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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

DINAS KESEHATAN KABUPATEN BINTAN

PUSKESMAS : BULAN :
KECAMATAN : TAHUN : 2019
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


1 A C T ( Artesunat 50 mg + Amodiaquin 200 mg ) tablet tablet Rp 1,409 0 0 Rp -
2 Artemeter Injeksi @ 1ml ampul ampul Rp 12,500 0 0 Rp -
3 Artesunat Injeksi vial Rp 19,000 0 0 Rp -
4 Albendazol tablet 400 mg tablet Rp 451 0 0 Rp -
5 Alopurinol tablet 100 mg tablet Rp 99 0 0 Rp -
6 Ambroksol sirup 15 mg/5 ml. @ 60 ml. botol Rp 4,950 0 0 Rp -
7 Ambroksol tablet 30 mg tablet Rp 187 0 0 Rp -
8 Aminofilin injeksi 24 mg / ml @ 10 ml ampul Rp 3,349 0 0 Rp -
9 Aminofilin tablet 200 mg tablet Rp 97 0 0 Rp -
10 Amitriptilin HCl tablet salut 25 mg tablet Rp 165 0 0 Rp -
11 Amlodipin 10 mg tablet tablet Rp 95 0 0 Rp -
12 Amlodipin tablet 5 mg tablet Rp 77 0 0 Rp -
13 Amoksisilin 100 mg/ml drop kering botol Rp 22,990 0 0 Rp -
14 Amoksisilin capsul 250 mg kapsul Rp 196 0 0 Rp -
15 Amoksisilin injeksi 1000 mg vial Rp 10,123 0 0 Rp -
16 Amoksisilin kaplet 500 mg kaplet Rp 248 0 0 Rp -
17 Amoksisilin sirup kering 125 mg / 5 ml botol Rp 1,920 0 0 Rp -
18 Ampisilin serbuk injeksi 1000 mg vial Rp 2,887 0 0 Rp -
19 Antasida DOEN I tablet komb : Al(OH) 200 mg + Mg (OH) 200 mg tablet Rp 188 0 0 Rp -
Antasida DOEN II susp. 60 ml.komb.:Al(OH) 200 mg/5 ml.+Mg(OH) 200
20 mg/5 ml botol Rp 2,098 0 0
Rp -
Anti Bakteri DOEN salap komb : Basitrasin 500 IU/g + Polimiksin 1000
21 IU/g tube Rp 3,490 0 0
Rp -
22 Anti Fungi DOEN komb : As. Benzoat 6 % + As. Salisilat 3 % pot Rp 5,170 0 0 Rp -
23 Anti Hemoroid DOEN kombinasi supp Rp 3,642 0 0 Rp -
24 Anti Malaria DOEN kombinasi : Pirimetamin 25 mg + Sulfadoksin 500 mg tablet Rp 546 0 0
Rp -
25 Anti Migren DOEN kombinasi : Ergotamin Tartrat 1 mg + Koffein 50 mg tablet Rp 129 0 0
Rp -
26 Anti Skabies (Permetrin) 5% krim 10 gr tube Rp 12,155 0 0 Rp -
27 Aqua Dest Steril 500 ml botol Rp 12,100 0 0 Rp -
28 Aqua Pro Injeksi steril 25 ml botol Rp 2,860 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


29 Asam Asetil Salisilat ( Asetosal ) tablet 80 mg tablet Rp 99 0 0 Rp -
30 Asam Askorbat tablet 50 mg tablet Rp 120 0 0 Rp -
31 Asam Askorbat tablet 250 mg tablet Rp 124 0 0 Rp -
32 Asam Folat tablet 0.4 mg tablet Rp 62 0 0 Rp -
33 Asam Mefenamat capsul 250 mg capsul Rp 150 0 0 Rp -
34 Asam Mefenamat kaplet 500 mg kaplet Rp 253 0 0 Rp -
35 Asam Traneksamat injeksi 100 mg @ 5 ml ampul Rp 2,530 0 0 Rp -
36 Asam Traneksamat tablet 500 mg tablet Rp 1,784 0 0 Rp -
37 Asetil sisterina 100mg/5ml drop kering botol Rp 50,820 0 0 Rp -
38 Asetil sisteina 200 mg kapsul kapsul Rp 1,265 0 0 Rp -
39 Asiatikosida krim 1 % @ 10 g tube Rp 56,100 0 0 Rp -
40 Asiklovir krim 5 % @ 5 gram tube Rp 3,447 0 0 Rp -
41 Asiklovir tablet 200 mg tablet Rp 236 0 0 Rp -
42 Asiklovir tablet 400 mg tablet Rp 425 0 0 Rp -
43 Atropin Sulfat Injeksi 0,25mg/ml-1 ml. ampul Rp 1,300 0 0 Rp -
44 Atropin Sulfat Tetes Mata 0,5 % @ 5 ml. tablet Rp 13,500 0 0 Rp -
45 Attapulgite tablet 600 mg tablet Rp 149 0 0 Rp -
46 Benzatin Benzil Penisillin injeksi 2,4 Juta IU vial Rp 16,675 0 0 Rp -
47 Besi sirup dengan mutivitamin mineral 100 ml botol Rp 13,750 0 0 Rp -
48 Betahistin Mesilat tablet 6 mg tablet Rp 110 0 0 Rp -
49 Betametason Krem 0,1 % @ 5 g tube Rp 1,373 0 0 Rp -
50 Bisakodil suppositoria 10 mg dewasa supp Rp 5,800 0 0 Rp -
51 Bisakodil suppositoria 5 mg anak-anak supp Rp 6,000 0 0 Rp -
52 Bisakodil tablet 10 mg tablet Rp 317 0 0 Rp -
53 Bisoprolol tablet 5 mg tablet Rp 316 0 0 Rp -
54 Borax Gliserin solutio 15 ml. botol Rp 3,300 0 0 Rp -
55 Bromheksin sirup 100 ml botol Rp 11,550 0 0 Rp -
56 Bromheksin tablet 8 mg tablet Rp 440 0 0 Rp -
57 Cefadroksil 125 mg / 5 ml sirup kering @ 60ml botol Rp 4,086 0 0 Rp -
58 Cefadroksil 250 mg / 5 ml sirup kering @ 60 ml botol Rp 5,910 0 0 Rp -
59 Cefadroksil kapsul 500 mg capsul Rp 1,155 0 0 Rp -
60 Cefixime 100 mg capsul Rp 923 0 0 Rp -
61 Cefixime 100 mg/5 ml sirup kering @ 30ml botol Rp 5,710 0 0 Rp -
62 Cefotaksim injeksi 1 g vial Rp 6,600 0 0 Rp -
63 Ceftriakson injeksi 1 g vial Rp 13,346 0 0 Rp -
64 Carboxymetyhlcelulose (Cendo Cenfresh) eye drop 5 ml Botol Rp 38,500 0 0 Rp -
65 Cendo Lyteers eye drop 15 ml Botol Rp 24,200 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


66 Cendo Xitrol eye drop 5 ml Botol Rp 33,000 0 0 Rp -
67 Cetirizina Hcl 10 mg/ml tetes botol Rp 60,500 0 0 Rp -
68 Cetirizina kapsul 10 mg kapsul Rp 115 0 0 Rp -
69 Cetirizina sirup 5 mg / 5 ml @ 60 ml botol Rp 3,300 0 0 Rp -
70 Ciprofloksasin kaplet 500 mg kaplet Rp 281 0 0 Rp -
71 Clindamisin Capsul 150 mg capsul Rp 754 0 0 Rp -
72 Deksametason injeksi 5 mg / ml - 1 ml ampul Rp 1,210 0 0 Rp -
73 Deksametason tablet 0,5 mg tablet Rp 34 0 0 Rp -
74 Diazepam injeksi 5 mg / ml - 2 ml ampul Rp 1,913 0 0 Rp -
75 Diazepam larutan Rectal 5 mg/2.5 ml tube Rp 13,384 0 0 Rp -
76 Diazepam tablet 2 mg tablet Rp 242 0 0 Rp -
77 Diazepam tablet 5 mg tablet Rp 109 0 0 Rp -
78 Difenhidramin HCl injeksi 10 mg / ml - 1 ml ampul Rp 1,220 0 0 Rp -
79 Digoksin tablet 0,25 mg tablet Rp 109 0 0 Rp -
80 Dimenhidrinat tablet 50 mg tablet Rp 121 0 0 Rp -
81 Doksisiklin capsul 100 mg capsul Rp 264 0 0 Rp -
82 Domperidon 5 mg/ml drop @ 10ml botol Rp 26,240 0 0 Rp -
83 Domperidon Suspensi 5mg/5ml @ 60 ml botol Rp 2,862 0 0 Rp -
84 Domperidon tablet 10 mg tablet Rp 86 0 0 Rp -
85 Efedrin HCl tablet 25 mg tablet Rp 59 0 0 Rp -
86 Ekstrak Plasenta Gel @ 15 g tube Rp 15,180 0 0 Rp -
87 Epinefrin HCl (Adrenalin) inj 0,1 % - 1 ml ampul Rp 1,518 0 0 Rp -
88 Eritromisin kaplet 500 mg kaplet Rp 781 0 0 Rp -
89 Eritromisin sirup 200 mg / 5 ml botol Rp 7,893 0 0 Rp -
90 Etakridin ( Rivanol ) larutan 0,1 % @ 300 ml. botol Rp 3,450 0 0 Rp -
91 Etambutol tablet 250 mg tablet Rp 178 0 0 Rp -
92 Etanol larutan 70 % @ 100 ml. botol Rp 5,335 0 0 Rp -
93 Etanol larutan 70 % @ 1000 ml. botol Rp 28,750 0 0 Rp -
94 Etil Klorida semprot @100 ml botol Rp 110,000 0 0 Rp -
95 Eugenol cairan 10 ml. botol Rp 20,815 0 0 Rp -
96 Fenilbutazon tablet 200 mg tablet Rp 69 0 0 Rp -
97 Fenobarbital injeksi 50 mg / ml - 2 ml ampul Rp 2,265 0 0 Rp -
98 Fenobarbital tablet 100 mg tablet Rp 276 0 0 Rp -
99 Fenobarbital tablet 30 mg tablet Rp 197 0 0 Rp -
100 Fero Sulfat tablet 300 mg (tablet tambah darah) tablet Rp 43 0 0 Rp -
101 Fitomenadion (Vitamin K1) injeksi 10 mg/ml - 1 ml ampul Rp 5,005 0 0 Rp -
102 Fitomenadion (Vitamin K1) tablet salut gula 10 mg tablet Rp 790 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


103 Fitomenadion (Vitamin K1) 2 mg/ml injeksi ampul Rp 4,236 0 0 Rp -
104 Flavoksat HCl tab. 200 mg tablet Rp 5,244 0 0 Rp -
105 Flukonazol 150 mg kapsul kapsul Rp 20,700 0 0 Rp -
106 Framisetin sulfat gauze dressing 10 cm x 10 cm lembar Rp 20,350 0 0 Rp -
107 Furosemid injeksi 10 mg/ml @ 2 ml. ampul Rp 1,333 0 0 Rp -
108 Furosemid tablet 40 mg tablet Rp 79 0 0 Rp -
109 Gameksan Emulsi 1 % botol Rp 4,400 0 0 Rp -
110 Garam Oralit untuk 200 ml air sachet Rp 273 0 0 Rp -
111 Gemfibrozil capsul 300 mg capsul Rp 436 0 0 Rp -
112 Gemfibrozil capsul 600 mg capsul Rp 853 0 0 Rp -
113 Gentamisin injeksi 40 mg/ml @ 2ml ampul Rp 3,545 0 0 Rp -
114 Gentamisin injeksi 80 mg vial Rp 3,528 0 0 Rp -
115 Gentamisin salep kulit 5 g tube Rp 2,145 0 0 Rp -
116 Gentamisin Sulfat tetes mata 0.3% botol Rp 4,885 0 0 Rp -
117 Gentian Violet larutan 1 % 10 ml botol Rp 3,364 0 0 Rp -
118 Glibenklamid tablet 5 mg tablet Rp 137 0 0 Rp -
119 Glimepiride tablet 1 mg tablet Rp 200 0 0 Rp -
120 Gliseril Guayakolat tablet 100 mg tablet Rp 121 0 0 Rp -
121 Gliserin larutan 50% @ 100 ml botol Rp 6,600 0 0 Rp -
122 Griseofulvin tablet 125 mg, micronized tablet Rp 223 0 0 Rp -
123 Haloperidol 5 mg tablet tablet Rp 98 0 0 Rp -
124 Haloperidol tablet 1,5 mg tablet Rp 74 0 0 Rp -
125 Haloperidol tablet 2 mg tablet Rp 130 0 0 Rp -
126 Hidroklortiazida tablet 25 mg tablet Rp 178 0 0 Rp -
127 Hidrokortison krim 2,5 % @ 5g. tube Rp 2,533 0 0 Rp -
128 Hyoscine-N-Butilbromide injeksi ampul Rp 22,000 0 0 Rp -
129 Hyoscine-N-Butilbromide tablet 10 mg tablet Rp 2,519 0 0 Rp -
130 Ibuprofen Suspensi 100 mg / 5 ml botol Rp 2,560 0 0 Rp -
131 Ibuprofen tablet 200 mg tablet Rp 112 0 0 Rp -
132 Ibuprofen tablet 400 mg tablet Rp 113 0 0 Rp -
133 Ichtyol ( Salap Hitam ) pot Rp 259 0 0 Rp -
134 Ipratrium Br 21 mcg, Salbutamol Sulfat 120 mcg perhirup (Combivent) botol Rp 4,550 0 0 Rp -
135 Isoniazid tablet 100 mg tablet Rp 79 0 0 Rp -
136 Isoniazid tablet 300 mg tablet Rp 170 0 0 Rp -
137 Isosorbid Dinitrat tablet sublingual 5 mg tablet Rp 93 0 0 Rp -
138 Jelly (Ecolab aquagel sterile) 82 g tube Rp 45,543 0 0 Rp -
139 Kalium diklofenak 25 mg tablet tablet Rp 410 0 0 Rp -
140 Kalium diklofenak 50 mg tablet tablet Rp 440 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


141 Kalium Permanganat serbuk 5 g. pot Rp 5,089 0 0 Rp -
142 Kalsium Glukonat injeksi 10% (100 mg/ml) @ 10 ml ampul Rp 8,949 0 0 Rp -
143 Kalsium Laktat tablet 500 mg tablet Rp 104 0 0 Rp -
144 Kanamycin injeksi 1 gram vial Rp 16,000 0 0 Rp -
145 Kaolin Pektin sirup botol Rp 6,262 0 0 Rp -
146 Kaptopril tablet 12,5 mg tablet Rp 65 0 0 Rp -
147 Kaptopril tablet 25 mg tablet Rp 80 0 0 Rp -
148 Kaptopril tablet 50 mg tablet Rp 134 0 0 Rp -
149 Karbamazepin tablet 200 mg tablet Rp 230 0 0 Rp -
150 Karbol (Fenol) Gliserol tetes telinga 10% @ 5 ml botol Rp 2,590 0 0 Rp -
151 Ketokonazol krim 2 % @ 10 g. tube Rp 2,577 0 0 Rp -
152 Ketokonazol tablet 200 mg tablet Rp 286 0 0 Rp -
153 Ketoprofen injeksi 100 mg @ 1 ml ampul Rp 5,933 0 0 Rp -
154 Ketoprofen tablet 100 mg tablet Rp 1,417 0 0 Rp -
155 Ketorolac 30 mg/ml injeksi @ 1ml ampul Rp 1,045 0 0 Rp -
156 Kloramfenikol capsul 250 mg capsul Rp 255 0 0 Rp -
157 Kloramfenikol salap mata 1 % @ 3,5 g. tube Rp 1,925 0 0 Rp -
158 Kloramfenikol suspensi 125 mg / 5 ml. @ 60 ml. botol Rp 4,000 0 0 Rp -
159 Kloramfenikol tetes mata 0,5 % botol Rp 11,550 0 0 Rp -
160 Kloramfenikol tetes telinga 3 % @ 5 ml botol Rp 6,050 0 0 Rp -
161 Klorfeniramin Maleat ( CTM ) tablet 4 mg tablet Rp 24 0 0 Rp -
162 Klorheksidin lar 0.2% (larutan kumur antiseptik gigi) @ 60 ml botol Rp 18,700 0 0 Rp -
163 Klorokuin tablet 150 mg tablet Rp 58 0 0 Rp -
164 Klorpromazin HCl injeksi 25 mg / ml - 1 ml ampul Rp 1,425 0 0 Rp -
165 Klorpromazin HCl tablet salut 25 mg tablet Rp 24 0 0 Rp -
166 Klorpromazin HCl tablet salut 100 mg tablet Rp 179 0 0 Rp -
167 Kodein Fosfat tablet 10 mg tablet Rp 630 0 0 Rp -
Kombinasi anti alergi lotion 100 ml (Kalamin 8%, Difenhidramin HCl 1%,
168 Kamfer 0.1%, Gliserol alkohol 2%) botol Rp 9,900 0 0
Rp -
Kotrimoksazol susp. komb. : Sulfametoksazol 200 mg. + Trimetoprim 40
169 mg/5ml botol Rp 2,052 0 0
Rp -
170 Kotrimoksazol tab dewasa komb : Sulfametoksazol 400 mg+Trimetoprim tablet Rp 214 0 0
80 mg Rp -
Kotrimoksazol tab dewasa komb : Sulfametoksazol 800 mg+Trimetoprim
171 160 mg kaplet Rp 512 0 0
Rp -
172 Krim untuk nyeri @30 gr tube Rp 12,100 0 0 Rp -
173 Kuinin ( Kina ) tablet 200 mg tablet Rp 737 0 0 Rp -
174 Kuinin Injeksi IV 25 % sebagai 2HCl - 2 ml ampul Rp 6,510 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


175 Lactobacillus sachet Rp 4,950 0 0 Rp -
176 Lanzoprazol Kapsul 30 mg kaplet Rp 330 0 0 Rp -
177 Larutan infus Glukosa 10% steril @ 500 ml. botol Rp 7,500 0 0 Rp -
178 Larutan infus Glukosa 40% steril botol Rp 1,525 0 0 Rp -
179 Larutan infus Glukosa 5% steril @ 500 ml botol Rp 6,900 0 0 Rp -
180 Larutan Infus Ringer Laktat steril @ 500 ml botol Rp 7,150 0 0 Rp -
181 Larutan NaCl 0,225 %+ Dextrose 5 % ( cairan 1 : 4 ) infus @ 500 ml. botol Rp 9,350 0 0
Rp -
Larutan NaCl 1,75 g, KCl 1,5 g, Na Laktat 2,24 g, Dextrose 27 g @ 500 ml
182 botol Rp 11,314 0 0
(KaEN 3B) Rp -
183 Larutan Natrium Klorida Infus 0,9 % steril @ 500 ml. botol Rp 6,410 0 0 Rp -
184 Lidocain HCL 2% + Epinefrin 1:80.000 inj @ 2 ml ampul Rp 1,317 0 0 Rp -
185 Lidocain injeksi 2 % @ 2 ml ampul Rp 1,317 0 0 Rp -
186 Lidocain jelly 2% 10 gr syringe Rp 40,000 0 0 Rp -
187 Lidocain semprot 10 % botol Rp 149,100 0 0 Rp -
188 Linkomisin capsul 500 mg capsul Rp 1,167 0 0 Rp -
189 Lisol solutio 1000 ml. botol Rp 24,750 0 0 Rp -
190 Loperamid tablet 2 mg tablet Rp 171 0 0 Rp -
191 Loratadin tablet 10 mg tablet Rp 127 0 0 Rp -
192 Magnesium Sulfat injeksi (IV) 20 % - 25 ml vial Rp 3,200 0 0 Rp -
193 Magnesium Sulfat injeksi (IV) 40 % - 25 ml vial Rp 3,650 0 0 Rp -
194 Mantoux test (PPD 2 UT 1,5) vial Rp 887,700 0 0 Rp -
195 Mebendazol tablet 100 mg tablet Rp 141 0 0 Rp -
196 Meloksikam capsul 15 mg capsul Rp 1,144 0 0 Rp -
197 Metampiron ( Antalgin ) injeksi 500 mg /1 ml ampul Rp 3,050 0 0 Rp -
198 Metampiron ( Antalgin ) tablet 500 mg tablet Rp 242 0 0 Rp -
199 Metformin tablet 500 mg tablet Rp 102 0 0 Rp -
200 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul Rp 3,278 0 0 Rp -
201 Metilergometrin Maleat tablet salut 0,125 mg tablet Rp 495 0 0 Rp -
202 Metilprednisolon tablet 4 mg tablet Rp 139 0 0 Rp -
203 Metoklopramid drop 2 mg/ml @ 10 ml botol Rp 5,200 0 0 Rp -
204 Metoklopramid injeksi 5 mg/ml @ 2 ml ampul Rp 3,904 0 0 Rp -
205 Metoklopramid syrup @ 60 ml. botol Rp 2,750 0 0 Rp -
206 Metoklorpramid tablet 10 mg tablet Rp 83 0 0 Rp -
207 Metronidazol infus botol Rp 10,250 0 0 Rp -
208 Metronidazol sirup 125 mg/5ml botol Rp 3,800 0 0 Rp -
209 Metronidazol tablet 250 mg tablet Rp 98 0 0 Rp -
210 Metronidazol tablet 500 mg tablet Rp 115 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


211 Mikonazol krim 2 % @ 10 g tube Rp 3,926 0 0 Rp -
Multivitamin anak sirup dengan kalsium pidolat 300 mg, Rp -
212 botol Rp 33,636 0 0
fruktooligosakarida 300 mg dan kurkuminoid 2 mg per 5 ml
213 Multivitamin dan mineral tetes sirup@ 15 ml botol Rp 19,250 0 0 Rp -
214 Multivitamin mineral dengan zat besi tablet dewasa tablet Rp 935 0 0 Rp -
215 Natrium Bikarbonat tablet 500 mg tablet Rp 10 0 0 Rp -
216 Natrium Diklofenak emulgel tube Rp 12,161 0 0 Rp -
217 Natrium Diklofenak tab. 25 mg tablet Rp 142 0 0 Rp -
218 Natrium Diklofenak tab. 50 mg tablet Rp 136 0 0 Rp -
219 Natrium Heparina gel @ 20 g tube Rp 20,900 0 0 Rp -
220 Natrium Tiosulfat injeksi 25 % - 10 ml ampul Rp 14,768 0 0 Rp -
221 Neurotropik 5000 Vitamin injeksi ampul Rp 5,500 0 0 Rp -
222 Neurotropik Vitamin tablet tablet Rp 583 0 0 Rp -
223 Nifedipin tablet 10 mg tablet Rp 143 0 0 Rp -
224 Nistatin oral drop botol Rp 38,500 0 0 Rp -
225 Nistatin tablet salut 500.000 IU tablet Rp 881 0 0 Rp -
226 Nistatin tablet vaginal 100.000 IU / g tablet Rp 627 0 0 Rp -
227 Norepinefrin inj 1 mg/ml ampul Rp 55,248 0 0 Rp -
228 Norit (Carbo adsorben) tablet tube Rp 11,000 0 0 Rp -
229 Obat Anti Tuberkulosis Kategori Anak ( FDC ) paket Rp 267,400 0 0 Rp -
230 Obat Anti Tuberkulosis Kategori I ( FDC ) paket Rp 430,539 0 0 Rp -
231 Obat Anti Tuberkulosis Kategori II ( FDC ) paket Rp 1,492,574 0 0 Rp -
232 Obat Anti Tuberkulosis Kategori III paket Rp 154,000 0 0 Rp -
233 Obat Anti Tuberkulosis Sisipan paket Rp 66,000 0 0 Rp -
234 Obat Batuk Hitam ( O B H ) sirup 100 ml. botol Rp 5,500 0 0 Rp -
235 OBH Plus 100 ml (Paracetamol 200 mg, pseudoefedrin 3 mg, CTM 0.5mg, botol Rp 12,100 0 0 Rp -
Amonium klorida 25 mg, Succus liquiritiae 75 mg per 5ml)
236 Oksimetazolin tts hidung 0.025% @10 ml botol Rp 28,928 0 0 Rp -
237 Oksimetazolin tts hidung 0.05% @10 ml botol Rp 36,000 0 0 Rp -
238 Oksitetrasiklin HCl injeksi i.m 50 mg/ ml - 10 ml vial Rp 3,255 0 0 Rp -
239 Oksitetrasiklin HCl salap 3 % 5 g tube Rp 1,760 0 0 Rp -
240 Oksitetrasiklin HCl salap mata 1 % @ 3,5 g. tube Rp 2,600 0 0 Rp -
241 Oksitoksin inj 10 IU / ml-1 ml ampul Rp 1,900 0 0 Rp -
242 Omeprazol capsul 20 mg capsul Rp 138 0 0 Rp -
243 Ondansetron injeksi 4mg/2ml @ 2ml ampul Rp 1,254 0 0 Rp -
244 Ondansetron tablet 8mg tablet Rp 404 0 0 Rp -
245 Pancreatin komb. tablet tablet Rp 880 0 0 Rp -
246 Papaverin inj 40 mg / ml ampul Rp 716 0 0 Rp -
247 Papaverin tablet 40 mg tablet Rp 190 0 0 Rp -
248 Parasetamol 125 mg rektal Suppos Rp 15,840 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


249 Parasetamol 250 mg rektal Suppos Rp 30,800 0 0 Rp -
250 Parasetamol drop 100 mg/ml @ 10ml botol Rp 7,646 0 0 Rp -
251 Parasetamol syr 120mg / 5 ml @ 60 ml botol Rp 1,160 0 0 Rp -
252 Parasetamol tablet 500 mg tablet Rp 143 0 0 Rp -
253 Perak sulfadiazin krim 1% tube Rp 24,150 0 0 Rp -
254 Pirantel tablet 125 mg tablet Rp 331 0 0 Rp -
255 Pirasetam inj ampul Rp 2,021 0 0 Rp -
256 Pirasetam tablet 400 mg tablet Rp 495 0 0 Rp -
257 Piratiazin teoklat 40 mg, Piridoksin HCl 30 mg tablet tablet Rp 2,640 0 0 Rp -
258 Pirazinamid tablet 500 mg tablet Rp 248 0 0 Rp -
259 Piridoksin tablet 10 mg tablet Rp 141 0 0 Rp -
260 Piridoksin injeksi 1 ml. ampul Rp 1,050 0 0 Rp -
261 Piroksikam capsul 10 mg capsul Rp 121 0 0 Rp -
262 Piroksikam tablet 20 mg tablet Rp 143 0 0 Rp -
263 Povidon Iodida 10 % 30 ml botol Rp 3,335 0 0 Rp -
264 Povidon Iodida 10 % 300 ml botol Rp 20,700 0 0 Rp -
265 Prednison tablet 5 mg tablet Rp 85 0 0 Rp -
266 Primakuin tablet 15 mg tablet Rp 258 0 0 Rp -
267 Prokain Benzil Penisillin injeksi 3 Juta IU vial Rp 375 0 0 Rp -
268 Propanolol HCl tablet 40 mg tablet Rp 82 0 0 Rp -
269 Propanolol tablet 10 mg tablet Rp 69 0 0 Rp -
270 Propiltiourasil tablet 100 mg tablet Rp 335 0 0 Rp -
271 Psidii folium 250 mg/5ml @ 60 ml botol Rp 37,400 0 0 Rp -
272 Ranitidine Inj 25 mg/ml @ 2 ml ampul Rp 1,155 0 0 Rp -
273 Ranitidine tablet 150 mg tablet Rp 253 0 0 Rp -
274 Reserpin tablet 0,10 mg tablet Rp 26 0 0 Rp -
275 Reserpin tablet 0,25 mg tablet Rp 45 0 0 Rp -
276 Retinol (Vitamin A) Dosis Tinggi 100.000 IU capsul Rp 327 0 0 Rp -
277 Retinol (Vitamin A) Dosis Tinggi 200.000 IU capsul Rp 582 0 0 Rp -
278 Rifampisin capsul 300 mg capsul Rp 785 0 0 Rp -
279 Rifampisin kaplet 450 mg kaplet Rp 1,031 0 0 Rp -
280 Rifampisin kaplet 600 mg kaplet Rp 1,420 0 0 Rp -
281 Salap 2 - 4 Kombinasi : As.Salisilat 2 % + Belerang Endap 4 % @ 30 g pot Rp 3,013 0 0
Rp -
282 Salbutamol inhalasi 100 mcg/dosis @ 200 dosis botol Rp 41,250 0 0 Rp -
283 Salbutamol Nebules cairan ih 0.1% @ 2.5ml ampul Rp 11,935 0 0 Rp -
284 Salbutamol sulfat 1,2 mg guriafenisin 50 mg/5ml@ 100ml botol Rp 52,800 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


285 Salbutamol tablet 2 mg tablet Rp 64 0 0 Rp -
286 Salbutamol tablet 4 mg tablet Rp 77 0 0 Rp -
287 Salisil Bedak 2 % @ 50 g dus Rp 6,600 0 0 Rp -
288 Serum Anti Bisa Ular I injeksi (ABU I) (im/iv) @ 5ml vial Rp 479,996 0 0 Rp -
289 Serum Anti Difteri injeksi 20.000 IU / vial (ADS) vial Rp 732,848 0 0 Rp -
290 Serum Anti Tetanus injeksi 1.500 IU/ml (ATS) @1 ml ampul Rp 130,999 0 0 Rp -
291 Serum Anti Tetanus injeksi 20.000 IU / Vial (ATS) vial Rp 505,800 0 0 Rp -
292 Sianokobalamin injeksi 500 mcg/ml - 1 ml ampul Rp 1,087 0 0 Rp -
293 Sianokobalamin tablet 50 mcg tablet Rp 49 0 0 Rp -
294 Simvastatin tablet 10 mg tablet Rp 110 0 0 Rp -
295 Simvastatin 20 mg tablet tablet Rp 225 0 0 Rp -
296 Streptomisin injeksi 1500 mg / ml @ 15 ml. vial Rp 54,840 0 0 Rp -
297 Teofilin Tablet 150 mg tablet Rp 310 0 0 Rp -
298 Terbutalin tablet 2,5 mg tablet Rp 88 0 0 Rp -
299 Tetrasiklin HCl kapsul 500 mg capsul Rp 329 0 0 Rp -
300 Tiamfenikol capsul 500 mg capsul Rp 1,132 0 0 Rp -
301 Tiamin HCl injeksi 100 mg / ml - 1 ml ampul Rp 1,035 0 0 Rp -
302 Tiamin HCl tablet 50 mg tablet Rp 91 0 0 Rp -
303 Timolol 0.5% tetes mata 5 ml botol Rp 9,996 0 0 Rp -
304 Tramadol capsul 50 mg capsul Rp 88 0 0 Rp -
305 Tramadol Injeksi 50 mg/ml @ 2ml ampul Rp 1,984 0 0 Rp -
306 Triheksifenidil Hidroklorida tab 2 mg tablet Rp 56 0 0 Rp -
307 Tripolidin Hcl 1.25mg, Pseudoefedrin Hcl 30mg/5ml @100 ml botol Rp 19,800 0 0 Rp -
308 Tripolidin HCl 2.5 mg, Pseudoefedrin 60 mg tablet tablet Rp 1,386 0 0 Rp -
309 Vitamin B-Kompleks tablet tablet Rp 135 0 0 Rp -
310 Zinc siup 20 mg/5 ml @ 60 ml botol Rp 4,959 0 0 Rp -
311 Zinc tablet dispersible 20 mg tablet Rp 604 0 0 Rp -
BAHAN HABIS PAKAI
312 Alat Suntik Sekali Pakai 1 ml pcs Rp 1,614 0 0 Rp -
313 Alat Suntik Sekali Pakai 3 ml pcs Rp 857 0 0 Rp -
314 Alat Suntik Sekali Pakai 5 ml pcs Rp 1,065 0 0 Rp -
315 Alat Suntik Sekali Pakai 10 ml pcs Rp 1,200 0 0 Rp -
316 Alcohol swab pcs Rp 173 0 0 Rp -
317 Antiseptik tangan dengan dibilas 500 ml botol Rp 71,875 0 0 Rp -
318 Antiseptik tangan tanpa dibilas 500 ml botol Rp 63,900 0 0 Rp -
319 Arm sling ukuran S pcs Rp 17,424 0 0 Rp -
320 Arm sling ukuran M pcs Rp 17,424 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


321 Arm sling ukuran L pcs Rp 17,424 0 0 Rp -
322 Autoclick lancing device pcs Rp 18,287 0 0 Rp -
323 Bistury / mata pisau bedah pcs Rp 3,150 0 0 Rp -
324 Blood lancet pcs Rp 153 0 0 Rp -
325 Box Slide (kotak slides) isi untuk 50 slides kotak Rp 41,489 0 0 Rp -
326 Cat Gut Chromic No. 2/0 DS 19 mm pcs Rp 41,685 0 0 Rp -
327 Cat Gut Chromic No. 3/0 DS 19 mm pcs Rp 41,685 0 0 Rp -
328 Cat Gut Plain No. 2/0 DS 19 mm pcs Rp 41,685 0 0 Rp -
329 Cat Gut Plain No. 3/0 DS 19 mm pcs Rp 41,685 0 0 Rp -
330 Cervical collar universal (neck collar) pcs Rp 127,776 0 0 Rp -
331 Disposible Blood Transfution set Rp 13,976 0 0 Rp -
332 Feeding tube 3,5 fr (3,5cm) set Rp 8,841 0 0 Rp -
333 Folley Catheter 2. W 30 cc No.14 pcs Rp 59,960 0 0 Rp -
334 Folley Catheter 2. W 30 cc No.16 pcs Rp 59,960 0 0 Rp -
335 Folley Catheter 2. W 30 cc No.18 pcs Rp 59,960 0 0 Rp -
336 Handscoon No.6,5 steril pasang Rp 7,255 0 0 Rp -
337 Handscoon No.7 steril pasang Rp 7,255 0 0 Rp -
338 Handscoon No.7.5 steril pasang Rp 7,255 0 0 Rp -
339 Handscoon (gloves) ukuran L pcs Rp 564 0 0 Rp -
340 Handscoon (gloves) ukuran M pcs Rp 564 0 0 Rp -
341 Handscoon (gloves) ukuran S pcs Rp 564 0 0 Rp -
342 Handschoon obgyn steril pasang Rp 21,296 0 0 Rp -
343 I.V. Canula Venocath No. 20 pcs Rp 16,088 0 0 Rp -
344 I.V. Canula Venocath No. 22 pcs Rp 16,088 0 0 Rp -
345 I.V. Canula Venocath No. 26 pcs Rp 14,824 0 0 Rp -
346 I.V. Catheter Nomor 18 pcs Rp 13,779 0 0 Rp -
347 I.V. Catheter Nomor 20 pcs Rp 8,355 0 0 Rp -
348 I.V. Catheter Nomor 22 pcs Rp 13,779 0 0 Rp -
349 I.V. Catheter Nomor 24 pcs Rp 8,355 0 0 Rp -
350 Infus Set Anak set Rp 10,406 0 0 Rp -
351 Infus Set Dewasa set Rp 5,940 0 0 Rp -
352 Kapas Berlemak 500 gram roll Rp 18,150 0 0 Rp -
353 Kapas Pembalut / Absorben 250 gram roll Rp 13,750 0 0 Rp -
354 Kasa Hidrofil 40 x 80 cm roll Rp 115,500 0 0 Rp -
355 Kasa hidrofil 36 x 80 cm roll Rp 143,500 0 0 Rp -
356 Kasa Hidrofil Steril 18 x 22 cm (isi 12 lbr) bungkus Rp 8,000 0 0 Rp -
357 Kasa Kompres 40 cm x 40 cm bungkus Rp 1,760 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


358 Kasa Pembalut 16 x 16 steril kotak Rp 8,800 0 0 Rp -
359 Kasa Pembalut 2 m x 80 cm bungkus Rp 10,419 0 0 Rp -
360 Kasa Pembalut Hidrofil 4 m x 10 cm roll Rp 3,561 0 0 Rp -
361 Kasa Pembalut Hidrofil 4 m x 15 cm roll Rp 2,310 0 0 Rp -
362 Kasa Pembalut Hidrofil 4 m x 3 cm roll Rp 649 0 0 Rp -
363 Kasa Pembalut Hidrofil 4 m x 5 cm roll Rp 825 0 0 Rp -
364 Mask (sungkup) oksigen anak pcs Rp 14,907 0 0 Rp -
365 Mask (sungkup) oksigen dewasa pcs Rp 14,907 0 0 Rp -
366 Masker hi oxygen dewasa (non rebreathing mask) pcs Rp 27,104 0 0 Rp -
367 Masker Disposible 3 ply pcs Rp 397 0 0 Rp -
368 Masker N95 pcs Rp 19,500 0 0 Rp -
369 Nasal canula anak pcs Rp 6,050 0 0 Rp -
370 Nasal canula bayi pcs Rp 6,050 0 0 Rp -
371 Nasal canula dewasa pcs Rp 6,050 0 0 Rp -
372 Needle Terumo 23 G pcs Rp 1,518 0 0 Rp -
373 Needle Terumo 24 G pcs Rp 330 0 0 Rp -
374 Needle Terumo 25 G pcs Rp 330 0 0 Rp -
375 Pembalut elastis ukuran 4 inci (10 cm x 4.55 m) roll Rp 33,000 0 0 Rp -
376 Pembalut elastis ukuran 6 inci (15 cm x 4.55 m) roll Rp 41,910 0 0 Rp -
377 Pembalut Gips roll Rp 5,600 0 0 Rp -
378 Plester 5 cm x 5 m roll Rp 29,455 0 0 Rp -
379 Plester kertas 9.2 m X 2,5 cm dengan pemotong roll Rp 9,943 0 0 Rp -
380 Plester Tahan Air ( 25 cm x 10 cm ) pcs Rp 14,459 0 0 Rp -
381 Plester transparan 5 m X 1,25 cm roll Rp 16,500 0 0 Rp -
382 S i l k ( Benang Bedah Sutera ) No. 1 DS 24 mm sachet Rp 31,040 0 0 Rp -
383 S i l k ( Benang Bedah Sutera ) No. 2/0 DS 19 mm sachet Rp 31,765 0 0 Rp -
384 S i l k ( Benang Bedah Sutera ) No. 3/0 DS 19 mm sachet Rp 31,765 0 0 Rp -
385 S i l k ( Benang Bedah Sutera ) No. 4/0 DS 19 mm sachet Rp 31,765 0 0 Rp -
386 Speculum vaginal disposible pcs Rp 11,220 0 0 Rp -
387 Underpad ukuran 60x90 cm steril pcs Rp 8,399 0 0 Rp -
388 Urine Bag set Rp 8,804 0 0 Rp -
PERBEKALAN KESEHATAN GIGI
389 Air Raksa Dental Use 100 G. botol Rp 220,000 0 0 Rp -
390 Bahan pengisi saluran akar gigi set Rp 709,500 0 0 Rp -
391 Bonding refill set Rp 302,500 0 0 Rp -
392 Cairan Irigasi NaOCl 5% dan EDTA 5% inf 1000 ml botol Rp 290,000 0 0 Rp -
393 Devitalisasi Pasta ( Non Arsen ) botol Rp 277,200 0 0 Rp -
394 Echant (etching) set Rp 287,100 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


395 Glass Ionomer semen (serbuk + larutan) anterior set Rp 891,000 0 0 Rp -
396 Glass Ionomer semen (serbuk + larutan) posterior set Rp 675,400 0 0 Rp -
397 Gutta percha kotak Rp 37,400 0 0 Rp -
398 Kalsium Hidroksida pasta @ 2 tube set Rp 1,063,700 0 0 Rp -
399 Klorfenol Kamfer Mentol ( CHKM ) cairan 10 ml. botol Rp 62,700 0 0 Rp -
400 Micro brush ktk Rp 74,800 0 0 Rp -
401 Mummifying Pasta botol Rp 600,600 0 0 Rp -
402 Semen Seng Fosfat serbuk & Cairan set Rp 723,250 0 0 Rp -
403 Silver Amalgam serbuk 65 - 75 % 1 oz set Rp 410,300 0 0 Rp -
404 Spons gelatin Cubicles 1 x 1 x 1 cm @ 24 pcs kotak Rp 106,700 0 0 Rp -
405 Temporary Stopping Fletcher serbuk 100 g. & cairan set Rp 199,100 0 0 Rp -
406 Trikresol Formalin (TKF) botol Rp 75,900 0 0 Rp -
407 Tumpatan Composite (Light cured) set Rp 3,411,430 0 0 Rp -
408 Tumpatan Composite Anterior A2 Tube Rp 389,400 0 0 Rp -
409 Tumpatan Composite Anterior A3 Tube Rp 269,500 0 0 Rp -
410 Tumpatan Composite Anterior A3.5 Tube Rp 389,400 0 0 Rp -
411 Tumpatan sementara (Caviton) set Rp 193,600 0 0 Rp -
412 Turbocaina (pengganti cresophene) ktk Rp 404,800 0 0 Rp -
BAHAN LABORATORIUM (REAGEN KIMIA)
413 Dect Glass / cover glass pcs Rp 221 0 0 Rp -
414 Developer 20 lt jerigen Rp 1,327,491 0 0 Rp -
415 Fixer 20 lt jerigen Rp 818,582 0 0 Rp -
416 Film Rongent dental 3 x 4 pcs Rp 18,227 0 0 Rp -
417 Film Rongent uk 24 x 30 pcs Rp 25,480 0 0 Rp -
418 Film Rongent uk 30 x 40 pcs Rp 40,508 0 0 Rp -
419 Film Rongent uk 35 x 35 pcs Rp 43,992 0 0 Rp -
420 Filter Paper pcs Rp 1,150 0 0 Rp -
421 Larutan Anisol 100 ml botol Rp 264,550 0 0 Rp -
422 Larutan Asam Asetat6% 100 ml botol Rp 44,000 0 0 Rp -
423 Larutan Asam Klorida 0,1N 100 ml botol Rp 25,521 0 0 Rp -
424 Larutan Asam sulfosalisilat 20 % 100 ml. botol Rp 309,600 0 0 Rp -
425 Larutan Benedict 100 ml. botol Rp 55,950 0 0 Rp -
426 Larutan Eosin 2 % 100 ml. botol Rp 181,825 0 0 Rp -
427 Larutan Etanol Asam 3% 100 ml. botol Rp 79,750 0 0 Rp -
428 Larutan Giemsa Stain 100 ml. botol Rp 361,850 0 0 Rp -
429 Larutan H2O2 3% @ 100 ml botol Rp 100,430 0 0 Rp -
430 Larutan Hayem 100 ml botol Rp 65,450 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


431 Larutan Karbol Fuchsin 100 ml. botol Rp 100,100 0 0 Rp -
432 Larutan KOH 10% 100 ml botol Rp 56,900 0 0 Rp -
433 Larutan Mersi Oil 100 ml botol Rp 403,650 0 0 Rp -
434 Larutan Metanol 100 ml. botol Rp 62,700 0 0 Rp -
435 Larutan Metilen Biru 100 ml. botol Rp 79,750 0 0 Rp -
436 Larutan Natrium Citras 3 % @100 ml botol Rp 55,475 0 0 Rp -
437 Larutan Ress echer 100 ml botol Rp 52,150 0 0 Rp -
438 Larutan Turk 100 ml. botol Rp 29,350 0 0 Rp -
439 Larutan Ziehl Nielsen paket Rp 178,750 0 0 Rp -
440 Lidi Vagina pcs Rp 3,339 0 0 Rp -
441 Object glass / Slide Glass pcs Rp 269 0 0 Rp -
442 Pot Sputum pcs Rp 3,900 0 0 Rp -
443 Rapid test for Dengue IgG/IgM pcs Rp 66,704 0 0 Rp -
444 Rapid test for Dengue Ns1 (oncoprobe) pcs Rp 181,720 0 0 Rp -
445 Rapid test HBsAg Antigen (Prog utk Bumil) pcs Rp 11,047 0 0 Rp -
446 Rapid test for Malaria Pan/Pf (Fokus) pcs Rp 47,397 0 0 Rp -
447 Rapid test for Malaria Pf dan Pv (Fokus) pcs Rp 53,260 0 0 Rp -
448 Rapid test HIV 1/2 pcs Rp 15,377 0 0 Rp -
449 Rapid test HIV Lini 2 (triline) pcs Rp 52,425 0 0 Rp -
450 Rapid test HIV Lini 3 (Oncoprobe) pcs Rp 85,800 0 0 Rp -
451 Rapid test HIV Lini I (SD) pcs Rp 72,700 0 0 Rp -
452 Rapid test sipilis pcs Rp 13,904 0 0 Rp -
453 Reagen Pemeriksa Gol Darah Anti A @10 ml botol Rp 116,600 0 0 Rp -
454 Reagen Pemeriksa Gol Darah Anti B @ 10 ml botol Rp 116,600 0 0 Rp -
455 RPR pcs Rp 4,557 0 0 Rp -
456 Stick asam urat pcs Rp 11,132 0 0 Rp -
457 Stick cholestrol pcs Rp 27,510 0 0 Rp -
458 Stick gula darah pcs Rp 5,162 0 0 Rp -
459 Tabung Hematokrit pcs Rp 1,510 0 0 Rp -
460 Tabung Vacutener tutup ungu dengan anti koagulan 3 ml pcs Rp 2,860 0 0 Rp -
461 Tes Kehamilan pcs Rp 2,133 0 0 Rp -
462 TPHA pcs Rp 19,435 0 0 Rp -
463 Urinalysa 10 Parameter pcs Rp 1,477 0 0 Rp -
464 Urinalysa 3 Parameter pcs Rp 1,097 0 0 Rp -
465 Tes Kehamilan pcs Rp 7,261 0 0 Rp -
466 TPHA pcs Rp 19,435 0 0 Rp -
467 Urinalysa 10 Parameter pcs Rp 1,477 0 0 Rp -
HARGA STOK PENERIM PERSEDI PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN SATUAN AWAL AAN AAN IAN AKHIR OPTIMUM AAN AN TOTAL HARGA KET

1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14


468 Urinalysa 3 Parameter pcs Rp 1,097 0 0 Rp -
JUMLAH TOTAL PERSEDIAAN

UMUM BPJS JUMLAH


JUMLAH KUNJUNGAN RESEP

Menyetujui Yang Menyerahkan Yang Melapor Petugas Pengelola Obat


Kepala Dinas Kesehatan Kepala Instalasi Farmasi Kepala Puskesmas Puskesmas
Kabupaten Bintan Kabupaten Bintan ..................................... ………………………..

(..........................................) (......................................) (......................................) (......................................)


LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) TAHUN 2018 (LAPORAN TAHUNAN)
PUSKESMAS ……………………………………….

HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA


NO NAMA OBAT SATUAN SATUAN AWAL 1 JAN-DES 2018 JAN-DES 2018 31 DES STOK
JAN 2018 2018
1 2 3 4 5 6 7 8 9=4*8
1 A C T ( Artesunat 50 mg + Amodiaquin 200 mg ) tablet tablet Rp 1,409 0
2 Artemeter Injeksi @ 1ml ampul ampul Rp 12,500 0
3 Artesunat Injeksi vial Rp 19,000 0
4 Albendazol tablet 400 mg tablet Rp 451 0
5 Alopurinol tablet 100 mg tablet Rp 99 0
6 Ambroksol sirup 15 mg/5 ml. @ 60 ml. botol Rp 4,950 0
7 Ambroksol tablet 30 mg tablet Rp 187 0
8 Aminofilin injeksi 24 mg / ml @ 10 ml ampul Rp 3,349 0
9 Aminofilin tablet 200 mg tablet Rp 97 0
10 Amitriptilin HCl tablet salut 25 mg tablet Rp 165 0
11 Amlodipin 10 mg tablet tablet Rp 95 0
12 Amlodipin tablet 5 mg tablet Rp 77 0
13 Amoksisilin 100 mg/ml drop kering botol Rp 22,990 0
14 Amoksisilin capsul 250 mg kapsul Rp 196 0
15 Amoksisilin injeksi 1000 mg vial Rp 10,123 0
16 Amoksisilin kaplet 500 mg kaplet Rp 248 0
17 Amoksisilin sirup kering 125 mg / 5 ml botol Rp 1,920 0
18 Ampisilin serbuk injeksi 1000 mg vial Rp 2,887 0
19 Antasida DOEN I tablet komb : Al(OH) 200 mg + Mg (OH) 200 mg tablet Rp 188 0

Antasida DOEN II susp. 60 ml.komb.:Al(OH) 200 mg/5 ml.+Mg(OH) 200


20 mg/5 ml botol Rp 2,098 0

Anti Bakteri DOEN salap komb : Basitrasin 500 IU/g + Polimiksin 1000
21 IU/g tube Rp 3,490 0
22 Anti Fungi DOEN komb : As. Benzoat 6 % + As. Salisilat 3 % pot Rp 5,170 0
23 Anti Hemoroid DOEN kombinasi supp Rp 3,642 0
Anti Malaria DOEN kombinasi : Pirimetamin 25 mg + Sulfadoksin 500
24 mg tablet Rp 546 0

25 Anti Migren DOEN kombinasi : Ergotamin Tartrat 1 mg + Koffein 50 mg tablet Rp 129 0


26 Anti Skabies (Permetrin) 5% krim 10 gr tube Rp 12,155 0
27 Aqua Dest Steril 500 ml botol Rp 12,100 0
28 Aqua Pro Injeksi steril 25 ml botol Rp 2,860 0
29 Asam Asetil Salisilat ( Asetosal ) tablet 80 mg tablet Rp 99 0
30 Asam Askorbat tablet 50 mg tablet Rp 120 0
31 Asam Askorbat tablet 250 mg tablet Rp 124 0
32 Asam Folat tablet 0.4 mg tablet Rp 62 0
33 Asam Mefenamat capsul 250 mg capsul Rp 150 0
34 Asam Mefenamat kaplet 500 mg kaplet Rp 253 0
35 Asam Traneksamat injeksi 100 mg @ 5 ml ampul Rp 2,530 0
36 Asam Traneksamat tablet 500 mg tablet Rp 1,784 0
37 Asetil sisterina 100mg/5ml drop kering botol Rp 50,820 0
38 Asetil sisteina 200 mg kapsul kapsul Rp 1,265 0
39 Asiatikosida krim 1 % @ 10 g tube Rp 56,100 0
40 Asiklovir krim 5 % @ 5 gram tube Rp 3,447 0
41 Asiklovir tablet 200 mg tablet Rp 236 0
42 Asiklovir tablet 400 mg tablet Rp 425 0
43 Atropin Sulfat Injeksi 0,25mg/ml-1 ml. ampul Rp 1,300 0
44 Atropin Sulfat Tetes Mata 0,5 % @ 5 ml. tablet Rp 13,500 0
45 Attapulgite tablet 600 mg tablet Rp 149 0
46 Benzatin Benzil Penisillin injeksi 2,4 Juta IU vial Rp 16,675 0
47 Besi sirup dengan mutivitamin mineral 100 ml botol Rp 13,750 0
48 Betahistin Mesilat tablet 6 mg tablet Rp 110 0
49 Betametason Krem 0,1 % @ 5 g tube Rp 1,373 0
50 Bisakodil suppositoria 10 mg dewasa supp Rp 5,800 0
51 Bisakodil suppositoria 5 mg anak-anak supp Rp 6,000 0
52 Bisakodil tablet 10 mg tablet Rp 317 0
53 Bisoprolol tablet 5 mg tablet Rp 316 0
54 Borax Gliserin solutio 15 ml. botol Rp 3,300 0
55 Bromheksin sirup 100 ml botol Rp 11,550 0
56 Bromheksin tablet 8 mg tablet Rp 440 0
57 Cefadroksil 125 mg / 5 ml sirup kering @ 60ml botol Rp 4,086 0
58 Cefadroksil 250 mg / 5 ml sirup kering @ 60 ml botol Rp 5,910 0
59 Cefadroksil kapsul 500 mg capsul Rp 1,155 0
60 Cefixime 100 mg capsul Rp 923 0
61 Cefixime 100 mg/5 ml sirup kering @ 30ml botol Rp 5,710 0
62 Cefotaksim injeksi 1 g vial Rp 6,600 0
63 Ceftriakson injeksi 1 g vial Rp 13,346 0
64 Carboxymetyhlcelulose (Cendo Cenfresh) eye drop 5 ml Botol Rp 38,500 0
65 Cendo Lyteers eye drop 15 ml Botol Rp 24,200 0
66 Cendo Xitrol eye drop 5 ml Botol Rp 33,000 0
67 Cetirizina Hcl 10 mg/ml tetes botol Rp 60,500 0
68 Cetirizina kapsul 10 mg kapsul Rp 115 0
69 Cetirizina sirup 5 mg / 5 ml @ 60 ml botol Rp 3,300 0
70 Ciprofloksasin kaplet 500 mg kaplet Rp 281 0
71 Clindamisin Capsul 150 mg capsul Rp 754 0
72 Deksametason injeksi 5 mg / ml - 1 ml ampul Rp 1,210 0
73 Deksametason tablet 0,5 mg tablet Rp 34 0
74 Diazepam injeksi 5 mg / ml - 2 ml ampul Rp 1,913 0
HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA
NO NAMA OBAT SATUAN AWAL 1 31 DES
SATUAN JAN 2018 JAN-DES 2018 JAN-DES 2018 2018 STOK

1 2 3 4 5 6 7 8 9=4*8
75 Diazepam larutan Rectal 5 mg/2.5 ml tube Rp 13,384 0
76 Diazepam tablet 2 mg tablet Rp 242 0
77 Diazepam tablet 5 mg tablet Rp 109 0
78 Difenhidramin HCl injeksi 10 mg / ml - 1 ml ampul Rp 1,220 0
79 Digoksin tablet 0,25 mg tablet Rp 109 0
80 Dimenhidrinat tablet 50 mg tablet Rp 121 0
81 Doksisiklin capsul 100 mg capsul Rp 264 0
82 Domperidon 5 mg/ml drop @ 10ml botol Rp 26,240 0
83 Domperidon Suspensi 5mg/5ml @ 60 ml botol Rp 2,862 0
84 Domperidon tablet 10 mg tablet Rp 86 0
85 Efedrin HCl tablet 25 mg tablet Rp 59 0
86 Ekstrak Plasenta Gel @ 15 g tube Rp 15,180 0
87 Epinefrin HCl (Adrenalin) inj 0,1 % - 1 ml ampul Rp 1,518 0
88 Eritromisin kaplet 500 mg kaplet Rp 781 0
89 Eritromisin sirup 200 mg / 5 ml botol Rp 7,893 0
90 Etakridin ( Rivanol ) larutan 0,1 % @ 300 ml. botol Rp 3,450 0
91 Etambutol tablet 250 mg tablet Rp 178 0
92 Etanol larutan 70 % @ 100 ml. botol Rp 5,335 0
93 Etanol larutan 70 % @ 1000 ml. botol Rp 28,750 0
94 Etil Klorida semprot @100 ml botol Rp 110,000 0
95 Eugenol cairan 10 ml. botol Rp 20,815 0
96 Fenilbutazon tablet 200 mg tablet Rp 69 0
97 Fenobarbital injeksi 50 mg / ml - 2 ml ampul Rp 2,265 0
98 Fenobarbital tablet 100 mg tablet Rp 276 0
99 Fenobarbital tablet 30 mg tablet Rp 197 0
100 Fero Sulfat tablet 300 mg (tablet tambah darah) tablet Rp 43 0
101 Fitomenadion (Vitamin K1) injeksi 10 mg/ml - 1 ml ampul Rp 5,005 0
102 Fitomenadion (Vitamin K1) tablet salut gula 10 mg tablet Rp 790 0
103 Fitomenadion (Vitamin K1) 2 mg/ml injeksi ampul Rp 4,236 0
104 Flavoksat HCl tab. 200 mg tablet Rp 5,244 0
105 Flukonazol 150 mg kapsul kapsul Rp 20,700 0
106 Framisetin sulfat gauze dressing 10 cm x 10 cm lembar Rp 20,350 0
107 Furosemid injeksi 10 mg/ml @ 2 ml. ampul Rp 1,333 0
108 Furosemid tablet 40 mg tablet Rp 79 0
109 Gameksan Emulsi 1 % botol Rp 4,400 0
110 Garam Oralit untuk 200 ml air sachet Rp 273 0
111 Gemfibrozil capsul 300 mg capsul Rp 436 0
112 Gemfibrozil capsul 600 mg capsul Rp 853 0
113 Gentamisin injeksi 40 mg/ml @ 2ml ampul Rp 3,545 0
114 Gentamisin injeksi 80 mg vial Rp 3,528 0
115 Gentamisin salep kulit 5 g tube Rp 2,145 0
116 Gentamisin Sulfat tetes mata 0.3% botol Rp 4,885 0
117 Gentian Violet larutan 1 % 10 ml botol Rp 3,364 0
118 Glibenklamid tablet 5 mg tablet Rp 137 0
119 Glimepiride tablet 1 mg tablet Rp 200 0
120 Gliseril Guayakolat tablet 100 mg tablet Rp 121 0
121 Gliserin larutan 50% @ 100 ml botol Rp 6,600 0
122 Griseofulvin tablet 125 mg, micronized tablet Rp 223 0
123 Haloperidol 5 mg tablet tablet Rp 98 0
124 Haloperidol tablet 1,5 mg tablet Rp 74 0
125 Haloperidol tablet 2 mg tablet Rp 130 0
126 Hidroklortiazida tablet 25 mg tablet Rp 178 0
127 Hidrokortison krim 2,5 % @ 5g. tube Rp 2,533 0
128 Hyoscine-N-Butilbromide injeksi ampul Rp 22,000 0
129 Hyoscine-N-Butilbromide tablet 10 mg tablet Rp 2,519 0
130 Ibuprofen Suspensi 100 mg / 5 ml botol Rp 2,560 0
131 Ibuprofen tablet 200 mg tablet Rp 112 0
132 Ibuprofen tablet 400 mg tablet Rp 113 0
133 Ichtyol ( Salap Hitam ) pot Rp 259 0
134 Ipratrium Br 21 mcg, Salbutamol Sulfat 120 mcg perhirup (Combivent) botol Rp 4,550 0
135 Isoniazid tablet 100 mg tablet Rp 79 0
136 Isoniazid tablet 300 mg tablet Rp 170 0
137 Isosorbid Dinitrat tablet sublingual 5 mg tablet Rp 93 0
138 Jelly (Ecolab aquagel sterile) 82 g tube Rp 45,543 0
139 Kalium diklofenak 25 mg tablet tablet Rp 410 0
140 Kalium diklofenak 50 mg tablet tablet Rp 440 0
141 Kalium Permanganat serbuk 5 g. pot Rp 5,089 0
142 Kalsium Glukonat injeksi 10% (100 mg/ml) @ 10 ml ampul Rp 8,949 0
143 Kalsium Laktat tablet 500 mg tablet Rp 104 0
144 Kanamycin injeksi 1 gram vial Rp 16,000 0
145 Kaolin Pektin sirup botol Rp 6,262 0
146 Kaptopril tablet 12,5 mg tablet Rp 65 0
147 Kaptopril tablet 25 mg tablet Rp 80 0
148 Kaptopril tablet 50 mg tablet Rp 134 0
149 Karbamazepin tablet 200 mg tablet Rp 230 0
150 Karbol (Fenol) Gliserol tetes telinga 10% @ 5 ml botol Rp 2,590 0
151 Ketokonazol krim 2 % @ 10 g. tube Rp 2,577 0
152 Ketokonazol tablet 200 mg tablet Rp 286 0
153 Ketoprofen injeksi 100 mg @ 1 ml ampul Rp 5,933 0
154 Ketoprofen tablet 100 mg tablet Rp 1,417 0
155 Ketorolac 30 mg/ml injeksi @ 1ml ampul Rp 1,045 0
156 Kloramfenikol capsul 250 mg capsul Rp 255 0
157 Kloramfenikol salap mata 1 % @ 3,5 g. tube Rp 1,925 0
158 Kloramfenikol suspensi 125 mg / 5 ml. @ 60 ml. botol Rp 4,000 0
159 Kloramfenikol tetes mata 0,5 % botol Rp 11,550 0
HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA
NO NAMA OBAT SATUAN AWAL 1 31 DES
SATUAN JAN 2018 JAN-DES 2018 JAN-DES 2018 2018 STOK

1 2 3 4 5 6 7 8 9=4*8
160 Kloramfenikol tetes telinga 3 % @ 5 ml botol Rp 6,050 0
161 Klorfeniramin Maleat ( CTM ) tablet 4 mg tablet Rp 24 0
162 Klorheksidin lar 0.2% (larutan kumur antiseptik gigi) @ 60 ml botol Rp 18,700 0
163 Klorokuin tablet 150 mg tablet Rp 58 0
164 Klorpromazin HCl injeksi 25 mg / ml - 1 ml ampul Rp 1,425 0
165 Klorpromazin HCl tablet salut 25 mg tablet Rp 24 0
166 Klorpromazin HCl tablet salut 100 mg tablet Rp 179 0
167 Kodein Fosfat tablet 10 mg tablet Rp 630 0
Kombinasi anti alergi lotion 100 ml (Kalamin 8%, Difenhidramin HCl
168 1%, Kamfer 0.1%, Gliserol alkohol 2%) botol Rp 9,900 0

169 Kotrimoksazol
40 mg/5ml
susp. komb. : Sulfametoksazol 200 mg. + Trimetoprim botol Rp 2,052 0

Kotrimoksazol tab dewasa komb : Sulfametoksazol 400


170 mg+Trimetoprim 80 mg tablet Rp 214 0

Kotrimoksazol tab dewasa komb : Sulfametoksazol 800


171 mg+Trimetoprim 160 mg kaplet Rp 512 0
172 Krim untuk nyeri @30 gr tube Rp 12,100 0
173 Kuinin ( Kina ) tablet 200 mg tablet Rp 737 0
174 Kuinin Injeksi IV 25 % sebagai 2HCl - 2 ml ampul Rp 6,510 0
175 Lactobacillus sachet Rp 4,950 0
176 Lanzoprazol Kapsul 30 mg kaplet Rp 330 0
177 Larutan infus Glukosa 10% steril @ 500 ml. botol Rp 7,500 0
178 Larutan infus Glukosa 40% steril botol Rp 1,525 0
179 Larutan infus Glukosa 5% steril @ 500 ml botol Rp 6,900 0
180 Larutan Infus Ringer Laktat steril @ 500 ml botol Rp 7,150 0
181 Larutan NaCl 0,225 %+ Dextrose 5 % ( cairan 1 : 4 ) infus @ 500 ml. botol Rp 9,350 0

182 Larutan NaCl 1,75 g, KCl 1,5 g, Na Laktat 2,24 g, Dextrose 27 g @ 500 botol Rp 11,314 0
ml (KaEN 3B)
183 Larutan Natrium Klorida Infus 0,9 % steril @ 500 ml. botol Rp 6,410 0
184 Lidocain HCL 2% + Epinefrin 1:80.000 inj @ 2 ml ampul Rp 1,317 0
185 Lidocain injeksi 2 % @ 2 ml ampul Rp 1,317 0
186 Lidocain jelly 2% 10 gr syringe Rp 40,000 0
187 Lidocain semprot 10 % botol Rp 149,100 0
188 Linkomisin capsul 500 mg capsul Rp 1,167 0
189 Lisol solutio 1000 ml. botol Rp 24,750 0
190 Loperamid tablet 2 mg tablet Rp 171 0
191 Loratadin tablet 10 mg tablet Rp 127 0
192 Magnesium Sulfat injeksi (IV) 20 % - 25 ml vial Rp 3,200 0
193 Magnesium Sulfat injeksi (IV) 40 % - 25 ml vial Rp 3,650 0
194 Mantoux test (PPD 2 UT 1,5) vial Rp 887,700 0
195 Mebendazol tablet 100 mg tablet Rp 141 0
196 Meloksikam capsul 15 mg capsul Rp 1,144 0
197 Metampiron ( Antalgin ) injeksi 500 mg /1 ml ampul Rp 3,050 0
198 Metampiron ( Antalgin ) tablet 500 mg tablet Rp 242 0
199 Metformin tablet 500 mg tablet Rp 102 0
200 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul Rp 3,278 0
201 Metilergometrin Maleat tablet salut 0,125 mg tablet Rp 495 0
202 Metilprednisolon tablet 4 mg tablet Rp 139 0
203 Metoklopramid drop 2 mg/ml @ 10 ml botol Rp 5,200 0
204 Metoklopramid injeksi 5 mg/ml @ 2 ml ampul Rp 3,904 0
205 Metoklopramid syrup @ 60 ml. botol Rp 2,750 0
206 Metoklorpramid tablet 10 mg tablet Rp 83 0
207 Metronidazol infus botol Rp 10,250 0
208 Metronidazol sirup 125 mg/5ml botol Rp 3,800 0
209 Metronidazol tablet 250 mg tablet Rp 98 0
210 Metronidazol tablet 500 mg tablet Rp 115 0
211 Mikonazol krim 2 % @ 10 g tube Rp 3,926 0
212 Multivitamin anak sirup dengan kalsium pidolat 300 mg,
fruktooligosakarida 300 mg dan kurkuminoid 2 mg per 5 ml botol Rp 33,636 0
213 Multivitamin dan mineral tetes sirup@ 15 ml botol Rp 19,250 0
214 Multivitamin mineral dengan zat besi tablet dewasa tablet Rp 935 0
215 Natrium Bikarbonat tablet 500 mg tablet Rp 10 0
216 Natrium Diklofenak emulgel tube Rp 12,161 0
217 Natrium Diklofenak tab. 25 mg tablet Rp 142 0
218 Natrium Diklofenak tab. 50 mg tablet Rp 136 0
219 Natrium Heparina gel @ 20 g tube Rp 20,900 0
220 Natrium Tiosulfat injeksi 25 % - 10 ml ampul Rp 14,768 0
221 Neurotropik 5000 Vitamin injeksi ampul Rp 5,500 0
222 Neurotropik Vitamin tablet tablet Rp 583 0
223 Nifedipin tablet 10 mg tablet Rp 143 0
224 Nistatin oral drop botol Rp 38,500 0
225 Nistatin tablet salut 500.000 IU tablet Rp 881 0
226 Nistatin tablet vaginal 100.000 IU / g tablet Rp 627 0
227 Norepinefrin inj 1 mg/ml ampul Rp 55,248 0
228 Norit (Carbo adsorben) tablet tube Rp 11,000 0
229 Obat Anti Tuberkulosis Kategori Anak ( FDC ) paket Rp 267,400 0
230 Obat Anti Tuberkulosis Kategori I ( FDC ) paket Rp 430,539 0
231 Obat Anti Tuberkulosis Kategori II ( FDC ) paket Rp 1,492,574 0
232 Obat Anti Tuberkulosis Kategori III paket Rp 154,000 0
233 Obat Anti Tuberkulosis Sisipan paket Rp 66,000 0
234 Obat Batuk Hitam ( O B H ) sirup 100 ml. botol Rp 5,500 0
235 OBH Plus 100 ml (Paracetamol 200 mg, pseudoefedrin 3 mg, CTM
0.5mg, Amonium klorida 25 mg, Succus liquiritiae 75 mg per 5ml) botol Rp 12,100 0
236 Oksimetazolin tts hidung 0.025% @10 ml botol Rp 28,928 0
237 Oksimetazolin tts hidung 0.05% @10 ml botol Rp 36,000 0
HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA
NO NAMA OBAT SATUAN AWAL 1 31 DES
SATUAN JAN 2018 JAN-DES 2018 JAN-DES 2018 2018 STOK

1 2 3 4 5 6 7 8 9=4*8
238 Oksitetrasiklin HCl injeksi i.m 50 mg/ ml - 10 ml vial Rp 3,255 0
239 Oksitetrasiklin HCl salap 3 % 5 g tube Rp 1,760 0
240 Oksitetrasiklin HCl salap mata 1 % @ 3,5 g. tube Rp 2,600 0
241 Oksitoksin inj 10 IU / ml-1 ml ampul Rp 1,900 0
242 Omeprazol capsul 20 mg capsul Rp 138 0
243 Ondansetron injeksi 4mg/2ml @ 2ml ampul Rp 1,254 0
244 Ondansetron tablet 8mg tablet Rp 404 0
245 Pancreatin komb. tablet tablet Rp 880 0
246 Papaverin inj 40 mg / ml ampul Rp 716 0
247 Papaverin tablet 40 mg tablet Rp 190 0
248 Parasetamol 125 mg rektal Suppos Rp 15,840 0
249 Parasetamol 250 mg rektal Suppos Rp 30,800 0
250 Parasetamol drop 100 mg/ml @ 10ml botol Rp 7,646 0
251 Parasetamol syr 120mg / 5 ml @ 60 ml botol Rp 1,160 0
252 Parasetamol tablet 500 mg tablet Rp 143 0
253 Perak sulfadiazin krim 1% tube Rp 24,150 0
254 Pirantel tablet 125 mg tablet Rp 331 0
255 Pirasetam inj ampul Rp 2,021 0
256 Pirasetam tablet 400 mg tablet Rp 495 0
257 Piratiazin teoklat 40 mg, Piridoksin HCl 30 mg tablet tablet Rp 2,640 0
258 Pirazinamid tablet 500 mg tablet Rp 248 0
259 Piridoksin tablet 10 mg tablet Rp 141 0
260 Piridoksin injeksi 1 ml. ampul Rp 1,050 0
261 Piroksikam capsul 10 mg capsul Rp 121 0
262 Piroksikam tablet 20 mg tablet Rp 143 0
263 Povidon Iodida 10 % 30 ml botol Rp 3,335 0
264 Povidon Iodida 10 % 300 ml botol Rp 20,700 0
265 Prednison tablet 5 mg tablet Rp 85 0
266 Primakuin tablet 15 mg tablet Rp 258 0
267 Prokain Benzil Penisillin injeksi 3 Juta IU vial Rp 375 0
268 Propanolol HCl tablet 40 mg tablet Rp 82 0
269 Propanolol tablet 10 mg tablet Rp 69 0
270 Propiltiourasil tablet 100 mg tablet Rp 335 0
271 Psidii folium 250 mg/5ml @ 60 ml botol Rp 37,400 0
272 Ranitidine Inj 25 mg/ml @ 2 ml ampul Rp 1,155 0
273 Ranitidine tablet 150 mg tablet Rp 253 0
274 Reserpin tablet 0,10 mg tablet Rp 26 0
275 Reserpin tablet 0,25 mg tablet Rp 45 0
276 Retinol (Vitamin A) Dosis Tinggi 100.000 IU capsul Rp 327 0
277 Retinol (Vitamin A) Dosis Tinggi 200.000 IU capsul Rp 582 0
278 Rifampisin capsul 300 mg capsul Rp 785 0
279 Rifampisin kaplet 450 mg kaplet Rp 1,031 0
280 Rifampisin kaplet 600 mg kaplet Rp 1,420 0
281 Salap 2 - 4 Kombinasi : As.Salisilat 2 % + Belerang Endap 4 % @ 30 g pot Rp 3,013 0
282 Salbutamol inhalasi 100 mcg/dosis @ 200 dosis botol Rp 41,250 0
283 Salbutamol Nebules cairan ih 0.1% @ 2.5ml ampul Rp 11,935 0
284 Salbutamol sulfat 1,2 mg guriafenisin 50 mg/5ml@ 100ml botol Rp 52,800 0
285 Salbutamol tablet 2 mg tablet Rp 64 0
286 Salbutamol tablet 4 mg tablet Rp 77 0
287 Salisil Bedak 2 % @ 50 g dus Rp 6,600 0
288 Serum Anti Bisa Ular I injeksi (ABU I) (im/iv) @ 5ml vial Rp 479,996 0
289 Serum Anti Difteri injeksi 20.000 IU / vial (ADS) vial Rp 732,848 0
290 Serum Anti Tetanus injeksi 1.500 IU/ml (ATS) @1 ml ampul Rp 130,999 0
291 Serum Anti Tetanus injeksi 20.000 IU / Vial (ATS) vial Rp 505,800 0
292 Sianokobalamin injeksi 500 mcg/ml - 1 ml ampul Rp 1,087 0
293 Sianokobalamin tablet 50 mcg tablet Rp 49 0
294 Simvastatin tablet 10 mg tablet Rp 110 0
295 Simvastatin 20 mg tablet tablet Rp 225 0
296 Streptomisin injeksi 1500 mg / ml @ 15 ml. vial Rp 54,840 0
297 Teofilin Tablet 150 mg tablet Rp 310 0
298 Terbutalin tablet 2,5 mg tablet Rp 88 0
299 Tetrasiklin HCl kapsul 500 mg capsul Rp 329 0
300 Tiamfenikol capsul 500 mg capsul Rp 1,132 0
301 Tiamin HCl injeksi 100 mg / ml - 1 ml ampul Rp 1,035 0
302 Tiamin HCl tablet 50 mg tablet Rp 91 0
303 Timolol 0.5% tetes mata 5 ml botol Rp 9,996 0
304 Tramadol capsul 50 mg capsul Rp 88 0
305 Tramadol Injeksi 50 mg/ml @ 2ml ampul Rp 1,984 0
306 Triheksifenidil Hidroklorida tab 2 mg tablet Rp 56 0
307 Tripolidin Hcl 1.25mg, Pseudoefedrin Hcl 30mg/5ml @100 ml botol Rp 19,800 0
308 Tripolidin HCl 2.5 mg, Pseudoefedrin 60 mg tablet tablet Rp 1,386 0
309 Vitamin B-Kompleks tablet tablet Rp 135 0
310 Zinc siup 20 mg/5 ml @ 60 ml botol Rp 4,959 0
311 Zinc tablet dispersible 20 mg tablet Rp 604 0
BAHAN HABIS PAKAI 0
312 Alat Suntik Sekali Pakai 1 ml pcs Rp 1,614 0
313 Alat Suntik Sekali Pakai 3 ml pcs Rp 857 0
314 Alat Suntik Sekali Pakai 5 ml pcs Rp 1,065 0
315 Alat Suntik Sekali Pakai 10 ml pcs Rp 1,200 0
316 Alcohol swab pcs Rp 173 0
317 Antiseptik tangan dengan dibilas 500 ml botol Rp 71,875 0
HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA
NO NAMA OBAT SATUAN AWAL 1 31 DES
SATUAN JAN 2018 JAN-DES 2018 JAN-DES 2018 2018 STOK

1 2 3 4 5 6 7 8 9=4*8
318 Antiseptik tangan tanpa dibilas 500 ml botol Rp 63,900 0
319 Arm sling ukuran S pcs Rp 17,424 0
320 Arm sling ukuran M pcs Rp 17,424 0
321 Arm sling ukuran L pcs Rp 17,424 0
322 Autoclick lancing device pcs Rp 18,287 0
323 Bistury / mata pisau bedah pcs Rp 3,150 0
324 Blood lancet pcs Rp 153 0
325 Box Slide (kotak slides) isi untuk 50 slides kotak Rp 41,489 0
326 Cat Gut Chromic No. 2/0 DS 19 mm pcs Rp 41,685 0
327 Cat Gut Chromic No. 3/0 DS 19 mm pcs Rp 41,685 0
328 Cat Gut Plain No. 2/0 DS 19 mm pcs Rp 41,685 0
329 Cat Gut Plain No. 3/0 DS 19 mm pcs Rp 41,685 0
330 Cervical collar universal (neck collar) pcs Rp 127,776 0
331 Disposible Blood Transfution set Rp 13,976 0
332 Feeding tube 3,5 fr (3,5cm) set Rp 8,841 0
333 Folley Catheter 2. W 30 cc No.14 pcs Rp 59,960 0
334 Folley Catheter 2. W 30 cc No.16 pcs Rp 59,960 0
335 Folley Catheter 2. W 30 cc No.18 pcs Rp 59,960 0
336 Handscoon No.6,5 steril pasang Rp 7,255 0
337 Handscoon No.7 steril pasang Rp 7,255 0
338 Handscoon No.7.5 steril pasang Rp 7,255 0
339 Handscoon (gloves) ukuran L pcs Rp 564 0
340 Handscoon (gloves) ukuran M pcs Rp 564 0
341 Handscoon (gloves) ukuran S pcs Rp 564 0
342 Handschoon obgyn steril pasang Rp 21,296 0
343 I.V. Canula Venocath No. 20 pcs Rp 16,088 0
344 I.V. Canula Venocath No. 22 pcs Rp 16,088 0
345 I.V. Canula Venocath No. 26 pcs Rp 14,824 0
346 I.V. Catheter Nomor 18 pcs Rp 13,779 0
347 I.V. Catheter Nomor 20 pcs Rp 8,355 0
348 I.V. Catheter Nomor 22 pcs Rp 13,779 0
349 I.V. Catheter Nomor 24 pcs Rp 8,355 0
350 Infus Set Anak set Rp 10,406 0
351 Infus Set Dewasa set Rp 5,940 0
352 Kapas Berlemak 500 gram roll Rp 18,150 0
353 Kapas Pembalut / Absorben 250 gram roll Rp 13,750 0
354 Kasa Hidrofil 40 x 80 cm roll Rp 115,500 0
355 Kasa hidrofil 36 x 80 cm roll Rp 143,500 0
356 Kasa Hidrofil Steril 18 x 22 cm (isi 12 lbr) bungkus Rp 8,000 0
357 Kasa Kompres 40 cm x 40 cm bungkus Rp 1,760 0
358 Kasa Pembalut 16 x 16 steril kotak Rp 8,800 0
359 Kasa Pembalut 2 m x 80 cm bungkus Rp 10,419 0
360 Kasa Pembalut Hidrofil 4 m x 10 cm roll Rp 3,561 0
361 Kasa Pembalut Hidrofil 4 m x 15 cm roll Rp 2,310 0
362 Kasa Pembalut Hidrofil 4 m x 3 cm roll Rp 649 0
363 Kasa Pembalut Hidrofil 4 m x 5 cm roll Rp 825 0
364 Mask (sungkup) oksigen anak pcs Rp 14,907 0
365 Mask (sungkup) oksigen dewasa pcs Rp 14,907 0
366 Masker hi oxygen dewasa (non rebreathing mask) pcs Rp 27,104 0
367 Masker Disposible 3 ply pcs Rp 397 0
368 Masker N95 pcs Rp 19,500 0
369 Nasal canula anak pcs Rp 6,050 0
370 Nasal canula bayi pcs Rp 6,050 0
371 Nasal canula dewasa pcs Rp 6,050 0
372 Needle Terumo 23 G pcs Rp 1,518 0
373 Needle Terumo 24 G pcs Rp 330 0
374 Needle Terumo 25 G pcs Rp 330 0
375 Pembalut elastis ukuran 4 inci (10 cm x 4.55 m) roll Rp 33,000 0
376 Pembalut elastis ukuran 6 inci (15 cm x 4.55 m) roll Rp 41,910 0
377 Pembalut Gips roll Rp 5,600 0
378 Plester 5 cm x 5 m roll Rp 29,455 0
379 Plester kertas 9.2 m X 2,5 cm dengan pemotong roll Rp 9,943 0
380 Plester Tahan Air ( 25 cm x 10 cm ) pcs Rp 14,459 0
381 Plester transparan 5 m X 1,25 cm roll Rp 16,500 0
382 S i l k ( Benang Bedah Sutera ) No. 1 DS 24 mm sachet Rp 31,040 0
383 S i l k ( Benang Bedah Sutera ) No. 2/0 DS 19 mm sachet Rp 31,765 0
384 S i l k ( Benang Bedah Sutera ) No. 3/0 DS 19 mm sachet Rp 31,765 0
385 S i l k ( Benang Bedah Sutera ) No. 4/0 DS 19 mm sachet Rp 31,765 0
386 Speculum vaginal disposible pcs Rp 11,220 0
387 Underpad ukuran 60x90 cm steril pcs Rp 8,399 0
388 Urine Bag set Rp 8,804 0
PERBEKALAN KESEHATAN GIGI
389 Air Raksa Dental Use 100 G. botol Rp 220,000 0
390 Bahan pengisi saluran akar gigi set Rp 709,500 0
391 Bonding refill set Rp 302,500 0
392 Cairan Irigasi NaOCl 5% dan EDTA 5% inf 1000 ml botol Rp 290,000 0
393 Devitalisasi Pasta ( Non Arsen ) botol Rp 277,200
394 Echant (etching) set Rp 287,100 0
395 Glass Ionomer semen (serbuk + larutan) anterior set Rp 891,000 0
396 Glass Ionomer semen (serbuk + larutan) posterior set Rp 675,400 0
397 Gutta percha kotak Rp 37,400 0
398 Kalsium Hidroksida pasta @ 2 tube set Rp 1,063,700 0
399 Klorfenol Kamfer Mentol ( CHKM ) cairan 10 ml. botol Rp 62,700 0
HARGA STOK PENERIMAAN PEMAKAIAN SISA STOK NILAI SISA
NO NAMA OBAT SATUAN AWAL 1 31 DES
SATUAN JAN 2018 JAN-DES 2018 JAN-DES 2018 2018 STOK

1 2 3 4 5 6 7 8 9=4*8
400 Micro brush ktk Rp 74,800 0
401 Mummifying Pasta botol Rp 600,600 0
402 Semen Seng Fosfat serbuk & Cairan set Rp 723,250 0
403 Silver Amalgam serbuk 65 - 75 % 1 oz set Rp 410,300 0
404 Spons gelatin Cubicles 1 x 1 x 1 cm @ 24 pcs kotak Rp 106,700 0
405 Temporary Stopping Fletcher serbuk 100 g. & cairan set Rp 199,100 0
406 Trikresol Formalin (TKF) botol Rp 75,900 0
407 Tumpatan Composite (Light cured) set Rp 3,411,430 0
408 Tumpatan Composite Anterior A2 Tube Rp 389,400 0
409 Tumpatan Composite Anterior A3 Tube Rp 269,500 0
410 Tumpatan Composite Anterior A3.5 Tube Rp 389,400 0
411 Tumpatan sementara (Caviton) set Rp 193,600 0
412 Turbocaina (pengganti cresophene) ktk Rp 404,800 0
BAHAN LABORATORIUM (REAGEN KIMIA)
413 Dect Glass / cover glass pcs Rp 221 0
414 Developer 20 lt jerigen Rp 1,327,491 0
415 Fixer 20 lt jerigen Rp 818,582 0
416 Film Rongent dental 3 x 4 pcs Rp 18,227 0
417 Film Rongent uk 24 x 30 pcs Rp 25,480 0
418 Film Rongent uk 30 x 40 pcs Rp 40,508 0
419 Film Rongent uk 35 x 35 pcs Rp 43,992 0
420 Filter Paper pcs Rp 1,150 0
421 Larutan Anisol 100 ml botol Rp 264,550 0
422 Larutan Asam Asetat6% 100 ml botol Rp 44,000 0
423 Larutan Asam Klorida 0,1N 100 ml botol Rp 25,521 0
424 Larutan Asam sulfosalisilat 20 % 100 ml. botol Rp 309,600 0
425 Larutan Benedict 100 ml. botol Rp 55,950 0
426 Larutan Eosin 2 % 100 ml. botol Rp 181,825 0
427 Larutan Etanol Asam 3% 100 ml. botol Rp 79,750 0
428 Larutan Giemsa Stain 100 ml. botol Rp 361,850 0
429 Larutan H2O2 3% @ 100 ml botol Rp 100,430 0
430 Larutan Hayem 100 ml botol Rp 65,450 0
431 Larutan Karbol Fuchsin 100 ml. botol Rp 100,100 0
432 Larutan KOH 10% 100 ml botol Rp 56,900 0
433 Larutan Mersi Oil 100 ml botol Rp 403,650 0
434 Larutan Metanol 100 ml. botol Rp 62,700 0
435 Larutan Metilen Biru 100 ml. botol Rp 79,750 0
436 Larutan Natrium Citras 3 % @100 ml botol Rp 55,475 0
437 Larutan Ress echer 100 ml botol Rp 52,150 0
438 Larutan Turk 100 ml. botol Rp 29,350 0
439 Larutan Ziehl Nielsen paket Rp 178,750 0
440 Lidi Vagina pcs Rp 3,339 0
441 Object glass / Slide Glass pcs Rp 269 0
442 Pot Sputum pcs Rp 3,900 0
443 Rapid test for Dengue IgG/IgM pcs Rp 66,704 0
444 Rapid test for Dengue Ns1 (oncoprobe) pcs Rp 181,720 0
445 Rapid test HBsAg Antigen (Prog utk Bumil) pcs Rp 11,047 0
446 Rapid test for Malaria Pan/Pf (Fokus) pcs Rp 47,397 0
447 Rapid test for Malaria Pf dan Pv (Fokus) pcs Rp 53,260 0
448 Rapid test HIV 1/2 pcs Rp 15,377 0
449 Rapid test HIV Lini 2 (triline) pcs Rp 52,425 0
450 Rapid test HIV Lini 3 (Oncoprobe) pcs Rp 85,800 0
451 Rapid test HIV Lini I (SD) pcs Rp 72,700 0
452 Rapid test sipilis pcs Rp 13,904 0
453 Reagen Pemeriksa Gol Darah Anti A @10 ml botol Rp 116,600 0
454 Reagen Pemeriksa Gol Darah Anti B @ 10 ml botol Rp 116,600 0
455 RPR pcs Rp 4,557 0
456 Stick asam urat pcs Rp 11,132 0
457 Stick cholestrol pcs Rp 27,510 0
458 Stick gula darah pcs Rp 5,162 0
459 Tabung Hematokrit pcs Rp 1,510 0
460 Tabung Vacutener tutup ungu dengan anti koagulan 3 ml pcs Rp 2,860 0
461 Tes Kehamilan pcs Rp 2,133 0
462 TPHA pcs Rp 19,435 0
463 Urinalysa 10 Parameter pcs Rp 1,477 0
464 Urinalysa 3 Parameter pcs Rp 1,097 0
465 Tes Kehamilan pcs Rp 7,261 0
466 TPHA pcs Rp 19,435 0
467 Urinalysa 10 Parameter pcs Rp 1,477 0
468 Urinalysa 3 Parameter pcs Rp 1,097 0
JUMLAH TOTAL PERSEDIAAN

………………………………, ……………………..

Mengetahui, Petugas Pengelola Obat


Kepala Puskesmas Puskesmas
..................................... ………………………..

(......................................) (......................................)
USULAN KEBUTUHAN OBAT DAN BMHP TAHUN 2019
PUSKESMAS ……………………………………….

SISA STOK PEMAKAIAN USULAN


HARGA RATA-RATA
31 DES PERBULAN STOK KEBUTUHAN
NO NAMA OBAT SATUAN SATUAN TH OPTIMUM SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
1 A C T ( Artesunat 50 mg + Amodiaquin 200 mg ) tablet tablet Rp 1,409 0 0
2 Artemeter Injeksi @ 1ml ampul ampul Rp 12,500 0 0
3 Artesunat Injeksi vial Rp 19,000 0 0
4 Albendazol tablet 400 mg tablet Rp 451 0 0
5 Alopurinol tablet 100 mg tablet Rp 99 0 0
6 Ambroksol sirup 15 mg/5 ml. @ 60 ml. botol Rp 4,950 0 0
7 Ambroksol tablet 30 mg tablet Rp 187 0 0
8 Aminofilin injeksi 24 mg / ml @ 10 ml ampul Rp 3,349 0 0
9 Aminofilin tablet 200 mg tablet Rp 97 0 0
10 Amitriptilin HCl tablet salut 25 mg tablet Rp 165 0 0
11 Amlodipin 10 mg tablet tablet Rp 95 0 0
12 Amlodipin tablet 5 mg tablet Rp 77 0 0
13 Amoksisilin 100 mg/ml drop kering botol Rp 22,990 0 0
14 Amoksisilin capsul 250 mg kapsul Rp 196 0 0
15 Amoksisilin injeksi 1000 mg vial Rp 10,123 0 0
16 Amoksisilin kaplet 500 mg kaplet Rp 248 0 0
17 Amoksisilin sirup kering 125 mg / 5 ml botol Rp 1,920 0 0
18 Ampisilin serbuk injeksi 1000 mg vial Rp 2,887 0 0
19 Antasida DOEN I tablet komb : Al(OH) 200 mg + Mg (OH) 200 mg tablet Rp 188 0 0

Antasida DOEN II susp. 60 ml.komb.:Al(OH) 200 mg/5 ml.+Mg(OH) 200


20 botol Rp 2,098 0 0
mg/5 ml
Anti Bakteri DOEN salap komb : Basitrasin 500 IU/g + Polimiksin 1000
21 IU/g tube Rp 3,490 0 0
22 Anti Fungi DOEN komb : As. Benzoat 6 % + As. Salisilat 3 % pot Rp 5,170 0 0
23 Anti Hemoroid DOEN kombinasi supp Rp 3,642 0 0
Anti Malaria DOEN kombinasi : Pirimetamin 25 mg + Sulfadoksin 500
24 mg tablet Rp 546 0 0

25 Anti Migren DOEN kombinasi : Ergotamin Tartrat 1 mg + Koffein 50 mg tablet Rp 129 0 0


26 Anti Skabies (Permetrin) 5% krim 10 gr tube Rp 12,155 0 0
27 Aqua Dest Steril 500 ml botol Rp 12,100 0 0
28 Aqua Pro Injeksi steril 25 ml botol Rp 2,860 0 0
29 Asam Asetil Salisilat ( Asetosal ) tablet 80 mg tablet Rp 99 0 0
30 Asam Askorbat tablet 50 mg tablet Rp 120 0 0
31 Asam Askorbat tablet 250 mg tablet Rp 124 0 0
32 Asam Folat tablet 0.4 mg tablet Rp 62 0 0
33 Asam Mefenamat capsul 250 mg capsul Rp 150 0 0
34 Asam Mefenamat kaplet 500 mg kaplet Rp 253 0 0
35 Asam Traneksamat injeksi 100 mg @ 5 ml ampul Rp 2,530 0 0
36 Asam Traneksamat tablet 500 mg tablet Rp 1,784 0 0
37 Asetil sisterina 100mg/5ml drop kering botol Rp 50,820 0 0
38 Asetil sisteina 200 mg kapsul kapsul Rp 1,265 0 0
39 Asiatikosida krim 1 % @ 10 g tube Rp 56,100 0 0
40 Asiklovir krim 5 % @ 5 gram tube Rp 3,447 0 0
41 Asiklovir tablet 200 mg tablet Rp 236 0 0
42 Asiklovir tablet 400 mg tablet Rp 425 0 0
43 Atropin Sulfat Injeksi 0,25mg/ml-1 ml. ampul Rp 1,300 0 0
44 Atropin Sulfat Tetes Mata 0,5 % @ 5 ml. tablet Rp 13,500 0 0
45 Attapulgite tablet 600 mg tablet Rp 149 0 0
46 Benzatin Benzil Penisillin injeksi 2,4 Juta IU vial Rp 16,675 0 0
47 Besi sirup dengan mutivitamin mineral 100 ml botol Rp 13,750 0 0
48 Betahistin Mesilat tablet 6 mg tablet Rp 110 0 0
49 Betametason Krem 0,1 % @ 5 g tube Rp 1,373 0 0
50 Bisakodil suppositoria 10 mg dewasa supp Rp 5,800 0 0
51 Bisakodil suppositoria 5 mg anak-anak supp Rp 6,000 0 0
52 Bisakodil tablet 10 mg tablet Rp 317 0 0
53 Bisoprolol tablet 5 mg tablet Rp 316 0 0
54 Borax Gliserin solutio 15 ml. botol Rp 3,300 0 0
55 Bromheksin sirup 100 ml botol Rp 11,550 0 0
56 Bromheksin tablet 8 mg tablet Rp 440 0 0
57 Cefadroksil 125 mg / 5 ml sirup kering @ 60ml botol Rp 4,086 0 0
58 Cefadroksil 250 mg / 5 ml sirup kering @ 60 ml botol Rp 5,910 0 0
59 Cefadroksil kapsul 500 mg capsul Rp 1,155 0 0
60 Cefixime 100 mg capsul Rp 923 0 0
61 Cefixime 100 mg/5 ml sirup kering @ 30ml botol Rp 5,710 0 0
62 Cefotaksim injeksi 1 g vial Rp 6,600 0 0
63 Ceftriakson injeksi 1 g vial Rp 13,346 0 0
64 Carboxymetyhlcelulose (Cendo Cenfresh) eye drop 5 ml Botol Rp 38,500 0 0
65 Cendo Lyteers eye drop 15 ml Botol Rp 24,200 0 0
66 Cendo Xitrol eye drop 5 ml Botol Rp 33,000 0 0
67 Cetirizina Hcl 10 mg/ml tetes botol Rp 60,500 0 0
68 Cetirizina kapsul 10 mg kapsul Rp 115 0 0
69 Cetirizina sirup 5 mg / 5 ml @ 60 ml botol Rp 3,300 0 0
70 Ciprofloksasin kaplet 500 mg kaplet Rp 281 0 0
71 Clindamisin Capsul 150 mg capsul Rp 754 0 0
72 Deksametason injeksi 5 mg / ml - 1 ml ampul Rp 1,210 0 0
73 Deksametason tablet 0,5 mg tablet Rp 34 0 0
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
74 Diazepam injeksi 5 mg / ml - 2 ml ampul Rp 1,913 0 0
75 Diazepam larutan Rectal 5 mg/2.5 ml tube Rp 13,384 0 0
76 Diazepam tablet 2 mg tablet Rp 242 0 0
77 Diazepam tablet 5 mg tablet Rp 109 0 0
78 Difenhidramin HCl injeksi 10 mg / ml - 1 ml ampul Rp 1,220 0 0
79 Digoksin tablet 0,25 mg tablet Rp 109 0 0
80 Dimenhidrinat tablet 50 mg tablet Rp 121 0 0
81 Doksisiklin capsul 100 mg capsul Rp 264 0 0
82 Domperidon 5 mg/ml drop @ 10ml botol Rp 26,240 0 0
83 Domperidon Suspensi 5mg/5ml @ 60 ml botol Rp 2,862 0 0
84 Domperidon tablet 10 mg tablet Rp 86 0 0
85 Efedrin HCl tablet 25 mg tablet Rp 59 0 0
86 Ekstrak Plasenta Gel @ 15 g tube Rp 15,180 0 0
87 Epinefrin HCl (Adrenalin) inj 0,1 % - 1 ml ampul Rp 1,518 0 0
88 Eritromisin kaplet 500 mg kaplet Rp 781 0 0
89 Eritromisin sirup 200 mg / 5 ml botol Rp 7,893 0 0
90 Etakridin ( Rivanol ) larutan 0,1 % @ 300 ml. botol Rp 3,450 0 0
91 Etambutol tablet 250 mg tablet Rp 178 0 0
92 Etanol larutan 70 % @ 100 ml. botol Rp 5,335 0 0
93 Etanol larutan 70 % @ 1000 ml. botol Rp 28,750 0 0
94 Etil Klorida semprot @100 ml botol Rp 110,000 0 0
95 Eugenol cairan 10 ml. botol Rp 20,815 0 0
96 Fenilbutazon tablet 200 mg tablet Rp 69 0 0
97 Fenobarbital injeksi 50 mg / ml - 2 ml ampul Rp 2,265 0 0
98 Fenobarbital tablet 100 mg tablet Rp 276 0 0
99 Fenobarbital tablet 30 mg tablet Rp 197 0 0
100 Fero Sulfat tablet 300 mg (tablet tambah darah) tablet Rp 43 0 0
101 Fitomenadion (Vitamin K1) injeksi 10 mg/ml - 1 ml ampul Rp 5,005 0 0
102 Fitomenadion (Vitamin K1) tablet salut gula 10 mg tablet Rp 790 0 0
103 Fitomenadion (Vitamin K1) 2 mg/ml injeksi ampul Rp 4,236 0 0
104 Flavoksat HCl tab. 200 mg tablet Rp 5,244 0 0
105 Flukonazol 150 mg kapsul kapsul Rp 20,700 0 0
106 Framisetin sulfat gauze dressing 10 cm x 10 cm lembar Rp 20,350 0 0
107 Furosemid injeksi 10 mg/ml @ 2 ml. ampul Rp 1,333 0 0
108 Furosemid tablet 40 mg tablet Rp 79 0 0
109 Gameksan Emulsi 1 % botol Rp 4,400 0 0
110 Garam Oralit untuk 200 ml air sachet Rp 273 0 0
111 Gemfibrozil capsul 300 mg capsul Rp 436 0 0
112 Gemfibrozil capsul 600 mg capsul Rp 853 0 0
113 Gentamisin injeksi 40 mg/ml @ 2ml ampul Rp 3,545 0 0
114 Gentamisin injeksi 80 mg vial Rp 3,528 0 0
115 Gentamisin salep kulit 5 g tube Rp 2,145 0 0
116 Gentamisin Sulfat tetes mata 0.3% botol Rp 4,885 0 0
117 Gentian Violet larutan 1 % 10 ml botol Rp 3,364 0 0
118 Glibenklamid tablet 5 mg tablet Rp 137 0 0
119 Glimepiride tablet 1 mg tablet Rp 200 0 0
120 Gliseril Guayakolat tablet 100 mg tablet Rp 121 0 0
121 Gliserin larutan 50% @ 100 ml botol Rp 6,600 0 0
122 Griseofulvin tablet 125 mg, micronized tablet Rp 223 0 0
123 Haloperidol 5 mg tablet tablet Rp 98 0 0
124 Haloperidol tablet 1,5 mg tablet Rp 74 0 0
125 Haloperidol tablet 2 mg tablet Rp 130 0 0
126 Hidroklortiazida tablet 25 mg tablet Rp 178 0 0
127 Hidrokortison krim 2,5 % @ 5g. tube Rp 2,533 0 0
128 Hyoscine-N-Butilbromide injeksi ampul Rp 22,000 0 0
129 Hyoscine-N-Butilbromide tablet 10 mg tablet Rp 2,519 0 0
130 Ibuprofen Suspensi 100 mg / 5 ml botol Rp 2,560 0 0
131 Ibuprofen tablet 200 mg tablet Rp 112 0 0
132 Ibuprofen tablet 400 mg tablet Rp 113 0 0
133 Ichtyol ( Salap Hitam ) pot Rp 259 0 0
134 Ipratrium Br 21 mcg, Salbutamol Sulfat 120 mcg perhirup (Combivent) botol Rp 4,550 0 0
135 Isoniazid tablet 100 mg tablet Rp 79 0 0
136 Isoniazid tablet 300 mg tablet Rp 170 0 0
137 Isosorbid Dinitrat tablet sublingual 5 mg tablet Rp 93 0 0
138 Jelly (Ecolab aquagel sterile) 82 g tube Rp 45,543 0 0
139 Kalium diklofenak 25 mg tablet tablet Rp 410 0 0
140 Kalium diklofenak 50 mg tablet tablet Rp 440 0 0
141 Kalium Permanganat serbuk 5 g. pot Rp 5,089 0 0
142 Kalsium Glukonat injeksi 10% (100 mg/ml) @ 10 ml ampul Rp 8,949 0 0
143 Kalsium Laktat tablet 500 mg tablet Rp 104 0 0
144 Kanamycin injeksi 1 gram vial Rp 16,000 0 0
145 Kaolin Pektin sirup botol Rp 6,262 0 0
146 Kaptopril tablet 12,5 mg tablet Rp 65 0 0
147 Kaptopril tablet 25 mg tablet Rp 80 0 0
148 Kaptopril tablet 50 mg tablet Rp 134 0 0
149 Karbamazepin tablet 200 mg tablet Rp 230 0 0
150 Karbol (Fenol) Gliserol tetes telinga 10% @ 5 ml botol Rp 2,590 0 0
151 Ketokonazol krim 2 % @ 10 g. tube Rp 2,577 0 0
152 Ketokonazol tablet 200 mg tablet Rp 286 0 0
153 Ketoprofen injeksi 100 mg @ 1 ml ampul Rp 5,933 0 0
154 Ketoprofen tablet 100 mg tablet Rp 1,417 0 0
155 Ketorolac 30 mg/ml injeksi @ 1ml ampul Rp 1,045 0 0
156 Kloramfenikol capsul 250 mg capsul Rp 255 0 0
157 Kloramfenikol salap mata 1 % @ 3,5 g. tube Rp 1,925 0 0
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
158 Kloramfenikol suspensi 125 mg / 5 ml. @ 60 ml. botol Rp 4,000 0 0
159 Kloramfenikol tetes mata 0,5 % botol Rp 11,550 0 0
160 Kloramfenikol tetes telinga 3 % @ 5 ml botol Rp 6,050 0 0
161 Klorfeniramin Maleat ( CTM ) tablet 4 mg tablet Rp 24 0 0
162 Klorheksidin lar 0.2% (larutan kumur antiseptik gigi) @ 60 ml botol Rp 18,700 0 0
163 Klorokuin tablet 150 mg tablet Rp 58 0 0
164 Klorpromazin HCl injeksi 25 mg / ml - 1 ml ampul Rp 1,425 0 0
165 Klorpromazin HCl tablet salut 25 mg tablet Rp 24 0 0
166 Klorpromazin HCl tablet salut 100 mg tablet Rp 179 0 0
167 Kodein Fosfat tablet 10 mg tablet Rp 630 0 0
Kombinasi anti alergi lotion 100 ml (Kalamin 8%, Difenhidramin HCl 1%,
168 Kamfer 0.1%, Gliserol alkohol 2%) botol Rp 9,900 0 0

169 Kotrimoksazol
mg/5ml
susp. komb. : Sulfametoksazol 200 mg. + Trimetoprim 40 botol Rp 2,052 0 0

Kotrimoksazol tab dewasa komb : Sulfametoksazol 400 mg+Trimetoprim


170 80 mg tablet Rp 214 0 0

Kotrimoksazol tab dewasa komb : Sulfametoksazol 800 mg+Trimetoprim


171 160 mg kaplet Rp 512 0 0
172 Krim untuk nyeri @30 gr tube Rp 12,100 0 0
173 Kuinin ( Kina ) tablet 200 mg tablet Rp 737 0 0
174 Kuinin Injeksi IV 25 % sebagai 2HCl - 2 ml ampul Rp 6,510 0 0
175 Lactobacillus sachet Rp 4,950 0 0
176 Lanzoprazol Kapsul 30 mg kaplet Rp 330 0 0
177 Larutan infus Glukosa 10% steril @ 500 ml. botol Rp 7,500 0 0
178 Larutan infus Glukosa 40% steril botol Rp 1,525 0 0
179 Larutan infus Glukosa 5% steril @ 500 ml botol Rp 6,900 0 0
180 Larutan Infus Ringer Laktat steril @ 500 ml botol Rp 7,150 0 0
181 Larutan NaCl 0,225 %+ Dextrose 5 % ( cairan 1 : 4 ) infus @ 500 ml. botol Rp 9,350 0 0

Larutan NaCl 1,75 g, KCl 1,5 g, Na Laktat 2,24 g, Dextrose 27 g @ 500 ml


182 (KaEN 3B) botol Rp 11,314 0 0
183 Larutan Natrium Klorida Infus 0,9 % steril @ 500 ml. botol Rp 6,410 0 0
184 Lidocain HCL 2% + Epinefrin 1:80.000 inj @ 2 ml ampul Rp 1,317 0 0
185 Lidocain injeksi 2 % @ 2 ml ampul Rp 1,317 0 0
186 Lidocain jelly 2% 10 gr syringe Rp 40,000 0 0
187 Lidocain semprot 10 % botol Rp 149,100 0 0
188 Linkomisin capsul 500 mg capsul Rp 1,167 0 0
189 Lisol solutio 1000 ml. botol Rp 24,750 0 0
190 Loperamid tablet 2 mg tablet Rp 171 0 0
191 Loratadin tablet 10 mg tablet Rp 127 0 0
192 Magnesium Sulfat injeksi (IV) 20 % - 25 ml vial Rp 3,200 0 0
193 Magnesium Sulfat injeksi (IV) 40 % - 25 ml vial Rp 3,650 0 0
194 Mantoux test (PPD 2 UT 1,5) vial Rp 887,700 0 0
195 Mebendazol tablet 100 mg tablet Rp 141 0 0
196 Meloksikam capsul 15 mg capsul Rp 1,144 0 0
197 Metampiron ( Antalgin ) injeksi 500 mg /1 ml ampul Rp 3,050 0 0
198 Metampiron ( Antalgin ) tablet 500 mg tablet Rp 242 0 0
199 Metformin tablet 500 mg tablet Rp 102 0 0
200 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul Rp 3,278 0 0
201 Metilergometrin Maleat tablet salut 0,125 mg tablet Rp 495 0 0
202 Metilprednisolon tablet 4 mg tablet Rp 139 0 0
203 Metoklopramid drop 2 mg/ml @ 10 ml botol Rp 5,200 0 0
204 Metoklopramid injeksi 5 mg/ml @ 2 ml ampul Rp 3,904 0 0
205 Metoklopramid syrup @ 60 ml. botol Rp 2,750 0 0
206 Metoklorpramid tablet 10 mg tablet Rp 83 0 0
207 Metronidazol infus botol Rp 10,250 0 0
208 Metronidazol sirup 125 mg/5ml botol Rp 3,800 0 0
209 Metronidazol tablet 250 mg tablet Rp 98 0 0
210 Metronidazol tablet 500 mg tablet Rp 115 0 0
211 Mikonazol krim 2 % @ 10 g tube Rp 3,926 0 0
212 Multivitamin anak sirup dengan kalsium pidolat 300 mg,
fruktooligosakarida 300 mg dan kurkuminoid 2 mg per 5 ml botol Rp 33,636 0 0
213 Multivitamin dan mineral tetes sirup@ 15 ml botol Rp 19,250 0 0
214 Multivitamin mineral dengan zat besi tablet dewasa tablet Rp 935 0 0
215 Natrium Bikarbonat tablet 500 mg tablet Rp 10 0 0
216 Natrium Diklofenak emulgel tube Rp 12,161 0 0
217 Natrium Diklofenak tab. 25 mg tablet Rp 142 0 0
218 Natrium Diklofenak tab. 50 mg tablet Rp 136 0 0
219 Natrium Heparina gel @ 20 g tube Rp 20,900 0 0
220 Natrium Tiosulfat injeksi 25 % - 10 ml ampul Rp 14,768 0 0
221 Neurotropik 5000 Vitamin injeksi ampul Rp 5,500 0 0
222 Neurotropik Vitamin tablet tablet Rp 583 0 0
223 Nifedipin tablet 10 mg tablet Rp 143 0 0
224 Nistatin oral drop botol Rp 38,500 0 0
225 Nistatin tablet salut 500.000 IU tablet Rp 881 0 0
226 Nistatin tablet vaginal 100.000 IU / g tablet Rp 627 0 0
227 Norepinefrin inj 1 mg/ml ampul Rp 55,248 0 0
228 Norit (Carbo adsorben) tablet tube Rp 11,000 0 0
229 Obat Anti Tuberkulosis Kategori Anak ( FDC ) paket Rp 267,400 0 0
230 Obat Anti Tuberkulosis Kategori I ( FDC ) paket Rp 430,539 0 0
231 Obat Anti Tuberkulosis Kategori II ( FDC ) paket Rp 1,492,574 0 0
232 Obat Anti Tuberkulosis Kategori III paket Rp 154,000 0 0
233 Obat Anti Tuberkulosis Sisipan paket Rp 66,000 0 0
234 Obat Batuk Hitam ( O B H ) sirup 100 ml. botol Rp 5,500 0 0
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
235 OBH Plus 100 ml (Paracetamol 200 mg, pseudoefedrin 3 mg, CTM botol Rp 12,100 0 0
0.5mg, Amonium klorida 25 mg, Succus liquiritiae 75 mg per 5ml)
236 Oksimetazolin tts hidung 0.025% @10 ml botol Rp 28,928 0 0
237 Oksimetazolin tts hidung 0.05% @10 ml botol Rp 36,000 0 0
238 Oksitetrasiklin HCl injeksi i.m 50 mg/ ml - 10 ml vial Rp 3,255 0 0
239 Oksitetrasiklin HCl salap 3 % 5 g tube Rp 1,760 0 0
240 Oksitetrasiklin HCl salap mata 1 % @ 3,5 g. tube Rp 2,600 0 0
241 Oksitoksin inj 10 IU / ml-1 ml ampul Rp 1,900 0 0
242 Omeprazol capsul 20 mg capsul Rp 138 0 0
243 Ondansetron injeksi 4mg/2ml @ 2ml ampul Rp 1,254 0 0
244 Ondansetron tablet 8mg tablet Rp 404 0 0
245 Pancreatin komb. tablet tablet Rp 880 0 0
246 Papaverin inj 40 mg / ml ampul Rp 716 0 0
247 Papaverin tablet 40 mg tablet Rp 190 0 0
248 Parasetamol 125 mg rektal Suppos Rp 15,840 0 0
249 Parasetamol 250 mg rektal Suppos Rp 30,800 0 0
250 Parasetamol drop 100 mg/ml @ 10ml botol Rp 7,646 0 0
251 Parasetamol syr 120mg / 5 ml @ 60 ml botol Rp 1,160 0 0
252 Parasetamol tablet 500 mg tablet Rp 143 0 0
253 Perak sulfadiazin krim 1% tube Rp 24,150 0 0
254 Pirantel tablet 125 mg tablet Rp 331 0 0
255 Pirasetam inj ampul Rp 2,021 0 0
256 Pirasetam tablet 400 mg tablet Rp 495 0 0
257 Piratiazin teoklat 40 mg, Piridoksin HCl 30 mg tablet tablet Rp 2,640 0 0
258 Pirazinamid tablet 500 mg tablet Rp 248 0 0
259 Piridoksin tablet 10 mg tablet Rp 141 0 0
260 Piridoksin injeksi 1 ml. ampul Rp 1,050 0 0
261 Piroksikam capsul 10 mg capsul Rp 121 0 0
262 Piroksikam tablet 20 mg tablet Rp 143 0 0
263 Povidon Iodida 10 % 30 ml botol Rp 3,335 0 0
264 Povidon Iodida 10 % 300 ml botol Rp 20,700 0 0
265 Prednison tablet 5 mg tablet Rp 85 0 0
266 Primakuin tablet 15 mg tablet Rp 258 0 0
267 Prokain Benzil Penisillin injeksi 3 Juta IU vial Rp 375 0 0
268 Propanolol HCl tablet 40 mg tablet Rp 82 0 0
269 Propanolol tablet 10 mg tablet Rp 69 0 0
270 Propiltiourasil tablet 100 mg tablet Rp 335 0 0
271 Psidii folium 250 mg/5ml @ 60 ml botol Rp 37,400 0 0
272 Ranitidine Inj 25 mg/ml @ 2 ml ampul Rp 1,155 0 0
273 Ranitidine tablet 150 mg tablet Rp 253 0 0
274 Reserpin tablet 0,10 mg tablet Rp 26 0 0
275 Reserpin tablet 0,25 mg tablet Rp 45 0 0
276 Retinol (Vitamin A) Dosis Tinggi 100.000 IU capsul Rp 327 0 0
277 Retinol (Vitamin A) Dosis Tinggi 200.000 IU capsul Rp 582 0 0
278 Rifampisin capsul 300 mg capsul Rp 785 0 0
279 Rifampisin kaplet 450 mg kaplet Rp 1,031 0 0
280 Rifampisin kaplet 600 mg kaplet Rp 1,420 0 0
281 Salap 2 - 4 Kombinasi : As.Salisilat 2 % + Belerang Endap 4 % @ 30 g pot Rp 3,013 0 0
282 Salbutamol inhalasi 100 mcg/dosis @ 200 dosis botol Rp 41,250 0 0
283 Salbutamol Nebules cairan ih 0.1% @ 2.5ml ampul Rp 11,935 0 0
284 Salbutamol sulfat 1,2 mg guriafenisin 50 mg/5ml@ 100ml botol Rp 52,800 0 0
285 Salbutamol tablet 2 mg tablet Rp 64 0 0
286 Salbutamol tablet 4 mg tablet Rp 77 0 0
287 Salisil Bedak 2 % @ 50 g dus Rp 6,600 0 0
288 Serum Anti Bisa Ular I injeksi (ABU I) (im/iv) @ 5ml vial Rp 479,996 0 0
289 Serum Anti Difteri injeksi 20.000 IU / vial (ADS) vial Rp 732,848 0 0
290 Serum Anti Tetanus injeksi 1.500 IU/ml (ATS) @1 ml ampul Rp 130,999 0 0
291 Serum Anti Tetanus injeksi 20.000 IU / Vial (ATS) vial Rp 505,800 0 0
292 Sianokobalamin injeksi 500 mcg/ml - 1 ml ampul Rp 1,087 0 0
293 Sianokobalamin tablet 50 mcg tablet Rp 49 0 0
294 Simvastatin tablet 10 mg tablet Rp 110 0 0
295 Simvastatin 20 mg tablet tablet Rp 225 0 0
296 Streptomisin injeksi 1500 mg / ml @ 15 ml. vial Rp 54,840 0 0
297 Teofilin Tablet 150 mg tablet Rp 310 0 0
298 Terbutalin tablet 2,5 mg tablet Rp 88 0 0
299 Tetrasiklin HCl kapsul 500 mg capsul Rp 329 0 0
300 Tiamfenikol capsul 500 mg capsul Rp 1,132 0 0
301 Tiamin HCl injeksi 100 mg / ml - 1 ml ampul Rp 1,035 0 0
302 Tiamin HCl tablet 50 mg tablet Rp 91 0 0
303 Timolol 0.5% tetes mata 5 ml botol Rp 9,996 0 0
304 Tramadol capsul 50 mg capsul Rp 88 0 0
305 Tramadol Injeksi 50 mg/ml @ 2ml ampul Rp 1,984 0 0
306 Triheksifenidil Hidroklorida tab 2 mg tablet Rp 56 0 0
307 Tripolidin Hcl 1.25mg, Pseudoefedrin Hcl 30mg/5ml @100 ml botol Rp 19,800 0 0
308 Tripolidin HCl 2.5 mg, Pseudoefedrin 60 mg tablet tablet Rp 1,386 0 0
309 Vitamin B-Kompleks tablet tablet Rp 135 0 0
310 Zinc siup 20 mg/5 ml @ 60 ml botol Rp 4,959 0 0
311 Zinc tablet dispersible 20 mg tablet Rp 604 0 0
BAHAN HABIS PAKAI
312 Alat Suntik Sekali Pakai 1 ml pcs Rp 1,614 0 0
313 Alat Suntik Sekali Pakai 3 ml pcs Rp 857 0 0
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
314 Alat Suntik Sekali Pakai 5 ml pcs Rp 1,065 0 0
315 Alat Suntik Sekali Pakai 10 ml pcs Rp 1,200 0 0
316 Alcohol swab pcs Rp 173 0 0
317 Antiseptik tangan dengan dibilas 500 ml botol Rp 71,875 0 0
318 Antiseptik tangan tanpa dibilas 500 ml botol Rp 63,900 0 0
319 Arm sling ukuran S pcs Rp 17,424 0 0
320 Arm sling ukuran M pcs Rp 17,424 0 0
321 Arm sling ukuran L pcs Rp 17,424 0 0
322 Autoclick lancing device pcs Rp 18,287 0 0
323 Bistury / mata pisau bedah pcs Rp 3,150 0 0
324 Blood lancet pcs Rp 153 0 0
325 Box Slide (kotak slides) isi untuk 50 slides kotak Rp 41,489 0 0
326 Cat Gut Chromic No. 2/0 DS 19 mm pcs Rp 41,685 0 0
327 Cat Gut Chromic No. 3/0 DS 19 mm pcs Rp 41,685 0 0
328 Cat Gut Plain No. 2/0 DS 19 mm pcs Rp 41,685 0 0
329 Cat Gut Plain No. 3/0 DS 19 mm pcs Rp 41,685 0 0
330 Cervical collar universal (neck collar) pcs Rp 127,776 0 0
331 Disposible Blood Transfution set Rp 13,976 0 0
332 Feeding tube 3,5 fr (3,5cm) set Rp 8,841 0 0
333 Folley Catheter 2. W 30 cc No.14 pcs Rp 59,960 0 0
334 Folley Catheter 2. W 30 cc No.16 pcs Rp 59,960 0 0
335 Folley Catheter 2. W 30 cc No.18 pcs Rp 59,960 0 0
336 Handscoon No.6,5 steril pasang Rp 7,255 0 0
337 Handscoon No.7 steril pasang Rp 7,255 0 0
338 Handscoon No.7.5 steril pasang Rp 7,255 0 0
339 Handscoon (gloves) ukuran L pcs Rp 564 0 0
340 Handscoon (gloves) ukuran M pcs Rp 564 0 0
341 Handscoon (gloves) ukuran S pcs Rp 564 0 0
342 Handschoon obgyn steril pasang Rp 21,296 0 0
343 I.V. Canula Venocath No. 20 pcs Rp 16,088 0 0
344 I.V. Canula Venocath No. 22 pcs Rp 16,088 0 0
345 I.V. Canula Venocath No. 26 pcs Rp 14,824 0 0
346 I.V. Catheter Nomor 18 pcs Rp 13,779 0 0
347 I.V. Catheter Nomor 20 pcs Rp 8,355 0 0
348 I.V. Catheter Nomor 22 pcs Rp 13,779 0 0
349 I.V. Catheter Nomor 24 pcs Rp 8,355 0 0
350 Infus Set Anak set Rp 10,406 0 0
351 Infus Set Dewasa set Rp 5,940 0 0
352 Kapas Berlemak 500 gram roll Rp 18,150 0 0
353 Kapas Pembalut / Absorben 250 gram roll Rp 13,750 0 0
354 Kasa Hidrofil 40 x 80 cm roll Rp 115,500 0 0
355 Kasa hidrofil 36 x 80 cm roll Rp 143,500 0 0
356 Kasa Hidrofil Steril 18 x 22 cm (isi 12 lbr) bungkus Rp 8,000 0 0
357 Kasa Kompres 40 cm x 40 cm bungkus Rp 1,760 0 0
358 Kasa Pembalut 16 x 16 steril kotak Rp 8,800 0 0
359 Kasa Pembalut 2 m x 80 cm bungkus Rp 10,419 0 0
360 Kasa Pembalut Hidrofil 4 m x 10 cm roll Rp 3,561 0 0
361 Kasa Pembalut Hidrofil 4 m x 15 cm roll Rp 2,310 0 0
362 Kasa Pembalut Hidrofil 4 m x 3 cm roll Rp 649 0 0
363 Kasa Pembalut Hidrofil 4 m x 5 cm roll Rp 825 0 0
364 Mask (sungkup) oksigen anak pcs Rp 14,907 0 0
365 Mask (sungkup) oksigen dewasa pcs Rp 14,907 0 0
366 Masker hi oxygen dewasa (non rebreathing mask) pcs Rp 27,104 0 0
367 Masker Disposible 3 ply pcs Rp 397 0 0
368 Masker N95 pcs Rp 19,500 0 0
369 Nasal canula anak pcs Rp 6,050 0 0
370 Nasal canula bayi pcs Rp 6,050 0 0
371 Nasal canula dewasa pcs Rp 6,050 0 0
372 Needle Terumo 23 G pcs Rp 1,518 0 0
373 Needle Terumo 24 G pcs Rp 330 0 0
374 Needle Terumo 25 G pcs Rp 330 0 0
375 Pembalut elastis ukuran 4 inci (10 cm x 4.55 m) roll Rp 33,000 0 0
376 Pembalut elastis ukuran 6 inci (15 cm x 4.55 m) roll Rp 41,910 0 0
377 Pembalut Gips roll Rp 5,600 0 0
378 Plester 5 cm x 5 m roll Rp 29,455 0 0
379 Plester kertas 9.2 m X 2,5 cm dengan pemotong roll Rp 9,943 0 0
380 Plester Tahan Air ( 25 cm x 10 cm ) pcs Rp 14,459 0 0
381 Plester transparan 5 m X 1,25 cm roll Rp 16,500 0 0
382 S i l k ( Benang Bedah Sutera ) No. 1 DS 24 mm sachet Rp 31,040 0 0
383 S i l k ( Benang Bedah Sutera ) No. 2/0 DS 19 mm sachet Rp 31,765 0 0
384 S i l k ( Benang Bedah Sutera ) No. 3/0 DS 19 mm sachet Rp 31,765 0 0
385 S i l k ( Benang Bedah Sutera ) No. 4/0 DS 19 mm sachet Rp 31,765 0 0
386 Speculum vaginal disposible pcs Rp 11,220 0 0
387 Underpad ukuran 60x90 cm steril pcs Rp 8,399 0 0
388 Urine Bag set Rp 8,804 0 0
PERBEKALAN KESEHATAN GIGI
389 Air Raksa Dental Use 100 G. botol Rp 220,000 0 0
390 Bahan pengisi saluran akar gigi set Rp 709,500 0 0
391 Bonding refill set Rp 302,500 0 0
392 Cairan Irigasi NaOCl 5% dan EDTA 5% inf 1000 ml botol Rp 290,000 0 0
393 Devitalisasi Pasta ( Non Arsen ) botol Rp 277,200 0 0
394 Echant (etching) set Rp 287,100 0 0
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
395 Glass Ionomer semen (serbuk + larutan) anterior set Rp 891,000 0 0
396 Glass Ionomer semen (serbuk + larutan) posterior set Rp 675,400 0 0
397 Gutta percha kotak Rp 37,400 0 0
398 Kalsium Hidroksida pasta @ 2 tube set Rp 1,063,700 0 0
399 Klorfenol Kamfer Mentol ( CHKM ) cairan 10 ml. botol Rp 62,700 0 0
400 Micro brush ktk Rp 74,800 0 0
401 Mummifying Pasta botol Rp 600,600 0 0
402 Semen Seng Fosfat serbuk & Cairan set Rp 723,250 0 0
403 Silver Amalgam serbuk 65 - 75 % 1 oz set Rp 410,300 0 0
404 Spons gelatin Cubicles 1 x 1 x 1 cm @ 24 pcs kotak Rp 106,700 0 0
405 Temporary Stopping Fletcher serbuk 100 g. & cairan set Rp 199,100 0 0
406 Trikresol Formalin (TKF) botol Rp 75,900 0 0
407 Tumpatan Composite (Light cured) set Rp 3,411,430 0 0
408 Tumpatan Composite Anterior A2 Tube Rp 389,400 0 0
409 Tumpatan Composite Anterior A3 Tube Rp 269,500 0 0
410 Tumpatan Composite Anterior A3.5 Tube Rp 389,400 0 0
411 Tumpatan sementara (Caviton) set Rp 193,600 0 0
412 Turbocaina (pengganti cresophene) ktk Rp 404,800 0 0
BAHAN LABORATORIUM (REAGEN KIMIA)
413 Dect Glass / cover glass pcs Rp 221 0 0
414 Developer 20 lt jerigen Rp 1,327,491 0 0
415 Fixer 20 lt jerigen Rp 818,582 0 0
416 Film Rongent dental 3 x 4 pcs Rp 18,227 0 0
417 Film Rongent uk 24 x 30 pcs Rp 25,480 0 0
418 Film Rongent uk 30 x 40 pcs Rp 40,508 0 0
419 Film Rongent uk 35 x 35 pcs Rp 43,992 0 0
420 Filter Paper pcs Rp 1,150 0 0
421 Larutan Anisol 100 ml botol Rp 264,550 0 0
422 Larutan Asam Asetat6% 100 ml botol Rp 44,000 0 0
423 Larutan Asam Klorida 0,1N 100 ml botol Rp 25,521 0 0
424 Larutan Asam sulfosalisilat 20 % 100 ml. botol Rp 309,600 0 0
425 Larutan Benedict 100 ml. botol Rp 55,950 0 0
426 Larutan Eosin 2 % 100 ml. botol Rp 181,825 0 0
427 Larutan Etanol Asam 3% 100 ml. botol Rp 79,750 0 0
428 Larutan Giemsa Stain 100 ml. botol Rp 361,850 0 0
429 Larutan H2O2 3% @ 100 ml botol Rp 100,430 0 0
430 Larutan Hayem 100 ml botol Rp 65,450 0 0
431 Larutan Karbol Fuchsin 100 ml. botol Rp 100,100 0 0
432 Larutan KOH 10% 100 ml botol Rp 56,900 0 0
433 Larutan Mersi Oil 100 ml botol Rp 403,650 0 0
434 Larutan Metanol 100 ml. botol Rp 62,700 0 0
435 Larutan Metilen Biru 100 ml. botol Rp 79,750 0 0
436 Larutan Natrium Citras 3 % @100 ml botol Rp 55,475 0 0
437 Larutan Ress echer 100 ml botol Rp 52,150 0 0
438 Larutan Turk 100 ml. botol Rp 29,350 0 0
439 Larutan Ziehl Nielsen paket Rp 178,750 0 0
440 Lidi Vagina pcs Rp 3,339 0 0
441 Object glass / Slide Glass pcs Rp 269 0 0
442 Pot Sputum pcs Rp 3,900 0 0
443 Rapid test for Dengue IgG/IgM pcs Rp 66,704 0 0
444 Rapid test for Dengue Ns1 (oncoprobe) pcs Rp 181,720 0 0
445 Rapid test HBsAg Antigen (Prog utk Bumil) pcs Rp 11,047 0 0
446 Rapid test for Malaria Pan/Pf (Fokus) pcs Rp 47,397 0 0
447 Rapid test for Malaria Pf dan Pv (Fokus) pcs Rp 53,260 0 0
448 Rapid test HIV 1/2 pcs Rp 15,377 0 0
449 Rapid test HIV Lini 2 (triline) pcs Rp 52,425 0 0
450 Rapid test HIV Lini 3 (Oncoprobe) pcs Rp 85,800 0 0
451 Rapid test HIV Lini I (SD) pcs Rp 72,700 0 0
452 Rapid test sipilis pcs Rp 13,904 0 0
453 Reagen Pemeriksa Gol Darah Anti A @10 ml botol Rp 116,600 0 0
454 Reagen Pemeriksa Gol Darah Anti B @ 10 ml botol Rp 116,600 0 0
455 RPR pcs Rp 4,557 0 0
456 Stick asam urat pcs Rp 11,132 0 0
457 Stick cholestrol pcs Rp 27,510 0 0
458 Stick gula darah pcs Rp 5,162 0 0
459 Tabung Hematokrit pcs Rp 1,510 0 0
460 Tabung Vacutener tutup ungu dengan anti koagulan 3 ml pcs Rp 2,860 0 0
461 Tes Kehamilan pcs Rp 2,133 0 0
462 TPHA pcs Rp 19,435 0 0
463 Urinalysa 10 Parameter pcs Rp 1,477 0 0
464 Urinalysa 3 Parameter pcs Rp 1,097 0 0
465 Tes Kehamilan pcs Rp 7,261 0 0
466 TPHA pcs Rp 19,435 0 0
467 Urinalysa 10 Parameter pcs Rp 1,477 0 0
468 Urinalysa 3 Parameter pcs Rp 1,097 0 0
JUMLAH TOTAL PERSEDIAAN

………………………………, ……………………..

Mengetahui, Petugas Pengelola Obat


Kepala Puskesmas Puskesmas
HARGA SISA STOK PEMAKAIAN
RATA-RATA STOK USULAN
NO NAMA OBAT SATUAN SATUAN 31 DES PERBULAN TH OPTIMUM KEBUTUHAN SUB TOTAL
2018 2018 TH 2019

1 2 3 4 5 6 7 8=(6*18bln)-5 9=4*8
..................................... ………………………..

(......................................) (......................................)
DATA SARANA PRASARANA KEFARMASIAN PUSKESMAS TAHUN 2018

Nama Puskesmas :
kabupaten : BINTAN
Propinsi : KEPULAUAN RIAU

Non Kamar Obat Ruang Pelayanan Obat


No Keterangan Perawatan Usulan Kebutuhan
Perawatan Jumlah Kondisi Jumlah Kondisi

1 Jenis Puskesmas

2 Luas (m2)

3 Lantai

4 Teralis

5 Rak Obat

6 Lemari Obat

7 Lemari Narkotika

8 Pallet

9 Blower/Exhaust

10 Kipas Angin

11 Komputer

12 Printer

13 AC

14 Termometer

15 Dispenser

16 Kulkas untuk Obat

Yang Melapor Petugas Pengelola Obat


Kepala Puskesmas Puskesmas
..................................... ………………………..
(......................................) (......................................)
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

UNIT :
BULAN :

STOK PEMAKAI PERMINT PEMBERI


NO NAMA OBAT SATUAN AWAL PENERIMAAN PERSEDIAAN AN STOK AKHIR AAN AN

1 2 3 5 6 7 8 9 10 11
1 Alat Suntik Sekali Pakai 1 ml pcs
2 Alat Suntik Sekali Pakai 3 ml pcs
3 Alat Suntik Sekali Pakai 5 ml pcs
4 Alat Suntik Sekali Pakai 10 ml pcs
5 Alcohol swab pcs
6 Antiseptik tangan botol
11 Autoclick lancing device pcs
13 Blood lancet pcs
14 Box Slide (kotak slides) isi untuk 50 slides kotak
28 Handscoon (gloves) ukuran L pcs
29 Handscoon (gloves) ukuran M pcs
30 Handscoon (gloves) ukuran S pcs
42 Kapas Pembalut / Absorben 250 gram roll
56 Masker Disposible 3 ply pcs
61 Needle Terumo 23 G pcs
62 Needle Terumo 24 G pcs
63 Needle Terumo 25 G pcs
67 Plester 5 cm x 5 m roll
420 Filter Paper pcs
421 Larutan Anisol 100 ml botol
422 Larutan Asam Asetat6% 100 ml botol
423 Larutan Asam Klorida 0,1N 100 ml botol
424 Larutan Asam sulfosalisilat 20 % 100 ml. botol
425 Larutan Benedict 100 ml. botol
426 Larutan Eosin 2 % 100 ml. botol
427 Larutan Etanol Asam 3% 100 ml. botol
428 Larutan Giemsa Stain 100 ml. botol
429 Larutan H2O2 3% @ 100 ml botol
430 Larutan Hayem 100 ml botol
431 Larutan Karbol Fuchsin 100 ml. botol
STOK PEMAKAI PERMINT PEMBERI
NO NAMA OBAT SATUAN AWAL PENERIMAAN PERSEDIAAN AN STOK AKHIR AAN AN

1 2 3 5 6 7 8 9 10 11
432 Larutan KOH 10% 100 ml botol
433 Larutan Mersi Oil 100 ml botol
434 Larutan Metanol 100 ml. botol
435 Larutan Metilen Biru 100 ml. botol
436 Larutan Natrium Citras 3 % @100 ml botol
437 Larutan Ress echer 100 ml botol
438 Larutan Turk 100 ml. botol
439 Larutan Ziehl Nielsen paket
441 Object glass / Slide Glass pcs
442 Pot Sputum pcs
443 Rapid test for Dengue IgG/IgM pcs
444 Rapid test for Dengue Ns1 (oncoprobe) pcs
445 Rapid test HBsAg Antigen (Prog utk Bumil) pcs
446 Rapid test for Malaria Pan/Pf (Fokus) pcs
447 Rapid test for Malaria Pf dan Pv (Fokus) pcs
448 Rapid test HIV 1/2 pcs
449 Rapid test HIV Lini 2 (triline) pcs
450 Rapid test HIV Lini 3 (Oncoprobe) pcs
451 Rapid test HIV Lini I (SD) pcs
452 Rapid test sipilis pcs
453 Reagen Pemeriksa Gol Darah Anti A @10 ml botol
454 Reagen Pemeriksa Gol Darah Anti B @ 10 ml botol
455 RPR pcs
456 Stick asam urat pcs
457 Stick cholestrol pcs
458 Stick gula darah pcs
459 Tabung Hematokrit pcs
460 Tabung Vacutener tutup ungu dengan anti koagulan 3 ml pcs
463 Urinalysa 10 Parameter pcs
464 Urinalysa 3 Parameter pcs

Penanggungjawab labor