የ ዲስ ፔን ሰ ሪ መድሀ ኒ ት ቆጠራ ቅጽ Page number ____ Date

24/12/2012 E.C
Dispensary/Other Service Units Inventory Form
Name of Health Facility _Ziquala Primary Hospital_ Section (unit) EOPD Pharmacy

To be Filled To be Filled After

During Physical
s.n
o Inventory Inventory

Retail Expiry Retail physical

Drug code Description(drug name unit Batch number date price quantity Unit cost Total cost Remark
Catg-79-1 Cat gut chromic 2/0 circle Pcs 36
1 cround A19046S 23-Dec 22.86 18.29 658.44
Catg-71-1 Cat gut chromic 4/0 circle pcs 14
2 cround L18060Q 23-Nov 19.2 15.36 215.04
Catg-71-1 Cat gut chromic 4/0 circle pcs 32
3 cround A19035Q 23-Dec 23.65 18.9 604.8
Penb-37- Pencillin G, Benzantine vial 41
4 1 2.4MIU 1.83E+09 21-Feb 12 9.6 393.6
Acyc-10- Acyclovir 200mg tablet tab 426
51 D18001673 21-Jul 1.2 0.96 408.96
Acyc-50- Acyclovir 5% topical cream tube 27
61 79839 22-Jan 50.4 40.32 1088.64
Alma-10- Al(HO)3 + MG trisilcate tab 740
7 27864 26-Sep 0.13 0.104 76.96
1 (120mg + 250mg) tablet-
Allo-10-1 Allopurinole
(chewable) 100mg tablet tab 100
8 73608 22-Sep 1.25 1 100
 Amit-11- Amitriptyline 25mg tablet tab 400
91 69356 21-Aug 2.55 2.04 816
Amox- Amoxacillin 250mg capsule cap 1000
10 01-1 26930 23-Aug 0.7 0.56 560
Amox- Amoxicillin 500mg capsule Cap 32200
11 31148 25-Mar 1 0.8 25760
02-1
Arte-30-1 Artisunate 60mg injection vial 9
12 2A1181103 21-Feb 5 4 36
Arlu-13-1 Arthemeter + lumefanthrine tab 618
13 (20mg+ 120mg) – tablet(6x4) EAD3904A 12-May 2.15 1.72 1062.96
Atro-30-1 Atropine sulphate 1mg/ml amp 2880
14 injection 183221015 21-Apr 3.3 2.64 7603.2
Ceft-31-1 Ceftazidime 1gm injection vial 13
15 183051148 21-Nov 21.95 17.56 228.28
Ceft-32-1 Ceftriaxone 1gm injection Vial 167
16 2TJ40078 23-Jun 19 15.2 2538.4
Ceti-11-1 Cetirizine 10mg tablet tab 1220
17 DCL1804 21-Sep 0.98 0.784 956.48 Free
Quic-11- Chloroquine phosphate 250mg tab 745
18 1 tablet 69802 21-Sep 2.5 2 1490
Cipr-11-1 Ciprofloxacillin 500mg tablet tab 1066
19 29953 22-Oct 0.15 0.12 127.92
Clar-11-1 Claritromycine 500mg tablet tab 674
20 419100010 21-Sep 3.7 2.96 1995.04
Clin-10-1 Clindamycine 150mg capsule cap 180
21 O24 20-Dec 4.3 3.44 619.2
Dexa-50- Dexamethasone 0.25%- topical tube 13
22 1 cream HS19002 21-Feb 63 50.4 655.2
Dexa-30- Dexamethasone 4mg/ml amp 64
23 1 injaection I19012 20-Dec 31 24.8 1587.2
Dext-22- Dextrometorphan 15mg/5ml 125ml 2
24  1 syrup 31665 22-May 44 35.2 70.4
 Dnsa-31- Dextrose 5% in normal saline 1000ml 10
25  1 with giving set o2519060730 21-Jun 33.55 26.84 268.4
Dw5p- Dextrose 5% in water 1000ml bag 2
26 31-1 infusion 2.62E+09 21-May 33.3 26.64 53.28
Diaz-30-1 Diazepam 5mg/2ml injection amp 127
27 FH803X 20-Dec 4.45 3.56 452.12
Dicp-11- Diclofenac potassium 50mg Tab 465
28 1 fcp5023 23-Feb 0.6 0.48 223.2
Dics-30-1 Diclofenac sodium 75mg/3ml Amp 114
29 injection 181116 21-Oct 1.5 1.2 136.8
Diph-20- Diphenhydramine hydrochloride bottle 5
1 12.5mg/5ml Elixir
30 NL9243 22-Nov 44 35.2 176
Doxy-01- Doxycycline 100mg capsule Cap 540
31 1 26803 22-Aug 0.5 0.4 216
Enal-11-1 Enalapril 5mg tablet tab 260
32 D19005BX52 21-Aug 0.6 0.48 124.8
Iron-10-1 Ferrous gluconate 300mg tab tab 980
33 G171201 20-Nov 0.65 0.52 509.6
 Catf-83- Folley catheter three way size 16 pcs 3
34 1 1.81E+09 23-Nov 16 12.8 38.4
Frus-10-1 Frusemide 40mg tablet tab 440
35 10190512 21-Mar 0.41 0.328 144.32
Gent-30- Gentamycin 10mg/ml injection amp 48
36  1 NK903 21-Dec 2.91 2.328 111.744
Glib-10-1 Glibenclamide 5mg tablet tab 400
37 183121041 21-Mar 2.4 1.92 768
Hydr-35- Hydralazine hydrochloride vial 9
38 1 20mg/1ml amp inje 420394 21-Nov 12.25 9.8 88.2
Thia-11-1 Hydrochlorothiazide 25mg tab 530
39 tablet oo719040020 21-Mar 0.32 0.256 135.68
 Cort-50-1 Hydrocortosone 1% topical 15gm 6
40 cream 200101 23-Jan 111 88.8 532.8
41 Hyos-32- Hyoscine hydrobromide amp 1801850 21-Jan 7.25 90 5.8 522
1Ivca-74-1 20mg/2ml amp injection
Intra voneous cannula size 22G pcs 374
42 o01806 22-Aug 5.6 4.48 1675.52
Liad-31-1 Lidocaine HCL + adrenaline 2% 20ml 10
43 injection I18296 20-Dec 24 19.2 192
Lora-10-1 Lorantidine 10mg tablet tab 365
44 C1004 21-Sep 0.98 0.784 286.16
Mebe-10- Mebendazole 100mg tablet tab 189
45 1 27680 21-Nov 0.2 0.16 30.24
Meto-11- Metoclorpramide 10mg tablet tab 770
46 1 T2207 20-Aug 0.25 0.2 154
Pram-30- Metoclorpramide 5mg/ml amp 23
47 1 injection 181007 21-Sep 6.95 5.584 128.432
Metr-10- Metronidazole 125mg/5ml 100ml 5
48 1 suspension 29739 21-Sep 14 11.2 56
Metr-01- Metronidazole 250mg capsule 500 892
49 1 906029N 21-Sep 0.7 0.56 499.52
Morp-14- Morphine sulphate 30mg tablet tab 203
50 1 GV1269 21-Sep 5.2 4.16 844.48
Muvi-11- Multivitamin with minerals tab tab 104
 51 1 D19125304 21-Jul 1.65 1.32 137.28
Norf-10-1 Norfloxacillin 400mg tablet tab 883
 52 1D121 21-Mar 1.2 0.96 847.68
Para-20-1 Paracetamole 120mg/5ml syrup 60ml 4
53 L2339 22-Oct 35 28 112
Para-60-1 Paracetamole 125mg supp 200
54 suppository 1193 23-Aug 2.1 1.68 336
Para-60-1 Paracetamole 125mg supp 290
55 suppository K2ACJ035 23-Jan 2.1 1.68 487.2
 Para-11-1 Paracetamole 500mg tablet tab 2583
56  31166 24-Feb 0.8 0.64 1653.12
Penb-36- Pencillin G, Benzantine 1.2MIU vial 24
57 1 711192 21-Oct 10 8 192
Toin-10-1 Phenytoin 50mg tablet tab 193
58 NT80322 21-Apr 1.25 1 193
Plpa-71-1 Plaster of paris(P.O.P) roll 42
59 10cmx3m JA190520X 24-May 13.5 10.8 453.6
Pota-12-1 Potassium chloride 600mg tablet tab 148
60 6190201 21-Feb 0.6 0.48 71.04
Praz-10-1 Praziquantel 600mg tablet tab 97
61 A1G113 22-Jul 4.45 3.56 345.32
Prim-10- Primaquine phosphate 7.5mg tab 688
62 1 tablet 80283 21-Feb 4.45 3.56 2449.28
63 Prom-10- Prometazine HCL 25mg tablet tab 8120273 21-Dec 0.2 955 0.16 152.8
1
Quin-10- Quinine sulfate 300mg tablet tab 576
64 1 9F117 22-May 1 0.8 460.8
Spir-10-1 Spiranolactone 25mg tablet tab 500
65 1866001 21-Oct 1.45 1.16 580
Sutr-20-1 Sulfametoxazole + Trimetoprim bottle 201
66 240mg/5ml suspension F3026F01 20-Sep 23.5 18.8 3778.8
Blad-79-1 Surgical blade size 22 Pcs 104
67 E3784 23-Aug 1.6 1.28 133.12
Syri-78-1 Syringe (Disposable ) 5ml with pcs 221
68 needle 190504 24-May 2 1.6 353.6
Syri-78-1 Syringe (Disposable) 5ml with pcs 100
69 needle o641 21-Aug 1.2 0.96 96
Tram-31- Tramadole HCL 100mg/2ml amp 44
70 1 injection BA08025a 21-Jul 19.5 15.6 686.4
Teta-30-1 Ttetanus antioxide 1500IU amp 200
71 10398A037 20-Sep 81.15 64.92 12984
 Vanc-30- Vancomycine 500mg injection vial 9
72 1 NP0046A 22-Jan 60.3 48.24 434.16
Vitb-30-1 Vitamin B complex injection tab 295
73 183211268 21-Aug 1.2 0.96 283.2
Vitb-30-2 Vitamin B complex injection amp 69
74 1801851 21-Jan 1.95 1.56 107.64
Vitk-30-1 Vitamin k1 10mg/ml injection amp 3
75 1801853 21-Jan 6.7 5.36 16.08
76 Wate-30- Water for injection 5ml- vial 2F549006 22-Apr 0.95 150 0.76 114
1 injection
Wate-31- Water for injection 10ml- vial 327
77 1 injection 34190750 21-Jul 1.2 1.28 418.56 Free
Zinc-11-1 Zinc sulfate 20mg tablet tab 812
78 N05 21-Jun 2 1.6 1299.2 Free
87196.296

Inventory Registered by Name ___________________Counted by Name ______________ Recounted by Name_____________________

Signature ___________________________ Signature ________ Signature______________________
Responsible Persons Name __________________________,__________________________,_____________________
Signature’s ____________________________,______________________,_______________________