RKA

REKAP USULAN KEBUTUHAN OBAT DAN BMHP KEGIATAN TAHUN ANGGARAN 2014
DINAS KESEHATAN KOTA SURABAYA
PUSKESMAS
Komponen

: KEPUTIH
Koefisien

Harga Satuan

:: Pengadaan obat dan perbekalan kesehatan

5.2.2.01.10. Belanja Pakai Habis Kedokteran / Perawatan Kesehatan / Laboratorium
Cat gut 2/0
Box
121,819
3
Cat gut 3/0
Box
121,819
3
Cell pack
kit
1,800,000
Diluterge

Diluton
Glukosa basah

botol

2,362,500

galon

3,600,000

kit

343,750

Box

110,000

Box

100,000

Stromatolyser

botol

2,278,100

Articulating paper (kertas warna

penanda oklusi)
BUN

Box

230,000

Kit

450,000

kit

345,000

Kit

1,547,500

Box

94,363

Gutta percha dan paper point

Pak

37,500

HDL cholesterol

Kit

2,683,000

Lidi Kapas Steril

Silk 3 / 0

Cholesterol total
Creatinin
Disposible spuit 3 cc

1
10
1

1
2
1
20

IV catheter

Buah

LDL cholesterol
Test kehamilan
Urine 10 parameter

Kit
200
3

16,400
6,359,000

Buah

10,000

Botol

350,000

Hasil

PPN

365457

10%

365457

10%

10%

7087500

10%

10%

343750

10%

1100000

10%

100000

10%

10%

10%

450000

10%

690000

10%

1547500

10%

1887260

10%

10%

2683000

10%

10%

10%

2000000

10%

1050000

10%

900000

10%

2088000

10%

810100

10%

350000

10%

Total Belanja
5.2.2.01.17. Belanja Pakai Habis Bahan Laboratorium
Yellow tip
2000
Stik Hb (Hemoglobin)
3
Trigliserida
1

buah

450

Kotak

696,000

Kit

810,100

Total Belanja
5.2.2.01.19 Belanja obat-obatan
albendazol susp 200 mg/5ml

100

Botol

3,500

antimalaria kombinasi :
sulfadoksin 500 mg + pirimetamin
25 mg
artemeter inj 80 mg/mL

Kapsul

atropin sulfat tablet 0,5 mg

diazepam larutan rektal 10 mg /
2,5 ml
diazepam larutan rektal 5 mg / 2,5
ml
ergokalsiferol (vitamin D) kaps
50.000 UI
ergokalsiferol (vitamin D) susp
10.000 UI/mL
fenitoin Na inj 100 mg/2ml
fenitoin Na inj 50 mg/ml
Fitomenadion inj (Vitamin K inj)
2mg/ml
furosemid inj 10 mg/mL (i.v./i.m.)
glipizid tab 5 mg

2
2
200

hepatitis B imunoglobulin (human)

inj 0,5 ml
human tetanus imunoglobulin inj
250 UI (i.m.)
ibuprofen sir 100 mg/5ml
ibuprofen sir 200 mg/5ml
kalamin lotio

Ampul

20,000

Tablet

68

Box

162,000

Box

108,000

Kapsul
Botol

2
2
10

10,000

gliseril trinitrat tab sublingual 0,5

mg
haloperidol tab 2 mg
haloperidol tab 5 mg

473

50

100

591
7,273

Ampul

18,410

Ampul

18,410

Ampul

3,107

Ampul

1,873

Tablet

369

Tablet

1,364

Tablet

115

Tablet

88

vial

1,207,273

Ampul

253,825

2
200
200

Botol

3,181

Botol

4,090

Botol

8,228

karbogliserin tts telinga 10 %

Botol

1,857

ketamin inj 100 mg/ml (i.v.)

Ampul

100,000

Botol

10,360

klorheksidin lar 0,2%

200

klorpromazin inj 5 mg/mL (i.m.)

Ampul

klorpromazin tab sal 25 mg

Botol

kodein tab 20 mg

3,000

kuinin tab 200 mg

Lidokain jeli 2%
metformin tab 850 mg

15
2,500

metronidazol lar infus 5 mg/mL

metronidazol suppositoria

300

mikonazol serb 2%
norepinefrin inj 1 mg/mL
oksimetazolin tts hidung 0,025%

5
30

955
34,545

Tablet

1,000

Tablet

610

Tube

36,364

Tablet

405

Botol

9,046

Buah

2,928

Botol

57,750

ampul

49,000

Botol

25,046

23650

10%

10%

10%

324000

10%

216000

10%

118181.81818182

10%

10%

36820

10%

36820

10%

31070

10%

10%

3690000

10%

10%

10%

8800

10%

10%

507650

10%

636181.81818182

10%

818000

10%

1645600

10%

10%

10%

31080

10%

10%

10%

3000000

10%

10%

545454.54545455

10%

1012500

10%

10%

878400

10%

10%

245000

10%

751380

10%

oksimetazolin tts hidung 0,050%

ampul

47,699

olopatadin tts mata 0,1%

Botol

125,000

Ampul

32,728

Botol

4,728

tube

20,910

omeprazol inj 40 mg/10 ml

parasetamol tts 60 mg/0,6ml

perak sulfadiazin krim 1%
pirantel pamoat susp 125 mg/ 5
ml
pirazinamid tab 500 mg

200
1,000

probenesid tab 500 mg

salbutamol lar ih 0,5%

10

Botol

7,600

Tablet

190

Box

150,000

botol

57,955

Tablet

81

botol

39,600

streptomisin serb inj 1000 mg/vial

Tablet

3,319

valproat sir 250 mg/ 5 ml

botol

36,364

valproat tab sal 250 mg

Tablet

2,540

valproat tab sal 500 mg

Tablet

4,955

zinc sir 10 mg/mL

Botol

11,673

Botol

6,728

salbutamol tab 4 mg (sebagai

sulfat)
setirizin sir 5mg/5ml

zinc sir 20 mg/5 mL

zinc tablet dispersible 20 mg
Ambroxol tablet 30 mg
Amitriptilin tablet salut 25 mg
(HCl)
Amlodipin tablet 10 mg
Amoksisilin + As. Klavulanat 625
mg tablet
Amoksisilin kapsul 500 mg
Antasida DOEN I tablet kunyah

150

1,000
25,000
150
200
5,000
2
20,000
10,000

Tablet
Box

Deksametason injeksi i.v./i.m. 5

mg/ml
Devitalisasi pasta (non arsen)
Etil klorida spray
Trikresol Formalin Cairan
Gliseril guaiakolat tablet 100 mg
Kalsium hidroksida pasta set
Klindamisin kapsul 150 mg

69,000

Tablet

102

Tablet

300

Box

137,742

Kapsul

238

Tablet

66

Set
Bahan tumpatan/Tambalan
sementara
Bahan tumpatan tetap dengan
sinar, set
Bisoprolol tablet 5 mg

431

3
1
14

20,000
1
300

10%

10%

98184

10%

10%

4182000

10%

7600000

10%

10%

10%

579550

10%

10%

5940000

10%

10%

10%

10%

10%

10%

6728000

10%

10772727.272727

10%

10350000

10%

20400

10%

1500000

10%

275484

10%

4760000

10%

660000

10%

860000

10%

10%

58700

10%

4311

10%

354545

10%

1337000

10%

10%

700000

10%

230250

10%

98700

10%

172,000

100

Paket

1,572,659

Tablet

587

Ampul

1,437

Botol

354,545

Botol

95,500

Botol

80,000

Tablet

35

Kotak

230,250

Kapsul

329

Kloramfenikol suspensi 125 mg/5

mlg
Lidokain injeksi 2% (HCl)
Lidokain semprot 10%
Lisol mengandung 50% kresol
1000 ml

200
200
10
15

Botol

3,346

Ampul

763

Botol

338,272

Botol

85,500

Misoprostol 200 mcg tablet

Nistatin suspensi 100.000 UI/ml

Box

285,000

Botol

25,000

Obat batuk hitam (O.B.H.) cairan

Botol

1,364

Botol

9,765

Botol

4,728

Ringer dekstrose larutan infus

Ringer laktat larutan infus 500 ml

1,800
5
5

Sefotaksim injeksi 1 g

vial

2,682

Seftriakson serbuk injeksi 1 g/ vial

vial

3,000

Simvastatin tablet 20 mg
Tiamfenikol kapsul 500 mg

15,000
2,500

Tablet

355

Kapsul

756

Triheksifenidil tablet 2 mg

Box

Vitamin B kompleks tablet

Tablet

20,000

3,746

Total Belanja
Grand Total
Petunjuk Pengisian :
1. Isi Volume Obat, reagen, BMHP sesuai kebutuhan di kolom b (berwarna kuning),
apabila tidak ada kebutuhan maka diisi dengan angka 0
2. Mohon tidak menghapus, menyisipkan data baru
3. Kolom berwarna merah tidak boleh dirubah (otomatis)

98

669200

10%

152600

10%

3382720

10%

1282500

10%

10%

10%

2455200

10%

48825

10%

23640

10%

10%

10%

5325000

10%

1890000

10%

10%

1960000

10%

Total

Belanja

402,003

Barang Jasa

402,003

Barang Jasa

Barang Jasa

7,796,250

Barang Jasa

Barang Jasa

378,125

Barang Jasa

1,210,000

Barang Jasa

110,000

Barang Jasa

Barang Jasa

Barang Jasa

495,000

Barang Jasa

759,000

Barang Jasa

1,702,250

Barang Jasa

2,075,986

Barang Jasa

Barang Jasa

2,951,300

Barang Jasa

Barang Jasa

Barang Jasa

2,200,000

Barang Jasa

1,155,000

Barang Jasa

21,636,916

990,000

Barang Jasa

2,296,800

Barang Jasa

891,110

Barang Jasa

891,110

385,000

Barang Jasa

26,015

Barang Jasa

Barang Jasa

Barang Jasa

356,400

Barang Jasa

237,600

Barang Jasa

130,000

Barang Jasa

Barang Jasa

40,502

Barang Jasa

40,502

Barang Jasa

34,177

Barang Jasa

Barang Jasa

4,059,000

Barang Jasa

Barang Jasa

Barang Jasa

9,680

Barang Jasa

Barang Jasa

558,415

Barang Jasa

699,800

Barang Jasa

899,800

Barang Jasa

1,810,160

Barang Jasa

Barang Jasa

Barang Jasa

34,188

Barang Jasa

Barang Jasa

Barang Jasa

3,300,000

Barang Jasa

Barang Jasa

600,000

Barang Jasa

1,113,750

Barang Jasa

Barang Jasa

966,240

Barang Jasa

Barang Jasa

269,500

Barang Jasa

826,518

Barang Jasa

Barang Jasa

Barang Jasa

108,002

Barang Jasa

Barang Jasa

4,600,200

Barang Jasa

8,360,000

Barang Jasa

Barang Jasa

Barang Jasa

637,505

Barang Jasa

Barang Jasa

6,534,000

Barang Jasa

Barang Jasa

Barang Jasa

Barang Jasa

Barang Jasa

Barang Jasa

7,400,800

Barang Jasa

11,850,000

Barang Jasa

11,385,000

Barang Jasa

22,440

Barang Jasa

1,650,000

Barang Jasa

303,032

Barang Jasa

5,236,000

Barang Jasa

726,000

Barang Jasa

946,000

Barang Jasa

Barang Jasa

64,570

Barang Jasa

4,742

Barang Jasa

390,000

Barang Jasa

1,470,700

Barang Jasa

Barang Jasa

770,000

Barang Jasa

253,275

Barang Jasa

108,570

Barang Jasa

736,120

Barang Jasa

167,860

Barang Jasa

3,720,992

Barang Jasa

1,410,750

Barang Jasa

Barang Jasa

Barang Jasa

2,700,720

Barang Jasa

53,708

Barang Jasa

26,004

Barang Jasa

Barang Jasa

Barang Jasa

5,857,500

Barang Jasa

2,079,000

Barang Jasa

Barang Jasa

2,156,000

Barang Jasa

98,126,737
120,654,763