Jurnal Januari

LAPORAN KETERSEDIAN OBAT
PUSKESMAS BOWONG CINDEA

DINAS KESEHATAN KABUPATEN PANGKEP
PERIODE : DESEMBER 2021
STOK AWAL PENERIMAAN

NO
NAMA OBAT SATUAN HARGA DESEMBER 2021 DESEMBER 2021
URUT
JUMLAH TOTAL HARGA JUMLAH
1 2 3 4 5 6 7
1 Allopurinol tablet 100 mg Tablet 90.00 -

2 Abon AMP (Amphetamine) Test 16,500.00 -
3 Ambroxol Tablet 160.00 -
4 Ambroxol tablet Tablet 224.40 - 1,000
5 Aminofillin 200 mg Tablet 160.00 -
6 Amlodipin 10 mg Tablet 74.00 240 17,760.00
1 Amlodipin 5 mg Tablet 55.00 629 34,595.00
8 Acyclofir 200 mg Tablet 251.00 -
9 Acyclofir cr Tube 3,625.00 -
10 Alkohol 70% Botol 37,638.70 - 5
2 Alkohol swab 100 pcs 14,490.00 1 14,490.00 5
12 Alat Suntik 3 ml (cosmomed) Psc 1,102.20 - 100
13 Amitriptilin tablet salut 25 mg Tablet 123.00 -
14 Antasida tab Tablet 78.00 -
Anti A Monocloral Blood Grouping
15 Botol 75,020.00 -
Reagents
16 Botol 75,020.00 -
Reagents
17 Botol 101,761.00 -
Reagents
18 Anti D Duocloral Monocloral Botol 125,477.00 -
3 Antihemoroid Tablet 3,260.00 14 45,640.00
20 Asam mefenamat tablet 122.00 -
4 Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 3879 178,434.00
Botol/25
22 Asam Urat Test Strip 276,891.50 -
Strip
23 Becefort Tablet 1,536.70 -
24 BD Gard Kapsul Tablet 10,890.00 -
25 Blood Lancet Psc 138.00 -
26 Bioplacenton Tulle Box 108,324.00 -
5 Benecheck Strip Cholesterol Pcs 25,283.923 -
6 Benecheck Strip Uric Acid Pcs 6,689.54 -
7 Benecheck Strip Glucose Pcs 3,206.20 -
8 Captopril tab 25 mg Tablet 75.00 -
9 Cetrisyn sirup 5 mg/5 ml Botol 2,215.00 18 39,870.00
32 Calsium Laktat tablet 60.00 - 1,300
33 Ciprofloxasin tab 500 mg Tablet 260.00 - 500
34 Deksametason tablet 0,5 mg Tablet 151.80 - 5,000
35 Dengue test NS1 Test 132,000.00 -
10 Dimenhidrinat 50 mg Tablet 109.00 170 18,530.00
37 Domperidon tablet 10 mg Tablet 75.00 859 64,425.00
Kotak/50
11 Face Mask Ear Loop 69,000.00 -
pcs
39 Fenol Gliserol Botol 3,300.00 - 5
40 Fokus febrile Antigen O-B Paratiphy Vial 26,784.00 -
41 Fokus febrile Antigen O-C Paratiphy Vial 26,784.00 -
42 Fokus febrile Antigen O-D Paratiphy Vial 26,784.00 -
43 Fokus febrile Antigen H-A Paratiphy Vial 26,784.00 -
44 Fokus febrile Antigen H-B Paratiphy Vial 26,784.00 -
45 Fokus febrile Antigen H-C Paratiphy Vial 26,784.00 -
46 Fokus febrile Antigen H Paratiphy Vial 26,784.00 -
Fitomenadion (Vitamin K1) tablet salut
47 Tablet 690.00 -
10 mg
48 Fitomenadion (Vit K1) injeksi 2 mg/ 1 ml Ampul 4,236.00 -
49 Fit D3 1000 Tablet 2,178.00 -

50 Foley Catheter 2 Way FR No.18 Pcs 36,696.00 -
51 Gliceril guaiacolat tab 100 mg Tablet 28.75 -
12 Glimepirid tab 1 mg Tablet 96.00 1610 154,560.00
Garam oralit kombinasi serbuk untuk
53 Sachet 317.00 -
200 ml
54 Glukosa Larutan Infus 5% Botol 5,720.00 -
13 Griseofulvin tablet 125 mg Tablet 210.00 125 26,250.00
56 Handschoen No. 7 Steril Psg 11,432.00 -
57 Handschoen No. 7,5 Steril Psg 3,630.00 -
58 Hiosina Butilbromida tab 10 mg Tablet 1,050.00 - 500
59 Hipafix 15 cm x 5 m Roll 302,000.00 -
60 Human Humasens Plus Unit 814,009.50 -
61 Ibuprofen tablet 200 mg Tablet 123.17 -
62 Infusion set Anak Pcs 3,333.00 -
63 Infusion set dewasa Pcs 8,867.00 -
64 IV Catheter 20 G (Abbocath-T) Pcs 16,000.000 -
67 Ketokonazol tab 200 mg Tablet 260.00 - 300
68 Kloramfenikol salep kulit 2% (Bufacetin) Tube 3,360.00 -
69 Klorfeniramine Maleat (CTM) tab 4 mg Tablet 20.55 -

Kotrimoksazol Tablet 480 mg
70 Tablet 152.00 -
(Dewasa)
Botol 60
71 Kotrimoksazol syr 2,298.00 -
ml
Dus/20
72 Kolestrol test strip (Human humasens) 547,319.00 -
strip
73 Lidokain inj 2% com (pehacain inj) Ampul 3,113.05 -
74 Lidokain gel 2% Tube 41,600.00 -
75 Lidokain spray oral 10% Botol 177,216.00 -
76 Metformin tablet 500 mg Tablet 118.50 -
Metilergometrin maleat inj 0,200 mg -
77 Ampul 3,712.00 -
ml
Tube 10
78 Mikonazol krim/salep 2% (Nitrat) 3,150.00 -
gr
14 Natrium Diklofenak 50 mg Tablet 109.00 1839 200,451.00
Botol 500
15 Natrium Klorida larutan infus steril 6,900.00 40 276,000.00
ml
16 Nistatin Tab Salut 500.000UI Tablet 869.00 400 347,600.00
17 Obat batuk Hitam (Herbakof Syrup) Botol 14,273.00 7 99,911.00
83 Obat batuk Hitam (OBH) Botol 3,450.00 -
84 Omeprazole kaps 20 mg kapsul 129.00 - 600
85 Papaverin tablet 40 mg Tablet 180.90 -
86 Parasetamol syrup 120 mg/5 ml Botol 1,535.00 -
87 Parasetamol tablet 500 mg Tablet 60.00 -
88 Phenylbutazon tablet 200 mg Tablet 88.21 -
89 Piridoksin HCl (Vit.B6) tablet 10 mg Tablet 18.95 -
90 Piridoksin HCl (Vit.B6) tablet 10 mg Tablet 26.35 -
91 Pirantel pamoat tablet scored 125 mg Tablet 318.00 -
92 Pitogin inj Ampul 5,291.00 -
93 Plester ( Leucoplast 3 x 5 ) Roll 35,532.00 -
94 Prednison tablet 5 mg Tablet 105.88 -
18 Pritavit Kaplet Kaplet 1,027.95 2285 2,348,865.75
19 Ringer laktat larutan infus steril Botol 7,703.00 145 1,116,935.00
20 Salep 24 Tablet 1,475.00 -
99 Ranitidin tablet Tablet 85.00 - 500
100 Sarung Tangan M Pcs 495.00 -
101 Sarung Tangan S Pcs 495.00 -
102 Sarung Tangan Steril No. 7,5 Pcs 3,630.00 -
103 Sarung Tangan Steril No. 7 Pcs 3,630.00 -
104 Simvastatin tablet salut 20 mg Tablet 73.00 - 1,500
105 Tetrasiklin HCl kaps 500 mg kapsul 279.82 -
106 Thiamin HCl (Vit.B1) tablet 50 mg Tablet 57.55 -
107 Underpad 60x90 cm ( Cosmomed ) Pcs 8,970.00 -
108 Urine bag Pcs 4,488.00 -
109 Vitamin B kompleks tablet Tablet 24.31 -
110 Zinc tablet dispersible 20 mg Tablet 521.00 -
TOTAL DAU 4,984,316.75
1 Alat suntik sekali pakai 0,05 ml Pcs 1,240.00 -

1 Alat suntik sekali pakai 0,05 ml Pcs 1,518.00 300 455,400.00
2 Alat suntik 5 ml Pcs 1,583.00 123 194,709.00
3 Alat suntik sekali pakai 0,5 ml Pcs 1,650.00 1300 2,145,000.00
5 Albendazol Suspensi 200 mg/5 ml Botol 4,600.00 -
6 Albendazol tablet 400 mg Tablet 380.00 -
7 Albendazol tab 400 mg Tablet 271.14 -
4 Albendazol tab 400 mg Tablet 494.00 23 11,362.00
9 Alkohol swab pcs 242.00 -
5 Clozapine Tablet 1,121.00 202 226,442.00
6 DHP Tablet 2,134.00 18 38,412.00
7 Garam oralit Saccet 275.00 60 16,500.00
13 Handscoun L Pcs 490.00 -
14 Handscoun L Kotak 48,999.50 -
15 Klorpromazin tablet salut 100 mg (HCl) Tablet 147.00 -
8 Pot Sputum Pcs 2,272.00 -

17 Pot Dahak Pcs 2,950.00 -
18 Pot Dahak Non steril pot 2,000.00 -
9 Primaquin 15 mg Tablet 242.00 20 4,840.00
20 Obat FDC Kategori Anak Paket 285,339.00 -
10 Obat FDC Kategori 1 Paket 477,791.00 7 3,344,537.00
22 Obat FDC Kategori 2 Paket 1,592,731.00 -
23 Obat FDC Kategori 1 Paket 447,791.00 -
24 Rapid 1 HIV (SD) Tes 11,975.00 -
11 Rapid test Syphilis (Trepocheck) Tes 9,300.00 200 1,860,000.00
26 Rapid test HbSAg Tes 9,878.00 -
6 Rapid test Tifoid Tes 33,334.00 -
28 Rapid test HbSAg Tes 8,300.00 200 1,660,000.00
12 Risperidone Tablet 287.00 412 118,244.00
30 RPR Focus tes 4,260.00 -
31 SD HIV 19 Tes 14,340.00 -
32 Vaksin VAR Dus 153,000.00 -
13 Triheksifenidil 2 mg tab Tablet 91.00 334 30,394.00
34 Vaksin Anti Rabies Vial 165,000.00 -
14 Vaksin BCG Vial 61,996.00 - 5
36 Vaksin Campak Vial 28,204.00 -
15 Vaksin DPT HB HiB Vial 78,991.00 - 25
38 Vaksin DT Vial 17,996.00 -
9 Vaksin IPV Vial 158,994.00 - 12
40 Vaksin Immuno Globuline Vial 1,325,000.00 -
41 Vaksin Meningitis Vial 135,000.00 -
42 Vaksin HB Uniject (HB 0) Uniject 23,991.00 -
16 Vaksin HB Rekombinasi (HB-Pid) Uniject 23,991.00 - 10
17 Vaksin MR Vial 155,813.00 - 5
18 Vaksin Polio Oral (OPV) Vial 19,954.00 - 15
19 Vaksin TD Vial 16,995.00 -
20 Vaksin Hepatitis Immuno Globuline Vial 1,325,000.00 -
13 Zinc Tablet 20 mg Tablet 604.00 -
TOTAL P2PL 10,105,840.00
1 Alat suntik sekali pakai 1 ml Set 728.00 -

Alat Suntik 5 cc Luerlock with needle
2 Psc 1,125.85 -
22 Gx1 1/2 (Nipro)
3 Alat suntik 5 cc (Stera) Psc 840.00 -
4 Alkohol Swab (Onemed) Box 11,200.00 -
5 Alkohol 70 % 1 L (onemed) Botol 25,155.00 -
6 Alkohol 70 % 1 L (onemed) Botol 27,500.00 -
7 Allopurinol tab 100 mg Tablet 105.00 -
8 Allopurinol tablet 100 mg Tablet 99.00 -
9 Air untuk injeksi amp 25 ml Ampul 2,860.00 -
10 Aminofilin 200 mg Tablet 86.00 -
11 Amitriptyline tablet salut 25 mg Tablet 123.00 -
12 Acetylcystein kapsul 200 mg Kapsul 908.00 -
1 Amlodipin tablet 5 mg Tablet 55.00 -
2 Amlodipin tab 10 mg Tablet 74.00 -
17 Amoksisillin kaplet 500 mg Tablet 265.00 -
3 Amoksisillin kaplet 500 mg Tablet 231.00 5489 1,267,959.00
19 Amoksisillin kaplet 500 mg Tablet 248.00 -
4 Amoksisilin kaplet 500 mg Tablet 360.00 -
21 Amoksisillin sirup kering 125 mg/ 5 ml Botol 2,560.00 -
4 Amoksisillin sirup forte 250 mg/ 5 ml Botol 3,846.00 -
23 Amoksisillin sirup DS 250 mg/ 5 ml Botol 3,510.00 90 315,900.00
24 Anios Gel 85 Botol 88,678.66 -
25 Antasida Suspensi Botol 2,098.00 -
28 Antasida Doen tablet Tablet 60.00 -
5 Antasida Doen tablet Tablet 54.00 1990 107,460.00
30 Asam Askorbat (Vit.C) tab 50 mg Tablet 120.00 -
31 Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 -
6 Asam mefenamat kaplet 500 mg Tablet 117.00 723 84,591.00
33 Asam mefenamat kaplet 500 mg Tablet 112.00 -
34 Asam mefenamat kaplet 500 mg Tablet 103.00 -
35 Antifungi Salep Kulit Tube 5,170.00 -
36 Asiklovir tablet 200 mg Tablet 251.00 -
7 Attapulgit 630 mg (Puralex) Tablet 175.00 44 7,700.00
8 Asiklovir tablet 200 mg Tablet 236.00 652 153,872.00
9 Asiklovir tablet 400 mg Tablet 425.00 305 129,625.00
Botol/500
40 Asering 9,646.00 -
ml
10 Attapulgit Tablet 149.00 -
42 Betametason krim 0,1% Tube 5 gr 1,515.00 -
11 Betametasone krim 0,1 % Tube 1,520.00 76 115,520.00
44 Bisakodil Tablet 5 mg Tablet 337.00 -
45 Bufacetin(chloramfenicol salep kulit) Tube 3,585.00 -
46 Calsium Laktat Tablet 82.00 -
47 Captopril 25 mg Tablet 75.00 154 11,550.00 300
48 Catgut 3/0 Pcs 64,191.00 -
49 Ciprofloxasin tab 500 mg Tablet 298.00 -
50 Cetrisyn sirup botol 3,061.00 -
51 Dermafix Bliste 2,298.84 -
52 Deksamethason injeksi 5 mg/ml - 1 ml Ampul 1,210.00 -
53 Deksametason tablet 0,5 mg Tablet 34.00 -

12 Disposable safety box 5 liter Buah 18,000.00 15 270,000.00
13 Domperidon tablet 10 mg Tablet 75.00 -
56 Domperidon Tablet 10 mg Tablet 90.00 -
57 Domperidone suspensi 5 mg/5 ml Botol 2,862.00 -
14 Diazepam tablet 2 mg Tablet 70.00 475 33,250.00
15 Diazepam inj 5 mg/ml Vial 1,545.00 3 4,635.00
Diazepam lar rektal 5 mg/2,5 ml
60 Tube 14,459.00 -
(Stesolid Rektal)
16 Tube 21,021.00 4 84,084.00
(Stesolid Rektal)
17 Difenhidramin Hcl injeksi 10 mg/ml Ampul 825.00 3 2,475.00
63 Doxycycline 100 mg Tablet 309.00 -
64 Eritromisin 500 mg Kapsul 766.00 -
65 Efinefrin (Adrenalin) injeksi 1 mg/ml Ampul 2,354.00 -
66 Efinefrin (Adrenalin) injeksi 1 mg/ ml Ampul 1,518.00 -
Botol100
67 Etil Klorida Semprot 115,500.00 -
ml
68 Examination gloves size L (Aximed) Pcs 508.20 -
69 Examination gloves size M (Aximed) Pcs 508.20 -
70 Examination gloves size M (Aximed) Pcs 508.20 -
Botol 100
71 Fenobarbital 7,010.00 -
ml
72 Fenobarbital Tablet Tablet 177.00 -
73 Fitomenadion (Vit.K) injeksi 10 mg/ 1 ml Ampul 3,754.00 -
74 Fitomenadion (Vit.K) injeksi 10 mg/ 1 ml Ampul 4,083.00 -
75 Fitomenadion (Vit.K) injeksi 2 mg/ml Ampul 4,236.00 -

Fitomenadion (Vit.K)Tablet salut gula
8 Tablet 873.00 -
10 mg
Fitomenadion (Vit.K) tablet salut gula
18 Tablet 781.00 120 93,720.00
10 mg
78 Folley Catheter 2 Way No.16 (urocare) Pcs 8,960.00 -
79 Furosemid tab Tablet 88.00 -

80 Furosemid tab Tablet 84.00 -
81 Glass ionomer ART Buah 606,900.00 -
82 Garam oralit Sachet 317.00 -
83 Garam oralit kombinasi Sachet 274.00 -
Botol 500
84 Glukosa larutan infus 5% steril 5,720.00 -
ml
85 Glukosa larutan infus 5% steril Botol 6,900.00 -
86 Glimepirid tablet 2 mg Tablet 297.00 -
Gliceril guaiacolat tab 100 mg
19 Kotak 14,600.30 30 438,009.00
(Guaifenesin)
88 Gliseril Gualakolat tablet 100 mg Tablet 228.00 -
89 Griseofulvin tablet 125 mg Tablet 241.00 -
90 Griseofulvin tablet 125 mg Tablet 238.00 -
Kotak/25
91 Glukosa test strip 137,500.00 -
strip
92 Glukosa test strip Strip 7,084.00 -
Kotak 60
93 Gelatine sponge 322,190.00 -
spons
94 Haloperidol 1,5 mg Tablet 76.00 -
95 Haloperidol 2 mg (lodomer) Tablet 90.00 -
20 Haloperidol 5 mg Tablet 60.00 32 1,920.00
97 Handschoen No. 6,5 steril psg 8,487.66 -
21 Hidrokortisom krim 2,5 % Tube 2,648.00 80 211,840.00
99 Hidrokortisom krim 2,5 % Tube 2,812.00 -
Hiosina butilbromida tab 10 mg
11 Tablet 2,329.80 -
(Scopamin)
22 Hiosina Butilbromida tab 10 mg Tablet 1,050.00 -
102 Ibuprofen tablet 200 mg Tablet 125.79 -
103 Ibuprofen suspensi 100 mg/ 5 ml Botol 2,560.00 -
104 Ibuprofen suspensi 100 mg/ 5 ml Botol 3,849.00 -
105 Infusion set Anak(PKD 2) Set 6,930.00 -
106 Infuset dewasa (Aximed) Pcs 5,280.00 -
107 Introcan No.22 Pcs 13,200.00 -
108 Introcan No.24 Pcs 13,750.00 -
109 Isosorbid Dinitrate 5 mg Tablet 93.00 -
110 IV Catheter 18G x 1 1/4 (Steracath) Pcs 4,256.00 -
111 IV Catheter 20G x 1 1/4 (Steracath) Pcs 4,256.00 -
112 IV Catheter 20G x 1 1/4 (Nipro) Pcs 8,070.70 -
113 IV Catheter 22G x 1 (Steracath) Pcs 4,256.00 -
114 IV Catheter 24G x 3/4 (Steracath) Pcs 4,256.00 -
23 Kalsium Laktat (kalk) tablet 500 mg Tablet 60.00 555 33,300.00
Bungkus/1
24 Kapas pembalut 60,830.00 -
kg
117 Kasa kompres 40x40 Pcs 1,700.00 -
25 Kasa 2 m x 80 cm (Onemed) Roll 8,624.00 21 181,104.00
26 Kasa Pembalut Hydrofil 4 m x 5 cm (On Roll 840.00 10 8,400.00
120 Kasa Pembalut 4 m x 10 cm (Onemed) Roll 1,680.00 -
121 Kasa pembalut hidrofil 4 m x 15 cm Roll 2,400.00 -

13 Kasa Pembalut 4 m x 3 cm (Onemed) Roll 660.80 -
123 Ketokonazol tab 200 mg Tablet 305.00 -
27 Kloramfenikol Salep Kulit (Bufacetin) Tube 3,760.00 72 270,720.00
125 Kloramfenikol salep mata 1% Tube 2,013.00 -
28 Klorfeniramine Maleat (CTM) tab 4 mg Tablet 24.00 2045 49,080.00
127 klorfeniramini maleat (CTM) Tablet 26.27 -
Botol 60
128 Kotrimoksazol suspensi 2,052.00 -
ml
29 Kotrimoksazol tablet 480 mg Tablet 126.00 300 37,800.00
130 Kotrimoksazol tablet 480 mg Tablet 152.00 -
131 Kotrimoksaxol dewasa 480 mg Tablet 125.00 -
132 Loperamid tablet 2 mg Tablet 97.00 -
133 Loratadine Tablet 127.00 -
30 Lidokain Injeksi Comp Ampul 847.00 75 63,525.00
14 Lysol 1 liter (onemed) Botol 47,970.00 -
136 Lidokain injeksi Comp Ampul 1,405.00 -
137 Masker Tali Box 31,165.00 -
31 Metformin Tablet Tablet 77.00 1720 132,440.00
32 Miconazole Salep Kulit Tube 1,900.00 68 129,200.00
140 Mikonazole salep 2 % Tube 3,926.00 -
141 MgS04 20% Vial 3,200.00 -
33 Methylergometrine inj tab 0,2 mg/ml Ampul 1,069.00 3 3,207.00
Methylergometrine maleat tab 0,125
143 Tablet 245.00 -
mg
144 Metokloperamide tablet Tablet 100.00 -
145 Metokloperamide syr (Lexapram) Botol 2,750.00 -
146 Natrium Klorida larutan infus 0,9% Botol 500 ml 6,840.00 -
147 Natrium Klorida larutan infus 0,9% Botol 500 ml 6,410.00 -
148 Natrium diklofenak tablet Tablet 136.00 -
149 Nifedipin tablet 10 mg Tablet 127.00 -
150 Nifedipin tablet 10 mg Tablet 123.00 -
151 Nistatin 100.000 IU Tablet 645.00 -
34 Nistatin 500.000 IU Tablet 910.00 73 66,430.00
153 Onoiwa Kaplet 5,650.00 -
154 Obat antituberkulosis FDC Kategori 2 Paket 1,319,900.00 -
35 Oksitosin injeksi Ampul 1,348.00 70 94,360.00
36 Omeprazol kaps 20 mg Kapsul 129.00 400 51,600.00
157 Parasetamol sirup 120 mg/ 5 ml Botol 4,950.00 -
158 Parasetamol sirup 120 mg/ 5 ml Botol 1,013.00 -
37 Parasetamol sirup Botol 1,160.00 107 124,120.00
161 Parasetamol tablet 500 mg Tablet 186.78 5821 1,087,246.38
Botol 15
163 Parasetamol drops 100 mg/ml 5,720.00 -
ml
Botol 15
164 Parsetamol drops 100 mg/ml 5,980.00 -
ml
Piridoksin (Vitamin B6) tablet 10 mg
39 Tablet 72.00 1238 89,136.00
HCl
Piridoksin (Vitamin B6) tablet 10 mg
16 Tablet 141.00 -
HCl
40 Prednison tablet 5 mg Tablet 73.00 1728 126,144.00
169 Propanolol 10 mg tab Tablet 80.00 -
170 Plester 3 x 5 H leukoplast Roll 50,600.00 -
171 Povidone Iodine 30 ml (Onemed) Botol 3,190.00 -
Botol 60
172 Povidone Iodine 100 mg/ml 25,215.00 -
ml
173 Pyrantel pamoat Tablet 318.00 -
17 Ringer laktat larutan infus botol 7,630.00 -
Botol 500
18 Ringer laktat larutan infus 7,150.00 -
ml
176 Ranitidin tablet 150 mg Tablet 114.00 -
177 Rivanol 300 cc (onemed) Botol 2,983.50 -
178 Sarung tangan obgyn steril Psg 22,000.00 -
41 Simvastatin tablet salut 20 mg Tablet 150.00 183 27,450.00
180 Simvastatin tablet salut 20 mg Tablet 252.00 -
42 Salbutamol tablet 4 mg Tablet 67.00 476 31,892.00
182 Salbutamol syr Botol 5,463.00 -
Pot 30
183 Salep 2-4 kombinasi 2,200.00 -
gram
184 Salep 2-4 kombinasi Pot 3,017.00 -
Sianokobalamin (Vit.B12)injeksi 500
185 Ampul 1,226.00 -
mcg
43 Sianokobalamin (Vit.B12) tablet 50 mg Tablet 44.00 351 15,444.00
187 Silk 3/0 Psc 53,064.00 -

188 Siprofloxacin Tablet 500 mg Tablet 281.00 -
189 Stesolid rektal 5 mg Tube 12,749.00 -
190 Tablet tambah darah Tablet 409.00 -
Thiamin HCl/Mononitrat (Vit.B1) tablet
191 Tablet 91.00 -
50 mg
192 Tetrasiklin HCl kapsul 250 mg Kapsul 174.00 -
193 Tetrasiklin HCl kapsul 500 mg Kapsul 329.00 -
194 Tetrasiklin HCl kaps 500 mg kapsul 279.82 -
kotak/10
195 Test trip kolestrol 255,000.00 -
strip
Kotak/25
196 Test trip asam urat 195,000.00 -
strip
44 Vitamin B kompleks tablet Tablet 144.00 3922 564,768.00
198 Vaksin Anti Rabies Vial 165,000.00 -
199 Vitamin B Kompleks tablet Tablet 135.00 -
200 Zink tablet dispersible 20 mg Tablet 604.00 -
Botol 60
201 Zink syrup 20 mg/ 5 ml 8,140.00 -
ml
Botol 60
202 Zink syrup 20 mg/ 5 ml 6,500.00 -
ml
203 Zink syrup 20 mg/ 5 ml Botol 3,285.00 -
TOTAL DAK 6,521,476.38
1 Alat Suntik 1 cc (Nipro) Pcs 1,004.85 -

1 Alat Suntik 3 cc (Abada) Pcs 924.00 50 46,200.00
3 Alat Suntik 3 cc (Abada) Pcs 887.70 -
2 Alat Suntik 3 cc (Nipro) Pcs 924.00 100 92,400.00
3 Chlodine 0,5% Jergen 5 L 395,384.74 1 395,384.74
4 Blood Lancet (Ekomed) Kotak 16,401.00 -
5 Folley Catheher No. 16 Pcs 11,945.23 9 107,507.07
6 Folley Catheher No. 18 Pcs 11,945.23 9 107,507.07
6 Handscoon Non Steril S Pcs 1,740.20 200 348,040.00
7 Handscoon Steril No. 7 Pasang 11,808.50 -
7 Handscoon Steril No. 7,5 Pasang 11,808.50 50 590,425.00
8 IV Catheter 18 G (Ekomed) Pcs 5,827.80 60 349,668.00
11 IV Catheter 24 G (Ekomed) Psg 5,827.00 75 437,025.00
10 Infus set dewasa Pcs 8,547.00 -
12 Infus set anak (Abada) Pcs 5,566.00 41 228,206.00
13 Infus set dewasa (Ekomed) Pcs 6,527.399 85 554,828.92
13 IV Catheter 24G (Abada) Pcs 6,455.90 -
14 IV Catheter 22 G (Abada) Roll 6,455.90 -
14 Kasa 16 x 16 Roll 4,114.00 43 176,902.00
15 Kasa hidrofil 40x80 Roll 143,022.00 -
17 Nasal O2 Canula Adult Pcs 7,502.00 -
18 Nasal O2 Canula Child Pcs 7,502.00 -
19 Nasal O2 Canula Neonatus Pcs 7,502.00 -
20 Nebulizer Mask Adult Pcs 16,032.50 -
21 Nebulizer Mask Pediatric Pcs 16,032.50 -
16 Oxygen nasal Canula anak Pcs 4,983.00 5 24,915.00
23 Oxygen nasal Canula dewasa Pcs 4,983.00 -
17 Oxygen Mask Anak Pcs 11,656.00 -
18 Oxygen Mask Dewasa Pcs 11,656.00 2 23,312.00
Chromic surgical catgut suture 3/0
26 Pcs 46,959.00 -
(Otot)
19 Roll 55,030.80 3 165,092.40
(Kulit)
20 Examination gloves size M Roll 1,740.20 - 500
21 Examination gloves size S Box 1,740.20 -
30 Pcs 49,491.20 - 24
(Kulit)
31 Onemed Povidone Iodine 300 ml Botol 21,060.00 -
32 Onemed Rivanol 300 cc Botol 2,983.50 -
33 Onemed Ultra One Test Kehamilan Pcs 2,132.90 -
34 Onemed surgical mask plus 3 ply plus Box 24,640.00 -
35 Onemed surgical mask plus 3 ply plus Box 31,165.00 -

Silk Braided Silk Coated Suture 3/0 3
22 Pcs 38,119.40 114,358.20
(Kulit)
23 Polipix 5 cm x 5 m Roll 41,100.00 5 205,500.00 5
38 Stera Syringe 3 cc Pcs 728.00 -
24 Urine Bag With Hanger Pcs 6,062.10 2 12,124.20
40 Urocare Folley Catheter 2 way No. 18 Pcs 8,960.00 -
TOTAL BMHP E-CAT DAK 5,581,820.60
1 Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 82 227,468.00

2 Fitomenadion (Vit.K) injeksi Ampul 4,236.00 60 254,160.00
3 Mineral Mix sachet 2,920.00 -
4 Magnesium Sulfat Inj 40% Vial 3,796.00 -
1 Oksitetrasiklin 1% Salep Mata Tube 2,600.00 -
6 Oksitosin injeksi Ampul 1,232.00 -
7 Oksitosin injeksi Ampul 1,199.00 -
3 Tablet tambah darah Tablet 409.00 5760 2,355,840.00
9 Tablet tambah darah Tablet 255.00 -
10 Vit A Bayi 100,000 IU ( biru ) Kapsul 354.00 -
11 Vit A Bayi 100,000 IU ( biru ) Kapsul 297.00 -
12 Vitamin Balita (merah) Kapsul 637.00 -
TOTAL KESMAS 2,837,468.00
kotak/100
1 Alat suntik sekali pakai 1 cc 118,973.00 -
set
2 Alat suntik sekali pakai 3 cc Pcs 832.00 -
3 Alat suntik sekali pakai 5 cc pcs 1,137.40 -
4 Catgut/Benang bedah No.2/0 Pcs 9,332.40 -
Catgut chromic 2/0 + jarum 1/2 GT 35
5 Pcs 7,146.67 -
mm
Catgut chromic 3/0 + jarum 1/2 GT 35
6 Pcs 7,146.67 -
mm
Botol
7 Etanol 70 % 28,567.00 -
1000 ml
Botol 100
8 Ethyl semprot 114,967.60 -
ml
9 Foley catheter No.16 Set 9,794.40 -
10 Foley catheter No.18 Set 9,794.40 -
11 Handscoen No. 7 steril Pairs 4,654.10 -
12 Handscoen No. 7,5 steril Pairs 4,654.10 -
Set/
13 Infusion Anak (PKD 2) 6,968.50 -
Kantong
14 Infusion set anak (20 drops/ml) Pcs 4,480.00 -
15 Infusion set anak (60 drops/ml) Pcs 4,480.00 -
16 Infusion set dewasa (20 drops/ml) Pcs 4,096.00 -
Set/
17 Infusion set dewasa (PKD 1) 6,470.20 -
Kantong
18 Kasa pembalut hidrofil 4 x 5 Roll 960.00 -
19 Kasa pembalut hidrofil 4 x 10 Roll 665.50 -
20 Kasa hidrofil steril uk. 16 x 16 Box/16 7,424.00 -
21 Kasa hidrofil 40 x 80 roll 134,371.60 -
22 Safeglove Exam (M) Box/100 41,600.00 -
23 Silk 3/0 pcs 7,647.20 -
24 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 3,911.11 -
25 Steracath i.v catheter No 18 G x 32 Pcs 4,864.00 -
29 Syringe disposible 3cc x 23 Gx11/2 Pcs 832.00 -
TOTAL KESMAS -
1 Cairan Pembersih Tangan Botol 55,000.00 -

2 Handscoon non steril L Pcs 470.500 -
1 Handscoon non steril M Pcs 470.500 200 94,100.00
4 Handscoon non steril S Pcs 470.500 -
5 Handscoon non steril L Pcs 464.64 -
6 Handscoon non steril M Pcs 464.64 -
7 IV Catheter 22 G (Abada) Pcs 5,775.00 -
8 Pot Dahak Pcs 3,300.00 -
9 Catgut 3/0 Pcs 63,103.00 -
TOTAL DAU PAJAK ROKOK 94,100.00
1 Baju hazmat/ APD Pcs 180,000.00 -

1 Celemek Plastik Pcs 66,000.00 30 1,980,000.00
3 Efinefrin injeksi 1 mg Ampul 6,691.85 -
1 Faceshield anti droplet Pcs 38,000.00 -
2 Handschoen No. 7 Steril Psg 12,000.00 -
2 Handschoen No. 7,5 Steril Psg 12,000.00 12 144,000.00
3 Masker N95 Pcs 66,000.00 30 1,980,000.00
4 Masker Tali Box 100,000.00 -
12 Nurse Cup Pcs 5,000.00 -
13 Onoiwa tablet 6,000.00 -
14 Rapid antigen Covid-19 Pcs 70,000.00 -
5 Sarung Tangan Genokologi non Steril Psg 55,000.00 -
6 Sarung Tangan L Box/100 200,000.00 -
9 Sarung Tangan M Box/100 200,000.00 -
TOTAL BANTUAN TAK TERDUGA 4,104,000.00
1 Rapid test Antigen Test 57,194.00 -

VTM (Transport Medium Dacron Swab)
2 Kit 1,878,709.677 5 9,393,548.39
2 ml
Corona Virus Ag Rapid Test Kotak 1,143,880.000 4
DAU RECOFUSING 9,393,548.39

TOTAL 43,622,570.110
Mengetahui
Kepala Puskesmas Bowong Cindea
Rusmiatih, AB
NIP. 19651231 198412 2 005
RSEDIAN OBAT
WONG CINDEA
ABUPATEN PANGKEP
DESEMBER 2021
PENERIMAAN PEMAKAIAN SISA PER 31

DESEMBER 2021 DESEMBER 2021 DESEMBER 2021 KET
TOTAL HARGA JUMLAH TOTAL HARGA JUMLAH TOTAL HARGA
8 9 10 11 12 13
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
224,400.00 244 54,753.60 756 169,646.40 DAU 0.00
- - - - DAU 0.00
- 240 17,760.00 - DAU 0.00
- 629 34,595.00 - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
188,193.50 5 188,193.50 - DAU 0.00
72,450.00 6 86,940.00 - DAU 0.00
110,220.00 100 110,220.00 - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU
0.00
- - - - DAU
0.00
- - - - DAU
0.00
- - - - DAU 0.00
- 14 45,640.00 - DAU 0.00
- - - - DAU 0.00
- 2,067 95,082.00 1812 83,352.00 DAU 0.00
- - - - DAU
0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- 9 19,935.00 9 19,935.00 DAU 0.00
78,000.00 415 24,900.00 885 53,100.00 DAU 0.00
130,000.00 50 13,000.00 450 117,000.00 DAU 0.00
759,000.00 1,230 186,714.00 3770 572,286.00 DAU 0.00
- - - - DAU 0.00
- - - 170 18,530.00 DAU 0.00
- 502 37,650.00 357 26,775.00 DAU 0.00
- - - - DAU
0.00
16,500.00 - - 5 16,500.00 DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU
0.00
- - - - DAU
0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- 530 50,880.00 1080 103,680.00 DAU 0.00
- - - - DAU
0.00
- - - - DAU 0.00
- - - 125 26,250.00 DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
525,000.00 50 52,500.00 450 472,500.00 DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
78,000.00 20 5,200.00 280 72,800.00 DAU 0.00
- - - - DAU
0.00
- - - - DAU 0.00
- - - - DAU
0.00
- - - - DAU
0.00
- - - - DAU
0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU
0.00
- - - - DAU
0.00
- 1,259 137,231.00 580 63,220.00 DAU 0.00
- 40 276,000.00 - DAU
0.00
- 60 52,140.00 340 295,460.00 DAU 0.00
- 7 99,911.00 - DAU 0.00
- - - - DAU 0.00
77,400.00 600 77,400.00 - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- 1,635 1,680,698.25 650 668,167.50 DAU 0.00
- 145 1,116,935.00 - DAU 0.00
- - - - DAU 0.00
42,500.00 - - 500 42,500.00 DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
109,500.00 1,372 100,156.00 128 9,344.00 DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
0.00
2,411,163.50 4,564,434.35 2,831,045.90 0.00
0.00
- - - - P2PL 0.00
- - - 300 455,400.00 P2PL 0.00
- 20 31,660.00 103 163,049.00 P2PL 0.00
- 620 1,023,000.00 680 1,122,000.00 P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- 2 988.00 21 10,374.00 P2PL 0.00
- - - - P2PL 0.00
- 60 67,260.00 142 159,182.00 P2PL 0.00
- - - 18 38,412.00 P2PL 0.00
- 60 16,500.00 - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL
0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - 20 4,840.00 P2PL 0.00
- - - - P2PL 0.00
- 7 3,344,537.00 - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- 200 1,860,000.00 - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- 200 1,660,000.00 - P2PL 0.00
- 60 17,220.00 352 101,024.00 P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- 155 14,105.00 179 16,289.00 P2PL 0.00
- - - - P2PL 0.00
309,980.00 2 123,992.00 3 185,988.00 P2PL 0.00
- - - - P2PL 0.00
1,974,775.00 7 552,937.00 18 1,421,838.00 P2PL 0.00
- - - - P2PL 0.00
1,907,928.00 12 1,907,928.00 - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
239,910.00 - - 10 239,910.00 P2PL 0.00
779,065.00 - - 5 779,065.00 P2PL 0.00
299,310.00 1 19,954.00 14 279,356.00 P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
- - - - P2PL 0.00
0.00
5,510,968.00 10,640,081.00 4,976,727.00 0.00
0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 5,161 1,192,191.00 328 75,768.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 19 66,690.00 71 249,210.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 1,430 77,220.00 560 30,240.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 702 82,134.00 21 2,457.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 44 7,700.00 - DAK 0.00
- 4 944.00 648 152,928.00 DAK 0.00
- 20 8,500.00 285 121,125.00 DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 22 33,440.00 54 82,080.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
22,500.00 400 30,000.00 54 4,050.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- 10 180,000.00 5 90,000.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 120 8,400.00 355 24,850.00 DAK 0.00
- 3 4,635.00 - DAK 0.00
- - - - DAK
0.00
- - - 4 84,084.00 DAK
0.00
- - - 3 2,475.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - 120 93,720.00 DAK
0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 16 233,604.80 14 204,404.20 DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 29 1,740.00 3 180.00 DAK 0.00
- - - - DAK 0.00
- 39 103,272.00 41 108,568.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 555 33,300.00 - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- 16 137,984.00 5 43,120.00 DAK 0.00
- - - 10 8,400.00 DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 72 270,720.00 - DAK 0.00
- - - - DAK 0.00
- 2,045 49,080.00 - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - 300 37,800.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 55 46,585.00 20 16,940.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 780 60,060.00 940 72,380.00 DAK 0.00
- 31 58,900.00 37 70,300.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 3 3,207.00 - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - 73 66,430.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - 70 94,360.00 DAK 0.00
- 400 51,600.00 - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 21 24,360.00 86 99,760.00 DAK 0.00
- - - - DAK 0.00
- 4,923 919,517.94 898 167,728.44 DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK
0.00
- 417 30,024.00 821 59,112.00 DAK
0.00
- - - - DAK
0.00
- - - - DAK 0.00
- 750 54,750.00 978 71,394.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- 183 27,450.00 - DAK 0.00
- - - - DAK 0.00
- 338 22,646.00 138 9,246.00 DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK
0.00
- 21 924.00 330 14,520.00 DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK
0.00
- 3,922 564,768.00 - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK 0.00
- - - - DAK
0.00
- - - - DAK
0.00
- - - - DAK 0.00
0.00
22,500.00 4,386,346.74 2,157,629.64 0.00
0.00
- - - - 0.00
- 50 46,200.00 - BMHP 0.00
- - - - BMHP 0.00
- 100 92,400.00 -
- 1 395,384.74 - BMHP 0.00
- - - - BMHP 0.00
- 1 11,945.23 8 95,561.84 BMHP
- 9 107,507.07 - BMHP
- 200 348,040.00 - BMHP
- - - - BMHP
- - - 50 590,425.00 BMHP
- 30 174,834.00 30 174,834.00 BMHP 0.00
- 70 407,890.00 85 495,295.00 BMHP 0.00
- 15 87,405.00 105 611,835.00 BMHP 0.00
- 7 40,789.00 68 396,236.00 BMHP 0.00
- - - - BMHP 0.00
- 5 27,830.00 36 200,376.00 BMHP 0.00
- 80 522,191.92 5 32,637.00 BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- 6 24,684.00 37 152,218.00 BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - 5 24,915.00 BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - 2 23,312.00 BMHP 0.00
- - - - BMHP
0.00
- - - 3 165,092.40 BMHP
0.00
870,100.00 500 870,100.00 - BMHP 0.00
- - - - BMHP 0.00
1,187,788.80 10 494,912.00 14 692,876.80 BMHP
0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP 0.00
- - - - BMHP
0.00
- - - - BMHP
0.00
- 3 114,358.20 - BMHP
0.00
205,500.00 7 287,700.00 3 123,300.00 BMHP 0.00
- - - - BMHP 0.00
- 2 12,124.20 - BMHP 0.00
- - - - BMHP 0.00
0.00
2,263,388.80 4,066,295.36 3,778,914.03 0.00
0.00
- 40 110,960.00 42 116,508.00 KESMAS 0.00
- - - 60 254,160.00 KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- 4,260 1,742,340.00 1500 613,500.00 KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
0.00
- 1,853,300.00 984,168.00 0.00
0.00
- - - - KESMAS
0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS
0.00
- - - - KESMAS
0.00
- - - - KESMAS
0.00
- - - - KESMAS
0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS
0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS
0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
- - - - KESMAS 0.00
0.00
- - - 0.00
0.00
- - - - DAU 0.00
- - - - DAU 0.00
- 200 94,100.00 - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
- - - - DAU 0.00
0.00
- 94,100.00 - 0.00
0.00
- - - - BTT 0.00
- 30 1,980,000.00 - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- 12 144,000.00 - BTT 0.00
- 30 1,980,000.00 - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
- - - - BTT 0.00
0.00
- 4,104,000.00 - 0.00
0.00
- - - - 0.00
- 5 9,393,548.39 -
0.00
4,575,520.00 - -
0.00
4,575,520.00 9,393,548.39 - 4,575,520.00
0.00
14,783,540.300 39,102,105.835 14,728,484.575 4,575,520.00
Bowong Cindea, 25 November 2021
Petugas Farmasi/Pengelola Obat
Ammar Mubarak, S.Farm., Apt.

NIP. 19891025 201903 1 003
0
0.00
0.00
0.00
450,800.00
0.00
36,000.00
70,448.00
0.00
0.00
376,397.00
173,892.00
220,640.00
0.00
0.00
0.00
0.00
0.00
0.00
91,308.00
0.00
364,626.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
79,776.00
158,600.00
261,000.00
1,528,000.00
0.00
37,400.00
130,568.00
0.00
33,010.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
312,340.00
0.00
0.00
52,750.00
0.00
0.00
1,051,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
156,600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
404,580.00
552,080.00
696,000.00
199,836.00
0.00
156,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,702,301.50
2,234,160.00
0.00
86,000.00
0.00
0.00
0.00
0.00
222,000.00
0.00
0.00
0.00
0.00
0.00
0.00
14,790,960.50
0.00
911,400.00
389,664.00
4,292,600.00
0.00
0.00
0.00
22,770.00
0.00
453,288.00
76,860.00
33,120.00
0.00
0.00
0.00
0.00
0.00
0.00
9,720.00
0.00
6,689,088.00
0.00
0.00
0.00
3,720,400.00
0.00
0.00
3,320,400.00
237,312.00
0.00
0.00
0.00
61,456.00
0.00
619,970.00
0.00
3,949,600.00
0.00
3,815,880.00
0.00
0.00
0.00
479,840.00
1,558,140.00
598,650.00
0.00
0.00
0.00
31,233,616.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,546,896.00
0.00
0.00
0.00
0.00
631,980.00
0.00
0.00
0.00
0.00
0.00
218,900.00
0.00
0.00
170,628.00
0.00
0.00
0.00
0.00
15,488.00
309,048.00
259,860.00
0.00
0.00
0.00
231,192.00
0.00
0.00
0.00
69,008.00
0.00
0.00
0.00
0.00
0.00
0.00
540,030.00
0.00
0.00
0.00
67,450.00
9,276.00
0.00
168,176.00
4,956.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
187,680.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
876,078.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,904.00
0.00
423,840.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
67,710.00
0.00
0.00
362,250.00
16,820.00
0.00
0.00
0.00
0.00
541,584.00
0.00
102,250.00
0.00
0.00
76,200.00
0.00
0.00
0.00
0.00
127,200.00
0.00
0.00
0.00
268,320.00
258,536.00
0.00
0.00
6,420.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
133,006.00
0.00
0.00
188,860.00
104,000.00
0.00
0.00
248,454.00
0.00
2,186,134.76
0.00
0.00
0.00
180,748.00
0.00
0.00
255,744.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
55,266.00
0.00
64,736.00
0.00
0.00
0.00
0.00
31,590.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,137,380.00
0.00
0.00
0.00
0.00
0.00
0.00
13,087,952.76
0.00
92,500.00
0.00
790,771.48
0.00
215,032.14
215,032.14
696,480.00
0.00
1,180,950.00
699,456.00
1,806,680.00
1,398,720.00
874,200.00
0.00
456,494.00
1,109,827.83
0.00
0.00
353,890.00
0.00
0.00
0.00
0.00
0.00
0.00
49,840.00
0.00
0.00
46,628.00
0.00
330,190.80
1,741,200.00
0.00
2,375,625.60
0.00
0.00
0.00
0.00
0.00
228,722.40
822,020.00
0.00
24,252.40
0.00
15,690,418.79
455,100.00
508,440.00
0.00
0.00
0.00
0.00
0.00
4,723,200.00
0.00
0.00
0.00
0.00
5,674,936.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
188,600.00
0.00
0.00
0.00
0.00
0.00
0.00
188,200.00
0.00
3,960,060.00
0.00
0.00
0.00
288,024.00
3,960,060.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,208,000.00
0.00
18,787,106.77
23,362,616.77
112,236,700.82
TERPAKAI
KEPADA PUSTU BULPUSTU BULPUSTU BORPUSTU BOR
WAKTU 05/01/22 22/01/22 13/01/22 24/01/22
NO. BAP 1 2 3 4
NAMA OBAT STOK

Ambroxol tablet 1000 0
Amlodipin 10 mg 140 100 100
Amlodipin 5 mg 629 0
Alkohol 70% 4 1
Alkohol swab 6 0
Alat Suntik 3 ml (cosmomed) 90 10
Antihemoroid 14 0
Asam Askorbat (Vit.C) tab 50 mg 3679 200
Cetrisyn sirup 5 mg/5 ml 14 4 2
Calsium Laktat 900 400 100 100
Ciprofloxasin tab 500 mg 500 0
Deksametason tablet 0,5 mg 4700 300 100 100
Dimenhidrinat 50 mg 170 0
Domperidon tablet 10 mg 809 50
Fenol Gliserol 5 0
Glimepirid tab 1 mg 1510 100 100
Griseofulvin tablet 125 mg 125 0
Hiosina Butilbromida tab 10 mg 500 0
Ketokonazol tab 200 mg 300 0
Natrium Diklofenak 50 mg 1739 100 50
Natrium Klorida larutan infus steril 40 0
Nistatin Tab Salut 500.000UI 400 0
Obat batuk Hitam (Herbakof Syrup) 7 0
Omeprazole kaps 20 mg 550 50 50
Pritavit Kaplet 2135 150
Ringer laktat larutan infus steril 145 0
Ranitidin tablet 500 0
Simvastatin tablet salut 20 mg 1450 50
Alat suntik sekali pakai 0,05 ml 300 0
Alat suntik 5 ml 123 0
Alat suntik sekali pakai 0,5 ml 1290 10 10
Albendazol tab 400 mg 23 0
Clozapine 202 0
DHP 18 0
Garam oralit 60 0
Primaquin 15 mg 20 0
Obat FDC Kategori 1 7 0
Rapid test Syphilis (Trepocheck) 200 0
Rapid test HbSAg 200 0
Risperidone 412 0
Triheksifenidil 2 mg tab 334 0
Vaksin BCG 5 0
Vaksin DPT HB HiB 25 0
Vaksin IPV 12 0
Vaksin HB Rekombinasi (HB-Pid) 10 0
Vaksin MR 5 0
Vaksin Polio Oral (OPV) 15 0
Amoksisillin kaplet 500 mg 4689 800 200 200 200
Amoksisillin sirup DS 250 mg/ 5 ml 85 5 5
Antasida Doen tablet 1790 200
Asam mefenamat kaplet 500 mg 623 100
Attapulgit 630 mg (Puralex) 44 0
Asiklovir tablet 200 mg 652 0
Asiklovir tablet 400 mg 305 0
Betametasone krim 0,1 % 66 10 5 5
Captopril 25 mg 254 200 100
Disposable safety box 5 liter 15 0
Diazepam tablet 2 mg 475 0
Diazepam inj 5 mg/ml 3 0
Diazepam lar rektal 5 mg/2,5 ml 4 0
(Stesolid Rektal)
Difenhidramin Hcl injeksi 10 mg/ml 3 0
Fitomenadion (Vit.K) tablet salut 120 0
gula 10 mg
Gliceril guaiacolat tab 100 mg 29 1 1
(Guaifenesin)
Haloperidol 5 mg 32 0
Hidrokortisom krim 2,5 % 75 5 5
Kalsium Laktat (kalk) tablet 500 mg 555 0
Kasa 2 m x 80 cm (Onemed) 21 0
Kasa Pembalut Hydrofil 4 m x 5 cm 10 0
(Onemed)
Kloramfenikol Salep Kulit 67 5 5
(Bufacetin)
Klorfeniramine Maleat (CTM) tab 4 1545 500 200 200
mg
Kotrimoksazol tablet 480 mg 200 100 100
Lidokain Injeksi Comp 50 25 15 10
Metformin Tablet 1620 100 100
Miconazole Salep Kulit 68 0
Methylergometrine inj tab 0,2 mg/ml 3 0
Nistatin 500.000 IU 73 0
Oksitosin injeksi 70 0
Omeprazol kaps 20 mg 400 0
Parasetamol sirup 102 5 5
Parasetamol tablet 500 mg 5021 800 200 200 200
Piridoksin (Vitamin B6) tablet 10 mg 1138 100 100
HCl
Prednison tablet 5 mg 1628 100 100
Simvastatin tablet salut 20 mg 183 0
Salbutamol tablet 4 mg 476 0
Sianokobalamin (Vit.B12) tablet 50 351 0
mg
Vitamin B kompleks tablet 3322 600 200 100
Alat Suntik 3 cc (Abada) 50 0
Alat Suntik 3 cc (Nipro) 90 10 10
Chlodine 0,5% 1 0
Folley Catheher No. 16 9 0
Folley Catheher No. 18 9 0
Handscoon Non Steril S 200 0
Handscoon Steril No. 7,5 50 0
IV Catheter 18 G (Ekomed) 60 0
Infus set anak (Abada) 41 0
Infus set dewasa (Ekomed) 85 0
Kasa 16 x 16 43 0
Oxygen nasal Canula anak 5 0
Oxygen Mask Dewasa 2 0
Chromic surgical catgut suture 2/0 3 0
(Kulit)
Examination gloves size M 500 0
Chromic surgical catgut suture 3/0 19 5 5
(Kulit)
Silk Braided Silk Coated Suture 3/0 3 0
(Kulit)
Polipix 5 cm x 5 m 10 0
Urine Bag With Hanger 2 0
Oksitetrasiklin 1 % Salep Mata 79 3 3
Fitomenadion (Vit.K) injeksi 60 0
Tablet tambah darah 5160 600 300
Handscoon non steril M 199 1 1
Celemek Plastik 30 0
Handschoen No. 7,5 Steril 12 0
Masker N95 30 0
VTM (Transport Medium Dacron 5 0
Swab) 2 ml
Corona Virus Ag Rapid Test 4 0
TOTAL
PUSTU BORPOSKESDESPOSKESDESPOSKESDESPOSKESDES JOLLO
27/01/22 28/01/22 18/01/22 26/01/22 31/01/22
5 6 7 8 9 10 11 12 13
10
200
2
200
100
50
50
50 100
50
200
200
100
100
100
200
200 100
300
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 69 70 71 72 73
74 75 76 77 78 79 80 81 82 83
84 85 86 87 88 89 90 91 92 93
94 95 96 97 98 99 100
NAMA OBAT DAN BMHP YANG DIKELUARKAN
.
KEPADA : PUSTU BULU CINDEA .
WAKTU : Sabtu,22 Januari 2022 .
NO. BAP : 2 .
.
SUMBER JUMLAH
NO NAMA OBAT SATUAN HARGA TOTAL HARGA
DANA PEMBERIAN
DAU Allopurinol tablet 100 mg Tablet 90.00 0 0.00

Abon AMP (Amphetamine) Test 16,500.00 0 0.00
Ambroxol Tablet 160.00 0 0.00
Ambroxol tablet Tablet 224.40 0 0.00
Aminofillin 200 mg Tablet 160.00 0 0.00
Amlodipin 10 mg Tablet 74.00 0 0.00
Acyclofir 200 mg Tablet 251.00 0 0.00
Acyclofir cr Tube 3,625.00 0 0.00
Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Alat Suntik 3 ml (cosmomed) Psc 1,102.20 0 0.00
Amitriptilin tablet salut 25 mg Tablet 123.00 0 0.00
Antasida tab Tablet 78.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents
Anti D Duocloral Monocloral Botol 125,477.00 0 0.00
Antihemoroid Tablet 3,260.00 0 0.00
Asam mefenamat tablet 122.00 0 0.00
Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 0 0.00
Botol/25
Asam Urat Test Strip 276,891.50 0 0.00
Strip
Becefort Tablet 1,536.70 0 0.00
BD Gard Kapsul Tablet 10,890.00 0 0.00
Blood Lancet Psc 138.00 0 0.00
Bioplacenton Tulle Box 108,324.00 0 0.00
Benecheck Strip Cholesterol Pcs 25,283.92 0 0.00
Benecheck Strip Uric Acid Pcs 6,689.54 0 0.00
Benecheck Strip Glucose Pcs 3,206.20 0 0.00
Captopril tab 25 mg Tablet 75.00 0 0.00
Cetrisyn sirup 5 mg/5 ml Botol 2,215.00 0 0.00
Calsium Laktat tablet 60.00 0 0.00
Ciprofloxasin tab 500 mg Tablet 260.00 0 0.00
Deksametason tablet 0,5 mg Tablet 151.80 0 0.00
Dengue test NS1 Test 132,000.00 0 0.00
Dimenhidrinat 50 mg Tablet 109.00 0 0.00
Domperidon tablet 10 mg Tablet 75.00 0 0.00
Kotak/50
Face Mask Ear Loop 69,000.00 0 0.00
pcs
Fenol Gliserol Botol 3,300.00 0 0.00
Fokus febrile Antigen O-B
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen O-C
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen O-D
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen H-A
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen H-B
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen H-C
Vial 26,784.00 0 0.00
Paratiphy
Fokus febrile Antigen H Paratiphy Vial 26,784.00 0 0.00
Fitomenadion (Vitamin K1) tablet

Tablet 690.00 0 0.00
salut 10 mg
Fitomenadion (Vit K1) injeksi 2
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Foley Catheter 2 Way FR No.18 Pcs 36,696.00 0 0.00
Gliceril guaiacolat tab 100 mg Tablet 28.75 0 0.00
Glimepirid tab 1 mg Tablet 96.00 0 0.00
Garam oralit kombinasi serbuk
Sachet 317.00 0 0.00
untuk 200 ml
Glukosa Larutan Infus 5% Botol 5,720.00 0 0.00
Griseofulvin tablet 125 mg Tablet 210.00 0 0.00
Handschoen No. 7 Steril Psg 11,432.00 0 0.00
Handschoen No. 7,5 Steril Psg 3,630.00 0 0.00
Hiosina Butilbromida tab 10 mg Tablet 1,050.00 0 0.00
Hipafix 15 cm x 5 m Roll 302,000.00 0 0.00
Human Humasens Plus Unit 814,009.50 0 0.00
Ibuprofen tablet 200 mg Tablet 123.17 0 0.00
Infusion set Anak Pcs 3,333.00 0 0.00
Infusion set dewasa Pcs 8,867.00 0 0.00
IV Catheter 20 G (Abbocath-T) Pcs 16,000.00 0 0.00
Ketokonazol tab 200 mg Tablet 260.00 0 0.00
Kloramfenikol salep kulit 2%
Tube 3,360.00 0 0.00
(Bufacetin)
Klorfeniramine Maleat (CTM) tab
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
Kotrimoksazol syr 2,298.00 0 0.00
ml
Kolestrol test strip (Human Dus/20
547,319.00 0 0.00
humasens) strip
Lidokain inj 2% com (pehacain inj) Ampul 3,113.05 0 0.00
Lidokain gel 2% Tube 41,600.00 0 0.00

Lidokain spray oral 10% Botol 177,216.00 0 0.00
Metformin tablet 500 mg Tablet 118.50 0 0.00
Metilergometrin maleat inj 0,200
Ampul 3,712.00 0 0.00
mg - ml
Tube 10
Mikonazol krim/salep 2% (Nitrat) 3,150.00 0 0.00
gr
Natrium Diklofenak 50 mg Tablet 109.00 0 0.00
Botol 500
Natrium Klorida larutan infus steril 6,900.00 0 0.00
ml
Nistatin Tab Salut 500.000UI Tablet 869.00 0 0.00
Obat batuk Hitam (Herbakof
Botol 14,273.00 0 0.00
Syrup)
Obat batuk Hitam (OBH) Botol 3,450.00 0 0.00
Omeprazole kaps 20 mg kapsul 129.00 0 0.00
Papaverin tablet 40 mg Tablet 180.90 0 0.00
Parasetamol syrup 120 mg/5 ml Botol 1,535.00 0 0.00
Parasetamol tablet 500 mg Tablet 60.00 0 0.00
Phenylbutazon tablet 200 mg Tablet 88.21 0 0.00
Piridoksin HCl (Vit.B6) tablet 10
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Pirantel pamoat tablet scored 125
Tablet 318.00 0 0.00
mg
Pitogin inj Ampul 5,291.00 0 0.00
Plester ( Leucoplast 3 x 5 ) Roll 35,532.00 0 0.00
Prednison tablet 5 mg Tablet 105.88 0 0.00
Pritavit Kaplet Kaplet 1,027.95 0 0.00
Ringer laktat larutan infus steril Botol 7,703.00 0 0.00
Salep 24 Tablet 1,475.00 0 0.00
Ranitidin tablet Tablet 85.00 0 0.00
Sarung Tangan M Pcs 495.00 0 0.00
Sarung Tangan S Pcs 495.00 0 0.00
Sarung Tangan Steril No. 7,5 Pcs 3,630.00 0 0.00
Sarung Tangan Steril No. 7 Pcs 3,630.00 0 0.00
Simvastatin tablet salut 20 mg Tablet 73.00 0 0.00
Tetrasiklin HCl kaps 500 mg kapsul 279.82 0 0.00
Thiamin HCl (Vit.B1) tablet 50 mg Tablet 57.55 0 0.00
Underpad 60x90 cm ( Cosmomed ) Pcs 8,970.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

Vitamin B kompleks tablet Tablet 24.31 0 0.00
Zinc tablet dispersible 20 mg Tablet 521.00 0 0.00
4564434.35 0.00
P2PL Alat suntik sekali pakai 0,05 ml Pcs 1,240.00 0 0.00

Alat suntik sekali pakai 0,05 ml Pcs 1,518.00 0 0.00
Alat suntik 5 ml Pcs 1,583.00 0 0.00
Albendazol Suspensi 200 mg/5 ml Botol 4,600.00 0 0.00
Albendazol tablet 400 mg Tablet 380.00 0 0.00

Albendazol tab 400 mg Tablet 271.14 0 0.00
Alkohol swab pcs 242.00 0 0.00
Clozapine Tablet 1,121.00 0 0.00
DHP Tablet 2,134.00 0 0.00
Garam oralit Saccet 275.00 0 0.00
Handscoun L Pcs 490.00 0 0.00
Handscoun L Kotak 48,999.50 0 0.00
Klorpromazin tablet salut 100 mg
Tablet 147.00 0 0.00
(HCl)
Pot Sputum Pcs 2,272.00 0 0.00
Pot Dahak Pcs 2,950.00 0 0.00
Pot Dahak Non steril pot 2,000.00 0 0.00
Primaquin 15 mg Tablet 242.00 0 0.00
Obat FDC Kategori Anak Paket 285,339.00 0 0.00
Obat FDC Kategori 1 Paket 477,791.00 0 0.00
Obat FDC Kategori 2 Paket 1,592,731.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00
Rapid test Syphilis (Trepocheck) Tes 9,300.00 0 0.00
Rapid test HbSAg Tes 9,878.00 0 0.00

Rapid test Tifoid Tes 33,334.00 0 0.00
Risperidone Tablet 287.00 0 0.00
RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Triheksifenidil 2 mg tab Tablet 91.00 0 0.00
Vaksin Anti Rabies Vial 165,000.00 0 0.00
Vaksin BCG Vial 61,996.00 0 0.00
Vaksin Campak Vial 28,204.00 0 0.00
Vaksin DPT HB HiB Vial 78,991.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin Immuno Globuline Vial 1,325,000.00 0 0.00
Vaksin Meningitis Vial 135,000.00 0 0.00
Vaksin HB Uniject (HB 0) Uniject 23,991.00 0 0.00
Vaksin HB Rekombinasi (HB-Pid) Uniject 23,991.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin Polio Oral (OPV) Vial 19,954.00 0 0.00
Vaksin TD Vial 16,995.00 0 0.00
Vaksin Hepatitis Immuno
Vial 1,325,000.00 0 0.00
Globuline
Zinc Tablet 20 mg Tablet 604.00 0 0.00
10640081 0.00
DAK Alat suntik sekali pakai 1 ml Set 728.00 0 0.00

Alat Suntik 5 cc Luerlock with
Psc 1,125.85 0 0.00
needle 22 Gx1 1/2 (Nipro)
Alat suntik 5 cc (Stera) Psc 840.00 0 0.00
Alkohol Swab (Onemed) Box 11,200.00 0 0.00
Alkohol 70 % 1 L (onemed) Botol 25,155.00 0 0.00
Allopurinol tab 100 mg Tablet 105.00 0 0.00
Allopurinol tablet 100 mg Tablet 99.00 0 0.00
Air untuk injeksi amp 25 ml Ampul 2,860.00 0 0.00
Aminofilin 200 mg Tablet 86.00 0 0.00
Amitriptyline tablet salut 25 mg Tablet 123.00 0 0.00
Acetylcystein kapsul 200 mg Kapsul 908.00 0 0.00

Amlodipin tablet 5 mg Tablet 55.00 0 0.00
Amlodipin tab 10 mg Tablet 74.00 0 0.00
Amoksisillin kaplet 500 mg Tablet 265.00 0 0.00
Amoksisillin kaplet 500 mg Tablet 231.00 200 46,200.00
Amoksisilin kaplet 500 mg Tablet 360.00 0 0.00
Amoksisillin sirup kering 125 mg/
Botol 2,560.00 0 0.00
5 ml
Amoksisillin sirup forte 250 mg/ 5
Botol 3,846.00 0 0.00
ml
Amoksisillin sirup DS 250 mg/ 5 ml Botol 3,510.00 0 0.00
Anios Gel 85 Botol 88,678.66 0 0.00

Antasida Suspensi Botol 2,098.00 0 0.00
Antasida Doen tablet Tablet 60.00 0 0.00
Asam mefenamat kaplet 500 mg Tablet 117.00 0 0.00
Antifungi Salep Kulit Tube 5,170.00 0 0.00

Asiklovir tablet 200 mg Tablet 251.00 0 0.00
Attapulgit 630 mg (Puralex) Tablet 175.00 0 0.00
Botol/500
Asering 9,646.00 0 0.00
ml
Attapulgit Tablet 149.00 0 0.00
Betametason krim 0,1% Tube 5 gr 1,515.00 0 0.00
Betametasone krim 0,1 % Tube 1,520.00 0 0.00

Bisakodil Tablet 5 mg Tablet 337.00 0 0.00
Bufacetin(chloramfenicol salep
Tube 3,585.00 0 0.00
kulit)
Calsium Laktat Tablet 82.00 0 0.00
Captopril 25 mg Tablet 75.00 0 0.00
Catgut 3/0 Pcs 64,191.00 0 0.00
Cetrisyn sirup botol 3,061.00 0 0.00
Dermafix Bliste 2,298.84 0 0.00
Deksamethason injeksi 5 mg/ml -
Ampul 1,210.00 0 0.00
1 ml
Disposable safety box 5 liter Buah 18,000.00 0 0.00
Domperidon Tablet 10 mg Tablet 90.00 0 0.00
Domperidone suspensi 5 mg/5 ml Botol 2,862.00 0 0.00
Diazepam tablet 2 mg Tablet 70.00 0 0.00

Diazepam inj 5 mg/ml Vial 1,545.00 0 0.00
Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Difenhidramin Hcl injeksi 10
Ampul 825.00 0 0.00
mg/ml
Doxycycline 100 mg Tablet 309.00 0 0.00
Eritromisin 500 mg Kapsul 766.00 0 0.00
Efinefrin (Adrenalin) injeksi 1
Ampul 2,354.00 0 0.00
mg/ml
Efinefrin (Adrenalin) injeksi 1 mg/
Ampul 1,518.00 0 0.00
ml
Botol100
Etil Klorida Semprot 115,500.00 0 0.00
ml
Examination gloves size L (Aximed) Pcs 508.20 0 0.00
Examination gloves size M

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
Fenobarbital 7,010.00 0 0.00
ml
Fenobarbital Tablet Tablet 177.00 0 0.00
Fitomenadion (Vit.K) injeksi 10
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Fitomenadion (Vit.K)Tablet salut
Tablet 873.00 0 0.00
gula 10 mg
Fitomenadion (Vit.K) tablet salut
Tablet 781.00 0 0.00
gula 10 mg
Folley Catheter 2 Way No.16
Pcs 8,960.00 0 0.00
(urocare)
Furosemid tab Tablet 88.00 0 0.00
Glass ionomer ART Buah 606,900.00 0 0.00
Garam oralit Sachet 317.00 0 0.00
Garam oralit kombinasi Sachet 274.00 0 0.00
Botol 500
Glukosa larutan infus 5% steril 5,720.00 0 0.00
ml
Glukosa larutan infus 5% steril Botol 6,900.00 0 0.00
Glimepirid tablet 2 mg Tablet 297.00 0 0.00
Kotak 14,600.30 0 0.00
(Guaifenesin)
Gliseril Gualakolat tablet 100 mg Tablet 228.00 0 0.00

Kotak/25
Glukosa test strip 137,500.00 0 0.00
strip
Glukosa test strip Strip 7,084.00 0 0.00
Kotak 60
Gelatine sponge 322,190.00 0 0.00
spons
Haloperidol 1,5 mg Tablet 76.00 0 0.00
Haloperidol 2 mg (lodomer) Tablet 90.00 0 0.00
Haloperidol 5 mg Tablet 60.00 0 0.00
Handschoen No. 6,5 steril psg 8,487.66 0 0.00
Hidrokortisom krim 2,5 % Tube 2,648.00 0 0.00
Tablet 2,329.80 0 0.00
(Scopamin)
Ibuprofen suspensi 100 mg/ 5 ml Botol 2,560.00 0 0.00
Infusion set Anak(PKD 2) Set 6,930.00 0 0.00

Infuset dewasa (Aximed) Pcs 5,280.00 0 0.00
Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Isosorbid Dinitrate 5 mg Tablet 93.00 0 0.00
IV Catheter 18G x 1 1/4
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)
IV Catheter 20G x 1 1/4 (Nipro) Pcs 8,070.70 0 0.00
IV Catheter 22G x 1 (Steracath) Pcs 4,256.00 0 0.00
IV Catheter 24G x 3/4 (Steracath) Pcs 4,256.00 0 0.00
Kalsium Laktat (kalk) tablet 500

Tablet 60.00 0 0.00
mg
Bungkus/
Kapas pembalut 60,830.00 0 0.00
1 kg
Kasa kompres 40x40 Pcs 1,700.00 0 0.00
Kasa 2 m x 80 cm (Onemed) Roll 8,624.00 0 0.00
Kasa Pembalut Hydrofil 4 m x 5 cm
Roll 840.00 0 0.00
(Onemed)
Kasa Pembalut 4 m x 10 cm
Roll 1,680.00 0 0.00
(Onemed)
Kasa pembalut hidrofil 4 m x 15
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Kloramfenikol Salep Kulit
Tube 3,760.00 5 18,800.00
(Bufacetin)
Kloramfenikol salep mata 1% Tube 2,013.00 0 0.00
Tablet 24.00 0 0.00
4 mg
klorfeniramini maleat (CTM) Tablet 26.27 0 0.00
Botol 60
Kotrimoksazol suspensi 2,052.00 0 0.00
ml
Kotrimoksazol tablet 480 mg Tablet 126.00 0 0.00
Kotrimoksaxol dewasa 480 mg Tablet 125.00 0 0.00
Loperamid tablet 2 mg Tablet 97.00 0 0.00
Loratadine Tablet 127.00 0 0.00
Lidokain Injeksi Comp Ampul 847.00 15 12,705.00
Lysol 1 liter (onemed) Botol 47,970.00 0 0.00
Lidokain injeksi Comp Ampul 1,405.00 0 0.00
Masker Tali Box 31,165.00 0 0.00
Metformin Tablet Tablet 77.00 100 7,700.00
Miconazole Salep Kulit Tube 1,900.00 0 0.00
Mikonazole salep 2 % Tube 3,926.00 0 0.00
MgS04 20% Vial 3,200.00 0 0.00
Methylergometrine inj tab 0,2
Ampul 1,069.00 0 0.00
mg/ml
Methylergometrine maleat tab
Tablet 245.00 0 0.00
0,125 mg
Metokloperamide tablet Tablet 100.00 0 0.00
Metokloperamide syr (Lexapram) Botol 2,750.00 0 0.00
Botol 500
Natrium Klorida larutan infus 0,9% 6,840.00 0 0.00
ml
Botol 500
ml
Natrium diklofenak tablet Tablet 136.00 0 0.00
Nifedipin tablet 10 mg Tablet 127.00 0 0.00
Nistatin 100.000 IU Tablet 645.00 0 0.00
Onoiwa Kaplet 5,650.00 0 0.00
Obat antituberkulosis FDC
Paket 1,319,900.00 0 0.00
Kategori 2
Oksitosin injeksi Ampul 1,348.00 0 0.00
Omeprazol kaps 20 mg Kapsul 129.00 0 0.00
Parasetamol sirup 120 mg/ 5 ml Botol 4,950.00 0 0.00
Parasetamol sirup Botol 1,160.00 0 0.00
Parasetamol tablet 500 mg Tablet 186.78 200 37,356.00
Botol 15
Parasetamol drops 100 mg/ml 5,720.00 0 0.00
ml
Botol 15
Parsetamol drops 100 mg/ml 5,980.00 0 0.00
ml
Piridoksin (Vitamin B6) tablet 10
Tablet 72.00 100 7,200.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Propanolol 10 mg tab Tablet 80.00 0 0.00
Plester 3 x 5 H leukoplast Roll 50,600.00 0 0.00
Povidone Iodine 30 ml (Onemed) Botol 3,190.00 0 0.00
Botol 60
Povidone Iodine 100 mg/ml 25,215.00 0 0.00
ml
Pyrantel pamoat Tablet 318.00 0 0.00
Ringer laktat larutan infus botol 7,630.00 0 0.00
Botol 500
Ringer laktat larutan infus 7,150.00 0 0.00
ml
Ranitidin tablet 150 mg Tablet 114.00 0 0.00
Rivanol 300 cc (onemed) Botol 2,983.50 0 0.00
Sarung tangan obgyn steril Psg 22,000.00 0 0.00
Salbutamol tablet 4 mg Tablet 67.00 0 0.00
Salbutamol syr Botol 5,463.00 0 0.00
Pot 30
Salep 2-4 kombinasi 2,200.00 0 0.00
gram
Salep 2-4 kombinasi Pot 3,017.00 0 0.00
Sianokobalamin (Vit.B12)injeksi
Ampul 1,226.00 0 0.00
500 mcg
Sianokobalamin (Vit.B12) tablet 50
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Siprofloxacin Tablet 500 mg Tablet 281.00 0 0.00
Stesolid rektal 5 mg Tube 12,749.00 0 0.00
Tablet tambah darah Tablet 409.00 0 0.00
Thiamin HCl/Mononitrat (Vit.B1)
Tablet 91.00 0 0.00
tablet 50 mg
Tetrasiklin HCl kapsul 250 mg Kapsul 174.00 0 0.00
kotak/10
Test trip kolestrol 255,000.00 0 0.00
strip
Kotak/25
Test trip asam urat 195,000.00 0 0.00
strip
Vitamin B kompleks tablet Tablet 144.00 200 28,800.00
Vitamin B Kompleks tablet Tablet 135.00 0 0.00
Zink tablet dispersible 20 mg Tablet 604.00 0 0.00
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
Zink syrup 20 mg/ 5 ml Botol 3,285.00 0 0.00
TOTAL 158,761.00
BMHP E- Alat Suntik 1 cc (Nipro) Pcs 1,004.85 0 0.00

CAT DAK Alat Suntik 3 cc (Abada) Pcs 924.00 0 0.00
Alat Suntik 3 cc (Abada) Pcs 887.70 0 0.00
Alat Suntik 3 cc (Nipro) Pcs 924.00 0 0.00
Chlodine 0,5% Jergen 5 L 395,384.74 0 0.00
Blood Lancet (Ekomed) Kotak 16,401.00 0 0.00

Folley Catheher No. 16 Pcs 11,945.23 0 0.00
Handscoon Non Steril S Pcs 1,740.20 0 0.00
Handscoon Steril No. 7 Pasang 11,808.50 0 0.00
Handscoon Steril No. 7,5 Pasang 11,808.50 0 0.00
IV Catheter 18 G (Ekomed) Pcs 5,827.80 0 0.00
IV Catheter 24 G (Ekomed) Psg 5,827.00 0 0.00
Infus set dewasa Pcs 8,547.00 0 0.00
Infus set anak (Abada) Pcs 5,566.00 0 0.00
Infus set dewasa (Ekomed) Pcs 6,527.40 0 0.00
IV Catheter 24G (Abada) Pcs 6,455.90 0 0.00
IV Catheter 22 G (Abada) Roll 6,455.90 0 0.00
Kasa 16 x 16 Roll 4,114.00 0 0.00
Kasa hidrofil 40x80 Roll 143,022.00 0 0.00
Nasal O2 Canula Adult Pcs 7,502.00 0 0.00
Nasal O2 Canula Child Pcs 7,502.00 0 0.00
Nasal O2 Canula Neonatus Pcs 7,502.00 0 0.00
Nebulizer Mask Adult Pcs 16,032.50 0 0.00
Nebulizer Mask Pediatric Pcs 16,032.50 0 0.00
Oxygen nasal Canula anak Pcs 4,983.00 0 0.00
Oxygen nasal Canula dewasa Pcs 4,983.00 0 0.00
Oxygen Mask Anak Pcs 11,656.00 0 0.00
Oxygen Mask Dewasa Pcs 11,656.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Examination gloves size M Roll 1,740.20 0 0.00
Examination gloves size S Box 1,740.20 0 0.00
Pcs 49,491.20 0 0.00
(Kulit)
Onemed Povidone Iodine 300 ml Botol 21,060.00 0 0.00
Onemed Rivanol 300 cc Botol 2,983.50 0 0.00

Onemed Ultra One Test
Pcs 2,132.90 0 0.00
Kehamilan
Onemed surgical mask plus 3 ply
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Silk Braided Silk Coated Suture 3/0
Pcs 38,119.40 0 0.00
(Kulit)
Polipix 5 cm x 5 m Roll 41,100.00 0 0.00
Stera Syringe 3 cc Pcs 728.00 0 0.00
Urine Bag With Hanger Pcs 6,062.10 0 0.00
Urocare Folley Catheter 2 way No.
Pcs 8,960.00 0 0.00
18
4066295.36 0.00
KESMAS Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 0 0.00

Fitomenadion (Vit.K) injeksi Ampul 4,236.00 0 0.00
Mineral Mix sachet 2,920.00 0 0.00
Magnesium Sulfat Inj 40% Vial 3,796.00 0 0.00
Oksitetrasiklin 1% Salep Mata Tube 2,600.00 0 0.00
Vit A Bayi 100,000 IU ( biru ) Kapsul 354.00 0 0.00
Vitamin Balita (merah) Kapsul 637.00 0 0.00
1853300 0.00
KESGRA kotak/
Alat suntik sekali pakai 1 cc 118,973.00 0 0.00
100 set
Alat suntik sekali pakai 3 cc Pcs 832.00 0 0.00
Alat suntik sekali pakai 5 cc pcs 1,137.40 0 0.00
Catgut/Benang bedah No.2/0 Pcs 9,332.40 0 0.00
Catgut chromic 2/0 + jarum 1/2 GT
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Foley catheter No.16 Set 9,794.40 0 0.00
Handscoen No. 7 steril Pairs 4,654.10 0 0.00
Handscoen No. 7,5 steril Pairs 4,654.10 0 0.00
Set/
Infusion Anak (PKD 2) 6,968.50 0 0.00
Kantong
Infusion set anak (20 drops/ml) Pcs 4,480.00 0 0.00
Infusion set dewasa (20 drops/ml) Pcs 4,096.00 0 0.00
Set/
Infusion set dewasa (PKD 1) 6,470.20 0 0.00
Kantong
Kasa pembalut hidrofil 4 x 5 Roll 960.00 0 0.00
Kasa hidrofil steril uk. 16 x 16 Box/16 7,424.00 0 0.00
Kasa hidrofil 40 x 80 roll 134,371.60 0 0.00
Safeglove Exam (M) Box/100 41,600.00 0 0.00
Silk 3/0 pcs 7,647.20 0 0.00
Silk 3/0 + jarum 1/2 GT 35 mm Pcs 3,911.11 0 0.00
Steracath i.v catheter No 18 G x 32 Pcs 4,864.00 0 0.00

Syringe disposible 3cc x 23 Gx11/2 Pcs 832.00 0 0.00
0 0.00
DAU Cairan Pembersih Tangan Botol 55,000.00 0 0.00

PAJAK Handscoon non steril L Pcs 470.50 0 0.00
ROKOK
Handscoon non steril M Pcs 470.50 0 0.00
Handscoon non steril S Pcs 470.50 0 0.00
Handscoon non steril L Pcs 464.64 0 0.00
IV Catheter 22 G (Abada) Pcs 5,775.00 0 0.00
Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
94100 0.00
BTT Baju hazmat/ APD Pcs 180,000.00 0 0.00

Celemek Plastik Pcs 66,000.00 0 0.00
Efinefrin injeksi 1 mg Ampul 6,691.85 0 0.00
Faceshield anti droplet Pcs 38,000.00 0 0.00
Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Onoiwa tablet 6,000.00 0 0.00
Rapid antigen Covid-19 Pcs 70,000.00 0 0.00
Sarung Tangan Genokologi non
Psg 55,000.00 0 0.00
Steril
Sarung Tangan L Box/100 200,000.00 0 0.00
Sarung Tangan M Box/100 200,000.00 0 0.00
4104000 0.00
DAU Rapid test Antigen Test 57,194.00 0 0.00

RECOFUS
ING VTM (Transport Medium Dacron
Kit 1,878,709.68 0 0.00
Swab) 2 ml
Corona Virus Ag Rapid Test Kotak 1,143,880.00 0 0.00
0 0 0.00 0
TOTAL 0.00
TOTAL 158,761.00
.
Yang Memberikan, Yang Menerima
.
.
.
_________________________________ _______________________________
.
KEPADA : 0 .
WAKTU : Sabtu,30 Desember 1899 .
NO. BAP : 11 .
.
SUMBER JUMLAH
DANA PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

TOTAL DAU 0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
TOTAL P2PL 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
Lidokain Injeksi Comp Ampul 847.00 0 0.00
Metformin Tablet Tablet 77.00 0 0.00
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
TOTAL DAK 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
TOTAL BMHP E-CAT DAK 0.00

TOTAL KESMAS 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
TOTAL KESMAS 0.00

ROKOK
Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
TOTAL DAU PAJAK ROKOK 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
TOTAL BANTUAN TAK TERDUGA 0.00

RECOFUS
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
DAU RECOFUSING 0.00
TOTAL 0.00
,
,
,
,
_________________________________ _______________________________
KEPADA : 0
WAKTU : Sabtu,30 Desember 1899
NO. BAP : 12
SUMBER JUMLAH
NO NAMA OBAT SATUAN HARGA
DANA PEMBERIAN
DAU Allopurinol tablet 100 mg Tablet 90.00 0

Abon AMP (Amphetamine) Test 16,500.00 0
Ambroxol Tablet 160.00 0
Ambroxol tablet Tablet 224.40 0
Aminofillin 200 mg Tablet 160.00 0
Amlodipin 10 mg Tablet 74.00 0
Acyclofir 200 mg Tablet 251.00 0
Acyclofir cr Tube 3,625.00 0
Alkohol 70% Botol 37,638.70 0
Alkohol swab 100 pcs 14,490.00 0
Alat Suntik 3 ml (cosmomed) Psc 1,102.20 0
Amitriptilin tablet salut 25 mg Tablet 123.00 0
Antasida tab Tablet 78.00 0
Botol 75,020.00 0
Reagents
Botol 75,020.00 0
Reagents
Botol 101,761.00 0
Reagents
Anti D Duocloral Monocloral Botol 125,477.00 0
Antihemoroid Tablet 3,260.00 0
Asam mefenamat tablet 122.00 0
Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 0

Botol/25
Asam Urat Test Strip 276,891.50 0
Strip
Becefort Tablet 1,536.70 0
BD Gard Kapsul Tablet 10,890.00 0
Blood Lancet Psc 138.00 0
Bioplacenton Tulle Box 108,324.00 0
Benecheck Strip Cholesterol Pcs 25,283.92 0
Benecheck Strip Uric Acid Pcs 6,689.54 0
Benecheck Strip Glucose Pcs 3,206.20 0
Captopril tab 25 mg Tablet 75.00 0
Cetrisyn sirup 5 mg/5 ml Botol 2,215.00 0
Calsium Laktat tablet 60.00 0
Ciprofloxasin tab 500 mg Tablet 260.00 0
Deksametason tablet 0,5 mg Tablet 151.80 0
Dengue test NS1 Test 132,000.00 0
Dimenhidrinat 50 mg Tablet 109.00 0
Domperidon tablet 10 mg Tablet 75.00 0
Kotak/50
Face Mask Ear Loop 69,000.00 0
pcs
Fenol Gliserol Botol 3,300.00 0
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Fokus febrile Antigen H Paratiphy Vial 26,784.00 0

Tablet 690.00 0
salut 10 mg
Ampul 4,236.00 0
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0
Foley Catheter 2 Way FR No.18 Pcs 36,696.00 0
Gliceril guaiacolat tab 100 mg Tablet 28.75 0
Glimepirid tab 1 mg Tablet 96.00 0
Sachet 317.00 0
untuk 200 ml
Glukosa Larutan Infus 5% Botol 5,720.00 0
Griseofulvin tablet 125 mg Tablet 210.00 0
Handschoen No. 7 Steril Psg 11,432.00 0
Handschoen No. 7,5 Steril Psg 3,630.00 0
Hiosina Butilbromida tab 10 mg Tablet 1,050.00 0
Hipafix 15 cm x 5 m Roll 302,000.00 0
Human Humasens Plus Unit 814,009.50 0
Ibuprofen tablet 200 mg Tablet 123.17 0
Infusion set Anak Pcs 3,333.00 0
Infusion set dewasa Pcs 8,867.00 0
IV Catheter 20 G (Abbocath-T) Pcs 16,000.00 0
Ketokonazol tab 200 mg Tablet 260.00 0
Tube 3,360.00 0
(Bufacetin)
Tablet 20.55 0
4 mg
Tablet 152.00 0
(Dewasa)
Botol 60
Kotrimoksazol syr 2,298.00 0
ml
547,319.00 0
humasens) strip
Lidokain inj 2% com (pehacain inj) Ampul 3,113.05 0
Lidokain gel 2% Tube 41,600.00 0

Lidokain spray oral 10% Botol 177,216.00 0
Metformin tablet 500 mg Tablet 118.50 0
Ampul 3,712.00 0
mg - ml
Tube 10
Mikonazol krim/salep 2% (Nitrat) 3,150.00 0
gr
Natrium Diklofenak 50 mg Tablet 109.00 0
Botol 500
Natrium Klorida larutan infus steril 6,900.00 0
ml
Nistatin Tab Salut 500.000UI Tablet 869.00 0
Botol 14,273.00 0
Syrup)
Obat batuk Hitam (OBH) Botol 3,450.00 0
Omeprazole kaps 20 mg kapsul 129.00 0
Papaverin tablet 40 mg Tablet 180.90 0
Parasetamol syrup 120 mg/5 ml Botol 1,535.00 0
Parasetamol tablet 500 mg Tablet 60.00 0
Phenylbutazon tablet 200 mg Tablet 88.21 0
Tablet 18.95 0
mg
Tablet 26.35 0
mg
Tablet 318.00 0
mg
Pitogin inj Ampul 5,291.00 0
Plester ( Leucoplast 3 x 5 ) Roll 35,532.00 0
Prednison tablet 5 mg Tablet 105.88 0
Pritavit Kaplet Kaplet 1,027.95 0
Ringer laktat larutan infus steril Botol 7,703.00 0
Salep 24 Tablet 1,475.00 0
Ranitidin tablet Tablet 85.00 0
Sarung Tangan M Pcs 495.00 0
Sarung Tangan S Pcs 495.00 0
Sarung Tangan Steril No. 7,5 Pcs 3,630.00 0
Sarung Tangan Steril No. 7 Pcs 3,630.00 0
Simvastatin tablet salut 20 mg Tablet 73.00 0
Tetrasiklin HCl kaps 500 mg kapsul 279.82 0
Thiamin HCl (Vit.B1) tablet 50 mg Tablet 57.55 0
Underpad 60x90 cm ( Cosmomed ) Pcs 8,970.00 0
Urine bag Pcs 4,488.00 0

Vitamin B kompleks tablet Tablet 24.31 0
Zinc tablet dispersible 20 mg Tablet 521.00 0
4564434.35 0.00
P2PL Alat suntik sekali pakai 0,05 ml Pcs 1,240.00 0

Alat suntik sekali pakai 0,05 ml Pcs 1,518.00 0
Alat suntik 5 ml Pcs 1,583.00 0
Albendazol Suspensi 200 mg/5 ml Botol 4,600.00 0
Albendazol tablet 400 mg Tablet 380.00 0

Albendazol tab 400 mg Tablet 271.14 0
Alkohol swab pcs 242.00 0
Clozapine Tablet 1,121.00 0
DHP Tablet 2,134.00 0
Garam oralit Saccet 275.00 0
Handscoun L Pcs 490.00 0
Handscoun L Kotak 48,999.50 0
Tablet 147.00 0
(HCl)
Pot Sputum Pcs 2,272.00 0
Pot Dahak Pcs 2,950.00 0
Pot Dahak Non steril pot 2,000.00 0
Primaquin 15 mg Tablet 242.00 0
Obat FDC Kategori Anak Paket 285,339.00 0
Obat FDC Kategori 1 Paket 477,791.00 0
Obat FDC Kategori 2 Paket 1,592,731.00 0
Rapid 1 HIV (SD) Tes 11,975.00 0
Rapid test Syphilis (Trepocheck) Tes 9,300.00 0
Rapid test HbSAg Tes 9,878.00 0

Rapid test Tifoid Tes 33,334.00 0
Risperidone Tablet 287.00 0
RPR Focus tes 4,260.00 0
SD HIV 19 Tes 14,340.00 0
Vaksin VAR Dus 153,000.00 0
Triheksifenidil 2 mg tab Tablet 91.00 0
Vaksin Anti Rabies Vial 165,000.00 0
Vaksin BCG Vial 61,996.00 0
Vaksin Campak Vial 28,204.00 0
Vaksin DPT HB HiB Vial 78,991.00 0
Vaksin DT Vial 17,996.00 0
Vaksin IPV Vial 158,994.00 0
Vaksin Immuno Globuline Vial 1,325,000.00 0
Vaksin Meningitis Vial 135,000.00 0
Vaksin HB Uniject (HB 0) Uniject 23,991.00 0
Vaksin HB Rekombinasi (HB-Pid) Uniject 23,991.00 0
Vaksin MR Vial 155,813.00 0

Vaksin Polio Oral (OPV) Vial 19,954.00 0
Vaksin TD Vial 16,995.00 0
Vial 1,325,000.00 0
Globuline
Zinc Tablet 20 mg Tablet 604.00 0
10640081 0.00
DAK Alat suntik sekali pakai 1 ml Set 728.00 0

Psc 1,125.85 0
Alat suntik 5 cc (Stera) Psc 840.00 0
Alkohol Swab (Onemed) Box 11,200.00 0
Alkohol 70 % 1 L (onemed) Botol 25,155.00 0
Allopurinol tab 100 mg Tablet 105.00 0
Allopurinol tablet 100 mg Tablet 99.00 0
Air untuk injeksi amp 25 ml Ampul 2,860.00 0
Aminofilin 200 mg Tablet 86.00 0
Amitriptyline tablet salut 25 mg Tablet 123.00 0
Acetylcystein kapsul 200 mg Kapsul 908.00 0

Amlodipin tablet 5 mg Tablet 55.00 0
Amlodipin tab 10 mg Tablet 74.00 0
Amoksisillin kaplet 500 mg Tablet 265.00 0
Amoksisilin kaplet 500 mg Tablet 360.00 0
Botol 2,560.00 0
5 ml
Botol 3,846.00 0
ml
Amoksisillin sirup DS 250 mg/ 5 ml Botol 3,510.00 0
Anios Gel 85 Botol 88,678.66 0

Antasida Suspensi Botol 2,098.00 0
Antasida Doen tablet Tablet 60.00 0

Asam mefenamat kaplet 500 mg Tablet 117.00 0
Antifungi Salep Kulit Tube 5,170.00 0

Asiklovir tablet 200 mg Tablet 251.00 0
Attapulgit 630 mg (Puralex) Tablet 175.00 0
Botol/500
Asering 9,646.00 0
ml
Attapulgit Tablet 149.00 0
Betametason krim 0,1% Tube 5 gr 1,515.00 0
Betametasone krim 0,1 % Tube 1,520.00 0

Bisakodil Tablet 5 mg Tablet 337.00 0
Tube 3,585.00 0
kulit)
Calsium Laktat Tablet 82.00 0
Captopril 25 mg Tablet 75.00 0
Catgut 3/0 Pcs 64,191.00 0
Cetrisyn sirup botol 3,061.00 0
Dermafix Bliste 2,298.84 0
Ampul 1,210.00 0
1 ml
Disposable safety box 5 liter Buah 18,000.00 0
Domperidon Tablet 10 mg Tablet 90.00 0
Domperidone suspensi 5 mg/5 ml Botol 2,862.00 0
Diazepam tablet 2 mg Tablet 70.00 0

Diazepam inj 5 mg/ml Vial 1,545.00 0
Tube 14,459.00 0
(Stesolid Rektal)
Tube 21,021.00 0
(Stesolid Rektal)
Ampul 825.00 0
mg/ml
Doxycycline 100 mg Tablet 309.00 0
Eritromisin 500 mg Kapsul 766.00 0
Ampul 2,354.00 0
mg/ml
Ampul 1,518.00 0
ml
Botol100
Etil Klorida Semprot 115,500.00 0
ml
Examination gloves size L (Aximed) Pcs 508.20 0

Pcs 508.20 0
(Aximed)
Pcs 508.20 0
(Aximed)
Botol 100
Fenobarbital 7,010.00 0
ml
Fenobarbital Tablet Tablet 177.00 0
Ampul 3,754.00 0
mg/ 1 ml
Ampul 4,083.00 0
mg/ 1 ml
Ampul 4,236.00 0
mg/ml
Tablet 873.00 0
gula 10 mg
Tablet 781.00 0
gula 10 mg
Pcs 8,960.00 0
(urocare)
Furosemid tab Tablet 88.00 0
Glass ionomer ART Buah 606,900.00 0
Garam oralit Sachet 317.00 0
Garam oralit kombinasi Sachet 274.00 0
Botol 500
Glukosa larutan infus 5% steril 5,720.00 0
ml
Glukosa larutan infus 5% steril Botol 6,900.00 0
Glimepirid tablet 2 mg Tablet 297.00 0
Kotak 14,600.30 0
(Guaifenesin)
Gliseril Gualakolat tablet 100 mg Tablet 228.00 0

Kotak/25
Glukosa test strip 137,500.00 0
strip
Glukosa test strip Strip 7,084.00 0
Kotak 60
Gelatine sponge 322,190.00 0
spons
Haloperidol 1,5 mg Tablet 76.00 0
Haloperidol 2 mg (lodomer) Tablet 90.00 0
Haloperidol 5 mg Tablet 60.00 0
Handschoen No. 6,5 steril psg 8,487.66 0
Hidrokortisom krim 2,5 % Tube 2,648.00 0
Tablet 2,329.80 0
(Scopamin)
Ibuprofen suspensi 100 mg/ 5 ml Botol 2,560.00 0
Infusion set Anak(PKD 2) Set 6,930.00 0

Infuset dewasa (Aximed) Pcs 5,280.00 0
Introcan No.22 Pcs 13,200.00 0
Isosorbid Dinitrate 5 mg Tablet 93.00 0
Pcs 4,256.00 0
(Steracath)
Pcs 4,256.00 0
(Steracath)
IV Catheter 20G x 1 1/4 (Nipro) Pcs 8,070.70 0
IV Catheter 22G x 1 (Steracath) Pcs 4,256.00 0
IV Catheter 24G x 3/4 (Steracath) Pcs 4,256.00 0

Tablet 60.00 0
mg
Bungkus/
Kapas pembalut 60,830.00 0
1 kg
Kasa kompres 40x40 Pcs 1,700.00 0
Kasa 2 m x 80 cm (Onemed) Roll 8,624.00 0
Roll 840.00 0
(Onemed)
Roll 1,680.00 0
(Onemed)
Roll 2,400.00 0
cm
Roll 660.80 0
(Onemed)
Tube 3,760.00 0
(Bufacetin)
Kloramfenikol salep mata 1% Tube 2,013.00 0
Tablet 24.00 0
4 mg
klorfeniramini maleat (CTM) Tablet 26.27 0
Botol 60
Kotrimoksazol suspensi 2,052.00 0
ml
Kotrimoksazol tablet 480 mg Tablet 126.00 0
Kotrimoksaxol dewasa 480 mg Tablet 125.00 0
Loperamid tablet 2 mg Tablet 97.00 0
Loratadine Tablet 127.00 0
Lidokain Injeksi Comp Ampul 847.00 0
Lysol 1 liter (onemed) Botol 47,970.00 0
Lidokain injeksi Comp Ampul 1,405.00 0
Masker Tali Box 31,165.00 0
Metformin Tablet Tablet 77.00 0
Miconazole Salep Kulit Tube 1,900.00 0
Mikonazole salep 2 % Tube 3,926.00 0
MgS04 20% Vial 3,200.00 0
Ampul 1,069.00 0
mg/ml
Tablet 245.00 0
0,125 mg
Metokloperamide tablet Tablet 100.00 0
Metokloperamide syr (Lexapram) Botol 2,750.00 0
Botol 500
Natrium Klorida larutan infus 0,9% 6,840.00 0
ml
Botol 500
ml
Natrium diklofenak tablet Tablet 136.00 0
Nifedipin tablet 10 mg Tablet 127.00 0
Nistatin 100.000 IU Tablet 645.00 0
Onoiwa Kaplet 5,650.00 0
Paket 1,319,900.00 0
Kategori 2
Oksitosin injeksi Ampul 1,348.00 0
Omeprazol kaps 20 mg Kapsul 129.00 0
Parasetamol sirup 120 mg/ 5 ml Botol 4,950.00 0
Parasetamol sirup Botol 1,160.00 0
Botol 15
Parasetamol drops 100 mg/ml 5,720.00 0
ml
Botol 15
Parsetamol drops 100 mg/ml 5,980.00 0
ml
Tablet 72.00 0
mg HCl
Tablet 141.00 0
mg HCl
Propanolol 10 mg tab Tablet 80.00 0
Plester 3 x 5 H leukoplast Roll 50,600.00 0
Povidone Iodine 30 ml (Onemed) Botol 3,190.00 0
Botol 60
Povidone Iodine 100 mg/ml 25,215.00 0
ml
Pyrantel pamoat Tablet 318.00 0
Ringer laktat larutan infus botol 7,630.00 0
Botol 500
Ringer laktat larutan infus 7,150.00 0
ml
Ranitidin tablet 150 mg Tablet 114.00 0
Rivanol 300 cc (onemed) Botol 2,983.50 0
Sarung tangan obgyn steril Psg 22,000.00 0
Salbutamol tablet 4 mg Tablet 67.00 0
Salbutamol syr Botol 5,463.00 0
Pot 30
Salep 2-4 kombinasi 2,200.00 0
gram
Salep 2-4 kombinasi Pot 3,017.00 0
Ampul 1,226.00 0
500 mcg
Tablet 44.00 0
mg
Silk 3/0 Psc 53,064.00 0
Siprofloxacin Tablet 500 mg Tablet 281.00 0
Stesolid rektal 5 mg Tube 12,749.00 0
Tablet tambah darah Tablet 409.00 0
Tablet 91.00 0
tablet 50 mg
Tetrasiklin HCl kapsul 250 mg Kapsul 174.00 0
kotak/10
Test trip kolestrol 255,000.00 0
strip
Kotak/25
Test trip asam urat 195,000.00 0
strip
Vitamin B Kompleks tablet Tablet 135.00 0
Zink tablet dispersible 20 mg Tablet 604.00 0
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0
ml
Zink syrup 20 mg/ 5 ml Botol 3,285.00 0
4386346.74 0.00
BMHP E- Alat Suntik 1 cc (Nipro) Pcs 1,004.85 0

CAT DAK Alat Suntik 3 cc (Abada) Pcs 924.00 0
Alat Suntik 3 cc (Abada) Pcs 887.70 0
Alat Suntik 3 cc (Nipro) Pcs 924.00 0
Chlodine 0,5% Jergen 5 L 395,384.74 0
Blood Lancet (Ekomed) Kotak 16,401.00 0

Folley Catheher No. 16 Pcs 11,945.23 0
Handscoon Non Steril S Pcs 1,740.20 0
Handscoon Steril No. 7 Pasang 11,808.50 0
Handscoon Steril No. 7,5 Pasang 11,808.50 0
IV Catheter 18 G (Ekomed) Pcs 5,827.80 0
IV Catheter 24 G (Ekomed) Psg 5,827.00 0
Infus set dewasa Pcs 8,547.00 0
Infus set anak (Abada) Pcs 5,566.00 0
Infus set dewasa (Ekomed) Pcs 6,527.40 0
IV Catheter 24G (Abada) Pcs 6,455.90 0
IV Catheter 22 G (Abada) Roll 6,455.90 0
Kasa 16 x 16 Roll 4,114.00 0
Kasa hidrofil 40x80 Roll 143,022.00 0
Nasal O2 Canula Adult Pcs 7,502.00 0
Nasal O2 Canula Child Pcs 7,502.00 0
Nasal O2 Canula Neonatus Pcs 7,502.00 0
Nebulizer Mask Adult Pcs 16,032.50 0
Nebulizer Mask Pediatric Pcs 16,032.50 0
Oxygen nasal Canula anak Pcs 4,983.00 0
Oxygen nasal Canula dewasa Pcs 4,983.00 0
Oxygen Mask Anak Pcs 11,656.00 0
Oxygen Mask Dewasa Pcs 11,656.00 0
Pcs 46,959.00 0
(Otot)
Roll 55,030.80 0
(Kulit)
Examination gloves size M Roll 1,740.20 0
Examination gloves size S Box 1,740.20 0
Pcs 49,491.20 0
(Kulit)
Onemed Povidone Iodine 300 ml Botol 21,060.00 0
Onemed Rivanol 300 cc Botol 2,983.50 0

Pcs 2,132.90 0
Kehamilan
Box 24,640.00 0
plus
Box 31,165.00 0
plus
Pcs 38,119.40 0
(Kulit)
Polipix 5 cm x 5 m Roll 41,100.00 0
Stera Syringe 3 cc Pcs 728.00 0
Urine Bag With Hanger Pcs 6,062.10 0
Pcs 8,960.00 0
18
4066295.36 0.00
KESMAS Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 0
Fitomenadion (Vit.K) injeksi Ampul 4,236.00 0
Mineral Mix sachet 2,920.00 0
Magnesium Sulfat Inj 40% Vial 3,796.00 0
Oksitetrasiklin 1% Salep Mata Tube 2,600.00 0
Vit A Bayi 100,000 IU ( biru ) Kapsul 354.00 0
Vitamin Balita (merah) Kapsul 637.00 0
1853300 0.00
KESGRA kotak/
Alat suntik sekali pakai 1 cc 118,973.00 0
100 set
Alat suntik sekali pakai 3 cc Pcs 832.00 0
Alat suntik sekali pakai 5 cc pcs 1,137.40 0
Catgut/Benang bedah No.2/0 Pcs 9,332.40 0
Pcs 7,146.67 0
35 mm
Pcs 7,146.67 0
35 mm
Botol
Etanol 70 % 28,567.00 0
1000 ml
Botol 100
Ethyl semprot 114,967.60 0
ml
Foley catheter No.16 Set 9,794.40 0
Handscoen No. 7 steril Pairs 4,654.10 0
Handscoen No. 7,5 steril Pairs 4,654.10 0
Set/
Infusion Anak (PKD 2) 6,968.50 0
Kantong
Infusion set anak (20 drops/ml) Pcs 4,480.00 0
Infusion set dewasa (20 drops/ml) Pcs 4,096.00 0
Set/
Infusion set dewasa (PKD 1) 6,470.20 0
Kantong
Kasa pembalut hidrofil 4 x 5 Roll 960.00 0
Kasa hidrofil steril uk. 16 x 16 Box/16 7,424.00 0
Kasa hidrofil 40 x 80 roll 134,371.60 0
Safeglove Exam (M) Box/100 41,600.00 0
Silk 3/0 pcs 7,647.20 0
Silk 3/0 + jarum 1/2 GT 35 mm Pcs 3,911.11 0
Steracath i.v catheter No 18 G x 32 Pcs 4,864.00 0
Syringe disposible 3cc x 23 Gx11/2 Pcs 832.00 0
0 0.00
DAU Cairan Pembersih Tangan Botol 55,000.00 0

PAJAK Handscoon non steril L Pcs 470.50 0
ROKOK
Handscoon non steril M Pcs 470.50 0
Handscoon non steril S Pcs 470.50 0
Handscoon non steril L Pcs 464.64 0
IV Catheter 22 G (Abada) Pcs 5,775.00 0
Catgut 3/0 Pcs 63,103.00 0
94100 0.00
BTT Baju hazmat/ APD Pcs 180,000.00 0

Celemek Plastik Pcs 66,000.00 0
Efinefrin injeksi 1 mg Ampul 6,691.85 0
Faceshield anti droplet Pcs 38,000.00 0
Masker N95 Pcs 66,000.00 0
Nurse Cup Pcs 5,000.00 0
Onoiwa tablet 6,000.00 0
Rapid antigen Covid-19 Pcs 70,000.00 0
Psg 55,000.00 0
Steril
Sarung Tangan L Box/100 200,000.00 0
Sarung Tangan M Box/100 200,000.00 0
4104000 0.00
DAU Rapid test Antigen Test 57,194.00 0

RECOFUS
Kit 1,878,709.68 0
Swab) 2 ml
0 0 0.00 0
TOTAL 0.00
TOTAL 0.00
_________________________________ _______________________________
.
. KEPADA : 0
. WAKTU : Sabtu,30 Desember 1899
. NO. BAP : 13
.
SUMBER
TOTAL HARGA NO NAMA OBAT SATUAN HARGA
DANA
0.00 DAU Allopurinol tablet 100 mg Tablet 90.00

0.00 Abon AMP (Amphetamine) Test 16,500.00
0.00 Ambroxol Tablet 160.00
0.00 Ambroxol tablet Tablet 224.40
0.00 Aminofillin 200 mg Tablet 160.00
0.00 Amlodipin 10 mg Tablet 74.00
0.00 Acyclofir 200 mg Tablet 251.00
0.00 Acyclofir cr Tube 3,625.00
0.00 Alkohol 70% Botol 37,638.70
0.00 Alkohol swab 100 pcs 14,490.00
0.00 Alat Suntik 3 ml (cosmomed) Psc 1,102.20
0.00 Amitriptilin tablet salut 25 mg Tablet 123.00
0.00 Antasida tab Tablet 78.00
0.00 Botol 75,020.00
Reagents
0.00 Botol 75,020.00
Reagents
0.00 Botol 101,761.00
Reagents
0.00 Anti D Duocloral Monocloral Botol 125,477.00
0.00 Antihemoroid Tablet 3,260.00
0.00 Asam mefenamat tablet 122.00
0.00 Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00

Botol/25
0.00 Asam Urat Test Strip 276,891.50
Strip
0.00 Becefort Tablet 1,536.70
0.00 BD Gard Kapsul Tablet 10,890.00
0.00 Blood Lancet Psc 138.00
0.00 Bioplacenton Tulle Box 108,324.00
0.00 Benecheck Strip Cholesterol Pcs 25,283.92
0.00 Benecheck Strip Uric Acid Pcs 6,689.54
0.00 Benecheck Strip Glucose Pcs 3,206.20
0.00 Captopril tab 25 mg Tablet 75.00
0.00 Cetrisyn sirup 5 mg/5 ml Botol 2,215.00
0.00 Calsium Laktat tablet 60.00
0.00 Ciprofloxasin tab 500 mg Tablet 260.00
0.00 Deksametason tablet 0,5 mg Tablet 151.80
0.00 Dengue test NS1 Test 132,000.00
0.00 Dimenhidrinat 50 mg Tablet 109.00
0.00 Domperidon tablet 10 mg Tablet 75.00
Kotak/50
0.00 Face Mask Ear Loop 69,000.00
pcs
0.00 Fenol Gliserol Botol 3,300.00
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Fokus febrile Antigen H Paratiphy Vial 26,784.00

0.00 Tablet 690.00
salut 10 mg
0.00 Ampul 4,236.00
mg/ 1 ml
0.00 Fit D3 1000 Tablet 2,178.00
0.00 Foley Catheter 2 Way FR No.18 Pcs 36,696.00
0.00 Gliceril guaiacolat tab 100 mg Tablet 28.75
0.00 Glimepirid tab 1 mg Tablet 96.00
0.00 Sachet 317.00
untuk 200 ml
0.00 Glukosa Larutan Infus 5% Botol 5,720.00
0.00 Griseofulvin tablet 125 mg Tablet 210.00
0.00 Handschoen No. 7 Steril Psg 11,432.00
0.00 Handschoen No. 7,5 Steril Psg 3,630.00
0.00 Hiosina Butilbromida tab 10 mg Tablet 1,050.00
0.00 Hipafix 15 cm x 5 m Roll 302,000.00
0.00 Human Humasens Plus Unit 814,009.50
0.00 Ibuprofen tablet 200 mg Tablet 123.17
0.00 Infusion set Anak Pcs 3,333.00
0.00 Infusion set dewasa Pcs 8,867.00
0.00 IV Catheter 20 G (Abbocath-T) Pcs 16,000.00
0.00 Ketokonazol tab 200 mg Tablet 260.00
0.00 Tube 3,360.00
(Bufacetin)
0.00 Tablet 20.55
4 mg
0.00 Tablet 152.00
(Dewasa)
Botol 60
0.00 Kotrimoksazol syr 2,298.00
ml
0.00 547,319.00
humasens) strip
0.00 Lidokain inj 2% com (pehacain inj) Ampul 3,113.05
0.00 Lidokain gel 2% Tube 41,600.00

0.00 Lidokain spray oral 10% Botol 177,216.00
0.00 Metformin tablet 500 mg Tablet 118.50
0.00 Ampul 3,712.00
mg - ml
Tube 10
0.00 Mikonazol krim/salep 2% (Nitrat) 3,150.00
gr
0.00 Natrium Diklofenak 50 mg Tablet 109.00
Botol 500
0.00 Natrium Klorida larutan infus steril 6,900.00
ml
0.00 Nistatin Tab Salut 500.000UI Tablet 869.00
0.00 Botol 14,273.00
Syrup)
0.00 Obat batuk Hitam (OBH) Botol 3,450.00
0.00 Omeprazole kaps 20 mg kapsul 129.00
0.00 Papaverin tablet 40 mg Tablet 180.90
0.00 Parasetamol syrup 120 mg/5 ml Botol 1,535.00
0.00 Parasetamol tablet 500 mg Tablet 60.00
0.00 Phenylbutazon tablet 200 mg Tablet 88.21
0.00 Tablet 18.95
mg
0.00 Tablet 26.35
mg
0.00 Tablet 318.00
mg
0.00 Pitogin inj Ampul 5,291.00
0.00 Plester ( Leucoplast 3 x 5 ) Roll 35,532.00
0.00 Prednison tablet 5 mg Tablet 105.88
0.00 Pritavit Kaplet Kaplet 1,027.95
0.00 Ringer laktat larutan infus steril Botol 7,703.00
0.00 Salep 24 Tablet 1,475.00
0.00 Ranitidin tablet Tablet 85.00
0.00 Sarung Tangan M Pcs 495.00
0.00 Sarung Tangan S Pcs 495.00
0.00 Sarung Tangan Steril No. 7,5 Pcs 3,630.00
0.00 Sarung Tangan Steril No. 7 Pcs 3,630.00
0.00 Simvastatin tablet salut 20 mg Tablet 73.00
0.00 Tetrasiklin HCl kaps 500 mg kapsul 279.82
0.00 Thiamin HCl (Vit.B1) tablet 50 mg Tablet 57.55
0.00 Underpad 60x90 cm ( Cosmomed ) Pcs 8,970.00
0.00 Urine bag Pcs 4,488.00

0.00 Vitamin B kompleks tablet Tablet 24.31
0.00 Zinc tablet dispersible 20 mg Tablet 521.00
0.00 0
0.00 P2PL Alat suntik sekali pakai 0,05 ml Pcs 1,240.00

0.00 Alat suntik sekali pakai 0,05 ml Pcs 1,518.00
0.00 Alat suntik 5 ml Pcs 1,583.00
0.00 Albendazol Suspensi 200 mg/5 ml Botol 4,600.00
0.00 Albendazol tablet 400 mg Tablet 380.00

0.00 Albendazol tab 400 mg Tablet 271.14
0.00 Alkohol swab pcs 242.00
0.00 Clozapine Tablet 1,121.00
0.00 DHP Tablet 2,134.00
0.00 Garam oralit Saccet 275.00
0.00 Handscoun L Pcs 490.00
0.00 Handscoun L Kotak 48,999.50
0.00 Tablet 147.00
(HCl)
0.00 Pot Sputum Pcs 2,272.00
0.00 Pot Dahak Pcs 2,950.00
0.00 Pot Dahak Non steril pot 2,000.00
0.00 Primaquin 15 mg Tablet 242.00
0.00 Obat FDC Kategori Anak Paket 285,339.00
0.00 Obat FDC Kategori 1 Paket 477,791.00
0.00 Obat FDC Kategori 2 Paket 1,592,731.00
0.00 Rapid 1 HIV (SD) Tes 11,975.00
0.00 Rapid test Syphilis (Trepocheck) Tes 9,300.00
0.00 Rapid test HbSAg Tes 9,878.00

0.00 Rapid test Tifoid Tes 33,334.00
0.00 Risperidone Tablet 287.00
0.00 RPR Focus tes 4,260.00
0.00 SD HIV 19 Tes 14,340.00
0.00 Vaksin VAR Dus 153,000.00
0.00 Triheksifenidil 2 mg tab Tablet 91.00
0.00 Vaksin Anti Rabies Vial 165,000.00
0.00 Vaksin BCG Vial 61,996.00
0.00 Vaksin Campak Vial 28,204.00
0.00 Vaksin DPT HB HiB Vial 78,991.00
0.00 Vaksin DT Vial 17,996.00
0.00 Vaksin IPV Vial 158,994.00
0.00 Vaksin Immuno Globuline Vial 1,325,000.00
0.00 Vaksin Meningitis Vial 135,000.00
0.00 Vaksin HB Uniject (HB 0) Uniject 23,991.00
0.00 Vaksin HB Rekombinasi (HB-Pid) Uniject 23,991.00
0.00 Vaksin MR Vial 155,813.00

0.00 Vaksin Polio Oral (OPV) Vial 19,954.00
0.00 Vaksin TD Vial 16,995.00
0.00 Vial 1,325,000.00
Globuline
0.00 Zinc Tablet 20 mg Tablet 604.00
0.00 0
0.00 DAK Alat suntik sekali pakai 1 ml Set 728.00

0.00 Psc 1,125.85
0.00 Alat suntik 5 cc (Stera) Psc 840.00
0.00 Alkohol Swab (Onemed) Box 11,200.00
0.00 Alkohol 70 % 1 L (onemed) Botol 25,155.00
0.00 Allopurinol tab 100 mg Tablet 105.00
0.00 Allopurinol tablet 100 mg Tablet 99.00
0.00 Air untuk injeksi amp 25 ml Ampul 2,860.00
0.00 Aminofilin 200 mg Tablet 86.00
0.00 Amitriptyline tablet salut 25 mg Tablet 123.00
0.00 Acetylcystein kapsul 200 mg Kapsul 908.00

0.00 Amlodipin tablet 5 mg Tablet 55.00
0.00 Amlodipin tab 10 mg Tablet 74.00
0.00 Amoksisillin kaplet 500 mg Tablet 265.00
0.00 Amoksisilin kaplet 500 mg Tablet 360.00
0.00 Botol 2,560.00
5 ml
0.00 Botol 3,846.00
ml
0.00 Amoksisillin sirup DS 250 mg/ 5 ml Botol 3,510.00
0.00 Anios Gel 85 Botol 88,678.66

0.00 Antasida Suspensi Botol 2,098.00
0.00 Antasida Doen tablet Tablet 60.00

0.00 Asam mefenamat kaplet 500 mg Tablet 117.00
0.00 Antifungi Salep Kulit Tube 5,170.00

0.00 Asiklovir tablet 200 mg Tablet 251.00
0.00 Attapulgit 630 mg (Puralex) Tablet 175.00
Botol/500
0.00 Asering 9,646.00
ml
0.00 Attapulgit Tablet 149.00
0.00 Betametason krim 0,1% Tube 5 gr 1,515.00
0.00 Betametasone krim 0,1 % Tube 1,520.00

0.00 Bisakodil Tablet 5 mg Tablet 337.00
0.00 Tube 3,585.00
kulit)
0.00 Calsium Laktat Tablet 82.00
0.00 Captopril 25 mg Tablet 75.00
0.00 Catgut 3/0 Pcs 64,191.00
0.00 Cetrisyn sirup botol 3,061.00
0.00 Dermafix Bliste 2,298.84
0.00 Ampul 1,210.00
1 ml
0.00 Disposable safety box 5 liter Buah 18,000.00
0.00 Domperidon Tablet 10 mg Tablet 90.00
0.00 Domperidone suspensi 5 mg/5 ml Botol 2,862.00
0.00 Diazepam tablet 2 mg Tablet 70.00

0.00 Diazepam inj 5 mg/ml Vial 1,545.00
0.00 Tube 14,459.00
(Stesolid Rektal)
0.00 Tube 21,021.00
(Stesolid Rektal)
0.00 Ampul 825.00
mg/ml
0.00 Doxycycline 100 mg Tablet 309.00
0.00 Eritromisin 500 mg Kapsul 766.00
0.00 Ampul 2,354.00
mg/ml
0.00 Ampul 1,518.00
ml
Botol100
0.00 Etil Klorida Semprot 115,500.00
ml
0.00 Examination gloves size L (Aximed) Pcs 508.20

0.00 Pcs 508.20
(Aximed)
0.00 Pcs 508.20
(Aximed)
Botol 100
0.00 Fenobarbital 7,010.00
ml
0.00 Fenobarbital Tablet Tablet 177.00
0.00 Ampul 3,754.00
mg/ 1 ml
0.00 Ampul 4,083.00
mg/ 1 ml
0.00 Ampul 4,236.00
mg/ml
0.00 Tablet 873.00
gula 10 mg
0.00 Tablet 781.00
gula 10 mg
0.00 Pcs 8,960.00
(urocare)
0.00 Furosemid tab Tablet 88.00
0.00 Glass ionomer ART Buah 606,900.00
0.00 Garam oralit Sachet 317.00
0.00 Garam oralit kombinasi Sachet 274.00
Botol 500
0.00 Glukosa larutan infus 5% steril 5,720.00
ml
0.00 Glukosa larutan infus 5% steril Botol 6,900.00
0.00 Glimepirid tablet 2 mg Tablet 297.00
0.00 Kotak 14,600.30
(Guaifenesin)
0.00 Gliseril Gualakolat tablet 100 mg Tablet 228.00

Kotak/25
0.00 Glukosa test strip 137,500.00
strip
0.00 Glukosa test strip Strip 7,084.00
Kotak 60
0.00 Gelatine sponge 322,190.00
spons
0.00 Haloperidol 1,5 mg Tablet 76.00
0.00 Haloperidol 2 mg (lodomer) Tablet 90.00
0.00 Haloperidol 5 mg Tablet 60.00
0.00 Handschoen No. 6,5 steril psg 8,487.66
0.00 Hidrokortisom krim 2,5 % Tube 2,648.00
0.00 Tablet 2,329.80
(Scopamin)
0.00 Ibuprofen suspensi 100 mg/ 5 ml Botol 2,560.00
0.00 Infusion set Anak(PKD 2) Set 6,930.00

0.00 Infuset dewasa (Aximed) Pcs 5,280.00
0.00 Introcan No.22 Pcs 13,200.00
0.00 Introcan No.24 Pcs 13,750.00
0.00 Isosorbid Dinitrate 5 mg Tablet 93.00
0.00 Pcs 4,256.00
(Steracath)
0.00 Pcs 4,256.00
(Steracath)
0.00 IV Catheter 20G x 1 1/4 (Nipro) Pcs 8,070.70
0.00 IV Catheter 22G x 1 (Steracath) Pcs 4,256.00
0.00 IV Catheter 24G x 3/4 (Steracath) Pcs 4,256.00

0.00 Tablet 60.00
mg
Bungkus/
0.00 Kapas pembalut 60,830.00
1 kg
0.00 Kasa kompres 40x40 Pcs 1,700.00
0.00 Kasa 2 m x 80 cm (Onemed) Roll 8,624.00
0.00 Roll 840.00
(Onemed)
0.00 Roll 1,680.00
(Onemed)
0.00 Roll 2,400.00
cm
0.00 Roll 660.80
(Onemed)
0.00 Tube 3,760.00
(Bufacetin)
0.00 Kloramfenikol salep mata 1% Tube 2,013.00
0.00 Tablet 24.00
4 mg
0.00 klorfeniramini maleat (CTM) Tablet 26.27
Botol 60
0.00 Kotrimoksazol suspensi 2,052.00
ml
0.00 Kotrimoksazol tablet 480 mg Tablet 126.00
0.00 Kotrimoksaxol dewasa 480 mg Tablet 125.00
0.00 Loperamid tablet 2 mg Tablet 97.00
0.00 Loratadine Tablet 127.00
0.00 Lidokain Injeksi Comp Ampul 847.00
0.00 Lysol 1 liter (onemed) Botol 47,970.00
0.00 Lidokain injeksi Comp Ampul 1,405.00
0.00 Masker Tali Box 31,165.00
0.00 Metformin Tablet Tablet 77.00
0.00 Miconazole Salep Kulit Tube 1,900.00
0.00 Mikonazole salep 2 % Tube 3,926.00
0.00 MgS04 20% Vial 3,200.00
0.00 Ampul 1,069.00
mg/ml
0.00 Tablet 245.00
0,125 mg
0.00 Metokloperamide tablet Tablet 100.00
0.00 Metokloperamide syr (Lexapram) Botol 2,750.00
Botol 500
0.00 Natrium Klorida larutan infus 0,9% 6,840.00
ml
Botol 500
ml
0.00 Natrium diklofenak tablet Tablet 136.00
0.00 Nifedipin tablet 10 mg Tablet 127.00
0.00 Nistatin 100.000 IU Tablet 645.00
0.00 Onoiwa Kaplet 5,650.00
0.00 Paket 1,319,900.00
Kategori 2
0.00 Oksitosin injeksi Ampul 1,348.00
0.00 Omeprazol kaps 20 mg Kapsul 129.00
0.00 Parasetamol sirup 120 mg/ 5 ml Botol 4,950.00
0.00 Parasetamol sirup Botol 1,160.00
Botol 15
0.00 Parasetamol drops 100 mg/ml 5,720.00
ml
Botol 15
0.00 Parsetamol drops 100 mg/ml 5,980.00
ml
0.00 Tablet 72.00
mg HCl
0.00 Tablet 141.00
mg HCl
0.00 Propanolol 10 mg tab Tablet 80.00
0.00 Plester 3 x 5 H leukoplast Roll 50,600.00
0.00 Povidone Iodine 30 ml (Onemed) Botol 3,190.00
Botol 60
0.00 Povidone Iodine 100 mg/ml 25,215.00
ml
0.00 Pyrantel pamoat Tablet 318.00
0.00 Ringer laktat larutan infus botol 7,630.00
Botol 500
0.00 Ringer laktat larutan infus 7,150.00
ml
0.00 Ranitidin tablet 150 mg Tablet 114.00
0.00 Rivanol 300 cc (onemed) Botol 2,983.50
0.00 Sarung tangan obgyn steril Psg 22,000.00
0.00 Salbutamol tablet 4 mg Tablet 67.00
0.00 Salbutamol syr Botol 5,463.00
Pot 30
0.00 Salep 2-4 kombinasi 2,200.00
gram
0.00 Salep 2-4 kombinasi Pot 3,017.00
0.00 Ampul 1,226.00
500 mcg
0.00 Tablet 44.00
mg
0.00 Silk 3/0 Psc 53,064.00
0.00 Siprofloxacin Tablet 500 mg Tablet 281.00
0.00 Stesolid rektal 5 mg Tube 12,749.00
0.00 Tablet tambah darah Tablet 409.00
0.00 Tablet 91.00
tablet 50 mg
0.00 Tetrasiklin HCl kapsul 250 mg Kapsul 174.00
kotak/10
0.00 Test trip kolestrol 255,000.00
strip
Kotak/25
0.00 Test trip asam urat 195,000.00
strip
0.00 Vitamin B Kompleks tablet Tablet 135.00
0.00 Zink tablet dispersible 20 mg Tablet 604.00
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 8,140.00
ml
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 6,500.00
ml
0.00 Zink syrup 20 mg/ 5 ml Botol 3,285.00
0.00 0
0.00 BMHP E- Alat Suntik 1 cc (Nipro) Pcs 1,004.85

0.00 CAT DAK Alat Suntik 3 cc (Abada) Pcs 924.00
0.00 Alat Suntik 3 cc (Abada) Pcs 887.70
0.00 Alat Suntik 3 cc (Nipro) Pcs 924.00
0.00 Chlodine 0,5% Jergen 5 L 395,384.74
0.00 Blood Lancet (Ekomed) Kotak 16,401.00

0.00 Folley Catheher No. 16 Pcs 11,945.23
0.00 Handscoon Non Steril S Pcs 1,740.20
0.00 Handscoon Steril No. 7 Pasang 11,808.50
0.00 Handscoon Steril No. 7,5 Pasang 11,808.50
0.00 IV Catheter 18 G (Ekomed) Pcs 5,827.80
0.00 IV Catheter 24 G (Ekomed) Psg 5,827.00
0.00 Infus set dewasa Pcs 8,547.00
0.00 Infus set anak (Abada) Pcs 5,566.00
0.00 Infus set dewasa (Ekomed) Pcs 6,527.40
0.00 IV Catheter 24G (Abada) Pcs 6,455.90
0.00 IV Catheter 22 G (Abada) Roll 6,455.90
0.00 Kasa 16 x 16 Roll 4,114.00
0.00 Kasa hidrofil 40x80 Roll 143,022.00
0.00 Nasal O2 Canula Adult Pcs 7,502.00
0.00 Nasal O2 Canula Child Pcs 7,502.00
0.00 Nasal O2 Canula Neonatus Pcs 7,502.00
0.00 Nebulizer Mask Adult Pcs 16,032.50
0.00 Nebulizer Mask Pediatric Pcs 16,032.50
0.00 Oxygen nasal Canula anak Pcs 4,983.00
0.00 Oxygen nasal Canula dewasa Pcs 4,983.00
0.00 Oxygen Mask Anak Pcs 11,656.00
0.00 Oxygen Mask Dewasa Pcs 11,656.00
0.00 Pcs 46,959.00
(Otot)
0.00 Roll 55,030.80
(Kulit)
0.00 Examination gloves size M Roll 1,740.20
0.00 Examination gloves size S Box 1,740.20
0.00 Pcs 49,491.20
(Kulit)
0.00 Onemed Povidone Iodine 300 ml Botol 21,060.00
0.00 Onemed Rivanol 300 cc Botol 2,983.50

0.00 Pcs 2,132.90
Kehamilan
0.00 Box 24,640.00
plus
0.00 Box 31,165.00
plus
0.00 Pcs 38,119.40
(Kulit)
0.00 Polipix 5 cm x 5 m Roll 41,100.00
0.00 Stera Syringe 3 cc Pcs 728.00
0.00 Urine Bag With Hanger Pcs 6,062.10
0.00 Pcs 8,960.00
18
0.00 0
0.00 KESMAS Oksitetrasiklin 1 % Salep Mata Tube 2,774.00
0.00 Fitomenadion (Vit.K) injeksi Ampul 4,236.00
0.00 Mineral Mix sachet 2,920.00
0.00 Magnesium Sulfat Inj 40% Vial 3,796.00
0.00 Oksitetrasiklin 1% Salep Mata Tube 2,600.00
0.00 Vit A Bayi 100,000 IU ( biru ) Kapsul 354.00
0.00 Vitamin Balita (merah) Kapsul 637.00
0.00 0
KESGRA kotak/
0.00 Alat suntik sekali pakai 1 cc 118,973.00
100 set
0.00 Alat suntik sekali pakai 3 cc Pcs 832.00
0.00 Alat suntik sekali pakai 5 cc pcs 1,137.40
0.00 Catgut/Benang bedah No.2/0 Pcs 9,332.40
0.00 Pcs 7,146.67
35 mm
0.00 Pcs 7,146.67
35 mm
Botol
0.00 Etanol 70 % 28,567.00
1000 ml
Botol 100
0.00 Ethyl semprot 114,967.60
ml
0.00 Foley catheter No.16 Set 9,794.40
0.00 Handscoen No. 7 steril Pairs 4,654.10
0.00 Handscoen No. 7,5 steril Pairs 4,654.10
Set/
0.00 Infusion Anak (PKD 2) 6,968.50
Kantong
0.00 Infusion set anak (20 drops/ml) Pcs 4,480.00
0.00 Infusion set dewasa (20 drops/ml) Pcs 4,096.00
Set/
0.00 Infusion set dewasa (PKD 1) 6,470.20
Kantong
0.00 Kasa pembalut hidrofil 4 x 5 Roll 960.00
0.00 Kasa hidrofil steril uk. 16 x 16 Box/16 7,424.00
0.00 Kasa hidrofil 40 x 80 roll 134,371.60
0.00 Safeglove Exam (M) Box/100 41,600.00
0.00 Silk 3/0 pcs 7,647.20
0.00 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 3,911.11
0.00 Steracath i.v catheter No 18 G x 32 Pcs 4,864.00
0.00 Syringe disposible 3cc x 23 Gx11/2 Pcs 832.00
0.00 0
0.00 DAU Cairan Pembersih Tangan Botol 55,000.00

0.00 PAJAK Handscoon non steril L Pcs 470.50
ROKOK
0.00 Handscoon non steril M Pcs 470.50
0.00 Handscoon non steril S Pcs 470.50
0.00 Handscoon non steril L Pcs 464.64
0.00 IV Catheter 22 G (Abada) Pcs 5,775.00
0.00 Catgut 3/0 Pcs 63,103.00
0.00 0
0.00 BTT Baju hazmat/ APD Pcs 180,000.00

0.00 Celemek Plastik Pcs 66,000.00
0.00 Efinefrin injeksi 1 mg Ampul 6,691.85
0.00 Faceshield anti droplet Pcs 38,000.00
0.00 Masker N95 Pcs 66,000.00
0.00 Nurse Cup Pcs 5,000.00
0.00 Onoiwa tablet 6,000.00
0.00 Rapid antigen Covid-19 Pcs 70,000.00
0.00 Psg 55,000.00
Steril
0.00 Sarung Tangan L Box/100 200,000.00
0.00 Sarung Tangan M Box/100 200,000.00
0.00 0
0.00 DAU Rapid test Antigen Test 57,194.00

RECOFUS
0.00 Kit 1,878,709.68
Swab) 2 ml
0.00 Corona Virus Ag Rapid Test Kotak 1,143,880.00
0 0 0.00
0.00 0
0.00 0
.
ang Menerima Yang Memberikan, Yang Menerima
.
.
.
_____________________ _________________________________ __________________________
KELUARKAN NAMA OBAT DAN BMHP YANG DIKELUARKAN
.
. KEPADA : 0
. NO. BAP : 14
.
JUMLAH SUMBER
TOTAL HARGA NO NAMA OBAT SATUAN
PEMBERIAN DANA
0 0.00 DAU Allopurinol tablet 100 mg Tablet

0 0.00 Abon AMP (Amphetamine) Test
0 0.00 Ambroxol Tablet
0 0.00 Ambroxol tablet Tablet
0 0.00 Aminofillin 200 mg Tablet
0 0.00 Amlodipin 10 mg Tablet
0 0.00 Acyclofir 200 mg Tablet
0 0.00 Acyclofir cr Tube
0 0.00 Alkohol 70% Botol
0 0.00 Alkohol swab 100 pcs
0 0.00 Alat Suntik 3 ml (cosmomed) Psc
0 0.00 Amitriptilin tablet salut 25 mg Tablet
0 0.00 Antasida tab Tablet
0 0.00 Botol
Reagents
0 0.00 Botol
Reagents
0 0.00 Botol
Reagents
0 0.00 Anti D Duocloral Monocloral Botol
0 0.00 Antihemoroid Tablet
0 0.00 Asam mefenamat tablet
0 0.00 Asam Askorbat (Vit.C) tab 50 mg Tablet

Botol/25
0 0.00 Asam Urat Test Strip
Strip
0 0.00 Becefort Tablet
0 0.00 BD Gard Kapsul Tablet
0 0.00 Blood Lancet Psc
0 0.00 Bioplacenton Tulle Box
0 0.00 Benecheck Strip Cholesterol Pcs
0 0.00 Benecheck Strip Uric Acid Pcs
0 0.00 Benecheck Strip Glucose Pcs
0 0.00 Captopril tab 25 mg Tablet
0 0.00 Cetrisyn sirup 5 mg/5 ml Botol
0 0.00 Calsium Laktat tablet
0 0.00 Ciprofloxasin tab 500 mg Tablet
0 0.00 Deksametason tablet 0,5 mg Tablet
0 0.00 Dengue test NS1 Test
0 0.00 Dimenhidrinat 50 mg Tablet
0 0.00 Domperidon tablet 10 mg Tablet
Kotak/50
0 0.00 Face Mask Ear Loop
pcs
0 0.00 Fenol Gliserol Botol
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Fokus febrile Antigen H Paratiphy Vial

0 0.00 Tablet
salut 10 mg
0 0.00 Ampul
mg/ 1 ml
0 0.00 Fit D3 1000 Tablet
0 0.00 Foley Catheter 2 Way FR No.18 Pcs
0 0.00 Gliceril guaiacolat tab 100 mg Tablet
0 0.00 Glimepirid tab 1 mg Tablet
0 0.00 Sachet
untuk 200 ml
0 0.00 Glukosa Larutan Infus 5% Botol
0 0.00 Griseofulvin tablet 125 mg Tablet
0 0.00 Handschoen No. 7 Steril Psg
0 0.00 Handschoen No. 7,5 Steril Psg
0 0.00 Hiosina Butilbromida tab 10 mg Tablet
0 0.00 Hipafix 15 cm x 5 m Roll
0 0.00 Human Humasens Plus Unit
0 0.00 Ibuprofen tablet 200 mg Tablet
0 0.00 Infusion set Anak Pcs
0 0.00 Infusion set dewasa Pcs
0 0.00 IV Catheter 20 G (Abbocath-T) Pcs
0 0.00 Ketokonazol tab 200 mg Tablet
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
0 0.00 Tablet
(Dewasa)
Botol 60
0 0.00 Kotrimoksazol syr
ml
0 0.00
humasens) strip
0 0.00 Lidokain inj 2% com (pehacain inj) Ampul
0 0.00 Lidokain gel 2% Tube

0 0.00 Lidokain spray oral 10% Botol
0 0.00 Metformin tablet 500 mg Tablet
0 0.00 Ampul
mg - ml
Tube 10
0 0.00 Mikonazol krim/salep 2% (Nitrat)
gr
0 0.00 Natrium Diklofenak 50 mg Tablet
Botol 500
0 0.00 Natrium Klorida larutan infus steril
ml
0 0.00 Nistatin Tab Salut 500.000UI Tablet
0 0.00 Botol
Syrup)
0 0.00 Obat batuk Hitam (OBH) Botol
0 0.00 Omeprazole kaps 20 mg kapsul
0 0.00 Papaverin tablet 40 mg Tablet
0 0.00 Parasetamol syrup 120 mg/5 ml Botol
0 0.00 Parasetamol tablet 500 mg Tablet
0 0.00 Phenylbutazon tablet 200 mg Tablet
0 0.00 Tablet
mg
0 0.00 Tablet
mg
0 0.00 Tablet
mg
0 0.00 Pitogin inj Ampul
0 0.00 Plester ( Leucoplast 3 x 5 ) Roll
0 0.00 Prednison tablet 5 mg Tablet
0 0.00 Pritavit Kaplet Kaplet
0 0.00 Ringer laktat larutan infus steril Botol
0 0.00 Salep 24 Tablet
0 0.00 Ranitidin tablet Tablet
0 0.00 Sarung Tangan M Pcs
0 0.00 Sarung Tangan S Pcs
0 0.00 Sarung Tangan Steril No. 7,5 Pcs
0 0.00 Sarung Tangan Steril No. 7 Pcs
0 0.00 Simvastatin tablet salut 20 mg Tablet
0 0.00 Tetrasiklin HCl kaps 500 mg kapsul
0 0.00 Thiamin HCl (Vit.B1) tablet 50 mg Tablet
0 0.00 Underpad 60x90 cm ( Cosmomed ) Pcs
0 0.00 Urine bag Pcs

0 0.00 Vitamin B kompleks tablet Tablet
0 0.00 Zinc tablet dispersible 20 mg Tablet
0.00 0
0 0.00 P2PL Alat suntik sekali pakai 0,05 ml Pcs

0 0.00 Alat suntik sekali pakai 0,05 ml Pcs
0 0.00 Alat suntik 5 ml Pcs
0 0.00 Albendazol Suspensi 200 mg/5 ml Botol
0 0.00 Albendazol tablet 400 mg Tablet

0 0.00 Albendazol tab 400 mg Tablet
0 0.00 Alkohol swab pcs
0 0.00 Clozapine Tablet
0 0.00 DHP Tablet
0 0.00 Garam oralit Saccet
0 0.00 Handscoun L Pcs
0 0.00 Handscoun L Kotak
0 0.00 Tablet
(HCl)
0 0.00 Pot Sputum Pcs
0 0.00 Pot Dahak Pcs
0 0.00 Pot Dahak Non steril pot
0 0.00 Primaquin 15 mg Tablet
0 0.00 Obat FDC Kategori Anak Paket
0 0.00 Obat FDC Kategori 1 Paket
0 0.00 Rapid 1 HIV (SD) Tes
0 0.00 Rapid test Syphilis (Trepocheck) Tes
0 0.00 Rapid test HbSAg Tes

0 0.00 Rapid test Tifoid Tes
0 0.00 Risperidone Tablet
0 0.00 RPR Focus tes
0 0.00 SD HIV 19 Tes
0 0.00 Vaksin VAR Dus
0 0.00 Triheksifenidil 2 mg tab Tablet
0 0.00 Vaksin Anti Rabies Vial
0 0.00 Vaksin BCG Vial
0 0.00 Vaksin Campak Vial
0 0.00 Vaksin DPT HB HiB Vial
0 0.00 Vaksin DT Vial
0 0.00 Vaksin IPV Vial
0 0.00 Vaksin Immuno Globuline Vial
0 0.00 Vaksin Meningitis Vial
0 0.00 Vaksin HB Uniject (HB 0) Uniject
0 0.00 Vaksin HB Rekombinasi (HB-Pid) Uniject
0 0.00 Vaksin MR Vial

0 0.00 Vaksin Polio Oral (OPV) Vial
0 0.00 Vaksin TD Vial
0 0.00 Vial
Globuline
0 0.00 Zinc Tablet 20 mg Tablet
0.00 0
0 0.00 DAK Alat suntik sekali pakai 1 ml Set

0 0.00 Psc
0 0.00 Alat suntik 5 cc (Stera) Psc
0 0.00 Alkohol Swab (Onemed) Box
0 0.00 Alkohol 70 % 1 L (onemed) Botol
0 0.00 Allopurinol tab 100 mg Tablet
0 0.00 Allopurinol tablet 100 mg Tablet
0 0.00 Air untuk injeksi amp 25 ml Ampul
0 0.00 Aminofilin 200 mg Tablet
0 0.00 Amitriptyline tablet salut 25 mg Tablet
0 0.00 Acetylcystein kapsul 200 mg Kapsul

0 0.00 Amlodipin tablet 5 mg Tablet
0 0.00 Amlodipin tab 10 mg Tablet
0 0.00 Amoksisillin kaplet 500 mg Tablet
0 0.00 Amoksisilin kaplet 500 mg Tablet
0 0.00 Botol
5 ml
0 0.00 Botol
ml
0 0.00 Amoksisillin sirup DS 250 mg/ 5 ml Botol
0 0.00 Anios Gel 85 Botol

0 0.00 Antasida Suspensi Botol
0 0.00 Antasida Doen tablet Tablet

0 0.00 Asam mefenamat kaplet 500 mg Tablet
0 0.00 Antifungi Salep Kulit Tube

0 0.00 Asiklovir tablet 200 mg Tablet
0 0.00 Attapulgit 630 mg (Puralex) Tablet
Botol/500
0 0.00 Asering
ml
0 0.00 Attapulgit Tablet
0 0.00 Betametason krim 0,1% Tube 5 gr
0 0.00 Betametasone krim 0,1 % Tube

0 0.00 Bisakodil Tablet 5 mg Tablet
0 0.00 Tube
kulit)
0 0.00 Calsium Laktat Tablet
0 0.00 Captopril 25 mg Tablet
0 0.00 Catgut 3/0 Pcs
0 0.00 Cetrisyn sirup botol
0 0.00 Dermafix Bliste
0 0.00 Ampul
1 ml
0 0.00 Disposable safety box 5 liter Buah
0 0.00 Domperidon Tablet 10 mg Tablet
0 0.00 Domperidone suspensi 5 mg/5 ml Botol
0 0.00 Diazepam tablet 2 mg Tablet

0 0.00 Diazepam inj 5 mg/ml Vial
0 0.00 Tube
(Stesolid Rektal)
0 0.00 Tube
(Stesolid Rektal)
0 0.00 Ampul
mg/ml
0 0.00 Doxycycline 100 mg Tablet
0 0.00 Eritromisin 500 mg Kapsul
0 0.00 Ampul
mg/ml
0 0.00 Ampul
ml
Botol100
0 0.00 Etil Klorida Semprot
ml
0 0.00 Examination gloves size L (Aximed) Pcs

0 0.00 Pcs
(Aximed)
0 0.00 Pcs
(Aximed)
Botol 100
0 0.00 Fenobarbital
ml
0 0.00 Fenobarbital Tablet Tablet
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ml
0 0.00 Tablet
gula 10 mg
0 0.00 Tablet
gula 10 mg
0 0.00 Pcs
(urocare)
0 0.00 Furosemid tab Tablet
0 0.00 Glass ionomer ART Buah
0 0.00 Garam oralit Sachet
0 0.00 Garam oralit kombinasi Sachet
Botol 500
0 0.00 Glukosa larutan infus 5% steril
ml
0 0.00 Glukosa larutan infus 5% steril Botol
0 0.00 Glimepirid tablet 2 mg Tablet
0 0.00 Kotak
(Guaifenesin)
0 0.00 Gliseril Gualakolat tablet 100 mg Tablet

Kotak/25
0 0.00 Glukosa test strip
strip
0 0.00 Glukosa test strip Strip
Kotak 60
0 0.00 Gelatine sponge
spons
0 0.00 Haloperidol 1,5 mg Tablet
0 0.00 Haloperidol 2 mg (lodomer) Tablet
0 0.00 Haloperidol 5 mg Tablet
0 0.00 Handschoen No. 6,5 steril psg
0 0.00 Hidrokortisom krim 2,5 % Tube
0 0.00 Tablet
(Scopamin)
0 0.00 Ibuprofen suspensi 100 mg/ 5 ml Botol
0 0.00 Infusion set Anak(PKD 2) Set

0 0.00 Infuset dewasa (Aximed) Pcs
0 0.00 Introcan No.22 Pcs
0 0.00 Isosorbid Dinitrate 5 mg Tablet
0 0.00 Pcs
(Steracath)
0 0.00 Pcs
(Steracath)
0 0.00 IV Catheter 20G x 1 1/4 (Nipro) Pcs
0 0.00 IV Catheter 22G x 1 (Steracath) Pcs
0 0.00 IV Catheter 24G x 3/4 (Steracath) Pcs

0 0.00 Tablet
mg
Bungkus/
0 0.00 Kapas pembalut
1 kg
0 0.00 Kasa kompres 40x40 Pcs
0 0.00 Kasa 2 m x 80 cm (Onemed) Roll
0 0.00 Roll
(Onemed)
0 0.00 Roll
(Onemed)
0 0.00 Roll
cm
0 0.00 Roll
(Onemed)
0 0.00 Tube
(Bufacetin)
0 0.00 Kloramfenikol salep mata 1% Tube
0 0.00 Tablet
4 mg
0 0.00 klorfeniramini maleat (CTM) Tablet
Botol 60
0 0.00 Kotrimoksazol suspensi
ml
0 0.00 Kotrimoksazol tablet 480 mg Tablet
0 0.00 Kotrimoksaxol dewasa 480 mg Tablet
0 0.00 Loperamid tablet 2 mg Tablet
0 0.00 Loratadine Tablet
0 0.00 Lidokain Injeksi Comp Ampul
0 0.00 Lysol 1 liter (onemed) Botol
0 0.00 Lidokain injeksi Comp Ampul
0 0.00 Masker Tali Box
0 0.00 Metformin Tablet Tablet
0 0.00 Miconazole Salep Kulit Tube
0 0.00 Mikonazole salep 2 % Tube
0 0.00 MgS04 20% Vial
0 0.00 Ampul
mg/ml
0 0.00 Tablet
0,125 mg
0 0.00 Metokloperamide tablet Tablet
0 0.00 Metokloperamide syr (Lexapram) Botol
Botol 500
0 0.00 Natrium Klorida larutan infus 0,9%
ml
Botol 500
ml
0 0.00 Natrium diklofenak tablet Tablet
0 0.00 Nifedipin tablet 10 mg Tablet
0 0.00 Nistatin 100.000 IU Tablet
0 0.00 Onoiwa Kaplet
0 0.00 Paket
Kategori 2
0 0.00 Oksitosin injeksi Ampul
0 0.00 Omeprazol kaps 20 mg Kapsul
0 0.00 Parasetamol sirup 120 mg/ 5 ml Botol
0 0.00 Parasetamol sirup Botol
Botol 15
0 0.00 Parasetamol drops 100 mg/ml
ml
Botol 15
0 0.00 Parsetamol drops 100 mg/ml
ml
0 0.00 Tablet
mg HCl
0 0.00 Tablet
mg HCl
0 0.00 Propanolol 10 mg tab Tablet
0 0.00 Plester 3 x 5 H leukoplast Roll
0 0.00 Povidone Iodine 30 ml (Onemed) Botol
Botol 60
0 0.00 Povidone Iodine 100 mg/ml
ml
0 0.00 Pyrantel pamoat Tablet
0 0.00 Ringer laktat larutan infus botol
Botol 500
0 0.00 Ringer laktat larutan infus
ml
0 0.00 Ranitidin tablet 150 mg Tablet
0 0.00 Rivanol 300 cc (onemed) Botol
0 0.00 Sarung tangan obgyn steril Psg
0 0.00 Salbutamol tablet 4 mg Tablet
0 0.00 Salbutamol syr Botol
Pot 30
0 0.00 Salep 2-4 kombinasi
gram
0 0.00 Salep 2-4 kombinasi Pot
0 0.00 Ampul
500 mcg
0 0.00 Tablet
mg
0 0.00 Silk 3/0 Psc
0 0.00 Siprofloxacin Tablet 500 mg Tablet
0 0.00 Stesolid rektal 5 mg Tube
0 0.00 Tablet tambah darah Tablet
0 0.00 Tablet
tablet 50 mg
0 0.00 Tetrasiklin HCl kapsul 250 mg Kapsul
kotak/10
0 0.00 Test trip kolestrol
strip
Kotak/25
0 0.00 Test trip asam urat
strip
0 0.00 Vitamin B Kompleks tablet Tablet
0 0.00 Zink tablet dispersible 20 mg Tablet
Botol 60
0 0.00 Zink syrup 20 mg/ 5 ml
ml
Botol 60
ml
0 0.00 Zink syrup 20 mg/ 5 ml Botol
0.00 0
0 0.00 BMHP E- Alat Suntik 1 cc (Nipro) Pcs

0 0.00 CAT DAK Alat Suntik 3 cc (Abada) Pcs
0 0.00 Alat Suntik 3 cc (Abada) Pcs
0 0.00 Alat Suntik 3 cc (Nipro) Pcs
0 0.00 Chlodine 0,5% Jergen 5 L
0 0.00 Blood Lancet (Ekomed) Kotak

0 0.00 Folley Catheher No. 16 Pcs
0 0.00 Handscoon Non Steril S Pcs
0 0.00 Handscoon Steril No. 7 Pasang
0 0.00 Handscoon Steril No. 7,5 Pasang
0 0.00 IV Catheter 18 G (Ekomed) Pcs
0 0.00 IV Catheter 24 G (Ekomed) Psg
0 0.00 Infus set dewasa Pcs
0 0.00 Infus set anak (Abada) Pcs
0 0.00 Infus set dewasa (Ekomed) Pcs
0 0.00 IV Catheter 24G (Abada) Pcs
0 0.00 IV Catheter 22 G (Abada) Roll
0 0.00 Kasa 16 x 16 Roll
0 0.00 Kasa hidrofil 40x80 Roll
0 0.00 Nasal O2 Canula Adult Pcs
0 0.00 Nasal O2 Canula Child Pcs
0 0.00 Nasal O2 Canula Neonatus Pcs
0 0.00 Nebulizer Mask Adult Pcs
0 0.00 Nebulizer Mask Pediatric Pcs
0 0.00 Oxygen nasal Canula anak Pcs
0 0.00 Oxygen nasal Canula dewasa Pcs
0 0.00 Oxygen Mask Anak Pcs
0 0.00 Oxygen Mask Dewasa Pcs
0 0.00 Pcs
(Otot)
0 0.00 Roll
(Kulit)
0 0.00 Examination gloves size M Roll
0 0.00 Examination gloves size S Box
0 0.00 Pcs
(Kulit)
0 0.00 Onemed Povidone Iodine 300 ml Botol
0 0.00 Onemed Rivanol 300 cc Botol

0 0.00 Pcs
Kehamilan
0 0.00 Box
plus
0 0.00 Box
plus
0 0.00 Pcs
(Kulit)
0 0.00 Polipix 5 cm x 5 m Roll
0 0.00 Stera Syringe 3 cc Pcs
0 0.00 Urine Bag With Hanger Pcs
0 0.00 Pcs
18
0.00 0
0 0.00 KESMAS Oksitetrasiklin 1 % Salep Mata Tube
0 0.00 Fitomenadion (Vit.K) injeksi Ampul
0 0.00 Mineral Mix sachet
0 0.00 Magnesium Sulfat Inj 40% Vial
0 0.00 Oksitetrasiklin 1% Salep Mata Tube
0 0.00 Vit A Bayi 100,000 IU ( biru ) Kapsul
0 0.00 Vitamin Balita (merah) Kapsul
0.00 0
KESGRA kotak/
0 0.00 Alat suntik sekali pakai 1 cc
100 set
0 0.00 Alat suntik sekali pakai 3 cc Pcs
0 0.00 Alat suntik sekali pakai 5 cc pcs
0 0.00 Catgut/Benang bedah No.2/0 Pcs
0 0.00 Pcs
35 mm
0 0.00 Pcs
35 mm
Botol
0 0.00 Etanol 70 %
1000 ml
Botol 100
0 0.00 Ethyl semprot
ml
0 0.00 Foley catheter No.16 Set
0 0.00 Handscoen No. 7 steril Pairs
0 0.00 Handscoen No. 7,5 steril Pairs
Set/
0 0.00 Infusion Anak (PKD 2)
Kantong
0 0.00 Infusion set anak (20 drops/ml) Pcs
0 0.00 Infusion set dewasa (20 drops/ml) Pcs
Set/
0 0.00 Infusion set dewasa (PKD 1)
Kantong
0 0.00 Kasa pembalut hidrofil 4 x 5 Roll
0 0.00 Kasa hidrofil steril uk. 16 x 16 Box/16
0 0.00 Kasa hidrofil 40 x 80 roll
0 0.00 Safeglove Exam (M) Box/100
0 0.00 Silk 3/0 pcs
0 0.00 Silk 3/0 + jarum 1/2 GT 35 mm Pcs
0 0.00 Steracath i.v catheter No 18 G x 32 Pcs
0 0.00 Syringe disposible 3cc x 23 Gx11/2 Pcs
0.00 0
0 0.00 DAU Cairan Pembersih Tangan Botol

0 0.00 PAJAK Handscoon non steril L Pcs
ROKOK
0 0.00 Handscoon non steril M Pcs
0 0.00 Handscoon non steril S Pcs
0 0.00 Handscoon non steril L Pcs
0 0.00 IV Catheter 22 G (Abada) Pcs
0.00 0
0 0.00 BTT Baju hazmat/ APD Pcs

0 0.00 Celemek Plastik Pcs
0 0.00 Efinefrin injeksi 1 mg Ampul
0 0.00 Faceshield anti droplet Pcs
0 0.00 Masker N95 Pcs
0 0.00 Nurse Cup Pcs
0 0.00 Onoiwa tablet
0 0.00 Rapid antigen Covid-19 Pcs
0 0.00 Psg
Steril
0 0.00 Sarung Tangan L Box/100
0 0.00 Sarung Tangan M Box/100
0.00 0
0 0.00 DAU Rapid test Antigen Test

RECOFUS
0 0.00 Kit
Swab) 2 ml
0 0.00 Corona Virus Ag Rapid Test Kotak
0 0 0
0.00 0
0.00 0
..
Yang Menerima Yang Memberikan,
.
.
.
_______________________________ _________________________________
BMHP YANG DIKELUARKAN NAMA OBAT DAN BMHP YANG DIKELU
.
. KEPADA : 0
. NO. BAP : 15
.
JUMLAH SUMBER
HARGA TOTAL HARGA NO NAMA OBAT
PEMBERIAN DANA
90.00 0 0.00 DAU Allopurinol tablet 100 mg

16,500.00 0 0.00 Abon AMP (Amphetamine)
160.00 0 0.00 Ambroxol
224.40 0 0.00 Ambroxol tablet
160.00 0 0.00 Aminofillin 200 mg
74.00 0 0.00 Amlodipin 10 mg
55.00 0 0.00 Amlodipin 5 mg
251.00 0 0.00 Acyclofir 200 mg
3,625.00 0 0.00 Acyclofir cr
37,638.70 0 0.00 Alkohol 70%
14,490.00 0 0.00 Alkohol swab
1,102.20 0 0.00 Alat Suntik 3 ml (cosmomed)
123.00 0 0.00 Amitriptilin tablet salut 25 mg
78.00 0 0.00 Antasida tab
75,020.00 0 0.00
Reagents
75,020.00 0 0.00
Reagents
101,761.00 0 0.00
Reagents
125,477.00 0 0.00 Anti D Duocloral Monocloral
3,260.00 0 0.00 Antihemoroid
122.00 0 0.00 Asam mefenamat
46.00 0 0.00 Asam Askorbat (Vit.C) tab 50 mg

276,891.50 0 0.00 Asam Urat Test Strip
1,536.70 0 0.00 Becefort

10,890.00 0 0.00 BD Gard Kapsul
138.00 0 0.00 Blood Lancet
108,324.00 0 0.00 Bioplacenton Tulle
25,283.92 0 0.00 Benecheck Strip Cholesterol
6,689.54 0 0.00 Benecheck Strip Uric Acid
3,206.20 0 0.00 Benecheck Strip Glucose
75.00 0 0.00 Captopril tab 25 mg
2,215.00 0 0.00 Cetrisyn sirup 5 mg/5 ml
60.00 0 0.00 Calsium Laktat
260.00 0 0.00 Ciprofloxasin tab 500 mg
151.80 0 0.00 Deksametason tablet 0,5 mg
132,000.00 0 0.00 Dengue test NS1
109.00 0 0.00 Dimenhidrinat 50 mg
75.00 0 0.00 Domperidon tablet 10 mg
69,000.00 0 0.00 Face Mask Ear Loop
3,300.00 0 0.00 Fenol Gliserol

26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00 Fokus febrile Antigen H Paratiphy

690.00 0 0.00
salut 10 mg
4,236.00 0 0.00
mg/ 1 ml
2,178.00 0 0.00 Fit D3 1000
36,696.00 0 0.00 Foley Catheter 2 Way FR No.18
28.75 0 0.00 Gliceril guaiacolat tab 100 mg
96.00 0 0.00 Glimepirid tab 1 mg
317.00 0 0.00
untuk 200 ml
5,720.00 0 0.00 Glukosa Larutan Infus 5%
210.00 0 0.00 Griseofulvin tablet 125 mg
11,432.00 0 0.00 Handschoen No. 7 Steril
3,630.00 0 0.00 Handschoen No. 7,5 Steril
1,050.00 0 0.00 Hiosina Butilbromida tab 10 mg
302,000.00 0 0.00 Hipafix 15 cm x 5 m
814,009.50 0 0.00 Human Humasens Plus
123.17 0 0.00 Ibuprofen tablet 200 mg
3,333.00 0 0.00 Infusion set Anak
8,867.00 0 0.00 Infusion set dewasa
16,000.00 0 0.00 IV Catheter 20 G (Abbocath-T)
260.00 0 0.00 Ketokonazol tab 200 mg
3,360.00 0 0.00
(Bufacetin)
20.55 0 0.00
4 mg
152.00 0 0.00
(Dewasa)
2,298.00 0 0.00 Kotrimoksazol syr
Kolestrol test strip (Human

547,319.00 0 0.00
humasens)
3,113.05 0 0.00 Lidokain inj 2% com (pehacain inj)
41,600.00 0 0.00 Lidokain gel 2%

177,216.00 0 0.00 Lidokain spray oral 10%
118.50 0 0.00 Metformin tablet 500 mg
3,712.00 0 0.00
mg - ml
3,150.00 0 0.00 Mikonazol krim/salep 2% (Nitrat)
109.00 0 0.00 Natrium Diklofenak 50 mg
6,900.00 0 0.00 Natrium Klorida larutan infus steril
869.00 0 0.00 Nistatin Tab Salut 500.000UI

14,273.00 0 0.00
Syrup)
3,450.00 0 0.00 Obat batuk Hitam (OBH)
129.00 0 0.00 Omeprazole kaps 20 mg
180.90 0 0.00 Papaverin tablet 40 mg
1,535.00 0 0.00 Parasetamol syrup 120 mg/5 ml
60.00 0 0.00 Parasetamol tablet 500 mg
88.21 0 0.00 Phenylbutazon tablet 200 mg
18.95 0 0.00
mg
26.35 0 0.00
mg
318.00 0 0.00
mg
5,291.00 0 0.00 Pitogin inj
35,532.00 0 0.00 Plester ( Leucoplast 3 x 5 )
105.88 0 0.00 Prednison tablet 5 mg
1,027.95 0 0.00 Pritavit Kaplet
7,703.00 0 0.00 Ringer laktat larutan infus steril
1,475.00 0 0.00 Salep 24
85.00 0 0.00 Ranitidin tablet
495.00 0 0.00 Sarung Tangan M
495.00 0 0.00 Sarung Tangan S
3,630.00 0 0.00 Sarung Tangan Steril No. 7,5
3,630.00 0 0.00 Sarung Tangan Steril No. 7
73.00 0 0.00 Simvastatin tablet salut 20 mg
279.82 0 0.00 Tetrasiklin HCl kaps 500 mg
57.55 0 0.00 Thiamin HCl (Vit.B1) tablet 50 mg
8,970.00 0 0.00 Underpad 60x90 cm ( Cosmomed )
4,488.00 0 0.00 Urine bag

24.31 0 0.00 Vitamin B kompleks tablet
521.00 0 0.00 Zinc tablet dispersible 20 mg
0.00 0
1,240.00 0 0.00 P2PL Alat suntik sekali pakai 0,05 ml

1,518.00 0 0.00 Alat suntik sekali pakai 0,05 ml
1,583.00 0 0.00 Alat suntik 5 ml
4,600.00 0 0.00 Albendazol Suspensi 200 mg/5 ml
380.00 0 0.00 Albendazol tablet 400 mg

271.14 0 0.00 Albendazol tab 400 mg
242.00 0 0.00 Alkohol swab
1,121.00 0 0.00 Clozapine
2,134.00 0 0.00 DHP
275.00 0 0.00 Garam oralit
490.00 0 0.00 Handscoun L
48,999.50 0 0.00 Handscoun L
147.00 0 0.00
(HCl)
2,272.00 0 0.00 Pot Sputum
2,950.00 0 0.00 Pot Dahak
2,000.00 0 0.00 Pot Dahak Non steril
242.00 0 0.00 Primaquin 15 mg
285,339.00 0 0.00 Obat FDC Kategori Anak
477,791.00 0 0.00 Obat FDC Kategori 1
1,592,731.00 0 0.00 Obat FDC Kategori 2
11,975.00 0 0.00 Rapid 1 HIV (SD)
9,300.00 0 0.00 Rapid test Syphilis (Trepocheck)
9,878.00 0 0.00 Rapid test HbSAg

33,334.00 0 0.00 Rapid test Tifoid
287.00 0 0.00 Risperidone
4,260.00 0 0.00 RPR Focus
14,340.00 0 0.00 SD HIV 19
153,000.00 0 0.00 Vaksin VAR
91.00 0 0.00 Triheksifenidil 2 mg tab
165,000.00 0 0.00 Vaksin Anti Rabies
61,996.00 0 0.00 Vaksin BCG
28,204.00 0 0.00 Vaksin Campak
78,991.00 0 0.00 Vaksin DPT HB HiB
17,996.00 0 0.00 Vaksin DT
158,994.00 0 0.00 Vaksin IPV
1,325,000.00 0 0.00 Vaksin Immuno Globuline
135,000.00 0 0.00 Vaksin Meningitis
23,991.00 0 0.00 Vaksin HB Uniject (HB 0)
23,991.00 0 0.00 Vaksin HB Rekombinasi (HB-Pid)
155,813.00 0 0.00 Vaksin MR

19,954.00 0 0.00 Vaksin Polio Oral (OPV)
16,995.00 0 0.00 Vaksin TD
1,325,000.00 0 0.00
Globuline
604.00 0 0.00 Zinc Tablet 20 mg
0.00 0
728.00 0 0.00 DAK Alat suntik sekali pakai 1 ml

1,125.85 0 0.00
840.00 0 0.00 Alat suntik 5 cc (Stera)
11,200.00 0 0.00 Alkohol Swab (Onemed)
25,155.00 0 0.00 Alkohol 70 % 1 L (onemed)
27,500.00 0 0.00 Alkohol 70 % 1 L (onemed)
105.00 0 0.00 Allopurinol tab 100 mg
99.00 0 0.00 Allopurinol tablet 100 mg
2,860.00 0 0.00 Air untuk injeksi amp 25 ml
86.00 0 0.00 Aminofilin 200 mg
123.00 0 0.00 Amitriptyline tablet salut 25 mg
908.00 0 0.00 Acetylcystein kapsul 200 mg

55.00 0 0.00 Amlodipin tablet 5 mg
74.00 0 0.00 Amlodipin tab 10 mg
265.00 0 0.00 Amoksisillin kaplet 500 mg
360.00 0 0.00 Amoksisilin kaplet 500 mg
2,560.00 0 0.00
5 ml
3,846.00 0 0.00
ml
3,510.00 0 0.00 Amoksisillin sirup DS 250 mg/ 5 ml
88,678.66 0 0.00 Anios Gel 85

2,098.00 0 0.00 Antasida Suspensi
60.00 0 0.00 Antasida Doen tablet

117.00 0 0.00 Asam mefenamat kaplet 500 mg
5,170.00 0 0.00 Antifungi Salep Kulit

251.00 0 0.00 Asiklovir tablet 200 mg
175.00 0 0.00 Attapulgit 630 mg (Puralex)
9,646.00 0 0.00 Asering
149.00 0 0.00 Attapulgit
1,515.00 0 0.00 Betametason krim 0,1%
1,520.00 0 0.00 Betametasone krim 0,1 %

337.00 0 0.00 Bisakodil Tablet 5 mg
3,585.00 0 0.00
kulit)
75.00 0 0.00 Captopril 25 mg
64,191.00 0 0.00 Catgut 3/0
3,061.00 0 0.00 Cetrisyn sirup
2,298.84 0 0.00 Dermafix
1,210.00 0 0.00
1 ml
18,000.00 0 0.00 Disposable safety box 5 liter
90.00 0 0.00 Domperidon Tablet 10 mg
2,862.00 0 0.00 Domperidone suspensi 5 mg/5 ml
70.00 0 0.00 Diazepam tablet 2 mg

1,545.00 0 0.00 Diazepam inj 5 mg/ml
14,459.00 0 0.00
(Stesolid Rektal)
21,021.00 0 0.00
(Stesolid Rektal)
825.00 0 0.00
mg/ml
309.00 0 0.00 Doxycycline 100 mg
766.00 0 0.00 Eritromisin 500 mg
2,354.00 0 0.00
mg/ml
1,518.00 0 0.00
ml
115,500.00 0 0.00 Etil Klorida Semprot
508.20 0 0.00 Examination gloves size L (Aximed)

508.20 0 0.00
(Aximed)
508.20 0 0.00
(Aximed)
7,010.00 0 0.00 Fenobarbital
177.00 0 0.00 Fenobarbital Tablet

3,754.00 0 0.00
mg/ 1 ml
4,083.00 0 0.00
mg/ 1 ml
4,236.00 0 0.00
mg/ml
873.00 0 0.00
gula 10 mg
781.00 0 0.00
gula 10 mg
8,960.00 0 0.00
(urocare)
88.00 0 0.00 Furosemid tab
606,900.00 0 0.00 Glass ionomer ART
274.00 0 0.00 Garam oralit kombinasi
5,720.00 0 0.00 Glukosa larutan infus 5% steril

297.00 0 0.00 Glimepirid tablet 2 mg
14,600.30 0 0.00
(Guaifenesin)
228.00 0 0.00 Gliseril Gualakolat tablet 100 mg

137,500.00 0 0.00 Glukosa test strip
322,190.00 0 0.00 Gelatine sponge
76.00 0 0.00 Haloperidol 1,5 mg

90.00 0 0.00 Haloperidol 2 mg (lodomer)
60.00 0 0.00 Haloperidol 5 mg
8,487.66 0 0.00 Handschoen No. 6,5 steril
2,648.00 0 0.00 Hidrokortisom krim 2,5 %
2,329.80 0 0.00
(Scopamin)
2,560.00 0 0.00 Ibuprofen suspensi 100 mg/ 5 ml
6,930.00 0 0.00 Infusion set Anak(PKD 2)

5,280.00 0 0.00 Infuset dewasa (Aximed)
13,200.00 0 0.00 Introcan No.22
13,750.00 0 0.00 Introcan No.24
93.00 0 0.00 Isosorbid Dinitrate 5 mg
4,256.00 0 0.00
(Steracath)
4,256.00 0 0.00
(Steracath)
8,070.70 0 0.00 IV Catheter 20G x 1 1/4 (Nipro)
4,256.00 0 0.00 IV Catheter 22G x 1 (Steracath)
4,256.00 0 0.00 IV Catheter 24G x 3/4 (Steracath)

60.00 0 0.00
mg
60,830.00 0 0.00 Kapas pembalut
1,700.00 0 0.00 Kasa kompres 40x40

8,624.00 0 0.00 Kasa 2 m x 80 cm (Onemed)
840.00 0 0.00
(Onemed)
1,680.00 0 0.00
(Onemed)
2,400.00 0 0.00
cm
660.80 0 0.00
(Onemed)
3,760.00 0 0.00
(Bufacetin)
2,013.00 0 0.00 Kloramfenikol salep mata 1%
24.00 0 0.00
4 mg
26.27 0 0.00 klorfeniramini maleat (CTM)
2,052.00 0 0.00 Kotrimoksazol suspensi
126.00 0 0.00 Kotrimoksazol tablet 480 mg

125.00 0 0.00 Kotrimoksaxol dewasa 480 mg
97.00 0 0.00 Loperamid tablet 2 mg
127.00 0 0.00 Loratadine
847.00 0 0.00 Lidokain Injeksi Comp
47,970.00 0 0.00 Lysol 1 liter (onemed)
1,405.00 0 0.00 Lidokain injeksi Comp
31,165.00 0 0.00 Masker Tali
77.00 0 0.00 Metformin Tablet
1,900.00 0 0.00 Miconazole Salep Kulit
3,926.00 0 0.00 Mikonazole salep 2 %
3,200.00 0 0.00 MgS04 20%
1,069.00 0 0.00
mg/ml
245.00 0 0.00
0,125 mg
100.00 0 0.00 Metokloperamide tablet
2,750.00 0 0.00 Metokloperamide syr (Lexapram)
6,840.00 0 0.00 Natrium Klorida larutan infus 0,9%
136.00 0 0.00 Natrium diklofenak tablet

127.00 0 0.00 Nifedipin tablet 10 mg
645.00 0 0.00 Nistatin 100.000 IU
910.00 0 0.00 Nistatin 500.000 IU
5,650.00 0 0.00 Onoiwa
1,319,900.00 0 0.00
Kategori 2
1,348.00 0 0.00 Oksitosin injeksi
129.00 0 0.00 Omeprazol kaps 20 mg
4,950.00 0 0.00 Parasetamol sirup 120 mg/ 5 ml
1,160.00 0 0.00 Parasetamol sirup
5,720.00 0 0.00 Parasetamol drops 100 mg/ml
5,980.00 0 0.00 Parsetamol drops 100 mg/ml

72.00 0 0.00
mg HCl
141.00 0 0.00
mg HCl
80.00 0 0.00 Propanolol 10 mg tab
50,600.00 0 0.00 Plester 3 x 5 H leukoplast
3,190.00 0 0.00 Povidone Iodine 30 ml (Onemed)
25,215.00 0 0.00 Povidone Iodine 100 mg/ml
318.00 0 0.00 Pyrantel pamoat

7,630.00 0 0.00 Ringer laktat larutan infus
114.00 0 0.00 Ranitidin tablet 150 mg

2,983.50 0 0.00 Rivanol 300 cc (onemed)
22,000.00 0 0.00 Sarung tangan obgyn steril
67.00 0 0.00 Salbutamol tablet 4 mg
5,463.00 0 0.00 Salbutamol syr
2,200.00 0 0.00 Salep 2-4 kombinasi

1,226.00 0 0.00
500 mcg
44.00 0 0.00
mg
53,064.00 0 0.00 Silk 3/0
281.00 0 0.00 Siprofloxacin Tablet 500 mg
12,749.00 0 0.00 Stesolid rektal 5 mg
409.00 0 0.00 Tablet tambah darah
91.00 0 0.00
tablet 50 mg
174.00 0 0.00 Tetrasiklin HCl kapsul 250 mg
255,000.00 0 0.00 Test trip kolestrol
195,000.00 0 0.00 Test trip asam urat

135.00 0 0.00 Vitamin B Kompleks tablet
604.00 0 0.00 Zink tablet dispersible 20 mg
8,140.00 0 0.00 Zink syrup 20 mg/ 5 ml
6,500.00 0 0.00 Zink syrup 20 mg/ 5 ml
3,285.00 0 0.00 Zink syrup 20 mg/ 5 ml
0.00 0
1,004.85 0 0.00 BMHP E- Alat Suntik 1 cc (Nipro)

924.00 0 0.00 CAT DAK Alat Suntik 3 cc (Abada)
887.70 0 0.00 Alat Suntik 3 cc (Abada)
924.00 0 0.00 Alat Suntik 3 cc (Nipro)
395,384.74 0 0.00 Chlodine 0,5%
16,401.00 0 0.00 Blood Lancet (Ekomed)

11,945.23 0 0.00 Folley Catheher No. 16
1,740.20 0 0.00 Handscoon Non Steril S
11,808.50 0 0.00 Handscoon Steril No. 7
11,808.50 0 0.00 Handscoon Steril No. 7,5
5,827.80 0 0.00 IV Catheter 18 G (Ekomed)
8,547.00 0 0.00 Infus set dewasa
5,566.00 0 0.00 Infus set anak (Abada)
6,527.40 0 0.00 Infus set dewasa (Ekomed)
6,455.90 0 0.00 IV Catheter 24G (Abada)
6,455.90 0 0.00 IV Catheter 22 G (Abada)
4,114.00 0 0.00 Kasa 16 x 16
143,022.00 0 0.00 Kasa hidrofil 40x80
7,502.00 0 0.00 Nasal O2 Canula Adult
7,502.00 0 0.00 Nasal O2 Canula Child
7,502.00 0 0.00 Nasal O2 Canula Neonatus
16,032.50 0 0.00 Nebulizer Mask Adult
16,032.50 0 0.00 Nebulizer Mask Pediatric
4,983.00 0 0.00 Oxygen nasal Canula anak
4,983.00 0 0.00 Oxygen nasal Canula dewasa
11,656.00 0 0.00 Oxygen Mask Anak
11,656.00 0 0.00 Oxygen Mask Dewasa
46,959.00 0 0.00
(Otot)
55,030.80 0 0.00
(Kulit)
1,740.20 0 0.00 Examination gloves size M
1,740.20 0 0.00 Examination gloves size S
49,491.20 0 0.00
(Kulit)
21,060.00 0 0.00 Onemed Povidone Iodine 300 ml
2,983.50 0 0.00 Onemed Rivanol 300 cc

2,132.90 0 0.00
Kehamilan
24,640.00 0 0.00
plus
31,165.00 0 0.00
plus
38,119.40 0 0.00
(Kulit)
41,100.00 0 0.00 Polipix 5 cm x 5 m
728.00 0 0.00 Stera Syringe 3 cc
6,062.10 0 0.00 Urine Bag With Hanger
8,960.00 0 0.00
18
0.00 0
2,774.00 0 0.00 KESMAS Oksitetrasiklin 1 % Salep Mata
4,236.00 0 0.00 Fitomenadion (Vit.K) injeksi
2,920.00 0 0.00 Mineral Mix
3,796.00 0 0.00 Magnesium Sulfat Inj 40%
2,600.00 0 0.00 Oksitetrasiklin 1% Salep Mata
354.00 0 0.00 Vit A Bayi 100,000 IU ( biru )
297.00 0 0.00 Vit A Bayi 100,000 IU ( biru )
637.00 0 0.00 Vitamin Balita (merah)
0.00 0
KESGRA
118,973.00 0 0.00 Alat suntik sekali pakai 1 cc
832.00 0 0.00 Alat suntik sekali pakai 3 cc

9,332.40 0 0.00 Catgut/Benang bedah No.2/0
7,146.67 0 0.00
35 mm
7,146.67 0 0.00
35 mm
28,567.00 0 0.00 Etanol 70 %
114,967.60 0 0.00 Ethyl semprot
9,794.40 0 0.00 Foley catheter No.16

4,654.10 0 0.00 Handscoen No. 7 steril
4,654.10 0 0.00 Handscoen No. 7,5 steril
6,968.50 0 0.00 Infusion Anak (PKD 2)
4,480.00 0 0.00 Infusion set anak (20 drops/ml)

4,096.00 0 0.00 Infusion set dewasa (20 drops/ml)
6,470.20 0 0.00 Infusion set dewasa (PKD 1)
960.00 0 0.00 Kasa pembalut hidrofil 4 x 5

7,424.00 0 0.00 Kasa hidrofil steril uk. 16 x 16
134,371.60 0 0.00 Kasa hidrofil 40 x 80
41,600.00 0 0.00 Safeglove Exam (M)
7,647.20 0 0.00 Silk 3/0
3,911.11 0 0.00 Silk 3/0 + jarum 1/2 GT 35 mm
4,864.00 0 0.00 Steracath i.v catheter No 18 G x 32
832.00 0 0.00 Syringe disposible 3cc x 23 Gx11/2
0.00 0
55,000.00 0 0.00 DAU Cairan Pembersih Tangan

470.50 0 0.00 PAJAK Handscoon non steril L
ROKOK
470.50 0 0.00 Handscoon non steril M
470.50 0 0.00 Handscoon non steril S
464.64 0 0.00 Handscoon non steril L
3,300.00 0 0.00 Pot Dahak
63,103.00 0 0.00 Catgut 3/0
0.00 0
180,000.00 0 0.00 BTT Baju hazmat/ APD

66,000.00 0 0.00 Celemek Plastik
6,691.85 0 0.00 Efinefrin injeksi 1 mg
38,000.00 0 0.00 Faceshield anti droplet
66,000.00 0 0.00 Masker N95
100,000.00 0 0.00 Masker Tali
5,000.00 0 0.00 Nurse Cup
6,000.00 0 0.00 Onoiwa
70,000.00 0 0.00 Rapid antigen Covid-19
55,000.00 0 0.00
Steril
200,000.00 0 0.00 Sarung Tangan L
200,000.00 0 0.00 Sarung Tangan M
0.00 0
57,194.00 0 0.00 DAU Rapid test Antigen

RECOFUS
1,878,709.68 0 0.00
Swab) 2 ml
1,143,880.00 0 0.00 Corona Virus Ag Rapid Test
0.00 0
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
OBAT DAN BMHP YANG DIKELUARKAN NAMA OBAT DAN BMHP YA
.
. KEPADA :
. WAKTU :
. NO. BAP :
.
JUMLAH SUMBER
SATUAN HARGA TOTAL HARGA NO
PEMBERIAN DANA
Tablet 90.00 - 0.00 DAU

Test 16,500.00 - 0.00
Tablet 160.00 - 0.00
Tablet 224.40 - 0.00
Tablet 160.00 - 0.00
Tablet 74.00 - 0.00
Tablet 55.00 - 0.00
Tablet 251.00 - 0.00
Tube 3,625.00 - 0.00
Botol 37,638.70 - 0.00
100 pcs 14,490.00 - 0.00
Psc 1,102.20 - 0.00
Tablet 123.00 - 0.00
Tablet 78.00 - 0.00
Botol 75,020.00 - 0.00
Botol 75,020.00 - 0.00
Botol 101,761.00 - 0.00
Botol 125,477.00 - 0.00

Tablet 3,260.00 - 0.00
tablet 122.00 - 0.00
Tablet 46.00 - 0.00

Botol/25
276,891.50 - 0.00
Strip
Tablet 1,536.70 - 0.00
Tablet 10,890.00 - 0.00
Psc 138.00 - 0.00
Box 108,324.00 - 0.00
Pcs 25,283.92 - 0.00
Pcs 6,689.54 - 0.00
Pcs 3,206.20 - 0.00
Tablet 75.00 - 0.00
Botol 2,215.00 - 0.00
tablet 60.00 - 0.00
Tablet 260.00 - 0.00
Tablet 151.80 - 0.00
Test 132,000.00 - 0.00
Tablet 109.00 - 0.00
Tablet 75.00 - 0.00
Kotak/50
69,000.00 - 0.00
pcs
Botol 3,300.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Tablet 690.00 - 0.00
Ampul 4,236.00 - 0.00
Tablet 2,178.00 - 0.00

Pcs 36,696.00 - 0.00
Tablet 28.75 - 0.00
Tablet 96.00 - 0.00
Sachet 317.00 - 0.00
Botol 5,720.00 - 0.00

Tablet 210.00 - 0.00
Psg 11,432.00 - 0.00
Psg 3,630.00 - 0.00
Tablet 1,050.00 - 0.00
Roll 302,000.00 - 0.00
Unit 814,009.50 - 0.00
Tablet 123.17 - 0.00
Pcs 3,333.00 - 0.00
Pcs 8,867.00 - 0.00
Pcs 16,000.00 - 0.00
Pcs 16,000.00 - 0.00
Pcs 16,000.00 - 0.00
Tablet 260.00 - 0.00
Tube 3,360.00 - 0.00
Tablet 20.55 - 0.00
Tablet 152.00 - 0.00
Botol 60
2,298.00 - 0.00
ml
Dus/20
547,319.00 - 0.00
strip
Ampul 3,113.05 - 0.00
Tube 41,600.00 - 0.00

Botol 177,216.00 - 0.00
Tablet 118.50 - 0.00
Ampul 3,712.00 - 0.00
Tube 10
3,150.00 - 0.00
gr
Tablet 109.00 - 0.00
Botol 500
6,900.00 - 0.00
ml
Tablet 869.00 - 0.00
Botol 14,273.00 - 0.00
Botol 3,450.00 - 0.00

kapsul 129.00 - 0.00
Tablet 180.90 - 0.00
Botol 1,535.00 - 0.00
Tablet 60.00 - 0.00
Tablet 88.21 - 0.00
Tablet 18.95 - 0.00
Tablet 26.35 - 0.00
Tablet 318.00 - 0.00
Ampul 5,291.00 - 0.00

Roll 35,532.00 - 0.00
Tablet 105.88 - 0.00
Tablet 68.15 - 0.00
Kaplet 1,027.95 - 0.00
Botol 7,703.00 - 0.00
Tablet 1,475.00 - 0.00
Tablet 85.00 - 0.00
Pcs 495.00 - 0.00
Pcs 495.00 - 0.00
Pcs 3,630.00 - 0.00
Pcs 3,630.00 - 0.00
Tablet 73.00 - 0.00
kapsul 279.82 - 0.00
Tablet 57.55 - 0.00
Pcs 8,970.00 - 0.00
Pcs 4,488.00 - 0.00

Tablet 24.31 - 0.00
Tablet 521.00 - 0.00
0.00 0
Pcs 1,240.00 - 0.00 P2PL

Pcs 1,518.00 - 0.00
Pcs 1,583.00 - 0.00
Pcs 1,650.00 - 0.00
Botol 4,600.00 - 0.00
Tablet 380.00 - 0.00

Tablet 271.14 - 0.00
Tablet 494.00 - 0.00
pcs 242.00 - 0.00
Tablet 1,121.00 - 0.00
Tablet 2,134.00 - 0.00
Saccet 275.00 - 0.00
Pcs 490.00 - 0.00
Kotak 48,999.50 - 0.00
Tablet 147.00 - 0.00
Pcs 2,272.00 - 0.00

Pcs 2,950.00 - 0.00
pot 2,000.00 - 0.00
Tablet 242.00 - 0.00
Paket 285,339.00 - 0.00
Paket 477,791.00 - 0.00
Paket 1,592,731.00 - 0.00
Paket 447,791.00 - 0.00
Tes 11,975.00 - 0.00
Tes 9,300.00 - 0.00
Tes 9,878.00 - 0.00

Tes 33,334.00 - 0.00
Tes 8,300.00 - 0.00
Tablet 287.00 - 0.00
tes 4,260.00 - 0.00
Tes 14,340.00 - 0.00
Dus 153,000.00 - 0.00
Tablet 91.00 - 0.00
Vial 165,000.00 - 0.00
Vial 61,996.00 - 0.00
Vial 28,204.00 - 0.00
Vial 78,991.00 - 0.00
Vial 17,996.00 - 0.00
Vial 158,994.00 - 0.00
Vial 1,325,000.00 - 0.00
Vial 135,000.00 - 0.00
Uniject 23,991.00 - 0.00
Uniject 23,991.00 - 0.00
Vial 155,813.00 - 0.00

Vial 19,954.00 - 0.00
Vial 16,995.00 - 0.00
Vial 1,325,000.00 - 0.00

Tablet 604.00 - 0.00
0.00 0
Set 728.00 - 0.00 DAK
Psc 1,125.85 - 0.00
Psc 840.00 - 0.00

Box 11,200.00 - 0.00
Botol 25,155.00 - 0.00
Botol 27,500.00 - 0.00
Tablet 105.00 - 0.00
Tablet 99.00 - 0.00
Ampul 2,860.00 - 0.00
Tablet 86.00 - 0.00
Tablet 123.00 - 0.00
Kapsul 908.00 - 0.00

Tablet 55.00 - 0.00
Tablet 79.00 - 0.00
Tablet 74.00 - 0.00
Tablet 94.00 - 0.00
Tablet 265.00 - 0.00
Tablet 231.00 - 0.00
Tablet 248.00 - 0.00
Tablet 360.00 - 0.00
Botol 2,560.00 - 0.00
Botol 3,846.00 - 0.00
Botol 3,510.00 - 0.00
Botol 88,678.66 - 0.00

Botol 2,098.00 - 0.00
Botol 2,106.00 - 0.00
Botol 2,098.00 - 0.00
Tablet 60.00 - 0.00
Tablet 54.00 - 0.00
Tablet 120.00 - 0.00
Tablet 46.00 - 0.00

Tablet 117.00 - 0.00
Tablet 112.00 - 0.00
Tablet 103.00 - 0.00
Tube 5,170.00 - 0.00

Tablet 251.00 - 0.00
Tablet 175.00 - 0.00
Tablet 236.00 - 0.00
Tablet 425.00 - 0.00
Botol/500
9,646.00 - 0.00
ml
Tablet 149.00 - 0.00
Tube 5 gr 1,515.00 - 0.00
Tube 1,520.00 - 0.00

Tablet 337.00 - 0.00
Tube 3,585.00 - 0.00
Tablet 82.00 - 0.00

Tablet 75.00 - 0.00
Pcs 64,191.00 - 0.00
Tablet 298.00 - 0.00
botol 3,061.00 - 0.00
Bliste 2,298.84 - 0.00
Ampul 1,210.00 - 0.00
Tablet 34.00 - 0.00

Buah 18,000.00 - 0.00
Tablet 75.00 - 0.00
Tablet 90.00 - 0.00
Botol 2,862.00 - 0.00
Tablet 70.00 - 0.00

Vial 1,545.00 - 0.00
Tube 14,459.00 - 0.00
Tube 21,021.00 - 0.00
Ampul 825.00 - 0.00
Tablet 309.00 - 0.00

Kapsul 766.00 - 0.00
Ampul 2,354.00 - 0.00
Ampul 1,518.00 - 0.00
Botol100
115,500.00 - 0.00
ml
Pcs 508.20 - 0.00
Pcs 508.20 - 0.00
Pcs 508.20 - 0.00
Botol 100
7,010.00 - 0.00
ml
Tablet 177.00 - 0.00
Ampul 3,754.00 - 0.00
Ampul 4,083.00 - 0.00
Ampul 4,236.00 - 0.00
Tablet 873.00 - 0.00
Tablet 781.00 - 0.00
Pcs 8,960.00 - 0.00
Tablet 88.00 - 0.00

Tablet 84.00 - 0.00
Buah 606,900.00 - 0.00
Sachet 317.00 - 0.00
Sachet 274.00 - 0.00
Botol 500
5,720.00 - 0.00
ml
Botol 6,900.00 - 0.00
Tablet 297.00 - 0.00
Kotak 14,600.30 - 0.00
Tablet 228.00 - 0.00
Tablet 241.00 - 0.00

Tablet 238.00 - 0.00
Kotak/25
137,500.00 - 0.00
strip
Strip 7,084.00 - 0.00
Kotak 60
322,190.00 - 0.00
spons
Tablet 76.00 - 0.00
Tablet 90.00 - 0.00
Tablet 60.00 - 0.00
psg 8,487.66 - 0.00
Tube 2,648.00 - 0.00
Tube 2,812.00 - 0.00
Tablet 2,329.80 - 0.00
Tablet 1,050.00 - 0.00

Tablet 125.79 - 0.00
Botol 2,560.00 - 0.00
Botol 3,849.00 - 0.00
Set 6,930.00 - 0.00

Pcs 5,280.00 - 0.00
Pcs 13,200.00 - 0.00
Pcs 13,750.00 - 0.00
Tablet 93.00 - 0.00
Pcs 4,256.00 - 0.00
Pcs 4,256.00 - 0.00
Pcs 8,070.70 - 0.00

Pcs 4,256.00 - 0.00
Pcs 4,256.00 - 0.00
Tablet 60.00 - 0.00
Bungkus/
60,830.00 - 0.00
1 kg
Pcs 1,700.00 - 0.00
Roll 8,624.00 - 0.00
Roll 840.00 - 0.00
Roll 1,680.00 - 0.00

Roll 2,400.00 - 0.00
Roll 660.80 - 0.00
Tablet 305.00 - 0.00
Tube 3,760.00 - 0.00
Tube 2,013.00 - 0.00
Tablet 24.00 - 0.00
Tablet 26.27 - 0.00

Botol 60
2,052.00 - 0.00
ml
Tablet 126.00 - 0.00
Tablet 152.00 - 0.00
Tablet 125.00 - 0.00
Tablet 97.00 - 0.00
Tablet 127.00 - 0.00
Ampul 847.00 - 0.00
Botol 47,970.00 - 0.00
Ampul 1,405.00 - 0.00
Box 31,165.00 - 0.00
Tablet 77.00 - 0.00
Tube 1,900.00 - 0.00
Tube 3,926.00 - 0.00
Vial 3,200.00 - 0.00
Ampul 1,069.00 - 0.00
Tablet 245.00 - 0.00
Tablet 100.00 - 0.00
Botol 2,750.00 - 0.00
Botol 500
6,840.00 - 0.00
ml
Botol 500
6,410.00 - 0.00
ml
Tablet 136.00 - 0.00
Tablet 127.00 - 0.00
Tablet 123.00 - 0.00
Tablet 645.00 - 0.00
Tablet 910.00 - 0.00
Kaplet 5,650.00 - 0.00
Paket 1,319,900.00 - 0.00
Ampul 1,348.00 - 0.00

Kapsul 129.00 - 0.00
Botol 4,950.00 - 0.00
Botol 1,013.00 - 0.00
Botol 1,160.00 - 0.00
Tablet 162.80 - 0.00
Tablet 186.78 - 0.00
Tablet 60.00 - 0.00
Botol 15
5,720.00 - 0.00
ml
Botol 15
5,980.00 - 0.00
ml
Tablet 72.00 - 0.00
Tablet 141.00 - 0.00
Tablet 79.00 - 0.00

Tablet 73.00 - 0.00
Tablet 80.00 - 0.00
Roll 50,600.00 - 0.00
Botol 3,190.00 - 0.00
Botol 60
25,215.00 - 0.00
ml
Tablet 318.00 - 0.00
botol 7,630.00 - 0.00
Botol 500
7,150.00 - 0.00
ml
Tablet 114.00 - 0.00
Botol 2,983.50 - 0.00
Psg 22,000.00 - 0.00
Tablet 150.00 - 0.00
Tablet 252.00 - 0.00
Tablet 67.00 - 0.00
Botol 5,463.00 - 0.00
Pot 30
2,200.00 - 0.00
gram
Pot 3,017.00 - 0.00
Ampul 1,226.00 - 0.00

Tablet 44.00 - 0.00
Psc 53,064.00 - 0.00

Tablet 281.00 - 0.00
Tube 12,749.00 - 0.00
Tablet 409.00 - 0.00
Tablet 91.00 - 0.00
Kapsul 174.00 - 0.00

Kapsul 329.00 - 0.00
kapsul 279.82 - 0.00
kotak/10
255,000.00 - 0.00
strip
Kotak/25
195,000.00 - 0.00
strip
Tablet 144.00 - 0.00
Vial 165,000.00 - 0.00
Tablet 135.00 - 0.00
Tablet 604.00 - 0.00
Botol 60
8,140.00 - 0.00
ml
Botol 60
6,500.00 - 0.00
ml
Botol 3,285.00 - 0.00
0.00 0
Pcs 1,004.85 - 0.00 BMHP E-

Pcs 924.00 - 0.00 CAT DAK
Pcs 887.70 - 0.00
Pcs 924.00 - 0.00
Jergen 5 L 395,384.74 - 0.00
Kotak 16,401.00 - 0.00

Pcs 11,945.23 - 0.00
Pcs 11,945.23 - 0.00
Pcs 1,740.20 - 0.00
Pasang 11,808.50 - 0.00
Pasang 11,808.50 - 0.00
Pcs 5,827.80 - 0.00
Pcs 5,827.00 - 0.00
Pcs 5,827.00 - 0.00
Psg 5,827.00 - 0.00
Pcs 8,547.00 - 0.00
Pcs 5,566.00 - 0.00
Pcs 6,527.40 - 0.00
Pcs 6,455.90 - 0.00
Roll 6,455.90 - 0.00
Roll 4,114.00 - 0.00
Roll 143,022.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 16,032.50 - 0.00
Pcs 16,032.50 - 0.00
Pcs 4,983.00 - 0.00
Pcs 4,983.00 - 0.00
Pcs 11,656.00 - 0.00
Pcs 11,656.00 - 0.00
Pcs 46,959.00 - 0.00
Roll 55,030.80 - 0.00
Roll 1,740.20 - 0.00

Box 1,740.20 - 0.00
Pcs 49,491.20 - 0.00
Botol 21,060.00 - 0.00
Botol 2,983.50 - 0.00
Pcs 2,132.90 - 0.00
Box 24,640.00 - 0.00
Box 31,165.00 - 0.00
Pcs 38,119.40 - 0.00
Roll 41,100.00 - 0.00

Pcs 728.00 - 0.00
Pcs 6,062.10 - 0.00
Pcs 8,960.00 - 0.00
0.00 0
Tube 2,774.00 - 0.00 KESMAS
Ampul 4,236.00 - 0.00
sachet 2,920.00 - 0.00
Vial 3,796.00 - 0.00
Tube 2,600.00 - 0.00
Ampul 1,232.00 - 0.00
Ampul 1,199.00 - 0.00
Tablet 409.00 - 0.00
Tablet 255.00 - 0.00
Kapsul 354.00 - 0.00
Kapsul 297.00 - 0.00
Kapsul 637.00 - 0.00
0.00 0
kotak/ KESGRA
118,973.00 - 0.00
100 set
Pcs 832.00 - 0.00
pcs 1,137.40 - 0.00
Pcs 9,332.40 - 0.00
Pcs 7,146.67 - 0.00
Pcs 7,146.67 - 0.00
Botol
28,567.00 - 0.00
1000 ml
Botol 100
114,967.60 - 0.00
ml
Set 9,794.40 - 0.00
Set 9,794.40 - 0.00
Pairs 4,654.10 - 0.00
Pairs 4,654.10 - 0.00
Set/
6,968.50 - 0.00
Kantong
Pcs 4,480.00 - 0.00
Pcs 4,480.00 - 0.00
Pcs 4,096.00 - 0.00
Set/
6,470.20 - 0.00
Kantong
Roll 960.00 - 0.00
Roll 665.50 - 0.00
Box/16 7,424.00 - 0.00
roll 134,371.60 - 0.00
Box/100 41,600.00 - 0.00
pcs 7,647.20 - 0.00
Pcs 3,911.11 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 832.00 - 0.00
0.00 0
Botol 55,000.00 - 0.00 DAU

Pcs 470.50 - 0.00 PAJAK
ROKOK
Pcs 470.50 - 0.00
Pcs 470.50 - 0.00
Pcs 464.64 - 0.00
Pcs 464.64 - 0.00
Pcs 5,775.00 - 0.00
Pcs 3,300.00 - 0.00
Pcs 63,103.00 - 0.00
0.00 0
Pcs 180,000.00 - 0.00 BTT

Pcs 66,000.00 - 0.00
Ampul 6,691.85 - 0.00
Pcs 38,000.00 - 0.00
Psg 12,000.00 - 0.00
Psg 12,000.00 - 0.00
Pcs 66,000.00 - 0.00
Box 100,000.00 - 0.00
Pcs 5,000.00 - 0.00
tablet 6,000.00 - 0.00
Pcs 70,000.00 - 0.00
Psg 55,000.00 - 0.00
Box/100 200,000.00 - 0.00

Box/100 200,000.00 - 0.00
0.00 0
Test 57,194.00 - 0.00 DAU

RECOFUS
Kit 1,878,709.68 - 0.00 ING
Kotak 1,143,880.00 - 0.00

0 0.00
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
.
0 .
Sabtu,30 Desember 1899 .
16 .
.
JUMLAH
NAMA OBAT SATUAN HARGA TOTAL HARGA
PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
0.00
Alat suntik sekali pakai 1 ml Set 728.00 0 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
0.00
Alat Suntik 1 cc (Nipro) Pcs 1,004.85 0 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
0.00
Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 0 0.00
0.00
kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
0.00
Cairan Pembersih Tangan Botol 55,000.00 0 0.00

Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
0.00
Baju hazmat/ APD Pcs 180,000.00 0 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
0.00
Rapid test Antigen Test 57,194.00 0 0.00

VTM (Transport Medium Dacron
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
0.00
0.00
.
.
.
.
_________________________________ _______________________________
.
KEPADA : 0 .
NO. BAP : 17 .
.
SUMBER JUMLAH
DANA PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

0 0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
0 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
0 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
0 0.00
0 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
0 0.00

ROKOK
Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
0 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
0 0.00

RECOFUS
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
0 0.00
0 0.00
.
.
.
.
_________________________________ _______________________________
KEPADA : 0
NO. BAP : 18
SUMBER JUMLAH
DANA PEMBERIAN

Botol 75,020.00 0
Reagents
Botol 75,020.00 0
Reagents
Botol 101,761.00 0
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy

Tablet 690.00 0
salut 10 mg
Ampul 4,236.00 0
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0
Sachet 317.00 0
untuk 200 ml
Tube 3,360.00 0
(Bufacetin)
Tablet 20.55 0
4 mg
Tablet 152.00 0
(Dewasa)
Botol 60
ml
547,319.00 0
humasens) strip

Ampul 3,712.00 0
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0
Syrup)
Tablet 18.95 0
mg
Tablet 26.35 0
mg
Tablet 318.00 0
mg

0 0.00


Tablet 147.00 0
(HCl)

SD HIV 19 Tes 14,340.00 0

Vial 1,325,000.00 0
Globuline
0 0.00

Psc 1,125.85 0

Botol 2,560.00 0
5 ml
Botol 3,846.00 0
ml



Botol/500
Asering 9,646.00 0
ml

Tube 3,585.00 0
kulit)
Catgut 3/0 Pcs 64,191.00 0
Ampul 1,210.00 0
1 ml

Tube 14,459.00 0
(Stesolid Rektal)
Tube 21,021.00 0
(Stesolid Rektal)
Ampul 825.00 0
mg/ml
Ampul 2,354.00 0
mg/ml
Ampul 1,518.00 0
ml
Botol100
ml

Pcs 508.20 0
(Aximed)
Pcs 508.20 0
(Aximed)
Botol 100
ml
Ampul 3,754.00 0
mg/ 1 ml
Ampul 4,083.00 0
mg/ 1 ml
Ampul 4,236.00 0
mg/ml
Tablet 873.00 0
gula 10 mg
Tablet 781.00 0
gula 10 mg
Pcs 8,960.00 0
(urocare)
Botol 500
ml
Kotak 14,600.30 0
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0
(Scopamin)

Pcs 4,256.00 0
(Steracath)
Pcs 4,256.00 0
(Steracath)

Tablet 60.00 0
mg
Bungkus/
1 kg
Roll 840.00 0
(Onemed)
Roll 1,680.00 0
(Onemed)
Roll 2,400.00 0
cm
Roll 660.80 0
(Onemed)
Tube 3,760.00 0
(Bufacetin)
Tablet 24.00 0
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0
Ampul 1,069.00 0
mg/ml
Tablet 245.00 0
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0
mg HCl
Tablet 141.00 0
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0
500 mcg
Tablet 44.00 0
mg
Silk 3/0 Psc 53,064.00 0
Tablet 91.00 0
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0
ml
0 0.00


Kasa 16 x 16 Roll 4,114.00 0
Pcs 46,959.00 0
(Otot)
Roll 55,030.80 0
(Kulit)
Pcs 49,491.20 0
(Kulit)

Pcs 2,132.90 0
Kehamilan
Box 24,640.00 0
plus
Box 31,165.00 0
plus
Pcs 38,119.40 0
(Kulit)
Pcs 8,960.00 0
18
0 0.00
0 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0
35 mm
Pcs 7,146.67 0
35 mm
Botol
Etanol 70 % 28,567.00 0
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0
0 0.00

ROKOK
Catgut 3/0 Pcs 63,103.00 0
0 0.00

Masker N95 Pcs 66,000.00 0
Psg 55,000.00 0
Steril
0 0.00

RECOFUS
Kit 1,878,709.68 0
Swab) 2 ml
0 0 0.00
0 0.00
0 0.00
_________________________________ _______________________________
.
. KEPADA : 0
. NO. BAP : 19
.
SUMBER
DANA

0.00 Alkohol 70% Botol 37,638.70
0.00 Botol 75,020.00
Reagents
0.00 Botol 75,020.00
Reagents
0.00 Botol 101,761.00
Reagents

Botol/25
Strip
Kotak/50
pcs
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy

0.00 Tablet 690.00
salut 10 mg
0.00 Ampul 4,236.00
mg/ 1 ml
0.00 Fit D3 1000 Tablet 2,178.00
0.00 Sachet 317.00
untuk 200 ml
0.00 Tube 3,360.00
(Bufacetin)
0.00 Tablet 20.55
4 mg
0.00 Tablet 152.00
(Dewasa)
Botol 60
ml
0.00 547,319.00
humasens) strip

0.00 Ampul 3,712.00
mg - ml
Tube 10
gr
Botol 500
ml
0.00 Botol 14,273.00
Syrup)
0.00 Tablet 18.95
mg
0.00 Tablet 26.35
mg
0.00 Tablet 318.00
mg
0.00 Salep 24 Tablet 1,475.00

0.00 0


0.00 DHP Tablet 2,134.00
0.00 Tablet 147.00
(HCl)
0.00 Rapid 1 HIV (SD) Tes 11,975.00

0.00 SD HIV 19 Tes 14,340.00

0.00 Vial 1,325,000.00
Globuline
0.00 0

0.00 Psc 1,125.85

0.00 Botol 2,560.00
5 ml
0.00 Botol 3,846.00
ml
0.00 Anios Gel 85 Botol 88,678.66



Botol/500
0.00 Asering 9,646.00
ml

0.00 Tube 3,585.00
kulit)
0.00 Catgut 3/0 Pcs 64,191.00
0.00 Ampul 1,210.00
1 ml

0.00 Tube 14,459.00
(Stesolid Rektal)
0.00 Tube 21,021.00
(Stesolid Rektal)
0.00 Ampul 825.00
mg/ml
0.00 Ampul 2,354.00
mg/ml
0.00 Ampul 1,518.00
ml
Botol100
ml

0.00 Pcs 508.20
(Aximed)
0.00 Pcs 508.20
(Aximed)
Botol 100
ml
0.00 Ampul 3,754.00
mg/ 1 ml
0.00 Ampul 4,083.00
mg/ 1 ml
0.00 Ampul 4,236.00
mg/ml
0.00 Tablet 873.00
gula 10 mg
0.00 Tablet 781.00
gula 10 mg
0.00 Pcs 8,960.00
(urocare)
Botol 500
ml
0.00 Kotak 14,600.30
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0.00 Tablet 2,329.80
(Scopamin)

0.00 Introcan No.22 Pcs 13,200.00
0.00 Introcan No.24 Pcs 13,750.00
0.00 Pcs 4,256.00
(Steracath)
0.00 Pcs 4,256.00
(Steracath)

0.00 Tablet 60.00
mg
Bungkus/
1 kg
0.00 Roll 840.00
(Onemed)
0.00 Roll 1,680.00
(Onemed)
0.00 Roll 2,400.00
cm
0.00 Roll 660.80
(Onemed)
0.00 Tube 3,760.00
(Bufacetin)
0.00 Tablet 24.00
4 mg
Botol 60
ml
0.00 MgS04 20% Vial 3,200.00
0.00 Ampul 1,069.00
mg/ml
0.00 Tablet 245.00
0,125 mg
Botol 500
ml
Botol 500
ml
0.00 Paket 1,319,900.00
Kategori 2
Botol 15
ml
Botol 15
ml
0.00 Tablet 72.00
mg HCl
0.00 Tablet 141.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0.00 Ampul 1,226.00
500 mcg
0.00 Tablet 44.00
mg
0.00 Silk 3/0 Psc 53,064.00
0.00 Tablet 91.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 8,140.00
ml
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 6,500.00
ml
0.00 0


0.00 Kasa 16 x 16 Roll 4,114.00
0.00 Pcs 46,959.00
(Otot)
0.00 Roll 55,030.80
(Kulit)
0.00 Pcs 49,491.20
(Kulit)

0.00 Pcs 2,132.90
Kehamilan
0.00 Box 24,640.00
plus
0.00 Box 31,165.00
plus
0.00 Pcs 38,119.40
(Kulit)
0.00 Pcs 8,960.00
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0.00 Pcs 7,146.67
35 mm
0.00 Pcs 7,146.67
35 mm
Botol
0.00 Etanol 70 % 28,567.00
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0.00 Silk 3/0 pcs 7,647.20
0.00 0

ROKOK
0.00 Catgut 3/0 Pcs 63,103.00
0.00 0

0.00 Masker N95 Pcs 66,000.00
0.00 Psg 55,000.00
Steril
0.00 0

RECOFUS
0.00 Kit 1,878,709.68
Swab) 2 ml
0 0 0.00
0.00 0
0.00 0
.
.
.
.
_____________________ _________________________________ __________________________
.
. KEPADA : 0
. NO. BAP : 20
.
JUMLAH SUMBER
PEMBERIAN DANA

0 0.00 Botol
Reagents
0 0.00 Botol
Reagents
0 0.00 Botol
Reagents

Botol/25
Strip
Kotak/50
pcs
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy

0 0.00 Tablet
salut 10 mg
0 0.00 Ampul
mg/ 1 ml
0 0.00 Sachet
untuk 200 ml
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
0 0.00 Tablet
(Dewasa)
Botol 60
ml
0 0.00
humasens) strip

0 0.00 Ampul
mg - ml
Tube 10
gr
Botol 500
ml
0 0.00 Botol
Syrup)
0 0.00 Tablet
mg
0 0.00 Tablet
mg
0 0.00 Tablet
mg

0.00 0


0 0.00 DHP Tablet
0 0.00 Tablet
(HCl)


0 0.00 Vial
Globuline
0.00 0

0 0.00 Psc

0 0.00 Botol
5 ml
0 0.00 Botol
ml



Botol/500
0 0.00 Asering
ml

0 0.00 Tube
kulit)
0 0.00 Ampul
1 ml

0 0.00 Tube
(Stesolid Rektal)
0 0.00 Tube
(Stesolid Rektal)
0 0.00 Ampul
mg/ml
0 0.00 Ampul
mg/ml
0 0.00 Ampul
ml
Botol100
ml

0 0.00 Pcs
(Aximed)
0 0.00 Pcs
(Aximed)
Botol 100
0 0.00 Fenobarbital
ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ml
0 0.00 Tablet
gula 10 mg
0 0.00 Tablet
gula 10 mg
0 0.00 Pcs
(urocare)
Botol 500
ml
0 0.00 Kotak
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0 0.00 Tablet
(Scopamin)

0 0.00 Pcs
(Steracath)
0 0.00 Pcs
(Steracath)

0 0.00 Tablet
mg
Bungkus/
1 kg
0 0.00 Roll
(Onemed)
0 0.00 Roll
(Onemed)
0 0.00 Roll
cm
0 0.00 Roll
(Onemed)
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
Botol 60
ml
0 0.00 MgS04 20% Vial
0 0.00 Ampul
mg/ml
0 0.00 Tablet
0,125 mg
Botol 500
ml
Botol 500
ml
0 0.00 Paket
Kategori 2
Botol 15
ml
Botol 15
ml
0 0.00 Tablet
mg HCl
0 0.00 Tablet
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0 0.00 Ampul
500 mcg
0 0.00 Tablet
mg
0 0.00 Silk 3/0 Psc
0 0.00 Tablet
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
ml
Botol 60
ml
0.00 0


0 0.00 Kasa 16 x 16 Roll
0 0.00 Pcs
(Otot)
0 0.00 Roll
(Kulit)
0 0.00 Pcs
(Kulit)

0 0.00 Pcs
Kehamilan
0 0.00 Box
plus
0 0.00 Box
plus
0 0.00 Pcs
(Kulit)
0 0.00 Pcs
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0 0.00 Pcs
35 mm
0 0.00 Pcs
35 mm
Botol
0 0.00 Etanol 70 %
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0 0.00 Silk 3/0 pcs
0.00 0

ROKOK
0.00 0

0 0.00 Psg
Steril
0.00 0

RECOFUS
0 0.00 Kit
Swab) 2 ml
0 0
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
BMHP YANG DIKELUARKAN
.
.
.
.
.
JUMLAH
HARGA TOTAL HARGA
PEMBERIAN
90.00 0 0.00
16,500.00 0 0.00
160.00 0 0.00
224.40 0 0.00
160.00 0 0.00
74.00 0 0.00
55.00 0 0.00
251.00 0 0.00
3,625.00 0 0.00
37,638.70 0 0.00
14,490.00 0 0.00
1,102.20 0 0.00
123.00 0 0.00
78.00 0 0.00
75,020.00 0 0.00
75,020.00 0 0.00
101,761.00 0 0.00
125,477.00 0 0.00
3,260.00 0 0.00
122.00 0 0.00
46.00 0 0.00
276,891.50 0 0.00
1,536.70 0 0.00
10,890.00 0 0.00
138.00 0 0.00
108,324.00 0 0.00
25,283.92 0 0.00
6,689.54 0 0.00
3,206.20 0 0.00
75.00 0 0.00
2,215.00 0 0.00
60.00 0 0.00
260.00 0 0.00
151.80 0 0.00
132,000.00 0 0.00
109.00 0 0.00
75.00 0 0.00
69,000.00 0 0.00
3,300.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
690.00 0 0.00
4,236.00 0 0.00
2,178.00 0 0.00
36,696.00 0 0.00
28.75 0 0.00
96.00 0 0.00
317.00 0 0.00
5,720.00 0 0.00
210.00 0 0.00
11,432.00 0 0.00
3,630.00 0 0.00
1,050.00 0 0.00
302,000.00 0 0.00
814,009.50 0 0.00
123.17 0 0.00
3,333.00 0 0.00
8,867.00 0 0.00
16,000.00 0 0.00
16,000.00 0 0.00
16,000.00 0 0.00
260.00 0 0.00
3,360.00 0 0.00
20.55 0 0.00
152.00 0 0.00
2,298.00 0 0.00
547,319.00 0 0.00
3,113.05 0 0.00
41,600.00 0 0.00
177,216.00 0 0.00
118.50 0 0.00
3,712.00 0 0.00
3,150.00 0 0.00
109.00 0 0.00
6,900.00 0 0.00
869.00 0 0.00
14,273.00 0 0.00
3,450.00 0 0.00
129.00 0 0.00
180.90 0 0.00
1,535.00 0 0.00
60.00 0 0.00
88.21 0 0.00
18.95 0 0.00
26.35 0 0.00
318.00 0 0.00
5,291.00 0 0.00
35,532.00 0 0.00
105.88 0 0.00
68.15 0 0.00
1,027.95 0 0.00
7,703.00 0 0.00
1,475.00 0 0.00
85.00 0 0.00
495.00 0 0.00
495.00 0 0.00
3,630.00 0 0.00
3,630.00 0 0.00
73.00 0 0.00
279.82 0 0.00
57.55 0 0.00
8,970.00 0 0.00
4,488.00 0 0.00
24.31 0 0.00
521.00 0 0.00
0.00
1,240.00 0 0.00
1,518.00 0 0.00
1,583.00 0 0.00
1,650.00 0 0.00
4,600.00 0 0.00
380.00 0 0.00
271.14 0 0.00
494.00 0 0.00
242.00 0 0.00
1,121.00 0 0.00
2,134.00 0 0.00
275.00 0 0.00
490.00 0 0.00
48,999.50 0 0.00
147.00 0 0.00
2,272.00 0 0.00
2,950.00 0 0.00
2,000.00 0 0.00
242.00 0 0.00
285,339.00 0 0.00
477,791.00 0 0.00
1,592,731.00 0 0.00
447,791.00 0 0.00
11,975.00 0 0.00
9,300.00 0 0.00
9,878.00 0 0.00
33,334.00 0 0.00
8,300.00 0 0.00
287.00 0 0.00
4,260.00 0 0.00
14,340.00 0 0.00
153,000.00 0 0.00
91.00 0 0.00
165,000.00 0 0.00
61,996.00 0 0.00
28,204.00 0 0.00
78,991.00 0 0.00
17,996.00 0 0.00
158,994.00 0 0.00
1,325,000.00 0 0.00
135,000.00 0 0.00
23,991.00 0 0.00
23,991.00 0 0.00
155,813.00 0 0.00
19,954.00 0 0.00
16,995.00 0 0.00
1,325,000.00 0 0.00
604.00 0 0.00
0.00
728.00 0 0.00
1,125.85 0 0.00
840.00 0 0.00
11,200.00 0 0.00
25,155.00 0 0.00
27,500.00 0 0.00
105.00 0 0.00
99.00 0 0.00
2,860.00 0 0.00
86.00 0 0.00
123.00 0 0.00
908.00 0 0.00
55.00 0 0.00
79.00 0 0.00
74.00 0 0.00
94.00 0 0.00
265.00 0 0.00
231.00 0 0.00
248.00 0 0.00
360.00 0 0.00
2,560.00 0 0.00
3,846.00 0 0.00
3,510.00 0 0.00
88,678.66 0 0.00
2,098.00 0 0.00
2,106.00 0 0.00
2,098.00 0 0.00
60.00 0 0.00
54.00 0 0.00
120.00 0 0.00
46.00 0 0.00
117.00 0 0.00
112.00 0 0.00
103.00 0 0.00
5,170.00 0 0.00
251.00 0 0.00
175.00 0 0.00
236.00 0 0.00
425.00 0 0.00
9,646.00 0 0.00
149.00 0 0.00
1,515.00 0 0.00
1,520.00 0 0.00
337.00 0 0.00
3,585.00 0 0.00
82.00 0 0.00
75.00 0 0.00
64,191.00 0 0.00
298.00 0 0.00
3,061.00 0 0.00
2,298.84 0 0.00
1,210.00 0 0.00
34.00 0 0.00
18,000.00 0 0.00
75.00 0 0.00
90.00 0 0.00
2,862.00 0 0.00
70.00 0 0.00
1,545.00 0 0.00
14,459.00 0 0.00
21,021.00 0 0.00
825.00 0 0.00
309.00 0 0.00
766.00 0 0.00
2,354.00 0 0.00
1,518.00 0 0.00
115,500.00 0 0.00
508.20 0 0.00
508.20 0 0.00
508.20 0 0.00
7,010.00 0 0.00
177.00 0 0.00
3,754.00 0 0.00
4,083.00 0 0.00
4,236.00 0 0.00
873.00 0 0.00
781.00 0 0.00
8,960.00 0 0.00
88.00 0 0.00
84.00 0 0.00
606,900.00 0 0.00
317.00 0 0.00
274.00 0 0.00
5,720.00 0 0.00
6,900.00 0 0.00
297.00 0 0.00
14,600.30 0 0.00
228.00 0 0.00
241.00 0 0.00
238.00 0 0.00
137,500.00 0 0.00
7,084.00 0 0.00
322,190.00 0 0.00
76.00 0 0.00
90.00 0 0.00
60.00 0 0.00
8,487.66 0 0.00
2,648.00 0 0.00
2,812.00 0 0.00
2,329.80 0 0.00
1,050.00 0 0.00
125.79 0 0.00
2,560.00 0 0.00
3,849.00 0 0.00
6,930.00 0 0.00
5,280.00 0 0.00
13,200.00 0 0.00
13,750.00 0 0.00
93.00 0 0.00
4,256.00 0 0.00
4,256.00 0 0.00
8,070.70 0 0.00
4,256.00 0 0.00
4,256.00 0 0.00
60.00 0 0.00
60,830.00 0 0.00
1,700.00 0 0.00
8,624.00 0 0.00
840.00 0 0.00
1,680.00 0 0.00
2,400.00 0 0.00
660.80 0 0.00
305.00 0 0.00
3,760.00 0 0.00
2,013.00 0 0.00
24.00 0 0.00
26.27 0 0.00
2,052.00 0 0.00
126.00 0 0.00
152.00 0 0.00
125.00 0 0.00
97.00 0 0.00
127.00 0 0.00
847.00 0 0.00
47,970.00 0 0.00
1,405.00 0 0.00
31,165.00 0 0.00
77.00 0 0.00
1,900.00 0 0.00
3,926.00 0 0.00
3,200.00 0 0.00
1,069.00 0 0.00
245.00 0 0.00
100.00 0 0.00
2,750.00 0 0.00
6,840.00 0 0.00
6,410.00 0 0.00
136.00 0 0.00
127.00 0 0.00
123.00 0 0.00
645.00 0 0.00
910.00 0 0.00
5,650.00 0 0.00
1,319,900.00 0 0.00
1,348.00 0 0.00
129.00 0 0.00
4,950.00 0 0.00
1,013.00 0 0.00
1,160.00 0 0.00
162.80 0 0.00
186.78 0 0.00
60.00 0 0.00
5,720.00 0 0.00
5,980.00 0 0.00
72.00 0 0.00
141.00 0 0.00
79.00 0 0.00
73.00 0 0.00
80.00 0 0.00
50,600.00 0 0.00
3,190.00 0 0.00
25,215.00 0 0.00
318.00 0 0.00
7,630.00 0 0.00
7,150.00 0 0.00
114.00 0 0.00
2,983.50 0 0.00
22,000.00 0 0.00
150.00 0 0.00
252.00 0 0.00
67.00 0 0.00
5,463.00 0 0.00
2,200.00 0 0.00
3,017.00 0 0.00
1,226.00 0 0.00
44.00 0 0.00
53,064.00 0 0.00
281.00 0 0.00
12,749.00 0 0.00
409.00 0 0.00
91.00 0 0.00
174.00 0 0.00
329.00 0 0.00
279.82 0 0.00
255,000.00 0 0.00
195,000.00 0 0.00
144.00 0 0.00
165,000.00 0 0.00
135.00 0 0.00
604.00 0 0.00
8,140.00 0 0.00
6,500.00 0 0.00
3,285.00 0 0.00
0.00
1,004.85 0 0.00
924.00 0 0.00
887.70 0 0.00
924.00 0 0.00
395,384.74 0 0.00
16,401.00 0 0.00
11,945.23 0 0.00
11,945.23 0 0.00
1,740.20 0 0.00
11,808.50 0 0.00
11,808.50 0 0.00
5,827.80 0 0.00
5,827.00 0 0.00
5,827.00 0 0.00
5,827.00 0 0.00
8,547.00 0 0.00
5,566.00 0 0.00
6,527.40 0 0.00
6,455.90 0 0.00
6,455.90 0 0.00
4,114.00 0 0.00
143,022.00 0 0.00
7,502.00 0 0.00
7,502.00 0 0.00
7,502.00 0 0.00
16,032.50 0 0.00
16,032.50 0 0.00
4,983.00 0 0.00
4,983.00 0 0.00
11,656.00 0 0.00
11,656.00 0 0.00
46,959.00 0 0.00
55,030.80 0 0.00
1,740.20 0 0.00
1,740.20 0 0.00
49,491.20 0 0.00
21,060.00 0 0.00
2,983.50 0 0.00
2,132.90 0 0.00
24,640.00 0 0.00
31,165.00 0 0.00
38,119.40 0 0.00
41,100.00 0 0.00
728.00 0 0.00
6,062.10 0 0.00
8,960.00 0 0.00
0.00
2,774.00 0 0.00
4,236.00 0 0.00
2,920.00 0 0.00
3,796.00 0 0.00
2,600.00 0 0.00
1,232.00 0 0.00
1,199.00 0 0.00
409.00 0 0.00
255.00 0 0.00
354.00 0 0.00
297.00 0 0.00
637.00 0 0.00
0.00
118,973.00 0 0.00
832.00 0 0.00
1,137.40 0 0.00
9,332.40 0 0.00
7,146.67 0 0.00
7,146.67 0 0.00
28,567.00 0 0.00
114,967.60 0 0.00
9,794.40 0 0.00
9,794.40 0 0.00
4,654.10 0 0.00
4,654.10 0 0.00
6,968.50 0 0.00
4,480.00 0 0.00
4,480.00 0 0.00
4,096.00 0 0.00
6,470.20 0 0.00
960.00 0 0.00
665.50 0 0.00
7,424.00 0 0.00
134,371.60 0 0.00
41,600.00 0 0.00
7,647.20 0 0.00
3,911.11 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
832.00 0 0.00
0.00
55,000.00 0 0.00
470.50 0 0.00
470.50 0 0.00
470.50 0 0.00
464.64 0 0.00
464.64 0 0.00
5,775.00 0 0.00
3,300.00 0 0.00
63,103.00 0 0.00
0.00
180,000.00 0 0.00
66,000.00 0 0.00
6,691.85 0 0.00
38,000.00 0 0.00
12,000.00 0 0.00
12,000.00 0 0.00
66,000.00 0 0.00
100,000.00 0 0.00
5,000.00 0 0.00
6,000.00 0 0.00
70,000.00 0 0.00
55,000.00 0 0.00
200,000.00 0 0.00
200,000.00 0 0.00
0.00
57,194.00 0 0.00
1,878,709.68 0 0.00
1,143,880.00 0 0.00
0.00
0.00
0.00
.
Yang Menerima
.
.
.
_______________________________
.
KEPADA : 0 .
NO. BAP : 21 .
.
SUMBER JUMLAH
DANA PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

TOTAL DAU 0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
TOTAL P2PL 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
TOTAL DAK 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
TOTAL BMHP E-CAT DAK 0.00

TOTAL KESMAS 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
TOTAL KESMAS 0.00

ROKOK
Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
TOTAL DAU PAJAK ROKOK 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
TOTAL BANTUAN TAK TERDUGA 0.00

RECOFUS
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
DAU RECOFUSING 0.00
TOTAL 0.00
,
,
,
,
_________________________________ _______________________________
KEPADA : 0
NO. BAP : 22
SUMBER JUMLAH
DANA PEMBERIAN

Botol 75,020.00 0
Reagents
Botol 75,020.00 0
Reagents
Botol 101,761.00 0
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy

Tablet 690.00 0
salut 10 mg
Ampul 4,236.00 0
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0
Sachet 317.00 0
untuk 200 ml
Tube 3,360.00 0
(Bufacetin)
Tablet 20.55 0
4 mg
Tablet 152.00 0
(Dewasa)
Botol 60
ml
547,319.00 0
humasens) strip

Ampul 3,712.00 0
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0
Syrup)
Tablet 18.95 0
mg
Tablet 26.35 0
mg
Tablet 318.00 0
mg

4564434.35 0.00


Tablet 147.00 0
(HCl)

SD HIV 19 Tes 14,340.00 0

Vial 1,325,000.00 0
Globuline
10640081 0.00

Psc 1,125.85 0

Botol 2,560.00 0
5 ml
Botol 3,846.00 0
ml



Botol/500
Asering 9,646.00 0
ml

Tube 3,585.00 0
kulit)
Catgut 3/0 Pcs 64,191.00 0
Ampul 1,210.00 0
1 ml

Tube 14,459.00 0
(Stesolid Rektal)
Tube 21,021.00 0
(Stesolid Rektal)
Ampul 825.00 0
mg/ml
Ampul 2,354.00 0
mg/ml
Ampul 1,518.00 0
ml
Botol100
ml

Pcs 508.20 0
(Aximed)
Pcs 508.20 0
(Aximed)
Botol 100
ml
Ampul 3,754.00 0
mg/ 1 ml
Ampul 4,083.00 0
mg/ 1 ml
Ampul 4,236.00 0
mg/ml
Tablet 873.00 0
gula 10 mg
Tablet 781.00 0
gula 10 mg
Pcs 8,960.00 0
(urocare)
Botol 500
ml
Kotak 14,600.30 0
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0
(Scopamin)

Pcs 4,256.00 0
(Steracath)
Pcs 4,256.00 0
(Steracath)

Tablet 60.00 0
mg
Bungkus/
1 kg
Roll 840.00 0
(Onemed)
Roll 1,680.00 0
(Onemed)
Roll 2,400.00 0
cm
Roll 660.80 0
(Onemed)
Tube 3,760.00 0
(Bufacetin)
Tablet 24.00 0
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0
Ampul 1,069.00 0
mg/ml
Tablet 245.00 0
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0
mg HCl
Tablet 141.00 0
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0
500 mcg
Tablet 44.00 0
mg
Silk 3/0 Psc 53,064.00 0
Tablet 91.00 0
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0
ml
4386346.74 0.00


Kasa 16 x 16 Roll 4,114.00 0
Pcs 46,959.00 0
(Otot)
Roll 55,030.80 0
(Kulit)
Pcs 49,491.20 0
(Kulit)

Pcs 2,132.90 0
Kehamilan
Box 24,640.00 0
plus
Box 31,165.00 0
plus
Pcs 38,119.40 0
(Kulit)
Pcs 8,960.00 0
18
4066295.36 0.00
1853300 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0
35 mm
Pcs 7,146.67 0
35 mm
Botol
Etanol 70 % 28,567.00 0
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0
0 0.00

ROKOK
Catgut 3/0 Pcs 63,103.00 0
94100 0.00

Masker N95 Pcs 66,000.00 0
Psg 55,000.00 0
Steril
4104000 0.00

RECOFUS
Kit 1,878,709.68 0
Swab) 2 ml
0 0 0.00 0
TOTAL 0.00
TOTAL 0.00
_________________________________ _______________________________
.
. KEPADA : 0
. NO. BAP : 23
.
SUMBER
DANA

0.00 Alkohol 70% Botol 37,638.70
0.00 Botol 75,020.00
Reagents
0.00 Botol 75,020.00
Reagents
0.00 Botol 101,761.00
Reagents

Botol/25
Strip
Kotak/50
pcs
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy

0.00 Tablet 690.00
salut 10 mg
0.00 Ampul 4,236.00
mg/ 1 ml
0.00 Fit D3 1000 Tablet 2,178.00
0.00 Sachet 317.00
untuk 200 ml
0.00 Tube 3,360.00
(Bufacetin)
0.00 Tablet 20.55
4 mg
0.00 Tablet 152.00
(Dewasa)
Botol 60
ml
0.00 547,319.00
humasens) strip

0.00 Ampul 3,712.00
mg - ml
Tube 10
gr
Botol 500
ml
0.00 Botol 14,273.00
Syrup)
0.00 Tablet 18.95
mg
0.00 Tablet 26.35
mg
0.00 Tablet 318.00
mg
0.00 Salep 24 Tablet 1,475.00

0.00 0


0.00 DHP Tablet 2,134.00
0.00 Tablet 147.00
(HCl)
0.00 Rapid 1 HIV (SD) Tes 11,975.00

0.00 SD HIV 19 Tes 14,340.00

0.00 Vial 1,325,000.00
Globuline
0.00 0

0.00 Psc 1,125.85

0.00 Botol 2,560.00
5 ml
0.00 Botol 3,846.00
ml
0.00 Anios Gel 85 Botol 88,678.66



Botol/500
0.00 Asering 9,646.00
ml

0.00 Tube 3,585.00
kulit)
0.00 Catgut 3/0 Pcs 64,191.00
0.00 Ampul 1,210.00
1 ml

0.00 Tube 14,459.00
(Stesolid Rektal)
0.00 Tube 21,021.00
(Stesolid Rektal)
0.00 Ampul 825.00
mg/ml
0.00 Ampul 2,354.00
mg/ml
0.00 Ampul 1,518.00
ml
Botol100
ml

0.00 Pcs 508.20
(Aximed)
0.00 Pcs 508.20
(Aximed)
Botol 100
ml
0.00 Ampul 3,754.00
mg/ 1 ml
0.00 Ampul 4,083.00
mg/ 1 ml
0.00 Ampul 4,236.00
mg/ml
0.00 Tablet 873.00
gula 10 mg
0.00 Tablet 781.00
gula 10 mg
0.00 Pcs 8,960.00
(urocare)
Botol 500
ml
0.00 Kotak 14,600.30
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0.00 Tablet 2,329.80
(Scopamin)

0.00 Introcan No.22 Pcs 13,200.00
0.00 Introcan No.24 Pcs 13,750.00
0.00 Pcs 4,256.00
(Steracath)
0.00 Pcs 4,256.00
(Steracath)

0.00 Tablet 60.00
mg
Bungkus/
1 kg
0.00 Roll 840.00
(Onemed)
0.00 Roll 1,680.00
(Onemed)
0.00 Roll 2,400.00
cm
0.00 Roll 660.80
(Onemed)
0.00 Tube 3,760.00
(Bufacetin)
0.00 Tablet 24.00
4 mg
Botol 60
ml
0.00 MgS04 20% Vial 3,200.00
0.00 Ampul 1,069.00
mg/ml
0.00 Tablet 245.00
0,125 mg
Botol 500
ml
Botol 500
ml
0.00 Paket 1,319,900.00
Kategori 2
Botol 15
ml
Botol 15
ml
0.00 Tablet 72.00
mg HCl
0.00 Tablet 141.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0.00 Ampul 1,226.00
500 mcg
0.00 Tablet 44.00
mg
0.00 Silk 3/0 Psc 53,064.00
0.00 Tablet 91.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 8,140.00
ml
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 6,500.00
ml
0.00 0


0.00 Kasa 16 x 16 Roll 4,114.00
0.00 Pcs 46,959.00
(Otot)
0.00 Roll 55,030.80
(Kulit)
0.00 Pcs 49,491.20
(Kulit)

0.00 Pcs 2,132.90
Kehamilan
0.00 Box 24,640.00
plus
0.00 Box 31,165.00
plus
0.00 Pcs 38,119.40
(Kulit)
0.00 Pcs 8,960.00
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0.00 Pcs 7,146.67
35 mm
0.00 Pcs 7,146.67
35 mm
Botol
0.00 Etanol 70 % 28,567.00
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0.00 Silk 3/0 pcs 7,647.20
0.00 0

ROKOK
0.00 Catgut 3/0 Pcs 63,103.00
0.00 0

0.00 Masker N95 Pcs 66,000.00
0.00 Psg 55,000.00
Steril
0.00 0

RECOFUS
0.00 Kit 1,878,709.68
Swab) 2 ml
0 0 0.00
0.00 0
0.00 0
.
.
.
.
_____________________ _________________________________ __________________________
.
. KEPADA : 0
. NO. BAP : 24
.
JUMLAH SUMBER
PEMBERIAN DANA

0 0.00 Botol
Reagents
0 0.00 Botol
Reagents
0 0.00 Botol
Reagents

Botol/25
Strip
Kotak/50
pcs
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy

0 0.00 Tablet
salut 10 mg
0 0.00 Ampul
mg/ 1 ml
0 0.00 Sachet
untuk 200 ml
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
0 0.00 Tablet
(Dewasa)
Botol 60
ml
0 0.00
humasens) strip

0 0.00 Ampul
mg - ml
Tube 10
gr
Botol 500
ml
0 0.00 Botol
Syrup)
0 0.00 Tablet
mg
0 0.00 Tablet
mg
0 0.00 Tablet
mg

0.00 0


0 0.00 DHP Tablet
0 0.00 Tablet
(HCl)


0 0.00 Vial
Globuline
0.00 0

0 0.00 Psc

0 0.00 Botol
5 ml
0 0.00 Botol
ml



Botol/500
0 0.00 Asering
ml

0 0.00 Tube
kulit)
0 0.00 Ampul
1 ml

0 0.00 Tube
(Stesolid Rektal)
0 0.00 Tube
(Stesolid Rektal)
0 0.00 Ampul
mg/ml
0 0.00 Ampul
mg/ml
0 0.00 Ampul
ml
Botol100
ml

0 0.00 Pcs
(Aximed)
0 0.00 Pcs
(Aximed)
Botol 100
0 0.00 Fenobarbital
ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ml
0 0.00 Tablet
gula 10 mg
0 0.00 Tablet
gula 10 mg
0 0.00 Pcs
(urocare)
Botol 500
ml
0 0.00 Kotak
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0 0.00 Tablet
(Scopamin)

0 0.00 Pcs
(Steracath)
0 0.00 Pcs
(Steracath)

0 0.00 Tablet
mg
Bungkus/
1 kg
0 0.00 Roll
(Onemed)
0 0.00 Roll
(Onemed)
0 0.00 Roll
cm
0 0.00 Roll
(Onemed)
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
Botol 60
ml
0 0.00 MgS04 20% Vial
0 0.00 Ampul
mg/ml
0 0.00 Tablet
0,125 mg
Botol 500
ml
Botol 500
ml
0 0.00 Paket
Kategori 2
Botol 15
ml
Botol 15
ml
0 0.00 Tablet
mg HCl
0 0.00 Tablet
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0 0.00 Ampul
500 mcg
0 0.00 Tablet
mg
0 0.00 Silk 3/0 Psc
0 0.00 Tablet
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
ml
Botol 60
ml
0.00 0


0 0.00 Kasa 16 x 16 Roll
0 0.00 Pcs
(Otot)
0 0.00 Roll
(Kulit)
0 0.00 Pcs
(Kulit)

0 0.00 Pcs
Kehamilan
0 0.00 Box
plus
0 0.00 Box
plus
0 0.00 Pcs
(Kulit)
0 0.00 Pcs
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0 0.00 Pcs
35 mm
0 0.00 Pcs
35 mm
Botol
0 0.00 Etanol 70 %
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0 0.00 Silk 3/0 pcs
0.00 0

ROKOK
0.00 0

0 0.00 Psg
Steril
0.00 0

RECOFUS
0 0.00 Kit
Swab) 2 ml
0 0 0
0.00 0
0.00 0
..
.
.
.
_______________________________ _________________________________
BMHP YANG DIKELUARKAN NAMA OBAT DAN BMHP YANG DIKELU
.
. KEPADA : 0
. NO. BAP : 25
.
JUMLAH SUMBER
HARGA TOTAL HARGA NO NAMA OBAT
PEMBERIAN DANA
90.00 0 0.00 DAU Allopurinol tablet 100 mg

16,500.00 0 0.00 Abon AMP (Amphetamine)
160.00 0 0.00 Ambroxol
224.40 0 0.00 Ambroxol tablet
160.00 0 0.00 Aminofillin 200 mg
74.00 0 0.00 Amlodipin 10 mg
55.00 0 0.00 Amlodipin 5 mg
251.00 0 0.00 Acyclofir 200 mg
3,625.00 0 0.00 Acyclofir cr
37,638.70 0 0.00 Alkohol 70%
14,490.00 0 0.00 Alkohol swab
1,102.20 0 0.00 Alat Suntik 3 ml (cosmomed)
123.00 0 0.00 Amitriptilin tablet salut 25 mg
78.00 0 0.00 Antasida tab
75,020.00 0 0.00
Reagents
75,020.00 0 0.00
Reagents
101,761.00 0 0.00
Reagents
125,477.00 0 0.00 Anti D Duocloral Monocloral
3,260.00 0 0.00 Antihemoroid
122.00 0 0.00 Asam mefenamat

276,891.50 0 0.00 Asam Urat Test Strip
1,536.70 0 0.00 Becefort

10,890.00 0 0.00 BD Gard Kapsul
138.00 0 0.00 Blood Lancet
108,324.00 0 0.00 Bioplacenton Tulle
25,283.92 0 0.00 Benecheck Strip Cholesterol
6,689.54 0 0.00 Benecheck Strip Uric Acid
3,206.20 0 0.00 Benecheck Strip Glucose
75.00 0 0.00 Captopril tab 25 mg
2,215.00 0 0.00 Cetrisyn sirup 5 mg/5 ml
132,000.00 0 0.00 Dengue test NS1
109.00 0 0.00 Dimenhidrinat 50 mg
69,000.00 0 0.00 Face Mask Ear Loop
3,300.00 0 0.00 Fenol Gliserol

26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00
Paratiphy
26,784.00 0 0.00 Fokus febrile Antigen H Paratiphy

690.00 0 0.00
salut 10 mg
4,236.00 0 0.00
mg/ 1 ml
2,178.00 0 0.00 Fit D3 1000
36,696.00 0 0.00 Foley Catheter 2 Way FR No.18
28.75 0 0.00 Gliceril guaiacolat tab 100 mg
96.00 0 0.00 Glimepirid tab 1 mg
317.00 0 0.00
untuk 200 ml
5,720.00 0 0.00 Glukosa Larutan Infus 5%
302,000.00 0 0.00 Hipafix 15 cm x 5 m
814,009.50 0 0.00 Human Humasens Plus
3,333.00 0 0.00 Infusion set Anak
8,867.00 0 0.00 Infusion set dewasa
3,360.00 0 0.00
(Bufacetin)
20.55 0 0.00
4 mg
152.00 0 0.00
(Dewasa)
2,298.00 0 0.00 Kotrimoksazol syr
Kolestrol test strip (Human

547,319.00 0 0.00
humasens)
3,113.05 0 0.00 Lidokain inj 2% com (pehacain inj)
41,600.00 0 0.00 Lidokain gel 2%

177,216.00 0 0.00 Lidokain spray oral 10%
118.50 0 0.00 Metformin tablet 500 mg
3,712.00 0 0.00
mg - ml
3,150.00 0 0.00 Mikonazol krim/salep 2% (Nitrat)
109.00 0 0.00 Natrium Diklofenak 50 mg
6,900.00 0 0.00 Natrium Klorida larutan infus steril
869.00 0 0.00 Nistatin Tab Salut 500.000UI

14,273.00 0 0.00
Syrup)
3,450.00 0 0.00 Obat batuk Hitam (OBH)
129.00 0 0.00 Omeprazole kaps 20 mg
180.90 0 0.00 Papaverin tablet 40 mg
1,535.00 0 0.00 Parasetamol syrup 120 mg/5 ml
88.21 0 0.00 Phenylbutazon tablet 200 mg
18.95 0 0.00
mg
26.35 0 0.00
mg
318.00 0 0.00
mg
5,291.00 0 0.00 Pitogin inj
35,532.00 0 0.00 Plester ( Leucoplast 3 x 5 )
1,027.95 0 0.00 Pritavit Kaplet
7,703.00 0 0.00 Ringer laktat larutan infus steril
1,475.00 0 0.00 Salep 24
85.00 0 0.00 Ranitidin tablet
495.00 0 0.00 Sarung Tangan M
495.00 0 0.00 Sarung Tangan S
3,630.00 0 0.00 Sarung Tangan Steril No. 7,5
3,630.00 0 0.00 Sarung Tangan Steril No. 7
57.55 0 0.00 Thiamin HCl (Vit.B1) tablet 50 mg
8,970.00 0 0.00 Underpad 60x90 cm ( Cosmomed )
4,488.00 0 0.00 Urine bag

521.00 0 0.00 Zinc tablet dispersible 20 mg
0.00 0
1,240.00 0 0.00 P2PL Alat suntik sekali pakai 0,05 ml

1,583.00 0 0.00 Alat suntik 5 ml
4,600.00 0 0.00 Albendazol Suspensi 200 mg/5 ml
380.00 0 0.00 Albendazol tablet 400 mg

242.00 0 0.00 Alkohol swab
1,121.00 0 0.00 Clozapine
2,134.00 0 0.00 DHP
490.00 0 0.00 Handscoun L
48,999.50 0 0.00 Handscoun L
147.00 0 0.00
(HCl)
2,272.00 0 0.00 Pot Sputum
2,950.00 0 0.00 Pot Dahak
2,000.00 0 0.00 Pot Dahak Non steril
242.00 0 0.00 Primaquin 15 mg
285,339.00 0 0.00 Obat FDC Kategori Anak
1,592,731.00 0 0.00 Obat FDC Kategori 2
11,975.00 0 0.00 Rapid 1 HIV (SD)
9,300.00 0 0.00 Rapid test Syphilis (Trepocheck)

33,334.00 0 0.00 Rapid test Tifoid
287.00 0 0.00 Risperidone
4,260.00 0 0.00 RPR Focus
14,340.00 0 0.00 SD HIV 19
153,000.00 0 0.00 Vaksin VAR
91.00 0 0.00 Triheksifenidil 2 mg tab
61,996.00 0 0.00 Vaksin BCG
28,204.00 0 0.00 Vaksin Campak
78,991.00 0 0.00 Vaksin DPT HB HiB
17,996.00 0 0.00 Vaksin DT
158,994.00 0 0.00 Vaksin IPV
1,325,000.00 0 0.00 Vaksin Immuno Globuline
135,000.00 0 0.00 Vaksin Meningitis
23,991.00 0 0.00 Vaksin HB Uniject (HB 0)
23,991.00 0 0.00 Vaksin HB Rekombinasi (HB-Pid)
155,813.00 0 0.00 Vaksin MR

19,954.00 0 0.00 Vaksin Polio Oral (OPV)
16,995.00 0 0.00 Vaksin TD
1,325,000.00 0 0.00
Globuline
604.00 0 0.00 Zinc Tablet 20 mg
0.00 0
728.00 0 0.00 DAK Alat suntik sekali pakai 1 ml

1,125.85 0 0.00
840.00 0 0.00 Alat suntik 5 cc (Stera)
11,200.00 0 0.00 Alkohol Swab (Onemed)
25,155.00 0 0.00 Alkohol 70 % 1 L (onemed)
27,500.00 0 0.00 Alkohol 70 % 1 L (onemed)
105.00 0 0.00 Allopurinol tab 100 mg
99.00 0 0.00 Allopurinol tablet 100 mg
2,860.00 0 0.00 Air untuk injeksi amp 25 ml
86.00 0 0.00 Aminofilin 200 mg
123.00 0 0.00 Amitriptyline tablet salut 25 mg
908.00 0 0.00 Acetylcystein kapsul 200 mg

74.00 0 0.00 Amlodipin tab 10 mg
360.00 0 0.00 Amoksisilin kaplet 500 mg
2,560.00 0 0.00
5 ml
3,846.00 0 0.00
ml
3,510.00 0 0.00 Amoksisillin sirup DS 250 mg/ 5 ml
88,678.66 0 0.00 Anios Gel 85


5,170.00 0 0.00 Antifungi Salep Kulit

175.00 0 0.00 Attapulgit 630 mg (Puralex)
9,646.00 0 0.00 Asering
149.00 0 0.00 Attapulgit
1,515.00 0 0.00 Betametason krim 0,1%
1,520.00 0 0.00 Betametasone krim 0,1 %

337.00 0 0.00 Bisakodil Tablet 5 mg
3,585.00 0 0.00
kulit)
75.00 0 0.00 Captopril 25 mg
64,191.00 0 0.00 Catgut 3/0
3,061.00 0 0.00 Cetrisyn sirup
2,298.84 0 0.00 Dermafix
1,210.00 0 0.00
1 ml
18,000.00 0 0.00 Disposable safety box 5 liter
90.00 0 0.00 Domperidon Tablet 10 mg
2,862.00 0 0.00 Domperidone suspensi 5 mg/5 ml
70.00 0 0.00 Diazepam tablet 2 mg

1,545.00 0 0.00 Diazepam inj 5 mg/ml
14,459.00 0 0.00
(Stesolid Rektal)
21,021.00 0 0.00
(Stesolid Rektal)
825.00 0 0.00
mg/ml
309.00 0 0.00 Doxycycline 100 mg
766.00 0 0.00 Eritromisin 500 mg
2,354.00 0 0.00
mg/ml
1,518.00 0 0.00
ml
115,500.00 0 0.00 Etil Klorida Semprot
508.20 0 0.00 Examination gloves size L (Aximed)

508.20 0 0.00
(Aximed)
508.20 0 0.00
(Aximed)
7,010.00 0 0.00 Fenobarbital
177.00 0 0.00 Fenobarbital Tablet

3,754.00 0 0.00
mg/ 1 ml
4,083.00 0 0.00
mg/ 1 ml
4,236.00 0 0.00
mg/ml
873.00 0 0.00
gula 10 mg
781.00 0 0.00
gula 10 mg
8,960.00 0 0.00
(urocare)
606,900.00 0 0.00 Glass ionomer ART
274.00 0 0.00 Garam oralit kombinasi

297.00 0 0.00 Glimepirid tablet 2 mg
14,600.30 0 0.00
(Guaifenesin)
228.00 0 0.00 Gliseril Gualakolat tablet 100 mg

322,190.00 0 0.00 Gelatine sponge
76.00 0 0.00 Haloperidol 1,5 mg

90.00 0 0.00 Haloperidol 2 mg (lodomer)
60.00 0 0.00 Haloperidol 5 mg
8,487.66 0 0.00 Handschoen No. 6,5 steril
2,329.80 0 0.00
(Scopamin)
6,930.00 0 0.00 Infusion set Anak(PKD 2)

5,280.00 0 0.00 Infuset dewasa (Aximed)
13,200.00 0 0.00 Introcan No.22
13,750.00 0 0.00 Introcan No.24
93.00 0 0.00 Isosorbid Dinitrate 5 mg
4,256.00 0 0.00
(Steracath)
4,256.00 0 0.00
(Steracath)
8,070.70 0 0.00 IV Catheter 20G x 1 1/4 (Nipro)
4,256.00 0 0.00 IV Catheter 22G x 1 (Steracath)
4,256.00 0 0.00 IV Catheter 24G x 3/4 (Steracath)

60.00 0 0.00
mg
60,830.00 0 0.00 Kapas pembalut
1,700.00 0 0.00 Kasa kompres 40x40

8,624.00 0 0.00 Kasa 2 m x 80 cm (Onemed)
840.00 0 0.00
(Onemed)
1,680.00 0 0.00
(Onemed)
2,400.00 0 0.00
cm
660.80 0 0.00
(Onemed)
3,760.00 0 0.00
(Bufacetin)
2,013.00 0 0.00 Kloramfenikol salep mata 1%
24.00 0 0.00
4 mg
26.27 0 0.00 klorfeniramini maleat (CTM)
2,052.00 0 0.00 Kotrimoksazol suspensi

125.00 0 0.00 Kotrimoksaxol dewasa 480 mg
97.00 0 0.00 Loperamid tablet 2 mg
127.00 0 0.00 Loratadine
847.00 0 0.00 Lidokain Injeksi Comp
47,970.00 0 0.00 Lysol 1 liter (onemed)
1,405.00 0 0.00 Lidokain injeksi Comp
31,165.00 0 0.00 Masker Tali
77.00 0 0.00 Metformin Tablet
1,900.00 0 0.00 Miconazole Salep Kulit
3,926.00 0 0.00 Mikonazole salep 2 %
3,200.00 0 0.00 MgS04 20%
1,069.00 0 0.00
mg/ml
245.00 0 0.00
0,125 mg
100.00 0 0.00 Metokloperamide tablet
2,750.00 0 0.00 Metokloperamide syr (Lexapram)
136.00 0 0.00 Natrium diklofenak tablet

645.00 0 0.00 Nistatin 100.000 IU
910.00 0 0.00 Nistatin 500.000 IU
5,650.00 0 0.00 Onoiwa
1,319,900.00 0 0.00
Kategori 2
129.00 0 0.00 Omeprazol kaps 20 mg
1,160.00 0 0.00 Parasetamol sirup
5,720.00 0 0.00 Parasetamol drops 100 mg/ml
5,980.00 0 0.00 Parsetamol drops 100 mg/ml

72.00 0 0.00
mg HCl
141.00 0 0.00
mg HCl
80.00 0 0.00 Propanolol 10 mg tab
50,600.00 0 0.00 Plester 3 x 5 H leukoplast
3,190.00 0 0.00 Povidone Iodine 30 ml (Onemed)
25,215.00 0 0.00 Povidone Iodine 100 mg/ml
318.00 0 0.00 Pyrantel pamoat

114.00 0 0.00 Ranitidin tablet 150 mg

2,983.50 0 0.00 Rivanol 300 cc (onemed)
22,000.00 0 0.00 Sarung tangan obgyn steril
67.00 0 0.00 Salbutamol tablet 4 mg
5,463.00 0 0.00 Salbutamol syr

1,226.00 0 0.00
500 mcg
44.00 0 0.00
mg
53,064.00 0 0.00 Silk 3/0
281.00 0 0.00 Siprofloxacin Tablet 500 mg
12,749.00 0 0.00 Stesolid rektal 5 mg
91.00 0 0.00
tablet 50 mg
255,000.00 0 0.00 Test trip kolestrol
195,000.00 0 0.00 Test trip asam urat

135.00 0 0.00 Vitamin B Kompleks tablet
604.00 0 0.00 Zink tablet dispersible 20 mg
8,140.00 0 0.00 Zink syrup 20 mg/ 5 ml
6,500.00 0 0.00 Zink syrup 20 mg/ 5 ml
3,285.00 0 0.00 Zink syrup 20 mg/ 5 ml
0.00 0
1,004.85 0 0.00 BMHP E- Alat Suntik 1 cc (Nipro)

924.00 0 0.00 CAT DAK Alat Suntik 3 cc (Abada)
887.70 0 0.00 Alat Suntik 3 cc (Abada)
924.00 0 0.00 Alat Suntik 3 cc (Nipro)
395,384.74 0 0.00 Chlodine 0,5%
16,401.00 0 0.00 Blood Lancet (Ekomed)

1,740.20 0 0.00 Handscoon Non Steril S
11,808.50 0 0.00 Handscoon Steril No. 7
11,808.50 0 0.00 Handscoon Steril No. 7,5
8,547.00 0 0.00 Infus set dewasa
5,566.00 0 0.00 Infus set anak (Abada)
6,527.40 0 0.00 Infus set dewasa (Ekomed)
6,455.90 0 0.00 IV Catheter 24G (Abada)
4,114.00 0 0.00 Kasa 16 x 16
143,022.00 0 0.00 Kasa hidrofil 40x80
7,502.00 0 0.00 Nasal O2 Canula Adult
7,502.00 0 0.00 Nasal O2 Canula Child
7,502.00 0 0.00 Nasal O2 Canula Neonatus
16,032.50 0 0.00 Nebulizer Mask Adult
16,032.50 0 0.00 Nebulizer Mask Pediatric
4,983.00 0 0.00 Oxygen nasal Canula anak
4,983.00 0 0.00 Oxygen nasal Canula dewasa
11,656.00 0 0.00 Oxygen Mask Anak
11,656.00 0 0.00 Oxygen Mask Dewasa
46,959.00 0 0.00
(Otot)
55,030.80 0 0.00
(Kulit)
1,740.20 0 0.00 Examination gloves size M
1,740.20 0 0.00 Examination gloves size S
49,491.20 0 0.00
(Kulit)
21,060.00 0 0.00 Onemed Povidone Iodine 300 ml
2,983.50 0 0.00 Onemed Rivanol 300 cc

2,132.90 0 0.00
Kehamilan
24,640.00 0 0.00
plus
31,165.00 0 0.00
plus
38,119.40 0 0.00
(Kulit)
41,100.00 0 0.00 Polipix 5 cm x 5 m
728.00 0 0.00 Stera Syringe 3 cc
6,062.10 0 0.00 Urine Bag With Hanger
8,960.00 0 0.00
18
0.00 0
2,774.00 0 0.00 KESMAS Oksitetrasiklin 1 % Salep Mata
4,236.00 0 0.00 Fitomenadion (Vit.K) injeksi
2,920.00 0 0.00 Mineral Mix
3,796.00 0 0.00 Magnesium Sulfat Inj 40%
2,600.00 0 0.00 Oksitetrasiklin 1% Salep Mata
354.00 0 0.00 Vit A Bayi 100,000 IU ( biru )
297.00 0 0.00 Vit A Bayi 100,000 IU ( biru )
637.00 0 0.00 Vitamin Balita (merah)
0.00 0
KESGRA
832.00 0 0.00 Alat suntik sekali pakai 3 cc

9,332.40 0 0.00 Catgut/Benang bedah No.2/0
7,146.67 0 0.00
35 mm
7,146.67 0 0.00
35 mm
28,567.00 0 0.00 Etanol 70 %
114,967.60 0 0.00 Ethyl semprot

4,654.10 0 0.00 Handscoen No. 7 steril
4,654.10 0 0.00 Handscoen No. 7,5 steril
6,968.50 0 0.00 Infusion Anak (PKD 2)

4,096.00 0 0.00 Infusion set dewasa (20 drops/ml)
6,470.20 0 0.00 Infusion set dewasa (PKD 1)

7,424.00 0 0.00 Kasa hidrofil steril uk. 16 x 16
134,371.60 0 0.00 Kasa hidrofil 40 x 80
41,600.00 0 0.00 Safeglove Exam (M)
7,647.20 0 0.00 Silk 3/0
3,911.11 0 0.00 Silk 3/0 + jarum 1/2 GT 35 mm
832.00 0 0.00 Syringe disposible 3cc x 23 Gx11/2
0.00 0
55,000.00 0 0.00 DAU Cairan Pembersih Tangan

470.50 0 0.00 PAJAK Handscoon non steril L
ROKOK
470.50 0 0.00 Handscoon non steril S
464.64 0 0.00 Handscoon non steril L
3,300.00 0 0.00 Pot Dahak
63,103.00 0 0.00 Catgut 3/0
0.00 0
180,000.00 0 0.00 BTT Baju hazmat/ APD

66,000.00 0 0.00 Celemek Plastik
6,691.85 0 0.00 Efinefrin injeksi 1 mg
38,000.00 0 0.00 Faceshield anti droplet
66,000.00 0 0.00 Masker N95
100,000.00 0 0.00 Masker Tali
5,000.00 0 0.00 Nurse Cup
6,000.00 0 0.00 Onoiwa
70,000.00 0 0.00 Rapid antigen Covid-19
55,000.00 0 0.00
Steril
200,000.00 0 0.00 Sarung Tangan L
200,000.00 0 0.00 Sarung Tangan M
0.00 0
57,194.00 0 0.00 DAU Rapid test Antigen

RECOFUS
1,878,709.68 0 0.00
Swab) 2 ml
1,143,880.00 0 0.00 Corona Virus Ag Rapid Test
0.00 0
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
OBAT DAN BMHP YANG DIKELUARKAN NAMA OBAT DAN BMHP YA
.
. KEPADA :
. WAKTU :
. NO. BAP :
.
JUMLAH SUMBER
SATUAN HARGA TOTAL HARGA NO
PEMBERIAN DANA
Tablet 90.00 - 0.00 DAU

Test 16,500.00 - 0.00
Tablet 160.00 - 0.00
Tablet 224.40 - 0.00
Tablet 160.00 - 0.00
Tablet 74.00 - 0.00
Tablet 55.00 - 0.00
Tablet 251.00 - 0.00
Tube 3,625.00 - 0.00
Botol 37,638.70 - 0.00
100 pcs 14,490.00 - 0.00
Psc 1,102.20 - 0.00
Tablet 123.00 - 0.00
Tablet 78.00 - 0.00
Botol 75,020.00 - 0.00
Botol 75,020.00 - 0.00
Botol 101,761.00 - 0.00
Botol 125,477.00 - 0.00

Tablet 3,260.00 - 0.00
tablet 122.00 - 0.00
Tablet 46.00 - 0.00

Botol/25
276,891.50 - 0.00
Strip
Tablet 1,536.70 - 0.00
Tablet 10,890.00 - 0.00
Psc 138.00 - 0.00
Box 108,324.00 - 0.00
Pcs 25,283.92 - 0.00
Pcs 6,689.54 - 0.00
Pcs 3,206.20 - 0.00
Tablet 75.00 - 0.00
Botol 2,215.00 - 0.00
tablet 60.00 - 0.00
Tablet 260.00 - 0.00
Tablet 151.80 - 0.00
Test 132,000.00 - 0.00
Tablet 109.00 - 0.00
Tablet 75.00 - 0.00
Kotak/50
69,000.00 - 0.00
pcs
Botol 3,300.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Vial 26,784.00 - 0.00
Tablet 690.00 - 0.00
Ampul 4,236.00 - 0.00
Tablet 2,178.00 - 0.00

Pcs 36,696.00 - 0.00
Tablet 28.75 - 0.00
Tablet 96.00 - 0.00
Sachet 317.00 - 0.00
Botol 5,720.00 - 0.00

Tablet 210.00 - 0.00
Psg 11,432.00 - 0.00
Psg 3,630.00 - 0.00
Tablet 1,050.00 - 0.00
Roll 302,000.00 - 0.00
Unit 814,009.50 - 0.00
Tablet 123.17 - 0.00
Pcs 3,333.00 - 0.00
Pcs 8,867.00 - 0.00
Pcs 16,000.00 - 0.00
Pcs 16,000.00 - 0.00
Pcs 16,000.00 - 0.00
Tablet 260.00 - 0.00
Tube 3,360.00 - 0.00
Tablet 20.55 - 0.00
Tablet 152.00 - 0.00
Botol 60
2,298.00 - 0.00
ml
Dus/20
547,319.00 - 0.00
strip
Ampul 3,113.05 - 0.00
Tube 41,600.00 - 0.00

Botol 177,216.00 - 0.00
Tablet 118.50 - 0.00
Ampul 3,712.00 - 0.00
Tube 10
3,150.00 - 0.00
gr
Tablet 109.00 - 0.00
Botol 500
6,900.00 - 0.00
ml
Tablet 869.00 - 0.00
Botol 14,273.00 - 0.00
Botol 3,450.00 - 0.00

kapsul 129.00 - 0.00
Tablet 180.90 - 0.00
Botol 1,535.00 - 0.00
Tablet 60.00 - 0.00
Tablet 88.21 - 0.00
Tablet 18.95 - 0.00
Tablet 26.35 - 0.00
Tablet 318.00 - 0.00
Ampul 5,291.00 - 0.00

Roll 35,532.00 - 0.00
Tablet 105.88 - 0.00
Tablet 68.15 - 0.00
Kaplet 1,027.95 - 0.00
Botol 7,703.00 - 0.00
Tablet 1,475.00 - 0.00
Tablet 85.00 - 0.00
Pcs 495.00 - 0.00
Pcs 495.00 - 0.00
Pcs 3,630.00 - 0.00
Pcs 3,630.00 - 0.00
Tablet 73.00 - 0.00
kapsul 279.82 - 0.00
Tablet 57.55 - 0.00
Pcs 8,970.00 - 0.00
Pcs 4,488.00 - 0.00

Tablet 24.31 - 0.00
Tablet 521.00 - 0.00
0.00 0
Pcs 1,240.00 - 0.00 P2PL

Pcs 1,518.00 - 0.00
Pcs 1,583.00 - 0.00
Pcs 1,650.00 - 0.00
Botol 4,600.00 - 0.00
Tablet 380.00 - 0.00

Tablet 271.14 - 0.00
Tablet 494.00 - 0.00
pcs 242.00 - 0.00
Tablet 1,121.00 - 0.00
Tablet 2,134.00 - 0.00
Saccet 275.00 - 0.00
Pcs 490.00 - 0.00
Kotak 48,999.50 - 0.00
Tablet 147.00 - 0.00
Pcs 2,272.00 - 0.00

Pcs 2,950.00 - 0.00
pot 2,000.00 - 0.00
Tablet 242.00 - 0.00
Paket 285,339.00 - 0.00
Paket 477,791.00 - 0.00
Paket 1,592,731.00 - 0.00
Paket 447,791.00 - 0.00
Tes 11,975.00 - 0.00
Tes 9,300.00 - 0.00
Tes 9,878.00 - 0.00

Tes 33,334.00 - 0.00
Tes 8,300.00 - 0.00
Tablet 287.00 - 0.00
tes 4,260.00 - 0.00
Tes 14,340.00 - 0.00
Dus 153,000.00 - 0.00
Tablet 91.00 - 0.00
Vial 165,000.00 - 0.00
Vial 61,996.00 - 0.00
Vial 28,204.00 - 0.00
Vial 78,991.00 - 0.00
Vial 17,996.00 - 0.00
Vial 158,994.00 - 0.00
Vial 1,325,000.00 - 0.00
Vial 135,000.00 - 0.00
Uniject 23,991.00 - 0.00
Uniject 23,991.00 - 0.00
Vial 155,813.00 - 0.00

Vial 19,954.00 - 0.00
Vial 16,995.00 - 0.00
Vial 1,325,000.00 - 0.00

Tablet 604.00 - 0.00
0.00 0
Set 728.00 - 0.00 DAK
Psc 1,125.85 - 0.00
Psc 840.00 - 0.00

Box 11,200.00 - 0.00
Botol 25,155.00 - 0.00
Botol 27,500.00 - 0.00
Tablet 105.00 - 0.00
Tablet 99.00 - 0.00
Ampul 2,860.00 - 0.00
Tablet 86.00 - 0.00
Tablet 123.00 - 0.00
Kapsul 908.00 - 0.00

Tablet 55.00 - 0.00
Tablet 79.00 - 0.00
Tablet 74.00 - 0.00
Tablet 94.00 - 0.00
Tablet 265.00 - 0.00
Tablet 231.00 - 0.00
Tablet 248.00 - 0.00
Tablet 360.00 - 0.00
Botol 2,560.00 - 0.00
Botol 3,846.00 - 0.00
Botol 3,510.00 - 0.00
Botol 88,678.66 - 0.00

Botol 2,098.00 - 0.00
Botol 2,106.00 - 0.00
Botol 2,098.00 - 0.00
Tablet 60.00 - 0.00
Tablet 54.00 - 0.00
Tablet 120.00 - 0.00
Tablet 46.00 - 0.00

Tablet 117.00 - 0.00
Tablet 112.00 - 0.00
Tablet 103.00 - 0.00
Tube 5,170.00 - 0.00

Tablet 251.00 - 0.00
Tablet 175.00 - 0.00
Tablet 236.00 - 0.00
Tablet 425.00 - 0.00
Botol/500
9,646.00 - 0.00
ml
Tablet 149.00 - 0.00
Tube 5 gr 1,515.00 - 0.00
Tube 1,520.00 - 0.00

Tablet 337.00 - 0.00
Tube 3,585.00 - 0.00
Tablet 82.00 - 0.00

Tablet 75.00 - 0.00
Pcs 64,191.00 - 0.00
Tablet 298.00 - 0.00
botol 3,061.00 - 0.00
Bliste 2,298.84 - 0.00
Ampul 1,210.00 - 0.00
Tablet 34.00 - 0.00

Buah 18,000.00 - 0.00
Tablet 75.00 - 0.00
Tablet 90.00 - 0.00
Botol 2,862.00 - 0.00
Tablet 70.00 - 0.00

Vial 1,545.00 - 0.00
Tube 14,459.00 - 0.00
Tube 21,021.00 - 0.00
Ampul 825.00 - 0.00
Tablet 309.00 - 0.00

Kapsul 766.00 - 0.00
Ampul 2,354.00 - 0.00
Ampul 1,518.00 - 0.00
Botol100
115,500.00 - 0.00
ml
Pcs 508.20 - 0.00
Pcs 508.20 - 0.00
Pcs 508.20 - 0.00
Botol 100
7,010.00 - 0.00
ml
Tablet 177.00 - 0.00
Ampul 3,754.00 - 0.00
Ampul 4,083.00 - 0.00
Ampul 4,236.00 - 0.00
Tablet 873.00 - 0.00
Tablet 781.00 - 0.00
Pcs 8,960.00 - 0.00
Tablet 88.00 - 0.00

Tablet 84.00 - 0.00
Buah 606,900.00 - 0.00
Sachet 317.00 - 0.00
Sachet 274.00 - 0.00
Botol 500
5,720.00 - 0.00
ml
Botol 6,900.00 - 0.00
Tablet 297.00 - 0.00
Kotak 14,600.30 - 0.00
Tablet 228.00 - 0.00
Tablet 241.00 - 0.00

Tablet 238.00 - 0.00
Kotak/25
137,500.00 - 0.00
strip
Strip 7,084.00 - 0.00
Kotak 60
322,190.00 - 0.00
spons
Tablet 76.00 - 0.00
Tablet 90.00 - 0.00
Tablet 60.00 - 0.00
psg 8,487.66 - 0.00
Tube 2,648.00 - 0.00
Tube 2,812.00 - 0.00
Tablet 2,329.80 - 0.00
Tablet 1,050.00 - 0.00

Tablet 125.79 - 0.00
Botol 2,560.00 - 0.00
Botol 3,849.00 - 0.00
Set 6,930.00 - 0.00

Pcs 5,280.00 - 0.00
Pcs 13,200.00 - 0.00
Pcs 13,750.00 - 0.00
Tablet 93.00 - 0.00
Pcs 4,256.00 - 0.00
Pcs 4,256.00 - 0.00
Pcs 8,070.70 - 0.00

Pcs 4,256.00 - 0.00
Pcs 4,256.00 - 0.00
Tablet 60.00 - 0.00
Bungkus/
60,830.00 - 0.00
1 kg
Pcs 1,700.00 - 0.00
Roll 8,624.00 - 0.00
Roll 840.00 - 0.00
Roll 1,680.00 - 0.00

Roll 2,400.00 - 0.00
Roll 660.80 - 0.00
Tablet 305.00 - 0.00
Tube 3,760.00 - 0.00
Tube 2,013.00 - 0.00
Tablet 24.00 - 0.00
Tablet 26.27 - 0.00

Botol 60
2,052.00 - 0.00
ml
Tablet 126.00 - 0.00
Tablet 152.00 - 0.00
Tablet 125.00 - 0.00
Tablet 97.00 - 0.00
Tablet 127.00 - 0.00
Ampul 847.00 - 0.00
Botol 47,970.00 - 0.00
Ampul 1,405.00 - 0.00
Box 31,165.00 - 0.00
Tablet 77.00 - 0.00
Tube 1,900.00 - 0.00
Tube 3,926.00 - 0.00
Vial 3,200.00 - 0.00
Ampul 1,069.00 - 0.00
Tablet 245.00 - 0.00
Tablet 100.00 - 0.00
Botol 2,750.00 - 0.00
Botol 500
6,840.00 - 0.00
ml
Botol 500
6,410.00 - 0.00
ml
Tablet 136.00 - 0.00
Tablet 127.00 - 0.00
Tablet 123.00 - 0.00
Tablet 645.00 - 0.00
Tablet 910.00 - 0.00
Kaplet 5,650.00 - 0.00
Paket 1,319,900.00 - 0.00
Ampul 1,348.00 - 0.00

Kapsul 129.00 - 0.00
Botol 4,950.00 - 0.00
Botol 1,013.00 - 0.00
Botol 1,160.00 - 0.00
Tablet 162.80 - 0.00
Tablet 186.78 - 0.00
Tablet 60.00 - 0.00
Botol 15
5,720.00 - 0.00
ml
Botol 15
5,980.00 - 0.00
ml
Tablet 72.00 - 0.00
Tablet 141.00 - 0.00
Tablet 79.00 - 0.00

Tablet 73.00 - 0.00
Tablet 80.00 - 0.00
Roll 50,600.00 - 0.00
Botol 3,190.00 - 0.00
Botol 60
25,215.00 - 0.00
ml
Tablet 318.00 - 0.00
botol 7,630.00 - 0.00
Botol 500
7,150.00 - 0.00
ml
Tablet 114.00 - 0.00
Botol 2,983.50 - 0.00
Psg 22,000.00 - 0.00
Tablet 150.00 - 0.00
Tablet 252.00 - 0.00
Tablet 67.00 - 0.00
Botol 5,463.00 - 0.00
Pot 30
2,200.00 - 0.00
gram
Pot 3,017.00 - 0.00
Ampul 1,226.00 - 0.00

Tablet 44.00 - 0.00
Psc 53,064.00 - 0.00

Tablet 281.00 - 0.00
Tube 12,749.00 - 0.00
Tablet 409.00 - 0.00
Tablet 91.00 - 0.00
Kapsul 174.00 - 0.00

Kapsul 329.00 - 0.00
kapsul 279.82 - 0.00
kotak/10
255,000.00 - 0.00
strip
Kotak/25
195,000.00 - 0.00
strip
Tablet 144.00 - 0.00
Vial 165,000.00 - 0.00
Tablet 135.00 - 0.00
Tablet 604.00 - 0.00
Botol 60
8,140.00 - 0.00
ml
Botol 60
6,500.00 - 0.00
ml
Botol 3,285.00 - 0.00
0.00 0
Pcs 1,004.85 - 0.00 BMHP E-

Pcs 924.00 - 0.00 CAT DAK
Pcs 887.70 - 0.00
Pcs 924.00 - 0.00
Jergen 5 L 395,384.74 - 0.00
Kotak 16,401.00 - 0.00

Pcs 11,945.23 - 0.00
Pcs 11,945.23 - 0.00
Pcs 1,740.20 - 0.00
Pasang 11,808.50 - 0.00
Pasang 11,808.50 - 0.00
Pcs 5,827.80 - 0.00
Pcs 5,827.00 - 0.00
Pcs 5,827.00 - 0.00
Psg 5,827.00 - 0.00
Pcs 8,547.00 - 0.00
Pcs 5,566.00 - 0.00
Pcs 6,527.40 - 0.00
Pcs 6,455.90 - 0.00
Roll 6,455.90 - 0.00
Roll 4,114.00 - 0.00
Roll 143,022.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 7,502.00 - 0.00
Pcs 16,032.50 - 0.00
Pcs 16,032.50 - 0.00
Pcs 4,983.00 - 0.00
Pcs 4,983.00 - 0.00
Pcs 11,656.00 - 0.00
Pcs 11,656.00 - 0.00
Pcs 46,959.00 - 0.00
Roll 55,030.80 - 0.00
Roll 1,740.20 - 0.00

Box 1,740.20 - 0.00
Pcs 49,491.20 - 0.00
Botol 21,060.00 - 0.00
Botol 2,983.50 - 0.00
Pcs 2,132.90 - 0.00
Box 24,640.00 - 0.00
Box 31,165.00 - 0.00
Pcs 38,119.40 - 0.00
Roll 41,100.00 - 0.00

Pcs 728.00 - 0.00
Pcs 6,062.10 - 0.00
Pcs 8,960.00 - 0.00
0.00 0
Tube 2,774.00 - 0.00 KESMAS
Ampul 4,236.00 - 0.00
sachet 2,920.00 - 0.00
Vial 3,796.00 - 0.00
Tube 2,600.00 - 0.00
Ampul 1,232.00 - 0.00
Ampul 1,199.00 - 0.00
Tablet 409.00 - 0.00
Tablet 255.00 - 0.00
Kapsul 354.00 - 0.00
Kapsul 297.00 - 0.00
Kapsul 637.00 - 0.00
0.00 0
kotak/ KESGRA
118,973.00 - 0.00
100 set
Pcs 832.00 - 0.00
pcs 1,137.40 - 0.00
Pcs 9,332.40 - 0.00
Pcs 7,146.67 - 0.00
Pcs 7,146.67 - 0.00
Botol
28,567.00 - 0.00
1000 ml
Botol 100
114,967.60 - 0.00
ml
Set 9,794.40 - 0.00
Set 9,794.40 - 0.00
Pairs 4,654.10 - 0.00
Pairs 4,654.10 - 0.00
Set/
6,968.50 - 0.00
Kantong
Pcs 4,480.00 - 0.00
Pcs 4,480.00 - 0.00
Pcs 4,096.00 - 0.00
Set/
6,470.20 - 0.00
Kantong
Roll 960.00 - 0.00
Roll 665.50 - 0.00
Box/16 7,424.00 - 0.00
roll 134,371.60 - 0.00
Box/100 41,600.00 - 0.00
pcs 7,647.20 - 0.00
Pcs 3,911.11 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 4,864.00 - 0.00
Pcs 832.00 - 0.00
0.00 0
Botol 55,000.00 - 0.00 DAU

Pcs 470.50 - 0.00 PAJAK
ROKOK
Pcs 470.50 - 0.00
Pcs 470.50 - 0.00
Pcs 464.64 - 0.00
Pcs 464.64 - 0.00
Pcs 5,775.00 - 0.00
Pcs 3,300.00 - 0.00
Pcs 63,103.00 - 0.00
-
0.00 0
Pcs 180,000.00 - 0.00 BTT

Pcs 66,000.00 - 0.00
Ampul 6,691.85 - 0.00
Pcs 38,000.00 - 0.00
Psg 12,000.00 - 0.00
Psg 12,000.00 - 0.00
Pcs 66,000.00 - 0.00
Box 100,000.00 - 0.00
Pcs 5,000.00 - 0.00
tablet 6,000.00 - 0.00
Pcs 70,000.00 - 0.00
Psg 55,000.00 - 0.00
Box/100 200,000.00 - 0.00

Box/100 200,000.00 - 0.00
0.00 0
Test 57,194.00 - 0.00 DAU

RECOFUS
Kit 1,878,709.68 - 0.00 ING
Kotak 1,143,880.00 - 0.00

0 0.00
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
.
0 .
Sabtu,30 Desember 1899 .
16 .
.
JUMLAH
NAMA OBAT SATUAN HARGA TOTAL HARGA
PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
0.00
Alat suntik sekali pakai 1 ml Set 728.00 0 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
0.00
Alat Suntik 1 cc (Nipro) Pcs 1,004.85 0 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
0.00
Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 0 0.00
0.00
kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
0.00
Cairan Pembersih Tangan Botol 55,000.00 0 0.00

Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
0.00
Baju hazmat/ APD Pcs 180,000.00 0 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
0.00
Rapid test Antigen Test 57,194.00 0 0.00

VTM (Transport Medium Dacron
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
0.00
0.00
.
.
.
.
_________________________________ _______________________________
.
KEPADA : 0 .
NO. BAP : 17 .
.
SUMBER JUMLAH
DANA PEMBERIAN

Alkohol 70% Botol 37,638.70 0 0.00
Alkohol swab 100 pcs 14,490.00 0 0.00
Botol 75,020.00 0 0.00
Reagents
Botol 75,020.00 0 0.00
Reagents
Botol 101,761.00 0 0.00
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy
Vial 26,784.00 0 0.00
Paratiphy

Tablet 690.00 0 0.00
salut 10 mg
Ampul 4,236.00 0 0.00
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0 0.00
Sachet 317.00 0 0.00
untuk 200 ml
Tube 3,360.00 0 0.00
(Bufacetin)
Tablet 20.55 0 0.00
4 mg
Tablet 152.00 0 0.00
(Dewasa)
Botol 60
ml
547,319.00 0 0.00
humasens) strip

Ampul 3,712.00 0 0.00
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0 0.00
Syrup)
Tablet 18.95 0 0.00
mg
Tablet 26.35 0 0.00
mg
Tablet 318.00 0 0.00
mg
Salep 24 Tablet 1,475.00 0 0.00
Urine bag Pcs 4,488.00 0 0.00

0 0.00


DHP Tablet 2,134.00 0 0.00
Tablet 147.00 0 0.00
(HCl)
Pot Dahak Pcs 2,950.00 0 0.00
Rapid 1 HIV (SD) Tes 11,975.00 0 0.00

RPR Focus tes 4,260.00 0 0.00
SD HIV 19 Tes 14,340.00 0 0.00
Vaksin VAR Dus 153,000.00 0 0.00
Vaksin DT Vial 17,996.00 0 0.00
Vaksin IPV Vial 158,994.00 0 0.00
Vaksin MR Vial 155,813.00 0 0.00

Vaksin TD Vial 16,995.00 0 0.00
Vial 1,325,000.00 0 0.00
Globuline
0 0.00

Psc 1,125.85 0 0.00

Botol 2,560.00 0 0.00
5 ml
Botol 3,846.00 0 0.00
ml
Anios Gel 85 Botol 88,678.66 0 0.00



Botol/500
Asering 9,646.00 0 0.00
ml

Tube 3,585.00 0 0.00
kulit)
Catgut 3/0 Pcs 64,191.00 0 0.00
Ampul 1,210.00 0 0.00
1 ml

Tube 14,459.00 0 0.00
(Stesolid Rektal)
Tube 21,021.00 0 0.00
(Stesolid Rektal)
Ampul 825.00 0 0.00
mg/ml
Ampul 2,354.00 0 0.00
mg/ml
Ampul 1,518.00 0 0.00
ml
Botol100
ml

Pcs 508.20 0 0.00
(Aximed)
Pcs 508.20 0 0.00
(Aximed)
Botol 100
ml
Ampul 3,754.00 0 0.00
mg/ 1 ml
Ampul 4,083.00 0 0.00
mg/ 1 ml
Ampul 4,236.00 0 0.00
mg/ml
Tablet 873.00 0 0.00
gula 10 mg
Tablet 781.00 0 0.00
gula 10 mg
Pcs 8,960.00 0 0.00
(urocare)
Botol 500
ml
Kotak 14,600.30 0 0.00
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0 0.00
(Scopamin)

Introcan No.22 Pcs 13,200.00 0 0.00
Introcan No.24 Pcs 13,750.00 0 0.00
Pcs 4,256.00 0 0.00
(Steracath)
Pcs 4,256.00 0 0.00
(Steracath)

Tablet 60.00 0 0.00
mg
Bungkus/
1 kg
Roll 840.00 0 0.00
(Onemed)
Roll 1,680.00 0 0.00
(Onemed)
Roll 2,400.00 0 0.00
cm
Roll 660.80 0 0.00
(Onemed)
Tube 3,760.00 0 0.00
(Bufacetin)
Tablet 24.00 0 0.00
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0 0.00
Ampul 1,069.00 0 0.00
mg/ml
Tablet 245.00 0 0.00
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0 0.00
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0 0.00
mg HCl
Tablet 141.00 0 0.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0 0.00
500 mcg
Tablet 44.00 0 0.00
mg
Silk 3/0 Psc 53,064.00 0 0.00
Tablet 91.00 0 0.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0 0.00
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0 0.00
ml
0 0.00


Kasa 16 x 16 Roll 4,114.00 0 0.00
Pcs 46,959.00 0 0.00
(Otot)
Roll 55,030.80 0 0.00
(Kulit)
Pcs 49,491.20 0 0.00
(Kulit)

Pcs 2,132.90 0 0.00
Kehamilan
Box 24,640.00 0 0.00
plus
Box 31,165.00 0 0.00
plus
Pcs 38,119.40 0 0.00
(Kulit)
Pcs 8,960.00 0 0.00
18
0 0.00
0 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0 0.00
35 mm
Pcs 7,146.67 0 0.00
35 mm
Botol
Etanol 70 % 28,567.00 0 0.00
1000 ml
Botol 100
Ethyl semprot 114,967.60 0 0.00
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0 0.00
0 0.00

ROKOK
Pot Dahak Pcs 3,300.00 0 0.00
Catgut 3/0 Pcs 63,103.00 0 0.00
0 0.00

Masker N95 Pcs 66,000.00 0 0.00
Masker Tali Box 100,000.00 0 0.00
Nurse Cup Pcs 5,000.00 0 0.00
Psg 55,000.00 0 0.00
Steril
0 0.00

RECOFUS
Kit 1,878,709.68 0 0.00
Swab) 2 ml
0 0 0.00
0 0.00
0 0.00
.
.
.
.
_________________________________ _______________________________
KEPADA : 0
NO. BAP : 18
SUMBER JUMLAH
DANA PEMBERIAN

Botol 75,020.00 0
Reagents
Botol 75,020.00 0
Reagents
Botol 101,761.00 0
Reagents

Botol/25
Strip
Kotak/50
pcs
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy
Vial 26,784.00 0
Paratiphy

Tablet 690.00 0
salut 10 mg
Ampul 4,236.00 0
mg/ 1 ml
Fit D3 1000 Tablet 2,178.00 0
Sachet 317.00 0
untuk 200 ml
Tube 3,360.00 0
(Bufacetin)
Tablet 20.55 0
4 mg
Tablet 152.00 0
(Dewasa)
Botol 60
ml
547,319.00 0
humasens) strip

Ampul 3,712.00 0
mg - ml
Tube 10
gr
Botol 500
ml
Botol 14,273.00 0
Syrup)
Tablet 18.95 0
mg
Tablet 26.35 0
mg
Tablet 318.00 0
mg

0 0.00


Tablet 147.00 0
(HCl)

SD HIV 19 Tes 14,340.00 0

Vial 1,325,000.00 0
Globuline
0 0.00

Psc 1,125.85 0

Botol 2,560.00 0
5 ml
Botol 3,846.00 0
ml



Botol/500
Asering 9,646.00 0
ml

Tube 3,585.00 0
kulit)
Catgut 3/0 Pcs 64,191.00 0
Ampul 1,210.00 0
1 ml

Tube 14,459.00 0
(Stesolid Rektal)
Tube 21,021.00 0
(Stesolid Rektal)
Ampul 825.00 0
mg/ml
Ampul 2,354.00 0
mg/ml
Ampul 1,518.00 0
ml
Botol100
ml

Pcs 508.20 0
(Aximed)
Pcs 508.20 0
(Aximed)
Botol 100
ml
Ampul 3,754.00 0
mg/ 1 ml
Ampul 4,083.00 0
mg/ 1 ml
Ampul 4,236.00 0
mg/ml
Tablet 873.00 0
gula 10 mg
Tablet 781.00 0
gula 10 mg
Pcs 8,960.00 0
(urocare)
Botol 500
ml
Kotak 14,600.30 0
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
Tablet 2,329.80 0
(Scopamin)

Pcs 4,256.00 0
(Steracath)
Pcs 4,256.00 0
(Steracath)

Tablet 60.00 0
mg
Bungkus/
1 kg
Roll 840.00 0
(Onemed)
Roll 1,680.00 0
(Onemed)
Roll 2,400.00 0
cm
Roll 660.80 0
(Onemed)
Tube 3,760.00 0
(Bufacetin)
Tablet 24.00 0
4 mg
Botol 60
ml
MgS04 20% Vial 3,200.00 0
Ampul 1,069.00 0
mg/ml
Tablet 245.00 0
0,125 mg
Botol 500
ml
Botol 500
ml
Paket 1,319,900.00 0
Kategori 2
Botol 15
ml
Botol 15
ml
Tablet 72.00 0
mg HCl
Tablet 141.00 0
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
Ampul 1,226.00 0
500 mcg
Tablet 44.00 0
mg
Silk 3/0 Psc 53,064.00 0
Tablet 91.00 0
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
Zink syrup 20 mg/ 5 ml 8,140.00 0
ml
Botol 60
Zink syrup 20 mg/ 5 ml 6,500.00 0
ml
0 0.00


Kasa 16 x 16 Roll 4,114.00 0
Pcs 46,959.00 0
(Otot)
Roll 55,030.80 0
(Kulit)
Pcs 49,491.20 0
(Kulit)

Pcs 2,132.90 0
Kehamilan
Box 24,640.00 0
plus
Box 31,165.00 0
plus
Pcs 38,119.40 0
(Kulit)
Pcs 8,960.00 0
18
0 0.00
0 0.00
KESGRA kotak/
100 set
Pcs 7,146.67 0
35 mm
Pcs 7,146.67 0
35 mm
Botol
Etanol 70 % 28,567.00 0
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
Silk 3/0 pcs 7,647.20 0
0 0.00

ROKOK
Catgut 3/0 Pcs 63,103.00 0
0 0.00

Masker N95 Pcs 66,000.00 0
Psg 55,000.00 0
Steril
0 0.00

RECOFUS
Kit 1,878,709.68 0
Swab) 2 ml
0 0 0.00
0 0.00
0 0.00
_________________________________ _______________________________
.
. KEPADA : 0
. NO. BAP : 19
.
SUMBER
DANA

0.00 Alkohol 70% Botol 37,638.70
0.00 Botol 75,020.00
Reagents
0.00 Botol 75,020.00
Reagents
0.00 Botol 101,761.00
Reagents

Botol/25
Strip
Kotak/50
pcs
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy
0.00 Vial 26,784.00
Paratiphy

0.00 Tablet 690.00
salut 10 mg
0.00 Ampul 4,236.00
mg/ 1 ml
0.00 Fit D3 1000 Tablet 2,178.00
0.00 Sachet 317.00
untuk 200 ml
0.00 Tube 3,360.00
(Bufacetin)
0.00 Tablet 20.55
4 mg
0.00 Tablet 152.00
(Dewasa)
Botol 60
ml
0.00 547,319.00
humasens) strip

0.00 Ampul 3,712.00
mg - ml
Tube 10
gr
Botol 500
ml
0.00 Botol 14,273.00
Syrup)
0.00 Tablet 18.95
mg
0.00 Tablet 26.35
mg
0.00 Tablet 318.00
mg
0.00 Salep 24 Tablet 1,475.00

0.00 0


0.00 DHP Tablet 2,134.00
0.00 Tablet 147.00
(HCl)
0.00 Rapid 1 HIV (SD) Tes 11,975.00

0.00 SD HIV 19 Tes 14,340.00

0.00 Vial 1,325,000.00
Globuline
0.00 0

0.00 Psc 1,125.85

0.00 Botol 2,560.00
5 ml
0.00 Botol 3,846.00
ml
0.00 Anios Gel 85 Botol 88,678.66



Botol/500
0.00 Asering 9,646.00
ml

0.00 Tube 3,585.00
kulit)
0.00 Catgut 3/0 Pcs 64,191.00
0.00 Ampul 1,210.00
1 ml

0.00 Tube 14,459.00
(Stesolid Rektal)
0.00 Tube 21,021.00
(Stesolid Rektal)
0.00 Ampul 825.00
mg/ml
0.00 Ampul 2,354.00
mg/ml
0.00 Ampul 1,518.00
ml
Botol100
ml

0.00 Pcs 508.20
(Aximed)
0.00 Pcs 508.20
(Aximed)
Botol 100
ml
0.00 Ampul 3,754.00
mg/ 1 ml
0.00 Ampul 4,083.00
mg/ 1 ml
0.00 Ampul 4,236.00
mg/ml
0.00 Tablet 873.00
gula 10 mg
0.00 Tablet 781.00
gula 10 mg
0.00 Pcs 8,960.00
(urocare)
Botol 500
ml
0.00 Kotak 14,600.30
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0.00 Tablet 2,329.80
(Scopamin)

0.00 Introcan No.22 Pcs 13,200.00
0.00 Introcan No.24 Pcs 13,750.00
0.00 Pcs 4,256.00
(Steracath)
0.00 Pcs 4,256.00
(Steracath)

0.00 Tablet 60.00
mg
Bungkus/
1 kg
0.00 Roll 840.00
(Onemed)
0.00 Roll 1,680.00
(Onemed)
0.00 Roll 2,400.00
cm
0.00 Roll 660.80
(Onemed)
0.00 Tube 3,760.00
(Bufacetin)
0.00 Tablet 24.00
4 mg
Botol 60
ml
0.00 MgS04 20% Vial 3,200.00
0.00 Ampul 1,069.00
mg/ml
0.00 Tablet 245.00
0,125 mg
Botol 500
ml
Botol 500
ml
0.00 Paket 1,319,900.00
Kategori 2
Botol 15
ml
Botol 15
ml
0.00 Tablet 72.00
mg HCl
0.00 Tablet 141.00
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0.00 Ampul 1,226.00
500 mcg
0.00 Tablet 44.00
mg
0.00 Silk 3/0 Psc 53,064.00
0.00 Tablet 91.00
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 8,140.00
ml
Botol 60
0.00 Zink syrup 20 mg/ 5 ml 6,500.00
ml
0.00 0


0.00 Kasa 16 x 16 Roll 4,114.00
0.00 Pcs 46,959.00
(Otot)
0.00 Roll 55,030.80
(Kulit)
0.00 Pcs 49,491.20
(Kulit)

0.00 Pcs 2,132.90
Kehamilan
0.00 Box 24,640.00
plus
0.00 Box 31,165.00
plus
0.00 Pcs 38,119.40
(Kulit)
0.00 Pcs 8,960.00
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0.00 Pcs 7,146.67
35 mm
0.00 Pcs 7,146.67
35 mm
Botol
0.00 Etanol 70 % 28,567.00
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0.00 Silk 3/0 pcs 7,647.20
0.00 0

ROKOK
0.00 Catgut 3/0 Pcs 63,103.00
0.00 0

0.00 Masker N95 Pcs 66,000.00
0.00 Psg 55,000.00
Steril
0.00 0

RECOFUS
0.00 Kit 1,878,709.68
Swab) 2 ml
0 0 0.00
0.00 0
0.00 0
.
.
.
.
_____________________ _________________________________ __________________________
.
. KEPADA : 0
. NO. BAP : 20
.
JUMLAH SUMBER
PEMBERIAN DANA

0 0.00 Botol
Reagents
0 0.00 Botol
Reagents
0 0.00 Botol
Reagents

Botol/25
Strip
Kotak/50
pcs
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy
0 0.00 Vial
Paratiphy

0 0.00 Tablet
salut 10 mg
0 0.00 Ampul
mg/ 1 ml
0 0.00 Sachet
untuk 200 ml
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
0 0.00 Tablet
(Dewasa)
Botol 60
ml
0 0.00
humasens) strip

0 0.00 Ampul
mg - ml
Tube 10
gr
Botol 500
ml
0 0.00 Botol
Syrup)
0 0.00 Tablet
mg
0 0.00 Tablet
mg
0 0.00 Tablet
mg

0.00 0


0 0.00 DHP Tablet
0 0.00 Tablet
(HCl)


0 0.00 Vial
Globuline
0.00 0

0 0.00 Psc

0 0.00 Botol
5 ml
0 0.00 Botol
ml



Botol/500
0 0.00 Asering
ml

0 0.00 Tube
kulit)
0 0.00 Ampul
1 ml

0 0.00 Tube
(Stesolid Rektal)
0 0.00 Tube
(Stesolid Rektal)
0 0.00 Ampul
mg/ml
0 0.00 Ampul
mg/ml
0 0.00 Ampul
ml
Botol100
ml

0 0.00 Pcs
(Aximed)
0 0.00 Pcs
(Aximed)
Botol 100
0 0.00 Fenobarbital
ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ 1 ml
0 0.00 Ampul
mg/ml
0 0.00 Tablet
gula 10 mg
0 0.00 Tablet
gula 10 mg
0 0.00 Pcs
(urocare)
Botol 500
ml
0 0.00 Kotak
(Guaifenesin)

Kotak/25
strip
Kotak 60
spons
0 0.00 Tablet
(Scopamin)

0 0.00 Pcs
(Steracath)
0 0.00 Pcs
(Steracath)

0 0.00 Tablet
mg
Bungkus/
1 kg
0 0.00 Roll
(Onemed)
0 0.00 Roll
(Onemed)
0 0.00 Roll
cm
0 0.00 Roll
(Onemed)
0 0.00 Tube
(Bufacetin)
0 0.00 Tablet
4 mg
Botol 60
ml
0 0.00 MgS04 20% Vial
0 0.00 Ampul
mg/ml
0 0.00 Tablet
0,125 mg
Botol 500
ml
Botol 500
ml
0 0.00 Paket
Kategori 2
Botol 15
ml
Botol 15
ml
0 0.00 Tablet
mg HCl
0 0.00 Tablet
mg HCl
Botol 60
ml
Botol 500
ml
Pot 30
gram
0 0.00 Ampul
500 mcg
0 0.00 Tablet
mg
0 0.00 Silk 3/0 Psc
0 0.00 Tablet
tablet 50 mg
kotak/10
strip
Kotak/25
strip
Botol 60
ml
Botol 60
ml
0.00 0


0 0.00 Kasa 16 x 16 Roll
0 0.00 Pcs
(Otot)
0 0.00 Roll
(Kulit)
0 0.00 Pcs
(Kulit)

0 0.00 Pcs
Kehamilan
0 0.00 Box
plus
0 0.00 Box
plus
0 0.00 Pcs
(Kulit)
0 0.00 Pcs
18
0.00 0
0.00 0
KESGRA kotak/
100 set
0 0.00 Pcs
35 mm
0 0.00 Pcs
35 mm
Botol
0 0.00 Etanol 70 %
1000 ml
Botol 100
ml
Set/
Kantong
Set/
Kantong
0 0.00 Silk 3/0 pcs
0.00 0

ROKOK
0.00 0

0 0.00 Psg
Steril
0.00 0

RECOFUS
0 0.00 Kit
Swab) 2 ml
0 0
0.00 0
0.00 0
.
.
.
.
_______________________________ _________________________________
BMHP YANG DIKELUARKAN
.
.
.
.
.
JUMLAH
HARGA TOTAL HARGA
PEMBERIAN
90.00 0 0.00
16,500.00 0 0.00
160.00 0 0.00
224.40 0 0.00
160.00 0 0.00
74.00 0 0.00
55.00 0 0.00
251.00 0 0.00
3,625.00 0 0.00
37,638.70 0 0.00
14,490.00 0 0.00
1,102.20 0 0.00
123.00 0 0.00
78.00 0 0.00
75,020.00 0 0.00
75,020.00 0 0.00
101,761.00 0 0.00
125,477.00 0 0.00
3,260.00 0 0.00
122.00 0 0.00
46.00 0 0.00
276,891.50 0 0.00
1,536.70 0 0.00
10,890.00 0 0.00
138.00 0 0.00
108,324.00 0 0.00
25,283.92 0 0.00
6,689.54 0 0.00
3,206.20 0 0.00
75.00 0 0.00
2,215.00 0 0.00
60.00 0 0.00
260.00 0 0.00
151.80 0 0.00
132,000.00 0 0.00
109.00 0 0.00
75.00 0 0.00
69,000.00 0 0.00
3,300.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
26,784.00 0 0.00
690.00 0 0.00
4,236.00 0 0.00
2,178.00 0 0.00
36,696.00 0 0.00
28.75 0 0.00
96.00 0 0.00
317.00 0 0.00
5,720.00 0 0.00
210.00 0 0.00
11,432.00 0 0.00
3,630.00 0 0.00
1,050.00 0 0.00
302,000.00 0 0.00
814,009.50 0 0.00
123.17 0 0.00
3,333.00 0 0.00
8,867.00 0 0.00
16,000.00 0 0.00
16,000.00 0 0.00
16,000.00 0 0.00
260.00 0 0.00
3,360.00 0 0.00
20.55 0 0.00
152.00 0 0.00
2,298.00 0 0.00
547,319.00 0 0.00
3,113.05 0 0.00
41,600.00 0 0.00
177,216.00 0 0.00
118.50 0 0.00
3,712.00 0 0.00
3,150.00 0 0.00
109.00 0 0.00
6,900.00 0 0.00
869.00 0 0.00
14,273.00 0 0.00
3,450.00 0 0.00
129.00 0 0.00
180.90 0 0.00
1,535.00 0 0.00
60.00 0 0.00
88.21 0 0.00
18.95 0 0.00
26.35 0 0.00
318.00 0 0.00
5,291.00 0 0.00
35,532.00 0 0.00
105.88 0 0.00
68.15 0 0.00
1,027.95 0 0.00
7,703.00 0 0.00
1,475.00 0 0.00
85.00 0 0.00
495.00 0 0.00
495.00 0 0.00
3,630.00 0 0.00
3,630.00 0 0.00
73.00 0 0.00
279.82 0 0.00
57.55 0 0.00
8,970.00 0 0.00
4,488.00 0 0.00
24.31 0 0.00
521.00 0 0.00
0.00
1,240.00 0 0.00
1,518.00 0 0.00
1,583.00 0 0.00
1,650.00 0 0.00
4,600.00 0 0.00
380.00 0 0.00
271.14 0 0.00
494.00 0 0.00
242.00 0 0.00
1,121.00 0 0.00
2,134.00 0 0.00
275.00 0 0.00
490.00 0 0.00
48,999.50 0 0.00
147.00 0 0.00
2,272.00 0 0.00
2,950.00 0 0.00
2,000.00 0 0.00
242.00 0 0.00
285,339.00 0 0.00
477,791.00 0 0.00
1,592,731.00 0 0.00
447,791.00 0 0.00
11,975.00 0 0.00
9,300.00 0 0.00
9,878.00 0 0.00
33,334.00 0 0.00
8,300.00 0 0.00
287.00 0 0.00
4,260.00 0 0.00
14,340.00 0 0.00
153,000.00 0 0.00
91.00 0 0.00
165,000.00 0 0.00
61,996.00 0 0.00
28,204.00 0 0.00
78,991.00 0 0.00
17,996.00 0 0.00
158,994.00 0 0.00
1,325,000.00 0 0.00
135,000.00 0 0.00
23,991.00 0 0.00
23,991.00 0 0.00
155,813.00 0 0.00
19,954.00 0 0.00
16,995.00 0 0.00
1,325,000.00 0 0.00
604.00 0 0.00
0.00
728.00 0 0.00
1,125.85 0 0.00
840.00 0 0.00
11,200.00 0 0.00
25,155.00 0 0.00
27,500.00 0 0.00
105.00 0 0.00
99.00 0 0.00
2,860.00 0 0.00
86.00 0 0.00
123.00 0 0.00
908.00 0 0.00
55.00 0 0.00
79.00 0 0.00
74.00 0 0.00
94.00 0 0.00
265.00 0 0.00
231.00 0 0.00
248.00 0 0.00
360.00 0 0.00
2,560.00 0 0.00
3,846.00 0 0.00
3,510.00 0 0.00
88,678.66 0 0.00
2,098.00 0 0.00
2,106.00 0 0.00
2,098.00 0 0.00
60.00 0 0.00
54.00 0 0.00
120.00 0 0.00
46.00 0 0.00
117.00 0 0.00
112.00 0 0.00
103.00 0 0.00
5,170.00 0 0.00
251.00 0 0.00
175.00 0 0.00
236.00 0 0.00
425.00 0 0.00
9,646.00 0 0.00
149.00 0 0.00
1,515.00 0 0.00
1,520.00 0 0.00
337.00 0 0.00
3,585.00 0 0.00
82.00 0 0.00
75.00 0 0.00
64,191.00 0 0.00
298.00 0 0.00
3,061.00 0 0.00
2,298.84 0 0.00
1,210.00 0 0.00
34.00 0 0.00
18,000.00 0 0.00
75.00 0 0.00
90.00 0 0.00
2,862.00 0 0.00
70.00 0 0.00
1,545.00 0 0.00
14,459.00 0 0.00
21,021.00 0 0.00
825.00 0 0.00
309.00 0 0.00
766.00 0 0.00
2,354.00 0 0.00
1,518.00 0 0.00
115,500.00 0 0.00
508.20 0 0.00
508.20 0 0.00
508.20 0 0.00
7,010.00 0 0.00
177.00 0 0.00
3,754.00 0 0.00
4,083.00 0 0.00
4,236.00 0 0.00
873.00 0 0.00
781.00 0 0.00
8,960.00 0 0.00
88.00 0 0.00
84.00 0 0.00
606,900.00 0 0.00
317.00 0 0.00
274.00 0 0.00
5,720.00 0 0.00
6,900.00 0 0.00
297.00 0 0.00
14,600.30 0 0.00
228.00 0 0.00
241.00 0 0.00
238.00 0 0.00
137,500.00 0 0.00
7,084.00 0 0.00
322,190.00 0 0.00
76.00 0 0.00
90.00 0 0.00
60.00 0 0.00
8,487.66 0 0.00
2,648.00 0 0.00
2,812.00 0 0.00
2,329.80 0 0.00
1,050.00 0 0.00
125.79 0 0.00
2,560.00 0 0.00
3,849.00 0 0.00
6,930.00 0 0.00
5,280.00 0 0.00
13,200.00 0 0.00
13,750.00 0 0.00
93.00 0 0.00
4,256.00 0 0.00
4,256.00 0 0.00
8,070.70 0 0.00
4,256.00 0 0.00
4,256.00 0 0.00
60.00 0 0.00
60,830.00 0 0.00
1,700.00 0 0.00
8,624.00 0 0.00
840.00 0 0.00
1,680.00 0 0.00
2,400.00 0 0.00
660.80 0 0.00
305.00 0 0.00
3,760.00 0 0.00
2,013.00 0 0.00
24.00 0 0.00
26.27 0 0.00
2,052.00 0 0.00
126.00 0 0.00
152.00 0 0.00
125.00 0 0.00
97.00 0 0.00
127.00 0 0.00
847.00 0 0.00
47,970.00 0 0.00
1,405.00 0 0.00
31,165.00 0 0.00
77.00 0 0.00
1,900.00 0 0.00
3,926.00 0 0.00
3,200.00 0 0.00
1,069.00 0 0.00
245.00 0 0.00
100.00 0 0.00
2,750.00 0 0.00
6,840.00 0 0.00
6,410.00 0 0.00
136.00 0 0.00
127.00 0 0.00
123.00 0 0.00
645.00 0 0.00
910.00 0 0.00
5,650.00 0 0.00
1,319,900.00 0 0.00
1,348.00 0 0.00
129.00 0 0.00
4,950.00 0 0.00
1,013.00 0 0.00
1,160.00 0 0.00
162.80 0 0.00
186.78 0 0.00
60.00 0 0.00
5,720.00 0 0.00
5,980.00 0 0.00
72.00 0 0.00
141.00 0 0.00
79.00 0 0.00
73.00 0 0.00
80.00 0 0.00
50,600.00 0 0.00
3,190.00 0 0.00
25,215.00 0 0.00
318.00 0 0.00
7,630.00 0 0.00
7,150.00 0 0.00
114.00 0 0.00
2,983.50 0 0.00
22,000.00 0 0.00
150.00 0 0.00
252.00 0 0.00
67.00 0 0.00
5,463.00 0 0.00
2,200.00 0 0.00
3,017.00 0 0.00
1,226.00 0 0.00
44.00 0 0.00
53,064.00 0 0.00
281.00 0 0.00
12,749.00 0 0.00
409.00 0 0.00
91.00 0 0.00
174.00 0 0.00
329.00 0 0.00
279.82 0 0.00
255,000.00 0 0.00
195,000.00 0 0.00
144.00 0 0.00
165,000.00 0 0.00
135.00 0 0.00
604.00 0 0.00
8,140.00 0 0.00
6,500.00 0 0.00
3,285.00 0 0.00
0.00
1,004.85 0 0.00
924.00 0 0.00
887.70 0 0.00
924.00 0 0.00
395,384.74 0 0.00
16,401.00 0 0.00
11,945.23 0 0.00
11,945.23 0 0.00
1,740.20 0 0.00
11,808.50 0 0.00
11,808.50 0 0.00
5,827.80 0 0.00
5,827.00 0 0.00
5,827.00 0 0.00
5,827.00 0 0.00
8,547.00 0 0.00
5,566.00 0 0.00
6,527.40 0 0.00
6,455.90 0 0.00
6,455.90 0 0.00
4,114.00 0 0.00
143,022.00 0 0.00
7,502.00 0 0.00
7,502.00 0 0.00
7,502.00 0 0.00
16,032.50 0 0.00
16,032.50 0 0.00
4,983.00 0 0.00
4,983.00 0 0.00
11,656.00 0 0.00
11,656.00 0 0.00
46,959.00 0 0.00
55,030.80 0 0.00
1,740.20 0 0.00
1,740.20 0 0.00
49,491.20 0 0.00
21,060.00 0 0.00
2,983.50 0 0.00
2,132.90 0 0.00
24,640.00 0 0.00
31,165.00 0 0.00
38,119.40 0 0.00
41,100.00 0 0.00
728.00 0 0.00
6,062.10 0 0.00
8,960.00 0 0.00
0.00
2,774.00 0 0.00
4,236.00 0 0.00
2,920.00 0 0.00
3,796.00 0 0.00
2,600.00 0 0.00
1,232.00 0 0.00
1,199.00 0 0.00
409.00 0 0.00
255.00 0 0.00
354.00 0 0.00
297.00 0 0.00
637.00 0 0.00
0.00
118,973.00 0 0.00
832.00 0 0.00
1,137.40 0 0.00
9,332.40 0 0.00
7,146.67 0 0.00
7,146.67 0 0.00
28,567.00 0 0.00
114,967.60 0 0.00
9,794.40 0 0.00
9,794.40 0 0.00
4,654.10 0 0.00
4,654.10 0 0.00
6,968.50 0 0.00
4,480.00 0 0.00
4,480.00 0 0.00
4,096.00 0 0.00
6,470.20 0 0.00
960.00 0 0.00
665.50 0 0.00
7,424.00 0 0.00
134,371.60 0 0.00
41,600.00 0 0.00
7,647.20 0 0.00
3,911.11 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
4,864.00 0 0.00
832.00 0 0.00
0.00
55,000.00 0 0.00
470.50 0 0.00
470.50 0 0.00
470.50 0 0.00
464.64 0 0.00
464.64 0 0.00
5,775.00 0 0.00
3,300.00 0 0.00
63,103.00 0 0.00
0.00
180,000.00 0 0.00
66,000.00 0 0.00
6,691.85 0 0.00
38,000.00 0 0.00
12,000.00 0 0.00
12,000.00 0 0.00
66,000.00 0 0.00
100,000.00 0 0.00
5,000.00 0 0.00
6,000.00 0 0.00
70,000.00 0 0.00
55,000.00 0 0.00
200,000.00 0 0.00
200,000.00 0 0.00
0.00
57,194.00 0 0.00
1,878,709.68 0 0.00
1,143,880.00 0 0.00
0.00
0.00
0.00
.
Yang Menerima
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LAPORAN KETERSEDIAN OBAT

PUSKESMAS BOWONG CINDEA

STOK AWAL PENERIMAAN

1 Allopurinol tablet 100 mg Tablet 90.00 -

49 Fit D3 1000 Tablet 2,178.00 -

68 Kloramfenikol salep kulit 2% (Bufacetin) Tube 3,360.00 -

69 Klorfeniramine Maleat (CTM) tab 4 mg Tablet 20.55 -

TOTAL DAU 4,984,316.75

1 Alat suntik sekali pakai 0,05 ml Pcs 1,240.00 -

15 Klorpromazin tablet salut 100 mg (HCl) Tablet 147.00 -

8 Pot Sputum Pcs 2,272.00 -

TOTAL P2PL 10,105,840.00

1 Alat suntik sekali pakai 1 ml Set 728.00 -

52 Deksamethason injeksi 5 mg/ml - 1 ml Ampul 1,210.00 -

53 Deksametason tablet 0,5 mg Tablet 34.00 -

73 Fitomenadion (Vit.K) injeksi 10 mg/ 1 ml Ampul 3,754.00 -

74 Fitomenadion (Vit.K) injeksi 10 mg/ 1 ml Ampul 4,083.00 -

75 Fitomenadion (Vit.K) injeksi 2 mg/ml Ampul 4,236.00 -

79 Furosemid tab Tablet 88.00 -

120 Kasa Pembalut 4 m x 10 cm (Onemed) Roll 1,680.00 -

121 Kasa pembalut hidrofil 4 m x 15 cm Roll 2,400.00 -

187 Silk 3/0 Psc 53,064.00 -

TOTAL DAK 6,521,476.38

1 Alat Suntik 1 cc (Nipro) Pcs 1,004.85 -

34 Onemed surgical mask plus 3 ply plus Box 24,640.00 -

35 Onemed surgical mask plus 3 ply plus Box 31,165.00 -

TOTAL BMHP E-CAT DAK 5,581,820.60

1 Oksitetrasiklin 1 % Salep Mata Tube 2,774.00 82 227,468.00

TOTAL KESMAS 2,837,468.00

1 Cairan Pembersih Tangan Botol 55,000.00 -

TOTAL DAU PAJAK ROKOK 94,100.00

1 Baju hazmat/ APD Pcs 180,000.00 -

TOTAL BANTUAN TAK TERDUGA 4,104,000.00

1 Rapid test Antigen Test 57,194.00 -

DAU RECOFUSING 9,393,548.39

Kepala Puskesmas Bowong Cindea

PENERIMAAN PEMAKAIAN SISA PER 31

14,783,540.300 39,102,105.835 14,728,484.575 4,575,520.00

Bowong Cindea, 25 November 2021

Petugas Farmasi/Pengelola Obat

Ammar Mubarak, S.Farm., Apt.

NAMA OBAT STOK

DAU Allopurinol tablet 100 mg Tablet 90.00 0 0.00

Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 0 0.00

Fokus febrile Antigen H Paratiphy Vial 26,784.00 0 0.00

Fitomenadion (Vitamin K1) tablet

Lidokain inj 2% com (pehacain inj) Ampul 3,113.05 0 0.00

Lidokain gel 2% Tube 41,600.00 0 0.00

Thiamin HCl (Vit.B1) tablet 50 mg Tablet 57.55 0 0.00

Underpad 60x90 cm ( Cosmomed ) Pcs 8,970.00 0 0.00

Urine bag Pcs 4,488.00 0 0.00

P2PL Alat suntik sekali pakai 0,05 ml Pcs 1,240.00 0 0.00

Albendazol Suspensi 200 mg/5 ml Botol 4,600.00 0 0.00

Albendazol tablet 400 mg Tablet 380.00 0 0.00

Rapid test HbSAg Tes 9,878.00 0 0.00

Vaksin HB Rekombinasi (HB-Pid) Uniject 23,991.00 0 0.00

Vaksin MR Vial 155,813.00 0 0.00

DAK Alat suntik sekali pakai 1 ml Set 728.00 0 0.00

Amitriptyline tablet salut 25 mg Tablet 123.00 0 0.00

Acetylcystein kapsul 200 mg Kapsul 908.00 0 0.00

Amoksisillin sirup DS 250 mg/ 5 ml Botol 3,510.00 0 0.00

Anios Gel 85 Botol 88,678.66 0 0.00

Asam Askorbat (Vit.C) tab 50 mg Tablet 120.00 0 0.00

Asam Askorbat (Vit.C) tab 50 mg Tablet 46.00 0 0.00