DAFTAR MUTASI

PUSKESMAS
PER 31 DESEM

VOLUME
AWAL PER 1
NO URAIAN PERSEDIAAN SATUAN PENGADAAN (PEN
JANUARI
2023

Januari
1 2 3 4
5
A OBAT DAN BMHP RUTIN 2022

1 Alopurinol tablet/kapsul/kaplet 300 mg Tablet

2 Alprazolam tablet/kapsul/kaplet 1 mg Tablet
Amitriptilin tablet/kapsul/kaplet/tablet
3 Tablet
salut selaput 25 mg
Amlodipin besilate tablet/kapsul/kaplet 5
4 Tablet
mg
Amoksisilin kaptab 500 mg, kemasan
5 Kaplet
strip/blister (G)
6 Amoksisilin sirup kering 250 mg/5 ml Botol
Amoksisilin trihydrate 100 mg/ml
7 Botol
drops/sirup kering, botol 15 ml
Antasida, kombinasi: Aluminium
8 hidroksida 200 mg + Magnesium Botol
hidroksida 200 mg, suspensi
Antasida, kombinasi: Aluminium
9 hidroksida 200 mg + Magnesium Tablet
hidroksida 200 mg, tablet kunyah

Anti bakteri salep kombinasi: Basitrasin

10 Tube
500 IU/g + Polimiksin 10.000 IU/g

Antihemoroid, kombinasi sup: Bismut

11 subgalat heksaklorofenlidokain seng Supp
oksida (G)
Asam asetilsalisilat (Asetosal)
12 Tablet
tablet/kapsul/kaplet 80 mg
Asam askorbat (Vitamin C)
13 Tablet
tablet/kapsul/kaplet 50 mg
14 Asam folat tablet 1 mg Kaplet
Asam mefenamat tablet/kapsul/kaplet
15 Tablet
500 mg
ASERING Asetat Ringer / Ringer
16 Fls
Asetat, @ 500 ml
17 Asiklovir krim 5 % Tube
18 Atropin inj. 0,25 mg/ml (i.m./i.v./s.k) (G) Ampul
19 Bedak Salisil serbuk 2% 60 gr Sac
Betahistin mesylate tablet/kapsul/kaplet
20 Tablet
6 mg
21 Betametason valerat krim 0,1 % Tube
BIOSAT 1,5 Serum Antitetanus (A.T.S)
22 Ampul
injeksi 1.500 IU/ml (i.m.)
23 Deksametason injeksi 5 mg/ml Ampul
24 Deksametason tablet 0,5 mg Tablet
Dextrofen Syrup @ 60 ml,
Destromethorpan HBr,
25 Tablet
Dexclorpheniramine Maleate,
Pehenylephrine HCL
Diazepam enema 5 mg/2,5 mL, tube @
26 Botol
2,5 ml (G)
27 Diazepam injeksi 5 mg / ml Tablet
28 Diazepam tablet/kapsul/kaplet 2 mg Tablet
29 Difenhidramin injeksi 10 mg/ml Ampul
30 Domperidon suspensi 5 mg/5 ml Tube
31 Domperidon tablet/kapsul/kaplet 10 mg Tablet

32 DULCOLAX Bisakodil suppositoria 5 mg Tablet

33 Epinefrin (Adrenalin) injeksi 1 mg/ml Tablet
Eritromisin stearate tablet/kapsul/kaplet
34 Ampul
500 mg
35 Etil Klorida spray 100 ml Tablet
36 Eugenol cairan Tablet
37 Furosemid tablet 40 mg Botol
Garam Oralit kombinasi: Natrium klorida
0,52 g + Kalium klorida 0,30 g +
38 Trinatrium sitrat dihidrat 0,58 g + Ampul
Glukosa anhidrat 2,70 g, serbuk (G)
serbuk
39 Gentamycin sulfate tetes mata Fls
40 Glukosa larutan infus 5 % 500 mL Tablet
41 Hidrokortison acetate krim 2,5 % Tablet
Hustab syrup @ 60 ml, bromhexin HCL
42 Tablet
4 mg
43 Ibuprofen suspensi 100 mg/5 ml Botol
44 Ibuprofen tablet/kapsul/kaplet 200 mg Ampul
ILIADIN Oksimetazolin tetes hidung
45 Tablet
0,025 %
ILIADIN Oksimetazolin tetes hidung
46 Botol
0,05 %
47 Isosorbid dinitrat tablet/kaplet 5 mg Botol
48 Kalsium Laktat tablet 500 mg Tablet
 Karbogliserin (Phenol Glycerol) tetes
49 Botol
telinga 10%
Ketokonazol tablet/kapsul/kaplet 200
50 Botol
mg
Ketorolak tromethamine inj. 30 mg/ml
51 Ampul
(3%)
52 Klindamisin tablet/kapsul/kaplet 300 mg Tablet
53 Klorfeniramin maleat (CTM) tablet 4 mg Fls
54 Klozapin tablet/kapsul/kaplet 25 mg Tablet
Kotrimoksazol suspensi:
55 sulfametoksazol 200 mg + trimetoprim Tablet
40 mg
Kotrimoksazol tablet/kapsul/kaplet 480
56 Botol
mg
57 Lansoprazol tablet/kapsul/kaplet 30 mg Botol
Lidokain 2% + Epinefrin 1: 80.000, inj 2
58 Tablet
ml
59 Lidokain gel 2% Tablet
60 Loperamid tablet/kapsul/kaplet 2 mg Ampul
61 Loratadin tablet/kapsul/kaplet 10 mg Tablet
62 Metformin tablet/kapsul/kaplet 500 mg Tablet
63 Metillergometrin inj. 0,2 mg/ml Tablet
Metilprednisolon tablet/kapsul/kaplet 4
64 Tablet
mg
65 Metronidazol tablet 500 mg Tablet
66 Metronidazole suspensi 125 mg/5 ml Kiur
MgSO4 20 Magnesium sulfate /
Magnesium sulfate heptahydrate /
67 Tablet
Magnesium sulfat injeksi 20% V (i.v.) @
25 ml
68 NaCl 0,9% 500 ml Botol
N-asetil sistein tablet/kapsul/kaplet 200
69 Botol
mg
Natrium diklofenak tablet salut enterik /
70 Botol
kaplet salut enterik 50 mg
Nifedipin tablet lepas lambat / kaplet
71 Kotak
lepas lambat 30 mg
72 Nistatin suspensi 100.000 IU/ml Pcs
73 Oksitosin inj.10 IU/ml Botol
74 Omeprazol tablet/kapsul/kaplet 20 mg Pcs
75 Parasetamol drops 60 mg/0,6 ml Pcs
76 Parasetamol sirup 120 mg / 5 ml, 60 ml Pcs
77 Parasetamol tablet 500 mg pcs
 Povidon Iodin larutan 100 mg/ml, botol
78 Pcs
@ 60 cc
79 Prednison tablet/kapsul/kaplet 5 mg Pcs
80 Ranitidin injeksi 25 mg/ml bungkus
81 Ranitidin tablet/kapsul/kaplet 150 mg Pcs
82 Ringer Laktat 500 ml Pcs
83 Risperidon tablet/kapsul/kaplet 2 mg Botol
84 Sefadroksil 500 mg Pcs
85 Sefadroksil sirup kering 125 mg/5ml pcs
86 Setirizin sirup 5 mg/5 ml pcs
87 Setirizin tablet/kapsul/kaplet 10 mg Pcs
Sianokobalamin (Vitamin B 12)
88 Pcs
tablet/kapsul/kaplet 50 mcg
Sianokobalamin (Vitamin B12) injeksi
89 Pcs
500 mcg/mL

Simvastatin tablet/kapsul/kaplet/tablet
90 Pcs
salut selaput 10 mg
91 Siprofloksasin tablet 500 mg Kotak
92 Tetrasiklin tablet 500 mg Pcs
93 Tiamin tablet 50 mg Tablet
Triheksifenidil tablet/kapsul/kaplet/tablet
94 Respules
salut selaput 2 mg

VERORAB Vaksin Rabies, untuk

95 Ampul
manusia inj. 2,5 IU (s.k)
96 Vitamin B Kompleks tablet/kapsul/kaplet Kapsul
97 Zink sirup 20 mg / 5 ml Kapsul
98 Alkohol 70% ukuran 1 L Tablet
Aseptan Antiseptic Liquid with
99 Botol
Moisturizer For Hand Rub 500ml + disp
100 Blood Lancet Kotak
101 Catgut Chromic with Needle 3/0 Pcs
102 Chlorhexidine 4% 500 ml Tablet
Dermafix Plester Non Woven + Aborben
103 Botol
Pad 10 x 15 cm
104 Foley Catheter 2 Way, FR 16, FR 18 Tablet
I.V Cannula With Teflon Catheter 1 Way
105 Tablet
22 G
I.V Cannula With Teflon Catheter 1 Way
106 Tube
24 G
107 Infusion Set Anak Ampul
108 Infusion Set Dewasa Type Y/ST 03 Tablet
109 Kapas Pembalut 250 gr Tablet
110 Kasa 55,6 cm x 3,6 m Botol
111 Kasa SNA Steril 16 cm x 16 cm (16 pcs) Botol
112 Lysol Botol
Nitrile Examination Gloves - Free
113 Kotak
Powder
Plesterin Roll non woven roll 10 cm x 5
114 Roll
m
115 Silk Suture with Needle 2/0 PCS
116 Surgical Glove Powder Free Pcs
117 Surgical Mask Earloop, 3 ply Pcs
118 Syringe 3 cc Pcs
119 Syringe 5 cc Pcs
120 Total Cholesterol Test Strip Kotak
121 Urine Bag Pcs
122 Asam askorbat (Vitamin C) tab 250 mg Tablet
BRICASMA RESPULES Terbutaline
123 Respules
sulfate, cairan inhalasi 2,5 mg/ml
124 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
125 Retinol 100.000 IU Kapsul
126 Retinol 200.000 IU Kapsul
127 Sefiksim tablet 200 mg Tablet
128 Alkohol 95% 1 Liter Botol
129 Alkohol Swab 2-ply @ 100 pcs Kotak
Perban Elastis (Uniflex) 10 cm x 4,5 m /
130 Pcs
96
131 dst….................
132
133
134
B OBAT DAN BMHP RUTIN 2023
135 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
136 Furosemid tablet 40 mg Tablet
Ketokonazol tablet/kapsul/kaplet 200
137 Tablet
mg
Anastetik lokal gigi, kombinasi
138 KDT/FDC mengandung: Lidokain 2% + Ampul
Epinefrin 1: 80.000, inj 2 ml

139 Metformin tablet/kapsul/kaplet 500 mg Tablet

140 Piridoksin (Vitamin B6) tablet 10 mg Tablet
141 Salbutamol tablet 2 mg Tablet
Asetil sistein tablet/kapsul/kaplet 200
142 Tablet
mg
 Hustab Sirup @60 mL, Bromhexin HCl
143 Botol
4 mg
144 Strip Test Asam Urat Kotak
C OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (BANTUAN PR
145 Azitromisin 500 mg Tablet
146 Biostarch Tablet
147 Favipiravir Tablet
148 Goldtrion Tablet
149 HB-Vit Tablet
150 Immunace Tablet
151 Oseltamivir Tablet
152 Parasetamol 500 mg Tablet
153 Proxidan Tablet
154 Santa-E Tablet
155 Selcom C Tablet
156 Selviplex Tablet
157 Sivit Zink Tablet
158 Vitamin C 500 mg Tablet
159 Cover All Pcs
160 Face Shield Pcs
161 Gown Pcs
162 Handscoon Non Steril Kotak
163 Hand Sanitizer 100 mL Botol
164 Kacamata Goggle Pcs
165 Masker Bedah Pcs
166 Masker KN95 Pcs
167 Masker N95 Pcs
168 Hazmat Pcs
169 Sepatu Boot Pasang
D OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (DANA REFOC
170 NaCl 0,9% 500 ml Fls
171 Abocath Kateter IV Pcs
172 Antigen Test Pcs
173 Antigen Test Pcs
174 Baju Coveral ( APD) Pcs
175 Canule Nasal 2m Pcs
176 Handsanitizer Botol
177 Handscoon Non Steril Pcs
178 Handscoon Steril Pcs
179 Hazmat Pcs
180 Infusion Set Pcs
181 Infusion Set Anak Pcs
182 Infusion Set Dewasa Pcs
183 Kapas Pembalut Pcs
184 Kateter IV Pcs
185 Leukoplast Pcs
186 Masker Medis earloop Kotak
187 Masker Medis Pcs
188 Masker N95 Pcs
189 Masker N95 Pcs
190 Oxygen Mask Pcs
191 Sabun Pencuci Tangan Pcs
192 VTM Pcs
E BMHP PENGADAAN DAK NF PUSKESMAS
193 All Cover Pcs
194 Bayclin Pcs
195 Goggle Pcs
196 Handscoon Non Steril Pcs
197 Handscoon Steril Pcs
198 Masker N95 Pcs
199 Masker Surgical Pcs
200 Pembersih Tangan Pcs
201 Pencuci Tangan Pcs
202 Sepatu Boot Pasang
203 Shoe Cover Pcs
204 Surgical Gynaecology Pcs
F OBAT DAN BMHP BANTUAN LAINNYA DALAM RANGKA PENANGANAN COVID-19
205 Obat Isoman Paket 1 Paket
206 Obat Isoman Paket 2 Paket
207 Obat Isoman Paket 3 Paket
208 Face Shield Pcs
209 Hand Sanitizer 100 mL Botol
210 Hand Sanitizer 500 mL Botol
211 Handscoon Non Steril Pcs
212 Hazmat Pcs
213 Helm Pcs
214 Jas Hujan Pcs
215 Kacamata Goggle Pcs
216 Larutan Carbol 10 L Pcs
217 Masker Medis Pcs
218 Masker N95 Pcs
219 Masker KN95 Pcs
220 Plastik Pelindung Sepatu Pcs
221 Sabun Pencuci Tangan 5 L Pcs
222 Sepatu Boot Karet/ Safety Shoes Pcs
223 Shoe Cover Pcs
H OBAT DAN BMHP PROGRAM HIV
224 Lamivudine 150 Tablet
225 Dolutegravir Tablet
226 Rapid 1 HIV (SD Bioline) @ 100 test Test
227 Rapid 1 HIV (SD Bioline) @ 25 test Test 25 -
228 Rapid 2 HIV (SD Bioline) @ 25 test Test
229 Rapid 3 HIV (SD Bioline) @ 25 test Test
230 Rapid HBsAg Kit
231 Rapid Sifilis Kit 25 -
I OBAT DAN BMHP PROGRAM TB PARU
232 OAT Dosis Harian Tablet
233 OAT Kategori 1 Tablet 14 -
234 OAT Kategori Anak Tablet -
235 OAT Kombipak Tablet -
236 Kaca Slide Tablet 30 -
237 Kotak Slide Tablet 30
238 Pot Sputum Tablet 800 -
239 Reagen Zn Tablet 13
240 Tuberkulin/Mantoux Test Tablet 1 -
J OBAT DAN BMHP PROGRAM IMUNISASI
241 BCG Vial
242 DPT-HB-HIB Vial
243 DT Vial
244 Hb-0 Set
245 IPV Vial
246 MR Vial
247 OPV Vial
248 PCV Vial
249 Td Vial
250 Alat Suntik 0,05 mL Vial
251 Alat Suntik 0,5 mL Vial
252 Alat Suntik 5 mL Vial
253 Safety Box 2,5 L Vial
254 Safety Box 5 L Vial
255 N0pv 2 Vial
K OBAT DAN BMHP PROGRAM KEJIWAAN
256 Amytriptilin tab 25 mg Tablet
257 Clozapine 25 Tablet
258 Diazepam Injeksi Tablet
259 Haloperidol injeksi 5 mg / ml Tablet
260 Haloperidol tablet 0,5 mg Tablet
261 Haloperidol tablet 5 mg Tablet
Klorpromazin tablet/kaplet salut selaput
262 Tablet
100 mg
263 Risperidon tablet/kapsul/kaplet 2 mg Tablet
264 Trihexyphenidyl tab Tablet
265 Hallodeclanoate inj Tablet
L OBAT DAN BMHP PROGRAM GIZI
266 Tablet Tambah Darah Tablet
Kapsul
267 Vitamin A Biru (100.000 IU)
Lunak
 Kapsul
268 Vitamin A Merah (200.000 IU)
Lunak
M OBAT DAN BMHP PROGRAM KECACINGAN
269 Albendazol 400 mg Tablet
N OBAT DAN BMHP PROGRAM DIARE
270 Garam Oralit Tablet
271 Zink Tablet Tablet
O OBAT DAN BMHP PROGRAM RABIES
272 Vaksin Anti Rabies Vial
P OBAT DAN BMHP PROGRAM JKN
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
Q OBAT DAN BMHP PROGRAM PTM
296 Stik Gula Darah
297
298
299
Q OBAT DAN BMHP PROGRAM VAKSINASI COVID-19
300 Alkohol Swab Pcs
301 Auto Disable Syringe 0,3ml Pcs
302 Auto Disable Syringe 0,5ml Pcs
303 Auto Disable Syringe 3ml Pcs
304 Safety Box 5 L Pcs
305 ……
Mengetahui
Kepala UPT Puskesmas ….......

….........................
NIP. …............................
DAFTAR MUTASI PERSEDIAAN
PUSKESMAS ….........
PER 31 DESEMBER 2023

PENGADAAN (PENAMBAHAN) PEMAKAIAN (PENGURANGAN)

Februari Maret Jumlah Januari Februari Maret

6 7 8 = 5+6+7 9 10 11

-
-
-

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-

-
-
-
-
 -
-
N COVID-19 (BANTUAN PROPINSI)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
N COVID-19 (DANA REFOCUSING)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
GANAN COVID-19
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
- - - 6 8 11
-
 -
-
- - - 6 8 11

-
- - - 3 3 1
-
-
- - - 1 - 1
- 1 - 1
- - - 80 80 40
- 1
- - -

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-

-
-
-
-
-
-
NGURANGAN) SALDO AKHIR
PER 31 MARET
2023

Jumlah
12 = 9+10+11 13 = (4 + 8) - 12

- -
- -
- -

- -

- -
- -
- -

- -

- -

- -

- -

- -

- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
25 -
- -
- -
- -
25 -

- -
7 7
- -
- -
2 28
2 28
200 600
1 12
- 1

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
Pengelola Obat

…...........
NIP. .….........
 DAFTAR MUTASI
PUSKESMAS
PER 31 DESEM

VOLUME
NO URAIAN PERSEDIAAN SATUAN AWAL PER 1 PENGADAAN (PEN
APRIL 2023

April
1 2 3 4
5
A OBAT DAN BMHP RUTIN 2022

1 Alopurinol tablet/kapsul/kaplet 300 mg Tablet

2 Alprazolam tablet/kapsul/kaplet 1 mg Tablet
Amitriptilin tablet/kapsul/kaplet/tablet
3 Tablet
salut selaput 25 mg
Amlodipin besilate tablet/kapsul/kaplet 5
4 Tablet
mg
Amoksisilin kaptab 500 mg, kemasan
5 Kaplet
strip/blister (G)
6 Amoksisilin sirup kering 250 mg/5 ml Botol
Amoksisilin trihydrate 100 mg/ml
7 Botol
drops/sirup kering, botol 15 ml
Antasida, kombinasi: Aluminium
8 hidroksida 200 mg + Magnesium Botol
hidroksida 200 mg, suspensi
Antasida, kombinasi: Aluminium
9 hidroksida 200 mg + Magnesium Tablet
hidroksida 200 mg, tablet kunyah

Anti bakteri salep kombinasi: Basitrasin

10 Tube
500 IU/g + Polimiksin 10.000 IU/g

Antihemoroid, kombinasi sup: Bismut

11 subgalat heksaklorofenlidokain seng Supp
oksida (G)
Asam asetilsalisilat (Asetosal)
12 Tablet
tablet/kapsul/kaplet 80 mg
Asam askorbat (Vitamin C)
13 Tablet
tablet/kapsul/kaplet 50 mg
14 Asam folat tablet 1 mg Kaplet
Asam mefenamat tablet/kapsul/kaplet
15 Tablet
500 mg
ASERING Asetat Ringer / Ringer
16 Fls
Asetat, @ 500 ml
17 Asiklovir krim 5 % Tube
18 Atropin inj. 0,25 mg/ml (i.m./i.v./s.k) (G) Ampul
19 Bedak Salisil serbuk 2% 60 gr Sac
Betahistin mesylate tablet/kapsul/kaplet
20 Tablet
6 mg
21 Betametason valerat krim 0,1 % Tube
BIOSAT 1,5 Serum Antitetanus (A.T.S)
22 Ampul
injeksi 1.500 IU/ml (i.m.)
23 Deksametason injeksi 5 mg/ml Ampul
24 Deksametason tablet 0,5 mg Tablet
Dextrofen Syrup @ 60 ml,
Destromethorpan HBr,
25 Tablet
Dexclorpheniramine Maleate,
Pehenylephrine HCL
Diazepam enema 5 mg/2,5 mL, tube @
26 Botol
2,5 ml (G)
27 Diazepam injeksi 5 mg / ml Tablet
28 Diazepam tablet/kapsul/kaplet 2 mg Tablet
29 Difenhidramin injeksi 10 mg/ml Ampul
30 Domperidon suspensi 5 mg/5 ml Tube
31 Domperidon tablet/kapsul/kaplet 10 mg Tablet

32 DULCOLAX Bisakodil suppositoria 5 mg Tablet

33 Epinefrin (Adrenalin) injeksi 1 mg/ml Tablet
Eritromisin stearate tablet/kapsul/kaplet
34 Ampul
500 mg
35 Etil Klorida spray 100 ml Tablet
36 Eugenol cairan Tablet
37 Furosemid tablet 40 mg Botol
Garam Oralit kombinasi: Natrium klorida
0,52 g + Kalium klorida 0,30 g +
38 Trinatrium sitrat dihidrat 0,58 g + Ampul
Glukosa anhidrat 2,70 g, serbuk (G)
serbuk
39 Gentamycin sulfate tetes mata Fls
40 Glukosa larutan infus 5 % 500 mL Tablet
41 Hidrokortison acetate krim 2,5 % Tablet
Hustab syrup @ 60 ml, bromhexin HCL
42 Tablet
4 mg
43 Ibuprofen suspensi 100 mg/5 ml Botol
44 Ibuprofen tablet/kapsul/kaplet 200 mg Ampul
ILIADIN Oksimetazolin tetes hidung
45 Tablet
0,025 %
ILIADIN Oksimetazolin tetes hidung
46 Botol
0,05 %
47 Isosorbid dinitrat tablet/kaplet 5 mg Botol
48 Kalsium Laktat tablet 500 mg Tablet
 Karbogliserin (Phenol Glycerol) tetes
49 Botol
telinga 10%
Ketokonazol tablet/kapsul/kaplet 200
50 Botol
mg
Ketorolak tromethamine inj. 30 mg/ml
51 Ampul
(3%)
52 Klindamisin tablet/kapsul/kaplet 300 mg Tablet
53 Klorfeniramin maleat (CTM) tablet 4 mg Fls
54 Klozapin tablet/kapsul/kaplet 25 mg Tablet
Kotrimoksazol suspensi:
55 sulfametoksazol 200 mg + trimetoprim Tablet
40 mg
Kotrimoksazol tablet/kapsul/kaplet 480
56 Botol
mg
57 Lansoprazol tablet/kapsul/kaplet 30 mg Botol
Lidokain 2% + Epinefrin 1: 80.000, inj 2
58 Tablet
ml
59 Lidokain gel 2% Tablet
60 Loperamid tablet/kapsul/kaplet 2 mg Ampul
61 Loratadin tablet/kapsul/kaplet 10 mg Tablet
62 Metformin tablet/kapsul/kaplet 500 mg Tablet
63 Metillergometrin inj. 0,2 mg/ml Tablet
Metilprednisolon tablet/kapsul/kaplet 4
64 Tablet
mg
65 Metronidazol tablet 500 mg Tablet
66 Metronidazole suspensi 125 mg/5 ml Kiur
MgSO4 20 Magnesium sulfate /
Magnesium sulfate heptahydrate /
67 Tablet
Magnesium sulfat injeksi 20% V (i.v.) @
25 ml
68 NaCl 0,9% 500 ml Botol
N-asetil sistein tablet/kapsul/kaplet 200
69 Botol
mg
Natrium diklofenak tablet salut enterik /
70 Botol
kaplet salut enterik 50 mg
Nifedipin tablet lepas lambat / kaplet
71 Kotak
lepas lambat 30 mg
72 Nistatin suspensi 100.000 IU/ml Pcs
73 Oksitosin inj.10 IU/ml Botol
74 Omeprazol tablet/kapsul/kaplet 20 mg Pcs
75 Parasetamol drops 60 mg/0,6 ml Pcs
76 Parasetamol sirup 120 mg / 5 ml, 60 ml Pcs
77 Parasetamol tablet 500 mg pcs
 Povidon Iodin larutan 100 mg/ml, botol
78 Pcs
@ 60 cc
79 Prednison tablet/kapsul/kaplet 5 mg Pcs
80 Ranitidin injeksi 25 mg/ml bungkus
81 Ranitidin tablet/kapsul/kaplet 150 mg Pcs
82 Ringer Laktat 500 ml Pcs
83 Risperidon tablet/kapsul/kaplet 2 mg Botol
84 Sefadroksil 500 mg Pcs
85 Sefadroksil sirup kering 125 mg/5ml pcs
86 Setirizin sirup 5 mg/5 ml pcs
87 Setirizin tablet/kapsul/kaplet 10 mg Pcs
Sianokobalamin (Vitamin B 12)
88 Pcs
tablet/kapsul/kaplet 50 mcg
Sianokobalamin (Vitamin B12) injeksi
89 Pcs
500 mcg/mL

Simvastatin tablet/kapsul/kaplet/tablet
90 Pcs
salut selaput 10 mg
91 Siprofloksasin tablet 500 mg Kotak
92 Tetrasiklin tablet 500 mg Pcs
93 Tiamin tablet 50 mg Tablet
Triheksifenidil tablet/kapsul/kaplet/tablet
94 Respules
salut selaput 2 mg

VERORAB Vaksin Rabies, untuk

95 Ampul
manusia inj. 2,5 IU (s.k)
96 Vitamin B Kompleks tablet/kapsul/kaplet Kapsul
97 Zink sirup 20 mg / 5 ml Kapsul
98 Alkohol 70% ukuran 1 L Tablet
Aseptan Antiseptic Liquid with
99 Botol
Moisturizer For Hand Rub 500ml + disp
100 Blood Lancet Kotak
101 Catgut Chromic with Needle 3/0 Pcs
102 Chlorhexidine 4% 500 ml Tablet
Dermafix Plester Non Woven + Aborben
103 Botol
Pad 10 x 15 cm
104 Foley Catheter 2 Way, FR 16, FR 18 Tablet
I.V Cannula With Teflon Catheter 1 Way
105 Tablet
22 G
I.V Cannula With Teflon Catheter 1 Way
106 Tube
24 G
107 Infusion Set Anak Ampul
108 Infusion Set Dewasa Type Y/ST 03 Tablet
109 Kapas Pembalut 250 gr Tablet
110 Kasa 55,6 cm x 3,6 m Botol
111 Kasa SNA Steril 16 cm x 16 cm (16 pcs) Botol
112 Lysol Botol
Nitrile Examination Gloves - Free
113 Kotak
Powder
Plesterin Roll non woven roll 10 cm x 5
114 Roll
m
115 Silk Suture with Needle 2/0 PCS
116 Surgical Glove Powder Free Pcs
117 Surgical Mask Earloop, 3 ply Pcs
118 Syringe 3 cc Pcs
119 Syringe 5 cc Pcs
120 Total Cholesterol Test Strip Kotak
121 Urine Bag Pcs
122 Asam askorbat (Vitamin C) tab 250 mg Tablet
BRICASMA RESPULES Terbutaline
123 Respules
sulfate, cairan inhalasi 2,5 mg/ml
124 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
125 Retinol 100.000 IU Kapsul
126 Retinol 200.000 IU Kapsul
127 Sefiksim tablet 200 mg Tablet
128 Alkohol 95% 1 Liter Botol
129 Alkohol Swab 2-ply @ 100 pcs Kotak
Perban Elastis (Uniflex) 10 cm x 4,5 m /
130 Pcs
96
131 dst….................
132
133
134
B OBAT DAN BMHP RUTIN 2023
135 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
136 Furosemid tablet 40 mg Tablet
Ketokonazol tablet/kapsul/kaplet 200
137 Tablet
mg
Anastetik lokal gigi, kombinasi
138 KDT/FDC mengandung: Lidokain 2% + Ampul
Epinefrin 1: 80.000, inj 2 ml

139 Metformin tablet/kapsul/kaplet 500 mg Tablet

140 Piridoksin (Vitamin B6) tablet 10 mg Tablet
141 Salbutamol tablet 2 mg Tablet
Asetil sistein tablet/kapsul/kaplet 200
142 Tablet
mg
 Hustab Sirup @60 mL, Bromhexin HCl
143 Botol
4 mg
144 Strip Test Asam Urat Kotak
C OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (BANTUAN PR
145 Azitromisin 500 mg Tablet
146 Biostarch Tablet
147 Favipiravir Tablet
148 Goldtrion Tablet
149 HB-Vit Tablet
150 Immunace Tablet
151 Oseltamivir Tablet
152 Parasetamol 500 mg Tablet
153 Proxidan Tablet
154 Santa-E Tablet
155 Selcom C Tablet
156 Selviplex Tablet
157 Sivit Zink Tablet
158 Vitamin C 500 mg Tablet
159 Cover All Pcs
160 Face Shield Pcs
161 Gown Pcs
162 Handscoon Non Steril Kotak
163 Hand Sanitizer 100 mL Botol
164 Kacamata Goggle Pcs
165 Masker Bedah Pcs
166 Masker KN95 Pcs
167 Masker N95 Pcs
168 Hazmat Pcs
169 Sepatu Boot Pasang
D OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (DANA REFOC
170 NaCl 0,9% 500 ml Fls
171 Abocath Kateter IV Pcs
172 Antigen Test Pcs
173 Antigen Test Pcs
174 Baju Coveral ( APD) Pcs
175 Canule Nasal 2m Pcs
176 Handsanitizer Botol
177 Handscoon Non Steril Pcs
178 Handscoon Steril Pcs
179 Hazmat Pcs
180 Infusion Set Pcs
181 Infusion Set Anak Pcs
182 Infusion Set Dewasa Pcs
183 Kapas Pembalut Pcs
184 Kateter IV Pcs
185 Leukoplast Pcs
186 Masker Medis earloop Kotak
187 Masker Medis Pcs
188 Masker N95 Pcs
189 Masker N95 Pcs
190 Oxygen Mask Pcs
191 Sabun Pencuci Tangan Pcs
192 VTM Pcs
E BMHP PENGADAAN DAK NF PUSKESMAS
193 All Cover Pcs
194 Bayclin Pcs
195 Goggle Pcs
196 Handscoon Non Steril Pcs
197 Handscoon Steril Pcs
198 Masker N95 Pcs
199 Masker Surgical Pcs
200 Pembersih Tangan Pcs
201 Pencuci Tangan Pcs
202 Sepatu Boot Pasang
203 Shoe Cover Pcs
204 Surgical Gynaecology Pcs
F OBAT DAN BMHP BANTUAN LAINNYA DALAM RANGKA PENANGANAN COVID-19
205 Obat Isoman Paket 1 Paket
206 Obat Isoman Paket 2 Paket
207 Obat Isoman Paket 3 Paket
208 Face Shield Pcs
209 Hand Sanitizer 100 mL Botol
210 Hand Sanitizer 500 mL Botol
211 Handscoon Non Steril Pcs
212 Hazmat Pcs
213 Helm Pcs
214 Jas Hujan Pcs
215 Kacamata Goggle Pcs
216 Larutan Carbol 10 L Pcs
217 Masker Medis Pcs
218 Masker N95 Pcs
219 Masker KN95 Pcs
220 Plastik Pelindung Sepatu Pcs
221 Sabun Pencuci Tangan 5 L Pcs
222 Sepatu Boot Karet/ Safety Shoes Pcs
223 Shoe Cover Pcs
H OBAT DAN BMHP PROGRAM HIV
224 Lamivudine 150 Tablet
225 Dolutegravir Tablet
226 Rapid 1 HIV (SD Bioline) @ 100 test Test
227 Rapid 1 HIV (SD Bioline) @ 25 test Test -
228 Rapid 2 HIV (SD Bioline) @ 25 test Test
229 Rapid 3 HIV (SD Bioline) @ 25 test Test
230 Rapid HBsAg Kit -
231 Rapid Sifilis Kit -
I OBAT DAN BMHP PROGRAM TB PARU
232 OAT Dosis Harian Tablet
233 OAT Kategori 1 Tablet 7 -
234 OAT Kategori Anak Tablet - -
235 OAT Kombipak Tablet
236 Kaca Slide Tablet
237 Kotak Slide Tablet 600 -
238 Pot Sputum Tablet 12 -
239 Reagen Zn Tablet -
240 Tuberkulin/Mantoux Test Tablet 1 -
J OBAT DAN BMHP PROGRAM IMUNISASI
241 BCG Vial
242 DPT-HB-HIB Vial
243 DT Vial
244 Hb-0 Set
245 IPV Vial
246 MR Vial
247 OPV Vial
248 PCV Vial
249 Td Vial
250 Alat Suntik 0,05 mL Vial
251 Alat Suntik 0,5 mL Vial
252 Alat Suntik 5 mL Vial
253 Safety Box 2,5 L Vial
254 Safety Box 5 L Vial
255 N0pv 2 Vial
K OBAT DAN BMHP PROGRAM KEJIWAAN
256 Amytriptilin tab 25 mg Tablet
257 Clozapine 25 Tablet
258 Diazepam Injeksi Tablet
259 Haloperidol injeksi 5 mg / ml Tablet
260 Haloperidol tablet 0,5 mg Tablet
261 Haloperidol tablet 5 mg Tablet
Klorpromazin tablet/kaplet salut selaput
262 Tablet
100 mg
263 Risperidon tablet/kapsul/kaplet 2 mg Tablet
264 Trihexyphenidyl tab Tablet
265 Hallodeclanoate inj Tablet
L OBAT DAN BMHP PROGRAM GIZI
266 Tablet Tambah Darah Tablet
Kapsul
267 Vitamin A Biru (100.000 IU)
Lunak
 Kapsul
268 Vitamin A Merah (200.000 IU)
Lunak
M OBAT DAN BMHP PROGRAM KECACINGAN
269 Albendazol 400 mg Tablet
N OBAT DAN BMHP PROGRAM DIARE
270 Garam Oralit Tablet
271 Zink Tablet Tablet
O OBAT DAN BMHP PROGRAM RABIES
272 Vaksin Anti Rabies Vial
P OBAT DAN BMHP PROGRAM JKN
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
Q OBAT DAN BMHP PROGRAM PTM
296 Stik Gula Darah
297
298
299
Q OBAT DAN BMHP PROGRAM VAKSINASI COVID-19
300 Alkohol Swab Pcs
301 Auto Disable Syringe 0,3ml Pcs
302 Auto Disable Syringe 0,5ml Pcs
303 Auto Disable Syringe 3ml Pcs
304 Safety Box 5 L Pcs
305 ……
Mengetahui
Kepala UPT Puskesmas ….......

….........................
NIP. …............................
DAFTAR MUTASI PERSEDIAAN
PUSKESMAS ….........
PER 31 DESEMBER 2023

PENGADAAN (PENAMBAHAN) PEMAKAIAN (PENGURANGAN)

Mei Juni Jumlah April Mei Juni

6 7 8 = 5+6+7 9 10 11

-
-
-

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-

-
-
-
-
 -
-
N COVID-19 (BANTUAN PROPINSI)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
N COVID-19 (DANA REFOCUSING)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
GANAN COVID-19
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
50 50 12 15 13
-
 -
- - - -
50 50 12 15 13

-
- - 100 1 5 1
- 3 3 - 2 -
-
-
- - - 40 50 60
- - - 1 - 1
-
- - - - 1

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-

-
-
-
-
-
-
NGURANGAN) SALDO AKHIR
PER 31 JUNI
2023

Jumlah
12 = 9+10+11 13 = (4 + 8) - 12

- -
- -
- -

- -

- -
- -
- -

- -

- -

- -

- -

- -

- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
40 10
- -
 - -
- -
40 10
-
- -
7 -
2 1
- -
- -
150 450
2 10
- -
1 -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
Pengelola Obat

…...........
NIP. .….........
 DAFTAR MUTASI
PUSKESMAS
PER 31 DESEM

VOLUME
NO URAIAN PERSEDIAAN SATUAN AWAL PER 1 PENGADAAN (PEN
JULI 2023

Juli
1 2 3 4
5
A OBAT DAN BMHP RUTIN 2022

1 Alopurinol tablet/kapsul/kaplet 300 mg Tablet

2 Alprazolam tablet/kapsul/kaplet 1 mg Tablet
Amitriptilin tablet/kapsul/kaplet/tablet
3 Tablet
salut selaput 25 mg
Amlodipin besilate tablet/kapsul/kaplet 5
4 Tablet
mg
Amoksisilin kaptab 500 mg, kemasan
5 Kaplet
strip/blister (G)
6 Amoksisilin sirup kering 250 mg/5 ml Botol
Amoksisilin trihydrate 100 mg/ml
7 Botol
drops/sirup kering, botol 15 ml
Antasida, kombinasi: Aluminium
8 hidroksida 200 mg + Magnesium Botol
hidroksida 200 mg, suspensi
Antasida, kombinasi: Aluminium
9 hidroksida 200 mg + Magnesium Tablet
hidroksida 200 mg, tablet kunyah

Anti bakteri salep kombinasi: Basitrasin

10 Tube
500 IU/g + Polimiksin 10.000 IU/g

Antihemoroid, kombinasi sup: Bismut

11 subgalat heksaklorofenlidokain seng Supp
oksida (G)
Asam asetilsalisilat (Asetosal)
12 Tablet
tablet/kapsul/kaplet 80 mg
Asam askorbat (Vitamin C)
13 Tablet
tablet/kapsul/kaplet 50 mg
14 Asam folat tablet 1 mg Kaplet
Asam mefenamat tablet/kapsul/kaplet
15 Tablet
500 mg
ASERING Asetat Ringer / Ringer
16 Fls
Asetat, @ 500 ml
17 Asiklovir krim 5 % Tube
18 Atropin inj. 0,25 mg/ml (i.m./i.v./s.k) (G) Ampul
19 Bedak Salisil serbuk 2% 60 gr Sac
Betahistin mesylate tablet/kapsul/kaplet
20 Tablet
6 mg
21 Betametason valerat krim 0,1 % Tube
BIOSAT 1,5 Serum Antitetanus (A.T.S)
22 Ampul
injeksi 1.500 IU/ml (i.m.)
23 Deksametason injeksi 5 mg/ml Ampul
24 Deksametason tablet 0,5 mg Tablet
Dextrofen Syrup @ 60 ml,
Destromethorpan HBr,
25 Tablet
Dexclorpheniramine Maleate,
Pehenylephrine HCL
Diazepam enema 5 mg/2,5 mL, tube @
26 Botol
2,5 ml (G)
27 Diazepam injeksi 5 mg / ml Tablet
28 Diazepam tablet/kapsul/kaplet 2 mg Tablet
29 Difenhidramin injeksi 10 mg/ml Ampul
30 Domperidon suspensi 5 mg/5 ml Tube
31 Domperidon tablet/kapsul/kaplet 10 mg Tablet

32 DULCOLAX Bisakodil suppositoria 5 mg Tablet

33 Epinefrin (Adrenalin) injeksi 1 mg/ml Tablet
Eritromisin stearate tablet/kapsul/kaplet
34 Ampul
500 mg
35 Etil Klorida spray 100 ml Tablet
36 Eugenol cairan Tablet
37 Furosemid tablet 40 mg Botol
Garam Oralit kombinasi: Natrium klorida
0,52 g + Kalium klorida 0,30 g +
38 Trinatrium sitrat dihidrat 0,58 g + Ampul
Glukosa anhidrat 2,70 g, serbuk (G)
serbuk
39 Gentamycin sulfate tetes mata Fls
40 Glukosa larutan infus 5 % 500 mL Tablet
41 Hidrokortison acetate krim 2,5 % Tablet
Hustab syrup @ 60 ml, bromhexin HCL
42 Tablet
4 mg
43 Ibuprofen suspensi 100 mg/5 ml Botol
44 Ibuprofen tablet/kapsul/kaplet 200 mg Ampul
ILIADIN Oksimetazolin tetes hidung
45 Tablet
0,025 %
ILIADIN Oksimetazolin tetes hidung
46 Botol
0,05 %
47 Isosorbid dinitrat tablet/kaplet 5 mg Botol
48 Kalsium Laktat tablet 500 mg Tablet
 Karbogliserin (Phenol Glycerol) tetes
49 Botol
telinga 10%
Ketokonazol tablet/kapsul/kaplet 200
50 Botol
mg
Ketorolak tromethamine inj. 30 mg/ml
51 Ampul
(3%)
52 Klindamisin tablet/kapsul/kaplet 300 mg Tablet
53 Klorfeniramin maleat (CTM) tablet 4 mg Fls
54 Klozapin tablet/kapsul/kaplet 25 mg Tablet
Kotrimoksazol suspensi:
55 sulfametoksazol 200 mg + trimetoprim Tablet
40 mg
Kotrimoksazol tablet/kapsul/kaplet 480
56 Botol
mg
57 Lansoprazol tablet/kapsul/kaplet 30 mg Botol
Lidokain 2% + Epinefrin 1: 80.000, inj 2
58 Tablet
ml
59 Lidokain gel 2% Tablet
60 Loperamid tablet/kapsul/kaplet 2 mg Ampul
61 Loratadin tablet/kapsul/kaplet 10 mg Tablet
62 Metformin tablet/kapsul/kaplet 500 mg Tablet
63 Metillergometrin inj. 0,2 mg/ml Tablet
Metilprednisolon tablet/kapsul/kaplet 4
64 Tablet
mg
65 Metronidazol tablet 500 mg Tablet
66 Metronidazole suspensi 125 mg/5 ml Kiur
MgSO4 20 Magnesium sulfate /
Magnesium sulfate heptahydrate /
67 Tablet
Magnesium sulfat injeksi 20% V (i.v.) @
25 ml
68 NaCl 0,9% 500 ml Botol
N-asetil sistein tablet/kapsul/kaplet 200
69 Botol
mg
Natrium diklofenak tablet salut enterik /
70 Botol
kaplet salut enterik 50 mg
Nifedipin tablet lepas lambat / kaplet
71 Kotak
lepas lambat 30 mg
72 Nistatin suspensi 100.000 IU/ml Pcs
73 Oksitosin inj.10 IU/ml Botol
74 Omeprazol tablet/kapsul/kaplet 20 mg Pcs
75 Parasetamol drops 60 mg/0,6 ml Pcs
76 Parasetamol sirup 120 mg / 5 ml, 60 ml Pcs
77 Parasetamol tablet 500 mg pcs
 Povidon Iodin larutan 100 mg/ml, botol
78 Pcs
@ 60 cc
79 Prednison tablet/kapsul/kaplet 5 mg Pcs
80 Ranitidin injeksi 25 mg/ml bungkus
81 Ranitidin tablet/kapsul/kaplet 150 mg Pcs
82 Ringer Laktat 500 ml Pcs
83 Risperidon tablet/kapsul/kaplet 2 mg Botol
84 Sefadroksil 500 mg Pcs
85 Sefadroksil sirup kering 125 mg/5ml pcs
86 Setirizin sirup 5 mg/5 ml pcs
87 Setirizin tablet/kapsul/kaplet 10 mg Pcs
Sianokobalamin (Vitamin B 12)
88 Pcs
tablet/kapsul/kaplet 50 mcg
Sianokobalamin (Vitamin B12) injeksi
89 Pcs
500 mcg/mL

Simvastatin tablet/kapsul/kaplet/tablet
90 Pcs
salut selaput 10 mg
91 Siprofloksasin tablet 500 mg Kotak
92 Tetrasiklin tablet 500 mg Pcs
93 Tiamin tablet 50 mg Tablet
Triheksifenidil tablet/kapsul/kaplet/tablet
94 Respules
salut selaput 2 mg

VERORAB Vaksin Rabies, untuk

95 Ampul
manusia inj. 2,5 IU (s.k)
96 Vitamin B Kompleks tablet/kapsul/kaplet Kapsul
97 Zink sirup 20 mg / 5 ml Kapsul
98 Alkohol 70% ukuran 1 L Tablet
Aseptan Antiseptic Liquid with
99 Botol
Moisturizer For Hand Rub 500ml + disp
100 Blood Lancet Kotak
101 Catgut Chromic with Needle 3/0 Pcs
102 Chlorhexidine 4% 500 ml Tablet
Dermafix Plester Non Woven + Aborben
103 Botol
Pad 10 x 15 cm
104 Foley Catheter 2 Way, FR 16, FR 18 Tablet
I.V Cannula With Teflon Catheter 1 Way
105 Tablet
22 G
I.V Cannula With Teflon Catheter 1 Way
106 Tube
24 G
107 Infusion Set Anak Ampul
108 Infusion Set Dewasa Type Y/ST 03 Tablet
109 Kapas Pembalut 250 gr Tablet
110 Kasa 55,6 cm x 3,6 m Botol
111 Kasa SNA Steril 16 cm x 16 cm (16 pcs) Botol
112 Lysol Botol
Nitrile Examination Gloves - Free
113 Kotak
Powder
Plesterin Roll non woven roll 10 cm x 5
114 Roll
m
115 Silk Suture with Needle 2/0 PCS
116 Surgical Glove Powder Free Pcs
117 Surgical Mask Earloop, 3 ply Pcs
118 Syringe 3 cc Pcs
119 Syringe 5 cc Pcs
120 Total Cholesterol Test Strip Kotak
121 Urine Bag Pcs
122 Asam askorbat (Vitamin C) tab 250 mg Tablet
BRICASMA RESPULES Terbutaline
123 Respules
sulfate, cairan inhalasi 2,5 mg/ml
124 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
125 Retinol 100.000 IU Kapsul
126 Retinol 200.000 IU Kapsul
127 Sefiksim tablet 200 mg Tablet
128 Alkohol 95% 1 Liter Botol
129 Alkohol Swab 2-ply @ 100 pcs Kotak
Perban Elastis (Uniflex) 10 cm x 4,5 m /
130 Pcs
96
131 dst….................
132
133
134
B OBAT DAN BMHP RUTIN 2023
135 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
136 Furosemid tablet 40 mg Tablet
Ketokonazol tablet/kapsul/kaplet 200
137 Tablet
mg
Anastetik lokal gigi, kombinasi
138 KDT/FDC mengandung: Lidokain 2% + Ampul
Epinefrin 1: 80.000, inj 2 ml

139 Metformin tablet/kapsul/kaplet 500 mg Tablet

140 Piridoksin (Vitamin B6) tablet 10 mg Tablet
141 Salbutamol tablet 2 mg Tablet
Asetil sistein tablet/kapsul/kaplet 200
142 Tablet
mg
 Hustab Sirup @60 mL, Bromhexin HCl
143 Botol
4 mg
144 Strip Test Asam Urat Kotak
C OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (BANTUAN PR
145 Azitromisin 500 mg Tablet
146 Biostarch Tablet
147 Favipiravir Tablet
148 Goldtrion Tablet
149 HB-Vit Tablet
150 Immunace Tablet
151 Oseltamivir Tablet
152 Parasetamol 500 mg Tablet
153 Proxidan Tablet
154 Santa-E Tablet
155 Selcom C Tablet
156 Selviplex Tablet
157 Sivit Zink Tablet
158 Vitamin C 500 mg Tablet
159 Cover All Pcs
160 Face Shield Pcs
161 Gown Pcs
162 Handscoon Non Steril Kotak
163 Hand Sanitizer 100 mL Botol
164 Kacamata Goggle Pcs
165 Masker Bedah Pcs
166 Masker KN95 Pcs
167 Masker N95 Pcs
168 Hazmat Pcs
169 Sepatu Boot Pasang
D OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (DANA REFOC
170 NaCl 0,9% 500 ml Fls
171 Abocath Kateter IV Pcs
172 Antigen Test Pcs
173 Antigen Test Pcs
174 Baju Coveral ( APD) Pcs
175 Canule Nasal 2m Pcs
176 Handsanitizer Botol
177 Handscoon Non Steril Pcs
178 Handscoon Steril Pcs
179 Hazmat Pcs
180 Infusion Set Pcs
181 Infusion Set Anak Pcs
182 Infusion Set Dewasa Pcs
183 Kapas Pembalut Pcs
184 Kateter IV Pcs
185 Leukoplast Pcs
186 Masker Medis earloop Kotak
187 Masker Medis Pcs
188 Masker N95 Pcs
189 Masker N95 Pcs
190 Oxygen Mask Pcs
191 Sabun Pencuci Tangan Pcs
192 VTM Pcs
E BMHP PENGADAAN DAK NF PUSKESMAS
193 All Cover Pcs
194 Bayclin Pcs
195 Goggle Pcs
196 Handscoon Non Steril Pcs
197 Handscoon Steril Pcs
198 Masker N95 Pcs
199 Masker Surgical Pcs
200 Pembersih Tangan Pcs
201 Pencuci Tangan Pcs
202 Sepatu Boot Pasang
203 Shoe Cover Pcs
204 Surgical Gynaecology Pcs
F OBAT DAN BMHP BANTUAN LAINNYA DALAM RANGKA PENANGANAN COVID-19
205 Obat Isoman Paket 1 Paket
206 Obat Isoman Paket 2 Paket
207 Obat Isoman Paket 3 Paket
208 Face Shield Pcs
209 Hand Sanitizer 100 mL Botol
210 Hand Sanitizer 500 mL Botol
211 Handscoon Non Steril Pcs
212 Hazmat Pcs
213 Helm Pcs
214 Jas Hujan Pcs
215 Kacamata Goggle Pcs
216 Larutan Carbol 10 L Pcs
217 Masker Medis Pcs
218 Masker N95 Pcs
219 Masker KN95 Pcs
220 Plastik Pelindung Sepatu Pcs
221 Sabun Pencuci Tangan 5 L Pcs
222 Sepatu Boot Karet/ Safety Shoes Pcs
223 Shoe Cover Pcs
H OBAT DAN BMHP PROGRAM HIV
224 Lamivudine 150 Tablet
225 Dolutegravir Tablet
226 Rapid 1 HIV (SD Bioline) @ 100 test Test 10
227 Rapid 1 HIV (SD Bioline) @ 25 test Test
228 Rapid 2 HIV (SD Bioline) @ 25 test Test
229 Rapid 3 HIV (SD Bioline) @ 25 test Test
230 Rapid HBsAg Kit
231 Rapid Sifilis Kit 10
I OBAT DAN BMHP PROGRAM TB PARU
232 OAT Dosis Harian Tablet
233 OAT Kategori 1 Tablet -
234 OAT Kategori Anak Tablet
235 OAT Kombipak Tablet -
236 Kaca Slide Tablet
237 Kotak Slide Tablet 450 -
238 Pot Sputum Tablet
239 Reagen Zn Tablet 12 -
240 Tuberkulin/Mantoux Test Tablet
J OBAT DAN BMHP PROGRAM IMUNISASI
241 BCG Vial
242 DPT-HB-HIB Vial
243 DT Vial
244 Hb-0 Set
245 IPV Vial
246 MR Vial
247 OPV Vial
248 PCV Vial
249 Td Vial
250 Alat Suntik 0,05 mL Vial
251 Alat Suntik 0,5 mL Vial
252 Alat Suntik 5 mL Vial
253 Safety Box 2,5 L Vial
254 Safety Box 5 L Vial
255 N0pv 2 Vial
K OBAT DAN BMHP PROGRAM KEJIWAAN
256 Amytriptilin tab 25 mg Tablet
257 Clozapine 25 Tablet
258 Diazepam Injeksi Tablet
259 Haloperidol injeksi 5 mg / ml Tablet
260 Haloperidol tablet 0,5 mg Tablet
261 Haloperidol tablet 5 mg Tablet
Klorpromazin tablet/kaplet salut selaput
262 Tablet
100 mg
263 Risperidon tablet/kapsul/kaplet 2 mg Tablet
264 Trihexyphenidyl tab Tablet
265 Hallodeclanoate inj Tablet
L OBAT DAN BMHP PROGRAM GIZI
266 Tablet Tambah Darah Tablet
Kapsul
267 Vitamin A Biru (100.000 IU)
Lunak
 Kapsul
268 Vitamin A Merah (200.000 IU)
Lunak
M OBAT DAN BMHP PROGRAM KECACINGAN
269 Albendazol 400 mg Tablet
N OBAT DAN BMHP PROGRAM DIARE
270 Garam Oralit Tablet
271 Zink Tablet Tablet
O OBAT DAN BMHP PROGRAM RABIES
272 Vaksin Anti Rabies Vial
P OBAT DAN BMHP PROGRAM JKN
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
Q OBAT DAN BMHP PROGRAM PTM
296 Stik Gula Darah
297
298
299
Q OBAT DAN BMHP PROGRAM VAKSINASI COVID-19
300 Alkohol Swab Pcs
301 Auto Disable Syringe 0,3ml Pcs
302 Auto Disable Syringe 0,5ml Pcs
303 Auto Disable Syringe 3ml Pcs
304 Safety Box 5 L Pcs
305 ……
Mengetahui
Kepala UPT Puskesmas ….......

….........................
NIP. …............................
DAFTAR MUTASI PERSEDIAAN
PUSKESMAS ….........
PER 31 DESEMBER 2023

PENGADAAN (PENAMBAHAN) PEMAKAIAN (PENGURANGAN)

Agustus September Jumlah Juli Agustus September

6 7 8 = 5+6+7 9 10 11

-
-
-

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-

-
-
-
-
 -
-
N COVID-19 (BANTUAN PROPINSI)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
N COVID-19 (DANA REFOCUSING)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
GANAN COVID-19
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
75 75 20 21 20
-
-
 -
-
75 75 20 21 20
-
-
- 4 4 - 2 2
-
-
-
200 - 200 36 50 60
-
- - - 1 - 1
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-

-
-
-
-
-
-
 SALDO AKHIR
NGURANGAN) PER 31
SEPTEMBER
2023
Jumlah
12 = 9+10+11 13 = (4 + 8) - 12

- -
- -
- -

- -

- -
- -
- -

- -

- -

- -

- -

- -

- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
61 24
- -
- -
- -
- -
61 24

- -
4 -
- -
- -
- -
146 504
- -
2 10
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
Pengelola Obat

…...........
NIP. .….........
 DAFTAR MUTASI
PUSKESMAS
PER 31 DESEM

VOLUME
AWAL PER 1
NO URAIAN PERSEDIAAN SATUAN PENGADAAN (PEN
OKTOBER
2023

Oktober
1 2 3 4
5
A OBAT DAN BMHP RUTIN 2022

1 Alopurinol tablet/kapsul/kaplet 300 mg Tablet

2 Alprazolam tablet/kapsul/kaplet 1 mg Tablet
Amitriptilin tablet/kapsul/kaplet/tablet
3 Tablet
salut selaput 25 mg
Amlodipin besilate tablet/kapsul/kaplet 5
4 Tablet
mg
Amoksisilin kaptab 500 mg, kemasan
5 Kaplet
strip/blister (G)
6 Amoksisilin sirup kering 250 mg/5 ml Botol
Amoksisilin trihydrate 100 mg/ml
7 Botol
drops/sirup kering, botol 15 ml
Antasida, kombinasi: Aluminium
8 hidroksida 200 mg + Magnesium Botol
hidroksida 200 mg, suspensi
Antasida, kombinasi: Aluminium
9 hidroksida 200 mg + Magnesium Tablet
hidroksida 200 mg, tablet kunyah

Anti bakteri salep kombinasi: Basitrasin

10 Tube
500 IU/g + Polimiksin 10.000 IU/g

Antihemoroid, kombinasi sup: Bismut

11 subgalat heksaklorofenlidokain seng Supp
oksida (G)
Asam asetilsalisilat (Asetosal)
12 Tablet
tablet/kapsul/kaplet 80 mg
Asam askorbat (Vitamin C)
13 Tablet
tablet/kapsul/kaplet 50 mg
14 Asam folat tablet 1 mg Kaplet
Asam mefenamat tablet/kapsul/kaplet
15 Tablet
500 mg
ASERING Asetat Ringer / Ringer
16 Fls
Asetat, @ 500 ml
17 Asiklovir krim 5 % Tube
18 Atropin inj. 0,25 mg/ml (i.m./i.v./s.k) (G) Ampul
19 Bedak Salisil serbuk 2% 60 gr Sac
Betahistin mesylate tablet/kapsul/kaplet
20 Tablet
6 mg
21 Betametason valerat krim 0,1 % Tube
BIOSAT 1,5 Serum Antitetanus (A.T.S)
22 Ampul
injeksi 1.500 IU/ml (i.m.)
23 Deksametason injeksi 5 mg/ml Ampul
24 Deksametason tablet 0,5 mg Tablet
Dextrofen Syrup @ 60 ml,
Destromethorpan HBr,
25 Tablet
Dexclorpheniramine Maleate,
Pehenylephrine HCL
Diazepam enema 5 mg/2,5 mL, tube @
26 Botol
2,5 ml (G)
27 Diazepam injeksi 5 mg / ml Tablet
28 Diazepam tablet/kapsul/kaplet 2 mg Tablet
29 Difenhidramin injeksi 10 mg/ml Ampul
30 Domperidon suspensi 5 mg/5 ml Tube
31 Domperidon tablet/kapsul/kaplet 10 mg Tablet

32 DULCOLAX Bisakodil suppositoria 5 mg Tablet

33 Epinefrin (Adrenalin) injeksi 1 mg/ml Tablet
Eritromisin stearate tablet/kapsul/kaplet
34 Ampul
500 mg
35 Etil Klorida spray 100 ml Tablet
36 Eugenol cairan Tablet
37 Furosemid tablet 40 mg Botol
Garam Oralit kombinasi: Natrium klorida
0,52 g + Kalium klorida 0,30 g +
38 Trinatrium sitrat dihidrat 0,58 g + Ampul
Glukosa anhidrat 2,70 g, serbuk (G)
serbuk
39 Gentamycin sulfate tetes mata Fls
40 Glukosa larutan infus 5 % 500 mL Tablet
41 Hidrokortison acetate krim 2,5 % Tablet
Hustab syrup @ 60 ml, bromhexin HCL
42 Tablet
4 mg
43 Ibuprofen suspensi 100 mg/5 ml Botol
44 Ibuprofen tablet/kapsul/kaplet 200 mg Ampul
ILIADIN Oksimetazolin tetes hidung
45 Tablet
0,025 %
ILIADIN Oksimetazolin tetes hidung
46 Botol
0,05 %
47 Isosorbid dinitrat tablet/kaplet 5 mg Botol
48 Kalsium Laktat tablet 500 mg Tablet
 Karbogliserin (Phenol Glycerol) tetes
49 Botol
telinga 10%
Ketokonazol tablet/kapsul/kaplet 200
50 Botol
mg
Ketorolak tromethamine inj. 30 mg/ml
51 Ampul
(3%)
52 Klindamisin tablet/kapsul/kaplet 300 mg Tablet
53 Klorfeniramin maleat (CTM) tablet 4 mg Fls
54 Klozapin tablet/kapsul/kaplet 25 mg Tablet
Kotrimoksazol suspensi:
55 sulfametoksazol 200 mg + trimetoprim Tablet
40 mg
Kotrimoksazol tablet/kapsul/kaplet 480
56 Botol
mg
57 Lansoprazol tablet/kapsul/kaplet 30 mg Botol
Lidokain 2% + Epinefrin 1: 80.000, inj 2
58 Tablet
ml
59 Lidokain gel 2% Tablet
60 Loperamid tablet/kapsul/kaplet 2 mg Ampul
61 Loratadin tablet/kapsul/kaplet 10 mg Tablet
62 Metformin tablet/kapsul/kaplet 500 mg Tablet
63 Metillergometrin inj. 0,2 mg/ml Tablet
Metilprednisolon tablet/kapsul/kaplet 4
64 Tablet
mg
65 Metronidazol tablet 500 mg Tablet
66 Metronidazole suspensi 125 mg/5 ml Kiur
MgSO4 20 Magnesium sulfate /
Magnesium sulfate heptahydrate /
67 Tablet
Magnesium sulfat injeksi 20% V (i.v.) @
25 ml
68 NaCl 0,9% 500 ml Botol
N-asetil sistein tablet/kapsul/kaplet 200
69 Botol
mg
Natrium diklofenak tablet salut enterik /
70 Botol
kaplet salut enterik 50 mg
Nifedipin tablet lepas lambat / kaplet
71 Kotak
lepas lambat 30 mg
72 Nistatin suspensi 100.000 IU/ml Pcs
73 Oksitosin inj.10 IU/ml Botol
74 Omeprazol tablet/kapsul/kaplet 20 mg Pcs
75 Parasetamol drops 60 mg/0,6 ml Pcs
76 Parasetamol sirup 120 mg / 5 ml, 60 ml Pcs
77 Parasetamol tablet 500 mg pcs
 Povidon Iodin larutan 100 mg/ml, botol
78 Pcs
@ 60 cc
79 Prednison tablet/kapsul/kaplet 5 mg Pcs
80 Ranitidin injeksi 25 mg/ml bungkus
81 Ranitidin tablet/kapsul/kaplet 150 mg Pcs
82 Ringer Laktat 500 ml Pcs
83 Risperidon tablet/kapsul/kaplet 2 mg Botol
84 Sefadroksil 500 mg Pcs
85 Sefadroksil sirup kering 125 mg/5ml pcs
86 Setirizin sirup 5 mg/5 ml pcs
87 Setirizin tablet/kapsul/kaplet 10 mg Pcs
Sianokobalamin (Vitamin B 12)
88 Pcs
tablet/kapsul/kaplet 50 mcg
Sianokobalamin (Vitamin B12) injeksi
89 Pcs
500 mcg/mL

Simvastatin tablet/kapsul/kaplet/tablet
90 Pcs
salut selaput 10 mg
91 Siprofloksasin tablet 500 mg Kotak
92 Tetrasiklin tablet 500 mg Pcs
93 Tiamin tablet 50 mg Tablet
Triheksifenidil tablet/kapsul/kaplet/tablet
94 Respules
salut selaput 2 mg

VERORAB Vaksin Rabies, untuk

95 Ampul
manusia inj. 2,5 IU (s.k)
96 Vitamin B Kompleks tablet/kapsul/kaplet Kapsul
97 Zink sirup 20 mg / 5 ml Kapsul
98 Alkohol 70% ukuran 1 L Tablet
Aseptan Antiseptic Liquid with
99 Botol
Moisturizer For Hand Rub 500ml + disp
100 Blood Lancet Kotak
101 Catgut Chromic with Needle 3/0 Pcs
102 Chlorhexidine 4% 500 ml Tablet
Dermafix Plester Non Woven + Aborben
103 Botol
Pad 10 x 15 cm
104 Foley Catheter 2 Way, FR 16, FR 18 Tablet
I.V Cannula With Teflon Catheter 1 Way
105 Tablet
22 G
I.V Cannula With Teflon Catheter 1 Way
106 Tube
24 G
107 Infusion Set Anak Ampul
108 Infusion Set Dewasa Type Y/ST 03 Tablet
109 Kapas Pembalut 250 gr Tablet
110 Kasa 55,6 cm x 3,6 m Botol
111 Kasa SNA Steril 16 cm x 16 cm (16 pcs) Botol
112 Lysol Botol
Nitrile Examination Gloves - Free
113 Kotak
Powder
Plesterin Roll non woven roll 10 cm x 5
114 Roll
m
115 Silk Suture with Needle 2/0 PCS
116 Surgical Glove Powder Free Pcs
117 Surgical Mask Earloop, 3 ply Pcs
118 Syringe 3 cc Pcs
119 Syringe 5 cc Pcs
120 Total Cholesterol Test Strip Kotak
121 Urine Bag Pcs
122 Asam askorbat (Vitamin C) tab 250 mg Tablet
BRICASMA RESPULES Terbutaline
123 Respules
sulfate, cairan inhalasi 2,5 mg/ml
124 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
125 Retinol 100.000 IU Kapsul
126 Retinol 200.000 IU Kapsul
127 Sefiksim tablet 200 mg Tablet
128 Alkohol 95% 1 Liter Botol
129 Alkohol Swab 2-ply @ 100 pcs Kotak
Perban Elastis (Uniflex) 10 cm x 4,5 m /
130 Pcs
96
131 dst….................
132
133
134
B OBAT DAN BMHP RUTIN 2023
135 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
136 Furosemid tablet 40 mg Tablet
Ketokonazol tablet/kapsul/kaplet 200
137 Tablet
mg
Anastetik lokal gigi, kombinasi
138 KDT/FDC mengandung: Lidokain 2% + Ampul
Epinefrin 1: 80.000, inj 2 ml

139 Metformin tablet/kapsul/kaplet 500 mg Tablet

140 Piridoksin (Vitamin B6) tablet 10 mg Tablet
141 Salbutamol tablet 2 mg Tablet
Asetil sistein tablet/kapsul/kaplet 200
142 Tablet
mg
 Hustab Sirup @60 mL, Bromhexin HCl
143 Botol
4 mg
144 Strip Test Asam Urat Kotak
C OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (BANTUAN PR
145 Azitromisin 500 mg Tablet
146 Biostarch Tablet
147 Favipiravir Tablet
148 Goldtrion Tablet
149 HB-Vit Tablet
150 Immunace Tablet
151 Oseltamivir Tablet
152 Parasetamol 500 mg Tablet
153 Proxidan Tablet
154 Santa-E Tablet
155 Selcom C Tablet
156 Selviplex Tablet
157 Sivit Zink Tablet
158 Vitamin C 500 mg Tablet
159 Cover All Pcs
160 Face Shield Pcs
161 Gown Pcs
162 Handscoon Non Steril Kotak
163 Hand Sanitizer 100 mL Botol
164 Kacamata Goggle Pcs
165 Masker Bedah Pcs
166 Masker KN95 Pcs
167 Masker N95 Pcs
168 Hazmat Pcs
169 Sepatu Boot Pasang
D OBAT DAN BMHP PENGADAAN DALAM RANGKA PENANGANAN COVID-19 (DANA REFOC
170 NaCl 0,9% 500 ml Fls
171 Abocath Kateter IV Pcs
172 Antigen Test Pcs
173 Antigen Test Pcs
174 Baju Coveral ( APD) Pcs
175 Canule Nasal 2m Pcs
176 Handsanitizer Botol
177 Handscoon Non Steril Pcs
178 Handscoon Steril Pcs
179 Hazmat Pcs
180 Infusion Set Pcs
181 Infusion Set Anak Pcs
182 Infusion Set Dewasa Pcs
183 Kapas Pembalut Pcs
184 Kateter IV Pcs
185 Leukoplast Pcs
186 Masker Medis earloop Kotak
187 Masker Medis Pcs
188 Masker N95 Pcs
189 Masker N95 Pcs
190 Oxygen Mask Pcs
191 Sabun Pencuci Tangan Pcs
192 VTM Pcs
E BMHP PENGADAAN DAK NF PUSKESMAS
193 All Cover Pcs
194 Bayclin Pcs
195 Goggle Pcs
196 Handscoon Non Steril Pcs
197 Handscoon Steril Pcs
198 Masker N95 Pcs
199 Masker Surgical Pcs
200 Pembersih Tangan Pcs
201 Pencuci Tangan Pcs
202 Sepatu Boot Pasang
203 Shoe Cover Pcs
204 Surgical Gynaecology Pcs
F OBAT DAN BMHP BANTUAN LAINNYA DALAM RANGKA PENANGANAN COVID-19
205 Obat Isoman Paket 1 Paket
206 Obat Isoman Paket 2 Paket
207 Obat Isoman Paket 3 Paket
208 Face Shield Pcs
209 Hand Sanitizer 100 mL Botol
210 Hand Sanitizer 500 mL Botol
211 Handscoon Non Steril Pcs
212 Hazmat Pcs
213 Helm Pcs
214 Jas Hujan Pcs
215 Kacamata Goggle Pcs
216 Larutan Carbol 10 L Pcs
217 Masker Medis Pcs
218 Masker N95 Pcs
219 Masker KN95 Pcs
220 Plastik Pelindung Sepatu Pcs
221 Sabun Pencuci Tangan 5 L Pcs
222 Sepatu Boot Karet/ Safety Shoes Pcs
223 Shoe Cover Pcs
H OBAT DAN BMHP PROGRAM HIV
224 Lamivudine 150 Tablet
225 Dolutegravir Tablet
226 Rapid 1 HIV (SD Bioline) @ 100 test Test
227 Rapid 1 HIV (SD Bioline) @ 25 test Test 24
228 Rapid 2 HIV (SD Bioline) @ 25 test Test
229 Rapid 3 HIV (SD Bioline) @ 25 test Test
230 Rapid HBsAg Kit -
231 Rapid Sifilis Kit 24
I OBAT DAN BMHP PROGRAM TB PARU
232 OAT Dosis Harian Tablet
233 OAT Kategori 1 Tablet - 10
234 OAT Kategori Anak Tablet 1
235 OAT Kombipak Tablet
236 Kaca Slide Tablet 23
237 Kotak Slide Tablet
238 Pot Sputum Tablet 504 -
239 Reagen Zn Tablet 11 -
240 Tuberkulin/Mantoux Test Tablet
J OBAT DAN BMHP PROGRAM IMUNISASI
241 BCG Vial
242 DPT-HB-HIB Vial
243 DT Vial
244 Hb-0 Set
245 IPV Vial
246 MR Vial
247 OPV Vial
248 PCV Vial
249 Td Vial
250 Alat Suntik 0,05 mL Vial
251 Alat Suntik 0,5 mL Vial
252 Alat Suntik 5 mL Vial
253 Safety Box 2,5 L Vial
254 Safety Box 5 L Vial
255 N0pv 2 Vial
K OBAT DAN BMHP PROGRAM KEJIWAAN
256 Amytriptilin tab 25 mg Tablet
257 Clozapine 25 Tablet
258 Diazepam Injeksi Tablet
259 Haloperidol injeksi 5 mg / ml Tablet
260 Haloperidol tablet 0,5 mg Tablet
261 Haloperidol tablet 5 mg Tablet
Klorpromazin tablet/kaplet salut selaput
262 Tablet
100 mg
263 Risperidon tablet/kapsul/kaplet 2 mg Tablet
264 Trihexyphenidyl tab Tablet
265 Hallodeclanoate inj Tablet
L OBAT DAN BMHP PROGRAM GIZI
266 Tablet Tambah Darah Tablet
Kapsul
267 Vitamin A Biru (100.000 IU)
Lunak
 Kapsul
268 Vitamin A Merah (200.000 IU)
Lunak
M OBAT DAN BMHP PROGRAM KECACINGAN
269 Albendazol 400 mg Tablet
N OBAT DAN BMHP PROGRAM DIARE
270 Garam Oralit Tablet
271 Zink Tablet Tablet
O OBAT DAN BMHP PROGRAM RABIES
272 Vaksin Anti Rabies Vial
P OBAT DAN BMHP PROGRAM JKN
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
Q OBAT DAN BMHP PROGRAM PTM
296 Stik Gula Darah
297
298
299
Q OBAT DAN BMHP PROGRAM VAKSINASI COVID-19
300 Alkohol Swab Pcs
301 Auto Disable Syringe 0,3ml Pcs
302 Auto Disable Syringe 0,5ml Pcs
303 Auto Disable Syringe 3ml Pcs
304 Safety Box 5 L Pcs
305 ……
Mengetahui
Kepala UPT Puskesmas ….......

….........................
NIP. …............................
DAFTAR MUTASI PERSEDIAAN
PUSKESMAS ….........
PER 31 DESEMBER 2023

PENGADAAN (PENAMBAHAN) PEMAKAIAN (PENGURANGAN)

Nopember Desember Jumlah Oktober Nopember Desember

6 7 8 = 5+6+7 9 10 11

-
-
-

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

-
-
-

-
-
-
-
 -
-
N COVID-19 (BANTUAN PROPINSI)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
N COVID-19 (DANA REFOCUSING)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
GANAN COVID-19
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
50 74 10 11 10
-
 -
50 50 3
50 74 10 11 10

10 10 2 2 1
- - 10 2 2 2
-
-
- - 23 1 - -
-
- - - 40 50 40
- - - 1 - 1
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-

-
-
-
-
-
-
NGURANGAN) SALDO AKHIR
PER 31
DESEMBER 2023

Jumlah
12 = 9+10+11 13 = (4 + 8) - 12

- -
- -
- -

- -

- -
- -
- -

- -

- -

- -

- -

- -

- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -

- -
- -
- -

- -

- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -

- -

- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
31 43
- -
- -
3 47
31 43

5 5
6 4
- 1
- -
1 22
- -
130 374
2 9
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -

- -

- -
- -

- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
Pengelola Obat

…...........
NIP. .….........