Laporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Puskesmas

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUS
PUSKESMAS : CIKEUSIK/ RANCASENENG

KECAMATAN : CIKEUSIK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE
JANUARI
Jumlah
N0 NAMA OBAT SATUAN Stok Awal Penerimaan
Persediaan
1 Alprazolam Tablet 0
2 Albendazol Tablet 400 mg Tablet 0
3 Allopurinol tablet 100 mg Tablet 40 50 90
4 Ambroxol sirup Botol 0
5 Ambroxol tablet 30 mg Tablet 0
6 Aminofilin Tablet 200 mg Tablet 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0
8 Amlodipin 10 mg Tablet 0
9 Amlodipin Besilate 5 mg Tablet 0
10 Amoksisilin Forte sirup kering 250mg Botol 0
11 Amoksisilin Injeksi 1 gr Vial 0
12 Amoksisilin Tablet 500 mg Tablet 35 100 135
13 Amoksisillin kapsul 250 mg Kapsul 0
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 5 5
Amoksisillin Sirup Kering 125 mg/5 ml Botol 0
15 Ampisilin Injeksi 1 gr Vial 0
16 Analog insulin Long Acting Pen 0
17 Analog insulin Mix Acting Pen 0
18 Antalgin (Metampiron) tablet 500 mg Tablet 0
19 Antalgin (Metampiron) tablet 500 mg Tablet 0
20 Antasida DOEN suspensi Botol 5 5
21 ANTASIDA DOEN Tablet Tablet 45 100 145
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 0
23 anti hemoroid doen kombinasi supp 0
24 Antifungi DOEN Tube 0
25 Antimigren DOEN Kombinasi : Tablet 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet 0
27 Antiparkinson Tablet ( Levopar ) Tablet 0
28 Aqua Pro Injeksi Vial 0
29 Artermeter injeksi Ampul 0
30 Artesunate injeksi 60 mg/ml vial 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 0
32 Asam Folat Botol 0
33 Asam Fusidat Cream Tube 0
34 Asam Klorida 0,1 N Botol 0
35 Asam Mefenamat 500 mg Tablet 0
36 Asam Traneksamat Inj 5% Ampul 0
37 Asering Botol 0
38 Asetosal tablet 500 mg Tablet 0
39 Asetyl Cysteine Capsul 30 60 90
40 Asiklovir Cream 5% Tube 0
41 Asiklovir tablet 200 mg Tablet 0
42 Asiklovir tablet 400 mg Tablet 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0
46 Berotec Metered Aerosol 100 mg Bok 0
47 Betadine Salep Antiseptik 5 mg Tube 2 2
48 Betametason krim 0,1 % Tube 0
49 Bisakodil Suppositoria supp 0
50 Bisoprolol 2,5 mg Tablet 0
51 Bisoprolol 5 mg Tablet 0
52 Cairan Infus KN-3B Botol 0
53 Cairan Infus Wida KDN 1 Botol 0
Cairan Infus Wida KDN 1 Botol
54 Cairan Pembersih ( Protektor ) Botol 0
55 Captopril Tablet 12,5 mg Tablet 30 50 80
56 Captopril Tablet 25 mg Tablet 0
57 Cefadroxil Capsul 500 mg Capsul 0
58 Cefixime Capsul 100 mg Capsul 0
59 Cefixime Sirup Botol 0
60 Cefotaksime 1 gr Injeksi Vial 0
61 Cetirizine Capsul 50 mg Capsul 0
62 Cetirizine sirup 5 mg/5 ml Botol 0
63 Ciprofloxcacin 500 mg tablet Tablet 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 0
65 D-Artepp tablet Tablet 0
66 deksametason tab Tablet 45 100 145
67 Dekstran 70 - larutan infus 6% steril Botol 0
68 Dekstrometorfan sirup Botol 0
69 Dekstrometorfan tablet 15 mg Tablet 0
70 Diazepam Rektal 0,5 mg / 2 ml supp 0
71 Diazepam tablet 2 mg Tablet 0
72 Diazepam tablet 5 mg Tablet 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1 Ampul 0
74 Digoksin tablet 0,25 mg Tablet 0
75 Diltiazem Tablet 0
76 Doksisiklin Kapsul 100 mg Capsul 0
77 Domperidon 10mg Tablet Tablet 50 50
78 Domperidon Suspensi 5 mg/ 5 ml Botol 0
79 Doxicyclin 500mg capsul 0
80 Efedrin HCLTablet 25 mg Tablet 0
81 Epinefrina HCL/Bitartrat Injeksi Ampul 0
82 Eritromicyn kapsul 250 mg capsul 0
83 Erytromicin kapsul 500 mg Kapsul 0
84 Erytromicin sirup 125 mg Botol 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol 0
86 Etambutol 500 mg Tablet 0
87 Etanol 70 % Botol 0
88 Etil Klorida Semprot Botol 0
89 Fenitoin Natrium kapsul 30 mg Kapsul 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0
91 Fenobarbital tablet 30 mg Tablet 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet 0
93 Fenol Gliserol tetes telinga 10 % Botol 0
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-Ampul 0
95 Fitomenadion (Vit.K1) tab salut gula 10 Tablet 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul 0
97 Furosemida tablet 40 mg Tablet 50 50
98 Furosemide Injeksi Ampul 0
99 Garam Oralit Sachet 0
100 Gemfibrozil 300 mg Tablet 0
101 Gentamicin Injeksi Ampul 0
102 Gentamicin Salep Kulit Tube 0
103 Gentamicin Salep mata Tube 0
104 Gentamicin Tetes Mata Botol 0
105 Gentian Violet 1 % Botol 0
106 Glibenclamid tablet 5 mg Tablet 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0
108 Glikazid 80 mg Tablet Tablet 0
109 Glimepiride 2 mg Tablet 0
110 Glukosa larutan infus 10% steril Botol 0
111 Glukosa larutan infus 5 % steril Botol 0
112 Griseofulvin tablet 500 mg, Tablet 0
113 Guaiafenesin 100 mg Tablet 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 0
115 Hidrokortison krim 2,5% Tube 0
116 Ibuprofen Suspensi Tablet 0
117 Ibuprofen tablet 200 mg Tablet 0
118 Ibuprofen tablet 400 mg Tablet 0
119 Imunomodulator sirup( STIMUNO) Botol 0
120 Isosorbid Dinitrat tablet sublingual 5 mgTablet 0
121 Kalsium Glukonas Injeksi Ampul 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 5 5
123 Kapas Berlemak 500 mg Bungkus 0
124 Ketokonazol Kream Tube 0
125 Ketokonazol Tablet 200 mg Tablet 10 10
126 Ketorolac inj Ampul 0
127 Kifadene tablet 20 mg Tablet 0
128 Kloramfenikol salep mata 1 % capsul 0
129 Kloramfenikol suspensi Botol 0
130 Kloramfenikol tetes telinga 3% Tube 0
131 Kloramphenicol 250 mg Capsul 0
132 Kloramphenicol 500 mg capsul 0
133 Kloramphenicol Tetes Mata Botol 0
134 Klorfeniramin Maleat (CTM) tablet 4 mgTablet 5 100 105
135 Klorokuin tablet 150 mg Tablet 0
136 Klorpromazin HCL tablet salut 25 mg Tablet 0
137 Kombinasi (Pirimetamin 25 mg + SolfadTablet 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 0
139 Kotrimoksazol Sirup / Suspensi Botol 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0
142 Lactobacilus serbuk Sachet 0
143 Lidocain 2%+efinefrin injeksi Ampul 0
144 Lidocain injeksi 2 ml Ampul 0
145 Lisinopril 10 mg tablet Tablet 0
146 Lisinopril 5 mg tablet Tablet 0
147 Loperamid 4 mg tablet Tablet 0
148 Lytacur Sirup Botol 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 0
150 Metamizol 500 mg Tablet 0
151 Metformin 500 mg Tablet Tablet 0
152 Methilprednisolon tablet 8 mg Tablet 0
153 Metilergometrin Maleat injeksi 1 ml Ampul 0
154 Metilergometrin Maleat Tablet Tablet 10 10
155 Metoklopramid Suspensi Botol 0
156 Metoklopramid tablet Tablet 0
157 Metronidazol 500 mg Tablet 0
158 Metronidazol infus / injeksi Botol 0
159 Metronidazol Ovula supp 0
160 Metronidazol suspensi Botol 0
161 Mikonazol kream Tube 2 2
162 Multivitamin Anak Sirup Botol 5 5
163 Multivitamin Dewasa Antioksidan ( BecoTablet 0
164 Natrium Diklofenak 25 mg Tablet Tablet 0
165 Natrium Diklofenak 50 mg Tablet Tablet 30 100 130
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 0
167 Nifedipine Tablet 10 mg box 0
168 Nistatin tablet vaginal 100.000 IU/g Tube 0
169 Obat anti Diare suspensi Botol 0
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 15 15
171 Obat Batuk Flu ( Molexflu ) BOX 0
Obat Batuk Flu ( Molexflu ) BOX 0
172 Obat Batuk Hitam (OBH) Botol 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0
174 Ofloxsacin Tetes Telinga Tube 0
175 Oksitetrasiklin HCL salep mata 1% Botol 0
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 0
177 Omeprazol injeksi Ampul 0
178 Omeprazol Kapsul 20 mg capsul 0
179 Ondancentron injeksi 4 mg Ampul 0
180 Ondancentron Tablet4 mg Tablet 10 30 40
181 Paracetamol Drop 15 ml Botol 0
182 Paracetamol Sirup 120 mg/5 ml Botol 2 2
183 Parafin Dresing ( Bioplacenton Tull ) pcs 0
184 Parasetamol tablet 100 mg Tablet 0
185 Parasetamol tablet 500 mg Tablet 0
186 Permetrin Krim 5 % Tube 0
187 Pirantel Sirup Botol 0
188 Pirantel tablet 125 mg Tablet 0
189 Pirazinamid Botol 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 0
191 Piroksikam tablet 20 mg Tablet 0
192 Polikresulen Tube 0
193 Povidon lodida 10% 300 ml 0
194 Povidon lodida 10% 60 ml Tablet 0
195 Prazikuantel tablet 600 mg Botol 0
196 Prednison Tablet 5 mg Tablet 5 100 105
197 Primakuin 15 mg Tablet 0
198 Probenesid 500 mg tablet Tablet 0
199 Prokain Benzil Penisilin 3 juta IU/vial inj Ampul 0
200 Propanolol HCL tablet 10 mg Tablet 0
201 Ranitidin injeksi Ampul 0
202 Ranitidin tablet Tablet 0
203 Resperidone 2 mg tablet Tablet 0
204 Ringer Laktat cairan infus (Otsuka) 0
205 Ringer Laktat cairan infus (Widatra) Botol 0
206 Rivanol 300 ml Botol 0
207 Salbutamol Tablet 2 mg Tablet 40 100 140
208 Salbutamol tablet 4mg Tablet 0
209 Salep 2-4 Tube 0
210 Salep kombinasi cream ( Berloson ) Tube 0
211 Salicil bedak Kotak 0
212 Serum Anti Bisa Ular Polivalen Inj 50 mlVial 0
213 Serum Anti Tetanus inj 1500 IU ( Tetag Vial 0
214 Sianokobalamin Injeksi Ampul 0
215 Simvastatin 10 mg tablet Tablet 5 5
216 Simvastatin 20 mg tablet Tablet 0
217 Sukralfat Suspensi Botol 0
218 Sukralfat tablet 500 mg Tablet 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 Tube 0
220 Temporary Stopping Fletcher serbuk & cTablet 0
221 Tetrakain HCL tetes mata 0,5% Tube 0
222 Tetrasiklin 250 mg capsul capsul 0
223 Tetrasiklin 500 mg capsul capsul 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0
Tiamin Tablet 50 mg ( B1 ) Tablet
225 Ventolin Nebulizer Ampul 0
226 vitamin b komplek Tablet 50 200 250
227 Zink sirup Botol 0 0
228 Zink tablet 20 mg Tablet 0 0
229 Deksametason inj Ampul 3 3
230 Diazepam inj 5 mg/ml Ampul 0 0
231 Griseofulvin 125 mcg Tablet 0 0
232 Kloramfenikol SK Tube 0 0
233 Nystatin tab 500.000 IU Tablet 0 0
234 magnesium Sulfat Inj. 25 ml 40% ampul 0 0
235 natrium bicarbonat tab 0 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 0 0
1 Alat suntik 1 ml Pcs 0 0
3 Alat suntik 2,5 ml Pcs 0 0
5 Alat suntik 3 cc (Remedi) 0 0
7 Alat suntik 5 ml pcs 0 0
8 Alkazide 1 L High Level Desinfectant Botol 0 0
9 Alkazyme Sachet 25 mg Pack 0 0
10 Alkohol 70 % 1 L Botol 0 0
11 Alkohol swab Sachet 0 0
12 Anti Septik Hand Rub Botol 0 0
13 Anti Septik Surgikal Hand Scrub Botol 0 0
14 Cat Gut no 2/0 Sachet 0 0
16 Cat Gut No 2/0 (24 mm) Sachet 0 0
18 Cathetter Jelly Biji 0 1 1
19 Demetech Silk 3/0 Set 0 0
20 E Care I.V Dresing Pcs 0 0
21 E-Care Surgical Mask Tie On Lembar 0 0
22 Folly No 14 Catether pcs 0 0
24 I.V Cathetter No. 20 Set 0 0
iv cathETER no 20 pcs 0 5 5
I.V Cathetter No. 22 Set 0 0
I.V Cathetter No. 24 Set
28 Infuset Anak Set 0 0
29 Infuset Dewasa Set 0 0
30 Jarum Insulin Tablet 0 0
31 Kapas Berlemak 250 gr Bungkus 0 0
33 Kasa 4 m x 10 cm Rol 0 0
34 Kasa Hidrofil 36 x 80 cm Rol 0 0
35 Kasa Pembalut 2 x 80 cm Pack 0 5 5
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 0 0
37 Lisol 1 L Botol 0 0
38 Masker karet Ear Loop Lembar 0 0
39 Masker tali Tube 0 0
40 Nasal Canula Oksigen Set 0 0
41 Plester 1" Rol 0 0
42 Plester Kertas 2,5 cm Rol 0 0
43 Plester Non Woven 5cm x 5 cm Rol 0 0
44 Policlean Botol 0 0
45 Polifik Kotak 0 0
46 Saraya Alsof A 500 ml Botol 0 0
47 Saraya Alsof Pure 500 ml Botol 0 0
48 Sarung Tangan Gynecolog No 7 Pasang 0 0
49 Sarung tangan M (Non Steril) Pasang 0 0
50 Sarung tangan no 6,5 Pasang 0 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0 0
52 Sarung tangan no 7,0 Steril Pasang 0 0
53 Selang Section ( Surgikal Conection Tu Pcs 0 0
54 Underpad Lembar 0 2 2
55 Urine Bag Biji 0 0
56 safety blackblood BOX 0 0
57 safety box BOX 0 0
58 Tabung BD Vacutener pcs 0 0
59 masker n95 box 0 0
60 t silk black 3/0 26 mm pcs 0 0
61 ALAT SUNTIK 1 ML BOX 0 0
62 alat suntik 3 ml box 0 0
63 iv cathETER no 18 pcs 0 0
OBAT JKN 0 0
1 acylovir cream tube 0 0
2 etil klorida spray btl 0 0
3 parasetamol inf botol 0 0
4 propyretic suppo box 0 0
5 selkom c tab box 0 0
6 trifadium tab box 0 0
7 vit k1 inj box 0 0
8 Ketorolac inj box 0 0
9 mp 4 mg box 0 0
10 parasetamol tab box 0 2 2
11 aminofilin inj box 0 0
12 asam mefenamat box 0 0
13 Acyclovir 200 mg box 0 0
15 Ciprofloxacin 500 mg box 0 0
16 GLUKOSA 5% BOTOL 0 0
17 glukosa 10% BOTOL 0 0
18 SIANOKOBALAMIN INJ 500 mg box 0 0
19 asam folat 400 mcg box 0 0
20 AMBROKSOL SYR BOTOL 0 0
21 asam tranexamat inj box 0 0
22 Bedak Salicyl 2% box 0 0
23 Cefadroxil 500 mg box 0 0
24 Cetirizine syr BOTOL 0 0
25 d40 BOTOL 0 0
26 Guanistrep syr BOTOL 0 0
27 IBUPROFEN 400 mg box 0 0
28 kloramfenikol tetes mata TUBE 0 0
29 Mecobalamin 500 Mg Tab box 0 0
30 metronidazol syr BOTOL 0 0
31 Metronidazole 500 mg box 0 0
32 Ondansetron inj 4 mg BOX 0 0
33 Paraflu Sirup BOTOL 0 0
34 parasetamol syr BOTOL 0 10 10
35 ranitidin tab 50 mg box 0 1 1
36 asam fusidat krim tube 0 0
37 amlodipin 10 mg box 0 3 3
39 asam traneksamat tab 500 mg box 0 0
40 cetirizin tab box 0 1 1
41 d40 % botol 0 0
42 dulcolax anak suppo box 0 0
43 gom box 0 0
44 HERBAKOF SYR botol 0 5 5
45 kloramfenikol tetes mata botol 0 0
46 Lexigo box 0 0
47 METRONIDAZOL SYR botol 0 0
48 mgso 4 40% Botol 0 0
49 mikrolax suppositoria Tube 0 0
50 natrium bicarbonat tab botol 0 1 1
51 nifedipin tab box 0 1 1
52 nisagon krim tube 0 0
53 oksitosin inj box 0 0
54 piroksikam 20 mg tab box 0 0
55 SELKOM C box 0 0
56 serum abu vial 0 0
57 SUKRALFAT SYR botol 0 0
58 ventolin nebu box 0 0
59 nacl botol 0 2 2
60 ringer laktat botol 0 2 2
0 0
BMHP JKN Set 0 0
1 LANSET pcs 0 0
2 BISTURI pcs 0 0
3 CHKM pcs 0 0
4 Jely pcs 0 0
5 handscoon steril 7,5 pcs 0 0
6 Kertas puyer pcs 0 0
7 Needle no 24 pcs 0 0
8 Selang Oksigen Anak-anak nca pcs 0 0
9 Selang Oksigen Dewasa ncd pcs 0 0
10 Larutan Gentian Violet pcs 0 0
11 mukus ekstraktor pcs 0 0
12 nesco asam urat pcs 0 0
13 pipet obat 1 ml pcs 0 0
14 pot urin pcs 0 0
15 reagen goldar A pcs 0 0
16 kertas goldar pcs 0 0
17 Rebreathing mask O2 anak pcs 0 0
18 Rebreathing mask O2 dewasa pcs 0 0
19 suction no 8 pcs 0 0
20 vaselin pcs 0 0
21 rapid test dengue nst box 0 0
22 suntik 20 cc box 0 0
23 rapid test dengue 1gg box 0 0
24 catgut plain box 0 0
25 antiseptik 5 L kompan 0 0
26 nesco hb box 0 0
27 UNDERPAD pack 0 0
28 rivanol botol 0 1 1
29 povidone botol 0 0
30 alkohol botol 0 0
32 nesco gds box 0 0
33 nesco asam urat box 0 0
34 hcg test box 0 0
35 lancet media box 0 0
36 IV CATHETER no 26 Pcs 0 0
37 MASKER EARLOOP Box 0 1 1
38 OIL IMMERSI Botol 0 0
39 OKSIGEN MASKER STANDAR ANAK pcs 0 0
40 OKSIGEN MASKER STANDAR DEWASA pcs 0 0
41 OXYGEN NASAL CANNULA NEONATUS ncb Pcs 0 0
42 PLASTIK KLIP SEDANG 13x8,7 CM Pack 0 0
43 PROTEIN URIN VERIFY botol 0 0
44 REAGEN GOLDAR Botol 0 0
45 SENDOK OBAT 5ML Pack 0 0
46 STRIP CHOLESTEROL Botol 0 0
47 STRIP GULA DARAH Botol 0 0
48 STRIP HB Botol 0 0
49 SUNGKUP ANAK NEBU pcs 0 0
50 SUNGKUP BAYI NEBU pcs 0 0
51 SUNGKUP DEWASA NEBU pcs 0 0
52 UMBILICAL KLEM Box 0 0
53 ALKOHOL SWAB Box 0 1 1
54 CATGUT CHROME SIZE : 2/0 WITH NEEDLE SBox 0 0
55 EXAMINATION GLOVE uk. M Box 0 1 1
56 FOLLEY CATHETER NO 16 Pcs 0 0
58 GLOVE STERILE GYNECOLOG NO. 6.5 Pair 0 0
59 INFUSION SET DEWASA Pcs 0 5 5
60 IV CATHETER NO. 18 Box 0 0
64 KASA 40X80 pcs 0 0
65 MASKER MEDIS HEADLOOP Box 0 0
66 PERBAN ELASTIS 10M Pcs 0 0
67 PLESTER INCL DISPENSER 1 INCH Box 0 0
68 POVIDION IODINE 15ML Btl 0 0
69 STRIP CHOLESTEROL Box 0 0
70 STRIP GULA DARAH Box 0
71 SYRINGE 1ML Box 0
72 SYRINGE 3ML Box 0
73 UMBILICAL KLEM Box 0
74 URINE BAG Pcs 0
YANG MENYERAHKAN
PENGELOLA OBAT
RENY WIGIAWATI, A.Pt

NIP.198601142019 02 2 003
AT ( LPLPO ) PUSKESMAS
DOKUMEN NOMOR TANGGAL

JAN DINKES KAB/KOTA
FEB GFK KAB/KOTA
PUSKESMAS
JANUARI
Stok Jumlah
PEMBERIAN
Pemakaian Stok Akhir Optimum Permintaan
BUFFER
APBD II JKN PROG LAIN LAIN
STOK
0
0
60 30
0
0
0
0
0
0
0
0
95 40
0
2 3
0
0
0
0
0
0
5 0
60 85
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30 60
0
0
0
0
0
0
0
1 1
0
0
0
0
0
0
0
35 45
0
0
0
0
0
0
0
0
0
0
65 80
0
0
0
0
0
0
0
0
0
0
30 20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
25 25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
10
0
0
0
0
0
0
0
0
75 30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
2 0
3 2
0
0
65 65
0
0
0
0
10 5
0
0
0
0
0
0
0
0
0
0
26 14
0
2 0
0
0
0
0
0
0
0
0
0
0
0
0
0
70 35
0
0
0
0
0
0
0
0
0
0
70 70
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
150 100
0
0
3 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
1 0
0
0
0
0
0
0
3 2
0
0
0
0
0
0
0
0
0
0
0
3 2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7 3
1 0
0
2 1
2 1
0
1 0
0
0
0
3 2
0
0
0
0
0
1 0
1 0
0
0
0
0
0
0
0
2 0
2 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
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
5
0
0
0
0
0
0
0
0
0
0
MENGETAHUI YANG MEMINTA :

KEPALA PUSKESMAS PENANGGUNG JAWAB PUSTU/POSKEDES
HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

NIP.19710804 199103 2 002 NIP.198910042017042002
TANGGAL DOKUMEN
PELAPORAN BULAN / PERIODE FEB DINKES KAB/KOTA
PERMINTAAN BULAN / PERIODE MARET GFK KAB/KOTA
PUSKESMAS
FEBRUARI
Stok Jumlah
JUMLAH Jumlah PEM
Stok Optimum Permintaan
Stok Awal Penerimaan Persediaa Pemakaian
Akhir
n APBD II
0 0 0
0 0 0
30 100 130 80 50 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
40 200 240 150 90 150
0 0 0
3 3 3
0 10 10 7 3 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 10 10 6 4 15
85 200 285 200 85 100
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 0 0
0 100 100 65 35 100
0 0 0
0 0 0
0 0 0
0 100 100 75 25 100
0 0 0
0 0 0
0 0 0
60 120 180 100 80 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 2 3 2 1 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2 1 1 3
0 0 0
45 45 35 10 100
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 0 0
0 0 0
80 200 280 200 80 100
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 0 0
0 0 0
20 100 120 85 35 100
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 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 0
0 0 0
0 0 0
25 200 225 155 70 100
0 0 0
0 25 25 21 4 10
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 0 0
0 200 200 120 80 100
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 0 0
0 0 0
0 0 0
0 0 0
5 5 3 2 10
0 0 0
0 0 0
10 10 5 5 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
30 200 230 180 50 100
0 0 0
0 0 0
0 0 0
0 100 100 65 35 100
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 0 0
0 0 0
0 0 0
0 0 0
0 300 300 250 50 150
0 0 0
0 0 0
10 10 7 3 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2 2 0 5
2 5 7 5 2 7
0 0 0
0 0 0
65 100 165 95 70 100
0 2 2 2 0 5
0 0 0
0 0 0
0 0 0
5 100 105 80 25 100
0 0 0
0 1 1 1 0 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
14 14 10 4 10
0 0 0
0 10 10 8 2 15
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 100 100 85 15 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
35 300 335 250 85 150
0 0 0
0 0 0
0 0 0
0 0 0
0 10 10 7 3 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
70 100 170 130 40 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 5 5 0 5
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 0 0
0 100 100 60 40 100
0 0 0
100 200 300 240 60 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2 2 0 3
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 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 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
0 0 0
0 0 0
0 0 0
2 2 2 0 4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 5 5 5 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2 0 4
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 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 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
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1 1 0 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2 2 0 4
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 2 2 2 0 3
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 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 3 0 5
0 2 2 2 0 3
0 0 0
1 2 3 3 0 4
1 2 3 3 0 4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2 0 3
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 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 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
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 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 0
0 0 0
0 0 0
0 0 0
1 1 1 0 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1 0 2
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 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1 0 2
0 0 0
1 1 1 0 1
0 0 0
0 0 0
0 0 0
5 5 5 0 7
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 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
YANG MENYERAHKAN MENGETAHUI YANG

PENGELOLA OBAT KEPALA PUSKESMAS PENANGGUNG JA
RENY WIGIAWATI, A.Pt HJ,IYOT SA'DIAH,S.ST Elis Febri

NIP.198601142019 02 2 003 NIP.19710804 199103 2 002
DINKES KAB/KOTA PELAPORAN BULAN / PERIODE
GFK KAB/KOTA PERMINTAAN BULAN / PERIODE
PUSKESMAS
MARET
PEMBERIAN JUMLAH Jumlah
Stok Awal Penerimaan Persedia Pemakaian
BUFFER an
JKN PROG LAIN LAIN
STOK
0 0
0 0
50 100 150 110
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
90 100 190 140
0 0
3 3 2
3 10 13 8
0 0
0 0
0 0
0 0
0 0
4 10 14 10
85 100 185 150
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
35 35 20
0 0
0 0
0 0
25 100 125 85
0 0
0 0
0 0
80 60 140 110
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 2 3 3
0 0
0 0
0 0
0 0
0 0
0 0
1 1 1
0 0
10 10 6
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80 60
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
35 35 25
0 5 5 3
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 0
0 0
0 0
0 0
0 0
0 0
70 50 120 90
0 0
4 4 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80 55
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 2 2
0 0
0 0
5 5 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 100 150 120
0 0
0 0
0 0
35 100 135 90
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50 35
0 0
0 0
3 3 3
0 0
0 0
0 0
0 0
0 0
0 0
0 2 2 2
2 5 7 5
0 0
0 0
70 70 45
0 0
0 0
0 0
0 0
25 25 15
0 0
0 1 1 1
0 0
0 0
0 0
0 24 24 15
0 0
0 0
0 0
0 0
4 4 2
0 3 3 3
2 10 12 8
0 0
0 0
0 0
0 0
0 0
0 0
0 0
15 15 10
0 0
0 0
0 0
0 0
0 0
85 85 60
0 0
0 0
0 0
0 0
3 3 3
0 0
0 0
0 0
0 0
0 0
40 40 25
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1 1 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
40 40 40
0 0
60 60 50
0 2 2 2
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 0
0 0
0 0
0 10 10 6
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 5 5 3
0 0
0 0
0 0
0 5 5 3
0 0
0 0
0 0
0 5 5 3
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 3 3 3
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 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
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 2 2 2
0 0
0 0
0 1 1 1
0 1 1 1
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 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2 2 2
0 0
0 2 2 2
0 2 2 2
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 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
0 0
0 0
0 0
0 0
0 0
0 50 50 30
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 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
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 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
0 0
0 5 5 4
0 0
0 0
0 0
0 0
0 0
0 0
0 1 1 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
YANG MEMINTA : YANG MENYERAHKAN MENGETAHU

PENANGGUNG JAWAB PUSTU/POSKEDES PENGELOLA OBAT KEPALA PUSKES
Elis Febriyani, Amd. Keb RENY WIGIAWATI, A.Pt

NIP.198910042017042002 NIP.198601142019 02 2 003
MARET DINKES KAB/KOTA
APRIL GFK KAB/KOTA
PUSKESMAS
Stok Jumlah
Stok PEMBERIAN JUMLAH
Optimum Permintaan
Akhir BUFFER
STOK
0
0
40 100
0
0
0
0
0
0
0
0
50 100
0
1 3
5 5
0
0
0
0
0
4 6
35 100
0
0
0
0
0
0
0
0
0
15 50
0
0
0
40 100
0
0
0
30 100
0
0
0
0
0
0
0
0 3
0
0
0
0
0
0
0
0
4 6
0
0
0
0
0
0
0
0
0
0
20 100
0
0
0
0
0
0
0
0
0
0
10 100
2 5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30 100
0
2 5
0
0
0
0
0
0
0
0
0
25 100
0
0
0
0
0
0
0
0
0
0
0
0
0 5
0
0
2 5
0
0
0
0
0
0
0
0
30 100
0
0
0
45 100
0
0
0
0
0
0
0
0
0
0
0
0
15 100
0
0
0 5
0
0
0
0
0
0
0 5
2 5
0
0
25
0
0
0
0
10 20
0
0 2
0
0
0
9 10
0
0
0
0
2 5
0 5
4 5
0
0
0
0
0
0
0
5 5
0
0
0
0
0
25 100
0
0
0
0
0 5
0
0
0
0
0
15 100
0
0
0
0
0
0
0
0
0
0 3
0
0
0
0
0
0
0
0
0
10 100
0 5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4 10
0
0
0
0
0
0
0
0
0
0
0
0
2 5
0
0
0
2 5
0
0
0
2 5
0
0
0
0
0
0
0
0
0
0
0 5
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
0
0
0
0
0
0
0
0
0
0
0
0
0 5
0
0
0 3
0 3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 4
0
0 3
0 3
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
0
0
0
0
0
20 20
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
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
0
1 5
0
0
0
0
0
0
0 3
0
0
0
0
0
0
0
0


NIP.19710804 199103 2 002 NIP.198910042017042002
LAPORAN PERSEDIAAN PUSKESMAS CIK
Nama Puskesmas : PKM CIKEUSIK/ NAMA PARKOS

Bulan : MARET
Saldo Awal 2021 Penerimaan T.A

N0 NAMA OBAT SATUAN
Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan
1 Alprazolam Tablet - - -
2 Albendazol Tablet 400 mg Tablet - 407 -
3 Allopurinol tablet 100 mg Tablet 50 105 5,250 100
4 Ambroxol sirup Botol - 3,300 -
5 Ambroxol tablet 30 mg Tablet - - -
6 Aminofilin Tablet 200 mg Tablet - 91 -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - 3,345 -
8 Amlodipin 10 mg Tablet - 93 -
9 Amlodipin Besilate 5 mg Tablet - 75 -
10 Amoksisilin Forte sirup kering 250mgBotol - 3,050 -
11 Amoksisilin Injeksi 1 gr Vial - 5,368 -
12 Amoksisilin Tablet 500 mg Tablet 90 249 22,410 100
13 Amoksisillin kapsul 250 mg Kapsul - - -
14 Amoksisillin Sirup Kering 125 mg/5 mBotol 3 5,500 16,500
Amoksisillin Sirup Kering 125 mg/5 mBotol 3 3,050 9,150 10
15 Ampisilin Injeksi 1 gr Vial - 10,300 -
16 Analog insulin Long Acting Pen - - -
17 Analog insulin Mix Acting Pen - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - 305 -
19 Antalgin (Metampiron) tablet 500 mg Tablet - 305 -
20 Antasida DOEN suspensi Botol 4 2,129 8,516 10
21 ANTASIDA DOEN Tablet Tablet 85 58 4,930 100
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - 3,035 -
23 anti hemoroid doen kombinasi supp - 3,167 -
24 Antifungi DOEN Tube - - -
25 Antimigren DOEN Kombinasi : Tablet - 173 -
26 Antiparkinson DOEN tablet Kombinasi Tablet - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - -
28 Aqua Pro Injeksi Vial - - -
29 Artermeter injeksi Ampul - 1,000 -
30 Artesunate injeksi 60 mg/ml vial - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 35 105 3,675
32 Asam Folat Botol - 55 -
33 Asam Fusidat Cream Tube - 5,506 -
34 Asam Klorida 0,1 N Botol - - -
35 Asam Mefenamat 500 mg Tablet 25 200 5,000 100
36 Asam Traneksamat Inj 5% Ampul - 1,748 -
37 Asering Botol - 9,646 -
38 Asetosal tablet 500 mg Tablet - - -
39 Asetyl Cysteine Capsul 80 382 30,560 60
40 Asiklovir Cream 5% Tube - 8,800 -
41 Asiklovir tablet 200 mg Tablet - 236 -
42 Asiklovir tablet 400 mg Tablet - 380 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 mlAmpul - 1,639 -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 mlVial - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - -
46 Berotec Metered Aerosol 100 mg Bok - 80,000 -
47 Betadine Salep Antiseptik 5 mg Tube 1 7,083 7,083 2
48 Betametason krim 0,1 % Tube - 1,340 -
49 Bisakodil Suppositoria supp - 5,800 -
50 Bisoprolol 2,5 mg Tablet - 650 -
51 Bisoprolol 5 mg Tablet - 263 -
52 Cairan Infus KN-3B Botol - 10,696 -
53 Cairan Infus Wida KDN 1 Botol - 1,007 -
Cairan Infus Wida KDN 1 Botol 1 11,435 11,435
54 Cairan Pembersih ( Protektor ) Botol - 22,000 -
56 Captopril Tablet 25 mg Tablet - 72 -
57 Cefadroxil Capsul 500 mg Capsul - 516 -
58 Cefixime Capsul 100 mg Capsul - 590 -
59 Cefixime Sirup Botol - 7,490 -
60 Cefotaksime 1 gr Injeksi Vial - 4,200 -
61 Cetirizine Capsul 50 mg Capsul - 90 -
62 Cetirizine sirup 5 mg/5 ml Botol - 2,849 -
63 Ciprofloxcacin 500 mg tablet Tablet - 265 -
64 Combivent UDV 2,5 mg+0,5mg/2,5 mAmpul - 4,550 -
65 D-Artepp tablet Tablet - - -
66 deksametason tab Tablet 80 77 6,160
67 Dekstran 70 - larutan infus 6% steril Botol - - -
68 Dekstrometorfan sirup Botol - - -
69 Dekstrometorfan tablet 15 mg Tablet - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp - 12,573 -
71 Diazepam tablet 2 mg Tablet - - -
72 Diazepam tablet 5 mg Tablet - 109 -
73 Difenhidramin HCL injeksi 10 mg/ml -Ampul - 1,176 -
74 Digoksin tablet 0,25 mg Tablet - 105 -
75 Diltiazem Tablet - - -
76 Doksisiklin Kapsul 100 mg Capsul - 264 -
77 Domperidon 10mg Tablet Tablet 35 91 3,185
78 Domperidon Suspensi 5 mg/ 5 ml Botol - 2,700 - 5
79 Doxicyclin 500mg capsul - - -
80 Efedrin HCLTablet 25 mg Tablet - - -
81 Epinefrina HCL/Bitartrat Injeksi/ E Ampul - 1,408 -
82 Eritromicyn kapsul 250 mg capsul - 583 -
83 Erytromicin kapsul 500 mg Kapsul - - -
84 Erytromicin sirup 125 mg Botol - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - 2,992 -
86 Etambutol 500 mg Tablet - - -
87 Etanol 70 % Botol - - -
88 Etil Klorida Semprot Botol - 137,500 -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - 1,740 -
91 Fenobarbital tablet 30 mg Tablet - 171 -
92 Fenoksimetil Penisilina tablet 250 mgTablet - - -
93 Fenol Gliserol tetes telinga 10 % Botol - 2,764 -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ Ampul - 3,550 -
95 Fitomenadion (Vit.K1) tab salut gula Tablet - 710 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul - 57,500 -
97 Furosemida tablet 40 mg Tablet 70 82 5,740 50
98 Furosemide Injeksi Ampul - - -
99 Garam Oralit Sachet 4 274 1,096
100 Gemfibrozil 300 mg Tablet - 380 -
101 Gentamicin Injeksi Ampul - 1,010 -
102 Gentamicin Salep Kulit Tube - 2,800 -
103 Gentamicin Salep mata Tube - 4,232 -
104 Gentamicin Tetes Mata Botol - 4,232 -
105 Gentian Violet 1 % Botol - - -
106 Glibenclamid tablet 5 mg Tablet - 119 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - -
108 Glikazid 80 mg Tablet Tablet - 235 -
109 Glimepiride 2 mg Tablet 80 207 16,560
110 Glukosa larutan infus 10% steril Botol - - -
111 Glukosa larutan infus 5 % steril Botol - 6,900 -
112 Griseofulvin tablet 500 mg, Tablet - 906 -
113 Guaiafenesin 100 mg Tablet - 132 -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - 155 -
115 Hidrokortison krim 2,5% Tube - 2,475 -
116 Ibuprofen Suspensi Tablet - - -
117 Ibuprofen tablet 200 mg Tablet - 105 -
118 Ibuprofen tablet 400 mg Tablet - - -
119 Imunomodulator sirup( STIMUNO) Botol - 23,540 -
120 Isosorbid Dinitrat tablet sublingual 5 Tablet - 89 -
121 Kalsium Glukonas Injeksi Ampul - 4,800 -
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 2 63 126
123 Kapas Berlemak 500 mg Bungkus - - -
124 Ketokonazol Kream Tube - 2,518 -
125 Ketokonazol Tablet 200 mg Tablet 5 270 1,350
126 Ketorolac inj Ampul - 1,045 -
127 Kifadene tablet 20 mg Tablet - - -
128 Kloramfenikol salep mata 1 % capsul - 1,881 -
129 Kloramfenikol suspensi Botol - 5,015 -
130 Kloramfenikol tetes telinga 3% Tube - - -
131 Kloramphenicol 250 mg Capsul - 310 -
132 Kloramphenicol 500 mg capsul - 1,163 -
133 Kloramphenicol Tetes Mata Botol - - -
134 Klorfeniramin Maleat (CTM) tablet 4 Tablet 50 60 3,000 100
135 Klorokuin tablet 150 mg Tablet - - -
136 Klorpromazin HCL tablet salut 25 mgTablet - - -
137 Kombinasi (Pirimetamin 25 mg + SolfTablet - - -
138 Kotrimoksazol Dewasa Tablet 480 mTablet 35 133 4,655 100
139 Kotrimoksazol Sirup / Suspensi Botol - 2,190 -
140 Kuinin Dihidroklorida injeksi 25% - 2 Ampul - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 Botol - - -
142 Lactobacilus serbuk Sachet - 14,707 -
143 Lidocain 2%+efinefrin injeksi Ampul - 1,229 -
144 Lidocain injeksi 2 ml Ampul - 1,140 -
145 Lisinopril 10 mg tablet Tablet - 448 -
146 Lisinopril 5 mg tablet Tablet - 375 -
147 Loperamid 4 mg tablet Tablet - 85 -
148 Lytacur Sirup Botol - - -
149 Magnesium Sulfat Inj. 25 ml 20% Ampul - 3,328 -
150 Metamizol 500 mg Tablet - 473 -
151 Metformin 500 mg Tablet Tablet 50 102 5,100
152 Methilprednisolon tablet 8 mg Tablet - - -
153 Metilergometrin Maleat injeksi 1 ml Ampul - 2,550 -
154 Metilergometrin Maleat Tablet Tablet 3 224 672
155 Metoklopramid Suspensi Botol - 2,345 -
156 Metoklopramid tablet Tablet - - -
157 Metronidazol 500 mg Tablet - - -
158 Metronidazol infus / injeksi Botol - - -
159 Metronidazol Ovula supp - 4,100 -
160 Metronidazol suspensi Botol - 3,799 -
161 Mikonazol kream Tube - 3,414 - 2
162 Multivitamin Anak Sirup Botol 2 9,900 19,800 5
163 Multivitamin Dewasa Antioksidan ( B Tablet - 1,440 -
164 Natrium Diklofenak 25 mg Tablet Tablet - - -
165 Natrium Diklofenak 50 mg Tablet Tablet 70 123 8,610
166 Natrium Klorida Cairan Infus ( NaCL Botol - 6,840 -
167 Nifedipine Tablet 10 mg box - - -
168 Nistatin tablet vaginal 100.000 IU/g Tube - 598 -
169 Obat anti Diare suspensi Botol - - -
170 Obat Anti Diare Tablet (Akita / MolagiTablet 25 145 3,625
171 Obat Batuk Flu ( Molexflu ) BOX - 64,900 -
Obat Batuk Flu ( Molexflu ) BOX - 59,090 - 1
172 Obat Batuk Hitam (OBH) Botol - - -
173 Obat Batuk Sirup Herbal ( Herbacop Botol - 11,363 -
174 Ofloxsacin Tetes Telinga Tube - - -
175 Oksitetrasiklin HCL salep mata 1% Botol - 12,700 - 24
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - -
177 Omeprazol injeksi Ampul - 9,898 -
178 Omeprazol Kapsul 20 mg capsul - 130 -
179 Ondancentron injeksi 4 mg Ampul - 1,070 -
180 Ondancentron Tablet4 mg Tablet 4 385 1,540
181 Paracetamol Drop 15 ml Botol - 6,649 - 3
182 Paracetamol Sirup 120 mg/5 ml Botol 2 1,181 2,362 10
183 Parafin Dresing ( Bioplacenton Tull ) pcs - - -
184 Parasetamol tablet 100 mg Tablet - - -
185 Parasetamol tablet 500 mg Tablet - 100 -
186 Permetrin Krim 5 % Tube - 11,825 -
187 Pirantel Sirup Botol - 9,700 -
188 Pirantel tablet 125 mg Tablet - 291 -
189 Pirazinamid Botol - - -
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 15 131 1,965
191 Piroksikam tablet 20 mg Tablet - - -
192 Polikresulen Tube - - -
193 Povidon lodida 10% 300 ml - 17,996 -
194 Povidon lodida 10% 60 ml Tablet - 6,550 -
195 Prazikuantel tablet 600 mg Botol - - -
196 Prednison Tablet 5 mg Tablet 85 73 6,205
197 Primakuin 15 mg Tablet - 224 -
198 Probenesid 500 mg tablet Tablet - - -
199 Prokain Benzil Penisilin 3 juta IU/vial Ampul - - -
200 Propanolol HCL tablet 10 mg Tablet - 60 -
201 Ranitidin injeksi Ampul 3 1,188 3,564
202 Ranitidin tablet Tablet - 105 -
203 Resperidone 2 mg tablet Tablet - 273 -
204 Ringer Laktat cairan infus (Otsuka) - 7,150 -
205 Ringer Laktat cairan infus (Widatra) Botol - 7,630 -
206 Rivanol 300 ml Botol - 2,992 -
207 Salbutamol Tablet 2 mg Tablet 40 67 2,680
208 Salbutamol tablet 4mg Tablet - 70 -
209 Salep 2-4 Tube - 2,797 -
210 Salep kombinasi cream ( Berloson ) Tube - 11,000 -
211 Salicil bedak Kotak - 1,025 -
212 Serum Anti Bisa Ular Polivalen Inj 50Vial - 512,204 -
213 Serum Anti Tetanus inj 1500 IU ( Te Vial - 130,999 -
214 Sianokobalamin Injeksi Ampul - 1,035 -
215 Simvastatin 10 mg tablet Tablet - 110 -
216 Simvastatin 20 mg tablet Tablet - 205 -
217 Sukralfat Suspensi Botol - 6,789 - 1
218 Sukralfat tablet 500 mg Tablet - 368 -
219 Suspensi Seng Insulin inj.40 IU/ml - Tube - - -
220 Temporary Stopping Fletcher serbuk Tablet - - -
221 Tetrakain HCL tetes mata 0,5% Tube - - -
222 Tetrasiklin 250 mg capsul capsul - 163 -
223 Tetrasiklin 500 mg capsul capsul - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet - 91 -
Tiamin Tablet 50 mg ( B1 ) Tablet 40 180 7,200
225 Ventolin Nebulizer Ampul - - -
226 vitamin b komplek Tablet 60 118 7,080
227 Zink sirup Botol - 3,171 - 2
228 Zink tablet 20 mg Tablet - 524 -
229 Deksametason inj Ampul - 1,097 -
230 Diazepam inj 5 mg/ml Ampul - 9,800 -
231 Griseofulvin 125 mcg Tablet - 210 -
232 Kloramfenikol SK/ BUFACETIN Tube - 3,242 -
233 Nystatin tab 500.000 IU Tablet - 843 -
234 magnesium Sulfat Inj. 25 ml 40% ampul - 11,100 -
235 natrium bicarbonat tab - -
- -
- -
- -
- -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) - - -
1 Alat suntik 1 ml Pcs - 777 -
2 Alat suntik 10 ml Pcs - 1,067 -
3 Alat suntik 2,5 ml Pcs - 649 -
4 Alat suntik 20 ml Pcs - 2,650 -
5 Alat suntik 3 cc (Remedi) - 816 -
6 Alat suntik 3 ml Pcs - 924 -
7 Alat suntik 5 ml pcs - 856 - 10
8 Alkazide 1 L High Level DesinfectantBotol - 2,702,700 -
9 Alkazyme Sachet 25 mg Pack - 801,000 -
10 Alkohol 70 % 1 L Botol - 25,000 -
11 Alkohol swab Sachet - 11,604 -
12 Anti Septik Hand Rub Botol - 26,500 -
13 Anti Septik Surgikal Hand Scrub Botol - - -
14 Cat Gut no 2/0 Sachet - 40,200 -
15 Cat Gut no 3/0 Sachet - 38,536 -
16 Cat Gut No 2/0 (24 mm) Sachet - 61,800 -
17 Cat Gut No 3/0 (26 mm) Sachet - 58,700 -
18 Cathetter Jelly Biji - 41,600 -
19 Demetech Silk 3/0 Set - 3,825 -
20 E Care I.V Dresing Pcs - 6,850 - 5
21 E-Care Surgical Mask Tie On Lembar - 520 -
22 Folly No 14 Catether pcs - 16,610 -
23 Folly No 16 Catether pcs - 12,036 -
24 I.V Cathetter No. 20 Set - 6,600 - 5
iv cathETER no 20 pcs - 6,277 -
25 I.V Cathetter No. 22 Set - 6,600 -
I.V Cathetter No. 22 Set - 6,239 -
26 I.V Cathetter No. 24 Set - 7,293 - 5
I.V Cathetter No. 25 Set - 6,239 -
27 I.V Cathetter No. 26 Set - 13,464 -
28 Infuset Anak Set - 8,400 -
29 Infuset Dewasa Set - 5,096 -
30 Jarum Insulin Tablet - 2,083 -
31 Kapas Berlemak 250 gr Bungkus - 20,600 -
32 Kapas Berlemak 500 gr Bungkus - - -
33 Kasa 4 m x 10 cm Rol - 1,440 -
34 Kasa Hidrofil 36 x 80 cm Rol - 127,600 -
35 Kasa Pembalut 2 x 80 cm Pack - 9,400 -
36 Kasa Steril / hidrofil 16 x 16 cm Kotak - 3,500 - 3
37 Lisol 1 L Botol - 40,997 -
38 Masker karet Ear Loop Lembar - 15,700 -
39 Masker tali Tube - 500 -
40 Nasal Canula Oksigen Set - - -
41 Plester 1" Rol - 8,167 -
42 Plester Kertas 2,5 cm Rol - 7,624 -
43 Plester Non Woven 5cm x 5 cm Rol - 23,760 -
44 Policlean Botol - 78,200 -
45 Polifik Kotak - 7,370 -
46 Saraya Alsof A 500 ml Botol - - -
47 Saraya Alsof Pure 500 ml Botol - - -
48 Sarung Tangan Gynecolog No 7 Pasang - 40,733 -
49 Sarung tangan M (Non Steril) Pasang - 968 -
50 Sarung tangan no 6,5 Pasang - 13,178 -
51 Sarung tangan no 6,5 Steril Gloves Pasang - 7,931 -
52 Sarung tangan no 7,0 Steril Pasang - 13,178 -
53 Selang Section ( Surgikal Conection Pcs - 30,003 -
54 Underpad Lembar - 7,900 -
55 Urine Bag Biji - - -
56 safety blackblood BOX - 204,167 -
57 safety box BOX - 22,433 -
58 Tabung BD Vacutener pcs - 1,690 -
59 masker n95 box - 130,240 -
60 t silk black 3/0 26 mm pcs - 19,700 -
61 ALAT SUNTIK 1 ML BOX - 64,694 -
62 alat suntik 3 ml box - 88,778 -
63 iv cathETER no 18 pcs - - -
-
OBAT JKN -
1 acylovir cream tube - 3,169 -
2 etil klorida spray btl - 352,000 -
3 parasetamol inf botol - 33,350 -
4 propyretic suppo box - 105,600 -
5 selkom c tab box - 65,000 -
6 trifadium tab box - 20,434 -
7 vit k1 inj box - 825,000 -
8 Ketorolac inj box - 20,010 -
9 mp 4 mg box - 44,000 -
10 parasetamol tab box - 16,939 - 2
11 aminofilin inj box - 107,998 -
12 asam mefenamat box - 32,746 -
13 Acyclovir 200 mg box - 26,675 - 1
14 Acyclovir 400 mg box - 37,829 - 1
15 Ciprofloxacin 500 mg box - 27,632 -
16 GLUKOSA 5% BOTOL - 7,363 -
17 glukosa 10% BOTOL - 8,003 -
18 SIANOKOBALAMIN INJ 500 mg box - 110,400 -
19 asam folat 400 mcg box - 24,000 -
20 AMBROKSOL SYR BOTOL - 5,500 -
21 asam tranexamat inj box - 110,000 -
22 Bedak Salicyl 2% box - 6,000 -
23 Cefadroxil 500 mg box - 110,000 -
24 Cetirizine syr BOTOL - 6,875 -
25 d40 BOTOL - 24,000 -
26 Guanistrep syr BOTOL - 6,325 -
27 IBUPROFEN 400 mg box - 52,800 -
28 kloramfenikol tetes mata TUBE - 11,330 -
29 Mecobalamin 500 Mg Tab box - 77,000 -
30 metronidazol syr BOTOL - 7,480 -
31 Metronidazole 500 mg box - 26,400 -
32 Ondansetron inj 4 mg BOX - 55,000 -
33 Paraflu Sirup BOTOL - 6,000 -
34 parasetamol syr BOTOL - 5,500 -
35 ranitidin tab 50 mg box - 22,000 - 2
36 asam fusidat krim/FUCILEX tube - 12,320 -
37 amlodipin 10 mg box - 15,400 - 2
38 amlodipin 5 mg box - 8,250 - 2
39 asam traneksamat tab 500 mg box - 102,300 -
40 cetirizin tab box - 31,350 -
41 d40 % botol - 24,000 -
42 dulcolax anak suppo box - 146,396 -
43 gom box - 95,040 -
44 HERBAKOF SYR botol - 12,100 -
45 kloramfenikol tetes mata botol - 11,330 -
46 Lexigo box - 27,500 -
47 METRONIDAZOL SYR botol - 6,600 -
48 mgso 4 40% Botol - 13,200 -
49 mikrolax suppositoria Tube - 20,625 -
50 natrium bicarbonat tab botol - 15,000 -
51 nifedipin tab box - 17,050 -
52 nisagon krim tube - 7,097 -
53 oksitosin inj box - 324,500 -
54 piroksikam 20 mg tab box - 18,480 -
55 SELKOM C box - 143,000 -
56 serum abu vial - 974,050 -
57 SUKRALFAT SYR botol - 27,500 -
58 ventolin nebu box - 220,000 -
59 nacl botol - 6,840 -
60 ringer laktat botol - 7,630 -
- - -
BMHP JKN Set - - -
1 LANSET CENTURY pcs - 36,700 -
2 BISTURI pcs - 438,750 -
3 CHKM pcs - 96,200 -
4 Jely pcs - 22,000 -
5 handscoon steril 7,5 pcs - 262,000 -
6 Kertas puyer pcs - 14,365 -
7 Needle no 24 pcs - 995 - 50
8 Selang Oksigen Anak-anak nca pcs - 7,163 -
9 Selang Oksigen Dewasa ncd pcs - 7,136 -
10 Larutan Gentian Violet pcs - 256,300 -
11 mukus ekstraktor pcs - 9,800 -
12 nesco asam urat pcs - 99,450 -
13 pipet obat 1 ml pcs - 350,000 -
14 pot urin pcs - 1,500 -
15 reagen goldar A pcs - 355,750 -
16 kertas goldar pcs - 38,675 -
17 Rebreathing mask O2 anak NRM pcs - 35,100 -
18 Rebreathing mask O2 dewasa NRM pcs - 35,100 -
19 suction no 8 pcs - 4,000 -
20 vaselin pcs - 9,240 -
21 rapid test dengue nst box - 1,375,000 -
22 suntik 20 cc box - 150,525 -
23 rapid test dengue 1gg box - 1,440,000 -
24 catgut plain box - 120,000 -
25 antiseptik 5 L kompan - 925,000 -
26 nesco hb box - 206,550 -
27 UNDERPAD pack - 45,140 -
28 rivanol botol - 8,500 -
29 povidone/ betadine botol - 105,000 -
30 alkohol botol - 75,250 -
31 suction no 8 pcs - 8,000 -
32 nesco gds box - 99,450 -
33 nesco asam urat box - 121,550 -
34 hcg test box - 88,400 -
35 lancet media box - 20,909 -
36 IV CATHETER no 26 Pcs - 26,400 -
37 MASKER EARLOOP Box - 115,900 -
38 OIL IMMERSI Botol - 695,310 -
39 OKSIGEN MASKER STANDAR ANAK SUN pcs - 19,400 -
40 OKSIGEN MASKER STANDAR DEWASA pcs - 19,400 -
41 OXYGEN NASAL CANNULA NEONATUS nPcs - 8,450 -
42 PLASTIK KLIP SEDANG 13x8,7 CM Pack - 95,000 -
43 PROTEIN URIN VERIFY botol - 249,250 -
44 REAGEN GOLDAR Botol - 396,700 -
45 SENDOK OBAT 5ML Pack - 53,200 -
46 STRIP CHOLESTEROL Botol - 206,550 -
47 STRIP GULA DARAH Botol - 99,450 -
48 STRIP HB NESCO Botol - 206,550 -
49 SUNGKUP ANAK NEBU pcs - 36,125 -
50 SUNGKUP BAYI NEBU pcs - 36,125 -
51 SUNGKUP DEWASA NEBU pcs - 36,125 -
52 UMBILICAL KLEM Box - 88,275 -
53 ALKOHOL SWAB Box - 24,850 -
54 CATGUT CHROME SIZE : 2/0 WITH NEEDLBox - 91,000 -
55 EXAMINATION GLOVE uk. M/ HANDSCO Box - 203,900 -
56 FOLLEY CATHETER NO 16 Pcs - 16,400 -
57 FOLLEY CATHETER NO 18 Pcs - 16,400 -
58 GLOVE STERILE GYNECOLOG NO. 6.5 Pair - 28,500 -
59 INFUSION SET DEWASA Pcs - 6,150 - 5
60 IV CATHETER NO. 18 Box - 214,100 -
64 KASA 40X80 pcs - 108,400 -
65 MASKER MEDIS HEADLOOP Box - 75,250 -
66 PERBAN ELASTIS 10M Pcs - 22,500 - 1
67 PLESTER INCL DISPENSER 1 INCH Box - 306,300 -
68 POVIDION IODINE 15ML/ betadine Btl - 3,680 -
69 STRIP CHOLESTEROL KOLES Box - 206,550 -
70 STRIP GULA DARAH GDS Box - 99,450 -
71 SYRINGE 1ML/ SUNTIK 1 CC Box - 150,525 -
72 SYRINGE 3ML/ SUNTIK 3 CC Box - 150,525 -
73 UMBILICAL KLEM Box - 88,275 -
74 URINE BAG Pcs - 8,150 -
TOTAL 237,444
Kepala Puskesmas Cikeusik

Kabupaten Pandeglang Puskesmas Cikeus
Hj. Iyot Sadiah, S. ST ELAH NURHAYATI.

NIP 19710804 199103 2 002 NIP. 19830108201
PERSEDIAAN PUSKESMAS CIKEUSIK
Penerimaan T.A 2021 Pengeluaran TA. 2021 Saldo Akhir

Harga per Unit
Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Harga per Unit (Rp) Jumlah (Rp) Jumlah satuan Jumlah (Rp)
(Rp)
- - - - - - -
407 - 407 - - 407 -
105 10,500 110 105 11,550 40 105 4,200
3,300 - 3,300 - - 3,300 -
- - - - - - -
91 - 91 - - 91 -
3,345 - 3,345 - - 3,345 -
93 - 93 - - 93 -
75 - 75 - - 75 -
3,050 - 3,050 - - 3,050 -
5,368 - 5,368 - - 5,368 -
249 24,900 140 249 34,860 50 249 12,450
- - - - - - -
5,500 - 2 5,500 11,000 1 5,500 5,500
3,050 30,500 8 3,050 24,400 5 3,050 15,250
10,300 - 10,300 - - 10,300 -
- - - - - - -
- - - - - - -
305 - 305 - - 305 -
305 - 305 - - 305 -
2,129 21,290 10 2,129 21,290 4 2,129 8,516
58 5,800 150 58 8,700 35 58 2,030
3,035 - 3,035 - - 3,035 -
3,167 - 3,167 - - 3,167 -
- - - - - - -
173 - 173 - - 173 -
- - - - - - -
- - - - - - -
- - - - - - -
1,000 - 1,000 - - 1,000 -
- - - - - - -
105 - 20 105 2,100 15 105 1,575
55 - 55 - - 55 -
5,506 - 5,506 - - 5,506 -
- - - - - - -
200 20,000 85 200 17,000 40 200 8,000
1,748 - 1,748 - - 1,748 -
9,646 - 9,646 - - 9,646 -
- - - - - - -
382 22,920 110 382 42,020 30 382 11,460
8,800 - 8,800 - - 8,800 -
236 - 236 - - 236 -
380 - 380 - - 380 -
1,639 - 1,639 - - 1,639 -
- - - - - - -
- - - - - - -
80,000 - 80,000 - - 80,000 -
7,083 14,166 3 7,083 21,249 - 7,083 -
1,340 - 1,340 - - 1,340 -
5,800 - 5,800 - - 5,800 -
650 - 650 - - 650 -
263 - 263 - - 263 -
10,696 - 10,696 - - 10,696 -
1,007 1,007 - - 1,007 -
11,435 - 1 11,435 11,435 - 11,435 -
22,000 - 22,000 - - 22,000 -
66 - 6 66 396 4 66 264
72 - 72 - - 72 -
516 - 516 - - 516 -
590 - 590 - - 590 -
7,490 - 7,490 - - 7,490 -
4,200 - 4,200 - - 4,200 -
90 - 90 - - 90 -
2,849 - 2,849 - - 2,849 -
265 - 265 - - 265 -
4,550 - 4,550 - - 4,550 -
- - - - - - -
77 - 60 77 4,620 20 77 1,540
- - - - - - -
- - - - - - -
- - - - - - -
12,573 - 12,573 - - 12,573 -
- - - - - - -
109 - 109 - - 109 -
1,176 - 1,176 - - 1,176 -
105 - 105 - - 105 -
- - - - - - -
264 - 264 - - 264 -
91 - 25 91 2,275 10 91 910
2,700 13,500 3 2,700 8,100 2 2,700 5,400
- - - - - - -
- - - - - - -
1,408 - 1,408 - - 1,408 -
583 - 583 - - 583 -
- - - - - - -
- - - - - - -
2,992 - 2,992 - - 2,992 -
- - - - - - -
- - - - - - -
137,500 - 137,500 - - 137,500 -
- - - - - - -
1,740 - 1,740 - - 1,740 -
171 - 171 - - 171 -
- - - - - - -
2,764 - 2,764 - - 2,764 -
3,550 - 3,550 - - 3,550 -
710 - 710 - - 710 -
57,500 - 57,500 - - 57,500 -
82 4,100 90 82 7,380 30 82 2,460
- - - - - - -
274 - 2 274 548 2 274 548
380 - 380 - - 380 -
1,010 - 1,010 - - 1,010 -
2,800 - 2,800 - - 2,800 -
4,232 - 4,232 - - 4,232 -
4,232 - 4,232 - - 4,232 -
- - - - - - -
119 - 119 - - 119 -
- - - - - - -
235 - 235 - - 235 -
207 - 55 207 11,385 25 207 5,175
- - - - - - -
6,900 - 6,900 - - 6,900 -
906 - 906 - - 906 -
132 - 132 - - 132 -
155 - 155 - - 155 -
2,475 - 2,475 - - 2,475 -
- - - - - - -
105 - 105 - - 105 -
- - - - - - -
23,540 - 23,540 - - 23,540 -
89 - 89 - - 89 -
4,800 - 4,800 - - 4,800 -
63 - 2 63 126 - 63 -
- - - - - - -
2,518 - 2,518 - - 2,518 -
270 - 3 270 810 2 270 540
1,045 - 1,045 - - 1,045 -
- - - - - - -
1,881 - 1,881 - - 1,881 -
5,015 - 5,015 - - 5,015 -
- - - - - - -
310 - 310 - - 310 -
1,163 - 1,163 - - 1,163 -
- - - - - - -
60 6,000 120 60 7,200 30 60 1,800
- - - - - - -
- - - - - - -
- - - - - - -
133 13,300 90 133 11,970 45 133 5,985
2,190 - 2,190 - - 2,190 -
- - - - - - -
- - - - - - -
14,707 - 14,707 - - 14,707 -
1,229 - 1,229 - - 1,229 -
1,140 - 1,140 - - 1,140 -
448 - 448 - - 448 -
375 - 375 - - 375 -
85 - 85 - - 85 -
- - - - - - -
3,328 - 3,328 - - 3,328 -
473 - 473 - - 473 -
102 - 35 102 3,570 15 102 1,530
- - - - - - -
2,550 - 2,550 - - 2,550 -
224 - 3 224 672 - 224 -
2,345 - 2,345 - - 2,345 -
- - - - - - -
- - - - - - -
- - - - - - -
4,100 - 4,100 - - 4,100 -
3,799 - 3,799 - - 3,799 -
3,414 6,828 2 3,414 6,828 - 3,414 -
9,900 49,500 5 9,900 49,500 2 9,900 19,800
1,440 - 1,440 - - 1,440 -
- - - - - - -
123 - 45 123 5,535 25 123 3,075
6,840 - 6,840 - - 6,840 -
- - - - - - -
598 - 598 - - 598 -
- - - - - - -
145 - 15 145 2,175 10 145 1,450
64,900 - 64,900 - - 64,900 -
59,090 59,090 1 59,090 59,090 - 59,090 -
- - - - - - -
11,363 - 11,363 - - 11,363 -
- - - - - - -
12,700 304,800 15 12,700 190,500 9 12,700 114,300
- - - - - - -
9,898 - 9,898 - - 9,898 -
130 - 130 - - 130 -
1,070 - 1,070 - - 1,070 -
385 - 2 385 770 2 385 770
6,649 19,947 3 6,649 19,947 - 6,649 -
1,181 11,810 8 1,181 9,448 4 1,181 4,724
- - - - - - -
- - - - - - -
100 - 100 - - 100 -
11,825 - 11,825 - - 11,825 -
9,700 - 9,700 - - 9,700 -
291 - 291 - - 291 -
- - - - - - -
131 - 10 131 1,310 5 131 655
- - - - - - -
- - - - - - -
17,996 - 17,996 - - 17,996 -
6,550 - 6,550 - - 6,550 -
- - - - - - -
73 - 60 73 4,380 25 73 1,825
224 - 224 - - 224 -
- - - - - - -
- - - - - - -
60 - 60 - - 60 -
1,188 - 3 1,188 3,564 - 1,188 -
105 - 105 - - 105 -
273 - 273 - - 273 -
7,150 - 7,150 - - 7,150 -
7,630 - 7,630 - - 7,630 -
2,992 - 2,992 - - 2,992 -
67 - 25 67 1,675 15 67 1,005
70 - 70 - - 70 -
2,797 - 2,797 - - 2,797 -
11,000 - 11,000 - - 11,000 -
1,025 - 1,025 - - 1,025 -
512,204 - 512,204 - - 512,204 -
130,999 - 130,999 - - 130,999 -
1,035 - 1,035 - - 1,035 -
110 - 110 - - 110 -
205 - 205 - - 205 -
6,789 6,789 1 6,789 6,789 - 6,789 -
368 - 368 - - 368 -
- - - - - - -
- - - - - - -
- - - - - - -
163 - 163 - - 163 -
- - - - - - -
91 - 91 - - 91 -
180 - 40 180 7,200 - 180 -
- - - - - - -
118 - 50 118 5,900 10 118 1,180
3,171 6,342 2 3,171 6,342 - 3,171 -
524 - 524 - - 524 -
1,097 - 1,097 - - 1,097 -
9,800 - 9,800 - - 9,800 -
210 - 210 - - 210 -
3,242 - 3,242 - - 3,242 -
843 - 843 - - 843 -
11,100 - 11,100 - - 11,100 -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
777 - 777 - - 777 -
1,067 - 1,067 - - 1,067 -
649 - 649 - - 649 -
2,650 - 2,650 - - 2,650 -
816 - 816 - - 816 -
924 - 924 - - 924 -
856 8,560 6 856 5,136 4 856 3,424
2,702,700 - 2,702,700 - - 2,702,700 -
801,000 - 801,000 - - 801,000 -
25,000 - 25,000 - - 25,000 -
11,604 - 11,604 - - 11,604 -
26,500 - 26,500 - - 26,500 -
- - - - - - -
40,200 - 40,200 - - 40,200 -
38,536 - 38,536 - - 38,536 -
61,800 - 61,800 - - 61,800 -
58,700 - 58,700 - - 58,700 -
41,600 - 41,600 - - 41,600 -
3,825 - 3,825 - - 3,825 -
6,850 34,250 3 6,850 20,550 2 6,850 13,700
520 - 520 - - 520 -
16,610 - 16,610 - - 16,610 -
12,036 - 12,036 - - 12,036 -
6,600 33,000 3 6,600 19,800 2 6,600 13,200
6,277 - 6,277 - - 6,277 -
6,600 - 6,600 - - 6,600 -
6,239 - 6,239 - - 6,239 -
7,293 36,465 3 7,293 21,879 2 7,293 14,586
6,239 - 6,239 - - 6,239 -
13,464 - 13,464 - - 13,464 -
8,400 - 8,400 - - 8,400 -
5,096 - 5,096 - - 5,096 -
2,083 - 2,083 - - 2,083 -
20,600 - 20,600 - - 20,600 -
- - - - - - -
1,440 - 1,440 - - 1,440 -
127,600 - 127,600 - - 127,600 -
9,400 - 9,400 - - 9,400 -
3,500 10,500 3 3,500 10,500 - 3,500 -
40,997 - 40,997 - - 40,997 -
15,700 - 15,700 - - 15,700 -
500 - 500 - - 500 -
- - - - - - -
8,167 - 8,167 - - 8,167 -
7,624 - 7,624 - - 7,624 -
23,760 - 23,760 - - 23,760 -
78,200 - 78,200 - - 78,200 -
7,370 - 7,370 - - 7,370 -
- - - - - - -
- - - - - - -
40,733 - 40,733 - - 40,733 -
968 - 968 - - 968 -
13,178 - 13,178 - - 13,178 -
7,931 - 7,931 - - 7,931 -
13,178 - 13,178 - - 13,178 -
30,003 - 30,003 - - 30,003 -
7,900 - 7,900 - - 7,900 -
- - - - - - -
204,167 - 204,167 - - 204,167 -
22,433 - 22,433 - - 22,433 -
1,690 - 1,690 - - 1,690 -
130,240 - 130,240 - - 130,240 -
19,700 - 19,700 - - 19,700 -
64,694 - 64,694 - - 64,694 -
88,778 - 88,778 - - 88,778 -
- - - - - - -
- - - -
- - - -
3,169 - 3,169 - - 3,169 -
352,000 - 352,000 - - 352,000 -
33,350 - 33,350 - - 33,350 -
105,600 - 105,600 - - 105,600 -
65,000 - 65,000 - - 65,000 -
20,434 - 20,434 - - 20,434 -
825,000 - 825,000 - - 825,000 -
20,010 - 20,010 - - 20,010 -
44,000 - 44,000 - - 44,000 -
16,939 33,878 2 16,939 33,878 - 16,939 -
107,998 - 107,998 - - 107,998 -
32,746 - 32,746 - - 32,746 -
26,675 26,675 1 26,675 26,675 - 26,675 -
37,829 37,829 1 37,829 37,829 - 37,829 -
27,632 - 27,632 - - 27,632 -
7,363 - 7,363 - - 7,363 -
8,003 - 8,003 - - 8,003 -
110,400 - 110,400 - - 110,400 -
24,000 - 24,000 - - 24,000 -
5,500 - 5,500 - - 5,500 -
110,000 - 110,000 - - 110,000 -
6,000 - 6,000 - - 6,000 -
110,000 - 110,000 - - 110,000 -
6,875 - 6,875 - - 6,875 -
24,000 - 24,000 - - 24,000 -
6,325 - 6,325 - - 6,325 -
52,800 - 52,800 - - 52,800 -
11,330 - 11,330 - - 11,330 -
77,000 - 77,000 - - 77,000 -
7,480 - 7,480 - - 7,480 -
26,400 - 26,400 - - 26,400 -
55,000 - 55,000 - - 55,000 -
6,000 - 6,000 - - 6,000 -
5,500 - 5,500 - - 5,500 -
22,000 44,000 2 22,000 44,000 - 22,000 -
12,320 - 12,320 - - 12,320 -
15,400 30,800 2 15,400 30,800 - 15,400 -
8,250 16,500 2 8,250 16,500 - 8,250 -
102,300 - 102,300 - - 102,300 -
31,350 - 31,350 - - 31,350 -
24,000 - 24,000 - - 24,000 -
146,396 - 146,396 - - 146,396 -
95,040 - 95,040 - - 95,040 -
12,100 - 12,100 - - 12,100 -
11,330 - 11,330 - - 11,330 -
27,500 - 27,500 - - 27,500 -
6,600 - 6,600 - - 6,600 -
13,200 - 13,200 - - 13,200 -
20,625 - 20,625 - - 20,625 -
15,000 - 15,000 - - 15,000 -
17,050 - 17,050 - - 17,050 -
7,097 - 7,097 - - 7,097 -
324,500 - 324,500 - - 324,500 -
18,480 - 18,480 - - 18,480 -
143,000 - 143,000 - - 143,000 -
974,050 - 974,050 - - 974,050 -
27,500 - 27,500 - - 27,500 -
220,000 - 220,000 - - 220,000 -
6,840 - 6,840 - - 6,840 -
7,630 - 7,630 - - 7,630 -
- - - - - - -
- - - - - - -
36,700 - 36,700 - - 36,700 -
438,750 - 438,750 - - 438,750 -
96,200 - 96,200 - - 96,200 -
22,000 - 22,000 - - 22,000 -
262,000 - 262,000 - - 262,000 -
14,365 - 14,365 - - 14,365 -
995 49,725 30 995 29,835 20 995 19,890
7,163 - 7,163 - - 7,163 -
7,136 - 7,136 - - 7,136 -
256,300 - 256,300 - - 256,300 -
9,800 - 9,800 - - 9,800 -
99,450 - 99,450 - - 99,450 -
350,000 - 350,000 - - 350,000 -
1,500 - 1,500 - - 1,500 -
355,750 - 355,750 - - 355,750 -
38,675 - 38,675 - - 38,675 -
35,100 - 35,100 - - 35,100 -
35,100 - 35,100 - - 35,100 -
4,000 - 4,000 - - 4,000 -
9,240 - 9,240 - - 9,240 -
1,375,000 - 1,375,000 - - 1,375,000 -
150,525 - 150,525 - - 150,525 -
1,440,000 - 1,440,000 - - 1,440,000 -
120,000 - 120,000 - - 120,000 -
925,000 - 925,000 - - 925,000 -
206,550 - 206,550 - - 206,550 -
45,140 - 45,140 - - 45,140 -
8,500 - 8,500 - - 8,500 -
105,000 - 105,000 - - 105,000 -
75,250 - 75,250 - - 75,250 -
8,000 - 8,000 - - 8,000 -
99,450 - 99,450 - - 99,450 -
121,550 - 121,550 - - 121,550 -
88,400 - 88,400 - - 88,400 -
20,909 - 20,909 - - 20,909 -
26,400 - 26,400 - - 26,400 -
115,900 - 115,900 - - 115,900 -
695,310 - 695,310 - - 695,310 -
19,400 - 19,400 - - 19,400 -
19,400 - 19,400 - - 19,400 -
8,450 - 8,450 - - 8,450 -
95,000 - 95,000 - - 95,000 -
249,250 - 249,250 - - 249,250 -
396,700 - 396,700 - - 396,700 -
53,200 - 53,200 - - 53,200 -
206,550 - 206,550 - - 206,550 -
99,450 - 99,450 - - 99,450 -
206,550 - 206,550 - - 206,550 -
36,125 - 36,125 - - 36,125 -
36,125 - 36,125 - - 36,125 -
36,125 - 36,125 - - 36,125 -
88,275 - 88,275 - - 88,275 -
24,850 - 24,850 - - 24,850 -
91,000 - 91,000 - - 91,000 -
203,900 - 203,900 - - 203,900 -
16,400 - 16,400 - - 16,400 -
16,400 - 16,400 - - 16,400 -
28,500 - 28,500 - - 28,500 -
6,150 30,750 4 6,150 24,600 1 6,150 6,150
214,100 - 214,100 - - 214,100 -
214,100 - 214,100 - - 214,100 -
214,100 - 214,100 - - 214,100 -
214,100 - 214,100 - - 214,100 -
108,400 - 108,400 - - 108,400 -
75,250 - 75,250 - - 75,250 -
22,500 22,500 1 22,500 22,500 - 22,500 -
306,300 - 306,300 - - 306,300 -
3,680 - 3,680 - - 3,680 -
206,550 - 206,550 - - 206,550 -
99,450 - 99,450 - - 99,450 -
150,525 - 150,525 - - 150,525 -
150,525 - 150,525 - - 150,525 -
88,275 - 88,275 - - 88,275 -
8,150 - 8,150 - - 8,150 -
1,067,514 990,091 314,867
Pengurus Barang Tim Pemeriksa,

Puskesmas Cikeusik
1 Iing, SKM
NIP. 19630407 198603 1 014
ELAH NURHAYATI. Amd. Keb
NIP. 198301082017042001
2 Reny Wigyawati. Apt
NIP. 19860114201902 2 003
3 Jujum Jumiati, Amd. Keb
NIP. 19780401 200604 2 020
243,917
44,910
-
26,040
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : UPT PUSKESMAS CIKEUSIK
PERHITUNGAN PERSEDIAAN
PER 31 MARET 2021
Harga Perhitungan Persediaan

No Uraian Satuan Satuan Reviu
(Rp) Administr Selisih
Fisik
asi
1 2 3 4 5 6 7 = (5-6)
BMHP+OBAT+HIBAH
HIBAH
GUDANG OBAT
RANCASENENG (BOP)
1 Alat suntik 5 ml pcs 856 4 4
2 E Care I.V Dresing Pcs 6,850 2 2
3 I.V Cathetter No. 20 Set 6,600 2 2
4 I.V Cathetter No. 24 Set 7,293 2 2
-
-
-
RANCASENENG (JKN) -
1 Needle no 24 pcs 995 20 20
2 INFUSION SET DEWASA Pcs 6,150 1 1
-
-
RANCASENENG (BOP) -
3 Amoksisillin Sirup Kering 125 mg/5Botol 5,500 1 1
4 Amoksisillin Sirup Kering 125 mg/5Botol 3,050 5 5
5 Antasida DOEN suspensi Botol 2,129 4 4
7 Asam Ascorbat ( Vit. C ) 50 MG Tablet 105 15 15
8 Asam Mefenamat 500 mg Tablet 200 40 40
12 Domperidon 10mg Tablet Tablet 91 10 10
13 Domperidon Suspensi 5 mg/ 5 ml Botol 2,700 2 2
14 Furosemida tablet 40 mg Tablet 82 30 30
15 Garam Oralit Sachet 274 2 2
16 Glimepiride 2 mg Tablet 207 25 25
17 Ketokonazol Tablet 200 mg Tablet 270 2 2
18 Klorfeniramin Maleat (CTM) tablet Tablet 60 30 30
19 Kotrimoksazol Dewasa Tablet 480Tablet 133 45 45
20 Metformin 500 mg Tablet Tablet 102 15 15
21 Multivitamin Anak Sirup Botol 9,900 2 2
22 Natrium Diklofenak 50 mg Tablet Tablet 123 25 25
23 Obat Anti Diare Tablet (Akita / MolaTablet 145 10 10
24 Oksitetrasiklin HCL salep mata 1%Botol 12,700 9 9
26 Paracetamol Sirup 120 mg/5 ml Botol 1,181 4 4
27 Piridoksin HCL (VIT B6) tablet 10 Botol 131 5 5
28 Prednison Tablet 5 mg Tablet 73 25 25
29 Salbutamol Tablet 2 mg Tablet 67 15 15
RANCASENENG (JKN) -
KOSONG -
Kepala Puskesmas Cikeusik Pengurus Barang

Kabupaten Pandeglang Puskesmas Cikeusik
Hj. Iyot Sadiah, S. ST ELAH NURHAYATI. Amd. Keb

NIP 19710804 199103 2 002 NIP. 198301082017042001
IAAN
1
Perhitungan Persediaan :
Penjelas
Mutasi Jumlah Nilai an
(+) (-) Fisik Persediaan Selisih
8 9 10 (6-8+9) 11 (4 x 10) 12
314,867
sisa 13 april
4 3,424 2
2 13,700 0
2 13,200 0
2 14,586 0
- 44,910
- -
- -
- -
20 19,890 0
1 6,150 0
- 26,040
- -
- -
40 4,200 15
50 12,450 20
1 5,500 0
5 15,250 0
4 8,516 0
35 2,030 10
15 1,575 5
40 8,000 15
30 11,460 10
4 264 0
20 1,540 5
10 910 0
2 5,400 0
30 2,460 10
2 548 0
25 5,175 10
2 540 0
30 1,800 10
45 5,985 15
15 1,530 5
2 19,800 0
25 3,075 10
10 1,450 5
9 114,300 0
2 770 0
4 4,724 0
5 655 0
25 1,825 10
15 1,005 5
10 1,180 0
243,917
- -
- -
Pengurus Barang Tim Pemeriksa,

skesmas Cikeusik
1 Iing, SKM
NIP. 19630407 198603 1 014
NURHAYATI. Amd. Keb
198301082017042001
2 Reny Wigyawati. Apt
NIP. 19860114201902 2 003
3 Jujum Jumiati, Amd. Keb

NIP. 19780401 200604 2 020

APRIL
Jumlah
Persediaan
1 Alprazolam Tablet 0 0
2 Albendazol Tablet 400 mg Tablet 0 0
4 Ambroxol sirup Botol 0 0
5 Ambroxol tablet 30 mg Tablet 0 0
6 Aminofilin Tablet 200 mg Tablet 0 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 0
8 Amlodipin 10 mg Tablet 0 0
9 Amlodipin Besilate 5 mg Tablet 0 0
10 Amoksisilin Forte sirup kering 250mg Botol 0 0
11 Amoksisilin Injeksi 1 gr Vial 0 0
13 Amoksisillin kapsul 250 mg Kapsul 0 0
Amoksisillin Sirup Kering 125 mg/5 ml Botol 5 5 10
15 Ampisilin Injeksi 1 gr Vial 0 0
16 Analog insulin Long Acting Pen 0 0
17 Analog insulin Mix Acting Pen 0 0
18 Antalgin (Metampiron) tablet 500 mg Tablet 0 0
19 Antalgin (Metampiron) tablet 500 mg Tablet 0 0
20 Antasida DOEN suspensi Botol 4 5 9
22 Anti Bakteri DOEN ( Bacitrasin ) Tube 0 0
23 anti hemoroid doen kombinasi supp 0 0
24 Antifungi DOEN Tube 0 0
25 Antimigren DOEN Kombinasi : Tablet 0 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet 0 0
27 Antiparkinson Tablet ( Levopar ) Tablet 0 0
28 Aqua Pro Injeksi Vial 0 0
29 Artermeter injeksi Ampul 0 0
30 Artesunate injeksi 60 mg/ml vial 0 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 15 15
32 Asam Folat Botol 0 0
33 Asam Fusidat Cream Tube 0 0
34 Asam Klorida 0,1 N Botol 0 0
36 Asam Traneksamat Inj 5% Ampul 0 0
37 Asering Botol 0 0
38 Asetosal tablet 500 mg Tablet 0 0
40 Asiklovir Cream 5% Tube 0 0
41 Asiklovir tablet 200 mg Tablet 0 0
42 Asiklovir tablet 400 mg Tablet 0 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0 0
45 Atropin Sulfat tablet 0,5 mg Tablet 0 0
46 Berotec Metered Aerosol 100 mg Bok 0 0
47 Betadine Salep Antiseptik 5 mg Tube 0 2 2
48 Betametason krim 0,1 % Tube 0 0
49 Bisakodil Suppositoria supp 0 0
50 Bisoprolol 2,5 mg Tablet 0 0
51 Bisoprolol 5 mg Tablet 0 0
52 Cairan Infus KN-3B Botol 0 0
53 Cairan Infus Wida KDN 1 Botol 0 0
Cairan Infus Wida KDN 1 Botol 0
54 Cairan Pembersih ( Protektor ) Botol 0 0
55 Captopril Tablet 12,5 mg Tablet 4 4
56 Captopril Tablet 25 mg Tablet 0 0
57 Cefadroxil Capsul 500 mg Capsul 0 0
58 Cefixime Capsul 100 mg Capsul 0 0
59 Cefixime Sirup Botol 0 0
60 Cefotaksime 1 gr Injeksi Vial 0 0
61 Cetirizine Capsul 50 mg Capsul 0 0
62 Cetirizine sirup 5 mg/5 ml Botol 0 0
63 Ciprofloxcacin 500 mg tablet Tablet 0 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 0 0
65 D-Artepp tablet Tablet 0 0
67 Dekstran 70 - larutan infus 6% steril Botol 0 0
68 Dekstrometorfan sirup Botol 0 0
69 Dekstrometorfan tablet 15 mg Tablet 0 0
70 Diazepam Rektal 0,5 mg / 2 ml supp 0 0
71 Diazepam tablet 2 mg Tablet 0 0
72 Diazepam tablet 5 mg Tablet 0 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1 Ampul 0 0
74 Digoksin tablet 0,25 mg Tablet 0 0
75 Diltiazem Tablet 0 0
76 Doksisiklin Kapsul 100 mg Capsul 0 0
78 Domperidon Suspensi 5 mg/ 5 ml Botol 2 2
79 Doxicyclin 500mg capsul 0 0
80 Efedrin HCLTablet 25 mg Tablet 0 0
81 Epinefrina HCL/Bitartrat Injeksi Ampul 0 0
82 Eritromicyn kapsul 250 mg capsul 0 0
83 Erytromicin kapsul 500 mg Kapsul 0 0
84 Erytromicin sirup 125 mg Botol 0 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol 0 0
86 Etambutol 500 mg Tablet 0 0
87 Etanol 70 % Botol 0 0
88 Etil Klorida Semprot Botol 0 0
89 Fenitoin Natrium kapsul 30 mg Kapsul 0 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0 0
91 Fenobarbital tablet 30 mg Tablet 0 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet 0 0
93 Fenol Gliserol tetes telinga 10 % Botol 0 0
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-Ampul 0 0
95 Fitomenadion (Vit.K1) tab salut gula 10 Tablet 0 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul 0 0
98 Furosemide Injeksi Ampul 0 0
99 Garam Oralit Sachet 2 2
100 Gemfibrozil 300 mg Tablet 0 0
101 Gentamicin Injeksi Ampul 0 0
102 Gentamicin Salep Kulit Tube 0 0
103 Gentamicin Salep mata Tube 0 0
104 Gentamicin Tetes Mata Botol 0 0
105 Gentian Violet 1 % Botol 0 0
106 Glibenclamid tablet 5 mg Tablet 0 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0 0
108 Glikazid 80 mg Tablet Tablet 0 0
109 Glimepiride 2 mg Tablet 25 25
110 Glukosa larutan infus 10% steril Botol 0 0
111 Glukosa larutan infus 5 % steril Botol 0 0
112 Griseofulvin tablet 500 mg, Tablet 0 0
113 Guaiafenesin 100 mg Tablet 0 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 0 0
115 Hidrokortison krim 2,5% Tube 0 0
116 Ibuprofen Suspensi Tablet 0 0
117 Ibuprofen tablet 200 mg Tablet 0 0
118 Ibuprofen tablet 400 mg Tablet 0 0
119 Imunomodulator sirup( STIMUNO) Botol 0 0
120 Isosorbid Dinitrat tablet sublingual 5 mgTablet 0 0
121 Kalsium Glukonas Injeksi Ampul 0 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0 0
123 Kapas Berlemak 500 mg Bungkus 0 0
124 Ketokonazol Kream Tube 0 0
126 Ketorolac inj Ampul 0 0
127 Kifadene tablet 20 mg Tablet 0 0
128 Kloramfenikol salep mata 1 % capsul 0 0
129 Kloramfenikol suspensi Botol 0 0
130 Kloramfenikol tetes telinga 3% Tube 0 0
131 Kloramphenicol 250 mg Capsul 0 0
132 Kloramphenicol 500 mg capsul 0 0
133 Kloramphenicol Tetes Mata Botol 0 0
135 Klorokuin tablet 150 mg Tablet 0 0
136 Klorpromazin HCL tablet salut 25 mg Tablet 0 0
137 Kombinasi (Pirimetamin 25 mg + SolfadTablet 0 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 45 45
139 Kotrimoksazol Sirup / Suspensi Botol 0 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0 0
142 Lactobacilus serbuk Sachet 0 0
143 Lidocain 2%+efinefrin injeksi Ampul 0 0
144 Lidocain injeksi 2 ml Ampul 0 0
145 Lisinopril 10 mg tablet Tablet 0 0
146 Lisinopril 5 mg tablet Tablet 0 0
147 Loperamid 4 mg tablet Tablet 0 0
148 Lytacur Sirup Botol 0 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul 0 0
150 Metamizol 500 mg Tablet 0 0
151 Metformin 500 mg Tablet Tablet 15 15
152 Methilprednisolon tablet 8 mg Tablet 0 0
153 Metilergometrin Maleat injeksi 1 ml Ampul 0 0
154 Metilergometrin Maleat Tablet Tablet 0 0
155 Metoklopramid Suspensi Botol 0 0
156 Metoklopramid tablet Tablet 0 0
157 Metronidazol 500 mg Tablet 0 0
158 Metronidazol infus / injeksi Botol 0 0
159 Metronidazol Ovula supp 0 0
160 Metronidazol suspensi Botol 0 0
161 Mikonazol kream Tube 0 0
162 Multivitamin Anak Sirup Botol 2 5 7
163 Multivitamin Dewasa Antioksidan ( BecoTablet 0 0
164 Natrium Diklofenak 25 mg Tablet Tablet 0 0
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 0 0
167 Nifedipine Tablet 10 mg box 0 0
168 Nistatin tablet vaginal 100.000 IU/g Tube 0 5 5
169 Obat anti Diare suspensi Botol 0 0
171 Obat Batuk Flu ( Molexflu ) BOX 0 0
Obat Batuk Flu ( Molexflu ) BOX 0 1 1
172 Obat Batuk Hitam (OBH) Botol 0 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0
174 Ofloxsacin Tetes Telinga Tube 0 0
175 Oksitetrasiklin HCL salep mata 1% Botol 9 3 12
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 0 0
177 Omeprazol injeksi Ampul 0 0
178 Omeprazol Kapsul 20 mg capsul 0 0
179 Ondancentron injeksi 4 mg Ampul 0 0
181 Paracetamol Drop 15 ml Botol 0 0
182 Paracetamol Sirup 120 mg/5 ml Botol 4 5 9
183 Parafin Dresing ( Bioplacenton Tull ) pcs 0 0
184 Parasetamol tablet 100 mg Tablet 0 0
185 Parasetamol tablet 500 mg Tablet 0 0
186 Permetrin Krim 5 % Tube 0 0
187 Pirantel Sirup Botol 0 0
188 Pirantel tablet 125 mg Tablet 0 0
189 Pirazinamid Botol 0 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 5 5
191 Piroksikam tablet 20 mg Tablet 0 0
192 Polikresulen Tube 0 0
193 Povidon lodida 10% 300 ml 0 0
194 Povidon lodida 10% 60 ml Tablet 0 0
195 Prazikuantel tablet 600 mg Botol 0 0
196 Prednison Tablet 5 mg Tablet 25 25
197 Primakuin 15 mg Tablet 0 0
198 Probenesid 500 mg tablet Tablet 0 0
199 Prokain Benzil Penisilin 3 juta IU/vial inj Ampul 0 0
200 Propanolol HCL tablet 10 mg Tablet 0 0
201 Ranitidin injeksi Ampul 0 0
202 Ranitidin tablet Tablet 0 0
203 Resperidone 2 mg tablet Tablet 0 0
204 Ringer Laktat cairan infus (Otsuka) 0 0
205 Ringer Laktat cairan infus (Widatra) Botol 0 0
206 Rivanol 300 ml Botol 0 0
207 Salbutamol Tablet 2 mg Tablet 15 15
208 Salbutamol tablet 4mg Tablet 0 0
209 Salep 2-4 Tube 0 0
210 Salep kombinasi cream ( Berloson ) Tube 0 0
211 Salicil bedak Kotak 0 0
212 Serum Anti Bisa Ular Polivalen Inj 50 mlVial 0 0
213 Serum Anti Tetanus inj 1500 IU ( Tetag Vial 0 0
214 Sianokobalamin Injeksi Ampul 0 0
217 Sukralfat Suspensi Botol 0 0
218 Sukralfat tablet 500 mg Tablet 0 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 Tube 0 0
220 Temporary Stopping Fletcher serbuk & cTablet 0 0
221 Tetrakain HCL tetes mata 0,5% Tube 0 0
222 Tetrasiklin 250 mg capsul capsul 0 0
223 Tetrasiklin 500 mg capsul capsul 0 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet 0 0
Tiamin Tablet 50 mg ( B1 ) Tablet 0
225 Ventolin Nebulizer Ampul 0 0
227 Zink sirup Botol 0 0
228 Zink tablet 20 mg Tablet 0 0
229 Deksametason inj Ampul 0 0
230 Diazepam inj 5 mg/ml Ampul 0 0
231 Griseofulvin 125 mcg Tablet 0 0
232 Kloramfenikol SK Tube 0 2 2
233 Nystatin tab 500.000 IU Tablet 0 0
234 magnesium Sulfat Inj. 25 ml 40% ampul 0 0
235 natrium bicarbonat tab 0 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 0 0
3 Alat suntik 2,5 ml Pcs 0 0
5 Alat suntik 3 cc (Remedi) 0 0
8 Alkazide 1 L High Level Desinfectant Botol 0 0
9 Alkazyme Sachet 25 mg Pack 0 0
10 Alkohol 70 % 1 L Botol 0 0
11 Alkohol swab Sachet 0 0
12 Anti Septik Hand Rub Botol 0 0
13 Anti Septik Surgikal Hand Scrub Botol 0 0
18 Cathetter Jelly Biji 0 0
19 Demetech Silk 3/0 Set 0 0
21 E-Care Surgical Mask Tie On Lembar 0 0
iv cathETER no 20 pcs 0 0
I.V Cathetter No. 22 Set 0 0
I.V Cathetter No. 24 Set 0
28 Infuset Anak Set 0 0
29 Infuset Dewasa Set 0 5 5
30 Jarum Insulin Tablet 0 0
33 Kasa 4 m x 10 cm Rol 0 0
34 Kasa Hidrofil 36 x 80 cm Rol 0 0
35 Kasa Pembalut 2 x 80 cm Pack 0 2 2
36 Kasa Steril / hidrofil 16 x 16 cm Kotak 0 2 2
37 Lisol 1 L Botol 0 0
38 Masker karet Ear Loop Lembar 0 0
39 Masker tali Tube 0 0
40 Nasal Canula Oksigen Set 0 0
41 Plester 1" Rol 0 0
42 Plester Kertas 2,5 cm Rol 0 0
43 Plester Non Woven 5cm x 5 cm Rol 0 0
44 Policlean Botol 0 0
45 Polifik Kotak 0 0
46 Saraya Alsof A 500 ml Botol 0 0
47 Saraya Alsof Pure 500 ml Botol 0 0
48 Sarung Tangan Gynecolog No 7 Pasang 0 0
49 Sarung tangan M (Non Steril) Pasang 0 0
50 Sarung tangan no 6,5 Pasang 0 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0 0
52 Sarung tangan no 7,0 Steril Pasang 0 0
53 Selang Section ( Surgikal Conection Tu Pcs 0 0
54 Underpad Lembar 0 2 2
55 Urine Bag Biji 0 0
56 safety blackblood BOX 0 0
57 safety box BOX 0 0
58 Tabung BD Vacutener pcs 0 0
59 masker n95 box 0 0
60 t silk black 3/0 26 mm pcs 0 0
61 ALAT SUNTIK 1 ML BOX 0 0
62 alat suntik 3 ml box 0 0
63 iv cathETER no 18 pcs 0 0
OBAT JKN 0 0
1 acylovir cream tube 0 0
2 etil klorida spray btl 0 0
3 parasetamol inf botol 0 0
4 propyretic suppo box 0 0
5 selkom c tab box 0 0
6 trifadium tab box 0 0
7 vit k1 inj box 0 0
8 Ketorolac inj box 0 0
9 mp 4 mg box 0 0
10 parasetamol tab box 0 2 2
11 aminofilin inj box 0 0
12 asam mefenamat box 0 0
15 Ciprofloxacin 500 mg box 0 0
16 GLUKOSA 5% BOTOL 0 0
17 glukosa 10% BOTOL 0 0
18 SIANOKOBALAMIN INJ 500 mg box 0 0
19 asam folat 400 mcg box 0 0
20 AMBROKSOL SYR BOTOL 0 0
21 asam tranexamat inj box 0 0
22 Bedak Salicyl 2% box 0 0
23 Cefadroxil 500 mg box 0 1 1
24 Cetirizine syr BOTOL 0 0
25 d40 BOTOL 0 0
26 Guanistrep syr BOTOL 0 0
27 IBUPROFEN 400 mg box 0 0
28 kloramfenikol tetes mata TUBE 0 0
29 Mecobalamin 500 Mg Tab box 0 0
30 metronidazol syr BOTOL 0 0
31 Metronidazole 500 mg box 0 0
32 Ondansetron inj 4 mg BOX 0 0
33 Paraflu Sirup BOTOL 0 0
34 parasetamol syr BOTOL 0 0
35 ranitidin tab 50 mg box 0 1 1
36 asam fusidat krim tube 0 0
39 asam traneksamat tab 500 mg box 0 0
40 cetirizin tab box 0 0
41 d40 % botol 0 0
42 dulcolax anak suppo box 0 0
43 gom box 0 0
44 HERBAKOF SYR botol 0 0
45 kloramfenikol tetes mata botol 0 0
46 Lexigo box 0 0
47 METRONIDAZOL SYR botol 0 0
48 mgso 4 40% Botol 0 0
49 mikrolax suppositoria Tube 0 0
50 natrium bicarbonat tab botol 0 0
51 nifedipin tab box 0 0
52 nisagon krim tube 0 0
53 oksitosin inj box 0 0
54 piroksikam 20 mg tab box 0 0
55 SELKOM C box 0 0
56 serum abu vial 0 0
57 SUKRALFAT SYR botol 0 0
58 ventolin nebu box 0 0
59 nacl botol 0 0
60 ringer laktat botol 0 0
0 0
BMHP JKN Set 0 0
1 LANSET pcs 0 0
2 BISTURI pcs 0 0
3 CHKM pcs 0 0
4 Jely pcs 0 0
5 handscoon steril 7,5 pcs 0 0
6 Kertas puyer pcs 0 0
8 Selang Oksigen Anak-anak nca pcs 0 0
9 Selang Oksigen Dewasa ncd pcs 0 0
10 Larutan Gentian Violet pcs 0 0
11 mukus ekstraktor pcs 0 0
12 nesco asam urat pcs 0 0
13 pipet obat 1 ml pcs 0 0
14 pot urin pcs 0 0
15 reagen goldar A pcs 0 0
16 kertas goldar pcs 0 0
17 Rebreathing mask O2 anak pcs 0 0
18 Rebreathing mask O2 dewasa pcs 0 0
20 vaselin pcs 0 0
21 rapid test dengue nst box 0 0
22 suntik 20 cc box 0 0
23 rapid test dengue 1gg box 0 0
24 catgut plain box 0 0
25 antiseptik 5 L kompan 0 0
26 nesco hb box 0 0
27 UNDERPAD pack 0 0
28 rivanol botol 0 0
29 povidone botol 0 0
30 alkohol botol 0 0
32 nesco gds box 0 0
33 nesco asam urat box 0 0
34 hcg test box 0 0
35 lancet media box 0 0
36 IV CATHETER no 26 Pcs 0 0
37 MASKER EARLOOP Box 0 0
38 OIL IMMERSI Botol 0 0
39 OKSIGEN MASKER STANDAR ANAK pcs 0 0
40 OKSIGEN MASKER STANDAR DEWASA pcs 0 0
41 OXYGEN NASAL CANNULA NEONATUS ncb Pcs 0 0
42 PLASTIK KLIP SEDANG 13x8,7 CM Pack 0 0
43 PROTEIN URIN VERIFY botol 0 0
44 REAGEN GOLDAR Botol 0 0
45 SENDOK OBAT 5ML Pack 0 0
46 STRIP CHOLESTEROL Botol 0 0
47 STRIP GULA DARAH Botol 0 0
48 STRIP HB Botol 0 0
49 SUNGKUP ANAK NEBU pcs 0 0
50 SUNGKUP BAYI NEBU pcs 0 0
51 SUNGKUP DEWASA NEBU pcs 0 0
53 ALKOHOL SWAB Box 0 0
54 CATGUT CHROME SIZE : 2/0 WITH NEEDLE SBox 0 0
55 EXAMINATION GLOVE uk. M Box 0 0
58 GLOVE STERILE GYNECOLOG NO. 6.5 Pair 0 0
59 INFUSION SET DEWASA Pcs 1 1
64 KASA 40X80 pcs 0 0
65 MASKER MEDIS HEADLOOP Box 0 0
66 PERBAN ELASTIS 10M Pcs 0 0
67 PLESTER INCL DISPENSER 1 INCH Box 0 0
68 POVIDION IODINE 15ML Btl 0 0
69 STRIP CHOLESTEROL Box 0 0
70 STRIP GULA DARAH Box 0 0
71 SYRINGE 1ML Box 0 0
72 SYRINGE 3ML Box 0 0
74 URINE BAG Pcs 0 0
YANG MENYERAHKAN
PENGELOLA OBAT

NIP.198601142019 02 2 003
DOKUMEN NOMOR
April DINKES KAB/KOTA
Mei GFK KAB/KOTA
PUSKESMAS
APRIL
SISA +
SISA PEMBERIAN
Pemakaian Stok Akhir SBBK
BUFFER
APBD II JKN PROG
STOK
0 0
0 0
25 115
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 220
0 0
1 0
5 5
0 0
0 0
0 0
0 0
0 0
4 5
25 110
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 5
0 0
0 0
0 0
25 215
0 0
0 0
0 0
20 70
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
4 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
15 55
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 0
2 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
0 0
0 0
0 0
0 0
0 0
0 0
30 0
-10 10
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
15 10
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 0
0 0
0 0
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
20 110
0 0
0 0
0 0
30 15
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 5
0 0
0 0
15 10
0 0
0 0
0 5
0 0
5 5
0 0
0 1
0 0
0 0
0 0
9 3
0 0
0 0
0 0
0 0
2 30
0 0
4 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 0
0 0
0 0
0 0
0 0
0 0
15 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 5
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 0
0 0
0 0
0 0
0 0
0 0
0 0
10 200
0 0
0 0
0 0
0 0
0 0
0 2
0 0
0 0
0 0 -
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 0
0 0
0 0
0 0
2 0
0 0
0 0
0 0
2 0
0 0
0 0
0 0
0 5
0 0
0 0
0 0
0 0
0 0
0 2
0 2
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 0
0 0
0 0
0 0
0 0
0 2
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 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
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 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
0 0
0 2
0 2
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 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
0 0
0 0
0 0
0 0
0 0
20 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
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 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
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 0
0 0
1 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
0 0
0 0
0 0


NIP.19710804 199103 2 002 NIP.198910042017042002
TANGGAL
JUMLAH
LAIN LAIN
:
U/POSKEDES
Keb

APRIL
Jumlah
Persediaan
1 Alprazolam Tablet - 0
2 Albendazol Tablet 400 mg Tablet - 0
4 Ambroxol sirup Botol - 0
5 Ambroxol tablet 30 mg Tablet - 0
6 Aminofilin Tablet 200 mg Tablet - 0
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - 0
8 Amlodipin 10 mg Tablet - 0
9 Amlodipin Besilate 5 mg Tablet - 0
10 Amoksisilin Forte sirup kering 250mg Botol - 0
11 Amoksisilin Injeksi 1 gr Vial - 0
13 Amoksisillin kapsul 250 mg Kapsul - 0
Amoksisillin Sirup Kering 125 mg/5 ml Botol 5 5 10
15 Ampisilin Injeksi 1 gr Vial - 0
16 Analog insulin Long Acting Pen - 0
17 Analog insulin Mix Acting Pen - 0
18 Antalgin (Metampiron) tablet 500 mg Tablet - 0
19 Antalgin (Metampiron) tablet 500 mg Tablet - 0
20 Antasida DOEN suspensi Botol 4 5 9
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - 0
23 anti hemoroid doen kombinasi supp - 0
24 Antifungi DOEN Tube - 0
25 Antimigren DOEN Kombinasi : Tablet - 0
26 Antiparkinson DOEN tablet Kombinasi : Tablet - 0
27 Antiparkinson Tablet ( Levopar ) Tablet - 0
28 Aqua Pro Injeksi Vial - 0
29 Artermeter injeksi Ampul - 0
30 Artesunate injeksi 60 mg/ml vial - 0
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 15 15
32 Asam Folat Botol - 0
33 Asam Fusidat Cream Tube - 0
34 Asam Klorida 0,1 N Botol - 0
36 Asam Traneksamat Inj 5% Ampul - 0
37 Asering Botol - 0
38 Asetosal tablet 500 mg Tablet - 0
40 Asiklovir Cream 5% Tube - 0
41 Asiklovir tablet 200 mg Tablet - 0
42 Asiklovir tablet 400 mg Tablet - 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - 0
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - 0
45 Atropin Sulfat tablet 0,5 mg Tablet - 0
46 Berotec Metered Aerosol 100 mg Bok - 0
47 Betadine Salep Antiseptik 5 mg Tube - 2 2
48 Betametason krim 0,1 % Tube - 0
49 Bisakodil Suppositoria supp - 0
50 Bisoprolol 2,5 mg Tablet - 0
51 Bisoprolol 5 mg Tablet - 0
52 Cairan Infus KN-3B Botol - 0
53 Cairan Infus Wida KDN 1 Botol - 0
Cairan Infus Wida KDN 1 Botol - 0
54 Cairan Pembersih ( Protektor ) Botol - 0
55 Captopril Tablet 12,5 mg Tablet 4 4
56 Captopril Tablet 25 mg Tablet - 0
57 Cefadroxil Capsul 500 mg Capsul - 0
58 Cefixime Capsul 100 mg Capsul - 0
59 Cefixime Sirup Botol - 0
60 Cefotaksime 1 gr Injeksi Vial - 0
61 Cetirizine Capsul 50 mg Capsul - 0
62 Cetirizine sirup 5 mg/5 ml Botol - 0
63 Ciprofloxcacin 500 mg tablet Tablet - 0
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul - 0
65 D-Artepp tablet Tablet - 0
67 Dekstran 70 - larutan infus 6% steril Botol - 0
68 Dekstrometorfan sirup Botol - 0
69 Dekstrometorfan tablet 15 mg Tablet - 0
70 Diazepam Rektal 0,5 mg / 2 ml supp - 0
71 Diazepam tablet 2 mg Tablet - 0
72 Diazepam tablet 5 mg Tablet - 0
73 Difenhidramin HCL injeksi 10 mg/ml - 1 Ampul - 0
74 Digoksin tablet 0,25 mg Tablet - 0
75 Diltiazem Tablet - 0
76 Doksisiklin Kapsul 100 mg Capsul - 0
78 Domperidon Suspensi 5 mg/ 5 ml Botol 2 2
79 Doxicyclin 500mg capsul - 0
80 Efedrin HCLTablet 25 mg Tablet - 0
81 Epinefrina HCL/Bitartrat Injeksi Ampul - 0
82 Eritromicyn kapsul 250 mg capsul - 0
83 Erytromicin kapsul 500 mg Kapsul - 0
84 Erytromicin sirup 125 mg Botol - 0
85 Etakridin ( Rivanol ) larutan 0,1% Botol - 0
86 Etambutol 500 mg Tablet - 0
87 Etanol 70 % Botol - 0
88 Etil Klorida Semprot Botol - 0
89 Fenitoin Natrium kapsul 30 mg Kapsul - 0
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - 0
91 Fenobarbital tablet 30 mg Tablet - 0
92 Fenoksimetil Penisilina tablet 250 mg Tablet - 0
93 Fenol Gliserol tetes telinga 10 % Botol - 0
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-Ampul - 0
95 Fitomenadion (Vit.K1) tab salut gula 10 Tablet - 0
96 Flufenazine Deconat Inj 25 mg/ml Ampul - 0
98 Furosemide Injeksi Ampul - 0
99 Garam Oralit Sachet 2 2
100 Gemfibrozil 300 mg Tablet - 0
101 Gentamicin Injeksi Ampul - 0
102 Gentamicin Salep Kulit Tube - 0
103 Gentamicin Salep mata Tube - 0
104 Gentamicin Tetes Mata Botol - 0
105 Gentian Violet 1 % Botol - 0
106 Glibenclamid tablet 5 mg Tablet - 0
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - 0
108 Glikazid 80 mg Tablet Tablet - 0
109 Glimepiride 2 mg Tablet 25 25
110 Glukosa larutan infus 10% steril Botol - 0
111 Glukosa larutan infus 5 % steril Botol - 0
112 Griseofulvin tablet 500 mg, Tablet - 0
113 Guaiafenesin 100 mg Tablet - 0
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - 0
115 Hidrokortison krim 2,5% Tube - 0
116 Ibuprofen Suspensi Tablet - 0
117 Ibuprofen tablet 200 mg Tablet - 0
118 Ibuprofen tablet 400 mg Tablet - 0
119 Imunomodulator sirup( STIMUNO) Botol - 0
120 Isosorbid Dinitrat tablet sublingual 5 mgTablet - 0
121 Kalsium Glukonas Injeksi Ampul - 0
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet - 0
123 Kapas Berlemak 500 mg Bungkus - 0
124 Ketokonazol Kream Tube - 0
126 Ketorolac inj Ampul - 0
127 Kifadene tablet 20 mg Tablet - 0
128 Kloramfenikol salep mata 1 % capsul - 0
129 Kloramfenikol suspensi Botol - 0
130 Kloramfenikol tetes telinga 3% Tube - 0
131 Kloramphenicol 250 mg Capsul - 0
132 Kloramphenicol 500 mg capsul - 0
133 Kloramphenicol Tetes Mata Botol - 0
135 Klorokuin tablet 150 mg Tablet - 0
136 Klorpromazin HCL tablet salut 25 mg Tablet - 0
137 Kombinasi (Pirimetamin 25 mg + SolfadTablet - 0
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 45 45
139 Kotrimoksazol Sirup / Suspensi Botol - 0
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - 0
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - 0
142 Lactobacilus serbuk Sachet - 0
143 Lidocain 2%+efinefrin injeksi Ampul - 0
144 Lidocain injeksi 2 ml Ampul - 0
145 Lisinopril 10 mg tablet Tablet - 0
146 Lisinopril 5 mg tablet Tablet - 0
147 Loperamid 4 mg tablet Tablet - 0
148 Lytacur Sirup Botol - 0
149 Magnesium Sulfat Inj. 25 ml 20% Ampul - 0
150 Metamizol 500 mg Tablet - 0
151 Metformin 500 mg Tablet Tablet 15 15
152 Methilprednisolon tablet 8 mg Tablet - 0
153 Metilergometrin Maleat injeksi 1 ml Ampul - 0
154 Metilergometrin Maleat Tablet Tablet - 0
155 Metoklopramid Suspensi Botol - 0
156 Metoklopramid tablet Tablet - 0
157 Metronidazol 500 mg Tablet - 0
158 Metronidazol infus / injeksi Botol - 0
159 Metronidazol Ovula supp - 0
160 Metronidazol suspensi Botol - 0
161 Mikonazol kream Tube - 0
162 Multivitamin Anak Sirup Botol 2 5 7
163 Multivitamin Dewasa Antioksidan ( BecoTablet - 0
164 Natrium Diklofenak 25 mg Tablet Tablet - 0
166 Natrium Klorida Cairan Infus ( NaCL ) Botol - 0
167 Nifedipine Tablet 10 mg box - 0
168 Nistatin tablet vaginal 100.000 IU/g Tube - 5 5
169 Obat anti Diare suspensi Botol - 0
171 Obat Batuk Flu ( Molexflu ) BOX - 0
Obat Batuk Flu ( Molexflu ) BOX - 1 1
172 Obat Batuk Hitam (OBH) Botol - 0
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol - 0
174 Ofloxsacin Tetes Telinga Tube - 0
175 Oksitetrasiklin HCL salep mata 1% Botol 9 3 12
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - 0
177 Omeprazol injeksi Ampul - 0
178 Omeprazol Kapsul 20 mg capsul - 0
179 Ondancentron injeksi 4 mg Ampul - 0
181 Paracetamol Drop 15 ml Botol - 0
182 Paracetamol Sirup 120 mg/5 ml Botol 4 5 9
183 Parafin Dresing ( Bioplacenton Tull ) pcs - 0
184 Parasetamol tablet 100 mg Tablet - 0
185 Parasetamol tablet 500 mg Tablet - 0
186 Permetrin Krim 5 % Tube - 0
187 Pirantel Sirup Botol - 0
188 Pirantel tablet 125 mg Tablet - 0
189 Pirazinamid Botol - 0
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 5 5
191 Piroksikam tablet 20 mg Tablet - 0
192 Polikresulen Tube - 0
193 Povidon lodida 10% 300 ml - 0
194 Povidon lodida 10% 60 ml Tablet - 0
195 Prazikuantel tablet 600 mg Botol - 0
196 Prednison Tablet 5 mg Tablet 25 25
197 Primakuin 15 mg Tablet - 0
198 Probenesid 500 mg tablet Tablet - 0
199 Prokain Benzil Penisilin 3 juta IU/vial inj Ampul - 0
200 Propanolol HCL tablet 10 mg Tablet - 0
201 Ranitidin injeksi Ampul - 0
202 Ranitidin tablet Tablet - 0
203 Resperidone 2 mg tablet Tablet - 0
204 Ringer Laktat cairan infus (Otsuka) - 0
205 Ringer Laktat cairan infus (Widatra) Botol - 0
206 Rivanol 300 ml Botol - 0
207 Salbutamol Tablet 2 mg Tablet 15 15
208 Salbutamol tablet 4mg Tablet - 0
209 Salep 2-4 Tube - 0
210 Salep kombinasi cream ( Berloson ) Tube - 0
211 Salicil bedak Kotak - 0
212 Serum Anti Bisa Ular Polivalen Inj 50 mlVial - 0
213 Serum Anti Tetanus inj 1500 IU ( Tetag Vial - 0
214 Sianokobalamin Injeksi Ampul - 0
215 Simvastatin 10 mg tablet Tablet - 0
216 Simvastatin 20 mg tablet Tablet - 0
217 Sukralfat Suspensi Botol - 0
218 Sukralfat tablet 500 mg Tablet - 0
219 Suspensi Seng Insulin inj.40 IU/ml - 10 Tube - 0
220 Temporary Stopping Fletcher serbuk & cTablet - 0
221 Tetrakain HCL tetes mata 0,5% Tube - 0
222 Tetrasiklin 250 mg capsul capsul - 0
223 Tetrasiklin 500 mg capsul capsul - 0
224 Tiamin Tablet 50 mg ( B1 ) Tablet - 0
Tiamin Tablet 50 mg ( B1 ) Tablet - 0
225 Ventolin Nebulizer Ampul - 0
227 Zink sirup Botol - 0
228 Zink tablet 20 mg Tablet - 0
229 Deksametason inj Ampul - 0
230 Diazepam inj 5 mg/ml Ampul - 0
231 Griseofulvin 125 mcg Tablet - 0
232 Kloramfenikol SK Tube - 2 2
233 Nystatin tab 500.000 IU Tablet - 0
234 magnesium Sulfat Inj. 25 ml 40% ampul - 0
235 natrium bicarbonat tab - 0
NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) - 0
1 Alat suntik 1 ml Pcs - 0
3 Alat suntik 2,5 ml Pcs - 0
5 Alat suntik 3 cc (Remedi) - 0
8 Alkazide 1 L High Level Desinfectant Botol - 0
9 Alkazyme Sachet 25 mg Pack - 0
10 Alkohol 70 % 1 L Botol - 0
11 Alkohol swab Sachet - 0
12 Anti Septik Hand Rub Botol - 0
13 Anti Septik Surgikal Hand Scrub Botol - 0
14 Cat Gut no 2/0 Sachet - 0
15 Cat Gut no 3/0 Sachet - 0
16 Cat Gut No 2/0 (24 mm) Sachet - 0
17 Cat Gut No 3/0 (26 mm) Sachet - 0
18 Cathetter Jelly Biji - 0
19 Demetech Silk 3/0 Set - 0
21 E-Care Surgical Mask Tie On Lembar - 0
22 Folly No 14 Catether pcs - 0
23 Folly No 16 Catether pcs - 0
iv cathETER no 20 pcs - 0
25 I.V Cathetter No. 22 Set - 0
I.V Cathetter No. 22 Set - 0
I.V Cathetter No. 24 Set - 0
27 I.V Cathetter No. 26 Set - 0
28 Infuset Anak Set - 0
29 Infuset Dewasa Set - 5 5
30 Jarum Insulin Tablet - 0
31 Kapas Berlemak 250 gr Bungkus - 0
32 Kapas Berlemak 500 gr Bungkus - 0
33 Kasa 4 m x 10 cm Rol - 0
34 Kasa Hidrofil 36 x 80 cm Rol - 0
35 Kasa Pembalut 2 x 80 cm Pack - 2 2
36 Kasa Steril / hidrofil 16 x 16 cm Kotak - 2 2
37 Lisol 1 L Botol - 0
38 Masker karet Ear Loop Lembar - 0
39 Masker tali Tube - 0
40 Nasal Canula Oksigen Set - 0
41 Plester 1" Rol - 0
42 Plester Kertas 2,5 cm Rol - 0
43 Plester Non Woven 5cm x 5 cm Rol - 0
44 Policlean Botol - 0
45 Polifik Kotak - 0
46 Saraya Alsof A 500 ml Botol - 0
47 Saraya Alsof Pure 500 ml Botol - 0
48 Sarung Tangan Gynecolog No 7 Pasang - 0
49 Sarung tangan M (Non Steril) Pasang - 0
50 Sarung tangan no 6,5 Pasang - 0
51 Sarung tangan no 6,5 Steril Gloves Pasang - 0
52 Sarung tangan no 7,0 Steril Pasang - 0
53 Selang Section ( Surgikal Conection Tu Pcs - 0
54 Underpad Lembar - 2 2
55 Urine Bag Biji - 0
56 safety blackblood BOX - 0
57 safety box BOX - 0
58 Tabung BD Vacutener pcs - 0
59 masker n95 box - 0
60 t silk black 3/0 26 mm pcs - 0
61 ALAT SUNTIK 1 ML BOX - 0
62 alat suntik 3 ml box - 0
63 iv cathETER no 18 pcs - 0
OBAT JKN - 0
1 acylovir cream tube - 0
2 etil klorida spray btl - 0
3 parasetamol inf botol - 0
4 propyretic suppo box - 0
5 selkom c tab box - 0
6 trifadium tab box - 0
7 vit k1 inj box - 0
8 Ketorolac inj box - 0
9 mp 4 mg box - 0
10 parasetamol tab box - 2 2
11 aminofilin inj box - 0
12 asam mefenamat box - 0
13 Acyclovir 200 mg box - 0
14 Acyclovir 400 mg box - 0
15 Ciprofloxacin 500 mg box - 0
16 GLUKOSA 5% BOTOL - 0
17 glukosa 10% BOTOL - 0
18 SIANOKOBALAMIN INJ 500 mg box - 0
19 asam folat 400 mcg box - 0
20 AMBROKSOL SYR BOTOL - 0
21 asam tranexamat inj box - 0
22 Bedak Salicyl 2% box - 0
23 Cefadroxil 500 mg box - 1 1
24 Cetirizine syr BOTOL - 0
25 d40 BOTOL - 0
26 Guanistrep syr BOTOL - 0
27 IBUPROFEN 400 mg box - 0
28 kloramfenikol tetes mata TUBE - 0
29 Mecobalamin 500 Mg Tab box - 0
30 metronidazol syr BOTOL - 0
31 Metronidazole 500 mg box - 0
32 Ondansetron inj 4 mg BOX - 0
33 Paraflu Sirup BOTOL - 0
34 parasetamol syr BOTOL - 0
35 ranitidin tab 50 mg box - 1 1
36 asam fusidat krim tube - 0
37 amlodipin 10 mg box - 2 2
38 amlodipin 5 mg box - 2 2
39 asam traneksamat tab 500 mg box - 0
40 cetirizin tab box - 0
41 d40 % botol - 0
42 dulcolax anak suppo box - 0
43 gom box - 0
44 HERBAKOF SYR botol - 0
45 kloramfenikol tetes mata botol - 0
46 Lexigo box - 0
47 METRONIDAZOL SYR botol - 0
48 mgso 4 40% Botol - 0
49 mikrolax suppositoria Tube - 0
50 natrium bicarbonat tab botol - 0
51 nifedipin tab box - 0
52 nisagon krim tube - 0
53 oksitosin inj box - 0
54 piroksikam 20 mg tab box - 0
55 SELKOM C box - 0
56 serum abu vial - 0
57 SUKRALFAT SYR botol - 0
58 ventolin nebu box - 0
59 nacl botol - 0
60 ringer laktat botol - 0
- 0
BMHP JKN Set - 0
1 LANSET pcs - 0
2 BISTURI pcs - 0
3 CHKM pcs - 0
4 Jely pcs - 0
5 handscoon steril 7,5 pcs - 0
6 Kertas puyer pcs - 0
8 Selang Oksigen Anak-anak nca pcs - 0
9 Selang Oksigen Dewasa ncd pcs - 0
10 Larutan Gentian Violet pcs - 0
11 mukus ekstraktor pcs - 0
12 nesco asam urat pcs - 0
13 pipet obat 1 ml pcs - 0
14 pot urin pcs - 0
15 reagen goldar A pcs - 0
16 kertas goldar pcs - 0
17 Rebreathing mask O2 anak pcs - 0
18 Rebreathing mask O2 dewasa pcs - 0
19 suction no 8 pcs - 0
20 vaselin pcs - 0
21 rapid test dengue nst box - 0
22 suntik 20 cc box - 0
23 rapid test dengue 1gg box - 0
24 catgut plain box - 0
25 antiseptik 5 L kompan - 0
26 nesco hb box - 0
27 UNDERPAD pack - 0
28 rivanol botol - 0
29 povidone botol - 0
30 alkohol botol - 0
31 suction no 8 pcs - 0
32 nesco gds box - 0
33 nesco asam urat box - 0
34 hcg test box - 0
35 lancet media box - 0
36 IV CATHETER no 26 Pcs - 0
37 MASKER EARLOOP Box - 0
38 OIL IMMERSI Botol - 0
39 OKSIGEN MASKER STANDAR ANAK pcs - 0
40 OKSIGEN MASKER STANDAR DEWASA pcs - 0
41 OXYGEN NASAL CANNULA NEONATUS ncb Pcs - 0
42 PLASTIK KLIP SEDANG 13x8,7 CM Pack - 0
43 PROTEIN URIN VERIFY botol - 0
44 REAGEN GOLDAR Botol - 0
45 SENDOK OBAT 5ML Pack - 0
46 STRIP CHOLESTEROL Botol - 0
47 STRIP GULA DARAH Botol - 0
48 STRIP HB Botol - 0
49 SUNGKUP ANAK NEBU pcs - 0
50 SUNGKUP BAYI NEBU pcs - 0
51 SUNGKUP DEWASA NEBU pcs - 0
52 UMBILICAL KLEM Box - 0
53 ALKOHOL SWAB Box - 0
54 CATGUT CHROME SIZE : 2/0 WITH NEEDLE SBox - 0
55 EXAMINATION GLOVE uk. M Box - 0
56 FOLLEY CATHETER NO 16 Pcs - 0
57 FOLLEY CATHETER NO 18 Pcs - 0
58 GLOVE STERILE GYNECOLOG NO. 6.5 Pair - 0
59 INFUSION SET DEWASA Pcs 1 1
60 IV CATHETER NO. 18 Box - 0
64 KASA 40X80 pcs - 0
65 MASKER MEDIS HEADLOOP Box - 0
66 PERBAN ELASTIS 10M Pcs - 0
67 PLESTER INCL DISPENSER 1 INCH Box - 0
68 POVIDION IODINE 15ML Btl - 0
69 STRIP CHOLESTEROL Box - 0
70 STRIP GULA DARAH Box - 0
71 SYRINGE 1ML Box - 0
72 SYRINGE 3ML Box - 0
73 UMBILICAL KLEM Box - 0
74 URINE BAG Pcs - 0
YANG MENYERAHKAN
PENGELOLA OBAT

NIP.198601142019 02 2 003

APRIL DINKES KAB/KOTA
MEI GFK KAB/KOTA
PUSKESMAS
APRIL
Stok Jumlah
PEMBERIAN
Pemakaian Stok Akhir Optimum Permintaan
BUFFER
STOK
0
0
85 55 100
0
0
0
0
0
0
0
0
130 120 100
0
1 0 4
6 4 5
0
0
0
0
0
5 4 5
95 40 100
0
0
0
0
0
0
0
0
0
10 5 10
0
0
0
180 60 100
0
0
0
50 40 100
0
0
0
0
0
0
0
2 0 5
0
0
0
0
0
0
0
0
2 2 5
0
0
0
0
0
0
0
0
0
0
45 25 100
0
0
0
0
0
0
0
0
0
0
5 5 10
2 0 10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15 15 10
0
2 0 5
0
0
0
0
0
0
0
0
0
15 10 10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 0 5
0
0
0
0
0
0
0
0
80 50 100
0
0
0
25 20 50
0
0
0
0
0
0
0
0
0
0
0
0
10 5 25
0
0
0
0
0
0
0
0
0
0
5 2 8
0
0
16 9 20
0
0
2 3 5
0
7 3 5
0
1 0 5
0
0
0
8 4 5
0
0
0
0
25 7 10
0
6 3 10
0
0
0
0
0
0
0
3 2 10
0
0
0
0
0
19 6 20
0
0
0
0
0
0
0
0
0
0
11 4 10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
180 30 100
0
0
0
0
0
2 0 5
0
0
0
0
0
0
0
0
0
0
4 0 5
0
0
0
0
0
0
0
0
0
0
0
0
2 0 3
0
0
0
2 0 3
0
0
0
2 0 3
0
0
0
5 0 7
0
0
0
0
0
2 0 4
2 0 4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 0 5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 0 5
0
0
0
0
0
0
0
0
0
0
0
0
1 0 3
0
0
0
0
0
0
0
0
0
0
0
1 0 3
0
2 0 3
2 0 3
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
0
0
0
0
0
15 5 10
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
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
0
1 0 5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0


NIP.19710804 199103 2 002 NIP.198910042017042002
TANGGAL DOKUMEN
PELAPORAN BULAN / PERIODE MEI DINKES KAB/KOTA
PERMINTAAN BULAN / PERIODE JUNI GFK KAB/KOTA
PUSKESMAS
MEI
Stok Jumlah
JUMLAH Jumlah PEM
Stok Optimum Permintaan
Stok Awal Penerimaan Persediaa Pemakaian
Akhir
n APBD II
0 0 0
0 0 0
55 50 105 55 50
0 0 0
0 0 0
0 0 0
0 0 0
0 30 30 30
0 30 30 30
0 0 0
0 0 0
120 100 220 120 100
0 0 0
0 0 0
4 3 7 4 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 10 14 4 10
40 40 40 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
0 0 0
5 5 5
0 0 5 -5
0 0 0
0 0 0
60 100 160 60 100
0 0 0
0 2 2 2 0
0 0 0
40 30 70 40 30
0 0 0
0 0 0
0 50 50 50 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
2 2 2 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
0 0 0
0 0 0
25 25 25 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
0 0 0
0 0 0
5 5 5 0
0 2 2 2 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
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 0 0
0 0 0
15 15 15 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
0 0 0
0 0 0
0 0 0
10 50 60 30 30
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 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 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 100 150 50 100
0 0 0
0 0 0
0 0 0
20 20 20 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
0 0 0
0 0 0
0 0 0
0 0 0
5 5 5 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
0 0 0
0 0 0
2 2 4 2 2
0 0 0
0 0 0
9 9 9
0 0 0
0 0 0
3 3 3 0
0 0 0
3 3 3 0
0 0 0
0 1 1 1 0
0 0 0
0 0 0
0 0 0
4 4 4 0
0 0 0
0 0 0
0 0 0
0 0 0
7 7 7 0
0 0 0
3 10 13 13 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
6 6 6 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
0 0 0
0 0 0
4 4 4 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
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 0 0
0 0
0 0 0
30 100 130 30 100
0 3 3 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 3 3 3 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
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 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 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 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 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
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 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 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
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 0 0
0 0 0
0 0 0
0 0 0
0 1 1 1 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
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 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 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
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 2 2 2 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
0 0 0
0 0 0
0 0 0
0 0 0
5 5 5 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
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 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 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
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 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 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
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 0 0
YANG MENYERAHKAN MENGETAHUI YANG

PENGELOLA OBAT KEPALA PUSKESMAS PENANGGUNG JA
RENY WIGIAWATI, A.Pt HJ,IYOT SA'DIAH,S.ST Elis Febri

NIP.198601142019 02 2 003 NIP.19710804 199103 2 002
DINKES KAB/KOTA PELAPORAN BULAN / PERIODE
GFK KAB/KOTA PERMINTAAN BULAN / PERIODE
PUSKESMAS
JUNI
PEMBERIAN JUMLAH Jumlah
Stok Awal Penerimaan Persedia Pemakaian
BUFFER an
JKN PROG LAIN LAIN
STOK
0 0
0 0
50 50
0 0
0 0
0 0
0 0
30 30
30 30
0 0
0 0
100 100
0 0
0 0
3 3
0 0
0 0
0 0
0 0
0 0
10 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
-5 -5
0 0
0 0
100 100
0 0
0 0
0 0
30 30
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 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
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 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
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 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 30
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 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
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 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
0 0
0 0
2 2
0 0
0 0
9 9
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 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
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 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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
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 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
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 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 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
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 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
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 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
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 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
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 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
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 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
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 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
YANG MEMINTA : YANG MENYERAHKAN MENGETAHU

PENANGGUNG JAWAB PUSTU/POSKEDES PENGELOLA OBAT KEPALA PUSKES
Elis Febriyani, Amd. Keb RENY WIGIAWATI, A.Pt

NIP.198910042017042002 NIP.198601142019 02 2 003
JUNI DINKES KAB/KOTA
JULI GFK KAB/KOTA
PUSKESMAS
Stok Jumlah
Stok PEMBERIAN JUMLAH
Optimum Permintaan
Akhir BUFFER
STOK
0
0
50
0
0
0
0
30
30
0
0
100
0
0
3
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
5
-5
0
0
100
0
0
0
30
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
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
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
0
0
2
0
0
9
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
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
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
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0
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0
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0
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0
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0
0
0
0
0
0
0
0
0
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0
0
0
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0
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0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
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0
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0
0
0
0
0
0
0
0
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0
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0
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0
0
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0
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0
0
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0
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0
0
0
0
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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
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
0
0
0
0
0
0
0
0
0
0
0


NIP.19710804 199103 2 002 NIP.198910042017042002

Laporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Puskesmas

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) PUS

PUSKESMAS : CIKEUSIK/ RANCASENENG

RENY WIGIAWATI, A.Pt

DOKUMEN NOMOR TANGGAL

MENGETAHUI YANG MEMINTA :

HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

YANG MENYERAHKAN MENGETAHUI YANG

RENY WIGIAWATI, A.Pt HJ,IYOT SA'DIAH,S.ST Elis Febri

YANG MEMINTA : YANG MENYERAHKAN MENGETAHU

Elis Febriyani, Amd. Keb RENY WIGIAWATI, A.Pt

MENGETAHUI YANG MEMINTA :

HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

Nama Puskesmas : PKM CIKEUSIK/ NAMA PARKOS

Saldo Awal 2021 Penerimaan T.A

Kepala Puskesmas Cikeusik

Hj. Iyot Sadiah, S. ST ELAH NURHAYATI.

Penerimaan T.A 2021 Pengeluaran TA. 2021 Saldo Akhir

Pengurus Barang Tim Pemeriksa,

Harga Perhitungan Persediaan

Kepala Puskesmas Cikeusik Pengurus Barang

Hj. Iyot Sadiah, S. ST ELAH NURHAYATI. Amd. Keb

Pengurus Barang Tim Pemeriksa,

3 Jujum Jumiati, Amd. Keb

PUSKESMAS : CIKEUSIK/ RANCASENENG

RENY WIGIAWATI, A.Pt

MENGETAHUI YANG MEMINTA :

HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

PUSKESMAS : CIKEUSIK/ RANCASENENG

RENY WIGIAWATI, A.Pt

DOKUMEN NOMOR TANGGAL

MENGETAHUI YANG MEMINTA :

HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

YANG MENYERAHKAN MENGETAHUI YANG

RENY WIGIAWATI, A.Pt HJ,IYOT SA'DIAH,S.ST Elis Febri

YANG MEMINTA : YANG MENYERAHKAN MENGETAHU

Elis Febriyani, Amd. Keb RENY WIGIAWATI, A.Pt

MENGETAHUI YANG MEMINTA :

HJ,IYOT SA'DIAH,S.ST Elis Febriyani, Amd. Keb

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