LPLPO PUSTU & POLINDES

8/19/2019 LPLPO PUSTU & POLINDES

1/32

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT( LPLPO )

PUSTU DAN POLINDES/PONKESDESNAMA PUSKESMAS : BANGILPUSTU/POLINDES :……………………….KECAMATAN : BANGILKABUPATEN : PASURUANPROPINSI : JAWA TIMUR

NO NAMA OBAT SATUANSTOK PENERI- PERSE- PEMA- SISA STOK

AWAL MAAN DIAAN KAIAN STOK OPT1 2 3 4 5 6 =(4+5) 7 8=(6-7) 9

Generik PKD1 A003 Aminoflin Injeksi 24 mg/ll Ampul 10 ml2 A004 Aminoflin Tablet 200 mg Tablet3 A006 Amoksisillin Kaplet 500 mg Kaplet4 A007 Amoksisillin Si up Ke ing 125 mg/5 ml !otol 60 ml5 A00" Antasi#a $%&' Tablet Kun(a) Tablet6 A010 Anti *ungi $%&' Kombinasi +ot7 A014 Asam Asko bat Tablet 50 mg Tablet" A015 Asam ,e-enamat Kaplet 500 mg Kaplet. A022 $eksametason Injeksi i 5 mg/ml Ampul 2 ml

10 A023 $eksametason Tablet 0 5 mg Tablet11 A02. $i-en)i# amin Injeksi i m 10 mg/ml l Ampul 2 ml

12 A032 $imen)i# inat Tablet 50 mg Tablet13 A036 &fne- in A# enalin Injeksi 0 1 Ampul 2 ml14 A037 &kst aks !ella#on Tablet 10 mg Tablet15 A04" *itomena#ion it K1 Injeksi 10 mg/ml Ampul 1 ml16 A04. *itomena#ion it K1 Tablet 10 mg Tablet17 A052 8a am % alit Se buk Sa9)et1" A056 8entian iolet :a utan 1 !otol 10 ml1. A05" 8lise il 8uaiakolat Tablet 100 mg Tablet20 A062 8lukosa :a utan In-us 5 Ste il !otol 500 ml21 A063 8 iseo-ul in Tablet 125 mg Tablet22 A06" i# oko tison K im 2 5 Tube23 A06. Ibup o-en Tablet 200 mg Tablet24 A070 Ibup o-en Tablet 400 mg Tablet25 A072 Kalsium :aktat Kalk Tablet 500 mg Tablet26 A073 Kaptop il Tablet 25 mg;; Tablet27 A07. Klo am-enikol Tetes ,ata 0 5 !otol 5 ml

l k l l

KodeObat


2/32

Kl ik l T T li 3

NO NAMA OBAT SATUANSTOK PENERI- PERSE- PEMA- SISA STOK

AWAL MAAN DIAAN KAIAN STOK OPT1 2 3 4 5 6 =(4+5) 7 8=(6-7) 9

KodeObat

30 A0"7 Kot imoksa


3/32

NO NAMA OBAT SATUANSTOK PENERI- PERSE- PEMA- SISA ST

AWAL MAAN DIAAN KAIAN STOK O1 2 3 4 5 6 =(4+5) 7 8=(6-7)

KodeObat

Per&eka'an Ke%e a an64 %001 Alat Suntik 0 05 ml Set65 %002 Alat Suntik 0 5 ml Set66 %003 Alat Suntik 1 ml Set67 %004 Alat Suntik 10 ml Set6" %005 Alat Suntik 2 5 ml Set6. %006 Alat Suntik 20 ml Set70 %007 Alat Suntik 5 ml Set71 %00" Alat Suntik 50 ml Set72 %012 !a(9lin !otol 100 ml73 %014 atgut / !enang !e#a) Sa9)et

74 %016 &tanol 70 100 ml !otol75 %017 &tanol 70 1000 ml !otol76 %021 an#s9)oon 'onste il !iji77 %022 an#s9)oon Ste il Set7" %025 I at)ete Set7. %026 In-usion Set Anak Set"0 %027 In-usion Set $e=asa Set"1 %030 Kapas 250 g !ungkus"2 %033

Kasa 2 m B "0 9m!iji

"3 %035 Kasa Ste il 16 C 16 Kotak"4 %036 Kasa e ban 4 m B 10 9m >ol"5 %037 Kasa e ban 4 m B 15 9m >ol"6 %03" Kasa e ban 4 m B 3 9m >ol"7 %03. Kasa e ban 4 m B 5 9m >ol"" %051 +o i#on Io#i#a 10 30 ml !otol 30 ml". %052 +o i#on Io#i#a 10 300 ml !otol 300 ml.0 %056 Sen#ok +lastik !iji.1 %057 Silk !enang Sut a >ol >ol.2 %05" Silk !enang Sut a Sa9)et Sa9)et


4/32

NO NAMA OBAT SATUANSTOK PENERI- PERSE- PEMA- SISA S

AWAL MAAN DIAAN KAIAN STOK1 2 3 4 5 6 =(4+5) 7 8=(6-7)

KodeObat

1

2 Denis %bat K! (ang #ise#iakan #isesuaikan #engan p og am peme inta)

3

Kunjungan >esep!a(a ASK&S Damkesmas Total

,elapo kan / ,eminta obat ,engeta)ui / ,en(etujuitanggalEEEEEEEEEEEEEE Kepala +T$ +uskesmas !angil +etugas %bat

( r.Ar!" K#rn!ant$ % ( A"ra&' S. ar). A'I+ 1.6.021" 200012 1 003 'I+ 1."4042. 201001 1

;; F Kaptop il )an(a untuk pasien pengobatan lanjutan (ang sebelumn(a tela) men#apatkan te api anti)ipe tensi #a i puskesmas in#uk

+ustu/ +olin#es/ +onkes#es bole) men(e#iakan semua jenis aksin ke9uali aksin ! 8 #an ampak #engan s(a at apabila memiliki tempat pen(impanan aksin (ang sesuai stan#a su)u 2?"


5/32

BULAN : ……………….TA+UN : ………………

KEGUNAAN OBAT

12

Obat Emergency Syok Anafilaktik

Bronkodilator (anti sesak)

Antibiotik

AntibiotikObat Gastritis

Antifungi

Roborantia/ Suplemen / Vitamin

Analgesik

Syok Anafilaktik (pengganti idrokortison in!)

"ortikosteroid oral


Antiemetik


Antispasmodik

"oagulansia

"oagulansia

Serbuk Re idrasi

Obat Saria#an

Eksapektoran (Obat Batuk)

$airan infus

Antifungi"ortikosteroid %opikal

Antipiretik

Antipiretik


Anti &ipertensi

Obat 'ata

Obat %elinga


6/32

KEGUNAAN OBAT

12

Antibiotik

Antibiotik

Anastesi okal

AnalgesikAntibiotik

Antibiotik

Eksapektoran (Obat Batuk)

Obat 'ata

Antispasmodik

Antipiretik

Antipiretik

Antipiretik

Roborantia/ Suplemen / Vitamin$airan infus

Antifungi

Bedak %abur

Obat 'ata

Antibiotik



Anti &ipertensi

Antidiare

Antidiare


Antidiare

"oagulansia

terotonikterotonik

terotonik






7/32

KEGUNAAN OBAT

12

*erbekalan "ese atan &abis *akai








+isinfektan


+isinfektan

+isinfektan*erbekalan "ese atan &abis *akai






*engganti ,- . ,- steril


*erbekalan "ese atan &abis *akai*erbekalan "ese atan &abis *akai



$airan Antiinfeksi okal

$airan Antiinfeksi okal





8/32

KEGUNAAN OBAT

12

+ene ima


9/32

hal 9 dari 32 311412286.xls - Dalbo

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT TAHUN 20 2UPTD KESEHATAN PUSKESMAS !e KABUPATEN PASURUAN

NO Kode Obat NAMA OBAT SATUAN

1 2 3 4

Generik PKD

1 A001 Alopurinol Tablet 100 mg Tablet2 A002 Ambroxol Tablet 30 mg Tablet

3 A003 Aminofilin Injeksi 24 mg/ll Ampul 10 ml

4 A004 Aminofilin Tablet 200 mg Tablet

5 A005 Amitrip tilin Tablet Salut 25 mg Tablet

A00 Amoksisillin !aplet 500 mg !aplet

" A00" Amoksisill in Sirup !ering 125 mg/5 ml #otol 0 ml

$ A00$ Antasi%a &'() Tablet !un*a+ Tablet

, A00, Anti #akteri &'() Salep Tube

10 A010 Anti -ungi &'() !ombinasi .ot

11 A011 Anti emoroi% &'() !ombinasi Suppositoria

12 A012 Anti igrain/(rgotamin Tablet

13 A013 A ua .ro Inj #otol 25 ml

14 A014 Asam Askorbat Table t 50 mg Tablet

15 A015 Asam efenamat !aplet 500 mg !aplet

1 A01 Asetosal Tablet 100 mg Tablet

1" A01" Asiklo ir !rim 5 Tube

1$ A01$ Asiklo ir Tablet 400 mg Tablet1, A01, Atropin Sulfat Injeksi 0 25 mg/ml Ampul 2 ml

20 A020 Atropin Sulfat Table t 0 5 mg Tablet

21 A021 #etametason !rim 0 1 Tube

22 A022 &eksametason Injeksi i 5 mg/ml Ampul 2 ml

23 A023 &eksametason Tablet 0 5 mg Tablet

24 A024 &ekstrometorfan Sirup 10 mg/5 ml #otol 0 ml

25 A025 &ekstrometorfan Tablet 15 mg Tablet

2 A02 &ia6epam Injeksi 5 mg/ml Ampul 2 ml

2" A02" &ia6epam Tablet 2 mg Tablet

2$ A02$ &ia6epam Tablet 5 mg Tablet

2, A02, &ifen+i%ramin Injeksi i m 10 mg/ml 7 8l9 Ampul 2 ml

30 A030 &igoksin Tablet 0 25 mg Tablet


10/32



31 A031 &ilt ia6em 8l Tablet 30 mg Tablet

32 A032 &imen+i%rinat Tablet 50 mg Tablet

33 A033 &oksisiklin !apsul 100 mg !apsul

34 A034 &omperi%on Tablet 10 mg Tablet

35 A035 (fe%rin Tablet 25 mg 7 8l9 Tablet

3 A03 (finefrin 7A%renalin9 Injeksi 0 1 Ampul 2 ml

3" A03" (kstraks #ella%on Tablet 10 mg Tablet

3$ A03$ (ritromisin !apsul 250 mg !apsul

3, A03, (ritromisin Sirup 200 mg/5 ml #otol 0 ml

40 A040 -enitoin !apsul 100 mg !apsul


42 A042 -enitoin )atrium Injeksi 50 mg/ml Ampul 2 ml

43 A043 -enobarbital Injeksi i m/i 50 mg/ml Ampul 1 ml

44 A044 -enobarbital Tablet 100 mg Tablet45 A045 -enobarbital Tablet 30 mg Tablet

4 A04 -enoksimetil .enisillin Tablet 500 mg Tablet

4" A04" -enol :l iserol Tetes Telinga 10 #otol 5 ml

4$ A04$ -itomena%ion 7;it !19 Injeksi 10 mg/ml Ampul 1 ml

4, A04, -itomena%ion 7;it !19 Tablet 10 mg Tablet

50 A050 -urosemi% Tablet 40 mg Tablet

51 A051 :ameksan


11/32



A0 aloperi%ol Tablet 5 mg Tablet

" A0 " i%roklorot+ia6i%a 7 8T9 Tablet 25 mg Tablet

$ A0 $ i%rokortison !rim 2 5 Tube

, A0 , Ibuprofen Tablet 200 mg Tablet

"0 A0"0 Ibuprofen Tablet 400 mg Tablet

"1 A0"1 Isosorbi% &initrat Tablet Sublingual 5 mg Tablet

"2 A0"2 !alsium


12/32



101 A101 )istatin ;agina Tablet 100 000 iu Tab;ag

102 A102 'bat #atuk itam 7'# 9 =airan #otol 100 ml

103 A103 'ksitetrasiklin 8l Salep !ulit 3 Tube

104 A104 'ksitetrasiklin 8l Salep ata 1 Tube

105 A105 .apa erin Injeksi 40 mg/ml Ampul 1 ml

10 A10 .apa erin Tablet 40 mg Tablet

10" A10" .araformal%e+i% Tablet 1 gram Tablet

10$ A10$ .arasetamol Sirup 120 mg/5 ml #otol 0 ml

10, A10, .arasetamol tablet 100 mg Tablet

110 A110 .arasetamol tablet 500 mg Tablet

111 A111 .eti%in Injeksi Ampul

112 A112 .iri%oksin 7;itamin # 9 tablet 10 mg 7 8l9 Tablet

113 A113 .re%nison Tablet 5 mg Tablet

114 A114 .ropanolol Tablet 10 mg Tablet115 A115 .ropanolol Tablet 40 mg Tablet

11 A11 .ropiltiourasil tablet 100 mg Tablet

11" A11" ?aniti%ine Tablet 150 mg Tablet

11$ A11$ ?eserpin Tablet 0 10 mg Tablet

11, A11, ?eserpin Tablet 0 25 mg Tablet

120 A120 ?inger


13/32



13 A13 Tiamin 7;itamin #19 Injeksi 100 mg/ml Ampul 1 ml

13" A13" Tri+eksifeni%il Tablet 2 mg Tablet

13$ A13$ ;itamin # !ompleks Injeksi ;ial

13, A13, ;itamin # !ompleks Tablet Tablet

140 A140 in= 'xi%e Salep .ot

141 A141 !aptopril Tablet 12 5 mg Tablet

142 A142 (ritromisin !apsul 500 mg !apsul

Generik Penunjang PKD143 #001 Alpra6olam Tablet 0 5 mg Tablet

144 #002 Ambroxol Sirup 15 mg/ml #otol 0 ml

145 #003 Amoksisillin Serbuk Injeksi 1000 mg / Bi%e=illin ;ial

14 #004 Antasi%a &'() Suspensi #otol 0 ml

14" #005 Asam -olat Tablet 1 mg / Anemolat Tablet

14$ #00 #eta+istin esilat Tablet mg Tablet14, #00" #rom+eksin Sirup / osa on Sir #otol 0 ml

150 #00$ #rom+eksin Tablet $ mg / )o a+eksin Tablet

151 #00, 8etiri6ine Tablet 10 mg Tablet

152 #010 8lobetasol !rim 0 05 / Ika%erm !rim Tube

153 #011 &omperi%on Suspensi 5 mg/5 ml #otol 0 ml

154 #012 -urosemi% Injeksi i /i m 10 mg/ml / Silax Ampul 2 ml

155 #013 :emfibro6il !apsul 300 mg !apsul

15 #014 :limepiri%e Tablet 2 mg Tablet

15" #015 :lukosa 5 C 0 225 )atrium !lori%a #otol 500 ml

15$ #01 :lukosa 5 C 0 45 )atrium !lori%a #otol 500 ml

15, #01" *os=ineD)D#utilbromi%e Injeksi / S=opamin / #us=opan Ampul

1 0 #01$ *os=ineD)D#utilbromi%e Tablet 10 mg / S=opma Tablet

1 1 #01, !etokona6ole !rim 2 Tube

1 2 #020 !etokona6ole Tablet 200 mg Tablet

1 3 #021 !etoprofen Injeksi 100 mg / -etix Ampul

1 4 #022 !etorola= Injeksi 30 mg Ampul

1 5 #023 !lin%amisin !apsul 150 mg !apsul1 #024 !lin%amisin !apsul 300 mg !apsul

1 " #025


14/32



1"0 #02$ eloksikam Suppositoria Suppositoria

1"1 #02, etformin 8l Tablet 500 mg Tablet

1"2 #030 etilpre%nisolon Tablet 4 mg Tablet

1"3 #031 etokloprami%e Injeksi / (t+iferan Ampul

1"4 #032 etokloprami%e Sirup #otol 0 ml

1"5 #033 etroni%a6ol Infus 500 mg/100 ml #otol 100 ml

1" #034 'mepera6ol !apsul 20 mg !apsul

1"" #035 .ira=etam Injeksi 1 g / 5 ml Ampul 5 ml

1"$ #03 .ira=etam Injeksi 3 g / 15 ml Ampul 15 ml

1", #03" .ira=etam tablet 1200 mg Tablet

1$0 #03$ .ira=etam tablet $00 mg Tablet

1$1 #03, ?aniti%ine Injeksi 25 mg/ml Ampul 2 ml

1$2 #040 Sefa%roksil Sirup !ering 125mg/5ml #otol 0 ml

1$3 #041 Sefa%roksil !apsul 500 mg !apsul1$4 #042 Sefiksim !apsul 100 mg !apsul

1$5 #043 Sefotaksim Injeksi 1 g ;ial

1$ #044 Seftriakson Serbuk Injeksi 1 g/;ial ;ial

1$" #045 Sim astatin Tablet 10 mg Tablet

1$$ #04 Terbutalin Tablet 2 5 mg Tablet

1$, #04" T+iamfenikol Sirup #otol 0 ml

1,0 #04$ Trama%ol Injeksi 50 mg/ml Ampul

1,1 #04, Trama%ol !apsul 50 mg !apsul

1,2 #050 Trifluopera6ine Tablet 1 mg / Stela6in Tablet


1,4 #052 ,ikona


15/32



204 800, AS(?I): 500 ml #otol 500 ml

205 8010 Attapulgite / )e> &iatab / olagit Tablet

20 8011 #alsam .ot

20" 8012 #etason ) 8ream Tube

20$ 8013 #ioplasenton Tube

20, 8014 #isa=o%il Tablet 5 mg / &ul=olax 5 mg Tab Tablet

210 8015 #iso=o%il Supp Anak 5 mg / &ul=olax 5 mg Suppositoria

211 801 #iso=o%il Supp &e>asa 10 mg / &ul=olax 10 mg Suppositoria

212 801" 8ounterpain Tube

213 801$ &ektran"0Don #otol

22 8031 ulti itamin Sirup / !urkumex Sirup #otol 0 ml

22" 8032 )euro%ial !aplet Tablet

22$ 8033 )eurotropik Injeksi / ersibion / )eurosanbe Ampul 5 ml

22, 8034 )eurotropik Tablet / Sakaneuron / 8orsaneuron Tablet

230 8035 )e> :uanist rep Sirup #otol 0 ml

231 803 .ankreoflat Tablet

232 803" .+armaton -ormula !aplet

233 803$ .olikresulen Sol 3 0 mg/ml / Albot+*l Solution #otol 10 ml

234 803, ?inger &ekstrosa


16/32



23, 8044 Tamba+ &ara+ !ombinasi )on :enerik / emafor% Tablet

240 8045 T+rombop+op :el Tube

241 804 ;i==illin Serbuk Injeksi 1 g ;ial

242 804" Eilomi%on Injeksi ;ia l ;ial

243 804$ Anti -ungi &rop / (n*stin &rop #otol

244 04. Abboti9 la it) om(9in Si up #otol 0 ml245 050 !iosanbe Kaplet !aplet24 051 !isol on :a -o 'ebuli


17/32



2 , I00" (ugenol 8airan #otol 10 ml

2"0 I00$ -luori%e Tablet 0 5 mg Tablet

2"1 I00, :lass Ionomer 8ement A?T Set

2"2 I010 !alsium i%roksi%a .asta !otak

2"3 I011 !lorfenol !amfer ent+ol 78+! 9 #otol 10 ml

2"4 I012 !uas .engoles #on%ing #iji

2"5 I013 ummif*ing .asta !otak

2" I014 ' 8 ' 8airan #otol

2"" I015 Semen Seng -osfat serbuk %an =airan #otol

2"$ I01 Sil er Amalgam #otol 5 ml

2", I01" Spon :elatin #iji

2$0 I01$ Temporar* Stopping -let=+er #otol

2$1 I01, T!- 7-orinokresol9 #otol

2$2 I020 A ti9ulating +ape !otak 12 .ak2$3 I021 austinep/ oustine austi- .ot gr 2$4 I022 eso-at #otol " 5gr 2$5 I023 esop)en #otol 13 ml2$ I024 +ulpe (l #otol 13ml

Proga Ke,a,ingan2$" F001 Alben%a6ol Tablet 400 mg Tablet

2$$ F002 eben%a6ol Sirup #otol 30 ml

2$, F003 eben%a6ol Tablet Tablet

2,0 F004 .irantel tablet s=ore 7base9 125 g Tablet

Proga K!"#G!$! 2,1 !001 #esi Sirup #otol 150 ml

2,2 !002 8alsium :lukonas Injeksi Ampul 10 ml

2,3 !003 -itomena%ion 7;it !19 Injeksi 2mg/ml 7)eo !9 Ampul 1 ml

2,4 !004 Io%iol !apsul


18/32



302 !012 ?etinol 7;itamin A9 100 000 I@ kapsul lunak !apsul


304 !014 Santa D ( Tablet

305 !015 Tablet Tamba+ &ara+ !ombinasi Sa=+et

Proga a'aria

30 i-ampisin 600 mg Kaplet !aplet

Per&eka'an Ke%e a an32" '001 Alat Suntik 0 05 ml Set

32$ '002 Alat Suntik 0 5 ml Set

32, '003 Alat Suntik 1 ml Set

330 '004 Alat Suntik 10 ml Set

331 '005 Alat Suntik 2 5 ml Set



19/32



333 '00" Alat Suntik 5 ml Set

334 '00$ Alat Suntik 50 ml Set

335 '00, A ua%est Steril #otol 500 ml

33 '010 A uasoni= :el Tube

33" '011 Asam Sulfosalisilat 20 #otol

33$ '012 #AG8


20/32



3 $ '042


21/32

hal 21 dari 32 311412286.xls - Rt2

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT TAHUN 20 2UPTD KESEHATAN PUSKESMAS !e KABUPATEN PASURUAN


1 2 3 4

Generik PKD

1 A001 Alopurinol Tablet 100 mg Tablet2 A002 Ambroxol Tablet 30 mg Tablet

3 A003 Aminofilin Injeksi 24 mg/ll Ampul 10 ml

4 A004 Aminofilin Tablet 200 mg Tablet

5 A005 Amitrip tilin Table t Salut 25 mg Tablet

A00 Amoksisillin !aplet 500 mg !aplet

" A00" Amoksisillin Sirup !ering 125 mg/5 ml #otol 0 ml

$ A00$ Antasi%a &'() Tablet !un*a+ Tablet

, A00, Anti #akteri &'() Salep Tube

10 A010 Anti -ungi &'() !ombinasi .ot

11 A011 Anti emoroi% &'() !ombinasi Suppositoria

12 A012 Anti igrain/(rgotamin Tablet

13 A013 A ua .ro Inj #otol 25 ml

14 A014 Asam Askorbat Tablet 50 mg Tablet

15 A015 Asam efenamat !aple t 500 mg !aplet

1 A01 Asetosal Tablet 100 mg Tablet

1" A01" Asiklo ir !rim 5 Tube

1$ A01$ Asiklo ir Tablet 400 mg Tablet1, A01, Atropin Sulfat Injeksi 0 25 mg/ml Ampul 2 ml

20 A020 Atropin Sulfat Tablet 0 5 mg Tablet

21 A021 #etametason !rim 0 1 Tube

22 A022 &eksametason Injeksi i 5 mg/ml Ampul 2 ml

23 A023 &eksametason Tablet 0 5 mg Tablet

24 A024 &ekstrometorfan Sirup 10 mg/5 ml #otol 0 ml

25 A025 &ekstrometorfan Table t 15 mg Tablet

2 A02 &ia6epam Injeksi 5 mg/ml Ampul 2 ml

2" A02" &ia6epam Tablet 2 mg Tablet

2$ A02$ &ia6epam Tablet 5 mg Tablet

2, A02, &ifen+i%ramin Injeksi i m 10 mg/ml 7 8l9 Ampul 2 ml

30 A030 &igoksin Tablet 0 25 mg Tablet


22/32

hal 22 dari 32 311412286.xls - Rt2


31 A031 &iltia6em 8l Tablet 30 mg Tablet

32 A032 &imen+i%rinat Tablet 50 mg Tablet

33 A033 &oksisiklin !apsul 100 mg !apsul

34 A034 &omperi%on Tablet 10 mg Tablet

35 A035 (fe%rin Tablet 25 mg 7 8l9 Tablet

3 A03 (finefrin 7A%renalin9 Injeksi 0 1 Ampul 2 ml

3" A03" (kstraks #ella%on Tablet 10 mg Tablet

3$ A03$ (ritromisin !apsul 250 mg !apsul

3, A03, (rit romisin Sirup 200 mg/5 ml #otol 0 ml



42 A042 -enitoin )atrium Injeksi 50 mg/ml Ampul 2 ml

43 A043 -enobarbital Injeksi i m/i 50 mg/ml Ampul 1 ml

44 A044 -enobarbital Tablet 100 mg Tablet45 A045 -enobarbital Tablet 30 mg Tablet

4 A04 -enoksimetil .enisillin Tablet 500 mg Tablet

4" A04" -enol :liserol Tetes Telinga 10 #otol 5 ml

4$ A04$ -itomena%ion 7;it !19 Injeksi 10 mg/ml Ampul 1 ml

4, A04, -itomena%ion 7;it !19 Tablet 10 mg Tablet

50 A050 -urosemi% Tablet 40 mg Tablet

51 A051 :ameksan


23/32

hal 23 dari 32 311412286.xls - Rt2


A0 aloperi%ol Tablet 5 mg Tablet

" A0 " i%roklorot+ia6i%a 7 8T9 Tablet 25 mg Tablet

$ A0 $ i%rokortison !rim 2 5 Tube

, A0 , Ibuprofen Tablet 200 mg Tablet

"0 A0"0 Ibuprofen Tablet 400 mg Tablet

"1 A0"1 Isosorbi% &initrat Tablet Sublingual 5 mg Tablet

"2 A0"2 !alsium


24/32

hal 24 dari 32 311412286.xls - Rt2


101 A101 )istatin ;agina Tablet 100 000 iu Tab;ag

102 A102 'bat #atuk itam 7'# 9 =airan #otol 100 ml

103 A103 'ksitetrasiklin 8l Salep !ulit 3 Tube

104 A104 'ksitetrasiklin 8l Salep ata 1 Tube

105 A105 .apa erin Injeksi 40 mg/ml Ampul 1 ml

10 A10 .apa erin Tablet 40 mg Tablet

10" A10" .araformal%e+i% Tablet 1 gram Tablet

10$ A10$ .arasetamol Sirup 120 mg/5 ml #otol 0 ml

10, A10, .arasetamol tablet 100 mg Tablet

110 A110 .arasetamol tablet 500 mg Tablet

111 A111 .eti%in Injeksi Ampul

112 A112 .iri%oksin 7;itamin # 9 tablet 10 mg 7 8l9 Tablet

113 A113 .re%nison Tablet 5 mg Tablet

114 A114 .ropanolol Tablet 10 mg Tablet115 A115 .ropanolol Tablet 40 mg Tablet

11 A11 .ropiltiourasil tablet 100 mg Tablet

11" A11" ?anit i%ine Tablet 150 mg Tablet

11$ A11$ ?eserpin Tablet 0 10 mg Tablet

11, A11, ?eserpin Tablet 0 25 mg Tablet

120 A120 ?inger


25/32

hal 25 dari 32 311412286.xls - Rt2


13 A13 Tiamin 7;itamin #19 Injeksi 100 mg/ml Ampul 1 ml

13" A13" Tri+eksifeni%il Tablet 2 mg Tablet

13$ A13$ ;itamin # !ompleks Injeksi ;ial

13, A13, ;itamin # !ompleks Tablet Tablet

140 A140 in= 'xi%e Salep .ot

141 A141 !aptopril Tablet 12 5 mg Tablet

142 A142 (ritromisin !apsul 500 mg !apsul

Generik Penunjang PKD143 #001 Alpra6olam Tablet 0 5 mg Tablet

144 #002 Ambroxol Sirup 15 mg/ml #otol 0 ml

145 #003 Amoksisillin Serbuk Injeksi 1000 mg / Bi%e=illin ;ial

14 #004 Antasi%a &'() Suspensi #otol 0 ml

14" #005 Asam -olat Tablet 1 mg / Anemolat Tablet

14$ #00 #eta+istin esilat Tablet mg Tablet14, #00" #rom+eksin Sirup / osa on Sir #otol 0 ml

150 #00$ #rom+eksin Tablet $ mg / )o a+eksin Tablet

151 #00, 8et iri6ine Tablet 10 mg Tablet

152 #010 8lobetasol !rim 0 05 / Ika%erm !rim Tube

153 #011 &omperi%on Suspensi 5 mg/5 ml #otol 0 ml

154 #012 -urosemi% Injeksi i /i m 10 mg/ml / Silax Ampul 2 ml

155 #013 :emfibro6il !apsul 300 mg !apsul

15 #014 :limepiri%e Tablet 2 mg Tablet

15" #015 :lukosa 5 C 0 225 )atrium !lori%a #otol 500 ml

15$ #01 :lukosa 5 C 0 45 )atrium !lori%a #otol 500 ml

15, #01" *os=ineD)D#utilbromi%e Injeksi / S=opamin / #us=opan Ampul

1 0 #01$ *os=ineD)D#utilbromi%e Tablet 10 mg / S=opma Tablet

1 1 #01, !etokona6ole !rim 2 Tube

1 2 #020 !etokona6ole Tablet 200 mg Tablet

1 3 #021 !etoprofen Injeksi 100 mg / -etix Ampul

1 4 #022 !etorola= Injeksi 30 mg Ampul

1 5 #023 !lin%amisin !apsul 150 mg !apsul1 #024 !lin%amisin !apsul 300 mg !apsul

1 " #025


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1"0 #02$ eloksikam Suppositoria Suppositoria

1"1 #02, etformin 8l Tablet 500 mg Tablet

1"2 #030 etilpre%nisolon Tablet 4 mg Tablet

1"3 #031 etokloprami%e Injeksi / (t+iferan Ampul

1"4 #032 etokloprami%e Sirup #otol 0 ml

1"5 #033 etroni%a6ol Infus 500 mg/100 ml #otol 100 ml

1" #034 'mepera6ol !apsul 20 mg !apsul

1"" #035 .ira=etam Injeksi 1 g / 5 ml Ampul 5 ml

1"$ #03 .ira=etam Injeksi 3 g / 15 ml Ampul 15 ml

1", #03" .ira=etam tablet 1200 mg Tablet

1$0 #03$ .ira=etam tablet $00 mg Tablet

1$1 #03, ?aniti%ine Injeksi 25 mg/ml Ampul 2 ml

1$2 #040 Sefa%roksil Sirup !ering 125mg/5ml #otol 0 ml

1$3 #041 Sefa%roksil !apsul 500 mg!apsul

1$4 #042 Sefiksim !apsul 100 mg !apsul

1$5 #043 Sefotaksim Injeksi 1 g ;ial

1$ #044 Seftriakson Serbuk Injeksi 1 g/;ial ;ial

1$" #045 Sim astatin Tablet 10 mg Tablet

1$$ #04 Terbutalin Tablet 2 5 mg Tablet

1$, #04" T+iamfenikol Sirup #otol 0 ml

1,0 #04$ Trama%ol Injeksi 50 mg/ml Ampul

1,1 #04, Trama%ol !apsul 50 mg !apsul



1,4 #052 ,ikona


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204 800, AS(?I): 500 ml #otol 500 ml

205 8010 Attapulgite / )e> &iatab / olagit Tablet

20 8011 #alsam .ot

20" 8012 #etason ) 8ream Tube

20$ 8013 #ioplasenton Tube

20, 8014 #isa=o%il Tablet 5 mg / &ul=olax 5 mg Tab Tablet

210 8015 #iso=o%il Supp Anak 5 mg / &ul=olax 5 mg Suppositoria

211 801 #iso=o%il Supp &e>asa 10 mg / &ul=olax 10 mg Suppositoria

212 801" 8ounterpain Tube

213 801$ &ektran"0Don #otol

22 8031 ulti itamin Sirup / !urkumex Sirup #otol 0 ml

22" 8032 )euro%ial !aplet Tablet

22$ 8033 )eurotropik Injeksi / ersibion / )eurosanbe Ampul 5 ml

22, 8034 )eurotropik Tablet / Sakaneuron / 8orsaneuron Tablet

230 8035 )e> :uanis trep Sirup #otol 0 ml

231 803 .ankreoflat Tablet

232 803" .+armaton -ormula !aplet

233 803$ .olikresulen Sol 3 0 mg/ml / Albot+*l Solution #otol 10 ml

234 803, ?inger &ekstrosa


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23, 8044 Tamba+ &ara+ !ombinasi )on :enerik / emafor% Tablet

240 8045 T+rombop+op :el Tube

241 804 ;i==illin Serbuk Injeksi 1 g ;ial

242 804" Eilomi%on Injeksi ;ial ;ial

243 804$ Anti -ungi &rop / (n*stin &rop #otol

244 04. Abboti9 la it) om(9in Si up #otol 0 ml245 050 !iosanbe Kaplet !aplet24 051 !isol on :a -o 'ebuli


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2 , I00" (ugenol 8airan #otol 10 ml

2"0 I00$ -luori%e Tablet 0 5 mg Tablet

2"1 I00, :lass Ionomer 8ement A?T Set

2"2 I010 !alsium i%roksi%a .asta !otak

2"3 I011 !lorfenol !amfer ent+ol 78+! 9 #otol 10 ml

2"4 I012 !uas .engoles #on%ing #iji2"5 I013 ummif*ing .asta !otak

2" I014 ' 8 ' 8airan #otol

2"" I015 Semen Seng -osfat serbuk %an =airan #otol

2"$ I01 Sil er Amalgam #otol 5 ml

2", I01" Spon :elatin #iji

2$0 I01$ Temporar* Stopping -let=+er #otol

2$1 I01, T!- 7-orinokresol9 #otol

2$2 I020 A ti9ulating +ape !otak 12 .ak2$3 I021 austinep/ oustine austi- .ot gr 2$4 I022 eso-at #otol " 5gr 2$5 I023 esop)en #otol 13 ml2$ I024 +ulpe (l #otol 13ml

Proga Ke,a,ingan2$" F001 Alben%a6ol Tablet 400 mg Tablet

2$$ F002 eben%a6ol Sirup #otol 30 ml

2$, F003 eben%a6ol Tablet Tablet

2,0 F004 .irantel tablet s=ore 7base9 125 g Tablet

Proga K!"#G!$! 2,1 !001 #esi Sirup #otol 150 ml

2,2 !002 8alsium :lukonas Injeksi Ampul 10 ml

2,3 !003 -itomena%ion 7;it !19 Injeksi 2mg/ml 7)eo !9 Ampul 1 ml

2,4 !004 Io%iol !apsul


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hal 30 dari 32 311412286.xls - Rt2




304 !014 Santa D ( Tablet

305 !015 Tablet Tamba+ &ara+ !ombinasi Sa=+et

Proga a'aria

30 i-ampisin 600 mg Kaplet !aplet

Per&eka'an Ke%e a an32" '001 Alat Suntik 0 05 ml Set

32$ '002 Alat Suntik 0 5 ml Set

32, '003 Alat Suntik 1 ml Set


331 '005 Alat Suntik 2 5 ml Set



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hal 31 dari 32 311412286.xls - Rt2


333 '00" Alat Suntik 5 ml Set

334 '00$ Alat Suntik 50 ml Set

335 '00, A ua%est Steril #otol 500 ml

33 '010 A uasoni= :el Tube

33" '011 Asam Sulfosalisilat 20 #otol

33$ '012 #AG8


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3 $ '042

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