PERMOHONAN PENGELUARAN UANG/BARANG

Oct-2022

FARMASI TMC ANGSANA

Distributor : PT. SUMBER SEHAT SEJAHTERA

Nomor Nama Obat Kemasan Banyaknya HNA Jumlah Stock Of Disc. Total Disc.
Hand
1 LERZIN Box 5 IDR 25,850 IDR 129,250 0 20% IDR 25,850
2 HISTIGO Box 3 IDR 32,300 IDR 96,900 0 20% IDR 19,380
3 LOKEV (OMEPRAZOLE) Box 3 IDR 27,050 IDR 81,150 20 20% IDR 16,230
4 OXICOBAL Box 2 IDR 54,750 IDR 109,500 0 20% IDR 21,900
5 ESTALEX Box 4 IDR 47,250 IDR 189,000 0 20% IDR 37,800
6 AMLODIPIN 5 MG OGB DEXA Box 5 IDR 95,999 IDR 479,995 0 65% IDR 311,997
7 AMLODIPIN 10 MG OGB DEXA Box 5 IDR 169,103 IDR 845,515 0 50% IDR 422,758
8 MIRASIC Box 2 IDR 36,500 IDR 73,000 110 20% IDR 14,600
9 MIRASIC FORTE 650 BOX100 Box 2 IDR 42,500 IDR 85,000 110 20% IDR 17,000
10 METHYL P. 4 MG OGB DEXA Box 4 IDR 44,055 IDR 176,220 0 20% IDR 35,244
11 METHYL P. 8 MG OGB DEXA Box 2 IDR 88,110 IDR 176,220 85 20% IDR 35,244
12 BETASON-N Tube 25 IDR 14,850 IDR 371,250 0 15% IDR 55,688
13 DEXTEEM PLUS Box 3 IDR 30,900 IDR 92,700 0 15% IDR 13,905
14 SELVIM 10 MG Box 5 IDR 21,050 IDR 105,250 0 20% IDR 21,050
15 SELVIM 20 MG Box 5 IDR 28,650 IDR 143,250 0 20% IDR 28,650
16 FENOFIBRAT 300 MG HEXAPHARM Box 2 IDR 65,000 IDR 130,000 150 10% IDR 13,000
17 GENOINT TETES MATA 5 ML Botol 7 IDR 10,100 IDR 70,700 0 10% IDR 7,070
18 FLUCADEX Box 2 IDR 92,200 IDR 184,400 90 30% IDR 55,320
19 Imboost 50's Box 4 IDR 159,700 IDR 638,800 0 -
20 FG Troches Box 3 IDR 160,000 IDR 480,000 0 1% IDR 4,800
21 Counterpain 120 gr Tube 5 IDR 93,900 IDR 469,500 0 -
22 Counterpain 30 gr Tube 5 IDR 37,300 IDR 186,500 0 -
23 BET. KUMUR 100 ML Botol 10 IDR 19,800 IDR 198,000 0 -
24 BET. KUMUR 190 ML Botol 10 IDR 29,700 IDR 297,000 0 -
25 MYCORAL CREAM Tube 12 IDR 14,000 IDR 168,000 0 2% IDR 3,360
26 HANSAPLAST Amplop 20 IDR 6,948 IDR 138,960 0 - -
27 Cefixime 100 mg Hj 50's Box 2 IDR 90,900 IDR 181,800 0 10% IDR 18,180
Jumlah IDR 6,297,860 IDR 1,179,025
Catt: pengadaan untuk 3 bulan IDR 5,118,835
TOTAL IDR 5,681,907

Angsana,24 Oktober 2022

Dibuat/Diajukan Oleh, Diperiksa Oleh, Disetujui Oleh,

Panca Handini dr. Tia Ariani Salsabila

TMC/FRM/PUR/008,Revisi 00

FORMULIR PENGAJUAN PURCHASE REQUEST

DEPARTEMEN : FARMASI TMC ANGSANA

JUMLAH PENGELUARAN
NOMOR KODE KETERANGAN
SATUAN JUMLAH

1 PENGADAAN OBAT OBATAN PT. SUMBER SEHAT TOP IDR 5,681,907

SEJAHTERA

JUMLAH IDR 5,681,907

Catatan :
Angsana, 24 Oktober 2022

Dibuat / Diajukan oleh, Diperiksa oleh, Disetujui oleh,

apt. Panca Handini dr. Tia Ariani Salsabila