PUSKESMAS PARIGI

PENGAJUAN OBAT DAN BMHP JKN TW I

TAHUN 2018
Jumlah Obat TW I Rp 44. 243. 948

HARGA SATUAN
No NAMA OBAT BENTUK SEDIAAN VOLUME JUMLAH HARGA (Rp) KETERANGAN
( Rp )
1 Amoxcillin 500 mg Box10 Strip @10Tablet 3000 Rp 770.00 Rp 2,310,000.00
2 Amoxcillin Syrup Kering 125 mg/5 ml Botol @ 60 ml 501 Rp 1,920.00 Rp 961,920.00
Antasida DOEN, Kombinasi : aluminium
3 hidroksida 200 mg + magnesium hidroksida Box 10 Strip @10 Tablet 5000 Rp 82.30 Rp 411,500.00
200 mg
4 Antasida DOEN Suspensi Botol @ 60 ml 150 Rp 5,968.00 Rp 895,200.00
5 Allopurinol Tab 100 mg Box 10 Strip @10 Tablet 2000 Rp 117.00 Rp 234,000.00
6 Asiklovir Tab 200 mg Box 5 Strip @10 Tablet 2000 Rp 259.00 Rp 518,000.00
7 Asiklovir Krim 5% Tube @ 5 gram 147 Rp 4,940.00 Rp 726,180.00
8 Ambroxol 30 mg Box 10 Strip @10 Tablet 5000 Rp 330.00 Rp 1,650,000.00
9 Amlodipin 5 mg Box 3 Strip @ 10 Tablet 5000 Rp 90.00 Rp 450,000.00
10 Amlodipin 10 mg Box 3 Strip @ 10 Tablet 5000 Rp 107.00 Rp 535,000.00
11 Asam Mefenamat 500 mg Box 10 Strip @10 Tablet 5000 Rp 102.00 Rp 510,000.00
12 Asam Askorbat (Vit. C) Botol @ 100 Tablet 5000 Rp 119.00 Rp 595,000.00

Analgesic Kombinasi : Methampyron 500 mg +

13 Box 10 Strip @10 Tablet 1000 Rp 558.00 Rp 558,000.00
Multivitamin Neurotropic (Novaphyron)

14 Attapulgit tablet 650 mg Box 10 Strip @10 Tablet 5000 Rp 230.00 Rp 1,150,000.00
15 Betafort Syrup Botol @ 60 ml 101 Rp 32,594.00 Rp 3,291,994.00
16 Betametason Krim 0,1 % Tube @ 5 gram 20 Rp 15,000.00 Rp 300,000.00
17 Beneuron tablet Box 10 Strip @10 Tablet 2000 Rp 770.00 Rp 1,540,000.00
18 Cendo Lyters 15 ml Botol @ 15 ml 50 Rp 35,400.00 Rp 1,770,000.00
19 Chlorampheniramin Maleat Tab 4 mg Box 20 Strip @ 10 Tablet 10000 Rp 39.00 Rp 390,000.00
20 Domperidon Tab 10 mg Box 10 Strip @10 Tablet 10000 Rp 116.00 Rp 1,160,000.00
21 Domperidon Suspensi 5mg/ 5ml Botol @ 60 ml 400 Rp 3,215.00 Rp 1,286,000.00
22 Dexametasone Tab 0,5 mg Box 10 Strip @10 Tablet 5011 Rp 45.00 Rp 225,495.00
23 Glimepirid Tab 1 mg Box 3 Strip @ 10 Tablet 10000 Rp 200.00 Rp 2,000,000.00
24 Glimepirid Tab 2 mg Box 3 Strip @ 10 Tablet 10000 Rp 231.00 Rp 2,310,000.00
25 Gentamisin 1 mg krim Tube 15 gr 99 Rp 12,500.00 Rp 1,237,500.00
26 Ibuprofen 400 mg Box 10 Strip @10 Tablet 5000 Rp 113.00 Rp 565,000.00
27 Ibuprofen Suspensi 100 mg/5ml Botol @ 60 ml 300 Rp 2,560.00 Rp 768,000.00
28 Klormfenicol T. Telinga 1 % Botol @ 5 ml 200 Rp 7,100.00 Rp 1,420,000.00
29 Klormfenicol T. Mata 0,5 % Botol @ 5 ml 85 Rp 12,900.00 Rp 1,096,500.00
30 Loratadin Tab 10 mg Box 10 Strip @10 Tablet 5000 Rp 134.00 Rp 670,000.00
31 Meloxicam Tab 7,5 mg Box 10 Strip @10 Tablet 1000 Rp 830.28 Rp 830,280.00
32 Metformin 500 mg Box 10 Strip @10 Tablet 2000 Rp 103.00 Rp 206,000.00
33 Natrium Diclovenac 50 mg Box 5 Strip @10 Tablet 2000 Rp 135.00 Rp 270,000.00
34 Noza Tab Box @100 Tablet 1000 Rp 997.00 Rp 997,000.00
35 Mulvitamin Tambah Darah (Novabion) Box 10 Strip @10 Tablet 1000 Rp 2,730.00 Rp 2,730,000.00
36 Methylprednisolon 4 mg Box 10 Strip @10 Tablet 2000 Rp 165.00 Rp 330,000.00
37 Omeprazole Kapsul Box 3 Strip @ 10 Kapsul 3000 Rp 148.00 Rp 444,000.00
38 Paracetamol Tab 500 mg Box 10 Strip @10 Tablet 3000 Rp 51.00 Rp 153,000.00
39 Paracetamol Syrup 120mg/5 ml Botol @ 60 ml 500 Rp 1,013.00 Rp 506,500.00
40 Ranitidin 150 mg Tab Box 10 Strip @10 Tablet 5000 Rp 110.00 Rp 550,000.00
41 Sefadroxil Kaps 500 mg Box 10 Strip @10 Kapsul 1000 Rp 1,210.00 Rp 1,210,000.00
42 Sefixim Kaps 100 mg Box, 5 strip @10 Kapsul 40 Rp 32,450.00 Rp 1,298,000.00
43 Simvastatin 10 mg Box 3 Strip @ 10 Tablet 3000 Rp 113.00 Rp 339,000.00
44 Sefadroxil Syrup Kering 125 mg/5 ml Botol @ 60 ml 148 Rp 9,840.00 Rp 1,456,320.00
45 Setirizin Syrup 5 mg / 5ml Botol @ 60 ml 149 Rp 3,300.00 Rp 491,700.00
46 Vit. B Complex Box 10 strip @ 10 Tablet 3000 Rp 132.00 Rp 396,000.00
47 Zinc Syrup 20 mg/5 ml Botol @ 60 ml 101 Rp 4,959.00 Rp 500,859.00
Jumlah Rp 44,243,948.00

Mengetahui Parigi, 22 Januari 2018

Kepala Puskesmas Parigi Yang Membuat

YUNITA TAGUNU, SKM Mohammad Arifin, S.Farm,Apt

Nip. 19830624 200312 2 005 Nip. 19790517 200604 1 021
 PUSKESMAS PARIGI
PENGAJUAN OBAT DAN BMHP JKN TW I
TAHUN 2018
Jumlah BMHP TW I Rp 29. 495. 965

HARGA SATUAN JUMLAH HARGA

No NAMA BMHP BENTUK SEDIAAN VOLUME KETERANGAN
( Rp ) (Rp)
1 Strip Gula Darah Nesco Botol @ 25 Strip 30 Rp 170,000.00 Rp 5,100,000.00
2 Strip Kolesterol Nesco Botol @ 10 Strip 55 Rp 264,294.00 Rp 14,536,170.00
3 Strip Asam Urat Nesco Botol @ 25 Strip 30 Rp 175,000.00 Rp 5,250,000.00
4 Kertas Puyer Pak 11 Rp 20,250.00 Rp 222,750.00
5 Plastik Klip Sedang 6 x 10 cm Pak 100 buah 109 Rp 15,000.00 Rp 1,635,000.00
6 Plastik Klip Kecil 5 x 8 cm Pak 100 buah 104 Rp 12,500.00 Rp 1,300,000.00
7 Aseptik Gel Botol @ 500 ml 55 Rp 26,400.00 Rp 1,452,000.00
8
9
10
Jumlah Rp 29,495,920.00

Mengetahui Parigi, 22 Januari 2018

Kepala Puskesmas Parigi Yang Membuat

YUNITA TAGUNU, SKM Mohammad Arifin, S.Farm,Apt

Nip. 19830624 200312 2 005 Nip. 19790517 200604 1 021