Harga Obat Perbulan

LAPORAN PENCACAHAN OBAT
TAHUN 2013
PUSKESMAS GEDA
No Nama Obat Satuan Harga Harga/

(satuan + biji
PPN 10%)
1 2 3 4
1 Acyclovir krim 5% 100 tablet/strip/blister , kotak 2,727.00 2,727.00
2 Acyclovir tablet 400 mg ktk 10 x 30 tablet 28,659.00 955.30
3 Alopurinol tablet 100 mg 100 tablet / botol 10,958.00 109.58
4 Ambroxol tablet 30 mg 30 ampul / kotak 8,593.00 85.93
5 Aminofilin tablet 200 mg 100 tablet/strip/blister , kotak 8,715.00 87.15
6 Amitriptilin tablet 25 mg 30 tablet/strip/kotak 10,200.00 873.00
7 Amoxicillin kapsul 250 mg 100 kaplet/strip, kotak 19,000.00 190.00
8 Amoxicillin syrup kering 125 mg/5 ml 120 kapsul/strip/blister, kotak 2,300.00 2,300.00
9 Amoxicillin tablet 500 mg Botol 60 ml 22,000.00 220.00
10 Antalgin tablet 500 mg 10 vial/kotak 124,500.00 124.50
11 Antasida syrup Botol 60 ml 1,865.00 1,865.00
12 Antasida tab 1000/tablet 7,794.00 7.79
13 Anti hemoroid supp box/10 24,500.00 2,450.00
14 Antifungi salep 24 pot @ 30 g / kotak 45,696.00 1,904.00
15 Asam mefenamat tablet 500 mg ktk 10 x 10 tablet 16,000.00 160.00
16 Asetosal tablet 100 mg ktk 10 x 10 tablet 10,000.00 100.00
17 Bedak Salycil 1 pot 1,300.00 1,300.00
18 Betahistin Mesilat tablet 6 mg ktk 3 x 10 tablet 25,200.00 840.00
19 Betametason krim 0.1% 25 tube@ 5 g 42,409.00 1,696.36
20 Bravoderm cr/Prodemis cr tube 5 gram 9,500.00 9,500.00
21 Bufacom cr tube 5 gram 8,000.00 80.00
22 Ciprofloxacin tablet 500 mg ktk 5 x 10 tablet 26,500.00 530.00
23 Cotrimoxazole syr Botol 60 ml 3,181.00 3,181.00
24 Cotrimoxazole tab ktk 10 x 10 tablet 15,000.00 150.00
25 CPZ tab botol 1000 tablet 19,860.00 19.86
26 CTM tablet botol 1000 tablet 17,165.00 17.17
27 Dexamethason tablet 0,5 mg botol 1000 tablet 77,000.00 77.00
28 Diazepam tablet 2 mg botol 1000 tablet 23,500.00 23.50
29 Digoxin tablet 0,25 mg 100 tablet/kotak 8,321.00 83.21
30 Dimenhidrinat tablet 50 mg botol 100 tablet 8,450.00 84.50
31 DMP syrup Botol 60 ml 2,454.00 2,454.00
32 DMP tablet botol 1000 tablet 90,000.00 90.00
33 Doksisiklin kapsul 100 mg ktk 10 x 10 tablet 20,909.00 209.09
34 Efedrin tablet 25 mg botol 1000 tablet 47,000.00 47.00
35 Ekstrak Belladona tablet 10 mg 1000 tablet / botol 24,000.00 24.00
36 Ergotamin tablet 100 tablet/botol 11,209.00 112.09
37 Erythromycin syrup Botol 60 ml 7,364.00 7,364.00
38 Erythromycin tablet 500 mg 100 tablet/kotak 84,545.00 845.45
39 Fe ( tablet tambah darah) sachet/30 81,900.00 136.50
40 Fenitoin kapsul 100 mg btl 250 kapsul 19,884.00 79.54
41 Fenobarbital tablet 30 mg botol 1000 tablet 42,000.00 42.00
42 Fenol glisetol tts telinga 10% 24 btl @ 5 ml / kotak 22,000.00 916.67
43 Furosemide tablet 40 mg ktk 20 x 10 tblet 14,404.00 72.02
44 Gentamycin salep kulit tube 5 gram 16,700.00 1,670.00
45 Gentamycin tetes mata btl 5 ml 3,000.00 3,000.00
46 Gentian violet botol 10 ml 409.00 409.00
47 Glibenklamid tablet 5 mg 100 tablet/kotak 6,545.00 65.45
48 Gliseril Guaiacolat tablet 100 mg botol 1000 tablet 21,127.00 21.13
49 Griseofulvin tablet 125 mg ktk 10 x 10 tablet 21,818.00 218.18
50 Haloperidol tablet 5 mg ktk 10 x 10 tablet 12,229.00 122.29
51 Hidroklortiazid (HCT) tablet 25 mg botol 1000 tablet 24,640.00 24.64
52 Hidrokortisone krim 2,5 % 24 tube @ 5 g / kotak 2,568.00 2,568.00
53 Ibuprofen tablet 200 mg btl/100 tab 9,545.00 95.45
54 Ibuprofen tablet 400 mg ktk 10 x 10 tablet 16,363.00 163.63
55 Isosorbid tablet 5 mg ktk 10 x 10 tablet 8,850.00 88.50
56 Kalk tablet btl/1000 tablet 47,272.00 47.27
57 Kaptopril tablet 25 mg ktk 10 x 10 tablet 12,523.00 125.23
58 karbamazepin tablet 200 mg ktk 10 x 10 tablet 24,645.00 246.45
59 Ketokonazole tablet 200 mg ktk 5 x 10 tablet 16,909.00 338.18
60 Klindamycin kapsul 150 mg ktk 5 x 10 tablet 23,181.00 463.62
61 Kloramfenicol kapsul 250 mg btl/250 kaps 38,275.00 153.10
62 Kloramfenicol salep mata 1% tube 5 gram 1,420.00 1,420.00
63 Kloramfenicol syrup 125 mg/5 ml btl 60 ml 3,636.00 3,636.00
64 Kloramfenicol tetes mata 0,5% btl 5 ml 2,273.00 2,273.00
65 Kloramfenicol tetes telinga 3% 24 botol@5 ml 24,000.00 24,000.00
66 Loratadine tablet ktk 50 tab 15,140.00 302.80
67 Meloxicam tablet 100 tablet / botol 9,545.00 95.45
68 Metformin tablet 500 mg ktk 10 x 10 tablet 16,500.00 165.00
69 Metilergometrin tablet ktk 10 x 10 tablet 9,996.00 99.96
70 Metilprednisolon tablet ktk 10 x 10 tablet 40,050.00 400.50
71 Metoclopramide tablet ktk 10 x 10 tablet 7,630.00 76.30
72 Metronidazole tablet 250 mg ktk 10 x 10 tablet 11,808.00 118.08
73 Metronidazole tablet 500 mg ktk 5 x 10 tablet 20,000.00 200.00
74 Molagit tablet/ Akita tablet ktk 10 x 10 tablet 26,250.00 262.50
75 Myconazole cr tube 10 gr 2,727.00 2,727.00
76 Natrium diklofenak 50 mg ktk 5 x 10 tablet 9,894.00 197.88
77 Nifedipin tablet 10 mg ktk 10 x 10 tablet 9,804.00 98.04
78 Nistatin vaginal tablet 100.000 IU/g ktk 10 x 10 tablet 28,891.00 288.91
79 Noza tablet ktk 25 x 4 tablet 36,250.00 362.50
80 Obat Batuk Hitam ( OBH ) syrup btl 60 ml 1,363.00 1,363.00
81 Oksitetrasiklin salep kulit tube 5 gram 1,523.00 1,523.00
82 Oksitetrasiklin salep mata 25 tube @ 3,5 g / kotak 43,636.00 1,745.44
83 Omeprazole kapsul 20 mg ktk 3 x 10 capsul 11,136.00 371.20
84 Oralit 100 kantong/kotak 9,115.00 91.15
85 Paracetamol syrup btl 60 ml 2,090.00 2,090.00
86 Paracetamol tablet 100 mg btl 100 2,569.00 2,569.00
87 Paracetamol tablet 500 mg 1000 tab/btl 95,450.00 95.45
88 Piracetam tablet 800 mg ampul 5,000.00 5,000.00
89 Pirantel tablet 125 mg ktk 25 x 4 tablet 29,091.00 290.91
90 Prednison tablet 5 mg 1000 tab/btl 56,818.00 56.82
91 Propanolol tablet 40 mg ktk 10 x 10 tablet 7,000.00 70.00
92 Propiltiourasil tablet 100 mg 100 tablet/btl 27,233.00 272.33
93 Ranitidine tablet 150 mg ktk 10 x 10 tablet 19,050.00 190.50
94 Sabutamol tablet 2 mg ktk 10 x 10 tablet 7,639.00 76.39
95 Salep 24 pot 1,113.00 1,113.00
96 Scabicid salep tube 8,500.00 8,500.00
97 Simvastatin tablet ktk 3 x 10 tablet 23,318.00 777.27
98 Sulfacetamide tetes mata 24 botol@5 ml 75,169.00 3,132.04
99 Tetrasiklin kapsul 500 mg ktk 10 x 10 kapsul 23,364.00 233.64
100 Thiamfenicol capsul 500 mg ktk 10 x 10 kapsul 52,727.00 527.27
101 Triheksifenidil tablet 2 mg ktk 10 x 10 tablet 3,706.00 37.06
102 Vitamin B komplek tablet 1000 tablet/botol 20,182.00 20.18
103 Vitamin B1 tablet 1000 tablet/botol 32,000.00 32.00
104 Vitamin B6 tablet 1000 tablet/botol 13,000.00 13.00
105 Vitamin C tablet 1000 tablet/botol 29,091.00 29.09
106 Vitamin K tablet 100 tablet/botol 68,062.00 680.62
107 Zinc tablet ktk 10 x 10 tablet 43,182.00 431.82
Injeksi
108 Aminophillin inj 30 ampul / kotak 97,200.00 3,240.00
109 Ampicillin inj 10 vial/kotak 48,800.00 4,880.00
110 Antalgin inj ampul 1,112.00 1,112.00
111 Anti Bisa Ular vial 218,590.00 218,590.00
112 Atropin Sulfas inj ampul 1,150.00 1,150.00
113 Cefotaxime inj ampul 6,300.00 6,300.00
114 Dexamethason inj 100 ampul / kotak 90,777.00 907.77
115 Diazepam inj 30 ampul / kotak 71,043.00 2,368.10
116 Difenhidramin inj 30 ampul / kotak 26,182.00 872.73
117 Epineprin inj ampul 1,127.00 1,127.00
118 Ehiferan inj/metoclopramide inj ampul 909.00 909.00
119 Oxitosin inj/Pitogin inj 30 ampul / kotak 53,550.00 1,785.00
120 Lidocain inj/Pehacain inj 30 ampul / kotak 31,000.00 1,033.33
121 Metilergometrin inj/Myomergin inj 30 ampul / kotak 38,746.00 1,291.53
122 Phenobarbital inj
123 Piracetam inj 1 ampul 5,000.00 5,000.00
124 Ranitidine inj 25 ampul/kotak 58,400.00 2,336.00
125 Serum Anti Tetanus amp 429,550.00 429,550.00
126 Teramycin inj box@10 ampul 28,181.00 2,818.10
127 Vitamin B1 inj 30 ampul / kotak 20,880.00 696.00
128 Vitamin B12 inj 100 ampul / kotak 88,181.00 881.81
129 Vitamin K inj 30 ampul / kotak 29,330.00 977.67
130 Calcii Gluconas inj
Cairan
131 Cairan NS/NaCl botol/500 ml 4,454.00 4,454.00
132 Cairan D5% botol/500 ml 4,600.00 4,600.00
133 Cairan RL botol/500 ml 4,727.00 4,727.00
134 Cairan Asering
135 Kaen 3B botol/500 ml 14,300.00 14,300.00
136 Kaen 4B botol/500 ml 14,300.00 14,300.00
Alat Kesehatan
137 Alat suntik sekali pakai 1 ml 100 set/kotak 99,318.00 993.18
138 Alat suntik sekali pakai 2,5 ml 100 set/kotak 94,350.00 943.50
141 Catgut chromic 3/0 24 x 70 cm /kotak 536,363.00 22,348.46
142 Catgut Plain 3/0 24 x 70 cm /kotak 536,363.00 22,348.46
143 Catgut Plain2/0 24 x 70 cm /kotak 536,363.00 22,348.46
144 Etil Klorid semprot can 100 ml 90,000.00 90,000.00
145 Infuset anak set/kantong 3,636.00 3,636.00
146 Infuset dewasa set/kantong 3,181.00 3,181.00
147 Iodine 30 ml botol 30 ml 1,818.00 1,818.00
148 Iodine 300 ml botol 300 ml 13,181.00 13,181.00
149 IV cateter 20 50 buah/kotak 780,000.00 15,600.00
152 Kapas rol 6,818.00 6,818.00
153 Kasa 2m x 80 cm rol 8,799.00 8,799.00
154 Kasa 4m x 15 cm rol 3,373.00 3,373.00
155 Kasa 4m x 3 cm rol 3,373.00 3,373.00
156 Masker box 48,750.00 975.00
157 Plester rol 21,477.00 21,477.00
158 Rivanol
159 Sarung tangan box 45000 45,000.00
160 Silk benang bedah 36 x 75 cm/kotak 228,545.00 6,348.47
161 Urine bag 1 ampul 3636 3636
162 Foley Catheter 16 bj 7722 7722
163 Lactodia sachet/30 138,514.00 4,617.13
164 Alkohol 1 L botol 1 l 18698 18698
165 Scopma tablet 10 x 10 tablet/kotak 27,273.00 272.73
166 Mecobion tab 10 x 10 tablet/kotak 27,000.00 270.00
167 Kasa steril kotak 7,727.00 7,727.00
168 Bioplacenton gel tube 10,100.00 10,100.00
169 Aquadest 1 vial 5,000.00 5,000.00
170 Bisoprolol tab 50 tablet/box 105,550.00 2,111.00
171 Lytamin syr botol 60 ml 4,350.00 4,350.00
172 Susuk KB bj 191,154.00 191,154.00
173 Magnesium sulfat 20% vial 15,398.00 15,398.00
174 Magnesium sulfat 40% vial 15,398.00 15,398.00
175 Cendo xitrol mini dose strip 19,500.00 19,500.00
176 Kasa elastis rol 6,363.00 6,363.00
177 Combivent nebules ampul 12,000.00 12,000.00
178 OAT kategori I 1 paket 327,272.00 327,272.00
179 Lisol 1 L
180 Cetirizin tab 30 tablet/strip/kotak 18,000.00 600.00
181 Amlodipin tab 30 tablet/strip/kotak 26,190.00 873.00
182 Phenytoin caps btl 250 kapsul 19,884.00 79.54
183 Albothyl sol btl 5 ml 12,273.00 12,273.00
184 Konflusin syr
185 Mersibion inj 1 ampul 4,750.00 4,750.00
186 Baby Cough syr botol 60 ml 3,500.00
187 Microlax tube 17,075.00 17,075.00
188 Vitamin C 250 mg tab btl/250 35,000.00 140.00
189 Kaptopril 12,5 mg box/100 9,450.00 94.50
190 Antimigrain tab btl/100 12,300.00 123.00
191 Serum Anti Bisa Ular 218,590.00 2,185.90
192 Stelosi tab
193 Blood tranfusion set
194 Mess 1,995.00 1,995.00
195 H2O2 100 ml 2,000.00 2,000.00
196 Vitamin K infant 1,975.00 1,975.00
TOTAL
Mengetahui
Kepala Puskesmas
Drg.Prima Puspito Rini

NIP.19710513 200604 2 024
APORAN PENCACAHAN OBAT (STOCK OPNAME)
TAHUN 2013
PUSKESMAS GEDANGAN
Jumlah Obat Jumlah Harga (+PPN 10%)

Stock Penerimaan Persedi Pengelua Sisa Stock Penerimaan Persediaan
Awal Jan-Des aan ran stock Awal Jan-Des thn 2013
thn 2014 Tahun 2013 thn 2013 (Rp) (Rp) (Rp)
5 6 7 8 9 10 11 12
265 265 32 233 722,655.00 - 722,655.00
927 927 338 589 885,563.10 - 885,563.10
1,160 1,160 0 1,160 127,112.80 - 127,112.80
2,587 2,587 938 1,649 222,300.91 - 222,300.91
2,043 2,043 376 1,667 178,047.45 - 178,047.45
0 0 0 - -
4,752 4,752 1,420 3,332 902,880.00 - 902,880.00
696 696 259 437 1,600,800.00 - 1,600,800.00
11,269 11,269 3,988 7,281 2,479,180.00 - 2,479,180.00
0 0 0 - - -
579 579 148 431 1,079,835.00 - 1,079,835.00
13,920 13,920 3,557 10,363 108,492.48 - 108,492.48
128 128 32 96 313,600.00 - 313,600.00
153 153 32 121 291,312.00 - 291,312.00
11,824 11,824 4,087 7,737 1,891,840.00 - 1,891,840.00
1,903 1,903 363 1,540 190,300.00 - 190,300.00
114 114 32 82 148,200.00 - 148,200.00
817 817 344 473 686,280.00 - 686,280.00
169 169 53 116 286,684.84 286,684.84
42 42 17 25 399,000.00 - 399,000.00
273 273 44 229 21,840.00 - 21,840.00
2,280 2,280 1,108 0 1,208,400.00 - 1,208,400.00
551 551 239 312 1,752,731.00 - 1,752,731.00
2,477 2,477 963 1,514 371,550.00 - 371,550.00
783 783 0 783 15,550.38 - 15,550.38
14,400 14,400 3,962 10,438 247,176.00 - 247,176.00
5,379 5,379 2,303 3,076 414,183.00 - 414,183.00
1,394 1,394 0 1,394 32,759.00 - 32,759.00
0 0 0 - - -
1,182 1,182 716 466 99,879.00 - 99,879.00
508 508 66 442 1,246,632.00 - 1,246,632.00
13,677 13,677 1,150 12,527 1,230,930.00 - 1,230,930.00
942 942 70 872 196,962.78 - 196,962.78
3,657 3,657 2 3,655 171,879.00 - 171,879.00
2,090 2,090 150 1,940 50,160.00 - 50,160.00
0 0 0 - - -
0 0 0 - - -
0 0 0 - - -
31,374 31,374 3,150 28,224 4,282,551.00 - 4,282,551.00
237 237 0 237 18,850.03 - 18,850.03
1,209 1,209 3 1,206 50,778.00 - 50,778.00
0 0 0 - - -
803 803 803 0 57,832.06 - 57,832.06
51 51 51 0 85,170.00 - 85,170.00
23 23 23 0 69,000.00 - 69,000.00
222 222 19 203 90,798.00 - 90,798.00
4,068 4,068 770 3,298 266,250.60 - 266,250.60
10,511 10,511 3,311 7,200 222,065.90 - 222,065.90
0 0 0 - - -
804 804 110 694 98,321.16 - 98,321.16
0 0 0 - - -
0 0 0 - - -
2,985 2,985 914 2,071 284,918.25 - 284,918.25
5,748 5,748 880 4,868 940,545.24 - 940,545.24
112 112 10 102 9,912.00 - 9,912.00
7,777 7,777 2,236 5,541 367,634.34 - 367,634.34
1,942 1,942 1,585 357 243,196.66 - 243,196.66
300 300 60 240 73,935.00 - 73,935.00
2,666 2,666 881 1,785 901,587.88 - 901,587.88
0 0 0 - - -
0 0 0 - - -
70 70 22 48 99,400.00 - 99,400.00
44 44 44 0 159,984.00 - 159,984.00
0 0 0 - - -
193 193 50 143 4,632,000.00 - 4,632,000.00
849 849 65 784 257,077.20 - 257,077.20
717 717 407 310 68,437.65 - 68,437.65
2,431 2,431 156 2,275 401,115.00 - 401,115.00
988 988 191 797 98,760.48 - 98,760.48
0 0 0 - - -
2,369 2,369 355 2,014 180,754.70 - 180,754.70
0 0 0 - - -
5,028 5,028 406 4,622 1,005,600.00 - 1,005,600.00
7,438 7,438 724 6,714 1,952,475.00 - 1,952,475.00
263 263 54 209 717,201.00 - 717,201.00
2,122 2,122 774 1,348 419,901.36 - 419,901.36
80 80 80 0 7,843.20 - 7,843.20
497 497 33 464 143,588.27 - 143,588.27
2,000 2,000 269 1,731 725,000.00 - 725,000.00
96 96 96 0 130,848.00 - 130,848.00
140 140 44 96 213,220.00 - 213,220.00
132 132 15 117 230,398.08 - 230,398.08
159 159 159 0 59,020.80 - 59,020.80
2,099 2,099 616 1,483 191,323.85 - 191,323.85
1,489 1,489 331 1,158 3,112,010.00 - 3,112,010.00
2,815 2,815 928 1,887 7,231,735.00 - 7,231,735.00
27,273 27,273 8,598 18,675 2,603,207.85 - 2,603,207.85
1,427 1,427 86 1,341 7,135,000.00 - 7,135,000.00
250 250 10 240 72,727.50 - 72,727.50
7,992 7,992 764 7,228 454,089.46 - 454,089.46
880 880 0 880 61,600.00 - 61,600.00
500 500 0 500 136,165.00 - 136,165.00
1,834 1,834 333 1,501 349,377.00 - 349,377.00
1,452 1,452 1,144 308 110,918.28 - 110,918.28
0 0 0 - - -
138 138 20 118 1,173,000.00 - 1,173,000.00
750 750 30 720 582,950.00 - 582,950.00
28 28 14 14 87,697.17 - 87,697.17
1,201 1,201 272 929 280,601.64 - 280,601.64
1,740 1,740 192 1,548 917,449.80 - 917,449.80
242 242 140 102 8,968.52 - 8,968.52
12,396 12,396 1,644 10,752 250,176.07 - 250,176.07
1,548 1,548 1,548 0 49,536.00 - 49,536.00
4,164 4,164 826 3,338 54,132.00 - 54,132.00
0 0 - - -
872 872 170 702 593,500.64 - 593,500.64
744 744 620 124 321,274.08 - 321,274.08
32 32 1 31 103,680.00 - 103,680.00
17 17 0 17 82,960.00 - 82,960.00
0 0 0 - - -
0 0 0 - - -
0 0 0 - - -
148 148 17 131 932,400.00 - 932,400.00
157 157 55 102 142,519.89 - 142,519.89
81 81 4 77 191,816.10 - 191,816.10
1,446 1,446 317 1,129 1,261,972.40 - 1,261,972.40
43 43 2 41 48,461.00 - 48,461.00
0 0 0 - - -
100 100 29 71 178,500.00 - 178,500.00
401 401 101 300 414,366.67 - 414,366.67
118 118 13 105 152,400.93 - 152,400.93
0
45 45 0 45 225,000.00 - 225,000.00
140 140 36 104 327,040.00 - 327,040.00
0 0 0 - - -
0 0 0 - - -
204 204 71 133 141,984.00 - 141,984.00
806 806 219 587 710,738.86 - 710,738.86
30 30 0 30 29,330.00 - 29,330.00
48 48 0 48 - - -
300 300 102 198 1,336,200.00 - 1,336,200.00

117 117 4 113 538,200.00 - 538,200.00
241 241 18 223 1,139,207.00 - 1,139,207.00
0
144 144 7 137 2,059,200.00 - 2,059,200.00
26 26 0 26 371,800.00 - 371,800.00
1,544 1,544 26 1,518 1,533,469.92 - 1,533,469.92

0 0 0 - - -
2,435 2,435 984 1,451 2,297,422.50 - 2,297,422.50
927 927 127 800 874,624.50 - 874,624.50
46 46 33 13 1,028,029.08 - 1,028,029.08
0 0 0 - - -
0 0 0 - - -
6 6 1 5 540,000.00 - 540,000.00
182 182 15 167 661,752.00 - 661,752.00
316 316 61 255 1,005,196.00 - 1,005,196.00
67 67 35 33 121,806.00 - 121,806.00
0 0 0 - - -
126 126 28 98 1,965,600.00 - 1,965,600.00
166 166 35 131 1,175,037.64 - 1,175,037.64
133 133 19 114 941,445.82 - 941,445.82
60 60 7 53 527,940.00 - 527,940.00
100 100 56 44 337,300.00 - 337,300.00
50 50 16 34 168,650.00 168,650.00
300 300 250 50 292,500.00 - 292,500.00
20 20 8 12 429,540.00 - 429,540.00
0 0 0 - - -
20 20 2 18 900,000.00 - 900,000.00
25 25 17 8 158,711.81 - 158,711.81
139 139 22 117 505,404.00 - 505,404.00
127 127 26 101 980,694.00 - 980,694.00
88 88 88 0 406,307.73 - 406,307.73
141 141 7 135 2,636,418.00 - 2,636,418.00
4,640 4,640 484 4,156 1,265,467.20 - 1,265,467.20
2,439 2,439 1,103 1,336 658,530.00 - 658,530.00
0 0 0 - - -
200 200 3 197 2,020,000.00 - 2,020,000.00
136 136 20 116 680,000.00 - 680,000.00
0 0 0 - - -
100 100 18 82 435,000.00 - 435,000.00
0 0 0 - - -
12 12 0 12 184,776.00 - 184,776.00
12 12 0 12 184,776.00 - 184,776.00
0 0 0 - - -
50 50 0 50 318,150.00 - 318,150.00
100 100 13 87 1,200,000.00 - 1,200,000.00
9 9 0 9 2,945,448.00 - 2,945,448.00
15 15 5 10
410 410 5 405 246,000.00 - 246,000.00
879 879 286 593 767,367.00 - 767,367.00
0 0 0 - - -
4 4 0 4 49,092.00 - 49,092.00
0
30 30 4 26 142,500.00 - 142,500.00
72 72 18 54 - - -
5 5 1 4 85,375.00 - 85,375.00
2,500 2,500 1,838 662 350,000.00 - 350,000.00
4,000 4,000 0 4,000 378,000.00 - 378,000.00
100 100 0 100 12,300.00 - 12,300.00
2 2 0 2 4,371.80 - 4,371.80
500 500 0 500 - - -
39 39 0 39 - - -
3 3 0 3 5,985.00 - 5,985.00
3 3 1 2 6,000.00 - 6,000.00
200 200 37 163 395,000.00 - 395,000.00
### - ###
Petugas Obat
Sofia Siswanti,Amd.Farm
NIP.19760216 201001 2 007
Harga (+PPN 10%)
Pengeluaran Sisa per
Bln Desember 2013
(Rp) (Rp)
13 14
87,264.00 635,391.00
322,891.40 562,671.70
- 127,112.80
80,602.34 141,698.57
32,768.40 145,279.05
- -
269,800.00 633,080.00
595,700.00 1,005,100.00
877,360.00 1,601,820.00
- -
276,020.00 803,815.00
27,723.26 80,769.22
78,400.00 235,200.00
60,928.00 230,384.00
653,920.00 1,237,920.00
36,300.00 154,000.00
41,600.00 106,600.00
288,960.00 397,320.00
196,777.76
161,500.00 237,500.00
3,520.00 18,320.00
587,240.00 -
760,259.00 992,472.00
144,450.00 227,100.00
- 15,550.38
68,007.73 179,168.27
177,331.00 236,852.00
- 32,759.00
- -
60,502.00 39,377.00
161,964.00 1,084,668.00
103,500.00 1,127,430.00
14,636.30 182,326.48
94.00 171,785.00
3,600.00 46,560.00
- -
- -
- -
429,975.00 3,852,576.00
- 18,850.03
126.00 50,652.00
- -
57,832.06 -
85,170.00 -
69,000.00 -
7,771.00 83,027.00
50,396.50 215,854.10
69,951.50 152,114.40
- -
13,451.90 84,869.26
- -
- -
87,241.30 197,676.95
143,994.40 796,550.84
885.00 9,027.00
105,700.19 261,934.15
198,489.55 44,707.11
14,787.00 59,148.00
297,936.58 603,651.30
- -
- -
31,240.00 68,160.00
159,984.00 -
- -
1,200,000.00 3,432,000.00
19,682.00 237,395.20
38,848.15 29,589.50
25,740.00 375,375.00
19,092.36 79,668.12
- -
27,086.50 153,668.20
- -
81,200.00 924,400.00
1,762,425.00
147,258.00 569,943.00
153,159.12 266,742.24
7,843.20 -
9,534.03 134,054.24
97,512.50 627,487.50
130,848.00 -
67,012.00 146,208.00
26,181.60 204,216.48
59,020.80 -
56,148.40 135,175.45
691,790.00 2,420,220.00
2,384,032.00 4,847,703.00
820,679.10 1,782,528.75
430,000.00 6,705,000.00
2,909.10 69,818.40
43,408.95 410,680.50
- 61,600.00
- 136,165.00
63,436.50 285,940.50
87,390.16 23,528.12
- -
170,000.00 1,003,000.00
23,318.00 559,632.00
43,848.58 43,848.58
63,550.08 217,051.56
101,235.84 816,213.96
5,188.40 3,780.12
33,179.21 216,996.86
49,536.00 -
10,738.00 43,394.00
- -
115,705.40 477,795.24
267,728.40 53,545.68
3,240.00 100,440.00
- 82,960.00
- -
- -
- -
107,100.00 825,300.00
49,927.35 92,592.54
9,472.40 182,343.70
276,656.47 985,315.93
2,254.00 46,207.00
- -
51,765.00 126,735.00
104,366.67 310,000.00
16,789.93 135,611.00
- 225,000.00
84,096.00 242,944.00
- -
- -
49,416.00 92,568.00
193,116.39 517,622.47
- 29,330.00
- -
454,308.00 881,892.00
18,400.00 519,800.00
85,086.00 1,054,121.00
100,100.00 1,959,100.00
- 371,800.00
25,822.68 1,507,647.24
- -
928,404.00 1,369,018.50
119,824.50 754,800.00
737,499.13 290,529.96
- -
- -
90,000.00 450,000.00
54,540.00 607,212.00
194,041.00 811,155.00
62,721.00 59,085.00
- -
436,800.00 1,528,800.00
247,748.90 927,288.74
134,492.26 806,953.56
61,593.00 466,347.00
188,888.00 148,412.00
114,682.00
243,750.00 48,750.00
171,816.00 257,724.00
- -
90,000.00 810,000.00
107,924.03 50,787.78
79,992.00 425,412.00
200,772.00 779,922.00
406,307.73 -
121,537.00 2,514,881.00
132,001.32 1,133,465.88
297,810.00 360,720.00
- -
30,300.00 1,989,700.00
100,000.00 580,000.00
- -
78,300.00 356,700.00
- -
- 184,776.00
- 184,776.00
- -
- 318,150.00
156,000.00 1,044,000.00
- 2,945,448.00
3,000.00 243,000.00
249,678.00 517,689.00
- -
- 49,092.00
19,000.00 123,500.00
- -
17,075.00 68,300.00
257,320.00 92,680.00
- 378,000.00
- 12,300.00
- 4,371.80
- -
- -
- 5,985.00
2,000.00 4,000.00
73,075.00 321,925.00
23,100,740.54 83,072,064.69
LAPORAN PENCACAHAN OBAT (ST
TAHUN 2014
PUSKESMAS GEDANGA
Jum
No Nama Obat Satuan Harga Harga/ Stock
(satuan + biji Awal
PPN 10%) thn 2014
1 2 3 4 5
1 Acyclovir krim 5% 100 tablet/strip/blister , kotak 2,727.00 2,727.00 233
2 Acyclovir tablet 400 mg ktk 10 x 30 tablet 28,659.00 955.30 589
3 Alopurinol tablet 100 mg 100 tablet / botol 12,000.00 120.00 1,160
4 Ambroxol tablet 30 mg 30 ampul / kotak 10,297.00 343.23 1,649
5 Aminofilin tablet 200 mg 100 tablet/strip/blister , kotak 10,300.00 103.00 1,667
6 Amitriptilin tablet 25 mg 30 tablet/strip/kotak 873.00 0
7 Amoxicillin kapsul 250 mg 100 kaplet/strip, kotak 31,500.00 315.00 3,332
8 Amoxicillin syrup kering 125 mg/5 ml 120 kapsul/strip/blister, kotak 3,363.00 3,363.00 437
9 Amoxicillin tablet 500 mg Botol 60 ml 33,636.00 336.36 7,281
10 Antalgin tablet 500 mg 10 vial/kotak 124,500.00 124.50 0
11 Antasida syrup Botol 60 ml 3,500.00 3,500.00 431
12 Antasida tab 1000/tablet 50,530.00 50.53 10,363
13 Anti hemoroid supp box/10 18,182.00 1,818.20 96
14 Antifungi salep 24 pot @ 30 g / kotak 37,488.00 1,562.00 121
15 Asam mefenamat tablet 500 mg ktk 10 x 10 tablet 16,000.00 160.00 7,737
16 Asetosal tablet 100 mg ktk 10 x 10 tablet 8,000.00 80.00 1,540
17 Bedak Salycil 1 pot 1,300.00 1,300.00 82
18 Betahistin Mesilat tablet 6 mg ktk 3 x 10 tablet 25,200.00 840.00 473
19 Betametason krim 0.1% 25 tube@ 5 g 42,409.00 1,696.36 116
20 Bravoderm cr/Prodemis cr tube 5 gram 9,500.00 9,500.00 25
21 Bufacom cr tube 5 gram 8,000.00 80.00 229
22 Ciprofloxacin tablet 500 mg ktk 5 x 10 tablet 26,500.00 530.00 1,172
23 Cotrimoxazole syr Botol 60 ml 3,181.00 3,181.00 312
24 Cotrimoxazole tab ktk 10 x 10 tablet 15,000.00 150.00 1,514
25 CPZ tab botol 1000 tablet 19,860.00 19.86 783
26 CTM tablet botol 1000 tablet 17,165.00 17.17 10,438
27 Dexamethason tablet 0,5 mg botol 1000 tablet 77,000.00 77.00 3,076
28 Diazepam tablet 2 mg botol 1000 tablet 23,500.00 23.50 1,394
29 Digoxin tablet 0,25 mg 100 tablet/kotak 8,321.00 83.21 0
30 Dimenhidrinat tablet 50 mg botol 100 tablet 8,450.00 84.50 466
31 DMP syrup Botol 60 ml 2,454.00 2,454.00 442
32 DMP tablet botol 1000 tablet 90,000.00 90.00 12,527
33 Doksisiklin kapsul 100 mg ktk 10 x 10 tablet 20,909.00 209.09 872
34 Efedrin tablet 25 mg botol 1000 tablet 47,000.00 47.00 3,655
35 Ekstrak Belladona tablet 10 mg 1000 tablet / botol 24,000.00 24.00 1,940
36 Ergotamin tablet 100 tablet/botol 11,209.00 112.09 0
37 Erythromycin syrup Botol 60 ml 7,364.00 7,364.00 0
38 Erythromycin tablet 500 mg 100 tablet/kotak 84,545.00 845.45 0
39 Fe ( tablet tambah darah) sachet/30 81,900.00 136.50 28,224
40 Fenitoin kapsul 100 mg btl 250 kapsul 19,884.00 79.54 237
41 Fenobarbital tablet 30 mg botol 1000 tablet 42,000.00 42.00 1,206
42 Fenol glisetol tts telinga 10% 24 btl @ 5 ml / kotak 22,000.00 916.67 0
43 Furosemide tablet 40 mg ktk 20 x 10 tblet 14,404.00 72.02 0
44 Gentamycin salep kulit tube 5 gram 16,700.00 1,670.00 0
45 Gentamycin tetes mata btl 5 ml 3,000.00 3,000.00 0
46 Gentian violet botol 10 ml 409.00 409.00 203
47 Glibenklamid tablet 5 mg 100 tablet/kotak 6,545.00 65.45 3,298
48 Gliseril Guaiacolat tablet 100 mg botol 1000 tablet 21,127.00 21.13 7,200
49 Griseofulvin tablet 125 mg ktk 10 x 10 tablet 21,818.00 218.18 0
50 Haloperidol tablet 5 mg ktk 10 x 10 tablet 12,229.00 122.29 694
51 Hidroklortiazid (HCT) tablet 25 mg botol 1000 tablet 24,640.00 24.64 0
52 Hidrokortisone krim 2,5 % 24 tube @ 5 g / kotak 2,568.00 2,568.00 0
53 Ibuprofen tablet 200 mg btl/100 tab 9,545.00 95.45 2,071
54 Ibuprofen tablet 400 mg ktk 10 x 10 tablet 16,363.00 163.63 4,868
55 Isosorbid tablet 5 mg ktk 10 x 10 tablet 8,850.00 88.50 102
56 Kalk tablet btl/1000 tablet 47,272.00 47.27 5,541
57 Kaptopril tablet 25 mg ktk 10 x 10 tablet 12,523.00 125.23 357
58 karbamazepin tablet 200 mg ktk 10 x 10 tablet 24,645.00 246.45 240
59 Ketokonazole tablet 200 mg ktk 5 x 10 tablet 16,909.00 338.18 1,785
60 Klindamycin kapsul 150 mg ktk 5 x 10 tablet 23,181.00 463.62 0
61 Kloramfenicol kapsul 250 mg btl/250 kaps 38,275.00 153.10 0
62 Kloramfenicol salep mata 1% tube 5 gram 1,420.00 1,420.00 48
63 Kloramfenicol syrup 125 mg/5 ml btl 60 ml 3,636.00 3,636.00 0
64 Kloramfenicol tetes mata 0,5% btl 5 ml 2,273.00 2,273.00 0
65 Kloramfenicol tetes telinga 3% 24 botol@5 ml 24,000.00 24,000.00 143
66 Loratadine tablet ktk 50 tab 15,140.00 302.80 784
67 Meloxicam tablet 100 tablet / botol 9,545.00 95.45 310
68 Metformin tablet 500 mg ktk 10 x 10 tablet 16,500.00 165.00 2,275
69 Metilergometrin tablet ktk 10 x 10 tablet 9,996.00 99.96 797
70 Metilprednisolon tablet ktk 10 x 10 tablet 40,050.00 400.50 0
71 Metoclopramide tablet ktk 10 x 10 tablet 7,630.00 76.30 2,014
72 Metronidazole tablet 250 mg ktk 10 x 10 tablet 11,808.00 118.08 0
73 Metronidazole tablet 500 mg ktk 5 x 10 tablet 20,000.00 200.00 4,622
74 Molagit tablet/ Akita tablet ktk 10 x 10 tablet 26,250.00 262.50 6,714
75 Myconazole cr tube 10 gr 2,727.00 2,727.00 209
76 Natrium diklofenak 50 mg ktk 5 x 10 tablet 9,894.00 197.88 1,348
77 Nifedipin tablet 10 mg ktk 10 x 10 tablet 9,804.00 98.04 0
78 Nistatin vaginal tablet 100.000 IU/g ktk 10 x 10 tablet 28,891.00 288.91 464
79 Noza tablet ktk 25 x 4 tablet 36,250.00 362.50 1,731
80 Obat Batuk Hitam ( OBH ) syrup btl 60 ml 1,363.00 1,363.00 0
81 Oksitetrasiklin salep kulit tube 5 gram 1,523.00 1,523.00 96
82 Oksitetrasiklin salep mata 25 tube @ 3,5 g / kotak 43,636.00 1,745.44 117
83 Omeprazole kapsul 20 mg ktk 3 x 10 capsul 11,136.00 371.20 0
84 Oralit 100 kantong/kotak 9,115.00 91.15 1,483
85 Paracetamol syrup btl 60 ml 2,090.00 2,090.00 1,158
86 Paracetamol tablet 100 mg btl 100 2,569.00 2,569.00 1,887
87 Paracetamol tablet 500 mg 1000 tab/btl 95,450.00 95.45 18,675
88 Piracetam tablet 800 mg ampul 5,000.00 5,000.00 1,341
89 Pirantel tablet 125 mg ktk 25 x 4 tablet 29,091.00 290.91 240
90 Prednison tablet 5 mg 1000 tab/btl 56,818.00 56.82 7,228
91 Propanolol tablet 40 mg ktk 10 x 10 tablet 7,000.00 70.00 880
92 Propiltiourasil tablet 100 mg 100 tablet/btl 27,233.00 272.33 500
93 Ranitidine tablet 150 mg ktk 10 x 10 tablet 19,050.00 190.50 1,501
94 Sabutamol tablet 2 mg ktk 10 x 10 tablet 7,639.00 76.39 308
95 Salep 24 pot 1,113.00 1,113.00 0
96 Scabicid salep tube 8,500.00 8,500.00 118
97 Simvastatin tablet ktk 3 x 10 tablet 23,318.00 777.27 720
98 Sulfacetamide tetes mata 24 botol@5 ml 75,169.00 3,132.04 14
99 Tetrasiklin kapsul 500 mg ktk 10 x 10 kapsul 23,364.00 233.64 929
100 Thiamfenicol capsul 500 mg ktk 10 x 10 kapsul 52,727.00 527.27 1,548
101 Triheksifenidil tablet 2 mg ktk 10 x 10 tablet 3,706.00 37.06 102
102 Vitamin B komplek tablet 1000 tablet/botol 20,182.00 20.18 10,752
103 Vitamin B1 tablet 1000 tablet/botol 32,000.00 32.00 0
104 Vitamin B6 tablet 1000 tablet/botol 13,000.00 13.00 3,338
105 Vitamin C tablet 1000 tablet/botol 29,091.00 29.09 0
106 Vitamin K tablet 100 tablet/botol 68,062.00 680.62 702
107 Zinc tablet ktk 10 x 10 tablet 43,182.00 431.82 124
Injeksi
108 Aminophillin inj 30 ampul / kotak 55,960.00 1,865.33 31
109 Ampicillin inj 10 vial/kotak 48,800.00 4,880.00 17
110 Antalgin inj ampul 1,112.00 1,112.00 0
111 Anti Bisa Ular vial 218,590.00 218,590.00 0
112 Atropin Sulfas inj ampul 1,150.00 1,150.00 0
113 Cefotaxime inj ampul 6,300.00 6,300.00 131
114 Dexamethason inj 100 ampul / kotak 90,777.00 907.77 102
115 Diazepam inj 30 ampul / kotak 71,043.00 2,368.10 77
116 Difenhidramin inj 30 ampul / kotak 26,182.00 872.73 1,129
117 Epineprin inj ampul 1,127.00 1,127.00 41
118 Ehiferan inj/metoclopramide inj ampul 909.00 909.00 0
119 Oxitosin inj/Pitogin inj 30 ampul / kotak 53,550.00 1,785.00 71
120 Lidocain inj/Pehacain inj 30 ampul / kotak 31,000.00 1,033.33 300
121 Metilergometrin inj/Myomergin inj 30 ampul / kotak 38,746.00 1,291.53 105
122 Phenobarbital inj 0
123 Piracetam inj 1 ampul 5,000.00 5,000.00 45
124 Ranitidine inj 25 ampul/kotak 58,400.00 2,336.00 104
125 Serum Anti Tetanus amp 429,550.00 429,550.00 0
126 Teramycin inj box@10 ampul 28,181.00 2,818.10 0
127 Vitamin B1 inj 30 ampul / kotak 20,880.00 696.00 133
128 Vitamin B12 inj 100 ampul / kotak 88,181.00 881.81 587
129 Vitamin K inj 30 ampul / kotak 29,330.00 977.67 30
130 Calcii Gluconas inj 48
Cairan
131 Cairan NS/NaCl botol/500 ml 4,454.00 4,454.00 198
132 Cairan D5% botol/500 ml 4,600.00 4,600.00 113
133 Cairan RL botol/500 ml 4,727.00 4,727.00 223
134 Cairan Asering 0
135 Kaen 3B botol/500 ml 14,300.00 14,300.00 137
136 Kaen 4B botol/500 ml 14,300.00 14,300.00 26
Alat Kesehatan
137 Alat suntik sekali pakai 1 ml 100 set/kotak 99,318.00 993.18 1,518
138 Alat suntik sekali pakai 2,5 ml 100 set/kotak 94,350.00 943.50 0
139 Alat suntik sekali pakai 3 ml 100 set/kotak 94,350.00 943.50 1,451
140 Alat suntik sekali pakai 5 ml 100 set/kotak 94,350.00 943.50 800
141 Catgut chromic 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 13
142 Catgut Plain 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 0
143 Catgut Plain2/0 24 x 70 cm /kotak 536,363.00 22,348.46 0
144 Etil Klorid semprot can 100 ml 90,000.00 90,000.00 5
145 Infuset anak set/kantong 3,636.00 3,636.00 167
146 Infuset dewasa set/kantong 3,181.00 3,181.00 255
147 Iodine 30 ml botol 30 ml 1,818.00 1,818.00 32
148 Iodine 300 ml botol 300 ml 13,181.00 13,181.00 0
149 IV cateter 20 50 buah/kotak 780,000.00 15,600.00 98
152 Kapas rol 6,818.00 6,818.00 0
153 Kasa 2m x 80 cm rol 8,799.00 8,799.00 53
154 Kasa 4m x 15 cm rol 3,373.00 3,373.00 44
155 Kasa 4m x 3 cm rol 3,373.00 3,373.00 34
156 Masker box 48,750.00 975.00 50
157 Plester rol 21,477.00 21,477.00 12
158 Rivanol 0
159 Sarung tangan box 45000 45,000.00 18
160 Silk benang bedah 36 x 75 cm/kotak 228,545.00 6,348.47 8
161 Urine bag 1 ampul 3636 3636 117
162 Foley Catheter 16 bj 7722 7722 101
163 Lactodia sachet/30 138,514.00 4,617.13 0
164 Alkohol 1 L botol 1 l 18698 18698 134
165 Scopma tablet 10 x 10 tablet/kotak 27,273.00 272.73 4,156
166 Mecobion tab 10 x 10 tablet/kotak 27,000.00 270.00 1,336
167 Kasa steril kotak 7,727.00 7,727.00 0
168 Bioplacenton gel tube 10,100.00 10,100.00 197
169 Aquadest 1 vial 500.00 500.00 116
170 Bisoprolol tab 50 tablet/box 105,550.00 2,111.00 0
171 Lytamin syr botol 60 ml 4,350.00 4,350.00 82
172 Susuk KB bj 191,154.00 191,154.00 0
173 Magnesium sulfat 20% vial 15,398.00 15,398.00 12
174 Magnesium sulfat 40% vial 15,398.00 15,398.00 12
175 Cendo xitrol mini dose strip 19,500.00 19,500.00 0
176 Kasa elastis rol 6,363.00 6,363.00 50
177 Combivent nebules ampul 12,000.00 12,000.00 87
178 OAT kategori I 1 paket 327,272.00 327,272.00 9
179 Lisol 1 L 10
180 Cetirizin tab 30 tablet/strip/kotak 18,000.00 600.00 405
181 Amlodipin tab 30 tablet/strip/kotak 26,190.00 873.00 593
182 Phenytoin caps btl 250 kapsul 19,884.00 79.54 0
183 Albothyl sol btl 5 ml 12,273.00 12,273.00 4
184 Konflusin syr 0
185 Mersibion inj 1 ampul 4,750.00 4,750.00 26
186 Baby Cough syr botol 60 ml 3,500.00 54
187 Microlax tube 17,075.00 17,075.00 4
188 Vitamin C 250 mg tab btl/250 35,000.00 140.00 662
189 Kaptopril 12,5 mg box/100 9,450.00 94.50 4,000
190 Antimigrain tab btl/100 15,000.00 150.00 100
191 Serum Anti Bisa Ular 218,590.00 2,185.90 2
192 Stelosi tab 500
193 Blood tranfusion set 39
194 Mess 1,995.00 1,995.00 3
195 H2O2 100 ml 2,000.00 2,000.00 2
196 Vitamin K infant 1,975.00 1,975.00 163
TOTAL
Mengetahui
Kepala Puskesmas
Drg.Prima Puspito Rini

NIP.19710513 200604 2 024
PENCACAHAN OBAT (STOCK OPNAME)
TAHUN 2014
PUSKESMAS GEDANGAN

Penerimaan Persedi Pengelua Sisa Stock Penerimaan Persediaan Pengeluaran
Jan-Des aan ran stock Awal Jan-Des thn 2013
Tahun 2013 thn 2013 (Rp) (Rp) (Rp) (Rp)
6 7 8 9 10 11 12 13
233 32 201 635,391.00 - 635,391.00 87,264.00
500 1,089 312 777 562,671.70 477,650.00 1,040,321.70 298,053.60
1,160 1,160 139,200.00 - 139,200.00 -
1,000 2,649 828 1,821 565,991.77 343,233.33 909,225.10 284,197.20
1,667 1,060 607 171,701.00 - 171,701.00 109,180.00
0 0 - - -
7,000 10,332 1,136 9,196 1,049,580.00 2,205,000.00 3,254,580.00 357,840.00
500 937 244 693 1,469,631.00 1,681,500.00 3,151,131.00 820,572.00
8,400 15,681 4,338 11,343 2,449,037.16 2,825,424.00 5,274,461.16 1,459,129.68
0 0 - - - -
500 931 100 831 1,508,500.00 1,750,000.00 3,258,500.00 350,000.00
10,363 2,604 7,759 523,642.39 - 523,642.39 131,580.12
96 10 86 174,547.20 - 174,547.20 18,182.00
120 241 16 225 189,002.00 187,440.00 376,442.00 24,992.00
18,000 25,737 3,667 22,070 1,237,920.00 2,880,000.00 4,117,920.00 586,720.00
1,540 114 1,426 123,200.00 - 123,200.00 9,120.00
144 226 32 194 106,600.00 187,200.00 293,800.00 41,600.00
473 236 237 397,320.00 - 397,320.00 198,240.00
116 55 61 196,777.76 196,777.76 93,299.80
25 8 17 237,500.00 - 237,500.00 76,000.00
229 22 207 18,320.00 - 18,320.00 1,760.00
1,172 824 348 621,160.00 - 621,160.00 436,720.00
312 200 112 992,472.00 - 992,472.00 636,200.00
1,514 1,031 483 227,100.00 - 227,100.00 154,650.00
783 783 15,550.38 - 15,550.38 -
14,400 24,838 4,120 20,718 179,168.27 247,176.00 426,344.27 70,719.80
5,000 8,076 1,281 6,795 236,852.00 385,000.00 621,852.00 98,637.00
1,394 1,394 32,759.00 - 32,759.00 -
0 0 - - - -
466 466 0 39,377.00 - 39,377.00 39,377.00
442 99 343 1,084,668.00 - 1,084,668.00 242,946.00
12,527 1,942 10,585 1,127,430.00 - 1,127,430.00 174,780.00
872 50 822 182,326.48 - 182,326.48 10,454.50
3,655 100 3,555 171,785.00 - 171,785.00 4,700.00
1,940 200 1,740 46,560.00 - 46,560.00 4,800.00
0 0 - - - -
0 0 - - - -
0 0 - - - -
28,224 2,650 25,574 3,852,576.00 - 3,852,576.00 361,725.00
237 3 234 18,850.03 - 18,850.03 238.61
1,206 11 1,195 50,652.00 - 50,652.00 462.00
0 0 - - - -
0 0 - - - -
200 200 51 149 - 334,000.00 334,000.00 85,170.00
0 0 - - - -
203 11 192 83,027.00 - 83,027.00 4,499.00
3,298 380 2,918 215,854.10 - 215,854.10 24,871.00
7,200 3,882 3,318 152,114.40 - 152,114.40 82,015.01
0 0 - - - -
694 140 554 84,869.26 - 84,869.26 17,120.60
0 0 - - - -
0 0 - - - -
2,071 512 1,559 197,676.95 - 197,676.95 48,870.40
4,868 642 4,226 796,550.84 - 796,550.84 105,050.46
102 63 39 9,027.00 - 9,027.00 5,575.50
10,000 15,541 1,495 14,046 261,934.15 472,720.00 734,654.15 70,671.64
357 357 0 44,707.11 - 44,707.11 44,707.11
240 30 210 59,148.00 - 59,148.00 7,393.50
1,785 582 1,203 603,651.30 - 603,651.30 196,820.76
0 0 - - - -
0 0 - - - -
96 144 11 133 68,160.00 136,320.00 204,480.00 15,620.00
96 96 72 24 - 349,056.00 349,056.00 261,792.00
0 0 - - - -
143 41 102 3,432,000.00 - 3,432,000.00 984,000.00
784 45 739 237,395.20 - 237,395.20 13,626.00
310 310 0 29,589.50 - 29,589.50 29,589.50
2,275 265 2,010 375,375.00 - 375,375.00 43,725.00
797 147 650 79,668.12 - 79,668.12 14,694.12
500 500 45 455 - 200,250.00 200,250.00 18,022.50
2,014 163 1,851 153,668.20 - 153,668.20 12,436.90
0 0 - - - -
4,622 505 4,117 924,400.00 - 924,400.00 101,000.00
6,714 792 5,922 1,762,425.00 - 1,762,425.00 207,900.00
209 117 92 569,943.00 - 569,943.00 319,059.00
2,700 4,048 445 3,603 266,742.24 534,276.00 801,018.24 88,056.60
0 0 - - - -
464 122 342 134,054.24 - 134,054.24 35,247.02
1,731 759 972 627,487.50 - 627,487.50 275,137.50
0 0 - - - -
100 196 24 172 146,208.00 152,300.00 298,508.00 36,552.00
117 23 94 204,216.48 - 204,216.48 40,145.12
300 300 230 70 - 111,360.00 111,360.00 85,376.00
2,400 3,883 498 3,385 135,175.45 218,760.00 353,935.45 45,392.70
1,158 336 822 2,420,220.00 - 2,420,220.00 702,240.00
1,887 530 1,357 4,847,703.00 - 4,847,703.00 1,361,570.00
20,000 38,675 7,200 31,475 1,782,528.75 1,909,000.00 3,691,528.75 687,240.00
1,341 1,341 6,705,000.00 - 6,705,000.00 -
240 6 234 69,818.40 - 69,818.40 1,745.46
7,228 713 6,515 410,680.50 - 410,680.50 40,511.23
880 20 860 61,600.00 - 61,600.00 1,400.00
500 500 136,165.00 - 136,165.00 -
1,501 590 911 285,940.50 - 285,940.50 112,395.00
2,000 2,308 1,183 1,125 23,528.12 152,780.00 176,308.12 90,369.37
0 0 - - - -
118 18 100 1,003,000.00 - 1,003,000.00 153,000.00
720 50 670 559,632.00 - 559,632.00 38,863.33
96 110 17 93 43,848.58 300,676.00 344,524.58 53,244.71
929 238 691 217,051.56 - 217,051.56 55,606.32
1,548 164 1,384 816,213.96 - 816,213.96 86,472.28
102 102 0 3,780.12 - 3,780.12 3,780.12
10,752 2,390 8,362 216,996.86 - 216,996.86 48,234.98
0 0 - - - -
3,338 1,781 1,557 43,394.00 - 43,394.00 23,153.00
0 0 - - - -
702 146 556 477,795.24 - 477,795.24 99,370.52
500 624 457 167 53,545.68 215,910.00 269,455.68 197,341.74
31 31 57,825.33 - 57,825.33 -
17 17 82,960.00 - 82,960.00 -
0 0 - - - -
0 0 - - - -
0 0 - - - -
131 16 115 825,300.00 - 825,300.00 100,800.00
102 35 67 92,592.54 - 92,592.54 31,771.95
77 3 74 182,343.70 - 182,343.70 7,104.30
1,129 350 779 985,315.93 - 985,315.93 305,456.67
41 3 38 46,207.00 - 46,207.00 3,381.00
0 0 - - - -
71 27 44 126,735.00 - 126,735.00 48,195.00
210 510 66 444 310,000.00 217,000.00 527,000.00 68,200.00
105 7 98 135,611.00 - 135,611.00 9,040.73
45 45 225,000.00 - 225,000.00 -
104 47 57 242,944.00 - 242,944.00 109,792.00
0 0 - - - -
0 0 - - - -
300 433 59 374 92,568.00 208,800.00 301,368.00 41,064.00
1,000 1,587 187 1,400 517,622.47 881,810.00 1,399,432.47 164,898.47
30 9 21 29,330.00 - 29,330.00 8,799.00
48 48 - - - -
200 398 78 320 881,892.00 890,800.00 1,772,692.00 347,412.00

113 14 99 519,800.00 - 519,800.00 64,400.00
223 29 194 1,054,121.00 - 1,054,121.00 137,083.00
137 8 129 1,959,100.00 - 1,959,100.00 114,400.00

26 1 25 371,800.00 - 371,800.00 14,300.00
1,518 68 1,450 1,507,647.24 - 1,507,647.24 67,536.24

0 0 - - - -
2,400 3,851 738 3,113 1,369,018.50 2,264,400.00 3,633,418.50 696,303.00
800 50 750 754,800.00 - 754,800.00 47,175.00
48 61 20 41 290,529.96 1,072,726.00 1,363,255.96 446,969.17
0 0 - - - -
0 0 - - - -
5 1 4 450,000.00 - 450,000.00 90,000.00
167 5 162 607,212.00 - 607,212.00 18,180.00
255 90 165 811,155.00 - 811,155.00 286,290.00
48 80 7 73 58,176.00 87,264.00 145,440.00 12,726.00
0 0 - - - -
98 35 63 1,528,800.00 - 1,528,800.00 546,000.00
131 35 96 927,288.74 - 927,288.74 247,748.90
114 10 104 806,953.56 - 806,953.56 70,785.40
53 19 34 466,347.00 - 466,347.00 167,181.00

100 144 24 120 148,412.00 337,300.00 485,712.00 80,952.00
34 16 18 114,682.00 114,682.00 53,968.00
50 50 0 48,750.00 - 48,750.00 48,750.00
12 24 4 20 257,724.00 257,724.00 515,448.00 85,908.00
0 0 - - - -
18 4 14 810,000.00 - 810,000.00 180,000.00
36 44 11 33 50,787.78 228,545.00 279,332.78 69,833.19
117 10 107 425,412.00 - 425,412.00 36,360.00
101 10 91 779,922.00 - 779,922.00 77,220.00
0 0 - - - -
134 4 130 2,505,532.00 - 2,505,532.00 74,792.00
4,156 335 3,821 1,133,465.88 - 1,133,465.88 91,364.55
1,336 995 341 360,720.00 - 360,720.00 268,650.00
0 0 - - - -
197 2 195 1,989,700.00 - 1,989,700.00 20,200.00
116 16 100 58,000.00 - 58,000.00 8,000.00
0 0 - - - -
82 9 73 356,700.00 - 356,700.00 39,150.00
0 0 - - - -
12 12 184,776.00 - 184,776.00 -
12 12 184,776.00 - 184,776.00 -
0 0 - - - -
50 50 0 318,150.00 - 318,150.00 318,150.00
87 6 81 1,044,000.00 - 1,044,000.00 72,000.00
9 4 5 2,945,448.00 - 2,945,448.00 1,309,088.00
10 2 8
405 30 375 243,000.00 - 243,000.00 18,000.00
593 414 179 517,689.00 - 517,689.00 361,422.00
0 0 - - - -
4 4 0 49,092.00 - 49,092.00 49,092.00
50 76 6 70 123,500.00 237,500.00 361,000.00 28,500.00

72 126 21 105 - - - -
4 4 68,300.00 - 68,300.00 -
2,000 2,662 1,544 1,118 92,680.00 280,000.00 372,680.00 216,160.00
4,000 792 3,208 378,000.00 - 378,000.00 74,844.00
100 100 15,000.00 - 15,000.00 -
2 2 4,371.80 - 4,371.80 -
500 500 - - - -
39 39 - - - -
3 3 5,985.00 - 5,985.00 -
2 1 1 4,000.00 - 4,000.00 2,000.00
163 22 141 321,925.00 - 321,925.00 43,450.00
86,326,825.89 25,220,900.33 ### 22,161,661.89

Petugas Obat
Sofia Siswanti,Amd.Farm
NIP.19760216 201001 2 007
%)
Sisa per
Bln Desember 2013
(Rp)
14
548,127.00
742,268.10
139,200.00
625,027.90
62,521.00
-
2,896,740.00
2,330,559.00
3,815,331.48
-
2,908,500.00
392,062.27
156,365.20
351,450.00
3,531,200.00
114,080.00
252,200.00
199,080.00
103,477.96
161,500.00
16,560.00
184,440.00
356,272.00
72,450.00
15,550.38
355,624.47
523,215.00
32,759.00
-
-
841,722.00
952,650.00
171,871.98
167,085.00
41,760.00
-
-
-
3,490,851.00
18,611.42
50,190.00
-
-
248,830.00
-
78,528.00
190,983.10
70,099.39
-
67,748.66
-
-
148,806.55
691,500.38
3,451.50
663,982.51
-
51,754.50
406,830.54
-
-
188,860.00
87,264.00
-
2,448,000.00
223,769.20
-
331,650.00
64,974.00
182,227.50
141,231.30
-
823,400.00
1,554,525.00
250,884.00
712,961.64
-
98,807.22
352,350.00
-
261,956.00
164,071.36
25,984.00
308,542.75
1,717,980.00
3,486,133.00
3,004,288.75
6,705,000.00
68,072.94
370,169.27
60,200.00
136,165.00
173,545.50
85,938.75
-
850,000.00
520,768.67
291,279.88
161,445.24
729,741.68
-
168,761.88
-
20,241.00
-
378,424.72
72,113.94
57,825.33
82,960.00
-
-
-
724,500.00
60,820.59
175,239.40
679,859.27
42,826.00
-
78,540.00
458,800.00
126,570.27
225,000.00
133,152.00
-
-
260,304.00
1,234,534.00
20,531.00
-
1,425,280.00
455,400.00
917,038.00
1,844,700.00
357,500.00
1,440,111.00
-
2,937,115.50
707,625.00
916,286.79
-
-
360,000.00
589,032.00
524,865.00
132,714.00
-
982,800.00
679,539.84
736,168.16
299,166.00
404,760.00
60,714.00
-
429,540.00
-
630,000.00
209,499.58
389,052.00
702,702.00
-
2,430,740.00
1,042,101.33
92,070.00
-
1,969,500.00
50,000.00
-
317,550.00
-
184,776.00
184,776.00
-
-
972,000.00
1,636,360.00
225,000.00
156,267.00
-
-
332,500.00
-
68,300.00
156,520.00
303,156.00
15,000.00
4,371.80
-
-
5,985.00
2,000.00
278,475.00
89,386,064.34
LAPORAN PENCACAHAN OBAT (STOCK OPNAME)
TAHUN 2014
PUSKESMAS LAWANG

No Nama Obat Satuan Harga Harga/ Stock Penerimaan Persedi Pengelua Sisa Stock Penerimaan Persediaan
(satuan + biji Awal Jan-Des aan ran stock Awal Jan-Des thn 2013
PPN 10%) thn 2014 Tahun 2014 thn 2014 (Rp) (Rp) (Rp)
1 2 3 4 5 6 7 8 9 10 11 12
1 Acyclovir krim 5% 100 tablet/strip/blister , kotak 2,727.00 2,727.00 219 200 419 267 152 597,213.00 545,400.00 1,142,613.00
2 Acyclovir tablet 400 mg ktk 10 x 30 tablet 28,659.00 955.30 361 1,900 2,261 1,881 380 344,863.30 1,815,070.00 2,159,933.30
3 Alopurinol tablet 100 mg 100 tablet / botol 12,000.00 120.00 1,327 5,000 6,327 5,401 926 159,240.00 600,000.00 759,240.00
4 Ambroxol tablet 30 mg 10,297.00 343.23 1,021 4,000 5,021 5,021 0 350,441.23 1,372,933.33 1,723,374.57
5 Aminofilin tablet 200 mg 100 tablet/strip/blister , kotak 10,300.00 103.00 3,829 1,000 4,829 2,832 1,997 394,387.00 103,000.00 497,387.00
6 Amitriptilin tablet 25 mg 30 tablet/strip/kotak 873.00 530 1,200 1,730 1,598 132 462,690.00 1,510,290.00
7 Amoxicillin kapsul 250 mg 100 kaplet/strip, kotak 31,500.00 315.00 0 5,500 5,500 4,504 996 - 1,732,500.00 1,732,500.00
8 Amoxicillin syrup kering 125 mg/5 ml 120 kapsul/strip/blister, kotak 3,363.00 3,363.00 168 1,520 1,688 1,280 408 564,984.00 5,111,760.00 5,676,744.00
9 Amoxicillin tablet 500 mg Botol 60 ml 33,636.00 336.36 5,931 76,200 82,131 62,602 19,529 1,994,951.16 25,630,632.00 27,625,583.16
10 Antalgin tablet 500 mg 10 vial/kotak 124,500.00 124.50 425 24,000 24,425 10,626 13,799 52,912.50 2,988,000.00 3,040,912.50
11 Antasida syrup Botol 60 ml 3,500.00 3,500.00 224 690 914 671 243 784,000.00 2,415,000.00 3,199,000.00
12 Antasida tab 1000/tablet 50,530.00 50.53 11,053 17,200 28,253 23,898 4,355 558,508.09 869,116.00 1,427,624.09
13 Anti hemoroid supp box/10 18,182.00 1,818.20 0 0 0 0 0 - - -
14 Antifungi salep 24 pot @ 30 g / kotak 37,488.00 1,562.00 155 96 251 105 146 242,110.00 149,952.00 392,062.00
15 Asam mefenamat tablet 500 mg ktk 10 x 10 tablet 16,000.00 160.00 3,406 45,000 48,406 38,956 9,450 544,960.00 7,200,000.00 7,744,960.00
16 Asetosal tablet 100 mg ktk 10 x 10 tablet 8,000.00 80.00 1,639 1,000 2,639 2,639 0 131,120.00 80,000.00 211,120.00
17 Bedak Salycil 1 pot 1,300.00 1,300.00 167 244 411 310 101 217,100.00 317,200.00 534,300.00
18 Betahistin Mesilat tablet 6 mg ktk 3 x 10 tablet 25,200.00 840.00 142 600 742 742 0 119,280.00 504,000.00 623,280.00
19 Betametason krim 0.1% 25 tube@ 5 g 42,409.00 1,696.36 107 250 357 157 200 181,510.52 424,090.00 605,600.52
20 Bravoderm cr/Prodemis cr tube 5 gram 9,500.00 9,500.00 0 0 0 - - -
21 Bufacom cr tube 5 gram 8,000.00 80.00 120 120 240 240 0 9,600.00 9,600.00 19,200.00
22 Ciprofloxacin tablet 500 mg ktk 5 x 10 tablet 26,500.00 530.00 1,159 3,000 4,159 4,159 614,270.00 1,590,000.00 2,204,270.00
23 Cotrimoxazole syr Botol 60 ml 3,181.00 3,181.00 44 700 744 481 263 139,964.00 2,226,700.00 2,366,664.00
24 Cotrimoxazole tab ktk 10 x 10 tablet 15,000.00 150.00 2,360 11,000 13,360 9,497 3,863 354,000.00 1,650,000.00 2,004,000.00
25 CPZ tab botol 1000 tablet 19,860.00 19.86 1,965 1,965 1,965 0 39,024.90 - 39,024.90
26 CTM tablet botol 1000 tablet 17,165.00 17.17 7,530 57,600 65,130 46,835 18,295 129,252.45 988,704.00 1,117,956.45
27 Dexamethason tablet 0,5 mg botol 1000 tablet 77,000.00 77.00 3,692 25,000 28,692 21,463 7,229 284,284.00 1,925,000.00 2,209,284.00
28 Diazepam tablet 2 mg botol 1000 tablet 23,500.00 23.50 0 700 700 509 191 - 16,450.00 16,450.00
29 Digoxin tablet 0,25 mg 100 tablet/kotak 8,321.00 83.21 1,026 1,026 278 748 85,373.46 - 85,373.46
30 Dimenhidrinat tablet 50 mg botol 100 tablet 8,450.00 84.50 618 618 618 52,221.00 - 52,221.00
31 DMP syrup Botol 60 ml 2,454.00 2,454.00 355 355 355 871,170.00 - 871,170.00
32 DMP tablet botol 1000 tablet 90,000.00 90.00 12,535 5,000 17,535 17,535 1,128,150.00 450,000.00 1,578,150.00
33 Doksisiklin kapsul 100 mg ktk 10 x 10 tablet 20,909.00 209.09 1,556 1,556 379 1,177 325,344.04 - 325,344.04
34 Efedrin tablet 25 mg botol 1000 tablet 47,000.00 47.00 1,091 4,000 5,091 4,696 395 51,277.00 188,000.00 239,277.00
35 Ekstrak Belladona tablet 10 mg 1000 tablet / botol 24,000.00 24.00 5,027 5,027 1,510 3,517 120,648.00 - 120,648.00
36 Ergotamin tablet 100 tablet/botol 11,209.00 112.09 0 400 400 200 200 - 44,836.00 44,836.00
37 Erythromycin syrup Botol 60 ml 7,364.00 7,364.00 22 120 142 142 0 162,008.00 883,680.00 1,045,688.00
38 Erythromycin tablet 500 mg 100 tablet/kotak 84,545.00 845.45 621 4,900 5,521 4,563 958 525,024.45 4,142,705.00 4,667,729.45
39 Fe ( tablet tambah darah) sachet/30 81,900.00 136.50 29,900 24,000 53,900 42,738 11,162 4,081,350.00 3,276,000.00 7,357,350.00
40 Fenitoin kapsul 100 mg btl 250 kapsul 19,884.00 79.54 500 500 0 500 39,768.00 - 39,768.00
41 Fenobarbital tablet 30 mg botol 1000 tablet 42,000.00 42.00 0 1,000 1,000 0 1,000 - 42,000.00 42,000.00
42 Fenol glisetol tts telinga 10% 24 btl @ 5 ml / kotak 22,000.00 916.67 27 240 267 129 138 24,750.00 220,000.00 244,750.00
43 Furosemide tablet 40 mg ktk 20 x 10 tblet 14,404.00 72.02 4,923 2,000 6,923 5,541 1,382 354,554.46 144,040.00 498,594.46
44 Gentamycin salep kulit tube 5 gram 16,700.00 1,670.00 27 300 327 327 0 45,090.00 501,000.00 546,090.00
45 Gentamycin tetes mata btl 5 ml 3,000.00 3,000.00 114 150 264 218 46 342,000.00 450,000.00 792,000.00
46 Gentian violet botol 10 ml 409.00 409.00 457 50 507 459 48 186,913.00 20,450.00 207,363.00
47 Glibenklamid tablet 5 mg 100 tablet/kotak 6,545.00 65.45 5,547 8,000 13,547 8,006 5,541 363,051.15 523,600.00 886,651.15
48 Gliseril Guaiacolat tablet 100 mg botol 1000 tablet 21,127.00 21.13 5,499 3,000 8,499 8,499 0 116,177.37 63,381.00 179,558.37
49 Griseofulvin tablet 125 mg ktk 10 x 10 tablet 21,818.00 218.18 2,862 2,862 432 2,430 624,431.16 - 624,431.16
50 Haloperidol tablet 5 mg ktk 10 x 10 tablet 12,229.00 122.29 0 0 0 - - -
51 Hidroklortiazid (HCT) tablet 25 mg botol 1000 tablet 24,640.00 24.64 3,464 3,464 3,464 0 85,352.96 - 85,352.96
52 Hidrokortisone krim 2,5 % 24 tube @ 5 g / kotak 2,568.00 2,568.00 21 21 21 0 53,928.00 - 53,928.00
53 Ibuprofen tablet 200 mg btl/100 tab 9,545.00 95.45 6,431 10,600 17,031 12,209 4,822 613,838.95 1,011,770.00 1,625,608.95
54 Ibuprofen tablet 400 mg ktk 10 x 10 tablet 16,363.00 163.63 1,520 15,200 16,720 13,688 3,032 248,717.60 2,487,176.00 2,735,893.60
55 Isosorbid tablet 5 mg ktk 10 x 10 tablet 8,850.00 88.50 200 600 800 476 324 17,700.00 53,100.00 70,800.00
56 Kalk tablet btl/1000 tablet 47,272.00 47.27 13,915 10,000 23,915 14,474 9,441 657,789.88 472,720.00 1,130,509.88
57 Kaptopril tablet 25 mg ktk 10 x 10 tablet 12,523.00 125.23 6,540 22,000 28,540 24,766 3,774 819,004.20 2,755,060.00 3,574,064.20
58 karbamazepin tablet 200 mg ktk 10 x 10 tablet 24,645.00 246.45 0 0 0 0 - - -
59 Ketokonazole tablet 200 mg ktk 5 x 10 tablet 16,909.00 338.18 1,982 650 2,632 2,482 150 670,272.76 219,817.00 890,089.76
60 Klindamycin kapsul 150 mg ktk 5 x 10 tablet 23,181.00 463.62 1,186 4,000 5,186 3,087 2,099 549,853.32 1,854,480.00 2,404,333.32
61 Kloramfenicol kapsul 250 mg btl/250 kaps 38,275.00 153.10 0 7,000 7,000 3,555 3,445 - 1,071,700.00 1,071,700.00
62 Kloramfenicol salep mata 1% tube 5 gram 1,420.00 1,420.00 76 96 172 83 89 107,920.00 136,320.00 244,240.00
63 Kloramfenicol syrup 125 mg/5 ml btl 60 ml 3,636.00 3,636.00 65 96 161 141 20 236,340.00 349,056.00 585,396.00
64 Kloramfenicol tetes mata 0,5% btl 5 ml 2,273.00 2,273.00 15 15 15 0 34,095.00 - 34,095.00
65 Kloramfenicol tetes telinga 3% 24 botol@5 ml 24,000.00 24,000.00 106 106 69 37 2,544,000.00 - 2,544,000.00
66 Loratadine tablet ktk 50 tab 15,140.00 302.80 360 6,500 6,860 6,860 109,008.00 1,968,200.00 2,077,208.00
67 Meloxicam tablet 100 tablet / botol 9,545.00 95.45 200 300 500 500 0 19,090.00 28,635.00 47,725.00
68 Metformin tablet 500 mg ktk 10 x 10 tablet 16,500.00 165.00 2,790 1,000 3,790 3,790 0 460,350.00 165,000.00 625,350.00
69 Metilergometrin tablet ktk 10 x 10 tablet 9,996.00 99.96 882 1,500 2,382 1,253 1,129 88,164.72 149,940.00 238,104.72
70 Metilprednisolon tablet ktk 10 x 10 tablet 40,050.00 400.50 0 4,500 4,500 4,500 - 1,802,250.00 1,802,250.00
71 Metoclopramide tablet ktk 10 x 10 tablet 7,630.00 76.30 522 7,500 8,022 4,933 3,089 39,828.60 572,250.00 612,078.60
72 Metronidazole tablet 250 mg ktk 10 x 10 tablet 11,808.00 118.08 0 0 0 0 - - -
73 Metronidazole tablet 500 mg ktk 5 x 10 tablet 20,000.00 200.00 2,469 6,000 8,469 8,135 334 493,800.00 1,200,000.00 1,693,800.00
74 Molagit tablet/ Akita tablet ktk 10 x 10 tablet 26,250.00 262.50 2,406 5,500 7,906 7,600 306 631,575.00 1,443,750.00 2,075,325.00
75 Myconazole cr tube 10 gr 2,727.00 2,727.00 247 480 727 681 46 673,569.00 1,308,960.00 1,982,529.00
76 Natrium diklofenak 50 mg ktk 5 x 10 tablet 9,894.00 197.88 2,108 24,900 27,008 22,345 4,663 417,131.04 4,927,212.00 5,344,343.04
77 Nifedipin tablet 10 mg ktk 10 x 10 tablet 9,804.00 98.04 2,222 11,500 13,722 11,090 2,632 217,844.88 1,127,460.00 1,345,304.88
78 Nistatin vaginal tablet 100.000 IU/g ktk 10 x 10 tablet 28,891.00 288.91 337 400 737 737 0 97,362.67 115,564.00 212,926.67
79 Noza tablet ktk 25 x 4 tablet 36,250.00 362.50 686 500 1,186 1,186 0 248,675.00 181,250.00 429,925.00
80 Obat Batuk Hitam ( OBH ) syrup btl 60 ml 1,363.00 1,363.00 117 180 297 297 0 159,471.00 245,340.00 404,811.00
81 Oksitetrasiklin salep kulit tube 5 gram 1,523.00 1,523.00 170 50 220 220 0 258,910.00 76,150.00 335,060.00
82 Oksitetrasiklin salep mata 25 tube @ 3,5 g / kotak 43,636.00 1,745.44 97 150 247 87 160 169,307.68 261,816.00 431,123.68
83 Omeprazole kapsul 20 mg ktk 3 x 10 capsul 11,136.00 371.20 125 2,100 2,225 1,432 793 46,400.00 779,520.00 825,920.00
84 Oralit 100 kantong/kotak 9,115.00 91.15 1,714 3,600 5,314 3,362 1,952 156,231.10 328,140.00 484,371.10
85 Paracetamol syrup btl 60 ml 2,090.00 2,090.00 61 1,512 1,573 1,111 462 127,490.00 3,160,080.00 3,287,570.00
86 Paracetamol tablet 100 mg btl 100 2,569.00 2,569.00 1,965 1,965 1,965 0 5,048,085.00 - 5,048,085.00
87 Paracetamol tablet 500 mg 1000 tab/btl 95,450.00 95.45 5,681 90,000 95,681 74,855 20,826 542,251.45 8,590,500.00 9,132,751.45
88 Piracetam tablet 800 mg ampul 5,000.00 5,000.00 1,812 500 2,312 1,153 1,159 9,060,000.00 2,500,000.00 11,560,000.00
89 Pirantel tablet 125 mg ktk 25 x 4 tablet 29,091.00 290.91 53 53 53 0 15,418.23 - 15,418.23
90 Prednison tablet 5 mg 1000 tab/btl 56,818.00 56.82 4,035 2,000 6,035 6,035 0 229,260.63 113,636.00 342,896.63
91 Propanolol tablet 40 mg ktk 10 x 10 tablet 7,000.00 70.00 311 311 148 163 21,770.00 - 21,770.00
92 Propiltiourasil tablet 100 mg 100 tablet/btl 27,233.00 272.33 200 200 0 200 54,466.00 - 54,466.00
93 Ranitidine tablet 150 mg ktk 10 x 10 tablet 19,050.00 190.50 3,184 5,000 8,184 5,705 2,479 606,552.00 952,500.00 1,559,052.00
94 Sabutamol tablet 2 mg ktk 10 x 10 tablet 7,639.00 76.39 2,162 2,162 2,162 0 165,155.18 - 165,155.18
95 Salep 24 pot 1,113.00 1,113.00 23 23 23 0 25,599.00 - 25,599.00
96 Scabicid salep tube 8,500.00 8,500.00 77 60 137 137 0 654,500.00 510,000.00 1,164,500.00
97 Simvastatin tablet ktk 3 x 10 tablet 23,318.00 777.27 1,117 2,600 3,717 2,919 798 868,206.87 2,020,893.33 2,889,100.20
98 Sulfacetamide tetes mata 24 botol@5 ml 75,169.00 3,132.04 40 120 160 138 22 125,281.67 375,845.00 501,126.67
99 Tetrasiklin kapsul 500 mg ktk 10 x 10 kapsul 23,364.00 233.64 517 1,500 2,017 2,017 0 120,791.88 350,460.00 471,251.88
100 Thiamfenicol capsul 500 mg ktk 10 x 10 kapsul 52,727.00 527.27 240 200 440 341 99 126,544.80 105,454.00 231,998.80
101 Triheksifenidil tablet 2 mg ktk 10 x 10 tablet 3,706.00 37.06 0 0 0 0 - - -
102 Vitamin B komplek tablet 1000 tablet/botol 20,182.00 20.18 0 40,400 40,400 36,330 4,070 - 815,352.80 815,352.80
103 Vitamin B1 tablet 1000 tablet/botol 32,000.00 32.00 9,658 11,000 20,658 20,658 0 309,056.00 352,000.00 661,056.00
104 Vitamin B6 tablet 1000 tablet/botol 13,000.00 13.00 15,228 5,000 20,228 20,228 0 197,964.00 65,000.00 262,964.00
105 Vitamin C tablet 1000 tablet/botol 29,091.00 29.09 1,000 4,000 5,000 3,728 1,272 29,091.00 116,364.00 145,455.00
106 Vitamin K tablet 100 tablet/botol 68,062.00 680.62 3,321 1,000 4,321 4,074 247 2,260,339.02 680,620.00 2,940,959.02
107 Zinc tablet ktk 10 x 10 tablet 43,182.00 431.82 2,171 2,000 4,171 4,171 937,481.22 863,640.00 1,801,121.22
Ventolin rotacaps - - 500 500 500 - - -
Hyoscine Inj - 0 360 360 360 - - -
0
0
0
Injeksi 0
108 Aminophillin inj 30 ampul / kotak 55,960.00 1,865.33 0 10 10 2 8 - 18,653.33 18,653.33
109 Ampicillin inj 10 vial/kotak 48,800.00 4,880.00 0 0 0 - - -
110 Antalgin inj ampul 1,112.00 1,112.00 0 120 120 85 35 - 133,440.00 133,440.00
111 Anti Bisa Ular vial 218,590.00 218,590.00 0 0 0 - - -
112 Atropin Sulfas inj ampul 1,150.00 1,150.00 0 30 30 30 - 34,500.00 34,500.00
113 Cefotaxime inj ampul 6,300.00 6,300.00 0 0 0 0 - - -
114 Dexamethason inj 100 ampul / kotak 90,777.00 907.77 22 300 322 200 122 19,970.94 272,331.00 292,301.94
115 Diazepam inj 30 ampul / kotak 71,043.00 2,368.10 9 40 49 37 12 21,312.90 94,724.00 116,036.90
116 Difenhidramin inj 30 ampul / kotak 26,182.00 872.73 615 750 1,365 1,102 263 536,731.00 654,550.00 1,191,281.00
117 Epineprin inj ampul 1,127.00 1,127.00 30 30 0 30 33,810.00 - 33,810.00
118 Ehiferan inj/metoclopramide inj ampul 909.00 909.00 34 34 30 4 30,906.00 - 30,906.00
119 Oxitosin inj/Pitogin inj 30 ampul / kotak 53,550.00 1,785.00 0 100 100 100 - 178,500.00 178,500.00
120 Lidocain inj/Pehacain inj 30 ampul / kotak 31,000.00 1,033.33 205 1,000 1,205 1,205 0 211,833.33 1,033,333.33 1,245,166.67
121 Metilergometrin inj/Myomergin inj 30 ampul / kotak 38,746.00 1,291.53 9 20 29 29 0 11,623.80 25,830.67 37,454.47
122 Phenobarbital inj 0 0
123 Piracetam inj 1 ampul 5,000.00 5,000.00 0 0 0 0 - - -
124 Ranitidine inj 25 ampul/kotak 58,400.00 2,336.00 30 50 80 18 62 70,080.00 116,800.00 186,880.00
125 Serum Anti Tetanus amp 429,550.00 429,550.00 0 0 0 0 - - -
126 Teramycin inj box@10 ampul 28,181.00 2,818.10 0 0 0 0 - - -
127 Vitamin B1 inj 30 ampul / kotak 20,880.00 696.00 807 150 957 547 410 561,672.00 104,400.00 666,072.00
128 Vitamin B12 inj 100 ampul / kotak 88,181.00 881.81 1,549 500 2,049 1,235 814 1,365,923.69 440,905.00 1,806,828.69
129 Vitamin K inj 30 ampul / kotak 29,330.00 977.67 108 108 108 0 105,588.00 - 105,588.00
130 Calcii Gluconas inj 48 48 0 48 - - -
0
0
0
0
Cairan 0
131 Cairan NS/NaCl botol/500 ml 4,454.00 4,454.00 199 20 219 187 32 886,346.00 89,080.00 975,426.00
132 Cairan D5% botol/500 ml 5,200.00 5,200.00 56 60 116 76 40 291,200.00 312,000.00 603,200.00
133 Cairan RL botol/500 ml 4,727.00 4,727.00 95 80 175 163 12 449,065.00 378,160.00 827,225.00
134 Cairan Asering 0 0
135 Kaen 3B botol/500 ml 14,300.00 14,300.00 0 0 0 - - -
136 Kaen 4B botol/500 ml 14,300.00 14,300.00 0 0 0 - - -
0
0
0
Alat Kesehatan 0
137 Alat suntik sekali pakai 1 ml 100 set/kotak 99,318.00 993.18 2,935 500 3,435 2,747 688 2,914,983.30 496,590.00 3,411,573.30
138 Alat suntik sekali pakai 2,5 ml 100 set/kotak 94,350.00 943.50 2,943 3,000 5,943 5,726 217 2,776,720.50 2,830,500.00 5,607,220.50
139 Alat suntik sekali pakai 3 ml 100 set/kotak 94,350.00 943.50 0 0 0 0 - - -
140 Alat suntik sekali pakai 5 ml 100 set/kotak 94,350.00 943.50 94 1,000 1,094 1,094 0 88,689.00 943,500.00 1,032,189.00
141 Catgut chromic 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 40 96 136 136 893,938.33 2,145,452.00 3,039,390.33
142 Catgut Plain 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 0 0 0 - - -
143 Catgut Plain2/0 24 x 70 cm /kotak 536,363.00 22,348.46 0 0 0 - - -
144 Etil Klorid semprot can 100 ml 90,000.00 90,000.00 4 3 7 7 0 360,000.00 270,000.00 630,000.00
145 Infuset anak set/kantong 3,636.00 3,636.00 130 130 103 27 472,680.00 - 472,680.00
146 Infuset dewasa set/kantong 3,181.00 3,181.00 190 190 75 115 604,390.00 - 604,390.00
147 Iodine 30 ml botol 30 ml 1,818.00 1,818.00 37 98 135 100 35 67,266.00 178,164.00 245,430.00
148 Iodine 300 ml botol 300 ml 13,181.00 13,181.00 1 9 10 5 5 13,181.00 118,629.00 131,810.00
149 IV cateter 20 50 buah/kotak 780,000.00 15,600.00 212 212 58 154 3,307,200.00 - 3,307,200.00
150 IV cateter 22 50 buah/kotak 353,927.00 7,078.54 107 107 34 73 757,403.78 - 757,403.78
151 IV cateter 24 50 buah/kotak 353,927.00 7,078.54 196 196 196 0 1,387,393.84 - 1,387,393.84
152 Kapas rol 6,818.00 6,818.00 14 30 0 0
153 Kasa 2m x 80 cm rol 8,799.00 8,799.00 0 180 180 161 19 - 1,583,820.00 1,583,820.00
154 Kasa 4m x 15 cm rol 3,373.00 3,373.00 0 110 110 74 36 - 371,030.00 371,030.00
155 Kasa 4m x 3 cm rol 3,373.00 3,373.00 0 125 125 70 55 - 421,625.00
156 Masker box 48,750.00 975.00 1,155 500 1,655 765 890 1,126,125.00 487,500.00 1,613,625.00
157 Plester rol 21,477.00 21,477.00 0 18 18 7 11 - 386,586.00 386,586.00
158 Rivanol 48 48 48 0 - - -
159 Sarung tangan box 45000 45,000.00 0 3,000 3,000 2,880 120 - 135,000,000.00 135,000,000.00
160 Silk benang bedah 36 x 75 cm/kotak 228,545.00 6,348.47 114 72 186 151 35 723,725.83 457,090.00 1,180,815.83
161 Urine bag 1 ampul 3636 3636 43 50 93 93 156,348.00 181,800.00 338,148.00
162 Foley Catheter 16 bj 7722 7722 35 10 45 35 10 270,270.00 77,220.00 347,490.00
163 Lactodia sachet/30 138,514.00 4,617.13 0 0 0 - - -
164 Alkohol 1 L botol 1 l 18698 18698 47 100 147 19 128 878,806.00 1,869,800.00 2,748,606.00
165 Scopma tablet 10 x 10 tablet/kotak 27,273.00 272.73 0 0 0 - - -
166 Mecobion tab 10 x 10 tablet/kotak 27,000.00 270.00 1,209 1,000 2,209 2,209 0 326,430.00 270,000.00 596,430.00
167 Kasa steril kotak 7,727.00 7,727.00 0 0 0 - - -
168 Bioplacenton gel tube 10,100.00 10,100.00 37 100 137 102 35 373,700.00 1,010,000.00 1,383,700.00
169 Aquadest 1 vial 500.00 500.00 61 20 81 46 35 30,500.00 10,000.00 40,500.00
170 Bisoprolol tab 50 tablet/box 105,550.00 2,111.00 0 0 0 - - -
171 Lytamin syr botol 60 ml 4,350.00 4,350.00 0 98 98 98 0 - 426,300.00 426,300.00
172 Susuk KB bj 191,154.00 191,154.00 0 0 0 - - -
173 Magnesium sulfat 20% vial 15,398.00 15,398.00 24 24 2 22 369,552.00 - 369,552.00
174 Magnesium sulfat 40% vial 15,398.00 15,398.00 19 19 2 17 292,562.00 - 292,562.00
175 Cendo xitrol mini dose strip 19,500.00 19,500.00 0 0 0 - - -
176 Kasa elastis rol 6,363.00 6,363.00 0 0 0 - - -
177 Combivent nebules ampul 12,000.00 12,000.00 0 0 0 - - -
178 OAT kategori I 1 paket 327,272.00 327,272.00 0 41 41 27 14 - 13,418,152.00 13,418,152.00
179 Lisol 1 L 16 16 7 9
180 Cetirizin tab 30 tablet/strip/kotak 18,000.00 600.00 0 500 500 500 0 - 300,000.00 300,000.00
181 Amlodipin tab 30 tablet/strip/kotak 26,190.00 873.00 280 4,500 4,780 4,417 363 244,440.00 3,928,500.00 4,172,940.00
182 Phenytoin caps btl 250 kapsul 19,884.00 79.54 500 500 0 500 39,768.00 - 39,768.00
183 Albothyl sol btl 5 ml 12,273.00 12,273.00 5 10 15 15 0 61,365.00 122,730.00 184,095.00
184 Konflusin syr 0 0
185 Mersibion inj 1 ampul 4,750.00 4,750.00 0 50 50 50 0 - 237,500.00 237,500.00
186 Baby Cough syr botol 60 ml 3,500.00 0 288 288 216 72 - - -
187 Microlax tube 17,075.00 17,075.00 0 15 15 15 0 - 256,125.00 256,125.00
188 Vitamin C 250 mg tab btl/250 35,000.00 140.00 0 0 0 - - -
189 Kaptopril 12,5 mg box/100 9,450.00 94.50 0 0 0 0 - - -
190 Antimigrain tab btl/100 15,000.00 150.00 0 200 200 0 200 - 30,000.00 30,000.00
191 Serum Anti Bisa Ular 218,590.00 2,185.90 0 0 0 - - -
192 Stelosi tab 0 0 0 - - -
193 Blood tranfusion set 30 1 31 19 12 - - -
194 Mess 1,995.00 1,995.00 300 300 54 246 598,500.00 - 598,500.00
195 H2O2 100 ml 2,000.00 2,000.00 0 0 0 - - -
196 Vitamin K infant 1,975.00 1,975.00 0 0 0 - - -
197 Glass Ionomer 5 5 5 0 - - -
198 Domperidone 167.00 600 600 58 542 - 100,200.00 100,200.00
199 MDT Kusta 18 18 15 3 - - -
200 Temporary Fletcher 6 6 6 0 - - -
201 Attapulgit 2000 2,000 2,000 - - -
202 OAT kategori II 3 3 3 0 - - -
203 Eugenol Cair 16,667.00 15 15 13 2 250,005.00 250,005.00
204 OAT Anak 1 1 1 0 - - -
205 Codein tab 500.00 1000 1,000 0 1,000 - 500,000.00 500,000.00
206 Salbutamol 4 mg 89.00 2500 2,500 1,114 1,386 - 222,500.00 222,500.00
Gentamicin salep mata 0.00 0 0 - - -
Paracetamol drops 0.00 280 280 280 - - -
TOTAL 74,952,802.80 291,143,975.80 ###
Mengetahui
Kepala Puskesmas Petugas Obat
Drg.Izzah El Maila Meiria Nurani,Amd.Farm

NIP.19780121 200604 2 031 NIP.19800517 201001 2 015
Harga (+PPN 10%)
Pengeluaran Sisa per
Bln Desember 2014
(Rp) (Rp)
13 14
728,109.00 414,504.00
1,796,919.30 363,014.00
648,120.00 111,120.00
1,723,374.57 -
291,696.00 205,691.00
1,395,054.00 115,236.00
1,418,760.00 313,740.00
4,304,640.00 1,372,104.00
21,056,808.72 6,568,774.44
1,322,937.00 1,717,975.50
2,348,500.00 850,500.00
1,207,565.94 220,058.15
- -
164,010.00 228,052.00
6,232,960.00 1,512,000.00
211,120.00 -
403,000.00 131,300.00
623,280.00 -
266,328.52 339,272.00
- -
19,200.00 -
2,204,270.00 -
1,530,061.00 836,603.00
1,424,550.00 579,450.00
39,024.90 -
803,922.78 314,033.68
1,652,651.00 556,633.00
11,961.50 4,488.50
23,132.38 62,241.08
52,221.00 -
871,170.00 -
1,578,150.00 -
79,245.11 246,098.93
220,712.00 18,565.00
36,240.00 84,408.00
22,418.00 22,418.00
1,045,688.00 -
3,857,788.35 809,941.10
5,833,737.00 1,523,613.00
- 39,768.00
- 42,000.00
118,250.00 126,500.00
399,062.82 99,531.64
546,090.00 -
654,000.00 138,000.00
187,731.00 19,632.00
523,992.70 362,658.45
179,558.37 -
94,253.76 530,177.40
- -
85,352.96 -
53,928.00 -
1,165,349.05 460,259.90
2,239,767.44 496,126.16
42,126.00 28,674.00
684,214.93 446,294.95
3,101,446.18 472,618.02
- -
839,362.76 50,727.00
1,431,194.94 973,138.38
544,270.50 527,429.50
117,860.00 126,380.00
512,676.00 72,720.00
34,095.00 -
1,656,000.00 888,000.00
2,077,208.00 -
47,725.00 -
625,350.00 -
125,249.88 112,854.84
1,802,250.00 -
376,387.90 235,690.70
- -
1,627,000.00 66,800.00
1,995,000.00 80,325.00
1,857,087.00 125,442.00
4,421,628.60 922,714.44
1,087,263.60 258,041.28
212,926.67 -
429,925.00 -
404,811.00 -
335,060.00 -
151,853.28 279,270.40
531,558.40 294,361.60
306,446.30 177,924.80
2,321,990.00 965,580.00
5,048,085.00 -
7,144,909.75 1,987,841.70
5,765,000.00 5,795,000.00
15,418.23 -
342,896.63 -
10,360.00 11,410.00
- 54,466.00
1,086,802.50 472,249.50
165,155.18 -
25,599.00 -
1,164,500.00 -
2,268,841.40 620,258.80
432,221.75 68,904.92
471,251.88 -
179,799.07 52,199.73
- -
733,212.06 82,140.74
661,056.00 -
262,964.00 -
108,451.25 37,003.75
2,772,845.88 168,113.14
1,801,121.22 -
- -
- -
3,730.67 14,922.67
- -
94,520.00 38,920.00
- -
34,500.00 -
- -
181,554.00 110,747.94
87,619.70 28,417.20
961,752.13 229,528.87
- 33,810.00
27,270.00 3,636.00
178,500.00 -
1,245,166.67 -
37,454.47 -
- -
42,048.00 144,832.00
- -
- -
380,712.00 285,360.00
1,089,035.35 717,793.34
105,588.00 -
- -
832,898.00 142,528.00
395,200.00 208,000.00
770,501.00 56,724.00
- -
- -
2,728,265.46 683,307.84
5,402,481.00 204,739.50
- -
1,032,189.00 -
3,039,390.33 -
- -
- -
630,000.00 -
374,508.00 98,172.00
238,575.00 365,815.00
181,800.00 63,630.00
65,905.00 65,905.00
904,800.00 2,402,400.00
240,670.36 516,733.42
1,387,393.84 -
-
1,416,639.00 167,181.00
249,602.00 121,428.00
236,110.00 185,515.00
745,875.00 867,750.00
150,339.00 236,247.00
- -
129,600,000.00 5,400,000.00
958,619.31 222,196.53
338,148.00 -
270,270.00 77,220.00
- -
355,262.00 2,393,344.00
- -
596,430.00 -
- -
1,030,200.00 353,500.00
23,000.00 17,500.00
- -
426,300.00 -
- -
30,796.00 338,756.00
30,796.00 261,766.00
- -
- -
- -
8,836,344.00 4,581,808.00
300,000.00 -
3,856,041.00 316,899.00
- 39,768.00
184,095.00 -
237,500.00 -
- -
256,125.00 -
- -
- -
- 30,000.00
- -
- -
- -
107,730.00 490,770.00
- -
- -
- -
9,686.00 90,514.00
- -
- -
- -
- -
33,334.00
- -
- 500,000.00
99,146.00 123,354.00
- -
- -
### 61,555,836.42
PUSKESMAS LAWANG
No Nama Obat PERMINTAAN PUSTU/POL/POSK JUMLAH

KEBTHN
1 2 BP UGD GIGI BEDALI SIDOLUHUR SIDODADI SRIGADINGSBR NGEPOHSBR PRONG KETINDAN LAWANG WONOREJO TURIREJO MULYOARJO KALIREJO
1 Acyclovir krim 5% 300 10 10 20.00 30.00 15.00 60.00 60.00 30.00 60.00 30.00 10.00 635.00
2 Acyclovir tablet 400 mg 6,000 200 180 200 200.00 600.00 300.00 100.00 200.00 200.00 300.00 300.00 100.00 8,880.00
3 Alopurinol tablet 100 mg 6,000 50 600 300 300.00 600.00 200.00 200.00 600.00 600.00 300.00 300.00 800.00 200.00 11,050.00
4 Ambroxol tablet 30 mg 20,000 50 300 1,200 1,000.00 1,200.00 600.00 300.00 600.00 600.00 420.00 600.00 2,000.00 400.00 29,270.00
5 Aminofilin tablet 200 mg 2,000 50 300 300 300.00 600.00 300.00 100.00 120.00 300.00 100.00 4,470.00
6 Amitriptilin tablet 25 mg 1,500 0 - 1,500.00
7 Amoxicillin kapsul 250 mg 6,000 0 600.00 300.00 300.00 600.00 2,000.00 - 9,800.00
8 Amoxicillin syrup kering 125 mg/5 ml 3,000 10 150 60 90.00 6.00 150.00 20.00 120.00 120.00 40.00 60.00 50.00 20.00 3,896.00
9 Amoxicillin tablet 500 mg 50,000 500 1,800 1,200 3,000.00 1,500.00 600.00 400.00 2,400.00 2,400.00 2,400.00 3,000.00 3,000.00 400.00 72,600.00
10 Antalgin tablet 500 mg 600 200 1,200 250.00 450.00 1,200.00 3,000.00 200.00 7,100.00
11 Antasida syrup 4,000 10 60 30 30.00 100.00 20.00 120.00 60.00 60.00 50.00 30.00 4,570.00
12 Antasida tab 40,000 500 1,200 1,200 1,200.00 600.00 600.00 500.00 900.00 900.00 2,000.00 2,000.00 3,000.00 600.00 55,200.00
13 Anti hemoroid supp 300 0 10.00 - 310.00
14 Antifungi salep 0 30 12.00 30.00 30.00 - 102.00
15 Asam mefenamat tablet 500 mg 30,000 500 1,800 1,000 1,200.00 1,200.00 600.00 600.00 600.00 2,000.00 3,000.00 600.00 43,100.00
16 Asetosal tablet 100 mg 0 600 300 300.00 200.00 - 1,400.00
17 Bedak Salycil 200 60 25.00 30.00 60.00 60.00 60.00 30.00 20.00 10.00 555.00
18 Betahistin Mesilat tablet 6 mg 5,000 100 360 200.00 60.00 60.00 200.00 300.00 500.00 100.00 6,880.00
19 Betametason krim 0.1% 600 10 60 15 15.00 40.00 30.00 60.00 15.00 845.00
20 Bravoderm cr/Prodemis cr 0 0 0 - - -
21 Bufacom cr 100 0 10.00 50.00 30.00 15.00 205.00
22 Ciprofloxacin tablet 500 mg 3,000 300 600 300 300.00 300.00 300.00 600.00 30.00 1,000.00 100.00 6,830.00
23 Cotrimoxazole syr 300 10 180 30 30.00 20.00 160.00 160.00 30.00 30.00 30.00 15.00 995.00
24 Cotrimoxazole tab 6,000 1,800 600 600.00 200.00 1,200.00 1,200.00 600.00 600.00 1,000.00 300.00 14,100.00
25 CPZ tab 0 0 - - -
26 CTM tablet 30,000 200 3,000 1,500 2,500.00 1,000.00 1,000.00 1,500.00 1,500.00 4,500.00 1,800.00 1,000.00 400.00 49,900.00
27 Dexamethason tablet 0,5 mg 6,000 600 1,800 1,000 1,000.00 600.00 600.00 900.00 900.00 1,200.00 1,000.00 200.00 15,800.00
28 Diazepam tablet 2 mg 500 100 0 - 600.00
29 Digoxin tablet 0,25 mg 3,000 0 - 3,000.00
30 Dimenhidrinat tablet 50 mg 6,000 100 600 1,000.00 - 7,700.00
31 DMP syrup 0 0 - -
32 DMP tablet 0 0 200.00 200.00
33 Doksisiklin kapsul 100 mg 300 - 300.00
34 Efedrin tablet 25 mg 10,000 0 100 200.00 600.00 300.00 150.00 500.00 250.00 12,100.00
35 Ekstrak Belladona tablet 10 mg 0 250 0 500 500.00 200.00 300.00 300.00 - 2,050.00
36 Ergotamin tablet 1,000 0 100.00 1,100.00
37 Erythromycin syrup 300 20 60 6.00 20.00 - 406.00
38 Erythromycin tablet 500 mg 5,000 500 300 500.00 - 6,300.00
39 Fe ( tablet tambah darah) 12,000 3,600 3,000 3,000.00 600.00 600.00 1,800.00 500.00 300.00 25,400.00
40 Fenitoin kapsul 100 mg 0 0 - -
41 Fenobarbital tablet 30 mg 0 0 - -
42 Fenol glisetol tts telinga 10% 200 30 10 10.00 12.00 10.00 272.00
43 Furosemide tablet 40 mg 600 200 1,200 900.00 200.00 300.00 100.00 3,500.00
44 Gentamycin salep kulit 400 50 60 15 20.00 30.00 60.00 60.00 30.00 30.00 15.00 770.00
45 Gentamycin tetes mata 100 50 30 10.00 25.00 60.00 60.00 12.00 30.00 10.00 387.00
46 Gentian violet 0 20 18 10 10.00 60.00 20.00 - 138.00
47 Glibenklamid tablet 5 mg 3,000 100 600 200 300.00 200.00 500.00 500.00 120.00 500.00 100.00 6,120.00
48 Gliseril Guaiacolat tablet 100 mg 30,000 200 1,800 1,000 1,000.00 1,000.00 1,200.00 1,200.00 2,700.00 5,000.00 400.00 45,500.00
49 Griseofulvin tablet 125 mg 1,000 0 100.00 100.00 1,200.00
50 Haloperidol tablet 5 mg 0 0 - -
51 Hidroklortiazid (HCT) tablet 25 mg 1,000 100 1,200 10 200.00 60.00 200.00 100.00 2,870.00
52 Hidrokortisone krim 2,5 % 600 20 60 10 40.00 30.00 60.00 30.00 25.00 875.00
53 Ibuprofen tablet 200 mg 2,500 600 1,000 1,000.00 600.00 1,200.00 500.00 200.00 7,600.00
54 Ibuprofen tablet 400 mg 10,000 200 1,800 1,000 1,000.00 1,000.00 1,200.00 600.00 3,000.00 19,800.00
55 Isosorbid tablet 5 mg 500 100 0 600.00
56 Kalk tablet 10,000 2,400 500 1,000.00 200.00 1,000.00 450.00 1,000.00 500.00 17,050.00
57 Kaptopril tablet 25 mg 10,000 1,200 700 800.00 600.00 150.00 150.00 600.00 14,200.00
58 karbamazepin tablet 200 mg 0 0 - -
59 Ketokonazole tablet 200 mg 500 300 500 200.00 600.00 300.00 400.00 200.00 300.00 100.00 3,400.00
60 Klindamycin kapsul 150 mg 2,500 0 200.00 900.00 900.00 600.00 300.00 100.00 5,500.00
61 Kloramfenicol kapsul 250 mg 1,000 200 300 500 500.00 1,500.00 200.00 150.00 250.00 4,600.00
62 Kloramfenicol salep mata 1% 100 20 12 10.00 25.00 20.00 12.00 30.00 - 229.00
63 Kloramfenicol syrup 125 mg/5 ml 200 20 30 10 10.00 20.00 120.00 18.00 30.00 15.00 473.00
64 Kloramfenicol tetes mata 0,5% 120 20 30 30.00 20.00 18.00 30.00 - 268.00
65 Kloramfenicol tetes telinga 3% 120 20 30 30.00 20.00 12.00 30.00 - 262.00
66 Loratadine tablet 600 200 300 300.00 500.00 100.00 2,000.00
67 Meloxicam tablet 600 100 0 500.00 100.00 1,300.00
68 Metformin tablet 500 mg 8,000 100 600 200 200.00 600.00 200.00 200.00 100.00 1,000.00 100.00 11,300.00
69 Metilergometrin tablet 300 50 300 200 200.00 200.00 200.00 200.00 600.00 500.00 100.00 2,850.00
70 Metilprednisolon tablet 300 100 0 - 400.00
71 Metoclopramide tablet 1,000 50 600 300.00 600.00 600.00 300.00 1,000.00 100.00 4,550.00
72 Metronidazole tablet 250 mg 0 0 200.00 - 200.00
73 Metronidazole tablet 500 mg 3,000 150 1,800 400 200.00 600.00 200.00 700.00 1,800.00 600.00 1,000.00 100.00 10,550.00
74 Molagit tablet/ Akita tablet 3,000 200 0 200 500.00 400.00 1,000.00 300.00 5,600.00
75 Myconazole cr 50 20 18 10 10.00 12.00 60.00 10.00 60.00 30.00 10.00 290.00
76 Natrium diklofenak 50 mg 25,000 600 500 500.00 480.00 400.00 600.00 450.00 1,000.00 2,000.00 600.00 32,130.00
77 Nifedipin tablet 10 mg 1,000 200 600 500 300.00 800.00 60.00 100.00 600.00 3,000.00 300.00 7,460.00
78 Nistatin vaginal tablet 100.000 IU/g 100 30 30 120.00 100.00 20.00 60.00 50.00 10.00 520.00
79 Noza tablet 500 0 - 500.00
80 Obat Batuk Hitam ( OBH ) syrup 200 30 60 20 60.00 30.00 70.00 60.00 60.00 50.00 20.00 660.00
81 Oksitetrasiklin salep kulit 60 20 60 60.00 30.00 60.00 12.00 60.00 30.00 - 392.00
82 Oksitetrasiklin salep mata 60 60 18.00 30.00 - 168.00
83 Omeprazole kapsul 20 mg 500 200 0 300.00 100.00 90.00 500.00 60.00 1,750.00
84 Oralit 5,000 120 100 200.00 2,000.00 2,000.00 150.00 400.00 500.00 100.00 10,570.00
85 Paracetamol syrup 500 150 180 50 30.00 200.00 140.00 90.00 60.00 50.00 50.00 1,500.00
86 Paracetamol tablet 100 mg 0 600 1,000 1,000.00 600.00 300.00 3,500.00
87 Paracetamol tablet 500 mg 40,000 300 3,000 2,000 3,000.00 1,500.00 3,000.00 2,400.00 3,000.00 3,000.00 600.00 61,800.00
88 Piracetam tablet 800 mg 500 100 300 100.00 300.00 500.00 1,800.00
89 Pirantel tablet 125 mg 500 0 100 100.00 200.00 900.00
90 Prednison tablet 5 mg 5,000 200 1,800 1,000 1,000.00 200.00 300.00 750.00 1,500.00 500.00 12,250.00
91 Propanolol tablet 40 mg 100 0 100.00
92 Propiltiourasil tablet 100 mg 100 0 100.00
93 Ranitidine tablet 150 mg 1,000 200 300 500 600.00 300.00 600.00 120.00 300.00 1,000.00 300.00 5,220.00
94 Sabutamol tablet 2 mg 2,000 100 300 500 300.00 300.00 400.00 300.00 300.00 500.00 100.00 5,100.00
95 Salep 24 30 30 30 10 10.00 20.00 30.00 30.00 20.00 210.00
96 Scabicid salep 76 30 106.00
97 Simvastatin tablet 1,000 1,200 200.00 100.00 300.00 600.00 1,000.00 300.00 4,700.00
98 Sulfacetamide tetes mata 120 60 10.00 30.00 30.00 20.00 10.00 280.00
99 Tetrasiklin kapsul 500 mg 300 600 200.00 600.00 600.00 100.00 2,400.00
100 Thiamfenicol capsul 500 mg 3,000 300 300 300.00 200.00 200.00 100.00 4,400.00
101 Triheksifenidil tablet 2 mg 0 0 -
102 Vitamin B komplek tablet 10,000 1,800 2,000 2,000.00 1,000.00 1,000.00 1,200.00 1,800.00 3,000.00 1,000.00 24,800.00
103 Vitamin B1 tablet 3,000 1,800 600.00 1,000.00 300.00 3,000.00 30.00 9,730.00
104 Vitamin B6 tablet 6,000 1,800 1,000.00 600.00 300.00 9,700.00
105 Vitamin C tablet 5,000 2,400 600 600.00 3,000.00 300.00 11,900.00
106 Vitamin K tablet 300 300 200 300.00 200.00 180.00 500.00 1,980.00
107 Zinc tablet 2,000 300 200.00 600.00 500.00 100.00 3,700.00
Salbutamol 4 mg 3,000 3,000.00
-
-
-
-
Injeksi -
108 Aminophillin inj 30 0 30.00
109 Ampicillin inj 0 0 -
110 Antalgin inj 90 0 5.00 30.00 125.00
111 Anti Bisa Ular 1 0 1.00
112 Atropin Sulfas inj 30 0 30.00
113 Cefotaxime inj 0 0 -
114 Dexamethason inj 300 60 60.00 60.00 480.00
115 Diazepam inj 10 0 10.00
116 Difenhidramin inj 120 100 150 150 150.00 60.00 50.00 780.00
117 Epineprin inj 30 10 0 40.00
118 Ehiferan inj/metoclopramide inj 0 30 12.00 30.00 72.00
119 Oxitosin inj/Pitogin inj 10 30 20 20.00 5.00 85.00
120 Lidocain inj/Pehacain inj 300 50 720 30 20 20.00 60.00 30.00 30.00 60.00 60.00 1,380.00
121 Metilergometrin inj/Myomergin inj 10 18 5 10.00 30.00 20.00 93.00
122 Phenobarbital inj 0 0 -
123 Piracetam inj 0 0 -
124 Ranitidine inj 0 50 0 5 18.00 12.00 85.00
125 Serum Anti Tetanus 5 0 5.00
126 Teramycin inj 0 0 -
127 Vitamin B1 inj 60 30 120 5.00 120.00 30.00 365.00
128 Vitamin B12 inj 100 120 150 150.00 30.00 180.00 730.00
129 Vitamin K inj 30 30 6 6.00 60.00 132.00
130 Calcii Gluconas inj 0 0 -
-
-
-
-
Cairan -
131 Cairan NS/NaCl 20 100 12.00 12.00 5.00 10.00 10.00 169.00
132 Cairan D5% 20 10 10.00 10.00 12.00 10.00 10.00 82.00
133 Cairan RL 20 100 20 20.00 15.00 15.00 18.00 15.00 10.00 233.00
134 Cairan Asering 0 -
135 Kaen 3B 0 -
136 Kaen 4B 0 -
-
-
-
Alat Kesehatan -
137 Alat suntik sekali pakai 1 ml 0 20 700 150 300.00 200.00 300.00 180.00 100.00 200.00 2,150.00
138 Alat suntik sekali pakai 2,5 ml 0 50 600 600 600.00 200.00 180.00 600.00 600.00 900.00 900.00 200.00 200.00 5,630.00
139 Alat suntik sekali pakai 3 ml 0 0 -
140 Alat suntik sekali pakai 5 ml 0 20 50 50.00 100.00 100.00 360.00 100.00 200.00 980.00
141 Catgut chromic 3/0 0 50 30 80.00
142 Catgut Plain 3/0 0 50 30 80.00
143 Catgut Plain2/0 0 50 0 50.00
144 Etil Klorid semprot 0 5 6 1 12.00
145 Infuset anak 0 20 0 20.00
146 Infuset dewasa 0 20 5 10 20.00 18.00 73.00
147 Iodine 30 ml 0 10 6 18 2 5.00 6.00 20.00 3.00 70.00
148 Iodine 300 ml 0 10 2 1 6.00 2.00 6.00 27.00
149 IV cateter 20 0 10 2 20.00 32.00
150 IV cateter 22 0 10 2 12.00
151 IV cateter 24 0 10 2 10.00 22.00
152 Kapas 0 50 12 3 3 6.00 3.00 6.00 83.00
153 Kasa 2m x 80 cm 0 50 60 60.00 10.00 18.00 198.00
154 Kasa 4m x 15 cm 0 50 65 30 12.00 15.00 10.00 30.00 212.00
155 Kasa 4m x 3 cm 0 50 30 15.00 12.00 107.00
156 Masker 500 100 300 60 50 50.00 100.00 1,160.00
157 Plester 0 50 2 3 3.00 3.00 5.00 6.00 72.00
158 Rivanol 0 12 2.00 5.00 19.00
159 Sarung tangan 0 500 1,800 60 100 100.00 100.00 100.00 100.00 200.00 3,060.00
160 Silk benang bedah 0 50 6 3.00 12.00 71.00
161 Urine bag 0 30 0 30.00
162 Foley Catheter 16 0 10 0 10.00
163 Lactodia 0 0 -
164 Alkohol 1 L 3 20 3 3.00 2.00 2.00 12.00 5.00 1.00 51.00
165 Scopma tablet 0 0 -
166 Mecobion tab 5,000 0 100.00 5,100.00
167 Kasa steril 0 50 30 80.00
168 Bioplacenton gel 10 20 0 10 5.00 18.00 10.00 73.00
169 Aquadest 0 12 3.00 12.00 10.00 37.00
170 Bisoprolol tab 0 0 -
171 Lytamin syr 50 60 10 120.00
172 Susuk KB 0 -
173 Magnesium sulfat 20% 10 2 12.00
174 Magnesium sulfat 40% 10 2 12.00
175 Cendo xitrol mini dose 0 0 -
176 Kasa elastis 0 30 30.00
177 Combivent nebules 0 0 -
178 OAT kategori I 36 0 36.00
179 Lisol 1 L 0 6 3.00 6.00 15.00
180 Cetirizin tab 500 0 500.00
181 Amlodipin tab 3,000 100 300 200 500.00 600.00 200.00 200.00 2,000.00 60.00 7,160.00
182 Phenytoin caps 0 0 -
183 Albothyl sol 10 6 3 6 6.00 3.00 34.00
184 Konflusin syr 0 0 -
185 Mersibion inj 0 60 60.00
186 Baby Cough syr 60 60 10 15.00 50.00 20.00 215.00
187 Microlax 5 5 12 10 20.00 52.00
188 Vitamin C 250 mg tab 0 0 -
189 Kaptopril 12,5 mg 10,000 1,200 11,200.00
190 Antimigrain tab 2,000 0 100.00 2,100.00
191 Serum Anti Bisa Ular 3 0 3.00
192 Stelosi tab 0 0 -
193 Blood tranfusion set 0 0 10.00 10.00
194 Mess 0 0 -
195 H2O2 100 ml 0 0 -
196 Vitamin K infant 0 0 -
-
POLI GIGI -
197 G I Komposit 3 3.00
198 Cresophen 1 1.00
199 CHKM 1 1.00
200 Spongostan 5 5.00
201 Mata Bur Bulat 6 6.00
202 Mata Bur Fisur 6 6.00
203 Mata Bur Longseng 6 6.00
204 Ceivitron 3 3.00
205 Guttap No. 15 s/d 40 1 1.00
206 Guttap No. 40 s/d 80 1 1.00
207 Devitasol 1 1.00
208 File 15 s/d 40 1 1.00
209 File 40 s/d 80 1 1.00
210 Bonding 2 2.00
211 Etsa 2 2.00
212 Aplikator 2 2.00
213 Arculating papper 3 3.00
214 Papper Point No 15 s/d 40 1 1.00
215 Papper Point No 40 s/d 80 1 1.00
216 Glass Ionomer Cemen 12 12.00
Mengetahui
Kepala Puskesmas Lawang
Drg.Izzah El Maila
NIP.19780121 200604 2 031
JUMLAH JUMLAH Harga/
TTL HARGA
PERSEDIAA PERMINTAA biji
174.00 461.00 3,400.00 2,159,000.00

627.00 8,253.00 336.00 2,983,680.00
1,204.00 9,846.00 86.00 950,300.00
- 29,270.00 125.00 3,658,750.00
2,286.00 2,184.00 80.00 357,600.00
200.00 1,300.00 112.00 168,000.00
1,506.00 8,294.00 211.00 2,067,800.00
509.00 3,387.00 2,445.00 9,525,720.00
24,793.00 47,807.00 261.00 18,948,600.00
14,872.00 (7,772.00) -
318.00 4,252.00 2,160.00 9,871,200.00
5,596.00 49,604.00 72.00 3,974,400.00
- 310.00 3,300.00 1,023,000.00
151.00 (49.00) -
12,879.00 30,221.00 112.00 4,827,200.00
- 1,400.00 116.00 162,400.00
126.00 429.00 1,250.00 693,750.00
- 6,880.00 923.00 6,350,240.00
200.00 645.00 1,520.00 1,284,400.00
- - -
63.00 142.00 -
1,000.00 5,830.00 -
221.00 774.00 2,167.00 2,156,165.00
4,750.00 9,350.00 138.00 1,945,800.00
- - -
22,372.00 27,528.00 -
8,801.00 6,999.00 62.00 979,600.00
200.00 400.00 -
787.00 2,213.00 97.00 291,000.00
- 7,700.00 104.00 800,800.00
- - -
- 200.00 -
1,177.00 (877.00) 167.00 50,100.00
759.00 11,341.00 -
3,696.00 (1,646.00) -
200.00 900.00 135.00 148,500.00
5.00 401.00 7,700.00 3,126,200.00
1,100.00 5,200.00 930.00 5,859,000.00
13,170.00 12,230.00 -
- - -
1,000.00 (1,000.00) -
144.00 128.00 -
1,382.00 2,118.00 -
- 770.00 1,350.00 1,039,500.00
50.00 337.00 -
50.00 88.00 -
6,232.00 (112.00) -
- 45,500.00 21.00 955,500.00
2,480.00 (1,280.00) -
- - -
- 2,870.00 25.00 71,750.00
- 875.00 2,541.00 2,223,375.00
5,472.00 2,128.00 -
4,741.00 15,059.00 150.00 2,970,000.00
363.00 237.00 88.00 52,800.00
10,576.00 6,474.00 -
8,485.00 5,715.00 -
- - -
200.00 3,200.00 -
2,370.00 3,130.00 361.00 1,985,500.00
3,662.00 938.00 249.00 1,145,400.00
96.00 133.00 1,600.00 366,400.00
27.00 446.00 -
- 268.00 -
41.00 221.00 -
2,203.00 (203.00) 154.00 308,000.00
- 1,300.00 234.00 304,200.00
- 11,300.00 105.00 1,186,500.00
1,277.00 1,573.00 154.00 438,900.00
- 400.00 205.00 82,000.00
3,715.00 835.00 108.00 491,400.00
- 200.00 110.00 22,000.00
482.00 10,068.00 160.00 1,688,000.00
2,810.00 2,790.00 190.00 1,064,000.00
78.00 212.00 3,000.00 870,000.00
6,021.00 26,109.00 176.00 5,654,880.00
3,602.00 3,858.00 110.00 820,600.00
- 520.00 640.00 332,800.00
- 500.00 -
- 660.00 2,500.00 1,650,000.00
- 392.00 1,529.00 599,368.00
168.00 - 1,600.00 268,800.00
900.00 850.00 211.00 369,250.00
2,217.00 8,353.00 288.00 3,044,160.00
575.00 925.00 1,438.00 2,157,000.00
- 3,500.00 -
26,158.00 35,642.00 79.00 4,882,200.00
1,269.00 531.00 -
- 900.00 298.00 268,200.00
- 12,250.00 -
169.00 (69.00) 107.00 10,700.00
200.00 (100.00) -
3,000.00 2,220.00 120.00 626,400.00
227.00 4,873.00 -
- 210.00 1,800.00 378,000.00
- 106.00 -
1,000.00 3,700.00 169.00 794,300.00
31.00 249.00 -
1,000.00 1,400.00 149.00 357,600.00
456.00 3,944.00 431.00 1,896,400.00
- - -
7,207.00 17,593.00 -
984.00 8,746.00 -
- 9,700.00 -
2,000.00 9,900.00 -
500.00 1,480.00 -
1,247.00 2,453.00 474.00 1,753,800.00
1,500.00 1,500.00 89.00 267,000.00
- -
- -
- -
- -
- -
8.00 22.00 3,822.00 114,660.00
- - -
47.00 78.00 -
- 1.00 -
- 30.00 -
- - -
127.00 353.00 1,580.00 758,400.00
10.00 - -
355.00 425.00 1,050.00 819,000.00
- 40.00 8,100.00 324,000.00
8.00 64.00 -
10.00 75.00 -
43.00 1,337.00 839.00 1,157,820.00
1.00 92.00 -
- - -
- - -
- 85.00 1,140.00 96,900.00
- 5.00 -
- - -
456.00 (91.00) -
886.00 (156.00) -
5.00 127.00 -
- - -
- -
- -
- -
- -
- -
36.00 133.00 -
41.00 41.00 -
18.00 215.00 -
- - -
- - -
- - -
- -
- -
- -
- -
864.00 1,286.00 -
274.00 5,356.00 650.00 3,659,500.00
- - -
45.00 935.00 750.00 735,000.00
- 80.00 -
- 80.00 -
- 50.00 -
- 12.00 -
27.00 (7.00) -
117.00 (44.00) -
44.00 26.00 -
5.00 22.00 -
154.00 (122.00) -
74.00 (62.00) -
- 22.00 -
- 83.00 -
- 198.00 -
27.00 185.00 -
55.00 52.00 -
957.00 203.00 -
11.00 61.00 -
- 19.00 -
285.00 2,775.00 -
35.00 36.00 -
46.00 (16.00) -
10.00 - -
- - -
100.00 (49.00) -
- - -
- 5,100.00 -
- 80.00 -
87.00 (14.00) -
39.00 (2.00) -
- - -
- 120.00 -
- - -
23.00 (11.00) -
17.00 (5.00) -
- - -
- 30.00 -
- - -
15.00 21.00 -
9.00 6.00 -
- 500.00 -
600.00 6,560.00 -
- - -
- 34.00 -
- - -
- 60.00 -
72.00 143.00 -
- 52.00 -
- - -
3,485.00 7,715.00 -
200.00 1,900.00 -
- 3.00 -
- - -
12.00 (2.00) -
246.00 (246.00) -
- - -
- - -
- -
- -
- 3.00 800,000.00 2,400,000.00
- 1.00 400,000.00 400,000.00
- 1.00 70,000.00 70,000.00
- 5.00 30,000.00 150,000.00
- 6.00 20,000.00 120,000.00
- 6.00 20,000.00 120,000.00
- 6.00 20,000.00 120,000.00
- 3.00 100,000.00 300,000.00
- 1.00 50,000.00 50,000.00
- 1.00 50,000.00 50,000.00
- 1.00 450,000.00 450,000.00
- 1.00 100,000.00 100,000.00
- 1.00 100,000.00 100,000.00
- 2.00 200,000.00 400,000.00
- 2.00 100,000.00 200,000.00
- 2.00 90,000.00 180,000.00
- 3.00 30,000.00 90,000.00
- 1.00 50,000.00 50,000.00
- 1.00 50,000.00 50,000.00
- 12.00 -
-
-
140,825,168.00
Malang,20 September 2014

Petugas Obat
Meiria Nurani
NIP.19800517 201001 2 015
LAPORAN PENCACAHAN OBAT (STOCK OPNAME
TAHUN 2014
PUSKESMAS SITIARJO
Jumlah Obat
No Nama Obat Satuan Harga Harga/ Stock Penerimaan Persedi
(satuan + biji Awal Jan-juli aan
PPN 10%) thn 2014 Tahun 2014
1 2 3 4 5 6 7
1 Acyclovir krim 5% 100 tablet/strip/blister , kotak2,727.00 2,727.00 219 219
2 Acyclovir tablet 400 mg ktk 10 x 30 tablet 28,659.00 955.30 361 361
3 Alopurinol tablet 100 mg 100 tablet / botol 12,000.00 120.00 1,327 1,327
4 Ambroxol tablet 30 mg 30 ampul / kotak 10,297.00 343.23 1,021 1,021
5 Aminofilin tablet 200 mg 100 tablet/strip/blister , kotak
10,300.00 103.00 3,829 3,829
6 Amitriptilin tablet 25 mg 30 tablet/strip/kotak 873.00 530 530
7 Amoxicillin kapsul 250 mg 100 kaplet/strip, kotak 31,500.00 315.00 0 0
8 Amoxicillin syrup kering 125 mg/5 ml kapsul/strip/blister, kotak3,363.00
120 3,363.00 168 168
9 Amoxicillin tablet 500 mg Botol 60 ml 33,636.00 336.36 5,931 5,931
10 Antalgin tablet 500 mg 10 vial/kotak 124,500.00 124.50 425 425
11 Antasida syrup Botol 60 ml 3,500.00 3,500.00 224 224
12 Antasida tab 1000/tablet 50,530.00 50.53 11,053 11,053
13 Anti hemoroid supp box/10 18,182.00 1,818.20 0 0
14 Antifungi salep 24 pot @ 30 g / kotak 37,488.00 1,562.00 155 155
15 Asam mefenamat tablet 500 mg ktk 10 x 10 tablet 16,000.00 160.00 3,406 3,406
16 Asetosal tablet 100 mg ktk 10 x 10 tablet 8,000.00 80.00 1,639 1,639
17 Bedak Salycil 1 pot 1,300.00 1,300.00 167 167
18 Betahistin Mesilat tablet 6 mg ktk 3 x 10 tablet 25,200.00 840.00 142 142
19 Betametason krim 0.1% 25 tube@ 5 g 42,409.00 1,696.36 107 107
20 Bravoderm cr/Prodemis cr tube 5 gram 9,500.00 9,500.00 0 0
21 Bufacom cr tube 5 gram 8,000.00 80.00 120 120
22 Ciprofloxacin tablet 500 mg ktk 5 x 10 tablet 26,500.00 530.00 1,159 1,159
23 Cotrimoxazole syr Botol 60 ml 3,181.00 3,181.00 44 44
24 Cotrimoxazole tab ktk 10 x 10 tablet 15,000.00 150.00 2,360 2,360
25 CPZ tab botol 1000 tablet 19,860.00 19.86 1,965 1,965
26 CTM tablet botol 1000 tablet 17,165.00 17.17 7,530 7,530
27 Dexamethason tablet 0,5 mg botol 1000 tablet 77,000.00 77.00 3,692 3,692
28 Diazepam tablet 2 mg botol 1000 tablet 23,500.00 23.50 0 0
29 Digoxin tablet 0,25 mg 100 tablet/kotak 8,321.00 83.21 1,026 1,026
30 Dimenhidrinat tablet 50 mg botol 100 tablet 8,450.00 84.50 618 618
31 DMP syrup Botol 60 ml 2,454.00 2,454.00 355 355
32 DMP tablet botol 1000 tablet 90,000.00 90.00 12,535 12,535
33 Doksisiklin kapsul 100 mg ktk 10 x 10 tablet 20,909.00 209.09 1,556 1,556
34 Efedrin tablet 25 mg botol 1000 tablet 47,000.00 47.00 1,091 1,091
35 Ekstrak Belladona tablet 10 mg 1000 tablet / botol 24,000.00 24.00 5,027 5,027
36 Ergotamin tablet 100 tablet/botol 11,209.00 112.09 0 0
37 Erythromycin syrup Botol 60 ml 7,364.00 7,364.00 22 22
38 Erythromycin tablet 500 mg 100 tablet/kotak 84,545.00 845.45 621 621
39 Fe ( tablet tambah darah) sachet/30 81,900.00 136.50 29,900 29,900
40 Fenitoin kapsul 100 mg btl 250 kapsul 19,884.00 79.54 500 500
41 Fenobarbital tablet 30 mg botol 1000 tablet 42,000.00 42.00 0 0
42 Fenol glisetol tts telinga 10% 24 btl @ 5 ml / kotak 22,000.00 916.67 27 27
43 Furosemide tablet 40 mg ktk 20 x 10 tblet 14,404.00 72.02 4,923 4,923
44 Gentamycin salep kulit tube 5 gram 16,700.00 1,670.00 27 27
45 Gentamycin tetes mata btl 5 ml 3,000.00 3,000.00 114 114
46 Gentian violet botol 10 ml 409.00 409.00 457 457
47 Glibenklamid tablet 5 mg 100 tablet/kotak 6,545.00 65.45 5,547 5,547
48 Gliseril Guaiacolat tablet 100 mg botol 1000 tablet 21,127.00 21.13 5,499 5,499
49 Griseofulvin tablet 125 mg ktk 10 x 10 tablet 21,818.00 218.18 2,862 2,862
50 Haloperidol tablet 5 mg ktk 10 x 10 tablet 12,229.00 122.29 0 0
51 Hidroklortiazid (HCT) tablet 25 mg botol 1000 tablet 24,640.00 24.64 3,464 3,464
52 Hidrokortisone krim 2,5 % 24 tube @ 5 g / kotak 2,568.00 2,568.00 21 21
53 Ibuprofen tablet 200 mg btl/100 tab 9,545.00 95.45 6,431 6,431
54 Ibuprofen tablet 400 mg ktk 10 x 10 tablet 16,363.00 163.63 1,520 1,520
55 Isosorbid tablet 5 mg ktk 10 x 10 tablet 8,850.00 88.50 200 200
56 Kalk tablet btl/1000 tablet 47,272.00 47.27 13,915 13,915
57 Kaptopril tablet 25 mg ktk 10 x 10 tablet 12,523.00 125.23 6,540 6,540
58 karbamazepin tablet 200 mg ktk 10 x 10 tablet 24,645.00 246.45 0 0
59 Ketokonazole tablet 200 mg ktk 5 x 10 tablet 16,909.00 338.18 1,982 1,982
60 Klindamycin kapsul 150 mg ktk 5 x 10 tablet 23,181.00 463.62 1,186 1,186
61 Kloramfenicol kapsul 250 mg btl/250 kaps 38,275.00 153.10 0 0
62 Kloramfenicol salep mata 1% tube 5 gram 1,420.00 1,420.00 76 76
63 Kloramfenicol syrup 125 mg/5 ml btl 60 ml 3,636.00 3,636.00 65 65
64 Kloramfenicol tetes mata 0,5% btl 5 ml 2,273.00 2,273.00 15 15
65 Kloramfenicol tetes telinga 3% 24 botol@5 ml 24,000.00 24,000.00 106 106
66 Loratadine tablet ktk 50 tab 15,140.00 302.80 360 360
67 Meloxicam tablet 100 tablet / botol 9,545.00 95.45 200 200
68 Metformin tablet 500 mg ktk 10 x 10 tablet 16,500.00 165.00 2,790 2,790
69 Metilergometrin tablet ktk 10 x 10 tablet 9,996.00 99.96 882 882
70 Metilprednisolon tablet ktk 10 x 10 tablet 40,050.00 400.50 0 0
71 Metoclopramide tablet ktk 10 x 10 tablet 7,630.00 76.30 522 522
72 Metronidazole tablet 250 mg ktk 10 x 10 tablet 11,808.00 118.08 0 0
73 Metronidazole tablet 500 mg ktk 5 x 10 tablet 20,000.00 200.00 2,469 2,469
74 Molagit tablet/ Akita tablet ktk 10 x 10 tablet 26,250.00 262.50 2,406 2,406
75 Myconazole cr tube 10 gr 2,727.00 2,727.00 247 247
76 Natrium diklofenak 50 mg ktk 5 x 10 tablet 9,894.00 197.88 2,108 2,108
77 Nifedipin tablet 10 mg ktk 10 x 10 tablet 9,804.00 98.04 2,222 2,222
78 Nistatin vaginal tablet 100.000 IU/g ktk 10 x 10 tablet 28,891.00 288.91 337 337
79 Noza tablet ktk 25 x 4 tablet 36,250.00 362.50 686 686
80 Obat Batuk Hitam ( OBH ) syrup btl 60 ml 1,363.00 1,363.00 117 117
81 Oksitetrasiklin salep kulit tube 5 gram 1,523.00 1,523.00 170 170
82 Oksitetrasiklin salep mata 25 tube @ 3,5 g / kotak 43,636.00 1,745.44 97 97
83 Omeprazole kapsul 20 mg ktk 3 x 10 capsul 11,136.00 371.20 125 125
84 Oralit 100 kantong/kotak 9,115.00 91.15 1,714 1,714
85 Paracetamol syrup btl 60 ml 2,090.00 2,090.00 61 61
86 Paracetamol tablet 100 mg btl 100 2,569.00 2,569.00 1,965 1,965
87 Paracetamol tablet 500 mg 1000 tab/btl 95,450.00 95.45 5,681 5,681
88 Piracetam tablet 800 mg ampul 5,000.00 5,000.00 1,812 1,812
89 Pirantel tablet 125 mg ktk 25 x 4 tablet 29,091.00 290.91 53 53
90 Prednison tablet 5 mg 1000 tab/btl 56,818.00 56.82 4,035 4,035
91 Propanolol tablet 40 mg ktk 10 x 10 tablet 7,000.00 70.00 311 311
92 Propiltiourasil tablet 100 mg 100 tablet/btl 27,233.00 272.33 200 200
93 Ranitidine tablet 150 mg ktk 10 x 10 tablet 19,050.00 190.50 3,184 3,184
94 Sabutamol tablet 2 mg ktk 10 x 10 tablet 7,639.00 76.39 2,162 2,162
95 Salep 24 pot 1,113.00 1,113.00 23 23
96 Scabicid salep tube 8,500.00 8,500.00 77 77
97 Simvastatin tablet ktk 3 x 10 tablet 23,318.00 777.27 1,117 1,117
98 Sulfacetamide tetes mata 24 botol@5 ml 75,169.00 3,132.04 40 40
99 Tetrasiklin kapsul 500 mg ktk 10 x 10 kapsul 23,364.00 233.64 517 517
100 Thiamfenicol capsul 500 mg ktk 10 x 10 kapsul 52,727.00 527.27 240 240
101 Triheksifenidil tablet 2 mg ktk 10 x 10 tablet 3,706.00 37.06 0 0
102 Vitamin B komplek tablet 1000 tablet/botol 20,182.00 20.18 0 0
103 Vitamin B1 tablet 1000 tablet/botol 32,000.00 32.00 9,658 9,658
104 Vitamin B6 tablet 1000 tablet/botol 13,000.00 13.00 15,228 15,228
105 Vitamin C tablet 1000 tablet/botol 29,091.00 29.09 1,000 1,000
106 Vitamin K tablet 100 tablet/botol 68,062.00 680.62 3,321 3,321
107 Zinc tablet ktk 10 x 10 tablet 43,182.00 431.82 2,171 2,171
Injeksi
108 Aminophillin inj 30 ampul / kotak 55,960.00 1,865.33 0 0
109 Ampicillin inj 10 vial/kotak 48,800.00 4,880.00 0 0
110 Antalgin inj ampul 1,112.00 1,112.00 0 0
111 Anti Bisa Ular vial 218,590.00 218,590.00 0 0
112 Atropin Sulfas inj ampul 1,150.00 1,150.00 0 0
113 Cefotaxime inj ampul 6,300.00 6,300.00 0 0
114 Dexamethason inj 100 ampul / kotak 90,777.00 907.77 22 22
115 Diazepam inj 30 ampul / kotak 71,043.00 2,368.10 9 9
116 Difenhidramin inj 30 ampul / kotak 26,182.00 872.73 615 615
117 Epineprin inj ampul 1,127.00 1,127.00 30 30
118 Ehiferan inj/metoclopramide inj ampul 909.00 909.00 34 34
119 Oxitosin inj/Pitogin inj 30 ampul / kotak 53,550.00 1,785.00 0 0
120 Lidocain inj/Pehacain inj 30 ampul / kotak 31,000.00 1,033.33 205 205
121 Metilergometrin inj/Myomergin inj 30 ampul / kotak 38,746.00 1,291.53 9 9
122 Phenobarbital inj 0
123 Piracetam inj 1 ampul 5,000.00 5,000.00 0 0
124 Ranitidine inj 25 ampul/kotak 58,400.00 2,336.00 30 30
125 Serum Anti Tetanus amp 429,550.00 429,550.00 0 0
126 Teramycin inj box@10 ampul 28,181.00 2,818.10 0 0
127 Vitamin B1 inj 30 ampul / kotak 20,880.00 696.00 807 807
128 Vitamin B12 inj 100 ampul / kotak 88,181.00 881.81 1,549 1,549
129 Vitamin K inj 30 ampul / kotak 29,330.00 977.67 108 108
130 Calcii Gluconas inj 48 48
Cairan
131 Cairan NS/NaCl botol/500 ml 4,454.00 4,454.00 199 199
132 Cairan D5% botol/500 ml 4,600.00 4,600.00 56 56
133 Cairan RL botol/500 ml 4,727.00 4,727.00 95 95
135 Kaen 3B botol/500 ml 14,300.00 14,300.00 0 0
136 Kaen 4B botol/500 ml 14,300.00 14,300.00 0 0
Alat Kesehatan
137 Alat suntik sekali pakai 1 ml 100 set/kotak 99,318.00 993.18 1,109 1,109
138 Alat suntik sekali pakai 2,5 ml 100 set/kotak 94,350.00 943.50 153 153
139 Alat suntik sekali pakai 3 ml 100 set/kotak 94,350.00 943.50 0 0
140 Alat suntik sekali pakai 5 ml 100 set/kotak 94,350.00 943.50 432 432
141 Catgut chromic 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 40 40
142 Catgut Plain 3/0 24 x 70 cm /kotak 536,363.00 22,348.46 0 0
143 Catgut Plain2/0 24 x 70 cm /kotak 536,363.00 22,348.46 0 0
144 Etil Klorid semprot can 100 ml 90,000.00 90,000.00 4 4
145 Infuset anak set/kantong 3,636.00 3,636.00 130 130
146 Infuset dewasa set/kantong 3,181.00 3,181.00 190 190
147 Iodine 30 ml botol 30 ml 1,818.00 1,818.00 37 37
148 Iodine 300 ml botol 300 ml 13,181.00 13,181.00 1 1
149 IV cateter 20 50 buah/kotak 780,000.00 15,600.00 212 212
152 Kapas rol 6,818.00 6,818.00 14
153 Kasa 2m x 80 cm rol 8,799.00 8,799.00 0 0
154 Kasa 4m x 15 cm rol 3,373.00 3,373.00 0 0
155 Kasa 4m x 3 cm rol 3,373.00 3,373.00 0 0
156 Masker box 48,750.00 975.00 1,155 1,155
157 Plester rol 21,477.00 21,477.00 0 0
158 Rivanol 48 48
159 Sarung tangan box 45000 45,000.00 0 0
160 Silk benang bedah 36 x 75 cm/kotak 228,545.00 6,348.47 114 114
161 Urine bag 1 ampul 3636 3636 43 43
162 Foley Catheter 16 bj 7722 7722 35 35
163 Lactodia sachet/30 138,514.00 4,617.13 0 0
164 Alkohol 1 L botol 1 l 18698 18698 47 47
165 Scopma tablet 10 x 10 tablet/kotak 27,273.00 272.73 0 0
166 Mecobion tab 10 x 10 tablet/kotak 27,000.00 270.00 1,209 1,209
167 Kasa steril kotak 7,727.00 7,727.00 0 0
168 Bioplacenton gel tube 10,100.00 10,100.00 37 37
169 Aquadest 1 vial 500.00 500.00 61 61
170 Bisoprolol tab 50 tablet/box 105,550.00 2,111.00 0 0
171 Lytamin syr botol 60 ml 4,350.00 4,350.00 0 0
172 Susuk KB bj 191,154.00 191,154.00 0 0
173 Magnesium sulfat 20% vial 15,398.00 15,398.00 24 24
174 Magnesium sulfat 40% vial 15,398.00 15,398.00 19 19
175 Cendo xitrol mini dose strip 19,500.00 19,500.00 0 0
176 Kasa elastis rol 6,363.00 6,363.00 0 0
177 Combivent nebules ampul 12,000.00 12,000.00 0 0
178 OAT kategori I 1 paket 327,272.00 327,272.00 0 0
179 Lisol 1 L 16 16
180 Cetirizin tab 30 tablet/strip/kotak 18,000.00 600.00 0 0
181 Amlodipin tab 30 tablet/strip/kotak 26,190.00 873.00 280 280
182 Phenytoin caps btl 250 kapsul 19,884.00 79.54 500 500
183 Albothyl sol btl 5 ml 12,273.00 12,273.00 5 5
184 Konflusin syr 0
185 Mersibion inj 1 ampul 4,750.00 4,750.00 0 0
186 Baby Cough syr botol 60 ml 3,500.00 0 0
187 Microlax tube 17,075.00 17,075.00 0 0
188 Vitamin C 250 mg tab btl/250 35,000.00 140.00 0 0
189 Kaptopril 12,5 mg box/100 9,450.00 94.50 0 0
190 Antimigrain tab btl/100 15,000.00 150.00 0 0
191 Serum Anti Bisa Ular 218,590.00 2,185.90 0 0
192 Stelosi tab 0 0
193 Blood tranfusion set 30 30
194 Mess 1,995.00 1,995.00 300 300
195 H2O2 100 ml 2,000.00 2,000.00 0 0
196 Vitamin K infant 1,975.00 1,975.00 0 0
TOTAL
AN OBAT (STOCK OPNAME)
UN 2014
MAS SITIARJO

Pengelua Sisa Stock Penerimaan Persediaan Pengeluaran Sisa per
ran stock Awal Jan-Des thn 2014 Bln Desember 2014
thn 2014 (Rp) (Rp) (Rp) (Rp) (Rp)
8 9 10 11 12 13 14
26 193 597,213.00 - 597,213.00 70,902.00 526,311.00
245 116 344,863.30 - 344,863.30 234,048.50 110,814.80
1,327 159,240.00 - 159,240.00 - 159,240.00
720 301 350,441.23 - 350,441.23 247,128.00 103,313.23
215 3,614 394,387.00 - 394,387.00 22,145.00 372,242.00
530 462,690.00 462,690.00 - 462,690.00
1,747 -1,747 - - - 550,305.00 (550,305.00)
439 -271 564,984.00 - 564,984.00 1,476,357.00 (911,373.00)
4,531 1,400 1,994,951.16 - 1,994,951.16 1,524,047.16 470,904.00
425 52,912.50 - 52,912.50 - 52,912.50
116 108 784,000.00 - 784,000.00 406,000.00 378,000.00
3,150 7,903 558,508.09 - 558,508.09 159,169.50 399,338.59
6 -6 - - - 10,909.20 (10,909.20)
16 139 242,110.00 - 242,110.00 24,992.00 217,118.00
3,136 270 544,960.00 - 544,960.00 501,760.00 43,200.00
284 1,355 131,120.00 - 131,120.00 22,720.00 108,400.00
20 147 217,100.00 - 217,100.00 26,000.00 191,100.00
237 -95 119,280.00 - 119,280.00 199,080.00 (79,800.00)
61 46 181,510.52 181,510.52 103,477.96 78,032.56
17 -17 - - - 161,500.00 (161,500.00)
22 98 9,600.00 - 9,600.00 1,760.00 7,840.00
348 811 614,270.00 - 614,270.00 184,440.00 429,830.00
112 -68 139,964.00 - 139,964.00 356,272.00 (216,308.00)
483 1,877 354,000.00 - 354,000.00 72,450.00 281,550.00
1,965 39,024.90 - 39,024.90 - 39,024.90
3,929 3,601 129,252.45 - 129,252.45 67,441.29 61,811.17
1,979 1,713 284,284.00 - 284,284.00 152,383.00 131,901.00
0 - - - - -
1,026 85,373.46 - 85,373.46 - 85,373.46
618 52,221.00 - 52,221.00 - 52,221.00
114 241 871,170.00 - 871,170.00 279,756.00 591,414.00
851 11,684 1,128,150.00 - 1,128,150.00 76,590.00 1,051,560.00
1,556 325,344.04 - 325,344.04 - 325,344.04
55 1,036 51,277.00 - 51,277.00 2,585.00 48,692.00
230 4,797 120,648.00 - 120,648.00 5,520.00 115,128.00
0 - - - - -
22 162,008.00 - 162,008.00 - 162,008.00
621 525,024.45 - 525,024.45 - 525,024.45
3,330 26,570 4,081,350.00 - 4,081,350.00 454,545.00 3,626,805.00
10 490 39,768.00 - 39,768.00 795.36 38,972.64
1,195 -1,195 - - - 50,190.00 (50,190.00)
27 24,750.00 - 24,750.00 - 24,750.00
4,923 354,554.46 - 354,554.46 - 354,554.46
68 -41 45,090.00 - 45,090.00 113,560.00 (68,470.00)
114 342,000.00 - 342,000.00 - 342,000.00
30 427 186,913.00 - 186,913.00 12,270.00 174,643.00
540 5,007 363,051.15 - 363,051.15 35,343.00 327,708.15
3,318 2,181 116,177.37 - 116,177.37 70,099.39 46,077.99
2,862 624,431.16 - 624,431.16 - 624,431.16
0 - - - - -
3,464 85,352.96 - 85,352.96 - 85,352.96
21 53,928.00 - 53,928.00 - 53,928.00
501 5,930 613,838.95 - 613,838.95 47,820.45 566,018.50
1,010 510 248,717.60 - 248,717.60 165,266.30 83,451.30
6 194 17,700.00 - 17,700.00 531.00 17,169.00
2,019 11,896 657,789.88 - 657,789.88 95,442.17 562,347.71
6,540 819,004.20 - 819,004.20 - 819,004.20
60 -60 - - - 14,787.00 (14,787.00)
442 1,540 670,272.76 - 670,272.76 149,475.56 520,797.20
1,186 549,853.32 - 549,853.32 - 549,853.32
0 - - - - -
21 55 107,920.00 - 107,920.00 29,820.00 78,100.00
24 41 236,340.00 - 236,340.00 87,264.00 149,076.00
15 34,095.00 - 34,095.00 - 34,095.00
32 74 2,544,000.00 - 2,544,000.00 768,000.00 1,776,000.00
21 339 109,008.00 - 109,008.00 6,358.80 102,649.20
200 19,090.00 - 19,090.00 - 19,090.00
160 2,630 460,350.00 - 460,350.00 26,400.00 433,950.00
20 862 88,164.72 - 88,164.72 1,999.20 86,165.52
41 -41 - - - 16,420.50 (16,420.50)
392 130 39,828.60 - 39,828.60 29,909.60 9,919.00
0 - - - - -
495 1,974 493,800.00 - 493,800.00 99,000.00 394,800.00
861 1,545 631,575.00 - 631,575.00 226,012.50 405,562.50
13 234 673,569.00 - 673,569.00 35,451.00 638,118.00
864 1,244 417,131.04 - 417,131.04 170,968.32 246,162.72
2,222 217,844.88 - 217,844.88 - 217,844.88
61 276 97,362.67 - 97,362.67 17,623.51 79,739.16
774 -88 248,675.00 - 248,675.00 280,575.00 (31,900.00)
117 159,471.00 - 159,471.00 - 159,471.00
147 23 258,910.00 - 258,910.00 223,881.00 35,029.00
21 76 169,307.68 - 169,307.68 36,654.24 132,653.44
70 55 46,400.00 - 46,400.00 25,984.00 20,416.00
559 1,155 156,231.10 - 156,231.10 50,952.85 105,278.25
348 -287 127,490.00 - 127,490.00 727,320.00 (599,830.00)
682 1,283 5,048,085.00 - 5,048,085.00 1,752,058.00 3,296,027.00
7,240 -1,559 542,251.45 - 542,251.45 691,058.00 (148,806.55)
63 1,749 9,060,000.00 - 9,060,000.00 315,000.00 8,745,000.00
51 2 15,418.23 - 15,418.23 14,836.41 581.82
811 3,224 229,260.63 - 229,260.63 46,079.40 183,181.23
311 21,770.00 - 21,770.00 - 21,770.00
200 54,466.00 - 54,466.00 - 54,466.00
249 2,935 606,552.00 - 606,552.00 47,434.50 559,117.50
1,125 1,037 165,155.18 - 165,155.18 85,938.75 79,216.43
23 25,599.00 - 25,599.00 - 25,599.00
12 65 654,500.00 - 654,500.00 102,000.00 552,500.00
30 1,087 868,206.87 - 868,206.87 23,318.00 844,888.87
15 25 125,281.67 - 125,281.67 46,980.63 78,301.04
112 405 120,791.88 - 120,791.88 26,167.68 94,624.20
194 46 126,544.80 - 126,544.80 102,290.38 24,254.42
0 - - - - -
2,140 -2,140 - - - 43,189.48 (43,189.48)
9,658 309,056.00 - 309,056.00 - 309,056.00
370 14,858 197,964.00 - 197,964.00 4,810.00 193,154.00
1,000 29,091.00 - 29,091.00 - 29,091.00
556 2,765 2,260,339.02 - 2,260,339.02 378,424.72 1,881,914.30
167 2,004 937,481.22 - 937,481.22 72,113.94 865,367.28
0 - - - - -
0 - - - - -
0 - - - - -
0 - - - - -
0 - - - - -
18 -18 - - - 113,400.00 (113,400.00)
22 0 19,970.94 - 19,970.94 19,970.94 -
2 7 21,312.90 - 21,312.90 4,736.20 16,576.70
326 289 536,731.00 - 536,731.00 284,511.07 252,219.93
8 22 33,810.00 - 33,810.00 9,016.00 24,794.00
34 30,906.00 - 30,906.00 - 30,906.00
32 -32 - - - 57,120.00 (57,120.00)
87 118 211,833.33 - 211,833.33 89,900.00 121,933.33
2 7 11,623.80 - 11,623.80 2,583.07 9,040.73
8 -8 - - - 40,000.00 (40,000.00)
58 -28 70,080.00 - 70,080.00 135,488.00 (65,408.00)
0 - - - - -
0 - - - - -
53 754 561,672.00 - 561,672.00 36,888.00 524,784.00
145 1,404 1,365,923.69 - 1,365,923.69 127,862.45 1,238,061.24
21 87 105,588.00 - 105,588.00 20,531.00 85,057.00
48 - - - - -
80 119 886,346.00 - 886,346.00 356,320.00 530,026.00

11 45 257,600.00 - 257,600.00 50,600.00 207,000.00
12 83 449,065.00 - 449,065.00 56,724.00 392,341.00
2 -2 - - - 28,600.00 (28,600.00)
0 - - - - -
112 997 1,101,436.62 - 1,101,436.62 111,236.16 990,200.46

153 144,355.50 - 144,355.50 - 144,355.50
862 -862 - - - 813,297.00 (813,297.00)
50 382 407,592.00 - 407,592.00 47,175.00 360,417.00
27 13 893,938.33 - 893,938.33 603,408.38 290,529.96
0 - - - - -
0 - - - - -
1 3 360,000.00 - 360,000.00 90,000.00 270,000.00
6 124 472,680.00 - 472,680.00 21,816.00 450,864.00
68 122 604,390.00 - 604,390.00 216,308.00 388,082.00
5 32 67,266.00 - 67,266.00 9,090.00 58,176.00
1 13,181.00 - 13,181.00 - 13,181.00
22 190 3,307,200.00 - 3,307,200.00 343,200.00 2,964,000.00
27 80 757,403.78 - 757,403.78 191,120.58 566,283.20
14 182 1,387,393.84 - 1,387,393.84 99,099.56 1,288,294.28
7 -7 - - - 61,593.00 (61,593.00)
57 -57 - - - 192,261.00 (192,261.00)
18 -18 - - 60,714.00 (60,714.00)
1,155 1,126,125.00 - 1,126,125.00 - 1,126,125.00
2 -2 - - - 42,954.00 (42,954.00)
48 - - - - -
5 -5 - - - 225,000.00 (225,000.00)
13 101 723,725.83 - 723,725.83 82,530.14 641,195.69
43 156,348.00 - 156,348.00 - 156,348.00
35 270,270.00 - 270,270.00 - 270,270.00
0 - - - - -
6 41 878,806.00 - 878,806.00 112,188.00 766,618.00
484 -484 - - - 132,001.32 (132,001.32)
341 868 326,430.00 - 326,430.00 92,070.00 234,360.00
0 - - - - -
5 32 373,700.00 - 373,700.00 50,500.00 323,200.00
10 51 30,500.00 - 30,500.00 5,000.00 25,500.00
0 - - - - -
6 -6 - - - 26,100.00 (26,100.00)
0 - - - - -
24 369,552.00 - 369,552.00 - 369,552.00
19 292,562.00 - 292,562.00 - 292,562.00
0 - - - - -
0 - - - - -
13 -13 - - - 156,000.00 (156,000.00)
0 - - - - -
2 14
90 -90 - - - 54,000.00 (54,000.00)
179 101 244,440.00 - 244,440.00 156,267.00 88,173.00
500 39,768.00 - 39,768.00 - 39,768.00
5 61,365.00 - 61,365.00 - 61,365.00
8 -8 - - - 38,000.00 (38,000.00)
52 -52 - - - - -
0 - - - - -
612 -612 - - - 85,680.00 (85,680.00)
1,603 -1,603 - - - 151,483.50 (151,483.50)
0 - - - - -
0 - - - - -
0 - - - - -
30 - - - - -
300 598,500.00 - 598,500.00 - 598,500.00
0 - - - - -
19 -19 - - - 37,525.00 (37,525.00)
70,792,194.12 - 70,792,194.12 20,504,026.59 50,288,167.53

PUSKESMAS LAWANG
No Nama Obat PERMINTAAN PUSTU/POL/POSK
1 2 BP UGD GIGI BEDALI SIDOLUHUR SIDODADI SRIGADINGSBR NGEPOH

Ambroxol tablet 30 mg 20,000 50 300 1,200 1,000.00 1,200.00 600.00
Anti hemoroid supp 300 0 10.00
Betahistin Mesilat tablet 6 mg 5,000 100 360 200.00
Bufacom cr 100 0
Hidrokortisone krim 2,5 % 600 20 60 10 40.00 30.00
Kloramfenicol tetes telinga 3% 120 20 30 30.00
Meloxicam tablet 600 100 0
Metformin tablet 500 mg 8,000 100 600 200 200.00 600.00 200.00
Nistatin vaginal tablet 100.000 IU/g 100 30 30 120.00 100.00
Noza tablet 500 0
Obat Batuk Hitam ( OBH ) syrup 200 30 60 20 60.00 30.00
Oksitetrasiklin salep kulit 60 20 60 60.00 30.00
Oksitetrasiklin salep mata 60 60
Scabicid salep 76 30
Vitamin B6 tablet 6,000 1,800 1,000.00
Injeksi
Lidocain HCL Inj 300 50 720 30 20 20.00 60.00
Alat Kesehatan
Alat suntik sekali pakai 2,5 ml 0 50 600 600 600.00 200.00
Catgut chromic 3/0 0 50 30
Catgut Plain 3/0 0 50 30
Catgut Plain2/0 0 50 0
Etil Klorid semprot 0 5 6 1
Kasa 2m x 80 cm 0 50 60 60.00
Kasa 4m x 15 cm 0 50 65 30 12.00
Kasa 4m x 3 cm 0 50 30
Masker 500 100 300 60 50 50.00
Plester 0 50 2 3 3.00
Sarung tangan 0 500 1,800 60 100 100.00 100.00
Kasa steril 0 50 30
Lytamin syr 50 60 10
Kasa elastis 0 30
Amlodipin tab 3,000 100 300 200 500.00 600.00
Albothyl sol 10 6 3 6
Baby Cough syr 60 60 10
Microlax 5 5 12 10
Serum Anti Bisa Ular 3 0
POLI GIGI
G I Komposit 3
Cresophen 1
CHKM 1
Spongostan 5
Mata Bur Bulat 6
Mata Bur Fisur 6
Mata Bur Longseng 6
Ceivitron 3
Guttap No. 15 s/d 40 1
Guttap No. 40 s/d 80 1
Devitasol 1
File 15 s/d 40 1
File 40 s/d 80 1
Bonding 2
Etsa 2
Aplikator 2
Arculating papper 3
Papper Point No 15 s/d 40 1
Papper Point No 40 s/d 80 1
Glass Ionomer Cemen 12
Mengetahui
Drg.Izzah El Maila
NIP.19780121 200604 2 031
AWANG
ERMINTAAN PUSTU/POL/POSK JUMLAH JUMLAH JUMLAH Harga/

KEBTHN PERSEDIAA PERMINTAA biji
SBR PRONG KETINDAN LAWANGWONOREJOTURIREJO MULYOARJO KALIREJO

300.00 600.00 600.00 420.00 600.00 2,000.00 400.00 29,270.00 - 29,270.00 125.00
- 310.00 - 310.00 3,300.00
60.00 60.00 200.00 300.00 500.00 100.00 6,880.00 - 6,880.00 923.00
10.00 50.00 30.00 15.00 205.00 63.00 142.00
60.00 30.00 25.00 875.00 - 875.00 2,541.00
20.00 12.00 30.00 - 262.00 41.00 221.00
500.00 100.00 1,300.00 - 1,300.00 234.00
200.00 100.00 1,000.00 100.00 11,300.00 - 11,300.00 105.00
20.00 60.00 50.00 10.00 520.00 - 520.00 640.00
- 500.00 - 500.00
70.00 60.00 60.00 50.00 20.00 660.00 - 660.00 2,500.00
60.00 12.00 60.00 30.00 - 392.00 - 392.00 1,529.00
18.00 30.00 - 168.00 168.00 - 1,600.00
106.00 - 106.00
600.00 300.00 9,700.00 - 9,700.00
- -
- -
- -
- -
30.00 30.00 60.00 60.00 1,380.00 43.00 1,337.00 839.00
- -
- -
- -
- -
- -
180.00 600.00 600.00 900.00 900.00 200.00 200.00 5,630.00 274.00 5,356.00 650.00
80.00 - 80.00
80.00 - 80.00
50.00 - 50.00
12.00 - 12.00
10.00 18.00 198.00 - 198.00
15.00 10.00 30.00 212.00 27.00 185.00
15.00 12.00 107.00 55.00 52.00
100.00 1,160.00 957.00 203.00
3.00 5.00 6.00 72.00 11.00 61.00
100.00 100.00 200.00 3,060.00 285.00 2,775.00
80.00 - 80.00
120.00 - 120.00
30.00 - 30.00
200.00 200.00 2,000.00 60.00 7,160.00 600.00 6,560.00
6.00 3.00 34.00 - 34.00
15.00 50.00 20.00 215.00 72.00 143.00
20.00 52.00 - 52.00
3.00 - 3.00
- -
3.00 - 3.00 800,000.00
1.00 - 1.00 400,000.00
1.00 - 1.00 70,000.00
5.00 - 5.00 30,000.00
6.00 - 6.00 20,000.00
6.00 - 6.00 20,000.00
6.00 - 6.00 20,000.00
3.00 - 3.00 100,000.00
1.00 - 1.00 50,000.00
1.00 - 1.00 50,000.00
1.00 - 1.00 450,000.00
1.00 - 1.00 100,000.00
1.00 - 1.00 100,000.00
2.00 - 2.00 200,000.00
2.00 - 2.00 100,000.00
2.00 - 2.00 90,000.00
3.00 - 3.00 30,000.00
1.00 - 1.00 50,000.00
1.00 - 1.00 50,000.00
12.00 - 12.00
-
-
Malang,6 Oktober 2014

Petugas Obat
Meiria Nurani
NIP.19800517 201001 2 015
TTL HARGA
3,658,750.00
1,023,000.00
6,350,240.00
-
2,223,375.00
-
304,200.00
1,186,500.00
332,800.00
-
1,650,000.00
599,368.00
268,800.00
-
-
-
-
-
-
1,157,820.00
-
-
-
-
-
3,659,500.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
2,400,000.00
400,000.00
70,000.00
150,000.00
120,000.00
120,000.00
120,000.00
300,000.00
50,000.00
50,000.00
450,000.00
100,000.00
100,000.00
400,000.00
200,000.00
180,000.00
90,000.00
50,000.00
50,000.00
-
27,814,353.00
DAFTAR USULAN OBAT TAHUN 2014
PUSKESMAS LAWANG
No Nama Obat PERMINTAAN PUSTU/POL/POSK
1 2 BP UGD GIGI BEDALI SIDOLUHUR SIDODADI SRIGADINGSBR NGEPOHSBR PRONG KETINDAN LAWANG WONOREJO TURIREJO MULYOARJO
1 Acyclovir krim 5% 600 20 50 10 50.00 50.00 50.00 30.00 60.00 60.00 60.00 100.00 60.00
2 Acyclovir tablet 400 mg 12,000 400 400 200 400.00 1,200.00 600.00 200.00 400.00 400.00 600.00 600.00 400.00
3 Alopurinol tablet 100 mg 12,000 100 1,000 300 600.00 1,200.00 400.00 400.00 1,200.00 1,200.00 600.00 600.00 1,600.00
4 Ambroxol tablet 30 mg 40,000 100 600 1,200 2,000.00 2,500.00 1,200.00 600.00 1,200.00 1,200.00 1,000.00 1,200.00 4,000.00
5 Aminofilin tablet 200 mg 4,000 100 600 300 600.00 1,200.00 600.00 200.00 250.00 600.00
6 Amitriptilin tablet 25 mg 3,000 0
7 Amoxicillin kapsul 250 mg 12,000 0 1,200.00 600.00 600.00 1,200.00 4,000.00
8 Amoxicillin syrup kering 125 mg/5 ml 6,000 20 300 60 200.00 150.00 300.00 40.00 250.00 250.00 100.00 120.00 100.00
9 Amoxicillin tablet 500 mg 100,000 1,000 4,000 1,200 6,000.00 3,000.00 1,200.00 800.00 5,000.00 5,000.00 5,000.00 6,000.00 6,000.00
10 Antalgin tablet 500 mg 1,200 400 2,500 500.00 900.00 2,400.00 6,000.00
11 Antasida syrup 8,000 20 120 30 60.00 50.00 200.00 40.00 250.00 120.00 120.00 100.00
12 Antasida tab 80,000 1,000 2,500 1,200 2,500.00 1,200.00 1,200.00 1,000.00 2,000.00 2,000.00 4,000.00 4,000.00 6,000.00
13 Anti hemoroid supp 600 0 20.00
14 Antifungi salep 120 60 24.00 60.00 60.00
15 Asam mefenamat tablet 500 mg 60,000 1,000 4,000 1,000 2,500.00 2,500.00 1,000.00 1,000.00 1,200.00 1,200.00 1,200.00 4,000.00 6,000.00
16 Asetosal tablet 100 mg 1,000 1,200 300 600.00 400.00
17 Bedak Salycil 400 120 50.00 60.00 30.00 120.00 120.00 120.00 60.00 40.00
18 Betahistin Mesilat tablet 6 mg 10,000 200 1,000 400.00 100.00 120.00 120.00 400.00 600.00 1,000.00
19 Betametason krim 0.1% 1,200 20 120 15 30.00 30.00 80.00 50.00 60.00 120.00
20 Bravoderm cr/Prodemis cr 120 0 10 -
21 Bufacom cr 200 10 20.00 100.00 60.00
22 Ciprofloxacin tablet 500 mg 6,000 600 1,200 300 500.00 600.00 600.00 1,200.00 60.00 2,000.00
23 Cotrimoxazole syr 600 20 500 30 60.00 50.00 40.00 50.00 400.00 350.00 60.00 60.00 60.00
24 Cotrimoxazole tab 12,000 5,000 600 1,200.00 500.00 400.00 300.00 2,500.00 2,500.00 1,200.00 1,200.00 2,000.00
25 CPZ tab 0 0 -
26 CTM tablet 60,000 400 6,000 1,500 5,000.00 2,000.00 2,000.00 2,000.00 3,000.00 3,000.00 9,000.00 4,000.00 2,000.00
27 Dexamethason tablet 0,5 mg 12,000 1,200 4,000 1,000 2,000.00 1,200.00 1,200.00 1,200.00 2,000.00 2,000.00 2,400.00 2,000.00
28 Diazepam tablet 2 mg 1,000 100 0
29 Digoxin tablet 0,25 mg 6,000 0
30 Dimenhidrinat tablet 50 mg 12,000 200 1,200 2,000.00
31 DMP syrup 0 0
32 DMP tablet 0 0
33 Doksisiklin kapsul 100 mg 500 600
34 Efedrin tablet 25 mg 10,000 100 100 400.00 1,200.00 600.00 300.00 1,000.00
35 Ekstrak Belladona tablet 10 mg 0 250 0 500 1,000.00 400.00 600.00 600.00
36 Ergotamin tablet 2,000 0
37 Erythromycin syrup 600 20 100 20.00 20.00 40.00
38 Erythromycin tablet 500 mg 10,000 500 600 1,000.00
39 Fe ( tablet tambah darah) 24,000 7,200 3,000 1,200.00 6,000.00 3,000.00 1,200.00 1,200.00 4,000.00 1,000.00
40 Fenitoin kapsul 100 mg 0 0
41 Fenobarbital tablet 30 mg 0 0
42 Fenol glisetol tts telinga 10% 400 60 10 20.00 24.00
43 Furosemide tablet 40 mg 1,200 400 2,400 2,000.00 400.00 600.00
44 Gentamycin salep kulit 800 100 120 15 40.00 60.00 30.00 120.00 120.00 60.00 60.00
45 Gentamycin tetes mata 200 100 60 20.00 50.00 50.00 120.00 120.00 24.00 24.00 60.00
46 Gentian violet 100 50 40 10 20.00 120.00 40.00
47 Glibenklamid tablet 5 mg 6,000 200 1,200 200 600.00 400.00 200.00 1,000.00 1,000.00 250.00 1,000.00
48 Gliseril Guaiacolat tablet 100 mg 60,000 400 4,000 1,000 2,000.00 2,000.00 2,000.00 2,000.00 2,500.00 2,500.00 5,000.00 10,000.00
49 Griseofulvin tablet 125 mg 2,000 0 200.00
50 Haloperidol tablet 5 mg 0 0
51 Hidroklortiazid (HCT) tablet 25 mg 1,000 100 2,500 10 400.00 200.00 120.00 400.00
52 Hidrokortisone krim 2,5 % 1,200 50 100 10 100.00 50.00 60.00 50.00 120.00 50.00 60.00
53 Ibuprofen tablet 200 mg 5,000 1,200 1,000 2,000.00 1,200.00 2,400.00 1,000.00
54 Ibuprofen tablet 400 mg 20,000 400 4,000 1,000 2,000.00 2,000.00 2,000.00 2,000.00 2,500.00 1,200.00 1,000.00 6,000.00
55 Isosorbid tablet 5 mg 1,000 200 0
56 Kalk tablet 20,000 5,000 500 2,000.00 2,000.00 400.00 1,000.00 2,000.00 900.00 1,000.00 2,000.00
57 Kaptopril tablet 25 mg 20,000 5,000 700 2,000.00 2,000.00 1,200.00 1,000.00 300.00 300.00 300.00
58 karbamazepin tablet 200 mg 0 0
59 Ketokonazole tablet 200 mg 1,000 600 500 500.00 1,200.00 600.00 200.00 800.00 400.00 600.00
60 Klindamycin kapsul 150 mg 5,000 0 400.00 200.00 2,000.00 2,000.00 1,200.00 600.00 300.00
61 Kloramfenicol kapsul 250 mg 2,000 500 600 500 1,000.00 3,000.00 400.00 400.00 300.00
62 Kloramfenicol salep mata 1% 200 50 25 20.00 20.00 50.00 50.00 40.00 24.00 60.00 60.00
63 Kloramfenicol syrup 125 mg/5 ml 400 50 60 10 20.00 20.00 40.00 40.00 250.00 40.00 60.00 60.00
64 Kloramfenicol tetes mata 0,5% 240 50 60 20.00 20.00 60.00 50.00 40.00 40.00 60.00
65 Kloramfenicol tetes telinga 3% 240 50 60 20.00 20.00 60.00 50.00 40.00 24.00 60.00 60.00
66 Loratadine tablet 1,200 400 600 600.00 1,000.00
67 Meloxicam tablet 1,200 200 0 1,000.00
68 Metformin tablet 500 mg 20,000 200 1,200 200 400.00 1,200.00 400.00 100.00 400.00 200.00 2,000.00
69 Metilergometrin tablet 600 100 600 200 400.00 800.00 400.00 200.00 400.00 400.00 1,200.00 1,000.00
70 Metilprednisolon tablet 600 200 0
71 Metoclopramide tablet 2,000 100 1,200 200.00 200.00 600.00 500.00 1,200.00 1,200.00 600.00 2,000.00
72 Metronidazole tablet 250 mg 0 0 400.00 400.00
73 Metronidazole tablet 500 mg 5,000 300 4,000 400 400.00 1,200.00 400.00 400.00 1,500.00 4,000.00 1,200.00 2,000.00
74 Molagit tablet/ Akita tablet 5,000 500 500 200 500.00 500.00 1,000.00 800.00 2,000.00
75 Myconazole cr 100 50 50 10 20.00 50.00 120.00 20.00 120.00 60.00
76 Natrium diklofenak 50 mg 50,000 300 1,200 500 1,000.00 500.00 800.00 500.00 1,200.00 900.00 2,000.00 4,000.00
77 Nifedipin tablet 10 mg 5,000 400 1,200 500 600.00 200.00 1,600.00 1,000.00 120.00 200.00 1,200.00 6,000.00
78 Nistatin vaginal tablet 100.000 IU/g 200 50 60 250.00 200.00 100.00 40.00 120.00 100.00
79 Noza tablet 1,000 300 200 100.00 100.00 100.00
80 Obat Batuk Hitam ( OBH ) syrup 500 50 120 20 20.00 120.00 60.00 50.00 140.00 120.00 120.00 100.00
81 Oksitetrasiklin salep kulit 120 50 120 120.00 60.00 50.00 120.00 24.00 120.00 60.00
82 Oksitetrasiklin salep mata 120 50 120 20.00 50.00 40.00 60.00
83 Omeprazole kapsul 20 mg 1,000 500 100 600.00 200.00 200.00 1,000.00
84 Oralit 10,000 50 300 100 400.00 300.00 300.00 300.00 4,000.00 4,000.00 300.00 800.00 1,000.00
85 Paracetamol syrup 1,000 150 400 50 60.00 400.00 400.00 300.00 200.00 120.00 100.00
86 Paracetamol tablet 100 mg 0 1,500 1,000 2,000.00 120.00
87 Paracetamol tablet 500 mg 80,000 600 6,000 2,000 6,000.00 3,000.00 3,000.00 6,000.00 5,000.00 6,000.00 6,000.00
88 Piracetam tablet 800 mg 500 100 600 200.00 600.00 1,000.00
89 Pirantel tablet 125 mg 500 0 100 100.00 400.00
90 Prednison tablet 5 mg 5,000 200 4,000 1,000 2,000.00 400.00 600.00 1,500.00 3,000.00 1,000.00
91 Propanolol tablet 40 mg 200 0
92 Propiltiourasil tablet 100 mg 100 0
93 Ranitidine tablet 150 mg 2,000 500 600 500 1,200.00 600.00 600.00 1,200.00 250.00 600.00 2,000.00
94 Sabutamol tablet 2 mg 4,000 200 600 500 600.00 600.00 600.00 800.00 600.00 600.00 1,000.00
95 Salep 24 60 50 60 10 20.00 40.00 60.00 60.00 40.00
96 Scabicid salep 140 50 60
97 Simvastatin tablet 2,000 500 2,500 100.00 400.00 200.00 600.00 1,200.00 2,000.00
98 Sulfacetamide tetes mata 240 50 120 20.00 60.00 60.00 40.00
99 Tetrasiklin kapsul 500 mg 600 1,200 400.00 1,200.00 1,200.00
100 Thiamfenicol capsul 500 mg 10,000 300 600 300 600.00 400.00 400.00 200.00
101 Triheksifenidil tablet 2 mg 0 0
102 Vitamin B komplek tablet 25,000 500 4,000 2,000 4,000.00 2,000.00 2,000.00 2,500.00 4,000.00 2,000.00 6,000.00
103 Vitamin B1 tablet 6,000 4,000 1,200.00 2,000.00 600.00 6,000.00 60.00
104 Vitamin B6 tablet 12,000 4,000 2,000.00 1,200.00
105 Vitamin C tablet 10,000 500 5,000 600 1,200.00 500.00 500.00 500.00 6,000.00
106 Vitamin K tablet 500 500 200 600.00 400.00 400.00 1,000.00
107 Zinc tablet 5,000 500 500 500.00 200.00 400.00 1,200.00 1,000.00
Salbutamol 4 mg 5,000 500 500.00
Injeksi
108 Aminophillin inj 60 0
109 Ampicillin inj 0 0
110 Antalgin inj 180 0 10.00 60.00
111 Anti Bisa Ular 2 0
112 Atropin Sulfas inj 60 0
113 Cefotaxime inj 0 0
114 Dexamethason inj 500 60 120.00 120.00
115 Diazepam inj 30 0
116 Difenhidramin inj 120 100 300 150 300.00 120.00 100.00
117 Epineprin inj 30 10 0
118 Ehiferan inj/metoclopramide inj 0 60 24.00 60.00
119 Oxitosin inj/Pitogin inj 10 60 20 40.00 10.00
120 Lidocain inj/Pehacain inj 600 100 1,500 60 20 40.00 120.00 60.00 60.00 120.00 120.00
121 Metilergometrin inj/Myomergin inj 10 40 5 20.00 60.00 40.00
122 Phenobarbital inj 0 0
123 Piracetam inj 0 0
124 Ranitidine inj 0 100 0 5 40.00 24.00
125 Serum Anti Tetanus 5 0
126 Teramycin inj 0 0
127 Vitamin B1 inj 60 30 240 5.00 240.00 60.00
128 Vitamin B12 inj 200 100 240 150 300.00 30.00 400.00
129 Vitamin K inj 30 60 6 12.00 120.00
130 Calcii Gluconas inj 0 0
Cairan
131 Cairan NS/NaCl 40 100 30.00 24.00 10.00 20.00 20.00
132 Cairan D5% 40 10 20.00 20.00 24.00 20.00 20.00
133 Cairan RL 40 100 20 40.00 30.00 30.00 40.00 30.00 20.00
135 Kaen 3B 0
136 Kaen 4B 0
Alat Kesehatan
137 Alat suntik sekali pakai 1 ml 0 20 1,500 300 600.00 200.00 400.00 600.00 400.00 200.00 400.00
138 Alat suntik sekali pakai 2,5 ml 0 100 1,200 600 500.00 1,200.00 400.00 400.00 1,200.00 1,200.00 1,800.00 2,000.00 400.00
139 Alat suntik sekali pakai 3 ml 0 0
140 Alat suntik sekali pakai 5 ml 0 20 100 100.00 100.00 200.00 200.00 700.00 200.00 400.00
141 Catgut chromic 3/0 0 50 60
142 Catgut Plain 3/0 0 50 60
143 Catgut Plain2/0 0 50 0
144 Etil Klorid semprot 0 5 12 2
145 Infuset anak 0 50 0
146 Infuset dewasa 0 50 10 10 10.00 40.00 40.00
147 Iodine 30 ml 0 20 6 40 2 2.00 10.00 12.00 40.00
148 Iodine 300 ml 0 10 2 2 12.00 5.00 12.00
149 IV cateter 20 0 20 5 40.00
150 IV cateter 22 0 20 5
151 IV cateter 24 0 20 5 20.00
152 Kapas 0 100 24 5 3 5.00 12.00 5.00 12.00
153 Kasa 2m x 80 cm 0 100 120 120 60.00 120.00 20.00 20.00
154 Kasa 4m x 15 cm 0 100 150 60 60.00 24.00 30.00 20.00 60.00
155 Kasa 4m x 3 cm 0 100 60 30.00 25.00
156 Masker 500 200 300 100 50 100.00 200.00
157 Plester 0 100 3 3 3.00 6.00 6.00 10.00 12.00
158 Rivanol 0 12 4.00 10.00
159 Sarung tangan 0 1,000 1,800 100 100 100.00 200.00 200.00 200.00 400.00
160 Silk benang bedah 0 100 10 6.00 24.00
161 Urine bag 0 60 0
162 Foley Catheter 16 0 20 0
163 Lactodia 0 0
164 Alkohol 1 L 3 30 6 2.00 2.00 6.00 4.00 4.00 24.00 10.00
165 Scopma tablet 0 0
166 Mecobion tab 10,000 500 100
167 Kasa steril 0 100 100 60
168 Bioplacenton gel 10 50 0 10 10.00 10.00 10.00 40.00
169 Aquadest 0 50 24 3.00 24.00 20.00
170 Bisoprolol tab 0 0
171 Lytamin syr 50 50 60 20
172 Susuk KB 0
173 Magnesium sulfat 20% 10 2
174 Magnesium sulfat 40% 10 2
175 Cendo xitrol mini dose 0 0
176 Kasa elastis 0 100 30
177 Combivent nebules 0 100 0
178 OAT kategori I 36 0
179 Lisol 1 L 0 10 6 1 3.00 3.00 12.00
180 Cetirizin tab 500 0
181 Amlodipin tab 6,000 500 300 400 400.00 500.00 1,000.00 400.00 400.00 4,000.00
182 Phenytoin caps 0 0
183 Albothyl sol 10 10 6 3 12 10.00 10.00 12.00 6.00
184 Konflusin syr 0 0
185 Mersibion inj 0 50 60 10
186 Baby Cough syr 60 50 60 20 20.00 20.00 30.00 100.00
187 Microlax 5 5 12 20 10.00 10.00 40.00
188 Vitamin C 250 mg tab 0 0
189 Kaptopril 12,5 mg 20,000 1,000 1,200 500 500.00 500.00
190 Antimigrain tab 2,000 0
191 Serum Anti Bisa Ular 3 0
192 Stelosi tab 0 0
193 Blood tranfusion set 0 50 0 20.00
194 Mess 0 0
195 H2O2 100 ml 0 10 0
196 Vitamin K infant 0 0
POLI GIGI
197 G I Komposit 6
198 Cresophen 2
199 CHKM 2
200 Spongostan 10
201 Mata Bur Bulat 12
202 Mata Bur Fisur 12
203 Mata Bur Longseng 12
204 Ceivitron 6
205 Guttap No. 15 s/d 40 2
206 Guttap No. 40 s/d 80 2
207 Devitasol 2
208 File 15 s/d 40 2
209 File 40 s/d 80 2
210 Bonding 4
211 Etsa 4
212 Aplikator 4
213 Arculating papper 6
214 Papper Point No 15 s/d 40 2
215 Papper Point No 40 s/d 80 2
216 Glass Ionomer Cemen 24
Mengetahui
Drg.Izzah El Maila
NIP.19780121 200604 2 031
JUMLAH JUMLAH JUMLAH Harga/
TTL HARGA
KEBTHN PERSEDIAA USULAN biji
KALIREJO
20.00 1,220.00 174.00 1,046.00 3,400.00 4,148,000.00
200.00 18,000.00 627.00 17,373.00 336.00 6,048,000.00
400.00 21,600.00 1,204.00 20,396.00 86.00 1,857,600.00
800.00 57,600.00 - 57,600.00 125.00 7,200,000.00
200.00 8,650.00 2,286.00 6,364.00 80.00 692,000.00
- 3,000.00 200.00 2,800.00 112.00 336,000.00
- 19,600.00 1,506.00 18,094.00 211.00 4,135,600.00
50.00 7,940.00 509.00 7,431.00 2,445.00 19,413,300.00
1,000.00 145,200.00 24,793.00 120,407.00 261.00 37,897,200.00
400.00 14,300.00 14,872.00 (572.00) -
60.00 9,170.00 318.00 8,852.00 2,160.00 19,807,200.00
1,200.00 109,800.00 5,596.00 104,204.00 72.00 7,905,600.00
- 620.00 - 620.00 3,300.00 2,046,000.00
- 324.00 151.00 173.00 -
1,200.00 87,800.00 12,879.00 74,921.00 112.00 9,833,600.00
- 3,500.00 - 3,500.00 116.00 406,000.00
20.00 1,140.00 126.00 1,014.00 1,250.00 1,425,000.00
200.00 14,140.00 - 14,140.00 923.00 13,051,220.00
30.00 1,755.00 200.00 1,555.00 1,520.00 2,667,600.00
- 130.00 - 130.00 -
30.00 420.00 63.00 357.00 -
200.00 13,260.00 1,000.00 12,260.00 -
30.00 2,310.00 221.00 2,089.00 2,167.00 5,005,770.00
600.00 30,000.00 4,750.00 25,250.00 138.00 4,140,000.00
- - - - -
800.00 100,700.00 22,372.00 78,328.00 -
400.00 32,600.00 8,801.00 23,799.00 62.00 2,021,200.00
- 1,100.00 200.00 900.00 -
- 6,000.00 787.00 5,213.00 97.00 582,000.00
- 15,400.00 - 15,400.00 104.00 1,601,600.00
- - - - -
400.00 400.00 - 400.00 -
- 1,100.00 1,177.00 (77.00) 167.00 183,700.00
500.00 14,200.00 759.00 13,441.00 -
- 3,350.00 3,696.00 (346.00) -
200.00 2,200.00 200.00 2,000.00 135.00 297,000.00
- 800.00 5.00 795.00 7,700.00 6,160,000.00
- 12,100.00 1,100.00 11,000.00 930.00 11,253,000.00
600.00 52,400.00 13,170.00 39,230.00 -
- - - - -
- - 1,000.00 (1,000.00) -
20.00 534.00 144.00 390.00 -
200.00 7,200.00 1,382.00 5,818.00 -
30.00 1,555.00 - 1,555.00 1,350.00 2,099,250.00
20.00 848.00 50.00 798.00 -
- 380.00 50.00 330.00 -
200.00 12,250.00 6,232.00 6,018.00 -
400.00 93,800.00 - 93,800.00 21.00 1,969,800.00
200.00 2,400.00 2,480.00 (80.00) -
- - - - -
200.00 4,930.00 - 4,930.00 25.00 123,250.00
50.00 1,900.00 - 1,900.00 2,541.00 4,827,900.00
400.00 14,200.00 5,472.00 8,728.00 -
44,100.00 4,741.00 39,359.00 150.00 6,615,000.00
1,200.00 363.00 837.00 88.00 105,600.00
1,000.00 37,800.00 10,576.00 27,224.00 -
1,200.00 34,000.00 8,485.00 25,515.00 -
- - - - -
200.00 6,600.00 200.00 6,400.00 -
200.00 11,900.00 2,370.00 9,530.00 361.00 4,295,900.00
500.00 9,200.00 3,662.00 5,538.00 249.00 2,290,800.00
- 599.00 96.00 503.00 1,600.00 958,400.00
30.00 1,080.00 27.00 1,053.00 -
- 640.00 - 640.00 -
- 684.00 41.00 643.00 -
200.00 4,000.00 2,203.00 1,797.00 154.00 616,000.00
200.00 2,600.00 - 2,600.00 234.00 608,400.00
200.00 26,500.00 - 26,500.00 105.00 2,782,500.00
200.00 6,500.00 1,277.00 5,223.00 154.00 1,001,000.00
- 800.00 - 800.00 205.00 164,000.00
200.00 10,000.00 3,715.00 6,285.00 108.00 1,080,000.00
- 800.00 - 800.00 110.00 88,000.00
200.00 21,000.00 482.00 20,518.00 160.00 3,360,000.00
600.00 11,600.00 2,810.00 8,790.00 190.00 2,204,000.00
20.00 620.00 78.00 542.00 3,000.00 1,860,000.00
1,200.00 64,100.00 6,021.00 58,079.00 176.00 11,281,600.00
600.00 18,620.00 3,602.00 15,018.00 110.00 2,048,200.00
20.00 1,140.00 - 1,140.00 640.00 729,600.00
- 1,800.00 - 1,800.00 -
40.00 1,460.00 - 1,460.00 2,500.00 3,650,000.00
- 844.00 - 844.00 1,529.00 1,290,476.00
- 460.00 168.00 292.00 1,600.00 736,000.00
120.00 3,720.00 900.00 2,820.00 211.00 784,920.00
200.00 22,050.00 2,217.00 19,833.00 288.00 6,350,400.00
100.00 3,280.00 575.00 2,705.00 1,438.00 4,716,640.00
600.00 5,220.00 - 5,220.00 -
1,200.00 124,800.00 26,158.00 98,642.00 79.00 9,859,200.00
3,000.00 1,269.00 1,731.00 -
1,100.00 - 1,100.00 298.00 327,800.00
18,700.00 - 18,700.00 -
200.00 169.00 31.00 107.00 21,400.00
100.00 200.00 (100.00) -
600.00 10,650.00 3,000.00 7,650.00 120.00 1,278,000.00
200.00 10,300.00 227.00 10,073.00 -
400.00 - 400.00 1,800.00 720,000.00
250.00 - 250.00 -
600.00 10,100.00 1,000.00 9,100.00 169.00 1,706,900.00
20.00 610.00 31.00 579.00 -
200.00 4,800.00 1,000.00 3,800.00 149.00 715,200.00
200.00 13,000.00 456.00 12,544.00 431.00 5,603,000.00
- - - -
2,000.00 56,000.00 7,207.00 48,793.00 -
19,860.00 984.00 18,876.00 -
600.00 19,800.00 - 19,800.00 -
600.00 25,400.00 2,000.00 23,400.00 -
3,600.00 500.00 3,100.00 -
200.00 9,500.00 1,247.00 8,253.00 474.00 4,503,000.00
6,000.00 1,500.00 4,500.00 89.00 534,000.00
- - -
- - -
- - -
- - -
- - -
60.00 8.00 52.00 3,822.00 229,320.00
- - - -
250.00 47.00 203.00 -
2.00 - 2.00 -
60.00 - 60.00 -
- - - -
800.00 127.00 673.00 1,580.00 1,264,000.00
30.00 10.00 20.00 -
1,190.00 355.00 835.00 1,050.00 1,249,500.00
40.00 - 40.00 8,100.00 324,000.00
144.00 8.00 136.00 -
140.00 10.00 130.00 -
2,800.00 43.00 2,757.00 839.00 2,349,200.00
175.00 1.00 174.00 -
- - - -
- - - -
169.00 - 169.00 1,140.00 192,660.00
5.00 - 5.00 -
- - - -
635.00 456.00 179.00 -
1,420.00 886.00 534.00 -
228.00 5.00 223.00 -
- - - -
- - -
- - -
- - -
- - -
- - -
244.00 36.00 208.00 -
154.00 41.00 113.00 -
350.00 18.00 332.00 -
- - - -
- - - -
- - - -
- - -
- - -
- - -
- - -
4,620.00 864.00 3,756.00 -
400.00 11,400.00 274.00 11,126.00 650.00 7,410,000.00
- - - -
2,020.00 45.00 1,975.00 750.00 1,515,000.00
110.00 - 110.00 -
110.00 - 110.00 -
50.00 - 50.00 -
19.00 - 19.00 -
50.00 27.00 23.00 -
160.00 117.00 43.00 -
6.00 138.00 44.00 94.00 -
43.00 5.00 38.00 -
65.00 154.00 (89.00) -
25.00 74.00 (49.00) -
45.00 - 45.00 -
166.00 - 166.00 -
560.00 - 560.00 -
504.00 27.00 477.00 -
215.00 55.00 160.00 -
1,450.00 957.00 493.00 -
143.00 11.00 132.00 -
26.00 - 26.00 -
4,100.00 285.00 3,815.00 -
140.00 35.00 105.00 -
60.00 46.00 14.00 -
20.00 10.00 10.00 -
- - - -
2.00 93.00 100.00 (7.00) -
- - - -
200.00 10,800.00 - 10,800.00 -
260.00 - 260.00 -
20.00 160.00 87.00 73.00 -
121.00 39.00 82.00 -
- - - -
180.00 - 180.00 -
- - - -
12.00 23.00 (11.00) -
12.00 17.00 (5.00) -
- - - -
130.00 - 130.00 -
100.00 - 100.00 -
36.00 15.00 21.00 -
35.00 9.00 26.00 -
500.00 - 500.00 -
120.00 14,020.00 600.00 13,420.00 -
- - - -
79.00 - 79.00 -
- - - -
120.00 - 120.00 -
40.00 400.00 72.00 328.00 -
102.00 - 102.00 -
- - - -
23,700.00 3,485.00 20,215.00 -
200.00 2,200.00 200.00 2,000.00 -
3.00 - 3.00 -
- - - -
70.00 12.00 58.00 -
- 246.00 (246.00) -
10.00 - 10.00 -
- - - -
- - -
- - -
6.00 - 6.00 800,000.00 4,800,000.00
2.00 - 2.00 400,000.00 800,000.00
2.00 - 2.00 70,000.00 140,000.00
10.00 - 10.00 30,000.00 300,000.00
12.00 - 12.00 20,000.00 240,000.00
12.00 - 12.00 20,000.00 240,000.00
12.00 - 12.00 20,000.00 240,000.00
6.00 - 6.00 100,000.00 600,000.00
2.00 - 2.00 50,000.00 100,000.00
2.00 - 2.00 50,000.00 100,000.00
2.00 - 2.00 450,000.00 900,000.00
2.00 - 2.00 100,000.00 200,000.00
2.00 - 2.00 100,000.00 200,000.00
4.00 - 4.00 200,000.00 800,000.00
4.00 - 4.00 100,000.00 400,000.00
4.00 - 4.00 90,000.00 360,000.00
6.00 - 6.00 30,000.00 180,000.00
2.00 - 2.00 50,000.00 100,000.00
2.00 - 2.00 50,000.00 100,000.00
24.00 - 24.00 -
-
-
###
Malang,21 Oktober 2014

Petugas Obat
Meiria Nurani
NIP.19800517 201001 2 015

Harga Obat Perbulan

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LAPORAN PENCACAHAN OBAT

No Nama Obat Satuan Harga Harga/

Drg.Prima Puspito Rini

Jumlah Obat Jumlah Harga (+PPN 10%)

300 300 102 198 1,336,200.00 - 1,336,200.00

1,544 1,544 26 1,518 1,533,469.92 - 1,533,469.92

Drg.Prima Puspito Rini

Jumlah Obat Jumlah Harga (+PPN 10%)

200 398 78 320 881,892.00 890,800.00 1,772,692.00 347,412.00

137 8 129 1,959,100.00 - 1,959,100.00 114,400.00

1,518 68 1,450 1,507,647.24 - 1,507,647.24 67,536.24

53 19 34 466,347.00 - 466,347.00 167,181.00

50 76 6 70 123,500.00 237,500.00 361,000.00 28,500.00

86,326,825.89 25,220,900.33 ### 22,161,661.89

Jumlah Obat Jumlah Harga (+PPN 10%)

TOTAL 74,952,802.80 291,143,975.80 ###

Drg.Izzah El Maila Meiria Nurani,Amd.Farm

No Nama Obat PERMINTAAN PUSTU/POL/POSK JUMLAH

174.00 461.00 3,400.00 2,159,000.00

Malang,20 September 2014

Jumlah Obat Jumlah Harga (+PPN 10%)

80 119 886,346.00 - 886,346.00 356,320.00 530,026.00

112 997 1,101,436.62 - 1,101,436.62 111,236.16 990,200.46

70,792,194.12 - 70,792,194.12 20,504,026.59 50,288,167.53

No Nama Obat PERMINTAAN PUSTU/POL/POSK

1 2 BP UGD GIGI BEDALI SIDOLUHUR SIDODADI SRIGADINGSBR NGEPOH

ERMINTAAN PUSTU/POL/POSK JUMLAH JUMLAH JUMLAH Harga/

SBR PRONG KETINDAN LAWANGWONOREJOTURIREJO MULYOARJO KALIREJO

Malang,6 Oktober 2014

No Nama Obat PERMINTAAN PUSTU/POL/POSK

Malang,21 Oktober 2014

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