PEMERINTAH KABUPATEN MUSI BANYUASIN

PUSKESMAS PENINGGALAN
Jl. Palembang - Jambi Km. 149 Desa Peninggalan Kec. Tungkal Jaya Kab. Musi Banyuasin

DAFTAR KEBUTUHAN BMHP DI DALAM E-KATALOG

PUSKESMAS PENINGGALAN TAHUN ANGGARAN 2019

JUMLAH PESANAN

TOTAL HARGA
NO NAMA/ JENIS PERSEDIAAN SATUAN HARGA QTY

1 2 3 4 5 6 7

1 AXIMED AIRFLOW TUBE, ETT with cuff, size 3.0 piece 27,830 10 pcs/box 0

2 AXIMED AIRFLOW TUBE, ETT with cuff, size 3.5 piece 27,830 10 pcs/box 0

3 AXIMED AIRFLOW TUBE, ETT with cuff, size 4.0 piece 27,830 10 pcs/box 0

4 AXIMED AIRFLOW TUBE, ETT with cuff, size 4.5 piece 27,830 10 pcs/box 0

5 AXIMED AIRFLOW TUBE, ETT with cuff, size 5.0 piece 27,830 10 pcs/box 0

6 AXIMED AIRFLOW TUBE, ETT with cuff, size 5.5 piece 27,830 10 pcs/box 0

7 AXIMED AIRFLOW TUBE, ETT with cuff, size 6.0 piece 27,830 10 pcs/box 0

8 AXIMED AIRFLOW TUBE, ETT with cuff, size 6.5 piece 27,830 10 pcs/box 0

9 AXIMED AIRFLOW TUBE, ETT with cuff, size 7.0 piece 27,830 10 pcs/box 0

10 AXIMED AIRFLOW TUBE, ETT with cuff, size 7.5 piece 27,830 10 pcs/box 0

16 AXIMED AIRFLOW TUBE, ETT with cuff, size 8.0 piece 27,830 10 pcs/box 0

17 AXIMED CONNECTING TUBE, 1 funnel piece 22,770 50 pcs/pack 0

18 AXIMED NASAL OXYGEN, O2 cannula, size XS piece 7,590 100 pcs/pack 0

19 AXIMED NASAL OXYGEN, O2 cannula, size S piece 7,590 100 pcs/pack 379,500
50

20 AXIMED NASAL OXYGEN, O2 cannula, size M piece 7,590 100 pcs/pack 379,500
50

21 AXIMED NASAL OXYGEN, O2 cannula, size L piece 7,590 100 pcs/pack 379,500
50

22 AXIMED INFUSET piece 5,520 25 pcs/box 1,380,000

250

23 AXIMED PEDIATRIC SET piece 5,865 25 pcs/box 293,250

50

24 AXIMED FEMALE CATHETER, no. 10 piece 6,578 20 pcs/box 131,560

20
25 AXIMED FEMALE CATHETER, no. 12 piece 6,578 20 pcs/box 131,560
20
26 AXIMED FEMALE CATHETER, no. 14 piece 6,578 20 pcs/box 0

27 AXIMED FEMALE CATHETER, no. 16 piece 6,578 20 pcs/box 80 526,240

28 AXIMED FEMALE CATHETER, no. 18 piece 6,578 20 pcs/box 526,240

80

29 AXIMED FOLEYCATH, 2-way latex foley cath, no.10 piece 12,650 10 pcs/box 126,500
10
30 AXIMED FOLEYCATH, 2-way latex foley cath, no.12 piece 12,650 10 pcs/box 126,500
10
31 AXIMED FOLEYCATH, 2-way latex foley cath, no.14 piece 12,650 10 pcs/box 126,500
10
32 AXIMED FOLEYCATH, 2-way latex foley cath, no.16 piece 12,650 10 pcs/box 759,000
60
33 AXIMED FOLEYCATH, 2-way latex foley cath, no.18 piece 12,650 10 pcs/box 60 759,000

34 AXIMED URINE DRAINAGE BAG, T valve, with hanger piece 6,325 20 pcs/box 40 253,000
35 AXIMED CHIRURGIC GLOVES, size 6.0 piece 8,740 50 pcs/box 0
36 AXIMED CHIRURGIC GLOVES, size 6.5 piece 8,740 50 pcs/box 0
37 AXIMED CHIRURGIC GLOVES, size 7.0 piece 8,740 50 pcs/box 250 2,185,000
38 AXIMED CHIRURGIC GLOVES, size 7.5 piece 8,740 50 pcs/box 250 2,185,000

39 AXIMED CHIRURGIC GLOVES, size 8.0 piece 8,740 50 pcs/box 0

40 AXIMED SWAB, 4-ply box 23,000 100 pcs/box 100 2,300,000

41 AXIMED SWAB, 2-ply box 12,650 100 pcs/box 100 1,265,000

42 SMI SILK BLACK 2/0 HR 26 MM sachet 21,065 24sachet/BOX 24 505,560
43 SMI SILK BLACK 3/0 HR 26 MM sachet 20,465 24sachet/BOX 48 982,320
44 Kasa Hydrofil 40Y X 80 cm roll 165,125 roll 25 4,128,125
45 Kasa Hydrofil 30Y X 80 cm roll 209,550 roll 0
46 Kasa Hydrofil 20Y X 80 cm roll 89,408 roll 0
47 Kasa Hydrofil 4Y X 15 cm Pack 185,801 Pack 10 1,858,010
48 Kasa Hydrofil 4Y X 7,5 cm Pack 185,801 Pack 0
49 Kasa Hydrofil 4Y X 10 cm Pack 124,333 Pack 0
50 Kasa Hydrofil 4Y X 5 cm Pack 124,333 Pack 0
 JUMLAH PESANAN

TOTAL HARGA
NO NAMA/ JENIS PERSEDIAAN SATUAN HARGA QTY

1 2 3 4 5 6 7
51 Kasa Hydrofil 40Y X 40 cm roll 86,614 roll 0
52 Kasa Hydrofil 2Y X 10 cm Pack 62,167 Pack 0
53 Kasa Hydrofil 2Y X 5 cm Pack 62,167 Pack 0
54 Kasa Hydrofil 16 cm X 16 cm box 56,998 12pcs/box 20 1,139,960

55 Ciringe 1 ml Syringe Luer Slip Centre With needle 26G X 1/2 box 107,950 100 pcs/box 5,397,500
50
56 Ciringe 3ml Syringe Luer Lock With needle 23G X1 1/4 box 104,910 100 pcs/box 20 2,098,200

57 Ciringe 3ml Syringe Luer Lock without needle box 89,700 100 pcs/box 0
58 Ciringe 5ml Syringe Luer Lock With needle 22G X 1 1/2 box 129,350 100 pcs/box 2 258,700

59 Ciringe 5ml Syringe Luer Lock without needle box 107,250 100 pcs/box 0

60 Ciringe 10 ml Syringe Luer Slip Centre With needle 21G X 1 1/2 box 167,640 100 pcs/box 167,640
1

61 Ciringe 20ml Syringe Luer Slip Center Without Needle (lubang tengah) box 146,050 50 pcs/box 0

62 Ciringe 20ml Syringe Luer Slip Eccentric Without Needle (lubang box 146,050 50 pcs/box 0
Pinggir)

63 Ciringe 50ml Syringe Luer Lock Without Needle (lubang tengah) box 174,625 25 pcs/box 174,625
1

64 Ciringe 50ml Syringe Luer Slip Eccentric Without Needle (lubang box 174,625 25 pcs/box 0
Pinggir)

65 ABADA Masker 3 Ply Tie On box 21,165 50pcs/box 50 1,058,250

66 ABADA Masker 3 Ply Ear loop Box 21,165 50pcs/box 100 2,116,500
67 ABADA Masker Kerudung/Jilbab Box 24,727 50pcs/box 50 1,236,350

68 IV Catheter Without Injection Port Size 16G BOX 372,682 50pcs/box 0

69 IV Catheter Without Injection Port Size 18G Box 372,682 50pcs/box 0
70 IV Catheter Without Injection Port Size 20G Box 372,682 50pcs/box 1 372,682

71 IV Catheter Without Injection Port Size 22G Box 372,682 50pcs/box 2 745,364
72 IV Catheter Without Injection Port Size 26G Box 372,682 50pcs/box 0

73 IV Catheter With Injection Port Size 16G BOX 372,682 50pcs/box 0

74 IV Catheter With Injection Port Size 18G Box 372,682 50pcs/box 0
75 IV Catheter With Injection Port Size 20G Box 372,682 50pcs/box 1 372,682

76 IV Catheter With Injection Port Size 22G Box 372,682 50pcs/box 5 1,863,410
77 IV Catheter With Injection Port Size 26G Box 372,682 50pcs/box 1 372,682
78 Disposable Infusion set Adult box 523,875 100Pcs/CTN 0
79 Disposable Infusion set Micro box 549,120 100Pcs/CTN 0
80 Glove Later Examination NonStrerile Powder Size S box 53,645 box @ 50pcs 0

81 Glove Later Examination NonStrerile Powder Size M box 53,645 box @ 50pcs 100 5,364,500

82 Glove Later Examination NonStrerile Powder Size L box 53,645 box @ 50pcs 100 5,364,500
83 Glove Later Examination NonStrerile Powder Size XL box 53,645 box @ 50pcs 0

84 MPM HCG Pregnancy test box 82,800 box @ 60pcs 3,312,000

40

85 Autocheck Uric Acid Test Strip box 232,375 box 929,500

4

86 Autocheck Total Cholesterol Test Strip box 479,050 box 1,916,200

4

87 Autocheck Glucose Test Strip box 178,750 box 715,000

4
88 Benecheck plus glucose test strip BOX 165,472 BOX 0

89 Benecheck plus total cholesterol test strip BOX 254,100 BOX 0

90 Benecheck plus uric test strip BOX 139,150 BOX 0

86 Alkohol 70% botol 12,000 botol 1,200,000

100
87 ACCU-CHEK performa test strips (PT. Roche Indonesia) BOX 420,000 BOX 6 2,520,000

88
Labstrips UII Plus Urine test strip (PT. Rafa Topaz Utama) BOX 334,840 BOX 3 1,004,520

89 ACON Hb Hemoglobin strip 50 test mission (PT. Mitra bahagia citr BOX 400,000 BOX 5 2,000,000

90 CATGUT CHROMIC 2/0 HR 20 MM (PT. Rajawali Nusindo) BOX 26,843 SACHET 100 2,684,300

91 STARDEC Vaginal Speculum M (PT. djembatan dua) Piece 4,000 Piece 500 2,000,000
92 Media Blood Lancet (PT. Bina sukses medika) BOX 15,950 BOX 100 1,595,000

TOTAL JUMLAH 69,666,930

TTD KEPALA PUSKESMAS TTD PENGELOLAH BPJS

KETERANGAN :
1. Isi di kolom jumlah pesanan yang ditandai warna kuning sesuai kebutuhan puskesmas masing-masing
2. kolom total jumlah akan otomatis menjumlah dari total yang di pesanan
 JUMLAH PESANAN

TOTAL HARGA
NO NAMA/ JENIS PERSEDIAAN SATUAN HARGA QTY

1 2 3 4 5 6 7

3. kolom total jumlah yang di tandai warna Hijau tidak boleh lebih dari dana BMHP JKN yang dimiliki Puskesmas
4. harus sudah selesai paling lambat tanggal 21 febuari baik softcopy di kirim ke email (debypuspitasari94@gmail.com)
dan untuk hardcopy sudah dikumpulkan ke Gudang farmasi Dinkes
BUSANA 2,218,750 ENDO 1,826,052
2,543,000 2,192,005
9,003,500 16,320,271
11,875,000 2,088,204
2,460,000 5,319,072
2,226,000 756,556
643,800 3,040,418
3,644,000 876,802
1,489,250 57,956,849
2,742,500 28,122,655
1,414,000 876,802
2,584,200
11,634,750 119,375,686
1,884,200
9,548,250
11,242,550
13,586,400
5,931,950

96,672,100
AXION 31,763,115
17,628,350
15,333,410
96,677,165
14,591,429
3,617,900
10,863,475
18,667,891
6,920,010
1,949,020
29,648,610
22,787,365
7,966,625
58,175,969
5,411,555
13,091,772
8,583,715
15,303,050

378,980,426

595,028,212