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LAMPIRAN BERITA ACARA STOK OPNAME

PERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN (BARANG PKM)


UPT PUSKESMAS SUKAMULYA
TAHUN 2017

PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK


NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

1 Alopurinol Tablet 100 mg Tablet - - - - -


2 Albendazol Tablet 400 mg Tablet - - - - -
3 Aminofilin Inj 24 mg/ml-10 ml Ampul - - - - -
4 Aminofilin Tablet 200 mg Tablet - - - - -
5 Amitriptilina HCl Tablet salut 25 mg Tablet - - - - -
6 Amlodipin Tablet 5 mg Tablet - - - - -
7 Amoksisilin Kaplet 500 mg Kaplet - - - - -
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol - - - - -
9 Antasida DOEN I Tablet Kunyah Tablet - - - - -
10 Antasida II Suspensi 60 ml Botol - - - - -
11 Anti Hemmoroid DOEN Supp - - - - -
12 Antibakteri DOEN Tube - - - - -
13 Antifungi DOEN kombinasi Pot - - - - -
14 Antimigren DOEN Tablet - - - - -
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial - - - - -
16 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet - - - - -
17 Asam Askorbat (VIT C) Tablet 50 mg Tablet - - - - -
18 Asam Mefenamat kaplet 500 mg Tablet - - - - -
19 Asiklovir Krim 5%/5g Tube - - - - -
20 Asiklovir Tablet 400 mg Tablet - - - - -
21 Atapulgit Tablet 600 mg Tablet - - - - -
22 Atropin Sulfat Inj 0,25 mg/ml Ampul - - - - -
23 Azithromisin Tablet 500 mg Tablet - - - - -
24 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial - - - - -
25 Betametason Krim 0.1 % Tube - - - - -
26 Bromheksin Tablet 8 mg Tablet - - - - -
27 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket - - - - -
28 Deksametason Inj 5 mg/ml-1 ml Ampul - - - - -
29 Deksametason Tablet 0,5 mg Tablet - - - - -
30 Dekstrometorfan Tablet kombinasi Tablet - - - - -
31 Dektrometorfan Sirup kombinasi Botol - - - - -
32 Devitalisasi Pasta Botol - - - - -
33 Dextrose Inj 40% Vial - - - - -
34 Diazepam Inj 5 mg/ml-2 ml Ampul - - - - -
35 Diazepam Rectal 10 mg/2,5 ml tube - - - - -
36 Diazepam Rectal 5 mg/2,5 ml tube - - - - -
37 Diazepam Tablet 2 mg Tablet - - - - -
38 Difenhidramin Inj 10 mg/ml Ampul - - - - -
39 Digoksin Tablet 0,25 mg Tablet - - - - -
40 Dimenhidrinat Tablet 50 mg Tablet - - - - -
41 Doksisilin Tablet 100 mg Tablet - - - - -
42 Domperidon Suspensi 5mg/5ml Botol - - - - -
43 Domperidon Tablet 10 mg Tablet - - - - -
44 Endometason Botol - - - - -
45 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul - - - - -
46 Eritromisin Kapsul 250 mg Kapsul - - - - -
47 Eritromisin Sirup 200 mg/5 ml Botol - - - - -
48 Etakridin Larutan 0,1 % Botol - - - - -
49 Etanol 70 %- 1000 ml Botol - - - - -
50 Etil Klorida Spray Botol - - - - -
51 Eugenol Cairan Botol - - - - -
52 Fenitoin Natrium Kapsul 100 mg Kapsul - - - - -
53 Fenobarbital Tablet 30 mg Tablet - - - - -
54 Fenoksimetil Penisilin Tablet 500 mg Tablet - - - - -
55 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet - - - - -
56 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul - - - - -
57 Fluconazol Tablet 150 mg Tablet - - - - -
58 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul - - - - -
59 Formokresol Cair Botol - - - - -
60 Furosemid Tablet 40 mg Tablet - - - - -
61 Garam Oralit I Serbuk Sachet - - - - -
62 Gentamisin Inj 40 mg/ml (Sulfat) Vial - - - - -
63 Gentamisin Salep Kulit 0,1% Tube - - - - -
64 Gentian Violet Larutan 1 %-10 ml Botol - - - - -
65 Glass Ionomer Cement Botol - - - - -
66 Glibenklamid Tablet 5 mg Tablet - - - - -
67 Gliseril Guaiakolat Tablet 100 mg Tablet - - - - -
68 Glukosa Larutan Infus 5% steril Fls - - - - -
69 Griseofulvin Tablet 125 mg Micronized Tablet - - - - -
70 Haloperidol 5 mg Tablet - - - - -
71 Haloperidol Tablet 1,5 mg Tablet - - - - -
72 Hidrokortison Krim 2,5 % Tube - - - - -
73 Hiosina butilbromida tab 10 mg Tablet - - - - -
Human Tetanus Imunoglobulin Im 250UI
74 Set - - - - -
(Tetagam)
75 Ibuprofen Tablet 400 mg Tablet - - - - -
76 Isoniazid Tablet 100 mg Tablet - - - - -
77 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet - - - - -
78 Kalsium glukonat inj 100 mg/ml Ampul - - - - -
79 Kalsium hidroksida pasta Botol - - - - -
80 Kalsium Laktat (Kalk) Tablet 500 mg Tablet - - - - -
81 Kaptropil Tablet 25 mg Tablet - - - - -
82 Karbamazepin Tablet 200 mg Tablet - - - - -
83 Karbogliserin Tetes Telinga 10 % Botol - - - - -
84 Karbon aktif tab 0,5 mg Tablet - - - - -
85 Ketokonazol Tablet 200 mg Tablet - - - - -
86 Kina Inj 26 % 2 ml Ampul - - - - -
87 Kina Tablet 222 mg Tablet - - - - -
88 Klindanmisin Tablet 300 mg Tablet - - - - -
89 Kloramfenikol Kapsul 250 mg Kapsul - - - - -
90 Kloramfenikol Kapsul 500 mg Kapsul - - - - -
91 Kloramfenikol Salep Kulit 2% Tube - - - - -
92 Kloramfenikol Salep Mata 1 % Tube - - - - -
93 Kloramfenikol Sirup 125 mg/5 ml Botol - - - - -
94 Kloramfenikol Tetes Mata 0.5% Botol - - - - -
95 Kloramfenikol Tetes telinga 3 % Tube - - - - -
96 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet - - - - -
97 Klorpropmazin HCl Tablet salut 100 mg Tablet - - - - -
98 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol - - - - -
99 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet - - - - -
Lidokain Inj Komp : Lidokain %+ Epinefrin 1 :
100 Ampul - - - - -
80000-2 ml
101 Lisol Botol - - - - -
102 Loratadin Tablet 10 mg Tablet - - - - -
103 Magnesium sulfat Inj (IV) 20 % Ampul - - - - -
104 Magnesium sulfat Inj (IV) 40 % Ampul - - - - -
105 MB Anak Blister - - - - -
106 MB Dewasa Blister - - - - -
107 Metformin HCl Tablet 500 mg Tablet - - - - -
108 Metilergomatrin Maleat Inj 0,200 mg Ampul - - - - -
Metilergometrin Maleat (Metilergometrin) Tablet
109 Tablet - - - - -
Salut 0,125 mg
110 Metilprednisolon Tablet 4 mg Tablet - - - - -
111 Metronidazol Tablet 500 mg Tablet - - - - -
112 Mikonazol Krim/Salep 2% Tube - - - - -
113 Mineral Mix Sachet - - - - -
114 Monoklorkamfer mentol cairan Botol - - - - -
115 Multivitamin + DHA + Lysin Botol - - - - -
116 Multivitamin + Mineral Kaplet - - - - -
117 N-asetil sistein kaps 200 mg Kapsul - - - - -
118 Natrium Bikarbonat Tablet 500 mg Tablet - - - - -
119 Natrium Diklofenak Tablet 50 mg Tablet - - - - -
120 Natrium Hipoklorit 3% Botol - - - - -
121 Natrium Klorida Larutan Infus 0,9% Fls - - - - -
122 Natrium Tiroksin Tablet 100 µg Tablet - - - - -
123 Nistatin Tablet Salut Gula 500.000 IU/g Tablet - - - - -
124 Nistatin Tablet Vaginal 100.000 IU/g Tablet - - - - -
125 OAT FDC Katagori 1 Paket - - - - -
126 OAT FDC Katagori 2 Paket - - - - -
127 OAT FDC Kategori Anak paket - - - - -
128 OAT FDC Kategori Sisipan Paket - - - - -
129 OAT Kombipak Kat I paket - - - - -
130 Obat Batuk Hitam (OBH) Cairan Botol - - - - -
131 Oksitetrasiklin HCl 1 % Salep Mata Tube - - - - -
132 Oksitetrasiklin HCl Salep Kulit 3 % Tube - - - - -
133 Oksitoksin in 10 IU/ml- 1 ml Ampul - - - - -
134 Omeprazol Kapsul 20 mg Kapsul - - - - -
135 Ondansetron Inj 4 mg/2 ml Ampul - - - - -
136 Parasetamol Sirup 120 mg / 5ml Botol - - - - -
137 Parasetamol Tablet 500 mg Tablet - - - - -
138 PB Anak Blister - - - - -
139 PB Dewasa Blister - - - - -
140 Permetrin 5% Krim (Scabimite) Tube - - - - -
141 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet - - - - -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

142 Povidon Iodida 10 %-30 ml Botol - - - - -


143 Povidon Iodida 10 %-300 ml Botol - - - - -
144 Prednison Tablet 5 mg Tablet - - - - -
145 Primakuin Tablet 15 mg Tablet - - - - -
146 Propanolol HCl Tablet 40 mg Tablet - - - - -
147 Propiltiourasil Tablet 100 mg Tablet - - - - -
148 Ranitidin Inj 25 mg/ml Ampul - - - - -
149 Ranitidin Tablet 150 mg Tablet - - - - -
150 Resperidon 2 mg Tablet - - - - -
151 Retinol (Vit A) Kapsul 100.000 IU Kapsul - - - - -
152 Retinol (VIT A) Kapsul 200.000 IU Kapsul - - - - -
153 Ringer Laktat Larutan Infus Steril Fls - - - - -
154 Salbutamol 2,5 mg/2,5 ml NaCl Ampul - - - - -
155 Salbutamol Tablet 4 mg Tablet - - - - -
156 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot - - - - -
157 Salisil Bedak 2 % Kotak - - - - -
158 Sefadroksil Sirup 125 mg/5 ml Botol - - - - -
159 Sefadroxil Kapsul 500 mg Kapsul - - - - -
160 Sefiksime 200 mg + Azitromisin 500 mg Paket - - - - -
161 Sefotaksim Inj 1 g Vial - - - - -
162 Seftriaxon Inj 1 g Vial - - - - -
163 Semen seng fosfat serbuk cairan Botol - - - - -
164 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul - - - - -
165 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial - - - - -
166 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul - - - - -
167 Simvastatin Tablet 10 mg Tablet - - - - -
168 Siprofloksasin (HCl) Tablet 500 mg Kaplet - - - - -
169 Tablet Tambah Darah Kombinasi Tablet - - - - -
170 Temporary Restorative Material Botol - - - - -
171 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
172 Tiamin HCL (Vit B1) Inj 100 mg/ml-1ml Ampul - - - - -
173 Tiamin HCL (Vit B1) Tablet 50 mg Tablet - - - - -
174 Triheksifenidil HCl Tablet 2 mg Tablet - - - - -
175 Vaksin BCG + Pelarut Set - - - - -
176 Vaksin Campak + Pelarut Set - - - - -
177 Vaksin DPT-Hb-Hib Vial - - - - -
178 Vaksin DT Vial - - - - -
179 Vaksin Hb-0 Set - - - - -
180 Vaksin IPV 10 ds Vial - - - - -
181 Vaksin IPV 5 ds Vial - - - - -
182 Vaksin Measles Rubella (MR) Vial - - - - -
183 Vaksin Meningitis Paket - - - - -
184 Vaksin Papillomavirus (HPV) Vial - - - - -
185 Vaksin Pneumococcus Vial - - - - -
186 Vaksin Polio 10 ds + Penetes Set - - - - -
187 Vaksin Polio 5 ds + Penetes Set - - - - -
188 Vaksin Rabies Vero Set - - - - -
189 Vaksin Td Vial - - - - -
190 Vitamin B Kompleks Tablet Tablet - - - - -
191 Zinc Tablet 20 mg Tablet - - - - -
ALKES HABIS PAKAI - - - - -
192 ADS 0.05 ml Buah - - - - -
193 ADS 0.5 ml Buah - - - - -
194 ADS 5 ml Buah - - - - -
195 Alat Suntik Sekali Pakai 1ml Set - - - - -
196 Alat Suntik Sekali Pakai 3 ml Set - - - - -
197 Alat Suntik Sekali Pakai 5 ml Set - - - - -
198 Alkohol Swab Buah - - - - -
199 Bisturi Buah - - - - -
200 Blood Lancet Buah - - - - -
201 Blood set Buah - - - - -
202 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set - - - - -

203 Catgut/Benang Bedah No.3/0 dengan jarum bedah Set - - - - -


204 Cover Glass Buah - - - - -
205 Cry tube Buah - - - - -
206 Folley Catheter No.18 Buah - - - - -
207 Holder Buah - - - - -
208 Infusion set anak Kantong - - - - -
209 Infusion set dewasa Kantong - - - - -
210 IV Catheter No.18 Set - - - - -
211 IV Catheter No.20 Set - - - - -
212 IV Catheter No.22 Set - - - - -
213 IV Catheter No.24 Set - - - - -
214 Jarum kulit Buah - - - - -
215 Jarum otot Buah - - - - -
216 Kaca Slide Buah - - - - -
217 Kantung mayat Buah - - - - -
218 Kapas Pembalut/absorben 250 mg Roll - - - - -
219 Kasa Hidrofil 2x80 Roll - - - - -
220 Kasa Hidrofil Steril 16 X 16 Lembar - - - - -
221 Kasa Pembalut Hidrofil 4 X 10 cm Roll - - - - -
222 Kasa Pembalut hidrofil 4 x 5 cm Roll - - - - -
223 Kassa Pembalut elastic 4 inchi Roll - - - - -
224 Masker Tie on Buah - - - - -
225 Masker N-95 Buah - - - - -
226 Mikropipet 15-200 µl Buah - - - - -
227 PH Paper Buah - - - - -
228 Plester 5 yard x 2 inch Roll - - - - -
229 Polybag Medis Lembar - - - - -
230 Polybag Nonmedis Lembar - - - - -
231 Polybag Ramah Lingkungan Lembar - - - - -
232 Pot Dahak Buah - - - - -
233 Safety box Buah - - - - -
234 Sarung Tangan Non Steril Uk.S Buah - - - - -
235 Sarung Tangan Non Steril Uk.M Buah - - - - -
236 Sarung Tangan Non Steril Uk.L Buah - - - - -
237 Sarung Tangan Steril No.6 Set - - - - -
238 Sarung Tangan Steril No.6,5 Set - - - - -
239 Sarung Tangan Steril No.7 Set - - - - -
240 Sendok Obat Buah - - - - -
Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum
241 Set - - - - -
Bedah
242 Tabung Vacutainer Buah - - - - -
243 Test Pack Buah - - - - -
244 Urin Bag Buah - - - - -
245 Vintip 60 Buah - - - - -
246 Vintip 61 Buah - - - - -
KESLING - - - - -
247 Desinfektan tablet Tablet - - - - -
248 Kaporit Kg - - - - -
249 PAC Sachet - - - - -
250 Penjernih air cepat Sachet - - - - -
REAGEN - - - - -
251 Cybow 10 Reagent Strip Set - - - - -
252 Golongan Darah Anti A - B - 10 ml Botol - - - - -
253 Humasens Plus Set - - - - -
254 Humasens Plus Strip Uric Acid Kotak - - - - -
255 Humasens Strip Glucose Kotak - - - - -
256 Iodin test Botol - - - - -
257 Larutan Asam Asetat 6% 100 ml Botol - - - - -
258 Larutan Benedict 100 ml Botol - - - - -
259 Larutan HCl 0,1 N 100 ml Botol - - - - -
260 Larutan Ziehl Neelsen Botol - - - - -
261 Rapid Test Biomedika HIV Sachet - - - - -
262 Rapid Test Biomeriux HIV Sachet - - - - -
263 Rapid Test Intec HIV Sachet - - - - -
264 Rapid Test Malaria Sachet - - - - -
265 Rapid Test Oncoprobe HIV Sachet - - - - -
266 Rapid Test SD HIV Sachet - - - - -
267 Rapid Test SD Syphilis Sachet - - - - -
268 Rapid Test Syphilis Sachet - - - - -
269 RPR Syphilis Sachet - - - - -
LAIN-LAIN - - - - -
270 Dekstrometorfan Tablet 15 mg Tablet - - - - -
271 Dektrometorfan Sirup 10 mg/5 ml Botol - - - - -
272 Jarum Vacutainer Buah - - - - -
273 Eritromisin 500 Kapsul Kapsul - - - - -
274 Lovinapir 200 mg Ronavir Tablet - - - - -
275 Efavirenz 600 mg Tablet - - - - -
276 Lamivudine 150 mg Tablet - - - - -
277 Nevirapine 200 mg Tablet - - - - -
278 TDF(300) + 3TC(300) + EFV(600) Tablet - - - - -
279 Tenofovir 300 mg Tablet - - - - -
280 Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet - - - - -
281 Zidovudine(300) + Lamivudine(150) Tablet - - - - -
282 Prokain Benzil Penicillin Vial - - - - -
283 Metildopa 250 mg Tablet - - - - -
284 Ketoprofen 100 mg supp Supp - - - - -
285 Asam Folat 0,4 mg Tablet - - - - -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

286 Tablet Tambah Darah ( Camabion ) Buah - - - - -


287 Humasens Strip Kolesterol Kotak - - - - -
LAMPIRAN BERITA ACARA STOK OPNAME
PERSEDIAAN OBAT DAN PERBEKALAN KESEHATAN (BARANG DINKES)
UPT PUSKESMAS SUKAMULYA
TAHUN 2017
18,091,718.20 - 18,091,718.20 209,153,921.80 209,013,976.33 - - 18,231,663.67
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK

NO NAMA OBAT SATUAN


HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

Tablet 86.00 - 900 90.00 81,000.00 800 90.00 72,000.00 100 90.00 9,000.00
1 Alopurinol Tablet 100 mg
46 86.00 3,956.00 46 86.00 3,956.00 -
2 Albendazol Tablet 400 mg Tablet - 1,356.00 - 2,000 390.00 780,000.00 1,324 390.00 516,360.00 676 390.00 263,640.00
3 Aminofilin Inj 24 mg/ml-10 ml Ampul - 3,822.00 - - 2,998.00 - - 2,998.00 - - 2,998.00 -
4 Aminofilin Tablet 200 mg Tablet - 90.00 - - 90.00 - - 90.00 - - 90.00 -
5 Amitriptilina HCl Tablet salut 25 mg Tablet - 143.00 - - 178.20 - - 178.20 - - 178.20 -
6 Amlodipin Tablet 5 mg Tablet - 187.00 - 430 85.00 36,550.00 300 85.00 25,500.00 130 85.00 11,050.00
7 Kaplet 272.00 - 50,800 190.00 9,652,000.00 47,784 190.00 9,078,960.00 3,016 190.00 573,040.00
Amoksisilin Kaplet 500 mg
3,211 272.00 873,392.00 3,211 272.00 873,392.00 -
Botol 2,445.00 - 1,560 1,881.00 2,934,360.00 1,488 1,881.00 2,798,928.00 72 1,881.00 135,432.00
8 Amoksisilin Sirup Kering 125 mg/5 ml
98 2,445.00 239,610.00 98 2,445.00 239,610.00 - -
Tablet 75.00 - 28,700 58.00 1,664,600.00 26,381 58.00 1,530,098.00 2,319 58.00 134,502.00
9 Antasida DOEN I Tablet Kunyah
1,481 75.00 111,075.00 1,481 75.00 111,075.00 -
Botol - 180 2,025.00 364,500.00 172 2,025.00 348,300.00 8 2,025.00 16,200.00
10 Antasida II Suspensi 60 ml
20 2,100.00 42,000.00 20 2,100.00 42,000.00 -
11 Anti Hemmoroid DOEN Supp - 3,045.00 - 180 3,300.00 594,000.00 160 3,300.00 528,000.00 20 3,300.00 66,000.00
12 Antibakteri DOEN Tube - 2,516.00 - 100 2,924.00 292,400.00 100 2,924.00 292,400.00 - 2,924.00 -
13 Antifungi DOEN kombinasi Pot - 4,158.00 - 222 4,323.00 959,706.00 212 4,323.00 916,476.00 10 4,323.00 43,230.00
14 Antimigren DOEN Tablet - 135.00 - 100 167.00 16,700.00 - 167.00 - 100 167.00 16,700.00
Vial 2,030.00 - 35 2,000.00 70,000.00 25 2,000.00 50,000.00 10 2,000.00 20,000.00
15 Aqua Pro Inj steril bebas pirogen- 20 ml
4 2,030.00 8,120.00 4 2,030.00 8,120.00 -
16 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet - 114.00 - - 114.00 - - 114.00 - - 114.00 -
17 Asam Askorbat (VIT C) Tablet 50 mg Tablet 145 104.00 15,080.00 4,900 104.00 509,600.00 4,767 104.00 495,768.00 278 104.00 28,912.00
Tablet 106.00 - 8,100 100.00 810,000.00 7,591 100.00 759,100.00 509 100.00 50,900.00
18 Asam Mefenamat kaplet 500 mg
250 106.00 26,500.00 250 106.00 26,500.00 -
Tube 3,300.00 - 165 2,640.00 435,600.00 150 2,640.00 396,000.00 15 2,640.00 39,600.00
19 Asiklovir Krim 5%/5g
5 3,300.00 16,500.00 5 3,300.00 16,500.00 -
Tablet 345.00 - 300 349.00 104,700.00 200 349.00 69,800.00 100 349.00 34,900.00
20 Asiklovir Tablet 400 mg
200 345.00 69,000.00 200 345.00 69,000.00 - 345.00 -
21 Atapulgit Tablet 600 mg Tablet 100 145.00 14,500.00 900 145.00 130,500.00 1,000 145.00 145,000.00 - 145.00 -
22 Atropin Sulfat Inj 0,25 mg/ml Ampul - 1,672.00 - - 1,672.00 - - 1,672.00 - - 1,672.00 -
23 Azithromisin Tablet 500 mg Tablet - 4,500.00 - - 4,500.00 - - 4,500.00 - - 4,500.00 -
24 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 5 13,400.00 67,000.00 - 13,400.00 - 5 13,400.00 67,000.00 - 13,400.00 -
Tube 1,520.00 - 373 1,349.00 503,177.00 346 1,349.00 466,754.00 27 1,349.00 36,423.00
25 Betametason Krim 0.1 %
3 1,520.00 4,560.00 3 1,520.00 4,560.00 - -
26 Tablet - 132.00 - 3,300 99.00 326,700.00 3,020 99.00 298,980.00 280 99.00 27,720.00
Bromheksin Tablet 8 mg
175 132.00 23,100.00 175 132.00 23,100.00
27 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket - 32,101.00 - - 2,160.00 - - 2,160.00 - - 2,160.00 -
Ampul - 1,500.00 - 25 1,540.00 38,500.00 20 1,540.00 30,800.00 5 1,540.00 7,700.00
28 Deksametason Inj 5 mg/ml-1 ml
7 1,500.00 10,500.00 7 1,500.00 10,500.00 -
Tablet - 44.00 - 10,422 41.00 427,302.00 9,188 41.00 376,708.00 1,234 41.00 50,594.00
29 Deksametason Tablet 0,5 mg
790 44.00 34,760.00 790 44.00 34,760.00
Tablet 825.00 - 2,600 536.80 1,395,680.00 2,500 536.80 1,342,000.00 100 536.80 53,680.00
30 Dekstrometorfan Tablet kombinasi
200 825.00 165,000.00 200 825.00 165,000.00
Botol - 11,550.00 - 310 9,845.00 3,051,950.00 296 9,845.00 2,914,120.00 14 9,845.00 137,830.00
31 Dektrometorfan Sirup kombinasi
5 11,550.00 57,750.00 5 11,550.00 57,750.00 -
32 Devitalisasi Pasta Botol - 506,000.00 - 2 246,400.00 492,800.00 1 246,400.00 246,400.00 1 246,400.00 246,400.00
33 Dextrose Inj 40% Vial 10 14,524.00 145,240.00 - 14,524.00 - 10 14,524.00 145,240.00 - 14,524.00 -
34 Diazepam Inj 5 mg/ml-2 ml Ampul - 4,180.00 - 75 4,180.00 313,500.00 75 4,180.00 313,500.00 - 4,180.00 -
35 Diazepam Rectal 10 mg/2,5 ml tube - 16,748.00 - 10 16,748.00 167,480.00 10 16,748.00 167,480.00 - 16,748.00 -
tube 11,525.00 - 5 12,090.00 60,450.00 5 12,090.00 60,450.00 - 12,090.00 -
36 Diazepam Rectal 5 mg/2,5 ml
2 11,525.00 23,050.00 2 11,525.00 23,050.00 -
37 Diazepam Tablet 2 mg Tablet - 45.00 - 1,900 45.00 85,500.00 1,900 45.00 85,500.00 - 45.00 -
Ampul - 1,054.00 - 25 1,060.00 26,500.00 15 1,060.00 15,900.00 10 1,060.00 10,600.00
38 Difenhidramin Inj 10 mg/ml
20 1,054.00 21,080.00 20 1,054.00 21,080.00 -
39 Digoksin Tablet 0,25 mg Tablet - 97.00 - 100 104.00 10,400.00 - 104.00 - 100 104.00 10,400.00
40 Dimenhidrinat Tablet 50 mg Tablet - 104.00 - 100 99.00 9,900.00 - 99.00 - 100 99.00 9,900.00
41 Doksisilin Tablet 100 mg Tablet - 270.00 - - 268.00 - - 268.00 - - 268.00 -
Botol - 3,333.00 - 65 3,000.00 195,000.00 55 3,000.00 165,000.00 10 3,000.00 30,000.00
42 Domperidon Suspensi 5mg/5ml
8 3,333.00 26,664.00 8 3,333.00 26,664.00 -
43 Domperidon Tablet 10 mg Tablet - 118.00 - 200 95.00 19,000.00 60 95.00 5,700.00 140 95.00 13,300.00
44 Endometason Botol - 660,000.00 - 1 132,000.00 132,000.00 - 132,000.00 - 1 132,000.00 132,000.00
Ampul - 8,100.00 - 20 2,204.00 44,080.00 10 2,204.00 22,040.00 10 2,204.00 22,040.00
45 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 %
10 8,100.00 81,000.00 10 8,100.00 81,000.00 -
46 Eritromisin Kapsul 250 mg Kapsul - 566.00 - - 557.00 - - 557.00 - - 557.00 -
47 Eritromisin Sirup 200 mg/5 ml Botol 6,700.00 - - 6,150.00 - - 6,150.00 - - 6,150.00 -
Botol - 2,550.00 - 7 3,150.00 22,050.00 7 3,150.00 22,050.00 - 3,150.00 -
48 Etakridin Larutan 0,1 %
2 2,550.00 5,100.00 2 2,550.00 5,100.00 -
Botol - 21,500.00 - 28 26,250.00 735,000.00 26 26,250.00 682,500.00 2 26,250.00 52,500.00
49 Etanol 70 %- 1000 ml
1 21,500.00 21,500.00 1 21,500.00 21,500.00 -
50 Etil Klorida Spray Botol 1 99,000.00 99,000.00 13 99,000.00 1,287,000.00 14 99,000.00 1,386,000.00 - 99,000.00 -
51 Eugenol Cairan Botol - 18,100.00 - 1 18,100.00 18,100.00 - 18,100.00 - 1 18,100.00 18,100.00
52 Fenitoin Natrium Kapsul 100 mg Kapsul - 154.00 - 1,000 152.00 152,000.00 950 152.00 144,400.00 50 152.00 7,600.00
53 Fenobarbital Tablet 30 mg Tablet 135.00 - 3,200 165.00 528,000.00 3,120 165.00 514,800.00 80 165.00 13,200.00
Tablet - 510.00 - 1,300 605.00 786,500.00 1,250 605.00 756,250.00 50 605.00 30,250.00
54 Fenoksimetil Penisilin Tablet 500 mg
220 510.00 112,200.00 220 510.00 112,200.00 -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

Tablet - 634.00 - 400 686.00 274,400.00 330 686.00 226,380.00 70 686.00 48,020.00
55 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg
100 634.00 63,400.00 100 634.00 63,400.00 -
Ampul - 3,417.00 - 365 3,550.00 1,295,750.00 365 3,550.00 1,295,750.00 - 3,550.00 -
56 Fitomenadion(Vit K1) Inj 2 mg/ml
15 3,417.00 51,255.00 15 3,417.00 51,255.00 -
57 Fluconazol Tablet 150 mg Tablet - 2,000.00 - - 18,000.00 - - 18,000.00 - - 18,000.00 -
58 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul - 55,000.00 - - 57,500.00 - - 57,500.00 - - 57,500.00 -
59 Formokresol Cair Botol - 71,500.00 - - 61,490.00 - - 61,490.00 - - 61,490.00 -
Tablet - 85.00 - 500 78.00 39,000.00 470 78.00 36,660.00 30 78.00 2,340.00
60 Furosemid Tablet 40 mg
20 85.00 1,700.00 20 85.00 1,700.00 -
Sachet - 264.00 - 2,200 260.00 572,000.00 2,150 260.00 559,000.00 50 260.00 13,000.00
61 Garam Oralit I Serbuk
100 264.00 26,400.00 100 264.00 26,400.00 -
62 Gentamisin Inj 40 mg/ml (Sulfat) Vial - 3,399.00 - 55 3,386.00 186,230.00 48 3,386.00 162,528.00 7 3,386.00 23,702.00
Tube - 2,420.00 - 650 2,090.00 1,358,500.00 650 2,090.00 1,358,500.00 - 2,090.00 -
63 Gentamisin Salep Kulit 0,1%
4 2,420.00 9,680.00 4 2,420.00 9,680.00 -
64 Gentian Violet Larutan 1 %-10 ml Botol 14 2,695.00 37,730.00 14 2,695.00 37,730.00 28 2,695.00 75,460.00 - 2,695.00 -
65 Glass Ionomer Cement Botol - 605,000.00 - 1 521,235.00 521,235.00 1 521,235.00 521,235.00 - 521,235.00 -
66 Glibenklamid Tablet 5 mg Tablet 100 104.50 10,450.00 1,000 104.50 104,500.00 1,000 104.50 104,500.00 100 104.50 10,450.00
Tablet - 38.50 - 16,000 82.50 1,320,000.00 15,322 82.50 1,264,065.00 678 82.50 55,935.00
67 Gliseril Guaiakolat Tablet 100 mg
1,406 38.50 54,131.00 1,406 38.50 54,131.00 -
Fls - 6,900.00 - 20 6,900.00 138,000.00 8 6,900.00 55,200.00 12 6,900.00 82,800.00
68 Glukosa Larutan Infus 5% steril
-
Tablet - 219.00 - - 247.00 - - 247.00 - - 247.00 -
69 Griseofulvin Tablet 125 mg Micronized
190 219.00 41,610.00 140 219.00 30,660.00 50 219.00 10,950.00
70 Haloperidol 5 mg Tablet - 75.00 - 200 75.00 15,000.00 150 75.00 11,250.00 50 75.00 3,750.00
71 Tablet - 66.00 - 100 61.00 6,100.00 - 61.00 - 100 61.00 6,100.00
Haloperidol Tablet 1,5 mg
- 66.00 - - 66.00 - - 66.00 -
Tube - 2,798.00 - 1,536 2,639.00 4,053,504.00 1,420 2,639.00 3,747,380.00 116 2,639.00 306,124.00
72 Hidrokortison Krim 2,5 %
78 2,798.00 218,244.00 78 2,798.00 218,244.00 -
73 Hiosina butilbromida tab 10 mg Tablet 2,797.50 - - 1,100.00 - - 1,100.00 - - 1,100.00 -
74 Human Tetanus Imunoglobulin Im 250UI (Tetagam) Set - 170,000.00 - - 170,000.00 - - 170,000.00 - - 170,000.00 -
Tablet - 127.00 - 19,400 111.00 2,153,400.00 18,015 111.00 1,999,665.00 1,385 111.00 153,735.00
75 Ibuprofen Tablet 400 mg
1,052 127.00 133,604.00 1,052 127.00 133,604.00 -
76 Isoniazid Tablet 100 mg Tablet - 137.00 - - 74.00 - - 74.00 - - 74.00 -
77 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet - 88.00 - - 90.00 - - 90.00 - - 90.00 -
78 Kalsium glukonat inj 100 mg/ml Ampul 88.00 - - 9,955.00 - - 9,955.00 - - 9,955.00 -
79 Kalsium hidroksida pasta Botol - 137,500.00 - - 187,000.00 - - 187,000.00 - - 187,000.00 -
Tablet - 70.00 - 9,890 56.00 553,840.00 9,088 56.00 508,928.00 802 56.00 44,912.00
80 Kalsium Laktat (Kalk) Tablet 500 mg
595 70.00 41,650.00 595 70.00 41,650.00 -
81 Kaptropil Tablet 25 mg Tablet 657 80.00 52,560.00 7,100 80.00 568,000.00 7,331 80.00 586,480.00 426 80.00 34,080.00
82 Karbamazepin Tablet 200 mg Tablet 204 270.00 55,080.00 3,000 270.00 810,000.00 3,094 270.00 835,380.00 110 270.00 29,700.00
Botol - 2,042.00 - 118 2,500.00 295,000.00 102 2,500.00 255,000.00 16 2,500.00 40,000.00
83 Karbogliserin Tetes Telinga 10 %
14 2,042.00 28,588.00 14 2,042.00 28,588.00 -
84 Karbon aktif tab 0,5 mg Tablet 596 110.00 65,560.00 - 110.00 - 596 110.00 65,560.00 - 110.00 -
Tablet - 300.00 - 300 280.00 84,000.00 300 280.00 84,000.00 - 280.00 -
85 Ketokonazol Tablet 200 mg
70 300.00 21,000.00 70 300.00 21,000.00 -
86 Kina Inj 26 % 2 ml Ampul - 6,200.00 - - 6,200.00 - - 6,200.00 - - 6,200.00 -
87 Kina Tablet 222 mg Tablet - 670.00 - - 670.00 - - 670.00 - - 670.00 -
88 Klindanmisin Tablet 300 mg Tablet - 553.00 - - 578.00 - - 578.00 - - 578.00 -
Kapsul - 273.74 - 100 273.74 27,374.33 100 273.74 27,374.33 - 273.74 -
89 Kloramfenikol Kapsul 250 mg
130 273.74 35,586.20 130 273.74 35,586.20 -
90 Kloramfenikol Kapsul 500 mg Kapsul 1,007.00 - 800 1,048.00 838,400.00 700 1,048.00 733,600.00 100 1,048.00 104,800.00
91 Kloramfenikol Salep Kulit 2% Tube 3,091.00 - 156 3,091.00 482,196.00 126 3,091.00 389,466.00 30 3,091.00 92,730.00
Tube - 1,600.00 - 252 1,798.00 453,096.00 199 1,798.00 357,802.00 53 1,798.00 95,294.00
92 Kloramfenikol Salep Mata 1 %
10 1,600.00 16,000.00 10 1,600.00 16,000.00 -
93 Kloramfenikol Sirup 125 mg/5 ml Botol - 3,955.00 - 40 4,700.00 188,000.00 40 4,700.00 188,000.00 - 4,700.00 -
94 Kloramfenikol Tetes Mata 0.5% Botol - 7,150.00 - 565 3,250.00 1,836,250.00 524 3,250.00 1,703,000.00 41 3,250.00 133,250.00
Tube - 6,160.00 - 190 6,600.00 1,254,000.00 174 6,600.00 1,148,400.00 16 6,600.00 105,600.00
95 Kloramfenikol Tetes telinga 3 %
5 6,160.00 30,800.00 5 6,160.00 30,800.00 -
Tablet - 51.00 - 31,500 37.00 1,165,500.00 28,603 37.00 1,058,311.00 2,897 37.00 107,189.00
96 Klorfenarimin Maleat (CTM) Tablet 4 mg
2,577 51.00 131,427.00 2,577 51.00 131,427.00 -
97 Klorpropmazin HCl Tablet salut 100 mg Tablet - 162.00 - - 162.00 - - 162.00 - - 162.00 -
Botol - 2,145.00 - 760 2,120.00 1,611,200.00 673 2,120.00 1,426,760.00 87 2,120.00 184,440.00
98 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml
74 2,145.00 158,730.00 74 2,145.00 158,730.00 - -
Tablet - 151.00 - 5,100 129.00 657,900.00 4,895 129.00 631,455.00 205 129.00 26,445.00
99 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg
181 151.00 27,331.00 181 151.00 27,331.00 -
100 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 80000-2 ml Ampul - 1,845.00 - 295 1,937.00 571,415.00 285 1,937.00 552,045.00 10 1,937.00 19,370.00
Botol - 41,000.00 - 3 43,050.00 129,150.00 3 43,050.00 129,150.00 - 43,050.00 -
101 Lisol
1 41,000.00 41,000.00 1 41,000.00 41,000.00 -
102 Loratadin Tablet 10 mg Tablet - 154.00 - 100 134.00 13,400.00 100 134.00 13,400.00 - 134.00 -
103 Magnesium sulfat Inj (IV) 20 % Ampul - 6,050.00 - - 3,200.00 - - 3,200.00 - - 3,200.00 -
104 Magnesium sulfat Inj (IV) 40 % Ampul - 3,650.00 - 150 3,650.00 547,500.00 25 3,650.00 91,250.00 125 3,650.00 456,250.00
105 MB Anak Blister - 19,800.00 - - 19,800.00 - - 19,800.00 - - 19,800.00 -
106 MB Dewasa Blister - 27,852.00 - - 27,852.00 - - 27,852.00 - - 27,852.00 -
107 Metformin HCl Tablet 500 mg Tablet - 112.50 - 300 100.00 30,000.00 200 100.00 20,000.00 100 100.00 10,000.00
108 Metilergomatrin Maleat Inj 0,200 mg Ampul 2,750.00 - 70 2,849.00 199,430.00 45 2,849.00 128,205.00 25 2,849.00 71,225.00
Tablet - 154.00 - 3,000 327.80 983,400.00 2,900 327.80 950,620.00 100 327.80 32,780.00
109 Metilergometrin Maleat (Metilergometrin) Tablet Salut 0,125 mg
103 154.00 15,862.00 103 154.00 15,862.00 -
Tablet - 205.00 - 8,500 150.00 1,275,000.00 6,759 150.00 1,013,850.00 1,741 150.00 261,150.00
110 Metilprednisolon Tablet 4 mg
100 205.00 20,500.00 8,500 100 205.00 20,500.00 -
Tablet - 160.00 - 4,100 113.00 463,300.00 3,660 113.00 413,580.00 440 113.00 49,720.00
111 Metronidazol Tablet 500 mg
17 160.00 2,720.00 17 160.00 2,720.00 -
Tube - 3,000.00 - 240 3,250.00 780,000.00 226 3,250.00 734,500.00 14 3,250.00 45,500.00
112 Mikonazol Krim/Salep 2%
6 3,000.00 18,000.00 6 3,000.00 18,000.00 -
113 Mineral Mix Sachet - 2,450.00 - - 2,450.00 - - 2,450.00 - - 2,450.00 -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

114 Monoklorkamfer mentol cairan Botol - 88,000.00 - - 63,800.00 - - 63,800.00 - - 63,800.00 -


115 Multivitamin + DHA + Lysin Botol - 10,230.00 - 135 10,725.00 1,447,875.00 124 10,725.00 1,329,900.00 11 10,725.00 117,975.00
Kaplet - 935.00 - 1,900 946.00 1,797,400.00 1,730 946.00 1,636,580.00 170 946.00 160,820.00
116 Multivitamin + Mineral
190 935.00 177,650.00 190 935.00 177,650.00 -
117 N-asetil sistein kaps 200 mg Kapsul - - 426.00 - - 426.00 - - 426.00 -
118 Natrium Bikarbonat Tablet 500 mg Tablet 460 38.50 17,710.00 5,000 38.50 192,500.00 5,222 38.50 201,047.00 238 38.50 9,163.00
Tablet - 200.00 - 7,170 159.00 1,140,030.00 6,885 159.00 1,094,715.00 285 159.00 45,315.00
119 Natrium Diklofenak Tablet 50 mg
414 200.00 82,800.00 414 200.00 82,800.00 -
120 Natrium Hipoklorit 3% Botol - 71,500.00 - - 71,500.00 - - 71,500.00 - - 71,500.00 -
121 Natrium Klorida Larutan Infus 0,9% Fls 10 6,410.00 64,100.00 80 6,410.00 512,800.00 75 6,410.00 480,750.00 15 6,410.00 96,150.00
122 Natrium Tiroksin Tablet 100 µg Tablet - 1,550.00 - - - - - - - - - -
123 Nistatin Tablet Salut Gula 500.000 IU/g Tablet - 640.00 - 370 765.00 283,050.00 295 765.00 225,675.00 75 765.00 57,375.00
124 Nistatin Tablet Vaginal 100.000 IU/g Tablet - 523.00 - 260 545.00 141,700.00 228 545.00 124,260.00 32 545.00 17,440.00
Paket - 359,900.00 - 24 374,379.00 8,985,096.00 23 374,379.00 8,610,717.00 1 374,379.00 374,379.00
125 OAT FDC Katagori 1
1 359,900.00 359,900.00 1 359,900.00 359,900.00 -
Paket - 1,199,985.00 - 3 1,247,984.00 3,743,952.00 1 1,247,984.00 1,247,984.00 2 1,247,984.00 2,495,968.00
126 OAT FDC Katagori 2
1 1,199,985.00 1,199,985.00 1 1,199,985.00 1,199,985.00 - -
paket - 214,985.00 - 14 223,583.00 3,130,162.00 12 223,583.00 2,682,996.00 2 223,583.00 447,166.00
127 OAT FDC Kategori Anak
1 214,985.00 214,985.00 1 214,985.00 214,985.00 -
128 OAT FDC Kategori Sisipan Paket - 160,000.00 - - 160,000.00 - - 160,000.00 - - 160,000.00 -
129 OAT Kombipak Kat I paket - 288,200.00 - - 288,200.00 - - 288,200.00 - - 288,200.00 -
Botol - 4,235.00 - 750 3,657.50 2,743,125.00 677 3,657.50 2,476,127.50 73 3,657.50 266,997.50
130 Obat Batuk Hitam (OBH) Cairan
7 4,235.00 29,645.00 7 4,235.00 29,645.00 -
131 Oksitetrasiklin HCl 1 % Salep Mata Tube 73 2,772.00 202,356.00 250 2,772.00 693,000.00 323 2,772.00 895,356.00 - 2,772.00 -
132 Oksitetrasiklin HCl Salep Kulit 3 % Tube - 1,870.00 - 539 1,870.00 1,007,930.00 539 1,870.00 1,007,930.00 - 1,870.00 -
133 Oksitoksin in 10 IU/ml- 1 ml Ampul 117 1,900.00 222,300.00 1,200 1,900.00 2,280,000.00 1,172 1,900.00 2,226,800.00 145 1,900.00 275,500.00
Kapsul - 211.00 - 870 160.00 139,200.00 850 160.00 136,000.00 20 160.00 3,200.00
134 Omeprazol Kapsul 20 mg
30 211.00 6,330.00 30 211.00 6,330.00 -
135 Ondansetron Inj 4 mg/2 ml Ampul - 1,650.00 - - 1,254.00 - - 1,254.00 - - 1,254.00 -
Botol - 1,438.00 - 1,728 1,010.00 1,745,280.00 1,602 1,010.00 1,618,020.00 126 1,010.00 127,260.00
136 Parasetamol Sirup 120 mg / 5ml
129 1,438.00 185,502.00 129 1,438.00 185,502.00 -
Tablet - 89.00 - 56,700 49.00 2,778,300.00 49,786 49.00 2,439,514.00 6,914 49.00 338,786.00
137 Parasetamol Tablet 500 mg
2,472 89.00 220,008.00 2,472 89.00 220,008.00 -
138 PB Anak Blister - 8,712.00 - - 8,712.00 - - 8,712.00 - - 8,712.00 -
139 PB Dewasa Blister - 8,712.00 - - 8,712.00 - - 8,712.00 - - 8,712.00 -
140 Permetrin 5% Krim (Scabimite) Tube - 12,155.00 - 230 12,155.00 2,795,650.00 230 12,155.00 2,795,650.00 - 12,155.00 -
141 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 1,172 118.00 138,296.00 8,700 118.00 1,026,600.00 8,920 118.00 1,052,560.00 952 118.00 112,336.00
Botol - 2,163.00 - 44 3,045.00 133,980.00 39 3,045.00 118,755.00 5 3,045.00 15,225.00
142 Povidon Iodida 10 %-30 ml
2 2,163.00 4,326.00 2 2,163.00 4,326.00 -
Botol - 14,203.00 - 13 18,900.00 245,700.00 11 18,900.00 207,900.00 2 18,900.00 37,800.00
143 Povidon Iodida 10 %-300 ml
1 14,203.00 14,203.00 1 14,203.00 14,203.00 -
144 Prednison Tablet 5 mg Tablet 289 96.00 27,744.00 5,500 96.00 528,000.00 5,479 96.00 525,984.00 310 96.00 29,760.00
145 Primakuin Tablet 15 mg Tablet - 224.00 - - 224.00 - - 224.00 - - 224.00 -
146 Propanolol HCl Tablet 40 mg Tablet - 60.00 - - 74.00 - - 74.00 - - 74.00 -
147 Propiltiourasil Tablet 100 mg Tablet - 319.00 - - 403.70 - - 403.70 - - 403.70 -
Ampul - 1,140.00 - 105 1,458.00 153,090.00 105 1,458.00 153,090.00 - 1,458.00 -
148 Ranitidin Inj 25 mg/ml
2 1,140.00 2,280.00 2 1,140.00 2,280.00 -
Tablet - 120.00 - 7,100 98.00 695,800.00 6,692 98.00 655,816.00 408 98.00 39,984.00
149 Ranitidin Tablet 150 mg
381 120.00 45,720.00 381 120.00 45,720.00 -
150 Resperidon 2 mg Tablet - 495.00 - - 495.00 - - 495.00 - - 495.00 -
151 Retinol (Vit A) Kapsul 100.000 IU Kapsul - 284.00 - - 284.00 - - 284.00 - - 284.00 -
152 Retinol (VIT A) Kapsul 200.000 IU Kapsul - 459.00 - - 508.00 - - 508.00 - - 508.00 -
153 Ringer Laktat Larutan Infus Steril Fls 13 7,150.00 92,950.00 808 7,150.00 5,777,200.00 787 7,150.00 5,627,050.00 34 7,150.00 243,100.00
154 Salbutamol 2,5 mg/2,5 ml NaCl Ampul - 6,600.00 - - 3,999.60 - - 3,999.60 - - 3,999.60 -
Tablet - 83.00 - 1,200 87.00 104,400.00 1,086 87.00 94,482.00 114 87.00 9,918.00
155 Salbutamol Tablet 4 mg
130 83.00 10,790.00 130 83.00 10,790.00 -
Pot - 2,000.00 - 528 2,527.00 1,334,256.00 469 2,527.00 1,185,163.00 59 2,527.00 149,093.00
156 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 %
20 2,000.00 40,000.00 20 2,000.00 40,000.00 -
Kotak - 1,250.00 - 370 1,020.00 377,400.00 368 1,020.00 375,360.00 2 1,020.00 2,040.00
157 Salisil Bedak 2 %
30 1,250.00 37,500.00 30 1,250.00 37,500.00 -
Botol - 4,746.00 - 210 4,485.00 941,850.00 197 4,485.00 883,545.00 13 4,485.00 58,305.00
158 Sefadroksil Sirup 125 mg/5 ml
3 4,746.00 14,238.00 3 4,746.00 14,238.00 -
159 Sefadroxil Kapsul 500 mg Kapsul 20 510.00 10,200.00 2,900 510.00 1,479,000.00 2,720 510.00 1,387,200.00 200 510.00 102,000.00
160 Sefiksime 200 mg + Azitromisin 500 mg Paket - 33,000.00 - - 30,030.00 - - 30,030.00 - - 30,030.00 -
161 Sefotaksim Inj 1 g Vial - 4,000.00 - - 4,000.00 - - 4,000.00 - - 4,000.00 -
162 Seftriaxon Inj 1 g Vial - 8,360.00 - - 9,900.00 - - 9,900.00 - - 9,900.00 -
163 Semen seng fosfat serbuk cairan Botol - 170,500.00 - 1 228,800.00 228,800.00 - 228,800.00 - 1 228,800.00 228,800.00
164 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul - 126,500.00 - - 126,500.00 - - 126,500.00 - - 126,500.00 -
165 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial - 473,000.00 - - 462,000.00 - - 462,000.00 - - 462,000.00 -
Ampul - 1,078.00 - 30 1,087.00 32,610.00 30 1,087.00 32,610.00 - 1,087.00 -
166 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml
20 1,078.00 21,560.00 20 1,078.00 21,560.00 -
167 Simvastatin Tablet 10 mg Tablet - 131.00 - 690 131.00 90,390.00 466 131.00 61,046.00 224 131.00 29,344.00
Kaplet - 281.00 - 2,200 240.00 528,000.00 1,810 240.00 434,400.00 390 240.00 93,600.00
168 Siprofloksasin (HCl) Tablet 500 mg
85 281.00 23,885.00 85 281.00 23,885.00 -
169 Tablet Tambah Darah Kombinasi Tablet - 50.00 - 5,500 350.00 1,925,000.00 4,560 350.00 1,596,000.00 940 350.00 329,000.00
170 Temporary Restorative Material Botol - 165,000.00 - - 330,000.00 - - 330,000.00 - - 330,000.00 -
Kapsul - 300.00 - 3,400 310.00 1,054,000.00 2,938 310.00 910,780.00 462 310.00 143,220.00
171 Tetrasiklin Kapsul 500 mg
20 300.00 6,000.00 20 300.00 6,000.00 -
172 Tiamin HCL (Vit B1) Inj 100 mg/ml-1ml Ampul - 767.00 - 40 767.00 30,680.00 40 767.00 30,680.00 - 767.00 -
Tablet - 86.00 - 18,800 82.00 1,541,600.00 17,220 82.00 1,412,040.00 1,580 82.00 129,560.00
173 Tiamin HCL (Vit B1) Tablet 50 mg
961 86.00 82,646.00 961 86.00 82,646.00 -
174 Triheksifenidil HCl Tablet 2 mg Tablet 80 88.00 7,040.00 1,200 88.00 105,600.00 1,160 88.00 102,080.00 120 88.00 10,560.00
175 Vaksin BCG + Pelarut Set 29 59,950.00 1,738,550.00 256 59,950.00 15,347,200.00 285 59,950.00 17,085,750.00 - 59,950.00 -
176 Vaksin Campak + Pelarut Set 28 28,204.00 789,712.00 195 28,204.00 5,499,780.00 223 28,204.00 6,289,492.00 - 28,204.00 -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

177 Vaksin DPT-Hb-Hib Vial 53 76,285.00 4,043,105.00 375 76,285.00 28,606,875.00 428 76,285.00 32,649,980.00 - 76,285.00 -
178 Vaksin DT Vial - 17,798.00 - 110 17,798.00 1,957,780.00 110 17,798.00 1,957,780.00 - 17,798.00 -
179 Vaksin Hb-0 Set 79 20,900.00 1,651,100.00 405 20,900.00 8,464,500.00 484 20,900.00 10,115,600.00 - 20,900.00 -
180 Vaksin IPV 10 ds Vial 34,815.00 - 23 34,815.00 800,745.00 23 34,815.00 800,745.00 - 34,815.00 -
181 Vaksin IPV 5 ds Vial - 15 139,000.00 2,085,000.00 15 139,000.00 2,085,000.00 - 139,000.00 -
182 Vaksin Measles Rubella (MR) Vial - 50 149,820.00 7,491,000.00 20 149,820.00 2,996,400.00 30 149,820.00 4,494,600.00
183 Vaksin Meningitis Paket - 198,000.00 - - - - - - - - - -
184 Vaksin Papillomavirus (HPV) Vial - - - - - - - - - -
185 Vaksin Pneumococcus Vial - - - - - - - - - -
186 Vaksin Polio 10 ds + Penetes Set 49 19,954.00 977,746.00 195 19,954.00 3,891,030.00 244 19,954.00 4,868,776.00 - 19,954.00 -
187 Vaksin Polio 5 ds + Penetes Set - - - - - - - - - -
188 Vaksin Rabies Vero Set - 78,500.00 - - 174,499.60 - - 174,499.60 - - 174,499.60 -
189 Vaksin Td Vial 44 16,500.00 726,000.00 85 16,500.00 1,402,500.00 129 16,500.00 2,128,500.00 - 16,500.00 -
190 Vitamin B Kompleks Tablet Tablet 1,744 115.00 200,560.00 23,500 115.00 2,702,500.00 23,950 115.00 2,754,250.00 1,294 115.00 148,810.00
191 Zinc Tablet 20 mg Tablet - 473.00 - 2,600 508.00 1,320,800.00 2,343 508.00 1,190,244.00 257 508.00 130,556.00
ALKES HABIS PAKAI - - - - - - -
192 ADS 0.05 ml Buah - 1,395.00 - - 1,395.00 - - 1,395.00 - - 1,395.00 -
193 ADS 0.5 ml Buah - 1,195.00 - - 1,195.00 - - 1,195.00 - - 1,195.00 -
194 ADS 5 ml Buah - 1,640.00 - - 1,640.00 - - 1,640.00 - - 1,640.00 -
Set - 650.00 - 1,800 787.00 1,416,600.00 1,650 787.00 1,298,550.00 150 787.00 118,050.00
195 Alat Suntik Sekali Pakai 1ml
80 650.00 52,000.00 80 650.00 52,000.00 -
Set - 650.00 - 6,500 827.00 5,375,500.00 6,300 827.00 5,210,100.00 200 827.00 165,400.00
196 Alat Suntik Sekali Pakai 3 ml
240 650.00 156,000.00 240 650.00 156,000.00 -
Set - 750.00 - 1,000 928.00 928,000.00 900 928.00 835,200.00 100 928.00 92,800.00
197 Alat Suntik Sekali Pakai 5 ml
130 750.00 97,500.00 130 750.00 97,500.00 -
198 Alkohol Swab Buah - - 103.00 - - 103.00 - - 103.00 -
199 Bisturi Buah - 770.00 - 10 396.00 3,960.00 10 396.00 3,960.00 - 396.00 -
200 Blood Lancet Buah - 3,600.00 - - - - - - -
201 Blood set Buah - - 3,708.00 - - 3,708.00 - - 3,708.00 -
202 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set 5,583.33 - 76 5,751.02 437,077.41 67 5,751.02 385,318.24 9 5,751.02 51,759.17
203 Catgut/Benang Bedah No.3/0 dengan jarum bedah Set - 5,583.33 - - 5,750.83 - - 5,750.83 - - 5,750.83 -
204 Cover Glass Buah - - - - - - -
205 Cry tube Buah - - - - - - -
206 Folley Catheter No.18 Buah - 8,000.00 - - 11,000.00 - - 11,000.00 - - 11,000.00 -
207 Holder Buah - - - - - - -
208 Infusion set anak Kantong - 5,100.00 - 10 5,100.00 51,000.00 10 5,100.00 51,000.00 - 5,100.00 -
Kantong - 6,435.00 - 195 4,975.00 970,125.00 177 4,975.00 880,575.00 18 4,975.00 89,550.00
209 Infusion set dewasa
26 6,435.00 167,310.00 26 6,435.00 167,310.00 -
Set - 3,800.00 - 16 6,000.00 96,000.00 16 6,000.00 96,000.00 - 6,000.00 -
210 IV Catheter No.18
5 3,800.00 19,000.00 5 3,800.00 19,000.00 -
Set 2 6,000.00 12,000.00 180 6,000.00 1,080,000.00 167 6,000.00 1,002,000.00 15 6,000.00 90,000.00
211 IV Catheter No.20
-
212 IV Catheter No.22 Set - 6,000.00 - - 6,000.00 - - 6,000.00 - - 6,000.00 -
213 IV Catheter No.24 Set - 6,000.00 - 110 6,000.00 660,000.00 94 6,000.00 564,000.00 16 6,000.00 96,000.00
214 Jarum kulit Buah - 2,291.67 - - 2,291.67 - - 2,291.67 - - 2,291.67 -
215 Jarum otot Buah - 2,291.67 - - 2,291.67 - - 2,291.67 - - 2,291.67 -
216 Kaca Slide Buah - - 19,700.00 - - 19,700.00 - - 19,700.00 -
217 Kantung mayat Buah - - 170,000.00 - - 170,000.00 - - 170,000.00 -
218 Kapas Pembalut/absorben 250 mg Roll - 12,500.00 - 27 12,875.00 347,625.00 26 12,875.00 334,750.00 1 12,875.00 12,875.00
219 Kasa Hidrofil 2x80 Roll - 7,700.00 - - 9,400.00 - - 9,400.00 - - 9,400.00 -
Lembar - 362.50 - 1,178 493.75 581,637.50 1,078 493.75 532,262.50 100 493.75 49,375.00
220 Kasa Hidrofil Steril 16 X 16
34 362.50 12,325.00 34 362.50 12,325.00 -
221 Kasa Pembalut Hidrofil 4 X 10 cm Roll - 1,500.00 - 175 2,300.00 402,500.00 175 2,300.00 402,500.00 - 2,300.00 -
222 Kasa Pembalut hidrofil 4 x 5 cm Roll - 750.00 - - 1,100.00 - - 1,100.00 - - 1,100.00 -
223 Kassa Pembalut elastic 4 inchi Roll - 14,630.00 - - 10,450.00 - - 10,450.00 - - 10,450.00 -
Buah - 330.00 - 800 480.00 384,000.00 775 480.00 372,000.00 25 480.00 12,000.00
224 Masker Tie on
35 330.00 11,550.00 35 330.00 11,550.00 -
225 Masker N-95 Buah - 7,810.00 - 40 7,810.00 312,400.00 40 7,810.00 312,400.00 - 7,810.00 -
226 Mikropipet 15-200 µl Buah - - - - - - -
227 PH Paper Buah - - - - - - -
Roll - 35,532.00 - 21 31,265.00 656,565.00 17 31,265.00 531,505.00 4 31,265.00 125,060.00
228 Plester 5 yard x 2 inch
2 35,532.00 71,064.00 2 35,532.00 71,064.00 -
229 Polybag Medis Lembar - - 300.00 - - 300.00 - - 300.00 -
230 Polybag Nonmedis Lembar - - 220.00 - - 220.00 - - 220.00 -
231 Polybag Ramah Lingkungan Lembar - - 250.00 - - 250.00 - - 250.00 -
232 Pot Dahak Buah - 155 5,890.00 912,950.00 75 5,890.00 441,750.00 80 5,890.00 471,200.00
233 Safety box Buah - 18,625.00 - - 18,625.00 - - 18,625.00 - - 18,625.00 -
234 Sarung Tangan Non Steril Uk.S Buah - 400 466.62 186,648.00 - 466.62 - 400 466.62 186,648.00
Buah - 356.20 - 2,100 466.62 979,902.00 2,050 466.62 956,571.00 50 466.62 23,331.00
235 Sarung Tangan Non Steril Uk.M
60 356.20 21,372.00 60 356.20 21,372.00 -
236 Sarung Tangan Non Steril Uk.L Buah - - 466.62 - - 466.62 - - 466.62 -
237 Sarung Tangan Steril No.6 Set - 20 - - 20 - - - - -
Set - 4,180.00 - 100 6,930.00 693,000.00 80 6,930.00 554,400.00 20 6,930.00 138,600.00
238 Sarung Tangan Steril No.6,5
13 4,180.00 54,340.00 13 4,180.00 54,340.00 -
239 Sarung Tangan Steril No.7 Set - - 6,930.00 - - 6,930.00 - - 6,930.00 -
240 Sendok Obat Buah - 170.50 - 3,200 253.00 809,600.00 3,150 253.00 796,950.00 50 253.00 12,650.00
241 Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum Bedah Set - 3,055.56 - 16 3,147.22 50,355.56 16 3,147.22 50,355.56 - 3,147.22 -
242 Tabung Vacutainer Buah - - - - - - - - - -
243 Test Pack Buah - 25 6,911.00 172,775.00 9 6,911.00 62,199.00 16 6,911.00 110,576.00
244 Urin Bag Buah - 3,000.00 - 5 5,500.00 27,500.00 5 5,500.00 27,500.00 - 5,500.00 -
245 Vintip 60 Buah - - - - - - - - - -
246 Vintip 61 Buah - - - - - - - - - -
KESLING - - - - - - -
247 Desinfektan tablet Tablet - - 500.00 - - 500.00 - - 500.00 -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

248 Kaporit Kg - - 20,000.00 - - 20,000.00 - - 20,000.00 -


249 PAC Sachet - - 5,000.00 - - 5,000.00 - - 5,000.00 -
250 Penjernih air cepat Sachet - - 5,000.00 - - 5,000.00 - - 5,000.00 -
REAGEN - - - - - - -
251 Cybow 10 Reagent Strip Set 133,750.00 - - 135,200.00 - - 135,200.00 - - 135,200.00 -
252 Golongan Darah Anti A - B - 10 ml Botol - - 92,510.00 - - 92,510.00 - - 92,510.00 -
253 Humasens Plus Set 805,950.00 - - 805,950.00 - - 805,950.00 - - 805,950.00 -
254 Humasens Plus Strip Uric Acid Kotak 548,300.00 - - 550,800.00 - - 550,800.00 - - 550,800.00 -
255 Humasens Strip Glucose Kotak 249,800.00 - - 252,300.00 - - 252,300.00 - - 252,300.00 -
256 Iodin test Botol - 5,806.00 - - 5,806.00 - - 5,806.00 - - 5,806.00 -
257 Larutan Asam Asetat 6% 100 ml Botol - - - - - - - - - -
258 Larutan Benedict 100 ml Botol - - 19,950.00 - - 19,950.00 - - 19,950.00 -
259 Larutan HCl 0,1 N 100 ml Botol - - 19,950.00 - - 19,950.00 - - 19,950.00 -
260 Larutan Ziehl Neelsen Botol - - 276,500.00 - - 276,500.00 - - 276,500.00 -
261 Rapid Test Biomedika HIV Sachet 35,000.00 - - 35,000.00 - - 35,000.00 - - 35,000.00 -
262 Rapid Test Biomeriux HIV Sachet 22,475.00 - - 22,475.00 - - 22,475.00 - - 22,475.00 -
263 Rapid Test Intec HIV Sachet 22,358.00 - - 22,358.00 - - 22,358.00 - - 22,358.00 -
264 Rapid Test Malaria Sachet 27,710.00 - - 27,710.00 - - 27,710.00 - - 27,710.00 -
265 Rapid Test Oncoprobe HIV Sachet 24,495.00 - - 24,495.00 - - 24,495.00 - - 24,495.00 -
266 Rapid Test SD HIV Sachet 22,330.00 - - 22,330.00 - - 22,330.00 - - 22,330.00 -
267 Rapid Test SD Syphilis Sachet 27,710.00 - - 27,710.00 - - 27,710.00 - - 27,710.00 -
268 Rapid Test Syphilis Sachet 22,385.00 - - 27,710.00 - - 27,710.00 - - 27,710.00 -
269 RPR Syphilis Sachet 22,385.00 - - 22,385.00 - - 22,385.00 - - 22,385.00 -
LAIN-LAIN - - - - - -
270 Dekstrometorfan Tablet 15 mg Tablet 110.00 - - - - - - - - -
271 Dektrometorfan Sirup 10 mg/5 ml Botol 2,865.00 - - - - - - - - -
272 Jarum Vacutainer Buah 22,330.00 - - - - - - - -
273 Eritromisin 500 Kapsul Kapsul 27,710.00 - 730.00 - 730.00 - - 730.00 -
274 Lovinapir 200 mg Ronavir Tablet 22,385.00 - 6,600.00 - 6,600.00 - - 6,600.00 -
275 Efavirenz 600 mg Tablet 22,385.00 - 6,375.00 - 6,375.00 - - 6,375.00 -
276 Lamivudine 150 mg Tablet - 1,500.00 - 1,500.00 - - 1,500.00 -
277 Nevirapine 200 mg Tablet 110.00 - 2,800.00 - 2,800.00 - - 2,800.00 -
278 TDF(300) + 3TC(300) + EFV(600) Tablet 2,865.00 - 11,895.00 - 11,895.00 - - 11,895.00 -
279 Tenofovir 300 mg Tablet - 8,100.00 - 8,100.00 - - 8,100.00 -
280 Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet - 3,058.00 - 3,058.00 - - 3,058.00 -
281 Zidovudine(300) + Lamivudine(150) Tablet - 3,700.00 - 3,700.00 - - 3,700.00 -
282 Prokain Benzil Penicillin Vial - 8,615.00 - 8,615.00 - - 8,615.00 -
283 Metildopa 250 mg Tablet - 911.00 - 911.00 - - 911.00 -
284 Ketoprofen 100 mg supp Supp - 2,640.00 - 2,640.00 - - 2,640.00 -
285 Asam Folat 0,4 mg Tablet - 55.00 - 55.00 - - 55.00 -
286 Tablet Tambah Darah ( Camabion ) Buah - 355.00 - 355.00 - - 355.00 -
287 Humasens Strip Kolesterol Kotak - 544,400.00 - 544,400.00 - - 544,400.00 -
288 Bisoprolol 5 mg Tablet - 260.00 - 260.00 - - 260.00 -
289 Setirizin Sirup 5 mg / 5 ml Botol - 3,150.00 - 3,150.00 - - 3,150.00 -
290 Golongan darah anti A - 10 ml Botol - 68,200.00 - 68,200.00 - - 68,200.00 -
291 Golongan darah anti B - 10 ml Botol - 68,200.00 - 68,200.00 - - 68,200.00 -
292 Salmonella Thyphi H - 5 ml Botol - 66,660.00 - 66,660.00 - - 66,660.00 -
293 Salmonella Thyphi O - 5 ml Botol - 66,660.00 - 66,660.00 - - 66,660.00 -
294 Nipedipin 10 mg Tablet - 99.00 - 99.00 - - 99.00 -
295 Lidocain Jelly 2 % Tube - 40,000.00 - 40,000.00 - - 40,000.00 -
296 Lidocain Spray 10 % Botol - 170,400.00 - 170,400.00 - - 170,400.00 -
297 Betahistin 6 mg Tablet - 149.00 - 149.00 - - 149.00 -
298 DBS collection kit dus - 545,593.00 - 545,593.00 - - 545,593.00 -
299 Phenolphtalein, paraffin liquidum, gliserin syr (laxadin syr) botol - 7,700.00 - 7,700.00 - - 7,700.00 -
300 Polikresulen ( Albotyl) 5 ml botol - 22,445.50 - 22,445.50 - - 22,445.50 -
301 Haloperidol inj 5 mg/ml Ampul - 4,000.00 - 4,000.00 - - 4,000.00 -
302 Haloperidol dekanoat inj 50 mg/ml Ampul - 97,500.00 - 97,500.00 - - 97,500.00 -
303 Clozapine 25 mg Tablet - 1,550.00 - 1,550.00 - - 1,550.00 -
304 Clobazam 10 mg Tablet - 760.00 - 760.00 - - 760.00 -
305 Larutan Rees Ecker 100 ml Botol - 48,802.08 - 48,802.08 - - 48,802.08 -
306 Larutan Natrium Citrat 3 - 13 % Botol - 19,475.00 - 19,475.00 - - 19,475.00 -
307 Larutan Turk 100 ml Botol - 26,387.00 - 26,387.00 - - 26,387.00 -
308 Larutan EDTA 10 % 100 ml Botol - 74,100.00 - 74,100.00 - - 74,100.00 -
309 Antifdifteri Vial - 2,200,000.00 - 2,200,000.00 - - 2,200,000.00 -
310 Pirimethamin Tablet - 1,315.00 - 1,315.00 - - 1,315.00 -
311 Amoksisilin forte sirup Kering 250 mg/5 ml Botol 3,984.00 - - - - -
312 Amoksisilin Kaplet 250 mg Kaplet 195.00 - - - - -
313 Antalgin (Metampiron) Tablet 500 mg Tablet 124.22 - - - - -
314 Benechek Plus Uric tes strip 25 Buah 127,618.89 - - - - -
315 Benechek Plus glucosa test srip 50 Buah 152,005.33 - - - - -
316 Benechek Plus total Cholesterol strip 10 Buah 232,060.00 - - - - -
317 Etanol 70 %- 100 ml Botol 2,500.00 - - - - -
318 HB Stik Accon Buah 8,010.00 - - - - -
319 HCT Tablet 25 mg Tablet 149.00 - - - - -
320 Lidokain Inj 2% Ampul 839.00 - - - - -
321 Metronidazol sirup Botol 3,800.00 - - - - -
322 Metronidazol tablet 250 mg Tablet 94.00 - - - - -
323 metylprednison 8 mg Tablet 309.00 - - - - -
324 Omeprazol inj Ampul 16,997.00 - - - - -
325 Piracetam Tablet 1200 mg Tablet 1,292.30 - - - - -
326 Salbutamol 2mg Tablet 66.00 - - - - -
327 Tiamfenikol Kapsul 500 mg Kapsul 605.00 - - - - -
328 Tramadol Inj 50 mg/ml Ampul 2,395.00 - - - - -
329 Tramadol Kapsul 50 mg Tablet 304.56 - - - - -
PERSEDIAAN AWAL PENERIMAAN PENYALURAN SISA STOK
NO NAMA OBAT SATUAN
HARGA HARGA HARGA
VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME JUMLAH HARGA VOLUME HARGA SATUAN JUMLAH HARGA
SATUAN SATUAN SATUAN

330 Vaksin TT Vial 14,498.00 - - - - -


JUMLAH 18,091,718.20 209,153,921.80 209,013,976.33 18,231,663.67

Garut, 31 Desember 2017


Kepala UPT Puskesmas Sukamulya
Dinas Kesehatan Kabupaten Garut

H.Atik Rahmat,S.Sos.SKM.M.Kes.
NIP 196710101988031004
PEMERINTAH KABUPATEN GARUT
DINAS KESEHATAN KABUPATEN GARUT
UPT PUSKESMAS SUKAMULYA
SALDO PERSEDIAAN PER 31 DESEMBER 2017

BERITA ACARA
STOCK OPNAME PERSEDIAAN BARANG

Pada hari ini Minggu, tanggal tiga puluh satu bulan Desember tahun dua ribu tujuh belas, kami yang bertanda tangan
di bawah ini :
Nama : H.Atik Rahmat, M.Kes.
Jabatan : Kepala UPT Puskesmas Sukamulya

Telah melaksanakan stok opname terhadap barang persediaan pada UPT Puskesmas Sukamulya
Dinas Kesehatan Kabupaten Garut, ditemukan saldo sebesar Rp 18,238,923.67 ,dengan rincian sebagai berkut:
1 . Obat dan Perbekalan Kesehatan Rp 18,231,663.67
2 . ATK Rp
3 . Reagen Rp
4 . Bahan Makanan dan Minuman Rp
5 . Cetakan Rp
6.
7.
8.
9.
10 .

Mulai tahun 2017


No Jenis Persediaan Saldo Per 1 Jan 2017 Saldo Per 31 Des 2017
Penambahan Pengurangan
1 2 3 4 5 6= 3+4-5
1 Untuk dijual 18,091,718.20 209,153,921.80 209,013,976.33 18,231,663.67

Demikian Berita Acara ini kami buat, untuk dipergunakan seperlunya. Rincian persediaan barang terlampir.

Kepala UPT Puskesmas Sukamulya


Dinas Kesehatan Kabupaten Garut

H.Atik Rahmat,S.Sos.SKM.M.Kes.
NIP 196710101988031004