LPLPO

PEMERINTAH KABUPATEN BANGLI
DINAS KESEHATAN
www.dikes.banglikab.go.id email : dikes@banglikab.go.id
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) OBAT UMUM SUMBER DAK
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , JULI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE AGUSTUS 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A
NO NAMA OBAT SATUAN STOK AWAL PERSEDIAA OBAT PEMBERIAAN

PENERIMAAN N PEMAKIAN ED/RUSAK STOK AKHIR PERMINTAAN
HARGA JUMLAH TOTAL APBD/APBN P2 KIA/GIZI LAIN KET ED
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
1 Alopurinol tablet 100 mg tablet 105 - - - -
2 Ambroxol sirup 15 mg/5 ml 4180 -
Ambroxol sirup 15 mg/5 ml 3,850 - - - 5
3 Aminofilina injeksi 24 mg/ml - 10 ml ampul 2,789
4 Amlodipin 5 mg tablet 78 80 - 80 30 50 -
5 Amoksisilin kaplet 500 mg kaplet 249 - - -
6 Amoksisilin kaplet 500 mg kaplet 253
100
7 Amoksisilin sirup kering 125 mg/5ml botol 4,400 -
- 8 8 - 8 -
8 Antasida DOEN II Suspensi.Komb botol 2,129 - - - - - 5
Antasida DOEN tab,kombinasi: Mg-
9 Hidroksida 200 mg + Al. Hidroksida. tablet 58 -
200 mg - - - - - 100
Anti Bakteri DOEN salep kombinasi:
10 Basitrasin 500 IU/g + Polimiksin tube 6,600
10.000 IU/g (Top Oint) 5
Antihemoroid DOEN kombinasi :
11 Bismut Subgalat 150 mg + supp 3,167
Heksaklorofen 250 mg - - 5
Antimigren: Ergotamin Tartrat 1 mg +
12 Kofein 50 mg tablet 185
13 Asam Askorbat (Vit C) tablet 250 mg tablet 105 -

120 120 - - 100
14 Asam Askorbat (Vit C) tablet 50 mg tablet 105 - - -
Asam Mefenamat tablet salut selaput
15 253
500 mg
16 500 mg 275 50
- 70 120 70 50 100
17 Asiklovir krim 5% tube 2,860 2
18 Asiklovir tablet 200 mg tablet 660
19 Asiklovir tablet 400 mg tablet 405 - - -
20 Attapulgit (Pularek) tab 600 mg tablet 162
21 Betahistin mesilat tab 6 mg tablet 110 50 50 - 50
22 Betametason krim 0.1% tube 1,430 - - - - -
23 Bisakodil tab 5 mg tablet 319
24 Cetirizine syr 5 mg/ml botol 2,915 - - - - 3
25 Cetirizine tab 10 mg tablet 90 100
26 Deksametason Injeksi I.v. 5 mg/ml ampul 1,567
- -
27 Deksametason Injeksi I.v. 5 mg/ml 1,097 -
2 2 - 2
28 Deksametason tablet 0,5 mg tablet 41
29 Deksametason tablet 0,5 mg 88 -

- - - - 100
30 Desoksimetason krim 0,25% tube 10,920
31 Diazepam Injeksi 5mg/ml ampul 1,735

32 Diazepam tablet 5 mg tablet 114 2
33 Difenhidramin Injeksi I.M. 10 mg/ml ampul 1,095 -
(HCL) - - - 5
34 Digoksin tablet 0,25 mg tablet 104 -
35 Dimenhidrinat tab 50 mg tablet 105
36 Doksisiklin kapsul 100 mg kapsul 280
37 Domperidon suspensi 5 mg/5ml botol 6,600
38 Domperidon tab 10 mg tablet 95 -
39 Domperidon tab 10 mg 220 - 30 - 30 - 30
40 Dulcolac 10 mg SUPP Supp 5,900
41 Epinefrin (Adrenalin) injeksi 0,1% ampul 1,408 -
(sebagai HCL) 2 2 - 2
42 Eritromisin kapsul 500 mg kapsul 730
43 Eritromisin sirup 200 mg/5 ml botol 14,300 -
44 Fenobarbital tablet 30 mg tablet 171 - - - - -
Fitomenadion (Vit.K1) tablet salut
45 tablet 758
gula 10 mg
46 Fitomenadion inj ampul 4,167
48 Flukonazol 150 mg tablet 18,720
49 Furosemid tablet 40 mg tablet 82
Garam Oralit I serbuk Kombinasi :
Natrium 0,70 g ,Kalium klorida 0,30 g,
50 Tribatrium Sitrt dihidrat 0,58 g saset 440
30 30 15 15
51 Gentamisin salep mata (Genoint) tube 2,960
52 Gentamisin salep kulit 0,1% tube - -
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 - 1 1 1 5
54 Glibenklamid tablet 5 mg tablet 119 100 100 - 100
55 Glibenklamid tablet 5 mg tablet 220
56 Glimepiride 2 mg tablet 207
67 Glukosa larutan infus 5% botol 7,363
Griseofulvin tablet 125 mg,
58 tablet 224
micronized
59 Hidroklorotiazida tablet 25 mg tablet 155
60 Hidrokortison krim 1 % tube 2,974
61 Hidrokortison krim 2,5 % tube 2,639
Hidrokortison krim 2,5 % 2,475 3 - 3 - 3 -
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 - - - - 2
63 Ibuprofen tablet 200 mg Tablet 150 - - -
64 Ibuprofen tablet 400 mg tablet 308 - - - 100
65 Isosorbid Dinitrat tablet sublingual 5 tablet 90
mg - - - -
Isosorbid Dinitrat tablet sublingual 5
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 80 - 80 10 70
68 Kalsium laktat (Kalk) tablet 500 ml tablet 165
69 Kaptopril tablet 12,5 mg tablet 66
70 Kaptopril tablet 25 mg tablet 165 110 - 110 20 90
71 Ketokonazol krim 2% tube 2,596 5
72 Ketokonazol tab 200 mg tablet 253 80 80 - - 80 -
73 Ketoprofen supp (Suprafenid) supp 2,380 - - 2
74 Kloramfenikol salep mata 1% tube 2,007
76 Kloramfenikol salep kulit 2% tube 3,242 2
(Bufacetin) - 2 - - 2
77 Kloramfenikol suspesi 125 mg/5 ml botol 5,015
Kloramfenikol tetes mata 0,5% (Reco
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
80 Kloramfenikol tetes telinga 3 % botol 8,800 - - - 3
Klorfeniramin Maleat (CTM) tablet 4
81 mg tablet 23 100
80 180 50 - 130
82 tablet 66
mg
83 Kodein 10 mg tablet 571
Kotrimosazol DOEN I (dewasa)
84 Kombinasi : Sulfametoksazol 400 mg, tablet 133
Trimetoprim 80 mg
Kotrimosazol Suspensi
85 Kombinasi :Sulfametoksazol 200 mg + botol 2,167
Trimetoprim 40 mg/ 5 ml
Kombinasi :Sulfametoksazol 200 mg + 2,190
86 Lidokain injeksi 2% ampul -
87 Lidokain injeksi 2% ampul 1,226 5 - 5 - 5
Lidokain injeksi 2% (HCL) + Epinefrin
88 ampul 1,210
1 : 80.000-2 ml
89 Lidokain injeksi 2% (HCL) + Epinefrin ampul 1,291

1 : 80.000-2 ml
90 Loratadin tablet 131
91 Madu Kele 275,000
92 Magnesium sulfat inj (IV) 40%-25ml ampul 3,796
1 1 - - 1
93 Magnesium sulfat inj (IV)20%-25ml ampul 3,328 - - - - - 1
Magnesium sulfat inj (IV)20%-25ml 11,000
94 Metformin HCl tab 500 mg tablet 102
95 Metilprednisolon tablet 16 mg tablet 551
96 Metilprednisolon tablet 4 mg tablet 143 - - - 100
97 Metilergometrin Meliat tablet 224 50 - 50 - 50
98 Metilergometrin Meliat Injeksi ampul 2,959 2 - 2 - 2
99 Metoklorpramide 5 mg tablet 121
100 Metronidazole infus botol 8,110
101 Metronidazole ovula (vagizol) ovula 3,590
102 Metronidazole syr 125mg/5ml botol 3,950
103 Metronidazole tablet 500 mg teblet 113
104 Miconazol krim/salep 2% (nitrat) tube 3,414 - 2 2 - 2
105 N-asetil sistein 200 mg tablet 373
106 Natrium diklofenak tab 25 mg tablet 145
107 Natrium diklofenak tab 25 mg 137 - - - - -
109 Natrium diklofenak tab 50 mg 123 - - - - - - 100
110 Natrium Klorida larutan infus 0,9 % botol 6,410 - - - 2
111 Nistatin tablet salut 500.000 IU/g tablet 843
Nistatin Vaginal tablet salut 100.000
112 560
IU/g 2 2 - 2
113 Nistatin Vaginal tablet salut 100.000 598
IU/g
114 Ofloksasin tab 200 mg tablet 440
Oksimetazolin tetes hidung 0,025%
115 botol 32,549
(iliadin drops)
116 Oksimetazolin tetes hidung 0,050% botol 34,320

(iliadin spray) -
117 Oksitetrasiklin HCl salep mata 1 % tube 2,500
118 Oksitosin injeksi 10 IU/ml - 1 ml ampul 1,199
119 Omeprazole kaps 20 mg kapsul 327
120 Omeprazole kaps 20 mg 550
121 Ondansetron inj 2mg/ml (4 mg/2 ml) ampul 1,124
122 Parasetamol infus botol 11,610

124 parasetamol drops botol 6,649 -
125 Parasetamol sirup 120 mg/5 ml botol 1,181 - - - - - 5
126 Parasetamol sirup 120 mg/5 ml botol 1,181
127 Parasetamol tablet 500 mg tablet 107
Parasetamol tablet 500 mg 220 50 100 150 50 100 100
128 Piridoksin HCl (Vit.B6) tablet 10 mg tablet 131
129 Piroksikam 10 mg tablet 80
130 Povidon Iodida 10 % 300 ml botol 19,800 1 1 - 1 -
131 Prednison tablet 5 mg tablet 73
132 Ranitidin tab 150 mg tablet 220
134 Ringer Laktat larutan infus botol 7,630 - - - - 2
135 Risperidon 2 mg tablet -
136 Salbutamol 2 mg tablet 67
138 Salbutamol 4 mg tablet 86 -
139 Salbutamol 4 mg tablet 154 - 20 20 - 20 100
140 Salbutamol 4 mg 83
Salep 2-4 , Kombinasi: Asam Salisilat
141 2% + Belerang Endap 4% pot 2,797
5
142 Salisil Bedak 2 % bks 6,600 5
143 Sefadroksil syr kering 125mg/ml botol 4,189
144 Sefadroksil syr kering 250 mg/5 ml botol 5,549
Sianokobalamin (Vit.B12) injeksi 500
145 ampul 1,104 -
mcg-ml 14 14 1 13 - 5
146 Sianokobalamin (Vit.B12) tablet tablet
147 Simvastatin 20 mg tablet 217
149 Sulvadiazine silver 35 gr tube 20,700
150 Tetagam botol 242,000
160 Tetagam 188,663
161 Tetrasiklin HCl kapsul 500 mg kapsul 310 -
Tiamin HCl / Mononitrat (Vit.B1)
167 tablet 91
tablet 50 mg - - 100
168 Tiamin HCl / Mononitrat (Vit.B1) tablet 187
tablet 50 mg
169 Triheksifenidil tablet 2 mg tablet 275
170 Ventolin inhaler (Salbutamol botol 77,000
inh/aerosol 100 mcg/dosis)
171 Vitamin B Kompleks tablet tablet 118 - 100 - 100 50 50
172 Zinc Sulfat syr 60 ml botol 3,171 - - - - -
177 Zinc Sulfat syr 60 ml 2,972
178 Zinc tablet 20 mg tablet 524 - - - - 50
179 Zincpro drops botol 6,281 - 2
180 SF tablet 350 10 100 110 - 110
Cefadroxil 500 mg tablet 100
Vitamin B 6 Tablet - - - -
Asam Folat tablet - - - 50
Kloramfenikol tetes telinga 3 % tablet -
OBAT PROGRAM - -
MALARIA -
1 ACT (Artesunate + Amodiaquin tablet 57,585
2 Primakuin tablet 15 mg tablet 253
ACT (Dehidro Artemisin +
3 tablet 2,134
Piperaquine)(D-ARTEPP) -
-
DIARE -
1 Garam Oralit 200 ml air saset 257
-
KECACINGAN -
1 Albendazol tablet 400 mg tablet 403 50 50 - 50 - 20
-
TB PARU (OAT FDC ) -
1 Obat Anti Tuberculosis 1 paket 389,344 -
2 Obat Anti Tuberculosis 2 paket 1,384,983
-
OAT Kombipak -
1 Katagori 1 paket 317,018 -
2 Obat Anti Tuberculosis Anak paket 248,120
-
GIZI -
Retinol ( vitamin A ) 100.000 IU

1 Kapsul Lunak Bayi ( 6 - 11 bln ) kapsul 306

2 Kapsul Lunak Balita ( 11- 59 kapsul 552
bln )
Kapsul Lunak Balita ( 11- 59 kapsul 517
bln )
-
OBAT GIGI -
1 Etil klorida spray botol 165,000
2 Eugenol cairan botol 20,087
3 Xylocain spray botol 330,000
TOTAL OBAT (A)
BMHP
1 Acon urinalisys 100 test test 2,560
2 Alat suntik sekali pakai 1 ml pcs 871.50 5 5 - 5
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 - 10 10 10 - 10
Alat suntik sekali pakai 2,5 ml/3 ml 932
4 Alat suntik sekali pakai 5 ml pcs 974
Alat suntik sekali pakai 5 ml 1,038
Alat suntik sekali pakai 5 ml 1033 2 2 - 0 2
5 Alkohol 70% 100 ml botol 2,790
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
9 Alkohol 70% 300 ml botol 7,150.00
10 Alkohol swab pcs 112 95 - 95 31 64
11 Alkohol swab/ coton swab pcs 1,114
12 Apron pack 50,000
13 Arm Sling L pcs 16,632
14 Arm Sling M pcs 16,632
15 Arm Sling S pcs 16,632
16 Blood lancet pcs 153
Catgut / Benang Bedah No. 2/0
18
dengan jarum bedah 1941.13
dengan jarum bedah 34,263

19 pcs 34,263 -
dengan jarum bedah 3 3 - 3
20 Cell Clean (CL-50) botol 1,197,900
21 Cito brush pcs 1,500
22 Cuticell clasic 10x10 cm pcs 5,520
23 E-Care surgical tape 1" ktk 98,000
24 Feeding tube pcs 8,085
25 Focus RPR Syfilis test 4,180
26 Folley Catheter No.16 pcs 11,550
30 Gelang pasien anak pcs 1,350
31 Gelang pasien dewasa pcs 1,350
32 Gol. Darah (anti AB) 91,625
33 Hanscoon Nonsteril L psg 2,310 - - - 100
Hanscoon Nonsteril L 1,275.34
34 Hanscoon steril 7,5 psg 2,930 4 - 4 2 2 5
Hanscoon steril 7,5 psg 8,659.20
35 Hanscoon steril 8 psg 2,930
Hipavix 5 x 5 cm rol 68,700 2 - 2 1 1
36 Infusion set anak set 5,100
Infusiont Set-Y type with injection
37 port/INFUSET DEWASA pcs 4,975

5,100 -
port/INFUSET DEWASA 2 2 - 2 -
39 IV Catheter No. 22 G pcs 6,380 2
40 Jarum jahit (bedah) no.10 (otot) bungkus 27,500
41 Jarum jahit (bedah) No.13 (kulit) bungkus 27,500
46 Jarum jahit (bedah) no.9(otot) bungkus 27,500
47 Kapas 500 gram bks 20,000 1 1 - 1
48 Kapas lidi pcs 140
Kapas Pembalut / Absorben 250
49 14,070
gram bks
50 Kasa Hidrofil 40 x 80 rol 135,300
Kasa Hidrofil steril uk. 16 x 16 (isi 16
51 kotak 3,850 2
lembar) 1 3 1 2 5
7,935.20
lembar)
52 Kasa Hidrofil steril uk. 18 x 22 (isi 12 kotak 5,800

lembar)
53 Kasa Hidrofile 3 yard x5 cm roll @10 1,461
54 Kasa Hidrofile 30 yard x 80 cm roll 73,025
56 Kasa Hidrofile 3yard x15 cm roll 1,645
57 Kasa Kompres 40/40 steril bks 1,600
58 Kasa Pembalut 2 m x 80 cm bks 9,000
59 Kasa Pembalut Elastis 3 inchi rol 22,000
61 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,500

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 12 - 12 9 3 10
64 Kasa Pembalut Hidrofil 4 m x 5 cm rol 788
Kasa Pembalut Hidrofil 4 m x 3 cm rol
65 Kertas perkamen bks 24,970 1 1 1
66 Klip 10x7 cm bal 99,000
67 klip Besar (13x18,7)cm bks 9,000 - - - - - 100
68 klip Besar (13x18,7)cm pcs 127
klip Besar (13x18,7)cm 10,000
69 Klip Kecil (5x8) cm pcs
70 Klip Tanggung (15x10) cm bks 10,000
71 Klip Tanggung (15x10) cm bks
72 Levin tube 125 No.16 (selang NGT) pcs 8,662.00
73 Lysol botol 45,100.00
74 Masker pcs 360.36
Masker 2,350.00 - - - - - -
75 Masker N 95 pcs 8,500 5 - 5 5
76 my jelly 82 gram botol - - - - - - 1
77 Nasal oxygen L pcs
7277.000
Nasal oxygen L 7,277.00
78 Nasal oxygen S pcs

7277.000
79 Nurse cap pcs 351.00
- - - - - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328
81 Pembalut Gips 3 inchi rol 15,000.00

Plesterin nonwoven uk 5 x5 cm one
84 roll 24,948.00
med
med
85 Povidon iodin 60 ml botol 4,961 -
- - - - -
86 PP tes (onemed tes hamil) pcs 1,997
10
87 Safety box dus 16,501
88 Sarung Tangan Steril 6,5 psg 2,930.40
89 Sarung Tangan Steril 7 psg 2,930

- -
90 Sendok syr pcs 1,485 -
- - - -
Silk (Benang Bedah Sutera) No. 3/0
91 23,125.00 -
dengan jarum bedah 1 1 1 - 5
92 Silk black 2/0 pcs 24,025.00
93 Umbilical cord klem pcs 1,365
94 Underpad (perlak sekali pakai)60x90 pcs 4,371
Underpad (perlak sekali pakai)60x91 3,749
95 USG gel 250 onemed / Ultra sonik gel botol 13,842

1
96 infusien set dewasa pcs
TAMBAHAN BMHP PROGRAM 2015 -

1 Kotak kaca isi 2 (kecil)/box slide kotak -
2 MDT Combi blister 39,880
3 Pot dahak pot 1,750
Pot dahak pot 5,154
4 Reagen TB/Ziel Nelsen paket 257,000
5 Slide frosted kotak 20,747.00
6 Sound timer pcs -
7 Tissue lensa lembar -
-
1 Blood lancet kotak 14,566
2 Cryotube tube 2,000
3 Mikropipet biru tube 250
4 Mikropipet ukuran 61 pcs 1,614
5 Parafilm pcs 599,500
6 Masker N-95 pcs 19,500
Masker N-96
Stik Pemeriksaan
1 Glukosa test Sinocare pcs
2 Kolesterol test Mission strip
3 Hemoglobin strip test test 8,652
4 Uric Acid Strip test strip 3,762
TAMBAHAN BMHP PROGRAM P2

2020
1 SD HIV 1/2 3.0 D 30T 11,400
OGXMTB/RIF-50-Xpert MTB/RIF 50
2 (Catridge) 259,175
Trepocheck Syphilis (Rapid Test

3 test 9,425
Syphilis RB-TS25:25 Tes) Tahap II
4 Diagnotar Test (GCHIV-402A) Rapid 3 test 13,411
KHB Diagnostic Kit for HIV (1+2)

5 test 12,500
Rapid 2
6 SD Bio Line (Reagen I)/HIV test 11,975
7 Tuberkulin PPD RT-23 vial 620,950
TOTAL BMHP (B)
TOTAL BMHP (A+B)
TAMBAHAN OBAT DAN BMHP

TAHUN 2021
1 Besi Fumarat + Asam Folat (TTD) tablet 354

Program Gizi
Besi Fumarat + Asam Folat (TTD)
tablet 354
Program Gizi
2 Sarung tangan Nitrile Golden Gloves pasang 2,431.00

Size M
Sarung tangan Nitrile Golden Gloves
Size M

Size L
4 Masker Bedah Stopamed pcs 2,290.00
5 Albendazole 400 mg tablet 431
6 Azitromycin tablet 500 mg tablet 1,888
7 Levofloxacin 500 mg tablet 824
8 Oxygen Mask dewasa pcs 11,130
9 Jelco IV Cath (Abocat) 20G pcs 7,909
Diagnostar DS HIV 1/2 One Step
10 Rapid Test (GCHIV-402A) test 12,527
11 Alkohol Swab pcs 128
Rapid test Syphiis RB-TS 25:25 Test
12 Tahap 1 (trepocheck) test 9,300
13 Dextrose 10% 500 ml (Satoria) botol 7,200.00
Sodium Chloride 0,9% 500 ml
14 botol 6,800.00
(Satoria)
15 Ringer Laktat 500 ml (Satoria) botol 7,630.00
16 Masker bedah (Aksamed FaceMask pcs 1,540
Ear Loop)
Handscon non steril M (SPMED
17 pasang 2,970.00
Gloves POWDERED Free M)
18 OAT FDC Kategori I paket 415,469.00
Ekstrak tanaman Phylantus niruri 50
19 kapsul 1,815.00
mg (Stimuno Kapsul)
20 Ekstrak tanaman Phylantus niruri 50 botol 19,690

mg (Stimuno Sirup)
21 HerbaCold tablet 1,034.00
22 Herbapain tablet 1,194.00
23 Ramuan Kebugaran (Jeg Seger) bungkus
24 Ramuan Kencing Manis (Semanis) bungkus
25 Ramuan Tekanan Darah Tinggi bungkus
(Tensiun)
26 Alopurinol 100 mg tablet 105
27 Dexametasone injeksi ampul 1,097
28 Prednison 5 mg tablet 73
30 Diazepam 5 mg tablet 109
31 Chlorpheniramin Maleat tab 4 mg tablet 24
(Indofarma)
TOTAL TAMBAHAN OBAT BMHP 2021
Obat 2020
1 Lanzoprasole kapsul 303
2 Aseptan Gel 500 cc+dispenser botol 22000.000
3 Bioplacenton Tulle 10x10 pcs 10400.000
4 Bisoprolol 5 mg tablet 645.000
5 Eritromisin kaps 250 mg kapsul 566.000
6 Flukonazol 150 mg tablet 22000.000
7 Folley Catheter No.16 12721.500
9 Sarung Tangan Steril 6,5 2930.000
10 Sefadroksil kaps 500mg 530.000
Tablet tambah darah (ferro fumarat
11 setara dgn Fe elemen 60 mg dan tablet
asam folat 0,40 mg) 350.000
12 Ventolin inhaler (Salbutamol botol
inh/aerosol 100 mcg/dosis) 63750.000
13 Wing Needle No. 21 G pcs 5770.000
15 Laxadine emulsi 60 ml botol 12450.000
Total
Mengetahui/menyetujui Yang menyerahkan Yang meminta Yang menerima

Kepala Dinas Kesehatan Kab.Bangli Kepala UPT Gudang Farmasi Kepala Puskesmas Pengelola obat puskesmas Pengelola obat pustu
dr. I Nengah Nadi, M.Kes I Made Dwija Dana Negara,SE.,M.Si I Wayan Wardana, SKM. Luh Nyoman Desi Setiawati. A.Mdkeb Ni Nyoman Supardani .A.Md Keb
NIP.196112311989111015 NIP.198505152005011007 NIP. 196905141990031008 NIP. 198608222017042011 NIP. 198006102005012013
DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , JUNI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE JULI 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
4 Amlodipin 5 mg tablet 78 80 - 80 - 80 -
100
7 Amoksisilin sirup kering 125 mg/5ml botol 4,400 5
- 3 8 - 8
200 mg - - - - - 100

150 150 30 120
14 Asam Askorbat (Vit C) tablet 50 mg tablet 105 10 - 10 10 -
15 253
500 mg
16 500 mg 275 100
- 90 190 120 70 100
19 Asiklovir tablet 400 mg tablet 405 50 50 - 50 -
21 Betahistin mesilat tab 6 mg tablet 110 50 50 - 50
24 Cetirizine syr 5 mg/ml botol 2,915 - - - - 3
- -
27 Deksametason Injeksi I.v. 5 mg/ml 1,097 2
- 2 - 2

- - - - 100

(HCL) - - - 5
39 Domperidon tab 10 mg 220 - 10 20 30 - 30
41 Epinefrin (Adrenalin) injeksi 0,1% ampul 1,408 2
(sebagai HCL) - 2 - 2
45 tablet 758
gula 10 mg
50 Tribatrium Sitrt dihidrat 0,58 g saset 440
30 30 - 30
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 - - - 5
58 tablet 224
micronized
Hidrokortison krim 2,5 % 2,475 3 3 - 3
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 - - - -
mg - - - -
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 30 50 80 - 80
72 Ketokonazol tab 200 mg tablet 253 90 90 10 - 80 -
76 Kloramfenikol salep kulit 2% tube 3,242
(Bufacetin) 4 4 4 -
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 100
30 130 50 - 80 100
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 - 5 5 - 5
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
98 Metilergometrin Meliat Injeksi ampul 2,959 2 - 2 - 2
104 Miconazol krim/salep 2% (nitrat) tube 3,414 2 2 2 - 3
112 560
IU/g 4 4 2 2
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray) -

Parasetamol tablet 500 mg 220 - 100 100 50 50 100
139 Salbutamol 4 mg tablet 154 40 40 40 - 100
5
145 ampul 1,104 5
mcg-ml 13 18 4 - 14
160 Tetagam 188,663
167 tablet 91
tablet 50 mg
171 Vitamin B Kompleks tablet tablet 118 - - 100 100 100
178 Zinc tablet 20 mg tablet 524 80 - 80 - 80 - 50
179 Zincpro drops botol 6,281 2 2 - 2 2
180 SF tablet 350 30 30 20 10 100
Vitamin B 6 Tablet - - - -
Asam Folat tablet 20 - 20 20 - 50
OBAT PROGRAM - -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
1 Albendazol tablet 400 mg tablet 403 50 50 - 50
-
-
OAT Kombipak -
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
2 Alat suntik sekali pakai 1 ml pcs 871.50 5 5 - 5
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 - 10 10 10 - 10
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 5 100 105 10 95
18

19 pcs 34,263 -
34 Hanscoon steril 7,5 psg 2,930 5 - 5 1 4
Hipavix 5 x 5 cm rol 68,700 1 1 2 - 2

5,100 -
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 2
lembar) - 2 1 1 5
7,935.20
lembar)

lembar)

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 4 10 14 2 12
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 - - - - - -
75 Masker N 95 pcs 8,500 5 - 5 5
7277.000

7277.000
- - - - - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
- - - - -
10

- -
- - - -
91 23,125.00 -
dengan jarum bedah 1 1 - 1 5
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , MEI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE JUNI 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
4 Amlodipin 5 mg tablet 78 80 - 80 - 80 -
100
7 Amoksisilin sirup kering 125 mg/5ml botol 4,400 3
- 3 - 3 5
200 mg - - - - - 100

170 170 20 150
14 Asam Askorbat (Vit C) tablet 50 mg tablet 105 10 - 10 - 10
15 253
500 mg
16 500 mg 275 100
- 90 190 100 90 100
19 Asiklovir tablet 400 mg tablet 405 50 50 - 50
21 Betahistin mesilat tab 6 mg tablet 110 - 50 50 - 50
24 Cetirizine syr 5 mg/ml botol 2,915 1 - 1 1 - - 3
- -
27 Deksametason Injeksi I.v. 5 mg/ml 1,097
- - - 5

- - - - 100

(HCL) 3 3 - 3 - 5
39 Domperidon tab 10 mg 220 - 10 - 10 - 10 50
(sebagai HCL) 2 2 - 2 - 2
45 tablet 758
gula 10 mg
50 Tribatrium Sitrt dihidrat 0,58 g saset 440 30
- 30 - 30
58 tablet 224
micronized
Hidrokortison krim 2,5 % 2,475
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 - - - - 4
mg - - - -
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 - 30 30 - 30 50
(Bufacetin) 4 4 - 4
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 -
70 70 40 - 30 100
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 3 - 3 3 - 5
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
98 Metilergometrin Meliat Injeksi ampul 2,959 2 2 - 2
104 Miconazol krim/salep 2% (nitrat) tube 3,414 - 2 2 - 2
112 560
IU/g 4 4 - 4
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray) -

Parasetamol tablet 500 mg 220 130 - 130 130 - 100
139 Salbutamol 4 mg tablet 154 50 50 10 40
5
145 ampul 1,104 10
mcg-ml 3 13 - - 13
160 Tetagam 188,663
167 tablet 91
tablet 50 mg
171 Vitamin B Kompleks tablet tablet 118 - - - - 100
178 Zinc tablet 20 mg tablet 524 80 - 80 - 80
179 Zincpro drops botol 6,281 2 2 - 2
180 SF tablet 350 - 30 30 - 30 100
Vitamin B 6 Tablet 100 - 100 - 100 -
Asam Folat tablet 20 - 20 - 20 50
OBAT PROGRAM - -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
-
-
OAT Kombipak -
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
2 Alat suntik sekali pakai 1 ml pcs 871.50 - 5.00 5 - 5
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 6 - 6 4 2 10
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 7 - 7 2 5 50
18

19 pcs 34,263 -
dengan jarum bedah 4 4 1 3
34 Hanscoon steril 7,5 psg 2,930 7 - 7 2 5
Hipavix 5 x 5 cm rol 68,700 1 - 1 - 1 1

5,100 -
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 -
lembar) - - - - 5
7,935.20
lembar)

lembar)

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 8 - 8 4 4 10
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 - - - - - -
75 Masker N 95 pcs 8,500 5 - 5 5
7277.000

7277.000
- - - - - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
- - - - -
10

- -
2 2 2 -
91 23,125.00 -
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , APRIL 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE MEI 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
4 Amlodipin 5 mg tablet 78 30 60 90 10 80 -
100
7 Amoksisilin sirup kering 125 mg/5ml botol 4,400
- 5
200 mg - - - - - 100

180 180 10 170
15 253
500 mg
16 500 mg 275 100
- 70 170 80 90 100
21 Betahistin mesilat tab 6 mg tablet 110 - - - - 50
24 Cetirizine syr 5 mg/ml botol 2,915 1 - 1 - - 1
- -
- - - 5

20 20 20 - 100

(HCL) 4 4 1 - 3
39 Domperidon tab 10 mg 220 - - 20 20 10 10 50
(sebagai HCL) 2 2 - 2
44 Fenobarbital tablet 30 mg tablet 171 50 50 - 50 -
45 tablet 758
gula 10 mg
50 Tribatrium Sitrt dihidrat 0,58 g saset 440 -
32 32 32 - 50
54 Glibenklamid tablet 5 mg tablet 119 120 120 20 100
58 tablet 224
micronized
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 2 2 2 -
mg - - - -
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 - - - 100
(Bufacetin) 4 4 - 4
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 -
90 90 20 - 70
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 3 - 3 - 3
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
98 Metilergometrin Meliat Injeksi ampul 2,959 2
104 Miconazol krim/salep 2% (nitrat) tube 3,414 - - - - 5
112 560
IU/g 7 7 3 4
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray) -

Parasetamol tablet 500 mg 220 130 100 230 100 130
5
145 ampul 1,104 -
mcg-ml 4 4 1 - 3
160 Tetagam 188,663
167 tablet 91
tablet 50 mg
171 Vitamin B Kompleks tablet tablet 118 - - - - 100
179 Zincpro drops botol 6,281
180 SF tablet 350 - - - - 100
Vitamin B 6 Tablet 100 - 100 - - 100
OBAT PROGRAM - -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
-
-
OAT Kombipak -
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
2 Alat suntik sekali pakai 1 ml pcs 871.50 5 - 5 - 5.00 - 5
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 10 - 10 4 6
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 7 - 7 - 7
18

19 pcs 34,263 -
34 Hanscoon steril 7,5 psg 2,930 7 - 7 - 7
Hipavix 5 x 5 cm rol 68,700 1 - 1 - 1

5,100 2
port/INFUSET DEWASA - 2 - 2 -
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 1
lembar) - 1 1 - 5
7,935.20
lembar)

lembar)

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 - - 10 2 8
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 - - - - - -
75 Masker N 95 pcs 8,500 5 - 5 5
7277.000

7277.000
- - - - - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
- - - - -
10

- -
4 4 2 2
91 23,125.00 -
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , MARET 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE Apr-23 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
Ambroxol sirup 15 mg/5 ml 3,850 - - - - 5
4 Amlodipin 5 mg tablet 78 - 30 30 - 30 100
5 Amoksisilin kaplet 500 mg kaplet 249 - - - -
100
5
200 mg - - - - - - 100

200 200 20 180
15 253
500 mg
16 500 mg 275 50
100 150 80 70 100
24 Cetirizine syr 5 mg/ml botol 2,915 2 - - 2 1 - 1
- -
- - - 5
29 Deksametason tablet 0,5 mg 88 20

10 - 30 10 20 100

(HCL) 4 4 - - 4
34 Digoksin tablet 0,25 mg tablet 104
38 Domperidon tab 10 mg tablet 95
39 Domperidon tab 10 mg 220 - - - - - 50
(sebagai HCL) 2 - 2 - 2
43 Eritromisin sirup 200 mg/5 ml botol 14,300
44 Fenobarbital tablet 30 mg tablet 171 50 50 - 50
45 tablet 758
gula 10 mg
12 32 - 32
51 Gentamisin salep mata (Genoint) tube 2,960 -
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 4 - 4 4 - 5
58 tablet 224
micronized
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 2 2 - 2
mg - - - -
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 10 - 10 10 - 100
70 Kaptopril tablet 25 mg tablet 165 170 - 170 - 170
(Bufacetin) 4 4 - 4
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 -
90 90 - 90
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 4 - 4 1 3
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
110 Natrium Klorida larutan infus 0,9 % botol 6,410 1 - - 1 1 - 2
112 560
IU/g 7 7 - 7
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray)

124 parasetamol drops botol 6,649
134 Ringer Laktat larutan infus botol 7,630 2 - 2 - 2 - 2
139 Salbutamol 4 mg tablet 154 60 60 60
5
145 ampul 1,104 -
mcg-ml 5 5 1 - 4
160 Tetagam 188,663
161 Tetrasiklin HCl kapsul 500 mg kapsul 310
167 tablet 91
tablet 50 mg
171 Vitamin B Kompleks tablet tablet 118 - - - 100
180 SF tablet 350 250 - 250 - 250 - 100
Vitamin B 6 Tablet 100 - 100 - - 100
Kloramfenikol tetes telinga 3 % tablet
OBAT PROGRAM -
MALARIA -
3 tablet 2,134
Piperaquine)(D-ARTEPP)
-
DIARE -
-
KECACINGAN -
-
1 Obat Anti Tuberculosis 1 paket 389,344
-
OAT Kombipak -
1 Katagori 1 paket 317,018
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
2 Alat suntik sekali pakai 1 ml pcs 871.50 5 - 5 - 5
924
Alat suntik sekali pakai 5 ml 1033 2 2 - 2
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 55 - 55 48 7
18

19 pcs 34,263 -
Hipavix 5 x 5 cm rol 68,700 1 - 1 - 1

5,100 -
port/INFUSET DEWASA 2 2 - 2 - 2
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 -
lembar) - - - - 5
7,935.20
lembar)

lembar)

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 10 - - 10 10 - 10
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 - - - - -
75 Masker N 95 pcs 8,500 5 - 5 5
76 my jelly 82 gram botol - - - - - 1
7277.000

7277.000
- - - - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
1 1 1 -
10

5 - 5 5 -
5 5 1 4
91 23,125.00 -
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , PEBRUARI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE MARET 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT
4 Amlodipin 5 mg tablet 78 - - - - 100
5 Amoksisilin kaplet 500 mg kaplet 249 - - - -
100
5
200 mg 40 - 40 - 40 - 100

220 220 20 200
15 253
500 mg
16 500 mg 275 100
110 210 110 100 50
17 Asiklovir krim 5% tube 2,860
24 Cetirizine syr 5 mg/ml botol 2,915 2 - - 2 - - 2
- -
- - - 5

- - 20 10 10 100

(HCL) 4 4 - 4
39 Domperidon tab 10 mg 220 10 - 10 10 - 50
45 tablet 758
gula 10 mg
50 Tribatrium Sitrt dihidrat 0,58 g saset 440 -
15 15 3 12 20
52 Gentamisin salep kulit 0,1% tube 4 3 7 3 4
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 - - - - - 5
58 tablet 224
micronized
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 5 5 3 2
mg - - - -
66 mg 143
67 Kalsium laktat (Kalk) tablet 500 ml tablet 63 20 - 20 10 10 100
(Bufacetin) - - - - 5
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 -
140 140 50 - 90
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 7 - 7 3 4
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
110 Natrium Klorida larutan infus 0,9 % botol 6,410 2 - - 1 - 1 2
112 560
IU/g 7 7 - 7
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray)

134 Ringer Laktat larutan infus botol 7,630 2 - 2 - - 2
5
145 ampul 1,104 3
mcg-ml 2 5 - - 5
160 Tetagam 188,663
167 tablet 91
tablet 50 mg
180 SF tablet 350 250 - 250 - 250
Vitamin B 6 Tablet 100 - 100 - - 100
OBAT PROGRAM -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
-
-
OAT Kombipak -
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
924
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 60 - 60 5 55
18

19 pcs 34,263 -
34 Hanscoon steril 7,5 psg 2,930 2 5 7 - 7
Hipavix 5 x 5 cm rol 68,700 1 - 1 - 1

5,100 -
port/INFUSET DEWASA 2 2 - 2
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 -
lembar) 5 5 5 - 5
7,935.20
lembar)

lembar)

63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 - - 10 10 - 10
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 20 - 20 20 -
75 Masker N 95 pcs 8,500 5 - 5 5
76 my jelly 82 gram botol 1 1 1 - 1
7277.000

7277.000
2 2 2 - -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
1 1 1 -
10

5 - 5 - 5
10 10 5 5
91 23,125.00 -
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , JANUARI 2023 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE PEBRUARI 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAA PEMAKIAN OBAT STOK AKHIR PERMINTAAN PEMBERIAAN
N ED/RUSAK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT

200 mg 50 - 50 10 40 100
10.000 IU/g (Top Oint)
12 Antimigren: Ergotamin Tartrat 1 mg + tablet 185
Kofein 50 mg

220 220 - 220
15 Asam Mefenamat tablet salut selaput 253
500 mg
16 Asam Mefenamat tablet salut selaput 275 100

500 mg 100 200 90 110 100
24 Cetirizine syr 5 mg/ml botol 2,915 2 - - 2 - - 2
- -
- - - 5

30 - 30 30 - 100

Difenhidramin Injeksi I.M. 10 mg/ml
33 ampul 1,095 3
(HCL) 1 4 - 4
39 Domperidon tab 10 mg 220 20 - 20 10 10 50
Epinefrin (Adrenalin) injeksi 0,1%
41 ampul 1,408 -
45 Fitomenadion (Vit.K1) tablet salut tablet 758
gula 10 mg
50 Natrium 0,70 g ,Kalium klorida 0,30 g, saset 440 20
Tribatrium Sitrt dihidrat 0,58 g
- 20 5 15 20
52 Gentamisin salep kulit 0,1% tube 2 3 5 1 4
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 2 - 2 2 - 5
58 Griseofulvin tablet 125 mg, tablet 224
micronized
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 - 5 5 - 5
mg - - - -
66 Isosorbid Dinitrat tablet sublingual 5 143
mg
72 Ketokonazol tab 200 mg tablet 253 100 100 10 - 90 -
78 Kloramfenikol tetes mata 0,5% (Reco botol 3,250
TM) - - - - 5
79 Kloramfenikol tetes mata 0,5% (Reco 8,800
TM)
81 tablet 23 100
mg 100 200 60 - 140
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 2 5 7 - 7
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
97 Metilergometrin Meliat tablet 224 - 50 50 - 50
109 Natrium diklofenak tab 50 mg 123 80 - 80 80 - - 100
110 Natrium Klorida larutan infus 0,9 % botol 6,410 2 - 2 2 - 2 -
IU/g 10 10 3 7
IU/g
115 botol 32,549
(iliadin drops)
116 botol 34,320
(iliadin spray)
134 Ringer Laktat larutan infus botol 7,630 - 2 2 - - 2
139 Salbutamol 4 mg tablet 154 100 100 30 - 70
141 Salep 2-4 , Kombinasi: Asam Salisilat pot 2,797
2% + Belerang Endap 4% 5
145 ampul 1,104 -
mcg-ml 2 2 - - 2 5
160 Tetagam 188,663
tablet 50 mg
180 SF tablet 350 250 - 250 - 250
Vitamin B 6 Tablet 100 - 100 - - 100
OBAT PROGRAM -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
-
-
OAT Kombipak -
-
GIZI -

1 kapsul 306
Kapsul Lunak Bayi ( 6 - 11 bln )

bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 20 10 30 10 - 20
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 90 - 90 30 60
18
Catgut / Benang Bedah No. 2/0 34,263
dengan jarum bedah
19 Catgut / Benang Bedah No. 3/0 pcs 34,263 2

34 Hanscoon steril 7,5 psg 2,930 3 - 3 1 2 5
Hipavix 5 x 5 cm rol 68,700 - 1 1 - 1
37 pcs 4,975
port/INFUSET DEWASA
5,100 -
38 pcs 8,867
port/INFUSET DEWASA
47 Kapas 500 gram bks 20,000 1 1 - 1
49 Kapas Pembalut / Absorben 250 14,070
gram bks
51 kotak 3,850 -
lembar) 5 5 - 5 5
7,935.20
lembar)

lembar)
10
63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 10
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 50 - 50 30 20
75 Masker N 95 pcs 8,500 5 5 5
76 my jelly 82 gram botol 1
7277.000

7277.000
2 2 - 2 -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328
84 Plesterin nonwoven uk 5 x5 cm one roll 24,948.00

med
med
85 Povidon iodin 60 ml botol 4,961 1
1 1 1 1
10

5 - 5 - 5
90 Sendok syr pcs 1,485 5
5 10 - 10
91 Silk (Benang Bedah Sutera) No. 3/0 23,125.00 -
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400
2 OGXMTB/RIF-50-Xpert MTB/RIF 50 259,175
(Catridge)
3 Trepocheck Syphilis (Rapid Test test 9,425
5 KHB Diagnostic Kit for HIV (1+2) test 12,500

Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021
1 tablet 354
Program Gizi
tablet 354
Program Gizi
2 pasang 2,431.00
Size M
Size M
3 pasang 2,431.00
Size L
10 Diagnostar DS HIV 1/2 One Step test 12,527
Rapid Test (GCHIV-402A)
12 test 9,300
Tahap 1 (trepocheck)
14 Sodium Chloride 0,9% 500 ml botol 6,800.00
(Satoria)
Masker bedah (Aksamed FaceMask
16 pcs 1,540
Ear Loop)
17 pasang 2,970.00
19 Ekstrak tanaman Phylantus niruri 50 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
Ramuan Tekanan Darah Tinggi
25 bungkus
(Tensiun)
Chlorpheniramin Maleat tab 4 mg
31 tablet 24
(Indofarma)
Obat 2020
Ventolin inhaler (Salbutamol
12 botol
Total

DINAS KESEHATAN
DOK NO TGL KET
PUSKESMAS/PUSTU : KINTAMANI III LAPORAN BULAN/PERIODE , DESEMBER 2022 GFK
KECAMATAN : KINTAMANI PERMINTAAN BULAN/PERIODE JANUARI 2023 PUSK
KABUPATEN : BANGLI
POLINDES MENGANI
A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT

200 mg 80 - 80 30 50
10.000 IU/g (Top Oint)

180 180 50 130
14 Asam Askorbat (Vit C) tablet 50 mg tablet 105 40 100 140 30 110
15 253
500 mg
16 500 mg 275 100
80 180 80 100 100
24 Cetirizine syr 5 mg/ml botol 2,915 - - 2 2 - - 2
- -
- - - 5

- - 30 - 30 100

(HCL) 1 1 - 1 5
39 Domperidon tab 10 mg 220 50 - 50 30 20 50
41 Epinefrin (Adrenalin) injeksi 0,1% ampul 1,408 2
(sebagai HCL) - - 2 - 2
45 tablet 758
gula 10 mg
15 25 25 - 50
51 Gentamisin salep mata (Genoint) tube 2,960 - -
52 Gentamisin salep kulit 0,1% tube 2 2 - 2
53 Gentamisin sulfat tetes mata 0,3% botol 4,232 2 2 4 2 2 -
58 tablet 224
micronized
62 Ibuprofen suspensi 100 mg/5ml botol 2,721 5 - 5 5 - 5
mg - - - -
66 mg 143
78 TM) botol 3,250 - - - - 5
79 8,800
TM)
81 mg tablet 23 100
50 150 50 - 100 100
82 tablet 66
mg
Trimetoprim 80 mg
87 Lidokain injeksi 2% ampul 1,226 5 - 5 3 2 5
88 ampul 1,210
1 : 80.000-2 ml

1 : 80.000-2 ml
1 1 - - 1
97 Metilergometrin Meliat tablet 224 50
109 Natrium diklofenak tab 50 mg 123 150 - 150 70 - 80
110 Natrium Klorida larutan infus 0,9 % botol 6,410 - - 2 2 - 2 -
112 560
IU/g 10 10 - 10
IU/g
115 botol 32,549
(iliadin drops)

(iliadin spray)

125 Parasetamol sirup 120 mg/5 ml botol 1,181 5 - 5 5 - 5
134 Ringer Laktat larutan infus botol 7,630 - - - - - 2
139 Salbutamol 4 mg tablet 154 120 100 120 20 - 100
5
145 ampul 1,104 2
mcg-ml 1 3 1 - 2 5
160 Tetagam 188,663
167 tablet 91
tablet 50 mg
178 Zinc tablet 20 mg tablet 524 100 - 100 20 80
180 SF tablet 350 100 200 300 50 250
Vitamin B 6 Tablet 100 - 100 - - 100
Asam Folat tablet 60 - 60 40 20 100
OBAT PROGRAM -
MALARIA -
3 tablet 2,134
-
DIARE -
-
KECACINGAN -
-
-
OAT Kombipak -
-
GIZI -


bln )
bln )
-
OBAT GIGI -
TOTAL OBAT (A)
BMHP
924
3 Alat suntik sekali pakai 2,5 ml/3 ml pcs 924 15 10 25 5 - 20 10
Alkohol 70% 100 ml 4,875
8 Alkohol 70% 300 ml botol 11,625.00
10 Alkohol swab pcs 112 100 - 100 10 90
18
dengan jarum bedah 1941.13 - 2.00 2 - 2

19 pcs 34,263
dengan jarum bedah - - - - 5
Hipavix 5 x 5 cm rol 68,700 1 - 1 1 - 1

5,100 -
47 Kapas 500 gram bks 20,000 1 1 - 1
49 14,070
gram bks
51 kotak 3,850 5
lembar) - 5 - 5 10
7,935.20
lembar)

lembar)

10
63 Kasa Pembalut Hidrofil 4 m x 5 cm rol 750 10
66 Klip 10x7 cm bal 99,000
Masker 2,350.00 - 50 50 - 50
75 Masker N 95 pcs 8,500 10
76 my jelly 82 gram botol 1
7277.000

7277.000
2 2 - 2 -
Nurse cap 600.00
80 Obgyn glove psg

19,950
Obgyn glove
20,328

84 roll 24,948.00
med
med
85 Povidon iodin 60 ml botol 4,961
1 1 - 1
10

5 - 5 - 5
90 Sendok syr pcs 1,485 5
- 5 - 5 5
91 23,125.00 1
dengan jarum bedah - 1 - 1 5
92 Silk black 2/0 pcs 24,025.00

1

Pot dahak pot 5,154
6 Sound timer pcs -
-
Masker N-96
Stik Pemeriksaan

2020
1 SD HIV 1/2 3.0 D 30T 11,400

3 test 9,425

5 test 12,500
Rapid 2
TOTAL BMHP (B)
TOTAL BMHP (A+B)

TAHUN 2021

Program Gizi
tablet 354
Program Gizi

Size M
Size M

Size L
14 botol 6,800.00
(Satoria)
Ear Loop)
17 pasang 2,970.00
19 kapsul 1,815.00
mg (Stimuno Kapsul)

mg (Stimuno Sirup)
(Tensiun)
(Indofarma)
Obat 2020
Total


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PEMERINTAH KABUPATEN BANGLI

NO NAMA OBAT SATUAN STOK AWAL PERSEDIAA OBAT PEMBERIAAN

13 Asam Askorbat (Vit C) tablet 250 mg tablet 105 -

29 Deksametason tablet 0,5 mg 88 -

31 Diazepam Injeksi 5mg/ml ampul 1,735

89 Lidokain injeksi 2% (HCL) + Epinefrin ampul 1,291

116 Oksimetazolin tetes hidung 0,050% botol 34,320

122 Parasetamol infus botol 11,610

Retinol ( vitamin A ) 100.000 IU

Retinol ( vitamin A ) 200.000 IU

Catgut / Benang Bedah No. 3/0

Infusiont Set-Y type with injection

52 Kasa Hidrofil steril uk. 18 x 22 (isi 12 kotak 5,800

61 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,500

62 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,575

78 Nasal oxygen S pcs

80 Obgyn glove psg

82 Pembalut Gips 4 inchi rol 17,500.00

83 Pembalut Gips 6 inchi rol 42,000.00

88 Sarung Tangan Steril 6,5 psg 2,930.40

89 Sarung Tangan Steril 7 psg 2,930

93 Umbilical cord klem pcs 1,365

94 Underpad (perlak sekali pakai)60x90 pcs 4,371

Underpad (perlak sekali pakai)60x91 3,749

95 USG gel 250 onemed / Ultra sonik gel botol 13,842

TAMBAHAN BMHP PROGRAM 2015 -

TAMBAHAN BMHP PROGRAM P2

Trepocheck Syphilis (Rapid Test

4 Diagnotar Test (GCHIV-402A) Rapid 3 test 13,411

KHB Diagnostic Kit for HIV (1+2)

TAMBAHAN OBAT DAN BMHP

1 Besi Fumarat + Asam Folat (TTD) tablet 354

2 Sarung tangan Nitrile Golden Gloves pasang 2,431.00

3 Sarung tangan Nitrile Golden Gloves pasang 2,431.00

20 Ekstrak tanaman Phylantus niruri 50 botol 19,690

TOTAL TAMBAHAN OBAT BMHP 2021

Mengetahui/menyetujui Yang menyerahkan Yang meminta Yang menerima

NO NAMA OBAT SATUAN STOK AWAL PERSEDIAA OBAT PEMBERIAAN

13 Asam Askorbat (Vit C) tablet 250 mg tablet 105 -

29 Deksametason tablet 0,5 mg 88 -

31 Diazepam Injeksi 5mg/ml ampul 1,735

89 Lidokain injeksi 2% (HCL) + Epinefrin ampul 1,291

116 Oksimetazolin tetes hidung 0,050% botol 34,320

122 Parasetamol infus botol 11,610

Retinol ( vitamin A ) 100.000 IU

Retinol ( vitamin A ) 200.000 IU

Catgut / Benang Bedah No. 3/0

Infusiont Set-Y type with injection

52 Kasa Hidrofil steril uk. 18 x 22 (isi 12 kotak 5,800

61 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,500

62 Kasa Pembalut Hidrofil 4 m x 10 cm rol 1,575

78 Nasal oxygen S pcs

80 Obgyn glove psg

82 Pembalut Gips 4 inchi rol 17,500.00

83 Pembalut Gips 6 inchi rol 42,000.00

88 Sarung Tangan Steril 6,5 psg 2,930.40

89 Sarung Tangan Steril 7 psg 2,930

93 Umbilical cord klem pcs 1,365

94 Underpad (perlak sekali pakai)60x90 pcs 4,371

Underpad (perlak sekali pakai)60x91 3,749

95 USG gel 250 onemed / Ultra sonik gel botol 13,842

TAMBAHAN BMHP PROGRAM 2015 -

TAMBAHAN BMHP PROGRAM P2

Trepocheck Syphilis (Rapid Test