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DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DANA BOK TAHUN 2017 NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
1 Alkohol 70% 1 liter
botol
33,000
3
3
99,000
2 Povidon Iodine 30 cc
botol
3,500
3
3
10,500
3 Povidon Iodine 60 cc
botol
4,300
2
2
8,600
4 Povidon Iodine 300 cc
botol
21,000
1
1
21,000
5 Aseptan 500 cc + dispenser (tanpa bilas)
botol
40,000
1
1
40,000
6 Aseptic Gel 500 cc + dispenser (tanpa bilas)
botol
25,500
1
1
25,500
Onescrub 500 cc + dispenser (Chlorhexidine 7 glukonate 4%) (bilas)
botol
72,000
1
1
72,000
8
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500 cc
botol
33,000
0
9
One step solution (cairan pembersih luka dan perawatan luka bakar) 500 cc
botol
33,000
0
10
Odex (antiseptik pada perawatan dan luka bakar) 500 cc
botol
110,000
0
11 Rivanol 300 cc
botol
3,600
6
6
21,600
12 Lysol 1 liter
botol
47,200
6
6
283,200
13 Ultrasonic Gel 250 ml
botol
16,000
0
0
14 Syringe 1 cc
buah
1,100
0
0
15 Syringe 2,5 cc
buah
800
300
300
240,000
16 Syringe 3 cc
buah
800
370
370
296,000
17 Syringe 5 cc
buah
900
100
100
90,000
18 Syringe 10 cc
buah
1,100
100
100
110,000
19 Blood Lancet 26G
100 buah/box
16,100
1
1
20 Blood Lancet 28G
100 buah/box
16,100
1
1
21 Kasa Hydrofil 40 x 80 m
roll
116,000
1
1
116,000
22 Kasa Pembalut Hydrofil 4 m x 3 cm
roll
650
11
11
7,150
23 Kasa Pembalut Hydrofil 4 m x 5 cm
roll
850
10
10
8,500
24 Kasa Pembalut Hydrofil 4 m x 10 cm
roll
1,700
10
10
17,000
25 Kasa Pembalut Hydrofil 4 m x 15 cm
roll
2,400
10
10
24,000
box/16
9,000
5
5
45,000
pcs
1,800
30
30
54,000
28 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's
pouch
3,200
20
20
64,000
29 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's
pouch
3,500
5
5
17,500
30 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's
pouch
7,200
5
5
36,000
31 Kasa Steril 10 x 10 cm, 8 ply 1 x 10's
pouch
10,400
5
5
52,000
32 Kapas Berlemak 500 gram
rolll
18,200
5
5
91,000
33 Kapas Pembalut putih250 gram
roll
13,800
5
5
69,000
34 Kapas Pembalut 500 gram
roll
30,050
3
3
90,150
box/50
20,400
10
10
204,000
26 Kasa Steril uk 16 x 16 cm 27 Kasa kompres 40 x 40
35 Surgical Mask earloop
0 0 0
16,100 16,100
NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
36 Surgical Mask tie on
box/50
20,400
10
10
204,000
37 Alkohol swab (ethyl alkohol 70%)
box/100
12,000
60
60
720,000
AC swab (ethyl alkohol 70% + Chlorhexidine Glukonate 2%)
box/100
18,000
60
60
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang 39 75 cm
box
147,500
6
6
40
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
147,500
6
6
41
Catgut chromic 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
147,500
6
6
42
Catgut chromic 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
147,500
6
6
43 Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
121,000
0
0
44 Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
121,000
0
0
45 Folley Catheter 2 way no. 12
box/10
88,000
0
0
46 Folley Catheter 2 way no. 14
box/10
88,000
0
0
47 Folley Catheter 2 way no. 16
box/10
88,000
0
0
48 Folley Catheter 2 way no. 18
box/10
88,000
0
0
49 Folley Catheter 2 way no. 20
box/10
88,000
0
0
50 Folley Catheter 2 way no. 22
box/10
88,000
0
0
51 Folley Catheter 2 way no. 24
box/10
88,000
0
0
52 Folley Catheter 3 way no. 20
box/10
358,000
0
0
53 Folley Catheter 3 way no. 22
box/10
358,000
0
0
54 Folley Catheter 3 way no. 24
box/10
358,000
0
0
55 Folley Catheter Pediatric no. 6
box/10
410000
0
0
56 Folley Catheter Pediatric no. 8
box/10
350,000
0
0
57 Folley Catheter Pediatric no. 10
box/10
350,000
0
0
58 IV Catheter No. 18 G x 32 mm
pcs
4,200
0
0
59 IV Catheter No. 20 G x 1 1/4"
pcs
4,200
0
0
60 IV Catheter No. 22 G x 1"
pcs
4,200
0
0
61 IV Catheter No. 24 G x 3/4"
pcs
4,200
0
0
62 IV Catheter No. 26 G x 1/2"
pcs
4550
0
0
63 Infusion set dewasa (20 drops/ml)
pcs
3,550
0
0
64 Infusion set Anak (60 drops/ml)
pcs
3,900
0
0
65 Infusion set Dewasa (Y Tube)
pcs
7,000
0
0
66 Blood Transfusion set
pcs
4,000
0
0
67 Three Way Stop Cock tanpa tube (50 buah/box)
box
110,000
0
0
68 Three Way Stop Cock dengan tube (50 buah/box)
box
18,000
0
0
69 Urine bag standard steril 2 Liter
pcs
3,500
0
0
70 Oxyflow Bubble (Bubble Nasal Canula)
buah
6,500
0
0
set
16,500
0
38
71
Maxiflow Bayi (masker oksigen bayi + tubing), panjang 2 m
1,080,000 885,000 885,000 885,000 885,000
0
HARGA/ SATUAN
NAMA/JENIS BMHP / REAGENSIA
72
Maxiflow Anak (masker oksigen bayi + tubing), panjang 2 m
set
15,500
0
73
Maxiflow Dewasa (masker oksigen bayi + tubing), panjang 2 m
set
15,500
0
74 Makes Nebulizer Set Anak
set
23,000
0
0
75 Makes Nebulizer Set Dewasa
set
23,000
0
0
76 Hi Oxygen Masker anak
set
28,000
0
0
77 Hi Oxygen Masker Dewasa
set
28,000
0
0
78 Examination Glove
box/100
39,200
0
0
79 Examination Glove No Powder
box/100
64,200
0
0
80 Surgical Steril Pre Powder No. 7/7,5
pasang
4,600
65
65
299,000
81 Sarung Tangan Obgyn Steril
pasang
23,500
24
24
564,000
82 Wing Needle 19 G
pcs
1,600
50
50
80,000
83 Wing Needle 21 G
pcs
1,600
50
50
80,000
84 Wing Needle 23 G
pcs
1,600
50
50
80,000
85 Wing Needle 25 G
pcs
1,600
50
50
80,000
86 Wing Needle 27 G
pcs
1,600
50
50
80,000
87 Suction Catether No. 6
pcs
4,800
30
30
144,000
88 Suction Catether No. 8
pcs
4,800
30
30
144,000
89 Suction Catether No. 10
pcs
4,800
30
30
144,000
90 Suction Catether No. 12
pcs
4,800
30
30
144,000
91 Suction Catether No. 14
pcs
4,800
30
30
144,000
92 Suction Catether No. 16
pcs
4,800
30
30
144,000
93 Suction Catether No. 18
pcs
4,800
30
30
144,000
Dermafix S (untuk pemasangan IV Catheter) 94 ukuran 6 X 7 cm
blister
2,300
500
500
95 Dermafix T (plester transparan) 5 X 7 cm
buah
1,900
0
0
96 Dermafix T (plester transparan) 10 X 8 cm
buah
4,700
0
0
97 Dermafix T (plester transparan) 10 X 12 cm
buah
7,100
0
0
98 Dermafix T (plester transparan) 10 X 145 cm
buah
9,200
0
0
99 Dermafix T (plester transparan) 10 X 20 cm
buah
11,000
0
0
100 Dermafix T (plester transparan) 10 X 25 cm
buah
17,000
0
0
200 pcs/box
35,000
0
102 Plesterin Roll 5 cm X 5 m
roll
28,000
0
0
103 Plesterin Roll 10 cm X 5 m
roll
48,000
0
0
104 Plesterin Roll 15 cm X 5 m
roll
80,000
0
0
105 Plesterin Roll 20 cm X 5 m
roll
92,000
0
0
box/72 pcs pak/10 box @ 100 pcs box isi 100 pcs
20,000
0
0
160,000
0
250,000
0
101
Plesterin Bulat (digunakan setelah pengambilan darah sample)
106 Object Glass 107 Cover Glass 22 x 22 mm 108 EDTA K3 Tubes
SATUAN (Harga Maksimum)
PERMINTAAN STOK
NO
KEB
PESANAN
HARGA TOTAL (Rp) 0 0
1,150,000
0
0 0
NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
109 Nurse Cap
box isi 100 pcs
50,000
0
110 Softpad (underpad) 60 X 90
pack isi 10
50,000
0
0
111 Arm Sling (tersedia ukuran S,M,L)
buah
20,000
0
0
Bracket Hand Wash ABS (keranjang tempat 112 aseptic gel)
buah
20,000
0
113 Reagensia Autocheck 3 in 1 (Glukosa)
box/25
120,000
2
2
240,000
114 Reagensia Autocheck 3 in 1 (Asam Urat)
box/25
150,000
2
2
300,000
115 Reagensia Autocheck 3 in 1 (Cholesterol)
box/10
250,000
1
1
250,000
116 Test Hamil box/50's
buah
2,300
0
0
117 Rapit test Gluko Protein Test bos/50's
buah
1,200
0
0
118 Detecto HBs Ag Hepatitis B
buah
5,500
0
0
25 test/box
560,000
0
0
120 Salmonella Thyphi H Widal Test (vial 5 ml)
vial
80,000
0
0
121 Salmonella Thyphi O Widal Test (vial 5 ml)
vial
80,000
0
0
122 Salmonella Thyphi AO Widal Test (vial 5 ml)
vial
80,000
0
0
123 Salmonella Thyphi BO Widal Test (vial 5 ml)
vial
80,000
0
0
124 Salmonella Thyphi CO Widal Test (vial 5 ml)
vial
80,000
0
0
125 Salmonella Thyphi AH Widal Test (vial 5 ml)
vial
80,000
0
0
126 Salmonella Thyphi BH Widal Test (vial 5 ml)
vial
80,000
0
0
127 Salmonella Thyphi CH Widal Test (vial 5 ml)
vial
80,000
0
0
128 Anti-A Monoclonal Golongan Darah (vial 10 ml)
vial
80,000
0
0
129 Anti-B Monoclonal Golongan Darah (vial 10 ml)
vial
80,000
0
0
Anti-A,B Monoclonal Golongan Darah (vial 10 130 ml)
vial
105,000
0
131 Anti-D Duoclone Golongan Darah (vial 10 ml)
vial
130,000
0
0
132 Larutan HCl 0,1N 100 ml/botol
botol
14,000
0
0
set
260,000
0
0
119 Rapid Test HIV
Larutan Ziehl Neelsen, tiap set terdiri atas : 1 botol Carbol Fuchsin 0,3% , 100 ml 133 3 botol Etanol Asam 3,0% , 100 ml 1 botol Methylene Blue 0,3% , 100 ml
0
0
0
TOTAL
11,999,900
KAPITASI
12,000,000
SISA KAPITASI
100
Petugas Obat Puskesmas : Sibolangit
diketahui oleh : KUPT Puskesmas Sibolangit Kecamatan Sibolangit
Franciskus Dohude NIP : 198503242010011013
dr. Tomo Edy NIP : 197907222010011012
disusun oleh :
DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DANA BPJS TAHUN 2017 Bulan : januari - maret 2017 NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
1 Alkohol 70% 1 liter
botol
33,000
0
0
2 Povidon Iodine 30 cc
botol
3,500
0
0
3 Povidon Iodine 60 cc
botol
4,300
0
0
4 Povidon Iodine 300 cc
botol
21,000
0
0
5 Aseptan 500 cc + dispenser (tanpa bilas)
botol
40,000
0
0
6 Aseptic Gel 500 cc + dispenser (tanpa bilas)
botol
25,500
0
0
Onescrub 500 cc + dispenser (Chlorhexidine 7 glukonate 4%) (bilas)
botol
72,000
0
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500 8 cc
botol
33,000
0
0 0
9
One step solution (cairan pembersih luka dan perawatan luka bakar) 500 cc
botol
33,000
0
10
Odex (antiseptik pada perawatan dan luka bakar) 500 cc
botol
110,000
0
11 Rivanol 300 cc
botol
3,600
0
0
12 Lysol 1 liter
botol
47,200
0
0
13 Ultrasonic Gel 250 ml
botol
16,000
0
0
14 Syringe 1 cc
buah
1,100
0
0
15 Syringe 2,5 cc
buah
800
0
0
16 Syringe 3 cc
buah
800
0
0
17 Syringe 5 cc
buah
900
0
0
18 Syringe 10 cc
buah
1,100
0
0
19 Blood Lancet 26G
100 buah/box
16,100
0
20 Blood Lancet 28G
100 buah/box
16,100
0
21 Kasa Hydrofil 40 x 80 m
roll
116,000
0
0
22 Kasa Pembalut Hydrofil 4 m x 3 cm
roll
650
0
0
23 Kasa Pembalut Hydrofil 4 m x 5 cm
roll
850
0
0
24 Kasa Pembalut Hydrofil 4 m x 10 cm
roll
1,700
0
0
25 Kasa Pembalut Hydrofil 4 m x 15 cm
roll
2,400
0
0
box/16
9,000
0
0
pcs
1,800
0
0
28 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's
pouch
3,200
0
0
29 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's
pouch
3,500
0
0
30 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's
pouch
7,200
0
0
31 Kasa Steril 10 x 10 cm, 8 ply 1 x 10's
pouch
10,400
0
0
32 Kapas Berlemak 500 gram
rolll
18,200
0
0
33 Kapas Pembalut putih250 gram
roll
13,800
0
0
34 Kapas Pembalut 500 gram
roll
30,050
0
0
26 Kasa Steril uk 16 x 16 cm 27 Kasa kompres 40 x 40
0 0
0 0
NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
35 Surgical Mask earloop
box/50
20,400
0
0
36 Surgical Mask tie on
box/50
20,400
0
0
37 Alkohol swab (ethyl alkohol 70%)
box/100
12,000
3
36,000
AC swab (ethyl alkohol 70% + Chlorhexidine Glukonate 2%)
box/100
18,000
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang 39 75 cm
box
147,500
2
2
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang 40 75 cm
box
147,500
2
2
41
Catgut chromic 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
147,500
2
2
42
Catgut chromic 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
147,500
2
2
43 Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
121,000
0
0
44 Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
121,000
0
0
45 Folley Catheter 2 way no. 12
box/10
88,000
1
1
88,000
46 Folley Catheter 2 way no. 14
box/10
88,000
1
1
88,000
47 Folley Catheter 2 way no. 16
box/10
88,000
1
1
88,000
48 Folley Catheter 2 way no. 18
box/10
88,000
1
1
88,000
49 Folley Catheter 2 way no. 20
box/10
88,000
1
1
88,000
50 Folley Catheter 2 way no. 22
box/10
88,000
1
1
88,000
51 Folley Catheter 2 way no. 24
box/10
88,000
1
1
88,000
52 Folley Catheter 3 way no. 20
box/10
358,000
0
0
53 Folley Catheter 3 way no. 22
box/10
358,000
0
0
54 Folley Catheter 3 way no. 24
box/10
358,000
0
0
55 Folley Catheter Pediatric no. 6
box/10
410000
0
0
56 Folley Catheter Pediatric no. 8
box/10
350,000
0
0
57 Folley Catheter Pediatric no. 10
box/10
350,000
0
0
58 IV Catheter No. 18 G x 32 mm
pcs
4,200
20
20
84,000
59 IV Catheter No. 20 G x 1 1/4"
pcs
4,200
20
20
84,000
60 IV Catheter No. 22 G x 1"
pcs
4,200
20
20
84,000
61 IV Catheter No. 24 G x 3/4"
pcs
4,200
20
20
84,000
62 IV Catheter No. 26 G x 1/2"
pcs
4550
20
20
91,000
63 Infusion set dewasa (20 drops/ml)
pcs
3,550
0
0
64 Infusion set Anak (60 drops/ml)
pcs
3,900
0
0
65 Infusion set Dewasa (Y Tube)
pcs
7,000
0
0
66 Blood Transfusion set
pcs
4,000
0
0
67 Three Way Stop Cock tanpa tube (50 buah/box)
box
110,000
0
0
68 Three Way Stop Cock dengan tube (50 buah/box)
box
18,000
50
50
69 Urine bag standard steril 2 Liter
pcs
3,500
50
50
175,000
70 Oxyflow Bubble (Bubble Nasal Canula)
buah
6,500
0
0
38
3
0
0 295,000 295,000 295,000 295,000
900,000
NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
71
Maxiflow Bayi (masker oksigen bayi + tubing), panjang 2 m
set
16,500
0
72
Maxiflow Anak (masker oksigen bayi + tubing), panjang 2 m
set
15,500
0
73
Maxiflow Dewasa (masker oksigen bayi + tubing), panjang 2 m
set
15,500
0
74 Makes Nebulizer Set Anak
set
23,000
0
0
75 Makes Nebulizer Set Dewasa
set
23,000
0
0
76 Hi Oxygen Masker anak
set
28,000
0
0
77 Hi Oxygen Masker Dewasa
set
28,000
0
0
78 Examination Glove
box/100
39,200
0
0
79 Examination Glove No Powder
box/100
64,200
0
0
80 Surgical Steril Pre Powder No. 7/7,5
pasang
4,600
0
0
81 Sarung Tangan Obgyn Steril
pasang
23,500
0
0
82 Wing Needle 19 G
pcs
1,600
10
10
16,000
83 Wing Needle 21 G
pcs
1,600
10
10
16,000
84 Wing Needle 23 G
pcs
1,600
10
10
16,000
85 Wing Needle 25 G
pcs
1,600
5
5
8,000
86 Wing Needle 27 G
pcs
1,600
5
5
8,000
87 Suction Catether No. 6
pcs
4,800
0
0
88 Suction Catether No. 8
pcs
4,800
0
0
89 Suction Catether No. 10
pcs
4,800
0
0
90 Suction Catether No. 12
pcs
4,800
0
0
91 Suction Catether No. 14
pcs
4,800
0
0
92 Suction Catether No. 16
pcs
4,800
0
0
93 Suction Catether No. 18
pcs
4,800
0
0
Dermafix S (untuk pemasangan IV Catheter) 94 ukuran 6 X 7 cm
blister
2,300
0
95 Dermafix T (plester transparan) 5 X 7 cm
buah
1,900
0
0
96 Dermafix T (plester transparan) 10 X 8 cm
buah
4,700
0
0
97 Dermafix T (plester transparan) 10 X 12 cm
buah
7,100
0
0
98 Dermafix T (plester transparan) 10 X 145 cm
buah
9,200
0
0
99 Dermafix T (plester transparan) 10 X 20 cm
buah
11,000
0
0
100 Dermafix T (plester transparan) 10 X 25 cm
buah
17,000
0
0
200 pcs/box
35,000
0
102 Plesterin Roll 5 cm X 5 m
roll
28,000
0
0
103 Plesterin Roll 10 cm X 5 m
roll
48,000
0
0
104 Plesterin Roll 15 cm X 5 m
roll
80,000
0
0
105 Plesterin Roll 20 cm X 5 m
roll
92,000
0
0
box/72 pcs
20,000
0
0
160,000
0
101
Plesterin Bulat (digunakan setelah pengambilan darah sample)
106 Object Glass 107 Cover Glass 22 x 22 mm
pak/10 box @ 100 pcs
0 0 0
0
0
0
NO
NAMA/JENIS BMHP / REAGENSIA
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
HARGA TOTAL (Rp)
108 EDTA K3 Tubes
box isi 100 pcs
250,000
0
109 Nurse Cap
box isi 100 pcs
50,000
0
110 Softpad (underpad) 60 X 90
pack isi 10
50,000
0
0
buah
20,000
0
0
buah
20,000
0
113 Reagensia Autocheck 3 in 1 (Glukosa)
box/25
120,000
2
2
240,000
114 Reagensia Autocheck 3 in 1 (Asam Urat)
box/25
150,000
2
2
300,000
115 Reagensia Autocheck 3 in 1 (Cholesterol)
box/10
250,000
1
1
250,000
116 Test Hamil box/50's
buah
2,300
100
100
230,000
117 Rapit test Gluko Protein Test bos/50's
buah
1,200
0
0
118 Detecto HBs Ag Hepatitis B
buah
5,500
0
0
25 test/box
560,000
0
0
120 Salmonella Thyphi H Widal Test (vial 5 ml)
vial
80,000
0
0
121 Salmonella Thyphi O Widal Test (vial 5 ml)
vial
80,000
0
0
122 Salmonella Thyphi AO Widal Test (vial 5 ml)
vial
80,000
0
0
123 Salmonella Thyphi BO Widal Test (vial 5 ml)
vial
80,000
0
0
124 Salmonella Thyphi CO Widal Test (vial 5 ml)
vial
80,000
0
0
125 Salmonella Thyphi AH Widal Test (vial 5 ml)
vial
80,000
0
0
126 Salmonella Thyphi BH Widal Test (vial 5 ml)
vial
80,000
0
0
127 Salmonella Thyphi CH Widal Test (vial 5 ml)
vial
80,000
0
0
128 Anti-A Monoclonal Golongan Darah (vial 10 ml)
vial
80,000
0
0
129 Anti-B Monoclonal Golongan Darah (vial 10 ml)
vial
80,000
0
0
vial
105,000
0
131 Anti-D Duoclone Golongan Darah (vial 10 ml)
vial
130,000
0
0
132 Larutan HCl 0,1N 100 ml/botol
botol
14,000
0
0
set
260,000
0
0
111 Arm Sling (tersedia ukuran S,M,L) 112
Bracket Hand Wash ABS (keranjang tempat aseptic gel)
119 Rapid Test HIV
130
Anti-A,B Monoclonal Golongan Darah (vial 10 ml)
Larutan Ziehl Neelsen, tiap set terdiri atas : 1 botol Carbol Fuchsin 0,3% , 100 ml 133 3 botol Etanol Asam 3,0% , 100 ml 1 botol Methylene Blue 0,3% , 100 ml
0 0
0
0
TOTAL
4,418,000
KAPITASI
4,422,900
SISA KAPITASI disusun oleh : Petugas Obat Puskesmas : Sibolangit
4,900 diketahui oleh : KUPT Puskesmas Sibolangit Kecamatan Sibolangit
NO
NAMA/JENIS BMHP / REAGENSIA Franciskus Dohude NIP : 198503242010011013
HARGA/ SATUAN
SATUAN (Harga Maksimum)
KEB
PERMINTAAN STOK
PESANAN
dr. Tomo Edy NIP : 197907222010011012
HARGA TOTAL (Rp)
DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DAK TAHUN 2018 NO
NAMA/JENIS BMHP / REAGENSIA
SATUAN
KEB
PERMINTAAN STOK
PESANAN
1 2 3 4 5 6
Alkohol 70% 1 liter Povidon Iodine 30 cc Povidon Iodine 60 cc Povidon Iodine 300 cc Aseptan 500 cc + dispenser (tanpa bilas) Aseptic Gel 500 cc + dispenser (tanpa bilas)
botol botol botol botol botol botol
24 120 24 12 12 12
24 120 24 12 12 12
7
Onescrub 500 cc + dispenser (Chlorhexidine glukonate 4%) (bilas)
botol
12
12
8
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500 cc
botol
12
12
9
One step solution (cairan pembersih luka dan perawatan luka bakar) 500 cc
botol
12
12
10
Odex (antiseptik pada perawatan dan luka bakar) 500 cc
botol
12
12
11 12 13 14 15 16 17 18
Rivanol 300 cc Lysol 1 liter Ultrasonic Gel 250 ml Syringe 1 cc Syringe 2,5 cc Syringe 3 cc Syringe 5 cc Syringe 10 cc
botol botol botol buah buah buah buah buah
72 60 3,600 36,000 36,000 24,000 6,000
72 60 0 3,600 36,000 36,000 24,000 6,000
19 Blood Lancet 26G
100 buah/box
120
120
20 Blood Lancet 28G
100 buah/box
120
120
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
roll roll roll roll roll box/16 pcs pouch pouch pouch pouch rolll roll roll box/50 box/50 box/100
36 1,200 1,800 600 360 144 240 240 240 240 240 120 120 120 60 60 60
36 1,200 1,800 600 360 144 240 240 240 240 240 120 120 120 60 60 60
Kasa Hydrofil 40 x 80 m Kasa Pembalut Hydrofil 4 m x 3 cm Kasa Pembalut Hydrofil 4 m x 5 cm Kasa Pembalut Hydrofil 4 m x 10 cm Kasa Pembalut Hydrofil 4 m x 15 cm Kasa Steril uk 16 x 16 cm Kasa kompres 40 x 40 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's Kasa Steril 10 x 10 cm, 8 ply 1 x 10's Kapas Berlemak 500 gram Kapas Pembalut putih250 gram Kapas Pembalut 500 gram Surgical Mask earloop Surgical Mask tie on Alkohol swab (ethyl alkohol 70%)
PERMINTAAN STOK
NO
NAMA/JENIS BMHP / REAGENSIA
SATUAN
38
AC swab (ethyl alkohol 70% + Chlorhexidine Glukonate 2%)
box/100
60
60
39
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
60
60
40
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
60
60
41
Catgut chromic 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
60
60
42
Catgut chromic 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
box
60
60
60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 600 600 600 600 600 600 600 600
Three Way Stop Cock tanpa tube (50 buah/box)
box box box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 box/10 pcs pcs pcs pcs pcs pcs pcs pcs pcs box
12
60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 600 600 600 600 600 600 600 600 0 12
68 Three Way Stop Cock dengan tube (50 buah/box)
box
12
12
69 Urine bag standard steril 2 Liter 70 Oxyflow Bubble (Bubble Nasal Canula)
pcs buah
360 6
360 6
20
20
43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm
Folley Catheter 2 way no. 12 Folley Catheter 2 way no. 14 Folley Catheter 2 way no. 16 Folley Catheter 2 way no. 18 Folley Catheter 2 way no. 20 Folley Catheter 2 way no. 22 Folley Catheter 2 way no. 24 Folley Catheter 3 way no. 20 Folley Catheter 3 way no. 22 Folley Catheter 3 way no. 24 Folley Catheter Pediatric no. 6 Folley Catheter Pediatric no. 8 Folley Catheter Pediatric no. 10 IV Catheter No. 18 G x 32 mm IV Catheter No. 20 G x 1 1/4" IV Catheter No. 22 G x 1" IV Catheter No. 24 G x 3/4" IV Catheter No. 26 G x 1/2" Infusion set dewasa (20 drops/ml) Infusion set Anak (60 drops/ml) Infusion set Dewasa (Y Tube) Blood Transfusion set
KEB
PESANAN
71
Maxiflow Bayi (masker oksigen bayi + tubing), panjang 2 m
set
72
Maxiflow Anak (masker oksigen bayi + tubing), panjang 2 m
set
0
73
Maxiflow Dewasa (masker oksigen bayi + tubing), panjang 2 m
set
0
NO
NAMA/JENIS BMHP / REAGENSIA
SATUAN
KEB
PERMINTAAN STOK
PESANAN
74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93
Makes Nebulizer Set Anak Makes Nebulizer Set Dewasa Hi Oxygen Masker anak Hi Oxygen Masker Dewasa Examination Glove Examination Glove No Powder Surgical Steril Pre Powder No. 7/7,5 Sarung Tangan Obgyn Steril Wing Needle 19 G Wing Needle 21 G Wing Needle 23 G Wing Needle 25 G Wing Needle 27 G Suction Catether No. 6 Suction Catether No. 8 Suction Catether No. 10 Suction Catether No. 12 Suction Catether No. 14 Suction Catether No. 16 Suction Catether No. 18
set set set set box/100 box/100 pasang pasang pcs pcs pcs pcs pcs pcs pcs pcs pcs pcs pcs pcs
30 30 30 30 60 60 100 100 60 60 60 60 60 60 60 60 60 60 60 60
30 30 30 30 60 60 100 100 60 60 60 60 60 60 60 60 60 60 60 60
94
Dermafix S (untuk pemasangan IV Catheter) ukuran 6 X 7 cm
blister
800
800
95 96 97 98 99 100
Dermafix T (plester transparan) 5 X 7 cm Dermafix T (plester transparan) 10 X 8 cm Dermafix T (plester transparan) 10 X 12 cm Dermafix T (plester transparan) 10 X 145 cm Dermafix T (plester transparan) 10 X 20 cm Dermafix T (plester transparan) 10 X 25 cm
buah buah buah buah buah buah
600 600 300 300 200 200
600 600 300 300 200 200
101
Plesterin Bulat (digunakan setelah pengambilan darah sample)
200 pcs/box
5
5
102 103 104 105 106
Plesterin Roll 5 cm X 5 m Plesterin Roll 10 cm X 5 m Plesterin Roll 15 cm X 5 m Plesterin Roll 20 cm X 5 m Object Glass
100 100 50 50 10
100 100 50 50 10
10
10
10
10
5
5
10 10
10 10
107 Cover Glass 22 x 22 mm 108 EDTA K3 Tubes 109 Nurse Cap 110 Softpad (underpad) 60 X 90 111 Arm Sling (tersedia ukuran S,M,L)
roll roll roll roll box/72 pcs
pak/10 box @ 100 pcs box isi 100 pcs box isi 100 pcs pack isi 10
buah
NO
NAMA/JENIS BMHP / REAGENSIA
112
Bracket Hand Wash ABS (keranjang tempat aseptic gel)
SATUAN
KEB
PERMINTAAN STOK
PESANAN
buah
10
10
box/25 box/25 box/10 buah buah buah
20 20 20 10
vial vial vial vial vial vial vial vial vial vial
20 20 20 10 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Anti-A,B Monoclonal Golongan Darah (vial 10 ml)
vial
0
131 Anti-D Duoclone Golongan Darah (vial 10 ml) 132 Larutan HCl 0,1N 100 ml/botol Larutan Ziehl Neelsen, tiap set terdiri atas : 1 botol Carbol Fuchsin 0,3% , 100 ml 133 3 botol Etanol Asam 3,0% , 100 ml 1 botol Methylene Blue 0,3% , 100 ml
vial botol
0 0
set
0
113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129
Reagensia Autocheck 3 in 1 (Glukosa) Reagensia Autocheck 3 in 1 (Asam Urat) Reagensia Autocheck 3 in 1 (Cholesterol) Test Hamil box/50's Rapit test Gluko Protein Test bos/50's Detecto HBs Ag Hepatitis B Rapid Test HIV Salmonella Thyphi H Widal Test (vial 5 ml) Salmonella Thyphi O Widal Test (vial 5 ml) Salmonella Thyphi AO Widal Test (vial 5 ml) Salmonella Thyphi BO Widal Test (vial 5 ml) Salmonella Thyphi CO Widal Test (vial 5 ml) Salmonella Thyphi AH Widal Test (vial 5 ml) Salmonella Thyphi BH Widal Test (vial 5 ml) Salmonella Thyphi CH Widal Test (vial 5 ml) Anti-A Monoclonal Golongan Darah (vial 10 ml) Anti-B Monoclonal Golongan Darah (vial 10 ml)
disusun oleh :
25 test/box
Petugas Obat Puskesmas : Sibolangit
diketahui oleh : KUPT Puskesmas Sibolangit Kecamatan Sibolangit
Franciskus Dohude NIP : 198503242010011013
dr. Tomo Edy NIP : 197907222010011012
