Download as xlsx, pdf, or txt
Download as xlsx, pdf, or txt
You are on page 1of 118

LAPORAN PERSEDIAAN OBAT PUSKESMAS ……………………..

31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
ACT (Artesunate 50mg+ Amodiaquin
1 tab. 1,049.00 -
200mg)
2 Air Raksa dental use 100 gram 250,000.00 -
3 Albendazol tab. 400 mg. tab. 230.98 -
4 Alopurinol tablet 100 mg tab. 90.00 -
5 Ambroxol sirup 15 mg/ml btl 60 ml 2,665.00 -
6 Ambroxol tablet 30 mg tab. 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml amp 4,204.00 -
8 Aminofilin tablet 200 mg tab. 86.00 -
9 Amitriptilin HCl tablet salut 25 mg tab. 123.00 -
10 Amlodipin 10 mg tab. 352.00 -
11 Amoksisilin kaplet 500 mg kapl 279.00 -
12 Amoksisilin sirup kering 125mg/5ml btl 60 ml 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. btl 60 ml. 4,730.00 -

14 Ampisillin serbuk Inj. i.m/i.v 1000 vial 5,181.00 -


mg/ml.
15 Antalgin (Metampiron) tablet 500 mg tab. 132.99 -
16 Antasida DOEN sirup btl 60 ml 2,300.00 -
17 Antasida DOEN tablet tab. 78.00 -
18 Anti Bakteri DOEN kombinasi tub 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 pot 2,096.00 -
20 Antihemoroid DOEN kombinasi supp. 3,350.00 -
21
Antimigren DOEN kombinasi (Ergotamin) tab. 149.00 -
22 Artemeter inj. amp 24,384.00 -
23 Arterakine tab. - -
24 Asam Ascorbat (vit. C) tablet 50 mg tab. 105.00 -
25 Asam Mefenamat tablet 500 mg tab. 127.00 -
26 Asiklovir krim 5% tube 5 gr 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tab. 354.00 -
29 Attapulgit (Pularex tab.) tab. 220.00 -
30 Betametason krim 0,1% tub 1,558.00 -
31 Bisakodil supp. 10 mg. (Stolax) supp. 6,045.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
32 Cetirizin tab. 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml amp 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) botol - -
36 Diaform tab. - -
37 Diazepam injeksi 5 mg/ml - 2 ml amp 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tab. 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml amp 1,160.00 -
42 Digoksin tablet 0,25 mg tab. 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg tab. - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% amp - -
47 Eritromisin kapsul 500 mg kaps 1,023.00 -
48 Eritromisin sirup 200mg/5 ml btl 60 ml 8,090.00 -
49 Etakridin larutan 0,1% btl 300 ml 2,354.22 -
50 Etanol 70% 1000 ml 30,000.00 -
51 Etanol 70% btl 100 ml. 2,625.00 -
52 Etil Klorida semprot btl 100 ml. 120,000.00 -
53 Eugenol cairan btl 10 ml 18,333.00 -
54 Fenitoin kapsul 100 mg btl 100 kapsul 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -
56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. ampul 1,980.00 -

57 Fenol Gliserol tetes telinga 10% btl 1,108.80 -


58 Fitomenadion (vit K) inj 10 mg/ml amp 3,754.00 -
59 Fitomenadion (vit K1) tablet salut gula
10 mg tab. 698.00 -
60 Furosemid inj. 10 mg/ml amp 2,012.00 -
61 Furosemid tablet 40 mg tab. 84.00 -
62 Garam Oralit sase 317.00 -
63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. amp 3,782.00 -

64 Gentamisin salep kulit 0.1% tube 5 gr. 1,469.00 -


65 Gentamisin Sulfat tetes mata 0.3% btl 5 ml 3,513.00 -
66 Gentian Violet larutan 1% btl 10 ml 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
67 Glass Ionomer cement (GC IX) set - -
68 Glibenklamida tablet 5 mg tab. 61.00 -
69 Glimepiride tab. 2 mg. tab. 447.00 -
70 Gliseril Guaiakolat tablet 100 mg btl 1000 tab 30.69 -
71 Glucosa 10% Btl 500 ml. 6,270.00 -
72 Glukosa larutan infus 40% steril amp 25 ml - -
73 Glukosa larutan infus 5% btl 500 ml 5,720.00 -
74 Griseofulvin tablet 125 mg, micronized tab. 241.00 -

75 Haloperidol tablet 0.5 mg tab. 62.00 -


76 Haloperidol tablet 1.5 mg tab. 76.00 -
77 Haloperidol tablet 5 mg tab. 105.00 -
78 Hidroklorotiazida tablet 25 mg tab. 39.93 -
79 Hidrokortison krim 2,5% tub 2,868.00 -
80 Ibuprofen Susp. 60 ml. btl 60 ml. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg tab. 157.00 -
83 Iodiol kapsul lunak kaps 1,023.00 -
84 Isosorbit Dinitrat tablet sublingual 5 mg tab. 98.00 -

85 Kalsium Glukonat 10% amp - -


86 Kalsium hidroksida pasta set - -
87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -
88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. tab. 269.00 -
91 Ketokonazol krim 2% tube 15 gr 2,633.00 -
92 Ketokonazol tablet 200 mg tab. 320.00 -
93 Ketorolac Inj. 10 mg/ml. amp. - -
94 Kloramfenikol kapsul 250 mg kaps 264.00 -
95 Kloramfenikol salap mata 1% tube 5 gr 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml btl 60 ml 5,500.00 -
97 kloramfenikol tetes telinga 3% Btl 5 ml 1,759.00 -
98 Kloramfenikol tts mata 1% btl 5 ml. - -
99 Klorfeniramina Maleat (CTM) tabet 4 mg tab. 54.00 -

100 Klorfenol kamfer mentol (CHKM) btl - -


101 Klorokuin tablet 150 mg tab. 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
102 Klorpromazin HCl inj.25 mg/ml amp 1,210.00 -
103 Klorpromazin HCl tablet salut 100 mg tab. 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -
106
Kontrasepsi inj. Depo progestin (3 bln) vial 5,968.00 -
107 Kotrimoksazol susp 60 ml 2,298.00 -
108 Kotrimoksazol tablet 480 mg tab. 152.00 -
109
Kotrimoksazol tablet pediatrik 120 mg tab. 79.00 -
110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg kaps 521.00 -
112 Larutan Benedik 100 ml - -
113 Larutan Eosin 100 ml - -
114 Larutan Etanol Asam 100 ml - -
115 Larutan Giemsa 100 ml - -
116 larutan Karbol Fuchin 100 ml - -
117 Larutan Metilen Blue 100 ml - -
118 Larutan Turk 100 ml - -
119 Lidokain injeksi 2% amp 2 ml 1,499.00 -
120 Loperamide / Bidium tab. 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) ampul 1,693.00 -
123 MDT MB Adult blister 25,742.00 -
124 MDT MB Child blister 18,300.00 -
125 MDT PB Adult blister 8,052.00 -
126 MDT PB Child blister 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg tab. 124.50 -
130 Metilergometrin maleat inj 0.200 mg-1 amp 2,750.00 -
ml

131 Metilergometrin maleat tab. Salut 0.125 tab. 169.00 -


mg
132 Metoklopramide tablet 10 mg tab. 108.00 -
133 Metronidazol tablet 250 mg tab. 116.00 -
134 MgSo4 40% inj. Vial 2,142.00 -
135 Mikonazol krim/salap 2% nitrat tube 10 gr 3,075.00 -
136 Mummifying pasta botol - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
137 Natrium Bikarbonat tablet 500 mg tab. 20.00 -
138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% btl 500 ml 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) tab. 1,870.00 -
141 Nifedipin tab. 110.00 -
142 Nistatin tablet salut 500.000 IU tab. 704.00 -
143 Nistatin vagina tablet 100.000 IU tab. 528.00 -
144 OAT FDC Katagori 1 paket 359,990.00 -
145 OAT FDC Katagori 2 paket 1,320,000.00 -
146 OAT Katagori Anak paket 214,990.00 -
147 Obat batuk Hitam (OBH) cairan btl 100 ml 3,060.00 -
148 OBP (Obat Batuk Putih) btl 100 ml - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml vial 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tube 3,5 gr 1,640.00 -


151 Oksitetrasiklin salap kulit 3% tube 5 gr 1,646.00 -
152 Oksitosin inj. 10 IU/ml - 1 ml amp 2,420.00 -
153 Omeprazol kapsul 20 mg kaps 221.00 -
154 Parasetamol sirup 120 mg/5 ml 60 ml 1,535.00 -
155 Parasetamol tablet 100 mg tab. 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) btl 150,000.00 -
158 Pirantel tablet 125 mg tab. 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg kaps 99.99 -
161 Povidon Iodida larutan 10% btl 30 ml 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg tab. 205.00 -
164 Prokain Benzil Penisillin G. inj. 3 jt - 15 vial 6,141.67 -
ml.
165 Propanolol HCl tablet 40 mg tab. 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) tab. 351.00 -
167 Ranitidin Inj. 25 mg/ml. amp 1,340.00 -
168 Ranitidin tablet 150 mg tab. 132.00 -
169 Retinol (vitamin A) 100.000 IU kapsul kaps 286.00 -
lunak

170 Retinol (vitamin A) 200.000 IU kapsul kaps 505.00 -


lunak
171 Ringer Laktat larutan infus btl 500 ml 5,720.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
172 Salap 2 - 4 pot 2,200.00 -
173 Salbutamol tablet 2 mg tab. 65.00 -
174 Salisil Bedak 2% 50 gram 1,350.00 -
175 Sefadroksil kapsul 500 mg kaps 548.00 -
176 Semen Seng Fosfat serbuk dan cairan set - -
177 Serum Anti Bisa Ular (ABU) inj. vial 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) amp. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) Vial 868,000.00 -

180 Sianokobalamin (vit B12) inj. 500 mcg amp. 1,050.00 -


181 Silk (benang bedah) no. 3 spcs 13,616.00 -
182 Silver Amalgam 1 oz - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg tab. 400.00 -
186 Sulfasetamid natrium tetes mata 15% btl 3,549.00 -
187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher set - -
189 Tetrasiklin kapsul 250 mg kaps 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -
191 Tiamfenikol kapsul 500 mg kaps 440.00 -
192 Tiamin (Vit B1) inj. 100 mg/ml amp 750.00 -
193 Tiamin tablet 50 mg tab. 136.00 -
194 Tramadol kapsul 50 mg kaps 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) botol - -
197 Vaksin BCG 2 ds/vial 59,950.00 -
198 Vaksin Campak 10 ds/vial 28,204.00 -
199 Vaksin DPT/HB 10 ds/vial - -
200 Vaksin DT 10 ds/vial 70,863.00 -
201 Vaksin HB - Uniject 1 ds/vial 20,900.00 -
202 Vaksin Pentabio 1 ds/vial 76,285.00 -
203 Vaksin Polio 10 ds/vial 19,954.00 -
204 Vaksin Td 10 ds/vial 16,500.00 -
205 Vaksin TT 10 ds/vial 14,498.00 -
206 Vitamin B Komplek tablet tab. 112.00 -
207 Zink 20 mg. tab. tab. 521.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
208 Zink sirup (Zircum Kid) btl 60 ml. 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. tab. 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Puskesmas Pengelola Obat puskesmas

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

uskesmas

………………………….
LAPORAN PERSEDIAAN BMHP PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES


NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -
4 ADS/Spuit 0,05 ml. pcs - -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Puskesmas Pengelola BMHP puskesmas

……………………………………….. ………………………………………………
NIP. NIP.
KET

puskesmas

………………………….
LAPORAN PERSEDIAAN OBAT PUSTU ……………………..
PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

ACT (Artesunate 50mg+ Amodiaquin


1 200mg) pcs 1,049.00 -
2 Air Raksa dental use pcs 250,000.00 -
3 Albendazol tab. 400 mg. pcs 230.98 -

4 Alopurinol tablet 100 mg tab. 90.00 -

5 Ambroxol sirup 15 mg/ml pcs 2,665.00 -


6 Ambroxol tablet 30 mg pcs 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml pcs 4,204.00 -
8 Aminofilin tablet 200 mg 100 gram 86.00 -
9 Amitriptilin HCl tablet salut 25 mg 100 pcs 123.00 -
10 Amlodipin 10 mg 100 pcs 352.00 -
11 Amoksisilin kaplet 500 mg 100 pcs 279.00 -
12 Amoksisilin sirup kering 125mg/5ml 100 pcs 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. tab. 4,730.00 -


Ampisillin serbuk Inj. i.m/i.v 1000
14 mg/ml. tab. 5,181.00 -
15 Antalgin (Metampiron) tablet 500 mg btl 60 ml 132.99 -
16 Antasida DOEN sirup tab. 2,300.00 -
17 Antasida DOEN tablet amp 78.00 -
18 Anti Bakteri DOEN kombinasi tab. 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 tab. 2,096.00 -
20 Antihemoroid DOEN kombinasi tab. 3,350.00 -

21 Antimigren DOEN kombinasi (Ergotamin) kapl 149.00 -


22 Artemeter inj. btl 60 ml 24,384.00 -
23 Arterakine btl 60 ml. - -

24 Asam Ascorbat (vit. C) tablet 50 mg vial 105.00 -

25 Asam Mefenamat tablet 500 mg tab. 127.00 -


26 Asiklovir krim 5% btl 60 ml 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tub 354.00 -
29 Attapulgit (Pularex tab.) pot 220.00 -
30 Betametason krim 0,1% supp. 1,558.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

31 Bisakodil supp. 10 mg. (Stolax) tab. 6,045.00 -


32 Cetirizin amp 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml tab. 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) tab. - -
36 Diaform tube 5 gr - -
37 Diazepam injeksi 5 mg/ml - 2 ml tab. 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tub 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml supp. 1,160.00 -
42 Digoksin tablet 0,25 mg pcs 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg amp - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% botol - -
47 Eritromisin kapsul 500 mg tab. 1,023.00 -
48 Eritromisin sirup 200mg/5 ml amp 8,090.00 -
49 Etakridin larutan 0,1% tab. 2,354.22 -
50 Etanol 70% tab. 30,000.00 -
51 Etanol 70% tab. 2,625.00 -
52 Etil Klorida semprot amp 120,000.00 -
53 Eugenol cairan tab. 18,333.00 -
54 Fenitoin kapsul 100 mg tab. 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -

56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. tab. 1,980.00 -


57 Fenol Gliserol tetes telinga 10% amp 1,108.80 -
58 Fitomenadion (vit K) inj 10 mg/ml kaps 3,754.00 -
Fitomenadion (vit K1) tablet salut gula
59 10 mg btl 60 ml 698.00 -
60 Furosemid inj. 10 mg/ml btl 300 ml 2,012.00 -
61 Furosemid tablet 40 mg 1000 ml 84.00 -
62 Garam Oralit btl 100 ml. 317.00 -

63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. btl 100 ml. 3,782.00 -


64 Gentamisin salep kulit 0.1% btl 10 ml 1,469.00 -
65 Gentamisin Sulfat tetes mata 0.3% btl 100 kapsul 3,513.00 -
66 Gentian Violet larutan 1% tab. 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

67 Glass Ionomer cement (GC IX) ampul - -


68 Glibenklamida tablet 5 mg btl 61.00 -
69 Glimepiride tab. 2 mg. amp 447.00 -
70 Gliseril Guaiakolat tablet 100 mg tab. 30.69 -
71 Glucosa 10% pcs 6,270.00 -
72 Glukosa larutan infus 40% steril amp - -
73 Glukosa larutan infus 5% tab. 5,720.00 -

74 Griseofulvin tablet 125 mg, micronized sase 241.00 -


75 Haloperidol tablet 0.5 mg amp 62.00 -

76 Haloperidol tablet 1.5 mg tube 5 gr. 76.00 -


77 Haloperidol tablet 5 mg btl 5 ml 105.00 -
78 Hidroklorotiazida tablet 25 mg btl 10 ml 39.93 -
79 Hidrokortison krim 2,5% set 2,868.00 -
80 Ibuprofen Susp. 60 ml. tab. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg btl 1000 tab 157.00 -
83 Iodiol kapsul lunak Btl 500 ml. 1,023.00 -

84 Isosorbit Dinitrat tablet sublingual 5 mg amp 25 ml 98.00 -


85 Kalsium Glukonat 10% btl 500 ml - -
86 Kalsium hidroksida pasta tab. - -

87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -


88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. pasang 269.00 -
91 Ketokonazol krim 2% tab. 2,633.00 -
92 Ketokonazol tablet 200 mg tub 320.00 -
93 Ketorolac Inj. 10 mg/ml. btl 60 ml. - -
94 Kloramfenikol kapsul 250 mg tab. 264.00 -
95 Kloramfenikol salap mata 1% tab. 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml set 5,500.00 -
97 kloramfenikol tetes telinga 3% set 1,759.00 -
98 Kloramfenikol tts mata 1% kaps - -
tab. -
99 Klorfeniramina Maleat (CTM) tabet 4 mg 54.00
100 Klorfenol kamfer mentol (CHKM) amp - -
101 Klorokuin tablet 150 mg set 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

102 Klorpromazin HCl inj.25 mg/ml tab. 1,210.00 -


103 Klorpromazin HCl tablet salut 100 mg bungkus 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -

106 Kontrasepsi inj. Depo progestin (3 bln) tab. 5,968.00 -


107 Kotrimoksazol susp rol 2,298.00 -
108 Kotrimoksazol tablet 480 mg pad 152.00 -

109 Kotrimoksazol tablet pediatrik 120 mg tube 15 gr 79.00 -


110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg amp. 521.00 -
112 Larutan Benedik kaps - -
113 Larutan Eosin tube 5 gr - -
114 Larutan Etanol Asam btl 60 ml - -
115 Larutan Giemsa Btl 5 ml - -
116 larutan Karbol Fuchin btl 5 ml. - -
117 Larutan Metilen Blue tab. - -
118 Larutan Turk btl - -
119 Lidokain injeksi 2% tab. 1,499.00 -
120 Loperamide / Bidium amp 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) tab. 1,693.00 -
123 MDT MB Adult tab. 25,742.00 -
124 MDT MB Child vial 18,300.00 -
125 MDT PB Adult 60 ml 8,052.00 -
126 MDT PB Child tab. 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg kaps 124.50 -
Metilergometrin maleat inj 0.200 mg-1
130 ml 100 ml 2,750.00 -
Metilergometrin maleat tab. Salut 0.125
131 mg 100 ml 169.00 -
132 Metoklopramide tablet 10 mg 100 ml 108.00 -
133 Metronidazol tablet 250 mg 100 ml 116.00 -
134 MgSo4 40% inj. 100 ml 2,142.00 -
135 Mikonazol krim/salap 2% nitrat 100 ml 3,075.00 -
136 Mummifying pasta 100 ml - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

137 Natrium Bikarbonat tablet 500 mg amp 2 ml 20.00 -


138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% tab. 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) ampul 1,870.00 -
141 Nifedipin ktk 110.00 -
142 Nistatin tablet salut 500.000 IU blister 704.00 -
143 Nistatin vagina tablet 100.000 IU blister 528.00 -
144 OAT FDC Katagori 1 blister 359,990.00 -
145 OAT FDC Katagori 2 blister 1,320,000.00 -
146 OAT Katagori Anak tab. 214,990.00 -
147 Obat batuk Hitam (OBH) cairan tab. 3,060.00 -
148 OBP (Obat Batuk Putih) tab. - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml amp 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tab. 1,640.00 -

151 Oksitetrasiklin salap kulit 3% tab. 1,646.00 -


152 Oksitosin inj. 10 IU/ml - 1 ml tab. 2,420.00 -
153 Omeprazol kapsul 20 mg Vial 221.00 -
154 Parasetamol sirup 120 mg/5 ml tube 10 gr 1,535.00 -
155 Parasetamol tablet 100 mg botol 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) tab. 150,000.00 -
158 Pirantel tablet 125 mg btl 500 ml 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg tab. 99.99 -
161 Povidon Iodida larutan 10% tab. 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg paket 205.00 -
Prokain Benzil Penisillin G. inj. 3 jt - 15
164 ml. paket 6,141.67 -
165 Propanolol HCl tablet 40 mg paket 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) btl 100 ml 351.00 -
167 Ranitidin Inj. 25 mg/ml. btl 100 ml 1,340.00 -
vial -
168 Ranitidin tablet 150 mg 132.00
Retinol (vitamin A) 100.000 IU kapsul
169 lunak tube 3,5 gr 286.00 -
Retinol (vitamin A) 200.000 IU kapsul
170 lunak tube 5 gr 505.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

171 Ringer Laktat larutan infus amp 5,720.00 -


172 Salap 2 - 4 kaps 2,200.00 -
173 Salbutamol tablet 2 mg 60 ml 65.00 -
174 Salisil Bedak 2% tab. 1,350.00 -
175 Sefadroksil kapsul 500 mg tab. 548.00 -
176 Semen Seng Fosfat serbuk dan cairan btl - -
177 Serum Anti Bisa Ular (ABU) inj. tab. 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) tab. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) kaps 868,000.00 -


180 Sianokobalamin (vit B12) inj. 500 mcg rol 1,050.00 -
181 Silk (benang bedah) no. 3 bh 13,616.00 -
182 Silver Amalgam btl 30 ml - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg vial 400.00 -

186 Sulfasetamid natrium tetes mata 15% tab. 3,549.00 -


187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher amp - -
189 Tetrasiklin kapsul 250 mg tab. 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -

191 Tiamfenikol kapsul 500 mg kaps 440.00 -

192 Tiamin (Vit B1) inj. 100 mg/ml btl 500 ml 750.00 -
193 Tiamin tablet 50 mg pcs 136.00 -
194 Tramadol kapsul 50 mg pot 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) 50 gram - -
197 Vaksin BCG kaps 59,950.00 -
198 Vaksin Campak set 28,204.00 -
199 Vaksin DPT/HB vial - -
200 Vaksin DT amp. 70,863.00 -
201 Vaksin HB - Uniject Vial 20,900.00 -

202 Vaksin Pentabio amp. 76,285.00 -


203 Vaksin Polio spcs 19,954.00 -
204 Vaksin Td 1 oz 16,500.00 -
205 Vaksin TT tab. 14,498.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

206 Vitamin B Komplek tablet tab. 112.00 -


207 Zink 20 mg. tab. tab. 521.00 -
208 Zink sirup (Zircum Kid) btl 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. set 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola Obat pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

ustu

………………………….
LAPORAN PERSEDIAAN OBAT PUSTU ……………………..
PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

ACT (Artesunate 50mg+ Amodiaquin


1 200mg) pcs 1,049.00 -
2 Air Raksa dental use pcs 250,000.00 -
3 Albendazol tab. 400 mg. pcs 230.98 -

4 Alopurinol tablet 100 mg tab. 90.00 -

5 Ambroxol sirup 15 mg/ml pcs 2,665.00 -


6 Ambroxol tablet 30 mg pcs 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml pcs 4,204.00 -
8 Aminofilin tablet 200 mg 100 gram 86.00 -
9 Amitriptilin HCl tablet salut 25 mg 100 pcs 123.00 -
10 Amlodipin 10 mg 100 pcs 352.00 -
11 Amoksisilin kaplet 500 mg 100 pcs 279.00 -
12 Amoksisilin sirup kering 125mg/5ml 100 pcs 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. tab. 4,730.00 -


Ampisillin serbuk Inj. i.m/i.v 1000
14 mg/ml. tab. 5,181.00 -
15 Antalgin (Metampiron) tablet 500 mg btl 60 ml 132.99 -
16 Antasida DOEN sirup tab. 2,300.00 -
17 Antasida DOEN tablet amp 78.00 -
18 Anti Bakteri DOEN kombinasi tab. 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 tab. 2,096.00 -
20 Antihemoroid DOEN kombinasi tab. 3,350.00 -

21 Antimigren DOEN kombinasi (Ergotamin) kapl 149.00 -


22 Artemeter inj. btl 60 ml 24,384.00 -
23 Arterakine btl 60 ml. - -

24 Asam Ascorbat (vit. C) tablet 50 mg vial 105.00 -

25 Asam Mefenamat tablet 500 mg tab. 127.00 -


26 Asiklovir krim 5% btl 60 ml 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tub 354.00 -
29 Attapulgit (Pularex tab.) pot 220.00 -
30 Betametason krim 0,1% supp. 1,558.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

31 Bisakodil supp. 10 mg. (Stolax) tab. 6,045.00 -


32 Cetirizin amp 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml tab. 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) tab. - -
36 Diaform tube 5 gr - -
37 Diazepam injeksi 5 mg/ml - 2 ml tab. 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tub 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml supp. 1,160.00 -
42 Digoksin tablet 0,25 mg pcs 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg amp - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% botol - -
47 Eritromisin kapsul 500 mg tab. 1,023.00 -
48 Eritromisin sirup 200mg/5 ml amp 8,090.00 -
49 Etakridin larutan 0,1% tab. 2,354.22 -
50 Etanol 70% tab. 30,000.00 -
51 Etanol 70% tab. 2,625.00 -
52 Etil Klorida semprot amp 120,000.00 -
53 Eugenol cairan tab. 18,333.00 -
54 Fenitoin kapsul 100 mg tab. 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -

56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. tab. 1,980.00 -


57 Fenol Gliserol tetes telinga 10% amp 1,108.80 -
58 Fitomenadion (vit K) inj 10 mg/ml kaps 3,754.00 -
Fitomenadion (vit K1) tablet salut gula
59 10 mg btl 60 ml 698.00 -
60 Furosemid inj. 10 mg/ml btl 300 ml 2,012.00 -
61 Furosemid tablet 40 mg 1000 ml 84.00 -
62 Garam Oralit btl 100 ml. 317.00 -

63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. btl 100 ml. 3,782.00 -


64 Gentamisin salep kulit 0.1% btl 10 ml 1,469.00 -
65 Gentamisin Sulfat tetes mata 0.3% btl 100 kapsul 3,513.00 -
66 Gentian Violet larutan 1% tab. 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

67 Glass Ionomer cement (GC IX) ampul - -


68 Glibenklamida tablet 5 mg btl 61.00 -
69 Glimepiride tab. 2 mg. amp 447.00 -
70 Gliseril Guaiakolat tablet 100 mg tab. 30.69 -
71 Glucosa 10% pcs 6,270.00 -
72 Glukosa larutan infus 40% steril amp - -
73 Glukosa larutan infus 5% tab. 5,720.00 -

74 Griseofulvin tablet 125 mg, micronized sase 241.00 -


75 Haloperidol tablet 0.5 mg amp 62.00 -

76 Haloperidol tablet 1.5 mg tube 5 gr. 76.00 -


77 Haloperidol tablet 5 mg btl 5 ml 105.00 -
78 Hidroklorotiazida tablet 25 mg btl 10 ml 39.93 -
79 Hidrokortison krim 2,5% set 2,868.00 -
80 Ibuprofen Susp. 60 ml. tab. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg btl 1000 tab 157.00 -
83 Iodiol kapsul lunak Btl 500 ml. 1,023.00 -

84 Isosorbit Dinitrat tablet sublingual 5 mg amp 25 ml 98.00 -


85 Kalsium Glukonat 10% btl 500 ml - -
86 Kalsium hidroksida pasta tab. - -

87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -


88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. pasang 269.00 -
91 Ketokonazol krim 2% tab. 2,633.00 -
92 Ketokonazol tablet 200 mg tub 320.00 -
93 Ketorolac Inj. 10 mg/ml. btl 60 ml. - -
94 Kloramfenikol kapsul 250 mg tab. 264.00 -
95 Kloramfenikol salap mata 1% tab. 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml set 5,500.00 -
97 kloramfenikol tetes telinga 3% set 1,759.00 -
98 Kloramfenikol tts mata 1% kaps - -
tab. -
99 Klorfeniramina Maleat (CTM) tabet 4 mg 54.00
100 Klorfenol kamfer mentol (CHKM) amp - -
101 Klorokuin tablet 150 mg set 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

102 Klorpromazin HCl inj.25 mg/ml tab. 1,210.00 -


103 Klorpromazin HCl tablet salut 100 mg bungkus 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -

106 Kontrasepsi inj. Depo progestin (3 bln) tab. 5,968.00 -


107 Kotrimoksazol susp rol 2,298.00 -
108 Kotrimoksazol tablet 480 mg pad 152.00 -

109 Kotrimoksazol tablet pediatrik 120 mg tube 15 gr 79.00 -


110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg amp. 521.00 -
112 Larutan Benedik kaps - -
113 Larutan Eosin tube 5 gr - -
114 Larutan Etanol Asam btl 60 ml - -
115 Larutan Giemsa Btl 5 ml - -
116 larutan Karbol Fuchin btl 5 ml. - -
117 Larutan Metilen Blue tab. - -
118 Larutan Turk btl - -
119 Lidokain injeksi 2% tab. 1,499.00 -
120 Loperamide / Bidium amp 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) tab. 1,693.00 -
123 MDT MB Adult tab. 25,742.00 -
124 MDT MB Child vial 18,300.00 -
125 MDT PB Adult 60 ml 8,052.00 -
126 MDT PB Child tab. 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg kaps 124.50 -
Metilergometrin maleat inj 0.200 mg-1
130 ml 100 ml 2,750.00 -
Metilergometrin maleat tab. Salut 0.125
131 mg 100 ml 169.00 -
132 Metoklopramide tablet 10 mg 100 ml 108.00 -
133 Metronidazol tablet 250 mg 100 ml 116.00 -
134 MgSo4 40% inj. 100 ml 2,142.00 -
135 Mikonazol krim/salap 2% nitrat 100 ml 3,075.00 -
136 Mummifying pasta 100 ml - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

137 Natrium Bikarbonat tablet 500 mg amp 2 ml 20.00 -


138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% tab. 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) ampul 1,870.00 -
141 Nifedipin ktk 110.00 -
142 Nistatin tablet salut 500.000 IU blister 704.00 -
143 Nistatin vagina tablet 100.000 IU blister 528.00 -
144 OAT FDC Katagori 1 blister 359,990.00 -
145 OAT FDC Katagori 2 blister 1,320,000.00 -
146 OAT Katagori Anak tab. 214,990.00 -
147 Obat batuk Hitam (OBH) cairan tab. 3,060.00 -
148 OBP (Obat Batuk Putih) tab. - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml amp 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tab. 1,640.00 -

151 Oksitetrasiklin salap kulit 3% tab. 1,646.00 -


152 Oksitosin inj. 10 IU/ml - 1 ml tab. 2,420.00 -
153 Omeprazol kapsul 20 mg Vial 221.00 -
154 Parasetamol sirup 120 mg/5 ml tube 10 gr 1,535.00 -
155 Parasetamol tablet 100 mg botol 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) tab. 150,000.00 -
158 Pirantel tablet 125 mg btl 500 ml 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg tab. 99.99 -
161 Povidon Iodida larutan 10% tab. 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg paket 205.00 -
Prokain Benzil Penisillin G. inj. 3 jt - 15
164 ml. paket 6,141.67 -
165 Propanolol HCl tablet 40 mg paket 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) btl 100 ml 351.00 -
167 Ranitidin Inj. 25 mg/ml. btl 100 ml 1,340.00 -
vial -
168 Ranitidin tablet 150 mg 132.00
Retinol (vitamin A) 100.000 IU kapsul
169 lunak tube 3,5 gr 286.00 -
Retinol (vitamin A) 200.000 IU kapsul
170 lunak tube 5 gr 505.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

171 Ringer Laktat larutan infus amp 5,720.00 -


172 Salap 2 - 4 kaps 2,200.00 -
173 Salbutamol tablet 2 mg 60 ml 65.00 -
174 Salisil Bedak 2% tab. 1,350.00 -
175 Sefadroksil kapsul 500 mg tab. 548.00 -
176 Semen Seng Fosfat serbuk dan cairan btl - -
177 Serum Anti Bisa Ular (ABU) inj. tab. 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) tab. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) kaps 868,000.00 -


180 Sianokobalamin (vit B12) inj. 500 mcg rol 1,050.00 -
181 Silk (benang bedah) no. 3 bh 13,616.00 -
182 Silver Amalgam btl 30 ml - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg vial 400.00 -

186 Sulfasetamid natrium tetes mata 15% tab. 3,549.00 -


187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher amp - -
189 Tetrasiklin kapsul 250 mg tab. 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -

191 Tiamfenikol kapsul 500 mg kaps 440.00 -

192 Tiamin (Vit B1) inj. 100 mg/ml btl 500 ml 750.00 -
193 Tiamin tablet 50 mg pcs 136.00 -
194 Tramadol kapsul 50 mg pot 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) 50 gram - -
197 Vaksin BCG kaps 59,950.00 -
198 Vaksin Campak set 28,204.00 -
199 Vaksin DPT/HB vial - -
200 Vaksin DT amp. 70,863.00 -
201 Vaksin HB - Uniject Vial 20,900.00 -

202 Vaksin Pentabio amp. 76,285.00 -


203 Vaksin Polio spcs 19,954.00 -
204 Vaksin Td 1 oz 16,500.00 -
205 Vaksin TT tab. 14,498.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

206 Vitamin B Komplek tablet tab. 112.00 -


207 Zink 20 mg. tab. tab. 521.00 -
208 Zink sirup (Zircum Kid) btl 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. set 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola Obat pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

ustu

………………………….
LAPORAN PERSEDIAAN OBAT PUSTU ……………………..
PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

ACT (Artesunate 50mg+ Amodiaquin


1 200mg) pcs 1,049.00 -
2 Air Raksa dental use pcs 250,000.00 -
3 Albendazol tab. 400 mg. pcs 230.98 -

4 Alopurinol tablet 100 mg tab. 90.00 -

5 Ambroxol sirup 15 mg/ml pcs 2,665.00 -


6 Ambroxol tablet 30 mg pcs 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml pcs 4,204.00 -
8 Aminofilin tablet 200 mg 100 gram 86.00 -
9 Amitriptilin HCl tablet salut 25 mg 100 pcs 123.00 -
10 Amlodipin 10 mg 100 pcs 352.00 -
11 Amoksisilin kaplet 500 mg 100 pcs 279.00 -
12 Amoksisilin sirup kering 125mg/5ml 100 pcs 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. tab. 4,730.00 -


Ampisillin serbuk Inj. i.m/i.v 1000
14 mg/ml. tab. 5,181.00 -
15 Antalgin (Metampiron) tablet 500 mg btl 60 ml 132.99 -
16 Antasida DOEN sirup tab. 2,300.00 -
17 Antasida DOEN tablet amp 78.00 -
18 Anti Bakteri DOEN kombinasi tab. 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 tab. 2,096.00 -
20 Antihemoroid DOEN kombinasi tab. 3,350.00 -

21 Antimigren DOEN kombinasi (Ergotamin) kapl 149.00 -


22 Artemeter inj. btl 60 ml 24,384.00 -
23 Arterakine btl 60 ml. - -

24 Asam Ascorbat (vit. C) tablet 50 mg vial 105.00 -

25 Asam Mefenamat tablet 500 mg tab. 127.00 -


26 Asiklovir krim 5% btl 60 ml 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tub 354.00 -
29 Attapulgit (Pularex tab.) pot 220.00 -
30 Betametason krim 0,1% supp. 1,558.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

31 Bisakodil supp. 10 mg. (Stolax) tab. 6,045.00 -


32 Cetirizin amp 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml tab. 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) tab. - -
36 Diaform tube 5 gr - -
37 Diazepam injeksi 5 mg/ml - 2 ml tab. 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tub 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml supp. 1,160.00 -
42 Digoksin tablet 0,25 mg pcs 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg amp - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% botol - -
47 Eritromisin kapsul 500 mg tab. 1,023.00 -
48 Eritromisin sirup 200mg/5 ml amp 8,090.00 -
49 Etakridin larutan 0,1% tab. 2,354.22 -
50 Etanol 70% tab. 30,000.00 -
51 Etanol 70% tab. 2,625.00 -
52 Etil Klorida semprot amp 120,000.00 -
53 Eugenol cairan tab. 18,333.00 -
54 Fenitoin kapsul 100 mg tab. 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -

56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. tab. 1,980.00 -


57 Fenol Gliserol tetes telinga 10% amp 1,108.80 -
58 Fitomenadion (vit K) inj 10 mg/ml kaps 3,754.00 -
Fitomenadion (vit K1) tablet salut gula
59 10 mg btl 60 ml 698.00 -
60 Furosemid inj. 10 mg/ml btl 300 ml 2,012.00 -
61 Furosemid tablet 40 mg 1000 ml 84.00 -
62 Garam Oralit btl 100 ml. 317.00 -

63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. btl 100 ml. 3,782.00 -


64 Gentamisin salep kulit 0.1% btl 10 ml 1,469.00 -
65 Gentamisin Sulfat tetes mata 0.3% btl 100 kapsul 3,513.00 -
66 Gentian Violet larutan 1% tab. 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

67 Glass Ionomer cement (GC IX) ampul - -


68 Glibenklamida tablet 5 mg btl 61.00 -
69 Glimepiride tab. 2 mg. amp 447.00 -
70 Gliseril Guaiakolat tablet 100 mg tab. 30.69 -
71 Glucosa 10% pcs 6,270.00 -
72 Glukosa larutan infus 40% steril amp - -
73 Glukosa larutan infus 5% tab. 5,720.00 -

74 Griseofulvin tablet 125 mg, micronized sase 241.00 -


75 Haloperidol tablet 0.5 mg amp 62.00 -

76 Haloperidol tablet 1.5 mg tube 5 gr. 76.00 -


77 Haloperidol tablet 5 mg btl 5 ml 105.00 -
78 Hidroklorotiazida tablet 25 mg btl 10 ml 39.93 -
79 Hidrokortison krim 2,5% set 2,868.00 -
80 Ibuprofen Susp. 60 ml. tab. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg btl 1000 tab 157.00 -
83 Iodiol kapsul lunak Btl 500 ml. 1,023.00 -

84 Isosorbit Dinitrat tablet sublingual 5 mg amp 25 ml 98.00 -


85 Kalsium Glukonat 10% btl 500 ml - -
86 Kalsium hidroksida pasta tab. - -

87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -


88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. pasang 269.00 -
91 Ketokonazol krim 2% tab. 2,633.00 -
92 Ketokonazol tablet 200 mg tub 320.00 -
93 Ketorolac Inj. 10 mg/ml. btl 60 ml. - -
94 Kloramfenikol kapsul 250 mg tab. 264.00 -
95 Kloramfenikol salap mata 1% tab. 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml set 5,500.00 -
97 kloramfenikol tetes telinga 3% set 1,759.00 -
98 Kloramfenikol tts mata 1% kaps - -
tab. -
99 Klorfeniramina Maleat (CTM) tabet 4 mg 54.00
100 Klorfenol kamfer mentol (CHKM) amp - -
101 Klorokuin tablet 150 mg set 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

102 Klorpromazin HCl inj.25 mg/ml tab. 1,210.00 -


103 Klorpromazin HCl tablet salut 100 mg bungkus 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -

106 Kontrasepsi inj. Depo progestin (3 bln) tab. 5,968.00 -


107 Kotrimoksazol susp rol 2,298.00 -
108 Kotrimoksazol tablet 480 mg pad 152.00 -

109 Kotrimoksazol tablet pediatrik 120 mg tube 15 gr 79.00 -


110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg amp. 521.00 -
112 Larutan Benedik kaps - -
113 Larutan Eosin tube 5 gr - -
114 Larutan Etanol Asam btl 60 ml - -
115 Larutan Giemsa Btl 5 ml - -
116 larutan Karbol Fuchin btl 5 ml. - -
117 Larutan Metilen Blue tab. - -
118 Larutan Turk btl - -
119 Lidokain injeksi 2% tab. 1,499.00 -
120 Loperamide / Bidium amp 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) tab. 1,693.00 -
123 MDT MB Adult tab. 25,742.00 -
124 MDT MB Child vial 18,300.00 -
125 MDT PB Adult 60 ml 8,052.00 -
126 MDT PB Child tab. 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg kaps 124.50 -
Metilergometrin maleat inj 0.200 mg-1
130 ml 100 ml 2,750.00 -
Metilergometrin maleat tab. Salut 0.125
131 mg 100 ml 169.00 -
132 Metoklopramide tablet 10 mg 100 ml 108.00 -
133 Metronidazol tablet 250 mg 100 ml 116.00 -
134 MgSo4 40% inj. 100 ml 2,142.00 -
135 Mikonazol krim/salap 2% nitrat 100 ml 3,075.00 -
136 Mummifying pasta 100 ml - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

137 Natrium Bikarbonat tablet 500 mg amp 2 ml 20.00 -


138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% tab. 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) ampul 1,870.00 -
141 Nifedipin ktk 110.00 -
142 Nistatin tablet salut 500.000 IU blister 704.00 -
143 Nistatin vagina tablet 100.000 IU blister 528.00 -
144 OAT FDC Katagori 1 blister 359,990.00 -
145 OAT FDC Katagori 2 blister 1,320,000.00 -
146 OAT Katagori Anak tab. 214,990.00 -
147 Obat batuk Hitam (OBH) cairan tab. 3,060.00 -
148 OBP (Obat Batuk Putih) tab. - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml amp 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tab. 1,640.00 -

151 Oksitetrasiklin salap kulit 3% tab. 1,646.00 -


152 Oksitosin inj. 10 IU/ml - 1 ml tab. 2,420.00 -
153 Omeprazol kapsul 20 mg Vial 221.00 -
154 Parasetamol sirup 120 mg/5 ml tube 10 gr 1,535.00 -
155 Parasetamol tablet 100 mg botol 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) tab. 150,000.00 -
158 Pirantel tablet 125 mg btl 500 ml 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg tab. 99.99 -
161 Povidon Iodida larutan 10% tab. 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg paket 205.00 -
Prokain Benzil Penisillin G. inj. 3 jt - 15
164 ml. paket 6,141.67 -
165 Propanolol HCl tablet 40 mg paket 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) btl 100 ml 351.00 -
167 Ranitidin Inj. 25 mg/ml. btl 100 ml 1,340.00 -
vial -
168 Ranitidin tablet 150 mg 132.00
Retinol (vitamin A) 100.000 IU kapsul
169 lunak tube 3,5 gr 286.00 -
Retinol (vitamin A) 200.000 IU kapsul
170 lunak tube 5 gr 505.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

171 Ringer Laktat larutan infus amp 5,720.00 -


172 Salap 2 - 4 kaps 2,200.00 -
173 Salbutamol tablet 2 mg 60 ml 65.00 -
174 Salisil Bedak 2% tab. 1,350.00 -
175 Sefadroksil kapsul 500 mg tab. 548.00 -
176 Semen Seng Fosfat serbuk dan cairan btl - -
177 Serum Anti Bisa Ular (ABU) inj. tab. 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) tab. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) kaps 868,000.00 -


180 Sianokobalamin (vit B12) inj. 500 mcg rol 1,050.00 -
181 Silk (benang bedah) no. 3 bh 13,616.00 -
182 Silver Amalgam btl 30 ml - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg vial 400.00 -

186 Sulfasetamid natrium tetes mata 15% tab. 3,549.00 -


187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher amp - -
189 Tetrasiklin kapsul 250 mg tab. 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -

191 Tiamfenikol kapsul 500 mg kaps 440.00 -

192 Tiamin (Vit B1) inj. 100 mg/ml btl 500 ml 750.00 -
193 Tiamin tablet 50 mg pcs 136.00 -
194 Tramadol kapsul 50 mg pot 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) 50 gram - -
197 Vaksin BCG kaps 59,950.00 -
198 Vaksin Campak set 28,204.00 -
199 Vaksin DPT/HB vial - -
200 Vaksin DT amp. 70,863.00 -
201 Vaksin HB - Uniject Vial 20,900.00 -

202 Vaksin Pentabio amp. 76,285.00 -


203 Vaksin Polio spcs 19,954.00 -
204 Vaksin Td 1 oz 16,500.00 -
205 Vaksin TT tab. 14,498.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

206 Vitamin B Komplek tablet tab. 112.00 -


207 Zink 20 mg. tab. tab. 521.00 -
208 Zink sirup (Zircum Kid) btl 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. set 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola Obat pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

ustu

………………………….
LAPORAN PERSEDIAAN OBAT PUSTU ……………………..
PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

ACT (Artesunate 50mg+ Amodiaquin


1 200mg) pcs 1,049.00 -
2 Air Raksa dental use pcs 250,000.00 -
3 Albendazol tab. 400 mg. pcs 230.98 -

4 Alopurinol tablet 100 mg tab. 90.00 -

5 Ambroxol sirup 15 mg/ml pcs 2,665.00 -


6 Ambroxol tablet 30 mg pcs 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml pcs 4,204.00 -
8 Aminofilin tablet 200 mg 100 gram 86.00 -
9 Amitriptilin HCl tablet salut 25 mg 100 pcs 123.00 -
10 Amlodipin 10 mg 100 pcs 352.00 -
11 Amoksisilin kaplet 500 mg 100 pcs 279.00 -
12 Amoksisilin sirup kering 125mg/5ml 100 pcs 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. tab. 4,730.00 -


Ampisillin serbuk Inj. i.m/i.v 1000
14 mg/ml. tab. 5,181.00 -
15 Antalgin (Metampiron) tablet 500 mg btl 60 ml 132.99 -
16 Antasida DOEN sirup tab. 2,300.00 -
17 Antasida DOEN tablet amp 78.00 -
18 Anti Bakteri DOEN kombinasi tab. 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 tab. 2,096.00 -
20 Antihemoroid DOEN kombinasi tab. 3,350.00 -

21 Antimigren DOEN kombinasi (Ergotamin) kapl 149.00 -


22 Artemeter inj. btl 60 ml 24,384.00 -
23 Arterakine btl 60 ml. - -

24 Asam Ascorbat (vit. C) tablet 50 mg vial 105.00 -

25 Asam Mefenamat tablet 500 mg tab. 127.00 -


26 Asiklovir krim 5% btl 60 ml 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tub 354.00 -
29 Attapulgit (Pularex tab.) pot 220.00 -
30 Betametason krim 0,1% supp. 1,558.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

31 Bisakodil supp. 10 mg. (Stolax) tab. 6,045.00 -


32 Cetirizin amp 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml tab. 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) tab. - -
36 Diaform tube 5 gr - -
37 Diazepam injeksi 5 mg/ml - 2 ml tab. 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tub 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml supp. 1,160.00 -
42 Digoksin tablet 0,25 mg pcs 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg amp - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% botol - -
47 Eritromisin kapsul 500 mg tab. 1,023.00 -
48 Eritromisin sirup 200mg/5 ml amp 8,090.00 -
49 Etakridin larutan 0,1% tab. 2,354.22 -
50 Etanol 70% tab. 30,000.00 -
51 Etanol 70% tab. 2,625.00 -
52 Etil Klorida semprot amp 120,000.00 -
53 Eugenol cairan tab. 18,333.00 -
54 Fenitoin kapsul 100 mg tab. 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -

56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. tab. 1,980.00 -


57 Fenol Gliserol tetes telinga 10% amp 1,108.80 -
58 Fitomenadion (vit K) inj 10 mg/ml kaps 3,754.00 -
Fitomenadion (vit K1) tablet salut gula
59 10 mg btl 60 ml 698.00 -
60 Furosemid inj. 10 mg/ml btl 300 ml 2,012.00 -
61 Furosemid tablet 40 mg 1000 ml 84.00 -
62 Garam Oralit btl 100 ml. 317.00 -

63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. btl 100 ml. 3,782.00 -


64 Gentamisin salep kulit 0.1% btl 10 ml 1,469.00 -
65 Gentamisin Sulfat tetes mata 0.3% btl 100 kapsul 3,513.00 -
66 Gentian Violet larutan 1% tab. 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

67 Glass Ionomer cement (GC IX) ampul - -


68 Glibenklamida tablet 5 mg btl 61.00 -
69 Glimepiride tab. 2 mg. amp 447.00 -
70 Gliseril Guaiakolat tablet 100 mg tab. 30.69 -
71 Glucosa 10% pcs 6,270.00 -
72 Glukosa larutan infus 40% steril amp - -
73 Glukosa larutan infus 5% tab. 5,720.00 -

74 Griseofulvin tablet 125 mg, micronized sase 241.00 -


75 Haloperidol tablet 0.5 mg amp 62.00 -

76 Haloperidol tablet 1.5 mg tube 5 gr. 76.00 -


77 Haloperidol tablet 5 mg btl 5 ml 105.00 -
78 Hidroklorotiazida tablet 25 mg btl 10 ml 39.93 -
79 Hidrokortison krim 2,5% set 2,868.00 -
80 Ibuprofen Susp. 60 ml. tab. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg btl 1000 tab 157.00 -
83 Iodiol kapsul lunak Btl 500 ml. 1,023.00 -

84 Isosorbit Dinitrat tablet sublingual 5 mg amp 25 ml 98.00 -


85 Kalsium Glukonat 10% btl 500 ml - -
86 Kalsium hidroksida pasta tab. - -

87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -


88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. pasang 269.00 -
91 Ketokonazol krim 2% tab. 2,633.00 -
92 Ketokonazol tablet 200 mg tub 320.00 -
93 Ketorolac Inj. 10 mg/ml. btl 60 ml. - -
94 Kloramfenikol kapsul 250 mg tab. 264.00 -
95 Kloramfenikol salap mata 1% tab. 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml set 5,500.00 -
97 kloramfenikol tetes telinga 3% set 1,759.00 -
98 Kloramfenikol tts mata 1% kaps - -
tab. -
99 Klorfeniramina Maleat (CTM) tabet 4 mg 54.00
100 Klorfenol kamfer mentol (CHKM) amp - -
101 Klorokuin tablet 150 mg set 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

102 Klorpromazin HCl inj.25 mg/ml tab. 1,210.00 -


103 Klorpromazin HCl tablet salut 100 mg bungkus 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -

106 Kontrasepsi inj. Depo progestin (3 bln) tab. 5,968.00 -


107 Kotrimoksazol susp rol 2,298.00 -
108 Kotrimoksazol tablet 480 mg pad 152.00 -

109 Kotrimoksazol tablet pediatrik 120 mg tube 15 gr 79.00 -


110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg amp. 521.00 -
112 Larutan Benedik kaps - -
113 Larutan Eosin tube 5 gr - -
114 Larutan Etanol Asam btl 60 ml - -
115 Larutan Giemsa Btl 5 ml - -
116 larutan Karbol Fuchin btl 5 ml. - -
117 Larutan Metilen Blue tab. - -
118 Larutan Turk btl - -
119 Lidokain injeksi 2% tab. 1,499.00 -
120 Loperamide / Bidium amp 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) tab. 1,693.00 -
123 MDT MB Adult tab. 25,742.00 -
124 MDT MB Child vial 18,300.00 -
125 MDT PB Adult 60 ml 8,052.00 -
126 MDT PB Child tab. 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg kaps 124.50 -
Metilergometrin maleat inj 0.200 mg-1
130 ml 100 ml 2,750.00 -
Metilergometrin maleat tab. Salut 0.125
131 mg 100 ml 169.00 -
132 Metoklopramide tablet 10 mg 100 ml 108.00 -
133 Metronidazol tablet 250 mg 100 ml 116.00 -
134 MgSo4 40% inj. 100 ml 2,142.00 -
135 Mikonazol krim/salap 2% nitrat 100 ml 3,075.00 -
136 Mummifying pasta 100 ml - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

137 Natrium Bikarbonat tablet 500 mg amp 2 ml 20.00 -


138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% tab. 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) ampul 1,870.00 -
141 Nifedipin ktk 110.00 -
142 Nistatin tablet salut 500.000 IU blister 704.00 -
143 Nistatin vagina tablet 100.000 IU blister 528.00 -
144 OAT FDC Katagori 1 blister 359,990.00 -
145 OAT FDC Katagori 2 blister 1,320,000.00 -
146 OAT Katagori Anak tab. 214,990.00 -
147 Obat batuk Hitam (OBH) cairan tab. 3,060.00 -
148 OBP (Obat Batuk Putih) tab. - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml amp 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tab. 1,640.00 -

151 Oksitetrasiklin salap kulit 3% tab. 1,646.00 -


152 Oksitosin inj. 10 IU/ml - 1 ml tab. 2,420.00 -
153 Omeprazol kapsul 20 mg Vial 221.00 -
154 Parasetamol sirup 120 mg/5 ml tube 10 gr 1,535.00 -
155 Parasetamol tablet 100 mg botol 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) tab. 150,000.00 -
158 Pirantel tablet 125 mg btl 500 ml 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg tab. 99.99 -
161 Povidon Iodida larutan 10% tab. 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg paket 205.00 -
Prokain Benzil Penisillin G. inj. 3 jt - 15
164 ml. paket 6,141.67 -
165 Propanolol HCl tablet 40 mg paket 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) btl 100 ml 351.00 -
167 Ranitidin Inj. 25 mg/ml. btl 100 ml 1,340.00 -
vial -
168 Ranitidin tablet 150 mg 132.00
Retinol (vitamin A) 100.000 IU kapsul
169 lunak tube 3,5 gr 286.00 -
Retinol (vitamin A) 200.000 IU kapsul
170 lunak tube 5 gr 505.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

171 Ringer Laktat larutan infus amp 5,720.00 -


172 Salap 2 - 4 kaps 2,200.00 -
173 Salbutamol tablet 2 mg 60 ml 65.00 -
174 Salisil Bedak 2% tab. 1,350.00 -
175 Sefadroksil kapsul 500 mg tab. 548.00 -
176 Semen Seng Fosfat serbuk dan cairan btl - -
177 Serum Anti Bisa Ular (ABU) inj. tab. 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) tab. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) kaps 868,000.00 -


180 Sianokobalamin (vit B12) inj. 500 mcg rol 1,050.00 -
181 Silk (benang bedah) no. 3 bh 13,616.00 -
182 Silver Amalgam btl 30 ml - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg vial 400.00 -

186 Sulfasetamid natrium tetes mata 15% tab. 3,549.00 -


187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher amp - -
189 Tetrasiklin kapsul 250 mg tab. 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -

191 Tiamfenikol kapsul 500 mg kaps 440.00 -

192 Tiamin (Vit B1) inj. 100 mg/ml btl 500 ml 750.00 -
193 Tiamin tablet 50 mg pcs 136.00 -
194 Tramadol kapsul 50 mg pot 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) 50 gram - -
197 Vaksin BCG kaps 59,950.00 -
198 Vaksin Campak set 28,204.00 -
199 Vaksin DPT/HB vial - -
200 Vaksin DT amp. 70,863.00 -
201 Vaksin HB - Uniject Vial 20,900.00 -

202 Vaksin Pentabio amp. 76,285.00 -


203 Vaksin Polio spcs 19,954.00 -
204 Vaksin Td 1 oz 16,500.00 -
205 Vaksin TT tab. 14,498.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

206 Vitamin B Komplek tablet tab. 112.00 -


207 Zink 20 mg. tab. tab. 521.00 -
208 Zink sirup (Zircum Kid) btl 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. set 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola Obat pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

ustu

………………………….
REKAPITULASI PUSTU ……………….
PUSKESMAS …………….
31 desember 2015

NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
1 ACT (Artesunate 50mg+ Amodiaquin 200mg) tab. 1,049.00 0 0 0 0
2 Air Raksa dental use 100 gram 250,000.00 0 0 0 0
3 Albendazol tab. 400 mg. tab. 230.98 0 0 0 0
4 Alopurinol tablet 100 mg tab. 90.00 0 0 0 0
5 Ambroxol sirup 15 mg/ml btl 60 ml 2,665.00 0 0 0 0
6 Ambroxol tablet 30 mg tab. 89.31 0 0 0 0
7 Aminofilin injeksi 24mg/ml - 10 ml amp 4,204.00 0 0 0 0
8 Aminofilin tablet 200 mg tab. 86.00 0 0 0 0
9 Amitriptilin HCl tablet salut 25 mg tab. 123.00 0 0 0 0
10 Amlodipin 10 mg tab. 352.00 0 0 0 0
11 Amoksisilin kaplet 500 mg kapl 279.00 0 0 0 0
12 Amoksisilin sirup kering 125mg/5ml btl 60 ml 2,560.00 0 0 0 0
13 Amoksisillin sirup kering 250 mg/5 ml. btl 60 ml. 4,730.00 0 0 0 0
14 Ampisillin serbuk Inj. i.m/i.v 1000 mg/ml. vial 5,181.00 0 0 0 0
15 Antalgin (Metampiron) tablet 500 mg tab. 132.99 0 0 0 0
16 Antasida DOEN sirup btl 60 ml 2,300.00 0 0 0 0
17 Antasida DOEN tablet tab. 78.00 0 0 0 0
18 Anti Bakteri DOEN kombinasi tub 2,767.00 0 0 0 0
19 Antifungi DOEN kombinasi 3 - 6 pot 2,096.00 0 0 0 0
20 Antihemoroid DOEN kombinasi supp. 3,350.00 0 0 0 0
21 Antimigren DOEN kombinasi (Ergotamin) tab. 149.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
22 Artemeter inj. amp 24,384.00 0 0 0 0
23 Arterakine tab. - 0 0 0 0
24 Asam Ascorbat (vit. C) tablet 50 mg tab. 105.00 0 0 0 0
25 Asam Mefenamat tablet 500 mg tab. 127.00 0 0 0 0
26 Asiklovir krim 5% tube 5 gr 2,367.00 0 0 0 0
27 Asiklovir tablet 200 mg. tab. 245.00 0 0 0 0
28 Asiklovir tablet 400 mg. tab. 354.00 0 0 0 0
29 Attapulgit (Pularex tab.) tab. 220.00 0 0 0 0
30 Betametason krim 0,1% tub 1,558.00 0 0 0 0
31 Bisakodil supp. 10 mg. (Stolax) supp. 6,045.00 0 0 0 0
32 Cetirizin tab. 190.00 0 0 0 0
33 Deksametason injeksi 5 mg/ml - 1 ml amp 1,738.00 0 0 0 0
34 Deksametason tablet 0,5 mg tab. 68.00 0 0 0 0
35 Devitalisasi pasta (non Arsen) botol - 0 0 0 0
36 Diaform tab. - 0 0 0 0
37 Diazepam injeksi 5 mg/ml - 2 ml amp 2,604.90 0 0 0 0
38 Diazepam tablet 2 mg tab. 46.00 0 0 0 0
39 Diazepam tablet 5 mg tab. 52.80 0 0 0 0
40 Dietil Karbamazin sitrat tablet 100 mg tab. 232.70 0 0 0 0
41 Difenhidramin HCl injeksi 10mg/ml amp 1,160.00 0 0 0 0
42 Digoksin tablet 0,25 mg tab. 103.00 0 0 0 0
43 Domperidon tablet 10 mg tab. 174.00 0 0 0 0
44 Efedrin HCl tablet 25 mg tab. - 0 0 0 0
45 Ekstrak Belladon tablet 10 mg tab. 42.00 0 0 0 0
46 Epinefrin injeksi 0,1% amp - 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
47 Eritromisin kapsul 500 mg kaps 1,023.00 0 0 0 0
48 Eritromisin sirup 200mg/5 ml btl 60 ml 8,090.00 0 0 0 0
49 Etakridin larutan 0,1% btl 300 ml 2,354.22 0 0 0 0
50 Etanol 70% 1000 ml 30,000.00 0 0 0 0
51 Etanol 70% btl 100 ml. 2,625.00 0 0 0 0
52 Etil Klorida semprot btl 100 ml. 120,000.00 0 0 0 0
53 Eugenol cairan btl 10 ml 18,333.00 0 0 0 0
54 Fenitoin kapsul 100 mg btl 100 kapsul 146.00 0 0 0 0
55 Fenobarbital tablet 30 mg tab. 70.00 0 0 0 0
56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. ampul 1,980.00 0 0 0 0
57 Fenol Gliserol tetes telinga 10% btl 1,108.80 0 0 0 0
58 Fitomenadion (vit K) inj 10 mg/ml amp 3,754.00 0 0 0 0
59 Fitomenadion (vit K1) tablet salut gula 10 mg tab. 698.00 0 0 0 0
60 Furosemid inj. 10 mg/ml amp 2,012.00 0 0 0 0
61 Furosemid tablet 40 mg tab. 84.00 0 0 0 0
62 Garam Oralit sase 317.00 0 0 0 0
63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. amp 3,782.00 0 0 0 0
64 Gentamisin salep kulit 0.1% tube 5 gr. 1,469.00 0 0 0 0
65 Gentamisin Sulfat tetes mata 0.3% btl 5 ml 3,513.00 0 0 0 0
66 Gentian Violet larutan 1% btl 10 ml 985.00 0 0 0 0
67 Glass Ionomer cement (GC IX) set - 0 0 0 0
68 Glibenklamida tablet 5 mg tab. 61.00 0 0 0 0
69 Glimepiride tab. 2 mg. tab. 447.00 0 0 0 0
70 Gliseril Guaiakolat tablet 100 mg btl 1000 tab 30.69 0 0 0 0
71 Glucosa 10% Btl 500 ml. 6,270.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
72 Glukosa larutan infus 40% steril amp 25 ml - 0 0 0 0
73 Glukosa larutan infus 5% btl 500 ml 5,720.00 0 0 0 0
74 Griseofulvin tablet 125 mg, micronized tab. 241.00 0 0 0 0
75 Haloperidol tablet 0.5 mg tab. 62.00 0 0 0 0
76 Haloperidol tablet 1.5 mg tab. 76.00 0 0 0 0
77 Haloperidol tablet 5 mg tab. 105.00 0 0 0 0
78 Hidroklorotiazida tablet 25 mg tab. 39.93 0 0 0 0
79 Hidrokortison krim 2,5% tub 2,868.00 0 0 0 0
80 Ibuprofen Susp. 60 ml. btl 60 ml. 3,849.00 0 0 0 0
81 Ibuprofen tablet 200 mg tab. 121.00 0 0 0 0
82 Ibuprofen tablet 400 mg tab. 157.00 0 0 0 0
83 Iodiol kapsul lunak kaps 1,023.00 0 0 0 0
84 Isosorbit Dinitrat tablet sublingual 5 mg tab. 98.00 0 0 0 0
85 Kalsium Glukonat 10% amp - 0 0 0 0
86 Kalsium hidroksida pasta set - 0 0 0 0
87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 0 0 0 0
88 Kaptopril 12,5 mg tab. 69.00 0 0 0 0
89 Kaptopril 25 mg tab. 97.00 0 0 0 0
90 Karbamazepin tablet 200 mg. tab. 269.00 0 0 0 0
91 Ketokonazol krim 2% tube 15 gr 2,633.00 0 0 0 0
92 Ketokonazol tablet 200 mg tab. 320.00 0 0 0 0
93 Ketorolac Inj. 10 mg/ml. amp. - 0 0 0 0
94 Kloramfenikol kapsul 250 mg kaps 264.00 0 0 0 0
95 Kloramfenikol salap mata 1% tube 5 gr 1,760.00 0 0 0 0
96 Kloramfenikol susp. 125mg/5 ml btl 60 ml 5,500.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
97 kloramfenikol tetes telinga 3% Btl 5 ml 1,759.00 0 0 0 0
98 Kloramfenikol tts mata 1% btl 5 ml. - 0 0 0 0
99 Klorfeniramina Maleat (CTM) tabet 4 mg tab. 54.00 0 0 0 0
100 Klorfenol kamfer mentol (CHKM) btl - 0 0 0 0
101 Klorokuin tablet 150 mg tab. 110.00 0 0 0 0
102 Klorpromazin HCl inj.25 mg/ml amp 1,210.00 0 0 0 0
103 Klorpromazin HCl tablet salut 100 mg tab. 162.00 0 0 0 0
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 0 0 0 0
105 Kodein tablet 10 mg. tab. 550.00 0 0 0 0
106 Kontrasepsi inj. Depo progestin (3 bln) vial 5,968.00 0 0 0 0
107 Kotrimoksazol susp 60 ml 2,298.00 0 0 0 0
108 Kotrimoksazol tablet 480 mg tab. 152.00 0 0 0 0
109 Kotrimoksazol tablet pediatrik 120 mg tab. 79.00 0 0 0 0
110 Kuinin (kina) tablet 200 mg tab. 737.00 0 0 0 0
111 Lansoprazol kapsul 30 mg kaps 521.00 0 0 0 0
112 Larutan Benedik 100 ml - 0 0 0 0
113 Larutan Eosin 100 ml - 0 0 0 0
114 Larutan Etanol Asam 100 ml - 0 0 0 0
115 Larutan Giemsa 100 ml - 0 0 0 0
116 larutan Karbol Fuchin 100 ml - 0 0 0 0
117 Larutan Metilen Blue 100 ml - 0 0 0 0
118 Larutan Turk 100 ml - 0 0 0 0
119 Lidokain injeksi 2% amp 2 ml 1,499.00 0 0 0 0
120 Loperamide / Bidium tab. 97.00 0 0 0 0
121 Loratadin tablet 10 mg tab. 170.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
122 Magnesium Sulfat inj. 20% (iv) ampul 1,693.00 0 0 0 0
123 MDT MB Adult blister 25,742.00 0 0 0 0
124 MDT MB Child blister 18,300.00 0 0 0 0
125 MDT PB Adult blister 8,052.00 0 0 0 0
126 MDT PB Child blister 8,052.00 0 0 0 0
127 Mebendazol tablet 100 mg tab. 248.00 0 0 0 0
128 Meloksikam tab. 15 mg. tab. 348.00 0 0 0 0
129 Metformin 500 mg tab. 124.50 0 0 0 0
130 Metilergometrin maleat inj 0.200 mg-1 ml amp 2,750.00 0 0 0 0
131 Metilergometrin maleat tab. Salut 0.125 mg tab. 169.00 0 0 0 0
132 Metoklopramide tablet 10 mg tab. 108.00 0 0 0 0
133 Metronidazol tablet 250 mg tab. 116.00 0 0 0 0
134 MgSo4 40% inj. Vial 2,142.00 0 0 0 0
135 Mikonazol krim/salap 2% nitrat tube 10 gr 3,075.00 0 0 0 0
136 Mummifying pasta botol - 0 0 0 0
137 Natrium Bikarbonat tablet 500 mg tab. 20.00 0 0 0 0
138 Natrium Diklofenak tablet 50 mg tab. 216.00 0 0 0 0
139 Natrium Klorida larutan infus 0,9% btl 500 ml 5,170.00 0 0 0 0
140 Natrium Tiroksin 100 mcg. (Euthyrax) tab. 1,870.00 0 0 0 0
141 Nifedipin tab. 110.00 0 0 0 0
142 Nistatin tablet salut 500.000 IU tab. 704.00 0 0 0 0
143 Nistatin vagina tablet 100.000 IU tab. 528.00 0 0 0 0
144 OAT FDC Katagori 1 paket 359,990.00 0 0 0 0
145 OAT FDC Katagori 2 paket 1,320,000.00 0 0 0 0
146 OAT Katagori Anak paket 214,990.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
147 Obat batuk Hitam (OBH) cairan btl 100 ml 3,060.00 0 0 0 0
148 OBP (Obat Batuk Putih) btl 100 ml - 0 0 0 0
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml vial 3,410.00 0 0 0 0
150 Oksitetrasiklin HCl salap mata 1% tube 3,5 gr 1,640.00 0 0 0 0
151 Oksitetrasiklin salap kulit 3% tube 5 gr 1,646.00 0 0 0 0
152 Oksitosin inj. 10 IU/ml - 1 ml amp 2,420.00 0 0 0 0
153 Omeprazol kapsul 20 mg kaps 221.00 0 0 0 0
154 Parasetamol sirup 120 mg/5 ml 60 ml 1,535.00 0 0 0 0
155 Parasetamol tablet 100 mg tab. 34.51 0 0 0 0
156 Parasetamol tablet 500 mg tab. 88.00 0 0 0 0
157 Pewarna Ziel Neelsen (BTA) btl 150,000.00 0 0 0 0
158 Pirantel tablet 125 mg tab. 318.00 0 0 0 0
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 0 0 0 0
160 Piroksikam kap 20 mg kaps 99.99 0 0 0 0
161 Povidon Iodida larutan 10% btl 30 ml 2,344.00 0 0 0 0
162 Prednison tablet 5 mg tab. 125.00 0 0 0 0
163 Primakuin tablet 15 mg tab. 205.00 0 0 0 0
164 Prokain Benzil Penisillin G. inj. 3 jt - 15 ml. vial 6,141.67 0 0 0 0
165 Propanolol HCl tablet 40 mg tab. 114.00 0 0 0 0
166 Propiltiourasil tablet 100 mg (PTU) tab. 351.00 0 0 0 0
167 Ranitidin Inj. 25 mg/ml. amp 1,340.00 0 0 0 0
168 Ranitidin tablet 150 mg tab. 132.00 0 0 0 0
169 Retinol (vitamin A) 100.000 IU kapsul lunak kaps 286.00 0 0 0 0
170 Retinol (vitamin A) 200.000 IU kapsul lunak kaps 505.00 0 0 0 0
171 Ringer Laktat larutan infus btl 500 ml 5,720.00 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
172 Salap 2 - 4 pot 2,200.00 0 0 0 0
173 Salbutamol tablet 2 mg tab. 65.00 0 0 0 0
174 Salisil Bedak 2% 50 gram 1,350.00 0 0 0 0
175 Sefadroksil kapsul 500 mg kaps 548.00 0 0 0 0
176 Semen Seng Fosfat serbuk dan cairan set - 0 0 0 0
177 Serum Anti Bisa Ular (ABU) inj. vial 567,600.00 0 0 0 0
178 Serum Anti Tetanus inj 1500 IU (ATS) amp. 151,800.00 0 0 0 0
179 Serum Anti Tetanus inj 20.000 IU (ATS) Vial 868,000.00 0 0 0 0
180 Sianokobalamin (vit B12) inj. 500 mcg amp. 1,050.00 0 0 0 0
181 Silk (benang bedah) no. 3 spcs 13,616.00 0 0 0 0
182 Silver Amalgam 1 oz - 0 0 0 0
183 Simetidin tablet 200 mg tab. 105.97 0 0 0 0
184 Simvastatin tablet 10 mg tab. 177.00 0 0 0 0
185 Siprofloksasin tablet 500 mg tab. 400.00 0 0 0 0
186 Sulfasetamid natrium tetes mata 15% btl 3,549.00 0 0 0 0
187 Tablet Tambah Darah besi II sulfat tab. 45.00 0 0 0 0
188 Temporary Stopping Fletcher set - 0 0 0 0
189 Tetrasiklin kapsul 250 mg kaps 162.00 0 0 0 0
190 Tetrasiklin kapsul 500 mg kaps 325.00 0 0 0 0
191 Tiamfenikol kapsul 500 mg kaps 440.00 0 0 0 0
192 Tiamin (Vit B1) inj. 100 mg/ml amp 750.00 0 0 0 0
193 Tiamin tablet 50 mg tab. 136.00 0 0 0 0
194 Tramadol kapsul 50 mg kaps 196.35 0 0 0 0
195 Triheksifenidil tablet 2 mg tab. 44.00 0 0 0 0
196 Trikresol Formalin (TKF) botol - 0 0 0 0
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15

A B C …..
197 Vaksin BCG 2 ds/vial 59,950.00 0 0 0 0
198 Vaksin Campak 10 ds/vial 28,204.00 0 0 0 0
199 Vaksin DPT/HB 10 ds/vial - 0 0 0 0
200 Vaksin DT 10 ds/vial 70,863.00 0 0 0 0
201 Vaksin HB - Uniject 1 ds/vial 20,900.00 0 0 0 0
202 Vaksin Pentabio 1 ds/vial 76,285.00 0 0 0 0
203 Vaksin Polio 10 ds/vial 19,954.00 0 0 0 0
204 Vaksin Td 10 ds/vial 16,500.00 0 0 0 0
205 Vaksin TT 10 ds/vial 14,498.00 0 0 0 0
206 Vitamin B Komplek tablet tab. 112.00 0 0 0 0
207 Zink 20 mg. tab. tab. 521.00 0 0 0 0
208 Zink sirup (Zircum Kid) btl 60 ml. 8,140.00 0 0 0 0
209 Dihidropiperaquin tab. 4,216.00 0 0 0 0
210 Risperidon 2 mg. tab. 1,781.00 0 0 0 0

JUMLAH

Mengetahui,
Kepala Puskesmas ………

…………………………………………
NIP.
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
TOTAL JUMLAH HARGA KET
PERSEDIAAN

0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -

esmas …………

……………………..
LAPORAN PERSEDIAAN BMHP PUSTU ……………………..
PUSKESMAS …………………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -

-
4 ADS/Spuit 0,05 ml. pcs -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola bmhp Pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

Pustu

………………………….
LAPORAN PERSEDIAAN BMHP PUSTU ……………………..
PUSKESMAS …………………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -

-
4 ADS/Spuit 0,05 ml. pcs -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola bmhp Pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

Pustu

………………………….
LAPORAN PERSEDIAAN BMHP PUSTU ……………………..
PUSKESMAS …………………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -

-
4 ADS/Spuit 0,05 ml. pcs -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola bmhp Pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

Pustu

………………………….
LAPORAN PERSEDIAAN BMHP PUSTU ……………………..
PUSKESMAS …………………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 15 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -

-
4 ADS/Spuit 0,05 ml. pcs -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Pustu Pengelola bmhp Pustu

……………………………………….. ………………………………………………
NIP. NIP.
KET

Pustu

………………………….
REKAPITULASI PUSTU ……………….
PUSKESMAS …………….
31 DESEMBER 2015

TOTAL
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15 PERSEDIAAN JUMLAH HARGA

A B C …..
1 Abbocath No 20 pcs 7,824.00 0 0 0 0 0 -
2 Abbocath No 22 pcs 7,824.00 0 0 0 0 0 -
3 Abbocath No 24 pcs 7,824.00 0 0 0 0 0 -
4 ADS/Spuit 0,05 ml. pcs - 0 0 0 0 0 -
5 ADS/Spuit 0,5 ml. pcs - 0 0 0 0 0 -
6 ADS/Spuit 5 ml. pcs 1,348.00 0 0 0 0 0 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 0 0 0 0 0 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 0 0 0 0 0 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 0 0 0 0 0 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 0 0 0 0 0 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 0 0 0 0 0 -
12 Folley Catheter No 18 pcs 8,495.00 0 0 0 0 0 -
13 Hand Scun pasang 6,325.00 0 0 0 0 0 -
14 Infusion set anak set 4,567.50 0 0 0 0 0 -
15 Infusion set dewasa set 4,176.00 0 0 0 0 0 -
16 Kasa 4 x 10 cm rol 2,534.24 0 0 0 0 0 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 0 0 0 0 0 -
18 Masker ktk 440.00 0 0 0 0 0 -
19 Plester rol 33,000.00 0 0 0 0 0 -
20 Pot Sputum bh 2,790.00 0 0 0 0 0 -
21 Safety Box 0,25 L pcs - 0 0 0 0 0 -
TOTAL
NO. NAMA OBAT SATUAN HARGA SISA STOK 31 DES. 15 PERSEDIAAN JUMLAH HARGA

A B C …..
22 Urine bag pcs 4,000.00 0 0 0 0 0 -

JUMLAH -

Mengetahui,
Kepala Puskesmas …………

…………………………………………..
NIP.
KET
KET
LAPORAN PERSEDIAAN OBAT PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES.


NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
ACT (Artesunate 50mg+ Amodiaquin
1 tab. 1,049.00 -
200mg)
2 Air Raksa dental use 100 gram 250,000.00 -
3 Albendazol tab. 400 mg. tab. 230.98 -
4 Alopurinol tablet 100 mg tab. 90.00 -
5 Ambroxol sirup 15 mg/ml btl 60 ml 2,665.00 -
6 Ambroxol tablet 30 mg tab. 89.31 -
7 Aminofilin injeksi 24mg/ml - 10 ml amp 4,204.00 -
8 Aminofilin tablet 200 mg tab. 86.00 -
9 Amitriptilin HCl tablet salut 25 mg tab. 123.00 -
10 Amlodipin 10 mg tab. 352.00 -
11 Amoksisilin kaplet 500 mg kapl 279.00 -
12 Amoksisilin sirup kering 125mg/5ml btl 60 ml 2,560.00 -

13 Amoksisillin sirup kering 250 mg/5 ml. btl 60 ml. 4,730.00 -

14 Ampisillin serbuk Inj. i.m/i.v 1000 vial 5,181.00 -


mg/ml.
15 Antalgin (Metampiron) tablet 500 mg tab. 132.99 -
16 Antasida DOEN sirup btl 60 ml 2,300.00 -
17 Antasida DOEN tablet tab. 78.00 -
18 Anti Bakteri DOEN kombinasi tub 2,767.00 -
19 Antifungi DOEN kombinasi 3 - 6 pot 2,096.00 -
20 Antihemoroid DOEN kombinasi supp. 3,350.00 -
21 Antimigren DOEN kombinasi (Ergotamin) tab. 149.00
-
22 Artemeter inj. amp 24,384.00 -
23 Arterakine tab. - -
24 Asam Ascorbat (vit. C) tablet 50 mg tab. 105.00 -
25 Asam Mefenamat tablet 500 mg tab. 127.00 -
26 Asiklovir krim 5% tube 5 gr 2,367.00 -
27 Asiklovir tablet 200 mg. tab. 245.00 -
28 Asiklovir tablet 400 mg. tab. 354.00 -
29 Attapulgit (Pularex tab.) tab. 220.00 -
30 Betametason krim 0,1% tub 1,558.00 -
31 Bisakodil supp. 10 mg. (Stolax) supp. 6,045.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
32 Cetirizin tab. 190.00 -
33 Deksametason injeksi 5 mg/ml - 1 ml amp 1,738.00 -
34 Deksametason tablet 0,5 mg tab. 68.00 -
35 Devitalisasi pasta (non Arsen) botol - -
36 Diaform tab. - -
37 Diazepam injeksi 5 mg/ml - 2 ml amp 2,604.90 -
38 Diazepam tablet 2 mg tab. 46.00 -
39 Diazepam tablet 5 mg tab. 52.80 -
40 Dietil Karbamazin sitrat tablet 100 mg tab. 232.70 -
41 Difenhidramin HCl injeksi 10mg/ml amp 1,160.00 -
42 Digoksin tablet 0,25 mg tab. 103.00 -
43 Domperidon tablet 10 mg tab. 174.00 -
44 Efedrin HCl tablet 25 mg tab. - -
45 Ekstrak Belladon tablet 10 mg tab. 42.00 -
46 Epinefrin injeksi 0,1% amp - -
47 Eritromisin kapsul 500 mg kaps 1,023.00 -
48 Eritromisin sirup 200mg/5 ml btl 60 ml 8,090.00 -
49 Etakridin larutan 0,1% btl 300 ml 2,354.22 -
50 Etanol 70% 1000 ml 30,000.00 -
51 Etanol 70% btl 100 ml. 2,625.00 -
52 Etil Klorida semprot btl 100 ml. 120,000.00 -
53 Eugenol cairan btl 10 ml 18,333.00 -
54 Fenitoin kapsul 100 mg btl 100 kapsul 146.00 -
55 Fenobarbital tablet 30 mg tab. 70.00 -
56 Fenobarbital Inj. i.m. 50 mg/ml - 2 ml. ampul 1,980.00 -

57 Fenol Gliserol tetes telinga 10% btl 1,108.80 -


58 Fitomenadion (vit K) inj 10 mg/ml amp 3,754.00 -
59 Fitomenadion (vit K1) tablet salut gula tab. 698.00
10 mg -
60 Furosemid inj. 10 mg/ml amp 2,012.00 -
61 Furosemid tablet 40 mg tab. 84.00 -
62 Garam Oralit sase 317.00 -
63 Gentamisin Inj. 40 mg/ml (sulfat) - 2 ml. amp 3,782.00 -

64 Gentamisin salep kulit 0.1% tube 5 gr. 1,469.00 -


65 Gentamisin Sulfat tetes mata 0.3% btl 5 ml 3,513.00 -
66 Gentian Violet larutan 1% btl 10 ml 985.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
67 Glass Ionomer cement (GC IX) set - -
68 Glibenklamida tablet 5 mg tab. 61.00 -
69 Glimepiride tab. 2 mg. tab. 447.00 -
70 Gliseril Guaiakolat tablet 100 mg btl 1000 tab 30.69 -
71 Glucosa 10% Btl 500 ml. 6,270.00 -
72 Glukosa larutan infus 40% steril amp 25 ml - -
73 Glukosa larutan infus 5% btl 500 ml 5,720.00 -
74 Griseofulvin tablet 125 mg, micronized tab. 241.00 -

75 Haloperidol tablet 0.5 mg tab. 62.00 -


76 Haloperidol tablet 1.5 mg tab. 76.00 -
77 Haloperidol tablet 5 mg tab. 105.00 -
78 Hidroklorotiazida tablet 25 mg tab. 39.93 -
79 Hidrokortison krim 2,5% tub 2,868.00 -
80 Ibuprofen Susp. 60 ml. btl 60 ml. 3,849.00 -
81 Ibuprofen tablet 200 mg tab. 121.00 -
82 Ibuprofen tablet 400 mg tab. 157.00 -
83 Iodiol kapsul lunak kaps 1,023.00 -
84 Isosorbit Dinitrat tablet sublingual 5 mg tab. 98.00 -

85 Kalsium Glukonat 10% amp - -


86 Kalsium hidroksida pasta set - -
87 Kalsium laktat (Kalk) tablet 500 mg tab. 76.00 -
88 Kaptopril 12,5 mg tab. 69.00 -
89 Kaptopril 25 mg tab. 97.00 -
90 Karbamazepin tablet 200 mg. tab. 269.00 -
91 Ketokonazol krim 2% tube 15 gr 2,633.00 -
92 Ketokonazol tablet 200 mg tab. 320.00 -
93 Ketorolac Inj. 10 mg/ml. amp. - -
94 Kloramfenikol kapsul 250 mg kaps 264.00 -
95 Kloramfenikol salap mata 1% tube 5 gr 1,760.00 -
96 Kloramfenikol susp. 125mg/5 ml btl 60 ml 5,500.00 -
97 kloramfenikol tetes telinga 3% Btl 5 ml 1,759.00 -
98 Kloramfenikol tts mata 1% btl 5 ml. - -
99 Klorfeniramina Maleat (CTM) tabet 4 mg tab. 54.00 -

100 Klorfenol kamfer mentol (CHKM) btl - -


101 Klorokuin tablet 150 mg tab. 110.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
102 Klorpromazin HCl inj.25 mg/ml amp 1,210.00 -
103 Klorpromazin HCl tablet salut 100 mg tab. 162.00 -
104 Klorpromazin HCl tablet salut 25 mg tab. 75.00 -
105 Kodein tablet 10 mg. tab. 550.00 -
106 Kontrasepsi inj. Depo progestin (3 bln) vial 5,968.00
-
107 Kotrimoksazol susp 60 ml 2,298.00 -
108 Kotrimoksazol tablet 480 mg tab. 152.00 -
109 Kotrimoksazol tablet pediatrik 120 mg tab. 79.00
-
110 Kuinin (kina) tablet 200 mg tab. 737.00 -
111 Lansoprazol kapsul 30 mg kaps 521.00 -
112 Larutan Benedik 100 ml - -
113 Larutan Eosin 100 ml - -
114 Larutan Etanol Asam 100 ml - -
115 Larutan Giemsa 100 ml - -
116 larutan Karbol Fuchin 100 ml - -
117 Larutan Metilen Blue 100 ml - -
118 Larutan Turk 100 ml - -
119 Lidokain injeksi 2% amp 2 ml 1,499.00 -
120 Loperamide / Bidium tab. 97.00 -
121 Loratadin tablet 10 mg tab. 170.00 -
122 Magnesium Sulfat inj. 20% (iv) ampul 1,693.00 -
123 MDT MB Adult blister 25,742.00 -
124 MDT MB Child blister 18,300.00 -
125 MDT PB Adult blister 8,052.00 -
126 MDT PB Child blister 8,052.00 -
127 Mebendazol tablet 100 mg tab. 248.00 -
128 Meloksikam tab. 15 mg. tab. 348.00 -
129 Metformin 500 mg tab. 124.50 -
130 Metilergometrin maleat inj 0.200 mg-1 amp 2,750.00 -
ml

131 Metilergometrin maleat tab. Salut 0.125 tab. 169.00 -


mg
132 Metoklopramide tablet 10 mg tab. 108.00 -
133 Metronidazol tablet 250 mg tab. 116.00 -
134 MgSo4 40% inj. Vial 2,142.00 -
135 Mikonazol krim/salap 2% nitrat tube 10 gr 3,075.00 -
136 Mummifying pasta botol - -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
137 Natrium Bikarbonat tablet 500 mg tab. 20.00 -
138 Natrium Diklofenak tablet 50 mg tab. 216.00 -
139 Natrium Klorida larutan infus 0,9% btl 500 ml 5,170.00 -
140 Natrium Tiroksin 100 mcg. (Euthyrax) tab. 1,870.00 -
141 Nifedipin tab. 110.00 -
142 Nistatin tablet salut 500.000 IU tab. 704.00 -
143 Nistatin vagina tablet 100.000 IU tab. 528.00 -
144 OAT FDC Katagori 1 paket 359,990.00 -
145 OAT FDC Katagori 2 paket 1,320,000.00 -
146 OAT Katagori Anak paket 214,990.00 -
147 Obat batuk Hitam (OBH) cairan btl 100 ml 3,060.00 -
148 OBP (Obat Batuk Putih) btl 100 ml - -
149 Oksitetrasiklin HCl inj. 50 mg/ml-10 ml vial 3,410.00 -

150 Oksitetrasiklin HCl salap mata 1% tube 3,5 gr 1,640.00 -


151 Oksitetrasiklin salap kulit 3% tube 5 gr 1,646.00 -
152 Oksitosin inj. 10 IU/ml - 1 ml amp 2,420.00 -
153 Omeprazol kapsul 20 mg kaps 221.00 -
154 Parasetamol sirup 120 mg/5 ml 60 ml 1,535.00 -
155 Parasetamol tablet 100 mg tab. 34.51 -
156 Parasetamol tablet 500 mg tab. 88.00 -
157 Pewarna Ziel Neelsen (BTA) btl 150,000.00 -
158 Pirantel tablet 125 mg tab. 318.00 -
159 Piridoksin (vitamin B6) tablet 10 mg tab. 121.00 -
160 Piroksikam kap 20 mg kaps 99.99 -
161 Povidon Iodida larutan 10% btl 30 ml 2,344.00 -
162 Prednison tablet 5 mg tab. 125.00 -
163 Primakuin tablet 15 mg tab. 205.00 -
164 Prokain Benzil Penisillin G. inj. 3 jt - 15 vial 6,141.67 -
ml.
165 Propanolol HCl tablet 40 mg tab. 114.00 -
166 Propiltiourasil tablet 100 mg (PTU) tab. 351.00 -
167 Ranitidin Inj. 25 mg/ml. amp 1,340.00 -
168 Ranitidin tablet 150 mg tab. 132.00 -
169 Retinol (vitamin A) 100.000 IU kapsul kaps 286.00 -
lunak

170 Retinol (vitamin A) 200.000 IU kapsul kaps 505.00 -


lunak
171 Ringer Laktat larutan infus btl 500 ml 5,720.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
172 Salap 2 - 4 pot 2,200.00 -
173 Salbutamol tablet 2 mg tab. 65.00 -
174 Salisil Bedak 2% 50 gram 1,350.00 -
175 Sefadroksil kapsul 500 mg kaps 548.00 -
176 Semen Seng Fosfat serbuk dan cairan set - -
177 Serum Anti Bisa Ular (ABU) inj. vial 567,600.00 -
178 Serum Anti Tetanus inj 1500 IU (ATS) amp. 151,800.00 -

179 Serum Anti Tetanus inj 20.000 IU (ATS) Vial 868,000.00 -

180 Sianokobalamin (vit B12) inj. 500 mcg amp. 1,050.00 -


181 Silk (benang bedah) no. 3 spcs 13,616.00 -
182 Silver Amalgam 1 oz - -
183 Simetidin tablet 200 mg tab. 105.97 -
184 Simvastatin tablet 10 mg tab. 177.00 -
185 Siprofloksasin tablet 500 mg tab. 400.00 -
186 Sulfasetamid natrium tetes mata 15% btl 3,549.00 -
187 Tablet Tambah Darah besi II sulfat tab. 45.00 -
188 Temporary Stopping Fletcher set - -
189 Tetrasiklin kapsul 250 mg kaps 162.00 -
190 Tetrasiklin kapsul 500 mg kaps 325.00 -
191 Tiamfenikol kapsul 500 mg kaps 440.00 -
192 Tiamin (Vit B1) inj. 100 mg/ml amp 750.00 -
193 Tiamin tablet 50 mg tab. 136.00 -
194 Tramadol kapsul 50 mg kaps 196.35 -
195 Triheksifenidil tablet 2 mg tab. 44.00 -
196 Trikresol Formalin (TKF) botol - -
197 Vaksin BCG 2 ds/vial 59,950.00 -
198 Vaksin Campak 10 ds/vial 28,204.00 -
199 Vaksin DPT/HB 10 ds/vial - -
200 Vaksin DT 10 ds/vial 70,863.00 -
201 Vaksin HB - Uniject 1 ds/vial 20,900.00 -
202 Vaksin Pentabio 1 ds/vial 76,285.00 -
203 Vaksin Polio 10 ds/vial 19,954.00 -
204 Vaksin Td 10 ds/vial 16,500.00 -
205 Vaksin TT 10 ds/vial 14,498.00 -
206 Vitamin B Komplek tablet tab. 112.00 -
207 Zink 20 mg. tab. tab. 521.00 -
SISA STOK 31 DES.
NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)
208 Zink sirup (Zircum Kid) btl 60 ml. 8,140.00 -
209 Dihidropiperaquin tab. 4,216.00 -
210 Risperidon 2 mg. tab. 1,781.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Puskesmas Pengelola Obat puskesmas

……………………………………….. ………………………………………………
NIP. NIP.
KET

7
KET

7
KET

7
KET

7
KET

7
KET

7
KET

uskesmas

………………………….
LAPORAN PERSEDIAAN BMHP PUSKESMAS ……………………..
31 DESEMBER 2015

SISA STOK 31 DES


NO. NAMA OBAT SATUAN HARGA 2015 JUMLAH HARGA

1 2 3 4 5 6 (4x5)

1 Abbocath No 20 pcs 7,824.00 -


2 Abbocath No 22 pcs 7,824.00 -
3 Abbocath No 24 pcs 7,824.00 -
4 ADS/Spuit 0,05 ml. pcs - -
5 ADS/Spuit 0,5 ml. pcs - -
6 ADS/Spuit 5 ml. pcs 1,348.00 -
7 Alat suntik sekali pakai 1 ml 100 pcs 1,540.00 -
8 Alat suntik sekali pakai 2.5 ml 100 pcs 650.00 -
9 Alat suntik sekali pakai 3 ml 100 pcs 957.00 -
10 Alat suntik sekali pakai 5 ml 100 pcs 1,348.00 -
11 Cat Gut/benang bedah No. 2/0 - 3/0 pcs 24,671.00 -
12 Folley Catheter No 18 pcs 8,495.00 -
13 Hand Scun pasang 6,325.00 -
14 Infusion set anak set 4,567.50 -
15 Infusion set dewasa set 4,176.00 -
16 Kasa 4 x 10 cm rol 2,534.24 -
17 Kasa pembalut hidrofil 16 x 16 cm pad 549.27 -
18 Masker ktk 440.00 -
19 Plester rol 33,000.00 -
20 Pot Sputum bh 2,790.00 -
21 Safety Box 0,25 L pcs - -
22 Urine bag pcs 4,000.00 -

JUMLAH -

Mengetahui, 04 Januari 2016


Kepala Puskesmas Pengelola BMHP puskesmas

……………………………………….. ………………………………………………
NIP. NIP.
KET

puskesmas

………………………….

You might also like