Download xlsx - Laporan Aset Kefarmasian.xlsx

PEMERINTAH KABUPATEN TANA TORAJADINAS KESEHATAN

Jalan Tilanga’ No. 03 Telp. 22129 Rantelemo

BUKU BESAR PERSEDIAAN OBAT-OBATAN

No NAMA OBAT SAT

Penerimaan Barang

Pemakaian

Sisa Stok

Total (Rp)

KETPermintaan Penyaluran

Triw IV Harga (Rp) Total (Rp) Dari Total (Rp) Oleh Total (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 191 Alat suntik sekali pakai 1 ml Set - 109,250 - 109,250 - 109,250 - - 109,250 -

2 Alat suntik sekali pakai 2,5 ml Set - 103,800 - 103,800 - 103,800 - - 103,800 -

3 Alat suntik sekali pakai 5 ml Set - 103,800 - 103,800 - 103,800 - - 103,800 -

4 Albendazole tablet 400 mg Tab - - - - - -

5 Allopurinol tablet 100 mg Tab - 106 - 106 - 106 - - 106 -

6 Aminophylline tablet 200 mg Tab - 93.31 - 93.31 - 93.31 - - 93.31 -

7 Aminophylline injeksi 24 mg/ml - 10 ml Amp - - - - - -

8 Amitriptyline HCl tablet salut 25 mg Tab - 118 - 118 - 118 - - 118 -

9 Amoxicillin sirup kering 125 mg/ 5 ml Btl - 2,511 - 2,511 - 2,511 - - 2,511 -

10 Amoxicillin kapsul 250 mg Kap - 220.24 - 220.24 - 220.24 - - 220.24 -

11 Amoxicillin kaplet 500 mg Kapl - 228 - 228 - 228 - - 228 -

12 Antalgin (metampiron) tablet 500 mg Tab - 15,070 - 15,070 - 15,070 - - 15,070 -

13 Antalgin injeksi 250 mg/ml - 2 ml Amp - - - - - -

14 Antasida DOEN tablet kombinasi Tab - 73.12 - 73.12 - 73.12 - - 73.12 -

15 Antasida DOEN syrup btl - 2,700 - 2,700 - 2,700 - - 2,700 -

16 Antibakteri DOEN salep kombinasi tube - 2,741 - 2,741 - 2,741 - - 2,741 -

17 Antihemoroid DOEN kombinasi Sup - 22,000 - 22,000 - 22,000 - - 22,000 -

18 Antifungi DOEN kombinasi Pot - 2,096.33 - 2,096.33 - 2,096.33 - - 2,096.33 -

19 Antimigrain DOEN kombinasi tab - - - - - -

20 Asam Askorbat (Vit.C) tablet 50 mg tab - 35,200 - 35,200 - 35,200 - - 35,200 -

21 Asam Mefenamat tablet 500 mg tab - 114.84 - 114.84 - 114.84 - - 114.84 -

22 aciklovir tablet 200mg Tab - 251 - 251 - 251 - - 251 -

23 aciklovir Krim - 2,367 - 2,367 - 2,367 - - 2,367 -

24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Amp - 25,958 - 25,958 - 25,958 - - 25,958 -

25 Atropin Sulfat Tab 0,5 mg Tab - 33,000 - 33,000 - 33,000 - - 33,000 -

26 Antimalaria DOEN Kombinasi Tab - 52,030 - 52,030 - 52,030 - - 52,030 -

27 Betahistin Mesilat tablet 6 mg Tab - 1,016 - 1,016 - 1,016 - - 1,016 -

28 Betametason krim 0,1% Tube - 1,668 - 1,668 - 1,668 - - 1,668 -

29 Calcium Lactate (Kalk) tabet 500 mg Tab - 57,200 - 57,200 - 57,200 - - 57,200 -

30 Captopril 25 mg Tab - 94 - 94 - 94 - - 94 -

31 Codein HCL tab. 10 mg Tab - 117,503 - 117,503 - 117,503 - - 117,503 -

32 Carbamazepine tablet 200 mg Tab - 267 - 267 - 267 - - 267 -

33 Catgut/benang bedah no.2/0 (plain & chromic) Sak - 704,000 - 704,000 - 704,000 - - 704,000 -


34 Chlorampenicol Kapsul 250 mg Kap - 250 - 250 - 250 - - 250 -

Total Penerimaan

Barang

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

35 Chlorampenicol Salep Mata 1% Tube - 1,523 - 1,523 - 1,523 - - 1,523 -

36 Chloramphenicol Syrup Btl - 4,016 - 4,016 - 4,016 - - 4,016 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

37 Chloramphenicol Tetes Telinga 3% Btl - 1,750 - 1,750 - 1,750 - - 1,750 -

38 Chlorpheniramine Maleat (CTM) tab.4 mg Tab - 23 - 23 - 23 - - 23 -

39 Chlorpromazine injeksi 2,5 mg/ml Amp - 1,045 - 1,045 - 1,045 - - 1,045 -

40 Chlorpromazine HCl injeksi 5 mg/ml Amp - 11,279 - 11,279 - 11,279 - - 11,279 -

41 Chlorpromazine HCl tablet 100 mg Tab - 146 - 146 - 146 - - 146 -

42 Chlorpromazine HCl tablet 25 mg Tab - 41,800 - 41,800 - 41,800 - - 41,800 -

43 Ciprofloxacin 500 mg Tab - 241 - 241 - 241 - - 241 -

44 Cotrimoxazole Pediatrik Tab - 79 - 79 - 79 - - 79 -

45 Cotrimoxazole Suspensi Btl - 2,212.94 - 2,212.94 - 2,212.94 - - 2,212.94 -

46 Cotrimoxazole Dewasa Tab - 146.24 - 146.24 - 146.24 - - 146.24 -

47 Cimetidine tablet 200 mg Tab - 115.52 - 115.52 - 115.52 - - 115.52 -

48 Clonidine tablet 0,15 mg Tab - 191 - 191 - 191 - - 191 -

49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml Amp - 52,000 - 52,000 - 52,000 - - 52,000 -

50 Chloramphenikol Tetes Mata Btl - - - - - -

51 Dexamethasone Injeksi Amp - 1,750 - 1,750 - 1,750 - - 1,750 -

52 Dexamethasone Kaplet 0,5 mg Kapl - 71.89 - 71.89 - 71.89 - - 71.89 -

53 Dekstromethorphan HBr sirup 10 mg/5 ml Btl - 1,467.4 - 1,467.4 - 1,467.4 - - 1,467.4 -

54 Dekstrometorphan HBr tablet 15 mg Tab - 102 - 102 - 102 - - 102 -

55 Diazepam inj 15 mg/ml - 2 ml Amp - 78,147 - 78,147 - 78,147 - - 78,147 -

56 Diazepam 2 mg Tab? - 39 - 39 - 39 - - 39 -

57 Diazepam 5 mg Tab - - - - - -

58 Dietilkarbamin sitrat tablet 100 mg Tab - - - - - -

59 Diphenhydramine HCl inj 10 mg/ml-1 ml Tab - 1,056 - 1,056 - 1,056 - - 1,056 -

60 Digoksin tablet 0,25 mg Tab - 96.48 - 96.48 - 96.48 - - 96.48 -

61 Diltiazem tab. 30 mg Tab - 129 - 129 - 129 - - 129 -

62 Doksisiklin 100 mg Tab - 250 - 250 - 250 - - 250 -

63 Efedrin HCl tablet 25 mg Tab - 14,097 - 14,097 - 14,097 - - 14,097 -

64 Ekstrak Belladon tablet 10 mg Tab - - - - - -

65 Erytromicin syr Btl - 8,910 - 8,910 - 8,910 - - 8,910 -

66 Erytromicin tab 250 mg Tab - 462 - 462 - 462 - - 462 -

67 Erytromicin tab 500 mg Tab - 912.94 - 912.94 - 912.94 - - 912.94 -

68 Epinefrin HCl inj 0,1% - 1 ml Amp - 10,371 - 10,371 - 10,371 - - 10,371 -

69 Etakridin(Rivanol) larutan 0,1 % Btl - 2,354.22 - 2,354.22 - 2,354.22 - - 2,354.22 -

70 Ethanol 70% Btl - - - - - -

71 Etil chlorida semprot Btl - 115,500 - 115,500 - 115,500 - - 115,500 -

72 Eugenol cairan Btl - 605,000 - 605,000 - 605,000 - - 605,000 -

73 Fenitoin natrium injeksi 50mg/ml Amp - - - - - -

74 Fenobarbital inj. 50mg/ml Amp - 20,100 - 20,100 - 20,100 - - 20,100 -

75 Fenobarbital tab. 30 mg Tab - 7,139 - 7,139 - 7,139 - - 7,139 -

76 Fenol gliserol tetes telinga 10 % Btl - 1,108.80 - 1,108.80 - 1,108.80 - - 1,108.80 -

77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml Amp - 57,420 - 57,420 - 57,420 - - 57,420 -

78 Fitomenadion (Vit K) tab. Salut 10 mg Tab - 640.59 - 640.59 - 640.59 - - 640.59 -

79 Fluour tablet 0,5 mg Tab - - - - - -

80 Furosemide tab. 40 mg Tab - 11,229 - 11,229 - 11,229 - - 11,229 -

81 Garam Oralit untuk 200 ml - air Sak - 41,800 - 41,800 - 41,800 - - 41,800 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

82 Gention violet 1 % Btl? - 495 - 495 - 495 - - 495 -

83 Glass ionomer cement (gx ic) Set - 434,500 - 434,500 - 434,500 - - 434,500 -

84 Glibenklamide tab. 5 mg Tab - 59 - 59 - 59 - - 59 -

85 Gliseril guayakolat tab. 100 mg Tab - 30,690 - 30,690 - 30,690 - - 30,690 -

86 Gliserin Btl - - - - - -

87 Glukosa larutan infus 10% steril Btl - - - - - -


89 Glukosa larutan infus 5% steril Btl - 5,844 - 5,844 - 5,844 - - 5,844 -

90 Griseofulvin tab. 125 mg, micronized Tab - 204 - 204 - 204 - - 204 -

91 Haloperidol tablet 0,5 mg Tab - 55.70 - 55.70 - 55.70 - - 55.70 -


93 Haloperidol tablet 5 mg Tab - 94.21 - 94.21 - 94.21 - - 94.21 -

94 Hidroklortiazid (HCT) tablet 25 mg Tab - 39,930.00 - 39,930.00 - 39,930.00 - - 39,930.00 -

95 Hidrokortison krim 2,5% Tube - 2,519.00 - 2,519.00 - 2,519.00 - - 2,519.00 -

96 Hyoscine -n- Butilbromide Tab - 33,000.00 - 33,000.00 - 33,000.00 - - 33,000.00 -

97 Handscoen No. 7 Set - 233,750 - 233,750 - 233,750 - - 233,750 -

98 Ibuprofen tablet 200 mg / Irgapan Tab - 96.21 - 96.21 - 96.21 - - 96.21 -

99 Ibuprofen tablet 400 mg Tab - 152.5 - 152.5 - 152.5 - - 152.5 -

100 Infusion set anak Set - 4,400 - 4,400 - 4,400 - - 4,400 -

101 Infusion set dewasa Set - 3,850 - 3,850 - 3,850 - - 3,850 -

102 I.V. Catheter No. 18 Set - - - - - -

103 I.V. Catheter No. 20 Set - 428,310 - 428,310 - 428,310 - - 428,310 -



106 Isosorbid Dinitrat tablet sublingual 5 mg Tab - 8,910 - 8,910 - 8,910 - - 8,910 -

107 Kasa kompres 40/40 steril roll - 1,393 - 1,393 - 1,393 - - 1,393 -

108 Kasa pembalut 2 m x 80 cm roll - 8,799 - 8,799 - 8,799 - - 8,799 -

109 Kasa pembalut hidrofil 4 m x 15 cm roll - 3,373 - 3,373 - 3,373 - - 3,373 -

110 Kapas pembalut/absorben 250 gram Bks - 8,250 - 8,250 - 8,250 - - 8,250 -

111 Kalsium Hidroksida pasta Tube - 266,200 - 266,200 - 266,200 - - 266,200 -

112 Ketoconazole 200 mg Tab - 267 - 267 - 267 - - 267 -

113 Lidokain kompositum injeksi Amp - 1,485 - 1,485 - 1,485 - - 1,485 -

114 Mebendazol tablet 100 mg Tab - - - - - -

115 Metilergometrin maleat tablet salut 0,125 mg Tab - 13,310 - 13,310 - 13,310 - - 13,310 -

116 Metilergometrin maleat inj. 0,200 mg - 1 ml Amp - 49,170 - 49,170 - 49,170 - - 49,170 -

117 Metronidazol tablet 250 mg Tab - 183 - 183 - 183 - - 183 -

118 Miconazole cream 10 g Tube - 3,300 - 3,300 - 3,300 - - 3,300 -

119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab - 12,100 - 12,100 - 12,100 - - 12,100 -

120 Metoklopramide HCl injeksi (Piralen) Amp? - 11,000 - 11,000 - 11,000 - - 11,000 -

121 Metoklopramide syrup Btl - 2,310 - 2,310 - 2,310 - - 2,310 -

122 Mineral Mix Set - 2,695 - 2,695 - 2,695 - - 2,695 -

123 Metformin tablet 500mg Tab - 105 - 105 - 105 - - 105 -

124 Natrium klorida lar. Infus 0,9% steril Btl - 5,390 - 5,390 - 5,390 - - 5,390 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

125 Nistatin 100.000 iu/g tab vaginal Tab - 28,876 - 28,876 - 28,876 - - 28,876 -

126 Nistatin 500.000 iu tab salut Tab - 704 - 704 - 704 - - 704 -

127 Nifedipin tablet 10 mg Tab - 118 - 118 - 118 - - 118 -

128 Natrium Diklofenak tablet 50 mg Tab - 206 - 206 - 206 - - 206 -

129 Obat Batuk Hitam (OBH) cairan Btl - 1,573 - 1,573 - 1,573 - - 1,573 -

130 Oksitetrasiklin HCl salep mata Tube - - - - - -

131 Oksitetrasiklin HCl salep Kulit 3% Tube - 1,646 - 1,646 - 1,646 - - 1,646 -

132 Oksitosin injeksi 10 iu/ml - 1 ml Amp - 58,905 - 58,905 - 58,905 - - 58,905 -

133 Paraformaldehid tablet 1 gram Tab - - - - - -

134 Parasetamol Drops Btl - 5,749 - 5,749 - 5,749 - - 5,749 -

135 Parasetamol sirup 120 mg/5 ml Btl - 1,403.6 - 1,403.6 - 1,403.6 - - 1,403.6 -

136 Parasetamol tablet 100 mg Tab - 34.51 - 34.51 - 34.51 - - 34.51 -


138 Pirantel Pamoat tablet 365 mg Tab - 343 - 343 - 343 - - 343 -

139 Piridoksin HCl tablet 10 mg Tab - 19,140 - 19,140 - 19,140 - - 19,140 -

140 Plester 5 yard x 2 inchi Roll - 23,625 - 23,625 - 23,625 - - 23,625 -

141 Prednison tablet 5 mg Tab - 68,750 - 68,750 - 68,750 - - 68,750 -

142 Primakuin tablet 15 mg Tab - 125 - 125 - 125 - - 125 -

143 Propiltiourasil tablet 100 mg Tab - 297 - 297 - 297 - - 297 -

144 Propanolol HCl tablet 40 mg Tab - 119 - 119 - 119 - - 119 -

145 Papaverin tablet 40 mg Tab - 128 - 128 - 128 - - 128 -

146 Pembalut Gips 4 inch Roll - 35,750 - 35,750 - 35,750 - - 35,750 -

147 Pembalut gips 6 inch Roll - 46,200 - 46,200 - 46,200 - - 46,200 -

148 Piroxicam tablet 20 mg Tab - 97.99 - 97.99 - 97.99 - - 97.99 -

149 Poly Chateter No. 16 Set - - - - - -

150 Poly Chateter No. 18 Set - 8,495 - 8,495 - 8,495 - - 8,495 -

151 Quinine dihidroklorida inj. 25% - 2 ml Amp - - - - - -

152 Quinine sulfat tab. 222 mg (7 h2o)l Tab - - - - - -

153 Reserpin tablet 0,25 mg Tab - 114 - 114 - 114 - - 114 -

154 Retinol (Vit.A) kaps 100.000 IU Kap - 254 - 254 - 254 - - 254 -


156 Ringer Laktat lar infus steril Btl - 5,720 - 5,720 - 5,720 - - 5,720 -

157 Ranitidin tab 150 mg Tab - 119 - 119 - 119 - - 119 -

158 Ranitidin injeksi 25mg/2 ml Amp - 1,157 - 1,157 - 1,157 - - 1,157 -

159 Salbutamol tablet 2 mg Tab - 70 - 70 - 70 - - 70 -

160 Salep 2-4 kombinasi Tube - 1,980 - 1,980 - 1,980 - - 1,980 -

161 Salisil bedak 2% Set - 1,180 - 1,180 - 1,180 - - 1,180 -

162 Simvastatin tablet Tab - 180 - 180 - 180 - - 180 -

163 Serum anti tetanus inj.1.500 iu/ampul ats Amp - 151,220 - 151,220 - 151,220 - - 151,220 -

164 Semen seng fosfat serbuk dan cairann set - 102,850 - 102,850 - 102,850 - - 102,850 -

165 Silk (benang bedah sutera) no. 3/0 Sak/? - 276,540 - 276,540 - 276,540 - - 276,540 -

166 Sulfadimidin tablet 500 mg Tab - - - - - -

167 Sulfasetamid Natrium tetes mata 15% Btl - 90,555 - 90,555 - 90,555 - - 90,555 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

168 Tablet tambah darah kombinasi Tab? - 220,000 - 220,000 - 220,000 - - 220,000 -

169 Temporary stopping fletcher serbuk /cairan Set - 37,400 - 37,400 - 37,400 - - 37,400 -

170 Tetrakain HCl tetes mata tube - - - - - -

171 Tetrasiklin HCl kapsul 250 mg Kap - 189 - 189 - 189 - - 189 -

171 Tetrasiklin HCl kapsul 500 mg kaps - 226 - 226 - 226 - - 226 -

172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml Amp - 21,900 - 21,900 - 21,900 - - 21,900 -

173 Thiamin (Vit.B1) tablet 50 mg Tab - 41,580 - 41,580 - 41,580 - - 41,580 -

174 Thiamfenikol 500 mg Kaps - 440 - 440 - 440 - - 440 -

175 Triheksifenidil tablet 2 mg Tab - 44 - 44 - 44 - - 44 -

176 Vitamin B Kompleks tablet Tab - 24,420 - 24,420 - 24,420 - - 24,420 -

177 Yodium Povidon larutan 10% 30 ml Btl - 2,100 - 2,100 - 2,100 - - 2,100 -


179 Zinc Tab - 491.50 - 491.50 - 491.50 - - 491.50 -

180 ACT Set - - - - - -

181 ACT Anak Paket - - - - - -

182 FDC Anak Paket - 235,300 - 235,300 - 235,300 - - 235,300 -

183 FDC Kategori 1 Paket - 395,900 - 395,900 - 395,900 - - 395,900 -

184 FDC Kategori 2 Paket - 1,317,000 - 1,317,000 - 1,317,000 - - 1,317,000 -

185 FDC Sisipan Paket - 175,120 - 175,120 - 175,120 - - 175,120 -

TOTAL HARGA (Rp) - - - - - - - - - - -

…………………….., ………………….2013 Mengetahui,

Kepala Puskesmas Petugas Apotik

Puskesmas

12,000 26,720 147,360 812,900 3,539 - 400,000 4,330 13,500 248 3,573 28,600 890 231,700 28,800 - 18 41 32 14,400 32,745 297 150,100 40 25,000 40 40 -

1,528 400

1,502 1,524,000 - 12 - 55 234,450 - 2,925 238,400 210,600 33,800 60 - 14,690 559,000 7,250 506,700 49 542,000 197,000 - 153 33,400 35,700 2,600 1,601 - 334 22,200 9,900 279 141 - 268 76 - 26 437 1,000 79 76,100

- 1,327 760

4,209 46 39,500 1,853 - - - 1,487 16,400 11,400 41,800 64,400 100 17,823 486 339 94,600 36,200 276 3,304 - 86 5 3 72 2,040 1,896 2,119 447 9 2,300 16,710 - 100 131 18,900 1,944 166

78 700 7,600 39,200 500

- - 30,600 370,300 19,165 - 207 100 - 800 19,550 - 2,157,800 256,500 1,231 974 609 - 2,500 7,200 338,000 50 100 53,700 - - - - - 10,000 61,700 3,502 67,500 900 62,900 6,480

2,750 7,560 11 10 58 - 497

509 16 - - - 330 1,036 49,400 32,100 890 1,426 - - - - 5 40 20 26




No NAMA OBAT SAT

Penerimaan BarangPemakaian

Sisa Stok

Total (Rp)


Triw III Harga (Rp) Total (Rp) Dari Total (Rp) Oleh Total (Rp)








8 Amitriptyline HCl tablet salut 25 mg Tab - 118 - 118 - 118 - - 118 -

9 Amoxicillin sirup kering 125 mg/ 5 ml Btl - 2,511 - 2,511 - 2,511 - - 2,511 -

10 Amoxicillin kapsul 250 mg Kap - 220.24 - 220.24 - 220.24 - - 220.24 -

11 Amoxicillin kaplet 500 mg Kapl - 228 - 228 - 228 - - 228 -

12 Antalgin (metampiron) tablet 500 mg Tab - 15,070 - 15,070 - 15,070 - - 15,070 -

13 Antalgin injeksi 250 mg/ml - 2 ml Amp - - - - - -

14 Antasida DOEN tablet kombinasi Tab - 73.12 - 73.12 - 73.12 - - 73.12 -

15 Antasida DOEN syrup btl - 2,700 - 2,700 - 2,700 - - 2,700 -

16 Antibakteri DOEN salep kombinasi tube - 2,741 - 2,741 - 2,741 - - 2,741 -

17 Antihemoroid DOEN kombinasi Sup - 22,000 - 22,000 - 22,000 - - 22,000 -

18 Antifungi DOEN kombinasi Pot - 2,096.33 - 2,096.33 - 2,096.33 - - 2,096.33 -

19 Antimigrain DOEN kombinasi tab - - - - - -

20 Asam Askorbat (Vit.C) tablet 50 mg tab - 35,200 - 35,200 - 35,200 - - 35,200 -

21 Asam Mefenamat tablet 500 mg tab - 114.84 - 114.84 - 114.84 - - 114.84 -

22 aciklovir tablet 200mg Tab - 251 - 251 - 251 - - 251 -

23 aciklovir Krim - 2,367 - 2,367 - 2,367 - - 2,367 -

24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Amp - 25,958 - 25,958 - 25,958 - - 25,958 -

25 Atropin Sulfat Tab 0,5 mg Tab - 33,000 - 33,000 - 33,000 - - 33,000 -

26 Antimalaria DOEN Kombinasi Tab - 52,030 - 52,030 - 52,030 - - 52,030 -

27 Betahistin Mesilat tablet 6 mg Tab - 1,016 - 1,016 - 1,016 - - 1,016 -

28 Betametason krim 0,1% Tube - 1,668 - 1,668 - 1,668 - - 1,668 -

29 Calcium Lactate (Kalk) tabet 500 mg Tab - 57,200 - 57,200 - 57,200 - - 57,200 -

30 Captopril 25 mg Tab - 94 - 94 - 94 - - 94 -

31 Codein HCL tab. 10 mg Tab - 117,503 - 117,503 - 117,503 - - 117,503 -

32 Carbamazepine tablet 200 mg Tab - 267 - 267 - 267 - - 267 -



34 Chlorampenicol Kapsul 250 mg Kap - 250 - 250 - 250 - - 250 -

35 Chlorampenicol Salep Mata 1% Tube - 1,523 - 1,523 - 1,523 - - 1,523 -

36 Chloramphenicol Syrup Btl - 4,016 - 4,016 - 4,016 - - 4,016 -

Total Penerimaan Barang

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

37 Chloramphenicol Tetes Telinga 3% Btl - 1,750 - 1,750 - 1,750 - - 1,750 -

38 Chlorpheniramine Maleat (CTM) tab.4 mg Tab - 23 - 23 - 23 - - 23 -

39 Chlorpromazine injeksi 2,5 mg/ml Amp - 1,045 - 1,045 - 1,045 - - 1,045 -

40 Chlorpromazine HCl injeksi 5 mg/ml Amp - 11,279 - 11,279 - 11,279 - - 11,279 -

41 Chlorpromazine HCl tablet 100 mg Tab - 146 - 146 - 146 - - 146 -

42 Chlorpromazine HCl tablet 25 mg Tab - 41,800 - 41,800 - 41,800 - - 41,800 -

43 Ciprofloxacin 500 mg Tab - 241 - 241 - 241 - - 241 -

44 Cotrimoxazole Pediatrik Tab - 79 - 79 - 79 - - 79 -

45 Cotrimoxazole Suspensi Btl - 2,212.94 - 2,212.94 - 2,212.94 - - 2,212.94 -

46 Cotrimoxazole Dewasa Tab - 146.24 - 146.24 - 146.24 - - 146.24 -

47 Cimetidine tablet 200 mg Tab - 115.52 - 115.52 - 115.52 - - 115.52 -

48 Clonidine tablet 0,15 mg Tab - 191 - 191 - 191 - - 191 -

49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml Amp - 52,000 - 52,000 - 52,000 - - 52,000 -

50 Chloramphenikol Tetes Mata Btl - - - - - -

51 Dexamethasone Injeksi Amp - 1,750 - 1,750 - 1,750 - - 1,750 -

52 Dexamethasone Kaplet 0,5 mg Kapl - 71.89 - 71.89 - 71.89 - - 71.89 -

53 Dekstromethorphan HBr sirup 10 mg/5 ml Btl - 1,467.4 - 1,467.4 - 1,467.4 - - 1,467.4 -

54 Dekstrometorphan HBr tablet 15 mg Tab - 102 - 102 - 102 - - 102 -

55 Diazepam inj 15 mg/ml - 2 ml Amp - 78,147 - 78,147 - 78,147 - - 78,147 -

56 Diazepam 2 mg Tab? - 39 - 39 - 39 - - 39 -

57 Diazepam 5 mg Tab - - - - - -

58 Dietilkarbamin sitrat tablet 100 mg Tab - - - - - -

59 Diphenhydramine HCl inj 10 mg/ml-1 ml Tab - 1,056 - 1,056 - 1,056 - - 1,056 -

60 Digoksin tablet 0,25 mg Tab - 96.48 - 96.48 - 96.48 - - 96.48 -

61 Diltiazem tab. 30 mg Tab - 129 - 129 - 129 - - 129 -

62 Doksisiklin 100 mg Tab - 250 - 250 - 250 - - 250 -

63 Efedrin HCl tablet 25 mg Tab - 14,097 - 14,097 - 14,097 - - 14,097 -

64 Ekstrak Belladon tablet 10 mg Tab - - - - - -

65 Erytromicin syr Btl - 8,910 - 8,910 - 8,910 - - 8,910 -

66 Erytromicin tab 250 mg Tab - 462 - 462 - 462 - - 462 -

67 Erytromicin tab 500 mg Tab - 912.94 - 912.94 - 912.94 - - 912.94 -

68 Epinefrin HCl inj 0,1% - 1 ml Amp - 10,371 - 10,371 - 10,371 - - 10,371 -

69 Etakridin(Rivanol) larutan 0,1 % Btl - 2,354.22 - 2,354.22 - 2,354.22 - - 2,354.22 -

70 Ethanol 70% Btl - - - - - -

71 Etil chlorida semprot Btl - 115,500 - 115,500 - 115,500 - - 115,500 -

72 Eugenol cairan Btl - 605,000 - 605,000 - 605,000 - - 605,000 -

73 Fenitoin natrium injeksi 50mg/ml Amp - - - - - -

74 Fenobarbital inj. 50mg/ml Amp - 20,100 - 20,100 - 20,100 - - 20,100 -

75 Fenobarbital tab. 30 mg Tab - 7,139 - 7,139 - 7,139 - - 7,139 -

76 Fenol gliserol tetes telinga 10 % Btl - 1,108.80 - 1,108.80 - 1,108.80 - - 1,108.80 -

77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml Amp - 57,420 - 57,420 - 57,420 - - 57,420 -

78 Fitomenadion (Vit K) tab. Salut 10 mg Tab - 640.59 - 640.59 - 640.59 - - 640.59 -

79 Fluour tablet 0,5 mg Tab - - - - - -

80 Furosemide tab. 40 mg Tab - 11,229 - 11,229 - 11,229 - - 11,229 -

81 Garam Oralit untuk 200 ml - air Sak - 41,800 - 41,800 - 41,800 - - 41,800 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

82 Gention violet 1 % Btl? - 495 - 495 - 495 - - 495 -

83 Glass ionomer cement (gx ic) Set - 434,500 - 434,500 - 434,500 - - 434,500 -

84 Glibenklamide tab. 5 mg Tab - 59 - 59 - 59 - - 59 -

85 Gliseril guayakolat tab. 100 mg Tab - 30,690 - 30,690 - 30,690 - - 30,690 -

86 Gliserin Btl - - - - - -



89 Glukosa larutan infus 5% steril Btl - 5,844 - 5,844 - 5,844 - - 5,844 -

90 Griseofulvin tab. 125 mg, micronized Tab - 204 - 204 - 204 - - 204 -



93 Haloperidol tablet 5 mg Tab - 94.21 - 94.21 - 94.21 - - 94.21 -

94 Hidroklortiazid (HCT) tablet 25 mg Tab - 39,930.00 - 39,930.00 - 39,930.00 - - 39,930.00 -

95 Hidrokortison krim 2,5% Tube - 2,519.00 - 2,519.00 - 2,519.00 - - 2,519.00 -

96 Hyoscine -n- Butilbromide Tab - 33,000.00 - 33,000.00 - 33,000.00 - - 33,000.00 -

97 Handscoen No. 7 Set - 233,750 - 233,750 - 233,750 - - 233,750 -

98 Ibuprofen tablet 200 mg / Irgapan Tab - 96.21 - 96.21 - 96.21 - - 96.21 -

99 Ibuprofen tablet 400 mg Tab - 152.5 - 152.5 - 152.5 - - 152.5 -

100 Infusion set anak Set - 4,400 - 4,400 - 4,400 - - 4,400 -

101 Infusion set dewasa Set - 3,850 - 3,850 - 3,850 - - 3,850 -

102 I.V. Catheter No. 18 Set - - - - - -




106 Isosorbid Dinitrat tablet sublingual 5 mg Tab - 8,910 - 8,910 - 8,910 - - 8,910 -

107 Kasa kompres 40/40 steril roll - 1,393 - 1,393 - 1,393 - - 1,393 -

108 Kasa pembalut 2 m x 80 cm roll - 8,799 - 8,799 - 8,799 - - 8,799 -

109 Kasa pembalut hidrofil 4 m x 15 cm roll - 3,373 - 3,373 - 3,373 - - 3,373 -

110 Kapas pembalut/absorben 250 gram Bks - 8,250 - 8,250 - 8,250 - - 8,250 -

111 Kalsium Hidroksida pasta Tube - 266,200 - 266,200 - 266,200 - - 266,200 -

112 Ketoconazole 200 mg Tab - 267 - 267 - 267 - - 267 -

113 Lidokain kompositum injeksi Amp - 1,485 - 1,485 - 1,485 - - 1,485 -

114 Mebendazol tablet 100 mg Tab - - - - - -

115 Metilergometrin maleat tablet salut 0,125 mg Tab - 13,310 - 13,310 - 13,310 - - 13,310 -

116 Metilergometrin maleat inj. 0,200 mg - 1 ml Amp - 49,170 - 49,170 - 49,170 - - 49,170 -

117 Metronidazol tablet 250 mg Tab - 183 - 183 - 183 - - 183 -

118 Miconazole cream 10 g Tube - 3,300 - 3,300 - 3,300 - - 3,300 -

119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab - 12,100 - 12,100 - 12,100 - - 12,100 -

120 Metoklopramide HCl injeksi (Piralen) Amp? - 11,000 - 11,000 - 11,000 - - 11,000 -

121 Metoklopramide syrup Btl - 2,310 - 2,310 - 2,310 - - 2,310 -

122 Mineral Mix Set - 2,695 - 2,695 - 2,695 - - 2,695 -

123 Metformin tablet 500mg Tab - 105 - 105 - 105 - - 105 -

124 Natrium klorida lar. Infus 0,9% steril Btl - 5,390 - 5,390 - 5,390 - - 5,390 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

125 Nistatin 100.000 iu/g tab vaginal Tab - 28,876 - 28,876 - 28,876 - - 28,876 -

126 Nistatin 500.000 iu tab salut Tab - 704 - 704 - 704 - - 704 -

127 Nifedipin tablet 10 mg Tab - 118 - 118 - 118 - - 118 -

128 Natrium Diklofenak tablet 50 mg Tab - 206 - 206 - 206 - - 206 -

129 Obat Batuk Hitam (OBH) cairan Btl - 1,573 - 1,573 - 1,573 - - 1,573 -

130 Oksitetrasiklin HCl salep mata Tube - - - - - -

131 Oksitetrasiklin HCl salep Kulit 3% Tube - 1,646 - 1,646 - 1,646 - - 1,646 -

132 Oksitosin injeksi 10 iu/ml - 1 ml Amp - 58,905 - 58,905 - 58,905 - - 58,905 -

133 Paraformaldehid tablet 1 gram Tab - - - - - -

134 Parasetamol Drops Btl - 5,749 - 5,749 - 5,749 - - 5,749 -

135 Parasetamol sirup 120 mg/5 ml Btl - 1,403.6 - 1,403.6 - 1,403.6 - - 1,403.6 -



138 Pirantel Pamoat tablet 365 mg Tab - 343 - 343 - 343 - - 343 -

139 Piridoksin HCl tablet 10 mg Tab - 19,140 - 19,140 - 19,140 - - 19,140 -

140 Plester 5 yard x 2 inchi Roll - 23,625 - 23,625 - 23,625 - - 23,625 -

141 Prednison tablet 5 mg Tab - 68,750 - 68,750 - 68,750 - - 68,750 -

142 Primakuin tablet 15 mg Tab - 125 - 125 - 125 - - 125 -

143 Propiltiourasil tablet 100 mg Tab - 297 - 297 - 297 - - 297 -

144 Propanolol HCl tablet 40 mg Tab - 119 - 119 - 119 - - 119 -

145 Papaverin tablet 40 mg Tab - 128 - 128 - 128 - - 128 -

146 Pembalut Gips 4 inch Roll - 35,750 - 35,750 - 35,750 - - 35,750 -

147 Pembalut gips 6 inch Roll - 46,200 - 46,200 - 46,200 - - 46,200 -

148 Piroxicam tablet 20 mg Tab - 97.99 - 97.99 - 97.99 - - 97.99 -

149 Poly Chateter No. 16 Set - - - - - -

150 Poly Chateter No. 18 Set - 8,495 - 8,495 - 8,495 - - 8,495 -

151 Quinine dihidroklorida inj. 25% - 2 ml Amp - - - - - -

152 Quinine sulfat tab. 222 mg (7 h2o)l Tab - - - - - -

153 Reserpin tablet 0,25 mg Tab - 114 - 114 - 114 - - 114 -



156 Ringer Laktat lar infus steril Btl - 5,720 - 5,720 - 5,720 - - 5,720 -

157 Ranitidin tab 150 mg Tab - 119 - 119 - 119 - - 119 -

158 Ranitidin injeksi 25mg/2 ml Amp - 1,157 - 1,157 - 1,157 - - 1,157 -

159 Salbutamol tablet 2 mg Tab - 70 - 70 - 70 - - 70 -

160 Salep 2-4 kombinasi Tube - 1,980 - 1,980 - 1,980 - - 1,980 -

161 Salisil bedak 2% Set - 1,180 - 1,180 - 1,180 - - 1,180 -

162 Simvastatin tablet Tab - 180 - 180 - 180 - - 180 -

163 Serum anti tetanus inj.1.500 iu/ampul ats Amp - 151,220 - 151,220 - 151,220 - - 151,220 -

164 Semen seng fosfat serbuk dan cairann set - 102,850 - 102,850 - 102,850 - - 102,850 -

165 Silk (benang bedah sutera) no. 3/0 Sak/? - 276,540 - 276,540 - 276,540 - - 276,540 -

166 Sulfadimidin tablet 500 mg Tab - - - - - -

167 Sulfasetamid Natrium tetes mata 15% Btl - 90,555 - 90,555 - 90,555 - - 90,555 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

168 Tablet tambah darah kombinasi Tab? - 220,000 - 220,000 - 220,000 - - 220,000 -

169 Temporary stopping fletcher serbuk /cairan Set - 37,400 - 37,400 - 37,400 - - 37,400 -

170 Tetrakain HCl tetes mata tube - - - - - -

171 Tetrasiklin HCl kapsul 250 mg Kap - 189 - 189 - 189 - - 189 -

171 Tetrasiklin HCl kapsul 500 mg kaps - 226 - 226 - 226 - - 226 -

172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml Amp - 21,900 - 21,900 - 21,900 - - 21,900 -

173 Thiamin (Vit.B1) tablet 50 mg Tab - 41,580 - 41,580 - 41,580 - - 41,580 -

174 Thiamfenikol 500 mg Kaps - 440 - 440 - 440 - - 440 -

175 Triheksifenidil tablet 2 mg Tab - 44 - 44 - 44 - - 44 -

176 Vitamin B Kompleks tablet Tab - 24,420 - 24,420 - 24,420 - - 24,420 -



179 Zinc Tab - 491.50 - 491.50 - 491.50 - - 491.50 -

180 ACT Set - - - - - -

181 ACT Anak Paket - - - - - -

182 FDC Anak Paket - 235,300 - 235,300 - 235,300 - - 235,300 -

183 FDC Kategori 1 Paket - 395,900 - 395,900 - 395,900 - - 395,900 -

184 FDC Kategori 2 Paket - 1,317,000 - 1,317,000 - 1,317,000 - - 1,317,000 -

185 FDC Sisipan Paket - 175,120 - 175,120 - 175,120 - - 175,120 -

TOTAL HARGA (Rp) - - - - - - - - - - -

…………………….., ………………….2013 Mengetahui,

Kepala Puskesmas Makale Utara Petugas Apotik

Puskesmas Makale Utara

drg. Benedicta M.W.S Febrianti Guling Rissing, AMdFarNIP. 19660307 199312 2 001 NIP. 19880201 201101 2 017

12,000 26,720 147,360 812,900 3,539 - 400,000 4,330 13,500 248 3,573 28,600 890 231,700 28,800 - 18 41 32 14,400 32,745 297 150,100 40 25,000 40 40 - 1,528 400

1,502 1,524,000 - 12 - 55 234,450 - 2,925 238,400 210,600 33,800 60 - 14,690 559,000 7,250 506,700 49 542,000 197,000 - 153 33,400 35,700 2,600 1,601 - 334 22,200 9,900 279 141 - 268 76 - 26 437 1,000 79 76,100 - 1,327 760

4,209 46 39,500 1,853 - - - 1,487 16,400 11,400 41,800 64,400 100 17,823 486 339 94,600 36,200 276 3,304 - 86 5 3 72 2,040 1,896 2,119 447 9 2,300 16,710 - 100 131 18,900 1,944 166 78 700 7,600 39,200

500

- - 30,600 370,300 19,165 - 207 100 - 800 19,550 - 2,157,800 256,500 1,231 974 609 - 2,500 7,200 338,000 50 100 53,700 - - - - - 10,000 61,700 3,502 67,500 900 62,900 6,480 2,750 7,560 11 10

58 - 497

509 16 - - - 330 1,036 49,400 32,100 890 1,426 - - - - 5 40 20 26




No NAMA OBAT SAT


Sisa Stok

Total (Rp)


Triw II Harga (Rp) Total (Rp) Dari Total (Rp) Oleh Total (Rp)








8 Amitriptyline HCl tablet salut 25 mg Tab - 118 - 118 - 118 - - 118 - 12,000 9 Amoxicillin sirup kering 125 mg/ 5 ml Btl - 2,511 - 2,511 - 2,511 - - 2,511 - 26,720

10 Amoxicillin kapsul 250 mg Kap - 220.24 - 220.24 - 220.24 - - 220.24 - 147,360 11 Amoxicillin kaplet 500 mg Kapl - 228 - 228 - 228 - - 228 - 812,900 12 Antalgin (metampiron) tablet 500 mg Tab - 15,070 - 15,070 - 15,070 - - 15,070 - 3,539 13 Antalgin injeksi 250 mg/ml - 2 ml Amp - - - - - - - 14 Antasida DOEN tablet kombinasi Tab - 73.12 - 73.12 - 73.12 - - 73.12 - 400,000 15 Antasida DOEN syrup btl - 2,700 - 2,700 - 2,700 - - 2,700 - 4,330 16 Antibakteri DOEN salep kombinasi tube - 2,741 - 2,741 - 2,741 - - 2,741 - 13,500 17 Antihemoroid DOEN kombinasi Sup - 22,000 - 22,000 - 22,000 - - 22,000 - 248 18 Antifungi DOEN kombinasi Pot - 2,096.33 - 2,096.33 - 2,096.33 - - 2,096.33 - 3,573 19 Antimigrain DOEN kombinasi tab - - - - - - 28,600 20 Asam Askorbat (Vit.C) tablet 50 mg tab - 35,200 - 35,200 - 35,200 - - 35,200 - 890 21 Asam Mefenamat tablet 500 mg tab - 114.84 - 114.84 - 114.84 - - 114.84 - 231,700 22 aciklovir tablet 200mg Tab - 251 - 251 - 251 - - 251 - 28,800 23 aciklovir Krim - 2,367 - 2,367 - 2,367 - - 2,367 - - 24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Amp - 25,958 - 25,958 - 25,958 - - 25,958 - 18 25 Atropin Sulfat Tab 0,5 mg Tab - 33,000 - 33,000 - 33,000 - - 33,000 - 41 26 Antimalaria DOEN Kombinasi Tab - 52,030 - 52,030 - 52,030 - - 52,030 - 32 27 Betahistin Mesilat tablet 6 mg Tab - 1,016 - 1,016 - 1,016 - - 1,016 - 14,400 28 Betametason krim 0,1% Tube - 1,668 - 1,668 - 1,668 - - 1,668 - 32,745 29 Calcium Lactate (Kalk) tabet 500 mg Tab - 57,200 - 57,200 - 57,200 - - 57,200 - 297 30 Captopril 25 mg Tab - 94 - 94 - 94 - - 94 - 150,100 31 Codein HCL tab. 10 mg Tab - 117,503 - 117,503 - 117,503 - - 117,503 - 40 32 Carbamazepine tablet 200 mg Tab - 267 - 267 - 267 - - 267 - 25,000 33 Catgut/benang bedah no.2/0 (plain & chromic) Sak - 704,000 - 704,000 - 704,000 - - 704,000 - 40 33 Catgut/benang bedah no.3/0 (plain & chromic) Sak - 639,138 - 639,138 - 639,138 - - 639,138 - 40 34 Chlorampenicol Kapsul 250 mg Kap - 250 - 250 - 250 - - 250 - - 35 Chlorampenicol Salep Mata 1% Tube - 1,523 - 1,523 - 1,523 - - 1,523 - 1,528 36 Chloramphenicol Syrup Btl - 4,016 - 4,016 - 4,016 - - 4,016 - 400

Total Penerimaan

Barang

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

37 Chloramphenicol Tetes Telinga 3% Btl - 1,750 - 1,750 - 1,750 - - 1,750 - 1,502 38 Chlorpheniramine Maleat (CTM) tab.4 mg Tab - 23 - 23 - 23 - - 23 - 1,524,000 39 Chlorpromazine injeksi 2,5 mg/ml Amp - 1,045 - 1,045 - 1,045 - - 1,045 - - 40 Chlorpromazine HCl injeksi 5 mg/ml Amp - 11,279 - 11,279 - 11,279 - - 11,279 - 12 41 Chlorpromazine HCl tablet 100 mg Tab - 146 - 146 - 146 - - 146 - - 42 Chlorpromazine HCl tablet 25 mg Tab - 41,800 - 41,800 - 41,800 - - 41,800 - 55 43 Ciprofloxacin 500 mg Tab - 241 - 241 - 241 - - 241 - 234,450 44 Cotrimoxazole Pediatrik Tab - 79 - 79 - 79 - - 79 - - 45 Cotrimoxazole Suspensi Btl - 2,212.94 - 2,212.94 - 2,212.94 - - 2,212.94 - 2,925 46 Cotrimoxazole Dewasa Tab - 146.24 - 146.24 - 146.24 - - 146.24 - 238,400 47 Cimetidine tablet 200 mg Tab - 115.52 - 115.52 - 115.52 - - 115.52 - 210,600 48 Clonidine tablet 0,15 mg Tab - 191 - 191 - 191 - - 191 - 33,800 49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml Amp - 52,000 - 52,000 - 52,000 - - 52,000 - 60 50 Chloramphenikol Tetes Mata Btl - - - - - - - 51 Dexamethasone Injeksi Amp - 1,750 - 1,750 - 1,750 - - 1,750 - 14,690 52 Dexamethasone Kaplet 0,5 mg Kapl - 71.89 - 71.89 - 71.89 - - 71.89 - 559,000 53 Dekstromethorphan HBr sirup 10 mg/5 ml Btl - 1,467.4 - 1,467.4 - 1,467.4 - - 1,467.4 - 7,250 54 Dekstrometorphan HBr tablet 15 mg Tab - 102 - 102 - 102 - - 102 - 506,700 55 Diazepam inj 15 mg/ml - 2 ml Amp - 78,147 - 78,147 - 78,147 - - 78,147 - 49 56 Diazepam 2 mg Tab? - 39 - 39 - 39 - - 39 - 542,000 57 Diazepam 5 mg Tab - - - - - - 197,000 58 Dietilkarbamin sitrat tablet 100 mg Tab - - - - - - - 59 Diphenhydramine HCl inj 10 mg/ml-1 ml Tab - 1,056 - 1,056 - 1,056 - - 1,056 - 153 60 Digoksin tablet 0,25 mg Tab - 96.48 - 96.48 - 96.48 - - 96.48 - 33,400 61 Diltiazem tab. 30 mg Tab - 129 - 129 - 129 - - 129 - 35,700 62 Doksisiklin 100 mg Tab - 250 - 250 - 250 - - 250 - 2,600 63 Efedrin HCl tablet 25 mg Tab - 14,097 - 14,097 - 14,097 - - 14,097 - 1,601 64 Ekstrak Belladon tablet 10 mg Tab - - - - - - - 65 Erytromicin syr Btl - 8,910 - 8,910 - 8,910 - - 8,910 - 334 66 Erytromicin tab 250 mg Tab - 462 - 462 - 462 - - 462 - 22,200 67 Erytromicin tab 500 mg Tab - 912.94 - 912.94 - 912.94 - - 912.94 - 9,900 68 Epinefrin HCl inj 0,1% - 1 ml Amp - 10,371 - 10,371 - 10,371 - - 10,371 - 279 69 Etakridin(Rivanol) larutan 0,1 % Btl - 2,354.22 - 2,354.22 - 2,354.22 - - 2,354.22 - 141 70 Ethanol 70% Btl - - - - - - - 71 Etil chlorida semprot Btl - 115,500 - 115,500 - 115,500 - - 115,500 - 268 72 Eugenol cairan Btl - 605,000 - 605,000 - 605,000 - - 605,000 - 76 73 Fenitoin natrium injeksi 50mg/ml Amp - - - - - - - 74 Fenobarbital inj. 50mg/ml Amp - 20,100 - 20,100 - 20,100 - - 20,100 - 26 75 Fenobarbital tab. 30 mg Tab - 7,139 - 7,139 - 7,139 - - 7,139 - 437 76 Fenol gliserol tetes telinga 10 % Btl - 1,108.80 - 1,108.80 - 1,108.80 - - 1,108.80 - 1,000 77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml Amp - 57,420 - 57,420 - 57,420 - - 57,420 - 79 78 Fitomenadion (Vit K) tab. Salut 10 mg Tab - 640.59 - 640.59 - 640.59 - - 640.59 - 76,100 79 Fluour tablet 0,5 mg Tab - - - - - - - 80 Furosemide tab. 40 mg Tab - 11,229 - 11,229 - 11,229 - - 11,229 - 1,327 81 Garam Oralit untuk 200 ml - air Sak - 41,800 - 41,800 - 41,800 - - 41,800 - 760

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

82 Gention violet 1 % Btl? - 495 - 495 - 495 - - 495 - 4,209 83 Glass ionomer cement (gx ic) Set - 434,500 - 434,500 - 434,500 - - 434,500 - 46 84 Glibenklamide tab. 5 mg Tab - 59 - 59 - 59 - - 59 - 39,500 85 Gliseril guayakolat tab. 100 mg Tab - 30,690 - 30,690 - 30,690 - - 30,690 - 1,853 86 Gliserin Btl - - - - - - - 87 Glukosa larutan infus 10% steril Btl - - - - - - - 88 Glukosa larutan infus 40% steril Btl - - - - - - - 89 Glukosa larutan infus 5% steril Btl - 5,844 - 5,844 - 5,844 - - 5,844 - 1,487 90 Griseofulvin tab. 125 mg, micronized Tab - 204 - 204 - 204 - - 204 - 16,400 91 Haloperidol tablet 0,5 mg Tab - 55.70 - 55.70 - 55.70 - - 55.70 - 11,400 92 Haloperidol tablet 1,5 mg Tab - 64.43 - 64.43 - 64.43 - - 64.43 - 41,800 93 Haloperidol tablet 5 mg Tab - 94.21 - 94.21 - 94.21 - - 94.21 - 64,400 94 Hidroklortiazid (HCT) tablet 25 mg Tab - 39,930.00 - 39,930.00 - 39,930.00 - - 39,930.00 - 100 95 Hidrokortison krim 2,5% Tube - 2,519.00 - 2,519.00 - 2,519.00 - - 2,519.00 - 17,823 96 Hyoscine -n- Butilbromide Tab - 33,000.00 - 33,000.00 - 33,000.00 - - 33,000.00 - 486 97 Handscoen No. 7 Set - 233,750 - 233,750 - 233,750 - - 233,750 - 339 98 Ibuprofen tablet 200 mg / Irgapan Tab - 96.21 - 96.21 - 96.21 - - 96.21 - 94,600 99 Ibuprofen tablet 400 mg Tab - 152.5 - 152.5 - 152.5 - - 152.5 - 36,200

100 Infusion set anak Set - 4,400 - 4,400 - 4,400 - - 4,400 - 276 101 Infusion set dewasa Set - 3,850 - 3,850 - 3,850 - - 3,850 - 3,304 102 I.V. Catheter No. 18 Set - - - - - - - 103 I.V. Catheter No. 20 Set - 428,310 - 428,310 - 428,310 - - 428,310 - 86 104 I.V. Catheter No. 22 Set - 428,227 - 428,227 - 428,227 - - 428,227 - 5 105 I.V. Catheter No. 24 Set - 428,310 - 428,310 - 428,310 - - 428,310 - 3 106 Isosorbid Dinitrat tablet sublingual 5 mg Tab - 8,910 - 8,910 - 8,910 - - 8,910 - 72 107 Kasa kompres 40/40 steril roll - 1,393 - 1,393 - 1,393 - - 1,393 - 2,040 108 Kasa pembalut 2 m x 80 cm roll - 8,799 - 8,799 - 8,799 - - 8,799 - 1,896 109 Kasa pembalut hidrofil 4 m x 15 cm roll - 3,373 - 3,373 - 3,373 - - 3,373 - 2,119 110 Kapas pembalut/absorben 250 gram Bks - 8,250 - 8,250 - 8,250 - - 8,250 - 447 111 Kalsium Hidroksida pasta Tube - 266,200 - 266,200 - 266,200 - - 266,200 - 9 112 Ketoconazole 200 mg Tab - 267 - 267 - 267 - - 267 - 2,300 113 Lidokain kompositum injeksi Amp - 1,485 - 1,485 - 1,485 - - 1,485 - 16,710 114 Mebendazol tablet 100 mg Tab - - - - - - - 115 Metilergometrin maleat tablet salut 0,125 mg Tab - 13,310 - 13,310 - 13,310 - - 13,310 - 100 116 Metilergometrin maleat inj. 0,200 mg - 1 ml Amp - 49,170 - 49,170 - 49,170 - - 49,170 - 131 117 Metronidazol tablet 250 mg Tab - 183 - 183 - 183 - - 183 - 18,900 118 Miconazole cream 10 g Tube - 3,300 - 3,300 - 3,300 - - 3,300 - 1,944 119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab - 12,100 - 12,100 - 12,100 - - 12,100 - 166 120 Metoklopramide HCl injeksi (Piralen) Amp? - 11,000 - 11,000 - 11,000 - - 11,000 - 78 121 Metoklopramide syrup Btl - 2,310 - 2,310 - 2,310 - - 2,310 - 700 122 Mineral Mix Set - 2,695 - 2,695 - 2,695 - - 2,695 - 7,600 123 Metformin tablet 500mg Tab - 105 - 105 - 105 - - 105 - 39,200

124 Natrium klorida lar. Infus 0,9% steril Btl - 5,390 - 5,390 - 5,390 - - 5,390 - 500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

125 Nistatin 100.000 iu/g tab vaginal Tab - 28,876 - 28,876 - 28,876 - - 28,876 - - 126 Nistatin 500.000 iu tab salut Tab - 704 - 704 - 704 - - 704 - - 127 Nifedipin tablet 10 mg Tab - 118 - 118 - 118 - - 118 - 30,600 128 Natrium Diklofenak tablet 50 mg Tab - 206 - 206 - 206 - - 206 - 370,300 129 Obat Batuk Hitam (OBH) cairan Btl - 1,573 - 1,573 - 1,573 - - 1,573 - 19,165 130 Oksitetrasiklin HCl salep mata Tube - - - - - - - 131 Oksitetrasiklin HCl salep Kulit 3% Tube - 1,646 - 1,646 - 1,646 - - 1,646 - 207 132 Oksitosin injeksi 10 iu/ml - 1 ml Amp - 58,905 - 58,905 - 58,905 - - 58,905 - 100 133 Paraformaldehid tablet 1 gram Tab - - - - - - - 134 Parasetamol Drops Btl - 5,749 - 5,749 - 5,749 - - 5,749 - 800 135 Parasetamol sirup 120 mg/5 ml Btl - 1,403.6 - 1,403.6 - 1,403.6 - - 1,403.6 - 19,550 136 Parasetamol tablet 100 mg Tab - 34.51 - 34.51 - 34.51 - - 34.51 - - 137 Parasetamol tablet 500 mg Tab - 84.8 - 84.8 - 84.8 - - 84.8 - 2,157,800 138 Pirantel Pamoat tablet 365 mg Tab - 343 - 343 - 343 - - 343 - 256,500 139 Piridoksin HCl tablet 10 mg Tab - 19,140 - 19,140 - 19,140 - - 19,140 - 1,231 140 Plester 5 yard x 2 inchi Roll - 23,625 - 23,625 - 23,625 - - 23,625 - 974 141 Prednison tablet 5 mg Tab - 68,750 - 68,750 - 68,750 - - 68,750 - 609 142 Primakuin tablet 15 mg Tab - 125 - 125 - 125 - - 125 - - 143 Propiltiourasil tablet 100 mg Tab - 297 - 297 - 297 - - 297 - 2,500 144 Propanolol HCl tablet 40 mg Tab - 119 - 119 - 119 - - 119 - 7,200 145 Papaverin tablet 40 mg Tab - 128 - 128 - 128 - - 128 - 338,000 146 Pembalut Gips 4 inch Roll - 35,750 - 35,750 - 35,750 - - 35,750 - 50 147 Pembalut gips 6 inch Roll - 46,200 - 46,200 - 46,200 - - 46,200 - 100 148 Piroxicam tablet 20 mg Tab - 97.99 - 97.99 - 97.99 - - 97.99 - 53,700 149 Poly Chateter No. 16 Set - - - - - - - 150 Poly Chateter No. 18 Set - 8,495 - 8,495 - 8,495 - - 8,495 - - 151 Quinine dihidroklorida inj. 25% - 2 ml Amp - - - - - - - 152 Quinine sulfat tab. 222 mg (7 h2o)l Tab - - - - - - - 153 Reserpin tablet 0,25 mg Tab - 114 - 114 - 114 - - 114 - - 154 Retinol (Vit.A) kaps 100.000 IU Kap - 254 - 254 - 254 - - 254 - 10,000 155 Retinol (Vit.A) kaps 200.000 IU Kap - 412 - 412 - 412 - - 412 - 61,700 156 Ringer Laktat lar infus steril Btl - 5,720 - 5,720 - 5,720 - - 5,720 - 3,502 157 Ranitidin tab 150 mg Tab - 119 - 119 - 119 - - 119 - 67,500 158 Ranitidin injeksi 25mg/2 ml Amp - 1,157 - 1,157 - 1,157 - - 1,157 - 900 159 Salbutamol tablet 2 mg Tab - 70 - 70 - 70 - - 70 - 62,900 160 Salep 2-4 kombinasi Tube - 1,980 - 1,980 - 1,980 - - 1,980 - 6,480 161 Salisil bedak 2% Set - 1,180 - 1,180 - 1,180 - - 1,180 - 2,750 162 Simvastatin tablet Tab - 180 - 180 - 180 - - 180 - 7,560 163 Serum anti tetanus inj.1.500 iu/ampul ats Amp - 151,220 - 151,220 - 151,220 - - 151,220 - 11 164 Semen seng fosfat serbuk dan cairann set - 102,850 - 102,850 - 102,850 - - 102,850 - 10

165 Silk (benang bedah sutera) no. 3/0 Sak/? - 276,540 - 276,540 - 276,540 - - 276,540 - 58 166 Sulfadimidin tablet 500 mg Tab - - - - - - - 167 Sulfasetamid Natrium tetes mata 15% Btl - 90,555 - 90,555 - 90,555 - - 90,555 - 497

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

168 Tablet tambah darah kombinasi Tab? - 220,000 - 220,000 - 220,000 - - 220,000 - 509 169 Temporary stopping fletcher serbuk /cairan Set - 37,400 - 37,400 - 37,400 - - 37,400 - 16 170 Tetrakain HCl tetes mata tube - - - - - - - 171 Tetrasiklin HCl kapsul 250 mg Kap - 189 - 189 - 189 - - 189 - - 171 Tetrasiklin HCl kapsul 500 mg kaps - 226 - 226 - 226 - - 226 - - 172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml Amp - 21,900 - 21,900 - 21,900 - - 21,900 - 330 173 Thiamin (Vit.B1) tablet 50 mg Tab - 41,580 - 41,580 - 41,580 - - 41,580 - 1,036 174 Thiamfenikol 500 mg Kaps - 440 - 440 - 440 - - 440 - 49,400 175 Triheksifenidil tablet 2 mg Tab - 44 - 44 - 44 - - 44 - 32,100 176 Vitamin B Kompleks tablet Tab - 24,420 - 24,420 - 24,420 - - 24,420 - 890 177 Yodium Povidon larutan 10% 30 ml Btl - 2,100 - 2,100 - 2,100 - - 2,100 - 1,426 178 Yodium Povidon larutan 10% 300 ml Btl - 14,700 - 14,700 - 14,700 - - 14,700 - - 179 Zinc Tab - 491.50 - 491.50 - 491.50 - - 491.50 - - 180 ACT Set - - - - - - - 181 ACT Anak Paket - - - - - - - 182 FDC Anak Paket - 235,300 - 235,300 - 235,300 - - 235,300 - 5 183 FDC Kategori 1 Paket - 395,900 - 395,900 - 395,900 - - 395,900 - 40 184 FDC Kategori 2 Paket - 1,317,000 - 1,317,000 - 1,317,000 - - 1,317,000 - 20 185 FDC Sisipan Paket - 175,120 - 175,120 - 175,120 - - 175,120 - 26

TOTAL HARGA (Rp) - - - - - - - - - - -

…………………….., ………………….2013 Mengetahui,



drg. Benedicta M.W.S Febrianti Guling Rissing,AMdFarNIP. 19660307 199312 2 001 NIP.19880201 201101 2 017

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT( LPLPO )

KODE PUSKESMAS :

PUSKESMAS :

KECAMATAN : Bulan :

KABUPATEN : Tahun :

PROPINSI :

No NAMA OBAT SAT PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT.PEMBERIAN

KET

PKD BUFFER LAIN . JML1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 151 Alat suntik sekali pakai 1 ml 32 Set

2 Alat suntik sekali pakai 2,5 ml 32 Set

3 Alat suntik sekali pakai 5 ml 32 Set

4 Albendazole tablet 400 mg 6,1,1 Tab

5 Allopurinol tablet 100 mg 1.2 Tab

6 Aminophylline tablet 200 mg 26.1 Tab

7 Aminophylline injeksi 24 mg/ml - 10 ml 26.1 Amp

8 Amitriptyline HCl tablet salut 25 mg 23.2 Tab

9 Amoxicillin sirup kering 125 mg/ 5 ml 6,2,1 Btl

10 Amoxicillin kapsul 250 mg 6,2,1 Kap

11 Amoxicillin kaplet 500 mg Kapl

12 Antalgin (metampiron) tablet 500 mg 1.2 Tab

13 Antalgin injeksi 250 mg/ml - 2 ml 1.2 Amp

14 Antasida DOEN tablet kombinasi 25.1 Tab

15 Antasida DOEN syrup btl

16 Antibakteri DOEN salep kombinasi 18.2 tube

17 Antihemoroid DOEN kombinasi 25.3 Sup

18 Antifungi DOEN kombinasi 18.3 Pot

19 Antimigrain DOEN kombinasi 7.2 tab

20 Asam Askorbat (Vit.C) tablet 50 mg 29 tab

21 Asam Mefenamat tablet 500 mg tab

22 aciklovir tablet 200mg Tab

23 aciklovir Krim

24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 25.4 Amp

25 Atropin Sulfat Tab 0,5 mg Tab

26 Antimalaria DOEN Kombinasi Tab

27 Betahistin Mesilat tablet 6 mg Tab

28 Betametason krim 0,1% 18.4 Tube

29 Calcium Lactate (Kalk) tabet 500 mg 29 Tab

30 Captopril 25 mg Tab

31 Codein HCL tab. 10 mg 26.2 Tab

32 Carbamazepine tablet 200 mg 5 Tab

33 Catgut/benang bedah no.2/0 (plain & chromic) 32 Sak

33 Catgut/benang bedah no.3/0 (plain & chromic) 32 Sak

34 Chlorampenicol Kapsul 250 mg 6,2,2 Kap

35 Chlorampenicol Salep Mata 1% 21,2,1 Tube

36 Chloramphenicol Syrup Btl

Hal 1 LB 2

KELAS TERAPI

STOK AWAL

PERMIN TAAN

1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 1537 Chloramphenicol Tetes Telinga 3% 28.1 Btl

38 Chlorpheniramine Maleat (CTM) tab.4 mg 3 Tab

39 Chlorpromazine injeksi 2,5 mg/ml 25.4 Amp

40 Chlorpromazine HCl injeksi 5 mg/ml 23.4 Amp

41 Chlorpromazine HCl tablet 100 mg 23.4 Tab

42 Chlorpromazine HCl tablet 25 mg 23.4 Tab

43 Ciprofloxacin 500 mg Tab

44 Cotrimoxazole Pediatrik 6,2,2 Tab

45 Cotrimoxazole Suspensi 6,2,2 Btl

46 Cotrimoxazole Dewasa 6,2,2 Tab

47 Cimetidine tablet 200 mg Tab

48 Clonidine tablet 0,15 mg Tab

49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml 10.1 Amp

50 Chloramphenikol Tetes Mata Btl

51 Dexamethasone Injeksi 3 Amp

52 Dexamethasone Kaplet 0,5 mg 16.4 Kapl

53 Dekstromethorphan HBr sirup 10 mg/5 ml 26.2 Btl

54 Dekstrometorphan HBr tablet 15 mg 26.2 Tab

55 Diazepam inj 15 mg/ml - 2 ml 5 Amp

56 Diazepam 2 mg 5 Tab?

57 Diazepam 5 mg 5 Tab

58 Dietilkarbamin sitrat tablet 100 mg 6,1,2 Tab

59 Diphenhydramine HCl inj 10 mg/ml-1 ml 3 Tab

60 Digoksin tablet 0,25 mg 17.5 Tab

61 Diltiazem tab. 30 mg Tab

62 Doksisiklin 100 mg Tab

63 Efedrin HCl tablet 25 mg 26.1 Tab

64 Ekstrak Belladon tablet 10 mg 25.4 Tab

65 Erytromicin syr Btl

66 Erytromicin tab 250 mg Tab

67 Erytromicin tab 500 mg Tab

68 Epinefrin HCl inj 0,1% - 1 ml 3 Amp

69 Etakridin(Rivanol) larutan 0,1 % 13.2 Btl

70 Ethanol 70% 13.2 Btl

71 Etil chlorida semprot 14.1 Btl

72 Eugenol cairan 14.1 Btl

73 Fenitoin natrium injeksi 50mg/ml 5 Amp

74 Fenobarbital inj. 50mg/ml 5 Amp

75 Fenobarbital tab. 30 mg 5 Tab

76 Fenol gliserol tetes telinga 10 % 28.2 Btl

77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml 10.2 Amp

78 Fitomenadion (Vit K) tab. Salut 10 mg 10.2 Tab

79 Fluour tablet 0,5 mg 14.1 Tab

80 Furosemide tab. 40 mg 14 Tab

81 Garam Oralit untuk 200 ml - air 20.1 Sak

1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 1582 Gention violet 1 % 14.2 Btl?

83 Glass ionomer cement (gx ic) 14.1 Set

84 Glibenklamide tab. 5 mg 16,1,1 Tab

85 Gliseril guayakolat tab. 100 mg 26.3 Tab

86 Gliserin 25.6 Btl

87 Glukosa larutan infus 10% steril 20.2 Btl



90 Griseofulvin tab. 125 mg, micronized 6.3 Tab

91 Haloperidol tablet 0,5 mg 23.4 Tab

92 Haloperidol tablet 1,5 mg 23.4 Tab

93 Haloperidol tablet 5 mg 23.4 Tab

94 Hidroklortiazid (HCT) tablet 25 mg 15 Tab

95 Hidrokortison krim 2,5% 18.4 Tube

96 Hyoscine -n- Butilbromide Tab

97 Handscoen No. 7 Set

98 Ibuprofen tablet 200 mg / Irgapan 1.2 Tab

99 Ibuprofen tablet 400 mg 1.2 Tab

100 Infusion set anak 32 Set

101 Infusion set dewasa 32 Set

102 I.V. Catheter No. 18 Set




106 Isosorbid Dinitrat tablet sublingual 5 mg 17.1 Tab

107 Kasa kompres 40/40 steril 32 roll

108 Kasa pembalut 2 m x 80 cm 32 roll

109 Kasa pembalut hidrofil 4 m x 15 cm 32 roll

110 Kapas pembalut/absorben 250 gram 32 Bks

111 Kalsium Hidroksida pasta 14.1 Tube

112 Ketoconazole 200 mg Tab

113 Lidokain kompositum injeksi 14.1 Amp

114 Mebendazol tablet 100 mg 6,1,1 Tab

115 Metilergometrin maleat tablet salut 0,125 mg 22.1 Tab

116 Metilergometrin maleat inj. 0,200 mg - 1 ml 22,,1 Amp

117 Metronidazol tablet 250 mg 6,2,2 Tab

118 Miconazole cream 10 g Tube

119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab

120 Metoklopramide HCl injeksi (Piralen) Amp?

121 Metoklopramide syrup Btl

122 Mineral Mix Set

123 Metformin tablet 500mg Tab

124 Natrium klorida lar. Infus 0,9% steril 20.2 Btl

1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15125 Nistatin 100.000 iu/g tab vaginal 6.3 Tab

126 Nistatin 500.000 iu tab salut 6.3 Tab

127 Nifedipin tablet 10 mg Tab

128 Natrium Diklofenak tablet 50 mg Tab

129 Obat Batuk Hitam (OBH) cairan 26.3 Btl

130 Oksitetrasiklin HCl salep mata 21,2,2 Tube

131 Oksitetrasiklin HCl salep Kulit 3% Tube

132 Oksitosin injeksi 10 iu/ml - 1 ml 22.1 Amp

133 Paraformaldehid tablet 1 gram 13.2 Tab

134 Parasetamol Drops 1.2 Btl

135 Parasetamol sirup 120 mg/5 ml 1.2 Btl

136 Parasetamol tablet 100 mg 1.2 Tab

137 Parasetamol tablet 500 mg 1.2 Tab

138 Pirantel Pamoat tablet 365 mg 6,1,1 Tab

139 Piridoksin HCl tablet 10 mg 29 Tab

140 Plester 5 yard x 2 inchi 32 Roll

141 Prednison tablet 5 mg 16.4 Tab

142 Primakuin tablet 15 mg 6,4,2,2 Tab

143 Propiltiourasil tablet 100 mg 16.3 Tab

144 Propanolol HCl tablet 40 mg 7.1 Tab

145 Papaverin tablet 40 mg Tab

146 Pembalut Gips 4 inch Roll

147 Pembalut gips 6 inch Roll

148 Piroxicam tablet 20 mg Tab

149 Poly Chateter No. 16 Set

150 Poly Chateter No. 18 Set

151 Quinine dihidroklorida inj. 25% - 2 ml 6,4,2,2 Amp

152 Quinine sulfat tab. 222 mg (7 h2o)l 6,4,2,2 Tab

153 Reserpin tablet 0,25 mg 17.3 Tab

154 Retinol (Vit.A) kaps 100.000 IU 29 Kap

155 Retinol (Vit.A) kaps 200.000 IU 29 Kap

156 Ringer Laktat lar infus steril 20.2 Btl

157 Ranitidin tab 150 mg Tab

158 Ranitidin injeksi 25mg/2 ml Amp

159 Salbutamol tablet 2 mg 26.1 Tab

160 Salep 2-4 kombinasi 18.4 Tube

161 Salisil bedak 2% 18.8 Set

162 Simvastatin tablet Tab

163 Serum anti tetanus inj.1.500 iu/ampul ats 2701 Amp

164 Semen seng fosfat serbuk dan cairann set

165 Silk (benang bedah sutera) no. 3/0 32 Sak/?

166 Sulfadimidin tablet 500 mg 6,2,2 Tab

167 Sulfasetamid Natrium tetes mata 15% 21,2,2 Btl

1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15168 Tablet tambah darah kombinasi 10.1 Tab?

169 Temporary stopping fletcher serbuk /cairan 14.1 Set

170 Tetrakain HCl tetes mata 21.2 tube

171 Tetrasiklin HCl kapsul 250 mg 6,2,2 Kap

171 Tetrasiklin HCl kapsul 500 mg 6,2,2 kaps

172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml 29 Amp

173 Thiamin (Vit.B1) tablet 50 mg 29 Tab

174 Thiamfenikol 500 mg Kaps

175 Triheksifenidil tablet 2 mg 9 Tab

176 Vitamin B Kompleks tablet 29 Tab

177 Yodium Povidon larutan 10% 30 ml 13.1 Btl

178 Yodium Povidon larutan 10% 300 ml 13.1 Btl

179 Zinc Tab

180 ACT Set

181 ACT Anak Paket

182 FDC Anak Paket

183 FDC Kategori 1 Paket

184 FDC Kategori 2 Paket

185 FDC Sisipan Paket


PUSKESMAS …………………


No NAMA OBAT SAT

Stok Awal Tahun 2013 Penerimaan Barang Tahun 2013

Harga (Rp) Total (Rp)

Pemakaian Barang Tahun 2013

Total (Rp) Sisa Stok Harga (Rp) Total (Rp) KETHarga (Rp) Total (Rp) Triw I Triw II Triw III Triw IV Harga (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 201 Alat suntik sekali pakai 1 ml Set 109,250 - - - - - - 109,250 - 109,250 - - 109,250 -

2 Alat suntik sekali pakai 2,5 ml Set 103,800 - - - - - - 103,800 - 103,800 - - 103,800 -

3 Alat suntik sekali pakai 5 ml Set 103,800 - - - - - - 103,800 - 103,800 - - 103,800 -

4 Albendazole tablet 400 mg Tab - - - - - - - - - -

5 Allopurinol tablet 100 mg Tab 106 - - - - - - 106 - 106 - - 106 -

6 Aminophylline tablet 200 mg Tab 93.31 - - - - - - 93.31 - 93.31 - - 93.31 -

7 Aminophylline injeksi 24 mg/ml - 10 ml Amp - - - - - - - - - -

8 Amitriptyline HCl tablet salut 25 mg Tab 118 - - - - - - 118 - 118 - - 118 - - 9 Amoxicillin sirup kering 125 mg/ 5 ml Btl 2,511 - - - - - - 2,511 - 2,511 - - 2,511 - -

10 Amoxicillin kapsul 250 mg Kap 220.24 - - - - - - 220.24 - 220.24 - - 220.24 - - 11 Amoxicillin kaplet 500 mg Kapl 228 - - - - - - 228 - 228 - - 228 - - 12 Antalgin (metampiron) tablet 500 mg Tab 15,070 - - - - - - 15,070 - 15,070 - - 15,070 - - 13 Antalgin injeksi 250 mg/ml - 2 ml Amp - - - - - - - - - - - 14 Antasida DOEN tablet kombinasi Tab 73.12 - - - - - - 73.12 - 73.12 - - 73.12 - - 15 Antasida DOEN syrup btl 2,700 - - - - - - 2,700 - 2,700 - - 2,700 - - 16 Antibakteri DOEN salep kombinasi tube 2,741 - - - - - - 2,741 - 2,741 - - 2,741 - - 17 Antihemoroid DOEN kombinasi Sup 22,000 - - - - - - 22,000 - 22,000 - - 22,000 - - 18 Antifungi DOEN kombinasi Pot 2,096.33 - - - - - - 2,096.33 - 2,096.33 - - 2,096.33 - - 19 Antimigrain DOEN kombinasi tab - - - - - - - - - - - 20 Asam Askorbat (Vit.C) tablet 50 mg tab 35,200 - - - - - - 35,200 - 35,200 - - 35,200 - - 21 Asam Mefenamat tablet 500 mg tab 114.84 - - - - - - 114.84 - 114.84 - - 114.84 - - 22 aciklovir tablet 200mg Tab 251 - - - - - - 251 - 251 - - 251 - - 23 aciklovir Krim 2,367 - - - - - - 2,367 - 2,367 - - 2,367 - - 24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Amp 25,958 - - - - - - 25,958 - 25,958 - - 25,958 - - 25 Atropin Sulfat Tab 0,5 mg Tab 33,000 - - - - - - 33,000 - 33,000 - - 33,000 - - 26 Antimalaria DOEN Kombinasi Tab 52,030 - - - - - - 52,030 - 52,030 - - 52,030 - - 27 Betahistin Mesilat tablet 6 mg Tab 1,016 - - - - - - 1,016 - 1,016 - - 1,016 - - 28 Betametason krim 0,1% Tube 1,668 - - - - - - 1,668 - 1,668 - - 1,668 - - 29 Calcium Lactate (Kalk) tabet 500 mg Tab 57,200 - - - - - - 57,200 - 57,200 - - 57,200 - - 30 Captopril 25 mg Tab 94 - - - - - - 94 - 94 - - 94 - - 31 Codein HCL tab. 10 mg Tab 117,503 - - - - - - 117,503 - 117,503 - - 117,503 - - 32 Carbamazepine tablet 200 mg Tab 267 - - - - - - 267 - 267 - - 267 - - 33 Catgut/benang bedah no.2/0 (plain & chromic) Sak 704,000 - - - - - - 704,000 - 704,000 - - 704,000 - - 33 Catgut/benang bedah no.3/0 (plain & chromic) Sak 639,138 - - - - - - 639,138 - 639,138 - - 639,138 - - 34 Chlorampenicol Kapsul 250 mg Kap 250 - - - - - - 250 - 250 - - 250 - - 35 Chlorampenicol Salep Mata 1% Tube 1,523 - - - - - - 1,523 - 1,523 - - 1,523 - - 36 Chloramphenicol Syrup Btl 4,016 - - - - - - 4,016 - 4,016 - - 4,016 - -

Total Penerimaan

BarangJumlah Barang

Jumlah Barang

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2037 Chloramphenicol Tetes Telinga 3% Btl 1,750 - - - - - - 1,750 - 1,750 - - 1,750 - - 38 Chlorpheniramine Maleat (CTM) tab.4 mg Tab 23 - - - - - - 23 - 23 - - 23 - - 39 Chlorpromazine injeksi 2,5 mg/ml Amp 1,045 - - - - - - 1,045 - 1,045 - - 1,045 - - 40 Chlorpromazine HCl injeksi 5 mg/ml Amp 11,279 - - - - - - 11,279 - 11,279 - - 11,279 - - 41 Chlorpromazine HCl tablet 100 mg Tab 146 - - - - - - 146 - 146 - - 146 - - 42 Chlorpromazine HCl tablet 25 mg Tab 41,800 - - - - - - 41,800 - 41,800 - - 41,800 - - 43 Ciprofloxacin 500 mg Tab 241 - - - - - - 241 - 241 - - 241 - - 44 Cotrimoxazole Pediatrik Tab 79 - - - - - - 79 - 79 - - 79 - - 45 Cotrimoxazole Suspensi Btl 2,212.94 - - - - - - 2,212.94 - 2,212.94 - - 2,212.94 - - 46 Cotrimoxazole Dewasa Tab 146.24 - - - - - - 146.24 - 146.24 - - 146.24 - - 47 Cimetidine tablet 200 mg Tab 115.52 - - - - - - 115.52 - 115.52 - - 115.52 - - 48 Clonidine tablet 0,15 mg Tab 191 - - - - - - 191 - 191 - - 191 - - 49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml Amp 52,000 - - - - - - 52,000 - 52,000 - - 52,000 - - 50 Chloramphenikol Tetes Mata Btl - - - - - - - - - - - 51 Dexamethasone Injeksi Amp 1,750 - - - - - - 1,750 - 1,750 - - 1,750 - - 52 Dexamethasone Kaplet 0,5 mg Kapl 71.89 - - - - - - 71.89 - 71.89 - - 71.89 - - 53 Dekstromethorphan HBr sirup 10 mg/5 ml Btl 1,467.4 - - - - - - 1,467.4 - 1,467.4 - - 1,467.4 - - 54 Dekstrometorphan HBr tablet 15 mg Tab 102 - - - - - - 102 - 102 - - 102 - - 55 Diazepam inj 15 mg/ml - 2 ml Amp 78,147 - - - - - - 78,147 - 78,147 - - 78,147 - - 56 Diazepam 2 mg Tab? 39 - - - - - - 39 - 39 - - 39 - - 57 Diazepam 5 mg Tab - - - - - - - - - - - 58 Dietilkarbamin sitrat tablet 100 mg Tab - - - - - - - - - - - 59 Diphenhydramine HCl inj 10 mg/ml-1 ml Tab 1,056 - - - - - - 1,056 - 1,056 - - 1,056 - - 60 Digoksin tablet 0,25 mg Tab 96.48 - - - - - - 96.48 - 96.48 - - 96.48 - - 61 Diltiazem tab. 30 mg Tab 129 - - - - - - 129 - 129 - - 129 - - 62 Doksisiklin 100 mg Tab 250 - - - - - - 250 - 250 - - 250 - - 63 Efedrin HCl tablet 25 mg Tab 14,097 - - - - - - 14,097 - 14,097 - - 14,097 - - 64 Ekstrak Belladon tablet 10 mg Tab - - - - - - - - - - - 65 Erytromicin syr Btl 8,910 - - - - - - 8,910 - 8,910 - - 8,910 - - 66 Erytromicin tab 250 mg Tab 462 - - - - - - 462 - 462 - - 462 - - 67 Erytromicin tab 500 mg Tab 912.94 - - - - - - 912.94 - 912.94 - - 912.94 - - 68 Epinefrin HCl inj 0,1% - 1 ml Amp 10,371 - - - - - - 10,371 - 10,371 - - 10,371 - - 69 Etakridin(Rivanol) larutan 0,1 % Btl 2,354.22 - - - - - - 2,354.22 - 2,354.22 - - 2,354.22 - - 70 Ethanol 70% Btl - - - - - - - - - - - 71 Etil chlorida semprot Btl 115,500 - - - - - - 115,500 - 115,500 - - 115,500 - - 72 Eugenol cairan Btl 605,000 - - - - - - 605,000 - 605,000 - - 605,000 - - 73 Fenitoin natrium injeksi 50mg/ml Amp - - - - - - - - - - - 74 Fenobarbital inj. 50mg/ml Amp 20,100 - - - - - - 20,100 - 20,100 - - 20,100 - - 75 Fenobarbital tab. 30 mg Tab 7,139 - - - - - - 7,139 - 7,139 - - 7,139 - - 76 Fenol gliserol tetes telinga 10 % Btl 1,108.80 - - - - - - 1,108.80 - 1,108.80 - - 1,108.80 - - 77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml Amp 57,420 - - - - - - 57,420 - 57,420 - - 57,420 - - 78 Fitomenadion (Vit K) tab. Salut 10 mg Tab 640.59 - - - - - - 640.59 - 640.59 - - 640.59 - -

79 Fluour tablet 0,5 mg Tab - - - - - - - - - - - 80 Furosemide tab. 40 mg Tab 11,229 - - - - - - 11,229 - 11,229 - - 11,229 - - 81 Garam Oralit untuk 200 ml - air Sak 41,800 - - - - - - 41,800 - 41,800 - - 41,800 - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2082 Gention violet 1 % Btl? 495 - - - - - - 495 - 495 - - 495 - - 83 Glass ionomer cement (gx ic) Set 434,500 - - - - - - 434,500 - 434,500 - - 434,500 - - 84 Glibenklamide tab. 5 mg Tab 59 - - - - - - 59 - 59 - - 59 - - 85 Gliseril guayakolat tab. 100 mg Tab 30,690 - - - - - - 30,690 - 30,690 - - 30,690 - - 86 Gliserin Btl - - - - - - - - - - - 87 Glukosa larutan infus 10% steril Btl - - - - - - - - - - - 88 Glukosa larutan infus 40% steril Btl - - - - - - - - - - - 89 Glukosa larutan infus 5% steril Btl 5,844 - - - - - - 5,844 - 5,844 - - 5,844 - - 90 Griseofulvin tab. 125 mg, micronized Tab 204 - - - - - - 204 - 204 - - 204 - - 91 Haloperidol tablet 0,5 mg Tab 55.70 - - - - - - 55.70 - 55.70 - - 55.70 - - 92 Haloperidol tablet 1,5 mg Tab 64.43 - - - - - - 64.43 - 64.43 - - 64.43 - - 93 Haloperidol tablet 5 mg Tab 94.21 - - - - - - 94.21 - 94.21 - - 94.21 - - 94 Hidroklortiazid (HCT) tablet 25 mg Tab 39,930.00 - - - - - - 39,930.00 - 39,930.00 - - 39,930.00 - - 95 Hidrokortison krim 2,5% Tube 2,519.00 - - - - - - 2,519.00 - 2,519.00 - - 2,519.00 - - 96 Hyoscine -n- Butilbromide Tab 33,000.00 - - - - - - 33,000.00 - 33,000.00 - - 33,000.00 - - 97 Handscoen No. 7 Set 233,750 - - - - - - 233,750 - 233,750 - - 233,750 - - 98 Ibuprofen tablet 200 mg / Irgapan Tab 96.21 - - - - - - 96.21 - 96.21 - - 96.21 - - 99 Ibuprofen tablet 400 mg Tab 152.5 - - - - - - 152.5 - 152.5 - - 152.5 - -

100 Infusion set anak Set 4,400 - - - - - - 4,400 - 4,400 - - 4,400 - - 101 Infusion set dewasa Set 3,850 - - - - - - 3,850 - 3,850 - - 3,850 - - 102 I.V. Catheter No. 18 Set - - - - - - - - - - - 103 I.V. Catheter No. 20 Set 428,310 - - - - - - 428,310 - 428,310 - - 428,310 - - 104 I.V. Catheter No. 22 Set 428,227 - - - - - - 428,227 - 428,227 - - 428,227 - - 105 I.V. Catheter No. 24 Set 428,310 - - - - - - 428,310 - 428,310 - - 428,310 - - 106 Isosorbid Dinitrat tablet sublingual 5 mg Tab 8,910 - - - - - - 8,910 - 8,910 - - 8,910 - - 107 Kasa kompres 40/40 steril roll 1,393 - - - - - - 1,393 - 1,393 - - 1,393 - - 108 Kasa pembalut 2 m x 80 cm roll 8,799 - - - - - - 8,799 - 8,799 - - 8,799 - - 109 Kasa pembalut hidrofil 4 m x 15 cm roll 3,373 - - - - - - 3,373 - 3,373 - - 3,373 - - 110 Kapas pembalut/absorben 250 gram Bks 8,250 - - - - - - 8,250 - 8,250 - - 8,250 - - 111 Kalsium Hidroksida pasta Tube 266,200 - - - - - - 266,200 - 266,200 - - 266,200 - - 112 Ketoconazole 200 mg Tab 267 - - - - - - 267 - 267 - - 267 - - 113 Lidokain kompositum injeksi Amp 1,485 - - - - - - 1,485 - 1,485 - - 1,485 - - 114 Mebendazol tablet 100 mg Tab - - - - - - - - - - - 115 Metilergometrin maleat tablet salut 0,125 mg Tab 13,310 - - - - - - 13,310 - 13,310 - - 13,310 - - 116 Metilergometrin maleat inj. 0,200 mg - 1 ml Amp 49,170 - - - - - - 49,170 - 49,170 - - 49,170 - - 117 Metronidazol tablet 250 mg Tab 183 - - - - - - 183 - 183 - - 183 - - 118 Miconazole cream 10 g Tube 3,300 - - - - - - 3,300 - 3,300 - - 3,300 - - 119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab 12,100 - - - - - - 12,100 - 12,100 - - 12,100 - - 120 Metoklopramide HCl injeksi (Piralen) Amp? 11,000 - - - - - - 11,000 - 11,000 - - 11,000 - -

121 Metoklopramide syrup Btl 2,310 - - - - - - 2,310 - 2,310 - - 2,310 - - 122 Mineral Mix Set 2,695 - - - - - - 2,695 - 2,695 - - 2,695 - - 123 Metformin tablet 500mg Tab 105 - - - - - - 105 - 105 - - 105 - - 124 Natrium klorida lar. Infus 0,9% steril Btl 5,390 - - - - - - 5,390 - 5,390 - - 5,390 - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20125 Nistatin 100.000 iu/g tab vaginal Tab 28,876 - - - - - - 28,876 - 28,876 - - 28,876 - - 126 Nistatin 500.000 iu tab salut Tab 704 - - - - - - 704 - 704 - - 704 - - 127 Nifedipin tablet 10 mg Tab 118 - - - - - - 118 - 118 - - 118 - - 128 Natrium Diklofenak tablet 50 mg Tab 206 - - - - - - 206 - 206 - - 206 - - 129 Obat Batuk Hitam (OBH) cairan Btl 1,573 - - - - - - 1,573 - 1,573 - - 1,573 - - 130 Oksitetrasiklin HCl salep mata Tube - - - - - - - - - - - 131 Oksitetrasiklin HCl salep Kulit 3% Tube 1,646 - - - - - - 1,646 - 1,646 - - 1,646 - - 132 Oksitosin injeksi 10 iu/ml - 1 ml Amp 58,905 - - - - - - 58,905 - 58,905 - - 58,905 - - 133 Paraformaldehid tablet 1 gram Tab - - - - - - - - - - - 134 Parasetamol Drops Btl 5,749 - - - - - - 5,749 - 5,749 - - 5,749 - - 135 Parasetamol sirup 120 mg/5 ml Btl 1,403.6 - - - - - - 1,403.6 - 1,403.6 - - 1,403.6 - - 136 Parasetamol tablet 100 mg Tab 34.51 - - - - - - 34.51 - 34.51 - - 34.51 - - 137 Parasetamol tablet 500 mg Tab 84.8 - - - - - - 84.8 - 84.8 - - 84.8 - - 138 Pirantel Pamoat tablet 365 mg Tab 343 - - - - - - 343 - 343 - - 343 - - 139 Piridoksin HCl tablet 10 mg Tab 19,140 - - - - - - 19,140 - 19,140 - - 19,140 - - 140 Plester 5 yard x 2 inchi Roll 23,625 - - - - - - 23,625 - 23,625 - - 23,625 - - 141 Prednison tablet 5 mg Tab 68,750 - - - - - - 68,750 - 68,750 - - 68,750 - - 142 Primakuin tablet 15 mg Tab 125 - - - - - - 125 - 125 - - 125 - - 143 Propiltiourasil tablet 100 mg Tab 297 - - - - - - 297 - 297 - - 297 - - 144 Propanolol HCl tablet 40 mg Tab 119 - - - - - - 119 - 119 - - 119 - - 145 Papaverin tablet 40 mg Tab 128 - - - - - - 128 - 128 - - 128 - - 146 Pembalut Gips 4 inch Roll 35,750 - - - - - - 35,750 - 35,750 - - 35,750 - - 147 Pembalut gips 6 inch Roll 46,200 - - - - - - 46,200 - 46,200 - - 46,200 - - 148 Piroxicam tablet 20 mg Tab 97.99 - - - - - - 97.99 - 97.99 - - 97.99 - - 149 Poly Chateter No. 16 Set - - - - - - - - - - - 150 Poly Chateter No. 18 Set 8,495 - - - - - - 8,495 - 8,495 - - 8,495 - - 151 Quinine dihidroklorida inj. 25% - 2 ml Amp - - - - - - - - - - - 152 Quinine sulfat tab. 222 mg (7 h2o)l Tab - - - - - - - - - - - 153 Reserpin tablet 0,25 mg Tab 114 - - - - - - 114 - 114 - - 114 - - 154 Retinol (Vit.A) kaps 100.000 IU Kap 254 - - - - - - 254 - 254 - - 254 - - 155 Retinol (Vit.A) kaps 200.000 IU Kap 412 - - - - - - 412 - 412 - - 412 - - 156 Ringer Laktat lar infus steril Btl 5,720 - - - - - - 5,720 - 5,720 - - 5,720 - - 157 Ranitidin tab 150 mg Tab 119 - - - - - - 119 - 119 - - 119 - - 158 Ranitidin injeksi 25mg/2 ml Amp 1,157 - - - - - - 1,157 - 1,157 - - 1,157 - - 159 Salbutamol tablet 2 mg Tab 70 - - - - - - 70 - 70 - - 70 - - 160 Salep 2-4 kombinasi Tube 1,980 - - - - - - 1,980 - 1,980 - - 1,980 - - 161 Salisil bedak 2% Set 1,180 - - - - - - 1,180 - 1,180 - - 1,180 - -

162 Simvastatin tablet Tab 180 - - - - - - 180 - 180 - - 180 - - 163 Serum anti tetanus inj.1.500 iu/ampul ats Amp 151,220 - - - - - - 151,220 - 151,220 - - 151,220 - - 164 Semen seng fosfat serbuk dan cairann set 102,850 - - - - - - 102,850 - 102,850 - - 102,850 - - 165 Silk (benang bedah sutera) no. 3/0 Sak/? 276,540 - - - - - - 276,540 - 276,540 - - 276,540 - - 166 Sulfadimidin tablet 500 mg Tab - - - - - - - - - - - 167 Sulfasetamid Natrium tetes mata 15% Btl 90,555 - - - - - - 90,555 - 90,555 - - 90,555 - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20168 Tablet tambah darah kombinasi Tab? 220,000 - - - - - - 220,000 - 220,000 - - 220,000 - - 169 Temporary stopping fletcher serbuk /cairan Set 37,400 - - - - - - 37,400 - 37,400 - - 37,400 - - 170 Tetrakain HCl tetes mata tube - - - - - - - - - - - 171 Tetrasiklin HCl kapsul 250 mg Kap 189 - - - - - - 189 - 189 - - 189 - - 171 Tetrasiklin HCl kapsul 500 mg kaps 226 - - - - - - 226 - 226 - - 226 - - 172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml Amp 21,900 - - - - - - 21,900 - 21,900 - - 21,900 - - 173 Thiamin (Vit.B1) tablet 50 mg Tab 41,580 - - - - - - 41,580 - 41,580 - - 41,580 - - 174 Thiamfenikol 500 mg Kaps 440 - - - - - - 440 - 440 - - 440 - - 175 Triheksifenidil tablet 2 mg Tab 44 - - - - - - 44 - 44 - - 44 - - 176 Vitamin B Kompleks tablet Tab 24,420 - - - - - - 24,420 - 24,420 - - 24,420 - - 177 Yodium Povidon larutan 10% 30 ml Btl 2,100 - - - - - - 2,100 - 2,100 - - 2,100 - - 178 Yodium Povidon larutan 10% 300 ml Btl 14,700 - - - - - - 14,700 - 14,700 - - 14,700 - - 179 Zinc Tab 491.50 - - - - - - 491.50 - 491.50 - - 491.50 - - 180 ACT Set - - - - - - - - - - - 181 ACT Anak Paket - - - - - - - - - - - 182 FDC Anak Paket 235,300 - - - - - - 235,300 - 235,300 - - 235,300 - - 183 FDC Kategori 1 Paket 395,900 - - - - - - 395,900 - 395,900 - - 395,900 - - 184 FDC Kategori 2 Paket 1,317,000 - - - - - - 1,317,000 - 1,317,000 - - 1,317,000 - - 185 FDC Sisipan Paket 175,120 - - - - - - 175,120 - 175,120 - - 175,120 - -

TOTAL HARGA (Rp)

Mengetahui, …………………….., ………………….2013 Kepala Puskesmas Makale Utara

Petugas Apotik


drg. Benedicta M.W.S

NIP. 19660307 199312 2 001 Febrianti Guling Rissing,AMdFarNIP. 19880201 201101 2 017




No NAMA OBAT SAT


Sisa Stok

Total (Rp)


Triw I Harga (Rp) Total (Rp) Dari Total (Rp) Oleh Total (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 191 Alat suntik sekali pakai 1 ml Set 173 1,093 189,003 1,093 - 1,093 - 173 1,093 189,089

2 Alat suntik sekali pakai 2,5 ml Set 420 1,038 435,960 1,038 - 110 1,038 114,180 310 1,038 321,780

3 Alat suntik sekali pakai 5 ml Set 160 1,038 166,080 1,038 - 1,038 - 160 1,038 166,080


5 Allopurinol tablet 100 mg Tab 440 106 46,640 106 - 106 - 440 106 46,640

6 Aminophylline tablet 200 mg Tab 345 93.31 32,192 93.31 - 93.31 - 345 93.31 32,192


8 Amitriptyline HCl tablet salut 25 mg Tab 415 118 48,970 118 - 118 - 415 118 48,970 12,000 9 Amoxicillin sirup kering 125 mg/ 5 ml Btl 233 2,511 585,063 2,511 - 2,511 - 233 2,511 585,063 26,720

10 Amoxicillin kapsul 250 mg Kap 1,800 220.24 396,432 220.24 - 220.24 - 1,800 220.24 396,432 147,360 11 Amoxicillin kaplet 500 mg Kapl 17,400 228 3,967,200 228 - 228 - 17,400 228 3,967,200 812,900 12 Antalgin (metampiron) tablet 500 mg Tab 1,400 151 210,980 15,070 - 15,070 - 1,400 15,070 21,098,000 3,539 13 Antalgin injeksi 250 mg/ml - 2 ml Amp - - - - - - - 14 Antasida DOEN tablet kombinasi Tab 4,000 73.12 292,480 73.12 - 73.12 - 4,000 73.12 292,480 400,000 15 Antasida DOEN syrup btl 90 2,700 243,000 2,700 - 2,700 - 90 2,700 243,000 4,330 16 Antibakteri DOEN salep kombinasi tube 175 2,741 479,675 2,741 - 2,741 - 175 2,741 479,675 13,500 17 Antihemoroid DOEN kombinasi Sup 20 2,200 44,000 22,000 - 22,000 - 20 22,000 440,000 248 18 Antifungi DOEN kombinasi Pot 41 2,096.33 85,950 2,096.33 - 2,096.33 - 41 2,096.33 85,950 3,573 19 Antimigrain DOEN kombinasi tab - - - - - - 28,600 20 Asam Askorbat (Vit.C) tablet 50 mg tab 14,300 35 503,360 35 - 35 - 14,300 35 503,360 890 21 Asam Mefenamat tablet 500 mg tab 3,000 114.84 344,520 114.84 - 114.84 - 3,000 114.84 344,520 231,700 22 aciklovir tablet 200mg Tab 400 251 100,400 251 - 251 - 400 251 100,400 28,800 23 aciklovir Krim - 2,367 - 2,367 - 2,367 - - 2,367 - - 24 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Amp - 25,958 - 25,958 - 25,958 - - 25,958 - 18 25 Atropin Sulfat Tab 0,5 mg Tab - 33,000 - 33,000 - 33,000 - - 33,000 - 41 26 Antimalaria DOEN Kombinasi Tab - 52,030 - 52,030 - 52,030 - - 52,030 - 32 27 Betahistin Mesilat tablet 6 mg Tab - 1,016 - 1,016 - 1,016 - - 1,016 - 14,400 28 Betametason krim 0,1% Tube 200 1,668 333,600 1,668 - 1,668 - 200 1,668 333,600 32,745 29 Calcium Lactate (Kalk) tabet 500 mg Tab 3,728 57 213,242 57 - 57 - 3,728 57 213,242 297 30 Captopril 25 mg Tab 2,000 94 188,000 94 - 94 - 2,000 94 188,000 150,100 31 Codein HCL tab. 10 mg Tab - 117,503 - 117,503 - 117,503 - - 117,503 - 40 32 Carbamazepine tablet 200 mg Tab 100 267 26,700 267 - 267 - 100 267 26,700 25,000 33 Catgut/benang bedah no.2/0 (plain & chromic) Sak - 29,333 - 29,333 - 29,333 - - 29,333 - 40 33 Catgut/benang bedah no.3/0 (plain & chromic) Sak 24 26,630 639,120 26,630 - 26,630 - 24 26,630 639,120 40 34 Chlorampenicol Kapsul 250 mg Kap 40 250 10,000 250 - 250 - 40 250 10,000 - 35 Chlorampenicol Salep Mata 1% Tube 50 1,523 76,150 1,523 - 1,523 - 50 1,523 76,150 1,528 36 Chloramphenicol Syrup Btl 5 4,016 20,080 4,016 - 4,016 - 5 4,016 20,080 400

Total Penerimaan

Barang

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

Jumlah Barang

Jumlah Harga (Rp)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

37 Chloramphenicol Tetes Telinga 3% Btl 24 1,750 42,000 1,750 - 1,750 - 24 1,750 42,000 1,502 38 Chlorpheniramine Maleat (CTM) tab.4 mg Tab 15,556 23 357,788 23 - 23 - 15,556 23 357,788 1,524,000 39 Chlorpromazine injeksi 2,5 mg/ml Amp - 1,045 - 1,045 - 1,045 - - 1,045 - - 40 Chlorpromazine HCl injeksi 5 mg/ml Amp - 11,279 - 11,279 - 11,279 - - 11,279 - 12 41 Chlorpromazine HCl tablet 100 mg Tab - 146 - 146 - 146 - - 146 - - 42 Chlorpromazine HCl tablet 25 mg Tab 1,000 42 41,800 41,800 - 41,800 - 1,000 41,800 41,800,000 55 43 Ciprofloxacin 500 mg Tab 4,699 241 1,132,459 241 - 241 - 4,699 241 1,132,459 234,450 44 Cotrimoxazole Pediatrik Tab 90 79 7,110 79 - 79 - 90 79 7,110 - 45 Cotrimoxazole Suspensi Btl 245 2,212.94 542,170 2,212.94 - 2,212.94 - 245 2,212.94 542,170 2,925 46 Cotrimoxazole Dewasa Tab 6,190 146.24 905,226 146.24 - 146.24 - 6,190 146.24 905,226 238,400 47 Cimetidine tablet 200 mg Tab 1,580 115.52 182,522 115.52 - 115.52 - 1,580 115.52 182,522 210,600 48 Clonidine tablet 0,15 mg Tab 100 191 19,100 191 - 191 - 100 191 19,100 33,800 49 Cyanocobalamin (Vit.B12) inj 500 mcg/ml Amp 82 520 42,640 520 - 520 - 82 520 42,640 60 50 Chloramphenikol Tetes Mata Btl - - - - - - - 51 Dexamethasone Injeksi Amp 62 1,750 108,500 1,750 - 1,750 - 62 1,750 108,500 14,690 52 Dexamethasone Kaplet 0,5 mg Kapl 13,154 71.89 945,641 71.89 - 71.89 - 13,154 71.89 945,641 559,000 53 Dekstromethorphan HBr sirup 10 mg/5 ml Btl 309 1,467.4 453,427 1,467.4 - 1,467.4 - 309 1,467.4 453,427 7,250 54 Dekstrometorphan HBr tablet 15 mg Tab 4,696 102 478,992 102 - 102 - 4,696 102 478,992 506,700 55 Diazepam inj 15 mg/ml - 2 ml Amp 7 78,147 547,029 78,147 - 78,147 - 7 78,147 547,029 49 56 Diazepam 2 mg Tab? 2,000 39 78,000 39 - 39 - 2,000 39 78,000 542,000 57 Diazepam 5 mg Tab - - - - - - 197,000 58 Dietilkarbamin sitrat tablet 100 mg Tab - - - - - - - 59 Diphenhydramine HCl inj 10 mg/ml-1 ml Tab 10 1,056 10,560 1,056 - 1,056 - 10 1,056 10,560 153 60 Digoksin tablet 0,25 mg Tab 100 96.48 9,648 96.48 - 96.48 - 100 96.48 9,648 33,400 61 Diltiazem tab. 30 mg Tab - 129 - 129 - 129 - - 129 - 35,700 62 Doksisiklin 100 mg Tab - 250 - 250 - 250 - - 250 - 2,600 63 Efedrin HCl tablet 25 mg Tab 3,006 56 169,502 56 - 56 - 3,006 56 168,336 1,601 64 Ekstrak Belladon tablet 10 mg Tab - - - - - - - 65 Erytromicin syr Btl 10 8,910 89,100 8,910 - 8,910 - 10 8,910 89,100 334 66 Erytromicin tab 250 mg Tab - 462 - 462 - 462 - - 462 - 22,200 67 Erytromicin tab 500 mg Tab 200 912.94 182,588 912.94 - 912.94 - 200 912.94 182,588 9,900 68 Epinefrin HCl inj 0,1% - 1 ml Amp 100 10,371 1,037,100 10,371 - 10,371 - 100 10,371 1,037,100 279 69 Etakridin(Rivanol) larutan 0,1 % Btl 8 2,354.22 18,834 2,354.22 - 2,354.22 - 8 2,354.22 18,834 141 70 Ethanol 70% Btl - - - - - - - 71 Etil chlorida semprot Btl 2 115,500 231,000 115,500 - 115,500 - 2 115,500 231,000 268 72 Eugenol cairan Btl 2 605,000 1,210,000 605,000 - 605,000 - 2 605,000 1,210,000 76 73 Fenitoin natrium injeksi 50mg/ml Amp - - - - - - - 74 Fenobarbital inj. 50mg/ml Amp 36 20,100 723,600 20,100 - 20,100 - 36 20,100 723,600 26 75 Fenobarbital tab. 30 mg Tab 1,101 7,139 7,860,039 7,139 - 7,139 - 1,101 7,139 7,860,039 437 76 Fenol gliserol tetes telinga 10 % Btl 24 1,108.80 26,611 1,108.80 - 1,108.80 - 24 1,108.80 26,611 1,000 77 Fitomenadion (Vit K) inj. 10mg/ml- 1ml Amp 45 57,420 2,583,900 57,420 - 57,420 - 45 57,420 2,583,900 79 78 Fitomenadion (Vit K) tab. Salut 10 mg Tab 200 640.59 128,118 640.59 - 640.59 - 200 640.59 128,118 76,100 79 Fluour tablet 0,5 mg Tab - - - - - - - 80 Furosemide tab. 40 mg Tab 220 11,229 2,470,380 11,229 - 11,229 - 220 11,229 2,470,380 1,327 81 Garam Oralit untuk 200 ml - air Sak 639 418 267,102 41,800 - 41,800 - 639 41,800 26,710,200 760

]

1 2 3 4 5 \ 7 8 9 10 11 12 13 14 15 16 17 18 19

82 Gention violet 1 % Btl? 26 495 12,870 495 - 495 - 26 495 12,870 4,209 83 Glass ionomer cement (gx ic) Set 1 434,500 434,500 434,500 - 434,500 - 1 434,500 434,500 46 84 Glibenklamide tab. 5 mg Tab 690 59 40,710 59 - 59 - 690 59 40,710 39,500 85 Gliseril guayakolat tab. 100 mg Tab 6,026 31 184,938 31 - 31 - 6,026 31 184,938 1,853 86 Gliserin Btl - - - - - - - 87 Glukosa larutan infus 10% steril Btl - - - - - - - 88 Glukosa larutan infus 40% steril Btl - - - - - - - 89 Glukosa larutan infus 5% steril Btl 4 5,844 23,376 5,844 - 5,844 - 4 5,844 23,376 1,487 90 Griseofulvin tab. 125 mg, micronized Tab 500 204 102,000 204 - 204 - 500 204 102,000 16,400 91 Haloperidol tablet 0,5 mg Tab 220 55.70 12,254 55.70 - 55.70 - 220 55.70 12,254 11,400 92 Haloperidol tablet 1,5 mg Tab - 64.43 - 64.43 - 64.43 - - 64.43 - 41,800 93 Haloperidol tablet 5 mg Tab - 94.21 - 94.21 - 94.21 - - 94.21 - 64,400 94 Hidroklortiazid (HCT) tablet 25 mg Tab - 39,930.00 - 39,930.00 - 39,930.00 - - 39,930.00 - 100 95 Hidrokortison krim 2,5% Tube 188 2,519.00 473,572 2,519.00 - 2,519.00 - 188 2,519.00 473,572 17,823 96 Hyoscine -n- Butilbromide Tab 415 330.00 136,950 330.00 - 330.00 - 415 330.00 136,950 486 97 Handscoen No. 7 Set 50 2,338 116,875 234 - 234 - 50 234 11,688 339 98 Ibuprofen tablet 200 mg / Irgapan Tab 532 96.21 51,184 96.21 - 96.21 - 532 96.21 51,184 94,600 99 Ibuprofen tablet 400 mg Tab 874 152.5 133,285 152.5 - 152.5 - 874 152.5 133,285 36,200

100 Infusion set anak Set 5 4,400 22,000 4,400 - 4,400 - 5 4,400 22,000 276 101 Infusion set dewasa Set 7 3,850 26,950 3,850 - 3,850 - 7 3,850 26,950 3,304 102 I.V. Catheter No. 18 Set - - - - - - - 103 I.V. Catheter No. 20 Set 13 428,310 5,568,030 428,310 - 428,310 - 13 428,310 5,568,030 86 104 I.V. Catheter No. 22 Set 5 428,227 2,141,135 428,227 - 428,227 - 5 428,227 2,141,135 5 105 I.V. Catheter No. 24 Set 5 428,310 2,141,550 428,310 - 428,310 - 5 428,310 2,141,550 3 106 Isosorbid Dinitrat tablet sublingual 5 mg Tab - 8,910 - 8,910 - 8,910 - - 8,910 - 72 107 Kasa kompres 40/40 steril roll 55 1,393 76,615 1,393 - 1,393 - 55 1,393 76,615 2,040 108 Kasa pembalut 2 m x 80 cm roll 21 8,799 184,779 8,799 - 8,799 - 21 8,799 184,779 1,896 109 Kasa pembalut hidrofil 4 m x 15 cm roll 75 3,373 252,975 3,373 - 3,373 - 75 3,373 252,975 2,119 110 Kapas pembalut/absorben 250 gram Bks 6 8,250 49,500 8,250 - 8,250 - 6 8,250 49,500 447 111 Kalsium Hidroksida pasta Tube 2 266,200 532,400 266,200 - 266,200 - 2 266,200 532,400 9 112 Ketoconazole 200 mg Tab 155 267 41,385 267 - 267 - 155 267 41,385 2,300 113 Lidokain kompositum injeksi Amp 60 1,485 89,100 1,485 - 1,485 - 60 1,485 89,100 16,710 114 Mebendazol tablet 100 mg Tab - - - - - - - 115 Metilergometrin maleat tablet salut 0,125 mg Tab 200 133 26,620 133 - 133 - 200 133 26,620 100 116 Metilergometrin maleat inj. 0,200 mg - 1 ml Amp - 49,170 - 49,170 - 49,170 - - 49,170 - 131 117 Metronidazol tablet 250 mg Tab 1,000 183 183,000 183 - 183 - 1,000 183 183,000 18,900 118 Miconazole cream 10 g Tube 31 3,300 102,300 3,300 - 3,300 - 31 3,300 102,300 1,944 119 Metoklopramide HCl tablet 10 mg (Xylastin) Tab 590 12,100 7,139,000 12,100 - 12,100 - 590 12,100 7,139,000 166 120 Metoklopramide HCl injeksi (Piralen) Amp? - 11,000 - 11,000 - 11,000 - - 11,000 - 78 121 Metoklopramide syrup Btl - 2,310 - 2,310 - 2,310 - - 2,310 - 700 122 Mineral Mix Set 105 2,695 282,975 2,695 - 2,695 - 105 2,695 282,975 7,600 123 Metformin tablet 500mg Tab 420 105 44,100 105 - 105 - 420 105 44,100 39,200

124 Natrium klorida lar. Infus 0,9% steril Btl 11 5,390 59,290 5,390 - 5,390 - 11 5,390 59,290 500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

125 Nistatin 100.000 iu/g tab vaginal Tab 87 28,876 2,512,212 28,876 - 28,876 - 87 28,876 2,512,212 - 126 Nistatin 500.000 iu tab salut Tab - 704 - 704 - 704 - - 704 - - 127 Nifedipin tablet 10 mg Tab 412 118 48,616 118 - 118 - 412 118 48,616 30,600 128 Natrium Diklofenak tablet 50 mg Tab 750 206 154,500 206 - 206 - 750 206 154,500 370,300 129 Obat Batuk Hitam (OBH) cairan Btl 233 1,573 366,509 1,573 - 1,573 - 233 1,573 366,509 19,165 130 Oksitetrasiklin HCl salep mata Tube - - - - - - - 131 Oksitetrasiklin HCl salep Kulit 3% Tube 52 1,646 85,592 1,646 - 1,646 - 52 1,646 85,592 207 132 Oksitosin injeksi 10 iu/ml - 1 ml Amp 380 589 223,839 589 - 589 - 380 589 223,839 100 133 Paraformaldehid tablet 1 gram Tab - - - - - - - 134 Parasetamol Drops Btl 10 5,749 57,490 5,749 - 5,749 - 10 5,749 57,490 800 135 Parasetamol sirup 120 mg/5 ml Btl 240 1,403.6 336,864 1,403.6 - 1,403.6 - 240 1,403.6 336,864 19,550 136 Parasetamol tablet 100 mg Tab - 34.51 - 34.51 - 34.51 - - 34.51 - - 137 Parasetamol tablet 500 mg Tab 18,960 84.8 1,607,808 84.8 - 84.8 - 18,960 84.8 1,607,808 2,157,800 138 Pirantel Pamoat tablet 365 mg Tab 320 343 109,760 343 - 343 - 320 343 109,760 256,500 139 Piridoksin HCl tablet 10 mg Tab 6,432 19 123,108 19 - 19 - 6,432 19 123,108 1,231 140 Plester 5 yard x 2 inchi Roll 14 3,938 55,125 3,938 - 3,938 - 14 3,938 55,132 974 141 Prednison tablet 5 mg Tab 1,155 69 79,406 69 - 69 - 1,155 69 79,406 609 142 Primakuin tablet 15 mg Tab - 125 - 125 - 125 - - 125 - - 143 Propiltiourasil tablet 100 mg Tab - 297 - 297 - 297 - - 297 - 2,500 144 Propanolol HCl tablet 40 mg Tab - 119 - 119 - 119 - - 119 - 7,200 145 Papaverin tablet 40 mg Tab 4,016 128 514,048 128 - 128 - 4,016 128 514,048 338,000 146 Pembalut Gips 4 inch Roll - 35,750 - 35,750 - 35,750 - - 35,750 - 50 147 Pembalut gips 6 inch Roll - 46,200 - 46,200 - 46,200 - - 46,200 - 100 148 Piroxicam tablet 20 mg Tab 860 97.99 84,271 97.99 - 97.99 - 860 97.99 84,271 53,700 149 Poly Chateter No. 16 Set - - - - - - - 150 Poly Chateter No. 18 Set - 8,495 - 8,495 - 8,495 - - 8,495 - - 151 Quinine dihidroklorida inj. 25% - 2 ml Amp - - - - - - - 152 Quinine sulfat tab. 222 mg (7 h2o)l Tab - - - - - - - 153 Reserpin tablet 0,25 mg Tab - 114 - 114 - 114 - - 114 - - 154 Retinol (Vit.A) kaps 100.000 IU Kap 100 254 25,400 254 - 254 - 100 254 25,400 10,000 155 Retinol (Vit.A) kaps 200.000 IU Kap 1,800 412 741,600 412 - 412 - 1,800 412 741,600 61,700 156 Ringer Laktat lar infus steril Btl 9 5,720 51,480 5,720 - 5,720 - 9 5,720 51,480 3,502 157 Ranitidin tab 150 mg Tab 1,390 119 165,410 119 - 119 - 1,390 119 165,410 67,500 158 Ranitidin injeksi 25mg/2 ml Amp - 1,157 - 1,157 - 1,157 - - 1,157 - 900 159 Salbutamol tablet 2 mg Tab 190 70 13,300 70 - 70 - 190 70 13,300 62,900 160 Salep 2-4 kombinasi Tube 14 1,980 27,720 1,980 - 1,980 - 14 1,980 27,720 6,480 161 Salisil bedak 2% Set 20 1,180 23,600 1,180 - 1,180 - 20 1,180 23,600 2,750 162 Simvastatin tablet Tab 260 180 46,800 180 - 180 - 260 180 46,800 7,560 163 Serum anti tetanus inj.1.500 iu/ampul ats Amp - 151,220 - 151,220 - 151,220 - - 151,220 - 11 164 Semen seng fosfat serbuk dan cairann set - 102,850 - 102,850 - 102,850 - - 102,850 - 10

165 Silk (benang bedah sutera) no. 3/0 Sak/? 39 11,523 449,378 276,540 - 276,540 - 39 276,540 10,785,060 58 166 Sulfadimidin tablet 500 mg Tab - - - - - - - 167 Sulfasetamid Natrium tetes mata 15% Btl 44 3,773 166,018 3,773 - 3,773 - 44 3,773 166,012 497

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

168 Tablet tambah darah kombinasi Tab? 8,280 73 607,172 73 - 73 - 8,280 73 604,440 509 169 Temporary stopping fletcher serbuk /cairan Set 1 37,400 37,400 37,400 - 37,400 - 1 37,400 37,400 16 170 Tetrakain HCl tetes mata tube - - - - - - - 171 Tetrasiklin HCl kapsul 250 mg Kap - 189 - 189 - 189 - - 189 - - 171 Tetrasiklin HCl kapsul 500 mg kaps - 226 - 226 - 226 - - 226 - - 172 Thiamin (Vit.B1) inj 100 mg/ml - 1 ml Amp - 21,900 - 21,900 - 21,900 - - 21,900 - 330 173 Thiamin (Vit.B1) tablet 50 mg Tab 10,066 42 418,544 42 - 42 - 10,066 42 418,544 1,036 174 Thiamfenikol 500 mg Kaps - 440 - 440 - 440 - - 440 - 49,400 175 Triheksifenidil tablet 2 mg Tab - 44 - 44 - 44 - - 44 - 32,100 176 Vitamin B Kompleks tablet Tab 11,416 24 278,779 24 - 24 - 11,416 24 278,779 890 177 Yodium Povidon larutan 10% 30 ml Btl 22 2,100 46,200 2,100 - 2,100 - 22 2,100 46,200 1,426 178 Yodium Povidon larutan 10% 300 ml Btl - 14,700 - 14,700 - 14,700 - - 14,700 - - 179 Zinc Tab 500 491.50 245,750 491.50 - 491.50 - 500 491.50 245,750 - 180 ACT Set - - - - - - - 181 ACT Anak Paket - - - - - - - 182 FDC Anak Paket - 235,300 - 235,300 - 235,300 - - 235,300 - 5 183 FDC Kategori 1 Paket - 395,900 - 395,900 - 395,900 - - 395,900 - 40 184 FDC Kategori 2 Paket - 1,317,000 - 1,317,000 - 1,317,000 - - 1,317,000 - 20 185 FDC Sisipan Paket - 175,120 - 175,120 - 175,120 - - 175,120 - 26

TOTAL HARGA (Rp) - 186,820 62,971,198 - - - - 110 114,180 186,710 162,568,020

…………………….., ………………….2013 Mengetahui,



drg.Benedicta M.W.S Febrianti Guling Rissing,AMdFarNIP.19660307 199312 2 001 NIP.19880201 201101 2 017