyl Chloride
Fuji IX GP Besar
Fuji IX GP Kecil
Hydcal (Calsidol)
Iodotin/ Iodoform
Composit
Sponestan / Surgipson
Cavit G
Tri Kresol Formalin (TKF)
Klorfenol Kamfer Mentol
Devitalisasi Pasta Ion Arsen
Pulp - X
Eugenol
LABORATORIUM
Golda A
Golda B
Golda AB
Golda Resus D
HB Mission 50's Acon
Kertas Lensa
Kartu Golongan Darah
Micropipet MT.II 1000 µl
Micropipet MT.I 200 µl
Object Glass Frosted (Slide)
Rak Tabung Reaksi 50 Lubang Multipurpose
Standbio Glucose 1 x 250 ml
Standbio Uric Acid 4 x 30 ml
Standbio Cholesterol 4 x 30 ml
Stik Nesco Cholestrol
Stik Nesco Asam Urat
Stik Nesco Gula
Stik Easy Touch Asam Urat
Stik Easy Touch Gula
Stik Easy Touch Cholestrol
Stik Benecek Asam Urat
Stik Benecek Gula
Stik Benecek Cholestrol
Mindray U-II Urin Tes
Stik Urin 3 Parameter 100'S
Stik Urin 10 Parameter 100'S
Stik Gluko Protein Tes 10'S
Widal
DILUENT
RINSE
LYSE
Probe Cleanser
EZ Cleanser
Giemsa
Oil Emersi 100 ml
Blue Tip
BAHAN KIMIA
Cynolf
Kaporit
ABATE
BMHP
APRON White
APD LENGKAP
Cover All Suit
Faceshield
Faceshield kacamata
Nasofaring Kecil
Masker Ear loop 3 ply
Masker Tis On 3Ply
Masker Kain Scuba (Anak)
Masker Kain Scuba (dewasa)
3M Particulate N95-8210
Masker KN95 (Protective Mask)
Masker N95 (mask 5 play) smiles
Sarung Tangan Non Steril L
Sarung Tangan Steril 7.5
Sarung Tangan Obgyn
Surgical Gown Water Proff
Termometer & Hemidity meter
Tensi ( Blood Pressure Monitor )
Termogun HTI
Termogun ( OMRON Digital Forehead Termometer)
TAMBAHAN
Kasa panjang 42y x 110 cm Poli Kassa
LABORATORRIUM
Stik Cholesterol Easy Touch
Stik Asam Urat Easy Touch
Stik Glucose Easy Touch
Stik Glucose Nesco
Stik Cholestrol Nesco
Stik Uri Acid Nesco
Stik Uri Acid Nesco
Stik Cholestrol Bhenecek
Stik Uri Acid Bhenecek
Stik Uri Acid Bhenecek
Tabung EDTA Tutup ungu
VTM + Stik Steril Swab
VTM
Rapid Antigen (Clungene Taishan)
Rapid Test Indec
Standar Q Covid-19 Ag
VTM + Stik Steril Swab Dacron
OBAT-OBATAN
Asam Ascorbat (Vitamin C) 250 mg
Azithromycin 500 mg
Allopurinol 100 mg
Allopurinol 300 mg
Cavicur
Chlorpromazine 100 mg
Ciprofloxacin 500 mg
Chloroquin Phospat 150 mg
Chloroquin Phospat 150 mg
Domperidon 10 mg
Farbion
Favipiravir 200 mg
Gold Trion
Ibuprofen 400 mg
Levofloxacin 500 mg
N-acetylcystein 30/box
Oseltamivir Capsules 75 mg
Paracetamol 500 mg
Piroxicam 20 mg
Piridoxin
Seloxy
Kolkisin
INJEKSI DAN PELARUT
Phytominadion inj
SEDIAAN TOPIKAL
Salep 2 - 4
Alkacide ( DESINFEKTAN)
T. Handrub 100 ml
E-Care Handrub 500 ml
Alkohol 70%
Kaporit 60% 15 Kg
HIBAH
Jas Hujan (TorchMed-Guard)
Kacamata
Nurse Cap ONE MED / penutup kepala
Sepatu Boot
JKN
Salbutamol 2 mg
Ethyl Chloride
Povidone 60 ml
Masker Hijab
Vitamin B12
Bionicom Zinc
Masker Oksigen Non Rebriting Bayi
JUMLAH KUNJUNGAN
JUMLAH RESEP
MENGETAHUI,
Maman .SKM,M.Mkes
NIP. 19651231 198603 1 221
LAPORAN PEMAKAI
: RASABOU
: HU'U
: DOMPU
STOCK
SATUAN SUMBER DANA
AWAL
3 4 6
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0
PAKET 0
Rol 0
Pcs 0
Pcs 0
Pcs 2
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Set 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Roll 0
Pcs 0
Pcs 0
Tablet 156
Tablet 0
Tablet 0
Tablet 0
Tablet 0
ktk 1
Tablet 0
Tablet 0
Sachet 250
Tablet 0
Tablet 100
Tablet 0
Blister 5
Blister 0
Blister 0
Sachet 13
Tablet 0
Tablet 0
Paket 5 APBD I 2021
Paket 0
Paket 1
Paket 0
Tablet 86
Tablet 0
Kapsul lunak 233 APBD I
Kapsul lunak 397 APBD I
Tablet 0
Tablet 18660
Tablet 0
Botol 0
Vial 0
Vial 0
Ampul 0
Ampul 0
Ampul 0
Ampul 0
Ampul 0
Pcs 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0
Vial 8
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0
Ampul 0
Ampul 0
Ampul 0
Ampul 0
0
Flash 0
Tube 0
Tube 0
Tube 0
Pot 0
ktk/72 pcs 0
Pcs 0
Pcs 0
Pcs 0
25 kit/box 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 1
Botol 0
pak 0
kotak 0
botol 0
kotak 0
Buah 0
10 ktk/Dus 0
25 pcs/kotak 50 APBN I 2023
Test 0
25 kit/box 0
Pcs 0
Pcs 40
Pcs 0
vial 0
vial 0
vial 0
vial 0
25/kotak 125
25/kotak 7
Vial 0
Pcs 0
Botol 0
0
Botol 0
Botol 0
Botol 0
Botol 0
0
BOX/20 0
Pcs 0 APBD I
Pcs 0 APBD I
Pcs 0
Pcs 0
Pcs 0 DAK 2022
Pcs 0 DAK 2021
Pcs 0
Pcs 381
Pcs 200
Pcs 54 DAK 2021
Pcs 0
Pcs 43
Pcs 0
Pcs 0
Pcs 19
Pcs 0 DAK 2021
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Pcs 209
Pcs 193
Pcs 91 DAK 2022
Pcs 2 DAK 2022
Pcs 0
Pcs 0
Bungkus 3
Rol 4
kotak 0
Pcs 0
Pcs 5
Pcs 6
Pcs 14
Pcs 4
Pcs 0
Roll 7
200/box 700
Pcs 0
Pcs 300 DAK 2022
Pcs 0
Pcs 62
Pcs 0
Pcs 70
Pcs 0
Pcs 23
Pcs 250 DAK 2022
Stip 0
kotak 0
Tablet 6752 DAK 2022

Tablet 200
Tablet 0
Tablet 0
Tablet 0
Tablet 1590
Tablet 0
Tablet 0
Tablet 4904
Tablet 1550
Tablet 770
tablet 130
Tablet 1090
Tablet 50
Tablet 660
Tablet 0
Tablet 0
Tablet 5150 DAK 2022
Tablet 540
Tablet 2030
Tablet 0
Tablet 835
Tablet 5245
Tablet 0
Tablet 0
Tablet 1740
Tablet 0
Tablet 0
Tablet 0
Tablet 450 DAK 2021
Tablet 0
Tablet 0
Tablet 0
Tablet 20
Tablet 0
Tablet 310
Tablet 0
Tablet 100
Tablet 0
Tablet 0
Tablet 100
Tablet 730
Tablet 0
Tablet 0
Tablet 0
Tablet 1120
Tablet 0
Tablet 0
Tablet 635
Tablet 0
Tablet 60
Tablet 0
Tablet 210 DAK 2022
Tablet 0 DAK 2021
Tablet 0
Tablet 1759
Tablet 9050
Tablet 80
Tablet 0
Tablet 0
Tablet 100
Tablet 191
Tablet 0
Tablet 490
Tablet 0
Tablet 0
Tablet 690
Tablet 0
Tablet 0 DAK 2022
Botol 0
Botol 35 DAK 2022
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Vial 0
Flush 0
Botol 0
Ampul 0
Ampul 0
Ampul 12
Ampul 0
Ampul 5
Ampul 100 DAK 2022
Ampul 30
Ampul 60 DAK 2022
Ampul 0
Vial 4 DAK 2022
Vial 4
Ampul 83 DAK 2022
Ampul 17
Vial 0
Tube 0
Tube 0
Tube 0
Tube 0
Tube 0
Tube 0
Botol 0
Tube 28 DAK 2022
Tube 0
Tube 95 DAK 2022
Tube 0
Botol 0
Tube 0
Tube 0
Tube 22 DAK 2022
Tube 0
Supp 0
Supp 0
Supp 0
Botol 0
Botol 0
Botol 0
Botol 9
Botol 0
Botol 0
Vial 0
Vial 2
Botol 12
Botol 20
Botol 281
Botol 85
Botol 0
Kaleng 0
pcs 0
pcs 0
pcs 0
pcs 0
Pcs 0
pcs 24
pcs 0
Set 0
pcs 0
pcs 0
Botol 3 DAK 2022
Botol 2
Vial 0
Vial 0
Vial 0
Vial 0
pcs 0
Buah 0
Lembar 0
Pak 0
Pak 0
Box 0
Pcs 0
25 kit/box 0
Kit 0
Kit 0
Kit 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0 DAK 2022
Botol 0
pcs 0
pcs 0
pcs 0
Box 0
kotak 0
GALON 0
GALON 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 500
Botol 0
Galon 0
1 Kg/ Botol 0 APBN
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 2000 DID 2021
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 14
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
Rol 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
Tablet 0
20/ktk 0
Tablet 0
Tablet 450
Tablet 0
Tablet 0
Tablet 0
100/ktk 0
100/ktk 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
50/ktk 0
Tablet 0
Kapsul 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 233
Ampul 0
pot 0
Pot 0
Botol 0
botol 0
Botol 0
Botol 8 DAK 2022
Galon 0
pcs 0
pcs 0
pcs 0
pcs 0
Tablet 470
Botol 0
Botol 0
0
Pcs 500
Tablet 890
Tablet 900
Pcs 2 DAK 2023
pcs 0
UMUM GRATIS
222 30
285 0
YANG MENYERAHKAN,

NIP. 19690307 198903 2 013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (
TANGGAL HARGA PENERIM PERSEDI

KADALUARSA SATUAN AAN AAN
7 8 9 10=9+4
0
0
0
0
11/30/2025 Rp70 0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
7/1/2023 156
0
0
0
0
1
0
0
200 450
0
100
0
5
0
0
13
0
0
2/29/2024 Rp436,445 3 8
0
1
0
86
0
6/30/2025 Rp586 233
5/30/2025 Rp324 397
0
8200 26860
0
0
0
0
0
0
0
0
0
0
0
0
10/17/2026 Rp1,185 0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
Rp14,000 0
0
0
0
8/31/2023 Rp3,280 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
300 300
2 2
7/31/2024 50
0
0
0
20 60
0
0
0
0
0
125
7
0
0
0
0
0
0
0
0
0
0
10/14/2023 0
8/31/2024 0
0
0
0
0
4/9/2027 Rp979 0
7/9/2026 Rp1,056 0
5100 5100
381
5100 5300
2/1/2025 Rp3,600 100 154
0
24 67
0
0
19
10/16/2024 Rp14,341 0
0
0
250 250
0
209
193
11/30/2026 Rp4,862 91
8/30/2027 Rp12,804 2
0
0
3
4 8
0
0
5
6
14
4
0
31 38
700
1000 1000
4/30/2027 Rp546 2000 2300
0
72 134
0
70
0
23
3/30/2027 50 300
5050 5050
2 2
0
9/30/2024 Rp307 6752
200
0
0
0
2000 3590
3000 3000
8000 8000
4904
4000 5550
770
130
1000 2090
500 550
1000 1660
0
0
7/30/2024 Rp70 3000 8150
540
2030
0
835
5245
0
0
1740
0
0
0
10/1/2023 Rp43 450
0
0
0
20
0
500 810
0
100
0
5500 5500
100
730
0
0
0
2000 3120
0
0
635
0
60
0
3/30/2024 Rp0 210
7/1/2026 Rp114 0
0
800 2559
5500 14550
80
0
0
100
191
0
490
3000 3000
2000 2000
690
0
10/30/2026 Rp1,100 0
0
0
12/31/2024 Rp3,510 100 135
0
0
0
0
0
0
0
0
0
0
0
0
12
0
5
6/30/2026 Rp847 200 300
30
4/1/2028 Rp3,677 60
0
11/8/2023 Rp3,760 4
4
3/31/2025 Rp1,298 83
17
0
0
0
0
0
0
48 48
0
0
6/30/2024 Rp2,325 48 76
0
3/31/2025 Rp1,900 24 119
0
0
0
0
9/30/2024 Rp6,578 22
0
0
0
0
0
0
0
0
0
9
0
0
0
0
2
0
12
20
281
12/4/2025 700 785
0
0
0
0
0
0
0
0
24
0
0
0
0
1/7/2025 Rp210,500 3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12/31/2023 Rp25,723 0
0
0
0
40 40
8/31/2024 0
0
0
0
0
0
0
0
0
500
0
0
0
6/8/2024 Rp0 0
0
0
0
0
0
0
0
0
0
0
4000 6000
0
0
0
0
0
0
14
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500 950
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
600 833
0
0
0
0
0
0
0
0
0
11/30/2023 Rp58,000 8
0
0
0
0
0
0
0
1000 1470
0
0
500
890
900
2
1000 1000
JKN TOTAL
470 722
653 938
NYERAHKAN, YANG MEMINTA,

TD IFP DOMPU KEPALA UPTD PUSKESMAS
i, A.Md.,Farm Joharis, AMG

07 198903 2 013 NIP. 19660219 199401 1 002
NTAAN OBAT (LPLPO)
PELAPORAN BULA
PERMINTAAN BULA
TAHUN
JUMLAH TOTAL SUB STOCK

PEMAKAIAN
EXPIRED UNIT GUDANG
11 12 = (10-11-13) 13 14
0
0
0
0
0
0
0
0
0
0 2
0
0
0
0
0
0
0
0
0
0
0
31 125 0
0
0
0
0
1 0
0
0
303 47 100
0
90 10
0
0 5
0
0
1 0 12
0
0
2 0 6
0
0 0 1
0
0 0 86
0
78 55 100
0 47 350
0
3368 92 23400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4 4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 1
0
0
0
0
0
20 280
0 2
50 0
0
0
0
60 0
0
0
0
0
0
100 25
5 2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
400 4700
61 20 300
300 5000
40 114
0
6 61
0
0
2 17
0
0
0
177 73
0
59 10 140
157 16 20
91 0
2 0
0
0
3 0
4 4
0
0
2 3
1 5
4 10
4 0
0
28 10
270 430
100 900
1300 1000
0
44 90
0
10 60
0
5 18
150 150
0 5050
2 0
0
222 30 6500
0 200
0
0
0
1298 292 2000
150 50 2800
2370 130 5500
2444 60 2400
2902 48 2600
647 43 80
0 30 100
950 40 1100
186 64 300
530 130 1000
0
0
4580 170 3400
540
261 169 1600
0
205 30 600
1510 135 3600
0
0
277 63 1400
0
0
0
110 40 300
0
0
0
20 0 0
0
20 90 700
0
0 100
0
3635 165 1700
80 20 0
175 155 400
0
0
0
1870 50 1200
0
0
120 15 500
0
0 60
0
25 15 170
0
0
687 72 1800
5100 50 9400
80
0
0
0 100
0 191
0
245 45 200
475 25 2500
300 1700
690
0
0
0
0
25 10 100
0
0
0
0
0
0
0
0
0
0
0
0
0 12
0
0 5
105 2 193
30
45 15
0
0 4
0 4
58 25
0 17
0
0
0
0
0
0
5 19 24
0
0
32 20 24
0
10 9 100
0
0
0
0
5 0 17
0
0
0
0
0
0
0
0
0
2 7
0
0
0
0
0 2
0
12 0 0
19 1 0
19 2 260
540 5 240
0
0
0
0
0
0
0
0
0 0 24
0
0
0
0
0 0 3
0 0 2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20 20
0
0
0
0
0
0
0
0
0
0 500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000 1000 4000
0
0
0
0
0
0
2 0 12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
375 75 500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
33 200 600
0
0
0
0
0
0
0
0
0
5 0 3
0
0
0
0
0
0
0
66 104 1300
0
0
500 0 0
181 209 500
835 65 0
2 0 0
0 0 1000
MEMINTA, YANG MEN

TD PUSKESMAS PENGELOLA OBAT
aris, AMG apt. Ajhar, S

219 199401 1 002 NIP. 19910201 20
LAPORAN BULAN : MEI
RMINTAAN BULAN : JUNI
: 2023
STOCK PERMINTAA
AKHIR N
15 16 17= 12+(9*50%) 18
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
2 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
125 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
147 Rp29,400 200
0 Rp0
0 Rp0
0 Rp0
5 Rp0
0 Rp0
0 Rp0
12 Rp0
0 Rp0
0 Rp0
6 Rp18
0 Rp0
1 Rp0
0 Rp0
86 Rp0
0 Rp0
155 Rp0
397 Rp0
0 Rp0
23492 ###
0 Rp0
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
4 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
1 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
280 Rp84,000
2 Rp4
0 Rp0 100
0 Rp0
0 Rp0
0 Rp0
0 Rp0 100
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
25 Rp0 50
2 Rp0 3
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
4700 Rp23,970,000
320 Rp0
5000 Rp25,500,000
114 Rp11,400
0 Rp0
61 Rp1,464
0 Rp0
0 Rp0
17 Rp0
0 Rp0
0 Rp0
0 Rp0
73 Rp18,250 200
0 Rp0
150 Rp0
36 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
4 Rp16 5
0 Rp0
0 Rp0 10
3 Rp0 10
5 Rp0
10 Rp0
0 Rp0
0 Rp0
10 Rp310 30
430 Rp0
900 Rp900,000
1000 Rp2,000,000
0 Rp0
90 Rp6,480
0 Rp0
60 Rp0
0 Rp0
18 Rp0
150 Rp7,500
5050 Rp25,502,500
0 Rp0
Rp0
6530 Rp0
200 Rp0
0 Rp0
0 Rp0
0 Rp0
2292 Rp4,584,000
2850 Rp8,550,000 10000
5630 Rp45,040,000
2460 Rp0
2648 Rp10,592,000 3000
123 Rp0 2000
130 Rp0
1140 Rp1,140,000 3000
364 Rp182,000 1000
1130 Rp1,130,000
0 Rp0
0 Rp0
3570 Rp10,710,000
0 Rp0
1769 Rp0
0 Rp0
630 Rp0
3735 Rp0
0 Rp0
0 Rp0
1463 Rp0
0 Rp0
0 Rp0
0 Rp0
340 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
790 Rp395,000
0 Rp0
100 Rp0
0 Rp0
1865 Rp10,257,500 5000
20 Rp0 100
555 Rp0
0 Rp0
0 Rp0
0 Rp0
1250 Rp2,500,000 4000
0 Rp0
0 Rp0
515 Rp0
0 Rp0
60 Rp0
0 Rp0
185 Rp0
0 Rp0
0 Rp0
1872 Rp1,497,600
9450 Rp51,975,000
0 Rp0
0 Rp0
0 Rp0
100 Rp0
191 Rp0
0 Rp0
245 Rp0 1000
2525 Rp7,575,000
1700 Rp3,400,000
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
110 Rp11,000
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
12 Rp0
0 Rp0
5 Rp0
195 Rp39,000
0 Rp0
15 Rp0 60
0 Rp0
4 Rp0
4 Rp0
25 Rp0 100
17 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
43 Rp2,064
0 Rp0
0 Rp0
44 Rp2,112 24
0 Rp0
109 Rp2,616
0 Rp0
0 Rp0
0 Rp0
0 Rp0
17 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
7 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
2 Rp0
Rp0
0 Rp0 40
1 Rp0 10
262 Rp0
245 Rp171,500 300
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
24 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
3 Rp0
2 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
20 Rp800
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
500 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
5000 Rp20,000,000
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
12 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
575 Rp287,500
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
800 Rp480,000
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
3 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
1404 Rp1,404,000
0 Rp0
0 Rp0
0
709
65
0
1000 Rp1,000,000
YANG MENERIMA,
NGELOLA OBAT PUSKESMAS
apt. Ajhar, S.Farm

NIP. 19910201 202203 1 007
PEMBERIA
N
19
PUSKESMAS : RASABOU PELAPORAN BULAN : JUNI

KECAMATAN : HU'U PERMINTAAN BULAN : JULI
1 2 3 4 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19
APBD 1 / APBN
Alat Kesehatan
5 Alkohol Swabs 100's Pcs 0 11/30/2025 Rp70 0 0 0 Rp0
10 Kaca Mata Google TB Pcs 2 2 2 0 Rp0
OBAT-OBATAN Rp0
1 Albendazole 400 mg Tablet 125 7/1/2023 125 5 120 0 120 Rp0
6 DHP Frimal (Kotak @9 Tablet) ktk 0 0 0 0 Rp0
11 INH(Ishonizide) Tablet 0 0 0 0 0 Rp0
13 MDT Combi Dewasa MB (Merah) Blister 5 5 0 0 5 5 Rp0
16 Mineral Mix Sachet 12 12 0 0 12 12 Rp0
19 OAT Kat. 1,3 Paket 6 APBD I 2021 2/29/2024 Rp436,445 6 3 0 3 3 Rp0
21 OAT Kat Anak Paket 1 1 0 0 1 1 Rp0
23 Primaquin 15 mg Tablet 86 100 186 30 0 156 156 Rp15,600
25 Retinol 200.000 IU (Merah) Kapsul lunak 155 APBD I 6/30/2025 Rp586 155 45 60 50 110 Rp0
26 Retinol 100.000 IU (Biru) Kapsul lunak 397 APBD I 5/30/2025 Rp324 397 1 46 350 396 Rp0
3 Metronidazole infus Botol 0 7 7 0 0 7 7 Rp49
4 Gentamicin inj Ampul 0 36 36 0 0 36 36 Rp1,296
5 MgSO4 20% Ampul 0 3 3 0 0 3 3 Rp9
6 MgSO4 40% Ampul 0 11 11 0 0 11 11 Rp121
7 Phytomenadion inj 2 mg/ml Ampul 0 126 126 0 0 126 126 Rp15,876
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 10/17/2026 Rp1,185 0 0 0 Rp0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 4 4 2 0 2 2 Rp0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 0 0 0 Rp0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 8/31/2023 Rp3,280 0 0 0 Rp0
4 Salep 2-4 Pot 0 0 0 0 Rp0
4 Catride TCM
Malaria TB
Ag. pLDH/HRP2 (COMBO Card Test) Pcs 0 0 0 0 Rp0
6 (MALARIA)
Handsanitizer 50 ml Botol 0 0 0 0 Rp0
10 Oil Emersi 500 ml Botol 1 1 0 0 1 1 Rp0
16 Pot Dahak / Pot Sputum Buah 280 280 180 0 100 100 Rp0
17 Reagen ZN 10 ktk/Dus 2 2 0 0 2 2 Rp0
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 0 APBN I 2023 7/31/2024 0 0 0 Rp0 5
19 Test 0 0 0 0 Rp0
21 Pcs 0 0 0 0 Rp0
22 Rapid Antigen (Whole Power) Pcs 0 160 160 60 0 100 100 Rp16,000
28 SD HIV-1/2 3,0 25/kotak 25 250 275 150 0 125 125 Rp31,250
29 TRIPOCHECK SYPHILIS 25/kotak 2 6 8 4 0 4 4 Rp24
30 Tuberkulin Vial 0 2 2 2 0 0 0 Rp0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 APBD I 10/14/2023 0 0 0 Rp0
39 Virotec Dengue Kombo (P2M) Pcs 0 APBD I 8/31/2024 0 0 0 Rp0
DAK 0 0 Rp0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 Rp0
3 Alat Suntik sekali pakai 3 ml Pcs 0 DAK 2022 4/9/2027 Rp979 0 0 0 Rp0
4 Alat Suntik sekali pakai 5 ml Pcs 0 DAK 2021 7/9/2026 Rp1,056 0 0 0 Rp0
5 Alkohol Swabs 100's Pcs 4700 4700 1300 100 3300 3400 Rp0
6 Blade Sterile (Mess) Pcs 320 320 70 50 200 250 Rp0
7 Blood Lancet Pcs 5000 5000 300 0 4700 4700 Rp0
8 Blod TransfusiSet Stera Pcs 114 DAK 2021 2/1/2025 Rp3,600 114 20 3 91 94 Rp0
10 Catgut Plain 3/0 HR 37 mm Pcs 61 61 34 3 24 27 Rp0
13 Female Catheter no. 18 Pcs 17 17 0 0 17 17 Rp0
14 Foley Catheter no. 18 Pcs 0 DAK 2021 10/16/2024 Rp14,341 0 0 0 Rp0
16 Infus Set Anak Pcs 0 0 0 0 Rp0
17 Infus Set Dewasa Pcs 73 73 51 4 18 22 Rp0 200
19 IV Catheter no. 18 Pcs 150 150 88 10 52 62 Rp0
20 IV Catheter no. 20 Pcs 36 36 36 0 0 0 Rp0
21 IV Catheter no. 22 Pcs 0 DAK 2022 11/30/2026 Rp4,862 0 0 0 Rp0
22 IV Catheter no. 24 Pcs 0 DAK 2022 8/30/2027 Rp12,804 0 0 0 Rp0
25 Kapas Pembalut 500 gr Bungkus 0 0 0 0 Rp0
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 4 5 9 6 1 2 3 Rp15 7
27 Kassa Steril kotak 0 0 0 0 Rp0
29 Masker Nebul Dewasa Pcs 3 3 3 0 0 0 Rp0
30 Nasal Canula Bayi (Oxyflow) Pcs 5 3 8 4 0 4 4 Rp12
31 Nasal Canula Anak (Oxyflow) Pcs 10 10 9 1 0 1 Rp0
32 Nasal Canula Dewasa (Oxyflow) Pcs 0 0 0 0 0 0 Rp0
34 Polifix / Hipavix 5mx5cm Roll 10 32 42 12 2 28 30 Rp960
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 430 430 30 0 400 400 Rp0
36 Sarung Tangan Non Steril M Pcs 900 900 900 0 0 0 Rp0
37 Sarung Tangan Non Steril L Pcs 1000 DAK 2022 4/30/2027 Rp546 1100 2100 1080 20 1000 1020 Rp1,122,000
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile) Pcs 90 90 37 3 50 53 Rp0 72
41 Tes kehamilan Pcs 60 60 7 3 50 53 Rp0
42 Under Pad (Soft Pad 60 x 90 cm) Pcs 0 0 0 0 Rp0
43 Urine Bag Pcs 18 18 5 0 13 13 Rp0
44 Sarung Tangan Steril 7 Pcs 150 DAK 2022 3/30/2027 100 250 83 2 165 167 Rp16,700
45 Stik Benecheck Glukosa PTM Stip 5050 5050 2050 0 3000 3000 Rp0
46 Benecheck Plus Monitoring PTM kotak 0 0 0 0 Rp0
OBAT-OBATAN 0 0 Rp0
1 Acetylcystein 200 mg Tablet 6530 DAK 2022 9/30/2024 Rp307 6530 320 30 6180 6210 Rp0
2 Tablet 200 200 0 0 200 200 Rp0
)
5 Amlodipin 5 mg Tablet 0 0 0 0 Rp0
7 Amoxicillin 500 mg Tablet 2850 13000 15850 5850 100 9900 10000 ###
8 Antasida DOEN Tablet Tablet 5630 5630 2720 110 2800 2910 Rp0 5000
9 Asam Ascorbat 50 mg Tablet 2460 1500 3960 1560 2400 2400 Rp3,600,000 2000
11 Attapulgit 600 mg (pularex) Tablet 123 123 123 0 0 Rp0 5000
13 Captopril 12,5 mg Tablet 1140 1140 440 700 700 Rp0 5000
14 Captopril 25 mg Tablet 364 364 364 0 0 Rp0
15 Calcium Lactate Tablet 1130 1130 640 90 400 490 Rp0 1000
17 Ciprofloxacin 500mg Tablet 0 0 0 0 Rp0
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 3570 DAK 2022 7/30/2024 Rp70 3570 2700 70 800 870 Rp0
19 Cotrimoxazol 480 mg Tablet 0 0 0 0 Rp0
20 Cetirizin HCL Tablet 1769 1769 489 80 1200 1280 Rp0
25 Dimenhydrinat 50 mg Tablet 0 0 0 0 Rp0
30 Folic Acid 1mg Tablet 340 DAK 2021 10/1/2023 Rp43 340 140 0 200 200 Rp0 1000
36 Griseovulfin 125 mg Tablet 790 790 10 80 700 780 Rp0
38 Hydrochlorthiazide 25 mg Tablet 100 100 0 0 100 100 Rp0
40 Ibuprofen 400 mg Tablet 1865 3500 5365 2585 80 2700 2780 Rp9,730,000 5000
41 Ketokonazole 200 mg Tablet 20 20 20 0 0 Rp0
43 Loratadine 10 mg Tablet 0 0 0 0 Rp0
44 Metyl Ergometrin 0,125 MG Tablet 0 0 0 0 Rp0
46 Metformin 500 mg Tablet 1250 1250 1250 0 0 Rp0
51 Nifedipin 20 mg (Adalat Oros ) Tablet 60 60 0 0 60 60 Rp0
53 Nystatin 500.000 IU Tablet Tablet 185 DAK 2022 3/30/2024 Rp0 185 0 15 170 185 Rp0
54 Natrium Diklofenak 25 mg Tablet 0 DAK 2021 7/1/2026 Rp114 0 0 0 Rp0
55 Natrium Diklofenak 50 mg Tablet 0 0 0 0 Rp0
56 Omeprazole Cap Tablet 1872 1872 1212 60 600 660 Rp0 3000
57 Paracetamol 500 mg Tablet 9450 9450 4050 100 5300 5400 Rp0 5000
58 Phytomenadion 10 mg Tablet 0 0 0 0 Rp0
60 Prednisone 5 mg Tablet 0 0 0 0 Rp0
61 Propylthiouracil 100 mg Tablet 100 100 0 0 100 100 Rp0
62 Pyrantel Pamoate 125 mg Tablet 191 191 1 0 190 190 Rp0
63 Ranitidine 150 mg Tablet 0 0 0 0 Rp0
64 Salbutamol 4 mg Tablet 245 1000 1245 365 80 800 880 Rp880,000
65 Simvastatin 10 mg Tablet 2525 2525 915 10 1600 1610 Rp0 2000
67 Vitamin B Kompleks Tablet 0 0 0 0 Rp0 5000
68 Zinc 20 mg Tablet 0 0 0 0 Rp0 3000
68 Cefadroksil Monohidrat 500 mg Tablet 0 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0
1 Amoxicillin Syr 125 mg/5ml Botol 0 0 0 0 Rp0
2 Amoxicillin Syr 250 mg/5ml Botol 110 DAK 2022 12/31/2024 Rp3,510 110 0 10 100 110 Rp0
3 Antasida DOEN Suspensi Botol 0 0 0 0 Rp0
8 Paracetamol Sirup 120 mg/5ml Botol 0 0 0 0 Rp0
2 Aqua Pro Injeksi 25 ml Flush 0 0 0 0 Rp0
4 Ampul 0 0 0 0 Rp0
5 Dexamethasone Injeksi Ampul 0 0 0 0 Rp0
6 Diphenhydramin inj Ampul 12 12 0 0 12 12 Rp0
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 0 0 0 0 Rp0
8 Gluconat Calcicum Inj 100 mg/ml Ampul 5 5 0 0 5 5 Rp0
9 Lidocain HCl 2% Ampul 195 DAK 2022 6/30/2026 Rp847 195 120 5 70 75 Rp0 100
10 Ampul 0 60 60 0 0 60 60 Rp3,600
11 Meprovent Inhaler Ampul 15 DAK 2022 4/1/2028 Rp3,677 15 15 0 0 0 Rp0
13 MgSO4 20% Vial 4 DAK 2022 11/8/2023 Rp3,760 4 0 0 4 4 Rp0
14 MgSO4 40% Vial 4 4 0 0 4 4 Rp0
15 Oxytocin Injeksi Ampul 25 DAK 2022 3/31/2025 Rp1,298 25 25 0 0 0 Rp0
16 Omeprazole Inj 40 mg/ml Ampul 17 17 0 0 17 17 Rp0
17 Phytomenadion Inj 2 mg/ml Vial 0 0 0 0 Rp0
2 Tube 0 0 0 0 Rp0
IU/g + Polimiksin
DOEN Kombinasi:
3 Tube 0 0 Rp0
Asam Salisilat 3%
4 Betamethasone cream Tube 0 0 0 0 Rp0 48
5 Chloramphenicol 1% Salep Mata Tube 43 43 11 8 24 32 Rp0 24
6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 0 Rp0
8 Hydrocortison 2,5% Tube 44 DAK 2022 6/30/2024 Rp2,325 24 68 24 20 24 44 Rp1,056 24
10 Miconazole 2% Tube 109 DAK 2022 3/31/2025 Rp1,900 109 37 4 68 72 Rp0
14 Tube 0 0 0 0 Rp0
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 17 DAK 2022 9/30/2024 Rp6,578 17 7 2 8 10 Rp0 10
16 Bedak Salisyl 2% Tube 0 0 0 0 Rp0
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 Rp0
ANTISEPTIK DAN DESINFEKTAN 0 0 Rp0
4 Povidon 300 ml Botol 7 7 5 0 2 2 Rp0
1 Serum Anti Bisa Ular /Biosave SABU Vial 0 0 0 0 Rp0
2 Vial 2 2 2 0 0 Rp0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 Rp0
1 Glucosa 5% (D5%) 500 ml Botol 0 40 40 21 2 17 19 Rp760 40
2 Glucosa 10% (D10%) 500 ml Botol 1 40 41 3 3 35 38 Rp1,520
3 Natrium Chlorida (NaCl) 0,9% Botol 262 262 120 2 140 142 Rp0
4 Ringer Laktat Botol 245 12/4/2025 580 825 520 5 300 305 Rp176,900 300
OBAT GIGI 0 0 Rp0
7 Sponestan / Surgipson pcs 24 24 0 0 24 24 Rp0
12 Pulp - X Botol 3 DAK 2022 1/7/2025 Rp210,500 3 0 0 3 3 Rp0
12 Eugenol Botol 2 2 0 0 2 2 Rp0
12 25 kit/box 0 0 0 0 Rp0
16 Stik Nesco Cholestrol Box 0 0 0 0 Rp0
17 Stik Nesco Asam Urat Box 0 0 0 0 Rp0
18 Stik Nesco Gula Box 0 0 0 0 Rp0
19 Stik Easy Touch Asam Urat Box 0 0 0 0 Rp0
20 Stik Easy Touch Gula Box 0 0 0 0 Rp0
21 Stik Easy Touch Cholestrol Box 0 0 0 0 Rp0
22 Stik Benecek Asam Urat Box 0 0 0 0 Rp0
23 Stik Benecek Gula Box 0 0 0 0 Rp0
24 Stik Benecek Cholestrol Box 0 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0
28 Stik Gluko Protein Tes 10'S pcs 20 10 30 20 0 10 10 Rp100
29 Box 0 8/31/2024 0 0 0 Rp0
30 Widal kotak 0 0 0 0 Rp0
31 DILUENT GALON 0 0 0 0 Rp0
32 RINSE GALON 0 0 0 0 Rp0
38 Blue Tip Botol 500 500 0 0 500 500 Rp0
BAHAN KIMIA 0 0 Rp0
3 ABATE 1 Kg/ Botol 0 APBN 6/8/2024 Rp0 0 0 0 Rp0
DANA DID, BTT & DBHCHT COVID 0 0 Rp0
BMHP 0 0 Rp0
8 pcs 0 0 0 0 Rp0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 5000 DID 2021 550 5550 1400 150 4000 4150 Rp2,282,500
21 Sarung Tangan Obgyn pcs 12 12 1 0 11 11 Rp0
TAMBAHAN 0 0 Rp0
LABORATORRIUM 0 0 Rp0
11 Tabung EDTA Tutup ungu pcs 0 0 0 0 Rp0
13 VTM pcs 0 0 0 0 Rp0
OBAT-OBATAN 0 0 Rp0
4 Allopurinol 300 mg Tablet 575 575 235 40 300 340 Rp0 500
19 Piroxicam 20 mg Tablet 0 0 0 0 Rp0
20 Piridoxin Tablet 0 0 0 0 Rp0
22 Kolkisin Tablet 800 800 320 60 420 480 Rp0
0 0 Rp0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0
2 Pot 0 0 0 0 Rp0
ANTISEPTIK DAN DESINFECTAN 0 0 Rp0
4 Alkohol 70% Botol 3 DAK 2022 11/30/2023 Rp58,000 3 3 0 0 Rp0
HIBAH 0 0 Rp0
JKN 0 0 Rp0
1 Salbutamol 2 mg Tablet 1404 1404 1304 0 100 100 Rp0 2000
1 Masker Hijab Pcs 0 0 0 0

2 Vitamin B12 Tablet 709 709 279 30 400 430 500
3 Bionicom Zinc Tablet 65 65 65 0 0 0
4 Masker Oksigen Non Rebriting Bayi Pcs 0 DAK 2023 0 0 0 0 0 5
5 Sarung Tangan Non Steril S pcs 1000 1000 0 0 1000 1000 Rp0


NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007
PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
NO NAMA OBAT / ALKES
1 2
APBD 1 / APBN
Alat Kesehatan
4 Apron Biru malaria
6 APD IMUNISASI COVID
7 Gips 4 Inch
8 BAJU (Cover All Suit /Hazmat Suit) baju BOHO
9 Masker Bedah 3 Ply (TB)
10Kaca Mata Google TB
11Masker Bedah 3 Ply (HIV)
12Masker TB N95
13Masker N95 (Sure And Me)
14Masker Bedah Anak
15APD Lengkap Foging
16Masker Las (Foging)
17Masker Malaria
18Sarung Tangan Non Steril S
19Sarung Tangan Non Steril M
20Kelambu
21Plester Bulat @200pcs
22Sarung Tangan Steril 7
OBAT-OBATAN
1 Albendazole 400 mg
3 Bedaquiline
4 Closerin 250 mg
5 Clofazimin
6 DHP Frimal (Kotak @9 Tablet)
7 Ethionamide
8 Linezolid 600 mg
9 Garam Oralit
11 INH(Ishonizide)
12 Lompren ( Clofazimine)
13 MDT Combi Dewasa MB (Merah)
14 MDT Combi Dewasa PB (Hijau)
15 MDT Combi Anak MB ( ORANGE)
16 Mineral Mix
17 Moxifloxacin ( moximed)
19 OAT Kat. 1,3
20 OAT Kat. II
21 OAT Kat Anak
22 OAT Kat kombipak
23 Primaquin 15 mg
24 Rifampicin
25 Retinol 200.000 IU (Merah)
26 Retinol 100.000 IU (Biru)
27 Sivit Zinc
28 Tablet Tambah Darah
29 Zinc 20 mg
1 Albendazole sirup
INJEKSI DAN PELARUT
1 Artesunat Injeksi 60 mg/ml
2 Dextrose 40%
3 Metronidazole infus
4 Gentamicin inj
5 MgSO4 20%
6 MgSO4 40%
7 Phytomenadion inj 2 mg/ml
VAKSIN DAN SERUM
2 Vaksin BCG
3 Vaksin Td
4 Vaksin HB0
5 Vaksin IPV
6 Vaksin Polio (POLIO)
7 Vaksin MR (1-2) ( Rubela/Campak)/Bian
8 Vaksin MR (1-2) ( Rubela/Campak)
9 Vaksin DT
10 Vaksin PCV
11 Vaksin DPT / DPT-HB / DPT-HB-Hib(1-4)
12 Tinta Vaksin Bian
13 Hepatitis B Imunoglobin (HbIg) Bayi
14 RABIES VACCINE INACTIVATED
15 RABIES IMMUNE GLOBULIN (HUMAN) 1 ML
16 Vaksin Covid-19 (Sinovac)
17 Vaksin Covid-19 (Biofarma) (1 Vial/10 dosis)
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC
19 Vaksin Covid-19 Pfizer (@ 6 Dosis)
20 Vaksin Covid-19 (@ 2 Dosis) ANTRAZENECA
21 Vaksin Covid-19 @14 (Moderna)
22 Vaksin Sinopharm @ 2 dosis
23 Vaksin Covid-19 (Moderna) @10 DOSIS
24 Vaksin Covid-19 (@ 2 Dosis) CORONAVAC
25 Vaksin Covid -19 Pfizer (@ 6 Dosis)
26 Vaksin Covid-19 (@10 Dosis) ASTRAZENECA
27 Cadox (Konecavax)@10 dosis
28 Safety Box 5 Liter
29 Pelarut MR Bian
30 Pelarut BCG
31 Pelarut MR
32 Pelarut Pfizer NaCl 0,9% 10 ml
34 Pelarut NaCl 0,9% 10 ml
SEDIAAN TOPIKAL
1 Chloramphenicol SM 1%
2 Hidrocortison salep
3 Oxytetrasiklin Salep Mata 0,1%
4 Salep 2-4
LABORATORIUM
1 Box Slide ( Warna Hijau )(malaria) 72'S
2 Blood Lancet 100 'S
3 Fesco Blood Lancet 200 'S
4 Catride TCM TB
5 (Whole Blood) (Warna PEACH)(AG PCDH)
6 (MALARIA)
Handsanitizer 50 ml
8 Giemsa 100 ml
9 Oil Emersi 100 ml
11 Giemsa 500 ml
13 Lab. Kit Malaria
14 Oil Emersi
15 Paket KIT TB
16 Pot Dahak / Pot Sputum
17 Reagen ZN
18 Rapid Test HBsAg/ Virocheck
19
20 RDT DBD SD BIOLINE
21
22 Rapid Antigen (Whole Power)
23 Rapid Antigen Entram
24 Reagen Golda A
25 Reagen Golda B
26 Reagen Golda AB
27 Anti Resus D
28 SD HIV-1/2 3,0
29 TRIPOCHECK SYPHILIS
30 Tuberkulin
31 VTM + Stik Steril Swab (CITO)
32 BETAFOG
34 Human Colesterol Liquid
35 Human Glucose liquid
36 Human Hemoglobine liquid
37 Human Tryglyceride liquid
38 Providen
39 Sars Cov-2 Anti Bodi Test
40 Standar Q HIV 1/2 Ab 3 Line R3
39 Virotec Dengue Kombo (P2M)
DAK
6 Blade Sterile (Mess)
7 Blood Lancet
8 Blod TransfusiSet Stera
9 Catgut Chromic (Absorbable Suture Sterile)
10 Catgut Plain 3/0 HR 37 mm
11 Dermatix
16 Infus Set Anak
17 Infus Set Dewasa
18 IV Catheter No. 16
23 Jarum Kulit GT 14
24 Jarum Otot GR 14
25 Kapas Pembalut 500 gr
27 Kassa Steril
28 Masker Nebul Anak
29 Masker Nebul Dewasa
30 Nasal Canula Bayi (Oxyflow)
31 Nasal Canula Anak (Oxyflow)
32 Nasal Canula Dewasa (Oxyflow)
33 Needle No. 25G x 25 mm
34 Polifix / Hipavix 5mx5cm
35 Plesterin Bulat Soft (Box @200 Pcs)
38 Sarung Tangan Steril 7,5
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile)
40 Stomach tube no. 18
41 Tes kehamilan
42 Under Pad (Soft Pad 60 x 90 cm)
43 Urine Bag
45 Stik Benecheck Glukosa PTM
46 Benecheck Plus Monitoring PTM
OBAT-OBATAN
1 Acetylcystein 200 mg
2
)
3 acyclovir 400 mg
5 Amlodipin 5 mg
6 Amlodipin 10 mg
7 Amoxicillin 500 mg
8 Antasida DOEN Tablet
10 Asam Mefenamat 500 mg
11 Attapulgit 600 mg (pularex)
12 Betahistine
13 Captopril 12,5 mg
14 Captopril 25 mg
15 Calcium Lactate
16 Cavicur
17 Ciprofloxacin 500mg
18 Chlorpheniramin Maleat (CTM) 4 mg
19 Cotrimoxazol 480 mg
20 Cetirizin HCL
21 Chlorampenicol 250 mg
22 Chlorampenicol 500 mg (Cloramex 500)
23 Dexamethasone 0,5 mg
24 Digoxin 0,25 mg
25 Dimenhydrinat 50 mg
26 Domperidon 10 mg
27 Ergotamin
30 Folic Acid 1mg
31 Furosemide 40 mg
33 Glimepiride 1 mg
34 Glimepiride 2 mg
35 Glimepiride 3mg
38 Hydrochlorthiazide 25 mg
39 Ibuprofen 200 mg
40 Ibuprofen 400 mg
41 Ketokonazole 200 mg
42 Loperamide
43 Loratadine 10 mg
44 Metyl Ergometrin 0,125 MG
45 Methyl Prednisolon 4 mg
46 Metformin 500 mg
50 Nifedipin 10 mg
51 Nifedipin 20 mg (Adalat Oros )
52 Nystatin 100.000 IU Tablet Vaginal
53 Nystatin 500.000 IU Tablet
56 Omeprazole Cap
58 Phytomenadion 10 mg
59 Propranolol
60 Prednisone 5 mg
61 Propylthiouracil 100 mg
62 Pyrantel Pamoate 125 mg
63 Ranitidine 150 mg
64 Salbutamol 4 mg
67 Vitamin B Kompleks
68 Zinc 20 mg
68 Cefadroksil Monohidrat 500 mg
3 Antasida DOEN Suspensi
4 Cotrimoxazol Suspensi 240 mg/5ml
5 Domperidon suspensi
6 Ibuprofen 200 mg/5ml suspensi
7 Metronidazole Sirup
8 Paracetamol Sirup 120 mg/5ml
INJEKSI DAN PELARUT
1 Ampicillin Injeksi 1000 mg
2 Aqua Pro Injeksi 25 ml
3 Aqua DM 1000 ml
4
5 Dexamethasone Injeksi
6 Diphenhydramin inj
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml
8 Gluconat Calcicum Inj 100 mg/ml
9 Lidocain HCl 2%
10
11 Meprovent Inhaler
12 Methyl Ergometrin Inj 0,2 mg/ml
13 MgSO4 20%
14 MgSO4 40%
15 Oxytocin Injeksi
16 Omeprazole Inj 40 mg/ml
17 Phytomenadion Inj 2 mg/ml
SEDIAAN TOPIKAL
1 Aciclovir salep kulit
2
IU/g + Polimiksin
DOEN Kombinasi:
3
Asam Salisilat 3%
4 Betamethasone cream
5 Chloramphenicol 1% Salep Mata
6 Chloramphenicol 2% Salep Kulit (Bufacetin)
7 Chloramphenicol Tetes Telinga (Erlamycetin)
8 Hydrocortison 2,5%
9 Ketokonazole Cream
10 Miconazole 2%
11 Oxytetrasiklin Salep Mata
12 Phenol Glyserol (Tetes Telinga)
13 perak sulfaduazine
14
Belerang Endap 4%
15 Permetrin/ Scabisite
16 Bedak Salisyl 2%
1 Antihemoroid Suppo
1 Antiseptik Kumur
2 E-Care Hand Sanitizer 500 ml
3 E care hand Wash (Sabun Cair 500 mL)
4 Povidon 300 ml
5 Povidon 60 ml
6 Lisol 1 L
VAKSIN DAN SERUM
1 Serum Anti Bisa Ular /Biosave SABU
2
(Tetagram)
1 Glucosa 5% (D5%) 500 ml
2 Glucosa 10% (D10%) 500 ml
3 Natrium Chlorida (NaCl) 0,9%
4 Ringer Laktat
5 Ringer Asering
OBAT GIGI
1 Ethyl Chloride
2 Fuji IX GP Besar
3 Fuji IX GP Kecil
4 Hydcal (Calsidol)
5 Iodotin/ Iodoform
6 Composit
7 Sponestan / Surgipson
8 Cavit G
9 Tri Kresol Formalin (TKF)
10 Klorfenol Kamfer Mentol
11 Devitalisasi Pasta Ion Arsen
12 Pulp - X
12 Eugenol
LABORATORIUM
1 Golda A
2 Golda B
3 Golda AB
4 Golda Resus D
5 HB Mission 50's Acon
6 Kertas Lensa
8 Micropipet MT.II 1000 µl
9 Micropipet MT.I 200 µl
10 Object Glass Frosted (Slide)
11 Rak Tabung Reaksi 50 Lubang Multipurpose
12
13 Standbio Glucose 1 x 250 ml
14 Standbio Uric Acid 4 x 30 ml
15 Standbio Cholesterol 4 x 30 ml
16 Stik Nesco Cholestrol
17 Stik Nesco Asam Urat
18 Stik Nesco Gula
19 Stik Easy Touch Asam Urat
20 Stik Easy Touch Gula
21 Stik Easy Touch Cholestrol
22 Stik Benecek Asam Urat
23 Stik Benecek Gula
24 Stik Benecek Cholestrol
25 Mindray U-II Urin Tes
28 Stik Gluko Protein Tes 10'S
29
30 Widal
31 DILUENT
32 RINSE
33 LYSE
34 Probe Cleanser
35 EZ Cleanser
36 Giemsa
38 Blue Tip
BAHAN KIMIA
1 Cynolf
2 Kaporit
3 ABATE
BMHP
3 APRON White
4 APD LENGKAP
5 Cover All Suit
6 Faceshield
7 Faceshield kacamata
8
Nasofaring Kecil
9 Masker Ear loop 3 ply
10 Masker Tis On 3Ply
11 Masker Kain Scuba (Anak)
12 Masker Kain Scuba (dewasa)
13 3M Particulate N95-8210
14 Masker KN95 (Protective Mask)
15 Masker N95 (mask 5 play) smiles
20 Sarung Tangan Steril 7.5
21 Sarung Tangan Obgyn
22 Surgical Gown Water Proff
23 Termometer & Hemidity meter
24 Tensi ( Blood Pressure Monitor )
25 Termogun HTI
26 Termogun ( OMRON Digital Forehead Termometer)
TAMBAHAN
LABORATORRIUM
1 Stik Cholesterol Easy Touch
2 Stik Asam Urat Easy Touch
3 Stik Glucose Easy Touch
4 Stik Glucose Nesco
5 Stik Cholestrol Nesco
8 Stik Cholestrol Bhenecek
11 Tabung EDTA Tutup ungu
12 VTM + Stik Steril Swab
13 VTM
14 Rapid Antigen (Clungene Taishan)
15 Rapid Test Indec
16 Standar Q Covid-19 Ag
OBAT-OBATAN
1 Asam Ascorbat (Vitamin C) 250 mg
2 Azithromycin 500 mg
5 Cavicur
6 Chlorpromazine 100 mg
7 Ciprofloxacin 500 mg
10 Domperidon 10 mg
11 Farbion
12 Favipiravir 200 mg
13 Gold Trion
14 Ibuprofen 400 mg
15 Levofloxacin 500 mg
16 N-acetylcystein 30/box
17 Oseltamivir Capsules 75 mg
19 Piroxicam 20 mg
20 Piridoxin
21 Seloxy
22 Kolkisin
INJEKSI DAN PELARUT
1 Phytominadion inj
SEDIAAN TOPIKAL
1 Salep 2 - 4
2
1 Alkacide ( DESINFEKTAN)
2 T. Handrub 100 ml
3 E-Care Handrub 500 ml
4 Alkohol 70%
5 Kaporit 60% 15 Kg
HIBAH
1 Jas Hujan (TorchMed-Guard)
2 Kacamata
3 Nurse Cap ONE MED / penutup kepala
4 Sepatu Boot
JKN
1 Salbutamol 2 mg
2 Ethyl Chloride
3 Povidone 60 ml
1 Masker Hijab
2 Vitamin B12
3 Bionicom Zinc
4 Masker Oksigen Non Rebriting Bayi
JUMLAH KUNJUNGAN
JUMLAH RESEP
MENGETAHUI,
Maman .SKM,M.Mkes
NIP. 19651231 198603 1 221
LAPORAN PEMAKAIAN DAN LEMBAR P
: RASABOU
: HU'U
: DOMPU
STOCK TANGGAL HARGA

SATUAN SUMBER DANA
AWAL KADALUARSA SATUAN
3 4 6 7 8
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0 11/30/2025 Rp70
PAKET 0
Rol 0
Pcs 0
Pcs 0
Pcs 3
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Set 0
Pcs 0
Pcs 0
Pcs 0
Pcs 0
Roll 0
Pcs 0
Pcs 0
Tablet 4520 7/1/2023

Tablet 0
Tablet 0
Tablet 0
Tablet 0
ktk 0
Tablet 0
Tablet 0
Sachet 315
Tablet 0
Tablet 0
Tablet 0
Blister 5
Blister 0
Blister 0
Sachet 12
Tablet 0
Tablet 0
Paket 1 APBD I 2021 2/29/2024 Rp436,445
Paket 0
Paket 1
Paket 0
Tablet 156
Tablet 0
Tablet 0
Tablet 21500
Tablet 0
Botol 0
Vial 0
Vial 0
Botol 6
Ampul 35
Ampul 3
Ampul 11
Ampul 126
Pcs 0 10/17/2026 Rp1,185

Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Vial 0
Pcs 0 Rp14,000
Ampul 0
Ampul 0
Ampul 0
Ampul 0 8/31/2023 Rp3,280
Pcs 0
Flash 0
Tube 0
Tube 0
Tube 0
Pot 0
ktk/72 pcs 0
Pcs 0
Pcs 0
Pcs 0
25 kit/box 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 1
Botol 0
pak 0
kotak 0
botol 0
kotak 0
Buah 280
10 ktk/Dus 2
25 pcs/kotak 2 APBN I 2023 7/31/2024
Test 0
25 kit/box 0
Pcs 0
Pcs 20
Pcs 0
vial 0
vial 0
vial 0
vial 0
25/kotak 150
25/kotak 6
Vial 0
Pcs 0
Botol 0
0
Botol 0
Botol 0
Botol 0
Botol 0
0
BOX/20 0
Pcs 0 APBD I 10/14/2023
Pcs 0 APBD I 8/31/2024
Pcs 0
Pcs 0
Pcs 0 DAK 2022 4/9/2027 Rp979
Pcs 0 DAK 2021 7/9/2026 Rp1,056
Pcs 3400
Pcs 250
Pcs 4700
Pcs 94 DAK 2021 2/1/2025 Rp3,600
Pcs 0
Pcs 27
Pcs 0
Pcs 0
Pcs 17
Pcs 0 DAK 2021 10/16/2024 Rp14,341
Pcs 0
Pcs 0
Pcs 22
Pcs 0
Pcs 62
Pcs 0
Pcs 0 DAK 2022 11/30/2026 Rp4,862
Pcs 0 DAK 2022 8/30/2027 Rp12,804
Pcs 0
Pcs 0
Bungkus 0
Rol 3
kotak 0
Pcs 0
Pcs 0
Pcs 4
Pcs 1
Pcs 0
Pcs 0
Roll 30
200/box 400
Pcs 0
Pcs 1020 DAK 2022 4/30/2027 Rp546
Pcs 0
Pcs 53
Pcs 0
Pcs 53
Pcs 0
Pcs 13
Pcs 167 DAK 2022 3/30/2027
Stip 3000
kotak 0
Tablet 6210 DAK 2022 9/30/2024 Rp307

Tablet 200
Tablet 0
Tablet 0
Tablet 0
Tablet 1320
Tablet 10000
Tablet 2910
Tablet 2400
Tablet 2040
Tablet 0
tablet 130
Tablet 700
Tablet 0
Tablet 490
Tablet 0
Tablet 0
Tablet 870 DAK 2022 7/30/2024 Rp70
Tablet 0
Tablet 1280
Tablet 0
Tablet 600
Tablet 240
Tablet 0
Tablet 0
Tablet 1303
Tablet 0
Tablet 0
Tablet 0
Tablet 200 DAK 2021 10/1/2023 Rp43
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 780
Tablet 0
Tablet 100
Tablet 0
Tablet 2780
Tablet 0
Tablet 150
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 330
Tablet 0
Tablet 60
Tablet 0
Tablet 185 DAK 2022 3/30/2024 Rp0
Tablet 0 DAK 2021 7/1/2026 Rp114
Tablet 0
Tablet 660
Tablet 5400
Tablet 0
Tablet 0
Tablet 0
Tablet 100
Tablet 190
Tablet 0
Tablet 880
Tablet 1610
Tablet 1010
Tablet 0
Tablet 0
Tablet 0 DAK 2022 10/30/2026 Rp1,100
Botol 0
Botol 110 DAK 2022 12/31/2024 Rp3,510
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Vial 0
Flush 0
Botol 0
Ampul 0
Ampul 0
Ampul 12
Ampul 0
Ampul 5
Ampul 75 DAK 2022 6/30/2026 Rp847
Ampul 60
Ampul 0 DAK 2022 4/1/2028 Rp3,677
Ampul 0
Vial 4 DAK 2022 11/8/2023 Rp3,760
Vial 4
Ampul 0 DAK 2022 3/31/2025 Rp1,298
Ampul 17
Vial 0
Tube 0
Tube 0
Tube 0
Tube 0
Tube 32
Tube 0
Botol 0
Tube 44 DAK 2022 6/30/2024 Rp2,325
Tube 0
Tube 72 DAK 2022 3/31/2025 Rp1,900
Tube 0
Botol 0
Tube 0
Tube 0
Tube 10 DAK 2022 9/30/2024 Rp6,578
Tube 0
Supp 0
Supp 0
Supp 0
Botol 0
Botol 0
Botol 0
Botol 2
Botol 0
Botol 0
Vial 0
Vial 0
Botol 19
Botol 38
Botol 142
Botol 305 12/4/2025
Botol 0
Kaleng 0
pcs 0
pcs 0
pcs 0
pcs 0
Pcs 0
pcs 24
pcs 0
Set 0
pcs 0
pcs 0
Botol 3 DAK 2022 1/7/2025 Rp210,500
Botol 2
Vial 0
Vial 0
Vial 0
Vial 0
pcs 0
Buah 0
Lembar 0
Pak 0
Pak 0
Box 0
Pcs 0
25 kit/box 0
Kit 0
Kit 0
Kit 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0 DAK 2022 12/31/2023 Rp25,723
Botol 0
pcs 0
pcs 0
pcs 10
Box 0 8/31/2024
kotak 0
GALON 0
GALON 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 0
Botol 500
Botol 0
Galon 0
1 Kg/ Botol 0 APBN 6/8/2024 Rp0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 4150 DID 2021
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 11
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
Rol 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
Box 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
pcs 0
Tablet 0
20/ktk 0
Tablet 0
Tablet 340
Tablet 0
Tablet 0
Tablet 0
100/ktk 0
100/ktk 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
50/ktk 0
Tablet 0
Kapsul 0
Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tablet 480
Ampul 0
pot 0
Pot 0
Botol 0
botol 0
Botol 0
Botol 0 DAK 2022 11/30/2023 Rp58,000
Galon 0
pcs 0
pcs 0
pcs 0
pcs 0
Tablet 100 DAK 2022

Botol 0
Botol 0
0
Pcs 0
Tablet 430 DAK 2022
Tablet 0
Pcs 0 DAK 2023
pcs 1000
UMUM GRATIS JKN

102 33 531
YANG MENYERAHKAN,

NIP. 19690307 198903 2 013 NIP.
AN LEMBAR PERMINTAAN OBAT (LPLPO)
PELAPORAN BULA
PERMINTAAN BUL
TAHUN
PENERIM PERSEDI JUMLAH TOTAL SUB STOCK

PEMAKAIAN
AAN AAN EXPIRED UNIT GUDANG
9 10=9+4 11 12 = (10-11-13) 13 14
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 0 0 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
4520 0 120 4400

0 0
0 0
0 0
0 0
0 0 0
0 0
0 0
315 0 15 300
0 0
0 0
0 0
5 0 0 5
0 0
0 0
12 0 0 12
0 0
0 0
1 0 0 1
0 0
1 0 0 1
0 0
156 0 0 156
0 0
70 0 20 50
396 0 46 350
0 0
21500 0 5000 16500
0 0
0 0
0 0
0 0
0 0
0 0
6 0 0 6
35 0 0 35
3 0 0 3
11 0 0 11
126 0 0 126
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 0 0 1
0 0
0 0
0 0
0 0
0 0
280 0 0 280
2 0 0 2
2 0 0 2
0 0
0 0
0 0
20 0 0 20
0 0
0 0
0 0
0 0
0 0
150 0 0 150
6 0 0 6
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3400 1370 30 2000
250 80 20 150
4700 200 0 4500
94 35 2 57
0 0
27 4 5 18
0 0
0 0
17 1 0 16
0 0
0 0
0 0
22 -290 3 309
0 0
62 -43 5 100
0 0
0 -80 5 75
0 -60 5 55
0 0
0 0
0 0
3 -1 0 4
0 0
0 0
0 0
4 2 0 2
1 1 0 0
0 0
0 0
30 13 1 16
400 100 0 300
0 -450 50 400
1020 120 0 900
0 0
53 45 3 5
0 0
53 33 0 20
0 0
13 6 0 7
167 47 0 120
3000 400 0 2600
0 0
0 0
6210 2790 120 3300
200 0 0 200
0 0
0 0
0 0
1320 -2330 50 3600
10000 3380 120 6500
2910 -2660 70 5500
2400 1670 30 700
2040 -2960 100 4900
0 -5000 100 4900
130 0 30 100
700 -3760 60 4400
0 0
490 -700 90 1100
0 -480 80 400
0 0
870 870 0 0
0 0
1280 520 60 700
0 0
600 0 0 600
240 190 50 0
0 0
0 0
1303 23 80 1200
0 0
0 0
0 0
200 -1750 50 1900
0 0
0 0
0 0
0 0
0 0
780 40 40 700
0 0
100 0 0 100
0 0
2780 -2310 90 5000
0 0
150 -3420 70 3500
0 0
0 0
0 0
0 0
0 0
0 0
330 100 30 200
0 0
60 0 0 60
0 0
185 55 30 100
0 0
0 -5090 90 5000
660 580 80 0
5400 3280 120 2000
0 0
0 0
0 0
100 0 0 100
190 190 0 0
0 0
880 240 40 600
1610 -1320 30 2900
1010 -1840 50 2800
0 -6070 70 6000
0 -3340 40 3300
0 0
0 0
0 0
110 77 4 29
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
12 0 0 12
0 0
5 0 0 5
75 -26 10 91
60 60 0
0 0
0 0
4 0 0 4
4 0 0 4
0 0
17 17 0 0
0 0
0 0
0 0
0 0
0 0
0 -40 5 35
32 -24 8 48
0 0
0 0
44 11 10 23
0 0
72 42 6 24
0 0
0 0
0 0
0 0
10 -8 5 13
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 2 0
0 0
0 0
0 0
0 0
0 0
0 0
19 -18 2 35
38 18 2 18
142 -33 5 170
305 -141 6 440
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
24 0 24
0 0
0 0
0 0
0 0
3 0 0 3
2 0 0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 0 0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
500 0 0 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
4150 600 50 3500
0 0
0 0
0 0
0 0
0 0
0 0
11 1 0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
340 -90 30 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
480 50 30 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 -2000 100 2000
0 0
0 0
0 0
430 -430 60 800
0 0
0 0
1000 200 0 800
TOTAL
666
0
YANG MEMINTA, YANG MEN
KEPALA UPTD PUSKESMAS PENGELOLA OB
Joharis, AMG apt. Ajhar,

NIP. 19660219 199401 1 002 NIP. 19910201 2
LAPORAN BULAN : JULI
RMINTAAN BULAN : AGUSTUS
: 2023
STOCK PERMINTAA PEMBERIA

AKHIR N N
15 16 17= 12+(9*50%) 18 19
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
3 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
4520 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
315 Rp0
0 Rp0
0 Rp0
0 Rp0
5 Rp0
0 Rp0
0 Rp0
12 Rp0
0 Rp0
0 Rp0
1 Rp0
0 Rp0
1 Rp0
0 Rp0
156 Rp0
0 Rp0
70 Rp0
396 Rp0
0 Rp0
21500 Rp0
0 Rp0
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
6 Rp0
35 Rp0
3 Rp0
11 Rp0
126 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
1 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
280 Rp0
2 Rp0
2 Rp0
0 Rp0
0 Rp0
0 Rp0
20 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
150 Rp0
6 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
2030 Rp0
170 Rp0
4500 Rp0
59 Rp0
0 Rp0
23 Rp0
0 Rp0
0 Rp0
16 Rp0
0 Rp0
0 Rp0
0 Rp0
312 Rp0
0 Rp0
105 Rp0
0 Rp0
80 Rp0
60 Rp0
0 Rp0
0 Rp0
0 Rp0
4 Rp0
0 Rp0
0 Rp0
0 Rp0
2 Rp0
0 Rp0
0 Rp0
0 Rp0
17 Rp0
300 Rp0
450 Rp0
900 Rp0
0 Rp0
8 Rp0
0 Rp0
20 Rp0
0 Rp0
7 Rp0
120 Rp0
2600 Rp0
0 Rp0
Rp0
3420 Rp0
200 Rp0
0 Rp0
0 Rp0
0 Rp0
3650 Rp0
6620 Rp0
5570 Rp0
730 Rp0
5000 Rp0
5000 Rp0
130 Rp0
4460 Rp0
0 Rp0
1190 Rp0
480 Rp0
0 Rp0
0 Rp0
0 Rp0
760 Rp0
0 Rp0
600 Rp0
50 Rp0
0 Rp0
0 Rp0
1280 Rp0
0 Rp0
0 Rp0
0 Rp0
1950 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
740 Rp0
0 Rp0
100 Rp0
0 Rp0
5090 Rp0
0 Rp0
3570 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
230 Rp0
0 Rp0
60 Rp0
0 Rp0
130 Rp0
0 Rp0
5090 Rp0
80 Rp0
2120 Rp0
0 Rp0
0 Rp0
0 Rp0
100 Rp0
0 Rp0
0 Rp0
640 Rp0
2930 Rp0
2850 Rp0
6070 Rp0
3340 Rp0
0 Rp0
Rp0
0 Rp0
33 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
12 Rp0
0 Rp0
5 Rp0
101 Rp0
0 Rp0
0 Rp0
0 Rp0
4 Rp0
4 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
40 Rp0
56 Rp0
0 Rp0
0 Rp0
33 Rp0
0 Rp0
30 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
18 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
Rp0
37 Rp0
20 Rp0
175 Rp0
446 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
24 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
3 Rp0
2 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
10 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
500 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
3550 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
10 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
430 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
430 Rp0
Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
0 Rp0
0 Rp0
0 Rp0
0 Rp0
Rp0
2100 Rp0
0 Rp0
0 Rp0
0
860
0
0
800 Rp0
YANG MENERIMA,
ENGELOLA OBAT PUSKESMAS
apt. Ajhar, S.Farm

NIP. 19910201 202203 1 007
PUSKESMAS : RASABOU PELAPORAN BULAN : AGUSTUS

KECAMATAN : HU'U PERMINTAAN BULAN : SEPTEMBER
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA PEMAKAIAN TOTAL HARGA STOK OPTIMUM
1 2 3 4 5 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19
APBD 1 / APBN
Alat Kesehatan
5 Alkohol Swabs 100's Pcs 0 GM2011244 11/30/2025 Rp70 0 0 0 Rp0
10 Kaca Mata Google TB Pcs 3 3 0 3 3 Rp0
OBAT-OBATAN 0 Rp0
1 Albendazole 400 mg Tablet 4520 1107273 7/1/2023 4520 4420 100 100 Rp0
6 DHP Frimal (Kotak @9 Tablet) ktk 0 0 0 0 Rp0
9 Garam Oralit Sachet 315 500 815 215 600 600 Rp300,000
11 INH(Ishonizide) Tablet 0 0 0 0 Rp0
13 MDT Combi Dewasa MB (Merah) Blister 5 3 8 3 5 5 Rp15
16 Mineral Mix Sachet 12 12 0 12 12 Rp0
19 OAT Kat. 1,3 Paket 1 46461012 APBD I 2021 2/29/2024 Rp436,445 10 11 1 10 10 Rp100
21 OAT Kat Anak Paket 1 1 0 1 1 Rp0
23 Primaquin 15 mg Tablet 156 156 156 0 0 0 Rp0
25 Retinol 200.000 IU (Merah) Kapsul lunak 70 F21209W APBD I 6/30/2025 Rp586 70 5 65 65 Rp0
26 Retinol 100.000 IU (Biru) Kapsul lunak 396 E20910W APBD I 5/30/2025 Rp324 396 16 30 350 380 Rp0
SIRUP, SUSPENSI DAN DROP 0 0 0 Rp0
INJEKSI DAN PELARUT 0 0 0 Rp0
3 Metronidazole infus Botol 6 6 0 6 6 Rp0
4 Gentamicin inj Ampul 35 35 0 35 35 Rp0
5 MgSO4 20% Ampul 3 3 0 3 3 Rp0
6 MgSO4 40% Ampul 11 11 2 9 9 Rp0
7 Phytomenadion inj 2 mg/ml Ampul 126 126 0 126 126 Rp0
VAKSIN DAN SERUM 0 0 0 Rp0
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 2110125 10/17/2026 Rp1,185 0 0 0 Rp0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 0 0 0 0 Rp0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 FX2761 0 0 0 Rp0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 B832 8/31/2023 Rp3,280 0 0 0 Rp0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 0 Rp0
SEDIAAN TOPIKAL 0 0 0 Rp0
4 Salep 2-4 Pot 0 0 0 0 Rp0
LABORATORIUM 0 0 0 Rp0
4 Catride TCM TB
Malaria Ag. pLDH/HRP2 (COMBO Card Test) Pcs 0 0 0 0 Rp0
6 (MALARIA)
Handsanitizer 50 ml Botol 0 0 0 0 Rp0
10 Oil Emersi 500 ml Botol 1 1 0 1 1 Rp0
16 Pot Dahak / Pot Sputum Buah 280 280 280 0 0 Rp0
17 Reagen ZN 10 ktk/Dus 2 2 0 2 2 Rp0
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 2 H22019 APBN I 2023 7/31/2024 2 2 0 0 Rp0 5
19 Test 0 0 0 0 Rp0
21 Pcs 0 0 0 0 Rp0
22 Rapid Antigen (Whole Power) Pcs 20 20 20 0 0 Rp0
28 SD HIV-1/2 3,0 25/kotak 150 150 0 150 150 Rp0
29 TRIPOCHECK SYPHILIS 25/kotak 6 6 2 4 4 Rp0
30 Tuberkulin Vial 0 0 0 0 Rp0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 5352AF1AC APBD I 10/14/2023 0 0 0 Rp0
39 Virotec Dengue Kombo (P2M) Pcs 0 H22023 APBD I 8/31/2024 0 0 0 Rp0
DAK 0 0 0 Rp0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 0 Rp0
3 Alat Suntik sekali pakai 3 ml Pcs 0 2/13/1901 DAK 2022 4/9/2027 Rp979 0 0 0 Rp0
4 Alat Suntik sekali pakai 5 ml Pcs 0 710 DAK 2021 7/9/2026 Rp1,056 0 0 0 Rp0
5 Alkohol Swabs 100's Pcs 2030 2030 1230 800 800 Rp0
6 Blade Sterile (Mess) Pcs 170 170 96 74 74 Rp0
7 Blood Lancet Pcs 4500 4500 200 4300 4300 Rp0
8 Blod TransfusiSet Stera Pcs 59 280320088 DAK 2021 2/1/2025 Rp3,600 59 22 37 37 Rp0
10 Catgut Plain 3/0 HR 37 mm Pcs 23 23 16 7 7 Rp0
13 Female Catheter no. 18 Pcs 16 16 16 0 0 0 Rp0
14 Foley Catheter no. 18 Pcs 0 20191017 DAK 2021 10/16/2024 Rp14,341 0 0 0 Rp0
16 Infus Set Anak Pcs 0 0 0 0 Rp0
17 Infus Set Dewasa Pcs 312 312 163 6 143 149 Rp0
19 IV Catheter no. 18 Pcs 105 100 205 88 8 109 117 Rp11,700
20 IV Catheter no. 20 Pcs 0 0 0 0 Rp0
21 IV Catheter no. 22 Pcs 80 21L2506J DAK 2022 11/30/2026 Rp4,862 100 180 140 1 39 40 Rp4,000 100
22 IV Catheter no. 24 Pcs 60 20108D003 DAK 2022 8/30/2027 Rp12,804 100 160 93 5 62 67 Rp6,700 50
25 Kapas Pembalut 500 gr Bungkus 0 0 0 0 Rp0
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 4 5 9 4 5 5 Rp25 5
27 Kassa Steril kotak 0 0 0 0 Rp0
29 Masker Nebul Dewasa Pcs 0 0 0 0 Rp0
30 Nasal Canula Bayi (Oxyflow) Pcs 2 2 0 2 2 Rp0
31 Nasal Canula Anak (Oxyflow) Pcs 0 0 0 0 Rp0
32 Nasal Canula Dewasa (Oxyflow) Pcs 0 0 0 0 Rp0
34 Polifix / Hipavix 5mx5cm Roll 17 15 32 27 5 5 Rp75 20
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 300 300 100 200 200 Rp0
36 Sarung Tangan Non Steril M Pcs 450 1000 1450 550 900 900 Rp900,000
37 Sarung Tangan Non Steril L Pcs 900 7117306137 DAK 2022 4/30/2027 Rp546 200 1100 400 700 700 Rp140,000
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile) Pcs 8 144 152 80 72 72 Rp10,368
41 Tes kehamilan Pcs 20 20 20 0 0 Rp0
42 Under Pad (Soft Pad 60 x 90 cm) Pcs 0 0 0 0 Rp0
43 Urine Bag Pcs 7 10 17 7 10 10 Rp100
44 Sarung Tangan Steril 7 Pcs 120 SH2202032 DAK 2022 3/30/2027 120 31 39 50 89 Rp0
45 Stik Benecheck Glukosa PTM Stip 2600 2600 600 2000 2000 Rp0
46 Benecheck Plus Monitoring PTM kotak 0 0 0 0 Rp0
OBAT-OBATAN 0 0 0 Rp0
1 Acetylcystein 200 mg Tablet 3420 22AS1211 DAK 2022 9/30/2024 Rp307 3420 320 100 3000 3100 Rp0
2 Tablet 200 200 0 200 200 Rp0
)
4 Allopurinol 100 mg Tablet 0 4000 4000 500 3500 3500 Rp14,000,000
5 Amlodipin 5 mg Tablet 0 0 0 0 Rp0
6 Amlodipin 10 mg Tablet 3650 2000 5650 1035 115 4500 4615 Rp9,230,000
7 Amoxicillin 500 mg Tablet 6620 3000 9620 3335 85 6200 6285 Rp18,855,000
8 Antasida DOEN Tablet Tablet 5570 3000 8570 1480 190 6900 7090 Rp21,270,000
9 Asam Ascorbat 50 mg Tablet 730 730 730 0 0 Rp0
10 Asam Mefenamat 500 mg Tablet 5000 3000 8000 1310 90 6600 6690 Rp20,070,000
11 Attapulgit 600 mg (pularex) Tablet 5000 5000 150 150 4700 4850 Rp0
13 Captopril 12,5 mg Tablet 4460 2000 6460 240 220 6000 6220 Rp12,440,000
14 Captopril 25 mg Tablet 0 5000 5000 362 338 4300 4638 Rp23,190,000
15 Calcium Lactate Tablet 1190 1000 2190 330 60 1800 1860 Rp1,860,000
16 Cavicur Tablet 480 5000 5480 510 70 4900 4970 Rp24,850,000
17 Ciprofloxacin 500mg Tablet 0 0 0 0 Rp0
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 0 2207099 DAK 2022 7/30/2024 Rp70 6000 6000 4430 70 1500 1570 Rp9,420,000
19 Cotrimoxazol 480 mg Tablet 0 0 0 0 Rp0
20 Cetirizin HCL Tablet 760 500 1260 765 95 400 495 Rp247,500 1500
25 Dimenhydrinat 50 mg Tablet 0 0 0 0 0 0 Rp0
30 Folic Acid 1mg Tablet 1950 2110-050365 DAK 2021 10/1/2023 Rp43 1950 280 170 1500 1670 Rp0
32 Glibenclamide 5 mg Tablet 0 4000 4000 430 70 3500 3570 Rp14,280,000
36 Griseovulfin 125 mg Tablet 740 740 30 110 600 710 Rp0
38 Hydrochlorthiazide 25 mg Tablet 100 100 20 80 80 Rp0
40 Ibuprofen 400 mg Tablet 5090 3000 8090 2270 120 5700 5820 Rp17,460,000
41 Ketokonazole 200 mg Tablet 0 250 250 40 10 200 210 Rp52,500
42 Loperamide Tablet 3570 3570 40 130 3400 3530 Rp0
43 Loratadine 10 mg Tablet 0 0 0 0 Rp0 3000
44 Metyl Ergometrin 0,125 MG Tablet 0 0 0 0 Rp0
46 Metformin 500 mg Tablet 0 0 0 0 Rp0
51 Nifedipin 20 mg (Adalat Oros ) Tablet 60 60 0 60 60 Rp0
53 Nystatin 500.000 IU Tablet Tablet 130 46371001 DAK 2022 3/30/2024 Rp0 130 30 100 100 Rp0
54 Natrium Diklofenak 25 mg Tablet 0 G12162J DAK 2021 7/1/2026 Rp114 0 0 0 Rp0
55 Natrium Diklofenak 50 mg Tablet 5090 3000 8090 1250 240 6600 6840 Rp20,520,000
56 Omeprazole Cap Tablet 80 5000 5080 1055 125 3900 4025 Rp20,125,000
57 Paracetamol 500 mg Tablet 2120 5000 7120 3400 120 3600 3720 Rp18,600,000
58 Phytomenadion 10 mg Tablet 0 0 0 0 Rp0 200
60 Prednisone 5 mg Tablet 0 0 0 0 Rp0
61 Propylthiouracil 100 mg Tablet 100 100 0 100 100 Rp0
62 Pyrantel Pamoate 125 mg Tablet 0 0 0 0 Rp0
63 Ranitidine 150 mg Tablet 0 0 0 0 Rp0
64 Salbutamol 4 mg Tablet 640 1000 1640 235 105 1300 1405 Rp1,405,000
65 Simvastatin 10 mg Tablet 2930 2930 480 50 2400 2450 Rp0
66 Simvastatin 20 mg Tablet 2850 2850 130 120 2600 2720 Rp0
67 Vitamin B Kompleks Tablet 6070 6070 2265 205 3600 3805 Rp0
68 Zinc 20 mg Tablet 3340 3340 420 220 2700 2920 Rp0
68 Cefadroksil Monohidrat 500 mg Tablet 0 2210-12-57 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0
SIRUP, SUSPENSI DAN DROP 0 0 0 Rp0
1 Amoxicillin Syr 125 mg/5ml Botol 0 120 120 28 92 92 Rp11,040
2 Amoxicillin Syr 250 mg/5ml Botol 33 B10223 DAK 2022 12/31/2024 Rp3,510 33 33 0 0 Rp0
3 Antasida DOEN Suspensi Botol 0 0 0 0 Rp0
8 Paracetamol Sirup 120 mg/5ml Botol 0 0 0 0 Rp0
2 Aqua Pro Injeksi 25 ml Flush 0 50 50 5 45 45 Rp2,250
4 Ampul 0 0 0 0 Rp0
5 Dexamethasone Injeksi Ampul 0 300 300 20 280 280 Rp84,000
6 Diphenhydramin inj Ampul 12 12 0 12 12 Rp0
7 Epinefrina HCl/Bitartrat(Adrenalina) inj.0,1%-1ml Ampul 0 0 0 0 Rp0
8 Gluconat Calcicum Inj 100 mg/ml Ampul 5 5 2 3 3 Rp0
9 Lidocain HCl 2% Ampul 101 56362059-3 DAK 2022 6/30/2026 Rp847 100 201 121 80 80 Rp8,000
10 Ampul 0 90 90 60 30 30 Rp2,700
11 Meprovent Inhaler Ampul 0 N2D028 DAK 2022 4/1/2028 Rp3,677 0 0 0 Rp0
13 MgSO4 20% Vial 4 B771451B DAK 2022 11/8/2023 Rp3,760 4 0 4 4 Rp0
14 MgSO4 40% Vial 4 4 4 0 0 0 Rp0
15 Oxytocin Injeksi Ampul 0 9622C0076A DAK 2022 3/31/2025 Rp1,298 100 100 10 90 90 Rp9,000 100
16 Omeprazole Inj 40 mg/ml Ampul 0 0 0 0 Rp0
17 Phytomenadion Inj 2 mg/ml Vial 0 0 0 0 Rp0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 0 Rp0
SEDIAAN TOPIKAL 0 0 0 Rp0
2 Tube 0 0 0 0 Rp0
IU/g + Polimiksin
DOEN Kombinasi:
3 Tube 0 0 Rp0
Asam Salisilat 3%
4 Betamethasone cream Tube 40 50 90 23 7 60 67 Rp3,350
6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 0 Rp0
8 Hydrocortison 2,5% Tube 33 F21197W DAK 2022 6/30/2024 Rp2,325 33 26 7 0 7 Rp0 50
10 Miconazole 2% Tube 30 DAK 2022 3/31/2025 Rp1,900 30 13 4 13 17 Rp0 30
14 Tube 0 0 0 0 Rp0
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 18 21J101 DAK 2022 9/30/2024 Rp6,578 18 8 10 10 Rp0 10
16 Bedak Salisyl 2% Tube 0 0 0 0 Rp0
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 0 Rp0
ANTISEPTIK DAN DESINFEKTAN 0 0 0 Rp0
VAKSIN DAN SERUM 0 0 0 Rp0
1 Serum Anti Bisa Ular /Biosave SABU Vial 0 0 0 0 Rp0
2 Vial 0 0 0 0 Rp0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 0 Rp0
2 Glucosa 10% (D10%) 500 ml Botol 20 20 1 1 18 19 Rp0
3 Natrium Chlorida (NaCl) 0,9% Botol 175 175 15 20 140 160 Rp0
4 Ringer Laktat Botol 446 F222L10 12/4/2025 160 606 346 20 240 260 Rp41,600 300
OBAT GIGI 0 0 0 Rp0
7 Sponestan / Surgipson pcs 24 24 0 24 24 Rp0
12 Pulp - X Botol 3 PK21222108 DAK 2022 1/7/2025 Rp210,500 3 0 3 3 Rp0
12 Eugenol Botol 2 2 2 0 0 0 Rp0
LABORATORIUM 0 0 0 Rp0
12 25 kit/box 0 0 0 0 Rp0
16 Stik Nesco Cholestrol Box 0 0 0 0 Rp0
17 Stik Nesco Asam Urat Box 0 0 0 0 Rp0
18 Stik Nesco Gula Box 0 0 0 0 Rp0
19 Stik Easy Touch Asam Urat Box 0 0 0 0 Rp0
20 Stik Easy Touch Gula Box 0 0 0 0 Rp0
21 Stik Easy Touch Cholestrol Box 0 0 0 0 Rp0
22 Stik Benecek Asam Urat Box 0 0 0 0 Rp0
23 Stik Benecek Gula Box 0 0 0 0 Rp0
24 Stik Benecek Cholestrol Box 0 C22128080 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0
28 Stik Gluko Protein Tes 10'S pcs 10 20 30 10 20 20 Rp400
29 Box 0 H22023 8/31/2024 0 0 0 Rp0
30 Widal kotak 0 0 0 0 Rp0
31 DILUENT GALON 0 0 0 0 Rp0
32 RINSE GALON 0 0 0 0 Rp0
38 Blue Tip Botol 500 500 0 500 500 Rp0
BAHAN KIMIA 0 0 0 Rp0
3 ABATE 1 Kg/ Botol 0 224R070007 APBN 6/8/2024 Rp0 0 0 0 Rp0
DANA DID, BTT & DBHCHT COVID 0 0 0 Rp0
BMHP 0 0 0 Rp0
8 pcs 0 0 0 0 Rp0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 3550 DID 2021 3550 1550 2000 2000 Rp0
21 Sarung Tangan Obgyn pcs 10 10 5 5 5 Rp0 10
TAMBAHAN 0 0 0 Rp0
LABORATORRIUM 0 0 0 Rp0
11 Tabung EDTA Tutup ungu pcs 0 0 0 0 Rp0
13 VTM pcs 0 0 0 0 Rp0
OBAT-OBATAN 0 0 0 Rp0
4 Allopurinol 300 mg Tablet 430 430 105 25 300 325 Rp0
19 Piroxicam 20 mg Tablet 0 2500 2500 430 170 1900 2070 Rp5,175,000
20 Piridoxin Tablet 0 1000 1000 400 600 600 Rp600,000
22 Kolkisin Tablet 430 430 5 125 300 425 Rp0
0 0 0 Rp0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0
2 Pot 0 0 0 0 Rp0
ANTISEPTIK DAN DESINFECTAN 0 0 0 Rp0
4 Alkohol 70% Botol 0 2022033065 DAK 2022 11/30/2023 Rp58,000 0 0 0 Rp0
HIBAH 0 0 0 Rp0
JKN 0 0 0 Rp0
1 Salbutamol 2 mg Tablet 2100 DAK 2022 2100 200 100 1800 1900 Rp0
0
1 Masker Hijab Pcs 0 0 0 0
2 Vitamin B12 Tablet 860 DAK 2022 860 10 150 700 850
3 Bionicom Zinc Tablet 0 0 0 0
4 Masker Oksigen Non Rebriting Bayi Pcs 0 DAK 2023 0 0 0 0
5 Sarung Tangan Non Steril S pcs 800 100 900 0 900 900 Rp90,000
6 R1 Anti HIV 1/2 Test WB/S/P pcs 0 150 150 150 0 0 Rp0

JUMLAH RESEP 184 161 807 1152

NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007
PUSKESMAS : RASABOU PELAPORAN BULAN : SEPTEMBER

KECAMATAN : HU'U PERMINTAAN BULAN : OKTOBER
STOCK TANGGAL PENERIM PERSEDI JUMLAH TOTAL SUB STOCK STOCK PERMINTAA
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA HARGA SATUAN PEMAKAIAN TOTAL HARGA STOK OPTIMUM
AWAL KADALUARSA AAN AAN EXPIRED UNIT GUDANG AKHIR N
1 2 3 4 5 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18
APBD 1 / APBN
Alat Kesehatan
5 Alkohol Swabs 100's Pcs 0 GM2011244 11/30/2025 Rp70 0 0 0 Rp0 0
12 Masker TB N95 Pcs 0 0 0 0 Rp0 0
OBAT-OBATAN 0 Rp0 0
1 Albendazole 400 mg Tablet 100 1107273 7/1/2023 100 0 0 100 100 Rp0 0
6 DHP Frimal (Kotak @9 Tablet) ktk 0 18 18 0 0 18 18 Rp324 0
9 Garam Oralit Sachet 600 300 900 121 4 775 779 Rp233,700 181.5
11 INH(Ishonizide) Tablet 0 0 0 0 Rp0 0
13 MDT Combi Dewasa MB (Merah) Blister 5 5 0 0 5 5 Rp0 0
16 Mineral Mix Sachet 12 13 25 13 0 12 12 Rp156 19.5
19 OAT Kat. 1,3 Paket 10 46461012 APBD I 2021 2/29/2024 Rp436,445 4 14 10 0 4 4 Rp16 15 10
21 OAT Kat Anak Paket 1 1 0 0 1 1 Rp0 0
23 Primaquin 15 mg Tablet 0 0 0 0 Rp0 0
25 Retinol 200.000 IU (Merah) Kapsul lunak 65 F21209W APBD I 6/30/2025 Rp586 65 25 40 0 40 Rp0 37.5
26 Retinol 100.000 IU (Biru) Kapsul lunak 380 E20910W APBD I 5/30/2025 Rp324 380 0 30 350 380 Rp0 0
28 Tablet Tambah Darah Tablet 26085 8200 34285 6445 40 27800 27840 ### 9667.5
SIRUP, SUSPENSI DAN DROP 0 0 0 Rp0 0
INJEKSI DAN PELARUT 0 0 0 Rp0 0
3 Metronidazole infus Botol 6 6 0 0 6 6 Rp0 0
4 Gentamicin inj Ampul 35 35 5 0 30 30 Rp0 7.5
5 MgSO4 20% Ampul 3 3 0 0 3 3 Rp0 0
6 MgSO4 40% Ampul 9 9 2 0 7 7 Rp0 3
7 Phytomenadion inj 2 mg/ml Ampul 126 126 6 0 120 120 Rp0 9
VAKSIN DAN SERUM 0 0 0 Rp0 0
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 2110125 10/17/2026 Rp1,185 0 0 0 Rp0 0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 0 0 0 0 Rp0 0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0 0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 FX2761 0 0 0 Rp0 0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 B832 8/31/2023 Rp3,280 0 0 0 Rp0 0
TETES MATA, TETES TELINGA, SALEP DAN 0 0
SEDIAAN TOPIKAL 0 0
4 Salep 2-4 Pot 0 0 0 0 Rp0 0
LABORATORIUM 0 0
4 Catride TCM TB
Malaria Ag. pLDH/HRP2 (COMBO Card Test) Pcs 0 0 0 0 Rp0 0
6 (MALARIA)
Handsanitizer 50 ml Botol 0 0 0 0 Rp0 0
10 Oil Emersi 500 ml Botol 1 1 1 0 Rp0 1.5
16 Pot Dahak / Pot Sputum Buah 0 280 280 0 0 280 280 Rp78,400 0
17 Reagen ZN 10 ktk/Dus 2 2 0 0 2 2 Rp0 0
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 0 H22019 APBN I 2023 7/31/2024 25 25 25 0 0 0 Rp0 37.5
19 Test 0 0 0 0 Rp0 0
21 Pcs 0 0 0 0 Rp0 0
22 Rapid Antigen (Whole Power) Pcs 0 0 0 0 Rp0 0
24 Reagen Golda A vial 0 0 0 0 Rp0 0 1
25 Reagen Golda B vial 0 0 0 0 Rp0 0 1
26 Reagen Golda AB vial 0 0 0 0 Rp0 0 1
27 Anti Resus D vial 0 0 0 0 Rp0 0 1
28 SD HIV-1/2 3,0 25/kotak 150 150 75 0 75 75 Rp0 112.5
29 TRIPOCHECK SYPHILIS 25/kotak 4 4 3 0 1 1 Rp0 4.5
34 Human Colesterol Liquid Botol 0 0 0 0 Rp0 0
35 Human Glucose liquid Botol 0 0 0 0 Rp0 0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 5352AF1AC APBD I 10/14/2023 0 0 0 Rp0 0
39 Virotec Dengue Kombo (P2M) Pcs 0 H22023 APBD I 8/31/2024 0 0 0 Rp0 0
DAK 0 0 0 Rp0 0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 0 Rp0 0
3 Alat Suntik sekali pakai 3 ml Pcs 0 2/13/1901 DAK 2022 4/9/2027 Rp979 0 0 0 Rp0 0
4 Alat Suntik sekali pakai 5 ml Pcs 0 710 DAK 2021 7/9/2026 Rp1,056 0 0 0 Rp0 0
5 Alkohol Swabs 100's Pcs 800 500 1300 1180 20 100 120 Rp60,000 1770 2000
6 Blade Sterile (Mess) Pcs 74 74 27 5 42 47 Rp0 40.5
7 Blood Lancet Pcs 4300 4300 400 0 3900 3900 Rp0 600
8 Blod TransfusiSet Stera Pcs 37 280320088 DAK 2021 2/1/2025 Rp3,600 37 20 2 15 17 Rp0 30
10 Catgut Plain 3/0 HR 37 mm Pcs 7 7 7 0 0 0 Rp0 10.5
14 Foley Catheter no. 18 Pcs 0 20191017 DAK 2021 10/16/2024 Rp14,341 0 0 0 Rp0 0
17 Infus Set Dewasa Pcs 149 100 249 150 9 90 99 Rp9,900 225 100
19 IV Catheter no. 18 Pcs 117 117 72 18 27 45 Rp0 108 200
20 IV Catheter no. 20 Pcs 0 300 300 195 5 100 105 Rp31,500 292.5 100
21 IV Catheter no. 22 Pcs 40 21L2506J DAK 2022 11/30/2026 Rp4,862 200 240 146 4 90 94 Rp18,800 219 200
22 IV Catheter no. 24 Pcs 67 20108D003 DAK 2022 8/30/2027 Rp12,804 100 167 61 6 100 106 Rp10,600 91.5 100
25 Kapas Pembalut 500 gr Bungkus 0 0 0 0 Rp0 0 5
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 5 5 10 6 1 3 4 Rp20 9
27 Kassa Steril kotak 0 0 0 0 Rp0 0 30
28 Masker Nebul Anak Pcs 0 0 0 0 Rp0 0 15
29 Masker Nebul Dewasa Pcs 0 0 0 0 Rp0 0 15
30 Nasal Canula Bayi (Oxyflow) Pcs 2 2 2 0 0 0 Rp0 3
31 Nasal Canula Anak (Oxyflow) Pcs 0 0 0 0 Rp0 0
32 Nasal Canula Dewasa (Oxyflow) Pcs 0 0 0 0 Rp0 0
34 Polifix / Hipavix 5mx5cm Roll 5 40 45 17 3 25 28 Rp1,120 25.5
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 200 200 200 0 0 0 Rp0 300
36 Sarung Tangan Non Steril M Pcs 900 100 1000 770 30 200 230 Rp23,000 1155 1000
37 Sarung Tangan Non Steril L Pcs 700 7117306137 DAK 2022 4/30/2027 Rp546 700 400 0 300 300 Rp0 600 1000
41 Tes kehamilan Pcs 0 0 0 0 Rp0 0
43 Urine Bag Pcs 10 20 30 3 2 25 27 Rp540 4.5
44 Sarung Tangan Steril 7 Pcs 89 SH2202032 DAK 2022 3/30/2027 89 87 0 2 2 Rp0 130.5
45 Stik Benecheck Glukosa PTM Stip 2000 2000 200 0 1800 1800 Rp0 300
46 Benecheck Plus Monitoring PTM kotak 0 0 0 0 Rp0 0
OBAT-OBATAN 0 0 0 Rp0 0
1 Acetylcystein 200 mg Tablet 3100 22AS1211 DAK 2022 9/30/2024 Rp307 3100 2440 60 600 660 Rp0 3660
2 Tablet 200 200 0 0 200 200 Rp0 0
)
7 Amoxicillin 500 mg Tablet 6285 5000 11285 5385 200 5700 5900 Rp29,500,000 8077.5
8 Antasida DOEN Tablet Tablet 7090 3000 10090 3440 150 6500 6650 Rp19,950,000 5160
14 Captopril 25 mg Tablet 4638 1000 5638 759 179 4700 4879 Rp4,879,000 1138.5
15 Calcium Lactate Tablet 1860 3000 4860 845 15 4000 4015 Rp12,045,000 1267.5
16 Cavicur Tablet 4970 1000 5970 2160 110 3700 3810 Rp3,810,000 3240
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 1570 2207099 DAK 2022 7/30/2024 Rp70 6000 7570 4790 180 2600 2780 Rp16,680,000 7185 3000
19 Cotrimoxazol 480 mg Tablet 0 0 0 0 Rp0 0
20 Cetirizin HCL Tablet 495 495 495 0 0 0 Rp0 742.5
23 Dexamethasone 0,5 mg Tablet 0 0 0 0 Rp0 0
30 Folic Acid 1mg Tablet 1670 2110-050365 DAK 2021 10/1/2023 Rp43 1670 1230 440 0 0 0 Rp0 660
32 Glibenclamide 5 mg Tablet 3570 3570 940 130 2500 2630 Rp0 1410 2500
34 Glimepiride 2 mg Tablet 0 3000 3000 250 50 2700 2750 Rp8,250,000 375
36 Griseovulfin 125 mg Tablet 710 710 0 110 600 710 Rp0 0
38 Hydrochlorthiazide 25 mg Tablet 80 80 0 0 80 80 Rp0 0
40 Ibuprofen 400 mg Tablet 5820 7000 12820 5230 90 7500 7590 Rp53,130,000 7845
41 Ketokonazole 200 mg Tablet 210 1000 1210 50 10 1150 1160 Rp1,160,000 75
42 Loperamide Tablet 3530 1000 4530 172 58 4300 4358 Rp4,358,000 258
43 Loratadine 10 mg Tablet 0 4000 4000 980 20 3000 3020 Rp12,080,000 1470
44 Metyl Ergometrin 0,125 MG Tablet 0 100 100 0 0 100 100 Rp10,000 0
46 Metformin 500 mg Tablet 0 0 0 0 Rp0 0
49 Metronidazole 500 mg Tablet 130 130 70 60 0 60 Rp0 105
53 Nystatin 500.000 IU Tablet Tablet 100 46371001 DAK 2022 3/30/2024 Rp0 100 0 30 70 100 Rp0 0
54 Natrium Diklofenak 25 mg Tablet 0 G12162J DAK 2021 7/1/2026 Rp114 0 0 0 Rp0 0
55 Natrium Diklofenak 50 mg Tablet 6840 5000 11840 2700 140 9000 9140 Rp45,700,000 4050
56 Omeprazole Cap Tablet 4025 1000 5025 975 150 3900 4050 Rp4,050,000 1462.5
57 Paracetamol 500 mg Tablet 3720 3720 3720 0 0 0 Rp0 5580
58 Phytomenadion 10 mg Tablet 0 200 200 30 70 100 170 Rp34,000 45
61 Propylthiouracil 100 mg Tablet 100 100 200 0 0 200 200 Rp20,000 0
62 Pyrantel Pamoate 125 mg Tablet 0 0 0 0 Rp0 0
64 Salbutamol 4 mg Tablet 1405 1405 75 130 1200 1330 Rp0 112.5
65 Simvastatin 10 mg Tablet 2450 500 2950 1010 240 1700 1940 Rp970,000 1515
66 Simvastatin 20 mg Tablet 2720 500 3220 680 40 2500 2540 Rp1,270,000 1020
67 Vitamin B Kompleks Tablet 3805 6000 9805 2425 80 7300 7380 Rp44,280,000 3637.5
68 Zinc 20 mg Tablet 2920 3000 5920 230 90 5600 5690 Rp17,070,000 345
68 Cefadroksil Monohidrat 500 mg Tablet 0 2210-12-57 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0 0
1 Amoxicillin Syr 125 mg/5ml Botol 92 92 45 7 40 47 Rp0 67.5 200
2 Amoxicillin Syr 250 mg/5ml Botol 0 B10223 DAK 2022 12/31/2024 Rp3,510 0 0 0 Rp0 0
2 Aqua Pro Injeksi 25 ml Flush 45 45 5 5 35 40 Rp0 7.5
4 Ampul 0 0 0 0 Rp0 0
5 Dexamethasone Injeksi Ampul 280 280 20 60 200 260 Rp0 30
6 Diphenhydramin inj Ampul 12 12 0 0 12 12 Rp0 0
8 Gluconat Calcicum Inj 100 mg/ml Ampul 3 3 0 0 3 3 Rp0 0
9 Lidocain HCl 2% Ampul 80 56362059-3 DAK 2022 6/30/2026 Rp847 100 180 26 4 150 154 Rp15,400 39
10 Ampul 30 30 60 0 0 60 60 Rp1,800 0
11 Meprovent Inhaler Ampul 0 N2D028 DAK 2022 4/1/2028 Rp3,677 0 0 0 Rp0 0
13 MgSO4 20% Vial 4 B771451B DAK 2022 11/8/2023 Rp3,760 4 0 0 4 4 Rp0 0
14 MgSO4 40% Vial 0 0 0 0 Rp0 0
15 Oxytocin Injeksi Ampul 90 9622C0076A DAK 2022 3/31/2025 Rp1,298 100 190 0 0 190 190 Rp19,000 0
16 Omeprazole Inj 40 mg/ml Ampul 0 0 0 0 Rp0 0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 0 Rp0 0
SEDIAAN TOPIKAL 0 0 0 Rp0 0
2 Tube 0 0 0 0 Rp0 0
IU/g + Polimiksin
DOEN Kombinasi:
3 Tube 0 0 Rp0 0
Asam Salisilat 3%
4 Betamethasone cream Tube 67 25 92 31 5 56 61 Rp1,525 46.5 100
5 Chloramphenicol 1% Salep Mata Tube 38 24 62 13 5 44 49 Rp1,176 19.5
8 Hydrocortison 2,5% Tube 7 F21197W DAK 2022 6/30/2024 Rp2,325 7 6 1 0 1 Rp0 9
10 Miconazole 2% Tube 17 DAK 2022 3/31/2025 Rp1,900 17 17 0 0 0 Rp0 25.5
14 Tube 0 0 0 0 Rp0 0
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 10 21J101 DAK 2022 9/30/2024 Rp6,578 28 38 10 3 25 28 Rp784 15
16 Bedak Salisyl 2% Tube 0 30 30 5 5 20 25 Rp750 7.5
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFEKTAN 0 0 0 Rp0 0
2 E-Care Hand Sanitizer 500 ml Botol 0 0 0 0 Rp0 0 10
2 Vial 0 0 0 0 Rp0 0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 0 Rp0 0
3 Natrium Chlorida (NaCl) 0,9% Botol 160 160 27 3 130 133 Rp0 40.5
4 Ringer Laktat Botol 260 F222L10 12/4/2025 300 560 475 5 80 85 Rp25,500 712.5 400
OBAT GIGI 0 0 0 Rp0 0
7 Sponestan / Surgipson pcs 24 24 0 0 24 24 Rp0 0
12 Pulp - X Botol 3 PK21222108 DAK 2022 1/7/2025 Rp210,500 3 0 0 3 3 Rp0 0
12 Eugenol Botol 0 0 0 0 Rp0 0
LABORATORIUM 0 0 0 Rp0 0
1 Golda A Vial 0 0 0 0 Rp0 0
2 Golda B Vial 0 0 0 0 Rp0 0
3 Golda AB Vial 0 0 0 0 Rp0 0
4 Golda Resus D Vial 0 0 0 0 Rp0 0
12 25 kit/box 0 0 0 0 Rp0 0
22 Stik Benecek Asam Urat Box 0 0 0 0 Rp0 0
24 Stik Benecek Cholestrol Box 0 C22128080 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0 0
28 Stik Gluko Protein Tes 10'S pcs 20 20 0 0 20 20 Rp0 0
29 Box 0 H22023 8/31/2024 0 0 0 Rp0 0
38 Blue Tip Botol 500 500 0 0 500 500 Rp0 0
BAHAN KIMIA 0 0 0 Rp0 0
3 ABATE 1 Kg/ Botol 0 224R070007 APBN 6/8/2024 Rp0 0 0 0 Rp0 0
DANA DID, BTT & DBHCHT COVID 0 0 0 Rp0 0
BMHP 0 0 0 Rp0 0
3 APRON White pcs 0 30 30 0 0 30 30 Rp900 0
8 pcs 0 0 0 0 Rp0 0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 2000 DID 2021 2000 950 50 1000 1050 Rp0 1425 2000
21 Sarung Tangan Obgyn pcs 5 10 15 3 2 10 12 Rp120 4.5
TAMBAHAN 0 0 0 Rp0 0
LABORATORRIUM 0 0 0 Rp0 0
13 VTM pcs 0 0 0 0 Rp0 0
4 Allopurinol 300 mg Tablet 325 325 25 0 300 300 Rp0 37.5
19 Piroxicam 20 mg Tablet 2070 1000 3070 1470 100 1500 1600 Rp1,600,000 2205
20 Piridoxin Tablet 600 600 300 100 200 300 Rp0 450 1000
22 Kolkisin Tablet 425 425 0 25 400 425 Rp0 0
0 0 0 Rp0 0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0 0
2 Pot 0 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFECTAN 0 0 0 Rp0 0
4 Alkohol 70% Botol 0 2022033065 DAK 2022 11/30/2023 Rp58,000 0 0 0 Rp0 0
HIBAH 0 0 0 Rp0 0
JKN 0 0 0 Rp0 0
1 Salbutamol 2 mg Tablet 1900 DAK 2022 500 2400 195 105 2100 2205 Rp1,102,500 292.5
0 Rp0 0
1 Masker Hijab Pcs 0 0 0 0 Rp0 0
2 Vitamin B12 Tablet 850 DAK 2022 850 190 60 600 660 Rp0 285
3 Bionicom Zinc Tablet 0 0 0 0 Rp0 0
4 Masker Oksigen Non Rebriting Bayi Pcs 0 DAK 2023 0 0 0 Rp0 0 10
5 Sarung Tangan Non Steril S pcs 900 900 800 0 100 100 Rp0 1200
6 R1 Anti HIV 1/2 Test WB/S/P pcs 0 0 0 0 Rp0 0
6 Atropin sulfate Ampul 0 5 5 0 0 5 5 Rp25 0

JUMLAH RESEP 0

NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007
PUSKESMAS : RASABOU PELAPORAN BULAN : OKTOBER

KECAMATAN : HU'U PERMINTAAN BULAN : NOVEMBER
STOCK TANGGAL PENERIM PERSEDI JUMLAH TOTAL SUB STOCK STOCK PERMINTAA PEMBERIA
NO NAMA OBAT / ALKES SATUAN NO. BACTH SUMBER DANA HARGA SATUAN PEMAKAIAN TOTAL HARGA STOK OPTIMUM
AWAL KADALUARSA AAN AAN EXPIRED UNIT GUDANG AKHIR N N
1 2 3 4 5 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19
APBD 1 / APBN
Alat Kesehatan
5 Alkohol Swabs 100's Pcs 0 GM2011244 11/30/2025 Rp70 0 0 0 Rp0 0
12 Masker TB N95 Pcs 0 60 60 0 60 60 Rp3,600 0
OBAT-OBATAN 0 Rp0 0
1 Albendazole 400 mg Tablet 100 1107273 7/1/2023 100 0 0 100 100 Rp0 0
6 DHP Frimal (Kotak @9 Tablet) ktk 18 18 0 0 18 18 Rp0 0
9 Garam Oralit Sachet 779 779 169 10 600 610 Rp0 253.5
11 INH(Ishonizide) Tablet 0 0 0 0 Rp0 0
13 MDT Combi Dewasa MB (Merah) Blister 5 5 10 3 0 0 7 7 Rp35 0
16 Mineral Mix Sachet 12 12 0 0 12 12 Rp0 0
19 OAT Kat. 1,3 Paket 4 46461012 APBD I 2021 2/29/2024 Rp436,445 10 14 2 0 12 12 Rp120 3
21 OAT Kat Anak Paket 1 1 0 0 1 1 Rp0 0
23 Primaquin 15 mg Tablet 0 200 200 0 200 200 Rp40,000 0
25 Retinol 200.000 IU (Merah) Kapsul lunak 40 F21209W APBD I 6/30/2025 Rp586 40 15 25 0 25 Rp0 22.5
26 Retinol 100.000 IU (Biru) Kapsul lunak 380 E20910W APBD I 5/30/2025 Rp324 380 0 30 350 380 Rp0 0
28 Tablet Tambah Darah Tablet 27840 8200 36040 5990 50 30000 30050 ### 8985
3 Metronidazole infus Botol 6 6 0 0 6 6 Rp0 0
4 Gentamicin inj Ampul 30 30 0 0 30 30 Rp0 0
5 MgSO4 20% Ampul 3 3 0 0 3 3 Rp0 0
6 MgSO4 40% Ampul 7 7 0 0 7 7 Rp0 0
7 Phytomenadion inj 2 mg/ml Ampul 120 120 0 0 120 120 Rp0 0
1 Alat Suntik sekali pakai 0,3 ml Pcs 0 2110125 10/17/2026 Rp1,185 0 0 0 Rp0 0
13 Hepatitis B Imunoglobin (HbIg) Bayi Vial 0 0 0 0 Rp0 0
18 Vaksin Covid-19 (@2 Dosis) CORONAVAC Vial 0 0 0 0 Rp0 0
25 Vaksin Covid -19 Pfizer (@ 6 Dosis) Vial 0 FX2761 0 0 0 Rp0 0
32 Pelarut Pfizer NaCl 0,9% 10 ml Ampul 0 B832 8/31/2023 Rp3,280 0 0 0 Rp0 0
TETES MATA, TETES TELINGA, SALEP DAN 0 0
SEDIAAN TOPIKAL 0 0
4 Salep 2-4 Pot 0 0 0 0 Rp0 0
LABORATORIUM 0 0
4 Catride TCM TB
Malaria Ag. pLDH/HRP2 (COMBO Card Test) Pcs 0 0 0 0 Rp0 0
6 (MALARIA)
Handsanitizer 50 ml Botol 0 0 0 0 Rp0 0
11 Giemsa 500 ml Botol 0 1 1 0 1 1 Rp1 0
16 Pot Dahak / Pot Sputum Buah 280 280 280 0 0 0 Rp0 420
17 Reagen ZN 10 ktk/Dus 2 15 17 15 0 2 2 Rp30 22.5
18 Rapid Test HBsAg/ Virocheck 25 pcs/kotak 0 H22019 APBN I 2023 7/31/2024 125 125 100 0 25 25 Rp3,125 150
19 Test 0 0 0 0 Rp0 0
21 Pcs 0 0 0 0 Rp0 0
22 Rapid Antigen (Whole Power) Pcs 0 0 0 0 Rp0 0
24 Reagen Golda A vial 0 0 0 0 Rp0 0
25 Reagen Golda B vial 0 0 0 0 Rp0 0
26 Reagen Golda AB vial 0 0 0 0 Rp0 0
27 Anti Resus D vial 0 0 0 0 Rp0 0
28 SD HIV-1/2 3,0 25/kotak 75 75 25 0 50 50 Rp0 37.5
29 TRIPOCHECK SYPHILIS 25/kotak 1 2 3 1 0 2 2 Rp4 1.5
34 Human Colesterol Liquid Botol 0 0 0 0 Rp0 0
35 Human Glucose liquid Botol 0 0 0 0 Rp0 0
40 Standar Q HIV 1/2 Ab 3 Line R3 Pcs 0 5352AF1AC APBD I 10/14/2023 0 0 0 Rp0 0
39 Virotec Dengue Kombo (P2M) Pcs 0 H22023 APBD I 8/31/2024 30 30 0 30 30 Rp900 0
DAK 0 0 0 Rp0 0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 0 Rp0 0
3 Alat Suntik sekali pakai 3 ml Pcs 0 2/13/1901 DAK 2022 4/9/2027 Rp979 1000 1000 500 500 500 Rp500,000 750
4 Alat Suntik sekali pakai 5 ml Pcs 0 710 DAK 2021 7/9/2026 Rp1,056 1000 1000 200 800 800 Rp800,000 300
5 Alkohol Swabs 100's Pcs 120 1700 1820 1800 20 0 20 Rp34,000 2700 2000
6 Blade Sterile (Mess) Pcs 47 47 47 0 0 0 Rp0 70.5
7 Blood Lancet Pcs 3900 3900 400 0 3500 3500 Rp0 600
8 Blod TransfusiSet Stera Pcs 17 280320088 DAK 2021 2/1/2025 Rp3,600 17 5 2 10 12 Rp0 7.5 100
10 Catgut Plain 3/0 HR 37 mm Pcs 0 0 0 0 0 0 Rp0 0
14 Foley Catheter no. 18 Pcs 0 20191017 DAK 2021 10/16/2024 Rp14,341 0 0 0 Rp0 0
16 Infus Set Anak Pcs 0 0 0 0 Rp0 0 300
17 Infus Set Dewasa Pcs 99 150 249 145 4 100 104 Rp15,600 217.5 300
19 IV Catheter no. 18 Pcs 45 100 145 90 5 50 55 Rp5,500 135 300
20 IV Catheter no. 20 Pcs 105 200 305 230 5 70 75 Rp15,000 345 300
21 IV Catheter no. 22 Pcs 94 21L2506J DAK 2022 11/30/2026 Rp4,862 150 244 40 4 200 204 Rp30,600 60
22 IV Catheter no. 24 Pcs 106 20108D003 DAK 2022 8/30/2027 Rp12,804 100 206 150 6 50 56 Rp5,600 225 300
25 Kapas Pembalut 500 gr Bungkus 0 5 5 1 4 4 Rp20 1.5
26 Kasa panjang 42y x 110 cm Poli Kassa Rol 4 5 9 5 1 3 4 Rp20 7.5 6
27 Kassa Steril kotak 0 30 30 10 20 20 Rp600 15
28 Masker Nebul Anak Pcs 0 0 0 0 Rp0 0
29 Masker Nebul Dewasa Pcs 0 0 0 0 Rp0 0
30 Nasal Canula Bayi (Oxyflow) Pcs 0 0 0 0 0 0 Rp0 0
31 Nasal Canula Anak (Oxyflow) Pcs 0 0 0 0 Rp0 0
32 Nasal Canula Dewasa (Oxyflow) Pcs 0 0 0 0 Rp0 0
34 Polifix / Hipavix 5mx5cm Roll 28 28 17 1 10 11 Rp0 25.5
35 Plesterin Bulat Soft (Box @200 Pcs) 200/box 0 400 400 100 0 300 300 Rp120,000 150
36 Sarung Tangan Non Steril M Pcs 230 1000 1230 1180 0 50 50 Rp50,000 1770
37 Sarung Tangan Non Steril L Pcs 300 7117306137 DAK 2022 4/30/2027 Rp546 1000 1300 1200 0 100 100 Rp100,000 1800
39 Silk 3/0 (Silk Braided Non Absorbable Suture Sterile) Pcs 142 142 90 2 50 52 Rp0 135 100
41 Tes kehamilan Pcs 0 0 0 0 Rp0 0
43 Urine Bag Pcs 27 27 5 2 20 22 Rp0 7.5
44 Sarung Tangan Steril 7 Pcs 2 SH2202032 DAK 2022 3/30/2027 2 2 0 0 0 Rp0 3
45 Stik Benecheck Glukosa PTM Stip 1800 1800 100 0 1700 1700 Rp0 150
46 Benecheck Plus Monitoring PTM kotak 0 0 0 0 Rp0 0
1 Acetylcystein 200 mg Tablet 660 22AS1211 DAK 2022 9/30/2024 Rp307 3800 4460 3490 70 900 970 Rp3,686,000 5235 5000
2 Tablet 200 200 0 0 200 200 Rp0 0
)
6 Amlodipin 10 mg Tablet 8225 8225 1525 100 6600 6700 Rp0 2287.5
7 Amoxicillin 500 mg Tablet 5900 5900 4700 200 1000 1200 Rp0 7050 10000
8 Antasida DOEN Tablet Tablet 6650 6650 4500 150 2000 2150 Rp0 6750 5000
10 Asam Mefenamat 500 mg Tablet 7770 7770 2400 170 5200 5370 Rp0 3600
15 Calcium Lactate Tablet 4015 4015 2000 15 2000 2015 Rp0 3000 3000
16 Cavicur Tablet 3810 3810 2200 110 1500 1610 Rp0 3300
18 Chlorpheniramin Maleat (CTM) 4 mg Tablet 2780 2207099 DAK 2022 7/30/2024 Rp70 4500 7280 4800 180 2300 2480 Rp11,160,000 7200 5000
19 Cotrimoxazol 480 mg Tablet 0 0 0 0 Rp0 0
20 Cetirizin HCL Tablet 0 1000 1000 620 80 300 380 Rp380,000 930 2000
23 Dexamethasone 0,5 mg Tablet 0 0 0 0 Rp0 0
30 Folic Acid 1mg Tablet 0 2110-050365 DAK 2021 10/1/2023 Rp43 0 0 0 0 0 Rp0 0
32 Glibenclamide 5 mg Tablet 2630 2500 5130 1200 130 3800 3930 Rp9,825,000 1800
36 Griseovulfin 125 mg Tablet 710 710 0 110 600 710 Rp0 0
38 Hydrochlorthiazide 25 mg Tablet 80 80 0 0 80 80 Rp0 0
40 Ibuprofen 400 mg Tablet 7590 7590 5200 90 2300 2390 Rp0 7800 5000
41 Ketokonazole 200 mg Tablet 1160 1160 50 10 1100 1110 Rp0 75
43 Loratadine 10 mg Tablet 3020 3020 1000 20 2000 2020 Rp0 1500
44 Metyl Ergometrin 0,125 MG Tablet 100 100 0 0 100 100 Rp0 0
46 Metformin 500 mg Tablet 0 0 0 0 Rp0 0
49 Metronidazole 500 mg Tablet 60 60 60 0 0 0 Rp0 90
53 Nystatin 500.000 IU Tablet Tablet 100 46371001 DAK 2022 3/30/2024 Rp0 100 0 30 70 100 Rp0 0
54 Natrium Diklofenak 25 mg Tablet 0 G12162J DAK 2021 7/1/2026 Rp114 0 0 0 Rp0 0
55 Natrium Diklofenak 50 mg Tablet 9140 9140 3000 140 6000 6140 Rp0 4500
56 Omeprazole Cap Tablet 4050 4050 900 150 3000 3150 Rp0 1350
57 Paracetamol 500 mg Tablet 0 0 0 0 0 0 Rp0 0 1000
58 Phytomenadion 10 mg Tablet 170 170 80 40 50 90 Rp0 120 300
61 Propylthiouracil 100 mg Tablet 200 200 0 0 200 200 Rp0 0
62 Pyrantel Pamoate 125 mg Tablet 0 0 0 0 Rp0 0
64 Salbutamol 4 mg Tablet 1330 1330 70 60 1200 1260 Rp0 105
67 Vitamin B Kompleks Tablet 7380 7380 2100 80 5200 5280 Rp0 3150
68 Zinc 20 mg Tablet 5690 5690 300 90 5300 5390 Rp0 450
68 Cefadroksil Monohidrat 500 mg Tablet 0 2210-12-57 DAK 2022 10/30/2026 Rp1,100 0 0 0 Rp0 0
1 Amoxicillin Syr 125 mg/5ml Botol 47 151 198 111 7 80 87 Rp13,137 166.5 100
2 Amoxicillin Syr 250 mg/5ml Botol 0 B10223 DAK 2022 12/31/2024 Rp3,510 0 0 0 Rp0 0
2 Aqua Pro Injeksi 25 ml Flush 40 40 5 5 30 35 Rp0 7.5
4 Ampul 0 0 0 0 Rp0 0
5 Dexamethasone Injeksi Ampul 260 260 10 50 200 250 Rp0 15
6 Diphenhydramin inj Ampul 12 12 0 0 12 12 Rp0 0
8 Gluconat Calcicum Inj 100 mg/ml Ampul 3 3 0 0 3 3 Rp0 0
9 Lidocain HCl 2% Ampul 154 56362059-3 DAK 2022 6/30/2026 Rp847 154 40 4 110 114 Rp0 60
10 Ampul 60 60 0 0 60 60 Rp0 0
11 Meprovent Inhaler Ampul 0 N2D028 DAK 2022 4/1/2028 Rp3,677 0 0 0 Rp0 0
13 MgSO4 20% Vial 4 B771451B DAK 2022 11/8/2023 Rp3,760 4 0 0 4 4 Rp0 0
14 MgSO4 40% Vial 0 0 0 0 Rp0 0
15 Oxytocin Injeksi Ampul 190 9622C0076A DAK 2022 3/31/2025 Rp1,298 190 0 0 190 190 Rp0 0
16 Omeprazole Inj 40 mg/ml Ampul 0 0 0 0 Rp0 0
TETES MATA, TETES TELINGA, SALEP DAN 0 0 0 Rp0 0
SEDIAAN TOPIKAL 0 0 0 Rp0 0
2 Tube 0 0 0 0 Rp0 0
IU/g + Polimiksin
DOEN Kombinasi:
3 Tube 0 0 Rp0 0
Asam Salisilat 3%
4 Betamethasone cream Tube 61 100 161 56 5 100 105 Rp10,500 84
8 Hydrocortison 2,5% Tube 1 F21197W DAK 2022 6/30/2024 Rp2,325 1 1 0 0 0 Rp0 1.5
10 Miconazole 2% Tube 0 DAK 2022 3/31/2025 Rp1,900 0 0 0 0 0 Rp0 0
14 Tube 0 0 0 0 Rp0 0
Belerang Endap 4%
15 Permetrin/ Scabisite Tube 28 21J101 DAK 2022 9/30/2024 Rp6,578 28 10 3 15 18 Rp0 15
16 Bedak Salisyl 2% Tube 25 25 10 5 10 15 Rp0 15
SUPPOSITORIA DAN LARUTAN REKTAL 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFEKTAN 0 0 0 Rp0 0
2 E-Care Hand Sanitizer 500 ml Botol 0 10 10 5 5 5 Rp50 7.5
2 Vial 0 0 0 0 Rp0 0
(Tetagram)
LARUTAN ELEKTROLIT DAN CAIRAN INFUS 0 0 0 Rp0 0
1 Glucosa 5% (D5%) 500 ml Botol 18 18 7 1 10 11 Rp0 10.5
2 Glucosa 10% (D10%) 500 ml Botol 17 17 5 2 10 12 Rp0 7.5
3 Natrium Chlorida (NaCl) 0,9% Botol 133 133 80 3 50 53 Rp0 120 60
4 Ringer Laktat Botol 85 F222L10 12/4/2025 640 725 600 5 120 125 Rp80,000 900 600
OBAT GIGI 0 0 0 Rp0 0
7 Sponestan / Surgipson pcs 24 24 0 0 24 24 Rp0 0
12 Pulp - X Botol 3 PK21222108 DAK 2022 1/7/2025 Rp210,500 3 0 0 3 3 Rp0 0
12 Eugenol Botol 0 0 0 0 Rp0 0
LABORATORIUM 0 0 0 Rp0 0
1 Golda A Vial 0 3 3 3 0 Rp0 4.5
2 Golda B Vial 0 3 3 3 0 Rp0 4.5
3 Golda AB Vial 0 3 3 3 0 Rp0 4.5
4 Golda Resus D Vial 0 3 3 3 0 Rp0 4.5
12 25 kit/box 0 0 0 0 Rp0 0
22 Stik Benecek Asam Urat Box 0 0 0 0 Rp0 0
24 Stik Benecek Cholestrol Box 0 C22128080 DAK 2022 12/31/2023 Rp25,723 0 0 0 Rp0 0
28 Stik Gluko Protein Tes 10'S pcs 20 20 10 0 10 10 Rp0 15
29 Box 0 H22023 8/31/2024 0 0 0 Rp0 0
38 Blue Tip Botol 500 500 0 0 500 500 Rp0 0
BAHAN KIMIA 0 0 0 Rp0 0
3 ABATE 1 Kg/ Botol 0 224R070007 APBN 6/8/2024 Rp0 0 0 0 Rp0 0
DANA DID, BTT & DBHCHT COVID 0 0 0 Rp0 0
BMHP 0 0 0 Rp0 0
3 APRON White pcs 30 30 0 0 30 30 Rp0 0
8 pcs 0 0 0 0 Rp0 0
Nasofaring Kecil
9 Masker Ear loop 3 ply pcs 1050 DID 2021 2000 3050 1000 50 2000 2050 Rp4,100,000 1500
21 Sarung Tangan Obgyn pcs 12 12 5 2 5 7 Rp0 7.5
TAMBAHAN 0 0 0 Rp0 0
LABORATORRIUM 0 0 0 Rp0 0
13 VTM pcs 0 0 0 0 Rp0 0
19 Piroxicam 20 mg Tablet 1600 1000 2600 1700 100 800 900 Rp900,000 2550 3000
20 Piridoxin Tablet 300 1000 1300 300 100 900 1000 Rp1,000,000 450
22 Kolkisin Tablet 425 425 0 25 400 425 Rp0 0
0 0 0 Rp0 0
SEDIAAN TOPIKAL
1 Salep 2 - 4 pot 0 0 0 0 Rp0 0
2 Pot 0 0 0 0 Rp0 0
ANTISEPTIK DAN DESINFECTAN 0 0 0 Rp0 0
4 Alkohol 70% Botol 0 2022033065 DAK 2022 11/30/2023 Rp58,000 0 0 0 Rp0 0
HIBAH 0 0 0 Rp0 0
JKN 0 0 0 Rp0 0
1 Salbutamol 2 mg Tablet 2205 DAK 2022 2205 200 105 1900 2005 Rp0 300
0 Rp0 0
1 Masker Hijab Pcs 0 0 0 0 Rp0 0
2 Vitamin B12 Tablet 660 DAK 2022 660 100 60 500 560 Rp0 150
3 Bionicom Zinc Tablet 0 0 0 0 Rp0 0
4 Masker Oksigen Non Rebriting Bayi Pcs 0 DAK 2023 0 0 0 Rp0 0
5 Sarung Tangan Non Steril S pcs 100 100 100 0 0 0 Rp0 150
6 R1 Anti HIV 1/2 Test WB/S/P pcs 0 0 0 0 Rp0 0
6 Atropin sulfate Ampul 5 5 0 0 5 5 Rp0 0


NIP. 19651231 198603 1 221 NIP. 19690307 198903 2 013 NIP. 19660219 199401 1 002 NIP. 19910201 202203 1 007

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LAPORAN PEM

Kombinasi Ipratropium Bromida 0,5 mg + Salbutamol

7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol

RIGHT SIGN Malaria P.f/Pan Rapid Test Cassette

13 Standbio Glucose 1 x 250 ml Kit

MENGETAHUI, YANG MENYERAHKAN,

Maman .SKM,M.Mkes Indi Hartini, A.Md.,Farm

TANGGAL HARGA PENERIM PERSEDI JUMLAH TOTAL SUB

GRATIS JKN TOTAL

YANG MENYERAHKAN, YANG MEMINTA, YANG

PALA UPTD IFP DOMPU KEPALA UPTD PUSKESMAS PENGELOLA

ndi Hartini, A.Md.,Farm Joharis, AMG

STOCK STOCK PERMINTAA

apt. Ajhar, S.Farm

NO NAMA OBAT / ALKES

34 Pelarut NaCl 0,9% 10 ml

7 Chloramphenicol Tetes Telinga (Erlamycetin)

13 Standbio Glucose 1 x 250 ml

STOCK TANGGAL HARGA

Tablet 280 7/1/2023

Pcs 0 10/17/2026 Rp1,185

Tablet 3400 DAK 2022 9/30/2024 Rp307

Ampul 8 DAK 2022 4/1/2028 Rp3,677

UMUM GRATIS JKN

Indi Hartini, A.Md.,Farm

PENERIM PERSEDI JUMLAH TOTAL SUB STOCK

4000 4280 4114 166 0

390 270 120 0 0

YANG MEMINTA, YANG MENE

Joharis, AMG apt. Ajhar, S

STOCK PERMINTAA PEMBERIA

apt. Ajhar, S.Farm

PUSKESMAS : RASABOU PELAPORAN BULAN : MARET

1 2 3 4 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19

Kombinasi Ipratropium Bromida 0,5 mg + Salbutamol

5 Dexamethasone Injeksi Ampul 0 0 0 0 Rp0 0

6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 0 Rp0 0

7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol 0 0 0 0 Rp0 0

RIGHT SIGN Malaria P.f/Pan Rapid Test Cassette

13 Standbio Glucose 1 x 250 ml Kit 0 0 0 0 Rp0 0

UMUM GRATIS JKN TOTAL

MENGETAHUI, YANG MENYERAHKAN, YANG MEMINTA, YANG MENERIMA,

PUSKESMAS : RASABOU PELAPORAN BULAN : APRIL

1 2 3 4 6 7 8 9 10=9+4 11 12 = (10-11-13) 13 14 15 16 17= 12+(9*50%) 18 19

Kombinasi Ipratropium Bromida 0,5 mg + Salbutamol

5 Dexamethasone Injeksi Ampul 0 0 0 0 Rp0

6 Chloramphenicol 2% Salep Kulit (Bufacetin) Tube 0 0 0 0 Rp0 20

7 Chloramphenicol Tetes Telinga (Erlamycetin) Botol 0 0 0 0 Rp0

RIGHT SIGN Malaria P.f/Pan Rapid Test Cassette

13 Standbio Glucose 1 x 250 ml Kit 0 0 0 0 Rp0

UMUM GRATIS JKN TOTAL

MENGETAHUI, YANG MENYERAHKAN, YANG MEMINTA, YANG MENERIMA,

NAMA OBAT / ALKES

Tablet 6752 DAK 2022

Indi Hartini, A.Md.,Farm

TANGGAL HARGA PENERIM PERSEDI

NYERAHKAN, YANG MEMINTA,

i, A.Md.,Farm Joharis, AMG

JUMLAH TOTAL SUB STOCK

MEMINTA, YANG MEN

aris, AMG apt. Ajhar, S

apt. Ajhar, S.Farm

PUSKESMAS : RASABOU PELAPORAN BULAN : JUNI