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1. SATUAN KERJA ADALAH NAMA APOTEK, KLINIK, FKTP, FKRTL, DINKES PROVINSI dan KAB/KOTA atau BKKBN 2. JUMLAH KEBUTUHAN TAHUN 2021 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2020 DIKALI 18 BULAN DALAM SA 3. RENCANA KEBUTUHAN TAHUN 2021 ADALAH RENCANA KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI 4. RENCANA PENGADAAN TAHUN 2021 ADALAH RENCANA OBAT DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPL 5. SURAT PENGANTAR DAN LAMPIRAN HARUS DI TANDATANGANI OLEH KEPALA SATUAN KERJA DAN DIBERI STEMPEL 6. MOHON UNTUK TIDAK MELAKUKAN PENAMBAHAN MAUPUN PENGURANGAN BARIS/KOLOM PADA FORMAT
RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP UPTD TAMPAKSIRING 2 SATUAN KERJA : Dinas Kesehatan Kab. Gianyar
NO
NAMA OBAT
SATUAN
SISA STOK PER 31 DESEMBER 2023
PEMAKAIAN RATA-RATA PER BULAN SELAMA 2023
(a) 1 Air untuk injeksi amp 20 ml 2 Air untuk injeksi amp 25 ml 3 Albendazol susp 200 mg/5 ml 4 Albendazol tab 400 mg 5 Alopurinol tab 100 mg 6 Alopurinol tab 300 mg 7 Aminofilin inj 24 mg/ml 8 Aminofilin tab 150 mg 9 Aminofilin Tab 200 mg 10 Amitriptilin tab sal 25 mg 11 Amlodipin tab 10 mg 12 Amlodipin tab 5 mg 13 Amoksisilin drops 100 mg/ml 14 Amoksisilin sir forte 250 mg/5 ml
ampul/vial/botol ampul/vial/botol 25 mL Botol tablet/kapsul/kaplet Tab tablet/kapsul/kaplet ampul/vial 10 ml tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet Botol botol 60 ml
15 Amoksisilin sir kering 125 mg/5 ml
Botol
16 Amoksisilin tab 250 mg tablet/kapsul/kaplet 17 Amoksisilin tab 500 mg tablet/kapsul/kaplet 18 Ampisilin serb inj 1000 mg/vial ampul/vial 19 Ampisilin serb inj 250 mg/vial Vial 20 Anestetik lokal gigi kombinasi : ampul/vial lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 ml
(b) 0 0 0 3,500 0 0 0 0 0 4,200 0
2 0 10 200 1,500 500 0 0 0 100 5,000 10,000 10 100
0
100
0 11,800 0 0 20
200 6,500 0 0 30
21 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium hidroksida 200 mg
tablet/kapsul/kaplet
1,200
2,500
22 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium hidroksida 200 mg
botol 60 ml
0
30
23 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg
Kaps
0
0
24 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3%
pot 30 g
0
30
25 Antihemoroid, kombinasi: bismut Suppositoria subgalat 150 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
0
20
26 Artesunat serb inj 60 mg/ml (i.v./i.m.)
ampul/vial
0
0
27 Articulating paper kertas warna penanda oklusi
Kertas warna penanda oklusi
0
1
28 Asam asetat tetes telinga 2% Botol 29 Asam asetilsalisilat (asetosal) tab 80 tablet/kapsul/kaplet mg
0 0
0 10
30 Asam askorbat (vitamin C) tab 250 mg
Tab
0
31 Asam askorbat (vitamin C) tab 50 mg
tablet/kapsul/kaplet
3,000
2,000
32 Asam folat tab 0,4 mg 33 Asam folat tab 1 mg 34 Asam folat tab 5 mg 35 Asam mefenamat kaps 250 mg 36 Asam mefenamat kaps 500 mg 37 Asam salisilat lar 0,1% 38 Asam salisilat salep 10% 39 Asam salisilat salep 2% 40 Asam salisilat salep 5% 41 Asiklovir tab 200 mg 42 Asiklovir tab 400 mg 43 Atapulgit 600 mg 44 Atapulgit tab 630 mg 45 Atapulgit tablet 650 mg 46 Atapulgit tablet 750 mg 47 Atenolol tab 100 mg 48 Atenolol tab 50 mg
tablet/kapsul/kaplet tablet/kapsul/kaplet Tab tablet/kapsul/kaplet tablet/kapsul/kaplet/kaptab Botol Tube Tube Tube tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet Tab tablet/kapsul/kaplet tablet/kapsul/kaplet
0 3,500 0 0 4,700 0 0 0 0 0 2,000 0 3,000 0 0 0 0
0 1,500 100 0 2,000 0 0 10 0 50 200 300 700 300 300 0 0
49 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
0
0
50 Atropin tab 0,5 mg Tab 51 Bahan tumpatan sementara lar, serb Botol
0 0
0 0
52 Bedak salisil serb 2% 53 Betametason krim 0,1% 54 Betametason krim 0,5 mg/g 55 Betametason salep 0,1% 56 Betametason tts mata 1 mg/ml 57 Bisakodil sup 10 mg 58 Bisakodil sup 5 mg 59 Bisakodil tab sal 5 mg 60 Budesonid cairan ih 0,25mg/ml 61 Budesonid cairan ih 0,25mg/ml, respoules 2 ml
Dus/Sachet/Plastik tube 5 gram Tube tube 5 gram botol Suppositoria Suppositoria tablet/kapsul/kaplet Botol @ 4 ml respoules
0 0 0 0 0 0 0 0 0
50 75 75 50 0 5 5 0 0 0
62 Budesonid cairan ih 0,5 mg/ml 63 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml
Botol @ 4 ml respoules
0 0
0 0
64 Budesonid serb ih 100 mcg/dosis
Botol
0
0
65 Budesonid serb ih 200 mcg/dosis
100 dosis
0
0
66 Budesonid serb ih 200 mcg/dosis
200 dosis
0
0
0 0
0 0 7
67 Coal tar lar 5 % Botol 68 Copper T set/buah 69 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 70 Deksametason tab 0,5 mg 71 Diazepam enema 10 mg/2,5 ml 72 Diazepam enema 5 mg/2,5 ml 73 Diazepam inj 5 mg/ml (i.v./i.m.) 74 Diazepam tab 2 mg 75 Diazepam tab 5 mg 76 Dietilkarbamazin tab 100 mg 77 Difenhidramin inj 10 mg/ml (i.v./i.m.)
tablet/kapsul/kaplet tube @ 2,5 mL tube @ 2,5 mL ampul/vial tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet ampul/vial
5,716 0 5 0 0 0 0 60
2,000 5 5 3 0 600 0 5
78 Digoksin tab 0,25 mg 79 Diltiazem hcl tab 30 mg 80 Diltiazem kaps SR 100 mg 81 Diltiazem kaps SR 200 mg 82 Diltiazem tab 30 mg 83 Dimenhidrinat tab 50 mg 84 Doksisiklin kaps 100 mg
tablet/kapsul/kaplet tablet/kapsul/kaplet Kapsul lepas lambat Kapsul lepas lambat Tab tablet/kapsul/kaplet tablet/kapsul/kaplet
0 0 0 0 0 0 0
0 0 0 0 0 0 0
85 Domperidon susp 5 mg/5 ml 86 Domperidon tab 10 mg 87 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.)
botol @60 ml tablet/kapsul/kaplet ampul/vial
0 0 15
20 50 5
88 Epinefrin (adrenalin) inj 1 mg/ml
Ampul
0
5
89 Ergotamin tab 1 mg 90 Eritromisin kaps 250 mg 91 Eritromisin sir 200 mg/5 ml 92 Eritromisin tab 500 mg 93 Estrogen terkonjugasi tab sal 0,625 mg
Tab tablet/kapsul/kaplet Botol @ 60 ml tablet/kapsul/kaplet tablet salut gula/kaplet salut gula
0 0 0 0 0
0 0 0 0 0
12 0 0 0 0 0 0 0 1,500 0
7 1 0 0 0 0 0 0 1,000 0
94 Etanol 70% cairan 70% 95 Etil klorida semprot 100 ml 96 Etonogestrel implan 68 mg 97 Eugenol 98 Fenitoin Na inj 50 mg/ml 99 Fenitoin Na kaps 100 mg 100 Fenitoin Na kaps 30 mg 101 Fenobarbital tab 100 mg 102 Fenobarbital tab 30 mg 103 Fenoksimetil penisilin (penisilin V) tab 250 mg
Botol Botol Set Botol ampul @ 2 ml Kaps Kaps Tab tablet/kapsul/kaplet Tab
104 Fenoksimetil penisilin (penisilin V) tab 500 mg
Tab
0
0
105 Ferro fumarat kaps lunak 300 mg
Kaps lunak
0
2,000
106 Ferro sulfat sir. 150 mg/5 ml 107 Ferro sulfat tab salut 300 mg 108 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.)
Botol Tab sal ampul/vial
0 0 0
0 0 20
109 Fitomenadion (vitamin K 1) tab sal 10 mg
Tab sal
0
0
110 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m)
tablet salut gula/kaplet salut gula
0
0
111 Fluoksetin kaps 10 mg 112 Fluor kapl 1 mg 113 Fluor sediaan topikal 114 Fluoresein tts mata 2,5 mg/ml 115 Formokresol 116 Framisetin Sulfat Tulle 1% 117 Furosemid inj 10 mg/ml (i.v./i.m.)
tablet/kapsul/kaplet Kaplet Tube Botol Botol Patch ampul/vial
0 0 0 0 0 0 0
0 0 0 0 0 0 0
118 Furosemid tab 40 mg
tablet/kapsul/kaplet
0
10
119 Galactose microparticle 200-400 mg Vial micropart/ml
0
0
120 Garam oralit kombinasi : natrium sachet klorida 0,52 g + kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
200
200
121 Gentamisin salep mata 0,3% Tube 122 Gentamisin tts mata 0,3% Botol 123 Glass ionomer ART (Atraumatic Sachet Restorative Treatment) cocoa butter 5g
0 0 0
20 25 0
124 Glass ionomer ART (Atraumatic Restorative Treatment) lar
Botol
0
0
125 Glass ionomer ART (Atraumatic Restorative Treatment) serb
Vial
0
0
126 Glibenklamid tab 2,5 mg 127 Glibenklamid tab 5 mg 128 Glikuidon tab 30 mg 129 Glimepirid tab 1 mg 130 Glimepirid tab 2 mg 131 Glipizid tab 5 mg 132 Gliseril trinitrat tab 0,5 mg 133 Gliserin tts 100 mg/ml 134 Glukosa Larutan Infus 10% steril 100 ml
tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet Botol Botol
0 3,000 0 0 300 0 0 0 0
0 3,000 0 1,000 1,000 0 0 20 0
135 Glukosa Larutan Infus 10% steril 250 Botol ml
0
0
136 Glukosa Larutan Infus 10% steril 500 Botol ml
0
1
137 Glukosa Larutan Infus 40% Ampul @25 ml 138 Glukosa Larutan Infus 5% steril 100 Botol ml
0 0
0 0
139 Glukosa Larutan Infus 5% steril 250 Botol ml
0
0
140 Glukosa Larutan Infus 5% steril 500 Botol ml
0
0
141 Griseofulvin (micronized) tab 125 mg
tablet/kapsul/kaplet
0
0
142 Griseofulvin (micronized) tab scored tablet/kapsul/kaplet 250 mg
0
0
143 Gutta percha dan paper points 15 - Roll 40 mm
0
0
144 Gutta percha dan paper points 45 - Roll 80 mm
0
0
145 Haloperidol inj 5 mg/ml (i.m.)
0
0
Vial
146 Haloperidol tab 0,5 mg 147 Haloperidol tab 1,5 mg 148 Haloperidol tab 2 mg 149 Haloperidol tab 5 mg 150 Haloperidol tts 2 mg/ml 151 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml
tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet botol Ampul
152 Hidrogen peroksida cairan 3% Botol 153 Hidrogen peroksida lar. Konsentrat Botol 3%
0 0 0 700 0 0
0 0 0 700 0 0
0 0
2 0
0 50 0 0 20
0 75 0 0 50
154 Hidroklorotiazid tab 25 mg 155 Hidrokortison krim 2,5% 156 Hidrokortison serb inj 100 mg 157 Hiosina butilbromida tab 10 mg 158 Human tetanus imunoglobulin inj 250 UI (i.m.)
tablet/kapsul/kaplet tube @ 5 g Vial tablet/kapsul/kaplet Ampul
159 Human tetanus imunoglobulin inj 500 UI (i.m.)
Ampul
0
0
160 Ibuprofen sir 100 mg/5 ml 161 Ibuprofen sir 200 mg/5 ml 162 Ibuprofen tab 200 mg 163 Ibuprofen tab 400 mg 164 Ipratropium bromida aerosol 20 mcg/semprot
botol @ 60 ml botol @ 60 ml tablet/kapsul/kaplet tablet/kapsul/kaplet Botol
0 0 0 0
0 0 0 800 0
165 Ipratropium bromida cairan ih 0,025%
Botol
0
20
166 Ipratropium bromida ih 20mcg/puff Botol
0
0
167 Isoniazid tab 100 mg 168 Isoniazid tab 300 mg 169 Isosorbid dinitrat tab 5 mg 170 IUD Cu T 380 A 171 IUD Levonorgestrel 172 Kalamin 173 Kalsium glukonat inj 100 mg/ml 174 Kalsium hidroksida bubuk, pasta
Tab Tab tablet/kapsul/kaplet Set Set Tube ampul/vial Tube
0 0 0 0 0 0 0 0
0 0 0 0 0 50 0 0
175 Kalsium karbonat tab 500 mg 176 Kalsium laktat (kalk) tab 500 mg 177 Kaptopril tab 12,5 mg 178 Kaptopril tab 25 mg 179 Kaptopril tab 50 mg 180 Karbamazepin sir 100 mg/5 ml 181 Karbamazepin tab 100 mg 182 Karbamazepin Tab 200 mg
tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kaplet tablet/kaplet tablet/kaplet Botol Tab Tablet
0 2,420 1,940 5,250 0 0 0 800
0 700 0 4,000 0 0 0 600
183 Karbo adsorben tab 0,5 g 184 Karbogliserin tts telinga 10 % 185 Ketokonazol tab 200 mg 186 Klindamisin kaps 150 mg 187 Klindamisin kaps 300 mg 188 Klofazimin, micronized kaps 50 mg
Tab Botol tablet/kapsul/kaplet Kaps tablet/kapsul/kaplet Kapsul
189 Klofazimin, micronizedkaps 100 mg kapsul
0 0 0 0 0
0 50 50 0 0 0
0
0
0 0 0 0 0 0 0 0 3,000 0
0 0 30 15 5 15 10 0 2,000 0
190 Klonidin tab 0,15 mg 191 Kloramfenikol kaps 250 mg 192 Kloramfenikol salep kulit 2% 193 Kloramfenikol salep mata 1% 194 Kloramfenikol susp 125 mg/5 ml 195 Kloramfenikol tetes telinga 3% 196 Kloramfenikol tts mata 0,5% 197 Kloramfenikol tts mata 1% 198 Klorfeniramin tab 4 mg 199 Klorfenol kamfer mentol (CHKM)
tablet/kapsul/kaplet tablet/kapsul/kaplet tube 15g tube @ 5 gram botol 60 ml Botol botol Botol tablet/kapsul/kaplet Botol
200 Klorheksidin lar 0,2% 201 Klorheksidin lar 15% 202 Klorpromazin inj 25 mg/ml (i.m.)
Botol Botol ampul/vial
0 0 0
0 0 0
203 Klorpromazin inj 5 mg/ml (i.m.) 204 Klorpromazin tab sal 100 mg 205 Klorpromazin tab sal 25 mg 206 Klortalidon tab 50 mg 207 Klozapin tab 100 mg 208 Klozapin tab 25 mg 209 Kodein tab 10 mg 210 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab sal selaput
ampul/vial tablet salut selaput/kaplet salut sela Tab sal Tab tablet tablet tablet/kapsul/kaplet tablet salut selaput/kaplet salut sela
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
211 Kombinasi : artemether 20 mg + lumefantrin 120 mg
tablet/kapsul/kaplet
0
0
212 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200
Tab
0
0
213 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg
Tab
0
0
214 Kombinasi : ergotamin 1 mg+ kafein tablet/kapsul/kaplet 50 mg
0
0
215 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut
0
0
tablet salut gula
216 Kombinasi : levonorgestrel 150 mcg tab salut gula + etinilestradiol 30 mcg
0
0
217 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg
Tab
0
0
218 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 mg
Tab
0
0
219 Kombinasi: ipratropium Br 0,5 mg+ ampul/vial salbutamol 2,5 mg nebules
0
0
220 Kombinasi: kaolin 550 mg + pektin 20 mg
0
0
221 Komposit resin Set 222 Kotrimoksazol (dewasa) kombinasi : tab/kaptab sulfametoksazol 400 mg+ trimetoprim 80 mg
0 670
0 200
223 Kotrimoksazol (dewasa) kombinasi : tab/kaptab sulfametoksazol 800 mg+ trimetoprim 160 mg
0
0
224 Kotrimoksazol kombinasi tiap 5 ml botol 60 mL suspensi : sulfametoksazol 200 mg + trimetoprim 40 mg
0
5
225 Kuinin inj 25% (i.v.) 226 Kuinin tab 200 mg 227 Laktulosa sir 3,335 g/5 ml 228 Larutan mengandung Elektrolit (Kalium Klorida)
0 0 0 0
0 0 5 0
229 Larutan mengandung Elektrolit (KCl Botol 0,15%, NaCL 0,9%) (KN1)
0
1
230 Larutan mengandung Elektrolit (KCl Botol 0,3%,NaCl 0,9%) (KN2)
0
0
231 Larutan mengandung Elektrolit (Na Softbag @ 500 ml 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
0
0
232 Larutan mengandung Elektrolit (Na Botol plastik @ 500 ml 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
0
0
233 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)
0
0
Tab
Vial tablet/kapsul/kaplet botol @ 60 mL Botol
Botol
234 Larutan mengandung Elektrolit Botol (Sodium Lactate sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
0
0
235 Larutan mengandung Elektrolit (Tiap Botol 1000 ml mengandung electrolit: Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Magnesium 1.0 mmol/l, Chloride 118 mmol/l, Acetate 24 mmol/l, Malate 5.0 mmol/l)
0
0
236 Larutan mengandung Karbohidrat Botol (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L)
0
0
237 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Xylitol 100 g/ L)
Botol
0
0
238 Larutan mengandung Karbohidrat Botol (Fructose 60 g, glucose 33 g, Xylitol 30 g/ L)
0
0
239 Larutan mengandung Karbohidrat (Maltose 10%)
Botol
0
0
240 Larutan mengandung Karbohidrat + Botol Elektrolit (25.00g maltose, 3.00 g sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride dihydrate dan 1.55 g sodium lactate)
0
0
241 Larutan mengandung Karbohidrat + Botol Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)
0
0
242 Larutan mengandung Karbohidrat + Botol Elektrolit (Dextrose 5%, NaCL 0,45%, KCl) (HSD)
0
0
243 Larutan mengandung Karbohidrat + Botol Elektrolit (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + elektrolit)
0
0
244 Larutan mengandung Karbohidrat + Botol Elektrolit (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
0
0
245 Larutan mengandung Karbohidrat + Botol Elektrolit (Glukosa 55 g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
0
0
246 Larutan mengandung Karbohidrat + Botol Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 g)
0
0
247 Larutan mengandung Karbohidrat + Botol Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS)
0
0
248 Larutan mengandung Karbohidrat + Botol Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS)
0
0
249 Larutan mengandung Karbohidrat + Botol Elektrolit (Larutan nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
0
0
250 Larutan mengandung Karbohidrat + Botol Elektrolit (Larutan Ringer & Glukosa 5%)
0
0
251 Larutan mengandung Karbohidrat + Botol Elektrolit (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr)
0
0
252 Larutan mengandung Karbohidrat + Botol Elektrolit (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Glukosa 100 gr)
0
0
253 Larutan mengandung Karbohidrat + Botol Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
0
0
254 Larutan mengandung Karbohidrat + Botol Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
0
0
255 Levonorgestrel implan 2 rods, 75 mg pack/ sachet/ set (3-4 tahun)
0
0
256 Lidokain gel 2% 257 Lidokain inj 2% (infiltr/p.v.) 258 Lidokain spray oral 10% 259 Linestrenol tab 0,5 mg 260 Loperamid tab 2 mg 261 Loratadin tab 10 mg 262 Lorazepam tab 0,5 mg 263 Lorazepam tab 1 mg 264 Lorazepam tab sal 2 mg 265 Lugol 266 Magnesium sulfat inj 20% 267 Magnesium sulfat inj 20% 268 Magnesium sulfat inj 40% 269 Magnesium sulfat inj 40% 270 Magnesium sulfat serb, ktg 30 g 271 Mebendazol sir 100 mg/5 ml 272 Mebendazol tab 100 mg 273 Mebendazol tab 500 mg 274 Medroksi progesteron asetat inj 150 mg/ml
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 40 1 0 0 50 0 0 0 0 2 2 2 0 0 0 0 0 0
275 Medroksi Progesteron Asetat Inj 50 ampul/vial mg/ml
0
0
276 Metenamin mandelat (heksamin Tab salut mandelat) tab salut enterik 500 mg
0
0
syringe/syringe plastik ampul/vial botol tablet/kapsul/kaplet Tab tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet Tab sal Botol ampul/vial ampul/vial @25 ml ampul/vial @25 ml ampul/vial Sachet Botol Tan tablet/kapsul/kaplet ampul/vial
277 Metformin tab 500 mg 278 Metformin tab 850 mg 279 Metilergometrin inj 0,2 mg/ml 280 Metilergometrin tab salut 0,125 mg
tablet/kapsul/kaplet tablet/kapsul/kaplet ampul/vial tablet/kaplet salut selaput
8,000 0 0 0
6,000 0 3 0
281 Metilprednisolon tab 4 mg 282 Metoklopramid inj 5 mg/ml 283 Metoklopramid tab 10 mg 284 Metoklopramid tab 5 mg 285 Metronidazol lar inf 5 mg/ml 286 Metronidazol susp 125 mg/5 ml 287 Metronidazol susp 125 mg/5 ml 288 Metronidazol tab 250 mg
tablet/kapsul/kaplet ampul/vial tablet/kapsul/kaplet tablet/kapsul/kaplet botol Botol @ 60 ml Botol @ 100 ml tablet/kapsul/kaplet
2,000 0 0 0 0 0 0 0
3,000 0 0 0 0 0 0 0
289 Metronidazol tab 500 mg 290 Mikonazol krim 2% 291 Mikonazol serb 2% 292 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Acetate)
tablet/kapsul/kaplet tube botol / sachet Sachet
200 0 0 0
50 50 30 0
293 N-asetil sistein kaps 200 mg 294 NaCl 0,9% Larutan 295 NaCl 0,9% Larutan 296 NaCl 0,9% Larutan 297 Natrium diklofenak tab 25 mg 298 Natrium diklofenak tab 50 mg 299 Natrium Diklofenak Tetes Mata 1 mg/ml
tablet/kapsul/kaplet Botol plastik/botol plastik pi Botol ampul/botol plastik/botol plas tablet salut enterik/kaplet salut ente tablet salut enterik/kaplet salut ente botol 5 mL
500 60 0 0 0 1,000 0
2,000 20 0 0 0 2,000 0
300 Natrium hipoklorit cairan konsentrat Botol 5%
0
0
301 Natrium tiosulfat inj 25% (i.v.) 302 Nifedipin kaps 10 mg 303 Nikotinamid tab 100 mg 304 Nikotinamid tab 5 mg 305 Nistatin susp 100.000 UI/ml 306 Nistatin tab salut 500.000 UI 307 Nistatin tab vaginal 100.000 UI 308 Nitrofurantoin tab 50 mg 309 Norepinefrin inj 1 mg/ml 310 Obat Anti Tuberculosis FDC Kategori Anak
0 0 0 0 0 0 0 0 0 0
0 10 0 0 0 0 30 0 0 0
311 Obat Anti Tuberculosis FDC Kategori paket I
0
0
312 Obat Anti Tuberculosis FDC Kategori paket II
0
1
313 Obat Anti Tuberculosis FDC Kategori paket Sisipan
0
0
314 Obat Anti Tuberculosis Kombipak Anak
Paket
0
0
315 Obat Anti Tuberculosis Kombipak Dewasa
paket
0
0
316 Oksigen ih, gas dlm tabung 317 Oksimetazolin tts hidung 0,025%
Botol botol @ 10 mL
0 0
3 3
318 Oksimetazolin tts hidung 0,050%
botol @ 10 mL
0
10
319 Oksitetrasiklin 1% Salep Mata
tube
0
20
Ampul tablet/kapsul/kaplet Tab Tab botol/vial tablet salut gula/kaplet salut gula tablet/kaplet Tab ampul/vial paket
320 Oksitosin inj 10 UI/ml 321 Olopatadin tts mata 0,1% 322 Omeprazol inj 40 mg/10 ml 323 Omeprazol kaps 20 mg 324 Paraformaldehid tab 1 g 325 Parasetamol sir 120 mg/5 ml 326 Parasetamol tab 500 mg 327 Parasetamol tts 60 mg/0,6 ml 328 Pasta devitalisasi (non arsen) 329 Pasta pengisi saluran akar (pasta)
ampul/vial Botol ampul/vial tablet/kapsul/kaplet Tab botol @ 60 mL tablet/kapsul/kaplet botol @ 15 mL Tube Tube
0 0 0 0 0 0 2,000 60 0 0
10 0 0 1,000 0 150 10,000 100 0 0
330 Perak nitrat lar 20% 331 Perak sulfadiazin krim 1% 332 Permetrin krim 5 % 333 Pirantel pamoat susp 125 mg/5 ml
Botol Tube Tube Botol
0 0 0 0
0 4 0 0
334 Pirantel pamoat tab 500 mg Tab 335 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet
0 0
0 0
336 Pirantel pamoat tab scored 250 mg Tab
0
0
337 Piridoksin (vitamin B6) inj 100 mg/ml
Ampul
0
0
338 Piridoksin (vitamin B6) tab 10 mg
tab/kap/kapl
0
0
339 Piridoksin (vitamin B6) tab 25 mg
tablet/kapsul/kaplet
600
50
340 Povidon iodin lar 100 mg/ml 341 Povidon iodin lar 100 mg/ml 342 Povidon iodin lar 100 mg/ml 343 Povidon iodin lar 100 mg/ml 344 Prednison tab 5 mg 345 Primakuin tab 15 mg 346 Probenesid tab 500 mg 347 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.)
botol @ 1.000 mL botol 30 mL botol @ 60 mL Botol 300 ml tablet/kapsul/kaplet Tab tablet/kapsul/kaplet ampul/vial
0 0 0 30 0 0 0 0
0 0 0 5 0 0 0 0
348 Propiltiourasil tab 100 mg 349 Propranolol tab 10 mg 350 Ranitidin tab 150 mg 351 Retinol (vitamin A) kaps lunak 100.000 UI
tablet/kapsul/kaplet tablet/kapsul/kaplet tablet/kapsul/kaplet kaps lunak
0 0 0
0 0 500 10
352 Retinol (vitamin A) kaps lunak 200.000 UI
kaps lunak
0
10
353 Rifampisin kaps 300 mg 354 Ringer Laktat Larutan
tablet/kapsul/kaplet Botol
0 0
0 10
355 Risperidon tab sal 1 mg 356 Risperidon tab sal 2 mg 357 Salbutamol cairan ih 0,1% 358 Salbutamol lar ih 0,5 % 359 Salbutamol sir 2 mg/5 ml 360 Salbutamol tab 2 mg 361 Salbutamol tab 4 mg 362 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 %
tablet/kapsul/kaplet tablet/kapsul/kaplet ampul/vial/botol Botol Botol tablet/kapsul/kaplet tablet/kapsul/kaplet pot 30 gram
0 0 0 0 0 0 2,000 0
0 0 0 20 0 0 700 30
363 Salep 2-4, kombinasi : asam salisilat pot 15 gram 2 %+ belerang endap 4 %
0
10
364 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.)
Vial
0
0
365 Serum anti bisa ular :A.B.U.II Vial (khusus ular dari Papua) inj (i.m./i.v.)
0
0
366 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/
Vial
0
0
367 Serum antirabies inj 100 UI/ml 368 Serum antirabies inj 200 UI/ml 369 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.)
Vial Vial Vial
0 0 0
0 0 0
370 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.)
Ampul
0
0
0
0
371 Serum antitetanus (A.T.S) inj 20.000 Vial UI/vial (i.m /i.v.) 372 Setirizin sir 5 mg/5 ml. 373 Sianokobalamin (vitamin B12) inj 500 mcg/ml
botol @ 60 mL ampul/vial
0
150 0
374 Sianokobalamin (vitamin B12) tab 50 mcg
tablet/kapsul/kaplet
0
500
375 Simvastatin tab sal 10 mg 376 Simvastatin tab sal 20 mg 377 Simvastatin tab sal selaput 40 mg
tablet/kapsul/kaplet/tablet salut sel 0 tablet/kapsul/kaplet/tablet salut selaput/kaplet salu Tab sal 0
200 400 0
378 Siprofloksasin tab scored 500 mg
tablet salut selaput/kaplet salut sela
0
200
379 Siprofloksasin tetes mata 3 mg/ml
Catchcover, botol 0,6 ml
0
0
380 Spironolakton tab 25 mg 381 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial
tablet/kapsul/kaplet Vial
0 0
0 0
382 Streptomisin serb inj 1.000 mg/vial ampul/vial
0
0
383 Surgical ginggival pack 384 Tenofovir tab 300 mg 385 Tetanus toxoid inj 386 Tetrakain tts mata 0,5% 387 Tetrasiklin kaps 250 mg 388 Tetrasiklin kaps 500 mg 389 Tetrasiklin Salep Mata 1% 390 Tiamin (vitamin B1) tab 50 mg 391 Timolol tts mata 0,25% 392 Timolol tts mata 0,5% 393 Triheksifenidil tab 2 mg 394 Urea krim 10 % 395 Vaksin BCG inj (i.k) 396 Vaksin bivalen OPV (b-OPV) drops 10 dosis
Tube tablet salut selaput/kaplet salut sela Ampul Botol tablet/kapsul/kaplet tablet/kapsul/kaplet Tube tablet/kapsul/kaplet botol @ 5 mL botol @ 5 mL tablet/kapsul/kaplet pot Vial Vial
0 0 0 0 0 0 0 0 0 1,000 0 0 0
0 0 0 0 0 0 0 8,000 0 0 600 0 0 0
397 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml (i.m)
Vial
0
0
398 Vaksin Influenza 399 Vaksin Japanese Enchepalitis (J.E)
Vial Vial
0 0
0 0
400 Vaksin jerap difteri tetanus (DT) 401 Vaksin jerap difteri tetanus (Td) 402 Vaksin kombinasi DPT-HB-Hib 403 Vaksin measless rubella (MR) Inj 0,5 mL (s.k)
Vial Vial Vial Vial
0 0 0 0
0 0 0 0
404 Vaksin Meningitis Meningokokus
Vial
0
0
405 Vaksin polio IPV inj 0,5 ml 406 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster
Vial Vial
0 0
0 0
407 Vaksin rabies, untuk manusia serb Inj 2,5 IU
Vial
0
0
408 Vaksin Yellow Fever 409 Valproat sir 250 mg/5 ml 410 Valproat tab sal 250 mg 411 Valproat tab sal 500 mg 412 Vitamin B kompleks 413 Zinc drops 10 mg/ml 414 Zinc serb 10 mg 415 Zinc sir 10 mg/ml 416 Zinc sir 20 mg/5 ml 417 Zinc tab disp 20 mg
Vial botol @ 120 ml tablet salut enterik/ kaplet salut ente Tab sal tablet Botol Sachet Botol botol tablet dispersible
0 0 0 0 2,000 0 0 0 0 0
0 0 0 0 10,000 10 0 0 0 500
IKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF KAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2020 : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2021 BERDASARKAN PERKI N DIBERI STEMPEL DA FORMAT
T PERTAMA (FKTP) TAHUN 2024
JUMLAH KEBUTUHAN TAHUN 2023
RENCANA KEBUTUHAN TAHUN 2023
(c) = (b) x 18 36 0 180 3,600 27,000 9,000 0 0 0 1,800 90,000 180,000 180 1,800
(d) = (c) - (a) 36 0 180 3,600 23,500 9,000 0 0 0 1,800 90,000 175,800 180 1,800
1,800 3,600 117,000 0 0 540
RENCANA PENGADAAN TAHUN 2023
RENCANA PENGADAAN TAHUN 2022
(e)
REALISASI PENGADAAN TAHUN 2021
(f)
KETERANGAN
(g)
(h)
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
1,800
0
0
0
3,600 105,200 0 0 520
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
45,000
43,800
0
0
0
540
540
0
0
0
0
0
0
0
0
540
540
0
0
0
360
360
0
0
0
0
0
0
0
0
18
18
0
0
0
0 180
0 180
0 0
0 0
0 0
0
0
0
0
0
36,000
33,000
0
0
0
0 27,000 1,800 0 36,000 0 0 180 0 900 3,600 5,400 12,600 5,400 5,400 0 0
0 23,500 1,800 0 31,300 0 0 180 0 900 1,600 5,400 9,600 5,400 5,400 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
0 0
0 0
0 0
0 0
0 0
900 1,350 1,350 900 0 90 90 0 0 0
900 1,350 1,350 900 0 90 90 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 126
0 0 126
0 0 0
0 0 0
0 0 0
36,000 90 90 54 0 10,800 0 90
30,284 90 85 54 0 10,800 0 30
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
360 900 90
360 900 75
0 0 0
0 0 0
0 0 0
90
90
0
0
0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
126 18 0 0 0 0 0 0 18,000 0
114 18 0 0 0 0 0 0 16,500 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
36,000
36,000
0
0
0
0 0 360
0 0 360
0 0 0
0 0 0
0 0 0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
180
180
0
0
0
0
0
0
0
0
3,600
3,400
0
0
0
360 450 0
360 450 0
0 0 0
0 0 0
0 0 0
0
0
0
0
0
0
0
0
0
0
0 54,000 0 18,000 18,000 0 0 360 0
0 51,000 0 18,000 17,700 0 0 360 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0
0
0
0
18
18
0
0
0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 12,600 0 0
0 0 0 11,900 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
36 0
36 0
0 0
0 0
0 0
0 1,350 0 0 900
0 1,300 0 0 880
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0
0
0
0
0
0 0 0 14,400 0
0 0 0 14,400 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
360
360
0
0
0
0
0
0
0
0
0 0 0 0 0 900 0 0
0 0 0 0 0 900 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 12,600 0 72,000 0 0 0 10,800
0 10,180 -1,940 66,750 0 0 0 10,000
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 900 900 0 0 0
0 900 900 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0
0
0
0
0 0 540 270 90 270 180 0 36,000 0
0 0 540 270 90 270 180 0 33,000 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 3,600
0 2,930
0 0
0 0
0 0
0
0
0
0
0
90
90
0
0
0
0 0 90 0
0 0 90 0
0 0 0 0
0 0 0 0
0 0 0 0
18
18
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
36 720 18 0 0 900 0 0 0 0 36 36 36 0 0 0 0 0 0
36 720 18 0 0 900 0 0 0 0 36 36 36 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
0
0
0
0
0
108,000 0 54 0
100,000 0 54 0
0 0 0 0
0 0 0 0
0 0 0 0
54,000 0 0 0 0 0 0 0
52,000 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
900 900 540 0
700 900 540 0
0 0 0 0
0 0 0 0
0 0 0 0
36,000 360 0 0 0 36,000 0
35,500 300 0 0 0 35,000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0
0
0
0
0 180 0 0 0 0 540 0 0 0
0 180 0 0 0 0 540 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
18
18
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
54 54
54 54
0 0
0 0
0 0
180
180
0
0
0
360
360
0
0
0
180 0 0 18,000 0 2,700 180,000 1,800 0 0
180 0 0 18,000 0 2,700 178,000 1,740 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 72 0 0
0 72 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
900
300
0
0
0
0 0 0 90 0 0 0 0
0 0 0 60 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 9,000 180
0 0 9,000 180
0 0 0 0
0 0 0 0
0 0 0 0
180
180
0
0
0
0 180
0 180
0 0
0 0
0 0
0 0 0 360 0 0 12,600 540
0 0 0 360 0 0 10,600 540
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
180
180
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0
0
0
0
0
0
0
0
0
0
2,700 0
2,700 0
0 0
0 0
0 0
9,000
9,000
0
0
0
3,600 7,200 0
3,600 7,200 0
0 0 0
0 0 0
0 0 0
3,600
3,600
0
0
0
0
0
0
0
0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
0 0 0 0 0 0 0 144,000 0 0 10,800 0 0 0
0 0 0 0 0 0 0 144,000 0 0 9,800 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
0 0
0 0
0 0
0 0
0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
0
0
0
0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
0 0 0 0 180,000 180 0 0 0 9,000
0 0 0 0 178,000 180 0 0 0 9,000
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
/ SACCHET / PUFF
2021 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2021
KEBUTUHAN BMHP TAHUN 2023 NO
NAMA OBAT
SATUAN
SISA STOK PER PEMAKAIAN JUMLAH 31 DESEMBER RATA-RATA KEBUTUHAN 2021 PER BULAN TAHUN 2023 SELAMA 2021 (a)
BMHP
1 Alkohol
botol
2 Cairan desinfektan ruangan
botol
3 Povidone Iodine 300 ml
botol
4 Cairan desinfektan tangan
botol
5 Blood Lancet
box
6 Sabun tangan atau Anti septik
Botol
7 Desinfektan
Botol
8 Alkohol swab/kapas alkohol
dus
9 Sarung tangan Steril, size 7.0
piece
10 Sarung tangan steril size 7.5
piece
11 Kantong urine
piece
12 Masker
dus
13 Kateter folley Dewasa
piece
14 Sarung tangan non steril
box
15 Infuset dewasa
piece
16 Plester non woven
roll
17 Disposable Syringe 3 cc
dus
18 Disposable Syringe 5 cc
DUS
(b)
(c) = (b) x 18
0
10
180
0
10
180
30
5
90
0
20
360
0
3
54
12
10
180
0
10
180
0
10
180
0
30
540
0
0
0
0
5
90
11
50
900
0
5
90
0
40
720
50
10
180
30
6
108
500
100
1,800
0
10
180
19 Kasa Steril 40 x 40cm
pack
20 Kasa non steril 4m x 10cm
piece
21 Kasa non steril 4m x 5cm
roll
22 Kasa non steril 2m x 80cm
pack
23 Kasa Steril 16 x 16 cm
pack
24 Infuset anak
piece
25 Infuset darah
piece
Infuset dengan wing needle untuk anak 26 dan bayi no 25 Blister Infuset dengan wing needle untuk anak 27 dan bayi no 23 Blister 28 Kateter intravena 20 G/Abocat
piece
29 Kateter intravena 22 G/Abocat
piece
30 Benang Chromic Catgut
Sachet
31 Benang silk
Sachet
32 Kasa non steril 36m x 80cm
roll
33 Kapas Pembalut Hidrofil DRC 250gr
roll
34 Pembalut Elastis 10 cm x 4,55 m
roll
35 Pembalut Elastis 7,5 cm x 4,55 m
roll
36 Sofratul
piece
37 Plester Merah
roll
Jika ada tambahan tulis dibawahnya lagi
400
100
1,800
600
200
3,600
0
100
1,800
0
100
1,800
0
10
180
0
5
90
0
10
180
0
10
180
0
0
0
0
20
360
0
20
360
20
360
40
720
10
180
0
10
180
0
2
36
0
2
36
0
20
360
0
3
54
0
RENCANA RENCANA KEBUTUHAN PENGADAAN TAHUN 2023 TAHUN 2023 (d) = (c) - (a) 180
RENCANA REALISASI HARGA SATUAN JUMLAH HARGA PENGADAA PENGADAAN N TAHUN TAHUN 2021 2022
(e)
(f) 0
(g) 0
0
180
0
0
0
60
0
0
0
360
0
0
0
54
0
0
0
168
0
0
0
180
0
0
0
180
0
0
0
540
0
0
0
0
0
0
0
90
0
0
0
889
0
0
0
90
0
0
0
720
0
0
0
130
0
0
0
78
0
0
0
1,300
0
0
0
180
0
0
0
0 90,000 45,100 36,000 24,200 15,003 29,040 15,972 12,100 8,360 8,360 6,050 125,000 12,100 200,000 5,280 48,235 900 1,200
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1,400
0
0
0
3,000
0
0
0
1,800
0
0
0
1,800
0
0
0
180
0
0
0
90
0
0
0
180
0
0
0
180
0
0
0
0
0
0
0
360
0
0
0
360
0
0
0
360
0
0
0
720
0
0
0
180
0
0
0
180
0
0
0
36
0
0
0
36
0
0
0
360
0
0
0
54
0
0
0
0 1,625 1,535 765 7,760 5,850 10,406 13,976 5,643 5,643 8,355 8,355 42,465 24,205 149,800 27,300 40,692 35,460 22,000 35,532
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DAFTAR PERMOHONAN OBAT DAN BAHAN GIGI TAHUN 2023
NO
NAMA OBAT
SATUAN
SISA STOK PER 31 DESEMBER 2021
PEMAKAIAN JUMLAH RATA-RATA KEBUTUHAN PER BULAN TAHUN 2023 SELAMA 2021
(a) 1
Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 ml
2 3 4
Etil klorida semprot 100 ml Eugenol Formokresol
5
Cavit G / Tumpatan sementara
6 7
Cresofate/Cresotine Pasta Cresotin Liquid II
8
Devitalisasi Pasta (non arsen)
(b)
(c) = (b) x 18
amp botol botol botol
0 0 3 0
20 3 1 0
360 54 18 0
botol botol botol
6 6 10
1 1 2
18 18 36
tube botol botol
0 5 13
1 0 2
18 0 36
12 Cresophene
botol botol
5 0
1 0
18 0
13 Cholorophenol Camphormenthol (CHKM)
botol
5
1
18
14 Cresolformalin (Tricresolformalin) 15 Rockles 16 Pulperyl 17 OCO 18 Etsa 19 Bonding 20 Komposit warna A3 21 Komposit warna A2
botol botol botol botol botol botol botol botol
0 0 0 0 2 4 6 4
1 1 1 1 1 1 1 1
18 18 18 18 18 18 18 18
22 Kalsium hidroksida /Ca(OH)2/ subbase 23 Articulating paper
tube box
4 18
1 0
18 0
24 Bur High speed (round, fisure, inverted)
set
40
3
54
9 Fuji II 10 Fuji IX 11
Elite sement/ Polikarboksilat Cement
25 Arkansas stone 26
Olyco disposable dental needles 27 Septocaine anastesi lokal amp 28 Jarum injeksi 1 ml biji
Jika ada tambahan tulis dibawahnya lagi
0
1
18
1 0
10 10 20
180 180 360
RENCANA RENCANA KEBUTUHAN PENGADAAN TAHUN 2023 TAHUN 2023
(d) = (c) - (a)
360 54 15 0 12 12 26 18 -5 23 13 0 13 18 18 18 18 16 14 12 14 14 -18 14
(e)
HARGA SATUAN
JUMLAH HARGA
18 179 180
obat tambahan /penunjang TAHUN 2023 NO
NAMA OBAT
SATUAN
SISA STOK PER PEMAKAIAN JUMLAH 31 DESEMBER RATA-RATA KEBUTUHAN 2021 PER BULAN TAHUN 2023 SELAMA 2021 (a)
1 2 3 4
(b)
(c) = (b) x 18
Asiklovir salep kulit Aquadest 500 ml KY Jely Ambroxol Syrup
Tube 5 gram
0
20
360
btl Tube btl/60ml
0 0
5 5
90 90
0
150
2700
Betahistin Mesilat tab 6 mg Burnazin zk Cefixim tablet
Tablet tube
0 0
200 5
3600 90
300
5400
Cetrizin tablet 10 mg Cetirizin sirup
Tablet btl
0 0
1500 200
27000 3600
combivet inhalation Doksisiklin kapsul 100mg Diasepam rektal 5 mg Dexocort zk Ergotamin tartrat
pcs
0
40
720
Kapsul pcs tube Tablet
0 0 0 0
10 10 40 0
180 180 720 0
Gentamisin salep kulit 0,1%
0
50
900
Kalium diklofenak tablet 50 mg Kloramfenikol tetes telinga 3%
Tube Tablet Botol
0
1500 20
Ketokonazol krim 2 %
tube 15 gram ampul Btl 60 ml Tablet tablet
50 30
900 540
0
0
0
22
Lidokain Injeksi 2% Metoklopramida syrup 5 mg/5ml Meloksikam tablet 7,5 mg Mutivitamin TABLET
0 0 0
1500
27000
23
0
5000
90000
Mutivitamin sirup
Botol
24
0
20
Multivitamin Herbal Multivitamin syrup herbal
tablet botol
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
25 26 27
Obat batuk herbal Ondansentron inkeksi
ampul
28
Oksitetrasiklin salep kulit
tube 5 gram
29 30 31
Parasetamol supp 250 Phenol gliserin tetes teliga Ranitidin injeksi
32 33
27000 360
360
2500 100
45000 1800
2000
36000
0 0
3 40
54 720
pcs btl ampul
0 0
30 40
540 720
0
4
72
Sefotaxim Injeksi 1 gram
Vial
0
0
0
Thiamfenikol kapsul 500mg
Kapsul
0
50
900
34 34 35 36 37 38
Cazetin Drop obat sariawan
Botol
Kaltrofen Sup Sup ampul Ketorolac injeksi Glukosa 40% Botol Glukosa 10% Botol Glukosa 5% Botol Jika ada tambahan tulis dibawahnya lagi
15
270
5 4 1 1 1
90
72 18 18 18
RENCANA KEBUTUHAN TAHUN 2023
RENCANA HARGA SATUAN PENGADAAN TAHUN 2023
(d) = (c) - (a)
(e)
360 90 90 2700
0 0 0
3600 90
0 0
27000 3600
0
720
0 0
180 180 720 0
0 0 0
900 27000 900 540 0 27000 90000
0
0 0 0 0 0 0 0
360
0
54 720
0
540 720 72 0 900
0 0 0 0 0 0
JUMLAH HARGA
KEBUTUHAN BAHAN LAB.TAHUN 2023 NO
NAMA BARANG
SATUAN
1
Tes golongan darah A
botol
2
Tes golongan darah B
botol
3
Tes golongan darah AB
botol
4
Tes golongan darah D
botol
5
Pot 20 cc
buah
6
Tissue 7 Pot urine
buah
kotak
jml kebutuhan
Harga satuan 3 3 3 3 540 50 540
96,250 96,250 96,250 180,400 1,265 14,960
Jumlah Harga
KEBUTUHAN BELANJA SARANA PENUNJANG KEFARMASIAN 2023 NO
1 2 3 4 5 6 7
NAMA BARANG
Klip obat besar 10 x 15 cm Klip obat tanggung 8,7 x 13 cm Klip obat kecil 7 x 10 cm Sendok syrup Kertas Perkamen Kertas puyer ( Cetak) Pot salep
SATUAN
bungkus/100 bungkus/100 bungkus/100 biji bungkus Pak / 1200 biji
Jika ada tambahan tulis dibawahnya lagi
jml kebutuhan Harga satuan 4000 11,000 4000 9,900 600 7,700 700 880 20 11,000 77,000 150 1,265
Jumlah Harga
