2022 LPLPO Puskesmas

FORMAT LPLPO 2020
BULAN PENGELUARAN
Ketersediaan
Januari Mei September
Rata2/Hari
Februari Juni Oktober
Keluar/bulan Maret Juli November
April Agustus Desember

Buffer stok
Lead Time Rekap Keluar Rekap ED

WAKTU TERSEDIANYA OBAT/BMHP DALAM SATU BULAN
MENU
TERSEDIANYA OB
NO NAMA OBAT /BMHP SATUAN
1 2 3 4
1 2 3
SEDIAAN TABLET/KAPLET/KAPSUL
1 ACETYL SISTEIN 200 MG TABLET 21
2 ALOPURINOL 100 MG TABLET 21
3 ALOPURINOL 300 MG TABLET
4 AMBROKSOL 30 MG TABLET
5 AMINOFILIN TABLET 200 MG TABLET
6 AMLODIPIN 5 MG TABLET
7 AMLODIPIN 10 MG TABLET 21
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 21
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET 21
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 21
12 ASAM FOLAT 1 MG TABLET
13 ASAM MEFENAMAT 500 MG TABLET 21
14 ATAFULGIT 600 MG ( PULAREX ) TABLET
15 ATROPIN SULFAT 0,5 MG TABLET
16 BETAHISTIN MEYSILAT 6 MG TABLET
17 BISOPROLOL 5 MG TABLET
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET
CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg,
19 Vitamin D 100 IU TABLET

21 CIMETIDIN 200 MG TABLET

22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 21
23 DEKSAMETASON TABLET 0,5 MG TABLET 21
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET
25 DIGOKSIN 0,25 MG TABLET 21
26 DIMENHIDRINAT 50 MG TAB TABLET 21
27 DOMPERIDON 10 TAB TABLET 21
28 FENITOIN NATRIUM 50 MG TABLET
29 FERRO SULFAT 300 MG TABLET SALUT TABLET
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 21
31 FUROSEMIDA 40MG TABLET
GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g ,

32 SACHET
Trinatrium Sitrat Dihidrat 0,58 g, Glukosa Anhidrat 2,7 g
21
33 GEMFIBROZIL 300 MG TABLET
35 GLIBENKLAMID 5 MG TABLET 21
36 GLIMEPIRID 1 MG TABLET 21
37 HEMAFORT TABLET
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET 21
39 IBUPROFEN 200 MG TABLET 21
41 ISOSORBID DINITRAT 5 MG TABLET 21
42 KALSIUM KARBONAT 500 MG TABLET
43 KALSIUM LAKTAT TABLET 21
44 KAPTOPRIL 12,5 MG TABLET 21
45 KAPTOPRIL 25 MG TABLET 21
46 KAPTOPRIL 50 MG TABLET
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 21
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET
49 LANSOPRAZOL 30 MG TABLET 21
50 LISINOPRIL 5 MG TABLET
51 LORATADIN TABLET 10 MG TABLET 21
52 LOPERAMID 2 MG TABLET
53 MELOKSIKAM 7,5 MG TABLET
54 MELOKSIKAM 15 MG TABLET
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET

58 METFORMIN HCl 500 MG TABLET
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET
61 METILPREDNISOLON 4 MG TABLET 12
63 METOKLOPRAMID 10 MG TABLET 21
MINERAL MIX : Bismut subcitrat tripotasium. Copper sulfat,

64 Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat TABLET
21
65 MINIASFI ( ASETOSAL 80 MG ) TABLET
66 NATRIUM BIKARBONAT 500MG TABLET
67 NATRIUM DIKLOFENAK 25 MG TABLET 21
68 NATRIUM DIKLOFENAK 50 MG TABLET
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET
70 NIFEDIPIN 10 MG TABLET 21
71 NIKOTINAMIDE 20 MG TABLET
72 OMEPRAZOLE 20 MG TABLET
73 ONDANSENTRON 4 MG TABLET
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 21
PEHAVRAL TABLET : Fe2Fumarat 20mg, kalsium karbonat 100 mg,

Vit.A 400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam
75 Tablet
Folat 1 mg, Vit. B12 2 mg, Nikotinamide 20 mg, Biotin 0,1 mg,
Tembaga Sulfat 1 mg, Magnesium Sulfat 1 mg, Seng Oksida 0,25 mg
21
76 PIRIDOKSIN 10 MG TABLET
78 PIROKSIKAM 10 MG TABLET
80 PREDNISON 5 MG TABLET 21
81 PROPANOLOL 40 MG TABLET 21
82 PROPANOLOL 10 MG TABLET
83 PROPILTIOURASIL 100 MG TABLET
84 RANITIDIN 150 MG TABLET 21
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL 21
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL
87 SALBUTAMOL 2 MG TABLET
88 SALBUTAMOL 4 MG TABLET 21
89 SETIRIZIN 10 MG TABLET
90 SIMVASTATIN 10 MG TABLET 21
TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam
91 folat 0,4 mg tablet salut TABLET
21
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 21
93 VITAMIN B. COMPLEKS TABLET
VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat
94 TABLET
Acid
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 21
96 GUAIFENISIN TABLET
SEDIAAN ANTIINFEKSI TABLET/KAPLET/KAPSUL
1 ALBENDAZOL 400 MG TABLET 21
2 AMOKSISILIN 500 MG TABLET 21
3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET
4 ASIKLOVIR 200 MG TABLET 21

6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET
7 CLINDAMISIN 300 MG TABLET 21
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET
9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET
10 DOKSISIKLIN 100 mg TABLET

11 ERITROMISIN 250 MG TABLET 21
13 ETAMBUTOL HCL 400 MG TABLET
15 FENOKSIMETIL PENISILIN 250MG TABLET
16 FENOKSIMETIL PENISILIN 500 MG TABLET
17 GRISEOFULVIN 125 MG TABLET
18 ISONIAZIDA ( INH ) 100 MG TABLET
19 ISONIAZIDA ( INH ) 300 MG PAKET
20 KETOKONAZOL 200 MG TABLET 21
21 KLORAMFENIKOL 250 MG TABLET
22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 21

24 KUININ SULFAT 200 MG TABLET
25 MEBENDAZOL 100 MG TABLET
26 METRONIDAZOL 250 MG TABLET
27 METRONIDAZOL 500 MG TABLET 21
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 21
30 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 2 PAKET
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET
35 PIRANTEL PAMOAT 125 MG TABLET
36 PRIMAKUIN 15 MG TABLET
37 RIFAMPISIN 300 MG TABLET
39 SEFADROKSIL 500 MG TABLET
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET
41 SIPROFLOKSASIN 500 MG TABLET 21
42 TETRASIKLIN 250 MG TABLET
44 THIAMPENIKOL 500 MG TABLET
SEDIAAN NARKOTIKA,PSIKOTROPIKA DAN PREKUSOR

1 ALPRAZOLAM 0,5 MG TAB TABLET
2 ALPRAZOLAM 1 MG TAB TABLET
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 21
5 CLOZAPIN 25 MG TABLET 21
6 DIAZEPAM 2 MG TABLET 21
8 DIAZEPAM INJ 5 MG/ML AMPUL 21
9 FENOBARBITAL 100 MG TABLET
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET
HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50
12 VIAL
MG/ML ) 21
13 HALOPERIDOL 0,5 MG TABLET
15 HALOPERIDOL 5 MG TABLET 21
16 KARBAMAZEPIN 200 MG TABLET 21
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 21
18 KLORPROMAZIN HCL SALUT 25 MG TABLET
19 KLORPROMAZIN HCL INJ 25 MG/ML - 1 ML AMPUL
21 KODEIN HCL 10 MG TABLET
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL
24 LORAZEPAM 2 MG TABLET
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET
26 RISPERIDON 1 MG TAB TABLET 21
28 RISPERIDON 3 MG TAB TABLET
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE
31 TRAMADOL 50 MG TABLET
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 21
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 21
SEDIAAN SIRUP / SUSPENSI

1 AMBROKSOL SYR 15 MG/5 ML BOTOL
2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 21
3 AMOKSISILIN SYRUP KRG FORTE BOTOL
4 ANTASIDA DOEN SYRUP BOTOL 21
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 21

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL
8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL 21
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL 21
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 21
14 PARASETAMOL DROPS 100 MG/ML BOTOL
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 21
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL
18 ZINK SIR 20 MG/5 ML BOTOL 21
19 Sucralfat Suspensi BOTOL 21
SEDIAAN INJEKSI / STERIL / PARENTERAL
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 21
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 21
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL 21
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL

21
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL
12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 21
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL 21
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 21
19 GENTAMISIN INJ 40 MG/ML AMPUL
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 21
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL
28 METAMIZOL INJ 500 MG/ML AMPUL
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 21
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 21
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL 21
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL
37 RANITIDIN INJEKSI 25 MG/ML AMPUL
38 RINGER LAKTAT LARUTAN INFUS KOLF 21
39 SEFOTAKSIM SERBUK INJ 1 G VIAL
40 SEFTRIAKSON SERBUK INJ 1 G VIAL
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL
47 TRAMADOL INJ AMPUL
SEDIAAN OBAT LUAR

ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000
1 IU/g TUBE
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 21

3 ANTI HEMOROID DOEN KOMBINASI SUPPO 21
4 BETAMETASON KRIM 0,1 % TUBE 10
COMBIVENT UDV-KOMBINASI : ipratropium bromida 0,5 mg ,
5 ALUBAG
salbutamol 2,5 mg
6 DULCOLAX 5 MG ( BISAKODIL SUPP 5 MG ) TUBE
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE 21
8 GENTAMISIN SALEP MATA 0,3 % TUBE 21
9 GENTAMYCIN 0,1 % SALF KULIT TUBE
10 HIDROKORTISON KRIM 2,5% TUBE
11 KETOKONAZOL CREM 2% 10 G TUBE 21
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE
13 KLORAMFENIKOL SALEP MATA 1% TUBE 21
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL
15 KLORAMFENIKOL TETES MATA 1 % BOTOL
16 MIKONAZOL KRIM 2% TUBE 21
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP 21
18 OKSITETRASIKLIN SALEP 3% TUBE
19 OKSITETRASIKLIN SALEP MATA 1% TUBE
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL
21 SALISIL BEDAK 2% 50 GRAM KOTAK
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT 21
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE
24 SULFADIAZIN SILVER KREM 1% TUBE
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL
26 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 21
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL
2 VAKSIN TT VIAL
3 VAKSIN DT 10 DOSIS VIAL
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL
5 VAKSIN TD 10 DOSIS VIAL
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL
7 VAKSIN DPT-HB ( Pentabio ) VIAL
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCH

POUCHES @ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI )
9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL

11 VAKSIN FLU BIO 0,5 ML AMPUL
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL
14 ADS 0,05 ML 0NEJECT PCS
16 ADS 5 ML SKIFA PCS
17 DROPPER POLIO BIVALEN DROP
18 PELARUT BCG VIAL
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL
IPV
BAHAN DAN PREPARAT GIGI
1 ETIL KLORIDA SPRAY 100 ML BOTOL
2 FUJI II 1-1-23 BOX
2 FUJI 7 1-1 WHITE BOX
3 FUJI IX GP 1-1 EXTRA A3 BOX
4 FUJI IX ART 1-1 BOX
5 GLASS IONOMER SEMEN (ART) BOTOL
6 KALSIUM HIDROKSIDA PASTA KOTAK
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL
8 MUMMYFYING PASTA KOTAK
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX 21
2 ALKOHOL SWAB COSMOMED @200 BOX
3 ALKOHOL 70% 100 ML AFIFARMA BOTOL
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 21
6 BILIRUBIN DIRECT BOTOL
7 BILIRUBIN TOTAL BOTOL
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS
9 CS-QC SERUM 5 L , DIRUI BOTOL 21
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL
13 CREATININ 2X60 ML, DIRUI BOTOL
14 DILUENT 20 L BF-6500, DIRUI BOX
15 GAMMA GT ,DIRUI BOX
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL
17 GOT (AST ) 2X60 ML, DIRUI BOTOL
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL
19 HBSAG WB 100T SD ,DIRUI PCS 21
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS
21 LYSE BF-6500 , DIRUI PCS
22 NaCl 0,9 INDOREAGENT BOTOL
23 PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % SET

, NaCl 0,9 % )
24 PEWARNA ZIEHL NEELSEN pack
25 STERINTECH Bowie Dick Test Pack PACK
26 TABUNG STERIL EDTA 3 ML PACK
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL
29 YELLOW TIP NESCO PACK '1000S
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS 21
2 ALAT SUNTIK 1 CC , TP PCS
4 ALAT SUNTUK 3 CC, OTSUCATH PCS
7 ALAT SUNTIK 5 CC ,TP PCS 21
8 ASEPTAN + DISP 500ML BOTOL
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 21

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET 21
13 CONNECTING TUBE, AXIMED PCS
14 FACE MASK EAR LOOP, AXIMED PCS
15 FACE MASK EAR LOOP, FESCO PCS
16 FACE MASK TIES ON, AXIMED PCS 21
17 FEEDING TUBE, 40 cm, NO. 10, AXIMED PCS
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS 21
22 INFUSION SET ANAK ( COSMOMED ) PCS 21
23 INFUSION SET DEWASA /20 DROPS PCS 21
24 INFUSION SET Y-TYPE, AXIMED PCS
25 IV CATHETER NO. 18 G NP PCS
26 IV CATHETER NO. 18 G Remedi , Steracath PCS 21
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 21
31 IV CATHETER NO. 24 G Otsucath PCS
32 IV CATHETER NO. 24 G Remedi PCS
33 IV CATHETER NO. 18 WING WITH INJECTION PORT WP PCS
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 21
39 KAPAS BERLEMAK 250 GRAM ROL
40 KAPAS HIDROPIL 250 GRAM ROL 21
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL 21
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 21
44 KASA STERIL 18 x 22 CM ONEMED ROL
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL 21
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 21
48 LISOL BOTOL 21
49 ODEX LARUTAN 500 ML BOTOL
50 ONE SCRUB CAIRAN 5 L GALON
51 NEDLE HOLDER No. 23 ( JARUM SUNTIK ) SET
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL 21
57 RIVANOL 300 ML, ONEMED BOTOL
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 21
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 21
66 SILK PLAIN 3/0 SACHET
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 21
69 SUCTION CATHETER, no. 12, AXIMED ROLL 21
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET 21
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET 21
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS 21
80 WING NEEDLE 27 G PCS
OBAT PROGRAM TB KHUSUS MULTY DRUGS RESISTEN ( MDR )

1 CLOPAZIMIN 100 MG TABLET
2 CYCLOSERINE 250 MG TABLET 21
3 ETHAMBUTOL 400 MG TABLET 21
4 ETHIONAMIDE 250 MG TABLET 21
5 ISONIAZID ( INH ) 300 MG TABLET
6 KANAMYCIN 1 G VIAL
7 LEVOFLOXACIN 250 MG TABLET 21
8 MOXIFLOXACIN 400 MG TABLET
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 21
10 PYRAZINAMIDA 500 MG TABLET 21
11 MASKER N95 TIPE 1860 S PCS 21
12 TP ADS 5 ML PCS
13 BEDAQUILINE (BDQ) 100 MG TABLET 21
LAIN-LAIN
SYPHILLIS 3.0MD 100T, DIRUI TEST
ONE SCRUB 500 ML BOTOL
KAPAS HIDROFIL 1 KG ROL
TERSEDIANYA OBAT/BMHP ( HARI )
5 6 7 8 9 10 11 12
4
LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO
TAHUN 2022
KODE PUSKESMAS : 12
NAMA PUSKESMAS : MELIAU
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
PROPINSI : KALIMANTAN BARAT
ED/
PENERIMAA PEMAKAI
NO NAMA OBAT /BMHP SATUAN STOK AWAL PERSEDIAAN RUSAK/ SISA STOK
N AN
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8
1 ACETYL SISTEIN 200 MG TABLET 3,720 3,720 1,380 2,340
2 ALOPURINOL 100 MG TABLET 3,900 3,900 100 3,800
3 ALOPURINOL 300 MG TABLET 0 - -
4 AMBROKSOL 30 MG TABLET 0 - -
5 AMINOFILIN TABLET 200 MG TABLET 0 - -
6 AMLODIPIN 5 MG TABLET 0 - -
7 AMLODIPIN 10 MG TABLET 1,600 1,600 1,600
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 5,500 5,500 100 5,400
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET 0 - -
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - - -
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 5,500 5,500 5,500
12 ASAM FOLAT 1 MG TABLET - - -
13 ASAM MEFENAMAT 500 MG TABLET 4,500 4,500 200 4,300
14 ATAFULGIT 600 MG ( PULAREX ) TABLET - - -
15 ATROPIN SULFAT 0,5 MG TABLET - - -
16 BETAHISTIN MEYSILAT 6 MG TABLET - - -
17 BISOPROLOL 5 MG TABLET - - -
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET - - -
19 TABLET - - -
Vitamin D 100 IU
20 TABLET - - -
Vitamin D 300 IU
21 CIMETIDIN 200 MG TABLET - - -
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 1,200 1,200 1,200
23 DEKSAMETASON TABLET 0,5 MG TABLET 5,900 5,900 5,900
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET - - -
25 DIGOKSIN 0,25 MG TABLET 800 800 100 700
26 DIMENHIDRINAT 50 MG TAB TABLET 1,800 1,800 1,800
27 DOMPERIDON 10 TAB TABLET 2,700 2,700 2,700
28 FENITOIN NATRIUM 50 MG TABLET - - -
29 FERRO SULFAT 300 MG TABLET SALUT TABLET - - -
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 2,000 2,000 100 1,900
31 FUROSEMIDA 40MG TABLET - - -

32 SACHET 2,300 2,300 2,300
33 GEMFIBROZIL 300 MG TABLET - - -

35 GLIBENKLAMID 5 MG TABLET 1,400 1,400 400 1,000
36 GLIMEPIRID 1 MG TABLET 300 300 200 100
37 HEMAFORT TABLET - - -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET 6,200 6,200 6,200
39 IBUPROFEN 200 MG TABLET 4,400 4,400 4,400
40 IBUPROFEN 400 MG TABLET 800 800 100 700
41 ISOSORBID DINITRAT 5 MG TABLET 800 800 800
42 KALSIUM KARBONAT 500 MG TABLET - - -
43 KALSIUM LAKTAT TABLET 2,800 2,800 100 2,700
44 KAPTOPRIL 12,5 MG TABLET 3,700 3,700 500 3,200
45 KAPTOPRIL 25 MG TABLET 1,100 1,100 1,100
46 KAPTOPRIL 50 MG TABLET - - -
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 4,100 4,100 400 3,700
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET - - -
49 LANSOPRAZOL 30 MG TABLET 1,500 1,500 60 1,440
50 LISINOPRIL 5 MG TABLET 1,000 1,000 1,000 -
51 LORATADIN TABLET 10 MG TABLET 3,500 3,500 3,500
52 LOPERAMID 2 MG TABLET - - -
53 MELOKSIKAM 7,5 MG TABLET - - -
54 MELOKSIKAM 15 MG TABLET - - -
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - - -
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - - -
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET - - -

58 METFORMIN HCl 500 MG TABLET - - -
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - - -
61 METILPREDNISOLON 4 MG TABLET 500 500 500 -
62 METILPREDNISOLON 16 MG TABLET 600 600 600
63 METOKLOPRAMID 10 MG TABLET 2,500 2,500 2,500

64 TABLET 1,520 1,520 1,520
Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - - -

66 NATRIUM BIKARBONAT 500MG TABLET - - -
67 NATRIUM DIKLOFENAK 25 MG TABLET 1,500 1,500 500 1,000
68 NATRIUM DIKLOFENAK 50 MG TABLET - - -
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET - - -
70 NIFEDIPIN 10 MG TABLET 1,100 1,100 100 1,000
71 NIKOTINAMIDE 20 MG TABLET - -
72 OMEPRAZOLE 20 MG TABLET - - -
73 ONDANSENTRON 4 MG TABLET - -
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 10,000 10,000 1,200 8,800
PEHAVRAL TABLET : Fe2Fumarat 20mg, kalsium karbonat 100 mg, Vit.A

400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat
75 Tablet 3,600 3,600 500 3,100
1 mg, Vit. B12 2 mg, Nikotinamide 20 mg, Biotin 0,1 mg, Tembaga
Sulfat 1 mg, Magnesium Sulfat 1 mg, Seng Oksida 0,25 mg
76 PIRIDOKSIN 10 MG TABLET - - -
78 PIROKSIKAM 10 MG TABLET - - -
80 PREDNISON 5 MG TABLET 3,500 3,500 300 3,200
81 PROPANOLOL 40 MG TABLET 2,000 2,000 100 1,900
82 PROPANOLOL 10 MG TABLET - - -
83 PROPILTIOURASIL 100 MG TABLET - - -
84 RANITIDIN 150 MG TABLET 5,500 5,500 400 5,100
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - - -
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - - -
87 SALBUTAMOL 2 MG TABLET - - -
88 SALBUTAMOL 4 MG TABLET 5,600 5,600 100 5,500
89 SETIRIZIN 10 MG TABLET - - -
90 SIMVASTATIN 10 MG TABLET 3,000 3,000 100 2,900
TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat
91 TABLET 79,350 79,350 79,350
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 2,500 2,500 2,500
93 VITAMIN B. COMPLEKS TABLET - - -
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,700 1,700 1,700

-
SEDIAAN ANTIINFEKSI TABLET/KAPLET/KAPSUL -
1 ALBENDAZOL 400 MG TABLET 3,750 3,750 3,750
2 AMOKSISILIN 500 MG TABLET 8,800 8,800 600 8,200
3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET - - -
4 ASIKLOVIR 200 MG TABLET 500 500 500

5 ASIKLOVIR 400 MG TABLET 1,200 1,200 1,200
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - - -
7 CLINDAMISIN 300 MG TABLET 3,000 3,000 200 2,800
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET - - -
9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET - - -
10 DOKSISIKLIN 100 mg TABLET - - -

11 ERITROMISIN 250 MG TABLET 1,000 1,000 1,000
12 ERITROMISIN 500 MG TABLET 2,000 2,000 200 1,800
13 ETAMBUTOL HCL 400 MG TABLET - - -
15 FENOKSIMETIL PENISILIN 250MG TABLET - - -
16 FENOKSIMETIL PENISILIN 500 MG TABLET - - -
17 GRISEOFULVIN 125 MG TABLET - - -
18 ISONIAZIDA ( INH ) 100 MG TABLET - - -
19 ISONIAZIDA ( INH ) 300 MG PAKET - - -
20 KETOKONAZOL 200 MG TABLET 800 800 800
21 KLORAMFENIKOL 250 MG TABLET - - -
22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET - - -
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 4,300 4,300 4,300

24 KUININ SULFAT 200 MG TABLET - - -
25 MEBENDAZOL 100 MG TABLET - - -
26 METRONIDAZOL 250 MG TABLET - - -
27 METRONIDAZOL 500 MG TABLET 6,800 6,800 6,800
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - - -
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 14 14 11 3
30 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 2 PAKET - - -
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET - - -
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET - - -
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET - - -
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET - - -
35 PIRANTEL PAMOAT 125 MG TABLET - - -
36 PRIMAKUIN 15 MG TABLET - - -
37 RIFAMPISIN 300 MG TABLET - - -
39 SEFADROKSIL 500 MG TABLET - - -
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET - - -
41 SIPROFLOKSASIN 500 MG TABLET 3,000 3,000 100 2,900
42 TETRASIKLIN 250 MG TABLET - - -
44 THIAMPENIKOL 500 MG TABLET - - -
1 ALPRAZOLAM 0,5 MG TAB TABLET 2,934 2,934 2,934 -

2 ALPRAZOLAM 1 MG TAB TABLET - - -
3 ALPRAZOLAM 1,5 MG TAB TABLET - - -
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 701 701 130 571
5 CLOZAPIN 25 MG TABLET 860 860 30 830
6 DIAZEPAM 2 MG TABLET 2,112 2,112 90 2,022
8 DIAZEPAM INJ 5 MG/ML AMPUL 204 204 204
9 FENOBARBITAL 100 MG TABLET - - -
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET - - -
12 VIAL 29 29 29
MG/ML )
13 HALOPERIDOL 0,5 MG TABLET - - -
15 HALOPERIDOL 5 MG TABLET 1,555 1,555 65 1,490
16 KARBAMAZEPIN 200 MG TABLET 2,960 2,960 435 2,525
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 582 582 15 567
18 KLORPROMAZIN HCL SALUT 25 MG TABLET - - -
19 KLORPROMAZIN HCL INJ 25 MG/ML - 1 ML AMPUL - - -
21 KODEIN HCL 10 MG TABLET - - -
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET - - -
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL - - -
24 LORAZEPAM 2 MG TABLET - - -
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET - - -
26 RISPERIDON 1 MG TAB TABLET 5 5 5
27 RISPERIDON 2 MG TAB TABLET 1,220 1,220 1,220
28 RISPERIDON 3 MG TAB TABLET - - -
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - - -
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE 1 1 1 -
31 TRAMADOL 50 MG TABLET - - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 1,120 1,120 1,120
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 190 190 60 130

1 AMBROKSOL SYR 15 MG/5 ML BOTOL - - -
2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 200 200 7 193
3 AMOKSISILIN SYRUP KRG FORTE BOTOL - - -
4 ANTASIDA DOEN SYRUP BOTOL 100 100 30 70
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - - -
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 100 100 5 95

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL - - -
8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL 144 144 144
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - - -
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL 200 200 200
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - - -
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL - - -

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 260 260 260
14 PARASETAMOL DROPS 100 MG/ML BOTOL - - -
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL - - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 100 100 100
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - - -
18 ZINK SIR 20 MG/5 ML BOTOL 321 321 321
19 SUCRALFAT SUSPENSI BOTOL 100 100 100
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL - - -
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 60 60 60
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 17 17 17
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL - - -
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL - - -
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - - -
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL 100 100 100
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL - - -
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL - - -
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 8 8 8
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - - -
12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 297 297 3 294

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - - -
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF - - -
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF - - -
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL 100 100 100
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - - -
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 50 50 50
19 GENTAMISIN INJ 40 MG/ML AMPUL - - -
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF - - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 80 80 80
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL - - -
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL - - -
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL - - -
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - - -
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL - - -
28 METAMIZOL INJ 500 MG/ML AMPUL - - -
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - - -
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 12 12 2 10
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL - - -
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 300 300 300
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL - - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL 80 80 80
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL - - -
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL - - -
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - - -
38 RINGER LAKTAT LARUTAN INFUS KOLF 114 114 24 90
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - - -
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - - -
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL - - -
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL - - -
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - - -
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - - -
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL - - -
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL - - -
47 TRAMADOL INJ AMPUL - - -
SEDIAAN OBAT LUAR

1 TUBE - - -
IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 18 18 12 6
3 ANTI HEMOROID DOEN KOMBINASI SUPPO 100 100 100
4 BETAMETASON KRIM 0,1 % TUBE 150 150 150
5 ALUBAG - - -
salbutamol 2,5 mg
6 DULCOLAX 5 MG ( BISAKODIL SUPP 5 MG ) TUBE - - -
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE 10 10 10
8 GENTAMISIN SALEP MATA 0,3 % TUBE 96 96 96
9 GENTAMYCIN 0,1 % SALF KULIT TUBE - - -
10 HIDROKORTISON KRIM 2,5% TUBE - - -
11 KETOKONAZOL CREM 2% 10 G TUBE 60 60 60
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - - -
13 KLORAMFENIKOL SALEP MATA 1% TUBE 72 72 72
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - - -
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - - -
16 MIKONAZOL KRIM 2% TUBE 432 432 432
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP 600 600 600
18 OKSITETRASIKLIN SALEP 3% TUBE - - -
19 OKSITETRASIKLIN SALEP MATA 1% TUBE - - -
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - - -
21 SALISIL BEDAK 2% 50 GRAM KOTAK - - -
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT 96 96 96
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - - -
24 SULFADIAZIN SILVER KREM 1% TUBE - - -
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL - - -
26 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL - - -
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 24 24 24
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL 5 5 5
2 VAKSIN TT VIAL - - -
3 VAKSIN DT 10 DOSIS VIAL - - -
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL - - -
5 VAKSIN TD 10 DOSIS VIAL 6 6 6
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 12 12 12
7 VAKSIN DPT-HB ( Pentabio ) VIAL - - -
VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100
8 POUCH 28 28 28
9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL - - -
10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 1 1 1
11 VAKSIN FLU BIO 0,5 ML AMPUL - - -
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL - - -
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL - - -
14 ADS 0,05 ML 0NEJECT PCS 267 267 267
15 ADS 0,5 ML 0NEJECT PCS 23 23 23
16 ADS 5 ML SKIFA PCS 223 223 223
17 DROPPER POLIO BIVALEN DROP 45 45 45
18 PELARUT BCG VIAL 70 70 70
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL 32 32 32
20 IPV - -
1 ETIL KLORIDA SPRAY 100 ML BOTOL - - -
2 FUJI II 1-1-23 BOX - - -
2 FUJI 7 1-1 WHITE BOX - - -
3 FUJI IX GP 1-1 EXTRA A3 BOX - - -
4 FUJI IX ART 1-1 BOX - - -
5 GLASS IONOMER SEMEN (ART) BOTOL - - -
6 KALSIUM HIDROKSIDA PASTA KOTAK - - -
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL - - -
8 MUMMYFYING PASTA KOTAK - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - - -
2 ALKOHOL SWAB COSMOMED @200 BOX 20 20 6 14
3 ALKOHOL 70% 100 ML AFIFARMA BOTOL - - -
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 13 13 4 9
6 BILIRUBIN DIRECT BOTOL - - -
7 BILIRUBIN TOTAL BOTOL - - -
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS - - -
9 CS-QC SERUM 5 L , DIRUI BOTOL 1 1 1 -
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - - -
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL - - -
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - - -
13 CREATININ 2X60 ML, DIRUI BOTOL - - -
14 DILUENT 20 L BF-6500, DIRUI BOX - - -
15 GAMMA GT ,DIRUI BOX - - -
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - -
17 GOT (AST ) 2X60 ML, DIRUI BOTOL - - -
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL - - -
19 HBSAG WB 100T SD ,DIRUI PCS 50 50 50 -
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS - - -
21 LYSE BF-6500 , DIRUI PCS - - -
22 NaCl 0,9 INDOREAGENT BOTOL - - -
PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % ,
23 SET - - -
NaCl 0,9 % )
24 PEWARNA ZIEHL NEELSEN pack - - -
25 STERINTECH Bowie Dick Test Pack PACK - - -
26 TABUNG STERIL EDTA 3 ML PACK - - -
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - -
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - -
29 YELLOW TIP NESCO PACK '1000S - - -
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS 400 400 400
2 ALAT SUNTIK 1 CC , TP PCS - - -
3 ALAT SUNTIK 3 CC , AXIMED PCS 1,000 1,000 100 900
4 ALAT SUNTUK 3 CC, OTSUCATH PCS - - -
7 ALAT SUNTIK 5 CC ,TP PCS 296 296 296
8 ASEPTAN + DISP 500ML BOTOL - - -
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - - -
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - - -
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 120 120 120
12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET 108 108 108
13 CONNECTING TUBE, AXIMED PCS - - -
14 FACE MASK EAR LOOP, AXIMED PCS - - -
15 FACE MASK EAR LOOP, FESCO PCS - - -
16 FACE MASK TIES ON, AXIMED PCS 1,500 1,500 1,500
17 FEEDING TUBE, 40 cm, NO. 10, AXIMED PCS - - -
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS - - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS 5 5 3 2
21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS 18 18 18
22 INFUSION SET ANAK ( COSMOMED ) PCS 74 74 74
23 INFUSION SET DEWASA /20 DROPS PCS 13 13 13
24 INFUSION SET Y-TYPE, AXIMED PCS - - -
25 IV CATHETER NO. 18 G NP PCS - - -
26 IV CATHETER NO. 18 G Remedi , Steracath PCS 27 27 27
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 137 137 5 132
30 IV CATHETER NO. 22 G Remedi , Steracath PCS 115 115 45 70
31 IV CATHETER NO. 24 G Otsucath PCS - - -
32 IV CATHETER NO. 24 G Remedi PCS 67 67 67
33 IV CATHETER NO. 18 WING WITH INJECTION PORT WP PCS - - -
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS - - -
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 100 100 20 80
39 KAPAS BERLEMAK 250 GRAM ROL - - -
40 KAPAS HIDROPIL 250 GRAM ROL 16 16 16
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - - -
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL 197 197 197
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 8 8 8
44 KASA STERIL 18 x 22 CM ONEMED ROL - - -
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL 125 125 125
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 120 120 120
48 LISOL BOTOL 2 2 1 1
49 ODEX LARUTAN 500 ML BOTOL 10 10 10
50 ONE SCRUB CAIRAN 5 L GALON - - -
51 NEDLE HOLDER No. 23 ( JARUM SUNTIK ) SET - - -
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET - - -
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL 30 30 30
57 RIVANOL 300 ML, ONEMED BOTOL - - -
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR - - -
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - - -
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - - -
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 1,000 1,000 1,000 -
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 1,300 1,300 800 500
66 SILK PLAIN 3/0 SACHET - - -
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET - - -
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 120 120 12 108
69 SUCTION CATHETER, no. 12, AXIMED ROLL 5 5 2 3
70 SUCTION CATHETER, no. 8, AXIMED ROLL 5 5 1 4
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET 2 2 2
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET 2 2 2
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL - - -
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL - - -
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS 25 25 25
80 WING NEEDLE 27 G PCS - - -

1 CLOPAZIMIN 100 MG TABLET - - -
2 CYCLOSERINE 250 MG TABLET 120 120 120
3 ETHAMBUTOL 400 MG TABLET 140 140 140
4 ETHIONAMIDE 250 MG TABLET 120 120 120
5 ISONIAZID ( INH ) 300 MG TABLET - - -
6 KANAMYCIN 1 G VIAL - - -
7 LEVOFLOXACIN 250 MG TABLET 186 186 186
8 MOXIFLOXACIN 400 MG TABLET - - -
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 90 90 90
10 PYRAZINAMIDA 500 MG TABLET 140 140 140
11 MASKER N95 TIPE 1860 S PCS 120 120 120
12 TP ADS 5 ML PCS - - -
BEDAQUILINE 100 mg TABLET 272 272 272
LAIN LAIN
SYPHILLIS 3.0MD 100T, DIRUI TEST - -
ONE SCRUB 500 ML BOTOL - -
- -
- -
- -
JKN
Umum ( Bayar ) Lainnya
JUMLAH KUNJUNGAN RESEP Mandiri Jamkesmas / Jamkesda
Mengetahui Yang Menyerahkan Yang Menerima / M
An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesmas M
Administrator Ahli Muda
Galuh Amalia, S.Si, Apt Lia Nirmawati. A. Md. Far dr. Agaka Sukarya
NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 19660408 19970
N DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2022
LAPORAN BULAN : JANUARI

PERMINTAAN BULAN : FEBRUARI
STOK PERMINTAA PEMBERIAN

OPTMUN N KETERANGAN
APBN APBD BUFFER PROGRAM JUMLAH
10 11=10-9 12 13 14 15 16 17
3,291 951 -
143 - 3,657 -
2,000 -
3,000 -
-
3,000 -
- - 1,600 -
693 - 4,707 -
- - -
3,000 -
- - 5,500 -
2,000 -
286 - 4,014 -
-
-
-
-
2,000 -
3,000 -
3,000 -
-
- - 1,200 -
1,100 - 4,800 -
-
143 - 557 -
550 - 1,250 -
- - 2,700 -
-
-
143 - 1,757 -
1,000 -
110 - 2,190 -
1,000 -
-
791 - 209 -
286 1,000 -
-
- - 6,200 -
- - 4,400 -
1,023 1,000 -
- - 800 -
-
253 - 2,447 -
824 - 2,376 -
- - 1,100 -
2,000 -
681 - 3,019 -
-
416 - 1,024 -
1,000 - ED: 12.21
550 - 2,950 -
3,000 -
3,000 -
3,000 -
3,000 -
3,000 -
-
-
3,000 -
2,000 -
1,800 3,000 -
- - 600 -
550 - 1,950 -
- - 1,520 -
2,000 -
-
714 2,000 -
3,000 -
-
143 1,000 -
-
2,000 -
2,000 -
5,564 - 3,236 -
934 - 2,166 -
3,000 -
-
2,000 -
2,000 -
539 - 2,661 -
143 - 1,757 -
-
1,000 -
571 - 4,529 -
- - -
750 -
3,000 -
143 - 5,357 -
3,000 -
209 - 2,691 -
- - 79,350 -
- - 2,500 -
3,000 -
3,000 -
110 - 1,590 -
-
- - 3,750 -
1,407 - 6,793 -
- - 500 -
- - 1,200 -
2,000 -
286 - 2,514 -
-
-
- - 1,000 -
286 - 1,514 -
-
-
-
-
2,000 -
-
-
110 - 690 -
2,000 -
2,000 -
- - 4,300 -
-
-
-
- - 6,800 -
1,000 -
16 16 -
-
-
-
-
-
1,000 -
-
-
-
2,000 -
-
143 - 2,757 -
-
-
2,000 -
-
1,000 - ED: 01.22

1,000 -
-
384 - 187 -
43 - 787 -
228 - 1,794 -
188 - 1,440 -
- - 204 -
-
-
-
- - 29 -
-
-
93 - 1,397 -
753 - 1,772 -
102 - 465 -
-
20 -
20 -
-
-
-
-
-
66 61 -
- - 1,220 -
-
10 -
10 -
1,000 -
- - 1,120 -
86 - 44 -
-
200 -
10 - 183 -
100 -
109 39 -
7 - 88 -
-
8 - 136 -
100 -
11 - 189 -
100 -
-
55 - 205 -
200 -
-
- - 100 -
200 -
11 - 310 -
- - 100 -
-
- - 60 -
2 - 15 -
-
-
100 -
- - 100 -
-
-
- - 8 -
8 -
15 - 279 -
100 -
-
-
- - 100 -
100 -
- - 50 -
-
50 -
- - 80 -
-
-
200 -
200 -
20 -
20 -
-
200 -
3 - 7 -
-
- - 300 -
-
11 - 69 -
-
-
200 -
111 21 -
50 -
50 -
-
50 -
200 -
50 -
-
-
100 -
-
200 -
17 11 -
- - 100 -
- - 150 -
-
- - 10 -
- - 96 -
100 -
200 -
6 - 55 -
200 -
- - 72 -
100 -
100 -
6 - 427 -
- - 600 -
100 -
-
100 -
200 -
- - 96 -
100 -
50 -
100 -
50 -
- - 24 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
50 -
1 -
1 -
1 -
1 -
1 -
1 -
1 -
1 -
- - -
-
-
-
11 10 -
-
-
-
1 1 -
-
1 -
-
-
-
-
-
-
-
71 71 -
-
-
-
-
-
-
1 -
1 -
-
-
- - 400 -
-
143 - 757 -
-
-
- - 98 -
121 - 175 -
50 -
2 -
50 -
4 - 116 -
- - 108 -
-
-
-
110 - 1,390 -
-
-
-
4 2 -
- - 18 -
- - 74 -
66 100 -
-
-
- - 27 -
-
62 - 70 -
-
64 - 6 -
-
-
-
-
-
-
-
29 - 51 -
-
2 - 14 -
-
1 - 196 -
1 - 7 -
50 -
- - 125 -
6 - 95 -
- - 120 -
1 0 -
50 -
2 -
-
-
-
- - 30 -
- - 20 -
- - 5 -
-
-
-
100 -
100 -
-
500 -
1,429 1,429 -
1,143 643 -
-
-
17 - 91 -
3 - 0 -
1 - 3 -
- - 2 -
- - 2 -
- - 2 -
- - 2 -
- - 2 -
- - 2 -
-
-
- - 25 -
100 -
-
-
- - 120 -
- - 140 -
- - 120 -
-
-
- - 186 -
-
- - 90 -
- - 140 -
- - 120 -
-
- - 272
-
-
-
-
-
Lainnya Jumlah
-
Yang Menerima / Melapor Petugas Pengelola Obat
Kepala Puskesmas Meliau Puskemas Meliau
dr. Agaka Sukaryamin apt. Gusna Sumarti, S. Farm

NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPL
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
PENERIMAA PEMAKAIA ED/

N N HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8
1 ACETYL SISTEIN 200 MG TABLET 2,340 2,340 2,340
2 ALOPURINOL 100 MG TABLET 3,800 3,800 3,800
3 ALOPURINOL 300 MG TABLET - - -
4 AMBROKSOL 30 MG TABLET - - -
5 AMINOFILIN TABLET 200 MG TABLET - - -
6 AMLODIPIN 5 MG TABLET - - -
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 5,400 5,400 5,400
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - - -
13 ASAM MEFENAMAT 500 MG TABLET 4,300 4,300 4,300
19 Vitamin D 100 IU TABLET - - -

20 Vitamin D 300 IU TABLET - - -

25 DIGOKSIN 0,25 MG TABLET 700 700 700
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 1,900 1,900 1,900

32 Trinatrium Sitrat Dihidrat 0,58 g, Glukosa Anhidrat 2,7 g SACHET 2,300 2,300 2,300

35 GLIBENKLAMID 5 MG TABLET 1,000 1,000 1,000
36 GLIMEPIRID 1 MG TABLET 100 100 100
40 IBUPROFEN 400 MG TABLET 700 700 700
41 ISOSORBID DINITRAT 5 MG TABLET 800 800 800
43 KALSIUM LAKTAT TABLET 2,700 2,700 2,700
44 KAPTOPRIL 12,5 MG TABLET 3,200 3,200 3,200
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 3,700 3,700 3,700
49 LANSOPRAZOL 30 MG TABLET 1,440 1,440 1,440
50 LISINOPRIL 5 MG TABLET - - -

61 METILPREDNISOLON 4 MG TABLET - - -

64 Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat TABLET 1,520 1,520 1,520

67 NATRIUM DIKLOFENAK 25 MG TABLET 1,000 1,000 1,000
70 NIFEDIPIN 10 MG TABLET 1,000 1,000 1,000
71 NIKOTINAMIDE 20 MG TABLET - - -
73 ONDANSENTRON 4 MG TABLET - - -
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 8,800 8,800 8,800

75 1 mg, Vit. B12 2 mg, Nikotinamide 20 mg, Biotin 0,1 mg, Tembaga Tablet 3,100 3,100 3,100
80 PREDNISON 5 MG TABLET 3,200 3,200 3,200
81 PROPANOLOL 40 MG TABLET 1,900 1,900 1,900
84 RANITIDIN 150 MG TABLET 5,100 5,100 5,100
88 SALBUTAMOL 4 MG TABLET 5,500 5,500 5,500
90 SIMVASTATIN 10 MG TABLET 2,900 2,900 2,900
91 TABLET 79,350 79,350 79,350
0,4 mg tablet salut

2 AMOKSISILIN 500 MG TABLET 8,200 8,200 8,200

7 CLINDAMISIN 300 MG TABLET 2,800 2,800 2,800


29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 3 3 3
41 SIPROFLOKSASIN 500 MG TABLET 2,900 2,900 2,900

4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 571 571 571
5 CLOZAPIN 25 MG TABLET 830 830 830
6 DIAZEPAM 2 MG TABLET 2,022 2,022 2,022
12 MG/ML ) VIAL 29 29 29

15 HALOPERIDOL 5 MG TABLET 1,490 1,490 1,490
16 KARBAMAZEPIN 200 MG TABLET 2,525 2,525 2,525
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 567 567 567
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 130 130 130

2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 193 193 193
4 ANTASIDA DOEN SYRUP BOTOL 70 70 70
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 95 95 95



12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 294 294 294
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 80 80 70 10
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 10 10 10
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL 80 80 130 - 50
38 RINGER LAKTAT LARUTAN INFUS KOLF 90 90 90
SEDIAAN OBAT LUAR

1 IU/g TUBE - - -
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 6 6 6

5 salbutamol 2,5 mg ALUBAG - - -

VAKSIN
5 VAKSIN TD 10 DOSIS VIAL 6 6 6
8 POUCHES @ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI ) POUCH 28 28 28

14 ADS 0,05 ML 0NEJECT PCS 267 267 267
15 ADS 0,5 ML 0NEJECT PCS 23 23 23
16 ADS 5 ML SKIFA PCS 223 223 223
IPV - - -
2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
2 ALKOHOL SWAB COSMOMED @200 BOX 14 14 14
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 9 9 9
9 CS-QC SERUM 5 L , DIRUI BOTOL - - -
19 HBSAG WB 100T SD ,DIRUI PCS - - -
20 ALERE HIV COMBO PCS - - -
23 NaCl 0,9 % ) SET - - -

29 YELLOW TIP NESCO PACK '1000 - - -
30 SD BIOLINE SYPHILIS 3.0 PCS - - -
BMHP
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 132 132 132
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 80 80 80
48 LISOL BOTOL 1 1 1
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - - -
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 500
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 108 108 108
69 SUCTION CATHETER, no. 12, AXIMED ROLL 3 3 3

9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 90 90 90
13 BEDAQUILINE (BDQ) 100 MG TABLET 272 272 272
LAIN-LAIN
PLESTERIN BULAT NON WOVEN E-CAT BOX - - -
ONE SCRUB 500 ML BOTOL - - -
KAPAS HIDROFIL 1 KG ROL - - -
- - -
- - -
JKN
Mandiri Jamkesmas / Jamkesda
JUMLAH KUNJUNGAN RESEP
Mengetahui Yang Menyerahkan Yang Meneri

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puske
Kepala Bidang Kefarmasian, Sarkes & SDM
Ub. Kasi PPOP, Alkes dan Perbekes
Galuh Amalia, S.Si, Apt Lia Nirmawati. A. Md. Far dr. Agaka
NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 1966040
AN LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2021
LAPORAN BULAN : FEBRUARI

PERMINTAAN BULAN : MARET
PEMBERIAN
PERMINTAA
STOK OPTMUN KETERANGAN
N APBN APBD BUFFER PROGRAM JUMLAH
10 11=10-9 12 13 14 15 16 17
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,000 -
1,000 -
-
-
-
-
-
-
-
-
-
-
-
-
1,000 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- ED: 02.21
-
-
-
-
-
-
-
-
-
-
-
-
- ED: 02.21
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Lainnya Jumlah


NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN : MARET
PROPINSI : KALIMANTAN BARAT PERMINTAAN BULAN : APRIL
ED/ PEMBERIAN
PENERIMAA PEMAKAI STOK PERMINTAA
NO NAMA OBAT /BMHP SATUAN STOK AWAL PERSEDIAAN RUSAK/ SISA STOK KETERANGAN
N AN OPTMUN N APBN APBD BUFFER PROGRAM JUMLAH
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9 12 13 14 15 16 17
1 ACETYL SISTEIN 200 MG TABLET 2,340 2,340 60 2,280 -
2 ALOPURINOL 100 MG TABLET 3,800 3,800 3,800 -
3 ALOPURINOL 300 MG TABLET - - - -
4 AMBROKSOL 30 MG TABLET - - - -
5 AMINOFILIN TABLET 200 MG TABLET - - - -
6 AMLODIPIN 5 MG TABLET - - 700 - 700 -
7 AMLODIPIN 10 MG TABLET 1,600 1,600 1,600 -
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 5,400 5,400 400 5,000 -
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - - 200 - 200 -
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - - - -
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 5,500 5,500 100 5,400 -
12 ASAM FOLAT 1 MG TABLET - - - -
13 ASAM MEFENAMAT 500 MG TABLET 4,300 4,300 200 4,100 -
14 ATAFULGIT 600 MG ( PULAREX ) TABLET - - - -
15 ATROPIN SULFAT 0,5 MG TABLET - - - -
16 BETAHISTIN MEYSILAT 6 MG TABLET - - - -
17 BISOPROLOL 5 MG TABLET - - - -
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET - - - -
19 TABLET - - - -
Vitamin D 100 IU
20 TABLET - - - -
Vitamin D 300 IU
21 CIMETIDIN 200 MG TABLET - - - -
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 1,200 1,200 200 1,000 -
23 DEKSAMETASON TABLET 0,5 MG TABLET 5,900 5,900 1,000 4,900 -
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET - - - -
25 DIGOKSIN 0,25 MG TABLET 700 700 700 -
26 DIMENHIDRINAT 50 MG TAB TABLET 1,800 1,800 200 1,600 -
27 DOMPERIDON 10 TAB TABLET 2,700 2,700 100 2,600 -
28 FENITOIN NATRIUM 50 MG TABLET - - - -
29 FERRO SULFAT 300 MG TABLET SALUT TABLET - - - -
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 1,900 1,900 200 1,700 -
31 FUROSEMIDA 40MG TABLET - - 400 - 400 - ED: 03. 21

32 SACHET 2,300 2,300 2,300 -
33 GEMFIBROZIL 300 MG TABLET - - - -

35 GLIBENKLAMID 5 MG TABLET 1,000 1,000 400 600 -
36 GLIMEPIRID 1 MG TABLET 100 100 100 -
37 HEMAFORT TABLET - - - -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET 6,200 6,200 100 6,100 -
39 IBUPROFEN 200 MG TABLET 4,400 4,400 200 4,200 -
40 IBUPROFEN 400 MG TABLET 700 700 300 400 -
41 ISOSORBID DINITRAT 5 MG TABLET 800 800 800 -
42 KALSIUM KARBONAT 500 MG TABLET - - - -
43 KALSIUM LAKTAT TABLET 2,700 2,700 600 2,100 -
44 KAPTOPRIL 12,5 MG TABLET 3,200 3,200 3,200 -
45 KAPTOPRIL 25 MG TABLET 1,100 1,100 1,000 100 -
46 KAPTOPRIL 50 MG TABLET - - - -
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 3,700 3,700 600 3,100 -
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET - - - -
49 LANSOPRAZOL 30 MG TABLET 1,440 1,440 20 1,420 -
50 LISINOPRIL 5 MG TABLET - - - -
51 LORATADIN TABLET 10 MG TABLET 3,500 3,500 400 3,100 -
52 LOPERAMID 2 MG TABLET - - - -
53 MELOKSIKAM 7,5 MG TABLET - - - -
54 MELOKSIKAM 15 MG TABLET - - - -
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - - - -
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - - - -
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET - - - -

58 METFORMIN HCl 500 MG TABLET - - - -
59 METFORMIN HCl 850 MG TABLET - - 400 - 400 -
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - - 100 - 100 -
61 METILPREDNISOLON 4 MG TABLET - - 1,000 - 1,000 -
62 METILPREDNISOLON 16 MG TABLET 600 600 300 300 -
63 METOKLOPRAMID 10 MG TABLET 2,500 2,500 2,500 -
64
TABLET 1,520 1,440 2,960 160 2,800 -
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - - 100 - 100 -
66 NATRIUM BIKARBONAT 500MG TABLET - - - -
67 NATRIUM DIKLOFENAK 25 MG TABLET 1,000 1,000 100 900 -
68 NATRIUM DIKLOFENAK 50 MG TABLET - - 800 - 800 -
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET - - - -
70 NIFEDIPIN 10 MG TABLET 1,000 1,000 900 100 -
71 NIKOTINAMIDE 20 MG TABLET - - - -
72 OMEPRAZOLE 20 MG TABLET - - 300 - 300 -
73 ONDANSENTRON 4 MG TABLET - - - -
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 8,800 8,800 1,200 7,600 -
75
Tablet 3,100 3,100 300 2,800 -
76 PIRIDOKSIN 10 MG TABLET - - - -
78 PIROKSIKAM 10 MG TABLET - - - -
79 PIROKSIKAM 20 MG TABLET - - - -
80 PREDNISON 5 MG TABLET 3,200 3,200 300 2,900 -
81 PROPANOLOL 40 MG TABLET 1,900 1,900 1,900 -
82 PROPANOLOL 10 MG TABLET - - - -
83 PROPILTIOURASIL 100 MG TABLET - - - -
84 RANITIDIN 150 MG TABLET 5,100 5,100 5,100 -
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - - - -
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - - - -
87 SALBUTAMOL 2 MG TABLET - - - -
88 SALBUTAMOL 4 MG TABLET 5,500 5,500 800 4,700 -
89 SETIRIZIN 10 MG TABLET - - - -
90 SIMVASTATIN 10 MG TABLET 2,900 2,900 360 2,540 -
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat
TABLET 79,350 80,520 159,870 3,120 156,750 -
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 2,500 2,500 2,500 -
93 VITAMIN B. COMPLEKS TABLET - - 500 - 500 -
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - - -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,700 1,700 100 1,600 -

96 GUAIFENISIN TABLET - - -
1 ALBENDAZOL 400 MG TABLET 3,750 3,750 3,750 -
2 AMOKSISILIN 500 MG TABLET 8,200 8,200 1,200 7,000 -
3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET - - - -
4 ASIKLOVIR 200 MG TABLET 500 500 500 -

5 ASIKLOVIR 400 MG TABLET 1,200 1,200 1,200 -
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - - 300 - 300 -
7 CLINDAMISIN 300 MG TABLET 2,800 2,800 2,800 -
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET - - - -
9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET - - - -
10 DOKSISIKLIN 100 mg TABLET - - - -

11 ERITROMISIN 250 MG TABLET 1,000 1,000 200 800 -
12 ERITROMISIN 500 MG TABLET 1,800 1,800 300 1,500 -
13 ETAMBUTOL HCL 400 MG TABLET - - - -
15 FENOKSIMETIL PENISILIN 250MG TABLET - - - -
16 FENOKSIMETIL PENISILIN 500 MG TABLET - - - -
17 GRISEOFULVIN 125 MG TABLET - - 200 - 200 -
18 ISONIAZIDA ( INH ) 100 MG TABLET - - - -
19 ISONIAZIDA ( INH ) 300 MG PAKET - - - -
20 KETOKONAZOL 200 MG TABLET 800 800 300 500 -
21 KLORAMFENIKOL 250 MG TABLET - - - -
22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET - - - -
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 4,300 4,300 300 4,000 -

24 KUININ SULFAT 200 MG TABLET - - - -
25 MEBENDAZOL 100 MG TABLET - - - -
26 METRONIDAZOL 250 MG TABLET - - - -
27 METRONIDAZOL 500 MG TABLET 6,800 6,800 6,800 -
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - - 100 - 100 -
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 3 3 2 1 -
30 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 2 PAKET - - - -
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET - - - -
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET - - - -
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET - - - -
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET - - - -
35 PIRANTEL PAMOAT 125 MG TABLET - - 300 - 300 -
36 PRIMAKUIN 15 MG TABLET - - - -
37 RIFAMPISIN 300 MG TABLET - - - -
39 SEFADROKSIL 500 MG TABLET - - 200 - 200 -
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET - - - -
41 SIPROFLOKSASIN 500 MG TABLET 2,900 2,900 200 2,700 -
42 TETRASIKLIN 250 MG TABLET - - - -
44 THIAMPENIKOL 500 MG TABLET - - - -

1 ALPRAZOLAM 0,5 MG TAB TABLET - 1,000 1,000 300 700 -
2 ALPRAZOLAM 1 MG TAB TABLET - - - -
3 ALPRAZOLAM 1,5 MG TAB TABLET - - - -
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 571 571 158 413 -
5 CLOZAPIN 25 MG TABLET 830 830 830 -
6 DIAZEPAM 2 MG TABLET 2,022 2,022 73 1,949 -
7 DIAZEPAM 5 MG TABLET 1,628 1,628 213 1,415 -
8 DIAZEPAM INJ 5 MG/ML AMPUL 204 204 204 -
9 FENOBARBITAL 100 MG TABLET - - - -
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET - - - -
12 VIAL 29 29 29 -
MG/ML )
13 HALOPERIDOL 0,5 MG TABLET - - - -
15 HALOPERIDOL 5 MG TABLET 1,490 1,490 65 1,425 -
16 KARBAMAZEPIN 200 MG TABLET 2,525 1,000 3,525 225 3,300 -
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 567 567 85 482 -
18 KLORPROMAZIN HCL SALUT 25 MG TABLET - - - -
19 KLORPROMAZIN HCL INJ 25 MG/ML - 1 ML AMPUL - - - -
21 KODEIN HCL 10 MG TABLET - - - -
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET - - - -
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL - - - -
24 LORAZEPAM 2 MG TABLET - - - -
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET - - - -
26 RISPERIDON 1 MG TAB TABLET 5 5 5 -
27 RISPERIDON 2 MG TAB TABLET 1,220 1,220 1,220 -
28 RISPERIDON 3 MG TAB TABLET - - - -
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - - - -
31 TRAMADOL 50 MG TABLET - - - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 1,120 1,120 1,120 -
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 130 130 120 10 -

1 AMBROKSOL SYR 15 MG/5 ML BOTOL - - - -
2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 193 193 193 -
3 AMOKSISILIN SYRUP KRG FORTE BOTOL - - - -
4 ANTASIDA DOEN SYRUP BOTOL 70 70 20 50 -
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - - - -
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 95 95 95 -

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL - - - -
8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL 144 144 144 -
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - - - -
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL 200 200 25 175 -
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - - - -
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL - - - -

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 260 260 260 -
14 PARASETAMOL DROPS 100 MG/ML BOTOL - - - -
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL - - - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 100 100 100 -
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - - - -
18 ZINK SIR 20 MG/5 ML BOTOL 321 321 321 -
19 SUCRALFAT SUSPENSI BOTOL 100 100 8 92
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL - - - -
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 60 60 60 -
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 17 17 17 -
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL - - - -
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL - - - -
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - - 40 - 40 - ED: 03. 21
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL 100 100 100 - - ED: 02. 21
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL - - - -
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL - - - -
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 8 8 8 -
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - - - -

12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 294 294 140 154 -
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - - 20 - 20 -
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF - - - -
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF - - - -
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL 100 100 100 -
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - - 60 - 60 -
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 50 50 50 -
19 GENTAMISIN INJ 40 MG/ML AMPUL - - - -
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF - - - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 10 10 10 -
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL - - - -
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL - - - -
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL - - - -
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - - 10 - 10 -
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL - - - -
28 METAMIZOL INJ 500 MG/ML AMPUL - - - -
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - - - -
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 10 10 5 5 -
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL - - - -
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 300 300 300 100 -
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL - - - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL - 50 - 50 - 50 -
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL - - - -
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL - - - -
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - - 100 - 100 -
38 RINGER LAKTAT LARUTAN INFUS KOLF 90 90 90 100 -
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - - 7 - 7 -
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - - 20 - 20 - ED: 03. 21
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL - - - -
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL - - - -
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - - - -
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - - 38 - 38 - Berubah Warna
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL - - - -
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL - - - -
47 TRAMADOL INJ AMPUL - - - 50 -
SEDIAAN OBAT LUAR

1 TUBE - - - -
IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 6 6 1 5 -
3 ANTI HEMOROID DOEN KOMBINASI SUPPO 100 100 45 55 -
4 BETAMETASON KRIM 0,1 % TUBE 150 150 150 -
5 ALUBAG - - - -
salbutamol 2,5 mg
6 DULCOLAX 5 MG ( BISAKODIL SUPP 5 MG ) TUBE - - - -
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE 10 10 10 -
8 GENTAMISIN SALEP MATA 0,3 % TUBE 96 96 3 93 -
9 GENTAMYCIN 0,1 % SALF KULIT TUBE - - - -
10 HIDROKORTISON KRIM 2,5% TUBE - - 48 - 48 -
11 KETOKONAZOL CREM 2% 10 G TUBE 60 60 30 30 -
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - - - -
13 KLORAMFENIKOL SALEP MATA 1% TUBE 72 72 72 -
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - - - -
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - - - -
16 MIKONAZOL KRIM 2% TUBE 432 432 24 408 -
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP 600 600 100 500 -
18 OKSITETRASIKLIN SALEP 3% TUBE - - - -
19 OKSITETRASIKLIN SALEP MATA 1% TUBE - - - -
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - - - -
21 SALISIL BEDAK 2% 50 GRAM KOTAK - - - -
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT 96 96 96 -
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - - - -
24 SULFADIAZIN SILVER KREM 1% TUBE - - - -
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL - - - -
26 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL - - - -
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 24 24 1 23 -
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL 5 85 90 22 68 -
2 VAKSIN TT VIAL - - - -
3 VAKSIN DT 10 DOSIS VIAL - - - -
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL - 50 50 50 -
5 VAKSIN TD 10 DOSIS VIAL 6 10 16 9 7 -
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 12 60 72 34 38 -
7 VAKSIN DPT-HB ( Pentabio ) VIAL - 60 60 32 28 -
8 POUCH 28 90 118 25 93 -
9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL - - - -
10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 1 1 1 -
11 VAKSIN FLU BIO 0,5 ML AMPUL - - - -
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL - - - -
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL - - - -
14 ADS 0,05 ML 0NEJECT PCS 267 200 467 65 402 -
15 ADS 0,5 ML 0NEJECT PCS 23 600 623 55 568 -
16 ADS 5 ML SKIFA PCS 223 200 423 423 -
17 DROPPER POLIO BIVALEN DROP 45 60 105 105 -
18 PELARUT BCG VIAL 70 85 155 155 -
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL 32 50 82 82 -
IPV - 50 50 10 40
1 ETIL KLORIDA SPRAY 100 ML BOTOL - - - -
2 FUJI II 1-1-23 BOX - - - -
2 FUJI 7 1-1 WHITE BOX - - - -
3 FUJI IX GP 1-1 EXTRA A3 BOX - - - -
4 FUJI IX ART 1-1 BOX - - - -
5 GLASS IONOMER SEMEN (ART) BOTOL - - - -
6 KALSIUM HIDROKSIDA PASTA KOTAK - - - -
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL - - - -
8 MUMMYFYING PASTA KOTAK - - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - - - -
2 ALKOHOL SWAB COSMOMED @200 BOX 14 14 14 -
3 ALKOHOL 70% 100 ML AFIFARMA BOTOL - - - -
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 9 9 1 8 10 -
6 BILIRUBIN DIRECT BOTOL - - - 1 -
7 BILIRUBIN TOTAL BOTOL - - - 1 -
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS - - - 1 -
9 CS-QC SERUM 5 L , DIRUI BOTOL - - - 1 -
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - - - 2 -
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL - - - -
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - - - 1 -
13 CREATININ 2X60 ML, DIRUI BOTOL - - - 1 -
14 DILUENT 20 L BF-6500, DIRUI BOX - - - 2 -
15 GAMMA GT ,DIRUI BOX - - - 1 -
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
17 GOT (AST ) 2X60 ML, DIRUI BOTOL - - - 1 -
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL - - - 1 -
19 HBSAG WB 100T SD ,DIRUI PCS - - - 100 -
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS - - - -
21 LYSE BF-6500 , DIRUI PCS - - - 2 -
22 NaCl 0,9 INDOREAGENT BOTOL - - - -
23 SET - - - -
NaCl 0,9 % )
24 PEWARNA ZIEHL NEELSEN pack - - - 4 -
25 STERINTECH Bowie Dick Test Pack PACK - - - -
26 TABUNG STERIL EDTA 3 ML PACK - - - -
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
29 YELLOW TIP NESCO PACK '1000S - - - -
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS 400 400 200 200 -
2 ALAT SUNTIK 1 CC , TP PCS - - - -
4 ALAT SUNTUK 3 CC, OTSUCATH PCS - - - -
6 ALAT SUNTIK 5 CC , AXIMED PCS 98 98 98 -
7 ALAT SUNTIK 5 CC ,TP PCS 296 296 27 269 -
8 ASEPTAN + DISP 500ML BOTOL - - - -
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - - - -
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - - - -
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 120 120 6 114 -
12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET 108 108 108 -
13 CONNECTING TUBE, AXIMED PCS - - - -
14 FACE MASK EAR LOOP, AXIMED PCS - - - -
15 FACE MASK EAR LOOP, FESCO PCS - - - -
16 FACE MASK TIES ON, AXIMED PCS 1,500 1,500 1,500 -
17 FEEDING TUBE, 40 cm, NO. 10, AXIMED PCS - - - -
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS - - - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS 2 2 1 1 -
22 INFUSION SET ANAK ( COSMOMED ) PCS 74 74 1 73 -
23 INFUSION SET DEWASA /20 DROPS PCS 13 13 75 - 62 -
24 INFUSION SET Y-TYPE, AXIMED PCS - - - -
25 IV CATHETER NO. 18 G NP PCS - - - -
26 IV CATHETER NO. 18 G Remedi , Steracath PCS 27 27 9 18 -
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 132 132 70 62 -
30 IV CATHETER NO. 22 G Remedi , Steracath PCS 70 350 420 150 270 -
31 IV CATHETER NO. 24 G Otsucath PCS - - - -
32 IV CATHETER NO. 24 G Remedi PCS 67 67 20 47 -
33 IV CATHETER NO. 18 WING WITH INJECTION PORT WP PCS - - - -
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS - - - -
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 80 80 80 -
39 KAPAS BERLEMAK 250 GRAM ROL - - - -
40 KAPAS HIDROPIL 250 GRAM ROL 16 16 1 15 -
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - - 84 - 84 -
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL 197 197 197 -
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 8 8 8 -
44 KASA STERIL 18 x 22 CM ONEMED ROL - - - -
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL 125 125 125 -
46 KASA PEMBALUT HIDROFIL 4 M x 10 CM ROL 100 100 25 75 -
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 120 120 5 115 -
48 LISOL BOTOL 1 1 3 - 2 -
49 ODEX LARUTAN 500 ML BOTOL 10 10 10 -
50 ONE SCRUB CAIRAN 5 L GALON - 9 9 9 -
51 NEDLE HOLDER No. 23 ( JARUM SUNTIK ) SET - - - -
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET - - - -
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL 30 30 30 -
57 RIVANOL 300 ML, ONEMED BOTOL - - 2 - 2 -
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR - - - -
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - - 50 - 50 -
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - - 600 - 600 -
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - - 200 - 200 -
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 500 -
66 SILK PLAIN 3/0 SACHET - - - -
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET - - - -
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 108 108 108 -
69 SUCTION CATHETER, no. 12, AXIMED ROLL 3 3 3 -
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET 2 2 2 -
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET 2 2 2 -
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL - - - -
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL - - - -
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS 25 25 25 -
80 WING NEEDLE 27 G PCS - - - -

1 CLOPAZIMIN 100 MG TABLET - - - -
2 CYCLOSERINE 250 MG TABLET 120 120 60 60 120 -
3 ETHAMBUTOL 400 MG TABLET 140 140 60 80 148 -
4 ETHIONAMIDE 250 MG TABLET 120 120 60 60 140 -
5 ISONIAZID ( INH ) 300 MG TABLET - - - -
6 KANAMYCIN 1 G VIAL - - - -
7 LEVOFLOXACIN 250 MG TABLET 186 186 90 96 174 -
8 MOXIFLOXACIN 400 MG TABLET - - 200 - 200 - DIKEMBALIKAN KE IFK
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 90 90 30 60 -
10 PYRAZINAMIDA 500 MG TABLET 140 140 60 80 120 -
11 MASKER N95 TIPE 1860 S PCS 120 120 120 -
12 TP ADS 5 ML PCS - - - -
13 BEDAQUILINE (BDQ) 100 MG TABLET 272 272 120 152 344 -
LAIN-LAIN
PLESTERIN BULAT NON WOVEN E-CAT BOX - - - 2 -
ONE SCRUB 500 ML BOTOL - - 3 - 3 -
KAPAS HIDROFIL 1 KG ROL - - - -
- - - -
- - - -
JKN
Umum ( Bayar ) Lainnya Jumlah
-
Mengetahui Yang Menyerahkan Yang Menerima / Melapor Petugas Pengelola Obat
An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesmas Meliau Puskemas Meliau

Galuh Amalia, S.Si, Apt Lia Nirmawati. A. Md. Far dr. Agaka Sukaryamin apt. Gusna Sumarti, S. Farm
NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN : APRIL
PROPINSI : KALIMANTAN BARAT PERMINTAAN BULAN : MEI
ED/ PEMBERIAN
N AN HILANG OPTMUN N APBN APBD BUFFER PROGRAM JUMLAH
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9 12 13 14 15 16 17
1 ACETYL SISTEIN 200 MG TABLET 2,280 2,280 600 1,680 -
2 ALOPURINOL 100 MG TABLET 3,800 3,800 3,800 -
3 ALOPURINOL 300 MG TABLET - - - -
4 AMBROKSOL 30 MG TABLET - - 100 - 100 -
5 AMINOFILIN TABLET 200 MG TABLET - - - -
6 AMLODIPIN 5 MG TABLET - 700 1,800 1,100 600 500 1,000 -
7 AMLODIPIN 10 MG TABLET 1,600 1,600 1,600 1,000 -
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 5,000 500 5,500 5,500 -
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - 200 - 200 - 200 -
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - - - 2,000 -
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 5,400 5,400 5,400 -
12 ASAM FOLAT 1 MG TABLET - - - -
13 ASAM MEFENAMAT 500 MG TABLET 4,100 500 4,600 700 3,900 -
14 ATAFULGIT 600 MG ( PULAREX ) TABLET - - - -
15 ATROPIN SULFAT 0,5 MG TABLET - - - -
16 BETAHISTIN MEYSILAT 6 MG TABLET - - - -
17 BISOPROLOL 5 MG TABLET - - - 1,000 -
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET - - - 2,000 -
19 CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg, TABLET - - - 2,000 -
Vitamin D 100 IU
20 TABLET - - - 2,000 -
Vitamin D 300 IU
21 CIMETIDIN 200 MG TABLET - - - -
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 1,000 600 1,600 1,600 -
23 DEKSAMETASON TABLET 0,5 MG TABLET 4,900 2,500 7,400 1,000 6,400 -
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET - - - -
25 DIGOKSIN 0,25 MG TABLET 700 700 700 1,000 -
26 DIMENHIDRINAT 50 MG TAB TABLET 1,600 500 2,100 200 1,900 -
27 DOMPERIDON 10 TAB TABLET 2,600 500 3,100 400 2,700 -
28 FENITOIN NATRIUM 50 MG TABLET - - - -
29 FERRO SULFAT 300 MG TABLET SALUT TABLET - - - -
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 1,700 1,700 1,700 -
31 FUROSEMIDA 40MG TABLET - 400 - 400 - 400 1,000 -

32 SACHET 2,300 2,300 2,300 -
33 GEMFIBROZIL 300 MG TABLET - - - 1,000 -

35 GLIBENKLAMID 5 MG TABLET 600 600 600 -
36 GLIMEPIRID 1 MG TABLET 100 100 100 -
37 HEMAFORT TABLET - - - 1,000 -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET 6,100 6,100 100 6,000 -
39 IBUPROFEN 200 MG TABLET 4,200 4,200 4,200 -
40 IBUPROFEN 400 MG TABLET 400 400 200 200 2,000 -
41 ISOSORBID DINITRAT 5 MG TABLET 800 800 800 1,000 -
42 KALSIUM KARBONAT 500 MG TABLET - - - -
43 KALSIUM LAKTAT TABLET 2,100 2,100 300 1,800 -
44 KAPTOPRIL 12,5 MG TABLET 3,200 3,200 100 3,100 -
45 KAPTOPRIL 25 MG TABLET 100 2,000 2,100 300 1,800 -
46 KAPTOPRIL 50 MG TABLET - - - -
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 3,100 1,500 4,600 400 4,200 1,000 -
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET - - - -
49 LANSOPRAZOL 30 MG TABLET 1,420 1,420 180 1,240 -
50 LISINOPRIL 5 MG TABLET - - - 1,000 -
51 LORATADIN TABLET 10 MG TABLET 3,100 1,000 4,100 300 3,800 -
52 LOPERAMID 2 MG TABLET - - - 2,000 -
53 MELOKSIKAM 7,5 MG TABLET - - - 2,000 -
54 MELOKSIKAM 15 MG TABLET - - - 2,000 -
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - - - -
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - - - 2,000 -
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET - - - -

58 METFORMIN HCl 500 MG TABLET - - - -
59 METFORMIN HCl 850 MG TABLET - 400 500 100 700 - 600 -
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - 100 - 100 - 100 -
61 METILPREDNISOLON 4 MG TABLET - 1,000 2,000 1,000 400 600 1,000 -
62 METILPREDNISOLON 16 MG TABLET 300 1,000 1,300 200 1,100 1,000 -
63 METOKLOPRAMID 10 MG TABLET 2,500 1,000 3,500 3,500 -

64 TABLET 2,800 2,800 2,800 -
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - 100 - 100 - 100 -

66 NATRIUM BIKARBONAT 500MG TABLET - - - -
67 NATRIUM DIKLOFENAK 25 MG TABLET 900 900 200 700 -
68 NATRIUM DIKLOFENAK 50 MG TABLET - 800 1,000 200 800 - 600 -
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET - - - -
70 NIFEDIPIN 10 MG TABLET 100 3,000 3,100 3,100 -
71 NIKOTINAMIDE 20 MG TABLET - - - -
72 OMEPRAZOLE 20 MG TABLET - 300 - 300 200 - 500 1,000 -
73 ONDANSENTRON 4 MG TABLET - - - 1,000 -
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 7,600 2,000 9,600 1,300 8,300 2,000 -

75 400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat Tablet 2,800 2,800 2,800 2,000 -
76 PIRIDOKSIN 10 MG TABLET - - 600 - 600 -

78 PIROKSIKAM 10 MG TABLET - - - 1,000 -
79 PIROKSIKAM 20 MG TABLET - - - 1,000 -
80 PREDNISON 5 MG TABLET 2,900 2,900 500 2,400 -
81 PROPANOLOL 40 MG TABLET 1,900 1,900 1,900 1,000 -
82 PROPANOLOL 10 MG TABLET - - - 1,000 -
83 PROPILTIOURASIL 100 MG TABLET - - - -
84 RANITIDIN 150 MG TABLET 5,100 5,100 5,100 -
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - - - -
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - - - -
87 SALBUTAMOL 2 MG TABLET - - - 2,000 -
88 SALBUTAMOL 4 MG TABLET 4,700 2,000 6,700 500 6,200 -
89 SETIRIZIN 10 MG TABLET - - - 2,000 -
90 SIMVASTATIN 10 MG TABLET 2,540 600 3,140 300 2,840 -
91 TABLET 156,750 156,750 3,450 153,300 -
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 2,500 2,500 2,500 -
93 VITAMIN B. COMPLEKS TABLET - 500 - 500 - 500 2,000 -
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - - 2,000 -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,600 1,600 100 1,500 -

96 GUAIFENISIN TABLET - - - -
1 ALBENDAZOL 400 MG TABLET 3,750 3,750 3,750 -
2 AMOKSISILIN 500 MG TABLET 7,000 7,000 800 6,200 -
3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET - - - -
4 ASIKLOVIR 200 MG TABLET 500 500 500 -

5 ASIKLOVIR 400 MG TABLET 1,200 1,200 1,200 -
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - 300 500 200 100 100 -
7 CLINDAMISIN 300 MG TABLET 2,800 2,800 2,800 -
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET - - - -
9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET - - - -
10 DOKSISIKLIN 100 mg TABLET - - - -

11 ERITROMISIN 250 MG TABLET 800 800 800 -
12 ERITROMISIN 500 MG TABLET 1,500 1,500 200 1,300 -
15 FENOKSIMETIL PENISILIN 250MG TABLET - - - -
16 FENOKSIMETIL PENISILIN 500 MG TABLET - - - -
17 GRISEOFULVIN 125 MG TABLET - 200 - 200 - 200 -
18 ISONIAZIDA ( INH ) 100 MG TABLET - - - -
19 ISONIAZIDA ( INH ) 300 MG PAKET - - - -
20 KETOKONAZOL 200 MG TABLET 500 1,000 1,500 250 1,250 -
21 KLORAMFENIKOL 250 MG TABLET - - - -
22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET - - - -
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 4,000 4,000 200 3,800 -

24 KUININ SULFAT 200 MG TABLET - - - -
25 MEBENDAZOL 100 MG TABLET - - - -
26 METRONIDAZOL 250 MG TABLET - - 200 - 200 -
27 METRONIDAZOL 500 MG TABLET 6,800 6,800 6,800 -
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - 100 - 100 - 100 -
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 1 1 1 -
30 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 2 PAKET - - - -
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET - - - -
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET - - - -
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET - - - -
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET - - - -
35 PIRANTEL PAMOAT 125 MG TABLET - 300 - 300 100 - 400 -
36 PRIMAKUIN 15 MG TABLET - - - -
39 SEFADROKSIL 500 MG TABLET - 200 - 200 - 200 -
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET - - - -
41 SIPROFLOKSASIN 500 MG TABLET 2,700 2,700 300 2,400 -
44 THIAMPENIKOL 500 MG TABLET - - - -
-
1 ALPRAZOLAM 0,5 MG TAB TABLET 700 200 900 335 565 -
2 ALPRAZOLAM 1 MG TAB TABLET - - - -
3 ALPRAZOLAM 1,5 MG TAB TABLET - - - -
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 413 500 913 135 778 -
5 CLOZAPIN 25 MG TABLET 830 830 830 -
6 DIAZEPAM 2 MG TABLET 1,949 200 2,149 5 2,144 -
7 DIAZEPAM 5 MG TABLET 1,415 700 2,115 30 2,085 -
8 DIAZEPAM INJ 5 MG/ML AMPUL 204 204 204 -
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET - - - -
12 MG/ML ) VIAL 29 29 29 -

15 HALOPERIDOL 5 MG TABLET 1,425 1,425 110 1,315 -
16 KARBAMAZEPIN 200 MG TABLET 3,300 3,300 445 2,855 -
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 482 200 682 30 652 -
18 KLORPROMAZIN HCL SALUT 25 MG TABLET - - - -
21 KODEIN HCL 10 MG TABLET - - - -
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET - - - -
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL - - - -
24 LORAZEPAM 2 MG TABLET - - - -
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET - - - -
26 RISPERIDON 1 MG TAB TABLET 5 5 5 -
27 RISPERIDON 2 MG TAB TABLET 1,220 1,220 130 1,090 -
28 RISPERIDON 3 MG TAB TABLET - - - -
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE - - 2 - 2 -
31 TRAMADOL 50 MG TABLET - - - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 1,120 1,120 1,120 -
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 10 10 10 -
-
1 AMBROKSOL SYR 15 MG/5 ML BOTOL - - - -
2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 193 193 193 -
3 AMOKSISILIN SYRUP KRG FORTE BOTOL - - - -
4 ANTASIDA DOEN SYRUP BOTOL 50 50 70 - 20 -
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - - - -
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 95 95 95 -

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL - - - -
8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL 144 144 144 -
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - - - -
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL 175 100 275 275 -
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - - - -
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL - - - -

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 260 260 50 210 -
14 PARASETAMOL DROPS 100 MG/ML BOTOL - - - -
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL - - - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 100 100 100 -
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - - - -
18 ZINK SIR 20 MG/5 ML BOTOL 321 321 321 -
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL - - - -
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 60 60 60 -
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 17 17 17 -
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL - - - -
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL - - - -
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - 40 - 40 - 40 -
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL - - - -
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL - - - -
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL - - - -
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 8 8 8 -
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - - - -

12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 154 154 154 -
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - 20 30 10 10 -
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF - - - -
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF - 100 100 100 -
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL 100 100 100 -
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - 60 - 60 - 60 -
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 50 50 50 -
19 GENTAMISIN INJ 40 MG/ML AMPUL - - - -
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF - - - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 10 10 10 -
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL - - - -
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL - - - -
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL - - - -
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - 10 - 10 - 10 -
28 METAMIZOL INJ 500 MG/ML AMPUL - - - -
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - - - -
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 5 5 5 -
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL - - - -
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 300 200 500 500 -
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL - - - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL - 50 100 50 50 -
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL - - - -
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL - - - -
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - 100 - 100 - 100 -
38 RINGER LAKTAT LARUTAN INFUS KOLF 90 90 90 -
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - 7 - 7 - 7 -
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - 20 - 20 - 20 -
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL - - - -
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL - - - -
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - - - -
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - 38 - 38 - 38 -
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL - - - -
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL - - - -
47 TRAMADOL INJ AMPUL - - - -
- - - -
SEDIAAN OBAT LUAR
1 TUBE - - 25 - 25 -
IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 5 5 5 -
3 ANTI HEMOROID DOEN KOMBINASI SUPPO 55 55 55 -
4 BETAMETASON KRIM 0,1 % TUBE 150 150 150 -
5 COMBIVENT UDV-KOMBINASI : ipratropium bromida 0,5 mg , ALUBAG - - - -

salbutamol 2,5 mg
6 DULCOLAX 5 MG ( BISAKODIL SUPP 5 MG ) TUBE - - - -
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE 10 10 10 -
8 GENTAMISIN SALEP MATA 0,3 % TUBE 93 93 93 -
9 GENTAMYCIN 0,1 % SALF KULIT TUBE - - - -
10 HIDROKORTISON KRIM 2,5% TUBE - 48 170 122 4 118 -
11 KETOKONAZOL CREM 2% 10 G TUBE 30 50 80 20 60 -
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - - - -
13 KLORAMFENIKOL SALEP MATA 1% TUBE 72 72 72 -
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - - - -
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - - - -
16 MIKONAZOL KRIM 2% TUBE 408 408 24 384 -
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP 500 100 600 600 -
18 OKSITETRASIKLIN SALEP 3% TUBE - - - -
19 OKSITETRASIKLIN SALEP MATA 1% TUBE - - - -
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - - - -
21 SALISIL BEDAK 2% 50 GRAM KOTAK - - - -
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT 96 96 96 -
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - - - -
24 SULFADIAZIN SILVER KREM 1% TUBE - - - -
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL - - - -
26 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL - - - -
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 23 23 4 19 -
-
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL 68 68 48 20 -
2 VAKSIN TT VIAL - - - -
3 VAKSIN DT 10 DOSIS VIAL - - - -
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 50 50 32 18 -
5 VAKSIN TD 10 DOSIS VIAL 7 7 16 - 9 -
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 38 38 25 13 -
7 VAKSIN DPT-HB ( Pentabio ) VIAL 28 28 14 14 -
8 POUCHES @ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI ) POUCH 93 93 54 39 -
9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL - - - -

10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 1 1 1 -
11 VAKSIN FLU BIO 0,5 ML AMPUL - - - -
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL - - - -
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL - - - -
14 ADS 0,05 ML 0NEJECT PCS 402 402 35 367 -
15 ADS 0,5 ML 0NEJECT PCS 568 568 572 - 4 -
16 ADS 5 ML SKIFA PCS 423 423 27 396 -
17 DROPPER POLIO BIVALEN DROP 105 105 15 90 -
18 PELARUT BCG VIAL 155 155 15 140 -
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL 82 82 18 64 -

1 ETIL KLORIDA SPRAY 100 ML BOTOL - - - -
2 FUJI II 1-1-23 BOX - - - -
2 FUJI 7 1-1 WHITE BOX - - - -
3 FUJI IX GP 1-1 EXTRA A3 BOX - - - -
4 FUJI IX ART 1-1 BOX - - - -
5 GLASS IONOMER SEMEN (ART) BOTOL - - - -
6 KALSIUM HIDROKSIDA PASTA KOTAK - - - -
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL - - - -
8 MUMMYFYING PASTA KOTAK - - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - - - -
2 ALKOHOL SWAB COSMOMED @200 BOX 14 14 14 -
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL - 5 5 5 -
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 8 5 13 4 9 -
6 BILIRUBIN DIRECT BOTOL - - - -
7 BILIRUBIN TOTAL BOTOL - - - -
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS - - - -
9 CS-QC SERUM 5 L , DIRUI BOTOL - 1 1 1 - -
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - - - -
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL - - - -
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - - - -
13 CREATININ 2X60 ML, DIRUI BOTOL - - - -
14 DILUENT 20 L BF-6500, DIRUI BOX - - - -
15 GAMMA GT ,DIRUI BOX - - - -
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
17 GOT (AST ) 2X60 ML, DIRUI BOTOL - - - -
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL - - - -
19 HBSAG WB 100T SD ,DIRUI PCS - - - -
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS - - - -
21 LYSE BF-6500 , DIRUI PCS - 2 2 2 - -
22 NaCl 0,9 INDOREAGENT BOTOL - - - -
23 SET - - - -
NaCl 0,9 % )
24 PEWARNA ZIEHL NEELSEN pack - 4 4 4 - -
25 STERINTECH Bowie Dick Test Pack PACK - - - -
26 TABUNG STERIL EDTA 3 ML PACK - - - -
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - -
29 YELLOW TIP NESCO PACK '1000S - - - -
-
BMHP
3 ALAT SUNTIK 3 CC , AXIMED PCS 400 1,200 1,600 1,600 -
4 ALAT SUNTUK 3 CC, OTSUCATH PCS - - - -
7 ALAT SUNTIK 5 CC ,TP PCS 269 269 269 -
8 ASEPTAN + DISP 500ML BOTOL - - - -
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - - - -
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - - - -
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 114 114 24 90 -

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET 108 108 108 -
13 CONNECTING TUBE, AXIMED PCS - - - -
14 FACE MASK EAR LOOP, AXIMED PCS - - - -
15 FACE MASK EAR LOOP, FESCO PCS - - - -
16 FACE MASK TIES ON, AXIMED PCS 1,500 1,500 1,500 -
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS - - - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS 1 1 4 - 3 -
22 INFUSION SET ANAK ( COSMOMED ) PCS 73 73 9 64 -
23 INFUSION SET DEWASA /20 DROPS PCS - 62 150 88 20 68 -
24 INFUSION SET Y-TYPE, AXIMED PCS - - - -
26 IV CATHETER NO. 18 G Remedi , Steracath PCS 18 150 168 106 62 -
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 62 150 212 30 182 -
30 IV CATHETER NO. 22 G Remedi , Steracath PCS 270 270 270 -
31 IV CATHETER NO. 24 G Otsucath PCS - - - -
32 IV CATHETER NO. 24 G Remedi PCS 47 47 47 -
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS - - - -
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 80 80 80 -
39 KAPAS BERLEMAK 250 GRAM ROL - - - -
40 KAPAS HIDROPIL 250 GRAM ROL 15 15 15 -
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - 84 100 16 16 -
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL 197 197 197 -
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 8 8 8 -
44 KASA STERIL 18 x 22 CM ONEMED ROL - - - -
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL 125 125 125 -
46 KASA PEMBALUT HIDROFIL 4 M x 10 CM ROL 75 25 100 100 -
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 115 115 115 -
48 LISOL BOTOL - 2 - 2 - 2 -
49 ODEX LARUTAN 500 ML BOTOL 10 10 10 -
50 ONE SCRUB CAIRAN 5 L GALON 9 9 9 -
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET - - - -
57 RIVANOL 300 ML, ONEMED BOTOL - 2 - 2 - 2 -
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - 50 - 50 - 50 -
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - 600 500 - 100 500 - 600 -
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - 200 - 200 - 200 -
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 500 -
66 SILK PLAIN 3/0 SACHET - - - -
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET - - - -
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 108 108 108 -
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL - - - -
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL - - - -
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS 25 25 25 -
80 WING NEEDLE 27 G PCS - - - -
-
1 CLOPAZIMIN 100 MG TABLET - - - -
2 CYCLOSERINE 250 MG TABLET 60 120 180 60 120 -
3 ETHAMBUTOL 400 MG TABLET 80 168 248 60 188 -
4 ETHIONAMIDE 250 MG TABLET 60 140 200 60 140 -
5 ISONIAZID ( INH ) 300 MG TABLET - - - -
6 KANAMYCIN 1 G VIAL - - - -
7 LEVOFLOXACIN 250 MG TABLET 96 180 276 90 186 -
8 MOXIFLOXACIN 400 MG TABLET - 200 - 200 - 200 -
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 60 60 30 30 -
10 PYRAZINAMIDA 500 MG TABLET 80 140 220 60 160 -
11 MASKER N95 TIPE 1860 S PCS 120 120 240 240 -
12 TP ADS 5 ML PCS - - - -
13 BEDAQUILINE (BDQ) 100 MG TABLET 152 188 340 120 220 - 220
LAIN-LAIN -
PLESTERIN BULAT NON WOVEN E-CAT BOX - - - -
ONE SCRUB 500 ML BOTOL - 3 - 3 - 3 -
KAPAS HIDROFIL 1 KG ROL - - - -
- - - -
- - - -
JKN
-

NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN : MEI
PROPINSI : KALIMANTAN BARAT PERMINTAAN BULAN : JUNI
ED/ PEMBERIAN
N AN OPTMUN N APBN APBD BUFFER PROGRAM JUMLAH
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9 12 13 14 15 16 17

1 ACETYL SISTEIN 200 MG TABLET 1,680 1,680 120 1,560 1,000
4 AMBROKSOL 30 MG TABLET - 100 - 100 - 100 1,000
6 AMLODIPIN 5 MG TABLET 500 500 200 300 1,000
7 AMLODIPIN 10 MG TABLET 1,600 1,600 1,600 2,000
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - 200 - 200 - 200
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - - - 2,000
13 ASAM MEFENAMAT 500 MG TABLET 3,900 3,900 100 3,800 2,000
17 BISOPROLOL 5 MG TABLET - - - 1,000
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET - - - 2,000
19 CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg, Vitamin D 100 IU TABLET - - - 2,000
20 CALPOROSIS D 800 : Tablet Mineral + Multivitamin : Ca. 500 mg, Vitamin D 300 IU TABLET - - - 2,000

23 DEKSAMETASON TABLET 0,5 MG TABLET 6,400 6,400 800 5,600
25 DIGOKSIN 0,25 MG TABLET 700 700 700 1,000
27 DOMPERIDON 10 TAB TABLET 2,700 2,700 100 2,600
31 FUROSEMIDA 40MG TABLET - 400 - 400 - 400 1,000
GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g , Trinatrium Sitrat
32 SACHET 2,300 2,300 2,300
Dihidrat 0,58 g, Glukosa Anhidrat 2,7 g
33 GEMFIBROZIL 300 MG TABLET - - - 1,000
35 GLIBENKLAMID 5 MG TABLET 600 600 600
36 GLIMEPIRID 1 MG TABLET 100 100 100
37 HEMAFORT TABLET - - - 2,000
40 IBUPROFEN 400 MG TABLET 200 200 200 2,000
41 ISOSORBID DINITRAT 5 MG TABLET 800 800 800 1,000
44 KAPTOPRIL 12,5 MG TABLET 3,100 3,100 3,100 1,000
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 4,200 4,200 4,200 1,000
50 LISINOPRIL 5 MG TABLET - - - 1,000
52 LOPERAMID 2 MG TABLET - - - 1,000
53 MELOKSIKAM 7,5 MG TABLET - - - 1,000
54 MELOKSIKAM 15 MG TABLET - - - 1,000
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - - - 1,000
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - - - 2,000
59 METFORMIN HCl 850 MG TABLET - 600 - 600 100 - 700 1,000
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - 100 - 100 200 - 300 1,000
61 METILPREDNISOLON 4 MG TABLET 600 600 200 400
62 METILPREDNISOLON 16 MG TABLET 1,100 1,100 1,100
MINERAL MIX : Bismut subcitrat tripotasium. Copper sulfat, Magnesium Chlorida
64 TABLET 2,800 2,800 2,800
Andydrous, Pottasium Chloride, Zinc Acetat
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - 100 - 100 - 100
67 NATRIUM DIKLOFENAK 25 MG TABLET 700 700 700
68 NATRIUM DIKLOFENAK 50 MG TABLET - 600 - 600 - 600
72 OMEPRAZOLE 20 MG TABLET - 500 - 500 - 500
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 8,300 8,300 600 7,700 2,000
PEHAVRAL TABLET : Fe2Fumarat 20mg, kalsium karbonat 100 mg, Vit.A 400 IU,
Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat 1 mg, Vit. B12 2
75 mg, Nikotinamide 20 mg, Biotin 0,1 mg, Tembaga Sulfat 1 mg, Magnesium Sulfat 1 Tablet 2,800 2,800 200 2,600 2,000
mg, Seng Oksida 0,25 mg
76 PIRIDOKSIN 10 MG TABLET - 600 - 600 - 600
78 PIROKSIKAM 10 MG TABLET - - - 1,000
81 PROPANOLOL 40 MG TABLET 1,900 1,900 1,900 1,000
82 PROPANOLOL 10 MG TABLET - - - 1,000
87 SALBUTAMOL 2 MG TABLET - - - 2,000
89 SETIRIZIN 10 MG TABLET - - - 2,000
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat 0,4 mg TABLET 153,300 153,300 2,450 150,850
tablet salut
93 VITAMIN B. COMPLEKS TABLET - 500 - 500 - 500 2,000
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - - 2,000

1 ALBENDAZOL 400 MG TABLET 3,750 3,000 6,750 6,750
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET 100 100 100

11 ERITROMISIN 250 MG TABLET 800 800 800
17 GRISEOFULVIN 125 MG TABLET - 200 - 200 - 200
20 KETOKONAZOL 200 MG TABLET 1,250 1,250 50 1,200
26 METRONIDAZOL 250 MG TABLET - 200 - 200 - 200
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - 100 - 100 - 100
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 1 1 1
35 PIRANTEL PAMOAT 125 MG TABLET - 400 - 400 - 400
39 SEFADROKSIL 500 MG TABLET - 200 - 200 - 200
41 SIPROFLOKSASIN 500 MG TABLET 2,400 2,400 2,400 2,000
44 THIAMPENIKOL 500 MG TABLET - - - 2,000

1 ALPRAZOLAM 0,5 MG TAB TABLET 565 565 455 110
5 CLOZAPIN 25 MG TABLET 830 830 30 800
8 DIAZEPAM INJ 5 MG/ML AMPUL 204 204 3 201
12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 MG/ML ) VIAL 29 29 1 28

27 RISPERIDON 2 MG TAB TABLET 1,090 1,090 30 1,060
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE - 2 - 2 - 2
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 10 10 90 - 80

1 AMBROKSOL SYR 15 MG/5 ML BOTOL - - - 100
3 AMOKSISILIN SYRUP KRG FORTE BOTOL - - - 100
4 ANTASIDA DOEN SYRUP BOTOL - 20 - 20 - 20 200
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 95 95 95 100
8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL 144 144 144 100
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - - - 100
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL 275 275 5 270
13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 210 210 210 100
14 PARASETAMOL DROPS 100 MG/ML BOTOL - - - 100
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 100 100 100 100
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 17 17 17 20
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - 40 - 40 - 40 100
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL - - -
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 10 10 10 100
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF 100 100 100
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - 60 - 60 30 - 90 ED : MEI 21
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF - - - 20
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - 10 - 10 - 10 100
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL - - - 10
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - - - 100
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 500 500 220 280 200
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - 100 - 100 - 100 100
38 RINGER LAKTAT LARUTAN INFUS KOLF 90 90 40 50 200
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - 7 - 7 30 - 37 100 ED : MEI 21
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - 20 - 20 - 20 100
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - - - 100
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - 38 - 38 - 38
47 TRAMADOL INJ AMPUL - - - 50
SEDIAAN OBAT LUAR
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 IU/g TUBE - 25 - 25 - 25 100

4 BETAMETASON KRIM 0,1 % TUBE 150 150 150 100
5 COMBIVENT UDV-KOMBINASI : ipratropium bromida 0,5 mg , salbutamol 2,5 mg ALUBAG - - -

10 HIDROKORTISON KRIM 2,5% TUBE 118 118 4 114
11 KETOKONAZOL CREM 2% 10 G TUBE 60 60 60 100
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - - - 100
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - - - 100
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - - - 100
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - - - 50
21 SALISIL BEDAK 2% 50 GRAM KOTAK - - - 50
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - - - 100
24 SULFADIAZIN SILVER KREM 1% TUBE - - - 50
VAKSIN
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 18 18 18
5 VAKSIN TD 10 DOSIS VIAL - 9 - 9 - 9
7 VAKSIN DPT-HB ( Pentabio ) VIAL 14 14 14
VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCHES @ 1
8 POUCH 39 39 39
PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI )
10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 30 30 29 1
14 ADS 0,05 ML 0NEJECT PCS 367 367 367
15 ADS 0,5 ML 0NEJECT PCS - 4 - 4 - 4
16 ADS 5 ML SKIFA PCS 396 396 396

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL 5 5 5
6 BILIRUBIN DIRECT BOTOL - - - 1
7 BILIRUBIN TOTAL BOTOL - - - 1
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - - - 2
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - - - 1
13 CREATININ 2X60 ML, DIRUI BOTOL - - - 1
14 DILUENT 20 L BF-6500, DIRUI BOX - - - 2
15 GAMMA GT ,DIRUI BOX - - - 1
17 GOT (AST ) 2X60 ML, DIRUI BOTOL - - - 1
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL - - - 1
19 HBSAG WB 100T SD ,DIRUI PCS - - - 400
21 LYSE BF-6500 , DIRUI PCS - - - 2
PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % , NaCl 0,9
23 SET - - -
%)
26 TABUNG STERIL EDTA 3 ML PACK - - - 4
29 YELLOW TIP NESCO PACK '1000S - - - 1
BMHP
3 ALAT SUNTIK 3 CC , AXIMED PCS 1,600 1,600 1,600
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 90 90 6 84
14 FACE MASK EAR LOOP, AXIMED PCS - - - 1,000
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS - 3 - 3 - 3
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL 16 16 16
48 LISOL BOTOL - 2 - 2 - 2
50 ONE SCRUB CAIRAN 5 L GALON 9 9 9
57 RIVANOL 300 ML, ONEMED BOTOL - 2 - 2 - 2
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - 50 - 50 100 - 150
62 SARUNG TANGAN STERIL NO. 8.0, AXIMED PAIR - - - 500
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - 600 - 600 - 600 1,000
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - 200 - 200 - 200 1,000
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 500 1,000
80 WING NEEDLE 27 G PCS - - - 100

2 CYCLOSERINE 250 MG TABLET 120 120 60 60
3 ETHAMBUTOL 400 MG TABLET 188 188 60 128
4 ETHIONAMIDE 250 MG TABLET 140 140 60 80
7 LEVOFLOXACIN 250 MG TABLET 186 186 90 96
8 MOXIFLOXACIN 400 MG TABLET - 200 - 200 - 200
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET 30 30 30 -
10 PYRAZINAMIDA 500 MG TABLET 160 160 60 100
13 BEDAQUILINE (BDQ) 100 MG TABLET 220 220 120 100
LAIN-LAIN -
PLESTERIN BULAT NON WOVEN E-CAT BOX - - - 10
ONE SCRUB 500 ML BOTOL - 3 - 3 - 3
KAPAS HIDROFIL 1 KG ROL - - -
- - -
JKN
NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN
PROPINSI : KALIMANTAN BARAT PERMINTAAN BU
ED/
NO NAMA OBAT /BMHP SATUAN STOK AWAL PENERIMAA PERSEDIAAN PEMAKAI RUSAK/ SISA STOK STOK PERMINTAA
N AN HILANG OPTMUN N
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9

1 ACETYL SISTEIN 200 MG TABLET 1,560 1,200 2,760 180 2,580
4 AMBROKSOL 30 MG TABLET - 100 - 100 400 - 500
6 AMLODIPIN 5 MG TABLET 300 600 900 200 700
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 5,400 5,400 100 5,300
13 ASAM MEFENAMAT 500 MG TABLET 3,800 2,000 5,800 600 5,200
19 CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg, TABLET - - -

Vitamin D 100 IU

Vitamin D 300 IU
23 DEKSAMETASON TABLET 0,5 MG TABLET 5,600 2,000 7,600 600 7,000
25 DIGOKSIN 0,25 MG TABLET 700 1,000 1,700 1,700
27 DOMPERIDON 10 TAB TABLET 2,600 1,000 3,600 100 3,500
31 FUROSEMIDA 40MG TABLET - 400 - 400 - 400
32 GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g , SACHET 2,300 2,300 25 2,275

35 GLIBENKLAMID 5 MG TABLET 600 600 100 500
36 GLIMEPIRID 1 MG TABLET 100 100 400 - 300
41 ISOSORBID DINITRAT 5 MG TABLET 800 1,000 1,800 1,800
43 KALSIUM LAKTAT TABLET 1,800 1,800 800 1,000
45 KAPTOPRIL 25 MG TABLET 1,800 1,800 100 1,700
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 4,200 1,000 5,200 200 5,000
50 LISINOPRIL 5 MG TABLET - 1,000 1,000 1,000
51 LORATADIN TABLET 10 MG TABLET 3,800 3,800 500 3,300

58 METFORMIN HCl 500 MG TABLET - - 100 - 100
59 METFORMIN HCl 850 MG TABLET - 700 1,000 300 100 200
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - 300 - 300 - 300
64 MINERAL MIX : Bismut subcitrat tripotasium. Copper sulfat, TABLET 2,800 2,800 2,800

67 NATRIUM DIKLOFENAK 25 MG TABLET 700 700 700 -
68 NATRIUM DIKLOFENAK 50 MG TABLET - 600 - 600 1,200 - 1,800
72 OMEPRAZOLE 20 MG TABLET - 500 - 500 300 - 800
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 7,700 2,000 9,700 1,300 8,400

75 400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat Tablet 2,600 2,600 2,600
76 PIRIDOKSIN 10 MG TABLET - 600 - 600 700 - 1,300

81 PROPANOLOL 40 MG TABLET 1,900 1,000 2,900 2,900
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat TABLET 150,850 150,850 150,850
0,4 mg tablet salut
93 VITAMIN B. COMPLEKS TABLET - 500 2,000 1,500 500 1,000

1 ALBENDAZOL 400 MG TABLET 6,750 6,750 50 6,700
2 AMOKSISILIN 500 MG TABLET 6,200 6,200 1,200 5,000

5 ASIKLOVIR 400 MG TABLET 1,200 1,200 50 1,150
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET 100 100 200 - 100

11 ERITROMISIN 250 MG TABLET 800 800 100 700
12 ERITROMISIN 500 MG TABLET 1,300 1,300 100 1,200
20 KETOKONAZOL 200 MG TABLET 1,200 1,200 250 950
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 3,800 3,800 300 3,500

29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 1 1 14 - 13

1 ALPRAZOLAM 0,5 MG TAB TABLET 110 2,000 2,110 220 1,890
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 643 500 1,143 140 1,003
5 CLOZAPIN 25 MG TABLET 800 500 1,300 30 1,270
7 DIAZEPAM 5 MG TABLET 1,939 500 2,439 30 2,409
12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL 28 25 53 53

MG/ML )
15 HALOPERIDOL 5 MG TABLET 1,225 1,000 2,225 105 2,120
16 KARBAMAZEPIN 200 MG TABLET 2,555 1,000 3,555 245 3,310
27 RISPERIDON 2 MG TAB TABLET 1,060 500 1,560 1,560
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - - 3 - 3
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 1,120 1,120 120 1,000
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET - 80 - 80 150 - 230

1 AMBROKSOL SYR 15 MG/5 ML BOTOL - 60 60 5 55
4 ANTASIDA DOEN SYRUP BOTOL - 20 200 180 180


16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 100 100 200 200
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - 40 - 40 - 40

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 10 10 10
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - 90 - 90 - 90
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - 10 60 50 10 40
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - 100 - 100 - 100
38 RINGER LAKTAT LARUTAN INFUS KOLF 50 200 250 7 243
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - 37 - 37 - 37
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - 20 - 20 - 20
SEDIAAN OBAT LUAR

1 TUBE - 25 - 25 - 25
IU/g
5 COMBIVENT UDV-KOMBINASI : ipratropium bromida 0,5 mg , ALUBAG - - -

salbutamol 2,5 mg
11 KETOKONAZOL CREM 2% 10 G TUBE 60 50 110 5 105
24 SULFADIAZIN SILVER KREM 1% TUBE - 56 56 56
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 19 19 1 18
VAKSIN
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 18 18 18
7 VAKSIN DPT-HB ( Pentabio ) VIAL 14 14 14
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCH 39 39 39

14 ADS 0,05 ML 0NEJECT PCS 367 367 367
15 ADS 0,5 ML 0NEJECT PCS - 4 - 4 - 4
16 ADS 5 ML SKIFA PCS 396 396 396

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
19 HBSAG WB 100T SD ,DIRUI PCS - 50 50 50 -
23 PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % , SET - - -

NaCl 0,9 % )
26 TABUNG STERIL EDTA 3 ML PACK - 4 4 4 -
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS 500 500 15 485
3 ALAT SUNTIK 3 CC , AXIMED PCS 1,600 1,600 10 1,590

21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS 12 5 17 1 16
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL 197 197 2 195
46 KASA PEMBALUT HIDROFIL 4 M x 10 CM ROL 100 100 3 97
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 115 115 2 113
48 LISOL BOTOL - 2 - 2 1 - 3
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - 150 - 150 - 150
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - 600 - 600 - 600
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - 200 - 200 - 200

9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET - - -
13 BEDAQUILINE (BDQ) 100 MG PCS 100 188 288 288
LAIN-LAIN
PLESTERIN BULAT NON WOVEN E-CAT - - -
ONE SCRUB 500 ML - 3 - 3 6 - 9
KAPAS HIDROFIL 1 KG - - -
- - -
JKN
Mengetahui Yang Menyerahkan Yang Menerima / Melapor

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesmas Meliau
Galuh Amalia, S.Si, Apt Lia Nirmawati. A. Md. Far dr. Agaka Sukaryamin
NIP: 19700628 199903 2 004 NIP: 19830118 201001 2 009 NIP : 19660408 199703 1 005
AN LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2021
LAPORAN BULAN : JUNI

PERMINTAAN BULAN : JULI
PEMBERIAN
KETERANGAN
APBN APBD BUFFER PROGRAM JUMLAH
12 13 14 15 16 17
Jumlah


NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
TAHUN 2021
KODE PUSKESMAS : 012

NAMA PUSKESMAS : PUSKESMAS MELIAU
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN : JULI
PROPINSI : KALIMANTAN BARAT PERMINTAAN BULAN : AGUSTUS
ED/ PEMBERIAN
PENERIMAA PEMAKAI STOK PERMINTAA KETERANG
NO NAMA OBAT /BMHP SATUAN STOK AWAL N PERSEDIAAN AN RUSAK/ SISA STOK OPTMUN N AN
HILANG APBN APBD BUFFER PROGRAM JUMLAH
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9 12 13 14 15 16 17

1 ACETYL SISTEIN 200 MG TABLET 2,580 2,580 260 2,320
4 AMBROKSOL 30 MG TABLET - 500 - 500 300 - 800
6 AMLODIPIN 5 MG TABLET 700 700 300 400
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 5,500 5,500 1,100 4,400 2,000
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - 200 - 200 100 - 300
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - - - 2,000
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 5,300 5,300 500 4,800 2,000
12 ASAM FOLAT 1 MG TABLET - - - 1,000
13 ASAM MEFENAMAT 500 MG TABLET 5,200 5,200 5,200 1,000
17 BISOPROLOL 5 MG TABLET - - - 1,000
19 CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg, TABLET - - - 2,000
Vitamin D 100 IU
20 Vitamin D 300 IU TABLET - - - 2,000
21 CIMETIDIN 200 MG TABLET - - - 1,000

22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 1,600 1,600 100 1,500
23 DEKSAMETASON TABLET 0,5 MG TABLET 7,000 7,000 500 6,500 1,000
25 DIGOKSIN 0,25 MG TABLET 1,700 1,700 100 1,600
26 DIMENHIDRINAT 50 MG TAB TABLET 1,900 1,900 1,900 1,000
31 FUROSEMIDA 40MG TABLET - 400 - 400 - 400 1,000

32 SACHET 2,275 2,275 23 2,252
33 GEMFIBROZIL 300 MG TABLET - - - 1,000

36 GLIMEPIRID 1 MG TABLET - 300 - 300 400 - 700 1,000
37 HEMAFORT TABLET - - - 1,000
39 IBUPROFEN 200 MG TABLET 4,200 4,200 700 3,500 2,000
40 IBUPROFEN 400 MG TABLET 200 200 200 2,000
41 ISOSORBID DINITRAT 5 MG TABLET 1,800 1,800 1,800
43 KALSIUM LAKTAT TABLET 1,000 1,000 1,000 1,000
46 KAPTOPRIL 50 MG TABLET - - - 1,000
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET - - - 1,000
49 LANSOPRAZOL 30 MG TABLET 1,240 1,240 200 1,040 1,000
50 LISINOPRIL 5 MG TABLET 1,000 1,000 1,000
51 LORATADIN TABLET 10 MG TABLET 3,300 3,300 500 2,800 1,000
52 LOPERAMID 2 MG TABLET - - - 1,000
53 MELOKSIKAM 7,5 MG TABLET - - - 1,000
54 MELOKSIKAM 15 MG TABLET - - - 1,000
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - - - 1,000
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - 1,050 1,050 100 950

58 METFORMIN HCl 500 MG TABLET - 100 - 100 - 100
59 METFORMIN HCl 850 MG TABLET 200 200 300 - 100 1,000
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - 300 - 300 - 300 1,000
61 METILPREDNISOLON 4 MG TABLET 400 400 500 - 100 1,000

67 NATRIUM DIKLOFENAK 25 MG TABLET - - 300 - 300
68 NATRIUM DIKLOFENAK 50 MG TABLET - 1,800 - 1,800 200 - 2,000 1,000
72 OMEPRAZOLE 20 MG TABLET - 800 - 800 - 800 1,000
73 ONDANSENTRON 4 MG TABLET - - - 1,000
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 8,400 8,400 2,600 5,800 5,000

75 Tablet 2,600 2,600 2,600 2,000
76 PIRIDOKSIN 10 MG TABLET - 1,300 - 1,300 - 1,300

83 PROPILTIOURASIL 100 MG TABLET - - 100 - 100
87 SALBUTAMOL 2 MG TABLET - - - 2,000
89 SETIRIZIN 10 MG TABLET - - - 2,000
90 SIMVASTATIN 10 MG TABLET 2,620 2,620 2,620 1,000
91 TABLET 150,850 150,850 4,450 146,400
0,4 mg tablet salut
93 VITAMIN B. COMPLEKS TABLET 1,000 1,000 500 500 1,000
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - - 2,000
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,500 1,500 500 1,000

2 AMOKSISILIN 500 MG TABLET 5,000 5,000 1,000 4,000 5,000

6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - 100 - 100 - 100


29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET - 13 - 13 1 - 14
39 SEFADROKSIL 500 MG TABLET - 200 - 200 - 200 2,000
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET - - - 2,000
41 SIPROFLOKSASIN 500 MG TABLET 2,400 2,400 2,400 2,000
44 THIAMPENIKOL 500 MG TABLET - - - 2,000

1 ALPRAZOLAM 0,5 MG TAB TABLET 1,890 1,890 220 1,670
2 ALPRAZOLAM 1 MG TAB TABLET - - - 1,000
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 1,003 1,003 1,003
5 CLOZAPIN 25 MG TABLET 1,270 1,270 30 1,240
12 MG/ML ) VIAL 53 53 53

14 HALOPERIDOL 1,5 MG TABLET - - - 500

1 AMBROKSOL SYR 15 MG/5 ML BOTOL 55 55 5 50
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - - - 20
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 95 95 95 50 ED: 08.20

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL - - - 50
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - - - 100 ED : 07. 20
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - - - 50

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 310 310 50 260 100
14 PARASETAMOL DROPS 100 MG/ML BOTOL - - - 100
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - - 5 - 5
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 60 60 60 50
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - 40 - 40 - 40 50
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL - - - 10

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 10 10 10 100
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 50 50 20 30
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL 40 40 100 - 60
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - - - 100
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 5 5 23 - 18
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF 375 375 60 315
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL 50 50 20 30
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL - - - 20
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - 100 - 100 - 100 100
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - 37 - 37 - 37 100
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - 20 - 20 - 20 100
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - - - 100
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - 38 - 38 - 38 100
47 TRAMADOL INJ AMPUL - - - 100
SEDIAAN OBAT LUAR
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 TUBE - 25 - 25 - 25 200
IU/g
4 BETAMETASON KRIM 0,1 % TUBE 150 150 150 200
5 ALUBAG - - -
salbutamol 2,5 mg
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE 10 10 50 - 40 50
9 GENTAMYCIN 0,1 % SALF KULIT TUBE - - - 100
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - - - 100
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - - - 100
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - - - 100
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP 600 600 600 ED: 08. 20
18 OKSITETRASIKLIN SALEP 3% TUBE - - - 100
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - - - 100
21 SALISIL BEDAK 2% 50 GRAM KOTAK - - - 100
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT 96 96 96 50
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - - - 100
24 SULFADIAZIN SILVER KREM 1% TUBE 56 56 2 54
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL - - - 100
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL 20 20 26 - 6
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 18 18 30 - 12
7 VAKSIN DPT-HB ( Pentabio ) VIAL 14 14 28 - 14

10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 1 1 1 30
14 ADS 0,05 ML 0NEJECT PCS 367 367 33 334
15 ADS 0,5 ML 0NEJECT PCS - 4 - 4 250 - 254
16 ADS 5 ML SKIFA PCS 396 396 396

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - - 4 - 4 10
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL 5 5 5 20
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - - - 2
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - - - 1
13 CREATININ 2X60 ML, DIRUI BOTOL - - - 1
14 DILUENT 20 L BF-6500, DIRUI BOX - - - 1
21 LYSE BF-6500 , DIRUI PCS - - - 2

NaCl 0,9 % )
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - - - 1
29 YELLOW TIP NESCO PACK '1000 - - - 1
Golongan darah paket 1
BMHP
7 ALAT SUNTIK 5 CC ,TP PCS 269 269 67 202
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - - - 2
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - - - 2
14 FACE MASK EAR LOOP, AXIMED PCS - - - 1,000
16 FACE MASK TIES ON, AXIMED PCS 1,500 1,500 1,500 1,000
21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS 16 16 1 15 5
22 INFUSION SET ANAK ( COSMOMED ) PCS 64 64 20 44
23 INFUSION SET DEWASA /20 DROPS PCS 68 68 85 - 17
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 8 8 1 7
48 LISOL BOTOL - 3 - 3 4 - 7 20
50 ONE SCRUB CAIRAN 5 L GALON 9 9 2 7
52 NEDLE HOLDER No. 25 ( JARUM SUNTIK ) SET - - - 100
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR - - - 1,000
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - 150 - 150 - 150 1,000
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - 600 - 600 - 600 1,000
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - 200 - 200 - 200 1,000
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 500 1,000
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS 25 25 3 22
80 WING NEEDLE 27 G PCS - - - 200

13 BEDAQUILINE 100 mg TABLET 288 288 288
LAIN-LAIN
OTSUCATH 18G X 1 1/4" - - -
OTSUCATH 22G X 1 1/4" - 9 - 9 - 9
IV CATHETER NO. 20 WING WITH INJECTION PORT SERENITY - - -
Salmonela tiphy Paket - - - 1
Blue tip Pack'100 - - - 1
Lancet Pack'100 - - - 1
JKN

Galuh Amalia, S.Si, Apt Roslina dr. Agaka Sukaryamin apt. Gusna Sumarti, S. Farm
NIP: 19700628 199903 2 004 NIP: 197750102 200212 2 007 NIP : 19660408 199703 1 005 NIP : 19891227 202012 1 006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU LAPORAN BULAN : AGUSTUS
PROPINSI : KALIMANTAN BARAT PERMINTAAN BULAN : SEPTEMBER
ED/ PEMBERIAN
NO NAMA OBAT /BMHP SATUAN STOK AWAL PENERIMAA PERSEDIAAN PEMAKAI RUSAK/ SISA STOK STOK PERMINTAA KETERANGAN
N AN HILANG OPTMUN N APBN APBD BUFFER PROGRAM JUMLAH
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11=10-9 12 13 14 15 16 17
4 AMBROKSOL 30 MG TABLET - 800 - 800 700 - 1,500
6 AMLODIPIN 5 MG TABLET 400 400 600 - 200 ED:08.20
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 4,400 2,000 6,400 6,400
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 4,800 2,000 6,800 300 6,500
13 ASAM MEFENAMAT 500 MG TABLET 5,200 1,000 6,200 1,200 5,000
19 TABLET - - -
Vitamin D 100 IU
20 TABLET - - -
Vitamin D 300 IU
23 DEKSAMETASON TABLET 0,5 MG TABLET 6,500 1,000 7,500 800 6,700
25 DIGOKSIN 0,25 MG TABLET 1,600 1,600 100 1,500
26 DIMENHIDRINAT 50 MG TAB TABLET 1,900 1,000 2,900 200 2,700

36 GLIMEPIRID 1 MG TABLET - 700 1,000 300 200 100
39 IBUPROFEN 200 MG TABLET 3,500 2,000 5,500 100 5,400
43 KALSIUM LAKTAT TABLET 1,000 1,000 300 700
44 KAPTOPRIL 12,5 MG TABLET 4,100 4,100 300 3,800
49 LANSOPRAZOL 30 MG TABLET 1,040 1,000 2,040 40 2,000
51 LORATADIN TABLET 10 MG TABLET 2,800 1,000 3,800 200 3,600
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet 950 950 400 550

59 METFORMIN HCl 850 MG TABLET - 100 1,000 900 600 300
61 METILPREDNISOLON 4 MG TABLET - 100 1,000 900 800 100

64 TABLET 2,800 2,800 2,800

67 NATRIUM DIKLOFENAK 25 MG TABLET - 300 - 300 250 - 550
68 NATRIUM DIKLOFENAK 50 MG TABLET - 2,000 - 2,000 300 - 2,300
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 5,800 2,000 7,800 700 7,100

75 Tablet 2,600 2,600 2,600

81 PROPANOLOL 40 MG TABLET 2,900 2,900 100 2,800
83 PROPILTIOURASIL 100 MG TABLET - 100 - 100 - 100
91 TABLET 146,400 146,400 146,400
0,4 mg tablet salut
93 VITAMIN B. COMPLEKS TABLET 500 500 500 -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,000 600 1,600 100 1,500


6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - 100 - 100 800 - 900

12 ERITROMISIN 500 MG TABLET 1,200 1,200 600 600
17 GRISEOFULVIN 125 MG TABLET - 200 - 200 - 200 ED: 06.20
20 KETOKONAZOL 200 MG TABLET 950 950 50 900

29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET - 14 - 14 - 14
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET - - - 4

2 ALPRAZOLAM 1 MG TAB TABLET - - - ED:09.20
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 1,003 1,003 135 868
5 CLOZAPIN 25 MG TABLET 1,240 1,240 20 1,220
8 DIAZEPAM INJ 5 MG/ML AMPUL 201 201 5 196
12 MG/ML ) VIAL 53 53 53

29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - 3 - 3 2 - 5
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE - 2 - 2 1 - 3
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 1,000 1,000 60 940
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET - 320 - 320 - 320


13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL 260 50 310 5 305
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - 5 - 5 35 - 40
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - - - ED: 09.20
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 10 10 10
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - 60 - 60 - 60
30 METOKLOPRAMID INJK 5 MG/ML AMPUL - 18 - 18 - 18
47 TRAMADOL INJ AMPUL - - - ED: 09.20
- - -
SEDIAAN OBAT LUAR
1 TUBE - 25 - 25 - 25
IU/g
5 ALUBAG - - -
salbutamol 2,5 mg
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE - 40 - 40 - 40
10 HIDROKORTISON KRIM 2,5% TUBE 66 66 66
24 SULFADIAZIN SILVER KREM 1% TUBE 54 54 54
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL - 6 - 6 - 6
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL - 12 - 12 - 12
7 VAKSIN DPT-HB ( Pentabio ) VIAL - 14 - 14 - 14
8 POUCH 39 39 39
14 ADS 0,05 ML 0NEJECT PCS 334 334 334
15 ADS 0,5 ML 0NEJECT PCS - 254 - 254 - 254
16 ADS 5 ML SKIFA PCS 396 396 396
- - -
BAHAN DAN PREPARAT GIGI - - -
2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - 4 - 4 - 4
23 NaCl 0,9 % ) SET - - -

BMHP
7 ALAT SUNTIK 5 CC ,TP PCS 202 200 402 402
23 INFUSION SET DEWASA /20 DROPS PCS - 17 150 133 10 123
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL 86 70 156 5 151
48 LISOL BOTOL - 7 - 7 - 7

LAIN-LAIN
OTSUCATH 18G X 1 1/4" - - -
OTSUCATH 22G X 1 1/4" - 9 - 9 - 9
OTSUCATH 24G X 3/4" - - -
SYPHILLIS 3.0MD 100T, DIRUI - - -
POT DAHAK - - -
JKN

Galuh Amalia, S.Si, Apt Roslina dr. Agaka Sukaryamin Apt. Gusna sumantri S.farm
NIP: 19700628 199903 2 004 NIP: 197750102 200212 2 007 NIP : 19660408 199703 1 005 NIP : 198912272020121006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
ED/
PENERIMAA PEMAKAI STOK
N AN OPTMUN
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10
4 AMBROKSOL 30 MG TABLET - 1,500 - 1,500 100 - 1,600
6 AMLODIPIN 5 MG TABLET - 200 - 200 300 - 500
19 TABLET - - -
Vitamin D 100 IU

Vitamin D 300 IU
23 DEKSAMETASON TABLET 0,5 MG TABLET 6,700 6,700 800 5,900
25 DIGOKSIN 0,25 MG TABLET 1,500 1,500 1,500

35 GLIBENKLAMID 5 MG TABLET 100 100 200 - 100
36 GLIMEPIRID 1 MG TABLET 100 100 300 - 200
39 IBUPROFEN 200 MG TABLET 5,400 5,400 300 5,100
41 ISOSORBID DINITRAT 5 MG TABLET 1,800 1,800 100 1,700
43 KALSIUM LAKTAT TABLET 700 700 700
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet 550 550 550 -

59 METFORMIN HCl 850 MG TABLET 300 300 200 100
61 METILPREDNISOLON 4 MG TABLET 100 100 200 - 100

67 NATRIUM DIKLOFENAK 25 MG TABLET - 550 - 550 750 - 1,300
68 NATRIUM DIKLOFENAK 50 MG TABLET - 2,300 - 2,300 - 2,300

75 Tablet 2,600 2,600 2,600

91 TABLET 146,400 146,400 146,400
0,4 mg tablet salut
93 VITAMIN B. COMPLEKS TABLET - - 500 - 500

- - -
SEDIAAN ANTIINFEKSI TABLET/KAPLET/KAPSUL - - -
2 AMOKSISILIN 500 MG TABLET 7,800 7,800 700 7,100




5 CLOZAPIN 25 MG TABLET 1,220 1,220 1,220
12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL 53 53 53

MG/ML )
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 940 940 940

4 ANTASIDA DOEN SYRUP BOTOL 150 150 180 - 30


17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - 40 - 40 - 40
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 8 8 2 6

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 10 10 50 - 40
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF 100 100 100 -
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL 100 100 95 5
48 PARACETAMOL INFUS BOTOL - - -
SEDIAAN OBAT LUAR - - -
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 TUBE - 25 - 25 - 25

IU/g

salbutamol 2,5 mg
8 GENTAMISIN SALEP MATA 0,3 % TUBE 93 93 10 83
10 HIDROKORTISON KRIM 2,5% TUBE 66 66 138 - 72
13 KLORAMFENIKOL SALEP MATA 1% TUBE 72 72 24 48
16 MIKONAZOL KRIM 2% TUBE 384 384 24 360
VAKSIN

14 ADS 0,05 ML 0NEJECT PCS 334 334 334
15 ADS 0,5 ML 0NEJECT PCS - 254 - 254 - 254
16 ADS 5 ML SKIFA PCS 396 396 396

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
23 SET - - -
NaCl 0,9 % )
BMHP
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS - 3 - 3 2 - 5
23 INFUSION SET DEWASA /20 DROPS PCS 123 123 3 120
32 IV CATHETER NO. 24 G Remedi PCS 47 47 3 44
40 KAPAS HIDROPIL 250 GRAM ROL 15 15 1 14
48 LISOL BOTOL - 7 - 7 - 7

LAIN-LAIN
OTSUCATH 18G X 1 1/4" - - -
OTSUCATH 22G X 1 1/4" - 9 - 9 - 9
POT DAHAK - - -
JKN
Mengetahui Yang Menyerahkan Yang Menerima / Melap

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesmas Meli
Galuh Amalia, S.Si, Apt Lia Nirmawati A.Md. far dr. Agaka Sukaryamin
NIP: 19700628 199903 2 004 NIP: 1983 0118 201001 2 009 NIP : 19660408 199703 1
N LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2021
LAPORAN BULAN : SEPTEMBER

PERMINTAAN BULAN : OKTOBER
PERMINTAA PEMBERIAN
KETERANGAN
11=10-9 12 13 14 15 16 17
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
500
500
1,000
1,000
1,000
1,000
1,000
2,000
1,000
1,000
1,000
1,000
1,000
1,000
3,000
1,000
500
1,000
1,000
1,000
3,000
5,000
2,000
2,000
2,000
2,000
2,000
2,000
1,000
100
100
200
50
100
100
ED: 10.20
50
50
100
2 ed : septermber 2021
10
50
100
50
100
100
10
10
100
100
100
50
50
100
50
50
50
100
100
50
50
50
48
50
50
50
50
50
50
50
50
1
1
20
5
5
50
2
50
20
100
20
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
100
Jumlah

dr. Agaka Sukaryamin Apt. Gusna Sumantri S.farm

NIP : 19660408 199703 1 005 NIP : 19891227 2020 121006
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
ED/
PENERIMAA PEMAKAI STOK
N AN OPTMUN
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10
1 ACETYL SISTEIN 200 MG TABLET 1,580 1,200 2,780 380 2,400
2 ALOPURINOL 100 MG TABLET 3,100 1,000 4,100 200 3,900
4 AMBROKSOL 30 MG TABLET - 1,600 - 1,600 - 1,600
6 AMLODIPIN 5 MG TABLET - 500 - 500 400 - 900
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 6,400 6,400 1,500 4,900
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - 300 - 300 300 - 600
13 ASAM MEFENAMAT 500 MG TABLET 5,000 1,000 6,000 200 5,800

Vitamin D 100 IU
20 TABLET - - -
Vitamin D 300 IU
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET 1,500 1,500 300 1,200
23 DEKSAMETASON TABLET 0,5 MG TABLET 5,900 1,000 6,900 1,000 5,900
26 DIMENHIDRINAT 50 MG TAB TABLET 2,700 2,700 300 2,400
27 DOMPERIDON 10 TAB TABLET 3,500 3,500 400 3,100

32 SACHET 1,950 500 2,450 50 2,400

35 GLIBENKLAMID 5 MG TABLET - 100 - 100 300 - 400
36 GLIMEPIRID 1 MG TABLET - 200 400 200 600 - 400
39 IBUPROFEN 200 MG TABLET 5,100 1,000 6,100 600 5,500
40 IBUPROFEN 400 MG / ARFEN TABLET 200 1,000 1,200 1,200
43 KALSIUM LAKTAT TABLET 700 700 700
45 KAPTOPRIL 25 MG TABLET 1,300 1,300 400 900
50 LISINOPRIL 5 MG TABLET 1,000 1,000 300 700
51 LORATADIN TABLET 10 MG TABLET 3,600 3,600 600 3,000

58 METFORMIN HCl 500 MG TABLET - 100 - 100 500 - 600
59 METFORMIN HCl 850 MG TABLET 100 100 500 600 - 1,000
61 METILPREDNISOLON 4 MG TABLET - 100 500 400 400 -
62 METILPREDNISOLON 16 MG TABLET 1,100 1,100 200 900
63 METOKLOPRAMID 10 MG TABLET 3,500 3,500 200 3,300
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - 100 - 100 1,000 - 1,100

67 NATRIUM DIKLOFENAK 25 MG TABLET - 1,300 1,000 - 300 500 - 800
72 OMEPRAZOLE 20 MG TABLET - 800 - 800 900 - 1,700
73 ONDANSENTRON 4 MG TABLET - 3,000 3,000 3,000
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 6,100 6,100 300 5,800

75 Tablet 2,600 2,600 2,600

80 PREDNISON 5 MG TABLET 1,800 1,000 2,800 100 2,700
81 PROPANOLOL 40 MG TABLET 2,800 2,800 100 800 1,900
84 RANITIDIN 150 MG TABLET 4,400 500 4,900 300 4,600
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - - 5,050 - 5,050
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - - 4,350 - 4,350
91 TABLET 146,400 146,400 146,400
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 2,500 2,500 400 2,100
93 VITAMIN B. COMPLEKS TABLET - 500 - 500 - 500
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,500 1,500 100 1,400

4 ASIKLOVIR 200 MG TABLET 500 500 1,300 - 800


11 ERITROMISIN 250 MG TABLET 700 700 100 600
12 ERITROMISIN 500 MG TABLET 600 1,000 1,600 1,600
20 KETOKONAZOL 200 MG TABLET 900 900 100 800
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 2,900 2,000 4,900 4,900

27 METRONIDAZOL 500 MG TABLET 6,800 2,000 8,800 8,800
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - 100 - 100 500 - 600
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET - 14 - 14 2 - 16

12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL 53 53 53

MG/ML )
16 KARBAMAZEPIN 200 MG TABLET 2,365 1,000 3,365 280 3,085

4 ANTASIDA DOEN SYRUP BOTOL - 30 100 70 70


17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - 40 - 40 60 - 100
18 ZINK SIR 20 MG/5 ML BOTOL 321 321 15 306
2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL 60 30 90 90
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 6 2 8 8

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - 40 - 40 - 40
48 PARACETAMOL INFUS BOTOL - 48 48 48
SEDIAAN OBAT LUAR
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 TUBE - 25 - 25 - 25

IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 5 5 35 - 30
3 ANTI HEMOROID DOEN KOMBINASI SUPPO 55 55 5 50
5 ALUBAG - - -
salbutamol 2,5 mg
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE - 40 10 - 30 - 30
8 GENTAMISIN SALEP MATA 0,3 % TUBE 83 83 43 40
10 HIDROKORTISON KRIM 2,5% TUBE - 72 - 72 - 72
13 KLORAMFENIKOL SALEP MATA 1% TUBE 48 48 24 24
16 MIKONAZOL KRIM 2% TUBE 360 360 24 336
- - -
VAKSIN
8 POUCH 39 39 39
14 ADS 0,05 ML 0NEJECT PCS 334 334 334
15 ADS 0,5 ML 0NEJECT PCS - 254 - 254 - 254
16 ADS 5 ML SKIFA PCS 396 396 396
- - -
2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - 4 - 4 1 - 5
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL 5 5 5 -
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - 1 1 1 -
14 DILUENT 20 L BF-6500, DIRUI BOX - 1 1 1 -
21 LYSE BF-6500 , DIRUI PCS - 1 1 1 -

NaCl 0,9 % )
BMHP

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET 108 108 12 96
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS - 5 5 - 2 - 2
22 INFUSION SET ANAK ( COSMOMED ) PCS 44 44 6 38
23 INFUSION SET DEWASA /20 DROPS PCS 120 120 152 - 32
32 IV CATHETER NO. 24 G Remedi PCS 44 44 110 - 66
40 KAPAS HIDROPIL 250 GRAM ROL 14 14 2 12
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL 16 16 111 - 95
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL 7 2 9 1 8
48 LISOL BOTOL - 7 - 7 - 7
50 ONE SCRUB CAIRAN 5 L GALON 7 7 7 -
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL 30 10 40 40
57 RIVANOL 300 ML, ONEMED BOTOL - 2 - 2 5 - 7
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - 200 500 300 300
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 500 500 1,000 1,000
- - -
OBAT PROGRAM TB KHUSUS MULTY DRUGS RESISTEN ( MDR ) - - -
LAIN-LAIN
OTSUCATH 18G X 1 1/4" - - 2 - 2
OTSUCATH 22G X 1 1/4" - 9 - 9 3 - 12
IV CATHETER NO. 20 WING WITH INJECTION PORT SERENITY - - 4 - 4
SYPHILLIS 3.0MD 100T, DIRUI BOTOL - - -
STIK CHOLESTEROL AUTO CEK BOTOL
STIK ASAM URAT AUTO CEK BOTOL
STIK GLUKOSA AUTO CEK BOTOL
REAGEN GOLONGAN DARAH BOTOL
SALMONELLA TYP PAKET
POT DAHAK - - -
JKN
Mengetahui Yang Menyerahkan Yang Menerima / Melapo

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesmas Meliau
Galuh Amalia, S.Si, Apt Lia Nirmawati A.Md. far dr. Agaka Sukaryamin
NIP: 19700628 199903 2 004 NIP: 1983 0118 201001 2 009 NIP : 19660408 199703 1 00
T ( LPLPO )
LAPORAN BULAN : OKTOBER

PERMINTAAN BULAN : NOVEMBER
PEMBERIAN
PERMINTAA
KETERANGAN
11=10-9 12 13 14 15 16 17
3,000
3,000
5,000
5,000
5,000
5,000
5,000
ED : 8-2021
5,000
5,000
5,000
2,000
3,000
2,000
5,000
3,000
3,000
1,000
5,000
5,000
500
2,000 ED : 10-2021
2,000
5,000
2,000
1,000
5,000
3,000
5,000
5,000
3,000
3,000
3,000
3,000
5,000
5,000
5,000
3,000
3,000
3,000
5,000
5,000
5,000
3,000
5,000 ED : 11-2021
3,000
5,000
5,000
1,000
2,000 ED : 08-2021
1,000
5,000
5,000
2,000
5,000
2,000
10,000
5,000
5,000
3,000
3,000
1,000
2,000 ED:7-2021 & 10-2021
500
5,000
ED : 8-2021
5,000
5,000
5,000
5,000 ED : 10-2021
3,000
5,000
6,000
3,000
5,000
500 ED: 9-2021

500
3,000
3,000
500
1,000
1,000
2,000
1,000
5,000
3,000
1,000 ED : 8-2021
2,000
3,000
3,000
3,000
5,000
3,000
3,000
3,000
3,000
3,000
3,000
500
2,000
100
100
1,000
ED: 10.2020
100
100
3,000
2,000
200
200
200
200
100
200
200
200
200
300
200
100
100
200
200
100
50
100
100
100
ED: 11. 2020
6
100
200
100
100
50
300
300
20 ED: 6-11-2020
20
100 ED: 11.2020

50
200
100
100
200
100
100
100
100
100
100
300
100
100
300
50
100
300
300
300
300
100
100
300
300
100
100
200
100
300
100
50
20
20
50
50
1
1
1
1
300
100
100
100
100
1,000
1,000
1,000
10
100
100
100
100
100
10
200
100
5
200
100
100
100
100
100
10
100
20
20
20
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
100
100
100
20
20
50
100
2
2
2
1
1
200
Jumlah
Menerima / Melapor Petugas Pengelola Obat

la Puskesmas Meliau Puskemas Meliau
Agaka Sukaryamin Rabiyati. MY., A. Md, Far
9660408 199703 1 005 NIP : 19841217 201101 2 010
TAHUN 2021
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
ED/
PENERIMAA PEMAKAI
NO NAMA OBAT /BMHP SATUAN STOK AWAL PERSEDIAAN RUSAK/
N AN HILANG
1 2 3 4 5 6=4+5 7 8
1 ACETYL SISTEIN 200 MG TABLET 2,400 3,000 5,400 840
3 ALOPURINOL 300 MG TABLET - -
4 AMBROKSOL 30 MG TABLET - 1,600 - 1,600
5 AMINOFILIN TABLET 200 MG TABLET - -
6 AMLODIPIN 5 MG TABLET - 900 - 900
7 AMLODIPIN 10 MG TABLET 2,600 1,200 3,800 600
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 4,900 5,500 10,400 500
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - 600 - 600
10 ASAM ASKORBAT ( VIT. C ) 250 MG TABLET - -
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET 6,300 5,400 11,700 900
12 ASAM FOLAT 1 MG TABLET - -
13 ASAM MEFENAMAT 500 MG TABLET 5,800 4,200 10,000 1,000
14 ATAFULGIT 600 MG ( PULAREX ) TABLET - -
15 ATROPIN SULFAT 0,5 MG TABLET - -
16 BETAHISTIN MEYSILAT 6 MG TABLET - -
17 BISOPROLOL 5 MG TABLET - -
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET - -
19 CALPOROSIS D 500 : Tablet Mineral + Multivitamin : Ca. 500 mg, TABLET - -

Vitamin D 100 IU
20 TABLET - -
Vitamin D 300 IU
21 CIMETIDIN 200 MG TABLET - -
23 DEKSAMETASON TABLET 0,5 MG TABLET 5,900 5,000 10,900 600
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET - -
25 DIGOKSIN 0,25 MG TABLET 1,500 1,500
28 FENITOIN NATRIUM 50 MG TABLET - -
29 FERRO SULFAT 300 MG TABLET SALUT TABLET - -
31 FUROSEMIDA 40MG TABLET - 400 - 400

32 SACHET 2,400 2,000 4,400 200
33 GEMFIBROZIL 300 MG TABLET - -

34 GEMFIBROZIL 600 MG TABLET - -
35 GLIBENKLAMID 5 MG TABLET - 400 - 400 200
36 GLIMEPIRID 1 MG TABLET - 400 - 400
37 HEMAFORT TABLET - -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET 6,000 5,000 11,000 100
39 IBUPROFEN 200 MG TABLET 5,500 6,000 11,500 3,600
40 IBUPROFEN 400 MG TABLET 1,200 1,200 200
41 ISOSORBID DINITRAT 5 MG TABLET 1,700 1,700
42 KALSIUM KARBONAT 500 MG TABLET - -
43 KALSIUM LAKTAT TABLET 700 3,300 4,000 300
45 KAPTOPRIL 25 MG TABLET 900 900 600
46 KAPTOPRIL 50 MG TABLET - -
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET - -
49 LANSOPRAZOL 30 MG TABLET 1,020 1,000 2,020 180
50 LISINOPRIL 5 MG TABLET 700 700
51 LORATADIN TABLET 10 MG TABLET 3,000 4,000 7,000 1,000
52 LOPERAMID 2 MG TABLET - -
53 MELOKSIKAM 7,5 MG TABLET - -
54 MELOKSIKAM 15 MG TABLET - -
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET - -
56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - -
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET - -

58 METFORMIN HCl 500 MG TABLET - 600 - 600
59 METFORMIN HCl 850 MG TABLET - 1,000 - 1,000
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - 300 - 300
61 METILPREDNISOLON 4 MG TABLET - - 500

64 TABLET 2,800 2,800
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - 1,100 - 1,100

66 NATRIUM BIKARBONAT 500MG TABLET - -
67 NATRIUM DIKLOFENAK 25 MG TABLET - 800 5,600 4,800 1,000
68 NATRIUM DIKLOFENAK 50 MG TABLET - 2,300 - 2,300
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET - -
70 NIFEDIPIN 10 MG TABLET 1,600 300 1,900 300
71 NIKOTINAMIDE 20 MG TABLET - 2,000 2,000
72 OMEPRAZOLE 20 MG TABLET - 1,700 - 1,700
73 ONDANSENTRON 4 MG TABLET 3,000 3,000

75 1 mg, Vit. B12 2 mg, Nikotinamide 20 mg, Biotin 0,1 mg, Tembaga Tablet 2,600 3,600 6,200
76 PIRIDOKSIN 10 MG TABLET - 1,300 - 1,300

77 PIRIDOKSIN 25 MG TABLET - -
78 PIROKSIKAM 10 MG TABLET - -
79 PIROKSIKAM 20 MG TABLET - -
82 PROPANOLOL 10 MG TABLET - -
83 PROPILTIOURASIL 100 MG TABLET - 100 - 100
84 RANITIDIN 150 MG TABLET 4,600 5,000 9,600 300
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - 5,050 - 5,050
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - 4,350 - 4,350
87 SALBUTAMOL 2 MG TABLET - -
88 SALBUTAMOL 4 MG TABLET 5,400 5,399 10,799 399
89 SETIRIZIN 10 MG TABLET - -
90 SIMVASTATIN 10 MG TABLET 2,150 3,400 5,550 400
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat TABLET 146,400 146,400
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET 2,100 2,100
93 VITAMIN B. COMPLEKS TABLET - 500 - 500
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,400 500 1,900

1 ALBENDAZOL 400 MG TABLET 6,700 6,700
2 AMOKSISILIN 500 MG TABLET 9,500 6,000 15,500 2,400
3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET - -
4 ASIKLOVIR 200 MG TABLET - 800 500 - 300

5 ASIKLOVIR 400 MG TABLET 1,150 500 1,650 50
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - 900 - 900
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET - -
9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET - -
10 DOKSISIKLIN 100 mg TABLET - -

11 ERITROMISIN 250 MG TABLET 600 500 1,100
13 ETAMBUTOL HCL 400 MG TABLET - -
14 ETAMBUTOL HCL 500 MG TABLET - -
15 FENOKSIMETIL PENISILIN 250MG TABLET - -
16 FENOKSIMETIL PENISILIN 500 MG TABLET - -
17 GRISEOFULVIN 125 MG TABLET - 200 - 200
18 ISONIAZIDA ( INH ) 100 MG TABLET - -
19 ISONIAZIDA ( INH ) 300 MG PAKET - -
20 KETOKONAZOL 200 MG TABLET 800 1,000 1,800 300
21 KLORAMFENIKOL 250 MG TABLET - -
22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET - -
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 4,900 3,300 8,200 800

24 KUININ SULFAT 200 MG TABLET - -
25 MEBENDAZOL 100 MG TABLET - -
26 METRONIDAZOL 250 MG TABLET - 200 - 200
27 METRONIDAZOL 500 MG TABLET 8,800 5,000 13,800 200
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - 600 - 600
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET - 16 - 16
30 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 2 PAKET - -
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET - -
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET - -
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET - -
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET - -
35 PIRANTEL PAMOAT 125 MG TABLET - 400 - 400
36 PRIMAKUIN 15 MG TABLET - -
37 RIFAMPISIN 300 MG TABLET - -
38 RIFAMPISIN 450 MG TABLET - -
39 SEFADROKSIL 500 MG TABLET - 200 - 200
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET - -
42 TETRASIKLIN 250 MG TABLET - -
43 TETRASIKLIN 500 MG TABLET - -
44 THIAMPENIKOL 500 MG TABLET - -

1 ALPRAZOLAM 0,5 MG TAB TABLET 1,084 2,000 3,084 150
2 ALPRAZOLAM 1 MG TAB TABLET - -
3 ALPRAZOLAM 1,5 MG TAB TABLET - -
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 698 550 1,248 135
5 CLOZAPIN 25 MG TABLET 1,220 1,220
7 DIAZEPAM 5 MG TABLET 2,199 1,000 3,199 30
9 FENOBARBITAL 100 MG TABLET - -
10 FENOBARBITAL 30 MG TABLET - -
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET - -
12 HALDOL
MG/ML )
DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL 53 53
13 HALOPERIDOL 0,5 MG TABLET - -

14 HALOPERIDOL 1,5 MG TABLET - -
15 HALOPERIDOL 5 MG TABLET 1,935 1,935 40
16 KARBAMAZEPIN 200 MG TABLET 3,085 3,000 6,085 405
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 562 500 1,062 30
18 KLORPROMAZIN HCL SALUT 25 MG TABLET - -
19 KLORPROMAZIN HCL INJ 25 MG/ML - 1 ML AMPUL - -
20 KLORPROMAZIN HCL INJ 5 MG/ML - 2 ML AMPUL - -
21 KODEIN HCL 10 MG TABLET - -
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET - -
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL - -
24 LORAZEPAM 2 MG TABLET - -
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET - -
26 RISPERIDON 1 MG TAB TABLET 5 5
27 RISPERIDON 2 MG TAB TABLET 1,440 500 1,940
28 RISPERIDON 3 MG TAB TABLET - -
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - 5 - 5
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE - 3 - 3
31 TRAMADOL 50 MG TABLET - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET 940 940
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET - 440 - 440 60

1 AMBROKSOL SYR 15 MG/5 ML BOTOL 10 10 60
3 AMOKSISILIN SYRUP KRG FORTE BOTOL - -
5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - -

7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL - -
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL - -
11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - -
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL - -

14 PARASETAMOL DROPS 100 MG/ML BOTOL - -
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL 200 200
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - 100 - 100
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL - -
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL 22 22
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL - -
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL - -
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - 40 - 40
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL - 100 100
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL - -
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL - -
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - -

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - 40 - 40
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF - -
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF - -
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - 90 - 90
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL 30 30
19 GENTAMISIN INJ 40 MG/ML AMPUL - -
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF 90 90
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL - -
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL - -
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL - -
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - 60 - 60
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL - -
27 MAGNESIUM SULFAT INJ (IV) 20% - 25 ML AMPUL - -
28 METAMIZOL INJ 500 MG/ML AMPUL - -
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL - -
30 METOKLOPRAMID INJK 5 MG/ML AMPUL - 18 - 18
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL - -
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL 30 30
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL - -
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL - -
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - 100 - 100
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - 37 - 37
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - 20 - 20
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL - -
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL - -
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL - -
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - 38 - 38
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL - -
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL - -
47 TRAMADOL INJ AMPUL - -
48 48
SEDIAAN OBAT LUAR - -
1 TUBE - 25 - 25
IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT - 30 24 - 6 6
5 ALUBAG - -
salbutamol 2,5 mg
6 DULCOLAX 5 MG ( BISAKODIL SUPP 5 MG ) TUBE - -
7 DULCOLAX 10 MG ( BISAKODIL SUPP 10 MG ) TUBE - 30 - 30
9 GENTAMYCIN 0,1 % SALF KULIT TUBE - -
10 HIDROKORTISON KRIM 2,5% TUBE - 72 - 72
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE - -
13 KLORAMFENIKOL SALEP MATA 1% TUBE 24 24
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL - -
15 KLORAMFENIKOL TETES MATA 1 % BOTOL - -
16 MIKONAZOL KRIM 2% TUBE 336 336
18 OKSITETRASIKLIN SALEP 3% TUBE - -
19 OKSITETRASIKLIN SALEP MATA 1% TUBE - -
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL - -
21 SALISIL BEDAK 2% 50 GRAM KOTAK - -
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE - -
24 SULFADIAZIN SILVER KREM 1% TUBE 54 54
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL - -
26 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL - -
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL 13 13
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL - 6 - 6
2 VAKSIN TT VIAL - -
3 VAKSIN DT 10 DOSIS VIAL - -
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL - 12 - 12
5 VAKSIN TD 10 DOSIS VIAL - 9 - 9
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 13 13
7 VAKSIN DPT-HB ( Pentabio ) VIAL - 14 - 14
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCH 39 39

9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL - -
10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 1 1
11 VAKSIN FLU BIO 0,5 ML AMPUL - -
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL - -
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL - -
14 ADS 0,05 ML 0NEJECT PCS 334 334
15 ADS 0,5 ML 0NEJECT PCS - 254 - 254
16 ADS 5 ML SKIFA PCS 396 396
17 DROPPER POLIO BIVALEN DROP 90 90
18 PELARUT BCG VIAL 140 140
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL 64 64
Safety Box PCS - -
1 ETIL KLORIDA SPRAY 100 ML BOTOL - -
2 FUJI II 1-1-23 BOX - -
2 FUJI 7 1-1 WHITE BOX - -
3 FUJI IX GP 1-1 EXTRA A3 BOX - -
4 FUJI IX ART 1-1 BOX - -
5 GLASS IONOMER SEMEN (ART) BOTOL - -
6 KALSIUM HIDROKSIDA PASTA KOTAK - -
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL - -
8 MUMMYFYING PASTA KOTAK - -
BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX - 5 - 5
3 ALKOHOL 70% 100 ML AFIFARMA BOTOL - -
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL - -
6 BILIRUBIN DIRECT BOTOL - -
7 BILIRUBIN TOTAL BOTOL - -
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS - -
9 CS-QC SERUM 5 L , DIRUI BOTOL - 1 1
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS - -
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL - -
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL - -
13 CREATININ 2X60 ML, DIRUI BOTOL - -
14 DILUENT 20 L BF-6500, DIRUI BOX - -
15 GAMMA GT ,DIRUI BOX - -
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - -
17 GOT (AST ) 2X60 ML, DIRUI BOTOL - -
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL - -
19 HBSAG WB 100T SD ,DIRUI PCS - 50 50
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS - -
21 LYSE BF-6500 , DIRUI PCS - -
22 NaCl 0,9 INDOREAGENT BOTOL - -
23 PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % , SET - -

NaCl 0,9 % )
24 PEWARNA ZIEHL NEELSEN pack - -
25 STERINTECH Bowie Dick Test Pack PACK - -
26 TABUNG STERIL EDTA 3 ML PACK - -
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - -
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL - -
29 YELLOW TIP NESCO PACK '1000S - -
BMHP
2 ALAT SUNTIK 1 CC , TP PCS - -
3 ALAT SUNTIK 3 CC , AXIMED PCS 1,100 1,100
4 ALAT SUNTUK 3 CC, OTSUCATH PCS - -
5 ALAT SUNTIK 3 CC , TP PCS - -
6 ALAT SUNTIK 5 CC , AXIMED PCS 196 196
7 ALAT SUNTIK 5 CC ,TP PCS 402 402
8 ASEPTAN + DISP 500ML BOTOL - -
9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - -
10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - -

13 CONNECTING TUBE, AXIMED PCS - -
14 FACE MASK EAR LOOP, AXIMED PCS - -
15 FACE MASK EAR LOOP, FESCO PCS - -
16 FACE MASK TIES ON, AXIMED PCS 1,500 2,000 3,500 500
17 FEEDING TUBE, 40 cm, NO. 10, AXIMED PCS - -
18 FEEDING TUBE, 100 cm, NO. 8, AXIMED PCS - -
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS - 2 - 2
22 INFUSION SET ANAK ( COSMOMED ) PCS 38 38
23 INFUSION SET DEWASA /20 DROPS PCS - 32 - 32 87
24 INFUSION SET Y-TYPE, AXIMED PCS - -
25 IV CATHETER NO. 18 G NP PCS - -
26 IV CATHETER NO. 18 G Remedi , Steracath PCS 4 4
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 119 119
31 IV CATHETER NO. 24 G Otsucath PCS - -
32 IV CATHETER NO. 24 G Remedi PCS - 66 - 66
33 IV CATHETER NO. 18 WING WITH INJECTION PORT WP PCS - -
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS - -
39 KAPAS BERLEMAK 250 GRAM ROL - -
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - 95 - 95
44 KASA STERIL 18 x 22 CM ONEMED ROL - -
48 LISOL BOTOL - 7 - 7
50 ONE SCRUB CAIRAN 5 L GALON - -
51 NEDLE HOLDER No. 23 ( JARUM SUNTIK ) SET - -
52 NEDLE HOLDER No. 25 ( JARUM SUNTIK ) SET - -
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET - -
57 RIVANOL 300 ML, ONEMED BOTOL - 7 - 7
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR - -
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - 150 - 150
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - 600 - 600
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 300 1,000 1,300 500
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 1,000 1,000 2,000 200
66 SILK PLAIN 3/0 SACHET - -
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET - -
69 SUCTION CATHETER, no. 12, AXIMED ROLL 3 3
70 SUCTION CATHETER, no. 8, AXIMED ROLL 4 4
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET 2 2
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET 2 2
74 SUTURE NEEDLE HECTING KULIT No. 12, REMEDI SET 2 2
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL - -
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL - -
80 WING NEEDLE 27 G PCS - -

1 CLOPAZIMIN 100 MG TABLET - -
2 CYCLOSERINE 250 MG TABLET 60 60
3 ETHAMBUTOL 400 MG TABLET 128 128
4 ETHIONAMIDE 250 MG TABLET 80 80
5 ISONIAZID ( INH ) 300 MG TABLET - -
6 KANAMYCIN 1 G VIAL - -
7 LEVOFLOXACIN 250 MG TABLET 96 96
8 MOXIFLOXACIN 400 MG TABLET - 200 - 200
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET - -
10 PYRAZINAMIDA 500 MG TABLET 100 100
11 MASKER N95 TIPE 1860 S PCS 240 240
12 TP ADS 5 ML PCS - -
13 BEDAQUILINE 100 mg TABLET 288 288
LAIN-LAIN - -
OTSUCATH 18G X 1 1/4" PCS - 2 - 2
OTSUCATH 22G X 1 1/4" PCS - 12 - 12
IV CATHETER NO. 20 WING WITH INJECTION PORT SERENITY PCS - 4 - 4
OTSUCATH 24G X 3/4" PCS - -
SYPHILLIS 3.0MD 100T, DIRUI PCS - -
POT DAHAK POT
SLIDE BOX PCS 1
KACA SLIDE BOX 1
BLOOD LANCET BOX 1
RDT MALARIA TEST 25
DHP BOX 1
PRIMAQUIN TABLET 14
QUININ TABLET 300
ANATON TABLET 200 200
BIOLISYN TABLET TABLET 400 400
- -
JKN
Umum ( Bayar )
Mengetahui Yang Menyerahkan

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten
Galuh Amalia, S.Si, Apt Roslina

NIP: 19700628 199903 2 004 NIP: 197750102 200212 2 007
PERMINTAAN OBAT ( LPLPO )
021
LAPORAN BULAN : NOVEMBER

PERMINTAAN BULAN : DESEMBER

SISA STOK KETERANGAN
OPTMUM N APBN APBD BUFFER PROGRAM JUMLAH
9=6-7-8 10 11=10-9 12 13 14 15 16 17
4,560
6,900
-
- 1,600
-
- 900
3,200
9,900
- 600
-
10,800
-
9,000
-
-
-
-
-
-
2,200
10,300
-
1,500
3,400
5,100
-
-
3,000
- 400
4,200
-
-
- 600
- 400
-
10,900
7,900
1,000
1,700
-
3,700
6,200
300
-
7,700
-
1,840
700
6,000
-
-
-
-
-
- 600
- 1,000
- 300
- 500
700
4,300
2,800
- 1,100
-
3,800
- 2,300
-
1,600
2,000
- 1,700
3,000
16,500
6,200
- 1,300
-
-
-
3,700
3,900
-
- 100
9,300
- 5,050
- 4,350
-
10,400
-
5,150
146,400
2,100
- 500
1,900
6,700
13,100
- 300
1,600
- 900
5,800
-
-
1,100
2,600
-
-
-
-
- 200
-
-
1,500
-
7,400
-
-
- 200
13,600
- 600
- 16
-
-
-
-
-
- 400
-
-
-
- 200
-
5,400
-
-
-
2,934
-
-
1,113
1,220
4,054
3,169
193
-
-
-
53
-
-
1,895
5,680
1,032
-
-
-
-
-
-
-
-
5
1,940
-
- 5
- 3
-
940
- 500
- 50
393
-
70
195
-
270
-
335
-
565
-
-
200
- 100
506
126
-
120
22
-
-
- 40
100
-
-
14
-
391
- 40
-
-
105
- 90
30
-
-
90
-
-
-
- 60
-
- ED: 27-11-2020
-
-
- 18
-
540
-
30
-
-
- 100
170
- 37
- 20
-
-
-
- 38
-
-
-
48
-
- 25
- 12
150
300
-
- 30
136
-
- 72
70
-
24
-
-
336
900
-
-
-
-
196
-
54
-
-
13
- 6
-
-
- 12
- 9
13
- 14
39
-
1
-
-
-
334
- 254
396
90
140
64
-
-
-
-
-
-
-
-
-
-
- 5
34
-
-
19
-
-
-
1
-
-
-
-
-
-
-
-
-
50
-
-
-
-
-
-
-
-
-
300
-
1,100
-
-
196
402
-
204
204
-
-
-
3,000
-
-
-
- 2
30
38
- 119
-
-
4
-
119
-
185
-
- 66
-
-
-
-
-
180
-
22
- 95
359
13
-
225
125
195
- 7
20
-
-
-
-
60
40
10
- 7
-
-
- 150
-
-
- 600
800
1,800
-
-
60
3
4
2
2
2
2
2
2
-
-
30
-
-
60
128
80
-
-
96
- 200
-
100
240
-
288
-
- 2
- 12
- 4
-
-
Lainnya Jumlah

dr. Agaka Sukaryamin Apt., Gusna Sumantri S.farm

NIP : 19660408 199703 1 005 NIP : 19891227 20201 21 006
TAHUN 2022
KODE PUSKESMAS : 12
KECAMATAN : MELIAU
KABUPATEN : SANGGAU
ED/
NO NAMA OBAT /BMHP SATUAN STOK AWAL PENERIMAA PERSEDIAAN PEMAKAI RUSAK/ SISA STOK
N AN
HILANG
1 2 3 4 5 6=4+5 7 8 9=6-7-8
1 ACETYL SISTEIN 200 MG TABLET 4,560 4,560 4,560
4 AMBROKSOL 30 MG TABLET - 1,600 - 1,600 - 1,600
6 AMLODIPIN 5 MG TABLET - 900 - 900 - 900

Vitamin D 100 IU

Vitamin D 300 IU

32 SACHET 4,200 4,200 4,200

35 GLIBENKLAMID 5 MG TABLET - 600 - 600 - 600
36 GLIMEPIRID 1 MG TABLET - 400 - 400 - 400
45 KAPTOPRIL 25 MG TABLET 300 300 300
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 7,700 7,700 7,700
50 LISINOPRIL 5 MG TABLET 700 700 700

59 METFORMIN HCl 850 MG TABLET - 1,000 - 1,000 - 1,000
61 METILPREDNISOLON 4 MG TABLET - 500 - 500 - 500

64 Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat TABLET 2,800 2,800 2,800
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - 1,100 - 1,100 - 1,100

67 NATRIUM DIKLOFENAK 25 MG TABLET 3,800 3,800 3,800
71 NIKOTINAMIDE 20 MG TABLET 2,000 2,000 2,000
72 OMEPRAZOLE 20 MG TABLET - 1,700 - 1,700 - 1,700
73 ONDANSENTRON 4 MG TABLET 3,000 3,000 3,000
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 16,500 16,500 16,500

75 Tablet 6,200 6,200 6,200

85 RETINOL ( VIT. A ) 200.000 IU KAPSUL - 5,050 - 5,050 - 5,050
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL - 4,350 - 4,350 - 4,350
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat TABLET 146,400 146,400 146,400
0,4 mg tablet salut
93 VITAMIN B. COMPLEKS TABLET - 500 - 500 - 500

- - -
SEDIAAN ANTIINFEKSI TABLET/KAPLET/KAPSUL - - -
4 ASIKLOVIR 200 MG TABLET - 300 - 300 - 300


20 KETOKONAZOL 200 MG TABLET 1,500 1,500 1,500


1 ALPRAZOLAM 0,5 MG TAB TABLET 2,934 2,934 2,934
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 1,113 1,113 1,113
12 VIAL 53 53 53
MG/ML )
15 HALOPERIDOL 5 MG TABLET 1,895 1,895 1,895
16 KARBAMAZEPIN 200 MG TABLET 5,680 5,680 5,680
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 1,032 1,032 1,032
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET - 500 - 500 - 500

1 AMBROKSOL SYR 15 MG/5 ML BOTOL - 50 - 50 - 50
2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 393 393 393
4 ANTASIDA DOEN SYRUP BOTOL 70 70 70


17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL - 100 - 100 - 100

13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - 40 - 40 - 40
38 RINGER LAKTAT LARUTAN INFUS KOLF 170 170 170
SEDIAAN OBAT LUAR

1 TUBE - 25 - 25 - 25
IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT - 12 - 12 - 12
5 ALUBAG - - -
salbutamol 2,5 mg
10 HIDROKORTISON KRIM 2,5% TUBE - 72 - 72 - 72
VAKSIN
8 POUCHES @ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI ) POUCH 39 39 39

14 ADS 0,05 ML 0NEJECT PCS 334 334 334
15 ADS 0,5 ML 0NEJECT PCS - 254 - 254 - 254
16 ADS 5 ML SKIFA PCS 396 396 396

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
9 CS-QC SERUM 5 L , DIRUI BOTOL 1 1 1
19 HBSAG WB 100T SD ,DIRUI PCS 50 50 50
23 SET - - -
NaCl 0,9 % )
BMHP
23 INFUSION SET DEWASA /20 DROPS PCS - 119 - 119 - 119
32 IV CATHETER NO. 24 G Remedi PCS - 66 - 66 - 66
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - 95 - 95 - 95
48 LISOL BOTOL - 7 - 7 - 7
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 800 800 800
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 1,800 1,800 1,800
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET - -

LAIN-LAIN
OTSUCATH 18G X 1 1/4" - 2 - 2 - 2
OTSUCATH 22G X 1 1/4" - 12 - 12 - 12
IV CATHETER NO. 20 WING WITH INJECTION PORT SERENITY - 4 - 4 - 4
POT DAHAK - - -
- - -
- - -
JKN
Mengetahui Yang Menyerahkan Yang Menerima

An. Kepala Dinas Kesehatan Kabupaten Sanggau Koordinator Pengelola Obat Kabupaten Kepala Puskesm
Galuh Amalia, S.Si, Apt Lia Nirmawati A.Md. far dr. Agaka Suk
NIP: 19700628 199903 2 004 NIP: 1983 0118 201001 2 009 NIP : 19660408 19
DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
TAHUN 2022
LAPORAN BULAN : DESEMBER

PERMINTAAN BULAN : JANUARI

KETERANGAN
OPTMUN N APBN APBD BUFFER PROGRAM JUMLAH
10 11=10-9 12 13 14 15 16 17
Lainnya Jumlah

dr. Agaka Sukaryamin Apt., Gusna Sumantri S.farm

NIP : 19660408 199703 1 005 NIP : 19891227 20201 21 006
Rata- Rata Pengeluaran sehari : Jumlah pengeluaran sebulan dibagi ketersediaan sebulan ( hari )
MENU
RATA-RATA
1 2 3 4
1 2 3



32 SACHET
0
37 HEMAFORT TABLET


0

75 Tablet
24
91 0,4 mg tablet salut TABLET
0
94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET





12 VIAL
MG/ML ) 0



0

0
SEDIAAN OBAT LUAR

1 IU/g TUBE

5 ALUBAG
salbutamol 2,5 mg
VAKSIN
2 VAKSIN TT VIAL

18 PELARUT BCG VIAL

BAHAN LABORATORIUM
23 PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % , SET

NaCl 0,9 % )
BMHP

48 LISOL BOTOL 0

12 TP ADS 5 ML PCS
0
LAIN-LAIN
RATA-RATA PENGELUARAN SEHARI
5 6 7 8 9 10 11 12
4
Pengeluaran Sebulan : Rata-Rata Pengeluaran sebulan dikali lamanya pelayanan sebulan
MENU
PENGELUARAN SELA
1 2 3 4
1 2 3
1 ACETYL SISTEIN 200 MG TABLET 1,200
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET
13 ASAM MEFENAMAT 500 MG TABLET


22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET
23 DEKSAMETASON TABLET 0,5 MG TABLET 1,000
25 DIGOKSIN 0,25 MG TABLET
27 DOMPERIDON 10 TAB TABLET
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET
31 FUROSEMIDA 40MG TABLET 200

32 SACHET 100

36 GLIMEPIRID 1 MG TABLET
37 HEMAFORT TABLET
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET
39 IBUPROFEN 200 MG TABLET
41 ISOSORBID DINITRAT 5 MG TABLET

62 METILPREDNISOLON 16 MG TABLET


70 NIFEDIPIN 10 MG TABLET
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 3,500

75 Tablet 200
84 RANITIDIN 150 MG TABLET
85 RETINOL ( VIT. A ) 200.000 IU KAPSUL
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET

93 VITAMIN B. COMPLEKS TABLET 100

1 ALBENDAZOL 400 MG TABLET
4 ASIKLOVIR 200 MG TABLET

5 ASIKLOVIR 400 MG TABLET
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET 100
7 CLINDAMISIN 300 MG TABLET

11 ERITROMISIN 250 MG TABLET
12 ERITROMISIN 500 MG TABLET
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET

40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET 200
41 SIPROFLOKSASIN 500 MG TABLET

2 ALPRAZOLAM 1 MG TAB TABLET 70
5 CLOZAPIN 25 MG TABLET
8 DIAZEPAM INJ 5 MG/ML AMPUL
12 VIAL
MG/ML )
14 HALOPERIDOL 1,5 MG TABLET 180
15 HALOPERIDOL 5 MG TABLET
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET

2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL
6 DOMPERIDON SYRUP 5 MG/ML BOTOL

9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 10

16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL

2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL 5
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL

16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL 60
30 METOKLOPRAMID INJK 5 MG/ML AMPUL
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF
39 SEFOTAKSIM SERBUK INJ 1 G VIAL 20
40 SEFTRIAKSON SERBUK INJ 1 G VIAL 10
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL 10
SEDIAAN OBAT LUAR

1 IU/g TUBE
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT

3 ANTI HEMOROID DOEN KOMBINASI SUPPO
4 BETAMETASON KRIM 0,1 % TUBE
5 ALUBAG
salbutamol 2,5 mg
8 GENTAMISIN SALEP MATA 0,3 % TUBE
10 HIDROKORTISON KRIM 2,5% TUBE 10
13 KLORAMFENIKOL SALEP MATA 1% TUBE
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL 10
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL 10
2 VAKSIN TT VIAL
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 10
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 30
7 VAKSIN DPT-HB ( Pentabio ) VIAL 30
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCHES POUCH 5

@ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI )
18 PELARUT BCG VIAL

BAHAN LABORATORIUM
1 ALKOHOL SWAB AXIMED BOX
9 CS-QC SERUM 5 L , DIRUI BOTOL
19 HBSAG WB 100T SD ,DIRUI PCS

NaCl 0,9 % )
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS
2 ALAT SUNTIK 1 CC , TP PCS 110
8 ASEPTAN + DISP 500ML BOTOL 2

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS
21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS
22 INFUSION SET ANAK ( COSMOMED ) PCS
26 IV CATHETER NO. 18 G Remedi , Steracath PCS
30 IV CATHETER NO. 22 G Remedi , Steracath PCS
32 IV CATHETER NO. 24 G Remedi PCS 50
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL
48 LISOL BOTOL
50 ONE SCRUB CAIRAN 5 L GALON 1
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET
69 SUCTION CATHETER, no. 12, AXIMED ROLL
70 SUCTION CATHETER, no. 8, AXIMED ROLL
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET
74 SUTURE NEEDLE HECTING KULIT No. 12, REMEDI SET
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS
80 WING NEEDLE 27 G PCS 5

2 CYCLOSERINE 250 MG TABLET
3 ETHAMBUTOL 400 MG TABLET
4 ETHIONAMIDE 250 MG TABLET
7 LEVOFLOXACIN 250 MG TABLET
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET
10 PYRAZINAMIDA 500 MG TABLET
11 MASKER N95 TIPE 1860 S PCS
12 TP ADS 5 ML PCS
LAIN-LAIN
PENGELUARAN SELAMA SEBULAN ( 30 HARI )
5 6 7 8 9 10 11 12
4
Buffer stok : persediaan 10% S/D 20% dr pengeluaran sebulan
untuk mengantisifasi apabila ada lonjakan kunjungan atau kejadian tak terduga lainnya
MENU
BUFFERS
1 2 3 4
1 2 3
4 AMBROKSOL 30 MG TABLET 0
5 AMINOFILIN TABLET 200 MG TABLET 0
12 ASAM FOLAT 1 MG TABLET 0
14 ATAFULGIT 600 MG ( PULAREX ) TABLET 0
15 ATROPIN SULFAT 0,5 MG TABLET 0
16 BETAHISTIN MEYSILAT 6 MG TABLET 0
17 BISOPROLOL 5 MG TABLET 0
18 BROMMER 30 MG (AMBROXOL 30 MG ) TABLET 0
0
0
21 CIMETIDIN 200 MG TABLET 0
24 DEPAKOT ER 500 mg : VALVROAT SR 500 MG TABLET 0
28 FENITOIN NATRIUM 50 MG TABLET 0
29 FERRO SULFAT 300 MG TABLET SALUT TABLET 0
31 FUROSEMIDA 40MG TABLET 20

32 SACHET
10
33 GEMFIBROZIL 300 MG TABLET 0
34 GEMFIBROZIL 600 MG TABLET 0
37 HEMAFORT TABLET 0
42 KALSIUM KARBONAT 500 MG TABLET 0
48 KOMBINASI : KAOLIN 550 MG + PEKTIN 20 MG TABLET 0
50 LISINOPRIL 5 MG TABLET 0
52 LOPERAMID 2 MG TABLET 0
53 MELOKSIKAM 7,5 MG TABLET 0
54 MELOKSIKAM 15 MG TABLET 0
55 MERFLAM TAB 50 : NATRIUM DIKLOFENAK TAB 50 MG TABLET 0
0
57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET 0
58 METFORMIN HCl 500 MG TABLET 0
59 METFORMIN HCl 850 MG TABLET 0
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET 0

0
65 MINIASFI ( ASETOSAL 80 MG ) TABLET 0
66 NATRIUM BIKARBONAT 500MG TABLET 0
69 NATRIUM TIROKSIN 100 MG ( EUTHYROX ) TABLET 0
71 NIKOTINAMIDE 20 MG TABLET 0
72 OMEPRAZOLE 20 MG TABLET 0
73 ONDANSENTRON 4 MG TABLET 0

75 Tablet
20
76 PIRIDOKSIN 10 MG TABLET 0
77 PIRIDOKSIN 25 MG TABLET 0
78 PIROKSIKAM 10 MG TABLET 0
79 PIROKSIKAM 20 MG TABLET 0
83 PROPILTIOURASIL 100 MG TABLET 0
86 RETINOL ( VIT.A ) 100.000 IU KAPSUL 0
89 SETIRIZIN 10 MG TABLET 0
0
93 VITAMIN B. COMPLEKS TABLET 10
0
0
SEDIAAN ANTIINFEKSI TABLET/KAPLET/KAPSUL 0
0
6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET 10
8 DIETILKARBAMAZIN SITRAT 100 MG TABLET 0
0
10 DOKSISIKLIN 100 mg TABLET 0
13 ETAMBUTOL HCL 400 MG TABLET 0
14 ETAMBUTOL HCL 500 MG TABLET 0
15 FENOKSIMETIL PENISILIN 250MG TABLET 0
16 FENOKSIMETIL PENISILIN 500 MG TABLET 0
17 GRISEOFULVIN 125 MG TABLET 0
18 ISONIAZIDA ( INH ) 100 MG TABLET 0
19 ISONIAZIDA ( INH ) 300 MG PAKET 0
21 KLORAMFENIKOL 250 MG TABLET 0
0
24 KUININ SULFAT 200 MG TABLET 0
25 MEBENDAZOL 100 MG TABLET 0
28 NISTATIN 500.000 IU/G TABLET SALUT TABLET 0
31 OBAT ANTI TUBERKULOSIS SISIPAN DEWASA PAKET 0
32 OBAT ANTI TUBERKULOSIS FDC KATAGORI ANAK PAKET 0
33 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI I PAKET 0
34 OBAT ANTI TUBERKULOSIS KOMBIPAK KATAGORI ANAK PAKET 0
35 PIRANTEL PAMOAT 125 MG TABLET 0
36 PRIMAKUIN 15 MG TABLET 0
37 RIFAMPISIN 300 MG TABLET 0
38 RIFAMPISIN 450 MG TABLET 0
39 SEFADROKSIL 500 MG TABLET 0
40 SIFLOX TAB 500 MG ( SIPROFLOKSASIN 500 MG ) TABLET 20
42 TETRASIKLIN 250 MG TABLET 0
43 TETRASIKLIN 500 MG TABLET 0
44 THIAMPENIKOL 500 MG TABLET 0
0
SEDIAAN NARKOTIKA,PSIKOTROPIKA DAN PREKUSOR 0
1 ALPRAZOLAM 0,5 MG TAB TABLET 0
2 ALPRAZOLAM 1 MG TAB TABLET 7
3 ALPRAZOLAM 1,5 MG TAB TABLET 0
9 FENOBARBITAL 100 MG TABLET 0
10 FENOBARBITAL 30 MG TABLET 0
11 FENOBARBITAL INJ 50 MG/ML, IV, IM TABLET 0
12 VIAL
MG/ML ) 0
19 KLORPROMAZIN HCL INJ 25 MG/ML - 1 ML AMPUL 0
20 KLORPROMAZIN HCL INJ 5 MG/ML - 2 ML AMPUL 0
21 KODEIN HCL 10 MG TABLET 0
22 LODOMER 2 MG : HALOPERIDOL TABLET SALUT 2 MG TABLET 0
23 LODOMER INJ I.M 5 MG/ML: HALOPERIDOL INJ I.M 5 MG/ML AMPUL 0
24 LORAZEPAM 2 MG TABLET 0
25 PEPREZAL ( FLUOKSETIN 20 MG ) TABLET 0
29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE 0
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE 0
31 TRAMADOL 50 MG TABLET 0
0
SEDIAAN SIRUP / SUSPENSI 0
1 AMBROKSOL SYR 15 MG/5 ML BOTOL 0
3 AMOKSISILIN SYRUP KRG FORTE BOTOL 0
0
7 ERITROMISIN SYRUP 200 MG/5 ML BOTOL 0
9 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL 1
0
12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL 0
14 PARASETAMOL DROPS 100 MG/ML BOTOL 0
15 PIRANTEL PAMOAT SUSPENSI 125 MG / 5 ML BOTOL 0
17 SETIRIZIN SIRUP 5 MG/ 5 ML BOTOL 0
0
SEDIAAN INJEKSI / STERIL / PARENTERAL 0
1 AMPISILIN SERB .INJ 1000 MG ( I.M ) VIAL 0
4 ARTESUNATE INJEKSI 60 MG/ML ( i.v/i.m ) VIAL 0
5 ARTEMETER INJEKSI 80 MG / Ml AMPUL 0
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL 1
8 BENZATIN BENZIL PENISILIN INJ 1,2 JUTA IU VIAL 0
9 BENZATIN BENZIL PINISILIN INJ 2,4 JUTA IU VIAL 0
0
11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL 0
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL 0
14 ECOSOL G 5 ( NRC ) GLUKOSA 5 % KOLF 0
15 ECOSOL RL ( NRC ) RINGER LAKTAT KOLF 0
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL 0
19 GENTAMISIN INJ 40 MG/ML AMPUL 0
20 GLUKOSA LARUTAN INFUS 40 % STERIL KOLF 0
22 KALSIUM GLUKONAT INJ 100 MG/ML AMPUL 0
23 KUININ DIHIDROKLORIDA INJ 25%-2ML AMPUL 0
24 LIDOKAIN INJ 2 % ( infiltr p.v ) AMPUL 0
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL 6
26 MAGNESIUM SULFAT INJ (IV) 40% - 25 ML AMPUL 0
27 MAGNESIUM SULFAT INJ (IV) 20% - 25 ML AMPUL 0
28 METAMIZOL INJ 500 MG/ML AMPUL 0
29 METIL ERGOMETRIN MALEAT INJEKSI 0,2 MG/ML AMPUL 0
31 NATRIUM TIOSULFAT INJ 25% - 10 ML VIAL 0
33 OKSITETRASIKLIN INJ 50 MG/ML - 10 ML VIAL 0
35 OMEPRAZOLE INJ 40 MG/ 10 ML AMPUL 0
36 PROKAIN BENZIL PENISILIN 3 JT U VIAL 0
37 RANITIDIN INJEKSI 25 MG/ML AMPUL 0
39 SEFOTAKSIM SERBUK INJ 1 G VIAL 2
40 SEFTRIAKSON SERBUK INJ 1 G VIAL 1
41 SERUM ANTI DIFTERI INJ 20.000 IU/ML ( ADS ) VIAL 0
42 SERUM ANTI TETANUS INJ 20.000 IU/VIAL ( ATS ) VIAL 0
43 SIANOKOBALAMIN INJ ( B 12 ) 500 MCG/ML AMPUL 1
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL 0
45 TETAGAM - human tetanus imunoglobulin inj i.m 250 IU AMPUL 0
46 THIAMIN HCL INJ 100 MM/ML - 1 ML AMPUL 0
47 TRAMADOL INJ AMPUL 0
0
SEDIAAN OBAT LUAR 0
1 IU/g TUBE
0
5 ALUBAG
salbutamol 2,5 mg 0
9 GENTAMYCIN 0,1 % SALF KULIT TUBE 0
10 HIDROKORTISON KRIM 2,5% TUBE 1
12 KLORAMFENIKOL SALEP KULIT 2 % ( BUFACETIN SALF ) TUBE 0
14 KLORAMFENIKOL TETES TELINGA 3% BOTOL 0
15 KLORAMFENIKOL TETES MATA 1 % BOTOL 0
18 OKSITETRASIKLIN SALEP 3% TUBE 0
19 OKSITETRASIKLIN SALEP MATA 1% TUBE 0
20 PHENOL GLYSEROL TETES TELINGA 10 % BOTOL 1
21 SALISIL BEDAK 2% 50 GRAM KOTAK 0
23 SCABIMITE CREAM 5 % : PERMETRIN KRIM 5 % TUBE 0
24 SULFADIAZIN SILVER KREM 1% TUBE 0
25 YODIUM POVIDON LARUTAN 10% 30 ML BOTOL 0
0
VAKSIN 0
1 VAKSIN BCG ( BAYI ) VIAL 1
2 VAKSIN TT VIAL 0
3 VAKSIN DT 10 DOSIS VIAL 0
4 VAKSIN CAMPAK 10 DOSIS ( MR ) VIAL 1
5 VAKSIN TD 10 DOSIS VIAL 0
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL 3
7 VAKSIN DPT-HB ( Pentabio ) VIAL 3
POUCHES @ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI ) 1
9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL 0
10 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 2 VIAL 0
11 VAKSIN FLU BIO 0,5 ML AMPUL 0
12 VAKSIN HEPATITIS B REKOMBINAN ( DEWASA ) 0,1 ML VIAL 0
13 HEPATITIS B IMMUNOGLOBULIN ( HYPERHIB B), DEWASA VIAL 0
14 ADS 0,05 ML 0NEJECT PCS 0
15 ADS 0,5 ML 0NEJECT PCS 0
16 ADS 5 ML SKIFA PCS 0
17 DROPPER POLIO BIVALEN DROP 0
18 PELARUT BCG VIAL 0
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL 0
0
BAHAN DAN PREPARAT GIGI 0
1 ETIL KLORIDA SPRAY 100 ML BOTOL 0
2 FUJI II 1-1-23 BOX 0
2 FUJI 7 1-1 WHITE BOX 0
3 FUJI IX GP 1-1 EXTRA A3 BOX 0
4 FUJI IX ART 1-1 BOX 0
5 GLASS IONOMER SEMEN (ART) BOTOL 0
6 KALSIUM HIDROKSIDA PASTA KOTAK 0
7 KLORFENOL KAMPER MENTOL ( CHKM ) BOTOL 0
8 MUMMYFYING PASTA KOTAK 0
0
BAHAN LABORATORIUM 0
2 ALKOHOL SWAB COSMOMED @200 BOX 0
3 ALKOHOL 70% 100 ML AFIFARMA BOTOL 0
4 ALKOHOL 70% 1000 ML AFIFARMA BOTOL 0
6 BILIRUBIN DIRECT BOTOL 0
7 BILIRUBIN TOTAL BOTOL 0
8 CBC ST PLUS-NORMAL DIATRON 1 VIAL, 2,5ML, DIRUI PCS 0
10 CLEANSER 500 ML BCC SERIES, DIRUI PCS 0
11 CHOLESTEROL TOTAL 2 X 60 ML - 2 X 15 ML ,DIRUI BOTOL 0
12 CONTROL MIDLE BF - 6500 , DIRUI VIAL 0
13 CREATININ 2X60 ML, DIRUI BOTOL 0
14 DILUENT 20 L BF-6500, DIRUI BOX 0
15 GAMMA GT ,DIRUI BOX 0
16 GLUCOSA HEXO 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL 0
17 GOT (AST ) 2X60 ML, DIRUI BOTOL 0
18 GPT ( ALT ) 2X60 ML, DIRUI BOTOL 0
20 HIV 1/2 3.0 MD 100T SD , DIRUI PCS 0
21 LYSE BF-6500 , DIRUI PCS 0
22 NaCl 0,9 INDOREAGENT BOTOL 0
NaCl 0,9 % ) 0
24 PEWARNA ZIEHL NEELSEN pack 0
25 STERINTECH Bowie Dick Test Pack PACK 0
26 TABUNG STERIL EDTA 3 ML PACK 0
27 TRIGLYCERIDA 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL 0
28 URID ACID 2 X 60 ML - 2 X 15 ML, DIRUI BOTOL 0
29 YELLOW TIP NESCO PACK '1000S 0
0
BMHP 0
4 ALAT SUNTUK 3 CC, OTSUCATH PCS 0
8 ASEPTAN + DISP 500ML BOTOL 0
0
0
13 CONNECTING TUBE, AXIMED PCS 0
14 FACE MASK EAR LOOP, AXIMED PCS 0
15 FACE MASK EAR LOOP, FESCO PCS 0
17 FEEDING TUBE, 40 cm, NO. 10, AXIMED PCS 0
18 FEEDING TUBE, 100 cm, NO. 8, AXIMED PCS 0
19 FEEDING TUBE, 100 cm, NO . 10, AXIMED PCS 0
24 INFUSION SET Y-TYPE, AXIMED PCS 0
25 IV CATHETER NO. 18 G NP PCS 0
31 IV CATHETER NO. 24 G Otsucath PCS 0
32 IV CATHETER NO. 24 G Remedi PCS 5
36 IV CATHETER NO. 24 WING WITH INJECTION PORT Serenity PCS 0
39 KAPAS BERLEMAK 250 GRAM ROL 0
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL 0
44 KASA STERIL 18 x 22 CM ONEMED ROL 0
48 LISOL BOTOL 0
49 ODEX LARUTAN 500 ML BOTOL 0
50 ONE SCRUB CAIRAN 5 L GALON 0
51 NEDLE HOLDER No. 23 ( JARUM SUNTIK ) SET 0
52 NEDLE HOLDER No. 25 ( JARUM SUNTIK ) SET 0
53 NEDLE HOLDER No. 27 ( JARUM SUNTIK) SET 0
57 RIVANOL 300 ML, ONEMED BOTOL 0
58 SARUNG TANGAN STERIL NO. 6.0, AXIMED PAIR 0
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR 0
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR 0
66 SILK PLAIN 3/0 SACHET 0
67 SILK 3/0 75cm, 1/2 Tapper 25 mm SACHET 0
77 TAPE FECOPLAST 5cm X 4,5 m ,FESCO ROLL 0
78 TAPE FECOPLAST 2,5cm X 4,5 m, FESCO ROLL 0
80 WING NEEDLE 27 G PCS 1
0
OBAT PROGRAM TB KHUSUS MULTY DRUGS RESISTEN ( MDR ) 0
1 CLOPAZIMIN 100 MG TABLET 0
5 ISONIAZID ( INH ) 300 MG TABLET 0
6 KANAMYCIN 1 G VIAL 0
8 MOXIFLOXACIN 400 MG TABLET 0
12 TP ADS 5 ML PCS 0
0
LAIN-LAIN 0
0
0
0
0
0
BUFFERSTOK ( 10% )
5 6 7 8 9 10 11 12
4
Leadtime : waktu tunggu sampai diterimanya obat/bmhp
MENU
LEADTIME ( WAKT
1 2 3 4
1 2 3
1 ACETYL SISTEIN 200 MG TABLET 1,971



32 SACHET
0
37 HEMAFORT TABLET

61 METILPREDNISOLON 4 MG TABLET 1,250

0
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 1,714

75 Tablet
714
0





12 VIAL
MG/ML ) 0



0

0
SEDIAAN OBAT LUAR

1 IU/g TUBE

5 ALUBAG
salbutamol 2,5 mg
VAKSIN
2 VAKSIN TT VIAL

18 PELARUT BCG VIAL

BAHAN LABORATORIUM

NaCl 0,9 % )
BMHP

48 LISOL BOTOL 1
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 1,429
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 1,143

12 TP ADS 5 ML PCS
0
LAIN-LAIN
LEADTIME ( WAKTU TUNGGU 30 HARI )
5 6 7 8 9 10 11 12
4
Rekap Pengeluaran /bulan thn 2020
MENU

1 2 3
1 2 3
1 ACETYL SISTEIN 200 MG TABLET 1,380 - 60
2 ALOPURINOL 100 MG TABLET 100 - -
6 AMLODIPIN 5 MG TABLET - - 700
8 ANTASIDA DOEN TABLET KOMBINASI TABLET 100 - 400
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - - 200
11 ASAM ASKORBAT ( VIT. C ) 50 MG TABLET - - 100
13 ASAM MEFENAMAT 500 MG TABLET 200 - 200
19 TABLET - - -
Vitamin D 100 IU
20 TABLET - - -
Vitamin D 300 IU
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET - - 200
23 DEKSAMETASON TABLET 0,5 MG TABLET - - 1,000
25 DIGOKSIN 0,25 MG TABLET 100 - -
26 DIMENHIDRINAT 50 MG TAB TABLET - - 200
27 DOMPERIDON 10 TAB TABLET - - 100
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET 100 - 200
32 GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g , SACHET - - -


35 GLIBENKLAMID 5 MG TABLET 400 - 400
36 GLIMEPIRID 1 MG TABLET 200 - -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET - - 100
39 IBUPROFEN 200 MG TABLET - - 200
40 IBUPROFEN 400 MG TABLET 100 - 300
41 ISOSORBID DINITRAT 5 MG TABLET - - -
43 KALSIUM LAKTAT TABLET 100 - 600
44 KAPTOPRIL 12,5 MG TABLET 500 - -
45 KAPTOPRIL 25 MG TABLET - - 1,000
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET 400 - 600
49 LANSOPRAZOL 30 MG TABLET 60 - 20
50 LISINOPRIL 5 MG TABLET - - -
51 LORATADIN TABLET 10 MG TABLET - - 400

59 METFORMIN HCl 850 MG TABLET - - 400
60 METIL ERGOMETRIN MALEAT 0,125 MG SALUT TABLET - - 100
61 METILPREDNISOLON 4 MG TABLET 500 - 1,000
62 METILPREDNISOLON 16 MG TABLET - - 300
63 METOKLOPRAMID 10 MG TABLET - - -

64 Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat TABLET - - 160
65 MINIASFI ( ASETOSAL 80 MG ) TABLET - - 100

67 NATRIUM DIKLOFENAK 25 MG TABLET 500 - 100
68 NATRIUM DIKLOFENAK 50 MG TABLET - - 800
70 NIFEDIPIN 10 MG TABLET 100 - 900
72 OMEPRAZOLE 20 MG TABLET - - 300
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET 1,200 - 1,200

75 400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat Tablet 500 - 300
80 PREDNISON 5 MG TABLET 300 - 300
81 PROPANOLOL 40 MG TABLET 100 - -
84 RANITIDIN 150 MG TABLET 400 - -
88 SALBUTAMOL 4 MG TABLET 100 - 800
90 SIMVASTATIN 10 MG TABLET 100 - 360
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat TABLET - - 3,120
0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET - - -
93 VITAMIN B. COMPLEKS TABLET - - 500
95 ZINC TABLET 20 MG DISPERSIBLE TABLET - - 100

1 ALBENDAZOL 400 MG TABLET - - -
2 AMOKSISILIN 500 MG TABLET 600 - 1,200
4 ASIKLOVIR 200 MG TABLET - - -

6 CHLORAMEX 500 MG ( KLORAMFENIKOL 500 MG ) TABLET - - 300
7 CLINDAMISIN 300 MG TABLET 200 - -

11 ERITROMISIN 250 MG TABLET - - 200
12 ERITROMISIN 500 MG TABLET 200 - 300
17 GRISEOFULVIN 125 MG TABLET - - 200
20 KETOKONAZOL 200 MG TABLET - - 300
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET - - 300

28 NISTATIN 500.000 IU/G TABLET SALUT TABLET - - 100
29 OBAT ANTI TUBEKULOSIS KATEGORI FDC KATAGORI 1 PAKET 11 - 2
35 PIRANTEL PAMOAT 125 MG TABLET - - 300
39 SEFADROKSIL 500 MG TABLET - - 200
41 SIPROFLOKSASIN 500 MG TABLET 100 - 200

1 ALPRAZOLAM 0,5 MG TAB TABLET - - 300
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET 130 - 158
5 CLOZAPIN 25 MG TABLET 30 - -
6 DIAZEPAM 2 MG TABLET 90 - 73
7 DIAZEPAM 5 MG TABLET 62 - 213
8 DIAZEPAM INJ 5 MG/ML AMPUL - - -
12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL - - -

MG/ML )
15 HALOPERIDOL 5 MG TABLET 65 - 65
16 KARBAMAZEPIN 200 MG TABLET 435 - 225
17 KLORPROMAZIN HCL SALUT 100 MG TABLET 15 - 85
30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE 1 - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET - - -
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET 60 - 120

2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL 7 - -
4 ANTASIDA DOEN SYRUP BOTOL 30 - 20
6 DOMPERIDON SYRUP 5 MG/ML BOTOL 5 - -

8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL - - -
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL - - 25

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL - - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL - - -
18 ZINK SIR 20 MG/5 ML BOTOL - - -

2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL - - -
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL - - -
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL - - -

12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 3 - 140
13 DIFENHIDRAMIN (HCl) INJ 10 MG/ML - 1 ML AMPUL - - 20
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL - - -
17 FITOMENADION ( VIT K ) INJ 2 MG/ML (i.m) AMPUL - - 60
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL - - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF - - -
25 LIDOKAIN KOMB : lidokain 2% + epinefrin 1:80.000 AMPUL - - 10
30 METOKLOPRAMID INJK 5 MG/ML AMPUL 2 - 5
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF - - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL - - -
37 RANITIDIN INJEKSI 25 MG/ML AMPUL - - 100
38 RINGER LAKTAT LARUTAN INFUS KOLF 24 - -
39 SEFOTAKSIM SERBUK INJ 1 G VIAL - - 7
SEDIAAN OBAT LUAR
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 TUBE - - -

IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 12 - 1
3 ANTI HEMOROID DOEN KOMBINASI SUPPO - - 45
4 BETAMETASON KRIM 0,1 % TUBE - - -

salbutamol 2,5 mg
8 GENTAMISIN SALEP MATA 0,3 % TUBE - - 3
10 HIDROKORTISON KRIM 2,5% TUBE - - 48
11 KETOKONAZOL CREM 2% 10 G TUBE - - 30
13 KLORAMFENIKOL SALEP MATA 1% TUBE - - -
16 MIKONAZOL KRIM 2% TUBE - - 24
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP - - 100
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT - - -
27 YODIUM POVIDON LARUTAN 10% 300 ML AFIFARMA BOTOL - - 1
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL - - 22
5 VAKSIN TD 10 DOSIS VIAL - - 9
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL - - 34
7 VAKSIN DPT-HB ( Pentabio ) VIAL - - 32
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCH - - 25

14 ADS 0,05 ML 0NEJECT PCS - - 65
15 ADS 0,5 ML 0NEJECT PCS - - 55
16 ADS 5 ML SKIFA PCS - - -
17 DROPPER POLIO BIVALEN DROP - - -
18 PELARUT BCG VIAL - - -
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL - - -

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
2 ALKOHOL SWAB COSMOMED @200 BOX 6 - -
5 ALKOHOL 70% 1000 ML ONEMED BOTOL 4 - 1
9 CS-QC SERUM 5 L , DIRUI BOTOL 1 - -
19 HBSAG WB 100T SD ,DIRUI PCS 50 - -

NaCl 0,9 % )
BMHP
1 ALAT SUNTIK 1 CC , AXIMED PCS - - 200
3 ALAT SUNTIK 3 CC , AXIMED PCS 100 - 500
6 ALAT SUNTIK 5 CC , AXIMED PCS - - -
7 ALAT SUNTIK 5 CC ,TP PCS - - 27
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS - - 6

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET - - -
16 FACE MASK TIES ON, AXIMED PCS - - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS 3 - 1
21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS - - 1
22 INFUSION SET ANAK ( COSMOMED ) PCS - - 1
23 INFUSION SET DEWASA /20 DROPS PCS - - 75
26 IV CATHETER NO. 18 G Remedi , Steracath PCS - - 9
28 IV CATHETER NO. 20 G Remedi, Steracath PCS 5 - 70
30 IV CATHETER NO. 22 G Remedi , Steracath PCS 45 - 150
32 IV CATHETER NO. 24 G Remedi PCS - - 20
38 IV CATHETER NO. 26 WING WITH INJECTION PORT WP PCS 20 - -
40 KAPAS HIDROPIL 250 GRAM ROL - - 1
41 KASA KOMPRES STERIL 40 X 40 , ONEMED ROL - - 84
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL - - -
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL - - -
45 KASA PEMBALUT HIDROFIL 4 M x 3 CM ROL - - -
46 KASA PEMBALUT HIDROFIL 4 M x 10 CM ROL - - 25
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL - - 5
48 LISOL BOTOL 1 - 3
49 ODEX LARUTAN 500 ML BOTOL - - -
54 NON WOVEN FIXATION 5 CM X 10 M, AXIMED ROLL - - -
57 RIVANOL 300 ML, ONEMED BOTOL - - 2
60 SARUNG TANGAN STERIL NO. 7.0 , AXIMED PAIR - - 50
63 SARUNG TANGAN NON STERIL SIZE S, AXIMED PAIR - - 600
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR 1,000 - 200
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR 800 - -
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET 12 - -
69 SUCTION CATHETER, no. 12, AXIMED ROLL 2 - -
70 SUCTION CATHETER, no. 8, AXIMED ROLL 1 - -
71 SUTURE NEEDLE HECTING KULIT No. 9, REMEDI SET - - -
72 SUTURE NEEDLE HECTING KULIT No.10, REMEDI SET - - -
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS - - -

2 CYCLOSERINE 250 MG TABLET - - 60
3 ETHAMBUTOL 400 MG TABLET - - 60
4 ETHIONAMIDE 250 MG TABLET - - 60
7 LEVOFLOXACIN 250 MG TABLET - - 90
8 MOXIFLOXACIN 400 MG TABLET - - 200
9 PIRIDOKSIN ( VIT B6 ) 100 MG TABLET - - 30
10 PYRAZINAMIDA 500 MG TABLET - - 60
11 MASKER N95 TIPE 1860 S PCS - - -
LAIN-LAIN
#NAME? - -
#NAME? - 3
- - -
- - -
- #NAME? #NAME?
- #NAME? #NAME?
#NAME? #NAME? #NAME?
- - -
PENGELUARAN TH 2020 TOTAL
KELUAR
4 5 6 7 8 9 10 11 12
4
600 120 180 260 560 180 380 840 - 4,560

- - - 200 400 100 200 - - 1,000
- - - - - - - - - -
100 - 400 300 700 100 - - - 1,600
- - - - - - - - - -
600 200 200 300 600 300 400 - - 3,300
- - - - - - - 600 - 600
- - - 1,100 - - 1,500 500 - 3,600
- - - 100 - - - - - 300
- - - - - - - - - -
- - 100 500 300 100 100 900 - 2,100
- - - - - - - - - -
700 100 600 - 1,200 - 200 1,000 - 4,200
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 100 - - 300 - - 600
1,000 800 600 500 800 800 1,000 600 - 7,100
- - - - - - - - - -
- - - 100 100 - - - - 300
200 - - - 200 - 300 - - 900
400 100 100 - - - 400 - - 1,100
- - - - - - - - - -
- - - - - - - - - -
- - 300 100 - - - - - 700
- - - - - - - - - -
- - 25 23 152 150 50 200 - 600
- - - - - - - - - -
- - - - - - - - - -
- - 100 100 300 200 300 200 - 2,000
- - 400 400 200 300 600 - - 2,100
- - - - - - - - - -
100 - - - - - - 100 - 300
- - - 700 100 300 600 3,600 - 5,500
200 - - - - - - 200 - 800
- - - - - 100 - - - 100
- - - - - - - - - -
300 - 800 - 300 - - 300 - 2,400
100 - - - 300 - - 1,600 - 2,500
300 - 100 - 200 200 400 600 - 2,800
- - - - - - - - - -
400 - 200 500 700 1,100 - 2,000 - 5,900
- - - - - - - - - -
180 - - 200 40 220 760 180 - 1,660
- - - - - - 300 - - 300
300 - 500 500 200 - 600 1,000 - 3,500
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 100 400 550 - - - 1,050
- - - - - - - - - -
- - 100 - - - 500 - - 600
700 100 100 300 600 200 500 - - 2,900
- - - - - - - - - 100
400 200 - 500 800 200 400 500 - 4,500
200 - - - - - 200 200 - 900
- - - - - - 200 - - 200
- - - - - - - - - 160
- - - - - - - - - 100
- - - - - - - - - -
200 - 700 300 250 750 500 1,000 - 4,300
800 - 1,200 200 300 - - - - 3,300
- - - - - - - - - -
- 300 100 400 200 - 500 300 - 2,800
- - - - - - - - - -
200 - 300 - - - 900 - - 1,700
- - - - - - - - - -
1,300 600 1,300 2,600 700 1,000 300 2,300 - 12,500
- 200 - - - - - - - 1,000
600 - 700 - - - - - - 1,300

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
500 - 300 - - 300 100 - - 1,800
- - - - 100 - 100 - - 300
- - - - - - - - - -
- - - 100 - - - - - 100
- - - - 600 100 300 300 - 1,700
- - - - - - - - - -
- - - - - - 4,350 - - 4,350
- - - - - - - - - -
500 - - - - 100 700 399 - 2,599
- - - - - - - - - -
300 10 210 - 270 - - 400 - 1,650
3,450 2,450 - 4,450 - - - - - 13,470
- - - - - - - - - -
- - 500 500 500 500 - - - 2,500
- - - - - - - - - -
100 - - 500 100 - 100 - - 900
- - 50 - - - - - - 50
800 - 1,200 1,000 1,200 700 2,600 2,400 - 11,700
- - - - - - - - - -
- - - - - - - - - -
- - 50 - - - - 50 - 100
100 - 200 - - - - - - 600
- - - - - - - - - 200
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 100 - - - 100 - - 400
200 - 100 - 600 - - - - 1,400
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 200
- - - - - - - - - -
- - - - - - - - - -
250 50 250 - 50 - 100 300 - 1,300
- - - - - - - - - -
- - - - - - - - - -
200 - 300 - 300 300 - 800 - 2,200

- - - - - - - - - -
- - - - - - - - - -
200 - - - - - - - - 200
- - - - - - - 200 - 200
- - - - - - - - - 100
- - 14 1 - - 2 - - 30
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
100 - - - - - - - - 400
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 200
- - - - - - - - - -
300 - - - - - - - - 600
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
335 455 220 220 198 205 183 150 - 2,266

- - - - - - - - - -
- - - - - - - - - -
135 135 140 - 135 30 140 135 - 1,138
- 30 30 30 20 - - - - 140
5 - 20 - - 70 - - - 258
30 146 30 60 60 60 30 30 - 721
- 3 - - 5 - - 3 - 11
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 1 - - - - - - - 1
- - - - - - - - - -
- - - - - - - - - -
110 90 105 60 40 30 55 40 - 660
445 300 245 315 315 315 280 405 - 3,280
30 30 - - 25 5 30 30 - 250
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
130 30 - - 60 - 60 - - 280
- - - - - - - - - -
- - 3 - 2 - - - - 5
2 - - - 1 - - - - 4
- - - - - - - - - -
- - 120 - 60 - - - - 180
- 90 150 90 - 60 60 60 - 690
- - 5 5 10 20 10 60 - 110
- - - 15 20 65 - 100 - 207
- - - - - - - - - -
70 - - 20 10 180 - 100 - 430
- - - - - - - - - -
- - - - - - - - - 5
- - - - - - - - - -
- - - 6 - 12 - - - 18
- - - - - - - - - -
- 5 - - 5 - - 30 - 65
- - - - - - - - - -
- - - - - - - - - -
50 - - 50 5 15 10 15 - 145
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 5 35 - 60 - - 100
- - - - - - 15 - - 15
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 15 - - 15
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 63 - - - 206
- - - - - 50 - - - 70
- - - - - - - - - -
- - - - - 100 - - - 100
- - - - - 95 - - - 95
- - - - - - - - - 60
- - - 20 - - - - - 20
- - - - - - - - - -
- - - - - - - - - -
- - - 5 10 5 - - - 20
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 10 100 - - - - - 120
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 23 - - - - - 30
- - - - - - - - - -
- 220 5 60 45 5 5 20 - 360
- - - - - - - - - -
- - - 20 - - - - - 20
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 100
- 40 7 7 54 35 5 72 - 244
- - - - - - - - - 7
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25 - - - - - - - - 25
- - - - - - 35 6 - 54
- - - - - - 5 - - 50
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 50 - - - - - 50
- - - - - 10 43 - - 56
- - - - - - - - - -
4 4 24 24 - 138 - - - 242
20 - 5 - 5 15 - 15 - 90
- - - - - - - - - -
- - - - - 24 24 - - 48
- - - - - - - - - -
- - - - - - - - - -
24 - - - - 24 24 - - 96
- - - - - - - - - 100
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 2 - - - - - 2
- - - - - - - - - -
- - - - - - - - - -
4 - 1 3 - - 2 - - 11
48 - - 26 - - - - - 96
- - - - - - - - - -
- - - - - - - - - -
32 - - 30 - - - - - 62
16 - - - - - - - - 25
25 - - - - - - - - 59
14 - - 28 - - - - - 74
54 - - - - - - - - 79
- - - - - - - - - -
- 29 - - - - - - - 29
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
35 - - 33 - - - - - 133
572 - - 250 - - - - - 877
27 - - - - - - - - 27
15 - - - - - - - - 15
15 - - - - - - - - 15
18 - - - - - - - - 18
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 4 - - 1 - - 5
- - - - - - - - - 6
- - - - - - - - - -
- - - - - - 5 - - 5
4 5 - 1 - - 9 - - 24
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
1 - - - - - - - - 2
- - - - - - 1 - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 1 - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 50 - - - - - - 100
- - - - - - - - - -
2 - - - - - 1 - - 3
- - - - - - - - - -
- - - - - - - - - -
4 - - - - - - - - 4
- - - - - - - - - -
- - 4 - - - - - - 4
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 15 65 - - 20 100 - 400
- - - - - - - - - -
- - 10 300 - 100 90 - - 1,100
- - - - - - - - - -
- - - - - - - - - -
- - 2 - - - - - - 2
- - - 67 - - - - - 94
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
24 6 - - - - 12 - - 48
- - - - - - 12 - - 12
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - 500 - 500
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
4 - - - - 2 2 - - 12
4 1 1 1 - - - - - 8
9 - - 20 - - 6 - - 36
20 - - 85 10 3 152 87 - 432
- - - - - - - - - -
- - - - - - - - - -
106 58 - - - - - - - 173
- - - - - - - - - -
30 - - 10 5 3 45 - - 168
- - - - - - - - - -
- - - 13 - - 67 5 - 280
- - - - - - - - - -
- - - - - 3 110 - - 133
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 20
- - - - - - - - - -
- - - - - 1 2 - - 4
- - - - - - 111 - - 195
- - 2 8 - 3 5 - - 18
- - - 1 - - 1 - - 2
- - - - - - - - - -
- - - - - - - - - -
- - 3 5 - - 67 - - 100
- - 2 27 5 - 41 15 - 95
- - 1 4 - - - - - 9
- - - - - - - - - -
- - - 2 - - 7 - - 9
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 5 - - 7
- - - - - - - - - -
- - - - - - - - - -
- 100 - - - - - - - 150
- - - - - - - - - -
- - - - - - - - - -
500 - - - - - - - - 1,100
- - - - - - - 500 - 1,700
- - - - - - - 200 - 1,000
- - - - - - - - - -
- - - - - - - - - -
- - - 12 - - 24 12 - 60
- - - - - - - - - 2
- - - - - - - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 3 - 3 8 1 - 15
- - - - - - - - - -
- - - - - - - - - -
60 60 - - - - - - - 180
60 60 - - - - - - - 180
60 60 - - - - - - - 180
- - - - - - - - - -
- - - - - - - - - -
90 90 - - - - - - - 270
- - - - - - - - - 200
30 30 - - - - - - - 90
60 60 - - - - - - - 180
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 2 - - #NAME?
- - 6 - - - 3 - - #NAME?
- - - - - - 4 - - 4
- #NAME? #NAME? - - - - - - #NAME?
#NAME? #NAME? #NAME? - - - - - - #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? - #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?
- - - - - - - - - -
REKAP ED/RUSAK/HILANG TH 2020
MENU

1 2 3
1 2 3
1 ACETYL SISTEIN 200 MG TABLET - - -
8 ANTASIDA DOEN TABLET KOMBINASI TABLET - - -
9 ANTI MIGREN KOMB: Ergotamin 1 mg + Kafein 50 mg TABLET - - -
13 ASAM MEFENAMAT 500 MG TABLET - - -
19 TABLET - - -
Vitamin D 100 IU
20 TABLET - - -
Vitamin D 300 IU
22 DECAFIL 150 MG ( AMINOFILIN 150 MG ) TABLET - - -
23 DEKSAMETASON TABLET 0,5 MG TABLET - - -
25 DIGOKSIN 0,25 MG TABLET - - -
26 DIMENHIDRINAT 50 MG TAB TABLET - - -
27 DOMPERIDON 10 TAB TABLET - - -
30 FITOMENADION ( VIT K ) SALUT 10 MG TABLET - - -
31 FUROSEMIDA 40MG TABLET - - 400
32 GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g , SACHET - - -


35 GLIBENKLAMID 5 MG TABLET - - -
36 GLIMEPIRID 1 MG TABLET - - -
38 HIDROKLOROTIAZID ( HCT ) 25 MG TABLET - - -
39 IBUPROFEN 200 MG TABLET - - -
40 IBUPROFEN 400 MG TABLET - - -
41 ISOSORBID DINITRAT 5 MG TABLET - - -
43 KALSIUM LAKTAT TABLET - - -
44 KAPTOPRIL 12,5 MG TABLET - - -
47 KLORFENIRAMIN MALEAT ( CTM ) 4 MG TABLET - - -
49 LANSOPRAZOL 30 MG TABLET - - -
50 LISINOPRIL 5 MG TABLET 1,000 - -
51 LORATADIN TABLET 10 MG TABLET - - -

63 METOKLOPRAMID 10 MG TABLET - - -

64 Magnesium Chlorida Andydrous, Pottasium Chloride, Zinc Acetat TABLET - - -

70 NIFEDIPIN 10 MG TABLET - - -
74 PARASETAMOL 500 MG : KAMOLAS 500 MG TABLET - - -

75 400 IU, Vit.C 40 mg, Vit.B6 2 mg, kalsium pantotenat 5 mg, Asam Folat Tablet - - -
80 PREDNISON 5 MG TABLET - - -
84 RANITIDIN 150 MG TABLET - - -
90 SIMVASTATIN 10 MG TABLET - - -
91 TABLET TAMBAH DARAH Kombinasi : ferro fumarat 60 mg + asam folat TABLET - - -

0,4 mg tablet salut
92 THIAMIN HCL MONINTRAT ( VIT.B 1 ) 50 MG TABLET - - -
95 ZINC TABLET 20 MG DISPERSIBLE TABLET - - -

1 ALBENDAZOL 400 MG TABLET - - -
2 AMOKSISILIN 500 MG TABLET - - -

7 CLINDAMISIN 300 MG TABLET - - -

11 ERITROMISIN 250 MG TABLET - - -
12 ERITROMISIN 500 MG TABLET - - -
20 KETOKONAZOL 200 MG TABLET - - -
23 KOTRIMOKSAZOL DEWASA 480 MG TABLET - - -

41 SIPROFLOKSASIN 500 MG TABLET - - -

1 ALPRAZOLAM 0,5 MG TAB TABLET 2,934 - -
4 AMILTRIPTILIN HCL TAB SALUT 25 MG TABLET - - -
5 CLOZAPIN 25 MG TABLET - - -
6 DIAZEPAM 2 MG TABLET - - -
7 DIAZEPAM 5 MG TABLET - - -
8 DIAZEPAM INJ 5 MG/ML AMPUL - - -
12 HALDOL DECANOAS INJEKSI 50 MG/ML (HALOPERIDOL INJEKSI 50 VIAL - - -

MG/ML )
15 HALOPERIDOL 5 MG TABLET - - -
16 KARBAMAZEPIN 200 MG TABLET - - -
32 TRIFLUOPERAZIN DIHIDROKLORIDE 5 MG TABLET - - -
33 TRIHEKSILFENIDIL HIDROKLORIDA 2 MG TABLET - - -

2 AMOKSISILIN SYRUP KRG 125 ML/ 5 ML BOTOL - - -
4 ANTASIDA DOEN SYRUP BOTOL - - -
6 DOMPERIDON SYRUP 5 MG/ML BOTOL - - -

8 IBUPROPEN SUSPENSI 200 MG / 5 ML BOTOL - - -
10 KOTRIMOKSAZOL SUSPENSI 240 MG/5 ML BOTOL - - -

13 PARASETAMOL SYRUP 120 MG/ 5 ML BOTOL - - -
16 SEFADROKSIL SIRUP 125 MG/ 5 ML BOTOL - - -
18 ZINK SIR 20 MG/5 ML BOTOL - - -

2 AMINOFILIN INJEKSI 24 MG/ML -10 ML AMPUL - - -
3 AQUA PRO INJEKSI BEBAS PIROGEN AMPUL - - -
6 ASAM TRANEKSAMAT INJ 50 MG/ ML AMPUL - - 40
7 ATROPIN SULFAT INJ O,25 MG/ML - 1 ML AMPUL - - 100
10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL - - -

12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL - - -
16 EFINEFRIN HCL ( ADRENALIN ) INJ 0,1 ML AMPUL - - -
18 FUROSEMIDA INJ INJ 10 MG/ ML ( I.V/ I.M ) AMPUL - - -
21 GLUKASA LARUTAN INFUS 5 % STERIL 500ML KOLF - 70 -
30 METOKLOPRAMID INJK 5 MG/ML AMPUL - - -
32 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL KOLF - - -
34 OKSITOSIN INJ 10 IU/ML - 1 ML AMPUL - 130 -
38 RINGER LAKTAT LARUTAN INFUS KOLF - - -
40 SEFTRIAKSON SERBUK INJ 1 G VIAL - - 20
44 SIANOKOBALAMIN INJ ( B 12 ) 1000 MCG/ML VIAL - - 38
SEDIAAN OBAT LUAR
1 ANTI BAKTERI SALEP KOMB: Basitrasin 500IU/g , Polimiksin B 10.000 TUBE - - -

IU/g
2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT - - -
3 ANTI HEMOROID DOEN KOMBINASI SUPPO - - -
4 BETAMETASON KRIM 0,1 % TUBE - - -

salbutamol 2,5 mg
8 GENTAMISIN SALEP MATA 0,3 % TUBE - - -
11 KETOKONAZOL CREM 2% 10 G TUBE - - -
13 KLORAMFENIKOL SALEP MATA 1% TUBE - - -
16 MIKONAZOL KRIM 2% TUBE - - -
17 NISTATIN VAGINA SUPP 100.000 IU/G SUPP - - -
22 SALEP 2-4 KOMB: Asam salisilat 2%,Belerang endap 4% POT - - -
VAKSIN
1 VAKSIN BCG ( BAYI ) VIAL - - -
5 VAKSIN TD 10 DOSIS VIAL - - -
6 VAKSIN POLIO 10 DOSIS ( BIVALEN ) VIAL - - -
8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCHES POUCH - - -

@ 1 PREFILLED SYRINGE @ 0,5 ) HB O , ( BAYI )
14 ADS 0,05 ML 0NEJECT PCS - - -
15 ADS 0,5 ML 0NEJECT PCS - - -
16 ADS 5 ML SKIFA PCS - - -
17 DROPPER POLIO BIVALEN DROP - - -
18 PELARUT BCG VIAL - - -
19 PELARUT MEASLES & RUBELLA ( MR ) VIAL - - -

2 FUJI II 1-1-23 BOX - - -
BAHAN LABORATORIUM
2 ALKOHOL SWAB COSMOMED @200 BOX - - -
5 ALKOHOL 70% 1000 ML ONEMED BOTOL - - -

NaCl 0,9 % )
BMHP
7 ALAT SUNTIK 5 CC ,TP PCS - - -
11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS - - -

12 CATGUT CHROMIC 3/0 HR 26 mm, SNI SACHET - - -
16 FACE MASK TIES ON, AXIMED PCS - - -
20 FOLEYCATH, 2-way latex foley cath, no.16, AXIMED PCS - - -
21 FOLEYCATH, 2-way latex foley cath, no.18, AXIMED PCS - - -
22 INFUSION SET ANAK ( COSMOMED ) PCS - - -
23 INFUSION SET DEWASA /20 DROPS PCS - - -
26 IV CATHETER NO. 18 G Remedi , Steracath PCS - - -
28 IV CATHETER NO. 20 G Remedi, Steracath PCS - - -
30 IV CATHETER NO. 22 G Remedi , Steracath PCS - - -
32 IV CATHETER NO. 24 G Remedi PCS - - -
40 KAPAS HIDROPIL 250 GRAM ROL - - -
42 KASA PEMBALUT 2 M x 80 CM ONEMED ROL - - -
43 KASA PEMBALUT 40 M x 80 CM ( 36 m ), HUSADA ROL - - -
47 KASA PEMBALUT HIDROFIL 4 M X 15 CM , PRO-KASA ROL - - -
48 LISOL BOTOL - - -
49 ODEX LARUTAN 500 ML BOTOL - - -
64 SARUNG TANGAN NON STERIL SIZE M, AXIMED PAIR - - -
65 SARUNG TANGAN NON STERIL SIZE L, AXIMED PAIR - - -
68 SILK 4/0 75cm, 1/2 Tapper 20 mm, WEGO SACHET - - -
69 SUCTION CATHETER, no. 12, AXIMED ROLL - - -
70 SUCTION CATHETER, no. 8, AXIMED ROLL - - -
79 URINE DRAINAGE BAG, with hanger, AXIMED PCS - - -

2 CYCLOSERINE 250 MG TABLET - - -
3 ETHAMBUTOL 400 MG TABLET - - -
4 ETHIONAMIDE 250 MG TABLET - - -
7 LEVOFLOXACIN 250 MG TABLET - - -
10 PYRAZINAMIDA 500 MG TABLET - - -
11 MASKER N95 TIPE 1860 S PCS - - -
LAIN-LAIN
#NAME? - -
#NAME? - -
- - -
- - -
- #NAME? #NAME?
- #NAME? #NAME?
- - -
JUMLAH ED/RUSAK/HILANG TOTAL
JUMLAH
4 5 6 7 8 9 10 11 12
4 5
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 300 - - 300
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 300 - - 300
- - - - - - - - - 400
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 1,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 600 - - 600
- 200 - - - - - - - 200
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 1,000 - - 1,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 800 - - 800
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 5,050 - - 5,050
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 200 - - 200
- - - - - - - - - -
- - - - - - 400 - - 400
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 1,300 - - 1,300
- - - - - - - - - -
- - - - 800 - - - - 800
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 500 - - 500
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 2,934
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 40
- - - - - - - - - 100
- - - - - - - - - -
- - - - - - - - - -
- - - - - 2 - - - 2
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 30 - - - - - - - 30
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 70
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 130
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 30 - - - - - - - 30
- - - - - - - - - 20
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 38
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - #NAME?
- - - - - - - - - #NAME?
- - - - - - - - - -
- #NAME? #NAME? - - - - - - #NAME?
#NAME? #NAME? #NAME? - - - - - - #NAME?
- - - - - - - - - -

2022 LPLPO Puskesmas

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2022 LPLPO Puskesmas

Uploaded by

Copyright:

Available Formats

FORMAT LPLPO 2020

Keluar/bulan Maret Juli November

April Agustus Desember

Lead Time Rekap Keluar Rekap ED

CALPOROSIS D 800 : Tablet Mineral + Multivitamin : Ca. 500 mg,

21 CIMETIDIN 200 MG TABLET

GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g ,

56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet

57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET

MINERAL MIX : Bismut subcitrat tripotasium. Copper sulfat,

PEHAVRAL TABLET : Fe2Fumarat 20mg, kalsium karbonat 100 mg,

4 ASIKLOVIR 200 MG TABLET 21

9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET

10 DOKSISIKLIN 100 mg TABLET

22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET

23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 21

SEDIAAN NARKOTIKA,PSIKOTROPIKA DAN PREKUSOR

SEDIAAN SIRUP / SUSPENSI

6 DOMPERIDON SYRUP 5 MG/ML BOTOL 21

12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL

10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL

SEDIAAN OBAT LUAR

2 ANTI FUNGI KOMB: Asam benzoat 6% , Asam salisilat 3% POT 21

8 VAKSIN HEPATITIS B REKOMBINAN CAIRAN INJ 0,5 ML ( 100 POUCH

9 VAKSIN RABIES UNTUK MANUSIA ( VERORAB ) 1 VIAL

23 PENGECATAN GRAM ( GENTIAN VIOLET, ALKOHOL 96 %, LUGOL 0,9 % SET

9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON

10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON

11 CATGUT CHROMIC 2/0 75 TAPPER 1/2 26 mm ,WEGO PCS 21

OBAT PROGRAM TB KHUSUS MULTY DRUGS RESISTEN ( MDR )

GARAM ORALIT KOMB : Natrium 0,52 g , Kalium Klorida 0,30 g ,

33 GEMFIBROZIL 300 MG TABLET - - -

56 MERSIBION 5000 : Tablet Multivitamin : B1, B6, B12 5000 IU Tablet - - -

57 MERSIBION : Tablet Multivitamin B1,B6,B12 TABLET - - -

MINERAL MIX : Bismut subcitrat tripotasium. Copper sulfat,

65 MINIASFI ( ASETOSAL 80 MG ) TABLET - - -

PEHAVRAL TABLET : Fe2Fumarat 20mg, kalsium karbonat 100 mg, Vit.A

94 VITOMIL AF : Tablet Multivitamin + Mineral + Betakaroten + Folat Acid TABLET - - -

95 ZINC TABLET 20 MG DISPERSIBLE TABLET 1,700 1,700 1,700

3 ANTIMALARIA KOMBINASI : Sulfadoksin 500 mg + Pirimetamin 25 mg TABLET - - -

4 ASIKLOVIR 200 MG TABLET 500 500 500

9 DHP : dihidroartemisin 40mg , piperakuin 320 mg tablet salut selaput TABLET - - -

10 DOKSISIKLIN 100 mg TABLET - - -

22 KOMBIPAK KOMB. AZITHEROMYCIN 500 MG + CEFIXIME 200 MG PAKET - - -

23 KOTRIMOKSAZOL DEWASA 480 MG TABLET 4,300 4,300 4,300

SEDIAAN NARKOTIKA,PSIKOTROPIKA DAN PREKUSOR

1 ALPRAZOLAM 0,5 MG TAB TABLET 2,934 2,934 2,934 -

29 STESOLID RECTAL 5 MG ( DIAZEPAM RECTAL 5 MG ) TUBE - - -

30 STESOLID RECTAL 10 MG ( DIAZEPAM RECTAL 10 MG ) TUBE 1 1 1 -

SEDIAAN SIRUP / SUSPENSI

5 DEPAKEN SIRUP 250 MG/5 ML : VALVROAT SIRUP 250 MG /5ML BOTOL - - -

6 DOMPERIDON SYRUP 5 MG/ML BOTOL 100 100 5 95

11 LAXADINE suspensi kombinasi : parafin + gliserin + fenolftalin BOTOL - - -

12 METRONIDAZOL SYR 125 MG/ 5 ML BOTOL - - -

10 BIOSAVE : SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML (ABU I) VIAL 8 8 8

11 BIOSAT : SERUM ANTI TETANUS INJ 1.500 IU/VIAL ( ATS ) VIAL - - -

12 DEKSAMETASON INJ 5 MG/ML - 1 ML AMPUL 297 297 3 294

SEDIAAN OBAT LUAR

9 BIOSANITIZER 1 L SANISWISS: Instrument I hyperconcentrate 5 L GALON - - -

10 BIOSANITIZER 500 Ml SANISWISS : Hand Gel H1 500 ml + PUMP GALON - - -

OBAT PROGRAM TB KHUSUS MULTY DRUGS RESISTEN ( MDR )

Administrator Ahli Muda

LAPORAN BULAN : JANUARI