SISA PENGUNAAN OBAT

A.PKD 2011

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp)
Obat Okt-16

1 2 3 4 5 6
1 Amitriptilin 25 mg Tab - - -
2 Pirantel 125mg Tab 0 0 0
3 PrimaQuine 15mg Tab - - -
4 Chloramphenicol salep M Tube - - -
5 Phtomenadion inj Amp - - -
- - -
JUMLAH -

B.GAKIN 2011

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp)
Obat okt-16

1 2 3 4 5 6
1 Dispo 3 cc Pcs - - -
JUMLAH -

59,328,066

64,160,595

Mengetahui
Kepala Puskesmas Pangi

VEMI LAMATOA, SKM

Nip. 19680204 198903 2 007
PENGUNAAN OBAT 2015

Sisa Stok 30-

Penerimaan Rp Pengeluaran Jumlah (Rp)
Nov-16

7 8 9 10 11
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
### - -

Sisa Stok 30-

Penerimaan Rp Pengeluaran Jumlah (Rp)
Nov-16

7 8 9 10 11
- - - - -
- -

11,095,069 6,262,540

Pangi,04-Nov- 2016
Yang Membuat Berita Acara
Pengelola Obat

ALFIANTI, A.Md.Far
Nip: 19780805 201101 2005
Jumlah Harga

12
-
-
-
-
-
-
-

Jumlah Harga

12

64,160,595
 SISA PENGUNAAN OBAT 2015
A.PELAYANAN KESEHATAN DASAR-2015

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah(Rp) Penerimaan Rp
obat Okt-16
1 2 3 4 5 6 7 8
1 Amoxsisilin 500mg Tab 279 1,500 418,500 - -
2 Amitriptilin 25mg Tab 123 200 24,600 - -
3 Aminofhillin 200mg Tab 86 500 43,000 - -
4 Alprazolam 0,5mg Tab 185 1,200 222,000 - -
5 Antalgin 500mg Tab 232 1,000 232,000 - -
6 Acyclovir 400mg Tab 362 1,400 506,800 - -
7 Allopurinol 100mg Tab 90 1,300 117,000 - -
8 Amlodipin 5mg Tab 197 - - - -
9 Alergen CTM 4mg Tab 45 3,000 135,000 - -
10 Ergotamin Kofein50mg Tab 149 - - - -
11 Ambroxol tab Tab 195 - - - -
12 Asam Mefenamat Tab 127 - - - -
13 Bisoprolol Fumarate Tab 695 720 500,400 - -
14 Cefadroxil 500mg Tab 548 - - - -
15 Captopril Tab 97 - - - -
16 Chlorpromazin 100mg Tab 156 500 78,000 - -
17 Ciprofloxacin 500mg Tab 443 1,000 443,000 - -
18 Cetrizine 10 mg Tab 313 - - - -
19 Clonidin 0,5mg Tab 193 - - - -
20 Digoxin Tab 103 100 10,300 - -
21 Dexametasone 0,5mg Tab 68 - - - -
22 Domperidon 10mg Tab 174 - - - -
23 Gliseril Guaiakolat 100mg Tab 43.505 5,000 217,525 - -
24 Griseofulvin 125 mg Tab 230 500 115,000 - -
25 Itrakonasol Tab 1,900 140 266,000 - -
26 Ibu Profen 400mg Tab 157 - - - -
27 Ketokonasol 200mg Tab 160 1,000 160,000 - -
28 Loratadin 10mg Tab 170 150 25,500 - -
29 Metformin 500mg Tab 125 500 62,500 - -
30 Metronidasol 500mg Tab 169 1,200 202,800 - -
31 Meloxicam 7,5mg Tab 761 - - - -
32 Metilergometrin maleat Tab 169 100 16,900 - -
33 Metil Dopa Tab 880 100 88,000 - -
34 Methyl prednisolon Tab 230 200 46,000 - -
35 Natrium Diklofenac Tab 193 - - - -
36 Novakal 500mg Tab 76 400 30,400 - -
37 Omeprazole 20mg Tab 221 210 46,410 - -
38 Propanolol 10mg Tab 85 1,000 85,000 - -
39 Papaverine Tab 155.21 3,000 465,630 - -
40 Prednison Tab 1236 - - - -
41 Piroxicam 10mg Tab 131 1,100 144,100 - -
42 Pirantel 125mg Tab 364 48 17,472 - -
43 Ranitidin 150 mg Tab 132 600 79,200 - -
44 Retinol (vit A) 200.000 kaps 505 - - - -
45 Suldox 500mg Tab 520 250 130,000 - -
46 Tetracyclin 500mg Tab 325 1,300 422,500 - -
47 Vit Bcomp Tab 112 - - - -
48 Vit C 50 mg Tab 105 1,400 147,000 - -
49 Vit K Tab 697 400 278,800 - -
50 Vit B12 Tab 63 1,000 63,000 - -
51 Salbutamol 4mg Tab 93 - - - -
52 Paracetamol 500mg Tab 88 - - - -
53 Simvastatin 10mg Tab 177 - - - -
54 Novabion Tab 349 300 104,700 - -
55 Vit B6 Tab 20 1,000 19,770 - -
56 Vit B1 Tab 590 400 235,800 - -
57 Vit B1 Tab 59 - - - -
58 PrimaQuin Tab 1,199 - - - -
59 Haloperidol 1,5 mg Tab 76 500 38,000 - -
60 Haloperidol 2 mg Tab 134 400 53,600 - -
61 PTU Tab 351 700 245,700 - -
62 Garam Oralit Ktk 317 1,300 412,100 - -
63 Bedak salicil Btl 1,350 197 265,950 - -
64 Amoxicilin Sirup kering Btl 2,560 55 140,800 - -
65 Antasid Suspensi Btl 2,300 85 195,500 - -
66 Cefadroxil sirup Btl 5,286 9 47,574 - -
67 Cotri Suspensi Btl 2,298 220 505,560 - -
68 PCT Sirup Btl 1,535 5 7,675 - -
69 Pirantel sirup Btl 9,100 10 91,000 - -
70 Novadiar Sirup Btl 6,875 100 687,500 - -
71 Novakid Syp Btl 10,900 - - - -
72 Kloramphenicol Syp Amp 4,949 90 445,410 - -
73 Aminophillin inj Amp 4,204 210 882,840 - -
74 Antalgin inj Amp 0 150 - - -
75 Benodon inj Amp 13.198 20 264 - -
76 Difenhidramin inj Amp 1,160 166 192,560 - -
77 Vit K inj Amp 3,754 310 1,163,740 - -
78 Dexametasone inj Amp 1,738 80 139,040 - -
79 Epinefrin inj Amp 8,910 40 356,400 - -
80 Metilergometrin maleat inj Amp 2,750 200 550,000 - -
81 Vit B12 inj Amp 1,141 200 228,200 - -
82 Vit BI inj Amp 1,199 165 197,835 - -
83 Lidocain Inj Amp 1,350 480 648,000 - -
84 Oksitosin inj Amp 1,900 300 570,000 - -
85 Pehacain inj Amp 3,080 90 277,200 - -
86 Phenobarbital inj Tube 1,980 30 59,400 - -
87 Salep 2-4 Tube 2,200 82 180,400 - -
88 Scabimite kream Tube 1,254 105 131,670 - -
89 Miconazole krim Tube 3,150 91 286,650 - -
90 Hidrocortison krim Tube 2,938 134 393,692 - -
91 Gentamicin Slp Kulit Tube 2,035 130 264,550 - -
92 Gentian Violet Tube 2,990 109 325,910 - -
93 Gentamicin Tts Mata Tube 3,513 3 10,539 - -
94 Oxytetra slp Kulit Tube 1,650 120 198,000 - -
95 Betametason Slp kulit Tube 1,596 54 86,184 - -
96 Acyclovir Kream Tube 3,140 10 31,400 - -
97 ErlamicetinTss telinga Tube 4,600 - - - -
98 Anti Fungi Tube 0 24 - - -
99 Bacitracin Slp Tube 2,767 50 138,350 - -
100 Ketokonazol Cream Tube 2,697 85 229,245 - -
101 Kloram Slp Mata Tube 1,680 67 112,560 - -
102 Burnazin Kream Btl 25,350 3 76,050 - -
103 Etil Klorida Pcs 115,200 4 460,800 - -
104 Abocat No.20 Btl 4,959 15 74,385 - -
105 Scopma Plus Tab 1,348 900 1,213,200 - -
106 Alkohol 70% Btl 0 64 - - -
107 Alkohol Swabs Pcs 130.5 400 52,200 - -
108 Rivanol 0,1 % Pcs 3,328 14 46,592 - -
109 Povidon Iodine 60ml Btl 5,500 30 165,000 - -
110 Aqua Pro injeksi Pcs 2,200 35 77,000 - -
111 Dispo 0,05 ml Pcs 0 200 - - -
112 Dispo 0,5 ml Pcs 0 199 - - -
113 Dispo 1 ml Pcs 1090 80 87,200 - -
114 Dispo 3 ml Pcs 848 700 593,600 - -
115 Dispo 5 ml Pcs 1130 355 401,150 - -
116 Dispo 10 ml Ktk 0 88 - - -
117 Kasa Steril Rol 0 100 - - -
118 Kasa Hidropilin 4x10 Ktk 1,958 108 211,464 - -
119 Kasa Steril 16x16 Rol 473 108 51,084 - -
120 Kasa 40Y x 80 cm Pcs 144,500 5 722,500 - -
121 Hanscond No.7,5 Pcs 6,325 5 31,625 - -
122 Hanscond No.7 Rol 4,670 10 46,700 - -
123 Kapas Pembalut 250mg Rol 16313 25 407,825 - -
124 Pembalut Elastis Rol 33,000 4 132,000 - -
125 Pembalut Gips 4" Inch Rol 32,426 10 324,260 - -
126 Plester(Dermafix) Btl 32,426 4 129,704 - -
127 Larutan Hcl 0,1 N Dus 0 2 - - -
128 Slide Mikroskop Btl 394 - - - -
129 Lisol Pcs 53,505 3 160,515 - -
130 Infuset Dewasa Pcs 84 30 2,520 - -
131 Catcut Cromic 3/0 Pcs 29,333 13 381,329 - -
132 Catcut Cromic 2/0 Pcs 29,333 8 234,664 - -
133 Catcut Plain 3/0 Pcs 29,333 10 293,330 - -
134 Catcut Plain 2/0 Pcs 29,333 10 293,330 - -
135 Catcut Silk 3/0 Pcs 18,944 48 909,312 - -
136 Urine Bag Btl 3,915 24 93,960 - -
137 OBH Syrup Tab 2,435 75 182,625 - -
138 Tablet tambah darah Saschet 45 700 31,500 - -
139 Cairan Rl Btl 5,720 2 11,440 - -
140 Cairan Nacl Btl 5,390 1 5,390 - -
141 Vit A 100.000 UI Btl 286 - - - -
142 Steracath IV Cath NO.24 Pcs 4,959 - - - -
JUMLAH 24,895,859

B.BAFFER DROPING-2015

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah(Rp) Penerimaan Rp
obat Okt-16
1 2 3 4 5 6 7 8
1 Amlodipin Tab 197 0 - 0 -
2 Cefadroksil Kapl 548 200 109,600 0 -
3 Deksametahason Tab 68 1800 122,400 0 -
4 Natrium Diklofenac Tab 206 0 - 0 -
5 Vit c Tab 105 500 52,500 0 -
6 Prednison Tab 103 3000 309,000 0 -
7 Ibu Profen Tab 96.21 0 - 0 -
8 Tablet Tambah darah Tab 135 - - 0 -
9 Vit Bcomp Tab 29.7 - - 0 -
10 Vit Bcomp Tab 112 1,000 112,000 0 -
11 Domperidon Tab 174 200 34,800 0 -
12 Zink Tab 521 100 52,100 0 -
13 Obh Sirup Tab 2435 36 87,660 0 -
14 Glibenclamid Tab 79.19 800 63,352 0 -
15 Tiamine 50 mg Tab 415.61 - - 900 374,049
 16 Kaptopril Tab 97 1,100 106,700 0 -
17 Alkohol 300ml Btl 9400 3 28,200 0 -
18 Vit A 100.000 IU Btl 286 - - 0 -
19 Vit A 200.000 IU Btl 505 - - - -
JUMLAH 1,078,312 374,049

C;ASKES SOS

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah(Rp) Penerimaan Rp
obat Okt-16
1 2 3 4 5 6 7 8
1 Prednison Tab 1236 0 - - -
JUMLAH - -

C.JAMKESDA-2015

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah(Rp) Penerimaan Rp
obat Okt-16
1 2 3 4 5 6 7 8
1 Salbutamol Cairan ih 0,1% Btl 7.260.0 20 145,200 0 -
2 Strip Glucosa Test 6,800 - - 0 -
3 StripCholesterol Test 27,000 - - 0 -
4 Strip Asam Urat Test 7,500 - - 0 -
5 Plester/Isoplast Roll 56,000 10 560,000 0 -
6 Tes Hamil Test 3,200 73 233,600 0 -
7 Sarung Tangan panjang Psg 45,000 10 450,000 0 -
8 Bisturi semua nomor Ktk 1,500 485 727,500 0 -
9 Kertas Puyer Obat Pak 35,000 - - 0 -
10 Golongan Darah ABO set 650,000 3 1,950,000 0 -
JUMLAH 4,066,300 -

Mengetahui
 Kepala Puskesmas Pangi

VEMI LAMATOA, SKM

Nip. 19680204 198903 2 007
SA PENGUNAAN OBAT 2015

Sisa Stok 30-

Pengeluaran Jumlah (Rp) Jumlah Harga
Nov-16
9 10 11 (5+4-9) 12 (11x4)
1,400 390,600 100 27,900
0 0 200 24,600
0 0 500 43,000
100 18,500 1,100 203,500
0 0 1,000 232,000
100 36,200 1,300 470,600
100 9,000 1,200 108,000
0 0 - -
1,000 45,000 2,000 90,000
0 0 - -
0 0 - -
0 0 - -
0 0 720 500,400
0 0 - -
0 0 - -
0 0 500 78,000
0 0 1,000 443,000
0 0 - -
0 0 - -
0 0 100 10,300
0 0 - -
0 0 - -
0 0 5,000 217,525
0 0 500 115,000
50 95,000 90 171,000
0 0 - -
 0 0 1,000 160,000
0 0 150 25,500
0 0 500 62,500
0 0 1,200 202,800
0 0 - -
0 0 100 16,900
0 0 100 88,000
200 46,000 - -
0 0 - -
0 0 400 30,400
0 0 210 46,410
300 25,500 700 59,500
0 0 3,000 465,630
0 0 - -
400 52,400 700 91,700
0 0 48 17,472
600 79,200 - -
0 0 - -
0 0 250 130,000
0 0 1,300 422,500
0 0 - -
1,400 147,000 - -
100 69,700 300 209,100
450 28,350 550 34,650
0 0 - -
0 0 - -
0 0 - -
0 0 300 104,700
0 0 1,000 19,770
0 0 400 235,800
0 0 - -
0 0 - -
0 0 500 38,000
0 0 400 53,600
0 0 700 245,700
 0 0 1,300 412,100
0 0 197 265,950
37 94,720 18 46,080
50 115,000 35 80,500
0 0 9 47,574
43 98,814 177 406,746
5 7,675 - -
0 0 10 91,000
0 0 100 687,500
0 0 - -
0 0 90 445,410
0 0 210 882,840
50 0 100 -
0 0 20 264
0 0 166 192,560
0 0 310 1,163,740
0 0 80 139,040
0 0 40 356,400
0 0 200 550,000
0 0 200 228,200
0 0 165 197,835
100 135,000 380 513,000
0 0 300 570,000
0 0 90 277,200
0 0 30 59,400
0 0 82 180,400
25 31,350 80 100,320
13 40,950 78 245,700
0 0 134 393,692
0 0 130 264,550
29 86,710 80 239,200
3 10,539 - -
0 0 120 198,000
24 38,304 30 47,880
0 0 10 31,400
 0 0 - -
0 0 24 -
0 0 50 138,350
0 0 85 229,245
0 0 67 112,560
1 25,350 2 50,700
0 0 4 460,800
15 74,385 - -
400 539,200 500 674,000
0 0 64 -
0 0 400 52,200
0 0 14 46,592
0 0 30 165,000
10 22,000 25 55,000
0 0 200 -
0 0 199 -
0 0 80 87,200
0 0 700 593,600
30 33,900 325 367,250
0 0 88 -
0 0 100 -
13 25,454 95 186,010
0 0 108 51,084
0 0 5 722,500
5 31,625 - -
10 46,700 - -
0 0 25 407,825
0 0 4 132,000
0 0 10 324,260
0 0 4 129,704
0 0 2 -
0 0 - -
2 107,010 1 53,505
0 0 30 2,520
0 0 13 381,329
 0 0 8 234,664
0 0 10 293,330
0 0 10 293,330
0 0 48 909,312
0 0 24 93,960
75 182,625 - -
700 31,500 - -
2 11,440 - -
1 5,390 - -
0 0 - -
0 0 - -
2,838,091 22,057,768

Sisa Stok 30-

Pengeluaran Jumlah (Rp) Jumlah Harga
Nov-16
9 10 11 (5+4-9) 12 (11x4)
0 - 0 -
100 54,800 100 54,800
1800 122,400 0 -
0 - 0 -
500 52,500 0 -
2000 206,000 1000 103,000
0 - 0 -
0 - - -
0 - - -
1,000 112,000 - -
200 34,800 - -
0 - 100 52,100
1 2,435 35 85,225
0 - 800 63,352
0 - 900 374,049
 0 - 1,100 106,700
0 - 3 28,200
0 - - -
0 - - -
584,935 867,426

Sisa Stok 30-

Pengeluaran Jumlah (Rp) Jumlah Harga
Nov-16
9 10 11 (5+4-9) 12 (11x4)
0 0 - -
0 -

Sisa Stok 30-

Pengeluaran Jumlah (Rp) Jumlah Harga
Nov-16
9 10 11 (5+4-9) 12 (11x4)
0 0 20 145,200
0 0 - -
0 0 - -
0 0 - -
2 112,000 8 448,000
3 9,600 70 224,000
0 0 10 450,000
5 7,500 480 720,000
0 0 - -
1 650,000 2 1,300,000
779,100 3,287,200

Yang Membuat Berita Acara

 Pengelola Obat

ALFIANTI, A.Md.Far
Nip: 19780805 201101 2005
 SISA PENGUNAAN OBAT

A. Sumber Obat : Pelayanan Kesehatan Dasar ( DAK-DAU ) 2014

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp) Penerimaan
obat Okt-16
1 Allopurinol Tablet 100 mg Tab 900 - - -
2 Alprazolam Tab 185 1,000 185,000 -
3 Albendasol Tab 407 18 7,326 -
4 Antalgin 500 mg Tab 232 - - -
5 Antasid Doen 400 mg Tab 78 - - -
6 Asiklovir tablet/kapsul/kaplet 400 mg Tab 362 - - -
7 Amlodipin Tab 197 - - 750
8 Amoksisilin 500mg Tab 279 - - 3,000
9 Ambroxol 30mg Tab 145 - - 2,000
10 Asam Traneksamat 500mg Tab 1490 - - 2,000
11 Asam Mefenamat Tab 113 - - 2,500
12 Asam Askorbat (vit C) Tab 120 - - 2,500
13 Klorfeniramina maleat (C T M ) Tab 91 - - -
14 Bisoprolol Fumarate Tab 695 - - -
15 Kloramphenikol Kapsul 250 mg Tab 250 - - -
16 Captopril Tab 72 - - 2,000
17 Ciprofloxin 500 mg Tab 290 - - -
18 Deksametason tab 0,5mg Tab 48 - - 2,000
19 Clonidin 0,15 mg Tab 193 - - -
20 Cotrimoksazol DOEN ( Dewasa ) Tab 152 - - -
21 Doksisiklin Kapsul 100 mg Tab 278 100 27,800 -
22 Digoxin 0,25 mg Tab 103 - - -
23 Domperidon Tab Tab 174 - - -
24 Diltiazem 30 mg Tab - 200 - -
25 Furesemid 40 mg Tab 98 - - -
26 Griseofulvin tablet 125 mg Tab 230 - - -
27 Glibenklamid tablet 5 mg Tab 61 - - -
28 IbuProfen 400mg Tab 133 - - 2,000
29 Isosorbid Dinitrat tablet sublingual 5 mg Tab 98 200 19,600 -
30 Omeprazole kapsul 20 mg Tab 221 120 26,520 -
31 Nistatin Vaginal tablet salut 100.000 IU/g Tab 528 100 52,800 -
32 Nistatin Tablet Salut 500.000 IU/g Tab 704 - - -
33 Natrium diclofenak 50 mg tab Tab 193 - - 1,250
34 Piroksikam 20 mg Tab 116 - - 2,000
35 Metil Prednisolon 4 mg Tab 230 - - -
36 Metoklopramid 5 mg Tab 113 200 22,600 -
37 Loperamid tablet 2 mg tab 97 - - -
38 Metformin Hcl 500 mg Tab 155 - - -
39 Propanolol 10 mg Tab 133 - - -
40 Ranitidin Tab 264 - - -
41 Papaverine 40 mg Tab 155 - - -
42 Prednison Tab 96.999 - - 5,000
43 Salbutamol 4 mg Tab 93 - - -
44 Simvastatin tab salut 10 mg Tab 135 - - 750
45 Tetrasiklin 250 mg Tab 162 - - -
46 Vitamin Bcomp Tab 112 - - 2,500
47 Zinc 20 mg Tab 521 - - -
48 Pirantel 125 mg Tab 318 - - -
49 Gliseril GuaIakolat Tab 44 - - -
50 Propylthiouracil 100 mg Tab 351 - - -
51 PrimaQuine 15 mg Tab 125 - - -
52 Fitomenadion (Vit k1) tablet salut gula Tab 697 - - -
53 Pirodoksin (B6) tablet Tab 19 - - -
54 Tiamin (Vitamin B1) Tab 5895 - - -
55 Asiklovir Krim 5% Tube 3,150 - - -
56 Betametason krim 0,1 % (sebagai valerat) Tube 1,596 - - -
57 Gentamycin Salep Kulit Tube 1,469 - - -
58 Hidrokortison Krim 2,5% Tube 5,200 - - -
59 Mikonazol krim /salep 2 % (nitrat) Tube 3,150 - - -
60 Oxytetrasiklin Hcl 3% Tube 1,646 - - -
61 Salep 2-4 Tube 1,352 - - -
62 Ketokonazol Krim 2% Tube 2,697 - - -
63 Reco Chlorampenicol Salep Mata Tube 1,680 - - -
64 Gentamycin Tetes Mata 0,3% Tube 3,513 - - -
65 Basitrasin Salep Tube 2,767 - - -
66 Kloramfenikol tts telinga 3 % Tube 1,760 - - -
67 Obh Syr Btl 1,575 - - -
68 Antasid syr Btl 2,300 - - -
69 Kotrimoksazol Suspensi Btl 2298 - - -
70 Paracetamol Sirup Btl 1119 - - 100
71 H202,0,3-0,5% Btl 29800 1.00 29,800 -
72 Ringer laktat larutan infus Btl 5,720 - - 100
73 Glukosa Larutan Infus Btl 5,844 5 29,220 -
74 Kasa kompres 16x16 steril( isi 16lmbr) Ktk 7,150 - - -
75 Infusion set Anak Pcs 4400 50 220,000 -
76 Infusion set dewasa Pcs 3,850 - - -
77 Ikat tali pusat Pcs 0 - - -
78 Gloves surgical No.7 Pcs 14.863.75 - - 100
79 Garam oralit serbuk, kombinasi: Sashet 317 - - -
80 Alat Suntik Sekali Pakai 3 ml Pcs 1425 - - -
81 Catgut/Benang Bedah Plain no.3/0 Pcs 27,000 48 1,296,000 -
82 Catgut/Benang Bedah Cromic no.3/0 Pcs 27,000 48 1,296,000 -
83 Catgut/Benang Bedah Plain no.2/0 Pcs 27,000 48 1,296,000 -
84 Catgut/Benang Bedah Cromic no.2/0 Pcs 27,000 48 1,296,000 -
85 Plester 5 yard x 2 Incih Roll 26840 - - -
86 Diazepam 2 mg Tab 114 - - -
87 Haloperidol 1,5 mg Tab 76 100 7,600 -
88 Haloperidol 2 mg Tab 134 - - -
89 Haloperidol 5 mg Tab 105 40 4,200 -
90 Fenobarbital 30 mg Tab 76 2,000 152,000 -
91 Lidokain Inj Amp 1350 300 405,000 -
92 Difenhidramin Inj 10 Mg Amp 1160 - - -
93 Sianokobalamin inj Amp 124 - - -
94 Epinefrin (adrenalin) inj Amp 297 30 8,910 -
95 Metilergometrin maleat inj Amp 2,750 - - -
96 Oksitetrasiklin inj Amp 1,843 - - -
97 Ranitidin inj Amp 134 - - -
 98 Oxybiotic Inj Amp 1843 - - -
99 Oksitosin inj Amp 500 - - -
100 Ketokonazol Tab 320 - - -
101 Itraconazole Tab 1,900 - - -
102 Strip Gula Darah Nesco Strip 6,180 - - 75
103 Strip Kolesterol Nesco Strip 25,450 - - 30
104 NaCl 0,9% Larutan Btl 6,410 - - 100
105 Retinol(Vit A)100.000 UI Kapsul Kap 286 - - -
JUMLAH 6,382,376

B.JAMKESDA-2014

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp) Penerimaan
obat Okt-16
1 Antalgin Tab Tab 1333 - - -
2 Albendasol Tab 407 - - -
3 Amitripilin Tab 123 - - -
4 Novakal Tab 76 - - -
5 Vit B12 Tab 63 - - -
6 Vit B 1 tab 59 - - -
7 Cendo tropin btl 0 2 - -
8 pirantel Sirup Btl 9100 - - -
9 Neuro tropik Inj Vial 0 10 - -
10 Povidon 10% Btl 12100 - - -
11 Rivanol 0,1% btl 3328 - - -
12 Desametasone Inj Amp 1738 - - -
13 Alkohol 70ml btl 2625 - - -
14 Bedak Salisil 2% Ktk 1350 - - -
15 Kasa 40mx80cm Rol 144500 - - -
16 Dispo 1cc Pcs 1090 - - -
17 Dispo 3cc Pcs 1425 - - -
18 Kasa pembalut One Med 250mg Pcs 15125 - - -
JUMLAH -
 Mengetahui

VEMI LAMATOA, SKM

Nip. 19680204 198903 2 007
T

Sisa Stok 30-Nov-

Rp Pengeluaran Jumlah (Rp) Jumlah Harga
16
- - - - -
- - - 1,000 185,000
- - - 18 7,326
- - - - -
- - - - -
- - - - -
147,750 - - 750 147,750
837,000 - - 3,000 837,000
290,000 - - 2,000 290,000
2,980,000 - - 2,000 2,980,000
282,500 - - 2,500 282,500
300,000 - - 2,500 300,000
- - - - -
- - - - -
- - - - -
144,000 2,000 144,000
- - - - -
96,000 2,000 96,000
- - - - -
- - - - -
- - - 100 27,800
- - - - -
- - - - -
- ### - 200 -
- - - - -
- - - - -
- - - - -
266,000 - - 2,000 266,000
 - - - 200 19,600
- - - 120 26,520
- - - 100 52,800
- - - - -
241,250 - - 1,250 241,250
232,000 - - 2,000 232,000
- - - - -
- - - 200 22,600
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
484,995 - - 5,000 484,995
- - - - -
101,250 - - 750 101,250
- - - - -
280,000 - - 2,500 280,000
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
 - - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
111,900 - - 100.00 111,900
- - - 1.00 29,800
572,000 - - 100 572,000
- - - 5 29,220
- - - - -
- - - 50 220,000
- - - - -
- - - - -
1,486,375 - - 100 1,486,375
- - - - -
- - - - -
- - - 48 1,296,000
- - - 48 1,296,000
- - - 48 1,296,000
- - - 48 1,296,000
- - - - -
- - - - -
- - - 100 7,600
- - - - -
- - - 40 4,200
- - - 2,000 152,000
- - - 300 405,000
- - - - -
- - - - -
- - - 30 8,910
- - - - -
- - - - -
- - - - -
 - - - - -
- - - - -
- - - - -
- - - - -
463,500 - - 75 463,500
763,500 - - 30 763,500
641,000 - - 100 641,000
- - - - -
10,721,020 17,103,396

Sisa Stok 30-Nov-

Rp Pengeluaran Jumlah (Rp) Jumlah Harga
16
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - 2 -
- - - - -
- - - 10 -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - -
- ### -
 Pangi, 04-November- 2016

Puskesmas Pangi

ALFIANTI, Amd.Far
NIP : 19780805 201101 2 005
 SISA PENGUNAAN OBA
a. BAFFER DROPING PUSAT 2012

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan
Obat Okt-16

1 2 3 4 5
1 IV Catheter No. 20 Pcs - 0
2 IV Catheter No. 24 Pcs 6,500 0
3 IV Catheter No. 18 Pcs 6,500 0
JUMLAH

B.Sumber PKD 2012

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan
Obat Okt-16

1 2 3 4 5
1 Diaz inj Amp 3 0
2 Phtomenadion inj Amp 107 0
JUMLAH

C. GAKIN 2012

Harga Satuan Sisa Stok 31-

NO Nama Obat Satuan
Obat Okt-16

1 2 3 4 5
1 Difenhidramin Inj 10 mg Amp 1,056 -
JUMLAH

Mengetahui
Kepala Puskesmas Pangi

VEMI LAMATOA, SKM

Nip. 19680204 198903 2 007
SISA PENGUNAAN OBAT

Sisa Stok 30-

Jumlah (Rp) Penerimaan Rp Pengeluaran Jumlah (Rp)
November-16

6 7 8 9 10 11
0 0 0 0 0
- 0 0 0 0 0
- 0 0 0 0 0
- 0 0

Sisa Stok 30-

Jumlah (Rp) Penerimaan Rp Pengeluaran Jumlah (Rp)
November-16

6 7 8 9 10 11
0 0 0 0 0 0
0 0 0 0 0 0
- 0 0

Sisa Stok 30-

Jumlah (Rp) Penerimaan Rp Pengeluaran Jumlah (Rp)
November-16

6 7 8 9 10 11
0 0 0 0 0 0
0 0 0

Pangi,04-November-
Pengelola Obat
Puskesmas Pangi

ALFIANTI, A.md.Far
NIP : 19780805 201101 2 005
 Jumlah Harga

12
0
-
-
-

Jumlah Harga

12
0
0
0

Jumlah Harga

12
-
-

gi,04-November- 2016
Pengelola Obat
Puskesmas Pangi

ALFIANTI, A.md.Far
: 19780805 201101 2 005
 SISA PENGUNAAN OBAT

A. Sumber PKD 2013

Harga satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp)
Obat Okt-16
1 2 3 4 5 6
1 Isosorbid Dinitrat Tab 101 - -
2 Papaverin Tab 128 - -
3 GG Tab 31 - -
4 PrimaQuin 15 mg Tab 125 - -
5 Fitomenadion Tab 641 - -
6 Dexametason Inj Amp 19 - -
7 CalcII Glukonas Inj Amp 150 - -
8 Tiamin (BI) Inj Amp 843 - -
9 Phytomenadion inj Amp 4,176 - -
10 Infuset Anak Pcs 150 - -
JUMLAH -

C. BAFFER DROPING PUSAT 2013

Harga satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp)
Obat Okt-16

1 2 3 4 5 6
1 Difenhidramin inj 10 mg Amp 1,160 - -
2 - -
JUMLAH -

D. ASKES SOS 2013

Harga satuan Sisa Stok 31-

NO Nama Obat Satuan Jumlah (Rp)
Obat Okt-16

1 2 3 4 5 6
1 Novadiar syp Btl 6,875 - -
2 - ###
JUMLAH -

Mengetahui
Kepala Puskesmas Pangi

VEMI LAMATOA, SKM

Nip. 19680204 198903 2 007
 Sisa Stok 30-
Penerimaan Rp Pengeluaran Jumlah (Rp)
Nov-16
7 8 9 10 11
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- - - ### -
- -

Sisa Stok 30-

Penerimaan Rp Pengeluaran Jumlah (Rp)
November-16

7 8 9 10 11
- - - ### -
### - - ### -
- -

Sisa Stok 30-

Penerimaan Rp Pengeluaran Jumlah (Rp)
November-16

7 8 9 10 11
- - - ### -
### - - ### -
- -

Pangi, 04-November- 2016

Yang Membuat Berita Acara
Pengelola Obat

ALFIANTI, A.Md.Far
Nip: 19780805 201101 2005
Jumlah Harga

12
-
-
-
-
-
-
-
-
-
-
-

Jumlah Harga

12
-
-
-

Jumlah Harga

12
-
-
-