LAPORAN PUSKESMAS TINOMBO

Lampiran Berita Acara Stock Opname OKTOBER 2017

* Sumber Dana DAK/DAU (Pelayanan Kesehatan Dasar) Tahun 2015
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER
NO NAMA OBAT JUMLAH PENGELUARA
SATUAN HARGA VOLUME PENERIMAAN JUMLAH HARGA JUMLAH HARGA
HARGA N
1 Propanolol tablet 10 mg (HCl) tablet 80 900 72,000 200 16,000 400 32,000
2 Ranitidin tablet 150 mg ktk/100 tab 132 -

Anti Bakteri DOEN salep kombinasi :

3 pot 2,767 346 957,382 95 262,865
Basitrasin 500 IU/g + Polimiksin 10.000 UI/g

4 Aminophylin inj ampul 4,204 108 454,032 -

5 Aminophylin tab Botol/100 tablet 86 100 8,600
6 Amitriphyline Ktk/100 tab 123 2,300 282,900
7 Allergen ktk/200 tablet 109 - -
8 Burnazin (silver sulphadiazin) Tube 25,350 - -
9 Deksametason injeksi i.v./i.m. 5 mg/ml ampul 1,738 811 1,409,518 511 888,118
10 Dopamet (methyldopa) ktt/100 tab 880 -
11 Glibenklamid tabet 5 mg tablet 61 - -
12 Haloperidol tablet 5 mg tablet 105 160 16,800 200 21,000 160 16,800
13 Haloperidol tablet 1,5 mg tablet 76 296 22,496 -
14 Zinc tablet dispersible 20 mg tablet 521 -
15 Isosorbid Dinitrat tablet sublingual 5 mg tablet 98 - -
17 Loperamid tablet 2 mg tablet 97 110 10,670 110 10,670

18 Cefadroksil sirup kering kering 125 mg/5 ml botol 5,286 73 385,878 73 385,878

19 Cefadroksil kapsul/kaplet 500 mg kapsul 548 -

20 Furosemid tablet 40 mg tablet 98 - -

Kotrimoksazol suspensi komb :
21 Sulfametoksazol 200 mg + Trimetoprim 40 botol 2,298 - -
mg / 5ml
22 Pirantel suspensi 125 mg/5 ml botol 9,100 2 18,200 -
23 Pirantel tablet ktk/100 tablel 318 -

24 Tetrasiklin kapsul/kaplet 250 mg kapsul 162 -

25 Tetrasiklin kapsul/kaplet 500 mg kapsul 325 40 13,000 40 13,000

26 Metronidazol tablet 500 mg tablet 169 - -

27 Bedak salisil serbuk 2 % pot 1,350 -
28 Benodon (methydopa)250mg Ktk/10 vial 13,198 234 3,088,332
29 Asam askorbat (vitamin C) tablet 50 mg tablet 105 -
30 Griseofulvin tablet 125 mg tablet 230 150 34,500 - 30 6,900
Antimalaria DOEN kombinasi : Pirimetamin
31 tablet 572 -
25 mg + Sulfadoksin 500 mg
Antimigren : Ergotamin Tartrat 1 mg + Kofein
32 tablet 149 - -
50
33 Asiklovir tablet 400 mg tablet 362 210 76,020
34 Betametason krim 0,1% (sebagai valerat) tube 1,596 -
35 Ketokonazol krim 2 % tube 2,697 -
36 Klonidin tablet 0,15 mg tablet 193 1,400 270,200 600 115,800 -
37 Metilergometrin Maleat tab salut 0,125 mg tablet 169 2,300 388,700 100 16,900 -
38 Salbutamol tablet 4 mg (sebagai sulfat) tablet 93 100 9,300 -
39 Sidiadril (Diphenhydramine)inj vial 1,560 36 56,160 25 39,000
40 Mikonazol krim/salep 2 % (Nitrat) tube 3,150 77 242,550 23 72,450 -
41 Vitamin B kompleks tablet ktk/100 tab 112 -
42 Retinol (vitamin A) 100.000 UI kapsul lunak kapsul 286 -
43 Diazepam inj Ampul 11.44 5 57
44 Diltiazem 30mg Tablet 129.00 300 38,700 300 38,700
45 -
46 Alopurinol tablet 100 mg ktk/100 tab 90 -
47 Amlodipin tablet 5 mg ktk/30 tablet 197 -
48 Cetirizin tablet 10 mg tablet 190 -
49 Alprazolam tablet 0,5 mg tablet 185 -
50 Amoksisilin tablet scored 500 mg tablet 279 -
51 Haloperidol tablet 2 mg ( lodomer ) tablet 134 600 80,400
52 Metilprednisolon tablet 4 mg tablet 230 - -
53 Ranitidin Injeksi 25 mg/2ml ampul 1,340 -
54 Cefotaxime injeksi 1 g vial 12,080 142 1,715,360 -
55 Ceftriaxone injeksi vial 3,900 74 288,600 -
56 Simvastatin scored tablet 10 mg ktk/100 tablet 177 -
Antasida DOEN II suspensi, kombinasi :
57 Aluminium Hidroksida 200 mg/5ml + Btl 60 ml 2,300 -
Magnesium Hidroksida 200 mg/5 ml
58 Difenhidramin injeksi i.m. 10 mg/ml ampul 1,160 618 716,880 -
59 Epinefrin (adrenalin) injeksi 1 mg/ml ampul 8,910 79 703,890
Garam Oralit I serbuk, kombinasi : Natrium klorida
60 0,52 g kalium klorida 0,30 g Trinatrium sitrat sachet 317 107 33,919 - -
dihidrat 0,58 g Glukosa Anhidrat 2,70 g
61 Kaptopril tablet scored 25 mg tablet 97 -
62 Nifedipine tablet 123 -
63 Novabion kapsul 349 -
64 Novadium tablet 247 -
65 Natrium Diklofenak tablet 50 mg tablet 193 -
66 Nistatin tablet salut 500.000 UI/g tablet 704 -
67 Novadiar Sirup Btl 60 ml 6,875 -
68 Novakid Sirup Btl 60 ml 10,900 -
69 Digoksin tablet 0,25 mg tablet 103 1,200 123,600 100 10,300 100 10,300
70 Fitomenadion (vit.K1) tablet salut gula 10 mg tablet 697 330 230,010 100 69,700
71 Amoksisillin sirup kering 125 mg/5 ml botol 2,560 -
72 Domperidone tablet 10 mg tablet 174 - - -

74 Ibuprofen tablet 400 mg tablet 157 -

75 Ketokonazol tablet 200 mg tablet 269 650 174,850 200 53,800 100 26,900

76 Omeprazol kapsul/kaplet 20 mg kapsul 221 -

77 Parasetamol sirup 120 mg/5 ml botol 1,535 -

78 Bisoprolol tablet 5 mg tablet 695 -

79 Asam Mefenamat kapsul/kaplet 500 mg tablet 127 -
80 Deksametason tablet 0,5 mg tablet 68 -
 Kotrimoksazol DOEN I (Dewasa) Kombinasi :
81 Sulfametoksazol 400 mg + Trimetoprim 80 ktk/100 tablet 152 1,470 223,440 -
mg
82 Loratadin tablet 10 mg tablet 170 2,100 357,000 2,050 348,500
83 Parasetamol tablet Ktk/100 tablet 88 -
Antasida DOEN I Tablet kunyah, kombinasi :
84 Aluminium Hidroksida 200 mg + Magnesium ktk/100 tablet 78 -
Hidroksida 200 mg

Kombinasi tablet salut : Besi (II) sulfat 7H2O

85 ktk/100 sachet 45 -
200 mg Asam folat 0,25 mg

86 Albendazol tablet 400 mg 30 Tab/blister/strip 407 -

87 Ambroxol tablet 30 mg ktk/100 tablet 1,949 -
Anti Scabies cream 10 g Kombinasi :
88 Tube 10 gram 31,350 -
Gameksan + As Usnat
89 Aqua Pro Injeksi Steril, bebas pirogen 10 vial @20 ml/kotak 2,200 4 8,800 -
90 Aqua Pro Injeksi Steril, bebas pirogen (25ml) Vial/25 ML 2,200 -
91 Asiklovir krim 5 % tube 5 gram 3,150 -
92 Atropin Sulfat tablet ktk /100 tablet 8,100 -
93 Calcii Gluconas injek ktk / 24 Ampul 15,000 112 1,680,000 -
94 Ciprofloxacine 500 mg ktk / 100 tablet 290 -
95 Clorfeniramina maleat (CTM)tablet 4mg 1000 Tablet/Botol 9.08 -
96 Diazepam tablet 2 mg ktk / 100 tablet 47 -
97 Doksisiklin kapsul 100 mg ktk /100 kapsul 298 -
98 -
99 Fenobarbital tablet 30 mg ktk/100 tablet 35 -
100 Fitomenadion (Vit. K1) injeksi 10 mg/ml 30 ampul / kotak 3,754 - - -
101 Gentamycin Salep Kulit tube 5 gram 2,035 -
102 Gentamycin Tetes Mata 0,3 % Btl 5 ml 3,513 -
103 Gentian Violet Larutan 1 % Botol 10 ml 2,990 48 143,520 4 11,960
104 Gliseril Gualakolat tablet 100 mg 1000 tablet / botol 31 -
105 Hidroklorotiazida tablet 25 mg ktk / 100 tablet 52 -
106 Hidrokortison krim 2,5% 24 tube @ 5 g / kotak 2,938 -
107 Hyoscine -N- Butilbromide tablet 10 mg ktk / 100 tablet 1,225 -
108 Itrakonazol kapsul 100 mg ktk / 30 kapsul 4,400 570 2,508,000 570 2,508,000
109 Kalsium Laktat (Kalk) tablet 500 mg Novakal ktk/100 tablet 76 -
110 Kloramfenikol suspensi botol 60 ml 4,949 67 331,583 9 44,541 48 237,552
111 Novachlor 250 mg kapsul ktk / 100 kapsul 553 900 497,790 90 49,779
112 Erlamycetin 1 % botol 5 ml 4,600 -
113 Kloramfenikol salep mata 1 % tube 5 gram 1,680 -
114 klorfeniramin maleat (CTM) tablet 4 mg ktk / 100 tablet 908 -
115 Klorpromazin tablet salut 25 mg 1000 tablet / botol 418 -
Lidokain injeksi 2% (HCL) + Epinefrin 1 :
116 ktk / 100 amp @ 2 ml 1,350 120 162,000 -
80.000 - 2 ml
117 Magnesium Sulfat 20% - 25 ml ktk / 10 vial 4,510 24 108,240 - -
118 Magnesium Sulfat 40% - 25 ml ktk / 10 vial 5,500 35 192,500
119 Meloksikam tab 7,5 mg ktk / 50 tablet 761 -
120 Metampiron injeksi 250 mg (Antalgin) ktk / 30 ampul @ 2 ml 1,333 -
121 Metampiron tablet 500 mg ktk / 100 tablet 232 -
122 Metformin HCl tablet 500 mg ktk / 100 tablet 125 - -
123 Metilergometrin Maleat injeksi 0,200 mg -1 ml 100 ampul / kotak 2,750 605 1,663,750 - -
124 Metoklopramide tablet 10 mg ktk / 100 tablet 110 -
125 Nistatin Vaginal tablet salut 100.000 IU/g ktk / 100 tablet Vaginal 528 70 36,960 -
126 Obat Batuk hitam ( O.B.H.) Botol 100 ml 2,435 -
127 Oksitetrasiklin HCl salep kulit 3 % tube 5 gram 1,650 -
128 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml 10 vial / kotak 7,700 54 415,800
129 Oksitosin injeksi 10 UI/ml-1 ml 100 ampul / kotak 1,900 14,246 27,067,400 -
130 Papaverin tablet 40 mg 1000 tablet / botol 155 11,510 1,786,467 -
131 Pehacain inj ktk/20 ampul 3,079 213 655,827 - -
132 Phenobarbital inj ktk/30 ampul 1,980 146 289,080 - -
133 Piridoksin (Vitamin B6) tablet 10 mg (HCL) 1000 tablet / botol 20 -
134 Piroksikam tab 10 mg ktk / 100 kapsul 116 -
136 Prednison tablet 5 mg ktk / 100 tablet 125 - - -
137 Prednison tablet 5 mg Botol / 1000 tablet -
138 Propiltiourasil tablet 100 mg Ktk / 100 tablet 351 800 280,800 -

139 Retinol (Vitamin A) 200.000 IU Kapsul Lunak btl / 50 Kapsul 505 -

Salep 2-4,Kombinasi:AsamSalisilat 2 % +
140 Ktk / 24 Pot @ 30g 2,200 -
Belerangendap 4 %
141 Sianokobalamin (vit. B 12) tab 500 mcg ktk/100 tablet 63 -
142 Sianokobalamin (vit. B 12) injeksi 500 mcg Ktk 100 amp@1 ml 63 1,586 99,918 319 20,097
143 Scopma Plus Ktk/100 tablet 1,348 -
144 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) 1000 tablet / botol 586 - - -
145 Tiamin (vitamin B1) injeksi 100 mg/ml ktk / 100 amp @ 1 ml 1,320 4 5,280
146 BAHAN HABIS PAKAI -
147 Abbocath (IV Catheter) no 18 G setara B'Brau ktk / 50 pcs 4,959 12 59,508 8 39,672
148 Abbocath (IV Catheter) no 20 G setara B'Brau ktk / 50 pcs 4,959 -
149 Abbocath (IV Catheter) no 22 G setara B'Brau ktk / 50 pcs 4,959 -
150 Abbocath (IV Catheter) no 24 G setara B'Bra ktk / 50 pcs 4,959 -
151 Alat suntik sekali pakai 0,05 ml 100 set / kotak 3,453 170 587,010
152 Alat suntik sekali pakai 0,5 ml 100 set / kotak 2,895 199 576,105 99 286,605
153 Alat suntik sekali pakai 1 ml 100 set / kotak 848 300 254,475 - -
154 Alat suntik sekali pakai 2,5 ml 100 set / kotak 1,425 314 447,450 -
155 Alat suntik sekali pakai 3 ml 100 set / kotak 1,425 302 430,350 -
156 Alat suntik sekali pakai 5 ml 100 set / kotak 979 376 368,010 9 8,809
157 Alat suntik sekali pakai 10 ml 100 set / kotak 1,207 147 177,429 - 13 15,691
158 Alkohol Swabs ktk/100 sachet 131 3,936 513,648 400 52,200
Catgut /Benang Bedah Chromic No.2/0 dg
159 kotak / 24 pcs 1,221 -
jarum
160 Catgut /Benang Bedah plain No.2/0 dg jarum kotak / 24 pcs 1,221 -
161 Catgut/Benang Bedah plain No.3/0 dg jarum kotak / 24 pcs 1,125 -
Catgut/Benang Bedah Chromic No.3/0 dg
162 kotak / 24 pcs 1,125 -
jarum
163 Catheter 20 pcs 8,352 14 116,928
164 Catheter 18,13-G-olig pcs 8,352 9 75,168
165 Catheter 18 15-G-10-G pcs 8,352 6 50,112
166 Foley Catheter no. 16 pcs 8,352 -
167 Fixomull stretch 15cmX5M Roll -
168 Dermafix 5 x 7 cm ktk / 25 pcs 887 3 2,662
169 Disposible Masker Elastik 3 ply green ktk / 20 pcs 1,238 -
170 Dispposable Needle no.18GX 1 1/2 pcs -
171 Etakridin larutan 0,1% (Rivanol) Botol 300 ml 3,328 - - -
172 Etanol 70% 100ml (Alkohol) botol 2,625 -
173 Gloves surgical No. 8 50 pasang / kotak 6,325 -
174 Povidon Iodida Larutan 10 % 300ml botol 15,386 55 846,230 35 538,510
175 Pipet tetes panjang Pcs 10,980.00 -
176 Kertas saring Roll 9,900.00 -
177 Infusion set anak Set / kantong 4,400 352 1,548,800 350 1,540,000
178 Infusion set dewasa Set / kantong 4,176 218 910,368 -
179 Pembalut elastis 10 cm X 4,55M Roll 35,750 4 143,000 1 35,750 -
180 Kapas Pembalut / Absorben 250 gram Bungkus 16,313 -
181 Kasa Kompres 16 x 16 steril (isi 16 lembar) ktk 7,569 4 30,276 -
182 Kasa hidrofil 4MX10CM (one med) Roll 287 10 2,870 -
183 Kasa Pembalut 40 m x 80 cm Roll 137,025 3 411,075 -
184 Plester 5 yards x 2 inch Roll 32,426 -
Silk (Benang Bedah Sutera) No. 3/0 dengan
185 12 x 3 x 75 cm / kotak 7,685 -
jarum bedah
186 Aplicators set -
187 Bonding set 1,110,500 -
188 Caviton set 282,000 -
189 Cresopate (Filling of Root Canals) set 500,000 -
190 Devitalisasi Pasta Non Arsen btl/ktk 429,000 -
191 Etil Klorida spray Vial / Can / 100 ml 115,200 1 115,200 - -
192 ETSA set 359,000 -
193 Glass Ionomer Cement ART Set / botol 874,000 -
194 Kalsium Hidroksida Pasta 2 tube / kotak 200,000 -
195 Glukosa larutan infus 5 % steril botol 5,720 161 920,920 153 875,160
196 NaCL 0,9 % botol 5,720 68 388,960 - -
197 Klorfenol kamfer Menthol ( CHKM ) Botol 10 ml 60,000 -
198 LC (Light Curing) A2 - A3 set 450,000 -
199 Lisol, mengandung kresol tersabun 50 % botol 1000 ml 53,505 - -
200 Surgical Blade No.11 pcs/ktk 100 1,500 68 102,000 39 58,500
201 Surgical Blade No.10 pcs/ktk 100 1,500 100 150,000
202 Surgical Blade No.15 pcs/ktk 100 1,500 94 141,000 -
203 Mummifying Pasta Botol / kotak 450,000 -
204 Microscape pcs 72 -
205 OCO botol 250,000 -
206 Semen Seng Fosfat serbuk dan cairan Set @ 30 gram / btl 250,000 -
207 Terumo Neode No.22G x 1 1/2 pcs 550 -
Temporary Stopping Fletcher (Fletcher)
208 Set @ 100 gram / btl 37,400 -
serbuk dan cairan
209 Handscoen no .7,5 50 pasang / kotak 6,325 -
210 Plester 5 5cm x 4,5 m Roll 32,426 - -
211 H2O2,0,3-0,5% Botol/100 ml 29,800 -
212 Lar.oil Emersi Botol/100 ml 164,535 -
213 Lar.Hydrogen peroxide 3% Botol -
214 lar. HCl 0,1 N Botol -
215 Dekstran 70-larutan infus 6% steril Botol 500 ml 8,908 -
216 Povidon Iodida larutan 10% 60ml Botol 5,500 15 82,500 - -
217 Urine bag Buah 3,915 146 571,590
218 Tes Uric Acid Botol/25 strip 7,500 -
219 Tes Glucosa Botol/25 strip 6,800 -
220 Umbilcal cord klem buah -
221 Mask pcs 431 343 147,833 - -
222 Ringer Laktat larutan infus botol 5,720 153 875,160 - -
Jumlah 61,484,295 386,541 8,391,866

Mengetahui Yang Membuat Berita Acara

Kepala Puskesmas Tinombo Pengelola Obat

Aswini Dimple,SKM Meiske Tamedia A.Md.Far

Nip.19791104 200212 2 002
 SISA STOK 31 OKTOBER 2017

VOLUME JUMLAH HARGA

700 56,000
-

251 694,517

108 454,032
100 8,600
2,300 282,900
-
- -
300 521,400
-
- -
200 21,000
296 22,496

- -
- -

- -

- -

2 18,200
 -

- -

-
234 3,088,332
-
120 27,600

210 76,020
-
-
2,000 386,000
2,400 405,600
100 9,300
11 17,160
100 315,000

5 57
- -
-
-
-
-
-
-
600 80,400
- -
 -
142 1,715,360
74 288,600
-
-
618 716,880
79 703,890

107 33,919

-
-
-
-
-
-
-
-
1,200 123,600
230 160,310
-
- -

750 201,750

-
-
-
1,470 223,440

50 8,500
-

-
-
-
4 8,800
-
-
-
112 1,680,000
-
-
-
-
-
-
- -
-
-
44 131,560
-
-
-
-
- -
-
 28 138,572
810 448,011
-
-
-
-

120 162,000

24 108,240
35 192,500
-
-
-
- -
605 1,663,750
-
70 36,960
-
-
54 415,800
14,246 27,067,400
11,510 1,786,467
213 655,827
146 289,080
-
-
- -
-
800 280,800

-
 -
1,267 79,821
-
- -
4 5,280
-
4 19,836
-
-
-
170 587,010
100 289,500
300 254,475
314 447,450
302 430,350
367 359,201
134 161,738
3,536 461,448

-
-

14 116,928
9 75,168
6 50,112
-
-
3 2,662
-
-
- -
 -
-
20 307,720
-
-
2 8,800
218 910,368
5 178,750
-
4 30,276
10 2,870
3 411,075
-

-
-
-
-
-
1 115,200
-
-
-
8 45,760
68 388,960
-
-
- -
29 43,500
100 150,000
94 141,000
 -
72 -
-
-
-

-
- -
-

15 82,500
146 571,590

343 147,833
153 875,160
53,478,971

Acara

Md.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stok Opname OKTOBER 2017
*. Sumber Dana JKN (Obat JKN Dinas Kesehatan) Tahun 2015
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER
NO NAMA OBAT/BHP JUMLAH JUMLAH
SATUAN HARGA VOLUME PENERIMAAN
HARGA HARGA
1 Asam Mefenamat Tablet 127 -
2 Amlodipin tablet 5 mg Tablet 197 -
3 Cefadroksil sirup kering 125 mg/5 ml Botol 5,286 -
4 Cefadroksil 500 mg Kapsul 548 -
5 Ibuprofen tablet 400 mg Tablet 157 -
6 Siobion Kapsul Kapsul -
Garam Oralit I serbuk, kombinasi : natrium 0,52 g, kalium
klorida 0,30 g, trinatrium sitrat dihidrat 0,58 g, glukosa Sachet
7 anhidrat 2,7 g 317 -
8 Kaptopril tablet 25 mg Tablet 97 -
9 Fitomenadion (vit.K1) tablet salut gula 10 mg Tablet 697 -
10 Ketokonazol krim 2 % Tube 2,697 -
11 Ketokonazol tablet 200 mg Tablet 320 380 121,600
12 Kloramfenikol kapsul/kaplet 250 mg Kapsul 270 -
Kotrimoksazol DOEN I (dewasa) kombinasi
Tablet
13 Sulfametoksazol 400 mg,Trimetoprim 80 mg 152 -
Kotrimoksazol suspensi kombinasi Sulfametoksazol 200
Botol
14 mg,Trimetoprim 40 mg 2,298 -

15 Metilprednisolon tablet 4 mg Tablet 230 -

16 Natrium diklofenak tablet 50 mg Tablet 193 -
17 Prednison tablet 5 mg Tablet 125 -
18 Ranitidin tablet 150 mg Tablet 132 -
19 Vitabiol sirup Botol 12500 -
20 Vitamin B Komplex Tablet 112 -
21 Scabimite cream Tube 55990 44 2,463,560
22 Hidrokortison krim 2,5 % Tube 2,938 -
23 Miconazole salep Tube 3,150 -
24 Reco salep mata Tube 12500 -
25 Povidon Iodida larutan 10 % 60ml Botol 15,386 -
26 Vitamin B 12 Tablet Tablet 63 -
27 Metro 500mg Tablet 169 970 163,930
28 Alat suntik sekali pakai 2,5 ml Pcs 1425 0 -
Jumlah 2,749,090

Mengetahui, Yang Membuat Berit

Kepala Puskesmas Pengelolah Ob

Aswini Dimple,SKM Meiske Tamedia,A.

Nip.19791104 200212 2 002
TINOMBO
ame OKTOBER 2017
s Kesehatan) Tahun 2015
PENGELUARAN OKTOBER SISA STOK 31 OKTOBER 2017
JUMLAH
PENGELUARAAN VOLUME JUMLAH HARGA
HARGA

- -
-
-
- -
130 41,600 250 80,000
-

-
-
-
-
-
-
44 2,463,560 -
 -
-
-
-
-
790 133,510 180 30,420
-
2,638,670 110,420

Yang Membuat Berita Acara

Pengelolah Obat

Meiske Tamedia,A.Md.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
*. Sumber Dana ( JAMKESDA Ta. 2015) Puskesmas Tinombo
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER SISA STOK 31 OKTOBER 2017
NO NAMA OBAT/BHP JUMLAH JUMLAH JUMLAH
SATUAN HARGA VOLUME PENERIMAAN PENGELUARAAN VOLUME JUMLAH HARGA
HARGA HARGA HARGA

Tablet
1 Amoksisilin kapsul/kaplet 500 mg 228 -
2 Ambroxol 30 mg Tablet 195 -
3 Aloprinol 100 mg Tablet 90 -
4 Asammefenamat 500mg Tablet 127 -
5 Glukosa 500 ml Botol 5,720 -
6 Paracetamol 500 mg 100 TAB Tablet 88 -
7 Scabimite 10 mg Tube 11,475 105 1,204,875 38 436,050 67 768,825
8 Tetrakain tetes mata Botol 11,500 - -
9 Captopril tablet 25 mg Botol 94 - -
10 Novabion Kapsul 344 - -
11 Dexametasone 0,5 100 tab Tablet 68 - -
12 Metronidazole 500 mg Tablet 169 - -
13 Brondisal 2 mg Kapsul 277 - -
14 Hexon 8 mg Sachet 231 - -
15 Calsium Laktac ( @ 500 Tablet) Tablet 82 - -
16 Neorotropic Plus Tablet 893 -
17 Vitamin B 12 1000 tab Tablet 319 - -
18 Metampiron tablet 500 mg Kapsul 122 - -
19 Chlorpeniramine 4 mg Tablet 38 - -
20 Hemafort kapsul Botol 726 - -
21 Hexon sirup Tablet 12,320 - -
22 Resovit sirup Tablet 77,000 - -
23 Mytaderm salep Tablet 8,932 - -
24 Ambroxol sirup Tablet 5,150 - -
25 Novatusin sirup Botol 6,110 - -
26 Sianocobalamin tab 1000 Tablet 38 - -
27 Asam Traneksamat inj 250/gr ampul 6,930 60 415,800 30 207,900 90 623,700
28 Pitogin inj Tube 7,550 -
29 Reco salep mata Tube 6,160 -
30 Scabies salep Tube 35,000 -
31 Recovit plus Tube 700 -
32 Abocath no.18 Botol 7,955 -
33 Abocath no.20 Tablet 7,955 -
34 Abocath no.22 Tablet 7,955 -
35 Abocath no.24 Pcs 7,955 -
36 Hanscun no 6,5 Pcs 10,500 -
37 Kertas puyer pack 20,500 -
38 Asamtreneksamat 200 mg Tablet 1,560 -
39 Cefad capsul Tablet 1,311 -
40 Metapiron Injeksi kotak 10 vial 175 -
41 Dipenhidramint Injeksi pial 15,600 -
42 Multi vitamin tambah Darah Kapsul 950
43 Hyoscine-N-bromide Tablet 2,700 -
44 Vastarel Tablet 950 -
45 simitin Tablet 421 -
46 Metilprednizolon Tablet 550 -
47 Plester /isopas Roll 56,100 -
48 Bisturi kotak 100 pcs Pcs 1,500 -
49 Steril Gula Darah Strip 170 -
50 Asam Urat 25 strip Strip 187,510 -
51 Infus Set Dewasa Pcs 11,200 -
52 Colesterol Strip 270 -
53 Amoxilin Sirup Botol 2,650 -
54 Paracetamol Sirup Botol 1,535 -
55 Sabutamol cair Botol 7,260 -
56 CTM 1000 Tablet Tablet 565 -
57 Kaometasirup Botol 8,700 -
58 Neorotropic Plus Tablet 950 -
59 Trimertaporte Tablet 600 -
60 Intriboks Tablet 232 -
61 Miracik Plus Tablet 752 1,600 1,203,200 - 1,600 1,203,200
Jumlah 2,823,875 207,900 436,050 2,595,725

Mengetahui Yang Membuat Berita Acara

Kepala Puskesmas Pengelola Obat
 Aswini Dimple,SKM Meiske Tamedia, A.Md.Far
Nip.19791104 200212 2002
OK !!
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
*. Sumber Dana JKN ( Obat JKN Puskesmas Tinombo ) Tahun 2014

SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER

NO NAMA OBAT/BHP JUMLAH JUMLAH JUMLAH
SATUAN HARGA VOLUME VOLUME PENGELUARAN
HARGA HARGA HARGA

1 Amoksisilin kapsul/kaplet 500 mg Tablet 525 -

2 Asam Mefenamat 500 mg Tablet 250 -
3 Allergen Tablet 109 - -
4 Asam Traneksamat Inj.250 gr Ampul 6,300 -
5 Aqua Pro Injeksi ( 1 Vial/50 gr) Botol 15,750 -
6 Brondisal 2 mg Tablet 252 -
7 Cotrimoxazole 480 mg Tablet 235 -
8 Cotrimokazole Supenses Botol 2,298 -
9 Cimetidine Tablet 163 -
10 Chlorpeniramine 4 mg (ctm)1000 Tablet 34 -
11 Calsium Laktat 1000 tab tablet 73 1,500 109,500 1,500 109,500
12 Chroramphenicol 250 mg kapsul 245 1,000 245,000 1,000 245,000
13 Dexametason 0,5 mg Tablet 44 -
14 Gricin Tablet 340 1,040 353,974 200 68,072
15 Ibuprofen 400 mg Tablet 291 -
16 Metronidazole 500 mg tablet 312 -
17 Novason 200 mg Tablet 114,873 -
18 Novatrim 960 mg Tablet 435 -
19 Novaxicam 20 mg kapsul 286 -
20 Novachlor kapsul 503 -
21 Novamaag Tablet 2,950 -
22 Novagesik 500 mg tablet 218 -
23 Novagesik Forte 650 mg Tablet 327 -
24 Novamox 500 mg Tablet 1,050 - -
25 Nufopec Tablet ### -
26 Novastan 500 mg Tablet ### -
27 Novadex 0,5 mg Tablet 163 -
28 Novabiotic 500 mg kapsul 648 -
29 Neorotropic Plus Tablet 812 -
30 Vastarel Tablet -
31 Vadrol Tablet 1,091 -
32 Livitan Sirup Botol 7,727 -
33 Domperidan Sirup Botol 17,955 -
34 Novagesik Sirup Botol 7,613 -
35 Novamox Sirup Botol 9,000 -
36 Ambroxol Sirup Botol 4,682 -
37 Novacabalamine 50 mg Tablet 31,909 -
38 Novaxifem sirup Botol 8,182 -
39 Novatusin Sirup Botol 5,555 -
40 Novatrim Sirup Botol 6,182 2 12,364
41 Chloramphenicol Sirup Botol 6,382 - -
42 Povidan iodida 30 ml Botol 3,405 -
43 Novadium Tablet 247 -
44 Vitamin B1 injeksi Ampul 4,200 -
45 Tes kehamilan one med pcs 3,110 -
46 Reco salep mata tube 5,600 -
47 Lidocain injeksi Ampul 7,000 -
48 Paracetamol 500 mg Tablet 46 -
49 Masker 3 ply pcs 1,237 -
50 Miconazole salep tube 5,700 -
51 ciproploxasin 500 mg Tablet 241 -
52 Handscun no.7.5 pcs 4,675 -
53 Thiamin 50 mg Tablet 85 -
54 Koameta syr Botol 8,700 -
55 Kasa steril 16 x 16 cm dos 5,909 -
Jumlah 720,838 422,572
Mengetahui Yang membuat Berita Acara
Kepala Puskesmas Pengelola Obat

Aswini Dimple,SKM Meiske Tamedia,A.Md.Far

Nip.19791104 200212 2 002
SISA STOK 31 OKTOBER 2017

VOLUME JUMLAH HARGA

- -

-
-
-
840 285,902

-
-
- -
2 12,364
-

298,266
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dari Dana DAU Tahun 2016 BHP Pelayanan UMUM
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER
NO NAMA OBAT/BHP
SATUAN HARGA VOLUME JUMLAH HARGA VOLUME VOLUME JUMLAH HARGA
JUMLAH HARGA
1 Steracath I.V Catheter no.18GX32 mm Pcs 4,370 40 174,800 -
2 Steracath I.V Catheter no.20GX1 1/4 mm Pcs 4,370 69 301,530 -
3 Steracath I.V Catheter no.22GX3/4 Pcs 4,370 80 349,600 17 74,290
4 Steracat I.V Catheter no.24GX3/4 Pcs 4,370 40 174,800 -
5 Strip Glucosa Strip 6,180 0 -
6 Strip Clolesterol Strip 25,450 0 -
7 Strip Asam Urat Strip 6,380 0 -
JUMLAH 1,000,730 74,290
Mengetahui Pengelola Obat Puske
Kepala Puskesmas

Aswini Dimple,SKM Meiske Tamedia

Nip.19791104 200212 2002
 SISA STOK 31 OKTOBER 2017
VOLUME JUMLAH HARGA

40 174,800
69 301,530
63 275,310
40 174,800
-
-
-
926,440
Pengelola Obat Puskesmas

Meiske Tamedia
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dana (Jamkesda Tahun 2016) Puskesmas Tinombo
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER
NO NAMA OBAT JUMLAH
SATUAN HARGA VOLUME JUMLAH HARGA PENERIMAAN JUMLAH HARGA PENGELUARAN
HARGA
1 Amoxillin 500mg ktk/100 tab 700 1,400 980,000 1,400 980,000
2 Asam Mefenamat 500mg ktk/100 tab 270 140 37,800 1,360 367,200 1,200 324,000
3 Asam Mefenamat 50mg/5ml Botol 10,000 16 160,000 -
4 Allopurinol 100mg ktk/100 tablet 230 - - -
5 Amlodipin 5mg ktk/100 tablet 1,047 230 240,872 230 240,872
6 Ambroxol 30mg ktk/100 tablet 300
7 Cefadroxil 500mg ktk/100 kapsul 1,100 550 605,000 550 605,000
8 Dexametasone 0,5mg ktk/100 tablet 140 200 28,000 200 28,000
9 Domperidone 5mg/5ml susp Botol 13,800 2 27,600 -
10 Methylprenisolone 4mg ktk/100 tablet 481 100 48,060 100 48,060
11 Meloxicam 7,5mg ktk/100 tablet 755 300 226,440 300 226,440
12 Natrium dictofenac 50mg ktk/100 tablet 237 2,000 474,940 2,000 474,940
13 Paracetamol 500mg ktk/100 tablet 150 5,600 840,000 2,300 345,000
14 Paracetamol sirup Botol 5,000 - -
15 Ranitidine 150mg ktk/100 kaplet 240 -
16 Ranitidine injeksi ktk/100 ampul 6,400 300 1,920,000
17 Simvastatin 10mg ktk/100 kaplet 1,865 - -
Jumlah 5,588,712 367,200 3,272,312

Mengetahui Yang Membuat Berita Acara

Kepala Puskesmas Tinombo Pengelola Obat
 Aswini Dimple,SKM Meiske Tamedia A.Md.Far
Nip 19791104 200212 2002
 SISA STOK 31 OKTOBER 2017

VOLUME JUMLAH HARGA

- -
300 81,000
16 160,000
- -
- -
- -
- -
- -
2 27,600
- -
- -
- -
3,300 495,000
- -
-
300 1,920,000
- -
2,683,600

Membuat Berita Acara

Pengelola Obat
ke Tamedia A.Md.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dana DAK/DAU (Pelayanan Kesehatan Dasar) Tahun 2016
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER SISA STOK 31 OKTOBE
NO NAMA OBAT JUMLAH
SATUAN HARGA VOLUME JUMLAH HARGA PENERIMAAN JUMLAH HARGA PENGELUARAN VOLUME
HARGA
1 Amoksisilin tablet scored 500 mg tablet 233 5,200 1,211,600 - 100 23,300 5,100
2 Alopurinol tablet 100 mg ktk/100 tab 90 500 45,000 3,000 270,000 1,490 134,100 2,010
3 Amlodipin tablet 5 mg ktk/30 tablet 105 4,160 436,800 1,850 194,250 2,310
4 Amlodipin tablet 10 mg ktk/30 tablet 163 2,310 376,530 910 148,330 1,400
Antimalaria DOEN kombinasi : Pirimetamin 25 mg + Sulfadoksin
5 tablet 572 - - -
500 mg
6 Antihemoroid,kombinasi supp 3,502 101 353,702 - 5 17,510 96
7 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 tablet 149 1,400 208,600 - 100 14,900 1,300
8 Asiklovir tablet/kapsul/kaplet 400 mg ktk/50 tab 381 50 19,050 - - 50
9 Asam askorbat (vitamin C) tablet 50 mg tablet 120 - - -
Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g +
10 pot 2,767 - - -
Polimiksin 10.000 UI/g
11 Allergen ktk/200 tablet 109 - - -
12 Acarbose 50mg ktk/100Tablet 657 2,700 1,773,900 - - 2,700
13 Alprazolam tablet 0,5 mg tablet 185 671 124,135 - 527 97,495 144
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida
14 Btl 60 ml 2,106 303 638,118 - 303 638,118 -
200 mg/5ml + Magnesium Hidroksida 200 mg/5 ml
Antasida DOEN I Tablet kunyah, kombinasi : Aluminium
15 ktk/100 tablet 64 300 19,200 - 300 19,200 -
Hidroksida 200 mg + Magnesium Hidroksida 200 mg
16 Asam traneksamat Tablet ktk/100 tablet 1,490 1,320 1,966,800 - - 1,320
17 Asam traneksamat Inj Box/10 Ampul 2,789 40 111,560 - - 40
18 Amoksisillin sirup kering 125 mg/5 ml botol 2,200 382 840,400 138 303,600 244
19 Asam Mefenamat kapsul/kaplet 500 mg tablet 127 1,000 127,000 - - 1,000
20 Albendazol tablet 400 mg 30 Tab/blister/strip 407 1,000 407,000 173 70,411 450 183,150 723
21 Ambroxol tablet 30 mg ktk/100 tablet 195 1,050 204,750 - 1,050 204,750 -
22 Anti Scabies cream 10 g Kombinasi : Gameksan + As Usnat Tube 10 gram 31,350 - - -
23 Aqua Pro Injeksi Steril, bebas pirogen 10 vial @20 ml/kotak 2,200 - - -
24 Asiklovir krim 5 % tube 5 gram 4,800 39 187,200 - 7 33,600 32
25 Atropin Sulfat tablet ktk /100 tablet 8,100 - - -
26 Bedak salisil serbuk 2 % pot 1,066 72 76,752 0 - 46 49,036 26
27 Benodon (methydopa)250mg Ktk/10 vial 13,198 - - -
28 Betametason krim 0,1% (sebagai valerat) tube 1,435 188 269,780 - 44 63,140 144
29 Betafort syr btl/60ml 31,900 - 100 3,190,000 36 1,148,400 64
30 Bisoprolol tablet 5 mg tablet 695 - - -
31 Cefadroksil sirup kering kering 125 mg/5 ml botol 5,286 250 1,321,500 6 31,716 31 163,866 225
32 Cefadroksil kapsul/kaplet 500 mg kapsul 548 200 109,600 60 32,880 - 260
33 Cetirizin tablet 10 mg tablet 154 50 7,700 - 50 7,700 -
34 Ceftriaxone injeksi vial 30,000 129 3,870,000 - - 129
35 Calcii Gluconas injek ktk / 24 Ampul 15,000 - - -
36 Calsium laktat ktk/100 tablet 69 50 3,450 30 2,070 20
37 Ciprofloxacine 500 mg ktk / 100 tablet 290 1,600 464,000 - 150 43,500 1,450
38 Clorfeniramina maleat (CTM)tablet 4mg 1000 Tablet/Botol 9.08 - - -
39 Clorfeniramina maleat (CTM) tablet 4 mg ktk / 100 tablet 45 - - -
40 Captopril tablet scored 25 mg tablet 72 2,094 150,768 - 1,694 121,968 400
41 Deksametason injeksi i.v./i.m. 5 mg/ml ampul 1,738 - - -
42 Diazepam inj Ampul 15,000.00 70 1,050,000 - - 70
43 Diltiazem 30mg Tablet 129.00 - - -
44 Difenhidramin injeksi i.m. 10 mg/ml ampul 1,356 150 203,400 - - 150
45 Domperidone tablet 10 mg tablet 174 - - -
46 Digoksin tablet 0,25 mg tablet 108 100 10,800 100 10,800 -
47 Deksametason tablet 0,5 mg ktk/100 tab 48 - 3,000 144,000 400 19,200 2,600
48 Diazepam tablet 2 mg ktk / 100 tablet 47 - - -
49 Doksisiklin kapsul 100 mg ktk /100 kapsul 298 800 238,400 - - 800
50 mycetin (chloramfeni)col tetes telinga botol 5 ml 6,000 58 348,000 5 30,000 38 228,000 25
51 Eugenol Cairan Botol 20,815 5 104,075 - - 5
52 Epinefrin (adrenalin) injeksi 1 mg/ml ampul 8,910 60 534,600 - 60
53 Furosemid tablet 40 mg tablet 165 1,000 164,500 - - 1,000
54 Fitomenadion (vit.K1) tablet salut gula 10 mg tablet 800 1,000 800,000 100 80,000 - 1,100
55 Fenobarbital tablet 30 mg ktk/100 tablet 35 - - -
56 Fitomenadion (Vit. K1) injeksi 10 mg/ml 30 ampul / kotak 4,083 - -
57 Gentamycin Salep Kulit tube 5 gram 2,035 - - -
58 Gentamycin Tetes Mata 0,3 % Btl 5 ml 3,513 - - -
59 Gentian Violet Larutan 1 % Botol 10 ml 2,500 78 195,000 - 78 195,000 0
60 Gliseril Gualakolat tablet 100 mg 1000 tablet / botol 31 - - -
61 Glibenklamid tabet 5 mg tablet 155 5,900 914,500 - 950 147,250 4,950
Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium
62 klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g Glukosa Anhidrat sachet 317 - - -
2,70 g
63 Griseofulvin tablet 125 mg tablet 369 3,000 1,107,000 - 1,000 369,000 2,000
64 Haloperidol tablet 5 mg tablet 105 200 21,000 - - 200
65 Haloperidol tablet 1,5 mg tablet 74 200 14,800 - 200
66 Haloperidol tablet 2 mg ( lodomer ) tablet 134 200 26,800 - - 200
67 Hidroklorotiazida tablet 25 mg ktk / 100 tablet 171 1,600 273,600 - - 1,600
68 Hidrokortison krim 2,5% 24 tube @ 5 g / kotak 2,812 116 326,192 - 60 168,720 56
69 Hyoscine -N- Butilbromide tablet 10 mg ktk / 100 tablet 2,190 2,520 5,518,800 - 2,420 5,299,800 100
70 Isosorbid Dinitrat tablet sublingual 5 mg tablet 93 900 83,700 - - 900
71 Ibuprofen syr botol 2,560 16 40,960 - 14 35,840 2
72 Ibuprofen tablet 400 mg tablet 133 450 59,850 - 450 59,850 0
73 Itrakonazol kapsul 100 mg ktk / 30 kapsul 4,400 - - -
74 Kalsium Laktat (Kalk) tablet 500 mg Novakal ktk/100 tablet 76 - - -
75 Kloramfenikol suspensi botol 60 ml 4,000 14 56,000 30 120,000 44
Kotrimoksazol suspensi komb : Sulfametoksazol 200 mg +
76 botol 2,225 250 556,250 43 95,675 95 211,375 198
Trimetoprim 40 mg / 5ml
77 Ketokonazol krim 2 % tube 2,697 - - -
78 Klonidin tablet 0,15 mg tablet 193 - - -
79 Ketokonazol tablet 200 mg Box/50 Tab 524 500 262,000 - 500
Kotrimoksazol DOEN I (Dewasa) Kombinasi : Sulfametoksazol
80 ktk/100 tablet 158 3,630 573,540 - 60 9,480 3,570
400 mg + Trimetoprim 80 mg
Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat
81 ktk/100 sachet 45 - - -
0,25 mg
82 Kloramfenikol salep mata 1 % tube 5 gram 1,680 87 146,160 10 16,800 39 65,520 58
83 Klorpromazin tablet salut 25 mg 1000 tablet / botol 170 725 123,250 45 7,650 - 770
84 Metilergometrin Maleat tab salut 0,125 mg tablet 174 1,300 226,200 - 100 17,400 1,200
85 Metronidazol tablet 500 mg tablet 140 3,000 420,000 - - 3,000
86 Mikonazol krim/salep 2 % (Nitrat) tube 3,737 66 246,642 63 235,431 - 129
87 Methylprednisolon 4 mg tablet 230 1,900 437,000 - 1,640 377,200 260
88 Magnesium Sulfat 20% - 25 ml ktk / 10 vial 4,510 - - -
89 Magnesium Sulfat 40% - 25 ml ktk / 10 vial 5,500 - - -
90 Meloksikam tab 7,5 mg ktk / 50 tablet 1,080 0 - - 0
91 Metampiron injeksi 250 mg (Antalgin) ktk / 30 ampul @ 2 ml 1,333 - - -
92 Metampiron tablet 500 mg ktk / 100 tablet 232 2,410 559,964 - 775 180,071 1,635
93 Metformin HCl tablet 500 mg ktk / 100 tablet 119 1,390 165,410 100 11,900 850 101,150 640
94 Metilergometrin Maleat injeksi 0,200 mg -1 ml 100 ampul / kotak 2,684 565 1,516,460 - 104 279,136 461
95 Metoklopramide tablet 5 mg ktk / 100 tablet 110 1,500 165,000 - 500 55,000 1,000
96 Nifedipine tablet 123 1,740 214,020 - - 1,740
97 Novabion kapsul 349 2,700 942,300 1,000 349,000 850 296,650 2,850
98 Novadium tablet - - -
99 Novapyron tablet/100 568 3,170 1,800,560 - 2,770 1,573,360 400
100 Natrium Diklofenak tablet 50 mg tablet 193 1,500 289,500 260 50,180 800 154,400 960
101 Nistatin tablet salut 500.000 UI/g tablet 704 400 281,600 - - 400
102 Novadiar Sirup Btl 60 ml 4,900 109 534,100 3 14,700 8 39,200 104
103 Novakid Sirup Btl 60 ml - - -
104 Novachlor 250 mg kapsul ktk / 100 kapsul 553 1600 884,960 1,600 884,960 -
105 Nistatin Vaginal tablet salut 100.000 IU/g ktk / 100 tablet Vaginal 528 - - -
106 Loperamid tablet 2 mg tablet 90 1,000 90,000 185 16,650 - 1,185
107 Loratadin tablet 10 mg tablet 170 1,500 255,000 - 260 44,200 1,240
108 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000 - 2 ml ktk / 100 amp @ 2 ml 1,350 - - -
109 Lisol, mengandung kresol tersabun 50 % botol 1000 ml 49,200 12 590,400 1 49,200 11
110 Omeprazol kapsul/kaplet 20 mg kapsul 164 - 150 24,600 - 150
111 Obat Batuk hitam ( O.B.H.) Botol 100 ml 2,350 88 206,800 6 14,100 59 138,650 35
112 Oksitetrasiklin HCl salep kulit 3 % tube 5 gram 2,770 7 19,390 - 5 13,850 2
113 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml 10 vial / kotak 7,700 - - -
114 Oksitosin injeksi 10 UI/ml-1 ml 100 ampul / kotak 1,900 596 1,132,400 - - 596
115 Pirantel suspensi 125 mg/5 ml botol 14,000 - - -
116 Pirantel tablet ktk/100 tablel 318 70 22,260 - 22 6,996 48
117 Primakuin tab 15mg ktk/100 tab 258 1,340 345,720 - - 1,340
118 Parasetamol sirup 120 mg/5 ml botol 1,119 389 435,291 11 12,309 222 248,418 178
119 Parasetamol tablet Box/100Tab 58 10,000 580,000 - 1,600 92,800 8,400
120 Papaverin tablet 40 mg ktk/100Tablet 280 1,100 308,000 - - 1,100
121 Piridoksin (Vitamin B6) tablet 10 mg (HCL) ktk/100 tab 136 1,740 236,640 105 14,280 540 73,440 1,305
122 Piroksikam tab 20 mg ktk / 100 kapsul 116 - - -
123 Prednison tablet 5 mg ktk / 100 tablet 125 - - -
124 Prednison tablet 5 mg Botol / 1000 tablet 97 22,350 2,167,928 - 4,500 436,496 17,850
125 Propiltiourasil tablet 100 mg Ktk / 100 tablet 590 160 94,400 - 160
126 Propanolol tablet 10 mg (HCl) Box/100Tab 69 200 13,800 - - 200
127 Ranitidin tablet 150 mg ktk/100 tab 119 600 71,400 - 70 8,330 530
128 Retinol (vitamin A) 100.000 UI kapsul lunak kapsul 286 - - -
129 Ranitidin Injeksi 25 mg/2ml ampul 3,080 470 1,447,600 - 20 61,600 450
130 Retinol (Vitamin A) 200.000 IU Kapsul Lunak btl / 50 Kapsul 505 - - -
131 Salbutamol tablet 4 mg (sebagai sulfat) tablet 93 100 9,300 1,200 111,600 - 1,300
132 Sidiadril (Diphenhydramine)inj - - -
133 Salep 24 Ktk / 24 Pot @ 30g 2,797 140 391,580 - 13 36,361 127
134 Sianokobalamin (vit. B 12) injeksi 50 mcg botol / 250 tablet 48 - 5,000 238,000 2,000 95,200 3,000
135 Sianokobalamin (vit. B 12) injeksi 500 mcg Ktk 100 amp@1 ml 1,226 828 1,015,128 - - 828
136 Scopma Plus Ktk/100 tablet - - -
137 Sefotaksim injeksi 1 g vial 30,600 115 3,519,000 - 55 1,683,000 60
138 Simvastatin scored tablet 10 mg ktk/100 tablet 135 3,000 405,000 - 1,080 145,800 1,920
139 Tambah Darah Ktk/100 tablet 495 11,750 5,816,250 8,430 4,172,850 13,010 6,439,950 7,170
140 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) 100 tablet/ kotak 586 3,000 1,758,000 1,830 1,072,380 1,170
141 Tiamin (vitamin B1) injeksi 100 mg/ml ktk / 100 amp @ 1 ml 2,400 75 179,999 - - 75
142 Tetrasiklin kapsul/kaplet 250 mg kapsul 162 - - -
143 Tetrasiklin kapsul/kaplet 500 mg kapsul 325 - - -
144 Vitamin B kompleks tablet ktk/100 tab 132 330 43,560 3,000 396,000 2,520 332,640 810
145 Zinc tablet dispersible 20 mg tablet 592 2,700 1,598,400 370 219,040 1,200 710,400 1,870
146 Abbocath (IV Catheter) no 18 G setara B'Braun ktk / 50 pcs 4,959 - - -
147 Abbocath (IV Catheter) no 20 G setara B'Braun ktk / 50 pcs 4,959 - - -
148 Abbocath (IV Catheter) no 22 G setara B'Braun ktk / 50 pcs 4,959 - - -
149 Abbocath (IV Catheter) no 24 G setara B'Braun ktk / 50 pcs 4,959 - - -
150 Alat suntik sekali pakai 0,05 ml 100 set / kotak 3,453 - - -
151 Alat suntik sekali pakai 0,5 ml 100 set / kotak 2,895 - - -
152 Alat suntik sekali pakai 1 ml 100 set / kotak 845 400 338,000 - - 400
153 Alat suntik sekali pakai 2,5 ml 100 set / kotak 1,425 - - -
154 Alat suntik sekali pakai 3 ml 100 set / kotak 852 1,500 1,277,295 - 1,500
155 Alat suntik sekali pakai 5 ml 100 set / kotak 1,013 400 405,244 - 400
156 Alat suntik sekali pakai 10 ml 100 set / kotak 1,216 300 364,800 - 300
157 Catgut /Benang Bedah Chromic No.2/0 dg jarum kotak / 24 pcs 1,221 - - -
158 Catgut chromic 3-0 75cm Round Bodied Ktk/12 pcs 4,521 31 140,138 - - 31
159 Catgut chromic 2-0 75cm Round Bodied Ktk/12 pcs 4,705 45 211,733 - - 45
160 Catgut Plain 2-0 75cm Round Bodied Ktk/12 pcs 4,539 27 122,551 - - 27
161 Catgut Plain 3-0 75cm Round Bodied Ktk/12 pcs 4,539 45 204,255 - 25 113,475 20
162 Catgut /Benang Bedah plain No.2/0 dg jarum kotak / 24 pcs 1,221 - - -
163 Catgut/Benang Bedah plain No.3/0 dg jarum kotak / 24 pcs 1,125 46 51,750 - 46
164 Catgut/Benang Bedah Chromic No.3/0 dg jarum kotak / 24 pcs 1,125 - - -
165 Catheter 20 pcs 8,352 - - -
166 Catheter 18 pcs 8,352 - - -
167 Dermafix 5 x 7 cm ktk / 25 pcs 887 - - -
168 Disposible Masker Elastik 3 ply green ktk / 20 pcs 1,238 - - -
169 Etakridin larutan 0,1% (Rivanol) Botol 300 ml 3,060 39 119,340 - - 39
170 Etanol 70% 100ml (Alkohol) botol 2,625 162 425,250 - 162
171 Foley Catheter no. 16 pcs 8,352 - - -
172 Fixomull stretch 15cmx5m Rol 112,087 11 1,232,957 - 2 224,174 9
173 Gloves surgical No. 7,5 pcs 297 200 59,455 - 200
174 Gloves surgical No.7 pcs 297 100 29,728 - - 100
175 Gloves surgical No. 8 50 pasang / kotak 6,325 - - -
176 Povidon Iodida Larutan 10 % 300ml botol 21,600 7 151,200 5 108,000 - 12
177 Objeck glass Frosted/Slide Box/72 331.38 288 95,437 - - 288
178 Kertas saring Roll 9,900.00 - - -
179 Infusion set anak Set / kantong 4,400 - - -
180 Infusion set dewasa Set / kantong 7,400 950 7,030,000 - - 950
181 Kapas Pembalut / Absorben 250 gram Bungkus 29,250 38 1,111,500 - 4 117,000 34
182 Kasa Kompres 16 x 16 steril (isi 16 lembar) ktk 8,731 28 244,468 - - 28
183 Kasa Pembalut 40 m x 80 cm Roll 137,025 25 3,425,625 - 25
184 Plester 5 yards x 2 inch Roll 32,426 - - -
185 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum bedah 76cm/ktk 12 pcs 3,506 0 - - 0
186 Silk (Benang Bedah Sutera) No. 2/0 dengan jarum bedah 76cm/ktk 12 pcs 3,552 - - -
187 Aplicators set 113,000 2 226,000 - 2
188 Bonding set 1,123,000 1 1,123,000 - 1
189 Cresopate (Filling of Root Canals) set 1,273,000 1 1,273,000 - 1
190 Devitalisasi Pasta Non Arsen btl/ktk 439,000 - - -
191 Etil Klorida spray Vial / Can / 100 ml 134,000 5 670,000 - 5
192 ETSA set 364,000 1 364,000 - 1
193 Glass Ionomer Cement ART Set / botol 873,000 1 873,000 - 1
194 Kalsium Hidroksida Pasta 2 tube / kotak 318,000 - - -
195 Glukosa larutan infus 5 % steril botol 6,900 181 1,248,900 - 181
196 NaCL 0,9 % botol 6,410 291 1,865,310 352 2,256,320 - 643
197 Klorfenol kamfer Menthol ( CHKM ) Botol 10 ml 243,000 - - -
198 Pembalut Elastis uk 10cmX4,55m Rol 21,406 - 3 64,218 - 3
199 Semen Seng Fosfat serbuk dan cairan Set @ 30 gram / btl 418,000 - - -
200 Terumo Neode No.22G x 1 1/2 - - -
201 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Set @ 100 gram / btl 37,400 - - -
202 Plester 5 5cm x 4,5 m Roll 32,426 - - -
203 H2O2,0,3-0,5% Botol/100 ml 29,800 - - -
204 lar. HCl 0,1 N Botol 34,800.00 - - -
205 Dekstran 70-larutan infus 6% steril Botol 500 ml 8,908 - - -
206 Povidon Iodida larutan 10% 60ml Botol 7,040 14 98,560 - - 14
207 Ringer Laktat larutan infus botol 7,150 1,742 12,455,300 - - 1,742
208 Urine bag Buah 5,005 72 360,360 - - 72
209 One scrub 500cc + Dispenser Botol 500 ml 75,000 10 750,000 10
210 Carviton Set 308,000 3 924,000 - 3
211 LC (Light Curing) A2-A3 Set 478,000 1 478,000 - 1
212 Trichloro Formalin (TKF) Set 270,000 1 270,000 - 1
213 Chloramex 500mg kapsul 1,155 600 693,000 - 600
214 Chloramphenicol susp Botol 4,000 66 264,000 - - 66
216 Domperidone Susp Botol 3,180 0 - - 0
217 Erphafillin (aminophyline 200mg) Tablet 160 1,000 160,000 - 1,000
218 Folic Acid 1mg (asam folat) Botol/100Tab 70 2,200 154,000 - 500 35,000 1,700
219 Guafenesin 100mg ktk/100Tablet 120 600 71,838 - 600 71,838 0
221 Chlomfenicol tetes mata Botol 13,500 62 837,000 62 837,000 -
222 Livron Bplex ktk/100Tablet 303 7,350 2,227,050 110 33,330 2,300 696,900 5,160
223 Abbocath(IV catheter)no.18G setara B'raun ktk/50pcs 11,954 200 2,390,800 - 200
224 Abbocath(IV catheter)no.20G setara B'raun ktk/50pcs 11,954 291 3,478,614 - 291
225 Abbocath(IV catheter no.22G setara B'raun ktk/50pcs 11,954 294 3,514,476 - 294
226 Abbocath(IV catheter no.24G setara B'raun ktk/50pcs 11,954 200 2,390,800 - 200
227 Catheter 2 Way Fr 18 pcs 15,054 15 225,803 - - 15
228 Etanol 70% 1000ml (Alkohol) Botol 25,800 14 361,200 - - 14
229 Kasa pembalut 4 m x 15 cm rol 4,080 82 334,560 - - 82
230 Blood lancets Box/100pcs 160 30 4,807 - 30
231 E-care (Alkohol swab) ktk/100lbr 207 50 10,340 - 50
232 Umbilicard cord klem pcs 1,150 147 169,050 - - 147
233 Hansccrub 500ml Botol 90,986 9 818,874 - - 9
234 Air untuk injeksi amp 25ml Ampul 2,750 34 93,500 - 12 33,000 22
235 Air untuk irigasi lar 1000ml Botol 10,700 49 524,300 - 49
236 Aminofilin inj 24mg ktk/30 Ampul 3,349 180 602,820 - - 180
238 Amitriptilin 25mg Box100 165 1,500 247,500 - - 1,500
239 Anestetik lokal gigi kombinasi lidokain +epinefrin Box/30 amp 2,122 540 1,145,880 - - 540
240 Antifungi kombinasi Asam Benzoat 6% as.salisilat Pot 4,782 264 1,262,448 - - 264
241 Burnazin salep Tube 61,000 7 427,000 - 7
242 Dihydroartemisin 40mg+piperaquin phosphate 320mg Box,1 strip@9 Tablet 3,498 225 787,050 - - 225
243 karbamazepin 200mg Box/100 Tab 306 1,250 382,500 - - 1,250
244 Permetrin krim Tube 12,155 60 729,300 - 60
245 Cefiksim 100mg Box/50kapsul 649 1,600 1,038,400 50 32,450 - 1,650
246 Thiamin (vit B1) Box/100Tab 91 100 9,100 - 100 9,100
247 Mask 3ply Ear loop Box/50 835 1,100 918,390 - - 1,100
248 Kasa Hydrophil 36mX80cm Rol 142,600 6 855,600 - - 6
249 Leukoplast 7,5cmX4,5cm Roll 35,532 61 2,167,452 - - 61
250 Aesculap Blades/carbon steel scalpel blades 15 Box/100pcs 3,300 500 1,650,000 - - 500
251 Aesculap Blades/carbon steel scalpel blades 23 Box/100 pcs 3,300 500 1,650,000 - - 500
252 Strip Closterol Botol/10 strip 254,500 - 50 12,725,000 50 12,725,000
253 Strip Gula Botol 154,500 50 7,725,000 75 11,587,500 100 15,450,000 25
254 Pot.Sputum Botol 50ml 5,000 50 250,000 - - 50
255 Piroksikam tab 10 mg ktk/100 tab 131 3,100 406,100 3,000 393,000 2,810 368,110 3,290
256 Obat anti Tuberculosis Kategori Anak Paket 247,234 - - -
257 Asam Asetilsalisilat (asetosal) tablet 80 mg ktk/ 100 tab 123 1,400 172,200 - - 1,400
258 Haloperidol tablet 0,5 mg ktk/ 100 tab 64 200 12,800 - 200
259 Klopidogrel tablet 75 mg ktk/ 30 tab 2,100 120 252,000 90 189,000 30
260 Natrium metamizole injeksi ktk/5 amp 12,880 80 1,030,400 - 80
261 Catgut Chomic 2/0+ jarum 1/2 GT 35 mm ktk/24 pcs 6,420 96 616,320 - 96
262 Catgut chromic 3/0+ jarum 1/2 GT 35 mm ktk/24 pcs 6,420 96 616,320 - 96
263 Catgut plain 2-0 75cm Round Bodied 1/2 circle, 25 mm ktk / 12 pcs 4,538 12 54,456 - 12
264 catgut Plain 3-0 75cm Round Bodied 1/2 circle, 25 mm ktk/ 12 pcs 4,538 24 108,912 24
265 Catgut Plain 2/0 + jarum 1/2 GT 35 mm ktk / 24 pcs 6,420 96 616,320 96
266 Catgut Plain 3/0 + jarum 1/2 GT 35 mm ktk / 24 Pcs 6,420 96 616,320 96
267 Silk 2/0 + jarum 1/2 GT 35 mm ktk/ 36 pcs 3,513 144 505,872 144
268 Silk 3/0 + jarum 1/2 GT 35 mm ktk/ 36 pcs 3,513 144 505,872 144
269 CATHY IV CANNULA 18 G ktk/ 100 pcs 11,954 100 1,195,400 100
270 Steracath I.V Catheter no. 18 G x 32 mm ktk/ 50 pcs 4,370 150 655,500 150
271 CATHY IV CANNULA 20 G ktk/ 100 pcs 11,954 100 1,195,400 100
272 Steracath I.V Catheter no. 20 G x 11/4 ktk/ 50 pcs 4,370 350 1,529,500 350
273 CATHY IV CANNULA 22 G ktk/ 100 pcs 11,954 100 1,195,400 100
274 Steracath I.V Catheter no. 22 G x 1 ktk/ 50 pcs 4,370 350 1,529,500 350
275 CATHY IV CANNULA 24 G ktk/ 100 pcs 11,954 100 1,195,400 100
276 Steracath I.V Catheter no. 24 G x 3/4 ktk/ 50 pcs 4,370 200 874,000 200
277 Syringe 1 cc tuberculin 27G x 1/2 ktk/ 100 pcs 748 100 74,800 100
278 Disposable Syringe 3 cc ktk / 100 pcs 851 100 85,100 100
280 Disposable Syringe 10 cc ktk/ 100 pcs 1,216 100 121,600 100
281 Syringe disposable 3 cc x 23 G x 1 1/4 ktk / 100 pcs 748 2,700 2,019,600 2,700
282 Syringe disposable 5 cc x 22 G x 1 1/2 ktk / 100 pcs 863 1,500 1,294,500 1,500
283 Onemed Mask 3 ply Ear Loop ktk/ 50 pcs 379 500 189,500 500
284 Foley Catheter 2 Way no. 18 pcs 9,200 20 184,000 20
285 Glove Surgical Non Steril M ktk/ 100 pcs 670 1,000 670,450 1,000
286 Glove Surgical Non Steril L ktk / 100 pcs 670 1,000 670,450 1,000
287 Onemed Kapas Pembalut / Absorben 250 gram bungkus 14,375 5 71,875 5
288 Onemed Kapas Pembalut / Absorben 500 gram bungkus 31,372 25 784,300 25
289 Kasa Hydrophil 40 mX80cm roll 120,750 25 3,018,750 25
290 Alkohol Swabs ktk/ 100 lbr 207 200 41,360 200 41,360 0
291 Urine bag standard steril 2 Lt ( T valve) buah 5,005 3 15,015 3
292 Abate pack/ 1000 gram 143 10,000 1,427,000 10,000 1,427,000
293 Iodium Test botol 10 ml 7,600 45 342,000 45
294 RDT DBD ktk/ 20 pcs 127,100 20 2,542,000 20
295 RDT Malaria ktk/ 25 pcs 20,579 50 1,028,964 50
296 Strip Asam Urat Nesco botol/ 25 strip 6,380 100 638,000 75 478,500 125 797,500 50
297 Gloves surgical sterile Gynaecolog no. 7,0 pcs 21,750 35 761,250 35 761,250 -
298 Gloves surgical sterile Gynaecolog no. 7,5 pcs 21,750 40 870,000 40
299 Test Kehamilan ktk/ 50 pcs 2,230 200 446,000 200
300 Biocombin injeksi box @ 10 ampul 7,420 20 148400 - 20
301 Bisakodil suppositoria Box @ 6 suppositoria 5,670 12 68040 - 1 5,670 11
302 Vagistin suppositoria box @ 10 suppositoria 18,900 186 3,515,400 - 186
Jumlah 175,261,986 39,406,090 59,982,433
Mengetahui
Kepala Puskesmas Tinombo Pengelola Obat Puskesmas

Aswini Dimple,SKM Meiske Tamedia A.Md.Far

Nip.19791104 200212 2002 -
TOK 31 OKTOBER 2017

JUMLAH HARGA

1,188,300
180,900
242,550
228,200

336,192
193,700
19,050
-

-
1,773,900
26,640

1,966,800
111,560
536,800
127,000
294,261
-

-
153,600
 -
27,716
-
206,640
2,041,600
-
1,189,350
142,480
-
3,870,000
-
1,380
420,500
-
-
28,800
-
1,050,000
-
203,400
-
-
124,800
-
238,400
150,000
104,075
534,600
164,500
880,000
-
-
-
 -
-
-
767,250

738,000
21,000
14,800
26,800
273,600
157,472
219,000
83,700
5,120
-
-
-
176,000

440,550

-
-
262,000

564,060

97,440
130,900
208,800
420,000
482,073
59,800
 -
-
-
-
379,892
76,160
1,237,324
110,000
214,020
994,650
-
227,200
185,280
281,600
509,600
-
-
-
106,650
210,800
-
541,200
24,600
82,250
5,540
-
1,132,400
-
15,264
345,720
199,182
487,200
308,000
 177,480
-
-
1,731,432
94,400
13,800
63,070
-
1,386,000
-
120,900
-
355,219
142,800
1,015,128
-
1,836,000
259,200
3,549,150
685,620
179,999
-
-
106,920
1,107,040
-
-
-
-
-
-
338,000
-
1,277,295
405,244
364,800
-
140,138
211,733
122,551
90,780
-
51,750
-
-
-
-
-
119,340
425,250
-
1,008,783
59,455
29,728
-
259,200
95,437
-
-
7,030,000
994,500
244,468
3,425,625
-
-
-
 226,000
1,123,000
1,273,000
-
670,000
364,000
873,000
-
1,248,900
4,121,630
-
64,218
-
-
-
-
-
-
-
98,560
12,455,300
360,360
750,000
924,000
478,000
270,000
693,000
264,000
-
160,000
119,000
-
-
1,563,480
2,390,800
3,478,614
3,514,476
2,390,800
225,803
361,200
334,560
4,807
10,340
169,050
818,874
60,500
524,300
602,820
247,500
1,145,880
1,262,448
427,000
787,050
382,500
729,300
1,070,850
-
918,390
855,600
2,167,452
1,650,000
1,650,000
-
3,862,500
250,000
430,990
 -
172,200
12,800
63,000
1,030,400
616,320
616,320
54,456
108,912
616,320
616,320
505,872
505,872
1,195,400
655,500
1,195,400
1,529,500
1,195,400
1,529,500
1,195,400
874,000
74,800
85,100
121,600
2,019,600
1,294,500
189,500
184,000
670,450
670,450
71,875
784,300
3,018,750
 -
15,015
-
342,000
2,542,000
1,028,964
319,000
-
870,000
446,000
148,400
62,370
3,515,400
154,685,643

smas

d.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dana JKN ( BHP JKN Puskesmas Tinombo ) Tahun 2016
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER SISA STOK 31 OKTOBER 2017
NO NAMA BHP PENERIMAA PENGELUA
SATUAN HARGA VOLUME JUMLAH HARGA JUMLAH HARGA JUMLAH HARGA VOLUME
N RAN
1 Alkohol 70% 1 Liter Botol 1000 ml 30,000 51 1,530,000 6 180,000 45
2 Alkohol Swab ktk/100 lbr 115 3,000 345,000 100 11,500 2,900
3 Foley Catheter II way no.16 ktk/10 pcs 9,200 200 1,840,000 200
4 Foley Catheter II way no.18 ktk/10 pcs 9,200 200 1,840,000 200
5 Foley Catheter II way no.22 ktk/10 pcs 9,200 200 1,840,000 200
6 Surgical Powder free glove size 6,5 Psg 8,033 221 1,775,293 184 1,478,072 37
7 Surgical Powder free glove size 7,0 Psg 8,033 276 2,217,108 31 249,023 245
8 Surgical Powder free glove size 7,5 Psg 8,033 84 674,772 66 530,178 18
9 Infusion set Dewasa pcs 3,680 50 184,000 9 33,120 41
10 Kapas pembalut/Absorben 250mg Rol 14,375 100 1,437,500 1 14,375 2 28,750 99
11 Kapas pembalut Hydrophil 4X3 cm Rol 679 75 50,925 - 75
12 Kapas pembalut Hydrophil 4X15 cm Rol 2,415 90 217,350 5 12,075 85
13 Kasa Hydrophil steril 16X16 Ktk/16 lbr 9,200 455 4,186,000 - 455
14 Lysol 1 Liter Botol 1000 ml 49,200 10 492,000 10
15 Rivanol 0,1% Botol 300ml 3,600 90 324,000 1 3,600 2 7,200 89
16 Silk 3/0+jarum1/2 GT 35 mm ktk/36 pcs 3,514 829 2,912,940 7 24,597 822
17 Steracath I V Catheter no.18G X 32mm pcs 4,370 72 314,640 10 43,700 - 82
18 Steracath I V Catheter no.20GX 1 1/4 pcs 4,370 90 393,300 5 21,850 85
19 Steracath I V Catheter no.22G X1 pcs 4,370 184 804,080 5 21,850 179
20 Steracath IV Catheter no.24GX3/4 pcs 4,370 196 856,520 27 117,990 169
21 Steracatg IV Catheter no.26 GX 1/2 Pcs 4,370 100 437,000 100
22 Syringe disposable 1cc pcs 748 700 523,600 700
23 Syringe disposable 3 cc pcs 748 2,000 1,496,000 375 280,500 1,625
24 Syringe disposable 10 cc pcs 1,063 500 531,500 500
25 Syringe disposable 50 cc pcs 3,910 200 782,000 200
26 Surgical Mask Plus 3 ply Plus Earloop Box/50pcs 506 4,900 2,479,400 250 126,500 4,650
27 Theree Way stop cock wih tube Box/50pcs 2,243 500 1,121,500 500
28 Pengikat Tali Pusat (Umbilical Cord Klem Steril) Box/50pcs 1,495 -
29 Strip Cholesterol Ktk/10 strip 25,450 - - -
30 Strip Uric Acid Ktk/25 strip 159,500 - - -
31 Strip Glucose Ktk/25 strip 154,500 - - -
 Jumlah 31,606,428 61,675 3,123,205
Mengetahui,
Kepala Puskesmas Tinombo Pengelola Obat Puskesmas

Aswini Dimple,SKM Meiske Tamedia,A.Md.Far

Nip.19791104 200212 2002
SISA STOK 31 OKTOBER 2017

JUMLAH HARGA

1,350,000
333,500
1,840,000
1,840,000
1,840,000
297,221
1,968,085
144,594
150,880
1,423,125
50,925
205,275
4,186,000
492,000
320,400
2,888,344
358,340
371,450
782,230
738,530
437,000
523,600
1,215,500
531,500
782,000
2,352,900
1,121,500
0
0
0
0
 28,544,899

a Obat Puskesmas

amedia,A.Md.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dana JKN ( Obat JKN Puskesmas Tinombo ) Tahun 2016
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER SISA STOK 31 OKTOBER 2017
NO NAMA OBAT PENGELUAR
SATUAN HARGA VOLUME JUMLAH HARGA PENERIMAAN JUMLAH HARGA JUMLAH HARGA VOLUME
AN

Amoksisilin kapsul/kaplet 500 14,000 9,800,000 4,200 2,940,000 9,800

1 mg
Tablet 700.00
-
2 Amlodipin 10mg ktk/100 tablet 1,847.00 2,340 4,321,980 30 55,410 2,310
3 Lanzoprazole ktk/100 kapsul 1,474.18 1,010 1,488,922 1,010 1,488,922 -
4 Asam Mefenamat 500 mg Tablet 270.00 8,750 2,362,500 1,790 483,300 6,960
5 Cefadroxil 500mg Ktk/100Kapsul 1,100.00 4,250 4,675,000 1,980 2,178,000 2,270
6 Cefixime 100mg ktk/100 kapsul 2,612.00 2,900 7,574,800 200 522,400 2,700
7 Chlopheniramine (CTM) Botol/1000 Tab 908.00 0 - 0
8 Dexametasone 0,5mg ktk/100 tablet 140.00 2,490 348,600 2,230 312,200 260
9 Metronidazole 500mg ktk/100 tablet 240.00 1,900 456,000 100 24,000 1,800
10 Metformin 500mg ktk/100 tablet 250.00 1,500 375,000 1,500
11 Natrium diclofenac ktk/100 tablet 237.47 2,300 546,181 300 71,241 2,000
12 Ranitidine injeksi ktk/100 ampul 6,400 932 5,964,800 200 1,280,000 132 844,800 1,000
13 Ranitidine Tab ktk/100 tab 240 11,400 2,736,000 2,940 705,600 8,460
14 Vaksin Rabies Ampul 222,500 16 3,560,000 16 3,560,000
15 Simvastatin 20mg ktk/100 tablet 1,119 2,350 2,630,308 350 391,748 2,000
16 Paracetamol 500 mg ktk/100 tab 150.00 26,200 3,930,000 8,130 1,219,500 18,070
17 Hydrocortisone cream 5gr ktk/25 6,000.00 100 600,000 12 72,000 88
18 Novabion Kapsul 349.00 - - -
19 Novapyron Tablet 510.00 -
Jumlah 51,370,091 1,280,000 14,869,121

Mengetahui,
Kepala Puskesmas Tinombo Pengelola Obat Puskesmas

Aswini Dimple,SKM Meiske Tamedia,A.Md.Far

Nip.19791104 200212 2002
SISA STOK 31 OKTOBER 2017

JUMLAH HARGA

6,860,000

4,266,570
-
1,879,200
2,497,000
7,052,400
-
36,400
432,000
375,000
474,940
6,400,000
2,030,400
-
2,238,560
2,710,500
528,000
-
-
37,780,970 OK !!!

Pengelola Obat Puskesmas

Meiske Tamedia,A.Md.Far
 LAPORAN PUSKESMAS TINOMBO
Lampiran Berita Acara Stock Opname OKTOBER 2017
Sumber Dana Jamkesda (BMHP Jamkesda) Tahun 2016
SISA STOK 30 SEPTEMBER 2017 PENERIMAAN OKTOBER PENGELUARAN OKTOBER SISA STOK 31 OKTOBER
NO NAMA BHP JUMLAH PENGELUARA JUMLAH JUMLAH
SATUAN HARGA VOLUME JUMLAH HARGA PENERIMAAN VOLUME
HARGA N HARGA HARGA
1 Alkohol 70% 1 Liter Botol 1000 ml 30,000 10 300,000 10 300,000
2 Catgut chromic 3/0 + jarum ktk/ 24 pcs 6,421 72 462,312 72 462,312
3 Kassa pembalut 2m x 80 cm Roll 8,855 10 88,550 3 26,565 7 61,985
4 Hanscrub 500 cc Botol 75,000 10 750,000 10 750,000
5 Infusion set Dewasa Ktk/100 pcs 3,680 300 1,104,000 300 1,104,000
6 Steracath I V Catheter no.18G X 32mm Pcs 4,370 100 437,000 100 437,000
7 Steracath I V Catheter no.20GX 1 1/4 Pcs 4,370 200 874,000 200 874,000
8 Steracath I V Catheter no.22G X1 Pcs 4,370 100 437,000 100 437,000
9 Steracath IV Catheter no.24GX3/4 pcs 4,370 100 437,000 100 437,000
10 Mask 3 ply earloop Pcs 380 2,450 931,000 100 38,000 2,350 893,000
11 Mask 3 ply tren on Pcs 380 650 247,000 500 190,000 150 57,000
12 Surgical powder free gloves size no 7,0 Pcs 8,033 300 2,409,900 300 2,409,900
13 Surgical powder free gloves size no 7,5 pcs 8,033 200 1,606,600 200 1,606,600
14 Plester non woven 20 cm x 5 m Roll 91,080 8 728,640 8 728,640
15 Superlife M Pcs 658 394 259,252 220 144,760 174 114,492
16 Tes Kehamilan Pcs 2,133 200 426,600 10 21,330 190 405,270
17 Umbilical Cord klem Pcs 575 250 143,750 50 28,750 200 115,000
Jumlah 11,642,604 449,405 11,193,199
Mengetahui,
Kepala Puskesmas Tinombo Pengelola Obat Puskesmas

Aswini Dimple,SKM Meiske Tamedia,A.Md.Far

Nip.19791104 200212 2002