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LAPORAN STOK AKHIR / STOK OPNAME OBAT DAN PERBEKALAN KESEHATAN TANGGAL 31 DESEMBER 2014 NAMA PUSKESMAS : BATUCEPER ALAMAT : JL. DAAN MOGOT KM 21 TELEPON : 021-5584508
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
OBAT 1
Alopurinol tablet 100 mg
Tablet
104
86.00
290
300.00
290
300
10
280
300
580
49,880
2
Amlodipin tablet 5 mg
Tablet
240
187.00
330.00
570.00
330
570
70
260
570
830
155,210
3
Aminofillin tablet 200 mg
Tablet
87
80.00
402.00
-
402
-
25
377
-
377
30,160
4
Amoksilin kaplet 500 mg
Kaplet
220
261.00
4,225.00
10,500.00
4,225
10,500
835
3,390
10,500
13,890
3,625,290
5
Amoksilin sirup kering 125 mg/ 5 ml - 60 ml
Botol
2,277
2,445.00
94.00
300.00
94
300
5
89
300
389
951,105
6
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg
Tablet
81
72.00
2,696.00
2,800.00
2,696
2,800
320
2,376
2,800
5,176
372,672
7
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200 mg /5 ml - 60 ml
Botol
1,866
2,140.00
57.00
-
57
-
-
57
-
57
121,980
8
Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 IU/g
Tube
2,266
2,516.00
36.00
75.00
36
75
-
36
75
111
279,276
9
Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% + Placenta Ekstrak 10 %) - 15 gr / Bioplacenton
Tube
11,000
11,000.00
-
1.00
-
1
-
-
1
1
11,000
10
Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / Neo Diaform
Tablet
145
145.00
719.00
1,500.00
719
1,500
62
657
1,500
2,157
312,765
11
Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60 ml
Botol
6,240
7,000.00
58.00
60.00
58
60
-
58
60
118
826,000
12
Antifungi DOEN kombinasi As. Benzoat 6% + As. Salisilat 3% - 30 gr / Whitefield
Pot
1,904
1,904.00
-
-
-
-
-
-
-
-
13
Anti Hemmoroid DOEN kombinasi : Bismut subgalat 150 mg + Heksaklorofen 2,5 mg
Supp
2,000
2,000.00
38.00
40.00
38
40
30
40
70
140,000
14
Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium 80% + Citrus Bioflavonoid 20% / Haemorogard
Kapsul
1,694
1,333.00
-
-
60
60
60
-
60
79,980
15
Antiinfeksi Topikal dengan Kortikosteroid krim (Kloramfenikol base 20 mg + Prednisolon 2,5 mg) - 10 gr / Klorfeson
Tube
7,080
6,900.00
21.00
36.00
21
36
20
36
56
386,400
16
Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg
Tablet
123
135.00
60.00
100.00
60
100
-
60
100
160
21,600
17
Aqua pro injeksi steril, bebas pirogen 20 ml
5,280
6,050.00
-
3.00
3
-
-
3
3
18,150
18
Asam Asetilsalisilat tablet 80 mg
Tablet
390
148.00
70.00
-
70
19
Asam Askorbat (Vitamin C) tablet 50 mg
Tablet
32
95.00
4,876.00
7,200.00
4,876
Vial
60
60.00
-
7,200
8
-
1
60
10
60
1,693
3,183
7,200
-
60
8,880
10,383
986,385
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
20
Asam Mefenamat kaplet 500 mg
Kaplet
100
112.00
2,970.00
8,000.00
2,970
8,000
880
2,090
8,000
10,090
1,130,080
21
Asiklovir krim 5 % - 5 gr
Tube
2,152
2,300.00
33.00
75.00
33
75
4
29
75
104
239,200
22
Asiklovir tablet 400 mg
Tablet
570
336.00
110.00
400.00
110
400
40
70
400
470
157,920
23
Atapulgit tablet 600 mg
Tablet
-
190.00
200.00
-
200
-
-
200
-
200
38,000
24
Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) 1 ml
Ampul
1,230
1,300.00
-
-
-
-
-
-
-
-
-
25
Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet tambah darah kombinasi)
Tablet
33
42.00
-
-
-
-
-
-
-
-
-
26
Betahistin Mesilat tablet 6 mg / Noverty
Tablet
924
270.00
70.00
50.00
70
50
-
70
50
120
32,400
27
Betametason Krim 0.1 % (sebagai valerat) - 5 gr
Tube
1,524
1,520.00
54.00
48.00
54
48
1.00
53
48
101
153,520
28
Bisoprolol tablet 5 mg
Tablet
2,300
645.00
-
-
-
-
-
-
-
29
Borax Glyserin ( GOM ) 10 % - 8 ml
Botol
1,964
2,500.00
36.00
72.00
36
72
6.00
30
72
102
255,000
30
Bromheksin tablet 8 mg / Bromifar
Tablet
39
75.00
185.00
700.00
185
700
10.00
175
700
875
65,625
31
Bromheksin larutan 2mg/ml (untuk Nebulizer) 50 ml / Bisolvon
Botol
59,125
7,500.00
-
-
-
-
-
-
-
32
Deksametason tablet 0,5 mg
Tablet
69
62.00
2,466.00
5,600.00
33
Deksametason injeksi 5 mg/ml-1ml
Ampul
641
1,580.00
-
-
-
-
-
-
-
-
-
34
Difenhidramin injeksi 10 mg/ml
Ampul
1,178
1,054.00
-
-
-
-
-
-
-
-
-
35
Digoksin tablet 0,25 mg
Tablet
140
97.00
-
-
36
Domperidon tablet 10 mg
Tablet
176
167.00
115.00
100.00
37
Doksisiklin kapsul 100 mg
Kapsul
209
245.00
-
38
Efedrin tablet 25 mg (HCl)
Tablet
43
43.00
167.00
39
Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) - 1 ml
Ampul
1,500
8,100.00
-
4.00
40
Eritromisin kapsul 500 mg
Kapsul
921
930.00
65.00
100.00
41
Eritromisin sirup 200 mg 5 /ml - 60 ml
Botol
7,220
7,700.00
-
42
Etakridin (Rivanol) Larutan 0,1 % - 300 ml
Botol
2,212
2,250.00
26.00
43
Fenol Gliserol tetes telinga 10 % - 5 ml
Botol
1,008
1,008.00
44
Fitomenadion(Vit. K1) tablet salut gula 10 mg
Tablet
579
45
Furosemid tablet 40 mg
Tablet
46
Garam Oralit I serbuk, kombinasi : Natrium 0,52 g, Kalium klorida 0,30 g , Trinatrium sitrat dihidrat 0,58 g, Glukosa anhidrat 2,7 g
47
Gemfibrozil 300 mg kapsul
2,466
5,600
-
821
1,645
5,600
7,245
-
449,190
-
-
-
-
-
-
115
100
20
95
100
195
-
-
-
-
-
-
-
-
167
-
-
167
-
167
7,181
-
-
4
4
32,400
30
100
130
120,900
-
4
32,565 -
65
100
35
-
-
-
-
-
-
-
-
26
-
1
25
-
25
56,250
23.00
48.00
23
48
1
22
48
70
70,560
634.00
84.00
400.00
84
400
5
79
400
479
303,686
83
75.00
90.00
-
90
-
-
90
-
90
6,750
Sach
292
288.00
184.00
500.00
184
500
36
148
500
648
186,624
Kapsul
265
289.00
180.00
840.00
180
840
-
180
840
1,020
294,780
-
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT 15=(11-13)
TOTAL
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
48
Gentamycin salep kulit 0,1% - 5 gr
Tube
1,469
1,700.00
15.00
100.00
15
100
-
15
100
115
49
Glibenklamid tablet 5 mg
Tablet
54
56.00
465.00
1,700.00
465
1,700
100
365
1,700
2,065
115,640
50
Gliseril Guaiakolat tablet 100 mg
Tablet
30
25.00
4,946.00
12,000.00
4,946
12,000
396
4,550
12,000
16,550
413,750
51
Glucose Larutan Infus 5% steril - 500 ml
Botol
5,313
5,200.00
-
-
-
-
-
-
-
-
-
52
Griseofulvin tablet 125 mg / Gricin
Tablet
200
219.00
-
-
-
-
-
-
-
-
-
53
Hidroklortiazid (HCT) tablet 25 mg
Tablet
36
37.00
1,093.00
-
1,093
-
-
54
Hidrokortison krim 2,5 % - 5 gr
Tube
2,399
3,000.00
63.00
72.00
63
72
55
Hyoscine - N - Butilbromide tablet 10 mg / Scopma
Tablet
300
300.00
10.00
-
10
-
56
Ibuprofen tablet 400 mg
Tablet
57
Ichtyol salep kulit - 15 gr
Pot
58
Isosorbid dinitrat (ISDN) tablet sublingual 5 mg
59
Kalium permanganat (PK) serbuk - 5 gr
60
Kalsium laktat (Kalk) tablet 500 mg
Tablet
61
Kaptopril tablet 25 mg
Tablet
62
Ketokonazol tablet 200 mg
Tablet
63
Klindamisin kapsul 300 mg
Kapsul
527
361.00
-
-
64
Kloramfenikol kapsul 250 mg
Kapsul
227
227.00
100.00
100.00
65
Kloramfenikol salep mata 1% - 5 gr
Tube
1,320
1,550.00
-
66
Kloramfenikol suspensi 125 mg/5ml - 60 ml
Botol
3,800
3,850.00
-
67
Kloramfenikol tetes mata 0,5 % - 5 ml
Botol
2,500
6,000.00
-
-
68
Kloramfenikol tetes telinga 3 % - 5 ml
Botol
1,599
1,600.00
26.00
-
26
1
25
25
40,000
69
Klorfeniramin maleat (CTM) tablet 4 mg
Tablet
21
73.00
5,675.00
17,300.00
5,675
17,300
1,247
4,428
17,300
21,728
1,586,144
70
Kotimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg
Tablet
140
138.00
660.00
600.00
660
600
60
600
600
1,200
165,600
71
Kotimoksazol DOEN II (pedriatik) kombinasi : Sulfametoksazol 100 mg + Trimetoprim 20 mg
Tablet
70
70.00
-
-
-
-
-
-
-
-
72
Kotimoksazol Suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml
Botol
1,975
2,145.00
29.00
100.00
29
100
-
29
100
129
276,705
73
Levertraan salep - 15 gr
Pot
2,837
2,837.00
17.00
24.00
17
24
-
17
24
41
116,317
74
Lidokain injeksi 2% - 2 ml
Ampul
900
839.00
-
-
-
-
-
-
-
-
-
75
Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 ml
Ampul
1,295
1,363.00
-
-
-
-
-
-
-
-
-
Tablet Pot
1,093
1,093
40,441
55
72
127
381,000
-
10
-
10
3,000
8
-
195,500
146
149.00
110.00
-
110
-
10
100
-
100
14,900
4,417
4,000.00
16.00
72.00
16
72
-
16
72
88
352,000
81
88.00
90.00
-
90
-
-
90
-
90
7,920
3,500
3,500.00
-
-
-
-
44
35.00
1,069.00
-
88
84.00
1,035.00
267
300.00
90.00
2,000
2,000.00
-
-
3,069
2,000
639
2,000
2,430
4,100.00
1,035
4,100
130
905
250.00
90
250
-
90
-
-
85,050
4,100
5,005
420,420
250
340
102,000
-
-
-
-
-
-
100
100
-
100
100
200
-
-
-
-
-
-
-
-
-
-
-
-
-
-
25
25
-
25
-
25
25
25.00
-
25
-
2,430
-
45,400 150,000
-
NAMA OBAT
SATUAN KEMASAN
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
1
2
76
Linkomisin kapsul 500 mg
Kapsul
520
520.00
-
-
-
-
-
-
-
-
77
Loperamid tablet 2 mg
Tablet
91
89.00
110.00
100.00
110
100
10
100
100
200
17,800
78
Loratadin tablet 10 mg
Tablet
160
154.00
160.00
200.00
160
200
10
150
200
350
53,900
79
Mebendazol tablet 100 mg
Tablet
141
141.00
-
-
80
Metampiron (Antalgin) tablet 500 mg
Tablet
116
158.00
2,655.00
700.00
2,655
81
Metformin HCl tablet 500 mg
Tablet
105
112.50
140.00
-
82
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg
Tablet
121
154.00
90.00
83
Metronidazol tablet 500 mg
Tablet
164
160.00
84
Mikonazol krim/ salep 2 % (Nitrat) - 10 gr
Tube
3,000
85
Multivit Sirup - 60 ml
Botol
17,215
86
Multivit Tablet
Tablet
778
700.00
87
Natrium Bikarbonat tablet 500 mg
Tablet
14
14.00
-
-
88
Natrium Diklofenak tablet 50 mg
Tablet
174
176.00
130.00
500.00
89
Natrium Klorida larutan infus 0,9% - 500 ml
Botol
4,900
4,700.00
-
90
Natrium Klorida larutan 0,9% - 25 ml (untuk Nebulizer)
Botol
2,530
2,530.00
-
91
Nifedipin tablet 10 mg
Tablet
108
110.00
79.00
-
79
-
-
79
-
79
8,690
92
Nistatin tablet salut 500.000 IU/g
Tablet
550
640.00
174.00
200.00
174
200
14
160
200
360
230,400
93
Nistatin vaginal tablet 100.000 IU/g
Tablet
345
370.00
109.00
300.00
109
300
3
106
300
406
150,220
94
Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol
Botol
4,274
4,500.00
200.00
720.00
200
720
80
120
720
840
3,780,000
95
Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg) / Librozym
Tablet
500
500.00
50.00
200.00
50
200
20
30
200
230
115,000
96
Oksitetrasiklin HCl salep kulit 3 % - 5 gr
Tube
1,450
1,700.00
58.00
25.00
58
25
5
53
25
78
132,600
97
Oksitetrasiklin HCl salep mata 1 % - 5 gr
Tube
1,920
1,920.00
43.00
-
43
-
4
39
-
39
74,880
98
Omeprazol kapsul 20 mg
Kapsul
265
211.00
80.00
30.00
80
30
-
80
30
110
23,210
99
Papaverin tablet 40 mg
Tablet
93
93.00
-
-
-
-
-
-
-
-
3
-
-
-
700
340
2,315
-
140
-
30
110
-
90
-
-
175.00
-
175
-
3,000.00
36.00
72.00
36
19,800.00
81.00
72.00
81
190.00
300.00
190
15=(11-13)
700
16=(14+15)
-
-
-
3,015
476,370
-
110
12,375
90
-
90
13,860
35
140
-
140
22,400
72
4
32
72
104
312,000
72
1
80
72
152
3,009,600
300
130
60
300
360
252,000
-
-
-
-
-
-
130
500
30
100
500
600
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
105,600
-
100 Parasetamol drops
botol
5,227
5,200.00
79.00
-
79
-
45
34
-
34
176,800
101 Parasetamol sirup 120 mg / 5ml - 60 ml
Botol
1,319
1,438.00
98.00
252.00
98
252
28
70
252
322
463,036
102 Parasetamol tablet 100 mg
Tablet
32
32.00
-
-
-
-
-
-
-
-
103 Parasetamol tablet 500 mg
Tablet
84
79.00
2,750.00
12,000.00
2,750
12,000
885
1,865
12,000
13,865
1,095,335
104 Piridoksin (Vitamin B6) tablet 10 mg (HCl)
Tablet
17
175.00
5,214.00
7,000.00
5,214
7,000
174
5,040
7,000
12,040
2,107,000
105 Piroksikam tablet 10 mg
Tablet
65
125.00
140.00
200.00
140
200
90
50
200
250
31,250
106 Polikresulen (kondensasi) - 10 ml
Botol
29,400
17,393.00
1.00
1.00
1
1
1
-
1
1
17,393
-
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
107 Povidon Iodida larutan 10 % - 300 ml
Botol
14,000
14,203.00
-
-
-
-
-
-
-
-
-
108 Prednison tablet 5 mg
Tablet
52
145.00
-
-
-
-
-
-
-
-
-
109 Propanolol tablet 10 mg (HCl)
Tablet
61
65.00
-
-
-
-
-
-
-
-
-
110 Propiltiourasil tablet 100 mg
Tablet
254
30.00
-
-
111 Ranitidin tablet 150 mg
Tablet
110
120.00
225.00
800.00
112 Ringer Laktat larutan infus - 500 ml
Botol
5,200
5,200.00
-
1.00
113 Salbutamol tablet 2 mg (sebagai sulfat)
Tablet
60
89.00
190.00
700.00
114
Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Ventolin
Botol
9,680
5,867.00
-
-
115
Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr
Pot
1,229
2,000.00
-
-
116 Salisil Bedak 2 % - 50 gr
Kotak
1,120
1,250.00
68.00
100.00
117 Sefadroksil Kapsul 500 mg
Kapsul
521
509.00
50.00
300.00
118 Sianokobalamin (vitamin B12) tablet 50 mcg
Tablet
14
150.00
-
-
119 Simvastatin tablet 10 mg
Tablet
180
169.00
298.00
120 Siprofloksasin tablet 500 mg (sebagai HCl)
Tablet
245
255.00
121 Sulfasetamida Natrium tetes mata 15 % - 5 ml
Botol
2,888
-
-
-
-
-
-
225
800
65
160
800
960
-
24
24.00
1
-
-
1
1
5,200
190
700
70
120
700
820
72,980
-
-
-
-
-
-
24
24
-
24
-
24
48,000
68
100
10
58
100
158
197,500
10
40
300
24
50
300
1,000
1,000
400.00
298
400
40
258
180.00
-
180
-
20
2,888.00
-
-
-
-
1,000
1,000.00
115,200
-
340
173,060
1,000
150,000
400
658
111,202
160
-
160
40,800
-
-
-
-
-
-
1,000
1,000
-
122 Tetrasiklin kapsul 250 mg
Kapsul
-
148.00
-
-
-
-
-
-
-
-
123 Tetrasiklin kapsul 500 mg
Kapsul
542
542.00
-
-
-
-
-
-
-
-
124 Thiamfenikol kapsul 500 mg
Kapsul
431
1,650.00
55.00
-
55
-
-
55
-
55
125 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat)
Tablet
33
35.00
3,430.00
9,000.00
3,430
9,000
600
2,830
9,000
11,830
414,050
126 Vitamin B Kompleks tablet
Tablet
22
107.00
3,975.00
7,000.00
3,975
7,000
291
3,684
7,000
10,684
1,143,188
127 Zinc tablet 20 mg
Tablet
455
474.00
270.00
600.00
270
600
65
205
600
805
381,570
7
3.00
4
1,439,960
90,750
OBAT PROGRAM TB PARU 128 Obat FDC Kategori 1
Paket
359,900
359,990.00
-
7.00
129 Obat FDC Kategori 2
Paket
1,199,900
1,199,990.00
-
-
3.00
-
3
130 Obat FDC Anak
Paket
214,898
214,990.00
-
1.00
-
131 Obat FDC Sisipan
Paket
159,900
160,000.00
-
-
-
-
3.00
-
1
-
-
-
4 1 -
1 -
214,990 -
OBAT PROGRAM IMS 132 Kanamisin injeksi 1 gr
9,780
4,700.00
-
4.00
-
133 Levofloksasin tablet 500 mg
Tablet
574
528.00
-
-
-
-
134 Sefiksim kapsul 100 mg
Kapsul
958
859.00
24.00
50.00
24
50
OBAT PROGRAM FILARIASIS
Vial
4
-
10.00
4
4
-
-
-
14
50
64
18,800 54,976
NAMA OBAT
1
2
SATUAN KEMASAN
3
135 Dietilkarbamazin Sitrat tablet 100 mg
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
Tablet
74
136 Albendazole tablet 400 mg
Tablet
365
137 Pirantel tablet score (base) 125 mg
Tablet
138 Retinol (Vitamin A) 100.000 IU kapsul lunak 139 Retinol (Vitamin A) 200.000 IU kapsul lunak
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
-
-
-
-
-
-
-
-
338.00
-
-
-
-
-
-
-
-
186
296.00
-
-
-
-
-
-
-
-
Kapsul
242
260.00
-
-
-
-
-
-
-
-
Kapsul
392
459.00
-
-
-
-
-
-
-
-
OBAT PROGRAM KECACINGAN
OBAT PROGRAM GIZI
OBAT KEJIWAAN 1
Alprazolam tablet 1 mg
Tablet
900
233.00
-
-
-
-
-
-
-
2
Amitriptilin tablet salut 25 mg (HCl)
Tablet
115
112.00
90.00
-
90
-
90
-
90
3
Clobazam tablet 10 mg
Tablet
760
9.00
-
-
4
Diazepam tablet 2 mg
Tablet
27
27.00
51.00
400.00
5
Diazepam tablet 5 mg
Tablet
29
29.00
-
6
Diazepam injeksi 5 mg /ml - 2 ml
Ampul
873
1,200.00
-
7
Diazepam tube Rectal 5 mg/2.5 ml
Tube
25,920
11,525.00
8
Fenitoin Kapsul 100 mg
Kapsul
-
9
Fenobarbital tablet 30 mg
Tablet
46
10
Fluoxetin tablet 10 mg /
Tablet
3,533
11
Haloperidol tablet 1,5 mg
Tablet
61
12
Haloperidol tablet 5 mg
Tablet
13
Imipramin tablet 25 mg / Tofranil
14
Karbamazepin tablet 200 mg
15 16
10,080
-
-
-
-
-
51
400
51
400
451
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1.00
-
133.00
-
-
-
-
-
-
-
-
133.00
-
-
-
-
-
-
-
-
419.00
19.00
-
19
-
19
-
19
69.00
-
-
-
-
-
-
-
-
88
96.00
-
-
-
-
-
-
-
-
Tablet
3,584
3,584.00
-
-
-
-
-
-
-
-
Tablet
238
245.00
-
-
-
-
-
-
-
-
Klorpromazin tablet salut 100 mg (HCl)
Tablet
133
149.00
-
-
-
-
-
-
-
Kodein tablet 10 mg
Tablet
387
500.00
215.00
-
215
-
215
-
215
17
Risperidon tablet 2 mg
Tablet
1,781
1,008.00
-
-
-
-
-
-
-
-
18
Sertralin tablet / Nudep
Tablet
7,388
3,300.00
-
-
-
-
-
-
-
-
19
Triheksifenidil tablet 2 mg
Tablet
40
41.00
-
-
-
-
-
-
-
-
25,300
Antiprestin
1
-
1
1
12,177
11,525
7,961
107,500
OBAT GIGI 1
Artikulating Paper
Buku
2
Bur diamond high Speed
Kotak
3
Bur arkansas high Speed
buah
4
Cavit / Dentorit (Tambalan Sementara)
Pot
138,000
25,300.00
-
-
-
-
-
-
-
-
170,000.00
-
-
-
-
-
-
-
-
12,000.00
-
-
-
-
-
-
-
120,000.00
-
6.00
-
6
-
6
6
720,000
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
5
Celluloid strip
Set
130,000
150,000.00
-
-
-
-
-
-
-
-
6
Cresopen - 13 ml
Botol
604,800
500,000.00
-
-
-
-
-
-
-
-
7
Dentin Conditioner
Botol
75,845
75,845.00
-
-
-
-
-
-
-
-
8
Devitalisasi Pasta (Non Arsen)
Btl / ktk
390,000
400,000.00
-
-
-
-
-
-
-
-
9
Disclosing Agent
60,000
15,000.00
-
-
-
-
-
-
-
-
10
Disposible saliva ejektor
68,970
68,970.00
-
-
-
-
-
-
-
11
Etil Chlorida spray - 100 ml
Tube Bungkus @ 100 pcs Botol
105,000
110,000.00
-
8.00
-
8
-
8
8
880,000
12
Eugenol cairan
Botol
45,833
16,667.00
-
1.00
-
1
-
1
1
16,667
13
Glass Ionomer Radiopak / Fuji VII
Set
984,000
1,000,000.00
-
2.00
-
2
-
2
2
2,000,000
14
Glass Ionomer Cement ART / Fuji IX / Ketac Molar
Set
395,000
900,000.00
-
5.00
-
5
-
5
5
4,500,000
15
Kalsium Hidroksida pasta / Calcidor / Dycal
Set
242,000
242,000.00
-
-
-
16
Macro gold + propylen + EDTA
Set
360,000
300,000.00
-
1.00
-
17
Oil Spray
Botol
372,000
372,000.00
-
-
-
-
-
-
-
-
18
Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml + Adrenalin 12.5 mcg )
Ampul
3,350
3,950.00
-
-
-
-
-
-
-
-
19
Pulperyl
Botol
342,000
342,000.00
-
-
-
-
-
-
-
-
20
Spon Gelatin Cubicels / Spongostan/ Haemospon
Pcs
6,428
6,428.00
-
-
-
-
-
-
-
-
21
Temporary Stopping Fletcher (Fletcher) serbuk dan cairan
Set
22
Tetric N Ceram
23
Tetric N Ceram Refill (A2, A3, A3,5) - 3,5 gr
24
Tetric Bonding - 6 gr
25 26
1
-
1
1
-
300,000
33,990
33,990.00
-
-
-
-
-
-
-
-
Paket
1,968,000
1,968,000.00
-
-
-
-
-
-
-
-
Tube
392,000
392,000.00
-
-
-
-
-
-
-
-
Botol
576,000
576,000.00
-
-
-
-
-
-
-
-
Tetric Etch Refill - 2 gr
Tube
240,000
240,000.00
-
-
-
-
-
-
-
-
Trikresol Formalin (TKF)
Botol
72,000
72,000.00
-
-
-
-
-
-
-
-
27
Xylestesin Adrenalin injeksi / Scandonest
Ampul
11,440
11,440.00
-
-
-
-
-
-
-
-
28
Xylestesin Non Adrenalin injeksi
Ampul
6,452
6,452.00
-
-
-
-
-
-
-
-
29
CHKM
Botol
54,900
54,900.00
-
-
-
-
-
-
-
-
30
Iodoform/Mumifying pasta
Botol
175,000.00
-
-
-
-
-
-
-
-
31
Semen zink phosphat (Powder 30 gram, Liquid 10 ml)
Botol
110,000.00
-
-
-
-
-
-
-
-
32
Tambalan Sinar (4 syringe, etching, bonding)
Paket
2,000,000.00
-
-
-
-
-
-
-
-
3,000.00
-
1,400.00
-
PERBEKALAN KESEHATAN 1
Alat Suntik sekali pakai 0,05 ml (ADS)
Pcs
2,695
1,400
-
1,400
1,400
4,200,000
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
2
Alat Suntik sekali pakai 0,5 ml (ADS)
Pcs
1,595
2,580.00
-
-
-
-
-
-
-
3
Alat Suntik sekali pakai 1 ml
Pcs
1,093
1,093.00
-
200.00
-
200
-
200
200
218,600
-
4
Alat Suntik sekali pakai 3 ml
Pcs
1,340
650.00
-
700.00
-
700
-
700
700
455,000
5
Alat Suntik sekali pakai 5 ml
Pcs
770
750.00
-
700.00
-
700
-
700
700
525,000
6
Blood set
Set
30,000
30,000.00
-
-
-
-
-
-
-
-
7
Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah
Sach
1,519
5,582.00
-
-
-
-
-
-
-
-
8
Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah
Sach
1,519
1,519.00
-
-
-
-
-
-
-
-
9
Benang Bedah Catgut Chromic 2/0 -100 m
Cassete
1,027,331
1,250,000.00
-
-
-
-
-
-
-
-
10
Benang Bedah Catgut Plain 3/0 -100 m
Cassete
998,407
998,407.00
-
-
-
-
-
-
-
-
Cassete
435,999
435,999.00
-
-
-
-
-
-
-
-
Pcs
34,991
34,991.00
-
-
-
-
-
-
-
11
Benang Bedah Silk Black 3/0 -100 m
12
Dental Film Hanshin
13
Etanol 70 % - 1 L
Botol
48,000
48,000.00
-
2.00
-
14
Gel USG / EKG
Botol
27,000
15,000.00
-
-
-
-
-
-
-
-
15
Infusion Set Anak
Pcs
4,000
3,500.00
-
-
-
-
-
-
-
-
16
Infusion Set Dewasa
Pcs
3,500
3,465.00
-
1.00
-
17
IV. Catheter No.18 G
Set
12,000
12,000.00
-
-
-
-
-
-
-
-
18
IV. Catheter No.20 G
Set
7,780
7,780.00
-
-
-
-
-
-
-
-
19
IV. Catheter No.22 G
Set
7,788
3,800.00
-
9.00
-
20
IV. Catheter No.24 G
Kotak
3,800.00
-
-
-
21
Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT
Sach
29,900
15,000.00
-
2.00
-
22
Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR
Sach
29,900
29,900.00
-
-
-
-
-
-
-
-
23
Kapas Pembalut / absorben 250 gram
Bungkus
7,500
12,500.00
-
-
-
-
-
-
-
-
24
Kassa Hidrofil Steril uk. 16 x 16
Kotak
8,500
8,000.00
-
-
-
-
-
-
-
-
25
Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm
Roll
55,000
140,000.00
-
-
-
-
-
-
-
-
26
Kassa pembalut hidrofil 4m x 10 cm
Roll
607
27
Kasa Hidrofil ukuran 40 yard x 40 cm
Roll
28
Kertas EKG
Roll
29
Kertas USG Sony 110 HG
Roll
30
Larutan Clorin 5,25% - 1 L (Desinfektan Alat)
Botol
31
Larutan desinfectan ruangan mengandung : pine oil 7% dan Benzyl Chlorophenol 0,6%
Botol
2
-
1
-
9
-
-
-
2
-
5
-
2
1
9 2
5
2
1
9 2
5
96,000
3,465
34,200 30,000
1,500.00
-
5.00
-
140,000.00
-
-
-
-
-
-
-
7,500 -
2,150
2,150.00
-
-
-
-
-
-
-
-
300,000
300,000.00
-
-
-
-
-
-
-
-
9,300
14,410.00
-
5.00
1.00
1
5
1.00
1.00
-
4
4
57,640
14,520
16,000.00
-
5.00
1.00
1
5
1.00
1.00
-
4
4
64,000
NAMA OBAT
SATUAN KEMASAN
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
1
2
3
32
Larutan antiseptik/ desinfektan handrub mengandung zat aktif dengan kadar minimal Chlorhexidine Gluconate 0,5% ( Aseptan 500 cc + Dispenser)
Botol
30,000.00
-
-
-
-
-
-
-
-
33
Larutan konsentrat untuk Antiseptik dan desinfektan Instrumen/ peralatan kedokteran aldehyd free (mengandung zat aktif: Cocospropilenediaminguanidine di acetat, surfaktan, parfumes, coloring dsb).
Botol 1 ltr
700,000.00
-
-
-
-
-
-
-
-
34
Kassa steril mengandung obat (Framycetin) / Lomatulle
Lembar
13,200
13,200.00
-
-
-
-
-
-
-
-
35
Masker
Kotak
27,500
16,500.00
-
3.00
36
Masker O2
Pcs
31,244
37
Masker 95
Pcs
38
Masker nebulizer set dewasa
Pcs
39
Masker nebulizer set anak
40
Plester 5 yard X 2 inch
41
Plester non alergi 0,5 inch / Micropore
42
Pot Urin
43
Sarung Tangan
44 45
1.00
1
3
1.00
1.00
-
15=(11-13)
2
16=(14+15)
2
33,000
31,244.00
-
-
-
-
-
-
-
-
125,000.00
-
-
-
-
-
-
-
-
35,000
35,000.00
-
-
-
-
-
-
-
-
Pcs
35,000
35,000.00
-
-
-
-
-
-
-
-
Roll
23,100
15,000.00
-
-
-
-
-
-
-
-
Roll
11,875
11,875.00
-
4.00
-
4
-
4
4
47,500
Pcs
700
748.00
-
400.00
-
400
-
400
400
299,200
Kotak
44,000
32,000.00
-
2.00
-
-
-
-
Safety Box
Pcs
1,400
25,000.00
-
-
-
-
-
-
-
-
Surgical blade no.11 (Pisau Bedah)
Pcs
803
803.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
2.00
2
2
2.00
2.00
PEMERIKSAAN TB PARU 1
Emersi
Botol 100 ml 440,600
440,600.00
-
-
2
Eter Alkohol
Botol 100 ml 125,400
3
Kaca Slide / Object Glass
4
Pot dahak
5
Reagen Zielnelsen
6
Spiritus Bakar
7
Tissu Lensa
8
Tissue lensa
9
Wadah Kaca Slide / Box Slide
10
Xylol/ Xylene
Botol 100 ml
11
Xylol/ Xylene
Botol 500 ml
EMBALAGE
125,400.00
-
4.00
2.00
Kotak
16,800
21,087.00
-
-
5.00
Pcs
1,800
1,859.00
-
200.00
-
Set
195,000
218,350.00
-
7.00
-
Botol
50,000
50,000.00
-
-
-
-
-
-
-
-
Kotak
50,160
72,061.00
-
-
-
-
-
-
-
-
Buku
23,500
23,500.00
-
-
-
-
-
-
-
-
Pcs
135,400
218,350.00
-
-
-
-
-
-
88,300
88,300.00
-
-
-
-
-
-
-
-
541,000
455,884.00
-
-
-
-
-
-
-
-
5.00
5.00
5.00
2
4
2.00
2.00
-
5
5
5.00
5.00
-
-
-
200
-
200
200
371,800
7
-
7
1,528,450
5
5
5.00
5.00
2
7
2
250,800 -
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
1
Kantong Kresek obat + cetakan, ukuran 15 x 30
Lembar
276
276.00
1,000.00
8,500.00
3,500.00
4,500
8,500
2
Plastik Obat dg klip + cetakan, ukuran 7 x 10 cm
Pak / 100lbr
7,700
6,500.00
20.00
130.00
50.00
70
130
3
Plastik Obat dg klip + cetakan, ukuran 10 x 15 cm
16,500
16,500.00
10.00
80.00
80.00
90
80
4
Kertas Perkamen ( ukuran 8 x 11 )
Pak / 100lbr Pak / 1000lbr
9,000
9,000.00
6.00
15.00
6
15
5
Sendok obat
275
275.00
171.00
-
171
-
Pcs
200.00
3.00
24.00
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
3,500.00
4,300
5,000
9,300
2,566,800
50.00
70
80
150
975,000
80.00
87
-
87
1,435,500
6
15
21
189,000
147
-
147
40,425
AKUPUNTUR 1
Jarum Akupuntur 13 mm
Kotak
26,400
30,000.00
-
-
-
-
-
-
-
-
2
Jarum Akupuntur 25 mm
Kotak
26,400
30,000.00
-
-
-
-
-
-
-
-
3
Jarum Akupuntur 40 mm
Kotak
26,400
30,000.00
-
-
-
-
-
-
-
-
4
Jarum telinga (press needle)
Kotak
30,376
30,376.00
-
-
-
-
-
-
-
-
5
Moxa Roll
Kotak
24,000
24,000.00
-
-
-
-
-
-
-
-
OBAT PONED 1
Apron plastik
Pcs
39,000
20,000.00
-
-
-
-
-
-
-
-
2
Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik
Ampul
11,550
11,550.00
-
-
-
-
-
-
-
-
3
Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal
Ampul
12,600
12,000.00
-
-
-
-
-
-
-
-
4
Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml
Ampul
968
968.00
-
-
-
-
-
-
-
-
5
Ikat Tali Pusat ( Umbilical Cord klem )
Pcs
5,400
5,400.00
-
-
-
-
-
-
-
-
6
Metilergometrin maleat injeksi 0,200 mg - 1 ml
Ampul
1,333
2,000.00
-
-
-
-
-
-
-
-
7
MgSO4 40% injeksi
Vial
1,357
7,000.00
-
-
-
-
-
-
-
-
8
Misoprostol tablet 0,2 mg / Noprostol
Tablet
9,000
9,000.00
-
-
-
-
-
-
-
-
9
Natrium Bicarbonat injeksi
Ampul
26,781
26,781.00
-
-
-
-
-
-
-
-
10
Nasal dewasa / Maxyflow
Pcs
13,000
13,000.00
-
-
-
-
-
-
-
-
11
Nasal infant/ Oxyflow
12
Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin
Pcs
13,200
5,000.00
-
-
-
-
-
-
-
-
Ampul
1,743
1,743.00
-
-
-
-
-
-
-
13
Penghisap Lendir Bayi Baru Lahir
-
Pcs
78,000
78,000.00
-
-
-
-
-
-
-
-
14 15
Sarung Tangan panjang obgyn No. 6,5
Pasang
15,000
15,000.00
-
-
-
-
-
-
-
-
Sarung Tangan panjang obgyn No. 7
Pasang
15,000
5,000.00
-
-
-
-
-
-
-
-
16
Sarung Tangan panjang obgyn No. 7,5
Pasang
25,800
25,800.00
-
-
-
-
-
-
-
-
17
Sarung tangan steril/Surgical gloves steril No. 6,5
Pasang
9,240
9,240.00
-
-
-
-
-
-
-
-
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
18
Sarung tangan steril/Surgical gloves steril No. 7
Pasang
9,240
5,000.00
-
-
-
-
-
-
-
-
19
Sarung tangan steril/Surgical gloves steril No.7,5
Pasang
9,240
9,240.00
-
-
-
-
-
-
-
-
20
Sungkup bayi
Set
264,000
264,000.00
-
-
-
-
-
-
-
-
21
Tanda Pengenal (ID Band) Bayi
Psc
2,000
900.00
-
-
-
-
-
-
-
-
22
Tanda Pengenal (ID Band) Ibu
Psc
2,000
900.00
-
-
-
-
-
-
-
-
23
Under Pad 60 x 90 cm
Psc
5,000
4,000.00
-
-
-
-
-
-
-
-
24
Valethamate Br 8 mg /ml injeksi / Epidosin
Ampul
21,780
21,780.00
-
-
-
-
-
-
-
-
TAMBAHAN 1
Ambroksol tablet 30mg
Tablet
112
120.00
-
-
-
-
-
-
-
-
2
Asam Mefenamat Sirup - 60 ml / Pondex
Botol
11,333
11,333.00
-
-
-
-
-
-
-
-
3
Asering infus/ Larutan mengandung elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
Botol
10,712
9,000.00
-
-
-
-
-
-
-
-
4
Asiklovir tablet 200 mg
Tablet
528
528.00
-
-
-
-
-
-
-
-
5
Bisacodyl 5 mg / Bicolax
Tablet
594
645.00
-
-
-
-
-
-
-
-
6
Biskodil sup 10 mg
Supp
-
6,045.00
-
-
-
-
-
-
-
-
7
Buskopan injeksi
Ampul
14,612
14,612.00
-
-
-
-
-
-
-
-
8
Bur Fissure standart
Pcs
29,459
29,459.00
-
-
-
-
-
-
-
-
9
Bur Fissure panjang
Pcs
38,500
38,500.00
-
-
-
-
-
-
-
-
10
Cetirizin HCl 10 mg
Tablet
-
181.00
-
-
-
-
-
-
-
-
11
Cetirizin syrup 100 mg / 5 ml
botol
-
1,000.00
-
-
-
-
-
-
-
-
12
Cefixim / sefiksim 100 mg caplet
kaplet
-
1,000.00
-
-
-
-
-
-
-
-
13
Etanol 96 % - 1 L
Botol
19,800
19,800.00
-
1.00
-
14
Gentian Violet larutan 1 %
Botol
446
446.00
-
-
-
-
-
-
-
-
15
Glucose Larutan Infus 10% Steril
Botol
3,894
3,894.00
-
-
-
-
-
-
-
-
16
Jarum Suntik No. 27 G
Pcs
1,071
1,071.00
-
-
-
-
-
-
-
-
17
Ketokonazole Krim 2%
Tube
-
4,700.00
-
-
-
-
-
-
-
-
18
Klindamisin kapsul 150 mg
Kapsul
509
509.00
-
-
-
-
-
-
-
-
19
Klindamisin 300 MG
Kapsul
-
553.00
-
-
-
-
-
-
-
-
20
Kasa Pembalut Hidrofil 4 m x 6 cm
Roll
747
747.00
-
-
-
-
-
-
-
-
21
Kasa 2x80
Roll
8,711
8,711.00
-
-
-
-
-
-
-
-
22
Kapas 500 gram
17,250
17,250.00
-
-
-
-
-
-
-
-
Bungkus
1
-
1
1
19,800
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT
TOTAL
15=(11-13)
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
23
Larutan H2O2
Botol
3,960
3,960.00
-
-
-
-
-
-
-
-
24
Methilprednisolon 4 mg
tablet
-
205.00
-
-
-
-
-
-
-
-
25
Metoklopramid injeksi / Primperan
7,321
7,321.00
-
-
-
-
-
-
-
-
26
Metoklopramid tablet 10 mg / Metolon
Tablet
76
76.00
-
-
-
-
-
-
-
-
27
Metronidazol tablet 250 mg
Tablet
82
110.00
-
-
-
-
-
-
-
-
28
Meylon injeksi
Botol
19,639
19,639.00
-
-
-
-
-
-
-
-
29
Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral
Tablet
269
269.00
-
-
-
-
-
-
-
-
30
Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob
Tube
47,500
47,500.00
-
-
-
-
-
-
-
-
31
Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1 mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf
Botol
23,650
23,650.00
-
-
-
-
-
-
-
-
32
Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi
Vial
1,928
1,928.00
-
-
-
-
-
-
-
-
33
Polymigel tablet 400 mg/Strocain P
Tablet
1,404
1,404.00
-
-
-
-
-
-
-
-
34
Propanolol tablet 40 mg (HCl)
Tablet
82
106.00
-
-
-
-
-
-
-
-
35
Ranitidin injeksi 25 mg/ml
Ampul
11,471
1,140.00
-
-
-
-
-
-
-
-
36
Saccaharine tablet
Tablet
8
8.00
-
-
-
-
-
-
-
-
37
Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole
Tube
2,839
2,839.00
-
-
-
-
-
-
-
-
38
Sefadroxil syrup 125 mg
botol
-
4,746.00
-
-
-
-
-
-
-
-
39
Sianokobalamin (Vit B12) Inj Dewasa
Ampul
-
15,203.00
-
-
-
-
-
-
-
-
40
Teofilin tablet / Bronsolvan
Tablet
85
85.00
-
-
-
-
-
-
-
-
41
Terbutalin tablet 2,5 mg / Astherin
Tablet
275
-
-
-
-
42
Bur Low Speed
Kotak
Vial
275.00
-
-
-
186,613.00
-
3.00
-
3
-
3
3
559,839
OBAT KESDA 1
Kalium Diklofenak tablet 50 mg
tablet
489
540.00
-
-
-
-
-
-
-
-
2
Obat Tetes mata kombinasi antiseptik & kortikosteroid (Dexamethason Sod.Phosfate 1,0 mg, Neomycin Sulphate setara Neomycin base 3,5 mg, Polymixin B Sulfat 6000 IU) - 5 ml
tube
10,716
27,000.00
-
-
-
-
-
-
-
-
NAMA OBAT
1
2
SATUAN KEMASAN
3
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
STOK AKHIR GUD. OBAT 15=(11-13)
TOTAL
16=(14+15)
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
3
Obat Analgetik - antipiretik - batuk kaplet (Paracetamol 500 mg, Dextromethorphan HBr 15 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 2 mg, ) / Alpara
kaplet
504
480.00
-
-
-
-
-
-
-
-
4
Obat Analgetik kombinasi dengan Psikotropik kaplet (Metampiron 500 mg, Diazepam 2 mg) / Metaneuron
kaplet
1,133
1,133.00
-
-
-
-
-
-
-
-
5
Obat Analgetik - vitamin B kompleks kaplet (Parasetamol 500 mg, Vitamin B6 100 mg, Vitamin B1 50 mg, Vitamin B12 100 mcg) / Erlagin
kaplet
360
360.00
-
-
-
-
-
-
-
-
6
Obat Antiinfluenza syrup ( Parasetamol 125 mg, Phenylprophanolamine HCl 3.125 mg, Chlorpheniramine Maleate 0.5 mg ) - 60 ml / Molexflu sirup
botol
5,280
6,500.00
-
-
-
-
-
-
-
-
7
Obat Antiinfluenza kaplet ( Paracetamol 500 mg. Phenylpropanolamin HCl 12,5 mg+ Chlorpheniramin Maleat 2 mg ) / Molexflu kaplet
kaplet
316
300.00
-
-
-
-
-
-
-
-
8
Obat Antitusif - ekspektorant sirup ( Diphenhydramin HCl 12,5 mg+ Ammonium Chlorida 125 mg+ Sodium Citrat 50 mg+ Menthol 1 mg ) - 60 ml / Molexdryl sirup
botol
4,800
5,000.00
-
-
-
-
-
-
-
-
9
Obat dekongestan, antiinfluenza tablet (tripolidin HCl 2,5 mg, Pseudoefedrin HCl 30mg)/Flutrop
792
792.00
-
-
-
-
-
-
-
-
10
Obat Neuramialgikum tablet (Vit.B1 100 mg, Vit.B6 200 mg, Vit.B12 250 mcg )
tablet
474
150.00
-
-
-
-
-
-
-
-
11
Obat spasmodikum tablet (Metampiron 500 mg, Ekstrak Belladona 10 mg, Papaverin HCl 25 mg) / Spasminal
tablet
590
590.00
-
-
-
-
-
-
-
-
12
Obat Vasokonstriktor dan antihistamin tablet ( Phenylpropanolamin HCl 15 mg+ Chlorpheniramin Maleat 2 mg ) / Nalgestan
tablet
826
826.00
-
-
-
-
-
-
-
-
13
Salep kulit analgetika (Metil salilsilat 11%, Mentol 6%, Eugenol 1,5%) - 30 gr / Painkilla
tube
12,960
12,960.00
-
-
-
-
-
-
-
-
14
Salep kulit kombinasi antiinfeksi dgn kortikosteroid (Betamethasone 1 mg, Neomycin sulfat 5 mg) - 5 gr / Bevalex
tube
8,400
8,400.00
-
-
-
-
-
-
-
-
NAMA OBAT
1
15
2 Vitamin B Komplek dengan Vit. C dosis tinggi Kaplet (Vit. B1 15 mg, Vit. B2 10 mg, Vit. B6 5 mg, Vit. B12 100 mcg, Vit. C 500 mg, Vit. E 30 mg, Ca. Pantothenate 20 mg, Nikotinamide 50 mg) / Becefort
SATUAN KEMASAN
3
kaplet
HARGA
HARGA SATUAN 2014
OBAT (Rp)
(Rp)
APOTIK
GUD. OBAT
APOTIK
GUD. OBAT
KAMAR OBAT
GUD. OBAT
APOTIK
GUD. OBAT
APOTIK
4
4
5
6
8
9
10=(5+8)
11=(6+9)
12
13
14=(10-12)
1,609
STOK AWAL
1,450.00
-
PENERIMAAN
PERSEDIAAN
-
-
PEMAKAIAN
-
JUMLAH (Rp.)
STOK AKHIR GUD. OBAT 15=(11-13)
-
-
Rp
TOTAL
16=(14+15)
-
TOTAL HARGA STOK AKHIR
KET
17=(4*16)
18
-
56,449,525
CATATAN : 1.
Agar dibuat 2 (dua ) rangkap.
2.
Agar melampirkan 3 (tiga) laporan obat Puskesmas bulan Desember 2014 terdiri dari : LPLPO Puskesmas, Laporan kamar obat, Laporan Pustu/rumah bersalin yang ditandatangani oleh Petugas yang bersangkutan dan Kepala Puskesmas
3.
Apabila ada tambahan jenis obat, agar berkoordinasi terlebih dahulu dengan Seksi Perbekalan Kesehatan untuk sinkronisasi harga, dll.
Mengetahui/Menyetujui :
Tangerang, 31 Desember 2014
Kepala UPTD. Puskesmas Batuceper
Pengurus Barang
Penanggung Jawab Obat
drg. Hj. R.R. Sri Wahyu H
Ani Adirahmini, SKM
Iin Choerun Nisa, A.Md.Far
NIP. 19620120 199203 2 003
NIP. 19811001 200604 2 015
NIP. 19831003 201001 2 005
Lampiran I/15 - 28 LAPORAN STOK AKHIR / STOK OPNAME OBAT DAN PERBEKALAN KESEHATAN TANGGAL 31 DESEMBER 2015 NAMA PUSKESMAS : BATUCEPER ALAMAT TELEPON
: JL. DAAN MOGOT KM 21 : 021-5584508 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
1
2
SATUAN
3
HARGA SATUAN
4
APOTIK
GUDANG OBAT
TOTAL
5
6
7=(5+6)
Hasil Penelusuran
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016 8
9
10
11
12
13
Jml Vol Hasil Penelusuran Apotik
Jml Vol Hasil Penelusuran Gudang Obat
Total
14 =9+(10-8)
15 =13+(11-9)
16=14+15
Nilai Hasil Penelusuran per 12 Jan 2016
OBAT 1
Alopurinol tablet 100 mg
-
-
10
280
300.00
290.00
300.00
590.00
-
2
Amlodipin tablet 5 mg
-
-
70
260
570.00
330.00
570.00
900.00
-
3
Aminofillin tablet 200 mg
-
-
25
377
402.00
-
4
Amoksilin kaplet 500 mg
-
-
835
3,390
10,500.00
4,225.00
10,500.00
14,725.00
-
5
Amoksilin sirup kering 125 mg/ 5 ml - 60 ml
-
-
5
89 2,376 57
300.00 2,800.00
94.00 2,696.00
300.00 2,800.00
394.00 5,496.00
-
57.00
-
111.00
-
6 7
Tablet Botol
-
-
320 -
8
Tube
-
-
-
-
-
9
Tube
-
-
-
-
10
Tablet
-
-
62
657
11 12 13
Botol Supp Kapsul
-
-
8 -
58 30 60
14 15
Tube Tablet
-
-
1 -
20 60
16 17
Vial Tablet
-
-
10
60
18 19
Tablet Kaplet
-
-
1,693 880
3,183 2,090
20 21
Tube Tablet
-
-
4 40
29 70
22 23 24
Tablet Tablet Tube
-
-
1.00
200 70 53
25 26
Botol Tablet
-
-
6.00 10.00
30 175
27 28
Tablet Tablet
-
-
821 20
1,645 95
29 30
Tablet Ampul
8,100.00
-
4.00
4.00
32,400.00
-
167 -
31 32 33
Kapsul Botol Botol
930.00 2,250.00 1,008.00
65.00 26.00 23.00
100.00 48.00
165.00 26.00 71.00
153,450.00 58,500.00 71,568.00
35 1 1
30 25 22
34 35
Tablet Tablet
634.00 75.00
84.00 90.00
400.00 -
484.00 90.00
306,856.00 6,750.00
5 -
79 90
1.00
60.00
57.00
-
-
36 75.00
60
402.00
60
36.00
1.00
1.00
-
1,500.00 60.00 40.00
719.00 58.00 38.00
1,500.00 60.00 40.00
2,219.00 118.00 78.00
-
36.00
21.00
36.00
57.00
-
100.00 3.00
60.00 -
100.00 3.00
160.00 3.00
-
7,200.00
70.00 4,876.00
7,200.00
70.00 12,076.00
-
8,000.00 75.00 400.00
2,970.00 33.00 110.00
8,000.00 75.00 400.00
10,970.00 108.00 510.00
-
50.00
200.00 70.00
50.00
200.00 120.00
-
48.00 72.00
54.00 36.00
48.00 72.00
102.00 108.00
-
700.00 5,600.00
185.00 2,466.00
700.00 5,600.00
885.00 8,066.00
-
100.00 -
115.00 167.00
100.00 -
215.00 167.00
-
4.00 100.00 -
65.00 26.00
4.00 100.00 -
4.00 165.00 26.00
32,400.00 153,450.00 58,500.00
48.00 400.00
23.00 84.00
48.00 400.00
71.00 484.00
71,568.00 306,856.00
90.00
6,750.00
-
-
75.00
90.00
-
Lampiran I/16 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN APOTIK
1 36
2
3 Sach
4
GUDANG OBAT
TOTAL
Hasil Penelusuran
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
288.00
5 184.00
6 500.00
7=(5+6) 684.00
196,992.00
8
9
10 36
11
12 148
Kapsul Tube Tablet
289.00 1,700.00 56.00
180.00 15.00 465.00
840.00 100.00 1,700.00
1,020.00 115.00 2,165.00
294,780.00 195,500.00 121,240.00
100
180 15 365
40 41
Tablet Tablet
25.00 37.00
4,946.00 1,093.00
12,000.00 -
16,946.00 1,093.00
423,650.00 40,441.00
396 -
4,550 1,093
42 43
Tube Tablet
3,000.00 300.00
63.00 10.00
72.00 -
135.00 10.00
405,000.00 3,000.00
8 -
55 10
44 45
Tablet Pot
149.00 4,000.00
110.00 16.00
72.00
110.00 88.00
16,390.00 352,000.00
10 -
100 16
46 47 48
Tablet Tablet Tablet
88.00 35.00 84.00
90.00 1,069.00 1,035.00
4,100.00
90.00 1,069.00 5,135.00
7,920.00 37,415.00 431,340.00
639 130
90 2,430 905
49 50
Tablet Kapsul
300.00 227.00
90.00 100.00
250.00 100.00
340.00 200.00
102,000.00 45,400.00
51 52
Botol Botol
6,000.00 1,600.00
26.00
-
26.00
41,600.00
53 54
Tablet Tablet
73.00 138.00
5,675.00 660.00
17,300.00 600.00
22,975.00 1,260.00
1,677,175.00 173,880.00
55 56
Levertraan salep - 15 gr
Botol Pot
2,145.00 2,837.00
29.00 17.00
100.00 24.00
129.00 41.00
276,705.00 116,317.00
-
57 58 59
Loperamid tablet 2 mg Loratadin tablet 10 mg Metampiron (Antalgin) tablet 500 mg
Tablet Tablet Tablet
89.00 154.00 158.00
110.00 160.00 2,655.00
100.00 200.00 700.00
210.00 360.00 3,355.00
18,690.00 55,440.00 530,090.00
10 10 340
100 150 2,315
60 61
Metformin HCl tablet 500 mg Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg
Tablet Tablet
112.50 154.00
140.00 90.00
-
140.00 90.00
15,750.00 13,860.00
30 -
110 90
62 63
Metronidazol tablet 500 mg Mikonazol krim/ salep 2 % (Nitrat) - 10 gr
Tablet Tube
160.00 3,000.00
175.00 36.00
72.00
175.00 108.00
28,000.00 324,000.00
35 4
140 32
64 65
Multivit Sirup - 60 ml Multivit Tablet
Botol Tablet
19,800.00 700.00
81.00 190.00
72.00 300.00
153.00 490.00
3,029,400.00 343,000.00
1 130
80 60
66 67 68
Natrium Diklofenak tablet 50 mg Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g
Tablet Tablet Tablet
176.00 110.00 640.00
130.00 79.00 174.00
500.00 200.00
630.00 79.00 374.00
110,880.00 8,690.00 239,360.00
30 14
100 79 160
69 70
Nistatin vaginal tablet 100.000 IU/g Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol
Tablet Botol
370.00 4,500.00
109.00 200.00
300.00 720.00
409.00 920.00
151,330.00 4,140,000.00
3 80
106 120
71
Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg) / Librozym
Tablet
500.00
50.00
200.00
250.00
125,000.00
20
30
72 73
Oksitetrasiklin HCl salep kulit 3 % - 5 gr Oksitetrasiklin HCl salep mata 1 % - 5 gr
Tube Tube
1,700.00 1,920.00
58.00 43.00
25.00 -
83.00 43.00
141,100.00 82,560.00
5 4
53 39
74 75
Omeprazol kapsul 20 mg Parasetamol drops
Kapsul botol
211.00 5,200.00
80.00 79.00
30.00 -
110.00 79.00
23,210.00 410,800.00
45
80 34
76 77 78
Parasetamol sirup 120 mg / 5ml - 60 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg
Botol Tablet Tablet
1,438.00 32.00 79.00
98.00 2,750.00
252.00 12,000.00
350.00 14,750.00
503,300.00 1,165,250.00
28 885
70 1,865
79 80
Piridoksin (Vitamin B6) tablet 10 mg (HCl) Piroksikam tablet 10 mg
Tablet Tablet
175.00 125.00
5,214.00 140.00
7,000.00 200.00
12,214.00 340.00
2,137,450.00 42,500.00
174 90
5,040 50
81
Polikresulen (kondensasi) - 10 ml
Botol
17,393.00
1.00
1.00
2.00
34,786.00
1
2,000.00
2,000
25
25.00
1 1,247 60
90 100 25
Jml Vol Hasil Penelusuran Gudang Obat
Total
500.00 840.00 100.00
14 =9+(10-8) 184.00 180.00 15.00
15 =13+(11-9) 500.00 840.00 100.00
16=14+15 684.00 1,020.00 115.00
196,992.00 294,780.00 195,500.00
1,700.00 12,000.00
465.00 4,946.00
1,700.00 12,000.00
2,165.00 16,946.00
121,240.00 423,650.00
72.00
1,093.00 63.00
72.00
1,093.00 135.00
40,441.00 405,000.00
10.00 110.00
3,000.00 16,390.00
13
37 38 39
2,000
Jml Vol Hasil Penelusuran Apotik
25 25 4,428 600 29 17
-
-
10.00 110.00
-
Nilai Hasil Penelusuran per 12 Jan 2016
72.00 -
16.00 90.00 1,069.00
72.00 -
88.00 90.00 1,069.00
352,000.00 7,920.00 37,415.00
4,100.00 250.00
1,035.00 90.00
4,100.00 250.00
5,135.00 340.00
431,340.00 102,000.00
100.00 -
100.00 -
100.00 -
200.00 -
45,400.00 -
17,300.00
26.00 5,675.00
17,300.00
26.00 22,975.00
41,600.00 1,677,175.00
600.00 100.00
660.00 29.00
600.00 100.00
1,260.00 129.00
173,880.00 276,705.00
24.00 100.00 200.00
17.00 110.00 160.00
24.00 100.00 200.00
41.00 210.00 360.00
116,317.00 18,690.00 55,440.00
700.00 -
2,655.00 140.00
700.00 -
3,355.00 140.00
530,090.00 15,750.00
90.00 175.00
13,860.00 28,000.00
-
90.00 175.00
-
72.00 72.00
36.00 81.00
72.00 72.00
108.00 153.00
324,000.00 3,029,400.00
300.00 500.00 -
190.00 130.00 79.00
300.00 500.00 -
490.00 630.00 79.00
343,000.00 110,880.00 8,690.00
200.00 300.00
174.00 109.00
200.00 300.00
374.00 409.00
239,360.00 151,330.00
720.00
200.00
720.00
920.00
4,140,000.00
200.00 25.00
50.00 58.00
200.00 25.00
250.00 83.00
125,000.00 141,100.00
30.00
43.00 80.00
30.00
43.00 110.00
82,560.00 23,210.00
252.00 -
79.00 98.00 -
252.00 -
79.00 350.00 -
410,800.00 503,300.00 -
12,000.00 7,000.00
2,750.00 5,214.00
12,000.00 7,000.00
14,750.00 12,214.00
1,165,250.00 2,137,450.00
200.00 1.00
140.00 1.00
200.00 1.00
340.00 2.00
42,500.00 34,786.00
Lampiran I/17 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN
GUDANG OBAT
APOTIK
1 82
Ranitidin tablet 150 mg
2
3 Tablet
83 84
Ringer Laktat larutan infus - 500 ml Salbutamol tablet 2 mg (sebagai sulfat)
85
Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr
86
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
TOTAL
120.00
5 225.00
6 800.00
7=(5+6) 1,025.00
123,000.00
65
160
Botol Tablet
5,200.00 89.00
190.00
1.00 700.00
1.00 890.00
5,200.00 79,210.00
70
120
Pot
2,000.00
-
-
-
-
Salisil Bedak 2 % - 50 gr
Kotak
1,250.00
68.00
100.00
168.00
210,000.00
87 88
Sefadroksil Kapsul 500 mg Sianokobalamin (vitamin B12) tablet 50 mcg
Kapsul Tablet
509.00 150.00
50.00 -
300.00 -
350.00 -
178,150.00 -
89 90
Simvastatin tablet 10 mg Siprofloksasin tablet 500 mg (sebagai HCl)
Tablet Tablet
169.00 255.00
298.00 180.00
400.00 -
698.00 180.00
117,962.00 45,900.00
40 20
258 160
91 92 93
Thiamfenikol kapsul 500 mg Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Vitamin B Kompleks tablet
Kapsul Tablet Tablet
1,650.00 35.00 107.00
55.00 3,430.00 3,975.00
9,000.00 7,000.00
55.00 12,430.00 10,975.00
90,750.00 435,050.00 1,174,325.00
600 291
55 2,830 3,684
94
Zinc tablet 20 mg OBAT PROGRAM TB PARU
Tablet
474.00
270.00
600.00
870.00 -
412,380.00 -
65
205
1 2
Obat FDC Kategori 1 Obat FDC Anak
Paket Paket
359,990.00 214,990.00
-
7.00 1.00
7.00 1.00
2,519,930.00 214,990.00
1
OBAT PROGRAM IMS Kanamisin injeksi 1 gr
4.00
18,800.00
Vial
4
Hasil Penelusuran
8
9
24
10
24.00
11
-
12
24
10 1,000
3.00
1,000.00
10 -
3.00
13
24 58
1,000
3.00
40 1,000
Total
14 =9+(10-8) 225.00 190.00
15 =13+(11-9) 800.00 1.00 700.00
16=14+15 1,025.00 1.00 890.00
-
-
Nilai Hasil Penelusuran per 12 Jan 2016
-
123,000.00 5,200.00 79,210.00 -
100.00 300.00
68.00 50.00
100.00 300.00
168.00 350.00
210,000.00 178,150.00
400.00
298.00
400.00
698.00
117,962.00
9,000.00
180.00 55.00 3,430.00
9,000.00
180.00 55.00 12,430.00
45,900.00 90,750.00 435,050.00
7,000.00 600.00
3,975.00 270.00
7,000.00 600.00
10,975.00 870.00
1,174,325.00 412,380.00
-
7.00
7.00
2,519,930.00
-
1.00 -
1.00 -
214,990.00 -
4.00
-
4.00 50.00
24.00
4.00 50.00
4.00 74.00
18,800.00 63,566.00
400.00
90.00 51.00
400.00
90.00 451.00
10,080.00 12,177.00
1.00 -
19.00
1.00 -
1.00 19.00
11,525.00 7,961.00
-
215.00 -
-
215.00 -
107,500.00 -
4,700.00
-
4.00
Sefiksim kapsul 100 mg OBAT KEJIWAAN
Kapsul
859.00
24.00
50.00
74.00 -
63,566.00 -
1 2 3
Amitriptilin tablet salut 25 mg (HCl) Diazepam tablet 2 mg Diazepam tube Rectal 5 mg/2.5 ml
Tablet Tablet Tube
112.00 27.00 11,525.00
90.00 51.00 -
400.00 1.00
90.00 451.00 1.00
10,080.00 12,177.00 11,525.00
90 51 -
4 5
Fluoxetin tablet 10 mg / Antiprestin Kodein tablet 10 mg
Tablet Tablet
419.00 500.00
19.00 215.00
-
19.00 215.00
7,961.00 107,500.00
19 215
1
OBAT GIGI Cavit / Dentorit (Tambalan Sementara)
720,000.00
-
2 3
Etil Chlorida spray - 100 ml Eugenol cairan
4 5 6
Glass Ionomer Radiopak / Fuji VII Glass Ionomer Cement ART / Fuji IX / Ketac Molar Macro gold + propylen + EDTA
1
PERBEKALAN KESEHATAN Alat Suntik sekali pakai 0,05 ml (ADS)
Pcs
3,000.00
2 3
Alat Suntik sekali pakai 1 ml Alat Suntik sekali pakai 3 ml
Pcs Pcs
1,093.00 650.00
4 5
Alat Suntik sekali pakai 5 ml Etanol 70 % - 1 L
Pcs Botol
6 7
Gel USG / EKG Infusion Set Anak
8 9 10
14
Pot
120,000.00
-
6.00
6.00
Botol Botol
110,000.00 16,667.00
-
8.00 1.00
8.00 1.00
880,000.00 16,667.00
-
1,000,000.00 900,000.00 300,000.00
-
2.00 5.00 1.00
2.00 5.00 1.00
2,000,000.00 4,500,000.00 300,000.00
-
-
1,400.00
1,400.00
4,200,000.00
-
-
200.00 700.00
200.00 700.00
218,600.00 455,000.00
-
750.00 48,000.00
-
700.00 2.00
700.00 2.00
525,000.00 96,000.00
-
Botol Pcs
15,000.00 3,500.00
-
-
-
-
-
Infusion Set Dewasa IV. Catheter No.18 G IV. Catheter No.20 G
Pcs Set Set
3,465.00 12,000.00 7,780.00
-
1.00 -
1.00 -
3,465.00 -
-
11 12
IV. Catheter No.22 G IV. Catheter No.24 G
Set Kotak
3,800.00 3,800.00
-
9.00 -
9.00 -
34,200.00 -
-
13
Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT
Sach
15,000.00
-
2.00
2.00
30,000.00
-
Set Set Set
-
Jml Vol Hasil Penelusuran Gudang Obat
-
2
10.00
800.00 1.00 700.00
Jml Vol Hasil Penelusuran Apotik
1.00
6.00 8.00
-
6.00 8.00
6.00 8.00
720,000.00 880,000.00
1.00 2.00 5.00
-
1.00 2.00 5.00
1.00 2.00 5.00
16,667.00 2,000,000.00 4,500,000.00
1.00
-
1.00 -
1.00 -
300,000.00 -
1,400.00 200.00
-
1,400.00 200.00
1,400.00 200.00
4,200,000.00 218,600.00
700.00 700.00
-
700.00 700.00
700.00 700.00
455,000.00 525,000.00
2.00 -
-
2.00 -
2.00 -
96,000.00 -
1.00 -
-
1.00 -
1.00 -
3,465.00 -
9.00
-
9.00
9.00
34,200.00
2.00
-
2.00
2.00
30,000.00
Lampiran I/18 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN
GUDANG OBAT
APOTIK
1 14
2 Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR
3 Sach
4 29,900.00
15 16 17
Kapas Pembalut / absorben 250 gram Kassa Hidrofil Steril uk. 16 x 16 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm
Bungkus Kotak Roll
18 19
Kassa pembalut hidrofil 4m x 10 cm Kasa Hidrofil ukuran 40 yard x 40 cm
20 21
Kertas EKG Kertas USG Sony 110 HG
22
5
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
TOTAL
6
Hasil Penelusuran
7=(5+6)
8
9
10
11
12
-
-
-
-
12,500.00 8,000.00 140,000.00
-
-
-
-
-
Roll Roll
1,500.00 140,000.00
-
5.00 -
5.00 -
7,500.00 -
-
Roll Roll
2,150.00 300,000.00
-
-
-
-
-
Larutan Clorin 5,25% - 1 L (Desinfektan Alat)
Botol
14,410.00
-
5.00
5.00
72,050.00
1.00
1.00
1.00
-
23
Larutan desinfectan ruangan mengandung : pine oil 7% dan Benzyl Chlorophenol 0,6%
Botol
16,000.00
-
5.00
5.00
80,000.00
1.00
1.00
1.00
-
24
Larutan antiseptik/ desinfektan handrub mengandung zat aktif dengan kadar minimal Chlorhexidine Gluconate 0,5% ( Aseptan 500 cc + Dispenser)
Botol
30,000.00
-
-
-
-
Larutan konsentrat untuk Antiseptik dan desinfektan Instrumen/ peralatan kedokteran aldehyd free (mengandung zat aktif: Cocospropilenediaminguanidine di acetat, surfaktan, parfumes, coloring dsb).
26
Kassa steril mengandung obat (Framycetin) / Lomatulle
27 28
Masker Masker O2
29 30 31 32 33 34 35
Total
14 =9+(10-8) -
15 =13+(11-9) -
16=14+15 -
5.00
-
5.00
5.00
-
-
-
-
4.00
-
5.00
5.00
72,050.00
4.00
-
5.00
5.00
80,000.00
-
-
-
-
-
-
-
-
-
-
2.00
-
3.00
3.00
-
-
-
-
-
-
-
-
-
-
-
Nilai Hasil Penelusuran per 12 Jan 2016
7,500.00 -
-
Botol 1 ltr
700,000.00
-
-
-
-
-
Lembar
13,200.00
-
-
-
-
-
Kotak Pcs
16,500.00 31,244.00
-
3.00 -
3.00 -
49,500.00 -
Masker 95 Masker nebulizer set dewasa
Pcs Pcs
125,000.00 35,000.00
-
-
-
-
-
Masker nebulizer set anak Plester 5 yard X 2 inch Plester non alergi 0,5 inch / Micropore
Pcs Roll
35,000.00 15,000.00
-
-
-
-
-
Roll Pcs Kotak
11,875.00 748.00 32,000.00
-
4.00 400.00 2.00
4.00 400.00 2.00
47,500.00 299,200.00 64,000.00
-
Pcs Pcs
25,000.00 803.00
-
-
-
-
Pot Urin Sarung Tangan
Jml Vol Hasil Penelusuran Gudang Obat
13
-
25
Jml Vol Hasil Penelusuran Apotik
1.00
1.00
2.00
2.00
1.00
2.00
-
36 37
Safety Box Surgical blade no.11 (Pisau Bedah)
-
1
PEMERIKSAAN TB PARU Emersi
Botol 100 ml
440,600.00
-
-
-
2 3
Eter Alkohol Kaca Slide / Object Glass
Botol 100 ml Kotak
125,400.00 21,087.00
-
4.00 -
4.00 -
501,600.00 -
4 5 6
Pot dahak Reagen Zielnelsen Spiritus Bakar
Pcs Set Botol
1,859.00 218,350.00 50,000.00
-
200.00 7.00 -
200.00 7.00 -
371,800.00 1,528,450.00 -
-
7 8
Tissu Lensa Tissue lensa
Kotak Buku
72,061.00 23,500.00
-
-
-
-
-
9 10
Wadah Kaca Slide / Box Slide Xylol/ Xylene
Pcs Botol 100 ml
218,350.00 88,300.00
-
-
-
-
11
Xylol/ Xylene EMBALAGE
Botol 500 ml
455,884.00
-
-
-
-
1 2
Kantong Kresek obat + cetakan, ukuran 15 x 30 Plastik Obat dg klip + cetakan, ukuran 7 x 10 cm
Lembar Pak /100lbr
276.00 6,500.00
1,000.00 20.00
8,500.00 130.00
9,500.00 150.00
2,622,000.00 975,000.00
3,500.00 50.00
200.00
3,500.00 50.00
4,300 70
3 4
Plastik Obat dg klip + cetakan, ukuran 10 x 15 cm Kertas Perkamen ( ukuran 8 x 11 )
Pak /100lbr Pak /1000lbr
16,500.00 9,000.00
10.00 6.00
80.00 15.00
90.00 21.00
1,485,000.00 189,000.00
80.00
3.00
80.00
87 6
2.00 5.00
5.00
5.00
5.00
2.00 5.00
5.00
2.00 5.00
5.00
-
-
4.00 400.00
49,500.00
-
4.00 400.00
4.00 400.00
47,500.00 299,200.00
-
-
2.00 -
2.00 -
64,000.00 -
-
-
-
-
2.00
-
4.00
4.00
501,600.00
200.00 7.00
-
200.00 7.00
200.00 7.00
371,800.00 1,528,450.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
5,000.00
1,000.00
8,500.00
9,500.00
2,622,000.00
80.00 15.00
20.00 10.00 6.00
130.00 80.00 15.00
150.00 90.00 21.00
975,000.00 1,485,000.00 189,000.00
Lampiran I/19 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN
GUDANG OBAT
APOTIK
1 5
Sendok obat
2
3 Pcs
4
1 2
AKUPUNTUR Jarum Akupuntur 13 mm Jarum Akupuntur 25 mm
Kotak Kotak
30,000.00 30,000.00
3 4
Jarum Akupuntur 40 mm Jarum telinga (press needle)
Kotak Kotak
5
Moxa Roll OBAT PONED
1 2
5 171.00
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
TOTAL
6
Hasil Penelusuran
-
7=(5+6) 171.00
47,025.00
8
-
-
-
30,000.00 30,376.00
-
-
Kotak
24,000.00
-
Apron plastik Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik
Pcs Ampul
20,000.00 11,550.00
3
Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal
Ampul
4
Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml
Ampul
5 6
Ikat Tali Pusat ( Umbilical Cord klem ) Metilergometrin maleat injeksi 0,200 mg - 1 ml
7 8
9
10 24.00
11
12
13 147
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
12,000.00
-
-
-
-
-
968.00
-
-
-
-
-
Pcs Ampul
5,400.00 2,000.00
-
-
-
-
-
MgSO4 40% injeksi Misoprostol tablet 0,2 mg / Noprostol
Vial Tablet
7,000.00 9,000.00
-
-
-
-
-
9 10
Natrium Bicarbonat injeksi Nasal dewasa / Maxyflow
Ampul Pcs
26,781.00 13,000.00
-
-
-
-
-
11 12
Nasal infant/ Oxyflow Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin
Pcs Ampul
5,000.00 1,743.00
-
-
-
-
-
13 14 15
Penghisap Lendir Bayi Baru Lahir Sarung Tangan panjang obgyn No. 6,5 Sarung Tangan panjang obgyn No. 7
Pcs Pasang Pasang
78,000.00 15,000.00 5,000.00
-
-
-
-
-
16 17
Sarung Tangan panjang obgyn No. 7,5 Sarung tangan steril/Surgical gloves steril No. 6,5
Pasang Pasang
25,800.00 9,240.00
-
-
-
-
-
18 19
Sarung tangan steril/Surgical gloves steril No. 7 Sarung tangan steril/Surgical gloves steril No.7,5
Pasang Pasang
5,000.00 9,240.00
-
-
-
-
-
20 21
Sungkup bayi Tanda Pengenal (ID Band) Bayi
Set Psc
264,000.00 900.00
-
-
-
-
-
22 23 24
Tanda Pengenal (ID Band) Ibu Under Pad 60 x 90 cm Valethamate Br 8 mg /ml injeksi / Epidosin
Psc Psc Ampul
900.00 4,000.00 21,780.00
-
-
-
-
-
1
TAMBAHAN Ambroksol tablet 30mg
Tablet
120.00
-
-
-
-
-
2
Asam Mefenamat Sirup - 60 ml / Pondex
Botol
11,333.00
-
-
-
-
-
3
Asering infus/ Larutan mengandung elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)
Botol
9,000.00
-
-
-
-
-
4
Asiklovir tablet 200 mg
Tablet
528.00
-
-
-
-
-
5 6
Bisacodyl 5 mg / Bicolax Biskodil sup 10 mg
Tablet Supp
645.00 6,045.00
-
-
-
-
-
7 8 9
Buskopan injeksi Bur Fissure standart Bur Fissure panjang
Ampul Pcs Pcs
14,612.00 29,459.00 38,500.00
-
-
-
-
-
10 11
Cetirizin HCl 10 mg Cetirizin syrup 100 mg / 5 ml
Tablet botol
181.00 1,000.00
-
-
-
-
-
12
Cefixim / sefiksim 100 mg caplet
kaplet
1,000.00
-
-
-
-
-
275.00
Jml Vol Hasil Penelusuran Apotik
Jml Vol Hasil Penelusuran Gudang Obat
Total
Nilai Hasil Penelusuran per 12 Jan 2016
14 =9+(10-8) 171.00 -
15 =13+(11-9) -
16=14+15 171.00 -
47,025.00 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Lampiran I/20 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN
GUDANG OBAT
APOTIK
1 13
Etanol 96 % - 1 L
2
3 Botol
14 15 16
Gentian Violet larutan 1 % Glucose Larutan Infus 10% Steril Jarum Suntik No. 27 G
17 18
4
5
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
TOTAL
19,800.00
-
1.00
7=(5+6) 1.00
19,800.00
-
Botol Botol Pcs
446.00 3,894.00 1,071.00
-
-
-
-
-
Ketokonazole Krim 2% Klindamisin kapsul 150 mg
Tube Kapsul
4,700.00 509.00
-
-
-
-
-
19 20
Klindamisin 300 MG Kasa Pembalut Hidrofil 4 m x 6 cm
Kapsul Roll
553.00 747.00
-
-
-
-
-
21 22
Kasa 2x80 Kapas 500 gram
Roll Bungkus
8,711.00 17,250.00
-
-
-
-
-
23 24 25
Larutan H2O2 Methilprednisolon 4 mg Metoklopramid injeksi / Primperan
Botol tablet Vial
3,960.00 205.00 7,321.00
-
-
-
-
-
26 27
Metoklopramid tablet 10 mg / Metolon Metronidazol tablet 250 mg
Tablet Tablet
76.00 110.00
-
-
-
-
-
28
Meylon injeksi
Botol
19,639.00
-
-
-
-
-
29
Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral
Tablet
269.00
-
-
-
-
-
30
Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob
Tube
47,500.00
-
-
-
-
-
31
Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1 mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf
Botol
23,650.00
-
-
-
-
-
32
Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi
Vial
1,928.00
-
-
-
-
-
33 34
Polymigel tablet 400 mg/Strocain P Propanolol tablet 40 mg (HCl)
Tablet Tablet
1,404.00 106.00
-
-
-
-
-
35 36
Ranitidin injeksi 25 mg/ml Saccaharine tablet
Ampul Tablet
1,140.00 8.00
-
-
-
-
-
37 38 39
Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole Sefadroxil syrup 125 mg Sianokobalamin (Vit B12) Inj Dewasa
Tube botol Ampul
2,839.00 4,746.00 15,203.00
-
-
-
-
-
40 41
Teofilin tablet / Bronsolvan Terbutalin tablet 2,5 mg / Astherin
Tablet Tablet
85.00 275.00
-
-
-
-
-
42
Bur Low Speed OBAT KESDA
Kotak
186,613.00
-
3.00
3.00 -
559,839.00 -
1
Kalium Diklofenak tablet 50 mg
tablet
540.00
-
-
-
2
Obat Tetes mata kombinasi antiseptik & kortikosteroid (Dexamethason Sod.Phosfate 1,0 mg, Neomycin Sulphate setara Neomycin base 3,5 mg, Polymixin B Sulfat 6000 IU) - 5 ml
tube
27,000.00
-
-
-
3
Obat Analgetik - antipiretik - batuk kaplet (Paracetamol 500 mg, Dextromethorphan HBr 15 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 2 mg, ) / Alpara
kaplet
4
Obat Analgetik kombinasi dengan Psikotropik kaplet (Metampiron 500 mg, Diazepam 2 mg) / Metaneuron
kaplet
480.00
1,133.00
6
Hasil Penelusuran
-
-
-
-
-
-
8
9
10
11
12
13 1.00 -
Jml Vol Hasil Penelusuran Apotik
Jml Vol Hasil Penelusuran Gudang Obat
Total
Nilai Hasil Penelusuran per 12 Jan 2016
14 =9+(10-8) -
15 =13+(11-9) 1.00 -
16=14+15 1.00 -
19,800.00 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3.00
-
3.00
3.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
559,839.00
-
-
Lampiran I/21 - 28 Menurut Pemeriksaan per 12 Januari 2016
Menurut Laporan per-31 Des 15 NO
Nama Obat
SATUAN
HARGA SATUAN
4
APOTIK
GUDANG OBAT
TOTAL
5
6
7=(5+6)
Hasil Penelusuran
Pengeluaran Pengeluaran Nilai Penerimaan Penerimaan Persediaan Persediaan Apotik 2 s.d Gudang Obat Persediaan Per Apotik 2 sd 12 Gudang Obat 2 Apotik per 12 Gudang Obat per 12 Januari 2 sd 12 Jan 31 Des 2015 Jan 2016 sd 12 Jan 2016 Januari 12 Januari 2016 2016
1
2
3
5
Obat Analgetik - vitamin B kompleks kaplet (Parasetamol 500 mg, Vitamin B6 100 mg, Vitamin B1 50 mg, Vitamin B12 100 mcg) / Erlagin
kaplet
6
Obat Antiinfluenza syrup ( Parasetamol 125 mg, Phenylprophanolamine HCl 3.125 mg, Chlorpheniramine Maleate 0.5 mg ) - 60 ml / Molexflu sirup
botol
6,500.00
-
-
-
-
-
7
Obat Antiinfluenza kaplet ( Paracetamol 500 mg. Phenylpropanolamin HCl 12,5 mg+ Chlorpheniramin Maleat 2 mg ) / Molexflu kaplet
kaplet
300.00
-
-
-
-
-
8
Obat Antitusif - ekspektorant sirup ( Diphenhydramin HCl 12,5 mg+ Ammonium Chlorida 125 mg+ Sodium Citrat 50 mg+ Menthol 1 mg ) - 60 ml / Molexdryl sirup
botol
5,000.00
-
-
-
-
-
9
Obat dekongestan, antiinfluenza tablet (tripolidin HCl 2,5 mg, Pseudoefedrin HCl 30mg)/Flutrop
10
Obat Neuramialgikum tablet (Vit.B1 100 mg, Vit.B6 200 mg, Vit.B12 250 mcg )
11
360.00
-
-
8 -
9
10
11
-
12
Total
-
-
-
-
tablet
150.00
-
-
-
-
-
Obat spasmodikum tablet (Metampiron 500 mg, Ekstrak Belladona 10 mg, Papaverin HCl 25 mg) / Spasminal
tablet
590.00
-
-
-
-
-
12
Obat Vasokonstriktor dan antihistamin tablet ( Phenylpropanolamin HCl 15 mg+ Chlorpheniramin Maleat 2 mg ) / Nalgestan
tablet
826.00
-
-
-
-
-
13
Salep kulit analgetika (Metil salilsilat 11%, Mentol 6%, Eugenol 1,5%) - 30 gr / Painkilla
tube
12,960.00
-
-
-
-
-
14
Salep kulit kombinasi antiinfeksi dgn kortikosteroid (Betamethasone 1 mg, Neomycin sulfat 5 mg) - 5 gr / Bevalex
tube
8,400.00
-
-
-
-
-
15
Vitamin B Komplek dengan Vit. C dosis tinggi Kaplet (Vit. B1 15 mg, Vit. B2 10 mg, Vit. B6 5 mg, Vit. B12 100 mcg, Vit. C 500 mg, Vit. E 30 mg, Ca. Pantothenate 20 mg, Nikotinamide 50 mg) / Becefort
kaplet
1,450.00
-
-
-
-
-
132,297.00
47,999,367.00
14 =9+(10-8)
15 =13+(11-9)
16=14+15
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
6,699.00
Tangerang, 8 Januari 2015 Penanggung Jawab Obat
3,059.00
6,887.00
6,699.00
42,095.00
95,707.00
42,283.00
99,347.00
141,630.00
Tangerang, 08 Januari 2015
Tim Pemeriksa :
drg. Hj. R.R. Sri Wahyu H NIP. 19620120 199203 2 003
Nilai Hasil Penelusuran per 12 Jan 2016
-
-
Mengetahui/Menyetujui : Kepala UPTD. Puskesmas Batuceper
Jml Vol Hasil Penelusuran Gudang Obat
13
792.00
TOTAL
Jml Vol Hasil Penelusuran Apotik
Iin Choerun Nisa, A.Md.Far NIP. 19831003 201001 2 005
1 Elvin Mustika, SE
(Pengawas)
.................
2. Teuku Sulaemansyah, SE, M.AP
(Ketua Tim)
.................
3. Farida Ratna Suci, SE
(Anggota Tim)
.................
47,999,367.00
Lampiran I/22 - 28
`
Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4
590.00
-
900.00
-
402.00
-
14,725.00
-
394.00 5,496.00
-
57.00
-
111.00
-
1.00
-
2,219.00 118.00 78.00
-
57.00
-
160.00 3.00
-
70.00 12,076.00
-
10,970.00 108.00 510.00
-
200.00 120.00
-
102.00 108.00
-
885.00 8,066.00
-
215.00 167.00
-
-
-
-
-
-
-
Lampiran I/23 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Lampiran I/24 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Lampiran I/25 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4 -
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Lampiran I/26 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4 -
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Lampiran I/27 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4 -
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Lampiran I/28 - 28 Selisih Menambah/Mengurangi
Vol
Nilai (Rp)
17=16-7
18=17x4
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9,333.00
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