KABUPATEN EMPAT LAWANG

OPD : DINAS KESEHATAN (PUSKESMAS PADANG TEPONG)

TA : 2022

MUTASI TAMBAH 2022 MUTASI KURANG 2022

SALDO AWAL 1 JANUARI 2022
2021 2021
KEMASAN NILAI HARGA NILAI
NO URAIAN HARGA SATUAN VOLUM HARGA SATUAN
BARANG VOLUME PERSEDIAAN SATUAN PERSEDIAAN VOLUME
(Rp) E (Rp)
(Rp) (Rp) (Rp)
1 2 3 4 5 6 7 8 9 10 11
OBAT TAHUN 2022
1 Acyclovir 400mg box 80 21450 1,716,000.00 - 20 21450
2 Albendazol Suspensi 200 mg/5ml botol - -
3 Albendazole 400 mg kotak @ 100 tablet - 25 38,000 950,000 25 38,000
4 Alupurinol 100 mg Box@100 tab - 2 10500 21,000 10500
5 Ambroxol syrup Botol - 800 9990 7,992,000 563 9990
6 Ambroxol tab 30 mg Box - 400 33000 13,200,000 300 33000
7 Amlodipin 5 mg Kotak@300 tab 1 23400 23,400.00 3 23400 70,200 4 23400
8 Amoksisilin 500 mg tab - 20,000 211 4,220,000 20,000 211
9 Amoksisilin sirup kering 125 mg/5 ml suspensi botol 20 3498 69,960.00 - 3498
10 Amoropo Plus kotak 100tab 54 207900 11,226,600 38 207900
11 Antasida tablet Kotak@100 tab - 67200 54 3,628,800 62,200 54
12 Antihemoroid supp supp - 50 3250 162,500 32 3250
13 asam mefenamat 500mg tab 9,000 111 999,000 5,600 111
14 Azitomicin tablet 20 1250 25,000 10 1250
15 Betahistin Tab 24 mg Box @ 30 Tab - 40 150000 6,000,000 20 150000
16 Betametason Cream Tube - 100 1520 152,000 100 1520
17 Biferce tabung 10tab 60 28000 1,680,000 60 28000
18 Bioron Injeksi Box - 84 27139 2,279,676 84 27139
19 Bisakodil 5 mg tab - -
20 Bufacetine 2% salep tube 80 3431 274,480.00 - 60 3431
21 Calcitriol 0,5 mg Tab - 1,500 2600 3,900,000 10 2600
22 Captopril 12,5 mg Tab - 60,000 68 4,080,000 40,000 68
23 Captopril 25 mg Tab - 20,000 75 1,500,000 10,000 75
24 Cetrizine tab tab - 35,000 50 1,750,000 30,000 50
25 Cetrizine sirup botol 2153 - 950 2153 2,045,350 365 2153
26 Ciprofloxacin 500 mg Tab - 15,000 250 3,750,000 3,000 250
27 cynof botol 2
28 Curcuma kotak 100tab 9 88000 792,000 7 88000
29 Corsona Kotak@100 tab - 3 20350 61,050 3 20350
30 Dextamine Tab Box - 30 540137 16,204,110 25 540137
31 Domperidone tablet 10 mg tab - -
32 Eugenol Cair botol - 22 20150 443,300 5 20150
33 Favipiravir 200mg talet 300 10399 3,119,700 100 10399
34 Fitomenadion injeksi 2 mg/ml kotak @ 30 ampul - -
35 Garam Oralit kotak 100 sachet 10 28,000 280,000.00 16 28,000 448,000 16 28,000
36 geriavita tab box 54 272,250 14,701,500 20 272,250
37 Geriavita tab botol 100 65227 6,522,700.00 90 65227 5,870,430 48 65227
38 Glimepiride 1 mg tab 500 93 46,500.00 - 93
39 Glipizid Tab 5 mg/ Glucitrol Tab tab 500 3090 1,545,000.00 - 3090
40 Hidroxy cloroquine sulfat tab 20 3000 60,000 5 3000
41 Hustab P 8 mg Box @ 300 Tab - 120 77700 9,324,000 100 77700
42 Hydrochlortiazide tab 100 148 14,800.00 - 148
43 Kotrimoksazole Syrup Botol - 400 2100 840,000 192 2100
44 Lansoprazole 30 mg tab - 3,000 278 834,000 2,600 278
45 Larvasida Malaria kotak/kg 10 1399500 13,995,000.00 - 1399500
46 Levofloxacin tab 90 2682 241,380 60 2682
47 Lidocaine 2% injeksi Ampul - 150 891 133,650 150 891
48 Magnesium Sulfat Inj 20 % ampul 50 3760 188,000.00 - 31 3760
49 Mefenamic Acid 500 mg Tab 2,000 111 222,000.00 10,000 111 1,110,000 111
50 Metformin 500mg tab 1,000 77 77,000.00 46,000 77 3,542,000 1,500 77
51 Methyl Prednisolon 4mg Tab 1 49.41 49.41 44,000 102 4,488,000 30,000 102
52 Methylergometrin 0,125 mg tab 1,000 214 214,000.00 - 270 214
53 Methylergometrin Maleat tablet tab 500 237 118,500.00 - 400 237
54 Methylergometrine Maleat 0,2 mg/ml ampul 50 1023 51,150.00 - 30 1023
55 Metronidazole 500 mg tab 2,000 264 528,000.00 18,000 264 4,752,000 1,200 264
56 NaCl 500 ml botol 200 6900 1,380,000.00 800 15714 12,571,200 695 15714
57 natirum diclofenak 50mg tab 41,000 108 4,428,000 33,000 108
58 Natrium Diklofenak 25 mg Kotak@50 tab - 22 5700 125,400 5700
59 NB Topikal Oint Tube - 288 17362 5,000,256 190 17362
NISTATIN OVULE 4,000 550 290 550
60 Nistatin 100.000 IU box 50 11750 587,500.00 - 50 11750
61 Oksitetrasiklin Salep Mata 1 % kotak @ 25 tube 10 87,500 875,000.00 - 10 87,500
62 Osteotin Box @ 60 Tab - 490 198801 97,412,490 490 198801
63 Oxytosin 10 iu/1 ml injeksi kotak @ 100 ampul 1 112,600 112,600.00 1 112,600 112,600 112,600
64 paracetamol 500mg box 26 29,992 779,792
65 Paracetamol 500 mg Box 20 36000 720,000.00 300 36000 10,800,000 216 36000
66 Paracetamol Syrup Botol - 2,300 1160 2,668,000 1,200 1160
67 Pehastan 500 mg Box - 2,000 445.5 891,000 1,800 445.5
68 Pehavit D3 botol 72 68000 4,896,000 56 68000
69 Phytomenadion 10mg/ml injeksi Ampul - 8,000 3600 28,800,000 5,000 3600
70 Propanolol 10 mg tab 1,000 59 59,000.00 - 200 59
71 Propiltiourasil 100 mg Kotak@100 tab - 1 40500 40,500 1 40500
72 Prove D3 drop botol 1 200000 200,000
73 retinol vitamin A 200.000 UI botol 77 29050 2,236,850 55 29050
74 retinol vitamin A 100.000UI botol 8 16050 128,400 2 16050
75 Pyrantel Pamoat 125 mg Unit 1,000 322 322,000.00 - 1,000 322
76 Ranitidin 150 mg tablet - 20000 85 1,700,000 15,800 85
77 Ringer Laktat 500 ml botol 50 7703 385,150.00 800 15700 12,560,000 400 15700
78 Simvastatin 10 mg Tab - 3,000 68 204,000 2,000 68
79 Simvastatin 20 mg Tab - 150 - 150
80 spironolacton tab 14,400 200 2,880,000 100 200
81 Stimuno Syrup Botol - 350 28374 9,930,900 28374
82 Tablet Tambah Darah kotak @ 30 tablet 1,500 11,160 16,740,000.00 - 1,000 11,160
83 Tablet Tambah Darah kotak 100 tablet 500 23,800 11,900,000.00 2300 23,800 54,740,000 1,300 23,800
84 Vitamin A 200.000 IU botol @ 50 kapsul 10 29,050 290,500.00 - 29,050
85 vitamin c 50mg tab 16000 43 688,000 10,410 43
86 asam askorbat Tab - 100 198 19,800 50 198
87 Vitamin D3 1000 IU (caviplex) tab 180 1195 215,100 130 1195
88 Water for injection 25 ml ampul 100 2650 265,000.00 60 2650 159,000 50 2650
89 Zinc 20 mg kotak @ 100 tablet 30 55,100 1,653,000.00 - 10 55,100
- -
VAKSIN RUTIN DAN COVID - -
1 Vaksin HB Uniject 1 dosis Kotak, 100 Pouch 10 23,991 239,910.00 14 23,490 328,860 24 23,490
2 Vaksin BCG 20 dosis + Pelarut Kotak, 50 Vial 20 61,996 1,239,920.00 15 88,288 1,324,320 30 88,288
3 Vaksin MR 10 dosis + Pelarut Kotak, 50 Vial 15 155,813 2,337,195.00 30 152,600 4,578,000 45 152,600
4 Vaksin Polio (bOPV ) 10 dosis + penetes Kotak @ 10 vial 10 23,991 239,910.00 35 19,540 683,900 40 19,540
5 ADS Skifa 5 ml pcs 50 1,583 79,150.00 1,583 - 45 1,583
6 ADS Oneject 0,05 ml pcs 50 1,565 78,250.00 1,565 - 30 1,565
7 ADS 0,3ml pcs 30 1,255 37,650.00 1600 1,255 2,008,000 1,000 1,255
8 ADS Oneject 0,5 ml pcs 20 1,240 24,800.00 4800 1,240 5,952,000 2,000 1,240
9 ADS 5ml pcs 100 1,110 111,000 20 1,110
10 ADS 3ml pcs 30 569 17,070.00 1900 913 1,734,700 800 913
11 ADS Oneject 5 ml pcs 50 1,900 95,000.00 1,900 - 200 1,900
12 Vaksin Polio (IPV) 5 dosis Kotak, 10 Vial 45 153,736 6,918,120.00 35 144,540 5,058,900 60 144,540
13 Vaksin DPT-HB-HiB 5 dosis Kotak, 10 Vial 50 153,736 7,686,800.00 40 77,366 3,094,640 60 77,366
14 Vaksin Td 10 dosis Kotak, 10 Vial 20 15,450 309,000.00 20 15,459 309,180 20 15,459
15 SB 5 Liter kotak -
16 Safety Box 2,5 liter Kotak, 25 Buah 5 12,500 62,500.00 - 2 12,500
17 Vaksin DT Kotak, 10 Vial 20 28,204 564,080.00 - 5 28,204
18 CORONAVAC vial 2 DOSIS 2 218,933 437,866.24 - 2 218,933
19 COVOVAX VIAL 10 DOSIS 3 1,052,295 3,156,885.15 - 3 1,052,295
20 PFIZER COVAX vial -
21 ASTRAZENECA vial -
22 MODERNA vial -
- -
- -
NAPZA - -
1 Clobazam 10mg tablet 1000 - 1000
2 Clozapine 25 mg tablet 300 473 141,900.00 473 - 300 473
3 Codein 10 mg tab 500 600 300,000.00 - 450 600
4 Diazepam 2 mg tablet 115 70 8,050.00 70 - 115 70
5 Diazepam 5 mg tablet 100 108 10,800.00 108 - 100 108
6 Diazepam injeksi 5 mg/ml ampul 100 1,545 154,500.00 1,545 - 90 1,545
7 Fenobarbital injeksi 50 mg/ml kotak @ 30 ampul 51,000 - - 51,000
8 Fenobarbital 30 mg tablet 100 182 18,200.00 182 - 100 182
9 Haldol Decanoat 50 mg/ml tablet 545 - - 545
10 Haloperidol injeksi 5 mg/ml ampul 120 1,190 142,800.00 1,190 - 110 1,190
11 Haloperidol tab 5 mg tablet 200 5,400 1,080,000.00 - 180 5,400
12 Risperidone 1 mg tablet 123 - 123 - 123
13 Risperidone 2 mg tablet 150 12,300 1,845,000.00 1000 12,300 12,300,000 150 12,300
14 THP tablet 100 9,100 910,000.00 500 9,100 4,550,000 100 9,100
15 ABU ( Anti Bisa Ular ) vial 8 517,132 4,137,056.00 517,132 - 8 517,132
16 OAT FDC Kat. I Paket 5 436,241 2,181,205.00 - 2 436,241
17 OAT FDC Kat. I Paket 7 437,695 3,063,865.00 - 2 437,695
18 OAT KDT harian kategori 1 Paket 5 409,461 2,047,305.00 - 5 409,461
- -
ALKES DAN BMHP - -
1 Alkohol 70 % 300 ml botol 200 6820 1,364,000.00 5 8074 40,370 80 6820
2 Alkohol Swab box 1,000 8380 8,380,000.00 11,640 8380 97,543,200 5,000 8380
3 Antiseptic Handrub botol 30 90188.64 2,705,659.20 - 8 90188.64
4 3 in 1 autocheck unit 4 222000 888,000 222000
5 Blood Lancet box 1,000 16265 16,265,000.00 400 16265 6,506,000 400 16265
6 blood glucose box 450 124120 55,854,000 300 124120
7 catgut cromic with neddle 3/075cm pcs 12 58516.17 702,194 12 58516.17
8 disinfectan jasmine all surface 500ml botol 50 55000 2,750,000 20 55000
9 Gynaecological Glove Size Large BOX @25PCS - 2 1075250 2,150,500 2 1075250
10 Gynaecological Glove Size Medium BOX @20PCS - 1 1075250 1,075,250 1 1075250
11 hand sanitizer 500ml botol 290 52200 15,138,000 90 52200
12 Infusion Set Adult pcs 20 5800 116,000.00 - 10 5800
13 IV chateter Non injection port pcs 200 7149 1,429,800 50 7149
14 IV chateter no 18 pcs 100 5600 560,000 70 5600
15 IV chateter no 22 pcs 100 5600 560,000 65 5600
16 IV cannula with injektion port 16 pcs 50 7100 355,000.00 - 15 7100
17 IV cannula with injektion port 18 pcs 20 7100 142,000.00 600 7100 4,260,000 250 7100
18 IV cannula with injektion port 20 pcs 50 7100 355,000.00 - 7100
19 IV cannula with injektion port 26 pcs 65 7100 461,500.00 - 7100
20 Hand scoon steril lengan panjang no 7,5 pasang 20 23199 463,980 20 23199
21 Hand scoon steril lengan panjang no 7 pasang 20 23199 463,980 20 23199
22 Hand scoon steril lengan panjang no 6,5 pasang 20 23199 463,980 20 23199
23 Kasa Hidrofil 16 x 16 cm pcs 100 2885 288,500.00 - 4 2885
24 Kassa Hidrophile 4 Y x 10 cm pcs 50 97900 4,895,000.00 30 147620 4,428,600 10 147620
25 Kassa Hidrophile 4 Y x 5 cm pcs 60 97900 5,874,000.00 30 147620 4,428,600 18 147620
26 Latex steril surgical gloves no. 6.5 box 10 4600 46,000.00 - 10 4600
27 Nipro SYRINGE 5 CC 22 G X 1-1/2 BOX @100PCS - 1 104500 104,500 104500
28 Paper tape dispenser 2 box 50 186857 9,342,850.00 - 10 186857
29 Paper Tape UK 1 INCH X 10 YARDS BOX @12ROLL 1 205543 205,543.00 1 205543 205,543 205543
30 Paper Tape UK 2 INCH X 10 YARDS BOX @12ROLL 1 205543 205,543.00 1 205543 205,543 205543
31 povidine 300ml botol 5 23132 115,660 3 23132
32 Rivanol 100 cc botol 123 1600 196,800.00 1600 - 100 1600
33 Sinar Ogan Masker Premium Earloop Box - 3,800 48000 182,400,000 3,500 48000
34 Sinar Ogan Masker Premium Headloop Box - 2,800 54000 151,200,000 2,500 54000
35 Surgical Facemask Earloop box 495 46494 23,014,530.00 120 46494 5,579,280 46494
36 Surgical Facemask Headloop box 300 46491 13,947,300.00 120 46494 5,579,280 46491
37 Surgical Gloves Size 7,0 BOX @50PCS - 2 678150 1,356,300 2 678150
38 Surgical Gloves Size 7,5 BOX @50PCS - 2 678150 1,356,300 2 678150
Ecolene Non-Absorbable Synthetic
39 Monofilament, Polypropylene, 4/USP, 75
CM, CUTING 3/5 CIRCLE, 24 MM BOX @12PCS - 2 312162 624,324 2 312162
Ecolene Non-Absorbable Synthetic
40 Monofilament, Polypropylene, 4/USP, 75
CM, CUTING 3/5 CIRCLE, 19 MM BOX @12PCS - 2 399,647 799,294 2 399,647

Ecolene Non-Absorbable Synthetic

41 Monofilament, Polypropylene, 4/USP, 75
CM, CUTING 3/5 CIRCLE, 17 MM,
DOUBLE NEEDLE BOX @12PCS - 1 399647 399,647 1 399647
- -
Jumlah 188,901,302.00 982,450,159.04
 URANG 2022
KADALUARSA/RUSAK SALDO AKHIR 30 DESEMBER 2022
2021
HARGA HARGA NILAI
NILAI PERSEDIAAN NILAI PERSEDIAAN
VOLUME SATUAN VOLUME SATUAN PERSEDIAAN
(Rp) (Rp)
(Rp) (Rp) (Rp)
12 13 14 15 16 17 18

429,000.00 0 60 21450 1,287,000.00

- 0 - -
950,000.00 0 - 38,000 -
- 0 2 10500 21,000.00
5,624,370.00 0 237 9990 2,367,630.00
9,900,000.00 0 100 33000 3,300,000.00
93,600.00 0 - 23400 -
4,220,000.00 0 - 211 -
- 0 20 3498 69,960.00
7,900,200.00 0 16 207900 3,326,400.00
3,358,800.00 0 5,000 54 270,000.00
104,000.00 0 18 3250 58,500.00
621,600.00 0 3,400 111 377,400.00
12,500.00 0 10 1250 12,500.00
3,000,000.00 0 20 150000 3,000,000.00
152,000.00 0 - 1520 -
1,680,000.00 0 - 28000 -
2,279,676.00 0 - 27139 -
- 0 - -
205,860.00 0 20 3431 68,620.00
26,000.00 0 1,490 2600 3,874,000.00
2,720,000.00 0 20,000 68 1,360,000.00
750,000.00 0 10,000 75 750,000.00
1,500,000.00 0 5,000 50 250,000.00
785,845.00 0 585 2153 1,259,505.00
750,000.00 0 12,000 250 3,000,000.00
- 0 2 -
616,000.00 0 2 88000 176,000.00
61,050.00 0 - 20350 -
13,503,425.00 0 5 540137 2,700,685.00
- 0 - -
100,750.00 0 17 20150 342,550.00
 1,039,900.00 0 200 10399 2,079,800.00
- 0 - -
448,000.00 10 28000 280000 10 28,000 280,000.00
5,445,000.00 0 34 272,250 9,256,500.00
3,130,896.00 0 142 65227 9,262,234.00
- 500 93 46500 500 93 46,500.00
- 500 3090 1545000 500 3090 1,545,000.00
15,000.00 0 15 3000 45,000.00
7,770,000.00 0 20 77700 1,554,000.00
- 100 148 14800 100 148 14,800.00
403,200.00 0 208 2100 436,800.00
722,800.00 0 400 278 111,200.00
- 0 10 1399500 13,995,000.00
160,920.00 0 30 2682 80,460.00
133,650.00 0 - 891 -
116,560.00 0 19 3760 71,440.00
- 0 12,000 111 1,332,000.00
115,500.00 0 45,500 77 3,503,500.00
3,060,000.00 0 14,001 102 1,428,102.00
57,780.00 0 730 214 156,220.00
94,800.00 0 100 237 23,700.00
30,690.00 0 20 1023 20,460.00
316,800.00 0 18,800 264 4,963,200.00
10,921,230.00 0 305 15714 4,792,770.00
3,564,000.00 0 8,000 108 864,000.00
- 0 22 5700 125,400.00
3,298,780.00 0 98 17362 1,701,476.00
0 3,710 550 2,040,500.00
587,500.00 0 - 11750 -
875,000.00 0 - 87,500 -
97,412,490.00 0 - 198801 -
- 0 2 112,600 225,200.00
- 0 26 -
7,776,000.00 0 104 36000 3,744,000.00
1,392,000.00 0 1,100 1160 1,276,000.00
801,900.00 0 200 445.5 89,100.00
3,808,000.00 0 16 68000 1,088,000.00
18,000,000.00 0 3,000 3600 10,800,000.00
11,800.00 0 800 59 47,200.00
40,500.00 0 - 40500 -
- 0 1 -
1,597,750.00 0 22 29050 639,100.00
32,100.00 0 6 16050 96,300.00
322,000.00 0 - 322 -
 1,343,000.00 0 4,200 85 357,000.00
6,280,000.00 0 450 15700 7,065,000.00
136,000.00 0 1,000 68 68,000.00
- 0 - 150 -
20,000.00 0 14,300 200 2,860,000.00
- 0 350 28374 9,930,900.00
11,160,000.00 0 500 11,160 5,580,000.00
30,940,000.00 0 1,500 23,800 35,700,000.00
- 0 10 29,050 290,500.00
447,630.00 0 5,590 43 240,370.00
9,900.00 0 50 198 9,900.00
155,350.00 0 50 1195 59,750.00
132,500.00 0 110 2650 291,500.00
551,000.00 0 20 55,100 1,102,000.00
- 0 - -
- 0 - -
563,760.00 0 - 23,490 -
2,648,640.00 0 5 88,288 441,440.00
6,867,000.00 0 - 152,600 -
781,600.00 0 5 19,540 97,700.00
71,235.00 0 5 1,583 7,915.00
46,950.00 0 20 1,565 31,300.00
1,255,000.00 0 630 1,255 790,650.00
2,480,000.00 0 2,820 1,240 3,496,800.00
22,200.00 0 80 1,110 88,800.00
730,400.00 0 1,130 913 1,031,690.00
380,000.00 0- 150 1,900 - 285,000.00
8,672,400.00 0 20 144,540 2,890,800.00
4,641,960.00 0 30 77,366 2,320,980.00
309,180.00 0 20 15,459 309,180.00
- 0 - -
25,000.00 0 3 12,500 37,500.00
141,020.00 0 15 28,204 423,060.00
437,866.24 0 - 218,933 -
3,156,885.15 0 - 1,052,295 -
- 0 - -
- 0 - -
- 0 - -
- 0 - -
- 0 - -
- 0 - -
- 0 - -
141,900.00 0 - 473 -
270,000.00 0 50 600 30,000.00
 8,050.00 0 - 70 -
10,800.00 0 - 108 -
139,050.00 0 10 1,545 15,450.00
- 0 - 51,000 -
18,200.00 0 - 182 -
- 0 - 545 -
130,900.00 0 10 1,190 11,900.00
972,000.00 0 20 5,400 108,000.00
- 0 - 123 -
1,845,000.00 0 1,000 12,300 12,300,000.00
910,000.00 0 500 9,100 4,550,000.00
4,137,056.00 0 - 517,132 -
872,482.00 0 3 436,241 1,308,723.00
875,390.00 0 5 437,695 2,188,475.00
2,047,305.00 0 - 409,461 -
- 0 - -
- 0 - -
545,600.00 0 125 6820 852,500.00
41,900,000.00 0 7,640 8380 64,023,200.00
721,509.12 0 22 90188.64 1,984,150.08
- 0 4 222000 888,000.00
6,506,000.00 0 1,000 16265 16,265,000.00
37,236,000.00 0 150 124120 18,618,000.00
702,194.04 0 - 58516.17 -
1,100,000.00 0 30 55000 1,650,000.00
2,150,500.00 0 - 1075250 -
1,075,250.00 0 - 1075250 -
4,698,000.00 0 200 52200 10,440,000.00
58,000.00 0 10 5800 58,000.00
357,450.00 0 150 7149 1,072,350.00
392,000.00 0 30 5600 168,000.00
364,000.00 0 35 5600 196,000.00
106,500.00 0 35 7100 248,500.00
1,775,000.00 0 370 7100 2,627,000.00
- 0 50 7100 355,000.00
- 0 65 7100 461,500.00
463,980.00 0 - 23199 -
463,980.00 0 - 23199 -
463,980.00 0 - 23199 -
11,540.00 0 96 2885 276,960.00
1,476,200.00 0 70 147620 10,333,400.00
2,657,160.00 0 72 147620 10,628,640.00
46,000.00 0 - 4600 -
- 0 1 104500 104,500.00
 1,868,570.00 0 40 186857 7,474,280.00
- 0 2 205543 411,086.00
- 0 2 205543 411,086.00
69,396.00 0 2 23132 46,264.00
160,000.00 0 23 1600 36,800.00
168,000,000.00 0 300 48000 14,400,000.00
135,000,000.00 0 300 54000 16,200,000.00
- 0 615 46494 28,593,810.00
- 0 420 46491 19,526,220.00
1,356,300.00 0 - 678150 -
1,356,300.00 0 - 678150 -

624,324.00 0 - 312162 -

799,294.00 0 - 399,647 -

399,647.00 0 - 399647 -

746,536,505.55 1886300 429,707,241.08

 Sesuai Bukti Keterangan
Pesawat Pulang Nota Bensin Berangkat Nota Bensin Pulang Nama Travel (mohon diisi
Kode Nama Travel Plat Nomor keterangan
Kode Basic / Harga Travel (Nilai)
Travel (Nilai) Taxi Tol
Penyebera
Lainnya Mobil (bila
Pemesanan No. TN e-ticket / PO TN Boarding Booking di Tanggal SPBU (Kode Jenis Harga (Berangk (Berang ngan Kapal tambahan - atau
Rute Maskapai Booking di Class Tanggal Published Nilai Tangg SPBU Jenis di (Pulang ) (Pulang) ada)
Via Penerbangan Number Pass Boarding & Jam SPBU, Kota) BBM di struk at) kat) Feri informasi lainnya)
Tiket Fare al Struk
Pass
100,000

100,000

160,000

160,000

160,000

160,000

200,000

200,000

280,000

100,000

100,000

160,000

160,000

160,000

160,000

200,000

200,000

280,000

100,000

100,000
160,000

160,000

160,000

160,000

200,000

200,000

280,000

100,000

100,000

160,000

160,000

160,000

160,000

200,000

200,000

280,000

100,000

100,000

160,000

160,000

160,000
 160,000

200,000

200,000

280,000

7,600,000